... D. usually places a protective shield over your eye. Cataract surgery recovery You will spend a short period of ... Safety Infographic IOL Implants: Lens Replacement and Cataract Surgery - Eye M.D.-approved information from EyeSmart Related Answers ...
Full Text Available With the aging population also increased the incidence of cataract, cataract has become the most common cause of blindness in the developing countries, the blind and vision damage has become a serious public, social and economic problem in developing countries. Although cataract surgery is the most cost-effective intervention, but to provide cataract surgical services in developing countries, there are still a lot of problems and challenges, manual small incision cataract surgery in the treatment of cataract in the past 10 years in some countrie shave achieved good results. In addition, the development of the different mode of the sustainable development of the prevention of blindness in these developing countries is also a challenge. We did a review of cataract surgery in developing countries in recent years.
Full Text Available Security and perfect vision and fewer complications are our goals in cataract surgery, and hard-nucleus cataract surgery is always a difficulty one. Many new studies indicate that micro-incision phacoemulsification in treating hard nucleus cataract is obviously effective. This article reviews the evolution process of hard nuclear cataract surgery, the new progress in the research of artificial intraocular lens for microincision, and analyse advantages and disadvantages of various surgical methods.
Full Text Available The management of congenital cataract is very different to the treatment of a routine age-related cataract. In adults, surgery may be delayed for years without affecting the visual outcome. In infants, if the cataract is not removed during the first year of life, the vision will never be fully regained after surgery. In adults, if the aphakia is not corrected immediately, it can be corrected later. In young children, if the aphakia is not corrected, the vision will never develop normally.
David Yorston FRCS FRCOphth
Intraoperative wavefront aberrometry is a relatively new technology that aims to improve refractive outcomes following cataract surgery by optimizing the spherical power of the intraocular lens implant or calculating the appropriate axis and power of toric lenses during cataract surgery in an aphakic state. This article reviews the literature on intraoperative wavefront aberrometry and provides a critical assessment of the benefits and shortcomings of that technology. PMID:23163261
Hemmati, Houman D; Gologorsky, Daniel; Pineda, Roberto
Cataract surgery with femtosecond lasers is approaching its practical application in ophthalmology. These lasers, working in the near infrared wavelength (1030 nm) can penetrate the transparent and even opaque tissues of the anterior segment of the eye, with limitations related to vessels and mineral opacities. Femtosecond lasers, guided by image systems can precisely outline the anatomy of the anterior segment of the eye, acting in a very precise way, performing corneal incisions, capsulorhexis, softening and breaking of the nucleus, which are essential steps in cataract surgery. In this article we summarize the four technologies available and approaching commercial application in the coming future. The main differences between the systems are based on the diagnostic imaging techniques, which might either be based on optical coherence tomography or the Scheimpflug principles. One model (the Technolas Femtec 520 F custom lens, 20/10 Perfect Vision), offers the possibility of combined use in corneal and intraocular surgery. While clinical studies are being performed with all of them, and most probably becoming available on the market during 2011 and 2012, the main problem of this emerging technology is its practical application as the increase in costs will affect their availability in the market of cataract surgery. Research is needed to confirm the practicality and the advantages of femtosecond laser cataract surgery over conventional surgery. Meanwhile, a new path for the future of cataract surgery is opening.
Alio, Jorge L.
AIMS—To analyse the clinical and sociodemographic characteristics associated with second eye cataract surgery.?METHODS—An observational, longitudinal study of patients scheduled for first eye cataract surgery that did not involve a combined procedure was carried at two teaching hospitals and one non-teaching hospital in Barcelona, Spain. Patients were followed for 2 years after first eye cataract surgery to assess whether and when they had undergone second eye cataract surgery. Cli...
Castells, X.; Alonso, J.; Ribo, C.; Nara, D.; Teixido, A.; Castilla, M.
Since the introduction of sutureless clear corneal cataract incisions, the procedure has gained increasing popularity worldwide because it offers several advantages over the traditional sutured scleral tunnels and limbal incisions. Some of these benefits include lack of conjunctival trauma, less discomfort and bleeding, absence of suture-induced astigmatism, and faster visual rehabilitation. However, an increasing incidence of postoperative endophthalmitis after clear corneal cataract surgery has been reported. Different authors have shown a significant increase up to 15-fold in the incidence of endophthalmitis following clear corneal incision compared to scleral tunnels. The aim of this report is to review the advantages and disadvantages of clear corneal incisions in cataract surgery, emphasizing on wound construction recommendations based on published literature. PMID:24669142
Al Mahmood, Ammar M; Al-Swailem, Samar A; Behrens, Ashley
Cataract is the most common cause of curable blindness in Nigeria. Nigeria has an overall population of approximately 110 million with a blindness prevalence rate of 1%. Cataract is responsible for 30 - 60% of the blindness. A great deal of blindness prevention activity should therefore centre around cataract surgery if we are to clear out cataract back log of over 1/2 a million individuals. Only 106 cataract surgeries were performed in the 24 months reviewed. There were 75 males and 31 females. This study highlights the meagre contribution of teaching hospitals to the prevention of blindness. Several factors including ignorance, poverty, socioeconomic and political tensions and teaching hospital bureaucracy are no doubt responsible for this. Hospitalization for cataract surgery is becoming very unpopular in the developed world as this tends to increase cost of surgery. The need to establish cataract surgery outreach services and adopt day case surgical procedures in our hospitals cannot be over emphasized as strategies for clearing our national cataract backlog. PMID:12744558
Osahon, A I
PURPOSE: To investigate the effects of alpha-1 adrenergic receptor antagonists for the treatment of benign prostatic hyperplasia (BPH) regarding potential risks of complications in the setting of cataract surgery. AIM: To address recommendations, optimal control therapy, voiding symptoms and safety within the setting of cataract surgery. MATERIALS AND METHODS: A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords "benign prostatic hyperplasia", ...
Full Text Available PURPOSE: To investigate the effects of alpha-1 adrenergic receptor antagonists for the treatment of benign prostatic hyperplasia (BPH regarding potential risks of complications in the setting of cataract surgery. AIM: To address recommendations, optimal control therapy, voiding symptoms and safety within the setting of cataract surgery. MATERIALS AND METHODS: A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords "benign prostatic hyperplasia", "intraoperative floppy iris syndrome", "adrenergic alpha-antagonist" and "cataract surgery". In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2009. RESULTS: The first report of intraoperative floppy iris syndrome (IFIS was observed during cataract surgery in patients taking systemic alpha-1 AR antagonists in 2005. It has been most commonly seen related to use of tamsulosin. Changes of medication and washout periods of up to 2 weeks have been attempted to reduce the risk of complications in the setting of cataract surgery. CONCLUSION: Patients under clinical treatment for BPH should be informed about potential risks of this drug class so that it can be discuss with their healthcare providers, in particular urologist and ophthalmologist, prior to cataract surgery.
The high prevalence of blindness associated with cataract is an urgent public health issue. Femtosecond (FS) laser offers several advantages over conventional laser, such as high penetration, short pulse-duration and micro-precision. Since 2009, several types of FS laser systems have been applied to cataract surgery, offering novel approaches to the three steps of clear corneal incision (CCI) construction, anterior capsulotomy and lens fragmentation. Superior accuracy, predictability, reproducibility and safety have been achieved with use of this innovative technology. However, certain problems remain unresolved. More studies are needed to clarify the optimal utilization of FS in cataract surgery. The purpose of this review is to outline the features, applications, benefits and risks of FS in cataract surgery, and to discuss current scientific evidence and relevant commercial issues. PMID:22447555
Yu, Yinhui; Yao, Ke
A case of planned routine extracapsular cataract extraction is described where surgery was complicated peroperatively by fracture of the posterior chamber lens implant. The technique of lens implantation is discussed.
Kirkpatrick, J. N.; Cook, S. D.
The aim of this paper is to illustrate the techniques of cataract surgery with implantation of intraocular lenses and some physical properties of the used materials. The new technology, coupled with extensive experience and the studied cases, permits to increase the standardization and accuracy of the engravings, by reducing the use and handling of surgical instruments inside the eye. At present it is possible to replace the cataract with crystalline lenses based on biopolymers such as PMMA, silicone, acrylic hydrophilic and hydrophobic acrylic. These materials are increasingly able to replace the natural lens and to ensure the fully functional of the eye. The role of femtosecond lasers in cataract surgery, to assist or replace several aspects of the manual cataract surgery, are discussed.
Roszkowska, A. M.; Torrisi, L.
Nowadays cataract surgery is refractive surgery as well. Intraocular lens implantation is gold standard, but there is plenty types of intraocular lenses, monofocal, multifocal, accommodating, and toric. Problem is to pick up correct one according life style, profession, health status and age. The aim is review current possibilities in cataract, refractive surgery and aphakia management. PMID:23837247
Full Text Available Because silicone oil's special physical and chemical properties, they are widely used in the vitreous retinal surgery, but the complications have aroused the concern of eye doctors, particularly, the complicated cataract. Nowadays, there are different kinds of surgery for silicone oil filling complicated cataract, but our aim is to choose a method which can be safe, effective and economical. This article reviews the progress in the research of silicone oil filling complicated cataract surgery.
The use of sodium hyaluronate in cataract surgery and intraocular lens implantation is often followed by a postoperative rise of intraocular pressure. A trial is described in which 10 patients underwent bilateral cataract extraction and Binkhorst intraocular lens implantation with the use of sodium hyaluronate. The enzyme hyaluronidase was instilled into the anterior chamber of the right eye only, to aid removal of sodium hyaluronate, and resulted in a statistically significant lowering of po...
The development of intraocular pressure (IOP) following standard cataract surgery is extremely dependent on the type of glaucoma and the prognosis is especially good for primary angle-closure glaucoma. Cataract extraction usually induces a mid-term and long-term increase of IOP in a well-working filtering bleb. Concerning the choice of intraocular lens (e.g. multifocal or toric) the surgeon has to consider the probability of subsequent incisional glaucoma surgery and the risk of decentration of the capsular bag (e.g. in exfoliative glaucoma or hydrophthalmos). According to the results of recent studies topical prostaglandin therapy does not seem to increase the risk of postoperative macular edema if given before cataract surgery. PMID:23519499
Dietlein, T S; Kohnen, T; Rosentreter, A; Lappas, A
Background/Aim. Cataract surgery has become one of the safest procedures in medicine thanks to advances in technology and surgical techniques. Although minimal, we still witness different complications. The aim of this study was to compare visual outcome and complication rate in different techniques of cataract surgery, ie in cataract surgeries with various corneal incision width. Methods. The study included 3,457 consecutive patients, ie 4,670 eyes that had undergone cataract surgery. ...
A randomized single blinded clinical trial to compare the cost-effectiveness of cataract surgery between extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was conducted at Hospital Universiti Kebangsaan Malaysia (HUKM) from March 2000 until August 2001. The cost of a cataract surgery incurred by hospital, patients and households were calculated preoperatively, one week, two months (for both techniques) and six months (for ECCE only). Effectiveness of cataract surgery w...
Manaf, Mohd R. A.; Aljunid, Syed M.; Annuar, Faridah H.; Leong, Chuah K.; Normalina Mansor
Intrastromal corneal inlays are an emerging treatment for presbyopic patients. The KAMRA™ small aperture inlay was the first such inlay to receive Conformité Européenne (CE) marking in 2005. It has been shown to improve uncorrected near and intermediate visual acuity without adversely affecting uncorrected distance visual acuity. Due to the age of presbyopic patients, they may eventually develop cataracts. In two such cases, we found that cataract surgery with the KAMRA implant left in place was not technically more difficult, and that the surgical procedure could be improved by additional ocular rotations to improve visualization. Biometry readings were reliable, and it appeared that the SRK/T formula was accurate for calculation of intraocular lens power. Cataract surgery with the KAMRA implant left in situ is a viable option for patients. PMID:24092969
Tan, Tien-En; Mehta, Jodhbir S
Full Text Available Abstract Background If decisions on health care spending are to be as rational and objective as possible, knowledge on cost-effectiveness of routine care is essential. Our aim, therefore, was to evaluate the cost-utility of routine cataract surgery in a real-world setting. Methods Prospective assessment of health-related quality of life (HRQoL of patients undergoing cataract surgery. 219 patients (mean (SD age 71 (11 years entering cataract surgery (in 87 only first eye operated, in 73 both eyes operated, in 59 first eye had been operated earlier filled in the 15D HRQoL questionnaire before and six months after operation. Direct hospital costs were obtained from a clinical patient administration database and cost-utility analysis performed from the perspective of the secondary care provider extrapolating benefits of surgery to the remaining statistical life-expectancy of the patients. Results Mean (SD utility score (on a 0–1 scale increased statistically insignificantly from 0.82 (0.13 to 0.83 (0.14. Of the 15 dimensions of the HRQoL instrument, only seeing improved significantly after operation. Mean utility score improved statistically significantly only in patients reporting significant or major preoperative seeing problems. Of the subgroups, only those whose both eyes were operated during follow-up showed a statistically significant (p Conclusion Mean utility gain after routine cataract surgery in a real-world setting was relatively small and confined mostly to patients whose both eyes were operated. The cost of cataract surgery per quality-adjusted life year gained was much higher than previously reported and associated with considerable uncertainty.
Abstract Aims: To measure spectacle dependence following bilateral monofocal intraocular lens (IOL) implantation and assess how it is predicted by post-operative refraction. Methods: 300 cataract patients had bilateral phacoemulsification surgery with monofocal IOL implantation. A spherical equivalent of 0 to -0.5 D was targeted. Three months after surgery patients were interviewed about spectacle dependence and refracted. Refractions were converted into vector notat...
We used the Honan intraocular pressure reducer, a balloon that applies a constant force, to the eyes in ten subjects with senile cataracts. An initially significant decrease in intraocular pressure after removal disappeared exponentially with a half-time of 9.6 minutes, indicating that the benefits derived from the Honan balloon do not result from a sustained reduction in intraocular pressure. Measurements made on a phantom eye showed both marked variability and unexpectedly high intraocular ...
Ernest, J. T.; Goldstick, T. K.; Stein, M. A.; Zheutlin, J. D.
Small incision cataract surgery (SICS) is one of the cataract surgical techniques commonly used in developing countries. This technique usually results in a good visual outcome and is useful for high-volume cataract surgery.1–3This article describes how to minimise surgical complications in SICS.
Reeta Gurung; Albrecht Hennig
Full Text Available Small incision cataract surgery (SICS is one of the cataract surgical techniques commonly used in developing countries. This technique usually results in a good visual outcome and is useful for high-volume cataract surgery.1–3This article describes how to minimise surgical complications in SICS.
Full Text Available Tien-En Tan,1,2 Jodhbir S Mehta2–4 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 2Singapore National Eye Centre, Singapore; 3Singapore Eye Research Institute, Singapore; 4Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore Abstract: Intrastromal corneal inlays are an emerging treatment for presbyopic patients. The KAMRA™ small aperture inlay was the first such inlay to receive Conformité Européenne (CE marking in 2005. It has been shown to improve uncorrected near and intermediate visual acuity without adversely affecting uncorrected distance visual acuity. Due to the age of presbyopic patients, they may eventually develop cataracts. In two such cases, we found that cataract surgery with the KAMRA implant left in place was not technically more difficult, and that the surgical procedure could be improved by additional ocular rotations to improve visualization. Biometry readings were reliable, and it appeared that the SRK/T formula was accurate for calculation of intraocular lens power. Cataract surgery with the KAMRA implant left in situ is a viable option for patients. Keywords: cataract surgery, KAMRA, corneal inlay, AcuTarget, presbyopia
Cataract is the first blinding eye disease in the world and China. However, due to various reasons, cataract surgery rate (CSR) in China is much lower than in developed countries and even some developing countries. Properly and standardized training of cataract surgery for ophthalmologists from primary hospital and young eye doctors is one of the key point to improve CSR. For above, we had explored actively to establish an appropriate and suitable training model of cataract surgery. Ophthalmologist in primary hospital can provide high quality medical services to cataract patients in accordance with their own conditions after training and promote the sustainable development of blindness prevention work. PMID:24841809
LF Porter1, RU Khan2, A Hannan3, SP Kelly11Royal Bolton Hospital NHS Foundation Trust, Bolton, UK; 2Departments of Microbiology, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK; 3Haughton Thornley Medical Centers, NHS Tameside and Glossop, UKIntroduction: Postoperative bacterial endophthalmitis is a devastating complication of cataract surgery. Methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis is rare. Recent debate over MRSA screening in United Kingdom (UK) National H...
Full Text Available Cataract surgery is most common in human surgery and comprises 80% of eye surgery programs. Owing to sophisticated technologies, it has become a routine surgery with lowered complications rate; hence, the functional outcome is more conditioned by operative trauma. The aim of this study was to demonstrate the significance of specular microscopy in the evaluation of operative trauma during extra-capsular cataract extraction (ECCE and phacoemulsification (P, in a controlled environment. The study included 100 consecutive patients who met the established criteria, and groups were formed according to the type of surgery by the assignment of successive numbers from a random number table. Examination and photographs of the corneal endothelium, as well as pachymetry were performed on Keeler-Konan Poclington Specular Microscope (KSP. The obtained results revealed significant dissimilarity in endothelial cell reduction (9.17% in group E, and 4.72% in group P, which generated statistically significant correlation of pre-operative and post-operative pachymetry in the group E (p=0.0004. On the basis of the results obtained by specular microscopy, it was concluded that under the same conditions phacoemulsification caused reduced operative trauma of the corneal endothelium.
?urovi? Branislav M.
Full Text Available Deepa R Anijeet, Prasad Palimar, Clive O PeckarDepartment of Ophthalmology, Warrington and Halton NHS Trust, UKAim: To compare the incidences of endophthalmitis after cataract operations before and after introduction of intracameral vancomycin at the end of surgery.Methods: A retrospective analysis was performed of presumed infectious endophthalmitis after cataract surgery from January 1, 1998 to December 31, 2008. From January 2001, the practice of using intracameral vancomycin at the end of cataract surgery was introduced. The period before introduction of intracameral vancomycin is considered as period A and that after as period B. The incidences of presumed or culture-proven endophthalmitis during periods A and B were compared.Results: A total of 16,606 cataract surgeries were performed during the study period. The incidence of endophthalmitis per 1000 cataract surgeries was 3.0 during period A and 0.08 during period B. This reduction was statistically significantly (Chi-squared test 36.6, P value < 0.0001. The relative risk of developing endophthalmitis without intracameral vancomycin prophylaxis was 38. The absolute risk reduction was 292 cases of endophthalmitis per 100,000 cataract surgeries.Conclusions: Intracameral vancomycin significantly reduced the incidence of postoperative endophthalmitis after cataract surgery. There is a universal need to adopt this mode of microbial prophylaxis to reduce the burden of endophthalmitis after cataract surgery.Keywords: endophthalmitis, intracameral vancomycin, cataract surgery
Deepa R Anijeet
Incision size in micro-incisional cataract surgery (MICS) is dependent on the minimal size of the folded or rolled intraocular lens (IOL) during implantation and thus the outer diameter of the injector system used. At present implantations through incisions IOLs have to be optimized for this small dimension in terms of material and lens body design. Compared to standard procedures, MICS induces little astigmatism and higher order aberrations. Thus MICS procedures provide better predictability in terms of postoperative refractive results. This is of special interest when implanting advanced optic designs, such as aspheric, toric or multifocal IOLs. PMID:20107811
Kohnen, T; Klaproth, O K
Full Text Available Femtosecond laser-assisted cataract surgery performs the anterior capsulotomy, lens fragmentation, corneal incisions making and astigmatic limbal relaxing incision with femtosecond laser, which effectively reduces the complications of conventional phacoemulsification surgery and improves the postoperative visual quality of patients. It further improves the technology and effect of cataract surgery and has broad clinical application prospects. This paper compares pros and cons as well as the clinical values of femtosecond laser-assisted cataract surgery with conventional phacoemulsification surgery based on the overview of published articles.
Full Text Available Jonathan S Chang, Harry W Flynn Jr, Darlene Miller, William E Smiddy Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA Background: Stenotrophomonas maltophilia is a Gram-negative organism known to cause opportunistic infections. It is a rare source of endophthalmitis, often in the setting of trauma, but has been reported following cataract extraction. The purpose of this study was to evaluate antimicrobial sensitivities, clinical characteristics, and treatment outcomes in patients with endophthalmitis caused by S. maltophilia following cataract extraction. Methods: A retrospective case review of records from January 1, 1990 to June 30, 2010 was performed at the Bascom Palmer Eye Institute. Results: Eight cases of S. maltophilia endophthalmitis were identified following cataract surgery. Initial visual acuity ranged from 20/200 to light perception. Time to diagnosis with cultures was 2–118 days. Patients received either intravitreal tap and inject (n = 5 or pars plana vitrectomy with intravitreal antibiotic injections (n = 3. All patients had vitreous or anterior chamber cultures positive for S. maltophilia. Seven of seven isolates tested were found to be sensitive to ceftazidime. Seven of eight isolates were sensitive to polymyxin B, six of eight isolates were sensitive to amikacin, and five of the seven isolates tested were sensitive to ciprofloxacin. Two of four tested isolates were sensitive to trimethoprim-sulbactam. All eight isolates were resistant to gentamicin and seven of the seven tested isolates were resistant to imipenem. All patients received intravitreal ceftazidime as part of the initial treatment regimen. Final visual acuity ranged from 20/25 to 4/200. Conclusion: S. maltophilia endophthalmitis is a rare source of endophthalmitis following cataract surgery. A case series of eight independent patients is reported, along with antibiotic resistance profiles and clinical outcomes. Isolates showed sensitivity to ceftazidime, amikacin, and polymyxin, with variable sensitivity to other antibiotics, therefore differing from previous reports. Keywords: endophthalmitis, Stenotrophomonas maltophilia, cataract
Full Text Available Perfect vision and fewer complications is our goal in cataract surgery, femtosecond laser-assisted cataract surgery hold the promise. Applications of femtosecond laser technology for capsulotomy, nuclear fragmentation and corneal incision in cataract surgery bring a new level of accuracy, reproducibility and predictability over the current cataract surgery. The femtosecond laser produces capsulotomies that are more precise, accurate, reproducible, and stronger than those created with the conventional manual technique, and further helps maintain proper positioning of the IOL. Femtosecond laser in nuclear fragmentation lead to a lower effective phacoemulsification time, and the corneal incision is more stable. But currently there are some complications and a clear learning curve associated with the use of femtosecond lasers for cataract surgery. The long-term safety and visual outcomes still need further investigation.
Full Text Available Background : A review of pediatric cataract cases operated between January 2003 and March 2005 in the tribal belt of central India was carried out. Aim : We present the profile of cataract cases in children ?18 years and postoperative visual status in the eyes operated upon. Settings and design : This was a retrospective medical record retrieval type of cohort study in a hospital setting. materials and Methods : Pediatric ophthalmologists examined children and operated eyes with cataract. The personal profile, preoperative, intraoperative and postoperative details were noted. The surgical procedures included cataract extraction, intraocular lens implantation, posterior capsulorrhaxis and anterior vitrectomy in most of the cases. We evaluated the visual status of eyes with cataract before and 6 weeks after surgery. Statistical analysis: We used univariate type of parametric type of statistical analysis. Results: A total of 575 eyes of 502 children had cataract. Cataract in 65 children was bilateral and in 437 cases it was unilateral. Congenital cataracts were in 88 (17.5% eyes. Traumatic cataracts were noted in 170 (33.9% eyes. The proportion of cataract was higher in males than in females. Variation in ?number of cataracts? among different age groups was noted. Vision following surgery was more than 6/18 in 84 (16.4% eyes. The vision could not be assessed in 256 (44% eyes. Conclusion: Improvement of child health care is needed for early detection of cataract in children. Role of rubella and trauma in childhood cataract should be investigated and addressed. Visual assessment and postoperative care should be further improved.
We present two patients with active, foul-smelling, methicillin-resistant Staphylococcus aureus (MRSA) wounds of the forehead and sternum following craniotomy or open heart surgery. Both had debilitating cataracts and were told by the infectious diseases team that cataract surgery is very risky. Both underwent sequential bilateral phacoemulsification with no sign of infection. Patients with active MRSA wound infections may safely undergo cataract surgery with additional precautions observed intraoperatively (good wound construction) and postoperatively (topical antibiotics and close observation). Banning such surgeries can unnecessarily jeopardize the lifestyles of such patients.
Mansour, Ahmad M; Salti, Haytham I
Full Text Available Abstract Background To determine the rate of glaucoma following congenital cataract surgery at Moorfields Eye Hospital (MEH, and to investigate potential risk factors for glaucoma in our case series. Methods A retrospective case notes review was undertaken of all congenital cataract lensectomies performed at MEH between 1994 and 2000. The following parameters were ascertained: age at surgery, unilateral or bilateral cataract, whether a posterior capsulotomy (PC was performed at the time of surgery, whether an intraocular lens (IOL was inserted, duration of follow-up, and if aphakic glaucoma (AG developed. All lensectomies were performed through a limbal incision by a single consultant surgeon. Results A total of 47 subjects were identified – 40 patients with bilateral cataracts and 7 with unilateral. Of the 40 bilateral cataract patients, 76 eyes had lensectomies; with 37 of these patients (71 lensectomies having at least 5 year follow-up. Based on patient count, the 5 year risk of AG in at least one eye following surgery was 21.6%. Based on eye count, the 5 year risk of AG after lensectomy was 15.5%. The average age at surgery of patients who did not develop AG, and had at least 5 years follow-up, was 28.7 months (range 2 weeks to 6 years, with 20% having surgery within the first month of life. In comparison, the average age at surgery of patients with at least 5 years follow-up, who developed AG was 1.6 months (range 2 weeks to 7 months, with 60% having surgery within the first month of life. In subjects with at least 5 years follow-up, a PC rate of 100% was identified in the eyes that developed AG, compared to 61% in eyes that did not develop AG. An IOL was inserted in O% of eyes with AG, compared to 57% in eyes that did not develop AG. Onset of AG ranged from one month post surgery to 7 years, with an average yearly incidence of 5.3%. Conclusion Early surgery in patients with bilateral cataracts is associated with a marked increase in risk of AG. Our data suggest that an intact posterior capsule may be associated with a lower rate of AG.
We report a case of a patient with a highly hyperopic eye who underwent cataract surgery combined with vitreous surgery to create a posterior vitreous detachment (PVD) to prevent choroidal neovascularization (CNV). A 78-year-old man noticed a decrease in his vision due to a cataract in his right eye. The patient had a severe visual loss in his left eye because of a CNV 2 years after a cataract surgery. His visual acuities were 20/30 OD and 20/600 OS, and funduscopic examination showed an oran...
Full Text Available Glaucoma is one of the most common causes of visual loss despite successful congenital cataract surgery. The overall incidence does not appear to have decreased with modern microsurgical techniques. The onset of glaucoma may be acute or insidious and notoriously refractory to treatment. Angle closure glaucoma may occur in the early postoperative period; but the most common type of glaucoma to develop after congenital cataract surgery is open angle glaucoma. Several risk factors have been identified and both chemical and mechanical theories have been proposed for its pathogenesis. Unlike children with congenital glaucoma, those with paediatric glaucoma following congenital cataract surgery are usually asymptomatic despite high intraocular pressure. They may require regular evaluation under anaesthesia, whenever there are any suspicious findings. Unlike congenital glaucoma, the first line of treatment for glaucoma in aphakia/pseudophakia may be medical. Traditional trabeculectomy in paediatric glaucoma following congenital cataract surgery has met with limited success. The addition of antimetabolites to trabeculectomy is known to inhibit fibrosis and enhance the success, but carries the lifelong risk of bleb-related endophthalmitis. Drainage implant surgery is a viable option to achieve longterm intraocular pressure control in this refractory group of patients. Cycloablative procedures may provide temporising treatment and should be reserved for patients with low visual potential. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. Further research is needed to understand the pathophysiology, prevention and treatment of this sight-threatening complication following successful cataract surgery in children.
AIM—To determine the visual benefit of cataract extraction in patients with retinitis pigmentosa and to identify risk factors for poor outcome.?METHODS—A retrospective analysis was undertaken of a continuous series of 142 eyes of 89 patients with retinitis pigmentosa undergoing cataract surgery between 1985 and 1997.?RESULTS—Mean age at surgery was 47.5 years (range 24-81 years). In 100 eyes there was posterior subcapsular lens opacity alone, 37 eyes also had moderate ...
Jackson, H.; Garway-heath, D.; Rosen, P.; Bird, A.; Tuft, S.
Cataract is the most common complication of vitrectomising surgery in the phakic eye. Progressive nuclear sclerosis (NS) causes a myopic shift. This change in refractive status can predispose to the development of monovision in presbyopic individuals. Recognition of adaptation to monovision is important when undertaking sequential cataract surgery. Our case describes a patient whose adaptation to monovision was only recognised after its reversal. Predisposing factors are discussed and lessons highlighted. PMID:22878623
Carrim, Zia I; Hickley, Nicholas M; Bishop, Fiona
Descemet's membrane detachment (DMD) is an uncommon condition with a wide range of etiologies. More than likely, the most common cause is a localized detachment occurring after cataract surgery. We report three cases of Descemet's membrane detachment that occurred after uncomplicated phacoemulsification cataract surgeries. The first patient was managed without surgical intervention, the second patient was treated using an intracameral air injection, and the last patient was treated with an in...
Kim, In Sik; Shin, Jung Chul; Im, Chan Yeong; Kim, Eung Kweon
Introduction. Vitreous loss (VL) is one of the most serious ocular complications during cataract surgery without correct management may causes other serious complications and sometimes visual loss. By selecting the correct method of anesthesia (general or local anesthesia) it is possible to reduce the incidence of this complication and consequent events. The aim of this research is to determine the incidence of VL in cataract surgery with local and general anesthesia and comparing them with e...
Mortazavi, A. A.; KH NAGHIBI
AIM: To evaluate the etiologies, management, and outcomes of pediatric traumatic cataract in eastern China. METHODS:Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of injury, time of injury, interval between injury and first visiting doctors, hospital of first visiting, surgeries, complications and prognosis. RESULTS:A total of 117 eyes of 117 patients (96 boys and 21 girls) with unilateral injuries (66 right and 51 left eyes) were included i...
Full Text Available OBJECTIVE: To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. METHODS: Effectiveness estimates are based on a review of the literature taking into account factors such as operative failure, complications and patient non-compliance. A population model was applied to follow the lifelong impact on individuals having cataract surgery. Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review. Costings were estimated for different geographical coverage levels using non-linear cost functions. FINDINGS: Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level would avert over 3.5 million disability-adjusted life years (DALYs per year globally. The cost-effectiveness ranges from 57 International dollars (I$ per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to I$ 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality. CONCLUSION: Extra-capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered. Analysts from countries within a region are encouraged to further contextualize the results based on their own country's specific parameters.
Full Text Available SciELO Brazil | Language: English Abstract in portuguese Qualidade Visual é a medida da capacidade individual de reconhecer detalhes de um objeto no espaço. Medições de função visual na clínica oftalmológica são limitadas por vários fatores, tal como máximo contraste e assim podem não refletir adequadamente as condições visuais reais, bem como os aspectos [...] subjetivos da percepção do mundo pelo paciente. O sucesso em uma cirurgia está não apenas em restaurar linhas de visão, mas sim qualidade visual. Portanto, as cirurgias refrativas e de catarata têm a responsabilidade de alcançar resultados de qualidade. É difícil definir qualidade visual por um único parâmetro, sendo os principais testes de função visual: sensibilidade ao contraste; glare; dispersão intraocular da luz e aberrometria. Nesta revisão os diferentes componentes da função visual são explicados e os diversos métodos disponíveis para se avaliar a qualidade de visão são descritos. Abstract in english Visual acuity is the measurement of an individual's ability to recognize details of an object in a space. Visual function measurements in clinical ophthalmology are limited by factors such as maximum contrast and so it might not adequately reflect the real vision conditions at that moment as well as [...] the subjective aspects of the world perception by the patient. The objective of a successful vision-restoring surgery lies not only in gaining visual acuity lines, but also in vision quality. Therefore, refractive and cataract surgeries have the responsibility of achieving quality results. It is difficult to define quality of vision by a single parameter, and the main functional-vision tests are: contrast sensitivity, disability glare, intraocular stray light and aberrometry. In the current review the different components of the visual function are explained and the several available methods to assess the vision quality are described.
Parede, Taís Renata Ribeira; Torricelli, André Augusto Miranda; Mukai, Adriana; Vieira Netto, Marcelo; Bechara, Samir Jacob.
Full Text Available A randomized single blinded clinical trial to compare the cost-effectiveness of cataract surgery between extracapsular cataract extraction (ECCE and phacoemulsification (PEA was conducted at Hospital Universiti Kebangsaan Malaysia (HUKM from March 2000 until August 2001. The cost of a cataract surgery incurred by hospital, patients and households were calculated preoperatively, one week, two months (for both techniques and six months (for ECCE only. Effectiveness of cataract surgery was assessed using Visual Function 14 (VF-14, quality of life measurement specifically for vision. The cost analysis results from each 50 subjects of ECCE and PEA group showed that average cost for one ECCE after six months post-operation is USD 458 (± USD 72 and for PEA is USD 528 (± USD 125. VF-14 score showed a significant increased after a week, two months and six months post-operation compared to the score before operation for both techniques (p<0.001. However, there was no significant difference between them (p = 0.225. This study indicated that ECCE is more cost effective compared to PEA with cost per one unit increment of VF-14 score of USD 14 compared to USD 20 for PEA. (Med J Indones 2007; 16:25-31 Keywords: cataract, cost-effectiveness, extracapsular cataract extraction, phacoemulsification, visual function 14
Mohd R.A. Manaf
Full Text Available Carmen Sílvia Bongiovanni1, Carla Cristina Serra Ferreira1, Ana Paula Silvério Rodrigues1, João Borges Fortes Filho2, Márcia Beatriz Tartarella11Department of Ophthalmology, Congenital Cataract Section, Medical School, Federal University of São Paulo, São Paulo; 2Department of Ophthalmology, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, BrazilAbstract: Knobloch syndrome is an autosomal recessive disorder associated with early-onset ocular abnormalities and central nervous system malformations. Ocular abnormalities are usually severe, and include high myopia, vitreoretinal degeneration, retinal detachment, macular abnormalities, and cataract. The most frequent systemic changes are midline malformations of the brain, ventricular dilation, and occipital encephalocele. Cognitive delay may occur. We report a case of cataract in a child with Knobloch syndrome. Cataract surgery and follow-up are described.Keywords: Knobloch syndrome, cataract, phacoemulsification, vitreous, right eye, left eye, genetic
Full Text Available Background/Aim. Cataract surgery has become one of the safest procedures in medicine thanks to advances in technology and surgical techniques. Although minimal, we still witness different complications. The aim of this study was to compare visual outcome and complication rate in different techniques of cataract surgery, ie in cataract surgeries with various corneal incision width. Methods. The study included 3,457 consecutive patients, ie 4,670 eyes that had undergone cataract surgery. The used surgical techniques were: extracapsular cataract extraction, phacoemulsification/ forceps IOL implantation, phacoemulsification/ injector IOL implantation, microincision cataract surgery (MICS. Patient follow up was 6 months. Patients were evaluated for: visual aquity, corneal astigmatism, cellular reaction in the anterior chamber, IOL position. Results. Uncorrected visual aquity 30 days postoperatively was ? 0.5 in 30% of the eyes - ECCE; 54.7% of the eyes - phacoemulsification/forceps IOL implantation; 63.0% of the eyes - phacoemulsification/injector IOL implantation; 5/8 of the eyes - MICS. Endophthalmitis was detected in 0.15% of the eyes - ECCE and 0.1% of the eyes - phacoemulsification/forceps IOL implantation. In eyes with phacoemulsification/injector IOL implantation or microincision cataract surgery (MICS there were no cases of endophthalmitis. After a 6-month period intraocular lens were dislocated in 7.2% of the eyes - ECCE, and 0.6% of the eyes - phacoemulsification/PMMA IOL. There was no IOL dislocation in other surgical techniques. Conclusion. Shorter corneal incision implies less complications, less operative trauma, faster visual rehabilitation and better visual outcome.
In February 2000, the worldwide ophthalmology community celebrated the 50th anniversary of one of the twentieth century's most important innovations in eye care--the implantation of the first intraocular lens after cataract extraction by Sir Harold Ridley. It was the initiation of a golden age for the development of ophthalmology, especially cataract surgery. In our paper we would like to remember this outstanding English ophthalmologist and his great invention. PMID:16118965
Obuchowska, Iwona; Mariak, Zofia
Full Text Available Introduction. Cataracts cause about 50% of world blindness. There is little likelihood of effective prevention becoming available in the next few years and so the only treatment will remain surgical. For many of the other major causes of world blindness, like trachoma, xerophthalmia and onchocerciasis, the remedy is community-based, not hospital-based, and requires prevention rather than treatment. The prevalence of blinding cataract will only increase as people live longer, so cataract will continue to be, by far, the most important treatable cause of blindness.
Aim: To study “manual small incision cataract surgery (MSICS)” for the rehabilitation of cataract visually impaired and blind patients in community based, high volume, eye hospital setting; to compare the safety and effectiveness of MSICS with conventional extracapsular cataract surgery (ECCE).
Gogate, P. M.; Deshpande, M.; Wormald, R. P.; Deshpande, R.; Kulkarni, S. R.
Full Text Available Makoto Inoue1,2, Kei Shinoda3, Tomoko Matsuda-Yamamitsu2, Ronaldo Yuiti Sano1, Susumu Ishida2,41Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan; 2Department of Ophthalmology, Keio University School of Medicine, Shinjuku, Tokyo, Japan; 3Department of Ophthalmology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan; 4Department of Ophthalmology, Hokkaido University School of Medicine, Sapporo, Hokkaido, JapanAbstract: We report a case of a patient with a highly hyperopic eye who underwent cataract surgery combined with vitreous surgery to create a posterior vitreous detachment (PVD to prevent choroidal neovascularization (CNV. A 78-year-old man noticed a decrease in his vision due to a cataract in his right eye. The patient had a severe visual loss in his left eye because of a CNV 2 years after a cataract surgery. His visual acuities were 20/30 OD and 20/600 OS, and funduscopic examination showed an orange-colored lesion OD and degenerative subretinal fibrosis OS. The posterior vitreous was attached to the retina in both eyes. The axial length was 18.9 mm OD and 19.0 mm OS. Cataract surgery combined with vitreous surgery to create PVD was performed on the right eye, and the vision improved to 20/20 with no signs of developing CNV after 5 years. We conclude that cataract surgery combined with vitreous surgery to create a PVD may prevent the development of CNV in highly hyperopic eyes.Keywords: hyperopia, macular degeneration, posterior vitreous detachment, cataract surgery
Full Text Available Surgery for cataract blindness, a major health problem, is undergoing a rapid transition. This study characterizes cataract surgery in India in terms of practice setting and surgical procedure. A survey questionnaire was mailed in December 1992 to 4356 members of the All India Ophthalmological Society, resident in India, requesting data on cataract surgery cases within the past 12 months. Two thousand one hundred thirty-four (49% ophthalmologists responded to the survey. Of the 1,023,070 cataract cases reported, two-thirds were private patients. Among private patients, 26.0% received extracapsular cataract extraction (ECCE with intraocular lens (IOL implantation and 20.7% received ECCE without an IOL. Among patients operated under government auspices, 9.1% received ECCE with IOL and 22.4% received ECCE without IOL. Overall, 82.8% of active surgeons reported experience with the ECCE procedure. The cataract case load in the private sector and the frequency of ECCE, with or without IOL implantation, among both private and government-operated cases is greater than previously recognized.
Full Text Available Rahul Reddy, Stephen Jae KimDepartment of Ophthalmology, Vanderbilt University, Nashville, TN, USABackground: The purpose of this review was to provide a critical appraisal of the literature supporting the efficacy of ophthalmic ketorolac (Acuvail® in the treatment of pain and inflammation after cataract surgery.Methods: Literature search and expert opinion of the authors.Results: Recent studies indicate greater intraocular drug levels in the anterior chamber and iris-ciliary body after topical application of Acuvail in comparison with older formulations of ketorolac. A large randomized, multicenter, placebo-controlled study demonstrated significantly less inflammation and pain after cataract surgery using Acuvail.Conclusion: Acuvail appears to be effective in reducing post-cataract surgery pain and inflammation.Keywords: ketorolac tromethamine, Acuvail®, postsurgical, cystoid macular edema, nonsteroidal anti-inflammatory drugs
Full Text Available The Search for Appropriate Sutureless Cataract Surgery. During the last decade, in industrialised countries phacoemulsification has largely replaced ab-externo extracapsular cataract extraction with posterior chamber intraocular lenses (ECCE/PC IOL with sutures. The small self-sealing phaco incision provides rapid visual rehabilitation, and the surgery is increasingly done on an outpatient basis. However, in developing countries phacoemulsification is performed only on selected patients, usually those able to pay high treatment charges. The reasons for this include the cost of a phaco machine and consumables such as foldable IOLs. Until now, phacoemulsification has played a very limited role in the reduction of cataract blindness in low income countries. Therefore, eye surgeons in developing countries are searching for alternatives to phacoemulsification. We need a surgical technique which is easy to learn, provides an immediate good uncorrected visual outcome, and is affordable to most cataract patients. Such a technique would advance cataract surgery in low income countries and contribute to reaching the goal of VISION 2020: The Right to Sight.
A heterogeneous group of conditions can cause changes to the intraocular lens (IOL) during or after implantation in uneventful cataract surgery. We describe a series of 5 patients presenting distinctive deposits on the surface of hydrophilic intraocular lenses, implanted during routine cataract surgery, with a follow-up of 1 to 24 months. Disposable forceps were found to be the source of the pigmented marks when used to hold the lens during the injector loading process. At the slit-lamp examination, the pigments were located in the centre of the lens optic, easily detectable. Although involving the visual axis, none of the patients were visually affected. To our knowledge, this is the first time such unusual occurrence has been described. The reported case-series shows the importance of in-house follow-up after cataract surgery. PMID:23960978
Zuberbuhler, Bruno; Carifi, Gianluca
Manual small incision cataract surgery has evolved into a popular method of cataract surgery in India. However, in supra hard cataract, bringing out the whole nucleus through the sclerocorneal flap valve incision becomes difficult. A bigger incision required in such cataracts loses its value action, as the internal incision and corneal valve slips beyond the limbus into sclera. Struggling with the supra hard cataracts through a regular small incision. Phacofracture in the anterior chamber bec...
Purpose To describe the demographic pattern of congenital cataract surgery at a referral ophthalmology center in Iran and to evaluate any possible difference between the genders. Methods Subjects aged 15 years or less scheduled for cataract surgery were enrolled in this cross-sectional study. Data was retrieved from the electronic medical records according to the ICD-10 coding system. Age and proportion of operations by sex were the main parameters of interest. We employed analysis of covariance to compare age at surgery and logistic regression to obtain the trend for the number of cataract procedures in boys and girls. Results Overall, 314 congenital cataract procedures were performed during the study period, 55 (17.5%) of which were related to second eye surgery. Operated eyes belonged to male subjects in 172 (54.8%) cases and female subjects in 142 (45.2%) cases. Mean age at operation for both first and second eyes was 3.2±3.0 years overall, and 3.1±2.9 versus 3.4±3.0 years in girls and boys, respectively (P= 0.62). Surgery was performed before one year of age in 33.2% and before 5 years in 75% of cases. Among patients undergoing second eye surgery, girls presented significantly later than boys (at 4.2±3.3 vs. 2.6±1.7 years, P= 0.012). Conclusion The rate of congenital/infantile cataract surgery in boys was almost 10% higher than girls. We observed a significant difference only regarding age at second eye surgery which comprised 17.5% of all operations. One third and two thirds of the procedures were performed under the age of one and five years, respectively.
Katibeh, Marzieh; Eskandari, Armen; Yaseri, Mehdi; Hosseini, Sara; Ziaei, Hossein
Abstract Background To evaluate results after seven years using prophylactic intracameral cefazolin for the prevention of endophthalmitis in cataract surgery. Methods A prospective, observational study of all patients submitted to cataract surgery over the period January 1996 to December 2009. All cases of postoperative endophthalmitis over that period were reviewed. The patients were classified in two groups: Group 1 (11,696 patients) operated on between Januar...
