Posterior Continuous Curvilinear Capsulorhexis Research Articles

The treatment for ciliary block glaucoma

Objective To investigate the efficacy of medical and surgical treatment for ciliary block glaucoma. Methods Eight eyes of 7 patients of ciliary block glaucima in our hospital from January 2010 to September 2013 were enrolled in the retrospective study. The effects of medical and surgical treatment, preoperative and postoperative visual acuity(VA)、intraocular pressure(IOP) and depth of anterior chamber were evaluated and analyzed. Results Six eyes of 5 cases received surgical treatment. Among 5 cases, 3 eyes of 2 patients were treated by phacoemulsification combined with intraocular lens implantation、posterior continuous curvilinear capsulorhexis (PCCC) and anterior vitrectomy (AV). One pseudophakic eye underwent PCCC and AV. One eye received intracapsular cataract extraction(ICCE) and AV without implantation of instraocular lens . The capsular tension ring was used in one case which complicated with lens subluxation. There was no recurrence of ciliary block glaucoma in patients after surgical treatment. The IOP was controlled well.Two eyes of two patients were treated with comprehensive medication, which included local cycloplegic, carbonic anhydrase inhibitor and glucocorticoid eyedrops.Of these two cases, one eye was cured with medication lasted for half an year and followed up 3.5 years; the other recurred 9 times in one year which recurred every time when stopping medication for one week. Conclusion Local cycloplegic and glucocorticoid, as the main medication of comprehensive treatment, in treatment of early ciliary block glaucoma partially, but easy to recur. Compared with medication treatment, phacoemulsification combined with intraocular lens implantation, PCCC and AV for the treatment of ciliary block glaucoma is a safe and effective method. Early and timely treatment is beneficial to the preservation of visual function. Key words: Glaucoma, ciliary block; Treatment; Anterior vitrectomy; Phacoemulsification; Posterior capsulorhexis

SURGICAL REMOVAL OF DENSE POSTERIOR CAPSULE OPACIFICATION AND VITREOUS FLOATERS IN ADULTS BY POSTERIOR CONTINUOUS CURVILINEAR CAPSULORHEXIS THROUGH THE PARS PLANA AND 23-GAUGE VITRECTOMY.

To evaluate the safety and efficacy of posterior continuous curvilinear capsulorhexis through the pars plana and 23-gauge vitrectomy in surgical management of dense posterior capsule opacification and vitreous floaters. Fifteen pseudophakic eyes of 15 patients with dense posterior capsule opacification and vitreous floaters between September 2012 and June 2014 were included; after vitrectomy, posterior continuous curvilinear capsulorhexis through the pars plana was performed. Data were collected, including baseline preoperative characteristics, postoperative outcomes, complications, and a modified quality-of-life survey that patients completed. No intraoperative or postoperative complications were encountered in any of the 15 cases. Mean Snellen best-corrected visual acuity was 20/250 preoperatively and improved to 20/32 postoperatively (P < 0.001). All patients showed normal intraocular pressure 7 days after the procedure. The mean overall corneal endothelial cell loss at postoperative Month 3 was 1.2%. Approximately 80% of the patients had no complaint of vitreous floaters after the procedure. Except for 1 patient (7%) diagnosed with age-related macular degeneration, the rest of the patients (93%) were satisfied with the procedure and would recommend it to friends with dense posterior capsule opacification and vitreous floaters. Posterior continuous curvilinear capsulorhexis through the pars plana combined with 23-gauge vitrectomy may be used to remove dense posterior capsule opacification and vitreous floaters in pseudophakic eyes.

