Omulecki W

Comparison of surgically induced astigmatism after coaxial phacoemulsification through 1.8 mm microincision and bimanual phacoemulsification through 1.7 mm microincision

PURPOSE: To compare surgically induced astigmatism (SIA) after coaxial 1.8 mm microincision cataract surgery (MICS) and bimanual 1.7 mm MICS calculated with 3 mathematical methods. SETTING: Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. METHODS: Study comprised a nonrandomized prospective consecutive series of 58 eyes of 58 patients who had uneventful coaxial MICS with implantation of an Akreos MI60 foldable intraocular lens (IOL) using a 1.8 mm temporal clear corneal incision. Fifty eyes of 50 patients who had uneventful bimanual MICS through a 1.7 mm clear corneal incision for a sleeveless phaco tip and a 1.5 mm side port for an irrigating chopper with implantation of an Acri.Smart 48S foldable IOL served as a comparison group. All surgery was performed by 2 experienced surgeons. Surgically induced astigmatism was calculated using 3 methods. RESULTS: The patients were examined preoperatively and 2 weeks to 1 month postoperatively. No intraoperative or postoperative complications were seen in any patient. The corrected distance visual acuity improved significantly in both groups after surgery (P<.01); the visual outcomes were not significantly different (P>.05). In vector analysis, the mean SIA was 0.42 ± 0.29 in the coaxial MICS group and 0.50 ± 0.24 in the bimanual group; the difference was not statistically significant (P>.05). In vector decomposition, the mean SIA (C90) coaxial MICS group was 0.23 ± 0.29 in the coaxial MICS group and 0.23 ± 0.22 in the bimanual MICS group; the difference was not significant. Using the Naeser method, ΔKP‐90 was calculated, amounting to 0.05 ± 0.44 in the coaxial MICS group and –0.04 ± 0.42 in the bimanual MICS group; the difference was not significant. CONCLUSIONS: The amount of SIA induced by bimanual MICS and coaxial MICS phacoemulsification was very small. The bimanual MICS induced a slightly higher degree of SIA; however, according to all methods of SIA analysis, there was no significant difference in the mean SIA induced by both techniques.

Evaluation of early corneal endothelial cell loss in bimanual microincision cataract surgery (MICS) in comparison with standard phacoemulsification

Purpose To analyze early corneal endothelial cell loss due to microincision cataract surgery (MICS) in comparison with standard phacoemulsification through the temporal clear corneal incision. Methods The examined group consisted of a nonrandomized, consecutive prospective series of 20 eyes of 20 patients who underwent uneventful microincision cataract surgery. Twenty eyes of 20 patients who underwent standard phacoemulsification with foldable intraocular lens (IOL) implantation served as a reference group. Patients with corneal disorders, contact lens wear, previous intraocular surgery, and a history of ocular trauma were excluded from the study. Patients were examined preoperatively and 10 days postoperatively. The following items were evaluated in this study: corneal endothelial cell density, intraoperative phaco power, effective phaco time, as well as pre- and postoperative visual acuity. Corneal endothelial cell counts were done in the central part of the cornea using a non-contact Topcon SP 2000P specular microscope before and 10 days after the surgery. The measurements were performed in a semiautomated, masked manner. Statistical analysis was done using nonparametric tests (Wilcoxon signed-ranks test and Mann-Whitney U test). Results All patients in the study underwent uneventful surgery. Best-corrected visual acuity (BCVA) examined 10 days postoperatively in the MICS group was 0.94±0.094, whereas in the standard phacoemulsification group it was 0.90±0.094. There was no significant difference between BCVA in the two groups (Mann Whitney U two-tailed test: p>0.05). In both groups there was a significant decrease in postoperative endothelial cell densities (ECDs) when compared to preoperative values. Mean postoperative ECDs were 2235±418 cells/mm2 in the MICS group and 2079±399 cells/mm2 in the standard phacoemulsification group; the difference was not statistically significant (Mann-Whitney U test: p>0.05). Patients in the MICS group lost an average of 9.5% of cells, whereas patients after standard phacoemulsification lost about 7.6% of cells. This difference was statistically insignificant. Conclusions Microincision cataract surgery induced corneal endothelial cell loss similar to a standard phacoemulsification and allowed excellent visual results in this series of patients. These results support the use of MICS technique for cataract surgery.

