PURPOSE: To compare the outcomes after phacoemulsification performed with the AquaLase(R) and phacoemulsification in MicroFlow(R) system, including surgically induced astigmatism (SIA), corneal endothelial cell damage and postoperative recovery of visual acuity. METHODS: The cataracts of Lens Opacities Classification System, version III (LOCS III) nuclear grade below 2 were subjected in this study. Nineteen eyes underwent cataract operation using AquaLase(R) (Alcon Laboratories, Fort Worth, Texas, U.S.A.). A control group (19 eyes) used the MicroFlow(R) system (Millenium, Stortz, U.S.A.) and was selected by matching age, sex, systemic disease, corneal astigmatism and corneal endothelial cell density. All the surgeries were performed by the same operator. SIA, corneal endothelial cell loss, visual acuity, and corneal thickness were evaluated postoperatively. RESULTS: SIA in the group using AquaLase(R) was less than that of the group using MicroFlow(R) system (P=0.022) at 2 months postoperatively. Evaluation of corneal endothelial cell loss, recovery of visual acuity and corneal thickness found no statistically significant differences between the two groups. CONCLUSIONS: Cataract surgery using AquaLase(R) induces less surgically induced astigmatism in mild to moderate cataracts.
Astigmatism/etiology ; Cataract Extraction/adverse effects/*methods/*standards ; Humans ; Phacoemulsification/adverse effects/*standards ; Prospective Studies ; Treatment Outcome

PURPOSE: This study was performed to assess efficiency and stability of astigmatic change by incision size after cataract surgery. METHODS: This work was designed as a retrospective, comparative, nonrandomized interventional study. A total of 121 cases of cataract surgery were reviewed in 98 patients performed by one surgeon at the Oregon Eye Institute in Eugene, OR, USA with 3-year follow-ups. All procedures were performed with the temporal approach of self-sealing incisions. The serial change in surgically induced astigmatisms were examined in all cases of three groups: Group A, cartridge injection of a foldable IOL through a 2.5 mm self-sealing incision; Group B, cartridge injection of a foldable IOL through a 3.0 mm self-sealing incision; Group C, cartridge injection of a foldable IOL through a 3.5 mm self-sealing incision. Keratometric data were obtained preoperatively, and 3 weeks, 3 months, 6 months, 9 months, 12 months, 24 months and 36 months postoperatively. Polar value analysis was performed to calculate the surgically induced astigmatism. RESULTS: The astigmatic change decreased over time in Group B (P<0.05). The other groups tended to remain in induced astigmatism. All groups showed anticlockwise torque at 3 weeks following surgery. Group B showed a decrease in deviation, but the other groups showed increases in their torque value at postoperative 12 months (P<0.05). CONCLUSIONS: The 3.0 mm incision size correlated with the least surgically induced astigmatism.
Retrospective Studies ; Phacoemulsification ; Lens Implantation, Intraocular ; Humans ; Cornea/*surgery ; Cataract Extraction/*adverse effects/*methods ; Astigmatism/*etiology

BACKGROUNDPhacoemulsification yields successful outcomes in eyes with standard cataract. Though techniques have been improved, it is still challenging to perform phacoemulsification in cases of hard cataracts for difficulty in nuclear management and much more complications. This study aimed at describing and evaluating the efficacy and safety of a peripheral radial chop technique to remove hard cataracts.

METHODSIn this prospective study conducted between January 2003 and January 2004, 107 consecutive eyes with hard cataract underwent modified phacoemulsification surgery with peripheral radial chop technique by the Bausch & Lomb Millennium phacoemulsifier with preset parameters of power less than 30%; vaccum, 150 mmHg; and bottle height, 85 cm when a DP8145 phaco tip was used, and vaccum, 380 mmHg; bottle height, 95 cm when a DP8245 phaco tip was used.

RESULTSThe mean ultrasonic power was 14.7% (range 9% to 19%), ultrasonic time was 1.98 minutes (range 1.55 to 3.18 minutes). At 1, 7 and 30 days postoperatively, the eyes with uncorrected visual acuity 0.5 or better accounted for 76.42%, 87.16% and 90.67% respectively. At 1 month, the endothelial cell loss rate was 9.74% (range 8% to 17%). There were 6 cases of posterior capsule rupture in an early period of study. No serious intraoperative or postoperative complications were noted.

CONCLUSIONSThe peripheral radial chop technique was effective without serious complications in hands of an experienced surgeon.

Aged ; Female ; Humans ; Male ; Middle Aged ; Phacoemulsification ; adverse effects ; methods ; Prospective Studies

BACKGROUNDTrabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract.

