Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.     

Posterior chamber intraocular lens implantation during diabetic pars plana vitrectomy

Combined cataract removal, posterior chamber intraocular lens (PC IOL) implantation, and pars plana vitrectomy were performed in 15 diabetic patients who presented with coexisting cataract and vitreoretinal complications from proliferative diabetic retinopathy (PDR). Posterior chamber IOLs were placed anterior to the anterior lens capsule after pars plana lensectomy and vitrectomy in nine eyes, whereas extracapsular cataract extraction (ECCE) with PC IOL placement was performed before vitrectomy in six eyes. Panretinal laser endophotocoagulation was applied in 13 of the 15 eyes as an important part of the operative procedure. Because of inactive diabetic retinopathy or satisfactory preoperative panretinal photocoagulation, 2 of the 15 eyes did not receive laser endophotocoagulation. Visual acuity was improved in 12 eyes and was similar to preoperative vision in 3 eyes. After a minimum of 6 months and a maximum of 28 months of follow-up, the visual results are the following: 20/40 or better (4 eyes), 20/50 to 20/200 (5 eyes), 20/400 to 5/200 (5 eyes), and hand motions (1 eye). Although 5 of the 15 eyes required secondary vitreoretinal procedures, neovascular glaucoma and complications attributable to the IOL did not occur. A recurrent postoperative retinal detachment (RD) developed with subsequent hypotony and rubeosis iridis in 1 of the 15 eyes.     

Extracapsular cataract extraction and implantation in the capsular sac during vitrectomy in diabetics]

Removal of the lens is often performed during pars plana vitrectomy for complications of proliferative diabetic retinopathy, but correction of aphakia often remains unsatisfactory. Some authors have reported posterior chamber intraocular lens implantation during pars plana vitrectomy in diabetic patients who presented with coexisting cataract and vitreoretinal complications from proliferative diabetic retinopathy. Some patients were operated by pars plana lensectomy and vitrectomy followed by posterior chamber intraocular lens implantation in the ciliary sulcus, others by extracapsular extraction, posterior chamber intraocular lens implantation in the ciliary sulcus, and pars plana vitrectomy. Other authors have described phacoemulsification through the limbus, pars plana vitrectomy and implantation in the capsular bag in one operation in various indications, including complications of proliferative diabetic retinopathy. We inserted a posterior chamber intraocular lens into the capsular bag in 18 eyes of 16 patients with complications of proliferative diabetic retinopathy after extracapsular cataract extraction and pars plana vitrectomy in a single session. A standard extracapsular cataract extraction was performed before pars plana vitrectomy. Sufficient anterior capsule was left in place in order to facilitate implantation in the capsular bag after pars plana vitrectomy. The anterior chamber was filled with sodium hyaluronate in order to maintain anterior chamber depth, corneal clarity, and good mydriasis during the continuation of the procedure. A standard three port pars plana vitrectomy was performed in all cases. After closure of superior sclerotomies, superior corneal incision was partially reopened, an intraocular lens specifically designed for the capsular bag with an optic size of 7 mm was inserted, and the corneal incision was closed with interrupted 10/0 sutures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Posterior chamber lens implantation concurrent with vitrectomy for proliferative diabetic retinopathy

Combined operation of cataract removal with posterior chamber intraocular lens implantation and pars plana vitrectomy were performed on 25 eyes in 22 patients with cataract concurrent with diabetic retinopathy. In 21 eyes, extracapsular cataract extraction followed by intraocular lens insertion, aiming at in-the-bag fixation, was performed, and in 4 eyes pars plana lensectomy with anterior capsule left and intraocular lens insertion between the iris and anterior capsule was carried out. Mean postoperative follow-up period was 14 months, ranging from 3 to 32 months. Visual acuity on the last examination was 0.5 or better in 2 eyes (8%), 0.1 or better in 12 eyes (48%), and worse than 0.05 in 9 eyes (36%). Major postoperative complications were fibrin reaction (20 eyes, 80%), pupillary deformation (19 eyes, 76%), pupil capture by intraocular lens (3 eyes, 12%), rhegmatogenous retinal detachment (1 eye, 4%), neovascular glaucoma (2 eyes, 8%), and recurrent vitreous hemorrhage (13 eyes, 52%). Intraocular pressure was well controlled in neovascular glaucoma cases. At the last examination ocular fundus was invisible due to vitreous hemorrhage in two eyes.     

