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Objective This paper presents the incidence, causes, and management of posterior capsule (PC) tears and their postoperative outcomes in a large series of eyes that underwent cataract removal and intraocular lens (IOL) implantation, operated on by one surgeon. Design Retrospective, noncomparative case series. Participants Eighteen thousand four hundred seventy consecutive eyes (1992–1999) were reviewed with the assistance of electronic medical records for incidence of PC tears in patients seeking treatment at an outpatient cataract surgery clinic. Intervention Eyes in this series underwent continuous curvilinear capsulorrhexis (CCC), nucleofractis phacoemulsification, and IOL implantation under topical anesthesia. Different intraoperative surgical strategies such as posterior continuous curvilinear capsulorrhexis (PCCC) were used in the management of PC tears. Main outcome measures Routine preoperative and postoperative visual and refractive outcomes were recorded, including incidence of lens capsule tears, IOL position, and postoperative complications. Results Posterior capsule tears occurred in 83 of 18,470 eyes, resulting in an overall incidence of 0.45%. Of these 83 eyes with PC tears, 49% received vitrectomy. Fifty-one of 83 PC tears (61.4%) were amenable to be converted to PCCC. Of these 51 procedures, 50 eyes had PC IOL in-the-bag fixation. One eye had PCCC with optic capture. There were no eyes with dropped nuclei or nuclear fragments requiring pars plana vitrectomy. Seventeen eyes (20.5%) had Neuhann anterior capsule rhexis fixation with the haptics placed in the sulcus and IOL securely in the bag. Ten eyes (12.1%) had the IOL placed in the sulcus, and 5 eyes (6.0%) required anterior chamber IOL fixation. None of the 83 PC tears resulted in clinically evident cystoid macular edema, retinal detachment, or endophthalmitis. Conclusions With an intact CCC and with conversion of PC tears to PCCC, in-the-bag fixation of IOLs can be achieved in most eyes.

Objective To compare the rate of refractive growth in pseudophakic children's eyes to that of aphakic eyes. Design Multicenter, retrospective observational case series. Participants 83 patients with pseudophakic eyes (100 eyes) and 74 patients with aphakic eyes (106 eyes), with an age of surgery between 3 months and 10 years and a minimum follow-up time of 3 years or more, depending on the age at surgery. Methods A logarithmic model was used to analyze the rate of refractive growth for each eye. Main outcome measures Age at surgery, intraocular lens power, intraocular lens A-constant, initial postoperative refraction, final refraction, and final age. Results Overall, pseudophakic eyes showed a lesser rate of refractive growth than aphakic eyes (−4.6 diopter vs. −5.7 diopter, P = 0.03). This trend was also present but less significant when the eyes were grouped into those less than 6 months of age at surgery (−3.3 diopter vs. −4.6 diopter, P = 0.09) and older patients (−5.0 diopter vs. −6.1 diopter, P = 0.07). However, the mean quantity of myopic shift was greater in pseudophakic eyes than in aphakic eyes (−5.26 diopter vs. −4.54 diopter), despite shorter follow-up times in the pseudophakic eyes. This is due to the optical effects of a constant intraocular lens power in a growing eye. Conclusions Pediatric pseudophakic eyes have a slightly lesser rate of refractive growth than aphakic eyes. The new rate values should be used for predicting future refractions in these eyes.

