Surgical Outcomes of Implantation of Newly Designed T-shaped Intraocular Lens in Congenital Cataract

PURPOSE: We evaluated the surgical outcomes and complications of new pediatric intraocular lens in congenital cataract. METHODS: A retrospective study was carried out on 29 eyes of 22 patients diagnosed with congenital cataract that underwent optic capture following lens emulsification. New pediatric intraocular lens (LJC 575A, Lucid Korea, Seoul, Korea) implantation into the bag was performed with posterior capsulorrhexis and anterior vitrectomy. RESULTS: After follow-up of 17.79+/-7.08 months, 15 eyes showed a visual acuity of 0.5 or above, and 10 (71.4%) of the 14 eyes showed a visual acuity of 20/470 or above. As for complications, posterior synechia developed in 8 eyes, exudative membrane was found in 3 eyes, iris capture by IOL haptic was found in 1 eye, and slight opacification of posterior capsule was identified in 1 eye. CONCLUSIONS: Use of new 8 mm pediatric intraocular lens in congenital cataract may be considered selectively.

A Comparison of Clinical Results in Unilateral and Bilateral Cataract Surgerys

PURPOSE: This study compares the outcomes of unilateral cataract surgery to those of bilateral cataract surgery in patients with cataract of both eyes. METHODS: Among a total of 153 patients, 61 underwent unilateral surgery and 92 bilateral surgery. RESULTS: The unilateral and bilateral surgeries were similar in demographic and ocular characteristics including visual acuity and visual function-14, except patient-reported factor, such as trouble with vision at baseline. The patient-reported factor was more serious in bilateral surgery than in unilateral surgery. The changes of three outcomes were associated not with unilateral eye or bilateral eye surgery, but with each baseline condition. CONCLUSION: The patient-reported factors such as symptom score, trouble with vision were the significant outcomes to decide unilateral or bilateral surgery in patients with cataract of both eyes. The result of unilateral or bilateral surgery did not affect the outcomes of cataract surgery after 12 months.

Clinical Results of Cataract Operations using Piggy-back Method

PURPOSE: To attain adequate intraocular lens power during cataract surgery in patients with high myopia or hyperopia, the implantation of two intraocular lenses by the piggy-back method are being widely attempted. Therefore, we report the clinical results of implantation of two intraocular lenses by the piggy-back method. MATERIALS AND METHODS: We illustrate a case of a 62-year old high myopic patient with cataract who received lens insertion of -5.0 diopter and -4.0 diopter piggy-back style in the capsular bag. Also, we illustrate a case of a 7-year old female with congenital cataract who received lens insertion in the capsular bag of +18.0 diopter and +17.0 diopter in the right eye and +17.0 diopter and +16.0 diopter in the left eye. RESULTS: Postoperative findings at 2 months showed well positioning of both lenses without noticeable complications.

Variation in Cataract Surgery Practice and Clinical Outcomes

PURPOSE: The purpose of this study was to examine the variations of the clinical outcomes of cataract surgery according to the characteristics of patients and surgeons and surgical technique. METHODS: The survey was conducted at 4 stages : preoperative period(389), perioperative period(344, 88.4%), postoperative 3~4 months(343, 88.2%), and postoperative 12 months(281, 72.2%). RESULTS: Eighty-five percent of surgery was performed by phacoemulsification and 14% by standard extracapsular (ECCE) techniques. The performance of phacoemulsification was associated with years of practice(11 years or more) and annual volume of cataract surgery(201 cases or more). The reported occurrence of posterior capsular opacification within 12 months of surgery was decreased in the patients operated by surgeons with years of practice(11 years or more). CONCLUSIONS: The factors influencing to better outcomes at 12 months after surgery were visual acuity of baseline operated eye(20/200 or less) and the absence of ocular morbidity. In this study, although there were some variations with cataract surgery practice, but the variations with cataract surgery practice did 434not give much influence to the patient's outcomes.

