Simultaneous Cataract Surgery Research Articles

Scleral Buckling and Primary Vitrectomy in Simple Rhegmatogenous Retinal Detachment

Purpose: To compare the outcomes of scleral buckling (SB) and primary pars plana vitrectomy (PPV) for treatment of simple rhegmatogenous retinal detachment (RD). Methods: One hundred and fifteen Eyes undergoing SB or PPV for the treatment of simple rhegmatogenous RD were prospectively identified and followed up at least six months. Anatomic results, functional outcomes and complications were compared between eyes treated with SB and eyes treated with PPV. Results: We detected no significant differences in overall success rates or final vision quality between the two treatment groups. However, the final vision quality of pseudophakic patients treated with PPV was significantly better than the final vision quality of pseudophakic patients treated with SB. Two treatment goups experienced similar rates of intraocular pressure elevation and proliferative vitreoretinopathy development. In phakic patients, the rates of cataract progression were higher in patients treated with PPV than in patients treated with SB. Conclusions: PPV can be an effective method for the treatment of simple rhegmatogenous RD, and maybe considered as a viable alternative to SB for simple cases. However, in phakic patients treated with PPV, simultaneous or follow-up cataract surgery should be considered as adjuvant treatments.

Surgical outcomes of transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection

AimsTo evaluate the outcomes and complications of 23-gauge transconjunctival sutureless vitrectomy (TSV) with Silicone oil (SO) tamponade in complex vitreoretinal diseases.Settings and DesignEge university hospital ophthalmology department. Retrospective case series.Materials and MethodsForty eyes of 40 patients with diabetic tractional retinal detachment (DTRD) and proliferative vitreoretinopathy (PVR) were included in the study. Vitrectomy using 23-gauge system with SO endotamponade was performed. Peroperative and postoperative complications, anatomical and visual results were evaluated.Statistical analysis usedPaired Student's t-test.ResultsSimultaneous cataract surgery was performed in 17 eyes. Peroperative complications were posterior capsule rupture during phacoemulsification in one patient, vitreous and retinal incarceration in one patient. One eye required suture placement at the end of surgery due to SO leakage. Postoperatively, a small subconjunctival SO bubble in three patients, and hypotony in one patient (6 mmHg) were observed. Recurrent retinal detachment under SO occurred in one patient. Mean follow-up was 6.5 months (±2.7). Pre- and postoperative mean visual acuity was 2.22±0.91 logMAR and 1.11±0.8 logMAR, respectively (P<0.001). Mean intraocular pressure (IOP) on the first postoperative day was lower than preoperative IOP (11.3 ±3.2 versus 14.0 ±2.4 mmHg) (P<0.001).ConclusionsTwenty-three gauge instrumentation seems to be feasible, effective and safe for vitrectomy with SO injection in DTRD and PVR, and can be considered in the surgical management of these complex vitreoretinal diseases.

Trans‐vitreal endoresection for vasoproliferative retinal tumours

We present an interventional consecutive case series to describe our experience of transvitreal endoresection (TVE) for vasoproliferative retinal tumours (VPRTs). Three patients with VPRTs refractory to conventional treatment modalities of cryotherapy, plaque radiotherapy and anti-VEGF presented with macular exudative changes and were offered TVE. Complete ophthalmic examination with colour fundal photographs was performed before and during the follow-up period. All patients were followed up for 6 months following silicone oil removal. At the last follow up, resolution of macular and retinal exudative changes with parallel improvement in vision was observed. No recurrences were detected during the follow-up period. Two of three patients had simultaneous cataract surgery and developed fibrinous uveitis, requiring management with intensive topical steroids. After 3 months, these patients had a fibrotic pupillary membrane enveloping the intraocular lens (IOL) with posterior synechiae. These two patients underwent SO removal, IOL explantation and artisan IOL (iris clipped) insertion, resulting in visual improvement. We did not observe any PVR complications in our cases. TVE represents an effective and safe option for the treatment of VPRTs refractory to other treatment modalities. Further studies with a larger sample size and long-term follow up are indicated to evaluate the role of TVE in the management of VPRTs.

