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PubMed2000

Penetrating keratoplasty for keratoconus: a long-term review of results and complications.

PURPOSE: To study the long-term complications of penetrating keratoplasty (PKP) to evaluate current recommendations to patients with keratoconus. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Retrospective study of all PKP procedures for keratoconus performed by 4 surgeons during a 312 year period. Follow-up was 1 day and 1, 3, 6, 12, and 24 months post-PKP. Data from 93 eyes were reviewed for allograft reaction, astigmatism, visual acuity, reasons for decreased visual acuity, and other complications. RESULTS: Allograft reaction was seen in 31% of cases but no graft failure due to allograft reaction. Mean astigmatism was 2.76 diopters (D) +/- 1.99 (SD) at 24 months, with only 15% > 5.00 D. Last best corrected visual acuity was 20/25 or better in 77% of cases (87% had 20/25 or better at some time during follow-up). Complications that did not cause decreased visual acuity were noted. Punctate keratitis was noted in 20% of patients 180 days or more after surgery. CONCLUSIONS: Penetrating keratoplasty is a good treatment option for patients with keratoconus but should be reserved for those who do not tolerate contact lenses or do not get needed visual acuity with contact lenses because of complications. This procedure has become a second-line treatment for keratoconus patients and has generally good results.

Astigmatism↗
PubMed2000

Protecting the retina during MemoryLens insertion.

BACKGROUND: To determine the light-scattering power of the folded MemoryLens(R). SETTING: Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA. METHODS: The focusing power of 10 unfolded MemoryLenses (Mentor Ophthalmics) was measured using an optical bench. The IOLs were then unfolded in a 37 degrees C distilled water bath and reexamined within 15 seconds of removal from the bath. Resolutions were read after the lenses were dried for 1 hour and cooled to room temperature and again after they were rehydrated and reheated in the water bath. RESULTS: In the rolled state, all lenses diffused the illumination of the light source. After the IOLs were unfolded in the water bath at 37 degrees C, they gave readings of acceptable to high resolution. After the lenses were air dried for 1 hour and cooled to room temperature, the resolution of all lenses decreased. However, after the IOLs were rehydrated and reheated for 1 more hour, resolution was similar to that of the original hydrated lenses. CONCLUSION: When folded, at a low temperature, or dehydrated, the MemoryLens may provide protection from the operating microscope by scattering light.

Eye Burns↗
PubMed2001

Identification of free radicals produced during phacoemulsification.

PURPOSE: To detect, identify, and quantitate free radicals produced during conditions similar to phacoemulsification cataract surgery. SETTING: Research laboratory at the Biotechnology Center, Utah State University, Logan, Utah, USA. METHODS: All experiments were performed using a Series Ten Thousand phacoemulsifier (Alcon Laboratories) modified to make a 10 mL continuous circulation loop (to increase sensitivity). The irrigating solution was passed through a 3 mL chamber in line with the circulation loop, and electron spin resonance spin trapping methods were used to detect, identify, and quantitate free radical production during phacoemulsification. As an additional indication of hydroxyl radical production, the hydroxylation of salicylate and thiocyanate was detected by high-performance liquid chromatography and spectrophotometry, respectively. RESULTS: The hydroxyl radical was formed when phacoemulsification was performed in the presence of solutions containing spin trap in double deionized water or balanced salt solution (BSS). Hydroxyl radical production was linear with respect to phacoemulsification time. Production of the hydroxyl radical was not observed when phacoemulsification was performed with anaerobic solutions, indicating a requirement for oxygen in radical production. The concentration of trapped hydroxyl radical was reduced in the presence of balanced salt solution with bicarbonate, dextrose, and glutathione (BSS Plus). Upon phacoemulsification, both salicylate and thiocyanate underwent hydroxylation when included in the irrigating solution, confirming the generation of the hydroxyl radical. Additional tests discounted the formation of superoxide or hydrogen peroxide during phacoemulsification. CONCLUSIONS: Hydroxyl radical was produced by phacoemulsification in the presence of aerobic solutions. Hydroxyl radical production was dependent on the presence of molecular oxygen and was not generated as a result of the homolytic cleavage of water. The amount of hydroxyl radical detected was directly proportional to phacoemulsification time and was reduced in the presence of BSS Plus. Other reactive oxygen species such as superoxide, hydrogen peroxide, and ozone were not detected during phacoemulsification under these conditions.

