Painful bullous keratopathy following pediatric cataract surgery with intraocular lens implantation

A child with a history of a monocular congenital cataract, cataract surgery and intraocular lens implantation at age three developed pseudophakic bullous keratopathy which persisted following intraocular lens removal and vitrectomy two years later. At age nine she presented to the Cornea Service at Wills Eye Hospital with painful bullous keratopathy and underwent a penetrating keratoplasty and anterior vitrectomy. The case is presented to bring attention to potential long-term corneal complications of pediatric cataract surgery with intraocular lens implantation.     

Intraocular lens implantation in acute angle closure glaucoma associated with cataract

We have performed planned extracapsular cataract extraction and implantation of a posterior chamber intraocular lens in four eyes of three patients undergoing surgery for acute angle closure glaucoma associated with cataract. Three of these four eyes suffered angle closure secondary to intumescent cataract. One suffered primary angle closure upon preoperative pupillary dilation prior to lens extraction. We have found no evidence of corneal decompensation, residual glaucoma, or increased surgical morbidity in our patients. We feel that acute glaucoma associated with cataract is not a contraindication to lens implantation.     

Ultrasonic diagnosis of ocular pathology: its significance for cataract surgery with and without IOL implantation.

The use of diagnostic ultrasound can alert the eye surgeon to certain pathologic conditions of the eye before cataract surgery, including problems associated with the vitreous, retina, choroid and lens. This knowledge may be applied to all cataract surgery and in particular to intraocular lens implantation.     

Ghost cell glaucoma following lens implantation

When intraocular hemorrhage occurs following cataract surgery and lens implantation, ghost cell glaucoma may develop. An intraocular lens (IOL) may be a factor in recurrent bleeding, particularly in the predisposed patient. Six patients with ghost cell glaucoma following cataract surgery and lens implantation are described. Because intraocular pressure (IOP) was uncontrolled, vitrectomy was performed to remove the reservoir of ghost cells. In each case, postoperative visual acuity improved to 20/40 or better and IOP was controlled with the use of medications.     

改良小切口白内障手术150例临床观察

目的分析改良小切口非超声乳化白内障手术联合人工晶体植入术治疗的老年白内障患者的临床疗效。方法我院2012年3月至2013年9月收治150例(213眼)老年白内障患者,接受小切口非超声乳化白内障囊外摘除联合人工晶体植入术,对其术后视力及并发症进行临床分析。结果术中发生后囊破裂致玻璃体脱出6眼(2.8%);虹膜根部断离8眼(3.8%)。术后发生虹膜炎症反应19眼(8.9%);一次性高眼压9眼(4.2%);角膜内皮水肿10眼(4.7%)。术后3~12个月视力0.5以上者104眼,0.3~0.5者89眼,0.1~0.3者10眼,低于0.1者10眼。患者脱残率为95.31%。结论行小切口非超声乳化白内障囊外摘除联合人工晶体植入术疗效显著且适应证广,特别适合在基层医院推广应用。     

小瞳孔下切口白内障人工晶状体手术35例探索

目的：探讨小瞳孔下切口白内障人工晶状体手术的临床治疗效果。方法选取我院2011年12月～2013年12月接收的小瞳孔白内障患者35例,所有患者均采用小切口非超声乳化白内障摘出人工晶状体植入术进行治疗,观察治疗效果。结果术后30d,20例矫正视力≥0.5,13例为0.1～0.4,2例＜0.1;均伴有不同程度的葡萄膜炎反应（7～10d消退）,2例出现巩膜隧道切口外口暴露（切口无渗漏,未做特殊处理,7-10d被结膜覆盖）,3例中度角膜水肿（7d内恢复）,2例前房小量出血（不影响手术,术后2d内吸收）。结论小瞳孔白内障患者行小切口非超声乳化白内障摘出人工晶状体植入术治疗效果满意,值得推广。     

手法小切口白内障手术治疗糖尿病性白内障的疗效分析

目的分析手法小切口白内障摘除联合人工晶状体植入术治疗糖尿病性白内障的疗效。方法对68例（96眼）糖尿病合并白内障的患者行小切口白内障摘除及人工晶状体植入术的临床资料进行回顾性分析。统计术后1、30d的视力,术后视力与糖尿病病程的关系以及术后并发症。结果术后第1天裸眼视力〉0.5者69眼（71.88%）,0.3～0.5者18眼（18.75%）,0.1～0.25者6眼（6.25%）,〈0.1者3眼（3.13%）;术后第30天裸眼视力〉0.5者74眼（77.08）,0.3～0.5者16眼（16.67%）,0.1～0.25者4眼（4.17%）,〈0.1者2眼（2.08%）。术后并发症主要有角膜水肿、前房纤维素性渗出、虹膜粘连、继发青光眼。结论手法小切口白内障摘除联合人工晶状体植入术治疗糖尿病性白内障是安全有效的,术后视力的恢复与糖尿病病程及糖尿病视网膜病变有关。     

