Choice of the lens implant model

Report on 530 lens implantation procedures performed in the years from 1981 to 1985. Different complications with different lens models are mentioned, in particular cystoid macular edema, subluxation or luxation of the artificial lens, vitreous complication, secondary cataract, and retinal detachment. A comparison was made with a group of aphakic eyes in which no lens implant was used. In a preliminary overall assessment in the group of eyes with lens implants there were no complications more severe than those in the group of aphakic eyes without artificial lenses.     

Peripheral retinal lesions in aphakia

The peripheral retina of 150 aphakic eyes with uncomplicated extraction was studied with the Goldmann three-mirror contact lens. The patients were examined 1 month to more than 2 years after cataract extraction. In addition to degenerations which are descirbed everywhere and are seen both in phakic and aphakic eyes, the authoris have emphasized lesions which they consider to be specific of aphakia. These lesions are retinal haemorrhages of wich four types are described; pigmentary anomalies and retinal tears and holes. Taking into consideration the great frequency of aphakic retinal detachment in comparison with phakic detachment, it is evident that such lesions must be held liable in aphakic retinal detachment.     

人工晶状体眼继发视网膜脱离的临床分析

目的 回顾性总结白内障超声乳化联合人工晶状体植入术后继发视网膜脱离病例,分析其致病因素、临床特征及治疗效果.方法 选择人工晶状体眼继发视网膜脱离病例24例25只眼.其临床体征表现为晶状体后囊膜破裂、人工晶状体偏位、晶状体皮质残留、瞳孔不易散大和眼轴长等特征;视网膜脱离范围2象限至全脱离;3只眼行外路视网膜脱离手术,22只眼行玻璃体手术.结果 24只手术眼视网膜复位良好,术后矫正视力较术前明显提高,未出现严重并发症,1只眼视网膜脱离复发,再次手术并硅油填充.结论 白内障术后致玻璃体活动度增加是造成人工晶状体眼继发视网膜脱离的主要原因,高度近视、晶状体囊膜破裂、玻璃体脱出及人工晶状体偏位等是继发视网膜脱离发生的高危因素,及早明确诊断,合理的手术治疗,会取得好的效果.     

人工晶状体眼继发视网膜脱离的临床分析

目的 回顾性总结白内障超声乳化联合人工晶状体植入术后继发视网膜脱离病例,分析其致病因素、临床特征及治疗效果.方法 选择人工晶状体眼继发视网膜脱离病例24例25只眼.其临床体征表现为晶状体后囊膜破裂、人工晶状体偏位、晶状体皮质残留、瞳孔不易散大和眼轴长等特征;视网膜脱离范围2象限至全脱离;3只眼行外路视网膜脱离手术,22只眼行玻璃体手术.结果 24只手术眼视网膜复位良好,术后矫正视力较术前明显提高,未出现严重并发症,1只眼视网膜脱离复发,再次手术并硅油填充.结论 白内障术后致玻璃体活动度增加是造成人工晶状体眼继发视网膜脱离的主要原因,高度近视、晶状体囊膜破裂、玻璃体脱出及人工晶状体偏位等是继发视网膜脱离发生的高危因素,及早明确诊断,合理的手术治疗,会取得好的效果.     

Frequency and predictors of retinal detachment after pediatric cataract surgery without primary intraocular lens implantation.

PURPOSE: To determine the frequency and to identify predictors of retinal detachment after pediatric cataract surgery without primary intraocular lens implantation. METHODS: Retrospective review at an eye hospital identified 1017 eyes among 579 patients who underwent limbal-approach surgery without primary IOL implantation at age < or =16 years for cataract unassociated with other ocular abnormalities aside from microcornea. Patients had a minimum of 2 years postoperative follow-up. The outcome measure was the presence or absence of postcataract surgery retinal detachment, and analyses were performed on patients' eyes with adjustment for intrasubject correlation. RESULTS: Mean postcataract surgery follow-up was 6.8 +/- 3.6 years (range, 2.0 to 18.3 years). Retinal detachment developed in 33 (3.2%) of the 1017 patients' eyes and was diagnosed at a mean of 6.8 +/- 4.4 years postcataract surgery (range, 0.4 to 14.8 years). Multivariable Cox proportional hazards regression analysis with adjustment for intrasubject correlation identified an aphakic refractive error more myopic than the age-adjusted aphakic norm [hazard ratio (HR), 5.9; 95% confidence interval (CI), 1.9 to 18.0; P = 0.002] and postcataract surgery wound dehiscence (HR, 15.4; 95% CI, 2.2 to 108.5; P = 0.006) as predictors of retinal detachment; a primary posterior capsulotomy/anterior vitrectomy procedure was not predictive of retinal detachment. CONCLUSIONS: Retinal detachment is infrequent following pediatric cataract surgery without primary IOL implantation, at least with short-term follow-up. A postoperative aphakic refractive error more myopic (less hyperopic) than the age-adjusted aphakic norm is predictive of this complication.     

