PC IOL Implantation Research Articles

Change in intraocular pressure within 1 week of phacoemulsification and intraocular lens implantation using Adatocel

To examine the change in intraocular pressure (IOP) within 1 week of phacoemulsification and foldable posterior chamber intraocular lens (PC IOL) implantation using Adatocel (hydroxypropyl methylcellulose 2% [HPMC]). Department of Ophthalmology, University of Sciences, Faculty of Medicine, Pécs, Hungary. In this prospective study, the IOP in 118 eyes of 118 patients (57 men, 61 women, mean age 68 years +/- 7.8 [SD]) with no history of glaucoma was assessed by Goldmann applanation tonometry 2 to 3, 6 to 8, and 22 to 24 hours and 1 week after uneventful phacoemulsification and PC IOL implantation. The effect of the removal of Adatocel ("partial removal" from the anterior chamber [AC] only versus "complete removal" from behind of the IOL as well), the lens type (Medicontur 601 HP versus Bausch & Lomb Hydroview), and the type of anesthesia (topical versus parabulbar) were compared. Statistical analysis was performed using the Student t test, and P< or =.05 was considered statistically significant. The mean preoperative IOP was 13.83 +/- 2.5 mmHg. There were no significant differences at any time in postoperative IOP measurements between the 2 IOL types and the 2 modes of anesthesia. At 2 to 3 hours, 6 to 8 hours, and 22 to 24 hours, the IOP was significantly higher in the 30 eyes in which the Adatocel was partially removed (from the AC only) than in the 88 eyes in which it was completely removed (from behind the PC IOL as well) (P< or =.05, P< or =.01, and P< or =.001, respectively). Severe postoperative IOP spikes in nonglaucomatous patients after uneventful phacoemulsification cataract surgery are rare. The type of implanted PC IOL and the mode of anesthesia had no significant effect on postoperative IOP. Total removal of the ophthalmic viscosurgical device, even when using HPMCs such as Adatocel, is necessary to prevent postoperative IOP spikes.

The Effect of Latanoprost, Bimatoprost, and Travoprost on Intraocular Pressure After Cataract Surgery

The aim of this study was to evaluate the effect of preoperative topical latanoprost, bimatoprost, and travoprost administration on postoperative intraocular pressure (IOP) after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. This prospective, randomized, double-masked study included 120 eyes of 120 consecutive, normotensive, uncomplicated cataract patients having phacoemulsification surgery with PC IOL implantation. They were randomized into 1 of 4 treatment groups, each of which had 30 patients. Two (2) h before the surgery, the patients received 0.005% latanoprost (Group 1), 0.004% bimatoprost (Group 2), 0.03% travoprost (Group 3), or placebo (Group 4, artificial tears). IOP was measured at preoperative, 4, 8, and 24 h postoperative with a Goldmann applanation tonometer. The anterior chamber was examined postoperatively 24 h for levels of cell and flare using slit-lamp biomicroscopy. The preoperative mean IOP was not statistically significant different among the four groups. In Groups 1 and 3, the mean IOP at 4, 8 and 24 h were significantly lower than the control (Group 4; P < 0.05). However, in Group 2, there was no significant difference in IOP during the study period, compared to the control (Group 4; P > 0.05). In addition, the mean postoperative IOP at 24 h in Groups 1 and 3 were significantly lower than the preoperative IOP (P < 0.05). No severe anterior chamber reaction was observed in any group. Our findings show that a single-dose topical of latanoprost and travoprost can prevent early postoperative IOP elevation after phacoemulsification surgery without any sideeffects.

Clinical study on the management of angle-closure glaucoma by phacoemulsification

目的 评价白内障超声乳化吸出后房人工晶状体植入术治疗合并白内障的闭角型青光眼的疗效.方法回顾分析2003年4月至2004年11月收住院的闭角型青光眼25例(26眼),其中14眼为原发性急性闭角型青光眼,7眼为原发性慢性闭角型青光眼,5眼为继发性急性闭角型青光眼.均有不同程度的晶状体浑浊,行透明角膜切口超声乳化吸出后房硬性人工晶状体植入术.随访6月～1年(平均9.40月).结果术后随访平均眼压(10.28±2.48)mmHg(1 mmHg=0.133kPa),比术前用药后眼压(18.36±3.23)mmHg明显降低,差异有统计学意义(P＜0.05),中央前房深度由术前的(1.56±0.45)mm,增加到术后的(2.23±0.34)mm,两者比较差异有统计学意义(P＜0.05).术后22眼(84.60%)最佳矫正视力有不同程度提高.结论透明角膜切口超声乳化白内障吸出联合后房型硬性人工晶状体植入术,可有效治疗合并白内障的闭角型青光眼。

