Preoperative latanoprost to prevent ocular hypertension after phacoemulsification and intraocular lens implantation.

PURPOSE: To evaluate the efficacy of latanoprost given 2 hours preoperatively to prevent ocular hypertension in the early period after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. SETTING: Departments of Ophthalmology, United Christian Hospital and Prince of Wales Hospital, Hong Kong, China. METHODS: Sixty-four eyes of 64 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 2 groups: application of latanoprost 0.005% 2 hours before surgery or no latanoprost (control). Intraocular pressure (IOP) was measured 3 and 24 hours postoperatively. The anterior chamber was examined for the level of cells and flare using a slitlamp biomicroscope. The level of significance was 5%. RESULTS: The decrease in the mean IOP was not statistically significantly different between eyes receiving latanoprost 2 hours preoperatively and control eyes 3 hours (P =.843) and 24 hours (P =.721) postoperatively. CONCLUSION: A single application of latanoprost given 2 hours before phacoemulsification and PC IOL implantation did not produce a statistically significant IOP-lowering effect when compared with a control group in the first 24 hours after surgery.     

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.     

曲伏前列腺素和卡巴胆碱对白内障术后眼压的影响

目的 评估白内障术中使用曲伏前列腺素和卡巴胆碱对术后眼压的影响.方法 将120例顺利行超声乳化加人工晶状体植入术的白内障患者平均分为4组.A组患者术毕结膜囊内滴入曲伏前列腺素滴眼液1滴,B组患者术毕前房注射卡巴胆碱0.2 mL加结膜囊内滴入曲伏前列腺素滴眼液1滴,C组患者术毕前房注射卡巴胆碱0.2 mL,D组患者术毕不使用药物,作为对照.分别于术前1 d及术后12、24、48 h对4组患者进行眼压测量,并对各组间的测量结果 进行比较.结果 A组、D组间各时间点眼压相比差异无统计学意义(P>0.05);B组、C组术后12、24 h眼压与D组相比差异均有统计学意义(P<0.01),但术后48 h眼压与D组相比差异无统计学意义(P>0.05);B组、C组各时间点间眼压相比差异无统计学意义(P>0.05). 结论 与对照组相比,白内障超声乳化加人工晶状体植入术中使用曲伏前列腺素不能降低患者术后眼压;使用卡巴胆碱可在术后早期(24 h内)明显降低眼压;曲伏前列腺素和卡巴胆碱联合应用不会产生协同或拮抗作用.(中国眼耳鼻喉科杂志,2009,9:155-156)     

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.     

Effects of topical dorzolamide on IOP after phacoemulsification with different types of ophthalmic viscosurgical devices

PURPOSE: To evaluate the effect of topical dorzolamide on postoperative intraocular pressure (IOP) after routine phacoemulsification surgery with different type of ophthalmic viscosurgical device (OVD). METHODS: Patients who were scheduled for phacoemulsification with intraocular lens (IOL) implantation were evenly divided into four groups. Group I (83 eyes) received one drop of topical dorzolamide immediately after surgery and 1.4% NaHa (BD Visc) was used as a cohesive OVD during IOL implantation. Group II (83 eyes) did not receive any topical antiglaucoma medication after operation and 1.4% NaHa was used as a cohesive OVD. Group III (83 eyes) received topical dorzolamide and 1% NaHa (Healon) was used, and Group IV (83 eyes) did not receive any topical and 1% NaHa was used in operation. Mean postoperative IOPs were compared between groups. RESULTS: Eyes with 1.4% NaHa usage (18.2+/-9.2 mmHg) had higher mean postoperative IOPs than eyes with 1% NaHa usage (15.5+/-5.3 mmHg) (p=0.002). Mean postoperative IOPs were lower in eyes with dorzolamide application (15.6+/-7.2 mmHg) than in eyes without any medication (18.1+/-8.5 mmHg) both in eyes with 1.4% NaHa and 1% NaHa usage (p=0.003). Dorzolamide application caused an average 2.5 mm decrease in mean postoperative IOPs in both groups. CONCLUSIONS: Effects of OVDs on IOP rises after phacoemulsification surgery are closely related to their molecular structure. Increase in viscosity rendered higher postoperative IOP increments. However, topical dorzolamide application effectively reduced postoperative IOP increments in eyes with both Healon and BD Visc use.     

