RESUMEN
PURPOSE: To evaluate the effects of posterior chamber implantation of phakic intraocular lenses on angle structures and the correlation with intraocular pressure (IOP). SETTING: Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria. METHODS: A Staar implantable contact lens (ICL) was implanted in 20 white patients (34 eyes) with high myopia. The patients were followed for a mean of 2.3 years (range 0.8 to 6.0 years). Two subgroups were created: One had a follow-up of 2.4 to 6.0 years and the other, 0.8 to 2.3 years. The mean spherical power of the implanted ICL was -16.8 diopters (D) (range -9.0 to -21.0 D). The angle structures were examined by gonioscopy using the Spaeth technique, and optical pachymetry and IOP were measured in dilated and undilated pupils. Trabecular pigmentation was measured semiquantitatively. The ICL models included a few prototypes (6 eyes), the V2 model (10 eyes), the V3 model (6 eyes), and the V4 model (12 eyes). RESULTS: The anterior chamber angle was between 11 and 20 degrees in 41% of eyes, between 21 and 30 degrees in 21%, larger than 30 degrees in 21%, and 10 degrees or smaller in 17%. An apparent iris root insertion was above Schwalbe's line in 6% of eyes, behind Schwalbe's line in 12%, at the scleral spur in 67%, and in a deep angle recess behind the scleral spur in 15%. The curvature of the iris was regular in 19 eyes and steep in 15 eyes. The mean pigmentation in all 4 quadrants was 1.3. (Grade 1 was defined as trace pigmentation.) The mean pachymetry from the endothelium to the ICL anterior surface was 2.7 mm and from the endothelium to the anterior surface of the crystalline lens, 3.2 mm. The mean IOP was 14.1 mm Hg in undilated pupils and 12.1 mm Hg in dilated pupils. There was no correlation between angle pigmentation and IOP. CONCLUSION: Trace pigmentation in the trabecular meshwork was common after ICL implantation. However, there was no direct influence on IOP. Long-term follow-up is necessary to evaluate the effect and progress of trabecular pigmentation in eyes with an ICL.
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Iris/metabolismo , Implantación de Lentes Intraoculares , Cristalino/fisiología , Miopía/cirugía , Malla Trabecular/metabolismo , Adulto , Femenino , Estudios de Seguimiento , Gonioscopía , Humanos , Presión Intraocular , Lentes Intraoculares , Masculino , Persona de Mediana Edad , Agudeza VisualRESUMEN
PURPOSE: To evaluate clinical characteristics, risk factors, management and outcome of contact lens induced keratitis (CLIK) associated with contact lens wear. METHODS: The study comprised all consecutive patients presenting with contact lens related presumed microbial keratitis during a 12-month period at our department. Detailed demographic data, type of contact lens, duration of lens wear, wearing schedule and lens hygiene were derived from a self-administered questionnaire. Severity of ulcer, corneal scrapings, treatment and final outcome were evaluated. RESULTS: 27 patients with CLIK, some of which may have been sterile peripheral infiltrates, due to contact lens wear were detected. In the majority of the cases patients had used disposable soft contact lenses (89%) and most of them had a daily wearing schedule (78%). 51.8% patients cleaned their lenses regularly. 6 (22%) applied no disinfection since their lenses were disposable on removal. In 3 of our cases with CLIK, penetrating keratoplasty had to be performed. CONCLUSION: Disposable contact lenses seem to have been a predisposing factor for contact lens induced keratitis also when used on a daily wear schedule. Insufficient contact lens care products and/or manufacturing characteristics may be responsible for CLIK, which is also observed in otherwise compliant contact lens users. In 3 of our patients with CLIK keratoplasty became necessary, indicating that contact lens induced keratitis may result in severe corneal complications.
