The iris-plane (Copeland) pseudophakos.

The iris-plane (Copeland) pseudophakos was evaluated in two 81-case surgical series. An early series consisted of the first 81 operations performed in the Miami community before a temporary moratorium on Oct 1, 1969. This series was compared with the first 81 operations performed after the moratorium was lifted on Oct 1, 1971. The follow-up period of those available for study was 63 months in the early series and 19 months in the later series. Objectivity was assured since all surgery was performed by one author (N.S.J.) and all examinations performed by the other author (L.R.D.). Visual acuity of 6/12 or better was obtained in approximately 80% of patients. The most frequent problems encountered were recurrent iritis and cystoid macular edema. The optic benefit was apparent in this elderly group of patients who avoided the optical problems of aphakia.

Chronic postoperative endophthalmitis associated with Propionibacterium acnes.

We present two cases of Propionibacterium acnes endophthalmitis that confirm the association of this organism with a delayed onset and chronic and indolent intraocular inflammation following extracapsular cataract extraction with posterior chamber intraocular lens implantation. The clinical, microbiologic, and histopathologic features of these cases suggest that the organism can be sequestered in the capsular bag, which may make this entity difficult to diagnose. We conclude that complete capsulectomy may be required if inflammation persists after conventional treatment for endophthalmitis, which may include pars plana vitrectomy, partial capsulectomy, and antibiotic therapy. Sterile postoperative uveitis is a diagnosis of exclusion. We stress the importance of appropriate microbiologic investigation in all cases of postsurgical inflammation, even if the onset is delayed until several months after surgery.

Results of intraocular lens implant surgery. The third Binkhorst medal lecture.

I compared an early series of 162 consecutive Copeland intraocular lens implants with a later series of 650 consecutive Binkhorst implants. Of the eyes with Copeland implants, 76.5% achieved 6/12 (20/40) or better visual acuity compared to 89.8% in the Binkhorst series. There was a striking difference in the incidence of clinically significant cystoid macular edema (less than 6/12 [20/40], visual acuity); 7.4% in the Copeland series and 1.4% in the Binkhorst series. I studied the Binkhorst series for visual acuity, causes of less than 6/12 (20/40) visual acuity, operative vitreous problems, additional surgery, secondary membranes, dislocations, and retinal detachment. A fluorescein angiographic study of 190 Binkhorst implants and 113 aphakic controls was done. There was a comparable incidence of cystoid macular edema in both groups at four, eight, and 16 to 24 months postoperatively. Extracapsular Binkhorst implants showed a lower incidence than intracapsular Binkhorst implants.

The changing scene of intraocular implant lens surgery.

A review of lens implant surgery using different implant styles and both methods of cataract extraction revealed that there is little difference in the final visual acuity regardless of which implant or cataract technique is used. There appears to be a higher rate of cystoid macular edema with the intracapsular technique and a higher rate of corneal edema with the extracapsular technique. A modern attitude toward this technologic explosion insists more than ever on conventional points of view regarding patients' needs.

Lens implantation and diabetes mellitus.

In a series of 1,160 implant cases, 82 patients were diabetic. In this subgroup, lenses were implanted in 87 eyes, and a visual acuity of 6/12 (20/40) or better was obtained in 77 (88.6%) of the patients, which compared well with the nondiabetic control group of 1,078 cases. Only patients with normal fundi or minimal background retinopathy were operated on, and the visual results obtained were independent of the diabetic medical management.

Transiridectomy suture technique for the Binkhorst iris-clip lens implant.

A magnet facilitated placement of the transiridectomy suture used in conjunction with the Binkhorst iris-clip lens implant.

Retinal detachment in myopic eyes after intracapsular and extracapsular cataract extraction.

We analyzed two consecutive series of cataract extractions in patients with moderate to severe myopia for the incidence of postoperative retinal detachment. One series consisted of 122 intracapsular cataract extractions without surgical loss of vitreous and the other series consisted of 151 extracapsular (phacoemulsification and planned extracapsular) cataract extractions without loss of vitreous and with intact posterior capsules. All patients were 40 years of age or older and all were followed up for one to four years. We defined moderate to severe myopia as an aphakic refraction of +7.00 diopters spherical equivalent or less. The rate of postoperative retinal detachment was greater in the intracapsular series (seven of 122 cases; 5.74%) than in the extracapsular series (one of 151 cases; 0.66%).

Pars plana vitrectomy as a primary treatment for acute bacterial endophthalmitis.

We successfully treated six patients with culture-proven acute bacterial endophthalmitis by a combination of emergency pars plana vitrectomy and the instillation of intravitreal antibiotics. All six patients regained satisfactory vision.

Lens implantation, miosis, and glaucoma.

