Foldable Lens Implantation Research Articles

Clear Lens Phacoemulsification in Alport Syndrome: Refractive Results and Electron Microscopic Analysis of the Anterior Lens Capsule

To report the ocular findings of patients with Alport syndrome and the results of clear lens extraction in this patient group. Twenty-three eyes of 15 patients with a diagnosis of Alport syndrome were included in this study. Clear corneal phacoemulsification and intraocular foldable lens implantation was performed in eyes with indeterminate refractive errors and/or poor visual acuity and anterior capsule samples were analyzed with electron microscopy. All patients had a history of hereditary nephritis and/or deafness as systemic involvement. Ophthalmologic examination revealed anterior lenticonus with high myopia and/or irregular astigmatism in all patients. The mean best-corrected visual acuity (BCVA) was 0.67 ± 0.17 logMAR (range 1.0-0.4) preoperatively and 0.17 ± 0.08 logMAR (range 0.3-0.0) postoperatively. Postoperative refractive lenticular astigmatism dramatically decreased and no ocular complications arose during the follow-up period. Transmission electron microscopic analysis of the lens capsules supported the diagnosis of Alport syndrome. Clear lens phacoemulsification and foldable intraocular lens implantation is a safe and effective therapeutic choice for the management of uncorrectable refractive errors and low visual acuity due to anterior lenticonus in patients with Alport syndrome.

Influence of different length corneal limbal incisions on the anterior and posterior corneal astigmatism after phacoemulsification

Background The different incisions in phacoemulsification,including the length,location and shape etc.,can cause surgery-induced astigmatism ( SIA ).But the SIA caused by 2.2 mm,3.0 mm corneal limbal incision after phacoemulsification,especially the change of posterior corneal surface astigmatism is still rarely reported. Objective This study was to investigate the anterior,posterior and total corneal SIA and compare their differences between phacoemulsification and foldable intraocular lens (IOL) implantation with 2.2 mm and 3.0 mm corneal limbal incisions. Methods Seventy-one eyes of 47 cases were randomly divided into two groups with matched age,visual acuity and astigmatism degree.Phacoemulsification and IOL implantation with 2.2 mm incision at the steepest corneal meridian was performed on the patients of 2.2 mm incision group,and the same surgery was adopted with 3.0 mm incision as 3.0 mm incision group.Corneal curvature radius and central corneal thickness were measured by Pentacam at 1 day before surgery and 1 week,1 month and 3 months after surgery respectively.The anterior and posterior corneal surface SIAs were calculated according to the flat axis and steep axis of corneal curvature and the air and the cornea refractive index.Based on the anterior and posterior surface SIAs,the total corneal SIA was then calculated using the vector analysis method.Jaffe/Clayman vector method was used to calculate the anterior and posterior and total corneal SIAs in the different time points,and the differences were compared between the two groups.Oral informed consent was obtained from each subject prior to the trial. Results The mean anterior and posterior surface corneal SIAs appeared to be lower in 2.2 mm incision group compared with 3.0 mm incision group at postoperative 1 day,1 week,1 month and 3 months but were not significantly different among groups at various time points ( anterior SIA:P =0.290 ; posterior SIA:P =0.740 ; total SIA:0.434 ).The mean anterior corneal surface SIAs were significantly lower at the postoperative 3 months than those at postoperative 1 day,1 week in both groups(2.2 mm incision group:P=0.020,0.036;3.0 mm incision group:P=0.006,0.023 ).The posterior corneal surface SIAs were (0.70±0.43 ) D and (0.75 ±0.54 ) D at 1 day in 2.2 mm incision group and 3.0 mm inscision group,respectively,and significantly decreased posterior corneal surface SIAs were found in postoperative 1 week,1 month and 3 months compared with 1 day in both groups ( 2.2 mm incision group:all P =0.001 ; 3.0 mm incision group:P=0.028,0.044,0.032).The total corneal surface SIA showed significant differences between 1 day and 1 week,1 month,3 months after surgery ( 2.2 mm incision group:P =0.015,0.002,0.002 ; 3.0 mm incision group:P =0.049,0.007,0.016 ). Conclusions There are no significant differences in the anterior,posterior and total corneal surface SIAs between 2.2 mm and 3.0 mm incisions after phacoemulsification with IOL implantation.The SIA is gradually reduced with the prolongation of postoperative time. Key words: Phacoemulsification; Surgery-induced astigmatism; Corneal limbal incision