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Lentes de Contacto Hidrofílicos/efectos adversos , Úlcera de la Córnea/etiología , Adulto , Soluciones para Lentes de Contacto/uso terapéutico , Úlcera de la Córnea/cirugía , Desinfección/métodos , Equipos Desechables , Femenino , Humanos , Queratoplastia Penetrante , Masculino , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Agudeza VisualRESUMEN
BACKGROUND: The treatment of pterygia often results in irregular astigmatism. Corneal smoothing at the end of surgery plays a major role in the development of astigmatism. The aim of our study was to compare the efficiency of corneal smoothing performed by phototherapeutic keratectomy compared with the conventional method performed by a diamond fraise. The effect of postoperative excimer laser smoothing on refraction, visual acuity and irregular astigmatism was investigated. PATIENTS AND METHODS: 32 eyes underwent pterygium excision using a standardized surgical procedure. In addition 9 eyes underwent postoperative phototherapeutic keratectomy of the wound region with an excimer laser, 23 eyes were treated with a diamond fraise for corneal smoothing. The postoperative examination was performed 7, 14 and 30 days after surgery. Corneal topography was performed by a computer-assisted videokeratoscope (TMS-1). The results were evaluated by the Fourier transform analysis. RESULTS: Both methods showed similar results concerning refraction and visual acuity postoperatively. Preoperatively all patients had an irregular flattening of the corneal topography in the area of the pterygium. Postoperatively a small irregular flattening was left in eyes treated with a diamond fraise. In the excimer laser treated group a steepening in the corneal topography could be observed. CONCLUSIONS: The phototherapeutic keratectomy with excimer laser in the treatment of pterygia suggests to be a gentle alternative creating a smooth wound surface. Despite of this advantage the treatment with the excimer laser effects a remarkable increase in administration and expense.
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Astigmatismo/etiología , Queratectomía Fotorrefractiva , Complicaciones Posoperatorias/etiología , Pterigion/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Topografía de la Córnea , Femenino , Estudios de Seguimiento , Análisis de Fourier , Humanos , Procesamiento de Imagen Asistido por Computador , Láseres de Excímeros , Masculino , Persona de Mediana Edad , Refracción Ocular , Resultado del TratamientoRESUMEN
AIMS: To calculate the diameter of halos perceived by patients with multifocal intraocular lenses (IOLs) and to stimulate halos in patients with refractive multifocal IOLs in a clinical experiment. METHODS: Calculations were done to show the diameter of halos in the case of the bifocal intraocular lens. 24 patients with a refractive multifocal IOLs and five patients with a monofocal IOL were asked about their subjective observation of halos and were included in a clinical experiment using a computer program (Glare & Halo, FW Fitzke and C Lohmann, Tomey AG) which simulates a light source of 0.15 square degrees (sq deg) in order to stimulate and measure halos. Halo testing took place monoculary, under mesopic conditions through the distance and the near focus of the multifocal lens and through the focus of the monofocal lens. RESULTS: The halo diameter depends on the pupil diameter, the refractive power of the cornea, and distance focus of the multifocal IOL as well as the additional lens power for the near focus. 23 out of 24 patients with a refractive multifocal IOL described halos at night when looking at a bright light source. Only one patient was disturbed by the appearance of halos. Under test conditions, halos were detected in all patients with a refractive multifocal IOL. The halo area testing through the distance focus was 1.05 sq deg +/- 0.41, through the near focus 1.07 sq deg +/- 0.49 and in the monofocal lens 0.26 sq deg +/- 0.13. CONCLUSIONS: Under high contrast conditions halos can be stimulated in all patients with multifocal intraocular lenses. The halo size using the distance or the near focus is identical.
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Lentes Intraoculares , Errores de Refracción/diagnóstico , Anciano , Anciano de 80 o más Años , Sensibilidad de Contraste , Fijación Ocular , Humanos , Persona de Mediana EdadRESUMEN
AIMS: To compare tritan colour contrast sensitivity (CCS), without and with glare, in patients with refractive multifocal intraocular lenses (IOLs) and with monofocal intraocular lenses. METHODS: Tritan CCS was determined (Moorfields Vision System, CH Electronics) in 15 eyes (14 patients, 75.7 (+/-6.6) years) with a refractive multifocal IOL (Allergan SA 40N) and in 11 eyes (10 patients, 73.7 (+/-6.4) years) with a monofocal IOL (Allergan SI 40 NB). Measurements were made monocularly under mesopic conditions at a distance of 2 metres from the monitor with best distance refraction plus 0.5 D at 0.5, 1, 3, 6, 11.4, and 22.8 cycles per degree (cpd). The test was then repeated for the multifocal IOLs, adding minus 2.5 D to the best distance refraction to force the patient to use the near focus. Both lenses were also investigated under glare conditions with the same set-up and using the brightness acuity tester (BAT). RESULTS: The tritan CCS function without glare in multifocal lenses through the distance focus was nearly identical to that through the near focus. The following statistically significant differences were measured: the CCS function without glare for the multifocal lens was worse at 0.5 cpd and 1.0 cpd than that of the monofocal lens. In CCS testing of the multifocal group with glare at 6 cpd, the results through the distance focus were better than the results through the near focus. For the CCS function with glare, the values for the distance focus in the multifocal lens were worse than the values for the monofocal lens at 0.5 cpd and 1 cpd. In CCS testing with glare through the near focus and CCS testing through the monofocal lens, the monofocal lens performed better at 0.5 cpd, 1 cpd, 3 cpd, and 6 cpd. CONCLUSION: Refractive multifocal intraocular lenses influence tritan CCS function compared to monofocal lenses.