Intraocular lens implantation in developing countries: an ophthalmic surgical dilemma

Rapid and remarkable development of intraocular lens technology during the past 10 years has made intraocular lens (IOL) implantation the standard of practice with cataract surgery in wealthy industrialized nations. However, although visual results of IOL implantation are vastly superior to aphakic spectacle correction after cataract surgery, several factors mitigate against the widespread implantation of IOLs in most developing nations: the high cost of surgical equipment, ancillary drugs, and intraocular lenses; difficulty in postoperative follow-up of cataract surgical patients; and a dearth of surgical personnel properly trained in IOL technology in developing nations. While many of these problems could be addressed through national initiatives, a major area of concern remains that of manpower, since the number of unoperated cataract patients is immense. One strategy for alternative surgical manpower development is the training of medical assistants to perform cataract surgery, as is presently being carried out in several African nations. The question arises, however, as to whether medical assistants, as opposed to ophthalmologists, are qualified to select patients and implant IOLs.     

Atonic pupil: an unusual complication of cataract surgery

Eight cases of atonic pupil, an unusual complication following cataract surgery, are presented. Six of the eyes involved had intracapsular cataract extraction and anterior chamber intraocular lens implantation; one case underwent extracapsular cataract extraction with a posterior chamber intraocular lens implantation; the other had an extracapsular procedure with no implant. The etiology is unknown, but we believe the most likely one is that the sodium hyaluronate used in all these patients caused a temporary reduction of the iris blood supply by mechanical factors or by a vasoconstriction induced by some toxicity of the material that produced a lesion on the iris sphincter.     

Limbal anesthesia for cataract surgery

We present a new technique for the administration of anesthesia in cataract surgery. The technique consists of injecting 0.5 ml of locally-acting anesthetic subconjunctivally (or sub-Tenon's) along the superior limbal border. Using this method, we performed extracapsular cataract extraction (ECCE) with and without posterior chamber intraocular lens (PC-IOL) implantation or secondary PC-IOL implantation on 176 cataract patients. Anesthesia was successfully induced in the majority of these patients and all surgeries were carried out successfully with no major complications. Voluntary eye movements remained but did not interfere with surgery. On the contrary, they helped expose certain surgical sites. This new anesthetic method for cataract surgery is simple and minimizes complications attributed to other blind anesthetic techniques.     

Cataract extraction and intraocular lens implantation after fistulizing glaucoma surgery

Cataract extraction with implantation of an intraocular lens was performed in 33 patients who had previously undergone fistulizing glaucoma surgery. A functioning filtering bleb and normal intraocular pressure were important preoperative criteria, however success depended largely upon enhanced postoperative aqueous outflow. Bleb failure following cataract surgery may be caused by prolonged intraoperative hypotony, vitreous or intraocular lens occlusion of the filtering site, or the presence of postoperative inflammatory components in the aqueous. Extracapsular cataract extraction was the most satisfactory technique. Most cases received prepupillary iridocapsular lenses.     

Development and treatment of cataract in myopic eye with phakic intraocular lens Fyodorov in the posterior chamber

This is a case report of a female patient who, due to high myopia, had silicone phakic intraocular lens type Fyodorov with plate-haptics implanted in the posterior chamber (PC pIOLs). The anterior subcapsular cataract (ASC) resulted in significant reduction of visual acuity and, therefore, the patient, after 16 years of the first surgery, underwent another surgical intervention. She had the pIOLs explantation, phacoemulsification and implantation of the flexible intraocular lens (IL) in the capsular bag. Explantation of the pIOLs, cataract surgery by phacoemulsification and IOL implantation were carried out through the same clear corneal incision and the intraoperative course was uneventful. The visual acuity of the operated eye was equal to pre-cataract period.     

Spontaneous iris retraction occurring after extracapsular cataract extraction and posterior lens implantation in patients with glaucoma

Of 53 cases of round-pupil extracapsular cataract surgery combined with posterior lens implantation in eyes with chronic glaucoma, 15 (28.3%) displayed iris retraction three to six weeks postoperatively. Eyes with trabeculectomy, round-pupil cataract extraction, and posterior implants are most likely to develop this iris retraction syndrome.     

Propionibacterium acnes endophthalmitis seven months after extracapsular cataract extraction and intraocular lens implantation

We present a case of endophthalmitis caused by Propionibacterium acnes seven months following extracapsular cataract extraction and intraocular lens implantation. The markedly delayed clinical course of endophthalmitis associated with this organism appears to be highly stereotypical. Recognition and treatment of this complication of cataract surgery allows an excellent chance at cure.     

