Intraoperative performance and long-term postoperative outcomes after scleral fixation of IOLs with polytetrafluoroethylene suture.

PURPOSE: To report intraoperative performance and long-term postoperative outcomes after scleral fixation of intraocular lenses (IOLs) with polytetrafluoroethylene suture (PTFE). SETTING: Raghudeep Eye Hospital, Ahmedabad, India. DESIGN: Prospective, interventional case series. METHODS: One hundred eyes undergoing scleral fixation of IOLs using PTFE suture (Gore-Tex) with 12 months or more postoperative follow-up were included. The primary outcome measures were occurrence of intraoperative and postoperative complications such as glaucoma, suture-related complications, and inflammation within the follow-up period. The secondary outcome measure was improvement in visual acuity (VA). RESULTS: Of the 100 eyes, posteriorly dislocated IOLs (53 eyes) followed by dropped nuclei (33 eyes) were the most common surgical indications. Mean follow-up was 23 months (range 12 months to 5 years). Seventy-one patients (77.17%) had 18 months or more follow-up; 21 eyes had a rise in intraocular pressure in the early postoperative period; 12 of them required glaucoma surgery. Early complications were vitreous hemorrhage in 13 eyes, retinal detachment in 6 eyes, and transient hyphema in 1 eye. Late postoperative complications were cystoid macular edema (9 eyes), epiretinal membrane (3 eyes), and bullous keratopathy (3 eyes). Mean VA improved from 0.92 ± 0.16 (SD) logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.41 ± 0.27 logMAR. LogMAR at final follow-up was 0.41 ± 0.28 (P < .01). There were no cases of suture-related complications (erosion/breakage/granuloma) or IOL decentration throughout the follow-up period. CONCLUSIONS: Scleral fixation of IOLs with PTFE suture was found to be safe and well tolerated. All eyes had well-centered IOLs, with no suture-related complications during long-term follow-up. VA improved significantly with acceptable postoperative complications.

Visual outcomes after toric intraocular lens implantation in pediatric eyes undergoing cataract surgery.

PURPOSE: To evaluate long-term visual outcomes and complications after toric intraocular lens (IOL) implantation in children with preexisting corneal astigmatism undergoing cataract surgery. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. DESIGN: Prospective, interventional case series. METHODS: Children with regular corneal astigmatism of at least 1.5 diopters (D) were included. A standardized surgical technique with in-the-bag implantation of a toric IOL was performed. All children were followed up on postoperative day 1 and periodically thereafter, until 36 months postoperatively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive astigmatism were documented 36 months postoperatively. Rotational stability of toric IOL was also evaluated through the follow-up duration. Complications, particularly visual axis obscuration (VAO) and glaucoma, were documented. RESULTS: In total, 76 eyes (51 children) were included in the study. Mean age at surgery was 7.41 ± 2.82 years (SD) and mean preoperative keratometric astigmatism was 1.56 ± 2.13 D. The CDVA (logarithm of the minimum angle of resolution [logMAR]) improved significantly from 0.59 ± 0.43 preoperatively to 0.23 ± 0.27 36 months postoperatively (P = .03). Mean postoperative UDVA was 0.32 ± 0.26 logMAR. Mean refractive astigmatism at final follow-up was -0.55 ± 0.40 D, with 74% patients having a UDVA of at least 20/40; 5% of eyes needed VAO treatment and none developed glaucoma. No eye required repositioning of toric IOL until final follow-up. CONCLUSIONS: Toric IOL implantation reduced postoperative refractive astigmatism and gave excellent UDVA at 36 months follow-up in pediatric eyes undergoing nontraumatic cataract surgery.

Evaluation of collagen derived antiangiogenic factors and matrix metalloproteinases in anterior lens epithelial cells of pediatric eyes with persistent fetal vasculature.

