Showing papers on "Cataract surgery published in 1991"
TL;DR: In this article, the authors compared the rates of retinal detachment (RD) repair and hospitalization for endophthalmitis after extracapsular cataract extraction (ECCE) in 1986 and 1987 with those following inpatient catarach extraction in 1984.
362 citations
TL;DR: Patients undergoing Nd:YAG laser capsulotomy require ongoing medical observation to detect and treat serious complications of cystoid macular edema, retinal detachment, and new onset of glaucoma, which developed most often many months after Capsulotomy and many months to years after the cataract surgery.
286 citations
TL;DR: Subgroup analysis of the suturing technique showed that the technique of wound closure, as well as the wound size, influenced the induced astigmatism, however, the variability in the amount of induced cylinder was least with the 4.0-mm wound.
239 citations
TL;DR: While the increased rate of RD after ICCE versus ECCE confirms previously held clinical beliefs, the increase in the risk following phacoemulsification (P less than 0.0001) has not been reported previously.
160 citations
TL;DR: Strabismus presenting after cataract surgery is etiologically related to a heterogenous group of disorders, and Traumatic injury to the inferior rectus muscle secondary to retrobulbar anesthesia injection is postulated to result from a Volkmann's type ischemic contracture occurring in peripheral skeletal muscles.
119 citations
TL;DR: There was no correlation between the age at the time of surgery and the attainment of these visual levels in this patient subset and the best achieved visual acuity in children with surgically significant unilateral congenital cataracts was between 20/50 and 20/100.
117 citations
TL;DR: A field trial was conducted to compare the effects of eight health education and economic incentive interventions on the awareness and acceptance of cataract surgery in south India and revealed that individuals who were aware of surgery tended to be male, literate, and more affluent than those who were unaware of that option.
Abstract: A field trial was conducted to compare the effects of eight health education and economic incentive interventions on the awareness and acceptance of cataract surgery. Cataract screening and follow-up surgery were offered to more than 19,000 residents age 40 years and older in a probability sample of 90 villages in south India. Eight months after intervention, an evaluation was conducted to identify those in need of surgery who had been operated on. Two principal measures of program effectiveness are examined: awareness of cataract surgery and acceptance of the surgery. The type of intervention had a negligible effect on awareness of cataract surgery. A multiple logistic regression analysis revealed that individuals who were aware of surgery tended to be male, literate, and more affluent than those who were unaware of that option. Interventions that covered the complete costs of surgery had higher surgery acceptance rates. One health education strategy, house-to-house visits by a subject with aphakia, increased acceptance of the procedure more than others. In a multiple logistic regression analysis of acceptance rates, persons accepting surgery tended to be male; other factors were not important in explaining variation in acceptance rates.
105 citations
TL;DR: Early postoperative laser photocoagulation may help to prevent these proliferative complications, and, provided a large, adequate capsulotomy is performed for capsular thickening, the presence of an IOL does not interfere with this photocogulation.
Abstract: In a retrospective study we have examined all diabetics (66 operated eyes) and an equal number of non-diabetic matched controls who underwent extracapsular cataract extracation (ECCE) with intraocular lens (IOL) implantation over a two-year period ending in December 1987. Of the diabetic patients' 76% eyes improved by at least two lines of Snellen acuity postoperatively. Of these patients 68% eyes and of the control eyes 83% achieved an acuity of 6/12 or better. In the diabetics the visual outcome depended on the state of the retinopathy and in particular the maculopathy. The diabetic group had a greater incidence of postoperative inflammation, but the major complications were related to continuing neovascularisation. Early postoperative laser photocoagulation may help to prevent these proliferative complications, and, provided a large, adequate capsulotomy is performed for capsular thickening, the presence of an IOL does not interfere with this photocoagulation. We also advise early postoperative assessment, and treatment if necessary, of any maculopathy. Diabetic retinopathy should no longer be regarded as a contraindication to intraocular lens insertion.
99 citations
TL;DR: Findings confirm the generally held clinical belief that posterior subcapsular opacities are disproportionally represented in the surgical population and suggest that they cause more significant visual disability than do other types of cataracts.
