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Associations in corticocapsular adhesions. Eye (Lond) 2022; 36:193-197. [PMID: 33674725 PMCID: PMC8727579 DOI: 10.1038/s41433-021-01482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine the patient-related factors that contribute to intraoperative corticocapsular adhesions (CCA) during phacoemulsification cataract extraction (PCE). METHODS Prospective, single surgeon, multi-year study of consecutive patients undergoing PCE was performed. At the conclusion of each procedure, the surgeon recorded the CCA and perceived surgeon stress score. Patient variables included gender, age, diabetes mellitus, intake of oral alpha blockers, floppy iris, laterality, pseudo-exfoliation, and intraocular lens power. RESULTS During the 10-year study, 1097 eyes underwent surgery and CCA was diagnosed intraoperatively in 41 eyes. On multi-variable analysis, the following patient characteristics were associated with intraoperative CCA: diabetes mellitus (p = 0.002), age >80 years (p = 0.002), presence of posterior capsular cataract (p = 0.046), severe nuclear sclerosis (p = 0.004), and absence of pseudo-exfoliation (p = 0.043). CONCLUSION Diabetes mellitus, advanced age and posterior subcapsular cataract are associated with CCA necessitating generous repetitive hydrodissection.
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Agarwal R, Dhull C, Siddhu N, Jain V, Sharma N. Sinskey hook and viscoelastic assisted posterior capsular plaque extraction. Indian J Ophthalmol 2020; 68:2202-2204. [PMID: 32971641 PMCID: PMC7727962 DOI: 10.4103/ijo.ijo_2013_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Posterior capsule plaques (PCPs) are a rare cause of suboptimal vision after eventless cataract surgery. While these can be managed with posterior capsulotomy, violation of the posterior capsular integrity and associated vitreous disturbances may lead to sight-threatening complications. Viscoseparation and peeling of PCPs with the aid of retinal end-grasping forceps and irrigation and aspiration have also been described in adults for getting rid of PCPs with minimal disturbance of PC and vitreous. While Sinskey hook (SH) has been used to peel PCPs in children, the combined use of SH with viscoseparation for removal of PCP, particularly for adults, remains vaguely described in the literature. Presently, we describe a method of SH and viscoelastic assisted PCP extraction (SVAPE) in adult eyes with centrally located PCPs.
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Affiliation(s)
- Rinky Agarwal
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chirakshi Dhull
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Navneet Siddhu
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vatika Jain
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Mavrommatis MA, Friedman AH, Fowkes ME, Hefti MM. Aicardi syndrome in a 20-year-old female. Am J Ophthalmol Case Rep 2018; 12:61-64. [PMID: 30238067 PMCID: PMC6143771 DOI: 10.1016/j.ajoc.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/12/2018] [Accepted: 09/04/2018] [Indexed: 01/28/2023] Open
Abstract
Purpose To describe an unusual case of Aicardi Syndrome that both affirms hallmark characteristics of the condition and introduces new observations. Observations We report the case of a 20-year-old woman with Aicardi Syndrome who presented in respiratory distress with bradycardia and died soon thereafter. She had a history of severe mental retardation, seizure disorder, advanced scoliosis and numerous contractures in addition to congenital ocular malformations resulting in bilateral blindness. The case is notable for her age and longevity, as most patients with Aicardi Syndrome expire much younger, as well as the presence of intact nuclei under the posterior lens capsule. Conclusions and importance Aicardi Syndrome is a rare X-linked cerebro-retinal disorder typified by seizures, agenesis of the corpus callosum, and chorioretinal lacunae. Documenting alterations from and additions to this triad of symptoms is critical to better understanding both the syndrome itself, as well as the full breadth of its clinical impact on the patient.
