SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
We report two cases of capsular bag contraction that occurred within 1 month after continuous curvilinear capsulorhexis, phacoemulsification, and intraocular lens implantation. Neither patient had a known risk for this complication. Both patients had a neodymium:YAG laser anterior capsulotomy, which disrupted the capsulorhexis margin and led to prompt capsular bag distension.
PURPOSE: To determine whether anterior vitrectomy is necessary along with primary posterior capsulorhexis in children less than 5 years of age with congenital cataracts. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHOD: This prospective study comprised 18 eyes of 16 children whose mean age was 2.3 years (range 3 months to 5 years). Primary posterior continuous curvilinear capsulorhexis (PCCC) and posterior chamber intraocular lens (IOL) implantation were performed in all eyes. No vitrectomy was done in 8 eyes (Group 1); an anterior vitrectomy was performed in 10 eyes (Group 2). Optic capture through the posterior capsule was achieved in 3 eyes in Group 1 and in 5 eyes in Group 2. Average follow-up was 13.3 months. RESULTS: Five eyes (62.5%) in Group 1 needed secondary pars plana vitrectomy because the visual axis was obscured; no eye in Group 2 needed a secondary procedure. Four Group 1 eyes developed significant complications (updrawn pupil, decentration, occlusio pupillae, transient glaucoma). While no Group 2 eye developed a serious complication, some degree of pigment dispersion was noted in all the eyes. CONCLUSION: The results suggest that anterior vitrectomy is desirable along with primary PCCC in children younger than 5 years with congenital cataracts.
We describe a method to enlarge an initial small capsulorhexis using an iris spatula and cystotome needle. The iris spatula is placed underneath the anterior capsulorhexis margin; the spatula supports the anterior capsule and protects the posterior capsule. A gentle touch on the spatula by the cystotome needle generates a break in the continuity. This is done prior to intraocular lens implantation with the capsular bag and anterior chamber filled with viscoelastic.
The Neuhann Capsulorhexis allows for a continuous, circular opening in the anterior lens capsule. After excavation of the lens matter the circular round edge in the anterior capsule provides maximum stability in the zonulolenticular diaphragm and facilitates controlled in-the-bag implantation of the lens haptic. Histologic studies of cadaver eyes have revealed that the correlation between the position of the lens loops as intended by the surgeon intraoperatively and their actual positioning is poor. It has therefore not been possible to prove the advantages of all-in-the-bag implantation as compared to sulcus fixation. The Neuhann Capsulorhexis reduces the morphological variability of the anterior capsule; furthermore, the position of the lens haptic can easily be determined both intraoperatively as well as postoperatively. This is a prerequisite for evaluating the best position for the lens haptic as well as for clinical evaluation of new types of intraocular lens.
Every cataract surgeon performing phacoemulsification has unintentionally damaged the posterior capsule. Thus he knows that the device is suitable for cutting the lens capsule. In recent years, I have performed various modifications of capsulorhexis with the aid of an ultrasound-guided cannula in all patients undergoing phacoemulsification. The following method proved to be practicable: The ultrasound-guided cannula is pressed on the lens capsule at 12 o'clock, thus opening the anterior capsule; the cannula is consecutively guided in two semicircular movements from 12 o'clock to 6 o'clock, and the anterior capsula is torn and cut open by directing the opening of the cannula toward the center of the pupil and simultaneously on the anterior capsula and away from the iris, thus making it possible to cut directly at the pupillary margin without damaging the iris. The anterior capsular tear has a smooth circular edge at the intersection of the two semicircles of the capsulorhexis, while a triangular flap directed towards the center of the pupil is often formed at 12 o'clock. At the end of phacoemulsification, the flap is aspirated with the suction rinsing device and cut off with a sharp cannula. This procedure simplifies and accelerates phacoemulsification.
Two patients developed cataract following iridocyclectomy for iris melanoma invading the angle. Although several clock hours of zonular fibers had been surgically resected, the use of a continuous, circular capsulorhexis followed by phacoemulsification maintained the integrity of the anterior capsular margin and allowed for stable "in-the-bag" placement of a posterior chamber intraocular lens (PC-IOL). Continuous, circular capsulorhexis is the optimal anterior capsulectomy procedure, minimizing the incidence of radial tears and the risk of subsequent PC-IOL decentration.
Continuous curvilinear capsulorhexis (CCC) has become a standard procedure in cataract surgery. In pediatric cataracts, however, this technique is difficult to perform. Because of the elasticity and tension of the pediatric anterior lens capsule the danger of radial tears is high. Similar conditions are found in the rabbit model. The anterior lens capsule of young albino rabbits is very elastic. We have developed a CCC technique in rabbits that allows a controlled round capsular opening. This technique was used in an experimental study with 16 rabbits (32 eyes). The mean capsulorhexis diameter was 4.9 +/- 0.9 mm. A radial tear occurred in only 2/32 cases. The technique permits a controlled circular anterior capsulectomy for capsules with high surface tension and elastic properties. This can readily be applied to human pediatric cases.
