Extracapsular Extraction Research Articles

Injectable and pH-Responsive Metformin-Loaded Hydrogel for Active Inhibition of Posterior Capsular Opacification.

Posterior capsular opacification (PCO) is a common complication following cataract surgery, which can lead to a significant vision loss. This study introduces a facile method for developing a metformin-derived hydrogel (HCM6) stabilized by dynamic covalent bonds among natural polymers. This hydrogel demonstrates antifibrotic properties, on-demand drug release, pH responsiveness, injectability, and self-healing capabilities. Our in vitro experiments confirmed that the HCM6 hydrogel exhibits excellent biocompatibility, inhibiting lens epithelial cell migration, and transforming growth factor-2β (TGFβ2)-induced α-smooth muscle actin (α-SMA) expression in lens epithelial cells. In vivo studies conducted in a rat extracapsular lens extraction (ECLE) model revealed that HCM6 significantly suppressed PCO after 21 days of implantation with no observed pathological effects on surrounding tissues or the optic nerve. According to our experimental results, the inhibitory mechanism of PCO may be attributed to metformin's suppressive effect on lens cell migration, epithelial-mesenchymal transition (EMT), and lens fiber formation. In summary, the long-acting, controllable, and on-demand release characteristics of the HCM6 hydrogel not only provide an effective strategy for preventing PCO but also offer new avenues for treating undesirable proliferative conditions in ophthalmology and beyond.

Bacteriophage Therapy for Staphylococcus aureus Induced Postoperative Acute Endophthalmitis In Vivo

Background: Postoperative acute endophthalmitis is a rare but severe complication following cataract surgery, with bacterial pathogens such as Staphylococcus aureus being the leading cause. Despite declining incidence rates globally, visual outcomes remain poor in many cases. Recent studies have explored the potential of bacteriophage therapy to treat bacterial infections, particularly for antimicrobial-resistant strains. This study aimed to assess the therapeutic effectiveness of bacteriophage treatment in a rabbit model of S. aureus-induced acute postoperative endophthalmitis. Methods: The study employed a randomized, controlled, posttest-only design using New Zealand white rabbits. Following extracapsular lens extraction surgery, rabbits were injected with S. aureus intracamerally to induce endophthalmitis. The treatment group received additional bacteriophage therapy. Ocular inflammation was assessed by measuring two biomarkers, myeloperoxidase (MPO) and intercellular adhesion molecule-1 (ICAM-1), using enzyme-linked immunosorbent assay (ELISA) from vitreous fluid samples. Histopathological analysis of retinal and scleral structures was performed post-enucleation. Statistical analyses were conducted using independent t-tests. Results: The treatment group showed significantly lower ICAM-1 levels (p < 0.001), indicating reduced leukocyte infiltration and inflammation compared to the control group. MPO levels were slightly elevated in the treatment group but were not statistically significant (p = 0.261). Histopathological examination revealed that retinal structures in the treatment group were preserved with reduced inflammatory cell infiltration, whereas the control group displayed extensive retinal damage, including neovascularization and retinal detachment. Conclusion: Bacteriophage therapy significantly reduced ocular inflammation and tissue damage in S. aureus-induced endophthalmitis, as evidenced by lower ICAM-1 levels and better-preserved retinal structures in the treatment group. These findings suggest that bacteriophage therapy may be an effective alternative to conventional treatments for postoperative acute endophthalmitis, particularly in cases involving antibiotic-resistant bacteria. Further studies are warranted to explore its broader clinical applicability.

PARS PLANA LENSECTOMY AND SUSHRUTA’S CHEDANA FOR CATARACT: A REVIEW

Jacques Daviel, a French ophthalmologist, is considered the father of cataract surgery for his revolutionary idea of extracapsular lens extraction technique, which was introduced in the eighteenth century. Prior to his concept, couching was prevalent in the millennia. Sushruta Samhita, a text dated between 800 BC - 1000 BC, has some descriptions of surgical technique with an extraocular expulsion of the lens with a Pars Plana incision/puncture. A proper analysis of Sushruta Samhita and its description of cataract surgery is necessary to understand the significance played by this ancient Indian surgeon in the evolution of present-day ophthalmology and the days of yore.