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Affiliation(s)
- Maria A Mavrommatis
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Alan H Friedman
- Department of Ophthalmology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA.,Department of Pathology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA
| | - Mary E Fowkes
- Department of Pathology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA
| | - Marco M Hefti
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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Manual Removal of Primary Posterior Capsular Plaques Using Retinal End-Grasping Forceps. Ophthalmol Ther 2017; 6:351-353. [PMID: 28936713 PMCID: PMC5693825 DOI: 10.1007/s40123-017-0108-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 11/06/2022] Open
Abstract
Introduction Primary posterior capsular plaques can be highly adherent to the posterior capsule leading to possible posterior capsular rupture during attempted removal. Here we describe a novel method for posterior capsular plaque removal using a technique inspired by the experience of retina surgeon in the peeling of membranes from the posterior pole. Methods Retinal end-grasping forceps were used to peel the plaque from the posterior capsule. Results We have performed this technique on 12 eyes with successful removal of the posterior capsular plaque in all instances without compromise of the posterior capsule in any case. Conclusions We hope that the anterior segment surgeons will benefit by employing this useful technique during cataract surgeries in the eyes with adherent posterior plaques.
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Kim EY, Kim SY, Lee YC, Kim SY. Incidence and Risk Factors of Nd:YAG Capsulotomy in Adult Cataract Patients under 50 Years of Age According to Different Age Groups. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.6.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eun Yeong Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Chun Lee
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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The change in axial length in the pseudophakic eye compared to the unoperated fellow eye in children with bilateral cataracts. J AAPOS 2014; 18:173-7. [PMID: 24698616 DOI: 10.1016/j.jaapos.2013.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/27/2013] [Accepted: 12/22/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the change in ocular axial length of the pseudophakic eye versus the fellow eye in children with bilateral cataracts who had surgery in only one eye. METHODS In this prospective cohort study, 50 eyes of 25 children with bilateral lamellar cataracts were analyzed. A complete ophthalmic examination and evaluation of axial length measurements by contact ultrasound biometry were performed in all eyes undergoing cataract surgery with IOL implantation and in contralateral eyes. The primary outcome measure was the percentage rate of growth between the final and initial measurements, defined as the initial minus the final measurement, with the difference being divided by the initial measurement and the result multiplied by 100. RESULTS Children aged 4-10 years of age were followed for a mean of 28.5 months. The values for axial length percentage rate of growth were significantly lower in pseudophakic eyes than in the unoperated, contralateral eyes (0.64% vs 2.09%, P < 0.05). Final visual acuity, follow-up time, and initial axial length did not affect the results. Pseudophakic eyes with posterior capsule opacification that underwent neodymium YAG laser showed a significantly higher rate of growth than unoperated eyes. CONCLUSIONS Axial length in children older than 4 years showed a trend toward stabilization, with lower changes in axial length measurements in pseudophakic eyes and a higher rate of axial growth in contralateral eyes.
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Vasavada AR, Raj SM, Shah GD, Nanavaty MA. Posterior capsule opacification after lens implantation: incidence, risk factors and management. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.80] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Joshi RS. Primary posterior capsular opacification in Indian rural population undergoing cataract surgery for hypermature senile cataract. Clin Ophthalmol 2013; 7:1605-8. [PMID: 23966767 PMCID: PMC3745297 DOI: 10.2147/opth.s49396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To find out the incidence of primary posterior capsular opacification (PCO) in rural patients with a hypermature senile cataract undergoing cataract surgery. SETTINGS Tertiary eye care center in central India. DESIGN Prospective, observational, noncomparative study. MATERIALS AND METHODS Two-hundred eyes of 200 patients presenting with a hypermature cataract underwent manual small incision cataract surgery. A single surgeon performed all surgeries under peribulbar anesthesia. After cortical clean-up, the capsular bag was inflated with viscoelastic. The presence or absence of opacity on the posterior lens capsule and location was noted. Postoperative follow-up was done for visual acuity and need for neodymium-doped yttrium aluminum garnet (ND:YAG) laser capsulotomy. RESULTS Primary PCO occurred in 76 eyes (incidence of 38%). It was peripheral in 58 eyes (76.3%) and central in 18 eyes (23.7%). At 6 weeks postoperatively, best corrected visual acuity for eyes with central primary PCO (n = 18) was 0.2-0.3 logMAR and 0-0.2 logMAR for eyes with peripheral primary PCO (n = 58). Best corrected visual acuity at the 6- and 12-month follow-up was 0-0.2 logMAR in both groups. Fibrotic primary PCO was seen in four patients. No predilection for the development of primary PCO to a particular quadrant of posterior capsule was observed. At 1 year postoperatively, eleven (14.5%) patients required ND:YAG laser capsulotomy, six (7.90%) of whom underwent ND:YAG laser capsulotomy at the 6-month follow-up. Seven patients with central primary PCO and four patients with peripheral primary PCO required ND:YAG laser capsulotomy. CONCLUSION A high incidence of primary PCO was noted in rural patients with a hypermature senile cataract undergoing cataract surgery. No serious intraoperative complications were noted. Visual outcome at 1-year follow-up was satisfactory. Need for early ND:YAG laser posterior capsulotomy should be explained to these patients before cataract surgery. No post ND:YAG capsulotomy complications were noted in any patient.
