[Extracapsular cataract extraction with intraocular lens implantation after glaucoma surgery]

PURPOSE

To analyse results of cataract surgery with intraocular lens implantation in eyes with previous glaucoma surgery.

MATERIAL AND METHODS

In the years 1994-1996 in 44 eyes of 39 patients (13 males and 26 females) cataract surgery was performed. The follow-up ranged from 3 to 12 months (mean 8.5 months). The time interval between glaucoma surgery and cataract surgery ranged from 1 month to 40 years. The most frequent kind of glaucoma surgery was trabeculectomy (77.3%). An inverse corneal incision and envelope capsulotomy was performed in every eye, thirty eight percent required synechiolysis and twenty percent iridoplastic surgery.

RESULTS

Intraoperatively there were 2 cases of posterior capsule tears with vitreous loss and 4 mild hemorrhages into anterior chamber. The most common postoperative complications were Descemet's membrane folds (36.4%), fibrinous exudate in anterior chamber (27.3%) and transient corneal oedema (9.2%). Fifty percent of eyes achieved the best corrected visual acuity-5/8 and better. Postoperative astigmatism mostly with the rule was observed in 86.4% eyes. Postoperative intraocular pressure was unchanged in 81.8% eyes, and in 13.8 percent of eyes preoperative glaucoma medication was no longer required.

CONCLUSIONS

The technique of extracapsular cataract extraction with intraocular lens implantation is a safe procedure giving good visual rehabilitation and having no influence on glaucoma control in patients who had previous glaucoma surgery.

[Removal of the dislocated lens in patients with funnel-shaped retinal detachment]

PURPOSE

Presentation of two cases of crystalline lens posterior dislocation with concomitant, total, funnel-shaped retinal detachment.

MATERIAL AND METHODS

The described patients were myopes and both had lost vision of the other eye earlier due to the same cause. The operation of dislocated lens removal through the limbal incision with the use of pars plana vitrectomy and simultaneous retinal detachment surgery were performed.

RESULTS

In one patient almost full visual acuity was achieved, and in the second case visual acuity was improved to 3/50.

CONCLUSION

The use of vitrectomy methods, including subretinal fluid drainage and intraocular silicone oil tamponade, enables efficient treatment of patients with dislocated lenses even in cases with total retinal detachment.

[Surgical management of intraocular lens dislocation into the vitreous cavity]

PURPOSE

To present our experiences in the management of intraocular lenses (IOLs) dislocated into the vitreous cavity.

MATERIAL AND METHODS

The authors report three cases with posteriorly dislocated IOLs in which pars plana vitrectomy techniques and limbal incision were used for IOLs removal. In one of these eyes perifluorocarbon liquid was injected after vitrectomy to float the IOL off the retina to the retropupillary space and transclerally sutured ciliary sulcus fixation IOL was implanted simultaneously. Anterior chamber IOLs were implanted in the two other cases.

RESULTS

Best corrected postoperative visual acuity was between 5/5 and 5/10 in all eyes. No important complications were observed.

CONCLUSIONS

Application of vitreoretinal microsurgical techniques allows for the safe removal of dislocated IOLs. Primary or secondary IOL re-implantation gives quick visual rehabilitation.

[Posterior chamber implants with scleral fixation in patients with lens subluxation or luxation]

PURPOSE

To present the operative technique and results of scleral fixation posterior chamber IOL implantations in eyes with lens dislocation.

MATERIAL AND METHODS

Pars plana vitrectomy technique was combined with the outside-in method for scleral fixation of PC IOL. Forty eyes of 36 patients were operated on between December 1994 and December 1996. Time of observation ranged from 1 to 24 months (mean 10.3 months).

RESULTS

The best corrected postoperative visual acuity was between 6/6 and 6/8 in 32 eyes, between 6/12 and 6/18 in 5, and between 6/24 and 1/60 in 3 eyes. Preoperative ocular hypertension was normalized in all 9 cases, although topical glaucoma therapy was necessary in 5 eyes. In one myopic patient retinal detachment occurred postoperatively. We observed one case of IOL decentration. No other severe complications were found.

CONCLUSION

Pars plana vitrectomy for the dislocated lens removal may be combined with simultaneous scleral fixation IOL implantation. The procedure is safe and gives good visual rehabilitation.

[Value of vitrectomy in treatment of lens dislocation into the vitreous]

PURPOSE

To present own experiences in vitrectomy in cases of subluxation or luxation of the lens to the vitreous cavity.

MATERIAL AND METHODS

41 eyes with subluxation (16) and luxation (25) of the lens, operated on between May 1992 and April 1994 were analysed. Before the surgery, secondary glaucoma was observed in 18 eyes, hypotony in 8. The aim of pars plana vitrectomy was to release the lens from the surrounding tissues, then the lens was put into anterior chamber and removed by limbal incision.

