Spontaneous disappearance of Elschnig pearls after neodymium:YAG laser posterior capsulotomy

Posterior capsule opacification (PCO) from Elschnig pearl formation is a common complication of extracapsular cataract extraction. After PCO treatment by neodymium:YAG (Nd:YAG) laser posterior capsulotomy, Elschnig pearls may undergo hyperproliferation at the edge of the capsulotomy, which may close it. We have seen six eyes in five patients who presented with spontaneous disappearance of Elschnig pearls, resulting in a perfectly clear posterior capsule several years after an Nd:YAG posterior capsulotomy. Possible causes include (1) falling of pearls into the vitreous through the capsulotomy; (2) phagocytosis of pearls by macrophages; (3) cell death by apoptosis.     

Use of a preanesthetic video for facilitation of parental education and anxiolysis before pediatric ambulatory surgery

PURPOSE: To find out whether there is a "hidden" group of patients with posterior capsule opacification (PCO) 5 years after cataract surgery and to establish the incidence of PCO. SETTING: Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden. METHODS: A random sample (n = 164) was selected among patients who had extracapsular cataract extraction (ECCE) with intraocular lens implantation in 1991 (N = 1672). All surgically treated cases that required neodymium:YAG (Nd:YAG) laser capsulotomy (n = 37) within the first 5 years after surgery were recorded. Patients still alive 5 years after surgery who had not had Nd:YAG treatment were offered an eye examination to determine whether PCO requiring capsulotomy existed. RESULTS: Thirty-seven of 110 patients (34%) alive 5 years after surgery had an Nd:YAG capsulotomy during the first 5 postoperative years. Follow-up was possible in 51 of 73 untreated patients (70%). Clinically significant PCO according to specified criteria was found in 7 cases (14%). Half of them would benefit from treatment; the other half had visual impairment from other eye disease. CONCLUSIONS: The estimated incidence of PCO 5 years after ECCE was 43%. Five years after surgery, there was an untreated group with clinically significant PCO, approximately 9% of the surgically treated population. This hidden group must be considered in PCO studies.     

Increased cataract rate and characteristics of Nd:YAG laser capsulotomy in retinitis pigmentosa

BACKGROUND: Retinitis pigmentosa (RP) is associated with the development of a posterior subcapsular cataract (PSC). The development of posterior capsule opacification (PCO) after cataract surgery and a decrease of central visual acuity is sometimes misinterpreted by the patients as natural course of RP. Therefore, therapeutic intervention is often delayed. PATIENTS AND METHODS: In a retrospective study (part 1) the incidence of PCO was evaluated in a group of 26 RP patients who underwent cataract surgery and IOL implantation. In a prospective analyse (part 2) PCO was quantified in 13 RP patients using the standardized photographic technique and image analysis system introduced by Tetz et al. Matched pairs were formed with a control group of 13 patients without retinal disease who matched the RP group in terms of age distribution and postoperative follow-up time. In part 3 the parameters of Nd:YAG laser capsulotomy in 12 RP patients and 14 controls were evaluated. RESULTS: Part 1: The cumulative PCO rate in RP at the end of the first postoperative year was 14.6%, 26.8% in the second, 53.7% in the third and 70.7% after the third year. Nd:YAG laser capsulotomy was performed in 70% of eyes (after 18.4 +/- 14.7 months). In eyes with significant PCO development 70% had PSC preoperatively, while in eyes without PCO formation only 41.7% showed PSC. Part 2: The matched pairs analysis showed a significantly higher PCO value for RP patients (2.11 +/- 1.42) than for the control group (0.89 +/- 0.72) (P = 0.038). Part 3: Average Nd:YAG laser energy levels were 12.8 +/- 11.2 MJ (RP) and 7.6 +/- 6.7 MJ (control). Some 25% of RP patients required further laser treatment of regrown secondary cataract. CONCLUSIONS: Patients with RP showed a significantly higher incidence and density of PCO. Whether RP-specific pathomechanisms are responsible for this needs further investigation.     

