Showing papers on "Cataract surgery published in 1996"

Gains from cataract surgery: visual function and quality of life.

Abstract: AIMS: To describe the impact of cataract surgery in terms of visual function (functioning in everyday life with respect to vision dependent activities) and health related quality of life. METHODS: An observational, longitudinal study of patients undergoing cataract surgery was carried out at three district general hospitals in outer London districts of North Thames Region with follow up at 4 and 12 months postoperatively for a clinical assessment and a standardised administered interview. Patients were admitted for surgery to the first eye for age-related cataract between 1 May 1993 and 31 August 1994. Visual functioning was assessed by the VF-14, health related quality of life was assessed by the sickness impact profile (SIP), and vision related quality of life was assessed by VR-SIP (a modification of the generic SIP). RESULTS: Significant gains in all the outcome measures were demonstrated at 4 months postoperatively. No significant change (gain or loss) was observed between 4 and 12 months after surgery to the first eye. Postoperatively, the mean visual function (VF-14) scores, and health related (SIP) and vision related (VR-SIP) quality of life scores, indicated less reported trouble with vision dependent activities and better perceived quality of life, respectively. The average gains in visual function and quality of life (health and vision related) were apparent in groups with good visual outcome and poor visual outcome. Significant additional gains were seen at 1 year in patients who had second eye surgery in the interval between the postoperative assessments. CONCLUSIONS: Gains in visual functioning and quality of life (health and vision related) have been demonstrated following cataract surgery. These gains were sustained at 1 year after surgery to the first eye, with additional gains being conferred if second eye surgery had been performed. Assessment of the outcomes of cataract surgery by clinical indicators alone may underestimate the overall benefits of surgery, particularly in patients with poor visual outcome.

A study of human lens cell growth in vitro : A model for posterior capsule opacification

Abstract: Purpose. After intraocular lens (IOL) implant surger for cataracty , cell growth on the posteriorcapsule is responsible for renewed visual impairmen in approximatelt y 30% of patients. Theauthors have, therefore, develope a humad n lens capsule system to study this growth in vitro.Methods. Sham cataract surgery, including anterior capsulorhexis, nucleus hydroexpression,and aspiratio onf lens fibers, was performed on donor eyes I.n some cases, a polymethylmeth-acrylate IOL implant was place idn th capsulae r bag Th. e capsular bag was dissected free,pinned flat o an plastic culture dish, covered with Eagle's minimum essential medium supple-mented with 10% fetal calf seru anmd observed by phase-contrast and dark-field microscopyfor as long as 100 days. At the end-point, capsules were examined by fluorescence microscopyfor actin, vimentin. , and chromatin.Results. Withi 2n4 hours, there was evidenc oef cell growth in the equatorial region. Afte 2rto 3 days, cells were normally observed growin thg froe rhexims onto the posterior capsuleand acros ths e anterior surface o f the IOL i,f present. Growth proceeded rapidl so thayt theposterior capsule fo,r example, was totally covere byd a confluent monolaye of cellr s at 5.8± 0.6 days and 7.2 ± 0.7 days for capsules aged 60 years, respectively. Totalcover of the anterior IOL surface generally followe 4 to 5 dayds behind tha otf the capsule.Capsular wrinkles became increasingly apparent as time progressed, causin a markegd rise inlight scatter A. n increase in capsular tension also occurred and th, e actin filaments becamemore polarized nea thre wrinkles.Conclusions. The model presented her foer posterior capsule opacification shows o manf theychanges seen in vivo, including rapid lens cell growth, wrinkling, tensioning, and light scatterin the posterior capsule It wil. l b e possibl teo develop strategie fors inhibitin g cell growthwith this system. Invest Ophthalmol Vi 1996s Sci 37:906-914;. .An modern extracapsular cataract surgery, to restorethe best possible vision, a small artificial lens is im-planted into the remaining lens capsular bag fromwhich most of the fiber mass has been removed. Thisapproach is not without subsequent complications,however, and within 2 years as many as 35% of patientsexperience a significant loss of visual acuity.

