Introduction
Phacoemulsification is the main method for elective cataract surgery; however, in some cases (such as hard cataracts, zonular laxity or loss and inadequate pupil dilatation) it can be challenging to complete the surgery without complication even for the most experienced surgeons. In these cases, preoperative planning and cautious intraoperative management are critical to avoid intraocular injury.
During the aging process, human lens undergoes progressive morphological changes, which lead loss of transparency. A hypermature or morgagnian cataract is a condition characterized by fibrous and calcified anterior lens capsule, liquefied cortex material, brownish rock-hard nucleus and zonular weakness. Therefore, most of the cataract surgeons hesitate to perform phacoemulsification in such cases.
In this case-report, we present management of a patient with morgagnian cataract, rigid anterior capsule and small pupil. Interestingly, none of the local eye surgeons offered cataract surgery to the patient previously.
Case-Report
A 73-year-old man presented with bilateral decreased visual acuity. He had visual acuity of light perception in both eyes for nine years, and local eye surgeons had not recommended cataract extraction to him. The patient underwent detailed ophthalmological examinations included slit-lamp biomicroscopy, intraocular pressure measurement (applanation tonometry), dilated fundus examination (+ 90 D) and B-scan ocular ultrasonography. On initial examination, visual acuity was light perception in both eyes. Slit-lamp biomicroscopy revealed bilateral fibro-calcified anterior lens capsule, brownish nucleus and inadequate pupil dilatation (Figure). Intraocular pressure measurements were normal. Dense cataract...
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...nian cataract might be challenging for any surgeon. Morphological lenticular changes might enforce the surgeon in any step of the phaco surgery. However, preoperative measures against potential risks can ease to perform a successful phaco surgery in cases with morgagnian cataract.
What was known:
Numerous nuclear fracture techniques were developed to make phaco surgery more efficient and safe, whereas most of these techniques focused on the first nuclear crack.
What this paper adds:
In phaco surgery, removing first lens piece is crucial and provide more endocapsular space, so following manipulations become easier.
Our technique allows the surgeon to chop first nuclear piece easily and safely under direct visualization of the lens periphery, unlike the classical "stop and chop" technique.
References
Figure legends
Loss of vision in one or both eyes
Glaucoma is a disease of the eye and it is fluid pressure within the eye rises and if the eye is left untreated the patient might lose vision or maybe even blind. But this disease is generally affects both eyes but although one of their eyes may have more severe signs or symptoms then the other eye. When you have glaucoma there are small spaces in the front of the eye and they are called anterior chamber. There is clear liquid that flows in and out of the anterior chamber and the fluid nourishes and bathes nearby the tissues. And if the patient has glaucoma the fluid dose not drain like it should drain but the fluid drains out of the eye. And this may lead to fluid build up and pressure inside the rises of the eye. Unless the pressure is brought down and controlled and the optic nerves and some of the other parts of the eye might become damaged leading to ...
...eye fluid to leave the eye. The new channel helps to lower the eye pressure. Surgery will be recommended only if your ophthalmologist feels the benefit of a lower eye pressure achieved with an operation outweighs possible complications and/or further progression of optic nerve damage.
Yale School of Medicine. (2014). Stereotactic radiosurgery/ gamma knife program. In Therapeutic Radiology. Retrieved from http://radonc.yale.edu/clinical/gamma.aspx
Ruckmann, Adrea von, Fitzke, Fredrick W., & Bird, Alan C., (1997). Fundus autofluorescence in age related macular disease imaged with a laser scanning opthalmoscope. Investigative Opthamology and Visual Science, 38 (2), 478-485.
The title refers to the removal of a dull film from the eyes. This is
Many signs include a "white pupil," also known as leukocoria. Retinoblastoma can occur in either one or two eyes (Paul T. Finger, Pg. 1). This abnormal white pupillary reflex is sometimes referred to as a cat's eye reflex. Another sign of retinoblastoma is a crossed eye (Ambramson, Ch3). Leukocoria doesn't always end up as being retinoblastoma, it can even result in: congenital cataract, Toxocara canis, Coat's disease, and persistent hypertrophic primary vitreous (PHPV) (Finger, Pg.2). Retinoblastoma occurs when there's a mutation or deletion of the q14 band of chromosome 13 (Finger, Pg. 1). Symptoms can be painful if not treated quickly. Some include a red, painful eye, swelling of the surrounding eye, poor vision, dilated pupil, even extra fingers or toes, and retardation (Ambramson, Ch3).
