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Exposure to allopurinol and the risk of cataract extraction in elderly patients.

OBJECTIVE: To determine whether exposure to allopurinol is associated with an increased risk of cataract extraction in elderly patients. METHODS: We conducted a case-control study using data from the Quebec universal health insurance program for all elderly patients. The 3677 cases were patients with a cataract extraction between 1992 and 1994. The 21,868 controls were randomly selected among patients not diagnosed with cataract and matched to cases on the date of the extraction. We determined the odds ratio of cataract extraction according to the cumulative dose and duration of allopurinol use relative to nonusers, using conditional logistic regression analysis. The analysis was adjusted for the effects of age, sex, diabetes mellitus, hypertension, glaucoma, and ophthalmic and oral corticosteroid exposure. RESULTS: A cumulative dose of allopurinol of more than 400 g or a duration of use of longer than 3 years were associated with an increased risk of cataract extraction, with odds ratios of 1.82 (95% confidence interval [CI], 1.18-2.80) and 1.53 (95% CI, 1.12-2.08), respectively. No increase in risk was observed for lower cumulative doses or shorter exposure periods. CONCLUSION: Long-term administration of allopurinol increases the risk of cataract extraction in elderly patients.

Aged↗

Cataract extraction after proton beam irradiation for malignant melanoma of the eye.

We evaluated visual outcome and risk of metastases in patients who underwent cataract extraction after protonbeam irradiation of a uveal melanoma. A total of 84 patients underwent cataract extraction between 2 months and 11 years after irradiation. One year after cataract extraction, approximately half of the patients had visual acuity of 20/100 or better, and approximately one third had an acuity of 20/40 or better. Larger tumor size was highly correlated with poor visual outcome 1 year after extraction. Six patients underwent enucleation after cataract removal, five due to blind, painful eyes and one due to continued growth of a previously undiagnosed ring melanoma. The rate of metastases was not higher among patients who underwent cataract extraction (adjusted rate ratio, 0.83). Results suggest that cataract extraction offers improvement of vision in selected eyes previously irradiated for a uveal melanoma, without adding to the risk of metastases among patients undergoing the procedure.

Adult↗

Preoperative functional expectations and postoperative outcomes among patients undergoing first eye cataract surgery.

OBJECTIVE: To describe the relationship between patients' preoperative expectations regarding the outcome of cataract surgery and actual postoperative experience. METHODS: A longitudinal study of 772 patients undergoing first eye cataract surgery recruited from 75 ophthalmology practices in three metropolitan areas was conducted. Prior to surgery and approximately 4 months after surgery, a detailed interview was conducted that included general and vision-specific health status measures (including the Visual Function 12-Item Scale [VF-12]), patient-reported level of trouble and satisfaction with vision, and questions addressing patients' preoperative expectations regarding the outcomes of surgery. In addition, detailed clinical data were collected preoperatively and postoperatively. A total of 552 patients had only single eye cataract surgery by 4 months postoperatively and are included in this analysis. RESULTS: Patients' preoperative expectations regarding the impact of cataract surgery were very high and were unrelated to their demographic or ocular characteristics. The preoperative VF-12 score, however, was positively correlated with expected postoperative VF-12 score (Spearman correlation, .45, P < .001). Only 61% of patients achieved or surpassed their expected level of postoperative functioning. The difference between expected and actual postoperative VF-12 scores was not associated with patients' demographic characteristics or provider-related variables. Older patients (> 75 years) and patients with ocular comorbidity had a larger difference between expected and actual postoperative functioning than younger patients and those without ocular comorbidity. CONCLUSION: Expectations regarding visual functioning after cataract surgery are very high, and in most cases such expectations are fulfilled. In selected cases, more comprehensive counseling may reduce the discrepancy between expectations and actual outcomes of cataract surgery.

Aged↗

Cataract and latitude.

