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PubMed1979

Updated concepts in extracapsular pseudophakia: posterior chamber pseudophakia.

Some concepts regarding posterior chamber pseudophakia have been set forth. Clearly, this is still investigational, and it is for that reason that I would urge the readers to exercise great judgement and wait for the results of laboratory testing of this rhetorical hypothesis. Currently, I am proceeding most patiently with posterior chamber pseudophakia in Rhesus monkeys using the Harris-McGhan lens, the Praeger suture style modification, and the Shearing posterior chamber lens. The ultimate answers will probably be answered over a due course of time in the human subject, but suffice it to say that the scientific approach to this problem must first be meticulously studied by the ocular histopathologist after surgery has been accomplished in primates. If, after an adequate trial with primates, the ocular histopathologist establishes this to be a safe and effective technique, then a conservative study should be undertaken wherein a number of humans will have this procedure done using different types of lenses by surgeons familiar with the lens and technique.

Aged↗
PubMed1999

Symptomatic aniseikonia in unilateral and bilateral pseudophakia. A projection space eikonometer study.

PURPOSE: To determine the incidence of aniseikonia and aniseikonic symptoms in pseudophakia (intraocular lens implantation after cataract extraction). METHOD: Aniseikonia, stereoacuity, and clinical symptoms were evaluated in patients with unilateral and bilateral pseudophakia. Aniseikonia was determined with the Essilor projection space eikonometer. Eight-seven cases were studied, fifty-four of unilateral pseudophakia and thirty-three of bilateral pseudophakia. Nine of the 87 patients had insufficient stereopsis to be examined or measured for aniseikonia with the Essilor instrument, and were studied with the "Double-D", a two dimensional "direct comparison eikonometer" device programmed and viewed on a computer. Stereoacuity was determined with the Titmus Stereo Test. RESULTS: Thirty-five (40.2%) of all pseudophakes had ophthalmic complaints referable to aniseikonia. The mean aniseikonia in the unilateral pseudophakia group was 4.1%, SD=3.41, while the mean aniseikonia in the bilateral group was 3.2%, SD=2.6. CONCLUSION: Symptomatic aniseikonia is common in pseudophakia. Unilateral pseudophakia has the higher degrees of aniseikonia, and is at a greater risk of loss of binocularity and of asthenopia.

Adult↗
PubMed1988

Colour discrimination in pseudophakia.

A study was undertaken to examine the colour discrimination of fifty pseudophakic patients and to compare results with fifty age matched normal observers. Using the Farnsworth-Munsell 100-Hue test and Desaturated panel D15, performance does not differ significantly from the age matched normals, although a theoretically superior colour discriminative ability might be expected in pseudophakia. A slight trend for increasing error scores with advancing age in pseudophakia lends some support to the importance of neural factors in the ageing of colour discrimination. Several other factors influencing colour vision in pseudophakia are discussed.

Aged↗
PubMed1984

[Pseudophakia and the pupil].

Postoperative disturbances of the pupil are discussed on the basis of experience with more than 2500 intraocular lenses implanted after extracapsular cataract extraction (planned extracapsular or phacoemulsification). Apart from the changes to the pupil caused by an iris-fixed intraocular lens itself, the pupil may also be affected by blood, fibrinous inflammation, or remnants of cortex material or the anterior capsule after posterior chamber lens implantation. These conditions are frequently followed by synechiae between the pseudophakia and the iris. Mechanical damage to the iris or the sphincter muscle may also occur. Changes in the shape of the pupil often affect its function, and synechiae do so regularly. Secondary cataract necessitating treatment occurred in about 10% of our patients over a 7-year period. Today, YAG laser surgery represents the best means of restoring clarity to the pupil, though there are still a number of unresolved problems with the method. Neither primary nor secondary capsulotomy after pseudophakia implantation can be recommended. The methods of extracapsular cataract extraction with posterior chamber lens implantation are still at a stage of development which is not altogether satisfactory, since optic irregularities of the pseudophakia or the central posterior capsule may result in glare, disturbing the patient in spite of good visual acuity.

Cataract Extraction↗
PubMed1999

Latanoprost accelerates disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema in early postoperative pseudophakias.

