青光眼滤过手术患者超声乳化白内障吸除术后血-房水屏障功能的改变

目的从血房水屏障功能方面评价青光眼滤过手术后白内障患者行超声乳化白内障吸除人工晶状体植入术的安全性。方法分别对40例(46只眼)青光眼滤过手术后白内障患者(试验组)和60例(64只眼)老年性白内障患者(对照组)行超声乳化白内障吸除人工晶状体植入术,使用激光蛋白细胞检测仪(LFCM)定量检测术前和术后1、7、30、90d房水蛋白浓度的变化,并进行比较。结果超声乳化白内障吸除人工晶状体植入术前及术后1、7、30、90d术眼平均房水闪光值试验组分别为(1512±287)、(4024±375)、(2433±338)、(2118±177)、(1651±170)光粒子数(PC)/ms,差异有统计学意义(P<005);对照组分别为(694±234)、(2627±1021)、(1396±644)、(907±267)、(716±189)PC/ms,差异有统计学意义(P<005)。其中2组术后1、7、30d均高于术前(P<005);术后90d与术前比较,差异均无统计学意义(P>005)。术前和术后1、7、30、90d2组平均房水闪光值比较,差异均有统计学意义(P<005)。试验组术后1d和30d与术前平均房水闪光值的差值均高于对照组(P<005)。结论青光眼滤过手术后患者血房水屏障功能紊乱;超声乳化白内障吸除人工晶状体植入术治疗青光眼滤过手术后白内障患者具有安全性,但加强抗炎性反应治疗,减轻手术损伤,是保证手术安全性的关键。     

Analysis of the blood aqueous barrier by measurement of aqueous flare in 31 eyes with Fuchs' heterochromic uveitis with and without secondary open-angle glaucoma

BACKGROUND: Fuchs' heterochromic uveitis is characterized by low-grade intraocular inflammation and a relatively benign clinical course. It was the aim of this study to quantitatively determine alterations of the blood-aqueous barrier in this disease by measuring the aqueous flare. METHODS: 31 affected eyes of 31 patients with the characteristic clinical picture of Fuchs' heterochromic uveitis, 31 apparently unaffected contralateral eyes, and 120 age and sex-matched normal control eyes were included in this retrospective study. Five of the eyes with Fuchs' heterochromic uveitis showed signs of secondary open-angle glaucoma. Determination of aqueous flare was performed in all eyes using the laser flare-cell meter FC-1000 (Kowa, Japan) after pupillary dilation. RESULTS: Aqueous flare values were moderately but significantly increased in eyes with Fuchs' heterochromic uveitis (mean 12.1 +/- 3.6 photon counts/ms) in comparison to normal control eyes (4.1 +/- 1.3 photon counts/ms, p < 0.001). Flare values of apparently unaffected contralateral eyes (mean 3.9 +/- 1.1 photon counts/ms) did not differ from normal control eyes (p = 0.5). In the group of eyes with Fuchs' heterochromic uveitis, aqueous flare was comparable in eyes with and without secondary open angle glaucoma (11.9 +/- 2.5 versus 12.1 +/- 3.8 photon counts/ms, p = 0.9). CONCLUSION: The alteration of the blood-aqueous barrier in patients with Fuchs' heterochromic uveitis is unilateral and relatively mild, corresponding to the well-known clinical picture of the disease. Secondary open-angle glaucoma appears not to be associated with additional increase of aqueous flare. The unilaterality and the relatively homogeneous distribution of the degree of increased aqueous flare values support the clinical impression that Fuchs' heterochromic uveitis is a distinct clinical entity that should be differentiated from other variants of chronic anterior uveitis.     

