Outcome of cataract surgery in central India: a longitudinal follow-up study.

An epidemiological follow-up study of patients who had intracapsular cataract extraction in a voluntary hospital and its associated eye camps in Central India has for the first time evaluated the outcome one year after surgery in terms of visual acuity, use of spectacles, and improvement in income and mobility. The findings indicate that under these fairly typical conditions, 92% of the cases have adequate vision of 6/18 or better one year after surgery. Information on high usage of spectacles and on considerable improvements in income and mobility after cataract surgery is also reported. The outcome for patients operated upon in eye camps was almost as favourable as for those operated upon in hospital. Although the small differences are not statistically significant, the comparative findings require cautious interpretation and give rise to the epidemiological issues which are briefly discussed in this paper.     

Predictions of postoperative visual outcome in subjects with cataract: a preoperative and postoperative study

AIM: To assess the ability of critical flicker frequency (CFF) and optimal reading speed (ORS) to predict the potential vision in patients with cataract with and without ocular comorbidity. METHODS: The two novel tests were compared with two well established potential vision tests (PVTs), the potential acuity meter (PAM) and the laser interferometer (LI). Measurements were made preoperatively in 1 eye of 88 subjects using the battery of 4 PVTs. Postoperative measurements were made with the CFF and the ORS. The subjects studied were consecutive cases over a 12-month period who fulfilled the inclusion and exclusion criteria, and agreed to participate in this study. RESULTS: CFF was the PVT most resistant to the presence of cataract. Both CFF and ORS give a similar predictive precision in the presence of cataract and ocular comorbidity, although CFF seems more precise when the cataract is dense. CONCLUSIONS: The PAM and the LI showed a limited clinical capability in predicting postoperative visual acuity, particularly with dense opacities. The CFF shows the most promise as a PVT, particularly with dense cataract. Further evaluation is required for both CFF and ORS.     

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。     

Sutureless cataract surgery with nucleus extraction: outcome of a prospective study in Nepal

AIM: To report the short and medium term outcome of a prospective series of sutureless manual extracapsular cataract extractions (ECCE) at a high volume surgical centre in Nepal. METHODS: Cataract surgery was carried out, on eyes with no co-existing diseases, in 500 consecutive patients who were likely to return for follow up. The technique involved sclerocorneal tunnel, capsulotomy, hydrodissection, nucleus extraction with a bent needle tip hook, and posterior chamber intraocular lens (PC-IOL) implantation according to biometry findings. Surgical complications, visual acuity at discharge, 6 weeks, and 1 year follow up, and surgically induced astigmatism are reported. RESULTS: The uncorrected visual acuity at discharge was 6/18 or better in 76.8% of eyes, and declined to 70.5% at 6 weeks' follow up, and 64.9% at 1 year. The best corrected visual acuity was 6/18 or better in 96.2% of eyes at 6 weeks and in 95.9% at 1 year. Poor visual outcome (<6/60) occurred in less than 2%. Intraoperative complications included 47 (9.4%) eyes with hyphaema, and one eye (0.2%) with posterior capsule rupture and vitreous in the anterior chamber. Surgery led to an increase in against the rule astigmatism, which was the major cause of uncorrected visual acuity less than 6/18. Six weeks postoperatively, 85.5% of eyes had against the rule astigmatism, with a mean induced cylinder of 1.41 D (SD 0.8). There was a further small increase in against the rule astigmatism of 0.66 D (SD 0.41) between 6 weeks and 1 year. The mean duration of surgery was 4 minutes and the average cost of consumables, including the IOL, was less than $10. CONCLUSION: Rapid recovery of good vision can be achieved with sutureless manual ECCE at low cost in areas where there is a need for high volume cataract surgery. Further work is required to reduce significant postoperative astigmatism, which was the major cause of uncorrected acuity less than 6/18.     

Long-term visual acuity and its predictors after surgery for congenital cataract: findings of the British congenital cataract study

