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Lens epithelial cell density and histomorphological study in cataractous lenses.

Human epithelial cell density was determined from flat preparation of 195 cataractous lenses from 108 males and 87 females between 30 and 80 years of age. The mature cataracts had significantly lower cell counts than the other cataracts. Cell density was significantly higher in the females than in the males. Morphohistological study of the epithelia was focused on the following cataract types: (1) nuclear, (2) posterior subcapsular, (3) mature, (4) mixed, (5) hypermature, and (6) black. The major cataractous changes in all types involved vacuolization of the cytoplasm. The mature types of cataractous epithelia showed 56% superimposed cells; the epithelia in nuclear, posterior subcapsular, and black cataracts showed between 6% and 16%. In the hypermature cataracts, four of five tissues analyzed showed superimposed cells. The superimposed areas are probably the source of increased and altered cell activity. We propose that the metaplastic processes leading to posterior capsular opacification originate from these areas. The majority of nuclear and black cataracts were almost similar to the normal human lens epithelium with more or less uniform distribution of cells. Nucleus shrinkage (5 microns) was more evident in nuclear cataracts; in subcapsular cataracts most of the nuclei were large (average 9 microns diameter). Variation in morphological changes like vacuolization of cytoplasm and nuclei, pyknotic nuclei, and superimposed cells was more evident in the mixed type of cataracts.

Adult↗

Naphthalene-induced cataract model in rats: A comparative study between slit and retroillumination images, biochemical changes and naphthalene dose and duration.

PURPOSE: The purpose of the study was to compare different methods of photographic evaluation of cataract formation in rats in response to different regimes of naphthalene treatment. Furthermore, we intended to study the relationship between cataract extension and biochemical parameters. METHODS: Brown Norway rats were treated with 0.10-1.5 g naphthalene/kg body weight, twice a week for ten weeks to induce cataract or placebo. Slit illumination and retroillumination (SI and RI) photographs were produced by an EAS-1000 instrument to document cataract formation as light-scattering intensity. The degree of the cataractous changes was quantified in SI photographs by the peak height and the integrated peak area, and in RI photographs by threshold setting. Finally, the lens concentration of Na(+) and K( +) and the protein composition were analyzed and correlated to the photographic analysis. RESULTS: The degree of the cataractous changes was most linearly related to dose and duration when the integrated peak area was estimated. However, protein fractions were non-linearly related to the cataractous changes estimated. Alterations in concentration of Na(+) and K(+) were small or insignificant, which indicate that naphthalene-induced cataract is not caused by osmotic changes. The lowest possible naphthalene dose to induce cataractous changes was between 0.10 and 0.50 g/kg twice a week for ten weeks. CONCLUSIONS: 0.50 and 1.0 g naphthalene/kg twice a week appeared to be optimal, because the rats in these groups were healthy and the cataractous changes were consistent between animals. Thus, the combination of the animal model with the cataract quantification system has the potential to be useful and reliable in studies of cataract-preventive compounds.

Animals↗

Recent epidemiologic studies on nutrition and cataract in India, Italy and the United States.

Three independent case-control studies with similar methodologies were conducted in India, the United States and Italy to investigate risk factors by cataract type. Their common objectives were to evaluate risk factors for each cataract type, giving priority to nutritional factors, and to determine whether risk factors differed among cataract types. Data included self-reporting of food frequencies and various biochemical determinations. A higher body mass index was the only nutritional factor found by more than one study to be associated with cataract, being less frequent in cases than in controls. Blood nutritional status from one study showed that a high antioxidant index decreased risk for at least one cataract type, high glucose-6-phosphate dehydrogenase values increased risk for at least one cataract type, a high albumin globulin ratio decreased risk for mixed cataract, and high iron levels decreased risk for cortical cataract. Only one of the three studies found that a high nutritional status, high dietary antioxidant index, and use of multiple vitamin supplements decreased risk for cataract. Findings from these studies suggest socioeconomic and nutritional components to cataract risk, although not consistently across studies or cataract types. Differences between studies may be due to differences in populations and/or data collection methods. Because reducing cataract risk would have major implications for a large segment of the population, clinical trials seem appropriate to confirm and evaluate the potentially modifiable risk factors suggested by these studies.

