Effect of intracameral acetylcholine on latanoprost in preventing ocular hypertension after phacoemulsification and intraocular lens implantation

PURPOSE: To evaluate the effect of intracameral acetylcholine on latanoprost in preventing ocular hypertension in the early period after phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. SETTING: Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong, China. METHODS: Patients with uncomplicated cataract having phacoemulsification with PC IOL implantation were included in this prospective randomized double-masked clinical trial. The eyes were randomly assigned to 1 of 4 groups based on postoperative application of latanoprost 0.005% alone (Group 1), latanoprost 0.005% with intracameral acetylcholine (Group 2), intracameral acetylcholine alone (Group 3), and no medication (controls (Group 4). Intraocular pressure (IOP) was measured 3 and 24 hours postoperatively. The anterior chamber was examined for the level of cells and flare using slitlamp biomicroscopy. RESULTS: Three and 24 hours after surgery, the decrease in mean IOP in eyes receiving latanoprost alone was not statistically significantly different from that in control eyes (P >.05). Eyes receiving intracameral acetylcholine alone had a significant decrease in the mean IOP at 3 hours (P <.05) but not at 24 hours compared to control eyes (P >.05). There were no significant differences in the mean postoperative IOP decrease between eyes receiving latanoprost with intracameral acetylcholine and those receiving intracameral acetylcholine alone (P >.05). CONCLUSIONS: A single application of latanoprost did not significantly lower IOP in the first 24 hours after phacoemulsification with PC IOL implantation. Eyes receiving intracameral acetylcholine alone had a significantly greater decrease in IOP than control eyes at 3 hours but not at 24 hours. The addition of intracameral acetylcholine to latanoprost did not enhance or reduce latanoprost's IOP-lowering effect.     

Latanoprost versus timolol gel to prevent ocular hypertension after phacoemulsification and intraocular lens implantation

PURPOSE: To evaluate the efficacy of latanoprost and timolol gel in preventing ocular hypertension in the early period after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. SETTING: Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China. METHODS: This prospective randomized double-masked clinical trial comprised patients with uncomplicated cataract having phacoemulsification with PC IOL implantation. They were randomly assigned to 1 of 3 groups: postoperative application of timolol 0.5% gel-forming solution (Timoptol-XE(R)) (Group 1), latanoprost 0.005% (Group 2), and control (Group 3). Intraocular pressure (IOP) was measured 2, 4, and 24 hours postoperatively. The anterior chamber was examined for the levels of cells and flare using slitlamp biomicroscopy. RESULTS: Group 1 had a significantly greater reduction in mean IOP 2, 4, and 24 hours after phacoemulsification and PC IOL implantation than Group 3 (P <.05). There were no significant differences between Groups 2 and 3 at any interval (P. 05). No excessive postoperative anterior chamber inflammation was observed in any group. CONCLUSIONS: A single dose of latanoprost given after phacoemulsification and PC IOL implantation did not produce a significant IOP-lowering effect when compared with a control group in the first 24 hours postoperatively. A single dose of timolol gel produced a significant postoperative IOP decrease as soon as 2 hours and up to 24 hours after surgery. Timolol gel and latanoprost are safe, but timolol is more effective than latanoprost in preventing postoperative ocular hypertension.     

The effect of latanoprost, bimatoprost, and travoprost on intraocular pressure after cataract surgery.

PURPOSE: The aim of this study was to evaluate the effect of preoperative topical latanoprost, bimatoprost, and travoprost administration on postoperative intraocular pressure (IOP) after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. METHODS: This prospective, randomized, double-masked study included 120 eyes of 120 consecutive, normotensive, uncomplicated cataract patients having phacoemulsification surgery with PC IOL implantation. They were randomized into 1 of 4 treatment groups, each of which had 30 patients. Two (2) h before the surgery, the patients received 0.005% latanoprost (Group 1), 0.004% bimatoprost (Group 2), 0.03% travoprost (Group 3), or placebo (Group 4, artificial tears). IOP was measured at preoperative, 4, 8, and 24 h postoperative with a Goldmann applanation tonometer. The anterior chamber was examined postoperatively 24 h for levels of cell and flare using slit-lamp biomicroscopy. RESULTS: The preoperative mean IOP was not statistically significant different among the four groups. In Groups 1 and 3, the mean IOP at 4, 8 and 24 h were significantly lower than the control (Group 4; P < 0.05). However, in Group 2, there was no significant difference in IOP during the study period, compared to the control (Group 4; P > 0.05). In addition, the mean postoperative IOP at 24 h in Groups 1 and 3 were significantly lower than the preoperative IOP (P < 0.05). No severe anterior chamber reaction was observed in any group. CONCLUSIONS: Our findings show that a single-dose topical of latanoprost and travoprost can prevent early postoperative IOP elevation after phacoemulsification surgery without any sideeffects.     

