Showing papers on "Cataract surgery published in 1992"

Dexmedetomidine reduces intraocular pressure, intubation reponses and anaesthetic requirements in patients undergoing ophthalmic surgery

Abstract: We studied the effects of a single i.v. dose of dexmedetomidine, a highly selective and specific alpha2 adrenoceptor agonist, on intraocular pressure (IOP), haemodynamic and sympathoadrenal responses to laryngoscopy and tracheal intubation, and on anaesthetic requirements in ophthalmic surgery. Thirty ASA I–II patients undergoing cataract surgery were allocated randomly to receive either dexmedetomidine 0.6 μg kg−1 or saline placebo i.v. 10 min before induction of anaesthesia in a double-blind design. After dexmedetomidine there was a 34% (95% confidence interval (Cl) 27–43%) reduction in IOP (P

A prospective study of cigarette smoking and risk of cataract surgery in women.

Abstract: Objective. —To examine prospectively the association between cigarette smoking and the risk of cataract extraction in women. Design. —Prospective cohort study beginning in 1980 with 8 years of follow-up. Setting. —United States, multistate. Participants. —Registered nurses 45 to 67 years of age and free of diagnosed cancer. There were 50 828 women included in 1980 and others were added as they became 45 years of age. Main Outcome Measure. —Incidence of senile cataract extraction. Results. —We documented 493 incident senile cataracts diagnosed and extracted during 470302 person-years of follow-up. The age-adjusted relative risk (RR) among women who smoked at least 65 pack-years was 1.63(95% confidence interval [Cl], 1.18 to 2.26; Pfor trend,.02). A similar increase in RR was noted when smoking was assessed in terms of number of cigarettes currently smoked or number of cigarettes smoked by past smokers. Results were also similar after adjusting for other potential risk factors for cataract. Smoking was also strongly associated with posterior subcapsular cataract specifically (RR, 2.59; 95% Cl, 1.49 to 4.50 for ≥65-pack-year smokers relative to nonsmokers). Conclusion. —Smoking appears to increase the risk of cataract extraction. ( JAMA . 1992;268:994-998)

Postsurgical inflammation after phacoemulsification and extracapsular extraction with soft or conventional intraocular lens implantation

Abstract: A one-year prospective study was conducted in 120 patients to assess the time course of changes in intraocular inflammation after three cataract surgery procedures: planned extracapsular extraction with poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation (11 mm incision group), phacoemulsification with PMMA IOL implantation (7 mm incision group), and phacoemulsification with foldable silicone single-piece IOL implantation (4 mm incision group). Each group was carefully matched for patients' ophthalmologic and systemic backgrounds. Patients with hard nuclei were excluded. The degree of inflammation was evaluated by quantitating aqueous flare intensity and cell count with the laser flare-cell meter. In the early postoperative period, both aqueous flare intensity and cell count were highest in the 11 mm incision group followed, in decreasing order, by the 7 mm and 4 mm incision groups. Significant between-group differences were observed at one, two, and seven postoperative days for flare and one day through one week for cells. Both parameters in each group decreased to a similar level one month after surgery, but flare intensity in all groups remained significantly higher than that of age-matched normal controls up to six months postoperatively.

The National Cataract Surgery Survey: I. Method and descriptive features.

Abstract: The National Cataract Surgery Survey is a prospective cross-sectional survey of surgery for age-related cataract within the National Health Service. It is the first national study of cataract surgery in the United Kingdom providing clinical data. This is the first in a series of papers and describes a profile of the characteristics of patients admitted for cataract surgery that includes: demography, referral sources, presence of co-existing ocular pathology, level of visual impairment on admission and waiting time for surgery. A profile of the process of the surgical procedure for 1990 is also described: number of operations performed, type of admission, type of anaesthetic, cataract extraction and intraocular lens and the grade of surgeon performing the procedure.

