DOCSLIB.ORG

Posterior Capsulotomy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Posterior Capsulotomy Br J Ophthalmol: first published as 10.1136/bjo.69.5.364 on 1 May 1985. Downloaded from British Journal of Ophthalmology, 1985, 69, 364-367 Retrospective study of 67 cases of secondary pars plana posterior capsulotomy N MASHHOUDI' AND J L PEARCE2 From the 'Birmingham and Midland Eye Hospital, Church Street, Birmingham B3 2NS, and 2Bromsgrove General Hospital, All Saints Road, Bromsgrove, Worcs B61 OBB SUMMARY A technique of late pars plana posterior capsulotomy following extracapsular cataract extraction and posterior chamber lens implantation is described. The results and complications of 67 cases with an average follow-up period of approximately 14 months are reported. The incidence of cystoid macular oedema following this procedure was 2-9%, with no incidence of retinal detachment. The procedure appears to be an acceptable method of treating a thickened posterior capsule, and in the absence of a neodymium YAG laser and in a small unit it could prove to be a reasonable substitute. Extracapsular cataract extraction (first described by adrenaline by Van Lint's method, and then a small Jacques Daviel in 1753) combined with posterior bleb of the same local anaesthetic is lifted in the chamber intraocular lens implantation is enjoying a inferotemporal and superonasal quadrant of the resurgence of interest because of the reported reduc- bulbar conjunctiva. The superonasal anaesthetic is tion in the incidence of postoperative cystoid macular necessary to enable the surgeon to grip the globe with oedema and aphakic retinal detachment.'2 The after toothed forceps. An operating microscope is used cataract, which forms in the scaffolding of the with full sterile procedure. Full pupillary dilatation is posterior capsule, remnants of the anterior capsule, effected by topical cyclopentolate 1% and/or http://bjo.bmj.com/ and lens matter, presents a special problem of phenylephrine 10%. Eyelid retraction is with a management in the presence of a posterior chamber Barraquer speculum, and corneal clarity is main- lens. tained with balanced salt solution (BSS) irrigation. This paper reports on the pars plana approach to Conjunctiva and Tenon's capsule are gripped in the late posterior capsulotomy, which is performed in superonasal quadrant, and the sclera is penetrated by our unit as an outpatient procedure. The complica- the needle knife 3-75 mm from the limbus in the tions related to this procedure are recorded. inferotemporal quadrant, with the initial penetration on September 26, 2021 by guest. Protected copyright. perpendicular to the sclera. The needle knife point is Materials and methods located in the pupil and engages the posterior capsule from below or above, and a slit is cut in such a way TECHNIQUE that it does not extend beyond the optic area of the Secondary pars plana capsulotomy was described by intraocular lens. Lindstrom and Harris3 and has been performed by At the end of the operation injections below Epstein in South Africa for many years. Tenon's capsule of antibiotics and long-acting In our department this procedure is performed on steroids are routinely prescribed. Patients are re- an outpatient basis with an operating microscope examined one hour postoperatively on a slit-lamp under local anaesthetic. A fine, sharp, self-sealing biomicroscope and discharged home on topical discission knife is essential to enable penetration of steroids and mydriatics. the sclera with minimal pressure. One of the authors (J.L.P.) has designed a micro needle knife for the PATIENTS' RECORDS procedure. The records of 77 patients who had undergone Anaesthesia is achieved by the following method: extracapsular cataract extraction by one of the facial akinesia with 2% lignocaine plus 1/10 000 authors (J.L.P.) and subsequent pars plana posterior capsulotomy with a minimum six-month follow up Correspondence to Mr N Mashhoudi, FRCS. (mean 14 months) were reviewed. Of these patients 364 Br J Ophthalmol: first published as 10.1136/bjo.69.5.364 on 1 May 1985. Downloaded from Retrospective study of67 cases ofsecondary pars planaposterior capsulotomy 365 58 attended for detailed examination for the pur- All but one of the patients underwent this pro- poses of this study. cedure because of an opaque posterior capsule. The Records of all cases were studied. Their visual one exception had uniocular diplopia, which was acuities were measured at 6 m on a Snellen's chart, eliminated by capsulotomy. The average follow-up refraction was performed in cases with visual acuity period was 14 months (minimum six months and less than 6/6, slit-lamp biomicroscopy was per- maximum 54 months). formed, contact lens, three-mirror funduscopy, and Sixty of the 64 eyes had intraocular implants. Table indirect ophthalmoscopy were routinely performed, 3 shows the type of intraocular lens implanted. Two and fluorescein angiography was carried out on those of the 64 eyes had primary posterior capsulotomy at with clinically equivocal