Showing papers on "Cataract surgery published in 1999"

Older drivers and cataract: driving habits and crash risk.

Abstract: BACKGROUND: Cataract is a leading cause of vision impairment in older adults, affecting almost half of those over age 75 years. Driving is a highly visual task and, as with other age groups, older adults rely on the personal automobile for travel. The purpose of this study was to examine the role of cataract in driving. METHODS: Older adults (aged 55-85 years) with cataract (n = 279) and those without cataract (n = 105) who were legally licensed to drive were recruited from eye clinics to participate in a driving habits interview to assess driving status, exposure, difficulty, and "space" (the distance of driving excursions from home base). Crash data over the prior 5 years were procured from state records. Visual functional tests documented the severity of vision impairment. RESULTS: Compared to those without cataract, older drivers with cataract were approximately two times more likely to report reductions in days driven and number of destinations per week, driving slower than the general traffic flow, and preferring someone else to drive. Those with cataract were five times more likely to have received advice about limiting their driving. Those with cataract were four times more likely to report difficulty with challenging driving situations, and those reporting driving difficulty were two times more likely to reduce their driving exposure. Drivers with cataract were 2.5 times more likely to have a history of at-fault crash involvement in the prior 5 years (adjusted for miles driven/week and days driven/week). These associations remained even after adjustments for the confounding effects of advanced age, impaired general health, mental status deficit, or depression. CONCLUSIONS: Older drivers with cataract experience a restriction in their driving mobility and a decrease in their safety on the road. These findings serve as a baseline for our ongoing study evaluating whether improvements in vision following cataract surgery expand driving mobility and improve driver safety.

National cataract surgery survey 1997–8: a report of the results of the clinical outcomes

Abstract: AIMS A national survey of over 100 hospitals in the UK was carried out to collect routine clinical information on the outcomes of cataract surgery. The clinical outcomes of interest were: visual acuity at time of discharge from postoperative hospital follow up, visual acuity at time of final refraction; complications related to surgery occurring during the operation, within 48 hours of surgery, and within 3 months of surgery. In addition, information on age and comorbidity was obtained. This article reports on the findings of the experience of approximately 18 000 patients who had cataract surgery in the hospital eye service of the NHS. RESULTS Of those with no ocular comorbidity, 85% achieved a visual acuity of 6/12 or better on discharge from postoperative hospital follow up, while 65% of patients with a serious co-existing eye disease achieved this level of acuity at this time. At final refraction, 92% of patients without ocular comorbidity and 77% of patients with ocular comorbidity achieved 6/12 or better visual acuity. The following main risk indicators were associated with visual outcomes and complications related to surgery: age, other eye diseases, diabetes and stroke, type of surgical procedure, and grade of surgeon. CONCLUSIONS The acceptability of these findings could fruitfully be the subject of discussion within the ophthalmic community and hopefully issues arising out of the study can lead to research, especially in-depth studies of the outcomes of cataract surgery in those patients with co-existing serious eye conditions.

Trypan blue capsule staining to visualize the capsulorhexis in cataract surgery

Abstract: A capsulorhexis may be difficult to perform in the absence of a red fundus reflex. Using 0.1 mL of trypan blue 0.1% to stain the anterior capsule in 30 patients with a mature cataract enabled us to visualize the capsulorhexis during phacoemulsification. No adverse reactions were observed up to 12 months after surgery. Trypan blue staining of the anterior capsule appears to be a safe technique to facilitate the performance of a capsulorhexis in the absence of a red fundus reflex.

Posterior capsular opacification after cataract surgery.

Abstract: This is a review of the current status of clinical research on the prevention of posterior capsular opacification (PCO), which is now the commonest complication of cataract surgery occurring in up to 50% of patients by 2 to 3 years after the operation. PCO is caused by lens epithelial cells retained in the capsular bag following surgery which then proliferate, migrate and transform to myofibroblasts. Interest in the prevention of PCO has centred around surgical technique, pharmacological methods to remove or destroy lens epithelial cells and changes in intraocular lens material and design. Changes in surgical technique have little effect in prevention of PCO although a capsulorhexis size which lies on the optic diameter appears to be beneficial. Many different cytotoxic drugs and pharmacological agents have been used experimentally to prevent PCO but the problem has limited damage only to lens epithelial cells. So far, no method has been shown to be safe for clinical use. Current interest is centred once again on the intraocular lens itself, particularly the material that it is made from and changes in its edge profile.

Limbal relaxing incisions to correct astigmatism in clear corneal cataract surgery.

