Cataract surgery and YAG-laser capsulotomy following vitrectomy for diabetic retinopathy

The present study was initiated to assess time-course and risk factors for the development of cataract and posterior-capsule opacification as well as complications of cataract surgery and YAG-laser capsulotomy following vitrectomy for diabetic retinopathy. The charts of all patients undergoing vitrectomy for diabetic retinopathy during a 5-year period in a university eye hospital were retrospectively reviewed. The course of 306 consecutive eyes in which the lens was retained during vitrectomy was analyzed for subsequent cataract surgery and YAG-laser capsulotomy. The first 6 months after cataract or YAG-laser surgery were examined for the occurrence of complications. Data were analyzed with regard to the time course using Kaplan-Meier life-table analysis. The proportion of eyes that underwent cataract surgery after vitrectomy increased nearly linearly with time, approaching 75% after 5 years. Silicone tamponade (relative risk 1.9; P = 0.0005) and transscleral retinal cryotherapy (relative risk 1.4; P = 0.003) were risk factors for subsequent cataract surgery. No significant cataractogenous effect of intravitreal gas as compared with balanced salt solution was found. YAG-laser capsulotomy was performed in 60% of vitrectomized diabetic eyes within 2 years but in only 10% of nondiabetic controls (P < 0.0001). Within 6 months of extracapsular cataract surgery with implantation of an intraocular lens (IOL) in 54 eyes, no serious complication was observed. After YAG-laser capsulotomy, vitreous hemorrhage occurred within 6 months in 6 of 21 eyes. In conclusion, cataract surgery was performed in 75% of the phakic eyes within 5 years of vitrectomy for diabetic retinopathy. Posterior capsular opacification is particularly common in this subset of eyes. No serious complication was observed after extracapsular cataract surgery with IOL implantation, but YAG-laser capsulotomy was associated with an increased risk for vitreous hemorrhage.     

Secondary intraocular lens implantation after cataract surgery in children

PURPOSE: To report results of secondary intraocular lens implantation after cataract surgery in children. METHODS: We reviewed clinical records for a 5-year period of patients who had cataract surgery in childhood and received a secondary intraocular lens implant. We studied indications for secondary intraocular lens placement; surgical procedures for intraocular lens implantation; preoperative and postoperative visual acuity, refractive error, and binocular status; and complications of the procedure. RESULTS: A secondary intraocular lens was placed in 28 eyes of 25 patients who had cataract surgery in childhood. In 20 eyes, the lenses were placed in the ciliary sulcus. The other eight eyes had insufficient capsular support for an intraocular lens; in two, the intraocular lens was placed in the anterior chamber and, in six, in the posterior chamber with suture fixation to the sclera. Twenty of 28 eyes (71%) had measurable improvement in visual acuity; only one eye had a decrease in visual acuity of 2 lines. Fifteen patients (54%) had a final refraction within 1.50 diopters of the fellow eye; 21 (75%) were within 3.00 diopters. During follow-up, two eyes developed glaucoma. One had transient pressure elevation; one required two filtration procedures. Three patients required Nd:YAG capsulotomy. Six patients demonstrated Worth fusion at distance and near; three demonstrated 200 seconds of arc or better stereo visual acuity. CONCLUSION: Secondary placement of an intraocular lens in the posterior chamber appears to be a safe, effective alternative for correction of aphakia in the contact lens- or spectacles-intolerant child or young adult.     

The future of intervention research at NIOSH

PURPOSE: Analysis of cataract surgery with intraocular lens implantation in children and youth performed between 1990 and 1995 in Bialystok University Eye Clinic. MATERIALS AND METHODS: Twenty patients between 5 and 19 years of age were operated. The subjects comprised 15 cases of traumatic and 5 of congenital cataract. Intraocular lens implantation was performed as a primary procedure in 18 patients and as a secondary procedure in 2 cases. RESULTS: Visual acuity of 5/50 to 5/12 was achieved in 14 patients and 5/10 to 5/5 in 6 patients. Posterior capsule opacification requiring YAG-laser capsulotomy was found in 12 patients (60%). CONCLUSIONS: Intraocular lens implantation may be a safe and effective technique for optical correction in children with traumatic and congenital cataracts.     

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.     