macular disease. the time of cataract extraction. The time period between cataract extraction and late pars plana Results capsulotomy varied from eight months to 68 months (average 30 months). Fifty-eight patients (64 eyes) were included in this The precapsulotomy visual acuity is shown in study (six bilateral cases), and three of them had a Table 4. The postcapsulotomy corrected visual second procedure performed (total of 67 cases). The acuity achieved at the time of the survey is shown in age range of the patients was 18-90 years (average Table 5. Table 6 shows the causes of a corrected 67). Table 1 shows the age distribution and Table 2 shows the type of cataract. Table 4 Visual acuity before pars plana posterior capsulotomy Table 1 Age distribution of58patients in study Precapsulotomy visual acuity Percentage Number Age group 6/6 or better* (one case) 1-5 10-19 1 6/12 or better 15-5 20-29 1 6/24 or better 36-5 30-39 1 Less than 6/24 46-5 40-49 3 50-59 7 *This case had uniocular diplopia due to capsular wrinkling, which 60-69 15 was eliminated with capsulotomy. 70-79 20 80-90 10 Table 5 Visual acuity after pars plana posterior Total 58 capsulotomy http://bjo.bmj.com/ Corrected visual acuity achieved Percentage Table 2 Type ofcataract in 64 eyes in study at the time ofsurvey (no exclusion) Type ofcataract Number 6/6 or better 37.5= 6/12 or better 37.5 Senile 49 6/24 or better 11-0 Familial 5 Less than 6/24 14.0 Traumatic 4 on September 26, 2021 by guest. Protected copyright. Congenital 2 Usher's syndrome 2 Table 6 Causes oflow visual acuity Retinitis pigmentosa I Complicated 1 Causes ofa corrected visual acuity Number Total 64 less than 6/9 Amblyopia 4 Table 3 Type ofintraocular lens implanted Cystoid macular oedema 2 Diabetic retinopathy 4 Type ofintraocular lens Number Low grade uveitis 1 Myopic degeneration 2 Pearce tripod posterior chamber lens 47 Optic atrophy 2. Pearce Y loop posterior chamber lens 7 Pigment deposit on intraocular lens 1 Binkhorst 4 loop iris clip lens 2 Retinal branch vein occlusion 2 Boberg-Ans iris clip lens 1 Retinitis pigmentosa 1 Simco anterior chamber lens 1 Retinal branch artery occlusion 1 Choyce anterior chamber lens 1 Senile macular degeneration 6 Others 1 Thickened posterior capsule 6 No intraocular implant 4 Usher's syndrome 2 Total 64 Vitreous membrane 1 Br J Ophthalmol: first published as 10.1136/bjo.69.5.364 on 1 May 1985. Downloaded from 366 NMashhoudi andJ L Pearce Table 7 Visual acuity after pars plana posterior localised vitreoretinal traction. The latter effect may capsulotomy be reinforced by vitreous haemorrhage, however slight, that may occur at the time of operation.4 It is Corrected visual acuity achieved excluding Percentage unrelated posterior pole pathology mandatory to avoid contact with the pars ciliaris of the ciliary body at the time of penetration of the 6/6 or better 60-501=87 globe, and this complication can be reduced by 6/12 or better 26-501 making the initial incision perpendicular to the 6/24 or better 10-50 Less than 6/24 2-50 sclera. There is a risk of endophthalmitis if organisms on the conjunctival surface are carried into the vitreous cavity. Table 8 Complications ofpars plana posterior In our study two of67 cases (2.9%) who underwent capsulotomy in 67 cases late pars plana posterior capsulotomy approximately 13 and 17 months after extracapsular cataract extrac- Complications Number tion and posterior chamber lens implantation Transient rise in IOP 7 developed cystoid macular oedema. The first patient Transient uveitis 4 achieved a corrected visual acuity of 6/6 immediately Vitreous haemorrhage (cleared) 3 after capsulotomy, but this reduced subsequently to Displacement of intraocular lens 3 Vitreous in anterior chamber 2 6/18 due to cystoid macular oedema. The visual Cystoid macular oedema 2 acuity in the second case was 6/60 immediately after Retinal detachment/dialysis 0 capsulotomy because of vitreous haemorrhage and Endophthalmitis 0 remained at this level despite the vitreous clearing, a result of florid cystoid macular oedema. We presume these two cases of cystoid macular oedema were due visual acuity of less than 6/9. The corrected visual to capsulotomy, though the prior capsular opacity acuity achieved apart from unrelated posterior pole precluded a clear view of the macula preoperatively. pathology is shown in Table 7. Table 8 shows the This figure compares with 3-5% incidence of cystoid complications attributable to the procedure. macular oedema after late posterior capsulotomy with the limbal approach reported by Livernois and Discussion Sinskey.5 The incidence of cystoid macular oedema follow- http://bjo.bmj.com/ Although there is sufficient evidence that the pres- ing late posterior capsulotomy with the non-invasive ence of an intact posterior capsule reduces the method of neodymium YAG laser has not been fully incidence of cystoid macular oedema and rhegmato- studied yet, but indications suggest a figure of around genous retinal detachment, 2 controversy remains on 2% (Harris, personal communication 1984).
