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PubMed1993

Cataract development and outcome of surgery in bone marrow transplanted children.

Cataract development in bone marrow transplanted (BMT) patients was studied prospectively. There were 61 children, transplanted before the age of 18 years, who survived more than 1 year after transplantation. Patients transplanted for leukaemia (n = 43) were conditioned before BMT with cyclophosphamide (Cy) and total body irradiation (TBI). Patients with severe aplastic anaemia (SAA) (n = 9) only received Cy. None of the patients with SAA developed cataracts. All children with leukaemia, who were followed for at least 3 years (n = 37), developed lens posterior subcapsular cataracts (PSC). Cataract extraction was performed in 28 eyes, on average 5.1 years (range 3-9 years) after BMT. Postoperative corrected visual acuity was similar to that before BMT. The majority of cases needed laser capsulotomy within 2 years after cataract extraction. TBI seems to be the main cause for the high incidence of cataract after BMT. A relationship to steroid administration could not be proved, but a contributory effect is not excluded.

Adolescent↗
PubMed1995

Smoking of beedies and cataract: cadmium and vitamin C in the lens and blood.

Estimation of cadmium and vitamin C was performed in the blood and lens of smokers in three age groups up to a maximum age of 58, habituated to smoking a minimum of 10 beedies a day for many years, as well as those of non-smokers in the same age groups. Only nuclear cataracts with or without posterior or anterior subcapsular cataract were chosen. It was found that there was a significant accumulation of cadmium in both the blood and the lens of the smokers. Such an accumulation of cadmium might have a role in cataractogenesis in chronic smokers. In a similar experiment, with smokers and non-smokers of two age groups up to a maximum age of 40, both without cataract, increased levels of cadmium were found in the blood of smokers only, though the extent of accumulation was not as high as in chronic smokers of higher age groups. Vitamin C content of lens was on the lower side of normal in both chronic smokers of beedies in the two age groups and non-smokers with nuclear cataract with or without posterior and anterior subcapsular cataract, and there was no significant change brought about by smoking. Vitamin C levels in blood were towards the lower side of the normal in smokers and non-smokers with and without cataract.

Adult↗
PubMed1998

Prevalence of blindness and cataract surgery in Nepal.

BACKGROUND: A national eye care programme was launched in Nepal in the early 1980s. The impact of this programme on blindness and cataract surgery prevalence was evaluated in two geographic zones. METHODS: People aged 45 years and older were sampled using a stratified cluster design. Within randomly selected clusters, door to door enumeration was followed by visual acuity measurement and eye examinations at conveniently located sites. The full survey was preceded by a pilot study where operational methods were refined and quality assurance measures carried out. RESULTS: Of the 5112 enumerated individuals 90% were examined. Blindness, defined as presenting visual acuity less than 6/60 in both eyes, was found in 5.3% (95% CI 3.6, 6.8) of individuals examined, with cataract being the principal cause in at least one eye in 78% of cases. Considering both cataract operated and unoperated cataract blind cases, surgical coverage was approximately 42%. CONCLUSION: The findings suggest that blindness prevalence may have decreased slightly from that estimated in a 1981 national survey, both overall and cataract related. Similarly, cataract surgical coverage may have increased somewhat. None of these changes, however, are at statistically significant levels. Accordingly, the blindness problem remains challengingly high.

Aged↗
PubMed2000

Is cataract surgery justified in patients with age related macular degeneration? A visual function and quality of life assessment.

AIMS: To determine whether patients with age related macular degeneration (ARMD) benefit from cataract surgery in terms of visual function and quality of life measures, and to assess the impact of surgery on the progression of ARMD. METHODS: A prospective study was carried out of patients with and without ARMD undergoing cataract surgery. Data were collected from 187 patients at the Princess Alexandra Eye Pavilion, Edinburgh and the Oxford Eye Hospital, Oxford. The patients were divided into three groups: (1) a control group with ARMD and no surgery (n=41), (2) a study group of patients with ARMD who underwent cataract surgery (n=90), and (3) a second control group of patients without ocular comorbidities who underwent cataract surgery (n=56). Visual function and quality of life assessments were carried out at baseline and 3-5 months after baseline or surgery. RESULTS: There were significant improvements both in terms of quality of life and visual function measures in the study group. Benefits were greater in patients with moderate cataract irrespective of the degree of ARMD. No increased incidence in progression to the "wet" form of ARMD was found. Improvements in quality of life measures and visual function were more pronounced in patients with no ocular comorbidities. CONCLUSIONS: Patients with mild and moderate degrees of ARMD do benefit from cataract surgery and the benefits are greater in patients with moderate degrees of lens opacity. Longer follow up is required to assess the risk of increased ARMD progression.

