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Simultaneous penetrating keratoplasty, extracapsular cataract extraction, and intraocular lens implantation.

The postoperative results of 210 consecutive eyes in 177 patients who had simultaneous penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens (IOL) implantation (triple procedure) were reviewed. All procedures were performed by one surgeon between January 1980 and December 1989. The most common diagnosis requiring a triple procedure was Fuchs' endothelial dystrophy. The remainder of the patients required the procedure for either corneal scarring, keratoconus, or Chandler's syndrome. Of the 210 grafts, 191 (91%) remained clear with a mean follow-up of 53 months (range 6 to 116 months). The mean preoperative keratometry (K) reading (n = 161) was 44.51/44.85 (SD 4.86/4.94), and the mean postoperative K reading (n = 111) was 44.29/43.50 (SD 3.83/3.63). The mean IOL power (n = 196) was + 20.87 diopters (D) (SD 2.86). The mean postoperative best visual acuity (n = 166) was 20/65 with a range from 20/20 to less than 20/400, although 61% had 20/50 acuity or better and 92% had 20/100 acuity or better. The mean spherical correction in 155 eyes was - 1.38 (SD 2.89), and the mean positive refractive cylinder was + 3.21 (SD 2.20). One hundred forty six of the 155 eyes with reported refractions (96%) had 6 D or less of refractive cylinder. Correlation of the recipient-donor disparity % and refractive cylinder was significant such that as disparity increased refractive cylinder increased (r = 0.197, P = .021). Correlation of the recipient-donor disparity % and keratometric cylinder indicated a similar trend but was not significant (r = 0.105, P = .310).

Adult↗

Bilateral cataract: extraction in classic haemophilia with retrobulbar anaesthesia and peripheral iridectomy.

A 47-year-old factor VIII deficient haemophiliac successfully underwent bilateral cataract extraction. The use of cryoprecipitates to achieve haemostasis permitted retrobulbar anaesthesia and a peripheral iridectomy without complication. We consider that the use of cryoprecipitated factor VIII concentrate allows safe elective ocular surgery in patients with classic haemophilia.

Anesthesia, Conduction↗

Combined no-stitch phacoemulsification cataract extraction with foldable silicone intraocular implant and holmium laser sclerostomy followed by 5-FU injections.

In an attempt to overcome some of the problems associated with combined cataract extraction and glaucoma filtration surgery, we attempted a new combined procedure: a small-incision phacoemulsification cataract removal with placement of a silicone foldable implant and no-stitch closure combined with a holmium laser sclerostomy in an adjacent quadrant, followed by injections of 5-fluorouracil.

Aged↗

Outcomes of combined cataract extraction, lens implantation, and trabeculectomy surgeries.

