Small Incision Cataract Extraction Research Articles

Observation of clinical efficacy of small incision cataract extraction using phacoemusification and no-phacoemulsification methods

目的 评价白内障小切口非超声乳化与超声乳化摘出手术的手术方法和疗效.方法 回顾性比较我院2005年1～12月间117例(129眼)老年性白内障分别行两种小切口白内障手术后的视力、散光、及术中术后的并发症.结果 术后1月超乳和小切口非超乳的视力大于0.4分别为92.31%和93.33%,术后1月散光分别是(1.63±0.87)D和(1.65±0.88)D,两组差异均无统计学意义.角膜反应术后1月全部消退.结论 两种手术方式疗效相近,可根据具体情况选择术式。

Application of small incision cataract extraction in traumatic cataract

目的 探讨小切口非超乳向内障摘出术在外伤性白内障手术中的疗效与优点.方法 24例(24眼)手术均采用小切口非超乳白内障摘出人工晶状体植入术.结果 24例手术均顺利完成,术后4周矫正视力≥0.8者9眼,0.4～0.6者7眼,0.1～0.3者5眼,小于0.1者3眼.结论 小切口非超乳白内障摘出术在外伤性白内障手术中是一种简便、安全、有效的方法。

Suture-related complications after congenital cataract surgery: Vicryl versus Mersilene sutures

To evaluate 10-0 polyester sutures (Mersilene) and 10-0 absorbable polyglactin sutures (Vicryl) for small-incision congenital cataract surgery. Goldschleger Eye Institute, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel. A retrospective review comprised 51 patients (70 eyes) who had small-incision congenital cataract extraction and intraocular lens implantation between 1999 and 2005. Surgery was done using Mersilene sutures or Vicryl sutures. Retinoscopy and a careful examination for suture-related complications were done 1 week after surgery and then every month for 6 months. The sutures were removed in cases of local tissue reaction but not for high postoperative astigmatism. The t test was used to evaluate postoperative astigmatism and the Fisher exact test, to evaluate the difference in the incidence of suture-related complications. The patients' age ranged from 2 months to 15 years. Ten cases (18%) of corneal vascularization occurred in the Mersilene group during the 6-month follow-up period. This necessitated suture removal, after which 1 incident of endophthalmitis occurred. In contrast, no suture-related complications were noted in the Vicryl group during that time. The difference in the incidence of complications between the 2 groups approached statistical significance (P = .07). Mean astigmatism 1 week postoperatively was 2.3 diopters (D) +/- 2.1 (SD) in the Mersilene group, which was significantly higher than in the Vicryl group (mean 1.4 +/- 1.1 D) (P = .038). However, the mean astigmatism decreased to less than 1.0 D in both groups during the 6-month follow-up period. Vicryl sutures are recommended for small-incision congenital cataract surgery.

Clinical observation of the operating on cataract combined with glaucoma

目的 探讨小切口非乳化白内障囊外摘出、人工晶状体植入联合小梁切除(以下简称联合手术)治疗白内障合并青光眼的手术方法,评价远期临床效果.方法 对46例48眼青光眼合并自内障施行联合手术,术后随访3～32个月,平均18个月,对视力、眼压、滤过泡及并发症等进行临床观察.结果 术后随访视力0.02～0.25者7眼,占14.58%;0.3～0.6者36眼,占75.00%;0.8～1.0者5眼,占10.42%.眼压控制在正常范围(≤21 mmHg)者45眼,占93.75%.3眼术后眼压在28 mmHg左右,用噻吗心安滴眼液滴眼,眼压可控制正常,滤过泡呈扁平状的功能性滤过泡41眼,占85.42%.并发症:角膜水肿29眼、上方虹膜片状萎缩2眼、瞳孔不圆伴机化膜2眼、人工晶状体瞳孔夹持2眼.结论 白内障合并青光眼联合手术远期效果良好。

Traumatic aniridia after small incision cataract extraction

Introduction Phacoemulsification and falls are both common in the elderly population. We present a case of acquired total aniridia and vitreous haemorrhage occurring as a result of trauma in a pseudophakic eye. Methods Interventional case report with history, clinical photograph and discussion with literature review. Results A previously healthy 74-year-old Caucasian female was referred with a painful left eye and poor vision following a fall and trauma to the left side of her face. Initial examination confirmed visual acuity of perception of light with total hyphaema and vitreous haemorrhage. Subsequent examination revealed complete aniridia with an intact capsular bag and well-centred posterior chamber intraocular lens and attached retina. Final visual acuity after treatment was 6/9. Conclusions Blunt trauma may cause total iris disinsertion in and expulsion from pseudophakic eyes. This relatively novel injury may present increasingly commonly to casualty departments and ophthalmologists.

