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PubMed1999

Combined phacoemulsification and penetrating keratoplasty.

To highlight indications, technique, and advantages of closed-chamber phacoemulsification and intraocular lens (IOL) implantation during penetrating keratoplasty for corneal opacities. Case reports of 2 patients who underwent combined phacoemulsification, IOL implantation and penetrating keratoplasty. The technique described allowed controlled capsulorrhexis, cataract removal and in-the-bag IOL implantation. Complications due to increased posterior pressure during open-sky extracapsular cataract were not encountered. The surgical technique described in this report can only be used in selected patients undergoing combined corneal transplant and cataract surgery. In this group of patients, however, the technique offers many intra- and postoperative advantages.

Corneal Diseases↗
PubMed1999

[Retrolenticular lens fragments--a problem of phacoemulsification?].

In a group of 100 consecutive operations of cataract by the method of phacoemulsification in 1998 in 9% penetration of fragments of lenticular material into the retrolenticular space was observed. It is a less frequent associated phenomenon of phacoemulsification. It provides evidence of the possible penetration of larger particles through the relatively intact suspensory apparatus. The authors did not observe an association of the phenomenon with clinical complications.

Aged↗
PubMed1999

Comparison of the effect of Healon vs. Viscoat on endothelial cell count after phacoemulsification and posterior chamber lens implantation.

To evaluate the protective effect of 1% sodium hyaluronate (Healon) vs. a mixture of 4% chondroitin sulfate and 3% sodium hyaluronate (Viscoat) on the central corneal endothelium during surgery, we prospectively examined 20 eyes of 20 patients who underwent clear corneal phacoemulsification and implantation of an intracapsular posterior chamber intraocular lens (PC-IOL) with either Healon (10 eyes) or a combined use of Viscoat and Healon (10 eyes) as viscoelastic material. We compared the central endothelial cell counts, recorded by specular microscopy, preoperatively and 6 weeks postoperatively. Our results suggest that Viscoat offers no significant better endothelial cell protection during phacoemulsification than Healon.

Adult↗
PubMed1999

Surgical outcome of combined phacoemulsification and trabeculectomy.

BACKGROUND: A retrospective study was undertaken to evaluate the results of phacoemulsification, intraocular lens implantation, and trabeculectomy in patients with cataracts coexisting with glaucoma. METHODS: This study consisted of 20 eyes from 19 patients. Fifteen eyes had chronic angle-closure glaucoma and 5 eyes had primary open-angle glaucoma. All cases were followed for a minimum of 6 months (range, 6 to 16 months). The mean preoperative intraocular pressure (IOP) was 17.3 +/- 4.5 mmHg. The mean preoperative visual acuity was 0.05 +/- 0.19. The mean number of preoperative antiglaucoma medications per patient was 2.3. RESULTS: Postoperatively, all patients except for one no longer required antiglaucoma medication. The mean IOP was 10.7 +/- 3.7 mmHg one month postoperatively and 13.7 +/- 4.3 mmHg at the final follow-up visit. Vision improved in 80% of the patients and remained unchanged in 20%. The failure to achieve improvement was due to advanced optic atrophy. The mean level of surgically induced astigmatism at the final visit was 0.98 +/- 0.91 diopters as calculated by vector analysis. Various extents of fibrin exudate was found in 10 eyes (50%). The most serious postoperative complication, occurring in one eye (5%), was temporary hypotony with moderate choroidal effusion, which later resolved spontaneously. CONCLUSION: Combined phacoemulsification and trabeculectomy is an effective and safe approach for obtaining good visual rehabilitation and glaucoma control.

Aged↗
PubMedDate not supplied

[New modified method of phacoemulsification in lenticular subluxation].

A new method for cataract removal by phacoemulsification in impaired lenticular joints consists in fixation during surgery of the anterior lenticular chamber along the edge of the capsulorrhexis by 4 retractor hooks and subsequent implantation of a soft intraocular lens. The operation was performed in 6 patients with cataracts of different types complicated by subluxation of the lens. The operation did not involve such complications as vitreous prolapse or displacement of the incompletely dislocated lens. All operations were finished with complete evacuation of lenticular mass and implantation of soft silicone intraocular lenses. The proposed method widens the category of patients in whom modern phacoemulsification can be used.

Humans↗
PubMed2000

[Cataract surgery by phacoemulsification in Werner's syndrome].

