ObjectiveTo examine the trends in major complications of cataract surgery in the Western Australian population over 22 years. DesignPopulation-based study. ParticipantsWe included 129 982 cataract/lens surgery patients across 46 health facilities. MethodsUsing the Western Australian Data Linkage System, we identified all patients who underwent cataract/lens surgery in Western Australia between 1980 and 2001. Complications of interest were identified from those patients admitted to hospital or who underwent unplanned surgery after cataract surgery and were validated by medical record review. Main Outcome MeasuresAdmission for retinal detachment, dropped nucleus, wound dehiscence, pseudophakic corneal edema, intraocular lens (IOL) dislocation, and postoperative endophthalmitis requiring surg...

We report a case with bilateral intumescent electric cataracts, outcomes of cataract surgery with a new technique, and a histopathologic study of the anterior capsule followed by a review of the literature on electric cataracts. The patient had bilateral cataract extraction and posterior chamber intraocular lens implantation, achieving a visual acuity of 20/20. Hematoxylin and eosin staining of the anterior capsule revealed significant scar tissue formation consisting of fibroblast proliferation and hyaloid production over the basement membrane of the anterior capsule. Electric injuries can cause bilateral intumescent cataracts; the outcomes after cataract surgery are excellent provided the fundus and optic nerve examinations are normal. Scar formation over the anterior capsule may disturb lens nutrition, leading to cataract formation. PMID:18655998

Cataract surgery remains the most widely performed intraocular procedure throughout the world. Safety and accuracy of the procedure are paramount and techniques should remain under constant review. Recently, the introduction of the femtosecond laser to assist cataract surgery has provided ophthalmologists with an exciting tool that may further improve outcomes. We review the existing literature and discuss the installation and initial experience of a femtosecond laser into our practice.

We report the endophthalmitis rate after cataract surgery in patients preoperatively given topical povidone-iodine and gentamicin-containing irrigation fluid as prophylaxis without intracameral cefuroxime or perioperative topical antibiotics. In a retrospective clinical study, we included patients undergoing cataract surgery over a 12-year period at one large university teaching hospital. Data from 26,566 cataract procedures were analysed. Cases of postoperative endophthalmitis were identified and diagnosed both clinically and microbiologically. A total of 26,566 cataract procedures were reviewed, and we identified 16 patients with postoperative endophthalmitis (rate: 0.6 per 1000 operations, or 0.06%; 95% confidence interval: 0.03-0.09%). A causative micro-organism was detected in 81.3% (13/16) of the cases. Most organisms were Gram-positive bacteria (10/13) with susceptibility to cefuroxime (9/10) and/or fluoroquinolones (4/8), and/or resistance to aminoglycosides (10/10). The three Gram-negative pathogens were susceptible to cefuroxime, aminoglycosides, and fluoroquinolones. Using our regimen of topical povidone-iodine and gentamicin irrigation, we observed a low postoperative endophthalmitis rate not differing from the infection rates recently reported in other large studies. We speculate that neither intracameral cefuroxime nor perioperative levofloxacin eye drops are necessary to minimise postoperative infectious complications following cataract surgery, and we suggest that the European Society of Cataract and Refractive Surgery guidelines (in which perioperative antibiotics are mandatory) therefore be revisited to permit alternative effective regimens for the prevention of postoperative infections following cataract surgery. PMID:21450368

... and what strength of replacement lens to use. Surgery Cataract surgery is a very safe and successful operation. The ... be done after the first has healed. Cataract surgery is usually an outpatient surgery, where the patient ...

The contributors to this text combine their expertise to make this book available on intraocular lenses, refractive corneal surgery, and the use of the YAG laser. Included is information on; IOL power calculations; the use of the YAG laser; retinal damage by short wavelength light; reviews of corneal refractive surgery; possibilities for the medical prevention of cataracts; and more.

