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PubMed2003

Cumulative probability of neodymium: YAG laser posterior capsulotomy after phacoemulsification.

PURPOSE: To retrospectively analyze the cumulative probability of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after phacoemulsification and to evaluate the risk factors. SETTING: Ando Eye Clinic, Kanagawa, Japan. METHODS: In 3997 eyes that had phacoemulsification with an intact continuous curvilinear capsulorhexis, the cumulative probability of posterior capsulotomy was computed by Kaplan-Meier survival analysis and risk factors were analyzed using the Cox proportional hazards regression model. The variables tested were sex; age; type of cataract; preoperative best corrected visual acuity (BCVA); presence of diabetes mellitus, diabetic retinopathy, or retinitis pigmentosa; type of intraocular lens (IOL); and the year the operation was performed. The IOLs were categorized as 3-piece poly(methyl methacrylate) (PMMA), 1-piece PMMA, 3-piece silicone, and acrylic foldable. RESULTS: The cumulative probability of capsulotomy after cataract surgery was 1.95%, 18.50%, and 32.70% at 1, 3, and 5 years, respectively. Positive risk factors included a better preoperative BCVA (P =.0005; risk ratio [RR], 1.7; 95% confidence interval [CI], 1.3-2.5) and the presence of retinitis pigmentosa (P<.0001; RR, 6.6; 95% CI, 3.7-11.6). Women had a significantly greater probability of Nd:YAG laser posterior capsulotomy (P =.016; RR, 1.4; 95% CI, 1.1-1.8). The type of IOL was significantly related to the probability of Nd:YAG laser capsulotomy, with the foldable acrylic IOL having a significantly lower probability of capsulotomy. The 1-piece PMMA IOL had a significantly higher risk than 3-piece PMMA and 3-piece silicone IOLs. CONCLUSIONS: The probability of Nd:YAG laser capsulotomy was higher in women, in eyes with a better preoperative BCVA, and in patients with retinitis pigmentosa. The foldable acrylic IOL had a significantly lower probability of capsulotomy.

Acrylic Resins↗
PubMed2004

Opposite clear corneal incisions on the steep meridian in phacoemulsification: early effects on the cornea.

PURPOSE: To evaluate the effect of on-axis opposite clear corneal incisions (OCCIs) in phacoemulsification on reducing preoperative corneal astigmatism and to predict the astigmatic outcome of the incisions. SETTING: Royal Eye Infirmary, Dorset County Hospital, and Winterbourne Hospital, Dorchester, Dorset, and the Department of Ophthalmology, East Somerset Hospital, Yeovil, Somerset, United Kingdom. METHODS: This prospective study included all patients (n = 103) who had on-axis OCCIs as a part of routine phacoemulsification with foldable intraocular lens (IOL) implantation performed by 1 surgeon during 2000. Keratometry was done 6 to 8 weeks postoperatively. The differences in the preoperative and postoperative corneal astigmatism and corneal spherical equivalent (SE) were recorded. Surgically induced astigmatism (SIA) was calculated using vector analysis. RESULTS: The mean reduction in corneal astigmatism was 0.50 diopter (D) (P<.001). The mean SIA was 1.57 D (95% confidence interval [CI], 1.42 to 1.71). There was a weak association between the SIA and the patient's age and axis of preoperative astigmatism. The mean change in SE was +0.02 D (95% CI, -0.08 to +0.12). CONCLUSIONS: Results indicate that on-axis OCCIs are a reliable and practical way of reducing preexisting corneal astigmatism. The change in SE was negligible and thus can be ignored during biometry.

Aged↗
PubMed1995

Combined phacoemulsification, intraocular lens implantation, and trabeculectomy with a modified scleral tunnel and single-stitch closure.

