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PubMed2004

Irrigating chopper and vacuum capsulorhexis: a new technique in phacoemulsification.

A continuous curvilinear capsulorhexis (CCC) technique for cataract extraction surgery by phacoemulsification is described. The technique replaces a forceps or needles with vacuum traction and further modifies vacuum capsulorhexis. The technique was performed in 30 patients. The achieved CCCs were compared with the desired CCC of approximately 6.0 mm (range 5.8 to 6.2 mm). The desired CCC was achieved in 19 patients; 7 patients had a smaller-diameter CCC and 2, a larger-than-desired diameter. Two patients had partial capsule tear. The mean diameter was 5.79 mm +/- 0.57 (SD). This technique allows CCC to be performed through small incisions (1.0 mm) without the use of ophthalmic viscosurgical devices.

Capsulorhexis↗
PubMed2004

Analysis of the capsule edge after Fugo plasma blade capsulotomy, continuous curvilinear capsulorhexis, and can-opener capsulotomy.

PURPOSE: To compare the quality of the edges of anterior capsulotomies performed in porcine eyes using 3 different techniques. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: Four porcine eyes were submitted to the center in 10% neutral buffered formalin. The cornea of the eyes had been removed, and a continuous capsulotomy had been performed in each eye using the Fugo plasma blade. To provide morphologic correlation, 4 additional porcine eyes were used in the study. In 2, a manual continuous curvilinear capsulorhexis (CCC) was performed after the cornea or cornea/iris was removed and in the other 2, a can-opener capsulotomy (COC) was performed. The eyes were then placed in 10% neutral buffered formalin. Gross (macroscopic) and microscopic analysis of each eye was performed, and photographs were taken. One eye in each group was also prepared and analyzed under scanning electron microscopy (SEM). RESULTS: The capsulotomy margin in the Fugo blade group presented some regularly spaced tags directed centrally with smooth edges at the base. Such a configuration would not interfere with the dynamics of the capsulorhexis sphincter and would generally not lead to radial tears. The smooth and regular nature of the capsulotomy margin in the CCC group was confirmed by gross and microscopic examinations of the eyes. The capsulotomy margin in the COC group presented some sharp notches directed outward, irregularly spaced, and irregular in shape. These are known to have a tendency to extend and form radial tears. CONCLUSION: Although performance of an anterior capsulotomy with the Fugo blade was associated with some margin irregularities, the geometry of the centrally directed tags prevented them from becoming the site of radial tear formation. The base of the capsulotomy performed with the Fugo blade appeared to be almost as smooth and regular as in the CCC under SEM evaluation.

Animals↗
PubMed2005

Direct puncture capsulorhexis.

I describe a simple technique for performing capsulorhexis without viscoelastic material or expensive instruments. A slightly barbed, bent, 30-gauge needle is used to directly puncture clear cornea and create a capsulorhexis without the need for a groove or stab incision. Hydrodissection is carried out with the attached 1 cc syringe (tuberculin) filled with a balanced salt solution. Hydrodissection, hydrodelineation, and mobilization of the nucleus can be carried out before the eye is entered with a blade. With direct puncture, the technique is immune to the effects of high intraocular pressure and a shallow anterior chamber. The Technique is ideally suited for bimanual microincision phacoemulsification.

Capsulorhexis↗
PubMed2006

Ring-shaped caliper for better anterior capsulorhexis sizing and centration.

We describe a new type of caliper to optimize the size, shape, and centration of the capsulorhexis during intraocular lens (IOL) surgery. This flexible, ring-shaped tool is positioned on the anterior capsule surface, where it is kept in place by an ophthalmic viscosurgical device. When in place, the caliper provides an ideal guide for the surgeon to follow and facilitates optimal capsulorhexis shape and centration.

Anterior Eye Segment↗
PubMed2001

Capsulorhexis phimosis in retinitis pigmentosa despite capsular tension ring implantation.

