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Presentation Type: Cataract
Co Authors: Ayser Fayed - - - - - - - - - -
Abstract Details:
Purpose:
To document ciliary body constriction and movement in eyes before and after cataract surgery using ultrasound biomicroscopy (UBM)
Setting:
Ophthalmology department, Benha faculty of medicine, Benha university
Methods:
20 eyes of 15 patients with no ocular conditions other than cataract had implantation of posterior chamber intraocular lens (AcrySof. SA 60 AT) after a clear corneal phacoemulsification. UBM was performed with and without instillation of 2% pilocarpine, as well as before and 3 months after cataract surgery. The increase in axial lengh of the ciliary body (CBAXL) was used as an indicator during accommodation.
Results:
The CBAXL value with and without pilocarpine before cataract extraction was 1.607 ± 0.156 mm and 1.591 ± 0.178 mm respectively. The CBAXL value with and without pilocarpine after cataract extraction was 1.898 ± 0.275 mm and 1.677 ± 0.297 mm respectively, which was significantly different.
Conclusions:
Significant centripetal movement and ciliary muscle contraction after cataract extraction. This show that a lenticular sclerotic component may influence both lens movement and ciliary muscle contractility.
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Presentation Type: Cataract
Co Authors: Nurhan Dinēer Kübra Sar?c? Kadir Eltutar - - - - - -
Abstract Details:
Purpose:
To evaluate the visual outcomes , peroperative and postoperative complications of phacoemulsification (PE) and posterior chamber intraocular lens implantation, (PC IOL) in patients with Fuchs heterochromic iridocyclitis (FHIC).
Setting:
?stanbul Education and Research Hospital, Eye Clinic
Methods:
Fifteen eyes of 15 (n=15) patients with FHIC and cataract who had phacoemulsification and intraocular lens implantation were enrolled in this retrospective study between 2002-2008. Visual acuities , intraocular inflammation and complications related to surgery were evaluated postoperatively.
Results:
There were 9 male and 6 female in the study; the mean age was 31.5 years ± 11 (SD). Mean follow-up time was 24.5 months. Preoperatively, best corrected visual acuity (BCVA) was less than 20/40 in all patients, which improved to 20/40 or better after surgery. Ten eyes achieved BCVA of 20/20. Intraoperative complications were observed only in peripheral iris bleeding during surgery, but did not prevent the surgery. There were no major intraoperative complications. Thirteen patients was observed with mild or moderate intraocular inflammation in the postoperative period.Postoperatively, mild anterior chamber fibrin reaction occurred in 2 patients (13.3%),transient intraocular pressure elevation occurred in 2 patients (13.3%) in the first postoperative day and vitreous inflammation developed in 1 patient (6.7%). There was 1 case of clinical cystoid macular edema that resolved with medication. During follow-up, 3 eyes (20 %) developed posterior capsule opacification requiring a neodymium:YAG (Nd:YAG) laser capsulotomy.
Conclusions:
Phacoemulsification with PC IOL implantation is a safe procedure with good visual outcomes in patients with FHIC and cataract. Postoperative inflammation is mild and visual results are quite good.
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Presentation Type: Cataract
Co Authors: Simonetta Morselli - - - - - - - - - -
Abstract Details:
Purpose:
To assess the anaesthetic efficacy and safety of topical ropivacaine versus topical lidocaine in Phacoemulsification combined with ExPress Implant
Setting:
Glaucoma Segment Unit, Ophthalmic Department, S.Bassiano Hospital, Bassano del Grappa, Vicenza - Italy
Methods:
Twenty patients were operated for combined cataract and glaucoma surgery. All patients were randomized into two groups. The group one (ten patients) was treated pre-operative with topical ropivacaine 1%. The group two (ten patients) was treated pre operative with topical lidocaine 4%. Surgery time, intraoperative and early postoperative complications, were recorded. Intraoperative and postoperative patients subjective pain was expressed, using a pain scale
Results:
Surgery time and intraoperative complications were the same in both groups. Four patients in the ropivacaine group and 5 in the lidocaine group required supplement with intraocular 1% lidocaine anaesthesia (P >.05). The mean subjective analog pain score was slightly higher in the lidocaine group (P >.05)
Conclusions:
The efficacy and safety of topical ropivacaine was at least as well as topical lidocaine for Phacoemulsification combined with ExPress Implant surgery. In our study the Ropivacaine was enough long-lasting analgesia during combined glaucoma and cataract surgery. Most of our patients didn''t require the supplement of intracameral anaesthesia during surgery. Topical Ropivacaine seems the best and long lasting anaesthetic drug for combined glaucoma and cataract surgery
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Presentation Type: Cataract
Co Authors: Selcuk Sizmaz Muge Karatas Yonca Akova - - - - - -
Abstract Details:
Purpose:
To investigate the effect of pupil dilation on the ocular biometry results.
Setting:
Baskent University, Faculty of Medicine, Department of Ophthalmology.
Methods:
Patients who were scheduled for cataract surgery underwent pupillometry, axial length measurement, and emmetropic intraocular lens power estimations for emmetropia were performed with SRK-T Formula. Forty-five minutes after two times of tropicamide 0.5% and phenylephrine HCl 2.5% application with ten minutes interval the measurements were repeated. The results were compared using paired t-test and Spearman''s correlation analysis.
Results:
A total of 175 patients were included in the study. Patients ages ranged from 19 to 89 years (mean ± SD 65.4 ± 9.9 years). Forty patients had diabetes, and8 had pseudoexfoliation. Pupil size was 3.1 ± 0.9 mm in mesopic light and 7.2 ±0.9 mm following dilation. Axial length was 23.6 ± 1.0 mm in both measurements. The biometry values were 20.6 ± 2.5 D and 20.6 ± 2.4 D, respectively. The axial length measurements were significantly not different (p= 0.928, 95% CI -0.032 0.035). The biometry results were also not different (p=0.908, 95% CI -0.103-0.091). There was no correlation for the biometry and axial length measurements between the presence of diabetes, pseudoexfoliation, and pupil size (p>0.05).
Conclusions:
In patients with cataract, neither the axial length measurements nor the biometry results were related to the size of the pupil. Studies with larger study groups and including the comparison of postoperative refraction are necessary to conclude that pupil size is not associated with either value.
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Presentation Type: Cataract
Co Authors: Canan Asl? Utine Deniz Marangoz Ilgaz Sagdic Yalvac - - - - - -
Abstract Details:
Purpose:
High resolution imaging of intraocular lens (IOL) and posterior capsule relation in a case of Capsular Block Syndrome (CBS)
Setting:
Case presentation after cataract surgery operation.
Methods:
IOL and posterior capsule distance images obtained by anterior segment Optical Coherence Tomograpy (OCT) (Visante, Carl Zeiss Meditec) and simultaneous photographs taken by digital imaging system.
Results:
Distance between posterior capsule and IOL were 2.16 mm at first postoperative day and 1.93 mm at the second day. At the 4th postoperative day IOL and posterior capsule were in touch. Also IOL and corneal distance were measured. Viscoelastic remnant was seen in photographs taken by imaging system.
Conclusions:
Quantitative analysis of IOL and posterior capsule could be made easily by anterior segment OCT. These images were useful at postoperative follow up. In our case as distance between capsule and IOL decreased at second day, we cancelled doing planned YAG Laser capsulotomy.
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Presentation Type: Cataract
Co Authors: Amber Senel Alper Sengul Erdal Yuzbas?oglu Rifat Rasier Halil Bahcecioglu - -
Abstract Details:
Purpose:
To report the incidence of cataract associated with traumatic lens injuries as a complication of intravitreal injection of anti-vascular endothelial growth factor (VEGF) in the treatment of intraocular neovascular or oedematous diseases and its management.
Setting:
Department of Ophthalmology, Istanbul Bilim University,Istanbul
Methods:
This clinical retrospective, noncomparative study included 3590 intravitreal injections of intravitreal anti-Vegf injections consecutively performed for 1167 eyes with exudative age-related macular degeneration and other retinal disease. Included were all patients receiving at least one injection of intravitreal bevacizumab or intravitreal ranibizumab. Injections were carried out using a 30-gauge needle at 4 mm posterior to the limbus as an outpatient procedure. Follow-up after each injection was at least 4 weeks.
Results:
Eight eyes of eight patients with complicated cataract caused by inadvertent needle penetration of the posterior capsule during an intravitreal administration of bevacizumab and ranibizumab were identified. After clinical appearance of complicated cataract, preoperative detailed examination of lens and fundus was carried out. Carefully intervention was performed using phacoemulsification technique with careful hydrodelineation without hydrodissection, careful nucleus rotation, low irrigation pressure, using dispersive viscoelastic agent to tamponade the vitreous and using IOL (intraocular lens implantation) capture technique. Of 8 eyes, in 5 eyes phacoemulsification surgery was completed succesfully without any complication. Nevertheless, despite prevention techniques, vitreoretinal surgery was necessary in 3 eyes because of enlargement of preexisting posterior capsular tear with vitreus loss. The overall incidence rate of cataract after anti-VEGF injections was 0.22%.
Conclusions:
Traumatic cataract associated with inadvertent lens injuries is a complication of intravitreal injection of anti-VEGF agents (approximately %0.22). Careful preoperative planning and attention to fluidics, careful hydrodelineation without hydrodissection and nucleus rotation, low irrigation pressure, using a dispersive viscoelastic agent and IOL capture technique are key in maximizing outcomes.
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Presentation Type: Cataract
Co Authors: Amber Senel Alper Sengul Erdal Yuzbas?oglu Rifat Rasier Halil Bahcecioglu - -
Abstract Details:
Purpose:
To compare the efficacy of fixed combination of timolol 0.5%/bimatoprost 0.03% with fixed combination of brimonidine 0.2%/timolol0.5% in preventing intraocular pressure (IOP) elevations after neodymium: YAG (Nd: YAG) laser posterior capsulotomy.
Setting:
Department of Ophthalmology, Istanbul Bilim University, Istanbul
Methods:
In this prospective randomized double-masked study, 150 eyes of 150 consecutive patients who had YAG laser capsulotomy for posterior capsule opacification were recruited. Eyes received either one drop of fixed combination of timolol 0.5%/bimatoprost 0.03% (78 patients) or fixed combination of brimonidine 0.2%/timolol0.5% (72 patients) one hour before laser surgery. A masked observer measured intraocular pressure (IOP) by Goldmann applanation tonometry before treatment and after treatment at 1 hour, 3, 24 hours and 7 days. Inflammation was evaluated after surgery. Formation of cystoid macular edema was assessed by measuring the macular thickness before and after laser surgery.
Results:
The average postoperative IOP elevation was 2.0±2.7 mmHg in the fixed combination of timolol 0.5%/bimatoprost 0.03% and 2.8±2.5 mmHg in the fixed combination of brimonidine 0.2%/timolol0.5% group. The difference was statistically significant (P<.001). Postoperative IOP elevations of 10mmHg or more occurred in 1 eye (1.28%) in the fixed combination of timolol 0.5%/bimatoprost 0.03% group and 4 eyes (5.55%) in the fixed combination of brimonidine 0.2%/timolol0.5%group. This was statistically different (P<.001). Macular edema and anterior chamber reaction were not observed releated to bimatoprost or timolol. No clinically significant side effects were noted in either group.
Conclusions:
Our results indicate that prophylactic use of fixed combination of timolol 0.5%/bimatoprost 0.03% is more effective than fixed combination of brimonidine 0.2%/timolol0.5% in preventing IOP elevation immediately after YAG laser capsulotomy. Fixed combination of timolol 0.5%/bimatoprost 0.03% as a prostamide analog with beta-blocker may provide new option for preventing IOP elevation after YAG laser capsulotomy.
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Presentation Type: Cataract
Co Authors: Nikos Ziakas Tatiana Naoumidi Vasilis Konidaris Nikos Georgiadis - - - -
Abstract Details:
Purpose:
We want to give the patient a step to present himself his visual experience
Setting:
A'' Ophthalmologic clinic of Aristotle University of Thessaloniki, AHEPA Hospital
Methods:
We asked our patients to describe with their own words what they saw during the phaco cataract surgery
Results:
Their experiences were surprising and diversible, but very interesting.
Conclusions:
We got many interesting images and impessions from our patients depending on their objective and subjective experiences
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Presentation Type: Cataract
Co Authors: Vasilis Boules Stefanos Maloutas Alexandros Alexandridis Nikolaos Georgiadis - - - -
Abstract Details:
Purpose:
The purpose of this study is to show the relation and the details of the cataract surgery which was performed during the period of the great acme of the islamic sciences (8th century AD to 14th century AD).
Setting:
A'' Ophthalmologic Clinic, AHEPA Hospital, Aristotle University of Thessaloniki
Methods:
We used the available works of the great Arab physicians as well works of Art with medical icons.
Results:
We found that the Arabic medicine was the bridge between the antiquity and the reinassance and dominated in the known world until the end of the 19th century
Conclusions:
The great Arab physicians contributed with their works in the flourish of the medical art and more specifically to the cataract surgery
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Presentation Type: Cataract
Co Authors: Erita Filipek Maria Forminska-Kapuscik Barbara Strzalka-Mrozik Urszula Mazurek Lidia Nawrocka Ewa Pieczara
Abstract Details:
Purpose:
The aim of the study was to determine differences in expression profiles of TGF? isoforms (TGF?1, TGF?2, TGF?3) in the fragments of the anterior lens capsule (ALC) and peripheral blood mononuclear cells (PBMC) of pediatric patients with congenital and traumatic cataract.
Setting:
Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
Methods:
77 children with congenital and 22 with traumatic cataract participated in the study. ALC fragments obtained during cataract surgery and whole blood samples were subjected to analysis. Transcriptional activity was assessed by the analysis of RT-PCR kinetics using the QuantiTect SYBR Green RT-PCR Kit and Opticon DNA Engine Sequence Detector. The levels of TGF? isoforms expression were determined based on the number of mRNA copies/1µg total RNA with real-time'' QRT-PCR.
Results:
TGF?1, TGF?2, and TGF?3 were detected in all study samples. In congenital cataract transcriptional activity of TGF?1 and TGF?2 in PBMC was higher compared to traumatic cataract (Mann-Whitney U test, TGF?1 p<0.001, TGF?2 p<0.05). Expression profiles of TGF? isoforms in ALC did not differ significantly between the groups (p>0.05).
Conclusions:
Patients with clinical diagnosis of congenital cataract have upregulated expression of TGF?1 and TGF?2 in PBMC compared to patients with traumatic cataract.
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Presentation Type: Cataract
Co Authors: Maria Forminska-Kapuscik Urszula Mazurek Barbara Strzalka-Mrozik Erita Filipek Ewa Pieczara Pawel Banasiak
Abstract Details:
Purpose:
Detection of mRNA levels of TGF?1,TGF?2, TGF?3 and TGF?RI, TGF?RII, TGF?RIII in the anterior lens capsule (ALC) lens fibres (LF) and peripheral blood mononuclear cells (PBMC) in children with congenital cataract.
Setting:
Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
Methods:
The study included children with unilateral (n=29) and bilateral (n=48) congenital cataract. Total RNA was measured in ALC, LF and PBMC obtained at the time of surgery. Gene expression was assessed by quantitative real time RT-PCR based on the number of mRNA copies/1µg total RNA.
Results:
All of the TGF? ligands and receptors were detected in all study samples. In bilateral congenital cataract transcriptional activity of TGF?3 in ALC, TGF?1 and TGF?2 in LF was significantly increased compared to unilateral congenital cataract. (Mann-Whitney U test, p<0.05).
Conclusions:
TGF? ligands in the lens tissues are differentiating factors between unilateral and bilateral congenital cataract.
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Presentation Type: Cataract
Co Authors: Niveditha Chittajallu - - - - - - - - - -
Abstract Details:
Purpose:
The purpose is to determine the effect of phacoemulsification on intraocular pressure (IOP) and visual acuity (VA) on patients with previous trabeculectomies.
Setting:
The study was performed by the glaucoma service in a U.K. teaching hospital.
Methods:
A retrospective audit was performed looking at the medical records of patients with trabeculectomies who underwent subsequent phacoemulsification and lens insertion.
Results:
18 eyes were included in the study. 15 eyes received intra-operative 5-Fluorouracil. There were no intra-operative complications. The mean IOP was 14.2mmHg pre-op and 15.0mmHg post-op. 70% eyes had a reduced or stable IOP post-op. Only one patient had a significant rise in IOP of 15mmHg. VA improved in 70% patients (6/18 to 6/9 mean) and was unchanged in 30% patients.
Conclusions:
Phacoemulsification can be safely performed in patients with trabeculectomies. The majority of patients have a significant improvement in VA and maintain good IOP control.
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Presentation Type: Cataract
Co Authors: Gökhan Pekel Fethi Cengiz Hac? U?ur Ēelik Ahmet Taylan Yaz?c? Ahmet Demirok Ömer Faruk Y?lmaz
Abstract Details:
Purpose:
To investigate the effects of intracameral triamcinolone on corneal endothelium, intraocular pressure and macula
Setting:
Beyo?lu Eye Research and Training Hospital, Istanbul, Turkey
Methods:
Forty patients who underwent uneventful cataract surgery in Beyo?lu Eye Research and Training Hospital in 2010 were included in this study. Twenty patients received intracameral triamcinolone and the other 20 patients formed the control group. All the surgeries were done under the same phacoemulsification machine by two experienced surgeons. Triamcinolone was given in 0,04 mg dosage intracamerally at the end of the phacoemulsification operation. Post-operative anterior chamber reactions, endothelial cell counts, macular thickness and intraocular pressure measurements were recorded.
Results:
The research is in progress and the exact data will be given later after the completion of the study at about 2 months.