Clinical evaluation of the Crystalens AT-45 accommodating intraocular lens

To evaluate the 12-month U.S. phase II clinical trial results of the Crystalens AT-45 (eyeonics, Inc.) intraocular lens (IOL) used to provide uncorrected distance, intermediate, and near visual acuities in patients having cataract extraction and to compare in a substudy the contrast sensitivity and near visual acuity in patients with the Crystalens AT-45 IOL and those receiving a standard IOL. Fourteen clinical sites throughout the U.S. for efficacy and 3 non-U.S. sites for safety and efficacy. Patients 50 years or older had small-incision cataract extraction with implantation of the Crystalens AT-45 IOL. Unilateral implantation was followed by fellow-eye implantation. Postoperatively, uncorrected distance, near, and intermediate visual acuities were determined. Near and intermediate visual acuities were tested through a distance correction to eliminate potential pseudoaccommodative effects of residual myopia and corneal cylinder. A substudy tested contrast sensitivity under mesopic conditions with and without glare, as well as visual acuity in a subset of Crystalens AT-45 patients and a control group receiving a standard IOL. A total of 263 patients participated in the U.S. clinical trial and had 1 year of follow-up. Near visual acuities through the distance correction of 20/40 (J3) or better, monocularly and bilaterally, respectively, were seen in 90.1% and 100%; intermediate near visual acuities were seen in 99.6% and 100%. More than half the bilaterally implanted Crystalens AT-45 patients achieved uncorrected near acuity of 20/25 (J1) or better through the distance correction, and 84% achieved 20/32 (J2) or better. In the substudy, monocular near vision through the distance correction of 20/25 (J1) or better was seen in 50.4% with the Crystalens AT-45 IOL and in 4.7% with the standard IOLs. Mesopic contrast sensitivity results with and without glare for the Crystalens AT-45 were similar to those with standard monofocal IOLs. Nearly all patients (74 patients; 97.3%) who bilaterally were within 0.50 diopter of plano postoperatively achieved 20/32 (J2) or better uncorrected near, intermediate, and distance visual acuities. The Crystalens AT-45 accommodating IOL provided good uncorrected near, intermediate, and distance vision in pseudophakic patients. Contrast sensitivity with the Crystalens AT-45 was not diminished relative to standard monofocal IOLs, and near and intermediate visual performance was significantly better than with standard IOLs.

The analysis on corneal edema after small-incision non-phacoemulsification cataract extraction

目的 探讨小切口非超声乳化白内障术后角膜水肿的原因及解决方法.方法对139例(163眼)小切口非超声乳化白内障囊外摘出(ECCE)或ECCE+PC-IOL术,分别观察术后1天、3天、1周角膜水肿情况,并将其按主要原因归类分析.结果术后第1天角膜水肿者103例123眼(75.46%);术后第3天仍水肿者12眼(7.36%);术后1周仍水肿者4眼(2.45%).角膜水肿的原因分析:因内切口靠前、娩核困难所致者70眼(42.94%);因灌注液压力过高时间长所致者41眼(25.15%);因暂时性眼压升高所致者6眼(3.68%);由于外伤性白内障术前角膜损伤所致者4眼(2.45%);由于后弹力层撕脱所致者及由于缩瞳剂所致者各1眼(各占0.61%).而水肿持续时间最长的原因是外伤性白内障术前原有角膜损伤和角膜后弹力层撕脱.结论小切口非超声乳化白内障囊外摘出术后角膜水肿的主要原因是内切口靠前、娩核困难,其次是术中高速度的液体冲洗。

Small incision cataract extraction and intraocular lens implantation for hyper-mature cataract

目的 探讨过熟期白内障小切口囊外摘出人工晶状体植入手术方法,减少并发症,提高疗效.方法对2000年1月～2004年10月58例(63眼)过熟期白内障小切口囊外摘出人工晶状体植入术进行回顾性分析.结果 58例(63眼)仅1例术中出现后囊破裂及玻璃体脱出.所有患眼术后视力均有提高,其中术后视力0.4以上者52眼(82.54%).结论正确术前指导,提高患者合作性,采用小切口和∩式撕囊能有效减少并发症,从而有利于患者术后视力康复。

Successful Bilateral Cataract and Circumcision Operation Performed in a Hemophilia-A Patient with Inhibitors by Using Recombinant Factor VIIa.