Two year clinical study of a soft acrylic intraocular lens

Abstract: Purpose: To assess the efficacy and safety of a soft acrylic intraocular lens (IOL) in small incision cataract surgery. Methods: Sixty-four eyes of 64 patients (mean age 71.0 ± 7.7 [SD] years) who had phacoemulsification and implantation of a soft acrylic IOL were followed for 2 years. Results: At day 1, 96.9% of patients had corrected visual acuity of 20/40 or better, and 50.0% had 20/20 or better. At 2 years postoperatively, 100% had 20/40 or better, and 86.3% had 20/20. Surgically induced keratometric cylinder remained quite stable throughout the 2 year follow-up period, with axis-based astigmatism of ±0.3 diopters. Flare intensity measured with the laser flare-cell meter was less than that with other type of IOLs measured, including poly(methyl methacrylate) and silicone. Neodymium:YAG laser capsulotomy was performed in seven cases (11.1 %) without causing damage to the optic. No other postoperative complications were encountered. Conclusion: Soft acrylic IOLs have clinically apparent advantages in small incision cataract surgery.

Blindness Due to Cataract: Epidemiology and Prevention

Abstract: 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.

Ocular findings in 55 patients with Down's syndrome.

Abstract: Fifty-five patients with Down's syndrome were examined to evaluate the characteristics and frequency of ocular findings. Of these patients, 29 (52.7%) were hypermetropes, 7 (12.7%) were emmetropes, and 7 (12.7%) were myopes; astigmatism of more than 3.00 diopters was present in 7(12.7%) patients. Strabismus was observed in 12 (21.8%) patients. All but one of these 12 patients also had esotropia. Congenital nasolacrimal duct obstruction was present in 12 subjects (21.8%). Blepharitis was found in 19 (34.5%) cases. Nystagmus occurred in 7 (12.7%) patients. Brushfield spots were detected in only 20 (36.3%) of the patients and were more common in light-colored irides. Lens opacities were diagnosed in 11 (20%) patients, and two underwent successful cataract surgery. On fundus examination, an increased number of retinal vessels crossing the optic nerve head was detected in 21 (38.1%) cases. One of the patients had a retinal detachment. Significant but correctable ocular problems are present in patients with Down's syndrome and may interfere with the quality of life of the patient and with binocular vision. Surgical intervention may be needed for strabismus and for cataracts.

Postoperative inflammatory response to phacoemulsification and extracapsular cataract surgery: Aqueous flare and cells

Abstract: Purpose: To compare the postoperative blood-aqueous barrier (BAB) breakdown induced by phacoemulsification with continuous curvilinear capsulorhexis (CCC) and by extracapsular cataract extraction (ECCE) with a linear capsulotomy. Setting: Cataract and Refractive Surgery Research Unit, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. Methods: Anterior chamber flare and cells were measured preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively in two parallel groups of 31 consecutive cataractous eyes. In Group 1, one surgeon performed ECCE with a linear capsulotomy; in Group 2, a second surgeon performed divide and conquer phacoemulsification with CCC. The preoperative, intraoperative, and postoperative medication regimen was the same in both groups. Results: Group 2 eyes had significantly lower anterior chamber flare and cell measurements in the first postoperative month than Group 1 eyes (.01 Conclusions: Phacoemulsification with CCC induced a less severe BAB breakdown than ECCE with a linear capsulotomy. Phacoemulsification with CCC may be preferable in high-risk eyes such as those with glaucoma, diabetes, or uveitis, which are prone to complications resulting from postoperative BAB breakdown.

Use of topical anesthesia alone in cataract surgery.

Abstract: Purpose: To evaluate pain and discomfort experienced by patients who have uncomplicated cataract extraction using topical anesthesia with no intravenous sedation. Setting: Fichman Eye Center, Manchester, Connecticut. Methods: Blood pressure, heart rate, and respiration were measured preoperatively, during cataract surgery, and postoperatively in 100 randomly selected patients. The average of these measurements (procedural vital) was compared with the blood pressure, heart rate, and respiration levels during surgery. Results: On average, patients had a negligible increase in blood pressure (1 %), a small decrease in heart rate (2%), and a slight decrease in respiration (1 %). Conclusion: Because the vital signs were essentially unchanged during surgery, I believe patients were very comfortable despite having no intravenous sedation.

