Toshiyuki Kageyama

Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments

AIM To evaluate outcome of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens material. METHODS Clinical records associated with consecutive 8536 phacoemulsification procedures were reviewed retrospectively. RESULTS 17 (0.20%) eyes had a posterior capsule rupture with retained lens material in the vitreous cavity that required vitrectomy. Final visual acuity was 0.5 or better in 14 eyes (82%) and 0.4 to 0.1 in three eyes (18%). Retinal detachment occurred in one eye during vitrectomy and two after the surgery. Cystoid macular oedema was observed in two eyes and none developed glaucoma. The corneal endothelial cell loss was 5.7% (SD 6.8 %) (n=15) at 3–6 months postoperatively. CONCLUSIONS Combined vitrectomy and intraocular lens implantation at the time of phacoemulsification complicated by intravitreal lens material is an option to be considered to reduce the risk of postoperative complications including secondary glaucoma and corneal endothelial cell damage.

Three-Year Prospective Randomized Study of Incidence of Posterior Capsule Opacification in Eyes Treated with Topical Diclofenac and Betamethasone

Purpose: To investigate the incidence of posterior capsule opacification (PCO) in eyes treated with diclofenac sodium (DFNa) and betamethasone phosphate (BMS) ophthalmic solutions. Methods: A total of 200 eyes with silicone intraocular lens implantation were treated with topical agents for 3 months postoperatively. Twenty-six cases of the DFNa group and 34 of the BMS group met the criteria, and the severity of PCO was evaluated after 3 years. Results: The results of axial densitometry by Scheimpflug photography were 27.8 computer-compatible tapes (CCT) in the DFNa-treated group and 32.6 CCT in the BMS-treated group (p = 0.1539). Posterior capsulotomy was performed in 11.5% of the DFNa group and 17.6% of the BMS group (p = 0.8375). The photographic grading of PCO showed no difference. Conclusion: The incidence of PCO in eyes treated with DFNa appears to be equal to that after BMS treatment.

Visual results and complications of temporal incision phacoemulsification performed with the non-dominant left hand by junior ophthalmologists

Aims: To assess the results of temporal incision phacoemulsification and aspiration performed with dominant and non-dominant hand of ophthalmology trainees. Methods: Retrospective analysis were made of 203 surgeries with dominant hand and 207 with non-dominant by five trainees at two institutions. Trainees sat at the patient’s head, manipulating instruments with the dominant right hand for the right eye, and the non-dominant left hand for the left eye. Results: Vitreous loss occurred in 12 (5.9%) of 203 dominant operated eyes and seven (3.4%) of 207 non-dominant operated eyes. The rate of endothelial cell loss was 6.1% (9.8%) in dominant and 7.4% (12.4%) in non-dominant. Mean ultrasound time were 1.81 (0.70) minutes in dominant and 1.78 (0.78) minutes in non-dominant. One trainee showed statistically significant excesses in incidence of vitreous loss in dominant operated eyes (8.7%, p=0.0270), and one showed statistically significant prolongation of the operation in nondominant operated eyes (26.3 minutes, p=0.0315). In all other trainees, all parameters had no difference in both sides. Conclusions: Ophthalmology trainees could successfully learn the technique with both hands. The authors consider that the skill of the non-dominant hand may be knowledge based and that surgeons avoid mistakes by mental efforts.

Removing silicone oil droplets from the posterior surface of silicone intraocular lenses.

A 67-year-old woman had droplets of silicone oil adhering to her silicone intraocular lens (IOL) resulting from a previous silicone oil tamponade. A lens hook and intraocular irrigation were used in conjunction by inserting an infusion cannula to remove the droplets. This restored clarity of the visual axis, improved visual acuity, and eliminated the need for IOL replacement. The technique is simple and less invasive than IOL exchange and may become the preferred way to remove silicone droplets from an IOL.

In Vitro Evaluation of Pressure Fluctuations with Differing Height of the Infusion Bottle in Phacoemulsification.

Purpose: To investigate the influence of the height of the infusion bottle and vacuum pressure on the development of an occlusion break surge in an in vitro model of the anterior chamber of the eye.Methods: We employed a rigid chamber device to simulate the anterior chamber of the human eye and performed phacoemulsification with a synthetic nucleus. We evaluated amplitude of pressure fluctuations in the chamber. An experimental occlusion break surge was produced at vacuum pressures of 200, 300, and 400 mm Hg. For each vacuum setting, the height of the infusion bottle was preset from 60 to 90 cm at intervals of 5 cm. We performed 6 measurements for each condition.Results: Increase in surge deflection amplitude was proportional to the increase in vacuum pressure (P <.0001). At all vacuum pressures, there was no significant relation between surge deflection amplitude and bottle height. Amplitude of pressure fluctuations in the chamber did not fall below the irrigating pressure if the bottles were kept 70 cm at a vacuum pressure of 200 mm Hg, and 85 cm at a vacuum pressure of 300 mm Hg. At a vacuum pressure of 400 mm Hg, surge deflection amplitude always exceeded irrigating pressure, even if the bottle height of 90 cm was chosen.Conclusion: Increases in vacuum pressure led to increase in amplitude of occlusion break surge. Elevation of the infusion bottle did not decrease the amplitude of occlusion break surge, but increased the pressure in the chamber at the beginning of the surge and prevented the pressure in the chamber from falling below the irrigating pressure.