Showing papers on "Cataract surgery published in 2003"
TL;DR: In this paper, an intraocular lens (IOL) with a modified anterior surface designed to compensate for the positive spherical aberration of the cornea in eyes of cataract patients results in improved pseudophakic quality of vision.
Abstract: Purpose To determine whether implantation of an intraocular lens (IOL) with a modified anterior surface designed to compensate for the positive spherical aberration of the cornea in eyes of cataract patients results in improved pseudophakic quality of vision. Setting Department of Ophthalmology, Bundesknappschaft’s Hospital, Sulzbach, Germany. Methods In an intraindividual randomized study of 45 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9000, Pharmacia) was compared with a biconvex lens with spherical surfaces (SI-40, Allergan). All patients had bilateral cataract surgery; in 1 eye the Z9000 IOL was implanted and in the other, the SI-40 IOL. After 1 and 3 months, the following investigations were performed: assessment of the anterior and posterior segments including IOL decentration and tilt, pupil size, high- and low-contrast visual acuities, photopic and mesopic contrast sensitivities, and wavefront aberration of the cornea and eye. Results Thirty-seven patients were examined at all follow-up visits. Although the eyes with the Z9000 IOL had significantly better best corrected visual acuity after 3 months, the improved quality of vision was more apparent when assessing low-contrast visual acuity and contrast sensitivity. Wavefront measurements revealed no significant spherical aberration in eyes with a Z9000 IOL but significantly positive spherical aberration in eyes with an SI-40 IOL. Conclusions The clinical results confirm the theoretical preclinical calculations that the spherical aberration of the eye after cataract surgery can be eliminated by modifying the anterior surface of the IOL. The Tecnis Z9000 lens compensates for the positive spherical aberration in older eyes. This leads to a significant improvement, particularly in contrast sensitivity and mesopic visual quality.
269 citations
TL;DR: The findings suggest that a temporal corneal incision may lead to an increased risk of postoperative endophthalmitis and that the IOL material does not affect the incidence of this complication.
Abstract: Purpose To determine whether endophthalmitis after small-incision cataract surgery is affected by the incision site (superior sclerocorneal versus temporal cornea) or the foldable intraocular lens (IOL) material (silicone versus acrylic) Setting Multicenter study Methods Patients who had small-incision cataract surgery at Toyama Medical and Pharmaceutical University Hospital and affiliated hospitals from March 1998 to March 2001 were examined prospectively The patients were randomized into 3 groups In Group A, an acrylic IOL (MA60BM, Alcon) was implanted through a temporal corneal incision In Group B, an acrylic IOL (MA60BM) was implanted via a superior sclerocorneal incision In Group C, a silicone poly(methyl methacrylate) IOL (SI-40NB, Allergan) was implanted via a superior sclerocorneal incision Each patient was followed for more than 6 months Results Initially, 7622 patients (12 317 eyes) agreed to participate in the study The final study included 3831 eyes in Group A, 3901 eyes in Group B, and 3863 eyes in Group C Postoperative endophthalmitis was diagnosed clinically in 11 eyes (029%) in Group A, 2 (005%) in Group B, and 2 (005%) in Group C Endophthalmitis proven by culture was found in 9 eyes in Group A, 2 in Group B, and 2 in Group C The incidence of endophthalmitis in Group A was higher than in the other groups The incidence of endophthalmitis in Group B was similar to that in Group C The relative risk of postoperative endophthalmitis proven by culture in Groups B and C was 46 times (P = 037) lower than in Group A Conclusion The findings suggest that a temporal corneal incision may lead to an increased risk of postoperative endophthalmitis and that the IOL material does not affect the incidence of this complication
239 citations
TL;DR: In this article, the authors assess whether cataract surgery in older persons increases risk for the development of late-stage age-related maculopathy (ARM) using longitudinal data from two population-based cohorts, the Beaver Dam Eye Study and Blue Mountains Eye Study.