Purpose: To measure levels of collagen-derived antiangiogenic factors (arresten, canstatin, tumstatin, endostatin) and matrix metalloproteinases (MMP-2 and MMP-9) in anterior lens epithelial cells (LECs) and anterior capsules of children with cataract and persistent fetal vasculature (PFV) as cases and cataract without PFV as controls. Methods: Anterior capsules harboring LECs were collected from pediatric cataract patients with (n = 13) and without PFV (n = 13) during surgery. Samples were immediately subjected to RNA extraction and cDNA preparation. Quantitative real time PCR was performed to determine the mRNA levels of antiangiogenic factors and matrix metalloproteinases. GAPDH (Glyceraldehyde 3-Phosphate Dehydrogenase) and ß Actin were used as the housekeeping control. The mRNA levels were expressed as a ratio, using the delta-delta method for comparing the relative expression results between controls and cases. The non-parametric Mann-Whitney U test was applied for statistical evaluation. P values < 0.05 were statistically significant. Results: The relative mRNA levels of arresten, canstatin, tumstatin, endostatin, MMP-2 and MMP-9 in cases were 6.20E-03 ± 0.003, 1.49E-01 ± 0.02, 1.70E-01 ± 0.007, 3.20E-03 ± 0.003, 1.11E-03 ± 0.0009 and 3.72E-04 ± 0.0001. The mRNA levels of arresten was 1.6 times lower (P = 0.01) while mRNA levels of MMP-2, tumstatin and canstatin were 4, 2.5, and 2.3 times higher in cases than in controls. No change was observed in mRNA levels of MMP-9 and endostatin (P = 0.82). Conclusion: A significant difference in the levels of arresten, canstatin, tumstatin, and MMP-2 was found in LECs with PFV.

Incorporating Optical Coherence Tomography in the Cataract Preoperative Armamentarium: Additional Need or Additional Burden?

PURPOSE: To determine the usefulness of preoperative optical coherence tomography (OCT) examination to detect asymptomatic macular abnormalities in patients scheduled for cataract surgery. METHODS: Design: Prospective, interventional case series. SETTING: Iladevi Cataract and Visakha Eye Center, Ahmedabad, India. STUDY POPULATION: Patients undergoing cataract surgery and intraocular lens (IOL) implantation for senile cataracts. Preoperatively no retinal/macular pathology was identified on clinical evaluation. INTERVENTION: All eyes underwent macular 5-line raster evaluation using spectral-domain OCT before and after cataract surgery (monthly for 3 months). Central subfield thickness (CST) analysis was done. OUTCOME MEASURES: The primary outcome measure was determining the incidence of asymptomatic retinal lesions on OCT examination in clinically "normal" maculas. Secondary outcome measures included documenting change in corrected distance visual acuity and OCT thickness postoperatively. RESULTS: A total of 1444 eyes were evaluated. OCT revealed asymptomatic lesions in 133 (9.21%) patients. At 3 months, all eyes showed significant median visual improvement (from 0.45 ± 0.13 logMAR to 0.06 ± 0.08 logMAR; P = .015) and insignificant median CST change (from 223.34 ± 21.1 µm to 249.12 ± 19.24 µm; P = .19). One eye showed increased vitreomacular traction (3 months). Patients with asymptomatic lesions did not have significantly worse postoperative visual outcomes at 3 months (from 0.52 ± 0.16 logMAR to 0.14 ± 0.1 logMAR; P = .12). CONCLUSION: A total of 9.21% patients with clinically normal maculas had subtle pathology detected on OCT, but this subset of patients did not have worse postoperative visual outcomes compared to eyes with normal OCT scans. Thus, a careful pre-cataract surgery fundus examination remains an essential part of the presurgical patient evaluation.

Comparison of ocular wavefront aberrations in subluxated lenses before and after lens extraction with intraocular lens implantation.

