Intraoperative floppy iris syndrome ­ epidemiology and clinical assessment.

Purpose: To assess the incidence, and to identify medications and clinical features associated with intraoperative floppy iris syndrome in patients undergoing cataract surgery. Material and methods: The non-randomized, observational, prospective study was performed in 616 eyes (610 patients) after cataract surgery to determine the incidence of intraoperative floppy iris syndrome and the medications associated with its higher prevalence. We used a slit lamp adapted optical coherence tomography to evaluate anterior segment of 155 eyes (154 patients), measuring pupil diameter before and after the use of mydriatics and assessing the pre-dilated iris thickness at the dilator and sphincter muscle region. Results: The overall incidence of intraoperative floppy iris syndrome was 4% (25/616 eyes). The highest prevalence of intraoperative floppy iris syndrome was shown in patients exposed to tamsulosin (39%). Pupil diameter in mm before and after mydriasis was significantly smaller in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (pre-dilated ­ 1.85 ± 0.43 vs. 2.16 ± 0.37; p < 0.01; dilated ­ 5.04 ± 1.01 vs. 5.70 ± 0.87; p < 0.01). The thickness of the iris in sphincter muscle region in µm was similar in patients with and without intraoperative floppy iris syndrome (520.3 ± 76.1 vs. 520.6 ± 72.4; p > 0.05). Significantly thinner iris in dilator muscle region was found in patients with intraoperative floppy iris syndrome as compared to the syndrome-free ones (409.9 ± 55.7 vs. 448.6 ± 55.8; p < 0.05). The presence of intraoperative floppy iris syndrome was correlated with a higher risk of intraoperative complications. Conclusions: Patients with intraoperative floppy iris syndrome have decreased pupil diameter and a thinner iris in dilator muscle region. Slit lamp optical coherence tomography is a useful device to preoperatively detect clinical features associated with intraoperative floppy iris syndrome. These findings may warn the surgeon of potential intra-operative difficulties. Slowa kluczowe: zespól sródoperacyjnie wiotkiej teczówki (IFIS), epidemiologia, operacja zacmy, optyczna koherentna tomografia skojarzona z lampa szczelinowa (sl-OCT).

Prospective analysis of outcomes of cataract phacoemulsification with the implantation of the Crystalens accommodative intraocular lens. / Prospektywna ocena wyników fakoemulsyfikacji zacmy z wszczepieniem wewnatrzgalkowej soczewki akomodacyjnej Crystalens.

Objectives: To evaluate visual outcomes after bilateral implantation of Crystalens accommodative intraocular lenses. Material and methods: The study group consisted of 20 patients (40 eyes) who underwent uneventful phacoemulsification through a 2.8 mm wide clear corneal incision followed by the implantation of an accommodative intraocular lens Crystalens HD or Crystalens AO. Uncorrected visual acuity, best corrected visual acuity, distance corrected intermediate visual acuity, distance corrected near visual acuity, best near visual acuity 1, 3, 6, 12 months postoperatively were evaluated. Distance visual acuity was measured with Snellen test. Near (40 cm) and intermediate (80 cm) visual acuity were measured with Jeager test. Results: The mean uncorrected distance visual acuity was 0.94 and 0.89 at month 1. and 12., respectively. The distance corrected intermediate visual acuity was 0.9 and 0.86 at month 1. and 12., respectively. The distance corrected near visual acuity was J1 in 10% and J3 in 50% of patients at month 1. It was J1 in 10% and J3 in 55% of patients at month 12. Conclusions: Crystalens intraocular lens implantation in our patients enabled them to achieve good distance, near and intermediate visual acuity. The majority of patients did not require spectacle correction for distance and near (87.5% and 65%, respectively). The achieved results did not differ significantly at months 1., 6., and 12. postoperatively.

The effect of the selected factors on corneal endothelial cell loss following phacoemulsification.

