Main description:

The authors of this book are busy practical men with no particular barrow to push. The text of the book includes a comprehensive review of all aspects of intraocular lens surgery including details of the design, optics chem istry and sterilization of intraocular lenses. Its value is enhanced by excellent illustrations and extensive tabulated references to the litera ture. Accounts of patient acceptability are balanced against candid discus sion of complications and their management. The historical introduction recalls that in the early stages of develop ment of the art, over a period of 10 years, two dozen different lens designs were proposed, most claiming elimination of problems which had arisen with their predecessors. Eventually nearly all disappeared from the scene. In an age where every cataract surgeon has to determine a personal position on intraocular lens implantation the author's reflections on these matters are timely. Intraocular lenses are neither a miracle nor a menace, provided that personal decisions and preferences are carefully thought through and put into practice upon the basis of known facts and not upon the basis of fickle fashion and fad. This book provides a background upon which the reader can eva luate in his own mind the validity of information provided by the manufacturers of various lens designs.

Contents:

I History.- I. Posterior Chamber Lenses.- II. Anterior Chamber Lenses.- III. Toward the Modern Implant Lenses.- II The Classic Modern Lens.- I. Design and Fixating Principles of the Classic Lens Models.- A. Iris Supported Lenses.- B. Iridocapsular and Capsular Supported Lenses.- C. Angle Supported Lenses.- II. General Nomenclature.- III Materials, Manufacture, and Sterilization.- 1 Basic Materials.- I. Plastics for Intraocular Use.- A. Polymethylmethacrylate.- 1. Synthesis of the Monomer.- 2. Polymerization.- B. Polyamides or Nylons.- 1. Nylon 6.- 2. Nylon 6/6.- 3. Properties of Polyamides.- 4. Nylon Degradation in vivo.- C. Polypropylene.- II. The Metals.- A. Platinum.- B. Titanium.- C. Stainless steel.- 2 Manufacture.- A. Rayner.- B. Mocher.- 3 Sterilization.- IV The Optics of Intraocular Lenses.- I. The Optical Quality of Polymethylmethacrylate Lenses.- II. The Dioptric Power of Human Crystallin.- III. The Pseudophakos as a Substitute for the Crystalline Lens.- IV. Determination of Implant Lens Power.- A. The 1.25 Diopter Rule.- B. Calculating the Lens Power from Biometrie Data.- V. Determination of the Iseikonic Lens Power.- VI. Practical Considerations on the Proper Selection of the Implant Power.- V Pre-, Per-, and Postoperative Management.- I. Preoperative Management.- A. Clean and Aseptic Surgery.- B. The Pupil.- C. General or Local Anesthesia.- D. Visibility.- E. Preparation of the Lens.- F. Obtaining a "Soft" Eye.- 1. Diuretics and Osmotic Agents.- 2. Ocular Massage.- 3. Separation of the Eyelids.- 4. Scleral Ring.- 5. Pars Plana Vitreous Tap-Vitrectomy.- 6. Anesthesia: Local and General.- II. Peroperative Management.- A. Incision.- B. Cataract Extraction.- 1. Intracapsular Cataract Extraction.- 2. Extracapsular Cataract Extraction.- a. Step I: Capsulotomy-Capsulectomy.- b. Step II: Removal of the Nucleus.- c. Step III: Evacuation of Cortical Remnants.- C. Common Points in Lens Implantation.- 1. After Intracapsular Cataract Extraction.- 2. After Extracapsular Cataract Extraction.- 3. Glides and Sleeves.- 4. Pupil Constriction.- 5. Iridectomies.- 6. Finishing Touches.- D. Wound Closure and Astigmatism.