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PubMed2005

Randomised controlled trial of preoperative information to improve satisfaction with cataract surgery.

AIM: To investigate the effects of an informational video on patient expectations and satisfaction with day-stay cataract surgery. METHODS: 141 patients undergoing day-stay cataract surgery were randomised into one of two video groups, explaining either what to expect from the cataract surgery or the anatomy of cataract. Patients were surveyed as to their expectations for visual outcome, anxiety, risk, and discomfort resulting from the surgery. After the operation, patients were again asked to rate their experience of anxiety, discomfort, risk, comprehension, overall satisfaction, and comparison with expectations. RESULTS: 84% of patients already thought they received enough or too much information. The expectations video group expected more risk and discomfort than the anatomy video group. Yet, after the surgery, the expectations video group was significantly more satisfied, understood better what was happening to them, and felt less anxious. There was no difference in the discomfort or risk actually experienced, or the expected visual outcomes. Patients with previous cataract surgery experience expected less anxiety and discomfort, and found the surgery closer to their expectations. None the less, previous cataract surgery experience did not negate the effects of the video. CONCLUSIONS: This study demonstrates that a simple, inexpensive videotape showing patients what to expect from cataract surgery results in significant increases in patient understanding of and satisfaction with the cataract surgery, as well as a decrease in anxiety. These effects were independent of patients' expected outcomes or previous experience with cataract surgery, and despite the fact that patients generally thought they had already received enough information.

Aged↗
PubMed2006

Bilateral cataract surgery and driving performance.

BACKGROUND: Cataract surgery is one of the most common medical procedures undertaken worldwide. AIMS: To investigate whether cataract surgery can improve driving performance and whether this can be predicted by changes in visual function. METHODS: 29 older patients with bilateral cataracts and 18 controls with normal vision were tested. All were licensed drivers. Driving and vision performance were measured before cataract surgery and after second eye surgery for the patients with cataract and on two separate occasions for the controls. Driving performance was assessed on a closed-road circuit. Visual acuity, contrast sensitivity, glare sensitivity and kinetic visual fields were measured at each test session. RESULTS: Patients with cataract had significantly poorer (p<0.05) driving performance at the first visit than the controls for a range of measures of driving performance, which significantly improved to the level of the controls after extraction of both cataracts. The change in contrast sensitivity after surgery was the best predictor of the improvements in driving performance in patients with cataract. CONCLUSIONS: Cataract surgery results in marked improvements in driving performance, which are related to concurrent improvements in contrast sensitivity.

Aged↗
PubMed2005

Impairment of visual acuity and reading performance and the relationship with cataract type and density.

PURPOSE: To evaluate the association between the density of nuclear, cortical, and posterior subcapsular lens opacities and visual impairment in patients with cataract. METHODS: In 80 patients, visual acuity and reading performance were evaluated 1 day before and 4 weeks after cataract surgery. Cataracts were categorized and graded according to the Lens Opacities Classification System (LOCS) III of nuclear color (NC), nuclear opalescence (NO), cortical (C), and posterior subcapsular cataract (P). A multiple linear regression analysis and partial correlation coefficients were calculated. Data were also checked for significant pre- and postoperative differences in visual performance related to cataract grading. RESULTS: In the multiple linear regression analysis, significant associations were found between the improvement in visual acuity and reading performance after cataract surgery and the NC, NO, and P scores (P < 0.001); no significant association was found for the C score (P > 0.05). High partial correlation coefficients were found between the P score and the preoperative visual acuity (r = 0.6; P < 0.001), reading acuity (r = 0.74; P < 0.001), and maximum reading speed (MRS; r = -0.77; P < 0.001). Significant but lower partial correlation coefficients were found for the NO score. No significant partial correlation coefficients were found for the NC and C score. Significant pre- and postoperative differences in MRS were found in patients with P scores > or =3 or NO and NC scores > or =5, representing functionally relevant impairment. CONCLUSIONS: A strong association was found between visual impairment in patients with cataract and the severity of posterior subcapsular cataract (PSC) and nuclear opacity. Particularly in patients with PSC, deficits in reading performance significantly increased. The functionally relevant deficits in patients with P scores > or =3 or NO and NC scores > or =5, should be carefully considered for planning cataract surgery or visual rehabilitation.

Aged↗
PubMedDate not supplied

Lens epithelial apoptosis and cell proliferation in human age-related cortical cataract.