INTRODUCTION: Corneal endothelium is a single layer of cells, which do not regenerate. Damage to the endothelium can take place in the course of certain diseases and after intraocular operations. When the number of endothelial cells decreases, corneal decompensation can occur. Pre- and postoperative measurement of the number of the corneal endothelial cells can help assess the degree of corneal damage during the surgery. PURPOSE: To compare the effect of various factors, such as: sex, age, corneal incision, intraocular pressure, cataract density, visual acuity and surgeon's experience on corneal endothelial cell loss following uneventful phacoemulsification. MATERIAL AND METHODS: 365 patients (114 men and 251 women aged 19 to 91 years) undergoing phacoemulsification were examined preoperatively and postoperatively at 4 weeks. 68 eyes underwent phacoemulsification through a 1.8 mm microincision and 297 eyes through a standard 2.75 mm incision. Patients were operated on by four surgeons. RESULTS: There was a significant difference in the postoperative endothelial cell loss relative to the degree of cataract hardness (p < 0.001). Endothelial cell loss was significantly higher in patients aged 71 and above than in the remaining age groups. Significant differences in the postoperative endothelial cell loss were observed in relation to the clear corneal incision size (p < 0.01). Preoperative best corrected visual acuity influenced the postoperative endothelial cell loss in a statistically significant way (p < 0.05). Endothelial cell loss was strongly influenced by the surgeon's experience. CONCLUSIONS: Surgeon's experience, hardness of cataract, type of corneal incision, age and preoperative visual acuity influenced endothelial cell loss at 4 weeks following uneventful phacoemulsification, however such factors as sex and intraocular pressure showed no statistically significant influence on corneal endothelial cell loss.

Comparative analysis of early distance visual acuity in patients after coaxial phacoemulsification through the micro-incision (1.8 mm) and after standard phacoemulsification through the small incision (2.75 mm).

INTRODUCTION: The purpose of the study was to evaluate early postoperative visual acuity outcomes of coaxial phacoemulsification with a foldable intraocular lens implantation, performed through a 1.8 mm wide clear corneal microincision (C-MICS) and to compare it with standard phacoemulsification through a 2.75 mm incision. MATERIAL AND METHODS: The examined group consisted of a non-randomised, prospective series of 130 eyes of 130 patients who underwent coaxial 1.8 mm microincision cataract surgery with foldable intraocular lens implantation (MI60, Bausch & Lomb). The reference group comprised 123 eyes of 123 patients who underwent standard phacoemulsification through the 2.75 mm incision with foldable intraocular lens implantation (Akreos Adapt AO, Bausch & Lomb). The following parameters were evaluated preoperatively and one day after the surgery: distance uncorrected visual acuity, distance best corrected visual acuity, intraocular pressure, anterior and posterior segment of the eye. All patients were divided into groups according to the LOCS III scale. RESULTS: The improvement of distance uncorrected visual acuity and distance best corrected visual acuity was observed postoperatively in both groups. The mean uncorrected visual acuity in the examined group was significantly better than in the reference group on the first postoperative day (0.88 +/- 0.18 vs 0.79 +/- 0.26). CONCLUSIONS: The early postoperative visual acuity results of C-MICS were better than the results of standard small incision phacoemulsification. As far as fast visual rehabilitation after MICS is concerned, the early uncorrected visual acuity should be considered as an important yardstick in measuring success in cataract surgery. These results are due to the MICS technique, which seems to be the minimally invasive surgery, and should be regarded nowadays as a procedure of choice.

[Evaluation of quality of life of patients after phacoemulsification with accommodating lens implantation]. / Ocena jakosci zycia pacjentów po fakoemulsyfikacji z wszczepieniem akomodacyjnej soczewki wewnatrzgalkowej.

INTRODUCTION: Intraocular lens implantation is an important part of cataract surgery, as it has a significant influence on the final result. Accommodative intraocular lenses (IOLs) are the latest solution for the lack of accommodation in pseudophakic eyes. PURPOSE: To evaluate the quality of life of patients who underwent cataract surgery with accommodating IOL implantation and to compare the data with results of patients after standard monofocal IOL implantation. MATERIAL AND METHODS: The study group consisted of 20 patients (40 eyes), aged from 48 to 73 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of an accommodating IOL Crystalens HD (Bausch & Lomb, USA). The control group consisted of 20 patients (40 eyes), aged from 63 to 83 years old, who underwent phacoemulsification through a 2.75 mm clear corneal incision followed by the implantation of a standard monofocal single-piece acrylic intraocular lens AcrySof (Alcon, USA). All enrolled patients had no coexisting ocular diseases which could influence the final visual acuity. All surgeries were uneventful. At one month postoperatively, the patients were requested to answer 36 questions included in the questionnaire in order to evaluate the quality of visual function. RESULTS: There was a significant improvement in the quality of life in both groups after cataract surgery. The study group tended to assess their own eyesight higher than the control group. Patients from the study group use spectacle correction for a lower number of activities, they find it easier to use fine motor skills when performing activities without spectacle correction in comparison with patients from the control group. Patients from the study group use spectacle correction for reading significantly less frequently, they also find it easier to read the normal size and small print without spectacle correction, in comparison with patients from the control group. CONCLUSIONS: Patients with accommodating IOLs self-evaluate their own eyesight highly, use spectacle correction for a lower number of activities and find it significantly easier to perform precise activities without spectacle correction, in comparison with patients after the standard monofocal intraocular lens implantation.

