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Continuous circular capsulorhexis (CCC) was demonstrated independently by Thomas Neuhann, Kimiya Shimizu, and Howard Gimbel in the 1980s and it finds mention in the landmark paper by Gimbel and Neuhann. The authors describe a technique of achieving the rhexis in a stable, viscoelastic-filled anterior chamber using the tunnel floor as the entry. This gets covered by the roof of the tunnel postoperatively and, therefore, does not leak. There is no oar-locking or striae even when cystitome goes beyond the edge of the tunnel. As there is no escape of the viscoelastic substance, there is no change in the pressure or shallowing of the anterior chamber. It is a useful technique for beginners. It is of great help in difficult cases like intumescent cataracts, shallow anterior chambers, hyperopes, nanophthalmos, pseudoexfoliation, small non-dilating pupils, intraoperative floppy iris syndrome (IFIS), and phacomorphic glaucoma.
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@#AIM: To investigate the effect of fine capsule treatment on the visual quality of diffractive multifocal intraocular lens.<p>METHODS: Ninety-eight patients(120 eyes)with DMIOL implanted in cataract Department of Hebei Eye Hospital from March 2017 to April 2018. They were randomly divided into A group and B group. 60 eyes in each group. Group A patients were treated with anterior and posterior capsular polishing and posterior continuous circular capsulorhexis, while in B group the fine capsule treatment was not performed. The UCDVA, UCIVA, UCNVA, visual quality, intraocular lens neutrality and PCO incidence were compared 6mo after operation.<p>RESULTS: At 6mo after operation, UCDVA, UCIVA and UCNVA in group A were superior to those in group B. The difference was statistically significant(<i>P</i><0.05). At 6mo after operation, the amount of eccentric intraocular lens in group A was less than that in group B. The difference was statistically significant(<i>P</i><0.05). PCO incidence: group A: 0 eyes; group B: 5 eyes(8.3%)in gradeⅠ, 3 eyes(5.0%)in grade Ⅱ, 2 eyes(3.3%)in grade Ⅲ.<p>CONCLUSION: In order to enhance the stability of IOL and maintain the long-term transparency of the optic axis, we performed fine polishing of the anterior and posterior capsule and continuous circular capsulorhexis of the posterior capsule. These could improve the visual quality and satisfaction of patients after surgery.
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@#AIM: To explore the clinical efficacy of the T-hook pre-chopping combined with capsule fine treatment technology for patients with high myopia and cataract.<p>METHODS: From March 2016 to February 2019, 56 cases(80 eyes)of cataract patients with high myopia were treated in cataract department of Hebei Province Eye Hospital. They were randomly divided into A and B groups, 40 eyes in each group. Group A underwent T-hook pre-chopping combined with fine capsular treatment. Cataract phacoemulsification combined with intraocular lens implantation was purely performed in group B. We compared the cumulative release energy of ultrasound during operation between the two groups. We also observed the best corrected visual acuity(BCVA), the amount of contraction of the anterior capsule, the degree of posterior capsule opacification, intraocular lens neutrality and complications for more than 6mo.<p>RESULTS: The cumulative release energy of ultrasound in group A was less than that in group B(12.23±3.61 <i>vs</i> 20.46±4.61, <i>P</i><0.01). The best corrected visual acuity of group A was better than that of group B at 6mo after operation(<i>Z</i>=5.328, <i>P</i>=0.002). The changes of anterior capsular contraction and intraocular lens decentration(0.18±0.14, 0.02±0.007mm)were less than those of group B(0.82±0.23, 0.65±0.240mm)(<i>P</i><0.05). In group A, there were 3mm round holes in the center of the posterior capsule, and the optic axis area remained transparent, while in group B, 13 eyes(32%)had turbid central area of the posterior capsule. In group A, there was no intraoperative posterior capsule rupture or postoperative retinal detachment. In group B, there were 2 eyes(5%)with intraoperative posterior capsule rupture and 1 eye(2%)with postoperative retinal detachment.<p>CONCLUSION: We used T-hook pre-chopping combined with capsule fine treatment technology to treat cataract with high myopia, which could reduce the use of ultrasound energy during operation, reduce the risk of posterior capsule rupture, effectively avoid the occurrence of posterior cataract, and achieve satisfactory clinical effect.
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@#AIM: To determine the lowest concentration of trypan blue(TB)used to stain the anterior capsule satisfactorily and to evaluate the clinical significance of trypan-blue-assisted capsulorhexis in cataract surgery. <p>METHODS:Totally 60 cases(60 eyes)of mature age-related cataract, of which the cortex lentis cloudy degree was C4-C5 and the nucleus of the lens was N3, were randomly divided into three groups. Different concentrations of TB, 0.03%, 0.015%, 0.0075%, were used in staining groups respectively to stain the anterior capsule during cataract surgery. All cases were performed with manual small-incision cataract surgery by the same ophthalmologist. The staining effects, the success rate of continuous circular capsulorrhexis(CCC), the posterior capsule rupture and the state of the intraocular lens(IOL)were studied during the operation. The significant statistics was conducted between the groups. The density of corneal endothelial cells, intraocular pressure(IOP), inflammation in anterior chamber, corneal edema, staining of other intraocular structures were also observed at 1d, 1wk, 3mo postoperatively. <p>RESULTS: Trypan blue in concentrations as low as 0.015% stained the anterior capsule satisfactorily, allowing safe creation of a CCC. At concentrations of 0.03% and 0.015%, the success rate of CCC and the state of the intraocular lens(IOL)was significantly better than 0.0075% group, the difference was statistically significant(<i>P</i><0.0083). The difference of posterior capsule rupture rates and the rate of lost corneal endothelial cells in three groups were not statistically significant(<i>P</i>>0.0083). The staining of CCC margin and side port disappeared in 1wk after surgery. Inflammation in anterior chamber of all cases was slight. There was not any evidence of residual stain in the anterior segment during the postoperative period. There was no corneal edema and intraocular pressure higher after 1wk. <p>CONCLUSION: Trypan blue staining of the anterior capsule is a safe and useful technique in cataract surgery, which can raise the success rate of cataract surgery. The 0.015% trypan blue staining, the lowest effective concentration, is strongly considered.