Long-term results of out-of-the-bag intraocular lens implantation

PURPOSE: To evaluate long-term results of out-of-the-bag intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Tenri Yorozu Hospital, Nara, Japan. METHODS: This study comprised 22 patients, 13 women and 9 men, who had cataract surgery by phacoemulsification and out-of-the-bag IOL implantation because of a posterior lens capsule rupture. Sixteen patients had in-the-bag IOL implantation in the fellow eye, and these eyes were used as a control group. The IOL's position was determined by ultrasound biomicroscopy (UBM). Anterior chamber flare counts were measured by a laser flare meter. The corneal endothelium was observed by specular microscopy. RESULTS: Mean follow-up after cataract surgery was 35 months +/- 22 (SD). The UBM revealed that in the 19 eyes with sulcus-to-sulcus IOL fixation, the optics touched the iris. In 3 eyes, 1 haptic was fixated at the sulcus and the other at the ciliary body. In 2 of these eyes, the optics did not touch the iris. Anterior chamber flare counts in eyes with sulcus-to-sulcus IOL fixation were significantly higher than in eyes with in-the-bag or sulcus-to-ciliary-body fixation (P < .05). There were no statistical differences in corneal endothelial cell counts based on haptic placement. CONCLUSION: Rubbing between the IOL optic and iris seems to contribute to the high flare counts in eyes with a sulcus-to-sulcus IOL fixation. A larger haptic angle may be needed to prevent contact between the iris and IOL optic in such cases.     

Blood-aqueous barrier after phacoemulsification with posterior chamber lens implantation; foldable acrylate lens vs PMMA lens-- a clinical study on 46 eyes

BACKGROUND: Cataract surgery leads to a more or less pronounced postoperative inflammation due to breakdown of the blood-aqueous barrier. This alteration of the blood-aqueous barrier can be reduced by minimally invasive surgery. The purpose of this study was to quantify the early course of the postoperative alteration of the blood-aqueous barrier following phacoemulsification with implantation of conventional PMMA posterior chamber lens (IOL) in comparison with foldable acrylic lens implantation. PATIENTS AND METHODS: Forty-six eyes of 46 patients (age 63 +/- 8.8 years) without preexisting deficiences of the blood-aqueous-barrier or previous intraocular surgeries were divided into two groups: group 1 (24 patients): phacoemulsification with one-piece-PMMA-IOL implantation (6.5 mm corneoscleral tunnel incision); group 2 (22 patients): phacoemulsification with foldable acrylic-IOL implantation (3.5 mm incision, 15 patients with corneoscleral tunnel and 7 patients with clear cornea incision). All surgical procedures were performed by one surgeon. The postoperative treatment was standardized. Alteration of the blood-aqueous barrier was quantified by the laser flare-cell meter (Kowa, FC-1000) preoperatively and on the first and the second day after surgery. RESULTS: Preoperative aqueous flare values (photon counts/ms) were comparable in both groups (6.7 +/- 2.7 versus 5.6 +/- 2.7 respectively, p = 0.1). On day 1, aqueous flare in group 1 (9.7 +/- 2.9) was not statistically significantly higher than in group 2 (9.2 +/- 2.2, p = 0.2) and remained relatively constant on day 2 after surgery (9.3 +/- 3.3), whereas the aqueous flare values in group 2 decreased statistically significant (6.7 +/- 2.3, p = 0.01). Postoperatively, there was no statistically significant difference of aqueous flare values between eyes with corneoscleral tunnel incision and eyes with clear corneal incision (p = 0.7) in group 2. CONCLUSIONS: Our study shows that phacoemulsification with foldable IOL implantation leads to a mild and short-lasting alteration of the blood-aqueous barrier. Thus, implantation of foldable IOL may be useful in eyes especially with preexisting alteration of the blood-aqueous-barrier.     

