Increased intraocular pressure and corneal endothelial cell loss following phacoemulsification surgery.

BACKGROUND AND OBJECTIVE: To compare the influence of low-molecular-weight viscoelastics on postoperative intraocular pressure (IOP) and corneal endothelial cell loss after phacoemulsification PATIENTS AND METHODS: Sixty-nine eyes undergoing phacoemulsification surgery were randomized to have either Opegan (Santen Pharmaceuticals, Osaka, Japan) alone or the soft-shell technique using Viscoat (Alcon Surgical, Fort Worth, TX) during phacoemulsification. The IOP was measured preoperatively and at 5 and 24 hours postoperatively. Intraoperative factors and corneal endothelial cell loss were also examined. RESULTS: Mean IOP was increased at 5 hours after surgery but returned to preoperative levels at 24 hours in the Opegan group, whereas it remained higher at 24 hours than at preoperative levels in the soft-shell group. When comparing groups, IOP at 5 and 24 hours postoperatively in the Opegan group was significantly less than that in the soft-shell group. Corneal endothelial cell loss was approximately the same in the two groups. CONCLUSION: The increase in IOP following phacoemulsification surgery with the use of Opegan was less than that with the soft-shell technique using Viscoat, although endothelial injury was almost the same.

Phacoemulsification and intraocular lens implantation for angle closure glaucoma after the relief of pupillary block.

PURPOSE: We studied the surgical outcomes of phacoemulsification and intraocular lens (IOL) implantation for cataract and/or uncontrolled intraocular pressure (IOP) in eyes with angle closure glaucoma. SETTING: Department of Ophthalmology, National Nagasaki Medical Center, Nagasaki, Japan. METHODS: Eighteen eyes from 15 patients after laser iridotomy (17 eyes) or peripheral iridectomy (1 eye) had undergone surgery and were studied. We used an iris retractor in 7 eyes due to insufficient mydriasis and a capsular tension ring in 2 eyes due to phacodonesis during the operation. The patients were followed up for at least 6 months (13.8 +/- 7.2 months; range: 6-36 months). RESULTS: The mean IOP significantly decreased from 17.4 +/- 8.1 to 13.5 +/- 3.3 mm Hg at 6 months after surgery. The IOP was below 21 mm Hg in all eyes. The visual acuity was not worsened in any eyes and became better than 2 Snellen lines in 14 eyes. The corneal endothelial cell count decreased from 2,365 +/- 517 to 1,960 +/- 661/mm2 (18.3 +/- 17.2%). CONCLUSIONS: Phacoemulsification and IOL implantation is useful in IOP control for angle closure glaucoma after relief of pupillary block. However, we should take care of operative complications because of a shallow anterior chamber, poor mydriasis and zonular weakness.

Phacoemulsification and intraocular lens implantation combined with trabeculotomy for open-angle glaucoma and coexisting cataract.

OBJECTIVE: To study the outcome of phacoemulsification and intraocular lens implantation combined with trabeculotomy. METHODS: We performed trabeculotomy combined with phacoemulsification and foldable lens implantation in 25 eyes with open-angle glaucoma and coexisting cataract in 18 patients. The series comprised 9 males (13 eyes) and 9 females (12 eyes). Mean age of the patients was 73.4 +/- 10.9 years (45-87 years). Mean follow-up period was 14.3 +/- 6.0 months (6-24 months). RESULTS: The preoperative intraocular pressure was 21.4 +/- 3.7 mm Hg. The postoperative intraocular pressure 6 months after the surgery was 12.8 +/- 3.4 mm Hg. A postoperative tension spike (>30 mm Hg) was observed in 2 eyes. Six months after the operation, the intraocular pressure was controlled under 21 mm Hg in all eyes, and under 16 mm Hg in 18 eyes. The medication score (one point per antiglaucomatous medication) was 2.0 +/- 1.6 before the surgery and 0.4 +/- 0.7 after the surgery. The mean refractive error after the operation was -0.8 +/- 0.7 D (range -2.4 to 0 D). The deviation of the actual refractive error from the predicted one was +0.29 +/- 0.54 D (range -0.52 to +1.10 D). CONCLUSION: The outcome of the combined operation for open-angle glaucoma and coexisting cataract was promising.