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PubMed1983

Indomethacin eyedrops and the postoperative irritation after extracapsular cataract extraction combined with intraocular lens implantation.

Indomethacin 0.5% solution eyedrops inhibit the prostaglandin effects after extracapsular cataract extraction combined with intraocular lens implantation. In a double-blind study Indomethacin was compared to Dexamethason and placebo using corneal thickness and iris vessel dilatation and leakage as parameters for postoperative irritation. The present evidence indicates that Indomethacin is an important additive medication to diminish the postoperative reaction.

Cornea↗
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↗
PubMed1996

Cataract extraction by phacoemulsification in situ and elliptical intraocular lens implantation.

OBJECTIVE: To investigate the technique of phacoemulsification in situ for cataract extraction and elliptical intraocular lens (IOL) implantation. METHODS: 60 eyes of 57 cases with cataract were included and the hardness of nucleus was grade-1-2 in 25 eyes, grade-3 in 27 eyes and grade-4 in 8 eyes. Tunnel incision was made and in situ phacoemulsification with elliptical (5 mm x 6 mm) IOL implantation was performed on all the cases. RESULTS: Phaco-spent-time was 45 seconds to 3 minutes 45 seconds (average 1 minute 52 seconds). Phacoemulsification in 53 eyes (88.3%) was successful in situ Visual acuities of 0.5 or better and 1.0 or better at postoperative one week were obtained in 75.0% and 56.7%, and at 1-12 month follow-up in 85.0% and 71.7% respectively. CONCLUSION: The technique of phacoemulsification in situ and elliptical IOL implantation is worthy to be spread due to minimum postoperative astigmatism and fast restoration of visual acuity.

Adult↗
PubMed2003

Validity and reliability of the Cataract TyPE Spec: an instrument for measuring outcomes of cataract extraction.

PURPOSE: To design and validate a survey instrument that measures vision-related functional status, which is appropriate for self-administration in a clinical practice and mail survey setting. DESIGN: Observational, validation study in sequential patients. METHODS: A prototype visual function instrument (the Cataract TyPE Spec) was developed based on focus group input and then validated in an outcomes study conducted among 1,823 patients who underwent cataract extraction performed by 22 surgeons at six centers in the United States. Reliability was determined by calculating Cronbach alpha for different types of administration (self-administration at the site of care and mailed survey) and across race and gender. Criterion validity was determined by correlating scores on the TyPE Spec with baseline measures and changes in visual acuity, overall rating of vision, and general quality of life. RESULTS: The instrument was internally valid (Chronbach alpha = 0.94), both on self-administration in the patient care setting and upon mailed survey administration and across patient race and gender. The TyPE Spec score was highly correlated with overall rating of vision (r =.54, P <.0001) and moderately correlated with Snellen acuity (r =.32, P <.0001), rating of vision in the better eye (r =.42, P <.0001), and quality of life, as measured by the physical component summary score of the SF-36 (r =.27, P <.001). Change in TyPE Spec similarly correlated with change in rating of vision overall, change in best-corrected Snellen acuity, and change in rating of vision in the operated eye. CONCLUSIONS: The cataract TyPE Spec instrument was found to be equally valid and internally consistent when administered in the patient care setting and by mail survey.

Adult↗
PubMed2005

Cataract extraction and primary hydrophobic acrylic intraocular lens implantation in infants.

PURPOSE: We sought to report the incidence of visual axis opacification and to evaluate the complication and reoperation rates after intraocular lens implantation in infants. METHODS: Twenty-one infants (31 eyes) who had cataract extraction with primary hydrophobic acrylic IOL implantation between October 1996 and May 2002 were reviewed. Posterior capsule was left intact in 14 eyes (group A); posterior capsulorrhexis or capsulotomy with anterior vitrectomy was performed in 17 eyes (group B). Complication and reoperation rates were compared with an age-matched control group of 17 patients (33 eyes) who were left aphakic after pars plicata lensectomy. Mean follow-up period was 41 months (range, 22-75 months) in group A, 37 months (range, 10-75 months) in group B, and 52 months (range, 7-97 months) in the control group. RESULTS: Mean age of the patients was 6.8 months (range, 3-10 months) in group A, 8.9 months (range, 3-18 months) in group B, and 4.9 months (range, 1-15 months) in the control group. Visual axis opacification was significantly higher in group A (86%) when compared with group B (17.6%; P < 0.0001). No significant difference was found in terms of pupillary irregularities and peripheral anterior synechiae formation between pseudophakic and aphakic group ( P = 0.43 and P = 0.306, respectively), whereas pigment dispersion and fibrinous reaction were significantly more common in the pseudophakic group ( P = 0.002). Serious complications, such as retinal detachment, pseudophakic bullous keratopathy, and secondary glaucoma, did not develop in any eye. Reoperation rate was significantly higher in group A (78%) when compared with group B (17%) and the control group (12%; P = 0.0011 and P < 0.0001, respectively). CONCLUSIONS: Visual axis opacification requiring a reoperation was significantly more common in patients with an intact posterior capsule. To decrease the reoperation rate and maintain a clear visual axis, posterior capsulorrhexis with anterior vitrectomy should be performed. Even although early complications were quite frequent, serious late complications were not encountered in any eye. Therefore, under appropriate conditions, IOL implantation is a suitable alternative in infants.