METHODSThis is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication.

RESULTSAfter 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59 ± 7.94) vs. (24.85 ± 14.39) mmHg, P = 0.614), complete success rate (88% vs. 71%, P = 0.370), formation rate of functioning blebs (65% (11/17) vs. 93% (13/14), P = 0.094), and complications (41% (7/17) vs. 57% (8/14), P = 0.380). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group.

CONCLUSIONPhacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

Aged ; Cataract Extraction ; Female ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Phacoemulsification ; adverse effects ; methods ; Postoperative Complications ; etiology ; Trabeculectomy ; adverse effects ; methods ; Visual Acuity

PURPOSE: The 2.2-mm microincision cataract surgery and small-gauge vitrectomy system is known to result in less surgically-induced astigmatism (SIA) in comparison to conventional surgical methods. We compared the amounts of SIA after combined phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy (23G-TSV) using the 2.2-mm microincision and 2.75-mm standard incision methods. METHODS: We studied 59 patients (61 eyes) who underwent combined phacoemulsification and 23G-TSV from November 2008 to September 2012. Twenty-eight patients (28 eyes) underwent 2.2-mm microincision coaxial phacoemulsification, and 31 patients (33 eyes) underwent 2.75-mm standard incision phacoemulsification. SIA was evaluated using Naeser's polar method with the simulated keratometric values obtained from corneal topography. Preoperative and 1-week and 1-month postoperative KP (Naeser's polar value along the specific axis) and DeltaKP values were compared between the 2.2-mm microincision and 2.75-mm standard incision groups. RESULTS: One week after surgery, both groups exhibited similar amounts of SIA (-DeltaKP[120], 0.40 +/- 0.41 vs. 0.51 +/- 0.56 diopters [D]; p = 0.390). One month after surgery, however, the amount of SIA was significantly smaller in the 2.2-mm microincision group as compared to the 2.75-mm standard incision group (-DeltaKP[120], 0.31 +/- 0.54 vs. 0.56 +/- 0.42 D; p = 0.045). CONCLUSIONS: In combined phacoemulsification with 23G-TSV, 2.2-mm microincision coaxial phacoemulsification induces less SIA than does 2.75-mm standard coaxial phacoemulsification.
Aged ; Astigmatism/diagnosis/*etiology ; *Cataract ; Cornea/surgery ; Corneal Topography/methods ; Female ; Humans ; Lens Implantation, Intraocular/*adverse effects/methods ; Male ; Middle Aged ; Phacoemulsification/*adverse effects/methods ; Postoperative Complications/diagnosis/etiology ; Sclera/surgery ; Vitrectomy/*adverse effects/instrumentation/methods

PURPOSE: To determine sequential intraocular pressure (IOP) changes after pars plana vitrectomy (PPV) with or without combined phacoemulsification and intraocular lens implantation (PE & IOL). METHODS: Consecutive patients who underwent PPV with PE & IOL (combined group) or without PE & IOL (vitrectomy group) were reviewed for postoperative sequential IOPs and the number of IOP lowering medications used. Of the 68 patients (68 eyes) who underwent simple PPV, 41 eyes were allocated to the vitrectomy group, and 27 eyes to the combined group. RESULTS: The mean IOPs were higher on postoperative days one and two, as compared to preoperative values, in both groups. The mean IOP changes on postoperative day one (10.0 mmHg vs. 5.3 mmHg, p = 0.02) and day two (3.7 mmHg vs. 1.3 mmHg, p = 0.02) were significantly higher in the combined group. CONCLUSIONS: Phacovitrectomy is associated with a higher risk of IOP elevation during the early postoperative period than PPV alone. Caution should be exercised in patients who are vulnerable to IOP fluctuations when combined surgery is indicated.
Aged ; Female ; Humans ; *Intraocular Pressure ; *Lens Implantation, Intraocular ; Male ; Middle Aged ; Phacoemulsification/*adverse effects ; *Postoperative Complications ; Risk Assessment ; Vitrectomy/*adverse effects/methods