Romero-Aroca Pedro; Méndez-Marin Isabel; Salvat-Serra Merce; Fernández-Ballart Juan; Almena-Garcia Matias; Reyes-Torres Javier
Presented is an assessment of the cost-effectiveness of cataract surgery using cost and services data from the Lumbini Zonal Eye Care Programme in Nepal. The analysis suggests that cataract surgery may be even more cost-effective than previously reported. Under a "best estimate" scenario, cataract surgery had a cost of US$5.06 per disability-adjusted life year (DALY). This places it among the most cost-effective of public health interventions. Sensitivity analysis indicates that cataract surg...
The authors underline the importance of accurate pre-anesthesiological assessment in children undergoing cataract. The alteration is frequently related to many genetic, metabolic and infectious pathologies that could interfere in anesthesia management whatever surgery is requested. Some possibly responsible congenital syndromes and related alterations are mentioned, particularly focusing on Down's syndrome. PMID:12908730
Sammartino, M; Morelli Sbarra, G; Ferro, G; Chiusolo, F; Garra, R; Marzola, M; Pascale, F
Full Text Available Intracapsular cataract extraction is still the most common type of operation performed in India, especially in eye camps, and most of these are done without magnification. To assess the surgical outcome of intracapsular cataract surgery in a rural hospital with various magnifying systems, 121 consecutive eyes (121 patients with uncomplicated cataract were randomly allocated to surgery with the operating microscope, binocular loupe or unaided eye. The surgery was performed by either consultants or first year residents. The best corrected vision at least four weeks post-operatively was compared among the three groups. The performance between the consultants and the junior residents was also compared. The improvement of surgical outcome with magnification was statistically significant (p=0.0045; and clinically important with a relative risk reduction of 60.6%. The comparison between microscope and loupe magnification did not show a significant difference (p=0.24. However, with an operating microscope, the consultants performed significantly better than the junior residents. These findings suggest that the use of magnification in intracapsular cataract extraction provides a definite advantage over an unaided eye and that the binocular loupe is a good alternative to the operating microscope in this kind of surgery.
Abstract Background Biometric methods are security technologies, which use human characteristics for personal identification. Iris recognition systems use iris textures as unique identifiers. This paper presents an analysis of the verification of iris identities after intra-ocular procedures, when individuals were enrolled before the surgery. Methods Fifty-five eyes from fifty-five patients had their irises enrolled before a cataract surgery was performed. They ...
Roizenblatt Roberto; Schor Paulo; Dante Fabio; Roizenblatt Jaime; Belfort Rubens
Full Text Available For any operation, including cataract surgery, the appropriate instruments must be available and in good working order. If instruments are not available, or are blunt, or do not function properly, it may be necessary to delay or postpone surgery. Using such instruments in an operation can result in a poor outcome, or even pose a risk to surgeons and their assistants.The impact is therefore considerable, and can damage the reputation of the hospital in the community.
Background Cataract surgery is the most common surgical procedure carried out in the developed world and surgery volumes have increased considerably during the last decades. Various aspects of the surgical procedure, including surgical incision size and intraocular lens materials, have changed substantially, improving the safety and the quality of the outcome. Previous research has primarily focused on the visual function results with a short follow-up time. Long-term population-based studies...
A prospective study of fifty patients who underwent cataract surgery with intraocular lens (IOL) implantation was undertaken. Factors aggravating and allaying pre-operative, intra-operative and post-operative anxiety were studied A good doctor-patient relations/lip, confidence in the ophthalmologist, and knowledge of successful surgery with IOL implantation in an acquaintance were the major anxiety relieving factors. The main anxiety provoking factors were concerns about the success of surger...
Chaudhury, S.; Chakraborty, P. K.; Gurunadh, V. S.; Ratha, P.
Full Text Available We propose the Maximal Mydriasis Test (MMT as a simple and safe means to provide the cataract surgeon with objective and dependable pre-operative information on the idiosyncratic mydriatic response of the pupil. The MMT results of a consecutive series of 165 eyes from 100 adults referred for cataract evaluation are presented to illustrate its practical applications and value. The results of the MMT allows the surgeon to anticipate problem eyes pre-operatively so that he can plan his surgical strategy more appropriately and effectively. Conversely, the surgeon can also appropriately and confidently plan surgical procedures where wide pupillary dilation is important. The MMT has also helped improve our cost-effectiveness by cutting down unnecessary delays in the operating room and enabling better utilisation of restricted costly resources.
Refraction was performed at frequent, regular intervals for six months following routine intracapsular cataract extraction. Patients were divided into two groups, those whose limbal sections were closed with 8-0 virgin silk or with 9-0 nylon. The stabilisation of refraction was observed, and the most suitable time to prescribe 'first glasses' was estimated retrospectively. In the silk group this was found to be at three months in the nylon group at four months. However, results in the latter ...
Baranyovits, P. R.
Full Text Available In Tanzania, many children are not brought for surgery in a timely fashion and follow up is often poor. Research at Kilimanjaro Christian Medical Centre (KCMC has shown that girls are more likely than boys to be negatively affected: * Only half as many girls as boys received cataract surgery. * Girls tended to be brought for surgery later than boys. * Girls who did receive surgery were less likely than boys to be brought for the appropriate two-week follow-up visit (36 per cent of girls vs 64 per cent of boys.
Purpose : We describe a technique for achieving pupillary dilatation in order to manage and counteract intraoperative miosis during pediatric cataract surgery using viscoadaptive viscoelastic (sodium hyaluronate 2.3%). Materials and Methods : The technique of viscomydriasis was used in six eyes with pediatric cataracts with intraoperative pupillary miosis. Results : Pupillary dilatation was achieved and maintained in all eyes throughout cataract surgery. All the...
Full Text Available Katarzyna Michalska-Ma?ecka,1 Mariusz Nowak,2 Piotr Go?ciniewicz,1 Jacek Karpe,3 Ludmi?a S?owi?ska-?o?y?ska,4 Agnieszka ?ypaczewska,1 Dorota Romaniuk11Department of Ophthalmology, University Hospital No 5, Medical University of Silesia, Katowice, 2Pathophysiology Division, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Zabrze, 3Department of Anesthesiology and Intensive Therapy, Medical University of Silesia, Zabrze, 4Department of Biophysics, Faculty of Medicine in Zabrze, Medical University of Silesia, Katowice, Silesia, PolandAim: The aim of our study was to retrospectively evaluate the effectiveness and safety of cataract surgery and intraocular lens implantation (IOL for patients aged 90 years or older, whom we define as “very elderly.”Methods: The study involved a total number of 122 patients (122 eyes with senile cataracts. The mean age of patients was 91.2 ± 2.3 years (range 90–100 years old. Phacoemulsification (phaco was done on 113 of 122 eyes, and 9 of 122 eyes had extracapsular cataract extraction (ECCE. Postoperative visual acuity and intraocular pressure (IOP were analyzed on the first postoperative day, 3 months after surgery, and 6 months after surgery.Results: Best corrected visual acuity (BCVA improved in 100 of 122 eyes (82.0%. BCVA remained the same in 20 of 122 eyes (16.4% and decreased in 2 of 122 eyes (1.6%, mainly because of coexisting age-related macular degeneration (AMD. The BCVA 3 months after surgery was ?0.8 in 23 of 122 eyes (18.9%, between 0.5 and 0.7 in 28 of 122 eyes (22.3%, and between 0.2 and 0.4 in 33 of 122 eyes (27.1%. We found significant implications of cataract surgery on decreasing IOP in the studied group of patients suffering from glaucoma compared to the patients without glaucoma.Conclusion: Advanced age is not a contraindication for cataract surgery. The results of the study showed that when systemic conditions are stable, both phaco and ECCE with IOL for very elderly patients are effective and safe.Keywords: very elderly patients, cataract surgery, postoperative best corrected visual acuity, intraocular pressure
Full Text Available AIM: To evaluate the etiologies, management, and outcomes of pediatric traumatic cataract in eastern China. METHODS:Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of injury, time of injury, interval between injury and first visiting doctors, hospital of first visiting, surgeries, complications and prognosis. RESULTS:A total of 117 eyes of 117 patients (96 boys and 21 girls with unilateral injuries (66 right and 51 left eyes were included in the study. The mean (SEM age at diagnosis was (6.6±3.2 years (range, 1.3-13.8 years. Each cataract was categorized according to the type of trauma:closed-globe (n=26 or open-globe (n=91 injuries. The most common injuring objects were sharp metal objects (37.61%. The most common complication in open-globe injuries was corneal laceration, whereas traumatic mydriasis was most common in closed-globe injuries. Of 68 eyes in patients with open-globe injuries who received cataract extraction, intraocular lens (IOLs were primarily implanted in 47 eyes (68.12%, whereas 18 eyes with closed-globe injuries received cataract extraction, and IOLs were primarily implanted in 17 eyes (94.4%. The surgical procedures included reconstruction of the anterior segment, synechiolysis, excision of the membrane, lensectomy, vitrectomy and related techniques. Postoperative vision was significantly improved compared with preoperative vision. CONCLUSION: Pediatric traumatic cataract should be treated in time to attenuate the complications, and education on pediatric traumatic cataract and improvements in pediatric health care are needed for the early detection of cataract in children.
Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL...
Goel, Ruchi; Kamal, Saurabh; Kumar, Sushil; Kishore, Jugal; Malik, K. P. S.; Angmo Bodh, Sonam; Bansal, Smriti; Singh, Madhu
Full Text Available Patients for cataract surgery in India routinely undergo preoperative syringing to rule out chronic dacryocystitis. We determined the sensitivity and specificity of the clinical test of regurgitation on pressure over the lacrimal sac (ROPLAS as a screening test for chronic dacryocystitis and compared it to syringing. 621 consecutive outpatients who needed syringing for various reasons (including 318 who had routine syringing prior to cataract surgery were examined in a masked manner for regurgitation on pressure over the lacrimal sac. They then underwent syringing by a trained (masked observer. The sensitivity and specificity of ROPLAS were 93.2% and 99.3%, respectively. Using a 6.6% prevalence of chronic dacryocystitis (the prevalence in our cataract population, the negative predictive value of the test was 99.5%. In the presence of regurgitation of pressure over the sac, the high specificity of ROPLAS confirms chronic dacryocystitis. In view of the opportunity costs, when ROPLAS is negative, preoperative syringing in cataract is perhaps unnecessary, unless the findings are equivocal or the index of suspicion for chronic dacryocystitis is very high.
Background: In order to perform cataract surgery, adequate dilatation of the pupil is essential. This is traditionally achieved by preoperative topical mydriatic eye-drops, commonly cyclopentolate and phenylephrine. This routine has several disadvantages. First, the slow penetration through the cornea delays the onset of mydriasis. Second, the limited bioavailability of topically administered substances with significant systemic absorption may increase the risk for systemic side effects. Thir...
Painless, sterile, noninfiltrated corneal ulceration and perforation, which may occur after recent cataract surgery in patients with rheumatoid arthritis, and Sjögren's syndrome, appears to be a distinct clinical entity. The cause is probably multifactorial. Contributing factors may be the underlying systemic disease process in rheumatoid arthritis and Sjögren's syndrome, the associated keratoconjunctivitis sicca, the surgical procedure, and the postoperative use of oral and topical cortico...
Cohen, K. L.
Full Text Available 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.
Nucleus management is critical in manual small incision cataract surgery (MSICS), as the integrity of the tunnel, endothelium and posterior capsule needs to be respected. Several techniques of nucleus management are in vogue, depending upon the specific technique of MSICS. Nucleus can be removed in toto or bisected or trisected into smaller segments. The pressure in the eye can be maintained at the desired level with the use of an anterior chamber maintainer or kept at atmospheric levels. In ...
Full Text Available AIM: To assess and compare the results of 2.2mm microincision coaxial cataract surgery(MCCSphacoemulsification with the conventional 3.0mm MCCS in hard nuclear cataracts. METHODS: Totally 132 eyes with hard cataract(? level and abovewere randomized to two groups: 2.2mm MCCS(group 1:60 eyesand 3.0mm MCCS(group 2:72 eyes. All patients underwent standard phacoemulsification and intraocular lens implantation surgery by one experienced surgeon. The average ultrasound power(AVEwas recorded during the operation. The incidences of capsule rupture and postoperative corneal edema were compared.Visual acuity, surgically induced astigmatism(SIAand the descent rate of endothelial cell density were compared at intervals of 1 day, 1 month and 3 months after surgery. Statistic analysis was taken by Student's t test and Chi square test. RESULTS: There was no significant difference on the incidences of capsule rupture, postoperative corneal edema and AVE(P> 0.05between the two groups(3.3%, 10.0%, 65.09±20.15and(4.2%, 11.1%, 69.13±15.44. One day after the surgery, the 2.2mm MCCS group showed better uncorrected visual acuity as compared to the 3.0mm MCCS group(P < 0.05. There were no significant differences on best-corrected visual acuity on 1 month and 3 months after the surgery. There was no significant difference on the descent rate of endothelial cell density(16.54%±10.20%, 17.69%±10.65%3 months after the surgery. One day, 1 month and 3 months after the surgery, SIA was 0.77±0.31,0.66±0.29, 0.52±0.25D in the 2.2mm MCCS group, and 1.41±0.73,0.98±0.61D,0.82±0.35D in the 3.0mm MCCS group, respectively. The differences were statistically significant. CONCLUSION: The operative safety of the 2.2mm MCCS group were the same as 3.0mm MCCS group with the hard nuclear cataracts. The 2.2mm MCCS phacoemulsification could significantly reduce SIA and get better earlier visual rehabilitation.
Roberto Bellucci1, Francesco Bellucci21Ophthalmic Unit, Department of Neurosciences, Hospital and University of Verona, Verona, Italy; 2Faculty of Psychology, University of Parma, Parma, ItalyBackground: Cataract surgery is mainly performed under topical anesthesia achieved either by tetracaine solution (0.5%–1.0%) or gel (0.5%), or by 2% lidocaine gel. This paper reviews the current knowledge about these two drugs, with special emphasis on a published prospective comparison between the...
Bellucci R; Bellucci F
The purpose of this study was to determine clinical presentation, microbiological spectrum and visual outcome of cluster endophthalmitis patients after cataract surgery in central India. The records of cluster endophthalmitis patients were retrospectively reviewed. Three clusters of patients were identified who had undergone vitreous biopsy followed by three-port pars plana vitrectomy with intraocular antibiotics and steroids. Good visual outcome was seen in eight (33%) of 24 patients....
Malhotra Sumeet; Mandal Partha; Patanker Gopal; Agrawal Deepshikha
Abstract Background Despite recommendations for greater use of second-eye cataract surgery and the bilateral progression of the disease, there is a substantial proportion of unmet need for this treatment. Few studies have explored the factors associated with second-eye cataract surgery utilisation. The objective of our study was to estimate the proportion of second-eye cataract surgery, evaluate its time-trend, and explore differences in utilisation by patients' gender, age, ...
Hoffmeister Lorena; Román Rubén; Comas Mercè; Cots Francesc; Bernal-Delgado Enrique; Castells Xavier
Full Text Available Roberto Bellucci1, Francesco Bellucci21Ophthalmic Unit, Department of Neurosciences, Hospital and University of Verona, Verona, Italy; 2Faculty of Psychology, University of Parma, Parma, ItalyBackground: Cataract surgery is mainly performed under topical anesthesia achieved either by tetracaine solution (0.5%–1.0% or gel (0.5%, or by 2% lidocaine gel. This paper reviews the current knowledge about these two drugs, with special emphasis on a published prospective comparison between them.Methods: The main pharmacological aspects of topical anesthetic agents are summarized, explaining the difference between the ester (tetracaine and the amide (lidocaine compounds. Tetracaine is available as single-use eye drops, or as a multidose gel containing benzalkonium chloride, a preservative not contained in the multidose lidocaine gel. A literature search was performed, using “tetracaine”, “tetracaine gel”, “lidocaine”, “lidocaine gel”, “lidocaine jelly”, and “cataract surgery” as keywords, and compiling cross-references. A total of 25 studies were identified and included in this review. Of them, seven were uncontrolled studies describing different experiences with the drugs of interest, and 18 were controlled studies. Six studies directly compared tetracaine eye drops or gel with lidocaine gel before cataract surgery.Results: Both tetracaine solution and gel and lidocaine gel proved to be effective in providing analgesia before cataract surgery. Both drugs were comparable with needle injection anesthesia when intracameral lidocaine was added to topical treatment. Direct comparisons indicate better activity for tetracaine when used at the 1% concentration in single-dose units, or in the gel form at a 0.5% concentration. Patients showed a slight preference for the agent that caused the least discomfort when administered (lidocaine, while the surgical complication rate and the surgeon satisfaction were the same with either drug.Conclusion: Tetracaine solution and lidocaine gel were equally effective in providing topical anesthesia for cataract surgery in the published studies. Tetracaine was found to be better than lidocaine only if augmented by either increasing the concentration to 1% (solution or by increasing the penetration by adding benzalkonium chloride (gel.Keywords: tetracaine, tetracaine gel, lidocaine, lidocaine gel, cataract surgery
Full Text Available X-Plain Cataracts Reference Summary Introduction A cataract is a clouding of the eye’s lens. Cataracts are a common eye condition that affects ... reached by you and your doctor together. This reference summary will help you understand what cataracts are ...
Purpose: To analyze and quantify the pattern of corneal astigmatism in patients awaiting cataract surgery to provide information for cataract surgeons and intraocular lens (IOL) manufacturers and to establish the demand for toric IOLs in a hospital.Methods: This cross-sectional retrospective study evaluated keratometric (K) values measured by partial coherence interferometry (IOLMaster) in cataract surgery candidates, who were then analyzed and correlated by age and axial length (AL) ranges.Results: The study evaluated the K values in 757 eyes of 380 patients with a mean age of 71.9 ± 10.2 years (range 33-96 years). The mean corneal astigmatism was 1.02 ± 0.69 D (range 0.06-4.57 D). It was 1 D or higher in 316 (41.74%) eyes. The mean AL was 23.56 ± 1.35 mm (range 20.53-31.86 mm).Conclusions: Our study shows that roughly 50% of the eyes have more than 1 D of astigmatism. The results can help hospitals plan and analyze the amount and costs of using toric IOLs in patients with corneal astigmatism. PMID:24366768
De Bernardo, Maddalena; Zeppa, Lucio; Cennamo, Michela; Iaccarino, Stefania; Zeppa, Lucia; Rosa, Nicola
Consecutive patients undergoing intracapsular cataract surgery with and without lens implantation were included in one of three groups of fifteen patients for postoperative corneal thickness measurement. One group underwent cataract extraction alone, another group had cataract extraction and lens implantation using iris supported posterior chamber implants, and another group underwent lens implantation with the use of sodium hyaluronate to reform the anterior chamber after cataract extraction...
The intraoperative management of complication during cataract surgery of vitreous loss and dropped nucleus strongly influences the outcome, and a well-rehearsed plan for both staff and surgeons is needed. Preventative measures, early recognition, damage control, and resolution are discussed in this article. Maintenance of appropriate pressure relationships and tissue planes limits vitreous prolapse and the surgeon's primary goal is to avoid vitreous traction resulting in retinal tears and detachment. A pars plana approach to anterior vitrectomy with staining of the prolapsed vitreous is the most effective technique. Although residual lens material should be removed from the anterior and posterior chambers, once a fragment is lost to the posterior segment, the authors advocate referral for a standard three-port posterior vitrectomy with fragmenter as needed because the goal of the cataract surgeon is to offer the patient a clean, pseudophakic anterior segment and the best chance for an optimal visual recovery. PMID:17067904
Arbisser, Lisa Brothers; Charles, Steve; Howcroft, Michael; Werner, Liliana
Full Text Available Abstract Background Biometric methods are security technologies, which use human characteristics for personal identification. Iris recognition systems use iris textures as unique identifiers. This paper presents an analysis of the verification of iris identities after intra-ocular procedures, when individuals were enrolled before the surgery. Methods Fifty-five eyes from fifty-five patients had their irises enrolled before a cataract surgery was performed. They had their irises verified three times before and three times after the procedure, and the Hamming (mathematical distance of each identification trial was determined, in a controlled ideal biometric environment. The mathematical difference between the iris code before and after the surgery was also compared to a subjective evaluation of the iris anatomy alteration by an experienced surgeon. Results A correlation between visible subjective iris texture alteration and mathematical difference was verified. We found only six cases in which the eye was no more recognizable, but these eyes were later reenrolled. The main anatomical changes that were found in the new impostor eyes are described. Conclusions Cataract surgeries change iris textures in such a way that iris recognition systems, which perform mathematical comparisons of textural biometric features, are able to detect these changes and sometimes even discard a pre-enrolled iris considering it an impostor. In our study, re-enrollment proved to be a feasible procedure.
Full Text Available Background: Preemptive analgesia is based on the idea that analgesia which initiates before a nociceptive even will be more effective than the analgesia commenced afterwards. This clinical trial compared postoperative analgesia and comfort in patients with general anesthesia combined with preoperative or postoperative local anesthesia. Methods: 90 patients who had been scheduled for phacoemulcification in Farabi Eye Hospital, 2002-3, were enrolled in the study. Sixty patients received general anesthesia: 15 received preoperative local anesthesia (GA+LA+OP, 15 received postoperative local anesthesia (GA+OP+LA, and 30 did not get local anesthesia (only GA. Thirty patients only received local anesthesia (LA. Subjective postoperative pain was determined by a visual analogue scale. Frequency of oculocardiac reflex, postoperative nausea and vomiting (PONV, and patient's comfort were assessed. Results: Postoperative pain was less in local anesthesia (LA compared to general anesthesia (GA (p < 0.0001. Additional preoperative application of local anesthesia (GA+LA+OP resulted in less pain than additional postoperative application (GA+OP+LA (p <0.05. Additional postoperative peribulbar block did not differ from general anesthesia (Only GA. The incidence of intraoperative oculocardiac reflex and postoperative nausea and vomiting was significantly less in patients with peribulbar block (P = .0001 and in GA+LA+OP group, as compared with others (P= 0.001. Conclusion: We conclude that preoperative local anesthesia (Only LA or in combination with general anesthesia provides the best comfort for the patient in eye surgery. Keywords: preemptive analgesia, analgesia, peribulbar block, postoperative pain, phacoemulcification, ocular surgery
Full Text Available Purpose : We describe a technique for achieving pupillary dilatation in order to manage and counteract intraoperative miosis during pediatric cataract surgery using viscoadaptive viscoelastic (sodium hyaluronate 2.3%. Materials and Methods : The technique of viscomydriasis was used in six eyes with pediatric cataracts with intraoperative pupillary miosis. Results : Pupillary dilatation was achieved and maintained in all eyes throughout cataract surgery. All the surgical steps including anterior and posterior capsulorrhexis and aspiration were performed successfully. Conclusions : Viscomydriasis is a simple and effective technique for the management of intraoperative pupillary miosis during cataract surgery in pediatric eyes.
Abstract Purpose: To report visual outcomes and barriers to uptake of cataract surgery among subjects of all ages in Mingshui County, Heilongjiang Province, China. Methods: Cluster sampling was used to select a cross-sectional sample of people living in the Heilongjiang Province. Each subject underwent a participant interview, presenting and best-corrected vision measurements and an ocular examination. Visual outcomes and barriers to uptake of cataract surgery were assessed among subjects undergoing cataract surgery. Individuals who needed cataract surgery were interviewed regarding barriers. Results: Of 11,787 subjects, 10,384 eligible participants underwent visual acuity (VA) testing and a basic eye examination (88.1% response rate). The cross-sectional sub-sample of 21 participants receiving cataract surgery had a median age of 63 years. Six eyes undergoing surgery at the county hospital with conventional intracapsular and extracapsular cataract extraction without an intraocular lens implant were aphakic, and 15 eyes (71.4%) undergoing surgery at tertiary care hospitals were pseudophakic. Seven eyes (33.3%) had corrected VA???20/60, and nine eyes (42.9%) had presenting VA???20/60. Approximately 28.6% (6/21) had poor outcomes. The principal causes of presenting blindness after cataract surgery were refractive error/uncorrected aphakia and posterior capsular opacification. Cost was the most common barrier (73.9%) to uptake of cataract surgery. Conclusions: Cataract surgical outcomes in northern China were poor. The principal barrier to uptake of cataract surgery was cost. These findings call for the establishment of cataract surgical services that are of high quality, affordable, and sensitive to high-risk groups. PMID:24697777
Li, Zhijian; Song, Zhen; Wu, Shubin; Xu, Keke; Jin, Di; Wang, Haijing; Liu, Ping
Full Text Available AIM: To compare the effect of treating cataract by sodium hyaluronate injection and lens-loop nucleus extraction of small incision cataract excision and explore more suitable method to promote the use of surgery in primary hospital. METHODS: All 146 cataract patients(166 eyeswere allocated to two groups in random: the control group 78 patients(84 eyesreceived conventional lens loop for extracapsular cataract extraction; the experiment group 68 patients(82 eyesunderwent nucleus extraction in small incision with sodium hyaluronate injection for extracapsular cataract extraction. Postoperative visual acuity and intraoperative and postoperative complications were compared between two groups. RESULTS: Incidence of posterior capsule rupture difference was statistically significant(PP> 0.05in postoperative visual acuity, astigmatism degree and postoperative complications compared with those of pre-operation. CONCLUSION: Compared with the lens loop nucleus extraction, sodium hyaluronate injection for extracapsular cataract extraction can effectively protect the posterior lens capsule and can be promoted in small incision cataract surgery.
Full Text Available Background: Ultrasonography is an important tool for evaluating the posterior segment in eyes with opaque media. Aim: To study the incidence of posterior segment pathology in eyes with advanced cataract and to see whether certain features could be used as predictors for an abnormal posterior segment on ultrasound. Setting: Tertiary care hospital in South India. Methods and Materials: In this prospective study conducted over a 6-month period, all eyes with dense cataracts precluding visualization of fundus underwent assessment with ultrasound. Presence of certain patient and ocular "risk" factors believed to be associated with a higher incidence of abnormal posterior segment on ultrasound were looked for and the odds ratio (OR for posterior segment pathology in these eyes was calculated. Results: Of the 418 eyes assessed, 36 eyes (8.6% had evidence of posterior segment pathology on ultrasound. Retinal detachment (17 eyes; 4.1% was the most frequent abnormality detected. Among patient features, diabetes mellitus (OR= 4.9, P=0.003 and age below 50 years (OR= 15.4, P=0.001 were associated with a high incidence of abnormal ultrasound scans. In ocular features, posterior synechiae (OR= 20.2, P=0.000, iris coloboma (OR= 34.6, P=0.000, inaccurate projection of rays (OR= 15.1, P=0.002, elevated intraocular pressure (OR= 15.1, P=0.004, and keratic precipitates (OR= 22.4, P=0.004 were associated with high incidence of posterior segment pathology. Only four eyes (1.5% without these features had abnormal posterior segment on ultrasonography. Conclusions: Certain patient and ocular features are indicative of a high risk for posterior segment pathology and such patients should be evaluated by ultrasonography prior to cataract surgery. In the absence of these risk factors, the likelihood of detecting abnormalities on preoperative ultrasonography in eyes with advanced cataracts is miniscule.
Nanophthalmos refers to an eyeball of short axial length, usually less than 20 mm which leads to angle closure glaucoma due to relatively large lens. Intra-ocular lens extraction relieves the angle closure in nanophthalmos. Cataract surgery in a nanophthalmic eye is technically difficult with high risk of complications such as posterior capsular rupture, uveal effusion, choroidal haemorrhage, vitreous haemorrhage, malignant glaucoma, retinal detachment and aqueous misdirection. Various options are explained in the literature to perform cataract surgery in nanophthalmos, like extracapsular cataract extraction with or without sclerostomy; small-incision cataract extraction by phacoemulsification which not only helps maintain the anterior chamber during surgery but also reduces the incidence of complications due to less fluctuation of intraocular pressure (IOP) during the surgery. Cataract surgery deepens and widens the anterior chamber angle in nanophthalmic eyes and has beneficial effects on IOP in eyes with nanophthalmos but is associated with a high incidence of complications. (author)
Bob Z Wang, Elsie Chan, Rasik B Vajpayee The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia Background: The purpose was to determine preoperative indications, intraoperative procedures, and outcomes of capsular tension ring (CTR) insertion during cataract surgery. Methods: A review of all patients undergoing cataract surgery with insertion of a CTR between July 2000 and ...
Bz, Wang; Chan E; Rb, Vajpayee
Full Text Available Pinakin Gunvant1,2, Anna Ablamowicz2, Subba Gollamudi31Western University of Health Sciences, College of Optometry, Pomona, CA, 2Southern College of Optometry, Memphis, TN, 3Eye Specialty Group, Memphis, TN, USAPurpose: To investigate if the parameters measured routinely prior to cataract surgery with multifocal intraocular lens (IOL implantation can predict the necessity of additional laser in situ keratomileusis (LASIK to improve visual outcome.Methods: Records of patients undergoing cataract surgery between January 2008 and December 2009 were reviewed. Individuals satisfied with visual outcome of cataract surgery and not satisfied were grouped (group 1 and 2, respectively. Preoperative data of refractive error, axial length, corneal astigmatism, intraocular pressure, and postoperative uncorrected visual acuity were recorded. Data was available for 62 patients (104 eyes, of which LASIK enhancement was deemed necessary in 21 eyes (20%; group 2. The receiver operator characteristic curves were used to discriminate between the groups and linear regression analysis was performed to predict the postoperative visual outcome.Results: The astigmatism measured preoperatively using manifest refraction had an accuracy of 64% in discriminating between the groups. Age, spherical component of refraction, axial length, corneal astigmatism, and intraocular pressure were very close to chance prediction 59%, 57%, 56%, 51%, and 51%, respectively. The postoperative uncorrected visual acuity had an accuracy of 79% in discriminating the groups. Individuals with uncorrected visual acuity worse than 20/40 after cataract surgery were most likely to undergo LASIK enhancement; however, approximately 20% of group 2 underwent LASIK enhancement despite having visual acuity of 20/30 or better. When combined, preoperative visual acuity accounted for just 7% of variance in postoperative uncorrected visual acuity.Conclusion: Requirement of LASIK enhancement after cataract surgery with multifocal IOL implant is complex in nature, and parameters routinely measured before surgery cannot successfully identify the group requiring LASIK enhancement or predict postoperative uncorrected visual acuity.Keywords: refractive error, axial length, corneal astigmatism, intraocular pressure, uncorrected visual acuity, visual outcome, multivariate analysis, LASIK enhancement
Full Text Available AIM: To evaluate the efficacy and clinical significance ofglycosylated hemoglobin(HbAlcdetermination on diabetic cataract surgery.METHODS: Totally 105 patients with diabetes(120 monocularundergone phacoemulsification in our hospital from March 2012 to March 2013 were enrolled into the observation group(glycosylated hemoglobin determination group, HbA1c RESULTS:Glycated hemoglobin determination group: the mean visual acuity recovery was 0.72, the incidence of TASS was 83.3%, and DDD was 45.5. Blood glucose group: those were 0.498, 93.7%, and 88.6. The difference of incidence, degree and occurrence time of TASS(SAS 15.0 software analysisand the degree of visual recovery between the two groups were statistically significant(PPCONCLUSION:Glycosylated hemoglobin determination is the gold standard to measure blood sugar preoperation and has important significance for choosing the right time for diabetic cataract surgery. TASS was significantly reduced in the patients with preoperative standard glycosylated hemoglobin, the visual acuity of them improved significantly, and DDD values were significantly lower.
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish La vitrectomía pars plana en el desprendimiento de retina, así como la cirugía de patologías maculares y de la retinopatía diabética, entre otras, exacerba la progresión y el desarrollo de catarata en pacientes fáquicos, considerada una complicación frecuente de esta intervención. La extracción de c [...] atarata en ojos con cirugía vítrea previa se caracteriza por una serie de diferencias que particularizan a este tipo de pacientes. Esta particularidad motivó la siguiente revisión con el propósito de hacer referencia a algunos factores que influyen en el desarrollo o progresión de la catarata después de la vitrectomía pars plana, complicaciones de los sustitutos vítreos, opciones en la realización simultánea o secuencial de la cirugía de segmento anterior y posterior. Se aborda también algunas consideraciones pre y transoperatorias de la cirugía de catarata en ojos vitrectomizados, así como complicaciones trans y postoperatorias. La capacidad visual puede mejorar significativamente luego de la cirugía de catarata, sin embargo, la cuantía de la misma estará determinada por la extensión y severidad de la patología vítreo-retiniana de base. Abstract in english Pars plana vitrectomy in retinal detachment as well as in macular pathology and diabetic retinopathy surgeries, among others, exacerbated the progression and the development of cataract in phakic patients, which is considered a common complication of this intervention. Cataract extraction in eyes th [...] at underwent previous vitreous surgery is characterized by a series of differences that particularize this type of patients. This particularity encouraged the following review to mention some factors influencing the development or the progression of cataract after pars plana vitrectomy, complications of vitreous replacements, options in simultaneous or sequential performance of the anterior and posterior segment surgery. It also dealt with some preoperative and transoperative considerations of the cataract surgery in vitrectomized eyes as well as transoperative and postoperative complications. The visual capacity may significantly improve after the cataract surgery; however, the magnitude of such capacity will be determined by the extension and severity of the underlying vitreous-retinal pathology.
Ailen, Garcés Fernández; Suzel, Veitía Rovirosa; Iván, López Hernández.
Full Text Available Abstract Background Capsule related complications are common following pediatric cataract surgery. We report a new technique of multiple anterior capsulorhexisotomies after lens aspiration and intraocular lens (IOL implantation. Methods After performing automated lens aspiration, an IOL was implanted into the capsular bag. A bent 26 gauge needle was introduced through one side port and multiple small cuts were made in one half of the circumference of the anterior capsular rim by making a radial movement of the needle tip centripetally over the margin of the anterior capsular rim. The needle was again introduced through the other side port and multiple similar cuts were made in the other half thereby creating nearly 20 – 30 cuts at the margin of the anterior capsular rim. Results The mean size of the primary capsulorhexis was 4.33 ± 0.20 mm. A uniform enlargement of the capsulorhexis could be performed in all the eyes without peripheral extension in any of the eyes. There was no damage to the posterior capsule and no scratch mark on the IOL. In one eye, the primary capsulorhexis was slightly eccentric, though it was covering the IOL optic all around. The rhexisotomies in this eye were limited to the capsular rim that was overlapping more on the IOL optic (sectoral anterior capsulorhexisotomies. Conclusion The technique of postage stamp anterior capsulorhexisotomies is a feasible technique in pediatric cataracts.
Full Text Available Introduction: With the growing and rapid development of refractive surgery, researches focus increasingly on improvement of visual quality after cataract surgery. Intraocular lenses (IOLs were a successful effort in the field of cataract surgery. Despite significant advances in cataract surgery, several complications related to surgical technique and IOL design after surgery can cause vision changes and reduce accuracy. Improvements in IOL design and surgical technique have a significant impact on the rate and extent of Tilt and Decentration effects. Because of small movement in modern intraocular lenses (aspheric, its performance can be significantly reduced, therefore aberration correction in the eye with an artificial lens requires to be more careful on IOL centration and location. Methods: In this paper, the characteristics of intraocular lenses and devices used in the measurement and design of this lens are also taken into consideration. In addition, factors affecting the optical and visual acuity in cataract surgery such as Tilt and Decentration are presented. Additionally, materials in regard to computer simulation of optical models of the eye in research as well as optical computations in clinical situations are provided. Conclusion: Finally, the findings revealed that obtaining optimal vision in cataract surgery requires precise measurement and computational techniques as well as an awareness of aberrations that may be created during or after surgery. Moreover, further research and improvement in the process of measurement and calculation will enhance the visual acuity in cataract surgery.
Purpose: To investigate if the larger capsulorhexis (7mm) is associated with a stable post-operative refraction with Acrysof IQ one-piece IOL (SN60WF, Alcon USA) implantation from 1month to 2 years after cataract surgery. Method: Retrospective chart review was made on 31 eyes of 20 patients. All eyes had uncomplicated phacoemulsification by the author with 7mm capsulorhexis and Acrysof one-piece IOLIQ (SN60WF, Alcon USA) implantation between 4/2007 and 7/2008. IOL Master was used to select...
Full Text Available Abstract Background Cataract day surgery has rapidly gained worldwide acceptance, because the new surgical techniques and costs are generally lower than those involved in ordinary hospitalization. Cataract surgery serves as a proxy indicator of the trend towards day surgery hospitalization in Italy and, therefore, of regional variability in health-care delivery and cost. The aim of this study was to update the diffusion of cataract day surgery through various surgical ophthalmological centers in central and southern Italy during 2005. Methods A two-stage stratified cluster sampling method was used to draw a sample of Cataract Surgery Unit from Ophthalmic Units of central and southern Italy. A questionnaire was sent to 25 cataract surgery centers in nine health districts that represented the range of establishments (public, private, accredited or otherwise in which cataract surgery is performed. Data were collected on numbers of procedures performed in 2005, hospital admission type, time from the onset of cataract day surgery, surgical procedure, and presence of other surgical centers. Results The response rate was 42% (10 surveys, resulting in at least one completed questionnaire for each of these 9 districts. There is a positive trend towards day surgery hospitalization in all surgical centers. The percentage of patients treated as outpatients during 2005 varied from 50–60% (Avellino, Naples, Campobasso, to 80–90% (Rome, Bari, up to 90–100% (Catania, Palermo, Siracusa and Trapani, with an increasing trend in all the centers studied. Few differences were found in surgical procedures, and these were statistically insignificant. Conclusion Our results confirm a positive trend towards day surgery in place of hospital inpatient admission for cataract surgery. This trend is expected to close the existing regional gap in Italy. Increased efficiency is an overriding need for the National Health Service in order to improve the rationalization of resources.
Full Text Available Nucleus management is critical in manual small incision cataract surgery (MSICS, as the integrity of the tunnel, endothelium and posterior capsule needs to be respected. Several techniques of nucleus management are in vogue, depending upon the specific technique of MSICS. Nucleus can be removed in toto or bisected or trisected into smaller segments. The pressure in the eye can be maintained at the desired level with the use of an anterior chamber maintainer or kept at atmospheric levels. In MSICS, unlike phacoemulsification, there is no need to limit the size of the tunnel or restrain the size of capsulorrhexis. Large well-structured tunnels and larger capsulorrhexis provide better control on the surgical maneuvers. Safety and simplicity of MSICS has made it extremely popular. The purpose of this article is to describe nucleus management by phacosection in MSICS.
Nucleus management is critical in manual small incision cataract surgery (MSICS), as the integrity of the tunnel, endothelium and posterior capsule needs to be respected. Several techniques of nucleus management are in vogue, depending upon the specific technique of MSICS. Nucleus can be removed in toto or bisected or trisected into smaller segments. The pressure in the eye can be maintained at the desired level with the use of an anterior chamber maintainer or kept at atmospheric levels. In MSICS, unlike phacoemulsification, there is no need to limit the size of the tunnel or restrain the size of capsulorrhexis. Large well-structured tunnels and larger capsulorrhexis provide better control on the surgical maneuvers. Safety and simplicity of MSICS has made it extremely popular. The purpose of this article is to describe nucleus management by phacosection in MSICS. PMID:19075409
Ravindra, M S
... Replacement Cataract Vision Simulator Cataract lens replacement: How IOLs work Like your eye's natural lens, an IOL ... may reduce your need for glasses. Intraocular lens (IOL) types Monofocal lens This common IOL type has ...
... lens. This clouding can cause a reduction in vision. The lens is composed of protein and water structured to allow light to clearly pass through. Changes to the structure of the protein result in a cataract. The changes in vision associated with a cataract depend upon which part ...
... Veterans What Is an Ophthalmologist? Your Eyes & the Sun Eye Health News Consumer Alerts What Are Cataracts? Tweet Cataract ... Sun - Eye M.D.-approved information from EyeSmart Sun Smart UV Safety Infographic ... 0:41 Subscribe for Eye Health Info Sign up for our monthly e-mail ...
AIM: We compared bimanual microincision cataract surgery (MICS) and standard coaxial phacoemulsification (CAP) in terms of uncorrected visual acuity (UCVA) recorded 1 h and 2 weeks postoperatively. METHODS: This was a prospective, nonrandomised comparative study. All MICS procedures were performed by one surgeon (MGM), and all CAP procedures were performed by another surgeon (SB). Eyes with visually consequential ocular morbidity were excluded. The primary outcome measure was UCVA recorded 1 h postoperatively. RESULTS: One hundred eyes underwent MICS and CAP (50 eyes in each group). The treatment groups did not differ significantly in terms of preoperative mean best corrected visual acuity (6\\/24 +\\/- 4.3 lines and 6\\/20 +\\/- 4.4 lines in the MICS and the CAP groups, respectively; P = 0.65). Also, there was no significant difference in terms of postoperative UCVA at 1 h or at 2 weeks (mean +\\/- standard deviation UCVA 1 h postoperatively: MICS: 6\\/36 +\\/- 5.7 lines; CAP: 6\\/30 +\\/- 4.7 lines; P = 0.80; UCVA 2 weeks postoperatively: MICS: 6\\/10 +\\/- 1.9 lines; CAP: 6\\/10 +\\/- 2.2 lines; P = 0.90). However, nine eyes (18%) and one eye (2%) achieved a UCVA of C6\\/12 at 1 h following MICS and CAP, respectively, and this difference was statistically significant (P = 0.02). CONCLUSION: Mean UCVA at 1 h and at 2 weeks following cataract surgery was not significantly different between eyes undergoing MICS and CAP. However, a greater proportion of patients achieved a UCVA of C6\\/12 following MICS when compared with CAP.
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Avaliar a frequência de complicações nas cirurgias de catarata realizada por residentes de um hospital universitário (segundo e terceiro anos), comparado com as realizadas por cirurgiões experientes (assistentes). MÉTODOS: Análise retrospectiva dos prontuários de todos pacientes submetidos [...] à cirurgia de catarata realizadas nas primeiras quinzenas de março (época do início do aprendizado da técnica cirúrgica) e de novembro (meados do aprendizado da técnica). Foram analisados a época da realização da cirurgia; graduação do cirurgião (residente ou médico assistente); técnica cirúrgica empregada (extração extracapsular ou facoemulsificação) e a ocorrência de complicações per-operatórias e pós-operatórias. RESULTADOS: Foram analisadas 481 cirurgias, destas, 194 (40%) foram realizadas pelos residentes do terceiro ano, 165 (34%) pelos residentes do segundo ano e 116 (26%) pelos assistentes. A complicação mais frequentemente encontrada em todas as cirurgias foi a rotura de cápsula posterior (4,8%). Não houve diferença estatisticamente significativa de complicações entre as cirurgias realizadas em março e novembro (p=0,97), bem como entre os residentes sob supervisão e os assistentes (p=0,08). CONCLUSÃO: A rotura de cápsula posterior continua sendo a complicação mais frequentemente encontrada nas cirurgias de residentes em treinamento. Não houve diferença estatisticamente significativa entre as taxas de complicação destes residentes e os assistentes, o que demonstra o importante papel de uma supervisão adequada. Abstract in english PURPOSE: To evaluate the complication's rate of cataract surgery performed by ophthalmology residents (second and third-year) and experienced surgeons at a public teaching hospital. METHODS: A retrospective chart review of all patients who had cataract surgery between March (begin of the technique p [...] ractice) and November (end of the technique practice) was conducted. RESULTS: In 481 cataracts surgeries, 194 (40%) was performed by third-year residents, 165 (34%) by second-year residents and 116 (26%) by experienced surgeons. The most frequent complication in all surgeries was the posterior capsule rupture (4,8%). No statistical diference was found between the residents and experienced surgeons complication's rates (p=0,08). CONCLUSION: The posterior capsule rupture remains the most frequent complication during the cataract surgery learning curve. In this study there was no statistical difference between residents and experienced surgeons, which demonstrates the important role of adequate supervision of the surgeires.
Barreto Junior, Jackson; Primiano Junior, Helio; Espíndola, Rodrigo França de; Germano, Renato Antunes Schiave; Kara-Junior, Newton.
The authors reviewed the records of thirteen patients with posterior uveal malignant melanoma who had developed a mature radiation cataract following cobalt-60 plaque radiotherapy. Cataract extraction had been performed in seven of these patients as of the survey date of this investigation. The authors attempted to determine if cataract extraction increased the risk of metastatic melanoma, improved or worsened visual function, or resulted in any consistent intraoperative or postoperative complications that did not occur if the cataract was retained. This analysis showed that removing the cataract did not appear to increase the risk of death from metastatic melanoma, but it also indicated that cataract extraction did not seem to improve the visual function of the irradiated eye. On the basis of this experience to date, the authors offer suggested guidelines for the management of patients who develop a mature cataract following cobalt-60 plaque radiotherapy of a posterior uveal malignant melanoma
Routine preoperative medical testing of patients undergoing cataract surgery is commonly done, although its value is uncertain. The authors studied whether such routine testing had any value in minimizing operative and postoperative medical complications....
