Intracapsular Surgery Research Articles

Let's talk about incisions

Let's talk about incisions

Ponseti Casting vs. Soft Tissue Release for the Initial Treatment of Non-idiopathic Clubfoot.

Purpose: Ponseti casting has universally been accepted as the gold standard for treatment of idiopathic clubfoot. Conversely, primary treatment for non-idiopathic clubfoot has not been established. The purpose of this study is to compare treatment outcomes following primary soft tissue release (STR) and Ponseti casting of non-idiopathic clubfoot.Methods: An IRB-approved retrospective study of patients treated for non-idiopathic clubfoot between 2005 and 2020 was conducted. Patients were included if they began treatment before the age of 2 and had at least 1 year of follow up. Patients were placed into either the STR group or Ponseti group and variables of interest were documented including reoccurrence of deformity, number of surgeries performed, type of surgeries performed, anesthesia time, and surgery time. Data was analyzed using Mann-Whitney U test for continuous variables.Results: A total of 33 children with 57 neuromuscular/syndromic clubfoot were identified of which 9 (15 feet) were treated with STR and 24 (42 feet) were treated with Ponseti casting. Average anesthesia and surgery time were found to be 291 and 179 min, respectively, for the STR group, and 113 and 67 min for the Ponseti group. The difference in operating time was determined to be significant (p = 0.02, p = 0.01). Patients treated with STR were found to have significantly more surgeries performed over the course of treatment than those treated with Ponseti casting (p = 0.001) with an average of 4.2 surgeries in the STR group and 1.5 surgeries in the Ponseti group. Extracapsular procedures were performed in 100% of the STR group and 97.6% of the Ponseti group (p = 0.55). Intracapsular procedures were performed in 100% of the STR group and 50% of the Ponseti group (p = 0.001).Conclusion: The Ponseti method should serve as the primary approach in the initial treatment of non-idiopathic clubfoot as it can reduce the risk of future invasive intracapsular surgery and shorten anesthesia and surgery times when surgical treatment is necessary.Level of Evidence: Level III retrospective case control study.

Variants and Modifications of the Retroauricular Approach Using in Temporomandibular Joint Surgery: A Systematic Review.

Introduction: The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of the mandibular head, which allows for the preservation of the lateral temporomandibular joint ligaments in the course of open intracapsular surgery. Aim: The aim of this study is to systematically review the currently used variants and modifications of RA. Materials and Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was performed based on the PubMed and BASE search engines; furthermore the authors performed a more detailed search in the Google Scholar article database as well as a loop search within the references of papers included in the systematic review. Results: Searching medical articles databases, Google Scholar, and references yielded a total of 85 records. First the titles and abstracts were blindly screened which was followed by a full-text eligibility check resulting in eventually including and qualifying 7 articles for detailed analysis. Discussion: All known variants and modifications of RA are characterized by high safety for the facial nerve and an aesthetically hidden scar. There were no reports of auricle necrosis in the collected material. Conclusions: In this systematic review, 2 variants and 2 modifications of RA that allow for open temporomandibular joint surgery have been identified; all of them together cover a large spectrum of indications for joint surgery, including reposition and osteosynthesis of mandibular head fractures, eminoplasty, or eminectomy and treatment of some forms of ankylosis.

Cost-effectiveness analysis of cataract surgery: a global and regional analysis.

To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. Effectiveness estimates are based on a review of the literature taking into account factors such as operative failure, complications and patient non-compliance. A population model was applied to follow the lifelong impact on individuals having cataract surgery. Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review. Costings were estimated for different geographical coverage levels using non-linear cost functions. Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level) would avert over 3.5 million disability-adjusted life years (DALYs) per year globally. The cost-effectiveness ranges from 57 International dollars (1 dollar) per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to 1 dollar 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality. Extra-capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered. Analysts from countries within a region are encouraged to further contextualize the results based on their own country's specific parameters.

Surgical interventions for age-related cataract.

