Cataract Intraocular Lens Research Articles

Long-term follow-up of visual functions after pediatric cataract extraction and intraocular lens implantation

To assess the visual acuity and binocular function of children after pediatric cataract extraction and intraocular lens implantation. 47 children with 68 eyes (< 13 years old) were included in the study: 12 children with monolateral traumatic cataract, 14 children with monolateral congenital cataract and 21 children with bilateral congenital cataract. Cataract type, cataract extent, age at surgery and presence of strabismus and nystagmus and the best corrected distant visual acuity (BCDVA) before surgery were recorded and as well. In addition, the best corrected near visual acuity (BCNVA) and binocular function were followed up for an average of (41.3 +/- 12.3) months. Statistical analysis was used to define factors that correlated with achieving good visual acuity and binocular function. BCDVA and BCNVA were 0.5 or better in 34 eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%). Age at surgery, extent of cataract, absence of strabismus and nystagmus were significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus, good BCDVA were significant for good binocular function. Good visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lens implantation. Multiple factors correlated with achieving good visual function such as timing of surgery, type and extent of cataract, absence of strabismus and nystagmus etal.

Intraocular Metabolites of Isopropyl Unoprostone

Purpose: It is still unknown which metabolite of isopropyl unoprostone is responsible for reducing intraocular pressure. This study was carried out to measure intraocular metabolites of isopropyl unoprostone in the aqueous humor of primate and human eyes. Methods: Nine monkeys were randomly divided into three groups, all of which received isopropyl unoprostone. In group I, the drug was scheduled to be instilled at 0 hr, in group II at 1 hr, and in group III at 2 hr, prior to aqueous humor aspiration in order to determine metabolite concentration. Furthermore, 27 patients scheduled for cataract surgery and intraocular lens implantation were divided into five groups that received isopropyl unoprostone. In group A, the drug was scheduled to be instilled at 0 hr, in group B at 1 hr, in group C at 2 hr, in group D at 3 hr, and in group E at 4 hr, prior to surgery. At the beginning of the operation, the aqueous humor was aspirated. Metabolites of isopropyl unoprostone in the aqueous humor were determined by high-performance liquid chromatography. Results: M1 (3-[(1R,2R,3R,5S)-3,5-dihydroxy-2-(3-oxodecyl)cyclopentyl]propionic acid) (unoprostone free acid) and M2 ((Z)-7-[(1R,2R,3R,5S)-3,5-dihydroxy-2-(3-oxodecyl)cyclopentyl]hept-5-enoic acid), an intraocular oxidized metabolite of isopropyl unoprostone, were measured. M1:M2 in monkeys was respectively 0:0 ng/ml in group I, 150.2 ± 45.1:9.5 ± 1.7 (p < 0.05) in group II, and 74.6 ± 31.4:19.2 ± 5.3 (p < 0.01) in group III. M1:M2 in humans was respectively 0:0 ng/ml in group A, 50.6 ± 22.3:3.2 ± 1.3 (p < 0.05) in group B, 125.0 ± 23.1:12.2 ± 3.4 (p < 0.001) in group C, 144.9 ± 33.8:24.5 ± 6.2 (p < 0.01) in group D, and 56.7 ± 21.5:18.7 ± 5.3 (p < 0.05) in group E. Conclusions: A free acid of isopropyl unoprostone is the major intraocular metabolite of isopropyl unoprostone that is expected to act on target tissues in the eyes of both monkeys and humans.

Nursing of the patients who received extra capsular cataract extraction and intraocular lens implantation

目的 探讨小切口白内障囊外摘出后房人工晶状体植入术患者的护理方法.方法对165例(165眼)采取充分的术前准备、心理护理、术后细致的观察及护理.观察术中、术后情况,及手术效果.结果术中、术后病人配合良好,医生及患者满意.并发症减少,术后视力0.5～1.2者为152眼(占92.2%),0.05～0.4者13眼(占7.8%),总脱盲率100%,患者满意.结论良好的护理方法是手术成功的重要因素。

Pars plana vitrectomy for vitreous opacity associated with ocular sarcoidosis resistant to medical treatment