Load more

Recommended publications
  • Wildlife Ophthalmology
    Wildlife Ophthalmology DR. HEATHER REID TORONTO WILDLIFE CENTRE TORONTO, ON CANADA Why understand eyes? Wildlife need to have excellent vision to survive in the wild Eye related problems are common in wildlife admitted to rehabilitation centers What we will cover Anatomy of the eye Differences between birds and mammals The eye exam Recognizing common problems Prognosis Treatment options When to see the vet Anatomy Around the Eye: Muscles & nerves Skin Eye lids Nictitating eyelid Conjunctiva & sclera Tear glands & ducts Ossicles (birds) Anatomy Front of the Eye: Cornea Iris Pupil Ciliary body Anterior Chamber Aqueous humor Anatomy Back of the Eye: Lens Retina Optic nerve Choroid Pecten (birds) Posterior Chamber Vitreous humor Fundus of the Eye Mammal Eye Bird Eye The Avian Eye - Differences Small eye size in most birds and small pupil size makes it hard to examine Can control the size of their pupil Lower eyelid more developed The nictitating membrane spreads the tears allowing birds to blink less Moves horizontally across eye The Avian Eye - Differences Eyes are not as protected by skull Less muscles around eye so less eye movement Boney ossicles support the eye Three main eye shapes; flat, globose & tubular The Avian Eye - Differences Four different color receptors compared to the three in mammals means better color detail Can see in the ultraviolet range Higher flicker rate – can detect lights that flicker at more than 100 flashes per second (humans detect at 50) The Avian Eye - Differences In some species the eye
    [Show full text]
  • Smartphone-Based Dilated Fundus Photography and Near Visual Acuity Testing As Inexpensive Screening Tools to Detect Referral Warranted Diabetic Eye Disease
    Smartphone-Based Dilated Fundus Photography and Near Visual Acuity Testing as Inexpensive Screening Tools to Detect Referral Warranted Diabetic Eye Disease BRIAN C. TOY, MD,*† DAVID J. MYUNG, MD, PHD,*† LINGMIN HE, MD,*† CAROLYN K. PAN, MD,*† ROBERT T. CHANG, MD,* ALISON POLKINHORNE, MA,‡ DOUGLAS MERRELL, BS,‡ DOUG FOSTER, MBA,‡ MARK S. BLUMENKRANZ, MD* Purpose: To compare clinical assessment of diabetic eye disease by standard dilated examination with data gathered using a smartphone-based store-and-forward teleoph- thalmology platform. Methods: 100 eyes of 50 adult patients with diabetes from a health care safety-net ophthalmology clinic. All patients underwent comprehensive ophthalmic examination. Concurrently, a smartphone was used to estimate near visual acuity and capture anterior and dilated posterior segment photographs, which underwent masked, standardized review. Quantitative comparison of clinic and smartphone-based data using descriptive, kappa, Bland-Altman, and receiver operating characteristic analyses was performed. Results: Smartphone visual acuity was successfully measured in all eyes. Anterior and posterior segment photography was of sufficient quality to grade in 96 and 98 eyes, respectively. There was good correlation between clinical Snellen and smartphone visual acuity measurements (rho = 0.91). Smartphone-acquired fundus photographs demon- strated 91% sensitivity and 99% specificity to detect moderate nonproliferative and worse diabetic retinopathy, with good agreement between clinic and photograph grades (kappa = 0.91 ± 0.1, P , 0.001; AUROC = 0.97, 95% confidence interval, 0.93–1). Conclusion: The authors report a smartphone-based telemedicine system that demon- strated sensitivity and specificity to detect referral-warranted diabetic eye disease as a proof-of-concept. Additional studies are warranted to evaluate this approach to expanding screening for diabetic retinopathy.
