[Outpatient treatment of postcataract using the neodymium-Yag laser].
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Aphakia, Postcataract↗
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A quality assessment of aphakic correction.
An assessment of the quality of care being provided to meet the needs of postcataract aphakes for refractive correction is presented. The procedure used was a review of patient records originally developed for inpatient care but was here applied to outpatient care in a centralized health facility. This paper demonstrates the feasibility and value of this method of quality assessment.
Adult↗
[Increase in the intraocular pressure in postcataract surgery using a neodymium YAG laser].
In a prospective clinical study 54 postcataract membrane dissections (51 patients) were performed using a Q-switch Nd-YAG laser. Under standardized conditions all patients were pretreated with prostaglandin inhibitors and received topical steroids and beta-blockers in low concentrations, as well as carbonic anhydrase inhibitors orally. The changes in visual acuity and the response of IOP to total energy input were analyzed. There was no statistically significant correlation between postoperative rise in IOP and total energy input. The clinical relevance of the results is discussed.
Adult↗
Recent developments in ophthalmology. Advances in correction of the optical problems of the postoperative cataract patient.
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Aphakia, Postcataract↗
Visual outcomes following lensectomy and vitrectomy for combined anterior and posterior persistent hyperplastic primary vitreous.
OBJECTIVE: To determine the visual outcome after surgery for persistent hyperplastic primary vitreous using modern vitreoretinal techniques. DESIGN: Retrospective medical record review during a 5-year period (June 1992 to June 1997). Information recorded for each patient included age, medical history, sex, results of preoperative ocular examination, age at diagnosis, procedure performed, intraoperative and postoperative complications, location and number of sclerotomy sites, type of aphakic rehabilitation, amblyopic therapy given, final visual acuity, and length of follow-up. RESULTS: Fourteen patients who underwent surgical management of combined anterior and posterior persistent hyperplastic primary vitreous were identified. Eleven patients underwent aphakic rehabilitation and aggressive amblyopic therapy consisting of occlusive therapy for several waking hours each day. One additional older patient received aphakic rehabilitation only. Ten eyes (71%) achieved a visual acuity of 20/300 or better, and 8 (57%) obtained a final visual acuity of 20/100 or better. Average length of follow-up was 22 months (range, 4-57 months). Nine patients were fitted with an aphakic soft contact lens, 2 older patients had a posterior chamber intraocular lens placed at the time of vitrectomy, and 1 patient wore aphakic spectacles. CONCLUSIONS: With modern vitreoretinal techniques, aphakic rehabilitation, and aggressive amblyopic therapy, useful vision can be obtained in the majority of patients with combined anterior and posterior persistent hyperplastic primary vitreous.
Amblyopia↗
Correlation of epinephrine use and macular edema in aphakic glaucomatous eyes.
One hundred twenty-eight consecutive aphakic glaucomatous eyes of 91 patients were examined by fluorescein angiography. Macular edema was present in 16 (28%) of 56 eyes currently being treated with epinephrine and 9 (13%) of 72 eyes not currently being treated with epinephrine. This difference is statistically significant at the 95% confidence level. Epinephrine therapy was discontinued in seven eyes with macular edema. A follow-up of these patients for six months to one year with serial anglograms showed resolution of edema in six of seven eyes. In one eye without macular edema, administration of epinephrine was associated with appearance of edema. Discontinuing epinephrine therapy was associated with resolution of edema. No significant correlation was found between use of other antiglaucomatous medications and macular edema. It is evident from this study that there is statistical support for the concept of an epinephrine-induced macular edema.
Adult↗
Retinal detachment in the second eye.
Bilateral retinal detachment (RD) occurred in 13% of 737 patients, with an interval between detachments of up to 30 years. Bilateral RD was more common in male patients and in those having more than 3 diopters of myopia. Detachment in the second eye was caused by retinal breaks in previously observed degeneration in 43% and in unsuspected diseased retina 57%. A significant number of patients with bilateral RD had multiple breaks. Aphakic RD occurred in bilateral RD and in unilateral RD patients at a comparable frequency; 28% of bilateral (mean duration, four years) and 35% of unilateral aphakic RDs occurred within one year of cataract surgery. Symptoms from retinal breaks were not reliable prognostic factors; only 39% of patients had warning before RD. Patients with bilateral RD had more reoperations with fewer successes, factors suggesting greater severity than unilateral RD.