In most combined phacoemulsification and filtration surgery, the standard tunnel incision is altered to create a scleral flap, usually a limbal-based scleral flap with radial suture closure. We describe a new technique that has the advantages of both scleral tunnel architecture and horizontal suture closure. It creates a scleral groove tangential to the limbus and a standard scleral tunnel. Phacoemulsification and intraocular lens implantation are performed under the scleral tunnel. A 10-0 nylon horizontal suture is positioned for scleral tunnel closure and looped aside. A central "T" relaxing incision is made at the midpoint of the scleral tunnel up to the posterior insertion of conjunctiva. A punch sclerectomy is performed. The 10-0 nylon horizontal suture is tied. The conjunctiva is closed and bleb elevation is confirmed via deepening through a corneal paracentesis incision. The results in an initial series of 24 consecutive eyes followed for a mean of seven months are presented: Mean visual acuity improved from 20/70 to 20/30 and mean intraocular pressure reduction was 5.0 +/- 2.4 mm Hg (standard deviation). By preserving standard scleral tunnel architecture and single horizontal suture closure, this technique permits rapid visual recovery and accelerated return to full activity. It also permits postoperative titration of aqueous outflow by laser suture lysis, if indicated. Against-the-rule astigmatic drift associated with limbal-based scleral flaps and antimetabolite therapy may be minimized.

Adult↗
PubMed1995

Anterior chamber fluid contamination after uncomplicated phacoemulsification.

This study determined the rate of anterior chamber aerobic bacterial contamination in 103 eyes that had uncomplicated posterior chamber phacoemulsification. Anterior chamber fluid was aspirated on completion of surgery. Cultures of sterile balanced salt solution served as a control. Of 103 anterior chamber cultures, 4 (3.9%) showed contamination; however, 3 of 103 control cultures (2.9%) also grew micro-organisms. These findings suggest a very low rate of aerobic bacterial contamination after uncomplicated phacoemulsification and underscore the importance of control cultures when determining contamination rates.

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PubMed1996

Changes in pupil size induced by phacoemulsification and posterior chamber lens implantation: consequences for multifocal lenses.

PURPOSE: Because the optical performance of eyes implanted with multifocal intraocular lenses will theoretically depend upon the size and position of the pupil relative to the near and distance zones of the lens, we designed a study to determine whether preoperative pupil size is useful in predicting the postoperative pupil size of patients having phacoemulsification with posterior chamber lens implantation. SETTING: Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas. METHODS: We prospectively measured pupil sizes preoperatively and postoperatively in 71 consecutive patients who had phacoemulsification with posterior chamber lens implantation. Pupil sizes were photographed under five lighting and viewing conditions that simulated a range of normal functional situations. RESULTS: The mean change in preoperative to postoperative pupil size was less than 0.5 mm in all five testing conditions. However, changes in pupil diameter of 1.0 mm or more were noted in approximately 10% of patients in each testing situation. Sex, iris color, and the presence or absence of intraoperative iris trauma were not predictive factors for determining which patients sustained large postoperative changes in pupil size. CONCLUSIONS: Preoperative pupil size does not predict postoperative size with sufficient consistency to ensure a good match between pupil diameter and the zone sizes of multizone multifocal intraocular lenses.

Follow-Up Studies↗
PubMed1996

Astigmatism after phacoemulsification with adjusted and unadjusted sutured versus sutureless 5.2 mm superior scleral incisions.

PURPOSE: To evaluate changes in astigmatism in the first 6 months after 5.2 mm superior scleral incision phacoemulsification using three different closures. SETTING: Department of Ophthalmology, Vejle Hospital, Denmark. METHODS: This study comprised 75 consecutive patients who had 5.2 mm superior scleral incision phacoemulsification. Patients were randomly assigned to one of three groups based on type of incision closure: Group 1, one intraoperatively adjusted cross suture; Group 2, one unadjusted cross suture; Group 3, no suture. Inclusion criteria were preoperative astigmatism of 2.00 diopters (D) or less (range of median 0.74 to 0.81 D) and no eye disease except cataract. Postoperative astigmatism was evaluated by keratometric cylinder, induced astigmatism (Naeser), and induced cylinder (Jaffe) on the first day and after 1 week and 1, 3, and 6 months. Time before stability was estimated. RESULTS: All groups had the same level of postoperative keratometric cylinder with no significant change between 1 week and 6 months (range of median 0.81 to 1.06 D). The groups reached the same level of induced astigmatism (Naeser) 3 to 6 months after surgery (range of median -0.44 to -0.64 D). Group 3 (sutureless) reached that value after 1 week, and induced astigmatism was stable thereafter. Both sutured groups (Groups 1 and 2) had a highly significant change between the first week and third month (P < .01). There were no significant intergroup differences in induced cylinder (Jaffe), which stabilized after 1 week in Groups 1 and 2 and after 1 month in Group 3 (range of median 0.61 to 0.87 D). During the early postoperative period, variation was highest in Group 2. CONCLUSIONS: Keratometric cylinder, induced astigmatism, and induced cylinder 3 to 6 months postoperatively were similar among the three groups, but early stability was only seen in the sutureless group. If a suture is used, intraoperative adjustment seems to result in lower variations in the early postoperative period.

