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Showing papers on "Cataract surgery published in 1993"


Journal ArticleDOI
TL;DR: Neodymium:YAG laser radial anterior relaxing capsulotomies done within three weeks of cataract surgery reduce the sphincter effect of the contraction and lessen the chronic zonular‐traction‐related complications of the condition, which may include spontaneous IOL dislocation and retinal detachment.
Abstract: Capsule contraction syndrome is an exaggerated reduction in anterior capsulectomy and capsular bag diameter after extracapsular cataract surgery. While rarely seen with can-opener-style capsulectomies with anterior radial capsular tears, it is relatively frequent with capsulorhexis. It is particularly common in patients with pseudoexfoliation and in eyes with a history of moderately severe uveitis. Its effects, which include extreme reduction in the capsulectomy opening, malposition of the opening, reduction in equatorial capsular diameter, and displacement of the IOL, seem more exaggerated in small capsulorhexis openings and in the older patient. Neodymium:YAG laser radial anterior relaxing capsulotomies done within three weeks of cataract surgery reduce the sphincter effect of the contraction and lessen the chronic zonular-traction-related complications of the condition, which may include spontaneous IOL dislocation and retinal detachment.

374 citations


Journal ArticleDOI
TL;DR: There seems to be a benefit associated with restoring binocular vision in this population of patients with bilateral, cataract-induced visual impairment, and this findings support the policy recommendation that cataracts surgery in both eyes remains the appropriate treatment.
Abstract: • Objective. —No previous study documents improvement in visual acuity and subjective visual function associated with cataract surgery in the first eye, second eye, and both eyes. Measurement of subjective aspects of visual function and quality of life provides information that cannot be obtained with simple measurement of Snellen visual acuity. Methods. —From 76 ophthalmology practices in three cities, patients undergoing cataract extraction with intraocular lens implantation (n=613) and comparison patients (n=408) were enrolled in a prospective study. Questionnaires elicited visual function information before and after surgery, and visual acuity was obtained from the ophthalmologic record. Results. —Among patients with cataract and no other eye disease, baseline subjective visual function before surgery in the second eye was better than that before surgery in the first eye. Improvement in subjective visual function was approximately equal postoperatively in first and second eyes. Improvement in subjective function in both eyes postoperatively was significantly greater than that after surgery in the first eye or second eye alone. No statistically significant difference across surgical groups in the proportion of patients demonstrating improvement in visual acuity was observed. Conclusion. —Patients who underwent surgery in both eyes reported greater improvement in subjective visual function than did those who underwent surgery in one eye. Thus, there seems to be a benefit associated with restoring binocular vision in this population. These findings support the policy recommendation that cataract surgery in both eyes remains the appropriate treatment for patients with bilateral, cataract-induced visual impairment.

231 citations


Journal ArticleDOI
TL;DR: Regardless of treatment, improvement across quality of life functions occurred when visual function improved, and many types of functional degeneration observed in older populations, attributed to a decline in vision, can be slowed, or even reversed, when visualfunction improved.
Abstract: • Objective. —Evaluation of health care in older populations has increasingly focused on quality of life as a critical outcome of treatment. Vision is assumed to be central to functioning. Data suggest that aging, in itself, is associated with a decline in visual functioning, which, in turn, is related to a decline in physical and mental functioning. Other studies indicate that cataract surgery is followed by significant improvement in vision and visual function. Our objective was to test these assumptions. Design.—Prospective study of 1021 patients, consecutively drawn from 76 randomly selected ophthalmologists' offices in three cities. Structured interviews were completed at baseline, 2 months, and 1 year after entry. Patients. —Six hundred thirteen patients with cataracts and 408 other ophthalmic patients drawn from the same offices but treated for other chronic ocular disorders. All received refractive services as needed. Setting. —Patients from three cities (Baltimore, Md, St Louis, Mo, and San Diego, Calif) were interviewed once in their homes and twice by telephone. Interventions. —The study involved the measurement of the effects of usual treatment for cataracts and other degenerative eye diseases. Major Outcome Measures. —Visual, social, and psychological functioning. Results. —Within 1 year of treatment, change in visual function was accompanied by significant changes, in the same direction, in quality of life functions: nighttime driving, daytime driving, community activities, home activities, mental health, and life satisfaction. In addition, the patients with cataracts showed significantly greater improvement in measures of vision than did the noncataract group. Conclusions. —Regardless of treatment, improvement across quality of life functions occurred when visual function improved. Thus, many types of functional degeneration observed in older populations, attributed to a decline in vision, can be slowed, or evenreversed, when visual function is improved. Cataract surgery was effective in improving vision and quality of life functions.

