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PubMed1981

Experimental posterior subcapsular cataracts-with special reference to 1-beta-D-arabinofuranosyl-cytosine (Ara C)-induced cataracts.

Experimental posterior subcapsular cataracts were induced by the action of 1-beta-D-arabinofuranosyl-cytosine (ara C) and vincristine sulfate (VCR) in the rat crystalline lens. Differences between these two types of cataracts observed by light microscopy were degenerative necrosis of the anterior capsular epithelial cells (in the ara C-induced cataract), and the transdifferentiation phenomenon of the lens epithelial cells (VCR-induced cataract). Transformation of the epithelial cells and subsequent abnormal cellular differentiation (transdifferentiation) could be the primary trigger in he development of cataracts.

Animals↗
PubMed1980

Histological comparison of senile posterior subcapsular cortical cataract and experimental posterior subcapsular cortical cataract induced by vincristine sulfate.

The similarity between vincristine sulfate-induced experimental cataract and posterior subcapsular cortical cataract in man is the grossly visible pathological processes of cataracts in the posterior subcapsular cortical region. In histological observations, these processes are described as degeneration and necrosis of the crystalline lens fibers immediately below the anterior capsular epithelial cells, as well as degeneration and necrosis of the cellular nuclei and irregularity of the cellular arrangement in the bow area, and degeneration and vesicle formation of the lens fibers immediately below the posterior capsule. The dissimilarities, on the other hand, are as follows: the posterior subcapsular cortical cataract in man, compared with vincristine salfate-induced cataract, is characterized by less advanced degeneration and atrophy of the anterior capsular epithelial cells and lack of specific changes of their nuclei. In man, cellular stratification was also lacking in the bow area.

Aged↗
PubMed2002

Phacoemulsification with indocyanine green versus manual expression extracapsular cataract extraction for advanced cataract.

PURPOSE: To compare the outcomes of indocyanine green dye (ICG)-assisted phacoemulsification with manual expression extracapsular cataract extraction (ECCE) in eyes with advanced cataract. SETTING: Parkland Memorial Hospital and Dallas Veterans Affairs Medical Center, Dallas, Texas, USA. METHODS: In this retrospective study, 72 consecutive cases of advanced or mature cataract extractions performed in a 1-year period were reviewed. Fifty-nine eyes met the inclusion and exclusion criteria; 33 had ICG-assisted phacoemulsification and 26, manual expression ECCE. Preoperative and intraoperative findings and the postoperative outcomes up to 6 months were analyzed. RESULTS: Intraoperative complications included posterior capsule tear with vitreous prolapse in 2 eyes (6.6%) and conversion to manual expression ECCE in 1 eye (3.3%) in the ICG phacoemulsification group. There was no intraoperative complication in the manual expression ECCE group. There were significantly more patients with a best corrected visual acuity of 20/30 or better in the ICG phacoemulsification group than in the manual expression ECCE group at all postoperative periods. The mean logMAR visual acuities were significantly better in the ICG phacoemulsification group at all postoperative intervals. The ICG phacoemulsification group had significantly less postoperative astigmatism. There was no significant difference between the groups in the early postoperative intraocular pressure. CONCLUSIONS: Phacoemulsification with ICG led to better postoperative visual acuity and less postoperative astigmatism than manual expression ECCE. Phacoemulsification with ICG was associated with more intraoperative complications than manual expression ECCE; however, the complication rate is comparable to a previously published rate for phacoemulsification performed in a university training program. Phacoemulsification with ICG appears to be a reasonable alternative to manual expression ECCE for advanced cataract.

Adolescent↗
PubMed1999

Visual outcomes after cataract surgery and cataract surgical coverage in India.