objective: To examine the results of pars plana vitrectomy for nonclearing vitreous opacities associated with ocular sarcoidosis that is resistant to corticosteroid treatment. Methods: Eight consecutive patients (11 eyes) with vitreous opacities and uveitis associated with sarcoidosis were studied. All patients were resistant to or intolerant of corticosteroid therapy. All eyes underwent pars plana vitrectomy, followed by evaluation of visual acuity and recording of the grade of inflammation and complications. Results: Seven eyes had gained two or more lines of Snellen visual acuity six months postoperatively; visual acuity remained unchanged in the other four eyes. Vitreous inflammation was reduced in all cases. Severe postoperative inflammation did not recur in any eyes. Five eyes developed visually significant cataracts and underwent cataract extraction and intraocular lens insertion within 8–30 months. Based on slit-lamp biomicroscopy and fluorescein angiography, preoperative cystoid macular edema in five eyes resolved or improved within six months after vitrectomy. Postoperative complications included elevated intraocular pressure in three eyes, cataract formation in six eyes, epiretinal membrane formation in one eye, and choroidal neovascularization in one eye. None of the patients developed cystoid macular edema postoperatively. Only three patients received systemic corticosteroids after surgery. At the final visit, only one patient required systemic corticosteroid therapy. Conclusions: Pars plana vitrectomy appears to have beneficial effects on restoring vision, stabilizing vitreous inflammation, and reducing systemic corticosteroid requirements in eyes with thick vitreous opacities associated with sarcoidosis that is resistant to medical treatment.

Post cataract-intraocular lens (IOL) surgery opacification.

Intraocular lens (IOL) implantation has no doubt been one of the most satisfying advances of medicine. Millions of individuals with visual disability or frank blindness from cataracts had and continue to have benefit from this procedure. It has been reported by ophthalmologists that the modern cataract-intraocular lens (IOL) surgery is safe and complication-free most of the time. This makes the watchword for any cataract surgeon to be 'implantation,' 'implantation,' 'implantation.' In the mid-1980s, as IOLs were evolving rapidly, the watchword of the implant surgeon was 'fixation,' 'fixation,' 'fixation.' Most techniques, lenses and surgical adjuncts now allow us to achieve the basic requirement for successful IOL implantation, namely long-term stable IOL fixation in the capsular bag. However despite this advancement some items 'slipped through cracks.' In this article, we would like to alert the reader to a new watchword, namely 'opacification,' 'opacification,' 'opacification.' Here we will be talking about the good, the bad, and the ugly. Examples of the 'good' include the recent successes now being achieved in reducing the incidence of posterior capsule opacification. Examples of the 'bad' include various proliferations of anterior capsule cells, problems caused by silicone oil adherence to IOLs and problems with piggyback IOLs. The 'ugly' include the sometimes striking and often visually disabling opacifications occurring on and within IOL optics, both on some modern foldable IOLs as well as a poly(methyl methacrylate) (PMMA) optic degradation occurring with some models a decade or more after implantation.

Cellular Fibronectin, but not Collagens, Disappears in the Central Posterior Capsules During Healing After Lens Extraction and IOL Implantation in Rabbits

Purpose: To investigate the nature of capsular opacification after cataract-intraocular lens (IOL) surgery in rabbit eyes, we immunohistochemically located extracellular matrix components in lens capsules after the surgery using light microscopy. The study was conducted also to compare the extracellular matrix components in rabbit capsules with those previously reported in the human eye. Methods: Twenty-seven eyes of 17 Japanese albino rabbits were lensectomized by phacoemulsification, and IOLs were implanted. Using immunohistochemical methods, the lens capsules were examined immediately after surgery, and 1, 2, 4, and 8 weeks after surgery. Results: In all cases at each time point, the edge of the anterior capsulotomy had contracted and was found to adhere to the inner surface of the posterior capsule, with both IOL haptics remaining in the capsular bag. Collagen types I and III were detected around the adhesion between the anterior capsulotomy edge and posterior capsule during all stages of healing and also observed on the central posterior capsules 1 or more weeks after surgery. Immunoreactivity for cellular fibronectin was seen around the adhesion between the anterior capsulotomy edge and posterior capsule during all stages of healing. It was also detected on the posterior capsules 2 and 4 weeks after surgery, but disappeared 8 weeks after surgery. Conclusion: Extracellular matrix components such as collagen types I and III and cellular fibronectin were expressed inside the residual lens capsular bag. Cellular fibronectin may play a role in the early wound healing process in the postoperative posterior capsule because the immunoreactivity in the central posterior capsule disappears in the later phase of healing.

Measurement of Apparent Accommodation with a 20 / 20 Near Vision Optotype

The value of apparent accommodation varies with methods of measurement. To discuss the details of apparent accommodation, it is appropriate to measure it with the smallest possible near vision optotype. In the present study, we used a 20/20 near vision optotype for the measurement of apparent accommodation. Forty-six eyes of thirty-eight patients (45-84 years old) who had undergone cataract surgery and intraocular lens implantation, and had at least 20/20 best corrected visual acuity at near and far distances, were used in this study. After the eyes were corrected by glasses to gain the best corrected long distance visual acuity, they were forced to watch a 20/20 near vision optotype. Then we gradually added plus lenses until they could recognize the optotype. The value of apparent accommodation was recorded by subtracting the value of plus lens by which the eye could first recognize the 20/20 near vision optotype from three diopters. The value of apparent accommodation was 0.00-3.00 D (medium 0.50 D). Two eyes had three diopters of apparent accommodation. In the present study with correction of astigmatism and small near vision optotype, most eyes showed smaller apparent accommodation than those in previous studies. Despite that, patients with three diopters of apparent accommodation do exist. To analyze high quality visual functions, we should use the smallest possible near vision optotype for the measurement of apparent accommodation.

