Phacoémulsification versus phacoalternative manuelle sans suture au cours de la chirurgie de masse de la cataracte

Introduction : La pratique de la phacoémulsification (phaco E) reste exceptionnelle dans les pays à faibles revenus contrairement à la phacoalternative manuelle sans suture (phaco A). Le but était de comparer les deux techniques au cours d'une chirurgie de masse de la cataracte. Population et méthodes : Il s'agissait d'une étude prospective menée en 2017 à Libreville. Elle concernait 233 patients (233 yeux) avec une cataracte liée à l'âge. Ils étaient répartis en deux groupes(phaco A, phaco E). Ceux ayant une acuité visuelle (AV) de loin inférieure à 2/10ème et une absence de pathologies oculaires associées pouvant compromettre la récupération visuelle étaient inclus. Résultats : L'âge moyen était de 67,6 ± 10,1 ans, les femmes représentaient 52,4% de l'effectif. La phaco A était pratiquée dans 57,5 % des cas. After surgery, patients operated by Phaco A had an AV without correction considered good in 75.4% of cases, average in 13.4% and bad in 11.2%. Pour ceux opérés par phaco E, elle était bonne dans 81,8% des cas et moyenne dans 18,2%. La récupération visuelle était meilleure pour le groupe phaco E (p = 0,002). La fréquence des complications per opératoires était de 3% pour la phaco E et 4,4% pour la phaco A (p = 0,731). Celle des complications post opératoires était de 3% pour la phaco E contre 3,7% pour la phaco A (p = 0,965). Conclusion : La récupération visuelle était meilleure après chirurgie de la cataracte par phaco E. Les deux techniques présentaient un faible taux de complications

Résultats fonctionnels de la chirurgie de la cataracte à l'hôpital central de Yaoundé par la technique de la petite incision manuelle

But. Décrire les résultats fonctionnels sans correction de la chirurgie de la cataracte par la technique de la petite incision manuelle ou phacoalternative à l'Hôpital Central de Yaoundé (HCY). Méthodologie. Il s'agit d'une étude transversale descriptive et rétrospective. Les dossiers de patients opérés de cataracte par phacoalternative entre mars 2013 et décembre 2017 comportant les données recherchées ont été retenus. L'âge, le sexe, l'acuité visuelle pré opératoire et l'acuité visuelle de loin au 30e jour post-opératoire étaient les variables analysées. Nous avons utilisé la classification de l'Organisation Mondiale de la Santé (OMS) pour l'évaluation du résultat fonctionnel post-opératoire. Le résultat était bon si l'acuité visuelle de loin était ≥ 3/10, limite si entre 1/10 et < 3/10 et mauvais si < 1/10. Résultats. Durant la période d'étude, 264 yeux ont été opérés, mais 94 patients (116 yeux) suivis jusqu'à un mois ont été inclus. Le sex-ratio homme / femme était de 1,25. L'âge moyen des patients était 66,87 ± 15,10 ans avec les extrêmes de 12 et 92 ans. A un mois post-opératoire, 53,45% des yeux opérés (n= 62/116) avaient un bon résultat sans correction. Conclusion. Le résultat fonctionnel de la chirurgie de la cataracte à l'HCY est bon dans 53,45% des cas. Ce chiffre est inférieur aux recommandations de l'OMS. L'amélioration de la disponibilité des implants selon la biométrie ainsi que le respect des protocoles de chirurgie et de suivi post opératoire par les chirurgiens devraient permettre d'améliorer le résultat visuel sans correction

Efficacy and Safety of Intracameral Moxoft Eye Drops (Moxifloxacin Ophthalmic Solution 0.5%) for Endophthalmitis Prophylaxis in Cataract Surgery.

