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PubMed2000

The Houston Vision Assessment Test (HVAT): an assessment of validity. The Cataract Outcome Study Group.

PURPOSE: Cataract surgery is one of the most successful procedures in medicine, and outcome is typically measured by a single factor - improvement in visual acuity. Health-related functional outcome testing, which quantifies the patient's self-reported perception of impairment, can be integrated with objective clinical findings. Based on the patient's self-assessed lifestyle impairment, the physician and patient together can make an informed decision on the treatment that is most likely to benefit the patient. METHOD: A functional outcome test (the Houston Vision Assessment Test - HVAT, copyrighted 1990, 1992) was evaluated in a cataract population of 149 patients from seven study centers. Test results were correlated with objective ophthalmic endpoints. The HVAT divides an estimated total impairment into subcomponents of Visual Impairment (correctable by cataract surgery) and non-visual Physical Impairments (co-morbidities not affected by cataract surgery). RESULTS: In this prospective study, the average Visual Impairment score improved by 19 points (65%) following cataract extraction (the mean HVAT Visual Impairment score was 29 points before surgery and 10 points at 5 months post-surgery, a change of 65%). Physical Impairment remained unchanged by surgery. Visual acuity was a poor predictor of Visual Impairment. CONCLUSIONS: The HVAT has 11 simple questions. It may be self-administered and is available on the Internet: http://www.DHAC.com. The physician may err if his decision in favor of cataract surgery is based only on visual acuity. The HVAT has the potential to guide the decision-making process between patient and physician.

Adult↗
PubMedDate not supplied

Retrospective comparison of surgical techniques to prevent secondary opacification in pediatric cataracts.

PURPOSE: To evaluate the effect of different surgical methods for management of the posterior capsule and anterior vitreous on the rate of posterior capsule opacification in pediatric cataracts. METHODS: Charts of 34 children (47 eyes) aged 40 days to 18 years (mean: 8.5 years) who had primary cataract surgery with or without posterior chamber intraocular lens (IOL) implantation during the past 5 years were reviewed. In 26 eyes, cataracts were managed with a posterior continuous curvilinear capsulorhexis, and in 21 eyes, the posterior capsule was left intact. Follow-up averaged 10 months (range: 6.5 months to 5 years). RESULTS: Visually significant secondary cataract developed in nine eyes with intact posterior capsules, and seven eyes required Nd:YAG laser posterior capsulotomy. The average time for YAG capsulotomy postcataract removal in the second group was 4 months. The visual axis remained clear in all eyes that had posterior continuous curvilinear capsulorhexis with or without posterior chamber IOL. Complications such as fibrinoid membrane, stromal edema, posterior synechiae, updrawn pupil, and transient glaucoma occurred in both groups at a similar rate. CONCLUSION: Primary posterior continuous curvilinear capsulorhexis is an effective method for preventing secondary cataract formation in pediatric cataracts.

Adolescent↗
PubMed2000

Visual outcome following cataract surgery in rural punjab.

In a cluster sample survey in rural areas of Punjab visual outcome after cataract surgery was assessed. Three hundred patients (428 cataract operated eyes) were included in the study from 24 sampled villages. The mean age at cataract extraction was 61.70 +/- 9.82 years. The average interval since the cataract surgery was 7.05 +/- 5.86 years (range 0.11-32 years). Of the 428 operated eyes, 72 (16.82%) were blind (VA < 3/60), 162 (37.85%) had low visual acuity (VA 3/60-< 6/18) and 194 (45.33%) eyes gained good visual acuity (VA > or = 6/18). Cataract surgery related complications were the principal causes leading to blindness in 50 of 72 eyes; these included corneal oedema, (17/72;23.3%), retinal detachment (14/72;19.4%), and aphakic glaucoma (13/72;18.05%). This study emphasizes the need to improve the qualitative aspect of cataract surgery including long-term follow up in rural India.

Aged↗
PubMed2000

[Surgical indications in coexisting cataracts and glaucoma].