In a series of 1,079 patients, average age 76.3 years, 48 eyes required an iridoplasty for chronic miosis and, of these, visual acuity was 6/12 (20/40) or better postoperatively in 89.6% (43). In those patients with glaucoma, the control of intraocular pressure was the same or better than post-operative levels in 83.3% (15) of patients. Lens implantation was not contraindicated in the miotic patient if adequate iris surgery was performed before both cataract extraction and implant insertion. When there was concomitant glaucoma, lens implantation was likewise not contraindicated if the glaucoma was well controlled.

Glare disability in eyes with intraocular lenses.

For 32 eyes tested for glare disability after undergoing extracapsular cataract extraction with implantation of posterior chamber intraocular lenses, the mean contrast threshold in the presence of the glare source was 23% for undilated pupils and 31% with dilation. A regression analysis of glare scores as a function of the amount of posterior capsule opacification showed a significant (P less than .00001) association between the two.

A fluorescein angiographic study of cystoid macular edema.

We performed a prospective fluorescein angiographic study on 66 patients who had undergone extracapsular cataract extractions with implantation of a Shearing posterior chamber intraocular lens. A primary posterior capsulotomy was performed in every case. The eyes were studied 11 to 23 months postoperatively. The incidence of cystoid macular edema (3%) was lower than that found in three series of cataract extractions previously reported. Extracapsular cataract extraction with either (1) a Shearing posterior chamber intraocular lens and a primary posterior capsulotomy or (2) a Binkhorst intraocular lens and an intact posterior capsule produces a lower rate of cystoid macular edema than does intracapsular cataract extraction either with a Binkhorst intraocular lens or without an intraocular lens. There was no significant difference in the incidence of cystoid macular edema in the two extracapsular series, indicating that preservation of an intact posterior capsule was not a significant factor.

Intraocular lenses, axial length, and retinal detachment.

A large series of patients with intraocular lens implants had an overall 0.98% incidence of retinal detachment (eight detachments in 819 eyes). Within this group, patients with axial lengths of more than 25 mm had a statistically significantly higher incidence of retinal detachment (P = .054).

A comparison of 500 Binkhorst implants with 500 routine intracapsular cataract extractions.

We compared 500 Binkhorst lens implants with 500 routine intracapsular cataract extractions. The two groups consisted of consecutive cases matched according to surgeons, surgical technique, time interval of the study, and ocular status. The results of visual acuity were comparable in the two groups; 89.0% of the implant group and 85.4% of the routine intracapsular group achieved 6/12 (20/40) or better visual acuity. The rate of complications in each group was comparable except in the case of corneal edema, which was higher in the implant group (1.2%) than in the routine intracapsular group (0.4%). The rate of clinically significant cystoid macular edema was higher in the routine intracapsular group (2.2%) than in the implant group (1.4%).

Glare and contrast: indications for cataract surgery.

The present method of using Snellen visual acuity to evaluate the vision of cataract patients is inadequate because it may grossly overestimate the nature of their visual world. Many of these patients have poor visual functioning as a result of glare disability and loss of contrast. The loss of visual contrast on the retina may be quantified using devices currently available and applicable to a clinical setting in the office. These are described. A study of glare disability in pseudophakic eyes following phacoemulsification or planned extracapsular cataract extraction with intact capsules is made and compared with a previous report of eyes with a primary posterior capsulotomy. It is recommended that glare disability be measured in eyes of cataract patients and be used as an indication for cataract surgery.

The outlook for intraocular lenses through 1990.

Extracapsular cataract extraction with posterior chamber intraocular lens implantation has become the most successful intraocular procedure ever practiced. The number of cataract extractions and intraocular lenses implanted have increased enormously over the past decade. One might ask if a saturation point is near. The progress of cataract extraction and intraocular lens implantation is reviewed from 1973 to 1983 and an attempt to predict their volume to 1990 is made. Significant research and development factors and their impact on the domestic and foreign markets are presented. Because of these and demographic factors, it is concluded that we are not nearing the saturation point in cataract surgery or the intraocular lens industry.

Cataract extraction in eyes with congenital colobomata.

Cataract surgery was performed in six eyes of four patients with typical colobomata of the iris, choroid, and retina. Contrary to previous reports of poor surgical results in these eyes, we saw no surgical or postoperative complications. Final visual acuity was excellent in four eyes. The other two had preexisting amblyopia. Most previous reports describe outmoded extracapsular techniques or contemporary intracapsular cataract extraction, all without an intraocular lens. Five of the six eyes in this study had modern cataract surgery--phacoemulsification with a posterior chamber lens placed in the capsular bag.

Spontaneous enlargement of neodymium:YAG posterior capsulotomy in aphakic and pseudophakic patients.

Two cases of spontaneous enlargement of a neodymium:YAG posterior capsulotomy, involving an aphakic and a pseudophakic patient, are presented. Consequences and possible causality are discussed.