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PubMed1982

Human posterior subcapsular cataracts.

Clinically and pathologically there are two kinds of posterior subcapsular cataracts: vacuolar-lacy and solid plaque. Vacuolar opacities occur in senile, diabetic, retinitis pigmentosa, steroid, and secondary cataracts (Elschnig pearls). Plaque opacities occur in congenital polar, myotonic dystrophy, and Turner syndrome (chromosome XO) cataracts. The vacuolar opacities tend to be more superficial (closer to the posterior capsule), whereas the plaque opacities are generally slightly deeper (more cortical). The vacuolar opacities show cellular proliferation of aberrantly migrated lens epithelial cells in the posterior pole which have added damage to the cataract by secretion of basement membrane, intra- and extra-cellular filaments, and release of cytolytic lysozymes causing liquefaction and necrosis. The plaque opacities are acellular. Both types of cataracts show breakdown of lens fibres into rounded up disorganized globules and some membranous whorls. The liquefied vacuolar opacity is more readily removed by extracapsular cataract extraction, but the retention of nucleated lens epithelial cells in the vacuolar type of opacity is the source of a secondary cataract or Hirchberg-Elschnig pearls which require a discussion or membranectomy to clear the visual axis. This article will review the salient features in the histopathology (light and electron microscopy) and morphology of PSC and amalgamate the findings reported by several investigators (Eshagian and Streeten, 1975; Eshagian, March, Goossens, and Rafferty, 1978, 1978; Eshagian, Rafferty, and Goossens, 1980, 1981; Eshagian, Rafferty, Goossens, and March, 1979; 1980; Streeten and Eshagian, 1978).

Adult↗
PubMed1994

[Complicated cataract after vitrectomy and gas-liquid exchange].

Cases with complicated cataract occurring after vitrectomy and gas-liquid exchange were reported. In a consecutive series of 62 eyes having undertaken the operation, a transient cataract developed in 8 eyes and an irreversible cataract in 28 eyes. The manifestation of the transient cataract is the posterior subcapsular opacity, feathery or placoid vacuolar in clusters in appearance. It was found that if the amount of the residual vitreous at the retrolental space is great enough, the chance of occurrence of complicated cataract is less. That the direct contact of the gas with the lens affects the lens metabolism and nutrition is the chief cause of the development of the cataract. It is suggested that to prevent the development of cataract induced by the gas, besides selection of body posture, quiet stay in bed and proper selection of gas type, the vitreous at retrolental space be resected as little as possible.

Adolescent↗
PubMedDate not supplied

[Practicability of cataract surgery at university hospitals: searching for an economic model].

UNLABELLED: Resources available for health care all over the world are not enough to cover all the demand in this sector. Cataract Free Zones conducted in many regions of the country show that only 10% to 20% of blind patients caused by senile cataract can get operated on. PURPOSE: To demonstrate feasibility of a model for cataract surgery with intraocular lens implantation at the Clinical Hospital from the University of Campinas, Unicamp, São Paulo, when considering the remuneration payed by the government for universitary services. METHODS: Costs with disposable material were collected for extracapsular cataract surgery, with posterior intraocular lens implant, at the Clinical Hospital, Unicamp. The model includes outpatient surgery under local anesthesia, and costs rationalization in acquisition and wear of material. University Hospitals have a different situation in the health system, where fixed costs and part of the variable costs of cataract surgery are subsidized by the State government. RESULTS: Cataract surgery performed under the proposed methodology is economically feasible, considering disposable components only, and the price achieved was US$ 77 with government payment of US$ 474. More surgical interventions increases the efficiency of the institution, provides more surgical training to residents and better community health care. CONCLUSION: The authors consider that it is an obligation of University Hospitals, regard their commitment with training, research and quality of eye care deliverance, to increase the number of cataract surgeries for the lowest possible price.

Ambulatory Surgical Procedures↗
PubMed1994

Lens epithelium in senile cataract.

