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Synechiae involving the iris pigment epithelium and the peripheral anterior lens capsule occur in capsular glaucoma. During cataract extraction they may bring about traction on the capsule threatening its rupture. The ultrastructural basis of these adhesions is a bonding of pigment cells to capsular surface by pseudoexfoliative material.
A 43-year-old man was diagnosed as a case of near-mature senile cataract, chronic simple glaucoma, and pterygium both eyes. Pterygium shaving and extracapsular cataract extraction were done together. Thick aftercataract was diagnosed with moderate iridocyclitis on fourth postoperative day. Treatment was started with atropine and steroids, but without any relief. A second operation of curette evacuation of aftercataract was done to rule out and treat the presumed lens induced uveitis, but the condition further deteriorated. In next four days the eye had to be evacuated. On culture material, Staphylococcus epidermidis (albus) growth was detected. Keeping in mind the possibility of postoperative endophthalmitis from the very beginning, doing vitreous aspiration, using lens matter for culture-sensitivity in early stages, and starting of intraocular antibiotics might have helped to save the eye.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Explore the source record for details and available documents.
A 75 year woman with chronic vitreous hemorrhage underwent extraction of a senile cataract. Surgery was complicated by the flow of brown fluid from the vitreous to the anterior chamber, which was not entirely removed. Post-operatively there was pain, 2 mm of brown hypopyon and intraocular pressure elevation to 60 mm Hg with the preoperative diagnosis of endophthalmitis, a pars plana vitreous tap and instillation of intravitreal antibiotics was performed. Bacterial cultures were negative and the presence of erythrocyte "ghost cells" established the diagnosis of hemolytic glaucoma. As medical management proved ineffective, a pars plana vitrectomy was performed. One year post-operatively the patient had a visual acuity of 0.4-0.5, normal intraocular pressure without medication and evidence of an old branch retinal vein occlusion. The mechanism of hemolytic "ghost-cell" glaucoma in this case is discussed.
Sixty patients were randomly assigned to Healon (20 patients) or Viscoat (40 patients) treatment during extracapsular cataract extraction and intraocular lens implantation surgery. The 40 patients in the Viscoat group were randomly subdivided into two groups. In one group (20 patients), Viscoat was irrigated/aspirated from the eye at the close of surgery, while in the second group of 20 patients, Viscoat was left in the eye. In all Healon cases, the viscoelastic substance was removed from the eye at the end of the surgical procedure. Compared with Viscoat, Healon better facilitated the surgical procedure and appeared to be a more advantageous viscoelastic preparation. Viscoat, in many cases, caused rises in intraocular pressure in the immediate postoperative period when either removed or left in the eye at the close of surgery.
Over a period of two years we performed combined penetrating keratoplasty, cataract extraction, and intraocular lens implantation in seven children between the ages of 2 and 12 years old. The interval between trauma and the surgery varied from six weeks to six months (3.5 +/- 1.6 months, mean +/- SD). All of the patients had undergone primary repair of corneal perforation. Fresh corneas preserved in McCarey-Kaufman medium were used. The graft size was 7.5 mm with 0.5 mm disparity. Posterior chamber polymethylmethacrylate C-loop lenses were used in all cases. The surgeon's average postkeratoplasty keratometry was used in the calculation of intraocular lens power. The follow-up period ranged from nine to 36 months (18 +/- 9.1 months, mean +/- SD). Six grafts remained clear at the final follow-up. The visual acuity ranged from 20/40 to 20/200 with final astigmatism ranging from 0.5 diopter to 2.0 diopters. One patient developed a retinal detachment 12 months after surgery, which was successfully reattached. One patient, who had preoperative corneal vascularization, had graft rejection, which was treated medically. Our limited series suggests that the triple ocular procedure is a good choice for the treatment of corneolenticular trauma in children. The proper postoperative treatment includes vigorous antiamblyopia therapy and Nd:YAG laser treatment of after-cataracts.
A transitory deposit of a fibrin-like material in the anterior chamber following extracapsular cataract extraction and intraocular lens (IOL) implantation is described. In two studies, one retrospective of 352 operations and one prospective of 189 operations, the fibrinoid reaction was observed in 17% and 11% of the eyes, respectively. The reaction appeared in the early postoperative period in an otherwise quiet eye and the signs varied from a few threads in the pupil area to a dense pupillary membrane in front of the IOL. The deposit disappeared one day to three weeks postoperatively, usually without any remnants. The majority of eyes with the fibrinoid reaction had received a posterior chamber IOL. A strong association with the exfoliation syndrome was found and an increased vascular permeability is suggested as a probable cause of the reaction.
In a prospective study corneal thickness and specular microscopic findings of corneal endothelium are reported in 37 patients undergoing intracapsular cataract extraction. Central endothelial cell loss was estimated six months after the operation and was found to correlate significantly to the immediate post-operative increase in central corneal thickness. A subgroup of patients showing slight endothelial dystrophy prior to the operation showed a significantly higher increase in corneal thickness fourth day after the operation. Six months after the operation a significant residual increase in corneal thickness was found for this group, while the rest of the patients had returned to near pre-operative levels. No correlation was found between cell loss and residual corneal thickness increase at this time. Six months after the operation a vertical difference in cell density was found. This difference could be correlated to the age of the patient, presumably indicating a less complete redistribution of the cell population in older patients.