OBJECTIVE: To study the effect of latanoprost, a prostaglandin analog, on the blood-aqueous barrier and angiographic cystoid macular edema (CME) formation in early postoperative pseudophakias. PATIENTS AND METHODS: Included in the study were eyes with ocular hypertension, normal-tension glaucoma, or primary open-angle glaucoma undergoing surgery for cataract. The study consisted of a randomized double-masked trial for latanoprost and an open-label controlled trial for determining the effects of diclofenac sodium or fluorometholone eyedrop use on latanoprost or its placebo. We compared 4 groups of eyes with concurrent application of latanoprost and diclofenac (group A), latanoprost and fluorometholone (group B), latanoprost placebo and diclofenac (group C), and latanoprost placebo and fluorometholone (group D). A laser flare cell meter was used to determine the severity of blood-aqueous barrier disruption, and fluorescein angiography was performed to determine angiographic CME formation. Mean diurnal intraocular pressure differences were compared on the preoperative baseline day and in the fifth postoperative week. Latanoprost (0.005%) or its placebo was given once a day starting 2 days before surgery until the fifth postoperative week. Diclofenac or fluorometholone eyedrops were given 4 times a day before surgery on the day of surgery and 3 times a day until the fifth postoperative week. RESULTS: In group B compared with group D, the amount of flare 3 days and 1 and 2 weeks after surgery and the incidence of angiographic CME in the fifth postoperative week were significantly higher. These 2 factors were significantly higher in group B than in group A (P < .05) and in group D than in group C (P < .01). There was no significant difference in these factors between groups A and C. The intraocular pressure decline was significant in groups A and B compared with groups C and D (P < .05), but there was no significant difference between groups A and B and between groups C and D. CONCLUSIONS: Latanoprost therapy enhances disruption of the blood-aqueous barrier and increases the incidence of angiographic CME formation in early postoperative pseudophakias. Because administration of nonsteroidal eyedrops such as diclofenac seems to prevent the adverse effects of latanoprost therapy while maintaining its effect to lower intraocular pressure, we suggest their concurrent application.

Aged↗
PubMed2001

Enhanced disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema by topical timolol and its preservative in early postoperative pseudophakia.

OBJECTIVE: To investigate the effects of timolol maleate with preservative and its preserved (PV) and nonpreserved vehicles (NPV) (benzalkonium chloride) on the blood-aqueous barrier and angiographic cystoid macular edema (CME) in early postoperative pseudophakia. PATIENTS AND METHODS: Patients with ocular hypertension, normal tension glaucoma, and primary open-angle glaucoma who underwent surgery for cataracts. The study included a double-masked trial for timolol, PV, and NPV and a single-masked trial on the effect of diclofenac sodium and fluorometholone acetate on all three. The patients were divided into 6 groups, each of which were simultaneously administered the following different combinations of compounds: timolol and diclofenac (group A), timolol and fluorometholone (group B), PV and diclofenac (group C), PV and fluorometholone (group D), NPV and diclofenac (group E), and NPV and fluorometholone (group F). The 6 groups were then compared using a laser flare cell meter to determine the degree of disruption of the blood-aqueous barrier and fluorescein angiography to investigate angiographic CME. The differences in mean daily fluctuations in intraocular pressure were compared on the preoperative baseline day and for 5 weeks postoperatively. Twice daily administration of 0.5% timolol maleate or the vehicles was started 2 days before surgery, and continued until 5 weeks after surgery. Diclofenac or fluorometholone drops were instilled in the eyes 4 times preoperatively, on the day of surgery, and 3 times daily for 5 weeks postoperatively. RESULTS: The flare amount was higher on the third and seventh days in group B than in group D, but was the same after the seventh day. The incidence of angiographic CME was the same between both groups. These 2 factors were significantly lower in group F. These 2 factors were also significantly lower in the 3 groups that received diclofenac instead of fluorometholone, with no difference among these groups. The intraocular pressure decline was significant in groups that received timolol compared with groups that received PV or NPV. CONCLUSIONS: Timolol and its preservative, benzalkonium chloride, cause disruption of the blood-aqueous barrier in early postoperative pseudophakia and increased incidence of angiographic CME. The concurrent administration of nonsteroidal anti-inflammatory drug such as diclofenac prevents these adverse effects without interfering with the drop in intraocular pressure caused by timolol. The addition of benzalkonium chloride to timolol contributes considerably to these adverse effects. CLINICAL RELEVANCE: The present results suggest the cause of similar complications produced by other antiglaucoma eyedrops containing similar preservatives.