Intraocular Pressure following Cataract Surgery using Sutureless Clear Corneal Incision

PURPOSE: The purpose of this study is to investigate the effect on intraocular pressure (IOP) of sutureless clear corneal phacoemulsification with foldable posterior intraocular lens implantation. METHODS: We measured the IOP using both a non-contact pneumotonometer and a Goldmann applanation tonometer preoperatively and postoperatively (1, 3, 10, 30, 60 and 90 days). In operation, the incision site was determined depending on the axis of preoperative corneal astigmatism and divided into two groups: Temporal (Group 1) and Superior clear corneal incision (Group 2). It is postulated that if there is more damage to the surrounding tissue in superior incision group due to poorer surgical accessibility than temporal group, it may affect on postoperative IOP. RESULTS: The mean preoperative IOP of Group 1 (59 eyes) and Group 2 (41 eyes) were 14.6 mmHg and 14.3 mmHg respectively. At postoperative 1 day, the IOP decreased in both groups by 14.2 mmHg and 14.0 mmHg respectively (p>0.05), and at 3 days, 13.1 mmHg and 13.2 mmHg respectively (p<0.05). And from then on, there was no statistically significant change to 3 months. The mean IOP of postoperative 3 months was 12.9 mmHg in both groups; decreased to 1.7 mmHg and 1.4 mmHg respectively compared to preoperative value (p<0.05). In all periods of this study, there was no significant difference between two groups and between two methods of measurement. CONCLUSIONS: These results suggest that in case of uncomplicated senile cataract, sutureless clear corneal phacoemulsification with foldable posterior intraocular lens implantation reduces the IOP in short term follow up period.

Clinical Results of Unilateral Implantation of AMO Array Multifocal Intraocular Lens

PURPOSE: We evaluated the clinical results of unilateral implantation of AMO Array(r) intraocular lens in unilateral or bilateral cataract patients with minimum follow-up of 6 months. METHODS: This prospective study comprised two groups of 20 eyes each: one with AMO Array(r) intraocular lens(multi group) and the other with monofocal silicone intraocular lens(mono group). Main outcome measures were Snellen distance visual acuities; near acuities with Birkhauser reading chart. RESULTS: The difference between two groups in mean distance visual acuity was not statistically significant. Both monocular and binocular uncorrected near visual acuity in the multi group were significantly better than mono group. Four of 20 patients(20%) in monofocal group and 13 of 20 patients(65%) in multifocal group noticed light sensation(glare, halo etc.) after surgery, with the majority not being bothered by all of these. More than 90% patients were satisfied after surgery in both groups. CONCLUSIONS: With appropriate patient selection, near vision without spectacles was functionally acceptable in a majority of unilateral multifocal intraocular lens implantation cases. And, there was no significant problem in unilateral implantation of AMO Array intraocular lens. AMO Array lens can be used in unilateral cataract surgery.

Clinical Results of AMO Array(R) Multifocal Intraocular Lens

PURPOSE: To evaluate the clinical results of a AMO Array mutifocal lens. METHOD: we performed a prospective clinical trial of 20 bilateral cataract patients for at least 6 months. RESULT: Mean monocular uncorrected distance acuity(Snellen) was 0.75, which increased to 0.9 with best correction. Mean biocular uncorrected distance acuity was 0.85,which increased to 1.0 with best correction. Mean monocular near acuity was 0.62, which reached 0.88 with best correction. Mean biocular near acuity was 0.71, which reached 1.00 with best correction. Mean contrast sensitivities were within normal range for all spacial frequencies. In glare discomfort, 10 patients had no complaint, 7 patients had no idea, and only 3 patients had some problem. Reading newspaper without glasses was achieved by 28 of 40 eyes(70%) and 15 of 20 patients(75%). CONCLUSION: AMO Array lens can be used as a method of treatment of presbyopia, when combined with correct biometry.

Visual Prognosis and the Development of After-cataract following Cataract Surgery in Atopic Dermatitis

PURPOSE: To investigate the visual prognosis, the interval, and the rate of development of after-cataract following cataract surgery in atopic dermatitis. METHODS: Twenty eyes of 13 patients diagnosed as cataract associated with atopic dermatitis were operated between January, 1994 and January, 2000. Visual acuity, postoperative inflammatory reaction, the interval, and the rate of development of after-cataract were investigated and compared with the cataract cases without atopic dermatitis. RESULTS: The average preoperative best corrected visual acuity of 20 eyes was 0.23+/-0.22. The average postoperative best corrected visual acuity at 1, 2, 7, and 12 months after surgery were 0.78+/-0.23, 0.83+/-0.16, 0.78+/-0.23, 0.83+/-0.26, respectively. These values showed no significant difference compared to the postoperative visual acuity of the cataract cases without atopic dermatitis. Aqueous flares measured with laser flare meter were 15.09+/-9.20, 11.15+/-4.68, and 7.38+/-0.75 photon counts/millisecond at 10 days, 1, and 2 months after surgery, which did not seem to influence the final visual acuity and the development of after-cataract (p>0.05). Among the 20 eyes, 66.67% finally developed after-cataract and the average time interval of the development of after-cataract was 11.25+/-4.22 months. CONCLUSIONS: Visual prognosis following cataract surgery in atopic dermatitis is good, while after-cataract seems to develop more frequently and earlier compared to the cases without atopic dermatitis.

