Phacoemulsification Cataract Extraction Research Articles

Late in-the-bag intraocular lens dislocation requiring explantation: risk factors and outcomes

To study the predisposing factors for late in-the-bag intraocular lens (IOL) dislocation and to analyze the outcomes after explantation surgery. In this retrospective multicentre study, 61 eyes were enrolled. The main inclusion criterion was in-the-bag spontaneous IOL dislocation after uneventful phacoemulsification cataract extraction. Only eyes with serious dislocation that required IOL explantation were eligible. Follow-up after explantation surgery of at least 3 months was required. Exclusion criteria were complicated cataract surgery, out-of-the-bag IOL dislocation, and dislocations that occurred in the first year after the cataract surgery. The main outcome measures were predisposing factors for dislocation, interval between cataract surgery and dislocation, surgical treatment at the time of explantation, preoperative and postoperative corrected distance visual acuity (CDVA), and postoperative complications. High myopia was detected in 12 cases (19.7%) and it was the main predisposing factor. Mean time interval from cataract surgery to dislocation was 7.5 (SD 5.2) years. The dislocated in-the-bag IOL was replaced with a scleral fixated IOL (36.1%), angle-supported anterior chamber IOL (31.1%), sulcus repositioning (18%), or posterior chamber iris sutured IOL (4.9%). Finally, 9.8% of the patients were left aphakic. Mean CDVA improved significantly after surgery (P=0.005). Final CDVA of 20/40 or better was achieved in 29 cases (47.5%). High myopia was the main risk factor for late in-the-bag IOL dislocation. Surgical treatment significantly improved the CDVA in our sample and was associated with a low complication rate.

Cataract Extraction Outcomes and the Prevalence of Zonular Insufficiency in Retinitis Pigmentosa

To examine surgical outcomes in patients with retinitis pigmentosa (RP) undergoing phacoemulsification cataract extraction. Retrospective observational case series. In this single-institution study of consecutive RP patients who underwent phacoemulsification cataract extraction and intraocular lens implantation by a single surgeon between 2002 and 2012, preoperative, intraoperative, and postoperative records were analyzed with attention to best-corrected visual acuity (BCVA), lens and zonular status, capsular tension ring use, incidence of posterior capsular opacification and neodymium-doped yttrium-aluminum-garnet (YAG) laser capsulotomy, and surgical complications. Eighty eyes of 47 RP patients (21 male) underwent cataract surgery during the study period at an average age of 48.9 years (range, 31-78 years). Mean follow-up time was 23.3months (range, 1day - 95months). Posterior subcapsular cataracts were present in 97.5% of patients. Mean BCVA improved from 20/340 (logarithm of the minimal angle of resolution [logMAR] 1.23) to 20/129 (0.81) within 3months of surgery, P < .0001. Eyes with a preoperative vision of 20/40 to 20/200 (47 eyes) improved from a mean of 20/81 (logMAR 0.61) preoperatively to 20/43 (0.33), P < .0001, postoperatively. Posterior capsule opacification occurred in 66 eyes (82.5%), and 42 eyes (52.5%) underwent a YAG laser capsulotomy at a mean of 10.8months after surgery. Fifteen eyes (18.8%) of 10 patients (21.3%) had signs of phacodonesis (3 eyes noted preoperatively, 8 intraoperatively, and 4 postoperatively). One patient had bilateral dislocated in-the-bag intraocular lenses at 5.5 years and 6 years after surgery. Cataract surgery yields significantly improved Snellen visual acuity in a majority of RP patients with a preoperative vision of 20/200 or better. Conversely, patients with a preoperative visual acuityof 20/400 or worse generally have more limited objective improvements, likely because of macular involvement, but usually report noticeable subjective improvement. A high prevalence of zonular instability is seen in RP patients undergoing cataract extraction. It is therefore important to conduct a careful preoperative assessment of lens stability with preparation for adjunctive methods that augment intraoperative and postoperative lens stabilization.

