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Intraoperative performance and longterm outcome of phacoemulsification in age-related cataract.  [cached]
Dholakia Sheena,Vasavada Abhay
Indian Journal of Ophthalmology , 2004,
Abstract: PURPOSE: To evaluate intraoperative performance and longterm surgical outcome after phacoemulsification of age-related cataracts. METHODS: Prospective, observational, non-comparative study of 165 consecutive eyes undergoing phacoemulsification with nuclear sclerosis Grade I to III (Scale I to V). Preoperative evaluation included specular microscopy. Phacoemulsification was performed by a single surgeon using a standardised surgical technique under topical anaesthesia. Intraoperatively, effective phaco time (EPT), wound site thermal injury (WSTI), serious complications (eg. vitreous loss, posterior capsule rupture, zonulolysis) and intraoperative posterior capsule opacification (plaque) were evaluated. Postoperatively, posterior capsule opacification (PCO), Neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate, corneal endothelial count, best corrected visual acuity and cystoid macular oedema were evaluated. Eyes were examined at 6 months and then yearly for 3 years. RESULTS: Mean ages of 78 males and 87 females were 59.12 +/- 8.56 and 58.34 +/- 7.45 years respectively. EPT was 36 +/- 19 seconds and WSTI occurred in 7 eyes (4.7%). No serious intraocular complications occurred. Intraoperative posterior capsule opacification (plaque) was present in 21 eyes (13.93%). Postoperatively, PCO occurred in 8 eyes (4.84%) and Nd:YAG laser posterior capsulotomy was performed in 3 eyes (1.8%). Endothelial cell loss was 7.1% at 3 years follow-up. At the end of 3 years follow-up, 146 eyes (88.89%) maintained a best corrected visual acuity of > or = 6/12. Cystoid macular oedema did not occur in any eye at 1 and 6 months′ follow-up. CONCLUSION: PCO rates and endothelial cell loss were acceptable. Consistent and reproducible outcome can be obtained after phacoemulsification of age related cataracts (grade I to III).
THE STUDY OF COMPLICATIONS OF ND: YAG LASER CAPSULOTOMY  [cached]
Gore V.S.
International Journal of Bioinformatics Research , 2012,
Abstract: Objective- To study the complications of ND:YAG Laser capsulotomy.Participants- Patients between age group of 08 to 80 who is having significant posterior capsular opacification leading to decreased visual acuity from early post operative days.Material and Method- 200 patients with PCO were studied for post ND:YAG laser complications. The patient who is not having any organic cause of decreased vision and who have completed at least three months after cataract surgery were selected. ND:YAG laser procedure was performed and their visual acuity improvement along with complications associated with this procedure were studied. Results- The procedure is absolutely safe if strict selection (inclusion/exclusion) criteria is followed. Most of complications are transient which can be managed by proper medication. Complications like retinal detachment or cystoid macular edema are multifactoral and can not always be only due to laser capsulotomy alone. Endophthalmitis is rare complication but highly unpredictable which can not be ruled out but be well treated with newer generation intravitreal drugs or vitrectomy surgery. Most of the patients 86% were significantly benifited by improved visual acuity.