Descemet Stripping with Automated Endothelial Keratoplasty for Bullous Keratopathies Secondary to Argon Laser Iridotomy-Preliminary Results and Usefulness of Double-Glide Donor Insertion Technique

Manipulation of the endothelial donor lamella in the anterior chamber during Descemet stripping with automated endothelial keratoplasty (DSAEK) is often difficult, especially in cases with bullous keratopathies (BK) secondary to argon laser iridotomy (ALI). We developed a novel nonfolding donor insertion technique using a Busin glide and an intraocular lens (IOL) sheet glide and evaluated post-DSAEK outcomes for ALI-induced BK using several insertion techniques. Fourteen patients (mean age, 74.2 +/- 4.9 years) with ALI-induced BK underwent DSAEK; simultaneous cataract surgery was performed in 12 patients. Donor insertions were done by taco-folding (n = 4), spatula-assisted (n = 3), Busin glide-assisted (n = 2), and Busin glide/IOL glide-assisted methods (n = 5). Endothelial cell counts, postoperative visual acuity, induced astigmatism, and complications were examined over a mean follow-up period of 228.3 +/- 132.2 days (range 58-458 days). In 1 case, DSAEK was converted to penetrating keratoplasty because of difficulties in donor insertion by the taco-folding method, resulting in vitreous prolapse. Overall, mean postoperative endothelial cell count was 1654.2 +/- 532.3 cells/mm2 (range 853-2610 cells/mm2), a 44.9% reduction compared with donor counts (mean 3003.3 +/- 425.5 cells/mm2). All patients reached acuity >20/40, with 3 (23.1%) reaching 20/20. Mean induced astigmatism in measurable cases was 0.53D +/- 0.38D. Although nonsignificant due to the small sample size, use of Busin glide with (37.9%) or without IOL glide (37.0%) tended to cause less endothelial damage than taco-folding (49.0%) or pull-through with spatula (44.2%) at 3 months postoperatively. DSAEK is effective in eyes with ALI-induced BK. Our results suggest that insertion with a Busin glide is reliable and associated with less endothelial cell damage than the conventional taco-folding technique. Simultaneous use of IOL glide (Kobayashi double-glide method) to help prevent iris prolapse is our preferred insertion method for narrow-angle eyes.

192: Feasibility and Safety of Bilateral Peribulbar Block for Bilateral Simultaneous Cataract Surgery - Case Serial

192: Feasibility and Safety of Bilateral Peribulbar Block for Bilateral Simultaneous Cataract Surgery - Case Serial

192. Feasibility and Safety of Bilateral Peribulbar Block for Bilateral Simultaneous Cataract Surgery - Case Serial

192. Feasibility and Safety of Bilateral Peribulbar Block for Bilateral Simultaneous Cataract Surgery - Case Serial

Feasibility and Safety of Bilateral Peribulbar Block for Bilateral Simultaneous Cataract Surgery - Case Serial

Feasibility and Safety of Bilateral Peribulbar Block for Bilateral Simultaneous Cataract Surgery - Case Serial

Quelles sont les membranes épimaculaires qu’il faut opérer ?

Which epiretinal membranes should be operated? J.-P. Berrod, A. Poirson Epimacular membrane (ERM) formation is an age-dependent more or less vision-threatening finding. Increased life expectancy and patient demand for better vision have led to increasing numbers of patients seeking therapy, making selection for surgery mandatory. The impressive improvements in macular hole surgery have influenced the epiretinal membrane and have renewed its therapeutic approach. Disturbing metamorphopsia, visual deterioration under 5/10, especially near-vision alteration and binocular disturbance, are major symptoms to motivate surgery. As epiretinal membrane removal can be considered a relatively safe and effective procedure today, with ILM peeling and simultaneous cataract surgery, visual acuity alone is no longer the single criterion. The patient’s demands regarding vision in daily life should be taken into account. Patients with moderate visual loss, recent onset of symptoms, or progression are the best candidates for ERM surgery. Functional outcome in patients with poor initial visual acuity or long-standing disease is unsatisfactory. The OCT macular profile helps detect the best candidates with thickening between 300 and 450 microns. The presence of a pseudo hole, traction, or an intraretinal cyst does not impair functional results. Complete traction relief during pucker surgery is believed to be a precondition for good functional results. Intended ILM peeling is a tool to achieve this goal.