207 citations
TL;DR: The risk of pseudophakic retinal detachment appears to be increased in myopic patients, in those patients in whom vitreous loss had occurred at the time of cataract surgery, and in patients undergoing Nd:YAG posterior capsulotomy.
193 citations
TL;DR: The risks of medical and ophthalmic events surrounding cataract surgery were so low that absolute differences in risk associated with changes in routine anticoagulant or antiplatelet use were minimal.
179 citations
TL;DR: Clear corneal incisions were found to be a statistically significant risk factor for acute post-cataract surgery endophthalmitis when compared with scleral tunnel incisions.
174 citations
TL;DR: IOLMaster optical biometry improves the refractive results of selected cataract surgery patients and is more accurate than applanation ultrasound biometry.
Abstract: Aims: To study the refractive outcome of cataract surgery employing IOLMaster biometry data and to compare it with that of applanation ultrasonography in a prospective study of 100 eyes that underwent phacoemulsification with intraocular lens implantation.
Methods: The Holladay formula using IOLMaster data was employed for the prediction of implanted intraocular lenses (IOLs). One month after cataract surgery the refractive outcome was determined. Preoperative applanation ultrasonography data were used retrospectively to calculate the IOL prediction error. The two different biometry methods are compared.
Results: 100 patients, 75.42 (SD 7.58) years of age, underwent phacoemulsification with IOL implantation. The optical axial length obtained by the IOLMaster was significantly longer (p<0.001, Student’s t test) than the axial length by applanation ultrasound, 23.36 (SD 0.85) mm v 22.89 (0.83) mm. The mean postoperative spherical equivalent was 0.00 (0.40) D and the mean prediction error −0.15 (0.38) D. The mean absolute prediction error was 0.29 (0.27) D. 96% of the eyes were within 1 D from the intended refraction and 93% achieved unaided visual acuity of 6/9 or better. The Holladay formula performed better than the SRK/T, SRK II, and Hoffer Q formulas. Applanation ultrasonography after optimisation of the surgeon factor yielded a greater absolute prediction error than the optimised IOLMaster biometry, 0.41 (0.38) D v 0.25 (0.27) D, with 93% of the eyes within 1 D from the predicted refraction.
Conclusion: IOLMaster optical biometry improves the refractive results of selected cataract surgery patients and is more accurate than applanation ultrasound biometry.
171 citations
TL;DR: Findings support the use of the NEI-VFQ as a measure of vision-targeted, health-related quality of life among patients with age-related macular degeneration, cataract, or reduced visual acuity.
Abstract: Objectives To describe the vision-targeted, health-related quality of life, measured with the National Eye Institute Visual Function Questionnaire (NEI-VFQ), in patients with age-related macular degeneration, cataract, or reduced visual acuity; to determine the relationship between the NEI-VFQ subscale scores and clinical measures of visual function; and to assess the internal consistency and reliability of the NEI-VFQ subscales. Design The 39-item NEI-VFQ was administered at the 5-year clinic visit to 4077 Age-Related Eye Disease Study participants. Results The subscales of the NEI-VFQ had moderate to high internal consistency(Cronbach's α = 0.58-0.91). The NEI-VFQ scores for participants with advanced age-related macular degeneration in 1 or both eyes, severe nuclear opacity, reduced visual acuity, or cataract surgery generally were lower than scores for disease-free participants ( P Conclusion These findings support the use of the NEI-VFQ as a measure of vision-targeted, health-related quality of life among patients with age-related macular degeneration, cataract, or reduced visual acuity.
167 citations
TL;DR: Age related cataracts are associated with a variety of risk factors among Chinese people in Singapore, similar to those reported in European, Indian, and African derived populations, and these data support common aetiological mechanisms for age relatedCataracts, irrespective of ethnic origin.
