Showing papers on "Cataract surgery published in 2006"
TL;DR: The FA implant significantly reduced uveitis recurrences, improved VA, and decreased the need for adjunctive therapy in the studied patient population.
408 citations
TL;DR: Intracameral cefuroxime administered at the time of surgery significantly reduced the risk for developing endophthalmitis after cataract surgery.
Abstract: To report results in the European Society of Cataract and Refractive Surgeons (ESCRS) multicenter study of the prophylaxis of endophthalmitis after cataract surgery. Twenty-four ophthalmology units and eye clinics in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom, with an administrative office in Ireland, coordinating center in England, and data management and statistical unit in Scotland. This partially masked randomized placebo-controlled multinational clinical study to evaluate prospectively the prophylactic effect of intracameral cefuroxime injection and/or perioperative levofloxacin eyedrops on the incidence of endophthalmitis after phacoemulsification cataract surgery began in September 2003 and was terminated early in January 2006. The study used random allocation of patients in a 2 × 2 factorial design. By the end of 2005, complete follow-up records had been received for 13 698 study patients. Such a clear beneficial effect from the use of intracameral cefuroxime had been observed that it was agreed it would be unethical to continue the study and to wait for the completion of all follow-up procedures before reporting this important result. If total reported cases of endophthalmitis are considered, the incidence rate observed in those treatment groups not receiving cefuroxime prophylaxis (23 cases in 6862 patients) was almost 5 times as high (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.74-12.08; P = .002) as that in the groups receiving this treatment (5 cases in 6836 patients). If only cases proved to be due to infection are considered, the rate was more than 5 times as high (OR, 5.32; 95% CI, 1.55-18.26; P = .008) in the treatment groups not receiving cefuroxime. Although the use of perioperative levofloxacin eyedrops as prophylaxis was also associated with a reduction in the observed incidence rate of postoperative endophthalmitis, this effect was smaller and was not statistically significant, whether total reported cases or only cases proven to be due to infection are used in calculating the rates. As not all follow-up procedures are complete, it is possible that further cases of endophthalmitis may be reported; however, it is not expected that this will alter the main conclusion. Nevertheless, it is anticipated that successful completion of follow-up procedures in all patients will increase the total number in the study to approximately 16 000. Intracameral cefuroxime administered at the time of surgery significantly reduced the risk for developing endophthalmitis after cataract surgery.
347 citations
TL;DR: In this paper, the authors present data and an hypothesis for the late development of open angle glaucoma (OAG) after vitrectomy, which is hypothesized to have a role in the pathogenesis.
185 citations
TL;DR: Various aspects of the surgery for age related cataract have changed substantially in the past five years, and the quality of outcome, plus the improved safety of the modern procedure, has in part driven the increase in numbers of procedures performed.
Abstract: Cataract surgery is the commonest single surgical procedure carried out in the developed world. In the developing world, cataract remains the commonest cause of blindness. In 1990 an estimated 37 million people were blind worldwide—40% of them because of cataract.1 Every year, an extra 1-2 million people go blind. Every five seconds one person in our world goes blind, and a child goes blind every minute. In 75% of these cases the blindness is treatable or preventable. However, 90% of blind people live in the poorest sections of the developing world, and without proper interventions the number of blind people will increase to 75 million by 2020.
Various aspects of the surgery for age related cataract have changed substantially in the past five years, and the quality of outcome, plus the improved safety of the modern procedure,2 has in part driven the increase in numbers of procedures performed.
Most cataracts arise because of ageing of the crystalline lens. As new lens fibres continue to be laid down in the crystalline lens, and existing ones are not replaced, the lens is unusual in being one of the few structures of the body that continues to grow during life. The transparency of the lens is maintained by many interdependent factors that are responsible for its optical homogeneity, including its microscopic structure and chemical constituents. With ageing, there is a gradual accumulation of yellow-brown pigment within the lens, which reduces light transmission. There are also structural changes to the lens fibres, which result in disruption of the regular architecture and arrangement of the fibres that are necessary to maintain optical clarity.
Extrinsic factors associated with cataract formation vary with socioeconomic and geographical differences (box 1). In the developing world a multitude of factors—such as malnutrition, acute dehydrating diseases at young age, …
180 citations
TL;DR: Spectacle independence was significantly higher with this multifocal IOL, which outweighed the photic symptoms it caused, and the AcrySof ReSTOR IOL provided predictably good uncorrected distance and unc corrected near acuities.