Cataract surgery in glaucoma patients remains a controversial subjects. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma as well as compliance with medical treatment--surgical procedures of cataract and glaucoma--sites of the surgery--use of antifibrosis agents and surgeon's experience. As cataract extraction alone decreases the intraocular pressure in open angle glaucoma and mainly in uncomplicated closed angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery with less complications we recommended the following surgical options: Cataract extraction alone in patients with controlled open angle glaucoma and in patients with closed angle glaucoma. A two step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open angle glaucoma or mixed closed angle glaucoma. Ambulatory surgery and topical anesthesia permit a two stages surgery with less inconveniences. A combined procedure in patients with a chronic closed angle glaucoma where filtering procedure alone is associated with important complications. Actually, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure remains trabeculectomy, or the new non penetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future new surgical procedures and new safe and non toxic pharmacologic drugs which modulate wound healing could be found in order to increase the efficacity and indications of combined surgery.

Cataract↗
PubMed2003

Cataract blindness--challenges for the 21st century.

Cataract prevalence increases with age. As the world's population ages, cataract-induced visual dysfunction and blindness is on the increase. This is a significant global problem. The challenges are to prevent or delay cataract formation, and treat that which does occur. Genetic and environmental factors contribute to cataract formation. However, reducing ocular exposure to UV-B radiation and stopping smoking are the only interventions that can reduce factors that affect the risk of cataract. The cure for cataract is surgery, but this is not equally available to all, and the surgery which is available does not produce equal outcomes. Readily available surgical services capable of delivering good vision rehabilitation must be acceptable and accessible to all in need, no matter what their circumstances. To establish and sustain these services requires comprehensive strategies that go beyond a narrow focus on surgical technique. There must be changes in government priorities, population education, and an integrated approach to surgical and management training. This approach must include supply of start-up capital equipment, establishment of surgical audit, resupply of consumables, and cost-recovery mechanisms. Considerable innovation is required. Nowhere is this more evident than in the pursuit of secure funding for ongoing services.

Age Factors↗
PubMed2001

[Cataract in uveitis patients: extracapsular and intraocular posterior implantation results. A retrospective study of 14 eyes].

PURPOSE: Checking visual results and progression after cataract surgery in uveitis patients. METHODS: Fourteen eyes of 13 patients were retrospectively studied after cataract extraction from December 1993 to April 1997. We describe the surgical procedure followed by the visual outcome of cataract surgery, complications, and treatment. RESULTS: Specific uveitic syndromes were determined in eight patients. Fuchs' heterochromic iridocyclitis was the cause in three cases, ankylosing spondylitis in one case, sarcoidosis in two cases, toxoplasmosis in one case and Birdshot chorioretinopathy in one case. Phacoemulsification was performed in 10 eyes and a manual extracapsular procedure in four eyes. Posterior chamber implantation was performed in 13 cases. Final visual acuity improved in 64% cases, from 1 to 8 lines (average 3.5). Eight eyes had visual acuity worse than 5/10, attributed to posterior segment abnormalities, in particular macular edema, which is the main limiting factor of optimal visual recovery. Capsular opacification was the most frequent complication in the anterior segment. Endophthalmitis was described in one patient. CONCLUSION: Visual results of cataract surgery depend on different uveitic entities and on posterior segment abnormalities. Results are generally successful when uveitis is not severe and the posterior segment can be carefully observed after cataract surgery. Extracapsular cataract extraction and posterior chamber implantation seem to be well tolerated if inflammation is perfectly under control before surgery.

Adult↗
PubMed2001

[The therapeutic effects and postoperative complications of cataract surgery in Laiwu City].

