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PubMed2006

[Posterior continuous curvilinear capsulorhexis with optic capture of the posterior chamber intraocular lens in pediatric cataract].

OBJECTIVE: To assess the clinical effects of posterior continuous curvilinear capsulorhexis with optic capture of the posterior chamber intraocular lens in pediatric cataract. METHODS: Fifty-one cases (83 eyes) received posterior continuous curvilinear capsulorhexis with optic capture of the posterior chamber intraocular lens. Preoperative and postoperative visual acuity and refractive error were recorded. Intraoperative and postoperative complications were observed. The follow-up period was from 6 to 36 months. RESULTS: Implantation of optic capture of the posterior chamber intraocular lens was successfully performed in 75 eyes (90.4%). The mean postoperative best corrected distant visual acuity achieved 0.5 or better in 75 eyes (48.0%). No eyes with optic capture were found optic axis opaque. The major complications of optic capture were anterior chamber fibrous exudation, iris posterior synechia and lenticular precipitates. CONCLUSION: Optic capture of the posterior chamber intraocular lens is safe and effective in the treatment of pediatric cataract to posterior continuous curvilinear capsulorhexis especially in the prevention of secondary opacification from the visual axis.

Adolescent↗
PubMed1995

Extracapsular cataract surgery using capsulorhexis with viscoexpression via a limbal section.

Two hundred consecutive patients had extracapsular cataract surgery by capsulorhexis and viscoexpression. Capsulorhexis, attempted in 195 eyes, was successful in 87.7%. Viscoexpression was attempted in 162 cases and successfully delivered the nucleus in 87.7%. There were five cases of zonule rupture, one of posterior capsule rupture, and two of vitreous loss. If the capsulorhexis is larger than 5 mm, viscoexpression can be safely used on all cataracts, regardless of nuclear density, and is the ideal transition to phacoemulsification.

Cataract Extraction↗
PubMed1995

Evaluation of 35 consecutive SI-30 PhacoFlex lenses with high-refractive silicone optic implanted in the capsulorhexis bag.

Thirty-five PhacoFlex foldable open-loop lenses with high-refractive silicone optics were evaluated. All lenses were implanted using a folding forceps and were fixated in the bag. Mean follow-up was 14 months. With adequate forceps, the lens may be inserted through a 3.2 mm incision, using a 3 mm long self-sealing sclerocorneal tunnel. With a well-centered 4 mm to 5 mm capsulorhexis opening, centration was very satisfactory. Moderate decentration occurred in two cases, one from a small, heavily shrinking capsulorhexis and the other from a poorly shaped capsulorhexis that captured the optic along its edge. Except in one case of combined cataract and filtering surgery, all optics were at a pronounced distance from the iris. Consequently, signs of iris chafing or iridocapsular synechias and cellular invasion were not seen. The optic typically exhibited a slight bluish tint and minute granular inclusions without clinical significance. Neither discoloration nor haze was present. Best visual acuity was 20/25 or better in all cases. The small wound required for insertion makes the PhacoFlex especially appropriate for clear corneal incision surgery. Attempts are being made to minimize the grainy appearance of the optic. Increasing the rigidity of the loops may be advantageous.

Aged↗
PubMed1994

Cataract surgery in children with capsulorhexis of anterior and posterior capsules and heparin-surface-modified intraocular lenses.

Cataract surgery was performed in 21 eyes in 14 children (one to 12 years, 5.6 +/- 4.0 [mean +/- SD]). Cataract surgery was standardized and included capsulorhexis of the anterior capsule, irrigation/aspiration of the nucleus and cortex, puncture of the posterior capsule, injection of sodium hyaluronate (Healon GV, 14 mg/ml) between the posterior capsule and the vitreous, and capsulorhexis of the posterior capsule. At the end of the procedure, a heparin-surface-modified (HSM) poly-(methyl methacrylate) intraocular lens (IOL) was implanted in the capsular bag. Follow-up ranged from four to 16 months. No complications such as the appearance of vitreous in the anterior chamber occurred during surgery. A mild postoperative inflammation was seen in all cases. Opacification of the visual axis was seen in one eye ten months after surgery. Posterior synechial formation was seen in one eye. Our results suggest that capsulorhexis of the anterior and posterior capsules with implantation of an HSM IOL in the capsular bag is a safe procedure in children and produces good postoperative results.