Adolescent↗
Clinical evaluation of the 6600 Autorefractor.
The 6600 Autorefractor was evaluated on 200 patients undergoing refraction. The automatic refractor showed a high degree of accuracy in determining the needed refractive correction, but the errors are sufficient that the automatic refractor alone without subjective refinement cannot be substituted for conventional complete refracting methods with subjective refinement. However, for aphakic patients and for patients with clear media and cylindric corrections over 0.50 diopters, the automatic refractor can be used as a substitute for retinoscopy in determining the starting point for a subjective refraction.
Adolescent↗
Transplant size and elevated intraocular pressure. Postkeratoplasty.
Elevated intraocular pressure after keratoplasty is a well-recognized phenomenon both in aphakia and in combined lens extraction and penetrating keratoplasty. Ninety-two consecutive cases of penetrating keratoplasty procedures were studied. These were randomly assigned to group A or B. Group A received a donor transplant 0.5 mm larger than the recipient bed. Group B received donor buttons equal in size to the recipient bed. Intraocular pressure was measured preoperatively and daily until the patients were discharged. Group A, which had aphakic penetrating keratoplasty or the combined procedure (0.5-mm larger button), also had significantly lower intraocular pressures (P less than .001) than group B (same size button). There was no difference in postoperative intraocular pressure between groups A and B for those who had phakic penetrating keratoplasties. A larger donor size can alleviate induced "aphakic keratoplasty glaucoma."
Aged↗
Aphakic keratoplasty. Determining donor tissue size to avoid elevated intraocular pressure.
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Aphakia, Postcataract↗
Determinants of graft clarity in penetrating kerotoplasty.
A total of 240 consecutive penetrating keratoplasties with a minimum six months' follow-up were examined to determine the influence of preoperative prognosis, donor age, death-enucleation time, death-surgery time, and surgical experience on graft clarity. Graft results, classified as clear, nebulous, or edematous, were compared within two prognostic categories in aphakic, combined, and phakic keratoplasty groups. Preoperative prognostic groups and surgical experience appeared to be most important in affecting graft clarity, whereas the donor age, death-enucleation time, and death-surgery time seemed to have little effect.
Age Factors↗
The lens and pars plana vitrectomy for diabetic retinopathy complications.
Major cataracts developed in 28 of 168 eyes during the six months after pars plana vitrectomy for complications of diabetic retinopathy. In only ten of these cases did the cataract influence the visual results. The visual acuities of the phakic and aphakic eyes six months after vitrectomy were almost identical. Rubeosis iridis occurred in 23% of the phakic eyes and 45% of the aphakic eyes, with the difference being related to the loss in the aphakic eyes of a protective barrier lens quality. However, this same barrier quality increased the incidence of postoperative opaque vitreous hemorrhage from 8% of the aphakic eyes to 21% of the phakic eyes. Corneal epithelial edema at surgery occurred in 55% of those eyes that had lens removal combined with vitrectomy, but in only 36% of those that retained their lenses, and the difference was caused by the increase in operative time and procedure.
Adult↗
Drainage of microspheres and RBCs from the vitreous of aphakic and phakic eyes.
The movements of plastic microspheres (7 to 10 mu in diameter) and autologous RBCs labeled with sodium chromate Cr 51 from the vitreous to the anterior chamber were studied in 24 rabbit eyes. Rabbits were made aphakic in one eye by intracapsular lens extraction of lensectomy via the pars plana, the fellow eyes serving as phakic controls. In phakic eyes the intravitreally injected microspheres and RBCs were retained inside the vitreous space, not gaining access to the anterior chamber. In aphakic eyes microspheres and RBCs moved to the anterior chamber and were usually seen on the corneal endothelium and in the chamber angle within two to ten days, although most particles remained in the vitreous for long periods of time. Removal of the lens thus improved forward drainage of particles from the vitreous space, but the structure of the vitreous seemed to preclude rapid clearance.
