Methods: The study was conducted between June and August 2015. All facilities in the country providing cataract services were contacted to obtain information on surgeries performed in 2014. Hospitals performing eye surgery in Quena, Sharkia, and Fayoum regions were visited and a questionnaire on resources for cataract surgery was completed.
Results: Cataract surgery was offered in the public sector by 64 government and 16 university teaching hospitals and in the private sector by 101 hospitals. Over 90% of all facilities in the country contacted participated in the study. In 2014, the national cataract surgical rate (CSR) was 3674 varying in governorates from 7579 in Ismailia to 402 in Suez. The private sector performed 70% of cataract surgeries.
Analysis of three regions showed an 11.7% increase in cataract output between 2010 and 2014. The average number of cataract surgeries per unit in 2014 was 2272 in private, 1633 in university, and 824 in government hospitals. Private hospitals had 60% of human resources for eye care. Phacoemulsification was the surgical technique in 85.6% of private, 72.1% of university, and 41% of government hospitals.
Reasons explaining the differences in output between public and private sectors were the lack of trainers, supervisors, and incentives.
Conclusion: The private sector provides most of the cataract services in Egypt, resulting in inadequate services for the poor. There is a 15-fold variation in CSR between the best and least served regions. The public sector could increase cataract output by improving training, supervision, and incentives. 相似文献
Methods: Study participants comprised 16,086 adults aged 40 years or older who had never been diagnosed with or undergone surgery for cataract using Korean National Health and Nutrition Examination Survey data from 2008 to 2012. Participants were assessed to have cataract when diagnosed with cortical, nuclear, anterior subcapsular, posterior subcapsular, or mixed cataract. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the magnitude and significance of the association between serum 25(OH)D levels and cataract in multivariable logistic regression models.
Results: The OR for nuclear cataract with the highest quintile of serum 25(OH)D levels was 0.86 (95% CI 0.75–0.99) compared to the lowest quintile. A linear trend across quintiles was significant. Natural log-transformed serum 25(OH)D levels were also significantly associated with nuclear cataract (OR 0.84, 95% CI 0.75–0.95). The opulation-attributable fraction of nuclear cataract due to serum 25(OH)D insufficiency (<30 ng/mL) was 8.8% (p = 0.048).
Conclusions: Serum 25(OH)D levels were inversely associated with the risk of nuclear cataract. Prospective studies investigating the effects of serum 25(OH)D levels on the development of nuclear cataract are needed to confirm our findings. 相似文献
Methods: Retrospective study of children with uveitis who underwent phacoemulsification with IOL implantation between January 2006 and May 2014.
Results: Twenty-one eyes of 16 children were included. Mean age at cataract surgery was 10.9 years. Juvenile idiopathic arthritis was associated in 37.5%, tuberculosis in 18.7%, Vogt Koyanagi Harada disease in 6.2%, and idiopathic uveitis in 37.5%. Anterior uveitis occurred in 8/21 eyes, intermediate uveitis in 9/21 eyes, and panuveitis in 4/21 eyes. Mean follow-up was 29.9 months. Posterior capsule opacification occurred in 15 eyes, glaucoma in two eyes, choroidal neovascular membrane in one eye, and cystoid macular edema in five eyes. At the last follow up, 19/21 eyes had improved vision and 14 had 20/40 or better vision.
Conclusion: Tight perioperative inflammatory control with immunosuppression may result in good vision after phacoemulsification and IOL implantation without posterior capsulorrhexis in older children with uveitic cataract. 相似文献
Methods: Twelve children with chronic uveitis underwent cataract surgery with primary posterior chamber intraocular lens (IOL) implantation.