Acetates↗
PubMed2001

Glistenings in the AcrySof intraocular lens: pilot study.

PURPOSE: To evaluate the prevalence, severity, and visual significance of glistenings seen in the AcrySof intraocular lens (IOL) and determine whether a large in-depth study of this lens is warranted. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Patients who had the AcrySof IOL implanted at 1 institution over the past 4 years were serially selected. Forty-two eyes that had phacoemulsification with implantation of the AcrySof IOL were evaluated. The examination consisted of visual acuity, glare, contrast sensitivity, and dilated fundus and dilated slitlamp evaluations. Glistenings in the IOL were graded at the slitlamp from trace to 4+. RESULTS: All 42 IOLs had some degree of lenticular glistenings. The glistenings were graded as trace in 27 IOLs (64%), 1+ in 5 (12%), 2+ in 5 (12%), 3+ in 3 (7%), and 4+ in 2 (5%). The Snellen acuity in eyes with severe glistenings (> or = 2+) was one-half line lower than in eyes with mild glistenings (+) (P =.01). In all eyes, the Brightness Acuity Tester score was a little more than one-half line lower than the Snellen acuity, and the difference was 1 full line in eyes with glistenings graded above 2+. Fourteen of 15 IOLs (93%) with glistenings graded greater than trace had been in the eye for more than 1 year. There was no evidence that contrast sensitivity was affected by the glistenings. CONCLUSIONS: Glistenings occurred frequently in AcrySof IOLs, with most cases mild. A larger study of this lens is needed to determine whether severe presentations affect visual function and to understand how glistenings change over time.

Acrylates↗
PubMed2000

Postoperative sterile endophthalmitis (TASS) associated with the memorylens.

PURPOSE: To report 10 cases of delayed-onset acute intraocular inflammation following cataract extraction and posterior chamber implantation of the MemoryLens(R) intraocular lens (IOL). SETTING: John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA. METHODS: This retrospective study evaluated 10 cases of postoperative inflammation that occurred after cataract extraction with placement of the posterior chamber MemoryLens IOL. Protocols of the Intermountain Ocular Research Center used to analyze outbreaks of unexplained postoperative inflammation as well as medical records were reviewed. RESULTS: Nine patients had uneventful cataract extraction and 1 had a small anterior capsule tear with placement of the MemoryLens IOL. All 10 patients presented with increased anterior segment inflammation a mean of 7.8 days (range 1 to 21 days) after surgery. Three cases were tapped and were culture negative, and 7 were presumed noninfectious. The anterior segment inflammation improved in all patients. Treatment of the 7 patients included intensive topical steroids. Careful analysis of the inflammation has not revealed an obvious etiology; however, the MemoryLens was associated with all the cases. CONCLUSIONS: We postulate that these cases of noninfectious postoperative endophthalmitis may be associated with the MemoryLens.

Adult↗
PubMed2001

Patient satisfaction after uneventful cataract surgery with implantation of a silicone or acrylic foldable intraocular lens. Comparative study.

PURPOSE: To compare patient satisfaction with vision 12 months after implantation of a silicone or acrylic foldable intraocular lens (IOL). SETTING: John A. Moran Eye Center, University of Utah Medical Center, Salt Lake City, Utah, USA. METHODS: Selection criteria included patients who had uneventful cataract extraction by phacoemulsification with a temporal clear corneal incision or superior scleral tunnel incision, a curvilinear capsulorhexis, and in-the-bag IOL placement. One hundred sixty-two patients surveyed had a mean follow-up of approximately 15 months (range 12 to 18 months). Patients were divided into 3 groups of 54 each based on IOL type: AMO SI-30/40, Alcon MA30BA, and Alcon MA60BA. All patients were surveyed over the telephone using a standardized questionnaire protocol. They were questioned about their perception of vision with best optical correction in relation to visual blurring symptoms, glare symptoms, night vision, near vision, and overall vision. RESULTS: There were no significant differences in patient satisfaction among the 3 IOL groups in visual blurring or night vision. Patients in the SI-30/40 and MA60BA groups reported significantly higher satisfaction with glare symptoms, near vision, and overall satisfaction than patients in the MA30BA group. CONCLUSION: The SI-30/SI-40 and the MA60BA IOLs received significantly higher patient satisfaction scores than the MA30BA IOL in glare symptoms, near vision, and overall satisfaction.