230 citations


Journal ArticleDOI
TL;DR: The most common complication was erosion of the polypropylene suture knots through half thickness scleral flaps, and other complications included clinically significant lens tilt/decentration, open angle glaucoma, and suprachoroidal hemorrhage.
Abstract: Thirty eyes with an average follow-up of 23 months following transscleral fixation of a posterior chamber intraocular lens (IOL) were retrospectively reviewed for complications. The most common complication was erosion of the polypropylene suture knots through half thickness scleral flaps (22 eyes, 73%). The average time for suture erosion through the sclera was 9.4 months (range one to 12). The polypropylene suture knots eroded through the conjunctiva in five eyes (17% incidence) at an average of 12 months postoperatively (range six to 18 months). All conjunctival erosions were surgically repaired. Other complications included clinically significant lens tilt/decentration (3/30, 10%), open angle glaucoma (5/30, 17%), and suprachoroidal hemorrhage (1/30, 3%). The complications associated with transscleral fixation of posterior chamber IOLs are distinctly different from those associated with anterior chamber IOLs. Prospective clinical trials may provide further information about pseudophakic rehabilitation in the absence of capsular support.

220 citations


Journal ArticleDOI
TL;DR: The major determinants of the cost to Medicare associated with cataracts surgery are the rate of performance of cataract surgery and neodymium-YAG laser capsulotomy and the charges allowed for these procedures.
Abstract: Although more than 1 million cataract surgeries are performed annually in the United States, little is known about the frequency of use or cost of various services provided in connection with this procedure. To assess the frequency with which various ophthalmic, optometric, anesthesia, and medical services are provided in conjunction with cataract surgery and to estimate the cost to Medicare associated with those services, we analyzed 1985 through 1988 Medicare claims records of a nationally representative 5% sample of Medicare beneficiaries. The experience of 57 103 Medicare beneficiaries who underwent extracapsular cataract surgery in 1986 or 1987 that was not combined with another ophthalmologic procedure formed the basis of our analysis. Projections for current costs were performed using 1991 charges allowed by Medicare for physician services. We estimate that the median charge allowed by Medicare for a "typical" episode of cataract surgery in 1991 was approximately $2500. In addition to the $3.4 billion that Medicare spent in 1991 on such "typical" episodes, Medicare spent more than $39 million on miscellaneous "atypical" preoperative ophthalmologic tests, such as specular microscopy (14% of cases) and potential acuity testing (8% of cases), more than $7 million on postoperative ophthalmologic diagnostic tests, such as fluorescein angiography (3% of cases), and more than $18 million on perioperative medical services (most commonly electrocardiography and chest roentgenography). The major determinants of the cost to Medicare associated with cataract surgery are the rate of performance of cataract surgery and neodymium-YAG laser capsulotomy and the charges allowed for these procedures. Many other ophthalmologic and medical services are often provided preoperatively and/or postoperatively, but total Medicare expenditures for these services are relatively small.

219 citations


Journal ArticleDOI
TL;DR: It is demonstrated that topical anesthesia avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye and is effective for intraoperative anesthesia for cataract surgery.
Abstract: Small incision self-sealing cataract surgery has created the opportunity to use less invasive anesthesia. One hundred patients were evaluated in a prospective study using a new technique of topical anesthesia to allow small incision construction, intercapsular phacoemulsification, and small incision intraocular lens implantation without a peribulbar or retrobulbar injection. This study demonstrated that topical anesthesia avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye and is effective for intraoperative anesthesia for cataract surgery.