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PubMed1996

Conjunctival wound closure by saline injection in sutureless, scleral tunnel incision phacoemulsification.

PURPOSE: To compare two methods of conjunctival closure in phacoemulsification. SETTING: Frimley Park Hospital NHS Trust, Surrey, England. METHODS: This prospective, randomized study comprised 40 patients (40 eyes) who had phacoemulsification via superior axis scleral tunnels and implantation of a poly(methyl methacrylate) intraocular lens with a 5.5 mm optic diameter. In 24 eyes, the conjunctival wound was closed manually with a Moorfields forceps (Group A). In 16, 0.5 ml of balanced salt solution was injected subconjunctivally to reappose the conjunctival wound (Group B). Conjunctival reapposition was assessed by measuring the maximum radial distance of bare sclera preoperatively and during outpatient clinic visits at 1, 7, and 28 days postoperatively. RESULTS: Follow-up was obtained on 38 eyes. One day after surgery, total wound closure was achieved in 15 of 16 eyes in Group B; however, closure was still incomplete in 13 of 22 Group A eyes. At 7 days postoperatively, the size of the conjunctival wound remained significantly smaller in Group B eyes (P < .01). CONCLUSION: The saline injection produced a faster rate of conjunctival wound closure than standard manual reapposition.

Aged↗
PubMed1996

Risk factors for corneal endothelial injury during phacoemulsification.

PURPOSE: To determine the principal risk factors for corneal endothelial injury during phacoemulsification. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: We prospectively investigated 859 consecutive eyes of 800 patients who had had phacoemulsification surgery. The percentage of corneal endothelial cell loss at 3 months after surgery was quantitated using specular microscopy. The firmness of the nucleus was graded by Emery's classification prior to surgery. We selected nine variables that could be associated with endothelial injury. The univariate associations between the endothelial cell loss and these variables were evaluated using simple correlation coefficients. A multiple linear regression analysis was performed to identify independent predictors of endothelial cell loss. RESULTS: In the simple regression analysis, older age, small pupil diameter, high nucleus grade, large nucleus, greater infusion volume, type of IOL implanted, and a greater amount of total emitted ultrasound energy were univariately associated with endothelial cell loss. In the multiple linear regression analysis, the best final model (R2 = 0.42) identified high nucleus grade, greater infusion volume, type of IOL implanted, and large nucleus as independent predictors of endothelial cell loss. CONCLUSION: Both univariate and multivariate analyses identified the firmness of the nucleus as the most significant risk factor for endothelial cell loss. Therefore, mechanical contact with nuclear fragments is considered the principal cause of endothelial injury.

Adult↗
PubMed1996

Phacoemulsification with intraocular lens implantation in high myopia.