This study aimed to clarify the role of lens epithelium in the mechanism of cataractogenesis. One hundred and twenty-six flat preparations of human lens epithelium obtained by endocapsular cataract extraction were studied. The mean lens epithelial cell density (LECD) was 3,683 +/- 655 cells/mm2; there was no significant difference with respect to age and sex (p > 0.05). A marked reduction in LECD, 2,857 cells/mm2, was noted in patients with advanced cataracts. The differences in LECD among the pure cortical, nuclear, and posterior subcapsular types of cataract were statistically insignificant (p > 0.05). We believe that a vicious cycle existed between the compromised lens epithelium and the formation of senile cataract: as a cataractous lens develops to a particular degree, the lens epithelium begins to lose its cell mass progressively and this results in the decreasing LECD. Simultaneously, the diminishing lens epithelial cell population leads to further cataract formation. Based on the outcome of this study, the authors stress the importance of the status of the lens epithelium in the formation of senile cataracts.

Adult↗
PubMed1993

[Cataract and implantation in the vitrectomized eyes].

Cataract is a frequent complication of vitreous surgery after some months or years. In these cases cataract extraction is somewhat difficult. We performed cataract surgery with implantation in 38 eyes from 37 patients between 1986 and 1991. Twenty patients underwent vitreous or vitreoretinal surgery with or without internal tamponade by gas, 17 underwent silicone oil tamponade and silicone oil removal, prior to cataract surgery. Timing of surgery, number of surgical procedures and complications previous to cataract surgery are detailed in the paper. Cataract extraction was extracapsular in 7 cases, intracapsular in 6 cases; phako was performed in 24 cases and phacophagy in one case. A posterior IOL was inserted in 31 cases, an anterior chamber IOL in 7 cases. Anatomical and visual results were satisfying. Visual acuity improved postoperatively in 29 cases (up to 20/20 in 4 cases), was unchanged in 6 cases, decreased in 3 cases. Among these, loss of vision occurred in 5 cases due to retinal detachment or redetachment. For anatomical reasons, lack of vitreous support and the frequent zonular weakness of these eyes, account for surgical difficulties. Thus, phakoemulsification appears the best way to manage cataract in vitrectomized eyes.

Adult↗
PubMed1993

Comparison of specific blue and green fluorescence in cataractous versus normal human lens fractions.

PURPOSE: The authors compared the specific green and blue fluorescence levels in soluble and insoluble fractions (cortical and nuclear) extracted from cataractous lenses with those corresponding to clear lenses and tried to establish the nature of the role of extrinsic fluorophores in cataractogenesis. METHODS: Laser-induced fluorescence was measured with an optical-fiber sensor. The specific fluorescence was evaluated as the ratio of the fluorescence intensity to the protein concentration. Four brunescent, three pure nuclear, and four mixed nuclear-subcapsular cataractous lenses were investigated. RESULTS: Specific blue fluorescence levels in cataractous fractions were similar to those in clear lens fractions, except for the insoluble nuclear fractions in which the levels were slightly lower. The specific green fluorescence in the soluble cataractous fractions showed marked increases compared with the clear lens fractions of similar ages. The insoluble cataractous fractions had similar (cortical fractions) or slightly lower (nuclear fractions) specific green fluorescence levels compared with the normal lens fractions. CONCLUSIONS: The similarity in blue fluorescence levels suggests that the blue fluorophore(s), although increasing in concentration with age, are not indicators of cataractogenesis and may not play an active role in opacification. The levels of specific green fluorescence indicate either a dramatic increase in the fluorescence quantum efficiency and/or an increase in the number of fluorescent sites per protein unit. The green-to-blue ratios were greater by a factor of as much as six in all cataractous soluble fractions versus clear ones. This suggests an accelerated formation of the green fluorescent species in cataractous tissues.

Adolescent↗
PubMed1997

Anesthesia providers' interventions during cataract extraction under monitored anesthesia care.

In 1993 Medicare paid more money to anesthesia providers for cataract surgery than for any other surgical procedure. Patients undergoing cataract surgery often receive monitored anesthesia care (MAC). Thus, cuts in anesthesia payments from Medicare for cataract surgery may be forthcoming. If few interventions were being done after a retrobulbar block was placed, then a registered nurse might be a safe alternative to an anesthesia provider to monitor the patient. The goal of this study was to describe interventions of anesthesia providers during cataract extraction after the placement of a retrobulbar block. Anesthetic records were reviewed for 560 consecutive cases of cataract extraction using MAC at a large tertiary medical center. Anesthesia providers performed interventions (e.g., administration of drugs) on 33% of patients after the retrobulbar block was in place (95% confidence bound, < 36%). In conclusion, insufficient evidence exists for managed care organizations or other groups to justify a change in practice toward a registered nurse monitoring patients undergoing cataract extraction with a retrobulbar block. Furthermore, until a prospective randomized study has been done, such organizations lack justification for decreasing the amount of time that anesthesia providers spend caring for such patients undergoing cataract extraction.