Objective: To evaluate the efficacy and safety of intracameral Moxoft eye drops (Moxifloxacin ophthalmic solution 0.5%) administered at the conclusion of phacoemulsification cataract surgery for the purpose of endophthalmitis prophylaxis. Design: Open label, multicentre, prospective. Setting: Three ophthalmologists across India. Methods: A total of 134 outpatients of either sex undergoing phacoemulsification with no ocular pathology other than cataract and meeting all inclusion/exclusion criteria were enrolled in the study. All patients received preoperatively 1 drop of Moxoft eye drops (Moxifloxacin ophthalmic solution 0.5%) topically every 15 minutes atleast 4 times one hour prior to surgery. 0.1 ml moxifloxacin solution was aspirated into the tuberculin syringe and injected into the capsular bag under the capsulorhexis edge after completion of the Phacoemulsification and IOL implantation. Post-operative treatment was as per standard protocol. Patients were assessed pre-operatively and on day 1, day 7 & day 30 after surgery for ocular symptom scores for pain in eyes, ocular discharge, hazy cornea, conjunctival hyperemia, and hypopyon and chemosis. Anterior chamber (AC) reaction was graded (if present) on all the visits with fixed slit-lamp settings and on 5-point rating scale for AC flare and cells in AC. Global assessment was done for efficacy and tolerability at the end of therapy on a 3-point scale. Result: Thirteen patients were excluded from the analysis due to insufficient data and an intentionto- treat analysis was done for efficacy on 121 patients. There was significant reduction in scores of pain in eyes, conjunctival hyperemia, mean AC flare, mean AC cells (p<0.0001 for all) and ocular discharge (p=0.018). Hypopyon and/or corneal endothelial cell damage was observed in none of the patients. Therapy was rated good to excellent on efficacy and tolerability parameters with no reporting of a poor rating. Conclusion: Moxoft eye drops (Moxifloxacin ophthalmic solution 0.5%) is safe for use by intracameral administration with no corneal decompensation. Tolerability and post-operative results were found to be excellent.

Prevalence of second-eye cataract surgery and time interval after first-eye surgery in Iran: a clinic-based study

To determine the prevalence of second-eye senile cataract surgery [SECS] as a proportion of all senile cataract surgeries and the trend in the interval between first and second cataract operations in a main referral and academic eye hospital. In this cross-sectional study, a list of patients who underwent senile cataract surgery over four consecutive years [2006-2009] was retrieved from hospital computer-based records as the sampling frame. With a systematic random method, 15% of records were selected [1, 585 out of 10, 517 records]. First- and second-eye operations were performed in 1, 139 [71.9%; 95% confidence interval [CI], 69.5-74.1] and 446 eyes [28.1%; 95% CI, 25.9-30.35], respectively. The proportion of SECS procedures increased from 24.3% in 2006 to 33.4% in 2009 [P- 0.017]. The median [interquartile range] interval between the two operations was 9 [4-24] months, which remained stable during the study period. The SECS rate was 10.4% higher [P - 0.0l] and the time interval was 13 months shorter [P- 0.007] in patients who underwent phacoemulsification than extracapsular cataract extraction. The number of cataract operations in this tertiary eye care setting increased 1.5 fold over the study period. The proportion of second-eye operations also rose from 1/4 to 1/3 during the same time

Approaches to a posterior polar cataract

Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection - instead performing 'inside-out' hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract

Femtosecond cataract surgery: a review of current literature and the experience from an initial installation

Cataract surgery remains the most widely performed intraocular procedure throughout the world. Safety and accuracy of the procedure are paramount and techniques should remain under constant review. Recently, the introduction of the femtosecond laser to assist cataract surgery has provided ophthalmologists with an exciting tool that may further improve outcomes. We review the existing literature and discuss the installation and initial experience of a femtosecond laser into our practice

Management of intraoperative miosis during pediatric cataract surgery using healon 5

We describe a technique for achieving pupillary dilatation in order to manage and counteract intraoperative miosis during pediatric cataract surgery using viscoadaptive viscoelastic [sodium hyaluronate 2.3%]. The technique of viscomydriasis was used in six eyes with pediatric cataracts with intraoperative pupillary miosis. Pupillary dilatation was achieved and maintained in all eyes throughout cataract surgery. All the surgical steps including anterior and posterior capsulorrhexis and aspiration were performed successfully. Viscomydriasis is a simple and effective technique for the management of intraoperative pupillary miosis during cataract surgery in pediatric eyes

Visual Outcome after Cataract Surgery at the University College Hospital; Ibadan

Aim: The aim of this study was to determine the visual outcome of patients who had cataract surgery in the University College Hospital Ibadan. Methodology: This is an observational descriptive; longitudinal study of consecutive patients undergoing cataract surgery at the University College Hospital conducted between May and October 2007. A total of 184 patients who presented to the hospital and met the inclusion criteria were recruited into the study. Patients were examined preoperatively; 1st day postoperatively and 8th week postoperatively. Results: The mean age was 66.5 years; and the male to female ratio was 1.2:1. Preoperatively; 137 patients (74.5) were blind in the operated eye; while 39 patients (23.6) were blind in both eyes at presentation. At 1st day postoperatively; 87 patients (47.3) had pinhole visual acuity of 6/6-6/18. Best corrected vision after refraction eight weeks postoperatively showed that 127 patients out of 161 patients (78.8) had good vision while 28 patients (17.4) had borderline vision; and six patients (3.8) had severe visual impairment after refraction. The number of bilaterally blind patients also reduced from 39 (23.6) to one (0.6). Uncorrected refractive error was the commonest cause of poor vision prior to refraction. Glaucoma was the commonest ocular co-morbidity accounting for poor vision in 9.1of patients eight weeks after cataract surgery. Conclusion: This study demonstrates that good results can be obtained with cataract surgery and intraocular lens implantation in the developing world. More attention should be directed towards ensuring that successful outcomes are indeed being realized by continued monitoring of postoperative visual outcomes and prompt refraction for all patients