147 citations


Journal ArticleDOI
01 Jan 1993-Eye
TL;DR: The short-term clinical outcomes of cataract extraction (within the context of established microsurgical practice) for a sample of all patients undergoing cataracts surgery in the United Kingdom in 1990 are presented.
Abstract: The short-term clinical outcomes of cataract extraction (within the context of established microsurgical practice) for a sample of all patients undergoing cataract surgery in the United Kingdom in 1990 are presented. Change in best corrected Snellen visual acuity 3 months after surgery and the occurrence of surgically related complications were taken as clinical indicators of outcome. Overall 80% (n = 764) of patients achieved a best corrected postoperative visual acuity of 6/12 or better at 3 months. Surgically related complications occurred in 7% (n = 71) of all patients in the intra-operative period, in 22% (n = 224) in the immediate post-operative period, in 18% (n = 176) at the first post-operative out-patient assessment and in 20% (n = 200) of patients at 3 months after surgery. Co-existing ocular pathology was identified as a risk factor for both poor visual outcome and the occurrence of complications. Increasing severity of ocular pathology was associated with increased risk of poor outcome. These results represent the first national figures for the short-term clinical outcomes of cataract surgery with respect to the current surgical practice in the United Kingdom.

142 citations


Journal ArticleDOI
TL;DR: An aggressive stepladder, steroid-sparing, therapeutic algorithm is used in the care of patients with iridocyclitis associated with juvenile rheumatoid arthritis to preserve vision, limit cataract formation, and improve probability of successful visual rehabilitation whenCataract surgery became necessary.

125 citations


Journal ArticleDOI
TL;DR: The incidence of cataract formation resulting from different regimens used as preparation for bone marrow transplant and to evaluate the influence of other risk factors were determined.
Abstract: Objective: To evaluate the incidence, time course, and factors associated with cataract formation in bone marrow transplant recipients. Design: Prospective cohort study. Setting: University Hospita...

102 citations


Book
01 May 1993
TL;DR: This resource addresses clear-corneal incision cataract surgery and focuses on topical anaesthesia and includes patient selection and preparation, protocol, complications and medicolegal issues.
Abstract: This resource addresses clear-corneal incision cataract surgery. The first section covers incision and phacoemulsification strategies. The second section focuses on topical anaesthesia and includes patient selection and preparation, protocol, complications and medicolegal issues.

91 citations


Journal ArticleDOI
TL;DR: Findings are consistent with the hypothesis that in some human patients with cataract, DNA damage in the lens epithelial cell population may be related to the development of lens fiber cell opacity.
Abstract: In recent years, there has been renewed interest in the association between DNA damage to the lens epithelium and the development of lens opacities. Although a number of in vitro studies have indicated that lens epithelial cells are susceptible to a variety of DNA damaging insults and that these cells posess the capacity to repair such damage, no previous studies have directly addressed whether DNA damage is associated with human cataract in vivo. Utilizing samples of lens epithelial cells obtained from patients undergoing cataract surgery, the percentage of cells containing DNA single strand breaks was directly determined by the single-cell gel assay (SGA) method. Non-cataractous human Eye Bank lenses of similar ages to the cataractous samples and calf lenses were used as controls. In approximately 50% of the cataractous samples analyzed, the proportion of cells containing DNA single strand breaks was significantly higher than in control lenses. No relationship between age and DNA damage was noted. These...

Journal ArticleDOI
TL;DR: It was found that age was a strong predictor of final visual acuity and chances of improvement and the prognosis of patients with diabetic retinopathy about to undergo cataract surgery, even extracapsular cataracts extraction with placement of a posterior chamber lens, is guarded.

