Showing papers on "Cataract surgery published in 2007"
TL;DR: Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis, and there was evidence that men were more predisposed to infection.
Abstract: Aims to identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract and Refractive Surgeons (ESCRS) multicenter study. Setting: Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 × 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated. Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8). Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs.
721 citations
TL;DR: SICS is significantly faster, less expensive, and less technology dependent than phacoemulsification, and may be the more appropriate surgical procedure for the treatment of advanced cataracts in the developing world.
265 citations
TL;DR: Diabetic eyes have a high incidence of increased center point thickness on OCT after cataract surgery, associated with a loss of vision at 1 month, with limited visual recovery at 3 months, and treatment to prevent this might improve outcomes in similar individuals after surgery.
226 citations
TL;DR: The cost-utility of cataract surgery varies substantially, depending how the benefit is assessed and on the duration of the assumed benefit, and is generally more cost-effective than either knee arthroplasty or defibrillator implantation when considered in absolute terms.
183 citations
TL;DR: When experienced surgeons could anticipate IFIS and employ compensatory surgical techniques, the complication rate from cataract surgery was low and the visual outcomes were excellent in eyes of patients with a history of tamsulosin use.
167 citations
TL;DR: Phacoemulsification needs additional cost for the machine (depreciation), replenishment of parts, and annual maintenance contract, and manual SICS is far more economical than phacoemulsion and is as safe.
147 citations
TL;DR: Patients who wait more than 6 months for cataract surgery may experience negative outcomes during the wait period, including vision loss, a reduced quality of life and an increased rate of falls.
Abstract: Background: Cataract surgery is the most common operative procedure performed in Canada, and how patients are affected by wait times for this surgery has important clinical, public health and health policy considerations. We conducted a systematic review to understand the relation between wait time for cataract surgery and patient outcomes and the variables that modify this relation. Methods: We performed an electronic search of 11 databases and the proceedings of 4 conferences. The search was restricted to studies published after the transition to phacoemulsification (1990). We assessed the quality of the included studies using the Jadad Scale for randomized controlled trials and the Newcastle–Ottawa Scale for cohort and case–control studies. The data were found to be inappropriate for meta-analysis, thus we performed a qualitative synthesis. Results: We found a total of 27 studies that met our inclusion criteria. When these studies were reviewed, a dichotomy was observed for the wait time–outcome relation: outcomes associated with wait times of ≤ 6 weeks were better than outcomes associated with wait times of ≥ 6 months. Patients who waited more than 6 months to receive cataract surgery experienced more vision loss, a reduced quality of life and had an increased rate of falls compared with patients who had wait times of less than 6 weeks. The outcomes associated with wait times between 6 weeks and 6 months remain unclear.
132 citations
TL;DR: An audit of 1000 consecutive patients undergoing cataract surgery on Patient Choice at the Western Eye Hospital asks whether the NCSS is out-of-date, and whether good outcomes on Choice schemes are compatible with Consultant-led training within the National Health Service.
Abstract: Purpose: Clinical outcomes for phacoemulsification surgery are still compared with the almost 10-year-old benchmark of the 1997–98 National Cataract Surgery Survey (NCSS) published in this journal. Extraneous to the peer-reviewed research literature, more recent databases suggest much better results may be being obtained. This offered the rare opportunity to perform an audit as research investigating if this was indeed the case and a new benchmark is needed, with the additional standard of rigorous study peer review by independent senior ophthalmologists. At this pilot centre for Patient Choice provision, all cataract surgery was performed on Consultant-supervised training lists, a novel extension in-sourcing care using public resources rather than to an independent sector that may not be supervised by NHS Consultants. Patient satisfaction was also surveyed. We asked whether the NCSS is out-of-date, and whether good outcomes on Choice schemes are compatible with Consultant-led training within the National Health Service? Methods: An audit of 1000 consecutive patients undergoing cataract surgery on Patient Choice at the Western Eye Hospital between October 2002 and September 2004. All subjects were scheduled for phacoemulsification. A novel policy was extending “choice” onto training list slots for this period. A validated questionnaire assessed patient satisfaction. Results: A best corrected visual acuity of 6/12 or better was obtained in 93% of cases. Over 80% of cases were ±1 D of target refraction (65.7% within 0.5 D). The total incidence of complications was 8.7%. Overall incidence of major complications was 2.4%. Incidence of vitreous loss was 1.1% and that of endophthalmitis 0.1%. Complications rates were lowest for consultants (less than 1%). User satisfaction with having cataract surgery on “patient choice” was high. Conclusions: Cataract surgery under patient choice on supervised training lists is associated with a visual outcome and an incidence of complications at least as good as the published national average. User satisfaction is high. Cataract surgery under patient choice is compatible with training activity in receiving hospitals. The improvement in outcomes since the 1997–98 NCSS suggest that the accepted standards for complication rates should be updated to reflect the fact that phacoemulsification has become an established procedure.
