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PubMed2005

Surgical technique and postoperative complications in congenital cataract surgery.

BACKGROUND: We evaluated cases that underwent congenital cataract surgery in terms of the surgical technique, post-operative complications, and visual prognosis. MATERIAL/METHODS: We retrospectively evaluated 132 eyes in 76 patients with congenital cataracts who underwent cataract surgery between January 1995 and December 2000. The patient age at surgery, surgical technique, post-operative complications, and final visual prognosis were evaluated. RESULTS: Thirty eyes underwent aspiration, posterior capsulotomy, and intraocular lens (IOL) implantation; 22 eyes underwent aspiration and posterior capsulotomy; 39 eyes underwent aspiration, posterior capsulotomy, and anterior vitrectomy; and 41 eyes underwent aspiration, posterior capsulotomy, anterior vitrectomy, and IOL implantation. The most frequent complications were secondary cataract (24.2%), posterior synechiae (9.1%), and glaucoma (3%). Groups were compared according to surgical technique and incidence of complications. Complications occurred most frequently with aspiration and posterior capsulotomy and occurred less frequently with aspiration, posterior capsulotomy, and anterior vitrectomy; these differences were statistically significant (p<0.05). The difference in the final visual prognosis was statistically significant in the aspiration, posterior capsulotomy, anterior vitrectomy, and IOL implantation groups as compared with the other groups (p<0.05). The mean follow up times was 15.5+/-1.78 months. CONCLUSIONS: The most frequent complication of congenital cataract surgery is secondary cataract formation. Today, posterior capsulotomy with anterior vitrectomy is the preferred method for decreasing the incidence of this complication.

Adolescent↗
PubMed2005

[Traumatic cataract: clinical and therapeutic aspects].

PURPOSE: To assess clinical and therapeutic outcomes in traumatic cataracts. METHODS: Retrospective study of 20 cases of traumatic cataracts seen between 2001 and 2004. Mean age at diagnosis was 35 years (5-72 yr), 25% were infants. There were 11 women and 9 men. Extracapsular cataract extraction was performed in eighteen patients (90% of cases), 13 were implanted in posterior chamber, 3 having zonular rupture were implanted in anterior chamber. Two patients remained aphakic because of retinal lesions. Two patients with lens subluxation underwent intracapsular cataract extraction with anterior chamber implantation. The mean delay of surgery was 4 weeks. RESULTS: Overall satisfactory with 55% of final visual acuity more than 1/10. Visual acuity was better in implanted eyes, poorer in infants and after ocular perforation. Fibrinous uveitis was the common early postoperative complication especially in children. CONCLUSION: The majority of eyes with traumatic cataract could be safely rehabilitated after surgery and lensimplantation. In traumatic cataract, the vision can be severely threatened, preventive methods should be encouraged.

Adolescent↗
PubMed2005

[Cataract in Burkina Faso: factors of choice between modern and traditional surgical procedures].

Despite advances in cataract surgery, many peoples in the Sub-Saharan region are still treated by the traditional lens couching technique. The purpose of this study is to investigate the factors leading to the choice of lens couching for cataract treatment. A total 34 patients (40 eyes) from the northern Burkina Faso who underwent lens couching were examined and interviewed. Most patients (56%) did not understand the etiology of cataracts and attributed the disease to fate. Nor did they know of any other cataract treatment than lens couching. Only 13 patients (38.2%) would recommend modern cataract treatment and 52% suggested that health workers should come out into the villages and operate as traditional healers do. In spite of its potentially dramatic complications, lens couching is still the only method of cataract treatment known in some communities of Burkina Faso. Public information campaigns are needed to put an end to the ancestral practice of lens couching.

Aged↗
PubMed2006

[Pseudoexfoliation syndrome in Moroccan patients with cataract scheduled for sugery].