OBJECTIVE: To decrease the prevalence of blindness and low vision in Laiwu City. METHODS: The therapeutic effects and postoperative complications of each method of cataract surgery were investigated and statistically analyzed. The cases with postoperative complications were treated after surgery. RESULTS: In the investigation, 1,274 eyes of 1,089 cases had undergone cataract surgeries, including couching for cataract, intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE) and ECCE with intraocular lens implantation. The prevalence of blindness and low vision was 4.87% and 23.70%, respectively. There were postoperative complications in 650 eyes (51.02%). They were corneal decompensation, secondary glaucoma, opacity of posterior capsuler, cystoid macular edema and retinal detachment. After treatment for the postoperative complications, the prevalence of blindness and low vision was decreased to 1.96% and 6.01%, respectively. The cases having escaped the blindness and handicap after treatment were lowest in the groups of couching and ICCE. CONCLUSIONS: The survey on the population having undergone cataract surgery in rural district is important. The postoperative complications can be treated in time and the prevalence of blindness and low vision can be decreased.

Cataract↗
PubMed1998

[Congenital cataract extraction with intraocular lens implantation in children].

OBJECTIVE: To evaluate the results of cataract extraction with intraocular lens (IOL) implantation in children. METHODS: Cataract extracapsular extraction with anterior vitrectomy and IOL implantation was performed on 104 eyes of 64 children with congenital cataract aged 1.5 - 14 years old. The visual acuity and possible complications were followed up for a mean period of 22 months. RESULTS: After operation 86.4% patients were relieved from blindness, 62.7% obtained corrected vision >or= 0.3, binocular vision and stereopsis were restored in 41.8% and 30.6% respectively. In 3 eyes secondary cataract developed and in 5 eyes slight iris capture occurred. CONCLUSIONS: Cataract extraction with anterior vitrectomy and IOL implantation is effective in pediatric cataract treatment. Most patients get remarkable improvement in visual acuity and visual function with minimal complications after surgery. The influence factors on the postoperative visual function need further study.

Adolescent↗
PubMed2002

[Intumescent cataract with ocular hypertony].

INTRODUCTION: Intumescent cataract with ocular hypertony is a medicosurgical emergency. The purpose of our study is to define the clinical and therapeutic particularities of these cataracts. MATERIAL AND METHODS: This retrospective study includes 40 consecutive patients with angle closure secondary to intumescent cataract. All patients were examined between 1st January 1998 and 30 October 2000. RESULTS: The patient population consisted of 28 women (70%) and 12 men ranging in age from 59 to 88 years (mean age: 78 years). Preoperative visual acuity was negative in 17% of cases and limited to light perception in 83% of cases. Ocular pressure varied from 25 to 68 mmHg. Patients underwent surgery one to 23 days after diagnosis. Surgical techniques consisted in extracapsular cataract extraction with (35%) and without (65%) intraocular lens. Preoperative complications were: vitreous loss in 20% of cases and expulsive haemorrhage in 2 cases (5%). Postoperative visual acuity improved in 70% of cases. COMMENT AND CONCLUSION: Intumescent cataract with ocular overpressure gives therapeutic problems, which can be prevented by a preoperative hypotony. Functional results of this study encouraged us to operate the intumescent cataract even if visual acuity is bad.

Aged↗
PubMed2003

Phacoemulsification in subluxated cataract.