超声乳化白内障吸除术对血-房水屏障功能的影响

目的　观察小切口超声乳化白内障吸除人工晶状体植入术及相关因素对血 房水屏障功能的影响。方法　使用激光蛋白细胞检测仪对 60例 (64只眼 )白内障患者超声乳化白内障吸除人工晶状体植入术前、后的房水蛋白浓度进行定量检测 ,记录并比较闪光值。术后随访时间为 3个月。结果　超声乳化白内障吸除人工晶状体植入术前 ,术后 1d、1周、1个月及 3个月术眼房水的平均闪光值分别为 (6 94± 0 3 4 )、(2 6 2 7± 1 3 7)、(13 96± 1 0 5)、(9 0 7± 0 43 )及 (7 16± 0 2 7)光粒子数 /ms ,其中术后 1d、1周及 1个月高于术前 ,且差异均有显著意义 (P <0 0 5) ;术后 3个月与术前比较 ,差异无显著意义 (P >0 0 5)。术后早期术眼房水蛋白浓度与患者年龄呈正相关 (r =0 40 0 ,P =0 0 0 1) ,与患者的性别和眼别均无相关。术中虹膜脱出者术后 1d和 1周血 房水屏障功能破坏严重。结论　超声乳化白内障吸除人工晶状体植入术在术后短期内影响术眼的血 房水屏障功能 ;激光蛋白细胞检测仪可动态评价超声乳化白内障吸除术对血 房水屏障功能的影响。 (中华眼科杂志 ,2 0 0 4,40 :2 6 2 9)     

Quantification of blood-aqueous barrier breakdown after phacoemulsification in Fuchs' heterochromic uveitis

PURPOSE: To quantify the breakdown of the blood-aqueous barrier (BAB) following phacoemulsification with posterior chamber lens implantation in eyes with Fuchs' heterochromic uveitis (FHU). PATIENTS AND METHODS: In this retrospective study, 19 eyes of 19 patients with FHU (mean age 38 +/- 14 years) and 35 eyes of 35 patients with senile cataracts (mean age 63 +/- 9 years) underwent phacoemulsification with one-piece PMMA posterior chamber lens implantation. Aqueous flare was quantified using the laser flare-cell meter (LFCM, Kowa FC-1000) following medical pupillary dilation preoperatively and 1, 3, and 5 days, then 1 and 6 weeks and 6 months postoperatively. RESULTS: Mean preoperative aqueous flare (in photon counts per millisecond) in FHU vs. controls was 11.7 +/- 3.5 vs. 5.8 +/- 1.7. Following cataract surgery, mean aqueous flare increased to 27.8 +/- 4.4 vs. 16.0 +/- 4.5 on day 1, decreased to 23.6 +/- 4.0 vs. 11.8 +/- 3.5 on day 3, and to 18.0 +/- 3.0 vs. 9.5 +/- 1.7 on day 5. In FHU eyes, it was 13.9 +/- 2.7 after 1 week, and had returned to preoperative levels after 6 weeks (10.9 +/- 2.5) and remained stable for up to 6 months (mean 10.3 +/- 2.2). Pre- and postoperatively, aqueous flare values were 2-3 times higher in FHU eyes than in control eyes with senile cataract (p = 0.01). No postoperative complications such as fibrin formation, synechiae, macrophages on the intraocular lens optic or endophthalmitis were observed in any of the patients. CONCLUSIONS: BAB breakdown following phacoemulsification with posterior chamber lens implantation is relatively mild in eyes with FHU and the BAB appears to be fully reestablished to preoperative levels 6 weeks postoperatively, explaining the usually good outcome of cataract surgery in this condition.     

Time course of changes in aqueous flare following intravitreous gas injection in rabbits

The quantitative changes of the aqueous flare following intravitreous gas injection were determined by laser flare-cell metry in rabbits. A volume of 0.4 ml of air, 100% sulfur hexafluoride (SF6), or 100% perfluoropropane (C3F8), was injected separately into the vitreous of pigmented rabbits. The normal range of the aqueous flare was 7.8 +/- 3.0 (photon counts/msec). Each model showed an increase of aqueous flare on the first day (air: 18.9 +/- 9.1, SF6: 19.5 +/- 11.5, C3F8: 40.8 +/- 22.8). Subsequently, the aqueous flare of air-injected eyes gradually decreased, while that of SF6-injected eyes increased on the 4th day, and then gradually decreased. Also that of C3F8-injected eyes increased on the 4th day, and the 7th day, then decreased on the 14th day, but it was still higher than normal. Cataracts developed in two of the five eyes injected with SF6 and all of the four eyes injected with C3F8. These findings revealed that following intravitreous gas injection, disruption of the blood-ocular barrier depended on the expansibility of the gas and the length of time it remained in the vitreous cavity.     

