后房型人工晶体巩膜缝线固定术

本研究主要探索白内障囊内摘除术后或白内障囊外伴后囊破损者，采用巩膜缝线固定技术植入后房型人工晶体的临床效果及并发症。２３例（２３眼），１３眼为白内障囊内摘除无晶体眼，１０眼为白内障囊外摘除术后后囊破裂或外伤性白内障后囊不完整，用巩膜缝线固定晶体襻技术植入后房型人工晶体。本组病例随访３－１６个月（平均８．３个月），视力在４．７（０．５）以上者２１眼，５．０（１．０）以上者１３眼，未发现严重手术并发症     

When may the posterior capsule be preserved in pediatric intraocular lens surgery?

PURPOSE: To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood. DESIGN: Noncomparative case series. PARTICIPANTS: Patients 1 to 13 years old who underwent cataract extraction with intent to preserve the posterior lens capsule and PCIOL implantation between January 1992 and December 1998 at a pediatric hospital. METHODS: Medical records were reviewed to determine the frequency and timing of posterior capsule opacification (PCO) after PCIOL surgery with preservation of an intact posterior capsule. Comparison of pseudophakic PCO rates for groups defined by age and several possible risk factors. Assessment of safety and efficacy for PPC with anterior vitrectomy performed through a limbal incision in cases where the posterior capsule could not be preserved. MAIN OUTCOME MEASURES: Need for neodymium:yttrium-aluminum-garnet laser capsulotomy or surgical membranectomy to treat PCO. RESULTS: PCO occurred in 40% of 30 eyes with intact posterior capsule. Mean follow-up duration was 22 months for eyes that had PCO develop and 24 months for those in which the posterior capsule remained clear. Laser capsulotomy was required for 64% of 14 eyes in the 1- to 6-year-old age range but for only 19% of 16 in the 6- to 13-year-old range (P < 0.05). Mean time from surgery to PCO was 7 months for the younger group and 13 months for the older group. A need for repeated capsulotomy (one eye) or membranectomy with anterior vitrectomy (two eyes) was found only in the younger age group. There was no association of PCO with trauma history, cataract type, residual lens cortex, IOL position, or postoperative fibrin clot. Final vision was possibly compromised as a result of PCO in one eye with amblyopia. None of 24 eyes in which PPC with anterior vitrectomy was performed out of intraoperative necessity before primary PCIOL implantation had secondary opacification develop. No reduction in postoperative vision was attributable to PPC. CONCLUSIONS: PPC seems to be advisable for children less than 6 years old when cataract extraction with PCIOL implantation is performed. Preservation of the posterior capsule remains appropriate for older children with pseudophakia.     

基于超声生物显微镜图像分型的先天性白内障摘出术后后发性白内障的手术设计及疗效观察

目的　基于超声生物显微镜（ultrasound biomicroscope，UBM）对先天性白内障摘出术后后发性白内障（posterior capsular opacification，PCO）图像特征的影像学分类，探讨PCO类型与手术方式选择的关系。方法　对在广州市妇女儿童医疗中心行先天性白内障摘出术，术后采用水囊式UBM成像技术进行检查，并确诊为PCO的27例（40眼）患儿的UBM检查结果进行分析。根据UBM图像特征将PCO分为3组，并根据分型实施不同的手术方式:膜性纤维化型组采用Nd:YAG激光晶状体后囊膜切开术，皮质再生型组采用前段玻璃体切割术，混合型组采用前段玻璃体切割联合电子撕囊术。术后定期随访并复查UBM。结果　全部术眼术中视轴区混浊均被清除，晶状体后囊膜中央切口均为直径3.0~4.0 mm的圆形透明区，PCO手术的成功率为100%。术后随访6~30个月，膜性纤维化型组20眼中2眼发生虹膜粘连、瞳孔膜样闭锁，再次手术，采用虹膜后粘连分离联合前段玻璃体切割术治疗，术后未再次复发；皮质再生型组14眼和混合型组6眼术后视轴区均未再次出现混浊。PCO术后总复发率为5.0%。结论　对先天性白内障摘出术后PCO的UBM图像进行分型，有助于最佳手术方式的选择，可达到更好的治疗效果。     

