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PubMed1997

Conventional routine clinical review may not be necessary after uncomplicated phacoemulsification.

AIM: To determine the clinical intervention rate during routine review after uncomplicated phacoemulsification. METHODS: A review of case notes in 651 consecutive cases of uncomplicated phacoemulsification from 1994 (< or = 5.5 mm self sealing wound) was performed. The intervention rate at scheduled routine review visits and at unscheduled visits to the eye casualty service in the first 120 postoperative days was recorded. Interventions were defined as departures from predetermined postoperative care protocols. RESULTS: Clinical interventions were reported in 2.8% (95% confidence interval 1.5 to 4.1%) of (n = 1652) routine follow up visits. Many of these interventions were avoidable or trivial; 90% of patients had no postoperative intervention at any visit. 7.3% of patients made unscheduled visits to the emergency service. The intervention rate in this group was 50% (35.9 to 64.1%). CONCLUSIONS: The intervention rate in routine clinical review after uncomplicated modern cataract surgery is low. Alternatives to conventional postoperative review, including shared care with non-ophthalmologists and improved perioperative patient education with an open channel for self referral, should be evaluated.

Adult↗
PubMed1999

Visual outcome after phacoemulsification and IOL implantation in diabetic patients.

AIMS: To follow visual acuity (VA) and progression of diabetic retinopathy (DR) after phacoemulsification in diabetic patients with different stages of DR and controls. METHODS: This prospective study included 27 diabetic patients with no or mild to moderate non-proliferative DR; 25 patients with moderate to severe non-proliferative, or proliferative DR; and 22 non-diabetic controls. All patients underwent uncomplicated, phacoemulsification surgery, with implantation of a heparin-surface modified (HSM) poly(methylmethacrylate) (PMMA) intraocular lens (IOL) into the capsular bag. Colour fundus photographs and fluorescein angiograms (FA) were taken at 1 week (baseline), 3 months, and 1 year postoperatively to determine stability or progression of DR. RESULTS: The VA of 46 diabetic eyes (88%), was improved 1 year after surgery and only six eyes (12%) were unchanged or worse. 41 diabetic eyes (79%) achieved a VA of 0.5 or better and 11 eyes (21%) had a final VA lower than 0.5. Significantly lower final corrected VA was found 1 year after surgery in eyes with advanced DR (median 0.5; range 0.1-1.0) compared with controls (1.0; 0.1-1.0) and eyes with no or mild to moderate DR (1.0; 0.1-1.0). Eyes with mild to moderate DR and clinically significant macular oedema (CSMO) 1 week postoperatively had a lower final VA than those without CSMO. Angiographic cystoid macular oedema (CMO) was detected with FA in 15% of all diabetic eyes 1 week postoperatively. 41 eyes (79%) showed no change or improvement of the retinal status 1 year after cataract surgery. Progression was found in 11 eyes (21%), mainly in eyes with mild to moderate DR and moderate to severe DR. Eyes with an indication for laser photocoagulation at baseline showed a significantly higher rate of progression of DR after surgery than those without indication for laser treatment. CONCLUSION: The final visual outcome was improved in the majority of diabetic eyes. Eyes with CSMO at the time of surgery had the worst prognosis regarding postoperative VA.

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PubMed1998

Intraocular pressure changes after phacoemulsification and foldable silicone lens implantation using Healon GV.

