Profile of patients presenting for cataract surgery in the UK: national data collection. (1/410)

AIMS/METHODS: A national data collection exercise was carried out in more than 100 hospital eye service units within the UK to provide clinical and administrative information on patients undergoing cataract surgery. This included patient clinical data such as visual acuity at the time of wait listing and at the time of admission for surgery, presence of other eye disorders, other serious medical disorders, and data on waiting time and type of admission. RESULTS: The profiles of the 18 454 patients aged 50 years or older are reported. Findings of particular note were as follows. At the time of wait listing for cataract surgery 31% had visual acuity of 6/12 or better, 54% had visual acuity between 6/18 and 6/60, and 15% had less than 6/60 vision. Considering those who had visual acuity of 6/12 or better at the time of wait listing, by the time of admission for surgery, the vision deteriorated to 6/18-6/60 in 33% and in a further 3% the vision deteriorated to below 6/60. In patients with moderately poor visual acuity (<6/12-6/60) at the time of wait listing, 13% had less than 6/60 vision by the time of admission for surgery. CONCLUSION: This type of data collection and reporting exercise provides new material that can be used in the planning and provision of cataract surgery services in the UK.  (+info)

The triple procedure: in the bag placement versus ciliary sulcus placement of the intraocular lens. (2/410)

AIMS: To evaluate the influence of intraocular lens (IOL) placement on triple procedure clinical results and to investigate whether it is appropriate to use phacoemulsification in patients with large lens nucleus. METHODS: 40 consecutive penetrating keratoplasties combined with cataract extraction performed in a single institution were studied. Whenever possible a capsulorhexis was performed and the IOL was placed into the capsular bag. Phacoemulsification was used when the nucleus was too large to pass through the capsulorhexis. RESULTS: Out of 25 patients with an intact capsulorhexis phacoemulsification was used in 13 (52.0%) whereas the entire nucleus passed through the capsulorhexis in the remaining 12 patients (48%). The average 12 month visual acuity was 0.46 (SD 0.21) in patients with in the bag IOL (n = 23) and 0.29 (0.08) in patients with ciliary sulcus IOL (n = 13) (p = 0.04). Elevated intraocular pressure occurred in 26.1% (6/23) of patients with in the bag IOL and 61.5% (8/13) of patients with ciliary sulcus IOL (p = 0.08). The average postoperative graft thickness at 18 months was 552 (27) microns in the former group and 650 (29) microns in the latter group (p = 0.04). No significant difference in graft survival, postoperative endothelial cell density, astigmatism, and videokeratoscopic measurements was found between both groups. CONCLUSION: In the bag placement of the intraocular lens during the triple procedure results in better outcome of transplantation than ciliary sulcus placement of the IOL. Phacoemulsification allows removal of large nuclei through a 5 mm capsulorhexis without performing relaxing incisions out towards the periphery of the capsule.  (+info)

Visual outcome after phacoemulsification and IOL implantation in diabetic patients. (3/410)

AIMS: To follow visual acuity (VA) and progression of diabetic retinopathy (DR) after phacoemulsification in diabetic patients with different stages of DR and controls. METHODS: This prospective study included 27 diabetic patients with no or mild to moderate non-proliferative DR; 25 patients with moderate to severe non-proliferative, or proliferative DR; and 22 non-diabetic controls. All patients underwent uncomplicated, phacoemulsification surgery, with implantation of a heparin-surface modified (HSM) poly(methylmethacrylate) (PMMA) intraocular lens (IOL) into the capsular bag. Colour fundus photographs and fluorescein angiograms (FA) were taken at 1 week (baseline), 3 months, and 1 year postoperatively to determine stability or progression of DR. RESULTS: The VA of 46 diabetic eyes (88%), was improved 1 year after surgery and only six eyes (12%) were unchanged or worse. 41 diabetic eyes (79%) achieved a VA of 0.5 or better and 11 eyes (21%) had a final VA lower than 0.5. Significantly lower final corrected VA was found 1 year after surgery in eyes with advanced DR (median 0.5; range 0.1-1.0) compared with controls (1.0; 0.1-1.0) and eyes with no or mild to moderate DR (1.0; 0.1-1.0). Eyes with mild to moderate DR and clinically significant macular oedema (CSMO) 1 week postoperatively had a lower final VA than those without CSMO. Angiographic cystoid macular oedema (CMO) was detected with FA in 15% of all diabetic eyes 1 week postoperatively. 41 eyes (79%) showed no change or improvement of the retinal status 1 year after cataract surgery. Progression was found in 11 eyes (21%), mainly in eyes with mild to moderate DR and moderate to severe DR. Eyes with an indication for laser photocoagulation at baseline showed a significantly higher rate of progression of DR after surgery than those without indication for laser treatment. CONCLUSION: The final visual outcome was improved in the majority of diabetic eyes. Eyes with CSMO at the time of surgery had the worst prognosis regarding postoperative VA.  (+info)