白内障硝子体同時手術後の屈折誤差からみたＩＯＬマスターの有用性

白内障硝子体同時手術後の屈折誤差からみたＩＯＬマスターの有用性

Bilateral Pseudomonas aeruginosa endophthalmitis following bilateral simultaneous cataract surgery

A bilateral simultaneous cataract surgery (BSCS) was performed on a 67-year-old man. The surgeon had not changed the surgical settings in between the two procedures for the two eyes. The patient developed fulminant bilateral endophthalmitis a day following the BSCS. Intravitreal culture grew Pseudomonas aeruginosa . The source of infection was not found. Immediate bilateral vitrectomy and intravitreal, subconjunctival, topical and systemic antibiotic did not save the eyes. Patient ended up with bilateral visual loss.

Simultaneous Versus Sequential Penetrating Keratoplasty and Cataract Surgery

To compare the surgical outcomes of simultaneous penetrating keratoplasty and cataract surgery with those of sequential surgery. Thirty-nine eyes of 39 patients scheduled for simultaneous keratoplasty and cataract surgery and 23 eyes of 23 patients scheduled for sequential keratoplasty and secondary phacoemulsification surgery were recruited. Refractive error, regular and irregular corneal astigmatism determined by Fourier analysis, and endothelial cell loss were studied at 1 week and 3, 6, and 12 months after combined surgery in the simultaneous surgery group or after subsequent phacoemulsification surgery in the sequential surgery group. At 3 and more months after surgery, mean refractive error was significantly greater in the simultaneous surgery group than in the sequential surgery group, although no difference was seen at 1 week. The refractive error at 12 months was within 2 D of that targeted in 15 eyes (39%) in the simultaneous surgery group and within 2 D in 16 eyes (70%) in the sequential surgery group; the incidence was significantly greater in the sequential group (P = 0.0344). The regular and irregular astigmatism was not significantly different between the groups at 3 and more months after surgery. No significant difference was also found in the percentage of endothelial cell loss between the groups. Although corneal astigmatism and endothelial cell loss were not different, refractive error from target refraction was greater after simultaneous keratoplasty and cataract surgery than after sequential surgery, indicating a better outcome after sequential surgery than after simultaneous surgery.

Comparison of two acrylic intraocular lenses with different haptic designs in patients with combined phacoemulsification and pars plana vitrectomy

The intra- and postoperative characteristics of two foldable single-piece intraocular lenses (IOL) with identical hydrophilic acrylic material, but different haptic designs (Akreos Adapt and Akreos Fit), were compared in combined phacoemulsification and pars plana vitrectomy (PPV). This was a prospective, randomized study in patients with simultaneous cataract and vitreoretinal surgery. Group A (n=47 patients) included implantation of Akreos Fit IOL (two-point haptic) and group B (n=46 patients) implantation of Akreos Adapt IOL (four-point haptic). All intraoperative modifications of small-incision phacoemulsification and three-port PPV and IOL implantation and centration were documented. At 1 and 2 days and 6 months after surgery, best-corrected visual acuity (BCVA), slit-lamp appearance (including inflammation, IOL centration, capsulorhexis diameter, posterior capsule opacification (PCO), tonometry, and fundus findings were evaluated. The groups did not differ with respect to age, surgical indications and modifications, intraoperative IOL handling, and centration. At day 2, inflammation and capsulorhexis diameters were similar, but IOL decentration was slightly more frequent with Akreos-Fit IOLs. Six months after surgery, the rates of PCO, posterior synechiae, and BCVA were similar. Akreos-Fit had slightly smaller capsulorhexis diameters and slightly more capsular contraction and IOL decentration (P>0.05). Both of the Akreos IOL are feasible for combined phacoemulsification and PPV. Although similar in intraoperative handling, BCVA, and PCO, IOL centration was slightly better with Akreos-Adapt than with Akreos-Fit after combined surgery.

