The results of this study indicate high patient satisfaction with the Array multifocal IOL and greater functional independence from spectacle wear, by objective and subjective patient measures, than with the monofocal IOL.
In the past year, harmony has developed among diverse areas of research in cataractogenesis. A number of epidemiologic studies have identified new, or strengthened the role of previous, risk factors in the development of cataract. Age, tobacco smoking, alcohol consumption, and inhaled corticosteroids have been implicated. Clinical observation of cataract in diseases such as cystic fibrosis, atopic dermatitis, Alzheimer's disease, and mitochondrial cytopathy have led to hypotheses of formation. The basic science research has, in some cases, given support to the clinical hypotheses, especially with respect to the role of estrogens and protein condensation in cataract as well as other systemic diseases. Although oxidative stress continues to be the leading proposed mechanism of cataractogenesis, genetic mechanisms are gaining increasing popularity. Finally, the results of previously contraindicated surgical management of cataract in the setting of advanced diabetic ocular disease and age-related macular disease are highlighted.
A prospective, randomized, observer-marked study was conducted to compare corneal endothelial and intraocular pressure (IOP) changes after cataract surgery with the viscoelastic agents Amvisc Plus and Viscoat. Forty-nine patients (50 eyes) who had uncomplicated phacoemulsification and implantation of a posterior chamber intraocular lens were randomly assigned to either Amvisc Plus (25 eyes) or Viscoat (25 eyes) groups. Surgical technique was rigidly standardized in all cases. No significant difference in endothelial parameters or postoperative IOPs measured at 24 hours, one week, and two months was detected by analysis of variance between the Amvisc Plus and the Viscoat groups. Visualization was difficult with Viscoat because of its tendency to retain bubbles. Phacoemulsification energy was related to a loss of endothelial density, regardless of the viscoelastic used. The postoperative beta blocker may have contributed to the lower average postoperative IOP than has been reported.
Implantation of an intraocular lens following vitreous loss at cataract surgery is a controversial decision. To address this issue, we retrospectively identified all cases performed at the University of Minnesota in the last three years that had either a posterior or an anterior chamber lens placed following anterior vitrectomy. Twenty patients had a posterior chamber lens implant; 14 had follow-up longer than six months. All these patients achieved 20/40 or better visual acuity, although one patient had a retinal detachment. Of the six patients with an anterior chamber lens implant, four achieved 20/40 or better acuity and two achieved 20/50 acuity with follow-up of six months; one patient had a retinal detachment. This review demonstrates that with a meticulous anterior vitrectomy, good visual results can be achieved, although the risk of retinal detachment is higher than in uncomplicated cases.
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