Abstract: Purpose To compare the visual outcome and subjective visual symptoms in patients who had implantation of the AcrySof ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories) with those in patients who received the AcrySof SA60AT monofocal IOL (Alcon Laboratories) in cataract surgery. Setting Southend Hospital, Essex, United Kingdom. Methods Eighty eyes of 40 patients received the ReSTOR multifocal IOL after cataract extraction. They were closely paired in age, sex, and ocular findings with patients who had monofocal IOL implantation during the same period. The distance and near visual acuities were compared, and patient satisfaction with their vision, visual symptoms, and spectacle dependence was assessed using a standardized questionnaire. Results There was no significant difference in the mean uncorrected and best corrected distance visual acuities between the groups. An uncorrected distance visual acuity of 20/30 or better was achieved in 93.8% eyes in the multifocal group and 82.5% in the monofocal group and of 20/20 or better in 57.5% and 40.0%, respectively ( P = .18). Uncorrected near visual acuity was 20/30 or better in 75.0% of eyes in the multifocal group and 3.8% in the monofocal group. Reading glasses were required by 2.5% in the multifocal group and by 92.5% in the monofocal group. Satisfactory uncorrected intermediate distance vision was achieved in 75.0% of eyes in the multifocal group and 87.5% in the monofocal group ( P = .089); 85.0% of patients in the multifocal group and 7.5% in the monofocal group never had to wear glasses. Moderate glare was reported by 21.3% in the multifocal group and 7.5% in the monofocal group ( P = .008); no patient reported severe glare. In the multifocal group, severe halos and moderate halos occurred in 5.0% of eyes and 33.8% of eyes, respectively. Conclusions The AcrySof ReSTOR IOL provided predictably good uncorrected distance and uncorrected near acuities. Spectacle independence was significantly higher with this multifocal IOL, which outweighed the photic symptoms it caused.
177 citations
TL;DR: A simple and accurate method for determining appropriate intraocular lens (IOL) power in cataract patients who had prior excimer laser photoablation for myopia or hyperopia because laser vision corrective surgery interferes with traditional keratometry and corneal topography is developed.
Abstract: Purpose To develop a simple and accurate method for determining appropriate intraocular lens (IOL) power in cataract patients who had prior excimer laser photoablation for myopia or hyperopia, because laser vision corrective surgery interferes with traditional keratometry and corneal topography, rendering IOL power calculations inaccurate. Setting Private Practice in Century City (Los Angeles), California, and free-standing outpatient surgery centers with institutional review boards. Methods Based on the empiric experience of the senior author, an IOL power correction factor that was proportional to the prior laser photoablation was determined and applied to the IOL power calculated by the IOLMaster (Zeiss). It was necessary to add to the predicted IOL power in eyes with prior myopic laser ablation, whereas eyes having prior hyperopic laser vision correction required a reduction in the IOL power. The correction factor was applied to 30 eyes that required cataract surgery at some time after laser refractive surgery; 23 eyes had prior treatment for myopia, and the remaining 7 eyes had prior hyperopic laser ablation. A regression formula was generated from the IOL power correction factor that was used in the 30 eyes. Results Using the correction factor for 30 eyes, the mean deviation from the desired postcataract refractive outcome was −0.15 diopter (D) ± 0.29 (SD); 28 of 30 eyes were within ±0.5 D of the intended goal; the remaining 2 eyes were both −0.75 D from the desired optical result of cataract surgery. Fourteen of the 30 eyes were emmetropic. Conclusions A simple IOL power corrective adjustment regression formula allowed accurate determination of IOL power after laser refractive photoablation surgery. The weakness of the current method is that knowledge of the amount of prior laser vision correction is necessary.
167 citations
TL;DR: The BESSt formula was statistically significantly more accurate than the other techniques tested and could significantly improve intraocular lens power calculation accuracy after keratorefractive surgery, especially when pre‐refractive surgery data are unavailable.
Abstract: Purpose To describe a new formula, BESSt, to estimate true corneal power after keratorefractive surgery in eyes requiring cataract surgery. Setting Moorfields Eye Hospital, London, United Kingdom. Methods The BESSt formula, based on the Gaussian optics formula, was developed using data from 143 eyes that had keratorefractive surgery. The formula takes into account anterior and posterior corneal radii and pachymetry (Pentacam, Oculus) and does not require pre-keratorefractive surgery information. A software program was developed (BESSt Corneal Power Calculator), and corneal power was calculated in 13 eyes that had keratorefractive surgery and required cataract surgery. Results In the eyes having phacoemulsification, target refractions calculated with the BESSt formula were statistically significantly closer to the postoperative manifest refraction (mean deviation 0.08 diopters [D] ± 0.62 [SD]) than those calculated with other methods as follows: history technique (−0.07 ± 1.92 D; P = .05); history technique with double-K adjustment (0.13 ± 2.39 D; P = .05); Holladay 2 with K-values estimated with the contact lens method (−0.76 ± 1.36 D; P = .03); Holladay 2 with K-values from Atlas topographer (Humphrey) (−0.55 ± 0.61 D; P Conclusions The BESSt formula was statistically significantly more accurate than the other techniques tested. Thus, it could significantly improve intraocular lens power calculation accuracy after keratorefractive surgery, especially when pre-refractive surgery data are unavailable.
167 citations
TL;DR: Compared with midazolam, dexmedetomidine does not appear to be suitable for sedation in patients undergoing cataract surgery, and while there was a slightly better subjective patient satisfaction, it was accompanied by relative cardiovascular depression and delayed recovery room discharge.
