Showing papers on "Cataract surgery published in 2001"

Blindness in the Indian state of Andhra Pradesh.

Abstract: PURPOSE. To determine the current prevalence and causes of blindness in the Indian state of Andhra Pradesh to assess if blindness has decreased since the last survey of 1986-1989. METHODS. A population-based epidemiology study, using a stratified, random, cluster, systematic sampling strategy, was conducted in the state of Andhra Pradesh in India. Participants of all ages (n = 10,293), 87.3% of the 11,786 eligible, from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh, underwent interview and a detailed dilated ocular evaluation by trained professionals. Blindness was defined as presenting distance visual acuity < 6/60 or central visual field < 20 in the better eye. RESULTS. Two hundred seventy-five participants were blind, a prevalence of 1.84% (95% confidence interval, 1.49%-2.19%) when adjusted for the age, sex, and urban-rural distribution of the population in 2000. The causes of this blindness were easily treatable in 60.3% (cataract, 44%; refractive error, 16.3%). Preventable corneal disease, glaucoma, complications of cataract surgery, and amblyopia caused another 19% of the blindness. Blindness was more likely with increasing age and decreasing socioeconomic status, and in female subjects and in rural areas. Among the 76 million population of Andhra Pradesh, 714,400 are estimated to have cataract-related blindness (615,600 cataract, 53,200 cataract surgery-related complications, 45,600 aphakia), and 228,000 refractive error-related blindness (159,600 myopia, 22,800 hyperopia, 45,600 refractive error-related amblyopia). If 95% of the cataract and refractive error blindness in Andhra Pradesh had been treated effectively, 3.4 and 7.4 million blind-person-years, respectively, could have been prevented. If 90% of the blindness due to preventable corneal disease and glaucoma had been prevented, another 2.7 million blind-person-years could have been prevented. CONCLUSIONS. The prevalence of blindness in this Indian state has increased from 1.5% in the late 1980s to 1.84% currently, as against the target of the National Program for Control of Blindness to reduce the prevalence to 0.3% by 2000. The number of people with cataract-related blindness has not reduced even with the eye care policy focus on cataract. Reduction of blindness in India will require strategies that are more effective than those that have been pursued so far.

Partial Coherence Interferometry: A Novel Approach to Biometry in Cataract Surgery

Abstract: • PURPOSE: To compare biometry performed by an enhanced version of dual beam partial coherence interferometry and applanation ultrasound in a prospective study of 85 cataract eyes to improve refractive outcome of cataract surgery due to a more accurate calculation of intraocular lens power. • METHODS: The SRK II formula using ultrasound biometry data was employed. Three months after surgery, partial coherence interferometry biometry was repeated and refractive outcome was determined. Preoperative partial coherence interferometry biometry data were used to determine the refractive power of the intraocular lenses retrospectively and to calculate the possible refractive outcome. • RESULT: Precision of partial coherence interferometry biometry was more than 10 times better than that of ultrasound. Therefore, the possible mean absolute error for postoperative refraction achieved with partial coherence interferometry biometry was 0.49 diopters (compared with 0.67 diopters with ultrasound biometry), resulting in an improvement of 27%. Axial eye length measured with the two techniques differed by a mean of 460 μm. The difference in lens thickness measured with partial coherence interferometry and ultra-sound significantly correlated with cataract grade. A mean shortening of 120 μm of axial eye length following cataract surgery was also detected by partial coherence interferometry. • CONCLUSIONS: The enhanced version of partial coherence interferometry offers biometry with un, precedented precision (<10 μm) and resolution (~12 μm), therefore improving the refractive outcome in cataract surgery. This noninvasive technique provides a high degree of comfort for the patient, with no need for local anesthesia or pupil dilation and minimized risk of corneal infection.

Effect of cataract surgery on intraocular pressure control in glaucoma patients.