PURPOSE: To assess phacoemulsification and posterior chamber intraocular lens (IOL) implantation in highly myopic eyes and to compare the results of sutureless scleral tunnel incision and sutured scleral incision techniques. SETTING: The Eye Institute of Utah, Salt Lake City. METHODS: A series of 109 highly myopic eyes (axial length over 26.00 mm) were reviewed at a mean postoperative follow-up of 27 months. RESULTS: Postoperative corrected visual acuity was 20/40 or better in 94% of eyes, and uncorrected visual acuity was 20/40 or better in 77% of eyes. Posterior capsule opacification developed in 50% of eyes; 95% of these had neodymium:YAG (Nd:YAG) laser capsulotomy. Cystoid macular edema occurred in two eyes, and one eye developed retinal detachment following Nd:YAG capsulotomy. Eyes that had sutureless scleral tunnel incisions attained earlier postoperative rehabilitation of visual acuity and stabilization of astigmatism than did patients who had sutured scleral incisions. CONCLUSIONS: The results of this study of highly myopic eyes indicate that treating retinal pathology preoperatively and using the sutureless procedure, phacoemulsification, and in-the-bag IOL placement lead to good visual outcome, a lower rate of retinal complications, and a more stable wound.

Adult↗
PubMedDate not supplied

Corneal endothelial cell loss in phacoemulsification surgery with silicone intraocular lens implantation.

PURPOSE: To clarify the extent of corneal endothelial injury from silicone intraocular lens (IOL) implantation in small incision cataract surgery. METHODS: Two hundred forty eyes that had phacoemulsification surgery were divided into four groups: Group A comprised 70 eyes that received a conventional silicone IOL; Group B, 63 eyes that received a higher refractive index silicone IOL; Group C, 71 eyes that received a poly(methyl methacrylate) (PMMA) IOL; Group D, 36 eyes that had phacoemulsification without an IOL. Cell density of the corneal endothelium in all eyes was examined by specular microscopy preoperatively and 3 months postoperatively, and the percentage of endothelial cell loss was determined. The differences in endothelial cell loss between the four groups were statistically compared using the Kruskal-Wallis test. RESULTS: Percentages of endothelial cell loss were 4.5 +/- 5.1% in Group A, 4.3 +/- 5.3% in Group B, 6.3 +/- 5.4% in Group C, and 4.3 +/- 4.9% in Group D. No statistically significant difference was observed among these four groups, although the percentage of cell loss in Group C was slightly larger than that in the other groups. CONCLUSION: The implantation of silicone IOLs and PMMA IOLs causes minimal corneal endothelial cell loss in contemporary small incision surgery.

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PubMed1997

Comparison of space-maintaining capabilities of Healon and Healon GV during phacoemulsification.

PURPOSE: To determine whether Healon GV or Healon (both sodium hyaluronate products) maintains space better during phacoemulsification with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Friedrich-Schiller-University of Jena, Germany. METHODS: This double-blind, randomized clinical trial comprised 60 patients (30 Healon GV, 30 Healon) eligible for cataract surgery. Patients were evaluated 6 and 24 hours and 5 days postoperatively. A digital slide gauge mounted on an operating microscope was used to measure the distance between the iris and epithelial side of the cornea before surgery and before and after capsulorhexis. The distance between the anterior and posterior lens capsules (i.e., space in the capsular bag) was also measured before and after IOL insertion. The surgeon's objective opinion of the products was evaluated. RESULTS: The mean anterior chamber depth after capsulorhexis was significantly greater in the Healon GV than in the Healon group (P = .003). The mean distance between the anterior and the posterior lens capsules was significantly larger in the Healon GV than in the Healon group before and after IOL insertion. The subjective evaluation of space-maintaining capacity during surgery also favored Healon GV. Healon was considered easier to inject and remove from the eye. CONCLUSION: Healon GV had better space-maintaining capacity than Healon during cataract surgery with phacoemulsification and IOL insertion.

Aged↗
PubMed1997

Visual outcome after management of a posteriorly dislocated lens nucleus during phacoemulsification.

