Intumescent Cataract Research Articles

Prognosis for Keratoplasty in Acanthamoeba Keratitis

Penetrating keratoplasty (PK) was undertaken between 1985-1991 at Moorfields Eye Hospital in 13 eyes (19 PKs) of 11 patients who developed Acanthamoeba keratitis. Infection was ultimately controlled in all cases. Retrospective analysis was undertaken to establish risk factors for PK. Six eyes were quiet and 7 had uncontrolled infection at the time of keratoplasty. The outcome for these was compared. Complications included cataract in 50% of quiet eyes and 100% of inflamed eyes. Intumescent cataract resulted in glaucoma requiring drainage surgery in 4 eyes. Graft rejection episodes occurred in 50% of quiet eyes, but were treated aggressively and did not cause graft failure. Graft survival was excellent for quiet eyes, but was compromised by recurrent infection in inflamed eyes and 6 patients were regrafted. Survival compared poorly with grafting for active herpetic or bacterial keratitis, indicating that early diagnosis and treatment are essential for adequate control of this disease.

Neodymium:YAG Laser Iridotomy An, the Initial Management of Phacomorphic Glaucoma

Acute angle-closure glaucoma can be triggered by a mature or intumescent cataract, and occurs in eyes with open angles, as well as in those with narrow, occludable angles. This is encountered more in developing countries, where patients present late. They tend to wait until the cataract becomes mature, because it is common belief among these patients that cataracts should not be operated on until vision drops to the level of hand movements or light perception. The authors reviewed the charts of 10 patients who were treated for phacomorphic glaucoma, by first undergoing neodymium:YAG (Nd:YAG) laser iridotomy. In all patients, the acute angle-closure glaucoma attack could be reversed or prevented by the iridotomy, before subsequent cataract extraction. The value of Nd:YAG laser iridotomy in the initial management of phacomorphic glaucoma is discussed.

Lens-induced glaucoma.

The crystalline lens is implicated as a causative element in producing several forms of glaucoma. Etiologically they represent a diversity in the presentation of the glaucomatous process. These conditions include glaucoma related to: lens dislocation (ectopia lentis), lens swelling (intumescent cataract), classical pupillary block, aqueous misdirection--ciliary block, phacoanaphylaxis, lens particle, and phacolytic glaucoma. The management of elevated intraocular pressure often requires altering the intraocular relationship of anatomic structures surrounding the lens or lens removal. We will review the entities that produce these lens-induced glaucomatous conditions and suggest a rational approach to their diagnosis and treatment.

Lens proteins in intumescent cataract.

Intumescent cataractous lenses were investigated as to their water content and protein composition. Nuclei were separated from cortices. Water-soluble, water-insoluble, urea-soluble and urea-insoluble portions were quantified and the subunit composition of the water-soluble crystallin fraction was looked at on SDS-gel electrophoresis. Compared to normal lenses it is observed that the water content in intumescent cataract is increased, water-soluble and urea-soluble fractions are diminished, whereas the urea-insoluble portions are augmented. No major changes are noted in the subunit composition of the soluble protein fractions. Particularly, the relative amount of gamma-crystallins is diminished in intumescent cataractous lenses.

Intraocular lens implantation in acute angle closure glaucoma associated with cataract

We have performed planned extracapsular cataract extraction and implantation of a posterior chamber intraocular lens in four eyes of three patients undergoing surgery for acute angle closure glaucoma associated with cataract. Three of these four eyes suffered angle closure secondary to intumescent cataract. One suffered primary angle closure upon preoperative pupillary dilation prior to lens extraction. We have found no evidence of corneal decompensation, residual glaucoma, or increased surgical morbidity in our patients. We feel that acute glaucoma associated with cataract is not a contraindication to lens implantation.

Glutathione content of the lens in various forms of cataract

Both the electrolyte ratio (K greater than Na) and high glutathione content of the lenses are generally undisturbed in the brunescent nuclear cataract (cataracta brunescens), the primary grey nuclear cataract, and the supranuclear cataract (senile cortical cataract). The electrolyte ratio (Na greater than K) and greatly decreased glutathione content are also grossly pathological in the subcapsular cataract (cataracta complicata, posterior subcapsular cataract), especially in connection with a secondary grey nuclear cataract, the mature cataract (cataracta matura), and the intumescent cataract. Alteration of the electrolyte concentrations and the glutathione content may be the results of physical, anatomical, and various metabolic disorders.

Bullous Keratopathy Following Lens Extraction in Eyes with Acute Glaucoma Due to Intumescent Cataract

Nine cases are presented, six of them in detail, which suggest that there is a high risk of bullous keratopathy developing when the lens is removed for the treatment of acute glaucoma due to an intumescent cataract. In some cases the keratopathy is due to detachment of Descemet's membrane from the cornea. Acute glaucoma due to an intumescent cataract should be treated medically or by peripheral iridectomy. The lens should be removed only after the intraocular pressure has been normal and the cornea free of edema for at least 6 weeks.