Results: Fourteen eyes were implanted with a foldable hydrophobic acrylic IOL. The mean follow-up was 35.39 months (8.72–69.57). The mean BCDVA before surgery and at the end of follow-up was 1.11 (0.40–2.30; SD: 0.57) and 0.48 (0–3; SD: 0.77; p=0.007) respectively. The mean oral corticosteroids dosage after surgery and at the end of follow-up was 0.80 mg/kg/day (SD: 0.37) and 0.17 mg/kg/day (SD: 0.24; p=0.001) respectively. All patients except one were treated with methotrexate. Four patients (5 eyes) were additionally treated with anti-tumor necrosis factor agent.
Conclusions: Cataract surgery with primary posterior chamber hydrophobic IOL implantation is possible and leads to a good visual recovery in cases of pediatric chronic uveitis. This surgery requires aggressive anti-inflammatory management with immunosuppressive drugs to control inflammation and reduce the corticosteroids dosage. 相似文献
Methods: In this cross-sectional study, 106 of 272 cataract surgical centers in Iran were selected through multistage random cluster sampling from all provinces. In each province, the selected number of centers was proportionate to the number of cataract surgeries, and in each center, the selected number of charts was proportionate to the center’s number of cataract surgeries, from which we retrieved intraoperative complications.
Results: The prevalence of intraoperative complications of cataract surgery was 5.04% (95% confidence interval, CI, 3.53–6.54%) in 2006, which decreased significantly to 3.44% (95% CI 1.84–5.04%) in 2010. The most common complication was posterior capsular rupture/vitreous loss which decreased from 4.29% (95% CI 2.93–5.66%) in 2006 to 2.81% (95% CI 1.3–4.31%) in 2010. The next most common complication was suprachoroidal hemorrhage at 0.56% (95% CI 0.25–0.87%) in 2006 and 0.46% (95% CI 0.3–0.62%) in 2010. The least common complication concerned intraocular lens (IOL)-drop. Complications were seen most with lensectomy, while phacoemulsification caused the least complications. Mean hospitalization time in uncomplicated cases was 0.59 days (95% CI 0.58–0.61 days) and in complicated cases 1.14 days (95% CI 1.07–1.20 days; p < 0.001).
Conclusion: Complications of cataract surgery in Iran had a decreasing trend during 2006–2010. However, results from 2010 indicate that cataract surgical complications still need to be focused on. Hospitalization was longer for cases with complications, and further reducing this could help decrease costs of cataract surgery. 相似文献
Methods: This is an interventional, retrospective, consecutive case series.
Results: Five patients with a history of well-controlled uveitis were included. All underwent vitrectomy, with removal of residual lens fragments if necessary. All received pre-, intra- and perioperative steroids, which were slowly tapered over the weeks after the surgery. If possible the dislocated IOL was rescued; otherwise, insertion of a new three-piece IOL was made. Postoperatively, all IOLs remained centered and haptics covered by conjunctiva without dislocation, erosion, or scleral thinning. There were no significant complications related to the surgery. Overall, the mean preoperative visual acuity was improved from logMAR 2.09 preoperatively to 0.59 postoperatively, which was statistically significant (p = 0.015). All eyes were deemed quiet at follow-up and none required escalation of therapy for long-term uveitis control.
Conclusion: SIS IOL fixation is a safe and effective option for well-controlled uveitic eyes. 相似文献
Methods: Using the resources of the Rochester Epidemiology Project, a retrospective population-based, case-control study was performed. Cases included 6024 county residents aged 50 years and older who had first-eye cataract surgery between 1 January 2004 and 31 December 2011. Controls included residents who had never had cataract surgery and were matched to cases by age, sex, and index date within 1 month of surgery. Statin medications continuously prescribed for at least 1 year before the surgery date (cases) or index date (controls) were examined. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models.
Results: There were 2557 (42%) statin users among cases having cataract surgery compared to 2038 (34%) statin users among controls never having had cataract surgery (p < 0.0001). Incident cataract surgery was significantly associated with increased odds of statin use (OR 1.29, 95% CI 1.19–1.55) after adjusting for age, sex, diabetes, cardiovascular disease, cerebrovascular disease, peripheral vascular disease, renal disease, oral and inhaled steroid use, and selective serotonin reuptake inhibitor use. The association was consistent in both subgroups of women (OR 1.34, 95%CI 1.22–1.49) and men (OR 1.17, 95% CI 1.05–1.30).