Intraocular pressure after phacoemulsification using hydroxypropyl methylcellulose and sodium hyaluronate as viscoelastics

Phacoemulsification and intraocular lens [IOL] implantation has resulted in early visual rehabilitation, increased wound stability and improved refractive results. Viscoelastic substances [VES] are important adjuncts in this type of surgery. Use of VES in phacoemulsification can be associated with adverse effects, the most common and potentially dangerous of which is the transient rise in intraocular pressure [IOP] in post-operative period. To evaluate the effects of viscoelastic substances on post-operative IOP after phacoemulsification with implantation of intraocular lens, a cross-sectional comparative, prospective study was conducted in the department of Ophthalmology, Combined Military Hospital, Peshawar, Pakistan, from October 2003 to March 2004. one hundred patients were randomized into two groups of 50 each. Phacoemulsification with implantation of intraocular lens was performed in all patients. 2% Hydroxypropyl Methylcelloulose [HPMC] was used in one group and 1% Sodium Hyaluronate [NaHa] was used in the other group. IOP was measured pre-operatively as well as 24 hours and 7 days post-operatively. There was no significant difference in the pre-operative intraocular pressure between the two groups [p=0.483]. Twenty four hours after surgery, the mean IOP increased by 2.84 +/- SD 2.12 mm Hg in 2% Hydroxypropyl Methylcellulose group and 4.54 +/- 2.07 mm Hg in 1% Sodium Hyaluronate group. The increase returned to near pre-operative levels in both the groups. Sodium Hyaluronate causes significantly higher increase in intraocular pressure in early post-operative period after cataract surgery in spite of maximum aspiration of viscoelastic substance from the eye following phacoemulsification surgery

Cyclophosphamid in preparing Behcet's patients for cataract surgery

Our study aimed to assess the effects of using single monthly dose of intravenous cyclophosphamie administered to patients having Behcet's disease, in three doses before cataract surgery, and another three doses following the surgery. 15 Behcet's disease patients [3 females and 12 males] did phacoemulsification with intraocular lens [IOL] implantation. Cyclophosphamide was given in monthly bolus dose of 10mg/kg by iv in 1000cc normal saline over 90 minutes period. The dose was repeated for 3 months before the surgery, and another 3 months following surgery. Three cases showed mild reaction, which was controlled by single dose of IV prednisolone within 10 days. One case showed vitritis, which needed vitrectomy within the first month. Six cases showed mild hair falling. Hemorrhagic cystitis was not reported with our regimen. Leucopenia never reached less than 4000mm[2]. Cyclophosphamide is an effective and relatively safe immunosuppressive drug in short-term therapy for patients with Behcet's disease undergoing cataract surgery

effect of retrobulbar anaesthesia on intraocular pressure and ocular blood flow

To study the effect of retrobulbar anaesthesia on intraocular presssure [lOP] and ocular blood flow [OBF]. Fourty eyes of 40 patients [who were prepared for cataract surgery] received retrobulbar anaesthesia. The patients were divided into 2 groups: group I [retrobulbar anaesthesia without hyaluronidase] and group II [retrobulbar anaesthesia with hyaluronidase]. We measured intraocular pressure [by applanation tonometry] as well as blood flow velocity and resistivity index of central retinal artery and short posterior ciliary arteries [by Doppler sonography] just before anaesthesia, I minute after anaesthesia, and 10 minutes after anaesthesia. Both groups showed significant elevations of intraocular pressure after 1 minute of anaesthetia: group I [+ 17.9% +/- 3.7%] and group II [+ 15.8% +/- 3.3%]. However, the intraocular pressure nearly returned back to its pre-anaesthetic measurement after 10 minutes of anaesthesia. As well, both groups showed significant reductions of ocular blood flow. Group I patients [retrobulbar anaesthesia without hyaluronidase] showed a significant drop of peak systolic velocity in both central retinal artery [- 26.6% +/- 8.0%] and short posterior ciliary arteries [- 18.8% +/- 5.2%] in the 1 minute post-anaesthetic measures, as well as a significant drop of peak systolic velocity in both central retinal artery [- 30.5% +/- 7.0%] and short posterior ciliary arteries [- 22.1% +/- 13.9%] in the 10 minute post-anaesthetic measures. Group II patients [retrobulbar anaesthesia with hyaluronidase] showed a significant drop of peak systolic velocity in both central retinal artery [- 22,0% +/- 6.9%] and short posterior ciliary arteries [- 15.1% +/- 5.9%] in the 1 minute post-anaesthetic measures, as well as a significant drop of peak systolic velocity in both central retinal artery [- 26.4% +/- 13.9%] and short posterior ciliary arteries [- 17.2% +/- 10.3%] in the 10 minute post-anaesthetic measures, Retrobulbar anaesthesia results in the reduction of both choroidal and retinal blood flows. Retrobulbar anaesthesia might carry the risk of visual loss in patients with compromised ocular blood flow before surgery. It may be safer to use other anaesthetic techniques [e.g. topical or subconjunctival] in patients with ocular vascular compromise

