Cases reported "Pseudophakia"

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1/9. alcaligenes xylosoxidans and propionibacterium acnes postoperative endophthalmitis in a pseudophakic eye.

    PURPOSE: To report a case of persistent polymicrobial postoperative endophthalmitis caused by alcaligenes xylosoxidans and propionibacterium acnes in a pseudophakic eye. A. xylosoxidans is a gram-negative bacteria resistant to most antibiotics. methods: Case report. RESULTS: A 72-year-old man presented with clinical signs of endophthalmitis on the first postoperative day after a phacoemulsification procedure with posterior chamber intraocular lens, left eye. Initial treatment included topical, subconjunctival, and oral antibiotics. After initial clearing, there was recrudescence of infection on postoperative day 37 that prompted referral of the patient to the Cullen Eye Institute. Treatment at that time included anterior chamber and vitreous taps with intravitreal antibiotic injections. Complete pars plana vitrectomy and intraocular lens explantation were eventually required because of persistent infection with a resistant organism. Cultures from the first procedure grew A. xylosoxidans and P. acnes. Cultures from the vitrectomy grew only A. xylosoxidans. At the final follow-up visit 6 months after the initial procedure. The eye was without inflammation with best-corrected visual acuity of 20/40. CONCLUSION: Both A. xylosoxidans and P. acnes can cause chronic progressive endophthalmitis after cataract extraction often resistant to corrective antibiotic therapy. Successful intervention may require complete vitrectomy with intraocular lens and capsule removal.
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ranking = 1
keywords = phacoemulsification
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2/9. Positive and negative dysphotopsia in patients with acrylic intraocular lenses.

    PURPOSE: To report the incidence, management, and prevention of patient reports of glare and streaks around a point source of light or a dark shadow in the temporal field of vision after acrylic intraocular lens (IOL) implantation. SETTING: A private practice. methods: Cases in which patients complained vigorously of dysphotopsia were catalogued prospectively during the implantation experience in 6668 consecutive eyes having surgery between January 1995 and June 1999. The techniques of topical-intracameral anesthesia, temporal clear corneal incisions, and phacoemulsification were used in all cases. Alternate IOL styles were selected for use from July 1999 to April 2000. RESULTS: Fourteen cases (0.2%) were identified. The complaints resolved in 1, were diminished in 1, and were tolerated without change in 7. Five eyes of 4 patients required IOL exchange with capsular bag placement of a poly(methyl methacrylate) (PMMA) or silicone lens for resolution of symptoms. Selecting alternate IOL styles reduced the incidence of dysphotopsia. CONCLUSIONS: glare and streaks from a point source of light represent positive photic expressions of dysphotopsia, and temporal dark shadows represent similar negative photic expressions. Both appear to be associated with shiny square-edge optics made of high-refractive-index acrylic polymer. Intraocular lenses of PMMA and silicone with rounded edges, along with square-edge acrylic IOLs with nonreflective edges, appear less likely to cause clinically significant pseudophakic dysphotopsia.
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ranking = 1
keywords = phacoemulsification
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3/9. role of ultrasound biomicroscopy in managing pseudophakic pupillary block glaucoma.

    We describe a case of anterior capsule adherence to the iris that occurred after phacoemulsification with in-the-bag intraocular lens (IOL) implantation. This adherence led to the development of pseudophakic pupillary block glaucoma. There were no synechias at the pupillary margin associated with the capsule-iris adherence. Ultrasound biomicroscopy, used to evaluate the anterior segment in vivo, clarified the mechanism of pseudophakic pupillary block. The pupillary block was relieved by a single laser iridotomy.
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ranking = 1
keywords = phacoemulsification
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4/9. Comparison of Scheimpflug images of posterior capsule opacification and histological findings in rabbits and humans.

