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At least 181 records · Page 10Linked to original sources
PubMed2000

An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation.

PURPOSE: The benefits of sutureless cataract surgery have not been available to the majority of developing world patients. This report describes a surgical technique developed to gain the benefits of self-sealing sutureless techniques, without the need for costly, complex instrumentation, expensive consumables, or difficult nucleus fragmentation manoeuvres in the anterior chamber. METHOD: A detailed description of a sutureless technique that uses only standard manual extracapsular cataract extraction instrumentation is presented. The clinical records of 362 consecutive completed sutureless surgeries were reviewed, and preliminary indicative data of visual outcome for those having follow up between postoperative weeks 3 and 8 are also presented. RESULTS: Hospital and eye camp experience confirms this operation offers speed, routinely 5 min or less with mature cataracts, reduced cost because no suture, viscoelastic or anterior chamber maintainer is needed, wound security and stability, and rapid effective visual rehabilitation. Uncorrected distance visual acuity during the third to eighth postoperative week was available for 266 of the 362 patients (73%): 10, 145, 101, and 10 had acuities of better than 6/9, 6/9-6/18, 6/24-6/60, and worse than 6/60, respectively. Ninety-seven, 165, 12, and two of the 276 (76%) patients with recorded corrected distance acuity were in the same groups. Comparing postoperative with preoperative corneal astigmatism for each patient with postoperative information available (208), without regard to axis, the amplitude of astigmatism worsened by a mean of 0.94 dioptres (+/- 0.17, 95% confidence; +/- 1.23 standard deviation; 7.5D maximum worsening; 2.5D maximum improvement). No attempt has been made to analyse complication type or frequency in this preliminary report. CONCLUSION: The authors believe this sutureless cataract extraction technique to be an innovation with widespread application in the developing world. Further and more exhaustive critical appraisal is warranted.

Cataract Extraction↗
PubMed2000

The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery.

BACKGROUND: Routine preoperative medical testing is commonly performed in patients scheduled to undergo cataract surgery, although the value of such testing is uncertain. We performed a study to determine whether routine testing helps reduce the incidence of intraoperative and postoperative medical complications. METHODS: We randomly assigned 19,557 elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of medical tests (electrocardiography, complete blood count, and measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose), in addition to a history taking and physical examination. Adverse medical events and interventions on the day of surgery and during the seven days after surgery were recorded. RESULTS: Medical outcomes were assessed in 9408 patients who underwent 9626 cataract operations that were not preceded by routine testing and in 9411 patients who underwent 9624 operations that were preceded by routine testing. The most frequent medical events in both groups were treatment for hypertension and arrhythmia (principally bradycardia). The overall rate of complications (intraoperative and postoperative events combined) was the same in the two groups (31.3 events per 1000 operations). There were also no significant differences between the no-testing group and the testing group in the rates of intraoperative events (19.2 and 19.7, respectively, per 1000 operations) and postoperative events (12.6 and 12.1 per 1000 operations). Analyses stratified according to age, sex, race, physical status (according to the American Society of Anesthesiologists classification), and medical history revealed no benefit of routine testing. CONCLUSIONS: Routine medical testing before cataract surgery does not measurably increase the safety of the surgery.

Aged↗
PubMed2001

Involvement of inducible nitric oxide synthase in cataract formation in Shumiya cataract rat (SCR).

PURPOSE: Our previous results showed that the oral administration of aminoguanidine (AG), an inhibitor of inducible nitric oxide synthase (iNOS), strongly suppresses lens opacification in Shumiya cataract rat (SCR). Therefore, we examine whether iNOS is upregulated and involved in cataract formation in SCR. METHODS: The expressions of iNOS mRNA and iNOS protein in SCR lenses were examined by RT-PCR and Western blotting, respectively. Calpain-mediated alphaB-crystallin proteolysis was analyzed by Western blotting using antibody specific to the calpain-generated fragment of alphaB-crystallin. Lens opacification was analyzed using computerized image analysis software connected to the Anterior Eye Segment Analysis System (EAS-1000, Nidek). Calcium contents in lenses were measured by atomic absorption spectrophotometry. RESULTS: High levels of iNOS mRNA and iNOS protein are expressed in cataractous lenses compared with normal lenses. The increases in their expression are markedly suppressed by the oral administration of AG, which acts to prevent lens opacification. The induction of iNOS protein is observed before the elevation in calcium content and the acceleration of calpain-mediated proteolysis, both of which are closely related to the development of lens opacification. CONCLUSIONS: These findings strongly suggest that iNOS is involved in cataract formation in SCR. The induction of iNOS occurs prior to the elevation of calcium content and its induction is inhibited by AG-treatment. Considering our previous result that the elevation of calcium content is also prevented by AG-treatment, it is conceivable that upregulation of iNOS causes calcium influx into lens cells and the subsequent activation of calpain.

