Showing papers on "Cataract surgery published in 1985"

Hyaluronate increases intraocular pressure when used in cataract extraction.

Abstract: A prospective randomised study of 26 eyes (24 patients) following uncomplicated intracapsular cataract surgery was carried out with three groups in which different agents were used to re-form the anterior chamber: air, seven eyes; sodium hyaluronate, seven eyes; and a combination of hyaluronate plus systemic acetazolamide, 12 eyes. The intraocular pressure (IOP) was measured by Goldmann applanation tonometry 16 hours before surgery and every eight hours after surgery for 72 hours. The IOP doubled in the two hyaluronate-treated groups for the first day following cataract surgery. By contrast, the IOP in the group receiving air initially decreased slightly. Throughout the study the effect of using acetazolamide was never statistically significant. After the first day and a half the differences in IOP among the three treatment groups disappeared, and the pressures returned to their preoperative values.

Aphakic retinal detachment.

Abstract: A study of 132 cases of aphakic retinal detachment (ARD) following mainly intracapsular cataract surgery has been made. Forty-nine cases (37%) were found to have vitreous incarcerated into the cataract section out of a total of 54 (41%) cases who had suffered a vitreous complication during cataract surgery. A study of the characteristics of ARD reveals that those cases having had a vitreous complication in the management of their cataracts are more likely to develop detachment within three months than those not suffering from such a complication. The occurrence of these early post-extraction retinal detachments is not influenced by the presence of underlying axial myopia. When we compared ARD in patients whose cataract extractions had been complicated by vitreous incarceration with those ARDs following uncomplicated cataract surgery, we found that the characteristics of the detachments were very similar. Thus distribution of underlying myopia, extent of detachment, length of time of detachment, and multiplicity and type of retinal holes were generally similar. However, ARD following complicated cataract surgery is more likely to suffer from periretinal fibrosis. The findings confirmed the risk of ARD following complicated intracapsular cataract surgery and support the tendency to perform the extracapsular operation.

Ocular massage before cataract surgery.

Abstract: We used the Honan intraocular pressure reducer, a balloon that applies a constant force, to the eyes in ten subjects with senile cataracts. An initially significant decrease in intraocular pressure after removal disappeared exponentially with a half-time of 9.6 minutes, indicating that the benefits derived from the Honan balloon do not result from a sustained reduction in intraocular pressure. Measurements made on a phantom eye showed both marked variability and unexpectedly high intraocular pressure during typical preoperative digital massage by a group of ophthalmic surgeons. Measurements made on a cadaver eye after application of the Honan balloon showed that very high intraocular pressures may be achieved under some conditions.

Cataract surgery in developing countries.

Abstract: INTRODUCTION There are probably over 40 million people in the world who are blind using the WHO criterion (less than 3/60 or less than counting fingers at 3 metres in each eye), and this number could increase several times over the next 50 years, simply on account of an increasing and ageing population. Trachoma and onchocerciasis are the leading causes of blindness in the world, whilst blinding malnutrition is the commonest cause of blindness in children. The eradication of these diseases depends on a programme of both prevention and treatment, the latter being effective only if instituted at an early stage. However, the third commonest cause of blindness is cataract. There are about 17 million people in the world severely handicapped by this condition (International Agency for the Prevention of Blindness 1980, page 7) who could be cured by simple and highly effective surgery, and each year 1.25 million additional people acquire cataract. In the developed countries, the great majority of people with cataract are able to undergo cataract surgery, well before they are severely visually handicapped. However, in the developing countries, there are millions of people blind from cataract who have no foreseeable prospect of having their vision restored. In India, there are 5 million people blind from treatable cataract (World Health Organization 1976) and 5lf2 million requiring surgery (WHO Chronicle 1976). In Africa, there are 3 million people requiring surgery and only 300 eye doctors (International Agency for the Prevention of Blindness 1980, page 8). Thus, each ophthalmologist in Africa would need to perform 10 000 cataract operations to eliminate the backlog. At the rate of 20 a day, 5 days a week, 46 weeks of the year, he would need over two years to achieve this task alone, with no time for any other surgical or medical or preventive work clearly an impossibility.