Visual outcomes of 2369 cataract operated persons(3655 eyes) across seven major Indian states were assessed in 1998. This is the largest ever study over the past decade in the country. 9.54 per cent of the examined population had undergone operation for cataract in one or both eyes. Intra-capsular cataract extraction was the commonest surgical modality adopted (91.62%). Intraocular lens implants resulted in better visual outcomes with 71.4 per cent of such patients achieving a good visual outcome (> or = 6/18 in operated eyes). Visual outcome was also good if ICCE operated patients were provided good quality aphakic spectacles. There were no gender differentials in surgical uptake rates. The risk of poor postsurgical visual outcome was strongly associated by type of surgery (Adjusted OR for ICCE-2.78; 95% CI: 1.41-5.49) and the non-availability or poor quality aphakic spectacles (Adjusted OR for poor/no spectacles 4.59-95% CI: 3.53-5.97). Duration since surgery and the source of surgery did not influence visual outcomes. Half the cataract blind remained unoperated in the study population.

Aged↗
PubMed1996

Visual impairment and general health among Danish cataract patients. Results from the Danish Cataract Surgery Outcomes Study. I.

This Danish multicenter study was undertaken to evaluate current indications for cataract extraction and to compare the heath status among patients enlisted for cataract surgery with that reported for the background population. A consecutive sample of 290 patients from all ophthalmic hospital departments in Denmark was examined and interviewed prior to cataract extraction. The mean visual acuity in the eye enlisted for surgery was 0.17. A visual acuity of < 0.05 occurred in 11.1% and 46.7% had a visual acuity of > or = 0.05 to 0.3. Comparing these figures to other recent European studies it seems reasonable to conclude that in Denmark surgery is performed at an earlier stage of the disease. Only a few patients with no functional impairment were seen; other appropriate indications for surgery were seen for these patients. Occurrence of angina, bronchitis and prior myocardial infarction was higher in the cataract sample as compared to the random sample of Danes. The likelihood of preferring an outpatient procedure was significantly increased among younger patients, patients of better general health and among patients with better pre-operative visual acuity in eye enlisted for surgery.

Aged↗
PubMed1994

Senile and presenile cataract. Survey of patients undergoing cataract surgery.

Two groups of patients operated on because of cataract were compared: 106 patients from Poland and 103 patients from Norway. Mean age in the Polish group was 60 years and in the Norwegian 76 years. To explain the difference in age at operation the incidence of some cataract risk factors--diabetes, myopia, rural residence, outdoor occupation, cataract in family, steroid therapy, smoking and alcohol intake--were evaluated. Significant differences between these two groups were found only for rural residence, alcohol intake and cigarette smoking. The author suggests another possible factor causing earlier cataract formation among Polish patients.

Adult↗
PubMed1992

Secondary cataract in infants after extracapsular cataract extraction and anterior vitrectomy.

Two infants developed secondary cataract after undergoing extracapsular cataract extraction (ECCE), posterior chamber intraocular lens (IOL) implantation, posterior capsulectomy, and anterior vitrectomy. A similar complication developed in a third child, who had undergone ECCE and posterior capsulotomy. The secondary cataracts developed in these patients from 3 to 12 weeks after the primary operation. In infants, unlike adults, posterior capsulectomy and anterior vitrectomy after ECCE do not seem always to prevent secondary cataracts. In infants, the complication may be related to IOL implantation.

Anterior Eye Segment↗
PubMedDate not supplied

Cataract blindness and barriers to cataract surgical intervention in three rural communities of Oyo State, Nigeria.

BACKGROUND: The study was a community based field survey that used a rapid assessment method to determine the prevalence of cataract blindness in people aged 50 years and above in 3 rural communities. OBJECTIVE: The purpose of the study was to determine the prevalence of cataract blindness and barriers to cataract surgical intervention in an area served by a health facility managed by a tertiary institution. METHOD: Abedo, Akinyele and Ketepe Villages in Akinyele Local Government Area of Oyo State Nigeria were selected based on their nearness to the primary health care centre in Abedo. RESULT: A total of 477 persons aged 50 years and above were seen being 73.3 percent of expected. Those with visual acuity of less than 3/60 in an eye and those with visual acuity of less than 3/60 in the better eye were examined in more details using a pen torch, an ophthalmoscope and tonometer to determine the cause of blindness. All persons who have had surgery were examined. The prevalence of blindness in persons aged 50 years and above was 1.47% and that of cataract blindness in the same age group in the villages was 0.84% constituting 57.14% of blindness. The main barriers to hospital presentation were cost of surgery (52.8%) and distance to hospital (33.8%). The constraints and limitations encountered during the study included rural-urban migration and population discrepancies between what obtained at the villages and those supplied by the Local Government Population Commission. CONCLUSION: It is hoped that this study will serve as a preliminary survey and a base line for further studies and the initiation of a blindness prevention programme in the area.

