Norman S. Jaffe

Cystoid Macular Edema after Intracapsular and Extracapsular Cataract Extraction With and Without an Intralocular Lens

A prospective cystoid macular edema study of aphakic and pseudophakic patients showed that extracapsular cataract surgery has a lower rate than intracapsular surgery when the surgery is uncomplicated. There was no difference in the rates with intracapsular surgery with and without an intraocular lens. A complicated extracapsular with an intraocular lens has a higher rate than when the surgery is uncomplicated. In extracapsular surgery with complications, there is no difference in the rates with and without an intraocular lens. When complications occur, the ratio of clinical to angiographic-proven cases is higher than when the surgery is uncomplicated. This study included four series of uncomplicated cataract extractions and three series of complicated cataract extractions. A fluorescein angiogram was performed on every patient at least one year after surgery.

Retinal detachment in myopic eyes after intracapsular and extracapsular cataract extraction.

We analyzed two consecutive series of cataract extractions in patients with moderate to severe myopia for the incidence of postoperative retinal detachment. One series consisted of 122 intracapsular cataract extractions without surgical loss of vitreous and the other series consisted of 151 extracapsular (phacoemulsification and planned extracapsular) cataract extractions without loss of vitreous and with intact posterior capsules. All patients were 40 years of age or older and all were followed up for one to four years. We defined moderate to severe myopia as an aphakic refraction of +7.00 diopters spherical equivalent or less. The rate of postoperative retinal detachment was greater in the intracapsular series (seven of 122 cases; 5.74%) than in the extracapsular series (one of 151 cases; 0.66%).

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).

Ptosis and cataract surgery: a multivariant computer analysis of a prospective study

A prospective study investigated the effect of local anesthesia, eyelid edema and superior rectus muscle injury on postoperative ptosis. Patients were randomized into four groups to study these effects. Group A received a Van Lint eyelid block and a superior rectus bridle suture. Group B received a Van Lint block and an episcleral retraction suture. Group C received a Nadbath retroauricular facial nerve block and a superior rectus bridle suture. Group D received a Nadbath block and an episcleral retraction suture. Results of the study indicate that postoperative ptosis can be significantly reduced by varying our operative techniques. Postoperative ptosis was significantly increased in group A and reduced in group D. It appears that trauma to the superior rectus muscle complex is the most critical factor in postoperative ptosis. Fifty five and one-half percent of the population entered the study with preoperative ptosis. Preoperative ptosis had no effect on postoperative ptosis. Lid crease, superior sulcus fullness and lash rotation are poor anatomical landmarks of levator insertion in the elderly population, both preoperatively and postoperatively.

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.

Glare and contrast: Indications for cataract surgery

ABSTRACT The present method of using Snellen visual acuity to evaluate the vision of cataract patients is inadequate because it may grossly overestimate the nature of their visual world. Many of these patients have poor visual functioning as a result of glare disability and loss of contrast. The loss of visual contrast on the retina may be quantified using devices currently available and applicable to a clinical setting in the office. These are described. A study of glare disability in pseudophaldc eyes following phacoemulsification or planned extracapsular cataract extraction with intact capsules is made and compared with a previous report of eyes with a primary posterior capsulotomy. It is recommended that glare disability be measured in eyes of cataract patients and be used as an indication for cataract surgery.

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.

Results of Intraocular Lens Implant Surgery: The Third Binkhorst Medal Lecture

I compared an early series of 162 consecutive Copeland intraocular lens implants with a later series of 650 consecutive Binkhorst implants. Of the eyes with Copeland implants, 76.5% achieved 6/12 (20/40) or better visual acuity compared to 89.8% in the Binkhorst series. There was a striking difference in the incidence of clinically significant cystoid macular edema (less than 6/12 [20/40], visual acuity); 7.4% in the Copeland series and 1.4% in the Binkhorst series. I studied the Binkhorst series for visual acuity, causes of less than 6/12 (20/40) visual acuity, operative vitreous problems, additional surgery, secondary membranes, dislocations, and retinal detachment. A fluorescein angiographic study of 190 Binkhorst implants and 113 aphakic controls was done. There was a comparable incidence of cystoid macular edema in both groups at four, eight, and 16 to 24 months postoperatively. Extracapsular Binkhorst implants showed a lower incidence than intracapsular Binkhorst implants.

A comparison of 500 Binkhorst implants with 500 routine intracapsular cataract extractions.

We compared 500 Binkhorst lens implants with 500 routine intracapsular cataract extractions. The two groups consisted of consecutive cases matched according to surgeons, surgical technique, time interval of the study, and ocular status. The results of visual acuity were comparable in the two groups; 89.0% of the implant group and 85.4% of the routine intracapsular group achieved 6/12 (20/40) or better visual acuity. The rate of complications in each group was comparable except in the case of corneal edema, which was higher in the implant group (1.2%) than in the routine intracapsular group (0.4%). The rate of clinically significant cystoid macular edema was higher in the routine intracapsular group (2.2%) than in the implant group (1.4%).

A Fluorescein Angiographic Study of Cystoid Macular Edema

We performed a prospective fluorescein angiographic study on 66 patients who had undergone extracapsular cataract extractions with implantation of a Shearing posterior chamber intraocular lens. A primary posterior capsulotomy was performed in every case. The eyes were studied 11 to 23 months postoperatively. The incidence of cystoid macular edema (3%) was lower than that found in three series of cataract extractions previously reported. Extracapsular cataract extraction with either (1) a Shearing posterior chamber intraocular lens and a primary posterior capsulotomy or (2) a Binkhorst intraocular lens and an intact posterior capsule produces a lower rate of cystoid macular edema than does intracapsular cataract extraction either with a Binkhorst intraocular lens or without an intraocular lens. There was no significant difference in the incidence of cystoid macular edema in the two extracapsular series, indicating that preservation of an intact posterior capsule was not a significant factor.