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Percepción de Color , Sensibilidad de Contraste , Lentes Intraoculares , Anciano , Anciano de 80 o más Años , Diagnóstico por Computador , Fijación Ocular , Humanos , Persona de Mediana Edad , Oftalmología/instrumentación , Oftalmología/métodos , Estadísticas no Paramétricas , Agudeza VisualRESUMEN
PURPOSE: To determine the efficacy and rotational stability of a toric posterior chamber silicone intraocular lens (IOL) to correct preoperative astigmatism in cataract patients. SETTING: Department of Ophthalmology, University Hospital of Vienna, Vienna Austria. METHODS: Between 1993 and 1998, foldable toric single-piece plate-haptic silicone IOLs were implanted in 37 eyes (30 patients). The cylindrical IOL power was 2.00 diopters (D) (n = 29), 3.50 D (n = 7), or 4.00 D (n = 1). Phacoemulsification was performed through a scleral or a corneal sutureless self-sealing incision. Outcomes of Snellen visual acuity (without, with spherical, and with best correction), refractive and keratometric astigmatism, and IOL rotation after early postoperative (mean 15.9 days +/- 10.1 [SD]) and long-term (mean 20.3 +/- 16.6 months) follow-ups were evaluated. RESULTS: At last follow-up, 31 eyes (83.8%) had a spherically corrected and 34 (91.9%) a best corrected visual acuity of 0.5 (20/40) or better. Mean preoperative refractive and keratometric astigmatism was 2.68 and 2.70 D, respectively. At the last postoperative follow-up, mean refractive astigmatism was reduced to 0.84 D; keratometric astigmatism was 2.30 D. In 7 eyes (18.9%), the IOL axis was rotated a maximum of 25 degrees. In all 37 eyes, the axis of the toric IOL remained within 30 degrees of rotation. CONCLUSIONS: Early postoperative and long-term follow-ups showed effective and stable correction of astigmatism after implantation of a foldable toric posterior chamber silicone IOL.
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Astigmatismo/cirugía , Catarata/complicaciones , Implantación de Lentes Intraoculares , Lentes Intraoculares , Elastómeros de Silicona , Anciano , Anciano de 80 o más Años , Astigmatismo/complicaciones , Astigmatismo/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Facoemulsificación/efectos adversos , Refracción Ocular , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza VisualRESUMEN
AIM: Different trephination methods may lead to differences in degree of tissue damage and endothelial cell loss, which both influence the outcome of penetrating keratoplasty. Light, transmission, and scanning electron microscopy were used to compare the ultrastructural appearance of the cut edges and the endothelial cell loss in 26 human corneal donor buttons obtained by trephination with the suction fixated guided trephine system (GTS) and with the free hand posterior punch technique (PPT). METHODS: Human corneas were stored between 5 and 14 days in Optisol. One cornea from each pair was used for each technique. Trephinations (7.5 mm) were performed either from the anterior direction with the GTS (n=13) or from the posterior direction with the PPT (n=13) using Pharmacia Superblade trephines. Light microscopy, transmission electron, and scanning electron microscopy were performed according to standard procedures. Widening of the cut edges and the extent of endothelial cell loss were measured at three different areas per corneal button and analysed statistically. RESULTS: In contrast with the PPT, the GTS trephine produced considerable fibrillar disorder at the cut edges of the corneal buttons. The distance to which the endothelial cell loss extended from the edges of the cuts was significantly (p<0. 001) lower for the GTS (42.2 (SD 50.8) microm from the edge) than for the PPT (109.3 (68.1) microm). Stromal widening at the edges (measured as percentage increase in stromal thickness, compared with the thickness of the central cornea) was observed with both techniques. However, the mean stromal widening produced by the GTS was significantly greater than that produced by PPT (106% (24%) v 69% (21%); p<0.002). CONCLUSION: Both trephination techniques produced only minor tissue damage. Nevertheless, there were distinct differences in the fine appearance of the cuts produced by the GTS and the PPT techniques. The extent of the fibrillar dislocation and stromal widening was greater at the edges of the GTS buttons. The GTS technique produced significantly less endothelial cell loss at the cut edges than did the free hand punching technique, PPT.