Outcomes of phacoemulsification and in-the-bag intraocular lens implantation in Fuchs' heterochromic iridocyclitis

To evaluate the visual outcomes and complications of phacoemulsification (PE) and posterior chamber intraocular lens implantation, (PC IOL) in patients with Fuchs heterochromic iridocyclitis (FHIC). Private clinic and an academic hospital. In this noncomparative interventional case series, existing data for 41 eyes of 40 consecutive patients clinically diagnosed with FHIC and cataract were studied retrospectively. Scleral tunnel PE and in-the-bag IOL implantation were performed in all cases. Preoperative and postoperative visual acuities and intraoperative and postoperative complications were evaluated. Twenty-four male and 16 female patients aged 12 years to 70 (SD) (mean 35 +/- 12 years) were operated on and followed for 17.8 +/- 8.7 months. Preoperatively, best corrected visual acuity (BCVA) was less than 20/40 in all patients, which improved to 20/40 or better after surgery. Twenty-two eyes (53.6%) achieved BCVA of 20/20. The major cause of postoperative visual acuity less than 20/20 was vitreous haze. There were no major intraoperative complications. Postoperatively, mild anterior chamber fibrin reaction occurred in 4 patients (9.7%), IOL deposits occurred in 11 eyes (26.8%), and decentration was observed in 1 eye. During follow-up, 6 eyes (14.6%) developed posterior capsule opacification requiring a neodymium:YAG (Nd:YAG) laser capsulotomy. There was 1 case of clinical cystoid macular edema that resolved with medication. There were no cases of posterior synechias, postoperative glaucoma, or retinal detachment. Phacoemulsification with PC IOL implantation is a safe procedure with good visual outcomes in patients with FHIC and cataract.

Spontaneous disinsertion of a multipiece foldable acrylic intraocular lens haptic 3 and 12 months after implantation

We report 2 cases of spontaneous postoperative haptic disinsertion with the Alcon AcrySof® MA60BM posterior chamber intraocular lens (PC IOL). A 14-year-old girl with a history of acute retinal necrosis and pars plana vitrectomy with lensectomy for retinal detachment repair had secondary implantation of a PC IOL in the ciliary sulcus. Three months later, the superior haptic disinserted from the optic and dislocated into the anterior chamber. In the second case, a 22-year-old man had lens aspiration and PC IOL implantation in the capsular bag. One year after surgery, the PC IOL had a similar problem, with the disinserted superior haptic remaining in the capsular bag while the optic and inferior haptic dislocated into the anterior chamber. In both patients, the PC IOLs were exchanged for rigid single-piece PC IOLs. The patients have had no further problems.

The phacoemulsification and IOL implantation combined with repair of corneal laceration

目的 评价角膜穿孔修补、外伤性白内障超声乳化吸出及人工晶状体植入联合手术的临床效果.方法对该联合手术38例38眼进行回顾性评价.首先完成角膜裂口修补,然后对损伤的晶状体进行超声乳化吸出,必要时行前段玻璃体切除,然后植入人工晶状体.术后随访1～36月,平均10.3月.结果38眼中20眼(52.6%)最终最佳矫正视力在0.5以上;30跟(38.9%)最终最佳矫正视力在0.3以上.结论选择角膜穿孔、晶状体损伤,进行角膜穿孔修补、白内障超声乳化吸出、人工晶状体植入联合手术,可以获得较好的视力。

The clinical observation of combined surgery for phacolytic glaucoma

目的 观察青光眼白内障联合手术及一期后房型人工晶状体植入三联术应用于晶状体溶解性青光眼的临床效果.方法 12例(12眼)晶状体溶解性青光眼,施行白内障囊外摘出、小梁切除及后房人工晶状体植入三联术,术后门诊随访3个月,临床观察其效果.结果本组患者83.3%视力达0.3以上;眼压均控制在10.3mmHg～18mmHg之间(1mmHg=0.133kPa),与术前相比有显著差异。

The small incision non-phacoemulsification cataract extraction and IOL implantation