Abstract: Background: To prevent surgically induced astigmatism following clear corneal cataract surgery.

Trends in vitreoretinal surgery at a tertiary referral centre: 1987 to 1996

Abstract: AIM To identify trends in vitreoretinal surgery at a tertiary referral centre from 1987 to 1996. METHODS A retrospective study of patients who had undergone vitreoretinal surgery at St Paul’s Eye Unit over two 6 month periods in 1987 and 1996. Preoperative ocular status, surgery details, and outcome were collected. χ 2 and Mann–Whitney U tests were used to analyse the data. RESULTS The two periods under study were July to December 1987 and January to June 1996. 110 operations performed during 1987 (96 patients) and 330 operations during 1996 (289 patients) were analysed. There was a fourfold rise in the number of tertiary referrals and a sevenfold rise in the number of operations performed for conditions other than rhegmatogenous retinal detachment (RRD). Increasing indications for surgery included diabetic eye disease, macular hole, dropped nucleus, endophthalmitis, and subretinal neovascular membrane. There was a rise in the proportion of patients with RRD following cataract surgery (from 19.5% to 29.5%). For both primary repair and reoperation, vitrectomy with internal tamponade was more commonly used in 1996. The anatomical success rate for primary repair changed from 76.6% to 84.7% after one operation and from 89.1% to 94.3% following additional surgery. CONCLUSIONS This study points to a trend towards subspecialisation and tertiary referral in vitreoretinal surgery. Vitrectomy techniques are more commonly used for the primary repair of RRD and are applied to a wider spectrum of diseases.

Combined cataract and glaucoma surgery: trabeculectomy versus endoscopic laser cycloablation.

Abstract: Purpose To determine whether combined cataract surgery with endoscopic laser cycloablation produces less inflammation than cataract surgery combined with a filtering procedure. Setting Taylor Regional Hospital (surgeries) and EyeSight Associates (examinations), Warner Robins, Georgia, USA. Methods A randomized prospective study was conducted of 58 eyes of 58 patients comparing endoscopic laser cycloablation performed through a cataract incision at the time of cataract surgery with combined trabeculectomy and cataract surgery. Results Mean follow-up was 2 years. At the final available visit, 30% of endoscopic laser patients achieved intraocular pressure control (below 19 mm Hg) without medication and 65% with medication. Forty percent of trabeculectomy patients achieved control without medication and 52% with medication. Four endoscopic laser patients (14%) and 3 trabeculectomy patients (10%) were considered treatment failures (required additional surgical intervention). Conclusion Endoscopic laser cycloablation performed through a cataract incision was a reasonably safe and effective alternative to combined cataract and trabeculectomy surgery, providing an option for cataract patients who have glaucoma requiring surgical intervention.

Profile of patients presenting for cataract surgery in the UK: national data collection.

Abstract: AIMS/METHODS A national data collection exercise was carried out in more than 100 hospital eye service units within the UK to provide clinical and administrative information on patients undergoing cataract surgery. This included patient clinical data such as visual acuity at the time of wait listing and at the time of admission for surgery, presence of other eye disorders, other serious medical disorders, and data on waiting time and type of admission. RESULTS The profiles of the 18 454 patients aged 50 years or older are reported. Findings of particular note were as follows. At the time of wait listing for cataract surgery 31% had visual acuity of 6/12 or better, 54% had visual acuity between 6/18 and 6/60, and 15% had less than 6/60 vision. Considering those who had visual acuity of 6/12 or better at the time of wait listing, by the time of admission for surgery, the vision deteriorated to 6/18–6/60 in 33% and in a further 3% the vision deteriorated to below 6/60. In patients with moderately poor visual acuity ( CONCLUSION This type of data collection and reporting exercise provides new material that can be used in the planning and provision of cataract surgery services in the UK.

Combined surgery for cataractand glaucoma: Phacoemulsification and deep sclerectomy compared with phacoemulsification and trabeculectomy

