Intracapsular Cataract Surgery Research Articles

"Partial Open Sky Method" - A novel technique to avoid the open sky condition during Triple procedure or Penetrating keratoplasty.

Penetrating keratoplasty is referred to as an "open-sky" procedure because the intraocular contents are entirely exposed to atmospheric pressure after the diseased cornea has been trephined off and before the donor button is sutured. Suprachoroidal hemorrhage (SCH) is a major vision-threatening complication, associated with this open-sky procedure. While numerous factors may predispose an eye to SCH, like hypertension, myopia, trauma, glaucoma, etc., it is better to be prepared for the worst eventuality. We described a novel technical modification, denoted as the "partial open sky technique", that we used during the surgical steps of trephining and excision of host corneal tissue in seven cases of triple procedure and penetrating keratoplasty in our center over two months. We propose that the technique would be additionally helpful in managing the inadvertent suprachoroidal hemorrhage associated with keratoplasty over the available existing methods. Abbreviations: SCH = Suprachoroidal hemorrhage, ICCE = Intracapsular cataract surgery, ECCE = Extracapsular cataract surgery, WTW = White to White.

Comparative study between medial canthus episcleral block versus peribulbar block in intracapsular cataract surgery

BackgroundOphthalmic regional anesthesia is now the most common anesthetic technique used for eye surgeries. There are various modes of needle-based ophthalmic anesthesia which are retrobulbar, peribulbar, and episcleral. The sub-Tenon episcleral anesthesia technique became a potential alternative to the retrobulbar and peribulbar anesthesia in most of the anterior and posterior segment eye surgeries; this is due to its better safety profile and tolerability than the other blocks. The aim of this study was to compare between medial episcleral block and peribulbar block in intracapsular cataract surgery as regards anesthesia and akinesia of the eye, the need of supplementation of local anesthetic, and finally the safety profile of each block. This was a prospective, comparative, randomized, double-blinded clinical study. It was carried out on 60 patients that were scheduled for intracapsular cataract surgery in ophthalmic surgery unit. The patients were randomly allocated into two equal groups; group A received medial canthus episcleral block technique and group B received peribulbar block technique.ResultsResults of this prospective, comparative, randomized, double-blinded study showed no statistical difference between the two groups as regards demographic and vital data. As regards Akinesia score, the ESA group had better akinesia score at 1, 5, and 10 min and at the end of surgery than PBA group (P value, 0.001). No patient in the ESA group received supplemental injection via inferotemporal peribulbar block technique, while 66.7% of PBA group was in need of supplementation. Regarding time to onset of acceptable akinesia score; ESA group had a faster onset with high statistical significance (P value, 0.001). Numeric pain scale was better in ESA group than PBA group with high statistical significance. There were chemosis after injection in two of the ESA group (6.6%). On the other hand, slight pricking pain at the end pf surgery developed in two cases in the PBA group.ConclusionMedial canthal episcleral technique proved to be superior in motor akinesia score, time to onset of acceptable akinesia score, and numeric pain scale in comparison to peribulbar anesthesia with high statistical significance between the two groups. Both techniques proved to be safe with no incidence of major complications.

Spontaneous expulsive choroidal hemorrhage. Case report

Clinical caseA case is presented of an 85-year-old woman living in a geriatric residence, who was admitted to the emergency department of our hospital with a spontaneous expulsive choroidal hemorrhage in her left eye. There was no a history of ophthalmic disease, and the patient only reported having intracapsular cataract surgery in both eyes 25 years ago, and that she also became blind in her left eye in the past few years. DiscussionNon-surgical spontaneous expulsive choroidal hemorrhage is a very rare and disastrous clinical event. The predisposing factors involved are: advancing age, vascular illness (especially atherosclerosis), glaucoma, and severe corneal damage.

