Control of intraocular inflammation associated with cataract surgery

Major advances in cataract extraction techniques and instrumentation have occurred over the past decade. Smaller incisions, more efficient phacoemulsifiers, and decreased surgical times are a few of the changes that have helped to alleviate postoperative inflammation, but postoperative inflammation continues to be a cause of patient discomfort; delayed recovery; and, in some cases, suboptimal visual results secondary to cystoid macular edema. This article reviews the most recent literature regarding the control of intraocular inflammation associated with cataract surgery.     

Early objective assessment of intraocular inflammation after phacoemulsification cataract surgery

PURPOSE: To evaluate the time course of blood-aqueous barrier (BAB) disturbance in the early period after small-incision cataract surgery. SETTING: Department of Ophthalmology, Vienna University, Vienna, Austria. METHODS: In a prospective study, 15 eyes of 15 patients with age-related cataract had small-incision cataract surgery by phacoemulsification with intraocular lens implantation. Care was taken to minimize trauma to the uvea during surgery. Postoperative inflammation was assessed by measuring aqueous flare and cell count with a laser flare-cell meter. Postoperative measurements were performed hourly for the first 6 hours, every 2 hours until 12 hours, every 4 hours until 40 hours, and every 8 hours until 56 hours. RESULTS: The time course of aqueous flare and cell count differed significantly among patients. The peak inflammatory response in most cases was 1 hour after surgery, with the response decreasing thereafter. The pattern of the time course was classified into subgroups defined by the presence and size of an initial spike immediately after surgery and the intensity of the subsequent inflammatory reaction. A slight increase in flare and cells was seen in the morning hours of the first postoperative day. CONCLUSIONS: Acute BAB disturbance within the first 48 hours after small-incision cataract surgery showed high interpatient variability. However, many differences were not detectable 1 day after surgery.     

Premature elevated intraocular pressure after cataract surgery

We evaluated the frequency of elevated intraocular pressure (IOP) the first 1-3 postoperative days for a group of patients undergoing standard or phacoemulsification extracapsular cataract extraction (ECCE). IOP was measured in the pre and postoperative period using non-contact tonometer. From the 356 operated patients, 21 patients (6%) had early elevated IOP. The frequency of elevated IOP was greater among the patients that received anterior chamber (AC) IOL (25%) as compared to that of patients that received posterior chamber (PC) IOL (5.5%). The viscoelastic substance was responsible for a great percentage of cases (51%). The results show that the majority of elevated IOP is transient, recovered spontaneously or by treatment with carbonic anhydrase inhibitors or beta-adrenergic blockers. Elevated postoperative IOP occurs more frequently in the presence of glaucoma, cataract associated with systemic diseases, in complicated and traumatic cataract.     

Control of intraocular pressure after cataract extraction

We carried out a prospective randomized study in 172 patients undergoing cataract extraction and lens implantation to compare the effects of pilocarpine gel, 1% acetylcholine chloride and 0.01% carbachol on early postoperative intraocular pressure (IOP), to determine the effect of sodium hyaluronate on IOP and to compare the effects of 0.01% carbachol (full-strength) and 0.005% carbachol (half-strength) on IOP, pupil size and brow ache. IOP was measured 3, 6, 9 and 24 hours after surgery, and in the full- and half-strength carbachol groups pupil size and subjective complaints of brow ache were recorded. The mean IOP 3 and 6 hours after surgery was significantly lower in all the treatment groups than in the control groups. At 9 and 24 hours it was significantly lower only in the carbachol groups. The use of sodium hyaluronate was not found to affect the postoperative IOP. There was no difference in postoperative IOP or miosis between the full- and half-strength carbachol groups, but fewer patients in the half-strength group than in the full-strength group reported brow ache at 9 and 24 hours. The results suggest that carbachol is the most effective agent currently available for the management of IOP after cataract extraction.     

Control of inflammation and prophylaxis of endophthalmitis after cataract surgery: a multicenter study

PURPOSE: To compare two different postcataract surgery antibiotic/steroid therapeutic combinations, for clinical results as well as patient satisfaction. METHODS: Prospective randomized clinical trial of patients with bilateral operative cataract. Postoperatively, for 15 days one eye was randomly assigned to therapy with the combination chloramphenicol 0.25%-betamethasone 0.13% gel three times a day (Group 1) and the other to the combination tobramycin 0.3%-dexamethasone 0.1% eyedrops four times a day (Group 2). RESULTS: A total of 142 patients (284 eyes) completed the study. The authors could not detect any significant difference between Group 1 and Group 2 concerning preoperative evaluation, surgical procedure, and complications. Pertaining to the two therapeutic regimens, efficacy, side effects, and clinical findings such as uncorrected visual acuity, intraocular pressure, edema or hyperemia of eyelids and/or conjunctiva, conjunctival and/or ciliary vessels congestion, decreased corneal transparency, corneal edema, Descemet folds, anterior chamber Tyndall and depth, and posterior synechiae were also comparable. Postoperative subjective pain and dry eye sensation were comparable between the two groups, while the gel preparation elicited a significantly more pleasant sensation in the patients (p=0.04). CONCLUSIONS: The motivation for use of a gel is to prolong the permanence of associated drugs on the ocular surface, increasing potency and decreasing concentration of the drug and rate of administration. This in order to improve compliance and decrease potential side effects. Chloramphenicol 0.25%-betamethasone 0.13% gel combination proved to have comparable efficacy, tolerance, and better acceptance by the patients than an aqueous tobramycin 0.3%-dexamethasone 0.1% preparation.     