Aged↗
PubMed2001

Results of cataract surgery in young children in east Africa.

BACKGROUND: Cataract is the leading cause of blindness in children in east Africa. The results of surgery are poor, partly because of inadequate correction of aphakia. METHODS: A retrospective survey of 118 eyes in 71 children with bilateral cataract. All eyes had implantation of an IOL at the time of cataract surgery. The average age at surgery was 3.5 years. 28 patients(39%) were less than 2 years old at the time of surgery on their first eye. RESULTS: Preoperatively, 75.4% of eyes and 76.1% of patients were blind. A follow up of at least 3 months was available in 91 (77.1%) eyes. In these eyes, 44% had a latest corrected vision of 6/18 or better and 91.2% had a latest corrected vision of 6/60 or better. Eyes with zonular cataract, and eyes operated after the age of 2 years were more likely to obtain a vision of 6/18 or better. 3.3% of eyes and 1.8% of patients had an acuity of less than 3/60. Nystagmus was present in 42.3% of patients before surgery. In those patients followed up for a minimum of 6 months, 10.2% still had nystagmus. The most frequent complication was severe fibrinous uveitis, which occurred in 36 (30.5%) eyes. 62 (52.5%) eyes had a posterior capsulotomy at the time of cataract extraction. Of the remaining 56 eyes, 20 (35.7%) had so far required a posterior capsulotomy. The leading cause of poor visual outcome was amblyopia. Two patients developed severe complications related to the intraocular lens. CONCLUSIONS: Insertion of a lens implant at the time of cataract extraction appears to be well tolerated in the short term, and may offer significant advantages in an African setting.

Amblyopia↗
PubMed2002

Eye healthcare services in eastern Europe: Part 1. Cataract surgery.

AIM: To describe cataract surgical services in 1998 in 12 eastern European countries and to identify their needs to reduce cataract blindness. METHODS: All inpatient eye departments in the 12 countries received a standardised questionnaire; the data obtained were further processed at the coordinating centre in Prague. RESULTS: All 458 eye departments in the region were involved. The response rate was 100%, except for Bulgaria (93%) and Romania (93%). The total number of cataract surgeries per one million inhabitants in 1998 was calculated: Belarus (800), Federation of Bosnia and Herzegovina (1275), Bulgaria (1730), the Czech Republic (4210), Estonia (2530), Hungary (3530), Latvia (1860), Lithuania (1550), Trans-Dniester Moldova (1300), Poland (1475), Romania (1260), and Slovakia (2430). Cataracts were mostly operated on by the extracapsular technique. Intracapsular extractions were frequently performed in Federation of Bosnia and Herzegovina (47%), Belarus (46%), Bulgaria (18%), and Romania (14.3%). Phacoemulsification was uncommonly used in 1998, except for the Czech Republic (86%), Estonia (50%), Slovakia (38%), and Hungary (16%). An IOL was implanted in more than 90% of patients in the Czech Republic, Estonia, Hungary, Latvia, Lithuania, and Slovakia. CONCLUSIONS: Conditions for cataract surgery in the eastern European region differ. The main barriers to cataract surgery were state budget limitations, insufficient supply of consumables, underutilisation of operating theatres, and poor detection of patients requiring surgery.

Aged↗
PubMed2004

The usefulness of Vistech and FACT contrast sensitivity charts for cataract and refractive surgery outcomes research.