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Córnea/cirugía , Queratoplastia Penetrante/métodos , Recolección de Tejidos y Órganos/métodos , Anciano , Muerte Celular , Córnea/ultraestructura , Endotelio Corneal/cirugía , Endotelio Corneal/ultraestructura , Epitelio Corneal/cirugía , Humanos , Microscopía Electrónica , Microscopía Electrónica de Rastreo , Persona de Mediana EdadRESUMEN
PURPOSE: To determine the long-term clinical outcome after keratoplasty with the guided trephine system in keratoconus eyes. METHODS: In a prospective study, all consecutive cases of penetrating keratoplasty had trephination performed with the guided trephine system, with which both donor and recipient cornea are trephined from the epithelial side with a same-sized blade. For wound closure, a double running antitorque suture technique with 10-0 nylon was used. Uncorrected and best-corrected Snellen visual acuity, subjective refraction, and astigmatism by keratometry were evaluated after final suture removal, 2 and 3 years postoperatively. RESULTS: In the 31 patients (31 eyes) enrolled, mean best-corrected visual acuity improved from 0.72 +/- 0.16 (20/30) after final suture removal to 0.88 +/- 0.15 (20/25) 3 years postoperatively (P < .001). The mean spherical equivalent increased from -0.86 +/- 2.10 diopters after final suture removal to -2.35 +/- 2.65 diopters 3 years postoperatively (P < .001). Mean keratometric astigmatism decreased from 4.68 +/- 1.76 diopters after final suture removal to 3.57 +/- 1.37 diopters 3 years postoperatively (P = .001). Furthermore, an increase in mean keratometric levels with time (P = .01) was observed and associated with myopic shift (r(s) = -.46, P = .008). CONCLUSION: With the guided trephine system, we attained favorable visual results, with prolonged improvement of visual acuity during the entire follow-up period. Our data show low and decreasing degrees of corneal astigmatism over time. During the follow-up period, a myopic shift was found after final suture removal. Nevertheless, this technique of performing same-sized grafts reduces postoperative residual myopia.
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Córnea/cirugía , Queratocono/cirugía , Queratoplastia Penetrante/instrumentación , Adulto , Femenino , Estudios de Seguimiento , Humanos , Queratoplastia Penetrante/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Refracción Ocular , Errores de Refracción/fisiopatología , Errores de Refracción/prevención & control , Técnicas de Sutura , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: In 15 keratoconus corneas, the three-dimensional arrangement of collagen lamellae was investigated by means of scanning electron microscopy. METHODS: Keratoconus corneas without visible scars were obtained during perforating keratoplasty. The noncollagenous matrix of the stroma was removed with sodium hydroxide. Descemet's membrane was removed mechanically and deeper layers of the stroma were exposed by cutting the tissue tangentially to the corneal surface with an ultramicrotome. The apical and the para-apical regions of keratoconus were compared the central regions of normal corneas. RESULTS: In the apical regions of 11 out of the 15 keratoconus corneas (73%), the arrangement of the collagen lamellae differs from those of the para-apical regions and normal corneas. Their collagen fibrils from uniform layers and no delimited collagen lamellae can be differentiated. Interlacing between adjacent layers in extremely decreased or even absent. In the para-apical region of keratoconus corneas the three-dimensional arrangement of collagen lamellae does not differ from that in normal corneas. CONCLUSION: Stromal thinning and conical ectasia in the apex of keratoconus corneas alters the organization of collagen. This will certainly affect the biomechanical properties of the cornea and further lead to a progression of keratoconus irrespective of its primary pathogenesis.