For many years, it has been suggested that exposure to sunlight, particularly its ultraviolet component, may be associated with an increased risk of senile cataract. This paper addresses 1) the physical and geographic variables that affect the entry of ultraviolet light in the eye; 2) the epidemiologic evidence that associates cataract with ultraviolet light exposure; and 3) the effectiveness of personal barrier protection (i.e. sunglasses and hats) in reducing ocular exposure to ultraviolet light. The epidemiologic evidence is drawn from studies in Australia, China, Tibet, and the United States. The U.S. evidence consists of data from the Maryland Watermen study and analyses of cataract surgery under the Medicare program which provides health insurance for nearly all Americans age 65 and over (30 million) and pays for 85% of the 1.3 million cataract extractions performed annually in the U.S. Analysis of the Medicard data shown that, after controlling for age, sex, and race, and income of the population and also controlling for supply of ophthalmologists, optometrists, price of surgery and local practice costs, the strongest predictor of cataract surgery likelihood in a Medicare beneficiary is the person's latitude of residence. Latitude correlates directly with the UV-B content of sunlight, because the incident angle of the sun determines the atmospheric penetration of ultraviolet radiation. Data suggest that the probability of cataract surgery in the U.S. increases by 3% for each 1 degree decrease (i.e. more Southerly) in latitude.

Aged↗

Management and outcome of cataract surgery in ocular cicatricial pemphigoid.

BACKGROUND: Patients with ocular cicatricial pemphigoid (OCP) lose vision due to corneal disease or cataract, which may be senile, drug induced or complex. The success of cataract surgery in these patients may be limited by an increased risk of surgical complications due to difficult access and visualisation, exacerbation of the cicatrising disease following surgery or later progression of the corneal disease. We report our experience on cataract surgery in OCP. METHODS: Cataract surgery was performed on 15 eyes of 13 patients. In the pre- and postoperative examinations the stage of the condition (according Foster's classification), the degree of conjunctival hyperaemia and the visual acuity (VA) were evaluated and topical and systemic medication recorded. All procedures used a corneal incision. The technique was intracapsular (ICCE) in 1, extracapsular (ECCE) in 4 and phacoemulsification in 10 eyes. In 13 of 15 cases an intraocular lens was implanted. The unoperated fellow eyes constituted a control group. Duration of postoperative follow-up was 35.8+/-39.1 months. RESULTS: 10 of 15 eyes had stage III disease or worse before surgery. Two eyes following ECCE showed early postoperative progression of the disease. Postoperative visual acuity improved in 14 eyes by 2 or more lines. Preoperatively 5 eyes met the criteria for blind registration, whereas postoperatively all eyes achieved a VA of at least 0.1. In 6 eyes the VA was sufficient to allow driving. However, by the 22nd postoperative month progressive cicatricial and ocular surface disease resulted in a regression of the achieved visual rehabilitation in 8 eyes. CONCLUSION: OCP does not prevent successful cataract surgery if appropriate techniques are used and precautions taken. Systemic perioperative immunosuppression is necessary in patients with active conjunctival inflammation. The use of small clear corneal incision surgery is recommended to reduce the risk of an acute exacerbation of conjunctival inflammation. Although visual rehabilitation may be only temporary due to progression of the conjunctival or corneal disease in OCP, cataract surgery can provide some benefit, in severely disabled patients, without precipitating an acute exacerbation of OCP.

Aged↗

Clinical characteristics and surgical outcomes of pediatric cataract in Taiwan.

PURPOSE: To report treatment of pediatric patients with cataract, and evaluate the efficiency of different surgical interventions. METHOD: This study comprised a consecutive series of pediatric patients with congenital or developing cataract who received surgery between 1993 and 2002 at Chang Gung Memorial Hospital in Taiwan. Patients' demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. RESULTS: Three hundred and ninety-nine eyes of 246 children were included; unilateral cataract was present 21.8% of the eyes. The age at surgery was ranged from 1 to 157 months. Eyes were grouped by surgical interventions performed: Group 1 included 98 eyes that had lensectomy. Group 2 included 89 eyes that had lensectomy and secondary intraocular lens implantation. Group 3 included 212 eyes that had lensectomy with primary intraocular implantation. The mean follow up time was 41.3 months. Finally, 23.1% group 1 patients, 42.1% group 2 patients, and 63.4% group 3 patients achieved visual acuity better than 20/60 (P=0.000). Upon analysis with multifactor regression, age at onset (P=0.011) was the only significant factor related to visual outcome. Complications such as after cataract and glaucoma occurred in 21.6% and 5.8% of all patients, respectively. CONCLUSIONS: Intraocular lens implantation for children with congenital or developing cataract is an effective treatment for visual rehabilitation, even for those patients age 2 years and younger.

Adolescent↗

Risk factors for requiring cataract surgery following total body irradiation.