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Affiliation(s)
- Rajesh Subhash Joshi
- Department of Ophthalmology, Vasatrao Naik Government Medical College, Yavatmal, India
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Ashraf KM. Primary posterior capsular opacification in hypermature white cataracts. J Cataract Refract Surg 2011; 36:2211-2. [PMID: 21111329 DOI: 10.1016/j.jcrs.2010.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Indexed: 11/15/2022]
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Praveen MR, Shah SK, Vasavada AR, Vasavada VA, Asnani PK, Anwar I, Trivedi RH. Incidence, management, and postoperative outcomes in pediatric eyes with coexisting posterior capsule plaque and cataract. J Cataract Refract Surg 2010; 36:2094-9. [DOI: 10.1016/j.jcrs.2010.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 06/30/2010] [Accepted: 07/08/2010] [Indexed: 11/17/2022]
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Biró Z, Kereskai L, Tsorbatzoglou A, Vasavada AR, Berta A. Histological examination of primary posterior capsule plaques. J Cataract Refract Surg 2007; 33:439-42. [PMID: 17321394 DOI: 10.1016/j.jcrs.2006.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2006] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To understand the source and evolution of the cellular elements of posterior capsule plaques. SETTING Department of Ophthalmology, University of Sciences, Faculty of Medicine, Pécs, Hungary. METHODS In 24 eyes of 24 patients, the primary fibrotic plaques were carefully peeled off the posterior capsule with forceps and sent for histological examination. The samples were stained with hematoxylin-eosin and with picrosirius to demonstrate collagen content. RESULTS Most plaques were found in elderly patients with mature cataracts. However, one was found in a patient with congenital cataract. The histological examination revealed different stages of plaques, permitting discrimination of early (cellular), transitional, and late (fibrotic) stages. The plaques in the early stage contained cuboidal cells with nuclei; collagen deposition led to the development of the transitional stage; and further collagen deposition led to the fibrotic stage. There was no significant correlation between the maturity of the cataract and the plaque stage, but other factors such as previous eye surgery (vitrectomy, glaucoma surgery), long-standing diabetes mellitus (DM), and a high degree of myopia appeared to contribute to the development of plaques. CONCLUSIONS Primary posterior capsule plaques were found primarily in elderly patients with mature cataracts but were also present post vitrectomy in those who had DM from a young age and had early stages of cataract. In the early plaque stage, cells with nuclei were found. It follows that plaques are capable of proliferation at this stage, aggravating visual disturbance. Therefore, removing the plaques by peeling from the posterior capsule or by posterior capsulorhexis during surgery is suggested.
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Affiliation(s)
- Zsolt Biró
- From the Department of Ophthalmology, University of Sciences, Faculty of Medicine, Pécs, Medical University of Debrecen, Hungary.