- III. Postoperative Management.- A. Postoperative Care.- B. Postoperative Complications.- 1. Shallow and Flat Anterior Chamber.- 2. Subluxation and Luxation.- 3. Decentration.- 4. Secondary Procedures for Lens Remnants.- 5. Incision of the Posterior Capsule and Secondary Membranes.- 6. Lens Removal.- IV. Stabilization of Implants by Sutures.- 1. Alpar's Approach.- 2. Simcoe's Approach.- 3. McCannel-Binkhorst Suture.- 4. The Strampelli Thread.- VI The Iris Supported Lenses.- 1 The Iris Clip Lens.- I. Introduction to the Lens and Its Evolution.- A. Binkhorst's Design Changes.- B. Binkhorst's Changes in Loop Orientation and Additional Fixation Aids.- C. Modifications of the Iris Clip Lens by Other Surgeons.- II. Implantation Techniques.- A. Binkhorst's Technique.- 1. Vertical Positioning of the Lens.- 2. Transiridectomy Suturing.- B. Other Techniques.- 1. The "Closed Chamber" Technique.- 2. Horizontal Positioning of the Lens.- 3. Modified Suturing Techniques.- III. Twenty Years of Experience with the Iris Clip Lens: 1958-1978.- A. The Developmental Period: Binkhorst's Experience, 1958-1971.- 1. Secondary Implantations: Binkhorst's First 70 Cases.- 2. Primary Implantations by Binkhorst from 1961 to 1971.- a. The First Primary Implantations of Iris Clip Lenses.- b. The Survey of J. Pearce.- c. Nordlohne's Survey of Binkhorst's Patients.- 3. Discussion and Conclusions about Binkhorst's Use of Iris Clip Lenses after ICCE during the Developmental Period.- a. The Materials Used.- b. Tissue Reaction.- c. Secondary Membranes.- d. Glaucoma.- e. Cystoid Macular Edema.- f. Retinal Detachment.- g. Hemorrhage.- h. Dislocation and Endothelial Corneal Dystrophy.- 1) The Problem of Dislocation.- - Types of Dislocation.- - Dislocation Prevention.- 2) The Problem of Endothelial Corneal Dystrophy.- - Analysis of Factors Contributing to ECD.- - Endothelial Corneal Dystrophy Prevention.- 4. Other Reports on the Iris Clip Lens after ICCE during the Developmental Period.- a. Results of Different Surgeons in 321 Cases.- b. Nordlohne's Survey of 485 Iris Clip Lenses Implantations by J. Worst.- 5. Conclusions for the Developmental Period.- B. The Current Situation: Recent Data on the Use of the Iris Clip Lens after Intracapsular Cataract Extraction.- 1. The Data Published by J. Draeger, K. Schott, and N.S. Jaffe.- 2. Conclusion.- 2 The Copeland Lens.- I. Introduction.- II. Implantation Techniques.- A. The Open-Sky Technique.- B. The Formed Chamber Technique.- III. Survey of the Early Results.- A. Jaffe's Series.- B. The Miami Series.- IV. Recent Studies.- A. Osher's Study.- B. Other Studies on the Copeland Lens.- 1. Snider's and Taylor's Series: 595 Cases.- 2. Benjamin's. Sherman's, and Gentri's Series: 101 Cases 209 V. Conclusions.- 3 Medallion Lens.- I. Introduction.- II. Implantation Techniques.- A. The Medallion Lens.- B. The Slotted Medallion Lens.- III. Development of the Medallion Lens.- A. Worst's Early Results.- B. The Developmental Period.- 1. Introduction.- 2. Worst's Modifications of the Medallion Lens.- a. The Medallion Platinum Clip Lens.- b. The Single Loop Medallion Lens.- 3. Other Lens Designs by Worst.- IV. The Current Situation: The Data Published by R. Drews, M.C. Kraff, and H. Lieberman.- V. Conclusion.- 4 The Sputnik Lens.- I. Introduction.- II. Implantation Techniques.- A. The Open-Sky Technique.- B. The Formed Chamber Technique.- III. Results.- A. Fyodorov's Series.- B. Galin's Series.- C. Kwitko's Series.- IV. Conclusion.- 5 Other Lens Designs.