Temporal Clear Corneal Phacoemulsification Research Articles

Short-term outcomes of Tanito microhook ab interno trabeculotomy combined with phacoemulsification in primary open-angle glaucoma - A pilot study.

The aim of the study was to assess the early postoperative efficacy and safety of Tanito microhook (TMH) ab interno trabeculotomy combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). This prospective interventional study was conducted on consecutive patients with visually significant cataract and mild-moderate POAG. All patients underwent a temporal clear corneal phacoemulsification combined with TMH ab interno trabeculotomy. Postoperative evaluation was done on day 1, 1 month, and 3 months. The outcome measures included intraocular pressure (IOP) at different follow-ups and postoperative complications. In total, 30 eyes of 30 patients were included in the study. There were 16 (53.3%) females and 14 (46.7%) males with a mean age of 62.63 ± 6.7 years. The mean IOP reduced from 23.57 ± 1.65 to 17.33 ± 2.84 at 3 months (P < 0.001). All eyes had a corrected distance visual acuity ≥6/9 at 1 month postoperatively. Postoperative complications included corneal stromal edema in eight (26.7%) eyes, hyphema in four (13.3%) eyes, and IOP spike in one (3.3%) eye. TMH ab interno trabeculotomy combined with phacoemulsification in patients with mild-moderate POAG is an effective and safe procedure with fewer complications.

Clinical study of functional visual recovery following phacoemulsification with IOL implantation

Aim To evaluate the functional visual recovery following phacoemulsification cataract surgery with foldable intraocular lens implantation through a temporal clear corneal incision. Methodology This prospective study was conducted at a tertiary health care centre in Western Maharashtra over a period of 2 years. Detailed history was taken and thorough ocular examination of was done. Visual Acuity, Color vision, Contrast sensitivity, Binocular vision was noted. Visual Fields were examined and Glare Disability was assessed. All patients underwent temporal clear corneal Phacoemulsification surgery through a 3.2 mm incision with implantation of an Aspheric Monofocal Foldable IOL under LA. All patients were started on tapering dose of antibiotic − steroid over 6 weeks and followed up post operatively on day 1, week 1, week 2, 6 weeks, 3months and at 6 months. Results 50 eyes of 46 patients with immature cataract aged between 40 to 80 years were included. At the end of 24 weeks the Distance Vision was ≥ 6/9 in 31 eyes, 6/18–6/12 in 17 eyes and &lt; 6/18 in 2 eyes. It was a statistically significant difference (P&lt;0.0001). No significant difference in near vision was seen at the end of 6 months. The difference in astigmatism post operatively in all 50 eyes was not statistically significant at the end of 6 months (P&lt;0.05). Significant improvement in contrast sensitivity was seen post operatively (P&lt;0.0001). The mean glare disability was 14.06 s at 24 weeks. No significant difference was seen (P&gt;0.05). Colour vision and Field of vision were similar postoperatively. All the patients maintained grade 3 binocular vision at end of the study. Conclusion Phacoemulsification with monofocal foldable intraocular lenses can be the choice of technique in treatment of cataract as being able to provide excellent visual results and also being cost effective.

Efficacy of Single-site versus Two-site Phacotrabeculectomy in Primary Open-angle Glaucoma: A Prospective Cohort Study