Abstract: Background Cataract surgery is commonly performed under local anaesthesia with midazolam sedation. Dexmedetomidine, a sedative-analgesic, is devoid of respiratory depressant effects, and its use in cataract surgery has not been reported. This double-blind study compared the use of dexmedetomidine and midazolam in patients undergoing cataract surgery. Methods Forty-four patients undergoing cataract surgery under peribulbar anaesthesia randomly received either i.v. dexmedetomidine 1 µg kg−1 over 10 min; followed by 0.1–0.7 µg kg−1 h−1 i.v. infusion (Group D), or midazolam 20 µg kg−1 i.v.; followed by 0.5 mg i.v. boluses as required (Group M). Sedation was titrated to a Ramsay sedation score of 3. Mean arterial pressure (MAP), heart rate (HR), readiness for recovery room discharge (time to Aldrete score of 10), and patients' and surgeons' satisfaction (on a scale of 1–7) were determined. Results MAP and HR were lower in Group D compared with Group M [86 (se 3) vs 102 (3) mm Hg and 65 (2) vs 72 (2) beats min−1, respectively] (P Conclusion Compared with midazolam, dexmedetomidine does not appear to be suitable for sedation in patients undergoing cataract surgery. While there was a slightly better subjective patient satisfaction, it was accompanied by relative cardiovascular depression and delayed recovery room discharge.
166 citations
TL;DR: Evidence is provided from seven RCTs that phacoemulsification gives a better outcome than ECCE with sutures and that ICCE with an anterior chamber lens implant is an effective alternative to ICCe with aphakic glasses, with similar safety.
Abstract: BACKGROUND: Cataract accounts for 50% of blindness globally and remains the leading cause of visual impairment in all regions of the world, despite improvements in surgical outcomes (WHO 2005). This number is expected to rise due to an aging population and increase in life expectancy. Although cataracts are not preventable, their surgical treatment is one of the most cost-effective interventions in healthcare. OBJECTIVES: To compare the effects of different surgical interventions for age-related cataract. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE up to July 2006, NRR Issue 3 2005, the reference lists of identified trials and we contacted investigators and experts in the field for details of published and unpublished trials. SELECTION CRITERIA: We included randomised controlled trials (RCTS). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and discrepancies were resolved by discussion. Where appropriate, risk ratios, odds ratios and weighted mean differences were summarised after assessing heterogeneity between the studies. MAIN RESULTS: We identified 17 trials that randomised a total of 9627 people. Phacoemulsification gave a better visual outcome than extracapsular surgery but similar average cost per procedure in Europe but not in poorer countries. Extracapsular surgery with posterior chamber lens implant and ICCE with or without an anterior chamber intraocular lens (IOL) implant gave acceptable visual outcomes but extracapsular surgery had less complications. Manual small incision surgery provides better visual outcome than ECCE but slightly inferior unaided visual acuity compared to phacoemulsification. AUTHORS' CONCLUSIONS: This review provides evidence from seven RCTs that phacoemulsification gives a better outcome than ECCE with sutures. We also found evidence that ECCE with a posterior chamber lens implant provides better visual outcome than ICCE with aphakic glasses. The long term effect of posterior capsular opacification (PCO) needs to be assessed in larger populations. The data also suggests that ICCE with an anterior chamber lens implant is an effective alternative to ICCE with aphakic glasses, with similar safety. Phacoemulsification provides the best visual outcomes but will only be accessible to the poorer countries if the cost of phacoemulsification and foldable IOLs decrease. Manual small incision cataract surgery provides early visual rehabilitation and comparable visual outcome to PHACO. It has better visual outcomes than ECCE and can be used in any clinic that is currently carrying out ECCE with IOL. Further research from developing regions are needed to compare the cost and longer term outcomes of these procedures e.g. PCO and corneal endothelial cell damage.
156 citations
TL;DR: The hypothesis that the long-term risk of developing late ARM is higher in cataract surgical eyes is supported, consistent with findings from the Beaver Dam Eye Study.
149 citations
TL;DR: This international cooperative study provided the opportunity to estimate the current incidence of endophthalmitis after cataract surgery in Europe and determine whether 1 or both of 2 antimicrobial regimens reduces the risk for postsurgical intraocular infection.
Abstract: Purpose To present the development and design of the European Society of Cataract & Refractive Surgeons multicenter study of the prevention of postsurgical infective endophthalmitis after phacoemulsification and to describe the process for its successful implementation and conduct. Setting Twenty-four ophthalmology units and eye clinics in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom, with an administrative office in Ireland, coordinating center in England, and data management and statistical unit in Scotland. Methods This partially masked randomized placebo-controlled multinational clinical study was designed to evaluate prospectively the prophylactic effect of intracameral cefuroxime and/or perioperative topical levofloxacin on postoperative endophthalmitis after cataract surgery. Random allocation was based on a 2 × 2 factorial design that included participating centers as a class variable. Real-time electronic data collection monitored study progress and provided weekly outcome tables, monthly recruitment summaries, and quarterly analytical reports for the study's Data Monitoring Committee, which evaluated the safety and efficacy by Internet-based conferences. Results A 2-year lead time was required to meet harmonized standards of clinical research in the European Union, obtain ministerial authorization in 3 countries, gain institutional approvals at 24 hospitals, and procure indemnity insurance for surgical centers. Informed consent instruments, designed to comply with national health policies, were translated into 8 languages. The use of information technology to collect study data enabled the organizers to evaluate individual eligibility at enrollment, adherence with study medications during and after surgery, and postoperative status during follow-up. Conclusion This international cooperative study provided the opportunity to estimate the current incidence of endophthalmitis after cataract surgery in Europe and determine whether 1 or both of 2 antimicrobial regimens reduces the risk for postsurgical intraocular infection.
