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PubMedDate not supplied

Expression of stress-response protein 60 in lens epithelial cells in atopic cataract.

PURPOSE: To clarify the pathogenesis of atopic cataract, especially to determine if there is any relationship between autoimmunity and atopic cataract. METHODS: We investigated the lens epithelia obtained at surgery from 12 patients (12 eyes) with atopic cataract: from 8 patients (8 eyes) with nonatopic cataract (5 with senile cataract, 2 with juvenile cataract, and one with secondary cataract due to anterior uveitis); and from 4 autopsy eyes as controls. RESULTS: Histopathological findings in the lens epithelial cells from atopic and nonatopic cataract patients were essentially the same: atrophy of the cells, presence of the superimposed cells, migration of cells into the lens cortex, cytoplasmic vacuolation, and loss of cells. In an immunohistochemical study, the expression of stress-response protein 60 (srp 60), srp 27, and srp 72 was examined in the lens epithelial cells. In atopic cataract specimens, 71%-87% of the lens epithelial cells were stained with the antibody against srp 60, but the cells in nonatopic cataract and control specimens were not stained. CONCLUSIONS: Srp 27 and srp 72 were not expressed in any observed epithelial cells. The expression of srp 60 may reflect a protective mechanism of the epithelial cells against injury triggered by immunorelated agents. These findings suggest that the pathogenesis of degeneration of the lens epithelial cells in patients with atopic cataract may be related to autoimmunity.

Adult↗
PubMed2003

Cost-utility analysis of cataract surgery in the second eye.

OBJECTIVE: To perform a reference case cost-utility analysis of second-eye cataract surgery by using the current literature on cataract outcomes and complications. DESIGN: Computer-based econometric modeling. METHODS: Visual acuity data of patients treated and observed over a 4-month postoperative period were obtained from the U.S. National Cataract Patient Outcomes Research Team report. The results from this prospective study were combined with those of other studies that investigated the complication rates of cataract surgery to complete the cohort of patients and outcomes. These synthesized data were incorporated with time trade-off utility values, which accounted for prior successful cataract surgery in the fellow eye. Cost-utility determinations were made with decision analysis, and present value modeling was used to account for the time value of money and health state consequences. MAIN OUTCOME MEASURES: The number of quality-adjusted life-years (QALYs) gained was calculated for the study group undergoing second-eye cataract surgery, assuming that the postoperative vision in the second eye was equivalent to the vision in the first eye after surgery (20/27). This was divided into the cost of the procedure to find the number of year 2001 nominal U.S. dollars spent per QALY gained. RESULTS: Second-eye cataract surgery, as compared with unilateral pseudophakia, resulted in a mean gain of 1.31 undiscounted QALYs per patient treated. A 3% annual discount rate, dependent on the duration of benefit, was used, yielding 0.92 discounted QALYs gained over a 12-year life expectancy. The mean discounted cost of treatment for each patient totaled 2509 US dollars. The cost divided by the QALYs gained (benefit) resulted in 2727 US dollars per QALY gained for this procedure. Sensitivity analysis varying costs and utility values revealed a range from 2045 US dollars to 3649 US dollars per QALY gained. CONCLUSIONS: Second-eye cataract surgery is an extremely cost-effective procedure when compared with other interventions across medical specialties. The cost-effectiveness of second-eye surgery diminishes only slightly from the 2023 US dollars per QALY gained from first-eye cataract surgery. This suggests that patients with good vision in one eye and visual loss from cataract in the fellow eye derive substantial benefit from cataract extraction.

Cataract↗
PubMed1996

Change in visual acuity associated with cataract surgery. The Beaver Dam Eye Study.