Results of phacoemulsification with Malyugin Ring in comparison with manual iris stretching with hooks in eyes with narrow pupil.

PURPOSE: To evaluate the results of phacoemulsification in eyes with a narrow pupil dilated with Malyugin Ring, in comparison with manual pupillary stretching with hooks. SETTING: Department of Ophthalmology, Medical University of Lodz, Poland. MATERIALS AND METHODS: The examined group (group 1) consisted of 23 eyes of 23 patients whose pupil was dilated using Malyugin Ring. The reference group (group 2) consisted of 17 eyes of 17 patients whose pupil was dilated manually by stretching with hooks. All patients underwent uneventful standard phacoemulsification. Patients were examined preoperatively, 1 day, and 1 month after the surgery. Best-corrected visual acuity (BCVA), intraocular pressure, anterior and posterior segment of the eye, and corneal endothelial cell density were evaluated. Statistical analysis was done using nonparametric tests. RESULTS: Mean preoperative BCVA in group 1 was 0.31±0.27 and in group 2 it was 0.26±0.26 (p>0.05). In both groups there was a significant improvement in BCVA after the surgery (p<0.05). Mean postoperative BCVA in group 1 was 0.75±0.30 and in group 2 it was 0.56±0.56 (p<0.05). Mean corneal endothelial cell loss measured 30 days postoperatively amounted to 9.35±11% in group 1 and 13.77±8.0% in group 2 (p<0.05). No serious complications were found. CONCLUSIONS: In eyes with narrow pupil, the use of Malyugin Ring makes the surgery easier and allows for better functional results and smaller corneal endothelial cell loss in comparison with manual pupillary stretching with 2 hooks.

Results of coaxial phacoemulsification through a 1.8-mm microincision in hard cataracts.

BACKGROUND AND OBJECTIVE: To assess the results of coaxial phacoemulsification through 1.8-mm coaxial microincision cataract surgery (C-MICS) phacoemulsification with foldable intraocular lens implantation in eyes with hard cataracts in comparison to eyes with soft cataracts. PATIENTS AND METHODS: Group 1 consisted of 40 eyes of 40 patients with hard cataracts (grade ≥ 4, Lens Opacities Classification System III scale) and group 2 consisted of 45 eyes of 45 patients with non-mature cataracts (grade ≤ 2, Lens Opacities Classification System III scale). All surgeries were performed by two experienced surgeons under topical and intracameral anesthesia. Examinations were performed preoperatively and 1 month after the surgery. Examined parameters included distance-corrected visual acuity (DCVA), autorefractometry, keratometry, tonometry, endothelial cell counts, and biomicroscopy of the anterior and posterior segment. Surgically induced astigmatism was calculated with vector analysis. RESULTS: Mean DCVA was 0.16 ± 0.16 preoperatively and 0.92 ± 0.21 postoperatively in group 1 (P < .05) and 0.62 ± 0.18 preoperatively and 0.97 ± 0.08 postoperatively in group 2 (P < .05). Mean surgically induced astigmatism was 0.48 ± 0.44 in group 1 and 0.53 ± 0.38 in group 2 (P > .05). Mean endothelial cell loss was 11.37% ± 12.87% in group 1 and 2.87% ± 9.66% in group 2 (P < .05). CONCLUSION: Although density of cataract has an unfavorable influence on early postoperative corneal endothelial cell loss, it did not significantly influence final DCVA and surgically induced astigmatism. C-MICS is a safe and effective method of treatment of cataracts, including cataracts with hard nuclei, and usually leads to good functional outcomes.

Evaluation of surgically induced astigmatism after coaxial phacoemulsification through 1.8 mm microincision and standard phacoemulsification through 2.75 mm incision.

