Retinal detachment following extracapsular cataract extraction and posterior chamber intraocular lens implantation.

Fourteen cases of primary retinal detachment after extracapsular cataract extraction and posterior chamber intraocular lens implantation were treated by scleral buckling surgery. Retinal reattachment was achieved in 100% of the cases. All eyes had a postoperative visual acuity of 6/30 or better; in six eyes the visual acuity was 6/12 or better. We attributed our high anatomical success rate to early detection of the retinal detachment, good visibility of the retinal breaks, lack of inflammatory reaction in the vitreous body, and preoperative absence of fixed retinal folds and preretinal membranes.     

Retinal detachment after extracapsular cataract extraction with posterior chamber intraocular lens

The authors reviewed 3065 consecutive cases of extracapsular cataract extraction with posterior chamber lens implant (ECCE-PC IOL) and found the incidence of retinal detachment to be 1.4% overall (44/3065) and 1.7% in a group of eyes followed for at least 1 year (40/2330). Retrospective analysis of the retinal detachment (RD) group (n = 44) showed the patients to be significantly younger than the overall group (n = 3065) (P less than 0.0001). Comparison with an age-matched group of 302 eyes without RD showed higher rates of RD in males (P = 0.0013) and in eyes with axial eye length (AEL) greater than 25 mm (P less than 0.0001). No significant correlation was found between RD and PC IOL manufacturer, phacoemulsification (PKE), or primary discission. Sixty-four percent of RDs occurred within 1 year of cataract operation. Only 10% occurred more than 2 years later. Visual results in eyes with ultimate anatomic success of RD repair (43 of 44 eyes, averaging 15 months follow-up) are substantially better than previously reported in series with other types of IOLs (96% greater than or equal to 20/40 if the macula was not involved, 75% greater than or equal to 20/40 if the macula was involved).     

后房型人工晶体植入术后视网膜脱离

目的 探讨后房型人工晶体植入术后视网膜脱离(retinal detachment,RD)的临床特点和治疗方法。 方法 回顾性分析巩膜扣带术与显微玻璃体视网膜手术结合注气及硅油填充治疗68例68只眼后房型人工晶体植入术后RD患者的临床资料 结果出院时视网膜复位者65只眼，占95.59%，随防6-60个月，视网膜保持平复者占94.12%；随访时视力在0.1以上者54只眼，占79.41%，0.3及其以上者18只眼，占26.47%. 结论 后房型人工晶体眼RD发生的主要原因与一般RD发生的原因相似；针对不同情况采取相应的手术方式，可以使后房型人工晶体眼RD取得较好疗效。(中华眼底病杂志,1998,14:167-169)     

Iris modifications following extracapsular cataract extraction with posterior chamber lens implantation

We prospectively examined 94 eyes of 93 consecutive patients who had planned extracapsular cataract extraction or phacoemulsification with posterior chamber intraocular lens (IOL) implantation. The observed postoperative iris biomicroscopic modifications are described and classified. Iris synechial formation was more frequently observed in eyes with pseudoexfoliation syndrome, when an irregular anterior capsulotomy was performed, when the IOL was other than in the bag, and in cases of postoperative fibrinous exudation. Synechias occurred more frequently in intraoperatively injured iris areas. Pupil capture was the only postoperative iris modification that was observed to affect visual acuity. The maximal postoperative dilation was greater and the pupillary photic reaction was significantly less modified postoperatively (P = .0058) when the IOL was fixated within the capsular bag.     

Cystoid macular edema following extracapsular cataract extraction and posterior chamber intraocular lens implantation

The outcome of clinical cystoid macular edema (CME) was studied in 20 symptomatic eyes in which extracapsular cataract extraction and posterior chamber intraocular lens implantation had been performed. Resolution of symptoms and apparent resolution of the macular edema were observed in 18 (90%) of the 20 cases. Clearing occurred within one year in 14 (78%) of these 18 eyes and in 17 (94%) within two years. In all eyes in which macular edema resolved, visual acuity returned to 20/40 or better. This study suggests that clinical cystoid macular edema occurring in association with a posterior chamber intraocular lens has a relatively favorable course.     