Acrylic Resins↗
PubMed2001

Laser in situ keratomileusis with the VISX Star laser for myopia over -10.0 diopters.

PURPOSE: To evaluate the efficacy, predictability, stability, and safety of laser in situ keratomileusis (LASIK) for myopia over -10.00 diopters (D). SETTING: The Eye Institute of Utah, Salt Lake City, Utah, USA. METHODS: The prospective study included 332 eyes of 183 patients having LASIK with the VISX Star laser to correct myopia of -10.00 to -18.00 D. The eyes were divided into 3 groups according to the preoperative refraction: Group A (n = 208), -10.00 to -11.90 D; Group B (n = 94), -12.00 to -14.00 D; Group C (n = 30), -14.10 to -18.00 D. The mean follow-up was 12.0 months +/- 5.6 (SD) (range 6 to 37 months). RESULTS: Overall, the mean spherical equivalent decreased 96%, from -11.69 +/- 1.46 D preoperatively to -0.37 +/- 0.80 D postoperatively. The mean astigmatism decreased 72%, from 1.66 +/- 1.22 D to 0.46 +/- 0.53 D. At the last visit, 84.0% of eyes were within +/-1.00 D of emmetropia and 96.4% were within +/-2.00 D. An overcorrection of more than +1.00 D was experienced by 1.8% of patients. The uncorrected visual acuity (UCVA) was 20/20 or better in 45.8% of eyes and 20/40 or better in 89.5%. Six eyes (1.8%) lost 2 or more lines of best corrected visual acuity; this included 1 eye in which iatrogenic keratectasia developed 18 months after LASIK retreatment. Retreatment was done in 37.0% of eyes at a mean of 6.3 +/- 5.3 months (3 to 32 months) after the initial treatment. At the last examination, 86.0% of eyes in Groups A and B and 70.0% in Group C were within +/-1.00 D of emmetropia. A significant difference was found between Groups A and C (P =.032). The UCVA was 20/20 in 52.0% of Group A eyes, 38.0% of Group B eyes, and 23.0% of Group C eyes. The difference between Groups A and C was significant (P =.001), but the difference between Groups A and B was not (P =.055). CONCLUSIONS: In this study, LASIK was effective in correcting myopia up to -14.00 D. The efficacy, predictability, and safety were significantly less in eyes with myopia greater than -14.00 D.

Adult↗
PubMed2002

In vitro comparison of glistening formation among hydrophobic acrylic intraocular lenses(1).

PURPOSE: To compare glistening formation induced by temperature stressing in vitro among hydrophobic acrylic intraocular lenses (IOLs) available in the United States. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Wagon Wheel (WW) packaged 1-piece AcrySof IOLs (Alcon), WW-packaged 3-piece AcrySof IOLs, and Sensar IOLs (Allergan Medical Optics) were analyzed in vitro for 5 consecutive days. Ten IOLs of each type were inserted into viewing chambers filled with balanced salt solution, maintained at 37 degrees C, and evaluated every 24 hours at 37 degrees C and then, after a 2-hour cooling, at room temperature. The IOLs were examined by slitlamp to quantify glistenings and by digital photography to determine glistening size. RESULTS: The glistening quantity was minimal and did not differ among IOL types at 37 degrees C. The glistenings were smallest in the 1-piece AcrySof IOLs (P <.001): 6.3 microm versus 11.5 microm in the Sensar and 13.4 microm in the 3-piece AcrySof. Upon cooling, the glistening quantity increased dramatically in the 1-piece AcrySof IOLs (P <.008) and was the highest among the IOL types at room temperature (P <.001). The mean glistening size was 7.7 microm. The 3-piece AcrySof IOLs showed a significant decrease in slitlamp-countable glistenings but acquired a dense haze seen as minute glistenings (4.0 microm) at x80 magnification. The glistening quantity in the Sensar IOLs was fairly stable upon cooling; a statistical increase was seen on the last day (P =.007). Cooling nearly doubled the size of the Sensar glistenings, which were the largest at room temperature, 21.7 microm (P <.001). CONCLUSIONS: Glistening quantity varied among hydrophobic acrylic IOLs and was temperature dependent. Sensar IOLs were more stable than the 2 other IOL types. The glistening phenomenon must be studied further to eliminate the problem.