Adult↗

Moderate caloric restriction delays cataract formation in the Emory mouse.

Eye lens senile cataract is a major cause of blindness, affecting the elderly in particular. The etiology of the disorder has been elusive, and attempts to delay the onset of senile cataracts have been unsuccessful. The need for more information is underscored by epidemiologists who estimate that the ability to delay cataract formation in humans by only 10 years would eliminate the need for 50% of the cataract extractions performed annually in the United States. The Emory mouse provides the best model for human senile cataracts. Feeding Emory mice a diet that was restricted in calories by approximately 21% delayed the onset of cataracts. This is the first study that demonstrates in vivo the delay of senile-type cataracts. In these animals, aging and cataracts are associated with diverse changes in the proportion of various proteins (particularly 21, 22, 31-34 kDa) and with transformation of proteins from a soluble to an insoluble state. In advanced cataracts, there is a loss of total protein. Within a cataract grade, there is no difference between restricted and nonrestricted animals in relative proportion of specific lens proteins or in amounts of total or soluble proteins. The transition from a clear to cataractous lens appears when the soluble-to-total protein ratio falls below about 0.58. The exclusive use of gamma-crystallin as an indicator of lens viability is questioned. To the extent that cataract formation is due to lens protein oxidation and/or an inability to proteolytically remove damaged protein, it would appear that caloric restriction results in enhanced protection against lens oxidative stress or in prolonged proteolytic function.

Aging↗

Cortical and subcapsular cataracts: significance of physical forces.

Cortical cataracts usually begin with either sharp limited clear fluid clefts, resulting in opaque spokes, or clear lamellar separations, resulting in cuneiform opacities. They do not commence prior to 45 years of age. From this age on an increase in lens nuclei hardening can be detected. Therefore, during disaccommodation in older lenses, mechanical shear stresses must develop between the soft remaining cortices and the harder nuclei. These shear stresses are significant regarding the different cortical ruptures in predisposed lenses: in a privileged radial direction (according to zonular traction) of the sharp limited cortical spokes, or in parallel microridges at the commencement of lamellar separations, as observed when a rubber surface slides against a harder object. In pure cortical cataracts the ion pump (K+ > Na+) and investigated metabolic parameters remain largely intact. Therefore, it is not surprising that, in contrast to subcapsular cataracts, subcapsular opacities do not occur. Subcapsular cataracts are known to be caused by a variety of factors: aging, diabetes, corticosteroids, iridocyclitis, or X-ray, among many others. In contrast to cortical cataracts, subcapsular cataracts were found to be closely associated with ion pump damage (Na+ > K+) and a variety of metabolic activity alterations. In subcapsular cataracts passive fluids (from the vitreous and camera anterior) enter externally through the lens capsule. This initially forms numerous free clear, secondary grey, subcapsular fluid vacuoles. If the ion pump (metabolic barrier) is more severely damaged fluids may also enter the lens nucleus (secondary grey nuclear cataract), which rarely results in intumescent cataract. In cortical and subcapsular cataracts and lens perforations the main cause of grey opalescence appears to be the result of lens proteins (water-soluble crystalline) coming into direct contact with free fluids (water). In cortical cataracts this happens in the area of sharp limited mechanical cortical ruptures (fluid clefts), and in subcapsular cataracts during passive, external fluid entry, resulting in subcapsular fluid vacuoles and opacities, and also later grey-white nuclear opacities. The importance of water contact with water-soluble lens crystallines in behalf of light scattering and turbidness also has been investigated experimentally.

Cataract↗

Free amino acids in the normal and cataractous bovine and human lens capsule and lens.

With circular chromatography on paper, we have tested the content of the free amino acids in the normal and cataractous bovine and human lens capsule and lens. The interpretation of the data shows that the normal bovine lens without capsule presents a greater quantity of free amino acids in relation to the bovine cataractous lens without capsule; the lens capsule of normal bovine lens presents a lesser quantity of free amino acids in relation to the lens capsule of the bovine cataractous lens; the normal human lens without capsule presents a relative increase in quantity of free amino acids in relation to the cataractous human lens without capsule (cortical and nuclear cataract); the lens capsule of the normal human lens presents a decrease in the quantity of free amino acids in relation to the lens capsule of the cataractous human lens (cortical and nuclear cataract); the human cataractous lens in "cataracta nigra" presents a marked decrease in quantity of free amino acids in relation to cataractous human lens without capsule (nuclear and cortical cataract), while the lens capsule of "cataracta nigra", presents a marked increase in quantity of free amino acids in relation to the normal human lens capsule, and decrease in relation to the lens capsule of the cataractous human lens (cortical and nuclear cataract).