超声乳化术治疗假性剥脱综合征白内障患者的疗效分析

目的：：评估在白内障超声乳化手术时使用适当的手术技巧及相应设备对假性剥脱综合征白内障患者的视力及术中、术后并发症的影响。方法：回顾性研究。选取53例67眼假性剥脱综合征白内障患者接受超声乳化及人工晶状体植入术。平均年龄71.68±9.96(53~89)岁,其中男性24例(45%),女性29例(55%),包括核性、皮质性及后囊下和成熟期的白内障。结果：核性白内障较其他类型更为常见(P=0.00)。术前平均最佳矫正视力为0.99±0.30(0.40~1.50) LogMAR,术后平均最佳矫正视力为0.32±0.31(0.00~1.00) LogMAR ( P=0.00)。运用虹膜牵拉器12眼(18%)。囊袋张力环植入15眼(22%),其中按计划植入8眼(12%),未计划7眼(10%)。后囊破裂4眼(6%),其中玻璃体脱出2眼(3%),并接受前段玻璃体切割术;且由于后囊破裂较大,此2眼(3%)转为白内障囊外摘除术。持续性角膜水肿4眼(6%),前房反应5眼(7%)。人工晶体脱位4眼(6%),仅1眼(1.5%)需复位。后囊混浊并接受Nd：YAG激光后囊切开术13眼(20%)。结论：假性剥脱综合征白内障患者术后视力良好,但术中及术后可能出现的并发症包括后囊破裂,玻璃体脱出,转为白内障囊外摘除术,持续性角膜水肿,前房反应及人工晶状体脱位。为避免并发症的发生,适当的手术技巧和相应设备的使用在手术时是必不可少的。     

Phacoemulsification in eyes with past pars plana vitrectomy: case-control study

PURPOSE: To determine intraoperative and postoperative complications and outcomes of phacoemulsification of cataract in eyes that had previous pars plana vitrectomy. SETTING: University-based anterior segment disease referral practice. METHODS: This was a retrospective case-control study of a surgical series of 52 consecutive postvitrectomy cataract extractions statistically compared with control eyes from the same practice. RESULTS: Cataract extraction followed vitrectomy by 2 months to 6 years (mean 19 months). Cataracts with a posterior subcapsular component were seen more frequently in postvitrectomy eyes (58% versus 25% in control eyes). Cataract extraction after pars plana vitrectomy was often more challenging than in control eyes. Challenges included unstable posterior capsules, loose zonules, and posterior capsule plaque. Postoperative posterior capsule opacification (PCO) was more common in study than in control eyes (51% versus 21%; P = .002), especially if expandable gas or silicone oil had been used at vitrectomy. Visual acuity improved in 87% of study eyes, with 46% achieving a visual acuity of 20/40 or better. In study eyes in which the indication for vitrectomy was macular hole or epiretinal membrane, nuclear sclerosis was the most common cataract type, no intraoperative complications occurred, the PCO rate was low (13%), and visual acuity was better (73% 20/40 or better) than in the other study eyes. CONCLUSION: Phacoemulsification after pars plana vitrectomy can be performed with a low complication rate and with good visual results, although limited by underlying retinal disease. Posterior capsule opacification requiring neodymium: YAG capsulotomy was common in this series.     

先天性白内障后发障形成的危险因素分析

目的评价先天性白内障摘除术后导致晶体后囊膜混浊(PCO)的危险因素。方法53例(87眼)先天性白内障病人的临床资料。所有眼均行巩膜隧道切口白内障摘除术,35眼保持后囊膜完整、19眼行后囊连续环形撕囊(PCCC)、33眼行PCCC联合前部玻璃体切除术(AV)。51眼I期植入人工晶体(IOL)。结果平均随访时间为18个月,30眼(34.48%)发生PCO,其中后囊完整组19眼(54.29%)、PCCC组5眼(26.32%)、PCCC AV组6眼(18.18%)。PCO的形成与术中未行PCCC AV(P<0.01)及I期IOL植入(P<0.05)有关。手术年龄越小,PCO形成的几率越大(P<0.05)。结论手术年龄小、I期IOL植入及保持后囊完整是PCO形成的危险因素。     

Primary posterior capsulorhexis without anterior vitrectomy in pediatric cataract surgery: longer-term outcome.