PURPOSE: Cataract is the most common age-related eye disease in most countries worldwide. However, unlike many age-related eye diseases, therapy, in the form of cataract surgery, is successful in restoring at least some function in the vast majority of patients. The purpose of this investigation is to evaluate the change in vision related to specific kinds of cataract and cataract surgery in a population-based study in Beaver Dam, Wisconsin. METHODS: The data are derived from the Beaver Dam Eye Study, a population-based incidence study of age-related eye disease. Participants were seen for their baseline evaluation (n = 4926) between March 1, 1988, and September 14, 1990, and for a follow-up examination (n = 3684) an average of 4.8 years later. All examinations, interviews, lens photography, and grading were performed using standard protocols. The age range was 43 to 84 years at the census preceding the baseline examination. RESULTS: For those with no cataract at baseline and without cataract surgery at follow-up, there was an average decline of 0.5 letters (on a logMAR scale) in the right eye by the follow-up examination. In persons with any cataract at baseline and without cataract surgery at follow-up, there was a decrease of four letters. When cataract surgery was done in the interval, it was associated with a significant (P < 0.0001) nine-letter (2-line) improvement in visual acuity. CONCLUSION: Cataract surgery in this population was associated with a significant improvement in visual acuity. It is appropriate to evaluate visual acuity, cataract, and visual needs in planning for eye care in aging populations.

Adult↗
PubMed2000

A prospective study of alcohol consumption and cataract extraction among U.S. women.

PURPOSE: Alcohol consumption has been implicated in the pathogenesis of cataract in some, but not all analytic studies. To date, no prospective analysis of the relationship between alcohol consumption and cataract has been conducted in women. METHODS: We examined the association between alcohol consumption and cataract extraction in a prospective cohort of female registered nurses. In 1980, 50,461 women were included and others were added as they became 45 years of age for a total of 77,466 women. Information on alcohol consumption and incidence of senile cataract extraction was ascertained during 12 years of follow-up with biennial questionnaires. RESULTS: We observed 1468 cases of cataract extraction in 761,036 person-years of follow-up. Compared to nondrinkers, those consuming alcohol were not at increased risk of cataract, even up to 25 grams or more per day (2 or more drinks). Results remained unchanged after controlling for cataract risk factors including cigarette smoking, body mass index, and diabetes. When risk was examined for specific cataract subtypes only, those in the highest category of consumption had a multivariate relative risk of 1.10 for nuclear cataracts and 1.50 for posterior subcapsular cataracts only. CONCLUSIONS: These prospective data suggest that there is no substantial overall increased risk of senile cataract due to alcohol intake. The possibility that alcohol consumption leads to a modest increased risk of posterior subcapsular type opacities requiring extraction merits further exploration.

Adult↗
PubMed2002

Prevalence of cataract in the Speedwell Cardiovascular Study: a cross-sectional survey of men aged 65-83.

AIMS: To ascertain the prevalence of cataract in a representative group of men who have been followed since 1979 for cardiovascular disease. METHODS: Of 2348 men aged 45-63 recruited in 1979 to the Speedwell Cardiovascular Study, 1420 were alive and willing to take part in further studies in 1997. They were sent a questionnaire about their eye health and invited to an ophthalmological examination at Bristol Eye Hospital. Cataract was graded using the Lens Opacities Classification System III (LOCS III) method. RESULTS: Of the 1420 men, 26 died before they could be examined. Out of the remaining 1394 men, 949 presented for examination and full information was available for 936. Some information about eye health was obtainable for 394 men and 51 were not contactable. The prevalence of cataract increased with age and 36 men (3.8%) had had previous cataract surgery in either or both eyes. Of the remaining 903 men with no previous history of cataract surgery, cortical cataract was present in the right eye of 75 men (8.3%), nuclear (opalescence) in 128 (14.2%) and posterior subcapsular in 15 (1.7%). Five men (0.6%) had visual acuity of 6/60 or worse attributable to cataract in the right eye and 232 (25%) had visual acuity in one or both eyes of 6/24 or less at least partially attributable to cataract. There was no association between social class and the presence of cataract. CONCLUSIONS: The prevalence of cataract in a representative cohort of men followed since 1979 for cardiovascular disease was comparable to that previously reported in the UK and is consistent with studies from around the world. It appears that substantial amounts of visual loss, attributable to cataract, are present in men. Further studies establishing the reasons for this should be undertaken.

