Outcomes of cataract extraction in functionally monocular patients. Case-control study

PURPOSE: To compare the ocular comorbidities, visual outcomes, and surgical complications between a series of functionally monocular patients who had phacoemulsification and intraocular lens (IOL) implantation and a control group of age- and sex-matched binocular patients. SETTING: Jules Stein Eye Institute and the Department of Ophthalmology, UCLA School of Medicine, Los Angeles, California, USA. METHODS: The records of a consecutive series of 100 functionally monocular patients who had phacoemulsification and IOL implantation were reviewed. The records of a control group of binocularly sighted patients who were matched to the monocular patients by age, sex, and date of surgery were also reviewed. RESULTS: Thirteen patients in the monocular group were monocular because of surgical complications. The remaining patients (87%) were monocular from medical conditions. Monocular patients had significantly more ocular comorbidity than binocular control patients (P <.0001). Age-related macular degeneration, diabetic retinopathy, and open-angle glaucoma were the most common reasons for monocular status and the most common ocular comorbidities in study eyes. The median preoperative best corrected visual acuity (BCVA) was 20/50 in the monocular group and 20/40 in the binocular group. The median postoperative BCVA was 20/25 and 20/20, respectively. A final BCVA of 20/40 or worse was the result of preexisting macular pathology or glaucoma in every instance. Surgical complications (P =.096) and the number of postoperative procedures (P =.724) were similar between the 2 groups. CONCLUSIONS: Ocular comorbidity was significantly more prevalent in the eyes of monocular patients. Monocular and binocular patients experienced a 3-line improvement in BCVA after cataract surgery; however, the final median acuity was 20/25 in the monocular group and 20/20 in the binocular group. The 2 groups had a similar complication rate.     

白内障人工晶状体植入术后多维立体视评估

目的 比较双眼白内障患者单眼及双眼不同类型人工晶状体（IOL）植入术后多维立体视的变化。方法 回顾性分析双眼白内障摘出联合IOL植入术患者的数据。比较不同类型IOL植入术后各阶立体视的差异,并比较单眼术后和双眼术后各阶立体视的变化。对影响各阶立体视的因素进行Logistic回归分析。结果 双眼白内障患者在行双眼手术后比单眼手术后各阶立体视均有改善,差异具有统计学意义。单眼术后立体视与患者年龄和双眼间最佳矫正视力（BCVA）差相关,年龄越小、双眼间BCVA差值越小,则立体视越好。IOL的不同类型对立体视无显著影响。结论 不同类型IOL植入术后均可获得良好的立体视,且差异无统计学意义。由于不同患者对立体视的需求不同,在单眼术后可依据双眼BCVA差值选择另眼手术的时机。     

Functional vision with cataracts of different morphologies: comparative study

PURPOSE: To evaluate the influence of cataract morphology on the functional vision of patients with age-related cataract and normal macular function and compare subjectively perceived functional impairments to distance visual acuity, reading acuity, and maximum reading speed between cataract types. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Seventy-five patients awaiting first-eye cataract surgery were asked to characterize their visual difficulties in everyday life using a German version of the VF-14 questionnaire. Cataracts were categorized and graded using the Lens Opacities Classification System III. Monocular and binocular visual acuity and reading performance were determined in randomized order. RESULTS: There were significant differences in functional vision between nuclear cataracts and posterior subcapsular cataracts (PSC); the VF-14 score and the self-reported visual satisfaction were significantly lower in PSC patients (P<.05). Posterior subcapsular cataracts significantly increased self-reported impairment in distance and near vision, although the visual acuity was comparable to that in the other groups (P =.9). Significant differences in functional vision were also seen between PSC and nuclear-cortical cataracts (P<.05). No significant differences in functional vision were found between nuclear cataracts and nuclear-cortical cataracts (P>.05). CONCLUSIONS: The VF-14 questionnaire reliably evaluated functional differences caused by different cataract morphologies; these differences were underestimated when only visual acuity was measured. Patients with PSC had increased functional impairment, indicating that cataract surgical intervention is indicated at an earlier stage in these patients. The significant differences between the morphological types of cataract should be taken into consideration when the benefit of cataract surgery is to be measured on the basis of functional improvement.     

