Showing papers on "Cataract surgery published in 1977"

Open-Angle Glaucoma Following Surgery for Congenital Cataracts

Abstract: • Eighteen patients who, years earlier, had undergone operations for congenital cataracts were discovered to have high Intraocular pressures. Several had profound glaucomatous loss of vision. All had deep anterior chambers with flat iris planes and wide open angles. The uveal meshwork was unusually coarse and pigmented in some cases. Nystagmus, aftercataracts, and small pupils made visual field testing and observation of optic discs difficult. Most cases were bilateral, which suggested a hereditary origin; some had a family history of glaucoma. In none did we observe signs of congenital glaucoma or rubella syndrome. The incidence of this disease is not yet known, but it is common enough in our clinic to indicate lifetime surveillance for glaucoma in all patients who undergo congenital cataract surgery. ( Arch Ophthalmol 95:1985-1987, 1977)

A possible cause of chronic cystic maculopathy.

Abstract: An apparent increase in incidence of chronic cystic maculopathy following cataract surgery in our patients prompted an analysis of changes in surgical procedure. The important change was in the increased amount and duration of exposure to the operating lights. Previous animal research by various authors suggested to us the precipitating factor was a photic maculopathy. Various methods of avoiding excessive exposure of the patient's eye to the operating lights are discussed.

Visual field changes following acute elevation of intraocular pressure.

Abstract: Visual field, acuity, and optic nerve head were evaluated in 24 patients with transient but marked elevations in intraocular pressure. The patient population consisted of 16 patients with angle-closure glaucoma and 7 with high tensions following cataract surgery. In all cases, duration and extent of pressure elevation is documented as well as subsequent visual field, acuity, and fundus examinations. In selected cases, visual field determinations were made during the acute pressure elevation. Previous reports of patients with acute pressure elevation are reviewed. The general absence of glaucomatous field defects in this patient population is discussed with respect to the possible pathogenesis of field loss seen in chronic simple glaucoma.

Corneal thickness after cataract surgery.

Abstract: An increase in corneal thickness occurs so regularly after cataract surgery as to be considered to be the rule. It reflects the state of endothelial activity and is therefore affected both by the preoperative condition of the endothelium and the degree of surgical manipulation. The question how quickly the endothelium can be expected to recover with consequent disappearance of corneal swelling is still open to discussion. The central corneal thickness of 55 eyes with normal slit-lamp endothelial appearance undergoing cataract surgery was measured preoperatively and on the 3rd, 7th, 14th, 21st, 28th, and 42nd postoperative days. The initial corneal thickness was 0.56 mm. The greatest corneal swelling, found on the third postoperative day, was 16%. Corneal thickness returned to preoperative values in four eyes within 7 days, in 19 eyes within 14 days, in 39 eyes within 21 days, in 50 eyes within 28 days, and in all 55 eyes within 42 days. Corneal swelling, as measured on the third postoperative day, was greatest (19%) when chromic catgut was used, less (13-16%) when black silk 7/0 was used, and least (9%) when virgin silk 8/0 was used.

Preoperative topical antibiotics and lash trimming in cataract surgery.

Abstract: Fifty patients admitted for cataract extraction had their lids and conjunctive cultured two days preoperatively, on the morning of surgery, and on each of the first four postoperative mornings. Multiple topical preoperative antibiotics given for forty-eight hours before surgery produced a marked reduction in the periocular bacterial flora, an effect which persisted throughout the postoperative period. Lash trimming prior to surgery did not alter the periocular bacterial flora present on the morning of surgery or at any time during the first four postoperative days. While multiple preoperative topical antibiotics may reduce the incidence of postoperative endophthalmitis through suppression of periocular bacterial flora, no such role can be postulated for lash trimming.

Prevention of postoperative ocular hypertension by prostaglandin inhibitors.

Abstract: The Pneumatonometer of Langham was used to monitor intraocular pressure in the operating theatre and in the early postoperative period after cataract surgery. Both indomethacin and aspirin were shown to prodcue a significant reduction in the acute ocular hypertension which can be expected to follow 6 hours after routine cataract surgery. It is suggested that the inhibition of prostaglandin synthesis by these drugs is probably responsible for this effect.