PURPOSE: To evaluate the prevalence of pseudoexfoliation syndrome (PES) in Moroccan patients with age-related cataract scheduled for surgery. PATIENTS AND METHODS: In a retrospective study, 837 consecutive eyes with age-related cataract scheduled for surgery were evaluated for the prevalence of PES, type of cataract, intraocular pressure (IOP) and operative complications. RESULTS: Exfoliation material was detected in 82 patients (9.8 %). The mean age was 69.3 years with no sex predilection. The condition was unilateral in 44 cases (53.7%) and bilateral in 38 cases (46.3%). The prevalence of PES increased with age (p=0.02). Patients with hypermature cataract had significantly more PES (p <0.001). Mean IOP was significantly higher in eyes with PES (17.7 +/- 6.4 mmHg) than those without PES (14.3 +/- 2.9 mmHg) (p<0.001). Operative complications occurred more frequently in patients with PES: 14 (17 %) than in those without PES: 58 (6.9 %). DISCUSSION: PES is a generalized degenerative fibrillopathy bound to age. The ethiopathogeny remains even unknown. The epidemiological data concerning the prevalence of the SPE in the African populations are scarce, and have not been published in Morocco, what motivated this study. Our study shows that this syndrome is common in Moroccan patients scheduled for cataract surgery with a prevalence of 9.8%. Its presence constitutes an important risk factor of primary open-angle glaucoma, and exposes more to peroperative complications at the time of surgery of cataract, independently of the technique used. CONCLUSION: There is great variation in the prevalence of PES among people of different regions and ethnic groups, although many factors interfere in the comparative analysis of results, hence the interest to achieve other complementary epidemiological studies.

Aged↗
PubMed1990

[The role of biogeochemical factors in the pathogenesis of age-related cataract].

The paper describes results of comparative analysis of the incidence of senile cataract in the siliceous and control subregions of the Chuvash ASSR biosphere. Primary morbidity per 10,000 population according to addresses, the number of cataract extractions per 10,000 population, the detection of cataract in active examination of rural population, the incidence of cataract among primary pathology of the eye were used as criteria for the assessment. Besides this, some indices of metabolic processes were studied in practically healthy persons inhabiting these subregions. It was found that the incidence of cataract is twice higher in the siliceous than in the control subregion. The character of lens opacification in the subjects with initial cataract from the siliceous subregion is characterized by predominance of cortical changes, while from the control subregion--by nucleic changes. Among the population of the siliceous subregion, changes in the state of biochemical processes in the body are recorded.

Age Factors↗
PubMed1989

Quantitative evaluation of electroretinogram before cataract surgery.

The ERGs (electroretinogram) of dense mature cataractous eyes were compared with those of the fellow eyes with good visual acuity in 22 senile patients who showed normal preoperative ERG. The mean amplitudes of the a- and b-waves were slightly reduced in the cataractous eyes as compared to those of the fellow eyes, but the difference was not significant. The light-absorbing effect of the cataract based on the a- and b-wave amplitudes was 0.5 log units. Another group of 13 eyes with senile mature cataract showed abnormal preoperative ERG. Chorioretinal atrophy was the most common cause of the subnormal ERG. Postoperative visual acuity was lower in cataractous eyes with subnormal ERGs than in eyes with normal ERGs. Despite the fact that it does not always reflect the macular function and the visual pathway, the ERG still remains a reliable guide in evaluating the visual prognosis before cataract surgery.

Aged↗
PubMed1989

[An improvement in the technic and results of phacoemulsification of congenital cataracts in children].

In 163 children (256 eyes), aged from 3 months to 14 years, with different clinical forms of bilateral and monolateral congenital cataracts surgical interventions were used. A new method of extracapsular cataract extraction is described: as a retractor and protector of the iris in the performance of the operation, a formed flap of the anterior lens capsule is used. The proposed method provides conditions for maximum and atraumatic removal of masses from the upper segment of the lens capsule, lowers the risk of the opening of the posterior capsule, prolapse of the vitreous body and prevents traumatizing of the iris. Optical results depended on the kind of cataract and the presence of associated pathology. Visual acuity of 0.3-1.0 was achieved in 37.1%-46.4% in zonular cataracts and in 21.7%-22.2% in total cataract. In case of atypical congenital forms of cataract it was, as a rule, not higher than 0.2.

Adolescent↗
PubMedDate not supplied

[NMR study of the state of water in the human lens during cataract development].

