AIMS: To analyze changes in surgically induced corneal astigmatism and articial intraocular lens (IOL) stability over time following cataract surgery. To compare the interchangeability of measurements between an automatic keratorefractometer (AKRM) and a biometer. MATERIAL AND METHODS: In this prospective observational study, the above-mentioned parameters were collected from 25 eyes (25 subjects) on the first day, first week, first and third month after uncomplicated cataract surgery. We used IOL-induced astigmatism (difference between refractometry and keratometry) as an indirect indicator of IOL stability change. We used the Blant-Altman method to analyze consistency between devices. RESULTS: At the above time points, surgically induced astigmatism (SIA) decreased as follows: 0.65 D; 0.62 D; 0.60 D and 0.41 D (in the first day, week, month and third month respectively). Astigmatism induced by changes of the position of the IOL varied as follows: 0.88 D; 0.59 D; 0.44 D and 0.49 D. Changes in both parameters were statistically significant (p0.05). CONCLUSION: Both surgically induced astigmatism and astigmatism induced by IOL decreased over time, in which both changes were statistically significant. The decrease in SIA was most pronounced between the first and third month after surgery. For IOL-induced astigmatism, the greatest decrease was within the first month after surgery. The differences in measurement between the biometer and AKRM were statistically insignificant, but the clinical interchangeability between the given methods is questionable, especially with regard to measurement of the astigmatism angle.
- Klíčová slova
- astigmatism change over time, intraocular lens position, surgically induced astigmatism,
- MeSH
- astigmatismus * diagnóza etiologie MeSH
- fakoemulzifikace * škodlivé účinky MeSH
- implantace nitrooční čočky škodlivé účinky metody MeSH
- katarakta * MeSH
- lidé MeSH
- nemoci rohovky * MeSH
- nitrooční čočky * škodlivé účinky MeSH
- refrakce oka MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
INTRODUCTION: To evaluate the results of the fluctuations of intraocular pressure (IOP) and calculated mean ocular perfusion pressure (MOPP) during the usual steps of standard phacoemulsification. METHODS: Nine human eyes were evaluated. The IOP was measured indirectly by electronic applanation tonometer. The MOPP was calculated using the systolic blood pressure (SBP), the diastolic blood pressure (DBP) and the IOP: MOPP = 2/3x[DBP + 1/3x(SBP - DBP)] - IOP. The operations were performed with the INFINITI® Vision System: main incision 2.2 mm, coaxial handpiece, 2 paracenteses 1.1 mm, bimanual irrigation/aspiration, bottle height 100 cm. As ocular viscoelastic device (OVD) Hypromel 2.5% (UNIMED) was used. RESULTS: The initial and final IOPs were 17-30 Torr (median 18) and 6-16 Torr (median 8), respectively. The IOP values oscillated between 4 and 63 Torr during the procedure. The highest values of the IOP were achieved at the beginning of phacoemulsification (from 42 to 63 Torr). The maximum pressure higher than 50 mmHg and 60 mmHg was found in 89% and 30% of cases, respectively. The mean ocular perfusion pressure (MOPP) at the beginning of the procedure was 46.4-67.0 (median 53.3) and 0.4-42.0 (median 19.3) during the maximum intraocular pressure. CONCLUSIONS: Measured IOP as well as MOPP varied in all normal steps of real phacoemulsification. High values of intraoperative IOL induced by irrigation may compromise the intraocular perfusion. These fluctuations may induce impairment of the optic nerve perfusion, as well as retina, or choroid.