Effect of antiglaucoma agents on postoperative intraocular pressure after cataract surgery with Viscoat

PURPOSE: To compare the effectiveness of brinzolamide 1%, brimonidine 0.2%, acetazolamide 250 mg, intracameral acetylcholine, and timolol 0.5% in preventing intraocular pressure (IOP) peaks during the early period after phacoemulsification in which sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) was used as the ophthalmic viscosurgical device (OVD). SETTING: Department of Ophthalmology, Baskent University Medical Faculty, Ankara, Turkey. METHODS: This prospective randomized study comprised 185 eyes of 185 patients with uncomplicated cataract scheduled for phacoemulsification using Viscoat as the OVD. Patients were randomly assigned to 1 of 6 groups: postoperative application of topical brinzolamide 1%, brimonidine 0.2%, oral acetazolamide 250 mg, intracameral acetylcholine, timolol 0.5%, or no ocular hypotensive agent (control group). The IOP was measured at baseline (preoperatively) as well as 6 hours, 20 to 24 hours, and 1 week after surgery. RESULTS: The mean preoperative IOP values were not significantly different between the groups. Six hours and 20 to 24 hours postoperatively, the mean IOP was significantly lower in all groups receiving an ocular hypotensive agent than in the control group (P<.01). Six hours after surgery, the mean IOP significantly increased in all groups but was higher in the control group. At 20 to 24 hours, the mean IOP decreased significantly in all ocular hypotensive agent groups but remained significantly high in the control group. One week after surgery, there were no significant differences between the groups. CONCLUSION: Brinzolamide, brimonidine, acetazolamide, intracameral acetylcholine, and timolol had similar effects in reducing IOP increases after phacoemulsification performed using Viscoat.     

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.     

抗青光眼滤过术后白内障摘除术对眼内压长期影响的临床观察

目的探讨抗青光眼滤过术后白内障摘除术对眼内压的长期影响。方法对抗青光眼滤过术后白内障患者69例69眼随机分为三组,分别采用颞侧角巩膜缘切口白内障囊外摘除及人工晶状体植入术(简称ECCE组)(18例18眼)、颞侧角巩膜缘隧道切口超声乳化白内障吸除及人工晶体植入术(简称角巩膜缘超声乳化组)(25例25眼)和上方透明角膜切口超声乳化白内障吸除及折叠式人工晶体植入术(简称透明角膜超声乳化组)(26例26眼),术后平均随访26个月,分别观察眼压和视力并进行比较。结果ECCE组、角巩膜缘超声乳化组、透明角膜超声乳化组术后最后一次随访时平均眼压升高分别为2.75mmHg,1.82mmHg和1.68mmHg,与术前比较,差异均无统计学意义(>0.05);视力改善分别为12眼(70.6%)、23眼(92.0%)和24眼(92.3%);ECCE组与角巩膜缘超声乳化组和透明角膜超声乳化组比较,术后效果低于两种超声乳化组,差异有统计学意义(<0.05),两种超声乳化组间比较,差异无统计学意义(>O.05)。结论抗青光眼滤过术后三种白内障摘除术术后眼压均可有效控制,视力改善,超声乳化白内障吸除术尤其是经透明角膜切口折叠式人工晶体植入术术后长期对眼压影响小,视力恢复快,是目前此类白内障手术的最佳术式。     

Transient corneal edema after phacoemulsification: comparison of 3 viscoelastic regimens