Comparative Study of Extracapsular Extraction with Manual Sutureless Phaco Alternative in Cataract Surgery at the Reference Health Center in Ouelessebougou

Cataract is a significant public health issue in developing countries, necessitating surgical treatment. The aim of this study was to compare extracapsular extraction with manual sutureless phaco alternative in terms of outcomes and functionality. It was a prospective study conducted from June 2023 to December 2023, involving 200 eyes followed up to Day 30 at the secondary ophthalmology center in Ouelessebougou. Data were analyzed using IBM SPSS and Excel 2016 software. Almost all of our patients, 92% in Phaco-A and 89% in EECC+ICP, underwent biometry. At Day 30 postoperative with spectacle correction, phaco alternative yielded 82% good results compared to 60% for extracapsular extraction. At Day 30 with spectacle correction in Phaco-A, 91% of patients had good visual acuity compared to 75% in EECC+ICP. This result is comparable to those of Konaté M [17] and Windinmanegdé Djiguimdé et al., [18], who achieved 83.49% and 79.6% good visual acuities. Phaco alternative provides better postoperative results in cataract surgery at the secondary ophthalmology center in Ouelessebougou.

Analysis of Ultrasonic Emulsification Surgery and Small Incision Cataract Extracapsular Extraction Surgery for Cataract Clinical Treatment Level Improvement

Objective: To analyze the efficacy of ultrasonic emulsification and small incision cataract extracapsular extraction in cataract patients. Methods: 96 cataract patients admitted from May 2021 to May 2023 were selected and randomly grouped into group A (ultrasonic emulsification) and group B (small-incision extracapsular cataract extraction), with 48 cases each. Results: At 1 week, 1-month, and 3 months post-operation, the visual acuity of group A was higher and the astigmatism value was lower than that of group B (P < 0.05); at 12h, 24h, and 48h post-operation, the intraocular pressure of group A was higher than that of group B (P < 0.05); the thickness of macular area of group A was lower than that of group B at 1 week and 1-month post-operation (P < 0.05). Conclusion: Ultrasonic emulsification in cataract patients was slightly better than small incision cataract extracapsular extraction in correcting astigmatism, improving visual acuity, and regulating macular thickness. However, due to the high energy of ultrasonic emulsification, the risk of complications such as high postoperative intraocular pressure was higher. Small-incision extracapsular cataract extraction has better application value in economically disadvantaged areas.

Functional Results of Cataract Surgery at the Secondary Ophthalmology Center of Ouelessebougou: A Study of 170 Cases

Cataract remains a significant public health issue in developing countries, and its treatment is predominantly surgical. The aim of this study was to evaluate extracapsular extraction using manual phaco alternative without sutures in terms of functional outcomes. This prospective study took place from January 2023 to June 2023, involving 170 eyes followed up to day 30 at the secondary ophthalmology center in Ouelessebougou. Data were analyzed using IBM SPSS and Excel 2016. Almost all our patients, 95% in Phaco-A and 93.3% in ECCE+PCI, underwent biometry. At day 30 postoperatively with correction, the phaco alternative yielded 88.8% good results, and extracapsular extraction showed 72.2% good results. At day 30 with correction, Phaco-A resulted in 88.75% of patients achieving good visual acuity compared to 72.22% in ECCE+PCI. This result is comparable to those of Konaté M [17] and Windinmanegdé Djiguimdé et al., [18], who achieved 83.49% and 79.6% good visual acuities, respectively. Phaco alternative provides better postoperative results in cataract surgery at the secondary ophthalmology center of Ouelessebougou.

Cystoid macular edema after cataract surgery. Aragua regional ophthalmological center and Maracay Central Hospital

Cystoid macular edema (CME) is a late complication of cataract surgery. Objective: To evaluate the frequency of cystoid macular edema after cataract surgery at the Regional Ophthalmology Center of Aragua and Hospital Central de Maracay during the period from March to August 2022. A quantitative investigation was developed, with a non-experimental, descriptive design. The study was prospective and longitudinal in a population of 148 patients for a sample of 45 eyes of 45 patients who presented cataracts and underwent surgery using extracapsular extraction and phacoemulsification techniques. Results: 6 cases of CME were presented, representing a frequency of 13%. The average age was 66 ± SD 12.49 years, 50% of the cases were between 65 and 71 years. 67% corresponded to the female sex, with the same frequency of 50% for both eyes. 67% presented corrected visual acuity less than 20/80 at the fourth week, this frequency rising to 83% at the sixth week; 18% presented a central foveal thickness greater than 241 µm in the fourth week, maintaining this value in the sixth. 67% of the patients were operated on by the EECC technique and the rest by FACO. Conclusion: CME is a post-surgical cataract complication, being higher in advanced age, female sex and with the application of the EECC technique. Patients with CME presented progressive deterioration of visual acuity and foveal thickening, observing that the lower the corrected visual acuity, the greater the foveal thickness.

