Effects of dexamethasone, diclofenac, or placebo on the inflammatory response after cataract surgery.

AIM: To compare the inflammatory response after phacoemulsification and intraocular lens (IOL) implantation using postoperative treatment with dexamethasone, diclofenac, or placebo. METHODS: A prospective, randomised, controlled double masked study including 180 patients enrolled for cataract surgery. The patients were 64-85 years old and had no eye disease other than cataract. After phacoemulsification and IOL implantation the patients were randomised to topical treatment with dexamethasone phosphate 0.1% (group I), diclofenac sodium 0.1% (group II), or placebo (saline 0.9%) (group III). The drops were administered four times daily during the first week and twice daily during the second, third, and fourth weeks. The inflammatory reaction in the anterior chamber was measured with laser flare photometry preoperatively and 1, 3, and 8 days, 2 and 4 weeks, 2 and 6 months, and 1, 2, and 4 years postoperatively. Inflammatory symptoms were registered. Biomicroscopy and visual acuity determinations were performed. The rate of Nd:YAG laser posterior capsulotomies after 2 and 4 years was determined. RESULTS: After 3 and 8 days (p <0.0001), 2 weeks (p <0.0001), and 1 month (p = 0.0013) median flare was highest in group III. There were no significant differences between group I and II. Inflammatory symptoms and striate keratopathy were more common in group III. CONCLUSION: Dexamethasone and diclofenac were equally effective in reducing postoperative inflammation after phacoemulsification and IOL implantation in eyes with no other disease than cataract. Both substances were more effective than placebo.

Ultrasound biomicroscopy examination of intraocular lens haptic position after phacoemulsification with continuous curvilinear capsulorhexis and extracapsular cataract extraction with linear capsulotomy.

PURPOSE: Intraocular lens (IOL) haptic position in 35 eyes that had undergone cataract surgery was examined with ultrasound biomicroscopy (UBM). METHODS: In a prospective randomized study the patients were operated by phacoemulsification using continuous curvilinear capsulorhexis (CCC) (group I) or by extracapsular cataract extraction (ECCE) using linear capsulotomy (group II). Ultrasound biomicroscopy was used to localize both haptics of the implanted intraocular lenses and to measure anterior chamber depth (ACD), iris thickness and anterior chamber angle. The inflammatory reaction in the anterior chamber was assessed with laser flare photometry. Slit lamp examination was performed. RESULTS: Both IOL haptics were found in the lens capsule in all 18 eyes in group I. In group II one of the haptics was located out of the capsule in 7 of 17 eyes (41%). The difference is statistically significant (p=0.01). Postoperatively mean ACD measured with the UBM was 4.06+/-0.30 mm in group I and 3.64+/-0.24 mm in group II (p=0.00025). CONCLUSION: The UBM examinations indicate that phacoemulsification with continuous curvilinear capsulorhexis is a more reliable technique than ECCE with linear capsulotomy to achieve implantation of the intraocular lens haptics in the capsular bag.

Randomized study of the blood-aqueous barrier reaction after phacoemulsification and extracapsular cataract extraction.

PURPOSE: To compare the blood-aqueous barrier (BAB) breakdown after endocapsular phacoemulsification and extracapsular cataract extraction (ECCE). METHODS: Forty-two patients (64-82 years) enrolled for cataract surgery were randomly assigned to phacoemulsification (group I) or ECCE (group II). Patients with pseudoexfoliation syndrome, small pupils, glaucoma, uveitis, dark brown irides, diabetes, treatment with eye drops or anti-inflammatory drugs were excluded. In group I the patients were operated with continuous curvilinear capsulorhexis (CCC), phacoemulsification and implantation of a poly-(methyl methacrylate) (PMMA) intraocular lens (IOL) through a 5.2 mm self-sealing incision. In group II linear capsulotomy, nucleus expression and PMMA IOL implantation through a large incision (10-11 mm) were performed. The incision was sutured. Before surgery and three days and three months after surgery postoperative inflammation and BAB reaction were measured by laser flare photometry and anterior chamber fluorophotometry after intravenous administration of fluorescein. The BAB diffusion coefficient was calculated. Laser flare photometry was performed also after one and two years. RESULTS: According to fluorophotometry, ECCE induced significantly more postoperative BAB breakdown than did phacoemulsification at three days (p=0.00016) and three months (p=0.00829). Laser flare photometry showed more inflammation in the ECCE group than in the phacoemulsification group at three days postoperatively (p=0.00005). CONCLUSIONS: This study suggests that cataract surgery performed with a small, self-sealing incision, CCC and phacoemulsification induces a reduced surgical trauma with less BAB breakdown compared to ECCE using a large sutured incision, linear capsulotomy and nucleus expression.

Phacoemulsification and lens implantation in rabbit eyes: capsular bag versus ciliary sulcus implantation and 4.0 versus 7.0 mm capsulorhexis.

