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PubMed1997

A triple procedure: phacoemulsification, intraocular lens implantation, and scleral buckling surgery.

BACKGROUND: To report the technique and results of simultaneous surgery for cataract and retinal detachment. METHODS: This retrospective study covered 452 cases of phakic detachment. Dense cataract was present in 15 cases that did not need intravitreal surgery. For these, a triple procedure involving phacoemulsification, posterior chamber lens insertion, and scleral buckling surgery was performed. Combined cataract and scleral buckling surgery was carried out after the failure of initial detachment surgery in four cases, including scleral buckling in three and vitrectomy in one. RESULTS: A clear intraoperative view of the fundus was obtained in all cases and retinal breaks were identified in 13. The retina was reattached by combined surgery in 13 cases (87%) and a final acuity of 20/40 or better was attained in 7 of these 13 reattached cases (54%). There was no instance of visual imbalance due to gross miscalculation of intraocular lens power. CONCLUSION: Combined cataract and scleral buckling surgery spares the patient repeat surgery and may improve the outcome by avoiding delay for detachment repair. To perform this procedure, however, vitreoretinal surgeons must be familiar with phacoemulsification techniques.

Adult↗
PubMed2002

Phacoemulsification combined with silicone oil removal through the posterior capsulorhexis tear.

PURPOSE: To evaluate phacoemulsification combined with silicone oil removal through the posterior capsulorhexis tear. METHOD: The records of 20 patients with cataract after silicone oil repair of retinal detachment with giant retinal tear or complicated by proliferative vitreoretinopathy were reviewed. All eyes underwent phacoemulsification, posterior capsulorhexis, aspiration of silicone oil with an irrigation-aspiration hand piece, and intraocular lens implantation into the capsular bag. Lens calculation was based on the fellow eye. The mean follow-up period after cataract surgery was 15.4 months. RESULTS: There were three recurrences of retinal detachment (15%). Transient corneal edema was noted in two eyes. Unpredictable refraction was the main problem, but the myopic refractive error was <4.5 diopters in all cases. CONCLUSION: Cataract extraction combined with silicone oil removal is an effective technique.

Adolescent↗
PubMed2005

New phacoemulsification technology.

PURPOSE OF REVIEW: Familiarization with each of the manufacturers' latest machines and upgrades assists in understanding the advances made in phacoemulsification technology. RECENT FINDINGS: Improvements in the delivery of energy through power modulations, alternative and adjunctive energy sources, and advanced fluidics allow the safe use of bimanual microincision techniques for lens extraction. SUMMARY: Continual advances in phacoemulsification technology and adjunctive surgical devices allow cataract surgery to be performed more safely and efficiently.

Humans↗
PubMed2001

Intraocular pressure and medication control after clear corneal phacoemulsification and AcrySof posterior chamber intraocular lens implantation in patients with filtering blebs.

PURPOSE: To determine whether clear corneal phacoemulsification and the implantation of a copolymer acrylic (AcrySof, Alcon, Fort Worth, TX) intraocular lens will maintain the intraocular pressure (IOP) and number of medications in patients with a previous filtering bleb. PATIENTS AND METHODS: This retrospective analysis included 69 consecutive patients with previous trabeculectomy who had a copolymer acrylic intraocular lens implanted during cataract surgery between 1995 and 1999 by a single surgeon (A.C.S.C.). RESULTS: Mean IOP significantly decreased from 26.03 mm Hg (range, 14.5-70 mm Hg; n = 69) before trabeculectomy to 13.58 +/- 3.98 mm Hg (range, 5-24 mm Hg; n = 69) before the cataract extraction. After cataract extraction, the mean IOP increased significantly by 1.49 mm Hg (n = 67; P = 0.0013), by 1.85 mm Hg (n = 57; P = 0.0005), and by 1.01 mm Hg (n = 67; P = 0.042) after 6 months, after 1 year, and at the patient's last appointment, respectively. When patients whose pressures were purposely increased during cataract surgery were not included (n = 5), the mean increase at the last appointment was not significantly increased (0.54 mm Hg; n = 62; P = 0.25). The average number of antiglaucoma medications decreased from 2.93 (range, 1-5; n = 69) before trabeculectomy to 0.36 (range, 0-2; n = 69) before cataract surgery. This mean decreased to 0.34 (range, 0-2; n = 67; P = 0.8366) 6 months after cataract surgery and increased to 0.49 (range, 0-3; n = 57; P = 0.1029) and 0.62 (range, 0-3; n = 67; P = 0.0006) after 1 year and at the last appointment, respectively. Of the total study population, two (2.9%) patients required additional glaucoma surgery and 14 (20.3%) patients required additional antiglaucoma medications as compared with their precataract levels. CONCLUSIONS: Clear corneal phacoemulsification and the implantation of a copolymer acrylic (AcrySof, Alcon) posterior chamber intraocular lens statistically increased the number of medications and IOP of patients in our study. These increases, although statistically significant, did not cause a clinically significant deterioration in IOP control.