Incidence of retinal detachment after cataract surgery and neodymium: YAG laser capsulotomy

The objective of this retrospective study was to determine the incidence of retinal detachment (RD) in patients following cataract extraction with intraocular lens placement and after neodymium:YAG (Nd:YAG) laser capsulotomy. This study comprised 1092 patients (1168 eyes) who had cataract extraction and related procedures between January 1986 and December 1992 identified from the coding and billing database. Of the 1092 patients, 215 (244 eyes) had had Nd:YAG laser capsulotomy. Their charts were reviewed for incidence of RD, and these data were correlated with age, sex, axial length, surgical complications, and other surgical procedures done at the time of cataract extraction. The incidence of RD following phacoemulsification alone was 0.75% (6/799), with a mean time between cataract extraction and RD of 11.6 months. The cases of RD after extracapsular cataract extraction, combined phacoemulsification and trabeculectomy, combined extracapsular cataract extraction and penetrating keratoplasty, and combined phacoemulsification and anterior vitrectomy were too few to draw any conclusions. The incidence of RD following Nd:YAG laser capsulotomy was 0.82% (2/244), with a mean time of 32 months between cataract surgery and capsulotomy and 13.5 months between capsulotomy and RD. There was a statistically significant higher incidence of RD after posterior capsule rupture and anterior vitrectomy than after uncomplicated phacoemulsification (2/12 versus 6/799). In conclusion, the rate of RD after uncomplicated phacoemulsification was less than or similar to the rate found in other recent studies. It was not statistically different from the rate following phacoemulsification and Nd:YAG laser capsulotomy (0.82%). This study confirms the increased risk of RD following posterior capsule rupture and anterior vitrectomy.     

Early central posterior capsular fibrosis in sulcus-fixated biconvex intraocular lenses

A series of 228 eyes implanted with one-piece all poly(methyl methacrylate) (PMMA) biconvex posterior chamber intraocular lenses was examined for posterior capsule opacification. One hundred forty-one eyes (61.8%) had opacification at an average postoperative period of 19.7 months. Seventy eyes (30.7%) developed an unusual form of early central posterior capsular fibrosis (ECPCF), which was confined to the capsulorhexis opening, sparing the peripheral aspect of the anterior and posterior capsules. Risk factors for developing this form of opacification were close apposition of peripheral anterior and posterior capsules caused by placing a posteriorly vaulted biconvex optic anterior to a capsulorhexis opening smaller than the optic diameter. This opacification occurred most often in cases of haptic fixation in the ciliary sulcus. The cumulative capsulotomy rate in this series was 5.26% at three months, 9.1% at 12 months, and 13.2% at 20 months. Of the ECPCF cases, 34.3% eventually required neodymium: YAG (Nd:YAG) laser capsulotomy; the capsulotomy rate for ECPCF was 4.8 times higher than that for Elschnig pearls. Early onset of ECPCF (average onset = 19.4 weeks) resulted in early Nd:YAG capsulotomy (average = 8.0 months after surgery). One-piece all-PMMA biconvex intraocular lenses may promote early central fibrosis of the posterior capsule if the lens optic is anterior to a capsulorhexis opening smaller than the optic diameter. The early onset of this form of opacification predisposes to earlier Nd:YAG capsulotomy with a higher risk of complications.     

Oropharyngeal candidiasis resistant to fluconazole in patients infected by HIV

Uncomplicated extracapsular cataract extraction (EC) followed by posterior chamber lens implantation (PCL) has been shown to cause long-term lowering of intraocular pressure (IOP) in most patients. Since it has been suggested that Neodymium: YAG (Nd:YAG) laser capsulotomy can provoke persistent glaucoma, we examined the hypothesis that Nd:YAG laser capsulotomy may lead to a permanent elevation of IOP. In a case-control study, we compared two groups of 75 normotensive patients, who were unilaterally pseudophakic after phacoemulsification (PE) + PCL. Patients in group 1 had undergone Nd:YAG capsulotomy at least 2 months prior to this study, while in group 2 the posterior capsule was intact. Both groups were selected at random. Prior to surgery, none of the patients had suffered from glaucoma. Goldmann applanation tonometry was performed in both eyes of each patient and from that the ratio of IOP(pseudophakic)/IOP(phakic) was calculated. The distribution of this ratio for the two groups was compared using the Wilcoxon signed-rank test. There were 52 female and 23 male patients in group 1 versus 56 female and 19 male patients in group 2. Their mean ages were 75 + or -11 (group 1) and 75 + or - 9 years (group 2). The mean interval after PE + PCL was 48 + or - 29 months for patients with Nd:YAG capsulotomy and 16 + or - 17 months for patients with intact posterior capsule. Since the Nd:YAG capsulotomy, 28 + or - 23 months had elapsed on average. The median ratio of IOP (pseudophakic)/IOP(phakic) was higher in the Nd:YAG capsulotomy group than in the group of patients with an intact posterior capsule (1.00 vs. 0.80; p < 0.0001). There was almost no percentile, for which the distribution curve of group 1 intersected the curve of group 2. The median IOP in pseudophakic eyes was 14 mm Hg in group 1 and 12 mm Hg in group 2 (p<0.0001). These results are in accordance with the hypothesis that Nd:YAG capsulotomy will raise IOP permanently in most patients. Therefore Nd:YAG capsulotomy may harbor the risk of glaucomatous optic nerve damage in the long run. Long-term follow-up seems advisable in order to prevent possible glaucoma damage.     

