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PubMed2006

Cataract extraction in the collaborative initial glaucoma treatment study: incidence, risk factors, and the effect of cataract progression and extraction on clinical and quality-of-life outcomes.

OBJECTIVES: To study the incidence of and predictors for cataract extraction (CE) in patients with newly diagnosed glaucoma, the impact of CE on visual function, and changes in the time around CE. METHODS: Patients were randomized to medical or surgical treatments for glaucoma at 14 centers and followed up for a median of 7.7 years. Vision-specific quality of life (VS-QOL) data were collected by telephone interview during follow-up of 607 patients randomized to medical or surgical treatments for glaucoma. The occurrence of CE was the signal event. Risk factors were evaluated using survival analyses; changes from before to after CE were evaluated by paired t tests; and trends were estimated by loess regression. RESULTS: During follow-up of 607 patients, CE took place in 99 study eyes. Initial surgery, older age, a more negative spherical equivalent, and a diagnosis of pseudoexfoliative glaucoma conferred a higher risk of CE. Visual field testing before and after CE showed the mean deviation improved but the pattern standard deviation worsened. The VS-QOL improved on most subscales. CONCLUSIONS: Initial surgery places a patient with glaucoma at a higher risk of CE. The impact of CE on visual field indexes is mixed-the mean deviation improved but the pattern standard deviation worsened. Most, but not all, VS-QOL subscales were responsive to worsening of cataract prior to and acute improvement in vision after CE.

Aged↗
PubMed2001

Multifocal versus monofocal intraocular lenses after cataract extraction.

BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens implantation. Near vision however still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) intraocular lenses are available that are claimed to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal intraocular lenses. OBJECTIVES: The objective of this review is to assess the effects of multifocal intraocular lenses, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL (which includes the Cochrane Eyes and Vision Group specialised register), MEDLINE and EMBASE. The reference lists of relevant articles were searched. Investigators of included studies and manufacturers of multifocal intraocular lenses were contacted for information about additional published and unpublished studies. SELECTION CRITERIA: All randomised controlled trials comparing a multifocal intraocular lens of any type with a monofocal intraocular lens as control were included. Both unilateral and bilateral implantation trials were included. DATA COLLECTION AND ANALYSIS: Data were collected and trial quality assessed. Where possible, statistical summary measures were calculated, otherwise data were tabulated. MAIN RESULTS: One ongoing and six completed trials were identified. There was significant variability between the trials in the outcomes reported. Unaided distance acuity was similar in multifocal and monofocal intraocular lenses (Peto odds ratio 1.27 (95% Confidence Interval (CI) 0.76 to 2.11)), with a small increase in the proportion of multifocal intraocular lens participants achieving less than 6/6 best corrected visual acuity (Peto odds ratio 1.64 (95% CI 1.10 to 2.42)). Unaided near vision tended to improve with the multifocal intraocular lenses. This resulted in decreased spectacle dependence with use of the multifocal intraocular lenses (Peto odds ratio 0.16 (95% CI 0.11 to 0.23)). Adverse effects included reduced contrast sensitivity and the subjective experience of haloes around lights. REVIEWER'S CONCLUSIONS: Multifocal intraocular lenses are effective at improving near vision relative to monofocal intraocular lenses. Whether that improvement outweighs the adverse effects of multifocal intraocular lenses will vary between patients, with motivation to achieve spectacle independence likely to be the deciding factor.

Cataract Extraction↗
PubMed1994

Cataract extraction and intraocular lens implantation in an infant with a monocular congenital cataract.

A cataract extraction and primary capsulotomy with intraocular lens (IOL) implantation was performed on a 17-day-old infant with a monocular mature congenital cataract. The IOL power, calculated at the time of surgery, was undercorrected to compensate for the growth of the eyeball. Two additional surgical procedures were required to resolve visual axis obstruction caused by lens epithelial cell proliferation. Follow-up was 18 months, during which amblyopia prevention therapy was instituted.

Amblyopia↗
PubMed2005

The prioritization of patients on waiting lists for cataract surgery: validation of the Western Canada waiting list project cataract priority criteria tool.

PURPOSE: To assess the validity of the Cataract Priority Criteria Score (PCS), developed by the Western Canada Waiting List (WCWL) Project to determine patient prioritization for cataract surgery. METHODS: Ophthalmologists assessed consecutive patients with the PCS and a visual analogue scale of urgency (VAS Urgency). Patients were mailed questionnaires pre- and post-surgery. Outcome measures were the Visual Function Assessment (VFA), EuroQol (EQ-5D), and best-corrected visual acuity. RESULTS: The sample of 253 patients was 58% female (mean age, 73.7 years); 166 completed pre-and post-surgery VFA. The correlation of the PCS and VAS Urgency was 0.65 (p = 0.000). Adjusting for age, first or second eye surgery, and post-operative complication, the PCS predicted improvement in the VFA and visual acuity (p < .05). CONCLUSIONS: These data provide some evidence to support the convergent and predictive validity of the PCS. Multiple patient outcomes should be used in the evaluation of the validity of priority scores.