Acrylic Resins↗
PubMed2002

Three-year clinical comparison of 3-piece AcrySof and SI-40 silicone intraocular lenses.

PURPOSE: To compare the 3-year performance of the 3-piece AcrySof (Alcon) and the SI-40 silicone (Allergan) intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: In this retrospective study, patients with no complications and at least a 3-year follow-up after IOL implantation were examined for signs of inflammation, visual function, posterior capsule opacification (PCO), and satisfaction. RESULTS: One hundred eleven patients were enrolled with equivalent visual acuity, inflammation, and PCO parameters. The AcrySof eyes had less anterior capsule opacification and more intralenticular inclusions than the other group. Complete anterior capsule overlap was associated with decreased PCO, and significantly more SI-40 eyes had complete anterior capsule overlap. CONCLUSIONS: The second-generation silicone IOL was equivalent to the 3-piece AcrySof in patient satisfaction, visual function, inflammation, and PCO. The amount of anterior capsule overlap on the IOL may help to explain the study differences.

Acrylic Resins↗
PubMed2003

Laser in situ keratomileusis for consecutive hyperopia after myopic LASIK and radial keratotomy.

PURPOSE: To evaluate and compare the efficacy, predictability, and safety of hyperopic laser in situ keratomileusis (H-LASIK) for the correction of consecutive hyperopia after myopic-LASIK (M-LASIK) and radial keratotomy (RK). SETTING: The Eye Institute of Utah, Salt Lake City, Utah, USA. METHODS: Seventy-seven eyes of 64 patients were studied. The eyes were divided into 2 groups based on the prior refractive procedures: in Group A (n = 34), H-LASIK was performed for overcorrection after M-LASIK and in Group B (n = 43), for overcorrection after RK. All eyes were included in the analysis of intraoperative and postoperative complications. Only eyes with a minimum follow-up of 6 months were included in the analysis of visual and refractive results. Among these 66 eyes, 30 were in Group A and 36 were in Group B. The mean follow-up in these eyes was 12.34 months +/- 5.95 (SD) (range 6 to 33 months). RESULTS: Overall, the mean spherical equivalent (SE) was +1.88 +/- 0.91 diopters (D) preoperatively and -0.37 +/- 0.65 D at the last visit. Eighty-three percent of eyes were within +/-1.00 D of emmetropia, and 66% were within +/-0.50 D. The uncorrected visual acuity (UCVA) was 20/20 in 39% of eyes and 20/40 or better in 92% of eyes. The preoperative SE was +1.43 +/- 0.59 D in Group A and +2.26 +/- 0.96 D in Group B; the difference in the preoperative SE was significant (P=.001). However, there was no statistically significant between-group difference in postoperative refraction and UCVA. One eye in Group B (3%) lost 2 or more lines of best corrected visual acuity. Corneal ectasia developed in 1 eye in Group B 11 months after H-LASIK. A sliver occurred in 1 eye in Group A after the flap was recut. CONCLUSION: Hyperopic LASIK was equally effective and predictable in treating consecutive hyperopia after overcorrected M-LASIK and overcorrected RK. The safety of the procedure in the RK group appeared to be inferior to that in the M-LASIK group. Although vision-threatening complications are rare after H-LASIK retreatment, corneal ectasia developed in 1 eye in the RK group.

Adult↗
PubMed2003

Implantation of a single-piece, hydrophilic, acrylic, minus-power foldable posterior chamber intraocular lens in a rabbit model: clinicopathologic study of posterior capsule opacification.