The effect of polymethylmethacrylate, silicone, and polyacrylic intraocular lenses on posterior capsular opacification 3 years after cataract surgery

OBJECTIVE: To compare the visual outcome, neodymium:YAG (Nd:YAG) capsulotomy rates, and percentage of posterior capsular opacification (PCO) seen with polymethylmethacrylate (PMMA), silicone, and polyacrylic intraocular lens implants 3 years after surgery. DESIGN: Randomized, prospective trial. PARTICIPANTS: Ninety eyes of 81 patients were examined at a British teaching hospital. INTERVENTION: Ninety eyes were prospectively randomized to receive a PMMA, silicone, or polyacrylic (AcrySof, Alcon, Fort Worth, TX) implant. All lenses had 6-mm disc optics with PMMA haptics. A standardized surgical protocol was performed by a single surgeon using an extracapsular technique with capsulorhexis; any surgical complications were excluded and all patients had standardized postoperative medication and follow-up. MAIN OUTCOME MEASURES: Patients were seen at 6 months and 1, 2, and 3 years after surgery. At 3 years, logarithm of the minimum angle of resolution (LogMAR) visual acuity and Pelli-Robson contrast sensitivity were measured and YAG capsulotomy rates determined. Posterior capsular opacification was assessed objectively by digital retroillumination imaging using dedicated software and calculated as the percentage area of opacified capsule. RESULTS: At 3 years, the overall follow-up rate was 71%: 19 patients were available for examination with polyacrylic lens implants, 22 with silicone, and 23 with PMMA. There was a significant difference in percentage PCO at 3 years among the lens types (P = 0.0001). Polyacrylic lenses were associated with less PCO (10%) than silicone (40%) and PMMA lenses (56%). The YAG capsulotomy rate was 0% for polyacrylic, 14% for silicone, and 26% for PMMA (P = 0.05). The visual acuity and contrast sensitivity were not significantly different among the three groups if patients with age-related macular degeneration and those requiring YAG capsulotomies are excluded. CONCLUSIONS: Intraocular lenses made from polyacrylic are associated with a significantly reduced degree of PCO and lower YAG rates.     

Corneal endothelial cell loss caused by detached opacified anterior lens capsule in the anterior chamber

From 1984 to 1986, we performed cataract surgery through a 1.5 mm anterior capsule hole in 77 eyes. The hole was enlarged to 6.0 mm by a slit incision, and an intraocular lens was implanted into an almost completely intact capsular bag. Twelve (16%) eyes developed severe postoperative anterior capsule opacification. The opacified central anterior capsule, approximately 5 mm in diameter, was detached by can-opener anterior capsulotomy using a neodymium:YAG laser and fell into the inferior anterior chamber. Inferior corneal endothelial cell loss occurred in nine of the 12 eyes within 20 months after detachment; in six of the nine, inferior corneal endothelial cell density decreased 50% more than central cornea cell density. This method will be unsuitable for treating the extensive anterior capsule opacification that will occur when endocapsular cataract surgery that retains most of the lens capsule is widely performed in the future.     

Decrease of capsular opacification with adjunctive mitomycin C in combined glaucoma and cataract surgery