Cataract Extraction↗
PubMed1976

Experimental studies on cataract.

I have discussed five aspects of lens metabolism and their possible relationship to cataract in man, and this has left me with five fundamental questions to be answered. 1. Are the fluorescent tryptophan derivatives, found only in the lens of man and higher primates, involved in the development of brown nuclear cataract? 2. Is naphthalene cataract in rabbits a model for any type of cataract in man--i.e., are quinones ever formed in the human eye? 3. Is diabetes the only cataract in which osmotic swelling is important? 4. Does self-digestion of protein in the human lens contribute to cataract development? 5. Are the consequences of the abnormal maturation of lens fibers, which occurs in tryptophan deficiency cataract in rats, ever seen in man?

Aging↗
PubMed1998

Nuclear cataract and light scattering in cultured lenses from guinea pig and rabbit.

PURPOSE: To compare calcium ionophore-induced cataract formation and in vitro light scattering in cultured lenses from guinea pig and rabbit. METHODS: Lenses from guinea pig and rabbit were cultured for 5 or 6 days with calcium ionophore A23187. To assess the involvement of calpain in cataract formation; SDS-PAGE, immunoblotting and calcium determinations were performed. For in vitro light scattering, lens soluble proteins from rabbit were hydrolyzed for 24 h by either endogenous lens calpain, or by addition of purified m-calpain and then further incubated for up to 10 days. Light scattering was measured daily at 405 nm. RESULTS: Lenses from younger guinea pigs cultured in A23187 first developed outer cortical opacities followed by nuclear cataract. Total calcium was markedly increased by A23187 in lenses of all ages. Proteolysis of crystallins and alpha-spectrin were observed in nuclear cataract in younger guinea pigs. This was attenuated with age, in association with the attenuation of cataract formation with age. Calpain 80 kDa subunit in the lenses cultured with A23187 was also decreased. Co-culture with SJA6017 or E64d (reversible and irreversible inhibitors of calpain, respectively) reduced A23187-induced nuclear opacities, proteolysis of crystallins and alpha-spectrin, and loss of calpain without affecting increased total calcium. In contrast, rabbit lenses cultured in A23187 did not develop nuclear cataract, although biochemical changes in cultured rabbit lenses were similar to those in cultured guinea pig lenses. Furthermore, no appreciable in vitro light scattering occurred in soluble proteins from rabbit lenses after activation of endogenous m-calpain, or after addition of exogenous purified m-calpain, although crystallins were partially hydrolyzed by calpain. CONCLUSIONS: Both rabbit and guinea pig lenses undergo calpain-induced proteolysis upon elevation of lenticular calcium. However, factors in intact guinea pig lenses may promote light scattering and insolubilization after proteolysis by calpain, but these factors were not functional in rabbit lenses. Discovery of the factors promoting light scatter and insolubilization after proteolysis will help to explain the role of certain crystallin polypeptides in cataract formation.

Animals↗
PubMed2001

[Laser flare in combined cataract and glaucoma surgery].

BACKGROUND: We used a laser-flare meter to compare inflammation of the anterior chamber in combined cataract and glaucoma surgery with that in pure filtering surgery. MATERIALS AND METHODS: In 34 consecutive patients with primary chronic open-angle glaucoma (PCOG) we combined glaucoma surgery and cataract extraction with phacoemulsification and implantation of a foldable intraocular lens via the same incision. We compared the results with those in 32 PCOG patients receiving a single goniotrephination and in 45 PCOG patients receiving cataract extraction via clear cornea with implantation of a foldable lens. RESULTS: The increase in the flare in the first 2 days was significant in those receiving combined cataract and glaucoma surgery and in those receiving single goniotrephination but not in those receiving a single cataract extraction. After 3 weeks there was no significant difference to the preoperative value in any of the groups. The highest flare values were in patients after combined surgery, significantly higher than after cataract extraction in the first days and higher than in the goniotrephination patients 3 weeks after the operation. CONCLUSION: The highest flare on the first day was in combined cataract and glaucoma surgery. This may explain the more frequent scarring of the filtering bleb in combined surgery. Postoperatively the intraocular pressure and number of drugs used for glaucoma did not differ in patients with combined and single goniotrephination.