PURPOSE: To probe the presence of apoptosis in the epithelium of human lenses with age-related cortical cataract as well as to assess cell proliferation, a predicted consequence of apoptotic cell death, in this specific cell population. METHODS: DNA fragmentation was assessed using terminal digoxigenin-labeled dUTP nick end labeling (TUNEL) in capsulotomy specimens obtained from patients who underwent either extracapsular cataract extraction for the removal of adult-onset cortical cataract (n=27) or clear lens extraction for the correction of high myopia (n=25). Cell proliferation was assayed in 23 epithelia of cataractous lenses, and 20 epithelia of non-cataractous lenses with the proliferation marker MIB1, a monoclonal antibody against the nuclear antigen Ki-67 that is detected throughout the cell cycle but is absent in the resting (G0) cell. RESULTS: TUNEL staining was observed in 25 (92.6%) specimens of cataractous lenses, whereas cells undergoing apoptosis were identified in 2 (8%) of the epithelia from non-cataractous lenses. Only two MIB1-positive samples were detected, one of which was a capsule obtained during intracapsular cataract extraction. CONCLUSIONS: The epithelium of human lenses with cortical cataract undergoes low rate apoptotic death. This limited epithelial apoptosis is unlikely to result in any significant cell density decrease since epithelial gaps are likely to be replaced by cell proliferation at the germinative zone of the anterior lens capsule. Nevertheless, the accumulation of small-scale epithelial losses during lifetime may induce alterations in lens fiber formation and homeostasis and result in loss of lens transparency.

Adult↗
PubMedDate not supplied

Posterior chamber intraocular lenses: long-term results in pediatric cataract patients.

Major problems in pediatric cataract patients include noncompliance with contact lenses resulting in amblyopia. Advances in intraocular cataract surgery have provided a better environment to perform intraocular lens (IOL) implantation in children. We prospectively analyzed the results of 34 consecutive pediatric patients who underwent cataract removal and insertion of an IOL. Operative technique performed was posterior scleral beveled or frown incision and IOL endocapsular fixation. Subgroups included 10 eyes with traumatic cataract, and 24 eyes with developmental cataracts. Six patients had bilateral IOLs. Data presented in each subgroup included initial and final visual acuity, age, sex, type of cataract, A and B scan biometry, early and late postoperative complications, time of YAG capsulotomy, postoperative refractive correction, and state of binocular vision. Preoperative visual acuity ranged from 20/70 to light perception. The success rate for postoperative visual acuity of 20/40 or better occurred in 29 of 34 eyes, or 85.3%. In the traumatic cataracts, 8 of 10 eyes (80%) obtained 20/40 vision or better. In developmental cataracts, 21 of 24 eyes (88%) achieved visual acuity of 20/40 or better. Amblyopia (three patients) or macular scar (two patients) accounted for reduced visual acuity in the five eyes with vision less than 20/40. Early complications included posterior synechiae and lens deposits. The primary late complication was opacification of the posterior capsule in 18 of 34 eyes. The average time for YAG capsulotomy post-cataract removal was 17 months. None of the 28 patients (34 eyes) developed glaucoma, IOL dislocation, or other significant postoperative problems related to IOL insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Combined cataract surgery and vitrectomy for recurrent retinal detachment.

PURPOSE: To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. METHODS: Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. RESULTS: The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. CONCLUSIONS: Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.

Adult↗
PubMed2000

Cataract surgical coverage: results of a population-based survey at Nkhoma, Malawi.

AIM: To determine the cataract surgical coverage (CSC) in the close proximity of Nkhoma Hospital, Malawi. METHOD: A rapid epidemiological assessment of the population aged 40 years and over was undertaken to determine the proportion of eyes and patients with cataract blindness that had previously received cataract surgery within a 10-mile radius of the hospital. RESULTS: A total of 993 people aged 40 years and above from all 31 small villages in the 10-mile radius were examined. The prevalence of blindness in this age group was 3.72%, of which 62% was due to cataract. The cataract surgical coverage for people with blinding cataract was calculated at 14.8%, and for eyes with cataract (visual acuity <3/60) 8.5%. CONCLUSION: Nkhoma Hospital has provided affordable cataract surgery for more than 20 years. Despite this, within a ten-mile radius of the hospital, only 1 in 7 people with bilateral blindness from cataract has received surgery.