PURPOSE: To evaluate the outcome of phacoemulsification in eyes with subluxated cataract. MATERIALS AND METHODS: This retrospective study comprised 22 eyes of 20 consecutive patients with subluxated cataracts of varying aetiology operated between March 1998 and March 2001. Detailed preoperative assessment included visual acuity (VA), slitlamp examination, presence of vitreous in anterior chamber extent of subluxation, intraocular pressure (IOP) and detailed fundus examination. Phacoemulsification was done to retain the natural bag support and all patients had acrylic foldable Acrysof IOL implantation either in-the-bag or by scleral fixation. Postoperative observations included best-corrected visual acuity (BCVA), IOP, pupillary reaction and the IOL position. RESULTS: The aetiology of the subluxation was traumatic in 11 patients and non-traumatic in 9 patients. Fifteen were males and 5 were females. Mean follow-up was 11.7 +/- 9.71 months (range 4-39). The average age was 39.15 +/- 16.33 (range 5-74). A 2-port anterior chamber vitrectomy was performed in 6 eyes (27.2%). Capsule tension ring (CTR) was implanted in 15 eyes (68.18%). Twelve eyes (54.5%) had in-the-bag implants, while 5 (22.72%) had scleral fixation. The remaining 5 eyes (22.72%) had one haptic in-the-bag and another sutured to sclera. No major intraoperative complications were noted. Twelve eyes (54.5%) had clinically and geometrically well centered IOLs while 9 eyes (40.9%) had geometrically decentered IOLs. One patient was lost to follow-up. Fifteen eyes (55.55%) had postoperative BCVA of 6/12 - 6/6 while 2 eyes (7.40%) had BCVA of 6/18. The remaining 4 eyes (14.81%) had less than 6/24 BCVA due to pre-existing posterior segment pathology. Postoperative complications included rise in IOP in 1 eye (4.54%), pupillary capture of the IOL optic in 2 eyes (9.09%); the same 2 eyes (9.09%) required redialing of IOL. One eye (4.54%) had to undergo refixation (one haptic was fixed to sclera) year after cataract surgery. Postoperative retinal detachment was noticed in one patient after a month of phacoemulsification. CONCLUSION: In subluxated cataracts it is essential to have appropriate parameters depending on the grade of cataract. This contributes to a safe and predictable outcome in subluxated cataract surgery.

Adolescent↗
PubMedDate not supplied

Visual outcome with +10 diopter sphere correction after intracapsular cataract extraction.

BACKGROUND: The aim of curing cataract blindness is to restore the patient's vision after surgery. The aim of the study was to determine the proportion of surgeries done for cataract blind patients and the visual outcome with +10 diopter sphere (DS) aphakic correction in two consecutive years. METHODS: Of the cataract operations done in the years 1995 and 1996, 8-15 cases were selected from each month by proportionate simple random sampling. Thirty-two (32) were excluded for incomplete or missing records. One hundred and eighteen (118) and one hundred (100) patient records were analyzed for 1995 and 1996 respectively. RESULTS: The patients' ages ranged from 40 to 80 years and all had age related cataract. There were 161 males and 57 females. All had intracapsular cataract extraction (ICCE) without intraocular lens implantation. Eighty-nine patients (75%) and seventy-six patients (76%) had their sight restored in 1995 and 1996 respectively. The proportion of surgeries on blind patients' was 31% and 42% respectively. The proportion of those who remained blind after surgery was the same for both years (2%). Using chi-square test, there was a statistically significant difference in the patients' vision status after ICCE with +10 DS correction (1995, p = 0.021; 1996, p = 0.017) but no difference in the visual outcome due to gender. [1995, p = 2.09; 1996, p = 1.98 (Yates correction applied)] [corrected]. CONCLUSION: Intracapsular cataract extraction with +10 DS correction improves the patients vision status and priority must be given to those already blind.

Adult↗
PubMed2003

[The pseudoexfoliative syndrome and its significance in cataract surgery].

OBJECTIVE: To find out factors or combinations of factors leading to increased occurrence of complications in operation on cataract in patients with pseudoexfoliative syndrome. SETTING: Eye Clinic SPAM, Bratislava. METHODS: Prospective non-randomized study in 2916 patient of different age and sex, followed for 6 months after the operation on cataract. The standardized operation protocol was used. Complications were followed during and after the operation in view of released supporting apparatus, loss of vitreous body, uveal reaction and the occurrence of secondary cataract. RESULTS: PEX occurred in 2.98% of the surgically treated patients of the group, most often in the age group of 75-84 years. The occurrence was independent of sex, but increased with age. There was not any relation between age and the type of cataract, incidence of complications, inflammatory reaction, and width of pupil, endo-telepathy and glaucoma. The incidence of per-operation complications in 13.7% is directly related to the syndrome, a narrow pupil, disorder of supporting (suspension) apparatus and worse visual acuity. From the 34 patients with PEX and increased inflammatory reaction, 22.9% suffered from secondary cataract after 6 months. A relationship between width of the pupil, time factor, hardness of cornea and the incidence of inflammatory reaction was demonstrated in 24.1%. CONCLUSION: PEX itself is the source of most severe complications in operation on cataract. The patients should be in dispensary care and operated on in time by an experience surgeon.