Journal ArticleDOI
TL;DR: The Medicare part B database is 99% accurate for cataract surgery having occurred and 96% accurate in terms of surgical approach, and in all cases in which the operative note indicated a secondary procedure performed at the time of surgery, the billing information was in agreement.
Abstract: • We studied the accuracy of Medicare part B coding for cataract extraction to provide validation for research involving Medicare data. Hospital and physician office records associated with a sample of 802 paid claims for cataract surgery were reviewed. The sample was randomly selected from 118 420 Medicare part B claims for cataract surgery submitted by physicians in an 11-state sample during the first quarter of 1988. Medical records were successfully obtained for 796 cataract surgery episodes (99.2%), of which 794 (99.7%) indicated that cataract extraction had been performed. In the remaining two cases, cataract surgery was attempted but aborted. In 24 (3%) of the 794 cases, the surgical approach (intracapsular or extracapsular) indicated in the operative note differed from that coded on the physician's bill. In all cases in which the operative note indicated a secondary procedure performed at the time of surgery, the billing information was in agreement. We conclude that, at least in the case of cataract surgery, the Medicare part B database is 99% accurate (95% confidence interval, ±0.6%) for cataract surgery having occurred and 96% accurate (95% confidence interval, ±1.4%) in terms of surgical approach.

Journal Article
TL;DR: This experimental model is the first to show that lens regeneration can occur after removal of cataracts secondary to inflammation, and it is estimated that lens regrowth can occur at a slower rate in eyes with extraction of a normal lens.
Abstract: PURPOSE To evaluate the regenerative capacity of the adult rabbit lens after removal of a Concanavalin A-induced posterior subcapsular cataract METHODS Cataractogenesis was induced by intravitreal injection of Concanavalin A in adult New Zealand albino rabbits At 7 mo postinjection, the cataracts were removed Endocapsular lens extraction was performed by phacoemulsification and irrigation/aspiration with Balanced Salt Solution RESULTS Postoperatively, lens regeneration was first noted in the Balanced Salt Solution normal lens group at 3 weeks and the Concanavalin A cataract group at 6 weeks By the 3-mo postoperative examination, lens regrowth, measured by digital image analysis, filled 745% of the capsule bag in the Balanced Salt Solution normal lens group and 466% in the Concanavalin A cataract group In the latter group, less lens material was regenerated and at a slower rate than in eyes with extraction of a normal lens CONCLUSION This experimental model is the first to show that lens regeneration can occur after removal of cataracts secondary to inflammation

Journal ArticleDOI
TL;DR: Clinical features associated with a poorer visual outcome included initial or indeterminate retinal detachment and 360 degrees suprachoroidal hemorrhage.

Journal ArticleDOI
TL;DR: The risk of rehospitalization for endophthalmitis following PK is five times higher and the risk of RD two times higher than that reported following cataract surgery, however, anterior vitrectomy results in similar risk increases following either surgery.
Abstract: We studied rehospitalization for endophthalmitis or retinal detachment (RD) in 40,351 Medicare beneficiaries who were admitted to US hospitals for penetrating keratoplasty (PK) between 1984 and 1987. This cohort represents 56.5% of all PKs performed during this period for recipients of age to receive Medicare benefits. Penetrating keratoplasty was combined with intracapsular cataract extraction in 1188 patients (2.9%) and with extracapsular cataract extraction in 7038 patients (17.4%). Anterior vitrectomy was performed in 8428 patients (20.9%). The risk of rehospitalization for endophthalmitis within 6 months of PK was 0.77%. Concurrent anterior vitrectomy increased this risk to 1.03% (P = .004). The risk of rehospitalization for RD within 2 years of PK was 1.85%. Concurrent anterior vitrectomy increased this risk to 2.49% (P = .0001). Combined PK and intracapsular cataract extraction demonstrated a 3.9-fold increased rate of RD compared with PK and extracapsular cataract extraction (P = .0001). Anterior vitrectomy with PK and extracapsular cataract extraction increased the risk of RD 4.3-fold compared with PK and extracapsular cataract extraction alone (P = .007). Men were at a 68% higher risk of RD than women (P = .0001). The risk of rehospitalization for endophthalmitis following PK is five times higher and the risk of RD two times higher than that reported following cataract surgery. Anterior vitrectomy, however, results in similar risk increases following either surgery.

