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Elderly patients with cataract phacoemulsification and intraocular lens implantation analysis_2602

By Francisco Bradley,2014-10-30 16:28
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Elderly patients with cataract phacoemulsification and intraocular lens implantation analysis_2602

    Elderly patients with cataract phacoemulsification and intraocular lens implantation analysis

     Abstract Objective: To evaluate the elderly patients with cataract phacoemulsification and intraocular lens implantation in the clinical efficacy and safety. Methods: 184 cases (221) 80 ~ 103-year-old cataract phacoemulsification and intraocular lens implantation on visual acuity and complications were analyzed. Results: After 1wk literacy rate of 95.0%, removal of residual rate of 77.8%. No serious local and systemic

    complications occurred. 49 after 1wk vision ? 0.3, which

    retinopathy accounted for 41 (83.7%). Conclusion: The elderly patients with cataract phacoemulsification and intraocular lens implantation is safe and effective. Retinopathy is the

    main reason affecting postoperative visual acuity.

     Key words elderly cataract phacoemulsification and intraocular lens

     Analysis of the effect of phacoemulsification and IOL implantation for aged patients

     Abstract AIM: To evaluate the clinical effect and

    safety of the phaco IOL of the cataract in the advanced age. METHODS: One hundred and eighty-four cases (221 eyes, 80-103

    years) were made the phaco IOL. The acuity of vision and complication were analyzed. RESULTS: The out of blindness rate

    and out of disability were 95.0% and 77.8%, respectively in one week. None of the cases had the severe complication all over the body. Forty-one eyes had the fundus oculi affection in the 49 cases that the post-operation acuity of vision was

    below 0.3 (83.7%). CONCLUSION: The phaco IOL of the cataract in the advanced age are safe and effective. The fundus oculi affection is the main reason that effect the recovery of the

vision after the phaco IOL of the advanced age.

     * KEYWORDS: cataract; advanced age; phacomulsification; IOL

     0 Introduction

     To improve the quality of life in his later years to choose a suitable way elderly cataract surgery has become an ophthalmologist concerns. 1997-12/2006-03 our hospital 184

    cases of 221 pairs over the age of 80 cataract patients with phacoemulsification and intraocular lens implantation, the effect, the report is as follows.

     An object and method

     1.1 Object 184 cases of 221 cataract patients, aged 80 to 103 years old. 125 male and 104 cases, female 80 cases of 96. Preoperative visual acuity from light perception to 0.3. Lens nuclear hardness classification method according to LOCS ?,

    ? grade nuclear 21, ? grade nuclear 91, ?-class nuclear or

    above 109. 148 cases of the coexistence of systemic diseases

    (80.4%), the main systemic diseases, coronary heart disease, hypertension, diabetes, cerebrovascular disease, chronic bronchitis, renal failure.

     1.2 Methods disinfected after completion of eye 4g / L times the promise hi eye drops three times line topical

    anesthesia. Above the temporal clear corneal tunnel incision made inside the 1mm, the opposite of doing a transparent supporting limbal incision, anterior chamber into the high adhesion of viscoelastic agents, to do with self-made needles,

    broken capsule continuous curvilinear capsulorhexis, full hydration of separation, according to hard-core using

    different pieces of different types of nuclear emulsion technologies, including improved segmentation broken nuclear, cortical, or naked to retain the nuclear spin etching methods such as the lens nucleus smash Gettering, suction lens cortex. Forward once again into the room and the capsular bag viscoelastic agents, artificial lens implantation in the capsular bag or ciliary sulcus. Final surgery under Qionglong Bu subconjunctival injection of dexamethasone 2.5mg + gentamycin 20000 U.

     2 Results

     Corrected visual acuity of 2.1 after 1wk best corrected visual acuity ? 0.05 were 210, accounting for 95.0%; best corrected visual acuity ? 0.3 were 172, accounting for 77.8%

    (Table 1).

     2.2 Ocular complications

     2.2.1 Intraoperative complications included posterior

    capsule rupture for 7 (3.5%), handling all of the preceding seven posterior vitreous and intraocular lens implantation.

     2.2.2 The main complications of corneal edema in 54 (24.4%), both endothelium-linear, or patchy gray turbid

    turbid, after local steroid hormones and (or) high exudate 1wk to basically subsided, no one corneal endothelial decompensation occurred. Pigmented membrane reaction strongly positive 23 (10.4%), wound dehiscence in 3 eyes (1.4%), hyphema in 2 eyes (0.1%).

     2.3 The intraoperative and postoperative systemic complications induced by non-one cases of severe systemic

    complications and increase the existing systemic diseases.

     2.4 Fundus examination after 1wk of visual acuity less than 0.3 49 to dilated examination, retinopathy 41, accounting for 83.7%. Which age-related macular degeneration 22, 10 optic atrophy, high myopia retinopathy in 4 eyes, diabetic retinopathy in 3 eyes, retinal pigment degeneration in 2 eyes. Reposted elsewhere in the paper for free download http://