The authors studied the intraocular pressure (IOP) changes after phacoemulsification with two different kinds of foldable silicone lens implantation using Healon GV as viscoelastic substance. One hundred patients undergoing cataract surgery were enrolled in this study. Inclusion criteria were: absence of ocular hypertension or glaucoma. Patients were randomly assigned to plate haptic (Silens PH, Domilens Chiron Vision, Lyon, France) or three-piece (CeeOntrade mark& ;920, Pharmacia spa, Milano, Italia) silicone intraocular lens (IOL) implantation. Following phacoemulsification and cortical aspiration, the capsular bag was reinflated with Healon GV. After foldable silicone IOL insertion residual Healon GV was removed from the anterior chamber. IOP was measured preoperatively and at 6, 24 h and 1 week postoperatively. Six hours postoperatively IOP was higher in the Silens PH group than in the CeeOn group (20. 85+/-5.42 vs. 18.88+/-2.95 mm Hg, p= 0.026). The difference was confirmed after 24 h (21.02+/-5.18 vs. 17.34+/-3.18 mm Hg, p < 0.01). Despite the medical treatment (acetazolamide 250 mg orally every 6 h), at the 24-hour control 2 eyes with plate haptic silicone lens showed IOP values higher than 30 mm Hg. Slitlamp examination showed in both eyes a shallowing of the anterior chamber together with the evidence of capsular bag hyperdistension and capsular block resulting from the occlusion of the circular anterior capsule opening by the plate haptic IOL. Residual Healon GV removal from the anterior chamber was performed. At 1-week control both eyes showed normalization of IOP. The use of a plate haptic silicone lens may be associated with a more consistent retention of Healon GV in the eye with trapping in the capsular bag. Retained viscoelastic may cause either trabecular meshwork blockage by viscoelastic substance or postoperative capsular bag hyperdistension, anteroplacement of the IOL optic and capsular block from occlusion of the circular anterior opening by the IOL optic.

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PubMedDate not supplied

Phacoemulsification and intraocular lens implantation combined with trabeculotomy for open-angle glaucoma and coexisting cataract.

OBJECTIVE: To study the outcome of phacoemulsification and intraocular lens implantation combined with trabeculotomy. METHODS: We performed trabeculotomy combined with phacoemulsification and foldable lens implantation in 25 eyes with open-angle glaucoma and coexisting cataract in 18 patients. The series comprised 9 males (13 eyes) and 9 females (12 eyes). Mean age of the patients was 73.4 +/- 10.9 years (45-87 years). Mean follow-up period was 14.3 +/- 6.0 months (6-24 months). RESULTS: The preoperative intraocular pressure was 21.4 +/- 3.7 mm Hg. The postoperative intraocular pressure 6 months after the surgery was 12.8 +/- 3.4 mm Hg. A postoperative tension spike (>30 mm Hg) was observed in 2 eyes. Six months after the operation, the intraocular pressure was controlled under 21 mm Hg in all eyes, and under 16 mm Hg in 18 eyes. The medication score (one point per antiglaucomatous medication) was 2.0 +/- 1.6 before the surgery and 0.4 +/- 0.7 after the surgery. The mean refractive error after the operation was -0.8 +/- 0.7 D (range -2.4 to 0 D). The deviation of the actual refractive error from the predicted one was +0.29 +/- 0.54 D (range -0.52 to +1.10 D). CONCLUSION: The outcome of the combined operation for open-angle glaucoma and coexisting cataract was promising.

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PubMedDate not supplied

The nature and origin of intraocular metallic foreign bodies appearing after phacoemulsification.

In order to evaluate the nature and origin of metallic foreign bodies embedded in the iris after uneventful phacoemulsification, we aimed to produce metallic fragments by applying ultrasound power with the same phaco machine and handpiece in an experimental model in vitro. In a glass bottle, we used linear phaco power of 100% continuously for 5 min first with a new phaco tip and then with a used tip. Afterwards, the fluid in the bottle was filtered through a Millipore filter. The remains on the filter were studied by scanning electron microscopy (SEM) and microprobe. Small particles remained on the filter which was used for the new tip. Microprobe microanalysis showed that these particles were mainly titanium, the same as the phaco tip. SEM of both the new and the used tips showed small fragments on the exterior surface and lumen. Intraocular metallic foreign bodies after phacoemulsification are likely to be shaken loose from the phaco tip. Although it is mostly agreed that these fragments are well tolerated, their overall effect remains to be evaluated in the long term.

Eye Foreign Bodies↗
PubMedDate not supplied

Phacoemulsification and intraocular lens implantation for angle closure glaucoma after the relief of pupillary block.