Pars Plana Vitrectomy, Lensectomy, or Extraction in Transscleral Intraocular Lens Fixation for the Management of Dislocated Lenses in a Family With Marfan's Syndrome

BACKGROUND AND OBJECTIVES Congenital lens subluxation may be a difficult therapeutic problem. Surgical treatment options include iris manipulation or lens decision, aspiration, intracapsular or extracapsular extraction, and lensectomy through the pars plana. It is not established which kind of aphakic correction is the most appropriate in these cases. PATIENTS AND METHODS A father and his two sons with Marfans syndrome were operatively treated for lens dislocation in both eyes. Pars plana vitrectomy was done in all eyes. Dislocated lenses were removed by lensectomy in three eyes and with an intracapsular method in three eyes. The outside-in scleral fixation technique was used for primary posterior chamber intraocular lens (PC IOL) implantation in all cases. RESULTS All eyes achieved good visual acuity (20/20-20/25). Time of observation ranged between 8 and 20 months. There were no intraoperative or post-operative complications. CONCLUSION Pars plana vitrectomy and primary scleral-fixated IOL implantation is a safe procedure and gives good visual rehabilitation in adult patients with Marfans syndrome.

Comparison of early corneal endothelial cell loss after coaxial phacoemulsification through 1.8 mm microincision and bimanual phacoemulsification through 1.7 mm microincision

PURPOSE: To compare corneal endothelial cell loss after coaxial 1.8 mm microincision cataract surgery (MICS) and bimanual 1.7 mm MICS. SETTING: Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. METHODS: The study comprised a nonrandomized prospective consecutive series of 51 eyes of 51 patients who had coaxial MICS with implantation of an MI60 foldable intraocular lens (IOL) using a 1.8 mm temporal clear corneal microincision. Fifty eyes of 50 patients who had uneventful bimanual MICS through a 1.7 mm temporal clear corneal incision for a sleeveless phaco tip and a side port for an irrigating chopper with a foldable Acri.Smart 48S foldable IOL implantation served as a reference group. Corneal endothelial cell density, intraoperative phaco power, effective phaco time, and preoperative and postoperative visual acuities were evaluated. The measurements were performed in a semiautomated masked manner. Statistical analysis was done using nonparametric tests (Wilcoxon signed rank test and Mann‐Whitney U test). RESULTS: The patients were examined preoperatively and 2 weeks to 1 month postoperatively. The mean follow‐up was 22.58 days ± 5.08 (SD). Postoperatively, the mean corrected distance visual acuity (CDVA)was 0.95 ± 13 in both groups. There was a significant decrease in endothelial cell density in both groups, 9.46% in Group 1 and 9.27% in Group 2. The between‐group difference was not statistically significant (P>.05, Mann‐Whitney U test). CONCLUSIONS: The visual results were excellent in both groups. Both MICS techniques enabled preservation of corneal endothelial cells equally well and were similar in terms of minor surgical trauma and the influence of surgery on corneal endothelial cell density. Our results support the use of both MICS techniques for cataract surgery.

Pars plana vitrectomy and transscleral fixation of black diaphragm intraocular lens for the management of traumatic aniridia.