Toward Zero Effective Phacoemulsification Time Using Femtosecond Laser Pretreatment

To compare effective phacoemulsification time after femtosecond laser pretreatment with conventional phacoemulsification and the associated effect on visual outcomes and endothelial cell loss. Prospective, consecutive, single-surgeon case-control study. Controls underwent phacoemulsification cataract extraction plus insertion of an intraocular lens (IOL). Cases underwent pretreatment with the femtosecond laser followed by phacoemulsification cataract extraction and IOL insertion. Two hundred one eyes underwent cataract surgery between April 2012 and July 2012. Data collected included patient demographics, preoperative characteristics, femtosecond lens fragmentation method, effective phacoemulsification time (EPT), intraoperative complications, and postoperative outcomes. Effective phacoemulsification time, intraoperative complications, corneal endothelial cell loss, as well as postoperative best-corrected visual acuity, intraocular pressure, and refractive outcomes. Patient demographics were similar between groups. There was no difference between baseline cataract grades (2.59 ± 0.71 vs. 2.52 ± 0.72, not significant). One hundred percent of cases pretreated with the femtosecond laser had complete capsulotomy. Mean EPT was reduced by 83.6% in the femtosecond pretreatment group (P<0.0001) when compared with controls, with 30% having 0 EPT (P<0.0001). Effective phacoemulsification time was reduced 28.6% within the femtosecond group using improved lens fragmentation algorithms, and a further 72.8% reduction was achieved with a 20-gauge phacoemulsification tip. Overall, there was a 96.2% reduction in EPT between controls and the optimized femtosecond pretreatment group. This was associated with a 36.1% reduction in endothelial cell loss in the femtosecond group. Visual and refractive outcomes were similar to those of conventional cataract surgery. Femtosecond laser pretreatment results in a significant reduction in effective phacoemulsification time, including the possibility of 0 EPT. Further reductions may be achieved using optimization of lens fragmentation patterns and surgical technique. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Preoperative Factors Associated with IOP Reduction After Cataract Surgery

To identify preoperative factors associated with postoperative intraocular pressure (IOP) reduction after phacoemulsification cataract extraction in patients with primary open-angle glaucoma (POAG) treated at a Veterans Affairs Medical Center. Examination records of 103 eyes of 75 patients with POAG who underwent uncomplicated phacoemulsification cataract extraction were reviewed. Preoperative data collected for analysis included IOP, number of glaucoma medications, spherical equivalent refractive errors, central corneal thickness, anterior chamber depth, and axial length. The IOPs measured 3 to 6 months after surgery were used to calculate the change in IOP after cataract extraction. Statistical analysis was performed to identify preoperative factors associated with postoperative IOP reduction. The mean postoperative IOP reduction was 1.8 ± 3.5 mm Hg (p < 0.001). Seventy-four percent of eyes (76 of 103) had decreased IOP after cataract surgery. Eight percent of eyes (8 of 103) had no change in IOP. Eighteen percent of eyes (19 of 103) had increased IOP after cataract surgery. The mean preoperative IOPs for eyes with increased, same, and decreased postoperative IOPs were 12 ± 2.2 mm Hg, 14.0 ± 2.3 mm Hg, and 16.4 ± 3.1 mm Hg, respectively. The mean postoperative IOPs change for eyes with increased and decreased postoperative IOPs were +2.7 ± 2.1 mm Hg and -3.7 ± 2.5 mm Hg, respectively. Preoperative IOP was the only preoperative factor significantly associated with postoperative IOP reduction (p < 0.001). Preoperative IOP was the only factor significantly associated with postoperative IOP reduction after cataract surgery in POAG patients. A higher preoperative IOP was strongly associated with a greater postoperative IOP reduction. Patients with low preoperative IOPs tended to have minimal reduction or even a mild increase in postoperative IOPs. These findings have important implications when considering combined cataract extraction and filtration surgery for POAG patients.

