Pseudomonas aeruginosa endophthalmitis caused by contamination of the internal fluid pathways of a phacoemulsifier.

PURPOSE: To report 4 cases of Pseudomonas aeruginosa endophthalmitis caused by internal contamination of the internal pathways of a phacoemulsifier. SETTING: Ophthalmology Center, Perpignan, France. METHODS: Four clinical cases of postoperative endophthalmitis occurred after phacoemulsification. An investigation was necessary to prove the cause of the bacteriological contamination. RESULTS: Serotyping and ribotyping of the Pseudomonas aeruginosa strains obtained from the vitreous samples and from the phacoemulsifier showed that all these strains were identical and that the initial site of the contamination was the phacoemulsifier. CONCLUSIONS: The profession should be cognizant of this cause of endophthalmitis, although its occurrence is rare. Cataract surgeons should test samples from the collection bags of their phacoemulsifiers to ensure there is no bacteriological contamination.

Evaluation of the biocompatibility and fixation of a new silicone intraocular lens in the feline model.

The biocompatibility and fixation of a new silicone intraocular lens was evaluated in the cat eye. Following extracapsular lens extraction, 14 cats were implanted with a silicone lens (SLM 2/UV type) with polypropylene modified J loops in one eye and a poly(methyl methacrylate) (PMMA) lens (Perspex CQ) of a similar design in the fellow eye. Half the lenses were placed in the ciliary sulcus and half in the capsular bag. The eyes were evaluated for up to one year. Neither lens material showed any signs of toxicity clinically or histopathologically. Both lenses achieved stable fixation in the capsular bag; however, some inflammatory reaction and lens dislocation were noted with sulcus placement of both lens types. The amount of proteinaceous and cellular debris on the explanted silicone lenses was significantly less than that on the PMMA lenses as assessed with methylene blue staining. All retrieved lenses were optically clear and no significant change in the lens surface morphology, clarity and/or optical properties was observed.

Spontaneous enlargement of neodymium:YAG posterior capsulotomy in aphakic and pseudophakic patients.

Two cases of spontaneous enlargement of a neodymium:YAG posterior capsulotomy, involving an aphakic and a pseudophakic patient, are presented. Consequences and possible causality are discussed.

Cataract extraction in eyes with congenital colobomata.

Cataract surgery was performed in six eyes of four patients with typical colobomata of the iris, choroid, and retina. Contrary to previous reports of poor surgical results in these eyes, we saw no surgical or postoperative complications. Final visual acuity was excellent in four eyes. The other two had preexisting amblyopia. Most previous reports describe outmoded extracapsular techniques or contemporary intracapsular cataract extraction, all without an intraocular lens. Five of the six eyes in this study had modern cataract surgery--phacoemulsification with a posterior chamber lens placed in the capsular bag.

The 1985 Binkhorst lecture. Ultraviolet-absorbing chromophores: chemical and ultraviolet transmission characteristics.

Intraocular lenses containing an ultraviolet chromophore, representing the products of seven manufacturers, were analyzed for chemical and ultraviolet transmission characteristics and the results are reported. The clinical use of this type of intraocular lens and the absence of any long-term safety data are discussed.

Bacterial recovery from automated cataract surgical equipment.

Internal tubing involved in the venting and vacuum mechanism of CooperVision's models 8000-V, 7500, and 6500 units were cultured. Several species of bacteria were found including Staphylococcus epidermidis. The clinical implications of this are discussed as well as a solution to the possibility of intraoperative bacterial contamination from the reported source.

Rayner lecture. Lens implantation and the monocular patient.

In a series of 1,000 consecutive cases of posterior chamber intraocular lens implantation, 49 patients were monocular, being irreversibly 20/200 or worse in the unoperated eye. The results of surgery on these patients are reported and it is noted that three patients required subsequent additional intraocular surgery, one of these cases related to loss of vision in the unoperated eye which affirms the bilaterality of some ocular disease. While intraocular lens implantation may be performed on monocular cases, attention should be given to the reason for visual loss in the fellow eye; moreover, both patient and surgeon should consider the risks involved.

Ptosis and cataract surgery. A multivariant computer analysis of a prospective study.

