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

Longitudinal changes in subjective and objective visual function in diabetics 5 years after cataract surgery

PURPOSE

To investigate and compare the long-term subjective and objective visual functional results of phacoemulsification in diabetics and non-diabetics.

METHODS

A prospective, longitudinal, population-based study comprising 57 diabetics and 473 non-diabetics, who had cataract surgery during a 1-year period at Norrlands University Hospital, Umeå, Sweden. Visual acuity data, visual function questionnaire (VF-14) responses, and level of diabetic retinopathy were recorded pre- and postoperatively as well as 5 years after surgery.

RESULTS

Four months postoperatively, the median VF-14 total score for both the diabetics and the non-diabetics was 100; at 5 years, the score decreased to 96.4 and 97.2, respectively (p = 0.81). The median best corrected visual acuity (BCVA) of the operated eye was log MAR 0.046 (Q1:Q3 = 0:0.15) for both the diabetics and the non-diabetics 4-8 weeks postoperatively. Five years later, the BCVA for the diabetics was log MAR 0.14 (Q1:Q3 = 0.02:0.34) and for the non-diabetics 0.1 (Q1:Q3 = 0.02:0.3), (p = 0.34). Five years after surgery, 26% of the diabetics and 22% of the non-diabetics had a reduction in VF14-score of 10 points or more (p = 0.64) compared with 4 months postoperatively. One-third of both the diabetics (18/57) and the non-diabetics (149/473) had lost more than 0.1 log MAR unit in BCVA of the operated eye (p = 0.86).

CONCLUSION

Subjective and objective visual function 5 years after cataract surgery remained stable in most surviving diabetics and non-diabetics. The longitudinal visual function in diabetics was not significantly worse compared with non-diabetics.

After-cataract evaluation after using balanced salt solution, distilled deionized water, and 5-fluorouracil with a sealed-capsule irrigation device in the eyes of 4-week-old rabbits

PURPOSE

To evaluate the Perfect Capsule sealed-capsule irrigation device (Milvella Pty., Ltd.) using 3 substances in young rabbit eyes.

SETTING

St. Erik's Eye Hospital, Stockholm, Sweden.

METHODS

Thirty 4-week-old rabbits had clear lens extraction in both eyes. In 1 randomly selected eye, the Perfect Capsule was applied and the lens capsule was irrigated for 5 minutes with 1 of 3 substances: balanced salt solution (BSS), distilled deionized water (DDW), or 5-fluorouracil (5-FU) 50 mg/mL. In the other eye, no sealed capsule irrigation was used. Forty days postoperatively, the animals were killed and the eyes fixed in formalin for histologic analysis. After-cataract was evaluated in 3 ways: clinically, from photographs, and histologically. Central posterior capsule thickness was evaluated using a microscope, camera, and computer.

RESULTS

The Perfect Capsule sealed-capsule irrigation system could be used in all selected eyes. The vacuum to the anterior capsule was tight, and the system was sealed in all eyes. After-cataract developed in the BSS group and DDW group, but not in the 5-FU group. The 5-FU group had significantly less after-cataract than the other 2 groups (P<.05). There was no difference between the groups in capsule thickness.

CONCLUSIONS

The Perfect Capsule sealed-capsule irrigation system could be used in small eyes. Distilled deionized water did not prevent after-cataract in rabbit eyes with highly proliferative cells, but 5-FU was effective in preventing after-cataract.

Cataracts in children

Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is nonprogressive, whereas lamellar cataract usually develops later and is progressive. Surgery must be performed promptly in cases with dense congenital cataract; if nystagmus has developed, the amblyopia is irreversible. A treatment regimen based on surgery within 2 months of birth combined with prompt optical correction of the aphakia and aggressive occlusion therapy with frequent follow-up has been successful in unilateral and bilateral cases. Both anterior and posterior capsulorhexes are performed in most children. Intraocular lens implantation can be performed safely in children older than 1 year. Anterior dry vitrectomy is recommended in preschool children to avoid after-cataract. Opacification of the visual axis is the most common complication of cataract surgery in children. Secondary glaucoma is the most sight-threatening complication and is common if surgery is performed early. Life-long follow-up is essential in these cases.

After-cataract in children having cataract surgery with or without anterior vitrectomy implanted with a single-piece AcrySof IOL

PURPOSE

To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye.

SETTING

Filatov Institute, Odessa, Ukraine.

METHODS

Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed.