Clear lensectomy and implantation of a low-power posterior chamber intraocular lens for correction of high myopia: a four-year follow-up

PURPOSE: To evaluate the 4-year postoperative outcomes of patients who are highly myopic who underwent clear lensectomy via phacoemulsification and low power posterior chamber intraocular lens implantation. METHODS: The authors performed surgery in 52 eyes of 30 patients in which prophylactic retinal treatment, clear lensectomy, and posterior chamber intraocular lens implantation were used to treat high myopia of 12 diopters (D) or greater. A total of 49 eyes of 28 patients were evaluated at the 4-year postoperative timeframe. Visual acuity, complications, and refractive stability were assessed. RESULTS: The incidence of retinal detachment through 4 years was 1.9%. No new macular complications were observed. Two patients had posterior vitreous detachment without clinical impact between 1 and 4 years after surgery. The incidence of neodymium:YAG (Nd:YAG) capsulotomy was 36.7%. The mean postoperative spherical equivalent was -0.92 D. Four patients had a myopic shift of 0.50 D to 1.00 D from the 1- to 4-year timeframe. Corrected visual acuity of 20/40 or better was achieved in 82% of eyes that had undergone Nd:YAG capsulotomy versus 56% of untreated eyes. Uncorrected visual acuity of 20/100 or better was achieved in 82% of eyes treated with the Nd:YAG laser versus 62% of untreated eyes. CONCLUSION: Visual acuity and refractive outcomes with clear lensectomy are favorable. Retinal detachment remains the major concern of this procedure. Continuous follow-up of these patients is necessary.     

"Adhesive anterior tooth restorations" with the use of dentin bonding with and without a cavity liner

The exfoliation syndrome as a risk factor for lens opacification was investigated with pairwise comparisons of lens opacity, visual acuity, refraction, and anterior chamber depth in 126 eyes of 63 patients with unilateral exfoliation syndrome, and in 84 eyes of 42 patients with unilateral capsular glaucoma. As compared with fellow eyes, the exfoliative eyes showed poorer visual acuity (p < 0.05) and more frequent occurrence of subcapsular cataract (2% vs 8%). Compared with the fellow eyes the lenses in the capsular glaucomatous eyes were more opaque, whether without pilocarpine (p < 0.05), or with pilocarpine treatment (p < 0.0001). Visual acuity was poorer (p < 0.01), refraction more myopic (p < 0.05), and anterior chamber depth less (p < 0.05) in the capsular glaucomatous eyes with pilocarpine treatment. Thus, there are slight changes in the lenses of the exfoliative eyes, the cataractous lens changes being more advanced in the capsular glaucomatous eyes.     

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.     

Extracapsular cataract extraction in diabetic eyes. The role of YAG laser capsulotomy

Cataract surgery may exacerbate preexisting diabetic retinopathy. Especially diabetics with active retinal neovascularisation are at high risk of rubeosis iridis after intracapsular cataract extraction. Thirty-five eyes previously treated with panretinal photocoagulation underwent extracapsular cataract extraction with posterior chamber lens implantation. Twenty-eight eyes with retinal neovascularisation required further Argon laser PRP after surgery. Fourteen eyes required YAG-laser capsulotomy. From the group of eyes without YAG-laser capsulotomy none developed neovascular glaucoma. From the YAG laser capsulotomy group six eyes developed rubeosis iridis and neovascular glaucoma. Our results indicate that eyes in which PRP has been performed, have an excellent prognosis after ECCE with posterior chamber lens implantation only if YAG Laser posterior capsulotomy is not performed.     

Use of intraocular lenses in children with traumatic cataract in south India

AIMS: To assess the long term results of intraocular lens (IOL) implantation for traumatic cataract in young children in a developing country. METHODS: Prospective hospital based study of 52 children (age 2-10 years) undergoing unilateral cataract extraction and IOL insertion for traumatic cataract performed by a single surgeon in south India. Children were reviewed regularly and followed up initially for 3 years. RESULTS: There were no serious operative complications. Clinically significant posterior capsule opacification was almost universal (92%) and YAG capsulotomy or membranectomy was performed on 48 eyes. Some degree of pupil capture affected 35% of eyes and was complete in 6%. Visual acuity was 6/12 or better in 67% of eyes at the last follow up examination. CONCLUSION: The visual acuity results 3 years after implantation of posterior chamber IOLs in older children with traumatic cataracts in south India were encouraging. In developing countries where follow up is unreliable it is essential to plan to clear the axial part of the posterior capsule either at the time of surgery or soon afterwards.     

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.     

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.     

Long-term results of implantation of a plate haptic silicone lens in the capsular sac

BACKGROUND: An important step in developing cataract surgery was the introduction of soft foldable silicone intraocular lenses in the middle 80's. Functional and morphological long-term data are a vital base for definite conclusions on the new material's safety and biocompatibility. PATIENTS AND METHODS: Our study presents the long-term results after the implantation of a silicone posterior chamber lens with solid plate haptic design (STAAR AA-4203). All lenses were folded and implanted through a 4-mm small corneoscleral incision. Our study includes 54 eyes in 52 patients with a mean follow-up period of 56.5 +/- 8.9 months. RESULTS: A visual acuity of 20/40 or better was found in 90.7% of all eyes. All except one of the 33 eyes without any further preexisting ocular pathology at the time of the operation achieved a visual acuity of 20/40 or better. Two thirds of all eyes had a horizontal astigmatism of +1.0 D or less. By slitlamp examination more or less dispersed pigment was seen on the IOL's surface in 46.3%. 83% of the silicone lenses were centrated within 0.5 mm. A YAG-laser capsulotomy was performed in 7 cases (13%). IOL-related intraocular inflammations, cystoid macular edema or an elevated intraocular pressure did not occur in this group. CONCLUSIONS: Our satisfactory long-term results suggest an excellent biocompatibility of the IOL's design and material.     

