Incidence Of Vitreous Loss Research Articles

A Study of Profile of Patients with Cataract

Background: Cataract blindness is a public health problem of major proportions in developing countries. Intra capsular cataract extraction with aphakic spectacles has been the standard surgical technique for restoring sight. Cataracts, the world's leading cause of blindness, are an enormous public health problem in both developing and industrialized countries. Objective: To study clinical profile of patients with cataract. Methods: After applying inclusion and exclusion criteria as well as after ethical consideration only patients having cataract were included in the study. In this way, it was possible to include the 1000 patients over a period of two years. Present study was hospital based cross sectional study. A pre tested, semi structured questionnaire was used to collect the data. Complete detailed history was taken as per the questionnaire. Thorough clinical examination was carried out. The collected data was entered in Microsoft Excel Sheet and analyzed with the help of proportions. Results: The prevalence of cataract was highest in the age group of 51-60 years i.e. 45.1%. The most common prevalent type of cataract was found to be mature cataract in 50.5% of cases followed by hyper-mature cataract in 34.7% of cases. The overall incidence of capsular rupture was 4.7%. Highest incidence of capsular rupture was seen in complicated cataract followed by intumescent cataract. Incidence of vitreous loss was most commonly present in intumescent cataract followed by complicated cataract. 51% of patients recovered to normal vision of 6/6. 41.2% of patients had corrected vision from 6/60 to 6/18. Conclusion: The prevalence of cataract is common above 50 years of age. The patients reporting to the hospital for the complaint of loss vision commonly have mature or hyper-mature cataract. Complications are less in the mature and hyper-mature type of cataract.

A comparative study of complications of cataract surgery with phacoemulsification in eyes with high and normal axial length

Background:This study performed to assess the safety of cataract extraction with phacoemulsification and intraocular lens (IOL) implantation in patients with high axial length compared with patients with normal axial length.Materials and Methods:A total of 866 eyes were enrolled in this study; all subjects underwent phacoemulsification and IOL implantation for treatment of cataract. Seven hundred and nine eyes fell in the normal group with axial lengths ranging between 21 and 24.5 mm, and 157 eyes were considered myopic with axial length equal or greater than 26 mm. The two groups were compared regarding intraoperative surgical complications, such as vitreous loss, posterior capsular rupture, nucleolus drop, and undesirable implantation of IOL in the anterior chamber.Results:Age was a risk factor in both groups, with each year increase of age, the chance of incidence of intraoperative complications increased 1.04-folds (P = 0.03). And with 1 mm increase in axial length, the incidence of complications raised 1.22-folds (P = 0.007). There was no significant correlation between axial length and incidence of vitreous loss, although the incidence of posterior capsular rupture and nucleus fragment drops increased with increment in the axial length. Sex of the patients and side of the left or right eye were not found to be significant risk factors.Conclusions:As the results illustrate, in this survey, age and high axial length were statistically significant risk factors for incidence of intraoperative complications of cataract surgery with phacoemulsification technique. Anticipation of these complications and also preparation and prophylactic measures may decrease incidence of these complications.

In-the-bag scleral suturing of intraocular lens in eyes with severe zonular dehiscence

PurposeTo compare the degree of tilt and decentration of an intraocular lens (IOL), refractive status, and prediction error between eyes that underwent trans-scleral suturing of the IOL within the capsular bag (in-the-bag scleral suturing) and eyes that underwent scleral suturing outside of the bag (out-of-the-bag scleral suturing) because of severe zonular dehiscence.Patients and methodsThirty eyes that underwent in-the-bag scleral suturing of an IOL and 38 eyes that underwent out-of-the-bag scleral suturing were recruited sequentially. The tilt and decentration of the IOL, anterior chamber depth, manifest refractive spherical equivalent (MRSE), prediction error, and incidence of complications were examined.ResultsThe mean tilt angle and the decentration length of the IOL of the in-the-bag suturing group were significantly less than those of the out-of-the-bag suturing group (P=0.0003 in tilt and P=0.0391 in decentration), although the anterior chamber depth was similar. The mean MRSE and prediction error of the in-the-bag suturing group were less than those of the out-of-the-bag suturing group (P=0.0006 in MRSE and P=0.0034 in error). The incidence of vitreous loss was less in the in-the-bag suturing group than in the out-of-the-bag suturing group (20% vs63.2%, P=0.0009).ConclusionsThe tilt and decentration of the IOL after in-the-bag scleral suturing are significantly less than those after out-of-the-bag scleral suturing, which may lead to less MRSE and less prediction error. As the incidence of vitreous loss is less after in-the-bag scleral suturing, in-the-bag suturing is advantageous for eyes of younger patients and of less complicated cases.