Hemorragia coroidea expulsiva espontánea. Caso clínico

Clinical caseA case is presented of an 85-year-old woman living in a geriatric residence, who was admitted to the emergency department of our hospital with a spontaneous expulsive choroidal hemorrhage in her left eye. There was no a history of ophthalmic disease, and the patient only reported having intracapsular cataract surgery in both eyes 25 years ago, and that she also became blind in her left eye in the past few years. DiscussionNon-surgical spontaneous expulsive choroidal hemorrhage is a very rare and disastrous clinical event. The predisposing factors involved are: advancing age, vascular illness (especially atherosclerosis), glaucoma, and severe corneal damage.

Relationship between clinical presentation and visual outcome in postoperative and posttraumatic endophthalmitis in South Central India

To determine risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis in a large referral center in south central India. In this prospective observational series the authors examined 388 patients of postoperative (n= 206) and posttraumatic (n= 182) endophthalmitis at the L V Prasad Eye Institute in Hyderabad, India between 1991 and 1997. The analysis was confined to 236 patients-128 (62.1%) postoperative and 108 (59.3%) posttraumatic patients who were followed for a minimum period of 3 months. A detailed protocol was followed. Chi-square and logistic regression analysis were used to determine risk factors for visual outcome worse than 6/18 and worse than 6/120. Postoperative endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included intracapsular cataract surgery, poor presenting visual acuity, presence of vitreous cells, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In the multivariate analysis, visual acuity of less or equal light perception (LP) at presentation was associated with a 3-month postoperative visual acuity of < 6/18, with an odds ratio of 5.85 [1.25 - 27.42, 95% CI], and vitreous membranes seen on ultrasonography was associated with a final visual acuity of < 6/120, with an odds ratio of 2.47 [1.05 - 5.83, 95% CI]. Posttraumatic endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included a retained intraocular foreign body (IOFB), trauma by needle (hypodermic or sewing), poor presenting visual acuity, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In multivariate analysis, IOFB was associated with a 3-month follow-up visual acuity of < 6/18, with an odds ratio of 5.90 [1.85 - 18.78, 95% CI], and trauma by a needle (hypodermic or sewing) and retained IOFB was associated with a final visual acuity of < 6/120, with an odds ratio of 4.47 [1.22 - 16.38, 95%CI] and 3.76 [1.36 - 10.37, 95% CI] respectively. This is the largest, single-centre, prospective study on risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis. The independent risk factor for 3-month follow-up visual acuity of < 6/18 was the presenting visual acuity of < or =LP in postoperative endophthalmitis and a retained IOFB in posttraumatic endophthalmitis. The independent risk factor for 3-month visual acuity of < 6/120 was the presence of vitreous membranes on ultrasonography in postoperative endophthalmitis, and trauma by a needle (hypodermic/ sewing) and retained IOFB in posttraumatic endophthalmitis.

Diamond iris retractor configuration for small-pupil extracapsular or intracapsular cataract surgery

We describe a technique that uses flexible iris retractors in a diamond configuration for small-pupil extracapsular or intracapsular cataract surgery in eyes with unusually dense nuclear sclerosis. Advantages of this technique include ease of conversion from phacoemulsification, optimal orientation of the maximum pupil diameter for nucleus expression or intracapsular lens removal, and conservation of iris tissue.

Long term clinical outcome of a randomised controlled trial of anterior chamber lenses after high volume intracapsular cataract surgery

BACKGROUNDAge related cataract remains the major cause of blindness throughout the world. In many countries, the majority of cataract surgery continues to be done by the intracapsular cataract extraction (ICCE)...

The South Asian Cataract Management Study: complications, vision outcomes, and corneal endothelial cell loss in a randomized multicenter clinical trial comparing intracapsular cataract extraction with and without anterior chamber intraocular lens implantation