Conclusions: Incident cataract surgery was associated with increased odds of statin use, and underscores the possibility that increasing statin use could be contributing to rising rates of cataract surgery. 相似文献
Methods: Computerized data was obtained from an Israeli health maintenance organization regarding cases of sun-related skin pathologies and cataract diagnosed between 2006 and 2011 in 686,260 members aged 40 or above.
Results: Sun-related skin disorders were found in 9.3% of the study population, more commonly among the elderly, and those who reside in areas of higher socioeconomic status. Cataract was diagnosed in 13.1% of the study population, with highest prevalence (47%) among squamous cell carcinoma patients, who were the oldest group. Multivariable analysis adjusting for age, sex, residential district, birth region, smoking, and chronic comorbidities showed no statistically significant association between melanoma and cataract (OR = 1.06; 95% CI: 0.91–1.22). Basal cell carcinoma, squamous cell carcinomas, and actinic keratosis were associated with increased likelihood of prevalent cataract with adjusted odds ratios (95% CI) of 1.14 (1.08–1.20), 1.11 (1.01–1.19), and 1.16 (1.13–1.19), respectively. When stratified by gender, the association between actinic keratosis and cataract was stronger in women than in men, particularly in patients under 65 years.
Conclusions: The association between the prevalence of skin cancers and the prevalence of cataract enhances the conclusion that cataract is related to UVR exposure. 相似文献
Methods: The number of patients in Scotland with APACG in each of the years between 1998 and 2012 was obtained from Information Service Division (ISD) Scotland. Data was also obtained for patients who had undergone laser PI and cataract surgery. The annual rates of APACG, PI and cataract surgery were calculated using Scotland’s population data during each of these years.
Results: Between 1998 and 2012 the rate of APACG in National Health Service patients decreased by 46.4% (from 46.7 to 25.0 per million, p < 0.005). The rate of PI increased overall by 116.3% (from 38.0 to 82.2 per million), but demonstrated a decrease of 48.2% (38.0 to 19.7 per million, p = 0.002) between 1998 and 2008, and an increase of 317.3% (19.7 to 82.2 per million, p = 0.005) between 2008 and 2012. Over the same 15-year period, cataract surgery increased by 73.4% (from 354.2 to 615.2 per 100,000, p < 0.005). In this timeframe, mid-year Scottish population estimates increased by 4.6%.
Conclusion: Our results demonstrate a significant reduction in the rate of APACG in the Scottish population between 1998 and 2012, along with a rising rate of PI and cataract surgery. The trend of decreasing APACG may be due to the increasing rate of cataract surgery in the same time period. This parallels patterns seen in other European countries. We discuss these findings together with other related epidemiological factors. 相似文献
Methods: We analyzed Illumina Human Exome Array data for 1,488 participants of European ancestry in the Beaver Dam Eye Study who were without cataract surgery for association with nuclear sclerosis grade, controlling for age and sex. We performed single-variant regression analysis for 32,138 variants with minor allele frequency (MAF) ≥0.003. In addition, gene-based analysis of 11,844 genes containing at least two variants with MAF < 0.05 was performed using a gene-based unified burden and non-burden sequence kernel association test (SKAT-O). Additionally, both single-variant and gene-based analyses were analyzed stratified by smoking status.
Results: No single-variant test was statistically significant after Bonferroni correction (p < 1.6 × 10–6; top single nucleotide polymorphism (SNP): rs144458991, p = 2.83 × 10–5). Gene-based tests were suggestively associated with the gene RNF149 overall (p = 8.29 × 10–6) and among never smokers (N = 790, p = 2.67 × 10–6).