Morphological and functional changes of the macula after vitrectomy and creation of posterior vitreous detachment in eyes with diabetic macular edema

The purpose of this study was to determine the morphological and functional changes in the macula after pars plana vitrectomy with the creation of a posterior vitreous detachment in eyes with diabetic macular edema (DME). A simple posterior vitreous detachment was created during pars plana vitrectomy accompanied by simultaneous cataract surgery in 19 eyes of 17 patients with DME. The visual acuity (log MAR units), multifocal electroretinograms (mfERGs), and optical coherence tomographically (OCT)-determined foveal thickness were determined preoperatively and at 6 months postoperatively. The median preoperative log MAR visual acuity was 0.7 (20/100; range, 0.3-1.1), and it improved significantly to 0.4 (20/50; range, 0.15-1.0) postoperatively (p = 0.016). The median foveal thickness was 510 (range, 194-800) microm preoperatively and was significantly reduced to 201 (range, 60-631) microm postoperatively (p =0.0002). The median of response density of the mfERGs in the macular area was 6.3 nV/ deg2 (range, 2.8-14.8) preoperatively, and 6.1 nV/deg2 (range, 2.4-14.3) postoperatively, a non-significant change (p = 0.27). The median of peak latency of the macular response was 30.0 ms (range, 25.0-44.2) preoperatively and it decreased significantly to 28.3 ms (range, 26.7-35.0) postoperatively (p = 0.003). In conclusion, vitrectomy with the creation of a PVD in eyes with DME improved the visual acuity and foveal thickness significantly. In addition, a decrease of the peak latency of the macular mfERGs suggested an improvement of the physiological function of the macula although the amplitude of the mfERGs was not changed significantly.

Long-Term Follow-Up of Intraocular Pressure After Penetrating Keratoplasty for Keratoconus and Fuchs' Dystrophy

In the literature, the incidence of "secondary glaucoma" after penetrating keratoplasty (PK) is reported to range from 10% to 42%, depending on the diagnosis and the complexity of surgery. The purpose of this study was to assess the impact of the trephination method and simultaneous cataract surgery on the early and long-term intraocular pressure (IOP) after PK in eyes without previous surgery and glaucoma. Inclusion criteria for this prospective, randomized, longitudinal clinical study were (1) one surgeon (G.O.H.N.), (2) primary central PK, (3) Fuchs' dystrophy (7.5/7.6 mm) or keratoconus (8.0/8.1 mm), and (4) 16-bite double running diagonal suture. Exclusion criteria were (1) previous intraocular surgery, (2) preoperative glaucoma, and (3) postoperative trauma or endophthalmitis. In 170 patients (mean age, 51 +/- 18 years), PK was performed with use of either a 193-nm excimer laser (Excimer patients) along metal masks with eight orientation teeth/notches (50 keratoconus, 32 Fuchs') or motor trephination (Control patients; 53 keratoconus, 35 Fuchs'). In 27% of Excimer patients and 29% of Control patients a triple procedure was performed. The perioperative systemic acetazolamide application and the postoperative topical steroid therapy were standardized. Maximal IOP during the first week after PK was 15.7 +/- 3.6 mm Hg (7% > 21; maximum, 28) in the Excimer group and 16.2 +/- 3.5 mm Hg (7% > 21; maximum, 30) in the Control group. During a mean follow-up of 3.4 +/- 1.3 years (maximal, 6.0), an IOP >21 mm Hg and/or application of topical antiglaucomatous medication was documented in 9% of Excimer patients versus 15% of Control patients (p = 0.32), in 15% of Fuchs' dystrophy versus 11% of keratoconus cases (p = 0.41), and in 11% of PK-only versus 15% of triple-procedure cases (p = 0.68). The IOP elevation started an average of 3.7 +/- 2.8 months (1 week to 9 months) after PK and ended an average of 6.5 +/- 3.1 months (6 weeks to 12 months) after PK. Mean maximal IOP during follow-up was 16.6 +/- 3.5 mm Hg (12-38) in the Excimer group and 17.2 +/- 3.2 mm Hg (12-30) in the Control group. Only one patient, who had undergone a triple procedure for Fuchs' dystrophy and had an elevated IOP, needed topical medication, from 32 months after PK to the end of follow-up. Glaucomatous optic disc damage was clinically detected in none of the patients. Temporary secondary ocular hypertension after PK is rare in eyes with keratoconus or Fuchs' dystrophy without previous surgery. There was no detectable impact from the trephination method, the diagnosis, or simultaneous cataract surgery. With meticulous microsurgical technique, careful suturing, and peripheral iridotomy, the development of secondary glaucoma with disc cupping seems to be the exception.