Aged↗
PubMedDate not supplied

Visual acuity testing in cataract--an insight (cataract classification density based).

The senile cataracts have been graded on the basis of density objectively. The letter visual acuity, laser interferometric visual acuity and pin hole visual acuity were compared in various grades of cataracts and controls (phakic and aphakic) in 140 eyes. It was found that good correlation exists in all eyes except when cataract density is grade III or IV. The laser interferometry has good prognostic value when the predictability is assessed in early stages of cataract (Grade I & II).

Cataract↗
PubMed1998

[The frequency of secondary cataract after extracapsular cataract extraction].

A complication of extracapsular cataract extraction is posterior capsule opacification (secondary cataract). In this study we found that 26.0% of patients operated for cataract with extracapsular technique were treated for secondary cataract. The average postoperative time to treatment with Nd-YAG-lasercapsulotomy was 15.2 months with a follow-up time of 34 months.

Adolescent↗
PubMed1994

Rigor of research methods in studies of the effectiveness and safety of cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team.

OBJECTIVE: To assess the rigor of research methods reported in studies of the safety or effectiveness of contemporary cataract surgery. DESIGN: Formal systematic identification of pertinent studies and critical appraisal of each study's research methods. SUBJECTS: From 6113 unique, potentially relevant citations that we identified, 90 original studies published between 1979 and 1991 that addressed visual acuity or complications following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phacoemulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. MAIN OUTCOME MEASURES: Strength of study design, performance, and reporting in 11 methodologic areas assessed with a standardized abstraction form by two reviewers masked to authors, their institutions, and the journal of publication. Results of reviews were tallied to produce an overall quality score (measure of rigor in research methods) for each study. RESULTS: The mean (+/- SD) quality score was 43.1 +/- 20.1 out of a maximum possible score of 100. Studies received intermediate scores on description of baseline ocular disease and low scores on descriptions of other characteristics of enrolled patients, standardization of outcome assessment and follow-up duration, and handling of patient attrition. Eighty-three studies (92%) lacked a comparison group. The rigor of research methods in studies varied by the journal of publication, did not improve over time, and was no greater for studies with larger vs smaller sample sizes. CONCLUSIONS: The rigor of research methods in studies of cataract surgery can be improved if more attention is paid to fundamental principles of study design, data analysis, and reporting.

Cataract Extraction↗
PubMed1996

Effect of selected anti-cataract agents on opacification in the selenite cataract model.

A systematic study of the anti-cataract activity of 14 reagents was conducted using the selenite model. The reagents or their derivatives were identified from literature reports of their potential effectiveness against cataract formation. The effects of each reagent were measured on the phase separation temperature, Tc, of lens homogenate in vitro. Tc is a direct measure of molecular interactions leading to protein aggregation. The protective effect of a single subcutaneous injection of each reagent [at a dose of 1.5 mmol (kg body weight)-1] on lens opacification was evaluated in vivo using rats administered selenite [at a dose of 19 mumol (kg body weight)-1] to initiate cataract formation. The strongest effects on lens opacification in vivo were observed with reagents having the strongest effect on Tc, in vitro. The weakest effects in vivo were observed with the reagents having the weakest effect on Tc, in vitro. The results were suggestive of a relationship between the effect of a reagent on Tc and protection against cataract formation in vivo.