Objective assessment of intraocular flare after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing in adults

AIM: Combining primary posterior capsulorhexis (PPC) and posterior optic buttonholing (POBH) in cataract surgery is an innovative approach to prevent after-cataract formation effectively and to increase postoperative stability of the intraocular lens (IOL). The present study was designed to compare the postoperative intraocular flare after cataract surgery with combined PPC and POBH to conventional in-the-bag implantation of the IOL. METHODS: Fifty consecutive age-related cataract patients with cataract surgery under topical anaesthesia in both eyes were enrolled prospectively into a prospective, randomised clinical trial. In randomised order, cataract surgery with combined PPC and POBH was performed in one eye; in the other eye cataract surgery was performed conventionally with in-the-bag IOL implantation keeping the posterior lens capsule intact. Intraocular flare was measured 1, 2, 4, 6, 12 and 24 h postoperatively, as well as 1 week and 1 month postoperatively, using a KOWA FC-1000 laser flare cell meter. RESULTS: The peak of intraocular flare was observed in POBH eyes and eyes with in-the-bag IOL implantation 1 h postoperatively. In both groups, the response was steadily decreasing thereafter. During measurements at day 1, small though statistically significant higher flare measurements were observed in eyes with in-the-bag IOL implantation (p<0.05). At 1 week and 1 month postoperatively, intraocular flare measurements were comparable again (p>0.05). CONCLUSION: Cataract surgery with combined PPC/POBH showed slightly lower postoperative anterior chamber reaction compared to conventional in-the-bag implantation during 4-week follow-up, indicating that POBH might trigger somewhat less inflammatory response. This could be explained by the posterior capsule sandwiching between the optic and the anterior capsule, preventing direct contact-mediated myofibroblastic trans-differentiation of anterior lens epithelial cells with consecutive cytokine depletion.     

Aqueous flare elevation in the fellow eye after vitrectomy

OBJECTIVE: Aqueous flare elevation has been shown to occur in the fellow eye after cataract surgery. This study tests whether such subclinical sympathetic reaction also takes place after vitrectomy. PATIENTS AND METHODS: In a prospective clinical study, preoperative and postoperative 2-week levels of aqueous flare in the fellow eyes of 38 patients who underwent vitrectomy during a 6-month period were measured with a laser flare-cell meter. RESULTS: Aqueous flare levels in the fellow eyes 2 weeks after vitrectomy (mean, 15.70 photon counts/millisecond) were significantly higher than preoperative flare levels (mean, 11.78 photon counts/millisecond, Wilcoxon's signed rank test, P = 0.04). CONCLUSION: This study demonstrated that subclinical sympathetic reaction did occur in the fellow eyes after vitrectomy.     

The Diagnosis of Intraocular Inflammation and Cytomegalovirus Retinitis in HIV-Infected Patients by Laser Flare Photometry Laser Flare Photometry in HIV-Infected Patients

Purpose: To assess the sensitivity and specificity of the Kowa Laser Flare Photometer in screening for intraocular inflammation and cytomegalovirus retinitis in HIV-infected patients. Patients and methods: Using the Kowa Flare-Cell 1000, 142 HIV-infected patients were evaluated for aqueous flare. Results: Patients with posterior segment disease had higher flare values (p<0.0001). A specificity of 93% and a sensitivity of 75% was found (cutoff value of 8 photon counts/msec). For a cutoff value of 5 photon counts/msec a specificity of 59% and a sensitivity of 91% was found. Patients with cytomegalovirus retinitis had higher flare values (p<0.0001). A specificity of 86% and a sensitivity of 75% was found for the cutoff value of 8 photon counts/msec and respectively of 53% and 91% for a cutoff value of 5 photon counts/msec. Assuming a 30% prevalence of cytomegalovirus retinitis in the HIV-infected population, positive predictive values of 70% (cutoff value of 8 photon counts/msec) and 45% (cutoff value of 5 photon counts/msec) were estimated. Conclusions: The clinical use of laser flare photometry may assist in the diagnosis of intraocular inflammation in HIV-infected patients. The authors recommend screening of HIV-infected patients by laser flare photometry, and, if high flare values are detected, they recommend that such patients have a full eye examination and be considered at risk of having more extensive disease. This technique does not replace a full ophthalmological examination if there are predisposing visual complaints.     

