Penetrating keratoplasty and cataract surgery

Of 46 eyes undergoing simultaneous penetrating keratoplasty and cataract extraction, 25 grafts (54%) remained clear with an average follow-up of 37 months. This low success rate can be party explained by the fact that more than 50% of our patients had unfavourable ocular conditions preoperatively. In case of simultaneous procedures, methods of cataract extraction (ICCE or ECCE) did not have any significant affect on the rate of clear grafts. In eyes with favourable ocular conditions preoperatively, the rates of clear grafts were similar (approximately 75%) in cases of simultaneous operation (21 eyes) and separate operation (8 eyes).     

Deep lamellar keratoplasty combined with cataract surgery

We used a surgical technique that combines deep lamellar keratoplasty, phacoemulsification, and intraocular lens implantation for treating patients with cataract and corneal stromal disease. Deep lamellar dissection of the cornea was first performed with viscoelastic substances (hyaluronate sodium) until the highly transparent Descemet membrane solely remained. We then created a short corneal tunnel to perform phacoemulsification with low vacuum and intraocular lens implantation. The resilience of the Descemet membrane ensured excellent viewing of the whole anterior chamber as well as the surgical conditions of a closed system. At the end of surgery, a full-thickness donor button was sutured into the recipient bed after its Descemet membrane was stripped. This technique was effective in these 4 patients with cataract and dense corneal opacity.     

Outcome of therapeutic penetrating keratoplasty in infectious keratitis.

BACKGROUND AND OBJECTIVE: To study the outcome of therapeutic penetrating keratoplasty in eyes with microbial keratitis. PATIENTS AND METHODS: A prospective database on 134 therapeutic cornea transplants in 134 patients recorded demographic details on age and gender of the patient, indication for surgery, size of the donor and recipient bed, graft clarity, complications, and residual morbidity. Patients included in this analysis had a minimum follow-up of 1 year. All patients underwent therapeutic penetrating keratoplasty by a similar method that involved a donor button that was oversized by 0.5 mm and 16 bites of interrupted sutures. RESULTS: Most of the 134 ulcers needing therapeutic grafts were bacterial (n = 54) or fungal (n = 54). One hundred eighteen eyes had perforation at presentation. One hundred six (90%) of the therapeutic grafts achieved anatomical success. The most common complication of glaucoma occurred in 22% of eyes with presurgical perforated ulcers and 1% of nonperforated ulcers. Persistent epithelial defects were significantly more frequent in grafts of 9 mm or more (P = .05). CONCLUSIONS: Our results confirm that therapeutic penetrating keratoplasty for infections is successful in restoring anatomic integrity in most eyes.     

治疗性角膜移植术临床分析

目的观察角膜移植治疗角膜病的效果及术后并发症.方法对85眼角膜病施行穿透角膜移植60眼,穿透角膜移植联合白内障囊外摘出5眼和联合人工晶状体植入术2眼,板层角膜移植17眼,眼前段重建术1眼.对术后并发症进行分析.结果85眼中视力＜0.05者20眼(23.5%),≥0.05者65眼(76.5%).并发症中排斥反应15眼(17.6%),虹膜前粘连11眼(12.9%),继发青光眼3眼(3.5%),术中损伤晶状体1眼(1.2%).结论此结果显示角膜移植对治疗角膜病是有效的.     

Simultaneous versus sequential penetrating keratoplasty and cataract surgery

PURPOSE: To compare the surgical outcomes of simultaneous penetrating keratoplasty and cataract surgery with those of sequential surgery. METHODS: Thirty-nine eyes of 39 patients scheduled for simultaneous keratoplasty and cataract surgery and 23 eyes of 23 patients scheduled for sequential keratoplasty and secondary phacoemulsification surgery were recruited. Refractive error, regular and irregular corneal astigmatism determined by Fourier analysis, and endothelial cell loss were studied at 1 week and 3, 6, and 12 months after combined surgery in the simultaneous surgery group or after subsequent phacoemulsification surgery in the sequential surgery group. RESULTS: At 3 and more months after surgery, mean refractive error was significantly greater in the simultaneous surgery group than in the sequential surgery group, although no difference was seen at 1 week. The refractive error at 12 months was within 2 D of that targeted in 15 eyes (39%) in the simultaneous surgery group and within 2 D in 16 eyes (70%) in the sequential surgery group; the incidence was significantly greater in the sequential group (P = 0.0344). The regular and irregular astigmatism was not significantly different between the groups at 3 and more months after surgery. No significant difference was also found in the percentage of endothelial cell loss between the groups. CONCLUSION: Although corneal astigmatism and endothelial cell loss were not different, refractive error from target refraction was greater after simultaneous keratoplasty and cataract surgery than after sequential surgery, indicating a better outcome after sequential surgery than after simultaneous surgery.     

