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PubMed1999

Combined phacoemulsification--vitrectomy surgery: technique, indications and outcomes.

PURPOSE AND METHODS: Cataract extraction may be combined with vitrectomy to improve the operative view and/or enhance post-operative rehabilitation. A retrospective review of the records of all patients undergoing combined phacoemulsification and vitrectomy procedures since 1993 was performed. Surgical technique is discussed. RESULTS: Fifty operations on 49 patients are described. Visual acuity improved overall (mean LogMAR acuity 1.58 +/- 0.74 pre-operatively and 1.17 +/- 0.76 LogMAR post-operatively), with 57% of patients having improved acuity post-operatively. Operative complications were few and post-operative complications were acceptable given the severity of the posterior segment disease. CONCLUSIONS: Combined phacoemulsification-vitrectomy surgery is a viable option in the management of posterior segment disease in the presence of cataract. It has a number of advantages over other approaches, and can be combined with intraocular lens insertion into the capsular bag in most cases.

Adult↗
PubMed2003

Subjective visual experience during phacoemulsification cataract surgery under sub-Tenon's block.

In a prospective survey, 121 patients received sub-Tenon's block and were interviewed on the same day after their phacoemulsification cataract surgery regarding their visual experience in the operated eye during surgery. Majority of patients (81%) reported that they could see some light during surgery and various colours were seen by 56%. Movements of various descriptions were also reported by 40% of patients. The majority of patients (93%) found the visual experience acceptable but 4% thought it to be unpleasant and 3% found it frightening. Patients undergoing phacoemulsification surgery under sub-Tenon's block experience a variety of visual sensations and some patients may be frightened. All patients should receive appropriate preoperative warning.

Anesthesia, Local↗
PubMed2003

Visual perception during phacoemulsification cataract surgery under subtenons anaesthesia.

AIM: The aim of this study was to record the subjective visual experience of patients during phacoemulsification and intraocular lens implantation under subtenons anaesthesia. METHODS: Prospective, nonrandomised, cohort, postoperative questionnaire based study. Patients selected underwent routine phacoemulsification and intraocular lens implantation under regional subtenons anaesthesia. chi(2) and Fisher's exact tests (two-tail) were used to evaluate the data. RESULTS: A total of 104 patients were selected, 38 (36.5%) were male and 66 (63.5%) were female. The mean age of patients was 74.0+/-8.8 years. In all, 87.5% saw light during the operation with 9.6% finding this painful. Photophobia was highest among younger patients (P=0.002). Coloured lights were seen by 56.7% and 13.5% found the visual experience frightening. Frightening visual experiences were significantly associated with the perception of colour (P=0.005) and photophobia (P=0.003). A volume of anaesthetic greater than 4 m was associated with a significant reduction in anxiety as a result of the visual experience (P=0.003). None of the other visual phenomena recorded were associated with a frightening visual experience. CONCLUSIONS: Patients undergoing regional anaesthesia experience a wide variety of visual sensations during cataract surgery. Perception of colour and volumes of anaesthetic less than 4 m appear to be associated with the visual experience being more frightening. Detailed preoperative counselling is mandatory. It should include comprehensive information about visual perception during the procedure relieving the patients from unnecessary distress.

Aged↗
PubMed2006

Cystoid macular oedema and changes in retinal thickness after phacoemulsification with optical coherence tomography.

AIMS: To study the incidence of cystoid macular oedema and changes in retinal thickness after phacoemulsification with optical coherence tomography (OCT). METHODS: In all, 131 eyes of 131 patients were studied at the ophthalmology clinic at Tung Wah Eastern Hospital from September 2001 to October 2002. All the patients had clinical assessment and OCT preoperatively and at weeks 2, 4, and 8 postoperatively. The incidence of postoperative cystoid macular oedema (CMO) was evaluated. The foveal thickness (FT) and central 1 mm retinal thickness (CT) at different time intervals were analysed. RESULTS: Four (3.05%) patients developed CMO after phacoemulsification, which was evident clinically and tomographically. Fluorescein angiogram confirmed leakage in all cases. For other patients, the mean preoperative FT was 189.36 +/- 26.83 microm. The mean FT, were 175.74 +/- 26.79 microm, 180.25 +/- 27.13 microm, 176.58 +/- 26.45 microm at 2 weeks, 4 weeks, and 8 weeks postoperatively, respectively. The preoperative FT was significantly thicker than those in the postoperative period. The same trend was noted for CT. CONCLUSION: OCT is useful for detecting and confirming clinical CMO after cataract surgery; however, its use in detecting subtle changes in retinal thickness is limited by the normal variation in retinal thickness. The measurement of retinal thickness with OCT may also be affected by the status of the lens.