PURPOSE: To report long-term postoperative visual acuity in a nationally representative group of children with congenital/infantile cataract and to investigate the factors associated with poor vision. METHODS: All children aged less than 16 years in the United Kingdom who had newly diagnosed congenital/infantile cataract in a 12-month period during 1995-1996 (the British Congenital/infantile Cataract Study) were traced through their managing ophthalmologists. Outcome data were collected at least 6 years after diagnosis, by using specifically designed questionnaires. Ordinal regression analysis identified factors associated with postoperative acuity. RESULTS: Of 153 children who had surgery, complete data were available in 122 (85%). Median age at follow-up was 7 and 6.91 years, respectively, for bilateral and unilateral disease. Median age at surgery was 4.57 months in bilateral and 2.99 months in unilateral cases, with 40% and 45%, respectively, of children operated on by 3 months. Median (range) postoperative acuity was 6/18 (6/5, no perception of light) in bilateral and 6/60 (6/5, no perception of light) in unilateral disease. Poor compliance with occlusion was the factor most strongly associated with poorer acuity in both unilateral and bilateral disease: the odds of worse vision in unilateral cataract were 7.92 times greater with <50% versus 100% compliance (95% CI 1.68-37.26). In bilateral disease, odds of worse vision were reduced with each month of decreasing age at surgery (0.98, 95% CI 0.94-0.99), but increased by the presence of additional medical conditions (3.53, 95% CI 1.08-11.44) and the presence of postoperative ocular complications (2.94, 95% CI 1.38-6.51). CONCLUSIONS: These findings support a secular improvement in postoperative acuity in bilateral, and to a lesser extent, unilateral disease. Nevertheless early detection of congenital cataract through effective newborn screening and improving concordance with occlusion both remain priorities. Further improvements in outcomes in unilateral disease are necessary before parents can be advised universally that treatment will achieve a functionally useful "spare" eye.     

Outcome of cataract surgery by a general medical doctor at district level, Zimbabwe: a retrospective follow-up study

From January 1990 until October 1992, 103 Zimbabwean patients underwent intracapsular cataract extraction by a general medical doctor. Of the first 100 patients operated upon, 50 were traced of which 37 could be assessed adequately. Operative complications and visual acuities after three months show that this is an effective means of restoring sight, but that a longer period of training of a general medical doctor than one month is adviseable. Twenty-five patients (68%) have a vision of 3/60 or better, which would have been 34 patients (92%) if post-operative refraction and adequate provision of glasses had been provided. The careful attention required regarding patients' needs and refraction is stressed by the authors. The study or better this factual report suggests that cataract surgery performed by a general medical doctor is an alternative for clearing the cataract backlog in developing countries.     

Use of a wick to deliver preoperative mydriatics for cataract surgery

Before cataract surgery at our institution, we traditionally dilated the pupils with 5 drops: proparacaine 0.5%, cyclopentolate 1%, phenylephrine 2.5%, flurbiprofen sodium 0.03% (Ocufen), and ofloxacin 0.3% (Ocuflox) at 15-minute intervals given 3 times. This was work intensive for the nursing staff. Since September 2000, we have used a wick soaked in a dilating mixture containing cyclopentolate 1%, phenylephrine 2.5%, diclofenac sodium 0.1% (Voltaren), and Ocuflox. Use of the wick has been beneficial and time saving to hospital staff.     

老年心血管疾病患者白内障手术前综合因素评估的临床价值

目的探讨对老年心血管疾病患者进行白内障手术前综合因素评估的临床价值.方法回顾性分析近5年我科对218例（255只眼）老年心血管疾病患者施行白内障手术的相关临床资料.结果13例（14只眼）老年心血管疾病患者因术前评估发现手术禁忌证、无法耐受手术或手术后视力无法提高而放弃手术;205例（241只眼）老年心血管疾病患者安全施行白内障超声乳化或小切口白内障摘除联合人工晶状体植入术,其中56例有明显心脏疾病症状者经内科调整用药,在心电监护和持续低流量吸氧下施行手术.术后随访1～18个月（平均6.3个月）,术后最佳矫正视力：光感至＜0.05者8例（9只眼）,占3.9%;0.05至＜0.3者32例（39只眼）,占15.6%;≥0.3者165例（193只眼）,占80.5%.手术脱残率为78.1%,脱盲率为91.8%.手术中均无严重全身和局部并发症发生,达到预期效果,1例手术后因吸入性肺炎转入呼吸内科抢救治疗.结论老年心血管疾病患者施行白内障摘除联合人工晶状体植入术应加强术前综合因素评估,综合性医院应发挥其优势.对老年心血管疾病患者的围手术期处理,应严格掌握手术适应证和手术禁忌证;镇静类、肾上腺素类及糖皮质激素类药物的应用应个体化;特殊类型患者手术中采用心电监护和持续底流量吸氧,使手术风险降至最低;对于Ⅳ级及以上的晶状体核采用非超声乳化小切口白内障摘除联合人工晶状体植入术较白内障超声乳化联合人工晶状体植入术为佳.     