PURPOSE: To compare the change in ocular higher-order wavefront aberrations (HOAs), visual acuity, and modulation transfer function (MTF) after lens extraction with intraocular lens (IOL) implantation in patients with subluxated lenses. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective case series. METHODS: Eyes with subluxated lenses having lens extraction with IOL implantation were included. Capsular bag fixation with in-the-bag IOL implantation or sutured or sutureless scleral fixation of the IOL was performed. Aberrometry was performed preoperatively and 6 months postoperatively. The following were compared: root-mean-square (RMS) value for total ocular HOAs, coma aberration, spherical aberration, MTF, and corrected distance visual acuity (CDVA). RESULTS: Of the 39 eyes with subluxated lenses, 26 eyes had Cionni ring fixation, 9 had sutured scleral fixation, and 4 had intrascleral fixation of the IOL. The mean preoperative and postoperative values, respectively, were as follows: RMS HOAs, 10.5 µm ± 9.5 (SD) and 4.73 ± 4.6 µm (P < .001); coma aberration, 2.46 ± 2.4 µm and 0.11 ± 0.1 µm (P = .03); and spherical aberration, 0.37 ± 0.9 µm and 0.02 ± 0.06 µm (P = .02). The MTF improved significantly in all eyes (mean 0.05 ± 0.02 preoperatively and 0.32 ± 0.16 postoperatively) (P = .005). The CDVA was statistically significant improved 6 months postoperatively. CONCLUSION: Lens extraction with IOL fixation in eyes with subluxated lenses significantly reduced ocular HOAs and improved the MTF.

A Prospective Evaluation of Posterior Capsule Opacification in Eyes With Posterior Capsule Plaque-A Case-Control Study.

PURPOSE: To compare the development of posterior capsule opacification (PCO) between eyes with and without posterior capsule plaque after single-piece hydrophobic acrylic intraocular lens (IOL) implantation 5 years postoperatively. DESIGN: A prospective observational case-control study. METHODS: One hundred one consecutive eyes with posterior capsule plaque (cases) were compared with the same number of cataractous eyes without posterior capsule plaque (controls). A detailed preoperative evaluation was done to detect the presence of posterior capsule plaque. Histomorphology of posterior capsule plaque was evaluated. Postoperatively, digital retroillumination photographic documentation was performed at 1 month and 1, 2, 3, and 5 years and analyzed for PCO using the Evaluation of Posterior Capsule Opacification (EPCO) software; EPCO scores and areas were calculated. The development of PCO and the influence of the anterior capsule cover (total and partial) on the IOL optic were compared. RESULTS: Posterior capsule plaque on histomorphology showed a large amount of collagenous, fibrous extracellular matrix, and immunofluorescence staining was positive for alpha smooth muscle actin. In the development of PCO, there was no difference between cases and controls at 1 month and 1, 2, 3, and 5 years. Between the 2 groups, there was no difference in the development of PCO within total cover and within partial cover of the anterior capsule on the IOL up to 5 years. CONCLUSIONS: The presence of posterior capsule plaque did not increase the incidence of PCO at 5 years.

Long-term postoperative outcomes after bilateral congenital cataract surgery in eyes with microphthalmos.

PURPOSE: To evaluate the long-term impact of bilateral cataract surgery on postoperative complications, influence of age at surgery on the pattern of axial growth and central corneal thickness (CCT), and visual and orthoptic assessment in microphthalmic eyes. SETTING: Iladevi Cataract and IOL Research Centre, Ahmedabad, India. DESIGN: Prospective longitudinal study. METHODS: This study assessed children with microphthalmos who had bilateral congenital cataract surgery. Microphthalmos was defined as an eye that has an axial length (AL) that was 2 standard deviations smaller than what is normally expected at that age. All eyes were left aphakic. One of the 2 eyes was randomly selected for analysis. Postoperative complications, AL, CCT, and visual acuity were documented. RESULTS: This study included 72 eys of 36 children. The mean age of the patients was 4.8 months ± 6.2 (SD) (range 0.5 to 15 months). Postoperative complications included secondary glaucoma (11/36, 30.6%), visual axis obscuration (4/36, 11.1%), and posterior synechiae (10/36, 27.8%). A significant rate of change was observed in axial growth up to 4 years and in CCT up to 3 years postoperatively. When age at the time of surgery was correlated with the profile of the rate of change in AL and CCT at 1 month and 1, 2, and 4 years, statistically significant differences in AL and CCT at all timepoints were found. Loss of vision after surgery occurred in 2 eyes. CONCLUSION: After early surgical intervention, an acceptable rate of serious postoperative complications and good visual outcomes were obtained in microphthalmic eyes. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