In order to determine the incidence of cataract surgery following total body irradiation (TBI), questionnaires were mailed to 173 surviving patients who had received single fraction TBI for haematological malignancies. All patients had undergone bone marrow transplantation at the Royal Marsden Hospital, Surrey, between 1977 and 1991. Replies were received from 135 patients (78%). Fifty-four patients had required cataract surgery. The probability of requiring surgery for cataract at 2, 5 and 10 years post TBI was 5%, 39% and 58%, respectively. No cataract surgery was performed at less than 2 years after the time of TBI, and 12 years is the longest interval, prior to surgery, recorded so far. From a number of potential risk factors, those found to predict independently for cataract surgery, and their relative risk (RR) factors, were: cranial radiotherapy preceding TBI (RR 4.2 for patients irradiated in year prior to TBI, 3.3 for others irradiated); skull dose (RR 2.3 for patients over 25 years at time of TBI); TBI dose rate (RR 2.1 for dose rate > 3.5 cGy/min). An additional 31 patients (22%) reported the presence of cataracts which had not yet required surgery.

Adult↗

Food and nutrient intake and risk of cataract.

The relationship between cataract extraction and diet was considered in a case-control study conducted in northern Italy. A total of 207 patients who had cataract extraction and 706 control subjects in a hospital for acute, nonneoplastic, nonoculistic, nondigestive tract diseases were interviewed during their hospital stay. Odds ratios (ORs) and their 95% confidence intervals (CIs), according to the intake of alcohol, coffee, tea, and cola, and frequency of intake of 34 food items and 8 micronutrients were derived from multiple logistic regression equations, including terms for age, sex, education, smoking status, body mass index, diabetes, and total calorie intake. Alcohol, coffee, decaffeinated coffee, tea, and cola intakes were not associated with cataract extraction. Among food items, reduced ORs for cataract extraction (highest tertile of intake compared to the lowest), with a significant inverse trend in risk, were found for intake of meat (OR 0.6, 95% CI 0.4 to 0.9), cheese (OR 0.7, 95% CI 0.5 to 1.0), cruciferae (OR 0.5, 95% CI 0.3 to 0.8), spinach (OR 0.6, 95% CI 0.4 to 0.9), tomatoes (OR 0.5, 95% CI 0.4 to 0.8), peppers (OR 0.7, 95% CI 0.4 to 1.1), citrus fruit (OR 0.5, 95% CI 0.2 to 1.3), and melon (OR 0.5, 95% CI 0.4 to 0.8). A significant increase in risk was found for the highest intake of butter (OR 2.8, 95% CI 1.2 to 6.4), total fat (OR 1.8, 95% CI 1.2 to 2.8), and salt (OR 2.4, 95% CI 1.4 to 4.0) compared to the lowest, and for consumption of oil other than olive oil (OR 1.6, 95% CI 1.1 to 2.2). Among micronutrients, lower ORs for cataract extraction (highest quintile of intake compared to the lowest) were found for intake of calcium (OR 0.5, 95% CI 0.3 to 0.8), folic acid (OR 0.4, 95% CI 0.2 to 0.7), and vitamin E (OR 0.5, 95% CI 0.3 to 1.0), while estimated intakes of methionine, retinol, beta-carotene, and vitamins A, C, and D were not associated. Thus, this study indicates that diet plays a considerable role in the risk of cataract extraction in this Italian population, with a protective action played by some vegetables, fruit, calcium, folic acid,and vitamin E, and an increased risk associated with elevated salt and fat intake.

Adult↗

A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal.

PURPOSE: To compare the efficacy and visual results of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery (SICS) for the treatment of cataracts in Nepal. DESIGN: Prospective, randomized comparison of 108 consecutive patients with visually significant cataracts. METHODS: settings: Outreach microsurgical eye clinic. patients: One hundred eight consecutive patients with cataracts were assigned randomly to receive either phacoemulsification or SICS. intervention Cataract surgery with implantation of intraocular lens. main outcome measures: Operative time, surgical complications, uncorrected and best-corrected visual acuity (BCVA), astigmatism, and central corneal thickness (CCT). RESULTS: Both surgical techniques achieved excellent surgical outcomes with low complication rates. On postoperative day 1, the groups had comparable uncorrected visual acuity (UCVA) (P = 0.185) and the SICS group had less corneal edema (P = 0.0039). At six months, 89% of the SICS patients had UCVA of 20/60 or better and 98% had a best-corrected visual acuity (BCVA) of 20/60 or better vs 85% of patients with UCVA of 20/60 or better and 98% of patients with BCVA of 20/60 or better at six months in the phaco group (P = 0.30). Surgical time for SICS was much shorter than that for phacoemulsification (P < .0001). CONCLUSION: Both phacoemulsification and SICS achieved excellent visual outcomes with low complication rates. SICS is significantly faster, less expensive, and less technology dependent than phacoemulsification. SICS may be the more appropriate surgical procedure for the treatment of advanced cataracts in the developing world.

