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Heavier molecular weight ocular viscoelastic devices and timing of post-operative review following cataract surgery
Balaji Thirumalai, Trudi L Blamires, Lucenne Brooker, Jon Deeks
BMC Ophthalmology , 2007, DOI: 10.1186/1471-2415-7-2
Abstract: 475 patients who underwent uncomplicated cataract surgery using heavier molecular weight ocular viscoelastic device (Healon GV) were studied. Of these 415 were phacoemulsification and 60 extracapsular and none received Intraocular pressure (IOP) lowering prophylaxis at the end of surgery. All were examined at 2 hours post-surgery and on the following day. Results were tabulated and analysed assessing wound stability, corneal clarity, anterior chamber reaction and IOP.In the time between the two assessments 44 (10.6%) patients developed a total of 53 new problems, with a majority being increases in IOP. Based on the lower threshold of IOP of 30 mmHg, the incidence of new problems at the next-day assessment was 9.8% (95% CI: 7.0 to 13.6) in the phacoemulsification group and 16.3% (7.3 to 29.7)in the extracapsular surgery group. At the higher threshold of IOP of 35 mmHg the corresponding figures were 6.6% and 16.3%.There is a higher incidence of new problems at the next-day assessment than previous studies with conventional OVD. Therefore results from previous studies using standard OVDs cannot be simply extrapolated to heavier molecular weight OVDs. When these agents are used, routine use of an ocular hypotensive agent may be necessary to increase the safety of abandoning the review on the first post-operative day for phacoemulsification patients. This is to be studied.The rising and, in some cases, universal trend towards day case cataract surgery raises a vexed question about the timing of postoperative review. This is particularly true if the aim is to do a "true" day case surgery where the patient is not seen in the hospital the next morning and so goes home on the day of surgery. A number of centres do send patients home on the day of surgery but they are reviewed on the next day either in the hospital or by a home visit by a trained staff member. Previous studies[1-5] have suggested that it is safe for patients to be seen in the immediate few hours after surgery
Prophylaxis of Postoperative Acute Endopthalmitis Following Cataract Surgery  [PDF]
Khalifa Alsawidi, Hamdy Abdulhady, Miriam Benlashhar, Amal Ahmed
Open Journal of Ophthalmology (OJOph) , 2020, DOI: 10.4236/ojoph.2020.101004
Abstract: Background: Postoperative Endophthalmitis is a rare complication after intraocular surgeries. However, it remains one of the most devastating complications following cataract surgery because of its poor prognosis. We describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery, particularly phacoemulsification. Aim of the work: To identify risk factors of acute endophthalmitis and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after phacoemulsification surgery. Methods: A prospective randomized cataract surgery study recruited 300 patients; 150 patients who received just intracameral vigamox at the end of surgery without topical antibiotics before surgery and 150 patients who received both intracameral vigamoxas well as topical perioperative vigamox which either just half an hour before surgery or three days preceding surgery. We took a conjunctival swab before and after vigamox administration in order to detect the type of conjunctival flora in the Libyan population as well as the effect of the vigamox on the conjunctival flora by using Phoenix-BD machine. In total we collected 166 specimens (83 patients). Results: In all groups no acute post-operative endophthalmitis was reported. Conclusions: The study was based on intracameral Moxifloxacin at the end of surgery with and without topical antibiotics drops administration. The incidence of postcataract endophthalmitis was not reported in our study after using intracameral antibiotics, as it seems to be effective in preventing endophthalmitis after cataract surgery.