目的 探讨小切口非超声乳化人工晶状体植入术的临床效果和优点.方法76例(82眼)采用反弧形巩膜隧道切口摘出白内障植入后房型人工晶状体,并与65例(68眼)传统大切口手术进行对比.结果术后1周及2月随访观察:小切口组裸眼视力≥0.5者分别占56.1%和79.3%,平均散光为(1.92±1.02)D和(0.92±0.75)D;大切口组裸眼视力≥0.5者分别占34.0%和60.3%,平均散光为(4.56±1.52)D和(2.51±1.48)D,两组相比差异有显著性意义(P＜0.05).结论小切口手术组织损伤轻,术后视力恢复快、散光小,费用低廉。

Visual sensation during phacoemulsification and intraocular lens implantation using topical and regional anesthesia

Purpose: To evaluate patients' visual sensations at different stages of phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation under topical and regional anesthesia. Setting: Department of Ophthalmology, United Christian Hospital and Tseung Kwan O Hospital, Kowloon, Hong Kong, China. Methods: Seventy-six consecutive patients having phacoemulsification were randomized to a topical anesthesia group (n = 35) or regional anesthesia group (n = 41). The topical anesthesia group received lidocaine hydrochloride 2% gel (Xylocaine ®) and the regional anesthesia group, a peribulbar or retrobulbar injection of lignocaine 2%. The patients' visual sensations, including light and color sensations, shape of objects, and visual patterns, were evaluated at different stages of surgery. Results: Two patients (4.9%) in the regional anesthesia group and none in the topical anesthesia group experienced total loss of light sensation throughout surgery ( P = .50). There was a significant association between color perception and the type of anesthesia at stages 1 and 2 ( P<.05) but not at stages 3, 4, and 5 ( P>.05). The perception of objects and visual patterns had no association with the type of anesthesia at any stage ( P>.05). Of all patients in the study, 56 (73.7%) reported color changes as surgery proceeded. Both groups saw waves, defined as curves with periodic fluctuations in amplitude, at all stages. The perception of some colors and a rectangular moving object was significantly associated with the type of anesthesia at some or all stages ( P<.05). Conclusions: Patients having phacoemulsification and PC IOL implantation under topical or regional anesthesia had a wide spectrum of visual sensations that were similar at most stages of surgery. Patients in the topical anesthesia group perceived more colors at the early stages and more blue throughout surgery than patients in the regional anesthesia group.

Cataract surgery in children with and without retinopathy of prematurity

Purpose: To report the outcomes of cataract surgery in children born prematurely who had or did not have retinopathy of prematurity (ROP). Setting: Seoul National University Hospital, Department of Ophthalmology, Seoul, Korea. Methods: Retrospective studies were conducted by reviewing the charts of 26 eyes of 14 premature infants with or without ROP that had cataract surgery. The patients' preoperative characteristics and postoperative visual outcomes were documented. Cataract surgery consisted of lensectomy, posterior capsulectomy, and anterior vitrectomy in patients younger than 2 years and primary posterior chamber intraocular lens (PC IOL) implantation or secondary PC IOL implantation in those 2 years or older. Postoperative optical correction in those younger than 2 years was by glasses or contact lenses. Results: Eight eyes of 5 patients had acute ROP; 4 eyes had stage 3, 2 had stage 2, and 2 had stage 1. Three eyes had transconjunctival cryotherapy for treatment of threshold ROP. First-eye cataract surgery were performed in children from 0.2 to 5.5 years old (mean 1.5 years) and second-eye surgery, in children from 1.8 to 12.1 years old (mean 4.3 years). Twenty eyes had implantation of a PC IOL. In 1 patient with stage 3+ ROP, Rush (plus) type, both eyes had combined cataract and scleral buckle encircling surgery. The mean follow-up after the last surgery was 1.4 years (0.5 to 3.1 years). At the last examination, the best corrected visual acuity was good fixation or better than 20/80 except in 2 eyes, 1 with esotropia and the other with a dense pupillary membrane. Conclusions: This is the first report of an encouraging surgical outcome for PC IOL implantation in premature infants with cataract regardless of the presence of ROP. However, if retinopathy is present and has progressed in the cataractous eye of a premature child, careful examination and timely surgical decisions are important.

