Postoperative Flare Research Articles

Chronic subclinical inflammation in phakic eyes with intraocular lenses to correct myopia

Purpose: To evaluate whether either of two anterior chamber intraccular lenses (IOLs) implanted in myopic, phakic eyes induced an inflammatory response that was measurable with a laser flare-cell meter but that could not be measured by other methods.Setting: Jiménez-Díaz Foundation and San Carlos University Hospital, Madrid, Spain.Methods: Thirty eyes with a Worst-Fechner IOL and 30 eyes with a Baikoff ZB5M IOL were evaluated using the flare mode of a laser flare-cell meter. Patients in each group were divided into three subgroups of 10 eyes each according to when the postoperative flare measurements were done: 12 months, 18 months, and 24 months. Thirteen phakic eyes with myopia greater than −6.00 diopters were used as controls.Results: Postoperative flare in the Worst-Fechner group was 27.05 ± 19 photons per millisecond (photons/ms) (mean ± SD) at 12 months, 18.09 ± 17.38 photons/ms at 18 months, and 31.03 ± 28.8 photons/ms at 24 months. Postoperative flare in the Baikoff group was 21.1 ± 5.9 photons/ms at 12 months, 16.13 ± 8.3 photons/ms at 18 months, and 21.05 ± 23.5 photons/ms at 24 months. Flare in the control group was 4.24 ± 2.8 photons/ms. Postoperative flare values were significantly higher in both IOL groups than in the control group at all follow-ups (Mann-Whitney test, P < .05). Postoperative flare values in the Worst-Fechner group were higher than in the Baikoff group at 12, 18, and 24 months, although the difference was not significant (Mann-Whitney test, P > .05).Conclusions: Our study shows chronic subdinical inflammation between 1 and 2 years after implantation of both IOL types.

Continuous curvilinear capsulorhexis and intraocular lens biocompatibility

Purpose: To study the influence of continuous curvilinear capsulorhexis (CCC) on poly(methyl methacrylate) (PMMA) intraocular lens (IOL) biocompatibility.Methods: Biocompatibility was assessed by measuring the postoperative bloodaqueous barrier breakdown and the cellular reaction at the anterior capsule-IOL interface. In a prospective study, 30 consecutive eyes, normal except for having extracapsular cataract extraction (ECCE) with CCC by a single surgeon, had laser flare and cell measurements and specular microscopy of the anterior IOL surface at 1 day, 1 week, and 1 and 3 months postoperatively.Results: In addition to the foreign-body reaction previously described in eyes that had other capsulotomy types, the eyes in this study also had a lens epithelial cell (LEC) reaction. The severity of the foreign-body reaction and postoperative aqueous flare and cells was significantly less in eyes with an intact CCC than in those with rim tears in the capsulorhexis and in those having an ECCE with a linear or can-opener capsulotomy, as previously reported.Conclusions: Continuous curvilinear capsulorhexis improves the biocompatibility of PMMA IOLs to a degree that could be of clinical benefit. In eyes with CCC, most cells seen on the anterior IOL surface were LECs.

The Incidence of Corneal Abnormalities in the Silicone Study

To determine factors that were prognostic of corneal abnormalities in eyes following surgery for severe proliferative vitreoretinopathy. Subgroup analysis of the Silicone Study. Community and university-based ophthalmology clinics. Eyes with attached maculae at the 24-month follow-up examination that did not have a pre-existing corneal abnormality. Vitrectomy surgery with long-acting gas or silicone oil. Epithelial and/or stromal edema, corneal opacity and/or previous corneal transplant. The incidence of corneal abnormalities at 24 months was 27% and did not differ significantly between treatment groups. Prognostic factors were preoperative aphakia or pseudophakia (P = .003), preoperative iris neovascularization (P = .006), reoperation (P = .001), the absence of a fluid/gas exchange (P = .03), corneal touch by silicone oil (P = .02), and the presence of aqueous cells (P = .009) or aqueous flare (P = .08). In a multivariate analysis, independent prognostic factors were iris neovascularization (relative risk [RR] = 13.1), aphakia or pseudophakia (RR = 3.0), postoperative aqueous flare (RR = 5.4), and reoperations (RR = 3.4). Corneal abnormalities were correlated with poor visual acuity and hypotony (P < .001). To our knowledge, this is the first study to document that the incidence rates of corneal abnormalities are equivalent between oil and gas. The incidence of corneal abnormalities in gas-filled eyes was higher than expected, and remained high in oil-filled eyes, despite the use of an inferior iridectomy. Successful surgical repair of the retinal detachment with a single operation, and prevention and early management of corneal touch by silicone oil should help to prevent corneal abnormalities. If rubeosis iridis or severe aqueous flare is present, preoperative treatment with intense topical and possibly periocular steroids might reduce inflammation, which might mediate corneal damage.

Effects of Cycloplegia and Iris Pigmentation on Postoperative Intraocular Inflammation

ABSTRACT Using the Kowa laser flare cell meter, we investigated the relation between anterior chamber inflammation following phacoemulsification and posterior chamber intraocular lens implantation, and (1) iris color and (2) the use of 1% cyclopentolate hydrochloride for 1 week postoperatively. One hundred sixty eyes, randomized into either a cycloplegic or noncycloplegic group, and classified into four different iris color groups-blue, brown, green, and hazel-were studied. Eyes with brown irides had significantly more intense flare 2 weeks postoperatively than eyes with blue irides. Overall, postoperative flare tended to be related to the degree of iris pigmentation. Use of 1% cyclopentolate hydrochloride for 1 week postoperatively failed to decrease anterior chamber inflammation in any of the eyes.

Healon GV in extracapsular cataract extraction with intraocular lens implantation

A randomized masked study was performed to compare Healon GV®, a new higher molecular weight sodium hyaluronate viscoelastic, with Healon® in extracapsular cataract surgery with posterior chamber intraocular lens insertion. Seventy patients were randomly divided into two groups. Postoperative intraocular pressures, pachymetry, endothelial cell counts and morphology, amount of viscoelastic and irrigating solution used, difficulty of surgery, and postoperative flare and cells were measured. Postoperative pressures were not significantly different between the Healon and Healon GV treatment groups, except at the eight-hour observation period, when the pressure was higher in the Healon GV group (P = .02). There was a significant (P = .002) reduction in the amount of viscoelastic required in the Healon GV group. Cell counts and morphology were not significantly different between the groups. Other parameters showed no significant difference. Clinically, Healon GV handled like Healon during instillation into the anterior chamber and aspiration at the end of the case. It did, however, appear to be much more effective at maintaining the anterior chamber, as demonstrated in the smaller amount of viscoelastic required.

Dupuytren's disease in women: Evaluation of long-term results after operation

A study of the long-term results after operation on 66 women (83 hands) with Dupuytren's disease showed that women are twice as likely as men to have a postoperative flare reaction. Why a flare reaction develops is uncertain. In this study, patients who had a carpal tunnel release at the time of operation for treatment of Dupuytren's disease or those who had an extensive fasciectomy, as opposed to removal of only the contracted tissue, were more apt to have a flare reaction. In addition, after operation, moderate or severe loss of finger flexion occurred in 35% of hands without a flare reaction and in 76% of those who had a flare reaction. This suggests that women having an operation for treatment of Dupuytren's disease are apt to have a worse result than men.