Mechanische Pupillenerweiterung zur Kataraktoperation: erste Erfahrungen mit dem 6,25 mm Malyugin-Ring

Inadequate mydriasis may cause major problems in phacoemulsification surgery. Usually 4 iris retractors are used to allow adequate pupillary dilatation. Implantation of a Malyugin ring to maintain a 6.25 mm pupil is a new alternative. A Malyugin ring was used in 46 eyes of 39 patients (aged 80.1 ± 6.2 years). The ring is im- and explanted with a disposable shooter through the main incision. Indications for the use of the ring were inadequate mydriasis due to pseudoexfoliation (n = 27), intraoperative floppy iris syndrome (n = 5), the combination of PEX and IFIS (n = 11), extensive posterior synechiae (n = 2) or inadquate mydriasis after long-term pilocarpine treatment (n = 1). In 44/46 eyes phacoemulsification with implantation of foldable posterior chamber lens was performed without complications. In 2 eyes with massive phakodonesis an Artisan anterior chamber lens had to be implanted after anterior vitrectomy because of total zonulolysis. There where no complications associated to the use of the device and with increasing experience duration of implantation as well as explantation was reduced to 2 - 4.5 min (median 2:51 min). In cases of phacoemulsification surgery with inadequate mydriasis implantation of a Malyugin ring is a simple, safe and fast alternative to iris-retractors; it allows better pupil-size without additional stab incisions.

Anterior Chamber Depth, Iridocorneal Angle Width, and Intraocular Pressure Changes After Phacoemulsification

To determine the association of changes in anterior chamber angle and anterior chamber depth (ACD) with intraocular pressure (IOP) reduction after uncomplicated phacoemulsification. In this prospective study, subjects underwent phacoemulsification with foldable lens implantation. Anterior chamber angle grading of 2 or less (Shaffer grading) in 3 or all quadrants was considered narrow angle (NA). Anterior segment optical coherence tomography and tonometry were performed preoperatively and 10 days and 1, 3, and 6 months after surgery. The ACD and angle opening distance at 500 μm anterior to the scleral spur (AOD500) were assessed from anterior segment optical coherence tomography. Data were collected from 63 eyes that underwent cataract surgery. Twenty-six eyes were classified as having NA. Before surgery, the mean (SD) AOD500 and ACD in the NA group were 0.179 (0.014) mm and 2.23 (0.07) mm, respectively. Six months after surgery, the mean (SD) AOD500 and ACD in the NA group were 0.389 (0.025) mm and 3.75 (0.05) mm, respectively. The postoperative IOP was reduced significantly in both groups. We found that each 0.1-mm increase in AOD500 corresponded to a mean (SD) 0.42 (0.18)-mm Hg decrease in IOP (P < .001) in the NA group and 0.32 (0.16) mm Hg (P = .046) in the OA group. Postoperative reduction in IOP was proportional to the increase in angle in both groups, but the IOP reduction per 0.1-mm increase in AOD500 in NA eyes was greater than that in OA eyes.

Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis

To compare orbital floor triamcinolone acetonide and oral prednisolone in cataract surgery in patients with chronic non-infectious uveitis with regard to visual outcome, postoperative inflammation and macular edema. Monocentric prospective randomized clinical trial with 40 eyes included. Patients underwent phacoemulsification with intraocular acrylic foldable lens (IOL) implantation. Patients were randomized either to intraoperative orbital floor triamcinolone acetonide (TA) (1 ml = 40 mg) (group 1, n = 20), or to 4-week postoperative oral prednisolone (group 2, n = 20). Laser flare photometry (LFM), cells in the anterior chamber (AC), best-corrected visual acuity (BCVA), IOL cell deposits, cystoid macular edema (CME) by means of fluorescein angiography, and central foveal thickness (OCT), posterior capsule opacification (PCO), and intraocular pressure (IOP) were analysed during a 6-months period. Mean BCVA postoperatively improved (p < 0.01) from logMAR 0.74 and 0.86 to 0.23 and 0.35 in groups 1 and 2 respectively.The number of AC cells, LFM and IOL cell deposits did not differ. Macular edema stayed unchanged in most cases in both groups, and mean foveal thickness (OCT) initially increased postoperatively, but after 6 months it nearly returned to baseline thickness. Differences between the groups were not significant. Up to 12% in group 1 and 28% of group 2 developed IOP elevation over 21 mmHg. A single intraoperative orbital floor injection of triamcinolone acetonide is as effective on postoperative inflammation, macular edema, and visual outcome as a 4-week course of postoperative oral prednisolone in cataract surgery with IOL implantation in uveitis patients.

Transscleral Fixation of Single-Piece Hydrophilic Acrylic Lenses With No Eyelets

Scleral fixation ofsulcus intraocular lenses is performed by most surgeons to correct aphakia in eyes with insufficient capsular support in which intraocular lenses cannot be implanted into the bag or sulcus. The implantation of foldable lenses maintains the advantages of small incision surgery, working with a closed system, less astigmatism, faster wound healing, and early visual rehabilitation. The authors describe a technique for using a single-piece hydrophilic foldable acrylic lens with no eyelets for scleral fixation.

Scheimpflug Biometry of the Anterior Segment After Implantation of Foldable Iris-fixated Lenses

To evaluate intraocular dimensions of the anterior segment of myopic phakic eyes after implantation of foldable iris-fixated lenses. Seventeen myopic eyes that received a foldable iris-fixated phakic intraocular lens (PIOL) were assessed. Distances between the cornea and the IOL-optic edge and between the IOL optic and the crystalline lens were evaluated using Scheimpflug photography 3 months postoperatively. The average postoperative distance between the central corneal endothelium and the anterior surface of the IOL was 2.01 +/- 0.26 mm. The distance between the corneal endothelium and the peripheral edge of the IOL averaged 1.32 +/- 0.18 mm at the 12 o'clock position and 1.34 +/- 0.21 mm at the 6 o'clock position. The distance between the crystalline lens and the posterior surface of the IOL averaged 0.73 +/- 0.09 mm. The high quality of the three-dimensional Scheimpflug images allowed measurements of intraocular distances in PIOL implanted eyes. Distances between the foldable iris-fixated IOL and crucial surrounding tissues could be determined 3 months postoperatively.

Analyse der optisch wirksamen Parameter nach Kataraktoperation mit Faltlinsenimplantation

Within the first few weeks after cataract surgery, changes of refraction can occur in patients with "clear cornea" surgery and implantation of foldable lenses. The possible reasons were analyzed. In 71 consecutive patients we determined axial length, anterior chamber depth, corneal refraction, and corneal thickness prior to cataract surgery, on the 1st postoperative day, and at a follow-up control after obtaining stable refraction. We divided the patients into three groups: patients with no change of refraction between the 1st postoperative day and the follow-up (group A), patients with hyperopic shift of refraction (group B), and patients with myopic shift of refraction (group C). In all three groups we measured no significant postoperative change of the axial length. Central corneal thickness increased by approximately 37 microm on the 1st postoperative day and had normalized at the time of control. Anterior chamber depth decreased in all groups by approximately 0.44 mm between the 1st postoperative day and the follow-up. Central corneal refraction showed an decrease in groups B and C and an increase in group A. The standard deviation was very high in all groups. The postoperative change of refraction depends on multiple factors among which changes of the anterior chamber depths, the corneal refraction, the swelling of the cornea, and the axial length can play a role.

Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients

To evaluate long-term IOP control after sutureless clear corneal phacoemulsification in eyes with preoperatively controlled glaucoma. Institutional study. The charts of 345 patients who had uneventful sutureless clear corneal phacoemulsification with acrylic foldable lens (IOL) implantation were retrospectively reviewed. Included were 58 patients with medically controlled open-angle glaucoma and 287 normal controls. Follow-up was 1 to 2 years. Outcome measures were postoperative IOP and number of glaucoma medications. Postoperatively, there was an insignificant decrease in IOP in the glaucoma group; the mean decrease was 1.5 mm Hg +/- 4.4 (SD) at 12 months and 1.9 +/- 4.9 mm Hg at 24 months. The mean number of medications decreased significantly at 12 months (0.53 +/- 0.86) and at 24 months (0.38 +/- 0.9) (P=.04). The control group also had a significant decrease in IOP, with a mean decrease of 0.72 +/- 3.7 mm Hg at 12 months (P=.01) and 1.33 +/- 3.2 mm Hg at 24 months (P<.0001). The decrease in IOP was more pronounced in eyes with a higher preoperative IOP in both the glaucoma and control groups. These findings suggest that sutureless clear corneal phacoemulsification with foldable acrylic IOL implantation is a relatively simple and efficient surgical option in patients with cataract and well-controlled glaucoma. The approach combines long-term IOP control with fewer medications and leads to rapid visual rehabilitation.

Intraoperative biometry for intraocular lens (IOL) power calculation at silicone oil removal.

Cataract development is common following retinal detachment surgery that necessitates silicone oil injection. Intraocular lens (IOL) power calculation in the presence of silicone oil is challenging for many reasons. The authors evaluated the accuracy of intraoperative biometry during cataract surgery in silicone-filled eyes. Twelve cases of cataract in eyes filled with silicone oil after retinal detachment surgery were included. Preoperatively, keratometric readings were documented. Intraoperative axial length was measured following removal of silicone oil using a sterile probe of the Nidek Echoscan US800 unit. IOL power calculation was computed using the SRK/T formula. This was followed by phacoemulsification and foldable lens implantation. Postoperative refraction allowed evaluation of the accuracy of intraoperative biometry. The predictability of three different formulas was also compared (Holladay, SRK/T, and SRK II). Seven men and five women with a mean age of 50.2 years were included in the study. The mean postoperative spherical equivalent using the described technique was 6.77 +/- 0.43 diopters. SRK/T and Holladay formula had the best predictability for high axial length eyes, whereas the three studied formulas showed no significant differences in predictability in eyes with normal axial length. Intraoperative biometry proved to have good predictability for the absolute postoperative refractive error in cataract surgery for eyes at the time of silicone oil removal. This predictability was accurate independent of axial length.

Phacoemulsification and Intraocular Lens Implantation Combined with Trabeculotomy for Open-Angle Glaucoma and Coexisting Cataract

Objective: To study the outcome of phacoemulsification and intraocular lens implantation combined with trabeculotomy. Methods: We performed trabeculotomy combined with phacoemulsification and foldable lens implantation in 25 eyes with open-angle glaucoma and coexisting cataract in 18 patients. The series comprised 9 males (13 eyes) and 9 females (12 eyes). Mean age of the patients was 73.4 ± 10.9 years (45–87 years). Mean follow-up period was 14.3 ± 6.0 months (6–24 months). Results: The preoperative intraocular pressure was 21.4 ± 3.7 mm Hg. The postoperative intraocular pressure 6 months after the surgery was 12.8 ± 3.4 mm Hg. A postoperative tension spike (>30 mm Hg) was observed in 2 eyes. Six months after the operation, the intraocular pressure was controlled under 21 mm Hg in all eyes, and under 16 mm Hg in 18 eyes. The medication score (one point per antiglaucomatous medication) was 2.0 ± 1.6 before the surgery and 0.4 ± 0.7 after the surgery. The mean refractive error after the operation was –0.8 ± 0.7 D (range –2.4 to 0 D). The deviation of the actual refractive error from the predicted one was +0.29 ± 0.54 D (range –0.52 to +1.10 D). Conclusion: The outcome of the combined operation for open-angle glaucoma and coexisting cataract was promising.