Change in intraocular pressure within 1 week of phacoemulsification and intraocular lens implantation using Adatocel

PURPOSE: To examine the change in intraocular pressure (IOP) within 1 week of phacoemulsification and foldable posterior chamber intraocular lens (PC IOL) implantation using Adatocel (hydroxypropyl methylcellulose 2% [HPMC]). SETTING: Department of Ophthalmology, University of Sciences, Faculty of Medicine, Pécs, Hungary. METHODS: In this prospective study, the IOP in 118 eyes of 118 patients (57 men, 61 women, mean age 68 years +/- 7.8 [SD]) with no history of glaucoma was assessed by Goldmann applanation tonometry 2 to 3, 6 to 8, and 22 to 24 hours and 1 week after uneventful phacoemulsification and PC IOL implantation. The effect of the removal of Adatocel ("partial removal" from the anterior chamber [AC] only versus "complete removal" from behind of the IOL as well), the lens type (Medicontur 601 HP versus Bausch & Lomb Hydroview), and the type of anesthesia (topical versus parabulbar) were compared. Statistical analysis was performed using the Student t test, and P< or =.05 was considered statistically significant. RESULTS: The mean preoperative IOP was 13.83 +/- 2.5 mmHg. There were no significant differences at any time in postoperative IOP measurements between the 2 IOL types and the 2 modes of anesthesia. At 2 to 3 hours, 6 to 8 hours, and 22 to 24 hours, the IOP was significantly higher in the 30 eyes in which the Adatocel was partially removed (from the AC only) than in the 88 eyes in which it was completely removed (from behind the PC IOL as well) (P< or =.05, P< or =.01, and P< or =.001, respectively). CONCLUSION: Severe postoperative IOP spikes in nonglaucomatous patients after uneventful phacoemulsification cataract surgery are rare. The type of implanted PC IOL and the mode of anesthesia had no significant effect on postoperative IOP. Total removal of the ophthalmic viscosurgical device, even when using HPMCs such as Adatocel, is necessary to prevent postoperative IOP spikes.     

Clinical comparison of Healon5 and Healon in phacoemulsification and intraocular lens implantation; Randomized multicenter study

PURPOSE: To compare the overall clinical performance during phacoemulsification and intraocular lens (IOL) implantation, the effect on intraocular pressure (IOP), and the effect on corneal endothelium of Healon5 (sodium hyaluronate 2.3%) and Healon (sodium hyaluronate 1.0%) ophthalmic viscosurgical devices (OVDs). SETTING: Multicenter study. METHODS: In this randomized prospective clinical study, the performance of Healon5 (viscoadaptive; dispersive and cohesive) and Healon (cohesive) during cataract surgery was evaluated in 157 patients, 79 with Healon5 and 78 with Healon. Surgeons evaluated the following on a 5-point scale: retention during phacoemulsification (primary endpoint), ease of injection, anterior chamber maintenance during continuous curvilinear capsulorhexis (CCC), facilitation of IOL implantation, and ease of removal from the eye. Masked examiners other than the surgeon performed the following measurements: IOP preoperatively and 5 and 24 hours, 7 days, and 3 months postoperatively; corneal thickness before and 24 hours, 7 days, and 3 months postoperatively; and corneal endothelial cell count preoperatively and 3 months postoperatively. RESULTS: Intraocular retention during phacoemulsification was assessed as good or very good in 77% in the Healon5 group and 8% in the Healon group; the difference was statistically significant (P<.0001, Wilcoxon rank sum test). The Healon5 group had significantly better scores for anterior chamber maintenance during CCC (P<.0001) and facilitation of IOL implantation (P =.032), and the Healon group had significantly better scores for ease of injection (P<.0001) and ease of removal (P<.0001). There were no statistically significant between-group differences in IOP, corneal endothelial cell count, or corneal thickness. CONCLUSIONS: Surgeons rated Healon5 better than Healon in retention during phacoemulsification, anterior chamber maintenance during CCC, and facilitation of IOL implantation. They assessed Healon as easier to inject and remove. There was no difference in safety-related parameters between the 2 OVDs. These findings indicate that Healon5 is effective in cataract surgery.     

