Incidence of fluorescein angiographic subclinical macular edema following phacoemulsification of senile cataracts

Fluorescein angiograms were performed in 90 patients the first and sixth week after removal of non-traumatic cataracts by phacoemulsification. The incidence of macular edema was found to be one half that reported in the literature for a comparable group of patients following intracapsular cataract extraction. The difference in incidence of macular edema between the phacoemulsification and the intracapsular groups seems dependent on the presence of the posterior capsule and perhaps the small size of the phacoincision. One of 21 maculas with angiographic evidence of edema developed clinical cystoid macular edema.     

Management of congenital cataracts

The management of congenital cataracts at the Wilmer Institute is presented, with emphasis on the need for careful preoperative assessment. The indications and techniques for surgery in uncomplicated cataracts are discussed, and the advantages of using vitrectomy instruments in complicated congenital cataracts, such as those associated with persistent hyperplastic primary vitreous, are described.     

Classification of hereditary cataracts in children by linkage analysis.

A total of 12-different types of hereditary cataracts have been positively assigned to the gene map. They are located on autosomes as well as on the X chromosome. This establishes several kinds of cataracts as distinct diseases caused by different mutations. In selected cases the information may be helpful for prenatal diagnosis.     

Pyramidal anterior polar cataracts

OBJECTIVE: To document clinical features and subsequent management of pyramidal anterior polar cataracts in children. DESIGN: Retrospective, noncomparative case series and clinicopathologic correlation. PARTICIPANTS: Fifteen patients who presented to the pediatric ophthalmology clinic. INTERVENTION: All patients underwent measurement of visual acuity, assessment of ocular motility, examination of the anterior and posterior segments, and cycloplegic refraction. Amblyopia treatment was instituted when appropriate. When visual impairment occurred from cataract progression or amblyopia or both, cataract removal with or without lens implantation was performed. After surgery, correction of refractive error and treatment of amblyopia were instituted. Several pyramidal opacities were retrieved during cataract extraction and examined by light and electron microscopy. MAIN OUTCOME MEASURES: Visual acuity at initial presentation, size of lens opacity before surgery, amblyopia status, most recent visual acuity after cataract extraction, and histologic examination of lens opacity. RESULTS: Nine children had bilateral and six had unilateral pyramidal cataracts (24 eyes). There was no discernible inheritance pattern. Patients were followed for 27 months on average. Twenty of 24 eyes developed cortical opacification that extended significantly beyond the base of the pyramidal lesion. Nineteen eyes required cataract surgery: 10 eyes underwent lensectomy with anterior vitrectomy and 9 had extracapsular cataract extraction, 8 of which had insertion of a posterior chamber intraocular lens. Amblyopia was present or developed in all six patients with unilateral cataract and in eight of nine patients with bilateral cataract. Visual acuity in many eyes remained poor despite amblyopia therapy. The pyramidal opacities consisted of hyperplastic lens epithelium, which exhibited a loss of polarity and was surrounded by a collagenous matrix. CONCLUSIONS: Pyramidal anterior polar cataracts are present at birth and may represent a variant of anterior polar lens opacities. They may be unilateral or, if bilateral, they may be either symmetric or asymmetric. They consist of hyperplastic lens epithelium in a collagenous matrix. Patients with pyramidal cataracts are likely to develop amblyopia. This can result from either unilateral occurrence or asymmetry of bilateral opacities and is often worsened by surrounding cortical opacification. Many patients require cataract surgery. All infants and young children with anterior polar opacities showing this configuration should be followed for cataract progression and amblyopia.     

Five years' follow-up in the surgical management of cataracts in high myopia treated with the Kelman phacoemulsification technique

With the advent of phacoemulsification, much interest has again been rekindled in extracapsular cataract surgery and its effects on the vitreoretinopathies associated in high myopia. Since 1972, 278 patients with high myopia greater than --7.50 D, as as determined by axial length echography, have been operated on by the author. The five-year follow-up with statistical analysis of these cases is presented. Comments as to the merits of extracapsular versus intracapsular surgery in high myopia will be set forth.     

Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts

Aim: To compare the intraoperative difficulty and postoperative outcome in patients who have white mature cataract in one eye and other types of senile cataract in the other eye undergoing clear corneal phacoemulsification and foldable intraocular lens implantation. METHODS: 82 patients who had white mature cataract in one eye, posterior subcapsular, cortical, nuclear, or mixed type cataract in the other eye were enrolled in this prospective study. Postoperative outcomes, intraoperative difficulties related to capsulorhexis, and phacoemulsification were analysed between the two groups of eyes. Postoperative examinations were done at 1 day, 1 week, 1 and 3 months. RESULTS: Postoperative visual acuity, central corneal thickness, intraocular pressure, and rate of posterior capsule rupture were not significantly different between the two group of eyes (p>0.05). Mean effective phaco time, frequency of postoperative corneal oedema and posterior capsular plaque were found to be significantly higher in the mature cataract group (p<0.05). CONCLUSIONS: A one stage, 5 mm continuous capsulorhexis was achieved using trypan blue and generous amounts of retentive viscoelastic agent in eyes with white mature cataract. Intraoperative difficulties and postoperative outcome of clear corneal incision phacoemulsification surgery and foldable intraocular lens implantation were similar in white mature and other types of senile cataract. Topical anaesthesia in phacoemulsification of eyes with white mature cataract is safe and well tolerated.     

Natural history of senile disciform macular dystrophy

Twenty-nine patients with severe visual loss in one eye from disciform macular dystrophy were prospectively studied for the incidence of visual loss in the fellow eye. Four developed such loss in the second eye during a mean period of follow-up of 32 months from the time of onset of visual loss in the first eye, an annual incidence rate of 5.2%. The degree of drusen and retinal pigment epithelial and subretinal pigment epithelial pathology correlated positively with the incidence of visual loss in the fellow eye.     

Indications and surgical techniques for orbital exenteration.

Indications for the mutilating operation of exenteration are enumerated. They usually involve a malignant neoplasm of the orbital contents, primary, direct extension, or adnexal tissue that cannot be controlled by simple excision or irradiation. Surgically, subtotal exenteration with partial preservation of lids and even conjunctiva may be achieved occasionally. However, total exenteration may be lifesaving. Techniques and precautions are discussed. Advantages and disadvantages of skin grafting that influence the postoperative care are noted.     

Pain, photophobia, and retinal and optic nerve function after phacoemulsification with intracameral lidocaine.

OBJECTIVE: To evaluate differences in pain, photophobia, retinal and optic nerve function in test eyes given intracameral lidocaine compared with control eyes given intracameral saline after phacoemulsification under topical anesthesia. DESIGN: Prospective paired-eye intervention study with random treatment allocation. PARTICIPANTS: Thirty eyes of 15 patients underwent cataract surgery in both eyes under topical anesthesia. INTERVENTION: The first eye of each patient was randomly assigned to either 0.5 ml preservative-free 2% intracameral lidocaine or 0.5 ml of intracameral sterile saline. Within 5 months, the second eye automatically received intracameral saline if the first eye received intracameral lidocaine or vice versa. MAIN OUTCOME MEASURES: The duration of surgery was recorded. Immediately after surgery, each patient was asked to evaluate the degree of pain and photophobia experienced during surgery using a nominal scale. In addition, in five patients, electroretinography (ERG) and visual evoked response (VER) were performed within 1 week before surgery, immediately after surgery, and 1 day after surgery. Amplitudes and latencies were calculated. RESULTS: There was no difference in the duration of surgery comparing test eyes given intracameral lidocaine with control eyes given sterile saline (P = 0.81). There was no significant difference in the level of pain reported when comparing test eyes given intracameral lidocaine with control eyes (P = 1.00). None of the patients reported any significant difference in photophobia between their two eyes (P = 1.00). When comparing ERG measurements, test eyes given intracameral lidocaine did not show any significant decrease in ERG amplitudes or prolonged latencies compared with control eyes. When comparing VER measurements, test eyes given intracameral lidocaine did not show any increase in P1 latencies compared with control eyes (P = 0.31). When evaluating all postoperative ERG results 1 day after surgery, there was a suggestion of improved cone function. CONCLUSIONS: Although intracameral lidocaine does not depress retinal or optic nerve function, the addition of intracameral lidocaine to topical anesthesia during phacoemulsification does not significantly reduce intraoperative pain or photophobia.     

The Effect of Atropine on Myopia

Sixty-two children were treated with atropine in one eye for one year; the fellow eye was the control. The eyes were switched the second year. Twenty-eight patients were treated for four years on the same basis. Control eyes showed significant increases in myopia compared to treated eyes. Some treated eyes showed decreases in myopia; no decreases were seen in control eyes. Posttreatment data analysis indicates the effects are long-term.     

Lateral canthal tendon tuck.

Senile and involutional entropion is occasionally associated with a marked relaxation of the canthal tendons. A simple adjunctive procedure to the imbrication of the lower lid retractors for the correction of senile entropion is described. This adjunctive procedure--the lateral canthal tendon tuck--should further reduce the remarkably low recurrence rate associated with the imbrication surgical procedure that directly corrects the pathophysiology of senile entropion.