摘要:

It is again a pleasure to serve as editor for the section on cataract surgery and lens implantation inCurrent Opinion in Ophthalmology.Once again, I have been able to recruit an outstanding group of contributors to this annual review of the art of cataract surgery and lens implantation.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Since the publication of my last article inCurrent Opinion in Ophthalmologyin 1991 (2:33–34), the use of multifocal intraocular lenses (IOLs) has not gained general acceptance among ophthalmologists. Despite this situation, major IOL companies have continued to invest in clinical trials of new designs. Recently, large optic multifocal lenses used mainly with extracapsular extraction provided good results, with 94% to 100% of best-corrected cases having distance correction of 20/40 vision or better; 77% to 100% similarly had J3 near vision or better, and approximately 52% to 63% of patients became eyeglass independent. Between 50% to 80% of eyes in which 20/40 vision or better was obtained and in which J2 or better resulted were unaided. However, all multifocal lens designs showed some reduction in contrast sensitivity compared with monofocal designs using Regan charts and Vistech 6500 tests. Contrast sensitivity loss was probably only significant when reading very small print or in low-contrast light. Small-incision surgery with phacoemulsification and more accurate IOL power calculations have made the goal of emmetropia more possible. Also, less eyeglass dependence with the use of multifocal IOLs is a more realistic expectation.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Until recently, cataract surgery in a patient with uveitis was regarded as a hazardous procedure that yielded unpredictable and often disappointing results. With an increasing number of ophthalmologists recognizing the consequences of chronic low-grade inflammation and therefore treating uveitis patients more aggressively, with a better selection of cases for surgery, and with better surgical techniques, more patients with a history of uveitis who need cataract surgery enjoy a successful outcome than ever before. Careful management and control of inflammation preoperatively and after surgery is critical to success. An in-the-bag posterior chamber lens implant can be part of the surgical plan in selected cases. The aims of the authors in this article are to emphasize the ideas of, intolerance to inflammation, a limited tolerance for steroids to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision, and strict criteria for selection and management of those patients with uveitis who need cataract surgery.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although certain methods such as retrobulbar blocks are used extensively, improvements in procedure can always be implemented. The use of ultrasound, low concentrations of anesthesia, careful monitoring, and, in the case of risk patients, anesthesia standby are all important considerations to ensure uneventful treatments. Topical anesthesia eliminates needle risk as well as risk of ptosis and bruising. Because it has been demonstrated that bacteria routinely enter the anterior chamber during uncomplicated cataract surgery, certain irrigation solutions are helpful, but still debatable. Postoperatively, diclofenac, flurbiprofen, and timolol have all been proven to be effective in reducing ocular inflammation, reducing incidence of CME, and controlling pressure increase, respectively.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The emphasis in cataract surgery has shifted to perfecting the refractive outcome. More accurate lens power calculations and refinement in techniques to reduce or eliminate surgically induced and preexisting astigmatism have moved us closer to the ultimate surgical result—emmetropia. Multifocal lenses and surgically induced multifocal corneas have the potential to eliminate not only myopia and hyperopia but also the loss of accommodation resulting from the pseudophakic state.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Advances in cataract surgery revolved around using existing technology in more efficient manners. Recent reports described methods that purport to offer simpler techniques for phacoemulsification, capsulotomy, nucleus expression, and even for reducing postoperative inflammation.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Keratometry and corneal topography remain the most important means of evaluating induced corneal changes after surgery and have comparable sensitivities in the paracentral region of the cornea. However, keratometry gives no information about the peripheral cornea or about asymmetry of the cornea. Videokeratography should be performed after cataract surgery in cases in which best-corrected visual acuity is not adequate and there are no other obvious causes for poor vision to determine whether corneal irregularities are present. The recent literature on corneal topographic evaluation of induced astigmatism after cataract surgery suggests that in general, smaller, temporal incisions result in less astigmatism. Preoperatively, corneal topography can be used in the calculation of intraocular lens power as well as incision planning. Postoperatively, it can be used to detect tight sutures, torsion of the wound, internal wound gape, and irregular astigmatism, as well as to guide suture removal. In the future, corneal topography will become increasingly important in the determination of intraocular lens power in difficult cases such as patients undergoing combined cataract extraction and penetrating keratoplasty as well as patients with a history of radial keratotomy or photorefractive surgery.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Ophthalmologists are choosing topical antibiotics and corticosteroids more frequently than injectable agents for their current cataract surgical techniques. The preoperative use of povidone-iodine 5%, dilute intracarheral antibiotics (via the balanced saline solution infusion), and postoperative impregnated collagen shields or soft contact lenses augment the therapeutic armamentarium. Nonsteroidal anti-inflammatory drugs, especially diclofenac 0.1%, have played an important role in decreasing postoperative convalescence through maintaining preoperative mydriasis, reducing anterior chamber reactions, and inhibiting cystoid macular edema. With fewer side effects, nonsteroidal anti-inflammatory drugs are minimizing the role of topical steroids.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Advances in cataract surgery and intraocular lens implantation techniques continue to allow improved safety for the cornea. Complications can include mechanical or toxic injury of the endothelium, stripped Descemet's membrane, epithelial toxicity and disruption, infectious keratitis, or epithelial ingrowth. Most of the recent work has addressed endothelial cell survival after cataract extraction and lens implantation or in cases following secondary lens implantation. A great deal of controversy has been raised over the past year as to whether flexible open-loop anterior chamber lenses, iris-fixated posterior chamber lenses, or transsclerally sutured posterior chamber lenses are safest for the cornea. Even with additional data accumulating, it still is not clear which type of implant provides the best degree of safety in cases requiring secondary implantation. Certainly, both flexible open-loop anterior chamber lenses and bag-fixated posterior chamber lenses placed at the time of cataract surgery have a good record of safety for the cornea. Patients with keratoconjunctivitis sicca require extra lubrication to prevent epithelial toxicity at the time of surgery and also postoperatively. Methylcellulose-containing lubricants appear to be most protective of the corneal epithelium. Overall, cataract surgery and intraocular lens implantation is extremely safe with modern techniques.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

I was extremely delighted to be invited to write a review of PhacoTmesis. However, there is not enough existing literature to review other than a few short articles authored by myself and a few short statements made by some investigators commenting on their short one-time trial of PhacoTmesis. The reason for this is that it has taken Chiron (Clairmont, CA) and myself more than 5 years to develop and evolve the concept and the machine to the level at which it can be used clinically with safety and efficiency prior to making it available to other ophthalmologists to explore its capabilities.

ISSN:1040-8738    

出版商:OVID    

年代:1996

数据来源: OVID