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PubMed1999

Functional improvement after phacoemulsification cataract surgery.

PURPOSE: To evaluate subjective functional visual improvement after phacoemulsification and intraocular lens (IOL) implantation and identify patient characteristics and treatment features associated with no functional improvement. SETTING: Academic referral practice, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA. METHODS: A retrospective review was performed of the surgical results in 106 consecutive eyes of 102 patients who completed the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Data Collection Form preoperatively and 1 month postoperatively. One surgeon performed all the surgery. The relationship of patient characteristics and treatment features and reported visual function was analyzed using an analysis of variance and the Wilcoxon rank sum and Fisher exact tests. RESULTS: One month postoperatively, all patients demonstrated improved visual acuity. However, 15 patients (14%) reported unimproved or decreased visual function. No statistically significant intergroup difference (P > .05) was detected in mean preoperative, postoperative, and fellow eye best spectacle-corrected visual acuities or refractive errors; reported severity of preoperative symptoms or satisfaction with vision; reported preoperative daily activity functioning or prevalence of hypertension and diabetes; type of anesthesia, lens material, or wound closure used; intraoperative or postoperative complication rates. However, patients reporting unimproved vision tended to be older and less satisfied with their quality of life and medical care than those reporting improved vision (P = .02, .03, .01, respectively). CONCLUSIONS: Self-reported visual function generally improved after phacoemulsification and IOL implantation; however, some older patients less satisfied with their quality of life and medical care reported no functional improvement despite improved visual acuity. These patients might benefit from an extended preoperative discussion of postoperative expectations.

Activities of Daily Living↗
PubMed2000

Effect of irrigating solution and irrigation temperature on the cornea and pupil during phacoemulsification.

PURPOSE: To evaluate the effect of irrigation solution and temperature on pupil diameter, corneal endothelium, and corneal pachymetry during and after phacoemulsification. SETTING: Klinik Dardenne, Bonn, Germany. METHODS: Eighty patients who had cataract surgery by phacoemulsification were assigned to 1 of 4 cross-classified groups and had intraoperative irrigation with room-temperature or refrigerated fortified balanced salt solution (BSS Plus) or modified Ringer's solution. Pupil diameters were recorded at different stages during the surgery. Epithelial cell counts and pachymetry were determined before and 1 day after surgery. RESULTS: The solution temperature did not affect any parameter. The type of solution did not influence endothelial cell loss; however, the solution had a significant effect on corneal pachymetry 1 day postoperatively. The corneas irrigated with BSS Plus were less swollen than the corneas irrigated with Ringer's solution. By day 14, corneal thickness was equal among all groups. CONCLUSION: Long-term results were equally favorable in all 4 groups. However BSS Plus induced less short-term corneal swelling than Ringer's solution. From these findings, it appears that BSS Plus may decrease corneal risk in cases with compromised corneas or prolonged surgery.

Adult↗
PubMed1999

Thermal effect on corneal incisions with different phacoemulsification ultrasonic tips.

PURPOSE: To evaluate the thermal effects of 3 phacoemulsification ultrasound (US) tips (standard, MicroTip, and Mackool) on the corneal incision based on the tip's position. SETTING: Department of Ophthalmology, Tokyo Dental College, Tokyo, Japan. METHODS: Thermal changes were recorded with an infrared thermal video during phacoemulsification in 18 porcine eyes. The 3 US tips were placed in 3 positions (primary, roofing, and flanking) in the corneal incision, and the resultant temperature changes were recorded. RESULTS: With the 3 US tips in the primary position, the temperature remained under 36 degrees C. When the tips were in the roofing position, a marked temperature increase (51.4 degrees C) was observed with the standard tip; with the MicroTip, a temperature increase occurred but was lower than with the standard tip; with the Mackool tip, the temperature remained stable. The temperature around the incision site increased with all tips when they were moved toward the corner of the incision, which resulted in direct contact with the silicone sleeve. This change was most obvious with the standard tip (temperature 51.5 degrees C), and a wound burn was observed. With the MicroTip, the temperature increase was moderate (44.2 degrees C), and the wound burn area was smaller. With the Mackool tip, the temperature increased the least (42.1 degrees C). CONCLUSION: The position of the US tips resulted in a temperature increase in the incision area and caused wound burn. Newly developed US tips could minimize this complication.

