Long-term evaluation of primary anterior chamber intraocular lens implantation in complicated cataract surgery

The long-term visual outcome and complications related to the use of a semiflexible open-loop all-PMMA anterior chamber intraocular lens were evaluated in 40 eyes in which the capsular support was lost. The mean follow up time was 2.3 years (range 6 months to 6.7 years). 55% of the eyes had exfoliation syndrome. 68% (27 of 40 eyes) obtained a visual acuity of 0.5 or better, and only in one of the remaining eyes decreased visual acuity was related to cataract surgery (cystoid macular oedema). No cases of corneal decompensation, uveitis-glaucoma-hyphaema syndrome or retinal detachment have developed, and no IOLs have been explanted. Based on these results, the use of a modern anterior chamber intraocular lens can be suggested at least in old persons, if the capsular support is lost.     

The role of intraocular lenses in anterior chamber contamination during cataract surgery

The findings of prenatal ultrasound diagnosis were compared with the autopsy findings in 183 fetuses (between the 14th and 24th week of gestation), aborted for fetal malformations in the period from 1995 to 1997. In these 183 cases, the primary diagnosis showed 50 central nervous system anomalies, 48 cardiovascular system anomalies, 42 genitourinary system anomalies, 18 respiratory system anomalies, 8 skeleton system anomalies, 6 gastrointestinal system anomalies and 11 other abnormalities. Of the total number of cases, 41% had multiple malformations. In 144 cases (78%), the prenatal diagnosis was confirmed by autopsy, in 36 cases (20%) the prenatal diagnosis was confirmed with additional significant pathology, and in only 3 cases (2%) the prenatally detected malformation was not confirmed by pathological examination. Autopsy remains an important component of the evaluation of fetal losses after induced abortion.     

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.     

Results of bilateral cataract extraction with posterior chamber intraocular lens implantation in children

OBJECTIVE: A retrospective study was undertaken to evaluate long-term anatomic and visual outcomes in eyes of children who underwent bilateral intraocular lens implantation. DESIGN: The study design was a review of medical records of 24 children operated on for bilateral cataracts and posterior chamber-intraocular lenses. PARTICIPANTS: Twenty-four children operated on for bilateral cataracts by 1 surgeon between February 1980 and February 1995 were studied. INTERVENTION: Cataract extraction with bilateral posterior chamber-intraocular lens implantation was performed. MAIN OUTCOME MEASURES: Best-corrected visual acuity, visual acuity without correction, intraocular pressure, manifest refraction, and any intraoperative or postoperative complications were measured. RESULTS: At last follow-up (mean follow-up, 50.8 months; range, 10-149 months), the intraocular lens was in good position and the intraocular pressure was normal without medication in all eyes. Four years after surgery, 79.2% (19 of 24) of first eyes achieved a best-corrected visual acuity of 20/40 or better compared to 66.7% (16 of 24) of second eyes. No eye had any loss in best-corrected visual acuity. In first eyes of 3- to 8-year olds at the time of surgery, 73.3% (11 of 15) achieved a spherical equivalent within 2 diopters of the intended at 4 years after surgery compared to 80% of second eyes. In the 9- to 18-year-old group, 88.9% (8 of 9) of first eyes and 100% of second eyes achieved a spherical equivalent within 2 diopters of the intended at 4 years after surgery. Intraoperative and postoperative complications were minimal. CONCLUSIONS: Long-term anatomic and visual results have been gratifying in this series of patients with bilateral implants.     

Corneal endothelium in patients with diabetes after extracapsular cataract extraction with intraocular lens implantation in the posterior chamber

We have examined endothelial cell density before and 3, 6, 12 months after extracapsular cataract extraction with intraocular lens implantation (posterior chamber) in diabetic patients and in non-diabetics. We have not found statistically significant differences between the mean loss of endothelial cells due to surgery in diabetic and non-diabetic patients.     

