Speciality
Spotlight

 




 


Ophthalmology


 

 





Cataract
Surgery

    

  • M
    Portellos, EG Buckley (Duke Univ, Durham, NC)

    Cataract Surgery and Intraocular Lens Implantation in Patients with
    Retinoblastoma.

    Arch Ophthalmol 116:449-452, 1998

       

    In
    the short term, IOL implantation in eyes with
    regressed retinoblastoma appears to be a safe and
    acceptable method for restoring vision.
    The long-term effects of such treatment have
    yet to be determined.

     

  • Schmitz Sabine, Dick H Burkhard, Krummenauer Frank, Schwenn Oliver, Krist Romano. (Univ of Mainz, Germany)

    Contrast sensitivity and glare disability by halogen light after monofocal and multifocal lens implantation.


    Br.J Ophthalmol 2000, 84(10), p.1109-1112.


      


    A new halogen glare test stimulating glare as seen with oncoming vehicle headlights was used to measure glare disability in patients implanted with multifocal and monofocal intraocular lenses (10Ls).

       


    The results suggest NO difference in glare disability induced by halogen light similar to oncoming vehicle headlights for patients implanted with monofocal and multifocal
    IOLs.

      

  • SR
    Rathinam, P Namperumalsamy, E.T. Cunningham Jr. (Aravind Eye Hosp. & PG Inst, of Ophthalmology, Madurai, Tamil Nadu, India & F.I. Proctor Foundation and the Dept. of Ophthalmology UCSF, Med Centre, San Francisco, CA, USA)


    Spontaneous cataract absorption in patients with leptospiral uveitis.



    BJO 2000; 84: 1135-1141.


      


    This article is a retrospective review of 394 eyes of 276 patients with seropositive leptospiral uveitis, seen in the uveitis clinic at Aravind Eye Hosp. Between January 1994 and December 1997.

      


    Of these, 54 eyes (13.7%) had a final visual acuity of 20/40 or worse attributable to cataract formation.

      


    Spontaneous cataract absorption was observed in 10 eyes (18.5%) of 8 patients (19.5%) and occurred from 6 weeks to 18 months, after the onset of cataract.

      


    Out of 12035 consecutive NON-leptospiral, non-traumatic, uveitic, control patients seen during the same 4 yrs of the study, NONE showed spontaneous cataract absorption.

      


    Spontaneous cataract absorption appears to be unique to this form of non-traumatic uveitis (occurring in patients with leptospirosis).

      

  • C
    Wirbelauer, H Iven, Bastian C, et al (Medizinische Universitat zu Lubeck, Germany)


    Systemic Levels of Lidocaine After Intracameral Injection During Cataract Surgery.


    J Cataract Refract Surg 25: 648-651, 1999.

      


    Blood concentrations were prospectively evaluated during cataract surgery to determine systemic concentrations and the safety of using Lidocaine after intracameral injection of 1% solution during cataract surgery.

      


    During surgery, 0.5ml of preservative free lidocaine hydrochloride 1% was slowly instilled using an insulin syringe through the scleral tunnel incision into the anterior chamber, after hydrodissection was complete and before starting phaco-emulsification.

      


    It was found that no systemic therapeutic concentrations of intracameral injection of 0.5ml lidocaine 1%, were detected in patients undergoing cataract surgery. The risk of allergic reactions cannot be excluded.

      

  • IS
    Barequet, ES Soriano, WR Green et al (Johns Hopkins Hosp, Baltimore, Md)


    Provision of Anesthesia With Single Application of Lidocaine 2% Gel


    J Cataract Refract Surg 25: 626- 631, 1999.

      


    A single pre-operative application of lidocaine 2% gel offered satisfactory patient comfort in patients undergoing clear corneal cataract surgery with I.O.L. implantation.

      

  • P S Koch (Koch Eye Associates, Warwick, RI)


    Efficacy of Lidocaine 2% Jelly as a Topical Agent in Cataract Surgery.


    J Cataract Refract Surg 25: 632-634, 1999.

      


    Reapplication of lidocaine jelly 5 minutes before entering the operation room yielded better pain scores than single-dose jelly and equivalent scores to patients who received intracameral anesthetic.

      


    Single dose jelly was not better than topical eye-drop anesthesia.

      

  • R
    Tipperman, MD 


    Editorial remarks on anesthesia for cataract surgery.


    – Year Book of Ophthalmology 2000,p.7

      


    In the editor’s opinion, lidocaine gel seems to work best if applied sometime (15 to 20 minutes) before the beginning of cataract surgery. There is better overall conjunctival and lid anesthesia, and there is less need for rewetting of the cornea during surgery.

      


    Gel is highly recommended as a supplement to intracameral anesthesia.

      

  • D
    Vicary, X-Y Sun, P Montgomery (Pacific Eye Centre, Brisbane, Australia)


    Refractive Lensectomy to Correct Ametropia.


    J Cataract Refract Surg 25: 943-948, 1999

      


    Refractive lensectomy offers highly predictable visual acuity and refractive outcome, no regression and no irregular astigmatism.

      


    However, it is controversial because of the risk of retinal detachment, loss of accommodation and risk of endophthalmitis.

      


    The authors retrospectively assessed the effectiveness and safety of refractive lensectomy with post chamber IOL implantation, in 138 consecutive patients, to correct a wide range of refractive errors.

      


    The results of Refractive Lensectomy were evaluated as safe, effective, predictable and had a low complication rate. However, follow-up was limited. The long-term effects of refractive lensectomy need to be evaluated.

      

  • O
    Cekic, C Batman (SSK Ankara Eye Hosp, Turkey)


    Effect of Capsulorrhexis Size on Postoperative intraocular pressure.


    J Cataract Refract Surg 25: 416-419, 1999

      


    The possible effect of capsulorrhexis size on intraocular pressure (IOP) was prospectively examined in 58 eyes of patients undergoing clear corneal phacoemulsification with IOL implantation.

      


    It was found that a 4mm capsulorrhexis produced a lower postoperative IOP compared with a 6mm
    capsulorrhexis.

      

  • Editorial comments on the above article:

      


    Though a large capsulorrhexis makes it easier to mobilize the nucleus and to place the IOL within the capsular bag, there are several disadvantages of this large capsulorrhexis.

    (1) IOL fixation is not stable (2) Greater chances of iridocapsular synechia (3) Unwanted optical images from edge glare effect because of the overlying of the capsulorrhexis on the lens optic.

      


    The authors speculate on several reasons as to why a smaller capsulorrhexis may produce a lower postoperative IOP, than a larger capsulorrhexis. In patients with anterior capsule contraction syndrome, it is often observed that they have a low IOP and after YAG laser capsulotomy the IOP will rise.

       

  • ED
    Griener, E Dahan, SR Lambert (Emory Univ, Atlanta, Ga)


    Effect of Age at Time of Cataract Surgery on Subsequent Axial Length Growth in Infants Eyes


    J Cataract Refract Surg 25: 1209-1213, 1999

      


    In a study of eleven infants aged 2 to 4 months who had a unilateral lensectomy along with a posterior chamber IOL in the sulcus, it was found that 70% of the pseudophakic eyes had diminished axial growth after surgery.

      


    Older children in other studies had minimal growth differences between pseudophakic and normal eyes. This indicates that there may be a critical period of growth after which the removal of the lens has no effect on ocular growth.

      


    Implantation of an IOL tends to inhibit axial length when compared with the contralateral phakic eye. This has far reaching implications for the calculation of appropriate IOL power.

      

  • O
    Findl, W Drexler, R Menapace, et al (Universitatsklinik fur Augenheilkunde, Allgemeines Krankenhaus Wien, Austria)


    Changes in Intraocular Lens Position After Neodymium: YAG Capsulotomy.


    J Cataract Refract Surg 25: 659-662, 1999.

      


    Dual-beam partial coherence interferometry has been developed for high-precision biometry and high resolution tomographic imaging. Accurate biometry can be performed in pseudophakic eyes using this
    technique.

      


    Changes in IOL position caused by ND: YAG capsulotomy were prospectively assessed with different types of IOLs.

      


    Anterior chamber depth (ACD) was determined by dual beam partial coherence interferometry in 32 pseudophakic eyes with posterior capsule opacity and immediately after planned YAG capsulotomy under mydriasis.

      


    All patients had backward IOL movements when Nd:YAG was used. Magnitude of movement was the same for the 1-piece PMMA and the 3-piece foldable IOLs and higher for the plate-haptic IOLs. 

      


    A hypermetropic shift after capsulotomy will usually be minimal and not clinically evident.

      

  • Halpern BL, Gallagher SP (Eye Specialists of Lancaster, Pa: Univ of Delaware, Newark)


    Refractive Error Consequences of Reversed-Optic AMO
    SI-40NB Intraocular Lens



    Ophthalmology 106: 901-903, 1999.


      


    Meagre information exists in literature regarding the inadvertent implantation of a reversed optic posterior chamber IOL.

      


    This unintentional error usually occurs when the lens is folded, slips out of the folding forceps, is refolded in a backward position, especially when the scrub nurse does the folding for the surgeon.

      


    The authors found that a well positioned reverse optic SI-40NB IOL is as likely to produce a satisfactory refractive result as a nonreversed IOL. Repositioning the lens is not warranted. Six cases of reversed optic lenses, were well described.

