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.     

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.     

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.     

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.     

Determination of visual function after implantation of intraocular lens

OBJECTIVE: To understand whether the binocular visual function could be restored after posterior chamber intraocular lens (IOL) implantation. METHODS: The visual function including corrected vision, simultaneous perception, fusion, stereoacuity, aniseikonia and retinal correspondence point were determined for 50 cases (64 eyes) after the surgery. RESULTS: The corrected visual acuities were 0.6 or better. Visual acuities of 1.0 or better were achieved in 65% and 0.6-0.9 in 35% of the eyes. All patients obtained simultaneous perception and fusion function. The near stereoacuity of 50 cases showed foveal stereoacuity < or = 60 seconds in 23 cases (46%), macular stereoacuity 80-200 seconds 10 cases (20%) and peripheral stereoacuity 400 seconds 17 cases (34%). The far stereoacuity of 50 cases comprised 34 cases of foveal stereoacuity (68%), 9 cases of macular stereoacuity (18%) and 7 cases of peripheral stereoacuity (14%). The postoperative retinal correspondence points were normal. There was no aniseikonia in 35 cases, except 15 cases of aniseikonia which was within normal tolerable limits. CONCLUSION: When binocular corrected vision is > or = 0.4 with ocular alignment, the binocular visual function could be restored for varying degrees.     

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.     

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.     

Degenerated lens epithelial cells in rabbit and human eyes after intraocular lens implantation

PURPOSE: To evaluate the role of lens epithelial cells (LECs) in posterior capsule opacification. SETTING: Departments of Ophthalmology and Pathology, Wakayama Medical College, Department of Anatomy, Kansai Shinkyu College, and Department of Ophthalmology, Kobe Kaisei Hospital, Japan. METHODS: We examined the presence of degenerated LECs on the capsules of the eyes of rabbits and a patient after intraocular lens (IOL) implantation. Phacoextraction of a crystalline lens and IOL implantation were done in 5 albino rabbits under general anesthesia. The animals were killed after 2 months. Lens capsules were removed and fixed. During vitreous surgery, a lens capsule with an IOL was removed from a patient. Ultrathin sections of specimens were studied by transmission electron microscopy. RESULTS: Presumed LECs proliferated between the posterior capsule and the IOL in association with collagenous matrix. Debris from the degenerated cells and destroyed intracellular organelles was also seen. CONCLUSION: Lens epithelial cells proliferating on the posterior capsule cannot survive indefinitely.     

Endothelial physiology and intraocular lens implantation

The endothelium is the cellular monolayer which lines the posterior surface of the cornea. This layer is important in clinical ophthalmology because it is vital to maintenance of the transparency of the cornea and vision through its pump and barrier functions which limit the ingress of fluid into the cornea from the aqueous. When the function of the corneal endothelium becomes compromised, the corneal stroma swells as it hydrates. Subsequently, epithelial bullae form with painful recurring epithelial erosions, and finally corneal scarring and blindness result. The relatively vulnerable position of the corneal endothelium renders it susceptible to iatrogenic injury during intraocular procedures, especially IOL implantation: the poor regenerative (mitotic) capacity of the human corneal endothelium limits its ability to recover normal function once it is injured.     

Secondary intraocular lens implantation in children

OBJECTIVE: The study was designed to determine the visual outcome and indication of secondary posterior chamber intraocular lens (IOL) implantation. METHODS: The operation was performed on 34 eyes with aphakia in children after separation of posterior iris synechia from posterior capsule and formation of a posterior chamber space large enough to insert an intraocular lens. Based on whether the integrity of the posterior capsule was complete or not, various techniques of secondary IOL implantation were adopted. RESULTS: The follow-up periods ranged from 6 to 24 months. The results showed that 29 of the eyes (85.29%) achieved a post-operative corrected visual acuity equal to or better than that of the best corrected visual acuity before the surgery; the postoperative uncorrected visual acuities in 16 eyes (47.06%) and corrected visual acuities in 28 eyes (82.35%) reached 0.5 or better. CONCLUSION: Secondary posterior chamber IOL implantation is a safe and effective method in children who have a complete or partial posterior capsule.     

A clinical analysis of pupillary membrane formation after intraocular lens implantation

In 540 cases having undertaken extracapsular cataract extraction and intraocular lens implantation, a pupillary membrane developed in 76 cases, the rate of occurrence being 14%. Generally, the membrane appears on the fifth post-operative day and corticosteroids are effective in its treatment. After treatment no significant sequela is left and the corrected postoperative visual acuity is not affected. The pathogenesis, treatment and prognosis of the pupillary membrane are briefly discussed in the report.     

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.     

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.     

An experimental study of the interleukin 1 levels in aqueous humor after intraocular lens implantation

Identification of unknown bodies is mainly made by dental examination and comparison with accurate dental records. Therefore it is necessary to examine the jaws carefully and to locate every tooth-coloured dental restoration. Overlooking dental fillings can make positive identification impossible. The technique described prepares the natural dental hard tissue by etching with 37% phosphoric acid. In the next step an indicator colours the roughened dental tissue but not the polished restoration material. In this way all 15 tested dental restoration materials could be detected with high sensitivity.     

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.