Long-term Results After Penetrating Keratoplasty for Fuchs' Endothelial Dystrophy

Abstract: Objective: To determine the graft survival, visual outcome, complications, and frequency of subsequent cataract extraction after penetrating keratoplasty for Fuchs' dystrophy. Design: The medical records of 236 patients with the diagnosis of Fuchs' dystrophy who were examined on the Cornea Service at Wills Eye Hospital, Philadelphia, Pa, between Jauary 1, 1988, and December 31, 1988, were reviewed retrospectively. Subjects: Penetrating keratoplasties had been or were subsequently performed on 130 phakic eyes of the 236 patients with Fuchs' dystrophy. Results were analyzed in 126 eyes with at least 1 year of follow-up. Statistical analysis was done to determine the risk factors for subsequent cataract surgery in the first eye of patients who had penetrating keratoplasty as their initial surgical procedure. Results: Mean±SD follow-up after transplantation was 8.4±4.8 years. The graft remained clear in 112 eyes (89%). A best corrected visual acuity of 20/40 or better was achieved in 81 eyes (64%). Graft rejection occurred in 37 eyes (29%). Subsequent cataract surgery was performed in 55 eyes (44%), and the mean time from transplantation was 3.5±3.4 years. Advanced age at the time of transplantation was a significant risk factor for having cataract extraction ( P =.003, Mantel-Haenszel × 2 test) and a shorter time to cataract surgery after penetrating keratoplasty ( P =.04, Mantel-Haenszel × 2 test). Pregraft lens status approached significance as a risk factor for subsequent cataract surgery ( P =.07, Mantel-Haenszel × 2 test). Conclusions: Long-term results are favorable after penetrating keratoplasty for Fuchs' dystrophy. In older patients with Fuchs' dystrophy and mild-to-moderate lens changes, combined penetrating keratoplasty, cataract extraction, and intraocular lens implantation procedure should be considered.

Diabetic retinopathy before and after cataract surgery.

Abstract: AIMS/BACKGROUND: Increased retinopathy progression has been reported after cataract surgery in patients with diabetes mellitus. To assess the influence of cataract surgery on visual acuity and retinopathy progression, all diabetic patients who were subjected to cataract surgery during 1991-3 have been followed up at the Department of Ophthalmology in Helsingborg. The average follow up time was 2 years. METHODS: One eye of each of 70 patients was included in the study, 35 monocularly and 35 binocularly operated on. Sixteen of the 70 patients had proliferative diabetic retinopathy (PDR) at baseline. The Wisconsin scale was used for the grading of retinopathy. The degree of glycaemic control was assessed by measurements of HbA1c. RESULTS: Most patients obtained improved visual acuity; a postoperative visual acuity of 0.5 or better was achieved in 89% of diabetic surgical eyes. Progression of the retinopathy occurred in 30 out of the 70 eyes, and was associated with mean level of HbA1c (p = 0.04), duration of diabetes (p = 0.02), insulin treatment (p = 0.001), and presence of retinopathy at baseline (p = 0.01). Patients who progressed had a significantly higher incidence of macular oedema (p = 0.006) than those who did not progress. No significant differences were found when operated and non-operated eyes were compared in the 35 patients with monocular surgery. Two patients in this group, however, ended up with macular oedema and worse vision in the operated eye than in the eye which was not operated on. Both patients had background retinopathy before surgery. CONCLUSIONS: Patients in this study, also those with PDR, obtained good visual acuity, better than in most previous studies. Poor glycaemic control was a factor of importance for the progression of diabetic retinopathy after cataract surgery.

Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study.

Abstract: AIMS: To estimate the risk of retinal detachment (RD) following cataract extraction in Denmark, and to compare the risk with that following cataract extraction in the USA, and with that in a sample of Danish patients who did not have ocular surgery. METHODS: A sample was created from the administrative Danish Hospital Register and included 19,252 patients who underwent first eye cataract surgery between 1985 and 1987, and who were 50 years of age or older. The patients were then followed for 4-6 years using the register data. The design and definition of events were identical to the US National Study of Cataract Outcomes. RESULTS: In Denmark a 4 year cumulative risk of hospitalisation for RD of 0.93% (95% confidence interval (CI) 0.71-1.16) was observed following an extracapsular cataract extraction with a lens implant. A similar cumulative risk of RD was reported from the US study. Thus, no difference in outcomes concerning risk of RD was shown between Denmark and the USA. In a multivariate analysis younger age, male sex, and intracapsular cataract extraction were all associated with higher risk of postoperative RD. A reference group of 7636 people not undergoing any ocular surgery was created and the incidence of RD in this group was calculated. During the sixth year following cataract surgery, the incidence of RD in the cataract group was still 7.5 (95% CI 1.6-22.0) times higher than that observed in the reference group.