Retrobulbar Versus Topical Anesthesia for Phacoemulsification

To evaluate and compare intraoperative pain, perioperative complications and hemodynamic changes during phacoemulsification under topical and retrobulbar anesthesia. A total of 564 patients were randomly allocated into topical and retrobulbar groups. All patients received 2 mcg kg(-1) fentanyl 5 min before the start of their procedures. Patients in the topical group were treated with tetracaine 0.5% eye drops and given preservative free lidocaine 2% intracamerally during surgery. Patients in the retrobulbar group received a 4 mL lidocaine 2% into the retrobulbar space. The number of complications, hemodynamic changes, phaco time and pain severity on the base of a 10-point visual analog scale of pain were recorded immediately after surgery. Differences between the 2 study groups in age, sex, postoperative visual acuity and phaco time were not statistically significant. Blood oxygen saturation, heart rate, systolic and diastolic blood pressure had no difference before and after surgery in the two groups (p > 0.05). Chemosis, periorbital hematoma and subconjunctival hemorrhage occurred only in the retrobulbar anesthesia group. Incidence of vitreous loss, corneal edema and zonular tear was not statistically significant in the two groups. Two hundred thirty five patients (83%) in the retrobulbar and 238 (84%) in the topical group reported minimal discomfort (0-2). The Mean +/- SD pain score in the topical group was 1.13 +/- 1.36 and in the retrobulbar group 1.14 +/- 1.47 (p = 0.92). Patients undergoing cataract surgery with topical anesthesia and those undergoing cataract surgery with retrobulbar block did not vary in terms of subjective pain score and other parameters measuring intraoperative pain, efficacy of anesthesia and feasibility of surgery. This suggests that cataract surgery can be performed with topical anesthesia without compromising the safety of the procedure.

Decrease in complications during cataract surgery with the use of a silicone-tipped irrigation/aspiration instrument

To compare rates of vitreous loss during cataract surgery when a silicone-tipped irrigation/aspiration (I/A) instrument is used for cortex removal as opposed to a metal tip. Parkland Memorial Hospital, Dallas, Texas, USA. A retrospective chart review of all patients who had cataract extraction by phacoemulsification by third-year ophthalmology residents between September 2000 and February 2004 was conducted. A silicone-tipped I/A instrument was used to remove cortex for all surgeries beginning in September 2002, whereas a metal I/A tip was used previously. Of the 1072 cases performed with a metal I/A tip, there were 13 cases of vitreous loss during cortex removal (rate 1.2%) and 26% of all vitreous loss during that time occurred during cortex removal. Of the 805 cases performed with a silicone I/A tip, there was a single case (0.1%) of vitreous loss during cortex removal (P=.004); only 4% of all vitreous loss during that time occurred during cortex removal (P=.011). The overall incidence of vitreous loss during cortex removal and the ratio of vitreous loss during cortex removal to all cases of vitreous loss were significantly decreased using the silicone-tipped I/A instrument.

Posterior capsule rupture and vitreous loss during phacoemulsification with or without the use of an anterior chamber maintainer

Purpose: To compare the incidence of posterior capsule rupture and vitreous loss during phacoemulsification with and without the use of an anterior chamber maintainer (ACM) Setting: Aristotle University Eye Clinic, Thessaloniki, Greece. Methods: The surgical records of patients who had phacoemulsification by experienced surgeons over a 2-year period were reviewed. The cases were divided into 2 groups: surgery performed without the use of an ACM (no-ACM group) and surgery performed with the use of an ACM (ACM group). Results: The no-ACM group comprised 231 cases and the ACM group, 312 cases. Posterior capsule rupture occurred in 19 cases (8.22%) and 22 cases (7.05%), respectively. Of the patients with posterior capsule rupture, 6 (31.57%) in the no-ACM group and 16 (72.72%) in the ACM group had vitreous loss and required an anterior vitrectomy; the difference between the 2 groups was statistically significant ( P = .03). Conclusions: The use of an ACM in phacoemulsification provided a consistently deep anterior chamber and approximately the same rate of complications as with a standard technique in the hands of experienced surgeons. However, when posterior capsule rupture occurred, the incidence of vitreous loss was significantly higher in eyes with an ACM.

