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).     

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.     

Extracapsular cataract extraction and primary posterior chamber lens implantation

We reviewed the charts of 420 consecutive extracapsular cataract extraction cases in which the surgeon's primary intention was to implant a posterior chamber lens. Posterior chamber lens implantation was precluded in eight cases (1.9%) because of vitreous loss or capsule dehiscence. A visual acuity of 20/40 or better was achieved by 83.8% of patients. When nonoperative causes of poor vision were eliminated, this result was achieved by 96.7% of patients. The percentage of patients achieving 20/40 or better acuity decreased with increasing age but remained constant despite varying follow-up periods. The most common complication was opacification of the posterior capsule, occurring in 25.7%; 83.8% of the complications occurred during the first two postoperative years. We conclude that extracapsular cataract extraction with primary posterior chamber lens implantation is an efficient way to restore good vision after cataract formation and that the results appear to remain stable over time.     

Clinical cystoid macular edema with intracapsular cataract extraction and posterior chamber lens implantation

A prospective clinical study has been undertaken to determine the rate of clinical cystoid macular edema in a population that has had intracapsular cataract extraction with the implantation of an iris-supported posterior lens. Transient cystoid macular edema developed in 7.2% of the patients in this study, and persistent cystoid macular edema developed in 1.02% of the patients. A chi 2 test shows that there is no significant difference in the rates of transient and persistent cystoid macular edema in this group with intracapsular cataract extraction and a group reported in the literature who had extracapsular cataract extraction and the implantation of a Shearing lens.     

Extracapsular extraction of hard cataract with simultaneous implantation of intraocular lens and anti-glaucoma operation

The authors present 7 cases of extracapsular hard cataract extraction with implantation of posterior chamber lens or an intracapsular disc-shaped lens. Because of existing indications they performed simultaneously an anti-glaucoma operation. In all the cases the postoperative IOP persisted in normal limits without any necessity of application of a pharmacological treatment.     

Short- and long-term endothelial cell loss associated with cataract extraction and intraocular lens implantation

A group of 249 patients undergoing cataract extraction with intraocular lens implantation underwent specular microscopic endothelial cell photographs before surgery and eight weeks, one year, and two years after surgery. The intraocular lenses used were the Shearing posterior chamber lens and the transiridectomy clip lens after extracapsular cataract extraction and the Medallion iris suture lens after intracapsular cataract extraction. Thirty-seven patients who underwent cataract extraction without implantation served as controls. Eight weeks after surgery, there was no statistical difference between the groups with intraocular lenses and the groups without them. One year and two years after surgery, endothelial cell loss had occurred in all groups except the group who underwent extracapsular cataract extraction without intraocular lens implantation--a group in which the patients were younger. The long-term endothelial cell loss was greater after intracapsular cataract extraction and was greater in the presence of an implant. There was statistically more endothelial cell loss with the transiridectomy clip lens than with the posterior chamber lens eight weeks and one year after surgery; the patients with posterior chamber lenses had continued to have more endothelial cell loss during the second postoperative year.     

小切口手法非超乳三联术治疗青光眼合并白内障在基层医院的应用

目的探讨小切口白内障囊外摘除联合人工晶状体植入及小梁切除术治疗急性闭角型青光眼合并白内障的临床疗效。方法选择41例41只眼青光眼合并老年性白内障患者作为研究对象,均接受小切口白内障囊外摘除联合人工晶状体植入及小梁切除术治疗,观察手术前后视力、眼压、术后并发症。结果术后随访6个月,平均眼压由术前的31.5±6.5mm Hg降至11.2±3.5mm Hg,差异有统计学意义（P〈0.05）;视力均有不同程度提高,差异有统计学意义（P〈0.05）。所有患者无严重并发症发生。结论白内障囊外摘除联合人工晶状体植入及小梁切除术治疗急性闭角型青光眼合并老年性白内障不仅安全有效、而且术后并发症轻微,值得临床推广应用。     

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).     

葡萄膜炎并发白内障的人工晶状体植入术

目的 探讨葡萄膜炎并发白内障人工晶状体植入的手术时机、方法和疗效。方法 对３６例（３８眼）葡萄膜炎并发白内障囊外摘出的同时植入后房型人工晶状体。平均随访１８月（１６～３０月）。结果 ７８．９％的患者术后矫正视力达０．５以上,术后并发症包括晶状体后囊浑浊与虹膜后粘连。结论 对葡萄膜炎并发白内障囊外摘出联合后房型人工晶状体植入术是可行的。但应有选择地进行,以减少手术并发症的发生。     

Cystoid macular edema in anterior chamber lens implantation following posterior capsule rupture

By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacine (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.Abbreviations AC-IOL anterior chamber intraocular lens - CME cystoid macular edema - ECCE extracapsular cataract extraction - ICCE intracapsular cataract extraction - IOL intraocular lens - PC-IOL posterior chamber intraocular lens     

无缝线巩膜隧道小切口及前房维持器在白内障摘出人工晶状体植入术中的应用

目的探讨无缝线巩膜隧道小切口联合前房维持器在白内障手术中的临床应用价值。方法对112例（127只眼）白内障行无缝线巩膜隧道小切口白内障囊外摘出术中使用前房维持器维持灌注,并植入后房型人工晶状体。结果无一眼因眼压波动而造成术中严重的并发症,术后第1天裸眼视力0.3～0.9者72只眼,占56.69%,第3天≥0.3者89只眼,占70.07%,≥1.0者32只眼,占25.19%。结论无缝线巩膜隧道小切口联合前房维持器在白内障手术中具有简化手术操作,减小手术并发症,使手术更安全。     

A prospective study of intraocular pressure four months after extracapsular cataract extraction with implantation of posterior chamber lenses

Sixty-six consecutive cases of extracapsular cataract extraction (ECCE) and sulcus implantation of a posterior chamber lens had intraocular pressure (IOP) measurements recorded four months postoperatively. These results were compared to the fellow unoperated eyes, as well as to a group of 64 patients, whom we reported previously, who had intracapsular cataract extraction (ICCE) and implantation of an anterior chamber lens. The ECCE and posterior chamber lens group demonstrated a significant reduction in the IOP of the operated eye after four months (P less than 0.001), with none of the patients having an IOP greater than 20 mm Hg. No significant IOP change could be demonstrated in the fellow eye (0.1 less than P less than 0.2). We found a significant difference between the ECCE and ICCE groups in the IOP of the operated eye (P less than 0.001).     