Aged↗
PubMed2005

A comparison of the potential acuity meter (PAM) and the illuminated near card (INC) in patients undergoing phacoemulsification.

PURPOSE: To compare the accuracy of the potential acuity meter (PAM) and the illuminated near card (INC) in patients undergoing phacoemulsification. METHODS: During presurgical evaluations, both PAM and INC were tested on each study patient following dilation. Patients then rated the subjective ease of use of each test. Best spectacle-corrected visual acuity (BSCVA) was recorded at 4 and 12 weeks postoperatively. McNemar's chi(2) test for paired associations was used to analyse categorical data; paired t-tests were used for continuous variables. RESULTS: Overall, the INC was more likely than the PAM to predict BSCVA within one Snellen line (P=0.002), but this difference decreased for accuracy within two lines. The PAM predicted BSCVA within one line in 87 (70.7%) eyes, as compared to 102 (82.9%) eyes by the INC. The PAM was accurate within two lines in 109 (88.6%) eyes; the INC was accurate in 115 (93.5%) eyes. The PAM was more likely to underpredict potential acuity (P<0.001), while the INC was more likely to overpredict (P=0.004) or give exact predictions of BSCVA (P<0.001). Accuracy of the INC declined in eyes with macular comorbidity. The PAM and INC were rated as 'easy' tests by 54 (45.4%) and 93 (78.2%) patients, respectively. CONCLUSIONS: Both the PAM and the INC were useful for predicting BSCVA after phacoemulsification, but the PAM was more likely to underestimate potential acuity. The INC was easier for patients to use, and had better accuracy than the PAM in patients without macular comorbidity, but was more likely to overestimate potential acuity.

Adolescent↗
PubMed2006

Corneal endothelial function after phacoemulsification using the fluid-based system compared to conventional ultrasound technique.

AIM: To quantitatively assess corneal endothelial changes after phacoemulsification with the fluid-based system compared to conventional ultrasound technique. METHODS: This prospective, randomized clinical study included patients with cataract who were randomly assigned either to have phacoemulsification with the fluid-based system (30 eyes of 30 patients--Group 1) or with traditional ultrasound (30 eyes of 30 patients--Group 2). Patients who were available at each follow-up visit (25 eyes in both groups) were enrolled in the statistical analysis. Endothelial function was evaluated by measuring central corneal thickness, central endothelial cell density (ECD), mean cell size, and coefficient of variation in cell size preoperatively, 10 days, 1 and 3 months, and 1 year after surgery. Statistical analyses were performed using two-way repeated measure ANOVA. RESULTS: An acute, reversible increase of central corneal thickness (CCT) was found 10 days after surgery, which was similar in both groups (P=0.35). ECD decreased, whereas mean cell size increased significantly immediately after surgery. However, the impairments were finished after 1 month. The alterations were similar in both groups (ECD: P=0.99; mean cell size: P=0.85). The coefficient of variation in cell size remained stable after surgery (P=0.08), and significant difference was not found between groups (P=0.99). The endothelial cell loss (ECL) was 6.5+/-8.4% in Group 1 and 6.5+/-11.7% in Group 2 (P=0.69). CONCLUSIONS: Corneal endothelial changes were similar using the fluid-based system compared to the traditional ultrasound technique. The fluid-based method proved to be as safe as conventional ultrasound in cataract surgery.

Aged↗
PubMed2006

Patients' expectation and experience of visual sensations during phacoemulsification under topical anaesthesia.