RESULTS

Children in the younger age group (</=62 months at surgery) had surgery for after-cataract more often than children in the older age group (P<.01). Patients who did not receive an anterior vitrectomy had surgery for after-cataract more often (P<.01). Age at surgery and whether an anterior vitrectomy was performed did not significantly affect the EPCO score. The patients who had surgery for after-cataract had a significantly higher EPCO score (P<.001). The IOL remained centered in all eyes; no eye developed posterior synechias.

CONCLUSIONS

This prospective study shows that cataract surgery with anterior vitrectomy is advantageous in younger patients concerning after-cataract formation. The AcrySof SA30AL maintains good centration, produces minimal inflammation, and is well tolerated in the pediatric eye.

A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery

OBJECTIVES

To introduce and evaluate the infusion and aspiration rates and operative times of the 25-gauge transconjunctival sutureless vitrectomy system (TSV) DESIGN: In vitro experimental and comparative interventional study.

PARTICIPANTS AND CONTROLS

Twenty eyes of 20 patients underwent a variety of vitreoretinal procedures using the 25-gauge TSV, including idiopathic epiretinal membrane (n = 10), macular hole (n = 4), rhegmatogenous retinal detachment (n = 3), branch retinal vein occlusion (n = 2), diabetic vitreous hemorrhage (n = 1), and 20 cases similar in diagnosis and severity were matched to provide comparison between duration of individual portions of the surgical procedures with the existing 20-gauge vitrectomy system.

METHODS

Description of the 25-gauge TSV is provided; infusion and aspiration rates of the 25-gauge and standard 20-gauge vitrectomy system were measured in vitro using balanced saline solution and porcine vitreous for several levels of aspirating power and bottle height, and operating times of individual portions of surgical procedures were measured for the 25-gauge and 20-gauge vitrectomy system.

MAIN OUTCOME MEASURES

Infusion, aspiration rates, and operative times of the 20-gauge and 25-gauge vitrectomy system.

RESULTS

Infusion and aspiration rates of the 25-gauge TSV system were reduced by an average of 6.9 and 6.6 times, respectively, compared with the 20-gauge system when balanced saline solution was used. The average flow rate of the Storz 25-gauge cutter (at 500 mmHg, 1500 cuts per minute [cpm]) was 40% greater than that of the 20-gauge pneumatic cutter (at 250 mmHg, 750 cpm) but about 2.3 times less than the 20-gauge high-speed cutter (at 250 mmHg, 1500 cpm). Mean total operative time was significantly greater for the 20-gauge high-speed cutter (26 minutes, 7 seconds) than for the 25-gauge vitrectomy system (17 minutes, 17 seconds) (P = 0.011).

CONCLUSIONS

Although the infusion and aspiration rates of the 25-gauge instruments are lower than those for the 20-gauge high-speed vitrectomy system, the use of 25-gauge TVS may effectively reduce operative times of select cases that do not require the full capability of conventional vitrectomy.

Transient corneal edema after phacoemulsification: comparison of 3 viscoelastic regimens

PURPOSE

To evaluate the effect of different viscoelastic substances on the grade and time course of postoperative corneal edema.

SETTING

Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden.

METHODS

This study comprised 62 patients with otherwise healthy eyes who had routine phacoemulsification and intraocular lens (IOL) implantation. Patients were divided into 3 groups. Group 1 was given Healon GV (sodium hyaluronate 1.4%) at phacoemulsification and IOL implantation. Group 2 was given Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) at phacoemulsification and Healon GV at IOL implantation. Group 3 was given Viscoat at phacoemulsification and Provisc (sodium hyaluronate 1.0%) at lens implantation. The central corneal thickness was measured with ultrasonic pachymetry before surgery and 5 and 24 hours, 1 week, and 1 month after surgery.

RESULTS

The mean increase in corneal thickness was significantly greater in Group 1 than in the other 2 groups 5 and 24 hours and 1 week after surgery.

CONCLUSIONS

The transient postoperative increase in central corneal thickness was greater in patients receiving Healon GV during phacoemulsification than in patients receiving Viscoat. The use of Provisc or Healon GV for IOL implantation did not affect the postoperative corneal thickness when Viscoat was used for phacoemulsification. The time course of the edema may be explained by a difference between the 2 agents in endothelial protection from ultrasonic, mechanical, or irrigation trauma.

Short-term blood-aqueous barrier breakdown after implantation of the 1CU accommodative posterior chamber intraocular lens

PURPOSE

To quantify intraocular inflammation after phacoemulsification with implantation of an accommodative posterior chamber intraocular lens (IOL).

SETTING

Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.