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Colágeno/ultraestructura , Córnea/ultraestructura , Queratocono/patología , Adolescente , Adulto , Humanos , Microscopía Electrónica de Rastreo , Persona de Mediana EdadRESUMEN
PURPOSE: To compare contrast sensitivity and glare disability provided by diffractive and refractive multifocal intraocular lenses (IOLs). SETTING: University Eye Clinic Vienna, Austria. METHOD: This study evaluated the contrast sensitivity and glare disability in 29 eyes with a diffractive multifocal IOL (3M815LE) and 12 with a three-piece, five-zone refractive multifocal IOL (AMO Array SSM 26 NB). The Brightness Acuity Tester (Mentor, Inc.) was used with stationary sinusoidal gratings at spatial frequencies of 0.5, 1, 3, 6, 11.4, and 22.8 cycles per degree (cpd) generated on a television monitor (Nicolet CS 2000). RESULTS: The contrast sensitivity functions of both multifocal IOL groups were within the reference range and were identical at 0.5, 1, and 22.8 cpd spatial frequencies. At 3, 6, and 11.4 cpd, the contrast sensitivity function in the diffractive IOL group was 6, 9, and 10% lower than in the refractive IOL group, and the difference between groups was statistically significant at 6 cpd. When glare was present, contrast sensitivity in the diffractive IOL group was generally in the lower limit of the reference range and remained below at 3 and 6 cpd. Contrast sensitivity in the refractive IOL group remained below the reference range at 3 cpd. At 0.5 and 1 cpd, there were no differences between the groups. At the middle and high spatial frequencies (3, 6, 11.4, 22.8 cpd), contrast sensitivity in the diffractive group was 8, 16, 11, and 12% lower than in the refractive group. At 6 cpd, the between-group difference was statistically significant. CONCLUSION: Diffractive multifocal IOLs provided decreased contrast sensitivity and greater glare disability than refractive multifocal IOLs.
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Sensibilidad de Contraste , Deslumbramiento , Lentes Intraoculares , Adulto , Anciano , Anciano de 80 o más Años , Capsulorrexis , Humanos , Implantación de Lentes Intraoculares , Persona de Mediana Edad , Facoemulsificación , Estudios Retrospectivos , Agudeza VisualRESUMEN
PURPOSE: To determine depth of focus and visual quality after implantation of a diffractive intraocular lens (IOL) and a refractive IOL. SETTING: University Eye Clinic, Vienna, Austria. METHOD: This study comprised 10 eyes of 9 patients with a diffractive IOL (3M 825x + 4) and 13 eyes of 9 patients with a refractive lens (AMO Array SSM 26NB). Depth of focus was evaluated in a defocused range of -6.0 to +3.0 diopters (D), and Snellen visual acuity was recorded. RESULTS: Distance acuity peaked at 1.0 +/- 0.2 (3M group) and 0.91 +/- 0.13 (AMO group). The near acuity peaks were at 0.82 +/- 0.15 and 0.55 +/- 0.14, respectively. Visual acuity of 0.5 was possible in a range of defocus of +1.0 to -4.0 D (3M) and +1.0 to -3.5 D (AMO). CONCLUSION: Pseudoaccommodation and full distance visual acuity were realized with both types of multifocal lenses. For intermediate distances, visual acuity may be limited to activities that do not require optimal vision. At near distances, the 3M lens provided statistically significantly better visual acuity.
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Acomodación Ocular , Percepción de Profundidad/fisiología , Lentes Intraoculares , Agudeza Visual/fisiología , Anciano , Capsulorrexis , Estudios de Seguimiento , Humanos , Implantación de Lentes IntraocularesRESUMEN
A self-sealing incision technique for cataract surgery has been developed. It is appropriate for implantation of rigid-optic intraocular lenses (IOLs) up to 7.0 mm. The incision is designed to meet the principle criteria of sutureless cataract surgery, such as optimal instrument handling, easy IOL implantation, and minimal postoperative patient care.