UNLABELLED: The capsulorhexis technique has become established as procedure of choice for anterior capsular opening in cataract surgery. With the spread of the method even relatively rare complications are gaining in importance. CASE: In a patient with cataract and multifocal chorioretinitis, phacoemulsification with implantation of a one-piece PMMA posterior chamber IOL through a capsulorhexis opening was performed without complications. Within a period of 3 months, shrinking of the anterior capsule led to complete occlusion of the anterior aperture. To our knowledge, no comparably severe finding has been reported. The anterior capsule was successfully opened by by means of Nd:YAG laser capsulotomy. However, improvement in visual acuity was limited by cystoid macular edema due to the basic condition. CONCLUSION: No relations with other systemic or eye diseases have yet been demonstrated. As another case report describes a similar--though less severe--combination of progressive constriction of the anterior capsule and inflammatory eye disease, the opening of the anterior capsule in such cases should be sufficiently large. If anterior capsular shrinkage has developed, Nd:YAG-laser capsulotomy is a low-risk method of therapy.
We undertook this study to determine the safe limits of capsulorhexis during nucleus expression in 40 eyes of patients undergoing extracapsular cataract extraction (ECCE) with a posterior chamber intraocular lens (PCIOL) implantation and in 30 cadaver eyes. In group I (patient eyes), capsulorhexis of 4.5 to 7.5 mm was performed and the nucleus was expressed by hydrodissection. The nuclei measured 4.5 to 9.0 mm. One relaxing incision at 12 o'clock position had to be placed in 9 patients. In group II (cadaver eyes), continuous curvilinear capsulotomies of 4.0, 4.5, 5.0, 5.5, 6.0 and 6.5 mm were made in 5 eyes each. No relaxing incisions were placed. In both the groups, nuclei of all sizes could be safely delivered through intact capsulotomies measuring 5.5 mm or more. In two patient eyes, posterior capsule rupture occurred with rhexis measuring 4.5 and 5.0 mm, respectively. In the cadaver eyes, intracapsular extraction occurred in 4 eyes with rhexis measuring 5.0 mm or less. We conclude that a rhexis less than 5.5 mm is not safe for nucleus delivery during ECCE.
The stretching capacity of continuous circular capsulorhexis (CCC) in 20 human cadaver eyes was determined. The increases in circumference of the tear opening ranged from 164. 5% to 190.9% and that in area of the opening ranged from 235.2% to 364.6%. If a proper technique of capsulorhexis is adopted, the nucleus of 7-9.5 mm in diameter and 3-4.5mm in thickness can be delivered through a CCC opening of 4-6mm in diameter by hydrodissection and hydroexpression of nucleus without capsular tear.
AIM: To assess the efficacy and safety of indocyanine green (ICG) 0.5% and trypan blue 0.1% for anterior capsule staining in cases of white cataract. METHODS: This prospective study comprised 55 eyes of 55 patients with white cataract that had phacoemulsification with foldable intraocular lens implantation. ICG in 30 eyes and trypan blue in 25 eyes were used under air to stain the anterior lens capsule. The staining patterns and the ease of creating a continuous curvilinear capsulorhexis (CCC) were assessed; the intraoperative and postoperative complications were noted. The mean follow-up was 17.68+/-1.65 months. RESULT: Either ICG or trypan blue stained the anterior capsule uniformly. However, the staining provided by trypan blue was slightly superior. A CCC was successfully achieved in 25 eyes (100%) with trypan blue, and 29 eyes (96.7%) with ICG, respectively. There was no significant postoperative reaction in any eye. CONCLUSION: The use of vital dyes such as ICG and trypan blue guarantees a complete CCC and makes it possible to deliver the benefits of phacoemulsification in the patients with white cataract.
Cataract surgery is the most commonly performed surgical procedure in the US, it consists of three steps: introduction of a hole into the lens capsule, removal of the clouded lens through this access hole, and insertion of an artificial lens. We hypothesize that errant behavior by the residual epithelial cells of the lens capsule following surgery are due, in part, to surgically-induced changes of the native stress and strain fields in the lens capsule. Because the capsular bag can be regarded mechanically as a membrane, here we study changes in curvature and strains due to the most common means of introducing the initial access hole: a continuous circular capsulorhexis (CCC). We show that a modest sized CCC increases circumferential strains and decreases meridional strains by up to approximately 20% and that curvatures change by up to approximately 13%, particularly near the edge of the CCC. We submit that such changes can induce mechanobiological responses that are responsible, in part, for some of the long-term complications following cataract surgery.