Aged↗
PubMed1995

Indications and efficacy of combined trabeculectomy and extracapsular cataract extraction with intraocular lens implantation in cataract patients with coexisting open angle glaucoma.

In an observational study 19 eyes with cataract and coexisting primary open angle glaucoma were scheduled to undergo combined procedure with ECCE-IOL and trabeculectomy. The aim of the present study was to investigate the results and the efficacy of combined surgery, when we extended the indication for surgery. Thus the surgical decision making was not based solely upon IOP readings, but also involved social/psychological factors. Median decrease in IOP (IOPpost-IOPpre) was significant through a 12-month observation period, p < 0.001. The number of medications dropped from 1.74 to 0.21, p < 0.01. Complication rate during operation and in the postoperative follow-up period was low. We conclude that it seems justified to extend the indication for combined surgery in cataract patients with coexisting open angle glaucoma in case of uncontrolled IOP, poor compliance, inability of sufficient medical care, or unacceptable medication. We recommend careful monitoring of the early postoperative IOP, even if hypotensive agents are given prophylactically.

Aged↗
PubMed1991

[Effect of cataract extraction on aqueous humor dynamics in patients with senile cataract. A prospective fluorophotometric study].

The influence of posterior chamber lens implantation on the aqueous humor dynamics was investigated using anterior chamber fluorophotometry before and 9 weeks after cataract extraction and IOL implantation. Thirty-four patients finished the protocol. Patients with preexisting glaucoma or those having a history of ocular or systemic inflammation were excluded from the study, as were those taking topical or systemic drugs with potential influence on the aqueous humor dynamics. Nine weeks after IOL implantation a mean increase in aqueous humor flow was noted. This increase was highly significant (p less than 0.01, Student's paired t-test). There were no significant changes in aqueous humor dynamics in the unoperated fellow eyes which served as controls. The significant difference in aqueous humor flow 9 weeks after cataract extraction and IOL implantation indicates that the liberation of prostaglandins may cause an increase in the ease of outflow facility.

Aged↗
PubMed1990

A modified extracapsular cataract extraction for pediatric cataracts.

We present a modified procedure of extracapsular cataract extraction (ECCE) with a small central posterior capsulectomy for pediatric cataracts that is designed to eliminate posterior capsule opacification and to keep open the option of later secondary implantation of a posterior chamber intraocular lens. Of 76 study eyes in which the procedure was performed only three developed posterior capsule opacification. All seven control eyes that had standard ECCE with the posterior capsule left intact developed secondary membranes shortly after surgery.

Adolescent↗
PubMedDate not supplied

Dislocation of cataractous lens by enzymatic zonulolysis: a suggested solution to the problem of the 18 million individuals blind from cataracts in Third-World countries.

There are 18 million persons blind from cataracts in Third-World countries and the number is doubling every 20 to 25 years. It is impossible to cure this many blind with present sophisticated surgical techniques. Enzymatic dislocation of the cataractous lens could be performed by nonmedical personnel and the patients given inexpensive mass-produced spectacles, which could solve this tremendous problem.

Blindness↗
PubMed1997

Confocal microscopy of cataracts from animal model systems: relevance to human nuclear cataract.

A recent study demonstrated that cytosolic lipid membrane structures, independent of the plasma membrane, preferentially occurred in human cataractous lenses. Animal model systems of cataractogenesis (selenite treated rats: galactose fed rats; buthionine-sulfoxime treated mice; Emory mice) were screened for possible relevant structures using the lipid membrane probe DiI and confocal microscopy. Well delineated plasma membranes of lens fiber cells with independent cytosolic staining structures were only observed in the selenite model system. These cytosolic structures were not observed in aged matched control lenses or within the transparent cortical regions of selenite treated animals with intense nuclear opacification. These results suggested that the morphological changes in DiI staining structures seen in the nucleus of the human cataractous lens were best approximated by those seen in the selenite model system.

Animals↗
PubMed1992

Study of the substructure of the Morgagni and Brunescens cataract with the TAO non-coating technique. Part 1: Morgagni cataract.

Lens tissue from a Morgagni cataract was examined by SEM and TEM. For SEM, after prefixation with glutaraldehyde and postfixation with the tannic acid/arginine/OsO4 non-coating (TAO) technique, and for TEM, after prefixation with glutaraldehyde, postfixation with OsO4/K4Fe(CN)6 and poststaining with uranyl acetate/lead citrate. The TAO technique seems to be a particularly suitable postfixation method for the SEM investigation of cataract tissue because of the presence of the protein structures present. The cortical region showed areas of radially, instead of concentrically, arranged lens fibres, degenerated lens fibres with holes (vacuoles), broken ball and socket connections between the lens fibres, and oval or spherical structures varying in size from 0.5-20 microns, the largest resembling a golfball, arising from the cytoplasm of degenerating lens fibres. The smallest, 0.2-0.5 microns, appear to have been expelled from the furrowed lens epithelium.