Abstract: • The distribution and prevalence of lens opacities were examined and compared among three general population-based groups and a group that underwent cataract surgery. The population-based groups comprised subjects from the Framingham Eye Survey, the National Health and Nutrition Examination Survey, and the study of watermen in Maryland. Comparison among these groups revealed similar frequencies of lens opacities among age groups, with slightly higher rates for older individuals in the watermen study population. Comparison between the watermen and the surgical groups revealed that, of lenses with opacities, posterior subcapsular cataracts were present in a far greater percentage of surgery cases (60.6%) than in general population cases (5.3%). These findings confirm the generally held clinical belief that posterior subcapsular opacities are disproportionally represented in the surgical population and suggest that they cause more significant visual disability than do other types of cataracts.
87 citations
TL;DR: A detailed description of the construction of a self‐sealing incision for cataract surgery and the results of patients who had such an incision are reported.
Abstract: A detailed description of the construction of a self-sealing incision for cataract surgery and the results of patients who had such an incision are reported.
81 citations
TL;DR: It is suggested that the IOL material, poly(methyl methacrylate), stimulates lens epithelial cells to undergo fibrous metaplasia and to produce collagen fibers, which suggests that this effect should be considered as a parameter of biocompatibility in developing and evaluating new biomaterials.
Abstract: Characteristic lens epithelial cell behavior in the pseudophakic eye was examined by comparing 30 eyes that had extracapsular cataract surgery by the intercapsular technique and posterior chamber intraocular lens (IOL) implantation with lens epithelial cell removal but without anterior capsule capsulectomy and nine aphakic eyes that had the same procedure but without posterior chamber lens implantation over a mean follow-up period of 30 and 23 months, respectively. Fibrous anterior capsule opacification was observed in 83% of the pseudophakic eyes in the area of contact with the IOL, while the region beyond the margin of the IOL remained transparent. Fibrous anterior capsular opacification was not noted in the aphakic eyes. This suggests that the IOL material, poly(methyl methacrylate), stimulates lens epithelial cells to undergo fibrous metaplasia and to produce collagen fibers. Various cytokines such as IL-1 and TGF-β synthesized by lens epithelial cells may play a crucial role as mediators in the process. We recommend that this effect be considered as a parameter of biocompatibility in developing and evaluating new biomaterials.
TL;DR: The use of musseI adhesive protein in epikeratophakia and a new ophthalmie tissue adhesive and cell attachment factor.
Abstract: posterior capsular opaeification. J Cataract Refract Surg 1990; 16:188-192 5. Faulkner HW, Duffy RJ. Early capsular fibrosis with posterior convex surface posterior chamber intraocular lenses. J Cataract Refract Surg 1990; 16:271-272 6. Piceiano PT, Benedict Cv. MusseI adhesive protein. A new ophthalmie tissue adhesive and cell attachment factor. Invest Ophthalmol Vis Sei 1986; 27(Suppl):31 7. Robin JB, Salazar J. The use of musseI adhesive protein in epikeratophakia. ARVO abstracts. Invest Ophthalmol Vis Sei 1987; 28 (Suppl):225
TL;DR: A study of glaucoma in a cohort of 103 patients with Fuchs' Heterochromic Uveitis is reported, and 5-Fluorouracil is to be recommended as an adjunct to surgery.
Abstract: A study of glaucoma in a cohort of 103 patients with Fuchs' Heterochromic Uveitis (FHU) is reported. Twenty-seven patients (26.2%) had glaucoma. Half of these had glaucoma on presentation. The risk of development of glaucoma after presentation with FHU is 0.5% per year, falling substantially after 15 years follow-up. Causes of glaucoma include inflammation with peripheral anterior synechiae, rubeosis, lens-induced angle closure and recurrent spontaneous hyphaema, but most patients had chronic open angle glaucoma. Cataract surgery may precipitate glaucoma. Most patients were managed medically. The failure rate of glaucoma drainage surgery was 55.5%, and 5-Fluorouracil is to be recommended as an adjunct to surgery.
TL;DR: Within the last 6 months, three cases of infectious endophthalmitis following sutureless cataract surgery have been referred to us.