Pars plana vitrectomy during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes

PURPOSE: To report the use of pars plana vitrectomy as a prophylactic measure during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes. METHODS: Chart review of two patients with severe aqueous misdirection in their first eye at the time of cataract surgery that only responded to pars plana vitrectomy. RESULTS: In both patients, cataract extraction with posterior chamber intraocular lens implantation was initially performed after pars plana vitrectomy, with the creation of hyaloido-capsulo-iridotomy to establish a communication between the vitreous cavity and the anterior chamber. CONCLUSION: Pars plana vitrectomy as a prophylactic measure during cataract surgery may have a beneficial role in fellow eyes at high risk for developing aqueous misdirection.     

Massive proliferation of lens epithelial remnants after Nd-YAG laser capsulotomy.

Eight eyes exhibited massive proliferation of lens epithelial remnants following Nd-YAG posterior capsulotomy. All eyes had pre-existing retinal pathology. Six had undergone vitrectomy (four for proliferative diabetic retinopathy) before extracapsular cataract extraction with posterior chamber intraocular lens implantation. The other two eyes had familial exudative vitreoretinopathy or retinopathy of prematurity, respectively. Five eyes required removal of the lens proliferations via a pars plana approach. High levels of growth factors in the posterior segment associated with proliferative disorders of the retina may play a role in lens cell proliferation.     

Surgical vitrectomy for pseudophakic malignant glaucoma

Four eyes that had undergone cataract extraction with intraocular lens implantation developed malignant glaucoma. Three eyes had posterior chamber lenses and one eye had an anterior chamber lens. Medical therapy was unsuccessful in each case. One eye was treated with Nd-YAG laser disruption of the anterior hyaloid face, but this did not reverse the glaucoma. In all four eyes pars plana vitrectomy reversed the glaucoma process. In the eyes with posterior chamber lenses, the vitrectomy included excision of a localized area of lens capsule and zonules. A pathway for the anterior flow of aqueous was created without dislocating the intraocular lens.     

Extracapsular cataract extraction with intraocular lens implantation after scleral buckling surgery

We reviewed the records of 28 patients who had undergone successful scleral buckling surgery followed by extracapsular cataract extraction with implantation of an intraocular lens. Posterior chamber intraocular lenses were inserted in 27 eyes, and anterior chamber intraocular lenses were inserted in two eyes with posterior capsule rupture at the time of surgery. The mean follow-up period was 44 months. Final visual acuity was 20/40 or better in 15 of 29 eyes (52%). One eye (3.4%) developed a recurrent retinal detachment 15 months after cataract surgery. Two eyes (6.9%) developed angiographically proven cystoid macular edema. The outcome for extracapsular cataract extraction with intraocular lens implantation in eyes that had previously undergone successful scleral buckling for retinal detachment is favorable.     

Vitrectomy for retained lens fragments in the vitreous after phacoemulsification

PURPOSE: To assess the visual results, retinal detachment (RD) rate, incidence of glaucoma, and intraocular lens (IOL) placement after vitrectomy for removal of retained lens fragments in the vitreous after phacoemulsification. SETTING: Department of Ophthalmology, University Hospital of Lund, Lund, Sweden. METHODS: This retrospective noncomparative interventional case series included all cases of pars plana vitrectomy for removal of retained lens fragments from January 1997 through January 2000. RESULTS: Sixty-six eyes of 65 patients had pars plana vitrectomy with removal of the lens material over the 3-year period. Visual acuity on presentation was 0.1 or worse in 36 eyes (54%). Visual acuity after vitrectomy was 0.5 or better in 35 eyes (53%). The postoperative visual acuity was worse than 0.1 in 14 eyes (21%). Twenty-seven (56%) of the 48 eyes operated on within 1 week and 8 (44%) of the 18 eyes operated on later achieved a visual acuity of 0.5 or better. Twelve eyes (80%) that had secondary posterior chamber IOL implantation achieved an acuity of 0.5 or better. An RD occurred in 7 eyes (11%). CONCLUSIONS: There was no statistically significant difference in outcomes between those having vitrectomy the first few days after cataract surgery and those having it later, although there was a trend toward better results when the vitrectomy was done sooner. Secondary IOL implantation resulted in a good visual outcome. Retinal detachment was the most severe complication.     