Introduction: The prevalence of co-existing cataract and glaucoma is increasing in the adult population. Combined surgeries have become more popular. However, there is a conflict over which technique provides the best Intraocular Pressure (IOP) control with good postoperative outcomes. Aim: To compare the efficacy of single-site versus two-site phacotrabeculectomy with mitomycin-C in patients with Primary Open-angle Glaucoma (POAG) and cataract. Materials and Methods: A prospective cohort study was conducted in the Department of Ophthalmology, S.V. Medical College, Tirupati, Andhra Pradesh, India, over a period of one year from January 2019 to January 2020. A total of 50 cases of POAG coexisting with cataract were analysed in the present study. Twentyfive cases were included in each group (Group-1 and Group-2). Phacoemulsification and trabeculectomy were both performed through a superior scleral tunnel in the single-site approach. The two-site method combines a superior trabeculectomy with a temporal clear corneal phacoemulsification. A concentration of 0.2 mg/mL of MMC was applied in both groups for three minutes. Patients were followed-up for three months after surgery to evaluate Intraocular Pressure (IOP), the need for antiglaucoma medication, and postoperative best-corrected Visual Acuity (VA). Comparative analysis was done using the Student’s t-test, and a p-value &lt;0.05 was considered statistically significant. Results: Throughout the three-month duration, the patients were monitored. In the single-site group, the average preoperative IOP was 21.880±8.4079 mmHg, which significantly decreased to 11.16±9.95 mmHg after three months (p&lt;0.001). In the twosite group, the corresponding figures were 22.640±6.3040 and 10.8±1.19 mmHg, respectively (p&lt;0.001), with no discernible statistical distinction between the two groups (p=0.486). At the final follow-up, the number of antiglaucoma medications was 0.24±0.5 in the single-site group compared to 0.16±0.24 in the two-site group. The mean postoperative Best Corrected Visual Acuity (BCVA) did not exhibit any significant variation between the two groups. Furthermore, there was no disparity in the occurrence rate of complications between the two groups. Conclusion: Both single and two-site phacotrabeculectomy led to a significant reduction in IOP and improvement in BCVA. The final IOP was similar in the two procedures, although the twosite group needed less glaucoma medication. As both surgical procedures are equally effective, the choice of procedure remains at the discretion of the surgeon.

COMPARISON OF SURGICALLY INDUCEDASTIGMATISM BETWEEN PHACOEMULSIFICATION AND SMALL INCISION CATARACT SURGERY AT TRIPOLI MEDICAL CENTER

Aim: The aim of study was to check the incidence, amount, type, and course of surgically induced astigmatism and visual sense in temporal 3.5-mm clear corneal phacoemulsification and 6-mm superior scleral incision in Small incision cataract surgery (SICS). Materials and Methods: A total of 200 eyes of 200 patients with a mean age of 62 years were included within the study. Cases were randomly divided into two groups. group A had undergone 3.5-mm temporal clear corneal phacoemulsification and blood type had undergone 6-mm superior scleral SICS. Surgically induced astigmatism was analyzed by SIA software. Results: Mean age in A was 61(±8) years and in group B was 63(±10) years. Mean surgically induced astigmatism in blood group was 1.05(±0.58)D,1.13(±0.52)D, 1.13(±0.56)D, and 1.08(±0.52)D on 1st, 7 th ,21 th, and 45 th postoperative days, respectively. The change from 1st to 45th day wasn't significant. the identical in blood group was 0.75(±0.58) D, 0.81(±0.54)D, 0.88(±0.49)D, and 0.91(±0.47)D 1st, 7th, 21th, and 45th postoperative days, respectively. Surgically induced astigmatism was comparable on all days between the groups. We found significant with the rule and against the rule form of astigmatism post-operatively within the temporal clear corneal incision in phacoemulsification group and in superior scleral incision in small incision cataract surgery group respectively. Conclusion: Surgically induced astigmatism was higher within the the superior scleral group than in 3.5-mm temporal clear corneal group. Clinical outcome of both surgeries was same, as there was no significant difference within the uncorrected postoperative acuity in between the groups.

