Intraocular pressure following extracapsular cataract extraction and posterior chamber intraocular lens implantation

Knowledge of the incidence of both short- and long-term elevation of intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) insertion is essential for the practicing ophthalmologist. We reviewed retrospectively the IOP data in 384 consecutive patients (506 eyes) that underwent the above procedure. A postoperative rise of 8 mm Hg above baseline or above 23 mm Hg was observed in 149 eyes (29%). Secondary glaucoma well controlled medically developed in 21 eyes (4%). Three eyes developed glaucoma after the first year postoperatively. Therefore, over the total follow-up period of 6 years, 24 eyes (4.7%) developed pseudophakic glaucoma. None, however, required laser or other surgical intervention. These results further support the prevailing view that ECCE with PC-IOL is the procedure of choice.     

The effect of diclofenac sodium on renal function

The effects of diclofenac sodium on the kidneys were studied during 4 1/2 hours in eight patients with normal renal function. Urinary output decreased within 10 min after the injection, and maximally by 80%. The renal plasma flow and the glomerular filtration rate initially diminished significantly, by 35%, but began to increase after only 2 hours. The dominant and persistent effect was reduction of free water clearance, with maximum fall from 5.9 to 0.08 ml/min after 2 1/2 hours. The long-lasting increased tubular reabsorption of water probably is important for the lowered intrapelvic pressure that is associated with good analgetic effect of diclofenac in ureteral colic.     

The effect of intravenous diazepam on rise of intraocular pressure following succinylcholine

Because succinylcholine raises intraocular pressure, its use to facilitate tracheal intubation for ocular surgery, especially in emergency open-eye cases, has been a controversial topic among anaesthetists for more than two decades. In recent years, intravenous diazepam pretreatment before succinylcholine has been reported to reduce the untoward side effects of myalgia, and elevation of serum potassium and creatine phosphokinase. This study was designed to assess the effect of pretreatment with intravenous diazepam 0.1 mg kg^–1 on control (base-line) intraocular pressure and to determine if such pretreatment diminished the rise in intraocular pressure following the standard anaesthesia induction sequence of thiopentone 3-5mg-kg^–1 and succinylcholine lmg kg^–1, followed by tracheal intubation. Such diazepam pretreatment was shown to reduce the intraocular pressure from control levels and to diminish the rise of intraocular pressure following succinylcholine and tracheal intubation. Because succinylcholine produces rapid onset of neuromuscular block for tracheal intubation and since only minor intraocular pressure elevation occurs following thiopentone and succinylcholine in patients pretreated with diazepam, its use in ocular surgery, including emergency open-eye cases, can be rationally advocated. The addition of 0.6 mg· kg^–1d-tubocurarine to the diazepam pretreatment did not produce a further reduction of the increase of intraocular pressure following succinylcholine.     

The effect of external ocular compression on intraocular pressure following retrobulbar anesthesia

Thirty consecutive patients scheduled for cataract surgery were randomized to external compression with the Honan intraocular pressure (IOP) reducer or digital pressure. The average increase in IOP after retrobulbar injection of 4 ml of anesthetic was 6.20 mm Hg. This increase was followed by a rapid decline in IOP within the first 2 1/2 minutes, averaging 1.20 mm Hg +/- 0.70 below baseline level for the Honan group and 1.00 mm Hg +/- 0.96 below baseline level for the digital group. From 5 to 10 minutes after injection there was a more gradual decline in IOP that averaged 0.35 mm Hg/min in the Honan group and 0.36 mm Hg/min in the digital group. After 10 minutes of external compression the IOP was 5.73 mm Hg +/- 0.96 below baseline level in the Honan group and 4.67 mm Hg +/- 0.64 below baseline level in the digital group. No statistical difference between the IOP measurements of the two groups was observed at 2 1/2 minutes at 5 minutes, or at 10 minutes.     

The morphine sparing effect of diclofenac sodium following caesarean section under spinal anaesthesia

We have studied the morphine sparing effect of a single 100 mg diclofenac sodium suppository following elective caesarean section performed under spinal anaesthesia. Fifty patients randomly allocated into a placebo or an active group were compared. There was a statistically significant (P < 0.05) reduction in total morphine consumption and in consumption calculated as mg kg h(-1) in the diclofenac group, although pain scores were comparable in the two groups.     

Trabecular pigmentation following extracapsular cataract extraction and posterior chamber intraocular lens implantation

We prospectively evaluated the change in trabecular pigmentation following extracapsular cataract extraction and posterior-chamber intraocular lens implantation in 70 patients (94 eyes) with senile cataracts. Using the Boys-Smith pigment gradation lens to measure semiquantitatively the amount of pigment visible in the angle, we estimated the mean trabecular pigmentation preoperatively and at 3-month intervals postoperatively. Both the mean pigmentation and the number of eyes with heavy pigmentation rose after the operation and then gradually returned to preoperative levels. There was no correlation between the amount of trabecular pigmentation and intraocular pressure.     

