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Speciality Spotlight
Cataract
Phaco-emulsification
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L Drolsum, E Haaskjold, K Sandvig (Natl Hosp, Oslo, Norway)
Phacoemulsification in Eyes With Pseudoexfoliation.
J Cataract Refract Surg 24: 787-792, 1998.
Intraoperative complication rates were higher in eyes with pseudo-exfoliation. The incidence of capsular or zonular tear and vitreous loss is greater. Inspite of this, phacoemulsification is safe for most eyes with pseudoexfoliation.
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W. Birchall, M.K. Raynor, et al (Royal Eye Hosp, Manchester, England)
Inadvertent Staining of the Posterior Lens Capsule with Trypan Blue Dye During Phacoemulsification
Arch Ophthal, vol.119, July 2001, pp.1082-83
The authors stress the need to be alert to the possibility of the temporary staining of the posterior capsule (sufficient to prevent adequate light transmission to and from the retina) when trypan blue is used to facilitate capsulorrhexis, during complex, post-vitrectomy cataract surgery.
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Dick HB, Schwenn O, Krummenauer F, et al (Johannes Gutenberg-Univ, Mainz, Germany)
Inflammation After Sclerocorneal Versus Clear Corneal Tunnel Phacoemulsification
Ophthalmology 107: 241-247, 2000
One hundred patients with 100 affected eyes were randomly assigned to temporal sclerocorneal or clear corneal tunnel incision.
It was found that among patients undergoing phacoemulsification and foldable IOL implantation postoperative changes in the blood aqueous barrier were significantly lower after clear corneal tunnel incision than after sclerocorneal incision in the first 3 postoperative days.
However 5 months after surgery, differences in flare changes were not significant. It has been previously shown (editor’s comment) that a lower incidence of fibrin formation and cystoid macular edema was noted with clear corneal incisions.
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Dowler JGF, Hykin PG, Hamilton AMP (Moorfields Eye Hosp, London)
Phacoemulsification Versus Extracapsular Cataract Extraction in Patients With Diabetes
Ophthalmology 107: 457-462, 2000
In a study of 46 patients with diabetes and bilateral cataract, one eye was treated by phacoemulsification surgery with a silicone intraocular lens (IOL), while the other eye was treated by extracapsular cataract surgery with a 7-mm polymethylmethacrylate IOL.
The authors conclude that for diabetic patients with cataracts, phacoemulsification results in better postoperative visual activity, less postoperative inflammation, and less need for capsulotomy than conventional ECCE.
However, the main determinant of postoperative visual acuity appears to be the presence or absence of clinically significant macular edema (CSME) at the time of surgery regardless of technique.
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Mittra RA, Borrillo JL, Dev S, et al (Med College of Wisconsin, Milwaukee; Retina Associates of Cleveland, Ohio)
Retinopathy Progression and Visual Outcomes After Phacoemulsification in Patients With Diabetes Mellitus
Arch Ophthalmol 118: 912-917, 2000
A retrospective review was conducted of 150 eyes that underwent phacoemulsification during a five-year period.
It was found that the visual outcome and rate of retinopathy progression after phacoemulsification surgery did not vary significantly from those of other techniques.
A higher progression of retinopathy and a reduction in the chance for visual improvement was observed with resident surgery and with the presence of diabetic retinopathy.
There is a potential for the development of or worsening of diabetic retinopathy after cataract surgery. Prolonged surgical time definitely increases the potential for retinal phototoxic effects from the operating microscope.