Primary posterior capsulotomy in adults with posterior capsule opacification

To evaluate the efficacy and safety of primary posterior continuous curvilinear capsulorhexis (PCCC) in adult patients with cataract. Zagazig University Hospital, Ash-Sharkya, Egypt. Prospective nonrandomized case series. This study comprised patients with senile cataract who had phacoemulsification. All patients had a dense posterior capsule opacification (PCO) discovered intraoperatively. Primary PCCC was performed to remove the residual opacification after posterior capsule polishing. All patients were followed for 3months postoperatively. The outcome measures were corrected distance visual acuity (CDVA), macular edema detected by optical coherence tomography, and the occurrence of intraoperative or postoperative complications. Twenty-five eyes of 25 cataract patients had phacoemulsification. The mean age was 61.9years±7.5 (SD). The mean CDVA preoperatively was 0.14±0.08 and postoperatively it was 0.86±0.15 at 1week, 0.93±0.08 at 1month, and 0.94±0.08 at 3months (P=.001). The mean central macular thickness was 313.16±8.39μm preoperatively and 315.04±10.6μm, 319.88±26.06μm, and 316.4±13.7μm at 1week, 1month, and 3months postoperatively, respectively (P=.35). Posterior capsule opening contracture occurred in 1 eye (4%), although it did not affect the patient's vision. Intraoperative posterior capsule extension occurred in 1 eye (4%). No serious complications, such as retinal detachment or endophthalmitis, were detected in any patient. Cataract surgery with primary PCCC was a safe procedure to treat residual PCO in adults and had a low rate of complications. Neither author has a financial or proprietary interest in any material or method mentioned.

Timing and approaches in congenital cataract surgery: a randomised controlled trial

BackgroundThe optimum timing of surgery and the approach that should be used during congenital cataract surgery are controversial and present challenges for paediatric cataract surgeons in China. The aim of this study was to compare visual prognoses and postoperative adverse effects of paediatric cataract surgery done at different times and using different surgical approaches. MethodsIn this prospective, randomised controlled trial, we recruited Chinese patients aged 3 months or younger who were diagnosed with bilateral diffuse or total cataracts, but who did not have coexisting ocular, systemic or neurological diseases. Patients were randomly assigned into two surgical timing groups: a 3-month-old and a 6-month-old. Each eye had one of three randomly assigned surgical procedures: lens aspiration, lens aspiration with posterior continuous curvilinear capsulorhexis, and lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy. Long-term visual acuity and incidence of postoperative secondary glaucoma and severe posterior capsular opacification were the primary outcomes. χ2 tests, Fisher's exact tests and Kruskal-Wallis tests were used to compare the outcomes between groups. Generalised Estimating Equation with a working covariance matrix of unstructured correlations was integrated into the multivariate linear regression to explore the relationship between long-term visual acuity and the incidence of complications. The research protocol was approved by the Institutional Review Board and Ethics Committee of Sun Yat-sen University. Informed written consent was obtained from at least one family member of each participating patient, and the study was done according to the Declaration of Helsinki. This trial is registered with ClinicalTrials.gov, number NCT02581046. FindingsWe recruited 61 patients (30 girls, 31 boys) to our study. 4 children were excluded from the final analysis because their parents declined participation. A total of 57 participants (114 eyes) with a mean follow-up of 48·7 months were included in the final analysis. Long-term visual acuity in patients who underwent surgery aged 6 months (0·81 [SD 0·28]) was better than that of patients who had surgery aged 3 months (0·96 [0·30], p=0·02) and incidence of posterior capsular opacification during the 6 months following surgery was positively correlated with long-term visual acuity (β=-0·080, p=0·036). Two (2/95, 2%) eyes with a confirmed diagnosis of secondary glaucoma were in the 3-month-old group, and additional surgical interventions were done in these patients to lower the intraocular pressure. For patients who had surgery aged 6 months, the incidence of severe posterior capsular opacification was significantly higher in the lens aspiration group than other two groups (lens aspiration, 8/15 [53%]; lens aspiration with posterior continuous curvilinear capsulorhexis, 3/21 [14%]; and lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, 3/16 [19%]; p=0·03). InterpretationIt was safer and more effective for Chinese bilateral diffuse congenital cataract patients to have surgery of lens aspiration with posterior continuous curvilinear capsulorhexis with or without anterior vitrectomy at 6 months of age than at 3 months of age. FundingNational Basic Research Program (973; 2015CB964600); Natural Science Foundation of Guangzhou (91546101, 81300750); Clinical Research and Translational Medical Center for Pediatric Cataract in Guangzhou, China.

Primary posterior continuous curvilinear capsulorhexis combined with diffractive multifocal intraocular lens implantation.