128 citations
TL;DR: After cataract surgery, a mild increase of foveal thickness without impact on visual acuity could be observed and no correlation between macular thickening andVisual acuity and selected surgical and biometrical parameters could be found.
Abstract: Using standardized macular optical coherence tomography (OCT) in the postoperative period, subclinical changes in macular thickness can be detected. With this method, postoperative development of macular thickness in healthy eyes is evaluated. The repeatability of the method and the influence of selected surgical (phaco time and phaco energy) and biometric parameters (axial length and anterior chamber depth) on the results were assessed. In a prospective study, 33 patients without macular pathology in both eyes were examined. Phacoemulsification and intraocular lens (IOL) implantation was performed in one eye, and the contralateral eye served as control. OCT (StratusOCT; Zeiss, Dublin, CA, USA), mean minimal foveal thickness (MMFT) and mean foveal thickness (MFT) were measured preoperatively, at 1 day, 1 week and 6 weeks postoperatively. At these visits, the best-corrected visual acuity (BCVA) tests and slit-lamp examination were performed. To assess the influence on foveal thickness ocular axial length, anterior chamber depth, phacotime and energy were documented. Statistical analysis using parametric tests was carried out with standard statistical software (SPSS11, BIAS). MMFT of the operated eyes and the intraindividual difference of MMFT increased significantly at one day (+12.31 ± 24.2 μm, P < 0.001) and 6 weeks (+6.76 ± 22.6 μm, P = 0.009). MFT in the operated eyes and intraindividual difference of MFT rose significantly at 1 day, 1 week and 6 weeks (1 day: +10.66 ± 20.8 μm, P = 0,026; 1 week: +15.23 ± 19.7 μm; 6 weeks: +17.33 ± 14.81 μm, P < 0.001). Repeatability was better for MFT in controls (ICR = 0.92) than for MMFT in controls (ICR = 0.77). No clinical cystoid macular edema was diagnosed in this study. No correlation between macular thickening and visual acuity and selected surgical and biometrical parameters could be found. After cataract surgery, a mild increase of foveal thickness without impact on visual acuity could be observed. This increase may be due to both subclinical changes and to influence of changes in media opacity on the measurement technique. Surgical and biometric parameters such as phacotime and energy and axial length did not correlate to the degree of macular thickening.
126 citations
TL;DR: This large survey found a lower rate of reported serious complications with sub-Tenon’s, topical and topical-intracameral LA compared with retrobulbar and peribulbar techniques, and these “newer” methods may be preferable for routine cataract surgery.
Abstract: Background: The techniques of sub-Tenon’s, topical and topical-intracameral local anaesthesia (LA) have become common in routine practice. Aims: This study aimed (i) to estimate the frequency of various LA techniques used in cataract surgery, (ii) to estimate the incidence of severe adverse events associated with each LA technique, and (iii) to document these adverse events. Methods: This was a prospective, 13 month observational study of routine practice in the UK in 2002–2003. The British Ophthalmological Surveillance Unit sent a monthly mailing to UK ophthalmologists, asking for reports of “potentially sight-threatening or life-threatening complications of LA for cataract surgery”. Current LA practice was assessed by questionnaire. Results: Cataract surgery comprised 4.1% general anaesthesia, 92.1% LA without sedation and 3.9% LA with sedation. Of the estimated 375 000 LAs 30.6% were peribulbar, 3.5% retrobulbar, 42.6% sub-Tenon’s, 1.7% sub-conjunctival, 9.9% topical and 11.0% topical-intracameral LA. “Potentially sight-threatening complications” were mostly associated with retrobulbar and peribulbar techniques and “potentially life-threatening” complications with all techniques except topical/intracameral LA. Eight neurological complications consistent with brainstem anaesthesia were reported: 7 with peribulbar or retrobulbar LA. Poisson regression analysis strongly indicated that rates vary with technique (p Conclusions: This large survey found a lower rate of reported serious complications with sub-Tenon’s, topical and topical-intracameral LA compared with retrobulbar and peribulbar techniques. These “newer” methods may be preferable for routine cataract surgery.