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Extracción de Catarata/métodos , Córnea/cirugía , Colgajos Quirúrgicos , Técnicas de Sutura , Humanos , Implantación de Lentes IntraocularesRESUMEN
BACKGROUND: The implantation of a diffractive multifocal lens (dMIOL) as alternative to a monofocal lens is justified if after surgery there is practically no need to wear glasses. PATIENTS AND METHODS: 31 patients had an implantation of a total of 35 dMIOLs (3M 815 LE). We evaluated the visual acuity, the refractive data and the patients' attitude to wearing glasses. The average age was 67.0 +/- 11.8 years. Follow up took place after 18.7 +/- 5.4 months. RESULTS: The mean value of the uncorrected distance acuity was 0.59 +/- 0.17 and the corrected distance acuity 0.96 +/- 0.13. The uncorrected near acuity amounted to Jg 2.40 +/- 0.94, best distance correction was Jg 1.49 +/- 0.55. The patients still accepted an average of 0.68 +/- 0.37 dpt for the best near correction (near vision over the diffractive near focus) and thus achieved Jg 1.46 +/- 0.55. At the best distance correction plus 3.5 dpt, the near visual acuity was improved to 1.03 +/- 0.17. 54.8% of the patients indicated that they did not use glasses at all. 32.3% stated that they only used glasses for reading. 9.7% wore bifocals all the time, and 3.2% always used glasses for the distance. CONCLUSIONS: Regarding distance vision, the dMIOL is equivalent to monofocal lenses. Without any correction the results of the dMIOLs for the near vision are superior to monofocal lenses. Glasses can be dispensed with if the uncorrected visual acuity of the operated eye is at least 0.6 Jg 2-3 after surgery and the other eye too, does not need any correction. In case the postoperative visual acuity is worse, good visual acuity of the other eye may render glasses unnecessary. Part of the patients put up with a correctable loss of visual acuity in order not to become dependent on glasses. The need to wear glasses may be decreased considerably by implanting a dMIOL in both eyes and by avoiding postoperative refraction errors.
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Anteojos , Lentes Intraoculares , Refracción Ocular , Agudeza Visual , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Óptica y FotónicaRESUMEN
The development and introduction of multifocal intraocular lenses (MIOL) should provide the patient with a pseudoaccomodation for distance and near acuity without spectacle corrections. For this study two different types of multifocal lenses have been investigated concerning their visual properties. For diffractive MIOL (3M, type 815LE) an uncorrected distance visual acuity of Snellen 0.59 +/- 0.17 was found. The near visual acuity was J 2.4 +/- 0.94 and Snellen Acuity of 0.5 was achieved in a range of defocus of -1.25 D to +4.0 D. For refractive MIOL (Allergan, type Array SSM 26NB) an uncorrected distance visual acuity of Snellen 0.79 +/- 0.17 was found. The near visual acuity was J 2.75 +/- 1.35 and Snellen Acuity of 0.5 was achieved in a range of defocus of -1.0 D to +3.5 D. With this multifocal lenses the patients reached functional results for distance vision as well as with monofocals. Because of the existing pseudo-accommodation the results for near vision lay over of those of monofocals and the need spectacle correction decrease.
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Lentes Intraoculares , Óptica y Fotónica , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Refracción Ocular , Pruebas de Visión , Agudeza VisualRESUMEN
PURPOSE: To evaluate and compare the efficacy of a sodium-bicarbonate-adjusted preparation of lidocaine 4% (pH = 7.2) and standard lidocaine (pH = 5.2) for topical anesthesia in clear corneal cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Austria. METHODS: In a prospective, randomized, double-blind clinical trial, clear corneal cataract surgery was performed under topical anesthesia in 44 eyes of 34 patients. In 22 eyes, pH-adjusted lidocaine 4% was administered; in the other 22, standard lidocaine 4%. Aqueous and serum concentrations of lidocaine were measured by high-performance liquid chromatography and ultraviolet detection. Subjective pain was assessed using a visual analog scale of no pain (0%) to worst imaginable pain (100%). On the first postoperative day, visual acuity, intraocular pressure, and corneal staining with fluorescein were examined. RESULTS: In the pH-adjusted lidocaine group, significantly higher lidocaine concentrations were found in the aqueous humor (15.06 microg/mL +/- 8.2 [SD] versus 4.75 +/- 3.5 microg/mL; P < .0001). In all samples (n = 8), serum lidocaine concentrations were below a minimum detectable level of 0.02 microg/mL. Subjective pain ratings were similar in the pH-adjusted and standard lidocaine groups (mean 9.73 +/- 10.4% and 10.0 +/- 15.4%, respectively). There was no significant between-group difference in intraoperative and postoperative outcomes. CONCLUSIONS: In this study, pH-adjusted lidocaine 4% was a safe, effective topical anesthetic for clear corneal surgery and had minimal local and systemic toxicity. Administration of pH-adjusted lidocaine 4% resulted in significantly higher aqueous humor lidocaine concentrations than administration of standard lidocaine 4%.