BACKGROUND AND OBJECTIVES Partial or complete aniridia occurring after severe ocular trauma is a difficult therapeutic problem. Diaphragm intraocular lenses were developed for the correction of aniridia, but the safety and efficacy of implanting such lenses are not well established in traumatic cases because of very few reports, and the small number of cases studied. PATIENTS AND METHODS Six patients, 4 men and 2 women with a mean age of 44 years, were treated for traumatic aniridia using pars plana vitrectomy and transscleral fixation of a black diaphragm intraocular lens. Total aniridia was observed in 3 eyes and partial aniridia in 3 eyes. Four eyes were aphakic and severe lens subluxation was seen in 2 eyes. Vitreous hemorrhage coexisted in 2 patients and bacterial endophthalmitis was present in 1 patient. Follow-up time ranged between 4 and 39 months (mean, 23 months). RESULTS Best-corrected visual acuity improved in 5 patients and 1 remained unchanged. Good visual acuity (20/20 - 20/40) was achieved in all cases and all lenses were well-centered. No severe complications were noted. Three of 6 patients required glaucoma topical medications pre- and postoperatively achieving good intraocular pressure control. CONCLUSION The management of traumatic aniridia using pars plana vitrectomy and implantation of scleral fixation black diaphragm intraocular lenses seem to be safe. Very good functional results and lack of severe complications are encouraging. Additional cases with a longer follow-up study are necessary to support our opinion.

Management of persistent diplopia after surgical repair of orbital fractures

PURPOSE To present the results of management of patients with persistent diplopia after orbital reconstructive surgery with respect to the type of ocular motility impairment pattern. METHODS All patients referred during a 2-year period because of persistent diplopia after surgical repair of orbital fracture were categorized according to the degree and pattern of ocular motility impairment on the basis of orthoptic examination 3-4 weeks postoperatively. Patients were followed for a mean period of 10.5 months (range, 6-12 months), during which adequate treatment was implemented. RESULTS A total of 52 patients were included in the study (45 males; mean age, 41.8 ± 16.6 years). Most could be divided into 1 of 4 groups according to the type of ocular motility impairment. The follow-up orthoptic examination revealed resolution of diplopia in 9 patients (15%) and persistent but unbothersome diplopia in 26 (43.4%). Significant diplopia was treated conservatively in 3 patients (5%) and with strabismus surgery in 14 (23.3%) cases. CONCLUSIONS The results of this study indicate that in most cases of persistent diplopia after reconstructive surgery for orbital fractures, symptoms resolve over time without treatment; nevertheless, strabismus surgery is unavoidable in some cases.

Factors affecting patient cooperation and level of pain perception during phacoemulsification in topical and intracameral anesthesia.

PURPOSE To evaluate selected factors that may influence pain perception and patient cooperation with the surgeon during phacoemulsification performed under topical and intracameral anesthesia. METHODS A total of 203 consecutive patients who had uncomplicated cataract phacoemulsification with foldable intraocular lens implantation through clear corneal 2.8 mm temporal incision under topical anesthesia were enrolled into the study. The factors assessed included gender, age, level of education, professional activity, place of residence, pain sensitivity declared preoperatively, patient mood before operation, preoperative visual acuity, and whether it was the patients first or second cataract surgery. The correlation between postoperatively declared level of pain perception and cooperation with the surgeon was also evaluated. For statistical analysis, gamma correlation coefficient test was used. RESULTS The strongest correlation was found between gender and cooperation and level of perceived pain. The weakest dependencies were noticed between the level of education and these parameters. Women, patients who were professionally active, and patients who were in a better mood before the operation were more cooperative. A strong correlation was found between patient pain perception and cooperation. CONCLUSIONS Pain perception was positively influenced by female gender, rural place of residence, younger age of patient, and lower preoperative visual acuity. Cooperation with the surgeon was positively influenced by female gender, professional activity, patient good mood before operation, and no pain perception during surgery. There was no correlation between level of education, preoperatively declared pain sensitivity, sequence of operation, and estimated parameters.