We describe a technique for creating a continuous curvilinear capsulorhexis (CCC) using an endoscope. Three 2.0 mm limbal incisions 120 degrees apart were made in 4 cadaver eyes. The anterior capsule was stained with trypan blue 0.1% (Vision Blue). Under endoscopic visualization, a CCC was attempted in each of the 4 globes. It was completed in 1 of them. Endoscopy provides a safe and effective tool to visualize the anterior chamber and perform a CCC when there is a poor view through the cornea.
Backward traction on the capsule flap forms the basis of a predictable technique for rescuing the capsulorhexis from a radial tear-out.
PURPOSE: To evaluate anterior capsule staining using 3 dyes to perform continuous curvilinear capsulorhexis (CCC) in postmortem human eyes with advanced/white cataract. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: In experimental closed-system surgery, CCC was performed in 12 postmortem human eyes with cataract after the anterior capsule was stained with 3 capsule dyes (fluorescein sodium 2%, indocyanine green [ICG] 0.5%, and trypan blue 0.1%). Two commonly used techniques for capsule staining were also compared: staining within an air bubble and intracameral subcapsular injection of dye. RESULTS: In all globes, CCC was uneventful using the 3 dyes and with both techniques. With the intracameral subcapsular injection, the dye remained trapped in the subcapsular space in contact with the posterior surface of the anterior capsule, allowing enough time to perform any maneuver. The staining provided by ICG, at the concentration used, was slightly superior to that of the other dyes. Leakage of fluorescein sodium into the vitreous cavity was seen using the Miyake-Apple posterior video/photographic technique. CONCLUSION: Intracameral subcapsular injection of ICG allowed the easiest recognition of the capsular flap by staining the posterior surface of the anterior capsule and without leaking into the vitreous cavity.
PURPOSE: To evaluate the use of 2 dyes for staining the posterior capsule to enhance visualization during posterior continuous curvilinear capsulorhexis (PCCC). SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Indocyanine green 0.5% (ICG) and trypan blue 0.1% were used to stain the posterior capsule for performing PCCC in 8 human eyes obtained postmortem. The eyes were prepared according to the posterior video technique of Miyake-Apple. After CCC and hydrodissection/delineation were performed, the nucleus was carefully delivered by hydroexpression. Cortical cleanup was completed by irrigation/aspiration. The posterior capsule was stained by instilling 1 microdrop of ICG (4 eyes) or trypan blue (4 eyes) in the capsular bag. A PCCC was then performed by 2 independent surgeons (4 eyes/surgeon) not familiar with this technique. Each surgeon also performed PCCC in 2 eyes without the use of dye. RESULTS: Both dyes facilitated the performance of PCCC after staining the otherwise transparent posterior capsule. It was easier to differentiate the stained posterior capsule flap from the underlying transparent anterior hyaloid phase of the vitreous. In addition, optic capture of an intraocular lens, with or without anterior vitrectomy, was easily accomplished because of the enhanced visualization by posterior capsule staining. CONCLUSIONS: Posterior capsule staining can be successfully used to learn and perform the PCCC procedure, combined with optic capture, anterior vitrectomy, or both.
We modified an inexpensive, easily prepared model using a postmortem pig eye for training ophthalmology residents to perform continuous curvilinear capsulorhexis. To reduce the tension and elasticity of the porcine anterior lens capsule, 0.05 mL of formalin mixed with hydroxyethylcellulose or a viscoelastic material is injected into the anterior chamber via the corneal limbus to fix the surface of the central anterior lens capsule of the pig eye in situ. One or 2 minutes after the injection, only the anterior lens capsule is fixed and corneal transparency is maintained. The reduction in tension and elasticity of the anterior lens capsule caused by its fixation increases the resemblance of the simulated cataract to the human cataract.
We describe a triple procedure combining corneal transplantation, cataract extraction, and intraocular lens implantation in which the continuous curvilinear capsulorhexis (CCC) is performed in a closed system when corneal transparency is sufficient or using an open-sky method when corneal transparency is poor. With the closed system, the CCC is performed first followed by trephination and hydroexpulsion of the nucleus. A Caporossi coaxial forceps is used to reduce the corneal incision to 1.2 mm, preventing the need for sutures. Tunnel formation, which could limit the size of trephination, is avoided. In addition, endothelial cell loss at the periphery of the recipient cornea is reduced. This technique was performed in 10 eyes without intraoperative complications. With the open-sky method, the CCC is created while counterpressure is applied to the center of the lens with a large spatula, reducing posterior pressure and thus the risk of capsule tear. This technique was performed in 9 eyes without intraoperative complications.