Animals↗
PubMed1999

Phacoemulsification in eyes with past pars plana vitrectomy: case-control study.

PURPOSE: To determine intraoperative and postoperative complications and outcomes of phacoemulsification of cataract in eyes that had previous pars plana vitrectomy. SETTING: University-based anterior segment disease referral practice. METHODS: This was a retrospective case-control study of a surgical series of 52 consecutive postvitrectomy cataract extractions statistically compared with control eyes from the same practice. RESULTS: Cataract extraction followed vitrectomy by 2 months to 6 years (mean 19 months). Cataracts with a posterior subcapsular component were seen more frequently in postvitrectomy eyes (58% versus 25% in control eyes). Cataract extraction after pars plana vitrectomy was often more challenging than in control eyes. Challenges included unstable posterior capsules, loose zonules, and posterior capsule plaque. Postoperative posterior capsule opacification (PCO) was more common in study than in control eyes (51% versus 21%; P = .002), especially if expandable gas or silicone oil had been used at vitrectomy. Visual acuity improved in 87% of study eyes, with 46% achieving a visual acuity of 20/40 or better. In study eyes in which the indication for vitrectomy was macular hole or epiretinal membrane, nuclear sclerosis was the most common cataract type, no intraoperative complications occurred, the PCO rate was low (13%), and visual acuity was better (73% 20/40 or better) than in the other study eyes. CONCLUSION: Phacoemulsification after pars plana vitrectomy can be performed with a low complication rate and with good visual results, although limited by underlying retinal disease. Posterior capsule opacification requiring neodymium: YAG capsulotomy was common in this series.

Adolescent↗
PubMed1999

Managing a dropped nucleus during the phacoemulsification learning curve.

Three patients had a pars plana vitrectomy to remove retained nuclei within 72 hours after phacoemulsification performed by a surgeon making the transition from extra-capsular cataract extraction to phacoemulsification. After vitrectomy, the nuclei were brought to the midvitreous cavity from the retinal surface with a posterior segment phacofragmenter, emulsified, and completely removed. Then, a posterior chamber intraocular lens was implanted in the sulcus through the previous cataract surgery incision and remained well centered postoperatively. Postoperative complications included cystoid macular edema in 1 patient and choroidal detachment in another. No other complications were detected. Final visual acuity ranged from 20/60 to 20/30.

Aged↗
PubMed2001

Prevention of posterior segment complications of phacoemulsification.

The prevention of posterior segment complications of cataract surgery depends on the maintenance of an intact lens capsule and zonular apparatus. The phacoemulsification techniques presented here, including cortical cleaving hydrodissection, hydrodelineation, ultrasound power modulation, and management of the epinucleus and cortex, together with the special techniques presented for management of small pupils and compromised zonule, minimize the risk of damage to the posterior capsule by maximizing control of nuclear disassembly and evacuation. Choo-choo chop and flip phacoemulsification, in particular, provides a management strategy for cataracts of all grades of nuclear hardness whether in the presence of a small pupil or compromised zonule.

Eye Diseases↗
PubMed2004

Corneal topographic changes after phacoemulsification through steep axis incision.