Abstract: Aim: To describe risk factors for nuclear, cortical, and posterior subcapsular (PSC) cataracts in Chinese Singaporeans. Methods: A population based cross sectional study was carried out on ethnic Chinese men and women aged 40–81 years. A stratified, clustered, disproportionate (more weights to older people), random sampling procedure was used to initially select 2000 Chinese names of those aged 40–79 years from the 1996 electoral register in the Tanjong Pagar district in Singapore. Eligible subjects (n = 1717) were invited for a standardised ocular examination and interview at a centralised clinic, following which an abbreviated examination was conducted for non-respondents in their homes. Cataract was graded clinically using to the Lens Opacity Classification System (LOCS) III system. The main outcome measures were adjusted odds ratio for risk factors for specific cataract types (nuclear, cortical and PSC), any cataract and cataract surgery, examined in multiple logistic regression models. Results: Out of the 1232 (71.8%) examined, 1206 (70.2%) provided lens data for this analysis. Increasing age was associated with all cataract types, any cataract, and cataract surgery. There was no significant sex difference in presence of any cataract, specific cataract types or cataract surgery. After controlling for age, sex, and other factors, diabetes was associated with cortical cataract (3.1; 95% CI: 1.6 to 6.1), PSC cataract (2.2; 95% CI 1.2 to 4.1), any cataract (2.0; 95% CI: 0.9 to 4.5), and cataract surgery (2.3; 95% CI: 1.3 to 4.1). Lower body mass index was associated with cortical cataract (1.8; 95% CI: 1.1 to 2.9; lowest versus highest quintile) and any cataract (2.3; 95% CI: 1.3 to 4.0). Current cigarette smoking was associated with nuclear cataract (1.7, 95% CI: 1.0 to 2.9; more than 10 cigarettes per day versus none). A non-professional occupation was associated with nuclear cataract (2.9; 95% CI: 1.5 to 5.8; for production or machine operators and 2.6; 95% CI: 1.2 to 5.5; for labourers or agricultural workers, both versus professionals). Lower education was associated with nuclear cataract (2.3; 95% CI: 1.0 to 5.2, none versus tertiary), while lower household income was associated with PSC cataract (4.7, 95% CI: 1.1 to 20.0; income S$4000). Conclusions: Age related cataracts are associated with a variety of risk factors among Chinese people in Singapore, similar to those reported in European, Indian, and African derived populations. These data support common aetiological mechanisms for age related cataracts, irrespective of ethnic origin.
158 citations
TL;DR: Computer simulations and in vitro measurements show that tilts and decentrations might be contributors to the increased third-order aberrations in vivo in comparison with in vitroMeasurements found good agreement among in vivo, in vitro, and simulated measures of spherical aberration.
Abstract: Corneal and ocular aberrations were measured in a group of eyes before and after cataract surgery with spherical intraocular lens (IOL) implantation by use of well-tested techniques developed in our laboratory. By subtraction of corneal from total aberration maps, we also estimated the optical quality of the intraocular lens in vivo. We found that aberrations in pseudophakic eyes are not significantly different from aberrations in eyes before cataract surgery or from previously reported aberrations in healthy eyes of the same age. However, aberrations in pseudophakic eyes are significantly higher than in young eyes. We found a slight increase of corneal aberrations after surgery. The aberrations of the IOL and the lack of balance of the corneal spherical aberrations by the spherical aberrations of the intraocular lens also degraded the optical quality in pseudophakic eyes. We also measured the aberrations of the IOL in vitro, using an eye cell model, and simulated the aberrations of the IOL on the basis of the IOL's physical parameters. We found a good agreement among in vivo, in vitro, and simulated measures of spherical aberration: Unlike the spherical aberration of the young crystalline lens, which tends to be negative, the spherical aberration of the IOL is positive and increases with lens power. Computer simulations and in vitro measurements show that tilts and decentrations might be contributors to the increased third-order aberrations in vivo in comparison with in vitro measurements.
154 citations
TL;DR: This overview presents the current knowledge of the mechanical properties of the human lens capsule on basis of its structure and its role in accommodation and cataract surgery.
TL;DR: There are an estimated 650 000 blind adults aged 30 and over in Bangladesh, the large majority of whom are suffering from operable cataract, indicating the need for the development and implementation of a national plan for the delivery of effective eye care services.