Water proton spin-spin relaxation times (T2) and the content of bound, "non-freezable" at -9 degrees C water in both normal human lenses and human lenses of different stages of cataract progression (cataracta incipiens, nondum matura, mature hypermatura) were measured by NMR spin echoes method. By the stage of cataracta nondum matura, increase of bound water content and simultaneous, almost half decrease of the relaxation time (T2), were observed. However, on the following stages of cataract evaluation (almost mature, mature cataracts) a gradual decrease of bound water content is noted, but only for the mature cataract stage the water content significantly differs from that of the normal one. On the stage of hypermature cataract the presence of two unexchanged with each other fractions of water is found. The obtained data are explained by lens protein reconstructions during the cataract progression.

Body Water↗
PubMed1980

Combined trabeculectomy and cataract extraction. Advantages of a modified technique and review of current literature.

The management of eyes with both cataract and glaucoma is reviewed. An argument is made for the use of combined cataract and glaucoma surgery as the initial procedure in eyes that have glaucoma, regardless of preoperative control, with cataract which requires removal. The combined operation is also recommended in eyes that require glaucoma surgery and have significant cataract (i.e. visual acuity of 6/12 or reading 6 pt print). A comparison of the results of a modified combined procedure with those of an initial cataract or glaucoma procedure followed by a second procedure at a later date and with those of previous combined procedures demonstrates the advantages of the former. The combined trabeculectomy and cataract extraction is modified by the use of a fornix-based conjunctival flap and by tightly suturing the lamellar trabeculectomy scleral flap to its base. The advantage of this technique is that a 3 1/2-year follow-up demonstrates a lower risk of postoperative complications compared with combined trabeculectomy with a loosely-sutured or unsutured scleral flap which has the same risk of postoperative complications, including shallow or flat anterior chamber, as do combined classical filtering procedures (thermal sclerostomy, trephination, sclerectomy, iridencleisis). We have reviewed 46 eyes operated by this technique and followed them for an average of 3 1/2 years. In 44 eyes the postoperative intraocular pressure is well controlled and the visual fields remain stable.

Cataract↗
PubMed1995

Delayed visual evoked potentials in adults after monocular visual deprivation by a dense cataract.

PURPOSE: To study the effect of monocular visual deprivation caused by dense unilateral cataracts in adults. METHODS: Visual evoked potentials have been recorded in 11 patients after removal of a dense unilateral cataract acquired in adulthood. These were compared with those from 8 control patients after removal of a mild lens opacity. RESULTS: Visual evoked potentials recorded on the first day after removal of a longstanding, dense, unilateral cataract showed a marked delay to stimulation of the operated eye compared to the unoperated eye. No delay was found in the operated or unoperated eye of control patients. Delays in the visual evoked potential returned to normal within approximately 3 months after surgery, with the exception of the two patients with the most longstanding cataracts in whom the delays persisted much longer. CONCLUSIONS: The adult central visual system is sensitive to visual deprivation caused by a longstanding, dense, unilateral cataract. The changes found may be important in understanding the causes of intractable diplopia, which sometimes occurs after the removal of such cataracts.

Adult↗
PubMed1994

[Establishment of a primary eye care network and creation of a cataract-free zone in Shunyi County of Beijing].

Based on the epidemiological survey of eye diseases in 1985, a primary eye care network was established in Shunyi County of Beijing in 1987. Cataract surgery was the primary measure for the prevention of blindness, with the aim of creating a cataract-free zone in the county. The activities included (1) establishment of a County Guiding Committee for the prevention of blindness; (2) establishment of a 3-levelled primary eye care network and a referral and monitor system; (3) training of 7 ophthalmologists, 449 eye care workers and 6 optometrists; (4) extensive publicity of knowledge for the prevention of blindness; (5) screening of low vision and blindness in which 815 cataract blind patients were identified; and (6) conducting benefit ophthalmic counselling services. Up to December, 1991, 667 cataract operations were performed, representing 81.84% of the total cataract blind, to meet the qualifications of a cataract-free zone. 90.64% of the blind were restored sight and 59.16% of the blind were able to resume work. Operative infection occurred in none and 97.42% of the operations had no complication.