Conclusions:
Early results showed that intracameral triamcinolone has no adverse effects on endothelial cell count, intraocular pressure and macular thickness. But the final conclusion will be given later after the completion of the study.
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Presentation Type: Cataract
Co Authors: Ba?ak Bostanc? Ceran Gülizar Soyugelen Tamer Takmaz - - - - - -
Abstract Details:
Purpose:
To evaluate and compare the clinical results of two different diffractive multifocal small incision intraocular lenses (IOL) implanted after biaxial microincision cataract surgery (B-MICS).
Setting:
Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey
Methods:
In this prospective, comparative study, Acri.Lisa 366 D (Group 1) and Acriva Reviol MFM 611 (Group 2) IOLs were implanted each in 30 eyes with B-MICS technique and patients were followed for at least 6 months postoperatively. Groups were comparable and standard for all their preoperative and intraoperative data. Uncorrected distance (UDVA), intermediate (UIVA), near (UNVA) and corrected distance (CDVA), distance corrected intermediate (DCIVA) and near (DCNVA) visual acuities, contrast sensitivity (CS) measurements with and without glare were determined. Early and late complications, subjective complaints were recorded and evaluated.
Results:
There was no statistical difference between mean postoperative spherical equivalent (SE) which were, -0.30±0.30 and -0.26±0.28 D. (p=.584), UDVA, 0.80±0.14 and 0.86±0.17 (p=.158 ), UNVA, J 1.46±0.73 and J 1.23±0.50 (p=.155) in Acri-Lisa and Reviol groups respectively. Reviol group showed significantly better results for UIVA (J 2.23±0.72) than Acri.Lisa group (J 3.06±0.90) (p=.000). Mesopic CS results, complication and dysphotopsic complaint rates were not significantly difference between the groups.
Conclusions:
Acri-Lisa 366 D and Acriva Reviol MFM 611 seemed to be effective multifocal IOLs in order to take the advantages of microincisional cataract surgery techniques. Both designs provided high level of distance and near visual acuities and CS results in addition Acriva Reviol IOL gave much better and satisfactory results for intermediate distance.
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Presentation Type: Cataract
Co Authors: Dinesh Dave Mina Shekarchian Kasra Taherian - - - - - -
Abstract Details:
Purpose:
To report a recent case of iatrogenic intraocular injury caused by forceful cannula detachment during intracameral injection in cataract surgery, despite the use of a luer-lock mechanism. To issue preventive recommendations based on our experience and the review the literature on this topic.
Setting:
A National Health Service District General Hospital in the United Kingdom.
Methods:
A case report and review of literature.
Results:
An 80-year old female underwent elective phacoemulsification surgery. The initial stages of surgery including cataract removal and in the bag intraocular lens implantation were uncomplicated. Towards the end of the procedure intra-cameral acetylcholine (miochol) was being injected into the anterior chamber using a one handed technique. The cannula flew off from the tip of the luer-lock syringe, projected across the anterior chamber, made a hole in the iris at about 11 o''clock meridian, hit the intraocular lens with force rupturing the posterior capsule and some of the zonules. Vitreous appeared in the anterior chamber requiring anterior vitrectomy. Fortunately the lens could still be retained in the bag and the patient did well overall. She attained 20/20 unaided vision at one-month post operatively despite having early dry age-related macular degeneration. A root cause analysis of the incident was conducted including a review of the scientific literature on the topic and we report our recommendations below.
Conclusions:
To eliminate or minimize the risk of iatrogenic cannula related injuries we recommend a three tiered preventive approach during intra-cameral injections. Step1: Universal use of luer-lock syringes for routine as well as for the occasional supplementary injections. Step 2: Checking the tightness of the attachment of the cannula to the syringe by both the nurse and the surgeon prior to injecting. Step 3: Avoiding one handed injections. The surgeon should hold the base (plastic part) of the cannula between the index and middle finger of his non-dominant hand whilst injecting the solution into the eye with his dominant hand.
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Presentation Type: Cataract
Co Authors: Evgenia Kanonidou Alexandros Chatzirallis Christina Kanonidou Petros Kiryttopoulos Lazaros Poulatsidis Leonidas Papazisis
Abstract Details:
Purpose:
Our study aims to investigate if the risk of an intraoperative complication during phacoemulsification cataract surgery increases with age.
Setting:
Department of Ophthalmology, General Hospital of Veroia, Veroia, Greece.
Methods:
Participants of the study were 426 consecutive patients, 201 male and 225 female, mean age 78.4 years old (SD 10.34), who underwent phacoemulsification cataract surgery by the same surgeon from March 2009 to April 2010 . The patients were divided into four categories according to their age (50-60, 61-70, 71-80, >80 years old). Data on the occurrence of any intraoperative complications (incomplete capsulorrhexis, posterior capsule rupture, intraoperative floppy iris syndrome, vitreous loss, lost nucleus, zonule dehiscence and wound leak) were collected and logistic regression was used to examine whether age was a risk factor for the aforementioned complications.
Results:
There was no significant association between age and the risk of an intraoperative complication. Nevertheless, there was little evidence that patients >84 years old were at a greater risk of an intraoperative complication than those <84 years old (p=0.49).
Conclusions:
Age alone is not a risk factor for any intraoperative complications occurring during phacoemulsification cataract surgery.
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Presentation Type: Cataract
Co Authors: Evgenia Kanonidou Christina Kanonidou Alexandros Chatzirallis Petros Kiryttopoulos Lazaros Poulatsidis Leonidas Papazisis
Abstract Details:
Purpose:
Our study aims to investigate whether routine medical testing before cataract surgery reduces the incidence of intraoperative complications.
Setting:
Department of Ophthalmology, General Hospital of Veroia, Veroia, Greece.
Methods:
Participants in the study were 653 consecutive patients, 302 male and 351 female, mean age 77.3 (SD 9.51), who underwent phacoemulsification cataract surgery from November 2008 to March 2010. The patients were randomized in two groups: i) having a preoperative routine medical test (n=326, T-group) and ii) having no preoperative routine medical test (n=327, NT-group). The standard medical test consisted of electrocardiography, chest X-ray, complete blood count, measurement of serum levels of glucose, urea nitrogen, creatinine and electrolytes. Intraoperative adverse medical events were recorded and statistically analyzed.
Results:
There were no statistically significant differences between the two groups in the rates of intraoperative events (p=0.827). The most frequent medical events in both groups were treatment for hypertension and arrythmia. It is also worthy to say that two scheduled operations were cancelled due to findings of the preoperative routine medical testing (one due to first-diagnosed lung cancer and the other due to severe heart failure).
Conclusions:
This study suggests that routine medical testing before phacomeulsification cataract surgery does not increase the safety of cataract surgery. Nevertheless, adverse medical events remain a concern due to the large number of elderly patients with multiple comorbidities who undergo cataract surgery.
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Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To introduce a new technique using the sagittal phaco chop in cataract surgery
Setting:
Clinique de la Vision. Oran, Algeria
Methods:
156 cataracts were operated by the same surgeon using a Sagittal Phaco Chop technique. The capsulorhexis size must be between 6 and 8mm. With a Chang canula you perform at the same time at the equator and under the anterior capsule a rotation and elevation of the head of the nucleus. This maneuver will set the whole nucleus out of its bag and in a sagittal position inside the anterior chamber. When, with a high vacuum the phaco probe is holding the nucleus, the chopper is sagittally chopping the nucleus in many quadrants and pieces. Even you miss your capsulorhexis this technique remains very helpful.This technique is used for cataracts grade 3 to 5
Results:
The unique position of the nucleus in the anterior chamber makes the surgery safer since there is no stress on the zonula, you operate far away from the posterior capsule and far away from the endothelio descemet membrane.
Conclusions:
A very safe technique which any phaco chop surgeon must have in his directory>A complete video shows the Sagittal Phaco Chop technique
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Presentation Type: Cataract
Co Authors: gökhan gülk?l?k ersin oba mahmut odabasi semra tiryaki erhan özdal efe can
Abstract Details:
Purpose:
To present the results of treatment in cases of toxic anterior segment syndrome(TASS) after cataract surgery
Setting:
Sisli Etfal Education and Research Hospital 2.Eye Clinic, Istanbul, Turkey
Methods:
This study was a retrospective case study. Patient files from Januar 2006 to September 2010 were reviewed for TASS. Sixteen eyes of 14 patients (8 women, 6 men and mean age was 63.4+/-10.1 years). were identified to have TASS. Visual acuity, lid and corneal edema, conjunctival injection and chemosis, anterior chamber reaction, fibrin formation on IOL surface and on pupill area , hypopyon ,vitritis and pain studied parameters.were recorded.Patients were also evaluated concerning their age, sex, nature of applied therapy.The control examination were done postoperative 1, 3, 10, and 30 days. The route of therapy was subconjunctival steroid injection and topical therapy which included antibiotic, steroid, mydriatic, timolol maleat %0.5 eyedrops and steroid oinment. The results were analyzed.
Results:
All of TASS cases were recognized in the first 2 postoperative days. All patients had uneventfull phacoemulsification through clear corneal incision with implantation of an acrylic IOLPatients had no pain..Mean Visual acuity was 1/10 in Snellen line. All of
.Patients had Lid edema, all patients had mild conjunctival injection, mild chemosis, and corneal edema, fibrin formation on the IOL and on pupil area , and cell reaction in anterior chamber(1+-4+). The vitritis and hypopyon was not observed in any case. When the diagnosis of TASS was established patients had one dose of subconjuctival injection of dexamethasone.The therapy was continued with topical dexamethasone % 0.1 or prednisolone acetate %1 eye drops 1x1 per 30 minutes for 4 days, than 1x1 per hour for 5 days, after 5x1/day for 3 weeks.Tropicamide forte % 1 eye drop 3x1/day for 7 days, ofloxacin %0.3 eyedrops 5x1/day for 30 days.Timolol maleat %0.5 eyedrop 2x1/day for 15 days. Dexamethasone eye oinment %0.1 one time in bed time for 10 days.The last control done on 30. day fibrin formation, anterior chamber reaction, conjunctival chemosis, corneal edema were disappeared in all cases.Mean visual acuity was 10/10
Conclusions:
Toxic anterior segment syndrome(TASS) is a clinical condition of various etiologies . Early, managment is important and provide good results with appropiate therapy consisting mainly steroids use
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Presentation Type: Cataract
Co Authors: Ersin oba A.burcu Dirim i.Gökhan Gülk?l?k Mahmut Odabas? Zeynep Özkurt - -
Abstract Details:
Purpose:
To compare the degree surgically induced astigmatism after phacoemulsification with IOL implantation through 3.0 mm and 4.0 mm clear corneal temporal incisions in patients without preoperative astigmatism
Setting:
Sisli Etfal Education and Research Hospital,2. eye clinic , Istanbul,turkey
Methods:
This retrospective analysis included 44 eyes of 28 patients(18 women and 10 men, mean age 68+/-6.4 years) who underwent phacoemulsification and intraocular lens(IOL) implantation without complication.. Patients without preoperative astigmatism were recorded.Two groups of were formed.The Group 1 included 22 eyes operated on through 3.0 mm incision and IOL was implanted using IOL injector.Group 2 included 22 eyes operated on through 3.0 mm incision and after the enlargement of the incision to 4 mm, the IOL was implanted using the IOL forceps. In both group incisions were created with special metal knives 3.0 mm at without pre-cut groove. All of lenses were implanted in the bag. Preoperative and postperative corneal astigmatism after 3 months was measured using autokeratorefractometer. Statistical analysis was performed using U-Mann-whitney''s test.
Results:
Patients in each group were homogenous with respect to the age, sexe, Surgically induced astigmatism in group 1 and 2 were 0.32 +/-0.14 and 0.34+/-0.12. diopter respectively Statistically no difference was found between two goups(p>0.05)
Conclusions:
Postoperative astigmatism may be disturbing for the patients who have no preoperative astigmatism.This study shows that there is no astimatism difference in patients without preoperative astigmatism who underwent uncomplicated coaxial phacoemulsification surgeryr through 3.0 and 4.0 mm temporal clear corneal incisions three months after the surgery
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Presentation Type: Cataract
Co Authors: Ersin Oba Mehmet Demir Mahmut Odaba?? Efe Can - - - -
Abstract Details:
Purpose:
The purpose of this study was to evaluate the postoperative astigmatism after implantation of scleral fixation intraocular lenses (SF-?OL).
Setting:
Sisli Etfal Education and Research Hospital 2. Eye Clinic , Istanbul, Turkey
Methods:
Eight patients who underwent SF-IOL implantation in ophthalmological department of Sisli Etfal Education and Research Hospital between November 2006 and September 2010 were evaluated retrospectively. Preoperative and postoperative astigmatism were measured and compared using Javal keratometer and autorefractometer. In seven patients, SF-IOL implantation was performed due to complications of previous cataract surgery and in one patient, it was performed because of the lens pathologies developed due to blunt trauma. Three of the patients were aphakic, one had the IOL in the vitreus and four had subluxated ?OL . One patient had secondary traumatic glaucoma. SF-?OLs were implanted after performing pars plana vitrectomy.
Results:
Preoperatively, mean total astigmatism and mean corneal astigmatism were 1.5D(0.5-2.75) and 1.5D(0.5-2.50) respectively.Postoperatively, mean total astigmatism and mean corneal astigmatism were 4.0 D(2-7.00 ) and 3.75D(2.25-7.0) respectively. The mean total astigmatism regressed to 1.00 D within 16 weeks equaling mean postoperative corneal astigmatism due to sclero-corneal wound healing.There was no residual astigmatism due to the tilted SF-IOL.
Conclusions:
Our study shows that in patients with SF-?OL implantation, when SF-?OL correctly implanted,there is no residual astigmatism due to IOL tilt or decentration.Corneal astigmatism regresses also in the short term period as long as 16 weeks equaling preoperative values. In aphakic eyes in which IOL implantation into sulcus or capsular bag is not possible due to insufficient capsule support SF-?OL implantation is an effective method causing no residual astigmatism.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Stéphane Cotin Jean-Franēois Rouland - - - - - - - -
Abstract Details:
Purpose:
Current methods of cataract surgery training are based on companionship. Training periods of this apprenticeship model depend on the availability of the instructor and potentially expose patients to complications due to the inexperience of the operator. In this context, recent reports have demonstrated the advantages and added value of computer-based simulation over conventional training. These motivations led us to develop a cataract surgery simulator that could offer a new way of learning for young ophthalmologists and help assess their level of proficiency.
Setting:
This work results from a collaboration between clinicians of the department of Ophthalmology, University Hospital in Lille, France, and researchers of INRIA, Lille North Europe.
Methods:
A complete prototype of simulation system for cataract surgery has been designed and integrated in a realistic mock up surgical unit. It consists of a computer system for simulating the biomechanics of the eye and rendering the virtual anatomy. The main components of the human eye, that provide the visual background of our simulation have been designed. In addition, the dynamic behavior of the structures manipulated during the procedure has been modeled to account for their actual physical characteristics. For the physical simulation, we used the open source library SOFA, developed by INRIA and primarily targeted at medical simulation. Specific algorithms have been developed to enable real time computation without sacrificing realism. Among the available interface is an optical tracking system, integrated within a surgical microscope, which transmits the position of mock surgical instruments to the simulator. Visual feedback is provided through stereoscopic glasses, also integrated in the microscope which permits to visualize the virtual anatomy. The overall training system also includes a whole body mannequin for added realism and a higher level of immersion of the simulation.
Results:
The main stages of cataract surgery, namely capsulorhexis, phacoemulsification and injection of the intra ocular lens, have been simulated. The capsulorhexis procedure is the key part of cataract surgery. This circular opening created into the lens capsule is simulated by using a computer model that takes into account the existence of fibers within the soft anisotropic tissue. This influences the deformation and impacts the direction of propagation for the fracture during tearing. The fragmentation and aspiration of the lens is performed in 3D and in real-time by using the phacoemulsificator''s pedal which activates a local change in the geometry and behavior of the lens volumetric model. At last the injection of the lens and its deployment in the capsule in real time is performed by simulating the intra ocular lens deformation and interaction within the capsule. By combining these key steps of a cataract procedure, it is possible to recreate a realistic virtual environment for resident training.
Conclusions:
The outcome of this work, resulting from a collaboration between clinicians and researchers in the field of computer science, is the creation of a computer-based simulation system for cataract surgery. In addition the IOL deployment has never been addressed before in a system like this. It will offer an useful additional tool and an alternative surgery training for resident without risk for patients and reduced requirements for the instructor. The first results are promising. We plan to include the simulation of complications, the preoperative simulation in the complex cases and define validation metrics.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To compare the efficacy and phacoemulsification parameters of torsional mode versus the combined torsional and logtudinal ultrasound mode in hard cataract of Egyptian patients.
Setting:
all cases are done by a single doctor in a private haspital at cairo
Methods:
This prospective study evaluated eyes 1, 7, and 30 days after phacoemulsification with an Infiniti Vision System using the torsional mode versus the combined torsional (100%) and logtudinal ultrasound (US) mode (20%). Egyptian patients with nucleus grade ranging from NO4/NC4 to NO5/NC5 were selected. Nucleus fragmentation was done by the stop and chop method. Primary outcome measures were phaco time, mean phaco power, mean torsional amplitude, amount of infused fluid , aspiration time, cumulative dissipated energy (CDE) and total energy.
Results:
42 eyes of 42 patients divided randomly into two groups were evaluated. There is no statistical difference between the torsional mode and the combined torsional and logtudinal ultrasound (US) mode as regarding the phacoemulsification parameters, although they were lower in the combined mode. No complications were recorded among both groups.
