Allan Storr-Paulsen

Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique.

PURPOSE: To compare endothelial cell damage during cataract surgery performed using the divide‐and‐conquer or phaco‐chop nuclear fracturing technique. SETTINGS: Department of Ophthalmology, Frederiksberg University Hospital, Frederiksberg, Denmark. METHODS: In a prospective study, 60 eyes of 60 patients were randomly assigned to 1 of 2 groups (30 eyes each group) based on the phacoemulsification technique used: phaco chop or divide and conquer. During surgery, phaco time, phaco power, irrigation volume, and grade of nuclear firmness were recorded. The endothelial cell density, variation in endothelial cell size, percentage of hexagonal cells, and central corneal thickness (CCT) were recorded at baseline and 3 and 12 months postoperatively. Sample size was based on a power calculation (power 0.90, P = .05, clinically important difference = 300 cells/mm2). RESULTS: Significantly less phaco power was used during phaco‐chop surgery than during divide‐and‐conquer surgery. Postoperatively, both groups had a significant but equal decrease in cell density. There were no statistically significant changes in variation in endothelial cell size, percentage of hexagonal cells, or CCT. Visual acuity increased significantly and equally in the 2 groups. Higher endothelial cell loss was significantly correlated with shorter axial length. CONCLUSIONS: It has been suggested that the phaco‐chop technique is less harmful to the corneal endothelium than the divide‐and‐conquer technique because it uses less phaco power. The findings did not support this hypothesis as similar and low cell loss was observed in the 2 groups.

Corneal endothelial cell changes associated with cataract surgery in patients with type 2 diabetes mellitus.

Purpose: To investigate the corneal endothelial cell density and morphology in patients with and without diabetes after phacoemulsification with intraocular lens implantation. Methods: A clinical prospective study including 30 patients with type 2 diabetes and 30 control patients without diabetes scheduled to undergo cataract surgery. No difference in preoperative age was observed between the 2 groups (P = 0.90). Sample size was based on a power calculation (power 0.90; P = 0.05). The patients without diabetes had a casual blood glucose test performed to disclose undetected diabetes. The patients with diabetes had a serum glycosylated hemoglobin (HbA1c) test performed to reveal the glycemic control. The endothelial cell density, variation in endothelial cell size (CV), percentage of hexagonal cells, and central corneal thickness (CCT) were recorded at baseline and at 3 months postoperatively. Results: The mean decrease in endothelial cell density at 3 months in the diabetic group was 154 cells per square millimeter (6.2%) and 42 cells per square millimeter (1.4%) in the control group. The difference in cell loss between the 2 groups was significant (P = 0.04). A significant decrease in the percentage of hexagonal cells was also seen in the diabetic group (P = 0.01). There was no statistically significant change in CV or CCT. Visual acuity increased significantly and equally in the 2 groups. Conclusions: The present study reveals a significantly greater loss of corneal endothelial cells in a diabetic group under good glycemic control, compared with nondiabetic group 3 months after phacoemulsification. The morphological changes in the endothelial cells in patients with well-controlled diabetes were not reflected in impaired function as judged by CCT.

Corneal Endothelial Cell Loss After Mitomycin C-augmented Trabeculectomy

PurposeTo determine the effect on the corneal endothelium of mitomycin C (MMC)-augmented trabeculectomy 3 and 12 months after surgery. Patients and MethodsIn a prospective, observational clinical study, 14 eyes of 14 patients with well-established open angle glaucoma were followed for 12 months after MMC-augmented trabeculectomy. We measured the endothelial cell density, the variation in mean cell size, the percentage of hexagonal cells, and the central corneal thickness at baseline and 3 and 12 months postoperatively. ResultsThe mean endothelial cell density was 2525 [standard deviation (SD) 457] cells/mm2 before surgery and 2332 (SD 643) cells/mm2 and 2283 (SD 597) cells/mm2 at 3 and 12 months after surgery, respectively, representing a cell loss of 9.5% (P=0.052) and 10.0% (P=0.027). The cell loss from 3 to 12 months was nonsignificant (P=0.40). After 12 months of follow-up, the variation in mean cell size and the percentage of hexagonal cells had not yet stabilized around the preoperative values. ConclusionsOur results show that significant cell loss occurs during or immediately after MMC-augmented trabeculectomy. However, no progressive cell loss was observed from 3 to 12 months, demonstrating that MMC has no prolonged toxic effect on the corneal endothelium. From 3 to12 months after MMC-augmented trabeculectomy, active endothelial adaptations were taking place.

The visual field after trabeculectomy. A follow-up study using computerized perimetry.

Series of visual fields in 20 eyes in which trabeculectomy had been performed were studied retrospectively. Computerized perimetry was used and the condition of the visual field was summarized into single numbers. Regression analysis was applied to series of such performance numbers. No correlation was found between the regression coefficient and the mean post‐operative pressure or the mean pressure reduction. A dependence of the regression coefficient on the size of the visual field defect was observed.