Decreased incidence of capsule complications and vitreous loss during phacoemulsification in eyes with pseudoexfoliation syndrome

Purpose: To report a series of patients with pseudoexfoliation syndrome who had phacoemulsification without an increased incidence of intraoperative complications or late intraocular lens (IOL) dislocation. Setting: Department of Ophthalmology, Kaiser Permanente, Denver, Colorado, USA. Methods: Patients were prospectively recruited from a consecutive series of all cases of phacoemulsification performed by 1 surgeon. There were 67 eyes with pseudoexfoliation syndrome and 1670 eyes without pseudoexfoliation. The incidence of vitreous loss, capsule tears, and zonular dialysis was compared between the 2 groups. Results: The incidence of vitreous loss was 1.5% in eyes with pseudoexfoliation syndrome and 2.3% in eyes without pseudoexfoliation. The difference between the 2 groups was not statistically significant (chi square = 0.203; P = .33). There were no cases of posterior capsule tears or zonular dialysis in pseudoexfoliation eyes without vitreous loss. No IOL dislocated over a mean follow-up of 54.1 months. Conclusion: Although caution is still advised, patients with pseudoexfoliation syndrome who have phacoemulsification can achieve results similar to patients without pseudoexfoliation.

Incidence of Vitreous Loss among Third-year Residents Performing Phacoemulsification

The incidence of vitreous loss among third-year residents learning phacoemulsification was retrospectively evaluated. One hundred thirty-six cases of phacoemulsification were performed by six different third-year residents with the same attending physician supervising all cases. The incidence of vitreous loss was 14.7%. This study demonstrates that the rate of vitreous loss among residents learning phacoemulsification is higher than the reported incidence of vitreous loss for residents learning planned extracapsular cataract surgery with expression of the lens nucleus.

The Taylor Pressure Reducer in Cataract Surgery

A retrospective study was undertaken to determine whether the use of the Taylor pressure reducer during routine intracapsular cataract surgery lowered the incidence of vitreous loss. A significant reduction in the vitreous loss rate was noted. The Taylor pressure reducer is a useful device for the prevention of this complication in the Third World.

Vitreous Loss Rates in Extracapsular Cataract Surgery by Residents

Vitreous loss is a serious complication of cataract surgery. It has been suggested that high rates of vitreous loss may be an inevitable consequence when residents are learning extracapsular cataract extraction (ECCE). The authors retrospectively analyzed all (n = 936) cataract operations done by second- and third-year residents in a single Veterans Administration hospital from 1982 through 1988. Between 1982 and 1985, the incidence of vitreous loss was 10.3%. In 1985, a new program of resident surgical education was introduced, and the incidence from 1985 through 1988 declined to 3.2% (P < 0.001). Statistical analysis confirms that this decrease cannot be attributed to any individual surgeon, class of residents, or year of surgery. The authors believe that an educational program including practice surgery, graded responsibility, and experienced assistance may be responsible in part for dramatically reducing the rate of this serious complication during surgery done by the beginning resident.

Utilization of a Curved Aspiration-Irrigation Handpiece

The safest way to completely remove the cortex from under the iris superiorly is with the angulated aspiration-irrigation handpiece. It is recommended that a .3 or .5 handle be utilized in low aspiration. As the instrument is rotated around its axis the opening of the aspiration handpiece is up, the cortex is grasped, and the surgeon is able to stay away from the posterior capsule. The incidence of vitreous loss is markedly reduced.