PURPOSE: To describe what patients expect to see and the visual sensations they actually experience during phacoemulsification under topical anaesthesia. We also sought to determine if patients find their intraoperative visual experience frightening and the factors associated with this. MATERIALS AND METHODS: Ninety-eight patients who underwent phacoemulsification and intraocular lens implantation under topical anaesthesia were interviewed preoperatively on what they expected to see with their operated eye during surgery and again postoperatively on what they actually saw. No patient received counselling about possible intraoperative visual sensations. A logistic (multivariate) regression model was used for statistical analysis. RESULTS: Preoperatively, 36 patients (36.7%) expected at least light perception, 38 (38.8%) expected no light perception, and 24 (24.5%) were unsure what to expect. Some patients also expected a variety of different visual sensations. Postoperatively, all patients (100%) reported seeing light intraoperatively and many experienced various other visual sensations. Nineteen patients (19.4%) found their visual experience frightening. The following factors were statistically associated with a frightening visual experience: preoperative anxiety, previous cataract surgery in the fellow eye, experiencing an intraoperative increase in clarity, not seeing movement intraoperatively, and not knowing what to expect. CONCLUSIONS: The majority of patients in this study either expected that they would see nothing at all during the surgery or were unsure of what to expect. All patients subsequently saw at least some light, and many perceived various other visual sensations that were frightening to nearly one in five patients. Preoperative counselling should inform about possible intraoperative visual experience.

Adult↗
PubMed2006

Phacoemulsification in true exfoliation of the lens capsule: a case series.

PURPOSE: We report five cases (seven eyes) of true exfoliation during an 18-month period. Of the two bilateral cases, the first was identified immediately before cataract surgery and the second spontaneously developed a split in the anterior capsule just before capsulorrhexis, mimicking a partial capsulorrhexis. In the three unilateral cases, true exfoliation was noted during the first examination. METHODS: Vision blue aided uneventful capsulorrhexis differentiating its edge from the true exfoliation edge, and in the first two cases, the anterior capsule was sent for histopathology and ultrasound of the fellow eye was requested. RESULTS: Ultrasound and histopathology demonstrated lamellar separation of the anterior portion of the lens capsule, confirming the diagnosis of true exfoliation. Cataract surgery by phacoemulsification was uneventful in all cases. CONCLUSION: True exfoliation of the lens capsule can masquerade as a partial capsulorrhexis and should be looked for before surgery and immediately before capsulorrhexis to avoid creating a partial thickness capsulorrhexis and its related surgical complications. No zonule weakness was appreciated in our cases. To our knowledge, the spontaneous occurrence of a curvilinear lamellar capsular dehiscence with a flap before capsulorrhexis has not been reported before. This series highlights that cataracts associated with true exfoliation of the lens capsule can be safely operated, with the help of vision blue, by routine phacoemulsification without having to convert to the extracapsular technique.

Aged↗
PubMed2006

Change of foveal and perifoveal thickness measured by OCT after phacoemulsification and IOL implantation.

PURPOSE: Cataract surgery is known to elicit postoperative macular oedema owing to its traumatic effect. The aim of the study was to measure the foveal and perifoveal thickness of the retina after uneventful phacoemulsification and posterior chamber intraocular lens (PC-IOL) implantation. METHODS: Retinal thickness values of the foveal and perifoveal (fovea+3.0 mm, fovea+6.0 mm) sectors and the minimum values were measured in a prospective study using optical coherence tomography (OCT) in 71 eyes of 71 patients (34 men, 37 women, mean age: 68.8 years) who underwent cataract surgery. Phacoemulsification and 'in the bag' implantation of a foldable PC-IOL was performed under topical anaesthesia. Data were collected 1 day before the operation, and postoperatively at 1, 7, 30, and 60 days. Contralateral eyes of each patient served as controls. 'Student's t-test' was used for statistical analysis, and P<0.05 value was considered significant. RESULTS: No significant change of the thickness values could be measured 1 day after surgery. However, a significant increase could be detected on the postoperative 7, 30, and 60 days in the perifoveal 3.0 and 6.0 mm sectors either calculated alone or averaged together with the foveal values. The initial (preoperative) average value of 234.1+/-2.6 microm (mean+/-SEM, n=536) in the 6.0 mm perifoveal region increased to 242.5+/-2.6 microm (mean+/-SEM, n=488, P<0.01) 1 week, to 247.7+/-4.6 microm (n=352, P<0.01) 1 month, and to 246.0+/-5.9 microm (n=208, P<0.05) 2 months after surgery, which proved to be significant. However, the relative change of macular thickness was moderate, 3.5, 5.6, and 5.3% at the above periods, respectively. In a subgroup of patients (n=34) minimum 6 months after cataract surgery, the 6.0 mm perifoveal values were found to be elevated at (237.8+/-3.9 microm, mean+/-SEM, n=272) as compared to the control eyes (233.9+/-3.8 microm, mean+/-SEM, n=272). The difference was 1.7% and proved not to be significant (P>0.05). CONCLUSIONS: Mild subclinical perifoveal oedema following cataract surgery was detected using OCT at postoperative day 7 to 6 months. The minimal and the foveal values in itself are inadequate to describe the phenomenon. The macular thickness values of the perifoveal 3.0 and 6.0 mm sectors alone or averaged together with the foveal values provide more accurate description of the postoperative macular oedema.OCT enables the detection of minimal increases in perifoveal retinal thickness even 6 months after cataract surgery.