Inflammation after implantation of hydrophilic acrylic,hydrophobic acrylic,or silicone intraocular lenses in eyes with cataract and uveitis: comparison to a control group

PURPOSE: To compare the course of inflammation after small-incision cataract surgery with implantation of 1 of 3 types of foldable intraocular lenses (IOLs) in eyes with uveitis. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: Seventy-four eyes with uveitis and cataract and 68 control eyes with cataract were prospectively selected to receive a foldable hydrophilic acrylic (Hydroview, Bausch & Lomb), hydrophobic acrylic (AcrySof, Alcon), or silicone (CeeOn 911, Pharmacia) IOL. All surgery was performed by the same surgeon using a standardized protocol: clear corneal incision, capsulorhexis, phacoemulsification, and in-the-bag IOL implantation. Preoperative and postoperative inflammation was evaluated by measuring aqueous flare preoperatively and 1, 3, 7, 28, 90, and 180 days after surgery using the Kowa FC-1000 laser flare-cell meter. All uveitic eyes were in remission for at least 3 months before surgery. RESULTS: In the uveitic eyes, there was no statistically significant difference in the postoperative course of flare and cell among the 3 IOL groups. Six months after surgery in uveitic eyes, flare values reached preoperative levels and the cell count was lower than preoperatively in all 3 IOL groups. Relative flare values were higher in the eyes with uveitis and a CeeOn 911 IOL; however, the difference between this group and the 2 acrylic IOL groups was not significant. CONCLUSIONS: There were no significant differences in inflammation after implantation of foldable IOLs in uveitic eyes. Although absolute flare values and cell counts in eyes with uveitis were higher than in control eyes, primarily because of a damaged blood-aqueous barrier (BAB), BAB recovery was similar between the 2 groups. The changes in the BAB indicate that foldable IOL implantation is safe in uveitic eyes.     

Evaluation and monitoring of selected inflammation patterns in uveitis using laser tyndallometry

AIM: The purpose of the present study was to evaluate the degree of inflammation and to monitor the dynamics of the blood-aqueous barrier disruption in selected cases of uveitis using laser tyndalometry. MATERIAL AND METHOD: Measurements with the use of laser tyndalometer (Kowa FM-500) were performed in 72 patients (90 eyes) with various types of uveitis. They were divided into four groups: anterior uveitis (28 eyes), intermediate uveitis (pars planitis) (28 eyes), posterior uveitis (26 eyes) and panuveitis (8 eyes). Aqueous flare values were expressed as photon counts per millisecond. RESULTS: Tyndalometric mean values in control eyes were 4.8 +/- 1.0 ph/msec. Mean initial flare was pronounced in multifocal choroiditis and panuveitis--196.0 ph/msec, HLA-B27 positive acute anterior uveitis--145.4 ph/msec, and in acute herpes zoster anterior uveitis--52.4 ph/msec. It was mild to moderate in Fuchs uveitis syndrome--7.8 ph/msec, pars planitis--15.7 ph/msec, posterior uveitis in toxoplasmosis--6.8 ph/msec and toxocariasis--17.5 ph/msec. The potential of laser flare-meter for precise follow-up and adjustment of therapy was demonstrated in selected cases. CONCLUSIONS: Laser tyndalometry has been proved to be a useful tool for the objective and quantitative evaluation of anterior chamber flare in uveitis and for monitoring the effectiveness of the treatment, thus improving therapeutic efficacy of uveitis.     

