Microincision intraocular lens with plate haptic design. Evaluation of rotational stability and centering of a microincision intraocular lens with plate haptic design in 12-19 months of follow-up

BACKGROUND: Evaluation of rotational stability of a microincision intraocular lens with plate haptic design (*Acri.Smart 46S, *Acri.Tec AG) and its centering in the capsular bag after implantation. MATERIAL AND METHOD: In a total of 43 eyes in 37 patients a foldable, spherical microincision cataract surgery (MICS) intraocular lens (IOL) with plate haptic design was implanted through a 1.4-mm microincision by means of an injector system. The IOL was marked prior to implantation to allow exact determination of its endocapsular position. After 1 1/2 years the best corrected visual acuity, refraction, centering and rotational stability of the IOL were determined. RESULTS: No rotation or decentration was observed in any of the 42 eyes 12-19 months postoperatively. On the first postoperative day 1 IOL rotated in the counterclockwise direction by approx. 6 degrees as a result of flattening of the anterior chamber. Its position then remained stable. No unwanted complications occurred. CONCLUSIONS: Conclusions: *Acri.Smart 46S is a safe, effective and stable IOL that can also be used as the basis of complex refractive optical systems, e.g. for correction of astigmatism.     

Bimanual microphacoemulsification and Acri. Smart intraocular lens implantation combined with vitreoretinal surgery

PURPOSE: To assess the efficacy and safety of bimanual microphacoemulsification combined with vitrectomy in eyes with clinically evident cataract and vitreoretinal pathology. SETTING: Institute of Ophthalmology of the University of Modena and Reggio Emilia, Modena, Italy. METHODS: This prospective case series comprised 19 consecutive patients with clinically significant cataract who were scheduled for vitrectomy. Bimanual microphacoemulsification was performed, and an Acri.Smart 46 S hydrophobic acrylic intraocular lens (IOL) with a 6.0 mm optic (Acri.Tec, Inc.) was implanted in the capsular bag. Immediately after, standard 3-port vitrectomy was performed. RESULTS: The prevailing vitreoretinal pathology was retinal detachment, with 1 case of macular pucker and 1 case of macular hole. In all cases, the IOL was implanted in the capsular bag. There were no intraoperative complications during the cataract surgery or vitrectomy. Follow-up 1, 15, 30, 90, and 180 days after surgery showed significant visual recovery in all cases. The mean endothelial loss was 10.05%+/-2.01% (SD). In 3 cases that had tamponade with heavy silicone oil, progressive posterior capsule opacification occurred 6 months after surgery. CONCLUSIONS: Bimanual microphacoemulsification combined with vitrectomy was effective and safe. The microincisions and 19-gauge instruments provided excellent chamber resistance that simplified surgical maneuvers in eyes that might have a distorted fundus reflection and increased zonular laxity. The Acri.Smart 46 S IOL, which can be injected through a 2.0 mm incision, provided good fundus visibility during vitrectomy and good maneuverability up to the extreme periphery without resulting in glare or distracting reflections for the surgeon.     

Mikroinzisionsintraokularlinse mit Plattenhaptik

Background

Evaluation of rotational stability of a microincision intraocular lens with plate haptic design (*Acri.Smart 46S, *Acri.Tec AG) and its centering in the capsular bag after implantation.

Material and method

In a total of 43 eyes in 37 patients a foldable, spherical microincision cataract surgery (MICS) intraocular lens (IOL) with plate haptic design was implanted through a 1.4-mm microincision by means of an injector system. The IOL was marked prior to implantation to allow exact determination of its endocapsular position. After 1½ years the best corrected visual acuity, refraction, centering and rotational stability of the IOL were determined.

Results

No rotation or decentration was observed in any of the 42 eyes 12–19 months postoperatively. On the first postoperative day 1 IOL rotated in the counterclockwise direction by approx. 6° as a result of flattening of the anterior chamber. Its position then remained stable. No unwanted complications occurred.

Conclusions

Conclusions: *Acri.Smart 46S is a safe, effective and stable IOL that can also be used as the basis of complex refractive optical systems, e.g. for correction of astigmatism.     