A 56-year-old man with retinitis pigmentosa presented with dense nuclear sclerosis and scattered zonular loss with laxity confirmed by ultrasound biomicroscopy. He had extracapsular cataract extraction with a 6.0 mm continuous curvilinear capsulorhexis and implantation of a capsular tension ring (CTR) and a single-piece poly(methyl methacrylate) (PMMA) intraocular lens (IOL) in the capsular bag in his left eye. Severe anterior capsule fibrosis and contracture of the capsulorhexis opening with nasal decentration of the IOL were noted 4 months after surgery. A neodymium:YAG (Nd:YAG) laser anterior capsulotomy was performed to prevent further zonular stress and IOL decentration. The centripetal forces of capsular fibrosis after cataract surgery may exceed the centrifugal resistance of the standard CTR and PMMA IOL in patients with retinitis pigmentosa. Such patients must be carefully monitored postoperatively. An Nd:YAG laser anterior capsulotomy is a safe and effective option to manage anterior capsule fibrosis.

Capsulorhexis↗
PubMed2002

Two-incision push-pull capsulorhexis for pediatric cataract surgery.

Pediatric capsulorhexis is a challenging surgical technique because of the elasticity of the pediatric anterior capsule. This technique of manual capsulorhexis allows reliable and reproducible results for the size and centration of anterior and posterior capsulorhexes in pediatric cases. The technique is a modification of a previously reported method.

Capsulorhexis↗
PubMed2002

Intraoperative and early postoperative results of suction posterior capsulorhexis.

PURPOSE: To report the intraoperative complications and early postoperative visual results of suction posterior capsulorhexis (SPC). SETTING: Ophthalmology department of a district general hospital, Kent, United Kingdom. METHODS: This prospective observational study included all patients having phacoemulsification who required SPC as a planned procedure or because of posterior capsule tears (128 eyes of 122 patients). All patients were under the care of a single consultant. Intraoperative complications related to the SPC as well as postoperative complications and best corrected visual acuity (BCVA) in all cases and with best-case analysis (patients with preexisting ocular comorbidity excluded) were noted. RESULTS: Seven cases (5.5%) of vitreous prolapse occurred; none was specifically related to the SPC. A BCVA of 0.67 (6/9) or better was achieved in 94% of cases (100% of best cases). One retinal detachment (0.8%) occurred 8 months postoperatively that was successfully treated with no loss of BCVA. CONCLUSION: Suction posterior capsulorhexis had a low rate of intraoperative complications and did not adversely affect the early visual outcome.

Aged↗
PubMed2003

Anterior and posterior capsulorhexis in pediatric cataract surgery with or without trypan blue dye: randomized prospective clinical study.

PURPOSE: To evaluate the clinical efficacy of trypan blue 0.1% dye (Blurhex) in creating a complete anterior and posterior capsulorhexis during pediatric cataract surgery. SETTING: Tertiary eyecare center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: In a prospective randomized study, an anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis were performed in pediatric patients. In Group 1 (n = 19), the ACCC and PCCC were created without use of trypan blue dye. In Group 2 (n = 23), intracameral trypan blue dye was used to stain the anterior and posterior capsules. RESULTS: In Group 1, 14 eyes (73.6%) had a complete ACCC and 10 (52.6%) had a complete PCCC. In Group 2, 21 eyes (91.3%) had a complete ACCC and 19 (82.6%) had a complete PCCC. CONCLUSION: In cases of pediatric cataract, staining the anterior and posterior capsules with trypan blue 0.1% allowed recognition of capsule flaps and facilitated the creation of complete ACCCs and PCCCs.

Capsulorhexis↗
PubMed2004

Tissue damage at anterior capsule edges after continuous curvilinear capsulorhexis, high-frequency capsulotomy, and erbium:YAG laser capsulotomy.