Successful treatment of Paecilomyces lilacinus endophthalmitis following cataract extraction with intraocular lens implantation

We report a case of mycotic endophthalmitis caused by Paecilomyces lilacinus after cataract surgery. Treatment consisted of early vitrectomy, multiple intravitreal injections of amphotericin B and miconazole, intravenous miconazole and, later, oral ketoconazole. The intraocular lens, which initially appeared uninvolved, was removed six weeks after initiation of therapy and found to contain causative organisms. Final visual acuity was 20/20. We recommend aggressive therapy consisting of early vitrectomy, intravitreal injections repeated as necessary, removal of the intraocular lens, avoidance of intraocular steroid, and administration of systemic antifungal agents.     

The morphine sparing effects of diclofenac sodium following abdominal surgery

A randomised, double-blind placebo controlled study was undertaken to assess the analgesic efficacy of diclofenac. Following major abdominal surgery and 12 hours later, patients received either placebo or diclofenac 75 mg intramuscularly and their cumulative morphine requirements administered by a patient-controlled system over 24 hours were compared. Pain scores were also measured. Arterial blood gases and coagulation studies were assessed pre- and postoperatively. Morphine consumption was significantly greater in the placebo group (59.5 compared to 38.5 mg, p less than 0.01). Pain scores were significantly lower in the diclofenac group at 4 hours, but not thereafter. Arterial carbon dioxide was significantly increased in the control groups. There was no significant change in platelet count within each group, but a significant difference between the groups (p less than 0.05).     

Complications of cataract extraction with intraocular lens implantation

Due to continued improvement in lens design, lens manufacturing, and surgical technique, the incidence of complications of cataract surgery with intraocular lens (IOL) implantation have decreased in recent years. Complications may be categorized into operative and postoperative, both early and late onset. Operative complications include posterior capsule rupture with or without vitreous loss, loss of all or part of the lens nucleus, iris damage, and stripping of Descemet's membrane. Early postoperative complications include pupillary block, hyphema, elevation of the intraocular pressure associated with the use of viscoelastic substances, persistent uveitis with or without hypopyon, and endophthalmitis. Late postoperative complications include IOL malposition, secondary glaucoma, cystoid macular edema, retinal detachment, and pseudophakic bullous keratopathy.     

Randomized prospective double-blind placebo-controlled trial of effect of intravenous ondansetron on intraocular pressure during ophthalmic surgery

The effect of i.v. ondansetron, before induction of anaesthesia,on intraocular pressure (IOP) in patients undergoing cataractsurgery was investigated. Forty patients (two groups of 20)received either ondansetron 4 mg (treatment group) or 0.9% saline(placebo group) in a double-blind controlled manner. There wereno significant differences in IOP between the groups. Ondansetronhad no significant effect on IOP during the study period. Br J Anaesth 2001; 87: 629–31     

Effect of intraocular aspiration of sodium hyaluronate on postoperative intraocular pressure

A prospective, randomized, masked study was conducted to evaluate whether intraocular aspiration of sodium hyaluronate used in cataract surgery influenced postoperative intraocular pressure (IOP). Ninety-nine patients (105 eyes) underwent uncomplicated extracapsular extractions with posterior chamber intraocular lens implantation using 1% sodium hyaluronate (AMVISC). In 53 eyes, sodium hyaluronate was aspirated from the anterior chamber prior to wound closure. Sodium hyaluronate was left in the anterior chamber of 52 eyes. The IOP of 33 of the patients was measured 4 hours after surgery. No significant difference was found between the pressure in the eyes from which the sodium hyaluronate had been aspirated and the pressure in those from which it had not. The IOP of all the patients was measured on the first postoperative day. The mean 24 hours after surgery was 23.4 mm Hg in the aspirated eyes and 23.1 mm Hg in the not-aspirated group. Thirteen eyes in the aspirated group and 14 in the not-aspirated group had pressures above 30 mm Hg during the first 24 hours after surgery. There were no significant differences in visual outcome, patient discomfort, corneal clarity, anterior chamber inflammation, or subsequent IOPs during 3 months postoperative examination. Aspiration of sodium hyaluronate at the end of cataract surgery does not appear to significantly reduce either the incidence or the degree of postoperative pressure elevations.     