Toxic anterior segment inflammation following cataract surgery

Abstract: Cataract extraction with posterior chamber intraocular lens implantation is rarely complicated by an acute, sterile, anterior segment inflammation. We report three unrelated cases of acute intraocular inflammation following uncomplicated cataract extraction and posterior chamber intraocular lens placement. A constellation of clinical features were found in these cases. The hallmark of this entity was an acute toxic inflammatory reaction occurring in the anterior segment on the first postoperative day. Typically, widespread corneal edema with diffuse corneal endothelial damage occurred, accompanied by a fixed, dilated pupil with significant iris atrophy and sometimes a severe secondary glaucoma. Since all cultures were negative, the resulting inflammatory processes were not a result of endophthalinitis. We believe that a toxic insult introduced into the anterior chamber at the time of surgery precipitated the acute inflammatory processes seen in these cases.

Lens and cataract

Abstract: Anatomy and embryology lens biophysics lens physiology lens biochemistry evolution and molecular biology of lens proteins the normal aging lens the cataractous lens lens alterations the decision to operate optic correction of aphakia the technique of cataract surgery opacification of the posterior capsule postoperative endophthalmitis epithelial invasion of the anterior chamber anterior chamber depth abnormalities haemorrhage lens extraction in special situations.

Endophthalmitis following extracapsular cataract surgery: a review of 32 cases.

Abstract: Thirty two cases of endophthalmitis following extracapsular cataract surgery that had occurred within our department and had undergone intraocular diagnostic tap between May 1982 and May 1991 were reviewed. An infectious agent was identified in 20 cases (62.5%). The commonest organism was Staphylococcus epidermidis (11 cases) (55%). Proteus was the only gram negative organism identified (four cases) (20%). Both of these organisms were associated with a favourable visual outcome. In the culture positive subgroup 15 eyes (75%) achieved a final acuity of 6/60 or better with 10 eyes (50%) gaining 6/12 or better. Thirteen (65%) of the culture positive cases were managed without vitreal intervention. Of these 11 (85%) achieved 6/60 or better with eight (62%) gaining 6/12 or better. It appears that when an endophthalmitis follows uncomplicated extracapsular cataract surgery delivery of antibiotic by the 9conventional9 routes (topical, subconjunctival and systemic) is consistent with a favourable visual result in many cases. A modified anterior chamber diagnostic tap technique is described.

Premedication for outpatient cataract surgery: a comparative study of intramuscular alfentanil, midazolam and placebo

Abstract: The effects of i.m. alfentanil and midazolam on anxiety, sedation, hemodynamics, oxygen saturation and intraocular pressure were studied in 90 patients scheduled for outpatient cataract surgery with regional anesthesia. The study was randomized, double-blind, placebo-controlled, and performed on outpatients with ASA physical status I-III and mean age 67.7 +/- 11.7 years. Alfentanil (12.5 micrograms/kg) administered into the deltoid muscle had a marked anxiolytic and short sedative effect, and was associated with stable hemodynamics. Midazolam (20 micrograms/kg) administered similarly had a more prolonged anxiolytic and sedative effect, which impaired co-operation in some patients during surgery. The regional blockade was associated with a significant reduction of oxygen saturation (SpO2), regardless of the premedication used (P less than 0.05). A slight reduction of intraocular pressure (IOP) was found after premedication, but the change was not statistically significant. We conclude that i.m. alfentanil is well tolerated, and its anxiolytic and short sedative effects make it especially suitable as premedication for day-case cataract surgery.

Effect of combined peribulbar and retrobulbar injection of large volumes of anesthetic agents on the intraocular pressure.

Abstract: A prospective randomized study was done in 79 patients undergoing elective routine cataract surgery in which the Kelman phacoemulsification technique was used with placement of an intraocular lens. In all the patients anesthesia was induced with both a peribulbar and a retrobulbar injection of a large volume (total 10.5 mL) of local anesthetic. The patients were randomly assigned to receive either the peribulbar (39 patients) (group 1) or the retrobulbar (40 patients) (group 2) injection first. The intraocular pressure (IOP) was measured five times during anesthesia. The mean elevation in IOP immediately after the first injection was 0.4 mm Hg in group 1, compared with 2.0 mm Hg in group 2. Twenty minutes after both injections had been given and a Super Pinky pressure device had been placed on the eye, the mean decrease in IOP from the preoperative value was 3.1 mm Hg in group 1 and 4.8 mm Hg in group 2. We conclude that a combined peribulbar and retrobulbar approach is a safe and effective alternative method of regional anesthesia for cataract surgery.