Cataract Extraction↗
PubMed1990

Two-stage capsulorhexis for endocapsular phacoemulsification.

The continuous tear anterior capsulotomy or capsulorhexis technique is important for safe, successful cataract extraction and intraocular lens (IOL) implantation surgery. A two-stage continuous tear capsulotomy or capsulorhexis extends the possibility of achieving continuous tear capsulotomy to challenging and complicated cases. In endocapsular phacoemulsification this technique preserves the integrity of the capsule because it prevents the extension of radial tears in the capsule and thus facilitates safe cataract extraction and secure in-the-bag IOL placement. The benefits and advantages of the continuous tear capsulotomy are preserved by two-stage capsulorhexis.

Humans↗
PubMed1993

Hydroexpression and viscoexpression of the nucleus through a continuous circular capsulorhexis.

When a continuous circular capsulorhexis (CCC) is performed, conventional nucleus expression may be impossible because of the strong capsular rim. Hydroexpression of the nucleus seems to overcome the problem if the capsulorhexis opening is large enough. Because a viscoelastic material may be an even more gentle tool than balanced salt solution (BSS), hydroexpression and viscoexpression were evaluated in 16 pairs of human cadaver eyes. The diameter of the capsulorhexis opening ranged from 4 mm to 6 mm; it was the same in each pair of eyes. Hydroexpression was performed in one eye using BSS and viscoexpression was performed in the fellow eye using sodium hyaluronate (Healon Yellow). The fluid pressure in the capsular bag was measured during both procedures. The pressure was higher during hydroexpression than during viscoexpression. The pressure difference between fellow eyes ranged from 0 to 32 mm Hg and was most marked when the CCC opening was small. This correlation was significant (P < .05). Viscoexpression may enhance the safety in cases with a small CCC opening or in those that are otherwise difficult.

Adult↗
PubMed1996

Experimental study of different intraocular lens designs implanted in the bag after capsulorhexis.

OBJECTIVE: To analyze experimentally in cadaver eyes several models of commercially available posterior chamber intraocular lenses (IOLs) to determine their stability, fixation, and behavior in the capsular bag in relation to their overall size, optic diameter, shape, material, and haptic configuration. SETTING: Eye Bank and Department of Ophthalmology, University General Hospital of Alicante, Spain. METHODS: Thirty-three IOLs of different sizes, shapes, and designs, divided in two series and five groups, were implanted successively in 31 cadaver eyes. All the proceedings were videotaped, and measurements were made on the television screen with the picture static. Main outcome measures were the diameters of the lens, the empty capsular bag, and the capsulorhexis; capsular distension by the IOL haptics; extent of haptic arc of contact with the capsular equator; and IOL mobility in the bag. RESULTS: The stability of and stretching caused by the IOLs varied greatly depending on their overall size, haptic flexibility, and the extent of the arc of haptic contact with the capsular equator. Lenses between 13.5 and 14.0 mm had good stability but stretched the capsule excessively. The J-loop haptic configuration produced a spindle-shaped bag deformity that might come in contact with the ciliary processes in the physiologic eye. Among IOLs designed for in-the-bag implantation after capsulorhexis, the two smaller than 12.0 mm were unstable, permitting excessive mobility in the capsular bag. Except for IOLs with a 5.0 mm optic, all 12.0 mm IOLs had reasonable stability, little or no mobility within the capsular bag, and good short-term centering. Lenses with a broad angulation at the haptic-optic junction, to about 90 degrees, achieved the largest arc of contact with the equator and behaved as lenses with larger optics. The Pharmacia 808 performed best. CONCLUSION: After capsulorhexis and extracapsular cataract extraction, 12.0 mm, poly(methyl methacrylate), one-piece IOLs with modified C-shaped loops, 90 degree angulation at the haptic-optic junction, and an optic diameter between 6.0 and 6.5 mm performed best in the capsular bag.

Adolescent↗
PubMed1996

Effect of capsulorhexis diameter on glare disability.