Adult↗
PubMedDate not supplied

The outcome of the functioning filter after subsequent cataract extraction.

OBJECTIVE: To evaluate and compare the outcome of functioning filtration surgery followed by cataract surgery with posterior intraocular lens implantation by both phacoemulsification and extracapsular cataract extraction (ECCE) techniques in glaucomatous eyes. PATIENTS AND METHODS: We retrospectively evaluated the clinical course of 77 eyes (68 patients) that after successful trabeculectomy, underwent cataract surgery by either phacoemulsification or ECCE techniques. We determined the frequency of partial and absolute failure following cataract surgery by either phacoemulsification or ECCE in eyes with functioning trabeculectomies. Partial failure of intraocular pressure (IOP), control after cataract extraction was defined as the need for an increased number of antiglaucoma medications or argon laser trabeculoplasty to maintain IOP < or =21mm Hg. Complete failure of IOP control after cataract surgery was defined as an IOP >21 mm Hg on at least two consecutive measurements one or more weeks apart or the performance of additional filtration surgery. Failure rates were calculated using the Kaplan-Meier actuarial method. Failure rates between phacoemulsification and ECCE subgroups were compared using the log rank test. RESULTS: The probability of partial failure by the third postoperative year after cataract surgery was 39.5% in the phacoemulsification subgroup and 37.3% in the ECCE subgroup. This small difference is not statistically significant (P = 0.48). The probability of complete failure by the fourth postoperative year after cataract surgery was 12.0% in the phacoemulsification subgroup and 12.5% in the ECCE subgroup. This difference is also not statistically significant (P = 0.77). At the 6-month follow-up visit, visual acuity of both groups improved one or more lines in 87.0% of patients, and worsened one or more lines in 3.9% of patients. Sixty-one percent achieved visual acuity of 20/40 or better. The most frequent complication was posterior capsular opacification requiring laser capsulotomy that occurred in 31.2% of patients. CONCLUSION: Cataract extraction by either phacoemulsification or ECCE following trabeculectomy surgery may be associated with a partial loss of the previously functioning filter and the need for more antiglaucoma medications to control IOP.

Aged↗
PubMed2003

[Evaluation of the results of cataract surgery in eyes after silicone oil removal].

PURPOSE: To evaluate the results of cataract surgery in eyes after silicone oil removal and comparison of surgical technics. MATERIAL AND METHODS: Eighty-four eyes of 80 patients underwent cataract extraction and IOL implantation after vitrectomy with silicone oil, after its removal. In 50 eyes of group A cataract surgery was performed using the ECCE procedure, in 20 eyes of group B-phacoemulsification was done and in 14 eyes of group C cataract surgery was performed simultaneously with silicone oil removal. Ten eyes of the control group K underwent cataract extraction without IOL implantation. The follow-up was 15.5 +/- 11.2 months. RESULTS: Visual acuity of 6/60 or better was achieved in 65% of eyes. Statistically significant improvement in visual acuity was observed after cataract surgery, compared to the results after vitrectomy in the study group and in the control group. The most frequent complication was posterior capsule opacification, which occurred in 47 eyes (54.6%). CONCLUSIONS: Cataract surgery and IOL implantation in eyes after vitrectomy with silicone oil is safe and achieved visual acuity is similar or better, than before cataract formation. The usefulness of combined cataract surgery and silicone oil removal requires further studies.

Adult↗
PubMed2005

[Long-term follow-up of visual functions after pediatric cataract extraction and intraocular lens implantation].

OBJECTIVE: To assess the visual acuity and binocular function of children after pediatric cataract extraction and intraocular lens implantation. METHODS: 47 children with 68 eyes (< 13 years old) were included in the study: 12 children with monolateral traumatic cataract, 14 children with monolateral congenital cataract and 21 children with bilateral congenital cataract. Cataract type, cataract extent, age at surgery and presence of strabismus and nystagmus and the best corrected distant visual acuity (BCDVA) before surgery were recorded and as well. In addition, the best corrected near visual acuity (BCNVA) and binocular function were followed up for an average of (41.3 +/- 12.3) months. Statistical analysis was used to define factors that correlated with achieving good visual acuity and binocular function. RESULTS: BCDVA and BCNVA were 0.5 or better in 34 eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%). Age at surgery, extent of cataract, absence of strabismus and nystagmus were significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus, good BCDVA were significant for good binocular function. CONCLUSIONS: Good visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lens implantation. Multiple factors correlated with achieving good visual function such as timing of surgery, type and extent of cataract, absence of strabismus and nystagmus etal.