Journal ArticleDOI
TL;DR: Ophthalmologists should become familiar with the emerging concepts of delayed-onset, chronic, and often painless endophthalmitis in which the coagulase-negative staphylococci play a prominent role.

Journal Article
TL;DR: It is concluded that ultrasonographic examination can detect abnormalities of the posterior segment when opacity of the anterior segment precludes complete ophthalmoscopic examination and that it is a quick and easy procedure for screening dogs for retinal detachment prior to cataract surgery.
Abstract: Records of 147 dogs with cataracts and that had an ultrasonographic examination of their eyes were reviewed. Ultrasonography was performed, using a real-time mechanical sector scanner (7.5 or 10.0 MHz transducer), after topical anesthesia of the cornea. Vitreous degeneration was diagnosed in 23% of the eyes examined. Retinal detachment was detected in 11% of all eyes, but was detected in 4% of eyes with immature cataracts, 6.5% of eyes with mature cataracts, and 19% of eyes with hypermature cataracts. In 66% of the eyes, the cataract was the only ultrasonographic abnormality found. Vitreous degeneration and retinal detachment were most often observed in eyes with a hypermature cataract, and were uncommon in eyes with an immature cataract. We concluded that ultrasonographic examination can detect abnormalities of the posterior segment when opacity of the anterior segment precludes complete ophthalmoscopic examination and that it is a quick and easy procedure for screening dogs for retinal detachment prior to cataract surgery.

Journal ArticleDOI
TL;DR: No evidence of long‐term postoperative postoperative cognitive dysfunction was detected, and there was no significant difference between the performances of the two groups.
Abstract: One hundred and sixty-nine patients (aged 65-98 years) were randomised to receive either local or general anaesthesia for cataract surgery. Cognitive function was assessed using a battery of psychometric tests performed pre-operatively, and at 24 h, 2 weeks and 3 months postoperatively. Oxygen saturation, blood pressure and heart rate were monitored and the results recorded throughout the anaesthetic and immediate recovery period. In the general anaesthetic group, 19% of patients experienced at least one episode of oxygen desaturation during the procedure compared with none in the local anaesthetic group. Pulse rate and blood pressure were stable in the local anaesthetic group compared with the general anaesthetic group where marked fluctuations were noted; 61% of patients in the general anaesthetic group experienced falls in systolic blood pressure greater than 30% of the pre-induction value. No evidence of long-term postoperative cognitive dysfunction was detected and there was no significant difference between the performances of the two groups.

Journal ArticleDOI
TL;DR: Flexible open-loop AC IOLs are safe and effective for primary implantation after vitreous loss and for secondary implantation.

Journal ArticleDOI
TL;DR: Posterior subcapsular cataract following BMT is uncommon and rarely requires surgery, but the total dose and duration of corticosteroid therapy and total body irradiation are the most important risk factors.
Abstract: Objectives: To evaluate risk factors for the development of posterior subcapsular cataract following bone marrow transplantation (BMT) and the results of patients undergoing cataract extraction. Design: Retrospective case-control study. Setting: Tertiary referral center. Patients: Three hundred sixty-six patients (59% male, 41% female) undergoing BMT at one institution who survived for at least 1 month and underwent full ophthalmologic examination. Risk factors were then compared between patients who developed posterior subcapsular cataract and those who did not. Intervention: Cataract surgery in six eyes of four patients. Main Outcome Measure: Formation of posterior subcapsular cataract. Data were obtained on all patients for type of BMT, pretransplantation regimen, underlying malignancy, demographic background, complications of BMT, and medications. Results: Forty (10.9%) of 366 patients developed posterior subcapsular cataract. By univariate analysis, cataract formation was associated with total body irradiation, chronic graft-vs-host disease, the use of allogeneic bone marrow, and the total dose and duration of corticosteroid therapy. Multivariate analysis revealed that the total dose and duration of corticosteroid therapy were the most important risk factors, while total body irradiation was not a statistically significant risk factor. Cataract surgery was performed in six eyes of four patients, all of whom developed visual acuities of 20/40 or better. Conclusion: Posterior subcapsular cataract following BMT is uncommon and rarely requires surgery. Total dose and duration of corticosteroid therapy are the most important risk factors for development of cataract, but total body irradiation is not a statistically significant risk factor.