PURPOSE: To evaluate the effect of 5.5 mm sutured and 4.0 mm sutureless corneal incisions after phacoemulsification on corneal topograpy. MATERIAL AND METHODS: Twenty eyes of 20 patients that underwent phacoemulsification with IOL implantation were randomly divided into two. The first group received a PMMA IOL through a sutured 5.5 mm corneal incision. The second group received a foldable hydrophilic acrylic IOL through a sutureless 4.0 mm incision. Complete ocular examination and computerized corneal topography (Keratron Corneal Analyzer, Software version 3.2, Optikon 2000, Italy) were performed preoperatively, at 1 week, and 1 month postoperatively. The Maloney indices [best fit sphere (BFS), best fit cylinder (BFC) and topographic irregularity (TI)] were provided by the Keratron Corneal Analyzer. RESULTS: There was no statistically significant difference in the mean BFS between the groups preoperatively (p = 0.305), at postoperative week 1 (p = 0.362), and at postoperative month 1 (p = 0.160). The BFC was significantly higher in the 5.5 mm incision group than in the 4.0 mm incision group preoperatively (p = 0.025), however, there was no statistically significant difference between the groups at postoperative week 1 (p = 0.909), and at postoperative month 1 (p = 0.382). There was no statistically significant difference in the mean TI between the groups preoperatively (p = 0.494) and at postoperative week 1 (p = 0.271). However the mean TI at postoperative month 1 was significantly higher in the 5.5 mm incision group than the 4.0 mm incision group (p = 0.05). CONCLUSION: The 5.5 mm sutured incisions caused an increase in TI at 1 week and 1 month postoperatively. For a more rapid visual rehabilitation, 4.0 mm sutureless incisions are recommended.

Aged↗
PubMed1999

Ultrasound biomicroscopy examination of intraocular lens haptic position after phacoemulsification with continuous curvilinear capsulorhexis and extracapsular cataract extraction with linear capsulotomy.

PURPOSE: Intraocular lens (IOL) haptic position in 35 eyes that had undergone cataract surgery was examined with ultrasound biomicroscopy (UBM). METHODS: In a prospective randomized study the patients were operated by phacoemulsification using continuous curvilinear capsulorhexis (CCC) (group I) or by extracapsular cataract extraction (ECCE) using linear capsulotomy (group II). Ultrasound biomicroscopy was used to localize both haptics of the implanted intraocular lenses and to measure anterior chamber depth (ACD), iris thickness and anterior chamber angle. The inflammatory reaction in the anterior chamber was assessed with laser flare photometry. Slit lamp examination was performed. RESULTS: Both IOL haptics were found in the lens capsule in all 18 eyes in group I. In group II one of the haptics was located out of the capsule in 7 of 17 eyes (41%). The difference is statistically significant (p=0.01). Postoperatively mean ACD measured with the UBM was 4.06+/-0.30 mm in group I and 3.64+/-0.24 mm in group II (p=0.00025). CONCLUSION: The UBM examinations indicate that phacoemulsification with continuous curvilinear capsulorhexis is a more reliable technique than ECCE with linear capsulotomy to achieve implantation of the intraocular lens haptics in the capsular bag.

Aged↗
PubMed2001

Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma.

PURPOSE: To study the effect of phacoemulsification and intraocular lens implantation (PHACO IOL) on intraocular pressure (IOP) and glaucoma medication in open-angle glaucoma (OAG) eyes. METHODS: 38 open-angle glaucoma (OAG) eyes with cataract underwent phacoemulsification and intraocular lens implantation (PHACO IOL) performed by one surgeon (RJU). None of the patients had prior intraocular surgery. Surgery was performed by scleral incision on 37% and by clear corneal incision on 63%. Patients were re-examined on the first postoperative day, after one week, 4 months, and in 29 cases 1-3.7 (mean 2.8) years after the operation. RESULTS: The mean preoperative IOP was 18.4+/-3.3 mmHg with a mean of 1.7 glaucoma medications. On the first postoperative day, the mean IOP rose to 28.2 +/- 12.5 mmHg. IOP > or = 30 mmHg occurred in 39.5% of the eyes. After one week, IOP had returned to the preoperative level. After 4 months, IOP had further decreased to 16.1 +/- 3.8 mmHg (p = 0.0027). After a mean follow-up of 1-3.7 (mean 2.8) years, the average postoperative IOP was 15.1 +/- 2.9 mmHg, being significantly (p = 0.001) lower than the preoperative IOP with 86% of the patients having a mean of 1.6 drugs on average. The type of incision (scleral vs. corneal) did not affect the postoperative IOP level. Using the criteria of Bigger and Becker (1971) the long-term IOP control after PHACO-IOL surgery was improved or unchanged in 86% and worse in 14% of the preoperatively well-controlled OAG eyes. CONCLUSIONS: In OAG eyes PHACO IOL is associated with a significant decrease in IOP with less medication up to 1-3.7 (mean 2.8) years.