O. D. Schein
Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (P = 0.16). Both groups, achieved similar best corrected visual acuity (P = 0.73), although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS.
Goel, Ruchi; Kamal, Saurabh; Kumar, Sushil; Kishore, Jugal; Malik, K. P. S.; Angmo Bodh, Sonam; Bansal, Smriti; Singh, Madhu
Full Text Available Manual small incision cataract surgery (MSICS involves the manual removal of nucleus through a scleral tunnel. To achieve 100% success every time, one has to do a good capsulotomy and should master the technique to prolapse the nucleus into anterior chamber. During conversion from extracapsular cataract surgery to MSICS, one can perform a can-opener capsulotomy and prolapse the nucleus. However, it is safer and better to perform a capsulorrhexis and hydroprolapse the nucleus, as it makes the rest of the steps of MSICS comfortable. Use of trypan blue in white and brown cataracts makes the capsulorrhexis and prolapse simple and safe. Extra caution should be taken in cases with hypermature cataracts with weak zonules and subluxated cataracts.
Moataz F Elsawy, Nermine Badawi, Hany A KhairyOphthalmology Department, Menoufia University Hospital, Menoufia, EgyptObjective: To evaluate the prophylactic role of topical non-steroidal anti-inflammatory drugs in reducing the incidence of central macular edema (CME) in diabetic eyes post-cataract surgery.Patients and methods: This study included 86 eyes (70 patients) with high risk characteristics for the development of CME after cataract surgery. All patients underwent phacoemulsification a...
Mf, Elsawy; Badawi N; Ha, Khairy
The purpose of this study was to compare the anatomic and visual outcome of primary vitrectomy with scleral buckling in patients with retinal detachment following cataract surgery. Fifty-six consecutive patients with retinal detachment after cataract surgery were randomly assigned to two treatment groups: standard scleral buckling and standard three-port deep vitrectomy. Successful treatment was defined as improvement in vision (minimum of 2 lines in Snellen chart), anatomic reattachment and ...
Faghihi, H.; Lashay, A.; Ghazi, H.; Tabatabaee, A.; MR. Mansouri; Javadian, A.; Karkhaneh, R.; Riazi, M.; Mirshahi, A.; Alami, Z.; Movasat, M.; Ms, Farahvash; Amini, A.; Nili, H. Shams M.
Comparatively little attention has been paid to the conjunctival toxicity of antibiotics administered at the time of cataract surgery. We have observed the effect of subconjunctival gentamicin and cefuroxime injection, using colour photography in a randomised single blind trial of 121 patients undergoing routine cataract surgery. Our results suggest that a hyperaemic eye is likely to occur about twice as often in patients injected with gentamicin (p less than 0.001). Gentamicin is associated ...
Jenkins, C. D.; Mcdonnell, P. J.; Spalton, D. J.
Abstract Purpose: To assess the reasons for refusing cataract surgery in illiterate individuals in a tribal area of India. Methods: A prospective study evaluated 1046 subjects who had undergone screening in eye camps and included 398 of 492 referred subjects with cataract who refused to seek cataract surgery. Subjects were assessed to elicit general and specific reasons for non-compliance. Multiple logistic regression analysis was applied to determine the associations; p?proceed with cataract surgery were: fear of losing current vision, work priority, lack of support systems, a dependency due to old age, and expenses required after surgery. Odds of seeking treatment were lower among unemployed subjects (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19-0.86; p?=?0.01) and in patients with family income proceed with surgery. Reasons given for non-compliance were not directly related to the surgery but focused on valid day-to-day difficulties anticipated to increase following surgery. Beyond accessibility and cost of surgery, other social and infrastructural factors need to be addressed to increase the uptake of cataract surgery. PMID:24742058
Kovai, Vilas; Prasadarao, B V M; Paudel, Prakash; Stapleton, Fiona; Wilson, David
Abstract Background Cataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal. Methods Subjects aged 40 years and above was selected...
Thapa Suman S; Vd, Berg Rosa; Khanal Shankar; Paudyal Indira; Pandey Pooja; Maharjan Nhukesh; Twyana Shankha N; Paudyal Govinda; Gurung Reeta; Ruit Sanduk; Hmbv, Rens Ger
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Se realizó una revisión bibliográfica con el objetivo de exponer los principales aspectos relacionados con la cirugía de catarata en los pacientes con pseudoexfoliación. Se efectuó una búsqueda de los principales artículos científicos de los últimos 10 años y fueron seleccionados los contenidos más [...] relevantes para la confección del informe final. El síndrome de pseudoexfoliación es una patología sistémica asociada a un alto riesgo de complicaciones durante la cirugía de catarata debido principalmente a la debilidad del soporte zonular y la dilatación insuficiente de la pupila. Mediante un cuidadoso examen preoperatorio y una adecuada técnica quirúrgica correctamente valorada por el cirujano, el índice de complicaciones durante el proceder y en el posoperatorio puede reducirse significativamente. Abstract in english A literature review was made to present the main aspects of the cataract surgery in patients with pseudoexfoliative syndrome. The main scientific articles of the past ten years related to the topic were searched, and the most relevant contents were selected for the preparation of the final report. I [...] t was found that the pseudoexfoliation syndrome is a systemic pathology associated with high risk of complications during the cataract surgery mainly due to the weakness of the zonular support and the pupilar insufficient dilation. By means of a careful preoperative exam and an appropriate surgical technique, adequately assessed by the surgeon, the rate of complications during and after the surgical procedure may be significantly reduced.
Pérez González, Henry; García Concha, Yanet; Zozaya Aldana, Beatriz.
Background: This study aims to assess the quality of life and the time trade off-utility value of the first eye cataract surgery and the second eye cataract surgery in Lombok Island-Indonesia. Methods: This was an epidemiologic survey study on community of cataract surgery. Evaluations of quality of life (QoL) and time trade-off (TTO) were performed using questionnaire ...
Gondhowiardjo, Tjahjono D.; Hapsari, Retno U.
Day surgery has rapidly gained worldwide acceptance especially in the field of ophthalmology. In Italy, cataract surgery is the most frequently performed surgical procedure, even on account of the ageing of the population. This procedure represents a very sensitive indicator of trends in day surgery hospitalizations and of political-managerial situations in the different regional healthcare realities. The aim of this study was to evaluate the diffusion of cataract day surgery in ophthalmology centres/divisions in central and southern Italy in 2003. A questionnaire was used to collect information regarding the number of surgical procedures performed, types of hospital admissions, time since the introduction of cataract day surgery, perioperative norms, and presence of other operative surgical centres in the area. PMID:17206162
Cillino, Salvatore; Casuccio, Alessandra; Di Pace, Francesco; Lodato, Gaetano
Full Text Available Endophthalmitis is a rare, but serious, postoperative complication of cataract surgery. It can have a devastating consequence on a patient’s vision: some patients may lose all light perception.The incidence of endophthalmitis has been reported to be between 0.13% and 0.7%.1 The primary source of this intraocular infection is considered to be bacteria from the patient’s ocular surface (cornea, conjunctiva or adnexa (lacrimal glands, eyelids, and extraocular muscles. The bacteria most frequently isolated are gram-positive coagulase-negative cocci (mainly Staphylococcus epidermidis which account for 70% of culture-positive cases. Staphylococcus aureus is isolated in 10% of culture-positive cases, Streptococcus species in 9%, Enterococcus species in 2%, and other gram-positive species in 3% of cases. Gram-negative bacteria account for just 6% of culture-positive cases; however, an infection with these bacteria, particularly with Pseudomonas aeruginosa, can lead to a devastating visual outcome.
Eyes with pseudoexfoliation syndrome often exhibit insufficient mydriasis, zonular weakness and pronounced fibrotic capsular shrinkage. This may make cataract surgery as such difficult but also leads to postoperative complications, such as rhexis ovalization or phimosis (capsule contraction syndrome) or progressive zonular weakening with final spontaneous dislocation of the capsule-implant complex (CIC). To avoid or correct for this special techniques and implants may be used: as prophylaxis, intracameral adrenalin and retroiridal capsulorhexis, iris retractors or dilators, various models of capsular tension and bending rings, bimanual capsule ring implantation, capsular bag stabilization with iris retractors or segments and secondary capsulorhexis may be used. Rhexis phimosis may be excised by a special diathermic probe, a subluxated CIC may be sutured to the sclera either in toto or the lens only after removal from the capsule bag, the latter also to the posterior iris surface. When luxated into the vitreous cavity, the CIC may be lifted to the iris plane and refixed as described or exchanged for a new lens sutured into the sulcus or an angle or iris-supported anterior chamber lens. PMID:23053332
Full Text Available Luis J Haddock,1 Harry W Flynn Jr,1 Sander R Dubovy,1 Rahul N Khurana,2 Peter R Egbert31Department of Ophthalmology, Bascom Palmer Eye Institute, Miami Miller School of Medicine, Miami, FL, 2Northern California Retina Vitreous Associates, Mountain View, CA, 3Department of Ophthalmology, The Byers Eye Institute at Stanford, Stanford University, Palo Alto, CA, USAAbstract: A clinicopathologic correlation between two patients with acute-onset Aspergillus endophthalmitis undergoing enucleation is reported. These two patients presented with pain, redness, and decreased vision following uncomplicated cataract surgery. In both patients, vitreous aspiration and intravitreal injections were the initial treatment followed later by pars plana vitrectomy for clinical worsening. Despite repeated surgical and medical interventions, the clinical course of both patients was prolonged, unsuccessful, and resulted in enucleation for a blind painful eye. Histologic examination of the enucleated specimens showed that, in spite of prolonged local and systemic therapy, there was persistent diffuse infiltration of the anterior chamber and ciliary body by a filamentous mold.Keywords: mold, enucleation, voriconazole, amphotericin B
PurposeTo evaluate the images created in a model eye during simulated cataract surgery.Patients and methodsThis study was conducted as a laboratory investigation and interventional case series. An artificial opaque lens, a clear intraocular lens (IOL), or an irrigation/aspiration (I/A) tip was inserted into the 'anterior chamber' of a model eye with the frosted posterior surface corresponding to the retina. Video images were recorded of the posterior surface of the model eye from the rear during simulated cataract surgery. The video clips were shown to 20 patients before cataract surgery, and the similarity of their visual perceptions to these images was evaluated postoperatively.ResultsThe images of the moving lens fragments and I/A tip and the insertion of the IOL were seen from the rear. The image through the opaque lens and the IOL without moving objects was the light of the surgical microscope from the rear. However, when the microscope light was turned off after IOL insertion, the images of the microscope and operating room were observed by the room illumination from the rear. Seventy percent of the patients answered that the visual perceptions of moving lens fragments were similar to the video clips and 55% reported similarity with the IOL insertion. Eighty percent of the patients recommended that patients watch the video clip before their scheduled cataract surgery.ConclusionsThe patients' visual perceptions during cataract surgery can be reproduced in the model eye. Watching the video images preoperatively may help relax the patients during surgery. PMID:24788007
Inoue, M; Uchida, A; Shinoda, K; Taira, Y; Noda, T; Ohnuma, K; Bissen-Miyajima, H; Hirakata, A
Several months to years after exposure to ionizing radiation of the atomic bombs (A-bombs), some survivors developed cataracts. The characteristic clinical finding was a localized lenticular opacity on the inner surface of the posterior polar capsule presenting a polychromatic sheen, and punctate opacities or aggregations thereof in the subcapsular cortical layer of the posterior polar region. In the majority of the affected survivors, the degree of opacification of these radiation cataracts was minimal to moderate and remained unchanged. These cases had no other subjective disturbances associated with this condition. (auth.)
PURPOSE: To study changes in anterior segment morphometry after uneventful phacoemulsification cataract surgery, and to investigate whether there is a relationship between any observed changes and intraocular pressure (IOP) reduction after the procedure. METHODS: The anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), central corneal thickness (CCT), and IOP were measured in 101 non-glaucomatous eyes before and after uneventful phacoemulsification cataract surgery. RESULTS: After cataract surgery, the mean ACD, ACV, and ACA values increased by 1.08 mm, 54.4 mm(3), and 13.1 degrees , respectively, and the mean IOP (corrected for CCT) decreased by 3.2 mm Hg. The predictive value of a previously described index (preoperative ACD\\/preoperative IOP (corrected for CCT) or CPD ratio) for IOP (corrected for CCT) reduction after cataract surgery was confirmed, reflected in an r(2) value of 23.3% between these two parameters (P<0.001). Other indices predictive of IOP reduction after cataract surgery were also identified, including preoperative IOP\\/preoperative ACV and preoperative IOP\\/preoperative ACA, reflected in r(2) values of 13.7 and 13.7%, respectively (P<0.001 and P<0.001, respectively). CONCLUSIONS: Our study confirms the predictive value of the CPD ratio for IOP reduction after cataract surgery, and may contribute to the decision-making process in patients with glaucoma or ocular hypertension. Furthermore, two novel indices of preoperative parameters that are predictive for IOP reduction after cataract surgery were identified, and enhance our understanding of the mechanisms underlying IOP changes after this procedure.
Full Text Available AIM: To observe the changes of corneal endothelium in diabetes patients before and after cataract phacoemulsification surgery with confocal microscopy for exploring the variation and influencing factors. METHODS: Phacoemulsification were randomly divided into 50 aged-related cataract patients with diabetes mellitus(56 eyes, diabetes groupand 50 patients with senile cataract(60 eyes, control group. Cataract phacoemulsification and intraocular lens implantation were performed, central corneal thickness, the corneal endothelial cell density, coefficient of variation and percentage of hexagonal cell were measured before surgery, 1 week, 1 month and 3 months after surgery by confocal microscopy. RESULTS: Before surgery, there was no statistical difference between the two groups of central corneal thickness, corneal endothelial cell density, coefficient of variation and percentage of hexagonal cell(P>0.05. Compared with pre-operation, the central corneal thickness and coefficient of variation were increased post-operation, but the corneal endothelial cell density and percentage of hexagonal cell decreased gradually. The central corneal thickness of diabetes group was more significantly than control group 1 week, 3 months after surgery(P<0.05, and the corneal endothelial cell density was less significantly than control group(P<0.05. One week, 3 months after surgery, the percentage of hexagonal cell was less than control group(P<0.01. The coefficient of variation was significantly higher than control group(P<0.01. CONCLUSION: Aged-related cataract patients with diabetes mellitus were much more poor tolerability on cataract phacoemulsification surgery. Compared with senile cataract patients, the corneal endothelium injury was more serious and the velocity and validity of recovery were lower comparatively.
Congenital cataract (CC) is the primary cause of treatable childhood blindness. Population-based assessments of prevalence and surgery age of CC, which are critical for improving management strategies, have been unavailable in China until now. We conducted a hospital-based, cross-sectional study of the hospital charts of CC patients younger than 18 years old from January 2005 to December 2010 at Zhongshan Ophthalmic Center (ZOC) in Guangzhou, China. Residence, gender, age at surgery, hospitalization time, and the presence of other ocular abnormalities were extracted and statistically analyzed in different subgroups. The search identified 1314 patients diagnosed with CC from a total of 136154 hospitalizations, which accounted for 2.39% of all the cataract in-patients and 1.06% of the total in-patients over the six-year study period. Of the identified CC patients, 9.2% had ?2 hospitalizations due to the necessity of additional surgeries, with a total ratio of boys to girls of 1.75?1. Based on a subgroup analysis according to age, patients 2–6 years old constituted the highest proportion (29.22%) of all hospitalized CC patients, and those 13–18 years old constituted the lowest proportion (13.47%) of the total number. The average age at surgery was 27.62±23.36 months, but CC patients ?6 years old (especially ?6 months old) became increasingly prevalent throughout the 6-year study period. A total of 276 cases (20.93%) of CC were associated with one or more other ocular abnormalities, the highest incidence rates were observed for exotropia (6.24%), nystagmus (6.16%), and refractive error (3.65%). In conclusion, CC patients accounted for 2.39% of all cataract in-patients in a review of 6 years of hospitalization charts from ZOC. The age at the time of surgery decreased over the 6-year study period, which probably reflects the continuing improvement of public awareness of children’s eye care in China.
Lin, Haotian; Yang, Ye; Chen, Jingjing; Zhong, Xiaojian; Liu, Zhaochuan; Lin, Zhuoling; Chen, Wan; Luo, Lixia; Qu, Bo; Zhang, Xinyu; Zheng, Danying; Zhan, Jiao; Wu, Hanfu; Wang, Zhirong; Geng, Yu; Xiang, Wu; Chen, Weirong; Liu, Yizhi
AIM—To evaluate the results of cataract surgery performed in a rural Indian eye camp.?METHOD—The pre- and postoperative visual acuities and surgical complications were recorded prospectively in 6383 eyes undergoing cataract extraction for age related cataract in rural eye camps held in northern India in 1993-4. The best visual acuity and cause of poor outcome were recorded on 3908 eyes seen at 6 weeks' follow up.?RESULTS—Of 6383 operated eyes 94.8% had a visual acuity of...
Kapoor, H.; Chatterjee, A.; Daniel, R.; Foster, A.
Full Text Available Takatoshi Tano1, Yoshimune Hiratsuka2, Koichi Ono1, Akira Murakami11Department of Ophthalmology, Juntendo University School of Medicine, Tokyo; 2National Institute of Public Health, Tokyo, JapanPurpose: To investigate the impact of cataract surgery and blood pressure changes induced by one week of sodium restriction on retinal vascular diameter.Methods: Fundus photographs of 200 patients were obtained before and one week after cataract surgery. For one week after admission, 100 patients received sodium restriction and 100 patients (ie, the control group did not receive sodium restriction. The diameter of the retinal vessels and blood pressure were compared between the sodium restriction group and the control group. The vascular diameter was measured using an objective computer-based method.Results: Neither group had a significant change in the diameter of the retinal vessels after cataract surgery. Although there was no significant change in retinal arterial and venular diameter in the sodium restriction group, one-week sodium restriction significantly reduced mean blood pressure. However, multiple linear regression analyses indicated that an increase in retinal arteriolar diameter was significantly associated with diabetes, hyperlipidemia, and alcohol intake.Conclusion: Cataract surgery and blood pressure reduction induced by one week of sodium restriction resulted in no significant change in retinal arteriolar diameter.Keywords: cataract surgery, hypertension, retinal blood vessel diameter, retinal fundus camera, sodium restriction.
Full Text Available Antioxidant vitamins supplements have been suggested as a strategy to decrease the risk of age-related cataract development. However, the results from observational studies and interventional trials of associations between antioxidant vitamins A, C, and E and cataract development have been inconsistent. We aim to evaluate the effectiveness of multivitamin/mineral supplements for decreasing the risk of age-related cataracts by conducting a systematic review and meta-analysis. In September 2013, we searched multiple databases to identify relevant studies including both cohort studies and randomized controlled trials (RCTs. A random-effects model was used to calculate the pooled relative risks (RR with a 95% confidence interval (CI. Twelve prospective cohort studies and two RCTs were included. Pooled results from the cohort studies indicated that multivitamin/mineral supplements have a significant beneficial effect in decreasing the risk of nuclear cataracts (RR: 0.73; 95% CI: 0.64–0.82, cortical cataracts (RR: 0.81; 95% CI: 0.68–0.94, and any cataracts (RR: 0.66; 95% CI: 0.39–0.93. In addition, there were no decreases in the risk of posterior capsular cataracts (RR: 0.96; 95% CI: 0.72–1.20 or cataract surgery (RR: 1.00; 95% CI: 0.92–1.08. The two RCTs demonstrated that multivitamin/mineral supplements could decrease the risk of nuclear cataracts. There is sufficient evidence to support the role of dietary multivitamin/mineral supplements for the decreasing the risk of age-related cataracts.
AIM—To evaluate the effects of the dispersive viscoelastic agents Ocucoat (hydroxypropyl methylcellulose 2%) and Viscoat (sodium chondroitin sulphate 4%-sodium hyaluronate 3%) on postoperative intraocular pressure (IOP) after bilateral small incision cataract surgery.?METHODS—This prospective, randomised study comprised 80 eyes of 40 consecutive patients with age related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assig...
Full Text Available AIM: To evaluate factors influencing stereoacuity after surgery to correct unilateral developmental pediatric cataracts.METHODS: 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. RESULTS: 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.CONCLUSION: 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.
Background Cystoid macular edema (CME) remains an important complication after cataract surgery. There is no consensus about how to prevent this frequent complication. The purpose of this study was to conceive an effective anti-inflammatory strategy using nonsteroidal anti-inflammatory drugs (NSAIDs) together with regular treatment with corticosteroids to prevent CME and improve visual acuity after cataract surgery in patients without risk factors. Materials and methods We searched the PubMed, Cochrane, and Google Scholar databases focused on prospective, controlled, randomized, double-blind clinical trials published in the last 10 years, with a minimum follow-up of 4 weeks. Results A total of nine clinical trials, one systematic review, and two reviews satisfied our search criteria. Most studies highlighted that NSAIDs are as powerful as corticosteroids to diminish postoperative inflammation, and demonstrated an additional benefit when used in combination with standard corticosteroid postsurgical therapy. In addition, the use of NSAIDs in the perioperative period seems to significantly improve the outcome after surgery and helps prevent CME in low-risk patients. Conclusion The prophylactic use of NSAIDs in combination with the standard postoperative steroid scheme appears to be a positive course of action for preventing CME after cataract surgery. We suggest a therapeutic scheme based on the administration of one drop four times a day, beginning the day before surgery and for 4 weeks after the procedure. It is also advisable to administer one drop every 15 minutes in the hour prior to surgery in order to obtain better anti-inflammatory efficacy.
Quintana, Nicolas E; Allocco, Alejandro R; Ponce, Julia A; Magurno, Mauricio GB
We describe rigid gas-permeable (RGP) contact lens-assisted cataract surgery in patients with severe keratoconus. During cataract surgery in cases with severe keratoconus, the intraocular images are distorted and visual perspective is lost because of irregular corneal astigmatism. Poor visibility can lead to complications, including posterior capsule rupture and corneal endothelial cell damage. To overcome these problems, an RGP contact lens was placed on the cornea in 2 cases. The image distortion decreased markedly, and the visual perspective improved. Intraocular manipulations such as irrigation/aspiration were performed safely. Improvement in transillumination led to good visualization of the anterior and posterior capsules. No intraoperative or postoperative complications developed in either case. This technique provided excellent visualization during cataract surgery in patients with severe keratoconus. PMID:24491385
Oie, Yoshinori; Kamei, Motohiro; Matsumura, Nagakazu; Fujimoto, Hisataka; Soma, Takeshi; Koh, Shizuka; Tsujikawa, Motokazu; Maeda, Naoyuki; Nishida, Kohji
Full Text Available Abstract Background To evaluate results after seven years using prophylactic intracameral cefazolin for the prevention of endophthalmitis in cataract surgery. Methods A prospective, observational study of all patients submitted to cataract surgery over the period January 1996 to December 2009. All cases of postoperative endophthalmitis over that period were reviewed. The patients were classified in two groups: Group 1 (11,696 patients operated on between January 1996 and December 2002, Group 2 (13,305 patients between January 2003 and December 2009 (in whom a 1 mg/0.1 bolus of intracameral cefazolin was instilled. Results During the study period, 76 cases of endophthalmitis were observed in Group 1, and seven in Group 2. The rate of postoperative endophthalmitis reduced from 0.63% to 0.05% with a cefazolin injection. The relative risk (RR for endophthalmitis in Group 1 against group 2 was 11.45 [95% CI 5.72-22.84, p . Conclusions An intracameral bolus injection of cefazolin (1 mg in 0.1 ml solution at the conclusion of the cataract surgery significantly reduced the rate of postoperative endophthalmitis.
Full Text Available Abstract Background Cataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal. Methods Subjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of and knowledge (understanding of the disease of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39% subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCS??, retinal examination and SITA standard perimetry when indicated. Results The age-sex adjusted prevalence of blindness (best corrected Conclusion The low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population.
Twyana Shankha N
AIM: To evaluate the effect of polyethylene glycol eye drops on tear film break-up time and symptoms for dry eyes after cataract surgery.METHODS: Eighty patients with dry eyes secondary to cataract surgery who were treated in our hospital from January to August 2013 were randomly divided into group A and group B. Group A was treated with sodium hyaluronate eye drops for one week, and Group B was treated with polyethylene glycol eye drops for one week. The break-up time of tear film was mea...
The purpose of this article is to report a case of nonarteritic anterior ischemic optic neuropathy (NAION) after uneventful cataract surgery. A 53-year-old Filipina underwent cataract surgery. She had a small optic disc with cup-to-disc ratio of 0.2 in the left eye and 0.3 in the right eye. On the first postoperative day, the uncorrected visual acuity (UCVA) was 20/20, with an intraocular pressure (IOP) of 20 mmHg in the left eye. At one week after operation, the UCVA was 20/20 and the IOP wa...
Lee, Hun; Kim, Chan Yun; Seong, Gong Je; Ma, Kyoung Tak
Full Text Available Background: This study aims to assess the quality of life and the time trade off-utility value of the first eye cataract surgery and the second eye cataract surgery in Lombok Island-Indonesia. Methods: This was an epidemiologic survey study on community of cataract surgery. Evaluations of quality of life (QoL and time trade-off (TTO were performed using questionnaire prior and three weeks after cataract surgeries who had either first (group A or second eye cataract surgery (group B. Personal data was noted especially on self-care, mobility, socially, and mentally status. Data was analyzed by chi-square test for categorical data and unpaired t-test or Mann-Whitney test for numeric data. Results: A total of 77 subjects was included in this study, there were 50 subjects in group A and 27 subjects in group B. Elements of QoL were improved after surgeries including self care, mobility, social, and mental status in both groups (p < 0.001. The modified TTO was accepted in 35 subjects in group A and 22 subjects in group B. Quality of life was improved in 46 patients in group A, there was further improvement in 22 patients in group B. The degree of patient’s expectation was good in 87% of all subjects. Conclusion: Second- eye cataract surgery showed further improvement in QoL despite better outcome of the first- eye cataract surgery. The outcome of cataract surgery conducted was relevant to the patient’s expectation. (Med J Indones. 2013;22:107-13Keywords: First and second cataract surgery, quality of life, senile cataract, time trade-off
Tjahjono D. Gondhowiardjo
Full Text Available Atsushi Kawahara,1 Daijiro Kurosaka,2 Akitoshi Yoshida31Department of Ophthalmology, Sapporo Tokushukai Hospital, Sapporo, 2Department of Ophthalmology, Iwate Medical University, Morioka, 3Department of Ophthalmology, Asahikawa Medical University, Asahikawa, JapanBackground: The purpose of this study was to compare surgically induced astigmatism (SIA between one-handed and two-handed cataract surgery techniques.Methods: Eighty-eight eyes of 44 patients with no ocular disease other than cataract, who underwent cataract surgery by a single surgeon, were selected for this study. Cataract surgery was performed by coaxial phacoemulsification and intraocular lens implantation via a 2.4 mm transconjunctival single-plane sclerocorneal incision at the 12 o'clock position. In each patient, one eye was subjected to coaxial phacoemulsification using a one-handed technique while the fellow eye was subjected to coaxial phacoemulsification using a two-handed technique. For the two-handed technique, a corneal side port was created at the 2 o'clock position. The appropriate incision meridian was identified by a preoperative axis mark. SIA was calculated using the Alpins method.Results: Mean SIA was 0.40 ± 0.28 diopters (D in the one-handed technique group and 0.39 ± 0.25 D in the two-handed technique group. No statistically significant difference was found in the mean SIA score. The mean torque value was ?0.05 ± 0.26 D in the one-handed technique group and 0.11 ± 0.37 D in the two-handed technique group. Mean torque was significantly lower (P<0.05 in the one-handed technique group than in the two-handed technique group.Conclusion: The results indicate that the corneal side port in two-handed cataract surgery has a rotating effect on the axis of astigmatism.Keywords: cataract surgery, corneal side port, surgically induced astigmatism
AIMS--The first 662 cases of a multicentre randomised clinical trial of intracapsular cataract extraction (ICCE) with and without implantation of a four point multiflex (Cilco Kelman Choyce Modification) anterior chamber intraocular lens (AC IOL) were studied after 6 weeks to compare frequency of surgical complications, short term clinical outcomes, and corneal endothelial cell loss between groups. METHODS--Randomisation was performed after screening for predetermined inclusion and exclusion ...
We are reporting the successful anesthetic management of a 6 years old child, who had cyanotic congenital heart disease and underwent an operation for cataract extraction. Ketamine was used for the induction and maintenance of anesthesia. Ventilation was assisted manually by using laryngeal masks. (author)
Full Text Available Abstract Background Despite recommendations for greater use of second-eye cataract surgery and the bilateral progression of the disease, there is a substantial proportion of unmet need for this treatment. Few studies have explored the factors associated with second-eye cataract surgery utilisation. The objective of our study was to estimate the proportion of second-eye cataract surgery, evaluate its time-trend, and explore differences in utilisation by patients' gender, age, and region of residence. Methods All senile cataract surgeries performed between 1999 and 2002 in the public health system of Catalonia (Spain were obtained from the Minimum Data Set. The proportion of second-eye surgery from November 2000 to December 2002 was calculated. The time-trend of this proportion was characterised through linear regression models with the logarithmic transformation of time. Results The proportion of second-eye surgery was 30.0% and showed an increasing trend from 24.8% (95% Confidence Interval [CI] 21.6; 26.1 in November 2000 to 31.8% (95% CI 31.4; 33.6 in December 2002. This proportion was 1.9% (95% CI 0.9; 2.9 higher in women (p Conclusion We predict greater utilization of second-eye surgery in patients aged 70 to 79 years and in women. A greater increase in the utilisation rates of second-eye surgery is expected in the regions with lower proportions and in older patients. The observed trend suggests that there will be a substantial proportion of unmet need for bilateral surgery.
Purpose: The developing visual cortex has a strong potential to undergo plastic changes. Little is known about the potential of the ageing visual cortex to express plasticity. A pertinent question is whether therapeutic interventions can trigger plastic changes in the ageing visual cortex by restoring vision. Methods: Twelve patients aged 50-85 years underwent structural high-resolution T1-weighted MRI of the whole brain 2 days and 6 weeks after unilateral cataract surgery. Voxel-based morphometry (VBM) based on T1-weighted magnetic resonance imaging (MRI) was employed to test whether cataract surgery induces a regional increase in grey matter in areas V1 and V2 of the visual cortex. Results: In all patients, cataract surgery immediately improved visual acuity, contrast sensitivity and mean sensitivity in the visual field of the operated eye. The improvement in vision was stable throughout the 6 weeks after operation. VBM revealed a regional expansion of grey matter volume in area V2 contralateral to the operated eye during the 6-week period after surgery. Individual increases in grey matter were predicted by the symmetry in visual acuity between the operated eye and nonoperated eye. The more symmetrical visual acuity became after unilateral cataract surgery, the more pronounced was the grey matter increase in visual cortex. Conclusion: The data suggest that cataract surgery triggered a use-dependent structural plasticity in V2 presumably through improved binocular integration of visual input from both eyes. We conclude that activity-dependent cortical plasticity is preserved in the ageing visual cortex and may be triggered by restoring impaired vision.
Lou, Astrid R; Madsen, Kristoffer H
Background : A review of pediatric cataract cases operated between January 2003 and March 2005 in the tribal belt of central India was carried out. Aim : We present the profile of cataract cases in children ?18 years and postoperative visual status in the eyes operated upon. Settings and design : This was a retrospective medical record retrieval type of cohort study in a hospital setting. materials and Methods : Pediatric ophthalmologists exam...
Khandekar Rajiv; Sudhan Anand; Jain B; Shrivastav Kuldeep; Sachan Ramendra
Background: Intraoperative lidocaine is widely used in controlling discomfort during cataract surgery. However, recent studies have confirmed the toxic effect of lidocaine on ganglion cells. Ropivacaine is an anesthetic recently introduced in clinical practice that couples a long anesthetic effect with a mild vasoconstrictive action.
Aim: The results of a study designed to investigate the predictive value of preoperative anterior chamber depth (ACD) and intraocular pressure (IOP) are reported. The relation between these factors and their effect on the reduction in IOP following phacoemulsification cataract surgery was also studied.
Issa, S. A.; Pacheco, J.; Mahmood, U.; Nolan, J.; Beatty, S.
Abstract Introduction Systemic hypersensitivity reactions to topical ophthalmic treatment occur rarely, but when they do they can be severe as highlighted by this case. Case presentation A post-operative cataract surgery patient developed a severe and generalised hypersensitivity reaction following topical treatment with Maxitrol (Dexamethasone and Neomycin) eye drops. The patient reported a previous allergic reaction to Neomycin. Conclusion This c...
Ansari Imran A; Onyema Ernest
Full Text Available Incidence of preoperative rise in blood pressure (BP in cataract surgery among hypertensive and normotensive patients. Objective: To study the incidence of preoperative rise in BP in cataract surgery among normotensive individuals and hypertensive patients with historic good BP control in a population without other major chronic diseases. Settings: Ophthalmology Service of a University Hospital. Materials and Methods: A prospective study with 822 patients older than 40 years of age, with cataract surgery indication, and without major chronic diseases other than hypertension. The patients were divided in two groups: hypertensive and normotensive. Preoperative data, physical exams and medical adverse events were recorded in an evaluation questionnaire. Results: The sample included 427 normotensive (52% and 395 hypertensive patients (48%. The two groups had similar proportions of operations that were cancelled and not subsequently rescheduled, 2% (eight patients in each group. The incidence of preoperative rise in BP was 3.7% in the normotensive group and 10.9% in the hypertensive group (P < 0.001. Conclusion: Hypertensive patients with historic good BP control and without other major co-morbidities present a larger incidence of preoperative rise in BP than normotensive individuals in cataract surgery.
Lira Rodrigo Pessoa
Full Text Available Manual small incision cataract surgery has evolved into a popular method of cataract surgery in India. However, in supra hard cataract, bringing out the whole nucleus through the sclerocorneal flap valve incision becomes difficult. A bigger incision required in such cataracts loses its value action, as the internal incision and corneal valve slips beyond the limbus into sclera. Struggling with the supra hard cataracts through a regular small incision. Phacofracture in the anterior chamber becomes a useful option in these cases. In the snare technique, a stainless steel wire loop when lassoed around the nucleus in the anterior chamber constricts from the equator, easily dividing the hardest of the nuclei into two halves. The wire loop constricts in a controlled way when the second cannula of snare is pulled. The divided halves can easily be brought out by serrated crocodile forceps. This nuclear management can be safely performed through a smaller sclerocorneal flap valve incision where the corneal valve action is retained within the limbus without sutures, and the endothelium or the incision is not disturbed. However, the technique requires space in the anterior chamber to maneuver the wire loop and anterior chamber depth more than 2.5 mm is recommended. Much evidence to this wonderful technique is not available in literature, as its popularity grew through live surgical workshops and small interactive conferences.
A 49-year-old man with an uncorrected visual acuity (UCVA) of 20 / 1000, a best spectacle-corrected visual acuity (BSCVA) of 20 / 400, keratometric readings of K1 = 59.88 × 82° / K2 = 45.88 × 172°, and an inferior steepening that was consistent with keratoconus in his left eye was treated with clear-cornea phacoemulsification and an intraocular lens (IOL) implantation after insertion of keraring intrastromal corneal ring segments for severe keratoconus and cataract. An asymmetrical pair o...
Lee, Seung Jae; Kwon, Hyun Suk; Koh, Il Hwan
OBJECTIVE: To identify social characteristics and expectations of individuals seen during a community project for the treatment of senile cataracts. Expected results from their eye surgery and its consequences to their quality of life were studied as well. METHODOLOGY: Cataract patients (visual acuity equal to or lower than 0.2 in the more superior eye) aged 50 years or over, were surveyed by means of interviews held during their visit at the Cataract Project in São Paulo city, State of São...
AIMS/METHODS—A national data collection exercise was carried out in more than 100 hospital eye service units within the UK to provide clinical and administrative information on patients undergoing cataract surgery. This included patient clinical data such as visual acuity at the time of wait listing and at the time of admission for surgery, presence of other eye disorders, other serious medical disorders, and data on waiting time and type of admission.?RESULTS—The profiles of the 1...
Desai, P.; Reidy, A.; Minassian, D.
Eighty patients undergoing routine standardised extracapsular cataract surgery with lens implantation were divided randomly into two groups in a prospective double blind study comparing effects of preoperative norfloxacin eyedrops with placebo on bacterial contamination of anterior chamber aspirates after surgery. Pathogenic organisms were identified from 19 (24%) of the aspirates. The most commonly isolated organisms were coagulase negative Staphylococcus species. There was no statistical di...
Chitkara, D. K.; Manners, T.; Chapman, F.; Stoddart, M. G.; Hill, D.; Jenkins, D.
Full Text Available There has been analyzed one of the most frequent and serious complications of cataract surgery — exudative inflammatory response (EIR of eye. There has been presented current view on etiopathogenesis of the condition, classifications and the description of clinical presentation of various EIR types have been given. Known techniques of prognosis and prevention of postoperative exudative uveites have been presented. There have been given present methods of complex treatment of eye EIR: drug treatment, laser therapy and surgery.
Carmen Sílvia Bongiovanni1, Carla Cristina Serra Ferreira1, Ana Paula Silvério Rodrigues1, João Borges Fortes Filho2, Márcia Beatriz Tartarella11Department of Ophthalmology, Congenital Cataract Section, Medical School, Federal University of São Paulo, São Paulo; 2Department of Ophthalmology, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, BrazilAbstract: Knobloch syndrome is an autosomal recessive disorder associated with early-...
In Western Australia during the period 1 January 1976 to 31 December 1987 1089 eyes of 1044 patients in hospital were operated upon for primary rhegmatogenous retinal detachment due to causes other than penetrating trauma. Of these eyes 295 (27%) were aphakic or pseudophakic. During this period the annual number of cataract operations in the State increased by a factor of 245%, while aphakic and pseudophakic retinal detachment operations rose by only 55%. The declining risk of retinal detachm...
Gray, R. H.; Evans, A. R.; Constable, I. J.; Mcallister, I. L.
Full Text Available AIM:To investigate the reasons of the barriers to free cataract surgery in suburban area of one city in middle China. METHODS: From 2008 to 2009, in Sight Rehabilitation Programme of Cataract in suburban district of one city in middle China, all visually significant cataract patients screened were questioned about why he/she did not accept free cataract surgery. The answers were recorded and analyzed. RESULTS: Of 892 screened patients, only 387 patients(43.39%wanted a free cataract surgery at first. At last 490 patients(54.93%accepted free surgery. The main reasons for patients who did not accept free surgery include: be afraid of surgery and wanting other treatments(193, 21.64%, thinking the eyesight was enough for daily life(148, 16.59%, worrying about that the result would not be good as those paid for surgery(147, 16.48%, and other reasons(17, 1.91%.CONCLUSION: The reasons of the barriers to free cataract surgery include patients' ignorance, surgery outcome of patients around, and working mode of designated surgical hospital.
Full Text Available Abstract Introduction High-resolution ocular coherence computed tomography enables unprecedented visualization of the retinal microarchitecture. To the best of our knowledge, this is the first report of high-resolution ocular coherence tomography findings in the healed form of photic post-cataract retinopathy. Case presentation A 76-year-old Caucasian man complained of paracentral scotoma, persisting for six weeks after cataract surgery. Conclusion Ocular coherence tomography demonstrated a localized juxta-foveal area of retinal atrophy involving the photoreceptor layer, and the retinal pigment epithelium layer.
Yunis Muhammad H
Full Text Available Masahiko Shimura1, Toru Nakazawa2, Kanako Yasuda1, Takashi Shiono3, Kohji Nishida21Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan; 2Department of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, Japan; 3Department of Ophthalmology, Shiono Eye Center, Sendai, JapanPurpose: This study compares the effect of topical diclofenac with that of betamethasone against postoperative increase of intraocular pressure (IOP after cataract surgery in normal patients, and also investigated the risk factors for postoperative increase of IOP in each group.Methods: Fifty consecutive patients without systemic disease who have bilateral and symmetrical cataracts underwent uncomplicated cataract surgery in both eyes (100 eyes in total. Postoperatively, topical diclofenac was applied 4 times daily to one eye, and topical betamethasone to the other eye in each patient. IOP and best corrected logMAR visual acuity (BCVA in each eye were measured up to 8 weeks. Total surgery time and effective phacoemulsification time (EPT for each case was recorded.Results: BCVA in both diclofenac- and betamethasone-treated eyes significantly improved after the cataract surgery; however, no statistical difference in VA was noted between the diclofenac- and betamethasone-treated eyes throughout the observation period. IOP in the diclofenac-treated eyes decreased with time, in contrast to the IOP in the betamethasone-treated eyes, which showed a slight increase. At 4 and 8 weeks postoperatively, there was significant difference between these two eye groups. Multiple regression analysis revealed that postoperative increase in IOP at 8 weeks in the betamethasone-treated eyes was closely correlated with total surgery time and EPT, but the IOP in the diclofenac-treated eyes showed no correlation with any surgical or clinical parameters.Conclusions: Postoperative increase in IOP after cataract surgery was affected by total surgery time and EPT in the betamethasone-treated eye. The time for surgery and EPT is longer in complicated cases including patients with a hard nucleus or small pupils, and also longer for beginning surgeons and in older patients. In these cases, diclofenac in place of betamethasone as a postoperative topical antiinflammatory drug is recommended for the prevention of postoperative increase in IOP.Keywords: intraocular pressure, cataracts, visual acuity, betamethasone, diclofenac
Full Text Available Purpose: To study the effect of a topical non-steroidal anti-inflammatory drug as an alternative to topical steroids for postoperative control of inflammation in cataract surgery. Methods: The effect of diclofenac sodium 0.1% following cataract surgery was studied and compared to routine corticosteroid, dexamethasone phosphate 1% in a prospective, double-blind randomized study. Both groups were similar in baseline parameters. Postoperative inflammatory response, intraocular pressure and best-corrected visual acuity following standard extracapsular cataract extraction were assessed in both groups in the initial 21 days and the severity of these parameters was graded. The severity of postoperative inflammatory response to the two drugs was graded at 1, 3, 7, 14 and 21 days. Intraocular pressure and visual acuity at baseline and endpoint were compared and statistically analyzed. Results: The two groups did not differ statistically in treatment effect for any of the variables including aqueous cells, flare, ciliary congestion, Descemet?s folds, visual acuity and intraocular pressure (p< 0.001. However there seemed to be a trend towards quicker improvement with corticosteroid when cells in the anterior chamber were considered. There were no side effects from topical diclofenac, and it was well tolerated. Conclusion: Dicfofenac sodium is as effective as topical corticosteroid and can be used as an alternative in routine postoperative treatment following uncomplicated cataract surgery.
Background The purpose of this study was to compare surgically induced astigmatism (SIA) between one-handed and two-handed cataract surgery techniques. Methods Eighty-eight eyes of 44 patients with no ocular disease other than cataract, who underwent cataract surgery by a single surgeon, were selected for this study. Cataract surgery was performed by coaxial phacoemulsification and intraocular lens implantation via a 2.4 mm transconjunctival single-plane sclerocorneal incision at the 12 o’clock position. In each patient, one eye was subjected to coaxial phacoemulsification using a one-handed technique while the fellow eye was subjected to coaxial phacoemulsification using a two-handed technique. For the two-handed technique, a corneal side port was created at the 2 o’clock position. The appropriate incision meridian was identified by a preoperative axis mark. SIA was calculated using the Alpins method. Results Mean SIA was 0.40 ± 0.28 diopters (D) in the one-handed technique group and 0.39 ± 0.25 D in the two-handed technique group. No statistically significant difference was found in the mean SIA score. The mean torque value was ?0.05 ± 0.26 D in the one-handed technique group and 0.11 ± 0.37 D in the two-handed technique group. Mean torque was significantly lower (P<0.05) in the one-handed technique group than in the two-handed technique group. Conclusion The results indicate that the corneal side port in two-handed cataract surgery has a rotating effect on the axis of astigmatism.