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Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Córnea/cirugía , Lidocaína/administración & dosificación , Facoemulsificación/métodos , Administración Tópica , Anciano , Anestésicos Locales/farmacocinética , Humor Acuoso/metabolismo , Tampones (Química) , Cromatografía Líquida de Alta Presión , Método Doble Ciego , Femenino , Humanos , Concentración de Iones de Hidrógeno , Presión Intraocular , Lidocaína/farmacocinética , Masculino , Soluciones Oftálmicas , Estudios Prospectivos , Bicarbonato de Sodio , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar anesthesia in clear corneal cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Austria. METHODS: In this prospective, double-blind clinical trial, 36 patients had bilateral cataract surgeries performed from 1 to 3 months apart. Half of the patients had topical anesthesia for the first surgery and peribulbar anesthesia for the second surgery. The other half had peribulbar first and then topical. All surgery was done using a temporal clear corneal approach and bimanual phacoemulsification followed by in-the-bag intraocular lens implantation. Subjective pain was assessed using a visual analog scale of no pain (0%) to worst pain imaginable (100%) and intraoperative motility using a rank scale of adverse motility (-5) to ideal patient cooperation (+5). RESULTS: Subjective pain was comparable whether topical or peribulbar anesthesia was used (mean 10.75 versus 10.97%; P > .6). Patient cooperation (motility) was significantly better when topical anesthesia was used (+2.16 versus +1.11; P = .03). There were no significant differences in complications. A peribulbar block was given in addition to the topical anesthesia in two cases. CONCLUSIONS: Topical anesthesia is a safe, effective alternative to peribulbar anesthesia in clear corneal cataract surgery.
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Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Córnea , Facoemulsificación/métodos , Administración Tópica , Anciano , Anestésicos Locales/efectos adversos , Bupivacaína/administración & dosificación , Bupivacaína/efectos adversos , Córnea/cirugía , Estudios Cruzados , Método Doble Ciego , Combinación de Medicamentos , Movimientos Oculares , Femenino , Humanos , Hialuronoglucosaminidasa/administración & dosificación , Hialuronoglucosaminidasa/efectos adversos , Lentes Intraoculares , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Masculino , Órbita , Dolor , Dimensión del Dolor , Complicaciones Posoperatorias , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate visual acuity, depth of focus, contrast sensitivity, and glare disability in eyes with an Array SSM 26-NB three-piece, five-zone multifocal intraocular lens (IOL). SETTING: University Eye Clinic, Vienna, Austria. METHOD: Fourteen eyes with an AMO Array IOL were evaluated for uncorrected and best corrected distance and near visual acuity. The reading distance produced by the near focus of the lens was varied with convex glasses of less power. Reading at distance focus was evaluated by adding +3.50 diopters (D) to the distance correction. Depth of focus was measured from -3.00 to +6.00 D. Contrast sensitivity and glare disability were also measured using the Brightness Acuity Tester with stationary sinusoidal gratings at 0.5, 1, 3, 6, 11.4, and 22.8 cycles/degree. RESULTS: Mean uncorrected distance acuity (Snellen) was 0.79 +/- 0.17 (SD), which increased to 0.94 +/- 0.14 with best correction. Near acuity was J2.75 +/- 1.35 and J2.59 +/- 1.10, respectively. When near focus was tested for reading distance, a mean of +0.54 +/- 0.02 D was accepted for improvement of near vision of J1.71 +/- 0.94. Near acuity with a distance focus addition of +3.50 D was J1.08 +/- 0.28. Contrast sensitivity and glare disability were lower than in 13 eyes with a monofocal poly(methyl methacrylate) IOL and 16 normal phakic eyes. CONCLUSIONS: Eyes with the Array IOL had full distance function. Reading performance could be improved with a near focus of more than +3.50 D. Full near vision could be achieved with the distance focus and conventional reading glasses. Depth of focus was sufficient but visual acuity was limited at intermediate and near distance. Although contrast sensitivity was relatively low, it was not beyond the reference range.