Abstract: Aim: To determine the age, sex, and cause specific prevalences of blindness and visual impairment in adults 30 years of age and older in Bangladesh.
Methods: A nationally representative sample of 12 782 adults 30 years of age and older was selected based on multistage, cluster random sampling with probability proportional to size procedures. The breakdown of the cluster sites was proportional to the rural/urban distribution of the national population. The examination protocol consisted of an interview, visual acuity (VA) testing, autorefraction, and optic disc examination on all subjects. Corrected VA retesting, cataract grading, and a dilated fundal examination were performed on all visually impaired subjects. The definitions of blindness (<3/60) and low vision (<6/12 to ≥3/60) were based on the presenting visual acuity in the better eye. The World Health Organization/Prevention of Blindness proforma and its classification system for identifying the main cause of low vision and blindness for each examined subject was used.
Results: In total, 11 624 eligible subjects were examined (90.9% response rate) across the 154 cluster sites. A total of 162 people were bilaterally blind (1.53% age standardised prevalence) while a further 1608 subjects (13.8%) had low vision ( 6/12 in the “better eye” in the remaining 9854 subjects (84.8%); however, 748 of these people had low vision in the fellow eye. The main causes of low vision were cataract (74.2%), refractive error (18.7%), and macular degeneration (1.9%). Cataract was the predominant cause (79.6%) of bilateral blindness followed by uncorrected aphakia (6.2%) and macular degeneration (3.1%).
Conclusions: There are an estimated 650 000 blind adults (95% CI 552 175 to 740 736) aged 30 and over in Bangladesh, the large majority of whom are suffering from operable cataract. This survey indicates the need for the development and implementation of a national plan for the delivery of effective eye care services, aimed principally at resolving the large cataract backlog and the inordinate burden of refractive error.
TL;DR: Results show that MSICS and ECCE are both safe and effective techniques for treatment of cataract patients in community eye care settings, but MSICS needs similar equipment to E CCE, but gives better uncorrected vision.
Abstract: Aim: To study “manual small incision cataract surgery (MSICS)” for the rehabilitation of cataract visually impaired and blind patients in community based, high volume, eye hospital setting; to compare the safety and effectiveness of MSICS with conventional extracapsular cataract surgery (ECCE).
Methods: In a single masked randomised controlled clinical trial, 741 patients, aged 40–90 years, with operable cataract were randomly assigned to receive either MSICS or ECCE and operated upon by one of eight participating surgeons. Intraoperative and postoperative complications were graded and scored according to the Oxford Cataract Treatment and Evaluation Team recommendations. The patients were followed up at 1 week, 6 weeks, and 1 year after surgery and their visual acuity recorded.
Results: This paper reports outcomes at 1 and 6 weeks. 706 of the 741(95.3%) patients completed the 6 week follow up. 135 of 362 (37.3%) of ECCE group and 165 of 344 (47.9%) of MSICS group had uncorrected visual acuity of 6/18 or better after 6 weeks of follow up. 314 of 362 (86.7%) of ECCE group and 309 of 344 (89.8%) of MSICS group had corrected postoperative vision of 6/18 or better. Four of 362 (1.1%) of ECCE group and six of 344 (1.7%) of MSICS group had corrected postoperative visual acuity less than 6/60. There were no significant differences between the two groups for intraoperative and severe postoperative complications.
Conclusion: MSICS and ECCE are both safe and effective techniques for treatment of cataract patients in community eye care settings. MSICS needs similar equipment to ECCE, but gives better uncorrected vision.
TL;DR: A history of cataract surgery was associated with an increased prevalence of late AMD in all three data sets after adjusting for age, race, sex, and smoking, but odds ratios were not individually statistically significant.
TL;DR: Second-eye cataract surgery is an extremely cost-effective procedure when compared with other interventions across medical specialties and the cost-effectiveness of second-eye surgery diminishes only slightly from the 2023 US dollars per QALY gained from first-eyes cataracts surgery.