Abstract: Purpose: To examine the effect of cataract surgery on intraocular pressure (IOP) control in eyes with angle-closure glaucoma (ACG) and open-angle glaucoma (OAG). Setting: Hayashi Eye Hospital, Fukuoka, Japan. Methods: This study included 74 eyes with ACG and 68 eyes with OAG having cataract surgery. The IOP was measured and the number of glaucoma medications recorded preoperatively, 1 month postoperatively, and then every 3 months. The IOP control in the 2 groups was compared using survival analysis, with failure criteria being an IOP greater than 21 mm Hg, addition of medications, or the need for additional glaucoma surgery. Results: The mean IOP and number of medications decreased significantly after surgery in both groups ( P P = .0012). The IOP was controlled without medication in 30 eyes (40.5%) in the ACG group and 13 (19.1%) in the OAG group; the difference between groups was significant ( P = .0055). Conclusions: Cataract surgery substantially reduced IOP and the number of medications required for IOP control in glaucomatous eyes. Specifically, cataract extraction normalized the IOP in most eyes with ACG.

The Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy.

Abstract: OBJECTIVES To compare the risk of cataract formation in eyes with and without prior trabeculectomy and to assess other risk factors for cataract. METHODS The Advanced Glaucoma Intervention Study (AGIS) has been following 789 eyes in 591 patients with medically uncontrolled open-angle glaucoma. From 1988 to 1992, these eyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy treatment sequence or a trabeculectomy-ALT-trabeculectomy sequence. Cox regression analyses were used to assess risk factors for cataract formation during 7 to 11 years of follow-up. MAIN OUTCOME MEASURES Cataract, defined as either having had cataract surgery or confirmed severe lens opacity with a best-corrected Early Treatment Diabetic Retinopathy Study visual acuity score less than 65 letters (worse than 20/50). RESULTS Data are presented on the expected 5-year cumulative probability of cataract formation in each randomized sequence by age and presence of diabetes at study entry. Overall, approximately half of the eyes studied developed cataract. A first trabeculectomy, whether as the first or second AGIS intervention, increased the overall risk of cataract by 78% (risk ratio [RR] = 1.78; P<.001). Diabetes (RR = 1.47; P =.004) and age at study entry (RR = 1.07 per year of age; P<.001) were also risk factors for cataract. When postoperative complications of trabeculectomy were included in the analysis, the increased risk of cataract for eyes with a first trabeculectomy reduced to 47% when complications did not occur (RR = 1.47; P =.003) and increased to 104% when complications did occur (RR = 2.04; P<.001). Several specific postoperative complications of trabeculectomy were associated with increased risk of cataract, particularly marked inflammation (RR = 3.29; P<.001) and flat anterior chamber (RR = 1.80; P =.004). Trabeculectomy with complications was also significantly associated with an increased risk of cataract in each of 3 lens regions: nuclear, cortical, and posterior subcapsular. CONCLUSIONS In eyes of AGIS patients, after adjustment for age and diabetes, trabeculectomy increased the risk of cataract formation by 78%.

The value of routine preoperative medical testing before cataract surgery

Abstract: A BSTRACT Background Routine preoperative medical testing is commonly performed in patients scheduled to undergo cataract surgery, although the value of such testing is uncertain. We performed a study to determine whether routine testing helps reduce the incidence of intraoperative and postoperative medical complications. Methods We randomly assigned 19,557 elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of medical tests (electrocardiography, complete blood count, and measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose), in addition to a history taking and physical examination. Adverse medical events and interventions on the day of surgery and during the seven days after surgery were recorded. Results Medical outcomes were assessed in 9408 patients who underwent 9626 cataract operations that were not preceded by routine testing and in 9411 patients who underwent 9624 operations that were preceded by routine testing. The most frequent medical events in both groups were treatment for hypertension and arrhythmia (principally bradycardia). The overall rate of complications (intraoperative and postoperative events combined) was the same in the two groups (31.3 events per 1000 operations). There were also no significant differences between the no-testing group and the testing group in the rates of intraoperative events (19.2 and 19.7, respectively, per 1000 operations) and postoperative events (12.6 and 12.1 per 1000 operations). Analyses stratified according to age, sex, race, physical status (according to the American Society of Anesthesiologists classification), and medical history revealed no benefit of routine testing. Conclusions Routine medical testing before cataract surgery does not measurably increase the safety of the surgery. (N Engl J Med 2000;342:168-75.)