Topical versus peribulbar anesthesia in clear corneal cataract surgery.

Abstract: Purpose: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar anesthesia in clear corneal cataract surgery. Setting: Department of Ophthalmology, University of Vienna, Austria. Methods: In this prospective, double-blind clinical trial, 36 patients had bilateral cataract surgeries performed from 1 to 3 months apart. Half of the patients had topical anesthesia for the first surgery and peribulbar anesthesia for the second surgery. The other half had peribulbar first and then topical. All surgery was done using a temporal clear corneal approach and bimanual phacoemulsification followed by in-the-bag intraocular lens implantation. Subjective pain was assessed using a visual analog scale of no pain (0%) to worst pain imaginable (100%) and intraoperative motility using a rank scale of adverse motility (−5) to ideal patient cooperation (+5). Results: Subjective pain was comparable whether topical or peribulbar anesthesia was used (mean 10.75 versus 10.97%; P > .6). Patient cooperation (motility) was significantly better when topical anesthesia was used (+2.16 versus +1.11; P = .03). There were no significant differences in complications. A peribulbar block was given in addition to the topical anesthesia in two cases. Conclusions: Topical anesthesia is a safe, effective alternative to peribulbar anesthesia in clear corneal cataract surgery.

Prospective evaluation of early visual and refractive effects with small clear corneal incision for cataract surgery

Abstract: Purpose: To evaluate the early postoperative visual and refractive effects of a 3.25 mm clear corneal self-sealing incision with foldable intraocular lens implantation. Setting: The Eye Institute of Utah, Salt Lake City. Methods: Visual acuity and refraction in 50 eyes of 50 consecutive patients having clear corneal phacoemulsification were prospectively evaluated at 30 minutes, 1 day, 1 week, and 1 and 3 months postoperatively. Results: Uncorrected visual acuity of 20/40 or better was obtained in 38% of eyes 30 minutes after surgery, 52% at 1 day, and 89% at 3 months. There was no significant refractive cylinder change ( P = .093). Visual rehabilitation and refractive stability were rapid, and induced astigmatism was low. A strong positive correlation was found between refraction at 30 minutes and that at 3 months after surgery ( R = .5788, P = .0003). The visual and refractive examination performed 30 minutes after surgery could help early detection of incorrect IOL power selection. Conclusion: The low induced astigmatism, excellent early visual acuity, and lack of surgical complications support the concept and justify the use of small temporal corneal incisions for cataract surgery.

Short- and long-term effect of clear corneal incisions on intraocular pressure

Abstract: Purpose: To evaluate short- and long-term intraocular pressure (IOP) after cataract surgery using clear corneal incision to assess whether there is a statistically significant postoperative IOP decrease. Setting: Advanced Vision Care, West Hills, California. Methods: We retrospectively 135 eyes of 89 randomly selected patients who had scleral tunnel or clear corneal cataract surgery with a follow-up of at least 6 months. Patients with pre-existing glaucoma were excluded. Results: In the clear corneal group (n = 84), mean IOP was statistically significantly lower ( P = .019) 12 months after surgery than preoperatively (13.65 versus 15.57 mm Hg). Although there was a trend toward decreased IOP in the scleral tunnel incision group (n = 51), the difference was not statistically significant ( P = .178). Conclusion: We found a trend toward lower IOP that, if permanent, raises serious implications about the necessity of combined procedures in patients with both glaucoma and cataract.

Posterior capsulorhexis in adult eyes with intact and clear capsules.

Abstract: Purpose: To evaluate the feasibility and risks of primary posterior capsulorhexis. Setting: Department of Ophthalmology, University Hospital of Liege, Belgium. Methods: Retrospective analysis of 319 patients with cataracts who had phacoemulsification or manual extracapsular cataract extraction with a simultaneous circular posterior capsulorhexis between August 1993 and April 1994. The number of intraoperative complications and the number of postoperative complications that could be related to the posterior capsule opening were looked at. Fluorescein angiography was performed in a random sample of patients. Results: Twelve intraoperative complications consisted of 5 irregular tears, 4 vitreous prolapses into the posterior capsulorhexis, and 3 vitreous prolapses into the anterior chamber; 11 occurred in eyes with positive posterior pressure. Postoperative complications consisted of 3 vitreous prolapses into the pupil and 1 retinal detachment. Two of the 3 late vitreous prolapses occurred in eyes in which the posterior capsulorhexis was larger than the intraocular lens (IOL) optic. The retinal detachment occurred in an eye with a 25.79 mm axial length. Fluorescein angiography of 49 cases revealed 3 with cystoid macular edema. Conclusions: Based on our results, we believe that primary posterior capsulorhexis can be a routine procedure during cataract surgery and IOL implantation in adults, except in cases of positive pressure. The diameter of the posterior capsulorhexis should be smaller than the diameter of the IOL optic.