Implantation of the modified endocapsular bending ring in pediatric cataract surgery using a viscoadaptive viscoelastic agent

Cataract surgery and intraocular lens (IOL) implantation in pediatric eyes remain controversial. Using a viscoadaptive viscoelastic agent, we implanted a modified capsular bending ring (CBR) as well as an acrylic IOL with a sharp-optic-edge design in the capsular bag. All operated eyes demonstrated a low postoperative inflammatory reaction and a clinically well-centered IOL. The band-shaped, sharp-edged CBR facilitates the creation of a sharp, discontinuous bend in the equatorial capsule, which prevents anterior and posterior capsule opacification. Combining the viscoadaptive viscoelastic agent and the CBR enhances the safety of primary and secondary posterior chamber IOL implantation in pediatric cataract surgery, reduces capsule opacification, and may facilitate IOL exchange.     

Visual outcome of microincision cataract surgery with implantation of an Acri. Smart lens

PURPOSE: To evaluate visual and refractive outcome of microincision cataract surgery (MICS) with implantation of an Acri.Smart 48S intraocular lens (IOL) (Acri.Tech) through a sub-1.9 mm incision. SETTING: Vissum/Instituto Oftalmologico de Alicante and Ophthalmology Department, Miguel Hernandez University, Alicante, Spain. METHODS: In this consecutive prospective observational noncomparative clinical trial, 45 eyes were included. Microincision cataract surgery was performed through a 1.9 mm or smaller clear corneal incision using low ultrasound power MICS. The IOL was injected using a hydraulic cartridge and injector. The final size of the clear corneal incision, postoperative uncorrected and best corrected near and distance acuities, lens stability, ease of implantation, rate of posterior capsule opacification (PCO), and complications were reported up to 6 months. RESULTS: The Acri.Smart lens was inserted through mean incision of 1.5 mm +/- 0.3 (SD). The mean uncorrected distance visual acuity improved significantly from 20/100 (0.2 +/- 0.2 decimal value) preoperatively to 20/32 (0.7 +/- 0.3) by the end of 6 months postoperatively (P<.000). The best corrected distance visual acuity improved significantly from 20/50 (0.4 +/- 0.2) preoperatively to 20/25 (0.9 +/- 0.2) after 6 months (P<0.000). The uncorrected near visual acuity at the end of 6 months was 20/32 (0.6 +/- 0.2, P<.000). The mean postoperative spherical equivalent was -1.1 +/- 0.9 diopters (P<.947). The safety index was 2.5 for distance and 1.4 for near. There were no intraoperative or postoperative complications. No eye had a neodymium:YAG laser capsulotomy for PCO or reported undesirable complications at the end of 6 months. CONCLUSIONS: Results show that the Acri.Smart 48S IOL is a safe, effective, and stable lens that could be inserted through sub-1.9 mm incisions. It provided excellent surgical performance, predictability, and some degree of pseudoaccommodation.     

One-year follow-up of bag-in-the-lens intraocular lens implantation in 60 eyes

PURPOSE: To report the feasibility and clinical results of implanting a bag-in-the-lens intraocular lens (IOL) designed to prevent posterior capsule opacification after cataract surgery. SETTING: Departments of Ophthalmology, University of Antwerp, Antwerp, Belgium, and University of Munich, Munich, Germany. METHODS: This prospective study comprised 63 eyes (55 patients; 7 children, 48 adults) scheduled for cataract surgery and bag-in-the-lens IOL implantation. A posterior curvilinear capsulorhexis the same size as the anterior capsulorhexis was created for IOL insertion. After surgery, lens epithelial cell (LEC) proliferation was documented every 6 months with a minimum follow-up of 12 months. RESULTS: Sixty of 63 eyes (95%) had implantation of the bag-in-the-lens IOL. Conversion to a conventional IOL was necessary in 2 cases. In 1 eye, postoperative luxation of the IOL into the vitreous occurred as a result of an oversized anterior and posterior capsulorhexis. Three eyes had early postoperative iris incarceration in the lens groove that required surgery. No LEC proliferation on the optic occurred during a mean follow-up of 22.7 months (range 12 to 64 months); LEC proliferation was confined to the peripheral capsular bag. CONCLUSION: Lens epithelial cell proliferation was mild and confined to the periphery of the capsular bag during follow-up, and the bag-in-the-lens IOL optic remained clear.     