PURPOSE: To assess the effectiveness of primary posterior capsulorhexis without anterior vitrectomy in preventing posterior capsule opacification (PCO) in pediatric cataract surgery. SETTING: Children's Hospital, Dublin, Republic of Ireland. METHODS: The study comprised 32 eyes of 22 pediatric patients who had cataract extraction between 1994 and 1998. Extracapsular cataract extraction was performed using radiofrequency diathermy capsulorhexis to the anterior and posterior capsules without an anterior vitrectomy. Posterior chamber intraocular lens implantation was performed in 20 eyes. There were 23 congenital, 6 developmental, and 3 traumatic cataracts. RESULTS: Patient age ranged from 1 month to 12 years. Mean follow-up was 19 months (range 6 to 50 months). Twenty-seven of 32 eyes (84.4%) had a clear visual axis at last follow-up. Five eyes required a neodymium: YAG capsulotomy, which was performed a mean of 5 months postoperatively (range 1 to 9 months). The incidence of PCO requiring capsulotomy was 15.6%. CONCLUSION: Primary posterior capsulorhexis without anterior vitrectomy was safe and effective, with a low reopacification rate. Long-term follow-up of this patient cohort is necessary.     

高度近视眼白内障术中Ⅰ期后囊膜连续环形撕除术

目的 探讨I期后囊膜连续环形撕除术(Posterior continuous curvilinear capsulorhexis,PCCC)对高度近视眼白内障术后后发障的预防作用.方法 对203例(211只眼)高度近视眼白内障行白内障超声乳化及人工晶状体植入术,其中70只眼术中行连续环形撕除后囊(A组),植入普通聚甲基丙烯酸甲酯(PMMA)人工晶状体;非PCCC组138只眼进一步分为普通PMMA人工晶状体组(B组)73只眼,光学部边缘直角设计的折叠人工晶状体组(C组)68只眼.B组和C组单纯行白内障超声乳化及人工晶状体植入术,保留完整后囊膜.所有患眼术后随访2年以上,观察术后后发障、视网膜脱离等并发症情况. 结果 A组2只眼(2.86%)发生了后发障,B组为18只眼(24.66%),C组8只眼(11.76%),两两对比差异显著具有统计学意义(P＜0.05);A组和C组无视网膜脱离发生,B组仅1只眼发生视网膜脱离. 结论 I期后囊膜连续环形撕除术安全有效,明显减少了高度近视眼白内障术后后发障的发生.     

两种先天性白内障手术方式预防后发性白内障的比较

目的比较2种先天性白内障手术方式预防后发性白内障的临床效果。方法回顾性分析先天性白内障患者89例（98眼）,按手术方式分为2组,A组42例（47眼）为超声乳化白内障摘出＋人工晶状体植入＋后囊膜撕囊术组;B组47例（51眼）为超声乳化白内障摘出＋人工晶状体植入＋后囊膜撕囊＋前段玻璃体切割术组,分别观察2组术后视力和后发性白内障的发生情况。结果A组发生后发性白内障者24眼,占51.06%;其中21眼行YAG激光后囊膜切开,3眼不合作者行手术后囊膜切开术。B组发生后发性白内障者10眼,占19.61%;其中8眼行YAG激光后囊膜切开术,2眼不合作行手术后囊膜切开术。2组术后后发性白内障发生率的比较,差异有统计学意义（P=0.001）。结论与超声乳化白内障摘出＋人工晶状体植入＋后囊膜撕囊术相比,超声乳化白内障摘出＋人工晶状体植入＋后囊膜撕囊＋前段玻璃体切割术能更好地减少先天性白内障术后后发性白内障的发生率。     