TL;DR: Trainee surgeons found phacoemulsification and capsulorhexis the most difficult stages of cataract surgery early in the learning curve and more time can be dedicated to mastering these steps in the wet lab.
Abstract: Purpose To measure the relative difficulty of each stage of phacoemulsification surgery performed by basic surgical trainees. Setting Mater Misericordiae University Hospital, Dublin, Ireland. Methods This prospective study comprised 100 consecutive cases of phacoemulsification performed by 8 trainee surgeons over an 11-month period. The trainees completed a questionnaire at the end of surgery, rating the degree of difficulty of 8 individual stages of phacoemulsification on a 5-point scale from 1 (very easy) to 5 (very difficult). Results At the start of the study, trainees had spent a mean of 9.4 months training. The mean preoperative best corrected decimal visual acuity was 20/70. The most difficult stages were phacoemulsification and capsulorhexis with the highest mean scores of 3.32 ± 1.00 (SD) and 3.30 ± 1.24, respectively and the lowest completion rates of 66.7% and 74.4%, respectively. The first 3 stages of peribulbar blockade (1.72 ± 0.75), draping the surgical field (1.35 ± 0.70) and corneal incision (1.97 ± 0.72) were easiest and had close to a 100% completion rate. Hydrodissection, irrigation/aspiration, and intraocular lens insertion had difficulty rates of 2.42 ± 0.92, 2.80 ± 1.10, and 2.58 ± 1.08, respectively, and completion rates of 92.3%, 78.4%, and 83.1%, respectively. Posterior capsule tear occurred in 9%, including 4% with vitreous loss; there was 1 case of zonular dehiscence. Conclusions Trainee surgeons found phacoemulsification and capsulorhexis the most difficult stages of cataract surgery early in the learning curve. More time can be dedicated to mastering these steps in the wet lab.
TL;DR: Cataract surgery resulted in not only complete dissolution of lens volume and pupillary block, but also attenuation of the anterior positioning of the ciliary processes, all of which contributed to postoperative widening of the angle in eyes with primary angle closure.
TL;DR: First eye cataract surgery reduces the risk of falling and visual function (especially stereopsis) improved in the operated group, and confidence, visual disability and handicap all improved inThe operated compared with the control group.
Abstract: Objective first eye cataract surgery reduces the risk of falling. Most cataracts in elderly people are bilateral. Some binocular functions (e.g. stereopsis) are associated with falls. We aimed to determine if second eye cataract surgery reduces the risk of falling and to measure associated health gain. Study design and setting we randomised 239 women over 70, who had been referred to a hospital ophthalmology department, with one unoperated cataract, to expedited (approximately 4 weeks) or routine (12 months wait) surgery. Falls were ascertained by diary, with follow-up every 3 months for 12 months. We measured health status after 6 months. Results visual function (especially stereopsis) improved in the operated group. Over 12 months follow-up, 48 (40%) operated participants fell at least once, 22 (18%) fell more than once. Forty-one (34%) unoperated participants fell at least once, 22 (18%) fell more than once. Rate of falling was reduced by 32% in the operated group, but this was not statistically significant (rate ratio 0.68, 95% CI 0.39, 1.19, P = 0.18). Confidence, visual disability and handicap all improved in the operated compared with the control group. Conclusion second eye cataract surgery improves visual disability and general health status. The effect on rate of falling remains uncertain.
TL;DR: Patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without an intraocular lens implant.
Abstract: Purpose: We sought to report the incidence of glaucoma in the eyes of children who underwent cataract surgery with and without intraocular lens implantation and to report the risk factors for developing glaucoma. Methods: We undertook a retrospective review of pediatric cataract surgery charts, excluding traumatic cataract, aniridia and Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract, retinopathy of prematurity, secondary IOL implantation, and patients with less than 1 month of postoperative follow-up. Results: After pediatric cataract surgery, 10 (3.8%) of 266 eyes with primary intraocular lens implantation were diagnosed with glaucoma, whereas 8 (17.0%) of 47 aphakic eyes were diagnosed with glaucoma. During the initial analyses, we noted that all of the patients who developed glaucoma underwent cataract surgery when they were 4.5 months or younger. For all patients who underwent surgery during the first 4.5 months of their life, the glaucoma incidence was 24.4% (10/41) in children with pseudophakic eyes and 19.0% (8/42) in age-matched children with aphakic eyes (risk ratio = 1.1, CI = 0.7–1.9; P = .555). In patients who underwent surgery during the first 4.5 months of their life, the average age of the patients who developed glaucoma was not significantly different than those who did not develop glaucoma in pseudophakic eyes (2.0 months ± 1.4 vs. 1.9 months ± 1.0, P = .700) or aphakic eyes (2.6 months ± 1.5 vs. 1.4 months ± 0.9, P = .070). The corneal diameter of the eyes that developed glaucoma versus eyes that did not was not significantly different in patients with pseudophakic eyes (P = .860) or aphakic eyes (P = .254). Glaucoma was diagnosed in patients at an average of 8.6 months and 117.9 months after cataract surgery in those with pseudophakic eyes and aphakic eyes, respectively. Conclusions: Patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without an intraocular lens implant.