Zonular dialysis and cataract surgery: results from a UK tertiary eye care referral centre

ObjectifLa dialyse zonulaire (DZ), c'est-à-dire un déficit du soutien de la capsule lenticulaire par la zonule, peut avoir diverses origines et n’être décelée qu'au moment de la chirurgie de la cataracte. Notre étude visait donc à évaluer les caractéristiques pré-, per- et postopératoires dans des yeux dont la DZ a été découverte pendant l'intervention, sans égard à son étiologie. MéthodesIl s'agissait d'une étude d'observation de cohorte rétrospective réalisée dans un seul établissement, soit le Moorfields Eye Hospital (NHS Foundation Trust, Londres, R.-U.), auprès d'une cohorte de patients opérés pour une cataracte entre le 1er janvier 2014 et le 22 août 2019, afin de repérer ceux dont la chirurgie a été jugée compliquée par la découverte peropératoire d'une DZ. Ont été notés les caractéristiques des patients, les observations cliniques peropératoires, les résultats visuels et réfractifs de même que les complications postopératoires. RésultatsOn a découvert une DZ pendant l'opération dans 447 yeux. La plupart des patients (213 sur 223; 96,8 %), ont subi une phacoémulsification, sans conversion vers une extraction intracapsulaire ni extracapsulaire. Le taux de complications peropératoires s'est chiffré à 46,2 % (103 sur 223), sans corrélation significative avec l’étendue de la DZ. On a implanté un anneau de tension capsulaire (ATC) chez 43,4 % des patients (97 sur 223); enfin, on a pu établir une corrélation entre le recours à un ATC et l'amélioration des résultats visuels et réfractifs postopératoires. ConclusionsLa DZ est une complication grave de la chirurgie de la cataracte qui doit être diagnostiquée et prise en charge sans délai pendant l'intervention. Les résultats de la chirurgie tendent à être moins bons en présence de DZ, mais l'implantation peropératoire d'un ATC semble améliorer les résultats visuels et réfractifs postopératoires.

Descemet’s Membrane Detachment Following Corneal Suture Removal: Case Report

Introduction: Descemet’s Membrane Detachment (DMD) is the separation of the descemet’s membrane from the overlying corneal stroma. It is a rare and a potential vision-threatening complication of cataract surgery, with incidence rates being reported at 0.044–0.5% after phacoemulsification and 2.5% after extra capsular extraction. In these cases, DMD is mostly seen during surgery or in the early post-operative period and it is associated to surgical technique, surgical equipment or genetic factors. It is one of the most serious complications of cataract surgery, leading to irreversible corneal decompensation. Small DMD may resolve spontaneously, but most large detachments require interventions such as pneumodescemetopexy. Case Report: We report a 70-year-old female patient, without any underlying disease, presented with the complaint of decreased vision in her pseudophakic right eye after a 15-weeks silent post-extra capsular cataract extraction period and two weeks after corneal suture removal. On slit-lamp examination, massive corneal edema was noticed on the temporal periphery with the involvement of the visual axis. Anterior segment optical coherence tomography revealed the presence of DMD in the superotemporal quadrant. To provide reattachment of DMD, we performed an anterior chamber tamponade with air. No complication associated with descemetopexy was noticed during recovery. Total Descemet’s membrane reattachment was achieved. Discussion: Among all intraocular surgeries, DMD is most commonly described after cataract surgery. It generally occurs in early- postoperative period and late-onset DMD have been reported less frequently. It presents as localized or diffuse corneal edema. Anterior segment optical coherence tomography examination can be clearly used for observation of the position and the range of DMD. There are several ways to manage DMD: medical treatment, pneumodescemetopexy, penetrating keratotplasty and endothelial keratoplasty. To the best of our knowledge, this is the first reported case of DMD after corneal suture removal. Conclusion: DMD after cataract surgery is associated with a variety of factors. Anterior segment optical coherence tomography examination can be used to find clear detachment of the descemet’s membrane. The position of detachment and surgical incision were found to be closely related. The location and the scope of detachment can be used to guide clinical treatments and improve prognosis of patients.

