The probable associations for corticocapsular adhesions in patients undergoing cataract surgery: A clinic-based observational study.

Background: Corticocapsular adhesions (CCA) are frequently seen between lens capsule and adjacent cortical layer. During cataract surgery, in the presence of CCA, excessive efforts to rotate the nucleus can result in zonular damage. To reduce morbidity, identification of associations with CCA can be helpful in appropriately modifying the surgical procedure. Aim: To investigate probable associations with CCA in patients undergoing cataract surgery. Setting and Design: Iladevi Cataract and IOL research center. Case-control study. Materials and Methods: A single eye of 600 patients, 200 patients with CCA (cases) and 400 patients without CCA (controls) were considered. A CCA diagnosis was based on: (i) preoperative presence of CCA on slit-lamp examination with visualization of furry surface of cortex during surgery; (ii) preoperative absence of CCA on slit-lamp examination but intraoperative visualization of furry surface of cortex. Variables such as age, gender, type of cataract, grade of cataract, high myopia, diabetes mellitus and hypertension were studied. Statistical Analysis: Multivariate logistic regression was done. Results were presented as odds ratio (OR) with 95% CI. Results: Mean age was 64.71 +/- 9.10 years in cases and 59.27 +/- 8.79 years in controls. Presence of CCA increased with age from 22% (n = 59) in 45 to 49 years to 70% (n = 110) in 70 to 79 years. An increase in age was associated with CCA by 3.3% (OR = 3.3%, P = 0.028). The odds of CCA for females were 83% higher ( P = 0.027). Presence of anterior cortical cataract increased odds of CCA by 9.5 times ( P = 0.001), while posterior cortical cataract increased odds by 3.3 times ( P = 0.001). Conclusion: Corticocapsular adhesions were strongly associated with cortical cataracts, increased age and female gender.

Preoperative prediction of posterior capsule plaque in eyes with posterior subcapsular cataract.

AIM: To determine whether the plaque on the posterior capsule can be predicted preoperatively, in patients with posterior subcapsular cataract (PSC), undergoing cataract surgery. MATERIALS AND METHODS: A prospective study of 140 consecutive eyes with PSC, who underwent cataract surgery, was conducted. The prediction of preoperative presence or absence of plaque within the PSC was noted on slit lamp examination, in dilated pupils. A single observer made the observations under oblique illumination, where the slit lamp was placed at an angle of 30 degrees to 45 degrees. Evaluation of the plaque through slit lamp examination was standardized in terms of illumination and magnification. The observations were recorded using a video camera (Image archiving system, Carl Zeiss, Jena Germany) attached to a slit lamp (Carl Zeiss, SL 120 Jena, Germany), keeping the illumination at 100%. The prediction of plaque was noted in terms of its presence or absence on the posterior capsule. All the patients received counseling regarding the presence of plaque. Capsule polishing of the posterior capsule in Cap Vac mode, was done in all cases. The posterior capsule was examined for presence or absence of plaque, either on the first postoperative day, or within a week, with maximal mydriasis. The observer's results were tabulated and later analyzed to judge the incidence of predictability of plaque in PSC. RESULTS: The mean age of the patients was 45+/-6.2 years (range 32-61 years); 104 (74.3%) were males. One hundred and eight (77.1%) patients were under 50 years. The presence or absence of plaque was predicted correctly in 124 (88.6%) eyes. The prediction of plaque was incorrect in 16 (11.4%) eyes. CONCLUSION: The prediction of presence or absence of plaque was accurate in 88.6% cases. We believe that counseling patients with posterior capsule plaque before the surgery is the key to avoiding unpleasant surprises.

Management of congenital bilateral subluxated cataract with Cionni ring.

Use of Cionni ring helped in the successful intraocular lens (IOL) implantation in a 30-year-old patient with bilateral congenital subluxated cataracts. The IOL was stable, well-centered without any iridodonesis or pseudophakodonesis.

Phacoemulsification in subluxated cataract.

PURPOSE: To evaluate the outcome of phacoemulsification in eyes with subluxated cataract. MATERIALS AND METHODS: This retrospective study comprised 22 eyes of 20 consecutive patients with subluxated cataracts of varying aetiology operated between March 1998 and March 2001. Detailed preoperative assessment included visual acuity (VA), slitlamp examination, presence of vitreous in anterior chamber extent of subluxation, intraocular pressure (IOP) and detailed fundus examination. Phacoemulsification was done to retain the natural bag support and all patients had acrylic foldable Acrysof IOL implantation either in-the-bag or by scleral fixation. Postoperative observations included best-corrected visual acuity (BCVA), IOP, pupillary reaction and the IOL position. RESULTS: The aetiology of the subluxation was traumatic in 11 patients and non-traumatic in 9 patients. Fifteen were males and 5 were females. Mean follow-up was 11.7 +/- 9.71 months (range 4-39). The average age was 39.15 +/- 16.33 (range 5-74). A 2-port anterior chamber vitrectomy was performed in 6 eyes (27.2%). Capsule tension ring (CTR) was implanted in 15 eyes (68.18%). Twelve eyes (54.5%) had in-the-bag implants, while 5 (22.72%) had scleral fixation. The remaining 5 eyes (22.72%) had one haptic in-the-bag and another sutured to sclera. No major intraoperative complications were noted. Twelve eyes (54.5%) had clinically and geometrically well centered IOLs while 9 eyes (40.9%) had geometrically decentered IOLs. One patient was lost to follow-up. Fifteen eyes (55.55%) had postoperative BCVA of 6/12 - 6/6 while 2 eyes (7.40%) had BCVA of 6/18. The remaining 4 eyes (14.81%) had less than 6/24 BCVA due to pre-existing posterior segment pathology. Postoperative complications included rise in IOP in 1 eye (4.54%), pupillary capture of the IOL optic in 2 eyes (9.09%); the same 2 eyes (9.09%) required redialing of IOL. One eye (4.54%) had to undergo refixation (one haptic was fixed to sclera) year after cataract surgery. Postoperative retinal detachment was noticed in one patient after a month of phacoemulsification. CONCLUSION: In subluxated cataracts it is essential to have appropriate parameters depending on the grade of cataract. This contributes to a safe and predictable outcome in subluxated cataract surgery.