UNLABELLED: Improvements in technology connected with cataract surgery have made it possible to decrease significantly the size of corneal incision created during phacoemulsification. Recently, coaxial phacoemulsification through a 1.8 mm microincision (C-MICS) has been introduced. This technique is perceived as the next step in development of phacoemulsification. PURPOSE: To compare surgically induced astigmatism (SIA) after coaxial 1.8 mm microincision cataract surgery (C-MICS) and standard phacoemulsification through 2.75 mm incision, calculated with three mathematical methods. MATERIAL AND METHODS: A consecutive, prospective series of 55 eyes of 55 patients who underwent uneventful C-MICS with foldable IOL implantation using 1.8 mm temporal clear corneal incision were included in group 1. Reference group (group 2) included 55 eyes of 55 patients who underwent uneventful phacoemulsification through 2.75 mm temporal clear corneal incision with a foldable IOL implantation. SIA was calculated using three methods. RESULTS: All patients had uneventful surgery and were examined before the surgery and one month postoperatively. There was a significant postoperative increase in corrected distance visual acuity in both groups (p < 0.01), and the visual outcomes in both groups were similar (p > 0.05). In vector analysis, mean SIA was 0.42 +/- 0.30 in group 1 and 0.77 +/- 0.55 in group 2. In vector decomposition, the mean SIA (C90) in group 1 was 0.24 +/- 0.29 and 0.49 +/- 0.54 in group 2 (p < 0.05). In Naeser's polar values method, deltaKP-0 was -0.06 +/- 0.43 in group 1 and -0.21 +/- 0.84 in group 2 (p > 0.05). CONCLUSIONS: 1.8 mm coaxial MICS induces a significantly smaller value of SIA than standard 2.75 mm phacoemulsification.

Results of implantation a new type of foldable anterior chamber intraocular lens.

UNLABELLED: In aphakic patients, lack of capsular support or insufficient capsular support require an implantation of an anterior chamber intraocular lens or a sclerally fixated lens. Rigid PMMA (polymethylmetacrylate) anterior chamber intraocular lenses or transscleral intraocular lenses require an incision 6.0-7.0 mm wide. PURPOSE: Of this study was to evaluate anatomic and functional results of a new foldable acrylic anterior chamber intraocular lens (Acri.Lyc 15A, Acritec) through a small incision (2.8 mm). MATERIAL AND METHODS: The examined group consisted of 30 eyes in 30 patients, at the age from 48 to 87 years (mean 70.90 years, SD +/- 10.57 years), who received a new type foldable acrylic anterior chamber intraocular lens (AC IOL). Examinations were performed before operation and 1-3 days, 1-2 weeks, 3-4 months, 6-8 months after the surgery. During all control examinations visual acuity, intraocular pressure, refraction, corneal endothelium density, pachymetry, keratometry, anterior and posterior segment of the eye were evaluated. RESULTS: Preoperative mean best corrected visual acuity (BCVA) was 0.32 +/- 0.36 and increased to 0.63 +/- 0.33, 6-8 months after the surgery. We observed that mean corneal endothelial cell density (ECD) gradually decreased in the postoperative period. We observed some minor complications after implantation of the AC IOL (e.g. corneal edema, Descemet folds, raised IOP, hyphaema, distorted pupil shape, "iris bombe", blood in the vitreous, displaced IOL and cystic macular edema), most of them were minor and did not influence the final results. CONCLUSIONS: The application of foldable anterior chamber intraocular lenses through a small incision is a safe alternative for rigid PMMA anterior chamber intraocular lenses and transscleral intraocular lenses.

Comparison of internal anterior chamber diameter measured with ultrabiomicroscopy with white-to-white distance measured using digital photography in aphakic eyes.

PURPOSE: Measuring the anterior chamber diameter (AC) is important both for diagnostics and before ocular surgery. In clinical practice, horizontal AC diameter is usually estimated on the basis of measurements of corneal diameter (so-called white-to-white [WTW] distance). The usual method for selecting an appropriate size for an AC lens is to add 1 mm to WTW measurement. The purpose of this study was to compare AC diameter measured using ultrasound biomicroscopy (UBM) with WTW distance measured using digital photography in aphakic eyes. METHODS: The data were gathered prospectively from a nonrandomized consecutive series of aphakic patients. The examined group consisted of 23 eyes of 23 adult patients, mean age 71.17 years. WTW diameter was measured in the 3 o'clock and 9 o'clock meridian on a digital photograph. Internal horizontal AC diameter measurements were performed in the 3 o'clock and 9 o'clock meridian with the Sonomed Ultrabiomicroscopy device with a 50-MHz probe. RESULTS: Mean horizontal WTW diameter measured using digital photographs was 11.65+/-0.38 mm and mean horizontal internal AC diameter measured using UBM was 13.53+/-0.83 mm. A significant difference in mean WTW diameter measured using digital photography and UBM was found (Mann-Whitney U test, p<0.05). There was a significant correlation between these values (Spearman=0.70, p<0.001). CONCLUSIONS: In order to obtain good and precise measurements of internal AC diameter, a method of direct visualization of the intraocular structures should be used. Despite the limits of a small case series, our results support the use of UBM technique for preoperative evaluation of the internal AC diameter and AC intraocular lens sizing in aphakic eyes.