The miRNA-34a/Sirt1/p53 pathway in a rat model of lens regeneration.

BackgroundThere are many molecular factors involved in Wolffian and corneal lens regeneration, but few in lens regeneration by lens epithelial cells (LECs) in mammals. Silent information regulator 1 (Sirt1) has a variety of physiological functions, such as a transport hub, and is involved in pathological conditions. We studied the expression of the microRNA (miRNA)-34a/Sirt1/tumor protein p53 (p53) pathway in a rat model of lens regeneration.MethodsWe performed extracapsular lens extraction in 42 healthy female Sprague-Dawley rats. Slit lamp observation was performed at 3, 7, 14, 21, 30, 60 and 90 days postoperatively, and the rats were killed humanely by cervical dislocation at 30, 60 and 90 days postoperatively to remove the eyeballs. We performed semiquantitative immunofluorescence analysis of Sirt1, p53, alpha-smooth muscle actin (α-SMA) and fibronectin (fn), and real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) to detect the relative expressions of miRNA-34a, Sirt1, p53, aquaporin 0 (AQP 0), γA-crystallin, and beaded filament structural protein 1 (BFSP1) mRNA in the lens and posterior capsule.ResultsThe posterior capsule wrinkled at 3 days and it increased at 7 days. At 14 days, pearl-like opacification appeared under the capsule, with increasing shrinkage. Greater mass-like proliferators in size and number accumulated under the capsule and at the equator after 21 days. A regenerated lens developed in the central depression of the capsule at 30 days, slightly protruding from it. Despite being thickened at 60 days, the central depression persisted, with a smaller change at 90 days than at 60 days. Although the relative mRNA expression of miRNA-34a and p53 in the lens and posterior capsule decreased over time (P=0.000), that of Sirt1 increased (P<0.01). α-SMA was uniformly expressed in the crystals and gradually decreased, while fn expression gradually increased.ConclusionsmiRNA-34a expression decreased and Sirt1 expression increased during lens regeneration. Furthermore, p53 expression decreased, thus reducing apoptosis. Therefore, Sirt1 acted as a key factor in the pathway, and played a protective role in lens regeneration.

Shot gun eye injuries: Senegalese experience

Purpose: To describe the cases of eye trauma caused by the use of home-made firearms and to highlight the difficulties of their management. Observations: We admitted five patients (0.16%) with firearm-related eye injuries during the period from January 01, 2010 to January 01, 2022. All our patients were male. The average age was 33.2 years with extremes between 21 and 55 years. The circumstances of occurrence were dominated by attacks with lead as the main traumatic agent in all our patients. The consultation time ranged from one week to three months with a starting visual acuity not exceeding the light perception. The lesions were bilateral in three patients. There was a loss of eyeball function in all patients. Intraocular foreign bodies were found in 80% of cases. All our patients received medical treatment. Two of our patients had received surgical treatment such as extra capsular extraction and anterior vitrectomy. Discussion and conclusion: Shot-gun eye injuries have increased in recent years. Facial screening makes all the severity of these traumas involving the functional prognosis of the eye. Young people in full employment are mainly affected, hence the importance of prevention. Keywords: Eye; Shot weapons; Trauma; Prognosis; Prevention.

Enhancement of lens extraction-induced MCP-1 upregulation and microglia response in long-term diabetes via c-jun, stat1 and ERK