METHODS

Twenty cataractous eyes of 20 patients without preexisting blood-aqueous barrier (BAB) deficiencies or previous intraocular surgery were included in this study. The mean age of the patients was 64.6 years +/- 16.0 (SD). A single surgeon performed phacoemulsification through a superior sclerocorneal tunnel incision and implantation of a 1CU IOL (HumanOptics AG) though a 3.2 mm incision. The haptics of the single-piece acrylic 1CU lens are designed for anterior optic movement following ciliary muscle contraction. The postoperative treatment was standardized. Postoperative BAB breakdown was quantified by laser flare photometry (FC-1000, Kowa) at 1 day, 1 and 4 weeks, and 3 and 6 months.

RESULTS

The mean aqueous flare was 6.3 photons/ms +/- 3.0 (SD) (range 4.0 to 12.2 photons/ms) 1 day postoperatively, with 64% of patients having normal aqueous flare values (<8.0 photons/ms). One week after surgery, the mean aqueous flare was 5.3 +/- 2.8 photons/ms (range 2.0 to 10.5 photons/ms). Four weeks postoperatively, aqueous flare was normal in all patients and remained stable below the normal limit for up to 6 months (mean 3.3 +/- 1.2 months; range 2.0 to 5.4 months). The number of aqueous cells did not increase at any follow-up and was normal in all eyes. No postoperative complications such as fibrin formation, synechias, macrophages on the IOL optic, or endophthalmitis were observed.

CONCLUSIONS

Phacoemulsification with implantation of the 1CU accommodative IOL led to minimal and short-lasting BAB alteration. No signs of persistent inflammation or pigment dispersion were detected.

Intraocular lens designed for the newborn infant eye

PURPOSE

To evaluate the effects of an intraocular lens (IOL) designed for small eyes after clear lens extraction in an animal model.

SETTING

St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden.

METHODS

Clear lens extraction was performed in both eyes in 19 3-week-old rabbits. In 1 randomly selected eye of each rabbit, a small IOL with long haptics was implanted. Axial length, corneal thickness, corneal diameter, and intraocular pressure were measured preoperatively and every month for 6 months postoperatively. Six months after surgery, the wet mass of the after-cataract was determined.

RESULTS

The IOL remained well centered in all eyes. Four animals developed severe glaucoma in 5 eyes (3 aphakic and 2 pseudophakic) soon after surgery and were excluded. In the 15 animals completing the study, signs of glaucoma evolved in 7 animals (5 aphakic and 4 pseudophakic eyes). In aphakic eyes, significant amounts of after-cataract (median 250 mg) developed in all 15 surviving animals. In pseudophakic eyes, small amounts of after-cataract (median 30 mg) were present. During the first 2 months after surgery, ocular growth was less in pseudophakic eyes than in aphakic eyes.

CONCLUSIONS

Results indicate that implantation of a down-sized IOL with long haptics in small eyes is safe. Considerable less after-cataract was found in eyes with the IOL than in aphakic control eyes.

Inflammation after phacoemulsification in diabetic retinopathy. Foldable acrylic versus heparin-surface-modified poly(methyl methacrylate) intraocular lenses

PURPOSE

To evaluate inflammation after cataract surgery in patients with nonproliferative diabetic retinopathy (NPDR) and compare results with 2 intraocular lenses (IOLs): a foldable hydrophobic acrylic and a heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA).

SETTING

Department of Ophthalmology, University of Vienna, Vienna, Austria.

METHODS

Patients with NPDR were randomized for implantation of an HSM PMMA IOL (811C, Pharmacia) through a 6.0 mm sclerocorneal incision (30 patients) or a foldable hydrophobic acrylic IOL (AcrySof, Alcon) through a 4.0 mm sclerocorneal incision (32 patients). Both IOLs had 6.0 mm optics. All patients were treated according to a standardized protocol. The degree of flare in the anterior chamber was measured with the Kowa 1000 laser flare-cell meter 1 day preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively.

RESULTS

In both IOL groups, flare was highest on the first postoperative day and decreased to preoperative levels by 3 months after surgery. There was no statistically significant difference in relative flare values between the 2 groups.

CONCLUSION

There was no difference in postoperative inflammation in eyes with a foldable hydrophobic acrylic IOL implanted through a small incision and those with a rigid HSM PMMA IOL. Postoperative inflammation results indicate that the lenses are equally suitable for the use in patients with diabetic retinopathy.

Daily tonometric curves after cataract surgery

AIM

To evaluate daily tonometric curves after cataract surgery in patients with cataract only and in patients with cataract and glaucoma.