Aged↗
PubMedDate not supplied

Senile cataract: a review on free radical related pathogenesis and antioxidant prevention.

Glutathione metabolism plays an essential role in the homeostasis of the lens. Thus, it is not surprising that experimental depletion of this substance leads to a process of lens disorganization similar to senile cataract and that in all types of irreversible cataract there is a decrease in the glutathione content of the lens. Therefore, it may be useful in preventive geriatrics to raise the glutathione concentration of the lens and, since glutathione monoethyl ester can cross the capsule and membranes of the lens, administration of this compound may be the treatment of choice. This could be complemented by long-term administration of small doses of acetylsalicylic acid, in the early stages of the development of cataracts. The data also suggest that, in the 'high lactose absorbers', diets deprived of lactose (in addition to antioxidant administration) may play a role in protecting against cataract development and may even reverse some of the early changes that occur in cataractous lenses. The present review provides a justification for detection of cataract risk factors (high lactose absorption and low antioxidant protection in blood) as well as for preventive and palliative treatment of cataracts by administration of physiological antioxidants.

Journal Article↗
PubMed2005

Acute-onset endophthalmitis after cataract surgery (2000-2004): incidence, clinical settings, and visual acuity outcomes after treatment.

PURPOSE: To report the incidence, clinical settings, and visual acuity outcomes of acute-onset endophthalmitis after cataract surgery. DESIGN: Retrospective, observational case series. METHODS: Annual cataract surgery statistics were determined by review of electronic surgical records. The clinical and microbiologic records were reviewed of all patients with clinically diagnosed endophthalmitis within 6 weeks after cataract surgery at a single university-affiliated hospital between January 2000 and November 2004. main outcome measures: Operative technique, intraoperative complications, and visual acuity. RESULTS: The incidence of acute-onset endophthalmitis after cataract surgery was 0.04% (7/15,920) for cataract surgeries of all methods, 0.05% (6/11,462) for cataract surgery by clear cornea phacoemulsification, and 0.02% (1/4,458) for cataract surgery by methods other than clear cornea phacoemulsification (P = .681, Fisher's exact test). Six of seven (86%) cases occurred in the right eye, and all cases were performed by right-handed surgeons through temporal incisions. Five of seven (71%) patients had relative immune compromise. Four of seven (57%) patients had an intraoperative complication: vitreous loss in three patients and iris prolapse in one patient. Two patients had topical placement of lidocaine 2% gel before povidone-iodine preparation. The visual acuity at final follow up was 20/25 or better in four patients and count fingers or worse in three patients. CONCLUSIONS: The incidence of acute-onset endophthalmitis after temporal clear cornea incision phacoemulsification is low (0.05%). Potential risk factors for endophthalmitis may include intraoperative complications, relative immune compromise, application of lidocaine 2% gel before povidone-iodine preparation, and inferior incision location.

Acute Disease↗
PubMed2005

Monitored anesthesia care provided by registered respiratory care practitioners during cataract surgery: a report of 1957 cases.