Corneal diameter in childhood aphakic glaucoma.

Abstract: Background Glaucoma occurring after successful cataract surgery in infancy and childhood requires persistence to establish timely diagnosis and presents a therapeutic challenge. Previous studies have sought to identify risk factors, which would alert the clinician for the likelihood of developing glaucoma after cataract surgery in the young patient. Some risk factors are early age of surgery, microcornea, poor pupillary dilation, retained lens cortex, coexisting ocular anomalies, and cataract type. Other studies did not find these associations. In our experience, the majority of young aphakic glaucoma patients have microcornea. This study was carried out to investigate this association. Methods The records were reviewed of all patients treated for aphakic glaucoma between 1991 and 1995 to determine the age at cataract surgery, age at glaucoma surgery, age at glaucoma diagnosis, corneal diameters, and other clinical characteristics. Results Forty-eight eyes in 29 patients were identified with aphakic glaucoma. Forty-five of the 48 (94%) eyes were found to have microcornea when compared with the normal corneal diameter for their age. Conclusion All children undergoing cataract surgery should have their corneal diameters recorded. Patients with corneal diameters smaller than normal should be followed closely for the development of glaucoma throughout childhood and beyond.

Long-term course of induced astigmatism after clear corneal incision cataract surgery

Abstract: Purpose: To determine whether a small clear corneal temporal incision produces less surgically induced astigmatism than a larger incision. Methods: One hundred three consecutive cases of postoperative astigmatism after clear corneal incision cataract surgery were studied for a minimum of 1 year. Only self-sealing incisions from the temporal side were made as follows: 3.2 mm (Group A); 4.0 mm (Group B); 5.2 mm (Group C). We considered the amount and axes of the keratometric readings at different times as well as their course over time. Induced astigmatism was calculated using three methods. Axial changes were also analyzed. Results: Immediately after the surgery, there was a small, surgically induced, withthe-rule astigmatic shift in all groups, which in most cases decreased to near preoperative levels with time. One year postoperatively, mean induced astigmatism was 0.09 diopter (D) in Group A, 0.26 D in Group B, and 0.54 D in Group C. Most cases had minimal axial changes. In Group A, 86% had an axial change of fewer than 30 degrees; in Group B, 76%; and in Group C, 73%. Conclusion: The smallest incision group had the least surgically induced astigmatism and axial change. All incision groups remained stable and had satisfactory clinical results.

Evaluation of intraocular pressure with Healon and Healon GV in sutureless cataract surgery with foldable lens implantation

Abstract: Purpose: To evaluate transient increases in intraocular pressure (IOP) after use of high-viscosity viscoelastic agents in cataract surgery. Setting: Military Hospital, Ulm, Germany. Methods: In a prospective, randomized study, we evaluated IOP following cataract surgery using two different viscoelastic substances (Healon®, Healon® GV). The viscosity of Healon GV is 10 times higher than that of Healon because of higher concentration and molecular weight. Patients having identical phacoemulsification procedures (sutureless clear corneal tunnel incision with foldable silicone lens implantation) (N = 60) and identical viscoelastic removal were assigned to groups of 15 based on viscoelastic used and removal time (20 or 40 seconds). Intraocular pressure was measured preoperatively and at 6, 24, 36, and 48 hours and 1 month postoperatively. Results: The highest mean IOP elevations in both viscoelastic groups were obtained at 24 hours postoperatively (2.9 mm Hg ± 4.3 [SD] with Healon and 3.3 ± 6.3 mm Hg with Healon GV). There were no statistically significant differences between the two viscoelastics and the two removal times during the entire follow-up period (unpaired t-test), but standard deviations were higher in the Healon GV groups at 6 and 24 hours. Two patients in the Healon groups and three in the Healon GV groups required medical treatment for IOP within the first 24 postoperative hours; however, all five patients had an IOP lower than 22 mm Hg on the second postoperative day. Conclusions: Based on postoperative IOP, both viscoelastics can be equally well removed from the anterior chamber. Incidence of high IOP using high-viscosity hyaluronic acid is minimized by the described removal technique.