The effect of single-piece hydrophobic acrylic intraocular lenses on the development of posterior capsule opacification.

PURPOSE: To evaluate the long-term effect of a single-piece hydrophobic acrylic intraocular lens (IOL), AcrySof SN60AT (Alcon Laboratories, Fort Worth, Texas, USA), on the development of posterior capsule opacification (PCO) 5 years postoperatively. DESIGN: Prospective, observational, consecutive, case series. METHODS: setting: Iladevi Cataract and IOL Research Center, Ahmedabad, India. STUDY POPULATION: Three hundred and ninety eyes with uncomplicated age-related cataract were included. Patients with diabetes mellitus, glaucoma, high myopia, pseudoexfoliation, traumatic cataract, subluxated cataract, previous ocular surgeries, and allergy to dilating drops were excluded. intervention procedures: Digital retroillumination photographic documentation was performed and analyzed for PCO using Evaluation of Posterior Capsule Opacification software. The scores and areas were calculated. MAIN OUTCOME MEASURES: PCO development and the influence of the anterior capsule cover (total on and part on) on the IOL optic was studied within the capsulorrhexis margin and the central 3.0 mm optic area. RESULTS: There was a significant increase in PCO up to 3 years. No significant change in PCO was observed between 3 and 5 years within the capsulorrhexis margin and central 3.0 mm optic area. In the total on group, within the capsulorrhexis margin, significantly lower scores and areas were observed when compared with part-on scores and areas. CONCLUSION: The increase in PCO up to 3 years was significant. Stabilization in PCO was observed between 3 and 5 years with no difference at 5 years. There was a low incidence of PCO in eyes with total anterior capsule cover over the IOL optic.

Long-term longitudinal assessment of postoperative outcomes after congenital cataract surgery in children with congenital rubella syndrome.

PURPOSE: To assess the intraoperative and long-term longitudinal postoperative outcomes of cataract surgery in children with congenital rubella syndrome. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective observational clinical study. METHODS: Children with congenital rubella syndrome who had cataract surgery were enrolled. All microphthalmic eyes were left aphakic. A 1-piece hydrophobic acrylic intraocular lens was implanted in the capsular bag in eyes without microphthalmos. The postoperative observations included complications and visual assessments up to 5 years. RESULTS: The mean age of the 21 children (37 eyes) was 3.97 months ± 2.1 (SD). Intraocular lens implantation was performed in 12 eyes (32.4%), while 25 eyes (67.6%) were left aphakic. Postoperatively, the median follow-up was 60.79 months. Posterior synechiae were observed in 22 eyes (59.5%) and visual axis opacification in 9 eyes (24.3%). Secondary glaucoma was observed in 16 eyes (43.2%), of which 14 were aphakic and 1 was pseudophakic. Nine eyes required trabeculectomy. Age at surgery and ocular comorbidities were statistically significantly associated with secondary glaucoma (P<.05, χ(2) test and Kendall τB criteria P<.05). The mean corrected distance visual acuity at the final follow-up was 0.72 ± 0.56 logMAR. CONCLUSIONS: The long-term results suggest good visual outcomes can be obtained with congenital cataract associated with congenital rubella syndrome after early surgical intervention. The rate of serious postoperative complications was acceptable.

Real-time dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial.

