Clear Corneal Cataract Extraction Research Articles

Incidence of nonarteritic ischemic optic neuropathy following topical clear corneal cataract surgery: survey and meta-analysis

We estimate the incidence and characteristics of post-cataract-surgery nonarteritic ischemic optic neuropathy (PCNAION) after topical clear corneal cataract extraction (CCCE) in Canada. Canada-wide internet survey and meta-analysis PARTICIPANTS: All certified Canadian ophthalmologists in the Canadian Ophthalmological Society directory, or belonging to a provincial ophthalmology internet group. Identical surveys were distributed to 5 regions in Canada. CCCE surgeons were asked to estimate the number of CCCE they had performed in their career, and the number of PCNAION events that occurred within 1 year after CCCE. The results were analyzed using a random effects meta-analysis of proportions for rare events. The estimated survey response rate was 18%-32%. The 182 survey respondents performed a total of 1 499 694 CCCE with 107 events of PCNAION. Twenty-six percent of surgeons had at least one patient with PCNAION. Meta-analysis revealed a pooled estimate incidence of 2.8 PCNAION events (95% confidence interval 1.6-4.7) per 100 000 cataract procedures during the year after cataract surgery. Seventy-seven percent (82/107) of the PCNAION cases occurred within 3 weeks of surgery, and 7 patients had bilateral PCNAION. PCNAION is a rare complication after topical CCCE. Its incidence is important to estimate for patient care and epidemiologic reasons.

Pain perception in sequential cataract surgery: Comparison of first and second procedures

To compare pain and anxiety between first and second cataract extractions under topical anesthesia with monitored anesthesia care. University ophthalmology clinic. Cohort study. Consecutive adults having bilateral sequential clear corneal cataract extraction using phacoemulsification under topical anesthesia with monitored anesthesia care were recruited. Exclusion criteria included baseline eye pain, poor comprehension, and complicated cataract extraction. Patients completed 4 short perioperative surveys with each cataract extraction as follows: the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Scale (STAI) preoperatively and a 0-to-10 visual analog scale pain survey twice after surgery. Pain and difference in pain were the primary outcomes. Of the 65 patients who completed the study, 26 (40%) reported higher visual analog scale pain scores for the second cataract extraction. Overall, the median pain score was 0 (range 0 to 6) for the first cataract extraction and 1 (range 0 to 9) for the second (P = .004). By 1 day postoperatively, the pain scores were similar (median 0; range 0 to 9; P = .58). Both APAIS and STAI anxiety scores decreased between surgeries (P = .003 and P < .001, respectively). Although cataract extraction remained relatively painless under topical anesthesia with monitored anesthesia care, there was a subtle increase in pain in the second surgery relative to the first. This appears to be associated with decreased preoperative anxiety and may be related to the amnestic effects of intravenous sedation. These data may explain a common operative observation. No author has a financial or proprietary interest in any material or method mentioned.

Change in Astigmatism After Temporal Clear Corneal Cataract Extraction in the Pediatric Population

Purpose:To evaluate the early postoperative change in astigmatism in pediatric patients having cataract extraction with intraocular lens implantation using sutured temporal clear corneal incision. Methods: A retrospective chart review was performed on all pediatric patients who underwent clear corneal cataract surgery with intraocular lens implantation between 12/01/2005 and 11/30/2006. Results: A total of 31 eyes of 22 patients who underwent temporal clear corneal cataract surgery and intraocular lens implantation were included. The mean patient age at surgery was 6.05 years (range 1.5 months to 17 years). Mean postoperative refractive astigmatism the first day after surgery was 2.35±1.37 diopters (D). There was a statistically significant decrease in mean postoperative astigmatism by postoperative week 1 to 1.45 ± 0.79 D. Mean astigmatism was 1.48 ± 0.98 D by postoperative months 2-4, which was not a statistically significant change from postoperative day 1. Conclusions: Postoperative astigmatism can be expected after sutured temporal clear corneal surgery in pediatric patients and decreases over time without removal of sutures. The amount of postoperative astigmatism in children requires close follow-up after pediatric cataract surgery.