Age Factors↗
PubMed2004

Five-year change in visual acuity following cataract surgery in an older community: the Blue Mountains Eye Study.

AIMS: To assess the change in visual acuity following cataract surgery in the Blue Mountains Eye Study (BMES) population. Change in visual acuity was assessed by age, sex, baseline cataract type, and baseline visual acuity. METHODS: A 5-year prospective follow-up of the population-based BMES cohort, who were initially examined in 1992. After 5 years, 2335 survivors of 3654 (75.1%) baseline BMES participants were re-examined. Slit-lamp and retro-illumination lens photographs were graded for the presence of incident cataract and evidence of cataract surgery. Visual acuity was measured using a logMAR chart, read at 2.4 m. The main outcome measure was change in the number of logMAR letters correctly identified by eyes that underwent cataract surgery during the 5-year follow-up period. RESULTS: In a multiple linear regression model, age (P<0.0001) and early age-related maculopathy (ARM) at baseline (P<0.0001) were found to affect adversely the postoperative visual acuity following the cataract surgery. As expected, eyes with any baseline cataract showed the greatest improvement in visual acuity after cataract surgery (right eyes: mean +/- s.e. change of 3.75 +/- 1.34 letters; left eyes: mean change +/- s.e. of 6.7 +/- 0.99 letters). There was also a statistically significant improvement in vision after cataract surgery in eyes with no significant lens opacity graded as present at baseline (right eyes: mean +/- s.e. change of 3.78 +/- 1.85 letters; left eyes: mean change +/- s.e. of 2.68 +/- 1.33 letters). CONCLUSIONS: Age and baseline cataract or ARM status, and baseline visual acuity were determinants of the postoperative visual outcome in older persons who underwent cataract surgery in this community.

Age Factors↗
PubMed2002

A prospective study of the relationship between body mass index and cataract extraction among US women and men.

BACKGROUND: Obesity may influence several physiologic processes involved in cataract formation such as oxidative stress, glycosylation and osmotic stress. OBJECTIVE: To examine the association between increased body mass index (BMI) and the incidence of cataract extraction. DESIGN AND SETTING: The Nurses' Health Study and the Health Professionals Follow-up Study, both prospective cohort studies of US women and men. SUBJECTS: A total of 87 682 women and 45 549 men aged 45 y and older who did not have diagnosed cataract or cancer at baseline (1980 for women, 1986 for men). MEASUREMENTS: Cataract extractions occurring between baseline and 1996, confirmed by medical records. RESULTS: During 16 y of follow-up in the women, and 10 y in the men, (1 097 997 person-y), 4430 incident cases were documented. Compared to participants with BMI less than 23 kg/m(2), those with BMI greater than or equal to 30 kg/m(2) had 36% higher risk of any type of cataract (pooled multivariate relative risk (RR), 1.36; 95% CI, 1.23-1.49) after adjusting for smoking, age and lutein/zeaxanthin intake. The association was strongest for posterior subcapsular (PSC) cataract (pooled multivariate RR, 1.99; 95% CI, 1.55-2.55). With adjustment for diabetes, the RR of obesity associated with posterior subcapsular cataract was 1.68 (95% CI, 1.30-2.17). Obesity was not significantly associated with nuclear cataract. CONCLUSION: Obesity increases the risk of developing cataract overall, and of PSC cataract in particular; the etiology of PSC cataract may be mediated at least in part by glucose intolerance and insulin resistance, even in the absence of clinical diabetes.

Aged↗
PubMed1994

[Surgical results of uni- and bilateral congenital and traumatic cataract in infancy to adolescence].

