Showing papers on "Cataract surgery published in 1970"

Repair of filtering blebs following cataract surgery.

Abstract: In a consecutive series of 710 cataract extractions, unintentional postoperative filtering blebs occurred in 18 eyes. The incidence of filtering blebs after limbus based conjunctival flaps vs after fornix based conjunctival flaps was 7:1. Postoperative complications were the most common etiologic factor associated with the production of filtering blebs. Site of suture placement, incision site into the anterior chamber, use of enzymatic zonulolysis, or operative complications could not be correlated either with development, size, or location of blebs. Indications for operative bleb closure include foreign body sensation, tearing, persistent leakage of aqueous, interference with contact lens wear, and macular edema. The technique for repairing the unintentional filtering bleb has proven safe and effective.

Hemorrhagic Macrocyst of the Retina: Mistaken for Malignant Melanoma of the Choroid

Abstract: MANY conditions have been mistakenly diagnosed as malignant melanoma of the choroid and these errors have led to unnecessary enucleation. A macrocyst of the retina filled with organized hemorrhage is one more example of a condition which can be erroneously diagnosed as choroidal melanoma. In the following case, this error resulted in enucleation. Report of a Case The patient underwent cataract extraction, OS, in 1958 at the age of 44. A retinal detachment developed in the left eye several months following cataract surgery. A scleral buckling operation at that time failed to reattach the retina and nothing further was done. The patient contacted me in 1967 to see if further surgery might repair this nine-year-old retinal detachment in the left eye. She was examined on June 3, 1967. In the right eye, the vision was only 20/100, with correction, due to a dense nuclear cataract. The refractive error was −14.00

Late Results of Congenital Cataract Surgery

Abstract: Generally speaking, it can be said, when considering all operated bilateral congenital cataracts, that a visual acuity of over 20/100 is found in approximately 50% of patients. In this study, 230 eyes were followed; of these 100 (43%) had an acuity of 20/60 or better and 130 (57%) had 20/100 or less. In conclusion the functional prognosis is better for incomplete cataracts than for total congenital cataracts. The main reason for this is the fact that total cataracts are often associated with cerebroretinal lesions or anomalies. The patient's age at operation and the surgical technique chosen are secondary factors. When considered from the standpoint of visual acuity, the results of congenital cataract surgery are discouraging, at least in the eyes with complete cataract. The visual prognosis could be better for total congenital cataracts if we operate on them at birth or immediately after birth.

The Cataract Problem in the Glaucoma Patient Population

Abstract: The incidence of eyes in a large glaucoma population with cataract sufficient to affect vision and severe enough to need cataract surgery for visual assistance is compared with the incidence of cataracts in nonglaucomatous populations. The effectiveness of cataract surgery in glaucoma patients as an aid to control of glaucoma is documented, and for comparison, the efficacy of antiglaucoma surgery in patients who did not need cataract surgery is tabulated. The frequency of need for resumption of miotic therapy after cataract surgery in glaucoma patients is tabulated, and time intervals before such recurring need for miotics are also shown.

Cataract extraction in glaucomatous patients.

Abstract: CATARACT formation with resultant reduction of vision is a frequent occurrence in patients receiving miotic therapy for glaucoma. This is especially true when using cholinesterase inhibitors which produce such intense miosis that the visual impairment from even minimal lens changes is greatly magnified. The development of proliferations of the pigment epithelium of the iris may cause further reduction of the pupillary opening in patients using these agents. In addition, individuals subjected to prolonged use of anticholinesterase drugs may develop central anterior subcapsular vacuoles and opacities. The necessity for cataract surgery, therefore, often arises in the long-term follow-up of glaucoma patients. Since the glaucoma patient will often require miotics postoperatively, it is advisable to create a permanent large pupillary opening at the time of cataract surgery. The advantages of the larger opening are twofold. First, during the operative procedure, the delivery of the lens is facilitated. Second, postoperatively, the fundus can

Epithelial downgrowth following cataract surgery. Cryotherapy for an intraocular foreign body.