TL;DR: Intracameral mydriatics were a rapid, effective, and safe alternative to topicalMydriatics in phacoemulsification and can simplify preoperative routines and in certain high‐risk groups, may reduce the risk for cardiovascular side effects.
Abstract: PURPOSE: To evaluate intracameral injection of mydriatics in phacoemulsification cataract surgery and compare the results with those of conventional topical mydriatics. SETTING: Department of Clini ...
TL;DR: Rapid recovery of good vision can be achieved with sutureless manual ECCE at low cost in areas where there is a need for high volume cataract surgery.
Abstract: Aim: To report the short and medium term outcome of a prospective series of sutureless manual extracapsular cataract extractions (ECCE) at a high volume surgical centre in Nepal.
Methods: Cataract surgery was carried out, on eyes with no co-existing diseases, in 500 consecutive patients who were likely to return for follow up. The technique involved sclerocorneal tunnel, capsulotomy, hydrodissection, nucleus extraction with a bent needle tip hook, and posterior chamber intraocular lens (PC-IOL) implantation according to biometry findings. Surgical complications, visual acuity at discharge, 6 weeks, and 1 year follow up, and surgically induced astigmatism are reported.
Results: The uncorrected visual acuity at discharge was 6/18 or better in 76.8% of eyes, and declined to 70.5% at 6 weeks’ follow up, and 64.9% at 1 year. The best corrected visual acuity was 6/18 or better in 96.2% of eyes at 6 weeks and in 95.9% at 1 year. Poor visual outcome (<6/60) occurred in less than 2%. Intraoperative complications included 47 (9.4%) eyes with hyphaema, and one eye (0.2%) with posterior capsule rupture and vitreous in the anterior chamber. Surgery led to an increase in against the rule astigmatism, which was the major cause of uncorrected visual acuity less than 6/18. Six weeks postoperatively, 85.5% of eyes had against the rule astigmatism, with a mean induced cylinder of 1.41 D (SD 0.8). There was a further small increase in against the rule astigmatism of 0.66 D (SD 0.41) between 6 weeks and 1 year. The mean duration of surgery was 4 minutes and the average cost of consumables, including the IOL, was less than $10.
Conclusion: Rapid recovery of good vision can be achieved with sutureless manual ECCE at low cost in areas where there is a need for high volume cataract surgery. Further work is required to reduce significant postoperative astigmatism, which was the major cause of uncorrected acuity less than 6/18.
TL;DR: Endophthalmitis caused by P. aeruginosa is associated with poor visual outcomes despite prompt treatment with intravitreal antibiotics to which the organisms were sensitive.
TL;DR: The most significant long-term complication after ICL implantation is the formation of opacifications of the crystalline lens with the risk of the necessity of subsequent cataract surgery (10.7%).
TL;DR: Differences in the water content of the hydrophilic acrylic materials used in the manufacture of these three lens designs may be responsible for the different patterns of calcium precipitation.
Abstract: Purpose To report and compare clinical and pathological features of hydrophilic acrylic intraocular lenses (IOLs) of three major designs, explanted from patients who had visual disturbances caused by opacification of the lens optic. Methods Eighty-seven hydrophilic acrylic IOLs (25 HydroviewTM, 54 SC60B-OUV, and 8 Aqua-SenseTM lenses) were explanted and sent to our center. Most patients became symptomatic during the second year after cataract surgery. A fine granularity was observed on the surface of the lens optic in the case of HydroviewTM. With the SC60B-OUV and Aqua-SenseTM lenses, the opacity resembled a nuclear cataract. Gross examination, light microscopy and staining with alizarin red and the von Kossa method (for calcium) were performed. Some lenses were submitted for scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Results Light microscopic and SEM analyses revealed the presence of irregular granular deposits on the external optical surfaces of HydroviewTM lenses. With the SC60B-OUV lenses, the opacity was caused by the presence of multiple fine, granular deposits within the lens optic, distributed in a line parallel to the anterior and posterior curvatures of the optic, with a clear zone just beneath its external surfaces. The Aqua-SenseTM lenses exhibited both patterns simultaneously. The deposits in all cases stained positive with alizarin red and von Kossa method. EDS also demonstrated the presence of calcium and phosphates within the deposits. Conclusion Differences in the water content of the hydrophilic acrylic materials used in the manufacture of these three lens designs may be responsible for the different patterns of calcium precipitation. Careful clinical follow up of patients implanted with these lenses is necessary to determine if this phenomenon is rare and sporadic or may be more widespread.