PurposeTo evaluate the effect of mild posterior capsule opacity (PCO) on visual acuity (VA) in eyes implanted with a diffractive multifocal intraocular lens (IOL) compared with a monofocal IOL, and the effect of posterior continuous curvilinear capsulorhexis (PCCC) combined with diffractive multifocal IOL implantation.MethodsFor the initial evaluation, we compared charge-coupled device (CCD) camera photographs taken through both a monofocal IOL-loaded model eye and a diffractive IOL-loaded model eye under the conditions of both with and without an opaque filter for the simulation of mild PCO. The clinical evaluation involved 20 patients who underwent bilateral implantation of the same diffractive multifocal IOL. In all 20 cases, PCCC was performed in 1 eye (PCCC group) and not performed in the fellow eye (NCCC group). Postoperative clinical results were then compared between the two groups.ResultsThe CCD photographs revealed that the diffractive IOL-loaded eye was more strongly affected by the simulated PCO than was the monofocal IOL-loaded eye. In the clinical setting, the PCCC group registered better results than NCCC group in distance and near VA, low-contrast VA, and contrast sensitivity testing.ConclusionsDiffractive multifocal IOLs tend to be more influenced by mild PCO than do monofocal IOLs, and PCCC prior to IOL implantation can contribute to the avoidance of this effect.

Clinical application of posterior continuous curvilinear capsulorhexis in traumatic cataract surgery

Objective To observe the clinical effect of posterior continuous curvilinear capsulorhexis in traumatic cataract with posterior capsular rupture. Methods Twenty-five 25 eyes of 25 patients were selected as clinical trial group and other 18 eyes of patients as control group. In trial group, traumatic cataract extraction, primary IOL implantation and posterior continuous curvilinear capsulorhexis were performed, while in control group, routine traumatic cataract extracion and IOL implantation were fulfilled. The visual acuity and surgical complications were compared between two groups. The follow-up period was 3 months. Results The differences of surgical complications and IOL position between two groups were statistically significant (P<0.05). Three months after operation, the differences of visual acuity, posterior capsular opacity, cystoid macular edema betweenin two groups were statistically significant (P<0.05). The visual acuity of trial group was better than that of control group, and the incidence rate of surgical complications in control group was higher than that in trial group. Conclusion Posterior continuous curvilinear capsulorhexis can improve the therapeutic effect and prevent surgical complications for traumatic cataract with posterior capsular rupture. Key words: Cataract, traumatic; Capsulorhexis, curvilinear, continuous, posterior

A safe technique for in-the-bag intraocular lens implantation in pediatric cataract surgery.

To describe a safe technique for in-the-bag intraocular lens (IOL) implantation in pediatric cataract patients who undergo lens aspiration with primary posterior capsulorhexis and anterior vitrectomy. Sixty eyes of 45 consecutive patients with congenital/developmental cataract underwent lens aspiration with primary posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy and in-the-bag IOL implantation using the described technique of IOL implantation using anterior capsule as support. All eyes had stable IOL at the end of surgery and none of the eyes had lens decentration/dislocation in posterior vitreous. Implantation of in-the-bag IOL is difficult in children who undergo primary PCCC with anterior vitrectomy. Our technique of implanting IOL by pushing it against the back surface of anterior capsule is a safe method and results in no complications related to faulty IOL implantation.

Factors influencing stereoacuity levels after surgery to correct unilateral developmental cataracts in children.

To evaluate factors influencing stereoacuity after surgery to correct unilateral developmental pediatric cataracts. We retrospectively surveyed 110 patients who had undergone removal of unilateral acquired developmental cataracts and primary posterior chamber intraocular lens implantation between February 1992 and December 2009. In all patients, stereoacuity was assessed using the Titmus test at the last follow-up period of minimum 2 years after surgery. Patients were divided into two groups according to the extent of stereoacuity: group 1 (n=42) had stereoacuity values≤100sec/arc and group 2 (n=68) values >100sec/arc. The values of ten parameters associated with stereoacuity were measured in each group: Cataract types, preoperative best corrected visual acuity (BCVA) of the affected eyes, preoperative inter-ocular difference of BCVA, age at cataract surgery, operative method, secondary cataract, postoperative strabismus, postoperative BCVA of the affected eyes, postoperative inter-ocular difference of BCVA, and anisometropia. The extent of stereoacuity was significantly associated with both operative method and secondary cataract (P=0.000 and P=0.016, respectively). All patients in whom the posterior capsule was preserved, had poor stereoacuity >100sec/arc. Significant correlations with the extent of stereoacuity were found with postoperative strabismus (P=0.048), postoperative BCVA of the affected eyes (P=0.002), anisometropia (P=0.034). : Postoperative stereoacuity was better in patients who underwent either optic capture or anterior vitrectomy after posterior continuous curvilinear capsulorhexis, and who didn't develop secondary cataracts or strabismus postoperatively. Furthermore, postoperative BCVA of the affected eyes, and anisometropia influenced the stereoacuity of the patients surgically treated for unilateral developmental pediatric cataracts.