    [Show full text]
  • Effects of Nd:YAG Laser Capsulotomy in Posterior Capsular Opacification
    Original Research Article Effects of Nd:YAG laser capsulotomy in posterior capsular opacification Praveen Kumar G S1, Lavanya P2*, Raviprakash D3 1Assistant Professor, 2Associate Professor, 3Professor & HOD, Department of Ophthalmology, Shridevi institute of Medical Sciences and Research Hospital, Sira Road, NH-4 Bypass Road, Tumkur- 572106, INDIA. Email: [email protected] Abstract Background: Posterior capsular opacification (PCO) is the most common long-term complication of cataract surgery in both phacoemulsification and extracapsular cataract extraction (ECCE). The overall incidence of PCO and the incidence of neodymium-doped yttrium–aluminum–garnet (Nd:YAG) laser posterior capsulotomy has decreased from 50% in the 1980s and early 1990s to less than 10% today. Reported complications of Nd:YAG laser posterior capsulotomy include elevated intraocular pressure, iritis, corneal damage, intraocular lens (IOL) damage, cystoids macular edema, disruption of the anterior hyaloid surface, increased risk of retinal detachment, and IOL movement or dislocation. In some patients, a refraction change is noticed after Nd:YAG laser posterior capsulotomy, but proving this remains difficult. Materials and Methods: Nd; YAG LASER capsulotomy was performed in 200 eyes of 200 patients, some with pseudophakia and some with aphakia at Kurnool medical college, Kurnool. They were followed up between October 2008 and September 2010. Results: Elevation of IOP has been well documented after anterior segment laser procedures. The IOP rise after YAG laser posterior capsulotomy is of short duration starting about 1 hr after laser procedure and lasting for 24 hrs. In this study, in 1case IOP came down to normal level after 3 days and in another case after 7 days.
    [Show full text]
  • Coding Competencies for Ophthalmic Techs – 2020 Coding Update
    3/5/2020 Coding Competencies for Ophthalmic Techs – 2020 Coding Update OAO Ophthalmic Medical Technology Friday, March 13, 2020 Joy Woodke, COE, OCS, OCSR 1 Financial Disclosure Joy Woodke, COE, OCS o This presenter does not have a financial interest or relationship to disclose relative to this activity. o Academy Coding & Practice Management Executive 2 Topics 2020 Coding Updates Coding Competencies Diagnostic testing services Modifiers Tech Takeaways Understanding insurance policies Ongoing coding education Resources 3 1 3/5/2020 2020 Coding Updates Extended Ophthalmoscopy & Cataract Surgery 4 Extended Ophthalmoscopy (EO) • CPT eliminated initial and subsequent codes for EO • New codes for drawing of • Peripheral retina, with scleral depression: 5% in work value over deleted initial EO • Optic nerve or macula: 32% compared to deleted initial EO 5 Extended Ophthalmoscopy (EO) • 92225 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial • 92226 subsequent 6 2 3/5/2020 Extended Ophthalmoscopy (EO) 92201 Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral 7 Ophthalmoscopy 92201 8 8 Extended Ophthalmoscopy (EO) 92202 with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral 9 3 3/5/2020 Ophthalmoscopy 92202 10 Extended Ophthalmoscopy (EO) • Payment was unilateral. 2020 is bilateral. 2019 2020 92225 $29.87 per eye 92201 $27.21 Only bill for the eye that has 92202 $17.21 pathology. 92226 $27.63 per eye Only bill for the eye that has pathology 11 Extended Ophthalmoscopy (EO) • Payment is the same whether one or both eyes are examined and pathology is drawn and labeled.