Acrylates↗
PubMed2003

Comparison between phacoemulsification and the Blumenthal technique of manual small-incision cataract surgery combined with trabeculectomy.

OBJECTIVE: To compare results of filtration combined with either phacoemulsification or the Blumenthal technique of manual small-incision cataract surgery. MATERIALS AND METHODS: Records of glaucoma "triple" operations from March 1997 to May 2000 were reviewed. Seventy-eight eyes (70 patients) that underwent phaco-triple were compared with 86 eyes (80 patients) that underwent the Blumenthal technique of manual small-incision cataract surgery combined with filtration (Blumenthal triple). Three minutes of 0.4 mgs/ml Mitomycin was used in all eyes. Posterior chamber IOLs were implanted through 5.5-mm incisions in both groups. Outcome measures were intraocular pressure (IOP) reduction and achievement of target IOP. Fourteen patients who underwent phacoemulsification-triple in one eye and Blumenthal triple in the other eye were also evaluated separately. RESULTS: The minimum follow-up period was 6 months (range 6-30 months). At last follow-up review, mean reduction in IOP was 17.7 mm Hg (+/- 9.3 mm Hg) in the phaco group and 17.1 mm Hg (+/- 10 mm Hg) in the Blumenthal group. At last visit, target IOP was achieved in 75.6% of the phaco group and 73% of the Blumenthal group. There was no significant difference between groups in IOP reduction or achievement of target IOP. In the 14 patients who had undergone phaco-triple in one eye and Blumenthal-triple in the other, there was no inter-eye difference in IOP reduction. CONCLUSIONS: In this small retrospective study we could not demonstrate a difference in IOP outcomes between the two procedures.

Cataract Extraction↗
PubMed2005

Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure.

PURPOSE: To evaluate the effectiveness of phacoemulsification and goniosynechialysis (PEGS) in managing acute and subacute primary angle closure unresponsive to conventional therapy. MATERIALS AND METHODS: Retrospective series of patients of six glaucoma-trained surgeons with primary angle closure that did not respond to medical management, Nd:YAG laser peripheral iridotomy, or argon laser peripheral iridoplasty. RESULTS: A total of twenty-one patients with an average age of 65.6 years were included. Underlying mechanism of angle closure included pupillary block (n = 18) and plateau iris (n = 3). Average intraocular pressure (IOP) immediately prior to PEGS was 40.7 mm Hg, and mean follow-up time after PEGS was 11.7 months. PEGS decreased mean IOP by 25 mm Hg (62%), and mean number of medications from 3.8 pre-surgery to 1.7 post-surgery (55%). Mean LogMar visual acuity improved after PEGS, from 0.64 to 0.44 (Paired t test t = 4.120 P = 0.001). Subsequent trabeculectomy was necessary in one case (5%). CONCLUSIONS: Phacoemulsification with goniosynechialysis may be an effective treatment option for primary angle closure unresponsive to conventional therapy.

Aged↗
PubMed2007

Innovations in phacoemulsification technology.

PURPOSE OF REVIEW: A working knowledge of the principles guiding recent technologic upgrades in phacoemulsification units will help the surgeon to maximize clinical benefits from the latest machines. RECENT FINDINGS: Reduced thermal energy combined with more efficient emulsification resulting from microfractionation of ultrasound energy, and improved chamber stability from automatic fluidic adjustments are achievable with the recent technological advances. SUMMARY: Improved safety and efficiency can be achieved with the most current advances in phacoemulsification technology.

Equipment Design↗
PubMed2006

Presumed herpetic endotheliitis following phacoemulsification surgery.

The authors present an observational case series. Three cases of presumed herpetic endotheliitis presented as cases of pseudophakic bullous keratopathy many years after successful phacoemulsification surgery. All patients had reduction of vision in the involved eye, corneal oedema and secondary glaucoma. The patients were treated with medical therapy consisting of topical corticosteroids, antiviral and antiglaucoma drugs. Resolution of corneal oedema, control of glaucoma and restoration of visual acuity were achieved in all cases. Specular microscopy performed thereafter demonstrated relatively normal endothelial cell counts. The authors conclude that pseudophakic bullous keratopathy occurring after phacoemulsification surgery may be caused by herpetic endotheliitis.