Amino Acids↗

Cataracts and hypertension in salt-sensitive rats. A possible ion transport defect.

In previous unrelated studies, we observed a 35 to 50% incidence of cataract formation in several groups of Dahl salt-sensitive hypertensive rats (DS) over a 4-year period. In the present study we evaluated longitudinal changes in blood pressure in DS in which cataracts eventually developed and those in which cataracts did not develop when all animals were maintained on a high sodium diet. Lenses were evaluated by slit-lamp microscopy to determine if cataractous lesions were similar among rats, to classify lesion types, and to define the age at which cataracts were detectable in DS. The possible participation of several cataractogenic risk factors as major influences on cataract formation also was evaluated. Finally, aqueous humor concentrations and lenticular content of sodium and potassium were determined to evaluate the possibility that a defect in ion transport at the lens epithelium and ciliary body might play a role in cataractogenesis in DS, since ion transport defects have been shown to lead to lens opacification in other models of genetic and experimental cataracts. Parallel studies were performed in Dahl salt-resistant control rats (DR). A high incidence of cataract formation was found in DS. Although systolic blood pressure was not consistently greater in adult DS with cataracts compared with values in age-matched DS without cataracts, the initial pressor response to a high salt diet was greatest in weanling DS in which cataractous lesions later developed. Slit-lamp analysis revealed that cataracts in this genetic model were cortical, with one mixed cortical, nuclear lesion. Posterior subcapsular lesions were not observed, suggesting that lesions were not steroid-induced.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The use of vitamin supplements and the risk of cataract among US male physicians.

OBJECTIVES: The purpose of this study was to examine prospectively the association between reported use of vitamin supplements and risk of cataract and cataract extraction. METHODS: The study population consisted of 17,744 participants in the Physicians' Health Study, a randomized trial of aspirin therapy and beta-carotene among US male physicians 40 to 84 years of age in 1982 who did not report cataract at baseline and provided complete information about vitamin supplementation and other risk factors for cataract. Self-reports of cataract and cataract extraction were confirmed by medical record review. RESULTS: During 60 months of follow-up, there were 370 incident cataracts and 109 cataract extractions. In comparison with physicians who did not use any supplements, those who took only multivitamins had a relative risk of cataract of 0.73 after adjustment for other risk factors. For cataract extraction, the corresponding relative risk was 0.79. Use of vitamin C and/or E supplements alone was not associated with a reduced risk of cataract, but the size of this subgroup was small. CONCLUSIONS: These data suggest that men who took multivitamin supplements tended to experience a decreased risk of cataract and support the need for rigorous testing of this hypothesis in large-scale randomized trials in men and women.

Adult↗

Analysis of lipid peroxidation and electron microscopic survey of maturation stages during human cataractogenesis: pharmacokinetic assay of Can-C N-acetylcarnosine prodrug lubricant eye drops for cataract prevention.