Aged↗
PubMed2002

Phacoemulsification in filtered chronic angle closure glaucoma eyes.

PURPOSE: To report the results of phacoemulsification in eyes with chronic angle closure glaucoma having a functional filtering bleb. METHODS: A prospective and non-comparative study was undertaken in 60 consecutive eyes of 44 patients having a functional filtering bleb for chronic angle closure glaucoma and undergoing cataract surgery. Only those cases who had intraocular pressure 0.05 using paired t-test). The central anterior chamber depth was statistically significant (P = 0.002) when preoperative (1.90 +/- 1.27 mm) was compared to postoperative at 6 months (2.11 +/- 1.27 mm). CONCLUSION: Phacoemulsification in eyes with a functional filtering bleb for chronic angle closure glaucoma is challenging. However, with slight modifications in technique, it can be accomplished without compromising the functioning of the bleb.

Capsulorhexis↗
PubMed2003

Randomized clinical trial of the efficacy and safety of tropicamide and phenylephrine in preoperative mydriasis for phacoemulsification.

PURPOSE: To compare the mydriatic effect and safety between different concentrations of tropicamide and phenyle-phrine in preoperative mydriasis for phaco-emulsification. METHODS: Two hundred and seventeen consecutive eyes in the same number of Chinese patients undergoing phaco-emulsification under local or topical anaesthesia in a university-based eye hospital were analyzed. Patients were randomized into two groups by cluster randomization, each group receiving a different preoperative mydriatic regimen. Regimen A consisted of tropicamide 1.0% with phenylephrine 2.5%, and Regimen B consisted of tropicamide 0.5% with phenylephrine 0.5%. The main outcome measures were horizontal pupillary diameter, systolic, diastolic and pulse pressure and pulse rate. RESULTS: The group who received Regimen A attained a mean horizontal pupillary diameter of 7.00 +/- 1.06 mm. Their pupils were significantly larger than those receiving Regimen B (6.61 +/- 1.03 mm, P = 0.007). No untoward cardiovascular effects were noted in either groups. CONCLUSION: Regimen A attained better preoperative mydriasis for phacoemulsification than Regimen B. Both regimens were safe with regard to their cardiovascular effects. The combination of tropicamide 1.0% and phenylephrine 2.5% is recommended as preoperative mydriatic for phacoemulsification in Chinese patients who have darkly pigmented irides.

Aged↗
PubMed2001

Phacoemulsification in a clouded leopard (Neofelis nebulosa).

Phacoemulsification and prophylactic retinopexy were performed on a 3-month-old hand-raised clouded leopard with a unilateral mature cataract. The same procedures were repeated 3 months later when a cataract developed in the fellow eye. Examination procedures, anesthetic protocols, and surgical techniques were similar to those utilized in domestic cats. The patient retains highly functional aphakic vision at the present age of 2.5 years. An inherited basis for the cataracts is proposed. Although the cub was hand raised, the cataracts were unlike nutritional cataracts reported previously in domestic cats and dogs. To the author's knowledge this is the first report of cataract formation and phacoemulsification in a clouded leopard.

Animals↗
PubMed2001

[Effect of duration of phacoemulsification on postoperative inflammation--a retrospective study].