Postoperative Complications After Simultaneous Vitrectomy and Cataract Surgery

We reviewed postoperative complications after simultaneous vitrectomy, phacoemulsification, aspiration, and acryl lens insertion. Combined surgery was performed in 316 eyes of 279 patients between 1995 and 1997. Postoperative observation was continued in all of them for more than 6 months. The diagnoses that led to vitrectomy included diabetic retinopathy in 155 eyes, rhegmatogenous retinal detachment in 64 eyes, macular hole in 43 eyes, and other diseases in 93 eyes. The rate of postoperative complications that needed any reoperation was investigated. Reoperations were needed for intravitreal hemorrhage in 23 eyes (7.3%), retinal detachment in 15 eyes (4.7%), rubeotic glaucoma in 6 eyes (1.9%), and other conditions in 4 eyes (1.3%). Among them, reoperations were performed on 13 eyes (4.1%) twice and more. A removal of an intraocular lens was needed in 16 eyes (5.1%) for treatment of vitreoretinal disease. In patients with diabetic retinopathy, reoperations were needed for intravitreal hemorrhage in 21 eyes (13.5%), rubeotic glaucoma in 6 eyes (3.9%), other diseases in 4 eyes (2.6%), and a removal of an intraocular lens was needed in 10 eyes (6.5%) at a higher rate than the other disease. This combined surgery is considered advantageous for removing peripheral vitreous, while preventing these complications is important for preserving visual function.

Pars plana vitrectomy in patients with intermediate uveitis

Objective: To describe the effect of pars plana vitrectomy in patients with intermediate uveitis. Methods: Retrospective analysis of the clinical course and visual outcome following pars plana vitrectomy in patients with intermediate uveitis. Results: Thirty-two patients (43 eyes) were included in the study. Pars plana vitrectomy was combined with cataract surgery in 22 of 43 eyes. The intermediate uveitis was associated with sarcoidosis in 16 eyes and multiple sclerosis in five eyes, and was idiopathic in 22 eyes. The mean (±SD) follow-up was 45.6 (±38) months (range: 6–146 months). In 19 of 43 eyes (44.1%), there was improvement in the course of uveitis, allowing the discontinuation of immunosuppressive treatment in seven patients. Cystoid macular edema resolved in 12 of 37 eyes (32.4%). Forty of 43 eyes achieved a better or retained their initial visual acuity. The remaining three eyes deteriorated by two or more lines in the Snellen chart due to the progression of cataract, chronic cystoid macular edema, and glaucomatous optic atrophy, respectively. Conclusions: The results of this study suggest that pars plana vitrectomy may have a beneficial effect on the course of uveitis and the associated complications of cystoid macular edema, thereby reducing the need for long-term immunosuppression. Pars plana vitrectomy combined with simultaneous cataract surgery can improve the visual outcome in these patients.