PURPOSE: To evaluate the effect of different viscoelastic substances on the grade and time course of postoperative corneal edema. SETTING: Department of Clinical Sciences/Ophthalmology, Ume? University Hospital, Ume?, Sweden. METHODS: This study comprised 62 patients with otherwise healthy eyes who had routine phacoemulsification and intraocular lens (IOL) implantation. Patients were divided into 3 groups. Group 1 was given Healon GV (sodium hyaluronate 1.4%) at phacoemulsification and IOL implantation. Group 2 was given Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) at phacoemulsification and Healon GV at IOL implantation. Group 3 was given Viscoat at phacoemulsification and Provisc (sodium hyaluronate 1.0%) at lens implantation. The central corneal thickness was measured with ultrasonic pachymetry before surgery and 5 and 24 hours, 1 week, and 1 month after surgery. RESULTS: The mean increase in corneal thickness was significantly greater in Group 1 than in the other 2 groups 5 and 24 hours and 1 week after surgery. CONCLUSIONS: The transient postoperative increase in central corneal thickness was greater in patients receiving Healon GV during phacoemulsification than in patients receiving Viscoat. The use of Provisc or Healon GV for IOL implantation did not affect the postoperative corneal thickness when Viscoat was used for phacoemulsification. The time course of the edema may be explained by a difference between the 2 agents in endothelial protection from ultrasonic, mechanical, or irrigation trauma.     

Comparative effects of latanoprost (Xalatan) and unoprostone (Rescula) in patients with open-angle glaucoma and suspected glaucoma

PURPOSE: To compare, in paired eyes of open-angle glaucoma patients and glaucoma suspects, hydrodynamic and visual changes after 1 month of topical latanoprost in one eye and unoprostone in the other.DESIGN: Single-center, institutional randomized clinical trial.METHODS: After completing a washout period off all topical medication, 25 adults (mean age 54 +/- SEM 2 years) with bilateral open-angle glaucoma or glaucoma suspect status underwent morning (8 to 10 AM) and afternoon (1 to 3 PM) measurements of intraocular pressure (IOP), pulsatile ocular blood flow (POBF), contrast, sensitivity, frequency doubling technology, and Humphrey 10-2 perimetry (HVFA II) in both eyes. Each then started unoprostone 0.15% (Rescula) in one randomly assigned eye and latanoprost 0.005% (Xalatan) in the other. Unoprostone was administered at 8 AM and 8 PM and latanoprost at 8 PM with placebo at 8 AM, both from masked bottles. After 28 days, differences were determined for each measured variable by two-tailed paired t test.RESULTS: Starting from similar baseline IOP levels, after 1 month of treatment, the mean morning IOP values differed according to the topical agent received (16.2 +/- SEM 0.6 mm Hg for latanoprost vs 17.9 +/- 0.7 mm Hg for unoprostone; P =.001). These morning pressures were 2.6 mm Hg lower than baseline in the eyes receiving latanoprost (P <.0001), and 1.6 mm Hg lower in unoprostone-treated eyes (P =.02). Afternoon values were 3.1 +/- SEM 0.6 lower than corresponding baseline in eyes receiving latanoprost, and 2.4 +/- SEM 0.6 mm Hg in unoprostone-treated eyes (P <.0001 from baseline for both medications; interdrug mean IOP difference; P =.04). Eyes receiving unoprostone showed a 1.7-db improvement in frequency doubling mean deviation (P =.03), the only significant visual function change observed. Pulsatile ocular blood flow increased 30% relative to baseline in eyes receiving latanoprost, (P <.0001) and 16% in eyes receiving unoprostone (P =.05) by the morning of day 28. That afternoon, mean POBF had increased 30% (P <.0001) relative to afternoon baseline values among eyes receiving latanoprost and 18% (P =.03) among those receiving unoprostone (interdrug change difference, P =.05). Humphrey perimetry and contrast sensitivity remained stable with both prostanoids.CONCLUSIONS: Both latanoprost and unoprostone produced significant reductions in IOP and increases in POBF, with stable central and perimacular visual function. Latanoprost once daily produced IOP reduction and POBF increases nearly twofold greater than those obtained with unoprostone twice daily. These differences in IOP and POBF change between unoprostone and latanoprost were statistically significant.     

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.     

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.     

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.     

Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients

PURPOSE: To evaluate long-term IOP control after sutureless clear corneal phacoemulsification in eyes with preoperatively controlled glaucoma. SETTING: Institutional study. METHODS: The charts of 345 patients who had uneventful sutureless clear corneal phacoemulsification with acrylic foldable lens (IOL) implantation were retrospectively reviewed. Included were 58 patients with medically controlled open-angle glaucoma and 287 normal controls. Follow-up was 1 to 2 years. Outcome measures were postoperative IOP and number of glaucoma medications. RESULTS: Postoperatively, there was an insignificant decrease in IOP in the glaucoma group; the mean decrease was 1.5 mm Hg +/- 4.4 (SD) at 12 months and 1.9 +/- 4.9 mm Hg at 24 months. The mean number of medications decreased significantly at 12 months (0.53 +/- 0.86) and at 24 months (0.38 +/- 0.9) (P=.04). The control group also had a significant decrease in IOP, with a mean decrease of 0.72 +/- 3.7 mm Hg at 12 months (P=.01) and 1.33 +/- 3.2 mm Hg at 24 months (P<.0001). The decrease in IOP was more pronounced in eyes with a higher preoperative IOP in both the glaucoma and control groups. CONCLUSIONS: These findings suggest that sutureless clear corneal phacoemulsification with foldable acrylic IOL implantation is a relatively simple and efficient surgical option in patients with cataract and well-controlled glaucoma. The approach combines long-term IOP control with fewer medications and leads to rapid visual rehabilitation.     

张力环植入与人工晶状体囊袋内单襻缝线固定两种手术方式的对比研究

目的　比较白内障超声乳化联合囊袋张力环及人工晶状体囊袋内植入术,与白内障超声乳化联合人工晶状体囊袋内单襻缝线固定术两种手术方式治疗白内障合并晶状体不全脱位的临床效果。方法　收集白内障伴晶状体不全脱位33例（41眼）,按手术方式分为两组,其中A组行囊袋张力环及人工晶状体囊袋内植入术,共14例17眼;B组行人工晶状体囊袋内单襻缝线固定术,共19例（24眼）。对两组术后视力、眼压、手术并发症及IOL稳定性等资料进行统计学分析。结果　A组术后最佳矫正视力为0.66±0.15;1眼（5.9%）发生低眼压;5眼（29.4%）发生高眼压;8眼（47.1%）发生人工晶状体-囊袋张力环复合体脱位;12眼（70.6%）发生后发性白内障。B组术后最佳矫正视力为0.72±0.14;8眼（33.3%）发生低眼压;1眼（4.2%）发生高眼压;18眼（75.0%）发生后发性白内障。两组术后最佳矫正视力差异无统计学意义（t=-1.150,P=0.257）;术后低眼压发生率比较,差异有统计学意义（χ²=4.377,P=0.036）;术后高眼压发生率比较,差异有统计学意义（χ²=5.077,P=0.024）。结论　两种手术方法均能有效改善患者视力,达到相似的临床效果。     

Management of large traumatic zonular dialysis with phacoemulsification and IOL implantation using the capsular tension ring

PURPOSE: To report our results and to evaluate the longterm effect of capsular tension ring (CTR) insertion in eyes with large traumatic zonular dialysis that underwent phacoemulsification with posterior chamber (PC) intraocular lens (IOL) implantation. METHODS: This prospective study included 17 eyes of 17 consecutive patients with cataract and large traumatic zonular dialysis (range 80-160 degrees determined pre-or intraoperatively). After insertion of a CTR, phacoemulsification with foldable acrylic PC IOL implantation was performed. Posterior capsule rupture, vitreous loss, best corrected visual acuity (BCVA), intraocular pressure (IOP) in the pre- and postoperative periods and postoperative IOL decentration were recorded. RESULTS: The mean follow-up period was 25.9 months (range 15-35 months). Capsule collapse did not occur in any eye with a CTR. Postoperatively, four eyes developed raised IOP that responded well to medical therapy. An improvement in BCVA was observed in all eyes except one because of co-existing fundus pathology. No IOL was found to be decentrated at the end of the follow-up period, apart from one eye in which the PC IOL was dislocated due to a postoperative trauma, in which an anterior chamber IOL was implanted. CONCLUSIONS: In cases of cataract associated with large traumatic zonular dialysis, implanting a CTR before or during phacoemulsification with an in-the-bag PC IOL is relatively safe technique with a high success rate. The CTR was found to be efficient in preventing IOL decentration in eyes with traumatic zonular deficiency.     