PURPOSE: To determine whether the diameter of the anterior capsulorhexis has an effect on postoperative glare. SETTING: Sapir Medical Center, Meir Hospital, Kfar Saba, Israel. METHODS: Forty patients had extracapsular cataract extraction (manual or phacoemulsification) through an intact continuous curvilinear capsulorhexis (CCC) of various sizes. The CCC diameter was measured and the opacity of the anterior and posterior capsules was evaluated before and after dilation of the pupils. Glare test (Miller-Nadler glare tester) was performed with the eyelid in a normal position and after lid elevation. RESULTS: The diameter of the CCC ranged from 3.50 to 7.00 mm (mean 4.87 mm). The anterior capsule was always opaque in the area of contact with the IOL material. None was graded clear; 60% were graded as +3. Mean glare disability prior to pupil dilation was 12.1 +/- 8.8 (SD) and after dilation, 17.3 +/- 9.7. There was no correlation between glare disability and the diameter of the capsulorhexis, the width of the exposed opacified capsular ring, or the grading of capsule opacification (anterior and posterior). Dilation of the pupil significantly increased glare disability (P = .016), unrelated to CCC diameter. CONCLUSION: A CCC larger than 3.5 mm does not induce significant glare.

Aged↗
PubMedDate not supplied

Continuous curvilinear capsulorhexis and intraocular lens biocompatibility.

PURPOSE: To study the influence of continuous curvilinear capsulorhexis (CCC) on poly(methyl methacrylate) (PMMA) intraocular lens (IOL) biocompatibility. METHODS: Biocompatibility was assessed by measuring the postoperative blood-aqueous barrier breakdown and the cellular reaction at the anterior capsule-IOL interface. In a prospective study, 30 consecutive eyes, normal except for having extracapsular cataract extraction (ECCE) with CCC by a single surgeon, has laser flare and cell measurements and specular microscopy of the anterior IOL surface at 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS: In addition to the foreign-body reaction previously described in eyes that had other capsulotomy types, the eyes in this study also had a lens epithelial cell (LEC) reaction. The severity of the foreign-body reaction and postoperative aqueous flare and cells was significantly less in eyes with an intact CCC than in those with rim tears in the capsulorhexis and in those having an ECCE with a linear or can-opener capsulotomy, as previously reported. CONCLUSIONS: Continuous curvilinear capsulorhexis improves the biocompatibility of PMMA IOLs to a degree that could be of clinical benefit. In eyes with CCC, most cells seen on the anterior IOL surface were LECs.

Biocompatible Materials↗
PubMed1997

Posterior continuous curvilinear capsulorhexis and optic capture of the intraocular lens to prevent secondary opacification in pediatric cataract surgery.

PURPOSE: To evaluate the safety and efficacy of posterior continuous curvilinear capsulorhexis with optic capture n preventing secondary opacification of the visual axis in pediatric eyes having cataract surgery and intraocular lens (IOL) implantation. SETTING: Gimbel Eye Centre, Calgary, Alberta, Canada. METHOD: Posterior continuous curvilinear capsulorhexis with optic capture of the IOL was performed in 18 of 19 consecutive pediatric cataract patients (ages 2 1/2 to 12 years). Heparin-coated IOLs with 6 degree angulation of the haptics were implanted in all eyes. Only eyes with a minimum of 18 months follow-up (n = 16) were analyzed. RESULTS: Mean follow-up in the 16 eyes was 35.5 months +/- 9.45 (SD), ranging from 19 to 49 months. To date, the visual axis has remained clear in all eyes. No anterior vitrectomy was purposefully performed in any eye. CONCLUSION: Posterior continuous curvilinear capsulorhexis with optic capture of the heparin-coated IOL appeared to successfully prevent secondary opacification of the visual axis in pediatric cataract cases.

Cataract↗
PubMedDate not supplied

Diathermic capsulotomy versus capsulorhexis: a biomechanical study.

PURPOSE: To compare the mechanical quality of a capsulotomy opening performed by diathermy with that made by capsulorhexis (tearing). SETTING: Department of Ophthalmology, Vejle Hospital, Denmark. METHODS: This study included 12 pairs of human cadaver eyes and 20 pairs of pig eyes. One in each pair was randomly selected for one capsulotomy technique. The capsulotomy edge was stretched in a materials testing machine until break; force and elongation values were continuously recorded. RESULTS: In humans, the extensibility of the diathermic capsulotomy edge was approximately half that of the capsulorhexis edge (mean 38% +/- 4 [SD] versus 68% +/- 6), and the force required to break the edge was reduced by a factor of five (26 +/- 8 mN versus 134 +/- 36 mN). CONCLUSION: The mechanical quality of the diathermic capsulotomy edge is significantly less than that of the capsulorhexis edge, which indicates that the diathermic capsulotomy edge would withstand less surgical manipulation.