PURPOSE: To compare the extent of posterior capsule opacification (PCO) after implantation of a standard-power biconvex Centerflex intraocular lens (IOL) and a newly introduced biconcave high-minus-power Centerflex design in rabbit eyes. SETTING: The Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, and the David J. Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah, USA. METHODS: Twelve rabbits had phacoemulsification and implantation of 2 foldable single-piece hydrophilic acrylic Centerflex posterior chamber IOLs. The right eyes received a standard-power (+21.00 diopters [D]) biconvex-optic lens and the left eyes, a minus-power (-7.00 D) biconcave-optic IOL. Formation of PCO was evaluated 3 weeks after surgery using the Miyake-Apple posterior photography technique. Histological sections from each globe were prepared to analyze capsular bag status and assess postsurgical intracapsular lens epithelial cell (LEC) proliferation, especially ingrowth of LECs across the visual axis. The data were analyzed using the Kruskal-Wallis 1-way analysis of variance for nonparametric measurements and the Mann-Whitney rank sum test. RESULTS: There was no significant difference in Soemmering's ring formation between the 2 IOL models. The biconcave minus-power IOL showed significantly lower central and peripheral PCO scores than the biconvex standard-power lens (P<.05). Pathological evaluations revealed that the effective site of blockage of LECs was at the truncated optic edge of both lenses, even in the presence of retained and/or regenerative cortical material. CONCLUSIONS: This study confirms the efficacy of a truncated IOL optic in helping reduce the incidence of PCO. Both IOL designs have optic geometries that create clear-cut barrier effects. However, the biconcave minus-power IOL, which has a thicker, square, truncated optic edge with a ridge that encircles the periphery of the optic for 360 degrees, appears to have an enhanced barrier effect, especially at the optic-haptic junction. This further minimizes the ingrowth of migrating LECs toward the visual axis.

Acrylic Resins↗
PubMed2004

Clinical experience with 21-gauge manual microphacoemulsification using Sovereign WhiteStar Technology in eyes with dense cataract.

PURPOSE: To present a series of patients who had 21-gauge microphacoemulsification using Sovereign WhiteStar technology. SETTING: John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah, USA. METHODS: Eighteen consecutive patients with cataracts judged to be 3+ or 4+ on a 4-point scale were prospectively monitored for complications, energy used during phacoemulsification, and results 1 day and 3 months postoperatively. RESULTS: No complications occurred during nucleus removal. On a 4-point scale, the mean level of inflammation at 1 day was 0.9 +/- 0.5 (SD), with 13 patients having no corneal edema. Seven patients had an uncorrected visual acuity of 20/40 or better on the first postoperative day. At 3 months, all corneas were clear, there was no sign of anterior chamber inflammation, and all patients had a best corrected visual acuity of 20/25 or better (best-case analysis). CONCLUSION: Results show that 21-gauge microphacoemulsification with Sovereign WhiteStar technology is safe and effective for removal of hard cataracts.

Cataract↗
PubMed1997

Clear lens extraction to correct hyperopia.

PURPOSE: To evaluate the effectiveness and safety of clear lens extraction with intraocular lens (IOL) implantation to correct hyperopia and to determine the most accurate and predictable method of IOL power selection. SETTING: The Eye Institute of Utah, Salt Lake City, Utah, USA. METHODS: The outcome of 20 phacoemulsification and IOL implantation procedures was assessed at a mean follow-up of 23.2 months (range 3 to 60 months). Intraocular lens power and predicted refraction were retrospectively evaluated in each eye with the SRK II and Holladay formulas with different attempted refractions based on the stabilized postoperative refraction. RESULTS: Uncorrected visual acuity (UCVA) improved from 20/200 preoperatively to 20/30 postoperatively. At the final examination, 89% of eyes achieved 20/40 or better UCVA. All eyes had 20/25 or better best corrected visual acuity (BCVA). No eye lost two or more Snellen lines of BCVA. There were no surgical or postoperative complications. The Holladay formula was more accurate than the SRK II formula. With the Holladay formula aiming for -1.00 diopter (D), the predicted mean postoperative spherical equivalent would be -0.21 D +/- 0.89 (SD); with the SRK II aiming for -1.50 D, it would be +0.43 +/- 1.10 D. The Holladay formula reduced the chance of postoperative residual hyperopia. CONCLUSION: Clear lens extraction with IOL implantation was an effective, safe procedure for the correction of hyperopia. However, this method was less accurate and less predictable for hyperopia below +3.00 D. With the Holladay formula aiming for -1.00 D, good visual and refractive results can be expected. Further study with a larger sample of patients and longer follow-up is needed to assess long-term safety and effectiveness.

