Postoperative complications after simultaneous vitrectomy and cataract surgery

OBJECTIVE: We reviewed postoperative complications after simultaneous vitrectomy, phacoemulsification, aspiration, and acryl lens insertion. PATIENTS AND METHODS: Combined surgery was performed in 316 eyes of 279 patients between 1995 and 1997. Postoperative observation was continued in all of them for more than 6 months. The diagnoses that led to vitrectomy included diabetic retinopathy in 155 eyes, rhegmatogenous retinal detachment in 64 eyes, macular hole in 43 eyes, and other diseases in 93 eyes. The rate of postoperative complications that needed any reoperation was investigated. RESULTS: Reoperations were needed for intravitreal hemorrhage in 23 eyes (7.3%), retinal detachment in 15 eyes (4.7%), rubeotic glaucoma in 6 eyes (1.9%), and other conditions in 4 eyes (1.3%). Among them, reoperations were performed on 13 eyes (4.1%) twice and more. A removal of an intraocular lens was needed in 16 eyes (5.1%) for treatment of vitreoretinal disease. In patients with diabetic retinopathy, reoperations were needed for intravitreal hemorrhage in 21 eyes (13.5%), rubeotic glaucoma in 6 eyes (3.9%), other diseases in 4 eyes (2.6%), and a removal of an intraocular lens was needed in 10 eyes (6.5%) at a higher rate than the other disease. CONCLUSION: This combined surgery is considered advantageous for removing peripheral vitreous, while preventing these complications is important for preserving visual function.     

Postoperative uveitis in cataract surgery

Postoperative uveitis is a complication of cataract surgery; this complication may compromise the functional outcome and sometimes loss of the eye ball. Between 1995-1996 in Ophthalmological Clinic from Cluj five hundred patients underwent one surgical procedure for cataract; from these in fifteen cases occurred postoperative uveitis. At thirty cases from them was practised the implant by posterior chamber and by anterior chamber at two cases. The debut and the clinical aspect shows the exogenic character in two cases and the endogenic character in thirty cases. The postoperative uveitis frequency in the cataract surgery was 0.4 per cent. In two cases the outcome was the functional loss of the eyeball. The endogenous uveitis answered favorable at the treat with topic and general corticotherapy. In none of the cases was the implant explantation effected.     

Postoperative inflammation after cataract surgery in patients with rheumatoid arthritis

The purpose of the present study was to assess the influence of preoperative activity of rheumatoid arthritis (RA) on early postoperative anterior chamber inflammation after phacoemulsification and intraocular lens implantation. Twenty-three eyes in 18 patients were included in our study. On the first postoperative day, anterior chamber inflammation was observed in 11 eyes (47.8%). Five days after surgery, we found postoperative inflammation only in 1 eye (4.3%). Keratic precipitates were observed in 1 eye (4.3%) on the second postoperative day. We found no correlation between the extent of anterior chamber inflammation and the preoperative activity of RA. Postoperative anterior chamber inflammation was also not associated with the medical management of RA.     

Postoperative increase in grey matter volume in visual cortex after unilateral cataract surgery

Purpose: The developing visual cortex has a strong potential to undergo plastic changes. Little is known about the potential of the ageing visual cortex to express plasticity. A pertinent question is whether therapeutic interventions can trigger plastic changes in the ageing visual cortex by restoring vision. Methods: Twelve patients aged 50–85 years underwent structural high‐resolution T1‐weighted MRI of the whole brain 2 days and 6 weeks after unilateral cataract surgery. Voxel‐based morphometry (VBM) based on T1‐weighted magnetic resonance imaging (MRI) was employed to test whether cataract surgery induces a regional increase in grey matter in areas V1 and V2 of the visual cortex. Results: In all patients, cataract surgery immediately improved visual acuity, contrast sensitivity and mean sensitivity in the visual field of the operated eye. The improvement in vision was stable throughout the 6 weeks after operation. VBM revealed a regional expansion of grey matter volume in area V2 contralateral to the operated eye during the 6‐week period after surgery. Individual increases in grey matter were predicted by the symmetry in visual acuity between the operated eye and nonoperated eye. The more symmetrical visual acuity became after unilateral cataract surgery, the more pronounced was the grey matter increase in visual cortex. Conclusion: The data suggest that cataract surgery triggered a use‐dependent structural plasticity in V2 presumably through improved binocular integration of visual input from both eyes. We conclude that activity‐dependent cortical plasticity is preserved in the ageing visual cortex and may be triggered by restoring impaired vision.     