PURPOSE: To assess the risk factors for endothelial cell loss after phacoemulsification with implantation of intraocular lens according to anterior chamber depth (ACD). METHODS: This prospective study included 94 eyes of 94 patients undergoing phacoemulsification cataract surgery. To assess the risk factors for corneal endothelial cell loss, we examined seven variables at 1 day, 1 week, 6 weeks, and 12 weeks postoperatively in each ACD-stratified group. RESULTS: Multiple linear regression analysis showed that the only variable influencing the percentage decrease in corneal endothelial cell density throughout the postoperative follow-up period in the long ACD group (ACD III) was nucleosclerosis. The variables influencing the percentage decrease in corneal endothelial cell density in the short ACD group (ACD I) at one day and one week postoperatively were corneal incisional tunnel length and nucleosclerosis. CONCLUSIONS: Risk factors for endothelial cell loss after phaoemulsification were different according to ACD. Long corneal tunnel length can be one of the risk factors for endothelial cell loss in short ACD eyes.
Anterior Chamber/ultrasonography ; Cataract/ultrasonography ; Cataract Extraction/*methods ; Cornea/pathology/surgery ; Corneal Endothelial Cell Loss/*etiology ; Humans ; Lens Implantation, Intraocular ; Phacoemulsification/*adverse effects/methods ; Prospective Studies ; Risk Factors

The purpose of this article is to report a case of nonarteritic anterior ischemic optic neuropathy (NAION) after uneventful cataract surgery. A 53-year-old Filipina underwent cataract surgery. She had a small optic disc with cup-to-disc ratio of 0.2 in the left eye and 0.3 in the right eye. On the first postoperative day, the uncorrected visual acuity (UCVA) was 20/20, with an intraocular pressure (IOP) of 20 mmHg in the left eye. At one week after operation, the UCVA was 20/20 and the IOP was 15 mmHg. Three weeks later, she underwent cataract surgery in the right eye. On the first postoperative day, her UCVA was 20/20 in both eyes, but she complained of a visual field decrease in the left eye. A relative afferent pupillary defect (RAPD) was noted and the optic disc was pallid and swollen diffusely. A red-free photo showed defect surrounding the optic disc. A visual field test showed tunnel vision sparing the central vision. In this report, the authors hypothesize an association between cataract extraction and delayed NAION. Since the risk of NAION in the fellow eye is 30-50%, visual acuity, visual field, fundus exam and RAPD should be routinely checked.
Cataract Extraction/*adverse effects/methods ; Female ; Humans ; Lens Implantation, Intraocular ; Middle Aged ; Optic Neuropathy, Ischemic/diagnosis/*etiology/*physiopathology ; Phacoemulsification ; *Visual Fields

OBJECTIVE: To evaluate the characteristics, safety and therapeutic effect of cataract phacoemulsification after vitreoretinal surgery. METHODS: We retrospectively reviewed 132 patients (132 eyes) which had phacoemulsification after vitreoretinal surgery between July 2001 and December 2004 in our hospital, among which 67 patients (50.75%) combined with silicon oil removal.We also analyzed the difficulties and complications of the surgery. RESULTS: Patients were followed up for 7-14 months.Three eyes with broken suspensory ligaments were implanted with one point transcleral fixed intraocular lens(iol).Corrected visual acuity improved in 123 patients (93.18%), no change in 6 patients (4.54%), and visual acuity loss in 3 patients (2.27%). CONCLUSION Cataract surgery is high difficult after the vitreoretinal surgery. Phacoemulsification can easily adjust and control intraocular pressure, simplify the operation,and reduce complications during and after the surgery. Silicon oil removal combined with cataract phacoemulsification is safe and economic.
Adolescent ; Adult ; Aged ; Cataract ; etiology ; Cataract Extraction ; methods ; Child ; Female ; Humans ; Male ; Middle Aged ; Phacoemulsification ; Retrospective Studies ; Vitreoretinal Surgery ; adverse effects ; Young Adult

A 60-year-old man with bilateral corneal opacity underwent cataract extraction surgery involving the use of a limbal relaxing incision in his left eye. He had lower lid ectropion and lagophthalmos in both eyes. Eleven days after the surgery, a slit-lamp examination revealed a neurotrophic corneal ulcer with a punch-out epithelial defect and rolled edges at the center of the pre-existing corneal opacity. The patient was treated with sodium hyaluronate, autologous serum, and oral doxycycline. Six weeks after the surgery an improvement in corneal sensation was observed and the neurotrophic corneal ulcer subsequently healed over the course of one year. In this report, we present a case of neurotrophic keratitis that occurred after performing cataract surgery concurrent with a limbal relaxing incision. As such, we suggest that limbal relaxing incisions should be performed cautiously in patients with causative risk factors for corneal hypesthesia.
Cataract Extraction/*adverse effects/*methods ; Corneal Diseases/etiology ; Corneal Ulcer/*etiology/*pathology/physiopathology ; Humans ; Hypesthesia/etiology ; Limbus Corneae/*surgery ; Male ; Middle Aged ; Ophthalmologic Surgical Procedures/*adverse effects ; Phacoemulsification ; Wound Healing