PURPOSE: To compare the effects of intraocular lens (IOL) implantation in the capsular bag versus the ciliary sulcus and of a 4.0 versus 7.0 mm continuous curvilinear capsulorhexis (CCC) on postoperative inflammation and after-cataract formation. SETTING: St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Trial 1 comprised 40 rabbits that had CCC, endocapsular phacoemulsification, and a poly(methyl methacrylate) IOL implanted in the capsular bag in one eye and the ciliary sulcus in the fellow eye. In Trial 2, 40 rabbits had a 4.0 mm CCC in one eye and a 7.0 mm CCC in the fellow eye followed by phacoemulsification and IOL implantation in the capsular bag. White blood cell (WBC) counts and prostaglandin E2 (PGE2) concentrations in aqueous humor were determined at 1, 3, 7(8), 28, and 56 days postoperatively. Wet mass of the dissected after-cataract was measured at day 56. In Trial 1, wet mass of the iris-ciliary body was measured at each observation. RESULTS: In Trial 1, WBC counts at day 1 were higher with a sulcus-fixated IOL (P = .05). The median wet mass of the dissected after-cataract was 108.5 mg in eyes with a sulcus-fixated IOL and 62.5 mg in eyes with a capsule-fixated IOL (P = .01). In Trial 2, WBC counts at day 8 were significantly higher in eyes with a 7.0 mm CCC than in those with a 4.0 mm CCC (P < .05). There was no significant difference in the amount of after-cataract. CONCLUSIONS: The results indicate that IOL implantation in the capsular bag causes less inflammation and after-cataract formation than sulcus fixation and that using a large CCC does not affect the total amount of after-cataract but may enhance the inflammatory response.

Inflammatory response after endocapsular phacoemulsification or conventional extracapsular lens extraction in the rabbit eye.

PURPOSE: We compared the inflammatory response after phacoemulsification and conventional extracapsular lens extraction in New Zealand albino rabbits. METHODS: One eye was selected at random and phacoemulsification was performed. Extracapsular lens extraction was done in the fellow eye. In both eyes a polymethylmetacrylate intraocular lens was implanted into the capsular bag and the wound was sutured with a 9-0 polypropylene continuous suture. The levels of prostaglandin E2 in aqueous humour and wet mass of the iris-ciliary bodies were measured at day 1. The number of white blood cells and protein levels in the aqueous humour were measured at day 1, 3, 7, 14 and 30. Corneal thickness was estimated with pachymetry. RESULTS: Prostaglandin E2 levels and wet masses of iris-ciliary bodies were significantly higher after extracapsular lens extraction, which also induced significantly higher white blood cells counts at day 1 and 3 and higher protein levels at day 7. Extracapsular lens extraction caused more corneal edema at day 3, 7 and 14. CONCLUSION: The results suggest that phacoemulsification induced less surgical trauma with less breakdown of the blood-aqueous barrier.

Inflammatory response in the rabbit after phacoemulsification and intraocular lens implantation using a 5.2 or 11.0 mm incision.

PURPOSE: To study the effect of two incision sizes, 5.2 and 11.0 mm, on the inflammatory response in rabbit eyes after lens extraction with phacoemulsification. SETTING: S:t Erik's Eye Hospital, Stockholm, and Pharmacia, Uppsala, Sweden. METHODS: Bilateral endocapsular phacoemulsification was performed on 32 rabbits. The wound was enlarged to 5.2 mm, and a poly(methyl methacrylate) intraocular lens (IOL) was implanted in the capsular bag. In each rabbit, one eye was selected at random and the wound in that eye enlarged to 11.0 mm. In both eyes the wound was sutured with a 9-0 polypropylene continuous suture. The number of white blood cells (WBCs) and prostaglandin E2 (PGE2) in the aqueous humor were measured at days 1, 3, 7, and 28 postoperatively. Corneal thickness was also measured by pachymetry. RESULTS: The number of WBCs at day 3 and the PGE2 levels at days 1, 3, and 7 were significantly higher in eyes with 11.0 mm incisions than in eyes with 5.2 mm incisions. One week after surgery, the corneas in the eyes with 11.0 mm incisions were significantly thicker than in those with 5.2 mm incisions. CONCLUSION: The results indicate that incision size is an important factor in the inflammatory response following phacoemulsification and IOL implantation in the rabbit eye.

Limbal sub-Tenon's administration of retrobulbar anesthesia using a blunt irrigating cannula.

BACKGROUND AND OBJECTIVE: To eliminate sharp needles when administering local anesthesia to the eye in order to reduce serious complications caused by needle perforation. PATIENTS AND METHODS: After topical anesthesia, limbal conjunctival incision, and sub-Tenon's dissection, a retrobulbar irrigation of an equal mixture of bupivacaine (5 mg/ml) and lidocaine (20 mg/ml) was given using a blunt cannula. RESULTS: The technique was used in both vitreoretinal surgery (n = 70) and anterior segment surgery (n = 235) with good analgesic and akinetic effects. No serious adverse were noted. CONCLUSION: This proved to be a safe and efficient technique that abandoned the use of sharp needles.

Comparison of endothelial cell loss and phacoemulsification energy during endocapsular phacoemulsification surgery.

We counted central corneal endothelial cells and measured corneal thickness in 64 human eyes before and three months after cataract extraction and posterior chamber lens implantation. Cataract surgery was the same in all patients and included capsulorhexis and posterior chamber phacoemulsification of the nucleus. Total phacoemulsification energy and time were recorded. A heparin-surface-modified intraocular lens or a regular poly(methyl methacrylate) lens, both having the same design and a 5.0 mm optic, was implanted in the capsular bag with the aid of sodium hyaluronate (Healon). Mean endothelial cell loss was 4%. However, the change in cell density did not correlate with the total phacoemulsification energy used during surgery. Three months after surgery, the central corneal thickness was the same as it had been preoperatively. The results suggest that phacoemulsification in the posterior chamber is a safe procedure even in cases with a hard nucleus.

Bilateral optic nerve hypoplasia with normal visual acuity.

A 26-year-old man, a 19-year-old man, and a 55-year-old man had bilateral optic nerve hypoplasia. They all had normal vision, but considerable defects in the inferior segments of the visual fields.