PURPOSE: We studied the surgical outcomes of phacoemulsification and intraocular lens (IOL) implantation for cataract and/or uncontrolled intraocular pressure (IOP) in eyes with angle closure glaucoma. SETTING: Department of Ophthalmology, National Nagasaki Medical Center, Nagasaki, Japan. METHODS: Eighteen eyes from 15 patients after laser iridotomy (17 eyes) or peripheral iridectomy (1 eye) had undergone surgery and were studied. We used an iris retractor in 7 eyes due to insufficient mydriasis and a capsular tension ring in 2 eyes due to phacodonesis during the operation. The patients were followed up for at least 6 months (13.8 +/- 7.2 months; range: 6-36 months). RESULTS: The mean IOP significantly decreased from 17.4 +/- 8.1 to 13.5 +/- 3.3 mm Hg at 6 months after surgery. The IOP was below 21 mm Hg in all eyes. The visual acuity was not worsened in any eyes and became better than 2 Snellen lines in 14 eyes. The corneal endothelial cell count decreased from 2,365 +/- 517 to 1,960 +/- 661/mm2 (18.3 +/- 17.2%). CONCLUSIONS: Phacoemulsification and IOL implantation is useful in IOP control for angle closure glaucoma after relief of pupillary block. However, we should take care of operative complications because of a shallow anterior chamber, poor mydriasis and zonular weakness.

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PubMedDate not supplied

Comparison of tilt and decentration between phacoemulsification and phacotrabeculectomy.

PURPOSE: To determine the extent of intraocular lens (IOL) tilt and decentration values after combined surgery in patients with cataract and glaucoma. MATERIALS AND METHODS: A total of 106 cataractous eyes undergoing IOL implantation were divided into 2 groups. Group 1 comprised 42 eyes undergoing phacotrabeculectomy surgery for cataract and primary open-angle glaucoma (POAG), and group 2 comprised 64 eyes undergoing phacoemulsification surgery for senile cataract. The length of IOL decentration and the angle of IOL tilt were quantitated by using Purkinje reflections and photographic documentation. RESULTS: The differences regarding both the IOL tilt (2.84 +/- 0.37; 2.97 +/- 0.37, respectively) and decentration (0.39 +/- 0.27; 0.49 +/- 0.35, respectively) was insignificant (p > 0.05) between groups. CONCLUSION: There is no increased effect of phacotrabeculectomy on tilt and decentration of IOLs in eyes with POAG when compared with eyes which underwent phacoemulsification surgery.

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PubMed2006

Comparative efficacy of acetazolamide and apraclonidine in the control of intraocular pressure following phacoemulsification.

PURPOSE: The purpose of our study was to compare the effects of systemically administered acetazolamide and topical apraclonidine 0.5% in the control of intraocular pressure (IOP) following phacoemulsification of senile cataracts. SETTING: The study was conducted on patients affected by cataract and followed at the Department of Ophthalmology. METHODS: Seventy-eight eyes in 78 patients were selected. Twenty-six eyes were randomly assigned to postoperative treatment with topical apraclonidine 0.5%, 26 received oral acetazolamide and the remaining 26 received no hypotensive treatment (control group). Statistical analyses were performed mainly by means of analyis of variance. RESULTS: IOPs measured 24 h after surgery were significantly (p = 0.01) lower in the apraclonidine group compared to the control group. CONCLUSIONS: Our double-blind prospective study conducted on patients randomly assigned to treatment with apraclonidine or acetazolamide shows that the former drug is undoubtedly effective in the prevention of IOP increases following phacoemulsification. IOPs recorded in patients treated with this drug were lower than those observed in the acetazolamide and the control groups. Considering the lower risk of toxicity associated with topical administration, apraclonidine 0.5% seems to be preferable to oral acetazolamide in this postoperative setting.

Acetazolamide↗
PubMed1997

Comparison of phacoemulsification and planned extracapsular extraction.