Aged↗
PubMedDate not supplied

Mechanized anterior capsulectomy as an alternative to manual capsulorhexis in children undergoing intraocular lens implantation.

BACKGROUND: Although manual capsulorhexis is an ideal anterior capsulectomy technique for adults, it is more difficult to perform in very young eyes because the capsular bag is more elastic. Our mechanized anterior capsulectomy technique has compared favorably with manual capsulorhexis in the laboratory using autopsy eyes. We now report the results of circular mechanized anterior capsulectomy in consecutive pediatric patients receiving a posterior chamber intraocular lens (IOL) after cataract extraction. METHODS: Twenty eyes of 17 consecutive patients between 6 months and 13 years of age underwent a mechanized anterior capsulectomy followed by IOL implantation into the capsular bag. The integrity of the anterior capsular edge was evaluated at the completion of capsulectomy, prior to IOL insertion, and at the end of surgery. RESULTS: A single radial tear developed in three eyes (15%) of two patients (12%). In the remaining 17 eyes (85%), an intact circular capsulectomy edge was verified at the completion of the mechanized capsulectomy, at the end of IOL insertion, and at the completion of surgery. Complete in-the-bag capsular fixation of the IOL was accomplished in all 20 eyes. Both patients who sustained radial tears were older children (age 11 years). All IOLs remain well centered behind a smooth circular anterior capsular edge after a minimum follow up of 6 months. CONCLUSION: A mechanized anterior capsulectomy technique can produce a circular capsular opening that resists tearing during lens aspiration and IOL insertion. The vitrector-cut capsulectomy performed well even in the youngest patients in whom manual capsulorhexis would have been difficult to control.

Adolescent↗
PubMed2002

[Primary implantation of posterior chamber intraocular lens in eyes with posterior capsulorhexis].

PURPOSE: To evaluate the effect of anterior vitrectomy combined with primary implantation of posterior chamber intraocular lens for the capsulorhexis following cataract extraction. METHODS: Anterior vitrectomy combined with primary implantation of posterior chamber intraocular lens was performed on 76 cases with capsulorhexis from 1 089 cases of cataract extraction. The surgical technique, postoperative visual acuity and postoperative complication were analyzed. RESULTS: The proportion, of which the corrected visual acuity was 0.5 or better one week and six months postoperatively, was 86.8% and 93.4% respectively. CONCLUSION: Anterior vitrectomy combined with primary implantation of intraocular lens for posterior capsulorhexis following cataract extraction is safe and effective.

Adolescent↗
PubMed1994

Anterior capsular shrinkage and intraocular pressure reduction after capsulorhexis.

A significantly lower intraocular pressure level was found 2 months after in-the-bag implantation of 4 different posterior-chamber lenses in a consecutive series of operations involving 401 eyes. The anterior capsular opening was achieved with either an intact continuous circular capsulorhexis (349) or a capsulorhexis with one radial tear (52). The typical shrinkage of the anterior capsule following a continuous capsulorhexis was hypothesized to be an essential part of the pressure-lowering mechanism by traction on the ciliary body via the zonula. However, a direct correlation between the degree of anterior capsular shrinkage and the degree of pressure reduction in glaucomatous and non-glaucomatous eyes could not be established. The reduction was equal in all shrinkage subgroups. Thus, the most likely explanation for intraocular pressure reduction after intracapsular implantation should be sought not in mechanical but in non-mechanical (i.e. biochemical) alterations and influences.

Adolescent↗
PubMed1994

[Capsulorhexis with a manual extracapsular extraction technic-- initial experience].

Capsulorhexis is a modern way of opening of the anterior capsule. The author describes the technique of capsulorhexis, he used on 52 eyes. When capsulorhexis is performed in ECCE, delivery of lens nucleus is more difficult. The author used either "Keyhole" modification or hydroexpression described by Thiem, Corydon with combination of reduction of the nucleus described by Nishi. He achieved very good results but does not recommend this method for the inexperienced extracapsular surgeons.

Anterior Eye Segment↗
PubMed2006

Completion rate of primary posterior continuous curvilinear capsulorhexis and vitreous disturbance during congenital cataract surgery.