Refractive status in children after long-term follow up of cataract surgery with intraocular lens implantation

The Epstein-Barr virus is a ubiquitous human herpesvirus that is associated with an increasing number of human malignancies. Among these are Epstein-Barr virus-associated lymphoproliferative diseases in immunocompromised patients, a spectrum of mainly B-cell diseases that range from polyclonal lymphoproliferative diseases, which resolve when immunosuppression is halted, to highly malignant lymphomas. Progress has identified Epstein-Barr virus gene products involved in B-cell transformation, variation in Epstein-Barr virus transforming genes, distinct target cell populations with differing regulation of Epstein-Barr virus expression, and selective recruitment of other supportive cell types as factors in the heterogeneity of lymphoproliferative diseases. New therapeutic approaches to treat lymphoproliferative diseases are also being developed. Finally, xenotransplantation poses new risks for the introduction of Epstein-Barr virus-like viruses and more aggressive lymphoproliferative diseases in heavily immunosuppressed patients.     

Reduced intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation

PURPOSE: To ascertain whether phacoemulsification with posterior chamber intraocular lens (IOL) implantation causes long-term reduction in intraocular pressure (IOP). SETTING: Private practice, Kempten, Germany. METHODS: Intraocular pressure was measured in both eyes of 120 consecutive patients who were unilaterally phakic after phacoemulsification a mean of 17 months +/- 17 (SD) previously. Mean age of the 36 men and 84 women was 76 +/- 10 years. Data were analyzed using binomial distribution and the Wilcoxon signed-rank test. RESULTS: The median ratio of IOP in the pseudophakic eye to IOP in the phakic eye was 0.83. The IOP was lower in the pseudophakic eye in 96 patients (80%). The median IOP was 12 mm Hg in the pseudophakic eyes and 14 mm Hg in the phakic eyes (P < .001). As measured by the interquartile range, IOP distribution was more centered in the pseudophakic than in the phakic eyes (3 versus 4). The IOP in the pseudophakic eyes remained lower to the last measurement, 5 years postoperatively, and appeared to be independent of patient age. Lower IOP in the pseudophakic eye was consistently present in patients with higher IOP in the phakic eye (16 to 22 mm Hg). CONCLUSION: Phacoemulsification with posterior chamber IOL implantation reduced IOP in most but not all patients with a preoperative IOP of 22 mm Hg or less. This reduction was maintained over several years, with the cause yet to be established. Lower IOP may decrease the risk of subsequent glaucomatous nerve damage in these patients.     

Phacoemulsification and posterior chamber intraocular lens implantation in uveitis

The effect of a pure alpha-adrenergic agent, methoxamine on ventricular fibrillation (VF) amplitude and the relation between hemodynamic parameters and survival in a rodent cardiopulmonary resuscitation (CPR) model were studied. Our results suggested that: 1) VF amplitude decreased during untreated VF, but it increased during pericardial chest compression: 2) methoxamine significantly increased the mean aortic pressure (MAP) and coronary perfusion pressure (CPP) but not VF amplitude, and the survival also increased due to elevation of CPP; and 3) all surviving animals with successful defibrillation had a higher VF amplitude.     

Cataract formation after posterior chamber phakic intraocular lens implantation

Posterior chamber phakic intraocular lens (PCP IOL) implantation is an emerging refractive procedure. We report a case of cataract formation 6 months after uneventful implantation of a Staar PCP IOL to correct high myopia. Visual recovery was achieved after explantation of the phakic IOL and phacoemulsification with implantation of a foldable IOL through the same unenlarged self-sealing corneal incision.     

Outcome of combined trabeculectomy with cataract operation and intraocular lens implantation

BACKGROUND: When trabeculectomy and cataract extraction with intraocular lens insertion are combined, do the success and complication rates add. MATERIAL AND METHODS: Follow-up of 47 eyes of 34 patients with combined trabeculectomy and cataract extraction with intraocular lens implantation after 12 to 42 months. RESULTS: With a low perioperative complication rate the intraocular pressure after one year was below 22 mm Hg in 90% without any medication and in 98% additional glaucoma therapy. After 2 and 3 years the intraocular pressure was normal without any additional therapy in 83% of the eyes. The visual acuity was better or equal to the preoperative value in 89% of the cases. CONCLUSIONS: The combination of trabeculectomy and of cataract extraction with intraocular lens implantation has a low complication rate and gives good results regarding intraocular pressure and visual rehabilitation. When a trabeculectomy is indicated, the indication for a simultaneous cataract extraction with intraocular lens implantation should not be to restricted.     