Retinal detachment following implantation of a posterior chamber lens

In a series of 6000 cases of pseudophakia following extracapsular cataract extraction and implantation of Simcoe-type posterior chamber lenses, observed for a minimum of 20 months, the incidence of retinal detachment was 21 cases (0.33%). Significant risk factors include male sex (18/21, 82%), high myopia (axial length, over 25 mm in men), intraoperative rupture and late discussion of the posterior capsule. The frequency of retinal detachment following intracapsular cataract extraction without lens implantation was four times greater than that after extracapsular cataract extraction with implantation of a posterior chamber lens. After intracapsular cataract extraction and implantation of an iris-fixation lens it was eight times greater. Horseshoe tears, most of which were located in the peripheral superior quadrants, were seen in 14 eyes (76%). In three eyes no holes were detected. Reattachment was less successful in eyes with posterior chamber implants than in phakic eyes with retinal detachments.     

白内障囊外摘出及人工晶状体植入术后继发性青光眼

目的探讨白内障囊外摘出及人工晶状体植入术后继发性青光眼的原因。方法对11例术后继发性青光眼进行详细的观察分析。结果发现其主要原因为房角阻塞,瞳孔阻滞,手术创伤及血—房水屏障破坏等。结论术后继发性青光眼原因多种多样,大部分可以预防及药物治愈。     

Exfoliation syndrome and extracapsular cataract extraction with implantation of posterior chamber lens.

Extracapsular cataract extraction followed by implantation of a one-piece posterior chamber polymethylmethacrylate intraocular lens (IOL) into the capsular bag was performed in 25 eyes with exfoliation syndrome and 20 control eyes. The patients were investigated preoperatively and then 1 day, 1 week, 3, 6 and 12 months after surgery. Preoperatively, maximal pupil dilatation was significantly smaller in eyes with exfoliation syndrome compared to controls. During surgery the incidence of complications such as ruptures of the zonule or posterior lens capsule, were higher in eyes with exfoliation syndrome. Furthermore, postoperative complications, such as fibrinoid reaction anterior to the IOL followed by posterior synechias and cell deposits, were more common in eyes with exfoliation syndrome compared to control eyes. The results imply that compared to control eyes, eyes with exfoliation syndrome are likely to present more complications both during extracapsular cataract extraction with implantation of intraocular lenses and postoperatively.     

Combined extracapsular cataract extraction and posterior chamber intraocular lens implantation and trabeculectomy

In a retrospective study in a consecutive series of operations performed by the author, 13 eyes in 10 patients underwent combined extracapsular cataract extraction, posterior chamber intraocular lens (IOL) implantation and trabeculectomy. All had significant cataract and chronic open-angle glaucoma with field loss, uncontrolled or marginally controlled on maximum tolerable medical treatment. All had a postoperative reduction in intraocular pressure. Significant complications included malignant glaucoma (in two eyes) and a late choroidal detachment (in one eye). The indications for and the advantages of the combined procedure are discussed, emphasising the advantages of extracapsular cataract extraction (ECCE) and posterior chamber lens implantation, in patients with chronic open-angle glaucoma (COAG).     

Low-cost high-volume extracapsular cataract extraction with posterior chamber intraocular lens implantation in Nepal.