      

  • Gayton
    JL, Sanders V, Van Der Karr M, et al (EyeSight Associates, Warner Robins, Ga; Ophthalmic Research Associates, Evanston, III; Ctr for Clinical Research, Elmhurst, III)


    Piggybacking Intraocular Implants to Correct Pseudophakic Refractive Error.



    Ophthalmology 106: 59-59, 1999.


      


    A second intraocular lens (IOL) to correct pseudophakic refractive error is an easy procedure and is preferable to replacing a previously implanted IOL.

      


    The risk of complications is lower if a second IOL is implanted. In a series of sixteen secondary piggy backed implants, vision after surgery improved to 20/40 or better in 50% of the cases.

      


    Intralenticular opacities develop between the 2 IOLs when they are both placed within the capsular bag. It is recommended that only one lens be placed in the capsular bag and the other implant be placed within the sulcus region.

      

  • Gills JP, Fenzi RE (St Luke’s Cataract and Laser Inst, Tarpon Springs,
    Fla)


    Minus-Power Intraocular Lenses to Correct Refractive Errors in Myopic Pseudophakia.



    J Cataract Refract Surg 25: 1205-1208, 1999.


      


    Myopic pseudophakic eyes with overpowered implanted IOLs CAN benefit from secondary implantation of a second minus power IOL to reduce the total implanted power. The secondary piggyback IOL’s power is more predictable than is achieved with an IOL exchange. Visual acuity was improved significantly.

      


    Minus power IOLs were previously not available but are now readily available. Hence this procedure of secondary piggyback IOL is preferred as a less traumatic surgery (compared to IOL exchange).

      

  • Mader
    TH, Koch DD, Manuel K, et al (Madigan Army Med Ctr, Tacoma, Wash; Baylor College of Medicine, Houston; National Aeronautics and Space Admin Houston)


    Stability of Vision During Space Flight in an Astronaut With Bilateral Intraocular Lens.


    Am J Ophthalmol 127: 342-343, 1999.

      


    The first use of IOLs in a physician mission specialist astronaut during a space shuttle mission was reported.

      


    There were preflight concerns that the IOL could move forward during choroidal expansion (due to microgravity), yet no change in visual acuity was noted by the patient, suggesting that the IOL position remained stable during microgravity.

      

  • Schein
    OD, for the study of Medical Testing for Cataract
    Surgery [John Hopkins Univ., Baltimore, Md ; et al

    The Value of 
    Routine Preoperative Medical Testing Before
    Cataract Surgery


    N
    Engl J Med 342: 168-175, 2000


     

    The
    rates of perioperative morbidity and mortality after
    cataract surgery are low, despite the fact that
    patients are elderly and have serious coexisting
    illnesses. These patients commonly undergo routine
    medical testing before cataract surgery.
    A prospective randomized clinical trial was
    performed to determine whether routine medical
    testing before cataract surgery reduces the rate of
    complications in the perioperative period.

     

    It
    was concluded that routine medical testing before
    cataract surgery does not improve the safety of the
    surgical procedure. It
    is possible to save the high costs of routine
    medical testing without any negative effects on
    patients’ health or clinical outcome.
    It is also reasonable to apply these
    observations to other patients undergoing other
    surgeries with low surgical risks, under local
    anesthesia and IV sedation.

       

  • G Rainer, Rupert Menapace, Oliver Findl, et al (Univ. of Vienna, Austria)

    Intraocular pressure rise after small incision cataract surgery: a randomised intraindividual comparison of two dispersive viscoelastic agents.

    Br.J. Ophthalmol. Feb.2001, 85: 139-142.

      

    This study (prospective and randomized) comprised 80 eyes of 40 consecutive patients who had bilateral small incision cataract surgery. Phacoemulsification was done after a 3.2mm sutureless incision and a foldable silicone intraocular lens was inserted.

      

    The patients were randomly assigned to receive OCUCOAT (hydroxy-propyl methylcellulose 2%) or viscoat (sodium chondroitin sulphate 4% – sodium hyaluronate 3%) for the first eye operation. The second eye which was operated later received the other viscoelastic agent.

       

    It was found that VISCOAT causes a significantly higher intraocular pressure (IOP) increase and significantly more IOP spikes thank OCUCOAT in the early postoperative period.

       

  • A
    Ionides, S Tuft (Moorfields Eye Hospital, London)

    Visual outcome following posterior capsule rupture during cataract surgery.

    Br. J Ophthalmol, Feb.2001, 85: 222-224.

      

    Prospective data were collected on 1420 consecutive eyes undergoing cataract extraction. The best spectacle corrected visual acuity was recorded at discharge. 

       

    Posterior capsule rupture occurred in 59cases (4.1%). Eyes with posterior capsular rupture were 3.8 times more likely to have a final best spectacle corrected visual acuity less than 6/12.

       

    Hence the authors conclude that eyes with posterior capsular rupture during cataract surgery have a significant risk of reduced visual acuity.

       

  • M C Westcott, S J Tuft, D C Minassian (Moorfields Eye Hospital and Institute of Ophthalmology , London)


    Effect of age on visual outcome following cataract extraction.



    B J Opthalmol 2000; 84: 1380-1382




    Eight Hundred and Eighty patient aged 60 yrs and above, undergoing cataract extraction between 1996 and 1999 were analysed. Analysis was performed after exclusion of patient identified pre-operatively as having ocular comorbidity, that was thought to limit their final corrected acuity.



    In patient with no comorbidity, the odds of achieving an acuity of ³ 6/12 were 4.6 times higher in the 60-69 year age group, than the oldest age group (over 80 yrs).

      

  • J.A.
    Mares-Perlman, B.J. Lyle, et al (Depts. of Ophthalmology and Visual Sciences, Univ. of Wisconsin-Madison Medical School, Madison)

    Vitamin Supplement Use and Incident Cataracts in a Population-Based Study

    Arch Ophthalmol, Nov.2000, vol.118, pg. 1556-1563

      

    This study was carried out to determine the relationship between vitamin supplement use and the 5-year incidence of nuclear, cortical, and posterior subcapsular cataract.



    Compared with non-users, the 5-yr risk for any cataract was 60% lower among persons who at follow-up, reported the use of multivitamins or any supplement containing vitamin C or E for more than 10 years. The use of multivitamins for this duration reduced the risk for nuclear and cortical cataracts but not for posterior subcapsular cataracts. Use of supplements for shorter periods was not associated with risk of cataract.



    The authors however feel that it is not possible to specify the nutrients responsible for lowering the risks of development of cataracts.



    Unmeasured life-style differences between supplement users and non-users may explain the results.

      

  • M
    Horiguichi, K Miyake, I Ohta, et al (Nagoya Univ, Japan; Shozan-Kai Miyake Eye Hosp, Nagoya, Japan) 

    Staining of the Lens Capsule for Circular Continuous Capsulorrhexis in Eyes with White Cataract. 

    Arch Ophthalmol 116:535-537, 1998.

         

    To improve visibility of the anterior capsule in eyes with a mature cataract and white lens cortex, a capsular-staining technique was developed using indocyanine green (ICG), which facilitates continuous circular capsulorrhexis.

        

    Further research is needed to determine the safety of this technique.

        

  • AK Hutchinson, ME Wilson, RA Saunders (Med Univ of South Carolina, Charleston) 

    Outcomes and Ocular Growth Rates After Intraocular Lens Implantation in the First 2 years of Life. 

    J Cataract Refract Surg 24:846-852, 1998.

        


    In this study 17 patients (aged 12 days to 22 months) had IOL implantation in 22 eyes.

        

    The results showed that IOL implantation in children under 2 yrs was a safe and effective alternative to contact lens or spectacle correction of aphakia. By eliminating periods of uncorrected aphakia, it may aid amblyopia treatment.

        

    The complication rate or re-operation rate was not significantly higher in pseudophakic patients than in a similar population having cataract extraction but who were left aphakic at the time of surgery.

        

  • CP
    Lohmann, M Heeb, H-J Linde, et al (Univ of Regensburg, Germany) 

    Diagnosis of Infectious Endophthalmitis after Cataract Surgery by
    Polymerase Chain Reaction. 

    J Cataract Refract Surg 24: 821-826, 1998.

        

    Polymerase chain reaction was more successful in detecting the infectious agent than the conventional microbiological tests, especially in the diagnosis of delayed endophthalmitis, where, in all eyes, the pathogen was detected in the aqueous humor.

        

  • ED
    Griener, E Dahan, SR Lambert (Emory Univ, Atlanta,
    Ga)

    Effect of Age at Time of Cataract Surgery on
    Subsequent Axial Length Growth in Infants Eyes


    J Cataract Refract Surg 25: 1209-1213, 1999

        

    In a study of eleven infants aged 2 to 4 months who
    had a unilateral lensectomy along with a posterior
    chamber IOL in the sulcus, it was found that 70% of
    the pseudophakic eyes had diminished axial growth
    after surgery.

        

    Older children in other studies had minimal growth
    differences between pseudophakic and normal eyes.
    This indicates that there may be a critical period
    of growth after which the removal of the lens has no
    effect on ocular growth.

        

    Implantation of an IOL tends to inhibit axial length
    when compared with the contralateral phakic eye.
    This has far reaching implications for the
    calculation of appropriate IOL power.