Intraoperative fracture of phacoemulsification sleeve
Jennifer WH Shum, Keith SK Chan, David Wong, Kenneth KW Li
BMC Ophthalmology , 2010, DOI: 10.1186/1471-2415-10-29
Abstract: Phacoemulsification surgery was performed in the left eye of a 58-year-old lady with grade II nuclear sclerosis & grade I cortical cataract. Towards the end of quadrant removal, there was anterior chamber instability with impaired followability of nuclear fragments. The distal part of the fractured sleeve remained inside the anterior chamber upon removal of the phacoemulsification probe. The retained sleeve was retrieved with a pair of forceps through the corneal incision site, which did not require widening. There was no missing fragments retained intraocularly and the patient had an uneventful recovery with vision of 20/25 at three months post-operatively.Phacoemulsification sleeve fracture is an uncommon complication. With early identification of this condition and proper management, major complications can be avoided.Instruments breakage during phacoemulsification surgeries can have detrimental effect on the eye. Common breakages can involve the phacoemulsification tips and second instruments. Intraoperative fracture of phacoemulsification sleeve occurs infrequently. We hereby report a case of intraoperative phacoemulsification sleeve fracture. The early signs of this condition are described and surgical management of this situation is discussed.A 58-year-old lady was clinically admitted for phacoemulsification surgery and intraocular lens (IOL) implantation in the left eye. She had the same surgery done to her right eye two years ago and later developed posterior capsule opacification requiring YAG posterior capsulotomy. Best-corrected visual acuity (BCVA) was 20/30 on the right eye and 20/100 on the left eye. Anterior segment examination revealed grade II nuclear sclerosis and grade I cortical cataract in the left eye. Intraocular pressure was within normal limits, and no other significant ocular abnormality was noted.Surgery was performed under topical anaesthesia with 2% xylocaine gel. A 2.75 mm superior corneal incision was created with keratome. Continuous
Lensectomy and PCIOL Implantation with versus without Posterior Capsulotomy and Anterior Vitrectomy for Pediatric Cataracts  [cached]
Mohammad-Reza Jafarinasab,Zahra Rabbanikhah,Farid Karimian,Mohammad-Ali Javadi
Journal of Ophthalmic & Vision Research , 2008,
Abstract: PURPOSE: To compare the visual outcomes and complications of lensectomy and posterior chamber intraocular lens (PCIOL) implantation with or without posterior capsulotomy and anterior vitrectomy in older subjects with pediatric cataracts. METHODS: Seventeen eyes of 12 children aged 10 to 15 years with congenital or developmental cataracts were randomly divided to two groups. Lensectomy and PCIOL (Alcon Acrysof MA60 AC) implantation was performed with (8 eyes) or without (9 eyes) posterior capsulotomy and anterior vitrectomy. RESULTS: Mean age at the time of surgery was 12.3±1.5 (range 10-15) years and mean follow-up period was 18.7±11.2 (range 6-36) months. Posterior capsule opacification developed in three eyes in the non-vitrectomy group; however, media opacification was mild and capsulotomy was not required in any case. All eyes in the vitrectomy group had a clear visual axis at final follow-up (P=0.2). No significant difference was observed between the two groups in term of visual acuity (P=0.3) or complications. CONCLUSION: Although posterior capsulotomy and anterior vitrectomy seems to be safe in pediatric cataract surgery, it may not be necessary as a routine procedure in older children.
Effect of Hydrophobic Acrylic versus Hydrophilic Acrylic Intraocular Lens on Posterior Capsule Opacification: Meta-Analysis  [PDF]
Ying Li, Jiaxing Wang, Zhuo Chen, Xin Tang
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077864
Abstract: Purpose This?meta-analysis aims to evaluate the differences in performance of posterior capsular opacification (PCO) between hydrophobic acrylic intraocular lens (IOLs) and hydrophilic acrylic IOLs. Setting Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China. Design Systematic review of randomized controlled trials (RCTs) or meta-analysis. Methods An electronic literature search was performed using the PubMed, EMBASE and Cochrane Library database before May in 2013 to identify prospective RCTs comparing hydrophobic acrylic IOLs and hydrophilic acrylic IOLs in patients after phacoemulsification with IOL implantation with a follow-up time of at least 1 year. Pertinent studies were selected by meeting predefined criteria and reviewed systematically by meta-analysis. The PCO scores and YAG capsulotomy rate, as indicator of PCO, were measured and discussed in a meta-analysis. Standardized mean differences (SMD), relative risk ratio (RR), and the pooled estimates were computed according to a random effect model or fixed effect model. Results Nine prospective RCTs involving 861 eyes were included in the current meta-analysis. The hydrophobic acrylic IOLs were favored and the pooled SMD of PCO severity was1.72 (95% confidence interval (CI), 0.20 to 1.23, P = 0.0002) and 1.79 (95% CI, 0.95 to 2.64, P<0.0001) with 1-year follow-up and 2-year follow-up respectively. The pooled RR of Nd:YAG laser capsulotomy rates at postoperative 2-year follow-up was 6.96 (95% CI, 3.69 to 13.11, P<0.00001) comparing hydrophilic acrylic IOLs with hydrophobic acrylic IOLs. Conclusions Compared with hydrophilic acrylic IOLs, the hydrophobic acrylic IOLs showed superior reduction in rates of PCO and laser capsulotomy in 2-year follow-up. More RCTs with standard methods for longer follow-up are needed to validate the association.