Retinal detachment and pseudophakia

Retinal detachments occur in up to 3.6% of pseudophakic patients. The intraocular lens makes it hard to see the peripheral fundus but the small pupil ophthalmoscope is a valuable help. The functional and anatomic success rates after operation are about 5% less than those of patients with aphakic retinal detachments matched for age and sex. I present fifteen cases of pseudophakic detachment. Any manipulation likely to induce contact between lens and cornea such as collapse of the globe after drainage of fluid or gas injections should be avoided. Careful examination of the fundus before and after cataract extraction and careful selection of paients for lens implantation are the only means of reducing the incidence of retinal detachment.     

Retinal detachment following intracapsular cataract extraction

A retrospective investigation of aphakic retinal detachments following intracapsular cataract extraction during a 12-year period was performed. A total of 8350 eyes had intracapsular cataract extraction in the study period and 118 eyes developed aphakic retinal detachment. The occurrence of retinal detachment is related to age, sex, intraoperative complications, myopia, hyperopia, and pseudophakia. Age and myopia were significantly associated with aphakic retinal detachment. Previous aphakic retinal detachment in the one eye was a strong predictor for the other eye.     

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.     

Posterior chamber intraocular lenses at the Wilmer Institute: a comparative analysis of complications and visual results.

Intraocular lens (IOL) implantation is now accepted as the most effective means of aphakic correction in selected patients undergoing cataract surgery. In terms of final rehabilitation, however, complications such as corneal oedema, retinal detachment, and cystoid macular oedema remain problematic. Results of prospective concurrent trials of IOL implantation performed at the Wilmer Institute are presented, with particular reference to the posterior chamber intraocular lens and with specific emphasis on postoperative complications.     

晶状体超声乳化联合巩膜扣带术的临床观察

目的探讨视网膜脱离合并白内障的手术方法及效果。方法2002年6月~2004年12月我们对35例(35眼)视网膜脱离合并白内障进行手术治疗。均先行晶状体超声乳化,术中以间接检眼镜检查,根据眼底情况,33例行巩膜扣带术,2例行玻璃体腔注气术。其中,26例植入人工晶状体。结果出院时视网膜全部复位。裸眼视力0.05以上者27眼,0.1~0.8者14眼。植入人工晶状体眼,瞳孔活动度好,屈光间质清晰。9例未植入人工晶状体者中,6例发生虹膜后粘连、囊袋闭合、晶状体后囊增厚。2例出现继发性青光眼,行YAG激光治疗。结论晶状体超声乳化人工晶状体植入联合巩膜扣带术,具有视力恢复快、并发症少及避免二次手术等优点。     

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).     

Traumatic pediatric cataract: A decade of follow-up after Artisan aphakia intraocular lens implantation

PURPOSE: To describe the long-term clinical outcome of Artisan((R)) aphakia intraocular lens (IOL; Ophtec, Groningen, The Netherlands) implantation in five aphakic eyes of five children, without capsular support, after cataract extraction following penetrating ocular trauma. METHODS: The charts of the five children were retrospectively reviewed. The data collected included follow-up time, nature of injury, age at cataract extraction and IOL implantation, visual outcome, endothelial cell counts, complications, and subsequent surgical interventions. RESULTS: Average follow-up was 11.0 years (range, 8.0-14.6 years). All eyes had a corneal perforation with various degrees of anterior segment injury. Mean patient age at lens extraction was 7.8 years (range, 5.6-10.2 years). Mean age at Artisan aphakia IOL implantation was 7.9 years (range, 5.7-10.2 years). The best spectacle-corrected visual acuity at last follow-up was 20/40 or better in four eyes. Mean endothelial cell loss compared with the healthy fellow eye was 40%. No patients experienced IOL dislocation, corneal decompensation, chronic anterior uveitis, cystoid macular edema, or iris atrophy. One eye had a retinal detachment 19 months after primary injury and needed vitreoretinal surgery. CONCLUSIONS: The Artisan aphakia IOL offers a useful alternative for correction of traumatic childhood aphakia. Although we only have results of a small number of patients, taking into account our long follow-up period, we feel that implantation of the Artisan aphakia IOL can be considered a treatment option in aphakic eyes of children that lack capsular support due to trauma.     

Retinal detachment after cataract surgery

Background: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predictive factors of poor anatomical and functional results. Methods: The authors retrospectively reviewed the files of 99 consecutive cases of aphakic and pseudophakic retinal detachment operated on by the same surgeon between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. Results: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 had a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 14% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsular extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PVR was present in 30% of the patients and 51% of detachments occurred more than 24 months as a mean after cataract surgery. The overall anatomic reattachment rate was 88% with no significant difference between the aphakic and the pseudophakic patients, either with an anterior chamber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02). Negative prognostic indicators for reattachment included poor preoperative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior chamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. Conclusion: Most aphakic or pseudophakic retinal detachment can now be reattached with either scleral or vitreo retinal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitrectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicone oil improves anatomical results but the functional results remain inferior.     

Pseudophakic retinal detachment.