Aged↗

Sleep and sleepiness 1 and 9 months after cataract surgery.

This study was undertaken to analyze sleep development in a group of patients during the first 9 months after cataract extraction. Men and women (n=407) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during two periods in 2000-2002 were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 and 9 months after the operation. The response rate was 90.8%. The mean ages of the participating men and women were 74.5 and 75.6 years, respectively. One week after cataract extraction the visual acuity in the treated eye was 0.67 (+/-0.31) in men and 0.69 (+/-0.28) in women (NS), and showed an inverse relationship to age in both men (P<0.01) and women (P<0.0001). One month after cataract extraction 28.3% of the men and 37.5% of the women experienced poor sleep, and after 9 months the figures were 15.8 and 31.4%, respectively. Frequent awakenings and difficulty in falling asleep after nocturnal awakenings improved correspondingly. Being well rested in the morning increased and daytime sleepiness decreased. The results indicate that in elderly persons with cataract sleep is improved 1 month after cataract extraction and further improvement during the first 9 months may be experienced.

Age Factors↗

The lens and cataracts.

It is conservatively estimated that some form of lens opacity is present in 5% to 7% of horses with otherwise clinically normal eyes.These opacities can range from small epicapsular remnants of the fetal vasculature to dense and extensive cataract. A cataract is defined technically as any opacity or alteration in the optical homogeneity of the lens involving one or more of the following: anterior epithelium, capsule, cortex, or nucleus. In the horse, cataracts rarely involve the entire lens structure (ie, complete cataracts) and are more usually localized to one anatomic landmark or sector of the lens. Complete cataracts are invariably associated with overt and significant visual disability. Focal or incomplete cataracts alone seldom cause any apparent visual dysfunction in affected horses,however.

Animals↗

Strabismus in senile cataract patients.

PURPOSE: We sought to determine the prevalence of strabismus among patients with senile cataract. METHODS: Forty-seven consecutive patients who were scheduled for cataract surgery underwent complete eye examinations, including ocular alignment evaluation. Twenty-four normal adults of the same age range underwent also complete eye examinations and were used as a control group. All patients of the cataract group underwent unilateral cataract surgery. The angle of strabismus was measured by the prism and cover test or prism and corneal reflex test. RESULTS: Mean preoperative deviation of the study group was 17.8 +/- 9.7 prism diopters (PD) of exophoria/tropia. In this group, 70.2% had exophoria and 27.7% had exotropia. In the control group exophoria was found in 75% of the persons whereas none of them had any heterotropia. Mean deviation in the control group was 4.7 +/- 5.1 PD of exophoria. Postoperatively, the angle of exophoria/tropia improved to 12.8 +/- 8.5 PD, which was different from the preoperative measurements (P < 0.01). In this group 78.8% had exophoria and 19.1% had exotropia. CONCLUSIONS: Patients with cataract have greater tendency to develop exotropia or exophoria than noncataract persons of the same age. Cataract surgery improves the heterophoric status of these patients.

Aged↗

Surgery in unilateral congenital cataract caused by persistent fetal vasculature or minimal fetal vascular remnants: age-related findings and management challenges.

PURPOSE: To document in detail the surgical management challenges over the wide spectrum of persistent fetal vasculature syndrome (PFVS). SETTING: Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria. METHODS: As part of an ongoing prospective clinical trial of the treatment and etiology of pediatric cataract, a subgroup of 31 children with unilateral cataract was defined. Standard surgical techniques were used based on age. Group 1 comprised infants between 0 and 1.5 years; Group 2, preschool children between 1.6 and 5.9 years; and Group 3, school-aged children between 6 and 16 years. Additional surgical procedures were used based on the degree of PFVS. RESULTS: All 31 eyes with unilateral cataract showed signs of PFVS. Characteristic features were found in 75% of eyes in Group 1, 8% of eyes in Group 2, and 67% of eyes in Group 3. Minimal fetal vascular remnants were found in 92%, 25%, and 33%, respectively. Correct diagnosis of PFVS was made preoperatively in 56% of eyes in Group 1, 8% in Group 2, and 67% in Group 3. Surgical procedures in addition to standard age-related techniques were necessary in all eyes with unilateral cataract. CONCLUSIONS: Results indicate that varying degrees of PFVS are a frequent cause of unilateral congenital cataract. Most severe cases were in infants, and preschool children were usually mildly affected. Vitreoretinal complications may lead to challenges in the surgical management in infants. In preschool children, cataract surgery must be performed in a guarded fashion because of the high risk for preexisting posterior capsule breaks due to minimal fetal vascular remnants.