超声乳化人工晶状体植人联合玻璃体切除术治疗增生型糖尿病视网膜病变

目的评价晶状体超声乳化、囊袋内人工晶状体植入联合玻璃体切除术治疗增生型糖尿病视网膜病变（PDR）的临床效果。方法回顾性分析合并不同程度白内障的增生型糖尿病视网膜病变6l例（66眼）。其中PDRlV期20眼,V期33眼,Ⅵ期13眼。实施晶状体超声乳化、囊袋内人工晶状体植人联合玻璃体切除术。观察术后视力改善程度和术中术后并发症。结果术后视力改善：PDR1V期19眼（95．0％）,V期28眼（84．8％）,Ⅵ期13眼（38．5％）。术后视力低下者多伴有明显的糖尿病黄斑病变。术中术后主要并发症包括：医源性裂孔7眼（10．6％）;玻璃体积血,术中17眼（25．8％）,术后7眼（10．6％）;角膜上皮延期愈合9眼（13．6％）;角膜水肿8眼（12．1％）。结论超声乳化、人工品状体植入联合玻璃体切除术治疗合并不同程度白内障的增生型糖尿病视网膜病变是安全有效的,可使大多数患者视力改善,避免玻切术后并发白内障再次手术。糖尿病黄斑病变是影响术后视力提高的主要原因。     

Combined pars plana vitrectomy and cataract surgery: outcome of phacoemulsification versus manual extracapsular cataract extraction through a sclerocorneal tunnel.

BACKGROUND AND OBJECTIVE: To compare the results of combined pars plana vitrectomy and cataract extraction with intraocular lens implantation by phacoemulsification versus manual extracapsular cataract extraction through a sclerocorneal tunnel. PATIENTS AND METHODS: Retrospective chart review of all patients who underwent combined pars plana vitrectomy with intraocular lens implantation and phacoemulsification or extracapsular cataract extraction through a sclerocorneal tunnel between March 1992 and July 2002. RESULTS: Fifty-four eyes of 51 patients were evaluated. Mean age was 69.68 +/- 9.11 years, and mean follow-up was 9 months. Phacoemulsification was performed in 35 cases (64%) and manual extraction in 19 cases (36%). Visual acuity improved from mean logarithm of the minimal angle of resolution 1.69 +/- 0.54 before surgery to 1.22 +/- 0.76 after surgery. There was a greater improvement of visual acuity in the phacoemulsification group (0.59 +/- 0.67) than in the extracapsular cataract extraction group (0.22 +/- 0.68) (P = .06). Final visual acuity was correlated to the vitreoretinal pathology. Ultrasound biomicroscopy showed well-positioned foldable or rigid intraocular lens in the bag or in the sulcus. CONCLUSION: Combined cataract extraction by phacoemulsification or extracapsular cataract extraction through sclerocorneal tunnel and pars plana vitrectomy are safe and effective procedures.     

Surgical management of cataract and posterior chamber intraocular lens implantation in Fuchs‘ heterochromic iridocyclitis