Conclusions:
Torsional mode alone can be used for emulsification of very hard cataract with no added risks or complications.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To analyse and describe footpedal functions to change management of fluidics und ulrasound during lens removal
Setting:
AugenCentrum, Rosenheim
Methods:
Switching from peristaltic and venturi pumpt during haco emulsification. Preprogrammed settings are steppwise used durting rotational chop lens removal. Two groups of cataract patients each of 30 eyey have been operated with the Signature ® System. Groupe 1 without any change of the preprogrammed settings during the whole procedure, groupe 2 with changing the settings using footpedal functions to adopt the programm to specific situations during the operation.
Results:
Savety and efficiency are recorded and compared in respect to: TTT total tip time, EPT effecitve phaco time, FPT footpedal time and BSS consumption. The steril assistance during surgery is less used.
Conclusions:
Using duo linear footpedal helps to adopt settings on the fly to specific situations during lens removal surgery. After a certain lerning curve this surgeon controlled and induced change of the settings helped to optimize safety and efficiency.Additional it is costeffective in reducing help of the nurse to change settings op the phaco mashine.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Ziba Safari Mohammad Yaser Kiarudi Mohammad Ali Zare
Abstract Details:
Purpose:
Corneal endothelial cell loss is a serious concern after cataract surgery. Several proposed factors that can influence endothelial cell damage are lens thickness, old age, time of surgery, axial length and surgical procedure. By theory, it has been stated that phaco-chop technique has less adverse effect on the corneal endothelial cells than the standard divide and conquer (D&C) technique; however, there are controversial results about corneal endothelial cell loss. The aim of this study was to compare the effect of phaco-chop and D&C technique on the corneal endothelial cell loss and investigate the surgical time of each technique.
Setting:
Farabi Eye Hospital, Tehran, Iran
Methods:
This randomized clinical trial was conducted on 60 patients with senile cataract. The patients were randomly submitted to two groups. The density of the cataract was graded clinically by the same examiner and was similar between two groups. Thirty patients in group 1 had phacoemulsification by the "divide and conquer" and 30 patients in group 2 had phacoemulsification by phaco-chop technique. In all patients surgery was performed by ARC machine. All steps of surgery in 2 groups were similar except nuclear fracturing and performed by one surgeon. Endothelial cell density (ECD) was assessed in 3 corneal zones using non contact specular microscope (SP 2000, Topcon) and the mean of them was calculated preoperatively, 1 month and 3 months after operation.
Results:
The mean age of patients in D&C and phaco-chop group was 61.1±10.4 and 64.7±8.2 years, respectively. There were no statistically significant differences between the 2 groups in age, gender and nuclear density. The mean phaco- time in D&C and phaco-chop group was 98.01±41 and 54.96±24 seconds (P<0.0001). Preoperative ECD was similar in 2 groups (1941±441 in phaco-chop and 1889.86±389 cells/mm2; p=0.64). The mean ECD was reduced to 1643±330 at 1 month and 1638±425 cells/mm2 at 3 months in the D&C group; with 11.9 and 12.3 percentage decrease in ECD. In phaco-chop group, the mean ECD was reduced to postoperative values of 1878±435 at 1 month and 1863±337 at 3 months with 3.1 and 4.2 percentage decrease of ECD. The reduction of ECD was significantly higher in D&C group at 1 month and 3 months (P<0.001).
Conclusions:
Although there is no consistent result among previous studies regarding safety of phaco-chop technique rather than D&C, but in the current study we found significantly higher corneal endothelial cell loss after divide and conquer technique with longer phaco-time.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Lorella Bertaina Giulia Pignata Visentin Beatrice Federico Torre Federico Grignolo - -
Abstract Details:
Purpose:
Photopic and mesopic constrast sensitivity function can provide information on the quality of vision. Recently it was demonstrated that a dual optic IOL (Synchrony) provide patients with good far, intermediate and near vision over years. Aim of this study was to investigate the quality of vision as measured with contrast sensitivity in patients implanted with this dual optic IOL and to compare it with patients implanted with a standard monofocal lens.
Setting:
Dipartimento di Fisiopatologia Clinica-Clinica Oculistica - Universita'' di Torino
Methods:
12 eyes of patients implanted with the Synchrony IOL and 10 eyes implanted with the SA60AT IOL were studied. Photopic and mesopic visual acuity with and without glare were determined using the Optec 6500 (Stereo Optical, Inc). Results were analyzed using a two- tailed unpaired t-test
Results:
There were no significant differences within the two groups for age (Synchrony: 77,6+/-3,9; monofocal: 72,43+/- 6), post-operative BSCVA (Synchrony: 0,92+/-0,19; monofocal: 0,84+/-0,18). Photopic and mesopic contrast sensitivity were not significantly different between the two groups.
Conclusions:
The dual optic Synchrony IOL provides patients with a contrast sensitivity similar to monofocal IOLs
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: BRATU ADRIANA FORLINI MATTEO ROSSINI PAOLO - - - - - -
Abstract Details:
Purpose:
To show the effectiveness of use of mini-invasive 25/23 gauge system for immediate management of cataract surgery complications.
Setting:
Department of Ophthalmology, S.Maria delle Croci Hospital, Ravenna, Italy
Methods:
We use anterior approach with 25 gauge vitrectomy system and 25/23G anterior chamber infusion when the capsule is ruptured with immediate implantation of posterior iris-fixed IOL implant. In case of dropped total or partial lens fragments into the vitreous cavity, a 25/23 gauge pars plana approach to remove the lens remnants.
Results:
No cases of serious uveitis or endophthalmitis were observed
Conclusions:
The 25/23 gauge systems allowed us to treat easily these complications, with minimal postoperative
inflammatory reaction and a fast functional recovery
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Wojciech Kolodziejczyk Monika Lazicka-Galecka Jerzy Szaflik - - - - - -
Abstract Details:
Purpose:
Comparison of axial length, keratometry measurements and IOL power calculations. Data were achieved with two non contact biometry devices LenStar LS 900 (Haag Streit) and IOL Master V.5 (Zeiss)
Setting:
Department of Ophthalmology Medical University of Warsaw, Warsaw, Poland Head: prof. Jerzy Szaflik, MD, PhD
Methods:
In a prospective study 204 eyes of 106 patients, who were listed for cataract extraction procedure in the Department of Ophthalmology Medical University of Warsaw, were measured . Measurements were taken with LenStar and IOL Master. Calculation was performed with both devices. Measurements and calculations were compared using Pearson Correlation calculations an Bland-Altman Plot method
Results:
Pearson Correlation revealed a high correlation for axial length, mean keratometry measurements and implant power calculation results in for algorithms (SRK II, SRK/T, Haigis, Holladay). The data analysis with Bland-Altman plot revealed differences in keratometry (dioptric measurements ) in steep and flat meridian. This is caused by different refractive index attributed to the cornea (n=1.3375 [IOL Master] and n=1.332 [LenStar])
Conclusions:
Measurements and calculation scores provided by LenStar LS 900 are very well correlated with those of the IOL Master. Usage of this devices is limited by calcification of posterior capsular bag, and dense opacification of the crystalline lens. In these cases ultrasound biometry should be performed. The LenStar LS 900 contains additional features which are very helpful tool in cataract surgery.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Ricardo Alarcon Victor Bohorquez Ivan Ossma - - - - - -
Abstract Details:
Purpose:
To demonstrate the mechanism of action of the Synchrony intraocular lens (IOL).
Setting:
Fundacion Valle del Lili, Cali, Colombia
Universidad Autonoma de Bucaramanga, Bucaramanga, Colombia
Methods:
Five eyes implanted with the Synchrony IOL were evaluated at 1, 2, 3 and 4 years after cataract surgery. Distance-corrected near visual acuity (DCNVA) and subjective push-down amplitude of accommodation were measured at 2, 3 and 4 years. The forward movement of the lens optic was measured using Ultrasound Biomicroscopy (UBM) imaging at 1 and 4 years. Additionally, iTrace aberrometry at 2, 3 and 4 years was used to confirm myopic refractive change when presented with a near target.
Results:
The average DCNVA among the subjects was better than 20/25 at all time points. DCNVA remained stable over successive time points (one-way repeated measures Anova, F2,14= 3.06, p = 0.09). The average push-down magnitude of accommodation measured over the 3 year period remained stable (one-way repeated measures Anova, F2,14= 2.32, p = 0.15). Objective measurements with UBM showed forward axial movement of the front optic during accommodation at 1 and 4 years with no significant difference between the two time points (paired t-test, p= 0.24). iTrace showed myopic refractive change during accommodation (one-way repeated measures Anova, F2,14= 0.10, p = 0.90).
Conclusions:
he presence and maintenance of accommodation with the Synchrony IOL was confirmed by subjective and objective techniques over a 4 year period in these selected study eyes. Accommodative forward movement of the lens was associated with myopic refractive change and improved near vision.
Financial Disclosure:
Yes.... receives consulting fees, retainer, or contract payments from a competing company , ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
A prospective intervention trial was conducted to evaluate the effectivity, safety and patient satisfaction of the YAG laser treatment for vitreous floaters.
Setting:
All patients were seen and treated by one ophthalmologist (FG) in Hilversum, the Netherlands. There were if possible also seen by a collugue or optometrist.
Methods:
Patients were asked to score the severity of their floater on a Floater Severity Score (FSS) from 1 to 10. With 1 for no symptoms and 10 for very severe symptoms. Only patients with a FSS of 6 or higher were included. After the treatment they were asked to score it again. All treatments were performed with a Zeiss Visulas II YAG laser. The lenses that were used were Karickhoff vitreous, Karickhoff vitreous off axis lens, Peyman 25 mm and Goldmann NMR fundus lens.
Results:
A total of 56 eyes of 49 patients were treated and completed for follow up. A total of 72 laser treatments were needed. On average 1.35 treatment per eye. 38 eyes (67,8%) needed only 1 treatment 16 eyes (28,6%) needed 2 treatments, 2 eyes (3.5%) needed 3 treatments. Average number of shots per eye was 335 (range 33-1145). Average patient age was 62 (range 23-89).The average FSS improved after the treatment from 7.92 to 2.19. Treatment was succesfull in 52 eyes (92.9%). Treatment failed in 4 cases (7.1%). They were all referred to a collegue for vitrectomy (all succesfully operated). The reasons for failure were two cases of difficult acces to the floater: one small pupil, one post lasik patient (-8) with a posterior capsular cataract inhibiting adequate focussing of the laser. In only 2 eyes the floaters were too extensive to be treated by laser. Two minor complications were observed (3.5%). One peripheral retinal hit causing a minor self limiting retinal hemorrhage. One lenticular hit causing a small opacity. The latter was one of the patients with too severe floaters to be treated by laser and was referred for vitrectomy .
Conclusions:
The majority (92.8%) of disturbing vitreous floaters can be successfully treated (evaporised) with a YAG laser. The risk profile is verly low. The combination of high success rate and low complication rate make the YAG laser the treatment of first choice for most vitreous floaters. It can be performed by a general ophthalmologist. Difficult cases or floaters that cannot be removed by the YAG laser can be referred to a vitreoretinal surgeon. In this series this was needed in only 7.1%. There is however a significant learning curve. This is especially important for the prevention of complications.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Korcan Aysun Gönen Fatih Horozo?lu Kadircan H. Keskinbora - - - - - -
Abstract Details:
Purpose:
To compare the effect of pilocarpine-induced accommodation according to cycloplegic status on anterior chamber depth between single-piece and three-piece hydrophobic acrylic intraocular lens after uneventful phacoemulsification using magnetic resonance imaging
Setting:
Namik Kemal University, School of Medicine, Department of Ophthalmology, Tekirdag, Turkey
Methods:
Nineteen eyes of 19 patients who had uneventful sutureless clear corneal phacoemulsification with intraocular lens (IOL) implantation were included in the study. Nine eyes (group 1) had single-piece hydrophobic acrylic foldable IOL (AcrySof SA60AT, Alcon) and 10 eyes (group 2) had three-piece hydrophobic acrylic foldable IOL (AcrySof MA60BM, Alcon). The average postoperative follow-up time was 16.1 ± 0.9 months in group 1 and 13.7 ± 0.8 months in group 2. Anterior chamber depth was measured in the axial and sagittal T2 weighted magnetic resonance images after pilocarpine 2% installation. One day later, the same procedure was repeated after cyclopentolate 1% installation. Statistical analysis were performed with the Mann-Whitney U test between groups and the Wilcoxon signed rank test within them.
Results:
The average anterior chamber depth after pilocarpine 2% instillation was 3.67 ± 0.39 mm and 4.06 ± 0.24 mm in group 1 and group 2, respectively (p=0.35). The average anterior chamber depth after cyclopentolate 1% instillation was 3.70 ± 0.37 mm and 4.01 ± 0.20 mm in group 1 and group 2, respectively (p=0.53). The difference between the average anterior chamber depth after pilocarpine 2% and cyclopentolate 1% instillations were 0.027 ± 0.087 mm and -0.045 ± 0.10 mm in group 1 and group 2, respectively. The difference between the groups was not significant (p>0.05).
Conclusions:
There is no statistically significant difference in the effect of pilocarpine-induced accommodation according to cycloplegic status on anterior chamber depth between single-piece and three-piece hydrophobic acrylic intraocular lens after uneventful phacoemulsification.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Ersin Oba Mehmet Demir Mahmut Odabas? - - - - - -
Abstract Details:
Purpose:
To present the long-term results of patients undergoing combined phacovitrectomy with 20-gauge trocar system.
Setting:
Sisli Etfal Education and Research Hospital,Istanbul, TURKEY
Methods:
The records of 24 eyes of 24 patients who underwent combined phacovitrectomy and foldable intraocular lens implantataion with various vitreoretinal abnormalities and visually significant cataracts were reviewed retrospectively. Pars plana vitrectomies were performed with 20-gauge trocar system. Main outcome measures were visual acuity (VA), change in corneal astigmatism and intraoperative and postoperative complications. Follow up period was 12 months.
Results:
The indications for surgery were diabetic vitreous hemorrhage (8 eyes), proliferative diabetic retinopathy (6 eyes), epiretinal membrane (4 eyes), rhegmatogenous retinal detachment (3 eyes), and macular hole (3 eyes). Preoperative vision ranged from 0.5 to hand motions; postoperative vision ranged from 0.8 to hand motions. Postoperatively, visual acuity improved in 19 eyes (79.2%), remained same in 3 eyes (12.5%), and decreased in 2 eyes (8.3%). Intraoperative complications included corneal edema, posterior capsule tear, and shallowing of anterior chamber during surgery. Postoperative complications included elevated intraocular pressure, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, anterior chamber hyphema, and posterior synechiae.
Conclusions:
Combined phacoemulsification and pars plana vitrectomy with 20-gauge trocar system is safe and effective in treating vitreoretinal abnormalities co-existing with visually significant cataract.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Halil Ates Suheyla Kose - - - - - - - -
Abstract Details:
Purpose:
To evaluate the effects and complications of cataract surgery in secondary angle-closure glaucoma patients with nanophthalmos.
Setting:
University hospital practice
Methods:
We reviewed the medical charts of 5 patients with angle-closure glaucoma secondary to nanophthalmos who had cataract surgery between 2006 and 2010 retrospectively. Ocular diagnose, axial length, visual acuity, intraocular pressure, surgical procedure, intraoperative and postoperative complications noted for all patients. Nanophthalmos is a clinical entity which is characterized by short axial length (less than 18.50 mm), shallow anterior chamber and high hyperopia.
Results:
Six eyes of 5 patients (4 women, 1 men), with a mean age of 50,2±16,6 years were reviewed. The procedure was planned as phacoemulsification in 4 eyes and extracapsular cataract surgery in 2 eyes. Three eyes had phacoemulsification with posterior chamber intraocular lens implantation and three eyes that had cataract extraction remained aphakic because of extremely shallow anterior chamber. All eyes treated with laser for glaucoma before cataract surgery but intraocular pressure control could not achieved with laser and medical treatment. In one eye extracapsular cataract surgery combined with trabeculectomy.
Mean axial length was 18.42±0.13 mm. Mean intraocular pressure was 23,2±5,3mmHg preoperatively with medical treatment and mean best corrected visual acuity was 0,1±0,08 Snellen preoperatively. After cataract surgery mean intraocular pressure descreased 13±5,6 mmHg and accept one, all patients discontinued medical antiglaucomatous treatment. Mean best corrected visual acuity was 0,3±0,1 postoperatively. Intraoperative complications included vitreous loss and choroidal hemorrhage in one eye. Postoperative complication included posterior capsule opacity (3 eyes), transient choroidal effusion (1 eye), anterior synechia (3 eyes). Except one eye, intraocular pressure decreased to normal levels in all eyes.
Conclusions:
Cataract surgery is an effective treatment for secondary angle-closure glaucoma in nanophthalmos patients. Advances in cataract surgery and glaucoma treatments are promising in these patients.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Celal Yeter - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate the safety and efficacy of microcoaxial phacoemulsification surgeries performed with Ozil Intelligent Phaco (IP) torsional mode an using Infiniti Vision System (Alcon Laboratories).
Setting:
Basaksehir State Hospital, Department of Ophthalmology, Istanbul, Turkey
Methods:
Between January and July 2010 microcoaxial phacoemulsification with Ozil IP torsional mode was performed in 30 eyes of 30 patients. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound amplitudes, mean operation time, mean volume of BSS used and surgical complications. Patients were seen 1,7 and 30 days after surgery. Postoperative outcome measures were anterior chamber reactions, change in the corneal clarity, central corneal thickness (CCT), early uncorrected visual acuity (UCVA) and final best corrected visual acuity (BCVA).
