1/22. Combined phacoemulsification and penetrating keratoplasty.To highlight indications, technique, and advantages of closed-chamber phacoemulsification and intraocular lens (IOL) implantation during penetrating keratoplasty for corneal opacities. case reports of 2 patients who underwent combined phacoemulsification, IOL implantation and penetrating keratoplasty. The technique described allowed controlled capsulorrhexis, cataract removal and in-the-bag IOL implantation. Complications due to increased posterior pressure during open-sky extracapsular cataract were not encountered. The surgical technique described in this report can only be used in selected patients undergoing combined corneal transplant and cataract surgery. In this group of patients, however, the technique offers many intra- and postoperative advantages.- - - - - - - - - - ranking = 1keywords = phacoemulsification (Clic here for more details about this article) |
2/22. Cataract surgery and intraocular lens implantation in anterior megalophthalmos.Six eyes of 4 patients with anterior megalophthalmos, 2 men and 2 women ranging in age from 32 to 47 years, had extracapsular cataract extraction or phacoemulsification and standard posterior chamber intraocular lens implantation. All had a family history of anterior megalophthalmos. Follow-up was from 6 to 30 months. All patients had a preoperative visual acuity of worse than 20/60, which improved to 20/20 in 5 eyes. Zonular dehiscence was observed during surgery in 3 cases, leading to vitreous loss in 1 case that developed a retinal detachment after 3 months.- - - - - - - - - - ranking = 0.16666666666667keywords = phacoemulsification (Clic here for more details about this article) |
3/22. Consecutive descemet membrane detachment after successive phacoemulsification.PURPOSE: To report a patient with consecutive Descemet's membrane (DM) detachments after successive phacoemulsification, review other reported patients with bilateral DM detachments, and explore the possibility of anatomic predisposition to DM detachment in some patients. methods: Our patient's course was reviewed along with the reported experience with three other patients with bilateral DM detachments. RESULTS: No clear underlying etiology of DM detachment was found in our patient or any of the other three reported patients reviewed. CONCLUSIONS: Some patients may be anatomically predisposed to DM detachment possibly because of an abnormality in the fibrillary stromal attachment to DM. Early postoperative surgical intervention often leads to satisfactory visual results.- - - - - - - - - - ranking = 0.83333333333333keywords = phacoemulsification (Clic here for more details about this article) |
4/22. phacoemulsification conditions resulting in thermal wound injury.PURPOSE: To determine and model the relationships between phacoemulsification conditions and viscoelastic agents that result in thermal wound injury. SETTING: Animal laboratory, Irvine, california, USA. methods: Mechanical and animal models, various wound sizes, phacoemulsification tips, and dispersive and cohesive viscoelastic agents were evaluated. Settings for phaco power, vacuum, and irrigation levels were controlled within a surgically relevant range. In the mechanical and animal models, incision temperature was assessed as a function of phacoemulsification parameters and time. In the animal model, wound damage was evaluated at the time of surgery. RESULTS: Induced time delays from the onset of phaco power to the onset of irrigation flow caused a thermal rise at the incision site. In these experiments, lack of irrigation and aspiration resulted in the greatest thermal rise and caused wound damage. Both the cohesive and dispersive viscoelastic agents were associated with a delay in the start of irrigation and aspiration, which resulted in similar maximum temperatures. Mathematical models were developed to estimate the maximum incision temperature from the phacoemulsification power, the duration (seconds) of occlusion, the tip gauge and type, and other phacoemulsification parameters. The models predict that under comparable conditions, occlusion with a viscoelastic agent will result in higher incision temperatures than occlusion with a balanced salt solution. CONCLUSION: Under comparable phacoemulsification conditions, both the cohesive and dispersive viscoelastic agents were associated with elevated temperatures that would be preventable by ensuring irrigation and aspiration flow before the onset of phacoemulsification power.- - - - - - - - - - ranking = 1.1666666666667keywords = phacoemulsification (Clic here for more details about this article) |
5/22. cystinosis, cataract surgery, and corneal erosions.A 21-year-old man presented with severe corneal cystinosis and steroid-related cataract bilaterally. Rather than combined cataract surgery and penetrating keratoplasty, the patient had uneventful phacoemulsification and intraocular lens implantation after which visual acuity improved to 66 in both eyes. The outcome indicates that conventional phacoemulsification is sufficient in these cases. A guarded prognosis is advised in patients with cystinosis having cataract surgery as the fundal view is often impaired and there may be associated maculopathy.- - - - - - - - - - ranking = 0.33333333333333keywords = phacoemulsification (Clic here for more details about this article) |
6/22. Late spontaneous resolution of a massive detachment of Descemet's membrane after phacoemulsification.We report the spontaneous resolution of a massive detachment of Descemet's membrane 10 months after uneventful phacoemulsification. diagnosis of the detachment was delayed because of severe corneal edema; thus, surgery was not performed. We propose that this complication of severe corneal edema after cataract surgery be considered and, given its excellent outcome, we recommend surgical treatment.- - - - - - - - - - ranking = 0.83333333333333keywords = phacoemulsification (Clic here for more details about this article) |