Role of Oral Vitamin ‘C’ on Astigmatic Errors in Phacoemulsification

ABSTRACT Purpose: To evaluate the role of oral vitamin C on postoperative astigmatism in phacoemulsification and to assess its effect on postoperative symptoms. Methods: The patients were selected from Department of Ophthalmology, GSVM Medical College, Kanpur who came for cataract surgery. Design: Prospective, randomized double-blind study; 400 consecutive patients of cataract were randomized into two groups consisting of 200 patients each. Group “A” patients were started on oral vitamin C (1,500 mg per day in three divided doses) from the first postoperative day and Group “B” patients were given routine postoperative medications along with placebo. The keratometry of both the groups was done preoperatively and postoperatively at 2, 4, and 6 weeks. All patients underwent temporal clear corneal phacoemulsification by the same surgeon. Results: The mean difference of astigmatism preoperatively in the right eye of Group “A” patients was 1.049 ± 0.971 which reduced to 0.680 ± 0.554 at 6 weeks postoperatively (p-value = 0.0018), whereas in Group B, it changed to 1.141 ± 0.771 at 6 weeks from 1.116 ± 0.566 of preoperatively (p-value = 0.759). In the left eye of Group “A” patients, its value was 0.995 ± 0.899 which changed to 0.574 ± 0.528 at 6 weeks (p-value = 0.0001) which was highly significant, whereas that in Group “B” patients, it was 0.733 ± 0.440 preoperatively which modified to 0.877 ± 0.581 at 6 weeks (p-value = 0.004). In Group “A,” 0.5% patients had pain, foreign body sensation, and photophobia at 6 weeks, whereas in Group “B” patients, 5% had pain, 1.5% had foreign body sensation, 1% had photophobia, and 0.5% had watering. Conclusion: Oral vitamin C may play a beneficial role in decreasing the postoperative astigmatism. It also enhances patients’ comfort levels and ensures faster recovery after phacoemulsification.

A Comparative Study of 5.5mm Temporal Sclerocorneal Manual Small Incision Cataract Surgery Versus 5.5mm Temporal Clear Corneal Extended-incision Phacoemulsification with Implantation of a 5.25mm Rigid pmma Intraocular lens in the Bag

Objective: Aim of the study is to Compare the astigmatism induced by a reduced temporal sclerocorneal tunnel incision manual small incision cataract surgery with an extended temporal clear corneal Phacoemulsification of similar width . Methods: A Prospective, randomised controlled study was carried out in 224 selected patients who were again divided into two groups - Group A (112 patients) and Group B (112 patients). Group A patients underwent temporal manual small incision cataract surgery with a 5.5 mm sclerocorneal incision and Group B underwent phacoemulsification by a 2.8 mm clear corneal temporal incision which was extended to 5.5 mm before IOL implantation. In both groups, a 5.25 mm rigid PMMA IOL was implanted in the bag. UCVA and BCVA of both group of patients was quantified and analyzed at 1 week and at 6 weeks Observation: It was seen that the mean surgically Induced astigmatism in group A (N=112) was 0.5625D , which was slightly lesser than that in Group B (N=112) which was 0.65D, although the p-value of 0.26 indicated that there was statistically no significant difference in visual outcomes between the two groups of patients. Here, a p-value of &lt; 0.05 was considered statistically significant. Conclusion: In Skilled and Safe hands, refractive outcomes following performing a 5.5mm temporal sclerocorneal frown-incision manual small incision cataract surgery and a phacoemulsification procedure by a 2.8mm temporal clear corneal incision extended to 5.5mm for implanting a 5.25mm rigid PMMA IOL , are comparable.

Acute-onset postoperative endophthalmitis after cataract surgery and transzonular intravitreal triamcinolone–moxifloxacin

To report 4 cases of acute postoperative endophthalmitis (POE) after uneventful temporal clear corneal topical dropless cataract surgery involving intravitreal triamcinolone-moxifloxacin (TriMoxi). Private practice in Peoria, IL, USA. Retrospective noncomparative case series. Charts of patients presenting with POE after an uneventful temporal clear corneal phacoemulsification with in-the-bag implantation of a posterior chamber intraocular lens over a 15-month period were reviewed. Patients presented with typical signs and symptoms of acute POE 3 to 14days after cataract surgery. The POE resolved after 25-gauge pars plana vitrectomy and injection of intravitreal vancomycin, ceftazidime, and dexamethasone. Two of 4 eyes were culture-positive for coagulase-negative Staphylococcus. The corrected distance visual acuity at the last follow-up visit was 20/40 or better in 3 eyes, and 20/400 in 1 eye because of underlying atrophic age-related macular degeneration. Postoperative endophthalmitis can occur after dropless cataract surgery with intravitreal triamcinolone-moxifloxacin.