Cataract Patients in a Defined Swedish Population, 1986 to 1990: V. Postoperative Retinal Detachments

Abstract: Objective: To estimate the risk of retinal detachment after cataract surgery. Design: Prospective study from December 17, 1985, through December 31,1992 of all cataract surgeries performed in a single referral region of the Lund (Sweden) Health Care District from December 17, 1985, through December 31, 1990. Setting: The University Hospital of Lund. Patients: Data were collected on 5878 consecutive cataract operations. The study population was complete enough to represent all cataract surgery in the referral region during this period. Results: Two years after cataract surgery, the risk of retinal detachment was 0.18%. The follow-up period after cataract surgery in this study was up to 7 years, with a mean of 50.7 months (>4 years), and the total risk of retinal detachment or detachment-related conditions was 0.71%, all cases included. The relative risk of detachment was 4.9 after YAG laser capsulotomy. It changed by a factor of 1.3 with an increase in the axial length of 1 mm and by 0.94 for each added year of patient age. Conclusion: A young patient with axial myopia operated on because of cataract and postoperatively treated with YAG laser capsulotomy runs an important increased risk of developing retinal detachment.

Phacoemulsification in diabetics.

Abstract: In a retrospective study we examined a consecutive group of diabetic patients (74 operated eyes) who underwent phacoemulsification and intraocular lens implantation over a 2 year period ending in June 1994. We compared this group with 66 diabetic eyes who underwent extracapsular surgery and lens implantation and who were examined for a previous study. There were no significant differences in progression of the retinopathy, complications, or final visual acuity. Seventy-two per cent of the phacoemulsification group improved by at least 2 lines of Snellen acuity postoperatively compared with 76% of the extracapsular group. Seventy-four per cent of the phacoemulsification group achieved an acuity of 6/12 or better compared with 68% of the extracapsular group. Overall there were fewer post-operative complications in the phacoemulsification group though there was an increased incidence of transient corneal oedema. The major cause of poor visual acuity in the phacoemulsification group was maculopathy, particularly in the presence of proliferative retinopathy in older patients. Use of a small intraocular lens did not prevent adequate fundal examination or photocoagulation. It is concluded that the outcome of cataract surgery in diabetics is largely determined by the degree of maculopathy. Phacoemulsification and extracapsular cataract surgery give similar visual results. Diabetic retinopathy should not be considered a contraindication to small-incision cataract surgery and phacoemulsification.

Cataract surgery in Australia 1985-94.

Abstract: Background:Cataract surgery is the most common form of major ophthalmic surgery in Australia and a common surgical procedure among the elderly. The purpose of this report is to compile the numbers and rates of cataract extractions and implant of IOLs over the period 1985–94 for Australia. Methods:Data were obtained for public and private cataract extractions and IOL implants from state and territory ministries of health and from the Health Insurance Commission. The data relating to cataract surgery were compared with the growth in the proportion of elderly people in the population. Results:The number of cataract extractions has increased by 2.6 times over the ten-year period to 67459 in 1994 and IOL implants have increased by 2.9 times over the same period to 70084. The increase in the elderly population for the period was 1.3 times so that there is a relative doubling in the rate of surgery. The proportion of public patients has risen from 19% to 28% from 1985 to 1994. Conclusions:The numbers of cataract extractions and IOL implants was increased at double the rate expected from the growth in the elderly population. Advances in microsurgery and IOL technology have resulted in improved outcomes and have created a greater patient demand. The improved outcomes have also lead to ophthalmologists recommending cataract surgery at better visual acuity levels than previously.

Influence of cataract surgery on the diabetic eye: a prospective study.