Abstract: Within the last 6 months, three cases of infectious endophthalmitis following sutureless cataract surgery have been referred to us. Two of these cases followed uncomplicated sutureless phacoemulsification with intraocular lens implantation. One case was complicated by a postoperative hyphema with additional surgery for clot removal 2 days following the initial procedure.
TL;DR: Lack of trained manpower is a serious limiting factor to the development of prevention of blindness programmes, and there is a need for the training of more ophthalmic assistants, cataract surgeons, and nurses in the diagnosis and management of common Ophthalmic disorders.
TL;DR: A prospective, computerized analysis of postoperative astigmatism, based on keratometry measurements, of 137 cases of extracapsular cataract extraction with intraocular lens implantation performed by one surgeon suggests that corneal curvature continues to change slowly even two to four years postoperatively.
Abstract: Little information on the natural course of corneal astigmatism following cataract surgery exists. We report a prospective, computerized analysis of postoperative astigmatism, based on keratometry measurements, of 137 cases of extracapsular cataract extraction with intraocular lens implantation performed by one surgeon. No sutures were cut postoperatively. Surgery induced 1.44 diopters (D) of with-the-rule astigmatism at one month, which declined at a rate of 0.77 D and 0.35 D per month for the next two months, respectively, with a more gradual decline thereafter. The mean surgically induced astigmatism at the last postoperative visit ranged from 0.29 D at six months (minimum follow-up) to 1.23 D at 48 months; both were against-the-rule. Mean follow-up was 28.92 months. These findings may be technique specific and suggest that (1) corneal curvature continues to change slowly even two to four years postoperatively; (2) most patients develop against-the-rule astigmatism, thus more with-the-rule astigmatism is desirable in the early postoperative period; (3) selective suture removal is necessary only when significantly more than 3.00 D of surgically induced with-the-rule astigmatism is present.
TL;DR: Diabetic patients scheduled for cataract surgery should undergo a thorough preoperative evaluation of any existing retinopathy, and should be followed up at close intervals so that any progression ofretinopathy can be promptly detected and considered for laser treatment.
Abstract: Five patients with mild to moderate retinopathy to both eyes underwent complication-free cataract surgery in one eye Within three months of surgery deterioration of the retinopathy was observed in the operated eye only In four patients there was an increase of intraretinal haemorrhages and hard exudates, accompanied by clinically significant macular oedema manifested as retinal thickening and extensive fluorescein leakage from both the macular and the peripapillary capillary networks Of these four patients one also developed retinal ischaemia, evident ophthalmoscopically by flame-shaped haemorrhages and cotton-wool spots and angiographically by areas of capillary non-perfusion The fifth patient showed proliferation of new blood vessels and vitreous haemorrhage Diabetic patients scheduled for cataract surgery should undergo a thorough preoperative evaluation of any existing retinopathy Postoperatively they should be followed up at close intervals so that any progression of retinopathy can be promptly detected and considered for laser treatment
TL;DR: It is suggested that IL-6 may play a crucial role in the occurrence of inflammation after cataract surgery, and it may lead to new therapeutic approaches to this problem.
Abstract: • The mechanism of uveitis following cataract surgery, which is mediated in part by the cyclooxygenase pathway, is complex, the complexity of which is likely to be due to several factors. We investigated the possible local involvement of interleukin 6 (IL-6) in this response. Using a specific bioassay, we showed a dramatic increase of IL-6 levels (>4 × 10 3 times) in all of the aqueous humors of 12 patients following cataract surgery. The IL-6 levels in serum samples were below detection limits, indicating a local production of this cytokine. In addition, the injection of highly purified recombinant interleukin 6 in the anterior chamber of the eye in rabbits resulted in an inflammatory response. These observations suggest that IL-6 may play a crucial role in the occurrence of inflammation after cataract surgery, and it may lead to new therapeutic approaches to this problem.
TL;DR: In the next 10 years growing numbers of adults will be reaching the age at which senile cataracts typically develop, and it is important to describe the effects of this treatment on the patient's quality of life.