Kawahara, Asushi; Kurosaka, Daijiro; Yoshida, Aktoshi
Full Text Available AIM: To compare the efficiency of coaxial micro-incision cataract surgery(MICSperformed by 3 phacoemulsification techniques(phaco-chop, divide-and- conquer and stop-and-chop.METHODS: It was a perspective and randomized clinical trial. Totally 135 patients with age-related cataract were selected randomly and underwent MICS. According to the lens nuclear opacity(NOof LOCS? grading standards, it can be divided into 3 groups as NO2, NO3 and NO4 group. All groups were randomly subdivided into 3 groups(phaco-chop, divide-and-conquer and stop-and-chop group. The observation target included best-corrected visual acuity(BCVA, central corneal thickness(CCTand endothelial cell count(ECCbefore operation and 1mo postoperation, ultrasound time(UST, cumulative dissipated energy(CDE, estimated fluied used(EFUin operation and complications.RESULTS:In lens nuclear opacity NO4 coaxial micro-incision phacoemulsification, phaco-chop group showed significantly less UST, CDE and EFU than the divide-and-conquer and stop-and-chop groups(P0.05and the ratio of endothelial cell loss was significantly lower in the phaco-chop group than in the divide-and-conquer and stop-and-chop groups 1mo after surgery(P0.05. However, after 1mo surgery, BCVA and CCT among three chop technique groups in different lens nuclear opacity groups had no significant differences(P>0.05.CONCLUSION: All 3 techniques may be effective for coaxialmicroincision cataract surgery in mild and moderate nuclear opacity cataracts. However, in eyes with severe nuclear opacity cataract, the phaco-chop technique can be more effective for phacoemulsification, and less corneal endothelial damage.
Purpose:? To evaluate waiting times for first-eye cataract surgery in Sweden following widespread adoption of the Nationell Indikationsmodell for Kataraktextraktion (NIKE) tool for prioritizing patients for cataract surgery. Methods:? Waiting times for all first-eye cataract surgeries in Sweden in 2009-2011 were identified from the Swedish National Cataract Register. Waiting times were compared according to demographic, clinical and NIKE indication group for surgery. Multivariate logistic regression modelling was used to determine factors associated with waiting times less than the 3-month Government guarantee period. Results:? There were 141?070 first-eye cataract surgeries in 2009 to 2011; an annual increase of around 6%. Over the study period, mean waiting times decreased across all NIKE groups. The proportion waiting NIKE groups. Surgery within 3?months of waitlisting was more likely for patients with a NIKE 1 indication classification (most need for surgery), in later years, male patients, younger patients and patients with a preoperative visual acuity in the better eye worse than 6/24. Conclusions:? Prioritizing patients for cataract surgery using NIKE reduces waiting times for those with the greatest need. PMID:23764232
Ng, Jonathon Q; Lundström, Mats
Full Text Available AbstractPurpose: To evaluate the results and complications of phacoemulsification surgery due to various factors in patients with cataract formation after intravitreal injection of triamcinolone acetonide (IVTA. Materials and Methods: Forty-five eyes of 32 patients with cataract formation that had developed after one or multiple IVTA injections were included in the study. Among these patients, 28 eyes had diabetic macular edema, 7 eyes had branch retinal vein occlusion, 2 eyes had central retinal vein occlusion, 4 eyes had choroidal neovascular membrane due to age-related macular degeneration, 2 eyes had uveitic cystoid macular edema and 2 eyes had posterior uveitis. The mean age of the patients was 52.4±11.0 years, and all patients underwent standard phacoemulsification surgery with foldable intraocular lens implantation. Results: Minimal hemorrhage developed during surgery in 2 patients with diabetic retinopathy. After anterior chamber lavage, there was no hemorrhage after surgery and during the following days. Postoperatively, transient intraocular pressure elevation treated with topical antiglaucomatous medication was observed in 5 eyes. Seven eyes required Nd:YAG laser therapy due to posterior capsule opasification after a mean follow-up time of 8.5 months.Conclusion: There were no additional complications secondary to IVTA injection during or after phacoemulsification surgery in patients with cataract formation following IVTA injection.
Esra Ayhan Tuzcu
Full Text Available Purpose: To study the effect of cataract extraction on the retinal nerve fiber layer (RNFL thickness, and assessment by scanning laser polarimetry (SLP, with variable corneal compensation (GDx VCC, at the glaucoma service of a tertiary care center in North India. Materials and Methods: Thirty-two eyes of 32 subjects were enrolled in the study. The subjects underwent RNFL analysis by SLP (GDx VCC before undergoing phacoemulsification cataract extraction with intraocular lens (IOL implantation (Acrysof SA 60 AT four weeks following cataract surgery. The RNFL thickness parameters evaluated both before and after surgery included temporal, superior, nasal, inferior, temporal (TSNIT average, superior average, inferior average, and nerve fiber index (NFI. Results: The mean age of subjects was 57.6 ± 11.7 years (18 males, 14 females. Mean TSNIT average thickness (?m pre- and post-cataract surgery was 49.2 ± 14.1 and 56.5 ± 7.6 ( P = 0.001. There was a statistically significant increase in RNFL thickness parameters (TSNIT average, superior average, and inferior average and decrease in NFI post-cataract surgery as compared to the baseline values. Mean NFI pre- and post-cataract surgery was 41.3 ± 15.3 and 21.6 ± 11.8 ( P = 0.001. Conclusions: Measurement of RNFL thickness parameters by scanning laser polarimetry is significantly altered following cataract surgery. Post the cataract surgery, a new baseline needs to be established for assessing the longitudinal follow-up of a glaucoma patient. The presence of cataract may lead to an underestimation of the RNFL thickness, and this should be taken into account when analyzing progression in a glaucoma patient.
We describe a rapid anterior capsule contraction following phacoemulsifiction and intraocular lens(IOL) implantation in an old woman with high myopia. The patient with high myopia complicated with cataract received phacoemulcification and IOL implantation bilaterally .The best-corrected visual acuity (BCVA) improved from 0.1 to 0.4 in the right eye and 0.5 in the left eye 1 week after surgeries.5 weeks after surgery of the right eye and 4 weeks after surgery of the left eye, the patient compl...
Xiao, Wei; Zhao, Dai-xin; Xue, Long-quan
Full Text Available Abstract Background To compare the lifetime costs of liberating patients from spectacles after cataract surgery by implanting the multifocal intraocular lens (IOL 'ReSTOR®' versus monofocal IOLs in France, Italy, Germany and Spain. Methods A Markov model was created to follow patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles after cataract surgery were obtained from clinical trials. Resource utilisation included implant surgery, IOLs, spectacles, visits to ophthalmologists and eye centres, transport, and time lost by patients. Economic perspectives were those of Society and Sickness Funds (SFs. Results The mean number of spectacles purchased after ReSTOR® was 1.34–1.61 and after monofocal IOLs 6.05–7.27. From the societal perspective, total cost estimates discounted by 3% were between €3,551 and €4,052 with ReSTOR® compared to €3,989 and €5,548 with monofocal IOLs. Undiscounted savings related to ReSTOR® ranged from €815 to €2,164. From the SFs' perspective total cost estimates discounted by 3% were between €2,150 and €2,524 with ReSTOR® compared to €2,324 and €2,610 with monofocal IOLs. Savings related to ReSTOR®, once costs discounted, ranged from €61 to €219. Discount and spectacle freedom prevalence rates were the most sensitive parameters. Conclusion The bulk of the savings related to ReSTOR® were realized outside the SF. From both a societal and SF perspective, savings, after a 3% discounting, achieved by liberating patients from spectacles counterbalanced the initially higher cost of ReSTOR®. ReSTOR® is a cost saving alternative to spectacles for patients requiring cataract surgery.
Full Text Available Abstract Background Cataracts are a common and significant cause of visual impairment globally. We aimed to evaluate uncorrected distance visual acuity (UDVA as an outcome in treating astigmatic cataract patients to assist clinicians or ophthalmologists in their decision making process regarding available interventions. Methods Medline, Embase and Evidence Based Reviews were systematically reviewed to identify relevant studies reporting changes in UDVA, UIVA and UNVA after cataract surgery in presbyopic patients. Strict inclusion/exclusion criteria were used to exclude any non-relevant studies. Relevant outcomes (UDVA, UIVA and UNVA were identified from the studies retrieved through the systematic review process. Results The systematic review identified 11 studies which reported UCVA. All 11 studies reported UDVA. Four brands of toric intraocular lenses (IOLs were reported in these studies. All studies identified in the literature search reported improvements in UDVA following surgical implant of a toric IOL. The largest improvements in VA were reported using the Human Optics MicroSil toric IOL (0.74 LogMAR, UDVA and the smallest improvements were also reported using the Human Optics MicroSil toric IOL (0.23 LogMAR, UDVA in a different study. Conclusions The results of this systematic review showed the aggregate of studies reporting a beneficial increase in UDVA with the use of toric IOLs in cataract patients with astigmatism.
Full Text Available Abstract Background Several recent studies have recommended that ophthalmologists must be aware of the visual sensations (and their associated anxiety/fear experienced by patients undergoing cataract surgery. We assessed the knowledge of a group of eye doctors in Pakistan regarding these phenomena. Methods This was a cross-sectional survey. Eye doctors (ophthalmologists, residents and medical officers attending the Ophthalmological Society of Pakistan Annual Conference 2011, in Karachi were invited to participate in the study. A self-administered structured questionnaire was used to examine their knowledge of visual sensations and their associated anxiety/fear experienced by patients during cataract surgery. Simple frequencies and proportions were calculated to describe the data. Results A total of 150 ophthalmologists, residents and medical officers were invited to participate in the study. Of these, 68 (45.3% responded. The mean age (±SD of the participants was 42.9 (13.2 years. The proportion of participants who thought that patients could experience visual sensations during cataract surgery under regional anaesthesia was 89.7% and that under topical anaesthesia was 73.5%. The most frequently cited sensations included: light perception, changes in light brightness, movements, instruments and surgeon’s hands or fingers. The eye doctors estimated that 38.9% and 64.3% patients would see at least something during cataract surgery under regional anaesthesia and topical anaesthesia, respectively. They also believed that 24.2%-36.9% of patients may experience anxiety/fear as a result of visual sensations during such surgery. Approximately half of the eye doctors did not think that retained vision was a source of fear or anxiety for the patients. While most of them acknowledged the importance of preoperative counselling in helping to alleviate such fear/anxiety, the majority of them did not regularly counsel their patients on what to expect during the surgery. Conclusion Our study reveals that a significant proportion of eye doctors do not have adequate knowledge of the visual phenomenon and their associated anxiety or fear, that patients can experience during cataract surgery. Targeted educational interventions are needed to increase awareness of this phenomenon among eye care professionals.
Tauqir Mohammad Zain
Full Text Available AIM: To observe the therapeutic effect of triple surgery in the treatment of glaucoma with cataract at different stages.METHODS: Totally 31 patients(55 eyeswith glaucoma and cataract were treated with phacoemulsification, lens implantation and trabeculectomy. Preoperation and postoperation of visual acuity, intraocular pressure, filtering bleb and postoperation complications were observed.RESULTS: After 6mo postoperation, the vision was significantly improved. The intraocular pressure was controlled in normal range and filtering bleb was good. There was a little complications after operation.CONCLUSION: Phacoemulsification intraocular lens implantation with anti-glaucoma establishes new aqueous humor outflow. It can effectively decrease intraocular pressure, deepen anterior chamber and improve vision, reduce all kinds of complications after simple glaucoma surgery.
Abstract Background Several recent studies have recommended that ophthalmologists must be aware of the visual sensations (and their associated anxiety/fear) experienced by patients undergoing cataract surgery. We assessed the knowledge of a group of eye doctors in Pakistan regarding these phenomena. Methods This was a cross-sectional survey. Eye doctors (ophthalmologists, residents and medical officers) attending the Ophthalmological Society of Pakistan Annual C...
Tauqir Mohammad Zain; Chaudhry Tanveer Anjum; Mumtaz Sehreen; Ahmad Khabir
Hypromellose can be used as a viscoelastic substance during cataract surgery. Two groups of patients, one group operated on using hypromellose, the other using sodium hyaluronate as a viscoelastic substance were followed up 2-6 months postoperatively. A total of 16.7% of the eyes operated on using hypromellose developed a non-reactive semidilated pupil whereas none of the eyes from the control group developed this phenomenon. It was concluded that there is a probable link between the intraocu...
Purpose: To assess the visual outcome after cataract surgery in a south Indian population. Materials and Methods: Population-based cross-sectional study of subjects aged 40 years or more. Three thousand nine hundred and twenty-four rural subjects from 27 contiguous villages and 3850 urban subjects from five randomly selected divisions were studied. All subjects underwent a comprehensive ophthalmic examination that included visual acuity, refraction, slit-lamp biomicroscopy, a...
Vijaya Lingam; George Ronnie; Rashima A; Raju Prema; Arvind Hemamalini; Baskaran Mani; Ve Ramesh
Atsushi Kawahara,1 Daijiro Kurosaka,2 Akitoshi Yoshida31Department of Ophthalmology, Sapporo Tokushukai Hospital, Sapporo, 2Department of Ophthalmology, Iwate Medical University, Morioka, 3Department of Ophthalmology, Asahikawa Medical University, Asahikawa, JapanBackground: The purpose of this study was to compare surgically induced astigmatism (SIA) between one-handed and two-handed cataract surgery techniques.Methods: Eighty-eight eyes of 44 patients with no ocular disease other than catar...
Kawahara A; Kurosaka D; Yoshida A
Aim To report the vitreoretinal (VR) surgical case mix in the United Kingdom, the intraoperative complication rate of pars plana vitrectomy (PPV), and the incidence of post-vitrectomy cataract extraction. Methods Participating hospitals prospectively collected ophthalmic data using a single electronic medical record system, with automatic extraction of anonymised data to a national database. This study included the subset of 11?618 VR operations undertaken on 9619 eyes, of 8741 patients, over 8 years, from 27 sites. Surgical data included the indication for surgery, all procedure elements, and whether or not an intraoperative complication occurred. Post-vitrectomy cataract data were also analysed. The main outcome measures were a description of the indications for surgery, intraoperative PPV complication rate, and percentage of eyes undergoing post-vitrectomy cataract surgery (PVCS). Results The most common indications for VR intervention were retinal breaks and rhegmatogenous retinal detachment (48.5%), macular hole (9.8%), epiretinal membrane (9.6%), and diabetic eye disease (7.3%). Overall, 7.8% of PPVs had at least one intraoperative complication—the most common were iatrogenic retinal breaks (3.2%), and lens touch (1.2–1.6% of phakic eyes). PVCS occurred in 50.2, 68.7, and 74.0% of eyes at 1, 2, and 3 years, respectively. Conclusion VR surgery is undertaken for a wide range of conditions, but a small number of diagnoses encompass the majority of cases. Intraoperative PPV complications are not uncommon, and post-vitrectomy cataract is to be expected in most phakic eyes.
Jackson, T L; Donachie, P H J; Sparrow, J M; Johnston, R L
A 60-year-old male was referred to the ophthalmologic clinic with aggravated anterior uveitis and corneal edema despite the use of topical and systemic steroids. He had undergone cataract surgery in both eyes 15 years previous. Slit lamp examinations revealed a retained lens fragment in the inferior angle of the anterior chamber, with severe corneal edema and mild anterior uveitis. The corneal edema and uveitis subsided following surgical extraction of the lens fragment. That a retained lens ...
Kang, Hae Min; Park, Jong Woon; Chung, Eun Jee
Full Text Available Moataz F Elsawy, Nermine Badawi, Hany A KhairyOphthalmology Department, Menoufia University Hospital, Menoufia, EgyptObjective: To evaluate the prophylactic role of topical non-steroidal anti-inflammatory drugs in reducing the incidence of central macular edema (CME in diabetic eyes post-cataract surgery.Patients and methods: This study included 86 eyes (70 patients with high risk characteristics for the development of CME after cataract surgery. All patients underwent phacoemulsification and intraocular lens implantation. Patients were divided into two equal groups (n = 43 [eyes]: a control group given topical dexamethasone 0.1%, four times/day for 12 weeks postoperatively and a study group given topical ketorolac tromethamine 0.4% twice daily in addition to topical dexamethasone 0.1% four times daily for 12 weeks. Patients were examined at 3, 6, and 12 weeks postoperatively for evaluation of CME development. The main study outcome was the change in the retinal fovea thickness measured with ocular coherence topography.Results: Ten eyes developed CME (11.6%; eight eyes in the control group and only two eyes in the study group. Mean retinal fovea thickness was significantly higher in the control group compared to the study group. Moreover, eyes of the control group developed CME significantly earlier than those of the study group.Conclusion: Prophylactic postoperative ketorolac 0.4% may have a role in reducing the frequency and severity of CME in diabetic eyes post-cataract surgery.Keywords: diabetes mellitus, cataract surgery, central macular edema, ketorolac, dexamethasone
Pinakin Gunvant1,2, Anna Ablamowicz2, Subba Gollamudi31Western University of Health Sciences, College of Optometry, Pomona, CA, 2Southern College of Optometry, Memphis, TN, 3Eye Specialty Group, Memphis, TN, USAPurpose: To investigate if the parameters measured routinely prior to cataract surgery with multifocal intraocular lens (IOL) implantation can predict the necessity of additional laser in situ keratomileusis (LASIK) to improve visual outcome.Methods: Records of patients undergoing cata...
Gunvant P; Ablamowicz A; Gollamudi S
Recent clinical studies indicate that flurbiprofen, a cyclooxygenase inhibitor, prevents miosis and breakdown of the blood-aqueous barrier during cataract surgery. Yet based on clinical and experimental data, some researchers do not agree that flurbiprofen prevents miosis. We conducted a double-blind clinical study of the effects of topical 0.03% flurbiprofen sodium on intraoperative pupillary diameter and iris fluorescein leakage after extracapsular cataract surgery. In the first phase of the study, 120 patients who had extracapsular cataract extraction with posterior chamber intraocular lens implantation were randomly assigned to receive preoperative topical flurbiprofen or a placebo, with or without intraoperative epinephrine, in addition to the standard regimen. In the second phase, 60 of the 120 patients continued the topical flurbiprofen or placebo for one month postoperatively. Iris fluorescein angiography was performed at the end of the first and the fourth weeks. The results indicate that flurbiprofen was significantly more effective (P < .0001) in maintaining mydriasis during surgery than the placebo. This action was enhanced by intraoperative epinephrine. Flurbiprofen also significantly reduced (P < .001) postoperative iris fluorescein leakage. PMID:8229720
Cillino, S; Casanova, F; Cucco, F; Ponte, F
Full Text Available AIM: To evaluate the effect of polyethylene glycol eye drops on tear film break-up time and symptoms for dry eyes after cataract surgery.METHODS: Eighty patients with dry eyes secondary to cataract surgery who were treated in our hospital from January to August 2013 were randomly divided into group A and group B. Group A was treated with sodium hyaluronate eye drops for one week, and Group B was treated with polyethylene glycol eye drops for one week. The break-up time of tear film was measured and the subjective symptoms were graded before and after the treatment.RESULTS: The tear film break-up time of group A was respectively 3.87±1.12s and 4.21±1.06s before and after the treatment, with no significant difference(P>0.05; it was respectively 3.98±1.04s and 8.98±1.30s with significant difference for group B(PPPPCONCLUSION: Polyethylene glycol eye drops can extend tear film break-up time and improve symptoms of dry eyes. It is an effective drug in treatment of dry eyes after cataract surgery.
Objective To evaluate the prophylactic role of topical non-steroidal anti-inflammatory drugs in reducing the incidence of central macular edema (CME) in diabetic eyes post-cataract surgery. Patients and methods This study included 86 eyes (70 patients) with high risk characteristics for the development of CME after cataract surgery. All patients underwent phacoemulsification and intraocular lens implantation. Patients were divided into two equal groups (n = 43 [eyes]): a control group given topical dexamethasone 0.1%, four times/day for 12 weeks postoperatively and a study group given topical ketorolac tromethamine 0.4% twice daily in addition to topical dexamethasone 0.1% four times daily for 12 weeks. Patients were examined at 3, 6, and 12 weeks postoperatively for evaluation of CME development. The main study outcome was the change in the retinal fovea thickness measured with ocular coherence topography. Results Ten eyes developed CME (11.6%); eight eyes in the control group and only two eyes in the study group. Mean retinal fovea thickness was significantly higher in the control group compared to the study group. Moreover, eyes of the control group developed CME significantly earlier than those of the study group. Conclusion Prophylactic postoperative ketorolac 0.4% may have a role in reducing the frequency and severity of CME in diabetic eyes post-cataract surgery.
Elsawy, Moataz F; Badawi, Nermine; Khairy, Hany A
Background. To compare the efficacy and safety of a new ocular insert versus conventional mydriasis in cataract surgery. Methods. We selected 70 patients undergoing cataract surgery. Thirty five patients (Group 1) received instillation of mydriatic drops (tropicamide 1%, phenylephrine 10%, and cyclopentolate 1%) prior to surgery, and 35 patients (Group 2) had a Mydriasert insert (Théa Pharma) (0.28?mg of tropicamide and 5.4?mg of phenylephrine hydrochloride) placed in the inferior fornix. Pupil size before and after surgery, blood pressure, and heart rate were measured. Results. Before surgery, pupil diameter was 9.44 ± 1.17?mm in Group 1 and 9.05 ± 1.54 in Group 2 (P > 0.05). Twenty four hours after surgery, pupil diameter was 5.20 ± 1.54?mm in Group 1 and 3.33 ± 1.15 in Group 2 (P < 0.001). There were no statistically significant differences in blood pressure or heart rate between groups. Conclusions. The effect of the Mydriasert insert was similar to conventional mydriatic agents. Pupil size was restored to normal faster when using the Mydriasert insert compared with conventional mydriatic agents for pupil dilation.
Torron, C.; Calvo, P.; Ruiz-Moreno, O.; Lecinena, J.; Perez-Inigo, A.
A 60-year-old man with bilateral corneal opacity underwent cataract extraction surgery involving the use of a limbal relaxing incision in his left eye. He had lower lid ectropion and lagophthalmos in both eyes. Eleven days after the surgery, a slit-lamp examination revealed a neurotrophic corneal ulcer with a punch-out epithelial defect and rolled edges at the center of the pre-existing corneal opacity. The patient was treated with sodium hyaluronate, autologous serum, and oral doxycycline. S...
Full Text Available Abstract Introduction Systemic hypersensitivity reactions to topical ophthalmic treatment occur rarely, but when they do they can be severe as highlighted by this case. Case presentation A post-operative cataract surgery patient developed a severe and generalised hypersensitivity reaction following topical treatment with Maxitrol (Dexamethasone and Neomycin eye drops. The patient reported a previous allergic reaction to Neomycin. Conclusion This case report emphasises the importance of a thorough drug and allergy history when patients are seen at pre-assessment or clerked in for surgery.
Ansari Imran A
We aimed to evaluate the potential impact of a cataract surgery programme at the Good Shepherd Hospital, Siteki, Swaziland, on the care of orphans and vulnerable children in Swaziland. We studied consecutive patients aged 50 years and older undergoing surgery for age-related cataract who reported having children living in their household. Of 131 subjects recruited, 65 (49.6%) were the primary caregivers for the child(ren) in their household. Visual acuities measured 2 weeks after surgery significantly improved. Four weeks after surgery, there was a sizable increase in the proportions of subjects who were able to undertake self-care activities, attend to activities of daily living, undertake income-generating activities and care for children. Cataract surgery on elderly visually impaired patients has the potential to impact positively on the care of orphans and vulnerable children. PMID:22380906
Pons, J; Mapham, W E; Newsome, B; Myer, L; Anderson, R; Courtright, P; Cook, C
Full Text Available AIM: To discuss visual acuity assessment after cataract surgery by pattern reversal visual evoked potential. METHODS:Data of 72 adult cataract patients received PRVEP before and after phaco and IOL in Department of Ophthalmology, Tongji Hospital from October 2012 to May 2013 was analyzed retrospectively. A total of 114 eyes were studied, including 76 eyes with senile cataract and 38 eyes with complicated cataract. According to the degree of lens opacity and the hardness of lens nucleus, these data were divided into two groups: Group 1(grade?, ?, ? and Group 2(grade ?, ? and was statistically studied with correlation analysis. RESULTS: Group 1:(1Preoperative: the average of visual acuity was 0.344, the incubation time of P100 wave was 107ms and the amplitude of N75- P100 wave was 4.633?V; postoperative: the average of visual acuity was 0.672, the incubation time of P100 wave was 104.37ms and the amplitude of N75- P100 wave was 4.400?V.(2The visual acuity before and after operation were both significantly negatively correlated with the incubation time of P100 wave(P75- P100 wave(preoperative: PP100 wave. Group 2:(1Preoperative: the average of visual acuity was 0.116,the incubation time of P100 wave was 118.905ms and the amplitude of N75-P100 wave was 1.650?V; postoperative: the average of visual acuity was 0.576, the incubation time of P100 wave was 108.429ms and the amplitude of N75- P100 wave was 5.132?V.(2The visual acuity before operation was significantly negatively correlated with the incubation time of P100 wave(P100 wave; the visual acuity before and after operation showed no relationship with the amplitude of N75- P100 wave.(3The improved rows of the visual acuity before and after operation showed no relationship with the change of the incubation time of P100 wave. CONCLUSION:According to the correlation among the visual acuity, the incubation time of P100 wave and the amplitude of N75- P100 wave, PRVEP is significantly affected by preoperative visual acuity(the degree of opacity in refractive media. PRVEP is not helpful as an indicator of visual prognosis after cataract surgery, and PRVEP before cataract surgery has no clinical significance.
OBJECTIVE: To identify daily life difficulties perceived by patients suffering from senile cataract before and after second eye cataract surgery. METHODS: Longitudinal prospective study with 84 patients consecutively seen within the framework of the Cataract Project, with visual acuity equal to or higher than 20/30 in the pseudophakic eye, and equal to or lower than 20/40 with the best possible optical correction in the cataractous eye. A questionnaire was applied during an interview. RESULTS...
Amaryllis Avakian; Edmea Rita Temporini; Newton Kara-José
Full Text Available Anne Herr,1 Andreas Remky,2 Thalia Hirsch,1 Corinna Rennings,1 Niklas Plange1 1Department of Ophthalmology, RWTH Aachen University, Aachen, Germany; 2Augenbelegabteilung Krankenhaus Barmherzige Brueder, Regensburg, Germany Introduction: Intraocular pressure (IOP determination using dynamic contour tonometry (DCT has been considered to be independent of central corneal thickness (CCT, while Goldmann applanation tonometry (GAT is known to be influenced by various corneal properties. In this study, IOP was measured before and 1 day after cataract surgery using GAT and DCT to investigate the possible effects of corneal edema on IOP measurements. Methods: Thirty patients with advanced cataracts were included in a pilot study. IOP was measured using GAT and DCT before and 1 day after phacoemulsification. CCT was determined before and after surgery to quantify postsurgical corneal edema. Results: CCT increased significantly (by 89.7 ± 107.4 µm, P < 0.0001 1 day after surgery. No significant difference was found for IOP measurements using GAT and DCT before surgery (mean IOP GAT: 17.5 ± 5.7 mmHg; mean IOP DCT: 17.9 ± 6.4 mmHg; P = 0.67 and 1 day after surgery (mean IOP GAT: 16.1 ± 6.6 mmHg; mean IOP DCT: 16.8 ± 8.3 mmHg; P = 0.69. IOP values using GAT and DCT were significantly correlated before as well as 1 day after surgery (before surgery: r = 0.82, P ? 0.0001; after surgery r = 0.83, P < 0.0001. Bland–Altman plots showed a high variability in the difference in IOP measurements between methods before and 1 day after surgery. Conclusion: GAT and DCT seem to be equally valuable in IOP determination in postsurgical central corneal edema, although large differences between both methods are present in individual patients. IOP evaluation in corneal edema remains a difficult clinical challenge. Keywords: Goldmann applanation tonometry, dynamic contour tonometry, corneal edema, cataract surgery, intraocular pressure
The intellectual biography of Jacques Daviel (1693-1762) offers unexpected opportunities to recall fundamental steps in the history of scientific ideas, academic institutions and surgical techniques. Kepler had, in fact, ousted the crystalline lens from the full seat of the visual power to the refracting medium, but his work had no effect on the central core of the eye doctors' practice, namely, cataract surgery. Daviel's audacity, which was not to push down but to extract the lens with the cataract, brought the Keplerian revolution to a completion. In addition, physiologists and philsophers tried to befriend Daviel, and they made use of his exceptional manual dexterity to work out Molyneux's question, that is, the test of the man born blind who recovered his sight, which posed problems in the 18th century in the theory of knowledge. PMID:11640568
Monti, M T
We report the complication of corneal endothelial staining with trypan blue that limited the surgical view during cataract extraction in a 10-month-old boy. The boy had presented with a pigmentary retinopathy, microphthalmia, and a dense, white, unilateral congenital cataract. He was suspected of having, and was later diagnosed with, congenital rubella syndrome. We hypothesize that the corneal staining may have resulted from virally induced corneal endothelial damage. To our knowledge, this is the first reported case of trypan blue adversely affecting congenital cataract surgery. PMID:24210344
Baldwin, Andrew; Risma, Justin; Longmuir, Susannah
Full Text Available AIM: To compare the clinical effect and characteristics of lens loop extracting nucleus method, water irrigation and nucleus fragmentation within anterior chamber in small incision cataract surgery with non-phacoemulsification. METHODS:There were 324 cases(324 eyeswith senile cataract randomly divided into three groups, by the lens loop extracting nucleus method(group A, water irrigation(group Band nucleus fragmentation within anterior chamber(group C, to complete the process of nucleus division. The time of nuclear removal, complication during operation, the degree of edema of corneal endothelium on the first day after the surgery and visual acuity after surgery were observed and recorded.RESULTS:The average extracting nucleus time was 45s in lens loop(group A; 34s in water irrigation(group Band 65s in manual fragmentation(group C.The differences of average time are statistically significant(PPP>0.05.Regarding the visual acuity on the first day after surgery, the difference between group A and group C, group B and group C were statistically significant(PPP>0.05.CONCLUSION:Manual fragmentation has obvious advantages in removing nuclear above ? grade; The water irrigation method has fewer complications with low incidence of corner edema, which is more preferable in removing the nuclear below ? grade.
Full Text Available Purpose: To determine the spectrum, clinical profile and risk factors for poor visual outcome in patients of post cataract surgery endophthalmitis. Methods: Data from 124 eyes were analysed. Various clinical and microbiological parameters were evaluated and risk factors for unfavourable outcome identified. Results: The mean age of the patients was 59.50±13.75 years; 60.5% were males. The median surgery-symptom interval was 7 days (mean 15.81±24.01 and the medium symptom-presentation interval 7.5 days (mean 14.19±19.13. Corneal infiltrates were seen in 29%, hypopyon in 62 (50%. Smear positivity was 52.5% and culture positivity 38%. Equivocal microbiological positivity was seen in 22 (18%, bacterial 12 (10%, fungal 27 (21.5%, polymicrobial 8 (6.5% and negative 55 (44%. 20% eyes had total loss of vision at last follow-up. Poor visual acuity at presentation, presence of intraocular lens, shorter surgery-symptom interval, corneal and surgical wound infiltrates, loss of red reflex, microbiological positivity of the vitreous tap and systemic diabetes mellitus were significant risk factors for unfavourable outcome. Conclusion: Our data highlights a low culture positivity and a predominance of fungal pathogens as a cause of post cataract surgery endophthalmitis. The visual outcome in these patients is still dismal and better treatment strategies should be evolved keeping in mind the microbiological spectrum. The risk factors identified may be helpful in prognosticating the outcome in such patients.
Full Text Available Surgeries on rabbits are more and more frequently as they are used as pet animals and the owner is interested in their welfare. Cataract surgery is already a routine intervention in small animals as dogs and cats. This is why the aim of this study is to present a case study of a rabbit anesthesia for cataract surgery. Our subject was a three year old female laboratory rabbit which weight 2.07 kg. We premedicated him using butorphanol 0.4 mg/kg and midazolam 1 mg/kg subcutaneous 30 minutes before induction. To prevent sever bradicardia,we administered glycopyrrolate 0.01 mg/kg. Induction was realized using ketamine 10% and midazolam 0.5% mixed in the same volume and administered at a dose of 2 ml/kg. After induction the rabbit was intubated using blind technique and isoflurane was administered by the endotracheal tube. The rabbit was perfused at a rate of 20 ml/kg/h with Hartman solution, colloids and glucose all along anesthesia. To minimize the risk of cataract surgery we administered cisatracurium at a dose of 0,05 mg/kg as multiple boluses. Neuromuscular blockade was assessed using a standard peripheral nerve stimulator. Postoperative we administered enrofloxacine 5 mg/kg, meloxicam 0.2 mg/kg for postoperative analgesia and metoclopramide 0.5 mg/kg for digestive stimulation. Even if there is no dose given in literature for cisatracurium in rabbits, we concluded that it can be used with great success and with no incidence at a dose used for dogs and cats.
Alexandru Cosmin TUTUNARU
Full Text Available Introduction: cataract surgery is .one of the most common operation in ophthalmology. Post operative caught can lead to anterior chamber hemmorage and dehiscence of suture so we were going to finding a way to overcome to this problem. Method: This study is a clinical trial one which was done on 150 ASA 1, 2 patient that were over 45 years old age. These patient have cataract surgery under GA in Farabi Hospital of Esfahan medical university. All of the patient were intubated under direct laryngoscopy. Patients that have more of one laryngoscope, difficult intubation, thraceal intubation prolonged more than 15 seconds and those which have opiate addiction. We divided the patients into two 75 patient group by randomized selection. This study is double blind and 30mg codeine phosphate and placebo has given to the patient one hour preoperatively. Heart rate and systolic and diastolic, blood pressure has been recorded preoperatively, three minutes after intubation and three minutes after extubation respectively. Caught has been counted and recorded immediately. Five minutes and 30 minutes after extubation and results in contorol group are compared with the results in another group. Discussion: According to the statistical analysis t-student test, chi-square and non parametric test and Pvalue only changes in heart rate after extubation has been different in two groups and other findings make no difference in two groups. There was not any significant difference between two groups about age, sex, duration of surgery, preoperative mean heart rate and blood pressure. There was not any difference about mean number of coughs between two groups and according to this study oral codeine phosphate has administered preoperatively has not any effect on reducing postoperative caught in patients who have GA and tracheal incubation for cataract surgery.
H SOLTANI NEZHAD
Cost-effectiveness analysis of cataract surgery: a global and regional analysis / Chirurgie de la cataracte: analyse de coût-efficacité à l'échelle mondiale et régionale / Costoeficacia de la cirugía de la catarata: análisis mundial y regional
Full Text Available SciELO Public Health | Language: English Abstract in spanish OBJETIVO: Estimar los efectos en la salud de la población, los costos y la costoeficacia de determinadas intervenciones de cirugía de la catarata en zonas del mundo que presentan distintos perfiles epidemiológicos. MÉTODOS: Las estimaciones de la eficacia se basan en una revisión de la literatura qu [...] e tiene en cuenta factores como el fracaso operatorio, las complicaciones y el incumplimiento por parte de los pacientes. Se aplicó un modelo de población para seguir el impacto de la operacion de catarata a todo lo largo de la vida en los individuos que se habían sometido a tal intervención. Las estimaciones de costos están basadas en datos primarios reunidos en 14 subregiones epidemiológicas por los equipos regionales de cálculo de costos y en una revisión de la literatura. Se usaron funciones de costos no lineales para estimar los costos asociados a distintos niveles de cobertura geográfica. RESULTADOS: Las operaciones de cirugía intracapsular y extracapsular de la catarata son un instrumento costoeficaz para reducir el impacto de la ceguera por catarata. La cirugía extracapsular es más costoeficaz que la intracapsular en todas las regiones consideradas. Proporcionando cirugía extracapsular a un 95% de quienes la necesitan (cobertura del 95%) se evitarían más de 3,5 millones de años de vida ajustados en función de la discapacidad (AVAD) cada año a nivel mundial. La costoeficacia varía entre 57 dólares internacionales (I$) por AVAD en la Región de Asia Sudoriental de la OMS, donde hay una alta mortalidad general de niños y adultos, y I$ 2307 por AVAD en la Región del Pacífico Occidental de la OMS, donde hay una baja mortalidad general de niños y adultos. CONCLUSIÓN: La cirugía extracapsular de la catarata, asegurando un alto nivel de cobertura, es la alternativa más costoeficaz para restablecer la vista en todas las subregiones epidemiológicas consideradas. Se alienta a los analistas de los países de cada región a que sigan contextualizando los resultados incorporando los parámetros específicos de su país. Abstract in english OBJECTIVE: To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles. METHODS: Effectiveness estimates are based on a review of the literature taking into account factors such as op [...] erative failure, complications and patient non-compliance. A population model was applied to follow the lifelong impact on individuals having cataract surgery. Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review. Costings were estimated for different geographical coverage levels using non-linear cost functions. FINDINGS: Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level) would avert over 3.5 million disability-adjusted life years (DALYs) per year globally. The cost-effectiveness ranges from 57 International dollars (I$) per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to I$ 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality. CONCLUSION: Extra-capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered. Analysts from countries within a region are encouraged to further contextualize the results based on their own country's specific parameters.
Baltussen, Rob; Sylla, Mariame; Mariotti, Silvio P..
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish El propósito de este estudio fue determinar los resultados obtenidos con la técnica de prechop (PCh) y su combinación con la microincision cataract surgery MICS (por sus siglas en inglés) (PChMICS) en la cirugía de catarata por facoemulsificación con el uso de el chopper de irrigación oblicua en el [...] Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología «Ramón Pando Ferrer» desde septiembre de 2006 hasta enero de 2007. El universo de trabajo estuvo constituido por 120 pacientes (ojos) con diagnóstico de catarata presenil y senil, que recibieron tratamiento quirúrgico. Se analizaron como variables: edad, sexo, agudeza visual con corrección, microscopia endotelial y cilindro refractivo, todos en el preoperatorio y posoperatorio, así como el tiempo de ultrasonido y complicaciones más frecuentes. Estos datos se analizaron a través de tablas de contingencia con frecuencias absolutas y relativas, medias y se utilizó la prueba t de Student para su comparación. Se encontró que la catarata predominó en pacientes menores de 60 años; la agudeza visual con corrección mejoró 5 líneas en la cartilla de Sellen, el cilindro refractivo apenas se modificó; el tiempo de ultrasonido aplicado estuvo dentro de valores normales; la pérdida de células endoteliales no fue importante, y la complicación transoperatoria más frecuente fue rotura de cápsula posterior con salida de vítreo. Abstract in english The objective of this study was to present the results of the prechop technique (PCh) combined with microincision cataract surgery (MICS) that was used in cataract surgery by phacoemulsification with the oblique irrigation chopper in the Center of Eye Microsurgery of "Ramón Pando Ferrer" Cuban Insti [...] tute of Ophthalmology from September, 2006 to January, 2007. The universe of study was made up of 120 patients (eyes) diagnosed with pre-senile and senile cataract and surgically treated. The analyzed variables were age, sex, visual acuity with correction, endothelial microscopy and refractive cylinder during the preoperative and postoperative periods, as well as ultrasound time and most common complications. For this analysis, contingency tables with absolute and relative frequencies and medians, and also Student´s t test for comparing data were used. It was found that cataract prevailed in patients under 60 years; visual acuity with correction improved 5 lines in Sellen chart, the refractive cylinder slightly changed, the time of ultrasound application was within the normal values; loss of endothelial cells was not significant and the most frequent transoperative complication was rupture of posterior capsule with vitreous detachment.
Juan Raúl, Hernández Silva; Meisy, Ramos López; Marcelino, RíoTorres; Luis, Curbelo Cunill; Gilberto, Fernández Vásquez; Francisco, Núñez Ordóñez; Carmen Ma., Padilla González.
Full Text Available El propósito de este estudio fue determinar los resultados obtenidos con la técnica de prechop (PCh y su combinación con la microincision cataract surgery MICS (por sus siglas en inglés (PChMICS en la cirugía de catarata por facoemulsificación con el uso de el chopper de irrigación oblicua en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología «Ramón Pando Ferrer» desde septiembre de 2006 hasta enero de 2007. El universo de trabajo estuvo constituido por 120 pacientes (ojos con diagnóstico de catarata presenil y senil, que recibieron tratamiento quirúrgico. Se analizaron como variables: edad, sexo, agudeza visual con corrección, microscopia endotelial y cilindro refractivo, todos en el preoperatorio y posoperatorio, así como el tiempo de ultrasonido y complicaciones más frecuentes. Estos datos se analizaron a través de tablas de contingencia con frecuencias absolutas y relativas, medias y se utilizó la prueba t de Student para su comparación. Se encontró que la catarata predominó en pacientes menores de 60 años; la agudeza visual con corrección mejoró 5 líneas en la cartilla de Sellen, el cilindro refractivo apenas se modificó; el tiempo de ultrasonido aplicado estuvo dentro de valores normales; la pérdida de células endoteliales no fue importante, y la complicación transoperatoria más frecuente fue rotura de cápsula posterior con salida de vítreo.The objective of this study was to present the results of the prechop technique (PCh combined with microincision cataract surgery (MICS that was used in cataract surgery by phacoemulsification with the oblique irrigation chopper in the Center of Eye Microsurgery of "Ramón Pando Ferrer" Cuban Institute of Ophthalmology from September, 2006 to January, 2007. The universe of study was made up of 120 patients (eyes diagnosed with pre-senile and senile cataract and surgically treated. The analyzed variables were age, sex, visual acuity with correction, endothelial microscopy and refractive cylinder during the preoperative and postoperative periods, as well as ultrasound time and most common complications. For this analysis, contingency tables with absolute and relative frequencies and medians, and also Student´s t test for comparing data were used. It was found that cataract prevailed in patients under 60 years; visual acuity with correction improved 5 lines in Sellen chart, the refractive cylinder slightly changed, the time of ultrasound application was within the normal values; loss of endothelial cells was not significant and the most frequent transoperative complication was rupture of posterior capsule with vitreous detachment.
Juan Raúl Hernández Silva
We wish to report an unusual complication of intraocular lens (IOL) insertion following uneventful phacoemulsification. After successful phacoemulsification surgery, a hydrophobic acrylic IOL was loaded in the injector for insertion into the capsular bag. During insertion, the IOL inadvertently extended into the corneal stromal lamella. The complication was recognized at a late stage, and the foldable acrylic lens was retrieved and reinserted correctly in the bag. The anterior chamber was made viscoelastically taut and was maintained in this state for 10 min, followed by a routine viscoelastic wash and air bubble injection. Cornea was slightly edematous with stromal haze, and the corneal thickness was 908 ?m. At the 1-month follow-up visit, the patient's vision was 20/40, the stromal haze had subsided, the corneal thickness was 572 ?m, and the patient was comfortable. Though it was unknown complication, following proper management patient recovered satisfactorily. PMID:25005208
Shah, Mehul A; Shah, Shreya A; Aggarwal, Parul M
Full Text Available SciELO South Africa | Language: English Abstract in english We aimed to evaluate the potential impact of a cataract surgery weeks after surgery, there was a sizable increase in the proportions programme at the Good Shepherd Hospital, Siteki, Swaziland, of subjects who were able to undertake self-care activities, attend on the care of orphans and vulnerable c [...] hildren in Swaziland. We to activities of daily living, undertake income-generating activities studied consecutive patients aged 50 years and older undergoing and care for children. Cataract surgery on elderly visually impaired surgery for age-related cataract who reported having children living patients has the potential to impact positively on the care of in their household. Of 131 subjects recruited, 65 (49.6%) were the orphans and vulnerable children. primary caregivers for the child(ren) in their household. Visual acuities measured 2 weeks after surgery significantly improved. Four weeks after surgery, there was a sizable increase in the proportions of subjects who were able to undertake self-care activities, attend to activities of daily living, undertake income-generating activities and care for children. Cataract surgery on elderly visually impaired patients has the potential to impact positively on the care of orphans and vulnerable children.
J, Pons; W, Mapham; B, Newsome; L, Myer; R, Anderson; P, Courtright; C, Cook.