Objective To compare the safety and efficacy of simultaneous bilateral to sequential bilateral laser in situ keratomileusis (LASIK) surgery for the correction of myopia. Design Retrospective, nonrandomized, comparative trial. Participants A total of 2142 consecutive simultaneous and sequential bilateral myopic LASIK surgery eyes operated from March 1996 through June 1998 for the correction of myopia were reviewed. Intervention Two surgeons (HVG and JAV) performed myopic LASIK using the Nidek EC-5000 excimer laser and either the Chiron Automated Corneal Shaper or the Bausch & Lomb Hansatome microkeratome. Main outcome measures The incidence of intra- or perioperative complications for sequential and simultaneous bilateral LASIK for myopia was recorded. Refractive and visual outcomes at 3 to 6 months postoperative were analyzed. Deviations from targeted spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and retreatment rates are reported. Results Laser in situ keratomileusis was performed on the first eye of 1853 patients scheduled for simultaneous bilateral myopic LASIK. Of these, 28 (1.5%) first eyes had intraoperative or perioperative complications. The second eye surgery was cancelled in 11 cases, and 1842 second eyes completed simultaneous surgery; 13 (0.7%) intraoperative or perioperative complications occurred. Of these 41 complications in simultaneous cases, 1 eye lost 1 line of BCVA at 6 months follow-up. Two hundred eighty-nine patients were scheduled for sequential bilateral myopic LASIK. Five (1.8%) first eyes of the sequential cases had intraoperative complications compared with four (1.4%) sequential second eyes. There was no loss of BCVA in any sequential bilateral case with complications at a minimum at 6 months follow-up. There was no statistically significant difference between intra- and perioperative complication rates comparing simultaneous to sequential bilateral LASIK. Three to 6 months postoperative visual and refractive data were reviewed; except when comparing simultaneous first eye postoperative SE to sequential first eye, there was no statistically significant difference in refractive or visual outcomes, including deviation from targeted SE, UCVA, BCVA, and retreatment rates. Conclusion Simultaneous bilateral LASIK is as safe and effective as sequential surgery. Simultaneous bilateral LASIK may offer several benefits to the patient.

Objective To identify intraoperative and early postoperative complications of laser in situ keratomileusis (LASIK) surgery learning curve and to offer recommendations on prevention and management. Design Retrospective noncomparative case series. Participants The first 1000 consecutive myopic LASIK eyes (April 1995-February 1997) operated on by one surgeon (HVG) were examined. Intervention Myopic LASIK surgery was performed with the Chiron Corneal Shaper and NIDEK EC-5000 excimer laser. Main outcome measures The preoperative and 6-month postoperative spherical equivalent, best-corrected visual acuity, and corneal status were recorded, as was the incidence of intraoperative and early postoperative complications. The rate of retreatments was also recorded. Results There were 32 (3.2%) intraoperative complications and surgical events recorded, including 19 (1.9%) microkeratome-related flap complications and 13 (1.3%) nonmicrokeratome-related surgical events such as inability to obtain sufficient suction. There were 18 (1.8%) postoperative complications requiring repositioning of microwrinkled or shifted flaps. Six-month spherical equivalent was −0.52 diopter [D] ± 1.19 D for eyes with microkeratome complications, −0.56 D ± 1.07 D for the group with nonmicrokeratome-related intraoperative events, and −0.78 D ± 0.92 for eyes requiring postoperative flap repositioning. None of the 32 eyes with intraoperative complications and surgical events lost 2 or more lines of vision. One eye in the postoperative complications group lost two lines of vision. The rate of microkeratome complications related to surgical technique and the overall surgery times decreased over the course of the first 1000 myopic LASIK cases. Conclusion The complications encountered during the early learning curve of LASIK surgery have not in this series resulted in a significant loss of best-corrected visual acuity. With increasing surgical experience, the incidence of complications, along with surgical times, has decreased.