Animals↗
PubMed1990

Small-incision cataract surgery using the Perrin intraocular cataract scissors and forceps.

An original operative technique for performing extracapsular cataract extraction through a small incision is described. The technique is both inexpensive and simple to perform. Intraocular cataract scissors are used to bisect the nucleus of the cataractous lens, and each of the halves of the bisected nucleus is removed with intraocular cataract forceps. Both the scissors and the forceps have been specifically designed for this task. The incision size of 7.5 mm allows insertion of currently available intraocular lenses. During the procedure viscoelastic is used to protect intraocular structures, in particular the corneal endothelium and the posterior capsule.

Cataract Extraction↗
PubMed1990

3.8 million blinded by cataract each year: projections from the first epidemiological study of incidence of cataract blindness in India.

Data from a population based longitudinal study of randomly selected communities in Central India have for the first time provided direct estimates of age specific incidence of blindness from cataract. Person-time denominators have been used to compute age specific incidence rates (risk) of blindness from cataract for populations aged 35 and older. These age specific incidence measures have been applied to the 'population at risk' in each 5-year age class in order to estimate the total number of new cases of cataract blindness that occur in the country each year. The findings indicate that an estimated 3.8 million persons become blind from cataract each year in India (approximate 95% confidence limits: 3 to 4.5 million). The reasons why the estimates are considered as minima, and their implications concerning future national planning of ophthalmic services, are briefly discussed.

Adult↗
PubMed1999

National cross sectional study of detection of congenital and infantile cataract in the United Kingdom: role of childhood screening and surveillance. The British Congenital Cataract Interest Group.

OBJECTIVES: To determine the mode of detection and timing of ophthalmic assessment of a nationally representative group of children with congenital and infantile cataract. DESIGN: Cross sectional study. SETTING: United Kingdom. SUBJECTS: All children born in the United Kingdom and aged 15 years or under in whom congenital or infantile cataract was newly diagnosed between October 1995 and September 1996. MAIN OUTCOME MEASURES: Proportion of cases detected through routine ocular examination and proportion assessed by an ophthalmologist by 3 months and 1 year of age. RESULTS: Data were complete for 235 (95%) of 248 children identified. Of these, 83 (35%) were detected at the routine newborn examination and 30 (12%) at the 6-8 week examination; 82 children presented symptomatically. 137 (57%) children had been assessed by an ophthalmologist by the age of 3 months but 78 (33%) were not examined until after 1 year of age. In 91 cases the child's carers suspected an eye defect before cataract was diagnosed. CONCLUSIONS: A substantial proportion of children with congenital and infantile cataract are not diagnosed by 3 months of age, although routine ocular examination of all newborn and young infants is recommended nationally. Strategies to achieve earlier detection through screening and surveillance are required.

Adolescent↗
PubMedDate not supplied

[Endothelial damage after planned extracapsular cataract extraction and phacoemulsification of hard cataracts].

PURPOSE: To evaluate and compare the endothelial damage after planned extracapsular cataract extraction (ECCE) and phacoemulsification of very hard cataracts. METHODS: In this prospective, randomized study, 41 patients with age-related and very hard cataract were divided into two groups: in group 1 (21 patients) an extracapsular cataract extraction was performed and in group 2 (20 patients), phacoemulsification. In both groups, intraocular lenses were implanted in the capsular bag. Preoperatively and 1, 3 and 6 months postoperatively, a complete ophthalmological examination, endothelial specular microscopy, and ultrasonic pachymetry were done. Endothelial cell loss, pleomorphism, polymegathism and corneal thickness were studied. RESULTS: Both groups presented an endothelial cell loss in the postoperative time, as compared with the preoperative values, but there were no significant differences among the postoperative values (1, 3 and 6 months). Six months after surgery, mean cell loss was 28.50% in group 1 and 34.77% in group 2. There were no differences among the indexes of pachymetry, polymegathism and pleomorphism between the two groups. CONCLUSIONS: Endothelial response was not statistically different between the two studied groups.