- Klíčová slova
- intraocular pressure, intraoperative IOP, perfusion, phacoemulsification,
- MeSH
- fakoemulzifikace škodlivé účinky metody MeSH
- glaukom chirurgie MeSH
- krevní tlak fyziologie MeSH
- lidé MeSH
- nitrooční tlak fyziologie MeSH
- reprodukovatelnost výsledků MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tonometrie oční metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIM: To compare the degree of posterior capsule opacification (PCO) after AquaLase and NeoSoniX phacoemulsification methods during an 8-year follow-up period using two types of software. DESIGN: Prospective, randomized clinical trial. METHODS: AquaLase was used in the right eye and NeoSoniX in the left eye of each patient with bilateral cataract. RESULTS: Fifty patients were analyzed 1 year, 46 patients 3 years, and 37 patients 8 years after cataract surgery. Mean EPCO 2000 values were for the AquaLase group 0.324 ± 0.305 and for the NeoSoniX group 0.298 ± 0.341 (P = 0.53) 1 year after surgery, for the AquaLase group 0.582 ± 0.506 and for the NeoSoniX group 0.594 ± 0.515 (P = 0.87) 3 years after surgery, and for the AquaLase group 0.648 ± 0.567 and for the NeoSoniX group 0.673 ± 0.542 (P = 0.30) 8 years after surgery. The OSCA results were for the AquaLase group 0.7097 ± 0.3778 and for the NeoSoniX group 0.8584 ± 0.4323 (P = 0.046) 1 year after surgery, for the AquaLase group 0.9667 ± 0.736 and for the NeoSoniX group 0.9540 ± 0.5250 (P = 0.91) 3 years after surgery, and for the AquaLase group 1,035 ± 0,952 and for the NeoSoniX group 1,103 ± 0,741 (P = 0.44) 8 years after surgery. CONCLUSION: There was minimal PCO difference between these 2 approaches, AquaLase and NeoSoniX. Neither AquaLase nor NeoSoniX technique was able to prevent a natural progression of PCO.
- Klíčová slova
- AquaLase, NeoSoniX, posterior capsule opacification,
- MeSH
- časové faktory MeSH
- fakoemulzifikace škodlivé účinky metody MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace etiologie MeSH
- prospektivní studie MeSH
- zkalení zadního pouzdra čočky etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
Capsular bag distension syndrome is a very rare complication of cataract surgery. Most cases occur after uneventful phacoemulsification with continuous curvilinear capsulorhexis and implantation of an intraocular lens in the capsular bag. The entity presents with reduction of visual acuity and myopic shift in the early-to-late postoperative period. Characteristic findings include the distension of the capsular bag due to the accumulation of milky material and the forward displacement of the intraocular lens. We present two cases with an unusually delayed presentation of 6 and 8 years respectively following phacoemulsification, and describe their successful management with Nd:YAG laser posterior capsulotomy.
- MeSH
- capsulorhexis škodlivé účinky MeSH
- fakoemulzifikace škodlivé účinky MeSH
- laserová terapie MeSH
- lidé MeSH
- pouzdro oční čočky patologie chirurgie MeSH
- senioři MeSH
- syndrom MeSH
- zkalení zadního pouzdra čočky etiologie MeSH
- zraková ostrost MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: The present study assesses the anterior-posterior shift of the AcrySof SP intraocular lens in the eye between the third and fifteenth month after surgery. METHODS: The observed set contained a total of 241 eyes operated for cataract at Beskydské oční centrum (Beskydy Eye Centre; BOC), Frýdek-Místek hospital from 7 February 2007 to 7 April 2010. All surgeries were performed through microcoaxial phacoemulsification and a 2,2 mm incision, with intraocular lens (IOL) AcrySof type SP implanted. For each eye, we examined BCVA, as well as anterior chamber depth by optical biometry (IOL-Master, Carl Zeiss GmbH, Jena), 3 and 15 months after the surgery. Average depths were calculated and compared; and their variations converted from mm to diopters. Based on the BCVA results, we were able to determine optimum dioptric power of the IOL, which should have been implanted in the eye to ensure postoperative emmetropia. Averages of all values were calculated and results thereof compared. RESULTS: We noted a slight average deepening of the anterior chamber depth (0,03 mm) causing a hypermetropic shift of 0,05 D, insignificant in terms of refraction. Though comparison of average optimum IOL values calculated based on examinations carried out 3 and 15 months after surgery, we ascertained an actual zero difference between the two values. CONCLUSION: Through our own calculations, we verified very good stability of the implanted hydrophobic acrylic SP AcrySof lenses in our set, with zero haptic angulation. There is de facto no anterior-posterior shift of the IOL between 3 and 15 months after surgery, and therefore no change in refraction noticeable by the patient.