Morphological and biophysical techniques described in this study have shown that membrane derangement occurs in human cataractous lenses. The data suggest that these disruptions were globules, vacuoles, multilamellar membranes and clusters of highly undulating membranes. Deleterious structural damage of the lens fibre cell plasma membranes serve as the primary light-scattering centres that cause the observed lens opacity. Nuclear cataract, a major cause of loss of lens transparency in the aging human, has been thought to be associated with oxidative damage, particularly at the site of the nuclear plasma membrane. Phospholipid molecules modified by oxygen accumulate in the lipid bilayer, change its geometry and impair lipid-lipid and protein-lipid interactions in lenticular fibre membranes. Lipid peroxidation (LPO) is a causative and pathogenic factor in cataract. Increased concentrations of primary molecular LPO products (diene conjugates, lipid hydroperoxides, oxy-derivatives of phospholipid fatty acids) and end-fluorescent LPO products have been detected in the lipid moieties of aqueous humour samples and human lenses obtained from patients with senile and complicated cataracts as compared with normal donors. In the present study, a rapid and simple high-performance liquid chromatographic (HPLC) assay for determination of imidazole-containing dipeptides in the aqueous humour of the eye was developed. The method was applied to determine the pharmacokinetic parameters and the time-course of N-acetylcarnosine and L-carnosine-related product in the eye, following a single dosage of topical ocular administration of peptide. Utilising data from pharmacokinetic studies and the specific purity of the N-acetylcarnosine (NAC) ingredient as a source of the pharmacological principle L-carnosine, we have created an ophthalmic time-release prodrug form including the US FDA-approved carboxymethylcellulose lubricant and other essential ingredients (Can-C, private label Nu-Eyes). This formulation increases the intraocular absorption of L-carnosine in the aqueous humour and optimises its specific antioxidant activity in vivo while reducing the toxic effects of lipid peroxides on the crystalline lens. L-carnosine that enters the aqueous humour can accumulate in the lens tissue for a reasonable period of time. The presence of L-carnosine in transparent crystalline lenses during normal aging was detected and its concentration in this case was about 25 microM. At different stages of cataract development, the level of L-carnosine drastically decreased, reaching about 5 microM in ripe human cataracts. However, administration of pure L-carnosine (1% solution) to the rabbit eye (instillation or subconjunctival injection) does not lead to accumulation of this natural compound in the aqueous humour at the time level over 30 minutes at a concentration exceeding that in placebo-treated matched eyes, and its effective concentration is exhausted more rapidly. Use of NAC prodrug eye drops optimises the clinical effects of L-carnosine in the treatment of ophthalmic disorders (such as prevention and reversal of cataracts in human and animal [canine] eyes). The data provided predict a clinical effect with NAC ophthalmic prodrug, and show that the magnitude and duration of this effect are directly related to the bioavailability of L-carnosine released from NAC in the aqueous humour of the anterior eye segment. The ophthalmic NAC drug shows promise in the treatment of a range of ophthalmic disorders that have a component of oxidative stress in their pathogenesis (including cataract, glaucoma, dry eye, vitreous floaters, inflammatory disorders, and corneal, retinal and systemic diseases [such as diabetes mellitus and its ophthalmic complications]). There is a need for further and better collaboration between Innovative Vision Products' cataract control and ophthalmic services, improved education of people affected by cataract, a commitment that N-acetylcarnosine eye drops will be the preferred treatment before orthodox cataract surgery is attempted, and consideration of outcomes and a possible role of the NAC drug cataract treatment as source of referral for orthodox surgical, ophthalmic and optometric services.

Adolescent↗

Population-based study on prevalence and risk factors of age-related cataracts in Peitou, Taiwan.

BACKGROUND: Age-related cataracts are the main cause of blindness throughout the world. Nonetheless, population-based data on the epidemiology of age-related cataracts among Taiwanese populations are not readily available. This study was conducted to estimate the prevalence of age-related cataracts and to determine the relationships of age, gender, blood pressure, diabetes and smoking to the risks of age-related cataracts in an urban Taiwanese population. METHODS: The study was part of a population-based survey of eye diseases among residents aged 50 years or older in Peitou Precinct, Taipei, Taiwan. Of the 2,700 eligible persons, 2,038 (75.5%) underwent a standard evaluation protocol including dilated slit-lamp examination, a questionnaire of medical and ophthalmic histories and blood pressure measurement. RESULTS: Among the participants, 1,040 were diagnosed with age-related cataracts. The prevalence was 51.0% (95% confidence interval, 48.9%-53.2%). Nuclear opacity was the most prevalent type (718/1,040; 35.2%) of cataracts, followed by posterior subcapsular opacity (311/1,040; 15.3%) and cortical opacity (163/1,040; 7.8%). An increased risk of age-related cataracts was associated with female gender (p = 0.002). When a single type of lens opacity was considered, diabetes was significantly associated with a posterior subcapsular cataract (p = 0.022). Overall, older women with diabetes and relatively lower diastolic blood pressure were more likely to have age-related cataracts. CONCLUSIONS: The study provided the first prevalence data on age-related cataracts in an urban Taiwanese population and highlighted the relationships of age, gender, blood pressure and diabetes to the frequency and type of age-related cataracts. The results can assist in the design and implementation of intervention programs to reduce the prevalence of age-related cataracts.