Risk Factors for Early Postoperative Intraocular Pressure Elevation after Phacoemulsification in Trabeculectomized Eyes

Purpose: In this study, we investigated the frequency and risk factors for early postoperative intraocular pressure (IOP) elevation after phacoemulsification in patients with a prior trabeculectomy. Methods: We performed a retrospective chart review of 200 eyes (172 patients, study group) with filtering bleb after previous trabeculectomy and 207 eyes (144 patients, control group) without previous trabeculectomy, who underwent temporal clear corneal phacoemulsification with posterior chamber lens implantation. Twelve possible risk factors including age, gender, glaucoma type, interval from trabeculectomy to phacoemulsification, axial length, preoperative IOP, preoperative bleb morphology (height, vascularity), glaucoma medication, and concomitant intraoperative procedures (iris manipulation, anterior vitrectomy, subconjunctival mitomycin C injection) were analyzed to identify independent risk factors using a multivariate logistic regression method. Early postoperative IOP elevation was defined as IOP value ≥ 25 mm Hg or an IOP increase ≥ 10 mm Hg the morning after surgery compared to the preoperative IOP. Results: There was a significant difference in the frequency of IOP elevation between the study group (25 eyes, 12.5%) and control group (6 eyes, 2.9%; p < 0.001). The mean early postoperative IOP (15.2 ± 6.7 mm Hg) was significantly higher than preoperative IOP (12.5 ± 4.4 mm Hg) in the study group (p < 0.001). Risk factors for early postoperative IOP elevation were low bleb height (odds ratio; OR = 9.995, p = 0.003) and iris manipulation (OR = 4.831, p = 0.026) in the study group while risk factors were preoperative use of glaucoma medication (OR = 3.492, p = 0.004) and iris manipulation (OR = 34.249, p = 0.009) in the control group. Conclusions: Phacoemulsification increases the risk of IOP spike in prior trabeculectomized eyes, especially those with low bleb height and intraoperative iris manipulation. We suggest intraoperative and postoperative efforts to minimize intraocular inflammation and earlier follow-up examination in these patients. J Korean Ophthalmol Soc 2014;55(11):1659-1668

Evaluation and comparison of surgically induced astigmatism between phacoemulsification and small incision cataract surgery

Background: Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery. Aim: The aim of study was to compare the incidence, amount, type, and course of surgically induced astigmatism and visual acuity in temporal 5.5-mm clear corneal phacoemulsification and 6-mm superior scleral incision in Small incision cataract surgery (SICS). Materials and Methods: A total of 200 eyes of 200 patients with a mean age of 62 years were included in the study. Cases were randomly divided into two groups. Group A had undergone 5.5-mm temporal clear corneal phacoemulsification and group B had undergone 6-mm superior scleral SICS. Surgically induced astigmatism was analyzed by SIA software. Results: Mean age in group A was 61 (±8) years and in group B was 63 (±10) years. Mean surgically induced astigmatism in group A was 1.05 (±0.58) D, 1.13 (±0.52) D, 1.13 (±0.56) D, and 1.08 (±0.52) D on 1 st , 7 th , 21 st , and 45 th postoperative days, respectively. The change from 1 st to 45 th day was not significant. The same in group B was 0.75 (±0.58) D, 0.81 (±0.54) D, 0.88 (±0.49) D, and 0.91 (±0.47) D on 1 st , 7 th , 21 st , and 45 th postoperative days, respectively. Surgically induced astigmatism was comparable on all days between the groups. We found significant with the rule and against the rule type of astigmatism post-operatively in the temporal clear corneal incision in phacoemulsification group and in superior scleral incision in small incision cataract surgery group respectively. Conclusion: Surgically induced astigmatism was higher in the 5.5-mm temporal clear corneal group than in the superior scleral group. Clinical outcome of both surgeries was same, as there was no significant difference in the uncorrected postoperative visual acuity in between the groups.