Cataract is the major cause of global blindness, accounting for 40 to 80% of all blindness in developing countries. The number of people blind from cataract is expected to rise due to the changing age distribution and increasing life expectancy. There is currently no proven intervention to prevent cataract and surgery is the only form of treatment. The objective of this review is to compare the effects of different surgical interventions for age-related cataract. We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR, which contains the Cochrane Eyes and Vision Group specialised register (Cochrane Library Issue 3 2001), MEDLINE (1966 to August 2001), EMBASE (1980 to September 2001), the reference lists of identified trials, and we contacted investigators and experts in the field for details of published and unpublished trials. We included randomised controlled trials evaluating surgical treatment for people with age-related cataract. Two reviewers independently extracted data and discrepancies were resolved by discussion. Where appropriate, relative risks, odds ratios and weighted mean differences were summarised after assessing heterogeneity between the studies. We used a fixed effect model due to the low number of trials in each comparison. We identified six trials that randomised a total of 7828 people. Phacoemulsification gave a better visual outcome than extracapsular surgery and gave a similar average cost per procedure in one trial conducted in the UK. Extracapsular surgery with posterior chamber lens implant and intracapsular surgery with or without an anterior chamber intraocular lens implant gave acceptable visual outcomes at 12 to 24 months after surgery. In three large trials in south Asia, best-corrected visual acuity of less than 6/60 ranged from 0.5 to 4%. Higher rates of poor outcome were observed in a multicentre study with 19 surgeons compared to a single-centre study with two surgeons. This review provides evidence from one randomised controlled trial that phacoemulsification gives a better visual outcome than extracapsular extraction with sutures. However, this trial was conducted in a developed country specialised hospital setting and extrapolation to other settings must be made with caution. This review also found evidence that extracapsular cataract extraction with a posterior chamber lens implant provides better visual outcome than intracapsular extraction with aphakic glasses. This finding is also based on the results of a single trial. The long term effects of posterior capsular opacification need to be assessed in larger populations. The data in the review suggest that intracapsular extraction with an anterior chamber lens implant is an effective alternative to intracapsular extraction with aphakic glasses, with similar safety. Further data from developing regions are needed to compare all aspects of intraocular lens surgery with the three main surgical procedures - intracapsular extraction with an anterior chamber lens, extracapsular surgery with a posterior chamber lens with or without sutures.

Discectomy for the treatment of internal derangements of the temporomandibular joint

Nearly 20 years before the characterization of temporomandibular joint (TMJ) internal derangement by routine disc imaging, disc removal was performed to address the symptomatic TMJ. 1 Lanz AB Discitis mandibularis. Zentralbl Chir. 1909; 36: 289 Google Scholar Notwithstanding a number of early critics of the procedure, 2 Toller PA Temporomandibular arthropathy. Proc R Soc Med. 1974; 67: 153 PubMed Google Scholar , 3 Poswillo D The treatment of mandibular dysfunction. in: Temporomandibular Joint Function and Dysfunction. , Munksgaard, Copenhagen, Denmark1979: 397 Google Scholar discectomy is probably the most common intracapsular surgery performed. Despite many descriptions of successful surgical management of internal derangement, recently, the role of disc displacement and disc surgery in the pathogenesis and management of temporomandibular disorders, respectively, have been questioned. 4 Dolwick MF Intra-articular disc displacement part I: Its questionable role in temporomandibular pathology. J Oral Maxillofac Surg. 1995; 53: 1069 Abstract Full Text PDF PubMed Scopus (82) Google Scholar With the successful application of surgical procedures that do not affect disc position, it is apparent that repositioning or removal of the displaced disc is not necessary for treatment success. 5 Merrill RG Arthroscopic lavage and lysis of the temporomandibular joint: A change in perspective (discussion). J Oral Maxillofac Surg. 1990; 48: 802 Abstract Full Text PDF Google Scholar , 6 Nitzan DW Dolwick MF Arthroscopic lavage and lysis of the temporomandibular joint: A change in perspective. J Oral Maxillofac Surg. 1990; 48: 798 Abstract Full Text PDF PubMed Scopus (151) Google Scholar , 7 Montgomery MT Gordon SM Van Sickels JE et al. Change in signs and symptoms following temporomandibular joint disc repositioning surgery. J Oral Maxillofac Surg. 1992; 50: 320 Abstract Full Text PDF PubMed Scopus (92) Google Scholar , 8 Hall HD Navarro ZE Gibbs JS Prospective study of modified condylotomy for treatment of non- reducing disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89: 147 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar Clearly, the emphasis in TMJ surgery has shifted toward procedures that preserve normal joint structures such as the synovium and articular connective tissue and enhance, or at least preserve, joint mechanics. 9 Israel HA Current concepts in the surgical management of temporomandibular joint disorders. J Oral Maxillofac Surg. 1994; 52: 289 Abstract Full Text PDF PubMed Scopus (25) Google Scholar Though probably not satisfying all of these treatment objectives, discectomy, when carefully performed, may improve the internal milieu of the TMJ. Data and lingering controversies regarding discectomy will be reviewed.

Efficacy of Argon Laser Trabeculoplasty in Aphakic and Pseudophakic Eyes

This study evaluated the efficacy of argon laser trabeculoplasty (ALT) in patients with aphakia or pseudophakia. The authors retrospectively analyzed 63 eyes of 63 patients with aphakia or pseudophakia who had uncontrolled open-angle glaucoma and were treated with 180 degrees or 360 degrees ALT. The mean intraocular pressure (IOP) before ALT was 25.1 mm Hg (+/- 8.1 mm Hg). Two years after ALT, the mean IOP in the successfully treated group was 15.4 mm Hg. The mean survival time (50% success rate) for all treated eyes was 23 months, and treatment was successful in 34% of eyes at 36 months. Pseudophakic eyes had a better response than aphakic eyes (P = .06), and eyes that had extracapsular surgery did better than eyes with intracapsular surgery (P = .07). ALT in aphakic or pseudophakic eyes with uncontrolled glaucoma is a safe, reasonably effective treatment that can delay the need for trabeculectomy.