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Dholakia SA, Vasavada AR, Singh R. Prospective evaluation of phacoemulsification in adults younger than 50 years. J Cataract Refract Surg 2005; 31:1327-33. [PMID: 16105602 DOI: 10.1016/j.jcrs.2004.11.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2003] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate intraoperative performance and long-term outcome of phacoemulsification in patients younger than 50 years. SETTING Iladevi cataract and IOL Research Centre, Ahmedabad, India. METHODS A prospective observational study was conducted comprising 54 patients (35 men and 19 women) under age 50 who had phacoemulsification. Preoperative evaluation included specular microscopy. Phacoemulsification with implantation of an AcrySof MA30BA intraocular lens (IOL) was performed. Intraoperatively, peripheral extension of capsulorhexis, intraoperative posterior capsule opacification (PCO; plaque), and serious complications (eg, posterior capsule rupture, vitreous loss) were noted. Postoperatively, endothelial cell loss, postoperative PCO, neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate, and best corrected visual acuity (BCVA) were assessed for 3 years. Patients with intraoperative PCO were analyzed separately. RESULTS Mean patient age was 42.7 years +/- 5.2 SD (men) and 43.1 +/- 3.25 years (women). Continuous curvilinear capsulorhexis was achieved in 49 patients (90.7%). Intraoperative PCO was present in 14 (25.92%) patients. An Nd:YAG laser posterior capsulotomy was performed in 4 patients (28.5%). Posterior capsule rupture leading to vitreous loss occurred in 1 patient (1.85%). At 3-year follow-up, endothelial cell loss was 5.9%. Postoperative PCO developed in 8 patients (22.2%), and Nd:YAG laser posterior capsulotomy was performed in 5 patients (13.8%). The BCVA was > or = 20/40 in 47 patients (94%). CONCLUSION Young patients pose a challenge in creating a capsulorhexis and display significant incidence of intraoperative and postoperative PCO.
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Affiliation(s)
- Sheena A Dholakia
- Iladevi Cataract and IOL Research Centre, Gurukul Road, Memnagar, Ahmedabad, India
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Ermisş SS, Oztürk F, Inan UU. Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts. Br J Ophthalmol 2004; 87:1356-9. [PMID: 14609833 PMCID: PMC1771891 DOI: 10.1136/bjo.87.11.1356] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To compare the intraoperative difficulty and postoperative outcome in patients who have white mature cataract in one eye and other types of senile cataract in the other eye undergoing clear corneal phacoemulsification and foldable intraocular lens implantation. METHODS 82 patients who had white mature cataract in one eye, posterior subcapsular, cortical, nuclear, or mixed type cataract in the other eye were enrolled in this prospective study. Postoperative outcomes, intraoperative difficulties related to capsulorhexis, and phacoemulsification were analysed between the two groups of eyes. Postoperative examinations were done at 1 day, 1 week, 1 and 3 months. RESULTS Postoperative visual acuity, central corneal thickness, intraocular pressure, and rate of posterior capsule rupture were not significantly different between the two group of eyes (p>0.05). Mean effective phaco time, frequency of postoperative corneal oedema and posterior capsular plaque were found to be significantly higher in the mature cataract group (p<0.05). CONCLUSIONS A one stage, 5 mm continuous capsulorhexis was achieved using trypan blue and generous amounts of retentive viscoelastic agent in eyes with white mature cataract. Intraoperative difficulties and postoperative outcome of clear corneal incision phacoemulsification surgery and foldable intraocular lens implantation were similar in white mature and other types of senile cataract. Topical anaesthesia in phacoemulsification of eyes with white mature cataract is safe and well tolerated.
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Affiliation(s)
- S S Ermisş
- Department of Ophthalmology, School of Medicine, University of Afyon Kocatepe, Afyon, Turkey.