Results:
Mean UST, CDE, longitudinal and torsional ultrasound amplitudes were 1 min. 21 sec. ± 35.56 sec., 10,18 ± 6,22, 0,55 ±0,49, 26,96 ± 9,33. Mean volume of BSS used was 65,25 cc ± 17,54 cc. Mean anterior chamber reactions was 0,50 ± 0,62. Mean corneal clarity changes was 0,53 ± 0,57. Mean CCT changes was 92,60µ ± 66,17µ. Mean early UCVA was 0,31 ± 0,22 logMAR. Mean of final BCVA was 0,11 ± 0,22 logMAR.
Conclusions:
Ozil IP torsional mode provided effective and safe lens removal by using very small amount of longitudinal energy.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Detlef Uthoff - - - - - - - - - -
Abstract Details:
Purpose:
The microincisional cataract surgery with incision size below 2.0mm is spreading more and more in ophthalmic surgery. The aim is to improve the postoperative result and the safety for the patient. Phakoemulsification using smaller incisions has to be as safe and efficient as using standard sizes. A second question is if the IOL used for microincisional cataract surgery are easy to implant and show good results concerning centration e.g. within the capsular bag. The authors want to demonstrate their experience during the change .
Setting:
Augenklinik Bellevue, Lindenalle 21, 24105 Kiel, Germany
Methods:
In july 2010 the Augenklinik Bellevue changed from the EasyPhako® tip using a incision size of 2.4mm to the Comics® tip using a 1.8mm. Both are customized be Oertli/Switzerland as well the phako system is the OS3®. The used IOL is the BiFlex® of Domilens/Germany, a foldable acrylic IOL with 6.0mm optic and 13.0mm total diameter. For the implantation a single use injector system is used.
Results:
The change to 1.8mm incision was without any complications like corneal burn, endothelium decompansation or rupture of the capsular bag. The authors did not need to change their favorate phako technique using only higher flow rate, vacuum and phako power. The stability of the anterior chamber is comparable to the EasyPhako® technique. Comics® showed good holdability and followability. After a learning curve of ca. 50 operations the phako time was comparable to the time using EasyPhako® . The BiFlex® IOL could be implanted without complications. The unfolding of the lens showed a moderate speed and is very controlled. The intraoperative centration was good. No problems like leakage of the incision occured intra- or postoperatively.
Conclusions:
The change to 1.8mm microincisional cataract surgery using the Comics® and the Oertli OS3 plattform is easy implies no change of the favorate phako technique for the surgeon. The BiFlex® IOL shows a good performance for implantation using a 1.8mm incision. Long time follow up concerning centration within the capsular bag and PCO is nessecary.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Ihsan Yilmaz Iltifat Sharif Omar Faruk Yilmaz - - - - - -
Abstract Details:
Purpose:
To evaluate the ocular findings after phacoemulsification surgery with implantation of Acrysof SA30D3 intraocular lens (IOL).
Setting:
Briz-L eye clinic, Baku, Azerbaijan.
Methods:
This is a retrospective study of 232 eyes of 164 patients (72 female, 92 male). Mean age was 63.73 ± 16.78 (range from 16 to 90). 96 patients (% 58.5) had uneventful unilateral phacoemulsification surgery of cataract and 68 patients (%41.4) had a bilateral surgery. All surgeries performed at the same clinic by two surgeons. The surgery was under topical anaesthesia (without sedation). All lenses were implanted in the capsular bag. Postoperative visits were set as 1 day, 1 week, 1 month, 6 month and 12 month after surgeries. Follow-up time was 12 months. Refraction, best corrected visual acuity (BCVA), corneal power (keratometry) and intraocular pressure (IOP) were measured. BCVA measured by using a standard Snellen chart. IOP measured with Goldmann applanation tonometer. Early and late complications were recorded.
Results:
Range of IOL power used in this study was -4 to 25 diyopter (mean 19.50 ± 4.53). Preoperative mean BCVA was 0.21 ± 0.21 (range 0.01-0.8) and improved to 0.71 ± 0.30 (range 0.05-1) postoperatively. Postoperative mean refractive error (s.e., D) was -0.08 ± 1.17 (range from -5 to 2). Mean IOP was 17.20 ± 5.64 mmHg (range 9-44) preoperatively and 15.34 ± 3.84 mmHg (range 8-28) was postoperatively. There was no statistically significant change in IOP. Corneal edema recorded as an early complication in 14 cases (%6.03), and was cured by topical drops. Any other early or late complications were not recorded in one year follow up time.
Conclusions:
We found out that using an Acrysof SA30D3 IOL in cataract surgery showed successful and predictable visual outcomes without severe complications in one year follow up time.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Norlina Ramli Nur Adura Yaakup Kasumawati Alli Kartini Rahmat - - - -
Abstract Details:
Purpose:
The aim of this study is to measure normal cornea and lens projection from superior, inferior and lateral orbital rims between three major South East Asian ethnic groups (Malay, Indian and Chinese) using computed tomography.
Setting:
University Malaya Medical Centre, Kuala Lumpur, Malaysia
Methods:
One hundred and fifty normal right orbits of 150 patients, equally divided among 3 major ethnic groups (Malay, Chinese and Indian) were analyzed using computed tomography scans. The images were visualized on the 16-slice CT scanners (Somatom Sensation 16; Siemens, Forchheim, Germany). Cornea and lens projection was measured as the distance between the anterior surfaces of the cornea and lens from the superior, lateral and inferior orbital rims. All measurements were made in standardized planes to control any variation in the patients'' position in the scanner.
Results:
There was no significant difference in corneal projection from the superior, lateral and inferior orbital rims between the Malay and Chinese groups. However, the cornea and lens projection from the superior and inferior rims were smallest in the Indian group. This difference were statistically significant. There was no significance difference between all three groups in corneal projection from the lateral orbital rim.
Conclusions:
This study is the first to compare the differences in cornea and lens projection from the orbital rims between three different major ethnic groups in a South East Asian country with a heterogenous society. The results showed that there are a significant differences in corneal and lens projection between the groups, with the Indian group having the smallest projection, suggesting deep-seated eyes. The results of this study provides an anatomical factor to be considered when planning cataract surgeries from either the superior and temporal approach in this population group.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Irini Chatziralli Vasileios Konidaris Christina Kanonidou Paraskevi Zotta Leonidas Papazisis - -
Abstract Details:
Purpose:
To evaluate the outcomes of phacoemulsification cataract surgery in patients with age-related macular degeneration (AMD)
Setting:
Department of Ophthalmology, General Hospital of Veria, Veria, Greece
Methods:
62 patients (39 male and 23 female), with a mean age of 78.3 years old (SD 5.21) and with varying severity of AMD, participated in our investigation. All underwent uneventful phacoemulsification cataract surgery during the year 2010. Best corrected visual acuity (BCVA) was measured preoperatively and three months postoperatively. In addition to this, patients'' contentment if they were satisfied or not with the result of the surgery was recorded
Results:
Postoperative visual acuity improved in 50 cases and remained stable or deteriorated in 12 cases with AMD. 55 patients were satisfied with the surgery outcomes while 7 patients mentioned dissatisfaction. There was a significant correlation between the improvement of visual acuity and the degree of satisfaction reported by the patients. In 3 patients, who were dissatisfied with the outcome of the surgery, the presence of a possitive scotoma in the central part of their visual field was related to their negative perception regarding the cataract surgery outcome. It is worthy to note that in these patients cataract surgery was performed in their dominant eye.
Conclusions:
Our study indicates that participants with varying severity of AMD benefited from cataract surgery with an increase in visual acuity postoperatively. Nevetheless, there is also a significant degree of dissatisfaction regarding the visual outcome after cataract surgery, especially in those parients with severe AMD, who present possitive central scotomas
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate the efficacy and effect of Toric intraocular lens implanation (IOL) (Alcon) implantation to correct preexisting corneal astigmatism, induced by residual operated pterygium, in a patient having cataract surgery.
Setting:
Department of Ophthalmology, General Hospital Of Trikala, Greece
Methods:
A 64-year-old man presented with cataract and astigmatism induced by previously operated pterygium in both eyes. Refraction of the right eye, operated for pterygium 6 years ago, was sph: -1,50 cyl:-4,50x60? while the refraction of the left eye, operated for pterygium 30 years ago, was sph:-4,00 cyl:-1,25x110?. Preoperative the uncorrected distance visual acuity(UDVA) of the right eye was 3/10 and the best correct visual acuity (BDVA) was 6/10 while of the left eye was 2/10 and 7/10 respectively. The patient underwent cataract surgery in both eyes, placing toric IOL Acrysof (Alcon) SN60T8 21,5D cyl 5,25 in the right eye due to high astigmatism and spherical IOL Acrysof IOL (Alcon) 21D in the left eye considering that the astigmatism in this eye would be eliminated by surgical induced astigmatism(SIA).
Results:
Refraction of the right eye after the operation was sph +0,50 while the refraction of the left eye was sph +0,75. The UDVA of the right eye 9/10 and the BCVA was 10/10 cc sph +0,50 while in the left eye was 9/10 and the BCVA was 10/10 cc sph +0,75. At last observation, 3 months after surgery, IOL alignment was 2 degrees moved clockwise. Patient satisfaction was rated to 9 (1=completely unsatisfied, 10=completely satisfied).
Conclusions:
Refraction of the right eye after the operation was sph +0,50 while the refraction of the left eye was sph +0,75. The UDVA of the right eye 9/10 and the BCVA was 10/10 cc sph +0,50 while in the left eye was 9/10 and the BCVA was 10/10 cc sph +0,75. At last observation, 3 months after surgery, IOL alignment was 2 degrees moved clockwise. Patient satisfaction was rated to 9 (1=completely unsatisfied, 10=completely satisfied).
Financial Disclosure:
-.-
Presentation Type: Cataract
Co Authors: Zofia Mariak - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate quantitatively changes in anterior chamber depth (ACD), angle width (AW, AOD) and intraocular pressure induced by phacoemulsification and intraocular lens (IOL) implantation in eyes with angle-closure glaucoma using ultrasoundbiomicroscopy (UBM).
Setting:
The participants were 35 men and 49 women aged average 77.58 (±6.99) ranging from 61 to 90 hospitalized in Ophthalmology Clinic of the Medical University of Bialystok.
Methods:
Foreword prospective study of 84 emmetropic eyes from 84 patients divided into two groups. Group I counted 49 eyes with angle-closure glaucoma underwent phacoemulsification and IOL implantation, group II- 25 control eyes of 25 age-matched patients scheduled for phacoemulsi?cation surgery. Additionally 10 healthy eyes were examined to determine normal biometric parameters. All operative procedure were performed by the same, highly qualified operator; all the implanted lenses were the same kind. The main diagnostic tests included measuring refraction, aplanation tonometry, keratometry, pachymetry, gonioscopy, ophthalmoscopy, and anterior chamber depth and angle width using UBM (Vu-max I, Sonomed). The examination was performed by the same person, in standardized conditions with the use of Vu-Max I, Sonomed, 35 Hz head.
Results:
In both groups ACD, AOD and AW increased after surgery (p<0.05). Before operation in eyes with angle-closure glaucoma group ACD = 1.68 ? 0.25mm, AW = 24.38 ? 10.9°, in comparison to no glaucoma eyes - ACD = 2.88 ? 0.44 mm, AW = 34.98 ? 9.12°. One month after operation in group I: ACD = 3.55 ± 0.48 mm, AW = 51.29 ± 8.31°; after half a year: ACD = 3.68 ± 0.48 mm, AW = 53.11 ± 7.1°; one year after: ACD = 3.63 ± 0.31 mm, AW = 52.47 ± 9.21°. One month after phacoemulsification in group II: ACD = 3.65 ? 0.4 mm, AW = 45.64 ± 16.04°(p<0.05); after 6 months: ACD =3.74 ? 0.3 mm, AW =38.84 ± 12.13°(P>0.05); one year after: ACD = 3.75 ? 0.29 mm, AW = 40.86 ? 9.15°.
Conclusions:
The width of the angle, and the depth of the anterior chamber in eyes with angle- closure glaucoma increased significantly after cataract extraction and IOL implantation. Additionally this effect is followed by the decrease in IOP in the postoperative period by an average of 2.16 mmHg in eyes without glaucoma and 5.11 mmHg in angle closure glaucoma. This effect is permament for at least one year after phacoemulsification. The study is still continued and will be verified with wider clinical material and control groups.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Michael Wolter-Roessler - - - - - - - - - -
Abstract Details:
Purpose:
This prospective study was conducted to evaluate postoperative visual acuity and patient satisfaction after implantation of multifocal Add-On-IOL implanted into the ciliary sulcus during regular cataract surgery.
Setting:
Outpatient Eye Surgery Center Erlangen-Mitte.
Methods:
86 eyes of 43 patients with age-related cataract underwent phacoemulsification with in-the-bag implantation of regular IOL simultaneously with implantation of sulcus-fixated multifocal Add-On-IOL (MS 714 PB Diff. near addition +3,5D, Dr. Schmidt Intraocularlinsen, Sankt Augustin). Standard surgery was performed by two surgeons. 12 weeks after surgery the following parameters were evaluated: near (33cm with EDTRS-chart) and distance visual acuity with and without best distance correction. Contrast sensitivity was tested with Ginsburg Box, Vision Science Research Corporation, San Ramon, CA. Patient satisfaction was analysed with a questionnaire with possible responses excellent; satisfied; not satisfied.
Results:
Surgery was completed in all cases without complications. Furthermore, no complications were observed postoperatively. The Snellen distance visual acuity (median) was 0,8±0,20 uncorrected and 0,8±0,15 with correction. Near visual acuity was 0,63±0,23 and 0,8±0,21 respectively.Contrast sensitivity under mesopic and scotopic conditions was within the normal range. Patient satisfaction was reported as excellent in 80% and satisfied in an additional 20%.
Conclusions:
Multifocal diffractive Add-On-IOLs are a welcomed addition to our refractive surgery armamentarium. They can be seen as an alternative to multifocal IOL implanted into the capsular bag. The presented results encourage using this method as a standard procedure.
Financial Disclosure:
Yes.... travel has been funded, fully or partially, by a competing company
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
Seven cases of subacute malignant glaucoma in pseudophakia are presented.
Setting:
hospital and private practice
Methods:
: Seven hyperopic eyes with mean axial length of 21.04( 16.92 to 22.39 mm) underwent uncomplicated phacoemulsification with IOL implantation. Trabeculectomy was associated in one case and keratoplasty in one case. Post-operatively, all 7 had very shallow anterior chambers including two that were completely flat. Mean immediate post-op refraction was - 4.75 D ( -1.75 D, and -8.00 D). Two eyes had elevated IOP medically uncontrolled. Atropine and Diamox treatment restored emmetropia in 4 cases. Echo B showed a complete posterior vitreous detachment in 3 cases.
Results:
Vitrectomy was performed 0.5 to 36 months after cataract surgery. In all cases, the vitreous was thick and homogenous. If there was not already a PVD pre-operatively, one was provoked during the vitrectomy. A large as complete as possible vitrectomy was performed followed by a zonulotomy and peripheral iridectomy. Postoperatively 2 retinal detachments occurred treated successfully with pneumoretinopexy.
Conclusions:
: A ciliary block (malignant glaucoma) mechanism may be present in hyperopic eyes operated on for cataract, suggested by an unexpected myopic result, due to forward movement of the IOL. The ultimate treatment is vitrectomy, despite the risk of retinal detachment in eyes without a pre-existing PVD.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Anna March Vanessa Valdivielso Josep Visa Josep Grącia - - - -
Abstract Details:
Purpose:
We report the complications in cataract extractions by phacoemulsification or extracapsular surgery performed in a training residency program
Setting:
Department of Ophthalmology, Hospital Parc Taulķ Sabadell, Universitat Autņnoma de Barcelona, Catalunya (Spain)
Methods:
This retrospective study analyzed 303 cataract surgeries by phacoemulsification or extracapsular surgery and intraocular lens implantation performed by a single resident between July 2007 and September 2010. Surgical and follow-up postoperative complications were examined. Of these procedures there were 3 extracapsular surgeries and 300 phacoemulsifications including a congenital cataract surgery in a child, floppy iris syndrome, with vitrectomized eyes, pseudoexfoliation, poor dilatation, corneal leucomas, and brunescent nucleous among other situations.
Results:
The 94,8% of the surgeries were succesful, the incidence of intraoperative complications have included posterior capsule tear and vitreous loss, which were the main outcomes. Appeared in 16 cases (5,2%) and in 5 cases (1,6%) respectively, during the phacoemulsification in 9 cases (56,25%) and during the irrigation-aspiration in 7 cases (43,75%). The IOL was placed in bag in 5 cases (31,25%), in sulcus in 9 cases (56,25%) and in anterior chamber in 2 cases (12,5%). Two cases (0,7%) presented pseudophakic cystoid macular edema in the follow-up. 5 gifts were received, 2 of them of patients under extracapsular surgery.
Conclusions:
The results indicate that with proper training and supervision, residents can obtain an acceptably low complication rate. The risk of such complications performed at the learning curve surgery is comparable with published papers, even the complications were no compared at the beginning and at the end of the training.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Hasan Erbil Ay?e Bilge Zeki Aslan Ali Olgun - - - -
Abstract Details:
Purpose:
Evaluating long term clinical efficacy of patients with accommodating intraocular lens (IOL) and the effect of laser capsulotomy for accommodation capability.