A Comparison of Grating Visual Acuity, Strabismus, and Reoperation Outcomes Among Children With Aphakia and Pseudophakia After Unilateral Cataract Surgery During the First Six Months of Life

Abstract: Purpose: The method of correcting aphakia after unilateral cataract extraction during infancy is controversial. Some authorities advocate correction with an intraocular lens (IOL) whereas others advocate correction with a contact lens (CL). We compared grating visual acuity, alignment, and reoperative outcomes in age-matched children treated with these 2 modalities at 5 clinical centers. Methods: Twenty-five infants born in 1997 or 1998 with a dense unilateral congenital cataract who had cataract surgery coupled with (IOL group, n = 12) or without (CL group, n = 13) primary IOL implantation were enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, and reoperation rates were assessed. Results: The mean grating visual acuity (LogMAR) for the affected eye was 0.70 ± 0.32 for the IOL group and 0.87 ± 0.31 for the CL group (P = .19). The mean interocular difference in grating visual acuity was 0.26 ± 0.30 for the IOL group and 0.50 ± 0.28 for the CL group (P = .048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P = .24). The incidence of reoperations was 83% in the IOL group compared with 23% in the CL group (P = .003). Conclusions: Our preliminary data suggest that correcting aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Study, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy. (J AAPOS 2001;5:70-5)

Posterior subcapsular and nuclear cataract after vitrectomy

Abstract: Purpose To examine the morphological changes in the postvitrectomy lens and to monitor the development of these changes over time. Setting Oxford Eye Hospital, Oxford, United Kingdom. Methods In this prospective study, 33 consecutive phakic patients having pars plana vitrectomy were recruited. Cataract development was quantified by clinical grading and digital Scheimpflug image analysis. Slitlamp biomicroscopy and photography were used to document the morphological appearance. The main outcome measures were the incidence, morphology, and development of posterior subcapsular and nuclear cataract. Results A characteristic, transient posterior subcapsular cataract (PSC) was present in 89% (17 of 19) of tamponade patients within 24 hours of surgery. Of the patients who had vitrectomy without tamponade, 9% (1 of 11) developed similar changes. Nuclear opacity developed in 61% (11 of 18) of tamponade patients and in 50% (3 of 6) of nontamponade patients. A longer term retrospective review of the same patients’ case notes revealed nuclear cataract in 67% (12 of 18) of tamponade cases and 30% (3 of 10) of nontamponade cases. Eighteen percent (2 of 11) of nontamponade cases and 67% (14 of 21) of tamponade cases had cataract surgery after a 10.7 month and a 12.4 month follow-up, respectively. Conclusions Vitrectomy and tamponade produced a characteristic transient PSC in the immediate postoperative period. Disruption of fluid balance in the region of the posterior lens was suggested by the morphological appearance. The acute changes resolved but were followed by accelerated nuclear opacification.

Refractive errors and incident cataracts: the Beaver Dam Eye Study.

