Risk factors, complications, and results in extracapsular cataract extraction.

PURPOSE: To examine a large series of extracapsular cataract extractions (ECCEs) to determine the risk factors for posterior capsule rupture with vitreous loss (PCR + VL) and the complications and results of this cataract surgery technique. SETTING: North Riding infirmary, Middlesbrough, United Kingdom. METHODS: In this retrospective study, the records of 1552 patients who had ECCE performed by two surgeons were examined. Follow-up was 4 months to 4 years. The main outcome measures were the incidence of risk factors, PCR + VL, major and minor postoperative complications, and the visual outcome. RESULTS: Three hundred twenty-two cases were considered high risk for PCR + VL. In this group, the PCR + VL rate was 5.3%; it was 3.7% in the low-risk group and 4.0% overall. Visual acuity of 6/9 or better was achieved by 76% of all eyes. Postoperative complications were 3 cases of endophthalmitis, 4 of retinal detachment, and 1 of pseudophakic bullous keratopathy. In 323 eyes, loose or broken sutures were removed and in 175, a neodymium: YAG capsulotomy was performed because of posterior capsule opacification. CONCLUSIONS: The incidence of perioperative and postoperative complications was comparable with those reported in other series. Factors that increased the risk of PCR + VL included pseudoexfoliation, diabetes mellitus, and a traumatic etiology. Previous glaucoma surgery and axial myopia of greater than 26.0 mm did not increase the PCR + VL risk. Loose or broken corneal sutures was a common finding that could be reduced substantially by planned suture removal.

Secondary implantation of open-loop, flexible, anterior chamber intraocular lenses.

PURPOSE: To assess the results of implantation of secondary, open-loop, flexible, anterior chamber intraocular lenses (IOLs) and compare the findings with those of other published studies. SETTING: A combined ophthalmology and ear, nose, and throat hospital in Middlesbrough, Cleveland, England. METHODS: This retrospective study comprised 81 patients who had secondary implantation of a flexible, open-loop, anterior chamber IOL by the one surgeon. The incidence of postoperative complications was ascertained, and best corrected preoperative and postoperative visual acuities were compared. RESULTS: Two serious complications occurred: one severe loss of vision that is still under investigation and one retinal detachment that was repaired with good residual visual function. Of all 81 patients, 92.5% were within one Snellen line of their preoperative best corrected visual acuity. These results compare favorably with those of other published studies. CONCLUSION: Using an open-loop, flexible, anterior chamber lens for secondary implantation is still an acceptable way to treat aphakia. The poor reputation of these lenses is undeserved.

Flexible open-loop anterior chamber intraocular lens implantation after posterior capsule complications in extracapsular cataract extraction.

OBJECTIVES: To analyze 50 cases of flexible open-loop anterior chamber intraocular lens (IOL) implantation after posterior capsule rupture and vitreous loss and compare the results with those of other published series. SETTING: North Riding Infirmary, Cleveland, England. METHODS: This retrospective study, with a follow-up between 3 and 81 months, comprised all patients who had a flexible open-loop anterior chamber IOL implanted because of significant posterior capsule problems during extracapsular cataract extraction. The incidence of postoperative complications and best corrected visual acuity results were determined. RESULTS: Three patients with cystoid macular edema achieved final best corrected visual acuity of 6/9 (20/30). There was one retinal detachment and one traumatic incision rupture with IOL loss 6 weeks postoperatively and subsequent retinal detachment and phthisis. Seventy-two percent achieved a best corrected visual acuity of 6/9 (20/30). CONCLUSIONS: Our results agree with those of other published series. Implantation of a flexible open-loop anterior chamber IOL as a primary lens is still an acceptable way of treating posterior capsule complications in cataract surgery.

Alterations in the shape of the automated perimetric profile arising from cataract.

The attenuation of the perimetric response arising from cataract was investigated and related to the degree of cataract quantified by glare sensitivity. Visual fields were measured with the Octopus and Dicon automated perimeters out to an eccentricity of 30 degrees. Nuclear and non-nuclear cataracts differed in their effect on the perimetric profile. Non-nuclear cataracts exhibited the same qualitative characteristics as a model developed in previous studies, whereby the overall pattern of perimetric attenuation was dependent upon target configuration. For these subjects, perimetric sensitivity was depressed to a greater extent at an eccentricity of 30 degrees compared with fixation when measured with the large projected stimuli, whereas the reverse was true when sensitivity was measured with the small LED stimuli. Conversely, nuclear cataracts depressed perimetric sensitivity to a greater extent at the fovea compared with more peripheral regions for both the large projected and small LED stimuli.

Visual after-effects associated with the use of high-resolution visual display units.

A long-lasting visual after-effect associated with the use of a high-resolution green visual display unit (VDU) is described in eight normal volunteers. Its duration to a standard VDU exposure is measured. It is related to the McCollough effect and is thought to be either a fatiguing of green colour-coded edge-detectors or an associative phenomenon. A reduction or loss of the usual foveal peak of the critical flicker frequency (CFF) to red is also described.

Analysis of the factors involved in cosmetic failure following excision of the eye.

We graded the overall cosmetic outcome of 56 patients who required excision of the eye. Each patient was then subjected to a more detailed analysis of the specific abnormalities associated with excision of the eye in order to discover which are associated most consistently with a poor cosmetic result. The only factor showing a statistically significant variation with the overall cosmetic outcome was the degree of upper lid sulcus. Taken individually the other features showed no statistically significant correlation. When each finding was scored, the averaged sum of the scores was related to cosmetic outcome with statistical significance. A method of quantifying orbital volume loss is described.

Double-blind controlled trial to compare anti-inflammatory effects of tolmetin 2%, prednisolone 0.5%, and placebo in post-cataract extraction eyes.

This paper compares the efficacy of tolmetin, prednisolone, and placebo (vehicle only) in controlling post-cataract extraction inflammation in a double-blind trial involving 120 patients. Seventeen patients were excluded from analysis. The results of the 103 patients analysed showed that 94% of the prednisolone treated group was judged to have been successfully treated as compared with 53% of the tolmetin treated group and 46% of the vehicle treated group. The differences between the prednisolone treated group and the other two groups were statistically significant (p less than 0.001). No statistical significance was found between the tolmetin and vehicle groups.

The effect of a once-daily oral dose of nadolol on intraocular pressure in normal volunteers.

We compared the effects of once-daily oral administration of 20 mg and 40 mg of nadolol vs placebo in 40 normal volunteers in a randomized, double-masked trial. Each of 23 women and 17 men (ranging in age from 18 to 50 years) had intraocular pressure, pulse rate, blood pressure, pupil size, amplitude of accommodation, and near point measured immediately before treatment and then at 24 hours, day 8, and day 15 after treatment. Both dosages of nadolol produced significant decreases in intraocular pressure at three hours (P less than .001). Although both dosages decreased intraocular pressure at 24 hours compared with placebo, only the change with the 40-mg dose was significant (P less than .05). Although both dosages produced significant decreases in pulse rate and blood pressure, side effects were minimal.