Clinical Result of Planned posterior Continuous Curvilinear Capsulorrhexis in Adult Cataract patients: 1 year follow-up

No Abstract Available.

Comparison of the Phakic and Pseudophakic Axial Length

To determine the actual axial length of the pseudophakic eye, we mea-sured the axial length using ultrasound before and after cataract surgery in 157 eyes of 97 patient.The measured axial length of the pseudophakic eye with silicone or acrylic intraocular lens was longer than the axial length measured before operation.There was linear correlation between axial length measured before and after operation in cases of PMMA, silicone, or acrylic intraocular lens.The axial length corrected with ultrasonic velocity and central thickness of the intraocular lens was approximate to the mea-sure before operaion.So, we concluded that axial length is not actually elongated after operation and the exact axial length may be obtained by correcting the measured axial length of the pseudophakic eye using ultra-sonic velocity and central thickness of the intraocular lens.

The Effect of Antimetabolites for Inhibiting the Proliferation of Rabbit Lens Epithelial Cells in Vitro

The most common cause of blurred vision after extracapsular cataract extraction is known to be an opacification of the posterior lens capsule. The pathogenesis of posterior lens capsule opacification is primarily caused by residual lens epithelial cells. For the prevention of posterior capsular opacification, several kinds of anti-mitotic drugs is being actively investigated. But the antimitotic drugs are not clinically used due to toxicity towards the intraocular tissues. The objectives of this study is to evaluate the effect of mitomycin C and tirilazad mesylate(FREEDOX(TM)) respectively for inhibiting the proliferation of rabbit lens epithelial cells when it is administered in a short period. Lens epithelial cells from white rabbits were harvested andcultured for 4 passages. Mitomycin C was applied for 3 minutes with 0.025mg/ml and 0.05mg/ml in concentration respectively. The proliferation assay was performed by [(3)H]-thymidine uptake test. Significant decrease of lens epithelial cell proliferation appeared in both drugs.When Mitomycin-C was applied with 0.025mg/ml for 3 minutes, cell proliferation was reduced to 31.5% compared with control and in 0.05mg/ml concentration, to 12.5%. When tirilazad mesylate was applied 0.15mg/ml for 3 minutes, cell proliferation was reduced to 46.5% compared with control and in 1.5mg/ml concentration, to 7.5%. If futher investigation would show the effectives and safety of these drugs, these agents could be applied into the lens capsular bad at the time of surgery to prevent the posterior capsular opacification after cataract surgery.

The effect of the haptic portion of intraocular lens on the development of posterior capsular opacification in rabbit

Using a white rabbit model, the effect of the haptic portion of the intraocular lens (IOL) and intracapsular ring on the development of posterior capsular opacification (PCO) after extracapsular cataract extraction (ECCE) with phacoemulsification was studied. Implantation of both the intracapsular ring and IOL developed less PCO than implantation of the IOL alone. ECCE followed by implantation of the intracapsular ring alone also developed less PCO than ECCE alone. Through this experimental work in a rabbit model, it could be conceived that the haptic portion of IOL and the intracapsular ring can prevent the development of PCO.

The Change of the Anterior Chamber Inflammation by Lens Epithelial Cell Revoval in Cataract Surgery

Remained lens epithelial cells after the cataract surgery can cause anterior and posterior capsular opacity and other complications from the postoperative anterior chamber inflammation. The removal of lens epithelial cells(LEC) during the cataract surgery is important clinically. We measured the degree of the anterior chamber inflammation after the removal of LEC in 360 degree and the removal of LEC in 180 degree. The anterior chamber inflammation was measured by flare-cell meter postoperatively the 1st day, 4th day, 1st week, 2nd week, 3rd week, 4th week, and 3rd month, and compared the results with the anterior chamber inflammation after the cataract surgery without the removal of LEC. There were no significant differencies among the groups before the 2nd week. The degree of inflammation was decreased significantly in the groups postoperatively compared to the group in which LEC were not removed. And the inflammation was lower significantly in the group of the 360 degree removal than the group of 180 degree removal after the 2nd week postoperatively. We conclude that LEC removal in cataract surgery decreased the anterior chamber inflammation significantly after the 2nd week postoperatively.

