Takako Hara

Refilling the lens with an inflatable endocapsular balloon: surgical procedure in animal eyes

In this report we describe the surgical details involved in refilling the lenses of 13 rabbit and 3 primate eyes using an inflatable endocapsular balloon to restore accommodation. The procedure involves endocapsular phacoemulsification through a small “buttonhole” or “dumbbell” anterior capsulotomy or minicircular capsulotomy and the simultaneous preservation of capsular integrity, including the zonules and ciliary muscles. An inflatable balloon made of thin silicone membrane is then inserted into the empty capsular bag. A liquid silicone polymer is injected into the balloon through a delivery tube, and the empty capsular bag is refilled by the inflated balloon. The procedure was found to be reproducible, and an accommodation of 6 D was confirmed in one primate eye. Capsular opacification occurred, but the proliferation and migration of residual lens epithelial cells could be hindered by abundant refilling. This lens-refilling technique may provide restoration of accommodation in future cataract surgery.

Efficacy and safety of fluorescein angiography with orally administered sodium fluorescein

PURPOSE To report the efficacy and safety of fluorescein angiography after oral administration of fluorescein solution in a large number of patients during a period of 8 years. METHODS A total of 1,787 patients (2,625 eyes) underwent fluorescein angiography after oral administration of sodium fluorescein at Hara Eye Hospital, Utsunomiya, Japan, between January 1989 and March 1997. The ingestible solution was 10 ml of 10% sodium fluorescein, the same material generally used for injection in conventional fluorescein angiography. Retinal photography began 15 minutes after ingestion and continued for 1 hour. The camera and the photography and film processing techniques were the same as those used for conventional fluorescein angiography using injected sodium fluorescein. RESULTS In 2,554 (97.3%) of 2,625 eyes, photographs adequate for clinical use were obtained. In 1,787 patients, no anaphylactic or other severe adverse effects were observed, and only 31 patients (1.7%) experienced minimal itching, discomfort, or nausea after oral sodium fluorescein intake. For conditions such as central serous chorioretinopathy, retinal vein occlusion, diabetic retinopathy, and cystoid macular edema, sufficient information for clinical use was obtained. CONCLUSIONS Fluorescein angiography using orally administered sodium fluorescein is generally effective and safe in standard clinical practice.

Clinical results of endocapsular phacoemulsification and complete in-the-bag intraocular lens fixation

ABSTRACT Endocapsular phacoemulsification was performed in the Hara Eye Hospital on 77 eyes of 69 patients between October 1984 and January 1986. The age of the patients ranged from 52 to 86 years with an average of 71 years. In 71 of 77 eyes, a posterior chamber lens was inserted. The procedure was attempted in 243 eyes and was successfully performed in 77 of them (32%). The causes of failure in 166 eyes were anterior capsule rupture in 149 eyes (90%) and posterior capsule rupture in 27 eyes (16%). With the exception of one eye lost to follow‐up, the results of these cases were satisfactory. A postoperative visual acuity of better than 20/20 was achieved in 45 eves (58%), better than 20/40, in 70 eyes (9170). The main postoperative complications in 50 completely recorded eyes were anterior capsule opacity in 44 eyes (88%), severe iris atrophy because of intraoperative ultrasound in seven eyes (9%), find posterior capsule opacity causing visual disturbance in three eyes (4%).

Further development of experimental techniques for refilling the lens of animal eyes with a balloon

ABSTRACT Various techniques for experimental refilling of the lens of animal eyes are possible. We describe two new methods: Balloon insertion after endocapsular phacoemulsification and after phacoemulsification with circular capsulorhexis. The feasibility of these techniques was tested in both rabbit eyes and pig cadaver eyes. With organosilicone gel as the balloon filling material, postoperative refractive changes of up to 4 diopters of residual hyperopia were achieved; accommodation changes were up to −1 diopter. The technique of refilling the lens with a balloon to avoid leakage of filling material warrants further study.

Specular microscopy of the anterior lens capsule after endocapsular lens implantation

ABSTRACT Endocapsular phacoemulsification and complete in‐the‐bag intraocular lens (IOL) fixation was performed on 77 eyes. Specular microscopy of the enterior lens capsule was performed postoperatively, and the process of anterior lens capsule opacification after endocapsular cataract surgey was classified. Lens epithelial cells on the inner surface of the anterior lens capsule, facing the optical portion of the IOL, underwent a diffuse fibrosis. In more peripheral areas, where the anterior and posterior capsules were tighly adherent, the regularly proliferating lens epithelial cells retained their polygonal shape. These findings suggest the possibility of retaining transparency of the anterior lens capsule postoperatively by refilling the capsular bag to apply internal pressure.