Adolescent↗
PubMed1995

Prevalence and incidence of blindness due to age-related cataract in the rural areas of South Africa.

OBJECTIVES: The Bureau for the Prevention of Blindness is responsible for the provision of cataract surgery to the rural indigent population of South Africa. It is important for the Bureau to know both the prevalence and the incidence of cataract blindness in the population. DESIGN, SETTING AND SUBJECTS: Blindness prevalence surveys were conducted in KwaZulu in 1990 and 1993. OUTCOME MEASURES AND RESULTS: The prevalence of cataract blindness was 0.59% (95% confidence interval 0.21) in 1990 and 1993. The prevalence of aphakia was 0.1% in 1990 and 0.2% in 1993, demonstrating a probable increase in the delivery of cataract surgical services, although this had not produced a demonstrable fall in the prevalence of cataract blindness. The calculated annual incidence of cataract blindness was 0.14%. CONCLUSION: Among a rural population of approximately 19 million South Africans, there is a backlog of 113,000 unoperated cataract-blind people and an incidence of 27,000 new cataract blind per year. The implications of this backlog for cataract blindness in our rural areas are discussed.

Age Factors↗
PubMed1996

Cataract surgery and YAG-laser capsulotomy following vitrectomy for diabetic retinopathy.

The present study was initiated to assess time-course and risk factors for the development of cataract and posterior-capsule opacification as well as complications of cataract surgery and YAG-laser capsulotomy following vitrectomy for diabetic retinopathy. The charts of all patients undergoing vitrectomy for diabetic retinopathy during a 5-year period in a university eye hospital were retrospectively reviewed. The course of 306 consecutive eyes in which the lens was retained during vitrectomy was analyzed for subsequent cataract surgery and YAG-laser capsulotomy. The first 6 months after cataract or YAG-laser surgery were examined for the occurrence of complications. Data were analyzed with regard to the time course using Kaplan-Meier life-table analysis. The proportion of eyes that underwent cataract surgery after vitrectomy increased nearly linearly with time, approaching 75% after 5 years. Silicone tamponade (relative risk 1.9; P = 0.0005) and transscleral retinal cryotherapy (relative risk 1.4; P = 0.003) were risk factors for subsequent cataract surgery. No significant cataractogenous effect of intravitreal gas as compared with balanced salt solution was found. YAG-laser capsulotomy was performed in 60% of vitrectomized diabetic eyes within 2 years but in only 10% of nondiabetic controls (P < 0.0001). Within 6 months of extracapsular cataract surgery with implantation of an intraocular lens (IOL) in 54 eyes, no serious complication was observed. After YAG-laser capsulotomy, vitreous hemorrhage occurred within 6 months in 6 of 21 eyes. In conclusion, cataract surgery was performed in 75% of the phakic eyes within 5 years of vitrectomy for diabetic retinopathy. Posterior capsular opacification is particularly common in this subset of eyes. No serious complication was observed after extracapsular cataract surgery with IOL implantation, but YAG-laser capsulotomy was associated with an increased risk for vitreous hemorrhage.

Adult↗
PubMed1998

Human age-related cataract and lens epithelial cell death.

PURPOSE: To evaluate the importance of lens epithelial cell death in age-related cataract. To determine whether the large percentage of terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labeling (TUNEL)-positive lens epithelial cells previously reported in human capsulotomy specimens results from apoptosis or necrosis. METHODS: Capsulotomy specimens from patients who had undergone cataract surgery and epithelia from cataractous lenses of eye bank eyes were compared with epithelia from noncataractous lenses of eye bank eyes. DNA fragmentation was assayed using the TUNEL method. Cell membrane integrity was tested using a fluorescent stain for DNA, BOBO-3, that is excluded from living cells. Cell proliferation was assayed by labeling with 5-bromo-2'-deoxyuridine (BrdU). The number of cells in different regions of the lens epithelium was measured by digital imaging and computerized counting of nuclei after staining with methyl green. RESULTS: TUNEL-positive cells were sometimes detected adjacent to denuded regions of capsulotomy specimens, especially when epithelia were not fixed immediately after surgery. TUNEL-stained cells usually stained with BOBO-3, indicating loss of plasma membrane integrity. No BrdU-labeled cells were detected in capsulotomy specimens. Cell density in cataractous lens epithelia was similar to that in normal lens epithelia. In cataractous lenses from eye bank eyes, cell density in the region of the epithelium overlying the cataract was higher than cell density in the region of the epithelium overlying the transparent part of the lens. No correlation was found between cell density and cataract severity or between cell density and age. CONCLUSIONS: TUNEL staining of lens epithelial cells in capsulotomy specimens most likely results from necrotic cell death caused by damage during or soon after cataract surgery. Loss of cells from the lens epithelium, by apoptosis or other mechanisms of cell death, does not seem to play a major role in age-related cataract formation.

