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PubMed1993

Chronic postoperative endophthalmitis following cataract extraction and intraocular lens implantation. Report on nine patients.

Between 1987 and 1992, nine patients (three men and six women; mean age, 75 years) presented with chronic postoperative endophthalmitis after cataract extraction and intraocular lens (IOL) implantation. Eight patients were referred from another institution. The interval between IOL implantation and the beginning of intraocular inflammation averaged 5.6 months (range, 1-19 months). The referral diagnosis was "toxic lens" syndrome in seven patients. The main clinical findings were a hypopyon in the anterior chamber (n = 8) and in the capsule bag (n = 2), and "fibrosis" of the lens capsule (n = 7). In eight patients a vitrectomy was performed, combined with removal of the IOL in six cases and with a total posterior capsulectomy in five cases. Pathogenic organisms were identified in vitreous aspirate (6/8), in culture (3/3), and on histopathological examination (4/5) of lens capsule and included coagulase-negative staphylococci (n = 3, Staphylococcus epidermidis), Propionibacterium acnes (n = 1), Streptococcus viridans (n = 1), Rhodococcus erythropodes and R. luteus (n = 1), and one hyphomycete (Alternaria alternata). In chronic recurrent intraocular inflammations following IOL implantation, an infectious agent should be excluded by diagnostic and therapeutic pars plana vitrectomy including removal of the IOL and posterior capsulectomy.

Aged↗
PubMed1987

Effects of extracapsular cataract extraction on the lens zonules.

The zonules of 27 postmortem eyes were studied grossly using a histologic staining technique that allowed easy visualization of the zonules. Large disinsertions of the zonules were present in 5 of the 20 eyes that had undergone extracapsular cataract extraction (ECCE).

Cataract Extraction↗
PubMed2001

Blood-aqueous barrier breakdown after penetrating keratoplasty with simultaneous extracapsular cataract extraction and posterior chamber lens implantation.

BACKGROUND: The purpose of this study was to quantify breakdown of the blood-aqueous barrier (BAB) following penetrating keratoplasty (PK) with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure) and compare it with the alterations following PK only. METHODS: This study included 72 eyes after triple procedure and 227 eyes after PK only. The diagnosis for PK was Fuchs dystrophy in 39%, keratokonus in 44%, stromal corneal dystrophy in 3% and avascular corneal scars in 6% of cases. The postoperative topical steroid treatment was standardized in both groups. Aqueous flare was quantified using the laser flare-cell meter (FC-1000, Kowa) at defined postoperative intervals (10 days, 6 weeks, then every 3 months until 1 year postoperatively). Patients with conditions associated with impairment of the BAB were excluded from the study. RESULTS: In the early postoperative course, aqueous flare values (photon counts/ms) were significantly higher in patients with triple procedure (21.9 +/- 11.0) than in patients with PK only (9.8 +/- 3.2; P = 0.001). At 6 weeks postoperatively, aqueous flare returned to normal levels in patients after PK only (5.2 +/- 2.3), whereas patients with triple procedure still showed significantly increased flare values (10.8 +/- 5.6; P = 0.01). At 6 months postoperatively, aqueous flare values of patients with triple had returned to normal levels (6.8 +/- 3.8) and did not differ significantly from those after PK only (5.2 +/- 1.9; P = 0.09). CONCLUSION: Our results indicate that triple procedure causes a more extensive and longer-lasting breakdown of the blood-aqueous barrier than PK only. Quantification of aqueous flare with the laser flare-cell meter is useful in the postoperative follow-up after triple procedure. Further studies are required to investigate the clinical relevance of BAB breakdown on endothelial cell count and the incidence of subsequent immunological graft rejection.

Aqueous Humor↗
PubMed1993

Intraocular pressure after extracapsular cataract extraction with implantation of posterior chamber lenses.