METHODS

108 patients scheduled for cataract surgery were randomly allocated to two groups: 57 patients with cataract only (normal) and 51 with cataract and primary open angle glaucoma (POAG). All patients underwent extracapsular cataract extraction (ECCE) (manual technique with long wound), phacoemulsification (automated technique with short wound), or nucleus capture (manual technique with short wound). Intraocular pressure (IOP) was measured by Goldmann tonometry in all patients every 2 hours for 12 hours before the operation and at 1 and 6 months postoperatively.

RESULTS

79 patients completed the 6 month examination. ECCE resulted in greater reductions in IOP than the other procedures (ECCE: 27% and 36% in normal patients and those with POAG, respectively; nucleus capture: 20% and 31%, respectively; phacoemulsification: 19% and 22%, respectively). The fluctuations in IOP before and after surgery were not statistically significant.

CONCLUSION

Cataract surgery in normal patients reduces IOP but does not eliminate fluctuations which are directly proportional to the IOP value and result partly from circadian rhythms. This important finding might influence our approach to treatment of patients with glaucoma.

Silicone intraocular lens implantation in children: preliminary results

PURPOSE

To evaluate the safety and outcome of foldable silicone intraocular lens (IOL) implantation in children.

SETTING

Department of Ophthalmology, University of Giessen, Giessen, Germany.

METHODS

The results of cataract extraction and silicone IOL implantation in children having surgery between 1992 and 1997 were retrospectively analyzed in 8 eyes (7 patients). All IOLs were implanted in the capsular bag through a 3.5 mm clear corneal incision. In 4 eyes, primary posterior capsulectomy and anterior vitrectomy were performed.

RESULTS

Mean patient age at the time of surgery was 5.1 years (range 8 months to 15 years). The surgeries were uneventful. All IOLs remained anatomically stable and well centered during the mean follow-up of 29.6 months (range 18 to 46 months). Postoperative inflammatory reaction was minimal. Neither fibrinoid exudation nor posterior synechias occurred postoperatively. Postoperative best spectacle-corrected visual acuity ranged from 20/800 to 20/20. All eyes with an intact posterior capsule developed posterior capsule opacification. In the 4 eyes that had primary posterior capsulectomy and anterior vitrectomy, the visual axis remained clear.

CONCLUSIONS

These preliminary results suggest that silicone IOL implantation in children is a safe procedure with good and stable short-term anatomic results. Longer follow-up is necessary to answer questions about the long-term safety of silicone lens implantation in a child's eye.

Ocular biocompatibility testing of intraocular lenses: a 1 year study in pseudophakic rabbit eyes

PURPOSE

To evaluate the appropriate duration for conducting ocular biocompatibility studies with an intraocular lens (IOL) in the pseudophakic rabbit model.

SETTING

Alcon Laboratories, Inc., Fort Worth, Texas, USA.

METHODS

A single-piece biconvex poly(methyl methacrylate) (PMMA) IOL was implanted in the capsular bag of 18 eyes of New Zealand white rabbits; 8 eyes received sham surgeries. Rabbits were monitored clinically and then sacrificed 6 or 12 months after surgery for histopathological examination of ocular tissues.

RESULTS

Biomicroscopic examination revealed mild ocular changes in all surgical eyes during the first 3 months postoperatively. After that, there was a high incidence of posterior synechias, flare, and posterior capsule opacification (PCO) in eyes with PMMA IOLs. Posterior synechias and flare scores remained mild to moderate throughout the study, whereas PCO severity increased over time. Similar findings were observed in sham eyes. In addition, several eyes with PMMA IOLs developed IOL dislocation, hyphema, iris bombe, and a fibrous membrane covering the IOL. No discernible differences in biomicroscopic scores were observed in eyes at 6 or 12 months. Intraocular pressures and morphology of the corneal endothelium were normal in both groups. Results from histopathological analysis of the ocular tissues were consistent with observations from the biomicroscopic examinations.

CONCLUSION

The results suggest that IOL implantation studies in the pseudophakic rabbit eye should be conducted for 3 or fewer months. Regulatory guidelines requiring longer ocular implantation studies should be revised to reflect the inherently rapid and extensive ocular response in the rabbit model.

Posterior capsule opacification after phacoemulsification in patients with diabetes mellitus

PURPOSE

To compare posterior capsule opacification (PCO) after phacoemulsification and implantation of heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) in the capsular bag in patients with diabetes mellitus with that in a control group.

SETTING

St. Erik's Eye Hospital, Stockholm, Sweden.