Animals↗
PubMed2004

Postoperative aphakia in modern cataract surgery: part 1: analysis of incidence and risks based on 5-year data from the Swedish National Cataract Register.

PURPOSE: To study the incidence of aphakia after cataract extraction and evaluate the relative risk for this outcome in subgroups of patients based on preoperative conditions. SETTING: Sixty-two community-run or private clinics participating in the Swedish National Cataract Register. METHODS: Data on cataract extractions were collected prospectively from 1997 through 2001. The set of data also covered type of surgery and type of intraocular lens (IOL), including a "no lens implanted" option. All data were stored in a database. Database calculations were made of frequencies and risk ratios of postoperative aphakia in the subgroups of patients based on preoperative conditions. RESULTS: For the entire study period, postoperative aphakia was reported in 1410 of 287,951 surgeries for which complete IOL data were available, corresponding to an overall frequency of 0.49%. The occurrence of ocular comorbidity and poor preoperative visual acuity (< or = 0.1) in the eye to be operated on was significantly related to postoperative aphakia for each year of the study (P<.001). Glaucoma and poor visual acuity (< or =0.1) in the surgical eye meant a 12.8 higher risk for aphakia after surgery than a better visual acuity (>0.1) and no ocular comorbidity. CONCLUSIONS: This national 5-year survey showed that in routine cataract surgery performed during the study, 1 of every 200 operations ended in postoperative aphakia. Poor visual acuity (< or =0.1) in the eye to be operated on combined with ocular comorbidity was the highest risk factor for postoperative aphakia.

Aged↗
PubMed2005

Cataract surgery in patients with Fuchs' corneal dystrophy: expanding recommendations for cataract surgery without simultaneous keratoplasty.

OBJECTIVE: To evaluate the use of preoperative pachymetry in patients with Fuchs' dystrophy who are undergoing cataract extraction to predict the need for future penetrating keratoplasty and to compare these findings with current published recommendations. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: A series of patients with Fuchs' dystrophy (136 eyes) undergoing cataract surgery. METHODS: We reviewed the medical records of 136 patients with Fuchs' dystrophy who underwent phacoemulsification and intraocular lens implantation between October 1990 and May 2002. MAIN OUTCOME MEASURES: Preoperative and postoperative visual acuity, pachymetry, and postoperative corneal decompensation requiring penetrating keratoplasty. RESULTS: The average preoperative corneal thickness was 584+/-39.5 microm (range, 482-674 microm). Fifty eyes (36.8%) had preoperative corneal thickness of > or =600 microm. The average postoperative best-corrected visual acuity (BCVA) was 20/33 (range, 20/15-20/250). Of the 50 eyes with preoperative pachymetry measurements of > or =600 microm, 5 (10%) progressed to penetrating keratoplasty; 90% of the 50 eyes did not need corneal transplants within the first year after cataract surgery and had an average postoperative BCVA of 20/35 (range, 20/20-20/200). Of those with a corneal thickness of > or =640 microm, 83% did not need a corneal transplant within this same time period and had an average postoperative BCVA of 20/50 (range, 20/20-20/200). CONCLUSIONS: To avoid unnecessary cost and delay in visual rehabilitation, we suggest changing the current recommendations for an initial triple procedure for eyes with preoperative pachymetry measurements of >600 microm. Our data suggest that current cataract removal techniques allow for excellent visual rehabilitation in patients with Fuchs' dystrophy who have a preoperative corneal thickness of >600 microm, and we suggest that preoperative pachymetry measurements of >640 microm may be a better guideline. This recommendation can be further expanded above 640 mum if a visual acuity of less than 20/20 is acceptable. A prospective randomized controlled study is required for validation of this analysis.

Adult↗
PubMed1998

The Madurai Intraocular Lens Study. I: A randomized clinical trial comparing complications and vision outcomes of intracapsular cataract extraction and extracapsular cataract extraction with posterior chamber intraocular lens.