PURPOSE: In a retrospective study the question to be answered is if and at what time unilateral and/or bilateral congenital cataracts have to undergo surgical treatment and from what age of life lens implantation, also after traumatic cataract, is effective. MATERIAL AND METHODS: The inquiry includes 75 patients who were treated by lensectomy at the Department of Ophthalmology, University of Zürich, before the end of the 20th year of their life in the period of 1985-1990. Of the test group, 26 patients had congenital cataracts (14 unilateral and 12 bilateral), 30 patients had traumatic cataracts and 19 patients had developmental cataracts of various etiology. RESULTS: Congenital cataract. Patients with bilateral cataracts had better visual results than those with unilateral cataracts. The amblyopic risk is relatively small. For infants, being children under the age of one year, the test group until 1990 is not large enough to declare a valid test group. Depending on various indications of surgery, in cases with monocular lens opacity a higher visual acuity is reached if surgery is performed between the 5th and the 15th year (acuity 0.4-1.0) versus before the 5th year (acuity 0.4). Cases with a posterior chamber lens implant have better visual results than those without. Cataracta varia (cataract after birth). Unilateral and bilateral surgical procedures are always justified, where possible with an intraocular lens (IOL). Traumatic cataract. Successful results occur, as soon as an IOL can be implanted. CONCLUSION: Unilateral congenital cataracts have to be surgically treated. In individual cases, astonishing results are possible, particularly in cases with persistent hyperplastic primary vitreous (PHPV). The extent and type of the lenticular opacity determines the indication and the timeframe of the surgical procedures. Knowledge about the growth of the eye-ball, experiences to date and the easing of rehabilitation by implantation of a posterior chamber lens, justify its application after the age of 18 months.

Cataract↗
PubMed1983

[Clinical and time factors of various forms of senile cataract. (Prospective study)].

This paper presents the results of vision and slit-lamp examinations of supranuclear senile cataracts in patients whom the author has been examining for several years with the same instrument. The supranuclear, gray senile cataract (water cleft-spokes, lamellar fissures, wedge-shaped opacities) is the one with the slowest rate of development, often changing only little or not at all for several years (6 or more). The primary gray nuclear cataract also develops very slowly and frequently causes a deterioration in vision only after several years, by producing a lens with a double focal point and increasing myopia. In very long-standing cases (more than 7 years) a black cataract develops. As a senile cataract, the subcapsular cataract (permeability cataract) deteriorates rapidly within months. Subcapsular colored glints, vacuoles and granular opacities occur, more often posteriorly than anteriorly. In some cases a secondary gray nuclear opacity develops very rapidly (in contrast to the primary variety), which does not lead to myopia or black cataract. Cation pump and glutathione content remain normal in the supranuclear gray senile cataract and the primary nuclear cataract for some time; however, they are disturbed immediately and to a great extent in the subcapsular cataract.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Blood and lens lipid peroxidation and antioxidant status in normal individuals, senile and diabetic cataractous patients.

PURPOSE: Oxidative mechanisms are believed to play an important role in the pathogenesis of cataract, the most important cause of visual impairment at advanced age. To determine the body's antioxidant status as well as its lipid peroxidation levels, both blood and lens parameters were evaluated. METHODS: This study was performed on the blood samples and lenses obtained from 46 patients diagnosed as having cataract and 20 control subjects. The control group was composed of 10 women and 10 men who do not smoke. Control subjects without any lens opacity or vacuoles when observed with a slit lamp were recruited on the same exclusion criteria as far as disease and treatment were concerned. No antioxidant medicines were used. They were all healthy individuals without any systemic diseases. Superoxide dismutase (SOD), glucose-6-phosphate dehydrogenase (G6PD), glutathione reductase (GSSG-Red) activities in red blood cell (RBC) lysates as well as whole blood glutathione (GSH) and plasma thiobarbituric acid reactive substances (TBARS), the indicator of lipid peroxidation concentrations, were determined quantitatively both in the blood samples and the lenses of the patients with senile and diabetic cataracts. RESULTS: Whole blood GSH values, and erythrocyte SOD activities were significantly lower in the cataractous patients than those in the control group. The values in the diabetic cataractous group were also less than those in the senile cataractous group. Significantly decreased erythrocyte GSSG-Red and G6PD activities were detected in the diabetic cataractous group. Plasma TBARS values were higher both in the senile and diabetic groups when compared to those in the control group. Significantly decreased values were observed for GSSG-Red activities and TBARS values in the lenses of the senile cataractous patients in comparison with those in the diabetic cataractous patients. The lens GSH values were found to be higher in the senile cataractous group than the values obtained in the diabetic cataractous group. CONCLUSIONS: A strong correlation was found between lens GSH and lens TBARS concentrations in the diabetic group. This emphasized the vital role of GSH as an antioxidant in the lens over the other antioxidant parameters, e.g., enzymes, and the oxidative stress is at the highest level in lens.