Aged↗
PubMed1992

[Cataract operations and implantation of intraocular lenses in children and adolescents].

The authors are presenting the results of 60 cataract operations performed in 54 patients younger then 18 years. Traumatic cataract was operated in 33 patient (29 boys, 4 girls), congenital cataract in 19 eyes and complicated cataract in 8 eyes. The visual acuity 0.5 and better was gained in 40% of the eyes in which it was possible to find out the visual acuity. This visual acuity was achieved in 50% of 19 patients with IOL implantation (the youngest was 4 years old). The visual acuity was 0.5 and better in 75% of 12 patients regularly wearing contact lens. The worse results were in patients with congenital cataract-just one eye from 10, in which the visual acuity was possible to evaluate, had the visual acuity 0.5. In one case it was necessary to replace the luxated posterior chamber IOL. The IOL implantation in children, especially in those with traumatic cataract, is becoming more frequent.

Cataract↗
PubMed2003

Changes of visual function and visual ability in daily life following cataract surgery.

PURPOSE: To examine best corrected visual acuity (BCVA), contrast sensitivity (CS) and functional visual complaints in early cataract and after the cataract surgery. PATIENTS AND METHODS: 53 eyes with early cataract (BCVA 20/30: Snellen charts) were examined before the surgery as well as 12 months after the surgery. BCVA was tested using logMAR chart. CS was examined using VCTS chart in 6 spatial frequencies. Influence of glare was tested using BAT. Patients' subjective visual functions were evaluted using a questionnaire (distance vision, near vision, mesopic vision and glare conditions). 22 subjects were examined as control group. RESULTS: BCVA was 0.52 (0.22-1.05) preoperatively and 0.83 (0.37-1.26) postoperatively. BCVA in patients in both terms was significantly lower compared to the control group. CS in patients before surgery was significantly lower compared to controls, postoperatively improved significantly and was only nonsignificantly lower compared to controls except for the highest spatial frequency. Glare had only nonsignificant influence. The questionnaire scores were correlated with visual performance in both terms. CONCLUSIONS: The significant improvement of both BCVA and CS suggest that cataract surgery improves quality of life in early cataract. Questionnaire should be considered as adjuncts to BCVA and CS in evaluating early cataract.

Adult↗
PubMed1992

A prospective study of cigarette smoking and risk of cataract surgery in women.

OBJECTIVE: To examine prospectively the association between cigarette smoking and the risk of cataract extraction in women. DESIGN: Prospective cohort study beginning in 1980 with 8 years of follow-up. SETTING: United States, multistate. PARTICIPANTS: Registered nurses 45 to 67 years of age and free of diagnosed cancer. There were 50,828 women included in 1980 and others were added as they became 45 years of age. MAIN OUTCOME MEASURE: Incidence of senile cataract extraction. RESULTS: We documented 493 incident senile cataracts diagnosed and extracted during 470,302 person-years of follow-up. The age-adjusted relative risk (RR) among women who smoked at least 65 pack-years was 1.63 (95% confidence interval [Cl], 1.18 to 2.26; P for trend, .02). A similar increase in RR was noted when smoking was assessed in terms of number of cigarettes currently smoked or number of cigarettes smoked by past smokers. Results were also similar after adjusting for other potential risk factors for cataract. Smoking was also strongly associated with posterior subcapsular cataract specifically (RR, 2.59; 95% Cl, 1.49 to 4.50 for greater than or equal to 65-pack-year smokers relative to nonsmokers. CONCLUSION: Smoking appears to increase the risk of cataract extraction.

Aged↗
PubMed2004

Glaucoma in aphakia and pseudophakia after congenital cataract surgery.

