A multipronged approach to prevent Argentinian flag sign in intumescent cataracts

In this communication, we describe a technique for creation of a single stage, adequately sized capsulorrhexis in intumescent cataracts by depressurizing the anterior and posterior intralenticular compartments in a nonleaky anterior chamber (AC) to prevent capsulorrhexis extension and Argentina flag sign. Initially, an incomplete main-port incision is made by the partial entry of a 2.2-mm keratome. A cohesive dispersive ophthalmic viscosurgical device (OVD) is injected into AC. Standard side-port incisions are made, followed by anterior capsular staining. The fluid cortex in anterior intralenticular compartment is aspirated by puncturing anterior capsule in the center using a 30-gauge needle entered through a separate limbal stab incision. The nucleus edge is gently tipped posteriorly with the needle tip to release the fluid from posterior intralenticular compartment also and as much fluid aspirated as possible. OVD is again injected and capsulorrhexis is performed in a single stage using micro-capsulorrhexis forceps.

Clinical evaluation of two-step capsulorhexis during phacoemulsification with intraocular lens implantation for hypermature cataract / 中华实验眼科杂志

Objective To investigate the clinical effect and safety of two-step capsulorhexis in phacoemulsification with intraocular lens (IOL) implantation for hypermature cataract.Methods A non-randomized controlled clinical trial was carried out in Huaibei People's Hospital.Forty eyes of 40 patients with hypermature cataracts were enrolled from January 2016 to March 2017.The patients were divided into 2 groups according to different capsulorhexis.Two-step curvilineal capsulorhexis was used during the phacoemulsification with IOL implantation in 20 eyes of the 20 patients in the two-step capsulorhexis group (to complete a 4 mm-diameter capsulorhexis with the ripping forceps firstly and then extented the capsulorhexis diameter until 5-6 mm),and conventional curvilineal capsulorhexis was used during the phacoemulsification with IOL implantation in 20 eyes of the 20 patients in the conventional capsulorhexis group.The demography was matched between the two groups and the same foldable IOLs were used in the surgery.The uncorrected visual acuity,successful rate of capsulorhexis,intra-and post-operative complications were compared.Results The postoperative visual acuity was considerably improved both in the two groups after surgery.The UCVA in postoperative 1 day and 3 days were 4.70±0.09 and 4.70±0.08 in the two-step capsulorhexis group,which were significantly better than 4.60 ± 0.08 and 4.60 ± 0.08 in the conventional capsulorhexis group (both at P＜0.05),and no significant differences were found in the UCVA in postoperative 7 days,1 month and 3 months between the two groups (all at P＞0.05).The successful rate of capsulorhexis in the two-step capsulorhexis group was 100％ (20/20),which was significantly higher than 80％ (16/20) in the control group (x2 =4.44,P＜0.05).Posterior capsule rupture occurred in 4 eyes in the conventional capsulorhexis group,and no posterior capsule rupture was found in the two-step capsulorhexis group (x2=4.44,P＜0.05).The incidence rates of corneal edema in postoperative 1 day and 3 days were 40％ and 45％ in the conventional capsulorhexis group,which were significantly higher than 10％ and 15％ in the two-step capsulorhexis group (x2 =4.80,4.19,both at P＜0.05),and the corneas were clear in 7 days after surgery.No significant differences were found in intraocular pressure between groups and various time points (Fgroup =0.091,P =0.765;Ftime =7.048,P ＞ 0.05).Conclusions Two-step capsulorhexis during phacoemulsification with IOL implantation for hypermature cataract is safe and effective in improving the successful rate of continuous curvilineal capsulorrhexis,reducing intra-operative and postoperative complications,and it is beneficial to the recovery of postoperative visual acuity.