Adult↗
PubMed1998

In vitro analysis of AcrySof intraocular lens glistenings in AcryPak and Wagon Wheel packaging.

PURPOSE: To compare the formation of "glistenings" in acrylic intraocular lenses (IOLs) packaged in Wagon Wheel and AcryPak packaging systems. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Acrylic IOLs in Wagon Wheel (WW) and AcryPak (AP) packaging were analyzed in vitro. The lenses were placed in a test chamber with a controlled temperature and evaluated every 48 hours for 336 hours. The presence of glistenings within the lens optic was assessed using slitlamp evaluation and a quantitative microscopic evaluation with an image analysis system. RESULTS: When maintained at a constant temperature, the WW-packaged IOLs showed no glistening formation and the AP-packaged IOLs, significant glistening formation. Glistenings were noted in the WW-packaged IOLs only under fluctuating temperature conditions. Quantitative image analysis confirmed the presence of glistenings only in AP-packaged IOLs maintained at a constant temperature. CONCLUSION: The glistenings in AcrySof IOLs were temperature dependent and confined to IOLs packaged in AcryPak folders and maintained at constant (body) temperatures. These findings are believed to be consistent with fluid formation within the acrylic optic, somehow related to the AcryPak packaging system.

Acrylates↗
PubMed1998

Prospective evaluation of topical versus retrobulbar anesthesia: a converting surgeon's experience.

PURPOSE: To evaluate and compare the efficacy of topical versus retrobulbar anesthesia for cataract surgery performed by a surgeon newly converting to the topical technique. SETTING: Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Ninety patients were prospectively assigned by permuted block restricted randomization to receive topical (Group 1; n = 45) or retrobulbar (Group 2; n = 45) anesthesia. Group 1 received topical bupivacaine 0.75% and intravenous midazolam and fentanyl for anesthesia. Group 2 received intravenous methohexital followed by retrobulbar block with an equal mixture of lidocaine 2% and bupivacaine 0.75% plus hyaluronidase 150 units. A visual pain analog scale was used to assess the degree of pain during anesthesia administration and surgery and postoperatively. The degree to which eye movement, touch, and light caused patient discomfort was assessed. Intraoperative conditions and complications were recorded. RESULTS: Intraoperative operating conditions were significantly better in Group 2 (P < .05). There was a small but statistically significant difference in the degree of discomfort during anesthesia administration and surgery (P < .05). There was no difference in postoperative discomfort. Chemosis, subconjunctival hemorrhage, and eyelid hemorrhage occurred only in Group 2, in which there was one retrobulbar hemorrhage. Although eyelid squeezing and ocular motility were present more frequently in Group 1, neither was a problem to the surgeon. CONCLUSION: Cataract surgery was safely performed by a surgeon converting to topical anesthesia. After a distinct learning curve, the procedure was performed with minimal patient discomfort. Surgical training and patient preparation are the key to safe use of topical anesthesia.

Administration, Topical↗
PubMed1999

Comparison of the effects of viscoelastic agents on clinical properties of the Unfolder lens injection system.