Administration, Topical↗
PubMed2005

Strabismus in pediatric pseudophakia.

OBJECTIVE: To evaluate strabismus associated with pediatric pseudophakia. DESIGN: Retrospective case series. PARTICIPANTS: Charts of 94 pediatric patients who underwent cataract extraction with primary intraocular lens implantation from 1990 to 2003 at Indiana University School of Medicine were reviewed. Only those patients who had pre-cataract extraction and post-cataract extraction alignment measurements were included. METHODS: Data were collected on gender, race, age at presentation, age at time of cataract surgery, and type of cataract. Pre-cataract extraction and post-cataract extraction data on visual acuity (VA), alignment, and amblyopia were recorded. Results of strabismus surgery were also evaluated. MAIN OUTCOME MEASURES: Frequency, type and amount of strabismus, and results of strabismus surgery. RESULTS: Ninety-four pediatric pseudophakia patients were identified, and 37 (39%) had strabismus. Exotropia (46%) was more common than esotropia (41%). Factors not associated with the development of strabismus included age at presentation, interval between diagnosis and cataract extraction, race, and type of cataract. Factors statistically associated with the development of strabismus include pre-cataract extraction and post-cataract extraction VA, type of strabismus, and post-cataract extraction amblyopia. The mean pre-cataract extraction deviation of the group that had strabismus surgery was 22 prism diopters, and 75% were aligned at the last examination (mean follow up, 24 months). CONCLUSION: Strabismus occurs more frequently in pseudophakic pediatric patients than in the general pediatric population. Pseudophakic children should be monitored carefully for the development of strabismus, which in many cases can be successfully treated.

Adolescent↗
PubMed1999

Minus-power intraocular lenses to correct refractive errors in myopic pseudophakia.

PURPOSE: To evaluate the effectiveness of a secondary, piggyback, minus-power intraocular lens (IOL) to correct the refractive error in patients with myopic pseudophakia. METHODS: In this prospective noncomparative cohort study, 51 myopic pseudophakic patients received implantation of a minus-power IOL as a secondary procedure to correct residual pseudophakic myopia. RESULTS: The mean residual myopia of -3.05 diopters (D) was reduced to -0.38 D. All eyes were within +/- 1.00 D of the desired refraction. Uncorrected visual acuity was 20/40 or better in 72% of eyes, and best corrected visual acuity was 20/40 or better in 96%. Uncorrected visual acuity improved by 2 or more lines in 85% of eyes and by 5 or more lines in 65%. CONCLUSION: Clinical outcomes can now be improved in patients with myopic pseudophakia whose previous options (i.e., lens exchange or refractive surgery) were more traumatic or less predictable.

Aged↗
PubMed2003

Trabeculectomy with or without mitomycin-C for paediatric glaucoma in aphakia and pseudophakia following congenital cataract surgery.

PURPOSE: To evaluate the safety and efficacy of trabeculectomy with or without mitomycin-C (MMC) in the management of glaucoma in aphakia and pseudophakia following congenital cataract surgery. PATIENTS AND METHODS: All patients of glaucoma with aphakia or pseudophakia who underwent trabeculectomy with or without MMC from January 1989 to April 2000 were included. The medical records of 19 consecutive patients (23 eyes) were reviewed. Data collected from a retrospective chart review were analysed. Outcome measures were evaluated using Kaplan-Meier survival analysis. Pre- and postoperative intraocular pressures (IOPs), visual acuities, success rate, bleb characteristics, surgical failure and complications were the main outcome measures. Successful IOP control was defined as an IOP between 6 and 21 mmHg, without antiglaucoma medications, without further antiglaucoma surgery and without any sight-threatening complication. RESULTS: The mean age of patients was 8.8+/-5.5 years at the time of trabeculectomy with MMC compared to 11.0+/-12.4 years for trabeculectomy without MMC. Eight patients underwent trabeculectomy with MMC and 11 patients underwent trabeculectomy without MMC. There was no statistically significant difference between the two groups in terms of visual acuity, IOP, antiglaucoma medications, age at cataract surgery and at trabeculectomy. The IOP reduced from a preoperative level of 34.2+/-8.9 mmHg (range: 20-52) to a postoperative level of 18.4+/-12.2 mmHg (range: 2-60) with a mean follow-up of 24.2+/-17.9 months. The mean reduction in IOP in the MMC group was 15.5+/-17.3 and 16.3+/-13.8 mmHg in the other group (P = 0.967). Overall, complete success was achieved in 36.8%, qualified success in 21.1% and surgical failure in 42.1% of patients with a mean follow-up of 24.2+/-17.9 months. There was no difference in the success between the two groups at the last follow-up. One patient developed bleb-related endophthalmitis in both eyes following trabeculectomy with MMC. CONCLUSIONS: The success rate of trabeculectomy in glaucoma following congenital cataract surgery was 36.8% at the end of 3 years. The present study proves a poor success rate of trabeculectomy in a small series of aphakic Asian Indian patients even with the use of MMC.