OBJECTIVE: To improve current clinical practices and ways of thinking about the problem of curable Third-World blindness resulting from cataract. DESIGN: A two-site prospective, nonrandomized, comparative clinical trial. PARTICIPANTS: Patients from 2 distinct surgical venues underwent cataract surgery following the same carefully outlined protocol: 62 consecutive cases from the Tilganga Eye Centre in Katmandu, Nepal, and 207 cases from a remote eye camp in rural Chaughada, Nepal. INTERVENTION: Extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation surgery using a technique developed by Dr. Sanduk Ruit of the Tilganga Eye Centre in conjunction with the Medical Directorate of the Fred Hollows Foundation of Australia. Also presented is the teaching method used to help make local doctors proficient in this technique. MAIN OUTCOME MEASURES: Visual acuity recorded at 2 months after surgery as well as surgical complications. RESULTS: Preoperative visual acuities for the 62 patients from the Tilganga Eye Centre ranged from 20/60 to light perception only (4 patients were untested). At 2 months after surgery, 87.1% had a best-corrected visual acuity of 20/60 or better. There were zero major surgical complications reported from the Tilganga group. Of the 207 patients at the Chaughada eye camp, preoperative visual acuities (recorded for 177 [85.5%]) ranged from 20/200 or greater to light perception only. One hundred eighty-nine (91.3%) of the patients returned for an examination at 2 months after surgery, at which time 54.5% had an uncorrected visual acuity of 20/60 or greater, improving to 74.1% with correction. There were six (2.9%) surgical complications documented at Chaughada. CONCLUSIONS: Because the average operative time using the technique presented here is less than 10 minutes per case and the cost per surgery is less than $20, the surgical results are significant in addressing the massive problem of cataract blindness in the Third World. With some changes in preoperative care, a simplified surgical technique, the development of local lens factories, and the implementation of teaching programs, effective lens implantation cataract surgery can be done in high volume at affordable costs in remote areas of underserved nations.     

Trabeculectomy and extracapsular cataract extraction with posterior chamber lens implantation: A long term study

Extracapsular cataract extraction with posterior chamber lens implantation and trabeculectomy was performed on 15 cataractous eyes in 15 patients: 5 were affected with chronic closed angle glaucoma and 10 with primary open angle glaucoma. This procedure offers the intraocular pressure control expected after trabeculectomy and, at the same time, gives the patients all visual benefits that cataract extraction with intraocular lens implantation warrants, without the introduction of new complications.     

Epithelial downgrowth following wound dehiscence after extracapsular cataract extraction and posterior chamber lens implantation: surgical management

Epithelial downgrowth occurred along a fistulous (nonfiltering) tract containing an incarcerated anterior capsular flap after extracapsular cataract extraction and posterior chamber lens implantation complicated by wound dehiscence. Months later, a YAG posterior capsulotomy was performed before it was realized that posterior capsule opacification was associated with epithelial downgrowth involving the posterior capsule. Surgical management of epithelial downgrowth after extracapsular cataract extraction and posterior chamber lens implantation is discussed, with emphasis on the role of combined cryotherapy, dissection of the retrocorneal membrane, and complete removal of the capsular bag. Histopathologically, we found it difficult to differentiate lens epithelial cells from corneal epithelial downgrowth within the capsular bag, but monoclonal antibody for keratin may help identify corneal epithelial cells.     

Postoperative Mycobacterium chelonae endophthalmitis after extracapsular cataract extraction and posterior chamber intraocular lens implantation

OBJECTIVE: To describe a case of postoperative endophthalmitis caused by Mycobacterium chelonae after extracapsular cataract extraction with posterior chamber intraocular lens implantation. DESIGN: Interventional case report. METHODS: The history and clinical presentation of a 66-year-old female patient, in whom a low-grade delayed-onset endophthalmitis and keratitis developed after extracapsular cataract extraction with posterior chamber intraocular lens implantation, is described. Microbiologic investigations of the scrapings of corneal infiltrate at the cataract incision site, aqueous humor and eviscerated material, and histopathologic study of eviscerated material and an enlarged cervical lymph node were performed. MAIN OUTCOME MEASURES: The clinical, histopathologic, and microbiologic findings in a case of low-grade delayed-onset endophthalmitis. RESULTS: Analysis of the direct smear of both the corneal infiltrate as well as the eviscerated material revealed acid-fast bacilli. M. chelonae was isolated from these specimens. Direct smear and culture of the aqueous humor were negative for bacteria (including mycobacteria) and fungus. Histopathologic examination of the eviscerated material showed a dense infiltration of polymorphonuclear leukocytes in the uveal tissue, extensive necrosis and hemorrhage, and exudates with hemorrhage in the vitreous cavity. Histopathologic examination of the lymph node revealed granulomatous inflammation with caseation necrosis, but did not reveal acid-fast bacilli. CONCLUSIONS: M. chelonae, although infrequent, should be considered an etiologic agent of delayed-onset, postoperative endophthalmitis and early bacterial diagnosis should help in institution of appropriate therapy.     