Vitrectorhexis versus forceps posterior capsulorhexis in pediatric cataract surgery

This study was done to compare the results of posterior continuous curvilinear capsulorhexis created using forceps with those created using vitrector in eyes suffering from congenital cataract. Vitrectorhexis term was first used by Wilson et al in 1999.[1] Fifty eyes with congenital and developmental cataract were included in this study. The posterior capsulorhexis was created using utrata forceps in 17 eyes or through a vitrector in 33 eyes. Forceps capsulorhexis was performed before IOL implantation, while vitrectorhexis was performed after IOL implantation in the bag. The results of both the surgery were compared using the following criteria: incidence of extension of rhexis, ability to achieve posterior rhexis of appropriate size, ability to implant the IOL in the bag, the surgical time, and learning curve. Vitrectorhexis after IOL implantation was an easy to learn alternative to manual posterior continuous curvilinear capsulorhexis in pediatric cataract surgery. It was more predictable and reproducible, with a short learning curve and lesser surgical time.

Risk Potentiality of Frontline Radiotherapy Associated Cataract in Primary Ocular Adnexal Mucosa-associated Lymphoid Tissue Lymphoma

PurposeTo elucidate risk potentiality of frontline radiotherapy associated cataracts in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML).MethodsData from eight consecutive patients of 41 total OAML patients who had undergone cataract surgery after frontline radiotherapy were analyzed.ResultsThe median patient age was 46 years (range, 36 to 69 years). The median total radiation dose was 3,780 cGy (range, 3,060 to 4,500 cGy), and the mean duration from radiation irradiation to cataract surgery was 36.60 ± 8.93 months. Preoperative lens opacification was primarily at the posterior lens subcapsule, and best-corrected visual acuity (BCVA) was 0.43 ± 0.21. Patients underwent the phacoemulsification surgical procedure with posterior chamber intraocular lens insertion. The average BCVA improved to 0.90 ± 0.14 after cataract surgery. Two patients underwent posterior continuous curvilinear capsulorhexis, and one had posterior capsule rupture. For posterior capsule opacification (PCO), three patients received Nd:YAG laser posterior capsulotomy after the initial surgery, and one patient is currently under consideration for laser posterior capsulotomy.ConclusionsRadiotherapy increased posterior subcapsule opacification at a relatively young age in primary OAML. Phacoemulsification was a manageable procedure without severe complications, and final visual outcomes were good. However, because after-cataracts progressed earlier than did senile cataracts, close follow-up should be considered for PCO management.

Assessment of intra-operative techniques to prevent visual axis opacification in congenital cataract surgery

ObjectiveTo evaluate the effectiveness of various surgical procedures in the management of posterior capsule and anterior vitreous for the prevention of visual axis opacification. Subjects, material and methodsWe retrospectively reviewed 120 eyes operated for unilateral congenital cataracts, with a median age at the time of cataract surgery of 21 months (interquartile range, 6–52 months). The eyes were divided into 3 groups: group 1 (eyes with intact posterior capsule, n=39), group 2 (eyes with posterior continuous curvilinear capsulorhexis, n=38), group 3 (eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, n=43). ResultsTo determine the effect of posterior continuous curvilinear capsulorhexis on visual axis opacification we compared group 2 with group 1 (chi-square Pearson test, P=.281), therefore in this study the implementation of the posterior continuous curvilinear capsulorhexis did not show any decrease in the incidence of visual axis opacification. To study the effect of posterior continuous curvilinear capsulorhexis associated anterior vitrectomy, we compared group 3 with group 1 (chi-square Pearson test, P=.014), demonstrating that the combination of both techniques (posterior continuous curvilinear capsulorhexis and anterior vitrectomy) decreases the incidence of visual axis opacification. ConclusionPosterior continuous curvilinear capsulorhexis as a single technique did not show any decrease in the incidence of visual axis opacification. Posterior continuous curvilinear capsulorhexis together with anterior vitrectomy is required to prevent visual axis opacification and to decrease reoperation rate.