Current practice of cataract extraction and anaesthesia.

Abstract: A questionnaire regarding preferred methods of cataract extraction and anaesthesia was sent to 456 consultant ophthalmologists in England and Wales. Replies were received from 86% (n = 392), 83% (n = 380) having completed the questionnaire in full. The most frequently employed surgical approach was non-automated extracapsular cataract extraction. Only 2% of surgeons (n = 8) used phacoemulsification routinely and 2% (n = 7) used intracapsular extraction. Intraocular lens implantation was the standard practice of 99% of surgeons (n = 376). There has been a dramatic increase in the popularity of local anaesthesia, which was employed routinely (in more than three-quarters of their cases) by 20% of surgeons (n = 76). Retrobulbar infiltration remains the most common method of administration. Sedation was given routinely by 45% of surgeons (n = 171) when using local anaesthesia. Medical contraindications and patient preference were considered the most important reasons for selecting local anaesthesia rather than general. The exclusive use of general anaesthesia in cataract surgery appears to be diminishing.

Continued breakdown of the blood aqueous barrier following cataract surgery.

Abstract: Following routine extracapsular cataract and posterior chamber implant surgery, recovery of the blood aqueous barrier (BAB) was quantified by sequential anterior chamber fluorophotometry. This was correlated with surgical details and postoperative findings to ascertain those factors which were related to excessive damage of the BAB immediately after surgery and to failure to recover a normal BAB by 3 months postoperatively. A cohort of 84 patients was followed. In the early postoperative period excessive levels of damage to the BAB were related to iris damage (p < 0.01) and diabetes mellitus (p < 0.01). By 3 months, 79% of the eyes had recovered normal BABs and 21% (18 eyes) had persisting excessive fluorescence which correlated with an abnormal pupil shape (p < 0.02) and the development of posterior synechiae (p < 0.001).

Effect of posterior chamber intraocular lens design and surgical placement on postoperative outcome.

Abstract: Intraocular lens (IOL) design, optical configuration, and placement have potential effects on postoperative outcome. Laboratory studies have suggested that one-piece, biconvex designs may reduce or delay posterior capsular opacification and that in-the-bag fixation of the posterior chamber IOL may reduce inflammation. To document the clinical significance of IOL design and placement, we conducted a randomized, prospective, clinical trial. Six hundred uncomplicated capsulorhexis and phacoemulsification patients were randomized in a three-factor design to receive an IOL that was one-piece or three-piece, had a biconvex, plano-convex, or laser ridge optic, and was bag-or sulcus-fixated. Treatment differences were related to lens placement. Patients with bag-fixated IOLs had less posterior capsular opacification, fewer YAG laser capsulotomies, a higher percentage of centered lenses, less inflammation, and fewer late posterior capsular striae than those with sulcus-fixated IOLs. In the latter group, patients with three-piece IOLs had fewer posterior capsular striae at three months postoperatively. All six occurrences of haptic loop distortion were in patients with three-piece IOLs. Patients with the one-piece design had less late inflammation than those with the three-piece design. Fewer YAG capsulotomies were necessary at one year in patients with the biconvex design than in those with the plano-convex or laser ridge configurations. Operative complications, endothelial cell loss, and postoperative complications were not IOL-related.

Comparison of small-incision phacoemulsification with standard extracapsular cataract surgery: post-operative astigmatism and visual recovery.

