Retinal detachment following extracapsular cataract extraction with posterior chamber lens implantation

Among 866 patients who had undergone extracapsular cataract extraction (ECCE) with implantation of a posterior chamber lens (Simcoe type), 4 cases of retinal detachment were found 1 to 3 years after an uneventful operation. This retinal detachment rate of 0.5% is significantly lower than the rate of 3.5% after intracapsular cataract extraction (ICCE).     

后房型人工晶体植入术后视网膜脱离

目的 探讨后房型人工晶体植入术后视网膜脱离(retinal detachment,RD)的临床特点和治疗方法。 方法 回顾性分析巩膜扣带术与显微玻璃体视网膜手术结合注气及硅油填充治疗68例68只眼后房型人工晶体植入术后RD患者的临床资料 结果出院时视网膜复位者65只眼，占95.59%，随防6-60个月，视网膜保持平复者占94.12%；随访时视力在0.1以上者54只眼，占79.41%，0.3及其以上者18只眼，占26.47%. 结论 后房型人工晶体眼RD发生的主要原因与一般RD发生的原因相似；针对不同情况采取相应的手术方式，可以使后房型人工晶体眼RD取得较好疗效。(中华眼底病杂志,1998,14:167-169)     

Retinal detachment after extracapsular cataract extraction with posterior chamber intraocular lens

The authors reviewed 3065 consecutive cases of extracapsular cataract extraction with posterior chamber lens implant (ECCE-PC IOL) and found the incidence of retinal detachment to be 1.4% overall (44/3065) and 1.7% in a group of eyes followed for at least 1 year (40/2330). Retrospective analysis of the retinal detachment (RD) group (n = 44) showed the patients to be significantly younger than the overall group (n = 3065) (P less than 0.0001). Comparison with an age-matched group of 302 eyes without RD showed higher rates of RD in males (P = 0.0013) and in eyes with axial eye length (AEL) greater than 25 mm (P less than 0.0001). No significant correlation was found between RD and PC IOL manufacturer, phacoemulsification (PKE), or primary discission. Sixty-four percent of RDs occurred within 1 year of cataract operation. Only 10% occurred more than 2 years later. Visual results in eyes with ultimate anatomic success of RD repair (43 of 44 eyes, averaging 15 months follow-up) are substantially better than previously reported in series with other types of IOLs (96% greater than or equal to 20/40 if the macula was not involved, 75% greater than or equal to 20/40 if the macula was involved).     

Cystoid macular edema following extracapsular cataract extraction and posterior chamber intraocular lens implantation

The outcome of clinical cystoid macular edema (CME) was studied in 20 symptomatic eyes in which extracapsular cataract extraction and posterior chamber intraocular lens implantation had been performed. Resolution of symptoms and apparent resolution of the macular edema were observed in 18 (90%) of the 20 cases. Clearing occurred within one year in 14 (78%) of these 18 eyes and in 17 (94%) within two years. In all eyes in which macular edema resolved, visual acuity returned to 20/40 or better. This study suggests that clinical cystoid macular edema occurring in association with a posterior chamber intraocular lens has a relatively favorable course.     

Combined extracapsular cataract extraction and posterior chamber intraocular lens implantation and trabeculectomy

In a retrospective study in a consecutive series of operations performed by the author, 13 eyes in 10 patients underwent combined extracapsular cataract extraction, posterior chamber intraocular lens (IOL) implantation and trabeculectomy. All had significant cataract and chronic open-angle glaucoma with field loss, uncontrolled or marginally controlled on maximum tolerable medical treatment. All had a postoperative reduction in intraocular pressure. Significant complications included malignant glaucoma (in two eyes) and a late choroidal detachment (in one eye). The indications for and the advantages of the combined procedure are discussed, emphasising the advantages of extracapsular cataract extraction (ECCE) and posterior chamber lens implantation, in patients with chronic open-angle glaucoma (COAG).     