OBJECTIVE: To evaluate the safety and feasibility of having monitored anesthesia care during cataract surgery provided by registered respiratory care practitioners (RRCPs). DESIGN: Retrospective case series. PARTICIPANTS: One thousand nine hundred fifty-seven consecutive patients undergoing cataract surgery at one surgical center between November 2001 and October 2003. METHODS: Phacoemulsification cataract surgery with intraocular lens insertion was performed using topical anesthesia, with or without IV sedatives. An RRCP, trained to function as an anesthesia assistant, provided monitored anesthesia care during all stages of surgery, with an anesthesiologist immediately available for consultation or assistance as required. MAIN OUTCOME MEASURES: The number of serious medical complications resulting from the anesthesia or surgery was measured. The rate of anesthesiologist intervention required at each stage of surgery--preoperative, intraoperative, and postoperative--was determined, along with the reasons for the interventions. Age, American Society of Anesthesiologists (ASA) risk class (a rating of preoperative physical status), and number of IV sedative agents given were analyzed as potential predictors of the need for anesthesiologist intervention. RESULTS: Among the 1957 cataract surgeries, there were no adverse medical events that resulted in death, hospitalization, or tracheal intubation. Two cases were aborted intraoperatively for medical reasons. A total of 78 cases (4.0%) required anesthesiologist intervention, with 34 (1.7%) requiring preoperative intervention, 43 (2.2%) requiring intraoperative intervention, and 3 (0.2%) requiring postoperative intervention; 4 cases required 2 separate interventions. The mean age of the intervention group (73.9 years) was statistically greater than that of the nonintervention group (71.0) (P = 0.02). A higher ASA rating (>2) correlated with an increased need for anesthesiologist intervention in terms of the total intervention rate (P<0.0001) and the intraoperative rate alone (P<0.0001). The use of more IV sedative agents (2 or 3 vs. 0 or 1) was marginally associated with a higher total intervention rate (P = 0.053) but not with a higher intraoperative intervention rate (P = 0.68). CONCLUSION: With the inherent safety of cataract surgery and the relatively low need for anesthesiologist intervention, we believe it is justified to allow RRCPs, trained as anesthesia assistants, to provide monitored anesthesia care during cataract surgery so long as anesthesiologist support is directly available when required. Potential benefits include cost savings in health care and decreased demand for anesthesiology services. To validate formally the preservation of patient safety from such a change in practice, however, a larger sample size would be required due to the inherently low rate of cataract surgery complications.

Adult↗
PubMed1997

Combined macular hole and cataract surgery.

PURPOSE: Cataract often develops after macular hole surgery, necessitating cataract surgery. We report a combination of macular hole surgery and cataract surgery on four eyes of four patients. METHODS: Four eyes of four patients had a full-thickness stage III or IV macular hole and some degree of cataract. Combined cataract surgery with intraocular lens implant and macular hole surgery was associated with intravitreal perfluoropropane at 15% concentration and with face-down positioning for 21 days. RESULTS: After combined cataract and macular hole surgery, the rim of subretinal fluid resolved successfully in four eyes of four patients. Twelve months after surgery, the macular hole reopened in one eye in association with the new onset of macular pucker. Best-corrected visual acuities ranged from 20/25 to 20/100 12 months after surgery, while preoperative visual acuities with best correction were 20/70 to 20/200. CONCLUSIONS: In selected cases, a combination of cataract surgery with intraocular lens implant and macular hole surgery offers advantages. This combined approach warrants consideration.

Aged↗
PubMed2003

Fungal infection of sutureless self-sealing incision for cataract surgery.

PURPOSE: To report the clinical picture and outcome of fungal infection of self-sealing wounds in cataract surgery. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seven postoperative cataract patients. METHODS: Seven consecutive patients who underwent cataract surgery in different locations in India and developed microbiologically proven fungal infection of the surgical wound were included. All were managed at a tertiary eye care center in India between May 2001 and April 2002. MAIN OUTCOME MEASURES: The data reviewed included patient age, gender, onset of symptoms after surgery, examination findings at the time of onset of symptoms and referral, laboratory workup, treatment, and outcome. The cataract surgeons involved were contacted to determine their cataract practice and to determine any possible breach in the sterile technique. RESULTS: The median interval to onset of symptoms after cataract surgery was 5.0 days (mean, 5.8 days; range, 3-9 days). The initial diagnoses at the time of onset of symptoms were keratitis (n = 3), scleritis (n = 1), and excessive anterior chamber reaction (n = 3). The last 4 patients were treated with topical and/or systemic corticosteroid therapy before referral. All cases subsequently developed deep keratitis. Specimens for microbiology workup were obtained by scrapings (n = 6), corneoscleral biopsy (n = 4), and anterior chamber paracentesis (n = 4). Organisms identified were Aspergillus flavus (n = 2), Aspergillus terreus (n = 2), Aspergillus spp. (n = 2), and Candida albicans (n = 1). The infection resolved with medical therapy in 2 cases; the final visual acuity was 20/125 in one case and 20/20 in the other case. The infection progressed to endophthalmitis in 5 eyes, resulting in complete loss of vision. The source of infection could not be identified in any case. CONCLUSIONS: Infection of self-sealing tunnel incision for cataract surgery is a diagnostic and therapeutic challenge.