AimDiabetic patients are reported to have a higher incidence of cataract surgery-induced retinal complications, possibly due to retinal inflammation. Our goal is to identify the key inflammatory cytokines, cells and regulatory pathways involved. Main methodsDiabetes mellitus (DM) induced by streptozotocin and control mice received extracapsular lens extraction (ECLE) in one eye. Neuroretinas were collected at postoperative day1(P1), day2(P2), and day7(P7). BV2 cells were harvested under the treatment of high glucose, lipopolysaccharide (LPS) and inhibitors. The method of qPCR, western blot and immunohistochemistry were used to identify the expression of cytokines and signaling pathways. Key findingsECLE induced increased inflammation in the neuroretina of surgery eye with a peak at P1. MCP-1 surge in long-term diabetes mellitus (LDM) mice at P1 is higher than short-term diabetes mellitus (SDM) mice and normal mice. Significant activation of c-jun and c-fos were found in LDM compared to normal and SDM. Advanced activation of stat1 and ERK was found at P1 in LDM instead of at P2 in SDM and Normal. Activation of microglia/macrophage was also detected in the LDM mice. Besides the inhibition of c-jun/JNK, MCP-1 expression can be attenuated by inhibiting stat1 and ERK under high glucose condition after LPS stimulation. SignificanceEnhancement of lens extraction-induced MCP-1 upregulation and microglia response in long-term diabetes might be due to the activation of cjun, stat1 and ERK, which provided potential therapeutic targets to attenuate retinal inflammation after surgery in diabetic individuals.

Curcumin Inhibits Proliferation and Epithelial-Mesenchymal Transition in Lens Epithelial Cells through Multiple Pathways.

Background Posterior capsule opacification (PCO), a complication of extracapsular lens extraction surgery that causes visual impairment, is characterized by aberrant proliferation and epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs). Curcumin, exerting inhibitive effects on cell proliferation and EMT in cancer, serves as a possible antidote towards PCO. Methods Cellular proliferation of LECs after treatment of curcumin was measured with MTT assay and flow cytometry. The transcriptional and expressional levels of proteins related to proliferation and EMT of LECs were quantified by western blotting and real-time PCR. Results Curcumin was found to suppress the proliferation of LECs by inducing G2/M arrest via possible inhibition of cell cycle-related proteins including CDK1, cyclin B1, and CDC25C. It had also inactivated proliferation pathways involving ERK1/2 and Akt pathways in LECs. On the other hand, curcumin downregulated the EMT of LECs through blocking the TGF-β/Smad pathway and interfering Notch pathway which play important roles in PCO. Conclusions This study shows that curcumin could suppress the proliferation and EMT in LECs, and it might be a potential therapeutic protection against visual loss induced by PCO.

Aldose reductase inhibition enhances lens regeneration in mice

After cataract surgery, epithelial cells lining the anterior lens capsule can transition to one of two divergent pathways, including fibrosis which leads to posterior capsular opacification (PCO), or lens fiber cell differentiation which leads to regeneration of lens material. We previously showed that the PCO response can be suppressed with aldose reductase (AR) inhibitors. In this present study we show that AR inhibition, both genetic and pharmacologic with Sorbinil, can augment the process of lens regeneration. Extracapsular lens extraction (ECLE) was carried out in C57BL/6 (WT), AR overexpression (AR-Tg), and AR knockout (ARKO) mice, and in some cases in mice treated with the AR inhibitor sorbinil. Whole eyes were harvested approximately 8 weeks after ECLE and evaluated by histological analysis and immunostaining for the fiber cell marker γ-crystallin. All eyes examined for lens regeneration were paraffin embedded for serial sectioning to produce three-dimensional reconstructed models of lens morphology and size. We observed that AR-null mice respond to ECLE by regenerating a lens-like structure with a circular shape and array of cell nuclei reminiscent of the lens bow region typical of the native mammalian lens. Although WT and AR-Tg eyes also produced some regenerated lens material after ECLE, their structures were consistently smaller than ARKO regenerated lenses. WT mice treated with sorbinil showed higher levels of lens regeneration after ECLE compared to WT mice, as assessed by size and three-dimensional morphology. Altogether, this study adds evidence for a critical role for AR in the response of lens epithelial cells to cataract extraction and lens regeneration.

Effects of Pranoprofen on Aqueous Humor Monocyte Chemoattractant Protein-1 Level and Pain Relief During Second-Eye Cataract Surgery