125 citations
TL;DR: Intracameral Vigamox 0.5 mg/mL appeared to be nontoxic in terms of visual rehabilitation, anterior chamber reaction, pachymetry, and corneal endothelial cell density.
Abstract: Purpose To determine the safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution (Vigamox) in patients having cataract surgery. Setting American Eye Center, Manila, Philippines. Methods Preoperative and 1-month postoperative anterior chamber reaction, corneal endothelial cell density, and corneal thickness were assessed in 65 eyes that had cataract surgery with intracameral moxifloxacin. All eyes received 0.1 mL intracameral moxifloxacin 0.5% ophthalmic solution containing 500 μg of moxifloxacin as the last step of phacoemulsification. Different ophthalmologists conducted the postoperative evaluation in an observer-masked fashion. A P value less than 0.05 was considered significant. Results All 65 eyes completed the study. The mean age was 69.5 years ± 9.13 (SD) (range 48 to 84 years). All eyes had a postoperative best corrected visual acuity of 20/30 or better. All eyes had trace to +2 cells and flare anterior chamber reaction only on the first day after surgery. The mean endothelial cell count was 2491.52 cells/mm 2 preoperatively and 2421.58 cells/mm 2 postoperatively. The mean difference was 70 cells/mm 2 , which not statistically significant ( P = .737). The increase of 17.80 μm in postoperative pachymetry 1 month after surgery was not statistically significant ( P >.65). Conclusion Intracameral Vigamox 0.5 mg/mL appeared to be nontoxic in terms of visual rehabilitation, anterior chamber reaction, pachymetry, and corneal endothelial cell density.
TL;DR: The initial desired refractive outcome following IOL implantation is thus hypermetropia, with the degree dependent on the age of the child, and the prevention of capsule opacification and cellular proliferation may in future be achieved by the use of devices to specifically target epithelial cells at surgery.
Abstract: Congenital and infantile cataracts produce deprivation amblyopia and can thus cause lifelong visual impairment. Successful management is dependent on early diagnosis and referral for surgery when indicated. Accurate optical rehabilitation and postoperative supervision are essential. The timing of surgery and its relationship to the duration of deprivation is important. Unilateral congenital cataract surgery within 6 weeks of birth produces the best outcomes. The equivalent ‘latent’ period for bilateral visual deprivation may be longer at around 10 weeks. Visual deprivation has a significant impact on the development of fixation stability. Major form deprivation, even after early surgery, leads to nystagmus. This is mostly manifest latent nystagmus (MLN). The latent period for fixation stability may be as short as 3 weeks. Preoperative congenital nystagmus (CN) can convert to more benign MLN after surgery. Infantile IOL implantation is becoming increasingly accepted. A satisfactory long-term refractive result requires that allowance be made for childhood axial growth and myopic shift. In a series of 25 infants (33 eyes) implanted before 12 months of age, the mean myopic shift at 12 months was 4.83 D. This increased to 5.3 D in infants implanted before 10 weeks. The initial desired refractive outcome following IOL implantation is thus hypermetropia, with the degree dependent on the age of the child. Glaucoma or ocular hypertension is a common complication following paediatric cataract surgery. Microphthalmia and surgery in early infancy are risk factors. Tonometry results may be influenced by the increased corneal thickness seen in aphakic and pseudophakic children. The long-term prognosis of eyes with aphakic glaucoma is not necessarily poor but intraocular pressure control may require three or more medications. Surgical intervention appears to be necessary in over a quarter of eyes. Posterior capsule opacification (PCO) is common in infants undergoing primary lens implantation. Primary capsulotomy and anterior vitrectomy reduce the risk of PCO. In the absence of anterior vitrectomy, primary posterior capsulotomy does not prevent visual axis opacification. Further developments will continue to be driven by clinical research. The prevention of capsule opacification and cellular proliferation may in future be achieved by the use of devices to specifically target epithelial cells at surgery.