- I. The Krasnov Extrapupillary Iris Lens.- II. The Sachar Lens.- III. The Boberg-Ans Lens.- IV. The Rainin Anchor Lens.- V. A Soft Iris Supported Lens.- VI. The Glass Intraocular Lens.- VII. The Anis Lens.- VIII. The Iris Claw Lens.- IX. The Severin Lenses.- General Conclusion on Iris Supported Lenses.- VII Iridocapsular and Capsular Supported Lenses.- I. Advantages of Lens Implantation after Extracapsular Cataract Extraction.- A. Practical Considerations.- B. Clinical Observations.- C. Theoretical Considerations: The Barrier Deprivation Syndr..- II. The Mechanism of Capsular Fixation.- III. Lens Styles Used after Extracapsular Cataract Extraction.- 1 Iridocapsular Lenses.- I. The Binkhorst Two-Loop Lens.- A. Binkhorst's Technique.- 1. Preliminary Steps.- 2. Implantation Technique.- 3. Postoperative Measures.- 4. Modifications of Binkhorst's Technique.- B. Binkhorst's Results.- C. Results of the Authors.- D. Results from Other Surgeons.- II. The Platinum Clip Lens.- A. Surgical Technique.- B. Results.- C. Modifications of the Platinum Clip Lens.- III. Other Iridocapsular lenses.- A. The Small Incision Lenses.- B. The Medallion Cloverleaf Lens.- C. The Medallion Slotted Boomerang Lens.- 2 Posterior Chamber Lenses.- I. The Pearce Posterior Chamber Lens.- A. Pearce's Surgical Technique.- B. Pearce's Results.- II. Other Posterior Chamber Lenses.- A. The Iridocapsular Lens as a Posterior Chamber Lens.- B. The Little-Arnott Lens.- C. The Harris Lens.- D. The Coleman-Taylor Lens.- E. The Anis Lens.- F. The Ong Capsular Lens.- G. The Sheets Lens.- III. The Shearing Lens.- A. Shearing's Surgical Technique.- B. Shearing's Results.- C. Results Obtained by Other Surgeons.- D. Modifications of the Shearing Lens.- Conclusion.- VIII Angle Supported Lenses.- I. Secondary Implantation.- A. The Developmental Period: Choyce Mark I - Choyce Mark VII.- 1. Mark I: The First 100 Cases.- 2. Modifications of the Mark I Lens.- 3. The Mark VI and Mark VII Lenses.- B. Fifteen Years of Experience with the Choyce Mark VIII Lens (1963-1978).- 1. Results and Complications with the Mark VIII: Choyce's Series.- 2. Evaluation by J. Pearce.- 3. Conclusion.- C. Secondary Implantations of the Choyce Mark VIII by Other Surgeons.- II. Primary Implantation.- A. Primary Implantation of the Choyce Mark VIII Lens by D.P. Choyce.- B. Growing Interest in Primary Implantation of the Choyce Mark VIII Lens.- C. Data on Primary Implantation of the Choyce Mark VIII Lens by Other Surgeons.- III. The Principal Problems with the Choyce Mark VIII Lens as Reported between 1976 and 1978.- A. Clinical Findings Concerning the UGH Syndrome.- B. Treatment of the UGH Syndrome.- C. Etiology of the UGH Syndrome.- 1. The Lens.- a. Warpage.- b. Improper Finishing.- c. Materials and Sterilization.- 2. Poor Surgical Judgment and Poor Surgical Technique.- IV. The Choyce Mark IX Lens.- A. Limitations of the Mark VIII Lens.- B. Description of the Mark IX Lens.- C. Advantages of the Mark IX over the Mark VIII Lens.- V. Surgical Technique.- A. Choyce's Method of Secondary Implantation.- B. Choyce's Method of Primary Implantation.- C. Additional Guidelines on the Proper Technical Management of Angle Supported Lenses.- 1. Lens Inspection.- 2. Determination of the Lens Length.- a. Preoperative Estimation of the Length.- b. Peroperative Estimation of the Lens Length.- c. Postoperative Controls.- 3. Remarks on the Incision.- 4. Remarks on the Insertion Technique.- 5. Vitreous Loss.- 6. Prevention of Iris Bulge and Pupillary Block.