Understanding Phacoemulsification. II. Principles Applied to Surgical Practice

Removal of the cataractous lens is now a much more complex process than in the days of intracapsular surgery, and indeed more complex than the techniques employed during the early development of phacoemulsification. Understanding how the phacoemulsification machine can be adjusted to maximize safety and effectiveness during the different stages of the modern operation should enable the surgeon and the patient to enjoy a more effective procedure. Some understanding of the basic principles ofphaco machines has been given elsewhere [1], and here the author intends to indicate how these principles can be put into practice.

A strategic approach to phacoemulsification based on nuclear density.

ARS AGO it was common practice to ing them learn intracapsular surgery first, followed by nucleus expression extracapsular procedures, followed then by phacoemulsification. It still remains a fairly common thought that one should learn phacoemulsification by first mastering iris plane phacoemulsification and then proceeding to endocapsular phacoemulsification. It is my opinion that following this pathway causes one to perform the inappropriate procedure in many eyes and that the decision-making process regarding the cataract surgery ought to be to perform the correct operation for that particular patient. Over a period of time one will learn to master various techniques based on their appropriateness and not based on any arbitrary chronological priority. I believe the thought process for cataract removal involves a series of decision points (Fig

Changes in the Corneal Endothelial Cell Density and Corneal Thickness Following Intraocular Lens Implantation

The central corneal thickness and the central corneal endothelium of a consecutive group of 60 patients was measured before intracapsular (ICCE) and extracapsular (ECCE) surgery with implantation of an anterior (32 patients) or posterior (28 patients) chamber lens. The same measurements were made at 10 days and 1, 3 and 6 months after surgery. The mean increase in corneal thickness after surgery was found to be 36.8 μm at 10 days and 25.5 μm at 6 months in the first group of patients. In the second group, 49.5 μm and 29.0 μm. The mean endothelial cell loss after surgery was 21.9% at 1 month and 26.6% at 6 months in the first group of patients and 19.6 and 23.8% in the second group. A significant correlation between increase in corneal thickness at 10 days and percentage of endothelial cell loss at 6 months was only found in the second group of patients (r = 0.52, P = 0.01).

Continuing Corneal Endothelial Loss in Intracapsular Surgery With and Without Binkhorst Four-Loop Lenses: A Long-Term Specular Microscopy Study

We analyzed pre- and postoperative corneal endothelial photographs of 17 intracapsular cataract extractions (ICCE) with Binkhorst four-loop intraocular lens (IOL) eyes and found 11.6% mean cell loss at 2 months (previously reported by Hirst et al) increasing to 42.4% after 5 years (p less than 0.05) and 51.8% at 7 years. Eleven ICCE eyes without IOLs similarly examined showed a 15.6% mean cell loss at 2 months (previously reported by Hirst et al), increasing to 33.4% at 5 years (p less than 0.005, paired t-test). Our results appear to indicate long-term continuing cell loss after ICCE, both with and without Binkhorst four-loop iris clip IOLs, and statistically significant greater cell loss (p less than .001, unpaired t-test) with IOLs than without.

Cataract Extraction in the Diabetic Eye after Vitrectomy

We examined 289 phakic, diabetic eyes for evidence of cataract formation after a successful vitrectomy. Of 289 eyes, 107 (37%) developed or had significant progression of a cataract over a follow-up period of 16 to 108 months. Postvitrectomy hemorrhage and vitreous lavage were associated with an increased rate of cataract formation. Of the 107 eyes, 33 (31%) subsequently had cataract extraction, with 24 eyes (73%) treated by extracapsular cataract extraction and nine eyes (27%) with intracapsular surgery. A posterior chamber lens was used in 11 of the 24 eyes that underwent extracapsular surgery. Of the 33 eyes, 31 (94%) had improved visual acuity after cataract extraction. Intraoperative and postoperative complications were minimal and did not result in permanent reduction of vision. Intraocular lenses were well tolerated in the 11 patients in whom they were used.

Retinal detachment following intraocular lens implantation.

This report concerns a consecutive series of 154 pseudophakic eyes in which primary scleral buckling procedures were performed for rhegmatogenous retinal detachments. Most cases involved eyes in which extracapsular surgery had been combined with iridocapsular implants or posterior chamber lenses or in which iris-fixation intraocular lenses were placed following intracapsular surgery. The characteristics of the detachments were similar, although there was a trend towards an increased incidence of significant preoperative proliferative vitreoretinopathy in the intracapsular cases. Anatomical success rates were over 90% in all groups. There was a trend for lower visual acuities following successful surgery in the eyes in which intracapsular surgery had been performed than in those following extracapsular procedures.