Phacoemulsification Cataract Extraction in Patients with Fuchs’ Heterochromic Iridocyclitis

Phacoemulsification Cataract Extraction in Patients with Fuchs’ Heterochromic Iridocyclitis

Antimicrobial Assay of Chlorhexidine-Wetted Textile Napkins for Surgical Site Disinfection in Ocular Surgery

Background: As a new intraoperative disinfection method, chlorhexidine-wetted textile napkins have been employed in order to cover the upper and lower eyelid edges, eyelid skin, eyelashes, lid margins and palpebral conjunctiva during phacoemulsification cataract extraction. This study was conducted to compare the antimicrobial activity of textile napkins before and after their use. Methods: This study evaluated 80 textile napkins wetted with 0.02% aqueous solution of chlorhexidine. All textile napkins were divided into groups. The study group consisted of 60 used textile napkins which were collected from 29 patients (30 eyes) at the end of phacoemulsification, and the control group included 20 unused sterile textile napkins. Antimicrobial assay was performed by means of measuring the growth inhibition zones of the standard or clinical isolate strains under the textile napkins on the surface of agar media. Results: The number of textile napkins and the diameter of the growth inhibition zones (mm) in the study group and in the control group relating to gram-positive, gram-negative, and fungi were: 24/31 vs. 8/31, 32/30 vs. 8/30, and 4/30 vs. 4/30. The diameter of the growth inhibition zones of gram-positive bacteria was more than other investigated microorganisms. In the growth inhibition zones, exogenous microorganism colonies were not found. Conclusion: Antimicrobial activity of textile napkins wetted with 0.02% aqueous solution of chlorhexidine against gram-positive bacteria is more than gram-negative bacteria and fungi, and is preserved to the end of the phacoemulsification.

The Stress of Cataract Surgery

Background: To assess the stress levels of three different grades of surgeons during cataract surgery. Design: Observational study. Participants: Three healthy male ophthalmic surgeons (Surgeon A, a specialty trainee, Surgeon B, a cataract surgery fellow, and Surgeon C, a consultant) were studied during 95 consecutive uncomplicated local anaesthetic phacoemulsification cataract extraction procedures. Methods: A pulse oximeter was used to record the heart rates of the 3 surgeons while they operated. The readings were taken at baseline and at every 2 seconds during the operation. The percentage change from baseline for each stage was compared for individual surgeons and amongst the three surgeons using one-way ANOVA test. Results: Observations were recorded on 29 cases for Surgeon A and 33 cases each for Surgeon B and Surgeon C. Overall there was a significant increase for capsulorhexis (p=0.007), phacoemulsification (p<0.001) and lens implantation (p=0.002) and wound closure (p=0.149). Surgeon A showed highest elevation during phacoemulsification (p<0.001). Surgeon B did not demonstrate a higher increase at a particular stage (p=0.103); and Surgeon C had a higher heart rate towards the completion of the procedure (p<0.001). Conclusions: Published reports have highlighted the stress surgeons in different specialties undergo. Ours is the first study to demonstrate a change of heart rate from the baseline and hence stress between cataract surgeons of different grades. This change may be attributed to the difference between their experience and skills. Further studies can be undertaken to better identify stages of greater stress and means to reduce it.

Femtosecond laser‐assisted cataract surgery compared with conventional cataract surgery