Equator ring efficacy in maintaining capsular bag integrity and transparency after cataract removal in monkey eyes

Abstract · Background: The purpose of the study was to evaluate the efficacy of the equator ring in maintaining capsular bag integrity at the equator and transparency of the posterior capsule after cataract surgery, using cynomolgus monkeys. · Methods: After lens removal using an infusion-aspiration method, a flexible silicone ring with a groove on its inner surface was inserted in the bag through a window made by continuous circular capsulorhexis in six eyes. Of these, four monkey eyes underwent posterior chamber intraocular lens (IOL) implantation and two monkey eyes did not receive IOLs. Lensectomy without ring insertion was performed as a control in the six fellow eyes. Of these, four eyes received an IOL and two did not. The eyes were followed for an average of 5.9 ± 1.1 months before enucleation. The effects were evaluated by stereo and light microscopy. · Results: The ring effectively maintained the circular contour of the capsular bag (ratio of the short and long axes, 0.97 ± 0.01) and posterior capsule transparency (P = 0.017). · Conclusions: This study demonstrated that the equator ring is a promising device for maintaining capsular bag integrity and minimizing posterior capsule opacification after cataract surgery.

Recent advance in intracapsular phacoemulsification and complete in-the-bag intraocular lens implantation

We have modified our technique of subcapsular phacoemulsification and aspiration in two ways: (1) Intracapsular phacoemulsification is performed without an anterior capsulotomy. Because the inner wall of the anterior capsule can be cleaned completely by the irrigation/aspiration tip through a small opening in the anterior lens capsule, the clean capsular bag is retained. (2) An intraocular lens (IOL) is inserted completely into the bag. If desired, the central part of the anterior capsule can be removed before or after IOL implantation. We propose changing the name of this technique to intracapsular phacoemulsification and aspiration and complete in-the-bag IOL fixation.

Intraoperative Stress Experienced by Surgeons and Assistants

BACKGROUND AND OBJECTIVE To determine the intraoperative stress on surgeons and assistants during cataract surgery, 12 surgeons and 3 assisting nurses were assessed based on their level of professional experience. METHODS Surgeons were classified as inexperienced, intermediate, or experienced. Nurse assistants were classified as inexperienced or experienced. The intraoperative heart rates and urine adrenaline levels of each participant were measured. RESULTS Inexperienced surgeons and nurse assistants had the highest heart rates at the beginning of surgery, and the rates tended to decrease toward the end of surgery. All values were higher than the other two groups throughout surgery. In surgeons with intermediate experience, the heart rates were not as high as in the inexperienced personnel; however, the heart rates were high throughout the surgery. The heart rate in one intermediate surgeon was markedly increased when a surgery was simultaneously broadcast on closed-circuit television. In experienced surgeons and a nurse assistant, the measurements increased slightly. CONCLUSIONS The variations in heart rates and urine adrenaline levels showed characteristic patterns based on the experience of the surgical personnel.

Accommodation in Primate Eyes After Implantation of Refilled Endocapsular Balloon

PURPOSE To restore accommodation after crystalline lens removal. METHODS The crystalline lens of one eye of each of four primates was removed by phacoemulsification. Each operated-on eye underwent endocapsular silicone balloon implantation followed by filling with an organosilicone mixture. Seven months postoperatively, the anterior chamber depth and refractive power changes were measured before and after topical application of 4% pilocarpine. RESULTS In the refilled eyes, the average anterior chamber depth reduction was 0.50 mm and the average maximal myopic change was 6.74 diopters. CONCLUSION After lens removal, measurable accommodation was restored in the eyes with the endocapsular balloon filled with an organosilicone mixture.

Fate of the capsular bag in endocapsular phacoemulsification and complete in-the-bag intraocular lens fixation

ABSTRACT We performed endocapsular phacoemulsification on 17 eyes of 15 patients between November 1984 and February 1985. Phacoemulsification was performed intracapsularly through a small incision in the anterior capsule. The inner wall of the bag was cleaned with the Cavitron handpiece. Posterior chamber intraocular lens implantation was performed completely in the bag. A clear capsular bag was present in 15 eyes with an average follow‐up of six months. Central anterior lens capsule opacity occurred in two eyes. Sixteen eyes had visual acuity better than 20/40 and nine eyes had visual acuity better than 20/20. We have changed the name of this procedure from intracapsular to endocapsular phacoemulsiftcation to prevent confusion.