Iris modifications following extracapsular cataract extraction with posterior chamber lens implantation

We prospectively examined 94 eyes of 93 consecutive patients who had planned extracapsular cataract extraction or phacoemulsification with posterior chamber intraocular lens (IOL) implantation. The observed postoperative iris biomicroscopic modifications are described and classified. Iris synechial formation was more frequently observed in eyes with pseudoexfoliation syndrome, when an irregular anterior capsulotomy was performed, when the IOL was other than in the bag, and in cases of postoperative fibrinous exudation. Synechias occurred more frequently in intraoperatively injured iris areas. Pupil capture was the only postoperative iris modification that was observed to affect visual acuity. The maximal postoperative dilation was greater and the pupillary photic reaction was significantly less modified postoperatively (P = .0058) when the IOL was fixated within the capsular bag.     

Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal.

OBJECTIVE: To improve current clinical practices and ways of thinking about the problem of curable Third-World blindness resulting from cataract. DESIGN: A two-site prospective, nonrandomized, comparative clinical trial. PARTICIPANTS: Patients from 2 distinct surgical venues underwent cataract surgery following the same carefully outlined protocol: 62 consecutive cases from the Tilganga Eye Centre in Katmandu, Nepal, and 207 cases from a remote eye camp in rural Chaughada, Nepal. INTERVENTION: Extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation surgery using a technique developed by Dr. Sanduk Ruit of the Tilganga Eye Centre in conjunction with the Medical Directorate of the Fred Hollows Foundation of Australia. Also presented is the teaching method used to help make local doctors proficient in this technique. MAIN OUTCOME MEASURES: Visual acuity recorded at 2 months after surgery as well as surgical complications. RESULTS: Preoperative visual acuities for the 62 patients from the Tilganga Eye Centre ranged from 20/60 to light perception only (4 patients were untested). At 2 months after surgery, 87.1% had a best-corrected visual acuity of 20/60 or better. There were zero major surgical complications reported from the Tilganga group. Of the 207 patients at the Chaughada eye camp, preoperative visual acuities (recorded for 177 [85.5%]) ranged from 20/200 or greater to light perception only. One hundred eighty-nine (91.3%) of the patients returned for an examination at 2 months after surgery, at which time 54.5% had an uncorrected visual acuity of 20/60 or greater, improving to 74.1% with correction. There were six (2.9%) surgical complications documented at Chaughada. CONCLUSIONS: Because the average operative time using the technique presented here is less than 10 minutes per case and the cost per surgery is less than $20, the surgical results are significant in addressing the massive problem of cataract blindness in the Third World. With some changes in preoperative care, a simplified surgical technique, the development of local lens factories, and the implementation of teaching programs, effective lens implantation cataract surgery can be done in high volume at affordable costs in remote areas of underserved nations.     

白内障囊外摘出及人工晶状体植入术后继发性青光眼

目的探讨白内障囊外摘出及人工晶状体植入术后继发性青光眼的原因。方法对11例术后继发性青光眼进行详细的观察分析。结果发现其主要原因为房角阻塞,瞳孔阻滞,手术创伤及血—房水屏障破坏等。结论术后继发性青光眼原因多种多样,大部分可以预防及药物治愈。     

Postoperative Mycobacterium chelonae endophthalmitis after extracapsular cataract extraction and posterior chamber intraocular lens implantation

OBJECTIVE: To describe a case of postoperative endophthalmitis caused by Mycobacterium chelonae after extracapsular cataract extraction with posterior chamber intraocular lens implantation. DESIGN: Interventional case report. METHODS: The history and clinical presentation of a 66-year-old female patient, in whom a low-grade delayed-onset endophthalmitis and keratitis developed after extracapsular cataract extraction with posterior chamber intraocular lens implantation, is described. Microbiologic investigations of the scrapings of corneal infiltrate at the cataract incision site, aqueous humor and eviscerated material, and histopathologic study of eviscerated material and an enlarged cervical lymph node were performed. MAIN OUTCOME MEASURES: The clinical, histopathologic, and microbiologic findings in a case of low-grade delayed-onset endophthalmitis. RESULTS: Analysis of the direct smear of both the corneal infiltrate as well as the eviscerated material revealed acid-fast bacilli. M. chelonae was isolated from these specimens. Direct smear and culture of the aqueous humor were negative for bacteria (including mycobacteria) and fungus. Histopathologic examination of the eviscerated material showed a dense infiltration of polymorphonuclear leukocytes in the uveal tissue, extensive necrosis and hemorrhage, and exudates with hemorrhage in the vitreous cavity. Histopathologic examination of the lymph node revealed granulomatous inflammation with caseation necrosis, but did not reveal acid-fast bacilli. CONCLUSIONS: M. chelonae, although infrequent, should be considered an etiologic agent of delayed-onset, postoperative endophthalmitis and early bacterial diagnosis should help in institution of appropriate therapy.     