Simultaneous penetrating keratoplasty, cataract extraction and artificial lens implantation ("triple procedure") 1981-1987

Between June 1981 and March 1987, the authors performed simultaneous penetrating keratoplasty, cataract extraction, and intraocular lens implantation in 90 eyes. The main indications were Fuchs's corneal endothelial dystrophy (38 cases), corneal cicatrization (33 cases) and corneal or scleral perforation (7 cases). Extracapsular cataract extraction with posterior chamber lens implantation was performed in 82 patients. The posterior capsule ruptured in nine eyes, necessitating an anterior vitrectomy in four of them. The corneal transplant was rejected in nine eyes (10%). The mean preoperative visual acuity of 9/100 in 89 patients improved to 39/100 six months after surgery in 59 patients who were followed up and to 50/100 in the 29 patients with Fuchs's corneal dystrophy. The authors believe that in cases presenting with both cataract and medically uncontrollable corneal disease, simultaneous penetrating keratoplasty with extracapsular cataract extraction and implantation of a posterior chamber lens represents the treatment of choice.     

Personal experience with extracapsular extraction and lens implantation into the posterior chamber

Author operated on 17 patients and describes the performance of the extracapsular cataract extraction together with the implantation of the lens into the posterior chamber, some peroperative and postoperative complications. Advantages of this kind of cataract surgery for operated patients were discussed.     

Prospective intrapatient comparison of extracapsular cataract extraction and lens implantation with and without trabeculectomy

PURPOSE:To determine whether extracapsular cataract extraction and posterior chamber lens implantation combined with trabeculectomy provides better long-term results than extracapsular cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract.METHODS:In a prospective, randomized clinical trial, 35 patients with bilateral, symmetric, primary open-angle glaucoma and visually disabling cataracts were randomly selected to undergo surgery with trabeculectomy in one eye and without in the other. All procedures were performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases.RESULTS:After an average of 87 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation reduced intraocular pressure by 4.4 +/- 3.3 mm Hg, reduced the number of medications by 1.28 +/- 0.86, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in six of 35 eyes. After an average of 80 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy reduced intraocular pressure by 8.2 +/- 4.6 mm Hg (P =.0001), reduced the number of medications by 1.76 +/- 0.82 (P=.0002), increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in one eye (P =.05). Both groups had similar improvement in visual acuity and perioperative complications.CONCLUSIONS:Extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered for patients in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.     

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.     

Epithelial downgrowth following wound dehiscence after extracapsular cataract extraction and posterior chamber lens implantation: surgical management

Epithelial downgrowth occurred along a fistulous (nonfiltering) tract containing an incarcerated anterior capsular flap after extracapsular cataract extraction and posterior chamber lens implantation complicated by wound dehiscence. Months later, a YAG posterior capsulotomy was performed before it was realized that posterior capsule opacification was associated with epithelial downgrowth involving the posterior capsule. Surgical management of epithelial downgrowth after extracapsular cataract extraction and posterior chamber lens implantation is discussed, with emphasis on the role of combined cryotherapy, dissection of the retrocorneal membrane, and complete removal of the capsular bag. Histopathologically, we found it difficult to differentiate lens epithelial cells from corneal epithelial downgrowth within the capsular bag, but monoclonal antibody for keratin may help identify corneal epithelial cells.     

白内障术中后囊破裂的Ⅰ期后房型人工晶状体植入术

目的评价白内障囊外摘出术中后囊破裂行前段玻璃体切割联合Ⅰ期后房型人工晶状体植入的手术效果。方法对１４８０例白内障囊外摘出联合后房型人工晶状体植入术中４９例后囊破裂,行前段玻璃体切割联合Ⅰ期后房型人工晶状体植入的手术技巧、术后并发症和术后视力等进行分析。结果手术后囊破裂率为３．３％,７０％患者人工晶状体植入囊袋内,３０％患者为睫状沟,８９．９％患者出院时裸眼视力≥０．５。结论白内障囊外摘出术中后囊破裂,行前段玻璃体切割联合Ⅰ期后房型人工晶状体植入是安全有效的。     

糖尿病患者白内障摘出人工晶状体植入

目的 评价糖尿病患者白内障摘出人工晶状体植入术的效果。方法 对37例46眼施行现代白内障囊外摘出联合后房人工晶状体植入术的糖尿病患者的血糖水平、视力、并发症情况进行了回顾性分析。结果 糖尿病白内障患者，血糖控制在10.80mmol/L以下施行手术较为安全，无术中、术后严重并发症，术后观察4-43月，视力恢复较满意。术后视力取决于视网膜病变程度和黄斑是否受累。常见的术后并发症有角膜水肿、前房渗出、色素播散等。结论 糖尿病患者血糖控制在10.80mmol/L以下施行白内障囊外摘出及人工晶状体植入术是安全和有效的。     

Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.