TL;DR: Men exposed to tamsulosin had a significantly higher risk for developing IFIS than men exposed to alfuzosin and the effect of IFIS on the complication rate of cataract surgery was evaluated.
Abstract: Purpose To compare the incidence of intraoperative floppy-iris syndrome (IFIS) in men exposed to tamsulosin and men exposed to alfuzosin and evaluate the effect of IFIS on the complication rate of cataract surgery. Setting Tertiary care hospital, Chicoutimi, Quebec, Canada. Methods The medical charts of 64 men (92 eyes) who had phacoemulsification cataract surgery between June 2005 and July 2006 and reported having used tamsulosin or alfuzosin at their initial visit for cataract evaluation were reviewed. The presence or absence of IFIS, potential confounding clinical covariates, duration of surgery, and complications were noted. The history of taking an α 1 -antagonist was verified. To address the main objective of the study, only patients who had exclusively used tamsulosin or alfuzosin were included. For the secondary objective, all eligible patients were included even if they had received more than one α 1 -antagonist in the past. Results Of men exclusively exposed to tamsulosin (22) or alfuzosin (13), 86.4% and 15.4%, respectively, developed IFIS ( P P Conclusions Men exposed to tamsulosin had a significantly higher risk for developing IFIS than men exposed to alfuzosin. Intraoperative floppy-iris syndrome significantly increased the complication rate of cataract surgery.
TL;DR: This comprehensive survey provides reliable estimates of the causes of blindness and visual impairment in Pakistan and suggests services for refractive errors need to be further expanded and integrated into eye care services, particularly those serving rural populations.
Abstract: Objective: To determine the causes of blindness and visual impairment in adults (⩾30 years old) in Pakistan, and to explore socio-demographic variations in cause.
Methods: A multi-stage, stratified, cluster random sampling survey was used to select a nationally representative sample of adults. Each subject was interviewed, had their visual acuity measured and underwent autorefraction and fundus/optic disc examination. Those with a visual acuity of <6/12 in either eye underwent a more detailed ophthalmic examination. Causes of visual impairment were classified according to the accepted World Health Organization (WHO) methodology. An exploration of demographic variables was conducted using regression modeling.
Results: A sample of 16 507 adults (95.5% of those enumerated) was examined. Cataract was the most common cause of blindness (51.5%; defined as <3/60 in the better eye on presentation) followed by corneal opacity (11.8%), uncorrected aphakia (8.6%) and glaucoma (7.1%). Posterior capsular opacification accounted for 3.6% of blindness. Among the moderately visually impaired (<6/18 to ⩾6/60), refractive error was the most common cause (43%), followed by cataract (42%). Refractive error as a cause of severe visual impairment/blindness was significantly higher in rural dwellers than in urban dwellers (odds ratio (OR) 3.5, 95% CI 1.1 to 11.7). Significant provincial differences were also identified. Overall we estimate that 85.5% of causes were avoidable and that 904 000 adults in Pakistan have cataract (<6/60) requiring surgical intervention.
Conclusions: This comprehensive survey provides reliable estimates of the causes of blindness and visual impairment in Pakistan. Despite expanded surgical services, cataract still accounts for over half of the cases of blindness in Pakistan. One in eight blind adults has visual loss from sequelae of cataract surgery. Services for refractive errors need to be further expanded and integrated into eye care services, particularly those serving rural populations.
TL;DR: Satisfactory results are achieved with primary implantation of current open-loop ACIOLs during cataract surgery complicated by loss of posterior capsule integrity, and eyes with these IOLs fared better than a cohort of eyes undergoing SFIOL implantation in a similar situation, at intermediate-term follow-up.