Anterior chamber maintainer for extracapsular cataract extraction and intraocular lens implantation

An instrument for maintaining a deep anterior chamber during extracapsular cataract extraction is described. This anterior chamber maintainer makes the different stages of extracapsular technique safer and easier to perform.     

Retinal detachment following implantation of a posterior chamber lens

In a series of 6000 cases of pseudophakia following extracapsular cataract extraction and implantation of Simcoe-type posterior chamber lenses, observed for a minimum of 20 months, the incidence of retinal detachment was 21 cases (0.33%). Significant risk factors include male sex (18/21, 82%), high myopia (axial length, over 25 mm in men), intraoperative rupture and late discussion of the posterior capsule. The frequency of retinal detachment following intracapsular cataract extraction without lens implantation was four times greater than that after extracapsular cataract extraction with implantation of a posterior chamber lens. After intracapsular cataract extraction and implantation of an iris-fixation lens it was eight times greater. Horseshoe tears, most of which were located in the peripheral superior quadrants, were seen in 14 eyes (76%). In three eyes no holes were detected. Reattachment was less successful in eyes with posterior chamber implants than in phakic eyes with retinal detachments.     

Exfoliation syndrome and extracapsular cataract extraction with implantation of posterior chamber lens.

Extracapsular cataract extraction followed by implantation of a one-piece posterior chamber polymethylmethacrylate intraocular lens (IOL) into the capsular bag was performed in 25 eyes with exfoliation syndrome and 20 control eyes. The patients were investigated preoperatively and then 1 day, 1 week, 3, 6 and 12 months after surgery. Preoperatively, maximal pupil dilatation was significantly smaller in eyes with exfoliation syndrome compared to controls. During surgery the incidence of complications such as ruptures of the zonule or posterior lens capsule, were higher in eyes with exfoliation syndrome. Furthermore, postoperative complications, such as fibrinoid reaction anterior to the IOL followed by posterior synechias and cell deposits, were more common in eyes with exfoliation syndrome compared to control eyes. The results imply that compared to control eyes, eyes with exfoliation syndrome are likely to present more complications both during extracapsular cataract extraction with implantation of intraocular lenses and postoperatively.     

Retinal detachment following intraocular lens implantation

This report concerns a consecutive series of 154 pseudophakic eyes in which primary scleral buckling procedures were performed for rhegmatogenous retinal detachments. Most cases involved eyes in which extracapsular surgery had been combined with iridocapsular implants or posterior chamber lenses or in which iris-fixation intraocular lenses were placed following intracapsular surgery. The characteristics of the detachments were similar, although there was a trend towards an increased incidence of significant preoperative proliferative vitreoretinopathy in the intracapsular cases. Anatomical success rates were over 90% in all groups. There was a trend for lower visual acuities following successful surgery in the eyes in which intracapsular surgery had been performed than in those following extracapsular procedures.Presented at the 1984 meeting of the Club Jules Gonin in Lausanne, Switzerland     

Outcome of cataract extraction and posterior chamber intraocular lens implantation following glaucoma filtration surgery

