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Query: UMLS:C0086543 (cataract)
 29,165 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

If the theoretical advantages of krypton laser over argon laser are proven clinically, this modality will be an important adjunct in the management of many of the leading causes of blindness. Our preliminary observations in over 400 cases treated with krypton laser correlate well with the theoretical and histopathologic observations of others. Possible advantages of krypton laser therapy for choroidal neovascularization (CNV) include its ability to penetrate foveal xanthophyll and retinal blood vessels and to minimize damage to the nerve fiber layer. Krypton also penetrates the xanthochrome in nuclear sclerotic cataract. The major disadvantage is increased choroidal hemorrhage. In proliferative retinopathies krypton penetrates moderate vitreous hemorrhage. It may minimize both epiretinal membrane changes and continuation of vitreo-retinal traction. It can be used after fluorescein injection. Disadvantages include increased choroidal hemorrhage and increased pain, often requiring retrobulbar anesthesia. Krypton laser cannot close surface neovascularization or stop bleeding by photocoagulating its source. The role of argon laser in CNV or how it benefits proliferative retinopathies is still not understood. The Macular Photocoagulation Study will help define the role of argon and krypton laser for CNV. A similar clinical trial to compare the efficacy of krypton laser to the proven efficacy of argon laser in the treatment of proliferative diabetic retinopathy is still anticipated.
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PMID:Red krypton laser therapy of macular and retinal vascular diseases. 618 65

The potential complications of cataract surgery in the general population are well known. In addition, cataract extraction in the patient with diabetes mellitus is associated with other potential complications common to this disease: neovascular glaucoma and acceleration of proliferative diabetic retinopathy with or without vitreous hemorrhage. We analyzed the records of 154 patients with diabetes mellitus who had undergone standard intracapsular cataract extraction in one eye only with the other eye serving as the unoperated control eye. We were able to determine the status of the diabetic retinopathy before the operation and to note the development of vitreous hemorrhage and rubeosis iridis/neovascular glaucoma after the operation. If either event occurred within six weeks of the surgery, it was considered to be a complication of the cataract extraction. Intracapsular cataract extraction in this diabetic population, without regard of the preoperative status of the retinopathy, was associated with a statistically significant incidence of postoperative rubeosis iridis/neovascular glaucoma (7.8% vs 0%). In patients with preoperative active proliferative diabetic retinopathy, the risk of developing postoperative rubeosis iridis/neovascular glaucoma was even higher (40% vs 0%). There was also a statistically significant incidence of vitreous hemorrhage after surgery in eyes with no diabetic retinopathy or background diabetic retinopathy (6.5% vs 0%). In patients with active proliferative diabetic retinopathy, there was an increased incidence of vitreous hemorrhage after surgery (20% vs 6.5%), but this was not statistically significant due to the small number of patients studied. Possible explanations for these findings are explored and therapeutic and prophylactic measures recommended.
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PMID:Neovascular glaucoma and vitreous hemorrhage following cataract surgery in patients with diabetes mellitus. 619 91

Visual acuity was measured in a population-based study of diabetic retinopathy in southern Wisconsin. Persons diagnosed prior to 30 years of age and taking insulin (younger onset, n = 996) and those diagnosed at 30 years of age or older (older onset, n = 1370) were examined. Best corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol. In the younger onset group, 1.4% had moderate visual impairment (best corrected visual acuity in the better eye of 20/80 to 20/160) and 3.6% were legally blind (visual acuity in the better eye of 20/200 or worse). Visual impairment in this group was associated with older age at examination, longer duration of diabetes, presence of proliferative retinopathy, and presence of senile cataracts. In the older onset group, 3.0% had moderate visual impairment and 1.6% were legally blind. Visual impairment in this group was associated with older age at examination, longer duration of diabetes, presence of senile cataract, presence of macular edema, and proliferative diabetic retinopathy. When assigning causes of impaired vision, diabetic retinopathy was responsible in part for 86% of eyes with visual acuity of 20/200 or worse in younger onset persons and for 33% in older onset persons.
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PMID:Visual impairment in diabetes. 670 12