Outcome of cataract surgery associated with posterior staphyloma

Purpose:To assess the outcome of cataract surgery in eyes with staphyloma and identify predictors of surgical success.Setting:Tertiary care referral center.Methods:A retrospective analysis was conducted of 107 consecutive patients with posterior staphyloma and 107 control patients who had cataract surgery. Potential associations of preoperative variables with surgical success were analyzed using the chi-square test, multivariate linear regression, and Student t test.Results:The staphyloma group was younger, had more women, and had a slowmean visual acuity preoperatively than the control group. All patients in the control group and all but 1 in the staphyloma group had intraocular lens (IOL) implantation at the time of cataract extraction. The rates of posterior capsule tear and vitrous loss were similar in the staphylom anad control groups. There was 1 case each of retinal detachment and IOL dislocation in the staphyloma group. The staphyloma group had significantly lower postoperative visual acuity than the control group however, the percentage in the staphyloma group with a visual acuity of finding counting or worse decreased from 80.4% preoperatively to 16.6% postoperative and the percentage with an uncorrected visual equity of 20(160 or better from 5.6% to 67.3%. Myopic degeneration was judge to be the cause of postoperativé acuity worse than 20/100 in 22.4% in the staphyloma and 0% in the control group; other causes for poor postoperative acuity were similar in the 2 groups. In the staphyloma but not the control group decreased-postoperative acuity was independently associated with age greater than 65 years and extra length greater than 29.0 mm.Conclusion:Myopic degeneration may limit the results of cataract extraction in up to one fourth of patients with posterior staphyloma. Nevertheless, a substantial improvement in mean visual acuity resulted that was not associated with a siginificant increase in surgical complications.     

重视白内障患者的术前准备与评估

白内障手术并非简单的手术，术前准备和评估均十分重要，如手术适应证的选择，术前采取预防并发症的措施以及对人工晶状体进行个体化选择等。只有在充分准备与评估的基础上，术前对患者进行详细的解释，才更利于获得手术成功。     

Outcome analysis of cataract surgery following therapeutic keratoplasty

PURPOSE: To assess the results of cataract surgery, in terms of visual outcome and effect on graft survival, in eyes that have previously undergone therapeutic penetrating keratoplasty for infective keratitis. METHODS: Case records of patients who had undergone cataract surgery alone (group A) or in combination with regrafting (group B) following initial therapeutic penetrating keratoplasty between January 2000 and December 2001 were reviewed retrospectively. Main outcome measures studied were visual acuity, astigmatism, and effect of the cataract surgery on graft survival. Results were compared with eyes undergoing cataract surgery after optical keratoplasty and between eyes in groups A and B. RESULTS: Frequency of cataract surgery after therapeutic keratoplasty was significantly greater than that following optical keratoplasty [68 (52%) versus 47 (21%); P<0.001]. Fifty-eight eyes of 58 patients undergoing cataract surgery after therapeutic penetrating keratoplasty were analyzed in detail. Mean follow-up period was 8.9 months (+/-7.6 months). Thirty eyes underwent cataract surgery alone (group A), and 28 eyes underwent cataract surgery with regrafting (group B). Eyes that had undergone therapeutic keratoplasty were significantly more likely to have opaque grafts requiring regrafting at the time of cataract surgery than eyes that had undergone optical keratoplasty [28 (48.3%) versus 5 (10.6%); P<0.001]. Incidence of graft failure after cataract surgery did not differ significantly in eyes that had undergone therapeutic or optical keratoplasty. Final visual acuity at last follow-up was 6/12 or better in 25 eyes (43%). There were no significant differences between eyes in groups A and B in terms of final visual acuity, astigmatism, or graft failure rates. CONCLUSIONS: Visual results of cataract surgery following therapeutic keratoplasty are comparable to those following optical keratoplasty. Combining a repeat keratoplasty for a failed graft with the cataract surgery does not significantly affect the final outcome.     

Factors affecting the visual outcome after cataract surgery

Postoperative visual outcome and factors related to poor visual acuity three months after cataract surgery were evaluated in 243 cataract patients operated on at the Oulu University Hospital in 1990. The surgical technique used was a planned extracapsular cataract extraction with implantation of an intraocular lens (IOL) in 240 cases: a posterior chamber IOL in 231 cases and an anterior chamber IOL in 9 cases. The postoperative visual acuity was 0.5 or better in 74.5% of the eyes, 11.9% (29 eyes) had low vision and 2.4% (6 eyes) were blind. The visual outcome was significantly related to age. The most common causes for low vision or blindness were age related macular degeneration and glaucoma. There was one case of postoperative endophthalmitis but other surgical complications did not result in visual loss. Visually significant posterior capsular opacification was observed in 2.5%, and significant postoperative astigmatism ( 3.5 D) was present in 11.1%.