早期白内障超声乳化吸除术及人工晶状体植入术后视觉质量评价

目的:评价早期白内障超声乳化吸除术及人工晶状体植入术后的视觉质量。方法:连续选取入院治疗的白内障患者120例,按照术前最佳矫正视力分为三组(A组:最佳矫正视力<4.0;B组:最佳矫正视力4.0～<4.5;C组:最佳矫正视力≥4.5,分别记录手术前及手术后1mo的矫正视力,并于手术前后分别进行VF-14问卷调查,记录VF-14评分。结果:三组患者的术前及术后矫正视力和VF-14评分差异均有明显的统计学意义(P<0.01),A组和B组,A组和C组的术前及术后VF-14评分差异有明显统计学意义,B组和C组的术前及术后VF-14评分差异无明显统计学意义。三组患者的术前矫正视力与VF-14评分呈明显正相关(rs=0.703,P<0.01);三组患者的术后矫正视力与VF-14评分呈明显正相关(rs=0.878,P<0.01)。结论:早期行白内障超声乳化吸除术及人工晶状体植入术能够明显提高术后视觉质量,从而改善生活质量。     

The VF-14 index of visual function in recipients of a corneal graft: a 2-year follow-up study

PURPOSE: To assess visual functioning and other health-related quality of life outcomes after corneal grafting.DESIGN: A cohort study of corneal graft recipients observed for a minimum of 2 years after transplantation.METHODS: Repeated measurements were obtained by telephone interviews preoperatively and later at 1 and 2 years post-corneal transplantation in 217 patients with the following questionnaires: visual function index (VF-14), visual symptom score and global measures of trouble with vision, dissatisfaction with vision, ocular pain, and discomfort. Demographic, past ocular history, repeated best-corrected visual acuity (BCVA), and detailed eye examination data were also collected.RESULTS: Grafted eyes gained a mean of more than four lines of vision on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart 1 year after transplantation. The mean visual function index (VF-14) score improved from 68% +/- 26% preoperatively to 81% +/- 21% at 1 year. Average visual acuity (VA) and VF-14 values were unchanged at 2 years. The activities of daily living that showed the largest and most significant improvement were reading small print, driving in daytime, and watching television. A number of subjects (9%) presented with a maximum VF-14 score preoperatively, leaving no room for improvement with this outcome index. The VF-14 was especially responsive for corneal graft candidates with low levels of vision before surgery. Blurry vision, pain and discomfort scores, and the global measures of trouble and dissatisfaction with vision also improved after corneal grafting.CONCLUSION: The VF-14 index of functional visual impairment is a responsive and useful outcome index in recipients of a corneal graft.     

Visual function after penetrating keratoplasty for keratoconus: a prospective longitudinal evaluation

AIMS: To evaluate visual function and vision specific health status in patients undergoing penetrating keratoplasty for keratoconus. METHODS: A prospective longitudinal study measuring logMAR visual acuity, contrast sensitivity, disability glare, binocular visual field, stereoacuity, and subjective visual function (VF-14) was conducted on 18 patients with keratoconus undergoing penetrating keratoplasty (PK), including six patients who had already had PK in the fellow eye. Data were collected preoperatively and at 3, 9, and 18 months after surgery. RESULTS: Within 3 months of surgery there was significant improvement in aided visual acuity, contrast sensitivity, and stereoacuity (p<0.05); disability glare (p<0.05) no longer had a significant detrimental effect on these variables. VF-14 score improved significantly throughout the postoperative period (p<0.05). There was significant correlation of the VF-14 score with aided visual acuity, binocular visual field, and stereoacuity. Postoperative astigmatism (<4D v >4D) did not affect the VF-14 score significantly. CONCLUSIONS: There is substantial and rapid improvement in visual function and vision specific health status in keratoconic patients as a result of uncomplicated penetrating keratoplasty.     