PURPOSE: To compare the impact of varying fluidic parameters on intraoperative intraocular pressure (IOP) fluctuations and postoperative outcomes. METHODS: Prospective randomized study of 80 eyes undergoing cataract surgery that were randomly assigned to low (aspiration flow rate: 20 cc/min; bottle height: 90 cm; vacuum: 400 mm Hg) and high (aspiration flow rate: 40 cc/min; bottle height: 110 cm; vacuum: 400 mm Hg) fluidic parameter groups. Real-time dynamic intraoperative IOP was measured during nuclear fragment removal. Mean maximum and minimum IOP and percentage reduction in IOP from maximum were compared between groups. Postoperatively, the rate of change in central corneal thickness and anterior chamber inflammation at days 1 and 7, endothelial cell density at 3 months, and corneal clarity on day 1 were compared. RESULTS: Minimum IOP in the low and high parameters groups was 35 ± 4.0 and 34.5 ± 6.8 mm Hg, respectively. Maximum IOP in the low and high parameters groups was 69 ± 3.0 and 85 ± 1.2 mm Hg, respectively (P < .002). Mean percent reduction from maximum was 59% in the high parameters group compared to 41% in the low parameters group, with the difference being statistically significant (P < .002). Rate of change in central corneal thickness was greater in the high parameters group at postoperative days 1 and 7 (P < .001). Anterior chamber inflammation and corneal clarity on the first postoperative day were significantly better in the low parameters group. CONCLUSIONS: Higher aspiration flow rate and bottle heights are associated with high intraoperative IOPs of up to 85 mm Hg. Prolonged elevated IOP during cataract surgery was found to have more anterior segment inflammation and more edematous corneas.

Contrast sensitivity assessment in pediatric cataract surgery: comparison of preoperative and early postoperative outcomes.

PURPOSE: To evaluate the preoperative and early postoperative differences in contrast sensitivity at high and low spatial frequencies after cataract extraction with in-the-bag intraocular lens (IOL) implantation in children presenting with lamellar and posterior subcapsular cataract. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective clinical trial. METHODS: In eyes with lamellar or posterior subcapsular cataract having cataract surgery with Acrysof SN60WF IOL implantation, contrast sensitivity testing was performed using the CSV-1000E sine wave grating test face at 3, 6, 12, and 18 cycles per degree under photopic (85.0 candelas [cd]/m(2)) and mesopic (2.7 cd/m(2)) conditions. The main outcome measures were contrast sensitivity under photopic and mesopic conditions preoperatively and 1 and 3 months postoperatively. The corrected distance visual acuity (CDVA) was recorded in logMAR units. The effect of the type of cataract and of age at surgery on contrast sensitivity preoperatively and 1 and 3 months postoperatively was also evaluated. RESULTS: The mean age of 13 patients (22 eyes) was 7.85 years ± 2.6 (SD). There was a statistically significant difference in contrast sensitivity at every timepoint at every spatial frequency under mesopic and photopic conditions. There was also a statistically significant improvement in CDVA from preoperatively to 1 month postoperatively and from 1 month to 3 months postoperatively (both P<.001). CONCLUSION: There was a significant improvement in contrast sensitivity at high and low spatial frequencies, even in children older than 4 years, after cataract surgery for lamellar or posterior subcapsular cataract. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Posterior Capsule Opacification After Phacoemulsification: Annual Review.

PURPOSE: The purpose of this article is to provide a clinical update on posterior capsule opacification (PCO) after phacoemulsification by reviewing the literature from the last 12 months. DESIGN: This article is a literature review. METHODS: The authors conducted a 1-year literature search in the English language on PCO using PubMed. The period used to conduct the literature search was from January 1, 2013, to January 1, 2014. The following search terms were used during the PubMed search: phacoemulsification, microcoaxial incision, posterior capsule opacification, long-term evaluation of intraocular lens (IOL) implantation, IOL edge design and material, surgical technique, anterior capsule overlap on the IOL optic, diabetes mellitus, myopia, pseudoexfoliation, retinitis pigmentosa, uveitis, and neodymium: yttrium-aluminum-garnet laser capsulotomy. RESULTS: This review incorporates original articles that provided fresh insights and updates on PCO. Particular attention was paid to observational, randomized, controlled clinical trials, as well as analyses of larger cohorts with a prospective and retrospective study design. Letters to the editor, unpublished works, experimental trials and abstracts were not considered. CONCLUSIONS: This annual review provides a brief update on PCO that might be of interest to the practicing clinical ophthalmologist.