Background: To determine the inflammatory course and level of visual rehabilitation after cataract extraction and posterior chamber lens implantation in patients withFuchs‘ heterochromic iridocyclitis complicated by cataract. Methods: In a clinical trial, 32 eyes (visual acuity of 20/160 or worse) of 30 patients underwent extracapsular cataract extraction (19 eyes) or lensectomy(13 eyes) accompanied by posterior chamber intraocular lens implantation. Indirect ophthalmoscopy was performed intraoperatively prior to intraocular lens implantation and the extent of vitreous haze was assessed. If vitreous haziness was 3+ or more, core vitrectomy (two eyes) or three-port pars plana deep vitrectomy (four eyes) was performed. Results: After an average follow up of14.4 months (6 to 24 months), there was no statistically significant increase in cell and flare in the anterior chamber and vitreous or in keratic precipitates compared with the preoperative status of the eyes. However, 12%of the eyes developed synechiae (anterior and/or posterior) in comparison to preoperative condition (p< 0.05). Eighty-seven percent of the eyes gained visual acuity of 20/40 or better (P < 0.005). Using the logistic regression model, a higher level of preoperative inflammation was associated with reduced likelihood of gaining visual acuity of 20/25 or more (OR = 0.25, 95%CI 0.049, 1.255). The complications of surgery were synechiae, 12%; opaque posterior capsule, 12%; vitreous loss, 3%; chronic glaucoma, 3%; and retinal detachment,3%. Conclusions: Implantation of a posterior chamber intraocular lens can be well tolerated in patients with Fuchs‘ heterochromic iridocyclitis. Vitrectomy, whenever indicated in addition to cataract extraction, improves visual rehabilitation. This revised version was published online in August 2006 with corrections to the Cover Date.     

Clinical outcomes of pars plana capsulotomy with anterior vitrectomy in pediatric cataract surgery.

PURPOSE: The management of the posterior capsule in pediatric cataract surgery remains challenging. The purpose of our study was to evaluate the role and clinical outcomes of primary pars plana capsulotomy and pars plana anterior vitrectomy during pediatric cataract surgery with intraocular lens (IOL) implantation. METHODS: Consecutive cases of pars plana capsulotomy and anterior vitrectomy during pediatric cataract surgery were retrospectively reviewed. The surgical technique was the same in all patients and involved pars plana capsulotomy with anterior vitrectomy after the IOL was implanted in the capsular bag. RESULTS: Seventy-six pediatric cataract cases in 61 patients performed from 1994 through 1999 used the pars plana posterior capsulotomy technique and were included in this analysis. A posterior chamber IOL was implanted in all cases. There were no intraoperative complications associated with the surgery. Median age at the time of surgery was 21 months. All patients had at least 1 year of follow-up and mean follow-up was 29.4 months. Among patients old enough to read Snellen's letters (53 eyes), final best-corrected visual acuity was 20/40 or better in 32 eyes (60%) and 20/50 to 20/200 in 21 eyes (40%). Poor final visual acuity was associated with deprivation amblyopia or optic nerve dysplasia or hypoplasia. There were no postoperative retinal complications or cases of IOL dislocation during the follow-up period. Seven eyes (9.2%) of five patients with a median age of 2.5 months developed reopacification of the visual axis at a mean of 4.1 months postoperatively. This event occurred in 6 of 28 eyes with an age of 6 months or less (21.4%), versus only 1 of 48 eyes with an age greater than 6 months (2.0%) (P =.006, Fisher exact test). The visual axis was restored by pars plana membranectomy in 6 eyes and 1 eye of one patient underwent neodymium:YAG laser membrane discission. CONCLUSIONS: Pars plana capsulotomy with pars plana anterior vitrectomy is a safe, effective method of managing the posterior capsule in pediatric cataract surgery with IOL implantation. Visual axis reopacification is associated with a very young age at the time of surgery. Continued follow-up of these patients is important to assess the long-term outcomes of this surgical approach.     

Postoperative anterior chamber inflammation after posterior chamber intraocular lens implantation concurrent with pars plana vitrectomy and lensectomy]

The authors compared postoperative anterior chamber inflammation of triple procedure; diabetic pars plana vitrectomy, lensectomy with anterior capsule left intact and posterior chamber intraocular lens implantation anterior to anterior capsule, to those of various cataract surgeries with posterior chamber intraocular lens implantation and vitrectomies in diabetic retinopathy eyes. The inflammation was evaluated in terms of the incidence of inflammatory complications (fibrin reaction and posterior synechia of iris), and by periodical measurement of flare counts for postoperative 6 months using a laser flare-cell meter. The inflammation was more intense than those after the following 3 surgeries; phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis, extracapsular extraction and in the bag intraocular lens implantation after can opener capsulotomy, and vitrectomy alone. The inflammation, however, was less intense compared with that of another method of triple procedure; pars plana vitrectomy, phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis or can opener capsulotomy, and development of posterior synechia was rarely observed.     

Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation. MATERIAL AND METHODS: The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes). RESULTS: Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina. CONCLUSIONS: Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.     