- 7. The Sore Eye Syndrome.- VI. Summary and Conclusions.- VII. New Lens Designs.- A. The Azar Pyramid Mark III Lens.- B. The Kelman Anterior Chamber Lens.- C. The Tennant Anchor Lens.- D. The Leiske Angle Supported Lens.- IX Mixed Results and Comparative Studies.- I. Results Obtained with Various Lens Types by the Same Surgeon or Surgical Team.- 1. J.C. Worst et al.- 2. H. Hirschman.- 3. N.S. Jaffe.- 4. D.D. Shepard.- 5. N.L. Snider and W.U. McReynolds.- 6. R. Kratz et al.- II. Intracapsular Cataract Extraction and Lens Implantation versus Extracasular Cataract Extraction and Lens Implantation.- 1. J.G.C. Renardel de Lavalette.- 2. R. Kern.- III. Pseudophakia versus Aphakia.- 1. N.S. Jaffe et al.- 2. B.S. Prokop.- 3. D.E. Williamson.- 4. R.F. Azar.- 5. W.J. Stark et al..- 6. M.A. Galin.- 7. D.M. Taylor et al..- X Secondary Lens Implantation.- I. Incidence.- II. Secondary Implantation of Iris and Iridocapsular Supported Lenses.- A. Indications.- B. Binkhorst's Fixation Modalities for Secondary Implantation.- III. Secondary Implantation of Angle Supported Lenses.- A. Indications.- B. Results.- IV. Secondary Lens Implantation Series of Various Lens Types.- A. Hardenberg's Study.- B. Shammas's and Milkie's Study.- Conclusion.- XI Lens Implantation in Children Traumatic and Infantile Cataracts.- I. Early Reports.- A. Traumatic and Infantile Cataracts: D.P. Choyce.- 1. Traumatic Cataract.- 2. Congenital Cataract.- B. Traumatic and Infantile Cataracts: CD. Binkhorst.- 1. Traumatic Cataracts.- a. Measures for the Prevention of Amblyopia and the Loss of Binocular Vision.- b. Some Technical Considerations.- 2. Congenital Cataract.- II. Later Reports.- A. Binkhorst's Latest Data on Traumatic Cataracts in Children.- 1. Functional Results.- 2. Complications.- 3. Remarks on General Management.- B. Reports by Other Surgeons.- 1. A.T.M. Van Balen's Report on 37 Traumatic Cataracts in Children.- a. Functional Results.- b. Implant Fixation and Postoperative Problems.- 2. D.A. Hiles's Report on 37 Traumatic Cataracts in Children.- a. Functional Results.- b. Some Remarks on the Technique and Postoperative Problems.- 3. Hiles's Survey of Lens Implantation in Children, 1978.- a. Traumatic Cataracts.- (1) Functional Results.- (2) Complications.- b. Infantile Cataracts.- (1) Functional Results.- (2) Complications.- Conclusions on Implantation in Children.- XII Lens Implantation and the Endothelium.- I. Postoperative Corneal Behavior as Evaluated by Pachometry and Specular Microscopy.- A. Pachometric Studies.- B. Studies with the Specular Microscope.- 1. Prospective Studies.- a. Cataract Extraction without Lens Implantation.- b. Cataract Extraction with Lens Implantation.- 2. Retrospective Studies.- a. Pseudophakic versus a Phakic Fellow Eye.- b. Pseudophakic versus an Aphakic Fellow Eye.- c. Pseudophakie versus a Pseudophakie Fellow Eye.- II. Endothelial Damage: Promoting Factors, Prevention, and Treatment.- A. Mechanical Damage.- 1. Folding the Cornea.- 2. Instrumental Touch.- 3. Damage by the Implant.- a. Damage during Surgery.- b. Damage after Surgery.- Shallow or Flat Anterior Chamber.- Decentration.- Lens Instability, Subluxation, Luxation.- B. Other Factors.- 1. Irrigating Solutions.- 2. Mydriatics.- 3. Miotics.- 4. Antibiotics.- 5. Air.- 6. Iritis and Uveitis.- III. The incidence of Endothelial Corneal Dystrophy.- Summary and Conclusion.- Keratoplasty and Lens Implantation.- A. Triple Procedures.- B. Combined Procedures in Apkakia.- C. Keratoplasty in Pseudopkakia.