Age Factors↗

[Cataract surgery in children].

INTRODUCTION: Cataract extraction in children has improved and became more popular over the past few decades but, due to particular features of children's eyes, still remains controversial--especially regarding the intraocular lens implantation. INDICATIONS FOR OPERATION: In contrast to adults, indications for cataract surgery in children are much more difficult to determine. Since subjective visual acuity cannot be obtained, greater reliance must be placed on the morphology and location of the lens opacity, and the behavior of the child. Forced preferential looking and visual evoked potentials can be helpful, but they should not be the only criteria. CORRECTION OF POSTOPERATIVE APHAKIA: In management of pediatric cataract, correction of postoperative aphakia is still an incompletely resolved problem. Conventionally, optical correction is achieved by spectacles or contact lenses. The power of both spectacles and contact lenses can be readily adjusted to compensate for ocular growth. The success of both depends significantly on parental compliance and the child's acceptance. Hutchinson reported that 44% children with aphakia stopped wearing glasses or contact lenses 2 months after surgery. Contact lens wearing can also result in a number of corneal complications, including infectious keratitis, corneal vascularization and hypoxic corneal ulceration. IOL implantation is theoretically superior to glasses and contact lenses since it provides almost immediate optical correction which is much more reliable because it does not depend on parental or child's compliance. Still, there are many controversies about IOL implantation in infants and young children like IOL-size, material, IOL power calculation, prevention and management of secondary cataract, as well as long term safety of IOLs in children's eyes. Although short-term anatomic results after cataract extraction and primary IOL implantation in children are excellent and stable, long-term follow-up is necessary to answer questions about the long-term safety of implants in children's eyes. POSTOPERATIVE COMPLICATIONS: A higher incidence of postoperative inflammation and opacification of the optical axis has been reported after pediatric cataract surgery. Posterior capsular opacification is almost an unavoidable complication in children's eyes if the posterior capsule is left intact. Several methods have been proposed in order to keep the optical axis clear in infants and young children. Comparison of posterior capsulectomy with and without anterior vitrectomy showed that posterior capsular opacification rates are diminished only after combined posterior capsulectomy and anterior vitrectomy and not after capsulectomy alone. Posterior capsulorhexis with optic capture seems to effectively prevent posterior capsular opacification. This technique eliminates the need for anterior vitrectomy and ensures the centration of the intraocular lens. Glaucoma and retinal detachment are late complications of pediatric cataract surgery. On average glaucoma develops 6.8 years after cataract operation. Retinal detachment develops several decades after cataract extraction. AMBLYOPIA: The functional results after pediatric cataract surgery depend not only on the anatomic success of the operation and postoperative maintenance of a clear optical axis, but even more on aphakic visual rehabilitation. Children's eyes with cataract severe enough to require cataract extraction usually have some degree of amblyopia already present prior to surgery. In unilateral pseudophakia amblyopia develops postoperatively unless the fellow eye is occluded or optically and/or pharmacologically penalized. Immediate optical correction is desirable because prevention and/or therapy of amblyopia should be initiated directly after surgery. Parental compliance with occlusion therapy and not successful surgery are major determinants of a good visual outcome in unilateral aphakic/pseudophakic children.

Aphakia, Postcataract↗

Mapping of A gene responsible for cataract formation and its modifier in the UPL rat.

PURPOSE: The Upjohn Pharmaceuticals Limited (UPL) rat is a unique model for cataracts, which are inherited as an autosomal semidominant trait and expressed as early-onset (E-type) cataracts in homozygotes and as late-onset (L-type) cataracts in heterozygotes. In this study, a gene and its modifier, which are responsible for formation of cataract, were mapped. METHODS: Fifty-five BN x (BN x UPL)F(1) backcross rats and 133 BN x UPL intercross rats were produced. The cataracts present in the rats at eye opening were diagnosed as E-type. Cataracts that developed after eye opening were diagnosed as L-type, and the ages when complete opacity in the lens was observed were used as a quantitative trait to map a gene that modifies the development of mature cataracts. Linkage analysis was performed using 64 arbitrarily primed-representational difference analysis (AP-RDA) markers and 74 microsatellite markers. RESULTS: A gene responsible for the formation of cataract was mapped to the vicinity of D2Rat134 on rat chromosome (chr) 2. A candidate gene, connexin 50 (Cx50/Gja8), had a C-to-T transition at codon 340 that is predicted to result in a nonconservative substitution of arginine by tryptophan. Recombination in the Cx50 genotype and formation of cataract was not observed. By quantitative trait loci analysis, a gene that modified the age of the development of mature cataract was mapped on rat chr 5. CONCLUSIONS: A candidate gene for formation of cataracts in UPL rats was mapped to rat chr 2, and the Cx50 gene was a strong candidate. In addition, a potential modifier gene was mapped on chr 5. Future cloning of these genes will provide good targets for new therapies that can delay the progression of cataracts.

