Aphakic macular oedema following prosthetic lens implantation.

Abstract

SUMMARY Fluorescein angiography of the iris was performed on patients with plastic lens implants with cystoid oedema of the macula, and the nature of the vascular changes was compared with controls provided by patients who did not have macular disease. Densitometry was used to quantitate leakage of fluorescein dye into the anterior chamber in residual angiograms 5 minutes after injection. Cystoid oedema was associated with marked increase in vascular permeability of the iris in the patients with implants, and in aphakics without implants, but to a lesser degree. Although it cannot be concluded that implants themselves cause either the increase in permeability or the onset of macular oedema, the presence of such implants must be considered an additional hazard in an eye which is already at risk. Iris angiography can be used as a diagnostic aid in patients in whom macular oedema is suspected. A persistent increase in permeability associated with a reduction in visual acuity should act as a warning of further visual loss and of eventual cystoid macular degeneration.With the increasing use of prosthetic lens implantation following cataract extraction, the nature and incidence of operative and postoperative complications are being investigated in more depth. Postoperative anterior uveitis, retinal detachment, acrylic lens dislocation, glaucoma, bullous keratopathy, and cystoid macular oedema have all been reported, but it is the macular disease which is particularly a cause for disappointment to the patient and concern for the ophthalmic surgeon.Macular oedema and visual loss following cataract extraction were originally described by Irvine (1953) as being associated with irritability of the eye and also rupture of the anterior hyaloid membrane leading to vitreous strands adhering to the section. Gass and Norton (1969) stated that adherence and traction were not a necessity for the development of macular oedema but when present tended to worsen the condition. In a study of macular disturbance 6 weeks after cataract extraction (Hitchings et al., 1975) transient oedema occurred in 50% of patients examined. No such changes developed in a group of controls who had glaucoma surgery. The authors

Iris Angiography after Cataract Extraction and the Effect of Indomethacin Eyedrops

“…This finding was also noted in the treated group. This result agrees with that of Easty et al [12], who used den sitometry. The above results do suggest, as Miyake described, that prostaglandins or other indomethacin-sensitive factors which are produced by surgical stimulation are associated with the onset of CME.…”

“…It is also possible to attribute vasculitis of the entire ocular tissue of a CME patient, which Mar lin et al [13] found on histopathological specimens, to prostaglandins. Increasing ac tivities of these factors have been actually observed by measurements of prostaglandin E and F2a in the aqueous humor, preoperatively, and 1 week after operation [14], Easty et al [12] did not observe the increase of prostaglandins El and E2 from chronic CME patients, but the number of his cases was small. ///// [ 14], followed by many au thors [15], performed anterior vitrectomy for the removal of vitreous-surgical wound ad hesions in patients with CME, and in general they produced a marked improvement.…”

Effect of lens implants on iris fluorescein angiography and the iris pigment layer

“…According to Easty et al (1977) examination by fluorescein angiography, in the absence of cystoid macular oedema, showed no evidence of vascular disturbance in eyes with intraocular lens implants. Ellingson ( 1978) described the UGH-syndrome with severe vascular complications.…”

“…Post-operatively both pupillary margin and radial vessel will leak dye, the same finding will be noticed whether an intraocular lens has been inserted or not. There is no difference in the recovery time (Easty et al 1977).…”

Indomethacin eyedrops and the postoperative irritation after extracapsular cataract extraction combined with intraocular lens implantation

“…Prostalandins have the following effects upon the eye: miosis, rise of intraocular pressure, vasodilation in iris and ciliary body, breakdown of blood-aqueous barrier and cystoid macular edema (Cole and Unger, 1973;Easty et al, 1977;Neufeld and Sears, 1973;Podos and Becker, 1976;Unger et al, 1975). Indomethacin, belonging to the group of prostaglandin inhibitors, is claimed to diminish these effects after the posttraumatic (surgical) release of prostaglandin E and F2a (Bhattacherjee and Eakins, 1974;Eakins, 1977;Katz, 1981).…”