Objective: Prothrombin complex concentrates (PCC), active prothrombin complex concentrates (APCC;FEIBA) or recombinant Factor VIIa (rFVIIa; Novoseven) are safely used for the treatment of hemorrhages in hemophiliac patients with inhibitors or during the interventions performed in these patients. A hemophilia-A patient with inhibitors in whom bilateral cataract operation and circumcision were successfully performed by rFVIIa administration was presented.Case: The 13 year old male patient had been diagnosed with severe Hemophilia-A by the detection of a FVIII level below 1% in the factor assay performed due to echhymoses in his body when he was 6 months old. The inhibitor level of the patient who developed bilateral cataract during the follow-up period was determined as 2.95 BU; however the cataract operation had to be delayed due to the absence of an adequate increase in his factor VIII level despite the 2000 U factor replacement administered in July 2002. The patient was readmitted to the hospital for operation in October 2002. However, the operation was delayed again since a safe level of factor VIII wasn't achieved with Factor VIII replacement. The patient was excluded from follow-up for approximately 2 years. In August 2004, the patient was hospitalized due to echhymosis in the scrotum, and his factor VIII level was measured as 1% and the VIII inhibitor level as 88 BU. IV steroid treatment was initiated in the patient at a dose of 2 mg/kg, with the factor VIII replacement intended at a level of 100 U/kg. 2 doses of 90 microgram/kg of rFVIIa were administered at a two-hour interval due to catheterization for plasmapheresis and subsequently, plasmapheresis program was carried out. The inhibitor level was measured as 25.6 BU after the first plasmapheresis. Factor VIII level of the patient whose FVIII inhibitor level declined to 15.4 BU with these treatments, didn't exceed 3%. 120 microgram/kg rFVIIa was administered to the patient prior to operation and maintained during the 1st and 2nd days of the operation every 2–3 hours at the same dose. At this operation, right eye small incision cataract extraction and posterior chamber intraocular lens implantation were performed under general anesthesia. A month later, cataract operation was performed in the other eye together with the circumcision operation. A 3-grade increase was achieved in visual acuity of both eyes.Conclusion: Here, the cataract operation together with the circumcision operation performed in a hemophiliac patient with inhibitors was presented, demonstrating that rFVIIa which has been started to be used also in other fields other than hemophilia patients, can be used safely in operations.

Cataract extraction and intraocular lens implantation through temporal small-incision to the filtered glaucoma with cataract

目的 评价青光眼滤过术后经颞侧小切口白内障囊外摘出人工晶状体植入术的效果.方法对26例(28眼)青光眼滤过术后的白内障,采用经颞侧行小切口白内障囊外摘出人工晶状体植入.切口不缝合.随访3～18月,观察术后角膜散光、眼压及视力等情况.结果 28眼术前视力手动～0.3,术后视力均较术前明显提高.其中0.05～0.2者8眼(28.57%),0.3～0.4者11眼(39.29%),0.5～0.8者5眼(17.86%),1.0～1.2者4眼(14.29%).术前角膜散光(0.76±0.88)D,术后1周(0.92±0.82)D,1月(0.76±0.88)D,3月(0.70±0.72)D,与术前相比P＞0.05,差异无显著意义(t检验),术前眼压(16.02±2.48)mmHg,术后1月眼压(17.30±1.88)mmHg(1 mmHg=0.133 kPa),与术前相比P＞0.05,差异无统计学意义(t检验).结论青光眼滤过术后白内障,采用经颞侧的小切口白内障囊外摘出人工晶状体植入术,可以避开滤过泡保存原有滤过功能,术后反应轻,视功能恢复好,手术安全可靠。

Long-term rates of PCO following small incision foldable acrylic intraocular lens implantation in children.