PURPOSE: To report outcomes and their association with preoperative and intraoperative factors of 456 combined cataract and glaucoma operations. METHODS: A concurrent series (from January 1, 1987, to October 1, 1997) of one surgeon's consecutive 585 (456 patients) combined cataract extraction, intraocular lens implantation, and trabeculectomy surgeries, some with intraoperative mitomycin C and/or postoperative subconjunctival 5-fluorouracil. The study was a retrospective outcomes analysis for the first 191 operations (before June 10, 1992) and, subsequently, concurrent outcomes analysis for the latter 394 operations. Main outcome measures included postoperative visual acuity, intraocular pressure, number of glaucoma medications, intraoperative and postoperative adverse event rates, and reoperation for glaucoma or other ocular surgical or laser intervention. RESULTS: Visual acuity was improved at the time of last follow-up in 402 (88.2%) of 456 first operated eyes of the 456 patients. Increasing age (coefficient = 0.025; CI [confidence interval], 0.017 to 0.33; P <.0001) was associated with a decreased likelihood of improved visual acuity, and a more recent operation (coefficient = 0.0037; 95% CI, -0.0064 to -0.0010, P =.0082) was associated with an increased likelihood of improved visual acuity. Forty-one (9.0%) of 456 eyes had reoperation to control intraocular pressure. Glaucoma reoperation was most strongly associated with a preoperative diagnosis other than primary open-angle, pigmentary, or pseudoexfoliative glaucoma, a history of previous ocular surgery, and high preoperative intraocular pressure. Mean intraocular pressure reduced 5.5 mm Hg from 21.8 mm Hg preoperatively to 16.3 mm Hg postoperatively and mean glaucoma medication from 2.0 to 0.9 medications. Mitomycin C or 5-fluorouracil use was significantly associated with a lower postoperative intraocular pressure and reduced postoperative glaucoma medication. Major postoperative adverse event or other reoperation (not for glaucoma) occurred in 12 (2.6%) of first operated eyes. CONCLUSIONS: Combined surgery outcomes in 456 first-operated eyes of 456 patients showed 88.2% improved visual acuity, 9% re-operation rate, 5.5 mm Hg mean intraocular pressure reduction, 1.1 glaucoma medication reduction, and a low major postoperative adverse event rate. Type of glaucoma, previous ocular surgery, and high preoperative intraocular pressure were the best predictors for the need for reoperation for glaucoma after combined surgery. Mitomycin C and/or 5-fluorouracil provided a greater reduction of mean intraocular pressure and glaucoma medication compared with patients not receiving these agents.

Adolescent↗

Exfoliation syndrome after cataract extraction.

The authors describe three cases in which exfoliative material was noted on the posterior surface of intraocular lenses, years after extracapsular cataract extraction and lens implantation in eyes where no exfoliative material was seen before the operation. All three cases had an open posterior capsule before the exfoliative material was first seen. This phenomenon has not been previously presented in the literature.

Aged↗

[Vitrectomy after intracapsular cataract extraction (author's transl)].

A report is given on transpupillar vitrectomy with the suction wedge for prolapse of the vitreous after intracapsular cataract extraction. From the results obtained this method can be recommended. In aphakic eyes with drawn up pupil the pupil should be cut out underneath after opening the anterior chamber. Also in this case vitrectomy must be performed before closure of the anterior chamber.

Anterior Chamber↗

Comparison of extracapsular and phaco-emulsification cataract extraction techniques when combined with intra-ocular lens placement and trabeculectomy: short-term results.

UNLABELLED: BACKGROUND METHODS: Fifty patients who had undergone combined extracapsular cataract extraction (ECCE), intra-ocular lens (IOL) placement and trabeculectomy (ECCE-trab) and 50 who had undergone combined cataract phaco-emulsification, IOL placement and trabeculectomy (phaco-trab) were reviewed over a period of 12 months. RESULTS: Postoperatively, intra-ocular pressure (IOP) in both eyes fell significantly (P < 0.005). Initially, IOP fell to roughly equal degrees (mean IOP being 14 mmHg at 3 months; P = 0.84). At 12 months, IOP in the phacotrab group was slightly lower than that in the ECCE-trab group (13.4+/-4.3 vs 15.4+/-4.4 mmHg, respectively; P = 0.0312). The number of pre-operative medications did not appear to affect outcome (P = 0.124). Visual recovery was approximately 3 months faster in the phaco-trab group. By 12 months there was little difference in visual acuity, with an average improvement of two Snellen lines (P = 0.68). The mean change in astigmatism was significantly less in the phaco-trab group (0.61+/-1.25 vs 1.39+/-1.46 D, respectively, P = 0.0063). Transient hypotony (IOP < 5 mmHg) was more frequent in the phaco-trab group (66 vs 32%, respectively; P < 0.002). The frequency of other complications was not significantly different between the two groups. CONCLUSION: Both ECCE-trab and phaco-trab procedures are safe and effective. However, the phaco-trab procedure may have slightly improved IOP control, earlier visual recovery and less astigmatism.

Aged↗

Small-incision manual extracapsular cataract extraction using selective hydrodissection.