Factors affecting patient cooperation and level of pain perception during phacoemulsification in topical and intracameral anesthesia.

PURPOSE: To evaluate selected factors that may influence pain perception and patient cooperation with the surgeon during phacoemulsification performed under topical and intracameral anesthesia. METHODS: A total of 203 consecutive patients who had uncomplicated cataract phacoemulsification with foldable intraocular lens implantation through clear corneal 2.8 mm temporal incision under topical anesthesia were enrolled into the study. The factors assessed included gender, age, level of education, professional activity, place of residence, pain sensitivity declared preoperatively, patient mood before operation, preoperative visual acuity, and whether it was the patient's first or second cataract surgery. The correlation between postoperatively declared level of pain perception and cooperation with the surgeon was also evaluated. For statistical analysis, gamma correlation coefficient test was used. RESULTS: The strongest correlation was found between gender and cooperation and level of perceived pain. The weakest dependencies were noticed between the level of education and these parameters. Women, patients who were professionally active, and patients who were in a better mood before the operation were more cooperative. A strong correlation was found between patient pain perception and cooperation. CONCLUSIONS: Pain perception was positively influenced by female gender, rural place of residence, younger age of patient, and lower preoperative visual acuity. Cooperation with the surgeon was positively influenced by female gender, professional activity, patient good mood before operation, and no pain perception during surgery. There was no correlation between level of education, preoperatively declared pain sensitivity, sequence of operation, and estimated parameters.

Comparison of surgically induced astigmatism after coaxial phacoemulsification through 1.8 mm microincision and bimanual phacoemulsification through 1.7 mm microincision.

PURPOSE: To compare surgically induced astigmatism (SIA) after coaxial 1.8 mm microincision cataract surgery (MICS) and bimanual 1.7 mm MICS calculated with 3 mathematical methods. SETTING: Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. METHODS: Study comprised a nonrandomized prospective consecutive series of 58 eyes of 58 patients who had uneventful coaxial MICS with implantation of an Akreos MI60 foldable intraocular lens (IOL) using a 1.8 mm temporal clear corneal incision. Fifty eyes of 50 patients who had uneventful bimanual MICS through a 1.7 mm clear corneal incision for a sleeveless phaco tip and a 1.5 mm side port for an irrigating chopper with implantation of an Acri.Smart 48S foldable IOL served as a comparison group. All surgery was performed by 2 experienced surgeons. Surgically induced astigmatism was calculated using 3 methods. RESULTS: The patients were examined preoperatively and 2 weeks to 1 month postoperatively. No intraoperative or postoperative complications were seen in any patient. The corrected distance visual acuity improved significantly in both groups after surgery (P<.01); the visual outcomes were not significantly different (P>.05). In vector analysis, the mean SIA was 0.42 +/- 0.29 in the coaxial MICS group and 0.50 +/- 0.24 in the bimanual group; the difference was not statistically significant (P>.05). In vector decomposition, the mean SIA (C90) coaxial MICS group was 0.23 +/- 0.29 in the coaxial MICS group and 0.23 +/- 0.22 in the bimanual MICS group; the difference was not significant. Using the Naeser method, DeltaKP-90 was calculated, amounting to 0.05 +/- 0.44 in the coaxial MICS group and -0.04 +/- 0.42 in the bimanual MICS group; the difference was not significant. CONCLUSIONS: The amount of SIA induced by bimanual MICS and coaxial MICS phacoemulsification was very small. The bimanual MICS induced a slightly higher degree of SIA; however, according to all methods of SIA analysis, there was no significant difference in the mean SIA induced by both techniques.

Comparison of early corneal endothelial cell loss after coaxial phacoemulsification through 1.8 mm microincision and bimanual phacoemulsification through 1.7 mm microincision.