Abstract: Purpose To describe the relation between refractive errors and incident age-related cataracts in a predominantly white US population Methods All persons aged 43 to 84 years of age in Beaver Dam, Wisconsin, were invited for a baseline examination from 1988 through 1990 and a follow-up examination 5 years later from 1993 through 1995 At both examinations, participants had refraction and photographic assessment of cataract, according to a standardized protocol Myopia was defined as a spherical equivalent of -10 diopters (D) or less, hyperopia as +10 D or more The relations between refractive errors at baseline and cataract at baseline (prevalent cataract), 5-year incident cataract, and incident cataract surgery were analyzed by using generalized estimating equations Results When age and gender were controlled for, myopia was related to prevalent nuclear cataract (odds ratio [OR], 167; 95% confidence interval [CI], 123-227), but not to cortical and posterior subcapsular cataracts Myopia was not related to 5-year incident nuclear, cortical, and posterior subcapsular cataracts, but was related to incident cataract surgery (OR 189; CI 118-304) Hyperopia was related to incident nuclear (OR 156; CI 125-195) and possibly cortical (OR 125; CI 096-163) cataracts, but not to posterior subcapsular cataract or cataract surgery After further adjustment for diabetes, smoking, and education, the association between myopia and incident cataract surgery was attenuated (OR 160; CI 096-264), but the associations between hyperopia and incident nuclear and cortical cataracts were unchanged Conclusions These data support the cross-sectional association between myopia and nuclear cataract seen in other population-based studies, but provide no evidence of a relationship between myopia and 5-year incident cataract Hyperopia may be related weakly to incident nuclear and cortical cataract

Cataract blindness and barriers to uptake of cataract surgery in a rural community of northern Nigeria

Abstract: Aims—A population based cross sectional survey was conducted to determine the magnitude of cataract blindness and the barriers to uptake of cataract services in a rural community of northern Nigeria. Methods—1461 people out of 1924 registered eligible people were examined. The study population was chosen by two stage cluster random sampling. In the first sampling stage 15 villages were randomly chosen while in the final stage 170 people who were 40 years and over were selected in each village. Each selected person had visual acuity recorded for both eyes. Those with vision of less than 3/60 in the better eye were assessed for cataract. People with cataract were asked why they had not sought medical attention. Results—A blindness prevalence of 8.2% (95% CI 5.8%‐10.5%) was found among the sampled population. Cataract was responsible for 44.2% of the blindness. Thus, a cataract blindness prevalence of 3.6% was found. The cataract surgical coverage (people) was 4.0% and the couching coverage (people) was 18%. The main barrier to seeking cataract surgery was cost of the service (61%). Conclusion—Some regions of the world still have high burden of cataract blindness that needs attention. Such areas need an eVective free cataract outreach programme. (Br J Ophthalmol 2001;85:776‐780)

Risk factors for late-onset infection following glaucoma filtration surgery.

Abstract: Objective To determine the risk factors for late-onset infection following glaucoma filtration surgery. Methods We performed a case-control study comparing 131 cases of late-onset infection collected from 27 surgeons at 10 centers with 500 controls matched for date of surgery and surgeon. The criterion for the presence of infection was severe anterior chamber reaction occurring later than 4 weeks after surgery. An opaque bleb and positive culture results were not required for diagnosis. Risk factors were identified by univariate and multivariate logistic regression analyses. Results Some of the risk factors that were statistically significant in the multivariate model after adjusting for age, race, and sex were (1) performance of a full-thickness rather than a guarded procedure (risk ratio [RR], 13.1; 95% confidence interval [CI], 2.12-80.9), (2) filtration surgery performed without concurrent cataract surgery (RR, 2.25; 95% CI, 1.24-4.08), (3) use of mitomycin (RR, 2.48; 95% CI, 1.06-5.83), (4) intermittent use of antibiotics after surgery (RR, 2.10; 95% CI, 1.09-4.02), and (5) continuous use of antibiotics after surgery (RR, 5.94; 95% CI, 2.09-16.9). Conclusions Eyes undergoing full-thickness procedures or filtration surgery without cataract extraction are at increased risk for late infection. Intraoperative mitomycin and episodic or continuous antibiotic use after the postoperative period are associated with an increased risk of infection.

Accuracy and predictability of intraocular lens power calculation after laser in situ keratomileusis.