PURPOSE: To evaluate the outcome of cataract extraction (CE) after glaucoma filtering surgery (GFS). METHODS: A total of 77 eyes (77 patients) who underwent CE with posterior chamber intraocular lens (PCIOL) implantation following GFS by a single surgeon were reviewed. Main outcome measures were preoperative and postoperative intraocular pressures (IOPs), visual acuities, medications, astigmatism, bleb survival, time of surgical failure, complications, and success rate. RESULTS: Mean time interval between GFS and CE was 46.8+/-50.9 months (range, 2-348 months). The mean preoperative IOP was 13.9+/-4.7 mmHg (range 3-27 mmHg) and mean postoperative IOP at 3 weeks was 13.6+/-5.5 mmHg (range, 6-44 mmHg). The mean follow-up was 19.5+/-20.1 months (range, 1.4-73 months; median 10.6 months). Complete success was achieved in 59 eyes (76.7%). The cumulative probability of complete success was 91.3+/-3.7, 82.0+/-5.6 and 78.1+/-6.5% at the end of 6 months, 1, and 2 years, respectively. Visual acuity before CE was < or =20/50 in all eyes (100%). Visual acuity at last visit was > or =20/40 in 33 eyes (42.8 %), 20/50-20/80 in 30 eyes (39.0%), < or =20/100 in 14 eyes (18.2%). Risk factors identified for qualified success included age at CE>60 years, interval of < or =5 months between GFS and CE, use of preoperative glaucoma medications, and postoperative IOP >19 mmHg within 2 weeks. CONCLUSIONS: IOP and bleb function was maintained after CE with PCIOL implantation following successful GFS with good visual recovery.     

人工晶体植入术后视网膜脱离

目的 探讨后房型人工晶体植入术后视网膜脱离的发病机制和相应的预防及处理方法。方法：分析39例39眼人工晶体植入术后继发视网膜脱离的特征及手术治疗方法,ECCE IOL25眼,PHACO IOL14眼。结果：术后随访3～36个月,最终视网膜复位35眼（89.7%）,26眼视力提高（66.7%）,12眼视力不变（30.8%）,1眼视力下降（2.5%）。结论：提高白内障手术成功率和精确使用Nd：YAG激光。加强术后随访观察可减少或避免视网膜脱离的发生;一旦人工晶体植入后继发视网膜脱离,尽早手术,可保存患者视功能。     

儿童白内障摘除联合后房型人工晶体植入术后并发症的处理

为了预防儿童白内障术后发生弱视和斜视,自１９９４ 年１ 月至１９９７ 年６ 月,对４０ 例（４８ 只眼）２ ～１４ 岁患儿行白内障现代囊外摘除联合后房型人工晶体植入术,均获得良好的效果。术后主要并发症为葡萄膜炎（ 具体表现瞳孔区有灰色纤维素膜） ,经过治疗获得满意的视力。出院时４８ 只眼中有１８ 只先天性白内障眼术后视力０－２ ～０－６ ,２６ 只外伤性白内障眼术后视力０－４ ～０－８ ,４ 只眼检查视力不合作。出院后追踪观察视力３ 个月至２ 年,均有不同程度提高。     

麻风患者小瞳孔下白内障囊外摘除并后房型人工晶状体植入的相关危险因素

目的：探讨麻风患者小瞳孔下白内障手术方法及相关危险因素分析及预防,使手术并发症减少到最低限度。

方法：对72例83眼麻风患者小瞳孔白内障行上下瞳孔括约肌剪开,软分离并钝分离剪开松解推动虹膜向周边移位,扩大瞳孔完成白内障囊外摘除并人工晶状体植入。术后进行回顾性分析手术前后最佳视力与手术并发症。

结果：术后6mo随访,最佳矫正视力≥0.5者20眼(24%),0.1～<0.5者33眼(40%),<0.1者14眼(17%),无变化16眼(19%)。术前和术后视力比较有统计学意义(χ²=99.04,P<0.01)。术后并发症：葡萄膜炎26眼(31%),后囊破裂14眼(17%),后发性白内障21眼(25%),继发青光眼13眼(16%)。

结论：麻风患者因病程长,麻风反应并长期存在葡萄膜炎导致虹膜血管的神经损害和瞳孔闭锁的现状,一般手术难度大,术后并发症多而复杂致术后视力恢复较差。     

过熟期白内障现代囊外摘除与人工晶体植入

目的 能使单眼过熟期白内障患者植入人工晶体，与健眼达到双眼单视，提高生活质量。方法 黏弹剂压迫前囊，不让液化皮质进入前房，先植入晶体，再剪除前囊膜；压迫前囊后采用开罐法等。结果 本组12眼手术全部成功，除1眼因废用性外斜视力4．0，其余6眼脱残，5眼脱盲。结论 掌握过熟期白内障特点，掌握手术操作关键，根据不同情况采用不同手术方式。而手术成功的关键仍在于破晶体前囊及后囊膜的完整。