Proper wound construction to prevent short-term ocular hypotony after clear corneal incision cataract surgery

To evaluate the stability of 2.2 mm and 3.0 mm clear corneal cataract incisions with square or nearly square surface architecture. Private practice ambulatory surgical center, Century City, California, USA. A retrospective chart review of 60 patients who had clear corneal cataract extraction between January and September 2006 was conducted. Fifty patients had clear corneal cataract extraction with a square 2.2 mm incision and 10 patients with a nearly square 3.0 mm incision. For the 2.2 mm incision subset, cataract surgery and intraocular lens implantation were accomplished through an unenlarged 2.2 mm clear corneal cataract incision using the Alcon Infiniti unit and an Ultrasleeve for infusion. For the 3.0 mm subset, the Allergan Sovereign unit was used. Intraocular pressure (IOP) was measured intraoperatively at the conclusion of each procedure with a Schiötz or Barraquer tonometer and set between 15 mm Hg and 20 mm Hg. Wound sealing was confirmed by intraoperative Seidel testing in all cases. Intraocular pressure was measured by a Tono-Pen (Medtronic) or Goldmann applanation tonometry between 2 hours and 6 hours after the conclusion of each procedure. The mean postoperative IOP was 19.2 mm Hg +/- 4.9 (SD) (median 18 mm Hg; range 11 to 35 mm Hg) in the group with a 2.2 mm square incision and 16.6 +/- 5.2 mm Hg (median 16.0 mm Hg; range 10 to 25 mm Hg) in the group with a 3.0 mm nearly square clear corneal incision. No patient had an IOP less than 10 mm Hg, and there was no evidence of hypotony or wound leakage by Seidel testing in either group. Clear corneal wounds of square or nearly square surface architecture that are meticulously checked for sealing were stable postoperatively as demonstrated by the absence of hypotony and wound leakage. In the presence of a sealed clear corneal wound, IOP remained reasonably stable relative to the level set at the conclusion of the procedure.

Traumatic total iridectomy after clear corneal cataract extraction

The increasing use of topical clear cornea techniques has led to an intense debate regarding wound stability. We present a case of traumatic aniridia post cataract extraction which illustrates the importance of wound dimensions and construction.

Acute Endophthalmitis Following Cataract Surgery

To determine the reported incidence of acute endophthalmitis following cataract extraction over time and to explore possible contributing factors, such as type of cataract incision. A systematic review of English-language articles was conducted by performing a broad search of PubMed from 1963 through March 2003 using such terms as cataract extraction, endophthalmitis, and postoperative complication. Additional studies were identified from bibliographies of relevant articles and published proceedings. Surgical approach was recorded, when available. Pooled incidence rates and relative risks of developing endophthalmitis using different incision techniques were assessed. From 4916 unique, potentially relevant citations, 215 studies that addressed endophthalmitis and met the selection criteria were analyzed. A total of 3 140 650 cataract extractions were pooled resulting in an overall rate of 0.128% of postcataract endophthalmitis. However, the incidence of acute endophthalmitis changed over time, with a significant increase since 2000 compared with previous decades (relative risk, 2.44 [95% confidence interval, 2.27-2.61]). The rate of endophthalmitis was 0.265% in the 2000-2003 period, 0.087% in the 1990s, 0.158% in the 1980s, and 0.327% during the 1970s. Furthermore, an upward trend in rates after 1992 was noted, compared with 1991 and prior. Incision type appeared to significantly influence risk, as endophthalmitis following clear corneal cataract extraction during the 1992-2003 period was 0.189% compared with 0.074% (relative risk, 2.55 [95% confidence interval, 1.75-3.71]) for scleral incision and 0.062% (relative risk, 3.06 [95% confidence interval, 2.48-3.76]) for limbal incision. This systematic review indicates that the incidence of endophthalmitis associated with cataract extraction has increased over the last decade. This upward trend in endophthalmitis frequency coincides temporally with the development of sutureless clear corneal incisions.