76% of cataract surgeons in German speaking countries use phacoemulsification (phaco) as the procedure of choice for cataract extraction while the other 24% still use the planned extracapsular extraction (ECCE). The opening technique of the anterior capsule is chosen accordingly: for phaco capsulorhexis is preferred, while for ECCE can opener or letter box technique is usually done. The length of the sclerocorneal incision is 3.2 mm in phaco, 6.2 mm for a PMMA posterior chamber lens implantation and 9-13 mm for the ECCE. We prospectively compared both procedures with each group including 100 consecutive patients. The mean irrigation volume was 96.6 +/- 48.8 ml in the phaco group as opposed to 48.1 +/- 26 ml in the ECCE group. The mean duration of irrigation was 130 +/- 67 s in the first versus 129 +/- 76 s in the second group; mean endothelial cell loss was 7.9 versus 7.1%. No correlation was found between endothelial cell loss and duration of irrigation. Mean postoperative astigmatism measured 1.0 +/- 0.49 in the first group as compared to 3.3 +/- 1.7 dpt in the second group. Except for the astigmatism, our study could not detect significant differences regarding the outcome between both procedures. There are advantages to the phacoemulsification procedure, however, such as a smaller incision (e.g. tunnel technique), a closed irrigation-aspiration system, controlled intraocular pressure and the more frequent use of capsulorhexis. Preferred indications are zonulolysis or previously performed fistulating surgery.

Astigmatism↗
PubMedDate not supplied

Lidocaine-assisted xylocaine jelly anesthesia versus one quadrant sub-Tenon infiltration for self-sealing sclerocorneal incision routine phacoemulsification.

PURPOSE: To compare the effect of xylocaine jelly and intracameral lidocaine with one quadrant instant sub-Tenon infiltration for self-sealing sclerocorneal phacoemulsification. METHODS: One hundred patients were enrolled into a prospective randomized study, receiving either a combination of topical 2% xylocaine jelly and 0.5 ml of intracameral 1% lidocaine or sub-Tenon infiltration with 2 ml of 2% xylocaine on the operating table. All patients underwent a standard divide and conquer phacoemulsification procedure through a superior sclerocorneal frown incision followed by implantation of a polymethylmethacrylate intraocular lens. Intraoperative pain was indicated by the patient by squeezing the bedside nurse's hand, who allocated it to particular stages of surgery on a chart. After surgery, patients assessed the pain experienced using a 10-unit visual analogue scale. RESULTS: Pain was indicated on 31 occasions during the operation in the sub-Tenon group (mainly the injection itself) and 67 times in the topical group. The median overall subjective pain score was 3 in the jelly group and 0 in the sub-Tenon. Five eyes (10%) had to be converted to sub-Tenon during the surgery because of intolerable pain. CONCLUSIONS: Whereas lidocaine supported xylocaine jelly anesthesia provided acceptable analgesia for 90% of patients operated, sub-Tenon anesthesia proved to deliver better intraoperative comfort in all patients receiving sclerocorneal incision cataract surgery.

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PubMed2005

[Cost of phacoemulsification in the national campaign of elective cataract surgery in Itápolis, SP, Brazil].

PURPOSE: To determine the average cost of cataract surgery using the phacoemulsification technique with intraocular lens implant (IOL). This study was conducted during a national campaign to treat patients with cataracts promoted by the Brazilian Council of Ophthalmology (CBO) and the Health Ministry in the city of Itápolis-SP from March to December, 2000. METHODS: All expenses related to the surgery were collected (pre-, intra-, and postoperative data) and analyzed. Fifty-eight patients with senile cataracts and without any other ocular findings were submitted to the procedure in a prospective study. RESULTS: The average cost of the surgery in this study was R$ 485.03 or USD 248.05. This value represents the average cost of the surgery itself; in which some materials, equipment, taxes and other services were previously determined and used for this project. CONCLUSION: The phacoemulsification technique for cataract surgery has been used more and more, due to its effectiveness, being an excellent method to treat cataracts. Although this is an excellent technique, the economical aspect does not allow it to be used for part of the population.

Brazil↗
PubMed2005

[Comparative study of the density of corneal endothelial cells after phacoemulsification by the "divide and conquer" and "quick chop" techniques].