Outcomes of cataract surgery in monocular patients

PURPOSE: To determine the best corrected visual acuity (BCVA) outcomes and surgical complications in a consecutive series of functionally monocular patients who had phacoemulsification and intraocular lens (IOL) implantation. SETTING: University-based referral practice, Los Angeles, California, USA. METHODS: The medical records of 93 monocular patients who had phacoemulsification and IOL implantation between December 1991 and February 1999 were reviewed. Patients were considered to be monocular if Snellen BCVA in their fellow eye (the eye not having surgery) was worse than 20/200. Recorded were demographic information, anesthesia method, additional surgery, IOL model, preoperative and postoperative BCVA, reason for poor vision in the unoperated eye, co-morbidities in the operated eye, intraoperative and postoperative complications, length of follow-up, and postoperative procedures. RESULTS: Mean patient age was 72 years and mean follow-up, 6 months. Thirteen patients (14%) were monocular from complications of surgery. Eighty patients (86%) were monocular because of medical eye conditions. Ocular co-morbidities were present in 75% of eyes having surgery. Preoperative median BCVA was 20/60. Median BCVA was 20/30 by the final scheduled follow-up examination and 20/25 by the final follow-up examination. Thirty-seven percent of eyes were correctable to 20/20 or better, and 67% were correctable to 20/40 or better. Two eyes lost BCVA by the final scheduled postoperative examination, and 3 eyes lost BCVA by the final follow-up examination. Final BCVA of worse than 20/40 was always related to preexisting macular or optic-nerve pathology. There were 16 intraoperative or early postoperative complications. The most common (3 eyes) was posterior capsule plaque that could not be removed by capsule polishing. Twenty eyes (22%) had subsequent surgical procedures, the most common being laser posterior capsulotomy. No patient who was monocular from surgical complications had similar problems with second-eye cataract surgery. CONCLUSIONS: Best corrected visual acuity, the standard measure of efficacy in cataract surgery, improved a median of 3 to 4 Snellen lines. The safety of the procedure, as evidenced by the small number of patients who lost BCVA or experienced surgical complications, was satisfactory. Functionally monocular patients are likely to have ocular co-morbidities, some of which may limit the final visual outcome of surgery.     

Measuring outcomes of cataract surgery using the Quality of Well-Being Scale and VF-14 Visual Function Index

PURPOSE: To evaluate the validity and responsiveness of the self-administered Quality of Well-Being Scale (QWB-SA) and the 14-item Visual Function Index (VF-14) to assess patients having cataract surgery. SETTING: Large Southern California health maintenance organization. METHODS: This study comprised 233 adults who had uneventful small-incision (< 3.0 mm) phacoemulsification cataract extraction under local anesthesia. Patients were assessed before surgery as well as 4 to 6 weeks and 4 months after surgery using the QWB-SA and the VF-14. RESULTS: Postoperatively, patients reported significant improvements on QWB-SA (P < .005) and VF-14 (P < .001) measures. Those grouped by visual acuity in the operated eye and unoperated eye and first-eye surgery or second-eye surgery had significant changes in VF-14 results (P < .001). Improvements on the QWB-SA were significant except when the preoperative visual acuity was better than 20/40 in the operated eye or 20/50 in the unoperated eye and when patients had first-eye surgery. The vision-specific VF-14 was more sensitive to improvements after surgery than the more general QWB-SA. Both demonstrated a greater magnitude of change with lower baseline scores and correlated significantly with self-reported satisfaction and trouble with vision. CONCLUSIONS: Both the utility-based generic QWB-SA and disease-specific VF-14 profile were responsive to changes in quality of life after cataract surgery. The VF-14 was more sensitive to change but cannot be used for comparison across disease states or for policy analysis. The QWB-SA can be used to estimate the cost/utility of cataract surgery.     

Functional and anatomic outcome of retinal detachment surgery in pseudophakic eyes