ObjectiveTo determine clinical outcomes of primary intracapsular cataract surgery with and without implantation of anterior chamber lenses. DesignA multicenter randomized clinical trial. ParticipantsOne thousand two hundred twenty-nine male and female patients 40–75 years of age with senile cataract. MethodsStudy patients were recruited from screening eye camps and outpatient clinics. Randomization to the two treatment groups was performed after screening for predetermined inclusion and exclusion criteria. Demographics, visual acuity, intraocular pressures, and corneal endothelial cell data were recorded before surgery and at 6 weeks, 12 months, and 24 months after surgery. Monitoring of the study was secured by a standardized image documentation procedure on all patients using the IMAGEnet digital imaging system. Analysis of corneal endothelial cell images was performed with the Cell Soft software (Topcon Corporation, Japan). Main outcome measuresVisual acuity and central corneal endothelial cell loss. ResultsThe patients were randomized to intraocular lens (IOL; n = 616) and no IOL (n = 613) implantation. Surgical complications were reported in 177 (14.4%) patients (IOL = 14.8%; no IOL = 14.0%). The most frequent complication observed was vitreous loss which occurred in 10.3% of eyes (IOL = 11.2%; no IOL = 9.5%). At the final examination (2 years after surgery), 88% of the operated eyes had a best corrected vision of 6/18 or better (IOL = 88.8%; no IOL = 86.6%). Analysis of corneal endothelial cell data showed a small but significantly greater cell loss 6 weeks after surgery in eyes with IOL compared with those without IOL, but no overall difference was found between the treatment groups in the long term follow-up. ConclusionsThe findings indicate that there is a rationale for the use of anterior chamber intraocular lenses in primary intracapsular cataract surgery.

Management of Cataract in Primary Health Care ServicesSecond edition. World Health Organization. Geneva, 1996. ISBN: 92 4 154499 6.

Book ReviewsManagement of Cataract in Primary Health Care Services Khalid F. TabbaraMD Khalid F. Tabbara Professor of Ophthalmology, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia Search for more papers by this author Published Online:1 Nov 1997https://doi.org/10.5144/0256-4947.1997.576aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionCataract is the most common cause of blindness in the world, and the majority of cases are curable.Similar to other books of the World Health Organization, this is a working group of the WHO, presenting programs for the control of blindness secondary to cataract. This is an attempt to solve the cataract backlog in developing countries. The 34-page publication contains comprehensive guidelines on the management of cataract through primary health care. It includes a review of the available information on the problems of the presence of blindness secondary to cataract and the strategies for managing cataract in countries with limited financial and human resources. The booklet is helpful in presenting guidelines for the planning of interventions. It also includes development of human resources and infrastructures for the management of cataract. The guidelines in this publications are intended to be adopted to suit the local conditions where there is a cataract backlog.The book is divided into nine sections. The first section is on the clinical aspects of cataracts, including the definitions and types of cataract, as well as the symptoms and signs. The second section is on the prevalence of cataract as a public health problem. The third section is on the organization of cataract services, including the assessment of the problem, identification of cases, motivation of the blind for the use of services and the selection of cases. It also has the provision of cost-effective, high-quality surgical services for management of cataract on a mass scale. The fourth section is on therapeutic strategies, including the choice of techniques and postoperative corrections of patients undergoing cataract surgery. The options of extracapsular and intracapsular cataract surgery are presented, and low-cost spectacles as well as low-cost intraocular lenses are discussed. The last four sections are on material requirements, personnel development, community participation, operational research and evaluation of the program.In brief, this is a helpful manual describing in a straightforward manner how blindness caused by cataract can be avoided. Consideration is given to means of increasing surgical output in the training of personnel and methods for the quality assurance and improvement of the programs. The second edition of this book has brought an update on the recent changes in technology for cataract surgery and their application to large-scale programs in developing countries. Previous article Next article FiguresReferencesRelatedDetails Volume 17, Issue 5September 1997 Metrics History Published online1 November 1997 InformationCopyright © 1997, Annals of Saudi MedicinePDF download