PURPOSE: To evaluate the effect of 7 viscoelastic materials on the physical properties of the Unfolder lens injection system. SETTING: John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah, USA. METHODS: New sterile SI-40NB intraocular lenses (IOLs) were loaded into the Unfolder (AMO PhacoFlex II SofTip insertion system (Allergan) using 7 viscoelastic materials: sodium hyaluronate 1.0% (Healon, Provisc), sodium hyaluronate 1.4% (Healon GV), sodium hyaluronate 1.6% (Amvisc Plus), hydroxypropyl methylcellulose 2.0% (Occucoat), sodium chondroitin 4.0%--sodium hyaluronate 3.0% (Viscoat), and hyaluronate 3.0% (Vitrax). The IOLs were then injected after 10 or 120 seconds in the chamber (chamber dwell time) and 10, 60, or 180 seconds in the barrel of the Unfolder cartridge (barrel dwell time). Torque values (g/cm) required to extrude the lenses were measured with a torque gauge, and the cartridges and IOLs were inspected for damage. RESULTS: Longer chamber dwell times resulted in lower torque values to extrude the IOLs (P < .001). Conversely, longer barrel dwell times resulted in higher torque requirements for IOL extrusion (P < .001). Furthermore, rates of adverse events, such as nondelivery, IOL damage, or Unfolder cartridge damage, were higher with shorter chamber dwell times and longer barrel dwell times (P < .001). However, IOL damage was avoided when the manufacturer's recommended chamber and barrel times were used. CONCLUSION: Increasing chamber dwell time and decreasing barrel dwell time resulted in lower torque values to extrude IOLs from the Unfolder and increased successful use. Moreover, dispersive viscoelastic agents tended to be more forgiving of changing dwell times and therefore had lower torque values and adverse event rates overall.

Chondroitin↗
PubMed2000

Incision width after phacoemulsification with foldable intraocular lens implantation.

PURPOSE: To determine the incision size after insertion of foldable intraocular lenses (IOLs) using both a forceps and injectors. SETTING: Intermountain Ocular Research Center, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: One hundred patients had phacoemulsification through a clear corneal wound. The incision width was measured before and after IOL implantation. A 3-piece silicone IOL and a 3-piece acrylic IOL (both with an optic diameter of 5.5 mm) were inserted using a forceps. A plate-haptic silicone lens and a 3-piece silicone lens with a 6.0 mm diameter optic were inserted using an injector. RESULTS: The wound size in the group with the 3-piece silicone lens inserted with a forceps enlarged 4.4% (3.23 to 3.38 mm) in the low-power IOL group (15.0 to 20.0 diopters [D]) and 6.2% (3.24 to 3.44 mm) in the high-power IOL group (20.5 to 25.0 D). Similarly, the acrylic IOL wound enlarged 5% (3.21 to 3.37 mm) in the low-power IOL group and 6% (3.25 to 3.44 mm) in the high-power IOL group when a forceps was used. The 3-piece silicone and plate silicone lenses inserted using an injector enlarged the wound 3.2% and 3.3% (3.02 to 3.11 mm and 3.05 to 3.15 mm), respectively. There was no difference in the wound size with higher IOL powers in eyes with injected lenses. CONCLUSIONS: Clear corneal incisions enlarge after insertion of foldable IOLs in a predictable manner, with a forceps-inserted IOL enlarging the wound diameter more than lenses inserted with an injector. The forceps-inserted lens group also showed a difference in wound size related to IOL power.

Acrylic Resins↗
PubMed2000

Cross-sectionally derived hysterectomy prevalence for correcting uterine and ovarian cancer incidence rates and probabilities.

PURPOSE: This paper presents a cross-sectional method for deriving age-specific hysterectomy prevalence. The influence of hysterectomy prevalence on uterine and ovarian cancer incidence rates and probabilities is illustrated.METHODS: Hysterectomy prevalence estimates are derived from cross-sectional data using a life table method. Analysis is based on hysterectomy data from the Utah Hospital Discharge Data Base and cancer cases recorded by the Utah Cancer Registry, 1995-1997.RESULTS: Correction for hysterectomy prevalence increases cancer incidence rates, more so at older ages, such that by ages 85 and older the increase is 92% for uterine cancers of the cervix and corpus, and 17% for ovarian cancer. Over the life span, correction for hysterectomy prevalence increases the estimated number per 100,000 developing these diseases by 195 (from 603 to 798) for uterine cervical cancer, 1,553 (from 2,580 to 4,133) for corpus uterine cancer, and 911 (1,674 to 2,585) for ovarian cancer.CONCLUSIONS: The utility of the cross-sectional method for deriving hysterectomy prevalence is that it does not require several years of data to obtain reasonable estimates. Correction for hysterectomy prevalence has a large effect on the cancer rates and probabilities, providing a more accurate representation of the risk and burden of these cancers.

Journal Article↗