Clinical results of phacoemulsification with the use of Healon5 or Viscoat

PURPOSE: To compare the ophthalmic viscosurgical devices Healon5 (viscoadaptive) and Viscoat (dispersive) regarding their overall clinical performance during phacoemulsification and posterior chamber intraocular lens (IOL) implantation as well as their influence on intraocular pressure (IOP). SETTING: Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. METHODS: In this prospective randomized patient- and observer-masked clinical study, the performance of Healon5 (sodium hyaluronate 2.3%) and Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) was assessed by 3 surgeons during cataract surgery in 90 patients. Surgeons used a 5-point scale for the subjective assessment of the ease of injection, maintenance capacity during continuous curvilinear capsulorhexis, remaining capacity during phacoemulsification, facilitation of IOL implantation, removal from the eye, transparency, and overall performance throughout surgery. Intraocular pressure was measured preoperatively and 24 hours and 7 days postoperatively. Best corrected visual acuity was assessed preoperatively and 7 days postoperatively. RESULTS: Overall intraoperative product performance was assessed as good or very good in 34 of 44 patients (77%) in the Healon5 group and in 16 of 46 patients (35%) in the Viscoat group (P <.001). Retention in the anterior chamber was graded good or very good in 36 patients (82%) in the Healon5 group and in 23 (50%) in the Viscoat group (P =.001). There were no statistically significant between-group differences in mean IOP preoperatively and 24 hours postoperatively. CONCLUSIONS: Surgeons graded Healon5 better than Viscoat in overall surgical performance and retention in the anterior chamber during phacoemulsification. These data support that Healon5 adapts to each step during surgery.     

Intraocular pressure after phacoemulsification with posterior chamber lens implantation in open-angle glaucoma

BACKGROUND: To evaluate changes in intraocular pressure (IOP) after phacoemulsification (Phaco) with posterior chamber lens (PC IOL) implantation in eyes with primary open-angle glaucoma (POAG) at least 2 years after surgery. PATIENTS AND METHODS: 19 eyes of 13 POAG patients who underwent uneventful clear cornea Phaco with PC IOL implantation and with follow-up of at least 2 years after surgery were included in this retrospective study. None of them had previous intraocular surgery or argon laser trabeculoplasty. RESULTS: The average preoperative IOP was 16.9 +/- 2.02 mm Hg. The average follow-up of was 36 +/- 11.8 months. 1 week after surgery a significant decrease in average IOP was observed (13.8 +/- 3.0 mm Hg; P = 0.000). 1 and 4 months after surgery IOP was still significantly lower than preoperatively. 8 months after surgery IOP significantly increased to 15.9 mm Hg (+/- 2.9 mm Hg; P = 0.022) with respect to 1 week postoperatively, but then again significantly decreased to 15.5 mm Hg (+/- 2.6 mm Hg; P = 0.020) 1 year after surgery and stayed approximately the same at 2 and 3 years after surgery. After 4 years the average IOP was 15.0 mm Hg (+/- 3.1 mm Hg; P = 0.216), that was statistically insignificant because of the small number of patients. In 79% (15 eyes) of our cases medical antiglaucoma treatment was unchanged, in 21% (4 eyes) the therapy was reduced. CONCLUSIONS: Uneventful Phaco with PC IOL implantation in good medically controlled POAG eyes was associated with a statistically significant long-term decrease in IOP, allowing the reduction of postoperative antiglaucoma medications in more than 20% of the eyes.     