Aging↗
PubMed2001

Risk of cataract in patients treated with statins.

BACKGROUND: Studies in dogs showed that some hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are associated with cataract when administered in excessive doses. Clinical safety data of statins regarding cataract development in humans have been of limited value so far. OBJECTIVE: To determine whether long-term use of statins is associated with an increased risk of cataract. METHODS: We conducted a case-control analysis using data from the United Kingdom-based General Practice Research Database. The main outcome was a first-time diagnosis of cataract and/or cataract extraction in patients aged 40 to 79 years. Controls were matched to cases on age, sex, practice, calendar time, and duration of medical history in the database. Use of statins, fibrates, or other lipid-lowering drugs was compared with nonuse of any lipid-lowering drug, stratified by exposure duration and dose. RESULTS: We identified 7405 cases and 28 327 controls. Long-term use of statins (eg, > or =30 prescriptions) was not associated with an increased cataract risk (adjusted odds ratio [OR], 0.9; 95% confidence interval [CI], 0.5-1.6), nor was use of fibrates or of other lipid-lowering drugs (adjusted OR, 0.5; 95% CI, 0.3-1.1; and OR, 0.7; 95% CI, 0.1-5.6, respectively). We found evidence that concomitant use of simvastatin and erythromycin, a potent inhibitor of simvastatin metabolism, is associated with an increased cataract risk (adjusted odds ratio, 2.2; 95% confidence interval, 1.2-4.1). CONCLUSIONS: Our study provides evidence that long-term use of therapeutic statin doses does not increase the risk of developing cataract. Concomitant use of erythromycin and simvastatin may increase the cataract risk.

Adult↗
PubMed2004

Prevalence of cataract and pseudophakia/aphakia among adults in the United States.

OBJECTIVES: To determine the prevalence of cataract and pseudophakia/aphakia in the United States and to project the expected change in these prevalence figures by 2020. METHODS: Summary prevalence estimates of cataract and of pseudophakia/aphakia were prepared separately for black, white, and Hispanic persons (for whom only cataract surgery data were available) in 5-year age intervals starting at 40 years for women and men. The estimates were based on a standardized definition of various types of cataract: cortical, greater than 25% of the lens involved; posterior subcapsular, present according to the grading system used in each study; and nuclear, greater than or equal to the penultimate grade in the system used. Data were collected from major population-based studies in the United States, and, where appropriate, Australia, Barbados, and Western Europe. The age-, gender-, and race/ethnicity-specific rates were applied to 2000 US Census data, and projected population figures for 2020, to obtain overall estimates. RESULTS: An estimated 20.5 million (17.2%) Americans older than 40 years have cataract in either eye, and 6.1 million (5.1%) have pseudophakia/aphakia. Women have a significantly (odds ratio = 1.37; 95% confidence interval, 1.26-1.50) higher age-adjusted prevalence of cataract than men in the United States. The total number of persons who have cataract is estimated to rise to 30.1 million by 2020; and for those who are expected to have pseudophakia/aphakia, to 9.5 million. CONCLUSION: The number of Americans affected by cataract and undergoing cataract surgery will dramatically increase over the next 20 years as the US population ages.

Adult↗
PubMed1989

Age-related cataract in the Tibet Eye Study.