- XIII Lens Implantation and Inflammatory Response and Glaucoma.- I. Some Considerations on Postoperative Uveal Reaction.- II. Uveal Behaviour and Introcular Pressure Dysregulation during the Early Postoperative Period.- 1. Iris Supported Lenses.- a. Iris Clip, Medallion, Sputnik Lens.- b. Copeland Lens.- 2. Iridocapsular Supported Lens.- 3. Angle Supported Lenses.- III. Uveal Behavior and Intraocular Pressure Dysregulation during the Late Postoperative Period.- A. Late Uveal Behaviour.- 1. Iris Supported Lenses.- a. Chronic Uveal Reactions.- b. Late Atrophic Changes.- c. Problems with Metal-Looped Iris Supported Lenses.- 2. Iridocapsular Supported Lenses.- a. Chronic Uveal Reactions with Metal-Looped Lenses.- b. Late Atrophic Changes with Metal-Looped Lenses.- 3. Angle Supported Lenses.- a. Chronic Uveal Reactions.- b. Late Atrophic Changes.- c. The U.G.H. Syndrome.- B. Late Intraocular Pressure Dysregulation.- IV. Lens Implantation after Glaucoma Surgery.- XIV Lens Implantation and Cystoid Macular Edema.- I. Introduction.- A. The Clinical Picture.- B. Evolution and Prognosis.- C. Pathogenesis.- D. Treatment.- II. Incidence of Cystoid Macular Edema without Lens Implantation.- A. Clinical Cystoid Macular Edema.- B. Angiographic Cystoid Macular Edema.- III. Incidence of Cystoid Macular Edema with Lens Implantation.- A. Clinical Cystoid Macular Edema.- B. Angiographic Cystoid Macular Edema.- 1. Retrospective Study by R.L. Winslow et al..- 2. Preliminary Comparative Study by N.S. Jaffe et al..- 3. Preliminary Study of ACME and the Status of the Posterior Capsule by R.L. Winslow et al..- IV. Discussion and Conclusions.- A. Is the Incidence of Cystoid Macular Edema the same in Aphakia as in Pseudophakia?.- B. How is the Occasional Higher Incidence after Lens Implantation to be Explained?.- C. Does Pseudophakic Cystoid Macular Edema have the same Characteristics as ordinary Cystoid Macular Edema and what are the Therapeutic Consequences?.- XV Lens Implantation and Retinal Detachment.- I. Data on Aphakic Retinal Detachment without Lens Implantation.- A. Incidence.- B. Time Interval.- C. Age.- D. Factors Contributing to Aphakic Retinal Detachment.- 1. Preoperative Conditions.- 2. Peroperative Factors.- 3. Postoperative Factors.- E. Aphakic Retinal Detachment after Extracapsular Cataract Extraction (Phakoemulsification).- II. Data on Aphakic Retinal Detachment with Lens Implantation.- A. Incidence.- B. Characteristics.- C. Problems Related to Pseudophakic Retinal Detachment.- 1. Visualization of the Retina.- 2. Measures to Improve Visual Access.- D. Results in Pseudophakie Retinal Detachment.- E. Remarks on the Presence of a Pseudophakos during the Treatment of Retinal Detachment.- III. Summary and Conclusions.- XVI Guidelines.- I. Alternative Solutions.- II. Surgical Skill and Judgment.- III. The Patient.- A. Age.- B. The Patient's Requirements.- 1. Restoration of Binocular Vision.- 2. Professional and Environmental Requirements.- 3. Some Mental and Physical Conditions.- 4. Unilateral Aphakia.- 5. The One-Eyed Patient.- 6. Bilateral Lens Implantation.- 7. General Conditions as Restrictive Factors.- C. Racial Factors.- IV. The Eye.- V. The Lens and the Appropriate Techniques.- A. Lens Types after Intracapsular Cataract Extraction.- 1. Angle Supported Lenses.- 2. Iris Supported Lenses.- B. Lens Types after Extracapsular Cataract Extraction.- 1. Angle Supported Lenses.- 2. Iris Supported Lenses.- 3. Iridocapsular Lenses.- 4. Posterior Chamber Lenses.- Conclusion.