Descemet′s membrane detachment managed with perfluro-n-octane liquid

We report the case of a 68-year-old male who developed Descemet's membrane detachment after temporal clear corneal phacoemulsification which did not settle with air or viscoelastic injection. The Descemet's membrane was successfully reattached with restoration of 20/50 vision with the help of perfluro-n-octane liquid. To our knowledge, this is the first such case to be reported.

Intraocular pressure change after temporal clear corneal phacoemulsification in normal eyes

To evaluate short- and long-term intraocular pressure (IOP) changes after temporal clear corneal phacoemulsification in normal eyes. The charts of 266 consecutive non-glaucoma patients who underwent uneventful cataract surgery were reviewed. We recorded preoperative and postoperative (1 day, 1 week, 1 month, 3 months, 6 months, 1 year and 2 years) IOP measurements as well as anatomical properties obtained using Zeiss Humphrey IOL Master (Zeiss Meditech, Dublin, California, USA). Mean IOP reduction after cataract surgery was 8.2%, 4.6%, 6.7% and 7.8% at 3 months, 6 months, 1 year and 2 years, respectively. Lens thickness was the only anatomical characteristic that correlated significantly with IOP decrease after surgery. Temporal clear corneal phacoemulsification results in a decrease in postoperative IOP that persists for 2 years following surgery.

Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: One-year results

To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm canal, a new nonpenetrating surgical procedure (canaloplasty) to treat open-angle glaucoma (OAG), combined with clear corneal phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Multicenter surgical sites. This international multicenter prospective study comprised adult patients with OAG having combined glaucoma and cataract surgery. Patients with qualifying treated preoperative intraocular pressure (IOP) of at least 21 mm Hg or higher and open angles were eligible. Evaluation was performed at baseline and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraoperative and postoperative high-resolution ultrasound imaging was used to assess Schlemm canal and anterior segment angle morphology, including distension of the trabecular meshwork due to the tensioning suture. Data from 54 eyes that had combined glaucoma and cataract surgery performed by 11 surgeons at 9 study sites were analyzed for this interim analysis. The mean baseline IOP was 24.4 mm Hg+/-6.1 (SD) with a mean of 1.5+/-1.0 medications per eye. In all eyes, the mean postoperative IOP was 13.6+/-3.8 mm Hg at 1 month, 14.2+/-3.6 mm Hg at 3 months, 13.0+/-2.9 mm Hg at 6 months, and 13.7+/-4.4 mm Hg at 12 months. Medication use dropped to a mean of 0.2+/-0.4 per patient at 12 months. Surgical complications were reported in 5 eyes (9.3%) and included hyphema (n=3, 5.6%), Descemet tear (n=1, 1.9%), and iris prolapse (n=1, 1.9%). Transient IOP elevation of more than 30 mm Hg was observed in 4 eyes (7.3%) 1 day postoperatively. Circumferential viscodilation and tensioning of Schlemm canal combined with clear corneal phacoemulsification and posterior chamber IOL implantation was a safe and effective procedure to reduce IOP in adult patients with OAG.

Ex-PRESS R-50 miniature glaucoma implant insertion under the conjunctiva combined with cataract extraction