Cataract surgery. Outcome assessments and epidemiologic aspects.

Abstract: Part one defines the topics and study purposes. The 12 studies reviewed in this survey focuses on following 3 topics of which the current knowledge is very limited: Assessment of outcome of cataract surgery (effectiveness studies). Pre-operative prediction of outcome of cataract surgery. Epidemiologic aspects of cataract surgery. These three topics were chosen as study objectives because more accurate knowledge of these points is necessary to assure a better cataract treatment in future, and as a basis for securing sufficient resource allocation to cataract surgery in the public health care. Each topic will be treated separately in the following 3 parts. Part two concerns the effectiveness studies on cataract surgery (publ. I-VI). Primary, a visual functioning index is presented and evaluated. The index is meant as a new supplementary tool for evaluation of the rehabilitation effect. This index, together with visual acuity and other outcome evaluators, was then used for assessment of the effectiveness of cataract extraction generally and in different sub-groups, supplemented with quantitative assessment of rehabilitation problems and analysis of outcome predictors. In a consecutive series of patients, in which intraocular lenses were not used, it was found, that 82% of the patients obtained a final visual acuity of 0.5 or better and 74% of the patients had normal or near normal basic visual functioning at one year follow-up. In spite of these good results, the rehabilitation of these aphakics were difficult. The difference between the two figures above represents some of the 'aphakic vision cripples' with severe difficulties of adaptation to aphakic spectacles. 26% of cataract extracted patients in a normal consecutive group were found to be dissatisfied with the outcome. Two main reasons for dissatisfaction were found: macular disease and low quality of vision with aphakic spectacles, especially in monaphakics, of which 75% had complaints about vision. Although monaphakics nearly reach the same level in basic functioning as the biaphakics, the latter are much more satisfied. It seems likely that basic visual functioning is gained by first eye surgery and more delicate visual functioning and a subjective 'visual comfort' is obtained by second eye surgery. Adaptation to aphakic spectacles seem to be far less difficult for the biaphakics. In series of patients rehabilitated with intraocular lenses or extended-wear contact lenses, the monaphakics appear to have a generally better visual functioning and they are much more satisfied with outcome than spectacles corrected monaphakics.(ABSTRACT TRUNCATED AT 400 WORDS)

Expulsive hemorrhage: its incidence in cataract surgery and a report of four bilateral cases.

Abstract: Between 1978 and 1983, 13,890 cataract extractions were performed in Baltimore at JHH and the GBMC with 14 expulsive hemorrhages for an incidence of 0.10%. In the years 1963 through 1983, 180,690 cataract extractions were performed in Taxila, Pakistan with 87 expulsive hemorrhages for an incidence of 0.05%. Reasons for the significant differences in incidence are presented. The six reported cases of bilateral expulsive hemorrhage are reviewed. Four more cases are added. A classification of choroidal hemorrhage is presented.

Long term complications from extracapsular cataract surgery.

Abstract: Long term follow up of extracapsular extraction showed visual results superior to those previously reported for intracapsular extraction. Ninety-six per cent of 197 eyes examined five years after extracapsular extraction with capsule supported lens implantation had a visual acuity of 6/12 or better. Of the 498 cases examined three years after surgery, including eyes without implants, 93 per cent had a visual acuity of 6/12 or better. Complications were rare provided the posterior capsule remained intact. Forty-five per cent of eyes without implants had required secondary capsulotomy within three years of surgery, compared with 11 per cent of eyes in which Binkhorst lenses had been used. Only 27 per cent of the eyes with Binkhorst lenses examined seven years after surgery were found to have required secondary capsulotomy. Opening of the capsule was seen to increase the risk of sight threatening complications, in particular of retinal detachment in high myopes. Implantation of posterior chamber lenses appeared to reduce the need for capsulotomy even further and it is suggested that their use in high myopia may help to lessen the chance of retinal detachment.