Exploration of molecular factors impairing superoxide dismutase isoforms activity in human senile cataractous lenses.

PURPOSE: To explore different molecular factors impairing the activities of superoxide dismutase (SOD) isoforms in senile cataractous lenses. METHODS: Enzyme activity of SOD isoforms, levels of their corresponding cofactors copper (Cu), manganese (Mn), zinc (Zn), and expression of mRNA transcripts and proteins were determined in the lenses of human subjects with and without cataract. DNA from lens epithelium (LE) and peripheral blood was isolated. Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) followed by sequencing was carried out to screen somatic mutations. The impact of intronic insertion/deletion (INDEL) variations on the splicing process and on the resultant transcript was evaluated. Genotyping of IVS4+42delG polymorphism of SOD1 gene was done by PCR-restriction fragment length polymorphism (RFLP). RESULTS: A significant decrease in Cu/Zn- and Mn-SOD activity (P < 0.001) and in Cu/Zn-SOD transcript (P < 0.001) and its protein (P < 0.05) were found in cataractous lenses. No significant change in the level of copper (P = 0.36) and an increase in the level of manganese (P = 0.01) and zinc (P = 0.02) were observed in cataractous lenses. A significant positive correlation between the level of Cu/Zn-SOD activity and the levels of Cu (P = 0.003) and Zn (P = 0.005) was found in the cataractous lenses. DNA sequencing revealed three intronic INDEL variations in exon4 of SOD1 gene. Splice-junction analysis showed the potential of IVS4+42delG in creating a new cryptic acceptor site. If it is involved in alternate splicing, it could result in generation of SOD1 mRNA transcripts lacking exon4 region. Transcript analysis revealed the presence of complete SOD1 mRNA transcripts. Genotyping revealed the presence of IVS4+42delG polymorphism in all subjects. CONCLUSIONS: The decrease in the activity of SOD1 isoform in cataractous lenses was associated with the decreased level of mRNA transcripts and their protein expression and was not associated with either modulation in the level of enzyme cofactors or with INDEL variations.

Histomorphological and immunofluorescence evaluation of clear corneal incisions after microcoaxial phacoemulsification with 2.2 mm and 1.8 mm systems.

PURPOSE: To compare changes in the incision's histomorphology and denaturation of collagen I in rabbit eyes having microcoaxial phacoemulsification through 2.2 mm and 1.8 mm incision-compatible systems. DESIGN: Randomized experimental trial. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: Thirty rabbit eyes were randomized into Group 1 (microcoaxial phacoemulsification through 2.2 mm incisions using Infiniti system [torsional ultrasound]) and Group 2 (microcoaxial phacoemulsification through 1.8 mm incisions using Stellaris system [longitudinal ultrasound]). Each group was then divided into 3 subgroups of 5 eyes each based on 1 of the 3 intervention options: phacoemulsification only, intraocular lens (IOL) insertion only, and phacoemulsification with IOL insertion. Left eyes were randomized for microcoaxial phacoemulsification, and right eyes were treated as controls. RESULTS: After phacoemulsification, eyes in Group 1 showed loss of epithelium at the roof of the incisions and Descemet membrane detachment at the floor of the incisions. These findings did not change after IOL insertion. After phacoemulsification, eyes in Group 2 showed loss of epithelium, but Descemet membrane remained attached. There was a longitudinal split in the incision's stroma in the direction of internal entry. The stromal damage increased after IOL implantation. Immunofluorescence studies showed no obvious irregularities in the arrangement of collagen I in either group. A dot blot analysis showed significant denaturation of collagen I in Group 2. CONCLUSION: The histomorphology of the 2.2 mm system incision showed localized Descemet membrane detachment and endothelial cell loss. The 1.8 mm system incision showed exaggerated stromal damage after IOL insertion.

