Comparison of posterior capsule opacification development with 3 intraocular lens types: five-year prospective study.

PURPOSE: To compare the effects of hydrophobic acrylic, silicone, and heparin-surface-modified poly(methyl methacrylate) (HSM PMMA) intraocular lenses (IOLs) on posterior capsule opacification (PCO). METHODS: In this 5-year prospective study, the same surgeon performed standard phacoemulsification in patients who were randomized to implantation of a round-edged HSM PMMA IOL (809C), a round-edged silicone IOL (SI-40NB), or a sharp-edged hydrophobic acrylic IOL (AcrySof MA60BM). The neodymium:YAG capsulotomy rate was recorded. To evaluate PCO and the position of the anterior capsulorhexis, retroillumination digital photographs were taken 5 years postoperatively and analyzed using the POCOman computer-analysis system. RESULTS: After 5 years, there was no significant difference in the fraction or severity of PCO between the silicone IOLs and acrylic IOLs (both P =1.0). The silicone IOL group had a significantly higher capsulotomy rate (29%) than the acrylic IOL group (8%) (P=.0068). The HSM PMMA IOL group had a significantly higher PCO fraction, severity, and capsulotomy rate (54%) than the silicone and acrylic groups. In all eyes, the fraction (P=.0076) and severity (P=.0081) of PCO were statistically significantly higher when the anterior capsulorhexis was partly decentered than when it was completely on the optic; within each IOL group, there was no significant difference. CONCLUSION: After 5 years, there was no significant difference in the semiquantitative evaluation of PCO between the sharp-edged acrylic IOL and round-edged silicone IOL. Eyes with the HSM PMMA IOL had more PCO than eyes with the other IOLs.

Two-year follow-up of posterior capsule opacification after implantation of a hydrophilic or hydrophobic acrylic intraocular lens.

PURPOSE: To evaluate posterior capsule opacification (PCO) 2 years after cataract surgery following implantation of a hydrophilic or a hydrophobic single-piece acrylic intraocular lens (IOL) with a sharp edge. METHODS: Phacoemulsification cataract surgery was performed in one eye of 120 patients with senile cataract in this prospective study. They were randomized to implantation of either a hydrophilic acrylic IOL (BL27; Bausch & Lomb, Rochester, NY, USA) or a hydrophobic acrylic IOL (AcrySof) SA60AT; Alcon Laboratories, Fort Worth, TX, USA). Two years after surgery, retroillumination images were obtained and PCO area and severity were evaluated using pocoman software. Best corrected visual acuity (VA) (both high-contrast [100%] and low-contrast [2.5%]), glare, laser flare and intraocular pressure were measured. Capsulotomy rates were recorded. RESULTS: Patients implanted with the hydrophilic IOL had a greater percentage area and severity of PCO compared with patients with the hydrophobic IOL (p < 0.001). There was no difference in PCO between men and women in the hydrophilic group. However, in the hydrophobic group, women had significantly more PCO than men (p < 0.05). Patients with the hydrophobic acrylic IOL had better high- and low-contrast visual activity (VA) (p < 0.01) and less glare (p < 0.001) than those with a hydrophilic acrylic IOL. Of the patients with the hydrophilic IOL, 42% underwent capsulotomy, compared with 10% in the hydrophobic group (p < 0.001). CONCLUSIONS: Two years after surgery, patients with the SA60AT hydrophobic acrylic IOL had less PCO and better high- and low-contrast VA than patients with the BL27 hydrophilic acrylic IOL.

Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location.

PURPOSE: To establish the nationwide rate of postoperative endophthalmitis (PE) after cataract extraction (CE) and to study the relationship between PE and type of incision and other possible risk factors. DESIGN: Prospective, multicenter, comparative, nonrandomized, observational study. PARTICIPANTS: All cataract surgeries in Sweden performed from January 2002 through December 2004 and all endophthalmitis cases in the same period that were reported to the Swedish National Cataract Register (NCR). METHODS: Through a standard reporting form sent to the NCR, patient and operation technique data were recorded. In addition, PE cases with a traceable number to the main register were collected. Various parameters with a possible impact on endophthalmitis development were evaluated. Univariate analyses and logistic regression were statistical methods. MAIN OUTCOME MEASURES: The rate and etiology of PE; possible risk factors pertaining to patient history and operation technique, with a special emphasis on incision type and location; use of injector for the intraocular lens implantation; kind of prophylaxis; and presence of peroperative communication between the anterior chamber and vitreous. RESULTS: The overall rate of PE was 0.048% (109 cases in 225 471 CEs). Incidences of PE were 0.053% with clear corneal incisions and 0.036% with sclerocorneal incisions (P = 0.14, logistic regression analysis). The corresponding results were 0.040% for superior incisions and 0.055% for temporal incisions (P = 0.14). Communication between the anterior segment and vitreous was found to be a highly significant independent risk factor for PE (P<0.001), as were patient age > or = 85 years (P<0.001) and the nonuse of intracameral cefuroxime (P<0.001). CONCLUSIONS: The overall rate of PE after cataract surgery is low in Sweden, which may be a consequence of the widespread use of prophylactic intracameral cefuroxime. Only a trend for an increased risk of PE was detected for clear corneal and temporal wounds. The present data indicate that the use of clear corneal and/or temporal approaches will result in 1 additional PE case in approximately 5500 procedures on top of the PE rate after sclerocorneal or superior incisions, which was approximately 1 case in 2400 operations.