Aged↗
PubMed2004

Incidence of cataract extraction after diabetic vitrectomy.

PURPOSE: To determine the frequency of visually significant cataracts after vitrectomy for complications of diabetic retinopathy. METHODS: We studied 40 patients and 56 concurrent control patients in a retrospective, consecutive, comparative case series in an institutional setting. Entry criteria included phakic patients with a clear lens or mild lens opacity undergoing anatomically successful diabetic vitrectomy, without lens removal at the time of vitrectomy, without intraocular gas or silicone oil use, and with at least 1 year of postoperative follow-up examination information. Two comparative phakic control groups with the diagnosis of macular hole or epiretinal membrane were selected, also with follow-up examination information of at least 1 year postoperatively. The occurrence of cataract extraction was the principal outcome measure. Its validity as a measure of cataract formation was evaluated by ascertainment of improved visual acuity after cataract extraction. A secondary endpoint analysis included eyes that needed cataract extraction at the final follow-up examination. RESULTS: For the primary analyses (clear lens preoperatively), there were 26 patients in the study group, 38 in the macular hole control group, and 18 in the epiretinal membrane control group. The cumulative cataract extraction rates at 2 years were 15%, 66%, and 53% respectively. By using multivariate survival analysis, the patient age was an important factor, with a younger age associated with a lower rate of progression to nuclear sclerosis. After controlling for age, the difference in these three groups was still statistically significant. In the four patients with diabetes undergoing cataract surgery, the visual acuity improved at least two lines in only one of the eyes and did not change in three eyes. After expanding the outcome measures to include study patients with mild lens opacities at baseline or those judged to be in need of cataract surgery at the final follow-up examination, there was still a strongly statistically significant difference between the three groups. CONCLUSION: The rate of cataract extraction after vitrectomy in patients with diabetes is lower than in patients without diabetes undergoing vitrectomy and suggests a lower rate of cataract formation. This inference should be considered when attributing subnormal vision in a patient who has had a diabetic vitrectomy to a cataract. This is especially significant because the risk ratio in patients with diabetes in general and in patients with a previous vitrectomy is likely less favorable compared with the general population.

Adult↗
PubMed2006

Cataract and its surgery in Timor-Leste.

PURPOSE: To determine the prevalence of visually significant and unoperated blinding cataract, and the coverage, characteristics and outcome of cataract surgery in Timor-Leste. METHODS: Based on the World Health Organization Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005. By two-stage cluster random sampling, 50 clusters of 30 people aged 40 years and older were selected. Each eye with a presenting visual acuity worse than 6/18 and/or a history of cataract surgery was examined. RESULTS: Of the 1470 people enumerated, 96.2% were examined. Of the eyes examined, 11.5% were blind (presenting vision less than 6/60). Cataract caused 66.3% of this, and 40.2% of vision impairment (presenting vision less than 6/18). For those people who were blind (7.7%; presenting vision less than 6/60 in the better eye), cataract was the most frequent cause (76.1%). Cataract surgery had occurred in 2% of participants. Gender and domicile were not associated with cataract blindness or surgery. Cataract Surgical Coverage (6/60) was 16.3% for Eyes and 20.2% for Persons. Surgical outcomes were poor, falling well short of World Health Organization guidelines. Astigmatism and posterior capsule opacity were important contributors to this. CONCLUSIONS: Until census data are available, age-gender-domicile correction of sample findings cannot be calculated. In the meantime, it is estimated there are 11 500 cataract blind in Timor-Leste. Long-term, indigenous cataract surgical services need to be capable of significantly increased output. Better surgical outcomes are required to ensure scarce resources are well used. Laser capsulotomy needs to be planned for as surgical numbers increase.

