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Mini-rhexis for white intumescent cataracts
Kara-Junior, Newton;Santhiago, Marcony Rodrigues de;Kawakami, Andrea;Carricondo, Pedro;Hida, Wilson Takashi;
Clinics , 2009, DOI: 10.1590/S1807-59322009000400007
Abstract: purpose: to compare the intraoperative safety of two techniques of capsulorhexis for intumescent white cataracts: traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis. methods: this prospective comparative randomized study included two groups: the 1-ccc group (11 patients) received traditional one-stage continuous curvilinear capsulorhexis with 5-6 mm diameter, and the 2-ccc (13 patients) group received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged, or a two-stage continuous curvilinear capsulorhexis. patients were stratified according to cataract subset, which was characterized echographically. six patients were considered as type 1, fifteen as type 2 and three as type 3. type 1 included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections, type 2 included white cataracts with voluminous nuclei, a small amount of whitish solid cortex, and minimal internal acoustic reflections, and type 3 included white cataracts with fibrous anterior capsules and few internal echo spikes. results: with the one-stage technique, 46.15% of patients had leakage of the liquefied cortex; in addition, the surgeon perceived high intracapsular pressure in 61.53% of cases. anterior capsule tears occurred in 23.07% of cases, discontinuity of capsulorhexis in 30.79% of cases and no posterior capsular rupture occurred. with the two-stage technique, leakage of the liquefied cortex occurred in 45.45% of cases; additionally, the surgeon perceived high intracapsular pressure in 36.36% of cases. no anterior capsule tears, discontinuity of capsulorhexis or posterior capsular rupture occurred. considering each cataract subset, there was a higher incidence of leakage for type 2 as compared to types 1 and 3. conclusions: two-stage continuous curvilinear capsulorhexis helps prevent unexpected radial tears of the initial capsulotomy from high intracapsular pressure
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.
Manual small incision cataract surgery in eyes with white cataracts  [cached]
Venkatesh Rengaraj,Das Manoranjan,Prashanth Sadasivam,Muralikrishnan Radhakrishnan
Indian Journal of Ophthalmology , 2005,
Abstract: PURPOSE: To assess the safety and efficacy of Manual Small Incision Cataract Surgery (MSICS) in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorthexis (CCC). MATERIALS AND METHODS: Prospective observational study on 100 consecutive eyes of 100 patients with white cataract who had undergone MSICS with trypan blue assisted CCC. The nucleus was prolapsed into anterior chamber by using a sinskey hook and extracted out of the eye using irrigating vectis. Intraoperative and postoperative findings (according to OCTET classification) as well as postoperative visual outcomes were used as main measures to report the safety and efficacy of the surgery. RESULTS: Of the 100 eyes, 16 had intumescent, 67 had mature and 17 had hypermature cataract. Intraoperatively CCC was incomplete in 4 eyes (4%) and had to be converted to canopener capsulotomy. None of the eyes had posterior capsular rupture or zonular dialysis and no eyes were converted to conventional Extra Capsular Cataract Extraction (ECCE). Postoperatively, 6 eyes (6%) developed corneal oedema with >10 Descemets folds and 7 eyes (7%) had corneal oedema with < 10 Descemets folds. Mild iritis was seen in 6 eyes (6%) and moderate iritis with fibrin membrane was seen in 3 eyes (3%). Iridodialysis was observed in 1 eye (1%). Of the 99 patients (99%) categorised under good visual outcomes category, 94 patients (94%) had a best-corrected visual acuity of 6/9 or better on the 40th post-operative day. CONCLUSION: In developing countries like India where phacoemulsification may not be affordable to a majority of those requiring cataract surgery, MSICS proves to be a safe and efficacious alternative for white cataracts especially with the adjunctive use of trypan blue dye.