PURPOSE: To compare corneal endothelial cell loss after coaxial 1.8 mm microincision cataract surgery (MICS) and bimanual 1.7 mm MICS. SETTING: Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. METHODS: The study comprised a nonrandomized prospective consecutive series of 51 eyes of 51 patients who had coaxial MICS with implantation of an MI60 foldable intraocular lens (IOL) using a 1.8 mm temporal clear corneal microincision. Fifty eyes of 50 patients who had uneventful bimanual MICS through a 1.7 mm temporal clear corneal incision for a sleeveless phaco tip and a side port for an irrigating chopper with a foldable Acri.Smart 48S foldable IOL implantation served as a reference group. Corneal endothelial cell density, intraoperative phaco power, effective phaco time, and preoperative and postoperative visual acuities were evaluated. The measurements were performed in a semiautomated masked manner. Statistical analysis was done using nonparametric tests (Wilcoxon signed rank test and Mann-Whitney U test). RESULTS: The patients were examined preoperatively and 2 weeks to 1 month postoperatively. The mean follow-up was 22.58 days +/- 5.08 (SD). Postoperatively, the mean corrected distance visual acuity (CDVA)was 0.95 +/- 13 in both groups. There was a significant decrease in endothelial cell density in both groups, 9.46% in Group 1 and 9.27% in Group 2. The between-group difference was not statistically significant (P>.05, Mann-Whitney U test). CONCLUSIONS: The visual results were excellent in both groups. Both MICS techniques enabled preservation of corneal endothelial cells equally well and were similar in terms of minor surgical trauma and the influence of surgery on corneal endothelial cell density. Our results support the use of both MICS techniques for cataract surgery.

Incidence and functional outcome of phacoemulsification complicated by posterior capsular rupture.

PURPOSE: To evaluate retrospectively anatomic and functional results of phacoemulsification with posterior chamber intraocular lens implantation, complicated by intraoperative posterior capsular rupture (PCR). MATERIAL AND METHODS: Data were gathered from medical records of 930 patients (one thousand eyes), who underwent phacoemulsification. The examined group consisted of 52 eyes of 52 patients, 27 women (52%), and 25 men (48%), 50 to 84 years old (mean age 73.52 +/- 7.8), who underwent phacoemulsification complicated by intraoperative posterior capsular rupture. The control group consisted of 427 patients, including 263 women (61.59%) and 164 men (38.41%), at the age 44 to 93 (mean age 70.3 +/- 10.2), who underwent uncomplicated cataract phacoemulsification. All patients had ophthalmic examination preoperatively, one day postoperatively and 10 to 14 days postoperatively. The evaluated data included: patients' age and gender, pre- and postoperative best corrected visual acuity, intraocular pressure, state of the anterior and posterior segment, early postoperative complications, type of implanted intraocular lens and whether anterior vitrectomy was performed. Nonparametric tests were used for statistical analysis (Wilcoxon signed-ranks test and Mann-Whitney U test). RESULTS: A statistically significant difference in postoperative BCVA between both groups was found. Mean postoperative BCVA in the PCR group was 0.63 +/- 0.27, whereas mean postoperative BCVA in the reference group was 0.78 +/- 0.18 (p < 0.001). Ten patients in the PCR group (19%), required anterior vitrectomy. In-the-bag implantation was performed in all eyes from the reference group, but it constituted only 31% (16 eyes), of the PCR group. We found that eyes with PCR are 2.6 times more likely to develop other intraoperative complications and early postoperative complications in comparison with controls. In our study eyes with PCR were about 5 times more likely to have a final BCVA worse than 0.5 than eyes from uncomplicated surgery group. CONCLUSIONS: Eyes with intraoperative PCR during phacoemulsification have a higher risk of reduced BCVA, however, it is possible to achieve good final BCVA in the majority of eyes. Appropriate intraoperative and postoperative management will usually allow to perform a successful procedure with safe placement of an intraocular lens, thus ensuring a relatively favourable outcome.

[Evaluation of visual acuity, contrast sensitivity and spherical aberrations in pseudophakic eyes with an intraocular lens]. / Ocena ostrosci wzroku, poczucia kontrastu i aberracji sferycznych w oczach pseudofakijnych z asferyczna soczewka wewnatrzgalkowa.