Posterior capsule opacification after implantation of a hydrophilic or a hydrophobic acrylic intraocular lens: one-year follow-up.

PURPOSE: To evaluate the effect of hydrophilic and hydrophobic single-piece acrylic intraocular lenses (IOLs) on posterior capsule opacification (PCO) after cataract surgery. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: In a prospective study, 120 patients having cataract surgery were randomized to implantation of a hydrophilic acrylic IOL (BL27, Bausch & Lomb) or a hydrophobic acrylic IOL (AcrySof SA60AT, Alcon). Surgery was performed according to a standardized protocol by 1 of 3 surgeons. Best corrected visual acuity, contrast sensitivity, glare, intraocular pressure, and flare were measured 1 week, 3 months, and 1 year after surgery. Posterior capsule opacification was assessed by digital retroillumination photography and analysis using POCOman software at 1 year. The rate of neodymium:YAG (Nd:YAG) capsulotomy for each IOL was also recorded. RESULTS: At 1 year, the hydrophilic acrylic IOL group had a significantly greater percentage area and severity of PCO than the hydrophobic acrylic IOL group (P<.001). Two patients in the hydrophilic acrylic IOL group and 4 in the hydrophobic acrylic IOL group had an Nd:YAG capsulotomy within the first year (P>.05). Contrast sensitivity was significantly better in the hydrophilic acrylic group at 3 months (P<.05); however, at 12 months no difference between the IOLs was observed. There was no significant difference in the other measured parameters. CONCLUSION: Patients with the hydrophilic acrylic BL27 IOL had a significantly greater percentage area and severity of PCO than those with the hydrophobic acrylic SA60AT IOL 1 year after surgery.

Endophthalmitis following cataract surgery in Sweden: national prospective survey 1999-2001.

PURPOSE: To investigate the epidemiology of postoperative endophthalmitis (POE) following cataract surgery in Sweden during a 3-year period, using the framework of the Swedish National Cataract Register. METHODS: Clinically presumed cases of POE were reported in a prospective survey involving all Swedish ophthalmic surgical units except one. Data on results of the intraocular culture and visual outcome after infection, as well as patient age and gender and various elements of the surgical procedure, were collected. RESULTS: The nationwide incidence of POE was 0.0595%, representing 112 cases in 188 151 cataract operations. Gram-positive bacteria were the predominant aetiology, with an 84.6% share of culture-positive cases. A significantly decreased risk for POE was found for patients who had received prophylactic intracameral antibiotics (mainly cefuroxime) in comparison with those who had been treated with topical antibiotics only. CONCLUSIONS: The prevalence of POE after cataract surgery in Sweden is at the lower end of the spectrum of incidence currently reported in the developed world. The administration of intracameral antibiotics may have contributed to these results.

Position of anterior capsulorhexis and posterior capsule opacification.

PURPOSE: To evaluate whether the position of the anterior continuous curvilinear capsulorhexis influences the rate of posterior capsule opacification (PCO). METHODS: A total of 119 patients, aged 61-86 years, underwent cataract surgery with phacoemulsification performed by a single surgeon. The patients were randomized to implantation with either a silicone intraocular lens (IOL) (SI40NB, Allergan) or an AcrySof IOL (MA60BM, Alcon). Three years after surgery, the rate of PCO was analysed using the evaluation of posterior capsule opacification computer software (EPCO). The results were related to the capsulorhexis position, which was assessed with a retroillumination photograph. RESULTS: If the capsulorhexis was located partially or completely off the optics of the IOL, compared to totally on the IOL, significantly more PCO was found (p = 0.0014). When comparing within each IOL type, patients with AcrySof IOLs were found to have significantly less PCO when the capsulorhexis was totally on the optic (p = 0.0048). This difference was also significant in the silicone group (p = 0.041). CONCLUSION: A relatively small and central capsulorhexis allowing for the complete covering of the IOL optics by the rhexis edges seems to protect against PCO in cataract surgery, with both round-edged silicone IOLs and sharp-edged hydrophobic acrylic IOLs.

Posterior capsule opacification: comparison of 3 intraocular lenses of different materials and design.