Abstract: The course of diabetic retinopathy following phacoemulsification and in-the-bag implantation of an intraocular lens (IOL) was studied prospectively in 223 patients (223 eyes). A total of 205 eyes were followed for 6 months. The nonoperated fellow eyes served as a control group. At the time of surgery, 158 patients had no diabetic retinopathy, 45 showed untreated background retinopathy, and 20 had more serious retinopathy with previous coagulation therapy. At 6 months of follow-up, 18.4% of the operated eyes without preoperative retinopathy developed background retinopathy, as did 14.3% of the untreated fellow eyes. Worsening of preexisting diabetic retinopathy during the observation period occurred in 27.6% of the operated eyes and in 29.3% of the non-operated eyes. Although the final visual acuity achieved in our patients was poorer than that reported for nondiabetics, our functional results were satisfying: 94.1% of the operated eyes showed improved visual acuity 6 months postoperatively, 2.4% deteriorated, and 3.4% were unchanged. We therefore conclude that cataract surgery in diabetic patients can be performed with an acceptable risk of complications. Furthermore, worsening of diabetic retinopathy seems to be correlated not with the cataract surgery but with the natural course of diabetic vascular disease.

Randomised trial of topical versus sub-Tenon's local anaesthesia for small-incision cataract surgery.

Abstract: Fifty unselected patients undergoing routine cataract surgery were randomised to receive either topical or sub-Tenon's local anaesthesia with 2% prilocaine administered by a blunt cannula. Visual analogue scales were used to assess pain during administration of sub-Tenon's anaesthetic and pain during surgery, and any complications were noted. Sub-Tenon's anaesthesia proved to be entirely comfortable to administer, and allowed for a statistically significantly more pain-free operation, at the expense of some residual eye movement and an inevitable subconjunctival haemorrhage. Both techniques compared well with other studies assessing periorbital or retro-orbital injections, and both have significant safety advantages which are discussed in the context of the joint Royal Colleges report on ophthalmic anaesthesia. It is suggested that a combination of one or other technique could safely cover all requirements for intraocular surgery under local anaesthesia.

Prevention of secondary cataract by antimitotic drugs: experimental study.

Abstract: To prevent the development of secondary cataract, mitomycin C (MC, 02 mg/ml) and 5-fluorouracil (5-FU, 50 mg/ml) were introduced in the irrigating solution (BSS Plus) during an extracapsular lens extraction in albino rabbits Cellular multiplication in the whole lens capsule was quantified by means of flow cytometry The total number of residual cells in the capsule after lens extraction together with the mitotic phases of the cell cycle were studied A statistically significant difference (p < 0005, Student t test) was obtained between the two groups treated with antimitotics when compared with the control group regarding the inhibition of mitosis in the capsular cell population together with the total cell number However, 5-FU has shown a more potent inhibitory effect than MC (p < 0005, Student t test) We did not record any ocular complication during a postoperative period of 2 months MC and 5-FU could be a promising alternative in the prevention of posterior capsule opacification

Cost-effectiveness of cataract surgery in a public health eye care programme in Nepal.

Abstract: Presented is an assessment of the cost-effectiveness of cataract surgery using cost and services data from the Lumbini Zonal Eye Care Programme in Nepal. The analysis suggests that cataract surgery may be even more cost-effective than previously reported. Under a "best estimate" scenario, cataract surgery had a cost of US$5.06 per disability-adjusted life year (DALY). This places it among the most cost-effective of public health interventions. Sensitivity analysis indicates that cataract surgery remains highly cost-effective even under a very pessimistic set of assumptions. The estimated mortality rates of those who receive surgery and of those who do not are among the variables that most influence the cost per DALY.

Monitoring and evaluating cataract intervention in India.

Abstract: AIM: To identify indicators to monitor and evaluate the cataract intervention programme in India. METHODS: Available data on blindness due to cataract, demography, staffing levels, and infrastructure available under the programme were reviewed. Four key elements of the programme were identified: the magnitude of blindness due to cataract and the need for surgical services; the available resources; the output, in quantity and in quality, as well as the resource utilisation; and lastly the impact this has on society and the problem of blindness due to cataract. Indicators to quantify these key elements were designed and available data were used to calculate the defined indicators. RESULTS: At least 2.5 million sight restoring cataract operations will have to be performed annually. Staffing levels and infrastructure resources at present allow for increased output. The effectiveness of cataract services can be increased with better case selection. CONCLUSION: The use of these indicators provides an insight into the dynamics of the problem of cataract blindness and its intervention. They facilitate adequate management and evaluation of the efficiency and effectiveness of the intervention programme and may ensure optimal utilisation of the available resources for cataract surgery.