Abstract: EPITHELIAL invasion of the anterior chamber is a rare but serious complication of cataract surgery. 1 Poor wound healing may precede the development of a downgrowth, although in many patients surgery is apparently uneventful and conditions responsible are obscure. The prognosis for treatment by either radiation or surgical excision is poor, 2-4 and the majority of involved eyes become blind and painful from secondary glaucoma and require enucleation. The following report of a patient with an epithelial downgrowth is of interest, first because of the association with a retained intraocular foreign body, and second because of a satisfactory response to iridectomy and cryotherapy. Clinical History In 1962, a white man aged 67, had an uneventful left cataract extraction performed with a good visual result. In January 1967, the right cataract was removed. The technique included a small fornix-based flap, a limbal section made with a Graefe knife and corneal scissors,

Cataract in Seckel Syndrome

Abstract: Seckel syndrome is an extremely rare inherited disorder characterised by severe growth retardation in utero, which continues later in life, resulting in short stature. Seckel syndrome presents as microcephaly, mental retardation, and a beak-like nose. This report describes a patient with Seckel syndrome who had bilateral cataract and underwent uneventful small incision cataract surgery in both eyes. The association of cataract with Seckel syndrome has not been described in the literature to the best of the authors’ knowledge.

Cataract Surgery Outcomes in New South Wales, Australia

Abstract: Aim: To prospectively assess the visual acuity outcomes of phacoemulsification surgery in 2 tertiary referral hospitals over an 8-year period, and to compare the outcomes achieved by ophthalmology consultants and registrars in routine clinical practice to assess the appropriateness of patient allocation.Methods: This prospective/retrospective case series of phacoemulsification surgery recruited patients from 1 July 2000 to 30 Dec 2008. Patients underwent detailed ophthalmic examination before and after surgery.Phacoemulsification and insertion of intraocular lens was performed by consultants and senior and junior registrars, who were allocated by the treating consultant. Postoperative review was conducted 1 day, 1 week, 1 month, and 3 months after surgery.Results: Of the 1812 cases, 1596 (88.1%) were complication free. The mean postoperative visual acuity was 0.17 LogMAR (6/9 Snellen equivalent), with 1630 cases (90.0%) achieving 0.30 LogMAR (6/12) or better. Consultants, and senior and junior registrars all achieved similar postoperative visual acuities of 0.15 to 0.17 LogMAR (p = 0.5). There was a significantly different rate of vitreous loss between the 3 groups (p = 0.002), with consultants at 2.9% (9/309), senior registrars at 1.9% (15/804) and junior registrars at 5.3% (37/699).Conclusions: The visual acuity outcomes and complication rates confirm that quality care is being delivered to patients. The different complication rates between consultants and registrars reflect consultants allocating themselves more complicated cases and the training of junior registrars. The similar postoperative visual acuities achieved showed that allocation of patients among consultants and registrars was appropriate and good visual acuity outcomes were delivered to all patients.

Effect of Varying Duration of Ocular Compression on Raised Intraocular Pressure following Fractionated Peribulbar Anaesthesia for Cataract Surgery

Abstract: Aim: To evaluate the effect of fractionated peribulbar anaesthesia and varying digital ocular compression time on intraocular pressure.Methods: Forty non-glaucomatous patients aged 40 years and older planned for cataract surgery were randomly divided into 2 groups based on the duration for which the globe was compressed digitally following each injection. Patients with a history of glaucoma or those who had had previous ocular surgery were excluded. Group 1 underwent 1 minute of compression and group 2 underwent 2 minutes of compression. Local anaesthetic (2% lidocaine 5 mL, 0.5% bupivacaine 5 mL, and hyaluronidase 25 IU/mL) was injected into the inferotemporal and superomedial quadrants. Intraocular pressure was measured (3 readings with <5% SD) before peribulbar block, after inferotemporal injection, following digital compression, after superomedial injection, following digital compression again, and at 1-minute intervals without compression until the globe attained normotension.Results: The mean (SD) intraocular pressure in group 1 was significantly elevated compared with the baseline mean intraocular pressure of 19.21 mm Hg (SD, 2.82 mm Hg) throughout the procedure (p < 0.0001). In group 2, the mean intraocular pressure was not significantly elevated from the baseline mean intraocular pressure of 19.13 mm Hg (SD, 3.27 mm Hg) following compression after each injection.Conclusions: Intraocular pressure rises significantly following each 5 mL of local anaesthetic injected into the peribulbar space at both the inferotemporal and superomedial sites. Digital ocular compression given for 2 minutes after each injection makes the globe normotensive.