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Vasavada AR, Singh R, Apple DJ, Trivedi RH, Pandey SK, Werner L. Effect of hydrodissection on intraoperative performance: randomized study. J Cataract Refract Surg 2002; 28:1623-8. [PMID: 12231323 DOI: 10.1016/s0886-3350(01)01252-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the effect of hydrodissection on intraoperative performance during phacoemulsification of age-related nuclear cataracts. SETTING Iladevi Cataract & IOL Research Centre, Ahmedabad, India, and Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS In a prospective study, 86 eyes were randomly assigned to have multiquadrant hydrodissection (+HD, n = 48) or no hydrodissection (-HD, n = 38) during phacoemulsification of a grade 1 to 3 nuclear cataract. Excluded were patients with grade 4 or 5 nuclear sclerosis, a poorly dilating pupil, or associated ocular/systemic disease. Parameters assessed were nucleus and cortex removal time, the amount of fluid used for cortex removal, and the total amount of fluid used. The ease of nucleus rotation and cortical cleanup was also evaluated and graded subjectively as very easy, difficult, or very difficult. Data were analyzed using the Student t test and the chi-square test. RESULTS The mean nucleus removal time was 355 seconds +/- 237 (SD) and 474 +/- 212 seconds in the +HD and -HD groups, respectively (P =.09). The mean cortex removal time was significantly less in the +HD group than in the -HD group (79 +/- 51 seconds and 220 +/- 222 seconds, respectively) (P =.007). Significantly less fluid (43%) was used for cortex removal in the +HD group than in the -HD group (mean 70 +/- 45 mL and 123 +/- 82 mL, respectively) (P =.013), and significantly less total fluid (35%) was used in the +HD group (312 +/- 132 mL and 422 +/- 80 mL, respectively) (P =.002). Nucleus rotation was easy in all eyes in the +HD group; 68.43% of eyes in the -HD group failed to achieve rotation (P =.001). Cortex removal was very easy in 52.08% of eyes in the +HD group and easy in 47.90%; it was easy in 52.63% in the -HD group, difficult in 36.84%, and very difficult in 10.52%. CONCLUSION The use of multiquadrant cortical-cleaving hydrodissection made removal of the lens nucleus and cortex easier and faster during phacoemulsification of age-related nuclear cataracts.
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Affiliation(s)
- Abhay R Vasavada
- Iladevi Cataract & IOL Research Centre, Memnagar, Ahmedabad, India.
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Abstract
Any breach in the continuity of the posterior capsule is defined as a posterior capsule tear. Posterior capsule tears can be preexisting (congenital or traumatic), spontaneous, or intrasurgical. Preexisting/congenital posterior capsule tears have been related to an intrauterine insult. Posterior capsule tears due to trauma may occur as a consequence of direct mechanical impact due to perforation or blunt injury. Depending on the duration of time between the posterior capsular trauma and the cataract surgery, these posterior capsule tears can have different features. Intrasurgical posterior capsule tears are the most common and can occur during any stage of cataract surgery. Also, they may be planned in the form of primary posterior capsulorhexis. The conventional management consists of prevention of mixture of cortical matter with vitreous, dry aspiration, and anterior vitrectomy, if required. In addition, during phacoemulsification low flow rate, high vacuum, and low ultrasound are advocated if a posterior capsule tear occurs. Dislocated nucleus or nuclear fragments require vitrectomy and the use of perfluorocarbon liquids. In the presence of a posterior capsule tear, the IOL can be placed in the sulcus, if the capsular rim is available, or in the bag, if the tear is small. Scleral fixated posterior chamber lenses and anterior chamber IOLs can be implanted when the posterior capsule tear is large.
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Affiliation(s)
- R B Vajpayee
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Colitz CM, Malarkey D, Dykstra MJ, McGahan MC, Davidson MG. Histologic and immunohistochemical characterization of lens capsular plaques in dogs with cataracts. Am J Vet Res 2000; 61:139-43. [PMID: 10685684 DOI: 10.2460/ajvr.2000.61.139] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine histologic and immunohistochemical characteristics of the multifocal adherent plaques that commonly develop on the internal surfaces of the anterior and posterior lens capsules in dogs with cataracts. SAMPLE POPULATION 31 anterior and 4 posterior capsular specimens collected during lens extraction surgery in dogs with cataracts. PROCEDURE Specimens were evaluated, using light and transmission electron microscopy. Immunohistochemical techniques were used to localize cytokeratin, vimentin, alpha-smooth muscle-specific actin, fibronectin, tenascin, and transforming growth factor-beta (TGF-beta) within plaques. RESULTS Histologically, plaques comprised elongated spindle-shaped cells that formed a placoid mass. Cells were embedded in an extracellular matrix containing collagen fibrils, often with duplicated or split basement membranes. Immunohistochemically, normal lens epithelial cells and cells within plaques stained for vimentin. Most cells and some areas of the extracellular matrix within plaques stained for TGF-beta and alpha-smooth muscle-specific actin. Fibronectin and tenascin were also detected in the extracellular matrix. CONCLUSIONS AND CLINICAL RELEVANCE Canine lens capsular plaques are histologically and immunohistochemically similar to posterior capsule opacification and subcapsular cataracts in humans, which suggests that the canine condition, like the human conditions, is associated with fibrous metaplasia of lens epithelial cells. Transforming growth factor-beta may play a role in the genesis of capsular plaques. Because severity of plaques was correlated with stage of cataract development, earlier surgical removal of cataracts may be useful to avoid complications associated with plaque formation.