Aged↗
PubMed2003

Visual perception during phacoemulsification cataract surgery under topical and regional anaesthesia.

PURPOSE: To compare the subjective visual experiences of patients during phacoemulsification and intraocular lens (IOL) implantation using regional and topical anaesthesia. DESIGN: A prospective, cohort, questionnaire-based study. METHODS: The study cohort consisted of 247 patients without pre-existing ocular pathology who underwent routine phacoemulsification and IOL implantation. The mean age of the subjects was 75.4 +/- 9.4 years and 34.5% of them had a history of cataract surgery. Three different methods of local anaesthesia were used: 66 (26.7%) of the patients were given topical anaesthesia (TA); 74 (30.0%) were given sub-Tenon's anaesthesia (SA), and 107(43.3%) were given peribulbar anaesthesia (PA). The patients were interviewed immediately after surgery by theatre staff using a standardized questionnaire that investigated their intraoperative visual experiences. RESULTS: There was no significant difference between the three methods of anaesthesia regarding light perception during the surgery. However, patients undergoing surgery under TA experienced brighter light intensity levels (78.3%) than those given SA (50.0%) and PA (55.7%) (p = 0.02). A total of 69.6% of subjects who received TA reported visual perception of colours during surgery, as opposed to 56.8% of SA recipients and 49.0% of PA recipients (p = 0.02). In addition, patients under TA were more aware of surgical instruments (26.1%) than those under SA (10.8%) and PA (15.9%) (p = 0.08). The vast majority of patients in all three groups found the visual experience to be non-frightening. There were no associations between intraoperative visual impression and age or sex. Although not statistically significant (p = 0.06), prior cataract surgery appeared to alleviate some of the anxiety associated with the visual experience. CONCLUSION: Patients undergoing regional and topical anaesthesia experience a wide variety of visual sensations during surgery. The differences in visual impressions between the groups may reflect the varying degrees of optic nerve blockade that result from the different anaesthetics.

Aged↗
PubMed1995

Intraocular deposition of metallic fragments during phacoemulsification: possible causes and effects.

We undertook a prospective slit lamp examination of 56 eyes which had undergone routine phacoemulsification, in order to determine the incidence of metallic intraocular foreign bodies. Characteristic small reflective particles were noted in 86%, with a mean of 5.1 particles per affected eye. No accompanying clinical problems were seen. The used phacoemulsification needles were examined with colour photography and scanning electron microscopy. A characteristic pattern of wear was observed, corresponding to an area under the plastic irrigating sleeve rather than at the tip. This suggests cavitation erosion rather than instrument contacts as the cause. Titanium alloy contains 6% aluminium, 4% vanadium and 0.25% iron. All its constituents may corrode and leach from the surface of the metal when in contact with body fluids and have been implicated in numerous adverse biological processes.

Aged↗
PubMed1995

Videokeratography: a comparison between 6 mm sutured and unsutured incisions for phacoemulsification.

One of the main aims of small incisions in cataract surgery is to reduce surgically induced astigmatism to a minimum. A prospective study was set up to compare sutured with unsutured 6 mm scleral pocket frown incision wounds for phacoemulsification. Videokeratography was used to study the topographical changes induced by surgery. Two groups of 15 patients were allocated to have either sutured or unsutured 6 mm frown incisions for their phacoemulsification. Videokeratography was performed 1 day pre-operatively, and repeated 6 weeks post-operatively. Statistical analysis of the resultant data is discussed. The results show a modest flattening in the vertical meridian in both groups of patients which was slightly larger in the unsutured group. The astigmatic change did not differ significantly between the two groups. The 6 mm scleral pocket incisions induce a small amount of astigmatism whether sutured or unsutured. However, we felt it was perhaps safer to suture an incision of that size. Videokeratography is an invaluable tool for collection of outcome audit data, and allows for accurate graphical assessment of the effect of differing surgical approaches.