    PURPOSE: To compare the posterior capsule opacification in Scheimpflug photographic images produced by an electronic anterior eye segment analysis system with the histopathological findings in rabbits and humans. SETTING: Department of ophthalmology, Wakayama Medical College, japan. methods: Opacified posterior capsules were photographed using the EAS-1000 system (Nidek) and were then extracted during vitreous surgery for proliferative diabetic retinopathy or proliferative vitreoretinopathy in 2 patients. In rabbits, phacoemulsification and aspiration (PEA) with intraocular lens (IOL) implantation was performed. The IOL was implanted in the bag or in the sulcus. After intervals of healing, the posterior capsule was photographed with the EAS-1000 and the animals were then killed. In both clinical and experimental specimens, the posterior capsule was processed for light microscopic histology and immunohistochemistry. RESULTS: Opacified human capsules were well imaged by the EAS-1000. histology showed that lens epithelial cells proliferated with and without an accumulation of extracellular matrix. Details such as rolling of the capsulotomy edge were seen well. Regenerated lens fibers of Soemmering's ring were seen as a mass within the capsule. In the rabbit model, Scheimpflug images accurately represented the capsules as they appeared histologically. CONCLUSION: The EAS-1000 system provided faithful, relatively high-resolution images that corresponded to the histologic findings in the posterior capsules after PEA-IOL surgery in humans and rabbits.
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ranking = 1
keywords = phacoemulsification
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5/9. Pseudophakic ametropia managed with a phakic posterior chamber intraocular lens.

    We report the use of a phakic posterior chamber intraocular lens (IOL) to correct pseudophakic ametropia. Two eyes of 2 patients developed ametropia after unilateral phacoemulsification and IOL implantation. The manifest refraction was -6.00 -0.50 x 50 in the first patient and 4.50 -1.00 x 15 in the second. Both patients were bothered by the induced anisometropia and had posterior chamber phakic IOL implantation in the pseudophakic eye. Postoperatively, uncorrected visual acuity improved from 20/400 to 20/30 in the first patient and from 20/200 to 20/40 in the second patient. The manifest refraction was -0.50 -0.75 x 55 and 1.50 -1.50 x 30, respectively. No complications were noted. Implantation of a phakic posterior chamber IOL may be an alternative to currently available methods of managing pseudophakic ametropia.
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ranking = 1
keywords = phacoemulsification
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6/9. Mystery of the vanishing iris.

    We present the first reported case of traumatic aniridia as an isolated injury after blunt trauma to an eye that had phacoemulsification through a corneal tunnel. This case provides insight into the properties of the self-sealing corneal tunnel and possible advantages that it may confer on the eye.
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ranking = 1
keywords = phacoemulsification
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7/9. Pseudophakic pupillary block caused by pupillary capture after phacoemulsification and in-the-bag AcrySof lens implantation.

    We describe a 50-year-old patient who developed pupillary block caused by pupillary capture 1 week after uneventful phacoemulsification and implantation of an AcrySof foldable intraocular lens (IOL). The patient had a large but intact capsulorhexis with the haptics lying in the bag; the optic lay in the pupillary area anterior to the capsulorhexis. This case was successfully managed by a neodymium: YAG laser iridotomy, IOL explantation, and subsequent implantation of a poly(methyl methacrylate) posterior chamber IOL. To prevent this complication, we suggest the optic be larger than the capsulorhexis and advocate correct, gentle insertion of the foldable IOL.
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ranking = 5
keywords = phacoemulsification
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8/9. Single-piece hydrophobic acrylic intraocular lens explanted within the capsular bag: case report with clinicopathological correlation.

    A 74-year-old woman had uneventful phacoemulsification with implantation of a single-piece hydrophobic acrylic intraocular lens (IOL) (SA30AL) in her left eye. Two weeks after the surgery, the patient presented for ophthalmological consultation reporting pseudophakic dysphotopsia, which she had subjectively noted since surgery. Explantation/exchange of the IOL was performed 3 months after the surgery. The IOL was strongly attached to the capsule, which was fibrotic and contracted; explantation of the capsular bag complex in toto was done. To our knowledge, this is the first case of explantation of this IOL design with clinicopathological correlation.
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ranking = 1
keywords = phacoemulsification
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9/9. Ultrasound biomicroscopy in traumatic aniridia 2 years after phacoemulsification.

    A 45-year-old man with retinitis pigmentosa experienced total aniridia in the left eye due to direct blunt trauma 2 years after uneventful bilateral phacoemulsification via a 3.5 mm clear corneal incision. Ultrasound biomicroscopy (UBM) of the left eye revealed no missing or stretched zonular fibers extending from the ciliary body to the anterior capsule, a few iris root remnants, a normal ciliary body, an in-the-bag acrylic intraocular lens, and Descemet's membrane dehiscence at the corneal tunnel through which the iris extruded. The eye recovered 20/25 visual acuity after 1 week. Transient hyphema and a rise in intraocular pressure were recorded. This is the first report of traumatic aniridia 2 years after phacoemulsification with UBM evidence of undamaged zonular apparatus. A UBM examination may be clinically helpful, especially when blood prevents accurate slitlamp examination of the anterior segment.
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ranking = 6
keywords = phacoemulsification
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