       

  • O
    Findl, W Drexler, R Menapace, et al (Universitatsklinik fur Augenheilkunde, Allgemeines Krankenhaus Wien, Austria)

    Changes in Intraocular Lens Position After Neodymium: YAG Capsulotomy.

    J Cataract Refract Surg 25: 659-662, 1999.

       

    Dual-beam partial coherence interferometry has been developed for high-precision biometry and high resolution tomographic imaging. Accurate biometry can be performed in pseudophakic eyes using this techniques.

      

    Changes in IOL position caused by ND: YAG capsulotomy were prospectively assessed with different types of IOLs.

      

    Anterior chamber depth (ACD) was determined by dual beam partial coherence interferometry in 32 pseudophakic eyes with posterior capsule opacity and immediately after planned YAG capsulotomy under mydriasis.

       

    All patients had backward IOL movements when Nd:YAG was used. Magnitude of movement was the same for the 1-piece PMMA and the 3-piece foldable IOLs and higher for the plate-haptic IOLs. 

       

    A hypermetropic shift after capsulotomy will usually be minimal and not clinically evident.

        

  • Rainer
    G, Menapace R, Schmetterer K, et al (Univ of Vienna)

    Effect of Dorzolamide and Latanoprost on
    Intraocular Pressure After Small Incision Cataract
    Surgery.


    J Cataract Refract Surg 25: 1624-1629, 1999.

       

    If there is elevated intraocular pressure (IOP)
    within 24 hrs. of cataract surgery, there may be a
    risk of developing corneal epithelial oedema, pain,
    retinal artery occlusion or anterior ischaemic optic
    neuropathy.

      

    In a study of 102 patients, it was found that both
    dorzolamide and latanoprost effectively reduced IOP
    rises after 6 hours. However only dorzolamide was of
    help after 20 to 24 hours.

      

    If untreated IOP rose about 5mmHg in 6 hrs and 1.5mm
    Hg within 24 hours. Using dorzolamide reduced the
    increase of IOP significantly. Latanoprost worked
    well only in the shorter term. Neither dorzolamide
    nor latanoprost could prevent IOP spikes of 30mm Hg
    or above.

       

  • Miyake K, Ota I, Maekubo, et al (Miyake Eye Hosp, Nagoya, Japan)

    Latanoprost Accelerates Disruption of the Blood-Aqueous Barrier and the Incidence of Angiographic Cystoid Macular Edema in Early Postoperative Pseudophakias.

    Arch Ophthalmol 117: 34-40, 1999

       

    Latanoprost (prostaglandin F2) lowers intraocular pressure (IOP) by increasing uveoscleral outflow. In human models, latanoprost did not disrupt the blood-aqueous barrier and did not affect cystoid macular oedema (CME) formation in eyes with longstanding pseudophakias.

        

    However, endogenous prostaglandins synthesized in the anterior uvea DO have a role in disrupting the blood-aqueous barrier and in inducing CME after cataract extraction.

       

    In a randomized, double-blind trial for latanoprost, as well as an open-label controlled trial for studying the effects of NSA drops on latanoprost and its place, the authors found that latanoprost disrupts the blood aqueous barrier and increases the incidence of angiographic CME in early postoperative pseduophakia.

       

    Concurrent instillation of NSA drops (e.g. diclofenac) can prevent the adverse effects of latanoprost and thus maintain the decrease in IOP.

        

  • Changwon Kee, Seong-Heon Moon. (Dept. of Ophthalmology, Samsung Medical Center College of Medicine, Seoul).

    Effect of cataract extraction and posterior chamber lens implantation on outflow facility and its response to pilocarpine in Korean subjects.

    Br.J Ophthalmol, 2000: 84: 987-989.

      

    Intraocular pressure was measured by Goldmann applanation tonometer in 42 patients with cataracts and outflow facility was measured by tonography preoperatively, before and after pilocarpine installation.

      

    All patients were operated by the same surgeon using clear corneal phaco-emulsification and a silicone foldable I.O.L. implantation within the bag.

      

    Two months after surgery, slit lamp examination, gonioscopy were performed and IOP and outflow facility were estimated.

      

    The statistical analysis carried out by the authors reveal that lens extraction causes a reduction in IOP and an increase in outflow facility in Korean subjects.

      

    Pilocarpine causes an increase in outflow facility which persists after cataract extraction and posterior chamber lens implant.

       

  • D
    Siriwardena, A Kotecha, D Minassian, et al
    (Institute of Ophthalmology, London)

    Anterior chamber flare after trabeculectomy and
    after phacoemulsification.

    Br. J.Ophthalmol 2000; 84: 1056-1057.

       

    This study of 131 consecutive patients was
    undertaken to evaluate and compare prospectively
    anterior chamber (a.c.) flare after
    phacoemulsification cataract extraction and after
    trabeculectomy with peripheral iridectomy.

      

    None of the patients had a history of
    pseudoexfoliation, uveitis or previous ocular
    surgery. It was found that a.c. inflammation and
    breakdown of the blood-aqueous barrier was much more
    prolonged after uncomplicated small incision
    cataract surgery than after glaucoma filtration
    surgery with peripheral iridectomy.

      

    This prolonged low grade inflammation is likely to
    be due to release of lens crystallins and lens
    epithelial cells into the aqueous humour, the effect
    of ultrasound, and/or the high volume of fluid
    passing through the eye at the time of surgery. 

      

    The above factors may increase the production of
    fibrogenic cytokines in the aqueous humour of
    patients who undergo phacoemulsification. 

      

    This may explain why the success rate of
    phaco-trabeculectomy is significantly lower than
    trabeculectomy alone. It may also explain why recent
    cataract surgery is a risk factor for failure of
    filtration surgery.

      

  • D C Minassian, P Rosen et al (Institute of Ophthalmology, University College, London, UK etc.)

    Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial

    Br J Opthalmology: 2001.85:822-829

     


    This article describes a two centre randomized trial comparing 232 patients with age related cataract who received ECCE and 244 received small incision surgery by phako.

     


    The main comparative outcomes were visual acuity, refraction, and complication rates.

     


    Phako was found to be superior due to the following reasons:

     


    (1) Surgical complications and capsular opacification within one year after surgery were significantly less frequent.

      


    (2) A higher proportion achieved an unaided visual acuity of 6/9 or better in the PHAKO group.

      


    (3) The average cost of surgery and postoperative care was similar for the two procedures.

         

  • L. Cassidy, J Rahi, K Nischal, et al ( Dept. of Ophthalmology, Great Ormond Street Hospital for Children, London)

    Outcome of lens aspiration and intraocular lens implantation in children aged 5 years and under.

    Br. J. Ophthal. May 2001, 85: 540 -542

      

    The authors evaluated 75 eyes of 45 children, under the age of 5 yrs (median age at surgery was 39 months), who underwent lens aspiration with primary posterior chamber intraocular lens implantation.

      

    73.5% eyes had a final best corrected visual acuity of 6/12 or better, while 20.5% achieved 6/18 or less.

      

    Mild uveitis which occurred in 28.2% eyes in the immediate post-operative period, resolved with topical steroids.

      

    In the short-term follow-up in this study, glaucoma, endophthalmitis or retinal detachment have not been observed postoperatively in any patient. The median follow-up period was three years.

      

    The authors conclude that in children under the age of 5 yrs, lens aspiration with IOL implantation is a safe procedure with good visual outcome in the short term.


      

  • E McLoone, G Mahon, et al (Queen’s Univ. of Belfast, U.K.)

    Silicone oil-intraocular lens interaction: which lens to use ?

    Br J Ophthal, May 2001: 85: 543-545

      

    PMMA, AcrySof, AR40, AQUA-Sense and Raysoft lenses were examined. Each lens was immersed for 5 minutes intervals in balanced salt solution (BSS) in stained silicone oil, and again in BSS before being photographed in air and in BSS. Percentage of silicone oil coverage of the lens optic was compared.

      

    The authors found that a Raysoft lens was a suitable lens in patients who are at risk of vitreo-retinal disease.


       

  • D J Apple, Liliana Werner et al

    Newly Recognized Complicaitons of Posterior Chamber Intraocular Lenses

    Arch.Ophthalmol, April 2001, vol.119, p.581-582.

       

    Yu and Shek reported an unexpected late postoperative opacification on the optical component of a modern foldable hydrogel IOL, the Hydroview lens (Bausch and Lomb). They felt that the opaque material, identified as hydroxyapatite, penetrates into the substance of the IOL optical component.

       

    However, the editor feels that the deposits are only on the IOL surface.

       

    The calcification process occurs on both anterior and posterior surfaces of the IOL, and appears between 12 and 25 months postoperatively. In advanced stages, the posterior capsule and fundus cannot be visualized.

       

    Attempts to remove the opacity with an Nd-YAG laser have been unsuccessful.

      

    The author has tested 23 explanted IOLS. The process of opacification appears to be 2-fold:

    (1) Degeneration of the UV filtration material and 

    (2) Deposits of calcium below the IOL’s optic surface, with the substance of the optic biomaterial.

       

    These complications have been mostly late postoperatively. The editor feels that some surgeons, manufacturers and governmental regulators appear to have become overconfident, even complacent, regarding oversight and quality control of both established and new IOL designs. Moreover curtailment of funding for the cataract IOL operation, probably leads to less scrutiny by surgeons and manufacturers.