Aged↗
PubMed1997

Variation in astigmatism following the single-step, self-sealing clear corneal section for phacoemulsification.

PURPOSE: A single-step, self-sealing, 3.2 mm clear corneal section is described and the incidence and variation of surgically induced astigmatism following phacoemulsification over a period of 3 months is determined. METHODS: Twenty-two patients who underwent uncomplicated 3.2 mm clear corneal phacoemulsification with foldable Allergan silicone intraocular lens implantation were autorefracted pre-operatively and on day 1, week 1, week 6 and at 3 months. The variation in induced astigmatism was analysed using the subtraction method and vector analysis. The change in direction of the cylindrical axis was examined. RESULTS: The induced astigmatism represented by the total vector on day 1 was 1.17 D and vector decomposition ratio, ATR:WTR (against-the-rule:with-the-rule), was 21.05:78.95. The total vector increased by 0.5 D in the first week and then stabilised. Vector decomposition showed an against-the-rule astigmatic drift so that by 3 months the ATR:WTR was 40.49:59.91. There was a tendency of the axis of the negative cylinder to swing towards the corneal section meridian on day 1 and to oscillate around that meridian at week 1 and week 6. By 3 months the direction reverted to that pre-operatively, in most cases. CONCLUSIONS: The single-step, self-sealing clear corneal section is mechanically stable and, though there is some variability in the measured astigmatism, there is an acceptable functional result throughout the post-operative period.

Aged↗
PubMed1997

Discharging routine phacoemulsification patients at one week.

The reduction of surgically induced astigmatism and rapid refractive stabilisation after phacoemulsification have been well studied and often lead to reduced follow-up. In this prospective study we reviewed a cohort of 100 patients discharged with a refractive prescription at their 1 week post-operative appointment following routine sutureless phacoemulsification through a corneal or scleral section. The aim was to assess the incidence of late pathology and need for review. Eighty-eight patients attended for review between 3 and 4 months post-operatively, of whom 8 (9.1%) who had been symptomatic had already visited ophthalmic casualty. Nine (10.2%) benefited from the follow-up appointment: 4 were given a new refractive prescription that increased their Snellen visual acuity by 1 line; the other 5 were all symptomatic or had incidental findings. We feel that provided there is easy access to the eye department, early discharge with or without refraction is justifiable as those with surgically related pathology at any stage are symptomatic.

Emergency Service, Hospital↗
PubMed1998

Early induced astigmatism following phacoemulsification and flexible lens implantation through an oblique corneal tunnel.

PURPOSE: To analyse the early surgically induced corneal astigmatism (SICA) with a 3.5 mm oblique clear corneal incision (CCI) for phacoemulsification and flexible silicone implant. METHODS: Sixty-four consecutive patients were included in this study. The keratometry readings were recorded on the day prior to surgery, the first day post-operatively and at 6 weeks. The SICA was evaluated according to four different methods: (i) simple subtraction, (ii) vector analysis, (iii) vector decomposition and (iv) Naeser polar values. RESULTS: At 6 weeks post-operatively the SICA was equally divided between with-the-rule (WTR) and against-the-rule (ATR) astigmatism, according to the vector analysis in combination with vector decomposition. Both the simple subtraction method and Naeser polar values were misleading. CONCLUSION: The oblique clear corneal section for phacoemulsification is a comfortable and safe incision with a predictable and acceptable degree of SICA that may be better tolerated than that induced by superior incision.

Adult↗
PubMed1998

The management of dislocated lens material after phacoemulsification.

