Erzsebet Kantor’s research while affiliated with Spitalul Clinic de Urgență pentru Copii Cluj-Napoca and other places

The study presents the technical difficulties of the capsulorhexis and phacoemulsification in the white, intumescent cataract and the incidences occurred during the foldable IOL implantation with the Monarch II injector. The clinical study comprises a number of 70 eyes with white intumescent cataract operated during 15 January-15 December 2003 by the same surgeon. The surgical intervention consisted of lens extraction by phacoemulsification with clear corneal incision, using the Monarch II injector for the foldable IOL implantation. In 56 eyes, the anterior capsule was stained with trypan blue. The intraoperative complications include: failed capsulorexis in 4 cases (5.71%), rupture of posterior capsule in 1 case (1.43%) and the conversion to classical extracapsular extraction in 3 cases (4.29%). IOL implantation was made with the help of the Monarch II injector in 67 cases (95.71%). The foldable IOL implantation in the bag was realised a single time in 44 cases (62.9%). We had the following incidences in the other cases: the upside down turning of the IOL during unfolding in 2 cases, the second haptic capture in the tunnel of the cartridge in 2 cases, the second haptic stucks outside or in the anterior chamber in 18 cases, the first haptic stays in the sulcus and the second one stays outside in 1 case. In eyes with 1 intumescent cataract we can perform the continuous curvilinear capsulorhexis using trypan blue, but also without staining the anterior capsule using mechanical or manual aspiration of the liquefied cortex and viscoelastic substances. The foldable intraocular lens implantation with the injector proves to be an easy and comfortable method after it has been practiced for a longer period of time if the right size of the cartridge is used.

The purpose of this study is to estimate the technical difficulties and the intraoperative complications which appear in patients with high myopia who had been operated on cataract through phacoemulsification technique; to establish the IOL refractive power and to estimate the functional results at 45 days postoperative. We performed a study on 44 eyes with high myopia and cataract operated in the Emergency Military Hospital from Cluj-Napoca during 15th of January -15th of June 2003. We analyzed the patients' age, the technical difficulties and intraoperative complications, the IOLs choosing and the functional results. The greatest frequency of patients with high myopia and cataract met into the study was between 50-60 years old (43.18%). The intraoperative complications were represented by the posterior capsule's refraction without loss of vitreous in one case, zonular rupture in one case and one case with loss of the nucleus into vitreous. In patients with high myopia and cataract the surgical procedure solves both visual problem and refractive deficiency. For the myopic eye is important to use IOL with 6 mm, 6.5 mm diameter.

Although the IOL implantation was used initially just for cataract surgery, in the last period IOLs are used in treating myopia more than -12D and hyperopia more than +4D, in phakic eyes, when the indications of excimer laser are limited. We present the case of a 40 years old patient with the diagnosis: biphakia, complicated cataract and high myopia in both eyes. VA-RE = 2/50 cc, VA-LE = 3/50 cc, IOP-RE:15 mmHg, IOP-LE:16 mmHg. We performed, in two separate surgeries, the explantation of the intraocular lens, then the extraction of the opacified crystalline lens through the same incision and the implantation of an AcrySof foldable lens with an adequate power, in the bag. We discuss the causes of cataract formation in eyes with posterior chamber phakic intraocular lens, the choice of the IOL power, the incision for explantation and implantation, and the intraoperative technical difficulties. The association of phakic IOLs and cataract represents a new challenge to the ophthalmic surgeon, taking into account that these IOLs are becoming more and more popular to correct high refractive errors.

The evaluation of the intra and post operative early complications of the phacoemulsification with posterior chamber artificial lens implant on my first 507 cases. A retrospective study on 507 eyes operated by cataract through phacoemulsification technique at the Emergency Military Hospital from Cluj-Napoca during the 1st of May-30th of June 2002. The surgeries were performed by the same surgeon through a corneal or a scleral incision using rigid and foldable artificial lenses. The evaluation period lasted 2 months, the types and frequency of the intraoperative and early postoperative complications being analyzed. The intraoperative complications were represented by the posterior capsule's efraction in 17 cases (3.37%); zonular rupture in 3 cases (0.59%); the loss of the nucleus into vitreous 4 cases (0.79%); the luxation of the crystalline lens in the anterior chamber in 5 cases (0.99%); the hyphaema and iris trauma in 14 cases (2.76%); incomplete cortical clean-up in 9 cases (1.78%); the failed capsulorhexis in 7 cases (1.38%) and the conversion to ECCE in 8 cases (1.58%). The early postoperative complications met into the study were: the corneal edema in 34 cases (6.71%); raised IOP in 18 cases (3.55%); the retained lens material in 9 cases (1.78%); the late inflammatory reactions in 6 cases (1.18%); hypopyon in 3 cases (0.59%); endophthalmitis in 3 cases (0.59%); retinal detachment in 1 case (0.2%) and the anterior capsule fibrosis in 4 cases (0.79%). The phacoemulsification is a high security technique because of the small incision and the sharp accuracy. The complications correlate themselves with the surgeon experience and with some particularities of the cataract (the brunescent cataract at the old patient, the medium dilatation of the pupil, etc.).