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish En este trabajo se realiza una panorámica de la experiencia en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el uso de la técnica de cirugía de catarata microincisional (MICS), phaconit, microfaco o facoemulsificación bimanual, uno de los avances mode [...] rnos de la cirugía de cataratas, que permite la realización de la cirugía, a través de incisiones de 1,8 mm o menos. Se discuten las particularidades de la aplicación de la tecnología de instrumental, software, máquinas de facoemulsificación y accesorios. Se describen las técnicas de facochop aplicadas al MICS, en particular de la técnica de multichop del doctor Curbelo diseñada en este centro y los resultados en pacientes operados entre los años 2004 y 2005 mediante MICS en nuestro instituto Abstract in english This paper presented an overview of the experience accumulated by the Ocular Microsurgery Center of “Ramón Pando Ferrer” Cuban Institute of Ophthalmology in the use of micro-incision cataract surgery, Phaconit, Microphaco or Bimanual phacoemulsification, one of the advances of modern cataract surger [...] y. This technique allows performing surgery through tiny incisions of 1,8 mm or less. The particularities in the application of instumental technology, software, phacoemulsification machines and accesories were discussed. Also the phacochop techniques applied to micro-incision cataract surgery, in particular the multichop technique designed by Dr. Curbelo in this center along with the results achieved in patients operated on from 2004 to 2005 through this procedure were described
Luis, Curbelo Cunill; Marcelino, Río Torres; Juan Raúl, Hernández Silva; Armando, Capote Cabrera; Eneida, Pérez Candelaria; Meisy, Ramos López; Gilberto, Fernández Vázquez; Raúl, Barroso Lorenzo.
Full Text Available AIM:To explore cataract surgery complication of the anterior chamber injection 0.1mL dexamethasone for uveitis complicated cataract patients. METHODS: The experimental group was injected 0.1mL dexamethasone to anterior chamber at the end of phacoemulsification(Phaco+intraocular lens(IOLimplantation, while the control group did not. And the different postoperative inflammation between them was observed. RESULTS: The differences of visual acuity between the two groups on the first two days after operation were statistically significant(P<0.05. The postoperative corneal edema and anterior chamber flare between the two groups in the first day were different(P<0.05. And the percentage of the experimental group postoperative visual acuity improved was higher than that of the control group. CONCLUSION: It can reduce short-term postoperative inflammation, improve visual acuity earlier and do not impact the short-term postoperative intraocular pressure that uveitis complicated cataract was injected 0.1mL dexamethasone to anterior chamber at the end of Phaco+IOL.
With most current cataract surgery techniques, an intraocular lens (IOL) is implanted in the capsular bag to emetropize the eye for distance vision. Modern IOLs are made of flexible materials (e.g., silicone and acrylic elastomers) allowing the surgeon to fold and insert the IOL through a smaller limbal incision (4 mm), thus reducing the number of sutures. When using a scleral pocket technique, suturing of such small wounds might not be required. Recently, IOLs having 2 foci (multifocal IOLs) have been introduced. These implants give the patient a second focal plane at normal reading distance, but the double image reduces both visual acuity and contrast sensitivity. However, with all present surgical techniques, the patient loses the natural ability to accommodate. By directing laser energy into a flexible fiber, cataract removal might be performed endoscopically while minimizing trauma to healthy tissue. Bath successfully demonstrated the use of the 308 nm XeCl excimer laser for cataract removal. A significant drawback, however, lies in the fluorescence induced by the 308 nm laser pulses which may cause significant retinal damage. The use of UV radiation also raises serious concerns about carcinogenesis and cataractogenesis risk to both the patient and the surgeon.
Ren, Qiushi; Simon, Gabriel; Gailitis, Raymond P.; Parel, Jean-Marie
Full Text Available AIM: To research the impact of different 3.2mm incisions of cataract surgery on patients whose corneal astigmatism was within 25 degrees by Orbscan. METHODS: We collected 40 cases of cataract patients whose corneal astigmatism was within 25 degrees detected by Orbscan and randomly divided them into groups A, B. Detected by Orbscan, 20 patients(20 eyesin group A was conducted with 3.2mm corneal astigmatism axial incision and 20 patients(20 eyesin group B was conducted with 3.2mm corneal incision on 90 degrees of the axis. All cataract operations were implemented by the same physician. We observed the postoperative changes of corneal astigmatism between two groups. RESULTS: The comparisons of Polar K on each time preoperative and postoperative point were significant differences within each group. But the comparisons of Polar K on each time preoperative and postoperative point were not statistically significant between two groups. After 3 months, two kinds of incisions would both increase about 0.3D Polar K in the cornea. CONCLUSION: 3.2mm corneal incision may cause Polar K 0.3D in corneal astigmatism.
Full Text Available Background: Corticocapsular adhesions (CCA are frequently seen between lens capsule and adjacent cortical layer. During cataract surgery, in the presence of CCA, excessive efforts to rotate the nucleus can result in zonular damage. To reduce morbidity, identification of associations with CCA can be helpful in appropriately modifying the surgical procedure. Aim: To investigate probable associations with CCA in patients undergoing cataract surgery. Setting and Design: Iladevi Cataract and IOL research center. Case-control study. Materials and Methods: A single eye of 600 patients, 200 patients with CCA (cases and 400 patients without CCA (controls were considered. A CCA diagnosis was based on: (i preoperative presence of CCA on slit-lamp examination with visualization of furry surface of cortex during surgery; (ii preoperative absence of CCA on slit-lamp examination but intraoperative visualization of furry surface of cortex. Variables such as age, gender, type of cataract, grade of cataract, high myopia, diabetes mellitus and hypertension were studied. Statistical Analysis: Multivariate logistic regression was done. Results were presented as odds ratio (OR with 95% CI. Results: Mean age was 64.71 ± 9.10 years in cases and 59.27 ± 8.79 years in controls. Presence of CCA increased with age from 22% (n = 59 in 45 to 49 years to 70% (n = 110 in 70 to 79 years. An increase in age was associated with CCA by 3.3% (OR = 3.3%, P = 0.028. The odds of CCA for females were 83% higher ( P = 0.027. Presence of anterior cortical cataract increased odds of CCA by 9.5 times ( P = 0.001, while posterior cortical cataract increased odds by 3.3 times ( P = 0.001. Conclusion: Corticocapsular adhesions were strongly associated with cortical cataracts, increased age and female gender.
Full Text Available AIM: To evaluate the efficacy and safety of large sized continuous curvilinear capsulorhexis(CCCinvolving zonular area in manual small incision cataract surgery(MSICS. METHODS:Totally 1 443 cataract patients(1 965 eyesunderwent MSICS, in which large CCC up to 7-8mm were performed.The related conditions such as success rate of performing CCC, capsule rupture, corneal edema and visual acuity after surgery were recorded and statistically analyzed.RESULTS:In total of 1 965 eyes, 1 942 eyes(98.83%had successful CCC, 15 eyes(0.76%had a radial tear which could not be saved when performing CCC, 8 eyes(0.41%had anterior capsule opened with a cystotome or a scissor due to capsule membrane calcification. No posterior capsule rupture occurred, and intraocular lens was transplanted in all cases. Transient corneal edema was noted in 36 eyes(1.83%. One day after surgery, 1 650 eyes(83.97%had visual acuity ?0.5, 1 867 eyes(95.01%?0.3. No unstable intraocular lens was noted in all cases. CONCLUSION: Large CCC technique for MSICS is safe and reliable,not decreasing stability capsular bag and intraocular lens. It is of high originality despite zonular area is involved so that it is worthy of application in basic medical institutions.
Full Text Available PURPOSE: To evaluate the conjunctival bacterial flora and its antibiotic resistance pattern in eyes of patients undergoing cataract surgery. METHODS: From August to October 2004, 50 patients undergoing cataract surgery in the "Fundação Altino Ventura", Recife, Brazil, were prospectively evaluated. Conjunctival material was obtained on the day of surgery, before the application of topical anesthetic, antibiotic or povidone-iodine. The collected material was inoculated and bacterioscopic analysis was carried out. In the cases where there was bacterial growth, antibiotic susceptibility tests and cultures, for isolation and identification of the bacteria, were performed. RESULTS: Of the 50 eyes, 43 (86.0% had positive cultures. The coagulase-negative Staphylococcus (CNS, found in 27 (54.0% eyes, was the most frequent organism. More than 90% of the isolates of this bacterium were susceptible to cephalotin, vancomycin, chloramphenicol, ofloxacin and gatifloxacin; 70 to 90% were susceptible to gentamicin, cefotaxime, oxacillin and ciprofloxacin; and less than 70% were sensible to neomycin. Four (10.5% of the bacterial isolates were resistant to four or more antibiotics, two of them were CNS. CONCLUSION: The most frequent bacterium in the conjunctival flora is the coagulase-negative Staphylococcus. The isolates of this organism showed low susceptibility rate to neomycin, and high susceptibility rates to cephalotin, vancomycin, chloramphenicol, ofloxacin and gatifloxacin.
Arantes Tiago Eugênio Faria e
Full Text Available Manuel S Falcão,1,2 Nuno M Gonçalves,2 Paulo Freitas-Costa,1,3 João B Beato,2 Amândio Rocha-Sousa,1,2 Ângela Carneiro,1,2 Elisete M Brandão,2 Fernando M Falcão-Reis1,21Department of Sense Organs, Faculty of Medicine, University of Porto, 2Department of Ophthalmology of Hospital de São João, 3Department of Anatomy, Faculty of Medicine, University of Porto, Porto, PortugalBackground: The aim of this study was to evaluate the effect of uneventful phacoemulsification on the morphology and thickness of the macula, the submacular choroid, and the peripapillary choroid.Methods: In 14 eyes from 14 patients, retinal macular thickness, choroidal submacular thickness, and choroidal peripapillary thickness were measured preoperatively and at one week and one month after phacoemulsification using enhanced depth imaging spectral domain optical coherence tomography. Changes in thickness of the different ocular tissues were evaluated.Results: There was a statistically significant increase in mean retinal macular thickness at one month. In horizontal scans, the mean increase was +8.67±6.75 µm (P<0.001, and in vertical scans, the mean increase was +8.80±7.07 µm (P=0.001. However, there were no significant changes in choroidal morphology in the submacular and peripapillary areas one month after surgery. In vertical scans, there was a nonsignificant increase in choroidal thickness (+4.21±20.2 µm; P=0.47 whilst in horizontal scans a nonsignificant decrease was recorded (?9.11±39.59 µm; P=0.41. In peripapillary scans, a nonsignificant increase in mean choroidal thickness was registered (+3.25±11.80 µm; P=0.36.Conclusion: Uncomplicated phacoemulsification induces nonpathologic increases in retinal macular thickness probably due to the inflammatory insult of the surgery; however these changes are not accompanied by significant changes in choroidal thickness. In the posterior segment, the morphologic response to the inflammatory insult of phacoemulsification is mainly observed at the retinal level, and seems to be independent of choroidal thickness changes.Keywords: phacoemulsification, macular thickness, choroidal thickness, prostaglandins
Full Text Available Yelda B Özkurt, Arzu Taskiran, Nadire Erdogan, Baran Kandemir, Ömer K Dog?anDepartment of Ophthalmology, Kartal Training and Research Hospital, Istanbul, TurkeyPurpose: To evaluate the influence of irrigation of the anterior chamber with heparin sodium on postoperative inflammation after pediatric cataract surgery. Setting: Kartal Training and Research Hospital, First Eye Clinic, Istanbul, Turkey.Design: Randomized prospective double-blind study.Methods: Fourteen consecutive eyes from 14 patients aged 8.9 ± 5.9 years, (range 3–18 years (group 1 and 19 eyes from 19 patients aged 9.1 ± 5.2 (range 1.5–18 years (group 2 underwent pediatric cataract surgery. Five patients in group 1 were between three and five years old. One patient was 1.5 years old and six patients in group 2 were between three and five years old. During the procedure, group 1 received anterior chamber irrigation with heparin sodium (5 IU/cc and 1 ml of heparin sodium (concentration 10 IU/ml added to the irrigating balanced salt solution (BSS Plus; Alcon Laboratories, Inc., Fort Worth, TX, USA while group 2 received BSS without heparin sodium only. Cases aged under three years received anterior vitrectomy in addition to posterior capsulorrhexis. One eye received anterior vitrectomy in group 1 and two eyes received anterior vitrectomy in group 2. Cases with preoperative complications were not included in the study. Early and late postoperative inflammatory complications, including fibrin formation, anterior and posterior synechia, cyclitic and pupillary membrane formation were recorded and compared.Results: Mild anterior chamber reaction was observed in three patients in Group 1, while nine cases in group 2 experienced marked anterior chamber reaction. In four of nine patients from group 2, anterior chamber reaction was severe and resulted in pupillary membrane and synechia despite treatment in the postoperative 7th day, while in all three cases in group 1, reaction disappeared by the 7th day.Conclusion: Anterior chamber irrigation with heparin during pediatric cataract surgery may minimize early inflammatory reaction and decrease the number of postoperative inflammatory related complications.Keywords: pediatric, cataract, surgery, inflammation
Yelda B Özkurt
We describe a technique of irrigating and thereby rapidly and effectively clearing the cornea of relatively large amounts of surface contaminants that reduce surgical visibility and may contribute to endophthalmitis. This technique is referred to as "macrowash." If the technique is required, it is usually at the commencement of cataract surgery, immediately after placement of the surgical drape. The technique not only saves time, but also reduces the volume of irrigating solution required by the "microwash" technique, which is traditionally carried out by the scrub nurse/surgical assistant using a Rycroft cannula attached to a 15 mL container of irrigating solution. PMID:20692554
Amjadi, Shahriar; Roufas, Athena; Figueira, Edwin C; Bhardwaj, Gaurav; Francis, Katherine E; Masselos, Katherine; Francis, Ian C
Full Text Available Mohamed AE Soliman Mahdy1,2, Mohamed Z Eid1, Mahmoud Abdel-Badei Mohammed3, Amr Hafez4,5, Jagdish Bhatia21Ophthalmic Department, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt; 2Ophthalmic Department, Rustaq Hospital, Rustaq, Sultanate of Oman; 3Research Institute of Ophthalmology, Cairo, Egypt; 4Magrabi Eye and Ear Center, Muscat, Sultanate of Oman; 5Ophthalmic Department, Al-Azhar University Hospital, Assuit, EgyptPurpose: To assess the relationship between postoperative endothelial cell loss and microcoaxial phaco parameters using Ozil IP (Alcon Laboratories, Inc, Fort Worth, TX in noncomplicated cataract surgery.Methods: In this prospective observational study, 120 consecutive cases of cataract patients with different grades of nuclear hardness underwent microcoaxial phacoemulsification through a 2.2-mm clear corneal incision. An Alcon Infinity Vision System with Ozil IP (Alcon Laboratories was used with an Ozil torsional handpiece and a Kelman-style 45° phacoemulsification tip. Patients underwent preoperative and postoperative central endothelial cell counts.Results: The study included 120 cases of age-related cataract whose mean age (standard deviation [SD] was 59.68 years (9.47. There was a highly statistically significant endothelial cell loss (P < 0.001. The endothelial cell loss ranged 11–1149 cells/mm2 with a median (interquartile range of 386 cells/mm2 (184.5–686 cells/mm2. The percentage of postoperative ECLoss% ranged from 0.48% to 47.8% with a median (interquartile range of 15.4% (7.2% to 26.8%. A significant positive correlation was found between the ECLoss% and different phaco parameters. The Spearman’s rank-order correlation coefficient values, rho, (? were as follows: CDE (? = 0.425, aspiration time (? = 0.176, and volume (? = 0.278. Also, ECLoss% was significantly correlated with the grade of nuclear opalescence (Kendall’s tau ? = 0.42.Conclusion: Microcoaxial phacoemulsification was efficient in removing noncomplicated cataracts; however a statistically significant endothelial cell loss was noted, especially with increased nuclear hardness. This endothelial cell loss was mostly related to the increased cumulative dissipated energy (CDE, aspiration time, and volume of balanced salt solution used.Keywords: cataract surgery, phacoemulsification, Ozil, endothelial cells, cumulative dissipated energy
Soliman Mahdy MAE
Background: Regular follow up and amblyopia treatment are essential for good outcomes after pediatric cataract surgery. Aim: To study the regularity of follow-up after cataract surgery in children and to gauge the causes of poor compliance to follow up. Subjects: 262 children (393 cataracts) who underwent cataract surgery in 2004-8. Materials and Methods: The children were identified and examined in their homes and a “barriers to follow-up” questionnaire completed. Demographic data collected, visual acuity estimated, and ocular examination performed. Statistical Analysis: SPSS version 19. Results: Of the 262 children, only 53 (20.6%) had been regularly following up with any hospital, 209 (79.4%) had not. A total of 150 (57.3%) were boys and the average age was 13.23 years (Std Dev 5 yrs). Poor follow up was associated with the older age group (P surgery (P = 0.001). It was not related to gender, numbers of children in family, ordinal status of child, and social strata. Distance and cost were major barriers, as was the inability of the eye care center to communicate the importance of follow up. A prospective follow-up visit showed that 93 children needed Nd: YAG LASER capsulotomy, 5 needed low vision aids, 4 contact lens, and 162 a change of spectacles. The average visual acuity improved in 150 (38.8%) eyes >1 line with regular follow-up. Conclusion: Regular follow-up is important and improves vision; eye care practitioners need to take special efforts to ensure better follow-up.
Gogate, Parikshit; Patil, Shailbala; Kulkarni, Anil; Mahadik, Ashok; Tamboli, Rahin; Mane, Rekha; Borah, Rishiraj; Rao, G V
Purpose To evaluate if the standard anesthetic regimen – topical combined with intracameral anesthesia without sedation – in a population-based cohort of unselected cataract surgery cases is adequate, optimal, and good practice, or if improvements are necessary. Methods We conducted a prospective, observational study on all cases of cataract surgery during a 1-year period at one institution (n=1249). Data were collected from the patients’ records. Outcome measures were use of preoperative sedation, type of anesthesia, complications, and adverse events. In a subgroup of patients (n=124) satisfaction with the anesthetic regimen was evaluated using a short questionnaire. Results Most cases (90%, 1125/1249) had combined topical and intracameral anesthesia without sedation. Patients who chose preoperative sedation (midazolam hydrochloride sublingually) were significantly younger and more often female (P=0.0001 and P=0.011, respectively). In the questionnaire subgroup, the median pain score after surgery was 0.7 (visual analog scale, 0–10). A pain score of 1.9 or less was reported by 76% of the patients. Patients reporting a pain score of 2 or more had sedation and additional anesthetics more often. No significant difference was found regarding age, sex, pulse rate, oxygen saturation, first or second eye surgery, or adverse intraoperative events for patients with pain scores of 1.9 or less and 2 or more. Conclusion This large population-based series of small-incision phacoemulsification surgery shows that combined topical and intracameral anesthesia without sedatives is well tolerated for most phacoemulsification patients. It is also effective in cases when complications or adverse events occur. It is important to be responsive to the individual patient’s needs and adjust operating procedures if necessary, as there were a few patients who experienced insufficient anesthesia.
Westborg, Inger; Monestam, Eva
Background: Despite several recent innovations in phacoemulsification surgery, importance of pupil diameter in this surgery is becoming more evident. Purpose: To compare the effect of opioid agonist (fentanyl) versus opioid agonist–antagonist (buprenorphine) on pupil diameter in cataract surgery and to choose the best opioid in high-risk phacoemulsification surgery. Methods: In this randomized double-blinded clinical trial, 60 patients who were candidates for elective phacoemulsification surgery were randomly divided into two equal groups: experimental (buprenorphine, 0.3 ?g/kg) and control (fentanyl, 1 ?g/kg). Pupil diameter was measured preinjection and at several times postinjection. Blood pressure was recorded at several intervals, as well as shivering, nausea and vomiting, and recovery time. Results: Mean (SD) recovery time was significantly less in the control group (19.46±5.43) than in the experimental group (33.23±10.75) (P<0.0001). The constriction effect (ie, pupillary diameter in mm) was significantly lower in the experimental group (0.53±0.45) than in the control group (1.06±0.52) (P=0.0001). The percentages of constriction effect in experimentaland control groups were 7.68% and 15.07%, respectively. The eye was two times more constricted in the control group in comparison with the experimental group after induction of anesthesia. Conclusion: Buprenorphine is a better solution to decrease pupil constriction in comparison with fentanylinhigh-risk phacoemulsification surgery.
Anaraki, Abdolreza Najafi; Akrami, Abbas; Motamed, Niloofar; Seydali, Elham
Full Text Available AIM: To research the curative effect analysis of two kinds of small incision surgery treating senile cataract patients. METHODS: Totally 71 senile cataract patients(123 eyes, aged from 76 years to 96 years, were selected as the research objects. All 55 eyes were all treated with small incision non-phacoemulsification(group A, and 68 eyes were treated with phacoemulsification(group B, and then both received intraocular lens implantation. RESULTS: The postoperative visual acuity of the patients between the two groups was no significant difference(P>0.05. There were 42 eyes in group A and 54 eyes in group B which suffered from corneal edema. There was no significant difference in the number of corneal edema of grade ?, grade ? and grade ? between the two groups(Chi-square =0.81, P>0.81. The ratio of corneal edema of grade ? in group A was less than that in group B. The corneal edema after surgery in patients of group A was with faster fading time than that in group B, and the eyes of corneal edema in group A fading at 1d postoperatively were more than that in group B(Chi-square=6.45, P2 and(2 181+282/mm2, respectively, and there was no significant difference between the two groups(P>0.05. Group A was with a low complication rate.CONCLUSION: Small incision non-phacoemulsification treating senile cataract patients can get a good result for postoperative visual acuity recovery and correction, and it is safe and effective. It receives the similar curative effect with phacoemulsification, but takes less expense. It is worthy of clinical and wide application.
Full Text Available AIM: To explore the feasibility and evaluation on prevention of blindness in poverty-stricken region of Yixing led by the People's Hospital.METHODS: By respectively comparing poverty-relief(hereafter referred to as povertypatients in poverty-stricken region with the patients in urban district(hereafter referred to as urbanin the following aspects: the situation of visual blindness and the visual disability before surgery and the situation of vision rehabilitation and getting rid of visual disability after operation, and then the differences were analyzed as the standard: blindness was vision less than 0.05, visual disablity was vision less than 0.3 and vision rehabilitation was postoperative vision equal to or more than 0.05 and getting rid of visual disability was postoperative vision equal to or more than 0.3. The differences were compared between the cataract surgery situation in poverty-stricken region led by our hospital and the requirements of “The prevention of blindness project for millions of poor cataract patients” during the twelfth five-year. RESULTS: There were 72 cases in the poverty group, including 41 cases of blindness and 70 cases of visual disability, while totally 210 cases were in the urban group, including 111 cases of visual blindness and 200 cases of visual disability. There were no difference between the poverty group and urban group in the visual blindness(?2=1.344, P?2=0.146, P?2=0.236, P?2=0.846, PCONCLUSION: “The prevention of blindness project for millions of poor cataract patients” has been carried out smoothly in our hospital which proves that we do have the ability to undertake the prevention of blindness in our city, but there is still some deficiency to be improved.
Purpose To explore changes in central macular thickness (CMT) after a two-month period of glaucoma therapy with topical latanoprost after uneventful phacoemulsification. Methods Forty-one eyes of 31 patients with primary open angle or pseudoexfoliative glaucoma who required glaucoma medications after cataract surgery were prospectively enrolled. All eyes had undergone uneventful phacoemulsification with intraocular lens implantation at least 4 months before initiation of latanoprost. After a complete ophthalmic examination, spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) were performed at baseline before starting latanoprost. All eyes received latanoprost for 2 months, and clinical examinations were repeated one and two months afterwards; OCT and FA were repeated after 2 months. Outcome measures were CMT and loss of more than 2 lines of best corrected visual acuity (BCVA). Results Mean patient age was 71.6±7.8 years. Intraocular pressure decreased from 21.5±3.4 mmHg to 14.4±2.6 mmHg (p0.05 for all comparisons). Conclusion Topical use of latanoprost later than 4 months after uncomplicated cataract surgery does not seem to predispose to increased macular thickness or CME and may safely be used in this setting.
Moghimi, Sasan; Zandian, Mehdi; Latifi, Golshan; Amini, Heydar; Eslami, Yadollah; Zarei, Reza; Fakhraie, Ghasem; Nouri-Mahdavi, Kouros
Full Text Available The fundamental aim of most ophthalmic interventions in later life is to improve the quality of patients' lives, whether through sight-restoring cataract surgery or the provision of visual aids. Amidst the pressures of targets, outputs, and backlogs, this may be all too easily forgotten. It is therefore important to step back and remember just how important good vision is in the lives of older adults.Vision loss has a major negative impact on the quality of older people's lives. Sight remains as valued and important in later life as at any other age and its loss is one of the things older people fear most. Improving access to eye care services for this age group, as well as older people's uptake of such services, is therefore very important.This article takes a closer look at some of the ways in which vision loss and blindness can affect the lives of older adults; it also highlights the positive impact sight-restoring cataract surgery has on older people's lives.
Full Text Available Inger Westborg,1,2 Eva Mönestam1 1Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden; 2Eye Clinic, Sunderby Hospital, Luleå, Sweden Purpose: To evaluate if the standard anesthetic regimen – topical combined with intracameral anesthesia without sedation – in a population-based cohort of unselected cataract surgery cases is adequate, optimal, and good practice, or if improvements are necessary. Methods: We conducted a prospective, observational study on all cases of cataract surgery during a 1-year period at one institution (n=1249. Data were collected from the patients’ records. Outcome measures were use of preoperative sedation, type of anesthesia, complications, and adverse events. In a subgroup of patients (n=124 satisfaction with the anesthetic regimen was evaluated using a short questionnaire. Results: Most cases (90%, 1125/1249 had combined topical and intracameral anesthesia without sedation. Patients who chose preoperative sedation (midazolam hydrochloride sublingually were significantly younger and more often female (P=0.0001 and P=0.011, respectively. In the questionnaire subgroup, the median pain score after surgery was 0.7 (visual analog scale, 0–10. A pain score of 1.9 or less was reported by 76% of the patients. Patients reporting a pain score of 2 or more had sedation and additional anesthetics more often. No significant difference was found regarding age, sex, pulse rate, oxygen saturation, first or second eye surgery, or adverse intraoperative events for patients with pain scores of 1.9 or less and 2 or more. Conclusion: This large population-based series of small-incision phacoemulsification surgery shows that combined topical and intracameral anesthesia without sedatives is well tolerated for most phacoemulsification patients. It is also effective in cases when complications or adverse events occur. It is important to be responsive to the individual patient’s needs and adjust operating procedures if necessary, as there were a few patients who experienced insufficient anesthesia. Keywords: anesthesia, local/methods, phacoemulsification, cataract extraction, humans, prospective observational studies
Full Text Available OBJECTIVE: To identify social characteristics and expectations of individuals seen during a community project for the treatment of senile cataracts. Expected results from their eye surgery and its consequences to their quality of life were studied as well. METHODOLOGY: Cataract patients (visual acuity equal to or lower than 0.2 in the more superior eye aged 50 years or over, were surveyed by means of interviews held during their visit at the Cataract Project in São Paulo city, State of São Paulo, Brazil, in 1999. RESULTS: The sample was composed of 331 subjects of low socioeconomic level ranging in age from 50 to 97 years (average = 71.8 years. Expectation of total recovery from the cataract condition by means of surgery was declared by 80.0% of the respondents, with no significant differences between male and female subjects (P < 0.1723. Hope to resume manual activities was expressed by 59.8%. CONCLUSION: A predominance of expectations of resuming normal activity and achieving a better quality of life after cataract surgery were identified.
Background The aim of this study was to evaluate visual performance, contrast sensitivity, and patient satisfaction in patients undergoing cataract surgery with bilateral implantation of the Tecnis ZMB00 diffractive multifocal IOL (intraocular lens). Material and Methods This was a prospective study of 40 eyes of 20 patients with an age range from 48 to 67 years and undergoing cataract surgery with implantation of the diffractive 1-piece IOL Tecnis ZMB00 (Abbott Medical Optics) in 1 eye and 3 weeks later in the other eye. The following parameters were evaluated at 3 and 6 months after the operation: binocular uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), uncorrected binocular photopic and mesopic distance and photopic near contrast sensitivity (CSV-1000), subjective symptoms, and patient satisfaction (VF-14). Results No significant change was observed in logMAR UDVA between 3 and 6 months postoperatively (-0.11±0.14 vs. -0.10±0.13, p>0.05). In contrast, UNVA (0.06±0.12 vs. -0.02±0.12, p=0.004) and UIVA (0.12±0.15 vs. 0.07±0.11, p=0.005) in this period improved significantly. At 3 and 6 months after surgery, 85% of patients no longer needed to wear corrective lenses. Contrast sensitivity under different conditions was within normal age-matched limits, with significant improvements for some spatial frequencies at 3 and 6 months after surgery (pIOL provides an effective restoration of the distance, intermediate, and near visual function, allowing patients to be totally free of need to wear corrective lenses and providing high levels of patient satisfaction. PMID:25022700
Lubi?ski, Wojciech; Gronkowska-Serafin, Jolanta; Podbor?czy?ska-Jodko, Karolina
Full Text Available Objetivo: Medición del impacto de la cirugía de catarata en la calidad de vida. Metodos: Medición de la calidad de vida en pacientes intervenidos de Catarata de sesenta a ochenta años de edad, de ambos géneros y con un nivel intelectual que les permitiera comprender el cuestionario de calidad de vida (SF-36. Se utiliza el SF-36 para medir las diferencias en calidad de vida pre y postcirugía, de tal manera que se completa el cuestionario ANTES del acto quirúrgico y SEIS MESES después. Resultados: Se realizaron 75 cuestionarios. La edad media fue de 73,88 años D.E. 5,27 años. Se ha encontrado una mejora significativa tanto de la función física (p=0,001 , cómo de la limitación de roles por problemas físicos (p=0,007 así cómo de la función social (p=0,003. Las dimensiones dolor corporal, limitación de roles debido a problemas emocionales, vitalidad, energía ó fatiga, percepción de la salud general y salud comparada con la de hace un mes, mejoraron en el periodo postcirugía, si bien no se encontraron diferencias significativas entre ambos periodos. Conclusiones: La Facoemulsificación e implante de lente intraocular ha demostrado que es un método efectivo para mejorar la calidad de vida, sobre todo en los aspectos físicos. La disminución de la limitación de roles debido a problemas de salud físicos tras la cirugía es concordante con la mejora física. La mejora en las relaciones sociales confirma la importancia de la medición de aspectos de calidad de vida en los resultados de cualquier intervención médica.Objective: To evaluate quality of life improvement after cataract surgery. Methods: Measurement of quality of life in 60-80-year-old patients undergoing phacoemulsification, both genders and able to comprehend the SF-36 quality of life questionnaire. The SF-36 explores the differences in quality of life before and after surgery. The questionnaire was completed prior to cataract surgery and six months after. Results: The answers of 75 patients were evaluated in this study. The average age was 73.88 S.E. 5.27 years old. After the surgery physical function increased (p=0.001, as did role limitation due to physical problems (p=0.007 and social function (p=0.003. Body pain, role limitation due to emotional problems, vitality, energy or tiredness, general health perception and health improved after surgery compared to one month before, but these findings were not statistically significant. Conclusions: Quality of life can be measurably improved by cataract surgery. Disease-specific questionnaires, such as the SF-36, should be used whenever possible as an outcome measure in clinical practice. The phacoemulsification cataract surgery has proved to be effective in improving quality of life.
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Analisar a incidência e causas de cancelamento de cirurgias de catarata em um hospital público de referência. MÉTODOS: Trata-se de um estudo retrospectivo em que foram analisados o número de cancelamentos de facectomias durante o ano de 2009. Foram analisados sexo, idade, tipo de procedime [...] nto suspenso (facoemulsificação ou extração extracapsular do cristalino), tipo de anestesia, convênio (Sistema Único de Saúde ou convênio/particular) e motivo de suspensão da cirurgia (causas clínicas, institucionais ou pessoais). RESULTADOS: Foram agendadas no período 2.965 cirurgias de catarata, havendo 650 cancelamentos (21,92%). Dentre as principais razões para a suspensão do procedimento destacaram-se as causas clínicas (86,90%). Os meses de inverno apresentaram os maiores índices de suspensão de cirurgias de catarata. CONCLUSÃO: A taxa de cancelamento de cirurgia de catarata em serviços públicos parece ser a mesma que há 10 anos. A principal causa de suspensão deve-se por condições clínicas (hipertensão, diabetes, falta de exames, etc.). Abstract in english PURPOSE: To report the incidence and causes of cataract surgery cancellations in a public hospital. METHODS: This is a retrospective study, which examined the number of cancellations of cataract surgery during 2009. We analyzed the type of procedure suspended (phacoemulsification or extracapsular ex [...] traction), type of anesthesia, gender, age, covenant (public/private) and the main reasons for suspension of the surgeries (clinical causes, institutional or personal). RESULTS: We analyzed 2,965 scheduled cataract surgeries, with 650 cancellations (21.92%). The main reason for the suspension of the procedure was clinical causes (86.90%). The winter months had the highest suspension rates of cataract surgery. CONCLUSION: The cancellation rate of cataract surgery in Brazilian public system seems to be the same as 10 years ago. The main cause of the suspension should be in clinical conditions (hypertension, diabetes, lack of exams, etc.).
Magri, Micheli Patrícia de Fátima; Espíndola, Rodrigo França de; Santhiago, Marcony Rodrigues de; Mercadante, Elisabeth Frolich; Kara Júnior, Newton.
Objective To determine the prevalence of cataract surgery and factors associated with post-surgical visual outcomes in migrant Indians living in Singapore. Research Design and Methods We conducted a population-based study in 3,400 Indian immigrants residing in Singapore?the Singapore Indian Eye Study (SINDI). All participants underwent comprehensive medical eye examination and a standardized interview. Post-operative visual impairment (VI) was defined as best-corrected or presenting visual acuity (BCVA or PVA) of 20/60 or worse. Results The age- and gender-standardized prevalence of cataract surgery was 9.7% (95% confidence interval [CI]: 8.9%, 10.7%) in Singapore resident Indians. Post-operative VI defined by BCVA occurred in 10.9% eyes (87/795). The main causes of post-operative VI were diabetic retinopathy (20.7%), posterior capsular opacification (18.4%), and age-related macular degeneration (12.6%). Undercorrected refractive error doubled the prevalence of post-operative VI when PVA was used. Conclusions The rate of cataract surgery is about 10% in Indian residents in Singapore. Socioeconomic variables and migration had no significant impact on the prevalence of cataract surgery. Diabetic retinopathy was a major cause of post-operative VI in migrant Indians living in Singapore. Uncorrected postoperative refractive error remains an efficient way to improve vision.
Gupta, Preeti; Zheng, Yingfeng; Ting, Tay Wan; Lamoureux, Ecosse L.; Cheng, Ching-Yu; Wong, Tien-Yin
Cataract, called in Sanskrit asÂ linganaashaÂ orÂ timira, is one of the leading causes for blindness today. Cataract is the opacification (light impenetrability) of the lens. In this condition, the lens of the eyes interferes with the eye vision. Since light cannot enter the opaque lens, therefore the eyes fail to give the representation of the objects... 2010-01-01
Cataract, called in Sanskrit asÂ linganaashaÂ orÂ timira, is one of the leading causes for blindness today. Cataract is the opacification (light impenetrability) of the lens. In this condition, the lens of the eyes interferes with the eye vision. Since light cannot enter the opaque lens, therefore the eyes fail to give the representation of the objects...
Purpose: To assess the target refractive error after cataract surgery to achieve best uncorrected visual acuity for both distance vision and reading vision.Methods: The study included patients consecutively undergoing routine phacoemulsification with clear corneal incisions and implantation of a foldable monofocal intraocular lens (IOL). Uncorrected distance visual acuity (UCDVA), best-corrected distance visual acuity (BCDVA), uncorrected near visual acuity (UCNVA,) and best-corrected near visual acuity were measured at 93 ± 47 days (minimum 4 weeks) after surgery. Inclusion criteria were a postoperative cylindrical refractive error ?1.5 D and an unremarkable postoperative status.Results: The study included 493 eyes of 493 patients with a mean age of 74.2 ± 8.7 years and mean axial length 23.4 ± 1.1 mm. The UCDVA significantly (prefractive error (spherical equivalent) towards emmetropia and then significantly (prefractive error. The UCNVA significantly (prefractive error. The ascending UCDVA line and the descending UCNVA line intersected in the refractive error range (spherical equivalent) of -1.00 D to -1.50 D. For patients with a BCDVA of ?20/25, the lines of UCDVA and UCNVA intersected at a UCDVA range between 20/40 (logMAR 0.30; -1.5 D) and 20/32 (logMAR 0.26; -1.0 D) and at a UCNVA range between Jaeger 3 (logMAR 0.26) and Jaeger 4 (logMAR 0.32).Conclusions: For routine unilateral cataract surgery with implantation of monofocal IOLs, target refractive error to achieve best uncorrected distance and near vision was in the range of -1.00 D to -1.50 D (spherical equivalent). PMID:24366766
Schuster, Alexander K; Schlichtenbrede, Frank C; Harder, Björn C; Beutelspacher, Sven C; Jonas, Jost B
Full Text Available OBJETIVOS: Avaliar a eficácia das incisões periféricas relaxantes limbares (IPRL na redução do astigmatismo pré-operatório durante a cirurgia de catarata. MÉTODOS: Foram estudados prospectivamente 103 olhos de 103 pacientes submetidos as IPRL, utilizando o nomograna de Nichamin durante a cirurgia de catarata pela facoemulsificação. Após o 1º e 6º mês foram avaliadas as mudanças no astigmatismo topográfico, na indução do astigmatismo e no índice de sucesso. Os pacientes foram separados em dois grupos segundo o tipo de astigmatismo no pré-operatório (a favor da regra e contra a regra e estudados separadamente. RESULTADOS: Ocorreram diferenças estatisticamente significativas entre os valores dos astigmatismos topográficos no pré e pós-operatório nos dois grupos. Verificou-se indução de 1,10 ± 0,9 dioptrias e 37% de índice de sucesso no grupo de astigmatismo a favor da regra e 1,70 ± 0,80 dioptrias e 51% de índice de sucesso no grupo de astigmatismo contra a regra após o 6º mês de seguimento. CONCLUSÃO: A incisão periférica relaxante limbar é efetiva na redução do astigmatismo pré-existente durante a cirurgia da catarata. O procedimento mostrou ser seguro e de fácil realização. O nomograma de Nichamim na nossa experiência hipocorrige o astigmatismo planejado em ambos os grupos estudados.PURPOSE: To evaluate the effect of peripheral limbar relaxing incisions (PLRI in the reduction of the astigmatism during cataract surgery. METHODS: We studied prospectively 103 eyes of 103 patients submitted to PLRI, using the Nichamim nomogram during cataract surgery by phacoemulsification. After the first and sixth month we analized the changes in astigmatism topography, induction of astigmatism and sucess rate. The patients were divided into two groups according to the astigmatism (with-the-rule and against-the-rule, and studied separately. RESULTS: There was a statistically significant change in the mean astigmatism topography in the preoperative and postoperative periods in both groups. There was an induction of 1.10 ± 0.9 D and 37% of sucess rate in the with-the-rule group and 1.70 ± 0.80 D and 51% of sucess rate in the against-the-rule group after six months of follow-up. CONCLUSIONS: The peripherical relaxing limbal incisions (PLRI are effective in reducing the preoperative astigmatism during cataract surgery. The procedure is safe and easy. The Nichamin nomogram caused hypocorrection in both types of preoperative astigmatism.
Edison Ferreira e Silva
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVOS: Avaliar a eficácia das incisões periféricas relaxantes limbares (IPRL) na redução do astigmatismo pré-operatório durante a cirurgia de catarata. MÉTODOS: Foram estudados prospectivamente 103 olhos de 103 pacientes submetidos as IPRL, utilizando o nomograna de Nichamin durante a cirurgia d [...] e catarata pela facoemulsificação. Após o 1º e 6º mês foram avaliadas as mudanças no astigmatismo topográfico, na indução do astigmatismo e no índice de sucesso. Os pacientes foram separados em dois grupos segundo o tipo de astigmatismo no pré-operatório (a favor da regra e contra a regra) e estudados separadamente. RESULTADOS: Ocorreram diferenças estatisticamente significativas entre os valores dos astigmatismos topográficos no pré e pós-operatório nos dois grupos. Verificou-se indução de 1,10 ± 0,9 dioptrias e 37% de índice de sucesso no grupo de astigmatismo a favor da regra e 1,70 ± 0,80 dioptrias e 51% de índice de sucesso no grupo de astigmatismo contra a regra após o 6º mês de seguimento. CONCLUSÃO: A incisão periférica relaxante limbar é efetiva na redução do astigmatismo pré-existente durante a cirurgia da catarata. O procedimento mostrou ser seguro e de fácil realização. O nomograma de Nichamim na nossa experiência hipocorrige o astigmatismo planejado em ambos os grupos estudados. Abstract in english PURPOSE: To evaluate the effect of peripheral limbar relaxing incisions (PLRI) in the reduction of the astigmatism during cataract surgery. METHODS: We studied prospectively 103 eyes of 103 patients submitted to PLRI, using the Nichamim nomogram during cataract surgery by phacoemulsification. After [...] the first and sixth month we analized the changes in astigmatism topography, induction of astigmatism and sucess rate. The patients were divided into two groups according to the astigmatism (with-the-rule and against-the-rule), and studied separately. RESULTS: There was a statistically significant change in the mean astigmatism topography in the preoperative and postoperative periods in both groups. There was an induction of 1.10 ± 0.9 D and 37% of sucess rate in the with-the-rule group and 1.70 ± 0.80 D and 51% of sucess rate in the against-the-rule group after six months of follow-up. CONCLUSIONS: The peripherical relaxing limbal incisions (PLRI) are effective in reducing the preoperative astigmatism during cataract surgery. The procedure is safe and easy. The Nichamin nomogram caused hypocorrection in both types of preoperative astigmatism.
Silva, Edison Ferreira e; Trindade, Fernando Cançado.
Abstract Background In Spain, there are substantial variations in the utilization of health resources among regions. Because the need for surgery differs in patients with appropriate surgical indication, introducing a prioritization system might be beneficial. Our objective was to assess geographical variations in the impact of applying a prioritization system in patients on the waiting list for cataract surgery in different regions of Spain by using a discrete-event simulati...
The aim of this study was to compare the visual performance of Acrysof ReSTOR and Acrysof Natural intraocular lenses (IOLs) following cataract surgery. A randomized prospective study was performed in which 64 eyes (51 patients) were divided randomly into two groups. Monofocal IOLs (Acrysof Natural) were implanted into 34 eyes (27 patients) and multifocal IOLs (Acrysof ReSTOR) were implanted into 30 eyes (24 patients) using phacoemulsification surgery. The corrected distance visual acuity, nea...
Ji, Jing; Huang, Xiaolin; Fan, Xianqun; Luo, Min
A 36 year-old patient with severe haemophilia A and high-titre inhibitor underwent cataract surgery under topical anaesthesia. Recombinant factor VIIa was used only three times, once before and twice following surgery. Tranexamic acid was given concomitantly. One month after the first successful procedure on the right eye, a second operation was performed on the left eye in the same manner. Both procedures were uneventful. Neither bleeding complications nor any other side effects occurred. PMID:16093736
Pekçelen, Yüksel; Yavuz, Akif S; Namli, Sule; Gücükoglu, Ahmet
Background/aim: Sub-Tenon’s block (STB) or topical anaesthesia alone (TOP) are popular techniques employed during cataract surgery. TOP is often preferred by healthcare providers because of financial or staffing reasons, despite existing evidence that pain during surgery is better controlled with STB. Pain is not the only consideration that determines patient preference for the anaesthesia technique. The authors decided to investigate the issue of patient satisfaction using the recently dev...
Ru?schen, H.; Celaschi, D.; Bunce, C.; Carr, C.
Purpose To ascertain whether cytokines in the aqueous humor can predict macular edema (ME) in non-diabetic patients following uncomplicated phacoemulsification cataract surgery. Methods Undiluted aqueous humor samples were obtained from 288 consecutive non-diabetic patients (288 eyes; 132 men and 156 women) who underwent cataract surgery. Macular edema was defined as an increase in the foveal center point thickness (FCPT) more than 30% from the preoperative baseline using optical coherence tomography 4 weeks after cataract surgery. The concentrations of 27 cytokines were measured in aqueous humor samples using the multiplex bead immunoassay. Results No major intraoperative complications occurred. The incidence of ME was 8.13% (23 patients) 4 weeks after cataract surgery. Compared to the ME (-) patients, the concentrations of interleukin-1? (IL-1?; p=0.016), IL-6 (p=0.013), monocyte chemotactic protein-1 (MCP-1; p=0.030), and vascular endothelial growth factor (VEGF; p=0.033) in the ME (+) patients were significantly higher. In addition, the aqueous humor levels of IL-1? (r=0.376), IL-6 (r=0.418), MCP-1 (r=0.348), and VEGF (r=0.375) positively correlated with the postoperative FCPT. However, the aqueous humor levels of IL-10 (p=0.017) were significantly lower in patients with ME and were negatively correlated with the postoperative FCPT (r=–0.424). Conclusions IL-1?, IL-6, MCP-1, VEGF, and IL-10 may be potential predictors of postoperative macular thickness in non-diabetic patients following uncomplicated phacoemulsification cataract surgery.