Results of phacoemulsification with Malyugin Ring in comparison with manual iris stretching with hooks in eyes with narrow pupil

Purpose. To evaluate the results of phacoemulsification in eyes with a narrow pupil dilated with Malyugin Ring, in comparison with manual pupillary stretching with hooks. setting. Department of Ophthalmology, Medical University of Lodz, Poland. Materials and Methods. The examined group (group 1) consisted of 23 eyes of 23 patients whose pupil was dilated using Malyugin Ring. The reference group (group 2) consisted of 17 eyes of 17 patients whose pupil was dilated manually by stretching with hooks. All patients underwent uneventful standard phacoemulsification. Patients were examined preoperatively, 1 day, and 1 month after the surgery. Best-corrected visual acuity (BCVA), intraocular pressure, anterior and posterior segment of the eye, and corneal endothelial cell density were evaluated. Statistical analysis was done using nonparametric tests. Results. Mean preoperative BCVA in group 1 was 0.31±0.27 and in group 2 it was 0.26±0.26 (p>0.05). In both groups there was a significant improvement in BCVA after the surgery (p<0.05). Mean postoperative BCVA in group 1 was 0.75±0.30 and in group 2 it was 0.56±0.56 (p<0.05). Mean corneal endothelial cell loss measured 30 days postoperatively amounted to 9.35±11% in group 1 and 13.77±8.0% in group 2 (p<0.05). No serious complications were found. Conclusions. In eyes with narrow pupil, the use of Malyugin Ring makes the surgery easier and allows for better functional results and smaller corneal endothelial cell loss in comparison with manual pupillary stretching with 2 hooks.

Transscleral suture fixation and anterior chamber intraocular lenses implanted after removal of posteriorly dislocated crystalline lenses

The surgical technique is described for simultaneous removal of posteriorly dislocated crystalline lenses and implantation of anterior chamber (AC) or scleral fixation posterior chamber (PC) intraocular lenses (IOL) using pars plana vitrectomy. Twenty-two patients underwent this complex operation. Observation time ranged from 2 to 10 months (mean 5 months). Best-corrected post-operative visual acuity was 1.0 in half the patients in the AC group (n=12), and in 80% of the PC group (n=10). It was less than 0.5 in 25% of cases in the AC group whereas all PC patients had visual acuity 0.5 or better. In nine cases with pre-operative ocular hypertension, post-operative intraocular pressure became normal, although topical glaucoma therapy was necessary in three patients in the AC group and in one from the PC group. No severe complications were found. Removal of posteriorly dislocated crystalline lens using pars plana vitrectomy and limbal incision is a safe procedure. Simultaneous AC or transscleral PC lens implantation is a good alternative to contact lenses. Visual rehabilitation was good in both groups of patients, although post-operative visual acuity was better after PC transscleral fixation than after AC surgery.

Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses

PURPOSE: To present a complex surgical technique used for the management of luxated crystalline lenses and evaluate treatment results. SETTING: Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. METHODS: This prospective study involved 29 consecutive patients (30 eyes) with the mean age of 60.3 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection, and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 10 eyes, and scleral‐fixated posterior chamber IOLs in 20 eyes. The follow‐up mean was 5.2 month (range 1 to 16 months). RESULTS: No complications were observed during phacofragmentation. Visual acuity improved in 22 cases and did not change in the other 8 eyes. The mean visual acuity was 0.40 ± 0.37 (SD) (range between hand movements and 1.0) preoperatively and 0.68 ± 0.34 (range 0.05 to 1.0) postoperatively. In 22 cases (73%), very good or good visual acuity (6/6 to 6/12) was achieved. There were no intraoperative complications. Postoperatively, transient hypotony was observed in 10 eyes, fibrinous reaction in the anterior chamber in 1 eye, dispersed blood in the vitreous cavity in 8 eyes, hyphema in 1 eye, corneal edema in 1 eye, vitritis in 3 cases, iris tug in 1 eye with an anterior chamber IOL, and slight dislocation of the scleral‐fixated IOL in 1 case. Intraocular pressure was elevated in 11 eyes preoperatively; postoperatively, it normalized in 7 eyes without medication. CONCLUSION: Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses was safe and effective method, providing good functional results.