Abstract: A prospective study compared post-operative astigmatism and visual acuity (corrected and uncorrected) following phacoem unification and extracapsular surgery. Fifty eyes had implantation of a 7 mm diameter optic intraocular lens (IOL) following conventional extracapsular cataract extraction (ECCE) with a 10 mm corneal incision. Forty-seven eyes were implanted with a 5×6 mm optic IOL through a 5 mm scleral incision after phacoemulsification. Uncorrected visual acuity of 6/9 or better was achieved in 25% of eyes on the first day following phacoemulsification, 36% at 1 week and 57% at 12 weeks. These results (and also the best corrected acuity) were significantly better than those following ECCE. Less astigmatism was induced by phacoemulsification than extracapsular surgery, measured at all post-operative time intervals.

The course of diabetic retinopathy following cataract surgery in eyes previously treated by laser photocoagulation.

Abstract: The course of diabetic retinopathy following extracapsular cataract extraction with posterior chamber lens implantation in eyes previously treated by laser photocoagulation for diabetic retinopathy was retrospectively studied in 33 eyes (33 patients). In 20 eyes (61%) there was no change in the retinal status postoperatively. In 13 (39%) there was postoperative progression of diabetic retinopathy compared with the fellow non-operated eye, in which progression occurred in nine eyes (27%). The severity of the preoperative status affected the incidence of progression. Four eyes (12%) developed complications of diabetic retinopathy--that is, rubeosis iridis and vitreous haemorrhage--which regressed after lasering. Cystoid macular oedema developed in 13 eyes (39%) and its incidence varied according to the postoperative course of diabetic retinopathy. The majority of the eyes showed a postoperative improvement in vision.

Combined small-incision cataract surgery and trabeculectomy--technique and results.

Abstract: In a prospective study 35 eyes of 25 patients with coexisting cataract and glaucoma underwent trabeculectomy, phacoemulsification and implantation of a folded polyHema intraocular lens through the trabeculectomy opening. Follow-up ranged from 6 to 27 months (mean 13.3). The mean age was 76.4 (68 to 88 years). 22 eyes suffered from primary open angle glaucoma, 10 eyes from a pseudoexfoliation glaucoma and 3 eyes had a chronic angle closure glaucoma. Preoperatively intraocular pressure was controlled in 10 eyes with a mean medication of 2.1 but uncontrolled in 25 eyes (mean medication: 2.5). The preoperative visual acuity ranged from 20/40 to hand motions. Postoperatively intraocular pressure was controlled (< 18 mmHg) in all (100%) eyes and without therapy in 32 (91%) eyes. Three (9%) eyes had to be treated with topical timolol twice a day after surgery. Mean intraocular pressure dropped from 21.2 +/- 6.0 mmHg preoperatively to 13.5 +/- 2.1 mmHg postoperatively. Vision improved in all but 4 eyes, 25 (74%) achieving a visual acuity of 20/40 or better. The causes for failed improvement or deterioration of vision were senile macular degeneration in 2 eyes and central retinal vein occlusion and vascular optic nerve atrophy in one eye respectively. Post-operative complications included hyphema in 9 (26%) eyes, fibrin effusion to a various extent into the anterior chamber in 19 (54%) eyes and delayed hypotony (< 5 mmHg) with chorioidal effusion in 1 (3%) eye. Fibrin effusion was frequently observed in eyes with intraocular pressure below 10 mmHg, iris surgery and hyphema. Finally the complications did not effect the results regarding visual acuity or glaucoma control.(ABSTRACT TRUNCATED AT 250 WORDS)

Permanent blindness following retrobulbar hemorrhage after peribulbar anesthesia for cataract surgery.

Abstract: We present a case in which a modified peribulbar anesthesia, administered with a 24-gauge (0.55 x 25 mm) sharp, disposable needle, induced an orbital hemorrhage, resulting in complete and permanent loss of vision. To our knowledge, this is the first report of severe complications following a peribulbar block.

Diffractive multifocal intraocular lens implants for unilateral cataracts in prepresbyopic patients.

Abstract: Multifocal intraocular lenses allow pseudophakic patients to obtain good near and distance visual acuities without an additional near correction. We report our experiences in implanting diffractive multifocal intraocular lenses in prepresbyopic patients with acquired unilateral cataracts and assess their postoperative visual acuities and stereoscopic vision. Accommodative function in patients following cataract surgery is discussed.