We reviewed 165 cases of non-referred pseudophakic retinal detachment. Fifty-three eyes (32%) had sustained significant complications due to cataract surgery prior to retinal detachment; 45 eyes (27%) presented with grade B, C or D proliferative vitreoretinopathy. The overall reattachment rate was 84%. This was significantly higher in the posterior chamber lens group than in the iris-fixated lens or anterior chamber lens groups (93 vs. 69 and 81%). Our data show that uneventful extracapsular cataract extraction plus posterior chamber lens implantation offers the best chance of successful detachment surgery.     

眼内异物摘出白内障摘出及人工晶状体植入术

目的 探讨眼内异物摘出联合白内障摘出及人工晶状体植入术的手术方法及效果。方法 筛选晶状体异物病例，晶状体浑浊无明显视网膜脱离或玻璃体浑浊的玻璃体内磁性异物，以及后极以外眼球壁或视网膜表面粘连异物，共3l例作为治疗对象。如异物位于晶状体表面或晶状体内，用镊子或磁铁摘出异物，行超声乳化手术同时植入人工晶状体。如异物位于玻璃体及眼球壁，则行超声乳化术后，间接检眼镜观察下摘出异物。结果 均顺利摘出异物、外伤性白内障摘出及人工晶状体植入术。结论 术前无明显的玻璃体或视网膜病变者，应植入人工晶状体。对于主要由晶状体浑浊，影响间接检眼镜检查的玻璃体内或视网膜表面的磁性异物，玻璃体切除法也并非必要。     

The Effect of Cataract Surgery on the Blood-Anueous Barrier

Orally-administered fluorescein was used as a quantitative test of the blood-aqueous barrier in a group of patients who had undergone cataract extraction and intraocular lens implantation in one eye. There was no statistically significant difference in the concentration of fluorescein in the anterior chamber between the aphakic or pseudophakic eye and the control eye of the total group of 46 patients. Eyes with an intracapsular cataract extraction with medallion suture implant lens, however, had a significantly lower concentration of fluorescein in the anterior chamber as compared to the control eye. This difference is probably due to loss of fluorescein into the vitreous by mixing and diffusion. In eyes with an intact posterior capsule, the time course of anterior chamber fluorescence in the aphakic eye is more comparable to that of the phakic eye. In such eyes the blood-aqueous barrier seems to remain normal long after cataract extraction and intraocular lens implantation.     

Presence of human epidermal growth factor (hEGF), basic fibroblast growth factor (bFGF) in human aqueous]

Thirty-eight cataract eyes and 15 artificial aphakic or pseudophakic eyes were enrolled in this study to determine levels of human epidermal growth factor (hEGF) and basic fibroblast growth factor (bFGF) in human aqueous, using a radioimmunoassay. Neither hEGF nor bFGF were detected in either congenital cataract eyes or senile cataract eyes without any complication. In cases of senile cataract complicated with glaucoma and traumatic cataract, bFGF range from 0.4 to 0.8 ng/ml whereas hEGF was not detected. In cases of senile cataract with myocardial or brain infarction and anterior subcapsular cataract, bFGF was detected ranging from 0.4 to 1.0 ng/ml and in some of the cases hEGF was detected at a level of 1.0 ng/ml. hEGF was detected at 1.0 ng/ml in some cases of secondary cataract after uveitis, cataract complicated with retinal detachment, cataract after scleral buckling or vitrectomy, and aphakic or pseudophakic eyes after extracapsular cataract extraction or phacoemulsification. These results showed that hEGF and bFGF exist at a level of about 1 ng/ml in human aqueous in some pathological states and it seems possible that proliferation of lens epithelial cells is promoted by the growth factors, with the result that after cataract, anterior capsular opacities and shrinkage become severe.     

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.     

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Removal of the crystalline lens increases the risk of rhegmatogenous retinal detachment (RD) by creating changes in the ocular environment that predispose to development of retinal breaks. The evolution of cataract surgery from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and phacoemulsification has reduced the incidence of RD, while advances in vitreoretinal surgery have resulted in improved outcomes when retinal detachment does occur. The incidence of RD varies between 0.4-3.6% for ICCE and between 0.55-1.65% for ECCE. In eyes having undergone phacoemulsification the incidence is similar to those of ECCE and ranges between 0.75-1.65%. In this article the authors review the incidence and risk factors associated with pseudophakic and aphakic RD. The risk factors discussed include pre-operative risk factors such as age, status of the fellow eye and myopia, and surgical risk factors such as vitreous loss, posterior capsular integrity and Nd : YAG capsulotomy.     

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Removal of the crystalline lens increases the risk of rhegmatogenous retinal detachment (RD) by creating changes in the ocular environment that predispose to development of retinal breaks. The evolution of cataract surgery from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and phacoemulsification has reduced the incidence of RD, while advances in vitreoretinal surgery have resulted in improved outcomes when retinal detachment does occur. The incidence of RD varies between 0.4–3.6% for ICCE and between 0.55–1.65% for ECCE. In eyes having undergone phacoemulsification the incidence is similar to those of ECCE and ranges between 0.75–1.65%. In this article the authors review the incidence and risk factors associated with pseudophakic and aphakic RD. The risk factors discussed include pre-operative risk factors such as age, status of the fellow eye and myopia, and surgical risk factors such as vitreous loss, posterior capsular integrity and Nd : YAG capsulotomy.