白内障超声乳化术后混浊人工晶状体置换术

目的探讨白内障超声乳化术后人工晶状体(intraocular lens,IOL)混浊的原因与治疗方法 ,研究改良手术方式以减少手术并发症。方法收集2001年8月至2011年1月在我院因超声乳化白内障吸出联合Hydroview H60M IOL植入术后远期IOL发生混浊的患者14例,在表面麻醉下行IOL置换术,比较术前与术后最佳矫正视力。术中采用IOL剪碎法、旋转法等方式将IOL取出,重新植入STAAR公司疏水性KN-X IOL。将取出的IOL在显微镜下进行观察拍照,用钙特异性茜素红染色并进行病理检查,与未使用的Hydroview H60M IOL对比观察。结果所有病例均成功实施IOL置换术,术后视力为0.4~1.0,有10例IOL重新植入囊袋内,有4例置换的IOL植入睫状沟内。术中晶状体后囊膜破裂1例、晶状体襻残留1例、睫状体出血2例、黄斑囊样水肿2例。混浊IOL茜素红染色呈阳性反应,光学部表面有粗糙的着色颗粒,光学部内有细小颗粒所组成的云雾状或团状着色区。结论 IOL混浊与IOL材质、IOL表面钙离子富集有关,IOL置换术是改善IOL混浊患者视力的有效方法 ,术中使用改良技术可以减少手术期并发症的发生。     

白内障手术相关性眼内炎症的控制

白内障手术相关性眼内炎症是导致术后严重并发症(如角膜水肿、高眼压、黄斑囊样水肿和后囊混浊)的重要因素。炎症反应的程度与手术技术、晶状体类型、炎性疾病史和虹膜色素沉着程度等手术依赖因子密切相关。综述了近几年来减少白内障术后炎症的新技术、新设备和抗炎药物。     

Control of intra-ocular inflammation associated with cataract surgery

Postoperative ocular inflammation following cataract surgery is related to the risk of complications like corneal edema, intraocular pressure spikes, cystoid macular edema, and posterior capsule opacification. The degree of postoperative inflammation following cataract surgery is linked to several surgery-dependent factors such as surgical technique, intraocular lens type, and also patient-dependent factors such as history of inflammatory disease and degree of iris pigmentation. During the past decade, major advances have occurred in cataract surgery techniques, equipment, and pharmacologic strategies that decrease the degree of postoperative inflammation following cataract surgery and reduce patients' risk for inflammation-related complications. This article reviews the most recent literature regarding the control of cataract surgery-induced intra-ocular inflammation.     

Outcomes of acute postoperative inflammation after cataract surgery

PURPOSE: To determine characteristics and final visual and surgical outcomes of patients who experienced early onset postoperative inflammation after cataract surgery and their early and late complications. METHODS: This is a prospective case series of 126 patients out of 1500 cases who underwent cataract surgery and experienced early onset postoperative inflammation during the first 2 weeks after cataract surgery. All the patients received complete ocular examinations at onset of signs and symptoms of inflammation. A total of 110 patients with follow-up examinations between 3 and 30 months after recovery of early onset postoperative inflammation (mean follow-up 11.6 months) were enrolled in the next part of the study to evaluate the final visual and surgical outcomes. Background systemic and ocular diseases, type of surgery, type of intraocular lenses and viscoelastic agent, early and late complications, and final best-corrected visual acuity were studied. RESULTS: Among 1500 patients, 126 cases (8.4%) had early onset postoperative inflammation, 64 cases (50.7%) were male, and 62 cases (49.3%) were female. Early complications were posterior synechia in 9 cases (7.1%), pupillary block in 2 cases (1.5%), and acute rise of intraocular pressure in 6 cases (4.7%). Late complications consisted of posterior capsular opacity in 38 cases (34.5%) and cystoid macular edema in 4 cases (3.2%). Peak of signs and symptoms of inflammation was during 2 weeks after surgery and all patients responded well to topical steroids. Final best-corrected visual acuity (BCVA) was 20/30 and better in 76 cases (69%), between 20/40 and 20/80 in 24 cases (22%), and less than 20/80 in 10 cases (9%). All cases with BCVA less than 20/80 had ocular diseases like choroidal neovascularization scar or age-related macular degeneration, advanced glaucoma, or corneal opacity. CONCLUSIONS: Early onset postoperative inflammation causes pain, decreased vision, and patient anxiety in the acute phase but neither decreases final visual acuity nor has any significant or permanent ocular sequels.     

Metaanalysis of cataract development after phakic intraocular lens surgery

We performed a systematic literature review to determine the incidence of and predisposing factors for cataract after phakic intraocular lens (pIOL) implantation. Of the 6338 eyes reported, 4.35% were noted to have new-onset or preexisting progressive cataract. The incidence of cataract formation was 1.29%, 1.11%, and 9.60% with anterior chamber, iris-fixated, and posterior chamber (PC) pIOLs, respectively. In the PC pIOL group, early cataract formation was related to surgical trauma and late-onset cataract was related to IOL-crystalline lens contact. Analysis of cataract progression in eyes with preexisting cataract showed a progression rate of 29.5% after pIOL surgery. These results suggest that cataract formation is most likely to occur after PC pIOL implantation. Patients with preexisting progressive cataract should be informed about the possibility of cataract progression and possible need for cataract surgery after pIOL implantation. Cataract surgical intervention resulted in restoration of visual acuity.