PURPOSE: To compare the effect of erbium:YAG laser photocapsulotomy (ELC), continuous curvilinear capsulorhexis (CCC), and high-frequency capsulotomy (HFC) on anterior capsule edges using light microscopy (LM) and transmission electron microscopy (TEM). SETTING: Department of Ophthalmology, Department of Histology and Embryology II, University of Vienna, Vienna, Austria. METHODS: Five anterior capsule membranes were obtained experimentally by ELC, which was performed with the Oertli MicroLaser photoemulsification tip in eyes from 5 human cadavers. Thirty anterior capsule membranes were obtained during cataract surgery by CCC (n = 15) or, in cases with poor or missing red fundus reflexes, by HFC (n = 15). Continuous curvilinear capsulorhexis was performed conventionally with a manual, bent, 27-gauge cannula, and HFC was performed according to Klöti. Membranes were processed and examined by LM and TEM according to standard procedures. RESULTS: The edges obtained by ELC showed mild signs of denaturation and mechanical disruption, tears, and micro-tears. Lens capsule edges obtained by CCC were smooth with no irregularities in any specimen; the edges were beveled anteriorly to posteriorly with no evidence of tearing. Edges produced by HFC were considerably wider; the surfaces showed distinct denaturation, preformed tears, and micro-tears. The edges were surrounded by a nonhomogeneous mass, which consisted mainly of denatured lens capsule material. CONCLUSIONS: Of the 3 techniques, CCC produced the mildest tissue damage. The histological damage at ELC edges was relatively mild and intermediate compared with that seen at CCC and HFC edges. These observations suggest that ELC is an appropriate option for anterior capsulotomy in cataract surgery.

Aged↗
PubMed1998

Capsulorhexis in eyes with phacomorphic glaucoma.

Phacomorphic glaucoma is a common condition in developing countries. Extracapsular cataract extraction with a sulcus-fixated intraocular lens (IOL) is associated with increased intraoperative and postoperative complications in this condition. We developed a technique that allows a safe, controlled capsulorhexis in the presence of the shallow anterior chamber, increased anterior capsule convexity, and high intralenticular pressure seen in eyes with phacomorphic glaucoma. The intumescent cataracts are decompressed by filling the anterior chamber with viscoelastic; a 30 gauge needle is then used to aspirate liquid cortex, which facilitates a controlled capsulorhexis. This allows safe phacoemulsification of the cataract and in-the-bag IOL implantation.

Anterior Chamber↗
PubMed1998

Fluorescein blue, light-assisted capsulorhexis for mature or hypermature cataract.

This technique is for use in eyes with mature or hypermature cataract resulting in lack of fundus reflex during capsulorhexis. Fluorescein staining is performed before the capsulorhexis is made. A blue filter in the coaxial light accentuates the remaining rim of bright blue fluorescence and aids in exact formation of the anterior opening. Seven eyes with a postoperative visual acuity of light perception had surgery using this technique. Visual acuity ranged from 20/200 to 20/20 up to 3 months postoperatively. No untoward reaction to the fluorescein was observed; however, the long ultrasound exposure for very hard nuclei (up to 4 minutes) caused corneal edema in two eyes. This technique is regularly used in all eyes with insufficient fundus reflex caused by lens opacity or vitreous disease.

Capsulorhexis↗
PubMed1998

Phacoemulsification, primary posterior capsulorhexis, and capsular intraocular lens implantation for uveitic cataract.

PURPOSE: To evaluate the safety and efficacy of phacoemulsification, primary posterior capsulorhexis (PCCC), and primary intraocular lens (IOL) implantation for uveitic cataracts. SETTING: Institutional practice. METHODS: Fifteen consecutive eyes of 13 patients with various causes of uveitis received anterior capsulorhexis, phacoemulsification, PCCC, and in-the-bag implantation of a heparin-surface-modified IOL for visually disabling cataract. The safety and efficacy of the combined operation were studied prospectively. RESULTS: At a mean follow-up of 16.9 months (range 8 to 30 months), all eyes had a clear central visual area. Fourteen of 15 eyes (93.3%) had good visual improvement after surgery. Eight eyes (53%) achieved a best corrected visual acuity (BCVA) of 20/30 or better and 6 (40%), 20/20 or better. Seventy-three percent of eyes attained a BCVA of 20/80 or better. The mean improvement in visual acuity was 5.2 Snellen lines (range 0 to 11 lines). No cases of uveitis flare-up or other major complications related to the cataract surgery occurred. CONCLUSIONS: The study's preliminary results are encouraging and indicate that phacoemulsification, PCCC, and IOL implantation can be considered in patients with visually disabling uveitic cataract.

Adolescent↗
PubMed1999

Small peripheral anterior continuous curvilinear capsulorhexis.