白内障术后眼内炎诊治

目的:探讨白内障术后眼内炎的临床表现及诊治方法。方法:回顾性分析2005-05/2008-03我院诊治的4例白内障术后眼内炎病例,总结临床表现及治疗方法。结果:药物治疗2例,玻璃体切除手术治疗2例,全部患者感染控制,视力提高3例。结论:白内障围手术期应制定规范预防方案,严格执行,减少眼内炎发生可能。尽早发现、根据病情选择合理方式是治疗眼内炎的关键。     

Ptosis after cataract surgery

An often over-looked complication of routine cataract surgery is post-operative ptosis. This form of ptosis is often transient, although persistent ptosis may require surgical intervention. The causes include eyelid edema and hematoma, anesthesia myotoxicity, and use of a lid speculum or bridle suture. This review demonstrates that a thorough evaluation of the patient and determination of etiology of post-operative ptosis can help direct the need and timing for intervention.     

Diplopia after cataract surgery

This article discusses clinical findings, differential diagnoses, management, and prognoses for patients with persistent diplopia after cataract extraction.     

Diplopia after cataract surgery

PURPOSE: To evaluate the cause of diplopia after cataract surgery. SETTING: Cataract surgery at 7 hospitals and examination of diplopia at a central eye hospital. METHODS: This study comprised 18 eyes of 17 patients with diplopia that developed after cataract surgery in which retrobulbar anesthesia was used. The Hess screen test was done to diagnose oculomotor dysfunction. RESULTS: Several cases showed superior or inferior deviation of the globe, but most patients had nonuniform disturbances of eye movement. Examination of 3 patients by the Hess chart within 1 week after surgery showed paralysis of eye muscles but an overaction at a later stage, evident by reversal of eye position 1 month later. Surgery for strabismus was performed in 6 cases. One case with diplopia improved spontaneously 3 months after cataract surgery and achieved good alignment. CONCLUSIONS: The Hess screen test was useful for comparing changes in oculomotor function before and after surgery. Oculomotor dysfunction after cataract surgery may be caused directly by traumatic injury during administration of anesthesia or surgery using bridle sutures or indirectly from sensitivity to anesthetic agents.     

Postoperative pain in retinal detachment surgery

Postoperative pain in retinal detachment surgery is frequent but it is often underestimated. The aim of this study was to determine the incidence of postoperative pain after retinal detachment surgery and to identify its predictive factors in a longitudinal study. We included 106 patients operated for retinal detachment surgery using an endo-ocular or exo-ocular approach with general anesthesia. Postoperative monitoring for 24 h evaluated the intensity of pain using a numerical scale. The possible predictive factors of this pain were studied: ocular antecedents, premedication, total amount of morphine used, type of surgery, duration of surgery, and vomiting. The incidence of postoperative pain was 57.5%, 56% of which was intense pain. Postoperative pain was greatest during the first 4 h. The predictive factors of this pain revealed by bivariate analysis of the data were the type of surgery and vomiting. The incidence and intensity of postoperative pain after retinal detachment surgery remain high. Pain management requires postoperative treatment of vomiting as well as the development of the endo-ocular surgery and locoregional anesthesia techniques.     

钇铝石榴石激光治疗白内障摘除术后并发症的临床研究

目的探讨白内障摘除术后钇铝石榴石(yttriumaluminumgarnet,YAG)激光的应用范围,激光后囊膜切除术的方法、疗效和并发症.方法超声乳化白内障吸除人工晶状体(intraocularlens,IOL)植入手术4600只眼,术后YAG激光治疗451只眼,其中行后囊膜切除380只眼,切除方法采用连续环状切开及后推膜瓣二步法;连续环状切开时平均单脉冲能量为(1.21±0.31)mJ,平均总能量为(52.44±14.62)mJ;后推膜瓣时平均单脉冲能量为(2.12±0.43)mJ,平均总能量为(50.88±10.32)mJ.IOL前膜切除42只眼,脉冲能量为1.0～1.4mJ,平均总能量为(56.28±32.74)mJ.治疗其他术后并发症29只眼.结果白内障摘除术后行YAG激光治疗451只眼(9.8%).后囊膜切除手术率为8.3%;1次激光手术成功率为96.3%;平均裸眼视力提高0.26,矫正视力为0.85;未出现明显的IOL损伤和移位;362只眼(95.3%)眼压正常;2只眼视网膜脱离.结论YAG激光无需切口可在眼内完成精确的分割手术,且操作方便、安全,疗效好、并发症少、应用范围广.