Aged↗
PubMedDate not supplied

The incidence of posterior capsule disruption during phacoemulsification and associated postoperative complication rates in dogs: 244 eyes (1995-2002).

OBJECTIVE: The objective of this retrospective study was to report the incidence of posterior capsule disruption during routine phacoemulsification and to document the postoperative outcomes and complications in eyes with posterior capsule disruption compared with eyes with intact posterior capsules. PROCEDURES: Records of 143 dogs (244 eyes) were reviewed. Data collected included whether the posterior capsule was disrupted, whether the disruption was planned or accidental, whether an intraocular lens was implanted, and visual outcome. Records were reviewed for postoperative complications. Intraocular lens implantation rates, complication rates, and visual outcomes were compared between intact and disrupted posterior capsule groups using Chi-square analyses. RESULTS: The posterior capsule was disrupted in 33/244 eyes (14%). Planned capsulotomies accounted for 36% of the disruptions. Intraocular lenses were implanted in 76% of eyes without a disruption of the posterior capsule and in 31% of eyes with a posterior capsule disruption. Intraocular lenses were more likely to be implanted in eyes with a planned disruption of the posterior capsule (7/12; 58%) than in eyes with an accidental disruption (3/20; 15%). There were no significant differences in postoperative complications or visual outcome between eyes with posterior capsule disruption and those without. CONCLUSIONS: The most significant complication of posterior capsule disruption during phacoemulsification is the inability to implant an intraocular lens. Intraocular lenses are more likely to be placed in eyes with intentional disruptions of the posterior capsule than those with accidental ruptures.

Animals↗
PubMed1996

Prognostic factors in long-term intraocular pressure control following combined phacoemulsification and trabeculectomy.

We studied 36 consecutive patients who underwent combined phacoemulsification and trabeculectomy to determine prognostic factors associated with intraocular pressure control one year postoperatively. In patients who were either easier (intraocular pressure < 16 mmHg, n = 19) or more difficult (> or = 16 mmHg, n = 17) to control, the mean intraocular pressure increased up to the fourth week postoperatively. In the more difficult to control group, however, the intraocular pressure continued to increase and a statistical difference between groups was noted by the second month postoperatively (P < 0.05). The peak intraocular pressure within the first month postoperatively was lower in patients easier to control long-term (P < 0.005). No statistical difference between groups in the filtering bleb or anterior chamber appearance, or postoperative complications, was noted (P > 0.05). This study suggests combined trabeculectomy and phacoemulsification is safe and effective in controlling intraocular pressure postoperatively. Determining from the early postoperative examination the long-term pressure control, however, is difficult.

Aged↗
PubMed1997

Temporal corneal phacoemulsification combined with separate-incision superior trabeculectomy vs standard phacotrabeculectomy. A comparative study.

The aim of the study was to compare functional and refractive outcome after temporal approach phacoemulsification combined with superior trabeculectomy against that of standard superior phacotrabeculectomy in patients affected by cataract and uncontrolled glaucoma. Fifty patients undergoing combined surgery were randomly allocated to receive either a standard superior phacotrabeculectomy (group A) or a temporal via clear cornea phacoemulsification combined with a separate superior trabeculectomy (group B). Short-term and long-term mean IOP reductions were similar in the two groups though, at 2 years, more patients in the standard phacotrabeculectomy group had need of medical therapy to control their ocular pressure (p = 0.04). Group B had less surgically induced astigmatism than group A (p = 0.05). There was no significant difference in ocular inflammation and complication rates between the 2 groups.

Adult↗
PubMed2004

Evaluation of surgical performance with intracameral mydriatics in phacoemulsification surgery.

PURPOSE: To evaluate surgical performance using intracameral mydriatics (ICM) in phacoemulsification surgery in a series of consecutive cases. METHODS: In a series of 198 consecutive procedures 50-200 microl of cyclopentolate 0.1%, phenylephrine 1.5% and lidocaine 1% was given intracamerally for mydriasis and anaesthesia. The previous 198 cases, dilated with topical mydriatics, were studied for comparison. Several pre- intra- and postoperative parameters were registered, and the subjective surgical performance was graded after each procedure. In 41 consecutive cases, the change in pulse and oxygen saturation induced by the ICM injection was registered. RESULTS: No increase in operation time or complication rates was seen with ICM, compared to when standard topical mydriatics were used. The subjective surgical performance was ranked as equally good for both groups. CONCLUSION: From this clinical evaluation, our impression is that ICM performs well in routine phacoemulsification surgery.