Intraindividual comparison of the effects of a fixed dorzolamide-timolol combination and latanoprost on intraocular pressure after small incision cataract surgery

To compare the effect of a fixed dorzolamide-timolol combination with that of latanoprost on intraocular pressure (IOP) after small incision cataract surgery.Department of Ophthalmology, University of Vienna, Vienna, Austria.This prospective randomized study comprised 60 eyes of 30 patients scheduled for small incision cataract surgery in both eyes. The patients were randomly assigned to receive 1 drop of a fixed dorzolamide-timolol combination or latanoprost immediately after cataract surgery in the first eye. The second eye received the other antiglaucomatous agent. Cataract surgery was performed under sodium hyaluronate 1% with a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively.Six hours after surgery, the mean IOP decreased by -0.8 mm Hg +/- 3.2 (SD) (P =.184) in the dorzolamide-timolol group and increased by 3.6 mm Hg +/- 3.5 (P <.001) in the latanoprost group. Twenty to 24 hours after surgery, the mean IOP decreased by -2.8 +/- 2.4 mm Hg (P <.001) in the dorzolamide-timolol group and increased by 0.6 +/- 3.5 mm Hg (P =.353) in the latanoprost group. The differences between groups were significant at 6 hours (P <.001) and 20 to 24 hours (P <.001).The fixed dorzolamide-timolol combination was more effective than latanoprost in reducing IOP after small incision cataract surgery. Only the fixed dorzolamide-timolol combination prevented a postoperative IOP increase and occasional IOP spikes of 30 mm Hg or higher.     

Intraocular pressure after small incision cataract surgery: temporal sclerocorneal versus clear corneal incision

PURPOSE: To compare intraocular pressure (IOP) after phacoemulsification and foldable intraocular lens (IOL) implantation using a temporal sclerocorneal or clear corneal incision. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: One hundred patients (100 eyes) with cataract having phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision. Intraocular pressure was measured preoperatively and 6 hours, 1, 2, and 3 days, and 5 months postoperatively. Statistical significance was determined by nonparametric group comparisons using 2-sample random Wilcoxon tests. RESULTS: Six hours postoperatively, the median IOP increase was significantly higher in the sclerocorneal tunnel group (57%) than in the clear corneal incision group (18%) (P <.001). No significant between-group difference in IOP was found at 1, 2, or 3 days or 5 months. At 5 months, IOP was 0.6 mm Hg lower than preoperatively in the sclerocorneal tunnel group and 1.5 mm Hg lower in the clear corneal group. CONCLUSIONS: After phacoemulsification and foldable IOL implantation, the immediate postoperative IOP increase was higher in eyes having a sclerocorneal incision than in those having a clear corneal tunnel incision. These results could be important in eyes with decreased outflow facility or preexisting optic nerve damage.     

原发性闭角型青光眼行超声乳化联合房角分离术后房角改变

目的:观察白内障超声乳化吸除并人工晶状体植入联合房角分离术治疗合并有白内障的原发性闭角型青光眼术前术后房角的改变。方法:回顾性分析合并有白内障的闭角型青光眼患者35例(37眼),其中前房角关闭范围≤180°者16眼,>180°者21眼,均在表面麻醉下行角巩膜隧道切口行白内障超声乳化吸除折叠式人工晶状体植入联合房角分离术,对其手术前后的房角状态,眼压,中央前房深度,视力进行对照观察。结果:随访3～24mo术后房角状态与术前比有3眼大部分开放,余房角均开放,随访期内未见房角关闭及粘连范围扩大,末次随访平均眼压(14.3±4.1)mmHg,较术前用药后平均眼压(26.4±3.2)mmHg明显降低,差异具有统计学意义(t=5.86,P<0.01),中央前房深度由术前的(2.0±0.3)mm,增加到术后的(3.2±0.4)mm,视力除2眼有视神经萎缩外,余均有不同程度提高。结论:对于合并有白内障的闭角型青光眼的治疗,行白内障超声乳化吸除折叠式人工晶状体植入联合房角分离术治疗能有效地降低眼压,开放房角,加深前房,提高视力,与滤过性手术相比,手术并发症少,是有效且安全的手术方法。     

Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation

PURPOSE: To evaluate intraocular pressure (IOP) after phacoemulsification and intraocular lens (IOL) implantation in nonglaucomatous eyes with and without exfoliation. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: One hundred ninety-six eyes that had phacoemulsification with IOL implantation were examined. Eyes with a history of intraocular disease or surgery that could affect IOP were excluded. The study comprised the remaining 160 eyes: 23 with exfoliation (EXF group) and 137 without exfoliation (non-EXF group). Follow-up data were available for 136 eyes. The same surgeon performed all surgeries. Patients were examined on the first postoperative day and after 1 week, 4 months, and 1.0 to 2.7 years. RESULTS: One day postoperatively, IOP rose in the EXF group from a mean preoperative level of 16.3 mm Hg +/- 2.7 (SD) to 21.0 +/- 8.5 mm Hg, a 28.4% increase (P =.0061). In the non-EXF group, mean IOP rose from 16.2 +/- 3.4 mm Hg to 20.5 +/- 5.7 mm Hg, a 29.9% increase (P =.001). In 4 eyes (17.4%) in the EXF group and 8 eyes (5.8%) in the non-EXF group, IOP increased to 30 mm Hg or higher at 1 day. After this, significant IOP decreases occurred in both the EXF and non-EXF group, respectively, as follows: 14.2 +/- 3.0 mm Hg (12.0% decrease from preoperative value; P =.001) and 15.0 +/- 2.9 mm Hg (5.9%; P =.001) 1 week postoperatively; 12.8 +/- 2.7 mm Hg (20.2%; P =.0002) and 13.8 +/- 2.7 mm Hg (13.2%; P =.001) after 4 months; and 12.3 +/- 2.6 mm Hg (23.2%; P =.0001) and 12.7 +/- 2.7 mm Hg (21.2%; P =.001) after 1.0 to 2.7 years. There was no significant difference between the 2 groups. CONCLUSION: After phacoemulsification with IOL implantation, IOP decreased significantly and remained lower than preoperatively in eyes with and without exfoliation. One day postoperatively, transient pressure peaks were more common in eyes with exfoliation. One eye without exfoliation developed glaucoma.     

Early intraocular pressure and anterior chamber depth changes after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes. Comparison of groups stratified by axial length

PURPOSE: To evaluate the changes in intraocular pressure (IOP) and anterior chamber depth (ACD) after phacoemulsification according to axial length (AL). SETTING: Department of Ophthalmology, St. Vincent's Hospital, Catholic University of Korea, Suwon, South Korea. METHODS: This prospective study comprised 71 eyes of 71 patients who had phacoemulsification and foldable intraocular lens (IOL) implantation. The IOP changes preoperatively and 1 day and 1, 3, and 5 weeks postoperatively and ACD changes preoperatively and at 1 day and 3 and 5 weeks were analyzed by AL (AL1, 21.0 to <23.0 mm; AL2, 23.0 to <25.0 mm; AL3, 25.0 to <27.0 mm; AL4, >or=27.0 mm). RESULTS: There was no statistically significant difference in preoperative IOP according to AL. However, there was a statistically significant postoperative IOP decrease in the AL1 and AL2 groups and a statistically significant IOP increase in the AL3 and AL4 groups. There was a statistically significant difference in the preoperative ACD between AL groups and a statistically significant increase in ACD with increased AL from preoperatively to 1, 3, and 5 weeks postoperatively. CONCLUSIONS: After uneventful phacoemulsification and foldable IOL implantation, the IOP and ACD changed significantly according to AL in the early postoperative period. The AL appeared to predict these changes.     