To evaluate the efficacy and safety of the Ex-PRESS R-50 implant (Optonol Ltd.) in eyes operated on for open-angle glaucoma combined with phacoemulsification. Glaucoma Unit, Ophthalmology Department, University of Lausanne, Lausanne, Switzerland. Between November 2000 and June 2002, the Ex-PRESS R-50 shunt was implanted in 35 eyes of 35 patients. The best corrected visual acuity (BCVA), intraocular pressure (IOP), number of medications, and complications were recorded preoperatively as well as postoperatively at 1 and 7 days and 1, 2, 3, 6, 9, 12, 24, 36, and 48 months. Temporal clear corneal phacoemulsification with intraocular lens implantation was performed first. The ophthalmic viscosurgical device was not removed, and the Ex-PRESS R-50 was implanted under the conjunctiva into the anterior chamber. The mean follow-up was 36.9 months +/- 18.2 (SD) and the mean age of the patients, 74.6 +/- 10.9 years. The mean preoperative IOP of 19.3 +/- 6.3 mm Hg decreased postoperatively to 15.3 +/- 6.2 mm Hg, 15.1 +/- 4.6 mm Hg, 13.8 +/- 2.8 mm Hg, 14.6 +/- 2.9 mm Hg, and 13.3 +/- 2.0 mm Hg at 6 months, 12 months, 24 months, 36 months, and 48 months, respectively (P<.005). At 48 months, the mean BCVA was 0.74 +/- 0.34 and the number of medications was reduced by 57% (P<.005). The microtube was removed in 10 patients, and bleb management was performed in 10 eyes. Ten patients (32%) had satisfactory IOP control (mean 13.2 +/- 2.2 mm Hg) without medication; minor transient complications were observed in 10 patients. Based on the cumulative survival curve after 48 months, the complete success rate was 32.7% and the qualified success rate, 53.7% (P<.05). Ex-PRESS R-50 implantation under the conjunctiva was associated with a relatively high number of complications, despite good IOP control in the uncomplicated cases. Refinement in the tube design and implantation technique would increase the success rate.

Incisiones limbares relajantes y cirugía de la catarata: nuestra experiencia

To evaluate the reduction of pre-existing corneal astigmatism at the time of cataract surgery with limbal relaxing incisions (LRIs). A prospective study of two groups of patients (treatment and control) with pre-existing astigmatism>or=1D was performed. The 30 patients in the control group had a temporal clear corneal phacoemulsification and the 32 patients of treatment group had combined temporal clear corneal phacoemulsification and LRIs. Holladay analysis was used to assess the efficacy of treatment. An astigmatism distribution and prevalence study in our population is also presented. Three months after surgery, the mean astigmatism change was -0.55D (-0.75 to -0.35) in the treatment group and 0.04D (-0.3 to 0.3) in the control group (p<.0001). LRI is a simple, safe and effective method not only for reducing pre-existing astigmatism during cataract surgery but in providing good unaided visual acuity.

Effect of temporal clear corneal phacoemulsification on intraocular pressure in eyes with prior Ahmed glaucoma valve insertion

To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes after Ahmed glaucoma valve insertion. Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. The files of 13 patients who received phacoemulsification after Ahmed glaucoma valve insertion were reviewed in this retrospective case series. Visual acuity, IOP, and the number of glaucoma medications before phacoemulsification were used as a baseline for comparison with the values at various follow-up intervals. The mean IOP before phacoemulsification was 15.1 mm Hg +/- 3.6 (SD). Postoperatively, it was 12.8 +/- 4.5 mm Hg, 13.1 +/- 3.6 mm Hg, 16.4 +/- 5.2 mm Hg, 15.8 +/- 4.0 mm Hg, 16.1 +/- 3.9 mm Hg, 15.3 +/- 4.1 mm Hg, and 15.2 +/- 3.4 mm Hg at 1 day after 1 week, at 1, 2, 6, and 12 months, and at last visits, respectively. The mean IOP did not differ significantly from the prephacoemulsification value at any follow-up. The number of glaucoma medications increased significantly after phacoemulsification (P = .031), and 6 of 13 eyes required additional glaucoma medication because of IOP elevation at approximately 1 month. Temporal clear corneal phacoemulsification did not increase IOP significantly in eyes with prior Ahmed glaucoma valve insertion. However, some eyes experienced an IOP elevation 1 month after phacoemulsification and required glaucoma medication.

Intraocular pressure control after clear corneal phacoemulsification in eyes with previous trabeculectomy: a controlled study

To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy. The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression. Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates. Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.