Treatment of ocular inflammation with diclofenac sodium: double-blind trial following cataract surgery.

Abstract: A controlled trial of diclofenac sodium was carried out in 100 patients undergoing intracapsular cataract extraction. All patients were treated with dexamethasone eyedrops twice daily, plus either diclofenac sodium 50 mg tid or matching placebo tid, started 24 hours before surgery and continued for four weeks. In comparison with those in the placebo group, patients in the diclofenac group showed significant decreases in most signs of ocular inflammation. Diclofenac therapy was well tolerated, except in one patient, and may safely be used to reduce intraocular inflammation.

The effect of prophylactic acetazolamide on the intraocular pressure rise associated with Healon-aided intraocular lens surgery

Abstract: Sixteen consecutive patients undergoing primary posterior chamber lens insertion with Healon were followed closely for any postoperative rise in intraocular pressure. Patients were divided into an experimental group (who received acetazolamide) and a control group (no acetazolamide). Careful attention was given to the same operative technique and the amount of Healon left in the eye. The treated group showed a mean intraocular pressure of 14.7 mm Hg, whereas the pressure in the control group was 22.6 mm Hg on the first postoperative day. These findings support the rationale for the use of prophylactic acetazolamide as an adjunct to Healon-aided cataract surgery.

Incidence of cataract extraction in Pima Indians. Diabetes as a risk factor.

Abstract: • The incidence of visually disabling cataract was estimated by the rate of first cataract extraction in a population of Pima Indians in Arizona. The annual age-specific rates of cataract surgery (first and second eyes) were 3.7 to 5.9 times as high as the estimated US rates. Diabetes was a strong risk factor for first cataract surgery in all age and sex groups except in men aged 75 to 84 years. Overall, with age and sex controlled, the rate of first cataract surgery was 2.2 times as high (95% confidence interval, 1.3 to 3.9) in diabetic as in nondiabetic subjects. Cataract surgery was related to the duration and type of treatment of diabetes. Insulin-treated diabetics had about five times the rate of those with normal glucose tolerance. The rate of cataract surgery was lowest in subjects with normal glucose tolerance, somewhat higher in those with impaired glucose tolerance, and even higher with increasing duration of diabetes.

Fire Hazard During Ophthalmic Surgery

Abstract: A plastic surgical drape was ignited by a disposable cautery during cataract surgery performed under local anesthesia. The flame was quickly extinguished, and the procedure was completed without complications. The patient did well postoperatively and attained a corrected visual acuity of 20/25. Precautions should be taken to minimize the possibility of fire occurring during ophthalmic surgery.

Comparison between the complications of cataract surgery following local anaesthesia with short stay and general anaesthesia with a five-day hospitalisation.

Abstract: In December 1979 97 patients underwent intracapsular cataract extraction under local anaesthetic with planned discharge on the day after operation. Twenty-three of these patients had a prolonged stay in hospital, and five of these required early operative intervention following surgical complications. Sixteen patients did not attain a visual acuity better than 6/18. The visual outcome and postoperative course are compared with those of a similar group of patients who stayed in hospital for five days after intracapsular cataract extraction.

Management of the posterior capsule before and after the YAG laser.

Abstract: A retrospective chart review of 2,514 consecutive posterior chamber implants was carried out to assess the management of the posterior capsule when vision loss dictated intervention. The capsulotomy technique used between May 1977 and March 1983 was pars plana posterior capsulotomy (227 eyes). All posterior capsulotomies performed after April 1, 1983 were with the YAG laser (342 eyes). Comparison of the complications with the two methods showed considerable differences. Anterior segment problems appear greater following YAG laser posterior capsulotomy than pars plana posterior capsulotomy, whereas posterior segment complications appear similar in both techniques. Comparison of CME following both techniques indicates that a delay of 6 months or more between cataract surgery and posterior capsulotomy is advisable.