One-Year Follow-up of 1000 Cases of Silicone Intraocular Lens Implantation

Implantation of silicone intraocular lens(IOL), which is inserted through a small incision, has as its advantages reduced postoperative astigmatism and early visual rehabilitation. It, however, has such disadvantages as unknown long-term biocompatibility, relatively more Nd:YAG laser-induced damage, and unstable fixation. Another difficulty is the possibility of damage to IOL and intraocular tissue during the process of folding and unfolding of the silicone IOL. One thousand cases of the silicone IOL implantation from Sept. 1993 to Mar. 1996 had been followed-up over 1 tear for intraoperative and postoperative complications. Postoperative conditions such as naked visual acuity, and intraocular pressure were also measured. Postoperative naked visual acuity showed fast recovery, with measurements above 20/50 in 71.8% and 85.1% atk postoperative Day 1 and Day 3, respectively. Intraoperative complication was observed in a single case in which an incomplete continuous curvilinear capsulorhexis resulted in cases(7.8%) of posterior capsule opacification requiring Nd:YAG laser posterior capsulotomy. None of the above 57 cases requiring Nd:YAG laser capsulotomy, however, resulted in reduced visual acuity. Other brane(0.4%), pupillary capture of the optic(0.4%), decentration of the IOL(0.3%) and elevated intraocular pressure(0.3%). The silicone IOL implantation showed early visual rehabilitation without severe intraoperative and postoperative complications.

IgG-lambda extramedullary Plasmacytoma of the Anterior Uveal Tract: Case Report

A solitary anterior uveal tumor was identified as a extramedullary plasmacytoma. A 72 year old woman presented incidentally with a solitary iris tumor. The mass was round to invade into the ciliary body. Total excision was successfully done by an en bloc resection with a good visual result. There were no positive findings in the systemic work-up for multiple myeloma. The light microscopic and imrnunoperoxidase staining findings suggest that the mass was of anterior uveal tract origin and showed an monoc1onality of IgG and lambda. It is the first case of extramedullary Plasmacytoma of iris-ciliary body origin presented as an iris mass.

Postsurgical Inflammation Measured with Laser Flare Meter after Silicone or PMMA Intraocular Lens Implantation

It has been reported that silicone intraocular lens(IOL) induces severer and longer intraocular inflammation than polymethylmethacrylate(PMMA) IOL after extracapsular cataract extraction and IOL implantation. In order to evaluate the effect of IOL type on intraocular inflammation the authors measured the aqueous flare intensity by using the laser flare meter(FM 500 Kowa company) from postoperative one day to six months in 100 eyes with phacoemulsification followed by silicone IOL implantation (silicone group) and 100 eyes with phacoemulsification followed by PMMA IOL implantation(PMMA group). Every subject had a simple cataractous lens without systemic disease like diabetes or hypertension. There were no statistically significant differences between two groups in postsurgical aqueous flare intensity during the followed up period(p>0.05). The changes of aqueous flare intensity was spiking on the postoperative one day, declining rapidly in the first week and then keeping a steady state in both groups. Conclusively, we considered that surgically induced inflammation was not influenced by IOL type of PMMA or silicone in cataract operation without complication.

The Effect of Anterior Capsulotomy Size and Lens Epithelial cells Removal on the Posterior Capsular Opacification

The most common complication of cataract surgery, posterior capsular opacification is known to arise from the lentivular epithelial proliferation. The simple mechanical elimination of the lenticular epithelial cells by irrigation and asiration is most widely used now. Recently, the defenite size of continous curvilinear capsulorhexis(C.C.C.) and the effect of partial mechanical removal of lens epi thelial cells is under the discussion. We used 15 Neuzealand white rabbits(30 eyes) to examine the appropriate capsulotomy size and the effect of simple irrigation and aspiration on the posterior capsular opacification for 3 months after operation. The results from by using the slit lamp and the ophthalmoscope examination showed that the posterior capsular opacificaiton grade score was lower in the small(3~4mm) capsulotomy with irrigation and aspiration group(1.7) than in the small capsulotomy(3~4mm) group without irrigation and aspiration group(2.3) or the large capsulotomy (6~7mm) group without irrigation and aspiration(2.4). The optical power meter and posterior eye evaluation technique also presented the same results of posterior capsular opacification grade as those of slit lamp and ophthalmoscope examination which was done on the eneuc1eated eyes at postoperative 3 months.