Chu, Liqun; Wang, Bingsong; Xu, Bing
Full Text Available Abstract Background The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients’ decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. Methods This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one’s own expense, overall patient satisfaction and postoperative visual clarity. Results The results showed that the patient’s gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Conclusions Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients.
Full Text Available Abstract Background In order to minimise postoperative intraocular pressure (IOP rise, after routine uncomplicated cataract surgery, prophylaxis may be adopted. Currently, there are no specific guidelines in this regard resulting in wide variation in practice across the UK. We sought to document these variations through a questionnaire survey. Methods A questionnaire was sent to all consultant ophthalmic surgeons in the UK. Results 62.6% of surgeons did not use any IOP lowering agents. 37.4% surgeons routinely prescribed some form of medication. The majority (86.8% used oral diamox. 20.6% of surgeons said they based their practice on evidence, 43.3% on personal experience, and 17.6% on unit policy. Surprisingly, among the two groups of surgeons (those who gave routine prophylaxis, and those who did not the percentages of surgeons quoting personal experience, unit policy, or presence of evidence was strikingly similar. The timing of the first postoperative IOP check varied from the same day to beyond 2 weeks. Only 20.2% of surgeons had ever seen an adverse event related to IOP rise; this complication is thus very rare. Conclusion This survey highlights a wide variation in the practice and postoperative management of phacoemulsification cataract surgery. What is very striking is that there is a similar proportion of surgeons in the diametrically opposite groups (those who give or do not give routine IOP lowering prophylaxis who believe that there practice is evidence based. The merits of this study suggests that consideration must be given to drafting a uniform guideline in this area of practice.
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Analisar a relevância da avaliação pré-operatória na prevenção de eventos clínicos adversos per e pós-operatórios na cirurgia de catarata. MÉTODOS: Foram incluídos no estudo 1.254 pacientes submetidos à cirurgia de catarata no Instituto da Catarata do Departamento Oftalmologia UNIFESP-EPM, [...] no período de jan-dez 2004. Dados referentes à avaliação pré-operatória e à ocorrência de eventos clínicos adversos relacionados ao procedimento anestésico/cirúrgico foram retrospectivamente coletados. RESULTADOS: Dezesseis pacientes (1,2%) apresentaram evento clínico adverso. Novecentos e trinta e seis pacientes (74,6%) apresentaram pelo menos um exame alterado, porém este fator não mostrou associação com a ocorrência de evento clínico adverso (p=0,334). CONCLUSÃO: Na série estudada a alteração de exames laboratoriais, eletrocardiograma e/ou radiografia de tórax não se correlacionou com a ocorrência de eventos clínicos adversos relacionados ao procedimento anestésico/cirúrgico. Abstract in english PURPOSE: Analysis of the relevance of preoperative evaluation to prevent adverse clinical events, pre- and postoperative, on cataract surgery. METHODS: The study includes 1254 patients submitted to cataract surgery at the Instituto da Catarata do Departamento de Oftalmologia da UNIFESP - EPM, in the [...] period of Jan - Dec 2004. Data referring to the preoperative evaluation and adverse clinical events related to anesthesia/surgical procedure were retrospectively collected. RESULTS: Sixteen patients (1.2%) showed an adverse clinical event. Nine hundred thirty-six patients (74.6%) showed at least one altered examination. This factor, nevertheless, did not show any relation to the adverse clinical event (p=0.334). CONCLUSION: Concerning the studied series, the altered laboratory tests, electrocardiogram and/or thorax x-ray has no correlation with the adverse clinical events related to the anesthesia/surgical procedure.
Tallo, Fernando Sabia; Soriano, Eduardo Sone; Alvarenga, Lênio Souza.
To evaluate the risk factors for secondary membrane (SM) formation after congenital cataract surgery with intraocular lens (IOL) implantation. A retrospective non-interventional comparative study. Thirty-nine patients (63 eyes) aged 1-135 months. The study included patients who underwent cataract extraction and primary IOL implantation between 1994 and 2001 at the University Hospital. The postoperative follow-up was 6-24 months. Thirty-three eyes received a poly(methyl methacrylate) (PMMA) IOL without square edges, 29 eyes received a hydrophobic acrylic IOL with truncated square edges (AcrySof), and there was no data for IOL type in one eye. Thirty-nine eyes had primary posterior capsulotomy (PPC) and anterior vitrectomy (AV) and in 24 eyes the posterior capsule was left intact. Cox proportional hazard regression analysis was performed to identify significant risk factors for SM formation, and Wilcoxon test to evaluate the difference in time from surgery to SM formation. SM developed in 24 eyes (38 %)-58 % of eyes with an intact posterior capsule and 26 % of eyes having PPC and AV, 42 % of eyes with a PMMA IOL, and 34 % of eyes with an AcrySof lens. In multivariate Cox regression analysis intraoperative PPC and AV (P = 0.02) and AcrySof lens implantation (P = 0.097) were associated with decreased postoperative incidence of SM formation. Median time until SM development was 2.9 months with PMMA IOLs (range 1-17 months) and 6 months with AcrySof lenses (range 1-21.8 months) (P = 0.037). Posterior capsule management as well as IOL design and material influence the incidence and the timing of SM formation after primary IOL implantation in children. PMID:24166705
Bar-Sela, Shai M; Har-Noy, Nurit Birman; Spierer, Abraham
Full Text Available Ali Simsek,1 Süleyman Ciftci21Department of Ophthalmology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey; 2Department of Ophthalmology, Diyarbakir Training and Research Hospital, Diyarbakir, TurkeyBackground: The aim of this study was to assess the value of ultrasonic biomicroscopy in reporting decreases in intraocular pressure resulting from changes in anterior chamber depth and angle after phacoemulsification and intracapsular lens implantation in patients with cataract.Methods: This prospective interventional case series included 50 eyes of 50 consecutive subjects operated at the same center. Patients with eye disease affecting visual acuity, a history of eye surgery, corneal surface irregularities, a pupil diameter < 5 mm after preoperative dilation, aged younger than 35 years, posterior capsule perforation, iris dialysis during surgery, intensive postoperative corneal edema, and inability to attend adequate follow-up were excluded. Intraocular pressure, anterior chamber depth and angle, and corneal thickness were measured before and one month after surgery.Results: The mean preoperative intraocular pressure was 14 mmHg and postoperatively was 11 mmHg. Mean anterior chamber depth preoperatively was 2.8 mm and increased to 3.7 mm postoperatively. The mean anterior chamber angle was measured as 27° preoperatively and as 42° postoperatively.Conclusion: After phacoemulsification and intracapsular lens implantation, ultrasonic biomicroscopy showed that the iris diaphragm had shifted backwards, widening the angle of the anterior chamber and decreasing intraocular pressure.Keywords: anterior chamber depth, anterior chamber angle, ultrasonic biomicroscopy
Aim Little information exists on the impact of cataract surgery on falls and other injuries in Vietnam. The aim of this study was to determine the impact of first and both eye cataract surgery on the number of falls and other injuries among bilateral cataract patients in Ho Chi Minh City, Vietnam. Materials and methods A longitudinal cohort study was conducted involving 413 bilateral cataract patients aged 50+ years. Participants were assessed at three time points: 1 week before, 1–3 months after, and 1 year after first-eye cataract surgery. Visual measures (visual acuity, contrast sensitivity and stereopsis) were taken, and self-reported falls and injury data were collected. A multilevel longitudinal Poisson regression model was used to investigate change in the number of falls after surgery. Results The risk of falls decreased by 78% (incidence-rate ratio [IRR] 0.22, 95% confidence interval [CI] 0.06–0.77; P=0.018) in the year after cataract surgery for participants who had first-eye surgery only and 83% (IRR 0.17, 95% CI 0.04–0.69; P=0.012) for participants who had the second eye operated on compared to before surgery. The risk of falls was three times higher for females than males (IRR 3.13, 95% CI 1.53–6.40; P=0.002). Improved binocular contrast sensitivity was also associated with a decrease in falls (IRR 0.40, 95% CI 0.17–0.97; P=0.042). The prevalence of other injuries also decreased after cataract surgery. Conclusion Cataract surgery reduced the number of falls and other injuries in Vietnam. Contrast sensitivity may be important for ophthalmologists to consider when prioritizing patients for surgery and assessing their fall risk.
To, Kien Gia; Meuleners, Lynn; Bulsara, Max; Fraser, Michelle L; Duong, Dat Van; Do, Dung Van; Huynh, Van-Anh Ngoc; Phi, Tien Duy; Tran, Hoang Huy; Nguyen, Nguyen Do
Full Text Available AIM: To evaluate the effect of brinzolamide-timolol fixed combination on intraocular pressure (IOP after cataract surgery.METHODS:The study included 92 eyes of 87 patients who underwent cataract surgery and intraocular lens implantation. Patients scheduled for phacoemulsification were assigned to 1 of 2 groups. The treatment group received 1 drop of brinzolamide-timolol fixed combination immediately after surgery, and the control group received no treatment. The IOP was measured preoperatively and at 2h and 24h postoperatively.RESULTS: The mean IOP change was lower in the treatment group than in the control group at 2h postoperatively. The difference between the mean IOP values of the two groups at 2h postoperatively was found to be statistically significant. Twenty-four hours after the surgery, the mean IOP change was still higher in the control group when compared to the treatment group.CONCLUSION: The fixed combination brinzolamide-timolol can effectively reduce IOP after cataract surgery.
Background: Intraocular surgery in patients with intellectual disability can be hazardous. Our aim was to determine the outcomes of surgery on all such patients seen in a consultant-led service, and to assess the overall risks and benefits. Materials and Methods: A retrospective chart review of patients with moderate to severe intellectual…
Cooke, C. A.; Frazer, D. G.; Jackson, A. J.
Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Casos clínicos: Caso 1: varón de 82 años intervenido de catarata mediante facoemulsificación e implante de lente Tecnis® Z 9000 en su ojo derecho (OD), bajo anestesia tópica. La duración de la cirugía fue de 14 minutos sin complicaciones. Caso 2: mujer de 60 años con glaucoma primario de ángulo abie [...] rto (GPAA) bilateral avanzado, intervenida sin complicaciones de catarata mediante facoemulsificación e implante de lente Tecnis® Z 9000 en su ojo derecho, bajo anestesia peribulbar. La duración de la cirugía fue de 36 minutos. Al mes de la cirugía ambos pacientes evidenciaron escotoma paracentral inferior y escasa mejora de la agudeza visual (AV). La angiografía fluoresceínica (AGF) de ambos casos reveló cambios en el epitelio pigmentario de la retina compatibles con un posible fototraumatismo macular intraoperatorio. Discusión: La maculopatía por fototoxicidad es una complicación descrita tras cirugía de catarata. El que las propiedades físicas de estas nuevas lentes de polisiloxano favorezcan el fototraumatismo retiniano en determinadas condiciones lumínicas han de ser aclaradas. Abstract in english Case report: Case 1: An 82-year-old man who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis® Z 9000 lens) in his right eye under topical anaesthesia. Surgery lasted 14 minutes. Case 2: A 60-year-old woman with bilateral advanced primary open angle glaucoma who underwent a [...] n uncomplicated phacoemulsification and IOL implantation (Tecnis® Z 9000 lens) in her right eye under peribulbar anaesthesia. Surgery lasted 36 minutes. One month after surgery both patients noted a para-central scotoma and impaired vision. Fluorescein angiography in both cases revealed retinal pigment epithelial changes compatible with intra-operative light-induced maculopathy. Discussion: Light-induced maculopathy has been reported following cataract surgery. Whether physical properties of these new polysiloxane lenses contribute to retinal susceptibility to phototoxicity under certain light conditions needs to be elucidated.
P, Gómez-Faíña; A-T, Ruiz Viñals; A, Antón López; D, Nahra Saad; J-A, Buil Calvo; M, Castilla Céspedes.
Purpose:? The purpose of this study was to assess the incidence of intraoperative floppy iris syndrome (IFIS) and the morphology of the corneal endothelium after cataract extraction in Caucasian male patients exposed to the ?-1a adrenergic receptor antagonist tamsulosin. Methods:? In a clinical prospective study, 23 male patients (23 eyes) treated with tamsulosin due to benign prostatic hyperplasia and 25 male patients (25 eyes) with no tamsulosin treatment had cataract surgery. The divide-and-conquer technique was used with the Infinity OZil(®) machine. A combination of Healon and Healon5 was used in all patients, but the use of additional Vision Blue, iris retractors or intracameral phenylephrine in the tamsulosin group was at the discretion of the surgeon. The endothelial cell density, variation in endothelial cell size (CV), percentage of hexagonal cells and central corneal thickness (CCT) were recorded at baseline and at 3?months postoperatively. Results:? In the tamsulosin-treated group, 19 of 23 eyes (83%) developed IFIS, compared with no IFIS in the control group. Compared with the control group, the tamsulosin group showed significantly less dilatation at the start of the operation, significant miosis during surgery and significantly greater corneal endothelial cell loss 3?months postoperatively (12% versus 3%; p?0.001). Conclusion:? Intraoperative floppy iris syndrome during cataract surgery is significantly associated with tamsulosin-treated male patients. Patients on tamsulosin showed less preoperative dilatation, significant miosis during surgery, and had significantly greater postoperative endothelial cell loss compared with nontreated patients despite recommended precautions. PMID:23617291
Storr-Paulsen, Allan; Jørgensen, Jesper Skovlund; Norregaard, Jens Christian; Thulesen, Jesper
Objectives: To study the incidence of steroid induced rise in intraocular pressure following cataract surgery using non contact tonometer. Materials and Methods: The study was undertaken in a tertiary care centre. 500 eyes which underwent uncomplicated cataract surgery were studied for IOP changes for up to six weeks following omission of steroid eye drops using non contact tonometer. Results: At the end of six weeks of steroid therapy, 21% patients had persistently raised IOP of which 2% had...
Dodiya Kamal S; Aggarwal Somesh V; Bareth Kiran; Shah Nirzari
We compared the Acrysoft monofocal intraocular lens (IOL) in the mini monovision formula (n = 20) with the Array multifocal intraocular lens (n = 20) for glasses independence after cataract surgery. The Acrysoft monofocal IOL group showed similar and even slightly better results than the Array multifocal IOL group. The monofocal Acrysoft IOL using the mini monovision (blended vision) formula is a good alternative for providing post-cataract surgery glasses independence. PMID:18025632
Chen, Ming; Atebara, Neal H; Chen, Te Tsaw
Pipat KongsapDepartment of Ophthalmology, Prapokklao Hospital, Chanthaburi, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandPurpose: To evaluate the effectiveness of subconjunctival anesthesia as compared to retrobulbar anesthesia for pain control during manual small-incision cataract surgery (MSICS) performed by third-year residents.Design: A randomized, controlled trial.Patients and methods: A total of 150 patients undergoing routine cataract surgery were randomly ...
Diode laser welding of ocular tissues is a procedure that enables minimally invasive closure of a corneal wound. This procedure is based on a photothermal effect: a water solution of Indocyanine Green (ICG) is inserted in the surgical wound, in order to stain the corneal tissue walls. The stained tissue is then irradiated with a low power infrared diode laser, delivering laser light through a 300-?m core diameter optical fiber. This procedure enables an immediate closure of the wounds: it is thus possible to reduce or to substitute the use of surgical threads. This is of particular interest in children, because the immediate closure improves refractive outcome and anti-amblyopic effect; moreover this procedure avoids several general anaesthesia for suture management. In this work, we present the first use of diode laser welding procedure in paediatric patients. 5 selected patients underwent cataract surgery (Group 1), while 4 underwent fs-laserassisted penetrating keratoplasty (Group 2). In Group 1 the conventional surgery procedure was performed, while no stitches were used for the closure of the surgical wounds: these were laser welded and immediately closed. In Group 2 the donor button was sutured upon the recipient by 8 single stitches, instead of 16 single stitches or a running suture. The laser welding procedure was performed in order to join the donor tissue to the recipient bed. Objective observations in the follow up study evidenced a perfect adhesion of the laser welded tissues, no collateral effects and an optimal restoration of the treated tissues.
Rossi, Francesca; Pini, Roberto; Menabuoni, Luca; Malandrini, Alex; Canovetti, Annalisa; Lenzetti, Ivo; Capozzi, Paolo; Valente, Paola; Buzzonetti, Luca
Natural eye lens is a crystalline substance to produce a clear passage for light. Cataract is opacity within the clear lens of the eye and is the dominant cause of socio-medical problem i.e., blindness worldwide. The only available treatment of cataract is surgery. However, insufficient surgical facilities in poor and developing countries and post-operative complications inspire researchers to find out other modes of treatment for cataract. In this review, an attempt has been made to appraise various etiological factors of cataract to make their perception clear to build up counterpart treatment. Present study is an assortment of various available literatures and electronic information in view of cataract etiopathogenesis. Various risk factors have been identified in development of cataracts. They can be classified in to genetic factors, ageing (systemic diseases, nutritional and trace metals deficiencies, smoking, oxidative stress etc.), traumatic, complicated (inflammatory and degenerative diseases of eye), metabolic (diabetes, galactosemia etc.), toxic substances including drugs abuses, alcohol etc., radiation (ultraviolet, electromagnetic waves etc.) are implicated as significant risk factors in the development of cataract. PMID:24618482
Gupta, Varun B; Rajagopala, Manjusha; Ravishankar, Basavaiah
At clinically relevant concentrations, volatile anaesthetic agents influence neutrophil function. Our hypothesis was that sevoflurane would inhibit neutrophil apoptosis and consequently influence the postoperative pro-inflammatory state. In order to identify selectively the effect of the anaesthetic agent sevoflurane, we studied patients undergoing minimally stimulating (cataract) surgery randomly allocated to receive either sevoflurane (n = 11) or local anaesthesia (n = 12). Venous blood samples were taken immediately prior to anaesthesia and at 1, 8 and 24 h thereafter. The rate of neutrophil apoptosis, plasma concentration of cytokines and differential white cell count were measured. The rates of neutrophil apoptosis and plasma concentrations of IL-1beta, TNF-alpha and IL-8 at each time point were similar in the two groups. IL-6 concentrations increased significantly and to a similar extent compared to preanaesthetic levels at 8 and 24 h. This study demonstrates that sevoflurane does not influence the rate of neutrophil apoptosis, cytokine concentrations and neutrophil count following cataract surgery.
AIMS—To determine the improvements in clinical and functional vision and perceived visual disability after first and second eye cataract surgery.?METHODS—Clinical vision (monocular and binocular high and low contrast visual acuity, contrast sensitivity, and disability glare), functional vision (face identity and expression recognition, reading speed, word acuity, and mobility orientation), and perceived visual disability (Activities of Daily Vision Scale) were measured in 25 subjec...
Elliott, D.; Patla, A.; Bullimore, M.
Bacterial isolation, identification and antimicrobial susceptibility tests were carried out in ocular material collected with swab and polimethylmethacrylate (PMMA) or silicone intraocular lenses (IOL) from forty six patients submitted to cataract surgery. Seventy six isolates and seven different microorganisms were identified. Coagulase-negative staphylococci (CNS) were the predominant microorganisms isolated from swabs (71.4% of cases), PMMA lenses (81.3%) and silicon lenses (77.8%). Coagul...
Locatelli, Claudete I.; Sérgio Kwitko; Amauri Braga Simonetti
The purpose of this study was to evaluate the effectiveness of intravitreal ranibizumab (Lucentis, Genentech, South San Francisco, Calif, USA) combined with cataract surgery for the prevention of clinically significant macular edema (CSME) in patients with diabetic retinopathy (DR). This prospective interventional case series included fifty-four eyes of 54 patients with a previous diagnosis of nonproliferative diabetic retinopathy (NPDR) without macular edema preoperatively. Subjects were ass...
Udaondo, Patricia; Garcia-pous, Maria; Garcia-delpech, Salvador; Salom, David; Diaz-llopis, Manuel
Full Text Available Abstract Background The use of conventional foldable hydrophobic intraocular lenses (IOLs in microincision cataract surgery (MICS currently requires wound enlargement. We describe a combined surgical technique of MICS and trabeculectomy with insertion of a foldable IOL through the trabeculectomy fistula. Methods After completion of MICS through two side port incisions, a 3.2 mm keratome is used to enter the anterior chamber under the previously outlined scleral flap. An Acrysof multi piece IOL (Alcon labs, Fort Worth, Tx is inserted into the capsular bag through this incision. The scleral flap is then elevated and a 2 × 2 mm fistula made with a Kelly's punch. The scleral flap and conjunctival closure is performed as usual. Results Five patients with primary open angle glaucoma with a visually significant cataract underwent the above mentioned procedure. An IOL was implated in the capsular bag in all cases with no intraperative complications. After surgery, all patients obtained a best corrected visual acuity of 20/20, IOL was well centered at 4 weeks follow up. The mean IOP (without any antiglaucoma medication was 13.2 + 2.4 mm Hg at 12 weeks with a well formed diffuse filtering bleb in all the cases. Conclusion The technique of combining MICS with trabeculectomy and insertion of a foldable IOL through the trabeculectomy fistula is a feasible and valuable technique for cases which require combined cataract and glaucoma surgery.
Sethi Harinder S
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Fundamento: La anestesia en cirugía de cataratas ha evolucionado simultáneamente a la técnica quirúrgica. La cirugía de pequeña incisión ha popularizado el uso de la anestesia tópica, la cual permite llevar a cabo la cirugía con una excelente tolerancia por parte del paciente. Objetivo: Analizar los [...] resultados de la cirugía de cataratas con crioanestesia mediante la técnica de Blumenthal en pacientes aquejados de catarata senil. Método: Se realizó un estudio explicativo sobre los resultados de la cirugía de cataratas con crioanestesia por la técnica de Blumenthal en el Servicio de Oftalmología del Hospital Docente Clínico Quirúrgico «Manuel Ascunce Domenech» desde diciembre de 2005 a agosto de 2006. El universo estuvo constituido por todos los pacientes con este diagnóstico con criterio quirúrgico a los que se les aplicó un formulario creado al efecto basado en la revisión bibliográfica y el criterio de expertos. Se estudiaron las variables sexo, estadio de la catarata, tiempo de exposición a la anestesia y grado de satisfacción del paciente. Resultados: La mayor cantidad de pacientes estuvo comprendida en el grupo de 70 a 79 años de edad, hubo menor efectividad con la técnica anestésica en los grupos de edades más jóvenes, no existió diferencia con respecto al sexo, aunque el masculino mostró menos efectividad en la técnica anestésica con una proporción de 2:1. Conclusiones: La catarata hipermadura disminuyó la validez de la técnica anestésica, la prolongación del tiempo quirúrgico con relación al estadio de la catarata redujo la eficacia de la técnica anestésica y tres de cada cinco pacientes evaluaron la técnica como excelente o buena. Abstract in english Background: The anesthesia in cataracts surgery has simultaneously evolved to the surgical technique. The surgery of small incision has popularized the use of topical anesthesia, which allows carrying out the surgery with excellent tolerance by the patient. Objective: To analyze the results of the c [...] ataracts surgery with cryoanesthesia by means of Blumenthal technique in patients suffering senile cataract. Method: An explicative study about the results of the cataracts surgery with cryoanesthesia by means of Blumenthal technique in the Ophthalmology service at «Manuel Ascunce Domenech» Surgical Clinic Educational Hospital from December 2005 to August 2006. The universe was constituted by all the patients with diagnosis of surgical criterion, to which was applied a formulary created to the effect based on the bibliographic review and experts criterion. Sexes, cataract stage, exposure time to anesthesia and satisfaction grade of the patient, were the variables studied. Results: The higher quantity of patients was comprised in the group of 70 to 79 years, there was less effectivity with the anesthetic technique in the younger age groups, there was no difference regarding to sex, though the masculine showed less effectivity in the anesthetic technique with a proportion of 2:1. Conclusions: The hypermature cataract diminished the validity of the anesthetic technique, prolongation of surgical time related to the cataract stage reduced the anesthetic technique effectiveness and three out of five patients assessed the technique as excellent or good.
Taimys, Payán Hechavarría; Lázara Mairelys, Molinet Vega; José Manuel, García Martínez.
Comparação a longo prazo entre a facectomia extracapsular combinada à trabeculectomia e à facotrabeculectomia / Longterm comparison between extracapsular cataract extraction combined with trabeculectomy and combined phacofiltration surgery
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Objetivo: Comparar os resultados a longo prazo entre a cirurgia extracapsular da catarata combinada à trabeculectomia (FEC/TREC) e a facotrabeculectomia (FACO/TREC). Métodos: Os prontuários de 46 pacientes (53 olhos) submetidos à cirurgia combinada na Santa Casa de São Paulo entre janeiro de 1996 e [...] novembro de 1999 foram revisados; dados relativos à pressão ocular (PO), acuidade visual (AV) e número de medicações foram analisados. Resultados: Em ambos os grupos, após seguimento médio de 18 meses, a acuidade visual melhorou e a pressão ocular diminuiu em relação aos valores pré-operatórios (P Abstract in english Purpose: To compare the safety and efficacy of extracapsular cataract extraction (ECCE) combined with trabeculectomy and combined phacoemulsification/trabeculectomy. Methods: The records of 46 patients (53 eyes) who underwent combined glaucoma and cataract surgery at the Santa Casa de São Paulo betw [...] een January 1996 and November 1999 were reviewed. Results: After a mean follow-up of 18 months, visual acuity improved and intraocular pressure decreased in both groups after surgery (P
Carmo, Mandia Jr.; Niro, Kasahara; Francisco Soares, Seixas; Maurício Della, Paolera; Geraldo Vicente de, Almeida; Ralph, Cohen.
Full Text Available Jian-Guo Wu, Rui-Hua Wei, Ai-Hua Liu, Xiao-Xu Zhou, Guo-Ling Sun, Xiao-Rong LiTianjin Medical University Eye Center, Tianjin, ChinaBackground: The purpose of this prospective, interventional, comparative case series was to evaluate the efficiency and feasibility of a disposable sutureless silicone lens ring for corneal contact lens stabilization during combined 23-gauge vitrectomy and cataract surgery.Methods: We developed a ring consisting of a single silicone component with three footplates along the ring margin to fit cannulae for holding conventional contact lenses. Thirty eyes from 30 patients with cataract and vitreoretinal disease were included, and divided into two matched groups according to disease type and ring used. In Group A, we used a 23-gauge transconjunctival vitrectomy system and a disposable sutureless silicone lens ring (n = 15. In Group B, we used a 23-gauge transconjunctival vitrectomy system and a conventional metal lens ring (n = 15. The main outcome measures were: time required for vitrectomy preparation, rate of intraoperative corneal limbus bleeding, and limbus scar rate at the final follow-up visit.Results: Thirty cases were successfully completed. The average vitrectomy preparation time was less in Group A than in Group B (P < 0.01, and the average preparation time saved was 3.94 minutes. None of the Group A patients had intraoperative bleeding or postoperative scarring, whereas all 15 Group B cases had bleeding and five had scarring. There was a statistically significant difference between Group A and Group B for these complications (P ? 0.05.Conclusion: This report demonstrates the advantages of using a sutureless silicone ring during combined 23-gauge vitrectomy and cataract surgery. Using this method could allow extra time for the surgeon to pay more attention to complex vitreoretinal procedures.Keywords: pars plana vitrectomy, contact lens, silicone ring, cataract surgery
We measured velocity distributions in the anterior chamber of porcine eyes under simulated cataract surgery using stereoscopic particle image velocimetry (stereo-PIV). The surface of the cornea was detected based on the images of laser-induced fluorescent light emitted from fluorescent dye solution introduced in a posterior chamber. A coaxial phacoemulsification procedure was simulated with standard size (standard coaxial phacoemulsification) and smaller (micro coaxial phacoemulsification) surgical instruments. In both cases, an asymmetric flow rate of irrigation was observed, although both irrigation ports had the same dimensions prior to insertion into the eye. In cases where the tip of the handpiece was placed farther away from the top of the cornea, i.e., closer to the crystalline lens, direct impingement of irrigation flow onto the cornea surface was avoided and the flow turned back toward the handpiece along the surface of the corneal endothelium. Viscous shear stress on the corneal endothelium was computed based on the measured mean velocity distribution. The maximum shear stress for most cases exceeded 0.1 Pa, which is comparable to the shear stress that caused detachment of the corneal endothelial cells reported by Kaji et al. in Cornea 24:S55-S58, (2005). When direct impingement of the irrigation flow was avoided, the shear stress was reduced considerably.
Sakakibara, Jun; Yamashita, Masaki; Kobayashi, Tatsuya; Kaji, Yuichi; Oshika, Tetsuro
Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo: Estudiar las características del estrabismo secundario a la cirugía de catarata con anestesia subtenoniana; su tratamiento y pronóstico. Método: Ocho enfermos sin estrabismo previo presentaron diplopía inmediatamente después de la cirugía de catarata; cinco de ojo izquierdo, tres de ojo de [...] recho. La exploración con cover test, prismas y ducción activa y pasiva mostró estrabismo restrictivo: siete de componente vertical y uno horizontal. La desviación media fue de 17,5 DE: 9,84 dioptrías prismáticas (rango 5-35) en la mirada al frente. La posición máxima de desviación fue en supraversión en siete, y en levoversión en otro. Todos tenían diplopía invalidante. Se considera buen resultado si desaparecía la diplopía con el tratamiento. Resultados: Cuatro casos recibieron tratamiento quirúrgico, en uno sólo se inyectó toxina botulínica y en tres se pusieron prismas. La toxina botulínica se empleó como primera opción en cuatro casos y sólo fue eficaz en un enfermo. De los cuatro casos operados, tres necesitaron dos cirugías y un paciente sólo un tiempo quirúrgico. Se consiguió buen resultado en los ocho pacientes tratados. El tiempo medio de evolución fue de 10,12 DE: 5,46 meses. Conclusiones: La anestesia subtenoniana puede provocar un estrabismo restrictivo y una diplopía muy invalidantes que no se resuelven espontáneamente. El recto inferior es el músculo más frecuentemente afectado. La cirugía muscular es necesaria para resolver el problema en la mitad de los casos. Se consiguen buenos Resultados quirúrgicos. Abstract in english Purpose: To study the clinical signs, treatment and prognosis of strabismus after sub-Tenon’s anesthesia for cataract surgery. Methods: Eight patients without previous strabismus developed incommitant diplopia immediately after cataract surgery; the left eye was affected in five patients and the rig [...] ht eye in three. Restrictive strabismus was diagnosed with the cover test, prisms, and active and passive ductions in all cases. In seven cases the deviation was vertical and in one patient it was horizontal. The average deviation was 17.5 S.D. 9.84 (range 5-35) prismatic dioptres in primary position. The deviation increased looking upward in seven cases, and looking sideways to the left in the other. It was considered to be a good result if the diplopia disappeared after treatment. Results: Botulinum toxin was the first treatment applied in four patients, but only one showed a good response and required no further therapy. Strabismus surgery was required in four cases, and prisms were adapted in three. Three patients required two strabismus operations. A good result was achieved in all cases, with the average time interval being 10.12 (SD 5.5) months. Conclusions: Sub-Tenon’s anesthesia may result in restrictive strabismus and incommitant diplopia which does not resolve spontaneously. The inferior rectus is the most commonly affected muscle. Strabismus surgery is required to resolve the diplopia in half of the cases. Good results have been achieved in all patients.
P., Merino; N., Muñoz-Sanz; P., Gómez-de-Liaño; B., Gutiérrez-Partida; O., Seijas-Leal.
Full Text Available Objetivo: Estudiar las características del estrabismo secundario a la cirugía de catarata con anestesia subtenoniana; su tratamiento y pronóstico. Método: Ocho enfermos sin estrabismo previo presentaron diplopía inmediatamente después de la cirugía de catarata; cinco de ojo izquierdo, tres de ojo derecho. La exploración con cover test, prismas y ducción activa y pasiva mostró estrabismo restrictivo: siete de componente vertical y uno horizontal. La desviación media fue de 17,5 DE: 9,84 dioptrías prismáticas (rango 5-35 en la mirada al frente. La posición máxima de desviación fue en supraversión en siete, y en levoversión en otro. Todos tenían diplopía invalidante. Se considera buen resultado si desaparecía la diplopía con el tratamiento. Resultados: Cuatro casos recibieron tratamiento quirúrgico, en uno sólo se inyectó toxina botulínica y en tres se pusieron prismas. La toxina botulínica se empleó como primera opción en cuatro casos y sólo fue eficaz en un enfermo. De los cuatro casos operados, tres necesitaron dos cirugías y un paciente sólo un tiempo quirúrgico. Se consiguió buen resultado en los ocho pacientes tratados. El tiempo medio de evolución fue de 10,12 DE: 5,46 meses. Conclusiones: La anestesia subtenoniana puede provocar un estrabismo restrictivo y una diplopía muy invalidantes que no se resuelven espontáneamente. El recto inferior es el músculo más frecuentemente afectado. La cirugía muscular es necesaria para resolver el problema en la mitad de los casos. Se consiguen buenos Resultados quirúrgicos.Purpose: To study the clinical signs, treatment and prognosis of strabismus after sub-Tenon’s anesthesia for cataract surgery. Methods: Eight patients without previous strabismus developed incommitant diplopia immediately after cataract surgery; the left eye was affected in five patients and the right eye in three. Restrictive strabismus was diagnosed with the cover test, prisms, and active and passive ductions in all cases. In seven cases the deviation was vertical and in one patient it was horizontal. The average deviation was 17.5 S.D. 9.84 (range 5-35 prismatic dioptres in primary position. The deviation increased looking upward in seven cases, and looking sideways to the left in the other. It was considered to be a good result if the diplopia disappeared after treatment. Results: Botulinum toxin was the first treatment applied in four patients, but only one showed a good response and required no further therapy. Strabismus surgery was required in four cases, and prisms were adapted in three. Three patients required two strabismus operations. A good result was achieved in all cases, with the average time interval being 10.12 (SD 5.5 months. Conclusions: Sub-Tenon’s anesthesia may result in restrictive strabismus and incommitant diplopia which does not resolve spontaneously. The inferior rectus is the most commonly affected muscle. Strabismus surgery is required to resolve the diplopia in half of the cases. Good results have been achieved in all patients.
Full Text Available AIM:To explore safety and effectiveness of stratified emulsion splitting technology in highly hard nuclear cataract ultrasonic emulsification. METHODS: Totally 43 cases(47 eyesof highly hard nuclear cataract was performed cataract extraction combined IOL implantation with stratified emulsion splitting cataract ultrasonic emulsification technology. RESULTS:Postoperative visual acuity 1 day, 1 week and 1 month best-corrected visual acuity ?0.5 was accounted for 70.21%, 87.23% and 89.36%. Intraoperative capsule rupture was found in 2 eyes. Corneal mild edema was found in 7 eyes(14.89%after the first l day post-operation. CONCLUSION:Stratified emulsion splitting technique has a practical application with little tissue damage, low capsular rupture rate and few complications for highly hard nuclear cataract patients and can bring a desirable outcome.
Full Text Available Kien Gia To,1,2 Lynn Meuleners,1 Max Bulsara,3 Michelle L Fraser,1 Dat Van Duong,4 Dung Van Do,2 Van-Anh Ngoc Huynh,2 Tien Duy Phi,5 Hoang Huy Tran,5 Nguyen Do Nguyen51Curtin Monash Accident Research Centre (C-MARC, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; 3Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia; 4United Nations Population Fund, Hanoi, Vietnam; 5Eye Hospital, Ho Chi Minh City, VietnamAim: Little information exists on the impact of cataract surgery on falls and other injuries in Vietnam. The aim of this study was to determine the impact of first and both eye cataract surgery on the number of falls and other injuries among bilateral cataract patients in Ho Chi Minh City, Vietnam.Materials and methods: A longitudinal cohort study was conducted involving 413 bilateral cataract patients aged 50+ years. Participants were assessed at three time points: 1 week before, 1–3 months after, and 1 year after first-eye cataract surgery. Visual measures (visual acuity, contrast sensitivity and stereopsis were taken, and self-reported falls and injury data were collected. A multilevel longitudinal Poisson regression model was used to investigate change in the number of falls after surgery.Results: The risk of falls decreased by 78% (incidence-rate ratio [IRR] 0.22, 95% confidence interval [CI] 0.06–0.77; P=0.018 in the year after cataract surgery for participants who had first-eye surgery only and 83% (IRR 0.17, 95% CI 0.04–0.69; P=0.012 for participants who had the second eye operated on compared to before surgery. The risk of falls was three times higher for females than males (IRR 3.13, 95% CI 1.53–6.40; P=0.002. Improved binocular contrast sensitivity was also associated with a decrease in falls (IRR 0.40, 95% CI 0.17–0.97; P=0.042. The prevalence of other injuries also decreased after cataract surgery.Conclusion: Cataract surgery reduced the number of falls and other injuries in Vietnam. Contrast sensitivity may be important for ophthalmologists to consider when prioritizing patients for surgery and assessing their fall risk.Keywords: falls, injuries, cataract surgery, longitudinal, older population, Vietnam
Background: The purpose of this prospective, interventional, comparative case series was to evaluate the efficiency and feasibility of a disposable sutureless silicone lens ring for corneal contact lens stabilization during combined 23-gauge vitrectomy and cataract surgery. Methods: We developed a ring consisting of a single silicone component with three footplates along the ring margin to fit cannulae for holding conventional contact lenses. Thirty eyes from 30 patients with cataract and vitreoretinal disease were included, and divided into two matched groups according to disease type and ring used. In Group A, we used a 23-gauge transconjunctival vitrectomy system and a disposable sutureless silicone lens ring (n = 15). In Group B, we used a 23-gauge transconjunctival vitrectomy system and a conventional metal lens ring (n = 15). The main outcome measures were: time required for vitrectomy preparation, rate of intraoperative corneal limbus bleeding, and limbus scar rate at the final follow-up visit. Results: Thirty cases were successfully completed. The average vitrectomy preparation time was less in Group A than in Group B (P silicone ring during combined 23-gauge vitrectomy and cataract surgery. Using this method could allow extra time for the surgeon to pay more attention to complex vitreoretinal procedures.
Wu, Jian-Guo; Wei, Rui-Hua; Liu, Ai-Hua; Zhou, Xiao-Xu; Sun, Guo-Ling; Li, Xiao-Rong
Full Text Available Background: The cataract (Cataracta senilis is the most frequent eye disease of elderly people worldwide. In Germany, the cataract operation - with currently 450,000 interventions each year the most frequent operation in ophthalmology – can be seen as routine surgery. The age related macular degeneration (AMD is a further one of the most common, age-related eye diseases and the most frequent cause of blindness of elderly people in industrial nations. Due to demographic changes an increasing number of patients will suffer from cataract and AMD at the same time. This coincidence leads to a greater interest in the question of a mutual influence of both diseases, respectively their therapies, on each other. Objectives: The aim of this report was the evaluation of the medical and health economic effects of cataract operations on the development and progression of an age related macular degeneration (AMD. It was differentiated between first manifestations of AMD, progression of early stages of AMD and influence on further impairment in late stages of AMD. Methods: The relevant publications for this report were identified by DIMDI via structured database enquiry as well as common, self-made enquiry and were evaluated, based on the criteria of evidence based medicine. The present report included German and English literature published since 1983. Results: The database enquiry generated a record of 2769 issue-related publications. Eight medical publications were eligible for analysis in the course of the present HTA report. No relevant studies on health economical, ethical, social or legal issues could be included. Three epidemiological cohort studies provided some evidence for a promoting influence of cataract extractions on the progression of early types of AMD. Two of the epidemiological studies assessed the risk of first manifestation of AMD after cataract extraction. Both came up with up with increased incidences that did not reach statistical significance despite a large number of participants. Only one out of two clinical studies looked at further impairment in late stages of AMD and could not find an interrelation with cataract extraction. Thus the available evidence was not sufficient to come to a conclusion on the contribution of cataract extractions to the first manifestation of AMD and to the further impairment in late stages. Discussion: The presentation of the evaluated literature made clear that only a small number of publications dealt with the development of age related macula degeneration in consequence of a cataract extraction. The overall scientific level of evidence of these articles was not very high. Therefore it was not possible to obtain a well-defined conclusion on the effect of a cataract extraction on the development or progression of an age related macula degeneration. Conclusion: Additional well conducted clinical trials, that offer a sufficient number of patients, length of study period and adequate control for confounding variables like age and severity of cataract, are urgently needed. Health economic, ethical, social and legal aspect of the problem could and should be investigated after clarification of the mentioned medical issues.
Willich, Stefan N.
To compare the effect of a fixed dorzolamide-timolol combination with that of latanoprost on intraocular pressure (IOP) after small incision cataract surgery. Department of Ophthalmology, University of Vienna, Vienna, Austria. This prospective randomized study comprised 60 eyes of 30 patients scheduled for small incision cataract surgery in both eyes. The patients were randomly assigned to receive 1 drop of a fixed dorzolamide-timolol combination or latanoprost immediately after cataract surgery in the first eye. The second eye received the other antiglaucomatous agent. Cataract surgery was performed under sodium hyaluronate 1% with a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively. Six hours after surgery, the mean IOP decreased by -0.8 mm Hg +/- 3.2 (SD) (P =.184) in the dorzolamide-timolol group and increased by 3.6 mm Hg +/- 3.5 (P combination was more effective than latanoprost in reducing IOP after small incision cataract surgery. Only the fixed dorzolamide-timolol combination prevented a postoperative IOP increase and occasional IOP spikes of 30 mm Hg or higher. PMID:11377900
Rainer, G; Menapace, R; Findl, O; Petternel, V; Kiss, B; Georgopoulos, M
Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo: Analizar la influencia de la longitud axial (LA) y la edad en el resultado poscirugía de las cataratas en términos de agudeza visual sin corrección (AVsc), con corrección (AVcc) y refracción subjetiva. Método: Estudio clínico retrospectivo de 171 ojos sometidos a cirugía no complicada de c [...] ataratas, en los que se analizó el resultado refractivo (AV y refracción posquirúrgica final) en función de su LA previa a la cirugía (LA 25 mm) y la edad del sujeto ( 60 años). Resultados: Después de la cirugía se ha encontrado una AVsc de 0,6 ± 0,33 y una AVcc de 0,93 ± 0,23 con un valor esférico medio posquirúrgico de 0,89 ± 0,78 dioptrías (D). No se han encontrado diferencias en la AVsc, AVcc y refracción en ninguno de los grupos de edad. Se han encontrado diferencias estadísticamente significativas (ANOVA, p = 0,004 con corrección de Bonferroni) entre los tres grupos de longitud axial; la diferencia mayor se da en sujetos con LA entre 22 y 25 mm. Los ojos con LA 25 mm, 0,23 ± 1,15 D. Conclusiones: La LA influye en el resultado refractivo y en la AVsc después de la cirugía de cataratas. Los ojos con LA menor de 22 mm consiguen peores resultados refractivos tras la cirugía. Abstract in english Purpose: To analyse the influence of axial length (AL) and age on refractive outcome after cataract surgery in terms of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and subjective refraction. Methods: A retrospective review of 171 consecutive cases of uncomplicated cataract [...] surgery was done. The refractive outcome was analysed (UCVA, BCVA and postoperative retraction) according AL before surgery (AL 25 mm) and age ( 60 years). Results: After surgery mean UCVA was 0.6 ± 0.33 Diopters (D) and mean BCVA was 0,93 ± 0,23 D. Mean refractive outcome was 0.89 ± 0.78 D. There were no significant differences in post-operative UCVA, BCVA and refraction between the three age groups. There were statistically significant differences (p = 0.004) in UCVA between the three AL groups. The group with AL between 22 and 25 mm had better UCVA. Mean refractive outcome was -0.95 ± 1.91 D in the group with AL 25 mm. Conclusions: AL influences refractive outcome and UCVA after cataract surgery. Eyes with AL
V. de, Juan; R., Martín; I., Pérez; J. M., Herreras.
Full Text Available Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3% was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of >0.50D was in 82.5% subjects of group A and 52.8% subjects of group B at 1st week. At 6th week postoperative astigmatism of less than 1D was in 79.95% subjects of Group A and 83.34% subjects of Group B. About 20% subjects in Group A and only 3.3% in Group B showed astigmatism of more than 1D and these differences on both the occasions were statistically significant. Conclusion: The post operative visual outcome was better in SICS with scleral incision (group B than in SICS with clear corneal incision (Group-A.