PURPOSE: To report a retrospective analysis of a combined procedure of extracapsular cataract extraction (ECCE) with heparin surface modified (HSM) posterior chamber intraocular lens (PCIOL) implantation along with primary Ahmed glaucoma valve (AGV) implantation in an attempt to optimize visual acuity gains and intraocular pressure (IOP) control in patients with phacomorphic glaucoma. METHODS: ECCE with HSM PC IOL and AGV implantation was performed through two separate incisions in 15 patients diagnosed with phacomorphic glaucoma. Postoperative improvement in visual acuity and IOP control were monitored. RESULTS: A steady control of IOP was maintained in all patients with minimum anti-glaucoma medications. The average visual acuity was approximately 6/24 at 3 months. CONCLUSION: Superior preoperative IOP control and a shorter phacomorphic attack resulted in better postoperative vision. The successful maintenance of IOP within the desired range in this study suggests that the procedure should be performed under similar conditions.
The present paper reports on experience gathered with the first 140 implantations of the Kelman II anterior chamber lens following intracapsular cataract extraction (ICCE). The technique of ICCE combined with lens implantation is described; the possible complications and the advantages of this new lens type are pointed out. With smooth implantation there have so far been no serious complications due to the lens, such as keratopathy, lens dislocation, secondary glaucoma, chronic iritis or membrane inflammation. The IC technique excludes the possibility of secondary cataract.
PURPOSE: To find out whether there is a "hidden" group of patients with posterior capsule opacification (PCO) 5 years after cataract surgery and to establish the incidence of PCO. SETTING: Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden. METHODS: A random sample (n = 164) was selected among patients who had extracapsular cataract extraction (ECCE) with intraocular lens implantation in 1991 (N = 1672). All surgically treated cases that required neodymium:YAG (Nd:YAG) laser capsulotomy (n = 37) within the first 5 years after surgery were recorded. Patients still alive 5 years after surgery who had not had Nd:YAG treatment were offered an eye examination to determine whether PCO requiring capsulotomy existed. RESULTS: Thirty-seven of 110 patients (34%) alive 5 years after surgery had an Nd:YAG capsulotomy during the first 5 postoperative years. Follow-up was possible in 51 of 73 untreated patients (70%). Clinically significant PCO according to specified criteria was found in 7 cases (14%). Half of them would benefit from treatment; the other half had visual impairment from other eye disease. CONCLUSIONS: The estimated incidence of PCO 5 years after ECCE was 43%. Five years after surgery, there was an untreated group with clinically significant PCO, approximately 9% of the surgically treated population. This hidden group must be considered in PCO studies.
The purpose of the study is to establish the amount of surgically induced astigmatism after extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation. Eighty three eyes of 79 patients who had ECCE + IOL implantation were examined in the period between the 6th and the 16th month after the operation. The pre- and post-operative auto keratometry readings (K1 and K2) were recorded for each patient. These readings were compared between themselves, as well as with the post-operative cylinder power estimated by an autorefractor (total astigmatism). The mean pre-operative corneal astigmatism (K1-K2) was 1.00 +/- 0.09 Dpt Cyl, and the mean post-operative -1.74 +/- 0.14 Dpt Cyl. The difference is statistically significant. The mean autorefractor cylinder power was 1.70 +/- 0.14 Dpt Cyl. It correlates strong with the post-operative corneal astigmatism. There is a moderate correlation between the degree of the post-operative corneal and total astigmatism. The surgically induced corneal astigmatism is the main component of the total post-operative astigmatism after ECCE + IOL implantation. The total astigmatism is mainly with the rule (vertical plus cylinder) and it does not seem to impair severely the post-operative visual acuity of the patients.
We reviewed 75 consecutive cases of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in 69 patients with glaucoma. The mean preoperative intraocular pressure was 19.3 mm Hg on an average of 2.3 glaucoma medications. Visual acuity improved in 58 eyes (77%) at two months, with an average improvement of 3.3 and 3.6 lines at two and 12 months, respectively. Of the 75 eyes, 49 (65%) achieved a visual acuity of 20/40 or better; three patients (4%) had further deterioration in vision at the completion of follow-up because of progressive glaucoma or macular disease. Postoperatively, the average intraocular pressure was 3.8 and 3.0 mm Hg lower than the preoperative level at two and 12 months (P less than .001) on 0.63 and 0.79 glaucoma medications, respectively. However, 27 (36%) of the 75 eyes had a recorded intraocular pressure greater than 30 mm Hg and 30 (40%) had a pressure 7 mm Hg or more above their preoperative level during the first six months after surgery. Despite improved long-term control of intraocular pressure, detectable conjunctival filtering blebs were present in only 31 (41%) of 75 eyes at two months and in seven (12%) of 56 eyes at 12 months. Hyphema occurred in 34 (45%) of the cases.