Acrylates↗
PubMed1994

Treatment of endophthalmitis after cataract extraction.

BACKGROUND: A series of 34 patients was prospectively treated for postoperative endophthalmitis according to a specific protocol. The data are from the pilot study performed before initiation of the Endophthalmitis Vitrectomy Study (EVS). METHODS: Patients with bacterial endophthalmitis that developed within 6 weeks of cataract extraction received intravitreal amikacin and vancomycin, subconjunctival and topical antimicrobials and corticosteroids, and systemic corticosteroids. All patients had diagnostic samples removed from the aqueous and vitreous, with randomized assignment to immediate vitrectomy versus vitreous tap and treatment with or without intravenous antibiotics. Outcome was evaluated 3 and 9 months after treatment. RESULTS: At the 9-month visit, visual acuity was 20/50 or better in 49% of all eyes, 20/200 or better in 79%, and 5/200 or better in 91%. Media clarity was such that a "20/40 or better view" of the retina was present in 71% of patients at 3 months and in 97% at 9 months. CONCLUSION: This is one of the largest series of patients with postoperative endophthalmitis treated and evaluated under a prospective protocol and without selection bias. Each of the options used in this study to treat postoperative endophthalmitis may result in good visual results.

Aged↗
PubMed1990

Extracapsular cataract extraction with keyhole capsulorhexis and lens epithelial cell removal.

Circular capsulorhexis with its round continuous anterior capsule opening allows secure fixation of a posterior chamber intraocular lens. The smooth capsular margin edge reduces stress concentration and the risk of radial tears but it makes nucleus delivery in planned extracapsular cataract extraction very difficult. This report describes a technique of small circular capsulorhexis with one relaxing incision that gives a keyhole-shaped capsular opening. A new irrigating capsule retractor for nucleus hydrodissection is also described. This technique is safe and highly reproducible and it allows secure posterior chamber lens fixation.

Cataract Extraction↗
PubMed1985

[Keratectomy and cataract extraction in Terrien disease].

In a 36-year-old patient with bilateral Terrien's disease, surgery to improve vision in the right eye, which was in Stage V, was no longer possible. In Stage III a thoroughgoing keratectomy parallel to the limbus was performed, in combination with cataract extraction and coreplasty. Even though Descemet's membrane was absent in the dystrophic corneal region, optimal healing was achieved by wound closure with a combination of biosutures, monofil sutures, and "Tissucol" biological tissue cement. The keratectomy reduced the corneal astigmatism from 11 to 4 D. With corrective lenses the patient regained a visual acuity of 0.4 in the left eye. The histological findings are discussed.

Adult↗
PubMed1993

Local anesthesia by peribulbar block for cataract extraction in an eye relief camp. A double-masked, randomized controlled trial.