Comparative results of combined procedures for glaucoma and cataract: II. Limbus-based versus fornix-based conjunctival flaps

BACKGROUND AND OBJECTIVE: One of the variables to be considered in a combined procedure for glaucoma and cataract is the type of conjunctival flap to be used. The objective of this study was to compare the effects of limbus-based and fornix-based conjunctival flaps on postoperative long-term intraocular pressure (IOP) control and visual acuity after combined trabeculectomy with phacoemulsification. PATIENTS AND METHODS: The authors retrospectively reviewed the charts of 189 patients (215 eyes) who underwent combined trabeculectomy with phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and intraoperative mitomycin-C administration and who had a minimum follow-up of 12 months. The results of the limbus-based (151 eyes) versus fornix-based (64 eyes) conjunctival incisions used in these combined procedures were compared. RESULTS: In the limbus-based conjunctival flap group, 146 eyes (97%) achieved an IOP of less than 20 mm Hg, with or without medication; 62 eyes (97%) of the fornix-based conjunctival flap group (P > .05) achieved this result. A visual acuity of 20/40 or better was noted in 106 eyes (70%) in the limbus-based conjunctival flap group and in 45 eyes (70%) in the fornix-based conjunctival flap group (P > .05) at the last examination. Early wound leakage was observed more frequently in the fornix-based conjunctival flap group (8% vs 1%) (P = .014); however, it was not a serious clinical problem, as only 1 eye required surgical repair. Posterior capsular opacification was found more often in the limbus-based conjunctival flap group (25% vs 14%) (P = .072) and required more frequent laser capsulotomy (22% vs 9%) (P = 0.03). CONCLUSION: Limbus-based and fornix-based conjunctival flaps appear to be comparable with respect to postoperative IOP control and visual acuity after a combined trabeculectomy with phacoemulsification and posterior chamber IOL implantation in cases supplemented by intraoperative mitomycin-C.     

Posterior chamber intraocular lens use in children

PURPOSE: The authors report on the efficacy of intraocular lens implantation during pediatric cataract surgery and the results of a consecutive series of intraocular lens implantation in children. METHODS: Twenty-one children underwent implantation of intraocular lenses in 23 eyes. Twenty-one surgeries were primary implantation immediately following anterior lensectomy. Two surgeries were secondary implantations. Primary posterior capsulectomy was performed in 18 of 21 primary implantations. All but two eyes underwent a primary anterior vitrectomy. Topical prednisolone acetate was administered in all cases. Oral prednisone was administered in 17 of 23 cases. Pre- and postoperative visual acuity, cycloplegic refraction, and postoperative complications related to inflammation such as intraocular lens (IOL) capture, IOL decentration, and posterior capsule opacification were examined. RESULTS: Eighteen of 23 eyes have achieved a visual acuity of 20/40 or better. None of the cases in which oral prednisone was used developed complications related to postoperative inflammation. One of the six cases (17%) in which oral prednisone was not used developed such complications. CONCLUSION: Intracular lens implantation accompanied by primary posterior capsulectomy, anterior vitrectomy, and management of postoperative inflammation appears to provide appropriate and safe optical rehabilitation in children.     

Clear lens extraction and implantation of negative-power posterior chamber intraocular lenses to correct extreme myopia