Aging↗

A prospective study of cigarette smoking and risk of cataract in men.

OBJECTIVE: To examine the association between cigarette smoking and the incidence of cataract. DESIGN, SETTING, AND PARTICIPANTS: The design was a prospective cohort study using data from the Physicians' Health Study, a randomized trial of aspirin and beta carotene among 22,071 US male physicians aged 40 to 84 years that began in 1982. This analysis includes the 17,824 physicians who did not report cataract at baseline and did provide complete risk factor information. Based on information reported at baseline, 10% were current smokers, 39% were past smokers, and 51% were never smokers. MAIN OUTCOME MEASURE: An incident cataract was defined as a self-report confirmed by medical record review to have been first diagnosed after randomization, age-related in origin, and responsible for a decrease in best corrected visual acuity to 20/30 or worse. MAIN RESULTS: During 60 months of follow-up, 557 incident cataracts among 371 participants were confirmed. Compared with never smokers, current smokers of 20 or more cigarettes per day had a statistically significant increase in the risk of cataract (relative risk [RR], 2.16; 95% confidence interval [Cl], 1.46 to 3.20; P less than .001). Similar results were obtained after simultaneously controlling for other potential cataract risk factors in a logistic regression model (RR, 2.05; 95% Cl, 1.38 to 3.05; P less than .001). Among the 557 eyes with cataract, nuclear sclerotic changes were present in 442 while posterior subcapsular changes were present in 204. After controlling for other potential cataract risk factors, current smokers of 20 or more cigarettes per day had statistically significant increases in nuclear sclerosis (RR, 2.24; 95% Cl, 1.47 to 3.41; P less than .001) and posterior subcapsular (RR, 3.17; 95% Cl, 1.81 to 5.53; P less than .001) cataract. Past smokers had an elevated risk of posterior subcapsular (RR, 1.44; 95% Cl, 0.97 to 2.13; P = .07) but not nuclear sclerosis cataract. For current smokers of fewer than 20 cigarettes per day, no increased risks were observed of total, nuclear sclerosis, or posterior subcapsular cataract. CONCLUSIONS: These data provide support for the hypothesis that cigarette smoking increases the risk of developing both nuclear sclerosis and posterior subcapsular cataract.

Adult↗

Acid phosphatase and lipid peroxidation in human cataractous lens epithelium.

The anterior lens epithelial cells undergo a variety of degenerative and proliferative changes during cataract formation. Acid phosphatase is primarily responsible for tissue regeneration and tissue repair. The lipid hydroperoxides that are obtained by lipid peroxidation of polysaturated or unsaturated fatty acids bring about deterioration of biological membranes at cellular and tissue levels. Acid phosphatase and lipid peroxidation activities were studied on the lens epithelial cells of nuclear cataract, posterior subcapsular cataract, mature cataract, and mixed cataract. Of these, mature cataractous lens epithelium showed maximum activity for acid phosphatase (516.83 moles of p-nitrophenol released/g lens epithelium) and maximum levels of lipid peroxidation (86.29 O.D./min/g lens epithelium). In contrast, mixed cataractous lens epithelium showed minimum activity of acid phosphatase (222.61 moles of p-nitrophenol released/g lens epithelium) and minimum levels of lipid peroxidation (54.23 O.D./min/g lens epithelium). From our study, we correlated the maximum activity of acid phosphatase in mature cataractous lens epithelium with the increased areas of superimposed cells associated with the formation of mature cataract. Likewise, the maximum levels of lipid peroxidation in mature cataractous lens epithelium was correlated with increased permeability of the plasma membrane. Conversely, the minimum levels of lipid peroxidation in mixed cataractous lens epithelium makes us presume that factors other than lipid peroxidation may also account for the formation of mixed type of cataract.