    [Show full text]
  • Endoscopic Vitreoretinal Surgery: Principles, Applications and New Directions Radwan S
    Ajlan et al. Int J Retin Vitr (2019) 5:15 International Journal https://doi.org/10.1186/s40942-019-0165-z of Retina and Vitreous REVIEW Open Access Endoscopic vitreoretinal surgery: principles, applications and new directions Radwan S. Ajlan1*, Aarsh A. Desai2 and Martin A. Mainster1 Abstract Purpose: To analyze endoscopic vitreoretinal surgery principles, applications, challenges and potential technological advances. Background: Microendoscopic imaging permits vitreoretinal surgery for tissues that are not visible using operat- ing microscopy ophthalmoscopy. Evolving instrumentation may overcome some limitations of current endoscopic technology. Analysis: Transfer of the fine detail in endoscopic vitreoretinal images to extraocular video cameras is constrained currently by the caliber limitations of intraocular probes in ophthalmic surgery. Gradient index and Hopkins rod lenses provide high resolution ophthalmoscopy but restrict surgical manipulation. Fiberoptic coherent image guides offer surgical maneuverability but reduce imaging resolution. Coaxial endoscopic illumination can highlight delicate vitreo- retinal structures difficult to image in chandelier or endoilluminator diffuse, side-scattered lighting. Microendoscopy’s ultra-high magnification video monitor images can reveal microscopic tissue details blurred partly by ocular media aberrations in contemporary surgical microscope ophthalmoscopy, thereby providing a lower resolution, invasive alternative to confocal fundus imaging. Endoscopic surgery is particularly useful when ocular
    [Show full text]
  • 2Nd Quarter 2001 Medicare Part a Bulletin
    In This Issue... From the Intermediary Medical Director Medical Review Progressive Corrective Action ......................................................................... 3 General Information Medical Review Process Revision to Medical Record Requests ................................................ 5 General Coverage New CLIA Waived Tests ............................................................................................................. 8 Outpatient Hospital Services Correction to the Outpatient Services Fee Schedule ................................................................. 9 Skilled Nursing Facility Services Fee Schedule and Consolidated Billing for Skilled Nursing Facility (SNF) Services ............. 12 Fraud and Abuse Justice Recovers Record $1.5 Billion in Fraud Payments - Highest Ever for One Year Period ........................................................................................... 20 Bulletin Medical Policies Use of the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Codes on Contractors’ Web Sites ................................................................................. 21 Outpatient Prospective Payment System January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS) ......................................................................................................................... 93 he Medicare A Bulletin Providers Will Be Asked to Register Tshould be shared with all to Receive Medicare Bulletins and health care
    [Show full text]
  • Using the Ophthalmoscope: Viewing the Optic Disc and Retina
    Using the Ophthalmoscope: Viewing the Optic Disc and Retina Judith Warner, MD University of Utah THE OPHTHALMOSCOPE DIRECT OPHTHALMOSCOPY • Jan Purkinje 1823 • Hermann von Helmholtz 1851 • Hand held ophthalmoscope • Direct up-right image Dials of the Ophthalmoscope RED-FREE FILTER (GREEN LIGHT) 450 nm monochromatic light nerve fiber layer optic nerve drusen OTHER DIALS • Used for measuring lesion size • Looking for the center of fixation OTHER DIALS: SLIT BEAM The wheel has lenses of power Panoptic-ophthalmoscope Direct type Wider field of view Distance from pt greater Similar apertures Not as easy to carry Slightly dimmer light source Not as magnified view of Disc Clean the rubber cup between patients Photographs: http://panoptic.welchallyn.com/faq.html WHEN EVER POSSIBLE: DILATE THE PATIENT Steps to Direct Ophthalmoscopy • Dimly lit room • Dilating drops • Patient fixates distant target • Align yourself • Red reflex • Dial in HOW TO USE THE DIRECT Ophthalmoscope.avi ophthalmoscope.wmv THE RED REFLEX The layers you will go through to see the optic disc THE OPTIC NERVE WHAT YOU SHOULD OBSERVE IN EVERYONE RIGHT EYE AND LEFT EYE THE NORMAL DISC • The disc is 1.62 mm or 1 million fibers • Central retinal artery and vein • Lamina Cribrosa • The optic cup The Normal Disc Appearance The lamina cribrosa is an important disc structure --Means Sieve --Anatomically present in all discs --Visible in about 1/3 --Shallow in myopia Look at the Cup-to-disc ratio: WHAT IS THE CUP-TO-DISC RATIO? .7 NO CUP 0.1 CUP 0.3 CUP 0.7 CUP 0.9 CUP What is the cup
    [Show full text]
  • The Capsulotomy: from There to Where?