Unsutured posterior chamber lens implantation in eyes requiring lens extraction at the time of pars plana vitrectomy with silicone oil tamponade

Purpose: To describe a technique for the subsequent placement of an unsutured posterior chamber lens intraocular lens (PC IOL) in eyes requiring cataract or clear lens extraction at the time of pars plana vitrectomy (PPV) with silicone oil tamponade. Setting: Department of Vitreoretinal Surgery, St. Thomas' Hospital, London, United Kingdom. Methods: This retrospective review comprised 25 patients who had phacoemulsification to allow an adequate intraoperative retinal view or adequate access to anterior retinal pathology. Anterior and posterior capsulorhexes were combined with an inferior radial capsulectomy to fashion a keyhole-shaped capsule. Results: The mean follow-up was 15.9 months ± 8.0 (SD) (range 3 to 34 months). Silicone oil was removed and IOLs were implanted in 15 eyes (60.0%). Posterior chamber IOLs were implanted in 10 eyes (66.7% of those receiving an IOL), and anterior chamber AC IOLs were implanted in 5 eyes (33.3%). Nine of the 10 eyes receiving a PC IOL (60.0% of all IOLs) had uneventful surgery. In 1 eye, the PC IOL subluxated inferiorly. Two eyes developed pupil block that required further surgery. Conclusions: This technique allowed PC IOL implantation in 60% of eyes that received an IOL, showing that in selected patients who require simultaneous lens extraction and silicone oil tamponade, a keyhole-shaped capsulectomy provides for subsequent unsutured PC IOL insertion. The pupil block rate of 8% compares favorably with published rates. Refining the technique may allow it to be used in a greater proportion of eyes that would benefit from safe refractive correction.

Intraocular pressure after phacoemulsification with posterior chamber lens implantation in open-angle glaucoma.

To evaluate changes in intraocular pressure (IOP) after phacoemulsification (Phaco) with posterior chamber lens (PC IOL) implantation in eyes with primary open-angle glaucoma (POAG) at least 2 years after surgery. 19 eyes of 13 POAG patients who underwent uneventful clear cornea Phaco with PC IOL implantation and with follow-up of at least 2 years after surgery were included in this retrospective study. None of them had previous intraocular surgery or argon laser trabeculoplasty. The average preoperative IOP was 16.9 +/- 2.02 mm Hg. The average follow-up of was 36 +/- 11.8 months. 1 week after surgery a significant decrease in average IOP was observed (13.8 +/- 3.0 mm Hg; P = 0.000). 1 and 4 months after surgery IOP was still significantly lower than preoperatively. 8 months after surgery IOP significantly increased to 15.9 mm Hg (+/- 2.9 mm Hg; P = 0.022) with respect to 1 week postoperatively, but then again significantly decreased to 15.5 mm Hg (+/- 2.6 mm Hg; P = 0.020) 1 year after surgery and stayed approximately the same at 2 and 3 years after surgery. After 4 years the average IOP was 15.0 mm Hg (+/- 3.1 mm Hg; P = 0.216), that was statistically insignificant because of the small number of patients. In 79% (15 eyes) of our cases medical antiglaucoma treatment was unchanged, in 21% (4 eyes) the therapy was reduced. Uneventful Phaco with PC IOL implantation in good medically controlled POAG eyes was associated with a statistically significant long-term decrease in IOP, allowing the reduction of postoperative antiglaucoma medications in more than 20% of the eyes.

Stability of refraction, accommodation, and lens position after implantation of the 1CU accommodating posterior chamber intraocular lens

Purpose: To investigate stability of refraction, anterior chamber depth (ACD), and accommodation up to 12 months after implantation of the 1CU accommodating posterior chamber intraocular lens (PC IOL). Setting: Department of Ophthalmology, University Erlangen-Nürnberg, Erlangen, Germany. Methods: In a prospective study, 15 eyes of 15 patients (mean age 62.2 years ± 13.4 [SD] [range 44 to 86 years]) had phacoemulsification and PC IOL implantation. Distance refraction, accommodative range measured by the near point with an accommodometer, ACD measured with the IOLMaster (Carl Zeiss Meditec), and near visual acuity with best distance correction (Birkhäuser charts at 35 cm) were determined after 3, 6, and 12 months and analyzed for signs of systematic changes. Results: After 3, 6, and 12 months, the mean distance refraction was −0.28 ± 0.54 diopters (D), −0.29 ± 0.52 D, and −0.21 ± 0.54 D, respectively; the mean accommodative range, 1.93 ± 0.47 D, 1.85 ± 0.62 D, and 2.02 ± 0.38 D, respectively; the mean ACD without pharmacological induction of ciliary muscle contraction, 4.40 ± 0.44 mm, 4.35 ± 0.50 mm, 4.25 ± 0.53 mm, respectively; and the mean near visual acuity with best distance correction, 0.41 ± 0.15, 0.37 ± 0.12, and 0.39 ± 0.11, respectively. There were no statistically significant changes in any measurement during the follow-up ( P>.1). Conclusions: Refraction, ACD, and accommodative range remained stable without indication of a systemic trend toward myopia, hyperopia, PC IOL dislocation, or regression of accommodative properties. The 1CU accommodating PC IOL provided stable refraction, accommodation, and PC IOL position for up to 1 year.

Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery

Purpose To determine and quantify corneal endothelial damage after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs). Setting Eye Clinic, University of Trieste, Trieste, Italy. Methods This retrospective study comprised 125 patients who had implantation of an AC IOL from January 1987 to December 1998. The mean follow-up was 5.2 years. The IOLs were the Domilens Chiron Vision Z (n = 52), the Iolab U85J (n = 38), and the AMO AC51B (n = 35). The Konan specular microscope was used to perform full morphometric analysis of the corneal endothelium. The values obtained were compared with those in fellow eyes, which were phakic or pseudophakic with a posterior chamber IOL (PC IOL). Two years later, 63 patients (mean follow-up 2.1 years) had another morphometric analysis and the values obtained were compared with those in the same eye at the previous examination. The Student t test for unpaired groups was used to compare the results at a 5% significance level. Results The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes ( P<.01). Patients who had primary AC IOL implantation in 1 eye and PC IOL implantation in the fellow eye had a difference in ECD that was not statistically significant. The endothelial cell difference was significantly greater in aphakic patients who had a secondary AC IOL implantation ( P<.05). The ECD ranged from 1015 to 2980 cells/mm 2. The endothelium in the various groups showed no significant changes in the coefficient of variation (CV) in cell size. The ECD and endothelial CV in the same eyes at the second examination were not significantly different from the values 2 years previously. Conclusions Anterior chamber IOL implantation did not appear to alter corneal endothelial function. Results indicate that the endothelial cell loss was related to surgical trauma rather than the presence of an IOL in the anterior chamber.

Modified capsular tension ring for patients with congenital loss of zonular support

Purpose To evaluate the results of implantation of a modified capsular tension ring (MCTR) and a posterior chamber intraocular lens (PC IOL) in patients with congenitally subluxated crystalline lenses. Setting Cincinnati Eye Institute, Cincinnati, Ohio, USA. Methods Ninety eyes of 57 patients with congenital loss of zonular support (Weill-Marchesani syndrome, idiopathic ectopia lentis, and Marfan's syndrome) had phacoemulsification with PC IOL and MCTR implantation. The preoperative examination included best corrected visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration, and vitreous prolapse. The postoperative evaluation included BCVA and the presence or absence of pseudophacodonesis, PC IOL centration, and posterior capsule opacification (PCO). Results At the last postoperative examination, the BCVA was 20/40 or better in 80 eyes (88.9%); 1 eye (1.1%) lost 1 line of acuity. Preoperatively, 18 eyes (20%) had phacodonesis; 1 eye had postoperative pseudophacodonesis. Decentration before surgery was present in 86 eyes (95.6%); 6 eyes (6.7%) developed late symptomatic PC IOL decentration a median of 17.84 months ± 10.73 (SD) after surgery. Other complications were increased intraocular pressure (2.2%), persistent iritis (3.3%), broken suture (10.0%), retinal detachment (1.1%), and PCO (20.0%). Conclusions Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.