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AIM: To explore the clinical effects of high frequency electrical capsulotomy in maturation period cataract surgery. ●METHODS: A total of 68 cases of maturation period cataract were selected and underwent the surgery of continuous circular capsulorhexis using the high frequency electrical capsulotomy. ●RESULTS: The success rate was 91% in 68 cases with the high frequency electrical capsulotomy. ● CONCLUSION: The high frequency electrical capsulotomy in maturation period cataract surgery has significant advantages and brilliant clinical values.
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AIM: To investigate the efficacy of 23G minimally vitrectomy without irrigation in cataract phacoemulsification and trabeculectomy of malignant glaucoma, and to analyze such compound operative procedures for phakic malignant glaucoma. ●METHODS:A total of 21 phakic malignant glaucoma patients (21 eyes) underwent anterior vitrectomy without irrigation by using 23G vitrectomy. During surgical course phacoemulsification with anterior and posterior continuous circular capsulorhexis, trabeculectomy combined with iridectomy would be completed. lntraocular pressure, anterior chamber depth changes and postoperative complications were observed after the operation. ●RESULTS:ln the three-month follow-up, intraocular pressures were reduced from ( 57. 18 ± 6. 18 ) mmHg to (16. 15 ± 2. 43 ) mmHg, there was statistical difference compared with pre - operation ( P ● CONCLUSION: The compound surgical method of anterior vitrectomy combined with phacoemulsifier and trabeculectomy can effectively treat phakic malignant glaucoma. Early diagnosis and early compound surgery may effectively reduce the intraocular pressure of malignant glaucoma.
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?AIM:To evaluate the clinical outcomes of Nd:YAG laser capsulotomy in the treatment of early stage capsular block syndrome ( CBS) .?METHODS:Eighteen patients (21 eyes) with early stage capsular block syndrome were treated using Nd:YAG laser by anterior capsulotomy only or combined with posterior capsulotomy from January 2010 to July 2015 in Anyang Eye Hospital. Uncorrected distance visual acuity, intraocular pressure, spherical equivalent, depth of anterior chamber were observed preoperatively and 2wk postoperatively.?RESULTS:Seventeen eyes simply underwent peripheral anterior capsulotomy with Nd:YAG laser. Four eyes were combined with posterior capsulotomy. Compared with preoperative, uncorrected distance visual acuity improved, intraocular pressure returned to normal, degree of myopia reduced, depth of anterior chamber had deepened.? CONCLUSION: Nd: YAG laser capsulotomy is an effective treatment for early stage capsular block syndrome.
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There are many unknown factors in the surgical treatment of congenital cataract such as time of surgery, surgical problems, and aphakic visual correction. Recently, the advancement of microsurgical technique and visual rehabilitation have reduced the rate of postoperative complications and visual losses. We have studied 81 eyes of 55 patients who had recieved cataract surgery from January 1994 to January 1998 at the department of ophthalmology, Yonsei University College of Medicine. These eyes have been categorized by age into three groups : Group l (0~1 year), Group ll (2~5 years), and Group lll(6~10 years). Cataract extraction was done in all eyes and posterior chamber intraocular lens implantation was performed in groups ll and lllfor aphakic visual correction and the followings were investigated : preoperative vision; surgical method; postoperative vision; refractive error;and complications. Improvements in surgical procedures such as lens aspiration, posterior continuous circular capsulorhexis, anterior vitrectomy, intraocular lens implantation, and intraocular lens capture (Group ll) have brought better visual outcomes in groups II and III as well as decreased incidence of after-cataract. Thus, intraocular lens implantation in congenital cataract of 1year and older should actively be considered.
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Humans , Capsulorhexis , Cataract Extraction , Cataract , Incidence , Lens Implantation, Intraocular , Lenses, Intraocular , Ophthalmology , Postoperative Complications , Rehabilitation , VitrectomyABSTRACT
The postoperative results of 77 paients:(82 eyes) who had undergone phacoemulsification with implantation of oval optic poly methylmethacrylate (PMMA) introoular intraowlar lens (IOL) (5 X 6mm) were evaluated retrospectively. Scleral pocket incision was done tangentially at the point 2mm. apart from the surgical limbus and 5mm in length. No suture in the group 1 (30 eyes), single horizontal suture in the group 2 (31 eyes) and single X suture in the group 3 (21 eyes) were used for the closure method. Average uncorrected visual acuity at postoperative one week was 0.5 or better in each group and there was no statistically significant difference among three groups (p>0.05). The change in mean keratometric astigmatism from postoperative one to eight weeks turned out to be less than 1 diopter (D) in each group and there was no statistically significant difference among three groups (p>0.05). When the diameter of continuous cirular capsulorhexis (CCC) was greater than 5mm or the position of CCC was decentered, it was found that optic was partially escaped form the bag due to adhesion between the remained anterior and posterior capsular structure. It could be suggested that oval optic PMMA IOL showes early visual recovery with less astigmatism regardless of the suture method and in order to place the optic of IOL properly in the bag postoperatively, the diameter of CCC should be less than 5mm and the position of CCC should be centered.