Effect of bimatoprost on intraocular pressure after cataract surgery

Background: An increase in intraocular pressure (IOP) frequently occurs after otherwise uneventful phacoemulsification cataract surgery. This study was conducted to determine the efficacy of bimatoprost 0.03% drops given preoperatively in preventing IOP rise following phacoemulsification cataract surgery.Methods: In this prospective, randomized, double-masked, placebo-controlled study, 91 eyes of 85 patients scheduled to have clear corneal phacoemulsification cataract surgery were randomly divided into 2 groups. One hour before surgery, 1 group (48 eyes) received 1 drop of bimatoprost 0.03%, and the other group (43 eyes) received 1 drop of a balanced saline solution (placebo). A masked observer measured IOP preoperatively, and 3 and 24 hours postoperatively. Anterior chamber cellular reaction was measured on the first day after surgery. Preoperative and postoperative central corneal thickness (CCT) was assessed.Results: The mean IOP changes from baseline were not statistically different between the 2 groups at 3 hours (p = 0.618). At 24 hours, there was a statistically significant difference between the mean IOP changes of the groups (p = 0.001). The incidence of IOP elevation greater than 5 or 10 mm Hg at 24 hours was significantly higher in the control group (9 of 43 eyes) than the bimatoprost group (3 of 48 eyes) (p = 0.039). Anterior chamber reaction was not increased by bimatoprost. Mean CCT change was not different between the groups at 24 hours (p = 0.615).Interpretation: When compared with placebo, prophylactic use of 1 drop of bimatoprost before phacoemulsification cataract surgery failed to produce a significantly different effect on IOP levels from placebo at 3 hours postoperatively, but it caused a significant IOP reduction at 24 hours.     

Medical control of intraocular pressure after phacoemulsification

PURPOSE: To compare the effectiveness of oral acetazolamide, topical brinzolamide 1%, and no ocular hypotensive medication after phacoemulsification. SETTING: Adnan Menderes University Department of Ophthalmology, Aydin, Turkey. METHODS: This prospective randomized double-blind study comprised 60 eyes of 52 patients having phacoemulsification under topical anesthesia. There were no intraoperative complications. Eyes were randomized to receive oral acetazolamide 500 mg 1 hour preoperatively followed by 250 mg acetazolamide every 6 hours, 1 drop of brinzolamide 1% every 12 hours starting immediately after speculum removal, or no ocular hypotensive medication. Intraocular pressure (IOP) was measured using a Perkins tonometer preoperatively and 4 to 6 hours and 18 to 24 hours postoperatively. RESULTS: The preoperative IOP was not significantly different between the 3 groups. Four to 6 hours postoperatively, the acetazolamide group (P=.002) and brinzolamide group (P=.001) had significantly lower IOP than the control group. The same trend was observed at 18 to 24 hours in the brinzolamide group (P=.001) but not the acetazolamide group (P=.018). The IOP levels were not significantly different between the acetazolamide group and brinzolamide group at any postoperative time point. No eye receiving medication and 2 eyes (10%) in the control group had an IOP of 30 mm Hg or higher 4 to 6 hours postoperatively. Compared with preoperatively, an IOP increase of more than 5 mm Hg was seen at 4 to 6 hours in 3 eyes (15%), 2 eyes (10%), and 14 eyes (70%) in the acetazolamide, brinzolamide, and control group, respectively. CONCLUSION: Brinzolamide was as effective as acetazolamide in preventing IOP elevation 4 to 6 hours after phacoemulsification and more effective than acetazolamide at 18 to 24 hours.     

Long-term results of combined 1-way phacoemulsification, intraocular lens implantation, and trabeculectomy

PURPOSE: To analyze the results of 1-way phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: This retrospective study comprised 42 eyes of 36 patients with glaucoma and cataract who had phacoemulsification with posterior chamber IOL implantation combined with trabeculectomy. The mean follow-up of 28.24 months +/- 10.99 (SD) (range 11 to 52 months) included measurement of intraocular pressure (IOP), visual acuity, visual field, endothelial cell loss, and notation of complications. RESULTS: There was a statistically significant postoperative improvement in visual acuity (P < .001). Mean preoperative best corrected visual acuity (BCVA) was 20/200 (range 20/30 to hand movements). Mean 1 year postoperative BCVA was 20/30 (range 20/20 to 20/60). The preoperative mean IOP of 24.06 mm Hg decreased to 15.36 mm Hg at 1 year (P < .001). All 42 eyes had a postoperative IOP of less than 21.00 mm Hg. Mean central cornea endothelial cell density preoperatively was 2238 +/- 396 cells/mm2 (range 1697 to 2906 cells/mm2) and postoperatively, 2005 +/- 397 cells/mm2 (range 1302 to 2801 cells/mm2). Early postoperative complications consisted of a choroidal detachment in 2 patients (4.76%). Three and 4 days after surgery, respectively, 2 patients (4.76%) had surgery to remove viscoelastic substance under the IOL. Late complications included posterior synechias in 3 eyes (7.14%). One year after surgery, because of a significant decrease in vision, a neodymium:YAG laser posterior capsulotomy was necessary in 2 eyes, 1 with an acrylic IOL (3.70%) and 1 with a silicone lens (9.09%). CONCLUSION: Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy was safe and effective in patients with coexisting glaucoma and cataract.     

Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing

PURPOSE: To compare axial position changes of the intraocular lens (IOL) by measuring anterior chamber depth (ACD) after small-incision cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the IOL and after conventional cataract surgery with phacoemulsification and in-the-bag IOL implantation. SETTING: Department of Ophthalmology, Medical University of Vienna, Austria. METHODS: This prospective comparative study comprised 23 patients (46 eyes) with age-related cataract who had bilateral cataract surgery and implantation of an acrylic IOL (YA-60BB, Hoya). In randomized order, cataract surgery with PPCCC and POBH of the IOL was performed in 1 eye of each patient. In the fellow eyes, conventional phacoemulsification cataract surgery with in-the-bag IOL implantation was performed. The ACD was measured 1 to 2, 6, and 24 hours as well as 7 and 30 days postoperatively using high-resolution partial coherence laser interferometry. A baseline measurement was taken preoperatively in all patients. RESULTS: Ten patients completed 10 to 12 months of follow-up. Postoperatively, the axial IOL position was stable in eyes with PPCCC-POBH (P>.05). In contrast, a significant axial shift of the IOL in the anterior direction was observed in control eyes with in-the-bag IOL implantation (P<.001). The resulting refractive shift was significantly higher in control eyes than in eyes with PPCCC-POBH (P<.001). CONCLUSION: Combined PPCCC and POBH for cataract surgery significantly reduced postoperative anterior movement of the IOL.     

肝素修饰人工晶体植入在抗青光眼术后白内障超声乳化术中的应用

目的观察肝素表面修饰折叠型人工晶体植入对抗青光眼术后白内障超声乳化吸除术后前房炎症反应的影响。方法对60例(88眼)抗青光眼术后白内障患者施行超声乳化吸除术,所有病例随机植入肝素表面修饰折叠型人工晶体或蓝光滤过折叠型人工晶体。应用激光闪光细胞检测仪(Laserflarecellmeter,LFCM)测量并比较术前及术后1天、7天、30天及90天房水的平均闪辉值,以评价前房炎症反应。并观察术前后的视力、眼压及滤过泡和角膜内皮计数情况。结果(1)术前,二组患者房水闪辉值没有显著性差异,植入肝素表面修饰折叠型人工晶体者,手术后7天内的房水闪辉值均明显低于蓝光滤过折叠型人工晶体植入组,而术后30、90天时两种人工晶体植入者之间差异无显著性。两组术后视力均明显提高,眼压控制稳定,角膜内皮功能正常。结论抗青光眼术后白内障手术后眼血-房水屏障功能受损,植入肝素表面修饰折叠型人工晶体能显著减轻白内障术后短期内的炎症反应,增加了手术安全性。     

超声乳化人工晶状体植入术后眼压的观察

目的探讨晶状体超声乳化人工晶状体植入术后早期的眼压变化及术中、术后用药对术后早期的眼压变化影响。方法本组病例均为我院行晶状体超声乳化白内障吸出人工晶状体植入术的住院患者,60例,分4组进行研究。对4组病例于术前、术后2h、4h6、h、8h、10h、12h1、4h2、4h及36h进行眼压测量,并进行组间对比。结果晶状体超声乳化白内障吸出人工晶状体植入术后早期眼压有不同程度升高,术中用缩瞳剂可使术后眼压下降,但仍明显高于术前;术后用醋氮酰胺也可使眼压下降。但在用缩瞳剂后,醋氮酰胺降眼压作用被缩瞳剂的作用所掩盖。术后早期(2小时后)眼压升高,于12小时达高峰,以后眼压逐渐下降,24~36小时已降至术前水平。结论晶状体超声乳化的白内障吸出人工晶状体植入术时术中应使用小量缩瞳剂,术后口服醋氮酰胺,这样可以有效的控制术后眼压。     