Retinal detachment following congenital cataract surgery.

Abstract: It is hoped that the results of surgery for retinal detachment after surgery for congenital cataract, when discission and aspiration or phacoemulsification under the microscope are used, will approach the present reattachment rate that has been achieved with improved examination, instrumentation, and surgical technique in cases of senile retinal detachment. Further studies of the role of retinal pathology as lattice degeneration, vitreous pathology, and the place for prophylactic cryotherapy all must be reevaluated. In summary, the low incidence of retinal detachment following the extraction of congenital cataracts as seen in major retinal referral centers suggests that the risks of detachment are not as high as previously reported, that the cure rate approaches that of senile aphakic detachment; therefore early operative intervention to prevent amblyopia, nystagmus, and strabismus is indicated.

Extracapsular Surgery and Lens Implantation

Abstract: Extracapsular surgery is an ideal type of cataract surgery in combination with lens implantation insofar as stability and fixation of the lens is greatly enhanced. However, a number of complications can be expected. The main probelms of extracapsular surgery is posterior capsule opacification. This is due to regeneration of germinal lens fibers. To prevent this a complete removal of cortical lens matter is advisable, even in lens implantation. This however requires special lenses, which have additional iris fixation.

Assessment of major intraocular and extraocular surgery performed as day cases.

Abstract: A review of 473 patients operated upon as day cases indicates that such surgery is safe, effective, and practicable. The surgical procedures included strabismus and ptosis correction in 265 children; major oculoplastic surgery for subtotal full-thickness eyelid reconstruction; and intraocular surgery in adults for trabeculectomy, cataract extractions with or without simultaneous intraocular implant introduction, and cataract extractions combined with trabeculectomy. No modification in surgical technique was required for strabismus and ptosis surgery. Slight modification was necessary for cataract surgery, and certain innovations were made in oculoplastic surgery.

Cataract surgery in eyes predisposed to retinal detachment.

Abstract: Modifications in cataract surgery technique in patients who have had previous retinal detachment surgery is considered in the following groups: previous "phakic" retinal detachment, in the same eye, in the fellow eye, and previous aphakic retinal detachment in the fellow eye. Prophylactic treatment prior to cataract surgery in these groups is also discussed as well as the prophylaxis of predisposing lesions prior to lens extraction. Finally, the place of cataract surgery in the presence of a retinal detachment is reviewed.

[Cataract operations and glaucoma - a study (author's transl)].

Abstract: This study reports on the favourable influence of lens extraction alone on intraocular pressure levels in different kinds of glaucoma (wide angle, angleclosure, secondary). Out of 2000 eyes undergoing cataract surgery 162 had medically treated glaucoma prior to surgery. Follow-up examinations of the intraocular pressure could be carried out in 118 eyes over a year. There resulted from this study no certain indications for a combined operation, whose value is discussed.

Cataract operation and retinal detachment.

Abstract: (1) 36 patients with a certified retinal detachment and a dense senile cataract who underwent cataract surgery prior to retinal surgery, (2) 32 patients with a history of detachment of one eye and a senile cataract of the other eye, who suffered a retinal detachment after cataract surgery. Discussion of the results of retinal surgery in the first group and on the incidence of retinal detachment and results of retinal surgery in the second group.

One-day hospitalization for extracapsular cataract surgery without phacoemulsification.

Abstract: A technique is described for an extracapsular cataract extraction that combines the advantage of freedom of activity associated with phacoemulsification without many of the disadvantages of this procedure. The technique retains one of the advantages of a small wound, the use of the irrigating cystotome, with an advantage of a large wound, ease of delivery of a firm nucleus. An intact posterior capsule is maintained. Although it is similar to the one-day intracapsular method that we described, the present procedure preserves the advantages of a well planned extracapsular extraction for the situations in which intracapsular surgery is not desirable. The technique has been used in 25 cases which have been followed longer than nine months, in which there have been no complications nor secondary opacification of the posterior capsule. The desirable and undesirable features of phacoemulsification, classical extracapsular, our extracapsular and intracapsular procedures have been compared. Comparison with the techniques of lens extraction through a pars plana approach is beyond the scope of this paper.