Cataract↗
PubMed2000

Dye-enhanced cataract surgery. Part 1: anterior capsule staining for capsulorhexis in advanced/white cataract.

PURPOSE: To evaluate anterior capsule staining using 3 dyes to perform continuous curvilinear capsulorhexis (CCC) in postmortem human eyes with advanced/white cataract. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: In experimental closed-system surgery, CCC was performed in 12 postmortem human eyes with cataract after the anterior capsule was stained with 3 capsule dyes (fluorescein sodium 2%, indocyanine green [ICG] 0.5%, and trypan blue 0.1%). Two commonly used techniques for capsule staining were also compared: staining within an air bubble and intracameral subcapsular injection of dye. RESULTS: In all globes, CCC was uneventful using the 3 dyes and with both techniques. With the intracameral subcapsular injection, the dye remained trapped in the subcapsular space in contact with the posterior surface of the anterior capsule, allowing enough time to perform any maneuver. The staining provided by ICG, at the concentration used, was slightly superior to that of the other dyes. Leakage of fluorescein sodium into the vitreous cavity was seen using the Miyake-Apple posterior video/photographic technique. CONCLUSION: Intracameral subcapsular injection of ICG allowed the easiest recognition of the capsular flap by staining the posterior surface of the anterior capsule and without leaking into the vitreous cavity.

Cadaver↗
PubMed2003

Visual functional outcomes of cataract surgery in the United States, Canada, Denmark, and Spain: report of the International Cataract Surgery Outcomes Study.

PURPOSE: To compare functional outcomes after cataract surgery performed at 4 sites in 4 countries that have been described as having significant differences in the organization of care and patterns of clinical practice. SETTING: Multicenter cohort study from the United States, Canada, Denmark, and Spain. METHODS: Clinical data and patient interview data were collected preoperatively and 4 months postoperatively. Functional outcomes were assessed by the Visual Function Index (VF-14), a self-reported measure of visual function. Scores on the VF-14 range from 0 (maximum impairment) to 100 (no impairment). RESULTS: Unilateral surgery was performed in 1073 patients. In this subgroup, the odds of achieving an optimal functional outcome (VF-14 score > or =95) were similar among sites after controlling for differences in case mix. Bilateral surgery was performed in 211 patients. A postoperative visual acuity of 0.50 or better in both eyes was reported in 155 patients. However, 37% of these patients reported visual function impairment (VF-14 score <95). CONCLUSIONS: A previously identified variation in treatment modalities among the 4 sites did not have a significant effect on the odds of achieving an optimal functional outcome. In addition to visual acuity measurements, the VF-14 index provides information on functional outcomes that is useful, especially in studies assessing the benefits of cataract surgery in a public health care setting.

Aged↗
PubMed1995

Cataract surgery in eyes with early cataracts.

This prospective study assessed visual results and subjective rehabilitation after cataract surgery in eyes with a preoperative acuity of 0.4 (20/40) or better. Fifty eyes (50 patients) were entered in the study. Corrected and uncorrected visual acuity, lens opacity, glare disability, and contrast sensitivity were measured before surgery and four months after surgery. Patient satisfaction was also measured. Best corrected visual acuity was 0.54 +/- 0.12 before surgery and 0.95 +/- 0.15 four months after surgery. Uncorrected visual acuity was 0.24 +/- 0.18 before and 0.58 +/- 0.27 after surgery. Impairment of corrected visual acuity from glare decreased from 0.12 +/- 0.09 before surgery to 0.04 +/- 0.08 four months after surgery. Contrast sensitivity at 6 cycles/degree increased from 2.71 +/- 0.94 units to 4.73 +/- 1.09 units. After surgery, 62% of patients judged their vision to be greatly improved, 32% judged it improved, 6% judged it unchanged. The patient's satisfaction was partially related to the improvement in uncorrected visual acuity. We conclude that cataract surgery can benefit eyes with limited visual impairment if the surgery is uncomplicated and IOL power is calculated correctly.

Aged↗
PubMed2001

Crystal cataracts: human genetic cataract caused by protein crystallization.