Effect of dorzolamide and latanoprost on intraocular pressure after small incision cataract surgery

PURPOSE: To evaluate the effect of dorzolamide 2% and latanoprost 0.005% on intraocular pressure (IOP) after small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective study comprised 102 eyes of 102 consecutive patients scheduled for small incision cataract surgery. The patients were assigned preoperatively to 1 of 3 groups of 34 each: dorzolamide, latanoprost, and control (no treatment). One drop of the assigned medication was instilled immediately after surgery. Intraocular pressure was measured preoperatively and 6 and 20 to 24 hours postoperatively. RESULTS: Six hours after surgery, the mean increase in IOP was 1.9 mm Hg +/- 3.9 (SD) in the dorzolamide group (P = .004 versus control), 2.2 +/- 3.0 mm Hg in the latanoprost group (P = .005 versus control), and 4.8 +/- 5.2 mm Hg in the control group. Twenty to 24 hours postoperatively, IOP decreased a mean of -0.9 +/- 3.5 mm Hg in the dorzolamide group (P = .012 versus control) and increased a mean of 0.3 +/- 3.6 mm Hg in the latanoprost group (P = 0.24 versus control) and 1.3 +/- 4.2 mm Hg in the control group. One eye in the dorzolamide group, 1 eye in the latanoprost group, and 4 eyes in the control group had an IOP of 30 mm Hg or higher 6 hours postoperatively. CONCLUSION: Six hours postoperatively, dorzolamide and latanoprost were effective in reducing the IOP increase after small incision cataract surgery; however, at 20 to 24 hours, only dorzolamide was effective. Neither drug prevented IOP spikes of 30 mm Hg or higher.     

Evaluation of intraocular pressure in the immediate postoperative period after phacoemulsification

PURPOSE: To determine the incidence of hypotony and intraocular pressure (IOP) elevation in the immediate and early postoperative period after temporal posterior limbal phacoemulsification and intraocular lens (IOL) implantation. SETTING: Ambulatory surgical center. METHODS: This prospective analysis comprised 310 eyes that had temporal posterior limbal phacoemulsification with IOL implantation. Surgical parameters included keratome incision of 2.85 mm, incision length of 2.5 mm, peribulbar anesthesia, case-completion IOP of 20 mm Hg, and postoperative lid taping. The IOP measurements were collected preoperatively and 30 minutes and 1 day after surgery. RESULTS: Nineteen eyes (6.1%) had an IOP lower than 5 mm Hg 30 minutes postoperatively in the absence of incision leakage at the paracentesis or keratome sites. Eighteen of the 19 eyes with postoperative hypotony received hydroxypropyl methylcellulose 2% (OcuCoat) and 1 received hypromellose 2% (Cellugel). None of the 23 eyes with an acrylic IOL implanted via a cylindrical lens inserter had an IOP lower than 5 mm Hg postoperatively. Suturing did not significantly affect the incidence of hypotony, and there were no postoperative complications related to hypotony. The mean IOP at 30 minutes was lower than at 1 day in the normal, glaucoma, and glaucoma-suspect groups. Twenty-one normal eyes (8.1%), 5 glaucoma eyes (15.6%), and 1 glaucoma-suspect eye (5%) had an IOP greater than 30 mm Hg 1 day postoperatively. CONCLUSIONS: Postoperative hypotony (IOP <5 mm Hg) occurred in 19 (6.1%) of 310 eyes. At 1 day, IOP higher than 30 mm Hg was more frequent in glaucoma eyes than in normal eyes. Although there were no direct problems related to hypotony at 30 minutes or to elevated IOP (>30 mm Hg) at 1 day, surgeons should be aware of and check for IOP variability (low and high) that can occur in normal, glaucoma, and glaucoma-suspect eyes within the first 24 hours after surgery.