The aim of our present study is to evaluate the efficacy of pranoprofen eye drops as pain relief during sequential second-eye cataract surgery and to investigate the possible mechanism. Seventy-six patients scheduled for bilateral sequential cataract surgery were randomly assigned to two groups: (1) treatment group (administered pranoprofen eye drops), or (2) control group (administered artificial tears). Preoperative anxiety and intraoperative pain were assessed. Monocyte chemoattractant protein 1 (MCP-1) in the aqueous humor was measured with a suspension cytokine array. An extracapsular lens extraction model was established in the Wistar rat and the MCP-1 concentrations were measured with an enzyme-linked immunosorbent assay. We found that in the control group, the pain scores were significantly higher during second-eye surgery than during first-eye surgery (both scores P < 0.001). In the treatment group, there was no significant difference in the pain scores during first-eye and second-eye surgery (both scores P > 0.1). The pain during second-eye surgery was significantly lower in the treatment group than in the control group (both scores P < 0.01). And in the 1-week and 6-week interval subgroups, the pain scores during second-eye surgery were significantly lower in the treatment group than the control group (P = 0.047 and P = 0.035, respectively). While the second-eye MCP-1 level was significantly lower after a 1-week interval in the treatment group than in the control group (P = 0.012), but did not differ significantly after a 6-week interval (P > 0.1). A parallel trend in the MCP-1 concentration was detected in the rat model. In conclusion, the preoperative administration of pranoprofen eye drops reduced the perceived pain during second-eye cataract surgery, especially when performed after 1-week and 6-week intervals between the first-eye and second-eye surgery. MCP-1, a pain-related cytokine, was associated with the pain-relief mechanism of pranoprofen when second-eye surgery was performed 1 week after second-eye surgery.

Aldose Reductase Inhibition Prevents Development of Posterior Capsular Opacification in an In Vivo Model of Cataract Surgery.

PurposeCataract surgery is a procedure by which the lens fiber cell mass is removed from its capsular bag and replaced with a synthetic intraocular lens. Postoperatively, remnant lens epithelial cells can undergo an aberrant wound healing response characterized by an epithelial-to-mesenchymal transition (EMT), leading to posterior capsular opacification (PCO). Aldose reductase (AR) inhibition has been shown to decrease EMT markers in cell culture models. In this study, we aim to demonstrate that AR inhibition can attenuate induction of EMT markers in an in vivo model of cataract surgery.MethodsA modified extracapsular lens extraction (ECLE) was performed on C57BL/6 wildtype, AR overexpression (AR-Tg), and AR knockout mice. Immunofluorescent staining for the myofibroblast marker α-smooth muscle actin (α-SMA), epithelial marker E-cadherin, and lens fiber cell markers αA-crystallin and Aquaporin 0 was used to characterize postoperative PCO. Quantitative reverse transcription PCR (qRT-PCR) was employed to quantify postoperative changes in α-SMA, vimentin, fibronectin, and E-cadherin. In a separate experiment, the AR inhibitor Sorbinil was applied postoperatively and qRT-PCR was used to assess changes in EMT markers.ResultsGenetic AR knockout reduced ECLE-induced upregulation of α-SMA and downregulation of E-cadherin. These immunofluorescent changes were mirrored quantitatively in changes in mRNA levels. Similarly, Sorbinil blocked characteristic postoperative EMT changes in AR-Tg mice. Interestingly, genetic AR knockout did not prevent postoperative induction of the lens fiber cell markers αA-crystallin and Aquaporin 0.ConclusionsAR inhibition prevents the postoperative changes in EMT markers characteristic of PCO yet preserves the postoperative induction of lens fiber cell markers.

Comparative Evaluation of Extra Capsular Extraction (ECE) with Suture and Small Incision Cataract Surgery (SICS) Manual without Suture in the University Hospital of Bouake (Ivory Coast)

Objective: Cataract is a partial or total opacification of the lens responsible for blindness. The treatment is surgical. The purpose of our study was to evaluate the results of the newly introduced manual small incision cataract surgery (SICS) and compare them with those of the conventional extra-capsular extraction method. Patients and Method: Analytical cross-sectional study was carried out at the ophthalmology department of the University Hospital of Bouaké for a period of 1 year. Results: The two surgical techniques were compared at equal proportions. The average duration of interventions was longer during the sutured Extra Capsular Extraction (ECE) compared to the SICS. Rupture of the posterior capsule with vitreous exit, which was the most observed intraoperative complication, was predominant with ECE with suture (16%) against 8% for SICS. Corneal edema observed in the early postoperative period, was predominant with sutured ECE (30%), against 20% for SICS. Corneal edema, which was more observed with EEC compared to SICS, dominated secondary and late postoperative complications. Post-operative astigmatism induced by ECE with suture was between ?2 and ?4 dioptre in 51.5% of patients and between ?0.5 and ?2 dioptre in 73.91% of SICS. Visual acuity without correction in the early days was better with SICS. Conclusion: In this comparative study of cataract surgery, we noted superimposable results for both techniques. However, the prevalence of pre- and post-operative complications was more frequent with sutured ECE. The technique without suture allows visual recovery and a quick return to normal life.