Posterior capsule opacification and neovascularization treated with intravitreal bevacizumab and Nd:YAG capsulotomy  [cached]
Grimelda Yuriana Sánchez-Castro,Alejandra Hitos-Fájer,Erick Mendoza-Schuster,Raul Velez-Montoya
Clinical Ophthalmology , 2008,
Abstract: Grimelda Yuriana Sánchez-Castro1, Alejandra Hitos-Fájer1, Erick Mendoza-Schuster1, Raul Velez-Montoya2, Cecilio Francisco Velasco-Barona11Asociación para Evitar la Ceguera en México. Hospital “Dr. Luis Sánchez Bulnes”, México, D.F. Ophthalmology Department – Anterior Segment; 2Asociación para Evitar la Ceguera en México. Hospital “Dr. Luis Sánchez Bulnes”, México, D.F. Ophthalmology Department – Retina departmentAbstract: We reported a 75-year-old diabetic man, who developed opacification and neovascularization of the posterior capsule after extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient was treated with two injections of 2.5 mg of intravitreal bevacizumab. The treatment produced an important regression of the posterior capsular new vessels, allowing us to perform a successful Nd:YAG capsulotomy, clearing the visual axis and improving the visualization of the posterior pole. Even though, best corrected visual acuity was 20/200 due to diabetic macular edema.Keywords: posterior capsule opacification, posterior capsule neovascularization, cataract surgery, postoperative complications, intravitreal bevacizumab
Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children  [cached]
Das Pranab,Ram Jagat,Brar Gagandeep,Dogra Mangat
Indian Journal of Ophthalmology , 2009,
Abstract: Purpose : To evaluate the outcome of intraocular lens (IOL) implantation using capsular tension ring (CTR) in subluxated crystalline or cataractous lenses in children. Setting : Tertiary care setting Materials and Methods : We prospectively studied 18 eyes of 15 children with subluxation of crystalline or cataractous lenses between 90° up to 210° after phacoemulsification, CTR and IOL implantation. Each child was examined for IOL centration, zonular dehiscence and posterior capsular opacification (PCO). Results : Age of the patient ranged between five to 15 years. Out of 18 eyes, seven had traumatic and 11 had spontaneous subluxation of crystalline or cataractous lens. Phacoemulsification was successfully performed with CTR implantation in the capsular bag. Intraoperative zonular dialysis occurred in two eyes. Anterior vitrectomy was performed in six eyes to manage vitreous prolapse. IOL implanted was polymethyl methacrylate (PMMA) in eight eyes, hydrophobic acrylic in seven and hydrophilic acrylic in three. Follow-up ranged from 24 months to 72 months. Sixteen eyes had a best corrected visual acuity of 20/40 or better. Nine eyes developed significant PCO and were managed with Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser posterior capsulotomy. One eye with acrylic IOL in the capsular bag had IOL dislocation after two years which was managed with vitrectomy and secondary trans-scleral fixation of IOL. Conclusions : Phacoaspiration with CTR implantation makes capsular bag IOL fixation possible in most of the eyes with subluxated crystalline or cataractous lenses. PCO still remains a challenge in children with successful phacoaspiration with CTR implantation
Estimation of mean ND: Yag laser capsulotomy energy levels for membranous and fibrous posterior capsular opacification  [PDF]
R Bhargava,P Kumar,A Prakash,KP Chaudhary
Nepalese Journal of Ophthalmology , 2012, DOI: 10.3126/nepjoph.v4i1.5861