Long-term rates of PCO following small incision foldable acrylic intraocular lens implantation in children.

To evaluate the long-term incidence of postoperative posterior capsular opacification (PCO) in children undergoing small incision foldable acrylic lens implantation with at least 2 years of follow up. In 18 children, 26 eyes underwent small incision cataract extraction with posterior chamber foldable acrylic lens implantation. The posterior capsule was left intact in all patients at the time of surgery. With a mean follow up of 2.75 years and a mean age at surgery of 8.25 years, 13 of 26 eyes (50%) developed visually significant PCO requiring intervention. In the group of children under 4 years of age, 5 of 5 eyes (100%) developed visually significant PCO, while 8 of 21 eyes (38%) in the group of children over 4 years of age developed opacification. Four of 26 eyes (15%) required two procedures (either repeat Nd:YAG laser capsulotomy or pars plana secondary membrane removal) to clear the visual axis. In this study, the incidence of PCO following small incision acrylic lens implantation in children over 4 years of age is lower than those rates reported by conventional large incision rigid lens techniques with a minimum of 2 years follow up. This technique has advantages over conventional techniques in older children because it offers less surgical intervention, a lower cost to patients, and less risk of vitreous and retinal complications.

Phacoemulsification and foldable lens implantation in a patient with congenital aniridia and glaucoma

A 37-year-old woman with congenital aniridia and open-angle glaucoma underwent phacoemulsification with implantation of a foldable intraocular lens in her right eye. After an uneventful surgery and postoperative period, the visual acuity improved from 0.1 to 0.5 in the right eye. This may be the first report of phacoemulsification and foldable lens implantation in a patient with congenital aniridia.

Para-limbic relaxing incisions for reduction of astigmatism within the scope of catarct surgery

Limbal relaxing incision (LRI) is an easy and safe procedure to reduce astigmatism. It should be clarified, whether the effect is discussed controversely, because the varying corneal diameter and consequently the varying LRI position was not considered. 56 patients aged 76 +/- 9 years with preoperative astigmatism of 1.6 D (0.6 to 7.0 D) underwent an almost astigmatically neutral cataract procedure (3.2 mm temporal clear corneal phacoemulsification with foldable lens implantation) and received independently from the given corneal diameter limbus related relaxing incisions of 80 degrees length and 0.6 mm depth. We performed the paired LRI in 4.5 mm, 5 mm and 5.5 mm distance from the corneal center on the steeper meridian. 4.3 months postoperatively we observed an astigmatic reduction of -1.0 D (-0.1 to -3.2 D) following LRI with a 9 mm optical zone, LRI with 10 mm diameter led to an astigmatic reduction of -0.4 D (-0.1 to -2.9 D) and LRI with 11 mm diameter were followed by an astigmatic reduction of -0.3 D (+0.5 to -1.1 D). Undercorrections were more frequently observed in younger patients, overcorrections more in elderly people. The application of three different kinds of limbus related relaxing incisions, with 4.5, 5 and 5.5 mm distance from the corneal center or 9, 10 and 11 mm optical zone respectively, corresponds to the variable anatomic situation of the limbus, therefore leading to nearly predictable data and explaining the divergent results of previous reports. The nearer the LRI is applied to the corneal center, the stronger is the relaxing effect.

Intraocular Lens Calculation for Cataract Treated with Photorefractive Keratectomy Using Ray Tracing Method

Purpose: Conventional methods (such as the SRK-II formula) do not accurately calculate the power of the intraocular lens (IOL) after refractive surgery. Therefore, we compared a new formula including a ray tracing method to the conventional method for foldable IOL lens implantation. Method: Foldable IOLs (MA 60 BM) were implanted in 26 patients (32 eyes) using the phakoemulsification technique. The power of the IOL was measured preoperatively using the SRK-II formula in all cases. From the results of postoperative refractive errors of these cases, the power of IOL calculated by the ray tracing method was compared to the SRK-II formula. Cataract patients first treated with photorefractive keratectomy (PRK) received IOL implants using our ray tracing method and their postoperative refraction was measured. Results: The average postoperative refractive error was 1.32 D in SRK-II formula, 0.95 D in the ray tracing method with Ray 1 used and 0.89 D with Ray 2 used. Postoperative refraction of both eyes first treated with PRK was −1.00 D. Conclusion: The average postoperative refractive error was reduced in the ray tracing method using Olsen's predicted ACD (Ray 2) compared to SRK-II formula. This new tracing method appears to be useful for determination of IOL power and it may be applied for IOL calculation for cataract surgery after refractive surgery.