Adult↗
PubMed2005

Cataract surgical coverage and outcome in the Tibet Autonomous Region of China.

BACKGROUND: A recently published, population based survey of the Tibet Autonomous Region (TAR) of China reported on low vision, blindness, and blinding conditions. This paper presents detailed findings from that survey regarding cataract, including prevalence, cataract surgical coverage, surgical outcome, and barriers to use of services. METHODS: The Tibet Eye Care Assessment (TECA) was a prevalence survey of people from randomly selected households from three of the seven provinces of the TAR (Lhoka, Nakchu, and Lingzhr), representing its three main environmental regions. The survey, conducted in 1999 and 2000, assessed visual acuity, cause of vision loss, and eye care services. RESULTS: Among the 15,900 people enumerated, 12,644 were examined (79.6%). Cataract prevalence was 5.2% and 13.8%, for the total population, and those over age 50, respectively. Cataract surgical coverage (vision <6/60) for people age 50 and older (85-90% of cataract blind) was 56% overall, 70% for men and 47% for women. The most common barriers to use of cataract surgical services were distance and cost. In the 216 eyes with cataract surgery, 60% were aphakic and 40% were pseudophakic. Pseudophakic surgery left 19% of eyes blind (<6/60) and an additional 20% of eyes with poor vision (6/24-6/60). Aphakic surgery left 24% of eyes blind and an additional 21% of eyes with poor vision. Even though more women remained blind than men, 28% versus 18% respectively, the different was not statistically significant (p = 0.25). CONCLUSIONS: Cataract surgical coverage was remarkably high despite the difficulty of providing services to such an isolated and sparse population. Cataract surgical outcome was poor for both aphakic and pseudophakic surgery. Two main priorities are improving cataract surgical quality and cataract surgical coverage, particularly for women.

Adult↗
PubMed2002

A population based eye survey of older adults in Tirunelveli district of south India: blindness, cataract surgery, and visual outcomes.

AIMS: To assess the prevalence of vision impairment, blindness, and cataract surgery and to evaluate visual acuity outcomes after cataract surgery in a south Indian population. METHODS: Cluster sampling was used to randomly select a cross sectional sample of people > or =50 years of age living in the Tirunelveli district of south India. Eligible subjects in 28 clusters were enumerated through a door to door household survey. Visual acuity measurements and ocular examinations were performed at a selected site within each of the clusters in early 2000. The principal cause of visual impairment was identified for eyes with presenting visual acuity <6/18. Independent replicate testing for quality assurance monitoring was performed in subjects with reduced vision and in a sample of those with normal vision for six of the study clusters. RESULTS: A total of 5795 people in 3986 households were enumerated and 5411 (93.37%) were examined. The prevalence of presenting and best corrected visual acuity > or =6/18 in both eyes was 59.4% and 75.7%, respectively. Presenting vision <6/60 in both eyes (the definition of blindness in India) was found in 11.0%, and in 4.6% with best correction. Presenting blindness was associated with older age, female sex, and illiteracy. Cataract was the principal cause of blindness in at least one eye in 70.6% of blind people. The prevalence of cataract surgery was 11.8%-with an estimated 56.5% of the cataract blind already operated on. Surgical coverage was inversely associated with illiteracy and with female sex in rural areas. Within the cataract operated sample, 31.7% had presenting visual acuity > or =6/18 in both eyes and 11.8% were <6/60; 40% were bilaterally operated on, with 63% pseudophakic. Presenting vision was <6/60 in 40.7% of aphakic eyes and in 5.1% of pseudophakic eyes; with best correction the percentages were 17.6% and 3.7%, respectively. Refractive error, including uncorrected aphakia, was the main cause of visual impairment in cataract operated eyes. Vision <6/18 was associated with cataract surgery in government, as opposed to that in non-governmental/private facilities. Age, sex, literacy, and area of residence were not predictors of visual outcomes. CONCLUSION: Treatable blindness, particularly that associated with cataract and refractive error, remains a significant problem among older adults in south Indian populations, especially in females, the illiterate, and those living in rural areas. Further study is needed to better understand why a significant proportion of the cataract blind are not taking advantage of free of charge eye care services offered by the Aravind Eye Hospital and others in the district. While continuing to increase cataract surgical volume to reduce blindness, emphasis must also be placed on improving postoperative visual acuity outcomes.