OCULAR SURGERY IN THE TWENTY-FIRST CENTURY

As we approach the new millennium, a quick reflection on the last century's accomplishments humbles us as to how far we have come in such a short time. From the incredible pace in the improvements in cataract surgery and intraocular lens implantation to the current demands on perfect refractive outcomes in our patients, our achievements are truly astounding. In the subspecialties of glaucoma, vitreoretinal surgery, oculoplastic, neuro-ophthalmic, and pediatric surgeries, we have given great hope to patients with profound and often life-threatening ocular and orbital conditions. By examining in greater detail the subspecialties of cataract, cornea, refractive, glaucoma, and vitreoretinal surgeries, we hope to examine where the long road from which we have come may ultimately be headed as we approach the twenty-first century.

Perioperative antibiotic, steroid, and nonsteroidal anti-inflammatory agents in cataract intraocular lens surgery

Ophthalmologists continue to choose topical antibiotics and corticosteroids more frequently than injectable agents for their current cataract surgical techniques. The preoperative use of povidone-iodine 5% and the postoperative use of impregnated soft contact lenses have helped augment our therapeutic armamentarium. NSAIDs play an important role in decreasing postoperative convalescence with fewer side effects. The intracameral administration of heparin and antibiotic solutions is discussed.

Perioperative antibiotic, steroid, and nonsteroidal anti-inflammatory agents in cataract intraocular lens surgery

Perioperative antibiotic, steroid, and nonsteroidal anti-inflammatory agents in cataract intraocular lens surgery

Posterior Capsulorhexis with Optic Capture in Pediatric Cataract and Intraocular Lens Surgery

A major concern in pediatric intraocular lens implantation surgery is the high incidence of posterior capsule opacification. The purpose of this article is to investigate a surgical technique for maintaining a clear visual axis after pediatric cataract and intraocular lens surgery. In a prospective evaluation, posterior capsulorhexis with optic capture as a surgical technique for preventing secondary membrane formation after pediatric cataract extraction is investigated. This technique involves capture of an intraocular lens optic through a posterior curvilinear capsulorhexis opening. Perioperative complications and incidence of secondary cataract are presented. Results will be compared to an historic cohort of patients with pediatric cataract-intraocular lens who did not have posterior continuous curvilinear capsulorhexis with optic capture. In 13 consecutive eyes operated on in children aged 2 to 12 years (mean, 5.8 years), there was no opacification of the visual axis at a mean follow-up of 19 months after surgery (range, 8-30 years). Posterior capsulorhexis with optic capture holds promise as a technique for preventing secondary membrane formation. This maneuver ensures centration of the posterior chamber intraocular lens while eliminating the need for an anterior vitrectomy. Apposition of the anterior and posterior capsule leaflets anterior to the optic may limit the migration of Elschnig pearls, reducing the incidence of secondary membranes and the need for additional procedures.

Cost-minimization analysis of capsulotomy after ECCE and IOL implantation.

An economic evaluation of capsulotomy for posterior capsular opacification after extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation was carried out using a cost minimization model. This model demonstrates the use of cost comparison to aid the decision making process. A flow-chart of capsulotomy mode, with associated complications, is illustrated. Costs of complications are calculated using assigned probability for each tree. Overall comparative costs are displayed graphically Further, the model is presented using a computer-assisted spreadsheet with an added calculation program. Variables can therefore be adjusted with instantaneous outcomes visually displayed. We present several examples with different sets of variables and find that, in most instances, YAG capsulotomy is a more economical option than surgical capsulotomy. This finding is a relevant finding in planning for eye health programs, particularly in developing countries. We suggest that the model be modified using local parameters in order to provide optimal benefits in similar health programs.