Changes in anterior chamber depth and intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation

BACKGROUND AND OBJECTIVE: To determine anterior chamber depth (ACD) and intraocular pressure (IOP) following uncomplicated cataract extraction with phacoemulsification and posterior chamber intraocular lens (IOL) implantation. PATIENTS AND METHODS: The ACDs and IOPs of 56 patients were prospectively evaluated after phacoemulsification and IOL implantation. Measurements of ACD were performed using ultrasonography and measurements of IOP were performed using a Goldmann applanation tonometer preoperatively and at 1 week and 1, 3, 6, and 9 months postoperatively. RESULTS: The mean IOP had decreased and the mean ACD had increased significantly by 1 month postoperatively (P < .03 and P < .01, respectively). Between 1 and 3 months, a significant increase in ACD (P < .05) and decrease in IOP (P < .01) was also observed. The ACD peaked (3.51 +/- 0.45 mm) and the IOP reached its lowest value (10.05 +/- 2.23 mm Hg) at 3 months postoperatively. The reduction in IOP and increase in ACD remained significant during the follow-up period, compared with the preoperative values. CONCLUSION: These results suggest that increases in ACD and decreases in IOP occur in selected patients after uncomplicated cataract extraction by phacoemulsification with IOL implantation.     

Visual results of progressive multifocal posterior chamber intraocular lens implantation

PURPOSE: To evaluate corrected and uncorrected near, intermediate, and distance visual acuities in eyes with a progressive multifocal intraocular lens (IOL) and to determine the effect of the lens on contrast sensitivity. SETTING: Multicenter study. METHODS: This prospective study comprised 59 eyes that had uneventful cataract surgery and implantation of a progressive multifocal IOL at three study centers. Uncorrected and corrected near, intermediate, and distance visual acuities were measured, as was contrast sensitivity at different frequencies. One year results are reported. Patient satisfaction was assessed using a subjective questionnaire. RESULTS: Distance visual acuity improved from 0.13 Snellen lines uncorrected and 0.23 with best correction preoperatively to 0.77 and 0.96 lines, respectively, postoperatively. Uncorrected preoperative near acuity was 13.28 Jaeger lines and best corrected acuity, 8.93 lines. These improved to 4.75 and 2.69 lines, respectively. The differences between visual acuity at intermediate distances and best distance and near acuities were not significant. Patient satisfaction was highest with vision under good light conditions and when viewing larger objects. CONCLUSION: Visual performance with the multifocal progressive IOL was adequate at various distances without additional correction. It was less satisfactory under poor light conditions.     

Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma

PURPOSE: To evaluate long-term intraocular pressure (IOP) control after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (IOL) implantation in patients with primary angle-closure glaucoma. SETTING: Ophthalmology Department, Groote Schuur Hospital, Cape Town, South Africa. METHODS: This retrospective study comprised 17 patients (19 eyes) with primary angle-closure glaucoma who had ECCE and posterior chamber IOL implantation. Four presented initially with acute glaucoma, 5 with subacute angle-closure glaucoma, and 8 (10 eyes) with chronic angle-closure glaucoma. In all, less than half the circumference of the angle was permanently closed. The drainage angle was evaluated preoperatively and postoperatively to monitor changes in the amount of angle closure. Intraocular pressure was measured in the early and late postoperative periods. RESULTS: On the first postoperative day, mean IOP was 17.2 mm Hg, although 5 patients (26%) had an IOP rise above 21 mm Hg despite the use of perioperative topical pilocarpine gel. After a mean follow-up of 19 months, IOP remained below 22 mm Hg without medication in 13 eyes (68%) and with topical medication in 5 eyes (26%). Mean number of glaucoma medications was reduced from 1.5/eye preoperatively to 0.5/eye postoperatively. CONCLUSION: Cataract extraction with IOL implantation resulted in good long-term IOP control in patients with primary angle-closure glaucoma, suggesting that combined cataract and trabeculectomy surgery may not be necessary to achieve long-term IOP control in these patients.     