Clinical characteristics of congenital cataract in 476 children / 眼科新进展

Objective To analyze the operative methods,intraocular lens (IOL) implantation and postoperative complications in children with congenital cataract,and give the references for treating of congenital cataract.Methods From January 2008 to January 2016,children under the age of 13 years with congenital cataract were enrolled.Preoperative and posterior slit lamp microscope,fundus,intraocular pressure were examined.Children under 2 years old were treated with phacoemulsification (PHACO),posterior continuous curvilinear capsulorrhexis (PCCC),anterior-vitrectomy (AV),and ＞ 2-4 years old with PHACO + PCCC + AV + IOL implantation,＞ 4-7 years old children with PHACO + PCCC + IOL implantation,children ＞ 7 years with PHACO + IOL implantation.Results A total of 476 patients (740 eyes) were enrolled in the study,the average age were (33.59 ± 37.14) months,of which 0 ～ 6 months were 166 cases (282 eyes,38.11％).260 eyes were implanted with IOL,aged (5.59 ±2.43) years,480eyes were implanted in the second surgery,aged (4.06 ± 2.12) years.Refaction diopter (equivalent spherical) after IOL implantation in children aged ＞ 2-4 years old was (3.53 ± 0.56) D,＞ 4-6 years old was (2.36 ± 0.32) D,＞ 6-8 years old was (1.65 ±0.52)D,＞8-13 years old was (-0.25 ±0.32) D.The postoperative complications occurred in 326 eyes,of which 115 eyes (35.28％) with iridotic adhesions,97 eyes (29.75％) with posterior cataract on the visual axis,and 54 eyes (16.56％) with glaucoma.At the last follow-up,the best corrected visual acuity were (0.56 ± 0.41) LogMAR for monocular cataract surgery and (0.42 ± 0.27) LogMAR for binocular cataract surgery,the difference was statistically significant (P =0.04).Conclusion One-third of children with congenital cataract are treated with surgical treatment under 6 months old,about half of the children undergo IOL implantation at 2 ～ 3 years of age.The postoperative visual acuity in children with binocular cataract is better than children with monocular cataract.The complications in children are more complicated than adults,which should be paid more attention.

Clinical Result of Planned Posterior Continuous Curvilinear Capsulorrhexis in Adult Patients

PURPOSE: Following planned posterior continuous curvilinear capsulorrhexis (PCCC) during cataract surgery in adults, we evaluated the clinical effects of visual acuity and prevention of posterior capsule opacity. METHODS: The clinical results were studied retrospectively by comparing 43 eyes of 43 patients who underwent cataract surgery with PCCC (the experimental group) and 46 eyes of 31 patients who underwent cataract surgery without PCCC (the control group). Preoperative and postoperative best corrected visual acuities (BCVAs) of patients were measured. BCVA (using log MAR) and the occurrence of posterior capsule opacity were closely monitored in both groups preoperatively, two months postoperatively, and at each group's final visit (14.6 months postoperatively for the experimental group and 15.7 months for the control group). One-piece plate intraocular lens was used in cataract surgery. RESULTS: Preoperative BCVA was lower in the control group but not significantly. The 2-month mean postoperative BCVA showed improvement in vision in both the control and experimental groups. In both groups, the BCVA was decreased at the final examination compared with the 2-month postoperative BCVA, and significant differences between the two groups were not observed. Under slit lamp examination, anterior hyaloid opacity was observed in 13 of 43 eyes that underwent PCCC. The decrease in BCVA in 13 eyes with anterior hyaloid opacity was significantly different (p < 0.05) compared with the 2-month postoperative BCVA. CONCLUSIONS: Considering the effort and operation skills required for PCCC, the clinical benefits are negligible. Since cataract surgery with PCCC can cause reduced vision due to anterior hyaloid opacity, side effects should be disclosed before PCCC is performed.

Clinical Results after Phacoemulsification in Mature Cataract

PURPOSE: To evaluate the clinical results after phacoemulsification in mature and immature cataracts. METHODS: Mature cataract was defined as a classification of C5 by Lens Opacities Classification System III compared with other types of cataracts as controls. The present study included 37 (37 eyes) patients diagnosed with mature cataracts that received phacoemulsification and were followed up for at least 1 year. Thirty-seven (37 eyes) patients with other types of cataracts were selected randomly as controls. Intraoperative factors and rate of complications during and after surgery were evaluated. Best corrected visual acuity (BCVA), corneal endothelial cell density and central macular thickness (CMT) were measured during the 1 year of follow-up and compared with the controls. RESULTS: Twenty-seven eyes (mature cataracts) and 36 eyes (controls) received a complete continuous curvilinear capsulorhexis (CCC). The success rate of complete CCC was significantly high in the control eyes (p = 0.025). However, in mature cataract patients, 3 cases of posterior capsule rupture occurred among the 6 cases of radial tear of the anterior capsule, resulting in implantation of the lens in the sulcus. Posterior capsular ruptures were observed in 4 patients with mature cataracts and in 1 control with no statistically significant difference in the occurrence rate. Total phacoemulsification time and effective phacoemulsification time were significantly longer in the mature cataract patients (p = 0.038 and p = 0.041, respectively). BCVA, the amount of corneal endothelial cell density reduction and CMT at postoperative 1 year was not different between the two groups. CONCLUSIONS: The success of complete CCC was a significant factor for the occurrence of intraoperative complications in mature cataract surgery. Based on the clinical results, the mature cataract patients and controls had a similar visual prognosis.

