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: This study was conducted to compare post-operative astigmatic outcomes of two groups, with-the-rule (WTR) and against-the-rule (ATR) astigmatism patients, according to the haptic axis of intraocular lenses (IOLs) inserted in cataract surgery. METHODS: Seventy-two eyes with WTR astigmatism and 79 eyes with ATR astigmatism had cataract surgery through a clear corneal temporal incision. These two groups of eyes were then each divided into 2 groups based on whether the haptic axis of the inserted IOL was at 180degrees or 90degrees. For ATR patients, the outcomes were analyzed according to the three types of IOLs. RESULTS: There was no difference in corneal astigmatism, but WTR patients with a 180degrees haptic axis of the inserted IOL and ATR patients with a 90degrees hepatic axis of the inserted IOL had a significant decrease in postoperative refractive astigmatism (p < 0.05). The changes in ATR astigmatism according to the IOL type were more effective in single-piece acrylic IOLs than in the three-piece polymethylmethacrylate haptic IOL group. CONCLUSIONS: Insertion of the IOL at the 180degrees haptic axis in WTR patients and at 90degrees in ATR patients during cataract surgery may have an effect in reducing pre-existing astigmatism. This observed effect was not consistent among the different types of IOLs.
Astigmatism/classification/*etiology/*physiopathology ; Cataract Extraction/*adverse effects ; Equipment Design ; Humans ; Lens Implantation, Intraocular/*methods ; *Lenses, Intraocular ; *Postoperative Complications ; Treatment Outcome

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

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

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

A 60-year-old diabetic patient transferred to our retina clinic for a regular follow-up for diabetic retinopathy. He had uneventful cataract surgery at the time of pars plana vitrectomy in the right eye due to diabetic retinopathy at a private ophthalmologic hospital. Six months after the surgery, neovascular glaucoma with hyphema developed in the right eye and an Ahmed valve was implanted at our hospital. Ten months after cataract surgery, we found opacification of the intraocular lens (IOL) which was causing significant visual disturbance. At the time, the best corrected visual acuity (BCVA) in the right eye was hand motion. The IOL was explanted 45 months after the operation. Five months after explantation, the BCVA was 0.06. Unfortunately, pathologic analysis was not performed. Patient-related factors such as an anterior chamber reaction caused by hyphema might have been responsible for the opacification. To our knowledge, there are no previous reports of opacification of the Akreos Adapt IOL.
Cataract/complications/etiology ; Cataract Extraction ; Device Removal ; Diabetic Retinopathy/surgery ; Equipment Failure ; Eyeglasses ; Glaucoma, Neovascular/etiology ; Humans ; Hyphema/etiology ; Lens Implantation, Intraocular ; Lenses, Intraocular/*adverse effects ; Male ; Middle Aged ; Postoperative Complications ; Vision Disorders/*etiology ; Visual Acuity ; Vitrectomy/methods

PURPOSE: To report the experiences at our institute of pars plana vitrectomy (PPV) in combination with intravitreal triamcinolone acetonide (IVTA) injection in patients with retained lens material after cataract surgery. METHODS: The medical records of patients who underwent PPV between January 2005 and December 2006 after complicated cataract surgery in which lens material was dropped into the vitreous cavity were reviewed retrospectively. RESULTS: Five eyes of five patients were treated by vitrectomy and removal of the dislocated lens material and were administered an adjuvant intravitreal injection of 4 mg triamcinolone acetonide at the end of surgery. IVTA administration induced a rapid improvement in vision within six weeks postoperatively. Final visual acuity was 20/32 or better in all patients. Inflammatory cystoid macular edema (CME) that existed preoperatively was promptly improved after IVTA. Intraocular pressure increased transiently in one patient. No procedure-related complications were observed. CONCLUSIONS: PPV with additional IVTA was successfully performed in five eyes with retained lens material and resulted in a marked resolution of vitreous inflammation, an improvement in CME and rapid visual recovery. The authors recommend that IVTA administration should be investigated more thoroughly as an adjunct during the management of retained lens material.
Aged ; Cataract Extraction/adverse effects ; Device Removal/*methods ; Female ; Follow-Up Studies ; Glucocorticoids/*administration & dosage ; Humans ; Injections ; Intraoperative Care/methods ; Lens Subluxation/pathology/*surgery ; Lenses, Intraocular/*adverse effects ; Macular Edema/etiology/pathology/*surgery ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Time Factors ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Visual Acuity ; Vitrectomy/*methods ; Vitreous Body

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

PURPOSE: To report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa (RP). METHODS: A 45-year-old male with RP presented with elevated intraocular pressure (IOP) in the right eye and was treated with laser iridotomy (LI). After LI, complete crystalline lens dislocation into the anterior chamber occurred. Surgical intervention, including anterior vitrectomy, intracapsular cataract extraction (ICCE), and IOL scleral fixation was performed. Two years later, the same episode occurred in his left eye and a similar treatment was done. RESULTS: Surgery was successful in both eyes. CONCLUSIONS: This is the first report of bilateral spontaneous anterior lens dislocation in a RP patient.
*Anterior Chamber ; Cataract/complications/diagnosis ; Cataract Extraction ; Electroretinography ; Follow-Up Studies ; Humans ; Iris/surgery ; Laser Therapy/adverse effects ; Lens Implantation, Intraocular/methods ; Lens Subluxation/diagnosis/*etiology/surgery ; Male ; Middle Aged ; Ocular Hypertension/complications/physiopathology/surgery ; Retinitis Pigmentosa/*complications/diagnosis/surgery ; Sclera/surgery ; Suture Techniques ; Visual Fields ; Vitrectomy

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