To investigate the safety and efficacy of the Catalys (Optimedica, Santa Clara, CA, USA) femtosecond laser-assisted cataract surgery system compared with conventional phacoemulsification cataract extraction. Prospective, consecutive, parallel cohort study. The first 200 eyes undergoing conventional cataract surgery to the first 200 eyes undergoing femtosecond laser-assisted cataract surgery between April and July 2012. Femtosecond laser-assisted cataract surgery involved anterior capsulotomy and lens fragmentation based on optical coherence tomography-guided treatment mapping. Conventional cataract surgery involved manual continuous curvilinear capsulorhexis. Both procedures were completed by standard phacoemulsification and insertion of an intraocular lens. Effective phacoemulsification time and intraoperative complication rates. Patient demographics were similar between both groups. There was no statistically significant difference in intraoperative complications between femtosecond laser-assisted cataract surgery and conventional surgery. There was one posterior capsule rupture in both groups (0.5%; not significant). One hundred per cent of cases treated with the femtosecond laser had a complete capsulotomy. Vacuum time decreased with experience. Effective phacoemulsification time was reduced by 70% in the femtosecond group (P < 0.0001). Twenty-six cases in the femtosecond group versus one case in the conventional group had 0 effective phacoemulsification time (P < 0.0001). Femtosecond laser-assisted cataract surgery appears to be as safe as conventional cataract surgery in the short term and results in significantly lower effective phacoemulsification time. Although it may allow for greater efficiency and decreased postoperative complications, further research is needed into long-term safety aspects such as corneal endothelial cell loss.

The operation timing of traumatic cataract caused by corneal penetrating injury

Objective To investigate the timing of traumatic cataract surgery.Methods 37 cases (37 eyes) of traumatic cataract caused by corneal penetrating injury were retrospectively analyzed.They underwent cataract surgery by phacoemulsification or extracapsular cataract extraction combined with posterior intraocular lens implantation at different time during 1 d to l m after injury.Primary or secondary IOL implantation was done.Results After 1 to 3 months follow-up postoperatively,the visual acuity was between no light perception to 1.0.It was no light perception in one eye (2.7％),hand movement in one eye (2.7％),0.05～0.1 in3 eyes (8.1％),0.12～0.3 in 11 eyes(29.7％),0.4～1.0 in21 eyes (56.8％).Infective endophthalmitis happened in two eyes in which one eye resulted in atrophy.Conclusion For traumatic cataract caused by corneal penetrating injury,suitable surgical timing and proper surgical method is important for visual outcome. Key words: Corneal penetrating injury ; Traumatic cataract; Lens, intraocular, posterior chamber; Implantation; Timing

Incidence of acute postoperative cystoid macular edema in clinical practice

To measure the incidence of acute postoperative cystoid macular edema (CME) in clinical practice. Private clinical practice, Eugene, Oregon, USA. Retrospective chart review. The electronic medical records database was searched for the charts of all patients having cataract surgery during a recent 5-year period. Each chart was then examined for a diagnosis of CME within the 3-month postoperative period. From March 1, 2007, through March 31, 2012, 2862 phacoemulsification cataract extraction and intraocular lens implantation procedures were performed. Of these, 3 cases (0.1%) of acute postoperative CME were confirmed by diagnosis within 90 days after surgery. This chart review found a 0.1% cumulative incidence of acute postoperative CME. Prophylaxis with topical steroidal and nonsteroidal agents may help reduce the incidence of CME. If the incidence of CME in this study applies generally, it would be harder to successfully and ethically perform a randomized trial of medical prophylaxis. Dr. Packer is a consultant to Advanced Medical Optics, Inc., Allergan, Inc., Bausch & Lomb Surgical, Inc., and Ista Pharmaceuticals, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Vitreous surgery for macular hole-related retinal detachment after phacoemulsification cataract extraction: 10-year retrospective review