Pseudophakic retinal detachments.

Primary scleral buckling procedures were performed for rhegmatogenous retinal detachments in a consecutive series of 179 pseudophakic eyes. Most cases involved eyes in which extracapsular surgery had been combined with iridocapsular implants or posterior chamber lenses or in which iris-fixation IOLs were placed following intracapsular surgery. The characteristics of the detachments were similar, regardless of the type of cataract surgery employed, although there was a trend toward an increased incidence of significant preoperative proliferative vitreoretinopathy in the intracapsular cases. Anatomic success rates were greater than 90% in all groups. There was a trend for lower visual acuities following successful surgery in the eyes in which intracapsular surgery had been performed than in those following extracapsular procedures.

Endothelial Line Associated with Pseudophakic Bullous Keratopathy

Three patients undergoing uncomplicated cataract extraction with intraocular lens implantation developed an endothelial line, clinically appearing identical to that seen in allograft rejection following corneal transplantation. Both intracapsular and extracapsular surgery were involved. Three different intraocular lens types were implanted (pupillary supported, anterior chamber, and posterior chamber). Each case was associated with postoperative iritis and glaucoma. They were nonresponsive to steroid therapy and eventually resulted in total corneal decompensation. This clinical entity may represent an autoimmune phenomenon stimulated by chronic inflammation induced by the intraocular lens.

Pseudophakia and Intraocular Pressure

We studied the change in intraocular pressure in 373 consecutive eyes undergoing cataract extraction with intraocular lens implantation between Jan. 1, 1981, and May 31, 1982. There was a mean increase in intraocular pressure of 0.1 mm Hg following this surgery. This increase, however, was not statistically significant (P greater than .5). There was a mean rise in pressure of 0.8 mm Hg in the eyes undergoing intracapsular surgery and a mean fall in pressure of 0.6 mm Hg in the eyes undergoing extracapsular surgery (P less than .05). The change in pressure was unrelated to age, surgeon, or lens type. The results of a separate analysis of 16 eyes with a preoperative diagnosis of glaucoma and eight eyes with ocular hypertension were similar.

PHACOEMULSIFICATION OF CATARACT WITH POSTERIOR CHAMBER LENS IMPLANTATION AND OPERATIVE POSTERIOR CAPSULOTOMY

An initial series of 500 eyes with cataract was managed with phacoemulsification and posterior chamber lens implantation, with operative capsulotomy. The operative technique, complications and visual results are presented. Complications reported with other lens implant techniques are discussed and reviewed. It was found that the complication rate associated with this technique was lower than that associated with routine intracapsular surgery, and that visual rehabilitation was far superior.

Cystoid Macular Edema after Intracapsular and Extracapsular Cataract Extraction With and Without an Intralocular Lens

A prospective cystoid macular edema study of aphakic and pseudophakic patients showed that extracapsular cataract surgery has a lower rate than intracapsular surgery when the surgery is uncomplicated. There was no difference in the rates with intracapsular surgery with and without an intraocular lens. A complicated extracapsular with an intraocular lens has a higher rate than when the surgery is uncomplicated. In extracapsular surgery with complications, there is no difference in the rates with and without an intraocular lens. When complications occur, the ratio of clinical to angiographic-proven cases is higher than when the surgery is uncomplicated. This study included four series of uncomplicated cataract extractions and three series of complicated cataract extractions. A fluorescein angiogram was performed on every patient at least one year after surgery.

Retinal Detachment After Phacoemulsification

We reviewed the characteristics of 100 retinal detachments after phacoemulsification. The characteristics of retinal breaks and the configurations of the detachments were similar to cases of retinal detachments after intracapsular surgery. Evidence indicates that detachments occurring within six months of cataract surgery appeared to be statistically different from those occurring more than one year after phacoemulsification. Those detachments occurring within six months after cataract surgery tended to be more phakic in nature than those occurring relatively late. The surgical reattachment rates in these eyes compared favorably to previously published figures on the repair of retinal detachment after intracapsular surgery.

The Evolution of the Anterior Chamber Implant up to, and Including, the Choyce Mark IX

Since 1963, the Choyce Mark VIII lens, a quadrupedal, anterior chamber implant, has proved satisfactory following conventional intracapsular surgery in eyes of normal size, but less successful after primary extracapsular procedures and in small eyes. Reducing some of its dimensions by as much as 30% enables the surgeon to treat a much wider range of cataract problems through a smaller incision. The reduced-size version is known as the Choyce Mark IX anterior chamber implant. The quadrupedal principle has been preserved.