A prospective study investigated the effect of local anesthesia, eyelid edema and superior rectus muscle injury on postoperative ptosis. Patients were randomized into four groups to study these effects. Group A received a Van Lint eyelid block and a superior rectus bridle suture. Group B received a Van Lint block and an episcleral retraction suture. Group C received a Nadbath retroauricular facial nerve block and a superior rectus bridle suture. Group D received a Nadbath block and an episcleral retraction suture. Results of the study indicate that postoperative ptosis can be significantly reduced by varying our operative techniques. Postoperative ptosis was significantly increased in group A and reduced in group D. It appears that trauma to the superior rectus muscle complex is the most critical factor in postoperative ptosis. Fifty five and one-half percent of the population entered the study with preoperative ptosis. Preoperative ptosis had no effect on postoperative ptosis. Lid crease, superior sulcus fullness and lash rotation are poor anatomical landmarks of levator insertion in the elderly population, both preoperatively and postoperatively.

Intraocular lens damage from the neodymium-YAG laser.

In an in vitro experiment, intraocular lens damage was induced by a neodymium-YAG Q-switched laser at energy levels equal or less than those advocated for a posterior capsulectomy.

Bimanual phacoemulsification.

Phacoemulsification is widely used in the USA for cataract extraction. The surgeon's ability has been enhanced by improved instrumentation and evolution of techniques which make the surgery less challenging. Such a technique is bimanual phacoemulsification, which is described in this paper.

Glare disability in eyes with intraocular lenses.

For 32 eyes tested for glare disability after undergoing extracapsular cataract extraction with implantation of posterior chamber intraocular lenses, the mean contrast threshold in the presence of the glare source was 23% for undilated pupils and 31% with dilation. A regression analysis of glare scores as a function of the amount of posterior capsule opacification showed a significant (P less than .00001) association between the two.

Retinal detachment in myopic eyes after intracapsular and extracapsular cataract extraction.

We analyzed two consecutive series of cataract extractions in patients with moderate to severe myopia for the incidence of postoperative retinal detachment. One series consisted of 122 intracapsular cataract extractions without surgical loss of vitreous and the other series consisted of 151 extracapsular (phacoemulsification and planned extracapsular) cataract extractions without loss of vitreous and with intact posterior capsules. All patients were 40 years of age or older and all were followed up for one to four years. We defined moderate to severe myopia as an aphakic refraction of +7.00 diopters spherical equivalent or less. The rate of postoperative retinal detachment was greater in the intracapsular series (seven of 122 cases; 5.74%) than in the extracapsular series (one of 151 cases; 0.66%).

Ultraviolet-absorbing intraocular lenses.

Chemical analysis of the ultraviolet-absorbing materials in American Medical Optics, Cilco, and Optical Radiation Corporation intraocular lenses is reported. Clinical considerations are discussed, and the absence of any long-term safety and effectiveness data is noted.

The capsule coupeur for automated anterior capsulectomy.

We present a mechanical automated anterior capsulectomy device that can operate from its own power source or from several pre-existent automated cataract and vitreous surgical systems.

Bilateral intraocular lens implantation.

A study of 1796 consecutive cataract patients in a posterior chamber intraocular lens implant (IOL) series revealed 373 patients (20.8%) who had bilateral IOLs. Visual acuity was 20/40 or better in 87% of first eyes operated and 90% in second eyes. The major cause of vision less than 20/40 was senile macular choroidal degeneration in both first and second eyes. The surgical reintervention rate was 11.8% in first eyes and 3.7% in second eyes. Ninety-two percent of patients had an interval of six months or more between surgery on the first and second eyes.

A comparison of ICCE-Binkhorst intraocular lens and ECCE-posterior chamber intraocular lens, thirty-four to forty months postoperatively.

A retrospective study of 450 consecutive intracapsular cataract extractions with a Binkhorst lens implant, and 450 consecutive extracapsular cataract extractions with a posterior chamber lens implant, was performed. All patients were examined between 34 and 40 months postoperatively, except for those patients who died before this time, those lost to followup, or those who were otherwise unavailable during this time. The results suggest that the extracapsular series had a more favorable outcome than the intracapsular series, especially with regard to final visual acuity and the incidence of clinical cystoid macular edema.