PURPOSE: The Madurai Intraocular Lens Study (MIOLS) was designed to compare safety, efficacy, and quality of life outcomes after either intracapsular cataract extraction with aphakic glasses (ICCE-AG) or extracapsular cataract extraction with posterior chamber intraocular lens (ECCE/ PC-IOL). METHODS: The Madurai Intraocular Lens Study was a nonmasked randomized controlled clinical trial conducted at a single hospital. Thirty-four hundred patients with age-related cataracts and having a best-corrected visual acuity less than or equal to 20/120 in the better eye were randomly assigned to either of the two cataract operative procedures. The main clinical outcomes were safety (complication rates) and efficacy (best-corrected visual acuity at 1 year equal to or better than 20/40). In addition, a subset of 1,700 trial participants received questionnaires before surgery, at 6 months after surgery, and at 1 year after surgery to measure visual functioning and vision-related quality of life. RESULTS: Details of study design, study organization, clinical and quality of life outcome variables, sample size calculations, patient eligibility criteria and recruitment, randomization and masking, participant flow, adherence to follow-up, quality assurance, and statistical methods are presented. CONCLUSIONS: The Madurai Intraocular Lens Study has sufficient power to detect clinically significant differences between the treatment options. There were no statistically significant differences between the two treatment groups for any of the major study variables at baseline. A high level of quality assurance was maintained throughout the October 1993 to June 1996 study period. The results should be applicable to all settings where the requisite expertise and resources are present.

Adult↗
PubMed1999

Extracapsular cataract extraction with a sutureless incision for dense cataracts.

PURPOSE: To evaluate the use of extracapsular cataract extraction (ECCE) via a sutureless incision for dense cataracts. SETTING: Nagata Eye Clinic, Nara, Japan. METHODS: This retrospective study comprised 51 eyes of 45 consecutive patients with dense cataracts who had ECCE with a sutureless incision between January 1996 and April 1998. A scleral incision from 6.0 to 8.5 mm was made at 12 o'clock or between 9 and 12 o'clock (oblique incision). Measures of outcome included postoperative visual acuity, surgically induced astigmatism (polar value method and vector analysis), complications, and changes in corneal endothelial cell density and morphology. RESULTS: Self-sealing was achieved in 45 eyes (88.2%), but additional sutures were required in 6 (11.8%). Intraoperative complications included posterior capsule rupture in 3 eyes (5.9%) and iris prolapse in 2 (3.9%). Corneal flattening against the preoperative steep meridian was observed in the 12 o'clock incision group (0.24 diopter [D] +/- 1.23 [SD]) and in the oblique incision group (0.17 +/- 0.89 D). By vector analysis, the surgically induced vector was 1.41 +/- 0.72 D in the 12 o'clock incision group and 1.02 +/- 0.66 D in the oblique incision group. After surgery, the mean cell loss was 8.2% +/- 12.5%. There were no significant differences, however, between other preoperative and postoperative morphometric indexes. CONCLUSION: This fast, safe, and inexpensive technique may be a viable treatment for dense cataracts with large, hard nuclei.

Aged↗
PubMed1993

Is cortical spoke cataract due to lens fibre breaks? The relationship between fibre folds, fibre breaks, waterclefts and spoke cataract.

Fibre folds, previously called lamellar separation of the lens, have been found by electron microscopy to be associated with fibre breaks, which are seen in vivo as the circular shades of Obazawa. This led to the present study to determine the relationship between fibre folds, fibre breaks, waterclefts and spoke cataract. All lenses with fibre folds were found to have circular shades. A few instances of circular shades without fibre folds were found, suggesting that the fibre break may be the primary pathology. It was found that circular shades occurred in association with spoke cataract only when fibre folds were also present. Thus there is no essential causal relationship between fibre breaks and spoke cataract. The occurrence of waterclefts was unrelated to the presence of the other features. The lower nasal quadrant of the lens was the most common site for the four features. The depth of spoke cataracts was found to be unrelated to the age of the patient, which makes it unlikely that accommodational stress at the time of onset of presbyopia is causative.

Age of Onset↗