TL;DR: The appeal of using NSAIDs in the treatment of ocular inflammation hinges on the complications associated with corticosteroids, the other commonly used therapy for ophthalmic inflammation.
Abstract: Recent advances in cataract surgery, such as phacoemulsification, small-incision surgery and advances in foldable intraocular lenses, have resulted in the decrease of physical trauma associated with cataract surgery. The decrease in the physical surgical trauma decreases the release of prostaglandins, which are the main players in postoperative ocular inflammation. However, postoperative inflammation continues to be a cause of patient discomfort, delayed recovery and, in some cases, suboptimal visual results. Left untreated, this inflammation might interfere with patients’ rehabilitation and/or contribute to the development of other complications, such as cystoid macular oedema. NSAIDs are commercially available, in topical or systemic formulations, for the prophylaxis and treatment of ocular conditions. Topically applied NSAIDs are commonly used in the management and prevention of non-infectious ocular inflammation and cystoid macular oedema following cataract surgery. They are also used in the management of pain following refractive surgery and in the treatment of allergic conjunctivitis. Despite their chemical heterogeneity, all NSAIDs share the similar therapeutic property of inhibiting the cyclo-oxygenase enzyme. The appeal of using NSAIDs in the treatment of ocular inflammation hinges on the complications associated with corticosteroids, the other commonly used therapy for ophthalmic inflammation.
TL;DR: There is a volume-outcomes relationship for cataract surgery, and this relationship persists even for very high-volume surgeons, according to a retrospective cohort study from 2001 through 2003.
TL;DR: This population‐based study found a substantial increase in incident cataract surgery among Olmsted County, Minnesota, residents during the 25‐year study period, and the rate of cataracts surgery increased in a nearly linear fashion during a period when phacoemulsification replaced extracapsularCataract extraction in the community.
Abstract: Purpose To estimate sex- and age-specific incidence rates of cataract surgery in a defined United States population and evaluate the change in incidence over time. Setting Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. Methods Rochester Epidemiology Project databases were used to identify all incident cataract surgeries in Olmsted County, Minnesota, residents during the 25-year period from January 1, 1980, through December 31, 2004. Annual incidence rates for each sex and 10-year age group were calculated and adjusted to the 2000 U.S. white population. Change in incidence over time was assessed by fitting generalized linear models assuming a Poisson error structure. Results During the study period, 10 245 cataract extractions were performed in 7141 residents of all ages. Overall, the age-adjusted cataract surgery incident rate per 100000 residents was 548 (95% confidence interval [CI], 534-561) for women, 462 (95% CI, 447-478) for men, and 511 (95% CI, 501-521) for all residents. The incidence of cataract surgery increased 500% among women and 467% among men during the study period ( P Conclusions This population-based study found a substantial increase in incident cataract surgery among Olmsted County residents during the 25-year study period. The rate of cataract surgery increased in a nearly linear fashion during a period when phacoemulsification replaced extracapsular cataract extraction in the community.
TL;DR: Considerable progress has been made in characterizing phenotypes, determining the prevalence and incidence in various population groups, and understanding risk factors for cataract.
Abstract: The purpose of this review is to highlight the advances made by epidemiologic research into cataract. Considerable progress has been made in characterizing phenotypes, determining the prevalence and incidence in various population groups, and understanding risk factors for cataract. Cataract surgery research has documented functional improvements following surgery and has identified aspects of surgery delivery that could be made. Cataract is an independent marker of early mortality, providing a possible system for studying the aging process. Promising future work in cataract epidemiology is highlighted. Despite the availability of cataract surgery, cataract is still the leading cause of blindness worldwide. From a public health standpoint, research that can identify ways to delay onset or progression, or achieve the holy grail of prevention of cataract, should remain a leading priority.
TL;DR: Intracameral phenylephrine is a simple and effective tool to prevent the effects of floppy iris syndrome in those patients undergoing cataract surgery who are on systemic tamsulosin.