We report two cases of Werner's syndrome, a sister and a brother of 32 and 28 years, respectively, who were operated on for cataracts in both eyes. This hereditary syndrome, also called the adult progeria, is characterized by several manifestations of premature aging. Cataract surgery in this syndrome often predisposes to complications such as wound dehiscence and bullous keratopathy. The 4 eyes of the two patients were operated on using the phacoemulsification technique. The operations were successful, and we did not observe any serious complications during the 2-year follow-up period: cystoid macular edema in the brother's right eye was easily cured by topical indomethacin. This experience with these two patients showed that Werner's syndrome cataracts can be safely managed with the current phacoemulsification and small-incision surgery techniques.

Adult↗
PubMedDate not supplied

Outcomes of temporal clear cornea versus superior scleral tunnel phacoemulsification incisions in a university training program.

BACKGROUND AND OBJECTIVES: To evaluate the complication and visual outcomes of residents performing temporal clear cornea (TCC) compared to superior scleral tunnel (SST) phacoemulsification. PATIENTS AND METHODS: We conducted a retrospective analysis of complications and visual outcomes for 534 phacoemulsification procedures done by third-year residents over a five-year period (June 1992-July 1997) at the department of ophthalmology, University of Chicago. All cases were completed using a TCC or SST incision. RESULTS: There was vitreous loss in 6.0% of 348 eyes with TCC incisions and in 11.8% of 186 eyes with SST incisions (P < 0.02). Posterior capsule breaks occurred in 1 1.5% of the TCC group versus 17.7% in the SST group (P < 0.0453). Best corrected visual acuity of 20/40 or better was achieved in 82.5% of all eyes with TCC incisions and in 75.3% of all eyes with SST incisions (P < 0.05). When 151 patients with previous ophthalmic conditions were excluded, the difference in BCVA between the two groups was not statistically significant. CONCLUSIONS: Most institutions train residents with the SST technique prior to advancing to TCC. This study demonstrates that with proper teaching, residents can achieve excellent outcomes using TCC incisions, and can therefore be trained in this technique concurrently with SST incisions.

Chicago↗
PubMed2000

[Phacoemulsification and foldable IOL implantation; posterior luxation of the nucleus; delayed phacophagia].

In the beginning, the paper presents some general words about the main intraoperative complications of the phacoemulsification and some practical attitudes patient in front of the rupture of the posterior capsule. The second part presents the case of a 63 years old patient who was intended to be operated for cataract by phacoemulsification and who suffered a complication during this procedure--the rupture of the posterior capsule with the luxation of the majority of the nucleus into the vitreous body.

Humans↗
PubMed2001

[Intra-bleb pigmentation after phacoemulsification].

CASE REPORT: We report the finding of an intense intra-bleb pigmentation 24 hours after uncomplicated phacoemulsification in an eye with previous trabeculectomy. In the follow-up, considerable reduction in degree of pigmentation was observed and intraocular pressure remained under control without medication. DISCUSSION: Intra-bleb pigmentation after trabeculectomy or phacotrabeculectomy has been recently reported by Wanichwecharungruang; however it has never been mentioned after isolated phacoemulsification. It is usually related with intraoperative pigment dispersion. A preexisting thin bleb provides a clear view of intra-bleb pigmentation, that appears associated with a successful filtration.

Aged↗
PubMed1999

[Phacoemulsification through a small pupil].

OBJECTIVE: To discuss the surgical techniques and attention points in phacoemulsification through a small pupil. METHOD: Eighty three cataracts of 77 patients were emulsified by using non-cut pupil dilation, cystotome or diathermic high-frequency capsulorrhexis. RESULTS: The 66 cataracts of 83 eyes were emulsified by means of the above method. After the surgery, all the pupils were recovered to normal size (2 to 3 mm), and none of them were damaged. In 17 eyes, the procedure was performed after separation of synechia and excision of the organized membranes; after the surgery, a round pupil was obtained in 15 cases and an irregular pupil in 2 cases. The visual acuity at postoperative 1 month was >or= 0.5 in 46 eyes (55.4%) and corrected >or= 0.5 in 71 eyes (85.5%). CONCLUSION: After phacoemulsification through a small pupil by non-cut pupil dilation method, the pupil can be recovered to normal and no unfavorable reaction is seen.

Adult↗
PubMed1999

[Phacoemulsification with foldable intraocular lens implantation through a limbus tunnel incision].