OBJECTIVE: The authors investigated the incidence of capsular opacification requiring YAG capsulotomy after primary trabeculectomy combined with phacoemulsification and implantation of all polymethylmethacrylate intraocular lenses. DESIGN: A prospective randomized study. PARTICIPANTS: One hundred seventy-four eyes of 174 nonselected patients with primary open-angle glaucoma (POAG) were randomized to either no adjunctive mitomycin C (MMC) control group of 93 eyes of 93 patients) or adjunctive subconjunctival MMC (MMC group of 81 eyes of 81 patients) during the primary glaucoma triple procedure (PGTP). INTERVENTION: Primary glaucoma triple procedure with and without MMC and YAG laser capsulotomy for posterior capsular opacification (PCO) was performed. MAIN OUTCOME MEASURES: The incidences of YAG capsulotomy for PCO were compared between the control and MMC groups and also between the control group and the MMC subgroups (1 minute, 3 minutes, and 5 minutes of MMC application) using Kaplan-Meier analysis with Mantel-Cox log-rank test. Cox proportional hazard regression analysis also was performed to identify significant factors affecting capsular opacification. RESULTS: The control and MMC groups were similar in preoperative characteristics. However, the probability of PCO requiring YAG capsulotomy was significantly lower in the MMC group than in the control group (P = 0.004). Among the MMC subgroups, MMC application for 3 minutes was most effective and significant when compared with that of the control group (P = 0.002). Although not as significant as the intraoperative use of MMC (P = 0.002), old age (P = 0.026) and presence of diabetes mellitus (P = 0.035) were also identified as significant beneficial factors for decreasing the incidence of YAG capsulotomy for PCO in Cox proportional hazard regression analysis. CONCLUSION: Intraoperative subconjunctival MMC application during combined glaucoma and cataract surgery has a beneficial effect of inhibiting PCO after combined surgery in patients with POAG. Thus, after intraoperative subconjunctival application of MMC at the concentration of 0.5 mg/ml for 3 minutes, the aqueous MMC level must have been great enough to inhibit the lens epithelial cell proliferation to result in a long-term decrease in PCO.     

Pseudophakic retinal detachment in high axial myopia

PURPOSE: To investigate the effect of extracapsular cataract surgery with intraocular lens (IOL) implantation and neodymium:YAG (Nd:YAG) laser posterior capsulotomy on the rate of retinal detachment (RD) in myopic eyes with an axial length of 27 mm or more. SETTING: Department of Ophthalmology, University of Giessen, Germany. METHODS: This retrospective, nonrandomized study comprised the records of 386 consecutive surgical procedures in 275 patients performed between December 1985 and December 1993. In May 1994, all patients were asked by a mailed questionnaire whether they had had an RD in either eye or laser treatment for posterior capsule opacification. Responses from 190 patients concerning 253 surgical procedures were evaluated. RESULTS: The pseudophakic RD rate was 0.8% (two cases). One patient developed aphakic RD after IOL explanation. One expulsive choroidal hemorrhage occurred during secondary IOL implantation. Four eyes (1.6%) had vitreous loss, and 74 eyes (29.2%) had an Nd:YAG capsulotomy. Mean axial length was 29.2 mm +/- 1.71 (SD), mean follow-up was 3.8 +/- 2 years, and mean age at surgery was 69.8 +/- 12 years. CONCLUSION: Pseudophakia with no other risk factor posed little additional risk for RD in eyes with high axial myopia; however, Nd:YAG laser posterior capsulotomy was a risk factor for pseudophakic RD. Complicated surgery, such as a secondary procedure or vitreous loss, and young age were major causative factors.     

Secondary cataracts in extreme myopia

INTRODUCTION: After cataract surgery there is a higher incidence of posterior capsular opacification (secondary cataract) in myopia than in normal population, and it varies from 40 to 60% [1, 2]. METHODS: Fifty myopic eyes operated for cataract at Prof. Dr. Ivan Stankovitsh Eye Department from 1988 to 1995 were examined for capsular opacification (secondary cataract). Extracapsular cataract extraction was performed in all patients and in 32 patients the posterior intraocular lens was placed. Capsular opacification was classified by type and treated with Nd:YAG laser or discussion at least 9 months to 3 years and 3 months from the operation. RESULTS: There were 13 secondary cataracts (26%) in our series of patients, of whom 22% with intraocular lenses, and 33% were aphakic patients. Visual acuity was 4/60 to 0.5. In 11 patients YAG-laser capsulotomy was performed and in one patient capsular discussion, and in one subject there was no treatment. Consequent visual acuity was 0.3 to 1.0. No correlation was found between the age, type of intraocular lens and capsular opacification. DISCUSSION: Capsular opacification is more often seen in myopic eyes and its treatment is associated with a higher rate of complications (cystoid macular oedema, rupture of anterior hyaloid, retinal detachment...) [3, 4]. It seems that posterior lens implants reduce the chance for development of posterior capsular opacification. The safest treatment is YAG-laser capsulotomy.     