Aged↗
PubMed1992

Studies on human lenses: II. Distribution and solubility of fluorescent pigments in cataractous and non-cataractous lenses of Indian origin.

Fluorometric studies of cataractous and non-cataractous human lenses were carried out to study the emission characteristics and the distribution and solubility of lenticular pigments. Most of the detected fluorophores were well distributed over the cortical and nuclear portion of the lens. The decrease in solubility of proteins with aging and cataract formation is concomitant with increasing photolysis of tryptophan. However, this is likely a phenomenon independent of the photochemical transformations of the lens proteins. The number of emitting species in the diseased lenses are higher than in the normal mature lenses. A species emitting around 375 or 388 nm is of particular interest (lambda cx 330 nm) in that the emission characteristics of this fluorophore resemble kynurenic acid which has a high photosensitizing efficiency. The concentration of fluorescent pigments in the lenses of Indian origin is significantly high. The intense pigmentation could be attributed largely to the formation of photoproducts in the absence of normal endogenous antioxidant accumulation that is dependent on nutrition standard. If, indeed, any of these fluorescent pigments, because of their photosensitizing ability, are responsible for lenticular opacity, it is not the abundance of sunlight alone but also malnutrition that could account for the high incidence of cataract in India.

Adult↗
PubMed1990

[Comparison of extracapsular cataract extraction with implantation of the artificial lens into the posterior chamber and intracapsular cataract extraction with implantation of the artificial lens into the anterior chamber].

Advantages and disadvantages of both methods are presented on the basis of comparison of 1200 cases of intracapsular cataract extraction with anterior chamber lens implantation and 600 cases of extracapsular cataract extraction with implantation of posterior chamber lens. One has to state that in general the preferential method of extracapsular cataract extraction with posterior lens implantation is connected with several complications. The main disadvantage of intracapsular cataract extraction with anterior chamber implantation is--in 66 p.c.--deformation of the pupil. From our point of view this is a problem of cosmetic nature. On the basis of comparison of disadvantages and advantages we are of opinion that both methods are equally suitable for a broad clinical use.

Anterior Chamber↗
PubMed1976

Combined cataract extraction and thermal sclerostomy versus combined cataract extraction and trabeculectomy.

We performed either a combined cataract extraction and trabeculectomy or a combined cataract extraction and thermal sclerostomy on 43 eyes. All eyes had chronic open angle glaucoma or chronic angle closure glaucoma, or a combination of the two. In our cataract/trabeculectomy group, 74% had improvement in visual acuity, 91% had normalized intraocular pressure without anti-glaucoma medications, 31% had transient postoperative hyphemas. In our cataract/thermal sclerostomy group, 61% had improvement in visual acuity, 61% had normalization of intraocular pressures without antiglaucoma medications, 17% had transient postoperative hyphemas. We could not correlate any of the complications of surgery with poor intraocular pressure results in either groups. The mechanism for the higher success rate with a combined cataract extraction and trabeculectomy as compared with a combined cataract extraction and thermal sclerostomy was not obvious after analyzing these patients.

Cataract Extraction↗
PubMed2003

Effectiveness of oxygenation and suction in cataract surgery: is suction of CO2-enriched air under the drape during cataract surgery necessary?