Induced endothelial cell loss in phacoemulsification using topical anesthesia plus intracameral lidocaine

Purpose To determine whether lidocaine 1% injected into the anterior chamber during phacoemulsification damaged the corneal endothelium. Setting Ophthalmology Service, University Hospital, San Juan de Alicante, Spain. Methods In 19 eyes of 19 patients, small incision phacoemulsification and foldable lens (AcrySof® MA60BM) implantation was performed using topical anesthesia supplemented by lidocaine 1% (0.3 mL) in the anterior chamber. All cases were operated by the same surgeon. Specular microscopy was performed before surgery and 1 and 3 months postoperatively. Results Mean endothelial cell loss was 5.41% ± 8.50 (SD) at 1 month and 5.93 ± 8.50% at 3 months. Conclusions The endothelial damage was similar to that described by other authors, suggesting that phacoemulsification surgery can be performed successfully using topical anesthesia supplemented by lidocaine 1% in the anterior chamber.

Surgically induced astigmatism with superior and temporal incisions in cases of with-the-rule preoperative astigmatism

Purpose: To evaluate surgically induced astigmatism (SIA), postoperative astigmatism, and uncorrected visual acuity' UCVA)-after cataract surgery with superior corneal, superior scleral, and temporal corneal 4.0 mm sutureless incisions in cases of preoperative with-the-rule (WTR) astigmatism.Setting: Hopital des Quinze-Vingts, Paris, France.Methods: This prospective evaluation included patients having phacoemulsification with foldable lens implantation through a 4.0 mm incision. Patients with preoperative VVTR astigmatism were randomly atslgned to 1 of 3 incisions: superior corneal (Group 1), superior scleral (Group 2)_or`temporal corneal (Group 3). All patients had autokeratometry preoperatively and postoperatively (1 day, 1 week, 1 month, 1 year). Surgically induced astigmatism using the vector method, postoperative astigmatism, and UCVA (patients whose spherical equivalent was within ±1 diopter) were evaluated.Results: Ninety patients were included in the. study; there were 30 in each incision group. One year postoperatively, Grt 1 had 1.52 diopters (D) of SIA and 1.36 D of postoperative astigmatism; 53.5% of patients had a UCVA of 20/32 or better. Group 2 had 0.69 D of SIA (P < .05) and 0,67' D of postoperative astigmatism (P < .05); 82.7% of patients had a UCVA of 20/32 or better (P < .05). Group 3 had 0.69 D (P > .05), 0.98 D (P < .05), and 79,3% (P > .05), respectively.Conclusions: In this study, the superior corneal incision produced significant SIA, leading to high postoperative astigmatism and poor UCVA. The scleral- and temporal incisions produced minimal SIA an6good UCVA.

Intraocular Pressure Changes after Phacoemulsification and Foldable Silicone Lens Implantation Using Healon GV®