Infectious endophthalmitis following sutureless cataract surgery.

Abstract: To the Editor. —The case reported by Hessburg and coworkers was not an uncomplicated case, but was one that had a secondary lens exchange through a previous "sutureless" incision. Two of the three cases reported by Stonecipher et al were also not uncomplicated. Case 1 was a wound gap with an inadvertent filtering bleb. Case 2 related to intraocular manipulation through the cataract incision in the early postoperative period to attempt to remove a hyphema. The third case was of late endophthalmitis occurring approximately 4 months following cataract surgery. In at least three of these four cases reported, there was additional intraocular manipulation or an improperly performed wound technique that can be implicated in the development of endophthalmitis. Hessburg and coworkers describe their serious reservations regarding this surgery and suggest that this is an experimental technique that should be investigated accordingly. Stonecipher et al also comment that maintenance of wound

Corneal edema following argon laser iridotomy.

Abstract: Laser iridotomy is generally a safe and effective procedure for narrow-angle glaucoma. However, since surgical success with the argon laser depends on a focal thermal effect, a corneal burn is a possible complication. I describe five patients with occludable anterior chamber angles and bilateral corneal guttata who developed uniocular progressive corneal edema with visual loss following argon laser iridotomy. These five patients underwent iridotomy with a total laser energy of 63, 48.5, 7, 25, and 25 J, respectively, and began to lose vision due to corneal edema immediately, and 5, 2, 4, and 2 years later, respectively. Following penetrating keratoplasty with cataract surgery, histopathology of the corneal buttons showed generalized endothelial cell loss in all five. Microstructural findings of guttata and thickened Descemet's membrane implied that prior endothelial dystrophy had predisposed these patients to laser-induced damage. Risk factors for immediate or delayed-onset bullous keratopathy after argon laser iridotomy include prior angle closure, preexisting endothelial guttata, and high laser energy with multiple applications. Recognizing the potential of this complication offers opportunities for preventive strategies.

Ocular diclofenac. A review of its pharmacology and clinical use in cataract surgery, and potential in other inflammatory ocular conditions.

Abstract: Diclofenac sodium is a potent nonsteroidal anti-inflammatory drug with analgesic activity. When instilled as a topical 0.1% solution in a limited number of patients undergoing cataract surgery, diclofenac limits surgically induced miosis, reduces signs of ocular inflammation, does not cause elevations in intraocular pressure, and reduces the occurrence and severity of cystoid macular oedema. Preliminary findings suggest a niche for topical diclofenac in other ocular inflammatory conditions such as iritis, episcleritis and conjunctivitis, although its efficacy in these areas awaits confirmation. The drug appears well tolerated, apart from a transient burning sensation after instillation in some patients. Ocular diclofenac thus appears well suited as a local anti-inflammatory adjunct to cataract surgery, and may be useful in some other inflammatory ocular conditions.

Perfluorocarbon heavy liquids in the management of posterior dislocation of the lens nucleus during phakoemulsification.

Abstract: We report a case in which the lens nucleus dislocated into the vitreous cavity through a posterior capsular rupture during phakoemulsification. We performed a vitrectomy and removed the lens nucleus using the perfluorocarbon heavy liquid perfluoro-1,3-dimethylcyclohexane. The management of posterior dislocation of the lens nucleus during cataract surgery is discussed.

Anterior capsular opacification after endocapsular cataract surgery.

Abstract: The central parts of the opacified anterior capsules of nine eyes of nine patients after endocapsular phacoemulsification followed by posterior chamber intraocular lens implantation were removed after an average postoperative period of 25 months and examined by light and electron microscopy. The opacified materials were judged to be collagen. Transmission electron microscopy revealed fibers 50 to 60 nm in diameter, with approximately 65-nanometer periodic bands in five of the nine eyes. Most remaining cells showed multilayered proliferation and were rich in cytoplasmic microtubules and surface dendrites. These results indicate that postoperative anterior capsular opacification is composed of fibroblast-like cells, presumably transformed from lens epithelial cells and collagen.