Abstract: In the next 10 years growing numbers of adults will be reaching the age at which senile cataracts typically develop. At the same time, pressure is strong to contain medical expenses. In order to formulate wise public policy in this area it is important to describe the effects of this treatment on the patient's quality of life. After a general discussion of research on patient-centered medical outcomes, 18 studies of patient-centered cataract surgery outcomes are reviewed. Then the findings, both direct outcomes (visual acuity, percentage visual impairment, complications, visual functioning, physical and mental functioning, general well-being, and satisfaction with care) as well as modifying factors (type of prosthesis, presurgical functional status, condition of fellow eye, other ocular pathology, comorbidity, age, gender, socioeconomic status, attitudes, and values) are summarized. The closing discussion summarizes findings, describes two studies underway, and suggests directions for future studies of cataract surgery effects.
TL;DR: Current research to improve surgical success includes the development of effective artificial drainage implants or the use of pharmacologic modulators of wound healing, which promote filtration by preventing scar formation.
TL;DR: The results demonstrate that outpatient surgery may be a safe and practical alternative to routine hospitalization for eye surgery in developing countries and 94% of patients believed that their vision improved after surgery.
Abstract: • Neither outpatient surgery nor intraocular lenses have been widely used in developing countries. We performed extracapsular cataract extraction with posterior chamber intraocular lens implantation in a simple outpatient clinic in Ghana, West Africa. Forty-nine (64%) of 77 eligible patients with follow-up times of 12 to 29 months after surgery underwent an eye examination and an interview related to activities of daily life. Preoperative visual acuity was counting fingers or worse in all but one patient. Visual acuity improved in 44 patients (90%) after surgery. Twenty-six patients (53%) had a corrected visual acuity of 20/40 or better, 11 (22%) had a corrected visual acuity of 20/50 to 20/100, and 12 (25%) had a corrected visual acuity of 20/200 or worse. Subjectively, 94% of patients believed that their vision improved after surgery. No major late complications occurred following the immediate postoperative period. In addition, our population experienced no complications attributable to the outpatient format of this surgery. Every patient, all of whom lived within a 32-km radius of the clinic, reliably returned for postoperative appointments. Our results demonstrate that outpatient surgery may be a safe and practical alternative to routine hospitalization for eye surgery in developing countries.
TL;DR: Examining the 2-year outcome of extracapsular cataract surgery with posterior chamber intraocular lens insertion by a single fellowship-trained surgeon in Kathmandu, Nepal found that 21% of patients had posterior capsular opacification at follow-up, comparable to that in developed countries.
Abstract: • We evaluated the 2-year outcome of extracapsular cataract surgery with posterior chamber intraocular lens insertion by a single fellowship-trained surgeon in Kathmandu, Nepal. Six hundred ten eyes were followed up for 2 years. Patients underwent manual irrigation and aspiration with the insertion of a modified J loop posterior chamber intraocular lens. Almost half of the patients had uncorrected visual acuities of 20/50 or better after surgery. Sight-threatening complications in seven eyes (1.2%) included retinal detachment, corneal decompensation, and endophthalmitis. Although this rate is comparable to that in developed countries, 21% of patients had posterior capsular opacification at follow-up. Extracapsular cataract surgery with intraocular lens insertion may be an alternative to intracapsular cataract surgery in developing nations, where aphakic spectacles are expensive, not easily obtainable, or difficult to replace.
TL;DR: Twelve patients who suffered penetration or perforation of the globe during injection of a local anesthetic before cataract surgery are described, showing that retinal penetrations without retinal detachment may be treated effectively with photocoagulation.
Abstract: • We herein describe 12 patients who suffered penetration or perforation of the globe during injection of a local anesthetic before cataract surgery. Minimum follow-up was 6 months. Six eyes had a final visual acuity of 20/50 or better and an attached retina. Four eyes had an attached retina with a visual acuity of 20/80 to 2/200. Two eyes were anatomic failures because of a recurrent retinal detachment complicated by proliferative vitreoretinopathy. These cases show that retinal penetrations without retinal detachment may be treated effectively with photocoagulation. Vitreous surgery is recommended when the retinal penetration is associated with a retinal detachment. Eyes with a dense vitreous hemorrhage and a suspicion of a penetrating injury should either be followed up closely with echography or should undergo vitreous surgery since the extent of the injury cannot be determined.
TL;DR: Earlier surgery may be indicated to prevent visual deprivation amblyopia in patients with posterior lenticonus who were treated by three pediatric ophthalmologists between 1974 and 1988.