- MeSH
- akrylové pryskyřice * MeSH
- dospělí MeSH
- fakoemulzifikace škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nitrooční čočky škodlivé účinky MeSH
- pooperační komplikace * MeSH
- přední komora oční patologie MeSH
- refrakce oka * MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- zadní segment oční patologie MeSH
- zraková ostrost MeSH
- zrakové testy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- akrylové pryskyřice * MeSH
PURPOSE: To study the effect of phacoemulsification on the development of macular edema and diabetic retinopathy in diabetic patients without preoperative retinopathy. PATIENTS AND METHODS: This study comprised 86 patients; 26 diabetics, who had no clinically detectable diabetic retinopathy preoperatively, formed a study group and 60 non-diabetics were included into the control group. Diabetes mellitus duration, preoperative hemoglobin A1c level, and diabetes treatment method were recorded in diabetics. Monocular cataract surgery was performed in all patients. The patients were clinically assessed with OCT examination preoperatively, and postoperatively on day 1, in week 1, and in months 1, 2, 3 and 6 respectively. Foveal, inner macular, outer macular thickness, and macular volume were analyzed. RESULTS: The increase of the retinal thickness after the cataract surgery reached maximum in both groups in months 1 and 2. Since month 3 on, there was a progressive decrease in abnormal retinal thickness. There was a significant major increase in retinal thickness in diabetics in all examined areas in month 2 (p < 0.05 for fovea and inner macula; p = 0.001 for outer macula and p = 0.005 for macular volume changes). Trend toward major increase in retinal thickness in diabetics was still evident even three months after the surgery. In no case did a diabetic eye develop clinically detectable diabetic retinopathy during the follow-up period. The correlation between hemoglobin A1c level and retinal thickness changes in diabetics was not significant. There was also no significant difference in final visual acuity between diabetics and non-diabetics. CONCLUSION: We can expect similar induced retinal thickness changes in diabetics without retinopathy as in non-diabetics after uneventful cataract surgery, though there was a trend toward major increase in retinal thickness in diabetics.
PURPOSE: To characterize the macular thickness changes after an uncomplicated cataract surgery measured by means of optical coherence tomography (OCT), to specify the incidence of cystoid macular edema (CME), and to attempt to establish a correlation between the retinal thickening after an operation and possible risk factors for its development. PATIENTS AND METHODS: This study comprised 100 patients (64 women and 36 men) with the mean age of 70 (70.08 +/- 9.37 [SD] years; range, 44-85 years). All patients underwent uneventful phacoemulsification, which was followed by in the bag intraocular lens implantation. The real phacoemulsification time and the duration of the entire surgical procedure were recorded. The operated eye was set into the study group; the contralateral, non operated eyes formed a control group. The patients were clinically assessed with Stratus OCT examination preoperatively, and on day 1, in week 1, and in months 1, 2, 3 and 6 postoperatively. Foveal (central area 1mm in diameter), inner macular (ring area between 1mm and 3mm in diameter), outer macular (ring area between 3mm and 6mm in diameter) thickness and macular volume were analyzed. RESULTS: An increase in retinal thickness and macular volume after the cataract surgery reached the maximum in months 1 and 2 in all examined areas. Since month 3 on, there was a progressive decrease of abnormal retinal thickness and macular volume. An increase in retinal thickness was proved to be most prominent in the inner macular area. An increase in macular volume and retinal thickness in inner and outer macular area were statistically significant in months 1, 2 and 3 (Student t-test, p < 0.001; [p = 0.01 for the data in month 3]), while an increase in retinal thickness in foveal area was statistically significant in months 1 and 2 (Student t-test, p < 0.05). Six months after the surgery, the difference was not statistically significant in any of the examined areas. Three patients (3 %) developed CME after the phacoemulsification, but in one patient (1 %) only the clinical CME with some degree of a visual loss 1 month after the surgery (BCVA = 0.5) was diagnosed. There was a positive statistical correlation between the real phacoemulsification time and the increase in macular volume and retinal thickness in fovea and inner macular area in week one, and in months one and two after the surgery (Spearman's correlation test, p < 0.05). A positive statistical correlation was also found between the overall duration of the surgical procedure and the increase in macular volume and retinal thickness in all areas one month after the surgery (Spearman's correlation test, p < 0.05). CONCLUSION: The results indicate that changes in retinal thickness in macular area must be taken into account even after an uncomplicated cataract surgery. The increase in retinal thickness and macular volume reached the maximum in months 1 and 2 and tends to decrease since month 3 on. There is a positive statistical correlation between the retinal thickness increase and the real phacoemulsification time as well as between the retinal thickness increase and the overall duration of the surgical procedure. The incidence of CME was 3 %, but clinically significant CME was detected in 1 % of the cases only. Topical application of non-steroid, anti-inflammatory drugs can be important to effectively prevent the CME development after an uneventful cataract surgery.