Md Shafiqul Alam
Aim To explore the views of consultant ophthalmic surgeons in Wales in the context of planning cataract surgery in patients with amblyopia. To compare prevailing views and preferences with recommendations in published literature. Method A cross-sectional survey was conducted in which all consultant ophthalmologists working in Wales were invited to complete an online survey designed using the Survey Monkey tool (http://www.surveymonkey.com). The survey included a clinical scenario involving an amblyopic patient with bilateral cataracts with questions designed to elicit responders’ preferences with regard to which eye they would operate on first as well as the reasoning behind their clinical decision making. Results 32 out of 42 consultants responded to the survey (a response rate of >75%). With regards to the chronological order of surgery 18 (56.26%) indicated that they would perform cataract surgery first on the non-amblyopic eye, 11 (34.4%) would surgically address the amblyopic eye first and three (9.4%) indicated that patient preference would dictate the choice regarding the laterality of the eye to be operated on first. While 24 responders (75.0%) had encountered amblyopic patients who had developed problems after cataract surgery only 10 (31.3%) opined that formal guidance from the Royal College of Ophthalmologists was warranted. Conclusion These results indicate that awareness of post-cataract surgery diplopia, and in particular fixation switch diplopia, is not widespread amongst consultant ophthalmic surgeons in Wales.
Samuel Williams, Gwyn; Radwan, Mahmoud; Menon, Jay
Full Text Available Takefumi Yamaguchi1,2, Kazuno Negishi1, Kazuhiko Ohnuma3, Kazuo Tsubota11Department of Ophthalmology, Keio University School of Medicine, Tokyo; 2Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba; 3Department of Medical System Engineering, Faculty of Engineering, Chiba University, Chiba, JapanBackground: The purpose of this study was to evaluate the correlation between contrast sensitivity and calculated higher-order aberrations based on individual natural pupil diameter after cataract surgery.Methods: This prospective study included 120 eyes from 92 patients who were randomized to receive one of four lenses, including three aspheric lenses (Acrysof SN60WF, Tecnis ZA9000, and Hoya Py60AD and one spherical lens (Acrysof SN60AT. Contrast sensitivity, higher-order aberrations of the whole eye, and pupil diameter under photopic and mesopic conditions were measured 1 month postoperatively. Higher-order aberrations were decomposed into Zernike coefficients, calculated according to individual pupil diameter. The correlation between higher-order aberrations and contrast sensitivity was evaluated.Results: There were no significant differences in contrast sensitivity function between the four types of lenses under photopic conditions. However, the contrast sensitivity function and area under log contrast sensitivity function in the aspheric lenses were significantly better than in the spherical lens under mesopic conditions. Under mesopic conditions, spherical aberration in eyes with aspheric lenses was significantly lower than in eyes with spherical lenses (P < 0.05. Under photopic conditions, coma aberration had a significant negative correlation with contrast sensitivity at 12 cycles/degree. Under mesopic conditions, spherical aberration had a significant negative correlation with contrast sensitivity at 3, 6, and 12 cycles/degree with glare, and with contrast sensitivity at 6 and 18 cycles/degree without glare.Conclusion: In terms of influence on visual function, coma aberration may be more significant under photopic conditions and spherical aberration under mesopic conditions.Keywords: mesopic conditions, spherical aberration, wavefront, photopic and mesopic conditions
Full Text Available AIM: To compare the effects of small incision extracapsular cataract extraction and phacoemulsification on corneal endothelial cells. METHODS: Eighty-two age-related cataract cases(82 eyesfrom March 2011 to October 2011, were randomly divided into two groups: phacoemulsification group(group Aand small incision extracapsular cataract extraction group(group B. Corneal edema after operation and changes in corneal endothelial cells in different stages before and after operation were observed. RESULTS: In both groups,there was significant difference in the data of corneal endothelial cell density before and after operation(PPPCONCLUSION: Phacoemulsification causes less damage to corneal endothelial cells and less postoperative corneal edema than small incision extracapsular cataract extraction.
Visual loss or disability from cataract represents a massive public health and socioeconomic problem in most developing countries. At present, some 13.5 million cases require treatment and this number will increase, as most countries in the Third World are unable to cope with both the backlog and new cases. Cataract extraction with intraocular lens (IOL) implantation is now the established and preferred method in industrialized countries. The introduction of IOLs in developing countries, howe...
PURPOSE: Identification of emotional factors related to daily difficulties and surgical treatment among patients with cataract at a university hospital. METHODS: A cross-sectional study was carried out by means of a questionnaire, elaborated based on a previous study. The sample consisted of patients seen at the cataract unit of the ophthalmology clinic of a university hospital. RESULTS: The sample consisted of 110 individuals of both sexes (34.5% men; 65.5% women) between the ages of 43 and ...
Roberta Marback; Edméa Temporini; Newton Kara Júnior
Objective: To compare the efficacy of subtenon with peribulbar local anesthesia without hyaluronidase in patients undergoing cataract surgery. Study Design: A randomized controlled trial. Place and Duration of Study: Eye B Unit, Khyber Teaching Hospital, Peshawar, from October 2009 to October 2010. Methodology: Patients undergoing cataract surgery were divided into two groups. Group A received subtenon anesthesia and group B received peribulbar anesthesia. Pain score, akinesia and intraocular pressure were compared in the two groups. Statistical Package for Social Sciences-14.0 was used for data analysis. Results: There were 304 patients, 152 patients in each group. At the time of injection, there was less pain in group A as compared to group B (p < 0.001). At the time of surgery and till 90 minutes after administration of anesthesia, there was no significant difference in pain between the 2 groups (p = 0.999 and 0.59 respectively). Group A had better akinesia as compared to group B (p = 0.04). There was a greater rise in mean intraocular pressure just after injection in group B as compared to group A (p < 0.001); in both groups, the intraocular pressure declined to its base level 10 minutes after the injection (p = 0.52). Conclusion: Subtenon anesthesia is less painful at the time of its administration, provides better akinesia and leads to smaller rise in intraocular pressure just after the injection than peribulbar anesthesia. (author)
Jian-Guo Wu, Rui-Hua Wei, Ai-Hua Liu, Xiao-Xu Zhou, Guo-Ling Sun, Xiao-Rong LiTianjin Medical University Eye Center, Tianjin, ChinaBackground: The purpose of this prospective, interventional, comparative case series was to evaluate the efficiency and feasibility of a disposable sutureless silicone lens ring for corneal contact lens stabilization during combined 23-gauge vitrectomy and cataract surgery.Methods: We developed a ring consisting of a single silicone component with three footplates...
J-g, Wu; R-h, Wei; A-h, Liu; X-x, Zhou; G-l, Sun; X-r, Li
Full Text Available Abstract Background In Spain, there are substantial variations in the utilization of health resources among regions. Because the need for surgery differs in patients with appropriate surgical indication, introducing a prioritization system might be beneficial. Our objective was to assess geographical variations in the impact of applying a prioritization system in patients on the waiting list for cataract surgery in different regions of Spain by using a discrete-event simulation model. Methods A discrete-event simulation model to evaluate demand and waiting time for cataract surgery was constructed. The model was reproduced and validated in five regions of Spain and was fed administrative data (population census, surgery rates, waiting list information and data from research studies (incidence of cataract. The benefit of introducing a prioritization system was contrasted with the usual first-in, first-out (FIFO discipline. The prioritization system included clinical, functional and social criteria. Priority scores ranged between 0 and 100, with greater values indicating higher priority. The measure of results was the waiting time weighted by the priority score of each patient who had passed through the waiting list. Benefit was calculated as the difference in time weighted by priority score between operating according to waiting time or to priority. Results The mean waiting time for patients undergoing surgery according to the FIFO discipline varied from 1.97 months (95% CI 1.85; 2.09 in the Basque Country to 10.02 months (95% CI 9.91; 10.12 in the Canary Islands. When the prioritization system was applied, the mean waiting time was reduced to a minimum of 0.73 months weighted by priority score (95% CI 0.68; 0.78 in the Basque Country and a maximum of 5.63 months (95% CI 5.57; 5.69 in the Canary Islands. The waiting time weighted by priority score saved by the prioritization system varied from 1.12 months (95% CI 1.07; 1.16 in Andalusia to 2.73 months (95% CI 2.67; 2.80 in Aragon. Conclusion The prioritization system reduced the impact of the variations found among the regions studied, thus improving equity. Prioritization allocates the available resources within each region more efficiently and reduces the waiting time of patients with greater need. Prioritization was more beneficial than allocating surgery by waiting time alone.
Full Text Available David L DeMill, Maylon Hsu, Majid MoshirfarJohn A Moran Eye Center, University of Utah, Salt Lake City, UT, USABackground: The purpose of this study was to evaluate the American Society of Cataract and Refractive Surgery (ASCRS intraocular lens (IOL calculator for eyes with prior radial keratotomy and assess the accuracy of its methods in predicting IOL power in patients with previous radial keratotomy.Methods: This retrospective study included data from 15 eyes with previous radial keratotomy and subsequent cataract surgery. The average central power and Humphrey Atlas methods from the ASCRS IOL calculator, along with an average IOL power produced from an average of these two methods (ASCRS average, were compared. Primary outcome measures for each method were mean arithmetic and absolute IOL prediction error, variance in mean arithmetic IOL prediction error, and the percentage of refractive outcomes within ±0.50, ±1.00, ±1.50, and ±2.00 diopters (D.Results: The average central power method and the ASCRS average were significantly more accurate than the Humphrey Atlas method in terms of mean absolute IOL prediction error (1.03 D and 1.02 D versus 1.53; P = 0.04 and P = 0.01, respectively. In addition, the average central power method and ASCRS average produced a higher percentage of refractive outcomes within ±0.50 D when compared with the Humphrey Atlas method (60% and 46.67% versus 0%, respectively. A comparison of the average central power method and the ASCRS average demonstrated a smaller variance and higher percentage of patients within ±1.00 D when using the ASCRS average.Conclusion: The ASCRS calculator for eyes with prior radial keratotomy is an easily accessible and valuable online tool for calculating IOL power in patients with previous radial keratotomy. We found that the ASCRS average produced by the calculator provided the best IOL prediction. We recommend using it with the addition of 1.00 to 1.50 D to its IOL power prediction.Keywords: radial keratotomy, cataract, intraocular lens calculator, American Society of Cataract and Refractive Surgery
Full Text Available Satish S Modi1, James A Davison2, Tom Walters3 1Seeta Eye Centers, Poughkeepsie, NY, USA; 2Wolfe Clinic, Marshalltown, IA, USA; 3Texas Eye Care, Austin, TX, USA Purpose: To evaluate the safety and efficacy of DisCoVisc ophthalmic viscosurgical device (OVD, Alcon Laboratories, Inc with respect to a comparator, Healon OVD (Advanced Medical Optics, Inc. Patients and methods: In this prospective study, patients with cataracts were randomized to an OVD, and then received phacoemulsification and injection of an intraocular lens. After each surgery, unmasked investigators completed subjective questionnaires about OVD characteristics during each stage of the procedure. Masked technicians evaluated objective safety parameters of intraocular pressure (IOP and endothelial cell density, with 90 days of follow-up. Results: The DisCoVisc OVD group (128 eyes and the Healon OVD group (121 eyes had statistically similar outcomes for IOP and for endothelial cell loss. Subjectively assessed viscosity was statistically different (P < 0.0001, with Healon OVD most often rated “cohesive” and DisCoVisc OVD most often rated “both dispersive and cohesive”. Workspace maintenance differed between groups (P < 0.0001, with workspace most frequently rated “full chamber maintained” when using DisCoVisc OVD and most frequently rated “workspace maintained” when using Healon OVD. “Flat” or “shallow” workspace ratings occurred only in the Healon OVD group. Conclusion: DisCoVisc OVD had both cohesive and dispersive properties, and was safe and effective for every stage of cataract surgery. Keywords: cataract, endothelial cell density, viscoelastic, phacoemulsification
Purpose. To determine the impact of biometric characteristics on changes of biomechanical properties of the human cornea due to standard cataract surgery using biomechanical analysis. Patients and Methods. This prospective consecutive cross-sectional study comprised 54 eyes with cataract in stages I or II that underwent phacoemulsification and IOL implantation. CH, CRF, IOPg, and IOPcc intraocular pressure were measured by biomechanical analysis preoperatively and at 1 month postoperatively. Changes (?) were calculated as preoperative value versus postoperative value. Biometrical data were extracted from TMS-5 (CSI and SAI), IOLMaster (AL), and EM-3000 (CCT and ECC) preoperatively. Results. The average values of the changes were ?CH = ?0.45 ± 1.27?mmHg, ?CRF = ?0.88 ± 1.1?mmHg, ?IOPg = ?1.58 ± 3.15?mmHg, and ?IOPcc = ?1.45 ± 3.93?mmHg. The higher the CSI the smaller the decrease in CH (r = 0.302, P = 0.028). The higher the CCT the larger the decrease in CRF (r = ?0.371, P = 0.013). The higher the AL the smaller the decrease in IOPg (r = 0.417, P = 0.005). The higher the AL, SAI, and EEC the smaller the decrease in IOPcc (r = 0.351, P = 0.001; r = ?0.478, P < 0.001; r = 0.339, P = 0.013). Conclusions. Corneal biomechanical properties were affected by comprehensive factors after cataract surgery, including corneal endothelium properties, biometry, and geometrical characteristics.
Langenbucher, Achim; Gatzioufas, Zisis; Seitz, Berthold; El-Husseiny, Moatasem
Full Text Available Objetivo: Conocer la efectividad de varios antibióticos en colirio para eliminar la flora conjuntival de los pacientes que se operan de cataratas y diferenciar los fracasos del tratamiento debidos a la falta de sensibilidad «in vitro» de las bacterias, de otras posibles causas. Método: Estudio retrospectivo de la flora conjuntival preoperatoria de 4.876 pacientes consecutivos; análisis de su sensibilidad «in vitro» agrupando las bacterias en ocho categorías; comparación de los porcentajes de susceptibilidad de la flora total a 5 antimicrobianos. Evaluación de la eficacia de los tratamientos con colirio de un solo antibiótico (Aureomicina, Cloranfenicol, Gentamicina, Norfloxacina ó Rifamicina, de sensibilidad probada, en los pacientes con bacterias conjuntivales patógenas. Resultados: La sensibilidad «in vitro» de nuestra flora a Rifampicina (83,9% y Cloranfenicol (84,4% fue similar (pObjective: To ascertain the effectiveness of various antibiotic eye-drops in eradicating the preoperative conjunctival bacteria of patients undergoing cataract surgery and to differentiate the failure of these treatments due to the lack of «in vitro» sensibility from other possible causes. Methods: Retrospective study of the preoperative conjunctival flora of 4876 consecutive patients; «in vitro» sensibility was analysed by grouping bacteria into eight categories; the susceptibility percentages of the total conjunctival flora to five antibacterial agents were compared. The effectiveness of the eye-drop treatment with a single sensitive tested antibiotic (Aureomicin, Chloramphenicol, Gentamicin, Norfloxacin or Rifamicin was evaluated in patients with pathogen bacteria. Results: The «in vitro» sensibilities of Chloramphenicol (84.4% and Rifampicin (83.9% were similar (p<0.01 and statistically higher than those of the other antibiotics. Nevertheless, the Chloramphenicol pathogen bacterium treatment failed in 21.2% of cases, in spite of being «in vitro» sensitive. Gentamicin presented the best effectiveness for eradicating Staphylococcus Aureus and Gram (- rods. Aureomicin had the best effectiveness against Streptococcus and Gram (- diplococci. Rifamicin was the most effective for eradicating the whole predominant Gram (+ flora. The effectiveness of all five antibiotics decreased when there was more than one pathogen. Conclusions: None of the five antibiotic monotherapies maintains the patients’ conjunctive free of pathogen bacteria 48 hours after finishing the treatment; however, there are bacterial patrons whose treatment could be optimised. The existence of polimicrobial flora decreases the effectiveness of the treatment.
E Fernández Rubio
Full Text Available Background: It has been reported that cataract surgery can compromise the function of a filtering bleb, resulting in loss of control of intraocular pressure (IOP. In a number of retrospective studies a rise of IOP after extra capsular extraction and even after phacoemulsification in filtered glaucoma eye was shown. Objective: To evaluate the effect of temporal clear corneal Phacoemulsification with Intraocular Lens implantation (IOL on IOP control in glaucoma patients who had previous successful trabeculectomy. Methods: The clinical course of 60 patients (60 eyes who underwent temporal clear corneal phacoemulsification after successful trabeculetomy was studied over a period of 3 years. The number of Primary Open Angle Glaucoma (POAG and Primary Angle Closure Glaucoma (PACG cases was equal in our study. Comparison of pre-operative and post-operative IOP, visual acuity, bleb morphology and the number of medications was made at follow up interval of 1 month, 3 months, 6 months and 12 months respectively.Results: The mean ± SD IOP before phacoemulsification was 12.2 ± 4.608 mmHg and it increased to 14.98, 14.47, 15.44 and 15.71 after 1, 3, 6 and 12 months respectively. At each interval the mean IOP was significantly higher than the pre-operative value (p = 0.000, 0.015, 0.000, 0.001 respectively There was also an increase in the number of antiglaucoma medications used after phacoemulsification. The mean ± SD of medication before phacoemulsification was 0.57 + 0.62 and it increased to 0.65, 0.70, 0.68, 0.67 after 1, 3, 6 and 12 months respectively. But the difference was not statistically significant. Conclusion: Temporal clear corneal phacoemulsification significantly increases IOP in eyes with pre-existing functioning filtering bleb. No statistically significant difference was found between the outcomes of POAG and PACG groups. There is a statistically significant improvement in visual acuity following phacoemulsification with intraocular lens implantation.
Sneh S. Dhannawat
To report an outbreak of Fusarium solani endophthalmitis after uneventful cataract surgeries performed on the same day in the same operating room. Nine patients underwent phacoemulsification at 4th Clinic of Beyoglu Eye Training and Research Hospital in Istanbul. Cefuroxime axetyl was injected intracamerally from the same vial to all patients at the end of surgery. All patients developed acute postoperative endophthalmitis. Presentation, cultural studies, treatment, clinical responses and risk factors were evaluated. Cultural and DNA sequence findings revealed F. solani. Antifungal therapy was begun and pars plana vitrectomy, intraocular lens and capsule extraction were performed. Corneal involvement was correlated with old age and systemic disease. Fusarium solani should be considered in acute postoperative endophthalmitis. This infection can be controlled with early and aggressive combined antifungal and surgical treatment. The patients with corneal involvement had poor prognosis. It is important to use solutions prepared separately for each patient. PMID:21627695
Güngel, Hülya; Eren, Mümin Hakan; P?narc?, Eylem Yaman; Altan, Ci?dem; Baylançiçek, Deniz Oygar; Kara, Necip; Gürsel, Tan?l; Yegeno?lu, Yildiz; Susever, Serdar
Full Text Available SciELO Argentina | Language: English Abstract in spanish La cirugía moderna de facoemulsificación del cristalino tiene una recuperación muy rápida. La elección correcta del lente intraocular que se coloca en la cirugía permite, muchas veces, anticipar si el paciente va a precisar anteojos luego de la cirugía. Este estudio analiza una muestra de pacientes [...] con catarata, mostrando la frecuencia relativa de cambios miópicos que permiten a los pacientes ver de cerca sin lentes antes de la cirugía. Se estudiaron retrospectivamente una serie de pacientes consecutivos que realizaron cirugía electiva de catarata. El cambio refractivo miópico fue documentado comparando las prescripciones antiguas con la medición subjetiva al momento del estudio. Los sujetos fueron agrupados de acuerdo a la presencia o ausencia de cambios miópicos, y se estudiaron las proporciones con respecto a su grado de opacidad nuclear. La edad promedio de los 229 sujetos estudiados fue de 71.5 ± 10.4 años, 109 (47.6%) varones. Se halló un cambio miópico, definido como un cambio mayor de - 0.5 dioptrías, en 85 (37.1%, IC95%: 30.8-43.4%). El porcentaje de sujetos con cambio miópico fue significativamente mayor en aquellos que tenían mayor opacidad nuclear al tiempo del examen. En este estudio de pacientes no seleccionados que buscaban realizar cirugía de catarata, más de un tercio tuvo cambios miópicos en la refracción. Si el paciente lograba ver bien de cerca antes de la cirugía, esto debería ser tenido en cuenta a la hora de elegir un correcto lente intraocular para que el sujeto no pierda este beneficio de la catarata. Abstract in english Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study anal [...] yses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.
Rafael, Iribarren; Guillermo, Iribarren.
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish INTRODUCCIÓN: El tratamiento de la catarata es quirúrgico, se logran muy buenos resultados en la recuperación visual de los pacientes; no obstante, después de ella pueden encontrarse resultados inesperados. El propósito de este estudio fue evaluar las características de las personas estudiadas según [...] su edad, los valores biométricos y queratométricos previos a la cirugía por catarata, la cirugía refractiva, y la técnica de excímer láser empleada en los pacientes operados, desde mayo de 2005 a julio de 2007, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer. MÉTODOS: Se realizó un estudio descriptivo, longitudinal y prospectivo de los pacientes operados de catarata que tuvieron un defecto refractivo residual -error o sorpresa refractiva-, a los cuales se les realizó cirugía por láser excímer. Se evaluaron las características de las personas estudiadas según su edad, los valores biométricos y queratométricos previos a la cirugía por catarata, y a la cirugía refractiva, así como la técnica de excímer láser empleada. RESULTADOS: En este estudio se obtuvo un predominio de las edades entre 40 y 59 años, la sorpresa refractiva más frecuente fue la miopía, la longitud axial indujo una sorpresa refractiva, coadyuvada por el error queratométrico, el LASIK prevaleció como técnica refractiva y logró corregir las sorpresas refractivas halladas. CONCLUSIONES: La sorpresa refractiva presente en todos los pacientes fue la miopía. Se demostró que la longitud axial indujo una sorpresa refractiva y que esta fue la más importante en nuestros resultados, derivada del error queratométrico, a pesar de ser este último poco significativo. Abstract in english INTRODUCTION: The treatment of cataract is surgical, very good results in visual recovery of patients are achieved; however, some unexpected results may appear after surgery. The purpose of this study was to evaluate the characteristics of the studied persons by their age, the biometric and keratome [...] tric values before the cataract surgery, the refractive surgery and the excimer laser technique used in patients who were operated on from May 2005 to July 2007 at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology. METHODS: A prospective, longitudinal and descriptive study was conducted in those patients operated on from cataract, who developed a residual refractive defect - error or refractive surprise- and were performed an excimer laser surgery. The characteristics of the studied persons by their age, the biometric and keratometric values prior to the cataract surgery and the refractive surgery as well as the used excimer laser technique were evaluated. RESULTS: This study revealed the prevalence of the 40-59 years-old age group, the most frequent refractive error was myopia, the axial length induced a refractive surprise contributed by the keratometric error; LASIK was the refractive technique that managed to correct the found refractive surprises. CONCLUSIONS: The refractive surprise present in all the patients was myopia. It was shown that the axial length induced a refractive surprise that was the most important outcome derived from a keratometric error, despite the latter being not significant.
Hernández Silva, Juan Raúl; Trujillo Blanco, Maricela; Río Torres, Marcelino; Ramos López, Meisy; Curbelo Cunill, Luis; Trujillo Blanco, William G..
Background Cataract surgery has been shown to improve quality of life and household economy in the short term. However, it is unclear whether these benefits are sustained over time. This study aims to assess the six year impact of cataract surgery on health related quality of life (HRQoL), daily activities and economic poverty in Bangladesh and The Philippines. Methods and Findings This was a longitudinal study. At baseline people aged ?50 years with visual impairment due to cataract (‘cases’) and age-, sex-matched controls without visual impairment were interviewed about vision specific and generic HRQoL, daily activities and economic indicators (household per capita expenditure, assets and self-rated wealth). Cases were offered free or subsidised cataract surgery. Cases and controls were re-interviewed approximately one and six years later. At baseline across the two countries there were 455 cases and 443 controls. Fifty percent of cases attended for surgery. Response rates at six years were 47% for operated cases and 53% for controls. At baseline cases had poorer health and vision related QoL, were less likely to undertake productive activities, more likely to receive assistance with activities and were poorer compared to controls (peconomy of the household. The findings of this study suggest these benefits are sustained in the long term.
Danquah, Lisa; Kuper, Hannah; Eusebio, Cristina; Rashid, Mamunur Akm; Bowen, Liza; Foster, Allen; Polack, Sarah
Fuchs heterochromic uveitis (FHU) in its classic presentation is a unilateral, chronic, low grade, often asymptomatic anterior uveitis. It is characterized by a classic triad of iris heterochromia, cataract and keratic precipitates. Neovascularization of the iris and the anterior chamber (AC) angle (radial and circumferential) occurs in 6–22% of cases. This angle and iris new vessels can sometimes lead to a characteristic filiform haemorrhage and formation of hyphaema after AC paracentesis ...
Ali Simsek,1 Süleyman Ciftci21Department of Ophthalmology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey; 2Department of Ophthalmology, Diyarbakir Training and Research Hospital, Diyarbakir, TurkeyBackground: The aim of this study was to assess the value of ultrasonic biomicroscopy in reporting decreases in intraocular pressure resulting from changes in anterior chamber depth and angle after phacoemulsification and intracapsular lens implantation in patients with cataract.Me...
Simsek A; Ciftci S
Full Text Available OBJECTIVE: To identify daily life difficulties perceived by patients suffering from senile cataract before and after second eye cataract surgery. METHODS: Longitudinal prospective study with 84 patients consecutively seen within the framework of the Cataract Project, with visual acuity equal to or higher than 20/30 in the pseudophakic eye, and equal to or lower than 20/40 with the best possible optical correction in the cataractous eye. A questionnaire was applied during an interview. RESULTS: Before surgery, 60.7% complained about visual impairment (moderate or marked; after surgery, 92.8% had no difficulty. Routine activities, mobility, and leisure activities were significantly altered after surgery (P =.001. CONCLUSION: According to the patients' perceptions, there was a significant reduction in visual difficulties after second eye cataract surgery.OBJETIVO: Identificar dificuldades na vida diária percebidas por pacientes com catarata senil, antes e após a cirurgia de catarata no segundo olho. MÉTODOS: Estudo longitudinal prospectivo de 84 pacientes consecutivos atendidos por "Projeto Catarata", com acuidade visual maior ou igual a 20/30 no olho pseudofácico e menor ou igual a 20/40 with the best possible optical correction no olho com catarata. Aplicou-se questionário por entrevista. RESULTADOS: Antes da cirurgia 60,7% declararam dificuldade visual (média ou muita; após, 92,8% nenhuma dificuldade. Atividades rotineiras, de mobilidade e lazer alteraram-se significativamente após a cirurgia (p= 0,001. CONCLUSÃO: Na percepção dos pacientes, após a cirurgia de catarata do segundo olho houve redução importante das dificuldades visuais.
Full Text Available Abstract Background Visual impairment caused by cataracts not only affects an individual's quality of life but can also have a profound impact on other important psychological factors and on the economic circumstances of individuals and their households. Cataract surgery is an effective intervention to restore vision and is also associated with other positive consequences including improvements in quality of life, economic and psychological outcomes. While there has been an increase in the number and quality of cataract surgeries performed in Vietnam, the programs currently in place are still unable to meet the existing demand and need for surgery. Data on both the cost-effectiveness of cataract surgery and the economic and psychological impact of untreated cataract in this setting is lacking. Methods/Design This study, investigating the psychological and economic impact of cataract surgery in Vietnam (VISIONARY, will recruit and interview a sample of adults (18 years or over who are referred for cataract surgery by one of the following sites and their outreach programs: Hue Eye Hospital; Thai Binh Eye Hospital; Binh Dinh Department of Health Eye Hospital and the Vinh Long Department of Health Social Disease Centre. All participants (those who have cataract surgery and those who do not have surgery will be followed up at six and 12 months. Discussion This study is designed to examine the impact of low vision on household economic circumstances and psychological outcomes as well as to investigate the effectiveness and cost-effectiveness of cataract surgery in Vietnam. It will help to inform international and national non-government organisations working in the country and local policy-makers on priorities for further investment in eye-health services in this setting and their relevance to broader economic development goals.
Cataract is the major cause of blindness and of visual impairment worldwide, so its prevention is of the greatest importance. At present no drug therapy is licensed for use in the UK or the US, so the only treatment for cataract is by surgery, which is expensive and has adverse effects. This article reviews research on prevention of cataract by a variety of agents, including micronutrients as well as drugs. Benefits have been claimed for many compounds or mixtures and this review concentrates on those most extensively studied. Information on possible benefits of putative anticataract agents comes from a variety of approaches, from laboratory experiments, both in vitro and in vivo, to epidemiological studies in patients. Sorbitol-lowering drugs were the first to be examined systematically and progressed to clinical trials which were disappointing, and now the entire rationale for their use in prevention of cataract is questionable. Micronutrients showed little promise in animals but came to clinical trial in patients with cataract without the publication of any major benefit. Pantethine showed more promise in animal studies but the only clinical trial was abandoned early. A variety of laboratory and epidemiological evidence supports the benefits of aspirin-like drugs but there has been no trial specifically in patients with cataract. Add-on studies to trials of aspirin for other indications have not been encouraging. Research into other compounds is interesting but less advanced. PMID:11482741
Harding, J J
Full Text Available Abstract Background A prerequisite for safe cataract surgery is an adequately dilated pupil. The authors conducted a trial to assess the efficacy (in terms of pupil diameter of a depot method of pre-operative pupil dilatation, as compared with repeated instillations of drops (which is time-consuming for the nursing staff and uncomfortable for the patient. Methods A prospective randomised masked trial was conducted comprising 130 patients with no significant ocular history undergoing elective clear corneal phacoemulsification. 65 patients had mydriatic drops (Tropicamide 1%, Phenylephrine 2.5%, Diclofenac sodium 0.1% instilled prior to surgery, 65 had a wick soaked in the same drop mixture placed in the inferior fornix. Horizontal pupil diameters were recorded on a millimetre scale immediately prior to surgery. Results There was no significant difference in pupil size between the two groups (p = 0.255, Student's t-test. Conclusion There was no significant difference between the mydriasis obtained with the depot system compared with conventional drop application. Use of a depot mydriatic delivery system appears to be a safe and efficient method of drug delivery. Trial Registration International Standard Randomised Controlled Trial Number Register ISRCTN78047760
RE Ang,1,2 GA Martinez,2,3 EM Cruz,1 AA Tiongson,1 AG Dela Cruz1 1Asian Eye Institute, Makati City, Philippines; 2Cardinal Santos Medical Center, San Juan City, Philippines; 3Pasig City General Hospital, Pasig City, Philippines Purpose: To compare the visual acuity and quality of vision achieved with three widely-used intraocular lenses (IOLs) in subjects with bilateral cataracts. Patients and methods: This three-arm, parallel, prospective, partially masked, single-surgeon study randomized 78...
Full Text Available ABSTRACT Purpose. Aim of the work was a comparative study of the results of cataract surgery with IOL implantation in children with congenital cataracts, complicated with microphthalmia operated on in the age from 1 to 12 months using the 20G and 25G technology. Materials and methods. A comparative study of cataract extraction with IOL implantation and pars plana removal of posterior capsule with a limited anterior vitrectomy were performed in 54 children with congenital cataracts, complicated with microphthalmia operated on in the age from 1 to 12 months (79 eyes. The children were divided into two subgroups: in the first group after the IOL implantation the pars plana removal of posterior capsule with a limited anterior vitrectomy 20G was carried in 26 children (41 eyes, and in the second group - with an access through pars plana using extremely small incisions 25G (28 patients, 38 eyes. Results. In the first subgroup in the early postoperative follow-up the complication rate was higher due to a more frequent occurrence of hyphema and a development of inflammatory reaction, the difference is statistically significant (34.1 and 10.5% respectively, p<0.01. Conclusions. The use of ultra-small accesses 25G, for the posterior casulectomy with the anterior vitrectomy after IOL implantation allows to reduce the quantity of early postoperative complications after removal of congenital cataracts, complicated with microphthalmia.
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish La catarata, en la mayoría de los casos, se considera una causa remediable de disminución de agudeza visual. A través del tiempo se han conseguido mejoras tecnológicas que hacen que la cirugía de catarata sea relativamente fácil, segura y la rehabilitación visual usualmente exitosa sobre todo cuando [...] esta se acompaña de implante de lente intraocular. Varias alternativas para dividir el núcleo del cristalino surgieron desde entonces, pero pocas son realmente necesarias. Este trabajo tiene como objetivo describir los resultados funcionales y anatómicos alcanzados con la técnica de facoemulsificación con quick chop, las edades de los pacientes, la agudeza visual corregida preoperatoria y posoperatoria, el astigmatismo preoperatorio y posoperatorio, la microscopia endotelial preoperatorio y posoperatoria, el tiempo de ultrasonido aplicado y las complicaciones presentadas. Realizamos un estudio descriptivo, prospectivo, de corte transversal, en 146 pacientes (ojos) operados entre enero de 2004 y enero de 2006 en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología “Ramón Pando Ferrer” El universo de trabajo lo constituyeron todos los pacientes con diagnóstico de catarata presenil y senil que cumplían con los criterios de selección y que aceptaron someterse a la técnica quirúrgica señalada. Con el fin de evaluar la eficacia de la técnica, se analizaron como variables: edad, sexo, agudeza visual con corrección (AVCC), y cilindro refractivo, así como microscopia endotelial, tiempo de ultrasonido, y complicaciones más frecuentes. Estos datos se analizaron a través de tablas de contingencia con frecuencias absolutas y relativas además con medias; se utilizó la prueba t de Student para compararlos. Se encontró que la catarata predominó en el sexo masculino en mayores de 60 años, la agudeza visual con corrección obtenida como promedio fue mejor que en el preoperatorio, el cilindro refractivo apenas se modificó, el tiempo de ultrasonido aplicado estuvo dentro de valores normales, y se correlacionó con la dureza del núcleo, la pérdida de células endoteliales no fue importante, y la complicación operatoria más frecuente fue la ruptura capsular. Abstract in english Cataract is mostly considered a remediable cause of visual acuity reduction. In the course of time, technical improvements have been implemented to make cataract surgery relatively easy and safe, and to support successful visual rehabilitation mainly when intraocular lens implant is added. Since the [...] n, a number of alternatives for dividing the crystalline nucleus emerged, but few are really necessary. This paper was aimed at describing the functional and anatomic results of quick chop phacoemulsification, the age of patients, preoperative and postoperative corrected visual acuity, preoperative and postoperative astigmatism, preoperative and postoperative microscopy, ultrasound time and complications. A prospective, descriptive and cross-sectional study was conducted in 146 patients (eyes) operated on from January 2004 to January 2006 at the Center of Eye Microsurgery of “Ramon Pando Ferrer” Cuban Ophthalmologic Institute. The universe of study was all the patients diagnosed with pre-senile and senile cataract, who also met the selection criteria and accepted to be operated on by this technique. With the objective of evaluating the technique effectiveness, the following variables were analyzed: age, sex, corrected visual acuity and refractive cylinder, endothelial microscopy, ultrasound time and most frequent complications. These data were studied through contingency tables using absolute and relative frequencies and medians. Student’s t test served to compare them. It was found that cataract predominated in males over 60 years of age; average corrected visual acuity was better after surgery, the refractive cylinder barely changed, the ultrasound time of application was within the normal range and depending on
Curbelo Cunill, Luis; Hernández Silva, Juan Raúl; Lanz, Luis; Ramos López, Meysi; Río Torres, Marcelino; Fernández Vázquez, Gilberto; Rodríguez Suárez, Belkys.
Full Text Available Stephen Smith1, Douglas Lorenz2, James Peace3, Kimberly McLeod4, RS Crockett5, Roger Vogel4, and the Difluprednate ST601-004 Study Group1Eye Associates of Fort Myers, Fort Myers, Florida, USA; 2Nevada Eye and Ear, Henderson, Nevada, USA; 3United Medical Research, Inglewood, California, USA; 4Sirion Therapeutics, Inc., Tampa, Florida, USA; 5DATA, Inc., Bayou La Batre, Alabama, USA. Clinical trial registration number: NCT00616993Objective: To evaluate the efficacy and safety of twice-daily difluprednate ophthalmic emulsion 0.05% (Durezol® versus placebo administered before surgery for managing inflammation and pain following cataract extraction.Methods: Eligible subjects (N = 121 were randomized 2:1 to topical treatment with 1 drop difluprednate or placebo administered twice daily for 16 days, followed by a 14-day tapering period. Dosing was initiated 24 hours before unilateral ocular surgery. Clinical signs of inflammation (anterior chamber [AC] cell and flare grade, bulbar conjunctival injection, ciliary injection, corneal edema, and chemosis, ocular pain/discomfort, intraocular pressure (IOP, and adverse events were assessed.Results: Clearing of inflammation on day 14 (primary endpoint, defined as an AC cell grade of 0 (?5 cells and a flare grade of 0 (complete absence, was achieved in a significantly greater percentage of subjects treated with difluprednate, compared with placebo (74.7% vs 42.5%; P = 0.0006. A significantly greater percentage of difluprednate-treated subjects were free of ocular pain/discomfort on day 14 than placebo-treated subjects (64.6% vs 30.0%; P = 0.0004. Three subjects (3.7% in the difluprednate group had a clinically significant IOP rise (defined as ?21 mmHg and a change from baseline ?10 mmHg at same visit.Conclusions: Difluprednate, administered 2 times daily starting 24 hours before cataract surgery, was highly effective for managing ocular inflammation and relieving pain and discomfort postoperatively. Difluprednate was well tolerated and provides a convenient twice-daily option for managing postoperative ocular inflammation.Keywords: difluprednate, safety, efficacy, twice daily, postoperative ocular inflammation, corticosteroids
Full Text Available Background: Postoperative nausea (PONV and vomiting is the most common complication after surgery that might prolong discharge time and cause some morbidity. Dexamethasone can effectively reduce PONV. This study was conducted to evaluate the efficacy of different doses of dexamethasone on PONV. Materials and Method: In a double blind clinical study we investigated the efficacy of three doses of dexamethasone (0.1mg/kg‚0.3mg/kg‚0.5mg /kg in ASA class I or II patients randomly allocated into three groups for cataract surgery. The patients were tracked for the frequency of development of PONV in the recovery room and the ward and were compared accordingly. Results: The patients were similar with respect to demographic parameters and duration of anesthesia. PONV occurred in 4%‚ 4% and 6% in patients in the 0.1mg/kg‚ 0.3mg/kg and 0.5mg/kg group, respectively (p= 0.577 Conclusion: We concluded that lower doses of dexamethasone could reduce PONV as much as higher doses. We suggest the lowest dose to reduce both the cost and side effects
Full Text Available AIM: To study the clinical effects of chopping with lens loop-pad in the small incision extracapsular cataract surgery with intraocular lens implantation.METHODS:A total of 75 cases(80 eyes, in which loop-pad and chop knife were performed to chop nucleus before implanting intraocular lens. Visual acuity, postoperative astigmatism degree, intraoperative and postoperative complications were observed. The post-operative follow-up periods ranged from 3 to 12mo.RESULTS: The visual acuity was 0.3-0.5 in 37 eyes and 0.6 or better in 21 eyes at 1d, while was respectively in 43 eyes and in 26 eyes at 1mo. Compared with preoperative astigmatism(0.85±0.29D, there were significant difference at postoperative 1wk(1.75±0.55D(PP>0.05. Intraoperative posterior capsule rupture occurred in 4 eyes, which implantation was successful in 1 eye and 3 eyes was managed viaciliary sulcus. Two eyes had dermatoglyphic pattern edema in corneal endothelium which recovered after about 3d. Two eyes had local patchy opacities which recovered in 2wk. Two eyes had transient high intraocular pressure.CONCLUSION: The surgery is efficient, low cost, easy process and less complications, it is worth to be popularized.
Full Text Available Purpose: To compare various outcome measures using torsional mode and longitudinal mode in the phacoemulsification of cataract with different nuclear densities. Setting: Magrabi Eye Hospitals, Kingdom of Saudi Arabia. Design: A randomized comparative clinical study. Materials and Methods: This study includes 200 eyes of 156 patients (100 in the ultrasound longitudinal "US" group and 100 in the torsional group. All eyes received AcrySof® single piece intraocular lens (Alcon Surgical, Fort Worth, TX. The primary outcome measures were ultrasound time (UST, cumulative dissipated energy (CDE, and surgical complications. Postoperative outcome measures were the degree of corneal edema on the first postoperative day and final best corrected visual acuity (BCVA and CCT (central corneal thickness. Results: The differences in UST and CDE between subgroups of nucleus hardness were statistically significant (P < 0.01. The UST and CDE consistently increased in eyes with higher grades of nucleus density. On day one, the mean BCVA was 0.61 ± 0.13 decimals in the ultrasound (US group and 0.67 ± 0.11 decimals in the torsional group (significant P < 0.05.Corneal edema was significantly less in the torsional group (P < 0.05. At 30 days, the mean BCVA was 0.94 ± 0.22 decimals in the US group and 1.0 ± 0.12 decimals in the torsional group but this difference was not statistically different (P > 0.05. Conclusions: The torsional mode provides an effective and safe method for cataract removal with lower energy usage as compared to longitudinal traditional phacoemulsification. However, the final visual outcome was similar for both study groups.
El-Moatassem Kotb Ahmed
Full Text Available Objetivo: Determinar las características epidemiológicas, diagnósticas y terapéuticas de un grupo de cataratas de nuestro medio con el propósito de mejorar el pronóstico visual de estos pacientes. Métodos: Estudio retrospectivo de 79 casos de cataratas pediátricas durante un periodo de 18 años (1986-2004. Hemos diferenciado dos grupos etiológicos de trabajo: cataratas congénitas y cataratas adquiridas. Resultados: La causa más frecuente entre las congénitas fue la idiopática (68% y la más frecuente de las adquiridas fue traumática (90%. La morfología más frecuente de las congénitas fue la nuclear 0,31 (31%. El 56% de las cataratas congénitas fueron bilaterales. El 27% de las cataratas congénitas se asociaban a otras anomalías oculares y la más frecuente fue el microftalmos. El signo clínico de presentación más frecuente de las cataratas congénitas fue la leucocoria, en 0,44 (44%. El 75% (0,75 de las cataratas congénitas de nuestro medio tardan menos de un mes en diagnosticarse desde la manifestación clínica. El 58% (0,58 de las cataratas congénitas se trataron con cirugía y el 50% de ellas tardaron menos de 1 mes en operarse. El 90% (0,9 de las adquiridas se trataron con cirugía y el 95% de ellas tardaron menos de un mes en operarse. Conclusiones: En nuestra serie conseguimos un diagnóstico y tratamiento precoz en un alto porcentaje de pacientes. El pronóstico visual de estos niños viene determinado por la precocidad en el diagnóstico y el tratamiento, es por ello que debemos continuar intentando acortar este período de tiempo y conseguir que todos los niños sean diagnosticados y tratados precozmente.Purpose: To determine the epidemiology, diagnosis and treatment features in a group of pediatric patients with cataracts treated at our hospital. The aim was to improve the visual prognosis in these patients. Methods: 79 children with cataracts were reviewed retrospectively during an 18 year period (1986-2004. This involved patients with congenital cataracts and those who acquired them later. Most of the latter group had a traumatic etiology (90%. Results: The etiology of most cataracts was idiopathic (68% for the congenital group and traumatic (90% for the acquired group. Congenital cataracts were frequently nuclear in type (31% with 56% being bilateral. 27% of the congenital group were associated with dysmorphic eye features, the most frequent being microphthalmos. The most frequent presenting feature was leucokoria, seen in 44% of patients. 75% of congenital cataracts were diagnosed within one month of clinical manifestation. 58% of the congenital cataracts were treated by surgery and 50% of these were performed within one month of the diagnosis. 90% of the acquired cataracts were treated surgically, and 95% of these were performed less than one month after diagnosis. Conclusions: We attained a prompt diagnosis and treatment in a high percentage of cases. Prompt diagnosis and treatment will determine the visual prognosis of these patients. We must continue trying to shorten this period of time in order that all children with this condition are diagnosed and treated urgently and efficiently.