Microbiological profile of anterior chamber aspirates following uncomplicated cataract surgery  [cached]
Prajna N,Sathish S,Rajalakshmi P,George Celine
Indian Journal of Ophthalmology , 1998,
Abstract: Anterior chamber aspirate cultures were done for 66 patients who underwent either an uncomplicated intracapsular cataract extraction, extracapsular cataract extraction with posterior-chamber intraocular lens implantation, or phacoemulsification with posterior-chamber intraocular lens implantation. The aspirate was obtained at the time of wound closure. The aspirates were immediately transferred to the microbiology laboratory where one drop of the aspirate was placed on a glass slide for gram stain, and the remainder was unequally divided and inoculated into blood agar, chocolate agar and thioglycolate broth. The cultures were incubated at 37° C with 5% CO2 and held for 5 days. Of 66 patients 4 (6%), had smear-positive anterior chamber aspirates. None of the aspirates showed any growth on any of the 3 culture media used. None of the eyes in the study developed endophthalmitis. This study concludes that there is no contamination of the anterior chamber by viable bacteria after cataract surgery, irrespective of the mode of intervention.
Histopathologic correlation of Aspergillus endophthalmitis following uncomplicated cataract surgery
Haddock LJ, Flynn HW Jr, Dubovy SR, Khurana RN, Egbert PR
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S35386
Abstract: topathologic correlation of Aspergillus endophthalmitis following uncomplicated cataract surgery Case report (1033) Total Article Views Authors: Haddock LJ, Flynn HW Jr, Dubovy SR, Khurana RN, Egbert PR Published Date September 2012 Volume 2012:6 Pages 1573 - 1577 DOI: http://dx.doi.org/10.2147/OPTH.S35386 Received: 27 June 2012 Accepted: 20 July 2012 Published: 25 September 2012 Luis J Haddock,1 Harry W Flynn Jr,1 Sander R Dubovy,1 Rahul N Khurana,2 Peter R Egbert3 1Department of Ophthalmology, Bascom Palmer Eye Institute, Miami Miller School of Medicine, Miami, FL, 2Northern California Retina Vitreous Associates, Mountain View, CA, 3Department of Ophthalmology, The Byers Eye Institute at Stanford, Stanford University, Palo Alto, CA, USA Abstract: A clinicopathologic correlation between two patients with acute-onset Aspergillus endophthalmitis undergoing enucleation is reported. These two patients presented with pain, redness, and decreased vision following uncomplicated cataract surgery. In both patients, vitreous aspiration and intravitreal injections were the initial treatment followed later by pars plana vitrectomy for clinical worsening. Despite repeated surgical and medical interventions, the clinical course of both patients was prolonged, unsuccessful, and resulted in enucleation for a blind painful eye. Histologic examination of the enucleated specimens showed that, in spite of prolonged local and systemic therapy, there was persistent diffuse infiltration of the anterior chamber and ciliary body by a filamentous mold.
Histopathologic correlation of Aspergillus endophthalmitis following uncomplicated cataract surgery  [cached]
Haddock LJ,Flynn HW Jr,Dubovy SR,Khurana RN
Clinical Ophthalmology , 2012,
Abstract: Luis J Haddock,1 Harry W Flynn Jr,1 Sander R Dubovy,1 Rahul N Khurana,2 Peter R Egbert31Department of Ophthalmology, Bascom Palmer Eye Institute, Miami Miller School of Medicine, Miami, FL, 2Northern California Retina Vitreous Associates, Mountain View, CA, 3Department of Ophthalmology, The Byers Eye Institute at Stanford, Stanford University, Palo Alto, CA, USAAbstract: A clinicopathologic correlation between two patients with acute-onset Aspergillus endophthalmitis undergoing enucleation is reported. These two patients presented with pain, redness, and decreased vision following uncomplicated cataract surgery. In both patients, vitreous aspiration and intravitreal injections were the initial treatment followed later by pars plana vitrectomy for clinical worsening. Despite repeated surgical and medical interventions, the clinical course of both patients was prolonged, unsuccessful, and resulted in enucleation for a blind painful eye. Histologic examination of the enucleated specimens showed that, in spite of prolonged local and systemic therapy, there was persistent diffuse infiltration of the anterior chamber and ciliary body by a filamentous mold.Keywords: mold, enucleation, voriconazole, amphotericin B
Study of Steroid Induced Rise in Intraocular Pressure Using Non-contact Tonometer After Cataract Surgery in Camp Patients at P.D.U. Medical College Rajkot, Gujarat  [cached]
Dodiya Kamal S,Aggarwal Somesh V,Bareth Kiran,Shah Nirzari
National Journal of Medical Research , 2012,