囊膜抛光器超声乳化术中抛光的临床效果分析

目的:探讨白内障超声乳化术中运用抛光器行后囊膜抛光,对减少后囊膜混浊(posterior capsule opacification,PCO)的效果。方法:选择我院149例189眼白内障手术患者,其中82例104眼白内障患者在进行白内障超声乳化及人工晶状体植入术中运用抛光器进行后囊膜抛光处理,选择同期67例85眼未行后囊膜抛光患者进行对照。结果:术后6mo,抛光组后囊膜混浊发生11眼(10.6%),对照组后囊膜混浊发生23眼(27.1%)。两组比较有显著差异。术后12mo,抛光组后囊膜抛光组混浊发生17眼(16.3%),而对照组术后后囊膜混浊发生31眼(36.5%)。对照组显著高于抛光组。术后抛光组和未抛光组视力检查发现,1wk时两组之间无明显差异,而术后6mo和12mo时差异具有统计学意义(P<0.05)。结论:白内障超声乳化术中使用抛光器行后囊膜抛光安全有效,明显减少术后后囊膜混浊,能更好的提高患者视力。     

Q开关Nd:YAG激光治疗后囊膜混浊

目的:探讨Q开关Nd:YAG激光后囊膜切开术治疗后囊膜混浊的疗效及安全性。方法:回顾性分析行Q开关Nd:YAG激光后囊膜切开术后囊膜混浊患者165例(193眼),记录手术前后视力、眼压及并发症,并进行统计学分析。结果:①后囊膜一次性切开成功率为100%,所用激光脉冲数平均24±21.7次,激光总能量4~451mJ;②91.2%(176眼)视力较术前提高;③59.6%(115眼)出现一过性眼压升高;手术前后眼压变化与是否植入人工晶状体、所用激光脉冲数以及白内障手术与后囊膜切开术间隔时间有关;④19.3%(32眼)出现人工晶状体损伤。结论:Q开关Nd:YAG激光后囊膜切开术治疗后囊膜混浊安全、有效,但应严格掌握适应证,并合理选择激光参数。     

Phacoemulsification cataract extraction and posterior chamber lens implantation in patients with uveitis

PURPOSE: This study reports outcomes of phacoemulsification cataract extraction and posterior chamber intraocular lens implantation within the capsular bag in patients with uveitis. METHODS: We retrospectively reviewed the charts of 32 patients (39 eyes) with uveitis who underwent phacoemulsification cataract extraction and posterior chamber intraocular lens implantation by two surgeons at The Cleveland Clinic Foundation from January 1990 to June 1998. Patients with less than 3 months of follow-up were excluded. RESULTS: Diagnoses of uveitis included idiopathic (15 eyes), sarcoidosis (10 eyes), pars planitis (four eyes), CMV retinitis (two eyes), Fuchs heterochromic iridocyclitis (two eyes), syphilis (two eyes), and one eye each of tuberculosis, Crohn's disease, HLA-B27 associated, and acute retinal necrosis. Average follow-up was 20 months (range, 3 to 63 months). Best-corrected visual acuity improved in 37 eyes (95%). Average improvement was 4 +/- 3 Snellen acuity lines (range, 1 to 10 lines). Thirty-four eyes (87%) attained final visual acuity better than or equal to 20/40. Visual loss occurred in one eye (3%) with CMV retinitis. No improvement in visual acuity was seen in one eye (3%) that developed a retinal pigment epithelial detachment. Posterior capsule opacification occurred in 24 eyes (62%), 12 of which required Nd:YAG capsulotomy (31%). Other postoperative complications included recurrence of uveitis (41%), cystoid macular edema (33%), epiretinal membrane formation (15%), and posterior synechiae (8%). CONCLUSIONS: Phacoemulsification cataract extraction with posterior chamber intraocular lens implantation is safe in patients with uveitis. The incidences of recurrence of uveitis, cystoid macular edema, epiretinal membrane, and posterior synechiae were lower than those reported previously for extracapsular cataract extraction.     

