Five year study of astigmatic stability after cataract surgery with intraocular lens implantation: comparison of wound sizes.

PURPOSE: To assess the long-term stability of cataract wounds of various lengths. SETTING: Private practice. METHODS: This retrospective study comprised 5 groups of consecutive cataract surgery cases and 1 control group with similar mean ages and wound lengths of 10.0, 6.0, 4.0, 2.0, and 0 (control) mm. Except for the 4.0 mm cases, follow-up was 5 years, with few patients lost during that time. Cases within each group had the same wound position, configuration, and suturing. Refractive data, controlled by keratometry, were collected and analyzed preoperatively and 1 day, 1 and 6 weeks, 3 and 6 months, and 1, 2, 3, 4, and 5 years postoperatively. No sutures were cut. RESULTS: With long-term follow-up, there was a progressive against-the-rule shift in astigmatism. Smaller wounds showed less immediate induced astigmatism. However, except for the unsutured 2.0 mm iridectomy wounds and the control group, all shifted similarly. Data were not available for the 4.0 mm wounds beyond 1 year. CONCLUSION: Wounds were not necessarily "stable" at 6 months. Larger wounds continued to shift years after surgery. Smaller wounds have significant postoperative advantages, but absolute long-term refractive stability may not be one.

Astigmatism after cataract surgery: nylon versus Mersilene. Five-year data.

This is a follow-up of a previous study that evaluated astigmatism after cataract surgery. In that study with a six-month follow-up, there was no statistically significant difference in astigmatism between eyes with nylon sutures and those with polyester fiber (Mersilene) sutures. This article reports the five-year data on this series of eyes.

Green cataract.

BACKGROUND: The term "green cataract" appears in the literature of the 16th century and at the same time it was mentioned that couching a green cataract would not restore the vision. PATIENTS: The cases of a 54-year-old women and a 74-year-old man with green cataract and the diagnosis of vitreous hemorrhage and end stage rubeosis iridis with absolute glaucoma and no light perception is recorded. In the second case an enucleation was performed. An iron stain of the lens revealed heavy accumulation of iron in the lens epithelium. CONCLUSION: Green cataract is a distinct entity. It is due to the presence of blood pigments from the breakdown of intraocular hemorrhage. It is usually accompanied by rubeosis irides and an absolute glaucoma. The observation, that surgery of these cataracts will not restore light, is also correct.

YAG laser demonstration of the anatomy of the lens nucleus.

I used YAG laser energy to demonstrate the position and surface of the core of the lens nucleus and to prove the existence of the radial structure of the lens nucleus. Not only does hydrodissection of the epinuclear layers from the nuclear core demonstrate the existence of an anatomical substrate, but also radial fracturing of the nucleus both in phacoemulsification and planned extracapsular surgery can make use of these anatomical features to achieve smaller incisions and thereby smaller wounds.

Evaluating postoperative cataract patients using the Kowa Flare Cell Meter.

The estimation of flare and cell in the anterior chamber is an important part of the postoperative care of patients who have had cataract surgery. The Kowa Flare Cell Meter uses a laser beam for a probe of light, lines it up precisely in a specially modified slit lamp, and controls and measures the results with a computer. The Kowa Flow Cell Meter incorporates a computer for input of demographics and a screen display and printer for output of the results. The anterior chamber findings are displayed both numerically and graphically.

Management of postoperative inflammation: dexamethasone versus flurbiprofen, a quantitative study using the new Flare Cell Meter.

A consecutive, random, prospective study was conducted to compare the effect of topical dexamethasone and flurbiprofen drops on postoperative inflammation in patients undergoing extracapsular cataract extraction with lens implantation. Objective, quantitative measurements were made postoperatively, using the Kowa FC-1000 Flare Cell Meter. The two treatments were equally effective.

Astigmatism after cataract surgery: nylon versus Mersilene.

To find out if postoperative astigmatism decays less if Mersilene rather than nylon sutures are used, 25 patients had a standard wound closure with 10-0 nylon in one eye and 11-0 Mersilene in the other. There was no difference in the astigmatism decay over a 6-month period.

The determination of lens implant power.

This article reviews published formulas for intraocular lens power determination. In the author's opinion, lack of agreement as to which formula is the most accurate is because none of them reduce the fundamental (biological) problem of variation (scatter, or standard deviation) of results. Suggestions are made for wise use.

An anatomic study of retrobulbar needle path length.

One hundred twenty human orbits were measured to determine orbital depth and the position of orbital structures in relation to the length of needles used for retrobulbar anesthesia. The distance from the inferior temporal orbital rim to the nasal entrance of the optic foramen ranged from 42 to 54 mm. Taking into account the size of the optic nerve, the common 38-mm (1.5-in) retrobulbar needle could perforate the optic nerve where it is fixed in front of the foramen in over 11% of the population. The authors recommend that needles be placed less than 31 mm (1.25 in) behind the orbital rim for both retro- and peribulbar anesthesia.

Ocufen and pupillary dilation during cataract surgery.

A random, masked prospective study was performed on 100 patients having elective extracapsular cataract extraction to evaluate the ability of Ocufen (flurbiprofen) to maintain dilation of the pupil. All the patients received a standard dilating regimen; half also received Ocufen drops. Surgery was recorded with a video camera attached to the operating microscope. Magnification was kept constant. Pupil diameters were measured on a calibrated video screen at four different stages of the operation: at the beginning, post-capsulotomy, post-nucleus delivery, and at the end. The age, sex, and iris color of each patient were recorded. Preoperative pupillary diameters were not statistically different between the control and Ocufen groups. The Ocufen-treated group maintained pupillary dilation better on the average and had a much smaller incidence of pupil constriction greater than 2 mm.

Astigmatism shift after extracapsular surgery: Mersilene versus nylon.

Mersilene sutures are said to produce a more stable wound postoperatively than nylon. To test this 25 patients had a standard wound closure with 10-0 nylon in one eye and with 11-0 Mersilene in the other. There was no difference in the astigmatism decay over a six month period.

Practical contrast sensitivity acuity testing.

A 2.0 neutral density (1% transmission) filter allows an easy, consistent and natural way of checking visual acuity on a low contrast Snellen test chart, and is particularly useful in documenting poor visual function in patients with certain types of cataract.