The histological examination of the vitreous body after partial vitrectomy in the rabbit eye shows a rarefication and coarsening of the vitreous fibres after refilling the vitreous cavity either with sodium hyaluronate, regular Ringer solution or with Ringer-lactate solution containing dextrose and sodiumbicarbonate. An analysis of postoperative results of 139 eyes yields the following conclusions: 1. Removal of clear lenses is not justified since following vitrectomy the vitreous body in aphakes is not significantly clearer than in phakic eyes. 2. Moderate lens opacities do not constitute an indication for cataract surgery, they have been found to progress following vitrectomy only in 5% of the cases. 2. Important factors in the development of postoperative keratopathy are: Presence or absence of the corneal epithelium, type of contact lens used, age of the patient, stage of a diabetic retinopathy, duration of the surgical procedure, and the combined removal of lens and vitreous body via pars plana. 4. Rubeosis iridis indicates a terminal stage of the diabetic retinopathy and cannot be considered a complication of vitrectomy. 5. Postoperative haemorrhage occur at almost equal rate either with or without the intraocular application of daithermy, however, diathermy-coagulation has been applied only in advanced stages of proliferative diabetic retinopathy. 6. In the course of lavage of the vitreous cavity in cases of recurrent haemorrhages a progression of diabetic retinopathy was usually observed. Vitreous lavage within short periods of time, preferentially with 6 to 8 weeks following the initial procedure is therefore recommended in cases of recurrent haemorrhages.
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PMID:[Vitrectomy via pars plana. A histological study and an analysis of clinical results (author's transl)]. 676 57

Vitreous surgery is often necessary to treat proliferative diabetic retinopathy. Sometimes cataract-extraction is indicated. A series of 37 eyes with ECCE, PC-IOL and vitrectomy in one operation is reviewed.
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PMID:Extracapsular lens extraction with posterior chamber lens implantation and vitrectomy for diabetic proliferative retinopathy in one operation. 749 23

Release of angiogenic factors in response to the ischaemic retina is currently the most favoured hypothesis for the pathogenesis of proliferative diabetic retinopathy. Reducing the stimulus for angiogenesis by destroying the ischaemic retina also forms the basis of the most effective treatment of diabetic retinopathy by photocoagulation. Though ischaemia is undoubtedly important for neovascularization, there is recent evidence which cast doubts on ischemia being the sole mechanism for diabetic retinopathy. Many clinical observations viz. the protective effects of glaucoma, myopia, unilateral carotid stenosis on diabetic retinopathy; and its worsening after cataract extraction are not adequately explained by the present hypothesis. Moreover, the recent in vitro culture studies on retinal pigment epithelial cells have suggested an alternative explanation for the effectiveness of photocoagulation in proliferative diabetic retinopathy. Furthermore, hyperglycemia has been strongly correlated with the incidence and progression of diabetic retinopathy, but has only been indirectly indicted in its pathogenesis. These facts can be integrated into a more plausible hypothesis for the pathogenesis of diabetic retinopathy. It is hypothesized that a relative reduction in intra-ocular pressure caused by persistent or intermittent hyperglycemia may be the missing link that induces certain morphological changes in the retinal pigment epithelium. These changes, in addition to the ischaemic retina, may be important for the pathogenesis of diabetic retinopathy. Such a hypothesis also explains most of the hitherto unexplained features of diabetic retinopathy.
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PMID:Pathogenesis of diabetic retinopathy--the missing link? 750 46