Astigmatism after small-incision clear corneal cataract extraction and intraocular lens implantation in children

To investigate the magnitude of postoperative astigmatism in children having cataract extraction with intraocular lens (IOL) implantation through a 3.0 mm superior clear corneal incision. Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA. This retrospective chart review comprised all pediatric patients having cataract surgery with IOL implantation through a 3.0 mm clear corneal incision from 1997 to 2002. One hundred two eyes of 75 patients were included. All refractions were performed manually by an experienced pediatric ophthalmologist. The mean postoperative retinoscopic cylinder in all patients was 0.63 diopter (D) (range 0.0 to 4.50 D) at 1 month, 0.40 D (range 0.0 to 1.75 D) at 6 months, and 0.51 D (range 0.0 to 2.50 D) at 1 year. Patients aged 0 to 36 months at the time of surgery had a mean postoperative cylinder of 0.22 D at 1 month, 0.03 D at 6 months, and 0.21 D at 1 year. Patients between 36 months and 6 years of age at surgery had a mean refractive cylinder of 0.50 D, 0.38 D, and 0.75 D, respectively. Patients older than 6 years at surgery had a mean refractive cylinder of 0.94 D, 0.75 D, and 0.76 D, respectively. Small-incision clear corneal cataract extraction with IOL implantation in children led to minimal postoperative astigmatism that remained stable over time. Less astigmatism was observed in children having surgery before they were 36 months old.

Surgical Management of Coexisting Glaucoma and Cataract

The management of coincident glaucoma and cataract is not only a common clinical challenge but also an important research topic in the ophthalmic surgical field. The purpose of this article is to compare the different surgical options on the basis of their achievable postoperative intraocular pressure (IOP) control, success rates, and complication rates reported in the related literature, and to give advice on how to manage typical situations of patients with both glaucoma and cataract. Main topics were focused on indications and rationale of 3 surgical options (only cataract surgery first and later trabeculectomy, only trabeculectomy first and later cataract surgery, or simultaneous combined surgery). Modern clear corneal cataract extraction techniques resulted in a modest intermediate-term reduction of IOP and has considerably improved the success rates of combined glaucoma and cataract surgery. It also enabled future trabeculectomy to be successfully performed at a later date if necessary. Trabeculectomy alone achieved better IOP regulation than phacotrabeculectomy (combined surgery), but subsequent cataract surgery may compromise preexisting filtering bleb. Combined surgery augmented with mitomycin C achieved a lower IOP than combined surgery alone but had a higher complication rate. In conclusion, the choice of the preferred surgical method should be determined according to the target pressure, the amount of glaucomatous damage, and the grade of visual disturbance caused by the cataract. Phacotrabeculectomy with adjunctive mitomycin C offers visual improvement and achieves the best IOP lowering of all types of combined glaucoma and cataract surgery currently used but is associated with potentially sight-threatening complications.

Topical anaesthesia: a risk factor for post-cataract-extraction endophthalmitis?

To investigate if the incidence of postoperative endophthalmitis in temporal clear corneal cataract surgery is influenced by the use of topical anaesthesia compared to retrobulbar anaesthesia. A retrospective study was conducted of one surgeon's cataract surgery between October 1997 and October 2001. Between October 1997 and May 2000, there were 633 cataract extractions performed with 219 patients operated under topical anaesthesia and 414 under retro-bulbar injection. The selection criteria were that surgically easier cases underwent topical anaesthesia. There were five patients who suffered postoperative endophthalmitis in their first week, of which four cases were under topical anaesthesia. This was shown to be borderline significance of P = 0.05 using the Fischer exact 2-tailed test. There was a complicated case, operated under retrobulbar anaesthesia, who had a low-grade endophthalmitis in the second postoperative week. The four topical cases and the case from the second week all grew Staphylococcus epidermidis. The retrobulbar case developing endophthalmitis in the first week grew alpha haemolytic Streptococcus. After May 2000, there was a change to performing all cataract surgery under retrobulbar anaesthesia and the next 453 cases had no incidence of endophthalmitis. Topical anaesthesia techniques in temporal clear corneal cataract extraction may be a factor in endophthalmitis.