Retinal detachment after cataract extraction in myopic eyes

Purpose: To determine the incidence of retinal detachment (RD) after cataract extraction in people 40 years of age or older with axial myopia (i.e., axial length ≥25.5 mm). Setting: Fifteen Danish eye clinics. Methods: Two hundred forty‐five eyes had cataract extraction performed at 15 eye clinics; 237 eyes had extracapsular cataract extraction (ECCE) and 8 eyes, intracapsular cataract extraction (ICCE). Postoperative data were reported by the practicing ophthalmologists. Mean follow‐up was 27 months (range 14 to 32 months). Results: Five RDs occurred in the 245 eyes (2.0%). Excluding the ICCE cases and the two cases of combined cornea transplantation and ECCE, RD occurred in 4 of the 235 eyes that had ECCE (1.7%). The incidence after ECCE with posterior chamber lens implantation was 1.4%. Complete postoperative status was reported on 158 eyes. Forty‐eight eyes (30.4%). had a neodymium:YAG capsulotomy and 3 (6.0%) developed an RD 1, 3.5, and 21 months after the capsulotomy. Conclusion: The RD incidence after ECCE with posterior chamber lens implantation was low but higher than that in unselected populations. The incidence increased after laser capsulotomy.

Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus

Purpose:  To investigate corneal endothelial cell density and morphology in type II diabetic and non‐diabetic patients and to relate potential differences to the glycaemic status.

Long-term natural and modified course of surgically induced astigmatism after extracapsular cataract extraction

Abstract A prospective study was carried out to investigate the long‐term course of surgically induced astigmatism after extracapsular cataract extraction. Sixty‐one eyes were followed for 36 months. In 27 eyes with postoperative astigmatism > 4D widi‐the‐rule, one or two sutures were cut in the steeper meridian after 3 months. In another group of 34 eyes with only minor or no postoperative astigmatism with‐the‐rule, no suture was cut. We found that 1) postoperative astigmatism was significantly increased in all eyes after 1 week and 3 months, but decreased in time approaching preoperative values after 3 years, 2) surgically induced astigmatism was with‐the‐rule at 1 week and 3 months but turned against‐the‐rule in rime in both groups. Astigmatism decay rate was significantly steeper in eyes with suture cutting, 3) the keratometric axis was exclusively with‐the‐rule after 1 week, but turned against‐the‐rule in both groups, approaching the preoperative distribution of axis after 3 years. We concluded that surgically induced astigmatism is a dynamic feature showing changes in size and axis even in the period 1–3 years postoperatively. Suture cutting seems to intensify the decrease in the induced astigmatism and accelerate the shift in astigmatic axis, turning astigmatism against‐the‐rule compared to eyes with intact sutures.

Corneal endothelial cell changes after cataract surgery in patients on systemic sympathetic α-1a antagonist medication (tamsulosin).

Purpose:  The purpose of this study was to assess the incidence of intraoperative floppy iris syndrome (IFIS) and the morphology of the corneal endothelium after cataract extraction in Caucasian male patients exposed to the α‐1a adrenergic receptor antagonist tamsulosin.

ANALYSIS OF THE SHORT-TERM EFFECT OF TWO VISCOELASTIC AGENTS ON THE INTRAOCULAR PRESSURE AFTER EXTRACAPSULAR CATARACT EXTRACTION : SODIUM HYALURONATE 1 % VS HYDROXYPROPYL METHYLCELLULOSE 2 %

Abstract We conducted a study to evaluate the short‐term effect on intraocular pressure (IOP) following extracapsular cataract extraction using either sodium hyaluronate 1% or hydroxypropyl methylcellulose 2%. In both groups a non‐significant rise in IOP at day 1 was followed by a significant decline in IOP at day 3 to values below the pre‐operative level (p < 0.05). At day 7 both groups had returned to pre‐operative values. Post‐operatively, spikes in intraocular pressure (> 25 mmHg) were seen equally in both groups. Patients with pre‐operatively diagnosed open‐angle glaucoma, high myopia and diabetic retinopathy are considered to be at high risk concerning post‐operatively elevated IOP, but with small variation these patients followed the main trend.

Intraoperative floppy iris syndrome (IFIS): a practical approach to medical and surgical considerations in cataract extractions.

Intraoperative floppy iris syndrome (IFIS) during cataract surgery is characterized by iris fluttering, iris prolapse towards the incisions, and a progressive pupillary constriction leading to high rates of complications. The syndrome has been reported following the treatment of benign prostatic hyperplasia with α‐1a adrenergic receptor inhibitors, especially tamsulosin. The present paper describes the syndrome and discusses its pharmacological background. Several techniques to prevent and to deal with the syndrome are presented.