Isolation and characterization of a myotoxic phospholipase A2 from the venom of the arboreal snake Bothriechis (Bothrops) schlegelii from Costa Rica

PURPOSE: To evaluate the cytotoxicity of immunotoxin 4197X-ricin A (4197X-RA) and its ability to inhibit protein synthesis and human lens epithelial cell (LEC) proliferation on the inner surface of the lens capsule. SETTING: Houston Biotechnology, Inc., The Woodlands, Texas. METHODS: A cell culture system was established using human LECs as a model for the proliferation of remnant LECs that occurs during posterior capsule opacification (PCO) after extracapsular cataract extraction. The LEC culture system was also used in vitro for testing compounds that might inhibit this process in vivo. Human LECs were cultured on the surface of the original lens capsule fixed to collagen. Variability was reduced by dissecting each lens capsule into equivalent halves and exposing the segments to immunotoxin 4197X-RA. RESULTS: Protein synthesis and LEC proliferation were almost completely inhibited at relatively low 4197X-RA concentrations after short exposure. The inhibitory effects persisted up to 3 weeks after withdrawal of the immunotoxin and after several media exchanges. CONCLUSION: Immunotoxin 4197X-RA may help prevent PCO after primary cataract surgery.     

Anterior capsule contraction and intraocular lens dislocation in eyes with pseudoexfoliation syndrome

OBJECTIVE: To quantitatively compare the extent of posterior capsule opacification (PCO) after polymethylmethacrylate (PMMA), silicone, and soft acrylic intraocular lens implantation. PATIENTS AND METHODS: A total of 240 eyes from 240 patients undergoing implant surgery were randomized into 3 groups based on the type of lens implanted: PMMA, silicone, and soft acrylic. The density value of PCO in 185 eyes was quantitated approximately 2 years after surgery by a new measurement method using the Scheimpflug videophotography system. RESULTS: Twenty-one eyes (30.4%) in the PMMA group, 4 (5.7%) in the silicone group, and 2 (2.7%) in the acrylic group had already undergone Nd:YAG laser posterior capsulotomy. The mean +/- SD PCO values were 26.3 +/- 12.2 computer-compatible tape steps (CCT) in the PMMA group, 12.0 +/- 8.3 CCT in the silicone group, and 16.0 +/- 10.3 CCT in the acrylic group. The PCO value in the PMMA group was significantly greater than that in the silicone or acrylic group (P < .001). The visual acuity loss in the PMMA group was also greater than that in the silicone or acrylic group (P < .001). CONCLUSION: Based on the PCO value and capsulotomy rate, the PCO was more extensive with the PMMA lens than with either the silicone or soft acrylic lens, which led to visual acuity loss.     

Serial backcross mapping of multiple loci associated with resistance to Leishmania major in mice

PURPOSE: Cataract surgery is often followed by a posterior capsule opacification, usually treated with YAG laser capsulotomy, however, there are huge variations in the incidence figures available in the literature, from 18 to 50% (Sterling & Wood 1986). We have therefore analyzed the incidence of secondary cataracts in a population-based cohort of patients, as revealed by the number of YAG laser capsulotomies performed postoperatively. METHODS: Data for all patients undergoing cataract surgery from 1986 up to and including 1990 in the Lund Health Care District were prospectively recorded, and 4722 patients were retrieved for analysis, using only one eye per patient. The patients had been operated on with extracapsular extraction (phacoemulsification or planned large incision procedure) or a combined trabeculectomy and cataract extraction procedure leaving an intact capsule after surgery. Death dates for each patient were obtained from the Swedish Bureau of Census up to and including 1991. Different risk factors were considered such as sex, age, preoperative axial length, preoperative average keratometry, preoperative intraocular pressure, glaucoma history, diabetes history, uveitis history (including both anterior and posterior uveitis), history of age related macular degeneration and a history of rheumatoid arthritis. We also considered the influence of factors connected to the operation itself on the incidence of secondary capsular haze: extraction mode (ordinary ECCE versus phacoemulsification or trabeculectomy) and the type of implant and the surgeon's surgical activity. RESULTS: Besides age, four variables significantly influenced the risk of having postoperative YAG laser treatment. They were gender, iris sphincterotomy, operation date, and whether the patient came from a rural or an urban region. After about four to five years, the percentage of patients not having had a YAG laser capsulotomy was reduced to around 50% for women and 60% for men. These percentages were based on a survival analysis, minimizing the confounding effect of the limited life span of these elderly patients. CONCLUSIONS: In this material, the most important predisposing factors for YAG laser capsulotomy after extracapsular cataract surgery are: young age, female gender, if the patient was operated late in the period observed, and if the patient came from an urban area.     