To evaluate the visual and anatomical results of surgery for macular hole-related retinal detachment (MHRD) after phacoemulsification cataract extraction. Data for all patients who underwent surgery for MHRD after phacoemulsification cataract extraction from 1 December 1998 to 30 September 2008 in one hospital were evaluated. Patient characteristics, best-corrected visual acuity (VA) preoperatively and at last examination, surgical technique, anatomical success, and follow-up period were extracted and analysed statistically. A total of 13 625 eyes of 10 076 patients who had phacoemulsification cataract surgery were included. In the follow-up period, 10 cases of MHRD in nine patients were observed, of which seven eyes had high myopia. The mean axial length was 30.97 ± 1.36 mm (29.19, 32.97) and mean myopia was-19.35 ± 1.93 (-7.5,-3.5) dioptres. Overall anatomical success was achieved in 90% (9 out of 10 eyes). There was no statistically significant difference (P=0.240) between the logarithm of the MAR VA before the phacoemulsification cataract extraction and after MHRD surgical repair. VA increased in three eyes but decreased in the other seven after MHRD surgery. As a primary procedure, vitreous surgery combined with other necessary adjunct procedures such as membrane peeling and retinal tamponade seems to be successful in achieving anatomical success. However, VA improvement is dependent on the type of macular lesion and not the surgical procedure.

Facoemulsificação versus extração extracapsular no sistema público de saúde: análise de custos para o hospital, para o governo e para a sociedade

PURPOSE: To compare the costs of cataract surgery for a public hospital, the government and the society between the techniques of phacoemulsification (PHACO) and extracapsular cataract extraction (EECP). METHODS: A review based on several clinical studies between 2002 and 2010 at the Ambulatorial Surgical Center of the University of São Paulo. RESULTS: The estimated expenses associated with medical supplies used for surgery were R$ 468.92 and R$ 259.96 in the PHACO and EECP groups respectivelly. The hospital expenditures in the [...]

Surgical outcomes of retinal detachment after phacoemulsification cataract extraction and intraocular lens implantation

Objective To observe surgical outcomes and influencing factors of retinal detachment (RD) after phacoemulsification cataract extraction and intraocular lens (IOL) implantation.Methods The clinical data of 38 patients who underwent retinal detachment after phacoemulsification cataract extraction and intraocular lens implantation were retrospectively analyzed.All patients diagnosed via visual acuity,slitlamp microscopy,direct or indirect ophthalmoscopy,A or B-scan ultrasonography and optical coherence tomography (OCT).There were 21 males (21 eyes) and 17 female (18 eyes).The age was from 42 to 83 years,with the mean of (57.4±11.2) years.There were nine patients (10 eyes) with simple macular hole RD (MHRD).Vitrectomy or scleral buckling or combined vitreetomy and scleral surgery were implemented according to RD range,the hole location and size,proliferative vitreoretinopathy (PVR) grading; simple MHRD eyes were treated posterior scleral reinforcement surgery.The follow-up was ranged from 3 to 12 months,with a mean of (11.9±6.8) months.Results The retina was reattached successfully through one operation in 36 eyes (92.3％),two eyes failed because of a relapse after surgery,and one eye finally succeeded by the third times of surgery.There were two eyes (5.1％) with improved vision,one eye (2.6％) with stable vision,and 36 eyes (92.3％) with decreased vision.Conclusion The ratio of the reattachment by one operation for RD after phacoemulsification cataract extraction and intraocular lens implantation is high,but the final visual prognosis remains poorly. Key words: Phacoemulsification/adverse effects; Retinal detachment/surgery

Establishment of a Lens Epithelial Cell Line from a Canine Mature Cataract

The aim of this study was to establish a lens epithelial cell (LEC) line originated from a cataract of a dog. An anterior capsulorhexis specimen from a dog naturally developing mature cataracts was obtained prior to routine phacoemulsification cataract extraction. The primary lens epithelial cells were transfected with expression plasmid DNA encoding the large T antigen of replication origin-defective simian virus 40 (SV40), and then a colony was cloned using a glass cylinder. The primary cells stopped proliferation in three passages, while the transfected cells remained proliferative. Functional analysis of Na-dependent vitamin C transporter (SVCT) indicated that the Km value toward ascorbic acid (vitamin C) was 19.9 ± 2.8 µM, and RT-PCR analysis showed that SVCT2 was observed in this cell line while SVCT1 was not, which is one of the characteristics of LECs. Western blot analysis and cytoimmunochemistry indicated immortalized cells produced a protein with a molecular mass of 25 kDa, which reacted with an antibody to αB-crystallin within the whole cytosol. The cloned cell line, termed cdLEC, grew well and could be propagated over 250 times by basically splitting at 1:20. These results indicate that cdLEC may also provide a useful in vitro system for the study of the pathophysiology of cataract.