Simultaneous and non-simultaneous penetrating keratoplasty and cataract surgery for Fuchs' corneal endothelial dystrophy and cataract

To determine outcome of simultaneous and non-simultaneous penetrating keratoplasty and cataract surgery in eyes with Fuchs' dystrophy and cataract. The medical records of all patients with a histopathologically confirmed diagnosis of Fuchs' dystrophy who underwent penetrating keratoplasty at the University of Iowa Hospitals and Clinics between January 1, 1990 and December 31, 1999 and who had also undergone cataract extraction and intraocular lens implantation prior to December 31, 2001 were retrospectively reviewed. Patients were assigned to group 1 [cataract surgery followed by penetrating keratoplasty], group 2 [simultaneous penetrating keratoplasty and cataract surgery], and group 3 [penetrating keratoplasty followed by cataract surgery]. Two hundred and twelve eyes met the inclusion criteria. Among these, there were 48 cases in which cataract extraction and IOL implantation was performed prior to penetrating keratoplasty [group 1], 154 in which all three procedures were performed simultaneously [group 2], and 10 in which cataract surgery was performed after penetrating keratoplasty [group 3]. There were no statistically significant differences between the 3 groups with respect to the percentage of eyes that obtained a final visual acuity of 20/40 or better or 20/200 or worse. There were also no statistically significant differences between the 3 groups with respect to graft survival. Patients in group 3 were more likely to have refractive IOL predictability to within 2D of emmetropia than those in group 1 [80.0% vs. 56.1%] and those in group 2 [80.0% vs. 48.0%], but these differences were not statistically significant [P = 0.08, 0.09, respectively]. The performance of either simultaneous or non-simultaneous cataract surgery with penetrating keratoplasty in eyes with Fuchs' dystrophy has no significant effect on visual outcome or graft survival. Cataract surgery performed subsequent to penetrating keratoplasty is associated with a better refractive outcome

Effect of anterior capsular polishing on the incidence of YAG capsulotomy

To study the effect of anterior capsule polishing during phacoemulsification on the incidence of post operative YAG laser capsulotomy. A retrospective controlled study of 159 patients who underwent uncomplicated phacoemulsification with anterior capsular polishing between October 1998 and March 2000. 169 age matched patients who underwent phacoemulsification but without anterior capsule polishing served as controls. Incidence of visually significant YAG capsulotomy, which improved the Snellen acuity for more than 1 line or at least 1 line with subjective improvements in symptoms. 2.51% of patients with anterior capsular polishing [Group 1] had YAG capsulotomy compared to 7.1% of patients in control group at one year. However, after two years, 11.3% of patients in Group I had YAG capsulotomy compared to 12.4% in Group 2. Anterior capsular polishing during cataract surgery may delay the opacification of posterior capsule during the early postoperative period. But does not decrease the incidence of YAG capsulotomy after two years

Peribulbar anesthesia for intraocular surgery comparison between three anesthetic solutions; evaluating anesthetic efficacy and ocular movements