Pathogenesis of posterior capsular opacification. Part I. Epidemiological and clinico-statistical data

We examined 895 eyes having extracapsular cataract surgery; 403 had an intraocular lens (IOL) implanted and 492 did not. The incidence of posterior capsular opacification was 7.69% in the eyes with an IOL and 14.23% in the eyes without an IOL. If we exclude complicated cataracts from the cases that did not have an IOL, the incidence of posterior capsular opacification decreases to 9.06%. Various models of implanted IOLs showed different incidences of posterior capsular opacification: For J-looped lenses the incidence was 11.02%; for Frezzotti-Caporossi lenses, 7.35%. The follow-up was too short for soft lenses. The Frezzotti-Caporossi lens can be inserted with the convex side either anterior or posterior. A statistical evaluation shows that the reverse optic or posterior convex orientation in the bag caused a lower incidence of posterior capsular opacification (3.01%).     

Microincision cataract surgery with implantation of an Acri. Smart 48S lens

PURPOSE: To evaluate visual and refractive outcome and complications after microincision cataract surgery (MICS) with implantation of an Acri.Smart 48S intraocular lens (IOL). MATERIAL AND METHODS: This study comprised 22 eyes of 11 patients having bilateral microincision cataract surgery. MICS was performed through a 1.4 mm clear corneal incision using the MacKool System and low ultrasound power. The IOL was implanted through a 1.7 or smaller clear corneal incision with a Acri.Smart Glide System. The final size of the clear corneal incision, postoperative uncorrected and best corrected distance visual acuity, best corrected near visual acuity (Snellen, Jaeger Table), astigmatism, pseudoaccommodation possibility of Acri.Smart 48S IOL, complications and patient satisfaction were analyzed. The follow up was 1 month. RESULTS: The Acri.Smart 48S lens was implanted through mean incision of 1.56 +/- 0.07 mm. One month after surgery the mean uncorrected distance visual acuity (UCVA) and the best corrected visual acuity (BCVA) significantly improved (UCVA: preoperatively--0.49 +/- 0.33; postoperatively--0.97 +/- 0.11; p < 0.001; BCVA: preoperatively 0.68 +/- 0.3; postoperatively--1.0; p < 0.001) as well as BCVA for near (BCVA: preoperatively--5.27 +/- 3.30; postoperatively--2.91 +/- 1.48; p = 0.002). One month after surgery, there was not significant increase of astigmatism and the pseudoaccommodative ability of Acri.Smart 48S was not observed. There were no serious intraoperative and postoperative complications. All the patients were highly satisfied with the quality of the vision. CONCLUSIONS: Our preliminary results show that MICS with Acri.Smart 48S lens implantation is safe and effective procedure. This conclusion has to be confirmed by studies with longer follow up period and larger series of patients.     

Intercapsular cataract surgery with lens epithelial cell removal. Part IV: Capsular fibrosis induced by poly(methyl methacrylate)

Characteristic lens epithelial cell behavior in the pseudophakic eye was examined by comparing 30 eyes that had extracapsular cataract surgery by the intercapsular technique and posterior chamber intraocular lens (IOL) implantation with lens epithelial cell removal but without anterior capsule capsulectomy and nine aphakic eyes that had the same procedure but without posterior chamber lens implantation over a mean follow-up period of 30 and 23 months, respectively. Fibrous anterior capsule opacification was observed in 83% of the pseudophakic eyes in the area of contact with the IOL, while the region beyond the margin of the IOL remained transparent. Fibrous anterior capsular opacification was not noted in the aphakic eyes. This suggests that the IOL material, poly(methyl methacrylate), stimulates lens epithelial cells to undergo fibrous metaplasia and to produce collagen fibers. Various cytokines such as IL-1 and TGF-beta synthesized by lens epithelial cells may play a crucial role as mediators in the process. We recommend that this effect be considered as a parameter of biocompatibility in developing and evaluating new biomaterials.     

