Simplified technique to remove posteriorly dislocated lens implants.

Visual loss caused by posterior dislocation of an intraocular lens (IOL) may be managed by placement of a secondary IOL without removal of the dislocated IOL. However, the improved visual acuity may lead to visual disturbances from the mobile, dislocated IOL. Removal of dislocated implants through the pars plana entails risks of a large pars plana incision to include hemorrhage, hypotony, and a greater potential for vitreous traction caused by extraction across the vitreous base. Removal via the corneal limbus lessens these risks but is made more difficult in the presence of a coexisting posterior chamber IOL. The technique reported allows a controlled conversion from posterior to anterior segment surgical techniques that may aid in either the removal or repositioning of posteriorly dislocated lens implants.

Managing a dropped nucleus during the phacoemulsification learning curve.

Three patients had a pars plana vitrectomy to remove retained nuclei within 72 hours after phacoemulsification performed by a surgeon making the transition from extra-capsular cataract extraction to phacoemulsification. After vitrectomy, the nuclei were brought to the midvitreous cavity from the retinal surface with a posterior segment phacofragmenter, emulsified, and completely removed. Then, a posterior chamber intraocular lens was implanted in the sulcus through the previous cataract surgery incision and remained well centered postoperatively. Postoperative complications included cystoid macular edema in 1 patient and choroidal detachment in another. No other complications were detected. Final visual acuity ranged from 20/60 to 20/30.

Staar Collamer intraocular lens: clinical results from the phase I FDA core study.

PURPOSE: To assess the early postoperative efficacy and safety of the Staar Collamer intraocular lens (IOL) in small incision cataract surgery. SETTING: Six private ophthalmology practices geographically distributed throughout the United States. METHODS: One hundred twenty-five patients with a mean age of 72.1 years were enrolled in the U.S. Food and Drug Administration (FDA) Phase 1 clinical study of the Staar Collamer IOL after having cataract removal by phacoemulsification. Of these, 107 completed 4 to 6 months of follow-up. RESULTS: At 4 to 6 months postoperatively, 97.1% of patients achieved 20/40 or better corrected visual acuity; 100% of patients without pre-existing pathology (best case) achieved the same result; both results were better than FDA grid values. No persistent sight-threatening complications were reported. Through 6 months, 4.7% of patients required a neodymium:YAG capsulotomy. No IOL dislocations or removals were reported. CONCLUSION: Results indicate that the Collamer material is safe and effective for platehaptic IOLs used in small incision cataract surgery.

Early results of 500 cases of no-stitch cataract surgery.

My first 500 cases of no-stitch cataract surgery were evaluated in a randomized prospective study to compare the results of a 4.0 mm incision (foldable intraocular lens [IOL]) and a 5.2 mm incision (poly[methyl methacrylate] [PMMA] IOL). An additional group of 7.0 mm incision (PMMA IOL) no-stitch cases were studied retrospectively. One-day postoperative intraocular pressure averaged 20 mm Hg for both the 4.0 mm and 5.2 mm incision groups and 23 mm Hg for the 7.0 mm incision group. Hyphema occurred in 5% of the 4.0 mm incision group, in 1% of the 5.2 mm incision group, and in 5% of the 7.0 mm incision group. Surgically induced astigmatism, as absolute change in cylinder (without regard to axis) at three months postoperatively averaged 0.46 diopter (D) for the 4.0 mm incision group, 0.57 D for the 5.2 mm incision group, and 0.52 D for the 7.0 mm incision group. A prospective comparison of cold versus warm (room temperature) balanced salt solution irrigation during phacoemulsification demonstrated no statistically significant difference in effect on either the hyphema rate or astigmatism. However, the effect of scleral cautery on astigmatism, comparing cautery completely to the limbus with cautery only posterior to the insertion of Tenon's fascia, demonstrated a significant difference: an average of 50% reduction in the one week postoperative induced astigmatism was observed when the cautery was not carried all the way to the limbus. At three months, a 20% difference was still present.(ABSTRACT TRUNCATED AT 250 WORDS)