Pediatric cataract surgery with or without anterior vitrectomy

PURPOSE: To evaluate after-cataract formation in children having cataract surgery with or without dry anterior vitrectomy and possible differences according to age. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This retrospective study comprised 85 eyes of 85 patients from 0 to 15 years old who had cataract surgery with or without anterior vitrectomy after the implantation of an intraocular lens (IOL). All patients had primary posterior capsulorhexis but no optic capture. Thirty-five patients received a heparin-surface-modified poly(methyl methacrylate) IOL (809C, Pharmacia & Upjohn) and 50 patients, a foldable acrylic IOL (AcrySof(R), Alcon). The records from follow-up visits at the patients' home clinics were used for analysis. RESULTS: Significantly fewer children were operated on for after-cataract if they had cataract surgery with anterior vitrectomy (P <.05). This applied to both IOL types. In the children older than 7 years in the AcrySof IOL group, there was no difference in the frequency of after-cataract surgery (P >.05). CONCLUSION: In children younger than 7 years with an AcrySof IOL, the rate of after-cataract surgery was significantly less in those who had an anterior vitrectomy at the time of cataract surgery (P <.05).In younger children, it is advantageous to perform cataract surgery with anterior vitrectomy to help prevent after-cataract formation; however, vitrectomy is not necessary in older children.     

Increased permeability of the blood-aqueous barrier after panretinal photocoagulation for proliferative diabetic retinopathy.

PURPOSE: To measure the permeability of the blood-aqueous barrier before and after panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy. METHODS: Twenty patients with diabetic proliferative retinopathy in one eye and background retinopathy in the other eye were included. PRP was performed in the proliferative eye, while the other eye served as control. Aqueous flare intensity was measured with a laser flare cell meter before, 10 and 90 days after treatment. RESULTS: The flare was stable in the control eye with a flare of 4.5+/-2.3, 4.4+/-2.4, and 4.5+/-1.7 photon counts/ms (mean+/-standard deviation) on Day 0, 10 and 90. In the laser treated eye corresponding figures were 5.2+/-2.4, 9.6+/-3.3, and 7.1+/-2.8 photon counts/ms, with a significant increase in aqueous flare at 10 days (p<0.001) and 90 days (p=0.002). CONCLUSION: A significant increase in aqueous flare was found 10 days after PRP, indicating a breakdown of the blood-aqueous barrier after retinal laser treatment. The breakdown was still present, however, less pronounced, after 3 months.     

Relationship between aqueous humor protein level and outflow facility in patients with uveitis

PURPOSE: To determine whether there is a relationship between the aqueous humor protein level and outflow facility in patients with uveitis. METHODS: Aqueous humor protein levels were determined by laser flare photometry, and outflow facility was determined by Schiotz tonography. RESULTS: Thirty patients with uveitis and 10 control subjects were studied. Outflow facility was lower in patients with uveitis (0.21 +/- 0.12 microl/min x mm Hg) than in control subjects (0.33 +/- 0.05 microl/min x mm Hg, P < 0.001). Patients with uveitis and laser flare photometry results (flare) more than 20 photon units/msec (n = 21) had a lower outflow facility (0.17 +/- 0.07 microl/min x mm Hg) than patients with uveitis and flare less than 20 photon units/msec (n = 9, 0.32 +/- 0.14 microl/min x mm Hg, P = 0.004). Furthermore, no difference was identified between outflow facility in patients with active uveitis (those who had anterior chamber cells) and flare less than 20 photon units/msec and outflow in control subjects. In patients with uveitis, there was a linear correlation between flare and outflow facility (r = -0.50, P = 0.005). There was no relationship between flare measurements and either intraocular pressure or aqueous humor cell levels when scored with a clinical, semiquantitative system. CONCLUSIONS: Outflow facility is significantly reduced in patients with uveitis who have high aqueous humor protein levels. Outflow facility appears to be normal in patients with active uveitis whose flare levels are low, and therefore the association between flare and outflow facility does not appear to be an indirect reflection of elevated anterior chamber cells. It is possible that elevated aqueous humor protein levels contribute to the development of uveitic glaucoma in some individuals by decreasing aqueous humor outflow facility, although a causal relationship cannot be established on the basis of this study.     

