ABSTRACT
The indications for penetrating keratoplasty have changed over the past several years. Nine hundred ninety-nine penetrating keratoplasty specimens from 1981 through 1990 were analyzed. Overall, keratoconus was the most common indication for penetrating keratoplasty (24.2%). This was followed by pseudophakic bullous keratopathy (23.0%), regraft (13.1%), scarring (8.2%), and Fuchs' endothelial dystrophy (5.8%). Pseudophakic bullous keratopathy was the most common indication for penetrating keratoplasty in each year from 1984 through 1989 with a peak in 1987 (33%). Since 1987, the number of pseudophakic bullous keratopathy cases has decreased; and in 1990, keratoconus (33.1%) surpassed pseudophakic bullous keratopathy (24.1%) as the most common indication for penetrating keratoplasty. This decreasing incidence of pseudophakic bullous keratopathy may reflect the discontinued use of closed-looped anterior chamber and iris-plane intraocular lenses most commonly associated with this complication.
Subject(s)
Corneal Diseases/surgery , Keratoplasty, Penetrating/trends , Cataract Extraction , Corneal Diseases/epidemiology , Humans , Incidence , Lenses, Intraocular , Utah/epidemiologyABSTRACT
Historically, extracapsular cataract extraction (ECCE) has been shown to cause less endothelial cell loss than phacoemulsification. To further evaluate endothelial cell loss following phacoemulsification, we prospectively studied 60 patients who underwent cataract extraction with "in situ" phacoemulsification within the capsular bag following a continuous-tear circular capsulotomy, with placement of a posterior chamber intraocular lens (PC-IOL) in the capsular bag. All procedures were performed by a single senior ophthalmology resident. The average preoperative endothelial count was 2318 +/- 36 cells/mm2; the average postoperative count (at 8.5 weeks) was 2167 +/- 41 cells/mm2. The average endothelial cell loss, then, was 6.4 +/- 1.2%. This level of cell loss with a capsular-bag-fixed PC-IOL is comparable to that reported for ECCE.
Subject(s)
Cataract Extraction/adverse effects , Endothelium, Corneal/pathology , Aged , Cataract Extraction/methods , Cell Count , Corneal Diseases/etiology , Follow-Up Studies , Humans , Internship and Residency , Lenses, Intraocular/adverse effects , Middle Aged , Prospective Studies , Treatment Outcome , Visual AcuityABSTRACT
Five of 16 patients who had uncomplicated cataract extraction with intraocular lens (IOL) implantation within a 2.5 day period experienced increased anterior segment inflammation on their first postoperative day. Four of these five patients had phacoemulsification and one a planned extracapsular cataract extraction. All had posterior chamber IOL implantation in the capsular bag. In all patients, this anterior segment inflammation cleared with topical steroids over two to three weeks with no evident residual ocular effects. A careful search for the possible cause of the inflammation showed that the ultrasonic cleaning bath and Weck liquid detergent used to clean the instruments contained Klebsiella pneumoniae bacteria. Further investigation demonstrated the presence of a heat-stable endotoxin produced by the bacteria. We postulate that endotoxin remaining on the instruments after cleaning and sterilization caused this postoperative anterior segment inflammation. To the best of our knowledge, these are the first reported cases caused by contaminated liquid detergent.
Subject(s)
Cataract Extraction , Endophthalmitis/microbiology , Equipment Contamination , Eye Infections, Bacterial/etiology , Klebsiella Infections/etiology , Klebsiella pneumoniae/isolation & purification , Aged , Aged, 80 and over , Detergents , Disinfectants , Female , Humans , Lenses, Intraocular , Male , Retrospective StudiesABSTRACT
Phacoemulsification combined with pars plana vitrectomy was performed on seven patients with both cataracts and vitreoretinal disease. Six of the seven had a posterior chamber intraocular lens (PC-IOL) placed in the capsular bag following cataract extraction. Visual acuities ranging from light perception to hand movement preoperatively, postoperatively ranged from hand movement to 20/25. There were no perioperative complications. During an average follow-up of more than 6 months, neovascular glaucoma developed in one patient, and a conjunctival cyst in another. The PC-IOLs were well tolerated. The small limbal incision used in phacoemulsification allows better control during the vitrectomy procedure and ensures a water-tight wound. In addition, with the limbal approach, the posterior lens capsule is maintained, with all the attendant advantages.