OBJECTIVE: To advance and evaluate the technique and therapeutic effects of phacoemulsification with foldable intraocular lens implantation through a limbus tunnel incision. METHODS: The surgery was performed through a 3.2 limbus tunnel incision on 110 eyes of 103 patients with senile, complicated, congenital and traumatic cataracts. RESULTS: Postoperatively, the visual acuities with spherical correction or without correction were 0.5 or better in 90.0% of the eyes at one day, and 1.0 or better in 42.5%, 63.7% and 68.0% at one week, one month and three months respectively. The mean postoperative astigmatism was (1.00 +/- 0.68) D at one week and only 0.07D more than the mean preoperative one (P > 0.05). There was also no statistical difference between the mean preoperative astigmatism and postoperative astigmatism at one and three months, which were respectively (0.91 +/- 0.55) D and (0.83 +/- 0.57) D. The mean postoperative astigmatism was almost the same as compared between the scleral tunnel incision and clear corneal incision groups. CONCLUSION: The phacoemulsification with foldable intraocular lens implantation through a limbus tunnel incision can reduce postoperative astigmatism and shorten the period of visual rehabilitation as the operation through a scleral tunnel or a clear corneal incision, and in the mean time the former method can overcome the shortages of the latter two methods.

Adolescent↗
PubMed2001

[Phacoemulsification for short eye axis cataract].

OBJECTIVE: To analyze the operative difficulty of cataract phacoemulsification in an eye with shorter axial length and discuss its preventive measures. METHODS: A retrospective study was performed to analyze the 122 patients (143 eyes) who had undergone cataract phacomulsification. Their ocular axial lengths were 20.21 to 22.10 mm. RESULTS: Because these patients had shorter ocular axis, shallower anterior chamber depth, narrower space in the anterior ocular segment and higher vitreous pressure, the operation was hard to perform. The rate of posterior capsular rupture was 7.69%. The postoperative inflammatory reaction was severe. The rate of reversible corneal edema (29.37%) was obviously higher than that in cataractous eyes with normal ocular axis (6.7%, P < 0.01), and also higher than that in eyes with normal ocular axis and hard nucleus (12.5%, P < 0.05). CONCLUSIONS: It is emphasized that the correct technique of incision, application of chopping and breaking nucleus technique, lower energy and higher aspiration for effective phacoemulsification with the help of Viscoat viscoelastic material and maintenance of deep anterior chamber are the key procedures to obtain satisfactory operative results.

Adult↗
PubMed2000

[A dynamic study on the surgically induced astigmatism after phacoemulsification through three different-sized scleral tunnel incisions].

OBJECTIVE: To compare the changes in the values and directions of surgically induced astigmatism (SIA) after phacoemulsification with three different-sized scleral tunnel incisions and to evaluate their clinical results. METHODS: The patients were divided into three groups; the length of the scleral tunnel incision was 3.2, 5.5 and 7.0 mm respectively in A, B and C groups. Keratometry measurements were obtained preoperatively, at postoperative 1 week, 1 month and 6 months respectively. SIAs were analyzed by "Cravy vector method". The mean SIA and uncorrected visual acuity were compared among the groups up to 6 months postoperatively. RESULTS: Eyes in A group displayed significantly less mean SIA and better uncorrected visual acuity than B and C groups at 1 week postoperatively (P < 0.05), but there were no significant differences between any groups at 1 month, 3 months and 6 months postoperatively (P > 0.05). There were no significant differences in the mean SIA and uncorrected visual acuity between B and C groups throughout the whole study period (P > 0.05). CONCLUSIONS: SIAs in eyes of 3.2 mm incision group of phacoemulsification are less and more stable; a better and quicker rehabilitation of uncorrected visual acuity can be obtained in the early postoperative period.

Astigmatism↗
PubMed2000

[Phacoemulsification with silicone foldable intraocular lens implantation through a small incision in glaucomatous eyes after filtering surgery].

OBJECTIVE: To investigate the method of cataract extraction in eyes that had undergone glaucoma filtering surgery and its effects on filtering bleb. METHODS: Phacoemulsification with posterior chamber intraocular lens implantation was performed on 262 eyes with a preexisting filtration bleb, in which at the temporal clear cornea a lateral or inferior lateral limbal incision was selected, the pupil sphincter was cut and the iris was sewed for the small and fixed pupil. RESULTS: The postoperative visual acuity of all patients improved in different degrees, with >or= 0.5 in 74.0% in the first month. The postoperative IOP increased by 3.08 mmHg. The functional filtering bleb was not apparently cicatrized. CONCLUSIONS: Glaucomatous eyes with cataract after filtering operation can rehabilitate their visual acuity and maintain the functional filtering bleb by phacoemulsification with foldable intraocular lens implantation through a temporal clear corneal incision or lateral scleral pocket incision. Theoretically, the effect of a transparent corneal incision on filtering bleb is less than that of a scleral pocket incision.

Aged↗
PubMed2000

[Analysis of postoperative astigmatism after phacoemulsification with intraocular lens implantation].