7/22. Severe keratomycosis secondary to scedosporium apiospermum.PURPOSE: To report an unusual case of severe keratomycosis caused by scedosporium apiospermum without any known previous ocular injury, that resulted in a corneal perforation, which was treated with an emergency penetrating tectonic keratoplasty and later with phacoemulsification and astigmatic keratotomy to restore good visual function. methods: A 45-year-old woman with a history of multiple sclerosis presented with a severe and refractory corneal abscess in her right eye without any known prior injury. Corneal scrapings were obtained and stained for microscopic evaluation. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. RESULTS: Microbiologic examination of the corneal scraping showed scedosporium apiospermum micelle. The fungal culture was sensitive to miconazole, itraconazole and voriconazole. Partial clinical improvement was achieved with hourly topical natamycin, amphotericin b, and systemic itraconazole application, although in vitro sensitivity tests showed resistance to the topical antifungal agents used. A corneal paracentral perforation occurred despite aggressive treatment. An emergency eccentric penetrating keratoplasty was performed with satisfactory results. Subsequent phacoemulsification and astigmatic keratotomy restored a good visual function. CONCLUSION: A fungal etiology should be suspected in a progressive and refractory corneal abscess. This report highlights the utility of microbiologic investigation to perform an early and accurate diagnosis. Aggressive medical treatment and even therapeutic penetrating keratoplasty to remove infected tissue could result in the maintenance of useful visual function. In view of the poor prognosis of this specific fungus, a closer observation and early keratoplasty might be required to preserve the ocular globe.- - - - - - - - - - ranking = 0.33333333333333keywords = phacoemulsification (Clic here for more details about this article) |
8/22. Descemet's membrane detachment after cataract surgery: management and outcome.OBJECTIVE: To analyze the possible causes of Descemet's membrane detachment (DMD) and the treatment and outcome of patients after cataract surgery. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Fifteen eyes of 12 patients. methods: We reviewed clinical data on 15 eyes of 12 patients with nonscrolled DMD after cataract surgery who presented to the Cornea Service at wills eye Hospital from 1986 to 2001. Institutional review board/ethics committee approval was obtained. MAIN OUTCOME MEASURES: visual acuity and reattachment of Descemet's membrane. RESULTS: Cataract procedures involved nine clear-corneal eyes, four limbal incisions, one trabeculectomy/combined phacoemulsification, and one extracapsular cataract extraction. From 1986 to 1990, we had 1 patient; from 1991 to 1995, no patients; and from 1996 to 2001, 11 patients (including all clear-corneal eyes). Of the 15 eyes, 8 resolved with medical treatment alone, with a mean time to resolution of 9.8 weeks. One patient was lost to follow-up while improving on medical treatment, and another required a penetrating keratoplasty (PK) after medical treatment failed. Five eyes received anterior-chamber SF(6) gas injection. Of these eyes, three DMDs resolved, one underwent repeated injection (not improving after 10 weeks), and another required a PK. CONCLUSIONS: Referrals for DMD seem to be increasing. This may be explained by the increase in clear-corneal cataract procedures. Medical treatment seems to be adequate in many cases and may be appropriate initial therapy. When needed, SF(6) gas injection may also be successful, but not in all cases.- - - - - - - - - - ranking = 0.16666666666667keywords = phacoemulsification (Clic here for more details about this article) |
9/22. Epithelial downgrowth after clear cornea phacoemulsification: report of two cases and review of the literature.OBJECTIVE: To report two cases of diffuse epithelial downgrowth after clear cornea phacoemulsification and to review the different treatment options for this ominous disease. DESIGN: Two interventional case reports. methods: Retrospective review of two eyes from two different patients in whom epithelial downgrowth developed 7 and 3 months after uneventful clear cornea phacoemulsification. In the first case, the epithelial invasion seemed to be growing from the temporal incision site onto the corneal endothelium toward the visual axis. cryotherapy was applied to the affected cornea, with control of the growing membrane. A penetrating keratoplasty was performed to restore visual function. In the second patient, the membrane was attached to the iris and posterior cornea and was confirmed by diagnostic argon laser photocoagulation. This case was surgically treated with en bloc excision and a corneoscleral graft. MAIN OUTCOME MEASURES: visual acuity at the final follow-up visit. RESULTS: Surgical treatment of the epithelial downgrowth was different for both patients. In the postoperative period, a best-corrected visual acuity of 20/60 and 20/30 was achieved in each case. No regrowth of the membrane was observed. CONCLUSIONS: Treatment of epithelial downgrowth is controversial. We present two cases of epithelialization of the anterior chamber with either clinical or histologic confirmation after clear cornea sutureless phacoemulsification. Surgical treatment should be attempted promptly to obtain a good visual prognosis.- - - - - - - - - - ranking = 1.1666666666667keywords = phacoemulsification (Clic here for more details about this article) |
10/22. corneal edema resolution after "descemetorhexis".A 79-year-old woman had left eye phacoemulsification complicated by inadvertent excision of Descemet's membrane (DM). One day postoperatively, the visual acuity was counting fingers with diffuse corneal edema. The patient was treated medically, with gradual resolution of the corneal edema over a 6-month period. The torn edge of DM could be visualized as the edema cleared, and no endothelial cell count could be obtained centrally. Approximately 1 year postoperatively, the central endothelial cell count was 2114 cells/mm(2) in the right eye and 827 cells/mm(2) in the left eye. The decreased cell count, increased polymegethism, and pleomorphism suggested that endothelial cells migrated to cover the stromal surface area in the absence of DM.- - - - - - - - - - ranking = 0.16666666666667keywords = phacoemulsification (Clic here for more details about this article) |
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