Extracapsular cataract extraction and posterior chamber intraocular lens implantation in glaucomatous eyes

A comparison of ciliary sulcus and capsular bag fixation of posterior chamber intraocular lenses.

• Forty-six patients with medically controlled open angle glaucoma were scheduled to undergo extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. Surgery was performed in 43 eyes; three eyes had an intraoperative complication that prevented a posterior chamber lens implantation. The mean preoperative intraocular pressure was 17.6 mm Hg with the patients receiving a mean of 1.9 medications. The mean intraocular pressure (16.2 mm Hg) and the number of medications (1.4) administered to the 43 eyes having the planned surgery were significantly decreased an average of 23.4 months following cataract surgery. Seventy-two percent of the eyes had a postoperative visual acuity of 20/40 or better. Operative complications were similar to those reported for the same type of cataract surgery in nonglaucomatous eyes. However, there seemed to be an increased incidence of postoperative cystoid maculopathy (11.6%) in these glaucomatous eyes compared with previous reports in the literature and with the incidence in nonglaucomatous eyes that we treated. Our study shows that extracapsular cataract extraction with a posterior chamber lens can be effective in restoring vision without compromising intraocular pressure control in eyes with preexisting open angle glaucoma.

Extracapsular Cataract Extraction With Posterior Chamber Lens Implantation in Patients With Glaucoma

The glaucomas in aphakia and pseudophakia.

• We present 12 cases of pupillary block associated with extracapsular cataract extraction and posterior chamber intraocular lenses. In one case, pupillary block occurred despite the presence of a surgical iridectomy. The other 11 patients did not have a surgical iridectomy performed. We recommend that a surgical iridectomy or laser iridotomy be performed in all patients who undergo extracapsular cataract extraction with the implantation of posterior chamber intraocular lenses. Ophthalmologists need to be vigilant in watching for the development of pupillary block in these patients, since pupillary block is not a benign event and serious visual loss or disability may occur.

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James D. Faulkner

Papers

Complications of extracapsular cataract surgery. The indications and risks of peripheral iridectomy.