Animals↗
Epithelialization of the anterior chamber: clinical investigation with the specular microscope.
Four patients, each of whom had had an uncomplicated cataract extraction, were examined because of an apparent epithelialization of the anterior chamber. In each instance, the diagnosis was later verified histopathologically. The involved eye was photographed with the clinical specular microscope and the endothelial photomicrographs were analyzed. It was noted that considerable endothelial cell loss had occurred, as evidence by the larger size of the remaining cells. Endothelial cells were present but they were grossly abnormal well below the demarcation line visible with the slit-lamp biomicroscope. These in vivo observations support the thesis that damage to the corneal endothelium is a necessary factor for epithelial invasion of the anterior chamber.
Aged↗
360 degrees prophylactic cryoretinopexy. A clinical and experimental study.
Complications occurred after 360 degrees prophylactic cryoretinopexy in three of six eyes in which fellow eyes had previously developed aphakic retinal detachment. Two of the six prophylactically treated eyes developed retinal detachment in advance of anticipated cataract surgery, and a third developed vitreitis and progressive preretinal membrane formation after uncomplicated cataract extraction. In an experiment study with rhesus monkeys, preretinal membrane formation was produced by administering heavy freezes with 360 degrees cryoretinopexy. Although the quantities of cold were considered excessive for clinical use, the cryoretinopexy used clinically in this series must also be considered excessive. The use of 360 degrees cryoretinopexy in the management of eyes at high risk for retinal detachment must be considered judiciously. Particular caution must be exercised in administering cryoretinopexy to nondetached retinas so as to avoid heavy freezes, which destroy the linear retinal layers.
Aged↗
Argon laser photocoagulation of the ciliary processes in cases of aphakic glaucoma.
A new procedure for the treatment of uncontrolled aphakic glaucoma has been the subject of a carefully conducted prospective clinical trial in 14 patients. The study spanned more than five years. The transpupillary argon laser photocoagulation of the ciliary process procedure, done on an outpatient basis, shows promise as a convenient, low-risk, and useful alternative procedure in selected aphakic glaucoma cases that are poorly controlled by medical or surgical measures. This new approach may also be used as an adjunct in the medical and/or surgical management of aphakic ciliary block glaucoma. The magnitude of intraocular pressure reduction is directly related to the number of ciliary processes coagulated and the level of laser energy applied. The indications for this new procedure are generally similar to that of the cyclocryotherapy.
Adult↗
Anterior ischemic optic neuropathy. IV. Occurrence after cataract extraction.
Findings are described from 13 eyes in which post-cataract-extraction anterior ischemic optic neuropathy (PCE-AION) developed immediately after an uncomplicated cataract extraction. During the early stages of the disease, the disc is edematous, with optic disc-related visual-field defects, but after about two months, the disc is pale. The almost invariable high rise of intraocular pressure during the immediate postoperative period plays a critical role in production of PCE-AION in eyes with vulnerable optic nerve head circulation. There is a high risk of development of PCE-AION in the second eye in patients with PCE-AION in the first eye, but this can be prevented by prophylactic measures. Post-cataract-extraction AION needs to be differentiated from ordinary AION seen in aphakic eyes months or years after the cataract extraction.
Adult↗
Aphakic cystoid macular edema in children.
Twenty-five eyes of 18 pediatric patients (aged 7 1/2 months to 14 years 8 months) who had had cataract extractions were examined for evidence of cystoid macular edema (CME) with fluorescein angiography. No patient showed CME when studied from five weeks to four years after surgery. One patient with Peter's anomaly, glaucoma, and chronic iridocyclitis had intense fluorescence of the aqueous and vitreous that precluded evaluation of the macula. Even if this patient is assumed to have had CME, its incidence in our population of aphakic pediatric patients was no more than 4%.
Adolescent↗