Neodymium:YAG laser cutting of polymethylmethacrylate and polypropylene anterior chamber and posterior chamber intraocular lens haptics was studied in terms of ease of transection and physical structure of the cut areas as seen by scanning electron microscopy. A marked difference was discovered, with the polymethylmethacrylate cutting easily along transverse planes, whereas the polypropylene resisted cutting along longitudinal fibers. Clinical guidelines are presented.
Posterior capsulotomy is occasionally performed at the conclusion of extracapsular cataract extraction because of the high incidence of secondary membrane formation. Using a Nd:YAG laser we successfully performed posterior capsulotomies on 16 children who developed secondary membranes following extracapsular cataract extraction in which the posterior capsule was left intact. Eleven patients had congenital cataracts and five had acquired cataracts. The youngest patient was four years. All had improvement in visual acuity. Preserving most of the posterior capsule provides additional support to the eye and has been associated with a decreased incidence of cystoid macular edema. It also allows secondary implantation of a posterior chamber intraocular lens in the future.
Since 1976 I have used a solution of hydroxypropyl methycellulose to prevent corneal endothelial damage during intraocular lens implantation. The substance is inexpensive, readily available, and can be easily dissolved. This paper describes preparation of a 2% solution.
A case is presented of a Medallion intraocular lens that dislocated posteriorly into the vitreous cavity. Four years later the lens spontaneously repositioned itself and was subsequently sutured in place.
Corneal endothelial cell loss is compared in four types of cataract procedures with intraocular lens implants performed by the authors. A total of 110 intracapsular cataract extractions, 182 extracapsular cataract extractions and 107 phacoemulsifications, divided into 47 anterior chamber emulsifications and 60 posterior chamber emulsifications (all with intraocular lens implants) are compared. A significant feature of these procedures is the incidence of endothelial cell loss greater than 1,200 cells/mm2. This occurred in 1% of the intracapsular cataract extractions, 4% of the planned extracapsular cataract extractions, 13% of the posterior chamber phacoemulsifications, and 17% of the anterior chamber phacoemulsifications. Pachymetry is a poor method for judging operative corneal endothelial trauma. Based upon the results of this study, it remains to be seen whether the advantages of phacoemulsification mitigate against the increased incidence of significant endothelial cell loss.
A fungal organism, identified as Ulocladium, was isolated from an unopened 15 ml bottle of balanced salt solution. The authors note the importance of visually inspecting solutions used in ophthalmic surgery.
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