PURPOSE: To determine the visual outcome, prognostic factors, and effect of timing of surgical intervention in patients with retained lens fragments after phacoemulsification. METHODS: A retrospective review was carried out of the notes of 44 consecutive patients who suffered posterior dislocation of lens fragments during phacoemulsification, of whom 34 underwent vitrectomy. RESULTS: The presence of severe uveitis at presentation was a significant predictor of a final visual acuity of less than 6/60 (p = 0.002). A raised intraocular pressure at presentation (> 29 mmHg) significantly increased the risk of chronic glaucoma (p = 0.0279), but there was no association between glaucoma and delay in vitrectomy. Patients operated on within 1 week of cataract surgery obtained a better visual outcome (64.7%) of patients achieved 6/12 or better visual acuity) than those operated on later than 1 week (41% obtained 6/12), but this difference did not reach statistical significance. CONCLUSIONS: The trend towards a better visual outcome with early vitrectomy was not statistically significant. A large prospective trial is indicated to determine the optimum time for vitrectomy in these patients.

Adult↗
PubMed1998

Combined phacoemulsification, pars plana vitrectomy, removal of intraocular foreign body (IOFB), and primary intraocular lens implantation for patients with IOFB and traumatic cataract.

PURPOSE AND METHODS: Small-incision cataract extraction by phacoemulsification through an anterior continuous circular capsulorhexis, pars plana vitrectomy, forceps removal of intraocular foreign body (IOFB) and primary intraocular lens implantation were performed in 4 eyes (4 patients) with IOFB and traumatic cataract, as an emergency combined procedure. RESULTS: At a mean follow-up of 12.3 months (range 7-19 months) the best corrected visual acuity of the 4 eyes ranged from 6/6 to 6/12. The only complication encountered in our series was an opacified posterior capsule that developed 10 months post-operatively in one case. This was easily dealt with by neodymium:YAG laser capsulotomy, with good final visual outcome. CONCLUSIONS: The results of combined one-stage instead of sequential surgeries, and phacoemulsification instead of lensectomy or extracapsular cataract extraction for patients with IOFB and cataract are encouraging. It could be a good option in selected cases. However, the safety and efficacy of this combined procedure need to be evaluated further by a larger-scale, longer follow-up study.

Adult↗
PubMed1998

A prospective controlled study of a 10/0 absorbable polyglactin suture for corneal incision phacoemulsification.

PURPOSE: To evaluate the performance of a 10/0 monofilament absorbable polyglactin suture for temporal 5.2 mm corneal incision phacoemulsification. METHODS: A prospective randomised controlled study of 49 patients undergoing phacoemulsification with a sutured temporal 5.2 mm corneal section was conducted to compare the refractive results and complications of a 10/0 monofilament absorbable polyglactin suture with 10/0 nylon. RESULTS: Thirty-eight patients completed the study. There was no significant difference in induced astigmatism between the two groups. All absorbable sutures were intact at 1 week. Six weeks post-operatively the absorbable suture was still intact in 1 (6%) patient, present but broken in 4 (24%) and completely absent in 12 (70%) patients. All polyglactin sutures had been completely absorbed by 12 weeks. Absorption of the polyglactin sutures was associated with mild localised corneal haze in 3(18%) cases (p = 0.055). One of the 18 patients (6%) in the polyglactin suture group presented with iris prolapse associated with knot failure 1 week post-operatively. There was no significant difference in foreign body symptoms between the two groups. CONCLUSIONS: 10/0 polyglactin sutures maintain adequate tensile strength during the immediate post-operative period for small incision surgery and are associated with minimal induction of astigmatism. Their subsequent absorption obviates the need for routine suture removal. Suture absorption is well tolerated although in some cases a mild degree of local tissue reaction raises concern about possible mechanisms of absorption. The risk of knot failure may be reduced by an alternative suture tying technique. 10/0 monofilament polyglactin is an attractive option when a suture is required during small incision cataract surgery.

Absorption↗