PURPOSE: To investigate the effectiveness of aspiration of expired air by a suction system on peripheral oxygen saturation (SpO(2)) and end tidal carbon dioxide (EtCO(2)) during cataract surgery. MATERIALS AND METHODS: In total, 160 pre-medicated patients aged between 40 and 70 years (ASA I-III, classification of patients according to the American Society of Anesthesiologists) scheduled for cataract surgery under retrobulbar or peribulbar block were examined in a randomised, single-blind manner. The patients were sedated with 3 mg midazolam i.v. 15 min before operation and were monitored with an anaesthesia monitor. Heart rate (HR), non-invasive mean arterial pressure (MAP), SpO(2) and EtCO(2) were continuously measured using a standardised monitor. The first group (non-suction group, n = 80) received 4 L min(-1) O(2) with nasal cannule while the second group (suction group, n = 80) received 4 L min(-1) O(2) with nasal cannule, and the expired air was aspired with a Y-piece suction system. EtCO(2) was measured with the line of the sampling tube in the anaesthesia monitor. Respiratory rate (RR) was counted for a period of 1 min at each measurement time with thoracic excursions. The results were evaluated by unpaired t-test and analysis of variance. RESULTS: Severe reduction of SpO(2) and raising of EtCO(2) were observed significantly in the first group during the operation. RR, HR and MAP increased due to hypoxaemia. In the second group, SpO(2) was stabilised at high levels and EtCO(2) did not increase. RR, HR and MAP levels remained within the normal limits. Differences between the two groups were statistically significant (P < 0.05). CONCLUSION: During cataract surgery with local anaesthesia, SpO(2) decreases and RR, HR and MAP increase because of reinspiration of expired air under the drape. Insufflation of O(2) and aspiration of expired air with a suction system have prevented severe reduction of SpO(2) and raising of EtCO(2). It was suggested that O(2) delivery and use of an aspiration system decreased the risk of hypoxaemia significantly in the patients undergoing the cataract surgery.

Adult↗
PubMed1996

Atherosclerotic disease in patients undergoing cataract extraction. A nationwide case-control study. The Cataract Patient Outcomes Research Team.

OBJECTIVE: To evaluate the association between cataract extraction and atherosclerosis and its complications. DESIGN: A nationwide case-control study. SETTING AND PARTICIPANTS: Using a 5% random sample of all Medicare beneficiaries, we analyzed Medicare claims data on 60803 persons 65 years of age and older who underwent cataract extraction in 1986 or 1987 and a control group of 63765 persons matched to the cases for age, race, sex, ZIP code, and reason for Medicare entitlement. MAIN OUTCOME MEASURE: Atherosclerosis and atherosclerosis-related disease and procedures were defined by International Classification of Diseases, Ninth Revision, Clinical Modification, codes or by Health Care Financing Administration Common Procedure Classification System (Current Procedural Terminology) codes. The strength of evidence for atherosclerotic disease was categorized on the basis of the types of bills in the Medicare claims file. RESULTS: Odds of atherosclerosis-related morbidity and procedures were higher for cases than for controls. The association decreased with patient age and was strongest in beneficiaries aged 65 to 69 years (odds ratio, 1.30; 95% confidence interval, 1.13-1.48). CONCLUSION: Our findings suggest that there is a weak association between a visually significant cataract requiring surgery and atherosclerosis in the younger elderly.

Aged↗
PubMed1997

International variation in ophthalmologic management of patients with cataracts. Results from the International Cataract Surgery Outcomes Study.

OBJECTIVES: To describe international variation in the management of patients with cataacts in 4 health care systems and to discuss the potential implications for cost and utilization of services. DESIGN: To characterize current clinical practice on patients with no coexisting medical or ocular conditions, a standardized questionnaire was sent to random samples of ophthalmologists in the United States (response rate, 82.5%), Canada (66.9%), and Barcelona, Spain (70.4%), and to all ophthalmologists in Denmark (80.1%). From the United States, 526 ophthalmologists who performed cataract surgery participated in the study; there were 276 from Canada, 89 from Barcelona, and 82 from Denmark. RESULTS: Although in all 4 sites most surgeons reported that they performed A-scanning, fundus examination, and refraction routinely before surgery, significant crossnational variation was observed in preoperative ophthalmic and medical testing. While preoperative medical tests were virtually unused in Denmark, they were widely used in the other sites. A significantly higher proportion of the surgeons in the United States and Barcelona reported that they performed less than 100 extractions per year compared with surgeons in Canada and Denmark (P < .001). A significantly higher proportion of the surgeons in the United States and Canada were performing predominantly phacoextraction compared with surgeons in Denmark and Barcelona (P < .001). Both within and across sites, considerable variation in number of follow-up visits and postoperative tests was observed. CONCLUSIONS: Significant international variation in the management of healthy patients with cataracts has been observed. If less intensive care is not associated with poorer outcomes, there is the potential for less costly care of patients with cataracts. Further research identifying the most cost-effective practices is needed.

Adult↗
PubMed1983

An in vitro cataract model for practice of cataract surgery.