TL;DR: For patients with diabetic retinopathy who survived, aggressive follow-up, with treatment when indicated, seems to be associated with maintenance of good long-term visual acuity for most patients.
TL;DR: This article examines recent publications of modeling studies of various methods for estimating effective K values for IOL calculation, cataract surgery case series following refractive surgery, new corneal topography technologies and methods for correcting “refractive surprises” postoperatively.
Abstract: As the number and types of keratorefractive procedures increase and as the baby boomer population moves into the "cataractous decades," the number of patients requiring cataract surgery following refractive surgery grows larger each year. While technological advances in surgical instrumentation and intraocular lens (IOL) design allow us to perform cleaner, faster, and more reliable cataract extractions, the ultimate postoperative refraction depends primarily on calculations performed before surgery. Third-generation IOL formulas ( Haigis, Hoffer Q, Holladay 2, or SRK/T) provide outstanding accuracy when used for eyes with physiologic, prolate corneas. In addition, most instruments used today for measuring corneal curvature and power were designed before the era of refractive surgery. These formulas and instruments make assumptions about the anatomy and refractive properties of the cornea that are no longer valid following most keratorefractive procedures. These breakdowns in IOL calculation often result in a "refractive surprise" after cataract surgery, which may require subsequent surgical correction. This article examines recent publications of modeling studies of various methods for estimating effective K values for IOL calculation, cataract surgery case series following refractive surgery, new corneal topography technologies and methods for correcting "refractive surprises" postoperatively.
TL;DR: Macular hole closure and visual acuity improvement after initially successful macular hole surgery persist at follow-up of 5 years and longer in the majority of patients; delayed visual acuit improvement is not attributable to cataract surgery alone.
TL;DR: Diclofenac sodium 0.1% solution and ketorolac tromethamine 0.5% topical ophthalmic solution eyedrops were equally effective in reducing the severity and duration of CME after uneventful phacoemulsification with posterior chamber IOL implantation.
Abstract: Purpose: To investigate whether topical diclofenac sodium 0.1% solution (Voltaren Ophthalmic®) is as efficacious as topical ketorolac tromethamine 0.5% solution (Acular®) in the treatment of established, chronic cystoid macular edema (CME) after uneventful phacoemulsification cataract extraction with posterior chamber intraocular lens (IOL) implantation.
Setting: Referral-based vitreoretinal private practice.
Methods: This randomized prospective study comprised 34 consecutive patients with clinical CME after uneventful phacoemulsification cataract extraction with posterior chamber IOL implantation who were referred to a private vitreoretinal practice for evaluation and management. Exclusion criteria included a history of previous intraocular surgery, vitreous loss during cataract surgery, CME, uveitis, and vitreoretinal pathology. The eye with CME was treated with 1 drop 4 times daily of diclofenac sodium 0.1% solution or ketorolac tromethamine 0.5% solution. Outcomes were measured by observing for improvement in CME and visual acuity.
Results: Both treatment methods resulted in a significant reduction in CME and a significant improvement in visual acuity. Within 26 weeks, diclofenac reduced CME in 16 patients (89%) and ketorolac, in 14 patients (88%) (P = .92, confidence interval [CI] 95%). Within 26 weeks, diclofenac eliminated CME in 14 patients (78%) and ketorolac, in 12 patients (75%) (P = .86, CI 95%). The mean time to initial CME reduction was 7.5 weeks with diclofenac and 8.0 weeks with ketorolac (P = .41, CI 95%). The mean time to CME resolution was 13.6 weeks with diclofenac and 12.8 weeks with ketorolac (P = .49, CI 95%).