Several human genetic cataracts have been linked recently to point mutations in the gammaD crystallin gene. Here we provide a molecular basis for lens opacity in two genetic cataracts and suggest that the opacity occurs because of the spontaneous crystallization of the mutant proteins. Such crystallization of endogenous proteins leading to pathology is an unusual event. Measurements of the solubility curves of crystals of the Arg-58 to His and Arg-36 to Ser mutants of gammaD crystallin show that the mutations dramatically lower the solubility of the protein. Furthermore, the crystal nucleation rate of the mutants is enhanced considerably relative to that of the wild-type protein. It should be noted that, although there is a marked difference in phase behavior, there is no significant difference in protein conformation among the three proteins.

Cataract↗
PubMed2002

The Roche European American Cataract Trial (REACT): a randomized clinical trial to investigate the efficacy of an oral antioxidant micronutrient mixture to slow progression of age-related cataract.

CONTEXT: Funding surgery worldwide for age-related cataract (ARC), a leading cause of blindness, is a huge economic burden. Non-surgical means of slowing ARC progression could benefit patients and reduce this burden. OBJECTIVE: To determine if a mixture of oral antioxidant micronutrients [mg/day] (beta-carotene [18], vitamin C [750], and vitamin E [600]) would modify progression of ARC. DESIGN: REACT was a multi-centered, prospective, double-masked, randomized, placebo-controlled, 3-year trial. SETTING: Consecutive adult American and English outpatients with early ARC were recruited. PATIENTS: Four-hundred-and-forty-five patients were eligible; 297 were randomized; 231 (78%) were followed for two years; 158 (53%) were followed for three years; 36 (12%) were followed for four years. Twelve patients died during the trial (9 on vitamins; 3 on placebo (p = 0.07)). There were no serious safety issues. INTERVENTION: After a three-month placebo run-in, patients were randomized by clinical center to the vitamin or placebo groups and followed every four months. MAIN OUTCOME MEASURE: Cataract severity was documented with serial digital retroillumination imagery of the lens; progression was quantified by image analysis assessing increased area of opacity. This measure of area, 'increase % pixels opaque' (IPO), was the main outcome measure. RESULTS: There were no statistically significant differences between the treatment groups at baseline. The characteristics of dropouts and the mean follow-up times by treatment group were the same. After two years of treatment, there was a small positive treatment effect in U.S. patients (p = 0.0001); after three years a positive effect was apparent (p = 0.048) in both the U.S. and the U.K. groups. The positive effect in the U.S. group was even greater after three years: (IPO = 0.389 (vitamin) vs. IPO = 2.517 (placebo); p = 0.0001). There was no statistically significant benefit of treatment in the U.K. group. In spite of nearly perfect randomization into treatment groups, the U.S. and U.K. cohorts differed significantly. CONCLUSION: Daily use of the afore-mentioned micronutrients for three years produced a small deceleration in progression of ARC.

Administration, Oral↗
PubMed1996

Hyperacuity test to evaluate vision through dense cataracts; research preliminary to a clinical study. III. Data on normal subjects obtained with and without a pseudo-nuclear cataract 6/60 (20/200) at the Aravind Eye Hospital, Madurai, India.

Using a recently discussed three-point Vernier alignment test, data were obtained on normal subjects with and without a pseudo-nuclear cataract 6/60 (20/200) at the Aravind Eye Hospital, Madurai, India. This experiment is a critical control exercise. The pseudo-cataract caused measurably and predictably reduced Vernier alignment thresholds, there were no meaningful differences between eyes, and necessary modifications in protocol for a later clinical study were defined.

Adolescent↗
PubMed1996

Hyperacuity test to evaluate vision through dense cataracts; research preliminary to a clinical study. IV. Data on patients with macular degeneration and minimal media disorders obtained with and without a pseudo-nuclear cataract 6/60 (20/200) at the Aravind Eye Hospital, Madurai, India.

Using a recently discussed three-point Vernier alignment test, data were obtained on patients with macular dysfunctions with and without a pseudo-nuclear cataract 6/60 (20/200) at the Aravind (Free) Eye Hospital, Madurai, India. The pseudo-cataract caused measurably and predictably reduced Vernier alignment thresholds, and necessary modifications deemed to be necessary in the protocol for later study are defined.

Cataract↗
PubMed2002

What causes steroid cataracts? A review of steroid-induced posterior subcapsular cataracts.

Prolonged use of glucocorticoids is a significant risk factor for the development of posterior subcapsular cataract. This places restrictions on the use of glucocorticoids in the treatment of systemic and/or ocular inflammatory conditions as well as in organ transplantation. The mechanisms responsible for the opacification are unknown and no effective treatment, other than surgical removal of the lens, is available. Difficulties in establishing suitable in vivo or in vitro models have limited research in this area. Nevertheless, several mechanisms, based on observations with other types of cataracts, have been proposed. In this review, these mechanisms are evaluated in light of the evidence available. A novel mechanism is also proposed, in which steroids do not directly act on the lens but rather affect the balance of ocular cytokines and growth factors.

Animals↗