PURPOSE: To evaluate the characteristics of eyes with a posteriorly dislocated lens nucleus during phacoemulsification and to assess the results of the management. SETTING: Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan. METHODS: Fifteen eyes (15 patients) with posteriorly dislocated lens nuclei during phacoemulsification were evaluated retrospectively. Patients ranged in age from 56 to 86 years old (mean 73.9 years +/- 9.6 [SD]). Thirteen of the 15 eyes had advanced cataract with hard nucleus before surgery Three patients developed secondary glaucoma resulting from the lens particle after nuclear dislocation. RESULTS: One dislocated lens nucleus was not removed surgically and only observed. In three patients, an attempt had been made to remove the dislocated lens nucleus at the time of cataract surgery. This caused massive choroidal hemorrhage with giant retinal tear, posterior retinal tear, and ora tear, respectively. Finally, the displaced nucleus was removed in 14 patients who had a pars plana vitrectomy at the time of cataract surgery (4 eyes) or a secondary procedure (10 eyes). In 5 eyes, liquid perfluorocarbon was used for the procedure. An intraocular lens (IOL) was successfully implanted in all eyes that were expected to have IOL implantation before surgery except in 1 eye with choroidal hemorrhage. CONCLUSION: Although the results of secondary management of displaced lens nucleus were fairly good, surgeons should take great care to avoid serious secondary complications such as retinal detachment and massive choroidal hemorrhage.

Aged↗
PubMed1997

Corneal endothelial protection by different viscoelastics during phacoemulsification.

PURPOSE: To evaluate corneal endothelium morphology and function after phacoemulsification using different viscoelastics. SETTING: Eye Clinic, University of Trieste, Italy. METHODS: This prospective, randomized study included results of preoperative and postoperative (7, 30, and 90 days) examinations of 66 patients scheduled for phacoemulsification without ocular pathology; 8 patients were excluded. Patients were randomly assigned to one of four groups based on type of viscoelastic used: 1% sodium hyaluronate (Healon); 1.4% sodium hyaluronate (Healon GV); 4% sodium chondroitin sulfate-3% sodium hyaluronate (Viscoat); 2% hydroxypropyl methylcellulose (Hymecel). Mean cell density and cell size variation coefficient were determined by specular microscopy; central corneal thickness, by ultrasonic pachymetry; and endothelial permeability coefficient and active pump function, by anterior segment fluorophotometry. RESULTS: There were no significant differences in postoperative mean cell loss among the groups. The cell size variation coefficient was altered in all groups 7 days after surgery and was still impaired at 30 days in the Hymecel group. A significant increase in mean corneal thickness, endothelial permeability, and active pump function occurred in the Healon and Hymecel groups 7 days after surgery. These parameters were still altered 30 days after surgery in the Hymecel group. Endothelial functional alterations did not occur in the Healon GV or Viscoat group. CONCLUSION: Viscoat and Healon GV are effective in minimizing functional damage of endothelial structure in the early medium-term postoperative period.

Aged↗
PubMedDate not supplied

Flexible iris hooks for phacoemulsification.

Flexible iris hooks can be used to facilitate phacoemulsification in eyes with small pupils or damaged zonules. In addition to their conventional use as an iris retractor, the hooks can create a tenting effect that, when combined with pupil and continuous curvilinear capsulorhexis (CCC) enlargement, can prevent anterior capsule damage during phacoemulsification in eyes with small pupils. In addition, CCC enlargement stabilizes the lens in eyes with zonular damage.

Humans↗
PubMed1997

Efficacy and safety of combined diclofenac 0.1% and gentamicin 0.3% eyedrops after phacoemulsification.

PURPOSE: To study the efficacy of combined diclofenac 0.1% and gentamicin 0.3% (Digen) eyedrops to treat postoperative inflammation and prevent ocular infection in eyes having phacoemulsification. SETTING: Department of Ophthalmology, University of Milan, San Paolo Hospital, Milan; Eye Clinic, University of Verona; and Department of Ophthalmology, University of Palermo, Italy. METHODS: This double-masked, randomized, clinical trial comprised 90 patients; 45 received Digen and 45, gentamicin 0.3% eyedrops. The main outcome measure of the study was the reduction in signs and symptoms of inflammation, graded on a four-point scale. Also assessed were the presence of bacteria in the conjunctival swab and the proportion of patients requiring additional medication. RESULTS: Digen was more effective in reducing postoperative inflammation than gentamicin alone (P < .01). No statistically significant between-group difference was found regarding antibacterial activity. Both treatments were well tolerated throughout the study. CONCLUSION: Digen seemed to maintain the properties and activities of each individual drug, making it a promising treatment for reducing inflammation after phacoemulsification.