PURPOSE: To compare posterior capsule opacification (PCO) after cataract surgery with implantation of 3 intraocular lenses (IOLs) of different materials and design. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: In this prospective clinical study, 180 patients had standardized phacoemulsification performed by a single surgeon and were randomized to have implantation of a heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) IOL (809C, Pharmacia & Upjohn), a silicone IOL (SI-40NB, Allergan), or an acrylic IOL (AcrySof MA60BM, Alcon). To morphologically evaluate PCO, retroillumination photographs were obtained and analyzed using Evaluation of Posterior Capsule Opacification computer software. The neodymium:YAG (Nd:YAG) capsulotomy rate was recorded. RESULTS: After 2 years, the HSM PMMA IOL group had significantly more PCO than the silicone and AcrySof IOL groups; the silicone group had significantly more PCO than the AcrySof group (P<.05). The Nd:YAG capsulotomy rate was 20% in the HSM PMMA group, 22% in the silicone group, and 8% in the AcrySof group. CONCLUSION: Patients with an AcrySof IOL developed significantly less PCO than those with a silicone or HSM PMMA IOL with a round-edged design.

Healon5: comparison of 2 removal techniques.

PURPOSE: To evaluate the effect on intraocular pressure (IOP) of the rock 'n roll and behind-the-lens techniques of removing Healon(R)5 (sodium hyaluronate 2.3%). SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: In a prospective randomized study of 159 patients, 2 techniques to remove Healon5--rock 'n roll and behind-the-lens--were compared during cataract surgery. Cataract surgery included identical phacoemulsification performed by 1 surgeon and implantation of a silicone intraocular lens (IOL) in the capsular bag. The removal time of Healon5 was recorded. The IOP was measured preoperatively and 5 and 24 hours postoperatively. RESULTS: The mean IOP before surgery was 15.7 mm Hg +/- 2.8 (SD) in the rock 'n roll group and 15.9 +/- 2.7 mm Hg in the behind-the-lens group. Five hours postoperatively, the mean IOP was 25.6 +/- 10.4 mm Hg and 22.4 +/- 7.6 mm Hg, respectively; the difference between the groups was statistically significant. By 24 hours postoperatively, the mean IOP was at preoperative levels in both groups. The mean removal time of Healon5 was 50 seconds in the rock 'n roll group and 39 seconds in the behind-the-lens group; the difference between the groups was statistically significant. CONCLUSIONS: Results indicate that the behind-the-lens technique for removing Healon5 is quicker and safer than the rock 'n roll technique.

Prophylactic intracameral cefuroxime. Efficacy in preventing endophthalmitis after cataract surgery.

PURPOSE: To evaluate the efficacy of prophylactic intracameral cefuroxime in preventing endophthalmitis in cataract surgery. SETTING: Department of Ophthalmology, St. Eriks Hospital, Stockholm, Sweden. METHODS: In a noncontrolled retrospective observational study, all cases of recorded postoperative endophthalmitis were related to the total number of uncombined cataract procedures from January 1996 to December 2000. RESULTS: Twenty cases of postoperative endophthalmitis occurred in 32180 procedures, yielding an overall rate of 0.06%. Cefuroxime-resistant organisms accounted for 12 of 13 culture-positive cases, and enterococci were the most common etiology. CONCLUSIONS: Intracameral cefuroxime 1 mg appeared to effectively inhibit sensitive bacterial strains and was associated with a low frequency of postoperative endophthalmitis. The causative organisms of future incidents of postoperative endophthalmitis will determine whether the present protocol must be reappraised.

Prophylactic intracameral cefuroxime. Evaluation of safety and kinetics in cataract surgery.

PURPOSE: To evaluate the safety and kinetics of prophylactic intracameral cefuroxime in cataract surgery. SETTING: Department of Ophthalmology, St. Eriks Hospital, Stockholm, Sweden. METHODS: In a nonrandomized observer-masked best-case trial, the visual rehabilitation and the evolution of laser flare intensity and corneal endothelial cell density after cataract surgery were assessed in 45 patients receiving intracameral cefuroxime and in 45 control patients. Immunoglobulin E-mediated sensitivity was evaluated using a skin prick test to cefuroxime in a screening program comprising all cataract patients operated on in 1997. Intracameral concentrations of cefuroxime in samples retrieved 30 seconds (n = 10) and 1 hour (n = 9) postoperatively were evaluated in an observer-masked fashion with a microbiological assay. RESULTS: Intracameral cefuroxime did not have a statistically significant effect on postoperative visual acuity, induced laser flare intensity, or endothelial cell loss compared with nonadministration of intracameral antibiotic prophylaxis. Three positive skin prick tests to cefuroxime were found in the 5813 screened cataract patients. The median aqueous humor concentration of cefuroxime at 30 seconds was 2742 mg/L, declining to 756 mg/L 1 hour after drug instillation. CONCLUSIONS: Intracameral cefuroxime 1 mg appears safe in terms of local toxicity. Immunoglobulin E-mediated allergy to cefuroxime is rare in the cataract population. The treatment achieved high aqueous concentrations even 1 hour after surgery.