Aged↗
PubMed2006

Inert intraocular eyelash foreign body following phacoemulsification cataract surgery.

INTRODUCTION: We describe the first reported case of tolerated eyelash inoculation following phacoemulsification surgery, with 4 years follow-up, that did not result in endophthalmitis or low grade chronic uveitis. CASE REPORT: A 79-year-old man with bilateral cataracts underwent phacoemulsification and posterior chamber intraocular lens implantation in the right eye. Three months later, he was found to have an eyelash within the right anterior chamber. The patient opted to leave his asymptomatic right eye alone. Four years later, he was referred to our hospital for review of his intraocular foreign body. He had remained asymptomatic with bilateral 6/6 vision, and without pain, photophobia or monocular diplopia. He declined surgery to remove the foreign body and opted for annual review. DISCUSSION: Intraocular implantation of cilia is a rare surgical complication following cataract surgery. The reaction of the eye to cilia has been reported to be variable and unpredictable, varying from absolute lack of reaction to endophthalmitis. Careful preoperative preparation can prevent similar incidents with potential complications. The position of the cilium is an important consideration. In contrast to other organic materials, a cilium is relatively inert and is rarely associated with infection. Acute inflammation most commonly occurs within days or after a few months, although the eye can tolerate the cilium for many years. Some ophthalmologists prefer observation, particularly when there is no inflammation present. We believe that each patient should be considered on an individual basis. The decision to remove an intraocular eyelash remains controversial and should be considered at the onset of inflammatory or infective clinical signs.

Aged↗
PubMed2006

The safety and efficacy of combined phacoemulsification and trabeculectomy with releasable sutures.

AIM: To evaluate the combined phacoemulsification with acrylic intraocular lens implantation and trabeculectomy with releasable sutures, without the use of antimetabolites, performed by one surgeon. METHODS: A retrospective analysis was performed on 251 eyes of 198 patients after a combined phaco/trabeculectomy procedure, followed up for an average of 16 months for vision, intraocular pressure (IOP), and number of glaucoma medications. Cox proportional hazard regression analysis provided measures of relative risk (RR) or hazards ratios and 95% confidence intervals (CIs) associated with the occurrence of several conditions or complications of surgery. RESULTS: Mean preoperative variables were best corrected vision, 0.6 (SD 0.4) logMAR (20/80 Snellen); IOP, 18.7 (4.9) mm Hg; and number of glaucoma medications, 1.7 (0.8). Mean postoperative results were best corrected vision, 0.2 (0.4) logMAR (20/32 Snellen); IOP, 15.1 (3.2) mm Hg; and number of glaucoma medications, 0.3 (0.6). Postoperatively, the mean decreases from baseline were 19.2% for IOP and 84.1% for number of glaucoma medications; 85% of eyes required fewer glaucoma medications and 78% of eyes were medication free, with IOP control. There were no significant operative or postoperative complications. CONCLUSION: Combined phacoemulsification and trabeculectomy with releasable sutures, in the absence of antimetabolites, is a safe, effective, and stable alternative for patients with cataracts and glaucoma.

Aged↗
PubMed2006

Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study.

AIM: To determine the long term intraocular pressure (IOP) response to phacoemulsification in patients with and without exfoliation syndrome (XFS). METHODS: Prospective, multicentre, cohort study with the following inclusion criteria: age over 50 years, open iridocorneal angle, and cataract. Two groups were enrolled: those with XFS and those without. The main outcome was mean IOP reduction 2 years after phacoemulsification cataract extraction (PCE). Univariate and multivariate analyses were performed. RESULTS: 183 patients were enrolled, 71 with and 112 without XFS. There were 29 patients with glaucoma in both groups. Mean baseline IOP was higher in XFS compared to control eyes (17.60 (SD 3.23) mm Hg v 16.08 (3.18) mm Hg, p = 0.002). Overall IOP reduction was significantly greater in the XFS group at the 2 year time point (-1.85 mm Hg v -0.62 mm Hg in the controls (p = 0.0037)). Multivariate analysis demonstrated that the IOP lowering effect in the XFS group may be related to irrigation volume at the time of surgery. In the subgroup analyses IOP lowering was significantly greater in the XFS and XFG patients than in controls without glaucoma, and POAG controls, respectively. The percentage of patients with a postoperative IOP spike was similar and relatively high in both XFS and control groups (34% v 25%; p = 0.54). CONCLUSION: IOP decreases more in patients with XFS following PCE compared to control eyes without XFS. This effect is more pronounced in glaucoma patients and persists for at least 2 years.