The authors studied the intraocular pressure (IOP) changes after phacoemulsification with two different kinds of foldable silicone lens implantation using Healon GV® as viscoelastic substance. One hundred patients undergoing cataract surgery were enrolled in this study. Inclusion criteria were: absence of ocular hypertension or glaucoma. Patients were randomly assigned to plate haptic (Silens PH®, Domilens® Chiron Vision, Lyon, France) or three-piece (CeeOn™& ;920, Pharmacia spa, Milano, Italia) silicone intraocular lens (IOL) implantation. Following phacoemulsification and cortical aspiration, the capsular bag was reinflated with Healon GV. After foldable silicone IOL insertion residual Healon GV was removed from the anterior chamber. IOP was measured preoperatively and at 6, 24 h and 1 week postoperatively. Six hours postoperatively IOP was higher in the Silens PH group than in the CeeOn group (20.85±5.42 vs. 18.88±2.95 mm Hg, p = 0.026). The difference was confirmed after 24 h (21.02±5.18 vs. 17.34±3.18 mm Hg, p < 0.01). Despite the medical treatment (acetazolamide 250 mg orally every 6 h), at the 24-hour control 2 eyes with plate haptic silicone lens showed IOP values higher than 30 mm Hg. Slitlamp examination showed in both eyes a shallowing of the anterior chamber together with the evidence of capsular bag hyperdistension and capsular block resulting from the occlusion of the circular anterior capsule opening by the plate haptic IOL. Residual Healon GV removal from the anterior chamber was performed. At 1-week control both eyes showed normalization of IOP. The use of a plate haptic silicone lens may be associated with a more consistent retention of Healon GV in the eye with trapping in the capsular bag. Retained viscoelastic may cause either trabecular meshwork blockage by viscoelastic substance or postoperative capsular bag hyperdistension, anteroplacement of the IOL optic and capsular block from occlusion of the circular anterior opening by the IOL optic.

Variation in clear cornea incision size after phacoemulsification and foldable lens implantation

Purpose: To study the changes in clear cornea incision size after phacoemulsification and implantation of a three-piece, silicone, foldable intraocular lens (IOL).Setting: Departamento de Oftalmología, Clinica Universitaria de Navarra, Pamplona, Spain.Methods: In this prospective study, phacoemulsification with implantation of a foldable IOL (AMO SI-30NB) was performed in 133 eyes. Surgery was carried out by four surgeons who implanted the IOL with the same forceps. The external incision size was measured before and after phacoemulsification and irrigation/aspiration and before and after IOL implantation.Results: Before phacoemulsification, the mean incision size was 3.07 mm; after phacoemulsification and irrigation/aspiration, it enlarged to 3.09 mm (P = .001). The mean incision size before foldable IOL implantation was 3.16 mm, and after implantation it increased to 3.32 mm (P = .0001). When the IOL was less than 22.0 diopters (D), the final incision size was 3.31 mm ± 0.11 (SD); when the IOL was 22.0 to 26.0 D, the final size was 3.32 ± 0.01 mm; and when the IOL was 26.0 D or more, the final size was 3.39 ± 0.08 mm (P = .01).Conclusions: Phacoemulsification and foldable IOL implantation enlarged the size of the clear cornea incision in this study. The IOL power may be a significant factor in determining the minimal incision size prior to IOL insertion and the final incision size.

Mitomycin-C supplemented trabeculectomy, phacoemulsification, and foldable lens implantation

Purpose: To evaluate the outcome of combined mitomycin-C filtering surgery, phacoemulsification, and foldable intraocular lens (IOL) implantation.Setting: Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.Methods: This retrospective study evaluated 182 eyes of 174 patients who had combined mitomycin-C trabeculectomy, phacoemulsification, and insertion of a foldable IOL through a 3.5 mm incision. Success of the combined procedure was defined as intraocular pressure (IOP) below 21 mm Hg, with or without medications, and no serious complication. Success rates were calculated using the Kaplan-Meier actuarial method.Results: Mean follow-up was 16.7 months ± 5.4 (SD). The probability of success at 6, 12, 18, and 24 months was 98.3, 95.6, 90.6, and 88.0%, respectively. When compared with preoperatively, visual acuity improved one or more lines in 148 eyes (81.3%) and worsened one or more lines in 15 (8.2%); 111 eyes (61.0%) achieved visual acuity of 20/40 or better. The most frequent complication was posterior capsule opacification requiring capsulotomy, which occurred in 22 cases (12.0%).Conclusion: The 1 year and 2 year IOP control rate of combined mitomycin-C filtering procedures and phacoemulsification in glaucoma patients was high.