Adolescent↗
PubMed2000

[Ocular axial length and refractive changes in pediatric pseudophakia].

PURPOSE: To evaluate the ocular axial length and refractive changes that occured in children who had cataract extraction with intraocular lens implantation and to investigate the factors that influenced the pseudophakic refraction. METHODS: A review of 12 eyes in 10 children (mean age 7.16 years, range 3.83 to 10.16 years) who had cataract extraction with intraocular lens implantation was undertaken. Patients were followed for an average of 35.8 months. The preoperative and the last postoperative axial length and corneal curvature (K readings) in both operated and unoperated eyes were measured. The distance from the vertex of the cornea to the anterior vertex of intraocular lens (AVpc) was measured in the final follw-up. The initial (in two weeks) and the last refractive status of pseudophakia were examined. Overall age at surgery averaged 7.16 years (range 3.83 to 10.16 years), with followed up of 35.8 months. RESULTS: In the 12 operated eyes, the mean axial growth was 0.39 mm, whereas in the other eight unoperated eyes it was 0.66 mm. Though the axial length of both eyes increased significantly after surgery (P < 0.05), there was no significant difference in the postoperative increase of axial length between the two groups(P > 0.05). In K readings, there was no significant difference between the operated and unoperated eyes before surgery and in the last follow-up respectively. There was no significant difference between the preoperation and the last follow-up in the operated and the unoperated eyes respectively. The average calculated AVpc (AVpc2) was 4.66 30 mm, but the average objective AVpc (AVpc1) measured with ultrasonic biometry was 3.83 mm. The average difference between them was 0.8320 mm and was significant (P < 0.01). According to SRK formula, using preoperative and the last postoperative axial length and corneal curvature to predict refractive changes, the myopic shift was -1.53 D, but the average objective refractive difference between the last and initial examination after surgery was -3.86 D. The average difference between the predicted and actual postoperative refractive changes was significant (P < 0.05). CONCLUSION: Our study suggests that there may be no effect on ocular growth in children (3 to 10 years) followed cataract extraction and intraocular lens implantation. Increasing of axial length and moving forward of intraocular lens induced by complication may result in myopic shift in pseudophakia of children. Slightly undercorrected eyes with intraocular lens in children after cataract extraction will gradually move to emmetropia or moderate myopia in adulthood.

Adolescent↗
PubMed1977

Argon laser photocoagulation of the posterior segment in pseudophakia.

A series of in vitro, in vivo, and clinical studies was performed to explore the safety and efficacy of argon laser and xenon arc photocoagulation in pseudophakia. The polymethylmethacrylate intracameral lens (Fyodorov) proved resistant to photothermal decomposition and allowed transmission of therapeutically effective energy levels to the retina. The argon laser delivered through a slit lamp and contact lens optical system appears to be the preferred method for posterior segment photocoagulation in pseudophakia. On the basis of five-day tissue culture studies and clinical experience of two years, the intracameral lens does not appear to be a toxic or transmission barrier to careful argon laser photocoagulation.

Animals↗
PubMed1995

Pars plana Baerveldt tube insertion with vitrectomy in glaucomas associated with pseudophakia and aphakia.