Silicone intraocular lens implantation in children: preliminary results

PURPOSE: To evaluate the safety and outcome of foldable silicone intraocular lens (IOL) implantation in children. SETTING: Department of Ophthalmology, University of Giessen, Giessen, Germany. METHODS: The results of cataract extraction and silicone IOL implantation in children having surgery between 1992 and 1997 were retrospectively analyzed in 8 eyes (7 patients). All IOLs were implanted in the capsular bag through a 3.5 mm clear corneal incision. In 4 eyes, primary posterior capsulectomy and anterior vitrectomy were performed. RESULTS: Mean patient age at the time of surgery was 5.1 years (range 8 months to 15 years). The surgeries were uneventful. All IOLs remained anatomically stable and well centered during the mean follow-up of 29.6 months (range 18 to 46 months). Postoperative inflammatory reaction was minimal. Neither fibrinoid exudation nor posterior synechias occurred postoperatively. Postoperative best spectacle-corrected visual acuity ranged from 20/800 to 20/20. All eyes with an intact posterior capsule developed posterior capsule opacification. In the 4 eyes that had primary posterior capsulectomy and anterior vitrectomy, the visual axis remained clear. CONCLUSIONS: These preliminary results suggest that silicone IOL implantation in children is a safe procedure with good and stable short-term anatomic results. Longer follow-up is necessary to answer questions about the long-term safety of silicone lens implantation in a child's eye.     

Intraoperative performance and postoperative outcomes of endocapsular ring implantation in pediatric eyes

PURPOSE: To study the intraoperative performance and postoperative outcomes of Cionni modified capsule tension ring (CTR) and intraocular lens (IOL) implantation in the capsular bag in pediatric eyes with ectopia lentis. SETTING: John A. Moran Eye Center, Salt Lake City, Utah, USA. METHODS: Thirty-five eyes (22 children) with ectopia lentis and visually significant cataract that had lens aspiration and in-the-bag implantation of single-piece AcrySof IOL and Cionni CTR were included. Single- and double-eyelet CTRs were used. The rings were sutured to the sclera using 9-0 or 10-0 polypropylene (Prolene) sutures. Preoperative and postoperative best corrected visual acuity (BCVA), intraoperative performance, IOL centration, and complications were studied. RESULTS: The mean patient age was 8.2 years +/- 5.1 (SD) and the median follow-up, 28 months. A double-eyelet CTR was implanted in 12 eyes and a single-eyelet CTR, in 23 eyes. The mean BCVA at the final follow-up (0.37 +/- 0.25 logMAR, 33 eyes) was significantly better than preoperatively (0.78 +/- 0.42 logMAR, 28 eyes) (P = .003). At the last examination, the BCVA was 20/40 or better in 16 eyes (45.7%). Three eyes (8.5%) required resuturing for IOL decentration. Nineteen eyes (54.3%) had a secondary procedure for posterior capsule opacification. Other complications included anterior capsule opacification (2.85%), cystoid macular edema (5.71%), chronic uveitis (5.71%), and vitreous prolapse (2.85%). CONCLUSION: Implantation of the Cionni CTR and single-piece AcrySof IOL in the capsular bag in pediatric eyes with subluxated lenses was safe and effective and led to a stable IOL with few significant complications.     

Pediatric cataract surgery in Nepal

PURPOSE: To describe the first pediatric cataract surgery case series report from Nepal. SETTING: Tilganga Eye Center, Kathmandu, Nepal. METHODS: This study comprised a consecutive series of 112 eyes of 85 children having cataract surgery with intraocular lens (IOL) implantation. General anesthesia of ketamine combined with peribulbar block was used in all patients. Patients' demographics, cataract type and presenting symptoms, surgical intervention, preoperative and postoperative visual acuities, and follow-up clinical examinations were recorded. RESULTS: Seventy-three eyes (65.2%) of 53 patients had extracapsular cataract extraction with posterior capsulotomy, anterior vitrectomy, and posterior chamber IOL implantation (ECCE+PCAP+AV+PCIOL), and 39 eyes (34.8%) of 32 patients had cataract extraction and IOL implantation with an intact posterior capsule (ECCE+PCIOL). Of all patients, the mean age at surgery was 6.2 years +/- 4.3 (SD). The median age in the ECCE+PCAP+AV+PCIOL group was 4.7 years and in the ECCE+PCIOL group, 11.0 years. The mean follow-up was 5.4 +/- 5.3 months. The most common postoperative complication in the ECCE+PCIOL group was visual axis/posterior capsule opacification, which was seen in 18 eyes (46.2%) compared to 4 eyes (5.5%) in the ECCE+PCAP+AV+PCIOL group. Visual acuity improved with surgery in both groups. The leading cause of poor outcomes was deprivation amblyopia. There were no anesthesia-related complications. CONCLUSIONS: Implantation of an IOL at the time of cataract extraction under combined systemic ketamine and peribulbar lidocaine anesthesia appeared to be well tolerated and produced significant visual improvement in pediatric patients in Nepal. Primary posterior capsulotomy and AV helped prevent visual axis opacification without a significant increase in complications.     