OBJECTIVE: To study the corneal astigmatism and the changes of surgically induced astigmatism after phacoemulsification with intraocular lens (IOL) implantation. METHODS: Thirty-eight eyes of 38 patients treated with phacoemulsification through a superior inversed frown shaped scleral incision were examined by corneal topography and auto-ref-keratometer preoperatively, one day, one month and three months postoperatively. RESULTS: The postoperative corneal astigmatism at one day, one month and three months were (1.10 +/- 0.71), (1.08 +/- 0.66) and (0.87 +/- 0.55) D respectively. There was no statistic significance between the postoperative astigmatism at three months and at preoperative one day (P > 0.05). The mean surgically-induced astigmatism at postoperative one day, one month and three months were (1.37 +/- 1.03), (1.24 +/- 0.93) and (1.04 +/- 0.75) D respectively. There was significant difference between the astigmatism at three months and at one day postoperatively (P < 0.05). CONCLUSIONS: The superior inversed frown shaped scleral small incision with no suture has little effect on corneal astigmatism. Vector analysis can systemically evaluate surgically induced astigmatism. The results of corneal topography are more reliable to reflect changes in corneal curvature than that of auto-ref-keratometer, and corneal topography has more important clinical value in evaluating surgically induced astigmatism.

Astigmatism↗
PubMed2001

[Clinical observation of phacoemulsification with foldable intraocular lens implantation through a limbus incision].

OBJECTIVE: To investigate the clinical therapeutic effects of phaco-emulsification with foldable intraocular lens implantation through a limbus tunnel incision. METHODS: Eighty-six patients (107 eyes) with senile cataract underwent phacoemulsification with acrylic foldable posterior chamber intraocular lens implantation through a 4 mm superior limbus tunnel incision. RESULTS: The corrected visual acuity of 0.5 or better was 62.6% at the 1st day, and 76.6%, 92.5% and 88.8% respectively at the 1st week, 1st month and 3rd month postoperatively. CONCLUSION: Phacoemulsification with foldable intraocular lens implantation through a limbus tunnel incision has advantages of both scleral tunnel incision and clear corneal tunnel incision. The postoperative therapeutic effects are satisfactory.

Adult↗
PubMed1998

[Phacoemulsification and foldable intraocular lens implantation through a clear corneal incision].

OBJECTIVE: To evaluate the therapeutic effects of phacoemulsification with foldable intraocular lens implantation through a clear corneal incision. METHODS: The surgery was performed through a 3.2 mm clear corneal incision on 100 eyes of 90 patients with senile, complicated, congenital and traumatic cataracts. RESULTS: Postoperatively, the visual acuities with spherical correction or without correction were 0.5 or better in 93.0% of eyes at one day, and 1.0 or better in 56.0%, 65.1% and 67.5% at one week, one month and three months respectively. The mean postoperative astigmatism was 0.93 +/- 0.58 D at one week and 0.20 D more than the mean preoperative one (P < 0.001). There was no statistical difference between the mean preoperative astigmatism and postoperative astigmatism at one and three months which were respectively 0.78 +/- 0.60 D and 0.73 +/- 0.59 D. CONCLUSION: The phacoemulsification with foldable intraocular lens implantation through a clear corneal incision can reduce early postoperative astigmatism, shorten the period of visual rehabilitation and simplify operative procedures.

Adolescent↗
PubMed1998

[Primary posterior chamber intraocular lens implantation of posterior capsular ruptur with cataract extracted by phacoemulsification].

OBJECTIVE: To evaluate the effect of primary posterior chamber intraocular lens (IOL) implantation of posterior capsular rupture (PCR) with cataract extracted by phacoemulsification. METHOD: Primary posterior chamber IOL implantation was performed on 29 cases (29 eyes) with PCR occurring in 184 cases (200 eyes) during cataract extraction by phacoemulsification. RESULTS: In-the-bag implantation was performed on 10 cases, and sulcus-fixed lens implantation on 19 cases. The post-operative uncorrected visual acuities in 17 cases (58.62%) were 1.0 or better and 0.5 - 0.9 in 10 cases (34.48%). The corrected visual acuities in 22 cases (75.86%) were 1.0 or better and 0.5 - 0.9 in 5 cases (17.24%) after 3 months of operation. The complications included corneal edema and damage of pupillary margin in the operation, and anterior vitreous inflammatory reaction after the operation. CONCLUSION: The posterior chamber IOL can be primarily implanted in cases with PCR and functional anterior or posterior capsular support after the anterior segment vitreous was cleaned.

Adult↗