Administration, Topical↗
PubMed1997

Prospective, randomized trial of Microvisc and Healon in routine phacoemulsification.

PURPOSE: To compare the safety and efficacy of the new sodium hyaluronate viscoelastic, Microvisc, with those of Healon in routine phacoemulsification. SETTING: York Finch Eye Associates and York Finch General Hospital, Toronto, Ontario, Canada. METHODS: An unmasked, prospective, randomized clinical trial of 100 eyes in 100 patients having routine phacoemulsification and intraocular lens implantation was conducted to compare the safety and efficacy of Microvisc with those of Healon. Visual acuity, corneal thickness, and intraocular pressure were assessed preoperatively and at 6 hours, 1 and 5 days, and 1 and 6 months postoperatively. RESULTS: There were no statistically significant differences between the two treatment groups at any follow-up CONCLUSION: Based on the parameters assessed, both viscoelastic products were safe and provided comparable outcomes.

Adult↗
PubMed1997

Prospective, randomized vector analysis of astigmatism after three-, one-, and no-suture phacoemulsification.

PURPOSE: To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification. SETTING: Johns Hopkins Hospital, Baltimore, Maryland and Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA. METHODS: This prospective, randomized study followed 131 patients treated with phacoemulsification with a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon sutures were used in the three- and one-suture groups. RESULTS: Mean astigmatism was greatest in the first postoperative week in all groups and stabilized after 8 weeks. The percentage of patients with with-the-rule (WTR) astigmatism increased from baseline in the one- and three-suture groups and decreased in the sutureless group. Mean uncorrected Snellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant differences in uncorrected acuity at other times. No statistically significant differences in the surgically induced spherical equivalent were noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively. At all follow-ups, the sutureless group had the greatest proportion of patients, with significant ATR astigmatic shift (1 week, 17%; 4 weeks, 32%); and the lowest proportion of patients with significant WTR astigmatic shift (10% after 1 week). At 4 weeks, the percentage of patients with significant WTR shift in the one-suture group dropped to that in the sutureless group (10%); however, those in the one-suture group had less ATR astigmatic shift (16%). CONCLUSION: Sutureless and one-suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-suture surgery resulted in less ATR shift.

Adult↗
PubMed1997

Occurrence of retained lens fragments after phacoemulsification in The Netherlands.

PURPOSE: To determine the incidence of retained lens fragments after phacoemulsification in The Netherlands and to evaluate the effect of vitrectomy on this complication. SETTING: Eleven vitreoretinal centers in The Netherlands. METHODS: We performed a retrospective analysis of all patients with retained lens fragments (N = 70) who were referred for vitreoretinal surgery to 11 specialized centers. Seven patients (10%) were treated with medication alone, and 63 (90%) had pars plana vitrectomy. Minimum follow-up after vitrectomy was 3 months. RESULTS: The incidence of retained lens fragments in The Netherlands was calculated at 0.9/1000 cataract operations. Retained lens fragments occurred during the learning curve and with experienced surgeons. After medical or surgical treatment, visual acuity was 20/40 or better in 43 of 70 patients (61%). Uveitis disappeared in all cases. Retinal detachment occurred in 10 patients (14%). Attached retinal breaks were treated in an additional 5 patients. Corneal grafting was performed in 2 patients. Patients who had immediate vitrectomy did not have better functional results than patients in whom vitrectomy was delayed. The iris-fixated claw lens was implanted successfully when capsular support was insufficient. CONCLUSIONS: The introduction of phacoemulsification in The Netherlands is associated with an increase of patients with retained lens fragments. Retained lens fragments are complicated by an increased risk for retinal detachment and corneal decompensation. Vitrectomy resulted in a marked improvement of visual acuity and clearing of uveitis.

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