Subtle signs of an intact anterior vitreous face during pediatric cataract surgery.

We describe the subtle signs of the anterior vitreous face as a bulging structure, a homogenous staining pattern of 3 buttonholes, and a lamellar or fibrillar pattern intact. This should help surgeons correctly recognize the intact anterior vitreous face.

Anti-inflammatory effect of low-molecular-weight heparin in pediatric cataract surgery: a randomized clinical trial.

PURPOSE: To determine if intraocular infusion of low-molecular-weight heparin (enoxaparin) reduces postoperative inflammation in pediatric eyes undergoing cataract surgery with IOL implantation. DESIGN: Prospective masked randomized controlled trial. METHODS: setting: Private, institutional practice. study population: Twenty children (40 eyes) undergoing bilateral cataract surgery with IOL implantation were randomized to receive enoxaparin in the intraocular infusion fluid (BSS) (Group I) or not to receive enoxaparin (Group II). The first eye was randomly assigned to 1 of the 2 groups and the second eye received alternate treatment. observation procedure: Patients were followed up in the first week and 1 and 3 months after surgery. main outcome measures: Anterior chamber flare and cells (Hogan's criteria), cell deposits on IOL, posterior synechiae. RESULTS: One week postoperatively, no eyes had >grade 2 flare/cells. Proportion of eyes with grade 2 cells was higher in eyes that did not receive enoxaparin (Group II: 80% vs Group I: 40%, P = .009). In the first week >10 small cell deposits were noted in the eyes that received enoxaparin (Group I: 20%, Group II: none, P = .005). Large cell deposits first appeared at 1 month in 40% of eyes in Group I and 55% of eyes in Group II (P = .34) and increased at 3 months (60% in both groups, P > .999). Posterior synechiae were seen in 10% of eyes in Group I at 1 month, which persisted at 3 months; no eyes in Group II showed posterior synechiae (P = .14). CONCLUSION: The results of our study suggest that there does not seem to be a benefit of using enoxaparin in the infusion fluid with respect to early postoperative inflammation.

Corneal endothelial morphologic assessment in pediatric cataract surgery with intraocular lens implantation: a comparison of preoperative and early postoperative specular microscopy.

PURPOSE: To observe longitudinal changes in the corneal endothelium after pediatric cataract surgery with intraocular lens implantation. DESIGN: Prospective, longitudinal study. METHODS: settings: Iladevi Cataract and IOL Research Centre, Ahmedabad, India. study population: This study included 100 pediatric eyes undergoing cataract surgery with intraocular lens implantation. Posterior capsule management was based on the status of the posterior capsule. Two-port anterior limbal vitrectomy was carried out after posterior capsule plaque peeling. observation procedures: Corneal endothelial morphologic features: endothelial cell density (cell/mm(2)), coefficient of variation, percentage of hexagonality, and central corneal thickness were assessed. main outcome measures: To evaluate whether there is a difference in endothelial cell morphologic features before surgery and 3 months after surgery and also whether pediatric cataract surgery with and without anterior vitrectomy has any impact on the endothelial cell morphologic features. RESULTS: A comparison of preoperative and postoperative specular microscopy is given here: endothelial cell density, 3225.1 ± 346.8 cells/mm(2) versus 3057.7 ± 330.1 cells/mm(2) (P < .001); coefficient of variation, 27.5 ± 10.6 versus 37.7 ± 16.3 (P < .001); percentage of hexagonality, 58.1 ± 15.3 versus 48.6 ± 13.4 (P < .001); and central corneal thickness, 529 ± 30 µm versus 527 ± 34 µm (P = .64). There was 5.1% decrease in mean endothelial cell loss at 3 months after surgery. No statistically significant difference was noted in the percentage decrease in mean endothelial cell density between eyes undergoing cataract surgery with intact posterior capsules, eyes undergoing manual posterior capsulorrhexis without anterior limbal vitrectomy, and eyes undergoing anterior limbal vitrectomy (P = .543). CONCLUSIONS: Endothelial cell loss with currently practiced techniques of pediatric cataract surgery is within acceptable limits by adhering to the principles of close chamber technique.