To evaluate the long-term incidence of postoperative posterior capsular opacification (PCO) in children undergoing small incision foldable acrylic lens implantation with at least 2 years of follow up. In 18 children, 26 eyes underwent small incision cataract extraction with posterior chamber foldable acrylic lens implantation. The posterior capsule was left intact in all patients at the time of surgery. With a mean follow up of 2.75 years and a mean age at surgery of 8.25 years, 13 of 26 eyes (50%) developed visually significant PCO requiring intervention. In the group of children under 4 years of age, 5 of 5 eyes (100%) developed visually significant PCO, while 8 of 21 eyes (38%) in the group of children over 4 years of age developed opacification. Four of 26 eyes (15%) required two procedures (either repeat Nd:YAG laser capsulotomy or pars plana secondary membrane removal) to clear the visual axis. In this study, the incidence of PCO following small incision acrylic lens implantation in children over 4 years of age is lower than those rates reported by conventional large incision rigid lens techniques with a minimum of 2 years follow up. This technique has advantages over conventional techniques in older children because it offers less surgical intervention, a lower cost to patients, and less risk of vitreous and retinal complications.

Combined phacoemulsification, pars plana vitrectomy, removal of intraocular foreign body (IOFB), and primary intraocular lens implantation for patients with IOFB and traumatic cataract.

Small-incision cataract extraction by phacoemulsification through an anterior continuous circular capsulorhexis, pars plana vitrectomy, forceps removal of intraocular foreign body (IOFB) and primary intraocular lens implantation were performed in 4 eyes (4 patients) with IOFB and traumatic cataract, as an emergency combined procedure. At a mean follow-up of 12.3 months (range 7-19 months) the best corrected visual acuity of the 4 eyes ranged from 6/6 to 6/12. The only complication encountered in our series was an opacified posterior capsule that developed 10 months post-operatively in one case. This was easily dealt with by neodymium:YAG laser capsulotomy, with good final visual outcome. The results of combined one-stage instead of sequential surgeries, and phacoemulsification instead of lensectomy or extracapsular cataract extraction for patients with IOFB and cataract are encouraging. It could be a good option in selected cases. However, the safety and efficacy of this combined procedure need to be evaluated further by a larger-scale, longer follow-up study.

Fibrin Glue in Temporal Clear Corneal Tunnel Incision

OBJECTIVE: While 3.5 mm clear corneal incisions for the implantation of foldable silicone lenses are commonly accepted, longer incisions for PMMA-IOL implantation are associated with a possibly higher risk of infection and less self-sealing properties. DESIGN: It was intended to reinforce the 5 mm clear corneal tunnel incision after phacoemulsification and IOL-implantation with fibrin adhesive. SETTING: Department of Ophthalmology, University of Giessen, Germany. METHODS: Upon simultaneous mixing of fibrinogen complex and thrombin, the final stages of the coagulation cascade are mimicked after application of fibrin glue, resulting in formation of a fibrin clot. MAIN OUTCOME: The sealant consolidated and adhered to the site of corneal application. The present case demonstrated that fibrin glue is efficacious in watertight wound closure of 5 mm clear corneal incision and provides good support for corneal healing. Only minimal surgically-induced with-the-rule astigmatism was observed. CONCLUSION: In the future, this technique of corneal wound closure might develop as an alternative to singlesuture wound closure after small incision cataract extraction.

Hydrosonic intercapsular piecemeal phacoemulsification or the 'HIPP' technique.

Hydrosonic Inter-capsular Phaco emulsification is a small incision cataract extraction technique performed totally within the confines of the intact capsular bag through a small peripheral anterior capsulorhexis located at 12 o'clock close to the external incision. In addition to the obvious protective advantages to the corneal endothelium and other structures of the anterior segment, the technique has inherent Hydrodynamics properties that increase the precision and safety of the procedure. Thorough Hydrodissection and Hydrofragmentation which are essential steps of the procedure are accomplished with the Hydrosonic handpiece. The following is a detailed description of the technique.

Total Detachment of Descemet's Membrane After Small-incision Cataract Extraction

Total Detachment of Descemet's Membrane After Small-incision Cataract Extraction

Small incision cataract extraction and implantation surgery using a manual phacofragmentation technique

The advantages of small incision cataract surgery may be obtained without relying on expensive and complicated instrumentation. A new technique which manually splits the nucleus and removes the fragments is described.