Acute Staphylococcus aureus wound infection after temporal clear corneal phacoemulsification

Acute Staphylococcus aureus wound infection after temporal clear corneal phacoemulsification

Multifocal intraocular lens implantation in patients with traumatic cataract

Objective To evaluate the postoperative outcome and complication rate of cataract extraction with implantation of a zonal-progressive multifocal intraocular lens (IOL) for traumatic cataract. Design Prospective, nonrandomized, comparative trial. Participants Fifty-one eyes of 51 subjects with traumatic cataract caused by nonpenetrating, penetrating, and perforating ocular trauma at two university institutions with more than 12 months follow-up. Interventions Temporal clear corneal phacoemulsification with foldable IOL implantation was performed in all eyes. In 29 subjects, a zonal-progressive optic multifocal IOL (Array SA40-N Allergan, Irvine, CA) was implanted, whereas 22 subjects received a monofocal IOL and served as controls. Results Preoperative subjects demographics, mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuity were similar in the two groups. Subjects with a multifocal IOL achieved a significantly better uncorrected near visual acuity than subjects with monofocal IOL (0.24 vs. 0.40; P = 0.0001). With distance correction only, mean near visual acuity was 0.21 vs. 0.43 ( P = 0.0001). Best-corrected near visual acuity was 0.17 for both groups ( P = 0.91), with +1.24 diopters (D) for the multifocal group and +2.45 D for the monofocal group ( P = 0.0001). Spectacle dependency differed significantly between the two groups, with 18 (81%) subjects of the monofocal group commonly requiring an additional plus add for near tasks compared with 5 (17%) subjects in the multifocal group ( P = 0.001). Stereopsis was superior in the multifocal group ( P < 0.001), with 20 (69%) and 16 (55%) patients with a multifocal IOL responding positively to the Lang and Titmus tests, respectively. In the monofocal group, only eight (36%) and five (22%) subjects gave correct answers. Conclusions Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in subjects with traumatic cataract.

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy

Purpose To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. Setting Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months ± 21 (SD) and the mean follow-up after phacoemulsification, 23 ± 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used. Results Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant ( P = .04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant ( P = .002 and P = .05, respectively). Conclusions Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.

Cataract surgery under topical anesthesia in patients with coexisting glaucoma

Purpose: To evaluate and compare levels of patient discomfort and complications during phacoemulsification with implantation of a foldable intraocular lens (IOL) under topical lidocaine hydrochloride in patients with and without various forms of chronic open-angle and chronic angle-closure glaucoma. Setting: Two university eye centers in Germany. Methods: This prospective nonrandomized comparative study comprised 176 eyes of 176 patients with various forms of chronic open-angle glaucoma and chronic angle-closure glaucoma. Eyes with cataract and without a glaucoma diagnosis or history of intraocular surgery served as a control group (n = 212). All patients received a minimum of 5 doses (2 drops per dose) of topical lidocaine hydrochloride 2% before standard temporal clear corneal phacoemulsification and foldable IOL implantation. No intracameral anesthetic injection was given, and no systemic sedatives were used. The main outcome measures were the number of complications and adverse events. Results: The intraoperative complication rate in all patients (n = 388) was capsule tear, 1.3%; zonule tear, 1.8%; vitreous loss, 1.0%; iris prolapse, 0.8%. No statistically significant differences in intraoperative or early postoperative complications were found between the glaucoma and control groups. The mean pain scores of patients were 0.38 ± 1.1 (SD) in the glaucoma group and 0.36 ± 0.8 in the control group ( P = .21) Patient preference for cataract surgery under topical anesthesia was similar in both groups. Conclusions: Surgery-related complications and patient discomfort were similar in patients with and without glaucoma who had phacoemulsification and IOL implantation under topical anesthesia. These results indicate that topical anesthesia is safe for routine phacoemulsification with foldable IOL implantation in patients with glaucoma and does not compromise patient comfort.