Abstract: Objectives: To study the incidence of steroid induced rise in intraocular pressure following cataract surgery using non contact tonometer. Materials and Methods: The study was undertaken in a tertiary care centre. 500 eyes which underwent uncomplicated cataract surgery were studied for IOP changes for up to six weeks following omission of steroid eye drops using non contact tonometer. Results: At the end of six weeks of steroid therapy, 21% patients had persistently raised IOP of which 2% had raised IOP at the end of six weeks following omission of steroid therapy. Conclusion: Non contact tonometry is equally effective for diagnosis and following up patients of drug (steroid) induced glaucoma. [National J of Med Res 2012; 2(2.000): 169-172]
Prostaglandin-Induced Cystoid Macular Edema Following Routine Cataract Extraction  [PDF]
Negin Agange,Sameh Mosaed
Journal of Ophthalmology , 2010, DOI: 10.1155/2010/690707
Abstract: To our knowledge, we are reporting the first case of a 59-year-old man who developed recurrent CME with three separate trials of three different prostaglandin class drugs following uncomplicated phacoemulsification with intraocular lens implantation. Despite multiple reports of individual prostaglandin (PG) analogues being suggested as the cause of CME, there are no recommendations regarding withholding these medications in the perioperative period. Our patient first developed CME OD 4-months post uncomplicated cataract extraction. XALATAN (Latanoprost) had been restarted after surgery and discontinued at onset of CME. While off XALATAN (Latanoprost), the patient's CME resolved, but his IOP rose. The patient was started on LUMIGAN (Bimatoprost) to control the IOP, but within weeks his CME recurred. The patient's CME was again treated and his IOP remained acceptable, but then progressively increased. TRAVATAN (Travoprost) was attempted, but he presented with a third round of CME. Definitive conclusions about causal relationships cannot be made without well-designed, prospective clinical trials addressing this issue.
Diclofenac prevents temporal increase of intraocular pressure after uneventful cataract surgery with longer operation time
Masahiko Shimura, Toru Nakazawa, Kanako Yasuda, Takashi Shiono, Kohji Nishida
Clinical Ophthalmology , 2009, DOI: http://dx.doi.org/10.2147/OPTH.S4386
Abstract: lofenac prevents temporal increase of intraocular pressure after uneventful cataract surgery with longer operation time Original Research (4793) Total Article Views Authors: Masahiko Shimura, Toru Nakazawa, Kanako Yasuda, Takashi Shiono, Kohji Nishida Published Date October 2008 Volume 2009:3 Pages 95 - 101 DOI: http://dx.doi.org/10.2147/OPTH.S4386 Masahiko Shimura1, Toru Nakazawa2, Kanako Yasuda1, Takashi Shiono3, Kohji Nishida2 1Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan; 2Department of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, Japan; 3Department of Ophthalmology, Shiono Eye Center, Sendai, Japan Purpose: This study compares the effect of topical diclofenac with that of betamethasone against postoperative increase of intraocular pressure (IOP) after cataract surgery in normal patients, and also investigated the risk factors for postoperative increase of IOP in each group. Methods: Fifty consecutive patients without systemic disease who have bilateral and symmetrical cataracts underwent uncomplicated cataract surgery in both eyes (100 eyes in total). Postoperatively, topical diclofenac was applied 4 times daily to one eye, and topical betamethasone to the other eye in each patient. IOP and best corrected logMAR visual acuity (BCVA) in each eye were measured up to 8 weeks. Total surgery time and effective phacoemulsification time (EPT) for each case was recorded. Results: BCVA in both diclofenac- and betamethasone-treated eyes significantly improved after the cataract surgery; however, no statistical difference in VA was noted between the diclofenac- and betamethasone-treated eyes throughout the observation period. IOP in the diclofenac-treated eyes decreased with time, in contrast to the IOP in the betamethasone-treated eyes, which showed a slight increase. At 4 and 8 weeks postoperatively, there was significant difference between these two eye groups. Multiple regression analysis revealed that postoperative increase in IOP at 8 weeks in the betamethasone-treated eyes was closely correlated with total surgery time and EPT, but the IOP in the diclofenac-treated eyes showed no correlation with any surgical or clinical parameters. Conclusions: Postoperative increase in IOP after cataract surgery was affected by total surgery time and EPT in the betamethasone-treated eye. The time for surgery and EPT is longer in complicated cases including patients with a hard nucleus or small pupils, and also longer for beginning surgeons and in older patients. In these cases, diclofenac in place of betamethasone as a postoperative topical antiinflammatory drug is recommended for the prevention of postoperative increase in IOP.