    JUNE 2017 # 42 In My View NextGen Profession Sitting Down With Presbyopia correction in Dry eye: how the humble Louis Pasquale believes it’s Innovator extraordinaire, younger patients – what’s best? eyedrop is evolving time to redefine POAG Sean Ianchulev 17 36 – 38 42 – 45 50 – 51 The Capsulotomy: From There to Where? A tale of jealousy, rivalry and pride… The unfolding story of the capsulotomy over time 18 – 27 www.theophthalmologist.com It’s all in CHOOSE A SYSTEM THAT EMPOWERS YOUR EVERY MOVE. Technique is more than just the motions. Purposefully engineered for exceptional versatility and high-quality performance, the WHITESTAR SIGNATURE PRO Phacoemulsification System gives you the clinical flexibility, confidence and control to free your focus for what matters most in each procedure. How do you phaco? Join the conversation. Contact your Phaco Specialist today. Rx Only INDICATIONS: The WHITESTAR SIGNATURE PRO System is a modular ophthalmic microsurgical system that facilitates anterior segment (cataract) surgery. The modular design allows the users to configure the system to meet their surgical requirements. IMPORTANT SAFETY INFORMATION: Risks and complications of cataract surgery may include broken ocular capsule or corneal burn. This device is only to be used by a trained, licensed physician. ATTENTION: Reference the labeling for a complete listing of Indications and Important Safety Information. WHITESTAR SIGNATURE is a trademark owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. © 2017 Abbott Medical Optics Inc. | PP2017CT0929 Image of the Month In a Micropig’s Eye This Wellcome Image Award winner depicts a 3D model of a healthy mini-pig eye.
    [Show full text]
  • Type of Article
    Original Research Article Comparison between a modified three bend cystitome and conventional two bend cystitome in performing capsulorhexis A Nayak1*, P Bharathi2, P Santosh3, A Shetty4 1,2,4Resident, Department of Ophthalmology, KIMS, Bangalore, INDIA. 3Comprehensive Fellow, Aravind Eye Hospital, 64, Sankagiri Main Road, Nethimedu, Salem. Email: [email protected] Abstract Aim: To evaluate the efficacy of a modified 3-bend cystitome compared with conventional 2-bend cystitome in performing continuous curvilinear capsulorhexis(CCC). Materials and Methods: We modified a 2-bend cystitome for CCC for Manual Small Incision Cataract Surgery and phacoemulsification surgery for improved safety and easier surgery. A 26G needle was converted into a cystitome with 3 bends. In our study, the performance of modified 3-bend cystitome was compared with a 2-bend cystitome. 162 eyes of 126 patients were included in our study. Results: In the 3- bend cystitome group, mean completion time of CCC and the viscoelastics used were less with the CCC success rate being higher. Complications like postoperative corneal edema and V-shaped tears, were also lower in 3-bend group. No posterior capsular rents or any other complication was observed in either group. Conclusion: It is safe, efficient and the 3 bend cystitome helps achieve a CCC while maintaining the anterior chamber depth (ACD) by keeping the posterior lip intact. The 3-bend cystitome allowed for adequate visualisation into the anterior chamber from a lack of wound deformation. Key Words: Capsulorhexis, Cataract, Cystitome, Phacoemulsification, SICS *Address for Correspondence: Dr. A. Nayak, Resident, Department of Ophthalmology, KIMS, Bangalore, INDIA. Email: [email protected] Received Date: 01/04/2019 Revised Date: 24/05/2019 Accepted Date: 11/07/2019 DOI: https://doi.org/10.26611/10091114 for a continuous curvilinear capsulorhexis (CCC), even Access this article online though femtosecond laser produced capsulotomies are Quick Response Code: more precise, accurate, reproducible, and stronger.