Aged↗
PubMed1993

Incidence of cataracts after single fraction total body irradiation: the role of steroids and graft versus host disease.

Eighty-eight patients who received single fraction total body irradiation (sfTBI) as part of their conditioning for allogeneic BMT have been evaluated for the risk of cataract formation. Thirty-eight (43%) have developed cataracts; 11 required surgery. With 9.5-13.6 years follow-up (median 10.7 years), all 12 recipients of unmanipulated marrow allografts have developed cataracts; the actuarial risk of needing surgery was 32 (+/- 18%, 95% confidence intervals (CI)). Ten of these 12 required high-dose steroids (prednisolone > 1 mg/kg/day) for the treatment of GVHD. Seventy-six patients received T cell-depleted allografts; 14 of 76 required post-transplant immunosuppression with high-dose steroids. With 1-9.4 years follow-up (median 5 years), the actuarial risk of cataract formation in T cell-depleted allograft recipients is 72% (+/- 52% CI), the actuarial risk for needing surgery is 20% (+/- 9% CI). Recipients of sfTBI and non-T cell-depleted allografts had a significantly greater risk of developing cataracts (p = 0.003, long rank test) and of needing surgery (p < 0.05, log rank test) than patients receiving T cell-depleted BM. Cataracts occurred more frequently in patients requiring post-transplant immunosuppression with steroids (relative risk 2.12, p < 0.01 log rank test).

Adolescent↗
PubMed1994

Influence of systemic diseases and environmental factors on age at appearance, location and type of acquired cataract.

We studied 257 patients scheduled for cataract surgery for possible correlation with systemic diseases, blood chemistry, and environmental exposure. We found that posterior subcapsular cataract appeared in patients 10 years younger on average than those with other types of cataract. Nuclear cataract patients had higher blood levels of uric acid and creatinine and lower blood levels of calcium. We suggest capsular insult as a possible pathophysiological explanation for cataract formation in young age groups (as well as diabetes) and a toxic effect of blood metabolites in patients with renal failure, resulting in earlier and more prevalent sclerosis of lens fibers. No effect of smoking or of exposure to sunlight on the distribution of various types of cataracts was noted.

Age Factors↗
PubMedDate not supplied

[Strategies to control cataracts].

Cataracts, often associated with aging (80%), are a major cause of blindness (more than 50% of cases of blindness in Africa), and for this reason, up to 80% of cases could be predicted or prevented. The socio-economic costs (care and loss of productivity) are increased by morbidity (blindness, impaired vision, congenital, complicated or infected cataracts). The biological determinants of cataracts account for the difficulties in developing and implementing effective preventive action. These epidemiological determinants (prevalence, incidence, increase in life expectancy) account for the size of the public health problem. The surgical removal of cataracts in Africa currently only deals with about 1% of the prevalence rate or 10% of the incidence. Cataracts are, however, easy to cure, resulting in great benefits to public health. The waiting list for cataract operations is very short because of social and cultural barriers which limit the acceptability and accessibility of treatment. Rather than formalizing the dogmatic choices of surgical techniques and structures (fixed, mobile, advanced?), we should promote all phases of treatment from active screening and the selection of cases for surgery to the follow-up of interventions and their impact. We should also increase public awareness, develop a system for the transfer of information that is effective and improve the cost-effectiveness and capacity of the region to provide high quality services on a large scale. We must promote patient satisfaction at all stages of treatment: its quality, its delivery and its low cost.

Africa↗
PubMed1998

Cataract surgery in Zimbabwe: the way forward.

The adoption of extracapsular cataract extraction and implant surgery as the standard method of managing senile cataracts in Zimbabwe has been hindered by several factors. These are; succumbing to pressure from promoters of intracapsular cataract surgery, inadequate human and material resources and the problems related to implementation. The problems with intracapsular cataract surgery and aphakic correction are well known. Practical methods of reducing the cost of extracapsular cataract extraction and implant surgery have been suggested. Considering the infrastructure and expertise currently available, coupled with the adoption of some of the cost cutting measures suggested, Zimbabwean ophthalmologists have the potential of providing high quality cataract surgery by international standards to the public without reservations.