Hydrodissection is a technique in which balanced salt solution is injected through a cannula into various layers of a cataractous lens to separate the lens lamella in a nonspecific location. Selective hydrodissection allows separation of the lens lamella at different desired anatomical layers. The technique allows the smallest possible nucleus, ie, the hard-core nucleus, to be hydroexpressed as a separate entity, requiring, correspondingly, a relatively small capsulorhexis and limbal incision. Then, in a second maneuver, the epinucleus, which engulfs the hardcore nucleus to form the adult nucleus, also can be aspirated or hydroexpressed as a whole. Selective hydrodissection permits scleral incision and stitchless surgery in planned extracapsular cataract extraction and also may serve as an intermediate step for surgeons who wish to convert to or learn phacoemulsification techniques.

Cataract Extraction↗

Mortality and causes of mortality among cataract-extracted patients. A 10-year follow-up.

PURPOSE: The purpose of this study was to compare the mortality among patients undergoing intracapsular cataract extraction to the mortality in a gender-and age-identical Danish reference population, and to compare the patients' primary causes of death to those in the general population. MATERIALS AND METHODS: We reviewed medical records of patients undergoing ICCE from January 1st 1984 to December 31st 1986 at the Department of Ophthalmology, Aalborg Hospital, Denmark. Information on the deaths of these patients was obtained from the Danish National Population Register. Information on mortality in Denmark was obtained from published statistics. RESULTS: We found an increased mortality among the patients with cataract with an SMR (standard mortality rate) of 1.12 (95% confidence interval 1.02-1.23). The slightly increased mortality was observed for both men and women and for all examined causes of death. CONCLUSION: The slightly increased mortality among patients with cataract may indicate a general deterioration of health for these patients.

Age Distribution↗

[Modification of the no-stitch technique in extracapsular cataract extraction by a single radial suture. Effect on postoperative astigmatism].

Self-sealing intrascleral wound construction with a trapezoidal 12-mm incision for extracapsular cataract extraction and implantation of a standard PMMA IOL with a 6.5-mm optical diameter using the no-stitch technique has been well established at our clinic since 1991. This technique allows cataract surgery in a nearly closed system. In consideration of our earlier results, the no-stitch technique was modified by a single perpendicular suture in the middle of the 12-mm incision to reduce postoperative induced astigmatism further. We examined 200 consecutive patients 6 months after surgery (no-stitch vs one-stitch wound closure). The preoperative average astigmatism was 0.86 +/- 0.68 D (1.01 +/- 0.95 D). Preoperatively 37% (47%) of the eyes had With the Rule Astigmatism and 47% (39%) Against the Rule Astigmatism. Six months after surgery 10% (8%) of the cases showed With the Rule Astigmatism and 72% (65%) Against the Rule Astigmatism. Induced astigmatism was stabilized to 1.43 +/- 0.87 D (2.11 +/- 1.43 D). Compared with sutureless wound closure, the one-stitch technique had no long-term effect on the axes of astigmatism but significantly diminished induced astigmatism about 0.5 D.

Astigmatism↗

Effect of cataract extraction on frequency doubling technology perimetry.

PURPOSE: To investigate the effect of cataract extraction on the results of frequency doubling technology (FDT) perimetry in healthy subjects. DESIGN: Single-center, prospective, case series. METHODS: We performed FDT threshold C20-1 and Humphrey Swedish Interactive Threshold Algorithm (SITA)-fast programs within 1 month before and 2 months after phacoemulsification in 52 consecutive nonglaucomatous patients. Global indexes, including mean deviation and mean sensitivity of FDT and mean deviation of SITA-fast, were compared before and after cataract surgery. Mean sensitivity of FDT at various visual field grid locations was also compared before and after cataract surgery, as were localized indexes of both FDT and SITA-fast. RESULTS: Mean deviation improved after cataract surgery in both FDT threshold (from -7.09 dB--2.16 dB) and SITA-fast program (from -6.14 dB--2.87 dB). The mean sensitivity at 17 grid locations when the FDT threshold program was used significantly improved postoperatively (from 19.6 dB-26.13 dB). Postoperative improvements in mean sensitivity were also significant at all different sectors, but there were no significant differences of improvement among them. Postoperative pattern standard deviations from FDT and SITA-fast did not differ significantly from their preoperative values. CONCLUSIONS: Cataracts induced a generalized reduction of sensitivity in FDT threshold as well as SITA-fast perimetry. Cataract removal did not change pattern standard deviation of FDT or of SITA-fast. Caution should be taken when interpreting the results of FDT perimetry in the eyes with cataract.