Retained intravitreal lens fragments after phacoemulsification: a clinicopathological correlation. (4/410)

AIMS: To explore the relation between clinical course and timing of vitrectomy with the nature and intensity of intraocular inflammatory response in eyes with retained intravitreal lens fragments following complicated phacoemulsification. METHODS: Prospective evaluation of 22 eyes with retained lens fragments with emphasis on corneal clarity, uveitis, intraocular pressure (IOP), timing of vitrectomy, and visual outcome. Numbers of different types of inflammatory cells in vitreous washings were counted, masked to clinical details, in three non-overlapping adjacent high power fields. Relations between clinical and pathological findings were assessed. RESULTS: The IOP was raised in 19 eyes before vitrectomy and remained high in nine postoperatively. The latter had higher median total cell count (104 cells/mm(2)) than those with normal postoperative IOP (37 cells/mm(2)) but this difference was not statistically significantly different (p=0.17). Nine of 22 eyes underwent vitrectomy within 1 week of cataract surgery. Median total cell count in these eyes was 20 cells/mm(2) compared with 140 cells/mm(2) in eyes vitrectomised later-this difference was statistically significant (p <0.001). Final visual acuity was 6/12 or better in 13 eyes, these had fewer intravitreal inflammatory cells than the remaining six with poor visual outcome and no pre-existing cause for this (three patients excluded) (p=0.02). Macrophages were the predominant inflammatory cell type. CONCLUSION: There was significantly less inflammatory cell activity in eyes which had retained lens fragments removed early (within 1 week). Later removal was associated with persistently elevated IOP and poorer visual outcome.  (+info)

Visual experience during phacoemulsification cataract surgery under topical anaesthesia. (5/410)

BACKGROUND/AIMS: Visual awareness during phacoemulsification cataract surgery is an important determinant of patient satisfaction with any anaesthetic technique. Topical anaesthesia could be associated with significant visual awareness because it does not affect optic nerve function. METHODS: The visual experience during phacoemulsification cataract surgery under topical anaesthesia (without sedation) was assessed for 106 consecutive unselected patients. Patients were interviewed immediately after surgery using a standardised questionnaire that explored specific aspects of their visual experience. RESULTS: Four patients were excluded because they had poor recollection of their visual experience. The visual awareness of the remaining 102 patients comprised operating microscope light (99), colours (73), flashes of light (7), vague movements (19), surgical instruments or other objects (12), change in light brightness during surgery (49), change in colours during surgery (30), and transient visual alteration during corneal irrigation (25). No patient found their visual experience during surgery unpleasant, though the operating microscope light was uncomfortably bright for two patients. Six patients lost light perception for a short interval during surgery. There was no association between the various visual phenomena reported and patients' age, sex, preoperative visual acuity, cataract morphology, coexisting ocular pathology, or previous experience of cataract surgery under local anaesthesia (p>0.05). CONCLUSIONS: Patients experience a wide variety of visual sensations during phacoemulsification cataract surgery under topical anaesthesia. Topical anaesthesia does not, however, appear to result in greater visual awareness than regional anaesthesia. Preoperative patient counselling should include information about the visual experience during surgery.  (+info)

Pain relief with intracameral mepivacaine during phacoemulsification. (6/410)