Abstract: Purpose: To. compare the outcome of phacoemulsification-intraocular lens (IOL) implantation-combined with nonperforating deep sclerectomy (P-DS) with that of phacoemulsification-IOL implantation combined with trabeculectomy (P T). Setting: Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. Methods: This prospective study involved 60 eyes of 60 patients with cataract andvarious types of open-angle glaucoma. Thirty eyes had P-DS and 30, P-T Follow-up was performed at regular intervals for up to 18 months. Results: Mean follow-up was 12.5 months ± 6.5 (SD) and 12.6 ± 4.9 months for the P-DS and P-T groups, respectively. Mean preoperative intraocular pressure (IOP) was similar in both groups (24.8 ± 5.9 mm Hg in the P-DS group and 24.6 ± 7.2 mm Hg in the P-T group). There was no statistically significant difference in IOP decrease (14.2 ± 4.0 mm Hg in the P-DS group and 15.2 ± 2.8 mm Hg in the P-T group). Visual outcome was similar in both groups. The P-DS group experienced significantly less inflammation (40.0% versus 83.0%; P = .0012) and hyphema (6.7% versus 36.7%; P = .010) than the P-T group. Conclusion: Deep sclerectomy combined with cataract surgery resulted in an IOP.reduction similar to that with phacotrabeculectomy with the same visual outcome, but the lower complication rate makes ambulatory care easier.

Unilateral intraocular lens implantation during the first six months of life.

Abstract: Purpose: The purpose of this study was to determine the incidence of postoperative complications and the occurrence of myopic shift in infantile eyes after cataract surgery and implantation of an intraocular lens (IOL). Methods: Cataract surgery and IOL implantation was performed on 11 infants with unilateral congenital cataracts who had a mean age of 10 ± 6 weeks at 5 clinical centers. IOLs with a mean power of 26.2 ± 2.3 D were implanted using a standardized protocol. The infants were then followed up for a mean of 13 ± 6 months for postoperative complications and longitudinal changes in their refractive error. Results: Eight of the 11 eyes had postoperative complications and were treated with a reoperation. Complications included open-angle glaucoma (n = 2), lens reproliferation into the visual axis (n = 2), pupillary membranes (n = 2), and corectopia (n = 2). A younger age at the time of surgery was positively correlated with the development of a postoperative complication requiring a reoperation (P = .03). A mean myopic shift of 5.49 D occurred in these eyes a year after surgery. No preoperative factors could be identified that correlated with the magnitude of the myopic shift. Conclusion: IOL implantation during infancy is associated with a high complication rate frequently requiring reoperation. A large myopic shift typically occurs that necessitates an initial or a late overcorrection with spectacles or a contact lens, depending on the power of the IOL implanted. Until ongoing randomized trials are completed, we recommend that surgeons exercise caution before implanting IOLs in the eyes of infants. (J AAPOS 1999;3:344-9)

Evaluating cataract surgery gains by assessing patients’ quality of life using the VF-7

Abstract: Purpose To describe the development and performance of a questionnaire designed to measure functional impairment caused by cataract. Setting Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. Methods The results of a visual-functioning index (VF-14) of 168 patients with first-eye cataract surgery were analyzed. Patients with significant comorbidity were excluded, leaving 142 patients for the final analysis. Snellen visual acuity measurements and complete preoperative and 4 month postoperative clinical status were performed by ophthalmologists. Outcome measures, including the VF-14, patient perception of trouble with vision, patient satisfaction with vision, and the cataract symptom score, were taken by nurses at the preoperative clinical examinations and at the 4 month postoperative visit. The Spearman rank correlation was used to determine which items of the VF-14 best correlated with a change in patient satisfaction. Results Seven items of the VF-14 that best correlated with patient satisfaction were selected for inclusion in a new 7-item index (the VF-7). Based on the Spearman rank correlation, the items from best to worst were nighttime driving; reading small print; watching television; seeing steps, stairs, or curbs; reading traffic, street, or store signs; cooking; and doing fine handwork. The correlation among changes in the VF-7 score and visual acuity in the operated eye was 0.17, while the correlation among changes in the VF-7 and patient satisfaction caused by cataract surgery was high (r = .56). Conclusion The VF-7 was a strong predictor of change in patient satisfaction caused by cataract surgery.

Cataract - a global perspective: Output outcome and outlay

Abstract: There are approximately 20 million people blind from cataract in the world, the majority of whom do not have access to affordable cataract surgery. This article will briefly address three questions regarding service delivery: How many cataracts need to be operated on? What are satisfactory results? How can cataract surgery be made affordable?

Changing trends in barriers to cataract surgery in India.

Abstract: Cataract is a major cause of blindness in Asia. Efforts in India to provide cataract surgical services have had limited success in reaching the cataract-blind population. Earlier studies identified the major barriers to cataract surgery as poverty, lack of transportation or felt need, or sex related; and the critical barriers in rural areas as lack of awareness, difficult access, and cost. Compared with these earlier data, the results of the present study in Karnataka State indicate a shift in the character of the barriers. They now appear to be more related to case selection and service provision. These shifts are analysed and alternative strategies to increase the uptake to cataract surgery are recommended.