PURPOSE: To determine the long-term anatomic and functional visual outcome of retinal detachment (RD) surgery in pseudophakic eyes after uncomplicated cataract surgery. DESIGN: An interventional, retrospective noncomparative case series PARTICIPANTS: One hundred thirty-eight consecutive patients who had undergone uncomplicated extracapsular cataract extraction and intraocular lens implantation followed by rhegmatogenous RD between 1990 and 1995. METHODS: One hundred one eligible patients were examined (inclusion ratio, 73%) a median of 4.3 years after last RD surgery. The best-corrected visual acuity (BCVA), visual fields, retinal status, and patient-rated visual outcome were recorded, the latter by a questionnaire that included self-reported satisfaction, trouble with vision, a modified Cataract Symptom Score, and the VF-14 Visual Functioning Index. MAIN OUTCOME MEASURES: BCVA, retinal attachment, diameter of visual field, modified Cataract Symptom Score, VF-14 score. RESULTS: Baseline characteristics of enrolled and nonenrolled patients were comparable, except that nonenrolled patients were older. When RD developed, 55 eyes had an intact posterior capsule, and 46 had a laser posterior capsulotomy (LCT). The BCVAs before (median, logarithm of the minimum angle of resolution [-logMAR] 1.2 versus 1.1, Snellen equivalent 0.063 versus 0.08) and after retinal surgery (median, -logMAR 0.46 versus 0.4, Snellen equivalent 0.35 versus 0.4) were comparable for eyes with and without LCT (P = 0.86). The retina was reattached with one procedure in 75 eyes (74%), with two procedures in 98 eyes (97%), and with three to five procedures in all eyes. The retina remained attached long term in 92 eyes (91%). Redetachment rate (9% versus 9%, P = 1.0) and visual field diameters were comparable for eyes with and without LCT. Overall, 80% of patients were satisfied or very satisfied with their binocular vision, and 62% had no or only a little trouble with binocular vision. Visual performance was similar regardless of presence or absence of LCT (median Cataract Symptom Score, 3.0 versus 3.0, P = 0.76; and median VF-14 score, 87.5 versus 87.5, P = 0.81). CONCLUSIONS: Nine in 10 pseudophakic retinal detachments remain attached long term, and 8 in 10 patients are satisfied with their binocular vision after surgery. Even though secondary cataract and posterior capsulotomy can cause problems for the retinal surgeon, the anatomic and functional outcomes of pseudophakic RD are not influenced by capsulotomy.     

Longitudinal changes in subjective and objective visual function 5 years after cataract surgery Prospective population-based study

PURPOSE: To investigate the long-term outcomes of cataract surgery by analyzing data collected 5 years after surgery and comparing with preoperative and postoperative subjective and objective visual function results. SETTING: Norrlands University Hospital, Ume?, Sweden. METHODS: A prospective longitudinal population-based cohort study comprised 810 patients who had cataract surgery during a 1-year period within a geographically defined area. Evaluated were visual acuity data and Visual Function-14 questionnaire (VF-14) results before and after surgery. Five years later, the 590 patients still alive were offered eye examinations and asked to fill out the questionnaire. RESULTS: Of the 590 patients asked to participate at 5 years, 530 answered the questionnaire and 467 had eye examinations. The median VF-14 total score for all patients after surgery was 100; at 5 years, the score decreased to 96.7 (P = .001). Five years after surgery, 46% of patients had unchanged or better visual acuity in the operated eye, 37% had lost more than 0.1 logMAR unit, and 22% had a reduction in VF-14 score of 10 points or more. The two main reasons for the decline in visual acuity and VF-14 scores were age-related macular degeneration (ARMD) (47% and 60%, respectively) and glaucoma (12% and 11%, respectively). Age, co-morbidity, and VF-14 scores after surgery were independently associated with the VF-14 score 5 years after surgery. CONCLUSIONS: Subjective and objective visual function 5 years after cataract surgery remained stable in most patients. Co-morbidity, most commonly ARMD, was the most frequent cause of deterioration of visual acuity and decrease in VF-14 scores. Age and co-morbidity were independently associated with the VF-14 score 5 years after surgery.     

白内障摘除手术单眼视设计度数对白内障患者预后视觉质量的影响

目的：探讨白内障摘除手术单眼视设计中不同的近附加度数对白内障患者预后视觉质量的影响。

方法：选取2016-02/2017-02在我院进行白内障摘除手术的白内障患者84例168眼进行前瞻性研究,根据单眼视设计中近附加度数的不同,将入选患者分为低近附加度数组(1.25～1.75D)和高近附加度数组(2.25～2.75D)每组各42例84眼。比较两组患者的术后6mo双眼裸眼近视力、中距离视力、远视力及立体视,以及治疗前后的视功能生存质量评分。