Blood-aqueous barrier breakdown after penetrating keratoplasty with simultaneous extracapsular cataract extraction and posterior chamber lens implantation

BACKGROUND: The purpose of this study was to quantify breakdown of the blood-aqueous barrier (BAB) following penetrating keratoplasty (PK) with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure) and compare it with the alterations following PK only. METHODS: This study included 72 eyes after triple procedure and 227 eyes after PK only. The diagnosis for PK was Fuchs dystrophy in 39%, keratokonus in 44%, stromal corneal dystrophy in 3% and avascular corneal scars in 6% of cases. The postoperative topical steroid treatment was standardized in both groups. Aqueous flare was quantified using the laser flare-cell meter (FC-1000, Kowa) at defined postoperative intervals (10 days, 6 weeks, then every 3 months until 1 year postoperatively). Patients with conditions associated with impairment of the BAB were excluded from the study. RESULTS: In the early postoperative course, aqueous flare values (photon counts/ms) were significantly higher in patients with triple procedure (21.9 +/- 11.0) than in patients with PK only (9.8 +/- 3.2; P = 0.001). At 6 weeks postoperatively, aqueous flare returned to normal levels in patients after PK only (5.2 +/- 2.3), whereas patients with triple procedure still showed significantly increased flare values (10.8 +/- 5.6; P = 0.01). At 6 months postoperatively, aqueous flare values of patients with triple had returned to normal levels (6.8 +/- 3.8) and did not differ significantly from those after PK only (5.2 +/- 1.9; P = 0.09). CONCLUSION: Our results indicate that triple procedure causes a more extensive and longer-lasting breakdown of the blood-aqueous barrier than PK only. Quantification of aqueous flare with the laser flare-cell meter is useful in the postoperative follow-up after triple procedure. Further studies are required to investigate the clinical relevance of BAB breakdown on endothelial cell count and the incidence of subsequent immunological graft rejection.     

After-cataract in children having cataract surgery with or without anterior vitrectomy implanted with a single-piece AcrySof IOL

PURPOSE: To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye. SETTING: Filatov Institute, Odessa, Ukraine. METHODS: Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed. RESULTS: Children in the younger age group (相似文献   

Anterior chamber inflammation following cataract surgery in patients with non-insulin-dependent diabetes mellitus

PURPOSE: The aim of the study was to estimate the early breakdown of the blood-aqueous barrier (BAB) following uneventful cataract surgery in patients with non-insulin dependent diabetes mellitus. MATERIAL AND METHODS: Aqueous flare was estimated in 54 diabetic eyes before and after cataract surgery. Fifteen eyes underwent uneventful ECCE (extracapsular cataract extraction with "can opener" capsulotomy) and 39 phacoemulsification with continuous curvilinear capsulorhexis. All procedures were performed by experienced surgeons. Fifty six eyes of age-matched healthy patients undergoing uncomplicated cataract surgery served, as control. Anterior chamber flare was quantified preoperatively, 1 and 3 days postoperatively, using laser-flare meter (Kowa FM-500). Laser flare values were expressed in photon counts/millisecond. RESULTS: Mean preoperative anterior chamber flare in diabetes type 2 was as follows: normal fundus--6.7, background retinopathy--8.6 and proliferative retinopathy--14.1 (p < 0.01 vs NF group). Significantly lower anterior chamber flare measurements following phacoemulsification (25.0-1 day, 17.8-3 days post surgery), than after ECCE (63.7 and 45.6, respectively) (p < 0.01) were observed in diabetic eyes. In phaco group, we noted lower flare values in eyes without retinopathy; 25.2-1 day, 14.0-3 days post surgery, than in proliferative retinopathy (31.5 and 28.4, respectively) (p < 0.05 vs no retinopathy group). CONCLUSIONS: Phacoemulsification, as a less traumatising technique produces less BAB breakdown and seems to be more suitable than ECCE in diabetic eyes. Following phacoemulsification, eyes with proliferative retinopathy had significantly higher flare values than eyes without retinopathy.     