TL;DR: The results would suggest that good visual outcomes can be achieved beyond this age, but the incidence of poor visual outcomes increases if cataract surgery is delayed beyond 10 weeks of age.
Abstract: Background: It generally is accepted that cataract surgery during the first 6 weeks of life is associated with the best visual outcomes for children with dense unilateral congenital cataracts. The latent period for children with dense bilateral congenital cataracts has not been clearly defined. Methods: The best-corrected visual acuity (BCVA) at 4 to 6 years of age was collected retrospectively on a series of 43 children with dense bilateral congenital cataracts from 4 institutions. All of the children underwent a lensectomy, posterior capsulotomy, and anterior vitrectomy at 36 weeks of age or younger. Results: Cataract surgery was performed at a mean age of 11.5 weeks for the better-seeing eye. BCVA was assessed when the children were a mean of 5.3 years of age. The visual acuities of 26 (60%) were 20/40 or better, 12 (28%) were 20/50 to 20/80, and 5 (12%) were 20/100 or worse. There was a trend for worse BCVA with increasing age at the time of surgery (r = 0.28, P = 0.07). We noted that a BCVA of 20/100 or worse occurred only among eyes undergoing surgery when infants were older than 10 weeks (≤10 weeks: 0/21 = 0% vs. >10 weeks: 5/22 = 23%, P = 0.049). Children with preoperative nystagmus had worse visual outcomes; only 38% of children with preoperative nystagmus achieved a BCVA of 20/40 or better compared with 74% of children without preoperative nystagmus (P = 0.03). Conclusion: Previous reports have proposed that cataract surgery during the first 5 to 8 weeks of life is associated with better visual outcomes in children with dense bilateral congenital cataracts. Our results would suggest that good visual outcomes can be achieved beyond this age, but the incidence of poor visual outcomes increases if cataract surgery is delayed beyond 10 weeks of age. The absence of preoperative nystagmus is a better predictor of a good visual outcome than the age at surgery.
TL;DR: No significant differences in corneal endothelial cell loss or endothelial morphology were found between MICS and standard incision techniques.
Abstract: Purpose To compare corneal endothelial changes after phacoemulsification performed with a standard technique versus a bimanual microincision cataract surgery (MICS) technique. Setting University ophthalmology department. Methods Eighty patients scheduled for routine cataract surgery were randomized into 2 groups; 40 eyes had standard stop-and-chop phacoemulsification (standard group) and 40 eyes had stop-and-chop phacoemulsification with microincision surgery (MICS group). Central corneal endothelial cell counts, coefficient of variation in cell size, hexagonality, and pachymetry were assessed preoperatively and 1 and 3 months postoperatively. Results The mean preoperative cell count in the entire sample was 2245 cells/mm2 ± 37 (SE). The mean decreased by 102 cells at 1 month (95% confidence interval [CI], −133 to −71; P Conclusion No significant differences in corneal endothelial cell loss or endothelial morphology were found between MICS and standard incision techniques.
TL;DR: In this paper, the authors evaluated complications and results of intravitreal triamcinolone acetonide for treatment of macular edema and found that the mean visual acuity improved from 20/125 to −1 to 20/100 + 2 by one to two months after injection at a mean of 1.2 years after injection.
Journal Article•
TL;DR: In this paper, the long-term cumulative risk of retinal detachment after cataract extraction was estimated using the Kaplan-Meier method using the resources of the Rochester Epidemiology Project.
Abstract: PURPOSE To estimate the long-term cumulative risk of retinal detachment (RD) after cataract extraction. METHODS Using the resources of the Rochester Epidemiology Project, we retrospectively identified all residents of Olmsted County, Minnesota, who had cataract extraction from 1980 through 2004 (10,256 cataract extractions in 7,137 residents) and were diagnosed with RD. The observed probability of RD after cataract extraction was estimated using the Kaplan-Meier method. A cumulative probability ratio of RD after cataract extraction was determined by comparing the observed probability of RD with the expected probability of RD in residents without cataract extraction. Two controls chosen from the primary cataract surgery cohort were matched to each RD case by age, sex, and duration of follow-up. Logistic regression models assessed differences between cases and controls. RESULTS Eighty-two cases of RD after cataract extraction were identified. The cumulative probability of RD after extracapsular cataract extraction (ECCE) and phacoemulsification was 0.27%, 0.71%, 1.23%, 1.58%, and 1.79% at 1, 5, 10, 15, and 20 years after surgery. There was no significant difference in the probability of RD after ECCE when compared to phacoemulsification (P =.13). The cumulative probability ratio of RD at 20 years after ECCE and phacoemulsification was four times (95% CI, 2.6-5.4) higher than would be expected in a similar group of residents not undergoing cataract extraction (P <.001). Males, younger age, myopia, and increased axial length were significantly associated with RD (P <.001). CONCLUSIONS The cumulative risk of RD after ECCE and phacoemulsification is increased for up to 20 years after surgery.