Abstract: Purpose To study the accuracy and predictability of intraocular lens (IOL) power calculation in eyes that had laser in situ keratomileusis (LASIK). Setting Gimbel Eye Centre, Calgary, Alberta, Canada. Methods Refractive outcomes in 6 cataract surgery and lensectomy eyes after previous LASIK were analyzed retrospectively. Target refractions based on measured and refraction-derived keratometric values were compared with postoperative achieved refractions. Differences between target refractions calculated using 5 IOL formulas and 2 A-constants and achieved refractions were also compared. Results The refractive error of IOL power calculation in postoperative LASIK eyes was significantly reduced when refraction-derived keratometric values were used for IOL power calculation. Persistent residual hyperopia still occurred in some cases; this was corrected by hyperopic LASIK. Refractive results appeared more accurate and predictable when the Holladay 2 or Binkhorst 2 formula was used for IOL power calculation. Conclusion Hyperopic error after cataract surgery in post-LASIK eyes was significantly reduced by using refraction-derived keratometric values for IOL power calculation. Persistent hyperopic error was corrected by hyperopic LASIK.

Corneal melts associated with topically applied nonsteroidal anti-inflammatory drugs.

Abstract: Purpose: Topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to prevent miosis during cataract surgery, to treat ocular allergies, to prevent excessive postoperative inflammation following cataract surgery, and to treat cystoid macular edema following cataract surgery. They have also been used to control pain and photophobia following radial keratotomy and excimer laser photorefractive keratectomy. During August of 1999, severe complications following topical NSAID use, including corneal melting, were reported by members of the American Society of Cataract and Refractive Surgery (ASCRS) responding to a survey distributed in letters from ASCRS to its members. The purpose of this report is to review 11 cases of corneal melting in patients treated with topical NSAIDs, with special attention to the observed toxicity and its relationship to dose and duration of treatment, coexistent disease and therapies, and the indication for treatment. The goal of this study is to identify factors useful in minimizing the occurrence of corneal toxicity. Methods: The medical records and/or histories of 11 patients with corneal melting associated with the use of topical NSAIDs are reviewed, with special attention to the indication for treatment, the dose and duration of treatment, and coexistent diseases and medical treatments. In addition, the relationship between NSAID treatment and surgery and between NSAID treatment and onset and extent of corneal toxicity are described. Results: Each of the 11 patients appeared to suffer severe corneal toxicity following the topical use of 0.5% diclofenac ophthalmic solution. Generic diclofenac (Falcon) (Alcon Laboratories, Inc, Fort Worth, Texas) was associated with 7 and Voltaren (Ciba Vision, Atlanta, Georgia) with 4 of these cases. Duration of treatment prior to corneal melting varied from 6 days to 17 months. Associated ocular and systemic diseases and their respective treatments complicate the analysis of these cases. In addition, the indication for treatment with topical NSAIDs was frequently unclear. Conclusions: The inconsistent and variable dose-toxicity relationships suggest that coexistent factors other than a simple drug toxicity are implicated, if not causative, in NSAID-associated corneal melting. These cases demonstrate the importance of making a clinical diagnosis before treatment and of following the clinical course of patients carefully during treatment.

Visual outcome following posterior capsule rupture during cataract surgery

Abstract: AIM—To determine the relative risk of a poor visual outcome following posterior capsule rupture during cataract surgery. METHODS—Prospective data were collected on consecutive eyes undergoing cataract extraction. The patient's age, preoperative visual acuity, ocular comorbidity, grade of surgeon, and operative complications were documented. The best spectacle corrected visual acuity was recorded at discharge from the hospital service. RESULTS—From a total of 1533 cases, 1420 (92.6%) eyes had complete follow up data. Posterior capsule rupture occurred in 59 (4.1%) cases. Eyes with posterior capsule rupture were 3.8 times more likely to have a final best spectacle corrected visual acuity less than 6/12. CONCLUSIONS—Eyes having posterior capsule rupture during cataract surgery have a significant risk of reduced visual acuity.

Quality of life after first- and second-eye cataract surgery: five-year data collected by the Swedish National Cataract Register.