PURPOSE: To evaluate the effectiveness, predictability, and safety of clear lens extraction to correct extreme myopia. SETTING: Clinica de Nuestra Se?ora de la Concepción, Fundación Jiménez Díaz, Madrid, Spain. METHODS: This retrospective study comprised 26 eyes of 17 highly myopic patients who had clear lens extraction and implantation of a negative-power posterior chamber intraocular lens (IOL). The IOL power was calculated using the SRK/T formula. Analyzed were visual and refractive results and intraoperative and postoperative complications. Follow-up was at least 12 months in all cases. RESULTS: Uncorrected visual acuity improved in all cases, with 80.77% of eyes achieving 20/100 or better and 42.30%, 20/40 or better. Best spectacle-corrected visual acuity (BSCVA) improved in 23 eyes (88.46%). The percentage of eyes achieving a BSCVA of 20/100 or better increased from 73.07% preoperatively to 92.30% postoperatively and the percentage achieving 20/40 or better, from 23.07 to 73.07%. Of the 26 eyes, 76.91% were within 1.00 diopter (D) of refractive error and 96.16% were within 2.00 D. No intraoperative complications occurred. Although postoperatively 3 eyes (11.53%) developed choroidal detachment and 5 (19.23%) had an intraocular pressure greater than 25 mm Hg, all had a favorable outcome. Four eyes (15.38%) developed posterior capsule opacification and had a neodymium:YAG laser posterior capsulotomy 6 months postoperatively. No retinal detachments were observed. CONCLUSION: Clear lens extraction with negative-power IOL implantation using the SRK/T formula had good effectiveness, acceptable predictability, and a low morbidity in eyes with extreme myopia over a short follow-up. A longer follow-up with more cases is needed to assess the safety of the procedure.     

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.     

Prothrombin gene G20210-->A transition is a risk factor for cerebral venous thrombosis

OBJECTIVE: The objective of the study was to determine the long-term outcome of patients with uveitis who underwent extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PCIOL) implantation. DESIGN: Retrospective review. PARTICIPANTS: Twenty-eight patients (36 eyes). INTERVENTION: Extracapsular cataract extraction and PCIOL implantation. MAIN OUTCOME MEASURES: Level of best-corrected Snellen visual acuity, change in visual acuity, length of follow-up, long-term findings, and complications. RESULTS: In long-term follow-up (mean, 81.4 months), 94% of eyes had visual acuity improvement compared with preoperative levels. Average change in visual acuity for all eyes was an improvement of 6.4 Snellen lines; 75% of eyes were 20/40 or better. The prevalences of cystoid macular edema (CME), epiretinal membrane (ERM), and posterior capsule opacification (PCO) were 56%, 56%, and 58%, respectively. CONCLUSIONS: Patients with uveitis who are treated with ECCE with PCIOL implantation can have successful visual results in long-term follow-up despite the prevalence of PCO or macular abnormalities such as CME and ERM.     

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.     

Bone disease after liver transplantation should not be underestimated

PURPOSE: To report the management and outcome of cataract surgery and intraocular lens placement in a child with unilateral posterior lenticonus. METHODS: Case report. A 7-year-old boy with a best-corrected visual acuity of RE, 20/200, posterior lenticonus, and cataract underwent a pars plana lensectomy, vitrectomy, posterior chamber intraocular lens insertion into the ciliary sulcus, and central anterior capsulotomy. RESULT: At 2 years of follow-up, best-corrected visual acuity was RE, 20/40. CONCLUSION: This technique allowed complete removal of the opaque posterior lenticonus plaque while preserving the peripheral anterior capsule for sulcus fixation of the posterior chamber intraocular lens.     

A novel ALL-L3 cell line, BALM-16, lacking expression of immunoglobulin chains derived from a patient with hypercalcemia

OBJECTIVE: The purpose of the study is to evaluate whether a posterior capsulectomy combined with anterior vitrectomy is a necessity in pediatric cataract. DESIGN: The incidence of posterior capsule opacification, the need for additional surgical interventions, and the influence of a primary posterior capsulectomy after cataract surgery in children were evaluated. The analysis was carried out by studying patients' records retrospectively or after prospective follow-up. PARTICIPANTS: In 94 eyes (69 aphakic and 25 pseudophakic), the medical records were studied retrospectively. Twenty-eight eyes (18 aphakic and 10 pseudophakic) were observed prospectively during 1 year after surgery. In 20 eyes (6 aphakic and 14 pseudophakic) of 10 patients with bilateral cataract, a prospective comparison between the 2 eyes of the same patient also was carried out. INTERVENTION: Cataract surgery through the limbus with or without a primary posterior capsulectomy was performed in 114 eyes (43 of these received a posterior chamber intraocular lens [IOL] and 71 remained aphakic). In 28 eyes, the surgery was carried out by way of the pars plana (6 eyes received an anterior chamber IOL and 22 remained aphakic). MAIN OUTCOME MEASURES: Incidence of posterior capsule opacification, the need for secondary surgical intervention, and visual acuity were measured. RESULTS: Opacification of the posterior capsule is observed in all children's eyes when a primary posterior capsulectomy (combined with an anterior vitrectomy) was not carried out. Earlier secondary cataract formation is associated with a younger age and with implantation of an IOL. Eyes undergoing a primary opening of the posterior capsule during the initial surgery of children with bilateral cataract achieved, in most cases, a better visual acuity than did their fellow eyes. CONCLUSION: Although possibly a choice in older children, a primary posterior capsulectomy combined with anterior vitrectomy is a must in younger children and particularly when implantation of an IOL is planned.