Adolescent↗

Pediatric cataract surgery in Nepal.

PURPOSE: To describe the first pediatric cataract surgery case series report from Nepal. SETTING: Tilganga Eye Center, Kathmandu, Nepal. METHODS: This study comprised a consecutive series of 112 eyes of 85 children having cataract surgery with intraocular lens (IOL) implantation. General anesthesia of ketamine combined with peribulbar block was used in all patients. Patients' demographics, cataract type and presenting symptoms, surgical intervention, preoperative and postoperative visual acuities, and follow-up clinical examinations were recorded. RESULTS: Seventy-three eyes (65.2%) of 53 patients had extracapsular cataract extraction with posterior capsulotomy, anterior vitrectomy, and posterior chamber IOL implantation (ECCE+PCAP+AV+PCIOL), and 39 eyes (34.8%) of 32 patients had cataract extraction and IOL implantation with an intact posterior capsule (ECCE+PCIOL). Of all patients, the mean age at surgery was 6.2 years +/- 4.3 (SD). The median age in the ECCE+PCAP+AV+PCIOL group was 4.7 years and in the ECCE+PCIOL group, 11.0 years. The mean follow-up was 5.4 +/- 5.3 months. The most common postoperative complication in the ECCE+PCIOL group was visual axis/posterior capsule opacification, which was seen in 18 eyes (46.2%) compared to 4 eyes (5.5%) in the ECCE+PCAP+AV+PCIOL group. Visual acuity improved with surgery in both groups. The leading cause of poor outcomes was deprivation amblyopia. There were no anesthesia-related complications. CONCLUSIONS: Implantation of an IOL at the time of cataract extraction under combined systemic ketamine and peribulbar lidocaine anesthesia appeared to be well tolerated and produced significant visual improvement in pediatric patients in Nepal. Primary posterior capsulotomy and AV helped prevent visual axis opacification without a significant increase in complications.

Adolescent↗

Cataracts in children.

Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is nonprogressive, whereas lamellar cataract usually develops later and is progressive. Surgery must be performed promptly in cases with dense congenital cataract; if nystagmus has developed, the amblyopia is irreversible. A treatment regimen based on surgery within 2 months of birth combined with prompt optical correction of the aphakia and aggressive occlusion therapy with frequent follow-up has been successful in unilateral and bilateral cases. Both anterior and posterior capsulorhexes are performed in most children. Intraocular lens implantation can be performed safely in children older than 1 year. Anterior dry vitrectomy is recommended in preschool children to avoid after-cataract. Opacification of the visual axis is the most common complication of cataract surgery in children. Secondary glaucoma is the most sight-threatening complication and is common if surgery is performed early. Life-long follow-up is essential in these cases.

Amblyopia↗

Persistent fetal vasculature and minimal fetal vascular remnants: a frequent cause of unilateral congenital cataracts.

