ABSTRACT
We evaluated postoperative keratometric astigmatism in 80 eyes that had phacoemulsification and intraocular lens implantation through sutureless corneal incisions. The eyes were separated into two groups based on the use of rigid ovoid or foldable silicone lenses inserted through 5.1 mm corneal lip incisions or 3.5 mm lip incisions, respectively. In the early postoperative period (one to three months), vector analysis showed less induced astigmatism in the 3.5 mm group than in the 5.1 mm group. Uncorrected visual acuity during the postoperative period was also better in the smaller incision group.
Subject(s)
Astigmatism/etiology , Cataract Extraction/adverse effects , Suture Techniques , Adult , Cataract Extraction/methods , Female , Humans , Lenses, Intraocular , Male , Middle Aged , Silicone Elastomers , Visual Acuity , Wound HealingABSTRACT
We report two cases in which hydrogel lens implants have dislocated posteriorly into the vitreous body following YAG laser capsulotomy. These lenses were placed in the bag in conjunction with a capsulorhexis. A comparison with our results using silicone and poly(methyl methacrylate) implants indicates that this phenomenon has occurred only with hydrogel implants. Analysis of the various parameters associated with the laser capsulotomy procedure suggests that the overall length and design of the hydrogel implants were key factors. Because of the severity of this complication, we have discontinued the use of this type of implant.
Subject(s)
Laser Therapy/adverse effects , Lens Capsule, Crystalline/surgery , Lenses, Intraocular , Vitreous Body , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Methylmethacrylates , Middle Aged , Prosthesis Design , Prosthesis Failure , Silicone ElastomersABSTRACT
In recent years bimanual phacoemulsification has become an increasingly popular method of cataract extraction. We describe a new spatula designed to manipulate and protect the posterior capsule safely during phacoemulsification. In addition, this spatula can be used to facilitate irrigation/aspiration.
Subject(s)
Cataract Extraction/instrumentation , Drainage , Equipment Design , Humans , Therapeutic IrrigationABSTRACT
Initial clinical studies with 117 silicone implants are presented. Techniques of implantation including flat insertion, bar-style folder, and syringe-style inserter are discussed. Visual results were compared with results after polymethylmethacrylate (PMMA) lens implantation and were equal if not better. Eliminating patients with preoperative pathology, best corrected visual results of 20/40 or better occurred in 96% of eyes with silicone implants and 88% with PMMA implants. Complications included "Z" dislocations because of inadvertent haptic placement in the bag and one case of severe uveitis and common transient pigment in the anterior chamber. In 37.5% of cases, posterior capsular opacities significant enough to require YAG laser capsulotomy occurred.
Subject(s)
Lenses, Intraocular , Silicones , Endophthalmitis/etiology , Evaluation Studies as Topic , Fluorescein Angiography , Humans , Lenses, Intraocular/adverse effects , Macular Edema/etiology , Macular Edema/pathology , Methylmethacrylates , Vision, OcularABSTRACT
This study is a comparison of endothelial cell loss seen by two surgeons using the same surgical technique (posterior chamber phacoemulsification) with posterior chamber implants of two different materials (silicone and polymethylmethacrylate [PMMA]). One hundred four silicone lenses were implanted following phacoemulsification and compared with 160 PMMA lenses implanted during the same period. A significant feature of these procedures was the incidence of endothelial cell loss of greater than 1,200 cells/mm2. This occurred in 12.0% of cases with PMMA implants and in 15.4% of cases with silicone implants. When silicone implants were analyzed by insertion technique, flat insertion had only 7.7% cell loss of over 1,200 cells/mm2 whereas folding-bar insertion (14.3%) and syringe-style insertion (16.9%) showed a significant increase in the incidence of cell loss. Pachymetric results coincided with endothelial cell counts. Although silicone implants inserted flat produced less endothelial cell loss than PMMA implants inserted flat, silicone implants inserted folded produced greater loss. Improved insertion techniques should be developed.
Subject(s)
Cataract Extraction/adverse effects , Endothelium, Corneal/pathology , Lenses, Intraocular/adverse effects , Methylmethacrylates , Silicones , Ultrasonic Therapy/adverse effects , Adult , Aged , Aged, 80 and over , Cell Count , Humans , Middle AgedABSTRACT
The clinical experience of two surgeons performing Nd:YAG laser anterior vitreolysis to disrupt vitreous strands adherent to surgical wounds with and without pupillary distortions and/or cystoid macular edema is presented. We describe our technique. The results indicate that vision improved in 50% of the cases, with visual acuity improving from 20/40 or better in three of 20 eyes preoperatively to 11 of 20 eyes postoperatively. No adverse effects or complications occurred in any of our 20 patients. Neodymium:YAG laser vitreolysis should be considered presently as the method of choice for initial treatment of vitreous strands incarcerated in the wound.
Subject(s)
Anterior Eye Segment/surgery , Laser Therapy , Vitreous Body/surgery , Humans , Macular Edema/surgeryABSTRACT
Corneal endothelial cell loss is compared in four types of cataract procedures with intraocular lens implants performed by the authors. A total of 110 intracapsular cataract extractions, 182 extracapsular cataract extractions and 107 phacoemulsifications, divided into 47 anterior chamber emulsifications and 60 posterior chamber emulsifications (all with intraocular lens implants) are compared. A significant feature of these procedures is the incidence of endothelial cell loss greater than 1,200 cells/mm2. This occurred in 1% of the intracapsular cataract extractions, 4% of the planned extracapsular cataract extractions, 13% of the posterior chamber phacoemulsifications, and 17% of the anterior chamber phacoemulsifications. Pachymetry is a poor method for judging operative corneal endothelial trauma. Based upon the results of this study, it remains to be seen whether the advantages of phacoemulsification mitigate against the increased incidence of significant endothelial cell loss.
Subject(s)
Cataract Extraction/adverse effects , Cornea/pathology , Lenses, Intraocular/adverse effects , Anterior Chamber/surgery , Cataract Extraction/methods , Endothelium/cytology , Humans , Postoperative Complications/pathologyABSTRACT
The clinical experience of two surgeons performing posterior capsulectomies with two fundamental, Q-switched YAG lasers (LASAG and AMO YAG 100) is presented. Results with both machines indicate 100% capsulectomy success with less than 100% visual improvement. Complications were minimal and usually transient. Nicking the implant was reduced by using low energy levels and precise focusing and by the surgeon's increased facility with the machine. Comparative features of each machine are discussed.