Setting:
Goztepe Training and Research Hospital, Ophthalmology Department
Methods:
In this prospective non-randomized clinical study, phacoemulsification and 1CU Accommodative IOL implantation in 40 eyes of 20 patients (group1) and monofocal hydrophilic acrylic IOL implantation in 44 eyes of 22 patients (group2) were performed in Ophthalmology Department of Goztepe Training and Research Hospital. Laser capsulotomies were done for capsular fibrosis between 14th and 23rd month. At 4th, 12th and 24th month, monocular best distance corrected and binocular uncorrected distance visual acuities (BDCVA,UCDVA), and monocular best distance corrected near and binocular uncorrected near visual acuities (BDCNVA,UCNVA), accommodative ranges, change in anterior chamber depth (ACD) with pilocarpine eye drop were measured.
Results:
Capsulotomy rates in group1 and 2 were 40% and 18% respectively. Group1 had statistically higher near visual acuity, accommodative range, ACD change (p<0.05). In group1, mean monocular BDCNVA, accommodative ranges, ACD change at 4th month were statistically higher than those at 12th and 24th month (p<0.05) and no significant difference was found between 12th and 24th month measurements for near visual acuity and accommodative parameters. No significant difference was found between accommodative parameters before and after laser treatment in group1 (p>0.05).
Conclusions:
In 1CU accommodative IOL group, a moderately better near vision was achieved and short term near visual acuities were higher than long term values. Laser capsulotomy didn''t cause a satisfactory increase in mean near visual acuity and accommodation amplitude at long postoperative period.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Ismail Halili Cüneyt Erdurman - - - - - - - -
Abstract Details:
Purpose:
To evaluate the outcomes of phacoemulsification surgery with posterior chamber intraocular lens (IOL) implantation in high myopic eyes.
Setting:
Gülhane Military Medical Academy and Medical School, Department of Ophthalmology, Ankara, Turkey.
Methods:
Data of 116 eyes of 58 high myopic patients (axial length >25.00 mm) who had undergone phacoemulsification surgery with posterior chamber IOL implantation in both eyes between January 2004 and December 2008 were reviewed. Patients had either clear lens extraction (CLE) or cataract surgery bilaterally. Visual acuity, axial length and refractive error [diopter (D); spherical equivalent] were assessed before and after surgery, and intra and postoperative complications were recorded.
Results:
Mean follow-up time was 38.6 ± 11.54 months 24 to 60) and mean age was 53.3±10.2 (42 to 71) years. Mean axial length was 28.9±1.7 mm (25.6 to 33.9) preoperatively. While mean best-corrected visual acuity (BCVA) was 0.7 (0.05 to 1.3) logmar preoperatively, it was 0.24 (00 to 1.00) logmar postoperatively (p<0.0001). Mean preoperative refractive error was -14.3 D (-9.5 to -23.5) and mean postoperative refractive error was -1.90 ± 0.72 D (+0.50 to -3.75). Tendency to overly deep anterior chamber in all cases was the main intraoperative problem. Capsular tear and an inadvertent implantation of the IOL in one eye (0.008%, for both) were main intraoperative complications. Subfoveal choroidal neovascularization developed in 2 (1.7%) eyes. Eight eyes (6.8%) had Nd:YAG laser capsulotomy. Retinal detachment (RD) developed in 2 cases (2.58%) one of which bilateral.
Conclusions:
Despite its potential complications, phacoemulsification surgery and IOL implantation have good effectiveness and acceptable predictability and satisfactory postoperative improvements in BCVA and refraction in high myopics over a long follow-up period. However, CLE seems to remain a controversial technique because of its invasiveness and risk of RD.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Iwona Obuchowska Zofia Mariak - - - - - - - -
Abstract Details:
Purpose:
To determine whether intraocular lens (IOL) occurs more frequently in the eyes with advanced forms of age-related macular degeneration (AMD).
Setting:
The study was undertaken in the Department of Ophthalmology of the Medical University of Bialystok, Poland.
Methods:
This prospective study analyzed 162 eyes of 81 patients with age-related macular degeneration. In this group were 59 women and 22 men at the age from 56 to 90 years old (mean age: 76.52±7.55). Each patient was given a full eye examination. AMD was diagnosed on the basis of fluorescein angiography or/and optical coherence tomography. The eyes were divided into two groups: with early AMD (76 eyes with hard and soft drusen) and with advanced AMD (86 eyes with neovascular AMD, geographic atrophy or disciform scar). The groups were compared in terms of the frequency of the cataract surgery with the intraocular lens implantation. The results were statistically analyzed using the Fisher test.
Results:
7 eyes had intraocular lens in the group with early age-related macular degeneration (9.21%). In the second group, with advanced forms of AMD, 19 eyes had IOL (22.09%). The difference is statistically significant (p <0.05).
Conclusions:
Eyes with advanced forms of AMD more often have IOL, instead of the natural lens, than the eyes with early AMD. Surgery of cataract extraction with the intraocular lens (IOL) implantation may pose a potential risk of developing advanced forms of AMD.Scientific work financed from the funds for science in 2009-2011.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Jerome Sherman Sheikh Hossain Daniel Epshtein Melody G. Nath - - - -
Abstract Details:
Purpose:
To determine if Avastin injection at the time of cataract surgery reduces retinal thickness in diabetic retinal edema.
Setting:
A clinical private practice setting.
Methods:
12 eyes with diabetic macular edema without maclar ischemia but with differing amounts of (mild to moderate) of non-perfusion in the mid peripheral retina received 0.05cc of avastin thru the pars plana after the completion of the cataract procedure. SD-OCT was performed about 2 weeks before and 2-6 weeks after surgery. The side port was burped after the injection in all cases to keep the intraocular pressure around 20 mm.
Results:
None of the eyes had any intraocular complications related to the avastin injection. Minor sub-conjunctival hemorrhage was seen in 3 eyes. Retinal thickness was reduced in 6 eyes, unchanged in 4eyes and increased in 2 eyes.
Conclusions:
Avastin intra-vitreal injection in eyes undergoing cataract extraction with co-existing diabetic retinal edema may have reduction in retinal thickness without significant complications associated with the injection.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Jerome Sherman Sheikh Hossain Daniel Epshtein Melody G. Nath - - - -
Abstract Details:
Purpose:
To determine if the presence of a pre-existing posterior vitreous detachment(pvd) in eyes undergoing cataract surgery is a factor influencing a change in retinal thickness.
Setting:
Clinical Private Practice.
Methods:
A retrospective evaluation of 20 eyes with pre-existing retinal edema from retinal vascular disease seen on SD-OCT and confirmed with fluorescein angiography were evaluated post-operatively with SD-OCT and Binocular Ophthalmoscopy. Both retinal thickness as well as the vitreo-retinal interface were evaluated 30-60 days after surgery. A well defined pvd was seen in7 eyes. A well defined posterior hyaloid attachment to a thickened Internal limiting membrane(ILM) was seen in 4 eyes. In the remaining eyes separation was ill defined or not noted.
Results:
Retinal thickness in eyes without pvd was increased in 6 eyes and unchanged in the rest. In the group with pvd, 2 eyes increased in thickness and 5 remained the same. Number of eyes with pvd did not change.
Conclusions:
SD-OCT before cataract surgery is able to help delineate vitreo-retinal interface and retinal thickness. Presence of PVD did not significantly alter risk of increased edema in eyes with retinal vascular disease.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Barbara Strzalka-Mrozik Urszula Mazurek Maria Forminska-Kapuscik Erita Filipek Pawel Banasiak Piotr Berezowski
Abstract Details:
Purpose:
Determination of the relationship between expression TGF? ligands and receptors in peripheral blood mononuclear cells (PBMC) and in the anterior lens capsule (ALC) in children with a secondary cataract after congenital cataract surgery.
Setting:
Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
Methods:
The study included 54 children after congenital cataract surgery. Total RNA was measured in ALC and PBMC obtained at the time of surgery. Gene expression was assessed by quantitative RT-PCR.
Results:
Expression of TGF?1 and TGF?2 in PBMC correlated with occurrence of secondary cataract (p<0.05).
Conclusions:
TGF?1 and TGF?2 in PBMC might be a potential candidate for a prognostic factor of a secondary cataract.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Sawsen SALAH Pierre-Jean PISELLA - - - - - - - -
Abstract Details:
Purpose:
To evaluate and compare the objective quality of vision and accommodative amplitude of eyes implanted with 4 different multifocal IOLs (Acrilisa®, Zeiss; Rezoom®, AMO; MPlus®, Oculentis; Crystalens®, Bausch and Lomb).
Setting:
CHU Bretonneau, Tours, France
Methods:
Patients were divided in four groups: group 1 (7 patients, 14 eyes implanted with diffractive IOL, Acrilisa®), group 2 (7 patients, 14 eyes implanted with refractive IOL, Rezoom®), group 3 (4 patients, 8 eyes implanted with bifocal IOL, Mplus®) and group 4 (4 patients, 8 eyes implanted with accommodative IOL, Crystalens®).
All eyes were targeted for emmetropia. Complete ophthalmological examination, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) was performed. Subjective defocus curve was also performed.
Results:
All eyes in all groups had BSCVA > or = 20/20 postoperatively. There was no difference in BSCVA in both groups (p>0,05). Intermediate visual acuity at 90 cm was better in accommodative group whereas intermediate visual acuity at 70 cm was better in bifocal group and near visual acuity was better in diffractive group (p<0.05). There was no significant difference in the quality of vision measurements (objective contrast sensitivities and MTFcutoff) in both groups. Objective scattered index (OSI) seemed to be lower in accommodative group versus other groups (1,2 +/- 0,3 versus 2,3 +/- 0,4 with p=0.02).
Conclusions:
The analysis of subjective defocus curve is important in order to assess near quality of vision. These differences may explain the reading speed ability of our patients implanted with multifocal IOLs. Moreover, OSI may be an objective measurement of halos or glare complaints.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: gokhan gulkilik mahmut odabas mehmet demir ayse burcu dirim
Abstract Details:
Purpose:
To report a case with moderate anterior chamber inflammation and cystoid macular edema due to iris capture by scleral fixation intraocular lens (SF IOL).
Setting:
Sisli Etfal Education and Research Hospital 2. Eye Clinic ISTANBUL/TURKEY
Methods:
A 65 years old male patient was admitted to our clinic complaining of blurred vision and glare in the right eye . Ocular history revealed a cataract surgery with IOL implantation due to blunt trauma performed 10 years ago. BCVA was 0.8 and at biomicroscopic examination there was a subluxated IOL with significant pseudo-phacodonesis. Capsular tension ring- IOL- the bag complex was extracted as a whole. Then scleral fixation IOL was implanted after anterior vitrectomy.Postoperatively patient''s complaints disappeared and VA improved to 0.8. Eleven months later the patient experienced decreased vision. The examination showed VA of 0.4 and a moderate anterior segment inflammation accompanied by iris capture of scleral fixation IOL. OCT examination showed cystoid macular edema with central macular thickness of 366 microns. We repositioned the SF IOL and corrected iris capture. Preoperative and postoperative BCVA, anterior segment inflammation, macular thickness were compared.
Results:
After repositioning of SF IOL BCVA improved from 0.4 to 0.7, anterior segment inflammation immediately disappeared in a week and macular thickness decrased to 267 microns.
Conclusions:
Scleral fixation IOL implantation may be a viable alternative procedure in eyes with subluxated IOLs. In vitrectomised eyes with blunt trauma history and "floopy" iris. The iris capture with SF IOL may occur inducing anterior segment inflammation and cystoid macular edema. Surgical repositioning may prevent chronic iris trauma , anterior segment inflammation and cystoid macular edema.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: mahmut odabasi gokhan gulkilik burcu dirim semra tiryaki - - - -
Abstract Details:
Purpose:
to describe and compare technical details of two anterior continous curvilinear capsulorhexis ( CCC )techniques routinely practised in our clinic and to evaluate their safety and surgical advantages in cataract patients operated on by phacoemulsification
Setting:
Second Eye Clinic,Sisli Etfal Training and Research Hospital,Istanbul,Turkey
Methods:
Two groups were formed each comprising 100 eyes of 100 patients having the same clinical characteristics (age, sex and grade II nuclear cataract). In both groups 27 gauge cystotome is introduced into the eye by the main incision. In the first group following a central horizontal 2 mm tear , the anterior capsule is flapped superiorly in a such a way that its posterior surface is facing upwards .The flap is maintained constantly in contact with the remaining capsule during progression of CCC and the diameter of the rhexis was always visible and easily adjusted if necessary. In the second group CCC were performed by pulling the hinge radially or tangentially without laying down of capsular flap on the remaining anterior capsule. Peroperative complications and surgical advantages of these techniques were compared.
Results:
In the first group,in any patient peripheral flap extension and zonular dialysis were observed. Radial tearing occurred in 4 eyes because of acute surgical surge of anterior chamber in 2 eyes,and uncontrolled high intralenticular pressure in 2 other eyes. Peroperative miosis occurred in 5 patients, a posterior capsule rupture detected in one patient during the phacoemulsification. In the second group peripheral flap extension occurred in 5 eyes, radial tearing in 8 eyes with 2 of them showed progression of the tear towards posterior capsule necessitating anterior vitrectomy. Peroperative zonular dialysis was noted in 2 eyes, miosis in 7 eyes, iris trauma in one eye and posterior capsule rupture detected in 2 eyes. There was a significant difference between two groups when comparing the peroperative complications(p<0.05)
Conclusions:
Returned capsular flap maintained constantly in contact with the remaining capsule provides significantly better adjustment of CCC diameter,prevents radial tears and may be safely used in teaching purposes when compared with CCC performed without flap adherence.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Valentina Kopayeva Youri Andreev - - - - - - - -
Abstract Details:
Purpose:
to evaluate of anew method of cataract removal by laser
Setting:
International Eye Center
Methods:
The device has an original delivery system of laser irridation by means of a separate laser probe and an aspiration/irrigation system with a separate probe, The original aspiration/irrigation probe is made in such a way that during the aspiration an additional laser crushing of lens fragments is carried out inside the aspiration port
Results:
The laser can treat all cataracts and can quickly remove more difficult hard cataracts, such as brown and brunescent ones Healing is usually faster after laser phaco compared with other techniques currently used
Conclusions:
laser phaco may have potential within the near future with additional developments
Financial Disclosure:
Yes.... gains financially from product or procedure presented
Presentation Type: Cataract
Co Authors: Mehmet Özdemir - - - - - - - - - -
Abstract Details:
Purpose:
Intravitreal triamcinolone acetonide injection (IVTA) is widely used to treat posterior segment diseases in clinical practice. Two well-documented side effects of this procedure are cataract progression and elevation of intraocular pressure. Injection of triamcinolone acetonide into the crystalline lens instead of vitreous cavity has been reported in two cases which resulted with localized lens opacification and phacolytic glaucoma (1,2). We report a case of intralenticular triamcinolone acetonide injection which rapidly induced a total lens opacification in a diabetic patient.
Setting:
The patient was a 68-year-old female with diffuse macular edema. Visual acuities were 1/10 on the right and 3/10 on the left. IVTA injection with a dosage of 4 mg / 0.1 ml was given into the vitreous at 4 mm posterior the limbus through the inferior pars plana.
Methods:
The patient complained of decreased vision at the end of the procedure and ophthalmological examination showed us a totally opacified crystalline lens with intralenticular yellowish granules (Figure-1). Anterior lens capsule was intact. Intraocular pressure was measured as normal.
Results:
The patient was informed about the complication and a cataract surgery was planned and performed in a few days. Despite a careful surgery, lens material fell posteriorly and a ruptured posterior capsule was recognized. Posterior vitrectomy and removal of lens material was performed successfully and an intraocular lens was implanted on to the anterior capsule.
Conclusions:
Cataract has been demonstrated in a majority of eyes following IVTA (3). Previous cases presented with a slowly progressive localized cataract and a painful eye with phacolytic glaucoma (1,2). This is the first case of a rapidly progressive cataract following IVTA injection which needed a pars plana vitrectomy to completely remove. The eye had no signs of intraocular inflammation and elevation of intraocular pressure during the follow up. Rupture of posterior capsule with the needle was recognized during surgery. To conclude, patients should be fully informed for the possible injection-related complications of this procedure
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Victor Bohorquez Andrea Galvis Ricardo Alarcon - - - - - -
Abstract Details:
Purpose:
To evaluate the nature and incidence of secondary procedures required over the first three years of follow-up in patients receiving either a diffractive apodized multifocal IOL or a dual optic accommodating intraocular lens.
Setting:
Fundacion Valle del Lili, Cali, Colombia. Universidad Industrial de Santander, Bucaramanga, Colombia`
Methods:
Multicenter Randomized Prospective Double Masked Clinical Trial of patients over 40 years requiring bilateral cataract surgery. Patients were excluded if they had comorbidities or corneal astigmatisms over 1.25 D. Patients were randomized to receive bilateral implantation with a dual optic accommodating IOL (Group I, N=43) or a diffractive apodized multifocal IOL (Group II, N=47). Follow-up visits included 1 day, 1 week, 1,3,6,12 and 24 months postoperative. At each visit, standardized visual testing was performed at 30,40,50,60,80,100,200 and 400 cm with and without correction. Reading speed was measured with the Spanish MN Read Chart and Contrast Sensitivity with the Optec 6500 device. The incidence and severity of glare/halos was evaluated with a questionnaire administered at the 6,12, 24 and 36-month visits. The nature and visual outcome of all secondary procedures was recorded.
Results:
Mean distance-corrected visual acuities were comparable between both groups at all study periods but were higher from 60 to 200 cm for the patients in the dual optic accomodating IOL group. The incidence of refractive enhancement (LASIK/PRK) was 4.6% and 6.3% of patients in Groups I and II respectively (Chi-Square 0.1284 p=0.720). The incidence of yag capsulotomy was 0 and 13.8% in groups I and II respectively (Chi-Square 12.81 p<0.001). Mesopi and Photopic Contrast Sensitivity curves were higher in Group I..
