Extracapsular cataract extraction and posterior chamber intraocular lens implantation in glaucomatous eyes

Two hundred ninety-six eyes of 250 patients undergoing extracapsular cataract extraction (ECCE) with or without the implantation of a posterior chamber intraocular lens (PC-IOL) were studied. Pre-existing glaucoma of varying severity was present in 139 eyes and no known ocular pathology other than cataract in 157 eyes. During the first eight weeks following surgery, intraocular pressure elevations greater than or equal to 15 mmHg above baseline were seen in 23% of glaucomatous eyes controlled before surgery with glaucoma medications, in 39% of glaucomatous eyes controlled before surgery with argon laser trabeculoplasty, and in only 3% of nonglaucomatous eyes. The implantation of a PC-IOL did not influence the incidence of postoperative intraocular pressure (IOP) elevations. Among glaucomatous eyes with severe preoperative visual field loss (split fixation or central island less than or equal to 10 degrees), 9.7% had worsening of visual field after surgery. Open angle glaucoma of unclear etiology developed in 1.4% of normal eyes following uncomplicated ECCE with PC-IOL implantation. Surgical techniques the authors have found useful in glaucomatous eyes undergoing ECCE with PC-IOL implantation are discussed.     

Cystoid macular edema in anterior chamber lens implantation following posterior capsule rupture

By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacine (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.Abbreviations AC-IOL anterior chamber intraocular lens - CME cystoid macular edema - ECCE extracapsular cataract extraction - ICCE intracapsular cataract extraction - IOL intraocular lens - PC-IOL posterior chamber intraocular lens     

Glaucoma triple procedure comprising trabeculotomy with a fornix-based scleral flap

A new triple surgery procedure was applied to 20 primary open-angle glaucomatous (POAG) eyes. This technique comprises trabeculotomy with narrow (2–3 mm) fornix-based scleral flap, combined with extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation. As to surgical results, at two years postsurgery 53% (9/17) of the eyes were controlled under 21 mm Hg without medication, 35% (6/17) with topical medication alone. Eighteen (90%) eyes showed improved visual acuity of two or more Snellen lines. No serious postoperative complications occurred. There was no significant difference in postoperative astigmatism as compared with ordinary ECCE and PC-IOL surgery. Trabeculotomy with fornix-based scleral flap offers the advantage of simple and safe surgery when combined with ECCE and PC-IOL implantation.Abbreviations POAG primary open-angle glaucomatous - ECCE extracapsular cataract extraction - PC-IOL posterior chamber intraocular lens - IOP intraocular pressure     

A prospective study of intraocular pressure four months after extracapsular cataract extraction with implantation of posterior chamber lenses

Sixty-six consecutive cases of extracapsular cataract extraction (ECCE) and sulcus implantation of a posterior chamber lens had intraocular pressure (IOP) measurements recorded four months postoperatively. These results were compared to the fellow unoperated eyes, as well as to a group of 64 patients, whom we reported previously, who had intracapsular cataract extraction (ICCE) and implantation of an anterior chamber lens. The ECCE and posterior chamber lens group demonstrated a significant reduction in the IOP of the operated eye after four months (P less than 0.001), with none of the patients having an IOP greater than 20 mm Hg. No significant IOP change could be demonstrated in the fellow eye (0.1 less than P less than 0.2). We found a significant difference between the ECCE and ICCE groups in the IOP of the operated eye (P less than 0.001).     

Comparative study of postoperative complications in primary and secondary implantation of posterior chamber intraocular lens in cataract surgery for diabetic patients]

Postoperative complications of diabetic cataract cases with active stage diabetic retinopathy, which underwent simultaneous extracapsular lens extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation in 84 eyes, ECCE only in 38 eyes and secondary implantation of PC-IOL after ECCE in 23 eyes, were studied. In the eyes of the primary PC-IOL implantation group, fibrous response in 35 eyes (42%), posterior iris synechia in 10 eyes (12%), progression of diabetic retinopathy in 13 eyes (16%), after cataract in 11 eyes (13%), pupil capture in 4 eyes (5%) and decentration of lens optics in 3 eyes (4%) were appeared, while in the ECCE only group, fibrous response in 11 eyes (29%), posterior iris synechia in 4 eyes (11%), after cataract in 11 eyes (29%), progression of diabetic retinopathy in 6 eyes (16%) were observed. On the other hand, in the secondary PC-IOL implantation group, only fibrous response was appeared in 1 eye (4%), Although PC-IOL implantation has been so far considered contraindication in cases with cataract combined with active stage retinopathy, the present studies strongly suggest that secondary PC-IOL implantation would be good indication in these cases whose blood sugar was properly controlled and the retinopathy was burned out by panretinal photocoagulation soon after ECCE.     