PURPOSE: We reviewed the course of intraocular pressure, visual acuity, and complications in patients with shallow anterior chambers or vitreous prolapse who underwent insertion of glaucoma drainage tubes through the pars plana (after a complete posterior vitrectomy). METHODS: Thirteen patients (13 eyes) with uncontrolled glaucoma associated with shallow anterior chamber or vitreous prolapse and aphakia or pseudophakia underwent pars plana Baerveldt tube insertion after vitrectomy. RESULTS: In 11 eyes the intraocular pressure was less than or equal to 15 mm Hg at a minimum follow-up of one year; the other two eyes underwent additional glaucoma surgery. Two of the 11 eyes with controlled intraocular pressure had limitation of ocular motility postoperatively. No retinal complications had occurred in any of the 13 eyes. CONCLUSION: This technique of combined pars plana vitrectomy and pars plana insertion of a Baerveldt tube provides intraocular pressure control in eyes with shallow anterior chamber or vitreous prolapse and glaucoma associated with pseudophakia or aphakia.

Adolescent↗
PubMed1982

Pseudophakia and glaucoma.

A retrospective study of 40 eyes with pseudophakia and glaucoma is presented. Consideration of pre-existing and secondary types of glaucoma is given. Complications relating to pseudophakia and glaucoma are included as well as a discussion of mechanisms. Visual function results are given and medical and surgical therapies are outlined.

Cataract↗
PubMed1996

The glaucomas in pseudophakia.

The glaucomas in pseudophakia are not uncommon. Because they can be related to different mechanisms, each case should be evaluated individually. Once glaucoma has been established and medication fails to maintain the intraocular pressure at a safe level, several options are available. As a group, the glaucomas are considered both difficult to manage with medications and also at high risk for failure of filtration surgery. Trabeculectomy adjuvated with anti-metabolites, draining implants, and cyclodestructive procedures are all effective procedures. Although complications and loss of vision as a consequence of glaucoma surgery are not frequent, they were reported by several authors. The likelihood of any given treatment to preserve the quality of life should be discussed with each patient and should be part of the decision-making process. This article reviews studies on the glaucomas in pseudophakia published from October 1994 to September 1995.

Antimetabolites↗
PubMed1992

[The visual field of patients with pseudophakia using kinetic and automated perimetry].

One of the major benefits of pseudophakia is to maintain a good visual field. Visual field was therefore studied in 40 pseudophakic eyes using: 1. kinetic perimetry according to Goldmann using 3 tests: I1, I2, I4; 2. Automated perimetry. Insertion of a posterior chamber intraocular lens was performed in 85% of cases whereas the remaining 15% received an anterior chamber intraocular lens. Visual acuity was > 5/10 P2-P4 in all patients. The results showed a 15% reduction in the visual field compared to normal values. This reduction was concentric and harmonious but was more marked in internal isopters. This reduction was less marked with posterior chamber intraocular lenses. On the other hand, automated perimetry showed that global retinal sensitivity was decreased in pseudophakia, and this deficiency was more pronounced in the periphery.

Follow-Up Studies↗
PubMed1991

[Glaucoma in pseudophakia].

Six hundred and eighty five eyes with pseudophakia after implantation of anterior chamber (162), posterior chamber (29) and pupillary lenses (494) were subjected to an analysis. Intraocular hypertension after implantation was observed sometimes either as a transitory or a permanent one. The frequency of glaucoma in eyes with pseudophakia is dependent on the kind of the implant. In the material investigated the chronic glaucoma was found relatively most frequently after implantation of anterior chamber lenses, less frequently after implantation after pupillary implantation, the least frequently after posterior chamber implantations. In cases of an ineffective pharmacological treatment trabeculectomy was performed.

Cataract↗
PubMed1989

[Comparison of the status of binocular function in corrected mononuclear aphakia and pseudophakia].

The authors investigated in a group of 31 adults with unilateral aphakia the state of binocular functions and evaluated the differences between a group of patients corrected with contact lenses and a group with pseudophakia. The investigation revealed surprising (excellent) results as regards the restoration of satisfactory binocular vision in particular in pseudophakias (85%), somewhat poorer results with contact lenses (72%) which is favourable for the return of patients into practical life.

Aphakia, Postcataract↗