Abstract: Introduction: Posterior capsule opacification (PCO) is a visually-disabling complication of cataract surgery. Objective: To estimate energy levels for capsulotomy in various subtypes of PCO (membranous, fibrous and fibro-membranous). Materials and methods: A total of 215 patients with PCO were randomly selected and evaluated for Nd: Yag laser capsulotomy, after a quiet post-operative course of 3 months. The ocular area was arbitrarily divided into three zones: YAG zone (3mm), Optical zone (6 mm) and the peripheral zone (12mm). A colour code was assigned to the subtype of PCO in these zones: fibrous green and membranous blue. The type of PCO in each quadrant of YAG zone was estimated in percentage. Results: The statistic mean values of initial energy levels were 1.80 mJ for membranous PCO, 3.17 mJ for fibrous PCO and 2.73 mJ for fibro-membranous PCO. The mean summated energy levels for membranous PCO was 22.80 mJ for membranous PCO, 80.06 mJ for fibrous PCO and 80.48 mJ for fibro-membranous type. Conclusion: Colour coding is extremely helpful for quantification of the type of PCO and in deciding the initial energy level necessary to create capsulotomy. Fibro-membranous PCO required more summated energy despite a lower starting energy. Therefore, we recommend firing the initial shot in fibrous portion in case of fibrous-membranous type of PCO. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5861 NEPJOPH 2012; 4(1): 108-113
Surgical management challenges and clinical results of bimanual micro-incision phacoemulsification cataract surgery in children with congenital cataract  [PDF]
M Amon
Nepalese Journal of Ophthalmology , 2011, DOI: 10.3126/nepjoph.v3i1.4270
Abstract: Introduction: Small incisions in cataract surgery have shown to reduce tissue damage, postoperative inflammation and pain. Objective: To describe in detail the surgical management challenges and clinical results of bimanual micro-incision phacoemulsification cataract surgery in children with congenital cataract. Materials and methods: In 22 eyes of 14 children aged from 11 months to 17 years with congenital cataract, micro-incision cataract surgery with lensectomy, bimanual aspiration or phacoemulsification and implantation of an intraocular lens (SN60WF, Alcon?) was performed under general anesthesia. The visual equivalent obtained with age-related methods, the slit-lamp examination, and refractive outcome were documented in the medical records and were analyzed retrospectively. The patients fulfilled at least 3 months of follow up. Results: In all operated eyes, micro-incision cataract surgery could be performed without serious intra-operative complications. Lensectomy was safely combined with a primary posterior capsulorhexis and anterior vitrectomy in 17 of 22 eyes. Corneal incision length ranged between 2.2 mm and 2.6 mm (mean: 2.3 ± 0.2 mm). No cases of postoperative hypotony and increased inflammation were observed. One eye required surgical removal of the after-cataract 7 months after surgery. Laser capsulotomy for posterior capsular opacification had to be performed in 2 (9 %) eyes. In all other eyes (19/22), visual axis remained clear during follow-up. Conclusion: Micro-incision cataract surgery is a promising alternative to conventional pediatric cataract surgery, since the technique showed to be comparably safe and effective. Longer follow-up examinations will now be performed. Key words: congenital cataract; bimanual micro-incision phacoemulsification DOI: 10.3126/nepjoph.v3i1.4270 Nepal J Ophthalmol 2011;3(5):3-8
"String of Pearls" following Nd:YAG laser posterior capsulotomy  [cached]
Chatterjee Samrat,Garg Prashant
Indian Journal of Ophthalmology , 2002,
Abstract: Posterior capsular re-opacification can occur following Nd-YAG capsulotomy. This necessitates multiple capsulotomies with its potential complications. We report one such case and discuss possible predisposing factors and preventive measures for this condition
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