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Affiliation(s)
- C M Colitz
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh 27606, USA
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Abstract
PURPOSE To find the incidence, contributing factors, outcomes, and clinical impact of intraoperative posterior capsule striae. SETTING Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS In a prospective study, 100 consecutive eyes had phacoemulsification and intraocular lens (IOL) (AcrySof MA30BA) implantation. The presence of striae was noted at the end of the operation, and factors contributing to their development were identified. Follow-up was done at regular intervals, and the clinical impact of striae on patients' vision was evaluated. RESULTS Striae were observed in 56 eyes (Group 1) but were absent in 44 (Group 2). Mean age in Group 1 was 65.96 years +/- 9.15 (SD) and in Group 2, 59.20 +/- 10.36 years (P = .0012). Mean axial lengths were 23.47 +/- 1.63 and 24.12 +/- 1.49 mm, respectively (P = .0419). Average lens thickness was greater in Group 1 (4.50 +/- 0.43 mm) than in Group 2 (4.13 +/- 0.41 mm) (P = .0001). The sex of patient, capsulorhexis size and centration, grade of cataract hardness, scleral rigidity, and IOL centration were not found to contribute to striae development. The striae disappeared by 5 months postoperatively and did not show a positive Maddox rod phenomenon. CONCLUSION Intraoperative striae observed in many patients were associated with relatively older age, greater lens thickness, and shorter axial length. The striae eventually disappeared and had no effect on vision.
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Affiliation(s)
- A R Vasavada
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
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Brazitikos PD, Tsinopoulos IT, Papadopoulos NT, Fotiadis K, Stangos NT. Ultrasonographic classification and phacoemulsification of white senile cataracts. Ophthalmology 1999; 106:2178-83. [PMID: 10571356 DOI: 10.1016/s0161-6420(99)90502-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To classify the white senile cataracts and report the results of phacoemulsification of white cataracts. DESIGN Prospective, noncomparative case series. PARTICIPANTS One hundred eyes were included. INTERVENTION White cataracts were examined biomicroscopically before surgery, and their acoustic structure was analyzed with standardized A-scan echography. White cataract surgery was performed with phacoemulsification via a superior temporal near-limbus corneal approach using a bimanual divide-and-conquer or stop-and-chop technique. Patients were followed after surgery for a period of 9 months. MAIN OUTCOMES MEASURES The A-scan acoustic structure of white cataracts; successful accomplishment of capsulorrhexis; mean phacoemulsification time, power, and energy; intraoperative and postoperative complications of phacoemulsification; and visual acuity at 9 months after surgery. RESULTS White senile cataracts were categorized into three different types. Type I included intumescent, white cataracts with cortex liquefaction and high internal acoustic reflections (44 eyes), type II included white cataracts with voluminous nuclei, little amount of whitish solid cortex, and low internal acoustic reflections (49 eyes), and type III included white cataracts with fibrosed anterior capsule and low internal echospikes (7 eyes). Circular capsulorrhexis was completed in 79 eyes and was significantly less successful in eyes with type I intumescent, white cataracts compared with type II white cataracts (P = 0.0034). Mean phacoemulsification time and energy were higher in type II and type III white cataracts. Posterior capsule rupture occurred in ten eyes, and three of these eyes were complicated by vitreous loss. In 95 eyes, the posterior chamber lens was implanted in the capsular bag and in five eyes in the sulcus. After surgery, a transient corneal edema developed in 31 eyes. At the final 6-month examination, the mean postoperative visual acuity was 20/30. CONCLUSION Current phacoemulsification techniques can safely manage eyes with senile white cataracts. The increased risk of difficulty with continuous capsulorrhexis in type-I and type-III white cataracts and the substantial nuclear hardness in type-II and mainly type-III white cataracts would suggest that current phacoemulsification techniques might not be as successful in these patients as they are in ordinary earlier cataracts.