  • H Jackson, D Garway-Health et al (Institute of Ophthalmology, Cayton street, London)

    Outcome of cataract surgery in patients with retinitis pigmentosa.

    B.J.O. Aug.2001; 85: 936-938






    This retrospective analysis was undertaken of a continuous series of 142 eyes of 89 patients with retinitis pigmentosa undergoing cataract surgery.



    The authors conclude that cataract surgery for relatively minor lens opacities is beneficial in patients with retinitis pigmentosa. Majority of patients report subjective improvement of visual symptoms. The incidence of capsular opacification is high. The incidence of postoperative macular oedema was unexpectedly low.

  • A. Assi, S Woodruff, et al (Moorfields Eye Hosp., London)

    Combined phacoemulsification and transpupillary drainage of silicone oil: results and complications.

    B.J.O. Aug.2001; 85: 942-945




    The authors have analyzed 74 consecutive cases of combined phacoemulsification and transpupillary drainage of silicone oil. They conclude that combined phacoemulsification and transpupillary drainage of silicone oil is a safe and reliable technique offering the advantage of diminished surgical trauma.

       

  • K. Negishi, K Ohnuma, et al (Toden Hosp. Tokyo, Japan)

    Effect of Chromatic Aberration on Contrast Sensitivity in Pseudophakic Eyes

    Arch Ophthal, vol.119, August 2001; p.1154-1158



    The authors evaluated the variations in chromatic aberrations occurring with the use of different materials in intraocular lenses.



    The eyes were divided into 3 groups.

    (1) Polymethyl methacrylate (2) Silicone and (3) an acrylate/methacrylate copolymer.



    Best corrected visual acuity (for distance) and contrast sensitivity were measured under white light and monochromatic light (with different wave lengths).



    Under both white monochromatic light and 470nm x 630nm monochromatic light, the mean contrast sensitivity in group 3 tended to be lower, than in other IOL groups.

      

  • Schein OD, for the Study of Medical Testing for Cataract Surgery (Johns Hopkins Univ, Baltimore, Md; et al) 

    The Value of Routine Preoperative Medical Testing Before Cataract Surgery 

    N Engl J Med 342: 168-175, 2000



    By random assignment over 18,189 patients scheduled for 19,557 elective cataract surgery at 9 centers, did or did not have a standard battery of medical assessments prior to surgery.



    Both groups had an overall complication rate of 31.3 events per 1000 operations.



    The authors conclude that routine medical testing prior to cataract surgery is costly and does not appear to markedly increase procedural safety. Cost may be avoided without adversely affecting clinical outcomes.

          

  • Allemann N, Chamon W, Tanaka HM, et al (Federal Univ of Sao Paulo, Brazil; Clinique Monticelli, Marseille, France)

    Myopic Angle-Supported Intraocular Lenses: Two-Year Follow-up

    Ophthalmology 107: 1549-1554, 2000

          


    Five men and seven women (mean age 29.5 years) with myopia > – 11 D were studied.

         


    Each eye was implanted with a NuVita IOL, which is a single-piece polymethylmethacrylate IOL with Z-shaped haptics. Each haptic has 2 footplates and an optical zone of 4.5 mm.

         


    Two years postoperatively it was found that angle-supported anterior chamber 10Ls were effective and safe in correcting high myopia.

         


    Many of the IOLs showed iris retraction, perhaps resulting from an oversized IOL diameter.

         


    Endothelial cell loss in the second year after surgery was also a concern. None of the IOLs had cataractous changes.

         

  • Petersen AM, Bluth LL, Campion M (Southwestern Eye Ctr, Mesa, Ariz) 

    Delayed Posterior Dislocation of Silicone Plate-Haptic Lenses After Neodymium: YAG Capsulotomy 

    J Cataract Refract Surg 26: 1827-1829, 2000

         


    The authors report 4 cases of posterior dislocation of silicone plate-haptic lenses that occurred several months after Nd: YAG capsulotomy.

          


    They strongly recommended that silicone plate-haptic lenses should not be used when capsular integrity is breached or zonular dialysis is present, because of risk of posterior dislocation of the
    IOL.

           

  • BenEzra D, Cohen E, (Hadassah Univ Med School, Jerusalem)

    Cataract Surgery in Children With Chronic Uveitis 

    Ophthalmology 107: 1255-1260, 2000

          


    Ten children with uniocular or markedly unequal binocular uveitis were included in the study. A posterior chamber IOL was implanted.

          


    It was found that whether or not an IOL was implanted, the postoperative course and immediate restored visual activities were similar. Visual acuity improved in all operated eyes, one month after surgery.

          


    When uveitis was associated with juvenile rheumatoid arthritis (JRA), active intraocular inflammation persisted for a longer time postoperatively along with secondary membranes in some cases.

          


    Tolerance to contact lenses (as compared to IOL implantation) was poor.

          

  • Pandey SK, Werner L, Escobar-Gomez M, et al (Med Univ of South Carolina, Charleston)

    Dye-Enhanced Cataract Surgery: Part 1. Anterior Capsule Staining for Capsulorhexis in Advanced/White Cataract 

    J Cataract Refract Surg 26: 1052-1059, 2000

          


    The absence of the red reflex in patients with total advanced/white cataract or in patients with pigmented fundi or vitreous diseases, makes it difficult to distinguish the anterior capsule from the underlying cortex.

          


    Continuous curvilinear capsulorhexis (CCC) was done in 12 postmortem human eyes with cataract in experimental, closed-system surgery. The anterior capsule was stained with 3 different dyes before CCC. 

         


    Staining with indocyanine green, 0.5%, was slightly better than with fluorescein sodium, 2%, and trypan blue, 1%.

          


    Intracameral subcapsular injection of indocyanine green stains the posterior surface of the anterior capsule without leaking into the vitreous cavity (compared to fluorescein sodium which leaked into the vitreous).

           

  • Kuchle M, Viestenz A, Martus P, et al (Univ Erlangen-Nurnberg, Erlangen Germany)

    Anterior Chamber Depth and Complications During Cataract Surgery in Eyes With Pseudoexfoliation Syndrome 

    Am J Ophthalmol 129: 281-285, 2000

          


    A few eyes with pseudoexfoliation syndrome have intraoperative complications associated with zonular weakness.

          


    174 eyes with pseudoexfoliation, scheduled for cataract surgery were reviewed. A- scan ultrasonography was done to measure anterior chamber depth, lens thickness and total axial length. 

          


    Twelve eyes had complications (6.9%). The authors observe than an anterior chamber depth < 2.5 m carried a 13.4% risk for intraoperative complications. 

           


    A shallow anterior chamber may indicate zonular instability in eyes with pseudoexfoliation syndrome. In case surgery is complicated, switching from topical anesthesia to a more traditional injection technique may be beneficial.

         

  • Jun AS, Pieramici DJ, Bridges WZ Jr (Johns Hopkins Med Institutions, Baltimore, Md) 

    Clear Corneal Cataract Wound Dehiscence During Pneumatic Retinopexy 


    Arch Ophthalmol 118: 847-848, 2000


           


    The authors reported two cases of clear corneal cataract wound dehiscence during pneumatic retinopexy, within 3 weeks after cataract surgery.

             


    To reduce the chance of this complication, paracentesis may be done before gas injection to minimize a rapid rise in
    IOP.

          

  • Age-Related Eye Disease Study Research Group

    AREDS Report No. 9

    A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E Beta Carotene for Age-Related Cataract and Vision Loss 

    Arch Ophthalmol. Vol. 119(10), October 2001; Pg. 1439-1452

            


    In a multicentre study (11-centres) of 4757 participants, it was found that use of a high-dose formulation of vitamin C, vitamin E, and beta carotene in a relatively well-nourished older adult cohort, had no apparent effect on the 7-year risk of development or progression of age-related lens opacities or visual acuity
    loss.

          

  • C. Y. Mardin, U. Schlotzer, et al (University Eye Hospital, Schwabachanlage, Erlaugan, Germany) 

    “Masked” Pseudoexfoliation Syndrome in Unoperated Eyes with Circular Posterior Synechiae 

    Arch Ophthalmol., October 2001, Vol. 119(10) Pg. 1500-1504

           


    This study included 27 consecutive patients with circular posterior synechiae and a history of miotic drug use without previous intraocular surgery, inflammation, or trauma, and without conventional signs of pseudoexfoliation (PEX) material in the anterior chamber.

          


    After cataract surgery, the excised anterior lens capsular were investigated for the presence of precapsular fibillar PEX deposits by electron microscopy.

           


    The authors conclude that posterior synechiae were more frequently associated with manifest or early stages of PEX syndrome. However, broad posterior synechiae found in miosis prevented a definite clinical diagnosis based on the classic changes of anterior lens capsule.

           


    The masked variant of PEX syndrome should be considered, in eyes with spontaneous or miotic-induced circular posterior synechiae without other obvious
    cause.

           

  • Doyle JW, Smith MF (Univ. of Florida, Gainesville)

    Effect of Phacoemulsification Surgery on Hypotony Following Trabeculectomy Surgery.

    Arch Ophthalmol 118: 763-765, 2000

       

    Chronic hypotomy is a frustrating complication following the use of local antimetabolites in trabeculotomy surgery.

      

    The authors reviewed the effects of phacoemulsification surgery in eyes with chronic hyptomy following trabeculectomy with mitomycin C.