Conclusions: Diclofenac sodium 0.1% solution and ketorolac tromethamine 0.5% topical ophthalmic solution eyedrops were equally effective in reducing the severity and duration of CME after uneventful phacoemulsification with posterior chamber IOL implantation. Either solution may be considered for CME after cataract surgery, especially in patients who may not tolerate corticosteroid treatment.
TL;DR: The most important predictor of final visual acuity after PPV for retained lens fragments is a less complicated clinical course (e.g., no suprachoroidal hemorrhage, no RD, no CME, and no additional surgery afterPPV).
TL;DR: The LOCS III cataract grading system enhanced the ability to estimate ultrasonic energy expenditure and BSS volume use during phacoemulsification and can help to create a more formally organized, integrated, customized operative plan.
Abstract: Purpose To report the correlation of features of cataracts graded by the Lens Opacities Classification System, version III (LOCS III), with phacoemulsification energy expenditure and the balanced salt solution (BSS ® ) volume used during cataract surgery. Setting Wolfe Clinic, Marshalltown, Iowa, USA. Methods This was a retrospective review of 2364 cases operated on by a single surgeon from January 1998 to July 2000 in which the cataract had been graded at the slitlamp using the 4 grading scales of the LOCS III: nuclear opalescence (NO), nuclear color (NC), cortical cataract (C), and posterior subcapsular cataract (P). Polynomial best-fit lines were derived using regression analysis correlating the 4 preoperative LOCS III characteristics with 3 intraoperative observations: machine-measured phacoemulsification time, mean power expenditure, and BSS volume. Results As determined by best-fit lines and their coefficient of determination ( R 2 ), there were exponential relationships between machine-measured phacoemulsification time and the degree of NC ( R 2 = 0.48) and NO ( R 2 = 0.40). Trends existed between NC and NO and the amount of BSS used ( R 2 = 0.08 and R 2 = 0.07, respectively). No relationships were observed between the LOCS III classes of cataract, C and P, at any intraoperative observation. Conclusions Exponentially, greater phacoemulsification energy was required as NC and NO increased. The LOCS III cataract grading system enhanced the ability to estimate ultrasonic energy expenditure and BSS volume use during phacoemulsification. Preoperative LOCS III cataract classification can help to create a more formally organized, integrated, customized operative plan.
TL;DR: The higher age-adjusted prevalence and relatively early onset of age-related cataracts in this population suggest that the cataract-centered approach to minimizing preventable blindness, adopted by the National Program for Prevention of Blindness in India, is appropriate.
Abstract: OBJECTIVES. To determine the prevalence of lens opacities in an older population in rural southern India. METHODS. A cross-sectional study of 5150 persons aged 40 years and more who were selected as part of a representative sample from three southern districts of the state of Tamil Nadu in southern India. All lenses were graded and classified for opacities and other disorders by slit lamp after pupillary dilation, using the Lens Opacification Classification System (LOCS) III and standard photographs. Definite cataract was defined as either LOCS III nuclear opalescence of grade 3.0 or more and/or cortical cataract of grade 3.0 or more and/or posterior subcapsular cataract (PSC) of grade 2.0 or more. RESULTS. Definite cataract was present in one or both eyes in 2499 (47.5%) of 5150 subjects. The age-adjusted prevalence (adjusted to U.S. population estimates for 2000) of definite cataract in this population was 61.9% (95% Cl, 60.6-6.3). The prevalence was significantly lower in men (P = 0.0002). In those eyes with cataracts, nuclear cataract (59.7%) was most common, and cortical cataract was present in 20.0% and PSC in 24.3%. Cataract surgery had been performed in 9.4% persons, including 3.0% who had bilateral surgery for cataracts. Best corrected visual acuity was less than 6/60 in 3.7% of aphakic eyes and in 0.8% of pseudophakic eyes. CONCLUSIONS. The higher age-adjusted prevalence and relatively early onset of age-related cataract in this population suggest that the cataract-centered approach to minimizing preventable blindness, adopted by the National Program for Prevention of Blindness in India, is appropriate.