To determine factors which influence postoperative intraocular pressure (IOP) we retrospectively reviewed changes in pressure during the first postoperative week in 633 consecutive eyes undergoing extracapsular cataract extraction (ECCE) with implantation of a posterior chamber lens. The material was restricted to four surgeons and two types of lenses. IOP was measured preoperatively, one day and one week after surgery. Glaucomatous eyes (n = 113) as well as exfoliative non-glaucomatous eyes (n = 79) had a higher mean IOP (27.8 and 26.1 mmHg) the first postoperative day compared to 'simple' cataract eyes (20.1 mmHg). After one week mean IOP in glaucomatous eyes still remained elevated while exfoliative non-glaucomatous eyes had regained preoperative values. Mean IOP on the first postoperative day (18.8, 24.5, 23.1 and 13.2 mmHg respectively) was also dependent on surgeon. To some extent the IOP could be correlated to tightness of suturing as estimated by keratometry. Only one surgeon had significant difference between irrigated and non-irrigated visco-elastic substance. Postoperative pressure was not only dependent on the status of the patient's eye, but factors for the individual surgeons seemed to be as important.

Adult↗
PubMed1996

Videokeratoscopy of recipient peripheral corneas in combined penetrating keratoplasty, cataract extraction, and lens implantation.

PURPOSE: We performed a prospective clinical trial to evaluate computerized videokeratoscopic analysis of the peripheral recipient cornea in intraocular lens power calculations for triple procedures: penetrating keratoplasty, cataract extraction, and intraocular lens insertion. METHODS: Patients with Fuchs' dystrophy underwent consecutive triple procedures. Surgery was performed in 16 eyes by a single surgeon (O.N.S.) using a single technique. If videokeratoscopic analysis disclosed dioptric powers greater than 40 diopters in the circumference of the corneal map, the surgeon's average postoperative central corneal power of 46 diopters was used with the regression formula. If dioptric powers less than 40 diopters were detected in the circumference of the corneal map, 45 diopters was used to avoid postoperative hyperopic shifts and to decrease deviation from intended refractive error. Refraction and videokeratoscopic analysis were performed six months after suture removal (18 to 24 months postoperatively). RESULTS: Analysis of covariance demonstrated that preoperative peripheral videokeratoscopic data of the recipient cornea correlated (P = .0001) with postoperative central corneal power, whereas preoperative central corneal power of the recipient cornea did not correlate (P = .35). Deviation from intended refraction (range, -2.54 to +1.22 diopters) was within 2 diopters in 14 eyes (88%) and within 3 diopters in all eyes. No patients had anisometropia greater than 3 diopters. CONCLUSION: Preoperative data from computerized videokeratoscopic analysis of the recipient peripheral cornea correlated with postoperative central corneal power, and improved postoperative refractive outcomes compared with previously reported results of triple procedures.

Cataract Extraction↗
PubMed2000

Peripheral ulcerative keratitis after clear corneal cataract extraction(1).

A previously healthy 80-year-old man had uneventful clear corneal cataract extraction. An extensive peripheral corneal infiltrate with overlying epithelial defect at the incision site was noted at the regular follow-up visit 1 week after surgery. Corneal cultures showed no evidence of infectious keratitis. A systemic evaluation uncovered early-stage, active rheumatoid arthritis. This case illustrates that peripheral ulcerative keratitis may occur with a small clear corneal incision and may be the presenting sign of a previously undiagnosed rheumatoid disease.

Aged↗
PubMedDate not supplied

[Laser magnetotherapy after cataract extraction with implantation of intraocular lens].

Effects of low-intensive laser and alternating magnetic field on the course of the postoperative period were studied in patients with exudative reaction after extracapsular cataract extraction with implantation of intraocular lens (IOL). The results are analyzed for 148 eyes with early exudative reaction after IOL implantation (136 patients aged 42-75 years). The patients were observed for up to 6 months. The treatment efficiency was evaluated by the clinical picture of inflammatory reaction, visual acuity, and results of biochemical analysis of the lacrimal fluid (the ratio of lipid peroxidation products to antioxidants in cell membrane). The course of the postoperative period was more benign and recovery sooner in patients of the main group in comparison with the control.

Adult↗
PubMed1990

Trial of a disc lens for intercapsular cataract extraction.