Conclusions: This study did not find a significant genetic association with nuclear sclerosis, the possible association with the RNF149 gene highlights a potential candidate gene for future studies that aim to understand the genetic architecture of nuclear sclerosis. 相似文献
Methods: Records of 13 patients (21 eyes) with IOL were retrospectively reviewed. SD-OCT was evaluated at initial visit and during follow-up.
Results: SD-OCT images at initial visit demonstrated disruption of the ellipsoid zone (8 eyes, 38.1%) and hyperreflective nodules at the retinal pigment epithelium (RPE) level (5 eyes, 23.8%). During follow-up, disruption of the ellipsoid zone (10 eyes, 47.6%) and hyperreflective nodules at the RPE level (7 eyes, 33.3%) were noted. In 5 eyes showing hyperreflective nodules at the RPE level, the hyperreflective nodules were reduced after treatment with intravitreal methotrexate.
Conclusions: Hyperreflective nodules in the outer retina and disruption of the ellipsoid zone were observed in nearly one-half of patients with IOL over time. SD-OCT may allow for early detection of small macular abnormalities and aid in monitoring of treatment efficacy in this disease. 相似文献
Methods: We performed 25-gauge pars plana vitrectomy, removal of dislocated intraocular lens (IOL), and secondary IOL fixation in the left eye. A similar procedure was performed in the right eye with 27-gauge pars plana vitrectomy.
Results: The postoperative visual acuities were 20/30 OD and 20/125 OS. Hematoxylin and eosin staining demonstrated an abundance of calcified tissue and rare osteoclasts in lacunae, compatible with osseous metaplasia (cataracta ossea).
Conclusion: To our knowledge this is the first clinicopathologic report demonstrating cellular metaplasia that resulted in osseous transformation of the cortical lens remnants into bone in both eyes of a psuedophakic patient with chronic granulomatous pan uveitis of unknown etiology. The surgical technique described in the supplemental videos demonstrates an effective way of managing this complication. 相似文献
Design: Interventional case report.
Participants: One patient.
Intervention: Steroids (Medrol dose pack) and radiation.
Main Outcome Measures: Unusual clinical presentation and pathological features of Juvenile Xanthogranuloma in the orbit.
Conclusions: Juvenile Xanthogranuloma affecting one orbit is very rare with unilateral involvement in an elderly patient. Steroids and radiation therapy were very effective in treatment and provided impressive results. 相似文献
Design: Review.
Methods: Review of literature, personal communication with several pioneers in the field, and own experience.
Conclusion: Radiofrequency surgery has evolved from rude burning to a sophisticated surgical technique. 相似文献
Design: Prospective study.
Methods: Eighty eight eyelids in 55 patients with mild and moderate ectropion were included in the study. An excision of a diamond of tarso-conjunctiva with retractor reattachment and concomitant correction of horizontal lid laxity, if present, was performed.
Results: Resolution of tearing was obtained in 77 eyes. In 11 eyes, persistent tearing was reported.
Conclusion: Conclusion:Conclusion: Repair of early to intermediate ectropion of the lacrimal punctum using the Raus–Garito clamp is associated with a good functional and cosmetic outcome. 相似文献
Methods: Seven patients with ocular complications following viper bite referred to uveitis clinic had slit-lamp examination, intraocular pressure (IOP) measurement, and fundus evaluation. Iris and fundus fluorescein angiography was performed on 2 patients. Histopathological examination was performed on iris tissues collected during cataract surgery.
Results: Strikingly similar clinical findings were noted, including circumpupillary superficial iris atrophy, mid dilated fixed pupil, marked pigment dispersion, low IOP, and cataract. All clinical signs were noted only in the anterior segment; the posterior segment was normal. Histopathology of iris revealed atrophy of iris stroma, necrotic iris pigment epithelium, and infiltration of T lymphocytes and fibrous membrane. Poor visual outcome was noted in patients with low IOP.