Simultaneous Bilateral Cataract Extraction: ECCE versus ICCE

OBJECTIVE: To evaluate the differences in visual rehabilitation between intracapsular (ICCE) and extracapsular (ECCE) cataract surgery as well as the significance for visual performance of the position of an intraocular lens in the eye. STUDY DESIGN: Prospective study of simultaneously performed cataract extraction in both eyes, with evaluation at 3 days, 6 weeks, 3 and 6 months after surgery. PATIENTS: Ten adult patients severely visually handicapped from equally advanced cataract in both eyes had simultaneous cataract surgery performed under general anaesthesia with an ECCE with a posterior chamber lens (PCL) in one eye and an ICCE with an anterior chamber lens (ACL) in the other eye. MAIN OUTCOME MEASURES: Refraction and visual acuity (VA) were obtained unbiased by a trained nurse with an autorefractor and with the same instrument a value for contrast (CS) and glare (GS) sensitivity were obtained, expressed as the numerical drop in Snellen lines from the best visual acuity obtained at the same time. RESULTS: After 6 months all patients seemed to have benefited almost equally in both eyes (mean VA/ECCE 0.72 ± 0.15); and mean VA (ICCE 0.80 ± 0.16). No subjective differences in visual performance was noticed between the eyes except in one of the ECCE patients, who experienced the beginnings of opacification in the posterior capsule. There were no significant differences in either CS (ECCE: 2.7 ± 1.8 and ICCE: 3.4 ± 1.3; P = 0.37) or GS (ECCE): 4.4 ± 1.6 and ICCE: 5.2 ± 1.9; P = 0.21) after 6 months. There was no significant difference in intraocular pressure, and no corneal or retinal complication occurred in either group. CONCLUSION: When ICCE and ECCE have been compared, it has always been by retrospective study of different patients operated on by different surgeons, using different microsurgical techniques and with different observation periods. This study is a unique attempt to evaluate the two surgical techniques in a prospective manner. During an observation period of 6 months no differences occurred in visual rehabilitation between ECCE/PCL and ICCE/ACL, when these procedures were performed at the same time in a small number of patients having simultaneous bilateral cataract surgery.

Results and evaluation of high volume intracapsular cataract surgery in Nepal.

One thousand intracapsular cataract extractions were performed by two ophthalmologists over a 57-day period at Lahan Eye Hospital in Nepal. Ninety-nine per cent of eyes had a visual acuity of less than 3/60 at surgery. Ninety-eight per cent of eyes achieved a visual acuity of 3/60 or better with aphakic spherical correction at discharge, of which 69% had a visual acuity of 6/36 or better. In 314 eyes seen at 1-month follow-up, 88% achieved 6/18 or better with full aphakic correction. The surgical time averaged less than 10 min and the cost of disposables less than pounds 1 per operation.

Extracapsular Cataract Extraction in Nepal

We evaluated the 2-year outcome of extracapsular cataract surgery with posterior chamber intraocular lens insertion by a single fellowship-trained surgeon in Kathmandu, Nepal. Six hundred ten eyes were followed up for 2 years. Patients underwent manual irrigation and aspiration with the insertion of a modified J loop posterior chamber intraocular lens. Almost half of the patients had uncorrected visual acuities of 20/50 or better after surgery. Sight-threatening complications in seven eyes (1.2%) included retinal detachment, corneal decompensation, and endophthalmitis. Although this rate is comparable to that in developed countries, 21% of patients had posterior capsular opacification at follow-up. Extracapsular cataract surgery with intraocular lens insertion may be an alternative to intracapsular cataract surgery in developing nations, where aphakic spectacles are expensive, not easily obtainable, or difficult to replace.

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.

Cataract Wound Neovascularization: An Often Overlooked Cause of Vitreous Hemorrhage

The cause of vitreous hemorrhage in aphakic eyes is sometimes difficult to ascertain, especially if fundus details are obscured. A vitreous hemorrhage secondary to comeoscleral wound neovascularization developed in nine eyes of eight patients 10 months to 17 years after intracapsular cataract surgery. Visualization of superior angle neovascularization, provocation of bleeding by rocking the gonioscopic contact lens, and documentation of vascular leakage by gonio-fluorescein angiography established the diagnosis. All affected eyes have remained hemorrhage-free after argon laser photocoagulation of the angle neovascularization. The clinician should be aware of cataract wound neovascularization, an apparently easy disorder to diagnose and treat, as a cause of vitreous hemorrhage.