Results of combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation

Purpose : To assess the outcome and complications after combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in patients with concomitant cataract and vitreoretinal abnormalities. Methods : This retrospective study consisted of 113 eyes of 109 patients with various vitreoretinal abnormalities and visually significant cataract. Vitreoretinal surgery was combined with clear corneal phacoemulsification and intra‐ocular implantation. Results : The combined surgery resulted in minimal complications, and postoperative visual acuity was improved in 83 eyes (71.6%). Visual acuity was improved by two or more lines in 26 eyes (66.6%) with proliferative diabetic retinopathy, 22 eyes (73%) with proliferative vitreoretinopathy, eight eyes (30.7%) with macular abnormalities, four eyes (55.5%) with trauma and two eyes (40%) with retinal vein occlusion. Conclusions : The combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation was safe and effective in treating vitreoretinal abnormalities coexisting with cataract. Combined surgery is recommended for all patients having simultaneous vitreoretinal pathological changes and cataract. The addition of phacoemulsification does not prolong vitreoretinal operative time notably nor increase the risk of intraoperative and post‐operative complications significantly.     

Preventing recurrent opacification of the visual pathway after pediatric cataract surgery

PURPOSE: To determine the rate of secondary opacification of the visual pathway following pediatric cataract surgery in children between the ages of 10 months and 7 years. METHODS: The medical records of children less than 7 years old who underwent lens aspiration, posterior chamber intraocular lens (IOL) implantation, primary pars plana posterior capsulectomy, and anterior vitrectomy were reviewed retrospectively. Twenty-six eyes in 19 children were included in the study. All procedures were performed by an anterior segment surgeon and a vitreoretinal surgeon. Main outcome measures were the prevalence of re-opacification of the visual pathway and of early postoperative complications. RESULTS: The visual pathway remained clear in 25 of 26 eyes (96%) after pediatric cataract surgery combined with primary pars plana posterior capsulectomy and anterior vitrectomy. The mean age at surgery was 46 +/- 23 months (+/-SD). Secondary opacification of the visual pathway occurred in one eye (4%), requiring another surgical procedure. At last follow-up (mean, 26 months; range, 6 to 79 months), the visual pathway was clear in all 26 eyes (100%). No cases of clinically significant IOL displacement or of retinal detachment were noted. CONCLUSIONS: For children undergoing pediatric cataract surgery between the ages of 10 months and 7 years, IOL implantation combined with primary pars plana posterior capsulectomy and anterior vitrectomy is effective in preventing re-opacification of the visual pathway.     

Combined phacoemulsification and pars plana vitrectomy for macular hole treatment

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens (IOL) implantation in eyes with macular hole. METHODS: A retrospective study was conducted in 38 eyes (36 patients) after combined phacoemulsification, insertion of a posterior capsule IOL and pars plana vitrectomy. RESULTS: The macular hole was successfully closed in 32 of the 38 eyes (84%). In six eyes (16%) the hole failed to close and one eye underwent a second operation. Vision improved by two or more Snellen lines in 29 eyes (73%), there was no change in seven eyes (18%), and visual acuity decreased in two eyes (5%). Intraoperative and postoperative complications included retinal tears in nine eyes (24%), posterior capsule rupture in two eyes (5%), transient postoperative increase of intraocular pressure in eight eyes (21%), and posterior capsule opacification in five eyes (13%). CONCLUSION: Combining phacoemulsification, IOL insertion and pars plana vitrectomy for macular hole repair can reduce the need for cataract surgery in the future, decrease costs, shorten postoperative recovery time and allow for clearer intraoperative visualization, making the procedure safer and more effective.     

Combined pars plana vitrectomy and lens management in complex vitreoretinal disease

Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. Historical concerns of increased risk of complications with the combined procedure have been shown not to be clinically significant. The combined procedure offers the advantages of a single procedure, including faster recovery time and cost effectiveness. Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.     

Combined pars plana vitrectomy and lens management in complex vitreoretinal disease

Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. Historical concerns of increased risk of complications with the combined procedure have been shown not to be clinically significant. The combined procedure offers the advantages of a single procedure, including faster recovery time and cost effectiveness. Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.