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      Quantification of Blood-Aqueous Barrier Breakdown after Phacoemulsification in Fuchs’ Heterochromic Uveitis

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          Abstract

          Purpose: To quantify the breakdown of the blood-aqueous barrier (BAB) following phacoemulsification with posterior chamber lens implantation in eyes with Fuchs’ heterochromic uveitis (FHU). Patients and Methods: In this retrospective study, 19 eyes of 19 patients with FHU (mean age 38 ± 14 years) and 35 eyes of 35 patients with senile cataracts (mean age 63 ± 9 years) underwent phacoemulsification with one-piece PMMA posterior chamber lens implantation. Aqueous flare was quantified using the laser flare-cell meter (LFCM, Kowa FC-1000) following medical pupillary dilation preoperatively and 1, 3, and 5 days, then 1 and 6 weeks and 6 months postoperatively. Results: Mean preoperative aqueous flare (in photon counts per millisecond) in FHU vs. controls was 11.7 ± 3.5 vs. 5.8 ± 1.7. Following cataract surgery, mean aqueous flare increased to 27.8 ± 4.4 vs. 16.0 ± 4.5 on day 1, decreased to 23.6 ± 4.0 vs. 11.8 ± 3.5 on day 3, and to 18.0 ± 3.0 vs. 9.5 ± 1.7 on day 5. In FHU eyes, it was 13.9 ± 2.7 after 1 week, and had returned to preoperative levels after 6 weeks (10.9 ± 2.5) and remained stable for up to 6 months (mean 10.3 ± 2.2). Pre- and postoperatively, aqueous flare values were 2–3 times higher in FHU eyes than in control eyes with senile cataract (p = 0.01). No postoperative complications such as fibrin formation, synechiae, macrophages on the intraocular lens optic or endophthalmitis were observed in any of the patients. Conclusions: BAB breakdown following phacoemulsification with posterior chamber lens implantation is relatively mild in eyes with FHU and the BAB appears to be fully reestablished to preoperative levels 6 weeks postoperatively, explaining the usually good outcome of cataract surgery in this condition.

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          Most cited references 14

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          Fuchs' heterochromic cyclitis: review of the literature on the pathogenetic mechanisms.

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            Inflammation after sclerocorneal versus clear corneal tunnel phacoemulsification.

            To compare the postoperative inflammation after phacoemulsification followed by intraocular lens (IOL) implantation by means of sclerocorneal versus clear corneal tunnel incision. Randomized controlled clinical trial. One hundred eyes of 100 patients were examined at a German University eye hospital. One hundred eyes with cataract necessitating phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision by a single surgeon. Preoperative and postoperative inflammation was evaluated by measurement of flare using laser flare photometry. Statistical inference was mainly based on nonparametric group comparisons by use of two sample Wilcoxon tests. Mean anterior chamber flare in the group with sclerocorneal tunnel increased from 7.5 photon counts/ms preoperatively to 19.6 at 6 hours postoperatively and decreased to 11.1 (day 1), 11.7 (day 2), 11.6 (day 3), and 9.2 (5 months) during the postoperative course. The mean flare in the clear corneal tunnel incision group increased from 7.7 preoperatively to 12.9 at 6 hours postoperatively and then decreased to 9.2 (day 1), 9.8 (day 2), 9.1 (day 3), and 9.2 (5 months). Individual postoperative flare changes were significantly lower in the clear corneal tunnel group at the day of surgery (P<0.0001), as well as at day 1 (P = 0.0011), day 2 (P = 0.0079), and day 3 (P = 0.0020). After 5 months, no statistically significant difference was found. After phacoemulsification and foldable IOL implantation, postoperative alteration in the blood-aqueous barrier was statistically significantly lower with the clear corneal tunnel incision group compared with the sclerocorneal incision group, in the first 3 days postoperatively.
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              Changes in anterior chamber flare and cells following cataract surgery.

              The laser flare cell meter allows rapid non-invasive quantification of aqueous flare and cells. In this prospective study laser photometry was used to document the recovery of the blood-aqueous barrier in 27 normal eyes following cataract surgery. Aqueous flare and cells were highest on the first postoperative day, declining rapidly in the first week and returning to preoperative levels by 3 months. In six eyes (22.2%) there was an increase in either flare and cells or flare alone during the first postoperative week which was associated with a delayed recovery of the blood-aqueous barrier for up to 1 month following surgery. A consensual flare response was found to occur in the fellow eye in five patients (18.5%).
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2005
                February 2005
                06 January 2005
                : 219
                : 1
                : 21-25
                Affiliations
                Department of Ophthalmology and University Eye Hospital, University of Erlangen-Nürnberg, Erlangen, Germany
                Article
                81778 Ophthalmologica 2005;219:21–25
                10.1159/000081778
                15627823
                © 2005 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 1, References: 32, Pages: 5
                Categories
                Original Paper

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