Conclusions:
The incidence of secondary procedures is lower in dual optic accommodating IOLs compared to diffractive apodized multifocal IOLs increasing patient safety. Objective visual function tests demonstrate better quality of vision in dual optic accomodating IOLs compared to apodized diffractive multifocal technologes.
Financial Disclosure:
Yes.... receives consulting fees, retainer, or contract payments from a competing company
Presentation Type: Cataract
Co Authors: Hikmet Ozcetin Gamze Ucan Ahmet Ozmen - - - - - -
Abstract Details:
Purpose:
To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for aphakia correction.
Setting:
Uludag University, Dept of Opthalmology, Bursa, Turkey
Methods:
A secondary posterior iris fixation of the Artisan® iris-claw IOL was implanted for aphakia correction in the authors'' clinical practice. Uncorrected visual acuity, best-corrected visual acuity (BCVA), astigmatism, manifest refraction, lens position, pigment dispersion, and intraocular pressure (IOP) were evaluated in 80 consecutive eyes of 80 patients.
Results:
BCVA was 20/40 or better in 70 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was -0.80 diopters (D; standard deviation [SD], 0.49 D) at six months after surgery. Mean prediction error was -0.1 D (SD, 0.25 D), and mean absolute prediction error was 0.25 D (SD, 0.15 D). Preoperative mean astigmatism was -1.0 D (SD, 0.5 D; range, 0.0 to -2.0 D). At six months after surgery, mean astigmatism was -2.0 D (SD, 0.8 D; range, -0.75 to -3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam® and ultrasound biomicroscopy [UBM], was parallel to the iris plane. No serious complications were observed.
Conclusions:
Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes without capsule support.
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No.-
Presentation Type: Cataract
Co Authors: Ulviye Yi?it Ahmet A?aēhan Murat K?l?ē Hande Mefkure Özkaya - - - -
Abstract Details:
Purpose:
To determine the outcomes and complications of cataract surgery with Phacoemulsification in monocular patients.
Setting:
Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Department, Istanbul.
Methods:
The records of 29 patients who are operated between June 2007 and May 2010 was rewieved. The patients who had 1.3 LogMAR or worser visual acuity in the blind eye was accepted as monocular. Outcome measures included the state of the blind eye preoperative and postoperative best corrected visual acuity (BCVA), preoperative and postoperative intraocular pressure (IOP) and complications due to the surgery.
Results:
Mean age of the patients was 74.9±10.5 (39-90 years old). Mean folow up time was 10,7 months. 6 patients were monocular because of surgical conditions and 23 patients were monocular because of medical conditions. Glaucoma, ischemic optic atrophy and cataract operation complications were the most common reason for monocular status. Mean preoperative BCVA was 1,06±0,38 LogMAR and mean postoperative BCVA was 0,37±0,45 LogMAR. 28 patients gained at least one row and 19 patients had 0,3 LogMAR or better BCVA. Mean preoperative and postoperative IOP was 14,9±3,5 mmHg and 13,4±2,9 mmHg. In 3 patients surgical complications occured and in 3 patients poastoperative complications occured.
Conclusions:
Although monocular patients has the same complication risks, especially those who are monucular due to previous surgery are very anxious of the surgery. In monocular patients awareness carefull and sophisticated instrumentation and surgery.
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Presentation Type: Cataract
Co Authors: Emrah Dirican Ahmet Sengun M. Erol Turacli - - - - - -
Abstract Details:
Purpose:
To investigate the effect of standard phacoemulsification surgery on central corneal asphericity evaluated at different diameters.
Setting:
Ufuk University Department of Ophthalmology.
Methods:
Corneal anterior surface asphericity (Q) values were calculated at 6mm and 8mm diameters using corneal topography in patients that received uncomplicated phacoemulsification surgery performed through 3.2 mm clear corneal incision. Corneal topographic examinations were performed via pentacam preoperatively and 1 month after the surgery. Cases with cataract related to intraocular inflammation or having any corneal pathologies such as ectasia or scars that distort corneal topography were excluded.
Results:
Fifty eyes of 46 patients aged between 30-86 years (mean 62,3) were included in the study. Preoperative corneal Q values were 0,097±0,223, -0,188±0,141 at 6 and 8 mm diameters respectively. Preoperative mean keratometry was 43,47 ±1,34 D, keratometric astigmatism was 1,17 ±0,82 D. Postoperative corneal Q values were 0,091±0,197, -0,174±0,149 at 6 and 8 mm diameters respectively. Postoperative mean keratometry was 43,36 ±1,28 D, mean keratometric astigmatism was 1,24 ±0,76 D. There was no statistically significant difference between the corneal Q values calculated before and after the surgery at both 6 and 8 mm diameters, also mean keratometric astigmatism was not changed significantly. Postoperative mean keratometry was significantly lower than the preoperative readings, p<0.001.
Conclusions:
The amount of changes induced by standard phacoemulsification surgery on central corneal asphericity seems to be under statistical significance at both 6 and 8 mm diameters.
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Presentation Type: Cataract
Co Authors: Sengul Ozdek Berati Hasanreisoglu - - - - - - - -
Abstract Details:
Purpose:
To report two cases of IOL subluxation secondary to severe anterior capsular contraction (ACC) in a case with retinal dystrophy and in another case with pseudoexfoliation (PEX).
Setting:
Gazi University, School of Medicine, Ophthalmology Department
Methods:
The 1st case was a 28 y-old lady with retinal dystrophy who had had a phacoemulsification surgery in another hospital within the last 3 months for both eyes. At presentation best corrected visual acuity (BCVA) was counting finger at 5 feet in both eyes. The 2nd case was a 66y-old woman with PEX who had a cataract surgery 1 month ago for the left eye with a BCVA of counting finger at 7 feet. Anterior segment examination revealed severe anterior capsular fibrosis and shrinkage with occlusion of the capsulorhexis opening leading to significant IOL decentralization and haptic immigration over the optic in both eyes of the 1st and left eye of the 2nd case. IOL and capsule extraction followed by implantation of scleral fixation IOL was performed for all 3 eyes. Scleral fixation was performed with a new knotless Z-suture technique.
Results:
There was no complication during or after surgeries. All of the IOLs were well centered. BCVA increased in all of the eyes; to 20/80 OD and 20/60 OS of the patient with retinal dystrophy and to 20/30 OS of the patient with PEX.
Conclusions:
Severe ACC with IOL dislocation is a potential complication following uncomplicated phacoemulsification especially in patients with risk factors like retinal dystrophies and PEX. IOL exchange with skleral fixation lens may be a mandatory and safe approach in severe cases.
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Presentation Type: Cataract
Co Authors: Alexandra Karavitaki George Kymionis Sophia Panagopoulou George Kontadakis George Kounis - -
Abstract Details:
Purpose:
To report the results after unilateral sulcus implantation of Crystalens HD intraocular lens
Setting:
Institute of Vision and Optics
Methods:
During this prospective study, two groups were created (cigliary sulcus group implantation, non sulcus group implantation) for the comparison of visual performance for far and near vision after cataract surgery and bilateral Crystalens HD intraocular lens implantation.
Results:
4 patients (8 eyes) with mean age 62,09± 4,49 years (range from 54 to 71 years) were included in the study. Mean follow-up was 10,62 ± 2,21 months (range 9 to 14) for the non-sulcus group and 10,25± 1,7 months (range 8 to 12) for the sulcus group. UDVA improved from 0,45±0,43(range 1,1 to 0) to 0,19±0,21(range 0,54 to 0)in the sulcus group and from 0,58± 0,38(range 1to 0,22) to 0,16±0,15(range 0,34 to 0) (LogMar )in the non sulcus group. CDVA improved from 0,14±0,18(range 0,4 to -0,04) to 0,04 ± 0,09 (range 0,2 to 0)in the sulcus group and from 0,15± 0,17 (range 0,36 to 0) to 0,03 ±0,05 (range 0,1 to 0) (LogMar)in the non sulcus group at the last follow up. In the sulcus group 100% of patients had J1-J2, over 75% of patients in the non sulcus group at the last follow up, measured with Birkhauser reading charts at 35cm under photopic conditions.
Conclusions:
Cigliary sulcus Crystalens HD implantation offers similar and equally satisfactory visual acuity results for far and near as the usual in the bag implantation
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Irini Chatziralli Evgenia Kanonidou Alexandros Chatzirallis Christina Kanonidou Lazaros Poulatsidis - -
Abstract Details:
Purpose:
Our study aims to assess the influence of the presence of unilateral cataract in driving performance.
Setting:
Department of Ophthalmology, General Hospital of Veroia, Veroia, Greece.
Methods:
Participants of the study were 47 consecutive male patients, mean age 71.3 years old (SD 8.57). All patients were diagnosed with unilateral cataract, while the other eye had either no cataract or underwent successful, uneventful phacoemulsification cataract surgery in the past. All were drivers and had neither diabetes mellitus nor other systematic/ocular disease. Their mean best corrected visual acuity was 8/10 binocularly (SD 1.06). A self-administered questionnaire was used to evaluate the influence of unilateral cataract in their driving performance.
Results:
41 patients (87%) had no problem when driving in familiar regions and 38 (81%) drove without difficulty under any circumstances. All patients had difficulty in driving at night. It is also worthy to mention that 83% of patients were not satisfied when driving in lights, even though their visual acuity was satisfactory
Conclusions:
Unilateral cataract does not seem to have a significant impact in driving performance. However, driving at night, especially in lights or in unknown regions, is reported as a major difficulty in patients with unilateral cataract, despite their satisfactory visual acuity.
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Presentation Type: Cataract
Co Authors: Koco Kocovski Ivanco Kocovski - - - - - - - -
Abstract Details:
Purpose:
Presentation a two cases of cataract associated with panuveitis, where were perform cataract surgery.
Setting:
Cataract may develop in eyes with chronic and recurrent uveitis as the result of both the inflammation and disease itself and corticosteroids used to treat it. Cataract surgery should be considered whenever the patient will benefit functionally.
Methods:
First patient has suffered from panuveitis more then 10 years, where inflammation has affected the entire inner eye. It was diffuse uveitis, originate as iridocyclitis then intermediate uveitis with chorioretinitis and eventually involve all of the structures of the uvea. In spite of intensive medical therapy after chronicle process and many recurrences this idiopathic inflammation result in fibrin exudation and forming anterior and posterior synechiae which result in pupillary miosis and also a developing the cataract.
Almost the same clinical appearance was in the second case but was less severe then in first one.
Results:
Studies have shown that extracapsular cataract extraction or phacoemulsification whit posterior chamber IOL implantation effectively improves vision and is well tolerated in many eyes with uveitis even over long periods. Cataract surgery may be more challenging in uveitic eyes than in noninflamed eyes, and intraocular inflammation should be controlled before surgery is performed. Posterior synechiae may require synechialysis and pupillary miosis may require pupil stretching.
In both patients, the cataract surgery of the chouse was phacoemulsification, which was performed. Posterior capsule opacification was treated with Nd:YAG laser capsulotomy.
Conclusions:
Success of the surgery in these difficult cases of panuveitis is unthankful.
Improvement of the vision in not as expected in spite a good surgery, because problem is not only the cataract but also involvement of retina in inflammatory processes due to a posterior uveitis in panuveitis.
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Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To present visual acuity outcomes and complication rates at twelve months for the EC-3 hydrophobic acrylic three-piece IOL in 254 European patients. Also, to present my personal experience with patients implanted with the EC-3 and followed to 36 months.
Setting:
Christophe PEY MD, Le Puy En Velay, France.
Methods:
Cataract removal via phacoemulsification followed by insertion of the EC-3 hydrophobic acrylic three-piece IOL through a 3.2 mm incision. Follow-up examinations occur at 1-2 days, 1 week, 1 month, 6 months, 12 months, 24 months and 36 months. Follow-up evaluations include uncorrected and best corrected visual acuity (BCVA), slit-lamp examination, an assessment of lens positioning and transparency (absences of vacuoles), PCO assessment, and patient satisfaction.
Results:
Two-hundred fifty-four (254) patients have been enrolled at European sites to date. The 24 and 36 month results will be reported. BCVA results are excellent with well over 90% seeing 20/40 or better. Complication rates are low. The EC-3 is well-centered and is transparent through the 36 months of follow-up at this site with no appearance of intralenticular vacuoles/glistenings. I have followed a subset of my 75 patients to 36 months. The lenses remain transparent and completely free of vacuoles or glistenings. Capsules have also remained clear. No Nd:YAG capsulotomies have been necessary in this group of patients.
Conclusions:
The EC-3 is a new hydrophobic acrylic IOL. 75 patients at this site followed to 24 to 36 months have demonstrated excellent visual acuity outcomes, low complication rates, and no glistenings. I have followed my patients to 36 months with no Nd:YAG procedures and no appearance of glistenings.
Financial Disclosure:
Yes.... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented
Presentation Type: Cataract
Co Authors: Maria Forminska-Kapuscik Urszula Mazurek Erita Filipek Lidia Nawrocka Barbara Strzalka-Mrozik Piotr Berezowski
Abstract Details:
Purpose:
Detection of mRNA levels of TGF?1,TGF?2, TGF?3 and TGF?RI, TGF?RII, TGF?RIII in the peripheral blood mononuclear cells (PBMC) in children with congenital cataract
Setting:
Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
Methods:
The study included children with congenital cataract (n=59) and healthy children (n=32) as a control group. Total RNA was measured in PBMC obtained before the cataract surgery. Gene expression was assessed by quantitative real time RT-PCR based on the number of mRNA copies/1µg total RNA.
Results:
All of the TGF? ligands and receptors were detected in all study samples.In congenital cataract transcriptional activity of TGF?1, TGF?3 and TGF?RI, TGF?RII in PBMC was significantly increased. (Mann-Whitney U test, p<0.05).
Conclusions:
Overexpression of TGF?1, TGF?3, TGF?RI and TGF?RII in peripheral blood mononuclear cells may be associated with congenital cataract.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate the conversion rate results of 2258 cases which had been operated with phacoemulsification technique.
Setting:
Dünya Eye Hospital, Altunizade, Istanbul, Turkey.
Methods:
All of the cases had been operated with phacoemulsification and pressurized system using anterior chamber maintainer (ACM). Under topical anesthesia, main incision was not performed at this stage,using only side port incisions, the nucleus was taken into the anterior chamber(AC) after making capsulorhexis, hydrodissection and hydrodelineation. The nature of the nucleus, hardness degree and diameter were evaluated by seen.The nucleus in which the hardness between +1 to+4, was broken using two IOL manipulator(Sinskey) partly inside the capsular bag and partly in the AC. Temporal clear corneal incision was made and phacoemulsification was performed.If the hardness of the nucleus was evaluated in high risk eye group,such as hard rock cataract, nigra cataract, we prefer to convert the surgery into manual incision sutureless cataract surgery(MISCS). It was performed with subconjunctival anesthesia and sclerocorneal tunnel. Closing the pressurized system, we used Viscoat onto the nucleus in order to protect EC. We put some VEM under nucleus and the glide was inserted under the nucleus into the capsular bag. When we opened the pressurized system again, as we touch with pressure the incision site, the nucleus will come to the sclerocorneal incision site. None of the cases, we need to use corneoscleral suture.
Results:
We found out that; conversion necessity in which high risk cases were 158 of total number 2258. My conversion rate was 7.00%. We also found that posterior capsule rupture(PCR) were occured 39 (1.85%) in phacoemulsification group, 2 (1.27%) eyes in conversion group. Difference of PCR rate between the group was not found statistically significant (p=0.597 , chi-square test).
Conclusions:
PCR rate was diminished to normal group in high risk group, which was expected to be higher. Another words, when we haven''t converted the case, probably it might has been increased. In such high risk eyes, MISCS could be a better option, not only over ECCE but also over phacoemulsification.The outcomes of the converted MISCS compared to ECCE and phacoemulsification is highly acceptable. In this technique surgical control is on high level especially in high risk eyes. Decision time to conversion is so high, it depends on surgical experience.
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No.-
Presentation Type: Cataract
Co Authors: Mark Wilkins - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate the variation in delivery characteristics and predictability of the injectable Alcon AcrySof IQ SN60WS intraocular lens (IOL) delivered via a preloaded AcrySert delivery system.
Setting:
Moorfields Eye Hospital, London.
Methods:
A prospective observational case series of 85 eyes undergoing elective phacoemulsification and IOL implant. Analysis was made of the digitally captured IOL delivery stage of the procedure.
Results:
In 36 of the 85 eyes (42%) delivery of the IOL was achieved uneventfully without the need for additional manipulation of the IOL orientation during its delivery. 49 of the 85 cases (58%) required manipulation of the orientation of the IOL during the progress of the IOL delivery, usually via an appropriate rotational movement of the injector nozzle itself while positioned in the main cornea wound. In 34 of these cases the leading haptic repeatedly presented into the anterior chamber orientated to the right, requiring a 180 degree rotation in order to correct the misdirection. On 4 occasions, following leading haptic misdirection in each case, the final IOL orientation was inverted 180 degrees, although centred in the capsular bag. In 6 of 85 cases (7%) the trailing haptic became trapped in the syringe nozzle requiring an additional action in order to deliver the IOL satisfactorily. Other events witnessed were haptic-optic adhesion (1) and overriding of the syringe plunger over the entire optic (1). The average time to achieve satisfactory capsular bag IOL position was 47 seconds. IOL power and the grade of operating surgeon did not appear to influence the important event of a misdirected leading haptic in this series.
Conclusions:
In its present form, the preloaded AcrySof IQ SN60WS AcrySert IOL system does not demonstrate predictable IOL delivery character, commonly requiring significant intra-wound manipulation of the injector in order to complete safe IOL delivery.In order to benefit from the potential advantages of a preloaded IOL system, further refinement is required.