Abstract: Purpose: To study the benefits of surgery and satisfaction with vision after first- and second-eye cataract surgery in comparable groups of patients. Setting: Clinics participating in the Swedish National Cataract Outcome Study from 1995 to 1999. Methods: A prospective observational study evaluated patients’ self-assessed visual function and satisfaction with vision before and 6 months after cataract extraction. Patients who had another cataract surgery in the fellow eye during the 6-month study were excluded. Data of 8595 patients having cataract extraction at participating clinics during the month of March for 1995 to 1999 were collected. Preoperative and intraoperative data were reported at the time of surgery. Final postoperative visual acuity was recorded. The Catquest questionnaire was completed before surgery and 6 months after surgery. Results: First-eye surgery was performed in 5570 patients and second-eye surgery, in 3025. Patient-assessed benefits of surgery and satisfaction with vision as defined by the Catquest was higher after second-eye surgery (P < .001). The outcomes were studied in detail in patients with equal visual acuity in the fellow eye before and after surgery and without ocular comorbidity. The better outcome after second-eye surgery was most pronounced in patients with good or intermediate visual acuity in the fellow eye. Conclusion: The self-assessed visual outcomes and satisfaction with vision were better after second-eye surgery than after first-eye surgery in comparable groups of patients.

Intra-ocular lens calculation status after corneal refractive surgery.

Abstract: The transition from incisional methods such as radial keratotomy (RK) to excimer laser surgery, eg, photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) has dramatically increased the volume of corneal refractive surgery performed worldwide in recent years. As the current younger generation of patients who have undergone refractive surgery ages, we can assume that the presently small number of postrefractive patients requiring cataract surgery and intraocular lens implantation will increase correspondingly. This article addresses the problems encountered with calculating intraocular lens power after corneal refractive procedures. Starting with a description of keratometry in normal eyes, the causes of evident mismeasurements and miscalculation of the corneal power after keratorefractive surgery will be discussed, and different approaches to improving IOL power prediction will be described.

Results of cataract surgery in young children in east Africa.

Abstract: BACKGROUND Cataract is the leading cause of blindness in children in east Africa. The results of surgery are poor, partly because of inadequate correction of aphakia. METHODS A retrospective survey of 118 eyes in 71 children with bilateral cataract. All eyes had implantation of an IOL at the time of cataract surgery. The average age at surgery was 3.5 years. 28 patients(39%) were less than 2 years old at the time of surgery on their first eye. RESULTS Preoperatively, 75.4% of eyes and 76.1% of patients were blind. A follow up of at least 3 months was available in 91 (77.1%) eyes. In these eyes, 44% had a latest corrected vision of 6/18 or better and 91.2% had a latest corrected vision of 6/60 or better. Eyes with zonular cataract, and eyes operated after the age of 2 years were more likely to obtain a vision of 6/18 or better. 3.3% of eyes and 1.8% of patients had an acuity of less than 3/60. Nystagmus was present in 42.3% of patients before surgery. In those patients followed up for a minimum of 6 months, 10.2% still had nystagmus. The most frequent complication was severe fibrinous uveitis, which occurred in 36 (30.5%) eyes. 62 (52.5%) eyes had a posterior capsulotomy at the time of cataract extraction. Of the remaining 56 eyes, 20 (35.7%) had so far required a posterior capsulotomy. The leading cause of poor visual outcome was amblyopia. Two patients developed severe complications related to the intraocular lens. CONCLUSIONS Insertion of a lens implant at the time of cataract extraction appears to be well tolerated in the short term, and may offer significant advantages in an African setting.

Visual outcomes and complications of posterior chamber intraocular lens implantation in the first year of life.