Abstract: To describe the use of intracameral phenylephrine to prevent the floppy iris syndrome seen in patients who are on the drug tamsulosin for benign prostatic hypertrophy, during cataract surgery. Prince Charles Eye Unit, King Edward VII Hospital, Windsor, Berkshire, UK. Seven patients who were on systemic tamsulosin for benign prostatic hypertrophy received intracameral phenylephrine before capsulorexhis during their cataract surgery. There was a significant reduction in the amount of mobility of the iris, reduction in the expected fluttering, and sustained papillary dilatation. Intracameral phenylephrine is a simple and effective tool to prevent the effects of floppy iris syndrome in those patients undergoing cataract surgery who are on systemic tamsulosin.
Journal Article•
TL;DR: In this paper, the authors estimated the 10-year incidence of cataract in an older Australian population using the Wisconsin Cataract Grading System (WGCG) and a prospective population-based study.
Abstract: PURPOSE
To estimate the 10-year incidence of cataract and cataract surgery in an older Australian population.
DESIGN
Prospective population-based study.
PARTICIPANTS
Persons at least 49 years old living in 2 postcode areas west of Sydney, Australia.
METHODS
Eye examinations were performed at baseline and at 5- and 10-year follow-up visits. Lens photographs were taken and graded by masked graders using the Wisconsin Cataract Grading System.
MAIN OUTCOME MEASURES
Incidences of nuclear cataract, cortical cataract, posterior subcapsular cataract (PSC), and cataract surgery.
RESULTS
Ten-year person-specific incidences were 36.0% for nuclear cataract, 28.0% for cortical cataract, 9.1% for PSC, and 17.8% for cataract surgery. Corresponding rates were 31.7%, 24.4%, 8.2%, and 14.4%, respectively, in men and 39.3%, 30.8%, 9.8%, and 20.1%, respectively, in women. The incidence for each type of cataract and cataract surgery was positively associated with age (P<0.0001). Women had a significantly higher incidence than men for nuclear cataract (P = 0.04), cortical cataract (P = 0.007), any cataract (P = 0.0006), and cataract surgery (P = 0.03) after adjusting for age. There was no significant gender difference for PSC. The mean age at cataract surgery was 75.8 years, and there was no significant gender difference (P = 0.9). Among persons who developed any cataract, 22% had more than one type and 1.3% had all 3 types present. Nuclear cataract and PSC were significantly associated with visual impairment (visual acuity worse than 20/40).
CONCLUSION
Age- and gender-specific cataract incidences in this study were similar to those reported from the U.S. Beaver Dam Eye Study. In this study, 72% of the participants were affected by cataract or had had cataract surgery over the 10-year follow-up period.
TL;DR: Tamsulosin is significantly associated with floppy iris behaviour during cataract surgery but not all of these patients will necessarily show all or any features of IFIS, which is likely to represent a continuum of severity.
Abstract: Aim: To assess the association of floppy iris behaviour during cataract surgery with use of α-1-antagonists and diabetes mellitus.
Methods: 1842 eyes of 1786 patients undergoing phacohoemulsification surgery were prospectively enrolled. The use of commonly prescribed α-1-antagonists and the presence or absence of diabetes mellitus were noted. The occurrence of any of the features of the intraoperative floppy iris syndrome (IFIS) was noted by surgeons blinded to the patient’s history.
Results: 57% of patients receiving tamsulosin showed features of IFIS compared with 1% of the non-tamsulosin group (p<0.001). Of these, more than half the patients manifested the syndrome in an incomplete form. Only 1 of the 51 patients receiving other α-1-antagonists had IFIS. Diabetes was also not associated with IFIS (p = 1).
Conclusions: Tamsulosin is significantly associated with floppy iris behaviour during cataract surgery. But not all of these patients will necessarily show all or any features of IFIS. The floppy iris syndrome is likely to represent a continuum of severity. Various undefined factors, diabetes not being one of them, may have a contributory role. Non-selective α-1-antagonists are unlikely to be associated with IFIS.
TL;DR: Nursing home residents who underwent cataract surgery because of functional problems experienced significant improvements in their vision-targeted health-related quality of life, in addition to dramatically improved vision.