BACKGROUND: The early postoperative inflammation after cataract surgery is mainly caused by surgical trauma. PATIENTS AND METHODS: 450 data-sheets of patients, who were operated for senile cataract with small-incision phacoemulsification and in-the-bag implantation of a foldable intraocular lens were retrospectively analysed. Postoperative inflammation was evaluated with the Laser Flare-Cell Meter Kowa FC-1000 on day 1, 3, 7 and 28. All the operations were done with the same phacomachine model Orbit Oertli. The absolute phacotime was measured, the data classified in steps of 20 seconds. Statistical analysis was made with the student's t-test. RESULTS: In the first postoperative week there is a statistical significant difference in the flare-values between the groups with short phacotime (up to 39 seconds) and the group with long phacotimes (over 80 seconds). One month after operation this significance was absent. CONCLUSIONS: The early postoperative inflammation is influenced by the duration of phacoemulsification. Surgical techniques and phacomachines that may reduce phacotime are helpful with respect to early postoperative inflammation.

Aged↗
PubMed1998

[Intra-chamber lidocaine in addition to tetracaine eyedrop anesthesia in clear cornea phacoemulsification].

BACKGROUND: We have been successfully using topical tetracaine 1% anesthesia in clear corneal phacoemulsification since 1992. Adding intracameral lidocaine to topical anesthesia in cataract surgery has been reported since 1996. PATIENTS AND METHODS: We examined the effectiveness of intracameral lidocaine 1%, which we dyed with methylene blue 2% in 600 cases. During surgery we merely inject 0.3 ccl lidocaine 1% twice over the iris under a shield of a viscoelastic substance. After only a few seconds time of action we remove it again from the anterior chamber. RESULTS: With intracameral lidocaine 1% postoperative pain was totally eliminated for one to two hours, and usually no pain was felt thereafter. Non of our cases showed any negative signs of postoperative reaction of the eye. With the use of intracameral lidocaine we were able to omit pre- and postoperative systemic pain medication completely. This has proven to be very advantageous in elderly outpatients. Staining the lidocaine with methylene blue 2% helps prevent mixups and emphasizes its significance. Yet, an intracameral blue flow was not visible enough to determine the spread of lidocaine. CONCLUSIONS: Intracameral lidocaine represents an ideal addition to topical tetracaine anesthesia in clear corneal phacoemulsification.

Aged↗
PubMed1997

[Development of corneal sensitivity after phacoemulsification with scleral tunnel incision].

BACKGROUND: after anterior segment surgery the anatomical structures and in particular corneal metabolism and corneal trophic are reduced. The corneal wound healing might be monitored by measuring corneal sensitivity. MATERIAL AND METHOD: In a prospective study of 1 year corneal sensation of 26 patients, age = 72.49 +/- 11.09 years, after phacoemulsification with scleral tunnel is examined. Corneal sensitivity is measured with the Draeger aesthesiometer in the corneal center, in the 6 o'clock and 12 o'clock position before and 4 weeks, 4 months and 1 year after the operation. RESULTS: The preoperative corneal sensitivity thresholds before the operation are with 11.61 +/- 10.49 x 10(-5) N in the 12 o'clock position, in the center with 2.43 +/- 2.57 x 10(-5) N and in the 6 o'clock position with 11.86 +/0 10.37 x 10(-5) N normal. Even 1 year after surgery corneal sensitivity is markedly reduced with 257.08 +/- 306.71 x 10(-5) N, 107.77 +/- 246.76 x 10(-5) N and 82.81 +/- 140.77 x 10(-5) N in the 6 o'clock position. CONCLUSION: Even 1 year after phacoemulsification corneal sensitivity is definitely hyposensitive in the center and descretely hypotensitive in the periphery at the 6 o'clock.

Adult↗
PubMed1996

[Phacoemulsification and clear cornea incision: review of 100 initial cases].