AIM: To investigate the repeatability and sensitivity of two commonly used sine wave patch charts for contrast sensitivity (CS) measurement in cataract and refractive surgery outcomes. METHODS: The Vistech CS chart and its descendant, the Functional Acuity Contrast Test (FACT), were administered in three experiments: (1) Post-LASIK and age matched normal subjects; (2) Preoperative cataract surgery and age matched normal subjects; (3) Test-retest repeatability data in normal subjects. RESULTS: Contrast sensitivity was similar between post-LASIK and control groups and between the Vistech and FACT charts. The percentage of subjects one month post-LASIK achieving the maximum score across spatial frequencies (1.5, 3, 6, 12, 18 cycles per degree) were (50, 33, 13, 13, 0 respectively) for FACT, but only (0, 0, 13, 4, 0 respectively) for Vistech. A small number of cataract patients also registered the maximum score on the FACT, but up to 60% did not achieve the minimum score. Test-retest intraclass correlation coefficients varied from 0.28 to 0.64 for Vistech and 0.18 to 0.45 for FACT. Bland-Altman limits of agreement across spatial frequencies were between +/-0.30 and +/-0.85 logCS for Vistech, and +/-0.30 to +/-0.75 logCS for FACT. DISCUSSION: The Vistech was confirmed as providing poorly repeatable data. The FACT chart, likely because of a smaller step size, showed slightly better retest agreement. However, the reduced range of scores on the chart due to the smaller step size led to ceiling (post-LASIK) and floor (cataract) effects. These problems could mask subtle differences between groups of patients with near normal visual function as found post-refractive or cataract surgery. The Vistech and FACT CS charts are ill suited for refractive or cataract surgery outcomes research.

Adult↗
PubMed1996

Blindness due to cataract: epidemiology and prevention.

Cataract is the leading cause of blindness, accounting for 50% of blindness worldwide. Although significant progress has been made toward identifying risk factors for cataract, there is no proven primary prevention or medical treatment. Surgical removal of cataract remains the only therapy. In this paper, we reviewed (a) the prevalence and incidence data of cataract, (b) the findings on risk factors for cataract, and (c) health service utilization and outcome of cataract surgery in both developed and developing countries.

Adult↗
PubMed2003

Osteopontin: a component of matrix in capsular opacification and subcapsular cataract.

PURPOSE: To examine whether tissues of human capsular opacification and subcapsular cataract contain osteopontin, an adhesive matrix protein, and whether mouse lens epithelium expresses osteopontin after injury. METHODS: An immunohistochemical examination was conducted to determine whether matrices in human postoperative capsular specimens and anterior subcapsular cataract contain osteopontin. The spatial and temporal protein expression patterns of osteopontin were then determined in epithelium of a healing mouse lens after a capsular incision. RESULTS: Human lens epithelial cells in the specimens extracted at the time of vitrectomy 10 days after cataract surgery and also after longer healing intervals were labeled with an anti-osteopontin antibody, whereas uninjured lens epithelium was not. In the later healing phase, matrix of capsular opacification was positive for osteopontin. Lens cells amid anterior subcapsular cataract tissue were also positive. Osteopontin was detected in the cell surface and membrane and the cytoplasm of lens cells, as well as in the matrix. Unlike normal uninjured specimens, anterior lens capsule of some of the healing postoperative specimens and anterior subcapsular cataract specimens also faintly or weakly stained for osteopontin. Mouse lens epithelium started to express osteopontin protein at 8 hours after injury, before the cells changed their shape from epithelial cell type to fibroblast type. Expression of osteopontin lasted during the healing interval, even after the cells transformed into fibroblast-like cells. CONCLUSIONS: Extracellular matrix in human postoperative capsular opacification and anterior subcapsular cataract contains osteopontin. Epithelial cells of a mouse lens also ectopically express osteopontin in response to capsular injury.

Adult↗
PubMed1989

Profile of cataract patients in the Eye, Ear, Nose and Throat Hospital, Rangoon.

We report on our experience of cataract surgery in the Eye, Ear, Nose and Throat Hospital (EENTH), Rangoon. Cataract patients constituted 52% of all those admitted with eye diseases to the EENTH in a year. The mean number of cataract cases operated per month was 282. Among cataracts the senile form was the commonest. The female to male ratio for senile cataract patients was 1.2, and the average age at admission was 68 years. The mean duration of stay in hospital was 7 days with an operation time of 19 min. The patients had to come to hospital for follow-up for an average period of 3.1 months to complete treatment. The need to consider cataract surgery as an outpatient procedure is discussed.

Adolescent↗
PubMed2004

Cataract surgery with foldable intraocular lens implants in captive lowland gorillas (Gorilla gorilla gorilla).

Two juvenile, male, captive-born lowland gorillas (Gorilla gorilla gorilla) with the same father but different mothers developed bilateral cataracts. The cataracts were surgically removed within 6 yr and 3 mo, respectively, of diagnosis, and foldable intraocular lenses were implanted. Although vision was not restored in one eye with a mature, 6-yr-old cataract in gorilla A, surgical intervention on the other eye was performed before a complete cataract developed, and vision was fully restored. Gorilla B was treated at the age of 17 mo, and normal visual development proceeded in both eyes. This animal developed bilateral after-cataract and therefore needed a second intervention in both eyes using Nd:YAG laser treatment. The genetic component of juvenile cataracts should be considered in breeding management programs.