Comparison of the effect of torsional and microburst longitudinal ultrasound on clear corneal incisions during phacoemulsification.

PURPOSE: To compare incision integrity after clear corneal microcoaxial phacoemulsification using longitudinal and torsional ultrasound (US). SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective randomized experimental clinical trial. METHODS: Part 1 comprised an experimental study of rabbit eyes. Group 1 received longitudinal US. Group 2 received torsional US. The right eye of each rabbit served as a control. Samples were processed for histomorphology and collagen I denaturation by immunofluorescence. Part 2 comprised a clinical trial of patients. Group 1 received torsional US. Group 2 received longitudinal US. At the end of surgery, trypan blue 0.0125% was instilled. After 2 minutes, 0.1 mL of aqueous was aspirated and its optical density measured. RESULTS: In part 1, incision histomorphology was comparable in both modalities. Collagen denaturation tests (immunofluorescence, dot blot analysis) showed no irregularity in collagen arrangement in either group. In Group 2, Descemet membrane was detached and endothelial cells were minimal at the roof of the incision. In part 2, trypan blue ingress into the anterior chamber was significantly greater in Group 1 than in Group 2 (mean 3.40 + 0.6 log units versus and 3.77 + 0.82 log units) (P<.007). CONCLUSIONS: Incision histomorphology in the torsional group showed minimal Descemet membrane detachment and minimal endothelial cell loss at the roof of the incision. Minimal ingress of trypan blue into the anterior chamber was observed with torsional US, indicating better wound integrity than with longitudinal US. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Outcomes of pediatric cataract surgery in anterior persistent fetal vasculature.

PURPOSE: To report the intraoperative performance and postoperative outcomes in eyes with anterior persistent fetal vasculature (PFV). SETTING: Iladevi Cataract & IOL Research Centre, India, and Filatov Institute Odessa, Ukraine. DESIGN: Prospective interventional case series. METHODS: Eyes with anterior PFV had surgery using a standardized surgical technique. Plaque peeling was used for small plaques and partial excision for larger plaques. In eyes in which the entire lens converted into a fibrovascular tissue, extensive capsulectomy with anterior 2-port limbal vitrectomy was performed. Microphthalmic eyes had no intraocular lens implantation. RESULTS: This study comprised 33 eyes. The mean age at surgery was 6.30 months ± 5.16 (SD). Microcornea was observed in 10 eyes (30.3%). Within the morphology of cataract, 10 eyes (30.3%) had the lens converted into fibrovascular mass, of which 4 had associated prominent ciliary process. Anterior continuous curvilinear capsulorhexis (CCC) and manual posterior CCC were performed in 23 eyes (69.7%) and 3 eyes (9.1%), respectively. Intraoperatively, posterior capsule plaque was seen in 20 eyes (60.6%). In 31 eyes (93.9%), 2-port limbal anterior vitrectomy was performed and in 2 eyes (6.1%), pars plana vitrectomy was performed. Intraocular lens implantation was performed in 16 eyes (48.5%); 17 eyes (51.5%) were left aphakic. Visual axis obscuration was observed in 6 eyes (18.2%). At the 3-year follow-up, visual acuity remained stable in 11 eyes (33.3%) and improved in 22 eyes (66.6%). CONCLUSION: The results suggest that good visual outcomes can be obtained in PFV eyes after surgical intervention, with an acceptable rate of serious postoperative complications. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.