Acid Phosphatase↗

The role of prostaglandins E2 and F2 alpha in ultraviolet radiation-induced cortical cataracts in vivo.

PURPOSE: Previous work has shown that exposure of lens epithelial cells or rabbit eyes in vivo to ultraviolet B (UVB) radiation enhanced prostaglandin (PG)E2 synthesis. Such enhanced PGE2 synthesis was related to the increased DNA synthesis that followed UVB exposure. The current study examined the relationship between enhanced prostaglandin synthesis and UVB-induced cataract formation. METHODS: Seventy albino (New Zealand white) rabbit eyes were exposed to UVB radiation in vivo. Fluence of radiation at the cornea was 2.8 J/cm2, 5.6 J/cm2, or 11.2 J/cm2. Eyes were examined 24 hours after UVB exposure and for as long as 10 days by slit lamp biomicroscopy. Mass spectrometry was used to measure PGE2, PGF2 alpha, and 6-keto-PGF1 alpha content of the lens and iris-ciliary body using authentic standards. To determine the effect of inhibition of prostaglandin synthesis on UVB-induced cataract formation, animals were given indomethacin intraperitoneally. Other pharmacologic agents, such as PGE2, PGF2 alpha, and misoprostol, were applied topically to the eye. The effect of UVB on K+ pump was determined by incubating isolated lenses with [86Rb+]. RESULTS: Twenty-four hours after UVB exposure, PGE2 and PGF2 alpha concentrations in aqueous humor were increased by 100- and 30-fold, respectively. Lens PGE2 and PGF2 alpha increased by 6- and 4-fold, respectively, after UVB radiation exposure. Pretreatment of animals with indomethacin prevented the rise in lens and aqueous humor PGE2 and PGF2 alpha levels. Furthermore, indomethacin was partially protective against UVB cataract formation and lowered cataract severity from stage 3 to stage 1, but it did not prevent UVB-induced lens changes completely. Topical application of PGE2 before UVB exposure completely prevented cataract formation in the UVB-exposed eye. In contrast, topical administration of PGF2 alpha increased cataract severity. UVB-induced cataract formation preceded changes in [86Rb]+ uptake in lenses subsequently incubated in K(+)-free Tyrode's. CONCLUSIONS: Enhanced synthesis of cyclooxygenase products of arachidonic acid metabolism in the lens is associated with UVB-induced cataract formation in albino rabbit eyes, and inhibition of cyclooxygenase by indomethacin decreased the severity of cataracts. PGE2, the principal arachidonic acid metabolite, appears to have a protective role because pretreatment of the eye with topical PGE2 completely prevented UVB-induced cataract formation, whereas PGF2 alpha increased the severity of the cataract. The evidence presented for a role of PGF2 alpha in the development of cataract suggests that caution be exercised in the use of PGF2 alpha derivatives in the therapy of glaucoma.

6-Ketoprostaglandin F1 alpha↗

[Incidence of cataract and risk factors in Northeastern Poland].

PURPOSE: Retrospective analysis of the incidence and risk factors of senile and pre-senile cataract in patients from North-East Region of Poland, operated on cataract in the years 1986-1995. MATERIAL AND METHODS: In the analysed decade, 6038 patients were operated on cataract in the Ophthalmology Department of the Clinical Hospital and Ophthalmology Department of the District Hospital in Bialystok. There were 2603 males and 3435 females, mean age amounted to 69 +/- 11 years. 44% of the patients came from rural communities (560.000 inhabitants in the region), whereas 56% of the patients were of urban province (796.000 inhabitants). Statistical analysis was performed on such variables like age, gender, place of residence, cataract history and presence of concomitant diseases: arterial hypertension, diabetes, lung and joints disorders, intestinal diseases. RESULTS AND CONCLUSIONS: Residence in rural communities increases the risk of cataract, although the condition in this environment tends to develop in older age. Gender distribution of the patients does not differ from male/female ratio in the population of the region, so both genders are exposed to similar risk of cataract. Females contract cataract in older age, on average about 3 years later than males. Age is the most important risk factor of cataract; 52% of the patients are older than 70, 43% are in the age of 51-70 years. Mean value of duration of cataract history before operation decreased during the analysed 10 years from 3.8 years in 1986 to 2.2 years in 1995. In 14% of patients cataract coexisted with arterial hypertension, in 8% with diabetes, and in 15% with other diseases. During the analysed 10 years period the number of patients with cataract increased in the same degree in all examined communities. The mean age of patients operated on cataract decreased in this period by 2 years in spite of increasing number of patients older than 75 years. This result can be explained by the fact that the disease tends now to develop earlier and by concomitant decreasing of the time between onset of the disease and decision for operation.