Demonstration of abnormalities of the lens by echography.

A demonstration of the B-scan echographic appearances of some commonly encountered lens abnormalities is presented. Examples of intumescent, traumatic and calcified cataracts, congenital and traumatic displacements and other abnormalities are shown. The significance of these findings is discussed and the importance of pre-operative ultrasonic examination of the patient for cataract extraction to exclude vitreous or retinal pathology is stressed. The value of echographic examination in traumatic cases, where vitreous haemorrhage has occurred, in the demonstration of intraocular abnormalities, such as retinal detachment or a non-radio-opaque foreign body is also discussed.

Fellow eye in angle-closure glaucoma.

118 consecutive patients with angle-closure glaucoma (ACG) were investigated. The primarily affected eye presented with acute ACG in 71 patients, with intermittent or chronic ACG in 41, and with acute ACG secondary to intumescent cataract in six. ACG was demonstrated in the fellow eye in 85 of the 118 patients (72 per cent.), including 72, 71, and 83 per cent. respectively of the three groups distinguished above. In 27 fellow eyes, ACG was demonstrable only by provocative testing. Eleven patients failed to return for follow-up investigation. A routine prophylactic peripheral iridectomy in the fellow eye is justified in patients who are unlikely to attend for follow-up examinations,, but may be avoided in about 23 per cent. of patients who attend regularly.

Dehydration of the crystalline lens: a possible means of extracting the hypermature cataract.

Some results of satisfactory operations for the extraction of intumescent cataract lenses after their dehydration with a 50% solution of glycerol are described. The advantages of this technique, which facilitates expeditious and optimal seizing of the capsule of the lens, are outlined and discussed.

Disposable cryophake--clinical evaluation.

Cryoprehensile cataract extraction is a new technique rapidly approaching perfection since Krwawicz1in attempting to eliminate the factor of unreliable methods of grasping the introduced his methanol-carbon dioxide ice cooled extractor in 1961. His instrument had three deficiencies: too short a freezing period, poor insulation about the tip, and crude technique for detaching tissues which accidentally became adherent to the extractor. However, the efficacy of the method was firmly established by him2in 1963 when he reported the results on over 600 cases of all types of cataracts with less than 3% of ruptures of the capsule despite the fact that over 400 cases were of intumescent cataract. He noted the probability of a too-narrow corneoscleral section as a major cause of capsule rupture as well as suggesting capsular shrinkage produced by the freezing as an etiological factor. Kelman and Cooper3in 1963, using a liquid

The lens and vitreous.

A new method is described for extracting intumescent cataracts by means of a pencilshaped metal instrument called the cryoextractor. The small, rounded, copper tip of the instrument is so refrigerated that when it is applied to the exposed lens superi¬ orly, the capsule and underlying cortex freeze and adhere to the cryoextractor. The lens is then removed by the sliding tech¬ nique. Contact with adjacent tissues should be avoided.9 A technique for removal of the posteriorly dislocated lens is described. A needle is passed through the sclera 5 or 6 mm. behind the limbus temporally. It is then passed behind the lens to the level of the nasal pupillary margin, where it is used as a lever, the lens being forced into the anterior cham¬ ber and against the cornea. The needle is introduced through the limbus nasally to hold the lens in place, and a combined ex¬ traction is performed in the usual manner, following which the needle is withdrawn.17 A study of 561 cases of cataract extrac¬ tion comparing the results of forceps extrac¬ tion with suction extraction by means of the Bell erisophake indicates comparable results by both methods. In intumescent cataract

A Procedure to Facilitate Intracapsular Forceps Extraction of Intumescent Cataracts

A Procedure to Facilitate Intracapsular Forceps Extraction of Intumescent Cataracts

CERTAIN ASPECTS OF THE INTRACAPSULAR EXTRACTION OF CATARACT BY FORCEPS

Though extraction of the cataract in its capsule is the ideal operation, the procedure is more difficult and the danger of prolapse of the vitreous is greater than in the extracapsular procedure, as the protection of the posterior capsule is lost. Notwithstanding, this operation is being performed in all parts of the world in steadily increasing numbers of cases, and progress is being made in studying its technic and combating the difficulties. The writings of Elschnig have done much to popularize the operation, especially in Europe. In discussing the indications it is convenient to classify cataract into the following clinical types: mature, nuclear, nuclear and posterior cortical and intumescent (mother-of-pearl cortex) cataracts, phakosclerosis and hypermature, morgagnian and shrunken (disciform) cataracts. Of these, the nuclear and posterior cortical opacities are the most frequent immature cataracts. In general the cataract is ready for operation when the anterior chamber is sufficiently