Objective: A retrospective study was undertaken to evaluate long-term anatomic and visual outcomes in eyes of children who underwent bilateral intraocular lens implantation. Design: The study design was a review of medical records of 24 children operated on for bilateral cataracts and posterior chamber-intraocular lenses. Participants: Twenty-four children operated on for bilateral cataracts by 1 surgeon between February 1980 and February 1995 were studied. Intervention: Cataract extraction with bilateral posterior chamber-intraocular lens implantation was performed. Main Outcome Measures: Best-corrected visual acuity, visual acuity without correction, intraocular pressure, manifest refraction, and any intraoperative or postoperative complications were measured. Results: At last follow-up (mean follow-up, 50.8 months; range, 10–149 months), the intraocular lens was in good position and the intraocular pressure was normal without medication in all eyes. Four years after surgery, 79.2% (19 of 24) of first eyes achieved a best-corrected visual acuity of 20/40 or better compared to 66.7% (16 of 24) of second eyes. No eye had any loss in best-corrected visual acuity. In first eyes of 3- to 8-year olds at the time of surgery, 73.3% (11 of 15) achieved a spherical equivalent within 2 diopters of the intended at 4 years after surgery compared to 80% of second eyes. In the 9- to 18-year-old group, 88.9% (8 of 9) of first eyes and 100% of second eyes achieved a spherical equivalent within 2 diopters of the intended at 4 years after surgery. Intraoperative and postoperative complications were minimal. Conclusions: Long-term anatomic and visual results have been gratifying in this series of patients with bilateral implants.

Background: A major concern in pediatric intraocular lens implantation surgery is the high incidence of posterior capsule opacification. The purpose of this article is to investigate a surgical technique for maintaining a clear visual axis after pediatric cataract and intraocular lens surgery. Methods: In a prospective evaluation, posterior capsulorhexis with optic capture as a surgical technique for preventing secondary membrane formation after pediatric cataract extraction is investigated. This technique involves capture of an intraocular lens optic through a posterior curvilinear capsulorhexis opening. Perioperative complications and incidence of secondary cataract are presented. Results will be compared to an historic cohort of patients with pediatric cataract- intraocular lens who did not have posterior continuous curvilinear capsulorhexis with optic capture. Results: In 13 consecutive eyes operated on in children aged 2 to 12 years (mean, 5.8 years), there was no opacification of the visual axis at a mean follow-up of 19 months after surgery (range, 8–30 years). Conclusion: Posterior capsulorhexis with optic capture holds promise as a technique for preventing secondary membrane formation. This maneuver ensures centration of the posterior chamber intraocular lens while eliminating the need for an anterior vitrectomy. Apposition of the anterior and posterior capsule leaflets anterior to the optic may limit the migration of Elschnig pearls, reducing the incidence of secondary membranes and the need for additional procedures.

To compare the rate of refractive growth in pseudophakic children's eyes to that of aphakic eyes.Multicenter, retrospective observational case series.83 patients with pseudophakic eyes (100 eyes) and 74 patients with aphakic eyes (106 eyes), with an age of surgery between 3 months and 10 years and a minimum follow-up time of 3 years or more, depending on the age at surgery.A logarithmic model was used to analyze the rate of refractive growth for each eye.Age at surgery, intraocular lens power, intraocular lens A-constant, initial postoperative refraction, final refraction, and final age.Overall, pseudophakic eyes showed a lesser rate of refractive growth than aphakic eyes (-4.6 diopter vs. -5.7 diopter, P = 0.03). This trend was also present but less significant when the eyes were grouped into those less than 6 months of age at surgery (-3.3 diopter vs. -4.6 diopter, P = 0.09) and older patients (-5.0 diopter vs. -6.1 diopter, P = 0.07). However, the mean quantity of myopic shift was greater in pseudophakic eyes than in aphakic eyes (-5.26 diopter vs. -4.54 diopter), despite shorter follow-up times in the pseudophakic eyes. This is due to the optical effects of a constant intraocular lens power in a growing eye.Pediatric pseudophakic eyes have a slightly lesser rate of refractive growth than aphakic eyes. The new rate values should be used for predicting future refractions in these eyes.