Adult↗

Poor uptake of cataract surgery in nursing home residents: the Salisbury Eye Evaluation in Nursing Home Groups study.

OBJECTIVE: To compare the uptake of cataract surgery in nursing homes in which assistance was provided in obtaining services with that in control homes. METHODS: The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) project is a randomized clinical trial studying the effect of a comprehensive vision restoration-rehabilitation program, including the provision of cataract surgery services when needed. Twenty-eight nursing homes in the Eastern Shore area of Maryland and Delaware were matched in pairs by size and payment type. Nursing homes within each pair were randomized to usual care or targeted intervention. Persons with cataract causing visual acuity in the better eye to be worse than 20/40 were informed of the possible benefit of cataract surgery. For those in intervention homes, additional support was provided in obtaining cataract surgery. RESULTS: Of residents with vision-impairing cataract in intervention homes, 31% underwent cataract surgery vs 2% in usual-care facilities. Residents with cataract compared with all residents without visual impairment, regardless of nursing home assignment, tended to be older (mean age, 86.7 vs 82.1 years; P<.001), were more likely to be black (age-adjusted P<.001), had lower Mini-Mental State Examination scores (mean, 11.7 vs 16.2; age-adjusted P<.001), and longer length of stay (mean, 42.3 vs 24.4 months; P<.001). Furthermore, cataract was associated with significant visual impairment and with functional limitations, with 20% of those recommended for surgery having a visual acuity of 20/100 or worse in the better-seeing eye. CONCLUSIONS: Screening for and identifying cataracts as a cause of vision loss rarely results in uptake of cataract surgery services in nursing homes. The addition of a support system to facilitate the process of scheduling surgery and getting to and from the hospital dramatically increases uptake rates.

Aged↗

Cataract and phthisis bulbi after laser photoablation for threshold retinopathy of prematurity.

PURPOSE: To describe the visual and structural outcome of eyes that developed a dense cataract after laser photoablation for threshold retinopathy of prematurity. METHODS: A retrospective review of eight consecutive infants who developed dense cataract(s) after bilateral laser photoablation for threshold retinopathy of prematurity. Of the 10 eyes with cataract, five eyes were treated with a diode laser and five with an argon laser. The stage and zone of the retinopathy of prematurity, number of burns applied, time of onset of the cataract, clinical findings at the time of cataract surgery, and the course after cataract surgery were reviewed. RESULTS: Six eyes had zone 1 disease and four had zone 2 disease. The mean number of burns applied per eye was 2532 +/- 856 (range, 1400 to 4500). A cataract was diagnosed a median of 3 [corrected] weeks (range, 1 to 28 weeks) after laser photoablation. Nine of the 10 cataracts were sufficiently dense to preclude a view of the fundus. All 10 eyes had clinical signs suggestive of an inflammatory or ischemic process that included one or more of the following findings: corneal edema, pupillary membrane, iris atrophy, depigmentation of ciliary processes, pigment on the anterior lens surface, posterior synechiae, hyphema, and shallow anterior chamber. Nine eyes underwent cataract surgery. Five of the 10 eyes had retinal detachment ranging in severity from stage 4A to stage 5 at the time of cataract surgery. Nine of the 10 eyes progressed to phthisis bulbi and no light perception. CONCLUSIONS: A dense cataract developing in the eye of an infant after laser photoablation for threshold retinopathy of prematurity is associated with a poor visual prognosis. The constellation of associated clinical findings appears to be most consistent with anterior segment ischemia.

Birth Weight↗