结果：低近附加度数组患者的双眼裸眼中、远视力分别为0.27±0.20、0.09±0.08,高近附加度数组患者的双眼裸眼中、远视力分别为0.29±0.25、0.10±0.07,两组相比差异均无统计学意义(P>0.05)。高近附加度数组患者的双眼裸眼近视力为0.03±0.06,显著优于低近附加度数组0.07±0.04,差异具有统计学意义(P<0.05)。治疗前两组患者视功能指数量表(VF-14)评分分别为27.93±4.52、28.24±4.91分,治疗后两组患者视功能指数量表(VF-14)评分分别为82.04±14.31、81.22±13.70分,差异均无统计学意义(P>0.05)。与治疗前相比,两组患者治疗后VF-14评分均显著增加,差异具有统计学意义(P<0.05)。低近附加度数组患者正常立体视、周边立体视及黄斑立体视所占百分比分别为47.6%、31.0%、21.4%,高近附加度数组正常立体视、周边立体视及黄斑立体视所占百分比分别为42.9%、23.8%、33.3%,两组相比差异均无统计学意义(P>0.05)。

结论：白内障患者的两种近附加度数对提高单眼视设计白内障摘除手术后患者的裸眼视力、视功能生存质量及立体视均有相似的优越性。     

白内障术前预测因素与术后视功能的相关性研究

目的:探讨白内障术前相关预测因素与术后视功能的相关性。方法:选取83例在我院眼科行白内障超声乳化和人工晶状体植入术患者,对其进行A超眼轴长度测量、白内障类型、核硬度等检查,分析术前预测因素与术后视力、视功能指数14(Visual Funtion Index14,VF-14)的相关性。结果:年龄、性别、眼轴、核硬度、术前矫正视力、白内障类型、高血压病史、糖尿病病史、对侧眼视力、患病时间与术后VF-14、术后30d矫正视力有相关性;术前VF-14、DM病史、对侧眼视力对于术后VF-14有83.5%的影响,具有重要意义。结论:通过术前相关检查能够有效地评估患者白内障术后视功能,术前VF-14量表的评价有一定意义。     

单眼与双眼老年性白内障摘除人工晶状体植入术后的双眼视觉比较分析

目的　比较分析单眼与双眼老年性白内障摘除人工晶状体植入术后双眼视功能恢复状况。方法　对单眼和双眼人工晶状体手术患者各 6 0例分别检测矫正视力、屈光状态、双眼影像 ,以及用同视机等方法检查双眼视功能。结果　两组患者的双眼同时视功能、融合功能无显著差异。双眼手术组患者的远近立体视功能显著优于单眼组。影响单眼手术患者双眼视功能恢复的主要原因是另侧非手术眼的白内障所导致的视力低下和两眼屈光参差。结论　双眼视功能恢复水平是评价人工晶状体术后视觉质量和生活能力改善的重要指标。单眼手术和双眼手术者双眼视觉的差异主要体现在立体视功能上     

Impact of differences between eyes on binocular measures of vision in patients with cataracts

PURPOSE: To assess the association of stereopsis with differences between eyes (better minus worse eye value) and the binocular value of visual acuity and contrast sensitivity, and to analyse binocular summation or inhibition phenomena owing to differences between eyes. METHODS: A cohort of 137 patients with bilateral cataracts (visual acuity of 0.3 LogMAR or worse in both eyes) was followed up through first- and second-eye cataract surgery. The patients were recruited from the ophthalmology departments of two teaching hospitals. Visual acuity, contrast sensitivity (monocular and binocular), and stereopsis were measured preoperatively, after first- and second-eye surgery. Multiple linear regression and local correlation analyses were used. RESULTS: Stereopsis was most strongly influenced by visual acuity in the postoperative period after first-eye surgery (standardized coefficients of 0.382 for difference between eyes and 0.356 for binocular visual acuity) and by contrast sensitivity in the postoperative period after second-eye surgery (standardized coefficients of 0.353 for the difference between eyes and -0.312 for binocular contrast sensitivity). After first-eye surgery, the correlation of the differences between eyes with stereopsis was stronger (between 0.4 and 0.5) when the differences were greater than 0.4 logMAR units for visual acuity. Slight binocular summation was found for contrast sensitivity. CONCLUSIONS: When assessing the indication for and outcomes of cataract surgery, analysis of visual function should include measures of both eyes, rather than measures of the operative eye only, as differences between eyes (better minus worse eye value) may play an important role in binocular measures such as stereopsis.     