AIM: Evaluation of complications during the learning period of phacoemulsifications with clear-corneal incision. PATIENTS AND METHODS: Retrospective study of the 100 first cases with a follow-up of 3 to 24 months. RESULTS: During operation, 5 (5%) cases (one 180 degrees dialysis, 4 broken posterior capsules) presented with a significant complication needing anterior vitrectomy. Eight corneal tunnels were sutured at the end of surgery and 3 others a few days later. No case showed signs of intraocular infection. Cystoid macular edema developed in 4 patients who all recovered good visual acuity. Excessive fibrosis of anterior capsule with capsulorhexis contraction was encountered in 2 cases harbouring plate haptic silicone lenses and needed YAG-laser treatment. None of the eyes with complications had visual acuity inferior to 0.6, except for 2 eyes which had preoperative macular diseases. CONCLUSION: This study demonstrates that phacoemulsification with clear cornea incision is a safe procedure, provided that the complications related to the learning period are set apart. None of the complications encountered in our 100 first cases severely prejudiced the functional results.

Adult↗
PubMed2001

Outcome of vitrectomy for retained lens fragments after phacoemulsification.

PURPOSE: To evaluate the incidence of complications and the visual outcome of pars plana vitrectomy in patients with retained lens fragments in the vitreous cavity after phacoemulsification. METHODS: A retrospective chart review of 85 patients who underwent vitrectomy for removal of retained lens fragments at the Barnes Retinal Institute/Washington University Medical Center between 1990 and 1998. RESULTS: At the time of presentation, uveitis (n = 57, 67.1%), increased intraocular pressure >25 mmHg (n = 44, 51.8%), and corneal edema (n = 42, 49.4%) were frequently observed. The initial visual acuity was 20/200 or worse in 61 (71.8%) eyes. However, the final visual acuity after vitrectomy, with 10.1 months follow-up, was 20/40 or better in 44 (51.8%) eyes. The major complication observed was retinal detachment, which was present in seven (8.2%) eyes: four before vitrectomy and three after vitrectomy. Visual outcome after vitrectomy and cataract extraction was compared among three groups based on the timing of the second surgery: < or =7 days postcataract extraction; 8-30 days postcataract extraction; and >30 days postcataract extraction. No statistically significant difference in final visual acuity was observed between the three intervals. CONCLUSIONS: The major complication associated with vitrectomy for retained lens fragments in the vitreous cavity after phacoemulsification was retinal detachment. The timing of vitrectomy did not affect the final visual acuity outcome. Visual prognosis was most closely related to the presence of age-related macular degeneration and cystoid macular edema. The type of intraocular lens did not influence the visual outcome. Management with vitrectomy yielded favorable visual results in most patients with retained lens fragments.

Aged↗
PubMed2006

Evaluation of 0.4% ketorolac tromethamine ophthalmic solution versus 0.5% ketorolac tromethamine ophthalmic solution after phacoemulsification and intraocular lens implantation.

PURPOSE: The aim of this study was to compare the effectiveness and patient tolerance of 0.4% ketorolac tromethamine ophthalmic solution and 0.5% ketorolac tromethamine ophthalmic solution after routine phacoemulsification and lens implantation. SETTING: The setting for this study was the Storm Eye Institute and Magill Research Center for Vision Correction, Medical University of South Carolina (Charleston, SC). METHODS: This work was a prospective, double-masked study that included 40 eyes of 40 patients randomly assigned to receive topical treatment with 0.4% ketorolac or 0.5% ketorolac, starting 15 min prior to routine phacoemulsification and foldable posterior chamber intraocular lens implantation. Following the procedure, patients were instructed to use the assigned treatment agent 4 times a day after surgery for 1 week and twice a day for 3 weeks, when drops were discontinued. Slit-lamp examination, intraocular pressure (IOP), laser cell and flare measurements, and subjective patient tolerance were evaluated postoperatively at 1, 7, and 30 d. Comparisons between the 2 groups were made at each visit, as well as comparisons to baseline. A P=value less than .05 was considered statistically significant. RESULTS: At day 1, a higher percentage of patients (70% vs. 40%) reported symptoms (mainly foreign body sensation and stinging/burning) in the 0.5% ketorolac group, compared to the 0.4% ketorolac group. No significant differences were found between the 2 groups over time regarding best-corrected visual acuity (BCVA), IOP, slit-lamp assessment of cells, and cell and flare measured using the laser cell/flare meter. CONCLUSIONS: Treatment with 0.4% ketorolac tromethamine ophthalmic solution is as effective as 0.5% ketorolac tromethamine ophthalmic solution in reducing inflammation after routine cataract surgery. Patients reported less discomfort using 0.4% ketorolac.

Aged↗