David S. Light

Intraocular Lenses, Axial Length, and Retinal Detachment

A large series of patients with intraocular lens implants had an overall 0.98% incidence of retinal detachment (eight detachments in 819 eyes). Within this group, patients with axial lengths of more than 25 mm had a statistically significantly higher incidence of retinal detachment (P = .054).

Pars Plana Vitrectomy as a Primary Treatment for Acute Bacterial Endophthalmitis

We successfully treated six patients with culture-proven acute bacterial endophthalmitis by a combination of emergency pars plana vitrectomy and the instillation of intravitreal antibiotics. All six patients regained satisfactory vision.

Lens Implantation and Diabetes Mellitus

In a series of 1,160 implant cases, 82 patients were diabetic. In this subgroup, lenses were implanted in 87 eyes, and a visual acuity of 6/12 (20/40) or better was obtained in 77 (88.6%) of the patients, which compared well with the nondiabetic control group of 1,078 cases. Only patients with normal fundi or minimal background retinopathy were operated on, and the visual results obtained were independent of the diabetic medical management.

Lens Implantation, Miosis, and Glaucoma

In a series of 1,079 patients, average age 76.3 years, 48 eyes required an iridoplasty for chronic miosis and, of these, visual acuity was 6/12 (20/40) or better postoperatively in 89.6% (43). In those patients with glaucoma, the control of intraocular pressure was the same or better than post-operative levels in 83.3% (15) of patients. Lens implantation was not contraindicated in the miotic patient if adequate iris surgery was performed before both cataract extraction and implant insertion. When there was concomitant glaucoma, lens implantation was likewise not contraindicated if the glaucoma was well controlled.

The results of extracapsular cataract extraction with a Shearing posterior chamber lens implant 34 to 40 months after surgery.

A series of 300 consecutive extracapsular cataract extractions with a Shearing posterior chamber lens implant (plus 13 with a surgical complication necessitating another kind of lens implant or no implant) was evaluated 34 to 40 months after surgery, except for those who died before this time (21 patients) and those lost to follow-up (15 patients). Ninety-one percent of the 264 patients who were examined achieved 20/40 or better visual acuity. Ninety-one percent of the 300 patients (those examined plus those who died and those lost to follow-up according to their last recorded examination) achieved 20/40 or better visual acuity. This series was compared to a previously reported series of 300 consecutive intracapsular cataract extractions with a Binkhorst iris clip lens implant examined 34 to 40 months after surgery.

Dislocation of Binkhorst Four-Loop Lens Implant

A consecutive series of 1,093 Binkhorst four-loop lens implantations was used to examine the problem of dislocation of implants used in intracapsular cataract extractions; emphasis of the study was on the need for suture fixation. Transiridectomy suture fixation was used in 497 procedures, no suture was used in 403 procedures, and a simple iris suture technique was used in 193 procedures. Although the transiridectomy suture fixation procedure had the lowest percentage of dislocations, the iris suture technique is considered safer. Suture fixation is recommended for Binkhorst four-loop implants used in intracapsular cataract extractions.

Pars Plana Vitrectomy for Complications of Intraocular Lens Implantation

Several clinical situations have been presented in which pars plana vitrectomy has proven beneficial in the treatment of vitreous complications of lens implantation. Removal of the central opacity and enlargement of the pupil are essential to improve vision, relieve pupillary block and achieve an adequate view of the retina. Pars plana vitrectomy offers a method for the controlled removal of membrane, vitreous and iris tissues without unnecessary distortion of anterior segment anatomy.

Lens implantation surgery in the second eye.

In a series of 730 patients who underwent lens implant surgery, 44 (6%) had bilateral implants. Eighty-eight percent of these patients had at least one years interval between operations and 50% more than two years. Surgery on the first eye resulted in vision of 20/40 or better in 86% of patients. Eighty-three percent of patients were 20/40 or better in the second eye following surgery. The principal cause of vision less than 20/40 was senile macular degeneration. Follow-up observation ranged from 4-96 months. Conservative criteria are advised for bilateral implant surgery, with an appropriate interval between operations considering the increased complexity of the implant procedure.