Effect of an acrylic posterior chamber intraocular lens on posterior capsule opacification in cataract patients with associated risk factors

Purpose To evaluate the effect of an acrylic foldable posterior chamber intraocular lens (PC IOL) on the rate of posterior capsule opacification (PCO) in patients with associated risk factors. Setting Department of Ophthalmology, Seoul National University, Seoul, Korea. Methods The medical records of 570 patients who had phacoemulsification and foldable PC IOL implantation by the same surgeon from January 1, 1998, to December 31, 1999, were reviewed. Patients with risk factors for PCO (ie, young age, diabetes mellitus) received an acrylic PC IOL to decrease the opacification rate. Their rate was compared to that in patients without associated risk factors who received a foldable silicone PC IOL. Results In the patients without diabetes mellitus, the PCO rate in patients younger than 60 years with an acrylic PC IOL and in patients older than 60 years with a silicone PC IOL were similar. In patients older than 60 years, the rate of PCO was significantly lower in patients with diabetes mellitus and an acrylic PC IOL than in patients without diabetes mellitus with a silicone foldable PC IOL. Conclusions The rate of PCO in patients with risk factors for PCO with an acrylic PC IOL was similar to or lower than that in patients without risk factors with a foldable silicone PC IOL. Therefore, acrylic PC IOLs are preferable, particularly in patients with risk factors for PCO.

Long-term observation of aqueous flare following penetrating keratoplasty.

To understand the influence of preoperative corneal conditions, combined implant surgeries, and subsequent rejection on the aqueous flare value following penetrating keratoplasty (PK). A total of 86 eyes of 86 patients were included. PK alone was performed on eyes with keratoconus (n = 7), corneal scar (from previous trauma or nonherpetic infection; n = 19), pseudophakic bullous keratopathy (PBK) (n = 16), and for regraft (n = 14). Combined ECCE and PC-IOL implantation (triple procedure) was performed on 17 eyes with corneal scar, and combined AC-IOL exchange was performed on 13 eyes with PBK. Aqueous flare was measured with a laser flare-cell meter at 1 week and 1, 3, 6, 12, and 24 months postoperatively. The mean follow-up was 24.7 (range 7-76) months. There were 11 cases (12.8%) of endothelial rejection (two in PK for corneal scar group, two in triple procedure group, two in PK for PBK group, three in PK and AC-IOL exchange group, and two in regraft group). Two corneas in PK for corneal scar group, one in PK and AC-IOL exchange group, and one in regraft group cleared up later; the remaining seven cases failed subsequently. Another 10 grafts (11.6%) failed from other causes. Eventually, 69 grafts (80.2%) remained clear at last follow-up. There was a significant difference in aqueous flare values among eyes undergoing PK only for keratoconus, corneal scar, PBK, and regraft from 1 week to 3 months postoperatively. In the corneal scar group, aqueous flare value was significantly higher from 1 week to 3 months when combined with cataract surgery. In the PBK group, the value was significantly higher from 1 week to 1 month and 6 months again when combined with AC-IOL exchange. Notably, significantly higher flare values were measured from 1 week to 6 months in eyes with later rejection. Preoperative diagnoses and additional implant surgeries influenced the aqueous flare counts at the early postoperative period. Persistently elevated flare value may be associated with later rejection.

Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification

Purpose To determine the incidence of retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) and define the characteristics of this type of RD. Setting A private practice, with statistical evaluation at a university department. Methods Five hundred twenty-six consecutive eyes that had Nd:YAG capsulotomy because of visually disturbing PCO were followed prospectively for up to 52 months (median 21 months) to determine the incidence of RD. The median age of the 142 men and 320 women was 76 years and the median axial length, 23.3 mm (range 20.5 to 31.3 mm). Before the capsulotomy, all eyes had uneventful phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). Eyes with additional surgical procedures or with panretinal laser photocoagulation were excluded. Eyes in which a retinal hole had been treated before Nd:YAG (n = 4) were included. The fundus was examined by binocular indirect ophthalmoscopy with a 2.2 diopter Volk lens in full mydriasis. If necessary, an examination with a 3-mirror lens was done. Results The incidence of RD was 0% (0/483; 95% confidence interval [CI], 0.0%-0.8%) at 6 months, 0% (0/407; 95% CI, 0.0%-0.9%) at 12 months, and 0.5% (1/213; 95% CI, 0.0%-2.6%) at 24 months. Twenty-one months after Nd:YAG capsulotomy, 1 eye developed an RD that occurred as the result of a horseshoe tear that reopened. The tear, which formed 7 months after phacoemulsification and PC IOL implantation and 6 years before Nd:YAG capsulotomy, had been immediately treated with argon laser photocoagulation. Excluding the 4 eyes with preexisting tears, presumably sealed retinal holes, the incidence at 24 months was 0% (0/212; 95% CI, 0.0%-1.7%). No other eye developed RD over the follow-up. Conclusions Retinal detachment after Nd:YAG capsulotomy for PCO was rare in eyes that had previous uneventful phacoemulsification and PC IOL implantation. The exact relationship between the 2 events remains to be established.