2318 Title: Long-term corneal endothelial damage after cataract extraction and intraocular lens implantation

2318 Title: Long-term corneal endothelial damage after cataract extraction and intraocular lens implantation

Long-term corneal endothelial damage after cataract extraction and intraocular lens implantation

Long-term corneal endothelial damage after cataract extraction and intraocular lens implantation

Corneal metabolism and epithelial barrier function after cataract surgery and intraocular lens implantation: a fluorophotometric study

The aim of this study was the assessment of possible changes in corneal metabolism and epithelial barrier function after an extracapsular lens extraction with artificial lens implantation. Ten patients without any eye medication were selected out of 140 patients attending for extracapsular lens extraction with lens implantation at the university hospital. Corneal metabolism was evaluated by fluorophotometric measurement of corneal autofluorescence. The corneal fluorescence values were corrected for interference by the fluorescence of the ocular lens. Corneal epithelial barrier function was evaluated by determination of corneal epithelial permeability. The permeability was calculated from the fluorescein penetration into the cornea after application of an eye bath containing fluorescein. Operated and fellow eyes were investigated 1 week before and 3-4 weeks after the operation. The corneal autofluorescence of the operated eye decreased significantly after surgery (mean decrease: 14%, Wilcoxon paired-sample test: P = 0.038). The corneal epithelial permeability of both eyes increased after surgery above the normal range of healthy controls (mean increase operated eye: 34%, P = 0.015, fellow eye: 32%, P = 0.15). Both corneal autofluorescence and epithelial permeability returned to normal values after one year. The lower corneal autofluorescence in the operated eye after surgery indicates a lower corneal metabolism which may be due to surgery. The increased epithelial permeability of both eyes implies a temporary impairment of the corneal barrier function. The interaction with the fellow eye indicates a consensual reaction which may attributed to damage to the neural system by the surgery.

Mersilene and Nylon Sutures in Cataract Surgery. A Comparative Study

OBJECTIVE: To compare the effects of 10/0 nylon and 10/0 mersilene sutures on the astigmatism following cataract surgery with a corneal incision. STUDY DESIGN: Prospective randomized study, until first spectacles were prescribed at 3 months postoperatively. SETTING: Teaching hospital. PATIENTS: Consecutive patients under the care of one consultant, due to undergo planned cataract extraction and intraocular lens implantation by one surgeon. No history of previous intraocular surgery. MAIN OUTCOME MEASURES: Keratometry and subjective refractions pre-operatively, and at 2, 6 and 13 weeks postoperatively. Time to complete suturing. RESULTS: No significant differences were found between the two suture materials for keratometry readings and final and surgically-induced astigmatism. Comparable ease of handling, as measured by the suturing time. CONCLUSIONS: There was no apparent benefit in the short-term for mersilene compared to nylon. However, mersilene costs more than nylon because it is double-ended. Single-ended mersilene should be made available.

Evaluation of two infrared autorefractors in pseudophakia

We investigated the viability of using an objective infrared autorefractor to identify high corneal astigmatism (> 3.00 D) in a pseudophakic population. The eyes of 91 patients, who had recently undergone cataract extraction and intraocular lens implanation, were refracted manually and using two infrared autorefractors, a Canon RK-1 and a Nikon NR-2000. Autorefractor measurements were repeated to provide estimates of reliability for each instrument. LogMAR visual acuities were also recorded with both the manual and autorefractor corrections. Approximately 75% of repeat autorefractor measurements were within 0.50 D of the initial readings, and about 75% of measurements were within 1.00 D of the manual refractions. Visual acuities with manual corrections were, on average, one line better than with autorefractor corrections. By validating the autorefractors against manual refraction, the efficiency of the autorefractors for detecting astigmatism > 3.00 D was calculated. Setting the cut-off criterion to ensure high sensitivity (95%), so that almost all patients with > 3.00 D were detected, resulted in both instruments having a poor specificity of about 40%.

Complications of Cataract Extraction and Intraocular Lens Implantation

Complications of Cataract Extraction and Intraocular Lens Implantation

Pupillary membrane after cataract extraction with posterior chamber lens in glaucoma patients

Deposition of a fibrin-like material leading to a membrane in the pupillary opening is described in glaucoma patients following extracapsular cataract extraction and intraocular lens implantation. The fibrinoid reaction was observed in 4 out of 57 eyes (7%), all operated on within two years by the same surgeon (CTL). The fibrinoid reaction appeared 2 to 15 days postoperatively in glaucoma patients on whom iridoplasty or synechiolysis had been performed during surgery. It seems advisable to give such patients long-acting subconjunctival steroids at the end of the operation.

Evaluation of Quality of Cataract Surgery. I. Corneal Endothelial Permeability

Fluorophotometry was carried out in 19 eyes with no pathology except for the presence of advanced cataracts. The age range was 60–75 and there was no evidence of systemic disorders such as diabetes mellitus or hypertension. The scanning fluorometer used (Fluorotron Master) was modified in order to improve depth resolution (0.585 mm). Corneal endothelial permeability (Pac) was calculated before surgery (Pac: 3.14 ± 0.60 × 10 -4 cm/min). In 11 eyes, corneal endothelial permeability was again measured one week after planned extracapsular cataract extraction and intraocular lens (IOL) implantation. The corneal endothelial permeability increased after surgery and this increase correlated well with duration of surgery. Longer surgical procedures (>20 min) were associated with greater increases in corneal endothelial permeability.