Amblyopia is a condition in which visual acuity in one eye is greatly reduced. It is caused by lack of stimulation or disuse during visual development (Rose, 1998). Because the eye is not fully developed at birth (Jarvis, 1992, as cited in Rose, 1998), infants need stimulation to complete the visual neural pathway. When one or both eyes are inhibited, for example due to misalignment of one eye (strabismus) or a large difference in refractive power between two eyes (anisometropia), the neural pathway for the inhibited eye develops abnormally, or does not develop at all. At approximately six years of age eye development is complete (Stager, 1990, as cited in Rose, 1998). Before visual development is complete amblyopia can be treated. If it is caught and treated at an early age, normal vision can be preserved (Rose, 1998).
Glaucoma is has several types which include congenital and acquired (Peate & Jones, 2014). Congenital glaucoma is present at birth (Peate & Jones, 2014). Whereas acquired glaucoma is not present at birth and is caused by medications, surgery, inflammation, or other processes (Glaucoma for Children, 2014). Glaucoma is then divided into two sub-groups called open-angle and closed-angle (Peate & Jones, 2014). The first sub-group, open-angle, is the most common of the two (Peate & Jones, 2014). In open-angle glaucoma patients do not notice a change in vision due to the fact that vision loss with this type
Fluid circulating inside the front portion of the eye is produced by a structure called the ciliary body, which is located behind the iris. This fluid moves through the opening of the pupil, passes into the space between the iris and the cornea, and drains out of the eye through a tissue called the angle. With glaucoma, the passing of fluid through the angle is either reduced or suddenly stops, and amounts of fluid inside the eye increase. This high fluid pressure hurts the nerve fibers and the eye's optic nerve and causes blind spots. It may lead to blindness in some cases.
The surgeon can use a mechanical microkeratome, a special blade, or a laser keratome, a cutting laser, to cut a flap from on the cornea. In the case of a doctor using a mechanical microkeratome, a ring will be placed on your eye to create ...
Macular degeneration in general can affect many people in minor or drastic ways. People who experience this form often complain of vision loss when they are in dim light, especially when they are reading. The "dry" type is often characterized by a more gradual loss of vision compared to the "wet" type. Signs of this disease include an increase in drusen, which is an accumulation of a yellow-white substance, in the underside of the macular retina. A loss of cells can be seen in the macula. The macula is our sensitive sight region, where intricate detail can be seen. Thus, vision in this area is helpful and necessary to drive, read, focus on small details, and recognize familiar faces. The macula is located in the back of the eye known as the retina. The macula is only about 5 mm in diameter, and includes the fovea, which gives us our detailed central vision. If a person suffers from the "dry" form in one eye they will be more likely to develop it in the other eye as well.
...he cornea is deformed so that its surface is oval instead of spherical. Light rays are distorted at the entrance of the eye. This produces a blurred image and is known as astigmatism. To correct it, glasses are given a nonspherical or cylindrical curvature. Cross-eyes and walleyes are produced when both eyes do not work together because of weakness of the eye muscles.
I had very many creases around them and was unhappy with my appearance. I contacted an agent for cosmetic surgery, thinking about whole face surgery. After a discussion with her, she convinced me to start by having correction around my eyes. The operation I had was performed under local anaesthetic although this method isn't entirely suitable for many people as it is quite painful. It is possible to have it done under general anaesthesia, or 'twilight anaesthesia'. Some tie it in with other surgery such as a facelift procedure. Still, I opted for the local anaesthetic - I found it comforting to be able to talk to the surgeon and his nurse and know what was going on, but it is not for the faint hearted. The operation itself took about one and a half hours and I was able to have a cup of tea, don dark glasses and go home. I was given pain killers, antibiotics and eye ointment