Glaucoma is one of the most common causes of visual loss despite successful congenital cataract surgery. The overall incidence does not appear to have decreased with modern microsurgical techniques. The onset of glaucoma may be acute or insidious and notoriously refractory to treatment. Angle closure glaucoma may occur in the early postoperative period; but the most common type of glaucoma to develop after congenital cataract surgery is open angle glaucoma. Several risk factors have been identified and both chemical and mechanical theories have been proposed for its pathogenesis. Unlike children with congenital glaucoma, those with paediatric glaucoma following congenital cataract surgery are usually asymptomatic despite high intraocular pressure. They may require regular evaluation under anaesthesia, whenever there are any suspicious findings. Unlike congenital glaucoma, the first line of treatment for glaucoma in aphakia/pseudophakia may be medical. Traditional trabeculectomy in paediatric glaucoma following congenital cataract surgery has met with limited success. The addition of antimetabolites to trabeculectomy is known to inhibit fibrosis and enhance the success, but carries the lifelong risk of bleb-related endophthalmitis. Drainage implant surgery is a viable option to achieve longterm intraocular pressure control in this refractory group of patients. Cycloablative procedures may provide temporising treatment and should be reserved for patients with low visual potential. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. Further research is needed to understand the pathophysiology, prevention and treatment of this sight-threatening complication following successful cataract surgery in children.

Aphakia, Postcataract↗
PubMed2005

[The influrence of visual acuity and contrast sensitivity on subjective evaluation of visual function before and after cataract surgery].

PURPOSE: To assess the influence of visual acuity and contrast sensitivity on subjective evaluation of visual function investigated by means of questionnaires in patients before and after cataract surgery. METHODS: Visual acuity was tested on Snellen projection optotypes and logMAR optotype chart with Landolt rings, contrast sensitivity was tested on Pelli-Robson chart. The questionnaire included Visual Functioning Index VF-14, Cataract Symptom Score and Global Measures of Vision--self-reported trouble and satisfaction with vision. 37 cataract patients were examined, including completing the questionnaire, 1 day before and 7 weeks after the surgery. RESULTS: Most patients (65%) suffer from moderate troubles with their vision and are moderately dissatisfied (51%) before cataract surgery. After the surgery, a majority of patients have no troubles (51%) and are very satisfied (54%). Visual acuity (VA) correlates only with VF-14, namely only VA of non-operated eye (p < 0.01), binocular VA before (p < 0.001) and after surgery (p < 0.05). Contrast sensitivity (of non-operated eye, operated eye, binocular) correlates with more subjective parameters (VF-14, self-reported trouble and satisfaction with vision), namely both before and after the surgery (p < 0.05, p < 0.01, p < 0.001). CONCLUSION: After cataract surgery, visual acuity, contrast sensitivity and subjective parameters of visual functions significantly improve. Subjective parameters correlate more with contrast sensitivity then with visual acuity. Contrast sensitivity is more related than visual acuity to real world in patients with cataract.

Aged↗
PubMed2005

Surgical treatment outcomes of congenital and juvenile cataracts.

PURPOSE: Evaluation of visual outcome after lens aspiration with or without intraocular lens implantation for isolated congenital and juvenile cataract in children aged 6 years and younger. MATERIAL AND METHODS: Retrospective review of 48 children with isolated congenital and juvenile cataract who were surgically treated between January 1993 and December 2002 and had a minimal follow-up of 12 months. RESULTS: In the group of children with unilateral cataract, 33% (3 out of 9 children) of aphakic children and 45.5% (5 out of 11 children) of pseudophakic children attained a final best corrected visual acuity of 20/200 and 20/60 respectively. In the group of children with bilateral involvement, 35% (6 out of 17 children) of aphakic children have a final best corrected visual acuity of 20/30 and 63.7% (7 out of 11 children) of pseudophakic children have a final best corrected visual acuity of 20/25 or more. CONCLUSION: The results of this study emphasize the need for early surgery and good organisation of postsurgical care in patients with pediatric cataract to optimise visual outcome. Furthermore patients with isolated unilateral congenital cataract surgically treated at an average age of 15 months without primary lens implantation and with variable and low compliance have suboptimal results. The effect of early surgery with primary lens implantation on the long term visual outcome in pediatric cataract needs to be further evaluated.

Anti-Bacterial Agents↗