We have developed an in vitro cataract model using enucleated animal eyes. A cataract is produced by immersing the enucleated eyes in hypertonic sodium chloride solution for one hour and re-incubating them for another hour in normal saline solution. The model is useful for practicing various techniques of cataract extraction.

Animals↗
PubMed1995

Extracapsular cataract extraction with or without posterior chamber intraocular lenses in eyes with cataract and high myopia.

PURPOSE: To compare the results of insertion of low-power or zero-power posterior chamber intraocular lenses (PC IOLs) after cataract extraction in eyes with high myopia with leaving the eye aphakic. METHODS: The outcome of extracapsular cataract extraction (ECCE) with low-power or zero-power PC IOLs in 184 consecutive highly myopic (axial length = 26.0 mm or longer) eyes was compared with 184 consecutive highly myopic eyes receiving ECCE without PC IOLs. Axial length, preoperative visual acuity, age, sex, and follow-up were similar between both groups. RESULTS: In the pseudophakic eyes, there was a statistically significantly better visual outcome (P = 0.006), decreased incidence of posterior capsule opacification (13.6% versus 33.2%, P < 0.01), and decreased requirement for YAG capsulotomy (6.5% versus 17.9%, P < 0.01). There were two retinal detachments in the pseudophakic eyes compared with four in the aphakic eyes. There were no sight-threatening complications in 12 pseudophakic eyes after YAG capsulotomy. There were four sight-threatening complications (2 retinal detachments, 2 cases of uveitis with secondary glaucoma) in 33 aphakic eyes after YAG capsulotomy. CONCLUSIONS: The use of PC IOLs may result in a lower complication rate and better visual outcome after ECCE in eyes with cataract and high myopia.

Adult↗
PubMed2002

Factors related to fear in patients undergoing cataract surgery: a qualitative study focusing on factors associated with fear and reassurance among patients who need to undergo cataract surgery.

The aim was to identify factors that are related to fear among patients who need to undergo cataract surgery. The data were collected by focus group interviews (n=27). The doctor-patient relationship, patient education, the wait, hospital organization, social support, sensations, previous experience, outcome of surgery, and coping strategies were identified as the main factors that contribute to feelings of fear related to cataract surgery. Five stages of fear were identified: at home after diagnosis, during preparation for surgery at the hospital, the day of surgery, the post-operative visits, and the period after these follow-up visits at home. A model regarding the factors related to fear in patients awaiting cataract surgery was developed, which emphasizes the importance of a good doctor-patient relationship, and the need for patient education that is tailored to the individual patients.

Aged↗
PubMed2001

1998 European Cataract Outcome Study: report from the European Cataract Outcome Study Group.

PURPOSE: To collect clinical data on cataract surgery to allow participating surgeons to compare their performance with that of their colleagues in an anonymous manner. SETTING: Surgeons from 31 surgical units providing cataract surgery in 13 European countries. METHODS: Every patient at each participating unit having surgery during 1 study month was evaluated. Data were reported to the coordinating center at the time of surgery and at the final examination. When the study was closed 6 months after surgery, all participants were provided with the outcomes from their own patients so they could compare them with outcomes from other centers. RESULTS: The study included preoperative and intraoperative data on 2950 patients. Complete follow-up data were available for 2731 patients. The surgical audit included surgically induced astigmatism, proximity of target refraction, and the frequency of major complications. For each variable, a large variation in outcome between participating centers was found. Most centers had results both above and below average for different variables. CONCLUSION: Cataract surgery data collected from 31 units in 13 European countries allowed participants to compare their performance with that of their colleagues in an anonymous manner. Significant variation was found in the outcomes among the units, with many units reporting results above and below the averages.

Aged↗
PubMed1996

The role of small-incision cataract surgery in combined cataract and glaucoma surgery.

Small-incision cataract surgery widens the scope of combined cataract and glaucoma surgery. Phacoemulsification is gaining in importance, although extracapsular extraction techniques are still commonly used. Trabeculectomy remains the standard filtration operation combined with cataract surgery. There are currently a number of areas of contention in combined trabeculectomy surgery, including-the use of shared or separate incisions, the use of antimetabolities, and the type of intraocular implant. Other adjunctive procedures such as trabeculotomy and endocyclophotocoagulation are also discussed in the context of combined surgery.

Cataract↗