    [Show full text]
  • (YAG) Laser Capsulotomy in a Patient with the Ocular Tilt Reaction
    Open Access Case Report DOI: 10.7759/cureus.16443 Resolution of Diplopia and Torsion Following Yttrium Aluminum Garnet (YAG) Laser Capsulotomy in a Patient With the Ocular Tilt Reaction Danny Lam 1 , Oliver Chen 2 , Elizabeth L. Wong 3 , Ian C. Francis 3 1. Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, AUS 2. Department of Ophthalmology, University of New South Wales, Sydney, AUS 3. Department of Ophthalmology, Prince of Wales Hospital, Sydney, AUS Corresponding author: Danny Lam, [email protected] Abstract The ocular tilt reaction is a rare neuro-ophthalmological phenomenon commonly occurring due to an injury to the vestibulo-ocular pathway, or a thalamic, brainstem, or cerebellar lesion. Most ocular tilt reactions are transient and demonstrate spontaneous recovery. This report documents the immediate resolution of diplopia and the patient’s ocular tilt reaction following visual recovery from left yttrium aluminum garnet laser capsulotomy. Categories: Neurology, Ophthalmology Keywords: ocular tilt reaction, yag laser capsulotomy, neuro-ophthalmology, diplopia, ocular torsion Introduction The ocular tilt reaction (OTR) is an acquired vertical misalignment (skew deviation) and conjugate rotation (cyclotorsion) of the eyes with ipsilateral head and neck tilt [1]. The OTR indicates an injury to the vestibulo-ocular pathways, commonly a unilateral peripheral deficit of the otolithic input, and may occur with any lesion of the brainstem or cerebellum or with vestibular neuritis [2,3]. The OTR may also relate to a unilateral lesion or infarction of the graviceptive (gravity-related control of body position) brainstem pathways from the vestibular nucleus to the interstitial nucleus of Cajal in the rostral midbrain [2,4].
    [Show full text]
  • Extended Ophthalmoscopy and Fundus Photography (L33467)
    Local Coverage Determination (LCD): Ophthalmology: Extended Ophthalmoscopy and Fundus Photography (L33467) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name Contract Type Contract Number Jurisdiction State(s) Palmetto GBA A and B MAC 10111 - MAC A J - J Alabama Palmetto GBA A and B MAC 10211 - MAC A J - J Georgia Palmetto GBA A and B MAC 10311 - MAC A J - J Tennessee Palmetto GBA A and B and HHH MAC 11201 - MAC A J - M South Carolina Palmetto GBA A and B and HHH MAC 11202 - MAC B J - M South Carolina Palmetto GBA A and B and HHH MAC 11301 - MAC A J - M Virginia Palmetto GBA A and B and HHH MAC 11302 - MAC B J - M Virginia Palmetto GBA A and B and HHH MAC 11401 - MAC A J - M West Virginia Palmetto GBA A and B and HHH MAC 11402 - MAC B J - M West Virginia Palmetto GBA A and B and HHH MAC 11501 - MAC A J - M North Carolina Palmetto GBA A and B and HHH MAC 11502 - MAC B J - M North Carolina Back to Top LCD Information Document Information LCD ID Original Effective Date L33467 For services performed on or after 10/01/2015 Original ICD-9 LCD ID Revision Effective Date L32953 For services performed on or after 01/29/2018 Revision Ending Date LCD Title 02/25/2018 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography Retirement Date N/A Proposed LCD in Comment Period N/A Notice Period Start Date N/A Source Proposed LCD N/A Notice Period End Date N/A AMA CPT / ADA CDT / AHA NUBC Copyright Statement Printed on 1/29/2018.
    [Show full text]
  • A Picture Atlas and Teaching Aid for Gonioscopy
    Pacific University CommonKnowledge College of Optometry Theses, Dissertations and Capstone Projects 5-1990 A picture atlas and teaching aid for gonioscopy Trisha L. Fjestad Pacific University Terri L. Horst Pacific University Recommended Citation Fjestad, Trisha L. and Horst, Terri L., "A picture atlas and teaching aid for gonioscopy" (1990). College of Optometry. 950. https://commons.pacificu.edu/opt/950 This Thesis is brought to you for free and open access by the Theses, Dissertations and Capstone Projects at CommonKnowledge. It has been accepted for inclusion in College of Optometry by an authorized administrator of CommonKnowledge. For more information, please contact [email protected]. A picture atlas and teaching aid for gonioscopy Abstract Gonioscopy is the only procedure available for viewing the anterior chamber angle structures. As optometry is expanding its scope and playing a more active role in the diagnosis and management of ocular disease, gonioscopy is becoming a procedure with which optometrists must be proficient. This paper is composed of pictures and slides of normal and anomalous anterior chamber angles. Included are interpretations of the pictures, explanations of the procedure, and indications for its use. Degree Type Thesis Degree Name Master of Science in Vision Science Committee Chair Nada Lingel Subject Categories Optometry This thesis is available at CommonKnowledge: https://commons.pacificu.edu/opt/950 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s).
    [Show full text]