PURPOSE: Since one of the most implicated factors in corneal endothelial cell loss after phacoemulsification is the ultrasound time, and that the "quick chop" technique utilizes less ultrasound time, the objective of this study was to compare and analyze the reduction of the central corneal endothelial cell density between the patients submitted to the "divide and conquer" and "quick chop" techniques. METHODS: Fifty-six patients with grade 3 senile cataract were prospectively selected and submitted to endocapsular phacoemulsification by the "divide and conquer" (28 patients, group 1) and "quick chop" (28 patients, group 2) techniques. The non-contact corneal central specular microscopy performed pre- and postoperatively at one month, 3 months and 6 months, and the ultrasound time used for each surgery, were verified. RESULTS: We observed that the "divide and conquer" technique spent an average of 2.0 minutes of ultrasound time and the "quick chop", 1.1 minute; that the reduction of the central corneal endothelial cell density was significant for both techniques in the first postoperative month (16.5% in group 1 and 19.4% in group 2) and that the variations in central corneal endothelial cell density that followed, at the 3rd and 6th month were not significant. There was no statistically significant difference between the variation of the central corneal endothelial cell density that occurred with both techniques (Student's "t" test p=0.334; in the 1st postoperative month). CONCLUSIONS: We concluded that the reduction of central corneal endothelial cell density was not statistically different between the two techniques.

Aged↗
PubMedDate not supplied

[Incidence of posterior capsule opacification in patients submitted to phacoemulsification and expandable acrylic intraocular lens implantation].

PURPOSE: To evaluate prospectively the results of expandable acrylic intraocular lenses in patients submitted to phacoemulsification as regard posterior capsule opacification. METHODS: The study group consisted of 830 patients, 1,200 eyes that underwent phacoemulsification from 1998 to 2002, by the same surgeon, using the same technique but with different diameters of capsulorrhexis, with expandable hydrophilic acrylic intraocular lens implantation. The mean follow-up was 2.4 years, ranging from 6 months to 4 years. RESULTS: The total number of posterior capsule opacification was 54 cases. CONCLUSIONS: The incidence of posterior capsule opacification was 4.6% in these patients.

Acrylic Resins↗
PubMedDate not supplied

[Endothelial damage after planned extracapsular cataract extraction and phacoemulsification of hard cataracts].

PURPOSE: To evaluate and compare the endothelial damage after planned extracapsular cataract extraction (ECCE) and phacoemulsification of very hard cataracts. METHODS: In this prospective, randomized study, 41 patients with age-related and very hard cataract were divided into two groups: in group 1 (21 patients) an extracapsular cataract extraction was performed and in group 2 (20 patients), phacoemulsification. In both groups, intraocular lenses were implanted in the capsular bag. Preoperatively and 1, 3 and 6 months postoperatively, a complete ophthalmological examination, endothelial specular microscopy, and ultrasonic pachymetry were done. Endothelial cell loss, pleomorphism, polymegathism and corneal thickness were studied. RESULTS: Both groups presented an endothelial cell loss in the postoperative time, as compared with the preoperative values, but there were no significant differences among the postoperative values (1, 3 and 6 months). Six months after surgery, mean cell loss was 28.50% in group 1 and 34.77% in group 2. There were no differences among the indexes of pachymetry, polymegathism and pleomorphism between the two groups. CONCLUSIONS: Endothelial response was not statistically different between the two studied groups.

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PubMed2006

Long-term complications after phacoemulsification for cataract removal in dogs: 172 cases (1995-2002).