老年性白内障摘除术后早期双眼视觉的恢复

目的　观察老年性白内障摘除术后早期患者双眼视觉的恢复情况 ,并探讨影响其恢复的原因。方法　对 5 5例 (6 6只眼 )老年性白内障患者行囊外白内障摘除人工晶状体植入术 (ECCE组 )或超声乳化白内障吸除人工晶状体植入术 (PHACO组 ) ,术后检查矫正视力、屈光度数 ,以及双眼同视、融合及远、近距离立体视功能。结果　术前术眼视力ECCE组低于PHACO组 ,差异有显著意义 (P <0 0 5 ) ;术后术眼和非术眼视力两组比较 ,差异均无显著意义 (P >0 0 5 )。术后ECCE组双眼柱镜屈光度数差值较大 ,与PHACO组比较差异有非常显著意义 (P <0 0 1)。两组患者术后均具有较好的双眼同视和融合功能。ECCE组和PHACO组分别有 83 3%和 94 7%的患者获得不同程度的远距离立体视 ,差异无显著意义 (P >0 0 5 ) ;分别有 2 8%和 2 1 1%的患者获得黄斑中心近距离立体视 ,差异有显著意义(P <0 0 5 )。结论　老年性白内障摘除术后早期患者的双眼视觉未完全恢复 ;术前长期的视觉抑制 ,尤其是单眼抑制和术后的屈光参差可能是影响双眼视觉恢复的原因。     

Diabetic retinopathy before and after cataract surgery.

AIMS/BACKGROUND: Increased retinopathy progression has been reported after cataract surgery in patients with diabetes mellitus. To assess the influence of cataract surgery on visual acuity and retinopathy progression, all diabetic patients who were subjected to cataract surgery during 1991-3 have been followed up at the Department of Ophthalmology in Helsingborg. The average follow up time was 2 years. METHODS: One eye of each of 70 patients was included in the study, 35 monocularly and 35 binocularly operated on. Sixteen of the 70 patients had proliferative diabetic retinopathy (PDR) at baseline. The Wisconsin scale was used for the grading of retinopathy. The degree of glycaemic control was assessed by measurements of HbA1c. RESULTS: Most patients obtained improved visual acuity; a postoperative visual acuity of 0.5 or better was achieved in 89% of diabetic surgical eyes. Progression of the retinopathy occurred in 30 out of the 70 eyes, and was associated with mean level of HbA1c (p = 0.04), duration of diabetes (p = 0.02), insulin treatment (p = 0.001), and presence of retinopathy at baseline (p = 0.01). Patients who progressed had a significantly higher incidence of macular oedema (p = 0.006) than those who did not progress. No significant differences were found when operated and non-operated eyes were compared in the 35 patients with monocular surgery. Two patients in this group, however, ended up with macular oedema and worse vision in the operated eye than in the eye which was not operated on. Both patients had background retinopathy before surgery. CONCLUSIONS: Patients in this study, also those with PDR, obtained good visual acuity, better than in most previous studies. Poor glycaemic control was a factor of importance for the progression of diabetic retinopathy after cataract surgery.     

The impact of penetrating keratoplasty in patients with keratoconus using the VF-14 questionnaire

To assess the visual function of patients with keratoconus who underwent penetrating keratoplasty with the use of the VF-14 questionnaire. Fourteen patients (9 male and 5 female) with a mean age of 38 years (SD 13.59) participated in the study. All patients had keratoconus, confirmed by corneal topography, and all had previously undergone penetrating keratoplasty in one eye. Their mean best-corrected visual acuity (BCVA) binocularly was 0.185 (SD 0.077) LogMAR. None of the grafted eyes had a BCVA <0.300 LogMAR. Fourteen healthy volunteers, age- and sex-matched, also participated in the study as control subjects. The VF-14 questionnaire was used to evaluate the effect of the ocular status in the daily life activities of the patients. The mean VF-14 result for the grafted patients with keratoconus was 62.37% (SD 22.60) and for the control group it was 100% (P < 0.001). There was only a weak correlation between the VF-14 score and the binocular BCVA (r = −0.394, P = 0.163). The mean VF-14 result in grafted patients with keratoconus is indicative of low functional ability despite the satisfactory postoperative BCVA. The absence of a significant correlation between the VF-14 score and the mean BCVA indicates that the low functional visual ability in these patients is probably associated more with the ‘perceived by themselves’ difficulty due to their ophthalmological condition.     