Age Distribution↗
PubMed1998

Cell-biological analysis of atopic cataractous lenses.

The number of people suffering from atopic dermatitis, a recent social problem believed to have arisen from environmental pollution and changes, continues to increase today, and these patients often encounter complications such as cataract and retinal detachment. In this study, I have conducted (1) a comparative study on the rate of cell proliferation between lens epithelial cells (LECs) obtained from 7 atopic cataractous lenses and from 1 normal lens, (2) a comparative study on cell density and alignment between LECs obtained from 5 nonatopic cataractous lenses and from 5 atopic cataractous lenses and (3) transmission electron microscopy of LECs obtained from 3 atopic cataractous lenses. My findings were as follows: (1) except for 1 case disclosing increased proliferative activity of the cells to become multilayered, LECs of atopic cataractous lenses showed diminished proliferative activity; (2) LECs of atopic cataractous lenses had decreased in cell density and revealed irregular cell alignment; (3) transmission electron microscopy of LECs of atopic cataractous lenses demonstrated multilayered cells, increased intercellular spaces, and degeneration and disappearance of some cells. A longer follow-up period and further studies using cells from additional atopic cataractous lenses are necessary before any conclusions can be drawn. However, obtaining human LECs especially of atopic cataract patients is not easy, and I do feel that my present study, although its number of patients may not be large enough, provides significant findings for further studies on the mechanism of atopic cataract formation.

Adolescent↗
PubMed1993

Ocular growth in infant aphakia. Bilateral versus unilateral congenital cataracts.

In a prospective study the changes in the ocular axial lengths and in the overall refractions were examined in cases of unilateral and bilateral congenital cataract requiring surgery during the first year of life. Measurements were taken on 18 children with unilateral and on 20 children with bilateral congenital cataract at the time of surgery and up to eight years postoperatively. Surgery was performed via a pars plana/plicata approach, and all infants were fitted with contact lenses. In cases of unilateral cataract, the ocular axial length tended to be superior to the age-matched values already prior to surgery. After four to eight years, one third of the eyes were clearly above normal. In cases of bilateral cataract, the axial lengths were reduced at the age of surgery in the majority of cases, and particularly in eyes that required surgery during the first six months of life. The curvatures of the contact lenses tended to remain unchanged in bilateral cataract, and decreased by about 0.7 mm in unilateral cases. This also reflects the high degree of microphthalmia in bilateral cases. After four to eight years, the degree of microphthalmia had usually increased. The overall refraction decreased significantly in unilateral and bilateral cataract during the first four years of life. The mean values were higher in bilateral than in unilateral cataract at all ages. The mean decrease was 15 diopters in unilateral cataract (SD +/- 5.5 dpt), and 10 diopters in bilateral cataract (SD +/- 6 dpt). When correlating the age-matched differences in the ocular axial lengths at the time of surgery with the overall refractions after four to eight years, a good correlation was found in the unilateral cases (eight eyes), and a poor correlation in the bilateral cases (24 eyes). The data indicate that intraocular implants should not be used in bilateral cataract requiring surgery during the first year of life as long as there is no possibility to change their refraction while in place. In unilateral cases, a relatively accurate prediction appears possible in a small number of eight eyes. However, an additional important correction with glasses would be needed before reaching the final refraction resulting in a high degree of aniseiconia, and eliminating the chances for binocular vision that are small anyway. Furthermore, data from other authors would indicate that the change in refraction may be much more important than expected when using intraocular implants in unilateral congenital cataract requiring surgery during the first year of life.(ABSTRACT TRUNCATED AT 400 WORDS)