Combined Iris and Cornea Retractor for Intracapsular Cataract Surgery

Combined Iris and Cornea Retractor for Intracapsular Cataract Surgery

Aphakic retinal detachment.

A study of 132 cases of aphakic retinal detachment (ARD) following mainly intracapsular cataract surgery has been made. Forty-nine cases (37%) were found to have vitreous incarcerated into the cataract section out of a total of 54 (41%) cases who had suffered a vitreous complication during cataract surgery. A study of the characteristics of ARD reveals that those cases having had a vitreous complication in the management of their cataracts are more likely to develop detachment within three months than those not suffering from such a complication. The occurrence of these early post-extraction retinal detachments is not influenced by the presence of underlying axial myopia. When we compared ARD in patients whose cataract extractions had been complicated by vitreous incarceration with those ARDs following uncomplicated cataract surgery, we found that the characteristics of the detachments were very similar. Thus distribution of underlying myopia, extent of detachment, length of time of detachment, and multiplicity and type of retinal holes were generally similar. However, ARD following complicated cataract surgery is more likely to suffer from periretinal fibrosis. The findings confirmed the risk of ARD following complicated intracapsular cataract surgery and support the tendency to perform the extracapsular operation.

Corneal thickness changes following cataract surgery: effect of lens implantation and sodium hyaluronate.

Consecutive patients undergoing intracapsular cataract surgery with and without lens implantation were included in one of three groups of fifteen patients for postoperative corneal thickness measurement. One group underwent cataract extraction alone, another group had cataract extraction and lens implantation using iris supported posterior chamber implants, and another group underwent lens implantation with the use of sodium hyaluronate to reform the anterior chamber after cataract extraction. Maximal increase in corneal thickness occurred within the first 24 hours of surgery in all groups. No significant difference in corneal thickness between the implant and non-implant group was found at any time. When sodium hyaluronate was used to reform the anterior chamber prior to lens implantation the increase in corneal thickness was significantly less than in the group not on sodium hyaluronate (0.01 less than p less than 0.02 on the third postoperative day). In the long term all patients' corneas returned to preoperative levels within 28 days of surgery.

The Surgical Management of Dislocated Traumatic Cataracts

Seven adult patients (six men and one woman, ranging in age from 50 to 83 years) underwent intracapsular cataract surgery for dislocated traumatic cataracts. Six of the seven also had anterior vitrectomies. All seven patients had preoperative visual acuities of counting fingers or worse. There were no serious postoperative complications and five of the patients had postoperative visual acuities of 20/60 or better. Visual acuity improved less in the other two patients because of pre-existing but unrecognized macular disease.

Erfahrungen mit der intrakapsulären Kataraktoperation bei myopen Patienten*

This paper reports on postoperative results and follow-up in 74 eyes of 51 patients suffering from myopia of between -5 and over -20 D. They underwent intracapsular cataract surgery for presenile or senile cataract. The operations were performed under local anesthetic after oculopression; a microscope was used. Only in 2 cases was there a loss of vitreous during the operation. After a 5-year follow-up a defect in the anterior membrane of the vitreous was found in 7 eyes. Forty-one eyes attained a visual acuity of between 0.4 and 1.0. Careful intracapsular cataract extraction by a skilled surgeon is justifiable for myopic patients. Degenerations of the periphery of the retina were easy to coagulate with the laser after the operation.

THE DISPOSABLE MODIFIED FORNIX FLAP FOR CATARACT SURGERY*

Thirty cataract operations were performed in 28 patients using the disposable modified fornix flap technique described by Quinn and Ewald. Vision was 6/12 or better in 26 of 30 eyes with a mean follow-up period of seven months. Vision was corrected in 11 patients with intraocular lens implants, in 10 patients with aphakic spectacles and in seven patients with contact lenses. Four of the seven contact lens wearers had ocular irritation related to contact lens wear. The technique appears to work satisfactorily for intracapsular or extracapsular cataract surgery and for intraocular lens implantation.