The Incidence of Endophthalmitis after Cataract Surgery among the U.S. Medicare Population Increased between 1994 and 2001

PURPOSE: To evaluate a laser technique and manual technique to perform capsulorrhexis in cataract eyes. METHODS: Anterior capsulotomy was performed with an intraocular femtosecond laser (LenSx Lasers Inc) in 54 eyes (FS group) and manual continuous curvilinear capsulorrhexis was performed in 57 eyes (CCC group). Circularity and area of capsulotomy and IOL decentration were measured using Photoshop CS4 Extended (Adobe Systems Inc) 1 week after surgery. Average keratometry, axial length, and preoperative anterior chamber depth were examined with the Lenstar LS 900 (HaagStreit AG). RESULTS: No statistically signifi cant differences were noted between groups in axial length, preoperative refractive state, and in the area of capsulotomy. Circularity values were signifi cantly better in the FS group (P=.032). We found incomplete overlap of capsulotomies in 28% of eyes in the CCC group and 11% in the FS group (P=.033). Signifi cant correlations were noted between axial length and area of capsulotomy, and between average keratometry and area of the capsulotomy in the CCC group (R=0.278, P=.036; and R=� 0.29, P=.033, respectively), but both did not correlate in the FS group (P� .05). In the CCC group, the pupillary area correlated signifi cantly with the area of the capsulotomy (R=0.27, P=.039). Signifi cant correlation was noted between IOL decentration and axial length in the CCC group (R=0.30, P=.026), but there was no correlation in the FS group (P� .05). CONCLUSIONS: Femtosecond laser capsulorrhexis was more regularly shaped, showed better centration, and showed a better intraocular lens/capsule overlap than manual capsulorrhexis. [J Refract Surg.

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Comparison of intraocular lens decentration parameters after femtosecond and manual capsulotomies.

Retinal detachment, separation of the neurosensory retina from the underlying retinal pigment epithelium, is a sight threatening condition that is considered one of the few ocular emergencies. The literature is enormously rich in studies that focused on different aspects of this disease process. Yet certain aspects remain largely unanswered. We briefly review major aspects of retinal detachment and discuss various important contributions in this field, focussing mainly on the pathogenesis of and predisposing factors to retinal detachment, and on the pathologic changes that occur following its development and following various surgical procedures currently used in its management.

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Pathology and pathogenesis of retinal detachment

Pseudophakic retinal detachment

The second part of a review of phakic intraocular lenses (pIOLs) addresses results and complications with current pIOL models. Phakic IOLs demonstrate reversibility, high optical quality, potential gain in visual acuity in myopic patients due to retinal magnification; correction is not limited by corneal thickness or topography. With proper anatomical conditions, pIOLs also show good results in hyperopic patients. Toric pIOL designs enable spherocylindrical correction. Complications are rare and primarily related to pIOL position and type. The main complications of anglesupported anterior chamber pIOLs are glare and halos, pupil ovalization, and corneal endothelial cell loss; of iris-fixated anterior chamber pIOLs, chronic subclinical inflammation, corneal endothelial cell loss, and dislocation or pupillary block glaucoma; and of posterior chamber pIOLs, anterior subcapsular cataract formation, pigment dispersion, and luxation or pupillary block glaucoma. No causative relationship between pIOL implantation (of any pIOL type) and retinal detachment has been established. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Andrea E. Singer

Papers

Risk factors for retinal detachment after cataract surgery. A population-based case-control study.