Animals↗
PubMed2000

Morphologic alterations in the anterior lens capsule of canine eyes with cataracts.

OBJECTIVE: To examine the morphologic changes in the anterior lens capsule and lens epithelium of canine eyes with cataracts. SAMPLE POPULATION: Anterior lens capsules from the eyes of 25 dogs with cataracts and from an additional 10 canine globes with lenses subjectively assessed to be normal. PROCEDURE: Thickness of each anterior lens capsule was measured by use of a digital microscopic camera and imaging software. All 25 capsules from eyes with cataracts were submitted for light microscopy; 4 were also submitted for electron microscopy. RESULTS: Thickness of the anterior lens capsule increased with age for the normal lenses and the lenses with cataracts; the change with age was similar for both groups. Light microscopy revealed fibrous metaplasia of lens epithelial cells in 7 of 25 anterior lens capsules with focal thickenings of the posterior aspect of the capsule. Electron microscopy revealed deposition of collagen and basement membrane-like material by fibroblast-like cells. CONCLUSIONS: Results indicate that thickness of the anterior lens capsule in dogs increases with age and that this increase in thickness is not significantly different between normal lenses and lenses with cataracts. In addition, epithelial cells from lenses with cataracts may undergo metaplasia to form plaques composed of fibrous tissue and ectopic basement membrane produced by epithelial cells.

Aging↗
PubMed2006

Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery.

PURPOSE: To investigate the causes and characteristics of glaucoma in children following cataract surgery. METHODS: Twenty-four patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma after cataract surgery were studied retrospectively. Variables included cataract morphology, surgical techniques, post-operative complications, time to the onset of glaucoma, gonioscopic findings, presence of microcornea and the histopathologic characteristics of the filtration angle (in one case). RESULTS: There was a bimodal onset of glaucoma after cataract surgery. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayed-onset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (p = 0.018) more likely to be due to angle closure than delayed-onset glaucoma. With delayed-onset glaucoma, the filtration angle was open in 86% of eyes and significantly (p = 0.006) more eyes in the delayed-onset group had microcornea. Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P < 0.001). CONCLUSIONS: The onset of glaucoma after cataract surgery during infancy follows a bimodal pattern that is correlated with the configuration of the filtration angle. The early-onset glaucoma group had high incidence of angle closure requiring surgical treatment, while in the delayed-onset group non-surgical treatment was sufficient to control intraocular pressure. Prophylactic iridectomy in eyes at risk for pupillary block is recommended. Eyes with delayed-onset glaucoma have open filtration angles yet also have findings of incomplete development of filtration structures. Microcornea is a risk factor for delayed-onset glaucoma.

Adolescent↗
PubMedDate not supplied

Sensory deviations subsequent to senile cataract.

PURPOSE: To evaluate the effect of extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation in patients with sensory deviations subsequent to senile cataract. METHODS: Twenty patients with dense cataract and associated sensory deviations underwent follow-up between April 1996 and April 1998 after extracapsular cataract extraction with posterior chamber IOL implantation in the deviating eye. All patients underwent follow-up for a minimum period of 6 months. RESULTS: Preoperatively, all patients had a visual acuity of PL positive (perception of light present) and PR (projection of rays) accurate in the deviating eye. Two patients had an esodeviation, and 18 patients had an exodeviation. Postoperatively, all patients had a corrected visual acuity of 20/40 or better in the operated eye at 12 weeks. Nineteen patients had ocular alignment within +/-8 prism diopters of orthophoria at 12 weeks. CONCLUSION: Sensory deviations subsequent to senile cataract usually resolve spontaneously after cataract surgery if visual gains are 20/40 or better. The prognosis for binocular vision is good.

Cataract↗
PubMedDate not supplied

Combined cataract and strabismus surgery with adjustable sutures.