       

    They found that statistically significant elevation in IOP occurs in association with phacoemulsification surgery in previously filtered eyes with hypotony. This may result in resolution of
    hypotony.

       

 



 

 

Speciality Spotlight

 

 

Cataract Surgery
    

  • M Portellos, EG Buckley (Duke Univ, Durham, NC)
    Cataract Surgery and Intraocular Lens Implantation in Patients with Retinoblastoma.
    Arch Ophthalmol 116:449-452, 1998
       
    In the short term, IOL implantation in eyes with regressed retinoblastoma appears to be a safe and acceptable method for restoring vision. The long-term effects of such treatment have yet to be determined.
     

  • Schmitz Sabine, Dick H Burkhard, Krummenauer Frank, Schwenn Oliver, Krist Romano. (Univ of Mainz, Germany)
    Contrast sensitivity and glare disability by halogen light after monofocal and multifocal lens implantation.
    Br.J Ophthalmol 2000, 84(10), p.1109-1112.
      
    A new halogen glare test stimulating glare as seen with oncoming vehicle headlights was used to measure glare disability in patients implanted with multifocal and monofocal intraocular lenses (10Ls).
       
    The results suggest NO difference in glare disability induced by halogen light similar to oncoming vehicle headlights for patients implanted with monofocal and multifocal IOLs.
      

  • SR Rathinam, P Namperumalsamy, E.T. Cunningham Jr. (Aravind Eye Hosp. & PG Inst, of Ophthalmology, Madurai, Tamil Nadu, India & F.I. Proctor Foundation and the Dept. of Ophthalmology UCSF, Med Centre, San Francisco, CA, USA)
    Spontaneous cataract absorption in patients with leptospiral uveitis.
    BJO 2000; 84: 1135-1141.
      
    This article is a retrospective review of 394 eyes of 276 patients with seropositive leptospiral uveitis, seen in the uveitis clinic at Aravind Eye Hosp. Between January 1994 and December 1997.
      
    Of these, 54 eyes (13.7%) had a final visual acuity of 20/40 or worse attributable to cataract formation.
      
    Spontaneous cataract absorption was observed in 10 eyes (18.5%) of 8 patients (19.5%) and occurred from 6 weeks to 18 months, after the onset of cataract.
      
    Out of 12035 consecutive NON-leptospiral, non-traumatic, uveitic, control patients seen during the same 4 yrs of the study, NONE showed spontaneous cataract absorption.
      
    Spontaneous cataract absorption appears to be unique to this form of non-traumatic uveitis (occurring in patients with leptospirosis).
      

  • C Wirbelauer, H Iven, Bastian C, et al (Medizinische Universitat zu Lubeck, Germany)
    Systemic Levels of Lidocaine After Intracameral Injection During Cataract Surgery.
    J Cataract Refract Surg 25: 648-651, 1999.
      
    Blood concentrations were prospectively evaluated during cataract surgery to determine systemic concentrations and the safety of using Lidocaine after intracameral injection of 1% solution during cataract surgery.
      
    During surgery, 0.5ml of preservative free lidocaine hydrochloride 1% was slowly instilled using an insulin syringe through the scleral tunnel incision into the anterior chamber, after hydrodissection was complete and before starting phaco-emulsification.
      
    It was found that no systemic therapeutic concentrations of intracameral injection of 0.5ml lidocaine 1%, were detected in patients undergoing cataract surgery. The risk of allergic reactions cannot be excluded.
      

  • IS Barequet, ES Soriano, WR Green et al (Johns Hopkins Hosp, Baltimore, Md)
    Provision of Anesthesia With Single Application of Lidocaine 2% Gel
    J Cataract Refract Surg 25: 626- 631, 1999.
      
    A single pre-operative application of lidocaine 2% gel offered satisfactory patient comfort in patients undergoing clear corneal cataract surgery with I.O.L. implantation.
      

  • P S Koch (Koch Eye Associates, Warwick, RI)
    Efficacy of Lidocaine 2% Jelly as a Topical Agent in Cataract Surgery.
    J Cataract Refract Surg 25: 632-634, 1999.
      
    Reapplication of lidocaine jelly 5 minutes before entering the operation room yielded better pain scores than single-dose jelly and equivalent scores to patients who received intracameral anesthetic.
      
    Single dose jelly was not better than topical eye-drop anesthesia.
      

  • R Tipperman, MD 
    Editorial remarks on anesthesia for cataract surgery.
    – Year Book of Ophthalmology 2000,p.7
      
    In the editor’s opinion, lidocaine gel seems to work best if applied sometime (15 to 20 minutes) before the beginning of cataract surgery. There is better overall conjunctival and lid anesthesia, and there is less need for rewetting of the cornea during surgery.
      
    Gel is highly recommended as a supplement to intracameral anesthesia.
      

  • D Vicary, X-Y Sun, P Montgomery (Pacific Eye Centre, Brisbane, Australia)
    Refractive Lensectomy to Correct Ametropia.
    J Cataract Refract Surg 25: 943-948, 1999
      
    Refractive lensectomy offers highly predictable visual acuity and refractive outcome, no regression and no irregular astigmatism.
      
    However, it is controversial because of the risk of retinal detachment, loss of accommodation and risk of endophthalmitis.
      
    The authors retrospectively assessed the effectiveness and safety of refractive lensectomy with post chamber IOL implantation, in 138 consecutive patients, to correct a wide range of refractive errors.
      
    The results of Refractive Lensectomy were evaluated as safe, effective, predictable and had a low complication rate. However, follow-up was limited. The long-term effects of refractive lensectomy need to be evaluated.
      

  • O Cekic, C Batman (SSK Ankara Eye Hosp, Turkey)
    Effect of Capsulorrhexis Size on Postoperative intraocular pressure.
    J Cataract Refract Surg 25: 416-419, 1999
      
    The possible effect of capsulorrhexis size on intraocular pressure (IOP) was prospectively examined in 58 eyes of patients undergoing clear corneal phacoemulsification with IOL implantation.
      
    It was found that a 4mm capsulorrhexis produced a lower postoperative IOP compared with a 6mm capsulorrhexis.
      

  • Editorial comments on the above article:
      
    Though a large capsulorrhexis makes it easier to mobilize the nucleus and to place the IOL within the capsular bag, there are several disadvantages of this large capsulorrhexis.
    (1) IOL fixation is not stable (2) Greater chances of iridocapsular synechia (3) Unwanted optical images from edge glare effect because of the overlying of the capsulorrhexis on the lens optic.
      
    The authors speculate on several reasons as to why a smaller capsulorrhexis may produce a lower postoperative IOP, than a larger capsulorrhexis. In patients with anterior capsule contraction syndrome, it is often observed that they have a low IOP and after YAG laser capsulotomy the IOP will rise.
       

  • ED Griener, E Dahan, SR Lambert (Emory Univ, Atlanta, Ga)
    Effect of Age at Time of Cataract Surgery on Subsequent Axial Length Growth in Infants Eyes
    J Cataract Refract Surg 25: 1209-1213, 1999
      
    In a study of eleven infants aged 2 to 4 months who had a unilateral lensectomy along with a posterior chamber IOL in the sulcus, it was found that 70% of the pseudophakic eyes had diminished axial growth after surgery.
      
    Older children in other studies had minimal growth differences between pseudophakic and normal eyes. This indicates that there may be a critical period of growth after which the removal of the lens has no effect on ocular growth.
      
    Implantation of an IOL tends to inhibit axial length when compared with the contralateral phakic eye. This has far reaching implications for the calculation of appropriate IOL power.
      

  • O Findl, W Drexler, R Menapace, et al (Universitatsklinik fur Augenheilkunde, Allgemeines Krankenhaus Wien, Austria)
    Changes in Intraocular Lens Position After Neodymium: YAG Capsulotomy.
    J Cataract Refract Surg 25: 659-662, 1999.
      
    Dual-beam partial coherence interferometry has been developed for high-precision biometry and high resolution tomographic imaging. Accurate biometry can be performed in pseudophakic eyes using this technique.
      
    Changes in IOL position caused by ND: YAG capsulotomy were prospectively assessed with different types of IOLs.
      
    Anterior chamber depth (ACD) was determined by dual beam partial coherence interferometry in 32 pseudophakic eyes with posterior capsule opacity and immediately after planned YAG capsulotomy under mydriasis.
      
    All patients had backward IOL movements when Nd:YAG was used. Magnitude of movement was the same for the 1-piece PMMA and the 3-piece foldable IOLs and higher for the plate-haptic IOLs. 
      
    A hypermetropic shift after capsulotomy will usually be minimal and not clinically evident.
      

  • Halpern BL, Gallagher SP (Eye Specialists of Lancaster, Pa: Univ of Delaware, Newark)
    Refractive Error Consequences of Reversed-Optic AMO SI-40NB Intraocular Lens
    Ophthalmology 106: 901-903, 1999.
      
    Meagre information exists in literature regarding the inadvertent implantation of a reversed optic posterior chamber IOL.
      
    This unintentional error usually occurs when the lens is folded, slips out of the folding forceps, is refolded in a backward position, especially when the scrub nurse does the folding for the surgeon.
      
    The authors found that a well positioned reverse optic SI-40NB IOL is as likely to produce a satisfactory refractive result as a nonreversed IOL. Repositioning the lens is not warranted. Six cases of reversed optic lenses, were well described.
      

