Effectiveness and tolerance of piroxicam 0.5% and diclofenac sodium 0.1% in controlling inflammation after cataract surgery.

PURPOSE: To compare the efficacy and tolerance of piroxicam 0.5% ophthalmic solution and diclofenac sodium 0.1% ophthalmic solution in controlling inflammation after phacoemulsification and intraocular lens (IOL) implantation. SETTING: Ophthalmological Department, San Donà di Piave Hospital, Venice, Italy. MATERIALS AND METHODS: Forty consecutive patients--18 men and 22 women--between 55 and 85 years of age (mean age, 75.1 +/- 7.12 years) who were scheduled for cataract extraction with phacoemulsification and IOL implantation were randomized to receive 0.5% piroxicam ophthalmic solution (piroxicam group, 20 patients) or 0.1% diclofenac sodium ophthalmic solution (diclofenac group, 20 patients) for 1 month postoperatively. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) measurements and slit-lamp biomicroscopy for the evaluation of corneal edema, Descemet membrane folds, Tyndall, and cells in the anterior chamber were carried out in all patients 1 day, 4 days, and 1 month postoperatively. Subjective symptoms after the nonsteroidal anti-inflammatory drug (NSAID) ophthalmic solution instillation were assessed using a questionnaire. RESULTS: There were no significant differences between the two groups in postoperative IOP, BCVA, anterior chamber flare and cell levels, corneal edema, or Descemet membrane folds. Ocular discomfort, evaluated as burning or stinging sensation after NSAID ophthalmic solution instillation, was significantly more frequent and intense in the diclofenac-treated eyes. Two eyes in the diclofenac group had a mild transient punctate keratitis. CONCLUSIONS: These results suggest that piroxicam is as effective as diclofenac sodium in preventing inflammation after cataract surgery with IOL implantation, and its better tolerance and safety can provide higher patient compliance.

Implantation of a black diaphragm intraocular lens in ten cases of post-traumatic aniridia.

PURPOSE: To retrospectively review the safety and efficacy of black-diaphragm intraocular lenses (IOL) implanted for the treatment of post-traumatic aniridia. METHODS: Ten patients (mean age 48 years, range 21-75) were implanted with a black-diaphragm posterior chamber IOL (Morcher GmbH, model 67F) for correction of post-traumatic aniridia associated with cataract or aphakia. This IOL, in poly(methylmethacrylate), consists of an opaque diaphragm surrounding the transparent optic, and was inserted through a 10-mm scleral tunnel (seven eyes) or through the corneal trephination in cases of simultaneous penetrating keratoplasty (three eyes), and in-the-sulcus implanted, trans-sclerally sutured (six eyes) or on capsular support (four eyes). Mean follow-up was 33.4 months (range 12-52). RESULTS: Best-corrected visual acuity (BCVA) improved in eight eyes and remained unchanged in two. Glare and photophobia decreased in all patients. Intraoperatively, ciliary sulcus bleeding occurred in two cases and haptic rupture during lens insertion in one. Postoperatively, persistent intraocular inflammation was seen in four eyes, secondary glaucoma in four eyes, transient hyphema and/or hemovitreous in four, IOL decentration in two, and post-traumatic haptic detachment in one eye. CONCLUSIONS: Although in our experience the haptics still seem weak and the diaphragm diameter too large, implantation of the black-diaphragm IOL type 67F appeared sufficiently safe and provided satisfactory functional results for correction of post-traumatic aniridia combined with cataract or aphakia, improving BCVA and reducing glare and photophobia in most patients, though clearly more cases and longer follow-up are needed to assess its clinical performance properly.

Posterior capsule opacification and Nd:YAG capsulotomy rates after implantation of silicone, hydrogel and soft acrylic intraocular lenses: a two-year follow-up study.

PURPOSE: To compare the posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) laser posterior capsulotomy rates associated with three different posterior chamber foldable intraocular lenses (IOL). METHODS: We retrospectively evaluated the rates of PCO and Nd:YAG laser capsulotomy in 1150 eyes two years after standard phacoemulsification with a no-stitch 3.5mm clear corneal incision (CCI) and in-the-bag implantation of one of three types of IOL: 190 eyes received a one-piece round-edged hydrogel IOL (Hydroview H60M, Bausch & Lomb); 475 eyes a three-piece round-edged silicone IOL (AMO PhacoFlex SI-40NB, Allergan); 485 eyes a three-piece square-edged soft acrylic lens (AcrySof MA60MA, Alcon). RESULTS: The PCO and Nd:YAG laser capsulotomy rates were respectively 43.15% and 20.5% in the Hydroview H60M group, 27.57% and 9.68% in the AMO PhacoFlex SI-40NB group, 10.5% and 2.47% in the AcrySof MA60MA group. CONCLUSIONS: PCO and Nd:YAG laser capsulotomy rates were significantly higher in the Hydroview H60M group and significantly lower with the AcrySof MA60MA lenses, which combine a bioactive constitutive material with the square-edged optic design.

Original three-point fixation technique for sutured posterior chamber intraocular lens.

PURPOSE AND METHODS: In order to avoid the complications associated with posterior chamber intraocular lens (IOL) scleral fixation, the authors have developed an original surgical technique by which the IOL is secured at the ciliary sulcus by suturing the haptics to the sclera in three points (at the 3, 5 and 9 o'clock positions). This technique was utilized for secondary IOL implantation in 21 aphakic eyes. The mean follow-up was 18 months, range 6-28 months. RESULTS: All eyes that underwent secondary implants had equal or better visual acuity postoperatively; none developed serious intra- or postoperative complications. No tilt or decentration of the IOL was observed postoperatively. DISCUSSION: The technique described appeared easy to perform and produced good visual outcomes with stable transscleral fixation of the IOL.