Valoración de técnicas intraoperatorias para la prevención de la opacificación del eje visual en la cirugía de cataratas congénitas

ObjectiveTo evaluate the effectiveness of various surgical procedures in the management of posterior capsule and anterior vitreous on the prevention of visual axis opacification. Subjects, material and methodsWe retrospectively reviewed 120 eyes operated for unilateral congenital cataracts, with a median age at the time of cataract surgery of 21 months (interquartile range, 6-52 months). The eyes were divided into 3 groups: group 1 (eyes with intact posterior capsule, n=39), group 2 (eyes with posterior continuous curvilinear capsulorhexis, n=38), group 3 (eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, n=43). ResultsTo determine the effect of posterior continuous curvilinear capsulorhexis on visual axis opacification we compared group 2 with group 1 (chi-square Pearson test, P=.281), therefore in this study the implementation of the posterior continuous curvilinear capsulorhexis did not show any decreases in the incidence of visual axis opacification. To study the effect of posterior continuous curvilinear capsulorhexis associated anterior vitrectomy, we compared group 3 with group 1 (chi-square Pearson test, P=.014), demonstrating that the combination of both techniques (posterior continuous curvilinear capsulorhexis and anterior vitrectomy) decreases the incidence of visual axis opacification. ConclusionPosterior continuous curvilinear capsulorhexis as a single technique did not show any decrease in the incidence of visual axis opacification. Posterior continuous curvilinear capsulorhexis together with anterior vitrectomy are required to prevent visual axis opacification and to decrease reoperation rate.

Outcomes of pediatric cataract surgery in anterior persistent fetal vasculature

To report the intraoperative performance and postoperative outcomes in eyes with anterior persistent fetal vasculature (PFV). Iladevi Cataract & IOL Research Centre, India, and Filatov Institute Odessa, Ukraine. Prospective interventional case series. Eyes with anterior PFV had surgery using a standardized surgical technique. Plaque peeling was used for small plaques and partial excision for larger plaques. In eyes in which the entire lens converted into a fibrovascular tissue, extensive capsulectomy with anterior 2-port limbal vitrectomy was performed. Microphthalmic eyes had no intraocular lens implantation. This study comprised 33 eyes. The mean age at surgery was 6.30 months ± 5.16 (SD). Microcornea was observed in 10 eyes (30.3%). Within the morphology of cataract, 10 eyes (30.3%) had the lens converted into fibrovascular mass, of which 4 had associated prominent ciliary process. Anterior continuous curvilinear capsulorhexis (CCC) and manual posterior CCC were performed in 23 eyes (69.7%) and 3 eyes (9.1%), respectively. Intraoperatively, posterior capsule plaque was seen in 20 eyes (60.6%). In 31 eyes (93.9%), 2-port limbal anterior vitrectomy was performed and in 2eyes (6.1%), pars plana vitrectomy was performed. Intraocular lens implantation was performed in 16 eyes (48.5%); 17 eyes (51.5%) were left aphakic. Visual axis obscuration was observed in 6 eyes (18.2%). At the 3-year follow-up, visual acuity remained stable in 11 eyes (33.3%) and improved in 22 eyes (66.6%). The results suggest that good visual outcomes can be obtained in PFV eyes after surgical intervention, with an acceptable rate of serious postoperative complications. No author has a financial or proprietary interest in any material or method mentioned.

Clinical outcomes of cataract surgery after bag-in-the-lens intraocular lens implantation following ISO standard 11979-7:2006