Algorithms↗

Cataract extraction: patient characteristics and preferences.

This paper reports the results of a comparative study of inpatient and day case patients undergoing a cataract extraction with intraocular lens implant. An assessment was made of their home circumstances, and included questions about their health and hobbies before and after surgery. The results show that patients were generally optimistic about their capabilities after the operation, and that most were pleased to have been randomly allocated to their particular group. There were no statistically significant differences between day cases and inpatients, suggesting a possibility of choice for patients within available resources.

Aged↗

Epidemiologic aspects of senile cataract extraction stratified by visual acuity, age, and sex.

A review of records for 221 patients 50 years old and older undergoing first cataract extractions showed that women constituted 64% of this population (142 cases). The men had a mean age of 70.8 years and the women a mean age of 71.8 years. This difference was not significant. Men had a significantly (P less than .05) better mean best corrected visual acuity preoperatively than women (20/100 vs 20/400). In the two younger groups (those aged 50 to 59 years and those aged 60 to 69 years), men also had significantly (P less than .05) better preoperative visual acuities.

Age Factors↗

Epidemiology of aphakic retinal detachment following intracapsular cataract extraction: a follow-up study with an analysis of risk factors.

We reviewed 604 eyes in 521 patients who had intracapsular cataract extraction. The follow-up period averaged 39 months. The incidence of rhegmatogenous aphakic retinal detachment (ARD) was 1.3% in the whole group. The ARD incidence was 1.0% in eyes without surgical complications and 5.4% in myopic eyes (myopia defined as an aphakic refraction less than or equal to +9.0 diopters). The log-rank test was used to estimate the statistical significance of various ARD predictors. Significant predictors were age at surgery below 70 years (P = .0004) and myopia (P = .001). Our results indicate that the high risk of ARD is concentrated in a small group of myopic patients operated on at a relatively early age. During the follow-up period, 128 patients died. Compared with the mortality rate of the entire Danish population, this was not an above average mortality rate. Thus, our results do not support the hypothesis that senile cataracts reflect general systemic deterioration rather than local eye disease.

Adult↗

[Cataract extraction and intraocular lens implantation in patients with uveitis].

Thirty two patients with uveitis had a posterior chamber intraocular lens implantation after extracapsular cataract extraction. After a mean follow-up period of 5.4 months (range 3 to 29 months), the corrected visual acuity in 93.7% of the patients reached to 0.5 or better. Postoperative complications included posterior capsule opacification and iris posterior synechiae. The results suggest that careful selection of candidates for IOL implantation be crucial for successful cataract surgery in uveitis patients.

Adolescent↗

Comparison of low- and high-volume irrigation-aspiration systems for extracapsular cataract extraction.

A low-volume irrigation-aspiration system with a 1-mm tip (0.3-mm aspiration port) has been developed for extracapsular cataract extraction. This autoclavable system uses approximately 36% less irrigating fluid during the irrigation and aspiration of cortical material when compared to currently available models. The time required for cortical aspiration is also shortened by 33%. After three years of clinical experience with the low-volume system at the Miami Veterans Administration Medical Center, where almost all extracapsular cataract surgery is now performed with the new system, there have been no adverse effects and subsequent capsulotomy has rarely been necessary.

Aged↗