后房型人工晶状体植入对青光眼滤过泡及眼压的影响

目的：探讨后房型人工晶状体植入对青光眼滤过泡及眼压的影响。方法：对25例26眼曾作过青光眼滤过性手术的白内障经颞下方角膜缘切口行白内障囊外摘除（ECCE）联合后房型人工晶状体（PC－IOL）植入手术。平均随访24．6个月。结果：视力≥0．5的有12（46．1％）;滤过泡无明显改变16眼（63．8％）,减少7眼（26．9％）,增大3眼（11．5％）;用或不用眼药能控制眼压占24眼（92．2％）;用或不用眼药能控制眼压占24眼（92．2％）,平均眼压为15．97mmHg;视野无明显改变占20眼（76．9％。结论经颞下方有膜缘切口行ECCE及PC－IOL植 已存青光眼滤过泡眼获得良好的视功能和眼压的稳定是一安全有效的方法。     

高眼压青光眼白内障三联手术的临床观察

目的:探讨高眼压状态下白内障青光眼联合术的临床疗效。方法:对18例18眼白内障青光眼患者在高眼压下行小切口非超声乳化白内障囊外摘出人工晶状体植入联合小梁切除术,术后观察视力,眼压及并发症情况。结果:术后眼压均比术前用降眼压药的情况下明显下降,11～22mmHg者17例,其中眼压26mmHg者1例。术后视力均较术前有不同程度的提高,术后并发症发生率及严重程度并不比小梁切除术或白内障囊外摘除人工晶状体植入术高。结论:在高眼压下行小切口非超声乳化白内障囊外摘出人工晶状体植入联合小梁切除术发生并发症的机会增多,但仍是一种安全、有效的治疗白内障合并青光眼的联合手术。     

三联手术治疗青光眼合并白内障

目的 探讨青光眼合并白内障施行三联手术的方法，评价其疗效。方法 对11眼青光眼合并白内障实行白内障囊外摘出、后房型人工晶状体植入联合小梁切除术治疗；对8眼实行白内障超声乳化人工晶状体植入联合小梁切除术。结果 术后平均随访9．6月，19眼眼压均低于21mmHg(1mmHg=0．133kPa)；视力提高16眼(84．2％)。术后并发症有角膜水肿、浅前房。结论 三联手术治疗青光眼合并白内障是安全有效的。     

Fuchs异色性虹膜睫状体炎白内障手术的疗效分析

目的：评估Ｆｕｃｈｓ异色性虹膜睫状体炎（ＦＨＩＣ）患者白内障囊外摘除术以及人工晶体（ＩＯＬ）植入术后的产７及并发症。方法：３２例ＦＨＩＣ患者行白内障手术，其中１７例植入后房型人工晶体（ＰＣＩＯＬ），另１５例患者行单纯的白内障囊外摘除术。结果：矫正视力在０．５及以上的患者中，ＩＯＬ组１４只眼（８８％），而无晶体眼１２只眼（８０％）。术 症为虹膜出血１２只眼，瞳孔不能散大６只眼，悬韧带离断、玻璃体脱出     

白内障小切口囊外摘除联合小梁切除治疗PACG合并白内障

目的：观察白内障小切口囊外摘除联合小梁切除术治疗原发性急性、慢性闭角型青光眼的疗效。

方法：急性闭角型青光眼合并白内障23例24眼,慢性闭角型青光眼合并白内障11例12眼,进行白内障小切口囊外摘除联合小梁切除术,均一期植入人工晶状体。

结果：术后随访1mo,急性闭角型青光眼组术前平均眼压30.68±7.60mmHg,术后17.83±5.95mmHg,差异有统计学意义(P<0.05); 慢性闭角型青光眼组术前平均眼压29.27±5.55mmHg,术后18.12±1.88mmHg,差异有统计学意义(P<0.05)。术前、术后两组间平均眼压差异无统计学意义。术后眼压控制良好者(6～21mmHg)者26眼(72%),局部使用抗青光眼药物后眼压控制良好者8眼(22%),总体有效控制率94%,眼压不能控制者(22～30mmHg)2眼(6%); 术后视力提高者32眼(89%),没有发生严重并发症。

结论：白内障小切口囊外摘除联合小梁切除术对于原发性闭角型青光眼(PACG)合并白内障的治疗可以有效控制眼压、提高视力,并发症少; 其在控制眼压方面对于原发性急/慢性闭角型青光眼无差异。