Asunto(s)
Percepción de Profundidad/fisiología , Lentes Intraoculares , Refracción Ocular/fisiología , Elastómeros de Silicona , Agudeza Visual/fisiología , Anciano , Estudios de Seguimiento , Deslumbramiento , Humanos , Pruebas de VisiónRESUMEN
PURPOSE: To determine whether a small clear corneal temporal incision produces less surgically induced astigmatism than a larger incision. METHODS: One hundred three consecutive cases of postoperative astigmatism after clear corneal incision cataract surgery were studied for a minimum of 1 year. Only self-sealing incisions from the temporal side were made as follows: 3.2 mm (Group A); 4.0 mm (Group B); 5.2 mm (Group C). We considered the amount and axes of the keratometric readings at different times as well as their course over time. Induced astigmatism was calculated using three methods. Axial changes were also analyzed. RESULTS: Immediately after the surgery, there was a small, surgically induced, with-the-rule astigmatic shift in all groups, which in most cases decreased to near preoperative levels with time. One year postoperatively. mean induced astigmatism was 0.09 diopter (D) in Group A, 0.26 D in Group B, and 0.54 D in Group C. Most cases had minimal axial changes. In Group A, 86% had an axial change of fewer than 30 degrees; in Group B, 76%; and Group C, 73%. CONCLUSIONS: The smallest incision group had the least surgically induced astigmatism and axial change. All incision groups remained stable and had satisfactory clinical results.
Asunto(s)
Astigmatismo/etiología , Extracción de Catarata/métodos , Complicaciones Posoperatorias/etiología , Astigmatismo/prevención & control , Estudios de Seguimiento , Humanos , Lentes Intraoculares , Complicaciones Posoperatorias/prevención & control , Refracción OcularRESUMEN
We studied postoperative astigmatism in 107 patients who were followed for 12 months after phacoemulsification and posterior chamber lens implantation. A scleral incision of 3.5 mm was used in Group A patients and one of 4.5 mm in Group B patients. In both groups a no-stitch wound closure technique was used. A high correlation between preoperative and 12-month postoperative height and time shift of keratometric values was found. In both groups the mean difference was less than 0.60 diopters (D). The mean postoperative cylinder increase was less than 0.50 D; it was less than 0.25 D after six months. The induced astigmatism was confirmed by three different methods. Immediately after surgery, a negative induced astigmatism was found in both groups. After 12 months, induced astigmatism in Group A was -0.37 D and in Group B, -0.67 D. Immediately after surgery there was an axis change; a decrease of with-the-rule astigmatism occurred concurrently with an increase toward oblique and against-the-rule astigmatism. This axis change was somewhat evident after 12 months.
Asunto(s)
Astigmatismo/etiología , Extracción de Catarata/efectos adversos , Técnicas de Sutura/efectos adversos , Astigmatismo/patología , Extracción de Catarata/métodos , Estudios de Seguimiento , Humanos , Lentes Intraoculares , Estudios Prospectivos , Cicatrización de HeridasRESUMEN
This study was performed to investigate the correlation between the contamination of the anterior chamber and the technique of extracapsular cataract extraction (ECCE). Three different methods were used: uncomplicated planned ECCE, phacoemulsification involving suturing method, and sutureless technique. All patients had posterior chamber intraocular lenses implanted. Two hundred and thirty consecutive patients were included in this prospective study, and preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber were investigated. Samples of the aqueous humor were taken at the beginning and at the end of the operation. Cultures were incubated and held for 14 days. More than 71% of the preoperative smears were contaminated by coagulase-negative staphylococci, the most commonly isolated bacteria. However, 27% of the patients had culture-positive anterior chamber aspirates intraoperatively, also with coagulase-negative staphylococci as the most frequent organisms. In no case did postoperative endophthalmitis develop. Preliminary results in a small population show that the contamination of the aqueous humor is statistically significantly less frequent if the cataract extraction is performed by phacoemulsification than if it is done without phacoemulsification. Another interesting finding is that anterior chamber contamination is not significantly more frequent, if a sutureless technique is used for cataract surgery.