Posterior capsule opacification after extra capsular cataract extraction in Indian rural population: foldable acrylic vs poly (methyl-methacrylate) intraocular lenses a randomized clinical trial

PURPOSE: To compare the performance of single-piece acrylic vspoly (methylmethacrylate) intraocular lenses (IOL) on the development of posterior capsule opacification (PCO) after conventional extra capsular cataract extraction (ECCE). MATERIALS AND METHODS: One hundred and eighty-two eyes of 91 patients with bilateral senile cataract undergoing ECCE were prospectively randomized to receive a single-piece Alcon AcrySof SA60AT IOL or a single-piece EPOCH polymethylmethacrylate IOL in the first eye to have surgery. At 1, 6 and 12 months post-operative follow-up, digital retro illumination images of the posterior capsule were taken for PCO assessment semi-objectively using PCO (POCO automated analysis software) system. Relationship of anterior capsule contact (total off and partial cover) on optic for PCO was analyzed. RESULTS: The AcrySof IOL was associated with less PCO than EPOCH lens at 6 months (10.01+/-8.75% vs 32.26+/-27.44%; P<0.001) and 1-year (11.65+/-10.55% vs 38.38+/-29.62%; P<0.001) follow-up. The EPOCH IOL showed a remarkably significant difference on development of PCO with anterior capsule overlap on IOL optic (total off and part on) 1 year (P<0.039), whereas no such difference was observed with the AcrySof IOL (P=0.197). CONCLUSION: The AcrySof IOL led to significantly less PCO than the EPOCH IOL post-operatively after extracapsular cataract extraction.     

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery

PURPOSE: To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and intraocular lens (IOL) design and material on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. SETTING: Tertiary care institution in India. PATIENTS: Sixty-four eyes of 52 children ranging in age from 3 months to 12 years who had cataract extraction with IOL implantation were prospectively evaluated for a minimum postoperative period of 2 years. METHODS: Thirty-two eyes received a hydrophobic acrylic lens with a truncated, square edge and 32, a single-piece poly(methyl methacrylate) (PMMA) lens that was not heparin surface modified. Sixteen eyes in each IOL group had PPC + AV; in the remaining 16 eyes in each group, the posterior capsule was left intact. RESULTS: Postoperatively, 25 eyes in the intact capsule group and 5 in the PPC + AV group developed PCO; the difference between groups was significant (P<.05). Of eyes with an intact capsule, 12 with an acrylic IOL and 13 with a PMMA IOL developed PCO (P>.05). In the PPC + AV group, 2 eyes with an acrylic IOL and 3 with a PMMA IOL developed PCO (P>.05). Overall, 14 eyes with an acrylic lens and 16 eyes with a PMMA lens developed PCO (P>.05). After surgery, there was a significant short-term delay in the development of PCO in the acrylic group (14 eyes; mean 6.66 months +/- 1.57 [SD]) compared to the PMMA group (16 eyes; mean 3.16 +/- 0.83 months) (P<.05). CONCLUSIONS: It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.     

Complications after rupture of the lens capsule with vitreous body prolapse during routine cataract operations