The preliminary results are presented of a prospective trial of a new 'disc' intraocular lens. (Pharmacia Model CD801A). Forty-four lenses were implanted into the capsular bag using an intercapsular cataract extraction technique. The lens is a one-piece all-polymethylmethacrylate (PMMA) lens with a 6 mm biconvex optic. The optic sits within a 9 mm diameter flexible PMMA ring. Two haptic stalks link this flexible haptic ring to the optic. The lens was assessed for its ease of insertion, its rate of decentration, the incidence of posterior capsular opacity and its effects on pupillary function. Results of the trial at three months follow-up are presented. They show that the lens is easy to insert into the capsular bag even through small pupils. It is very easy to dial, placing no stress on the bag when doing so. The incidence of decentration of 1 mm or greater was 5%, and the incidence of posterior capsular fibrosis at three months was 2%. As predicted, the lens sits well back in the eye, clear of the pupil.

Adolescent↗
PubMed1987

Morphological changes and lens position 2 1/2 years after intracapsular cataract extraction with implantation of a semiflexible anterior chamber lens. A prospective re-examination.

Morphological changes and lens position were examined in 51 patients 25 to 38 (mean 30) months after intracapsular cataract extraction (ICCE) with implantation of the semiflexible, 3M, style 70, anterior chamber lens. Morphological changes presumably associated with the ICCE proper were: iris transillumination defects (68.6%), rupture of anterior hyaloid membrane (20%), detachment of posterior vitreous (42.9%) and anterior synecchiae (13.7%). The implant-related morphological changes were caused by iris tucking (19.6%), small, mobile lenses causing endothelial disturbance (9.8%), iris-haptic adhesions and progressive ovalling of pupillary form. The present morphological changes were compared with a previously published examination of the same patients performed 4 months after surgery: 9 eyes without tissue changes around the lens feet at the previous follow-up now had iris-haptic adhesions involving from 1 to 4 lens feet. In 8 eyes the iris-haptic adhesions had progressed. Compared with the previous examination the fraction of eyes with tissue changes at the lens feet had risen from 47.1 to 64.7%, while the number of eyes with oval pupils had increased from 54.9 to 80.4%. Contact between lens haptic and iris root seems to constitute a constant stimulus for structural changes of the iris.

Aged↗
PubMed1991

Extracapsular cataract extraction and posterior chamber lens implantation in controlled open-angle glaucoma.

A consecutive series of 103 eyes, 37 with controlled simple glaucoma (SG) and 66 with capsular glaucoma (CG), underwent extracapsular cataract extraction (ECCE) and posterior chamber lens (PC-IOL) implantation. Two to 6 weeks after surgery, 48% of the SG eyes and 62% of the CG eyes had visual acuities better than 0.4, as compared with 8% and 3%, respectively, preoperatively. The corresponding figures after 12 to 43 months in the SG eyes were 62%, and after 14 to 38 months in the CG eyes, 55%. A slight increase of mean intraocular pressure (IOP), from 19.0 +/- 4.8 mm Hg to 25.3 +/- 13.3 mm Hg in the SG eyes, and from 19.0 +/- 3.9 mm Hg to 24.5 +/- 9.6 mm Hg in the CG eyes occurred 1 to 2 weeks after surgery; at 2 to 6 weeks the mean IOPs had returned to preoperative levels: 18.1 +/- 6.4 mm Hg in the SG eyes and 18.4 +/- 5.9 mm Hg in the CG eyes. After a mean of 26.5 months (range, 12 to 43 months), IOP had decreased to 17.3 +/- 2.9 mm Hg in the SG eyes; and after 24.2 months (range, 14 to 38 months) to 17.6 +/- 5.7 mm Hg in the CG eyes. The need for glaucoma medication was diminished at 2 to 6 weeks after surgery: IOP was controlled (less than 21 mm Hg) without glaucoma medication in 43% of the SG, and in 50% of the CG eyes (preoperatively, all of the SG and 89% of the CG eyes required medication).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Visual rehabilitation of adult patients after unilateral cataract extraction].

The influence of correcting soft contact lenses and pleoptic-orthoptic exercises on the improvement of the visual acuity and acquiring of binocular vision was analyzed in 22 patients aged 17-65 years after unilateral cataract extraction. Visual acuity of between 5/5 and 5/16 was attained in 88.6 p.c. of patients, binocular vision in 85.9 p.c. Poorer results were observed in persons with a diminished transparency of the ocular media caused by injury as well as in younger individuals after congenital cataract surgery.

Adolescent↗