OBJECTIVE: To determine common postoperative complications and risk factors for development of postoperative glaucoma or failure to preserve vision after phacoemulsification for cataract removal in dogs. Design-Retrospective case series. ANIMALS: 172 dogs (290 eyes) that underwent phacoemulsification surgery for cataract removal. PROCEDURE: Medical records were reviewed for postoperative complications; prevalence rates for each complication were calculated for follow-up periods of 3 months, > 3 to 6 months, > 6 months to 1 year, > 1 to 2 years, > 2 to 3 years, > 3 to 4 years, and > 4 years. Odds ratios for breed, age, sex, cataract hypermaturity, lens-induced uveitis, and diabetes mellitus were determined with respect to glaucoma and failure (ie, blindness, enucleation, or evisceration). RESULTS: The most common complication was mild posterior capsule opacification. Retinal detachment was uncommon (1% to 2%) for all time periods. Prevalence of glaucoma increased with time, although it remained < 10% until after the 1-year follow-up period. Boston Terriers, Cocker Spaniels, Cocker Spaniel-Poodle crosses, and Shih Tzus had increased risk of developing glaucoma. Eyes with hypermature cataracts were more likely to develop glaucoma. Prevalence of failure increased with time, although it remained < 10% until after the 3-year follow-up period. Cocker Spaniel-Poodle cross and Shih Tzus were more likely to have failure. CONCLUSIONS AND CLINICAL RELEVANCE: Evaluation of breed and cataract hypermaturity may aid in the selection of patients. The increasing prevalence of postoperative complications with time indicated that longterm monitoring is warranted.

Age Factors↗
PubMedDate not supplied

Phacoemulsification and implantation of an accommodating IOL after PRK.

PURPOSE: To present a case of phacoemulsification and implantation of an accommodating intraocular lens (IOL) in a patient with cataract formation after previous refractive surgery. METHODS: A 50-year-old man, who initially had photorefractive keratectomy to correct moderate myopia, developed a cataract in one eye. He subsequently underwent phacoemulsification and implantation of a 1CU accommodating IOL, as he wished to remain spectacle independent. RESULTS: The patient's distance vision was fully restored. However, accommodative function, which was assessed using subjective and novice objective techniques, was only partially restored. CONCLUSIONS: Although the accommodating IOL fully restored the patient's distance vision, accommodative function was only partially restored.

Accommodation, Ocular↗
PubMed2005

Corneal hydration intra-operatively during phacoemulsification.

PURPOSE: To evaluate incidence and risk factors for corneal hydration intra-operatively during phacoemulsification (CHIP). METHODS AND MATERIALS: This was a randomised, clinical trial, where 240 eyes of 240 patients with senile cataracts undergoing phacoemulsification were prospectively randomised to receive one of three possible types of incision architecture - single, two or three planes. Viscoelastic injection through paracentesis, before instruments were withdrawn from the main incision, was randomly done. Incision length was grouped into 1.5, 2 and 2.5 mm. CHIP was graded as nil, mild, moderate or severe: nil - no visible CHIP, mild-CHIP involving pillars of the incision, moderate - CHIP involving pillars and lateral extension, severe - extension of CHIP in front into the clear cornea. Moderate and severe categories were combined as 'significant' CHIP. Statistical analysis was done by logistic regression. RESULTS: The incidence of significant CHIP was 17.9 % (43 eyes out of 240). Five out of 80 eyes (6.25%) single plane, 8 out of 80 (10%) two plane and 30 out of 80 (37.5%) three- plane incisions developed significant CHIP (p = 0.005). Fifteen out of 120 (12.5%) with and 28 out of 120 (23.3%) without injection of viscoelastic developed significant CHIP (p = 0.044). Eighteen out of 43 (42.8%) and 25 out of 43(58.1%) with incision lengths 2 and 2.5 mm developed significant CHIP respectively (p<0.001). CONCLUSIONS: The incidence of significant CHIP was 17.9 %. Three-plane incisions, not injecting viscoelastic prior to retraction of instruments and incision length 2 mm or more are risk factors for significant CHIP.

Adult↗
PubMed2005

[Malignant glaucoma following combined Ahmed valve implant and phacoemulsification surgery for chronic angle-closure glaucoma].

CASE REPORT: Simultaneous Ahmed valve implant, combined with phacoemulsification cataract surgery, is a useful therapeutic option for patients with chronic angle-closure glaucoma, when conventional filtering surgery fails. This combined approach permits both control of intraocular pressure and early recovery of visual function. We report the results in five patients successfully treated with this combined procedure, two of whom developed early postoperative malignant glaucoma. DISCUSSION: Predisposing anatomic features in patients with chronic angle-closure glaucoma, associated with sudden anterior chamber decompression and increased postoperative inflammation, may facilitate the development of malignant glaucoma following combined glaucoma implant and phacoemulsification surgery.

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