Journal ArticleDOI
TL;DR: Clinical variation proved largely unrelated to cataract surgery events and postoperative management; bacterial factors were implicated and good visual outcome was associated statistically with intensive topical corticosteroid in the symptomatic period, but was negatively associated with operative subconjunctival cortICosteroid.

Journal ArticleDOI
TL;DR: In this paper, the effect of differing volumes of anaesthetic solution administration upon intraocular pressure for sub-Tenon, retrobulbar, and peribulbar administration was assessed and compared to posterior delivery by retro-bulbar injection.
Abstract: Objectives: (1) To assess the safety of administration of a sub-Tenon fluid bolus directly contacting the globe, and compare it to posterior delivery by retrobulbar injection. (2) To assess the effect of differing volumes of anaesthetic solution administration upon intraocular pressure for sub-Tenon, retrobulbar and peribulbar administration. Study Design: (1) Intraocular pressure assessment by Perkins applanation tonometry, immediately prior to and after administration of sub-Tenon and retrobulbar anaesthesia. (2) Intraocular pressure comparison of sub-Tenon, retrobulbar and peribulbar administration. Setting: Seventy-eight routine scheduled local anaesthetic administrations for cataract surgery at Moorfields Eye Hospital. Patients: Twenty-eight patients had sub-Tenon administration, 23 retrobulbar injection and 27 peribulbar administration. Main Outcome Measures: Volume administered and change in intraocular pressure. Results: The mean volume used was 3.2 ml for sub-Tenon, 3.6 ml for retrobulbar and 6.4 ml for peribulbar administration. After sub-Tenon delivery there was mean rise in intraocular pressure of 0.9 mmHg and after retrobulbar injection a mean rise of 1.4 mmHg. These rises did not reach statistical significance. Peribulbar injection involved a larger mean volume of administration than the sub-Tenon or retrobulbar techniques, with a mean rise of intraocular pressure of 4.9 mmHg, which is statistically significant ( P Conclusions: Retrobulbar and sub-Tenon administration have only a marginal effect upon intraocular pressure for small volumes (3–4 ml) and sub-Tenon administration of this volume load appears to be safe with regard to intraocular pressure. Where a significant volume of local anaesthetic agent is administered, as with peribulbar injection, this is likely to be associated with a significant rise in intraocular pressure and consideration should be given to use of a pressure lowering device.

Journal ArticleDOI
TL;DR: Examination of Medicare physician-claims data found that cataract surgery rates were influenced by economic and sociodemographic variables in predictable ways, suggesting that eliminating practice style as a factor in physician decision making would reduce variations in cataracts surgery rates by only a small amount.
Abstract: This study uses Medicare physician-claims data to examine patient and physician contributions to variations in cataract surgery rates across U.S. metropolitan areas. Utilization is modelled as having two phases: the decision to seek an ophthalmologist's care, which is made by patients, and the decision to perform surgery on patients who seek care, which is partially controlled by ophthalmologists. Under this model, the effect of physician practice style on cataract surgery rates occurs through the influence of practice style on the second phase of utilization. Variation in patient care-seeking behavior contributed to the variation in the rate of cataract surgery. Moreover, multivariate regression analyses found that cataract surgery rates were influenced by economic and sociodemographic variables in predictable ways. Using the regression results, a "purged" cataract surgery rate that was free of any possible influence of physician practice style was calculated. Variation in the purged surgery rate was only slightly lower than variation in the observed surgery rate, suggesting that eliminating practice style as a factor in physician decision making (e.g., through practice guidelines) would reduce variations in cataract surgery rates by only a small amount.