Effect of Anterior Capsule Polishing on the Need for Laser Capsulotomy  [PDF]
Hamad Elzarrug, Kevin M. Miller, Yu Fei, Shahriar Farzad, Yaroslav O. Grusha
Open Journal of Ophthalmology (OJOph) , 2017, DOI: 10.4236/ojoph.2017.74041
Purpose: To determine the effect of anterior capsule polishing (APC) on the rate of posterior capsule opacification (PCO) as assessed by the need for laser posterior capsulotomy. Setting: University-based clinical practice, Jules Stein Eye Institute, Los Angles, California, USA. Methods: This study involved a retrospective review of eyes that underwent phacoemulsification and intraocular lens implantation between September 1991 and June 1999. Lens epithelial cells in the 763 study eyes were mechanically debrided or polished from the inside surface of the anterior capsules using a pair of Shepherd-Rentsch (Morning STAAR Inc.) capsule polishers. The 484 control eyes that had surgery earlier in the series were not polished. The rate of laser capsulotomy in the ACP and the non-ACP groups was compared using a Kaplan-Meier survival analysis. Multivariate regression was performed to determine if variables other than ACP influenced the need for laser posterior capsulotomy. Results: We identified 763 eyes that had ACP and 484 that did not. At the 24-month follow-up interval, 26.6% of the eyes in the ACP group had received a capsulotomy versus 19.50% in the non-APC. Next, a separate study was done using only one eye per patient, taking the patient as the unit of analysis. Again the capsulotomy rate was higher in the ACP group compared to the non-ACP (1.02 per 100 person-months of follow-up vs. 0.74 per 100 person-months of follow-up). Finally, a third Kaplan-Meier analysis was done on 52 patients that had one eye treated with the ACP procedure and the other eye with the non-ACP procedure. Although the log-rank test showed the statistical significant of this analysis to be borderline, the results again favored the non-ACP group with a lower capsulotomy rate. Multivariate analysis showed very similar results to the above univariate studies. The mean time to capsulotomy was 46 months for the polished group and 70 months for the unpolished group. The severity of cataract (p = 0.46) and the type of haptics (p = 0.86) did not influence the rate of capsulotomy. Plate haptic IOLS had a higher rate of capsulotomy than loop haptic IOLS (p = 0.001). Conclusions: Polishing of the anterior capsule with Shepherd-Rentsch polishers may unexpectedly increase the rate of posterior capsule opacification in eyes with round-edge silicone lenses.
Anterior capsule staining using 0.025% trypan blue in cataracts without red reflex
Marback, Eduardo Ferrari;Freitas, Lincoln Lemes de;Fernandes, Fernanda Pelegrino;Branco, Bruno Castelo;Belfort Jr, Rubens;
Arquivos Brasileiros de Oftalmologia , 2001, DOI: 10.1590/S0004-27492001000400011
Abstract: purpose: to describe the use of anterior capsule staining in cataracts without red reflex using a 0.025% trypan blue solution. methods: six eyes of 6 patients with cataracts without red reflex were submitted to phacoemulsification using a direct injection of 0.2 to 0.5 ml of 0.025% trypan blue in the anterior chamber previous to viscoelastic injection. all patients had an ophthalmologic examination prior to surgery, as well as pre and postoperative corneal endothelial cell count. results: in all cases the capsule became stained with a faint blue color that enabled an adequate visibility of the flap during the continuous curvilinear anterior capsulotomy (ccc). there were no intra-or postoperative complications. the endothelial cell loss varied between 1.8% and 26.6% (mean 12.8%). conclusion: staining the anterior capsule with 0.025% trypan blue solution allows a good visibility of the capsular flap and facilitates the confection of ccc in cataracts without red reflex.
Capsulotomy and hydroprocedures for nucleus prolapse in manual small incision cataract surgery  [cached]
Venkatesh Rengaraj,Veena Kannusamy,Ravindran Ravilla
Indian Journal of Ophthalmology , 2009,
Abstract: Manual small incision cataract surgery (MSICS) involves the manual removal of nucleus through a scleral tunnel. To achieve 100% success every time, one has to do a good capsulotomy and should master the technique to prolapse the nucleus into anterior chamber. During conversion from extracapsular cataract surgery to MSICS, one can perform a can-opener capsulotomy and prolapse the nucleus. However, it is safer and better to perform a capsulorrhexis and hydroprolapse the nucleus, as it makes the rest of the steps of MSICS comfortable. Use of trypan blue in white and brown cataracts makes the capsulorrhexis and prolapse simple and safe. Extra caution should be taken in cases with hypermature cataracts with weak zonules and subluxated cataracts.
