Capsule contraction syndrome is an exaggerated reduction in anterior capsulectomy and capsular bag diameter after extracapsular cataract surgery. While rarely seen with can-opener-style capsulectomies with anterior radial capsular tears, it is relatively frequent with capsulorhexis. It is particularly common in patients with pseudoexfoliation and in eyes with a history of moderately severe uveitis. Its effects, which include extreme reduction in the capsulectomy opening, malposition of the opening, reduction in equatorial capsular diameter, and displacement of the IOL, seem more exaggerated in small capsulorhexis openings and in the older patient. Neodymium:YAG laser radial anterior relaxing capsulotomies done within three weeks of cataract surgery reduce the sphincter effect of the contraction and lessen the chronic zonular-traction-related complications of the condition, which may include spontaneous IOL dislocation and retinal detachment.

Capsule contraction syndrome

Hyaluronic acid (HA) and hydroxypropylmethylcellulose (HPMC) in buffered saline are “viscoelastics” used in ophthalmic surgery to prevent mechanical damage to delicate eye structures and to form a protective coating over corneal endothelium.

HA is a high molecular weight polysaccharide that exhibits decreasing viscosity at increased shear rates. HPMC is a cellulose derivative that exhibits low surface tension. This study examines the physical properties of HA and HPMC solutions and attempts to correlate these properties with the ability of those macromolecules to coat and protect ocular structures.

Results presented in this article suggest mixtures of HA and HPMC exhibit low surface tension and ease of aspiration characteristics that are desired in viscoelastic materials. For this reason a blend of these two macromoleculars offers handling advantages over each of these individual macromolecules. © 1994 John Wiley & Sons, Inc.

Physical properties of hyaluronic acid and hydroxypropylmethylcellulose in solution: Evaluation of coating ability

Objective To compare the outcomes of manual small incision cataract surgery (MSICS) and phacoemulsification performed by ophthalmology trainees. Design Retrospective cohort design. Setting Tertiary eye care centre. Participants A total of 1029 subjects underwent cataract surgeries with MSICS technique or phacoemulsification by trainees during one quarter (July–September 2007). Only 484 (47%) subjects were males. Surgeries which were primarily large incision extracapsular or intracapsular cataract extraction and performed on patients less than 20 years of age were excluded. Outcome measures The postoperative best corrected visual acuity (BCVA) along with the rates and types of complications were compared between both the groups. Results A total of 1029 surgeries were performed by 22 resident surgeons. In all, 522 (50.7%) were done using MSICS technique and 507 (49.2%) were done by phacoemulsification. Those in the MSICS group were significantly older (age >70 years; 5.7% vs 3.4%; p Conclusions Although the complication rate was higher in the MSICS group, there was no difference in BCVA in both the groups.

https://bmjopen.bmj.com/content/bmjopen/2/5/e001035.full.pdf

Comparative outcomes of manual small incision cataract surgery and phacoemulsification performed by ophthalmology trainees in a tertiary eye care hospital in India: a retrospective cohort design.

Purpose. To assess the particularities of extracapsular cataract extraction and posterior chamber intraocular lens implantation in patients with Fuchs' heterochromic iridocyclitis. Methods. Retrospective analysis of 24 extracapsular cataract operations performed from September 1991 to June 1994. Our technique - a slight modification of Blumenthal's technique - included a triplanar watertight small scleral incision, an envelope capsulotomy, nucleus hydrodissection and hydroexpression, anterior chamber maintainer use, thorough residual cortex removal through a side-port corneal incision and in the bag posterior chamber intraocular lens implantation. Results. Mydriasis was slightly larger than 5 mm in 79.16% of the total group. Posterior capsule rupture with vitreous loss occurred in one and without in two patients. A transient rise in intraocular pressure was seen in seven patients and a mild anterior chamber reaction in almost all patients. No bleeding occurred during anterior chamber opening, or postoperative I. O. L. decentration or glaucoma. Best corrected postoperative visual acuity ranged from 5-10/10 in 21 patients (87.50%). Conclusions. Extracapsular cataract extraction in patients with Fuchs' heterochromic iridocyclitis does not currently present any difficulties compared with normal senile cataract. No major complications occurred and the final visual acuity was satisfactory.

Cataract surgery in Fuchs' heterochromic iridocyclitis.

Retrobulbar haemorrhage (RBH) is the most common complication of retrobulbar anaesthesia. Following such haemorrhage the patient is traditionally discharged from hospital the following day and readmitted a month or so later to undergo surgery, preferably under general anaesthesia. Such a practice no doubt causes anxiety and disappointment for both the surgeon and the patient. This retrospective study was based at Victoria Hospital, Kirkcaldy, where most of the patients who develop RBH have repeat surgery under general anaesthesia or, if not suitable, under local anaesthesia within 2-4 days of the incident. The study showed that if certain guidelines are followed, then it is quite safe to proceed with planned surgery soon after the haemorrhage and that long postponement is not necessary.

/pdf/retrobulbar-haemorrhage-when-should-we-operate-5bfi1n47o7.pdf

Retrobulbar haemorrhage: when should we operate?

The surgical rehabilitation of vision

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The surgical rehabilitation of vision