25-G玻璃体手术系统在儿童白内障手术中的应用

目的 探讨儿童白内障手术中在无灌注状态下应用25-G玻璃体切除头切除视轴区晶状体后囊膜和玻璃体前皮质的安全性和有效性.方法 为前瞻性系列病例研究.对连续30例(40只眼)儿童白内障在全身麻醉下进行晶状体前囊环形撕开、白内障吸出和囊袋内折叠式人工晶状体(IOL)植入后,在前房保留黏弹剂的状态下,经扁平部应用25-G玻璃体切除头行视轴区晶状体后囊膜切开和前玻璃体皮质切除.观察记录手术切除时间、眼压变化、穿刺口愈合情况、手术并发症和手术疗效.结果 所有手术均顺利进行,术中无前房塌陷、晶状体后囊膜撕裂和其他并发症,IOL均位于囊袋内.视轴区后囊膜切开和玻璃体前皮质切除的时间为20～60 s,平均(38.8±11.2)s.有2只眼术后发生短暂低眼压,均在3 d内恢复正常,其余患儿术后眼压在正常范围.术后2只眼前房出现轻度纤维性渗出,在术后37～d完全吸收.超声活体显微镜显示巩膜穿刺口在术后1个月左右痊愈.随访时间4～30个月,平均8个月.所有患儿瞳孔均圆而居中,无虹膜后粘连、后囊膜切开区混浊、IOL偏位或夹持、玻璃体脱出、视网膜脉络膜脱离及增生性玻璃体视网膜病变发生.结论 在儿童白内障手术中利用25-G玻璃体切除头在无灌注状态下行视轴区晶状体后囊膜切开和玻璃体前皮质切除术安全有效,手术创伤小,操作容易控制,术后炎症反应轻.长期疗效及与其他手术方式疗效的比较还需进一步观察.     

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.     

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.     

高度轴性近视眼白内障小切口非超声乳化及人工晶状体植入术

目的:观察高度轴性近视眼白内障行小切口非超声乳化及人工晶状体植入术的临床疗效,分析影响术后视力的因素。方法:对我院158例186眼眼轴≥26mm的高度近视眼白内障行小切口非超声乳化及人工晶状体植入术,术后随访6mo,观察术后视力和术中术后并发症情况。结果:术后3mo裸眼视力≥0.5者145眼(78%),0.1~0.4者33眼(18%),<0.1者8眼(4%);并发症有后囊膜破裂11眼,角膜内皮水肿19眼,视网膜脱离3眼,后囊膜不同程度混浊13眼。结论:高度轴性近视眼白内障行小切口非超声乳化及人工晶状体植入术疗效良好,是一种安全性较高的理想的手术方法。     

Effect of intraocular lens and anterior capsule opening type on posterior capsule opacification.