Clinical observation on phacoemulsification combined with goniosynechiolysis in 86 patients with angle-clo-sure glaucoma

To investigate the clinical effect of phacoemulsification combined with goniosynechiol- ysis in treatment of angle-closure glaucoma. Methods 163 cases of angle-closure glaucoma with cataract were divid- ed into observed group（ 86 cases） and control group（ 87 cases）. The observed group was treated with phacoemulsification cataract extraction, artificial crystalline implantation and goniosynechiolysis, while the control group was treated with compound trabeculectomy. The vision,intraocular pressure and chamber depth after surgeries in the two groups were compared. Results The vision in observed group was enhanced distinctly after surgery,which was significantly better than the control group（ P 〈 O. 05 ）. The intraocular pressure in 2 weeks of observed group after surgery was significantly better than the conrol group（ P 〈 0.01 ）. Moreover the anterior chamber depth and chamber angle of observed group was better than the control group after operation（P 〈 0.05）. Conclusion The treatment of phacoemulsification combined with guniosynechiolysis for angle-closure glaucoma had good clinical effect. Key words: Angle-closure glaucoma; Phacoemulsification; Goniosynechiolysis

Establishment of a lens epithelial cell line from cataract dog

AbstractPurpose The aim of this study is to establish a lens epithelial cells (LECs) line originated from cataract dog.Methods Anterior capsulorrhexis specimen from a dog (8‐year‐old male Wire Fox Terrier) naturally developing mature cataracts was obtained prior to routine phacoemulsification cataract extraction. The primary lens epithelial cells were transfected with the expression plasmid DNA encoding replication origin defective simian virus 40 (SV40) large T antigen and then cloned a colony by using glass syrinder.Results The primary cells proliferated to confluent until three passages. However, the immortalized cells remained proliferative, and this cloned cell line, termed as cdLEC, grew well and could be propagated over 200 times by splitting at 1:20. Functional analysis of Na‐dependent vitamin C transporter (SVCT) indicated that the Km value toward ascorbic acid (vitamin C) was 19.9 + 2.8 M, and RT‐PCR analysis showed that SVCT2 was observed in this cell line while SVCT1 was not, which was the characteristic of LECs. Western blot analysis and cyto‐immunochemistry indicated immortalized cells produced a protein with a molecular weight of 25 kDa, which reacted with an antibody to B‐crystallin within the whole cytosol.Conclusion These results indicate that cdLEC may provide a useful in vitro system for the study of path‐physiology of canine cataract.

Relative factor analysis of macula hole retinal detachment after phacoemulsification cataract extraction combined with intraocular lens implantation

Objective To observe the incidence and related factors of macula hole retinal detachment (MHRD)after phacoemulsification cataract extraction and intraocular lens(IOL) implantation. Methods The clinical data of 10 076 patients (13 625 eyes) who underwent phacoemulsification cataract extraction and intraocular lens implantation were retrospectively analyzed. There are 1228 patients (1853 eyes) with high myopia. All the patients were examined by routine slit-lamp microscopy, ophthalmoscopy as well as A-or B-scan ultrasonography. The phacoemulsification cataract extraction with transparent cornea incision or scleral tunnel incision, combined with intraocular lens implantation was performed in all the patients. The follow-up was ranged from 12 to 126 months, with a mean of (48.2±31.1) months. The MHRD was confirmed by the examinations of the fundus, B-scan ultrasonography and optical coherence tomography.The incidence of postoperative MHRD and the risk factors were analyzed. Results 10/13 625 eyes (0.073%) with MHRD were observed. 7/1853 high myopia eyes (0.378%) with MHRD were observed.The occurrence time of MHRD was ranged from 9 to 74 months after surgery, with a mean of 38.5 months.The cumulative risk was estimated at 0.16% (95% confidence interval, 0.05%-0.27%). Conclusions The incidence of MHRD after phacoemulsification cataract extraction combined with intraocular lens implantation is 0.073%. The MHRD incidence of high myopia eyes is 0.378%. High myopia may be the risk factor for MHRD. Key words: Retinal detachment/etiology; Phacoemulsification; Phakic intraocular lenses