Abstract: Posterior lenticonus is associated with progressive lens opacification. We report a series of 40 consecutive patients (41 eyes) with posterior lenticonus who were treated by three pediatric ophthalmologists between 1974 and 1988. Prior to cataract surgery, appropriate patients were treated with atropine dilatation, spectacle correction including bifocals for refractive errors, and amblyopia occlusion therapy. Indications for surgery were a measured decrease in visual acuity, the loss of a central fixation reflex, or the onset of strabismus. The age at which cataract surgery was performed ranged from 2 months to 12 years (mean 4 years, 6 months). Nineteen eyes (49%) achieved postoperative acuities in the 20/20 to 20/40 range, 7(18%) eyes achieved 20/50 to 20/100, 4 (10%) eyes achieved 20/200, and 4 (10%) eyes achieved less than 20/200. Two (5%) young patients had central, steady, and maintained visual fixation reflexes and 3 (8%) additional patients had central, steady, but not maintained reflexes. After cataract surgery and aphakic optical correction, amblyopia was present in 84% of patients and strabismus was present in 51% of patients. The patients in this study had sufficient optical distortion to produce amblyopia. Cataract removal and optical correction alone did not correct the vision; occlusion therapy for amblyopia was required. Earlier surgery may be indicated to prevent visual deprivation amblyopia in patients with posterior lenticonus.
TL;DR: A closed‐system planned ECCE technique which allows a safe removal of the lens while maintaining the integrity of the capsular bag is presented and is combined with a low‐flow, anterior chamber maintainer in a closed‐ system and provides a useful surgical tool.
Abstract: Optimal fixation and position of an intraocular lens (IOL) is achieved when it is located in the capsular bag. A peripheral tear from the central opening to the lens periphery is associated with a high incidence of dislocation of at least one loop from within the capsular bag and lens decentration. A central round continuous capsulectomy (capsulorhexis), within the zonule-free area, provides long-term and balanced IOL fixation. To perform a well-controlled capsulectomy, a deep and stable anterior chamber should be maintained throughout the surgery. This is achieved by using a continuous anterior chamber maintainer that regulates the pressure in the anterior chamber. This paper reviews the clinical anatomical guidelines of the lens capsule and the anterior chamber and presents the authors' preferred technique for optimal anterior capsulectomy.
TL;DR: The results show the beneficial effects of local anaesthesia in preventing the hormonal, metabolic and cardiovascular changes found when cataract surgery is conducted under general anaesthesia.
Abstract: We studied the plasma catecholamine, plasma glucose and cardiovascular responses to cataract surgery in 20 elderly patients allocated randomly to receive either general anaesthesia or local anaesthesia by retrobulbar block. Local anaesthesia prevented the increase in plasma noradrenaline, adrenaline and glucose concentrations found in those patients who received general anaesthesia and also improved cardiovascular stability. The results show the beneficial effects of local anaesthesia in preventing the hormonal, metabolic and cardiovascular changes found when cataract surgery is conducted under general anaesthesia.
TL;DR: The present study showed that vitreous loss had occurred during cataract surgery in 28% of eyes, indicating that anterior segment complications are an important contributory factor to aphakic retinal detachment in these cases.
Abstract: A total of 93 cases of pseudophakic retinal detachment are reported. The present study showed that vitreous loss had occurred during cataract surgery in 28% of eyes, indicating that anterior segment complications are an important contributory factor to aphakic retinal detachment in these cases. There was impairment of the retinal view in 46% of eyes, and in 22.5% no retinal breaks could be identified. The main factor responsible for poor visibility was inadequate pupillary dilatation, which was found particularly in association with the use of iris-supported lenses. Detachment of the macula was unexpectedly found to occur in as many as 88% of cases. Reattachment of the retina either by conventional detachment procedures or by pars plana vitrectomy was achieved in 76.3% of eyes. Complications directly attributable to the presence of an intraocular lens (such as dislocation or haemorrhage) are described. Failure of surgery was more likely to occur in eyes exhibiting a poor fundal view, in which the detection of retinal breaks was difficult. The best results were achieved in eyes in which posterior-chamber lenses had been implanted.