     3 Discussion

     With the growing aging population, age-related cataract

    prevalence was significantly higher, 80 years of age or older due to cataract blindness rate of 83.02% [1]. The majority of these patients combined in one or several systemic diseases, decreased physical function, stress and metabolic capacity, and surgical tolerance is poor, so they requested that a short time to complete high-quality surgery. Phacoemulsification and intraocular lens implantation by small incision, less injury,

    less complications, shorter operative time and meet the needs of these patients surgery. Data indicate that [2] The most

common cataract surgery for the eye-heart reflex systemic

    complications, the very old may be as high as 56.6% incidence

    of serious cases, even lead to death. The most eye-cardiac

    reflex in retrobulbar anesthesia, pressure to soften the eye, and superior rectus traction suture phase [3]. All patients in this group using topical anesthesia, clear corneal incision,

    while not to mention hanging on the rectus muscle, which greatly reduces the eye-heart reflex cardio-cerebral vascular

    complications such as the incidence of bleeding after the ball to avoid local complications. This is suffering from cardio-

    cerebral vascular disease, coagulation disorders, diseases, surgery in elderly patients with greatly increased security, expanded surgical indications. And simplifying the anesthesia and surgical steps, shortening the operation time. All patients are able to withstand surgery, no obvious discomfort reaction. At the same time through the observation of this group of patients, we understand to ensure the successful completion of surgery to reduce postoperative reaction, there should be attention to the following questions: preoperatively

    detailed medical check-up, if necessary, request physician

    assisted diagnosis and treatment. Fasting blood glucose control in 9.0mol / L, postprandial 2h plasma glucose control in 12.0mol / L less; blood pressure controlled at below

    140/90mmHg; all cardio-cerebral vascular diseases should be in recovery or stable period. Renal failure patients before hemodialysis treatment 1d OK. Cardiopulmonary dysfunction who intraoperative be low-flow oxygen, and given ECG.

    Postoperative treatment with topical therapy-based, restricted

    activities, so as to avoid systemic adverse reactions.

     The normal function of corneal endothelial cells depends on the density and shape. Corneal endothelial cell density with age reduction, morphology and function also changes,

    right phacoemulsification is more sensitive to damage [4]. At the same time as the old cataract is often hard core, hard core of the difficulty of phacoemulsification and the degree of injury increases, will increase the damage to the corneal

    endothelium, resulting in corneal edema or endothelial decompensation occurred bullous keratopathy, for which are reported in the literature [5] on the old hard-core do not

    advocate the choice phacoemulsification cataract surgery. We sympathize with the use of intraoperative corneal endothelial protection is conducive to the high adhesion of viscoelastic agents, hard-core use different pieces of different types of

nuclear emulsion technology [6], to maintain in-situ emulsion,

    applied a low ultrasonic energy, high negative pressure

    working condition the shortest possible time,

    phacoemulsification can reduce the impact of surgery on the endothelial cells. Patients in this group occurred after 54 corneal edema, the incidence of 24.4%, both endothelium-

    linear, or patchy gray turbid turbid, after local steroid hormones and (or) high exudate 1wk basic dissipated within the edema, no one corneal endothelial decompensation occurred, indicating surgery on corneal endothelial damage caused by the smaller.

     As can be seen from Table 1 in this group of elderly patients with cataract visual acuity compared with preoperative visual acuity had significantly improved. After 1wk off disability rate (? 0.3) up to 77.8%, literacy rate

    (? 0.05) up to 95.0%, which greatly improved the quality of

    life in elderly patients. But the proportion of patients although the operation was a success, visual acuity increased to varying degrees, still unable to nursed back to health and even literacy. Analysis of the main reasons for low vision

    occurs with the original ocular fundus lesions related. Postoperative visual acuity less than 0.3 in this group of 49 eyes of retinopathy 41 accounted for 83.7%, this proportion is much higher than other age groups in patients with cataract.

    Therefore, elderly cataract patients before inquired in detail about history and the contralateral eye of scrutiny is particularly important, when necessary, visual

    electrophysiology, fluorescence angiography, B extra fine examination adequately assess prognosis and avoid unnecessary

    surgery in medical malpractice.

     In conclusion, elderly patients with cataract

    phacoemulsification and intraocular lens implantation is safe and effective, adequate surgical preparation and skillful surgical technique does not cause serious complications [7,8], should be used as first choice for elderly patients with cataract surgery type.

     References

     1 Amy. Ophthalmology book. Beijing: People's Medical Publishing House ,1996:974-979

     2 Wang Zhiyong, Yu Guiyun, Jun-Dong Wang. Electrocardiogram

    observed during cataract surgery in elderly. Ocular trauma ergophthalmological magazine, 1998; (21) 1:46-47

     3 Gao L, Tao Zhigang, Qing Wang, Wu Fa-liang, Xu Haifeng.

    Senile cataract eye surgery cardiac reflex. Chinese Journal of Ophthalmology, 1997; 33 (5) :334-336

     4 Xiao Qiong, Huang Ju days, Ge Jun, Lin Song-hui.

    Phacoemulsification cataract surgery in corneal endothelial cells observed. Chinese Journal of Practical Ophthalmology, 1998; 16 (9) :568-570

     5 Yao Ke, Jiang Kai Festival, Chen Peiqing, Weng Yan, Yang industry wave. Cataract phacoemulsification and posterior chamber intraocular lens implantation. Chinese Journal of Ophthalmology, 1996; 32 (2) :85-87

     6 Zhu Siquan, Wu Xiaomei, Xu Bing. Hard-core cataract

    phacoemulsification and intraocular lens implantation. Chinese Journal of Ophthalmology, 1998; 34 (1) :90-92

     7 Zhu Li, Shen Nim Chi, Yi Ding, Wang Yan, Wu Lei, Zhu Min. Old senile cataract phacoemulsification clinical observation. International Ophthalmology, 2004; 4 (2) :331-333

     8 Liang Ce, Que Peng Zhi Kyoshi leather, Shen clouds, Xiao-

    Mei Chen. A super-aged cataract extraction and intraocular lens implantation in 49 cases. International Ophthalmology, 2003; 3 (4) :105-106 reposted elsewhere in the paper for free

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