Dyschromatopsia following cataract surgery

The authors report on 19 individuals who experienced colour obscurations (dyschromatopsia) following cataract surgery. Although a transient blue discoloration (cyanopsia) might be expected following cataract surgery, an erythropsia (red vision) is more common. Symptoms generally begin after outdoor activity in bright sunlight, vary in duration and are recurrent. It is important to look for a history of drug use, migraine or cerebrovascular accidents.     

Endophthalmitis following cataract surgery

BACKGROUND: Infectious endophthalmitis is a serious complication following cataract surgery, since it often induces a substantial reduction of visual acuity. PATIENTS AND METHODS: We retrospectively evaluated the clinical data of 53 patients with endophthalmitis following cataract surgery who were treated at the department of ophthalmology of the University Hospital in Ulm between 1995 and May 2001.Of these patients, 50 had been referred.Clinical presentation, infecting organism, treatment and visual outcome were analysed with a followup ranging from 2 weeks up to 42 months (median: 6 months). RESULTS: In 52 patients endophthalmitis was preceeded by cataract extraction and IOL implantation, in one case by secondary IOL implantation.Confirmed microbiologic growth was demonstrated from intraocular specimens in 26 out of 41 operated eyes (63%), the most frequent causative organisms were coagulase-negative Staphylococci (50%). All isolated bacteria were sensitive to a combination of the antibiotics vancomycin and amikacin or vancomycin and ceftazidime. 13 patients were treated with intravenous antibiotic therapy alone. In 46% of patients, who were initially treated with intraocular antibiotic injections alone, required further therapeutic intervention for recurrent infection. Only 7.7% of the patients who initially underwent intraocular antibiotic injections combined with IOL removal or pars plana vitrectomy with or without IOL removal, required further surgical intervention. Initial visual acuity was hand movements (median) only but improved during follow-up to 0.2 (median). CONCLUSIONS: In this series all tested bacteria were susceptible to the combination of vancomycin with either amikacin or ceftazidime. Aggressive initial treatment including IOL removal may be associated with a lower frequency of recurrent disease.     

Conductive keratoplasty to correct residual hyperopia after cataract surgery

PURPOSE: To evaluate the efficacy, predictability, safety, and stability of conductive keratoplasty (CK) for correcting residual hyperopia after cataract surgery with intraocular lens implantation. SETTING: Vissum-Instituto Oftalmologico de Alicante, Alicante, and Vissum-Instituto de Albacete, Albacete, Spain. METHODS: Sixteen eyes of 16 patients had CK for the correction of residual hyperopia after cataract surgery. The CK was performed with the CK View Point Refractec (RCS-200, Refractec, Inc.). The follow-up was 12 months. RESULTS: One year after CK, 10 eyes (62.5%) achieved an uncorrected visual acuity (UCVA) of 0.50 or better. The mean UCVA was 0.50 +/- 0.21 (SD), and the mean best spectacle-corrected visual acuity (BSCVA) was 0.68 +/- 0.24. One eye lost 1 line of BSCVA, and none lost 2 or more lines. The mean spherical equivalent refraction was +0.39 +/- 0.84 D 1 year after CK. No vision-threatening complications occurred. CONCLUSIONS: One-year data show that CK for the correction of low to moderate hyperopia after cataract surgery was safe, stable, relatively predictable, and efficient. No complications occurred when CK was performed after phacoemulsification.     