We determined the anterior chamber inflammation by means of laser flaremetry after cataract intraocular lens surgery for the nuclear cataract that developed after vitrectomy. Cases (38 eyes of 36 patients) were divided into the following four groups according to their pathologies indicating vitrectomy; proliferative diabetic retinopathy (PDR, 14 eyes), idiopathic posterior vitreous membrane syndrome (PVMS, 9 eyes), rhegmatogenous retinal detachment (RRD, 8 eyes), and branch retinal vein occlusion (BRVO, 7 eyes). Mean intervals between the two surgeries were 31, 23, 27 and 18 months, respectively. Phacoemulsification and aspiration through the self-sealing sclerocorneal wound and intraocular lens implantation in the bag were performed. The mean flare count was already high before the cataract surgery in all groups. Postoperative course of mean flare count was an overlap of two waves, one (P1) with a peak on day 1 followed by rapid decrease and the other (P7) with a peak on day 7 followed by slow decrease. Peak values of P1 were higher than the day 1 value after cataract surgery without fundus pathology, and higher in PDR and BRVO groups than in PVMS and RRD groups. P7 was like that observed after vitrectomy and there was close similarity among the groups.
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PMID:[Anterior chamber inflammation after cataract intraocular lens surgery in postvitrectomy eyes]. 761 Oct 6

Silicone oil was used in combination with vitrectomy to treat 127 cases of complicated retinal detachments. An initial anatomic success in 120 cases (94%) was reduced to 68 (54%) after an average follow-up of 32 months and was attributable to ongoing proliferative vitreo-retinopathy (PVR). The indications for the use of silicone oil were: 1. Retinal detachment complicated by PVR (107 cases), 20 of which required multiple operations. Anatomic success was achieved in 59 (55%) and of these 23 (40%) had a visual acuity of 6/60. 2. Giant retinal tears (GRT) (7 cases). Four (57%) of these remained attached, three (75%) having a final vision of 6/36. 3. GRTs complicated by PVR (8 cases). Four (50%) were anatomically successful and two had a final vision of 6/60. 4. Proliferative diabetic retinopathy (5 cases). Two (40%) remained attached and one of these (50%) had hand movements vision. The silicone oil was removed electively in 23 eyes, 16 (70%) of these being anatomically successful. Oil was removed in 43 eyes because of complications, and in 20 (46%) of these, the retina remained attached at the end of follow-up. Complications included cataract in all 14 phakic eyes; rubeosis in 19 eyes (15%); corneal opacification in 52 eyes (41%), there being no clear cut difference between those eyes with an inferior iridectomy (35 of 85 eyes--41%) and those without (12 of 29 eyes--41%); and raised intraocular pressure in 55 eyes (43%). We conclude that although far from being ideal, silicone oil appears to have played some part in achieving the successful results reported in this study.
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PMID:Silicone oil insertion. A review of 127 consecutive cases. 761 51

Four patients with proliferative diabetic retinopathy developed anterior hyaloidal fibrovascular proliferation after extracapsular cataract extraction and posterior chamber lens implantation. This complication of cataract extraction has been described after vitrectomy in diabetic eyes. Risk factors for this entity after extracapsular cataract extraction include proliferative diabetic retinopathy, iris neovascularization, and anterior ischemic retina. Anterior hyaloidal fibrovascular proliferation was observed an average of 12 months postoperatively and affected vision in one of four patients. No progression was seen within an average of six months of follow-up, and no complications such as traction retinal detachment and vitreous hemorrhage developed.
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PMID:Anterior hyaloidal fibrovascular proliferation after extracapsular cataract extraction in diabetic eyes. 768 36

Eight eyes exhibited massive proliferation of lens epithelial remnants following Nd-YAG posterior capsulotomy. All eyes had pre-existing retinal pathology. Six had undergone vitrectomy (four for proliferative diabetic retinopathy) before extracapsular cataract extraction with posterior chamber intraocular lens implantation. The other two eyes had familial exudative vitreoretinopathy or retinopathy of prematurity, respectively. Five eyes required removal of the lens proliferations via a pars plana approach. High levels of growth factors in the posterior segment associated with proliferative disorders of the retina may play a role in lens cell proliferation.
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PMID:Massive proliferation of lens epithelial remnants after Nd-YAG laser capsulotomy. 748 90


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