INTRODUCTION: The use of modern technologies enables constructing and producing perfected intraocular lenses. Recently, aspheric implants have become widely available. PURPOSE: The purpose of the study was to evaluate functional results, contrast sensitivity in scotopic conditions and spherical aberrations of the optical system of the eye after phacoemulsification with implantation of aspheric intraocular lens. MATERIALS AND METHODS: The material was gathered prospectively from January until July 2006. The examined group included patients who received aspheric intraocular lenses Adapt AO or AcrySof SN60WF and who previously had received a conventional foldable spherical lens in the fellow eye. The examined group with an intraocular lens Adapt AO consisted of 25 eyes (25 patients) and the examined group with an intraocular lens AcrySof SN60WF consisted of 12 eyes (12 patients). We examined best corrected visual acuity (BCVA) and intraocular pressure. Contrastometry in scotopic conditions and aberrometry were performed. Intraoperative and early postoperative complications were noted. For statistical analysis non-parametric U Mann-Whitney test was used, all calculations were performed for the level of significance alpha = 0.05. RESULTS: In the examined groups there were no intraoperative and early postoperative complications. In both groups, there was no statistically significant difference in mean postoperative BCVA between eyes with an aspheric implant and eyes with a spherical lens. Assuming the mean contrast sensitivity in eyes with spherical implants as 100%, we observed that in eyes with an aspheric lens it was better nearly by one third. Mean value of spherical aberrations with a pupil diameter of 5mm (Zernike RMS 5 mm) in eyes with an aspheric lens was significantly lower in comparison with eyes with a spherical implant (p < 0.05). Similarly, mean value of higher order spherical aberrations with a pupil diameter of 5 mm (Higher Order Zernike RMS 5 mm), in eyes with an aspheric lens was significantly lower in comparison with eyes with a spherical implant (p < 0.05). CONCLUSIONS: Using aspheric lenses Adapt AO and AcrySof SN60WF allows for achieving very good functional and anatomic results and it enables to achieve better contrast sensitivity in scotopic conditions, as well as significantly decreases spherical aberrations of the optical system of the eye, in comparison with conventional spherical lenses.

[Comparison of efficacy and safety of cataract phacoemulsification in patients with different degree of nuclear sclerosis]. / Porównanie wyników fakoemulsyfikacji zacmy o róznym stopniu stwardnienia jadra soczewki i bezpieczenstwa jej wykonania.

PURPOSE: To compare the course of surgery and operative outcomes in patients with different stages of nuclear hardness. MATERIAL AND METHODS: The study comprises 36 patients with hard nucleus cataract (III and IV degree in LOCS scale)--group II and 45 patients with softer types of cataract (I and II degree in LOCS scale)--group I. All patients underwent clear corneal phacoemulsification and foldable intraocular lens implantation. In both groups intraoperative course was assessed and energy with effective phaco time were measured. Visual acuity, intraocular pressure, central corneal thickness and endothelial cell density were estimated preoperatively and one week postoperatively. RESULTS: Energy and effective phaco time were significantly higher in group II. Mean visual acuity in both groups was 0.8 +/- 0.2. Intraocular pressure, central corneal thickness and endothelium cell loss were not significantly different in both groups. Endothelium cell loss were not significantly correlated with increase of energy or duration of phacoemulsification in any of groups. CONCLUSIONS: Cataracts with higher stage of nuclear hardness required more energy and effective phaco time to be employed, but it did not influenced significantly postoperative visual acuity, intraocular pressure, central corneal thickness change and loss of endothelial cells.

[Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses--long-term results]. / Fakofragmentacja soczewek zwichnigetych do komory szklistej z uzyciem plynu perfluorokarbonowego i jednoczesnym wszczepieniem soczewki wewnatrzgalkowej--wyniki odlegle.

PURPOSE: Estimation of long-term results and complications of complex surgical technique, used for the management of luxated crystalline lenses. MATERIAL AND METHODS: This prospective study involved 29 consecutive patients (31 eyes) with the mean age of 62 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 13 eyes, and scleral-fixated, posterior chamber IOLs in 17 eyes. In one patient with high myopia the lens was not implanted. The follow-up ranged between 9 and 38 months (mean 22.8 months). RESULTS: No complications were observed during phacofragmentation. Improvement in visual acuity was achieved in 18 cases one week after operation and in 23 patients at last examination. We achieved visual acuity of 4/50--hand movements in 4 cases, 5/16-5/50 in 3 eyes, 5/8-5/12 in 7 and 5/5-5/7 in 17 cases, in last examination. There were no intra-operative complications. Low visual acuity in some cases was due to the presence of postoperative complications or coexisting eye diseases, such as secondary glaucoma, atonic pupil, age related macular degeneration, retinal detachment and macular hole. CONCLUSIONS: Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses is safe and effective method, providing very good long-term functional results.