Heparinised intraocular infusion and bacterial contamination in cataract surgery

In order to perform accurate low-flow anaesthesia ventilation, it is desirable to avoid the influence of fresh gas flow (FGF) and inspiration duration (ID) on the resulting minute volume (MV). The Sulla 808V anaesthesia ventilator (Draeger, Luebeck, Germany) is originally not equipped with a fresh-gas decoupling (FGD) device. Therefore, changes of FGF and ID settings applied during controlled ventilation may lead to alterations of the resulting MV. Recently, a low-cost FGD device (Carbamed, Bern-Liebefeld, Switzerland) has been developed, which can be inserted into the circle system. We investigated the effect of this device on MV in the Sulla 808V anaesthesia apparatus. METHODS: The performance of a Sulla 808V anaesthesia ventilator was tested with and without a FGD device. During ventilation of a test lung, stepwise changes of tidal volume (400-1000 ml), FGF (0.5-10 l/min), and ID (0.25-0.5) settings were consecutively applied, and the resulting MV was recorded. Correlation and mean prediction error between ventilation parameter settings and MV were calculated. RESULTS: In the presence of a FGD device, the administered MV was not affected by the magnitude of FGF and ID. A mean prediction error (bias) of -3.6 l/min of the resulting MV was observed. Without FGD the bias was only-1.8 l/min, while FGF and ID revealed a pronounced influence on MV. These effects were statistically significant when using FGF exceeding 4 l/min. CONCLUSIONS: The tested FGD device can easily be integrated into the circle system of conventional anaesthesia machines such as the Draeger Sulla 808V, and is available at a reasonable cost. It allows constant ventilation parameters to be maintained that remain unaffected by wide FGF and ID variations. With this FGD the performance of the ventilator can be improved considerably, and low-flow anaesthesia can be used more extensively.     

Myopic shift after intraocular lens implantation during childhood

PURPOSE: The purpose of the study is to evaluate the myopic shift that occurs in children 3 to 9 years of age who undergo cataract extraction with primary intraocular lens (IOL) implantation. METHODS: A review of 18 children (mean, 6.3 +/- 0.5 year; range, 3-9 years) who had undergone primary IOL implantation was undertaken. Patients were observed for an average of 3.2 years. The initial and last postoperative refractive errors were compared. RESULTS: The mean myopic shift was -0.99 +/- 0.22 diopter (D) (median, 1.0 D) with a range of -3.25 to +0.38 D. The difference in the myopic shift of the children 3 to 5 years of age (-0.94 +/- 0.30 D) was not significantly different from the myopic shift occurring in the children 6 to 9 years of age (-1.07 +/- 0.35 D). The myopic shift was less than 1.5 D in 70% of the eyes and only 3 eyes had a myopic shift greater than 2 D. Ninety percent of the children achieved a visual acuity of 20/40 or better in their pseudophakic eye or eyes. CONCLUSIONS: Although each patient should be evaluated on an individual basis, the authors recommend undercorrecting most children 3 to 9 years of age by 1 D from the IOL power predicted to achieve emmetropia.     

Posterior capsulorhexis with optic capture in pediatric cataract and intraocular lens surgery

To study brain regions involved in familiarity discrimination, rats were shown sets of novel and familiar objects. On each trial two objects were shown simultaneously to a rat so that one eye saw a novel object while the other saw a familiar object. Thus novel and familiar objects were seen with the same conditions of alertness and eye movements. Activated neurones were revealed by staining for products of the immediate early gene c-fos. Familiar stimuli activated significantly fewer neurones than novel stimuli in perirhinal cortex and area TE of temporal cortex, and the ventral lateral geniculate nucleus of the thalamus, but not in the hippocampus or other areas sampled. These findings are discussed in relation to recognition memory.     

Secondary intraocular lens implantation

Mere aphakia is not an indication for secondary intraocular lens implantation. However, many patients with positive indications may be benefited most strikingly by this procedure. These indications are illustrated and results of the author's first 65 secondary implantations are analyzed.