Visual function and outcomes after cataract surgery in a Singapore population

PURPOSE: To identify the predictors of visual outcomes (visual acuity and visual function) in cataract surgery patients in Singapore and compare the visual outcomes of phacoemulsification and extracapsular cataract extraction (ECCE). SETTING: Singapore National Eye Center, Singapore, Republic of Singapore. METHODS: The visual function was measured by the VF-14 and visual acuity in the operated and the better eye in 460 systematically sampled cataract surgery patients preoperatively and 3 months after surgery. Several patient- and surgery-related predictive factors were recorded. RESULTS: After cataract surgery, 85.1% of patients reported improved visual acuity in the operated eye and 77.6% reported improved visual function. Patients with poorer visual acuity and visual function at baseline reported greater improvements in visual acuity and visual function. Patients who had phacoemulsification had better final visual function (P =.006) and better final visual acuity (P <.001) scores. In multiple linear regression models, final visual function was better in patients without preexisting eye disease and with better baseline visual function, and final visual acuity in the operated eye was better in patients who were younger, were better educated, had no preexisting conditions or postoperative complications, and had a better baseline visual acuity. CONCLUSIONS: Patients with poorer baseline visual acuity or who had no preexisting eye disease reported more improvement in visual acuity in the operated eye. Several factors including no preexisting eye disease were associated with better final visual acuity and visual function scores.     

Depth of focus in eyes with diffractive bifocal and refractive multifocal intraocular lenses

PURPOSE: To evaluate monocular and binocular depth of focus in eyes with different multifocal intraocular lens (IOLs) systems. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: In this comparative interventional study, binocular implantation of multifocal IOLs was performed in 3 groups. In the first group, 26 eyes of 13 patients received asymmetric Acri.Twin (Acri.Tec) IOLs, a near-weighted 733D in 1 eye and a distance-weighted 737D in the fellow eye. In the second group, 26 eyes of 13 patients received a diffractive 811E IOL (Pharmacia). In the third group, 26 eyes of 13 patients received a refractive Array IOL (AMO). The visual acuity was tested monocularly and binocularly starting at 6 m in 0.50 diopter (D) defocusing steps. RESULTS: Distance visual acuity was best in eyes with the distance-dominated 737D IOL; eyes with the other IOLs had comparable results. Binocular distance visual acuity was comparable between the Acri.Twin group and the 811E group. The Acri.Twin group had better distance visual acuity than the Array group (P< or =.048). Near visual acuity was best in eyes with the near-weighted 733D, followed by the 737D and the 811E. Patients with Array IOLs had worse visual acuities at reading distance (between 33 cm and 40 cm) (P< or =.001). Patients with diffractive bifocal IOLs had better results than patients with refractive multifocal IOLs at reading distance (P< or =.018). CONCLUSION: The diffractive IOLs performed better than refractive IOLs. Asymmetric-weighted IOLs provided better binocular depth of field.     

单眼严重白内障伴外斜视患者临床疗效观察

目的：观察单眼严重白内障合并外斜视患者术后临床效果。 方法：回顾我院2010-03/2012-12单眼严重白内障合并外斜视行白内障摘除联合人工晶状体植入手术的患者资料45例。术前44例较差眼视力均〈0.05,1例2岁患儿无法配合视力检查。随诊观察术后6mo患者的最佳矫正视力、眼底、斜视度、双眼单视功能及复视情况。 结果：先天性白内障患者2例中有1例患儿2岁,无法配合视力及复视检查,眼底正常;另1例患儿术后无同时知觉,无复视。5例不明原因中青年单眼白内障患者中,有3例患者术后视力〉0.6,眼底正常,术后眼位正,有双眼单视;2例患者术后视力为指数,眼底有异常,术后斜视度与术前无变化,无同时知觉,无复视。38例老年性白内障患者中,有31例患者术后有双眼单视;3例患者术后斜视度与术前无差异,无同时知觉,无复视;3例患者术后斜视度与术前无差异,有复视,6mo内复视均自行消除;1例患者外斜10o,术后出现复视,且6mo内无改善,可用12？矫正,建议戴镜治疗。 结论：单眼严重视力障碍合并外斜视的成年患者多数术后可自行纠正眼位,获得一定的双眼单视功能。