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Presentation Type: Cataract
Co Authors: Tülay Alpar Akēetin Kadir Eltutar - - - - - - - -
Abstract Details:
Purpose:
To evaluate the clinical characteristics and surgical outcomes of patients with presenile cataracts.
Setting:
?stanbul Education and Research Hospital, Eye Clinic
Methods:
56 patients, namely 20 women and 36 men under 50 on whom cataract surgery is applied, are taken under the scope of this work.Detailed anamnesis has been taken for the risk factors such as corticosteroid usage in the patients, diabetes mellitus (DM), high myopic (AA 27 mm and higher) and atopy. The patients who have trauma, ocular inflammatory illness, congenital cataract, ocular surgery history have been excluded. Best corrected visual acuity (BCVA) in the eye examination made on the patients preoperatively (BCVA) and cataract type has been noted down. Routine facoemulsification cataract extraction and intraocular lens implantation has been applied on all the concepts.
Results:
The age ratio of the concepts is 43 ± 5.2 years. 16% of the patients have diabetes mellitus; 10% of them have corticosteroid usage history, 5% has atopy history, 5% has steroid usage + atopy history, 13% has high myopia, and 57% has high myopia + DM history. No risk factor has been determined in 44.6% of the patients and has been evaluated as idiopathic. Preoperative mean of the patients'' BCVA is 0,17 ± 0.20 according to Snellen scale, whereas postoperative mean of BCVA is 0,86 0,86 ± 0,13. 46,4% of the patients have posterior subcapsular cataract, 26% of them have cortical + posterior subcapsular cataract, 17,8% has nucleokortical cataract, and 8,9% has nuclear + posterior subcapsular cataract. In 16% of the patients, postoperative posterior capsule intensity has developed and Nd:YAG laser posterior capsultomy has been applied. All of these subjects, type of the cataract was posterior subcapsular cataract. No preoperative complication have been developed on any of the patients.
Conclusions:
Metabolic illnesses such as diabetes mellitus increase the frequency of the presenile cataract occurrence due to idiopathic reasons as well as risk factors such as high myopia, atopy and corticosteroid usage. Posterior subcapsular cataract has been frequently developed for the presenil cataracts case and there is increased risk for the formation of postoperative posterior capsule opacification.
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Presentation Type: Cataract
Co Authors: Peter Powers, PhD Gerald Zaidman, MD, FACS Matthew Giegengack, MD Shree Kurup, MD Steven Shaw, MD - -
Abstract Details:
Purpose:
To compare the performance of the diamond blade MultiKeratome (a keratome that is curved or arched with multiple points) with that of a stainless steel MultiKeratome when making corneal incisions.
Setting:
Classroom.
Methods:
An engineering analysis is performed to compare the diamond- and stainless steel- bladed MultiKeratome when performing a biplanar incision. The diamond-blade MultiKeratome (1) Must have a curved or arched surface made of straight-line segments due to manufacturing limitations (2) Makes an incision that has(a) For the first horizontal incision: A larger area to seal better under lower IOPs.(b) For the second inclined incision: A larger and more evenly thin, internal flap that closes more readily under higher and lower IOPs.
Results:
Because a diamond blade is so sharp that it cuts effectively even when shaped like a flat-tipped screwdriver or chisel, a diamond blade MultiKeratome makes the areas for the first horizontal and second inclined incisions larger, which seals better under both higher and lower IOPs.
Conclusions:
A diamond-blade MultiKeratome is engineered to provide better sealing capabilities than a stainless steelblade MultiKeratome at higher and lower pressures.
Financial Disclosure:
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Presentation Type: Cataract
Co Authors: Ozgur Artunay Alper Sengul Erdal Yuzbas?oglu Rifat Rasier Halil Bahcecioglu - -
Abstract Details:
Purpose:
To report a rheumatoid arthritis case of posterior dislocation of in-the-bag acrylic intraocular lens (IOL) into the vitreous cavity after 12 months after uneventful neodymium:YAG laser posterior capsulotomy.
Setting:
Department of Ophthalmology, Istanbul Bilim University,Istanbul
Methods:
The patient presented with an acutely painful eye associated with loss of vision. The patients had continuous curvilinear capsulorhexis (CCC), phacoemulsification, and in-the-bag implantation of a foldable acrylic IOL in lefte eye. The initial cataract surgery was uneventful and no peripheral capsule defect was observed at the time of laser capsulotomy or at subsequent follow-ups. Anterior capsule shrinkage and capsular phymosis occurred in the patient. The patient subsequently had removal of the dislocated IOL via a pars plana vitrectomy and implantation of an IOL in the ciliary sulcus.
Results:
Rheumatoid arthritis patients should be informed that posterior dislocation of IOL is an infrequent but possible complication of YAG laser posterior capsulotomy.and may occur months and even years after implantation or laser capsulotomy.
Conclusions:
Surgeon should be aware of this risk attributable to capsular phymosis after laser surgery in these population.
Financial Disclosure:
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Presentation Type: Cataract
Co Authors: Kasra Taherian - - - - - - - - - -
Abstract Details:
Purpose:
To describe the advantages of and a technique for the use of intracameral antibiotics for wound hydration in small incision cataract surgery
Setting:
Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
Methods:
A retrospective analysis of 50 consecutive routine phacoemulsification procedures operated by a single surgeon was done. In all cases a superior biplanar clear corneal incision of 2.80 mm and one 1.2 mm side port incision were performed. At the termination of all procedures stromal hydration of the main incision and the side port were performed with either intracemeral cefuroxime solution (1mg in 0.1ml) or in case of penicillin allergic patients with intracameral vancomycin (0.1mg in 0.1ml). Integrity of main incision and paracentesis were checked by sponges. If leakage was observed additional hydration with Balanced Salt Solution was done or 10.0 sutures were placed over the main incision as needed.
Results:
No cases of Endophthalmitis, leakage or flat anterior chamber were observed postoperatively. No new corneal problems (stromal opacification or endothelial problems) were noted post-operatively either.
Conclusions:
Since the aqueous humour has a rapid turnover, post-operative Intracameral antibiotic levels are likely to last longer if some of the antibiotic is gradually released into the anterior chamber from the corneal stroma (depot effect). This can be achieved by stromal hydration of the incision with the intracameral antibiotic solution. Moreover, the highest concentration of antibiotic will be near the wound which would be the portal of entry for any microbes in the early post-operative period. This appears to be a safe and effective technique and is specially suited for surgeons who use stromal hydration of the wound anyway.
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Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate the safety and visual performance after implantation the Quatrix aspheric IOL (Croma, Austria) in cases undergoing phacoemulsification for senile cataract.
Setting:
Al Noor Eye Hospital, Giza, Egypt.
Methods:
Prospective interventional case series:
15 eyes of 15 patients with senile cataract underwent phacoemulsification using the Infiniti phaco machine (Alcon Laboratories Inc.) with iplantation of the pre-loaded injectable Quatrix aspheric IOL into the capsular bag.
Postoperatively, patients were evaluated for UCVA,BCVA, Centration, Posterior Capsular Opacification, Total HOA, Spherical aberrations and RMS values.
Results:
6 months after surgery,the following results were observed:BCVA of 20/20 in 93.3% of cases.Adequate centration was observed in all cases.One case (6.67%) developed capsular phemosis and PCO that needed YAG capsulotomy.Mean Spherical aberrations was 0.0289 (SD 0.033)Mean total HOA was 0.306 (SD 0.066)Mean RMS value was 0.377 (SD 0.085)
Conclusions:
Implantation of the Quatrix aspheric IOL leads to very good visual acuity with reduction of the total spherical aberrations of the eye.Low PCO rates and good centration are observed 6 months after the surgery.However, longer follow up periods are needed to evaluate delayed capsular fibrosis and decentration.
Financial Disclosure:
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Presentation Type: Cataract
Co Authors: Suhas Haldipurkar - - - - - - - - - -
Abstract Details:
Purpose:
To determine the relationship of incidence of Pseudophakic Dysphotopsia after uneventful Phaco Surgery with Acrysof IQ SN60WF and Tecnis ZCB00 Intraocular lens to respective design features.
Setting:
Laxmi Eye Institute, Mumbai, India
Methods:
84 eyes of 68 patients were assessed. Patients were evaluated using a telephonic questionnaire between 3-6 months post surgery. Responses were rated on a scale from 0-4 (none-severe symptoms).
Results:
45.09% of eyes with IQ presented with various grades of dysphotopsia as against 27.4% eyes with ZCB00. 13.7% eyes with IQ were severely dysphotopic versus 3% with ZCB00.27.4% eyes with IQ experienced night-time glare as against 18.2% eyes with ZCB00. 5% eyes with IQ suffered severe glare versus none with ZCB00.
Conclusions:
Design features of the Tecnis ZCB00 lead to less dysphotopsia and night-time glare as compared to Acrysof SN60WF.
Financial Disclosure:
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Presentation Type: Cataract
Co Authors: Cem Küēükerdönmez Altu? Ēetinkaya Yonca Akova - - - - - -
Abstract Details:
Purpose:
To present a potential cause for toxic anterior segment syndrome.
Setting:
Baskent University, School of Medicine, Department of Ophthalmology
Methods:
We report 4 cases of toxic anterior segment syndrome that occurred following uneventful phacoemulsification and intraocular lens implantation.
Results:
The 4 cases were the initial consecutive 2 cases of 2 different surgery days, 5 months apart. The most prominent sign of toxic anterior segment syndrome was limbus-to-limbus corneal edema. Pain and/or intraocular pressure rise were also common. The sterilization technique was changed after the first outbreak; whereas the second outbreak required further investigation. Fibrin glue remnants from preceding pterygium surgery with conjunctival autografting, was the potential cause. Despite intensive corticosteroid therapy, corneal edema did not resolve in 2 patients who underwent keratoplasty.
Conclusions:
Toxic anterior segment syndrome as a sight-threatening condition, requires thorough investigation for prevention of new cases.
Financial Disclosure:
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Presentation Type: Cataract
Co Authors: Margaret Kearns - - - - - - - - - -
Abstract Details:
Purpose:
To identify preventable causes of endophthalmitis and toxic anterior segment syndromes
Setting:
Private Day Surgery in Sydney Australia in operation for 25 years
Methods:
Documentation and root cause analysis of all cases of endophthalmitis and TASS encountered over 25 years
Results:
This study identifies cases arising from faulty surgical products, breaks in sterilization and medication handling protocols as well as sporadic cases for which no cause could be identified. The overall incidence is not high relative to other studies but many of these cases were preventable. The study validates the importance of rigorous theatre systems and protocols.
Conclusions:
Incidence of endophthalmitis and TASS can be minimized by rigorous systems and protocols in the operating theatre
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Aaron Rifkind - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate the effect of intra-scleral implantation of PresView Scleral Implants (PSI) for pressure control in patients with elevated intraocular pressure due to OHT or POAG
Setting:
Private clinic setting
Methods:
43 eyes of 27 patients requiring treatment with glaucoma medications for management of intraocular pressure resulting from ocular hypertension or primary open angle glaucoma underwent PSI implantation after a thirty-day washout of all of their glaucoma medication. The patients were seen at 1, 2, 3, 6, 12 and 24 month intervals post-op where intra-ocular pressure and other safety parameters were measured.
Results:
At 12 and 24 month post-op, mean IOP reductions were found to be 7.7 mm Hg (±4.3) (p=0.0001) and 7.1 mm Hg (±3.3) (p=0.0005) respectively. Mean percent IOP reduction was - 27.6% (±12.6%) (p=0.0022) and - 25.6% (±9.7%) (p=0.0063) respectively. At both visits, more than 69% of the patients had >20% reduction in IOP.
Conclusions:
PSI were found to be an effective way to reduce IOP in glaucoma patients without the compliance problems and side effects of medication or the risks such as hypotony or infection associated with penetrating filtration surgery.
Financial Disclosure:
Yes.... is employed by a for-profit company with an interest in the subject of the presentation, ... travel has been funded, fully or partially, by a competing company , ... research is funded, fully or partially, by a competing company , ... receives consulting fees, retainer, or contract payments from a competing company
Presentation Type: Cataract
Co Authors: Sung-Kun Chung - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate the incidence or progression of macular edema in diabetic patients, and the risk factor of macular edema (ME)
Setting:
prospective study
Methods:
In a prospective study, 68 eyes were assessed by optical coherence tomography (OCT) and best-corrected visual acuity before operation, at 1 month, and at 3 months after operation. ME was defined as an increase of center macular thickness (CMT) on OCT by 30% more than before operation
Results:
The incidence of ME in diabetic patients was 11.7%. The increment of CMT in the patients of ME was 172.38±103.68?m, 128.00±61.91?m at 1 month, 3months after operation, respectively. The increment of CMT at 3 months after cataract surgery was statistically significant in the patients of diabetic duration ? 10years (p=0.049). But insulin treatment, the severity of diabetic retinopathy, diabetic nephropathy and hemoglobin A1c were not significant risk factors for ME.
Conclusions:
OCT might be useful to assess the ME after cataract surgery in diabetic patients. And in the patients who had long been suffered from diabetes, the incidence of ME could be higher, cataract surgery should be carefully considered.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Karl Mercieca Arun Brahma Hamish McKee - - - - - -
Abstract Details:
Purpose:
To evaluate indications for and visual results of phacoemulsification cataract extractions converted to extracapsular cataract extraction (ECCE) at the largest provincial teaching hospital in the United Kingdom.
Setting:
Manchester Royal Eye Hospital, Manchester, United Kingdom.
Methods:
Retrospective case note review of phacoemulsification to ECCE conversions between 2005 and 2009 during which approximately 2000 phacoemulsifications were undertaken. Cases were identified through clinical coding and the use of electronic operative records. Data was collected on pre- and post-operative visual acuity (VA) and refraction, surgical indications leading to ECCE conversion, grade of surgeon, if an intraocular lens (IOL) was implanted and any post-operative complications.
Results:
We present 18 phacoemulsification conversions to ECCE. The average patient age was 70 years. The mean VA pre-operatively was 6/36 (range 6/9.5 to perception of light). Reasons for conversion were inability to sculpt a dense nucleus (10/18) and inability to achieve a continuous curvilinear capsulorrhexis (8/10). The grade of surgeon was consultant for 15 cases and senior registrar/fellow for 3 cases. Three patients had vitreous loss and required anterior vitrectomy. An IOL was successfully implanted in 16 patients. One patient developed chronic cystoid macula oedema which limited VA to counting fingers (CF). The mean VA post-operatively was 6/12 (range 6/6 to CF). The mean post-operative spherical equivalent was +0.33 dioptres and the mean cylinder was +4.65 dioptres. No other patient had complications that led to a reduction in best corrected visual acuity and none had intolerable residual astigmatism.
Conclusions:
Conversion to ECCE should only be considered if cataract surgeons are skilled in ECCE surgery and if vitreous loss is not present nor likely. Our results suggest that a significant visual acuity improvement can be achieved in most cases of phacoemulsificaton requiring intraoperative conversion to ECCE.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
to evaluate our current main surgical technique efficacy and rate of serious complication,vitreous loss...
Setting:
we monitor all patient undergo cataract surgery in our only government eye hospital in the year 2009.
Methods:
we give full operation details to the computer from patients files immediately or shortly after surgery,then we calculate the rate of uneventful ECCE and cases of complicated surgeries by vitreous loss and how it managed in operation room,also we monitor the number of phaco surgery and complication rate...
Results:
of all patients undergo cataract surgery in 2009 locally with ECCE technique,1936 cases we have 129 cases with vitreous loss and of all phaco surgery done 132 cases we have 4 cases with vitreous loss
Conclusions:
still vitreous loss with ECCE technique was high ,we must think seriously in change our technique to phaco!!!
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Elif Erdem Ismail Hakki Undar Meltem Yagmur Reha Ersoz - - - -
Abstract Details:
Purpose:
To compare keratometry (K) readings and astigmatic axis measurements obtained by two different topogragrapy devices; to evaluate and to predict the possible effects of device and/or measurement related errors for intraocular lens calculation and for determination of the axis of astigmatism.
Setting:
The eyes of the patients who were scheduled for cataract surgery were enrolled in the study in Cukurova University, Ophthalmology Department, Adana, Turkey
Methods:
The corneal power measurements of the patients without any previous ocular surgery or concurrent ocular surface pathology were performed by Topcon KR 8100P® and CSO Sirius ® and were repeated three times. The steep K value , the flat K value, the axis of astigmatism and the standard deviation of the device were recorded.
Results:
The study evaluated 97 eyes of 73 patients. The mean age was 64.5±9.3(44-86) years. The mean flat K was 43.44±1.88 Dioptri (D) for Topcon, and 43.77±1.89 D for Sirius (p< 0.05); the mean steep K was 44.31±1.77 D for Topcon, and 44.72 ±1.84 D for Sirius (p< 0.05); the mean axis of astigmatism was 98.28±47.26 D for Topcon, and 82.23±51.35 D for Sirius (p< 0.05). The difference of the standard deviation of the device itself between Topcon and Sirius was statistically insignificant. The mean difference of flat K was 0.49±0.51 D. The mean difference of steep K was 0.51±0.53 D. Of the eyes with an astigmatism of 1.50 D or more, 41.5 % had astigmatic axis difference above 10 degrees.
Conclusions:
The corneal power measurement is an important factor for intraocular lens power calculation, and also is a potential source of error. The error could originate from the measurement technique, from the device itself and from the patient. The errors could cause miscalculation of lens power which in turn results in over or under correction, and affect the management of astigmatism, the toric lens choice and the determination of its intraocular position. To avoid postoperative refractive nightmares, preoperative evaluation including patient selection and keratometric measurements should be done correctly as much as possible, the appropriate intraocular lens formula should be chosen.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Halil Ibrahim Imamoglu Suleyman Mollamehmetoglu Hidayet Erdol Nurettin Akyol - - - -
Abstract Details:
Purpose:
To investigate the potential alterations of ocular hemodynamics following phacoemulsification cataract surgery.