PURPOSE: We sought to document the completion rate of primary posterior continuous curvilinear capsulorhexis during congenital cataract surgery and determine the incidence of disruption of vitreous face during this procedure. METHODS: One hundred six consecutive eyes of patients undergoing posterior continuous curvilinear capsulorhexis (PCCC) during congenital cataract surgery were evaluated prospectively for completion of PCCC and disruption of vitreous face. PCCC was performed under high-viscosity sodium hyaluronate (Healon GV 1.4%) initiated with 26 g of cystotome and later completed with Kraff-Uttrata forceps by frequent grasping and regrasping of the flap. Completion of PCCC and disruption of vitreous face during the procedure was noted. Even in cases of disrupted vitreous face, PCCC was performed and completed with forceps and, later, disruption of vitreous face was managed with 2-port automated limbal anterior vitrectomy. The size of PCCC was measured. An Alcon AcrySof SA30AL was implanted in-the-bag if the PCCC was 4 mm or smaller and in the sulcus when the PCCC was larger than 4 mm. RESULTS: The mean age of the 106 pediatric patients was 17 +/- 26 months (median, 6 months; range, 1 month to 8 years). PCCC was completed in all the eyes. Disruption of vitreous face during PCCC was noted in 5 of 106 (4.7%) eyes. The mean size of PCCC was 3.6 +/- 0.7 mm. A total of 98 (92.5%) had in-the-bag, and 8 (7.5%) eyes had sulcus implantation of IOL. CONCLUSION: PCCC was completed in all eyes with minimal disruption of vitreous face in a well-controlled manner under high-viscosity viscoelastics.

Capsulorhexis↗
PubMed2004

Eccentric capsulorhexis and postoperative dysphotopsia following phacoemulsification.

We report a case of troublesome visual symptoms or dysphotopsia in a 68-year-old patient after right phacoemulsification and implantation of a 3-piece AcrySof(R) MA60BM acrylic intraocular lens (IOL) (Alcon) in the capsular bag. The patient described multiple horizontal streaks in dim lighting conditions with light sources in the right temporal visual field. The anterior capsulorhexis was eccentric, leaving the nasal optic edge and site of polypropylene haptic insertion uncovered by the semi-opaque anterior capsule and the probable source of the flare images. Miotic therapy was poorly tolerated and IOL exchange declined. The case illustrates the importance of creating a central capsulorhexis smaller than the IOL optic to reduce the risk photic phenomena and edge effect with square-edged IOLs.

Aged↗
PubMed2005

Performance of the 1CU accommodating intraocular lens in relation to capsulorhexis size.

PURPOSE: To assess the correlation between continuous curvilinear capsulorhexis (CCC) size and visual outcomes in patients with an accommodating intraocular lens (IOL). SETTING: Heidelberg IOL and Refractive Surgery Research Group, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. METHODS: Nineteen eyes had phacoemulsification and implantation of a 1CU accommodating IOL (HumanOptics AG). Three months after surgery, the uncorrected and best corrected distance and near visual acuities and the distance corrected near visual acuity were measured. Retroillumination photographs were taken to assess CCC size and centration and the amount of overlap between the CCC and IOL optic. The photographs were analyzed using Evaluation of Posterior Capsule Opacification system software. RESULTS: The mean age of the patients was 53.5 years (range 30 to 73 years). The mean uncorrected distance acuity improved from 0.05 preoperatively to 0.70 at 3 months and the best corrected near acuity, from 0.30 to 0.94. The mean postoperative distance corrected near acuity was 0.5 (range 0.1 to 1.0), which improved to 0.9 with near correction. The mean CCC size (4.3 mm) and amount of CCC decentration (0.35 mm) did not correlate with visual outcomes. However, there was a correlation between the amount of CCC-optic overlap (mean 35%; range 16% to 55%) and distance corrected near acuity (r = 0.641, P = .003). Distance corrected near acuity was better with less overlapping; that is, with a larger CCC. CONCLUSIONS: A larger capsulorhexis with less CCC-optic overlapping gave better near visual outcomes. Results indicate that an overlap between 25% and 35%, which correlates with a CCC between 4.5 mm and 5.0 mm, provides the best capsule strength without compromising accommodation with the single-piece 1CU IOL.

Accommodation, Ocular↗