Aged↗
PubMed2005

Bimanual microincisional phacoemulsification: the future of cataract surgery?

PURPOSE OF REVIEW: Bimanual microincisional cataract surgery has recently become a procedure of interest among cataract surgeons, and a number of trials have shown its potential as a minimally invasive cataract surgery. The purpose of this review is to examine the studies that have been published to date and to evaluate the potential of bimanual phacoemulsification as a method of cataract extraction. RECENT FINDINGS: Recent studies have reinforced the safety of bimanual phacoemulsification. In particular, recently published studies have focused on evaluating various phacoemulsification technologies and their safety when used in bimanual phacoemulsification. Newly developed rollable hydrophilic acrylic ThinOptX lenses have been shown to be implantable in 2.2-mm incisions safely with good visual outcomes. SUMMARY: Bimanual phacoemulsification has been a potential technique for a number of years, but only recently have the technology, software, and technique advanced sufficiently to make bimanual phacoemulsification a feasible method of cataract extraction. Although the main disadvantage to bimanual phacoemulsification remains the lack of intraocular lenses that can fit through microincisions, necessitating the enlargement of corneal wounds for intraocular lens implantation, bimanual phacoemulsification has a number of advantages over traditional small-incision phacoemulsification. Theses advantages have been a source of interest for cataract surgeons and surgical companies who are now developing technologies that will permit the performance of truly microincisional cataract surgery.

Humans↗
PubMedDate not supplied

Cataract development in the GalKO mouse.

BACKGROUND: Deletion of the gene for the enzyme alpha-(1,3) galactosyltransferase in the BalbC mouse generates the GalKO mouse, an animal which develops early bilateral cataract. The cause is not obvious. As part of studies to elucidate the mechanism involved, we have examined the rate of development and the location of opacities. METHODS: The development of cataract was monitored through daily observations on more than 200 animals from 50 litters. The first appearance of opacity was noted as well as the time at which the cataract was mature. Slitlamp photography was used to determine the location of the opacity. RESULTS: Without exception, every animal developed bilateral cataract. A white pinhead opacity was observed in one eye at an average age of 36 to 37 days and in the second eye, one to two days later. There was no apparent preference for either eye or for gender. Rapid progression to full opacities occurred, on average, within seven to eight days. Slitlamp photography revealed early nuclear and posterior cortical changes as well as fibre folds and swollen sutures. CONCLUSIONS: The GalKO mouse cataract appears to be an autosomal dominant trait. The nature and rapidity of the lens changes are indicative of severe biochemical alterations resulting in osmotic cataracts. It is possible this may be a novel cataract model.

Journal Article↗
PubMed2006

Investigation of the stability of one-piece acrylic intraocular lenses in cataract surgery and in combined vitrectomy surgery.

BACKGROUND: To compare the degrees of intraocular lens (IOL) movement between eyes that received a one-piece acrylic IOL and those that received a three-piece acrylic IOL after cataract surgery, and also among eyes that received a one-piece acrylic IOL after a combined vitrectomy surgery for cataract. METHODS: In the first study, we report on 50 patients who were implanted with a one-piece acrylic IOL in one eye and a three-piece acrylic IOL in the contralateral eye for senile cataract. In the second study, we report on 50 patients who were implanted with a one-piece acrylic IOL in combined vitrectomy surgery for cataract and retinal diseases. The degree of IOL decentration and tilt, and anterior chamber depth (ACD) were measured using Scheimpflug video photography at 1 week, 1 month, 3 months and 6 months after surgery in both the studies. The postoperative refractive status was also examined. RESULTS: The mean decentration and tilt showed no marked changes during the follow-up in eyes with either IOL implanted, and no marked differences were noted in either study throughout the follow-up. The ACD did not change after surgery with one-piece IOL implantation, for either the cataract surgery group or the combined surgery group, except for 1 week after surgery in eyes requiring gas tamponade. In contrast, marked shallowing in ACD was observed in the three-piece group after cataract surgery. The spherical equivalent did not change markedly in either study. CONCLUSIONS: The one-piece acrylic IOL was stable in the capsular bag, both horizontally and vertically, after cataract surgery, and also after combined surgery.

Acrylic Resins↗