Peripheral ulcerative keratitis after clear corneal cataract extraction

A previously healthy 80-year-old man had uneventful clear corneal cataract extraction. An extensive peripheral corneal infiltrate with overlying epithelial defect at the incision site was noted at the regular follow-up visit 1 week after surgery. Corneal cultures showed no evidence of infectious keratitis. A systemic evaluation uncovered early-stage, active rheumatoid arthritis. This case illustrates that peripheral ulcerative keratitis may occur with a small clear corneal incision and may be the presenting sign of a previously undiagnosed rheumatoid disease.

Management of coincident corneal disease and cataract.

The status of the cornea is crucial to a good outcome with cataract extraction. Preexisting corneal disease must be managed appropriately to get the high-quality results that we have come to expect with cataract surgery. It is now more common to perform cataract surgery on patients with previous corneal refractive surgery, and in these patients intraocular-lens power calculation is more challenging. Complications following cataract surgery and intraocular-lens implantation that involve the cornea are uncommon because of advances in surgical techniques. Corneal complications can include mechanical or toxic injury of the endothelium, stripped Descemet's membrane, epithelial toxicity and disruption, infectious keratitis, and epithelial ingrowth. Endothelial-cell survival after cataract extraction and lens implantation is still the major concern. Healing of the cornea following clear corneal incisions has become more important, as this technique is more frequently used. Patients with ocular surface disease still require extra lubrication and management of blepharitis to prevent epithelial toxicity at the time of surgery as well as postoperatively. Clear corneal cataract extraction and lens implantation causes minimal disruption of the conjunctiva, allowing cataract surgery to be performed in patients with severe ocular surface disease such as ocular cicatricial pemphigoid. Overall, modern-day cataract extraction is very safe for the cornea.

Management of coincidental corneal disease and cataract.

The status of the cornea is crucial to a good outcome with cataract extraction. Preexisting corneal disease must be managed appropriately to get the high quality results that we have come to expect with modern day cataract surgery. It is now more common to perform cataract surgery on patients who have had previous corneal refractive surgery, and in these patients intraocular lens power calculation is more challenging. Complications following cataract surgery and lens implantation that involve the cornea are uncommon because of advances in surgical techniques. Corneal complications can include mechanical or toxic injury of the endothelium, stripped Descemet's membrane, epithelial toxicity and disruption, infectious keratitis, or epithelial ingrowth. Endothelial cell survival after cataract extraction and lens implantation is still the major concern. Healing of the cornea following clear corneal incisions has become more important, as this technique is used more frequently. There are several recent studies looking at the results of clear corneal incisions performed for cataract surgery. Patients with ocular surface disease still require extra lubrication and management of blepharitis to prevent epithelial toxicity at the time of surgery as well as postoperatively. Clear corneal cataract extraction and lens implantation cause minimal disruption of the conjunctiva, allowing cataract surgery to be performed in patients with severe ocular surface disease such as ocular cicatricial pemphigoid. Overall, modern day cataract extraction is very safe for the cornea.

Clear corneal section and cataract extraction.

The technic of clear corneal cataract extraction was used in 365 cases, and the visual and postoperative results are reviewed. Visual acuity of 20/30 or better was obtained in 71% of cases, and there was corneal astigmatism of one diopter or less in 33%. Hyphema and shallow anterior chamber were encountered in less than 2% of cases. No instance of epithelial downgrowth was encountered. A renewal of interest in this technic of cataract extraction is encouraged.