Forty five adult patients, ASA I - III, scheduled for cataract using single medial canthus peribulbar anesthesia were randomly allocated into 3 group, group I received the standard local anesthesia mixture with no hyaluronidase, group II received standard local anesthetic mixture with hyaluronidase 15 IU/ ml and vecronium bromide 1 mg and group III received standard local anesthetic mixture containing hyaluronidase 150 IU/ ml. Patients were assessed for ocular and eyelid movement using Brahma scoring at 1,5 and 10 minutes after injection, on completion of surgery and before the discharge from day surgery unit. If after 5 minutes there was still full movement in any direction or total score of 6 or greater, supplementary anesthesia was applied via inferiolateral route with, 3-5 ml of the test solution. If after 10 minutes, the block was still inadequate, a further infenolateral injection was performed. The need for supplementary anesthesia and total volume of local anesthetic mixture were recorded. There were no statistical differences between the 3 groups as regards the demographic data. The median ocular movement scoring was significantly reduced at 5 minutes in group II and III compared to group I [P <0.05]. No statistical difference in median ocular movement score at 1, 10 minutes and at the end of surgery was found between the groups. Median eyelid movement scoring was reduced significantly at 1 and 5 minutes in group II and III compared to group I [P <0.05]. No statislical difference between the 3 groups found as regards the ocular movement scoring before the discharge from day surgery unit. The number of the patients who received supplementary anesthesia were significantly, reduced in group II and III [5 and 3] compared to group I [8 patients]. The total volume of local anesthetic mixture was significantly lower in group II and III compared to group I [P < 0.05]. There was no difference between the 3 groups as regards the visual acuity at the start of surgery or before discharge. We concluded from the study that the addition of neuromuscular blocking agent vecronium bromide 1 mg to standard local anesthetic mixture with hyaluronidase 15 IU/ ml as recommended by British National Formulary improved global akinesia and operative condition with no side effects and without too much increase in the concentration of hyaluronidase in adult patients undergoing cataract surgery using single medial canthus peribulbar anesthesia

[Intraoperative and postoperative complications of posterior vitrectomy for diabetic retinopathy]

In spite of good results of posterior vitrectomy for the treatment of complications of diabetic retinopathy, there is a relatively high incidence of intraoperative and postoperative complications. This study aimed to determine the intraoperative and postoperative complications of posterior vitrectomy in diabetic patients with very advanced cases of diabetic retinopathy and the factors influencing them. Sixty seven eyes of 61 diabetic patients were treated pars plana vitrectomy either for severe vitreous hemorrhage with no retinal detachment threatening the macula in 34 [50.7%] eyes or for retinal detachment threatening macula or involving it with or without vitreous hemorrhage in 33 [49.3%] eyes. All patients were observed for 6 months after surgery. Iatrogenic retinal holes were recorded in 31eyes [46.26%] and retinal dialysis in 7 eyes [10.4%]. The retina could not be reattached during surgery in 3 eyes [5.7%] with preoperative retinal detachment. After surgery, a persistent epithelial defect was seen in 14 eyes [20.9%]. Cataract developed in 10/27 phakic eyes [37%]. Reproliferation of retinal fibrovascular tissue was observed in 3 eyes [4.4%] and anterior fibrovascular reproliferation with resultant phthisis bulbi occurred in 5 eyes [7.46%]. postoperative retnal deteachment not involving the macula was observed in 5 eyes [7.46%] and involving the macula in one eye. recurrent vitreous hemorrhage occurred in 4 eyes [6%] iris neovascularization in 7 eyes [10.4%] and elevated IOP in 5 eyes the incidence of intraoperative and postoperative complications of posterior vitrectomy in diabetic patients increased when the fibrovascular tissue on the retina is occupying a large space and is firmly attached to the restinal surface as this increases the incidence of iatrogenic retinal holes and the following need for intraocular tamponade. the need for intraocular tamponade leads to higher rate of cataract formation in phakic eyes. the occurrence of iatrogenic retinal predisposes to postoperative retinal detechment

[Congenital cataract with pre-existing posterior capsule defect]

To evaluate the diagnostic signs, intraoperative complications and postoperative outcomes in children with congenital cataract and pre-existing posterior capsule defect [PPCD]. This interventional case series was conducted on 14 eyes of 7 patients who underwent lensectomy-anterior vitrectomy for congenital cataract with PPCD. All children had bilateral cataract. Preoperative diagnostic sign of PPCD detected under maximum pupil dilation in patients without a mature cataract included a well-demarcated horizontal oval defect with white margin and scattered white dots around the defect. The greatest lens opacity was over the defect itself. In patients with mature cataract, PPCD was diagnosed during operation. Bimanual irrigation/aspiration and 2-port anterior vitrectomy was performed in all cases. The patients included in 2 girls and 5 boys with mean age of 11.4 +/- 4.1 month. PPCD was diagnosed preoperatively in 5 patients [10 eyes] and intraoperatinely in 2 patients [4 eyes]. Intraocular lens was implanted in 2 eyes of one patient and 12 eyes were left aphakic. Except for nucleus dislocation into the anterior vitreous in our first case which was successfully removed, no other intraoperative complication occurred. During a mean follow up of 21.1 +/- 7.1 month [18-36 month] the visual axis remained clear in all the eyes. Establishing the diagnosis of PPCD preoperatively with fully dilated pupil and careful surgical planning prevents intraoperative complications and produces satisfactory technical results