Retinal detachment following phacoemulsification in highly myopic cataract patients.

PURPOSE: To assess whether modern, small incision phacoemulsification techniques significantly reduce the retinal detachment (RD) risk in highly myopic patients who have visually significant cataracts. SETTING: University-associated ophthalmology practice. METHODS: This retrospective study included 80 eyes in 61 patients with preoperative myopia of 7.00 diopters (D) or more. Sixty-four eyes had an axial length of 25.0 mm or greater. All surgery was performed superiorly using a frown-shaped, self-sealing, scleral tunnel. The incision size ranged from 3.0 to 5.0 mm. Capsulorhexis was performed and then four-quadrant cracking phacoemulsification. The posterior capsule was routinely polished. A posterior chamber intraocular lens (IOL) was implanted in the capsular bag in all cases. RESULTS: No RDs occurred during the mean follow-up of 43 months (range 9 to 77 months) or the mean follow-up after neodymium:YAG capsulotomy of 20 months. No intraoperative complications occurred. Seventy-one of 80 eyes (89%) achieved best spectacle-corrected visual acuity of 20/25 or better. CONCLUSIONS: Retinal detachments following modern cataract surgery in high myopia are much less common than previously reported. We attribute this to small incision size, continued maintenance of the anterior chamber, posterior chamber IOL implantation, and lack of intraoperative complications.

Visual significance of glistenings seen in the AcrySof intraocular lens.

PURPOSE: To investigate the visual significance of "glistenings" in acrylic intraocular lenses (IOLS). SETTING: John Moran Eye Center, University of Utah, Salt Lake City. METHODS: Seventeen patients who had phacoemulsification with implantation of the AcrySof acrylic IOL were evaluated by slitlamp examination and visual acuity, contrast sensitivity, and glare testing. Ten patients had a silicone posterior chamber IOL in the opposite eye and had testing with similar visual parameters for comparison. Glistenings noted in the acrylic IOLs were graded at the slitlamp. Laboratory analysis of five acrylic IOLs was also done to reproduce the glistenings noted clinically. RESULTS: All 17 patients with the acrylic IOLs had some lenticular glistenings, ranging from trace to 2+. Statistical analysis of visual acuity, contrast sensitivity, and glare testing revealed a statistically significant difference between the acrylic and the silicone IOLs only in contrast sensitivity. Laboratory analysis of the acrylic IOLs showed similar glistenings from 48 to 72 hours after they were placed in balanced salt solution. CONCLUSIONS: A patients who received AcrySof IOLs that came in the AcryPak had some degree of glistenings. There was also a significant decrease in contrast sensitivity compared with that of fellow eyes with silicone IOLs. The glistenings are likely caused by water vacuoles that form within the lens after hydration within the eyes. Further studies are necessary to assess the exact cause of these glistenings.

Clinical types of corneal transplant rejection. Their manifestations, frequency, preoperative correlates, and treatment.

We report a retrospective series of 156 penetrating keratoplasties that were performed in 144 patients during a two-year period, with a minimum of one-year follow-up. Three different types of rejection were identified--endothelial rejection, epithelial rejection, and subepithelial infiltrates (SEIs). We also report the clinical signs, frequency, preoperative correlates, significance, and treatment of each type of rejection. The overall frequency of any kind of rejection was 29%. Endothelial rejection was seen in 21% of the grafts, epithelial rejection was seen in 10% of the grafts, and SEIs was seen in 15% of the grafts. The frequency of endothelial rejection increased with preoperative corneal vascularization. All three types of rejection decreased in frequency with the increasing age of the recipient. Endothelial rejection was more successfully treated in the cases that had no preoperative stromal vascularization.

Subepithelial infiltrates: a probable sign of corneal transplant rejection.

A previously undescribed slit-lamp manifestation of a probable corneal transplant rejection reaction was found in 22 patients among 145 who underwent penetrating keratoplasty during a two-year period. The reaction consisted of subepithelial infiltrates that were located only in the donor tissue; were without associated conjunctivitis; and that occurred six weeks to 21 months postoperatively, either alone or in association with epithelial and/or endothelial rejection; and that responded well to topical corticosteroid treatment. In one case, the subepithelial infiltrates preceded a severe endothelial rejection by only a few days. The lesions are a warning that all is not well and that corticosteroid therapy should be instituted or increased.