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Affiliation(s)
- P D Brazitikos
- Department of Ophthalmology, Aristotle University of Thessaloniki, Greece.
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Abstract
Posterior-capsule opacification, by far the most common complication of primary cataract surgery, continues to stimulate important work toward understanding its causes, preventing it, and effectively treating it. Of special note here are a report by Koch and Kohnen that a combination of vitrectomy and posterior capsulorhexis is required to inhibit posterior-capsule opacification in pediatric patients; work by Nishi et al. toward the dream of replacing the cataractous lens with a flexible artificial lens, supported by the natural capsular bag; and methods by Tetz et al. and Pande et al. for precise quantification of posterior-capsule opacification.
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Affiliation(s)
- J Emery
- Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030, USA
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Peng Q, Hennig A, Vasavada AR, Apple DJ. Posterior capsular plaque: a common feature of cataract surgery in the developing world. Am J Ophthalmol 1998; 125:621-6. [PMID: 9625545 DOI: 10.1016/s0002-9394(98)00032-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To study the histopathologic findings of posterior capsular plaque, a lesion that is discovered frequently in eyes undergoing cataract surgery in the developing world. METHODS Two hundred human crystalline lenses removed from 200 eyes of 200 patients who underwent intracapsular cataract extraction at Sagarmatha Choudhary Eye Hospital in Nepal were analyzed histopathologically. RESULTS Forty-nine lenses (24.5%) had a posterior capsular plaque. We confirm that the posterior plaques are composed of collagen that stains positively for Masson trichrome stain and that forms after pseudofibrous metaplasia of lens cells along the posterior capsule. The plaques form in a fashion analogous to a healing process. CONCLUSIONS We postulate that posterior capsular plaques result from posterior migration of epithelium and pseudofibrous metaplasia of lens epithelium. Most of the posterior capsular plaques are minute and not likely to affect vision. However, a small percentage of plaques are thicker and are likely to impair vision after extracapsular cataract surgery.
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Affiliation(s)
- Q Peng
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston 29425-2236, USA
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Abstract
PURPOSE To evaluate the intraoperative difficulties associated with phacoemulsification of white mature cataracts and develop a strategy for consistently achieving continuous curvilinear capsulorhexis (CCC) in these cases. SETTING Raghudeep Eye Clinic, Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS This prospective study comprised 60 eyes of 60 patients with senile white mature cataract. Mean follow-up was 7 months. Detailed preoperative and intraoperative notes were made including intraoperative subjective assessment of the intracapsular pressure and cataract hardness. A small capsulorhexis was attempted initially. Endophacoemulsification was performed using the stop, chop, chop, and stuff technique. The capsulorhexis was enlarged before intraocular lens implantation. An initial cut in the capsulorhexis margin was made with a cystotome needle while a spatula supported the anterior capsule. The capsulorhexis was then enlarged with forceps. RESULTS A CCC was achieved in 57 eyes (95%). Intracapsular pressure was judged to be raised in 24 eyes (40%). Of these, CCC was accomplished in 21 eyes (88%). Statistical analysis confirmed that raised intracapsular pressure was a significant factor. Capsule opacification or plaque was detected at the end of the surgery in 20 eyes (33%); 50% of the nuclei were of grade 5 hardness. CONCLUSION If a CCC can be achieved, the results of white cataract phacoemulsification are comparable to those of routine cataract surgery. When using the two-stage technique, one should be prepared to deal with a hard cataract through a small capsulorhexis.
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Affiliation(s)
- A Vasavada
- Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India
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