RESULTS

Visual acuity improvement was achieved in 73% of cases. Intraocular pressure was normalized in 14 eyes. Retinal detachment developed in 2 eyes after the surgery, and in one retina was reattached using silicone oil tamponade.

CONCLUSION

Our results indicate that it is possible to remove the dislocated lens using vitrectomy without perfluorocarbon.

[Implantation of bifocal intraocular lens from personal material]

Results of 25 bifocal IOLs implantations are presented. Follow-up time ranged from 3 to 6 months. Visual acuity for distant and near vision was estimated. The results were compared with a control group of 50 monofocal IOLs implantations. It was found that bifocal IOLs implantations enable good visual acuity for distant and near vision without additional correction, though visual acuity for distant vision was better in the monofocal group. Patients with bifocal IOLs have complained of glare and/or monocular diplopia more often than patients with monofocal IOLs.

Bilateral uveal melanoma presenting simultaneously

A case of bilateral uveal melanoma in a 54-year-old man is described. On admission of the patient for a choroidal melanoma of the left eye, an asymptomatic ciliary-body tumour was detected in his right eye. A thorough general examination did not reveal any metastases. The left eye was enucleated and local excision of the tumour in the right eye was performed 2 months later. Histology confirmed the presence of malignant melanomas in both eyes. The tumours were of similar A/B spindle-cell type. The patient remained healthy, showing no sign of metastasis or local recurrence of melanoma 9 months after the date of diagnosis. The visual acuity in his remaining eye remained 6/6. Immunological assessment of the blood serum revealed abnormally high interleukin 1 beta (IL-1 beta) and IL-2 levels. Possible implications of these findings are discussed.

[Intraocular lens implantation with circular capsulotomy and "envelope" techniques--comparison of results]

The studies comprised 200 patients with presenile and senile cataract who underwent cataract surgery with IOLs implantation. In 100 consecutive cases circular capsulotomy and in subsequent 100 "envelope" technique were used. The results indicate the advantages of "envelope" method: less intra- and post-operative complications, quicker visual convalescence; it is easier and safer.

[Surgical treatment of lenses dislocated to the vitreous cavity]

Removal of the lens dislocated to the vitreous body is one of the most difficult problems in ophthalmic surgery. The authors present 8 consecutive cases in which the lenses luxated to the vitreous were removed. Pars plana vitrectomy was used to free the lenses from the surrounding adhesions and to carry them over to the pupillary region. Then the limbal incision was performed to remove them from the eye. Good anatomical and functional results achieved in the described cases point to the suitability of this operative method.

[Visual field in pseudophakia]

Estimation of the visual field in pseudophakic eyes was the aim of this study. Results were compared between the groups of anterior chamber lenses, posterior ciliary sulcus fixation lenses, posterior intracapsular lenses and the control group of phakic patients. Each group consisted of 25 subjects. Visual field measurements were done using dynamic method with Goldmann perimeter and visual field areas were determined by adequate computer program. Statistical analysis of data showed the reduction of visual field in pseudophakic groups when compared to the control group and no significant differences between different types of implants.

[Abuse of local anesthetics in ophthalmology]

Surface anaesthesia is applied in ophthalmology for minor surgery, diagnostics tests and also in cases of corneal or conjunctival inflammation and injuries. The abuse of such anaesthetics may cause serious complications. The authors emphasize the necessity for their careful application.

[Early and late observations of intraocular pressure in patients with implanted intraocular lens]

The aim of the paper was to evaluate intraocular pressure changes that follow the implantation of posterior intraocular lens. In two examined groups of patients (I group--sulcus ciliaris, II group--intracapsular implantation) the decrease of average intraocular pressure values was observed in the early days after surgery, then during 3 months, it gradually returned to the initial values. This decrease was less marked in the first group of patients. Long-term observation showed the stabilization of intraocular pressure at a level similar to the mean values before surgery.

[3 cases of tumors of the optic disk]

Presented are 3 cases of tumors affecting the papilla of the optic nerve. On the basis of the ophthalmoscopic picture, of fluorescein angiography and of clinical symptoms the authors identified a capillary haemangioma, a pigmentary naevus and a meningeal hernia. In all the cases observation did not detect any increase in the changes.

[Observation or enucleation--a still unsolved problem in patients with uveal melanoma]

The authors performed retrospective investigations and evaluated the influence of the period of time between the onset of the first symptoms of the disease and the enucleation on the life expectations; the groups of patients treated by enucleation and non-treated were compared. Various opinions on the influence of enucleation on the prognosis in patients with uveal melanoma were discussed.

[Effect of X-ray irradiation of the orbit after enucleation in patients with uveal melanoma]

Retrospective investigations comprising 154 patients with an uveal melanoma treated in the period of 1945-1984 were performed. Evaluation of the methods applied showed a beneficial effect of combining enucleation with a postoperative irradiation of the orbit.

Ring melanoma of the iris and ciliary body

The case is described of a tumour of the iris and ciliary body--a ring type melanoma--primarily diagnosed and treated as pigmentary glaucoma.