Aged↗
PubMed2007

Outcome of phacoemulsification in patients with uveitis.

AIMS: To examine the visual outcome and identify risk factors for postoperative uveitis, macular oedema and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy after phacoemulsification and intraocular lens (IOL) implantation in patients with uveitis. METHOD: This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, keratouveitis and lymphoma-associated uveitis were excluded. RESULTS: At the first postoperative and final visits, visual acuity was significantly better (p<0.001), and 64.4% and 71.3% of patients, respectively, had achieved >or=2 Snellen's lines of visual improvement. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow-up, and this occurred at a higher rate in the presence of preoperative retinal or optic nerve lesions (HR (95% CI) 4.49 (1.41 to 14.29)). Within 3 months after operation, uveitis was more likely to develop in female patients (OR (95% CI) 6.21 (1.41 to 27.43)) and in the presence of significant intraoperative posterior synechiae (OR (95% CI) 8.43 (1.09 to 65.41)); macular oedema was more likely to develop in patients who developed postoperative uveitis (OR (95% CI) 7.45 (1.63 to 34.16)). Nd:YAG capsulotomy occurred at a higher rate in patients aged <or=55 years (HR (95% CI) 2.28 (1.06, 4.93)) and in those with hydrogel IOLs (HR (95% CI) 3.71 (1.04 to 13.20)), and occurred at a lower rate in patients who had prophylactic systemic corticosteroids (HR (95% CI) 0.25 (0.11 to 0.59)), with plate-haptic silicone IOLs (HR (95% CI) 0.23 (0.08 to 0.64)) and three-piece silicone IOLs (HR (95% CI) 0.19 (0.05 to 0.74)) in comparison to those with polymethylmethacrylate IOLs. CONCLUSION: Most patients with uveitis achieve improved visual acuity after phacoemulsification, but an increasing rate of visual loss is observed in those with pre-existent macular or optic nerve lesions. Identifying patients who are at risk of postoperative complications should help in patient counselling and to pre-empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.

Adolescent↗
PubMed1995

Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: effect of prophylactic medication, wound closure, and surgeon's experience.

AIMS: A prospective clinical trial was carried out to evaluate the effect of prophylactic medication, the technique of wound closure, and the surgeon's experience on the intraocular pressure rise after cataract extraction. METHODS: In 100 eyes, the intraocular pressure was measured before as well as 2-4, 5-7, and 22-24 hours after phacoemulsification and posterior chamber lens implantation. Each of 25 patients received either 1% topical apraclonidine, 0.5% topical levobunolol, 500 mg oral acetazolamide, or placebo. Forty four eyes were operated with sclerocorneal sutureless tunnel and 56 eyes with corneoscleral incision and suture. Sixty three operations were performed by experienced surgeons (more than 300 intraocular operations) and 37 by inexperienced surgeons (less than 200 intraocular operations). RESULTS: The pressure increase from baseline to the maximum 5-7 hours after surgery did not differ significantly (p = 0.8499) for apraclonidine (9.5 mm Hg), levobunolol (7.2 mm Hg), acetazolamide (7.8 mm Hg), and placebo (8.6 mm Hg). The increase was significantly (p = 0.0095) lower in eyes with corneoscleral tunnel (5.5 mm Hg) than in eyes with corneoscleral suture (10.5 mm Hg) and significantly (p = 0.0156) lower for experienced (6.6 mm Hg) than for inexperienced surgeons (11.2 mm Hg). CONCLUSIONS: The intraocular pressure rise after phacoemulsification and posterior chamber lens implantation depends strongly on the technique of wound closure and the surgeon's experience. Compared with these two factors, the effect of prophylactic medication can be neglected.

Acetazolamide↗
PubMed1996

First day follow up for routine phacoemulsification?

AIMS: To determine the postoperative morbidity on day 1 after uncomplicated phacoemulsification. METHODS: A prospective study was performed on 100 otherwise healthy eyes after uncomplicated phacoemulsification and lens implant. Patients were examined on the first postoperative day and any deviation from a set postoperative protocol was recorded. RESULTS: Transient intraocular pressure rises of 30 mm Hg or greater were seen in three eyes. These all settled after a single dose of oral acetazolamide 250 mg. CONCLUSIONS: The results of this study reinforce the clinical impression that the need for day 1 routine follow up in this selected group of patients is questionable and probably unnecessary.

Acetazolamide↗