获得性免疫缺陷综合征合并白内障患者经系统高效抗反转录病毒治疗后围手术期感染控制疗效

目的探讨获得性免疫缺陷综合征（AIDS）合并白内障患者经系统高效抗反转录病毒治疗（HAART）后围手术期感染控制的疗效。 方法回顾性分析首都医科大学附属北京地坛医院收治的10例AIDS合并白内障患者的术前基本资料及手术前后采取的感染防控方法，探讨其危险因素及防范措施。 结果对10例AIDS合并白内障患者行HAART后，CD4⁺ T淋巴细胞计数上升至196～745个/μl，病情稳定，无并发症发生；其中8例患者给予白内障超声乳化术加人工晶体植入术。1例患者合并黄斑前膜，另外1例患者合并视网膜脱离，二者均给予玻璃体切割术+白内障超声乳化术+人工晶体植入术。10例AIDS合并白内障患者术后均未发生感染。 结论AIDS合并白内障患者手术前给予系统高效抗逆转录病毒治疗（HAART），并严格执行术前消毒，术中无菌操作、术后观察及换药，可有效防止AIDS合并白内障患者术后感染的发生。     

Extracapsular cataract extraction with simultaneous implantation of 300 Copeland iris plane lenses: five-year follow-up--a retrospective study

Three hundred cases of extracapsular cataract extraction with Copeland iris plane lens implantation were reviewed. Two hundred sixty-six patients were followed objectively from 180-1,420 days with a mean follow-up of 1,026 days. 12.4% necessitated secondary operations, most of these being posterior capsulotomies. 89.5% of patients with a mean age of 73.6 years achieved visual acuity of 6/6-6/12. Using an extracapsular cataract extraction with a Copeland iris plane lens, the results obtained were considerably improved over that of intracapsular surgery. A similar retrospective study of a larger series using extracapsular cataract extraction with the Binkhorst iridocapsular lens is currently being carried out.     

The "disposable" flap: a modified fornix flap for corneal retraction during cataract surgery.

A simple and rapid method to facilitate corneal retraction with a fornix-based conjunctival flap is described. The procedure eliminates the need for placement of a corneal traction suture during cataract surgery and lens implantation.     

The early postoperative pressure course in glaucoma patients following cataract surgery

The intraocular pressure (IOP) course during the first 2 months after cataract surgery in patients with preexisting glaucoma was evaluated in 25 consecutive cases of extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC-IOL) implantation and in 25 cases of intracapsular cataract extraction (ICCE) without IOL implantation. Although the former group had a slightly more favorable postoperative IOP course, approximately half of each group had a pressure rise above 21 mm Hg on the first day postoperatively, and approximately 80% had an IOP rise during the first postoperative month. These findings support the position that all glaucoma patients require close monitoring of their IOPs immediately after both ECCE and ICCE, and that patients with moderate to advanced glaucomatous damage should probably have glaucoma surgery either before or in combination with their cataract operation.     

Keratoplasty with primary and secondary lens implantation.

Twenty-eight combined grafting and lens implantation operations were performed for patients with corneal disease plus cataract, or aphakia. Eighteen of these cases had cataract extraction at the time of surgery and ten had grafting, vitrectomy and secondary lens implantation in already aphakic eyes. The longest follow-up was forty-seven months; the shortest, six months with an average of 21 months. Complications included cystoid macular edema (five), transient rise in intraocular pressure, hemorrhage. One lens had to be removed, and one graft will have to be replaced with possible removal of the lens. Cystoid macular edema occurred in two cases of the 18 graft-cataract-implant cases (11%) and in three of the 10 cases of graft-vitrectomy-implant patients (30%), a total of 17.9%. Hemorrhage occurred in two cases (7%), and transient elevation of the intraocular pressure also in two cases (7%).     

Intraocular lens implantation after penetrating keratoplasty

Thirty-three postkeratoplasty eyes underwent extracapsular cataract extraction with posterior chamber lens implantation or secondary anterior chamber lens implantation 3 to 128 months following corneal transplantation. The mean follow-up after the secondary lens implantation was 24 months (range 2 to 70 months). Seven of the 33 corneas became cloudy 1 to 8 months after lens implantation. Prior to graft failure, 71% of the eyes achieved refractive errors within 2 diopters of emmetropia and 19 of 33 eyes (57%) achieved uncorrected visual acuities of 20/100 or better. In spite of surgical attempts to reduce preexisting astigmatism, the mean post-implant keratometry astigmatism was unchanged after secondary surgery. Compared with a concurrent series of triple procedures, the advantage of providing patients with refractive errors closer to emmetropia by performing surgery after a corneal transplant is outweighed by the increased risks to the graft, the increased costs and medical risks of two operations, the risk of increased astigmatism, and the delay in visual acuity recovery from the time of keratoplasty until obtaining a final refraction after secondary surgery.