Journal ArticleDOI
TL;DR: The visual acuity outcome was better following bilateral cataract surgery than unilateral surgery (P < .001 using chi 2 analysis) and was comparable with that achieved with extended wear contact lenses.
Abstract: Objective: To evaluate the effectiveness and safety of daily wear contact lenses in the treatment of infantile aphakia. Design: A study of prognosis using a cohort followed up for a mean of 58 months. Setting: All operations, contact lens care, and follow-up were conducted at a university referral center. Patients: Of 111 children undergoing surgery for cataract between 1980 and 1990, 51 (68 eyes) met the criteria of age younger than 2 years at the time of surgery and of cataract of nontraumatic origin. Patients were evaluated for visual acuity, complications, number of contact lenses worn per year, and changes in contact lens refractive power per month. A subgroup of 28 eyes of patients undergoing surgery before age 7 months and followed up for at least 24 months was studied. Intervention: Following cataract surgery, all patients were fitted with daily wear contact lenses. Main Outcome Measure: Final visual acuity and complications were studied. The distribution of mean contact lens power for each month of age was determined. Results: During the follow-up period, no serious complications were encountered. The visual acuity outcome was better following bilateral cataract surgery than unilateral surgery (P Conclusion: Daily wear contact lenses were found to be safe and effective in the treatment of infantile surgical aphakia. The daily care was easily learned by the parents.

Journal ArticleDOI
TL;DR: Topical anaesthesia is attainable for all those requiring cataract surgery who are able to communicate with the surgeon and deaf, dysphasic or mute patients are not good candidates.
Abstract: Objective: To show the techniques and the advantages and disadvantages of topical anaesthesia. Setting: Sarasota Cataract Institute, Florida, USA. Results And Conclusions: Topical anaesthesia is attainable for all those requiring cataract surgery who are able to communicate with the surgeon. Therefore, deaf, dysphasic or mute patients are not good candidates; neither are patients with macular scars, as they may not have the adequate foveal function to be able to target onto the microscope light or other small fixation device.

Journal ArticleDOI
TL;DR: Absolute control of inflammation in patients with pars planitis through a stepladder approach may reduce the incidence of cataract development, and can certainly improve visual rehabilitation after cataracts extraction.

Journal ArticleDOI
TL;DR: In this paper, the safety of intraocular lens (IOL) implantation in patients with uveitis was studied and there was a trend toward better visual acuity without IOLs.

Journal ArticleDOI
TL;DR: A short historic overview of the trabeculotomy procedure in adults, together with the technique using the new Fukasaku modification of the instrumentation (probes and forceps) and report 50 consecutive cases with a 100% three‐month follow-up.
Abstract: Cataract surgeons frequently face the challenge of treating an open-angle glaucoma patient presenting for cataract surgery and intraocular lens implantation. It seems logical to treat both problems during the same surgical procedure if it can be done without jeopardizing the results of either. We present a short historic overview of the trabeculotomy procedure in adults, together with our technique using the new Fukasaku modification of the instrumentation (probes and forceps) and report 50 consecutive cases with a 100% three-month follow-up. The mean preoperative intraocular pressure was 19.3 mm Hg (range 16.0 to 37.0 mm Hg); three months after surgery it was 14.2 mm Hg (range 6.0 to 24.0 mm Hg). The mean preoperative pressure-reducing medications were 2.3 drugs per patient, and the postoperative mean was 0.7. Except for three cases of small postoperative hyphemas, no other complications were encountered during the study.

Journal ArticleDOI
TL;DR: During a 5-month period, four patients developed contracture of the inferior rectus muscle following local anesthesia for cataract surgery in the practice of one ophthalmologist, with no patient having a previous history of strabismus.
Abstract: During a 5-month period, four patients developed contracture of the inferior rectus muscle following local anesthesia for cataract surgery in the practice of one ophthalmologist. Two anesthesiologists administered retrobulbar anesthesia. All patients had persistent vertical diplopia caused by a large hypotropia of the operated eye. Forced duction testing revealed marked restriction to elevation of the eye. In two patients, MRI demonstrated segmental thickening of the inferior rectus muscle, just posterior to the globe. All patients had normal thyroid function tests. No patient had a previous history of strabismus. Three of the four have had strabismus surgery consisting of recession of the markedly restricted inferior rectus muscle on an adjustable suture. These three patients have regained fusion and are now asymptomatic.