Aphakia, Postcataract↗
PubMed2001

Childhood cataracts.

OBJECTIVE: The aim of this study was to determine the surgical outcome of childhood cataracts. METHOD: Between 1990 and 1997, 137 patients less than 10 years of age (181 eyes) underwent cataract surgery at the Royal Alexandra Hospital for Children/New Children's Hospital. Data were collected retrospectively from medical records and supplemented with data from referrng ophthalmologists. RESULTS: In the majority of patients (53.0%), the cause of cataract was unknown. Sixty-two patients (45.3%) had bilateral and 75 patents (54.7%) had unilateral cataracts. In 84 patients (107 eyes: 59.1%), the onset of visually significant cataract was estimated to be before the age of 2 years. Reliable postoperatve visual acuity (VA) was obtained in 150 eyes from 116 patients. The mean LogMAR VA was 0.71 +/- 0.55 in bilateral cataracts and 1.17 +/- 0.68 in unilateral cataracts. Visual acuity was poor (LogMARVA > 1.0) in 71.8% of unilateral cataracts (compared to 27.9% in bilateral cataracts, P < 0.0001), and in 64.9% when onset was ess than 2 years (compared to 22.4% in later onset cataract, P < 0.0001). Posterior capsular opacity requiring laser or surgical removal was noted in 40 patients (44 eyes; 24.4%). Other complications included raised intraocular pressure in six patients (seven eyes: 3.7%), displaced intraocular lens or iris capture in 11 patients (12 eyes; 6.6%), ectopic pupil in five patients (five eyes; 2.7%), and severe inflammation in eight patients (12 eyes; 6.6%). There was cosmetically significant esotropia or exotropia in 24 patients (23 eyes; 12.7%). CONCLUSION: The prognosis for vision was significantly poorer in unilateral and earlier onset cataract. The importance of early diagnosis, prompt treatment and vigilant postoperative follow up in this subgroup cannot be overemphasized.

Cataract↗
PubMed2002

Gender and use of cataract surgical services in developing countries.

OBJECTIVE: To determine, from the existing literature, cataract surgical coverage rates by sex and the proportion of cataract blindness that could be eliminated if women and men had equal access to cataract surgical services. METHOD: Methodologically sound population-based cataract surveys from developing countries were identified through a literature search. Cataract surgical coverage rates were extracted from the surveys and rates for women were compared to those for men. Peto odds ratios were calculated for each survey and a meta-analysis of the surveys was performed. FINDINGS: From a literature review and meta-analysis of cataract surveys in developing countries, we found that the cataract surgical coverage rate was 1.2-1.7 times higher for males than for females. For females, the odds ratio of having surgery, compared to males, was 0.67 (95% confidence interval (CI): 0.60- 0.74). Despite their lower coverage rate, females accounted for approximately 63% of all cataract cases in the study populations, and if they received surgery at the same rates as males, the prevalence of cataract blindness would be reduced by a median of 12.5% (range 4-21%). CONCLUSION: Closing the gender gap could thus significantly decrease the prevalence of cataract blindness, and gender-sensitive intervention programmes are needed to improve cataract surgical coverage among females.

Cataract↗