Management of a posterior capsule rupture in planned extracapsular cataract extraction and posterior chamber lens implantation

Management of zonular dialysis and posterior capsule rupture during extracapsular cataract extraction is described. The Heslin gravity cannula is advocated to maintain the normal structure of the anterior segment in a closed chamber technique. Lens cortical material is stripped away using the manual technique described by Gills and McIntyre to avoid vitreous loss. It is then possible to proceed with posterior chamber lens implantation. If vitreous loss occurs, an adequate anterior vitrectomy with an automated vitreous cutter is recommended. A posterior chamber lens implant is preferred if there is adequate capsule to support the lens.     

Blood-aqueous barrier breakdown after penetrating keratoplasty with simultaneous extracapsular cataract extraction and posterior chamber lens implantation

BACKGROUND: The purpose of this study was to quantify breakdown of the blood-aqueous barrier (BAB) following penetrating keratoplasty (PK) with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure) and compare it with the alterations following PK only. METHODS: This study included 72 eyes after triple procedure and 227 eyes after PK only. The diagnosis for PK was Fuchs dystrophy in 39%, keratokonus in 44%, stromal corneal dystrophy in 3% and avascular corneal scars in 6% of cases. The postoperative topical steroid treatment was standardized in both groups. Aqueous flare was quantified using the laser flare-cell meter (FC-1000, Kowa) at defined postoperative intervals (10 days, 6 weeks, then every 3 months until 1 year postoperatively). Patients with conditions associated with impairment of the BAB were excluded from the study. RESULTS: In the early postoperative course, aqueous flare values (photon counts/ms) were significantly higher in patients with triple procedure (21.9 +/- 11.0) than in patients with PK only (9.8 +/- 3.2; P = 0.001). At 6 weeks postoperatively, aqueous flare returned to normal levels in patients after PK only (5.2 +/- 2.3), whereas patients with triple procedure still showed significantly increased flare values (10.8 +/- 5.6; P = 0.01). At 6 months postoperatively, aqueous flare values of patients with triple had returned to normal levels (6.8 +/- 3.8) and did not differ significantly from those after PK only (5.2 +/- 1.9; P = 0.09). CONCLUSION: Our results indicate that triple procedure causes a more extensive and longer-lasting breakdown of the blood-aqueous barrier than PK only. Quantification of aqueous flare with the laser flare-cell meter is useful in the postoperative follow-up after triple procedure. Further studies are required to investigate the clinical relevance of BAB breakdown on endothelial cell count and the incidence of subsequent immunological graft rejection.     

Retinal detachment with posterior chamber lens]

Pseudophakic retinal detachment was seen in 55 cases out of 13,692 patients that underwent cataract surgery and posterior chamber lens implantation in a 5 year period. The six-month incidence was 0.4%. Main risk factors were: myopia, capsular tear resp. zonular dialysis, and male gender. Sulcus- and capsular bag fixation showed the same incidence. 42% of pseudophakic retinal detachments occurred within the first 12 months after cataract surgery and 84% within the first three years. The resulting cumulation rate is discussed. The outcome of detachment surgery was reduced with increased rate of PVR. No typical localisation of retinal holes was found.     

Comparison of extracapsular cataract extraction with implantation of the artificial lens into the posterior chamber and intracapsular cataract extraction with implantation of the artificial lens into the anterior chamber

Advantages and disadvantages of both methods are presented on the basis of comparison of 1200 cases of intracapsular cataract extraction with anterior chamber lens implantation and 600 cases of extracapsular cataract extraction with implantation of posterior chamber lens. One has to state that in general the preferential method of extracapsular cataract extraction with posterior lens implantation is connected with several complications. The main disadvantage of intracapsular cataract extraction with anterior chamber implantation is--in 66 p.c.--deformation of the pupil. From our point of view this is a problem of cosmetic nature. On the basis of comparison of disadvantages and advantages we are of opinion that both methods are equally suitable for a broad clinical use.     

Anterior chamber maintainer for extracapsular cataract extraction and intraocular lens implantation

An instrument for maintaining a deep anterior chamber during extracapsular cataract extraction is described. This anterior chamber maintainer makes the different stages of extracapsular technique safer and easier to perform.