Abstract: Purpose: To document the visual outcome and postoperative complications in infants who had congenital cataract surgery with posterior chamber intraocular lens (PC IOL) implantation in the first year of life. Setting: The Children's Hospital, Dublin, Ireland. Methods: Twenty-seven eyes of 20 infants were reviewed. Seven infants (14 eyes) had bilateral congenital cataract and 13 (13 eyes), uniocular cataract. The mean age at surgery was 4 months (range 3 weeks to 11 months). A standard surgical technique involved anterior capsulorhexis, phacoemulsification with or without posterior capsulorhexis with in-the-bag PC IOL implantation, and no anterior vitrectomy. Surgery was performed by 1 surgeon. The mean follow-up was 41 months (range 6 to 88 months). Results: The main complication was lens reproliferation into the visual axis. Of the 11 eyes that did not have a primary posterior capsulorhexis, 10 had 1 or more capsulotomies. Seven required a neodymium:YAG (Nd:YAG) laser capsulotomy a mean of 6 months postoperatively, and 2 had 2 Nd:YAG capsulotomies. Six eyes also had a surgical capsulotomy when the membrane was deemed too thick for further laser treatment. Fourteen of 25 eyes had a primary posterior capsulorhexis; 8 had no further intervention. Four eyes had persistent hyperplastic primary vitreous (PHPV), 3 required a surgical capsulotomy, 2 had an Nd:YAG laser capsulotomy, 2 had an anterior vitrectomy, and 1 developed open-angle glaucoma. There was a mean refractive shift of 6.0 diopters after a mean follow-up of 41 months, with most of the myopic shift occurring in the first 24 months. Conclusions: Visual axis reopacification was the main complication of IOL implantation in infants, with PHPV leading to more complications and repeat procedures. Anterior vitrectomy appeared to reduce the reoperation rate. Results indicate that primary posterior capsulorhexis is important and Nd:YAG capsulotomy is not satisfactory in infants. In addition, the reduction in glaucoma with IOL implantation, if borne out over the long term, is a significant advantage in cases of congenital cataract.

Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome.

Abstract: Purpose To determine the intraocular pressure (IOP) response to phacoemulsification cataract extraction with posterior chamber intraocular lens (PC IOL) implantation in patients with pseudoexfoliation syndrome. Setting Eye clinics at the University of Ottawa Eye Institute, Ottawa, Ontario, Canada. Methods A retrospective cohort study design assigned patients to 1 of 3 subgroups: pseudoexfoliation syndrome (PEX) (n = 21), primary open-angle glaucoma (POAG) control (n = 23), and cataract control (n = 23). Inclusion criteria consisted of age older than 50 years, open angle by gonioscopy, and a cataract requiring phacoemulsification. The IOP response was determined at intervals up to 18 months. Results Postoperative IOP changes from baseline in the PEX group were –1.81, –4.52, and –2.31 mm Hg at 3, 6, and 12 months, respectively. The changes in the POAG control group were –2.22, –2.32, and –1.88 mm Hg, respectively, and in the cataract control group, –2.49, +0.45, and +0.28 mm Hg. Patients in the PEX group had a reduction in IOP from baseline at all postoperative measurements. That reduction was significantly greater than in the POAG and cataract control groups at 6 months ( P = .012 and P = .002, respectively) and 12 months ( P = .001 and P = .050, respectively). Conclusions Patients with pseudoexfoliation syndrome had a postoperative IOP reduction from baseline at all measurements and a significantly greater reduction than patients in the POAG and cataract control groups at 6 and 12 months. Phacoemulsification cataract surgery with PC IOL implantation may be effective in managing patients with pseudoexfoliation syndrome who have elevated IOP and visually significant cataract but no advanced optic nerve damage.

Control of intra-ocular inflammation associated with cataract surgery.

Abstract: Postoperative ocular inflammation following cataract surgery is related to the risk of complications like corneal edema, intraocular pressure spikes, cystoid macular edema, and posterior capsule opacification. The degree of postoperative inflammation following cataract surgery is linked to several surgery-dependent factors such as surgical technique, intraocular lens type, and also patient-dependent factors such as history of inflammatory disease and degree of iris pigmentation. During the past decade, major advances have occurred in cataract surgery techniques, equipment, and pharmacologic strategies that decrease the degree of postoperative inflammation following cataract surgery and reduce patients' risk for inflammation-related complications. This article reviews the most recent literature regarding the control of cataract surgery-induced intra-ocular inflammation.