[Results of bimanual phacoemulsification with intraocular lens implantation through the micro incision]. / Wyniki operacji zacmy metoda bimanualnej fakoemulsyfikacji z wszczepieniem soczewki--wewnqtrzgalkowej przez mikrociecie.

PURPOSE: To evaluate the postoperative results of bimanual, cold phacoemulsification with foldable lens implantation through 1.7 mm incision. MATERIAL AND METHODS: Thirty four bimanual cold phacoemulsifications with Acri. Smart (AcriTec) IOL implantation through 1.7 mm incision were performed in the Department of Ophthalmology, Medical University of Lódz, between March and May 2004. In the group of 34 patients, 24 were women and 10 were men. The mean age of patients was 67 years (range between 42 and 77). Preoperative visual acuity ranged from 0.5/50 to 5/10. Mean visual acuity was 0.3. Preoperative astigmatism ranged from 0.15 to 2.3 diopters (mean 0.7). Preoperatively, nuclear density was estimated according to LOCS III classification. Twenty patients (59%) had 1 to 3 nuclear density, and 14 (41%) had 4 to 6 nuclear density. All surgeries were performed with Oertli machine using the burst mode with a sleeveless phaco tip. Postoperative examinations were conducted on the 1st and the 7th day, and I month after the surgery. Visual acuity, astigmatism, status of the cornea and IOL centration were evaluated. RESULTS: No intraoperative complications were observed. All 34 patients maintained corneal transparency with no signs of thermal damage around the wound. Visual acuity improved in all cases. Mean visual acuity in 33 patients who had no coexisting ocular diseases I month after surgery was 0.98 and the mean induced astigmatism was 0.2 diopters. In all cases IOLs were very well centred. CONCLUSIONS: Bimanual phacoemulsification is a very safe method allowing to minimise corneal incision. Using Acri. Smart IOLs, the induced astigmatism is very small, almost imperceptible to patients.

Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses.

PURPOSE: To present a complex surgical technique used for the management of luxated crystalline lenses and evaluate treatment results. SETTING: Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. METHODS: This prospective study involved 29 consecutive patients (30 eyes) with the mean age of 60.3 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection, and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 10 eyes, and scleral-fixated posterior chamber IOLs in 20 eyes. The follow-up mean was 5.2 month (range 1 to 16 months). RESULTS: No complications were observed during phacofragmentation. Visual acuity improved in 22 cases and did not change in the other 8 eyes. The mean visual acuity was 0.40 +/- 0.37 (SD) (range between hand movements and 1.0) preoperatively and 0.68 +/- 0.34 (range 0.05 to 1.0) postoperatively. In 22 cases (73%), very good or good visual acuity (6/6 to 6/12) was achieved. There were no intraoperative complications. Postoperatively, transient hypotony was observed in 10 eyes, fibrinous reaction in the anterior chamber in 1 eye, dispersed blood in the vitreous cavity in 8 eyes, hyphema in 1 eye, corneal edema in 1 eye, vitritis in 3 cases, iris tug in 1 eye with an anterior chamber IOL, and slight dislocation of the scleral-fixated IOL in 1 case. Intraocular pressure was elevated in 11 eyes preoperatively; postoperatively, it normalized in 7 eyes without medication. CONCLUSION: Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses was safe and effective method, providing good functional results.

[Intraocular pressure in early postoperative period after cataract phacoemulsification]. / Cisnienie sródgalkowe po fakoemulsyfikacji we wczesnym okresie pooperacyjnym.

PURPOSE: The purpose of this study was to investigate the pattern of intraocular pressure (IOP) change after phacoemulsification and its bearing on timing of postoperative review. MATERIAL AND METHODS: 31 eyes of 31 consecutive patients having uneventful phacoemulsification were included in this study. The IOP was measured by Goldmann applanation tonometry preoperatively and 1-3 hours, 1 day and 1 week postoperatively. The relationship between these measurements' readings were examined. RESULTS: 31 patients completed the study. The IOP checked next day was significantly correlated with the IOP preoperatively. CONCLUSION: After phacoemulsification with OIL implantation the decrease in IOP was observed in first three postoperative hours in comparison with preoperative values and it was followed by an increase on the first postoperative day. It decreased again after a week reaching values lower than preoperatively. Only in few cases (10%) a transient intraocular hypertension (23-26 mmHg) appeared on the first postoperative day.