The influence of new surgical procedures on retinal pathology in aphakia after congenital cataract surgery.

Abstract: After reviewing the incidence of aphakic retinal detachment more specifically on eyes that have been submitted to surgery for congenital cataracts, the authors make some remarks and discuss the value, the advantages, and the yet unknown risks that the new methods of lens removal may have as regards retinal pathology. Special consideration is given to the balance of the advantages: more complete elimination of the opacities, lower incidence of immediate morbidity, better visual results and postoperative possibilities of retinal examinations; against the, as yet unknown, late retinal complications with new procedures such as ultrasonics, phacoemulsification, pars plana approach for lens removal, etc. Moreover, bearing in mind the typical late onset of retinal detachment in aphakic eyes after congenital cataract surgery with the older methods, such as linear extraction and multiple discussions, special attention is given to this feature as a comparative landmark for a prospective evaluation of recent methods of extracapsular lens surgery.

[Results of transpupillar vitrectomy (author's transl)].

Abstract: Vitreous prolapse in cataract surgery or during the extraction of a dislocated lens; corneal dystrophy in aphacic eyes due to corneo-vitreous contact and vitreous invading the anterior chamber following perforating injury proved to be valid indications for partial transpupillary vitrectomy. In malignant glaucoma, in postoperative wound rupture following cataract extraction, in open-sky-surgery of the anterior segment of aphacic eyes and in other particular conditions, transpupillary vitrectomy may also be considered. The transpupillary approach is not indicated in retinal detachment, unless prepupillary vitreous incarceration pulling up of the retina is obvious. Transpupillary vitrectomy can be performed without much harm to the eye even in children, if indicated (congenital cataract, congenital on traumatic lens dislocation, perforating lens injury). In general the results of transpupillary vitrectomy are good. Longterm complications are relatively rare. Experiences on 208 eyes are reported in particular.

Anaesthesia for cataract surgery. A preliminary communication.

Abstract: It is well recognized that patients presenting for cataract surgery are usually old, with a high incidence of medical disease. This combination is said greatly to increase the risk of general anaesthesia. In an unselected series of patients undergoing cataract surgery, 53.5% had a significant medical problem and 50% were receiving some form of medical treatment. All but three of the patients were given a general anaesthetic. The series is discussed against the background of anaesthetic morbidity. The authors recommend that routine electrocardiograms should be carried out on all patients over 60 years of age.

Correcting low vision in aphakic children.

Abstract: There are many children who have subnormal vision in spite of successful cataract surgery and aphakic spectacle lenses. There are children who have lens opacities for whom the state of aphakia would not be an improvement. Careful evaluation of functional vision, careful refraction, and the prescription of high adds or other optical devices are part of complete ophthalmological care for every one of these children. The dioptric strength of the reading add is determined by the functional reading vision and the calculation of the reciprocal of the visual acuity. It is also important to realize that many children who have lens opacities do not require special aids; functional vision is adequate until their accommodative reserve wanes with age. Continuous-wear contact lenses may eventually replace spectacle corrections for the aphakic child.

[Considerations on surgery of the iris (author's transl)].

Abstract: Surgery of the iris is of essential importance in anterior segment surgery. In angle closure glaucoma a peripheral iridectomy performed early enough, when the trabeculum is not yet altered, is curative. In simple glaucoma if a filtering operation is performed, the iridectomy is fundamental in order to have a good communication between the posterior chamber and the filtering bleb and to avoid iris incarceration into the filtering wound. In cataract surgery iridectomy is mandatory, especially in intracapsular extraction. In penetrating corneal grafts a patent iridotomy or iridectomy, or several, is a safety factor avoiding the consequences of pupillary block, anterior synechiae and irreducible mydriasis. Another important problem is the surgery of the iris for optical purposes. Other indications which are not discussed in this paper are trauma of the anterior segment of the eye, the removal of benign or malignant tumors, epithelial cysts etc.

The influence of changing cataract techniques on the ophthalmologist concerned with retinal diseases.

Abstract: This paper briefly presents a review of some of the retinal problems the ophthalmologist faces because of changing techniques in cataract surgery. It emphasizes the need for controlled clinical trials to properly evaluate the benefits or disadvantages of these changing techniques.