CATARACT
SARFRAZ HUSAIN SYED,MUHAMMAD ARIF,DR. MUHAMMAD SULTAN
The Professional Medical Journal , 2010,
Abstract: Objective: To observe the tendency of corticosteroids to raise the intraocular pressure after prolonged use of 0.1% dexamethasone eye drops during post operative period of cataract extraction. Study Design: Observational study. Period: From August 2008 to December 2009. Subjects and Setting: In the study 50 patients were included. These patients had age related cataract in one or both eyes.The IOP of every patient was measured preoperatively with the help of Goldman applanation tonometer. After cataract extraction, every patient received 0.1% dexamethasone eye drops four times a day for one month. The IOP was measured fortnightly. Setting: Department ofOphthalmology, Allied Hospital, Faisalabad and the clinics of the authors. Results: Topical administration of 0.1% Dexamethasone EyeDrops ,four times a day for one month after age related cataract extraction caused elevation of intraocular pressure more than 21 mm Hg in 8% of general population.
Diclofenac prevents temporal increase of intraocular pressure after uneventful cataract surgery with longer operation time  [cached]
Masahiko Shimura,Toru Nakazawa,Kanako Yasuda,Takashi Shiono
Clinical Ophthalmology , 2008,
Abstract: Masahiko Shimura1, Toru Nakazawa2, Kanako Yasuda1, Takashi Shiono3, Kohji Nishida21Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan; 2Department of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, Japan; 3Department of Ophthalmology, Shiono Eye Center, Sendai, JapanPurpose: This study compares the effect of topical diclofenac with that of betamethasone against postoperative increase of intraocular pressure (IOP) after cataract surgery in normal patients, and also investigated the risk factors for postoperative increase of IOP in each group.Methods: Fifty consecutive patients without systemic disease who have bilateral and symmetrical cataracts underwent uncomplicated cataract surgery in both eyes (100 eyes in total). Postoperatively, topical diclofenac was applied 4 times daily to one eye, and topical betamethasone to the other eye in each patient. IOP and best corrected logMAR visual acuity (BCVA) in each eye were measured up to 8 weeks. Total surgery time and effective phacoemulsification time (EPT) for each case was recorded.Results: BCVA in both diclofenac- and betamethasone-treated eyes significantly improved after the cataract surgery; however, no statistical difference in VA was noted between the diclofenac- and betamethasone-treated eyes throughout the observation period. IOP in the diclofenac-treated eyes decreased with time, in contrast to the IOP in the betamethasone-treated eyes, which showed a slight increase. At 4 and 8 weeks postoperatively, there was significant difference between these two eye groups. Multiple regression analysis revealed that postoperative increase in IOP at 8 weeks in the betamethasone-treated eyes was closely correlated with total surgery time and EPT, but the IOP in the diclofenac-treated eyes showed no correlation with any surgical or clinical parameters.Conclusions: Postoperative increase in IOP after cataract surgery was affected by total surgery time and EPT in the betamethasone-treated eye. The time for surgery and EPT is longer in complicated cases including patients with a hard nucleus or small pupils, and also longer for beginning surgeons and in older patients. In these cases, diclofenac in place of betamethasone as a postoperative topical antiinflammatory drug is recommended for the prevention of postoperative increase in IOP.Keywords: intraocular pressure, cataracts, visual acuity, betamethasone, diclofenac
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