To assess the clinical outcomes of bag-in-the-lens intraocular lens (BIL IOL) implantation following the International Organization for Standardization (ISO) 11979-7:2006 in pediatric eyes and eyes with ocular comorbidities. Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium. Cohort study. This cohort included the first series of patients having IOL implantation using the bag-in-the-lens technique. Surgeries were performed between December 1999 and September 2006. In addition to IOL implantation, the technique comprised creation of a primary posterior continuous curvilinear capsulorhexis (PCCC) equal in size to the anterior capsulorhexis. The study enrolled 807 eyes of 547 patients; 326 of the eyes (40.40%) had ocular comorbidity. In the 481 eyes without ocular comorbidity, the mean decimal corrected distance visual acuity was 0.52 ± 0.24 (SD) (0.276 ± 0.206 logMAR) preoperatively and 0.94 ± 0.18 (-0.012 ± 0.053 logMAR) postoperatively. The mean postoperative achieved spherical equivalent was 0.48 ± 0.83 diopter (D) and the mean targeted refraction, -0.24 ± 0.71 D. The A-constant was modified from 118.4 to 118.04. Posterior capsule opacification (PCO) did not occur in any adult eye during the follow-up. Retinal detachment after IOL implantation occurred in 10 eyes (1.24%). In 19 eyes, the iris was captured by the IOL haptics postoperatively. Hypopyon occurred in 3 patients and toxic anterior segment syndrome in 1 patient. The BIL IOL met the ISO criteria; that is, primary PCCC was safe in healthy eyes and in eyes with ocular comorbidities and no eye developed PCO over a mean follow-up of 26.1 ± 21.3 months.

Changes of corneal central thickness of aphakia following congenital cataract surgery under the first six months of life.

To observe the central corneal thickness (CCT) changes in infants and young children who had been undergone bilateral congenital cataract surgery, and to compare the changes with normal control group which was selected from healthy population. A cross section case-control study contained 28 cases (56 eyes) of bilateral aphakia (aphakic group) due to congenital cataract surgery combining with posterior continuous curvilinear capsulorhexis and with anterior vitrectomy during 2-6 months after birth. Fourteen children (28 eyes) of age-sex matched with the aphalic group were selected as normal control group. CCT and intraocular pressure (IOP) were measured postoperatively and the results were compared between groups. The mean CCT was 653.5±82.4μm in the aphakic group and 579.6±39.2μm in the control group, with a significant difference (P=0.000). The mean value of IOP in aphakic group (22.0±1.6mmHg) was greater than that of control group (16.9±2.1mmHg), P=0.023. There was a negative correlation between age and CCT in normal control group (r=-0.531, P=0.026), and there was no correlation in bilateral aphakia group (r=-0.324, P=0.165) Aphakic children due to congenital cataract surgery have a greater CCT than normal children. It is necessary to consider CCT in evaluating IOP for children after congenital cataract surgery.

Safety of the anterior vitreous detachment induced by microplasmin, pharmacologic vitreolysis to separate the posterior capsule from the anterior hyaloid

Abstract Purpose The aim of this project is to establish the safety of the use of microplasmin in the vitreolenticular interface to promote the separation of the anterior hyaloid from the posterior capsule. Methods The safety of the use of microplasmin solution will be examined in 24 eyes of 12 rabbits after having performed a cataract surgery and a primary posterior continuous curvilinear capsulorhexis and having exposed the anterior hyaloid interface with a solution of different doses of microplasmin (125µg or 250µg in 0.1ml balanced salt solution)and having left this solution in place during different time intervals starting from 5 minutes to one hour. The rabbit eyes will be examined at well‐defined time intervals: day 1 and 7, month 1,2,3,6 and 12. Slitlamp examination and OCT‐SLO imaging will be performed to monitor ocular inflammation, visual axis reproliferation and anterior vitreous anatomy. Conclusion Congenital cataracts, whether or not combined with persistent fetal vasculature may present different degrees of congenital dysgenesis of the vitreolenticular interface. Pharmacological separation of the interface between posterior lens capsule and anterior hyaloid would be benificial to improve the surgical outcome. Therefore the feasibility, safety and clinical application of intravitreal injection of microplasmin for this indication need to be examined first.

Triamcinolone-assisted vitrectomy in pediatric cataract surgery: Intraoperative effectiveness and postoperative outcome