Prevention of posterior capsule opacification with the CO2 laser

BACKGROUND AND OBJECTIVE: Posterior capsule opacification (PCO) is a common complication after cataract extraction, despite the modern surgical techniques and lenses being used for this procedure. Its prevention challenged many investigators, because the current treatment of choice, capsulotomy with Nd:YAG laser, is associated with sight-threatening complications. In the present study, the authors investigated two approaches of preventing PCO using the CO2 laser. MATERIALS AND METHODS: A 15-W CO2 laser with a 17- or 18-gauge hollow probe was used on 20 sheep eyes and 14 rabbit eyes. Lens extraction was done by phacoemulsification. In the equatorial treatment study, the anterior chamber was filled with either air or a viscoelastic substance, and laser burns were applied to the equator of the lens capsule and to the peripheral anterior capsule to destroy the epithelial cells. In the capsulotomy study, a primary posterior capsulotomy was created by delivering 1 to 3 laser shots to the capsule behind an implanted intraocular lens (IOL). RESULTS: The CO2 laser was satisfactory in sheep eyes after filling the anterior chamber with air. In rabbit eyes, however, it was technically impractical to work with air. Using a viscoelastic material to maintain the anterior chamber, the hollow probe of the CO2 laser becomes plugged up and therefore is unable to affect the ocular tissue. However, by combining viscoelastic and air pumping, both the destruction of the lens epithelial cells and the creation of a central posterior opening behind a capsular-fixated IOL was repeatedly achieved. CONCLUSION: Using the CO2 laser for destruction of lens epithelial cells and the creation of controlled posterior capsulotomy is feasible and practical. A different design of the probe (closed gauge) is required to enable it to operate clinically in a fluid or viscoelastic environment.     

Anterior capsule contraction and intraocular lens dislocation after implant surgery in eyes with retinitis pigmentosa

OBJECTIVE: The purpose of the study was to investigate the extent of anterior capsule contraction, intraocular lens (IOL) decentration, and tilt after implant surgery in eyes with retinitis pigmentosa (RP). DESIGN: A case-control study. PARTICIPANTS: Forty-seven eyes from 47 patients with typical RP and 47 control eyes from 47 age-matched healthy patients were studied. INTERVENTION: Phacoemulsification surgery with polymethylmethacrylate IOL implantation with continuous curvilinear capsulorrhexis was performed. MAIN OUTCOME MEASURES: The area of the anterior capsule opening obtained with capsulorrhexis and the amount of the decentration and tilt of the IOL were measured using a Scheimpflug photography system at 1 week and 1, 3, 6, 9, and 12 months after surgery. RESULTS: The mean area in the RP group was found to be significantly smaller than that in the control group at 1 month after surgery and later (P < 0.0001). The percent area reduction in the RP group at 6 months was 45.2 +/- 25.8% and 4.6 +/- 13.5% in the control group. Both the decentration length and tilt angle were also greater in the RP group than in the control group. Fourteen (29.8%) of the 47 RP eyes had undergone a neodymium:YAG (Nd:YAG) laser anterior capsulotomy at 12 months after surgery, whereas none of the control eyes had undergone an Nd:YAG. CONCLUSIONS: Anterior capsule contraction in the RP eyes was more extensive than in the control eyes, leading to a high Nd:YAG laser anterior capsulotomy rate. Both lens decentration and tilt also were greater in the RP eyes than in the control eyes.     

Distressed or relieved? Psychological side effects of breast cancer screening in The Netherlands

PURPOSE: To compare three methods of combined cataract extraction and glaucoma surgery. METHODS: Retrospective review of 35 eyes of patients who had extracapsular cataract extraction and trabeculectomy using a corneoscleral incision (SAME), 54 eyes undergoing extracapsular cataract extraction and trabeculectomy using a separated corneal incision for cataract extraction and 43 eyes undergoing phacoemulsification and trabeculectomy. RESULTS: Ninety-one percent of the eyes in the SAME group, 85% of the SEPARATE group and 97% of the phacoemulsification and trabeculectomy group had an IOP < 22 mmHg at 6 months with or without medication (NS). Postoperative visual acuity and astigmatism were not significantly different between the groups. The number of eyes requiring YAG laser capsulotomy was significantly greater in the extracapsular cataract extraction and trabeculectomy (same and separated incision) as compared to the phacoemulsification and trabeculectomy group (P < 0.001). CONCLUSION: Phacoemulsification and trabeculectomy was not significantly more successful than the other methods of combined surgery. Although complication rates were similar, visual rehabilitation was faster and there was a reduced incidence of early posterior capsule opacification.     