TL;DR: Patients characteristics rather than surgical complications constitute the major risks factors for retinal detachment after cataract surgery, and the odds ratio was linearly reduced for each subsequent decade.
TL;DR: In this article, a three-level expert grading scale was used to evaluate the discriminative abilities of signal-to-noise ratio (SNR) and signal strength and macular thickness.
Abstract: Background: As optical coherence tomography (OCT) is widely used for diagnosis and monitoring of ocular pathology, especially in the elderly people, the influence of cataract on image quality and macular retinal thickness was studied. Methods: In 29 patients scheduled for cataract surgery, preoperative and postoperative OCT scans were obtained. Cataracts were categorised as nuclear, posterior or cortical. Parameters for image quality (signal-to-noise ratio (SNR)) and signal strength and macular thickness were compared. A three-level expert grading scale was used to evaluate the discriminative abilities of SNR and signal strength. Results: Nuclear cataracts (n = 12) provided better preoperative scans (higher SNR/signal strength) than posterior (n = 7) and cortical (n = 10) cataracts (p Conclusions: OCT imaging is influenced by cataract; image quality is reduced preoperatively and macular thickness measurements are slightly increased postoperatively. In individual patients, OCT scans remain reliable for gross clinical interpretation, even in the presence of cataract.
TL;DR: The change in Contrast sensitivity after surgery was the best predictor of the improvements in driving performance in patients with cataract, which are related to concurrent improvements in contrast sensitivity.
Abstract: Background: Cataract surgery is one of the most common medical procedures undertaken worldwide. Aims: To investigate whether cataract surgery can improve driving performance and whether this can be predicted by changes in visual function. Methods: 29 older patients with bilateral cataracts and 18 controls with normal vision were tested. All were licensed drivers. Driving and vision performance were measured before cataract surgery and after second eye surgery for the patients with cataract and on two separate occasions for the controls. Driving performance was assessed on a closed-road circuit. Visual acuity, contrast sensitivity, glare sensitivity and kinetic visual fields were measured at each test session. Results: Patients with cataract had significantly poorer (p Conclusions: Cataract surgery results in marked improvements in driving performance, which are related to concurrent improvements in contrast sensitivity.
TL;DR: The MicroSil 6116TU toric IOL reduced visually significant keratometric astigmatism and increased spectacle independence and showed no significant rotation up to 6 months postoperatively.
Abstract: Purpose To evaluate the efficacy and rotational stability of the MicroSil 6116TU foldable 3-piece silicone toric intraocular lens (IOL) (HumanOptics). Setting Department of Ophthalmology, Hillingdon Hospital, Uxbridge, Middlesex, United Kingdom. Methods This prospective observational study included 21 eyes of 14 consecutive patients with more than 1.50 diopters (D) of preexisting corneal astigmatism having cataract surgery. Phacoemulsification was performed, and a MicroSil 6116TU toric IOL was inserted through a 3.4 mm temporal corneal incision. LogMAR uncorrected visual acuity (UCVA), best corrected visual acuity, refraction, keratometry, and cylinder axis of the toric IOL were measured. Results The mean preoperative refractive and keratometric astigmatism was 3.52 D ± 1.11 (SD) and 3.08 ± 0.76 D, respectively. Six months postoperatively, the logMAR UCVA in eyes without ocular comorbidity (n = 14) was 0.20 ± 0.15 (Snellen 20/32). Seventy-nine percent (11 eyes) had a visual acuity of 0.24 (Snellen 20/35) or better. The mean refractive astigmatism at 6 months was 1.23 ± 0.90 D. Vector analysis using the Holladay-Cravy-Koch method showed a mean reduction in refractive astigmatism of 2.16 ± 2.33 D. The mean difference between intended and achieved cylinder axis at 6 months was 5.2 degrees (range 0 to 15 degrees). No IOL rotated more than 5 degrees during the follow-up period. Conclusions The MicroSil 6116TU toric IOL reduced visually significant keratometric astigmatism and increased spectacle independence. The IOL was stable in the capsular bag, showing no significant rotation up to 6 months postoperatively.
TL;DR: Macular hole surgery with peeling of the ILM is a very safe procedure that leads to very good and stable functional and anatomical results and best-corrected visual acuity improved in 59 (92%) of 64 patients, remained unchanged in 2, and deteriorated in 3.