PURPOSE: To demonstrate the corneal magnification using trypan blue in cataract surgery. METHODS: Eight eyes of eight patients undergoing phacoemulsification with an intraocular lens implantation were enrolled in this study. After staining the anterior capsule with Trypan Blue 0.1% and performing the capsulorhexis, the excised anterior capsule was placed on the corneal surface. By observing and measuring the relationship between the border of the excised anterior capsule and the intracameral ...
Marques, Frederico F.; Marques, Daniela M. V.; Osher, Robert H.
Congenital cataracts are the most important cause of severe visual impairment in infants. Genetic factors contribute to the disease development and 29 genes are known to cause congenital cataracts. Identifying the genetic cause of congenital cataracts can be difficult because of genetic heterogeneity. V-maf avian musculoaponeurotic fibrosarcoma oncogene homolog (MAF) encodes a basic region/leucine zipper transcription factor that plays a key role as a regulator of embryonic lens fiber cell development. MAF mutations have been reported to cause juvenile-onset pulverulent cataract, microcornea, iris coloboma, and other anterior segment dysgenesis. We report on six patients in a family who have congenital cataracts were identified MAF mutation by whole exome sequencing (WES). The heterozygous MAF mutation Q303L detected in the present family occurs in a well conserved glutamine residue at the basic region of the DNA-binding domain. All affected members showed congenital cataracts. Three of the six members showed microcornea and one showed iris coloboma. Congenital cataracts with MAF mutation exhibited phenotypically variable cataracts within the family. Review of the patients with MAF mutations supports the notion that congenital cataracts caused by MAF mutations could be accompanied by microcornea and/or iris coloboma. WES is a useful tool for detecting disease-causing mutations in patients with genetically heterogeneous conditions. © 2014 Wiley Periodicals, Inc. PMID:24664492
Narumi, Yoko; Nishina, Sachiko; Tokimitsu, Motoharu; Aoki, Yoko; Kosaki, Rika; Wakui, Keiko; Azuma, Noriyuki; Murata, Toshinori; Takada, Fumio; Fukushima, Yoshimitsu; Kosho, Tomoki
Cataract surgery improves vision by restoring eye transparency and also by correcting previous refractive defects. Surgery has only to be done when the patient's quality of life is significantly impaired by vision troubles. Among patients with cognitive and behaviour troubles (i.e Alzheimer disease), surgery may improve cognitive scores, and autonomy. Multifocal intraocular lenses are sometimes indicated for correcting presbyopia. However, impairment of contrast sensitivity is constant, among adverse effects causing sometimes dissatisfaction. Therefore "monovision", with monofocal intraocular lenses may be proposed, in order to manage the loss of accommodation constant after cataract surgey. Patient's satisfaction level is high when the dominant eye is dedicated to far vision, and the other eye to near vision. Combining femtosecond laser technology and cataract surgery may in the future improve reproductibility and surgical outcomes, but is not currently responsible for obvious therapeutic benefits. PMID:23457826
Background Clinical data have shown that tick-borne diseases caused by Borrelia burgdorferi sensu lato, Bartonella spp., Coxiella burnetii, and Rickettsia spp. can affect the central nervous system, including the eye. The aim of this study was to establish a relationship between the incidence of cataract and evidence of bacterial infections transmitted by ticks. Material/Methods Fluid with lenticular masses from inside of the eye and blood from 109 patients were tested by PCR and sequencing. Sera from patients and the control group were subjected to serological tests to search specific antibodies to the bacteria. Results Microbiological analysis revealed the presence of Bartonella sp. DNA in intraoperative specimens from the eye in 1.8% of patients. Serological studies have shown that infections caused by B. burgdorferi sensu lato and Bartonella sp. were detected in 34.8% and 4.6% of patients with cataract surgery, respectively. Conclusions Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development.
Chmielewski, Tomasz; Brydak-Godowska, Joanna; Fiecek, Beata; Rorot, Urszula; Sedrowicz, Elzbieta; Werenowska, Malgorzata; Kopacz, Dorota; Hevelke, Agata; Michniewicz, Magdalena; Kecik, Dariusz; Tylewska-Wierzbanowska, Stanislawa
Background Clinical data have shown that tick-borne diseases caused by Borrelia burgdorferi sensu lato, Bartonella spp., Coxiella burnetii, and Rickettsia spp. can affect the central nervous system, including the eye. The aim of this study was to establish a relationship between the incidence of cataract and evidence of bacterial infections transmitted by ticks. Material and Methods Fluid with lenticular masses from inside of the eye and blood from 109 patients were tested by PCR and sequencing. Sera from patients and the control group were subjected to serological tests to search specific antibodies to the bacteria. Results Microbiological analysis revealed the presence of Bartonella sp. DNA in intraoperative specimens from the eye in 1.8% of patients. Serological studies have shown that infections caused by B. burgdorferi sensu lato and Bartonella sp. were detected in 34.8% and 4.6% of patients with cataract surgery, respectively. Conclusions Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development. PMID:24902636
Chmielewski, Tomasz; Brydak-Godowska, Joanna; Fiecek, Beata; Rorot, Urszula; S?drowicz, El?bieta; Werenowska, Ma?gorzata; Kopacz, Dorota; Hevelke, Agata; Michniewicz, Magdalena; K?cik, Dariusz; Tylewska-Wierzbanowska, Stanis?awa
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Determinar o custo médio do ato operatório da cirurgia de catarata, pela técnica de facoemulsificação com implante de lente intra-ocular (LIO), realizado durante a Campanha Nacional de Cirurgias Eletivas de Catarata, promovido pelo Conselho Brasileiro de Oftalmologia (CBO) e Ministério da [...] Saúde na cidade de Itápolis - SP, no hospital local, entre os meses de março a dezembro do ano de 2000. MÉTODOS: Análise de custos pré e pós-operatórios a partir de coleta de dados e cálculos inserido no trabalho que visam quantificar os resultados financeiros obtidos na cirurgia de catarata. Para isto realizou-se estudo prospectivo de caso em série. Um grupo com catarata senil submeteu-se à intervenção cirúrgica. Foram verificados neste estudo 58 cirurgias de catarata. RESULTADOS: O custo médio do ato operatório foi de R$ 485,03 ou US$ 248,05. Este valor representa o custo médio da intervenção cirúrgica propriamente dita; em que determinadas insumos, equipamentos, taxas e/ou outros serviços foram previamente determinados e utilizados para este projeto. CONCLUSÃO: A técnica de facoemulsificação na cirurgia de catarata, tem-se tornado procedimento cada vez mais utilizado devido à sua comprovada eficácia, sendo método de excelência no tratamento da catarata. Apesar desta técnica encontrar-se solidificada, deparamo-nos com um problema de ordem econômica, pois o seu custo ainda a faz inacessível a uma parcela da população. Abstract in english PURPOSE: To determine the average cost of cataract surgery using the phacoemulsification technique with intraocular lens implant (IOL). This study was conducted during a national campaign to treat patients with cataracts promoted by the Brazilian Council of Ophthalmology (CBO) and the Health Ministr [...] y in the city of Itápolis - SP from March to December, 2000. METHODS: All expenses related to the surgery were collected (pre-, intra-, and postoperative data) and analyzed. Fifty-eight patients with senile cataracts and without any other ocular findings were submitted to the procedure in a prospective study. RESULTS: The average cost of the surgery in this study was R$ 485.03 or US$ 248.05. This value represents the average cost of the surgery itself; in which some materials, equipment, taxes and other services were previously determined and used for this project. CONCLUSION: The phacoemulsification technique for cataract surgery has been used more and more, due to its effectiveness, being an excellent method to treat cataracts. Although this is an excellent technique, the economical aspect does not allow it to be used for part of the population
Roberto, Saad Filho; Flávia Gondim Loureiro, Saad; Lincoln Lemes de, Freitas.
Full Text Available ... PhD, Newcastle University) VIDEO: If I Had - Metastatic Breast Cancer - Dr. Susan Love, MD, David Geffen School ... lens. What are the steps involved in cataract surgery? Dr. El-Defrawy: The cataract surgery starts when ...
Extracapsular cataract extraction and intraocular lens implantation was performed on 4 eyes of 3 patients with radiation cataract. Case 1 was a 60-year-old man who was exposed to the ionizing radiation of the atomic bomb in Hiroshima 730 meters from the center of the explosion. He developed atomic bomb radiation senile cataracts in both eyes. Despite cataract surgery, a central plaque remained on the posterior capsule in the region corresponding to the central dense opacity in both eyes. Case 2 was an 81-year-old man who was in a streetcar 1,000 meters from the center of the explosion at the time of the atomic bombing. Senile and radiation-induced cataract decreased the visual acuity in both eyes. After extracapsular cataract extraction in his right eye, central opacification and a fibrous white membrane remained on the posterior capsule. These were removed by Nd-YAG laser capsulotomy six days after surgery. Case 3 was a 56-year-old man who developed radiation cataract after radiation therapy to a malignant lymphoma in the right orbit. Phacoemulsification and aspiration could not remove the fibrous white membrane from the posterior capsule in this case. Central opacities and fibrous white membranes on the posterior capsule after cataract surgery appears to be a characteristic of radiation cataract. (author)
Full Text Available Abstract Background The purpose of this study was to reduce the number of items, create a scoring method and assess the psychometric properties of the Freedom from Glasses Value Scale (FGVS, which measures benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal intraocular lens (IOL surgery. Methods The 21-item FGVS, developed simultaneously in French and Spanish, was administered by phone during an observational study to 152 French and 152 Spanish patients who had undergone cataract or presbyopia surgery at least 1 year before the study. Reduction of items and creation of the scoring method employed statistical methods (principal component analysis, multitrait analysis and content analysis. Psychometric properties (validation of the structure, internal consistency reliability, and known-group validity of the resulting version were assessed in the pooled population and per country. Results One item was deleted and 3 were kept but not aggregated in a dimension. The other 17 items were grouped into 2 dimensions ('global evaluation', 9 items; 'advantages', 8 items and divided into 5 sub-dimensions, with higher scores indicating higher benefit of surgery. The structure was validated (good item convergent and discriminant validity. Internal consistency reliability was good for all dimensions and sub-dimensions (Cronbach's alphas above 0.70. The FGVS was able to discriminate between patients wearing glasses or not after surgery (higher scores for patients not wearing glasses. FGVS scores were significantly higher in Spain than France; however, the measure had similar psychometric performances in both countries. Conclusions The FGVS is a valid and reliable instrument measuring benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal IOL surgery.
Abstract Background: Free radicals are known to cause cellular damage and are present in ophthalmic preparations. Corneal defence mechanisms are bypassed in intra-ocular surgery. We evaluated commonly used intracameral agents to ascertain the presence of free radicals and investigate the possibility of anterior segment and endothelial toxicity. Methods: Samples of 19 commonly used intracameral preparations were analysed for total free radical presence on an Instrument Lab...
A total of 1084 surgical procedures was performed during the first 10 years of independence in the small Pacific island nation of Tuvalu. Visiting surgical teams performed 29% of these. Obstetrical and gynaecological operations, eye and abdominal operations counted for more than half of the total number of operations; of the individual operations, cataract extraction, tubal ligation and appendicectomy were the most common. After local anaesthesia, epidural, spinal or ketamine anaesthesia, respectively, were performed more often than general anaesthesia. During the 10-year period, only 12 patients were sent overseas for surgical treatment. Of the estimated 110 patients needing surgical treatment in Tuvalu each year, the great majority can be managed with present facilities. Regular visits by an eye and a plastic surgery team are useful, and a small number of selected patients need surgical treatment overseas. The adequate treatment of surgical emergencies from outer islands in an island community with great distances and poor communications remains the biggest challenge for surgical services in the future. PMID:2334361
Leppaniemi, A K
The majority of those with keratoconus can maximise visual acuity with spectacle or contact lens correction as they age; however, as subjects enter their sixties, cataracts may supervene and contact lens tolerance diminishes with consequent reduction in visual acuity. Following cataract extraction, the complex refractive error associated with keratoconus may not be readily corrected by an intraocular lens alone. This report highlights the planned implantation of a primary posterior chamber toric intraocular lens with a secondary piggyback, sulcus-based, intraocular lens in advanced but stable keratoconus with extreme myopic astigmatism and cataract. PMID:23448261
Goh, Yi Wei; Misra, Stuti; Patel, Dipika V; McGhee, Charles N J
Full Text Available ... with uncontrolled hypertension is a poor risk for eye surgery. We take a complete medical history, review of ... we look at the entire health of the eye, but in this case we are particularly ... Recommended? Dr. Greenstein: The indication for cataract surgery ...
Present study investigated the intestinal parasitosis among 221 subjects undergoing cataract surgery (M: 129 and F: 92; aged 13-86 years) at the eye camps in three rural hilly districts (Ramechhap, Sindhupalchok and Dhading) in 2006. Stool samples collected in clean, dry, screw capped plastic containers were examined locally by direct smear technique and anti-parasitic drugs were distributed to parasite positive subjects. The remaining stool samples were fixed with 10% formal-saline, transported to Shi-Gan Health Foundation/Nat'l Inst of Trop Med and Public Health Research, Kathmandu and re-examined by formal-ether sedimentation technique. A total of 148 samples (66.9%) were positive for some kind of intestinal parasites (F: 68.5% and M: 65.9%; P > 0.05). Ramechhap (Manthali) and Sindhupalchok (Chautara) had higher positive rate (71.8% and 70.7%, respectively) than in Dhading (Salyantar) (60.0%) (P > 0.05). Tibeto-Burman (indigenous nationalities) ethnic group had highest positive rate (70.1%) compared with Indo-Aryan (64.7%) and Dalits (57.7%). Subjects without toilet (latrine) had marginally higher positive rate (69.7%) than those having toilet at their home (65.5) (P> 0 .05). Age was independent of positive rate. Vegetarians had marginally higher parasitic infection rate compared to their non-vegetarian counterparts. Helminths were more common than protozoa. Overall, hookworm was the commonest parasite detected. However, Ascaris was common in Dhading District. Entamoeba histolytica was most common among protozoa and was followed by Cyclospora and others. PMID:18828431
Rai, S K; Gurung, R; Saiju, R; Bajracharya, L; Rai, N; Gurung, K; Shakya, B; Pant, J; Psharma; Shrestha, A; Rai, C K
Full Text Available SciELO Brazil | Language: English Abstract in portuguese A partir de material ocular coletado de 46 pacientes submetidos à cirurgia de catarata foram realizados isolamento, identificação e teste de susceptibilidade de microrganismos frente a antimicrobianos, utilizando-se suabes e lentes intraoculares (LIO). Foram obtidos 76 isolados e identificados 7 tip [...] os de microrganismos. Estafilococos coagulase-negativos (CNS) foram os microrganismos mais freqüentemente detectados de suabes (71,4% dos casos), lentes de PMMA (81,3%) e lentes de silicone (77,8%). Isolados de CNS apresentaram elevada resistência à penicilina G, seguida por tetraciclina, cloranfenicol e aminoglicosídeos. No entanto, estes isolados mostraram grande sensibilidade à vancomicina, cefalotina e ofloxacina. Com exceção da penicilina G, os isolados de Staphylococcus aureus foram bastante sensíveis aos agentes antimicrobianos, incluindo a oxacilina. Entre as gram-negativas, Proteus mirabilis foi a bactéria mais freqüente e também se mostrou bastante resistente à tetraciclina e ao cloranfenicol. Os isolados de Enterococcus se mostraram sensíveis à vancomicina. Abstract in english Bacterial isolation, identification and antimicrobial susceptibility tests were carried out in ocular material collected with swab and polimethylmethacrylate (PMMA) or silicone intraocular lenses (IOL) from forty six patients submitted to cataract surgery. Seventy six isolates and seven different mi [...] croorganisms were identified. Coagulase-negative staphylococci (CNS) were the predominant microorganisms isolated from swabs (71.4% of cases), PMMA lenses (81.3%) and silicon lenses (77.8%). Coagulase-negative staphylococci isolates revealed high resistance to penicillin G followed by tetracycline, chloramphenicol and aminoglicosides. However, these isolates displayed great susceptibility to vancomycin, cephalothin and ofloxacin. Except for penicillin G, Staphylococcus aureus was very sensitive to the antimicrobial agents including oxacillin. Among Gram-negatives, Proteus mirabilis was prevalent and presented high resistance to tetracycline and chloramphenicol. Enterococcus isolates were vancomycin sensitive.
Locatelli, Claudete I.; Kwitko, Sérgio; Simonetti, Amauri Braga.
Full Text Available Bacterial isolation, identification and antimicrobial susceptibility tests were carried out in ocular material collected with swab and polimethylmethacrylate (PMMA or silicone intraocular lenses (IOL from forty six patients submitted to cataract surgery. Seventy six isolates and seven different microorganisms were identified. Coagulase-negative staphylococci (CNS were the predominant microorganisms isolated from swabs (71.4% of cases, PMMA lenses (81.3% and silicon lenses (77.8%. Coagulase-negative staphylococci isolates revealed high resistance to penicillin G followed by tetracycline, chloramphenicol and aminoglicosides. However, these isolates displayed great susceptibility to vancomycin, cephalothin and ofloxacin. Except for penicillin G, Staphylococcus aureus was very sensitive to the antimicrobial agents including oxacillin. Among Gram-negatives, Proteus mirabilis was prevalent and presented high resistance to tetracycline and chloramphenicol. Enterococcus isolates were vancomycin sensitive.A partir de material ocular coletado de 46 pacientes submetidos à cirurgia de catarata foram realizados isolamento, identificação e teste de susceptibilidade de microrganismos frente a antimicrobianos, utilizando-se suabes e lentes intraoculares (LIO. Foram obtidos 76 isolados e identificados 7 tipos de microrganismos. Estafilococos coagulase-negativos (CNS foram os microrganismos mais freqüentemente detectados de suabes (71,4% dos casos, lentes de PMMA (81,3% e lentes de silicone (77,8%. Isolados de CNS apresentaram elevada resistência à penicilina G, seguida por tetraciclina, cloranfenicol e aminoglicosídeos. No entanto, estes isolados mostraram grande sensibilidade à vancomicina, cefalotina e ofloxacina. Com exceção da penicilina G, os isolados de Staphylococcus aureus foram bastante sensíveis aos agentes antimicrobianos, incluindo a oxacilina. Entre as gram-negativas, Proteus mirabilis foi a bactéria mais freqüente e também se mostrou bastante resistente à tetraciclina e ao cloranfenicol. Os isolados de Enterococcus se mostraram sensíveis à vancomicina.
Claudete I. Locatelli
Full Text Available Abstract Background The aqueous humor (AH, a liquid of the anterior and posterior chamber of the eye, comprises many proteins with various roles and important biological functions. Many of these proteins have not been identified yet and their functions in AH are still unknown. Recently, our laboratory published the protein database of AH obtained from healthy rabbits which expanded known protein identifications by 65%. Our present study extends our previous work and analyses AH following two types of cataract surgery incision procedures (clear corneal and limbal incisions by using two dimensional gel electrophoresis (2-DE and liquid chromatography tandem mass spectrometry (LC-MS/MS. Although both incision protocols are commonly used during cataract surgeries, the difference in protein composition and their release into AH following each surgery has never been systematically compared and remains unclear. The first step, which is the focus of this work, is to assess the scale of the protein change, at which time does maximum release occurs and when possible, to identify protein changes. Results Samples of AH obtained prior to surgery and at different time points (0.5, 2, 12, 24 and 48 hours following surgery (n = 3/protocol underwent protein concentration determination, 2-DE and LC-MS/MS. There was a large (9.7 to 31.2 mg/mL and rapid (~0.5 hour influx of proteins into AH following either incision with a return to baseline quantities after 12 hours and 24 hours for clear corneal and limbal incision, respectively. We identified 80 non-redundant proteins, and compared to our previous study on healthy AH, 67.5% of proteins were found to be surgery-specific. In addition, 51% of those proteins have been found either in clear corneal (20% or limbal incision (31% samples. Conclusions Our results imply that a mechanism of protein release into AH after surgery is a global response to the surgery rather than increase in amount of protective proteins found in healthy AH and a mechanism of protein release for each type of incision procedure could be different. Although the total protein concentration was increased (at 0.5 and 2 hour time points and between types of surgery many of 2-DE protein spots were similar based on 2-DE and MS analyses, and only a small number of protein spots changed with either the time points or surgical conditions (0.4 -1.9%. This suggests that the high protein content is due to an increase in the concentration of the same proteins with only a few unique proteins being altered per time point and with the different surgery type. This is the first report on the comparison of AH protein composition following two different cataract surgery procedures and it establishes the basis for better understanding of protein release into AH during events such as cataract surgery or other possible intervention to the eyes.
McDonnell Peter J
Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity. PMID:21214933
Vallicelli, Carlo; Coccolini, Federico; Catena, Fausto; Ansaloni, Luca; Montori, Giulia; Di Saverio, Salomone; Pinna, Antonio D
Full Text Available Abstract Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity.
Di Saverio Salomone
Full Text Available Abstract Background Restoration of functional distance and near vision independently of additional correction remains a goal for cataract surgery. ReSTOR®, a new multi-focal intraocular lens (IOL addresses this issue with an improvement in both distance and near vision, often without need for glasses. This analysis attempted to discuss the patient-reported benefit of ReSTOR® using a full but organised representation of data. Methods Two non-randomised, open-label clinical trials conducted in Europe and the United-States were conducted to compare the efficacy of ReSTOR® to AcrySof® mono-focal IOLs. A total of 710 patients in need of bilateral cataract extraction were included in the pooled study. The TyPE, a patient questionnaire, was fully completed by 672 of them before and after each eye surgery. The TyPE, composed of 67 items measuring overall visual functioning in both conditions (with and without wearing glasses, evaluates limitations, troubles and satisfaction in distance and near vision. A principal component analysis (PCA of the TyPE questionnaire was performed on pooled data from baseline and post-surgery observations in order to fully represent the change in the TyPE data over time. ReSTOR® and mono-focal groups were used as illustrative variables. The coordinates of the first 2 factors were compared between visits and between IOLs (ReSTOR® vs. mono-focal, using paired t-tests and t-tests, respectively. Results The first factor of the PCA explained 55% of the variance and represented 'visual functioning and patient satisfaction'. The second factor explained 6% of the variance and was interpreted as 'independence from glasses'. An overall difference in factorial coordinates in both factors was seen between baseline and the first eye surgery, and between the first and the second eye surgery. No difference between ReSTOR® and mono-focal IOL groups was observed at baseline. After surgery, ReSTOR® treated-patients had higher coordinates on both "visual functioning and satisfaction" and "independence from glasses" factors. Findings observed on the factorial plan were supported by statistical comparisons of factorial coordinates. Conclusion Both mono-focal and ReSTOR®-implanted patients improved their visual functioning after bilateral cataract surgery. Moreover, ReSTOR® patients reported an additional benefit in independence from glasses as well as in visual functioning and patient satisfaction.
Congenital cataract surgery with intraocular lens implantation in microphthalmic eyes: visual outcomes and complications / Cirurgia de catarata congênita com implante de lente intraocular em olhos microftálmicos: resultados visuais e complicações
Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVOS: Relatar os resultados visuais e as complicações da cirurgia de catarata congênita com implante primário de lente intraocular em olhos microftálmicos de crianças menores de 4 anos. MÉTODOS: Esta série de casos retrospectiva incluiu 14 olhos microftálmicos de 10 crianças menores de 4 anos q [...] ue foram submetidas à cirurgia de catarata congênita com implante primário de lente intraocular. Sete pacientes tinham catarata bilateral (11 foram incluídos no estudo) e 3 tinham catarata unilateral. Os prontuários dos pacientes foram revisados para se obter informação sobre o exame oftalmológico pré- e pós-operatório. As principais variáveis analisadas foram pressão intraocular, acuidade visual com melhor correção e complicações intra- e pós-operatórias. RESULTADOS: A média da idade dos pacientes na época da cirurgia foi de 21,7 ± 2,9 meses. O diâmetro antero-posterior médio foi de 19,2 ± 0,9 mm. A pressão intraocular média pré-operatória foi 9,7 ± 1,7 mmHg e 10,3 ± 3,1 mmHg no último exame de acompanhamento pós-operatório (P=0,18). Não houve complicações intraoperatórias. Dois (15,4%) olhos desenvolveram opacificação secundária do eixo visual, dos quais um foi reoperado devido à baixa visual significativa (0,5 logMAR). AV pré- e pós-operatórias foram 2,09 ± 0,97 logMAR e 0,38 ± 0,08 logMAR em casos de catarata congênita bilateral e 1,83 ± 1,04 logMAR e 0,42 ± 0,13 logMAR em casos unilaterais, respectivamente. CONCLUSÃO: O implante primário de lente intraocular em cirurgia de catarata congênita em olhos microftálmicos resultou em uma melhora significativa da acuidade visual com nenhuma complicação intraoperatória e com pouca complicação no pós-operatório. Abstract in english PURPOSE: To report the visual outcomes and complications of congenital cataract surgery with primary intraocular lens implantation in microphthalmic eyes of children younger than 4 years of age. METHODS:This retrospective interventional case series included 14 microphthalmic eyes from 10 children wh [...] o underwent congenital cataract surgery with primary intraocular lens implantation younger than 4 years of age. Seven patients had bilateral cataracts (11 eyes met the study's inclusion criteria) and 3 patients had unilateral cataract. Patients' medical charts were reviewed to obtain information regarding the preoperative and postoperative ophthalmological examination. Main outcome measures were intraocular pressure (IOP), best-corrected visual acuity, and intraoperative and postoperative complications. RESULTS: Mean age at the time of surgery was 21.7 ± 2.9 months. Mean ocular axial length was 19.2 ± 0.9 mm. Mean preoperative IOP was 9.7 ± 1.7 mmHg and 10.3 ± 3.1 mmHg on final follow-up (P=0.18). There were no intraoperative complications. Two (15.4%) eyes developed secondary visual axis opacification, of which only one needed to be reoperated due to significantly decreased vision (0.5 logMAR). Preoperative and postoperative best-corrected visual acuity was 2.09 ± 0.97 logMAR and 0.38 ± 0.08 logMAR in bilateral cases and 1.83 ± 1.04 logMAR and 0.42 ± 0.13 logMAR in unilateral cases, respectively. CONCLUSION: Primary intraocular lens implantation in congenital cataract surgery in microphthalmic eyes resulted in a significant best-corrected visual acuity improvement with no intraoperative complications and minimal postoperative complications.
Ventura, Marcelo Carvalho; Sampaio, Virgínia Vilar; Ventura, Bruna Vieira; Ventura, Liana Oliveira; Nosé, Walton.
David L DeMill1, Majid Moshirfar1, Marcus C Neuffer1, Maylon Hsu1, Shameema Sikder21John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USABackground: To compare the average values of the American Society of Cataract and Refractive Surgery (ASCRS) and Ocular MD intraocular lens (IOL) calculators to assess their accuracy in predicting IOL power in patients with prior laser-in-situ keratomileusis (LASIK) or photor...
Dl, Demill; Moshirfar M; Mc, Neuffer; Hsu M; Sikder S
Full Text Available El síndrome de iris laxo intraoperatorio se caracteriza por una tríada de signos: ondulación, prolapso, y miosis progresiva. Este síndrome puede observarse en pacientes que serán sometidos a cirugía de catarata y son portadores de hiperplasia prostática benigna u otra patología tratada con alfabloqueadores sistémicos. Si el oftalmólogo tiene conocimiento de esta terapia puede planificar una estrategia quirúrgica adecuada y de esta manera disminuir la tasa de complicaciones.The intraoperative floppy iris syndrome is characterized by a triad: wave, prolapse of the iris, and progressive miosis. This syndrome can be observed in patients that will undergo cataract surgery, who are carriers of benign prostatic hyperplasia or another pathology treated with systemic alphablockers. If the ophthalmologist is acquainted with this therapy, he/she may design a suitable surgical strategy to reduce complications after surgery.
Belmary Aragonés Cruz
Full Text Available AIM: To evaluate the clinical effect of surgical treatment on monocular serious cataract with exotropia.METHODS: Reviewed 45 patients diagnosed as cataract with exotropia who accepted cataract surgery and intraocular lens implantation from Mar. 2010 to Dec. 2012 in our hospital. Preoperatively the visual acuity of 44 patients wasRESULTS: One 2-year old child couldn't cooperate with the examination. The other congenital cataract patient didn't acquire BSV and diplopia. Among 5 middle-aged patients, the BCVA of 3 cases were above 0.6 with normal fundus and BSV, 2 cases were finger count with abnormal fundus and without BSV. Among 38 senile cataract cases, 31 cases acquired BSV, 3 cases without BSV and diplopia, 3 cases appeared diplopia postoperatively and recovered in 6 months, 1 case with exotropia and diplopia accepted triple prism treatment.CONCLUSION: Most of adult patients with monocular serious cataract andexotropia can acquire normal eye position and BSV.
Flora bacteriana conjuntival após uso tópico de ciprofloxacino e gatifloxacino em cirurgia de catarata Conjunctival bacterial flora after topical use of ciprofloxacin and gatifloxacin in cataract surgery
Full Text Available OBJETIVO: Avaliar alterações da flora conjuntival após uso dos colírios de ciprofloxacino e gatifloxacino 0,3% na profilaxia dos pacientes submetidos à facectomia. MÉTODOS: Quarenta pacientes submetidos a facectomia foram alocados em dois grupos, conforme o colírio antibiótico utilizado: Grupo A: ciprofloxacino 0,3% e Grupo B: gatifloxacino 0,3%. Os pacientes usaram os colírios 1 hora antes da cirurgia e nos primeiros 14 dias pós-operatórios. Foi coletado material da conjuntiva em cinco momentos: 1 hora antes da cirurgia, sem medicações tópicas (t0; imediatamente antes da aplicação de iodopovidona (PVPI (t1, antes do início da cirurgia, após iodopovidona (t2, 14 dias após a cirurgia (t3 e 28 dias após a cirurgia (t4. RESULTADOS: O uso de antibióticos no pré-operatório diminuiu a positividade das culturas anteriores ao uso do iodopovidona em ambos os grupos; no Grupo A esta redução não alcançou significância estatística (Grupo A - p=0,07 e Grupo B - p=0,04. A positividade das culturas foi reduzida nos dois grupos após aplicação de iodopovidona e 14 dias após a cirurgia (pPURPOSE: To evaluate alterations of the conjunctival flora after the use of 0.3% ciprofloxacin and gatifloxacin in the prophylaxis of patients undergoing cataract surgery. METHODS: 40 patients undergoing cataract surgery were distributed into two groups according to the use of antibiotic eye drops: Group A: 0.3% ciprofloxacin and Group B: 0.3% gatifloxacin. Both groups used antibiotic eye drops 1 hour before surgery and 14 days after surgery. Conjunctival material was collected at 5 time points: 1 hour before surgery, without any topical medication (t0; immediately before the application of povidone-iodine (PVPI (t1, before the beginning of surgery, after povidone-iodine (t2, 14 days (t3 and 28 days after surgery (t4. RESULTS: Preoperative antibiotics reduced the positivity of the cultures before the use of PVPI in both groups, although in Group A this reduction was not significant (Group A - p=0.07 and Group B - p=0.04. The number of positive cultures was reduced in all groups after the use of povidone-iodine and on the 14th postoperative day (p<0.05. In t4 there was a reduction in the frequency of coagulase-negative Staphylococcus in Group A compared with Group B (p<0.05; the susceptibility to ciprofloxacin was also reduced in all groups, when compared with t0. CONCLUSIONS: Gatifloxacin eye drops applied one hour before surgery significantly reduced the number of positive conjunctival cultures. Both antibiotics reduced the conjunctival flora when administered in the postoperative period.
Tiago Eugênio Faria e Arantes
Three siblings developed bilateral, visually significant posterior subcapsular cataracts in their teenage years and were implanted with the SA40N Array Multifocal IOL. A recall examination was performed on the siblings at 12, 10, and 9 years, respectively, after implantation. PMID:24321427
Wilson, M Edward; Johnson, William J; Trivedi, Rupal H
Full Text Available Objetivo: valorar la cirugía de catarata desde la perspectiva científico-tecnológica y su impacto social en el contexto del subdesarrollo. Método: se realizó un estudio exploratorio en el periodo comprendido de octubre a diciembre de 2010 sobre el tema. Se utilizaron los buscadores médicos: Medline, Ebesco, Hinari, Scielo y otros. Se resumió la información en vistas a la presentación del informe final de la investigación. Además, se empleó la entrevista a expertos. Desarrollo: las Ciencias Médicas constituyen un ejemplo de la interacción ciencia-tecnología-sociedad, y la Oftalmología que no ha estado ajena a estos problemas actuales, entre los que se encuentra la alta prevalencia de ceguera por catarata, cuyo tratamiento es quirúrgico, y con respecto al cual existe un gran desarrollo técnico y científico. A pesar de ello, el número de personas ciegas por esta causa es de millones, estando ubicados la mayoría de los casos no caprichosamente en los países no desarrollados. Conclusiones: las principales limitantes sociales para la cirugía de catarata son: falta de mano de obra entrenada e insumos, elevado costo de la cirugía, falta de calidad en los servicios, lejanía de los hospitales, barreras sociales y culturales, desconocimiento acerca de los servicios, miedo a los resultados negativos de la cirugía y falta de voluntad política de los gobiernos. Cuba cuenta con un programa nacional de prevención de ceguera y constituye un paradigma dentro de la Oftalmología mundial.Objective: to assess the surgery of cataracts from a scientific-technological perspective and its social impact in the underdeveloped context. Method: an exploratory study from October to December 2010 about the topic. The theme was sought out in the Bibliographic Database of Medline, Ebsco, Hinari, Scielo and others. The information was collected to write the final report of the research, as well as interviews to experts. Development: Medical Sciences constitute an example of the interaction science-technology-society and Ophthalmology has always been aware of current problems, among them the prevalence of blindness due to cataracts, which treatment is surgical, where technical and scientific developments are observed. Despite; there are millions of blind people, the majority of them from the underdeveloped countries capriciously. Conclusion: the main social limiting factors to perform the cataract surgeries are: lack of trained human resources and medical supplies, the high cost of the surgery, lack of quality in health services, remoteness of hospital facilities, social and cultural barriers, ignorance about health services, fears to negative surgery outcomes and lack of political will of the governments. Cuba has designed a national program to prevent blindness and constitutes a worldwide paradigm in Ophthalmology.
Janet González Sotero
Purpose To evaluate the efficacy of bromfenac ophthalmic solution 0.07% dosed once daily in achieving zero-to-trace (0–5 cells) anterior chamber cells, following cataract surgery with posterior chamber intraocular lens implantation. Methods The study designed employed two Phase III, double-masked, placebo-controlled, multicenter clinical trials of 440 subjects, randomized to either bromfenac ophthalmic solution 0.07% (n=222) or placebo (n=218). Subjects self-dosed once daily, beginning 1 day before undergoing cataract surgery with intraocular lens implantation (day –1) and again on the day of surgery (day 0) and for 14 days postoperatively. Follow-up was on days 1, 3, 8, and 15. The outcome measures included the percentage of subjects with zero-to-trace anterior chamber cells at each visit, as determined by the percentage of subjects with ?5 anterior chamber cells, overall anterior chamber cell grades, and summed ocular inflammation score (SOIS) (combined anterior chamber cell and flare scores). Results The proportion of subjects with zero-to-trace anterior chamber cells was significantly higher in the bromfenac 0.07% group compared with the placebo group as early as day 3 (P=0.0007), continued at day 8 (P<0.0001), and through day 15 (P<0.0001). At day 15, 80.2% of subjects in the bromfenac 0.07% group achieved zero-to-trace anterior chamber cells compared with 47.2% of subjects who did so in the placebo group. The overall anterior chamber cell scores were significantly lower in the bromfenac 0.07% group compared with the placebo group at days 3, 8, and 15 (P<0.0001 at each visit). The SOIS were also significantly lower in the bromfenac group compared with the placebo group at days 3, 8, and 15 (P<0.0001 at each visit). Conclusion Bromfenac ophthalmic solution 0.07%, dosed once daily was clinically effective in achieving zero-to-trace anterior chamber cell severity after cataract surgery and was superior to placebo in all anterior chamber cell severity and inflammation outcome measures.
Silverstein, Steven M; Jackson, Mitchell A; Goldberg, Damien F; Munoz, Mauricio
Full Text Available Steven M Silverstein,1 Mitchell A Jackson,2 Damien F Goldberg,3 Mauricio Muñoz4On behalf of the Bromfenac Ophthalmic Solution 0.07% Once Daily Study Group1Silverstein Eye Centers, Kansas City, MO, USA; 2Jacksoneye, Inc., Lake Villa, IL, USA; 3Wolstan & Goldberg Eye Associates, Torrance, CA, USA; 4Bausch + Lomb, Irvine, CA, USAPurpose: To evaluate the efficacy of bromfenac ophthalmic solution 0.07% dosed once daily in achieving zero-to-trace (0–5 cells anterior chamber cells, following cataract surgery with posterior chamber intraocular lens implantation.Methods: The study designed employed two Phase III, double-masked, placebo-controlled, multicenter clinical trials of 440 subjects, randomized to either bromfenac ophthalmic solution 0.07% (n=222 or placebo (n=218. Subjects self-dosed once daily, beginning 1 day before undergoing cataract surgery with intraocular lens implantation (day ?1 and again on the day of surgery (day 0 and for 14 days postoperatively. Follow-up was on days 1, 3, 8, and 15. The outcome measures included the percentage of subjects with zero-to-trace anterior chamber cells at each visit, as determined by the percentage of subjects with ?5 anterior chamber cells, overall anterior chamber cell grades, and summed ocular inflammation score (SOIS (combined anterior chamber cell and flare scores.Results: The proportion of subjects with zero-to-trace anterior chamber cells was significantly higher in the bromfenac 0.07% group compared with the placebo group as early as day 3 (P=0.0007, continued at day 8 (P<0.0001, and through day 15 (P<0.0001. At day 15, 80.2% of subjects in the bromfenac 0.07% group achieved zero-to-trace anterior chamber cells compared with 47.2% of subjects who did so in the placebo group. The overall anterior chamber cell scores were significantly lower in the bromfenac 0.07% group compared with the placebo group at days 3, 8, and 15 (P<0.0001 at each visit. The SOIS were also significantly lower in the bromfenac group compared with the placebo group at days 3, 8, and 15 (P<0.0001 at each visit.Conclusion: Bromfenac ophthalmic solution 0.07%, dosed once daily was clinically effective in achieving zero-to-trace anterior chamber cell severity after cataract surgery and was superior to placebo in all anterior chamber cell severity and inflammation outcome measures.Keywords: ocular inflammation, anterior chamber inflammation, non-steroidal anti-inflammatory, cells and flare
Bendazac is an oxyacetic acid with anti-inflammatory, antinecrotic, choleretic and antilipidaemic properties, but its principal effect is to inhibit the denaturation of proteins. The lysine salt, which is better absorbed than the parent compound after oral administration, has been evaluated as a treatment for cataract, a condition which appears to result mainly from the denaturation, aggregation and precipitation of proteins within the lens. Results from a very small number of preliminary studies using objective photographic and densitometric methods have suggested that oral bendazac lysine, usually at a dosage of 500 mg 3 times daily, can stabilise the progression of lens opacification in patients with cataract. Significant improvements in individual and mean visual acuities in treated patients have been reported by several studies, but this parameter is not universally accepted as a reliable index of lens status. Preliminary studies evaluating bendazac lysine 0.5% eyedrops have reported comparable results to those obtained with oral treatment. Overall, tolerability of the drug has been good in studies to date. A dose-related laxative effect and other gastrointestinal disturbances are the most common adverse effects associated with oral therapy, and a transient burning sensation is the most commonly reported symptom occurring with eyedrop application. Bendazac lysine is one of a number of agents which have been introduced for the management of cataract. Although the results of preliminary studies have suggested that the drug may be useful for delaying the progression of cataract, further clinical studies using proven objective methods are required to fully establish its value in the management of this condition and its long term tolerability. PMID:2190795
Balfour, J A; Clissold, S P
Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo: Conocer la frecuencia y características de los portadores crónicos de bacterias patógenas conjuntivales entre los pacientes que se operan de cataratas, para diseñar estudios de su riesgo de endoftalmitis postquirúrgica. Métodos: Estudio retrospectivo de la flora conjuntival preoperatoria d [...] e 784 pacientes operados de las cataratas de ambos ojos en dos cirugías, separadas por 213 días (DE =170), desde noviembre de 1993 a diciembre de 1997. Los resultados de los cultivos de ambas cirugías, se obtuvieron de la base de datos de preoperatorios de cataratas del Laboratorio, mediante programa auxiliar en dBASE-III-PLUS. Se compararon las frecuencias de bacterias de ambos preoperatorios y se identificaron los pacientes que tenían el mismo patógeno (todas las bacterias excepto Staphylococcus Epidermidis y Corynebacterium sp.)en las dos cirugías. Los valores medios y desviaciones típicas se calcularon con Epiinfo 6.04, y las pruebas Chi² con Excel 97. Resultados: La flora del primer preoperatorio en los 784 pacientes fue estadísticamente igual que en nuestra población de referencia. Las bacterias patógenas disminuyeron en el segundo preoperatorio; sobretodo las frecuencias de Streptococcus Pneumoniae y Haemophilus sp. (p Abstract in english Purpose: To ascertain the frequency and characteristics of chronic carriers of conjunctival pathogen bacteria among patients undergoing cataract surgery in our hospital, to allow the design of studies of their postsurgical endophthalmitis risk. Methods: Retrospective study of the preoperative conjun [...] ctival flora of 784 patients operated on for cataracts in both eyes, in two operations separated by 213 days (SD 170), from November 1993 to December 1997. Results of both cultures for each patient were obtained from the Laboratory cataract preoperative database, by means of an auxiliary utility in dBASE-III-PLUS program. The preoperative bacteria in both surgeries were compared and the patients having the same pathogen bacteria (all except Staphylococcus coagulase negative and Corynebacterium sp.) were identified. The mean values and standard deviations were calculated using Epiinfo 6.04, and the Chi² test was carried out using Excel 97. Results: The conjunctival flora stemming from the first preoperative culture of the 784 patients were statistically similar to those of our reference population. The pathogen bacteria decreased in the second preoperative culture; especially the Streptococcus Pneumoniae and Haemophilus sp. frequencies (p
Fernández Rubio, E; Cuesta Rodríguez, T.
Human lens membranes contain the highest cholesterol content of any known biological membrane. Although cholesterol is prone to oxidation, the presence of its oxidation products in human cataract has not been shown before. This study was designed to investigate the presence of cholesterol oxides in human cataractous lenses. Human clear lenses (n = 48) were obtained from Coimbra University Hospital Eye Bank. Human cataracts (n = 54) were obtained by routine extracapsular surgery. Cholesterol o...
Gira?o, H.; Mota, Mc; Ramalho, J.; Pereira, P.
Full Text Available Ranjan Malhotra,1 Joseph Gira,2 Gregg J Berdy,1 Robert Brusatti11Ophthalmology Associates, 2Ophthalmology Consultants, St Louis, MO, USABackground: The purpose of this study was to evaluate the safety and tolerability of besifloxacin ophthalmic suspension 0.6% compared with moxifloxacin ophthalmic solution 0.5%, when used for infection prophylaxis following uncomplicated phacoemulsification clear cornea surgery using sutureless corneal incision.Methods: This prospective, two-site, parallel-group, investigator-masked clinical study included patients aged ?18 years scheduled to undergo phacoemulsification with intraocular lens implantation. Patients received one drop of either besifloxacin ophthalmic suspension or moxifloxacin ophthalmic solution four times daily, beginning 3 days prior to surgery, which was continued for 7 days postoperatively. The primary endpoint was the rate of adverse events. Secondary endpoints included endothelial cell count, central corneal thickness, and overall and central corneal staining measured on days 7 (±1 day and 28 (±2 days following surgery, and intraocular pressure and best-corrected visual acuity measured on days 1, 7 (±1 day, and 28 (±2 days following surgery.Results: Of the 60 patients enrolled, 58 (29 per treatment group completed the study. No adverse events were reported in either treatment group. Changes in the central corneal thickness, endothelial cell count, and corneal staining were small and similar between treatments at follow-up visits (P ? 0.1549. Intraocular pressure was similar between treatment groups at each visit, as was the distribution of best-corrected visual acuity. The final best-corrected visual acuity wa