Visual outcomes in Patients with Diabetic Macular Oedema undergoing Cataract Surgery with or without Intravitreal Bevacizumab

Abstract: Aims: To evaluate the efficacy of a single intravitreal bevacizumab injection after cataract surgery for the management of postoperative decrease in vision in patients with diabetic macular oedema.Methods: In this randomised controlled open-label parallel group study of 60 patients with diabetic macular oedema and lens opacity (grade ≥3), 30 eyes received a single intravitreal bevacizumab injection after cataract surgery, and 30 control eyes did not receive bevacizumab. The primary endpoint was change in best-corrected visual acuity 6 weeks after operation compared with that at baseline using the Snellen visual acuity chart.Results: Postoperative visual acuity was significantly different between the group receiving bevacizumab and the control group (p<0.005). All patients in the bevacizumab group had postoperative visual acuities above 6/18 with 27 patients having visual acuities of 6/12 or better compared with 6 patients in the control group. None of the patients in the bevacizumab group had visual acuities less than 6/18 compared with 11 patients in the control group.Conclusion: Intravitreal bevacizumab after cataract surgery appears to be beneficial for preventing postoperative visual loss in eyes with diabetic retinopathy by reducing the risk of macular thickening.

Droperidol in cataract surgery.

Abstract: The fact that so many techniques are available to surgeons and anaesthetists for cataract extraction, which is one of the most commonly-performed intraocular procedures, bears out the opinion of Stallard (I965) that \"the ideal local and general anaesthetic for eye surgery has yet to be found\". An important factor in cataract surgery is relaxation of the extraocular muscles, especially the orbicularis oculi, and for this reason general anaesthesia is used almost exclusively in many centres. But general anaesthesia has complications of its own and, apart from such minor difficulties as coughing and expectoration after tracheal intubation, ocular akinesia is not maintained in the postoperative period when the patient may be restless. A possible complication of local anaesthesia is retrobulbar haemorrhage but, with careful handling, this is a rare hazard, and the main problem is to keep the patient relaxed and cooperative, without making sudden violent movements. Laborit and Huguenard (I954) introduced the concept of \"hibernation anaesthesia\" and suggested the use of a mixture of pethidine, promethazine, and chlorpromazine, the so-called \"lytic cocktail\". Intravenous injection of potent phenothiazines, however, may produce marked and long-lasting cardiovascular instability in elderly patients and the anti-emetic effect of these drugs may be counteracted by the nausea consequent on sudden hypotension. Among the various analogues of pethidine which have recently been synthesized, phenoperidine hydrochloride has been found to be both more potent and more emetic, and to produce greater respiratory depression than its precursors (Rollason and Sutherland, I 963). To counteract the emetic effects of this useful drug it is often given in combination with one of the butyrophenones (Brown, I964), of which the best known is dehydrobenzperidol (droperidol). These drugs are potent tranquillizers and the resulting combination produces a condition known as \"neuroleptanalgesia\". Unfortunately the belief has arisen that, in order to produce this state of neuroleptanalgesia, these two classes of drug must be used together in the combinations suggested by the manufacturers; this misconception has caused this technique of producing a state of tranquillity with amnesia and analgesia ideal for ocular surgery in the aged, to be deprecated by some surgeons and anaesthetists as unreliable and dangerous. Any degree of intravenous overdosage with a powerful respiratory depressant such as phenoperidine (a drug used specifically for this effect in ventilator therapy) (Moran and Marshall, I966) can rapidly produce airway obstruction, desaturation, and venous engorgement; but systemic analgesia is an important adjunct in cataract surgery under local anaesthesia, because, for example, many elderly arthritic patients cannot lie still for any length of time on a hard operating table, despite the efficacy of the local anaesthesia or the gentleness of the surgeon.