Functional results of cataract surgery in the treatment of phacomorphic glaucoma.

Purpose. Analysis of functional outcome and complications reported in patients diagnosed with phacomorphic glaucoma, in which phacoemulsification or extracapsular extraction of the lens was performed. Methods. The retrospective study included 38 eyes diagnosed with phacomorphic glaucoma. In 25 cases, group 1, the lens was removed by phacoemulsification and in 13 cases, group 2, by extracapsular extraction. Intraocular pressure, visual acuity, and anterior chamber depth were evaluated preoperative and postoperative. The incidence of intra and postoperative complications was analyzed. The minimum follow-up period was 12 months. Results. The mean IOP decreased from the preoperative value of 38.4 +/ - 11.3 mmHg to 13.5 +/ - 3.4 mmHg in group 1 and 11.5 +/ - 3.2 mmHg in group 2. Persistent corneal edema was observed in 32% patients from group 1 and 23% of the patients from group 2. The inflammatory reaction of anterior chamber prevailed in patients from group 2 (46.1%). ACD modified from the preoperative mean of 1.3 +/- 0.5 mm to 2.3 +/- 0.2 mm in both groups. At the end of follow-up in both groups, the average BCVA was 0.6. 18.42% of the cases required long-term topical hypotensive therapy. Conclusions. Both phacoemulsification and extracapsular extraction were safe and effective procedures in the treatment of phacomorphic glaucoma, ensuring a rapid functional recovery and a satisfactory long-term IOP control. Although the rate of immediate postoperative complications and the final functional outcome were better in patients treated with phacoemulsification, not all the cases could be subjected to this type of surgery.

Intraocular silicone implant to treat chronic ocular hypotony: an in vivo trial.

The management of chronic ocular hypotony and complicated proliferative vitreoretinopathy-related retinal detachment represents a challenge. Being non-absorbable and non-biodegradable, a silicone oil implant is expected to restore the volume and the intraocular pressure of the globe, as well as to approximate the detached retina. Further advantages could be a long-term tamponade potential, absence of toxicity, and prevention of silicone oil emulsification or anterior chamber oil-prolapse. The aim of this study was to assess the histological tolerance of the silicone oil implant in a pig model. A seamless silicone balloon implant with optional surface modifications was developed. Mini pigs were used as experimental animals, and three variants of silicone implants with different surfaces were tested: uncoated, NCO-sP(EO-stat-PO) coated, and heparin-NCO-sP(EO-stat-PO) coated silicone implants. An extracapsular lens extraction was achieved via a standard phacoemulsification followed by a standard three-port vitrectomy. The implant was then placed in the posterior segment and filled with 5000 centistoke silicone oil. One month later, the pigs were euthanized, the eyes were enucleated, and histological specimens were prepared for microscopy. The analysis of the histology revealed that adverse histological changes in conjunctiva, cornea, iris, and ciliary body could be excluded in all eyes operated on regardless of which variant of implant had been employed. The retina as the implant-contacting ocular tissue showed overall good tolerance, although some inflammatory reaction and fibrous proliferation was evident in some cases. The silicone oil implant is a promising candidate and has the potential to fulfill clinical requirements to act as a long-term intraocular tamponade agent. The heparin-NCO-sP(EO-stat-PO) coating approach could lead to a novel bioactive surface for intraocular devices with excellent properties to hinder cell adhesion and protein adsorption, although further studies will be necessary to evaluate long-term biocompatibility and long-term resistance to biological attacks.

Stages of development of traditional simulation unit of surgery for manual extra capsular cataract extraction in sub-Saharan African region.

The manual extracapsular extraction of the lens is the surgical technique that is most practiced for the treatment of cataract in sub-Saharan Africa. Learning this technique requires the creation of a surgical simulation unit within training institutes. We describe the development stages of a traditional simulation unit. For this purpose, we present a description of four steps involved in the development of a simulation unit for cataract surgery: the physical creation of the room, the aseptic and antisepsis conditions, the management of the eyes, the development of a curriculum and the administrative policies.