Inflammatory response after cataract surgery : Randomized controlled clinical and laboratory studies of different surgical techniques
Author: Laurell, Carl-Gustaf
Date: 1997-12-19
Location: Föreläsningssalen, plan 1, S:t Eriks Ögonsjukhus
Time: 9.00
Abstract
During the last few years the phacoemulsification technique for cataract
extractionhas improved considerably. Because of this development
phacoemulsification has recentlysuperseded extracapsular cataract
extraction (ECCE) as the preferred method. Theaim of the present thesis
was to evaluate the new method for cataract surgery andto compare it with
ECCE in randomized controlled trials. Studies of details in thesurgical
technique were performed on rabbits.
The alleged advantages of phacoemulsification include the small incision
and theuse of a more durable anterior capsulotomy - the continuous
curvilinear capsulorhexis(CCC), which promotes fixation of the
intraocular lens (IOL) in the capsular bag.However, phacoemulsification
also involves more sophisticated technique and potentialhazards due to
the development of high energies and temperatures in the anteriorchamber
as well as the creation of air bubbles and free radicals.
The function of the blood-aqueous barrier (BAB) is a sensitive measure of
surgicaltechnique. Since BAB disruption is a sign of intraocular
inflammation, quantitativeand objective measurements of the postoperative
inflammatory response in the anteriorchamber are good indicators of the
quality of surgical methods and the biocompatibilityof implanted
materials.
In the present work the inflammatory response and BAB function was
studied onhumans with laser flare photometry and anterior chamber
fluorophotometry with determinationof the diffusion coefficient for
fluorescein leakage through the BAB. These methodscan detect clinical as
well as subclinical inflammatory reactions. In rabbits thesetechniques
may be less reliable. Samples from the rabbit aqueous humour were
takenand analysed for prostaglandin E2, white blood cells and proteins.
The rabbit iris-ciliarybody and after cataract were dissected for wet
mass measurements. Corneal thicknesswas measured by pachymetry.
In humans the clinical outcome was assessed with slit lamp examination,
visualacuity and intraocular pressure measurements.
Phacoemulsification induced significantly less surgical trauma with less
BAB disruptioncompared to ECCE. The size of the incision was a
significant factor for the intraocularinflammatory response. It is
important to secure placement of the IOL in the capsularbag since
significantly more inflammation and after-cataract was found
followingciliary sulcus fixation of the IOL. Eyes with a small CCC showed
less inflammationthan eyes with a large CCC. The diameter of the CCC did
not affect the amount ofafter-cataract. The postoperative inflammatory
response was not correlated to theamount of phacoemulsification energy
used during surgery. After phacoemulsificationand implantation of a
heparin surface modified IOL in eyes with no other known diseasethe great
majority of eyes healed satisfactorily without anti-inflammatory
treatment.These results indicate that phacoemulsification with IOL
implantation is a safe procedure,although repeated BAB reactions may
occur.
Key words: Cataract extraction, phacoemulsification, inflammation,
blood-aqueousbarrier, anti-inflammatory agents, heparin surface modified
intraocular lens, fluorophotometry,prostaglandins, after-cataract,
corneal oedema, lasers, comparative study, randomizedcontrolled trial,
double-blind method. ISBN 91-628-2762-6
Issue date: 1997-11-28
Publication year: 1997
ISBN: 91-628-2762-6
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