METHODS

This prospective study comprised 26 patients with diabetes mellitus and 26 control patients without diabetes. Those with glaucoma, exfoliation syndrome, uveitis, and pupil size smaller than 6.0 mm after dilation were excluded. All patients received the same standardized phacoemulsification procedure with implantation of an HSM PMMA IOL in the capsular bag. Posterior capsule opacification was scored 1 and 2 years after surgery by evaluating retroillumination images taken with a Scheimpflug camera (Nidek Anterior Eye Segment Analysis System) after pupil dilation with phenylephrine 10% and cyclopentolate 1%. The PCO density behind the IOL optic was graded clinically from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, 4 = severe) and scored using the Evaluation of Posterior Capsule Opacification medical software developing system.

RESULTS

No differences in PCO were found between the diabetic and control groups 1 year after surgery. The total PCO score was significantly less in diabetic than in control eyes 2 years after surgery (P < .05, Mann-Whitney). In addition, progression of PCO from 1 year to 2 years after surgery was significantly less in diabetic groups with different stages of diabetic retinopathy than in the control group (P < or = .05, Kruskal-Wallis analysis of variance and multiple comparisons).

CONCLUSION

The rate of PCO after phacoemulsification was statistically significantly lower in patients with diabetes mellitus than in those without diabetes.

Posterior continuous curvilinear capsulorhexis and postoperative inflammation

PURPOSE

To evaluate the influence of posterior continuous curvilinear capsulorhexis (PCCC) on inflammation after phacoemulsification and implantation of a foldable silicone intraocular lens (IOL) in the capsular bag.

SETTING

St. Erik's Eye Hospital, Stockholm, Sweden.

METHODS

Fifty patients were enrolled in this prospective, randomized study. Eyes with diabetes mellitus, glaucoma, uveitis, exfoliation syndrome, other previous ocular diseases, or an axial length greater than 26.0 mm were excluded. One group comprised 25 eyes of 25 patients (median age 76 years) in which phacoemulsification and implantation of a silicone IOL in the capsular bag were performed. The other group consisted of 25 eyes of 25 patients (median age 77 years) who received the same surgical procedure in addition to PCCC. The aqueous protein concentration was measured using a laser flare meter (FC 500, Kowa Co.) preoperatively and 1 day, 1 week, and 1 and 3 months after surgery.

RESULTS

Surgical trauma significantly increased aqueous flare values 1 day, 1 week, and 1 month after surgery in both groups (P < .05). Three months postoperatively, flare values in both groups were not different from preoperative values. No difference between the 2 groups was found in flare intensity measurements or in best corrected visual acuity before and after uneventful surgery. The incidence of postoperative clinical cystoid macular edema was 8% (2 eyes) in the control group and 4% (1 eye) in the group with PCCC.

CONCLUSION

Postoperative flare intensity after phacoemulsification with PCCC and implantation of a foldable silicone IOL was not significantly different than postoperative flare measurements in a control group.

Aqueous flare intensity after phacoemulsification in patients with diabetes mellitus

PURPOSE

To prospectively compare the postoperative blood-aqueous barrier breakdown induced by phacoemulsification and implantation of a heparin-surface-modified poly(methyl methacrylate) intraocular lens in the capsular bag in eyes with different stages of diabetic retinopathy (DR) and a control group.

SETTING

St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden.

METHODS

Aqueous flare intensity was measured preoperatively and 1 day, 1 week, and 3 months postoperatively in 21 nondiabetic control patients (Group 1), 20 diabetic patients with no or mild-moderate nonproliferative DR (Group 2), and 19 diabetic patients with advanced DR (moderate-severe, severe nonproliferative, and proliferative DR) who were divided into groups: without clinically significant macular edema (CSME), 7 eyes (Group 3), and with CSME, 12 eyes (Group 4).

RESULTS

Before surgery, flare intensity in Group 4 was significantly higher than in Groups 1 and 2 (P < .05). Surgical trauma increased flare values 1 day postoperatively in all groups. One week after surgery, Groups 1 and 4 had flare intensity significantly higher than preoperatively (P < .05). Recovery of flare occurred 3 months postoperatively in all groups except Group 2, in which it occurred 1 week after surgery. One day postoperatively, only Group 4 had significantly higher flare than Group 1 (P < .05). One week and 3 months after surgery, Group 4 had significantly higher flare intensity than Groups 1 and 2 (P < .05). The duration of phacoemulsification in Groups 2 and 4 was significantly longer than in Group 1 (P < .05). Operating time was significantly longer than in Group 1 only in Group 4 (P < .05).

CONCLUSION

Eyes with advanced stages of DR and with CSME had the highest flare intensity after cataract surgery.

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.