Abstract: Aim: To assess the impact of cataract surgery in nursing home residents on health-related quality of life, as compared to those who have cataracts but who do not undergo surgery. Methods: A prospective cohort study enrolled 30 nursing home residents (⩾60 years old) who had cataracts and underwent cataract surgery, and evaluated vision-targeted and generic health-related quality of life and depressive symptoms before and approximately 4 months after surgery. This cataract surgery group was compared to 15 nursing home residents who had cataracts but who did not have surgery, over the same timeframe. Results: Visual acuity for near and distance and contrast sensitivity improved following cataract surgery (p Conclusion: Nursing home residents who underwent cataract surgery because of functional problems experienced significant improvements in their vision-targeted health-related quality of life, in addition to dramatically improved vision.
TL;DR: A consistent difference between open-loop and plate-haptic lenses suggests that haptic design may influence the effective lens position in very small eyes and proposes a simple formula to optimize the Haigis and Hoffer Q formulae in patients with extreme hyperopia.
TL;DR: The residents can perform phacoemulsification well with a very low complication rate, without prior training with extracapsular cataract extraction technique, according to this retrospective case series.
Abstract: Aim: To describe the complications related to cataract surgery performed by phacoemulsification technique by third-year ophthalmology residents at New Jersey Medical School, who are trained to perform phacoemulsification without any prior experience with extracapsular extraction. Design: Retrospective, observational case series. Methods: A retrospective chart review of 755 patients who underwent cataract surgery by third-year residents between July 2000 and June 2005 at the Institute of Ophthalmology and Visual Science was performed. Details of intraoperative complications (posterior capsular rupture, vitreous loss, subluxation of lens fragments into the vitreous, extracapsular cases converted to phacoemulsification, retinal detachment, vitreous haemorrhage and haemorrhagic choroidals) of the cases done by phacoemulsification technique were recorded. Results were analysed and compared with complication rates reported from other residency programmes and from experienced ophthalmologists. Results: Of 755 cataract surgeries, 719 were performed using phacoemulsification technique. Posterior capsule disruption occurred in 48 (6.7%), vitreous loss in 39 (5.4%) and dislocated lenticular fragments in 7 (1.0%) of 719 cases that underwent phacoemulsification technique. Subsequent pars plana lensectomy was required in 5 (0.7%) cases; 1 case (0.1%) experienced retinal detachment and haemorrhagic choroidal detachment. Conclusion: The residents can perform phacoemulsification well with a very low complication rate, without prior training with extracapsular cataract extraction technique.
TL;DR: The overall rate of endophthalmitis after uncomplicated cataract surgery in patients treated with topical fourth-generation fluoroquinolones as antiinfective prophylaxis was 0.07%, which was within the range of previously reported rates in the literature.
TL;DR: Cataract surgery with a small superior incision induced consistent and significant changes in several corneal Zernike terms (vertical astigmatism, trefoil, and tetrafoil), resulting in a significantly increased overall corneale RMS wavefront error.
Abstract: Purpose To study the effect of cataract surgery through 3.2 mm superior incisions on corneal aberrations with 2 types of monofocal intraocular lenses (IOLs) with an aspherical design. Setting Instituto de Optica, Consejo Superior de Investigaciones Cientificas, and Fundacion Jimenez Diaz, Madrid, Spain. Methods Corneal topography of 43 eyes was obtained before and after small corneal incision cataract surgery. Twenty-two eyes had implantation of a Tecnis Z9000 silicone IOL (Advanced Medical Optics) and 21 had implantation of an AcrySof IQ SN60WF acrylic IOL (Alcon Research Labs) using the recommended injector for each IOL type. The intended incision size (3.2 mm) was similar in the 2 groups. Corneal aberrations were estimated using custom-developed algorithms (based on ray tracing) for 10.0 mm and 5.0 mm pupils. Comparisons between preoperative and postoperative measurements and across the groups were made for individual Zernike terms and root-mean-square (RMS) wavefront error. Results The RMS (excluding tilt and defocus) did not change in the AcrySof IQ group and increased significantly in the Tecnis group with the 10.0 mm and 5.0 mm pupil diameters. Spherical aberration and coma-like terms did not change significantly; however, vertical astigmatism, vertical trefoil, and vertical tetrafoil changed significantly with surgery with the 10.0 mm and 5.0 mm pupil diameters (P Conclusions Cataract surgery with a small superior incision induced consistent and significant changes in several corneal Zernike terms (vertical astigmatism, trefoil, and tetrafoil), resulting in a significantly increased overall corneal RMS wavefront error. These results can be used to improve predictions of optical performance with new IOL designs using computer eye models and identify the potentially different impact of incision strategies on cataract surgery.
TL;DR: The huge increase in cataract surgery over time and the wide geographical variation in rates, raise the question of whether there is now overcapacity for cataracts surgery.
Abstract: Aims: Phacoemulsification, day case surgery and Action on Cataracts have increased the national capacity for cataract surgery in England. The aim of this study was to examine time trends and geographical variation in rates of cataract surgery, and to determine whether there is evidence of overcapacity in current levels of surgical provision.
Methods: Hospital episode statistics (HES), the hospital in-patient enquiry (HIPE) and the Oxford record linkage study (ORLS) were analysed for cataract admissions between the 1960s and 2003.
Results: Annual rates of admission for cataract surgery in England rose ten-fold from 1968 to 2003: from 62 episodes per 100 000 population in 1968, through 173 in 1989, to 637 in 2004. The overall increase in cataract surgery was reflected by increases in every age group for both men and women. Geographical analysis showed that there was wide variation across local authority areas in annual rates of cataract surgery, from 172 to 548 people per 100 000 population in 1998-2003. The rate of surgery by local authority was positively correlated with the index of multiple deprivation (r 2 =0.24).
Conclusion: The huge increase in cataract surgery over time and the wide geographical variation in rates, raise the question of whether there is now overcapacity for cataract surgery. High levels of social deprivation are associated with high rates of cataract surgery; this may be caused by increased prevalence of cataract or differences in referral patterns.
TL;DR: Evaluating the visual and topographic outcomes in patients with keratoconus who have undergone cataract surgery and analyzing different methods of keratometry and formulas for intraocular lens (IOL) calculation found that IOL calculation is more predictable in mild keratconus than in moderate and severe disease.
Abstract: Purpose.To evaluate the visual and topographic outcomes in patients with keratoconus who have undergone cataract surgery and to analyze different methods of keratometry and formulas for intraocular lens (IOL) calculation in patients with keratoconus.Methods.In a retrospective case series, 12 eyes (n
TL;DR: Limbal relaxing incisions performed during phacoemulsification surgery appear to be a safe, effective, and stable procedure to reduce pre-existing corneal astigmatism.
Abstract: PURPOSE To evaluate the safety and efficacy of limbal relaxing incisions for the correction of corneal astigmatism during phacoemulsification. METHODS Fifty eyes of 37 patients (mean age 66.5 years, range: 45 to 80 years) with cataract and coexisting topographic astigmatism were included in the study. Eyes were randomly divided into two groups: eyes that underwent cataract surgery with limbal relaxing incisions (cataract LRI group) and eyes that underwent cataract surgery only (control group). All limbal relaxing incisions were performed during phacoemulsification. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), and corneal topography were recorded preoperatively and 1, 3, and 6 months postoperatively. RESULTS A statistically significant improvement in BSCVA was seen in the cataract LRI eyes from 0.9 +/- 0.7 preoperatively to 0.1 +/- 0.1 at 1, 3, and 6 months postoperatively (P < .01). A statistically significant improvement in BSCVA was seen in control eyes from 0.8 +/- 0.6 before surgery to 0.2 +/- 0.2 at 1, 3, and 6 months after surgery (P < .01). No difference in postoperative BSCVA was noted between the groups. A statistically significant reduction in the mean topographic astigmatism was seen in the cataract LRI eyes from 1.93 +/- 0.58 diopters (D) preoperatively to 1.02 +/- 0.60 D 6 months postoperatively (P < .05). The control eyes did not show a statistically significant change in topographic astigmatism. CONCLUSIONS Limbal relaxing incisions performed during phacoemulsification surgery appear to be a safe, effective, and stable procedure to reduce pre-existing corneal astigmatism.