Effects of traditional Sino-Japanese herbal medicines on aqueous flare elevation after small-incision cataract surgery.

We evaluated prospectively the effects of traditional Sino-Japanese herbal medicines on elevation of aqueous flare. Fifty-four patients with age-related cataract undergoing phacoemulsification with intraocular lens implantation were studied. In the control group, 20 patients received no herbal medicine. In the treated groups, 14 patients were given Orengedoku- to (Huanglian-Jie-Du-Tang in Chinese) granules (7.5 g daily), 10 patients were given Kakkon-to (Ge-Gen-Tang in Chinese) granules (7.5 g daily), and 10 patients were given Sairei-to (Cai-Ling-Tang in Chinese) granules (9.0 g daily), for 3 days before surgery, the day of surgery, and for 7 days after surgery. Aqueous flare was measured before and after surgery. The differences in preoperative flare intensities among the four groups were not significant. In the control group, the flare was 29.4 photon counts/msec on day 1, and then gradually decreased. The flare intensities on days 1, 3, and 5 in the Orengedoku-to and Kakkon-to groups were significantly lower than in the control group. The flare intensities in the Sairei-to group were the same as those of the controls. Oral administration of Orengedoku-to and Kakkon-to decreased aqueous flare elevation after small-incision cataract surgery. Sairei-to had no effect on the elevation.     

Implantable contact lens for high myopia.

PURPOSE: To evaluate the efficacy, safety, and biocompatibility of a collagen polymer implantable contact lens (ICL) (Staar Collamer) as a posterior chamber phakic intraocular lens (IOL) to correct high myopia. SETTING: Departments of Ophthalmology, Helsinki University Central Hospital, Helsinki, and Tampere University Hospital, Tampere, Finland. METHODS: A Staar Collamer posterior chamber phakic IOL was implanted in 38 eyes of 22 patients with a mean age of 39 years (range 24 to 54 years). The mean preoperative myopia was -15.10 diopters (D) (range -7.75 to -29.00 D). Surgical implantation was performed through a 3.0 mm clear corneal sutureless incision using paraocular anesthesia. The patients were followed clinically up to 3 years. The mean follow-up was 13.6 months (range 6 to 24 months) for refractive data and 22.3 months (range 6 to 35 months) for complications. The possible inflammatory response to the ICL was measured using a laser flare meter in 12 eyes. RESULTS: Postoperatively, all eyes had a significant increase in uncorrected visual acuity, allowing all but 3 patients (5 eyes) to manage most activities without spectacles. The mean spherical equivalent refraction at the last examination was -2.00 D +/- 2.48 (SD) (range +0.13 to -13.00 D), within +/-1.00 D of the targeted refraction in 31 eyes (81.6%) and within +/-0.50 D in 27 eyes (71.1%). In eyes in which the preoperative myopia was less than -18.00 D (n = 28), the achieved refraction was within +/-1.00 D of the intended refraction in 27 eyes (96.4%) and within +/-0.50 D in 24 eyes (85.7%). The refraction remained stable with a statistically insignificant change (P >.05) at each interval during the follow-up. The best corrected visual acuity (BCVA) improved by 1 or more lines in 23 of 32 eyes (71.9%) at 1 year. Two eyes (6.3%) lost 1 line of BCVA. Laser flare photometry showed normal aqueous flare values (11.71 +/- 6.61 photon counts/ms) in the 12 eyes measured at least 6 months after ICL implantation. Pupillary block glaucoma requiring surgical intervention occurred in 3 patients (7.9%). One patient (2.6%) developed cataract 1.5 years after ICL implantation; both ICLs were removed, and the refractive errors were corrected by lensectomy and implantation of low-power posterior chamber IOLs. One patient (2.6%) showed progression of dry macular degeneration at 17 months. CONCLUSION: At 1 year, ICL implantation had good visual and refractive results with excellent biocompatibility. Long-term follow-up is required to confirm that significant complications do not occur in most patients over time.