Pars plana or anterior lensectomy for traumatic cataracts?  [cached]
Tewari H,Sihota R,Verma N,Azad Rajvardhan
Indian Journal of Ophthalmology , 1988,
Abstract: Traumatic cataracts can nor be adequately managed with cutting aspiration systems by an anterior or pars planes approach 20 cases were randomly assured to these two approaches Pars plana lensectomy caused a more frequent uveitis and secondary glaucoma, though the visual acuity achieved post-operatively was similar in the two groups. We recommend an anterior lensectomy for patients who do not require simultaneous posterior segment surgery, because the retained posterior capsule decreases the indicence of complications.
Anterior mediastinal paraganglioma: A case for preoperative embolization
Murtaza Shakir, Geoff Blossom, John Lippert
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-134
Abstract: We report a case of anterior mediastinal paraganglioma that was embolized preoperatively, and was resected without the need for cardiopulmonary bypass and without major bleeding complications.We make a case to further the role of preoperative embolization in the treatment of mediastinal paragangliomas.
Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement
Tariq M Aslam, Niall Patton
BMC Ophthalmology , 2004, DOI: 10.1186/1471-2415-4-13
Abstract: 24 patients attending for capsulotomy had pre-operative measures of glare with BAT tester, visibility of posterior pole and grading of posterior capsular pearls and fibrosis seen at slit lamp. Visual function was measured before and after standardised capsulotomy. Correlations of the various preoperative measures with eventual visual function improvements were calculated.Pearls at slit lamp and poor posterior pole visualisation were all correlated with improvements in visual acuity and contrast sensitivity after capsulotomy. Amount of fibrosis visible at slit lamp and glare assessment were not correlated with vision improvements after laser.Of the various measures that are taken prior to Nd : YAG capsulotomy, some correlate with eventual visual improvement but for others no clinical utility was found. Practitioners should note these findings as they are especially of use in more questionable or high-risk cases to help determine whether referral for PCO treatment by Nd: YAG capsulotomy is likely to benefit the patient.Posterior capsular opacification (PCO) remains one of the most common post operative morbidities in modern day cataract surgery [1,2] and Nd:YAG posterior capsulotomy is one of the most commonly performed surgical procedures.However, the Nd: YAG capsulotomy procedure has been associated with complications such as damage to intraocular lenses [3], post operative intraocular pressure increases [4], cystoid macular oedema [4], disruption of the anterior vitreous face [5] and increased incidence of retinal detachment [6].Until recently Nd:YAG laser treatments have cost the U.S healthcare system up to $250 million annually [7]. Apart from exposing a patient to unnecessary risk, unqualified capsulotomies worsen this burden to the developed and developing world [8].PCO is an extremely common development in patients after cataract extraction and in many mild cases it may not be immediately obvious whether it is visually significant. Patients may have reduced vi
Anterior capsular staining with trypan blue for capsulorhexis in mature and hypermature cataracts. A preliminary study  [cached]
Kothari Kulin,Jain Sunil,Shah Nikunj
Indian Journal of Ophthalmology , 2001,
Abstract: Purpose: To study the efficacy and safety of 0.1% Trypan Blue dye to stain the anterior capsule for capsulorhexis in mature and hypermature cataracts. Methods: This preliminary study included 25 eyes of 25 patients with a unilateral mature or hypermature cataract, including one case of traumatic mature cataract. In all these cases 0.2ml of 0.1% trypan blue dye was used to stain the anterior capsule. The efficacy and safety of the dye was evaluated on the basis of intraoperative and postoperative observations. Results: In all 25 eyes the capsulorhexis was completed. There was peripheral extension of the capsulorhexis in the eye with traumatic cataract and the stained edge of the anterior capsule helped identification and redirection of the capsulorhexis. Successful phacoemulsification with intraocular lens implantation was performed in all eyes. Adverse reactions related to the dye such as raised intraocular pressure, anterior chamber inflammation and endothelial damage were not observed in the immediate postoperative period or at the end of mean follow-up of 3 months. Conclusion: Trypan blue dye staining of the anterior capsule appears to be a very useful and safe technique that simplifies capsulorhexis in mature and hypermature cataracts.
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