- MeSH
- dospělí MeSH
- fakoemulzifikace škodlivé účinky MeSH
- implantace nitrooční čočky MeSH
- lidé středního věku MeSH
- lidé MeSH
- makulární edém etiologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
A new technique of cataract surgery via two microincisions of 1.5 mm and a phacotip without silicone sleeve is described in this paper. The irrigation is performed via a service incision (port) with a supporting device of the diameter of 20 G. Main problems of this method are discussed: the risk of the wound burns, and the insufficient stability of the anterior chamber. Based on author's own experience from 80 operations performed, and on the data in the literature, the suggestions how to perform this surgery safely using the conventional phaco machine are outlined. The author uses microtip--micro Kelman, pulse mode 5-10 pulses/sec, flow ratio about 20 mL/min, vacuum up to 200 mm Hg, an overpressure cuff to increase the irrigation volume, and a thin walled supporting irrigation device of the inner diameter of 0.7 mm minimum. In the conclusion, it is discussed, if this may be regarded as a progressive method and if it will be widely used. A precondition for its extended use is the wider commercial offer of intraocular lenses, which could be easily implanted trough the micro-incision just described.
- MeSH
- fakoemulzifikace škodlivé účinky přístrojové vybavení metody MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE: To compare peroperative complications of standard phaco technique and phaco with pars plana infusion performed for cataract after pars plana vitrectomy. METHOD: This prospective study randomly divided group of 64 patients with cataract after PPV into group A (standard phaco, 38 patients) and group B (phaco with par olana infusion, 26 patients). The study verifies the rate of peroperative complications such as deep anterior chamber, diaphragma movement miosis, and zonular dehiscention in these two groups. RESULTS: Peroperative complications had slightly higher rate in group B (with infusion). No specific complication in group A (standard phaco) was found. CONCLUSION: Standard phaco technic without par plana infusion has at least the same level of safety as phaco with pars plana infusion.
- MeSH
- fakoemulzifikace škodlivé účinky metody MeSH
- implantace nitrooční čočky MeSH
- lidé MeSH
- peroperační komplikace * MeSH
- prospektivní studie MeSH
- vitrektomie škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- klinické zkoušky MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
The authors investigated changes of the intraocular pressure after non-complicated phacoemulsification with implantation of an intraocular lens of different types (OMMA, silicone, Acrysof) in 40 patients. From the results it is obvious that in some patients already 4 hours after surgery the intraocular pressure rises to an average of 31 +/- 17 mm Hg. The magnitude of the intraocular pressure was not influenced by the size of the surgical wound nor the type of intraocular lens. In values below 30 mm Hg the authors recommend merely follow up of the patients as they assume that these values have a positive impact on closure of the tunnel incision. In the differential diagnosis it is important to consider the post-operative inflammatory reaction, the absorption reaction of residual viscoelastic material, pupillary block while the lenticular capsule is intact and undiagnosed glaucoma. In values above 30 mm Hg the authors recommend administration of beta-blockers, Diluran and antiphlogistics.
- MeSH
- fakoemulzifikace * škodlivé účinky MeSH
- implantace nitrooční čočky MeSH
- lidé MeSH
- nitrooční tlak * MeSH
- oční hypertenze etiologie MeSH
- pooperační období MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