Keratoplasty and Intraocular Lenses: Follow-Up Study

In an effort of explore new approaches with the possibility of improving on existing methods of managing problem cases with combined corneal disease and cataracts, 35 patients were treated by keratoplasty, cataract extraction, and intraocular lens implantation in various combinations or by cataract extraction and lens implantation without keratoplasty over the past two years. Twenty-four of twenty-six grafts have remained clear over a 3- to 21-month period of observation. The two failures have been successfully regrafted. Eleven patients received a penetrating keratoplasty, cataract extraction and intraocular lens with ten remaining clear. Eight patients with corneal disease and aphakia received a penetrating graft and intraocular lens with all grafts remaining clear. Seven patients with a clear graft received a subsequent cataract extraction and lens implantation with six remaining clear. Nine patients with endothelial dystrophy and cataracts were not affected by cataract extraction and lens implantation. The relatively high success rate, rapid visual rehabilitation, and reduction in the incidence of vitreous loss, vitrectomy, and delayed vitreous complications via the methods employed have, to date, proven encouraging. Caution is advised until data from a larger case series and long-term follow-up become available. Short-term success is directly related to technique. To achieve immediate success, the need for considerable experience in keratoplasty and lens implantation can not be overemphasized.

Vitreous Loss Following Infantile Cataract Surgery

An improved understanding of the role of the vitreous in ocular pathology has led to a more rational approach to the prevention and management of vitreous loss during infantile cataract extractions. Infantile cataract surgery, properly performed by modifications of the Scheie aspiration and Kelman phacoemulsification techniques, should be associated with an incidence of vitreous loss no greater than that for adult extractions by current intracapsular or extracapsular techniques. Preexisting ocular lesions, faulty technique, and an inexperienced operator all contribute to the occurrence of vitreous loss. Improved techniques, surgical expertise, and an understanding of the factors that predispose to vitreous loss can reduce its incidence. Proper management of vitreous loss will decrease or eliminate its untoward sequelae; eyes so managed can be visually rehabilitated with the same ease or difficulty as similar eyes in which vitreous was not lost. The authors do not, however, advocate either the accidental or intentional disturbance of the intact vitreous body.

Alpha-Chymotrypsin for Lens Extraction in Infants and Children

With the discovery of the zonulytic effect of α-chymotrypsin in 1958 by Dr. Joaquin Barraquer, an important advance was made in the management of the cataractous lens. The application of this enzyme was undertaken with initial enthusiasm by ophthalmologists throughout the world. To be able to free the lens easily from the adherent zonule permitted a wider use of the intracapsular method of lens extraction than formerly had been possible, particularly in the younger age group. Many ophthalmologists have reported their experience with this enzyme in large series of cases. The literature contains many articles which generally agree that the ease of lens extraction has been increased by the use of α-chymotrypsin.1There are fewer ruptured capsules, but the incidence of vitreous loss has not been decreased by its use. It was at first hoped that the congenital cataract patient would be greatly benefited by enzymatic zonulysis. However, the

Urea in cataract extraction. Preliminary report.

Vitreous loss during cataract extraction remains a serious hazard. Its incidence has declined with development of improved akinesia, anesthesia, and particularly with the employment of digital compression. 1 Nevertheless, ophthalmologists would welcome any technique which could further reduce the occurrence of this complication. The use of urea as an ocular hypotensive agent prior to routine cataract surgery has not previously been reported. For this reason we undertook to assess the effect of intravenous urea prior to cataract extraction on the incidence of vitreous loss. We reasoned that urea would lower intraorbital, intraocular, and intravitreal pressure to a level which would allow cataract extraction to be performed with greater safety. Case Selection We are reporting the results of study on 100 unselected private and ward patients operated upon under the supervision of independent observers at 3 different institutions. The professional level of the operating surgeons includes both resident and attending physicians.

Flattened anterior chamber.

Flattened anterior chamber or absence of a formed anterior chamber is a complication of cataract surgery generally believed to be associated with a high incidence of aphakic glaucoma. While the incidence of vitreous loss, iris prolapse, and ocular infections has been reduced by refinements in anesthesia, wound closure, and antibiotic therapy, the occurrence of flat chamber still remains a problem. Postoperative flat chamber, with its attendant danger of aphakic glaucoma, has been of great concern to the ophthalmic surgeon. Czermak¹in 1897 recognized microscopically the closure of the chamber angle in aphakic glaucoma. A correlation between peripheral anterior synechiae and aphakic glaucoma was noted by Troncoso²in 1934. Kronfeld and Grossman,³McLean,⁴and, later, Meyer and Sternberg⁵indicated the relationship of delayed formation of the anterior chamber, peripheral anterior synechiae, and aphakic glaucoma. Sugar⁶attributed the delayed re-formation of the anterior chamber to poor