Faculty Bibliography

OBJECTIVE: To evaluate the safety and efficacy of a Q-switched neodymium:YAG (Nd:YAG) laser for removal of the human cataract. DESIGN: A multicenter, prospective, noncomparative study. PARTICIPANTS: A total of 100 consecutive eyes undergoing cataract extraction with the Dodick Photolysis, Q-switched Nd:YAG laser. MAIN OUTCOME MEASURE: Corneal endothelial cell loss, visual acuity improvement, intraocular pressure change, total intraocular energy used, and intraoperative and postoperative complications. RESULTS: The mean values were postoperative visual acuity improvement from 20/46.5 (0.43) to 20/26.6 (0.75), decrease in endothelial cell count of 177 cells/mm2 (7.55%), and intraocular energy used of 6.7 J. Minor complications were encountered in three cases. CONCLUSIONS: These data suggest that Dodick Photolysis may be a safe and effective new technology for cataract removal in human eyes. It appears to offer low intraocular energy and heat release, a clear-cornea incision less than 1.5 mm in size, and safe operation within the capsular bag

PURPOSE: To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification. SETTING: Johns Hopkins Hospital, Baltimore, Maryland and Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA. METHODS: This prospective, randomized study followed 131 patients treated with phacoemulsification with a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon sutures were used in the three- and one-suture groups. RESULTS: Mean astigmatism was greatest in the first postoperative week in all groups and stabilized after 8 weeks. The percentage of patients with with-the-rule (WTR) astigmatism increased from baseline in the one- and three-suture groups and decreased in the sutureless group. Mean uncorrected Snellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant differences in uncorrected acuity at other times. No statistically significant differences in the surgically induced spherical equivalent were noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively. At all follow-ups, the sutureless group had the greatest proportion of patients, with significant ATR astigmatic shift (1 week, 17%; 4 weeks, 32%); and the lowest proportion of patients with significant WTR astigmatic shift (10% after 1 week). At 4 weeks, the percentage of patients with significant WTR shift in the one-suture group dropped to that in the sutureless group (10%); however, those in the one-suture group had less ATR astigmatic shift (16%). CONCLUSION: Sutureless and one-suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-suture surgery resulted in less ATR shift

PURPOSE: We used a novel technique for explanting an improperly oriented silicone intraocular lens. METHODS: The elastomeric property of silicone was used to deform the optic and remove the intraocular lens in one piece. RESULTS: We explanted a flexible intraocular lens without compromising the integrity of the original wound, posterior lens capsule, or corneal endothelium. CONCLUSIONS: The technique offers a superior means of intraocular lens explantation while retaining the benefits of small-incision cataract surgery

Recent advances in cataract surgery have reduced the incidence of corneal complications. Review of the current literature reveals a trend toward early visual rehabilitation and minimization of postoperative astigmatism by careful selection of incision type and location for small-incision cataract surgery. Since the introduction of intraocular lenses, endothelial cell loss has been a concern. Preservation of corneal endothelial cell function continues to be a major goal as cataract surgery continues to evolve. Recent studies have been undertaken to determine the effect of incision location and size on endothelial cell loss. Several reports on iatrogenically induced corneal decompensation are of interest as this complication can be avoided if proper precautions are taken. Although improvements in surgical technique have lead to a decreased incidence of Descemet's membrane detachments and of epithelial and fibrous downgrowth, early recognition and intervention are imperative

In the more than 25 years since the development of ultrasound phacoemulsification, enormous change has occurred in cataract surgery. One of the latest and most significant changes in cataract surgery has been the development of devices that utilize laser energy for the removal of cataracts. Both ultraviolet (excimer) and infrared wavelengths have been studied, but in 1994, we have seen significant progress only with the infrared wavelengths. The lack of progress in the devices utilizing ultraviolet wavelengths are due to concerns with safety. Two infrared laser devices, one developed by Dodick and the other developed by Colvard have been used successfully for the removal of cataracts under Investigational Device Exemptions from the Food and Drug Administration. These developments have brought us a step closer to realizing the dream of laser cataract surgery

Since the development of ultrasound phacoemulsification more than 25 years ago, cataract surgery has changed dramatically. One of the major changes in cataract surgery has been the research into the use of laser for the removal of cataracts. To date, both ultraviolet and infrared wavelengths have been studied, with the infrared showing more promise. The ultraviolet end of the spectrum has shown promise, but concerns with safety have hindered its progress. An infrared laser device developed by Dodick has been used successfully for the removal of cataracts under an Investigational Device Exemption from the Food and Drug Administration and a second infrared laser developed by Colvard should be approved soon. These developments have brought us a step closer to realizing the dream of laser cataract surgery