To compare the safety and efficacy of simultaneous bilateral to sequential bilateral laser in situ keratomileusis (LASIK) surgery for the correction of myopia.Retrospective, nonrandomized, comparative trial.A total of 2142 consecutive simultaneous and sequential bilateral myopic LASIK surgery eyes operated from March 1996 through June 1998 for the correction of myopia were reviewed.Two surgeons (HVG and JAV) performed myopic LASIK using the Nidek EC-5000 excimer laser and either the Chiron Automated Corneal Shaper or the BauschLomb Hansatome microkeratome.The incidence of intra- or perioperative complications for sequential and simultaneous bilateral LASIK for myopia was recorded. Refractive and visual outcomes at 3 to 6 months postoperative were analyzed. Deviations from targeted spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and retreatment rates are reported.Laser in situ keratomileusis was performed on the first eye of 1853 patients scheduled for simultaneous bilateral myopic LASIK. Of these, 28 (1.5%) first eyes had intraoperative or perioperative complications. The second eye surgery was cancelled in 11 cases, and 1842 second eyes completed simultaneous surgery; 13 (0.7%) intraoperative or perioperative complications occurred. Of these 41 complications in simultaneous cases, 1 eye lost 1 line of BCVA at 6 months follow-up. Two hundred eighty-nine patients were scheduled for sequential bilateral myopic LASIK. Five (1.8%) first eyes of the sequential cases had intraoperative complications compared with four (1.4%) sequential second eyes. There was no loss of BCVA in any sequential bilateral case with complications at a minimum at 6 months follow-up. There was no statistically significant difference between intra- and perioperative complication rates comparing simultaneous to sequential bilateral LASIK. Three to 6 months postoperative visual and refractive data were reviewed; except when comparing simultaneous first eye postoperative SE to sequential first eye, there was no statistically significant difference in refractive or visual outcomes, including deviation from targeted SE, UCVA, BCVA, and retreatment rates.Simultaneous bilateral LASIK is as safe and effective as sequential surgery. Simultaneous bilateral LASIK may offer several benefits to the patient.

One hundred forty-nine selected patients with bilateral multifocal intraocular lenses (IOLs) were evaluated and compared retrospectively with 131 patients with bilateral monofocal IOLs. Seventy-eight percent of multifocal cases and 74.8% of monofocal cases had uncorrected visual acuity of 20/40 or better. Fifty-four percent of multifocal cases had near uncorrected visions of J1 to J3. Eighteen percent had best-corrected near vision of J4 or worse. Sixty-three percent of multifocal cases versus 4% of monofocal cases needed no spectacle correction. Multifocal cases reported significantly more visual side effects (flare, glare, and halos). The 10% of cases with poor satisfaction (rating vision as fairto-poor) had significantly ( P = 0.03) more postoperative astigmatism (1.1 prism diopters [D] versus 0.74 D) compared with satisfied (good-to-excellent) cases. Patients who were dissatisfied reported more need for corrective lenses but not more side effects. A greater decrease in contrast sensitivity at low contrast levels was detected among multifocal cases. Both groups had similar contrast sensitivity at 96% and 50% contrast, but at 11 % contrast, multifocal cases averaged a loss of 3.45 Snellen lines (to 20/48.2) compared with 2.65 lines (to 20/36) for monofocal cases.

The author conducted a six-group, randomized, clinical trial to compare the relative efficacies of use of preoperative topical Ocufen (flurbiprofen), or Indocid (indomethacin, Indocin), with and without concurrent intraoperative epinephrine treatment; epinephrine treatment alone; and placebo in maintaining surgical mydriasis produced by preoperative administration of phenylephrine and cyclopentolate before cataract intraocular lens (IOL) surgery. Two hundred sixteen cases were randomized to receive one of the six treatment combinations. The treatment groups not receiving epinephrine (placebo, Indocid, Ocufen) had average percent decreases in pupil diameter of 19 to 24%, whereas groups receiving epinephrine (with or without Ocufen or Indocid), had decreases of only 0.8 to 2.6%. The effect of epinephrine treatment was significant (P less than 0.0001), regardless of nonsteroidal anti-inflammatory drug (NSAID) treatment. Indocin patients (without epinephrine) had less miosis than placebo patients; the proportion of cases with large decreases in pupil diameter (greater than or equal to 2 mm) was reduced by approximately 50%. Ocufen had an additive effect with epinephrine; the group with Ocufen + epinephrine treatment had a smaller proportion of cases with pupil size decreases than the group with epinephrine alone.