PURPOSE: To determine the significance of persistent fetal vasculature (PFV) and remnants of fetal vessels in the pathogenesis of pediatric unilateral cataracts. STUDY DESIGN: Prospective observational case series. PARTICIPANTS: Thirty-one children with unilateral cataract aged between 2 weeks and 15 years. METHODS: As part of an ongoing prospective clinical trial concerning treatment and etiology of pediatric cataracts, a subgroup of 31 children with unilateral cataracts was defined. The affected eyes received preoperative and intraoperative biomicroscopic examinations to identify characteristic features of PFV and even minimal fetal vascular remnants (MFVRs) at the level of the posterior lens capsule and anterior hyaloid face. In eyes with MFVRs, 3 different severity degrees were assumed, according to different posterior capsule abnormalities: mild, A; moderate, B; and severe, C. All observations were documented on video and analyzed in relation to age (group I, infants between 0 and 1.5 years; group II, preschool children between 1.6 and 5.9 years; group III, schoolchildren between 6 and 16 years). MAIN OUTCOME MEASURES: Frequency and morphology of characteristic features of PFV and MFVRs of the posterior lens capsule/anterior hyaloid face, lens clouding, and microphthalmos. RESULTS: All 31 eyes with unilateral congenital cataracts showed signs of PFV syndrome (100%). Characteristic features of PFV were found in 75% of group I eyes, in 8% of group II eyes, and in 67% of group III eyes. Minimal fetal vascular remnants were found in 25% of group I eyes (severity degree C in all eyes), in 92% of group II eyes (severity degree A in 36.4%, B in 27.2%, and C in 36.4%), and in 33% of group III eyes (severity degree A). Associated microphthalmos was found in all eyes in groups I and III and in 73% of group II, whereas axial lengths were equal in both eyes in 27% of group II children with MFVRs. CONCLUSIONS: Varying degrees of PFV seem to be a frequent cause of unilateral congenital cataracts. Although characteristic features of PFV occurred mainly in infants, eyes of preschool children were usually very mildly affected, showing MFVRs that were detected only by careful observation during surgery. Abnormalities of the central part of the posterior capsule, such as a translucent opacity or a lenticonic area leading to a spontaneous hole during lens aspiration, may be caused by minimal remnants of PFV.

Adolescent↗

Pars plana lensectomy and intraocular lens implantation in pediatric radiation-induced cataracts in retinoblastoma.

OBJECTIVE: To investigate visual outcomes, surgical complications, and tumor recurrence among children with retinoblastoma (RB) undergoing pars plana lensectomy, vitrectomy, and simultaneous intraocular lens insertion for radiation-related cataract secondary to external beam radiotherapy (EBRT). DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records for all patients treated with pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens implantation for radiation-induced cataract after EBRT for RB at a single institution between January 1, 1990, and December 31, 2000, were reviewed. PARTICIPANTS: The study included 16 eyes of 12 children with Reese-Ellsworth stage V RB. MAIN OUTCOME MEASURES: Visual acuity, surgical and postoperative complications, postoperative refraction, and tumor recurrence. RESULTS: The median age at diagnosis of RB was 6 months (range, 1-49 months). All patients received EBRT as primary treatment and experienced radiation-induced cataracts. The median interval from RB diagnosis to cataract surgery was 42 months (range, 28-95 months). Preoperative mean visual acuity was 20/400, with 12 of 16 eyes (75%) having macular tumor involvement. All patients underwent pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens insertion. Vitreous samples were evaluated by cytopathologic examination, and no viable tumor cells were identified in any of the vitreous specimens. Postoperative complications included transient cystoid macular edema in 5 eyes (31%) and iridocyclitis in 3 eyes (19%). The mean follow-up after cataract surgery was 66 months (range, 30-94 months). Final visual acuity was 20/40 or better in 11 of 16 eyes (69%). No late intraocular recurrence, orbital tumors, or metastatic disease was noted in this study. CONCLUSIONS: Pars plana lensectomy, vitrectomy, and simultaneous intraocular lens implantation is an effective means of managing EBRT-induced cataracts in eyes with previously treated RB. There was no evidence of active tumor in eyes undergoing surgery at least 28 months after the diagnosis and commencement of therapy for RB, and no late intraocular, orbital, or metastatic tumors were detected. Visual acuity was limited by the presence of primary macular tumor pathologic features in a subset of patients, but final vision better than 20/400 may be achieved in these eyes.

Cataract↗

Epilenticular intraocular lens implantation in traumatic cataract with a ruptured posterior capsule.

PURPOSE: To present a case of rapidly progressing traumatic cataract caused by posterior capsule rupture after nonpenetrating ocular injury, as well as a surgical procedure to safely implant the intraocular lens in such a traumatized eye. METHODS: In a 23-year-old man with traumatic cataract and posterior lens capsule rupture, a one-piece polymethylmethacrylate IOL was implanted before cataract extraction into the ciliary sulcus in front of the cataractous lens. Subsequently, the cataract was removed by pars plana lensectomy. RESULTS: The surgery and postoperative course were uneventful. Postoperative visual acuity was 20/20. CONCLUSION: We present a method of intraocular lens implantation in cases of rapidly progressing traumatic cataract caused by posterior capsule rupture after a blunt ocular trauma.

Adult↗