Risk assessment of simple phacoemulsification in patients on combined anticoagulant and antiplatelet therapy

To assess the safety of phacoemulsification cataract extraction in patients on combined anticoagulant and antiplatelet treatment. Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel. Prospective interventional case series. Consecutive patients with simple cataract on combined anticoagulant (warfarin) and antiplatelet (aspirin or clopidogrel) treatment who were unable to discontinue the treatment because of a high risk for thromboembolic events were included. Patients had cataract extraction under topical anesthesia with a clear corneal incision (CCI), phacoemulsification, and implantation of a foldable posterior chamber intraocular lens. Prothrombin time-international normalized ratio and platelet functions were evaluated immediately before surgery. Patients were also examined 1 day and 7 days postoperatively. Intraoperative and postoperative ocular bleeding and other related complications were assessed. Forty patients (51 eyes) with a mean age of 72 years (range 51 to 90 years) had phacoemulsification. Hemorrhagic complications were not observed at surgery or during the 1-week follow-up. Surgical complications included 1 rupture of the capsulorhexis and 1 implantation of a capsular tension ring due to partial zonulysis. No patient had a thromboembolic event. In patients with uncomplicated cataract at high risk for thromboembolic events, phacoemulsification cataract surgery using a CCI under topical needle-free anesthesia was safely performed without discontinuing systemic anticoagulant and antiplatelet treatment.

Phacoemulsification versus extracapsular cataract extraction: where do we stand?

Cataract surgery at present is divisible into two general techniques: manual extracapsular cataract extraction and phacoemulsification--with ECCE further separated into the traditional form and small-incision cataract surgery. This review will discuss updates in surgical techniques, outcome comparisons, cost analysis, and the continued role of extracapsular cataract extraction in Western countries. Surgical techniques for manual extracapsular cataract extraction have undergone much refinement, with numerous descriptions of techniques in a recent literature. Studies that have emerged in the last several years allow us to compare surgical results between different techniques and suggest that there is little difference in final outcome when each surgery is done well. Overall cost-effectiveness and suitability of each technique vary based on location and facilities. Manual extracapsular cataract extraction (especially small-incision versions) occupies an important place in modern cataract surgery, and, while not a replacement for phacoemulsification in Western countries, should be part of a cataract surgeon's overall skill set.

Intraoperative Intravitreal Injection of Triamcinolone Acetonide for Cataract Extraction in Patients with Uveitis

Purpose: To evaluate the efficacy of intravitreal triamcinolone injection in controlling postoperative inflammation after cataract extraction in patients with uveitis.Methods: This retrospective study included 30 eyes with uveitis that had phacoemulsification or extracapsular cataract extraction with intraocular lens implantation. Intravitreal triamcinolone acetonide (4 mg) was injected at the end of surgery. No systemic steroids were given after surgery.Results: Visual acuity improvement of 2 lines or more occurred in 26 eyes (86.7%). Six eyes (20%) had a best-corrected visual acuity of 6/60 or better before surgery, which increased to 22 eyes (73.3%) after surgery. Five eyes (16.7%) had a visual acuity of 6/12 or better after surgery. Intravitreal triamcinolone injection controlled the postoperative inflammation in all eyes for at least 3 months following surgery.Conclusion: Intravitreal triamcinolone injection was effective in controlling postoperative inflammation after cataract extraction in patients with uveitis sparing the use of systemic steroids.