PURPOSE: To evaluate the rate of complications and visual outcome after vitreous loss due to an unintended rupture of the posterior lens capsule during routine cataract surgery. PATIENTS AND METHODS: The study included 32 consecutive patients who underwent planned cataract surgery by extra-capsular extraction or phacoemulsification during which the posterior lens capsule ruptured and vitreous prolaps occurred. In all patients, the same surgeon was called to continue with the operation. After substantial transpapillary vitrectomy, a posterior chamber lens was implanted in all patients. The pseudophakos was transsclerally fixed in 12 patients. Mean follow-up time was 20.9 months (range, 1.5 to 71.6 months). RESULTS: The list of complications included cystoid macula edema in 2 patients (2/32 or 6.2%), persisting corneal endothelial decompensation in 1 patient (1/32 or 3.1%), and dislocation of the pseudophakos in one patient (1/32 or 3.1%). Rhegmatogenous retinal detachment did not occur. Compared with the preoperative status, visual acuity increased in 26 patients (26/32 or 81%). Visual acuity of equal or better than 20/30 was achieved in 15 eyes (15/32 or 47%). In 5 eyes (5/32 or 16%), visual acuity was equal to or better than 20/25. CONCLUSIONS: In eyes with a ruptured posterior lens capsule during routine cataract surgery eventually requiring vitrectomy, frequencies of complications are relatively low, if all vitreous adherent to the edges of the lens capsule rupture is removed by substantial transpapillary vitrectomy, and if in doubt of a sufficient lens capsule support for the posterior chamber lens, the pseudophakos is fixed by transscleral sutures.     

不同类型白内障患者术后晶状体后囊膜混浊发生率的比较

目的 比较不同类型白内障患者术后晶状体后囊膜混浊发生率。设计 回顾性病例系列。研究对象 2007-2008年在石家庄市第一医院同一医师施行的超声乳化白内障吸除及人工晶状体植入术的2069眼。其中,单纯老年性白内障1574眼、糖尿病性白内障305眼、高度近视并发白内障165眼,陈旧性葡萄膜炎并发白内障25眼。方法 于术后2年进行视力、裂隙灯、眼底检查,观察记录晶状体后囊膜混浊程度,并根据Hayashi方法进行混浊分级。主要指标 晶状体后囊膜混浊发生率。结果 单纯老年性白内障组后囊膜混浊128眼（8.13%）,糖尿病性白内障组39眼（12.79 %）,葡萄膜炎并发白内障组4眼（16.00%）,高度近视并发白内障组36眼（21.82%）。4个组比较,后囊膜混浊发生率之差异有统计学意义（χ2=35.377,P=0.000）。1级后囊膜混浊发生率各组相近：单纯老年组60眼（3.81%）,糖尿病组6眼（1.97%）,葡萄膜炎组1眼（4.00%）,高度近视组5眼（3.03%）;2级后囊膜混浊发生率糖尿病组较高,20眼（6.56%）;3级后囊膜混浊发生率高度近视组较高,24眼（14.55%）。4组患者后囊膜混浊程度之间比较有显著差异（χ2=105.55,P=0.000）。结论 单纯老年性白内障术后后囊膜混浊发生率较低,高度近视组后囊膜混浊发生率较高,混浊程度较重。（眼科, 2014, 23： 91-93）     

Posterior capsule opacification and neodymium: YAG capsulotomy rates with AcrySof acrylic and PhacoFlex II silicone intraocular lenses

PURPOSE: To compare the incidence and severity of posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates between AcrySof(R) MA30BA acrylic (Alcon) and PhacoFlex(R) II SI-40NB silicone (AMO) intraocular lenses (IOLs). SETTING: Outpatient Cataract Surgery Center, TLC Eyecare and Laser Center, Jackson, Michigan, USA. METHODS: AcrySof and PhacoFlex II IOLs were implanted in fellow eyes of 156 patients requiring bilateral cataract extraction. The patients were followed for a mean of approximately 3 years for the incidence and severity of PCO and the Nd:YAG capsulotomy rates. RESULTS: Of the 63 eyes that were free of PCO throughout the study, 42 had the AcrySof IOL and 21 had the PhacoFlex II IOL. Of eyes that developed PCO, the mean severity in the AcrySof group was 16% less than that in the PhacoFlex II group. Of the 50 eyes that had an Nd:YAG capsulotomy, 17 were in the AcrySof group and 33 were in the PhacoFlex II group. All differences between groups were statistically significant (P<.05). CONCLUSION: The AcrySof MA30BA IOL was associated with less PCO proliferation and thus fewer Nd:YAG laser posterior capsulotomies than the PhacoFlex II SI-40NB IOL.     