Conclusion: Viper bite victims presented with clinical and histopathological signs of anterior segment ischemia and secondary inflammatory signs mimicking uveitis. 相似文献
Methods: We conducted a rapid assessment of avoidable blindness (RAAB) in 8 districts of Bangladesh (January 2010 – December 2012) to establish the prevalence and causes of blindness. People aged ≥50 years were selected, and eligible participants had visual acuity (VA) measured. Ocular examinations were performed in those with VA<6/18. Additional information was collected for those who had or had not undergone cataract surgery to understand service barriers and quality of service.
Results: In total, 21,596 people were examined, of which 471 (2.2%, 95% confidence interval, CI, 2.0–2.4%) were blind. The primary cause of blindness was cataract (75.8%). The majority of blindness (86.2%) was avoidable. Cataract and refractive error were the primary causes of severe visual impairment (73.6%) and moderate visual impairment (63.6%), respectively. Cataract surgical coverage for blind persons was 69.3% (males 76.6%, females 64.3%, P<0.001). The magnitude of blindness among people aged ≥50 years was estimated to be 563,200 people (95% CI 512,000–614,400), of whom 426,342 had un-operated cataract.
Conclusions: In Bangladesh, the majority of blindness (86.2%) among people aged ≥50 years was avoidable, and cataract was the most important cause of avoidable blindness. Improving cataract surgical services and refraction services would be the most important step towards the elimination of avoidable blindness in Bangladesh. 相似文献
Methods: This case-control study comprised 165 subjects (57 patients with nAMD and 108 controls). Controls were matched to cases by age and sex. Participants completed a questionnaire that included questions about sleep duration and quality. Four categories of sleep duration were established; <6 hours, 6–7 hours, 7–8 hours and >8 hours. Association of sleep duration and nAMD was assessed by logistic regression analysis. Multiple logistic regression models were performed to control for possible confounders.
Results: We found a significant association between short sleep duration and nAMD (for <6 hours, odds ratio, OR, 3.29, 95% confidence interval, CI, 1.32–8.27; for 6–7 hours, OR 2.25, 95% CI 0.80–6.32; and for >8 hours, OR 1.39, 95% CI 0.53–3.73) compared with the reference category of 7–8 hours. This association remained significant after adjustment for confounders (<6 hours, OR 3.09, 95% CI 1.20–7.97). In addition, a borderline significant association was observed between self-reported very bad sleep quality and nAMD (OR 2.84, 95% CI 1.02–7.88). The highest rate of sleep medication use was found in the nAMD group (p < 0.001).
Conclusion: Our findings provide evidence to support an association between short sleep duration and nAMD. Considering strategies to improve sleep in these patients may prevent the negative effects of sleep deficiency. 相似文献
Methods: Using a large US health insurance claims database, we identified a CF cohort and a GP cohort matched with respect to age, gender, and calendar year. The prevalence and incidence of diagnosed cataract (primary outcome) for both cohorts were calculated, as well as the incidence rate ratios (IRRs).
Results: The prevalence of diagnosed cataracts among patients with CF alive and enrolled in the health plan on August 31, 2012 was 4.8% versus 2.8% in the GP. The incidence in the CF cohort was higher than in the GP and increased with age in both cohorts. The adjusted IRR comparing the CF and GP cohorts was 1.5 (95% CI: 1.2–1.8).
Conclusions: The study suggests that the risk of developing cataract was higher among patients with CF than among the GP. 相似文献
Methods: Our study included 120 patients referred to cataract surgery (early and late stage of pseudoexfoliation syndrome (XFS), pseudoexfoliation glaucoma (XFG), and control group). Serum and humor levels of cytokines were measured in a sample with high sensitivity enzyme-linked immunosorbent assay (ELISA) kit.
Results: Our findings revealed that TNF-α and IL-17, overlooked by IL-6 action in the early stage and in the phase of glaucoma, played the main role in the inflammation activation in the tissue in the early and late stage of XFS and in XFG.
Conclusions: Local conditions cause chronic inflammation in the eye, subsequently activating fibrotic process with fibrotic tissue deposits in the eye. 相似文献