OBJECTIVE: To test the hypothesis that the median scores for globe anesthesia are not significantly different for patients receiving local anesthesia (LA) by peribulbar block (PB) than for those receiving retrobulbar block (RB) for cataract surgery. DESIGN: Double-masked, randomized controlled trial. SETTING: An eye camp in Bhetwa, India, base hospital was King George's Medical College, Lucknow. (Eye camps are temporary set-ups used for cataract surgery throughout rural India.) Study carried out over a 2-day period. PATIENTS: Out of 125 patients eligible for intracapsular cataract extract on under LA, 122 agreed to enter the trial, and were randomly allocated to 2 groups just before the operation. The groups were equal in size and similar in composition in terms of patient age and sex. INTERVENTION: PB or RB infiltrated with 5 mL of the same anesthetic at the same site but with a different needle size and direction. MAIN OUTCOME MEASURES: Globe anesthesia (primary outcome), globe akinesia, lid akinesia, pupillary dilatation, and hypotony were scored separately on a 4-point scale during surgery by a masked surgeon. During infiltration, surgery, and the 1st 30 minutes after surgery, pain was scored by patients and recorded by an interviewer. RESULTS: Median scores for globe anesthesia were 4.0 in both groups, and the Mann-Whitney test revealed no difference in the medians of these scores (P = 0.6). There was no difference in scores on other outcomes measured, except lid akinesia, which was better with PB. Subjective pain scores were significantly higher with RB. The surgeon's guess about the type of LA administered was correct only for 58% of patients. CONCLUSION: PB is no different from RB in terms of producing globe anesthesia when used for cataract surgery at eye camps.

Aged↗
PubMed1996

A comparison of Healon and Amvisc on the early postoperative pressure after extracapsular cataract extraction with implantation of posterior chamber lens.

Two viscoelastic agents, Healon and Amvisc, both hyaluronic acids, were evaluated in two prospective, randomized and masked studies in order to compare the effects of the viscoelastics and timolol (Blocadren ) on the early postoperative intraocular pressure (IOP) after planned extracapsular cataract extraction with implantation of a posterior chamber lens. The study protocols were similar, especially with regard to the sample size, pre-, per- and postoperative management and sampling. The IOP was measured preoperatively, 3-6 and 24 h postoperatively. The testing of Amvisc revealed that aspiration or non-aspiration of Amvisc at the end of surgery was of little importance for the IOP, and that timolol significantly reduced the IOP 3-6 h postoperatively in the order of about 8 mmHg. The postoperative IOP was lower for Amvisc than for Healon only when the viscoelastic material was aspirated and topical timolol was administered. In all the other groups there were no significant differences between the viscoelastics as far as the postoperative pressure was concerned. Multiple regression revealed a marked pressure reducing effect of timolol 3-6 h postoperatively in both groups, but no effect was observed 24 h postoperatively. The two viscoelastic agents showed minor effect on the IOP both 3-6 and 24 h postoperatively.

Administration, Topical↗
PubMed1991

Routine use of a lateral approach to cataract extraction to achieve rapid and sustained stabilization of postoperative astigmatism.

After observing that lateral under-riding scleral pocket incisions and closures decayed very little and required full correction on the table to achieve the desired reduction in astigmatism, I began performing routine lateral approaches to planned extracapsular cataract extraction (ECCE). The result was an improvement in early and prolonged stabilization of keratometric astigmatism. This improvement was statistically significant when compared with the identical surgery performed in the vertical meridian. Using a 6.5 mm scleral pocket incision and the same suture material and closure technique, I found that the results of phacoemulsification via vertical and lateral approaches were not statistically different from the planned ECCE via lateral approach. Scleral pocket incisions and modified shoelace closures with 11-0 polyester suture were used in all cases; no suture removal was performed. The early visual recovery with planned ECCE via lateral approach was equivalent to that with phacoemulsification but did not require the expensive instrumentation or the "phaco learning curve." The minimal and stable postoperative astigmatism, along with early and sustained visual recovery possible with ECCE via lateral approach, may reduce the potential benefit of mini-incision and foldable intraocular lens surgery.

Aged↗
PubMed1998

[Hard nucleus cataract extraction by phacoemulsification with intraocular lens implantation].

OBJECTIVE: To investigate the technique of phacoemulsification for hard nucleus cataract extraction and evaluate its therapeutic effects. METHODS: Three methods of phacoemulsification, the improved divide and conquer, the reserve lens cortex spin and no lens cortex spin, were performed on 62 eyes according to the type of nucleus hardness. RESULTS: With foldable or 5.5 mm PMMA intraocular lens implantation, the improved divide and conquer phacoemulsification was performed on 26 eyes, the reserve lens cortex spin phacoemulsification on 23 eyes and no cortex spin phacoemulsification on 13 eyes. At postoperative 3 days, 5 days and 30 days, the visual acuities without correction 0.5 or better were obtained respectively in 46 eyes (74.2%), 60 eyes (96.8%) and 61 eyes (98.4%). The major complications were corneal edema and posterior capsular rupture. CONCLUSION: The technique of phacoemulsification for hard nucleus cataract is worthy to be spread due to safety, easiness and minimum complication.

Aged↗