The use of sodium hyaluronate (Healon) in intracapsular cataract extraction with insertion of anterior chamber intraocular lenses

Intracapsular cataract extraction with insertion of anterior chamber intraocular lens was carried out on 40 subjects. In 21 procedures, balanced salt solution or air was used to deepen the anterior chamber. In 19 procedures, Hyaluronic Acid (Healon) was used to deepen the anterior chamber. In the two groups, no significant difference was noted in the endothelial cell count or in the corneal thickness. The surgeon felt that Healon made the surgery much easier, gave better control and greatly decreased the possibility of serious complications.     

Diagnosis and surgical management of phacoanaphylactic uveitis following extracapsular cataract extraction with intraocular lens implantation

One year after a successful extracapsular cataract extraction with posterior chamber lens implantation of a Cilco Kratz modified J-loop lens, the patient, a 79-year-old white female, developed a severe granulomatous uveitis unresponsive to topical or systemic steroid therapy. All usual uveitis tests were negative, and no evidence of masquerade-syndrome-type uveitis was found. The possibility of lens-induced uveitis was considered. A B-scan ultrasound revealed high density echoes in the superotemporal portion of the capsular bag, and an operative procedure consisting of a sector iridectomy, removal of the implant, removal of white cortical material in the capsular bag as well as residual lens capsule, and an anterior vitrectomy was done. Pathologic examination of the specimens revealed lens material engulfed by large macrophages, foam cells, and plasma cells. The patient's uveitis rapidly subsided. She is now off all medication and has normal aphakic vision. The differential diagnosis, surgical management, and implications of this problem are discussed.     

The effect of intraocular dilating solution on cat endothelium

Maintenance of pupillary dilatation can be a difficult problem. We found a dilute intraocular solution of atropine and epinephrine to be both effective and safe in inducing pupillary dilatation. No significant corneal endothelial toxicity could be demonstrated in the cat eye comparing preinjection and postinjection endothelial cell density.     

The effect of prone positioning on intraocular pressure in anesthetized patients.

BACKGROUND: Ocular perfusion pressure is commonly defined as mean arterial pressure minus intraocular pressure (IOP). Changes in mean arterial pressure or IOP can affect ocular perfusion pressure. IOP has not been studied in this context in the prone anesthetized patient. METHODS: After institutional human studies committee approval and informed consent, 20 patients (American Society of Anesthesiologists physical status I-III) without eye disease who were scheduled for spine surgery in the prone position were enrolled. IOP was measured with a Tono-pen XL handheld tonometer at five time points: awake supine (baseline), anesthetized (supine 1), anesthetized prone (prone 1), anesthetized prone at conclusion of case (prone 2), and anesthetized supine before wake-up (supine 2). Anesthetic protocol was standardized. The head was positioned with a pinned head-holder. Data were analyzed with repeated-measures analysis of variance and paired t test. RESULTS: Supine 1 IOP (13 +/- 1 mmHg) decreased from baseline (19 +/- 1 mmHg) (P < 0.05). Prone 1 IOP (27 +/- 2 mmHg) increased in comparison with baseline (P < 0.05) and supine 1 (P < 0.05). Prone 2 IOP (40 +/- 2 mmHg) was measured after 320 +/- 107 min in the prone position and was significantly increased in comparison with all previous measurements (P < 0.05). Supine 2 IOP (31 +/- 2 mmHg) decreased in comparison with prone 2 IOP (P < 0.05) but was relatively elevated in comparison with supine 1 and baseline (P < 0.05). Hemodynamic and ventilatory parameters remained unchanged during the prone period. CONCLUSIONS: Prone positioning increases IOP during anesthesia. Ocular perfusion pressure could therefore decrease, despite maintenance of normotension.     

The effect of thiopentone and fazadinium on intraocular pressure

Intraocular pressure was measured in twenty-four patients using an applanation tonometer, after using thiopentone and fazadinium as induction agents. No significant rise in intraocular pressure above resting levels was noted before or after tracheal intubation, and it is suggested that this combination of induction agents should be satisfactory for general anaesthesia of a patient with a perforating eye injury who presents with a full stomach.     

外伤性白内障人工晶状体植入术后视觉质量影响性研究

目的探讨对外伤性白内障人工晶状体植入术后视觉质量的影响性研究。方法对42例外伤性外伤性白内障人工晶状体植入术患者进行视觉质量及术后并发症的分析,并通过Logistic回归性分析找出对其视觉质量的影响性研究。结果示伤口大小、初次治疗时间、视网膜脱离、术前有PVR、术前视网膜受损伤、有玻璃体积血、视神经损伤及术后并发症等因素与人工晶体移植的视觉效果有关,P〈0.05。结论人工晶体移植的视觉质量影响因素的研究对预防具有重要的临床作用和价值。