  • Gayton JL, Sanders V, Van Der Karr M, et al (EyeSight Associates, Warner Robins, Ga; Ophthalmic Research Associates, Evanston, III; Ctr for Clinical Research, Elmhurst, III)
    Piggybacking Intraocular Implants to Correct Pseudophakic Refractive Error.
    Ophthalmology 106: 59-59, 1999.
      
    A second intraocular lens (IOL) to correct pseudophakic refractive error is an easy procedure and is preferable to replacing a previously implanted IOL.
      
    The risk of complications is lower if a second IOL is implanted. In a series of sixteen secondary piggy backed implants, vision after surgery improved to 20/40 or better in 50% of the cases.
      
    Intralenticular opacities develop between the 2 IOLs when they are both placed within the capsular bag. It is recommended that only one lens be placed in the capsular bag and the other implant be placed within the sulcus region.
      

  • Gills JP, Fenzi RE (St Luke’s Cataract and Laser Inst, Tarpon Springs, Fla)
    Minus-Power Intraocular Lenses to Correct Refractive Errors in Myopic Pseudophakia.
    J Cataract Refract Surg 25: 1205-1208, 1999.
      
    Myopic pseudophakic eyes with overpowered implanted IOLs CAN benefit from secondary implantation of a second minus power IOL to reduce the total implanted power. The secondary piggyback IOL’s power is more predictable than is achieved with an IOL exchange. Visual acuity was improved significantly.
      
    Minus power IOLs were previously not available but are now readily available. Hence this procedure of secondary piggyback IOL is preferred as a less traumatic surgery (compared to IOL exchange).
      

  • Mader TH, Koch DD, Manuel K, et al (Madigan Army Med Ctr, Tacoma, Wash; Baylor College of Medicine, Houston; National Aeronautics and Space Admin Houston)
    Stability of Vision During Space Flight in an Astronaut With Bilateral Intraocular Lens.
    Am J Ophthalmol 127: 342-343, 1999.
      
    The first use of IOLs in a physician mission specialist astronaut during a space shuttle mission was reported.
      
    There were preflight concerns that the IOL could move forward during choroidal expansion (due to microgravity), yet no change in visual acuity was noted by the patient, suggesting that the IOL position remained stable during microgravity.
      

  • Schein OD, for the study of Medical Testing for Cataract Surgery [John Hopkins Univ., Baltimore, Md ; et al
    The Value of  Routine Preoperative Medical Testing Before Cataract Surgery
    N Engl J Med 342: 168-175, 2000
     
    The rates of perioperative morbidity and mortality after cataract surgery are low, despite the fact that patients are elderly and have serious coexisting illnesses. These patients commonly undergo routine medical testing before cataract surgery. A prospective randomized clinical trial was performed to determine whether routine medical testing before cataract surgery reduces the rate of complications in the perioperative period.
     
    It was concluded that routine medical testing before cataract surgery does not improve the safety of the surgical procedure. It is possible to save the high costs of routine medical testing without any negative effects on patients’ health or clinical outcome. It is also reasonable to apply these observations to other patients undergoing other surgeries with low surgical risks, under local anesthesia and IV sedation.
       

  • G Rainer, Rupert Menapace, Oliver Findl, et al (Univ. of Vienna, Austria)
    Intraocular pressure rise after small incision cataract surgery: a randomised intraindividual comparison of two dispersive viscoelastic agents.
    Br.J. Ophthalmol. Feb.2001, 85: 139-142.
      
    This study (prospective and randomized) comprised 80 eyes of 40 consecutive patients who had bilateral small incision cataract surgery. Phacoemulsification was done after a 3.2mm sutureless incision and a foldable silicone intraocular lens was inserted.
      
    The patients were randomly assigned to receive OCUCOAT (hydroxy-propyl methylcellulose 2%) or viscoat (sodium chondroitin sulphate 4% – sodium hyaluronate 3%) for the first eye operation. The second eye which was operated later received the other viscoelastic agent.
       
    It was found that VISCOAT causes a significantly higher intraocular pressure (IOP) increase and significantly more IOP spikes thank OCUCOAT in the early postoperative period.
       

  • A Ionides, S Tuft (Moorfields Eye Hospital, London)
    Visual outcome following posterior capsule rupture during cataract surgery.
    Br. J Ophthalmol, Feb.2001, 85: 222-224.
      
    Prospective data were collected on 1420 consecutive eyes undergoing cataract extraction. The best spectacle corrected visual acuity was recorded at discharge. 
       
    Posterior capsule rupture occurred in 59cases (4.1%). Eyes with posterior capsular rupture were 3.8 times more likely to have a final best spectacle corrected visual acuity less than 6/12.
       
    Hence the authors conclude that eyes with posterior capsular rupture during cataract surgery have a significant risk of reduced visual acuity.
       

  • M C Westcott, S J Tuft, D C Minassian (Moorfields Eye Hospital and Institute of Ophthalmology , London)
    Effect of age on visual outcome following cataract extraction.
    B J Opthalmol 2000; 84: 1380-1382

    Eight Hundred and Eighty patient aged 60 yrs and above, undergoing cataract extraction between 1996 and 1999 were analysed. Analysis was performed after exclusion of patient identified pre-operatively as having ocular comorbidity, that was thought to limit their final corrected acuity.

    In patient with no comorbidity, the odds of achieving an acuity of ³ 6/12 were 4.6 times higher in the 60-69 year age group, than the oldest age group (over 80 yrs).
      

  • J.A. Mares-Perlman, B.J. Lyle, et al (Depts. of Ophthalmology and Visual Sciences, Univ. of Wisconsin-Madison Medical School, Madison)
    Vitamin Supplement Use and Incident Cataracts in a Population-Based Study
    Arch Ophthalmol, Nov.2000, vol.118, pg. 1556-1563
      
    This study was carried out to determine the relationship between vitamin supplement use and the 5-year incidence of nuclear, cortical, and posterior subcapsular cataract.

    Compared with non-users, the 5-yr risk for any cataract was 60% lower among persons who at follow-up, reported the use of multivitamins or any supplement containing vitamin C or E for more than 10 years. The use of multivitamins for this duration reduced the risk for nuclear and cortical cataracts but not for posterior subcapsular cataracts. Use of supplements for shorter periods was not associated with risk of cataract.

    The authors however feel that it is not possible to specify the nutrients responsible for lowering the risks of development of cataracts.

    Unmeasured life-style differences between supplement users and non-users may explain the results.
      

  • M Horiguichi, K Miyake, I Ohta, et al (Nagoya Univ, Japan; Shozan-Kai Miyake Eye Hosp, Nagoya, Japan) 
    Staining of the Lens Capsule for Circular Continuous Capsulorrhexis in Eyes with White Cataract. 
    Arch Ophthalmol 116:535-537, 1998.
         
    To improve visibility of the anterior capsule in eyes with a mature cataract and white lens cortex, a capsular-staining technique was developed using indocyanine green (ICG), which facilitates continuous circular capsulorrhexis.
        
    Further research is needed to determine the safety of this technique.
        

  • AK Hutchinson, ME Wilson, RA Saunders (Med Univ of South Carolina, Charleston) 
    Outcomes and Ocular Growth Rates After Intraocular Lens Implantation in the First 2 years of Life. 
    J Cataract Refract Surg 24:846-852, 1998.
        

    In this study 17 patients (aged 12 days to 22 months) had IOL implantation in 22 eyes.
        
    The results showed that IOL implantation in children under 2 yrs was a safe and effective alternative to contact lens or spectacle correction of aphakia. By eliminating periods of uncorrected aphakia, it may aid amblyopia treatment.
        
    The complication rate or re-operation rate was not significantly higher in pseudophakic patients than in a similar population having cataract extraction but who were left aphakic at the time of surgery.
        

  • CP Lohmann, M Heeb, H-J Linde, et al (Univ of Regensburg, Germany) 
    Diagnosis of Infectious Endophthalmitis after Cataract Surgery by Polymerase Chain Reaction. 
    J Cataract Refract Surg 24: 821-826, 1998.
        
    Polymerase chain reaction was more successful in detecting the infectious agent than the conventional microbiological tests, especially in the diagnosis of delayed endophthalmitis, where, in all eyes, the pathogen was detected in the aqueous humor.
        

  • ED Griener, E Dahan, SR Lambert (Emory Univ, Atlanta, Ga)
    Effect of Age at Time of Cataract Surgery on Subsequent Axial Length Growth in Infants Eyes
    J Cataract Refract Surg 25: 1209-1213, 1999
        
    In a study of eleven infants aged 2 to 4 months who had a unilateral lensectomy along with a posterior chamber IOL in the sulcus, it was found that 70% of the pseudophakic eyes had diminished axial growth after surgery.
        
    Older children in other studies had minimal growth differences between pseudophakic and normal eyes. This indicates that there may be a critical period of growth after which the removal of the lens has no effect on ocular growth.
        
    Implantation of an IOL tends to inhibit axial length when compared with the contralateral phakic eye. This has far reaching implications for the calculation of appropriate IOL power.
       

  • O Findl, W Drexler, R Menapace, et al (Universitatsklinik fur Augenheilkunde, Allgemeines Krankenhaus Wien, Austria)
    Changes in Intraocular Lens Position After Neodymium: YAG Capsulotomy.
    J Cataract Refract Surg 25: 659-662, 1999.
       