AIM: To assess the efficacy and safety of an intraoperative intracameral injection of mepivacaine, administered when patients experienced pain during the course of cataract surgery under topical anaesthesia. METHODS: This is a prospective placebo controlled double masked randomised clinical trial. 50 eyes were included; 25 receiving the active compound and 25 receiving placebo. Mepivacaine (2%, 0.4 ml) or placebo was administered intraoperatively under the iris of the patients who experienced pain during the course of phacoemulsification in spite of previous topical anaesthesia. Efficacy was evaluated by the patients themselves using a five point subjective pain rating scale, the Keele verbal pain chart. Safety was measured by assessing intraocular inflammation (clinical evaluation and laser flare meter), intraocular pressure, and endothelial cell count. RESULTS: The pain rating score significantly diminished after intracameral injection in the mepivacaine group (mean 3.0 (95% CI 2.6-3.4) v 0.8 (0.3-1.3), p<10(-4))) while remaining unchanged in the placebo group (2.9 (2.6-3.2) v 2.9 (2.5-3. 3)), the mean reduction in pain score being significantly different between the two groups (p<10(-4)). There was no indication of increased postoperative ocular inflammation, intraocular pressure change, or endothelial cell loss. CONCLUSIONS: These results suggest that it may not be necessary to systematically add intracameral anaesthesia with topical anaesthesia for cataract surgery. An intraoperative intracameral injection, performed only in patients who happen to suffer during surgery, is safe and effective.  (+info)

Two clinical trials of an intraocular steroid delivery system for cataract surgery. (7/410)

PURPOSE: To determine the safety and efficacy of an intraocular dexamethasone drug delivery system (Surodex) in the treatment of inflammation following cataract surgery. METHODS: Surodex is a biodegradable polymer that releases dexamethasone for 7 to 10 days after placement in the anterior segment. Study 1 was a prospective, randomized, double-masked Phase II clinical trial of 90 cataract surgical patients that compared treatment with Surodex to treatment with a placebo drug delivery system and to no anti-inflammatory drug treatment at all. Study 2 was a separate prospective, randomized, double-masked study of 60 cataract surgical patients that compared treatment with Surodex to topical dexamethasone (eye drop) therapy. RESULTS: In the first study, Surodex was superior to placebo in suppressing postsurgical inflammation throughout the 60-day postoperative period, as judged by masked-evaluator, slit-lamp grading of cell and flare. The differences were statistically significant from postoperative day 3 through postoperative week 3. The majority of Surodex patients did not require topical steroid by 2 weeks after surgery (93%) or by 2 months after surgery (88%). In the second study, Kowa laser flare meter readings were lower in Surodex patients throughout the 90-day postoperative period. The results were statistically significant at 4, 8, and 15 days following surgery. There were no significant adverse complications of Surodex in either study. CONCLUSION: Surodex was safe and effective in suppressing postcataract surgery inflammation and appears to be a promising alternative to topical steroids.  (+info)

Visual outcomes after anterior vitrectomy: comparison of ECCE and phacoemulsification. (8/410)

PURPOSE: To determine whether vitrectomy instrumentation improved outcomes when vitreous loss occurred during either extracapsular cataract extraction (ECCE) or phacoemulsification (PE) with posterior chamber lens implantation (PCIOL). METHODS: A consecutive series of ECCE + PCIOL (group 1: 1985-1989) and PE + PCIOL (group 2: 1993-1997) surgeries by a single surgeon was reviewed retrospectively. RESULTS: In group 1, 14 of 647 patients (2.2%) and in group 2, 9 of 665 patients (1.4%) experienced vitreous loss. In group 1, final visual acuity averaged 20/83; in group 2, 20/25 (P = .005). Average follow-up was 5.7 years (group 1) and 3.2 years (group 2). Uveitis, glaucoma, corneal problems, and retinal problems were assessed. CONCLUSIONS: Anterior vitrectomy reduced complications from vitreous loss. Fewer vitreous losses occurred with PE than ECCE. Patients with vitreous loss after PE attained better vision.  (+info)