TL;DR: The extent of capsular bag shrinkage after cataract surgery with intraocular lens (IOL) implantation was evaluated and a regression formula of moderate validity was determined to predict capsular carrier size.
Abstract: Purpose: To evaluate the extent of capsular bag shrinkage after cataract surgery with intraocular lens (IOL) implantation and develop a regression formula to predict postoperative capsular bag size.
Setting: Eye Hospital, Johannes Gutenberg-University, Mainz, Germany.
Methods: The axial length (AL), anterior chamber depth, and corneal radius in 58 eyes were measured preoperatively. Cataract surgery was by phacoemulsification followed by implantation of a 3-piece, acrylic, posterior chamber IOL. The capsular bag diameter and anterior capsulorhexis were measured intraoperatively and 1 day and 1, 3, and 6 months postoperatively using a Koch capsule measuring ring (HumanOptics).
Results: The mean capsular bag size was 10.53 mm intraoperatively, 10.31 mm at 1 day, 9.62 mm at 1 month, 9.07 mm at 3 months, and 9.01 mm at 6 months. The mean capsular bag shrinkage over the entire postoperative period was 14.8% (P<.001). Of the parameters studied, only AL had a positive correlation with capsule shrinkage. The correlation was moderate but statistically significant (P = .001).
Conclusions: A correlation was found between capsular bag shrinkage and AL. Using preoperative biometric data, a regression formula of moderate validity was determined to predict capsular bag shrinkage.
TL;DR: Both ECCE and MSICS are economical in community eye care settings, but MSICS is economical and gives better uncorrected visual acuity in a greater proportion of patients.
Abstract: Aim: To compare the cost of manual small incision cataract surgery (MSICS) with conventional extracapsular cataract surgery (ECCE) in community eye care settings. Method: A single masked randomised trial was used to compare the safety, efficacy, time, and patient satisfaction of surgery by both the techniques. The fixed facility and recurrent cost for the two procedures was calculated based on information collected from different sources. Average cost per procedure was calculated by dividing the total cost by the number of procedures performed. Result: The average cost of an ECCE procedure for the hospital was Rs 727.76 (US$15.82) and the average cost of a MSICS procedure was Rs 721.40 ($15.68), of which Rs. 521.51 ($11.34) was the fixed facility cost common to both. Conclusion: Both ECCE and MSICS are economical in community eye care settings, but MSICS is economical and gives better uncorrected visual acuity in a greater proportion of patients.
TL;DR: One year postoperatively, QoL benefits were maintained in the study group and there was no increased risk of progression of maculopathy in patients with mild and moderate degrees of ARMD.
Abstract: Purpose To determine whether patients with age-related macular degeneration (ARMD) benefit from cataract surgery and to assess the risk of progression of preexisting maculopathy 4 and 12 months postoperatively. Setting Princess Alexandra Eye Pavilion, Royal Infirmary of Edinburgh, Edinburgh, Scotland. Methods Two groups of patients were evaluated prospectively. The study group comprised patients with ARMD scheduled to have cataract surgery (n = 40). The control group comprised patients with ARMD not having cataract surgery (n = 43). Patients were assessed at baseline (preoperatively) and 4 and 12 months postoperatively. Assessment included visual function tests and quality of life (QoL) measures. The mean values for each item tested were obtained for each group at each visit, and comparisons between visits were done using the Wilcoxon signed rank test. Results There were significant benefits of cataract surgery in terms of visual function and QoL measures at 4 and 12 months. There was no increased risk of progression of maculopathy in the study group. There were no significant differences in the items tested in the control group. Conclusions One year postoperatively, QoL benefits were maintained in the study group and there was no increased risk of progression of maculopathy in patients with mild and moderate degrees of ARMD. Larger numbers of patients must be assessed prospectively for longer periods to determine the relative risk of progression of different stages of ARMD after cataract surgery.