Measurement of accommodation after implantation of an accommodating posterior chamber intraocular lens

Purpose To analyze techniques of measuring accommodation after implantation of an accommodating posterior chamber intraocular lens (PC IOL). Setting Department of Ophthalmology and University Eye Hospital, University Erlangen-Nürnberg, Erlangen, Germany. Methods This prospective study analyzed 23 eyes of 23 patients (aged 41 to 87 years) after cataract surgery and PC IOL implantation (1 CU®, HumanOptics) 4 weeks and 3 and 6 months after surgery. The results were compared to those in an age-matched control group (n = 20) 6 months after surgery. The following methods were used to measure accommodation: dynamic with objective techniques (PlusOptix PowerRefractor® videorefractometry, streak retinoscopy) and subjective techniques (subjective near point [push-up test, accommodometer], defocusing); static with pharmacologic stimulation after pilocarpine 2% eyedrops directly (conventional refractometry); indirectly (change in the anterior chamber depth [ACD] with Zeiss IOLMaster®). Results Results at 6 months, given as mean ± SD (range), in the study and control groups, respectively, were as follows: near visual acuity (Birkhäuser reading charts at 35 cm) with distance correction, 0.32 ± 0.11 (0.20 to 0.60) and 0.14 ± 0.10 (0.05 to 0.30); accommodation amplitude (diopters) by PowerRefractor, 1.00 ± 0.44 (0.75 to 2.13) and 0.35 ± 0.26 (0.10 to 0.65), by retinoscopy, 0.99 ± 0.48 (0.13 to 2.00) and 0.24 ± 0.21 (–0.13 to +0.75), by subjective near point, 1.60 ± 0.55 (0.50 to 2.56) and 0.42 ± 0.25 (0.00 to 0.75), and by defocusing, 1.46 ± 0.53 (1.00 to −2.50) and 0.55 ± 0.33 (0.25 to 0.87). The mean ACD decrease (mm) was 0.78 ± 0.12 (0.49 to 1.91) and 0.16 ± 0.09 (0.00 to 0.34) after pilocarpine 2% eyedrops, indicating a mean accommodation of 1.40 D and 0.29 D, respectively, based on Gullstrand’s model eye ( P = .001). The lowest fluctuation between follow-ups was with the subjective near point and the defocusing techniques followed by ACD decrease with the IOLMaster. Conclusions Accommodation after implantation of an accommodating PC IOL should be assessed with several techniques, including subjective and objective, to differentiate true pseudophakic accommodation from pseudoaccommodation. Researchers should be aware of the different variability and consistency of measurements with each technique over time.

Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis

Purpose To determine the safety and efficacy of capsular tension ring (CTR) insertion in eyes with zonular dialysis of less than 150 degrees having phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. Setting Dr. Agarwal’s Eye Hospital, Chennai, India. Methods This prospective study comprised 21 eyes of 19 patients with zonular dialysis of less than approximately 150 degrees determined preoperatively or intraoperatively. After insertion of a CTR, phacoemulsification with PC IOL implantation was performed. The mean follow-up was 242.33 days. Results Capsule collapse did not occur in any eye with a CTR. Intraoperative extension of the dialysis occurred in 2 eyes (9.52%). The IOL was placed in the bag in all the eyes except 1 that had traumatic cataract and received a scleral-fixated IOL during a subsequent surgery. Postoperatively, there was minimal corneal edema in 2 eyes (9.52%) and mild iritis in 5 eyes (23.80%). Three eyes (14.28%) developed raised intraocular pressure that responded well to medical therapy. The symptoms resolved in the 3 patients with preoperative diplopia. Fifteen eyes (71.42%) had a final visual acuity of 6/12 or better. Six eyes had a final best corrected visual acuity of worse than 6/12 because of coexisting fundus pathology. A dilated pupil examination at 6 months showed a well-centered IOL in all eyes. Conclusions Phacoemulsification with in-the-bag PC IOL and CTR implantation in eyes with zonular dialysis of up to approximately 150 degrees had a success rate of 90.47%. Visual recovery was not as good as in normal eyes because of the problems associated with zonular dialysis.