Outcome of cataract extraction and posterior chamber intraocular lens implantation following glaucoma filtration surgery

PURPOSE: To evaluate the outcome of cataract extraction (CE) after glaucoma filtering surgery (GFS). METHODS: A total of 77 eyes (77 patients) who underwent CE with posterior chamber intraocular lens (PCIOL) implantation following GFS by a single surgeon were reviewed. Main outcome measures were preoperative and postoperative intraocular pressures (IOPs), visual acuities, medications, astigmatism, bleb survival, time of surgical failure, complications, and success rate. RESULTS: Mean time interval between GFS and CE was 46.8+/-50.9 months (range, 2-348 months). The mean preoperative IOP was 13.9+/-4.7 mmHg (range 3-27 mmHg) and mean postoperative IOP at 3 weeks was 13.6+/-5.5 mmHg (range, 6-44 mmHg). The mean follow-up was 19.5+/-20.1 months (range, 1.4-73 months; median 10.6 months). Complete success was achieved in 59 eyes (76.7%). The cumulative probability of complete success was 91.3+/-3.7, 82.0+/-5.6 and 78.1+/-6.5% at the end of 6 months, 1, and 2 years, respectively. Visual acuity before CE was < or =20/50 in all eyes (100%). Visual acuity at last visit was > or =20/40 in 33 eyes (42.8 %), 20/50-20/80 in 30 eyes (39.0%), < or =20/100 in 14 eyes (18.2%). Risk factors identified for qualified success included age at CE>60 years, interval of < or =5 months between GFS and CE, use of preoperative glaucoma medications, and postoperative IOP >19 mmHg within 2 weeks. CONCLUSIONS: IOP and bleb function was maintained after CE with PCIOL implantation following successful GFS with good visual recovery.     

婴幼儿先天性白内障摘除术后无晶状体眼青光眼危险因素分析

目的 探讨婴幼儿先天性白内障摘除术后发生无晶状体青光眼的规律和特点.方法 回顾2001年9月至2009年9月间接受先天性白内障手术的婴幼儿患者228例(395只眼).白内障摘除手术两周后眼压高于25mmHg的患儿被视为无晶状体青光眼;术后随访时间为(56±13)月;追踪观察到眼压＞25mmHg的患儿有63只眼(15.9%).结果 对术后患儿术眼眼压观察结果进行统计学危险因素分析:出生后＜3月接受手术患儿,白内障摘除术后发生青光眼的危险性是13～36月接受手术患儿的13.429倍(P=0.001,OR=13.429);出生后3～6月接受手术患儿,发生青光眼的危险性是13～36月接受手术患儿的6.889倍(P=0.008,OR=6.889);在先天性白内障各种晶状体混浊形态中,核性白内障摘除术后无晶状体青光眼发病率最高;其危险性是全白内障的3.759倍(P=0.004,OR=3.759);其它形态的白内障与全白内障比较,术后发生青光眼的危险性没有统计学意义(P＞0.05);合并眼部其它先天异常的患儿,其白内障摘除术后发生无晶状体青光眼的危险性是单纯性白内障的21.382倍(P=0.000,OR值为21.382).结论 年龄过小、核性白内障及合并眼部其他先天性疾病是婴幼儿时期先天性白内障摘除手术后无晶状体青光眼发生的危险因素.

Abstract：

Objective To study and analyze the rules and characteristics of the development of aphakic glaucoma (AG) following infant cataract surgery.Methods A retrospective study of 228 cases (395 eyes)who received cataract surgery in Shengjing Hospital from September,2001 to September,2009.AG was defined as a repeated ocular hypertension (＞25mmHg) over 2 weeks after cataract surgery.The postoperative follow-up was x± s (56± 13) mo.Sixty-three eyes (15.9%) had the presence of AG.Results The OR value of ＜3mo group was 13.429 (P =0.001),3-6 mo group was 6.889 (P=0.008).The patients with nuclear cataract had the highest risk of AG (OR=3.759,P=0.004) among other cataract types.Cataract infants with other ocular abnormalities also had an extremely high risk of AG compared with simple cataract (OR=21.382,P =0.000).Conclusions Cataract surgery in earlier infancy,nuclear cataract and cataract with other ocular abnormalities are likely the risk factors of AG after infant cataract surgery.     

Astigmatism following cataract surgery.