PURPOSE: To determine the effect of intraocular lens (IOL) type and anterior capsulectomy technique on the incidence of posterior capsule opacification. SETTING: Department of Ophthalmology, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey. METHODS: Three hundred two eyes of 294 patients were examined retrospectively after IOL implantation in the capsular bag performed between February 1991 and November 1996. Patients were divided into 3 groups according to IOL type: poly(methyl methacrylate) (PMMA); heparin-surface-modified PMMA (HSM PMMA); plate-haptic silicone. Envelope capsulectomy or continuous curvilinear capsulorhexis (CCC) was used. Mean follow-up was 27 months (range 12 to 33 months). RESULTS: Posterior capsule opacification developed in 47 cases (15.6%): 21.7% in the PMMA lens group after planned extracapsular cataract extraction (ECCE), 17.4% in the HSM PMMA lens group after planned ECCE, and 7.7% in the plate-haptic silicone lens group after phacoemulsification. Posterior capsule opacification occurred less in patients who had anterior capsulectomy using the CCC technique (11.5%) than in those having an envelope capsulectomy (24.5%) (P < .05). Posterior capsule opacification was significantly less in eyes with a capsular-bag-fixated plate-haptic silicone lens than in those with a PMMA or HSM PMMA IOL (P < .05). CONCLUSION: This study demonstrated that the anterior capsulectomy technique and the IOL type influence the incidence of PCO.     

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery

PURPOSE: To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and intraocular lens (IOL) design and material on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. SETTING: Tertiary care institution in India. PATIENTS: Sixty-four eyes of 52 children ranging in age from 3 months to 12 years who had cataract extraction with IOL implantation were prospectively evaluated for a minimum postoperative period of 2 years. METHODS: Thirty-two eyes received a hydrophobic acrylic lens with a truncated, square edge and 32, a single-piece poly(methyl methacrylate) (PMMA) lens that was not heparin surface modified. Sixteen eyes in each IOL group had PPC + AV; in the remaining 16 eyes in each group, the posterior capsule was left intact. RESULTS: Postoperatively, 25 eyes in the intact capsule group and 5 in the PPC + AV group developed PCO; the difference between groups was significant (P<.05). Of eyes with an intact capsule, 12 with an acrylic IOL and 13 with a PMMA IOL developed PCO (P>.05). In the PPC + AV group, 2 eyes with an acrylic IOL and 3 with a PMMA IOL developed PCO (P>.05). Overall, 14 eyes with an acrylic lens and 16 eyes with a PMMA lens developed PCO (P>.05). After surgery, there was a significant short-term delay in the development of PCO in the acrylic group (14 eyes; mean 6.66 months +/- 1.57 [SD]) compared to the PMMA group (16 eyes; mean 3.16 +/- 0.83 months) (P<.05). CONCLUSIONS: It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.     

先天性白内障21眼治疗回顾分析

目的:探讨先天性白内障治疗的手术特点及患儿术后视觉重建的重要性。方法:对我院收治11例21眼先天性白内障患儿采用双撕囊联合白内障超声乳化手术联合人工晶状体(IOL)植入术联合前部玻璃体切除术治疗白内障,术后定期随访并进行配镜及弱势训练,重建患儿视觉,随访1a。结果:所有先天性白内障患儿经过治疗,视力均不同程度提高。发生后发性白内障3眼(14.3%);术后1wk9眼(42.9%)出现纤维素性渗出;随诊6mo后失访率达45.5%。结论:采用双撕囊联合白内障超声乳化手术联合IOL植入术联合前部玻璃体切除术治疗先天性白内障可以有效预防后发性白内障,为患儿提供更大的视觉恢复空间。但术后复诊和视觉重建是先天性白内障治疗不容忽视的难点。     

Polishing the posterior capsule after extracapsular extraction of senile cataract.

Posterior capsular polishing is performed to delay or prevent capsular opacification. To study its effectiveness, a prospective study of 412 patients with bilateral senile cataracts was conducted. Each patient had bilateral extracapsular cataract extraction with laser ridge, posterior chamber lens implantation. The right eye of each patient had posterior capsular polishing using the Tennessee-Freeman polisher. The posterior capsule in the left eye was not polished. All patients above the age of 80 years (22 patients) had bilateral opacification within 16 months postoperatively. For patients less than 80 years old (390 patients), the cumulative capsulotomy rate in the polished capsule group was 9.2% (36 eyes); in the unpolished capsule group the rate was 12.0% (47 eyes) for the same follow-up time (average 30 months). There was no statistical difference in the incidence of posterior capsular opacification between the polished and unpolished groups. Polishing the posterior capsule after lens cortex cleaning had no significant role in delaying or preventing capsular opacification.