Cataract surgery is routinely performed using an anterior continuous curvilinear capsulorhexis (CCC). A manual surgical technique is described for performing a small (less than 1.5 mm diameter) anterior CCC. This technique's applications extend from Phaco-Ersatz, a cataract surgical technique designed to restore accommodation to pediatric cataract surgery. An experimental rabbit study was conducted to determine the feasibility of the technique. Up to 9 small peripheral anterior CCCs were made in the same lens capsule without the capsule tearing. The mean diameter of the CCCs was 1.1 mm +/- 0.3 (SD). A 30 gauge needle and Utrata capsulorhexis forceps were used to construct the CCC. This technique shows promise for the successful performance of small CCCs in Phaco-Ersatz procedures and pediatric cataract surgery.

Animals↗
PubMed1999

Ultrasound biomicroscopy examination of intraocular lens haptic position after phacoemulsification with continuous curvilinear capsulorhexis and extracapsular cataract extraction with linear capsulotomy.

PURPOSE: Intraocular lens (IOL) haptic position in 35 eyes that had undergone cataract surgery was examined with ultrasound biomicroscopy (UBM). METHODS: In a prospective randomized study the patients were operated by phacoemulsification using continuous curvilinear capsulorhexis (CCC) (group I) or by extracapsular cataract extraction (ECCE) using linear capsulotomy (group II). Ultrasound biomicroscopy was used to localize both haptics of the implanted intraocular lenses and to measure anterior chamber depth (ACD), iris thickness and anterior chamber angle. The inflammatory reaction in the anterior chamber was assessed with laser flare photometry. Slit lamp examination was performed. RESULTS: Both IOL haptics were found in the lens capsule in all 18 eyes in group I. In group II one of the haptics was located out of the capsule in 7 of 17 eyes (41%). The difference is statistically significant (p=0.01). Postoperatively mean ACD measured with the UBM was 4.06+/-0.30 mm in group I and 3.64+/-0.24 mm in group II (p=0.00025). CONCLUSION: The UBM examinations indicate that phacoemulsification with continuous curvilinear capsulorhexis is a more reliable technique than ECCE with linear capsulotomy to achieve implantation of the intraocular lens haptics in the capsular bag.

Aged↗
PubMed2006

Comparison of epilenticular IOL implantation vs technique of anterior and primary posterior capsulorhexis with anterior vitrectomy in paediatric cataract surgery.

PURPOSE: To compare the functional outcome of epilenticular intraocular lens (IOL) implantation vs the technique of anterior continuous curvilinear capsulorhexis (ACCC), posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and in-the-bag IOL implantation in paediatric cataract surgery. METHODS: Forty eyes of 33 children with developmental or traumatic cataract, whose mean age was 2-12 years, were randomly divided into two groups A and B. Group A patients underwent epilenticular IOL implantation while in group B patients, ACCC, PCCC with anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and traumatic cataracts (subgroups A2 and B2) were allotted to both the groups. Postoperative visual acuity, opacification of the visual axis, and possible complications were observed and analysed. RESULTS: Four eyes in subgroup B2 had fibrous or ruptured capsules, and were managed by epilenticular IOL implantation technique. One eye in subgroup B2 developed central posterior capsular opacification and hence required a secondary capsulotomy. All cases in group A maintained a clear visual axis at the last follow-up. Minimal postoperative inflammation was noticed in all groups, which subsided with anti-inflammatory medication. At the last follow-up, all eyes in group A gained visual acuity >/=6/18. Whereas in group B, visual acuity >/=6/18 was obtained in 85.7% cases with the epilenticular IOL implantation technique and in 83.3% cases with ACCC and PCCC with anterior vitrectomy technique. CONCLUSION: Epilenticular IOL implantation offers a safe and effective alternative for management of paediatric cataract. In selected cases of traumatic cataract, it is the preferred treatment modality.

Capsulorhexis↗
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↗
PubMed2004

Recurrent posterior capsular opacification and capsulorhexis contracture after cataract surgery in myotonic dystrophy.

Cataracts are well known to be associated with myotonic dystrophy. Less well known are the phenomena of recurrent posterior capsule opacification and capsulorhexis contracture post cataract surgery. Two cases are described herein of postoperative capsular complications requiring multiple capsulotomies in patients with myotonic dystrophy. It is proposed that a common aetiology may underlie both posterior capsule opacification and capsulorhexis contracture in myotonic dystrophy cases.

Adult↗