Abstract: PURPOSE To report on long-term results of macular hole surgery with peeling of the internal limiting membrane (ILM) in a prospective nonrandomized study. METHODS Sixty-four consecutive patients with a follow-up of at least 36 months were included. Only idiopathic macular holes were included in the study. All patients had undergone standard pars plana vitrectomy with removal of the ILM and intraocular gas tamponade with a 15% hexafluoroethane (C2F6) gas-air mixture followed by a face-down position for at least 5 days. During each follow-up visit, complete clinical examination including determination of best-corrected visual acuity, Goldmann perimetry, and optical coherence tomography was performed. RESULTS Fifty-two patients were female and 12 were male, and the patients' mean age was 72 years (range, 53-82 years) at the last visit. We observed stage 2 holes in 5 patients, stage 3 holes in 47, and stage 4 holes in 12. The median postoperative follow-up was 62 months (mean, 56 months; range, 36-75 months). Sixty-two patients (97%) were pseudophakic at the last examination: 3 patients (5%) were already pseudophakic at the time of macular hole surgery; a combined procedure was performed on 9 patients (14%); and 50 patients (78%) underwent cataract surgery later. The median follow-up for patients after cataract extraction was 61 months (mean, 56 months; range, 36-75 months). Anatomical closure was achieved in 61 (95%) of 64 patients as confirmed clinically and by optical coherence tomography. No late reopening of a macular hole or formation of epiretinal membranes was observed after successful hole closure. Best-corrected visual acuity improved in 59 (92%) of 64 patients, remained unchanged in 2, and deteriorated in 3. Best-corrected visual acuity improved from a median of 20/100 preoperatively to a median of 20/32 postoperatively (P < 0.001). There was a median gain of 5 lines (range, -6 to 12). The development of visual acuity did not depend on the duration of symptoms, the number of surgeries, or the stage of the macular hole. CONCLUSIONS Macular hole surgery with peeling of the ILM is a very safe procedure, even in the long term. It leads to very good and stable functional and anatomical results.
TL;DR: Comparing the astigmatism, high order aberrations, and optical quality of the cornea after microincision versus small incision cataract surgery at Eye Center, Zhejiang University, Hangzhou, China shows no significant advantage in reducing corneal high order Aberrations over small incisions.
Abstract: PURPOSE: To compare the astigmatism, high order aberrations, and optical quality of the cornea after microincision (~1.7 mm) versus small incision (~3.2 mm) cataract surgery at Eye Center, Zhejiang University, Hangzhou, China. METHODS: This prospective, randomized clinical study included microincision cataract surgery and small incision cataract surgery performed on 60 eyes. Corneal astigmatism and higher order aberrations to the sixth order were measured using the NIDEK OPD-Scan aberrometer/topographer 1 month after surgery. To evaluate the optical quality of the cornea, the 0.5 modulation transfer function (MTF) value and 0.1 MTF value within a 5-mm pupil were calculated using OPD-Station software. Statistical analysis assessing the difference between groups was carried out using the independent t test.
TL;DR: These cases highlight the importance of appropriate wound construction and integrity, as well as the risks of tight eye patching following placement of ointment, in patients following cataract surgery with intraocular lens (IOL) implantation.
Abstract: Purpose To report clinical and laboratory findings of 8 cases of toxic anterior segment syndrome (TASS) related to an oily substance in the anterior chamber of patients following cataract surgery with intraocular lens (IOL) implantation. Setting John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Methods Eight patients had uneventful phacoemulsification by the same surgeon via clear corneal incisions with implantation of the same 3-piece silicone IOL design. Postoperative medications included antibiotic/steroid ointment and pilocarpine gel; each eye was firmly patched at the end of the procedure. On the first postoperative day, some patients presented with diffuse corneal edema, increased intraocular pressure, and an oily film-like material within the anterior chamber coating the corneal endothelium. The others presented with an oily bubble floating inside the anterior chamber, which was later seen coating the IOL. Additional surgical procedures required included penetrating keratoplasty, IOL explantation, and trabeculectomy. Two corneal buttons were analyzed histopathologically. Two explanted IOLs had gross and light microscopic analyses (as well as surface analyses of 1 of them), and 4 other explanted IOLs had gas chromatography-mass spectrometry. Results Pathological examination of the corneas showed variable thinning of the epithelium with edema. The stroma was diffusely thickened and the endothelial cell layer was absent. Evaluation of the explanted IOLs confirmed the presence of an oily substance coating large areas of their anterior and posterior optic surfaces. Gas chromatography-mass spectrometry of the lens extracts identified a mixed chain hydrocarbon compound that was also found in the gas chromatography-mass spectrometry analyses of the ointment used postoperatively. Conclusions The results indicate that the ointment gained access to the eye, causing the postoperative complications described. These cases highlight the importance of appropriate wound construction and integrity, as well as the risks of tight eye patching following placement of ointment.
TL;DR: With the biaxial microincision technique, EPT is shorter and BCVA improves more rapidly, with no difference in astigmatism, laser flare photometry results, or endothelial cell count relative to the coaxial small-incision techniques for phacoemulsification.
TL;DR: Extension of an anterior capsule tear can complicate cataract surgery at any stage and can be challenging yet compatible with implantation of a posterior chamber intraocular lens (IOL).
Abstract: Purpose To determine the incidence of anterior capsule tears, at what stage of surgery they occurred, and their intraoperative behavior. Setting Ambulatory surgery center, Cincinnati Eye Institute, Cincinnati, Ohio, USA. Methods This 5-year retrospective study was of patients having phacoemulsification with posterior chamber intraocular lens (IOL) implantation complicated by unplanned peripheral extension of the capsulorhexis tear or a radial anterior capsule tear. The operative notes and a videotape of the surgery were reviewed. The stage at which the tear was initially observed and when it extended were identified, as was whether the tear extended to the posterior capsule. Anterior vitrectomy and the design and location of the IOL implanted were also analyzed. Results A discontinuous anterior capsulorhexis or a break in the anterior capsule rim was observed in 21 eyes of 2646 cases, for an overall incidence of 0.79%. Anterior capsule tears were identified during ophthalmic viscosurgical device injection in 1 eye, capsulorhexis in 13 eyes, hydrodissection in 2 eyes, phacoemulsification in 3 eyes, irrigation/aspiration (I/A) in 1 eye, and implantation of a prosthetic iris device in 1 eye. Seven of the 13 tears identified during the capsulorhexis were managed by redirecting the second edge of the "safety" capsulorhexis to incorporate the tear. In 14 eyes, the tear in the anterior capsule extended into the zonules; 4 of these tears were limited. Ten tears extended around the equator and through the posterior capsule, occurring during the hydrodissection in 1 eye, phacoemulsification in 2 eyes, I/A in 1 eye, and IOL implantation in 6 eyes. An anterior vitrectomy was required in 4 eyes that had posterior capsule involvement. Endocapsular fixation of a 1-piece acrylic IOL was achieved in 18 eyes. Three eyes required implantation of a 3-piece acrylic IOL in the ciliary sulcus. Conclusions Extension of an anterior capsule tear can complicate cataract surgery at any stage. Extension of the tear through the posterior capsule occurred in almost half the eyes with an anterior capsule tear, often requiring an anterior vitrectomy. Managing an anterior capsule tear can be challenging yet compatible with implantation of a posterior chamber IOL.
TL;DR: Initial surgery places a patient with glaucoma at a higher risk of CE, and the impact of CE on visual field indexes is mixed-the mean deviation improved but the pattern standard deviation worsened.
Abstract: Objectives To study the incidence of and predictors for cataract extraction (CE) in patients with newly diagnosed glaucoma, the impact of CE on visual function, and changes in the time around CE. Methods Patients were randomized to medical or surgical treatments for glaucoma at 14 centers and followed up for a median of 7.7 years. Vision-specific quality of life (VS-QOL) data were collected by telephone interview during follow-up of 607 patients randomized to medical or surgical treatments for glaucoma. The occurrence of CE was the signal event. Risk factors were evaluated using survival analyses; changes from before to after CE were evaluated by paired t tests; and trends were estimated by loess regression. Results During follow-up of 607 patients, CE took place in 99 study eyes. Initial surgery, older age, a more negative spherical equivalent, and a diagnosis of pseudoexfoliative glaucoma conferred a higher risk of CE. Visual field testing before and after CE showed the mean deviation improved but the pattern standard deviation worsened. The VS-QOL improved on most subscales. Conclusions Initial surgery places a patient with glaucoma at a higher risk of CE. The impact of CE on visual field indexes is mixed—the mean deviation improved but the pattern standard deviation worsened. Most, but not all, VS-QOL subscales were responsive to worsening of cataract prior to and acute improvement in vision after CE.
TL;DR: The prevalence of patients taking tamsulosin and the appearance of intraoperative floppy‐iris syndrome (IFIS) and associated cataract surgery complications was lower in this study's English population than that reported in the U.S. literature.
Abstract: Purpose To determine the prevalence of patients taking tamsulosin and the appearance of intraoperative floppy-iris syndrome (IFIS) and associated cataract surgery complications. Setting District general eye unit with 10 consultants in West Midlands, England, United Kingdom. Methods This nonrandomized observational prospective study identified patients on tamsulosin from the preoperative assessment for cataract surgery performed between March and August 2005. A questionnaire on the presence of IFIS and related intraoperative complications was attached to the patients' records and answered on the day of surgery. Results Of the 2390 cataract procedures performed, 15 patients (17 eyes) were taking tamsulosin. Five eyes (30%) displayed all 3 characteristics of IFIS, 6 (35%) displayed some of the characteristics, and 6 (35%) did not display any IFIS feature. Adjustment in the surgical technique was necessary in 2 eyes. One case had zonular dehiscence. Conclusions The prevalence of tamsulosin intake was lower in this study's English population than that reported in the U.S. literature. The duration of tamsulosin intake did not appear to correlate with the severity of IFIS, and the overall complication rate was low.