Bilateral cataract surgery in adult and pediatric patients in a single session

Purpose To evaluate the results of bilateral simultaneous cataract surgery in adult and pediatric patients under local or general anesthesia. Setting Department of Ophthalmology, İnönü University, Turgut Özal Medical Center, Malatya, Turkey. Methods Eighty-two eyes of 41 patients were included in the study. Twelve of 17 pediatric patients with congenital cataract had bilateral simultaneous lensectomy, posterior capsulotomy, and anterior vitrectomy; 5 patients, aged 10 to 19 years, had bilateral extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC IOL) implantation. Forty-eight eyes of 24 adult patients had bilateral simultaneous ECCE with primary (43 eyes) or secondary (5 eyes) PC IOL implantation. Local anesthesia was administered to 20 adult patients by retrobulbar injection; the other cases were performed using general anesthesia. The procedures were treated as 2 separate surgeries in the same session; care was taken to ensure surgical asepsis. Results No serious intraoperative complications occurred such as posterior capsule rupture, vitreous loss, endophthalmitis, and anesthesia-related problems. Of patients tested, 84.4% achieved a final best corrected visual acuity of 6/12 or better and 31.0%, of 6/6 or better. Conclusions Simultaneous bilateral cataract surgery was not associated with an increased rate of complications, and visual results were good. If strict rules of surgical asepsis are followed, this may be a useful option in a variety of bilateral cases using general or local anesthesia.

Postoperative Refractive Error After Simultaneous Vitrectomy and Cataract Surgery

To evaluate the effect of vitrectomy on postoperative refraction after simultaneous vitrectomy and cataract surgery. We compared the spread between predicted and actual refractions in 206 eyes after a simultaneous vitrectomy, phacoemulsification, aspiration and acrylic lens insertion (combined surgery group), and in 67 eyes after cataract surgery only (cataract surgery group) as control. A vitrectomy was performed for diabetic retinopathy in 127 eyes, macular hole in 32 eyes, rhegmatogenous retinal detachment in 16 eyes, branch retinal vein occlusion in 15 eyes, and other conditions in 26 eyes. In the combined surgery group, 79 eyes had a gas tamponade after insertion of the intraocular lens. The spread between predicted and actual refractions was - 0.05 +/- 1.18 diopters (average +/- SD) in the combined surgery group and +0.55 +/- 1.32 D in the cataract surgery group. The actual refractive errors in the combined surgery group were found to shift toward myopia when compared with the controls. Among the combined surgery group, 127 eyes without a gas tamponade showed a postoperative refractive error of +0.14 +/- 1.11 D, while 79 eyes with a gas tamponade demonstrated an error of -0.36 +/- 1.22 D. Use of a gas tamponade in the combined surgery group increased the myopic change and was thought to have pressed the intraocular lens forward.

Perspectives in trabecular surgery.

The aim of trabecular surgery is to selectively combat the diseased structure central to the pathogenesis of chronic open-angle glaucoma, thereby reducing potential hazards during and after conventional filtering procedures. This overview considers new techniques in ab interno trabecular surgery. Special emphasis is placed on the description of each novel technique, its instrumentation, presumed mechanism of action and clinical results. Trabecular aspiration is evaluated as a method of clearing intertrabecular spaces of extracellular debris in pseudoexfoliation glaucoma with or without simultaneous cataract surgery or goniocurettage, while laser trabecular ablation is discussed for the treatment of absolute glaucomas. Where corneal haze has formed visualisation of the anterior chamber angle structures and trabecular surgery is performed with the aid of a microendoscope. Although the results are very promising it should be understood that some of these procedures are still in the experimental phase and are undergoing careful clinical evaluation, leaving plenty of room for refinements and further developments.

Combined Cataract Surgery, Intraocular Lens Insertion, and Vitrectomy in Eyes with Idiopathic Epiretinal Membrane

To report the surgical outcomes of combined cataract surgery and pars plana vitrectomy in eyes with idiopathic epiretinal membrane. This is a retrospective review of 8 consecutive patients with concurrent cataract and idiopathic epiretinal membrane who underwent the combined procedure. At a mean follow-up of 22 months, the visual acuity improved by 2 or more Snellen lines in 7 patients (88%). Median preoperative and postoperative best-corrected visual acquities were 20/200 and 20/50 respectively. Simultaneous cataract surgery and vitrectomy for idiopathic epiretinal membrane removal resulted in visual improvement in the majority of patients.