    Dual-beam partial coherence interferometry has been developed for high-precision biometry and high resolution tomographic imaging. Accurate biometry can be performed in pseudophakic eyes using this techniques.
      
    Changes in IOL position caused by ND: YAG capsulotomy were prospectively assessed with different types of IOLs.
      
    Anterior chamber depth (ACD) was determined by dual beam partial coherence interferometry in 32 pseudophakic eyes with posterior capsule opacity and immediately after planned YAG capsulotomy under mydriasis.
       
    All patients had backward IOL movements when Nd:YAG was used. Magnitude of movement was the same for the 1-piece PMMA and the 3-piece foldable IOLs and higher for the plate-haptic IOLs. 
       
    A hypermetropic shift after capsulotomy will usually be minimal and not clinically evident.
        

  • Rainer G, Menapace R, Schmetterer K, et al (Univ of Vienna)
    Effect of Dorzolamide and Latanoprost on Intraocular Pressure After Small Incision Cataract Surgery.
    J Cataract Refract Surg 25: 1624-1629, 1999.
       
    If there is elevated intraocular pressure (IOP) within 24 hrs. of cataract surgery, there may be a risk of developing corneal epithelial oedema, pain, retinal artery occlusion or anterior ischaemic optic neuropathy.
      
    In a study of 102 patients, it was found that both dorzolamide and latanoprost effectively reduced IOP rises after 6 hours. However only dorzolamide was of help after 20 to 24 hours.
      
    If untreated IOP rose about 5mmHg in 6 hrs and 1.5mm Hg within 24 hours. Using dorzolamide reduced the increase of IOP significantly. Latanoprost worked well only in the shorter term. Neither dorzolamide nor latanoprost could prevent IOP spikes of 30mm Hg or above.
       

  • Miyake K, Ota I, Maekubo, et al (Miyake Eye Hosp, Nagoya, Japan)
    Latanoprost Accelerates Disruption of the Blood-Aqueous Barrier and the Incidence of Angiographic Cystoid Macular Edema in Early Postoperative Pseudophakias.
    Arch Ophthalmol 117: 34-40, 1999
       
    Latanoprost (prostaglandin F2) lowers intraocular pressure (IOP) by increasing uveoscleral outflow. In human models, latanoprost did not disrupt the blood-aqueous barrier and did not affect cystoid macular oedema (CME) formation in eyes with longstanding pseudophakias.
        
    However, endogenous prostaglandins synthesized in the anterior uvea DO have a role in disrupting the blood-aqueous barrier and in inducing CME after cataract extraction.
       
    In a randomized, double-blind trial for latanoprost, as well as an open-label controlled trial for studying the effects of NSA drops on latanoprost and its place, the authors found that latanoprost disrupts the blood aqueous barrier and increases the incidence of angiographic CME in early postoperative pseduophakia.
       
    Concurrent instillation of NSA drops (e.g. diclofenac) can prevent the adverse effects of latanoprost and thus maintain the decrease in IOP.
        

  • Changwon Kee, Seong-Heon Moon. (Dept. of Ophthalmology, Samsung Medical Center College of Medicine, Seoul).
    Effect of cataract extraction and posterior chamber lens implantation on outflow facility and its response to pilocarpine in Korean subjects.
    Br.J Ophthalmol, 2000: 84: 987-989.
      
    Intraocular pressure was measured by Goldmann applanation tonometer in 42 patients with cataracts and outflow facility was measured by tonography preoperatively, before and after pilocarpine installation.
      
    All patients were operated by the same surgeon using clear corneal phaco-emulsification and a silicone foldable I.O.L. implantation within the bag.
      
    Two months after surgery, slit lamp examination, gonioscopy were performed and IOP and outflow facility were estimated.
      
    The statistical analysis carried out by the authors reveal that lens extraction causes a reduction in IOP and an increase in outflow facility in Korean subjects.
      
    Pilocarpine causes an increase in outflow facility which persists after cataract extraction and posterior chamber lens implant.
       

  • D Siriwardena, A Kotecha, D Minassian, et al (Institute of Ophthalmology, London)
    Anterior chamber flare after trabeculectomy and after phacoemulsification.
    Br. J.Ophthalmol 2000; 84: 1056-1057.
       
    This study of 131 consecutive patients was undertaken to evaluate and compare prospectively anterior chamber (a.c.) flare after phacoemulsification cataract extraction and after trabeculectomy with peripheral iridectomy.
      
    None of the patients had a history of pseudoexfoliation, uveitis or previous ocular surgery. It was found that a.c. inflammation and breakdown of the blood-aqueous barrier was much more prolonged after uncomplicated small incision cataract surgery than after glaucoma filtration surgery with peripheral iridectomy.
      
    This prolonged low grade inflammation is likely to be due to release of lens crystallins and lens epithelial cells into the aqueous humour, the effect of ultrasound, and/or the high volume of fluid passing through the eye at the time of surgery. 
      
    The above factors may increase the production of fibrogenic cytokines in the aqueous humour of patients who undergo phacoemulsification. 
      
    This may explain why the success rate of phaco-trabeculectomy is significantly lower than trabeculectomy alone. It may also explain why recent cataract surgery is a risk factor for failure of filtration surgery.
      

  • D C Minassian, P Rosen et al (Institute of Ophthalmology, University College, London, UK etc.)
    Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial
    Br J Opthalmology: 2001.85:822-829
     

    This article describes a two centre randomized trial comparing 232 patients with age related cataract who received ECCE and 244 received small incision surgery by phako.
     
    The main comparative outcomes were visual acuity, refraction, and complication rates.
     
    Phako was found to be superior due to the following reasons:
     
    (1) Surgical complications and capsular opacification within one year after surgery were significantly less frequent.
      
    (2) A higher proportion achieved an unaided visual acuity of 6/9 or better in the PHAKO group.
      
    (3) The average cost of surgery and postoperative care was similar for the two procedures.
         

  • L. Cassidy, J Rahi, K Nischal, et al ( Dept. of Ophthalmology, Great Ormond Street Hospital for Children, London)
    Outcome of lens aspiration and intraocular lens implantation in children aged 5 years and under.
    Br. J. Ophthal. May 2001, 85: 540 -542
      
    The authors evaluated 75 eyes of 45 children, under the age of 5 yrs (median age at surgery was 39 months), who underwent lens aspiration with primary posterior chamber intraocular lens implantation.
      
    73.5% eyes had a final best corrected visual acuity of 6/12 or better, while 20.5% achieved 6/18 or less.
      
    Mild uveitis which occurred in 28.2% eyes in the immediate post-operative period, resolved with topical steroids.
      
    In the short-term follow-up in this study, glaucoma, endophthalmitis or retinal detachment have not been observed postoperatively in any patient. The median follow-up period was three years.
      
    The authors conclude that in children under the age of 5 yrs, lens aspiration with IOL implantation is a safe procedure with good visual outcome in the short term.
      

  • E McLoone, G Mahon, et al (Queen’s Univ. of Belfast, U.K.)
    Silicone oil-intraocular lens interaction: which lens to use ?
    Br J Ophthal, May 2001: 85: 543-545
      
    PMMA, AcrySof, AR40, AQUA-Sense and Raysoft lenses were examined. Each lens was immersed for 5 minutes intervals in balanced salt solution (BSS) in stained silicone oil, and again in BSS before being photographed in air and in BSS. Percentage of silicone oil coverage of the lens optic was compared.
      
    The authors found that a Raysoft lens was a suitable lens in patients who are at risk of vitreo-retinal disease.
       

  • D J Apple, Liliana Werner et al
    Newly Recognized Complicaitons of Posterior Chamber Intraocular Lenses
    Arch.Ophthalmol, April 2001, vol.119, p.581-582.
       
    Yu and Shek reported an unexpected late postoperative opacification on the optical component of a modern foldable hydrogel IOL, the Hydroview lens (Bausch and Lomb). They felt that the opaque material, identified as hydroxyapatite, penetrates into the substance of the IOL optical component.
       
    However, the editor feels that the deposits are only on the IOL surface.
       
    The calcification process occurs on both anterior and posterior surfaces of the IOL, and appears between 12 and 25 months postoperatively. In advanced stages, the posterior capsule and fundus cannot be visualized.
       
    Attempts to remove the opacity with an Nd-YAG laser have been unsuccessful.
      
    The author has tested 23 explanted IOLS. The process of opacification appears to be 2-fold:
    (1) Degeneration of the UV filtration material and 
    (2) Deposits of calcium below the IOL’s optic surface, with the substance of the optic biomaterial.
       
    These complications have been mostly late postoperatively. The editor feels that some surgeons, manufacturers and governmental regulators appear to have become overconfident, even complacent, regarding oversight and quality control of both established and new IOL designs. Moreover curtailment of funding for the cataract IOL operation, probably leads to less scrutiny by surgeons and manufacturers.

  • H Jackson, D Garway-Health et al (Institute of Ophthalmology, Cayton street, London)
    Outcome of cataract surgery in patients with retinitis pigmentosa.
    B.J.O. Aug.2001; 85: 936-938



    This retrospective analysis was undertaken of a continuous series of 142 eyes of 89 patients with retinitis pigmentosa undergoing cataract surgery.