Setting:
Karadeniz Technical University, Faculty of Medicine, Department of Ophthalmology, Trabzon, Turkey
Methods:
In this prospective study, intraocular pressure (IOP) and ocular hemodynamics was measured preoperatively (baseline) as well as 1 and 3 weeks postoperatively, in 52 eyes of 26 patients (mean age 63.15±10.25 years) scheduled for unilateral phacoemulsification cataract surgery with intraocular lens implantation. In all eyes, the Ocular Blood Flow Analyser (OBFA, Paradigm Inc., UT, USA) was used to obtain measurements of IOP, pulsatile ocular blood flow (POBF), MNI (maximum net inflow), PEQ (pulsatility equavalence index), and IDR (inflow duration ratio). Obtained data from operated eyes were compared statistically to untreated fellow phakic eyes of the patients
Results:
For operated eyes, the mean baseline IOP, POBF, MNI, PEQ and IDR values were 17.19±4.34mmHg, 17.56±6.46µl/s, 2065.69±955.37, 2.99±0.46, 42.31±5.66, respectively. These values were 15.9±4.64mmHg, 17.41±4.84µl/s, 2119.81±841.36, 3.01±0.41, 41.88±5.38, respectively in the control eyes. Statistically significant differences from baseline measurements were not found 1 and 3 weeks postoperatively for both operated and unoperated eyes. There were also no statistically significant differences in any OBFA measurements between operated and unoperated eyes for all study period (p>0.05 for all).
Conclusions:
The effect of phacoemulsification surgery on ocular hemodynamics was not significant in normotensive eyes with cataract
Financial Disclosure:
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Presentation Type: Cataract
Co Authors: Angela Turtoro Riccardo Maggi Andrea Ubaldi Luca Buzzonetti
Abstract Details:
Purpose:
to demonstrate the efficacy of sclerally fixed multifocal IOLS in restoring pseudaccomodation in patients aged 6 to 14 years with Marfan''s Syndrome.
Setting:
Ophthalmology Department, "Bambino Gesù" Children''s Hospital, Rome, Italy
Methods:
The Autors present a series of 14 eyes (7 patients, age range 6-14 years) with Marfan''s Syndrome which underwent secondary implantation of a flexible multifocal IOL (SOLEKO, FIL 65 Pvs, add). Only patients with BCVA ?8/10, normal papillary activity, clear media, normal fundus were included in the study. Previously all patients had undergone lensectomy for ectopia lentis.
Results:
From 2008 to 2010 14 eyes of children with Marfan''s Syndrome were implanted with a multifocal scleral fixation IOL. 1 year of follow-up: 11 eyes (78.5%) had BCVA 10/10 (2 eyes , 18% uncorrected; 9 eyes, 82% with correction); 14 eyes (100%) had I for near; 3 eyes (21.5%) had far BVCA 8/10 (AMBLIOPIA); only 2 eyes (14.2%) belonging to the same patient presented post-operative tilting of the IOL towards the anterior chamber, treated with pilocarpine
Conclusions:
in our opinion, multifocal scleral fixation IOLS in children with Marfan''s Syndrome permit an excellent visual recovery, both for near and far vision.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To evaluate the efficacy, safety and stability of the AT-M IOL implant.
Setting:
INSTITUT OFTALMOLOGIC DE MENORCA, SPAIN
Methods:
Prospective study in eyes with cataract or clear lens exchange (CLE) surgery and corneal astigmatism ? 2 D. Microcoaxial phacoemulsification. Preoperative BCSVA, topography and IOL-Master biometry, were evaluated. Postop far and near UCVA, BCSVA and slit lamp pictures to check the IOL rotational stability.
Results:
15 eyes of 9 patients were included. Average follow-up 325 days. Postop UCVA ? 0.8 in 16 eyes and ? 0,6 in all cases. BCSVA = 1 in 14 eyes. The average postop SE was -0.25D. The average astigmatism < -0.50D. No changes in the IOL position. None eye lost lines of vision.
Conclusions:
AT-M IOL is effective and safe for the multifocal correction of those eyes with high astigmatism when undergo a cataract or CLE surgery. Is a long-term stable IOL
Financial Disclosure:
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Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
This ongoing study was prospectively designed to evaluate the visual performance and patient satisfaction after implantation of the Diffractiva-aA intraocular lens; a new monobloc hydrophilic acrylic MIOL commercially available in Europe since September 2010.
Setting:
Nine university clinics or private ophthalmic surgical centers in Europe
Methods:
A total enrollment of 45 patients (90 eyes) with bilateral cataract and eligible for MIOL implantation was targeted. Ophthalmic examinations including refraction, monocular and binocular uncorrected and distance-corrected visual acuity for far, intermediate (1 m) and near (40 cm) were scheduled at 1-week, 3-month and 6-month postoperatively. Evaluation of contrast sensitivity, defocus curve and patient satisfaction (quality-of-life questionnaire) was scheduled at 3-month and/or 6-month postoperatively.
Results:
At the time of this abstract, 5 patients (1 center) had completed the 1-week follow-up. Preoperative mean binocular best-corrected visual acuity (BCVA) was 0.41 ± 0.31 LogMAR (20/50). At 1-week postop, mean SE was 0.38 ± 0.25 D; uncorrected monocular far (UCVA) and near (UNVA) visual acuity was 0.04 ± 0.04 LogMAR (20/22) and 0.02 ± 0.04 LogMAR (20/21), respectively. All patients achieved 20/20 binocular uncorrected far and near visual acuity. Visual and refractive outcomes of the 45 patients at 1-week post-op will be presented at the meeting as well as the first results of patient functional vision and satisfaction.
Conclusions:
Early postoperative visual and refractive outcomes of the new Diffractiva-aA MIOL were excellent.
Financial Disclosure:
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Presentation Type: Cataract
Co Authors: Rajesh Narendran Peter Bacon - - - - - - - -
Abstract Details:
Purpose:
To evaluate the refraction accuracy of sulcus fixated hydrophilic Rayner Sulcoflex piggy-back lens to correct post-operative ametropia and astigmatism using Refractive Vergence formula.
Setting:
Scarborough hospital, Scarborough, UK
Methods:
Eight patients with post operative refractive surprise of +3.5D to -6.0D spherical equivalent (SE) received a newly designed hydrophilic piggy-back Rayner Sulcoflex lens of +5.0D to -5.0D power in the sulcus. The lens has 6.5mm optic diameter, 13.5mm length, a concave posterior surface and 10 degree angulated haptics. Refractive Vergence formula for sulcus placement was used to determine the lens power. The lens was implanted with a single use injector by reopening the 2.8mm incision. Two of eight patients with -1.5D and -3.0D cylinder received Sulcoflex-toric lens. The refraction was performed at one month and residual SE was calculated.
Results:
The lens was easy to load and prime in the injector under microscope. The implantation process was uneventful in all cases. Final SE was +0.5D to -1.25D and matched with the expected correction of residual refractive error. 5 patients achieved >20/40, 1 achieved 20/60 uncorrected vision. 2 patients with toric Sulcoflex achieved 20/10 and 20/40 uncorrected vision. All patients were highly satisfied with the outcome.
Conclusions:
The residual ametropia and astigmatism following phacoemulcification surgery can be easily and effectively treated with the new design sulcus fixated piggy-back Rayner Sulcoflex lens and its toric variant. The final refractive outcome was satisfactory when using this lens and the Refractive Vergence formula.
Financial Disclosure:
Yes.... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented
Presentation Type: Cataract
Co Authors: - - - - - - - - - - - -
Abstract Details:
Purpose:
To compare the predictability of intraocular lens (IOL) power using the partial coherence interferometry and applanation ultrasound biometry and different IOL power calculation formulas in patients with various axial length (AL).
Setting:
Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan
Methods:
The IOL power was calculated by the SRK/T, SRKII, Holladay 1, and Hoffer Q formulas. The patients undergoing uneventful phacoemulsification and implantation of IOL were divided into 4 groups: AL less than 22 mm as Group 1, between 22 and 26 mm as Group 2, between 26 and 29 mm as Group 3, AL more than 29 mm as Group 4. All groups were categorized into 2 subgroups: AL and keratometric value (K) measured by the IOLMaster as Group A, AL measured by applanation ultrasound and K by automatic keratometer as Group B. The predictive accuracy of the formula was analyzed by comparing the difference between the actual and predicted postoperative spherical equivalence (AE, absolute error).
Results:
There were totally 250 eyes. The AEs calculated in all patients by SRK/T was significantly lower than those by the other formulas (p < 0.05) either by using optical or ultrasonic biometry data. In Group 1 to 4, the AEs calculated by the four formulas were comparable between subgroup A and B (p > 0.05).
Conclusions:
Use of either optical or ultrasonic biometry data in the four formulas resulted in similar accuracy of IOL power prediction in eyes with various AL.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Paul Healey - - - - - - - - - -
Abstract Details:
Purpose:
Goniosynechialysis is a well described procedure to break peripheral anterior synechiae associated with angle closure. We performed a retrospective cohort study looking at the reliance on IOP lowering agents postoperatively.
Setting:
Westmead Hospital, NSW Australia
Methods:
All patients who underwent goniosynechialysis combined with cataract extraction at Westmead Hospital between 2001-2010 were enrolled in this study.
Results:
The cohort consisted of 36 eyes in 28 patients, approximately half of whom had a previous episode of acute angle closure or pupil block. Two patients had aqueous misdirection which at initial presentation were thought to be angle closure. The remainder had chronic angle closure. All but one of the patients hadlaser iridotomies at some point prior to the procedure. There were no major complications from the gonoisynechialysis procedure. Mean follow-up was 2.2 +/- 0.46 years. Patients were on average using 1.9+/-1.3 IOP lowering agents prior to the procedure. Mean preop IOP was 22.7mm Hg +/- 14.6. Mean postop IOP was 12.9+- 3.9 and drop usage was significantly lowered to 0.7+/-0.2 (p=0.0061). None of this cohort have required trabeculectomies or other IOP lowering surgery. No patient had an IOP greater than 20 at last follow-up. When those with documented acute angle closure events were compared with those that had not, there was a significantly greater drop in IOP (from 24.6+/-4.9 to 11.6+/-0.4) compared to the chronic group(16.6+/-1.3 to 15.1+/-1.5, p<0.001). Likewise, there was a significant drop in IOP controlling medication in the acute group (1.8+/-0.4 to 0.4+/-0.2) as compared to the chronic group (2.7+/-0.33 to 1.2+/-0.4, p=0.002).
Conclusions:
Combined cataract and goniosynechialysis surgery has a role in reducing IOP lowering agent dependence in cases of angle closure, especially in cases of a recently documented acute episode.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Lucia Derriman Shahrnaz Izadi Richard Smith - - - - - -
Abstract Details:
Purpose:
To investigate the relationship between IOL type and the time taken for development of PCO following cataract operation.
Setting:
Stoke Mandeville Hospital Eye department, Stoke Mandeville Hospital, Aylesbury, England, UK.
Methods:
Patients requiring Nd:YAG laser capsulotomy for PCO from 1998 to 2008 were identified using the laser register. The date of original cataract operation, operated eye, surgeon and IOL type were derived from operation registers. The study comprised of 816 eyes: 102 of 3-piece hydrophobic acrylic lens (Alcon Acrysof MA60C); 264 of 3-piece silicone lens (Pharmacia 911A); 288 of 3-piece foldable silicone lens (Pharmacia 9200); 118 of plate-haptic hydrophilic lens (Spectrum A2000) and 44 of plate-haptic acrylic lens (Spectrum A100).
Results:
One-way Analysis of Variance (ANOVA) demonstrated statistically significant differences in time taken for PCO development between the five IOL groups (F value = 13.63; F critical value = 2.38; p=9.18X10-11). Averages of time from cataract operation to PCO requiring Nd:YAG capsulotomy were 759 days with Alcon Acrysof MA60C; 733 days with Pharmacia 911A; 1020 days with Pharmacia 9200; 682 days with Spectrum A2000 and 1076 days with Spectrum A100.
Conclusions:
There can be a considerable delay before complications, such as PCO, develop following a cataract operation. The study revealed statistically significant differences in the time taken for PCO to develop, according to IOL type. In particular, the use of Pharmacia 9200 and Spectrum A100 were associated with a longer delay to PCO formation (1020 days and 1076 days respectively). Differences related to use of silicone versus acrylic lens material were not seen. Our findings help inform the decision-making process regarding type of IOL to be used. It also provides valuable information about the post-operative behaviour of different IOL types.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Firat Helvacioglu - - - - - - - - - -
Abstract Details:
Purpose:
To compare the safety and efficacy of microcoaxial and conventional phacoemulsification surgeries performed with combined torsional/longitudinal ultrasound (US) mode using Infiniti Vision System (Alcon Laboratories).
Setting:
Basaksehir State Hospital, Department of Ophthalmology, Istanbul, Turkey
Methods:
In this prospective randomized comparative study, 30 eyes were assigned to 2,2 mm microcoaxial phacoemulsification (G1) and 30 eyes were assigned to conventional phacoemulsification (G2). Combined torsional/longitudinal US modes with same parameters were used in all surgeries. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound amplitudes, mean operation time, surgical complications and surgically induced astigmatism (SIA). Postoperative outcome measures were anterior chamber reactions, change in the corneal clarity, central corneal thickness (CCT) measurements.
Results:
Mean longitudinal and torsional ultrasound amplitudes and CDE in G1-2 were 2,35, 3,94, 10,13 and 3,33, 3.38, 7,73 (p1-3). SIA of the groups were, 1,11 D and 1,15 D (p4). Mostly no or mild cornea edema and anterio chamber reactions were observed in both groups. CCT changes in group 1 and 2 were 80,10µ and, 125,80µ (p5). Statistical analysis of he parameters did not show any significant difference between the groups (p1=0,128, p2=0,392 p3= 0,241, p4=0,790, p5= 0,448).
Conclusions:
Microcoaxial and conventional phacoemulsification surgeries performed with combined torsional/longitudinal US showed similar safety and effectiveness. SIA was lower in microcoaxial group although the difference was statistically insignificant. We believe microcoaxial surgery could be chosen for all cataract patients.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Firat Helvacioglu - - - - - - - - - -
Abstract Details:
Purpose:
To compare the safety and efficacy of microcoaxial and biaxial phacoemulsification surgeries performed with combined torsional/longitudinal ultrasound (US) mode using Infiniti Vision System (Alcon Laboratories).
Setting:
Basaksehir State Hospital, Department of Ophthalmology, Istanbul, Turkey
Methods:
Between January and May 2010 microcoaxial phacoemulsification (G1) was performed in 30 eyes of 30 patients and biaxial phacoemulsification (G2) was performed in 30 eyes of 30 patients. Combined torsional/longitudinal US modes with same parameters were used in all surgeries. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), longitudinal and torsional ultrasound amplitudes, mean operation time, surgical complications and surgically induced astigmatism (SIA). Postoperative outcome measures were anterior chamber reactions, change in the corneal clarity, central corneal thickness (CCT) measurements.
Results:
Mean longitudinal and torsional ultrasound amplitudes and CDE in G1-2 were 2,36, 3,84 ve 10,06 and 2,26, 3.12 ve 6,21 (p1-3). SIA of the groups were, 1,09 D and 1,14 D (p4). Mostly no or mild cornea edema and anterio chamber reactions were observed in both groups. CCT changes in group 1 and 2 were 97,20µ and, 41,00µ (p5). Statistical analysis of he parameters did not show any significant difference between the groups except for the measurements of CDE and CCT which were found statistically significantly lower in biaxial group (p1=0,800, p2=0,307, p3= 0,016, p4=0,802, p5= 0,049)
Conclusions:
Biaxial phacoemulsification surgeries performed with combined torsional/longitudinal US provided more effective and safe lens removal than microcoaxial surgery by using significantly lower energy.
Financial Disclosure:
No.-
Presentation Type: Cataract
Co Authors: Ulviye Yigit I. Umut Onur Ahmet Agachan Betul Cakmak Hasan Oguzhan - -
Abstract Details:
Purpose:
To evaluate early macular changes in thickness of uncomplicated phacoemulsification cases by serial OCT exams.
Setting:
100 eyes of 50 patients without any chronic debilitating or ocular diseases who had undergone uneventful cataract surgery were enrolled into the study in a prospective fashion. The fellow eyes were assigned to control group.
Methods:
Effective Phaco Time (EPT) and Ultrasound Time (UST) were retrieved for each case. Macular thickness assesment of both operated and control eyes (Optovue ® RT100 MM5 protocol) were performed by postoperative 1st day, 1st week, 1st month successively.
Results:
Of operated eyes, the difference of the OCT macular thickness measurements on postoperative 1st day and 1 st week was 2.64 ±12.40 µ whereas 0.06 ± 9.02 µ in the control group. This data was found to be statistically insignificant (p> 0.05). Compared with postoperative 1st day and 1 st month, the difference of OCT macular thickness measurements of the operated eyes was 5.64 ± 10.59 µ whereas 0.34 ± 11.71 µ in the control group. The latter revealed statistically significant difference in the operated eyes (p <0.05). However, no cases of clinically significant macular edema was noticed or recognized in the study.
Conclusions:
Statistically significant increase in macular thickness without any visual disturbances were observed by postoperative 1 st month measurements of the operated eyes. No correlation between EPT, UST and macular thickness were revealed.
Financial Disclosure:
No.-
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