A Case of Uneventful Cataract Surgery in Idiopathic True Exfoliation Patient

PURPOSE: We present a case of uneventful cataract surgery in an idiopathic true exfoliation patient with areas of capsular delamination based on scanning electron microscope and transmission electron microscope results. CASE SUMMARY: A 77-year-old male presented with gradual deterioration of vision over 1 year in duration. Slit lamp examination revealed bilateral nuclear sclerotic cataracts with ring-shaped fibrous membrane floating within the anterior chamber in the right eye. In addition, the patient was diagnosed with cataract and true exfoliation of the right eye. He underwent uneventful phacoemulsification and posterior chamber intraocular lens implantation by placing capsulorrhexis outside the delaminated capsule margin. At 6 months after cataract surgery, the patient showed favorable visual outcome with uncorrected vision of 20/20 and intraocular pressure of 18 mm Hg in the right eye.

Trypan Blue Dye as an Adjunct to Cataract Surgery.

The current study was done to evaluate the utility and safety of Trypan Blue staining of the anterior capsule for enhancing visualization of capsulorrhexis in mature and hypermature cataracts.This study included 100 eyes of 100 patients with a unilateral mature or hypermature cataract. In all these cases 0.2ml of 0.1% Trypan blue dye was used to stain the anterior capsule in cataract surgery. In all 100 eyes the Continuous Curvilinear Capsulorrhexis (CCC) was completed. Successful cataract surgery with intraocular lens (IOL) implantation was performed in all eyes. Adverse reactions related to the dye such as raised intraocular pressure or anterior chamber inflammation was not observed in the immediate postoperative period or at the end of mean follow-up of 3 months.Trypan blue dye staining of the anterior capsule was found to be an effective and safe technique that helps in completion of Continuous Curvilinear Capsulorrhexis (CCC) in mature and hypermature cataracts.

Continuous Curvilinear Capsulorhexis (CCC) Remodeling after CCC Widening with a Nd:YAG Laser

PURPOSE: To analyze the factors that affected continuous curvilinear capsulorhexis (CCC) remodeling to different shapes after CCC widening with Nd:YAG laser. METHODS: The medical records of patients who underwent CCC widening with Nd:YAG laser between January 2002 and December 2010 in our clinic were retrospectively reviewed. Eyes that underwent phacoemulsification surgery alone or combined phacoemulsification surgery and vitrectomy were eligible for the study. A remodeled CCC with a nearly complete circle was classified as type a, starfish-shape as type b, and not remodeled CCC as type c, The factors that affected CCC remodeling were analyzed. RESULTS: Among 424 eyes of 316 patients, the type of CCC remodeling had a significant correlation with the time period from phacoemulsification surgery to Nd:YAG CCC widening. There was no significant correlation with age, sex, diabetes, type of intraocular lens, type of surgery and indications for surgery. CONCLUSIONS: CCC widening using Nd:YAG laser was effective and had minimal complications. The sooner the procedure was performed, the more circular CCC remodeling occurred. The capsule's elasticity may influence CCC remodeling, but more studies are needed to clarify other factors.

Staining of Lens Capsule with Trypan Blue for Capsulorrhexis in Eyes with White Cataract.

Objective: To evaluate the efficacy and safety of intracameral 0.1% Trypan blue dye for staining the anterior lens capsule during cataract surgery. Methods: 110 Patients who underwent Manual Small Incision Cataract Surgery (MSICS) and phacoemulsification for intumescent, mature or hypermature cataract in the Department of Ophthalmology, Tripura Medical College during the period of June 2009 to July 2010 were included in the study. Results: Satisfactory staining of the anterior lens capsule was seen in all cases with no major complications. Conclusion: Direct intracameral injection of trypan blue dye is an effective method for staining the anterior lens capsule during cataract surgery.

Completion rates of anterior and posterior continuous curvilinear capsulorrhexis in pediatric cataract surgery for surgery performed by trainee surgeons with the use of a low-cost viscoelastic.

Context: Pediatric cataract surgery is traditionally done with the aid of high-molecular-weight viscoelastics which are expensive. It needs to be determined if low-cost substitutes are just as successful. Aims: The study aims to determine the success rates for anterior and posterior capsulorrhexis and intraocular lens (IOL) implantation in the bag for pediatric cataract surgery performed with the aid of a low-molecular-weight viscoelastic. Settings and Design: Nonrandomized observational study. Materials and Methods: Children less than 6 years of age who underwent cataract surgery with IOL implantation in the period May 2008–May 2009 were included. The surgeries were done by pediatric ophthalmology fellows. A standard procedure of anterior capsulorrhexis, lens aspiration with primary posterior capsulorrhexis, anterior vitrectomy, and IOL implantation was followed. Three parameters were studied: successful completion of anterior and posterior capsulorrhexis and IOL implantation in the bag. Results: 33 eyes of 28 children were studied. The success rate for completion was 66.7% and 88.2 % for anterior and posterior capsulorrhexis, respectively. IOL implantation in the bag was successful in 87.9%. Conclusions: 2% hydroxypropylmethylcellulose is a viable low-cost alternative to more expensive options similar to high-molecular-weight viscoelastics. This is of great relevance to hospitals in developing countries.

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.