To evaluate intraoperative effectiveness and postoperative outcome of intracameral, preservative-free triamcinolone acetonide in pediatric cataract surgery. A prospective, interventional, observational case series was performed in children undergoing congenital cataract surgery. Three standardized applications of triamcinolone acetonide were used. Postoperatively, IOP, pachymetry, glaucoma, posterior synechiae, cell deposits, and posterior capsule opacification were studied at 1 week, 1 month, and 12 months after surgery. Mean age at the time of surgery was 14.8 +/- 12.2 months. Of 43 eyes, 5 were kept aphakic and 38 received IOL implantation. After manual posterior continuous curvilinear capsulorhexis and the first injection of triamcinolone, the anterior vitreous face disturbance was visualized as free-floating vitreous strands going into the incision in 18.6% of eyes (8 of 43). Triamcinolone was injected a second time after anterior vitrectomy: residual vitreous strands were identified and removed in 7 of these 8 eyes. Triamcinolone was used for a third time after IOL implantation: residual vitreous strands were identified in 5.3% of eyes (2 of 38). Mean IOP was 12.2 +/- 2.2 mm Hg preoperatively and was 13.6 +/- 3.2 at the 1 week follow-up visit, 12.8 +/- 2.8 at 1 month, and 12.4 +/- 2.0 mm Hg at 12 months. Preservative-free triamcinolone acetonide improved visualization of the vitreous during pediatric cataract surgery, thereby ensuring thorough and complete anterior vitrectomy. IOP was not affected, and no adverse postoperative results were observed.

Macular Thickness Changes after Phacoemulsification Combined with Primary Posterior Curvilinear Capsulorhexis

To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC). Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoglu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months. Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference between the mean preoperative and postoperative sixth month central macular thickness was not statistically significant (p=0.20). The greatest change in mean macular thickness was noted in the first month visit. No patient developed cystoid macular edema. Because primary PCCC does not have an adverse effect on macular integrity, this procedure may be preferred especially in patients with a high risk of posterior capsular opacification.

The effects of posterior continuous curvilinear capsulorhexis on contrast sensitivity

We aimed at evaluating the effects of posterior continuous curvilinear capsulorhexis (PCCC) on contrast sensitivity. In this prospective, randomized, bilateral clinical study, 40 eyes of 20 patients who underwent bilateral cataract surgery were included. The phacoemulsification machine, viscoelastic substances, surgical tools, and intraocular lenses (IOLs) were the same for both eyes. The only difference was that we conducted the PCCC procedure before IOL implantation to one of the eyes of the patients. The selection of the eye that underwent the PCCC procedure was decided randomly. The mean photopic contrast sensitivity values at spatial frequencies of 1.5, 3, 6, 12, and 18 cpd (cycles per degree) were 41.55, 59.90, 61.25, 32.35, and 9.75, respectively, and for the control group these values were 39.05, 56.60, 57.95, 29.80, and 8.75, respectively. The mean mesopic contrast sensitivity values at special frequencies of 1.5, 3, 6, 12, and 18 cpd were 41.20, 54.75, 55.55, 31.70, and 9.00, respectively, and for the control group these values were 38.35, 51.70, 52.15, 30.05, and 8.00, respectively. The mean contrast sensitivity values of the eyes that underwent the PCCC procedure were slightly better than the fellow eyes at all spatial frequencies, but the difference was statistically insignificant (P>0.05). In early post-operative period, the PCCC procedure exerts some positive effects on contrast sensitivity although these effects are statistically insignificant.

Comparison of 2 techniques of intraocular lens implantation in pediatric cataract surgery

To compare the results of 2 intraocular lens (IOL) implantation techniques in pediatric cataract surgery. Labbafinejad Medical Center, Tehran, Iran. This contralateral prospective randomized study comprised children with bilateral congenital or developmental cataract. In all cases, anterior capsulorhexis, lens aspiration, posterior continuous curvilinear capsulorhexis (PCCC), and anterior vitrectomy were performed. In 1 eye of each patient, a 3-piece AcrySof MA60BM IOL was implanted in the capsular bag. In the other eye, the same type of IOL was implanted in the ciliary sulcus and the optic was captured through the PCCC. Visual acuity, visual axis opacification, and complications were assessed. Twenty-eight eyes of 14 children were included in the study. The mean patient age at surgery was 5.1 years +/- 1.5 (SD) (range 2.5 to 8.0 years). The mean follow-up was 22.2 +/- 6.3 months (range 13 to 35 months). The visual axis remained clear in all eyes in both groups. There was no statistically significant difference between the 2 groups in best corrected visual acuity or complications (eg, postoperative uveitis, posterior synechia, significant IOL decentration). In pediatric cataract surgery, placement of haptics in the ciliary sulcus and IOL optic capture through the PCCC was a safe alternative to IOL implantation in the capsular bag.