儿童白内障摘除人工晶状体植入术联合连续环形撕后囊术

目的 评价儿童性白内障摘除人工晶状体植入联合连续环行撕后缀的临床疗效。方法 通过对25例(35眼)儿童性向内障摘除人工晶状体植入联合连续环行撕后囊术,观察后发障等并发症的发生率及视力情况。结果 发现本组儿童性白内障术后脱盲率为 90％,脱残率为 67％,后囊再次混浊 2眼(撕囊口玻璃体增殖)为 6％。结论 儿童性白内障摘除人工晶状体植入联合连续环行撕后囊术,可以有效地防止后发性白内障的发生,保持视轴清亮,绝大部分的患儿术后视力显著提高。     

Cataract in persons over 90 years old

PURPOSE: To evaluate effect of age over 90-ty on cataract surgery course, perioperative period and final corrected visual acuity. MATERIAL AND METHODS: A case series of 34 patients aged over 90 years (39 eyes) undergoing cataract extraction between 1993 - 2000 was studied. Detailed ophthalmological examination (best corrected visual acuity, tonometry, retinometry, anterior and posterior segment exmination, ultrasonography scan A and B), before and after operations was performed. Analyzed data was widen by internal physical examination. RESULTS: ECCE with posterior intraocular lens (IOL) in 38 eyes, and anterior IOL in 1 case (intraopertive posterior lens capsule rupture) implantation was performed. Postoperative course without complications in 35 eyes (89,7%), complications in 4 eyes (10,3%): keratopathy (2), exudative membrane (2). Improvement in visual acuity (defined as at least 2 lines in Snellen tables) was noted in 35 eyes (89,7%). Visual acuity over 0,3 was achieved in 23 eyes (58,9%), over 0,5 in 20 eyes (51,3%). Ocular comorbids: age related macular degeneration 7 eyes (17,9%), glaucomatous atrophy of optic nerve 5 eyes (12,8%), no diabetic retinopathy was diagnosed. CONCLUSIONS: 1. Advance in years is not a contradiction for cataract extraction. 2. Cataract surgery improved visual acuity: to far in 89,7%, to near in 71,8% - comparing with preopertive status. 3. Restoration of visual function, especially in persons with severe visual acuity reduction, has good impact on psychological status of patients. 4. Accurate perioperative care protects patients from serious systemic complications.     

Posterior capsular opacification in pseudophakic eyes with a silicone or acrylic intraocular lens

PURPOSE: To compare posterior capsular opacification in eyes with IOL of two different materials--silicone or acrylic. METHODS: Eighty consecutive eyes undergoing cataract surgery were prospectively randomized in two groups, 40 eyes receiving a silicone (Sl--30NB) and 40 eyes an acrylic (Acrysof MA60BM) intraocular lens (IOL). The same surgeon performed phacoemulsification and the intraocular lens (PHACO IOL) operation in all cases. Patients were re-examined on the first postoperative day, after one week, four months, and 1-2.4 years. Seven eyes were lost to late control. RESULTS: Clinically significant posterior capsular opacification (PCO) (including eyes with capsulotomy already performed) was equally common in both groups; 25% in the silicone group and 19% in the acrylic group (p=0.53). The posterior capsule remained clear in 61% of the silicone and 76% of the acrylic IOL eyes (p=0.18). In the whole study group, 29% of eyes with and 14% without concurrent ocular diseases had significant PCO (p=0.13). In the silicone IOL group, PCO was more common in eyes with concurrent ocular diseases (44%) than eyes without other diseases (10%) (p=0.049). Eyes with acrylic IOL showed no difference in significant PCO, with or without other diseases (18% and 20%, respectively). CONCLUSIONS: In a consecutive series of 80 cataract eyes central PCO was equally common in eyes receiving a silicone or an acrylic IOL. In the silicone IOL group, however, significant PCO was more common if there was concurrent ocular disease, while with the acrylic IOL concurrent ocular disease did not seem to increase the risk of PCO.