Cataract↗
PubMedDate not supplied

[Secondary cataracts in extreme myopia].

INTRODUCTION: After cataract surgery there is a higher incidence of posterior capsular opacification (secondary cataract) in myopia than in normal population, and it varies from 40 to 60% [1, 2]. METHODS: Fifty myopic eyes operated for cataract at Prof. Dr. Ivan Stankovitsh Eye Department from 1988 to 1995 were examined for capsular opacification (secondary cataract). Extracapsular cataract extraction was performed in all patients and in 32 patients the posterior intraocular lens was placed. Capsular opacification was classified by type and treated with Nd:YAG laser or discussion at least 9 months to 3 years and 3 months from the operation. RESULTS: There were 13 secondary cataracts (26%) in our series of patients, of whom 22% with intraocular lenses, and 33% were aphakic patients. Visual acuity was 4/60 to 0.5. In 11 patients YAG-laser capsulotomy was performed and in one patient capsular discussion, and in one subject there was no treatment. Consequent visual acuity was 0.3 to 1.0. No correlation was found between the age, type of intraocular lens and capsular opacification. DISCUSSION: Capsular opacification is more often seen in myopic eyes and its treatment is associated with a higher rate of complications (cystoid macular oedema, rupture of anterior hyaloid, retinal detachment...) [3, 4]. It seems that posterior lens implants reduce the chance for development of posterior capsular opacification. The safest treatment is YAG-laser capsulotomy.

Adult↗
PubMed1999

Small incision cataract surgery and placement of posterior chamber intraocular lenses in patients with diabetic retinopathy.

BACKGROUND AND OBJECTIVE: Diabetic patients undergoing cataract surgery have been demonstrated to have a guarded prognosis. Small incision cataract surgery has been postulated to cause fewer complications than other techniques of cataract extraction. We looked at small incision cataract surgery to see how diabetics fared. PATIENTS AND METHODS: One hundred fifty-four eyes of diabetic patients were evaluated preoperatively through dilated fundus examination and Snellen visual acuity. The eyes then underwent small incision cataract surgery and were followed, undergoing periodic ophthalmoscopy, Snellen visual acuity measurement and additional postoperative therapeutic and surgical intervention. RESULTS: Final visual acuity improved by two Snellen lines or more in 61 out of 154 (40%) eyes. Final visual acuity worsened in 38 out of 154 (25%) eyes. CONCLUSIONS: Our results are similar to those reported for extracapsular surgery and phacoemulsification, suggesting that the prognosis is guarded for diabetics, even when undergoing small incision cataract surgery.

Adult↗
PubMed1998

Wound complications following cataract surgery. A case-control study.

OBJECTIVE: To determine whether selected preoperative medical, social, or behavioral factors predict the occurrence of cataract wound complications. PATIENTS AND METHODS: Patients who underwent cataract surgery at a Veterans Administration hospital were used in a case-control study. Cases were defined by the occurrence of any postoperative cataract wound gape with or without iris prolapse within 12 weeks of surgery and requiring repair in the operating room. Controls were patients who had no postoperative complications. Two controls were selected for each case patient and matched for surgeon. RESULTS: Thirty-one patients with postoperative wound complications occurred after 2041 cataract extractions (1.5%). Occurrence of wound complications was predicted by previous hematologic disorder (odds ratio, 2.9; 95% confidence interval, 1.1-8.1). Phacoemulsification surgery had a protective effect against wound complication (odds ratio, 0.2; 95% confidence interval, 0.09-0.64). There was no difference in final visual acuity and refractive indexes in patients with and without wound complications (P = .6 by Student t test). CONCLUSIONS: Most medical social and behavioral preoperative factors have limited discriminatory power in predicting who will have postoperative cataract wound complications. The association of previous hematologic disorders to predict the occurrence of wound complications varied with the level of alcohol use. Although this study was not primarily designed to assess the role of surgical technique, phacoemulsification cataract extraction had a statistically significant protective effect against wound complications. Visual outcome in patients with postoperative wound complications is generally very good.

Aged↗