Reduction of intraocular pressure in mouse eyes treated with latanoprost.

PURPOSE: To determine whether topical treatment of mouse eyes with latanoprost alters intraocular pressure (IOP). METHODS: In a masked study design, NIH Swiss mice received a 2-microL topical instillation of 0.00015%, 0.0006%, 0.0025%, or 0.01% latanoprost or vehicle (phosphate-buffered saline [PBS]). After 1, 2, or 3 hours, the animals were anesthetized, and a fluid-filled glass microneedle connected to a pressure transducer was inserted through the cornea into the anterior chamber to measure IOP. The reduction of IOP after latanoprost measurement was calculated by the comparison between treated and nontreated eyes in the same mouse. The effect of latanoprost after a single 0.01% dose was also measured at 6, 12, and 24 hours. As in the previous study, the identity of all eye drop solutions was masked. RESULTS: In mouse eyes receiving topical PBS, the mean IOP was 14.8 +/- 2.2 mm Hg (n = 173 males). There was no significant difference in IOP between male and female eyes and between right and left eyes. At 1 hour after topical treatment with 0.00015% or 0.0025% latanoprost, IOP increased by as much as 11% +/- 7%. At 2 and at 3 hours after application, IOP decreased in a dose-dependent manner. These decreases were significant in eyes receiving 0.0025% or 0.01% latanoprost (P < 0.05, Student-Newman-Keuls test) and the largest decrease (14% +/- 8%) was noted 2 hours after treatment with 0.01% latanoprost. At 6, 12, or 24 hours after treatment, there was no difference in latanoprost- and PBS-treated eyes. CONCLUSIONS: Latanoprost reduces mouse IOP in a dose-dependent manner. The mouse may be a useful model for studying the effect of drugs on IOP.     

Cataract surgery in highly myopic eyes corrected by phakic anterior chamber angle-supported lenses(1)

PURPOSE: To assess the incidence of cataract, potential causes of its development, and the outcome of cataract surgery after previous implantation of phakic angle-supported anterior chamber intraocular lenses (AC IOLs) in highly myopic patients. SETTING: Instituto Oftalmológico de Alicante, Department of Refractive Surgery, Spain. METHODS: Two hundred sixty-three highly myopic phakic eyes of 160 patients had implantation of a phakic AC IOL. Follow-up was up to 8 years (range 38.4 to 103.2 months). Eyes that subsequently developed cataract had cataract extraction and were studied during follow-up for clinical association to other preoperative or postoperative data. Cataract surgery was performed after phakic IOL explantation by phacoemulsification and posterior chamber IOL (PC IOL) implantation (Domilens-Chiron AL3). RESULTS: Nuclear cataract developed in 9 cases (3.42%) a mean of 42.91 months +/- 17.7 (SD) after phakic AC IOL implantation. Final best spectacle-corrected visual acuity (BSCVA) was not significantly different from that after phakic AC IOL implantation (P =.25, paired Student t test). Mean endothelial cell loss after cataract surgery was 6.87% +/- 0.42% cells/mm(2). Age at implantation of older than 40 years and axial length greater than 30. 0 mm were the 2 factors significantly related to nuclear cataract development (r = 1.69 and 1.98, respectively; P <.05). CONCLUSIONS: There is a potential risk of nuclear cataract development after phakic AC IOL implantation to correct high myopia in patients older than 40 years and with very high (greater than 30.0 mm) axial myopia. Phakic IOL explantation, phacoemulsification, and PC IOL implantation successfully resolved this complication. The benefits in terms of BSCVA and spherical equivalent obtained after phakic AC IOL implantation were preserved after cataract surgery.     

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.