Comparison on Preoperative Intraocular Pressure Elevation after Performing between Pin Point Anesthesia and Retrobulblar Anesthesia

The importance of the preoperative intraocular pressure cannot be overemphasized for cataract operation. We compared the preoperative intraocular pressure between the conventional retrobulbar anesthesia technique and the pin point anesthesia technique with different anesthetic dosage using tono-pen in 23 patients(41 eyes) divided into 4 groups. In the 1st group(10 eyes), after conventional retrobulbar injection was performed using 3ml of 2% lidocaine, digital massage was done for 10 minutes. In 2nd group(13 eyes), 2% lidocaine 1.0ml was injected into subtenon's space(true muscle cone) through the small hole in the superior temporal quadrant 8mm posterior to limbus using specially designed blunt, curved cannula without any method to decrease the intraocular pressure (pin point anesthesia). In the 3rd group(13 eyes), and 4th group(5 eyes), same procedure was performed as 2nd group using 0.75ml and 0.50ml of 2% lidocaine respectively. As a results, in 1st group, average intraocular pressure was decreased around 5.6mm Hg after digital massage. In the 2nd, 3rd, and 4th group, preoperative intraocular pressure increased by 2.2, 0.8, and 0.5mmHg. As comparison of three group of the pin point anesthesia, in the 2nd group, sometimes there were mild chemosis, in the 4th group, often discomfort, in contrast, in 3rd group there were no chemosis, pain or discomfort. As a conclusion we want to recommend a pin poit anesthesia using 0.75ml of 2% lidocaine for the routine cataract operation.

Anatomical Barrier for Anterior and Posterior Capsular Tear Extension

We examined the anatomical barrier for both anterior capsular tear extension and posterior capsular rupture extension which are the most serious intraoperative complications during cataract surgery, using 28 human eyes obtained postmortem. An experimental radial tear, about 1.0 mm in size, was created on the 5.0 mm capsulorhexis margin in the 1st group(7 eyes). Lens nucleus was removed mechanically with hydrodissection and viscoexpression technique. Radial tear extension did not extend over the lens equator in six eyes, and in one eye stopped in front of Wieger's ligament. In the 2nd group(7 eyes), after making zonular rupture around 90 degrees, same procedures were performed. Radial tear extension stopped at the equator in four eyes, and in three eyes stopped in front of Wiegel's ligament. In the 3rd group(7 eyes), we performed capsulorhexis and routine phacoemulsification for lens nucleus and cortex removal. Then we created only a posterior capsule rupture with intact anterior hyaloid membrane and vitreous pressure was increased. Posterior capsular rupture extension stopped in front of Wieger's ligament in all seven eyes. In the 4th group(7 eyes), after creating the rupture of the posterior capsule including anterior hyaloid membrane, intraocular lens was inserted into the empty capsular bag as a perpendicular direction to the axis of the tear. Posterior capsular rupture extension passed Wieger's ligament in only one eye, but did not reach equator or anterior capsule. In this study, we found that zonules, equator portion of the capsular bag and Wieger's ligament act as anatomical barriers for anterior capsular teal extension as well as for posterior capsular rupture extension.

The Effect of the Toxic Reaction of the Retina by Liposome-encapsulated Tobramycin in Normal Rabbits

To determine whether liposome-encapsulated tobramycin is less toxic than commercial tobramycin and the threshold dose of liposome-encapsulated tobramycin required to produce toxic reactions when it was injected intravitreally in rabbit, we used liposome-encapsulated tobramycin, tobramycin in PBS, mixture of tobramycin and liposome-encapsulated saline, liposome-encapsulated saline and normal saline respectively. After those were injected, we examined the histologic findings and the functional changes of the retina. The final results are summarized as follows; 1. When tobramycin was injected intravitreally alone, there was no toxic reaction of the retina histologically and functionally with dosage 500 micro gram of commercial tobramycin, but dosage more than 750 micro gram produced toxic reaction. 2. When liposome-encapsulated tobramycin was injected intravitreally, there was toxic reaction of the retina histologically and functionally with dosage 1500 micro gram of tobramycin. 3. When a mixture of tobramycin and liposome-encapsulated saline was injected intravitreally, there was similar toxic reaction as tobramycin used alone with dosage more than 750 micro gram of tobramycin. Liposome-encapsulated saline and normal saline did not produce toxic reaction. The above results indicate that liposome encapsulation markedly reduces the ocular toxicity of tobramycin and that as mnch as dosage 1000 micro gram of liposome-encapsulated tobramycin may be tolerated by the intravitreal route in the rabbit eye. Therefore, the results of this study offer some hope that we may use the method of intravitreal injection of liposome-encapsulated tobramycin safely and effeciently for the treatment of bacterial endophthalmitis in near future.