The changes in corneal curvature were determined at regular intervals over a one-year period following intracapsular cataract extraction by microsurgical techniques. During the first postoperative month photokeratometric measurements showed rapid changes in astigmatism associated with large changes in the direction of the axis. Thereafter astigmatism against-the-rule predominated. Data from the small group of patients who underwent surgery in which the technique of phacoemulsification was used show that the smaller changes in corneal curvature are attributable to the smaller incision size and reduced number of sutures. With patients who underwent intracapsular extraction a comparison has been made between the effects of large and small section sizes, and a procedure is outlined whereby surgically induced astigmatism may be minimised.     

Orbital cellulitis following cataract surgery

Orbital cellulitis is an extremely uncommon complication following cataract surgery. Herein, a patient who developed orbital cellulitis less than 24 h after undergoing cataract surgery is described. She responded well to systemic antibiotic treatment and ultimately achieved good visual acuity in the affected eye. The most likely mode of pathogen entry in such cases is considered to be the anaesthetic block given before the cataract surgery. It has been suggested that a careful skin antiseptic preparation before the block is given could prevent this occurrence, but such a preparation did not do so in our case.     

Enterococcal endophthalmitis following cataract surgery

BACKGROUND: Postoperative endophthalmitis can be subdivided into acute and chronic forms which are typically caused by different organisms. Enterococcus faecalis is an organism which normally causes an acute form of endophthalmitis. PATIENTS AND METHODS: We report on four cases of different forms of endophthalmitis following cataract extraction and intraocular lens (IOL) implantation who had been referred to our institution between 1998 and 2001. Enterococcus faecalis was the causative organism in all of them. RESULTS: Two patients presented with an acute form and were immediately treated in our hospital after symptom onset utilizing pars plana vitrectomy with and without IOL explantation. The two other patients were initially treated with subconjunctival and/or systemic antibiotics and steroids over a period of about two months before referral to our hospital. After initial improvement the inflammation exacerbated in these two patients and vitrectomy with or without IOL and capsular bag explantation was performed. The explanted IOL and capsular bag of one patient were examined using scanning electron microscopy and it was shown that the enterococci were adherent to the IOL and the capsular bag. CONCLUSION:Enterococcus faecalis can be the causative organism both of an acute and of a recurrent form of postoperative endophthalmitis. The recurrent form may be caused by organisms which tend to adhere to the IOL and the capsular bag. This should be kept in mind when considering different treatment options.     

Corneal astigmatism following cataract surgery

Seventy-seven cases of intracapsular cataract extraction were analyzed for immediate and long-term induced corneal astigmatic changes. Sutures used were predominantly interrupted, absorbable sutures buried under a limbus-based conjunctival flap. The average induced astigmatism in the first week after surgery was 3.87 diopters with-the-rule. The average induced astigmatism after six weeks was 0.79 diopters against-the-rule. The cause of the induced change is discussed.     

Outcome of cataract surgery associated with posterior staphyloma

Purpose:To assess the outcome of cataract surgery in eyes with staphyloma and identify predictors of surgical success.Setting:Tertiary care referral center.Methods:A retrospective analysis was conducted of 107 consecutive patients with posterior staphyloma and 107 control patients who had cataract surgery. Potential associations of preoperative variables with surgical success were analyzed using the chi-square test, multivariate linear regression, and Student t test.Results:The staphyloma group was younger, had more women, and had a slowmean visual acuity preoperatively than the control group. All patients in the control group and all but 1 in the staphyloma group had intraocular lens (IOL) implantation at the time of cataract extraction. The rates of posterior capsule tear and vitrous loss were similar in the staphylom anad control groups. There was 1 case each of retinal detachment and IOL dislocation in the staphyloma group. The staphyloma group had significantly lower postoperative visual acuity than the control group however, the percentage in the staphyloma group with a visual acuity of finding counting or worse decreased from 80.4% preoperatively to 16.6% postoperative and the percentage with an uncorrected visual equity of 20(160 or better from 5.6% to 67.3%. Myopic degeneration was judge to be the cause of postoperativé acuity worse than 20/100 in 22.4% in the staphyloma and 0% in the control group; other causes for poor postoperative acuity were similar in the 2 groups. In the staphyloma but not the control group decreased-postoperative acuity was independently associated with age greater than 65 years and extra length greater than 29.0 mm.Conclusion:Myopic degeneration may limit the results of cataract extraction in up to one fourth of patients with posterior staphyloma. Nevertheless, a substantial improvement in mean visual acuity resulted that was not associated with a siginificant increase in surgical complications.