Comparison of methods to assess visual impairment from glare and light scattering with posterior capsule opacification

PURPOSE: To compare 2 glare tests to determine their relative usefulness in the assessment of posterior capsule opacification (PCO) and to evaluate the potential benefits of combined visual, acuity, contrast sensitivity, and glare testing. SETTING: Teaching hospital ophthalmology department. METHODS: Sixteen patients had glare, visual acuity, and contrast sensitivity testing before and after neodymium:YAG (Nd:YAG) capsulotomy. Results with the Brightness Acuity Tester (BAT, Mentor), which measures disability glare, and the Straylightmeter (Foundation for Eye Research, The Netherlands), which quantifies forward scatter by direct compensation techniques, were compared. The correlation between glare, ETDRS visual acuity, and Pelli-Robson contrast sensitivity was determined. RESULTS: Pretreatment visual acuity was significantly correlated with contrast sensitivity (P < .01). However, visual acuity and contrast sensitivity were poorly correlated with both the BAT and Straylightmeter (P > .05), indicating that visual acuity is predictive of contrast sensitivity but a poor predictor of glare. Glare was significantly improved (Straylightmeter, P < .0001; BAT, P < .05) following capsulotomy. While the Straylightmeter consistently measured precapsulotomy forward scatter that improved with treatment, corresponding BAT disability glare was unmeasurable in 18.8% of patients with PCO, as their visual acuities improved rather than deteriorated with glare testing. CONCLUSIONS: Glare testing provided more information than contrast sensitivity when combined with visual acuity in the evaluation of PCO. Glare related to PCO is better assessed using the Straylightmeter because the BAT may yield aberrant disability glare results.     

Intraoperative miotics and posterior capsular opacification following phacoemulsification with intraocular lens insertion

BACKGROUND AND OBJECTIVES: Posterior capsular opacification (PCO) is a frequent complication following phacoemulsification with intraocular lens (IOL) implantation. A series of consecutive patients receiving capsular bag-fixated, silicone IOL implants were assessed for both incidence of PCO and the administration of intraoperative miotics. PATIENTS AND METHODS: During a 5-year period, 477 consecutive eyes were retrospectively evaluated. Surgeries were grouped according to intraoperative miotic agent: 0.01% carbachol or 1.0% acetylcholine. Patients receiving no miotic drug served as a control group. Yttrium-aluminum-garnet (YAG) laser posterior capsulotomy was performed on patients with clinically significant PCO. RESULTS: The percentage of eyes requiring YAG laser capsulotomy was similar for the three groups: 21.6% (25 of 91) for the carbachol group, 18.4% (14 of 62) for the acetylcholine group, and 18.6% (53 of 232) for the control group. A chi-squared analysis indicated that the difference among the groups was not statistically significant. The three groups also had similar average follow-up times between surgery and YAG capsulotomy (carbachol group = 52.2 weeks, acetylcholine group = 47.5 weeks, and control group = 48.3 weeks). CONCLUSION: Intraocular miotics do not increase the incidence of PCO.     

Focal corneal decompensation caused by an anterior capsulotomy remnant

Capsule contraction syndrome, an infrequent but sight-compromising condition, can usually be managed by a neodymium:YAG (Nd:YAG) anterior capsulotomy. The anterior capsule can be split from the visual axis to the periphery with multiple spokes. In this patient, however, these spokes closed, leaving the small anterior capsulotomy indistinguishable from its pre-capsulotomy appearance. A subsequent Nd:YAG laser circumcision of the thickened capsulotomy margin restored the patient's sight. The excised capsular doughnut fell into the anterior chamber angle and resulted 34 months later in localized corneal decompensation. Removal of the capsular remnant markedly improved the corneal changes. The experience from this case suggests that multiple Nd:YAG relaxing incisions may be a safer way to manage capsule contraction syndrome than complete circumcision of the anterior capsule. If the latter approach is taken, the capsular remnant should not be cut completely free of the anterior capsule.