Phacovitrectomy without prone posture for full thickness macular holes

Abstract: AIMS—To investigate the role of phacovitrectomy surgery without prone posture for stage 2 and 3 macular holes. METHODS—A pilot study was performed on 20 patients (20 eyes) having phacoemulsification lens removal and vitrectomy surgery with 20% C2F6 tamponade. Patients were advised to avoid lying on their backs for 10 days following surgery but no other posturing instructions were given. Closure rates and improvement in visual acuity were compared with a group of historical controls in whom phacovitrectomy with gas tamponade and face down posturing was performed. RESULTS—Anatomical hole closure was noted in 18 of the 20 eyes (90%). 19 eyes (95%) showed an improvement of at least 0.3 logMAR units. This compares favourably with the postured group in which anatomical hole closure was noted in 11 of 13 eyes (85%) and nine of 13 eyes (69%) showed an improvement of at least 0.3 logMAR units. CONCLUSION—Combined surgery facilitates the use of a large gas bubble. Sufficient tamponade of the hole occurs for closure without prone posturing. Combined surgery prevents patients posturing and returning for cataract surgery.

1998 European cataract outcome study: Report from the European Cataract Outcome Study Group

Abstract: Purpose: To collect clinical data on cataract surgery to allow participating surgeons to compare their performance with that of their colleagues in an anonymous manner. Setting: Surgeons from 31 surgical units providing cataract surgery in 13 European countries. Methods: Every patient at each participating unit having surgery during 1 study month was evaluated. Data were reported to the coordinating center at the time of surgery and at the final examination. When the study was closed 6 months after surgery, all participants were provided with the outcomes from their own patients so they could compare them with outcomes from other centers. Results: The study included preoperative and intraoperative data on 2950 patients. Complete follow-up data were available for 2731 patients. The surgical audit included surgically induced astigmatism, proximity of target refraction, and the frequency of major complications. For each variable, a large variation in outcome between participating centers was found. Most centers had results both above and below average for different variables. Conclusion: Cataract surgery data collected from 31 units in 13 European countries allowed participants to compare their performance with that of their colleagues in an anonymous manner. Significant variation was found in the outcomes among the units, with many units reporting results above and below the averages.

Accuracy of intraocular lens power calculation in paediatric cataract surgery.

Abstract: Aims—To determine the accuracy of intraocular lens (IOL) power calculation in a group of pseudophakic children. Methods—A retrospective analysis of biometric and refractive data was performed on 52 eyes of 40 infants and children, who successfully underwent cataract extraction and IOL implantation. The following parameters were included: age at the time of surgery, keratometry, axial length, estimated refraction, and the power of IOL implanted. The postoperative refractive outcome was taken as the spherical equivalent of the refraction at 3 months after surgery. The prediction error was taken as the absolute diVerence between the estimated and actual postoperative refraction. The data were analysed to assess the eVects of age at the time of surgery, keratometry, and axial length on the accuracy of calculation of IOL power. Results—For the overall group the mean and median prediction errors were 1.40 D and 0.84 D (SD 1.60). The mean and median prediction errors in eyes with axial lengths >20 mm were 1.07 D and 0.71 D (SD 0.98) and in eyes 36 months were 1.06 D and 0.68 D (SD 1.02) and in children aged <36 months was 2.56 D and 2.29 D (SD 2.50). The diVerences between the prediction errors for both axial length and age were statistically significant (p<0.05). Conclusions—For the overall group IOL power calculation is satisfactory. In eyes with axial lengths less than 20 mm and in children less than 36 months of age larger errors can arise. This study demonstrates the need for an IOL formula specifically designed for paediatric use. (Br J Ophthalmol 2001;85:939‐941)