    The authors conclude that cataract surgery for relatively minor lens opacities is beneficial in patients with retinitis pigmentosa. Majority of patients report subjective improvement of visual symptoms. The incidence of capsular opacification is high. The incidence of postoperative macular oedema was unexpectedly low.

  • A. Assi, S Woodruff, et al (Moorfields Eye Hosp., London)
    Combined phacoemulsification and transpupillary drainage of silicone oil: results and complications.
    B.J.O. Aug.2001; 85: 942-945


    The authors have analyzed 74 consecutive cases of combined phacoemulsification and transpupillary drainage of silicone oil. They conclude that combined phacoemulsification and transpupillary drainage of silicone oil is a safe and reliable technique offering the advantage of diminished surgical trauma.
       

  • K. Negishi, K Ohnuma, et al (Toden Hosp. Tokyo, Japan)
    Effect of Chromatic Aberration on Contrast Sensitivity in Pseudophakic Eyes
    Arch Ophthal, vol.119, August 2001; p.1154-1158

    The authors evaluated the variations in chromatic aberrations occurring with the use of different materials in intraocular lenses.

    The eyes were divided into 3 groups.
    (1) Polymethyl methacrylate (2) Silicone and (3) an acrylate/methacrylate copolymer.

    Best corrected visual acuity (for distance) and contrast sensitivity were measured under white light and monochromatic light (with different wave lengths).

    Under both white monochromatic light and 470nm x 630nm monochromatic light, the mean contrast sensitivity in group 3 tended to be lower, than in other IOL groups.
      

  • Schein OD, for the Study of Medical Testing for Cataract Surgery (Johns Hopkins Univ, Baltimore, Md; et al) 
    The Value of Routine Preoperative Medical Testing Before Cataract Surgery 
    N Engl J Med 342: 168-175, 2000

    By random assignment over 18,189 patients scheduled for 19,557 elective cataract surgery at 9 centers, did or did not have a standard battery of medical assessments prior to surgery.

    Both groups had an overall complication rate of 31.3 events per 1000 operations.

    The authors conclude that routine medical testing prior to cataract surgery is costly and does not appear to markedly increase procedural safety. Cost may be avoided without adversely affecting clinical outcomes.
          

  • Allemann N, Chamon W, Tanaka HM, et al (Federal Univ of Sao Paulo, Brazil; Clinique Monticelli, Marseille, France)
    Myopic Angle-Supported Intraocular Lenses: Two-Year Follow-up
    Ophthalmology 107: 1549-1554, 2000
          
    Five men and seven women (mean age 29.5 years) with myopia > – 11 D were studied.
         
    Each eye was implanted with a NuVita IOL, which is a single-piece polymethylmethacrylate IOL with Z-shaped haptics. Each haptic has 2 footplates and an optical zone of 4.5 mm.
         
    Two years postoperatively it was found that angle-supported anterior chamber 10Ls were effective and safe in correcting high myopia.
         
    Many of the IOLs showed iris retraction, perhaps resulting from an oversized IOL diameter.
         
    Endothelial cell loss in the second year after surgery was also a concern. None of the IOLs had cataractous changes.
         

  • Petersen AM, Bluth LL, Campion M (Southwestern Eye Ctr, Mesa, Ariz) 
    Delayed Posterior Dislocation of Silicone Plate-Haptic Lenses After Neodymium: YAG Capsulotomy 
    J Cataract Refract Surg 26: 1827-1829, 2000
         
    The authors report 4 cases of posterior dislocation of silicone plate-haptic lenses that occurred several months after Nd: YAG capsulotomy.
          
    They strongly recommended that silicone plate-haptic lenses should not be used when capsular integrity is breached or zonular dialysis is present, because of risk of posterior dislocation of the IOL.
           

  • BenEzra D, Cohen E, (Hadassah Univ Med School, Jerusalem)
    Cataract Surgery in Children With Chronic Uveitis 
    Ophthalmology 107: 1255-1260, 2000
          
    Ten children with uniocular or markedly unequal binocular uveitis were included in the study. A posterior chamber IOL was implanted.
          
    It was found that whether or not an IOL was implanted, the postoperative course and immediate restored visual activities were similar. Visual acuity improved in all operated eyes, one month after surgery.
          
    When uveitis was associated with juvenile rheumatoid arthritis (JRA), active intraocular inflammation persisted for a longer time postoperatively along with secondary membranes in some cases.
          
    Tolerance to contact lenses (as compared to IOL implantation) was poor.
          

  • Pandey SK, Werner L, Escobar-Gomez M, et al (Med Univ of South Carolina, Charleston)
    Dye-Enhanced Cataract Surgery: Part 1. Anterior Capsule Staining for Capsulorhexis in Advanced/White Cataract 
    J Cataract Refract Surg 26: 1052-1059, 2000
          
    The absence of the red reflex in patients with total advanced/white cataract or in patients with pigmented fundi or vitreous diseases, makes it difficult to distinguish the anterior capsule from the underlying cortex.
          
    Continuous curvilinear capsulorhexis (CCC) was done in 12 postmortem human eyes with cataract in experimental, closed-system surgery. The anterior capsule was stained with 3 different dyes before CCC. 
         
    Staining with indocyanine green, 0.5%, was slightly better than with fluorescein sodium, 2%, and trypan blue, 1%.
          
    Intracameral subcapsular injection of indocyanine green stains the posterior surface of the anterior capsule without leaking into the vitreous cavity (compared to fluorescein sodium which leaked into the vitreous).
           

  • Kuchle M, Viestenz A, Martus P, et al (Univ Erlangen-Nurnberg, Erlangen Germany)
    Anterior Chamber Depth and Complications During Cataract Surgery in Eyes With Pseudoexfoliation Syndrome 
    Am J Ophthalmol 129: 281-285, 2000
          
    A few eyes with pseudoexfoliation syndrome have intraoperative complications associated with zonular weakness.
          
    174 eyes with pseudoexfoliation, scheduled for cataract surgery were reviewed. A- scan ultrasonography was done to measure anterior chamber depth, lens thickness and total axial length. 
          
    Twelve eyes had complications (6.9%). The authors observe than an anterior chamber depth < 2.5 m carried a 13.4% risk for intraoperative complications. 
           
    A shallow anterior chamber may indicate zonular instability in eyes with pseudoexfoliation syndrome. In case surgery is complicated, switching from topical anesthesia to a more traditional injection technique may be beneficial.
         

  • Jun AS, Pieramici DJ, Bridges WZ Jr (Johns Hopkins Med Institutions, Baltimore, Md) 
    Clear Corneal Cataract Wound Dehiscence During Pneumatic Retinopexy 
    Arch Ophthalmol 118: 847-848, 2000
           
    The authors reported two cases of clear corneal cataract wound dehiscence during pneumatic retinopexy, within 3 weeks after cataract surgery.
             
    To reduce the chance of this complication, paracentesis may be done before gas injection to minimize a rapid rise in IOP.
          

  • Age-Related Eye Disease Study Research Group
    AREDS Report No. 9
    A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E Beta Carotene for Age-Related Cataract and Vision Loss 
    Arch Ophthalmol. Vol. 119(10), October 2001; Pg. 1439-1452
            
    In a multicentre study (11-centres) of 4757 participants, it was found that use of a high-dose formulation of vitamin C, vitamin E, and beta carotene in a relatively well-nourished older adult cohort, had no apparent effect on the 7-year risk of development or progression of age-related lens opacities or visual acuity loss.
          

  • C. Y. Mardin, U. Schlotzer, et al (University Eye Hospital, Schwabachanlage, Erlaugan, Germany) 
    “Masked” Pseudoexfoliation Syndrome in Unoperated Eyes with Circular Posterior Synechiae 
    Arch Ophthalmol., October 2001, Vol. 119(10) Pg. 1500-1504
           
    This study included 27 consecutive patients with circular posterior synechiae and a history of miotic drug use without previous intraocular surgery, inflammation, or trauma, and without conventional signs of pseudoexfoliation (PEX) material in the anterior chamber.
          
    After cataract surgery, the excised anterior lens capsular were investigated for the presence of precapsular fibillar PEX deposits by electron microscopy.
           
    The authors conclude that posterior synechiae were more frequently associated with manifest or early stages of PEX syndrome. However, broad posterior synechiae found in miosis prevented a definite clinical diagnosis based on the classic changes of anterior lens capsule.
           
    The masked variant of PEX syndrome should be considered, in eyes with spontaneous or miotic-induced circular posterior synechiae without other obvious cause.
           

  • Doyle JW, Smith MF (Univ. of Florida, Gainesville)
    Effect of Phacoemulsification Surgery on Hypotony Following Trabeculectomy Surgery.
    Arch Ophthalmol 118: 763-765, 2000
       
    Chronic hypotomy is a frustrating complication following the use of local antimetabolites in trabeculotomy surgery.
      
    The authors reviewed the effects of phacoemulsification surgery in eyes with chronic hyptomy following trabeculectomy with mitomycin C.
       
    They found that statistically significant elevation in IOP occurs in association with phacoemulsification surgery in previously filtered eyes with hypotony. This may result in resolution of hypotony.
       

 

 

By |2022-07-20T16:42:11+00:00July 20, 2022|Uncategorized|Comments Off on Cataract Surgery

About the Author: