Reactivations of ocular toxoplasmosis after cataract extraction.

PURPOSE: To determine the risk of reactivation of ocular toxoplasmosis following cataract extraction. DESIGN: Retrospective case-control study. PARTICIPANTS: Out of 154 patients with ocular toxoplasmosis, 14 patients (15 eyes) who had undergone a cataract extraction and 45 age- and sex- matched controls without cataract were selected. INTERVENTION: A review of the medical records of 14 patients with ocular toxoplasmosis and cataract and 45 control patients with ocular toxoplasmosis but without cataract. The clinical records of the controls and patients were assessed for an identical 4-month period following the date of the cataract extraction in the index patients. MAIN OUTCOME MEASURES: Development of a new active retinal lesion within 4 months after cataract surgery in patients and age -and sex matched-controls. The presence of risk factors such as sex, congenital or postnatal acquisition of ocular toxoplasmosis, age at first clinical manifestation of ocular toxoplasmosis, total number of attacks per affected eye, type of cataract, age at the time of cataract surgery and the intervals between surgery and first clinical manifestation of ocular toxoplasmosis and between surgery and the last recurrence of ocular toxoplasmosis, as well as the use of antiparasitic medication during surgery, type and complications of surgery and optimal visual acuity before and after cataract surgery. RESULTS: Reactivations of ocular toxoplasmosis following cataract extraction occurred in 5/14 patients (5/15 eyes), which was higher than the incidence of recurrences in age -and sex-matched controls (p < 0.001). No additional risk factors for the development of recurrences of ocular toxoplasmosis after cataract surgery were found. Incidence of recurrences preceding surgery did not differ between patients and controls. CONCLUSION: We identified an increased risk of reactivation of ocular toxoplasmosis following cataract extraction which implies that prophylactic treatment with antiparasitic drugs during and after the cataract surgery might be worthwhile for patients at risk of visual loss.     

Corneal thickness after cataract extraction. Early observations]

The corneal thickness was measured after cataract extraction. In 36 patients the thickness was tested by an ultrasound pachymetry before the operation and on the 1, 3 and 7 day after surgery. The visual acuity and the clinical status of the cornea of the operated eye were also examined. The most pronounced oedema was seen on the first day in the neighbourhood of the incision. On the 7th postoperative day the corneal thickness approximated the status existing before the operation in the majority of patients. There was a dependence between the corneal thickness and its clinical status and the visual acuity.     

先天性无虹膜症青光眼白内障手术后眼压持续升高

【摘要】 一例11岁男孩,6个月时因双眼先天性无虹膜症、青光眼而行双眼小梁切除术,10岁时行超声乳化晶状体吸出人工晶状体植入术。术后6个月非接触眼压32、34 mm Hg,超声测量中央角膜厚度（CCT）：右眼850、左眼827 μm。眼底C/D 0.2。此患者需要继续治疗吗？（眼科,2012,21：234-238）     

Apraclonidine and early postoperative intraocular hypertension after cataract extraction.

The efficacy of topical 1% apraclonidine in controlling early postoperative IOP rise after cataract extraction was evaluated. Topical 1% apraclonidine was applied to 20 patients who underwent extracapsular cataract extraction with posterior intraocular lens implantation. On another 20 patients, who acted as control group a placebo (artificial tears) was given. The IOP was measured before preoperative medication and postoperatively at 6, 12 and 24 h, using the Perkins hand-held applanation tonometer. In the control group, 9 patients (45%) developed intraocular hypertension and in the treated group only 2 (10%) showed hypertension, but with short duration and a moderate IOP rise. The difference in frequency of intraocular hypertension between the groups was statistically significant (p less than 0.02). The statistical analysis showed that the postoperative IOP of operated treated eyes was significantly smaller than the IOP of operated control eyes. Furthermore, the postoperative IOP and the initial IOP did not differ statistically. The results of this study demonstrate the efficacy of topical apraclonidine 1% in controlling the early and transient intraocular hypertension following cataract extraction.     

Acquired anterior ocular melanocytosis following cataract extraction

The right eye of a 59-year-old man was the subject of extracapsular cataract extraction and posterior chamber lens implantation. He gradually developed superior sectoral scleral and diffuse iris hyperpigmentation within 7 years postoperatively. The iris was also uniformly thickened. He sustained 20/20 visual acuity in the pseudophakic eye. Despite marked pigmentation of the angle, his right intraocular pressure remained within normal limits. We use the term acquired anterior ocular melanocytosis because the pigmentary changes were confined to the anterior segment and the choroid was not involved. We conclude that surgical injury in the form of cataract extraction can induce episcleral/scleral hyperpigmentation and iris hyperchromia.     

白内障术后激素性高眼压危险因素的临床分析

目的:研究白内障术后激素性高眼压发生的危险因素,期望对临床白内障术后糖皮质激素的使用具有一定的指导作用。方法:回顾性分析2005-01/2006-12行白内障超声乳化联合人工晶状体植入术患者糖皮质激素使用后眼压情况。结果:使用糖皮质激素眼液的患者1459例中24例发生糖皮质激素性高眼压,男14例,女10例,年龄、高度近视、糖尿病、术前眼外伤、术前色素膜炎为白内障摘除联合人工晶状体植入术后糖皮质激素性高眼压的危险因素。结论:白内障摘除联合人工晶状体植入术后糖皮质激素性高眼压的发生率为1.36%。眼局部长期大量使用激素是其发生的重要危险因素。     

The natural history of glaucoma and ocular hypertension after pediatric cataract surgery.

INTRODUCTION: We sought to define the prevalence and natural history of ocular hypertension and glaucoma for at least a 10-year period after pediatric cataract surgery. METHODS: We conducted a prospective observational study of patients who received pediatric cataract surgery. Inclusion criteria included 2 directed ophthalmologic examinations performed at a minimum of 5 and 10 years after surgery. RESULTS: A total of 63 patients (22 with bilateral cataracts and 41 with unilateral cataracts) were examined at a median of 15.1 year (range, 10.3-21.3 years) after surgery. A majority of the subjects had glaucoma or ocular hypertension (ie, 59%; 37/63). Nineteen percent (12/63) had glaucoma (5/22 with bilateral cataracts and 7/41 with unilateral cataracts). Approximately half (7/12) had developed glaucoma during the first 5-year observational period and the remainder (5/12) developed it during the following observational period. Forty percent (25/63) of the patients had ocular hypertension in at least one aphakic eye (9/23 with bilateral cataracts and 16/40 with unilateral cataracts). The rate of progression from ocular hypertension to glaucoma over a mean observational period of 7.2 years (range, 6.2-8.1 years) was 23% (5/22). DISCUSSION: Patients who receive surgery for pediatric cataracts are at very high risk of developing ocular hypertension and glaucoma. Patients can develop late-onset glaucoma and ocular hypertension more than 10 years after surgery. Years of ocular hypertension may precede the diagnosis of late-onset glaucoma.     

A topical or oral carbonic anhydrase inhibitor to control ocular hypertension after cataract surgery

PURPOSE: To compare the effects of oral acetozolamide and topical 2% dorzolamide to prevent ocular hypertension after cataract surgery. METHODS: This prospective, randomized study comprised 62 consecutive patients who had extracapsular cataract extraction and posterior chamber intraocular lens implantation. Patients received either oral acetozolamide (Diazomide) 250 mg three times daily or topical dorzolamide 2% (Trusopt) three times daily, for three days. Intraocular pressures (IOP) were measured by Goldmann applanation tonometry preoperatively and 16, 40, 64 hours postoperatively. RESULTS: IOP in the dorzolamide group peaked at 16 hours and had returned to preoperative values by 40 hours. In the acetozolamide group mean IOP was significantly higher than preoperative values at 16, 40 and 64 hours (p<0.05). At all three postoperative measurement times, mean IOP was significantly higher in the acetozolamide group (p<0.05). CONCLUSIONS: Topical dorzolamide 2% offers better IOP control than oral acetozolamide to prevent ocular hypertension after cataract surgery.