The Tibet Eye Study was designed to estimate the prevalence of age-related cataract in Duilong-Deqing County, west of Lhasa, China (altitude, 4000 m). Previous reports have suggested an unusually high prevalence of age-related cataract in Tibet. A two-stage probability sample of persons aged 20 years or older from the 35 townships of the county targeted 2884 persons for inclusion in the study; 2665 (92.4%) were examined. Age-related cataract was diagnosed when (1) visual acuity was worse than 6/12 (20/40) because of nuclear or cortical (including posterior subcapsular) opacities, or (2) aphakia associated with a history of age-related cataract was present in either eye. The prevalence of age-related cataract among persons aged 20 to 39 years was 0.2%; among persons 40 years old or older, the prevalence was 11.8%. Cortical cataracts were by far the most common type of cataract diagnosed. Age- and sex-adjusted prevalence in Tibet was 60% higher than the prevalence in a similar, previously conducted study of 6951 person in Shunyi County, northeast of Beijing (altitude, 50 m). A second, independent slit-lamp classification of lens status was conducted in the Tibet Eye Study using standard photographs previously described. Age-specific cataract prevalence was similar with the two examination techniques. Results from the Tibet Eye Study support previous suggestions of a high prevalence of age-related cataract in Tibet.

Adult↗
PubMed1991

The Lens Opacities Case-Control Study. Risk factors for cataract.

The Lens Opacities Case-Control Study evaluated risk factors for age-related nuclear, cortical, posterior subcapsular, and mixed cataracts. The 1380 participants were ophthalmology outpatients, aged 40 to 79 years, classified into the following groups: posterior subcapsular only, 72 patients; nuclear only, 137 patients; cortical only, 290 patients; mixed cataract, 446 patients; and controls, 435 patients. In polychotomous logistic regression analyses, low education increased risk (odds ratio [OR] = 1.46) and regular use of multivitamin supplements decreased risk (OR = 0.63) for all cataract types. Dietary intake of riboflavin, vitamins C, E, and carotene, which have antioxidant potential, was protective for cortical, nuclear, and mixed cataract; intake of niacin, thiamine, and iron also decreased risk. Similar results were found in analyses that combined the antioxidant vitamins (OR = 0.40) or considered the individual nutrients (OR = 0.48 to 0.56). Diabetes increased risk of posterior subcapsular, cortical, and mixed cataracts (OR = 1.56). Oral steroid therapy increased posterior subcapsular cataract risk (OR = 5.83). Females (OR = 1.51) and nonwhites (OR = 2.03) were at increased risk only for cortical cataract. Risk factors for nuclear cataract were a nonprofessional occupation (OR = 1.96), current smoking (OR = 1.68), body mass index (OR = 0.76), and occupational exposure to sunlight (OR = 0.61). Gout medications (OR = 2.48), family history (OR = 1.52), and use of eyeglasses by age 20 years, which is an indicator of myopia (OR = 1.44), increased risk of mixed cataract. The results support a role for the nutritional, medical, personal, and other factors in cataractogenesis. The potentially modifiable factors suggested by this study merit further evaluation.

Adult↗
PubMed1991

National outcomes of cataract extraction. Endophthalmitis following inpatient surgery.

We analyzed the likelihood of rehospitalization for endophthalmitis in 338,141 Medicare beneficiaries over age 65 years who were admitted to US hospitals for cataract extraction in 1984. This cohort represents approximately one half of all persons who underwent cataract extraction under the Medicare program in 1984. Extracapsular extraction was performed in 195,587 (58%) of cases, intracapsular cataract extraction in 99,971 (30%), and phacoemulsification in 28,474 (8%). The risk of rehospitalization for endophthalmitis in the year following surgery was 0.17% for intracapsular cataract extraction compared with 0.12% for extracapsular extraction or phacoemulsification (P less than .002). The risk of endophthalmitis at 1 month was higher for intracapsular cataract extraction than for extracapsular extraction or phacoemulsification (0.11% vs 0.085%), although the difference did not reach statistical significance. Cataract surgery accompanied by anterior vitrectomy increased the 1-month risk of rehospitalization for endophthalmitis to 0.41%, more than a four-fold increase over that for cataract surgery alone (0.09%; P less than .05). The rates of endophthalmitis at 1 year were 0.58% and 0.13%, respectively, for cataract surgery with anterior vitrectomy and cataract surgery alone (P less than .0001). No significant differences in the rate of rehospitalization for endophthalmitis were observed based on the use of an intraocular lens, age, or race. Endophthalmitis within 1 year of surgery was 1.2 times more frequent in men than in women (0.16% vs 0.13%; P = .03). Overall, the likelihood of postoperative endophthalmitis from a national sample is consistent with case series previously reported.

Actuarial Analysis↗