BACKGROUND AND OBJECTIVE: To report the results of combined cataract and strabismus surgery using an adjustable suture technique in patients of different ages. PATIENTS AND METHODS: Twenty patients underwent combination surgery between March 1999 and January 2004. All adjustments of the muscle sutures were done 24 hours postoperatively to prevent diplopia, and topical anesthesia was used for all but 1 patient. Bilateral lateral rectus recession was performed for 5 patients; medial rectus resection and lateral rectus recession was performed for 11 patients, and medial rectus recession and lateral rectus resection was performed for 4 patients. Extracapsular cataract extraction and phacoemulsification plus intraocular lens implantation was done according to the type of cataract. RESULTS: Preoperative visual acuities ranged between 20/8000 and 20/400. Eighteen of the patients had a cataract and 2 of the patients had aphakia due to previous cataract surgery. Considerable improvement in vision was obtained in 10 patients, and a postoperative visual acuity of 20/25 was achieved in 1 patient. Deviations improved from between 30 and 45 prism diopters preoperatively to between 2 and 8 prism diopters postoperatively. CONCLUSION: Combined cataract and strabismus surgery with adjustable sutures can be an alternative to the conventional method. It is less time-consuming for both the patient and the surgeon, and provides faster cosmetic and functional rehabilitation in a single operation.

Adolescent↗
PubMed1995

Cataracts in systemic diseases and syndromes.

A comprehensive review of the ophthalmic literature on cataracts during the past year is presented. Topics covered include new epidemiologic associations, diabetic cataracts, and syndromes involving cataracts. Data from the Beaver Dam Eye Study suggest the presence of a recessive gene for nuclear sclerosis. Estrogen exposure may decrease the risk of nuclear sclerosis. The effects of amiodarone, propranolol, and lovastatin on the lens are discussed. Electron microscopy studies have furthered our understanding of diabetic cataracts and the rare Christmas tree cataract. Two new studies support the adverse effect of extracapsular cataract extraction on diabetic retinopathy. New associations between neurofibromatosis 2 and the lens will aid in the diagnosis of this condition. Other ocular and systemic syndromes are discussed.

Amiodarone↗
PubMed1997

Lensectomy-vitrectomy indications and techniques in cataract surgery.

Lensectomy-vitrectomy is the removal of the crystalline lens through a transscleral retrociliary incision (usually the pars plana) under clinical conditions in which the vitreous gel has to be partially or totally removed. It was designed in the early 1970s at the onset of modern vitreous surgery. The vitreous cutter was used to remove the lens and the vitreous (lensectomy as vitrectomy). With the development of small incision cataract surgery, foldable IOL, the term lensectomy-vitrectomy also applies to separate incisions in one procedure combining lens and vitreous surgery. With this in mind, it covers several very different situations from neonatal congenital cataracts to adult or senile-associated diseases. This type of surgery is widely accepted, and the main controversy is about the consequences of neonatal surgery and the age of IOL implantation in uni- or bilateral congenital cataracts. My personal work with laser flare and cellmetry demonstrates that pars plana vitrectomy alone creates very little trauma to the blood-aqueous barrier, as can be checked by the anterior chamber level of proteins (ie, flare). The postoperative flare in pars plana vitrectomy alone is very close to the preoperative level. Therefore, the association of pars plana vitrectomy and lens surgery should not be more traumatizing to the eye than lens surgery alone. This review will first report the consequences of neonatal lensectomy-vitrectomy to the eye. Subsequent indications for surgery and implantation will be discussed as well as special indications and complications in congenital cataracts, dislocated nucleus in cataract operation, cataract and associated vitreoretinal disorders in diabetes, and giant retinal tears and removal of the lens during vitrectomy.

Adult↗
PubMed1997

Cataract surgery in patients with uveitis.

Although cataract surgery for senile cataract is routine and easily performed, the decision to remove the cataract in a patient with a history of uveitis is considerably more complex and usually involves multiple considerations, related not only to the cause of the uveitis but also to the appropriate surgical procedures. The problems confronting the ophthalmologist caring for the patient with uveitis begin with the first visit. Establishing a diagnosis and controlling the inflammation are the critical elements in the treatment of the patient; these two factors will determine the incidence of cataract formation and other complications, the appropriate time for cataract removal, and the surgical strategy, as well as determine the visual outcome long before surgery occurs. Diagnosis, control of inflammation, preoperative management, particularities of the surgical techniques, and postoperative complications in patients with a history of uveitis have been reviewed previously in this section. Our aims in this article are to review the literature on this subject over the past year and to reemphasize the idea of a model of zero tolerance for inflammation to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision.

Cataract↗