The work deals with the results of surgical treatment of 155 patients, who had uveal cataract, by method of facoemulsification with artificial crystalline lens transplanting. The age of the sick varied from 3 to 15 as a result of a complex treatment, involving determination of ethnic factor in the development of uveal cataract, before- and after-operation conservative medical treatment, surgical treatment of abscuration ambliopia 78.1% children and the keenness of sight 0.4 and 68.7% got binocularious sight. The study lot of posttraumatic cataract affected children included 189 patients, from them 68 with stationary cataract, 87 with intumescent cataract and 34 with postoperatorial aphakia. Age from 2 to 15 years. 76.3% cases of evolution without postoperatorial complications, in 13.7% intraoperatorial were observed different complications. The work presents the results of surgical treatment 196 of children, who had innate cataract, by the method of facoasoriation with soft intra-eyepiece lens transplanting from 133 patients who had two-sided cataract, 63 had monolateral cataract. All children underwent laser simulation and videocomputer auto-training in post-operation period. As a result of the treatment, 66.8% patients got the amelioration of sight with 0.4, and 58% got binocular sight. The children's age varied between 6 months and 15 years. This article presents a review of the treatment results of 213 children with posttraumatic, congenital and complicated cataracts. The rehabilitation of the patients with the lens pathology includes a complex of measures of early diagnosis, surgery, optimal correction, medical treatment before and after surgery, the prophilaxis and treatment of complications. This approach permits to increase the visual acuity in 83.8% and to restore the binocular vision in 71.4% patients. PMID:21137197

This is a review of the major publications from the Nigeria national blindness survey in order to highlight major findings and challenges of eye care in Nigeria. The review summarizes methodology and key findings. Survey publications on methodology, prevalence and causes of visual impairment and outcome of cataract surgery were retrieved, reviewed and relevant data extracted, reported and discussed. The study was the largest and more detailed eye survey in Nigeria (15,375 people 40 years and older recruited). Participants had detailed eye examination including visual acuity, autorefractokeratometry, A- scan biometry, visual field and basic eye examination. Cause(s) of visual impairment in each eye using WHO algorithm was determined among participants with vision questions on barriers to uptake of services, quality of life and visual function. Major highlights of the results as contained in the publications include a high prevalence of blindness with 4.2% (95% CI: 3.8-4.6%;),of the study population having blindness (using presenting vision (PVA)) even with best correction the prevalence was 3.4% (95% CI: 3.0-3.8%. The prevalence of SVI using PVA was 1.5% (95% CI: 1.3-1.7%).and with best correction 0.8% (95% CI: 0.7-1.0%). Blindness varied by age groups, sex, literacy level and geopolitical zone. Furthermore, 84% of blindness was due to avoidable causes with cataract responsible for 43% of blindness, glaucoma 16.7%, uncorrected aphakia 8.4% and corneal opacity 7.9%. Of the total 538 eyes that had cataract surgery procedures, 42.7% had couching and the remaining had cataract surgery, but only 41.4% of cataract operated eyes had IOL surgery. Outcome of cataract surgery was good at presentation for only 30.8% of eyes (84 eyes) which improved to 56.8% with correction. The possible remedy for the high burden of needless blindness and harmful eye health practices in Nigeria are discussed. PMID:22684129

Use of vital dyes in ophthalmic surgery has gained increased importance in the past few years. Trypan blue (TB) has been a popular choice among anterior segment surgeons mainly due to its safety, ease of availability, and remarkable ability to enable an easy surgery in difficult situations mostly related to visibility of the targeted tissue. It is being used in cataract surgery since nearly a decade and its utilization has been extended to other anterior segment surgeries like trabeculectomy and corneal transplantation. This review will discuss the techniques and outcome of TB dye-assisted anterior segment surgeries.

Abstract. Purpose:- To longitudinally report the changes in visual acuity (VA) and subjective visual function, 10-years after cataract surgery. Methods:- This population-based prospective study reviewed 335 patients (85% of survivors) who underwent cataract surgery during a 1-year period in 1997-98, 289 of whom were also re-examined. The patients underwent a routine eye examination and answered the same visual function questionnaire (VF-14), preoperatively, 4-months postoperatively, 5-years and 10-years after surgery. Results:- Ten years after surgery, the best corrected VA (BCVA) of the operated eye had deteriorated to a median of 0.06 (logMAR) (Snellen acuity: 20/23) from 0.046 (logMAR) (20/22) postoperatively (p-=-0.001). More than two-thirds of the patients had <0.1 logMAR units worsen...

Background Simultaneous bilateral intraocular surgery (SBIS), defined as sequential bilateral intraocular surgery completed in one visit to the operating room, is a controversial topic. The reluctance of ophthalmologists to perform SBIS has been mainly attributable to concerns about bilateral catastrophic complications (endophthalmitis, expulsive hemorrhage, or retinal detachment). Herein we report our experience with SBIS in children and review the literature. Methods The medical records of 44 patients who underwent 48 cases of SBIS between 1994 and 2009 were reviewed. Of the 48 cases, 27 were bilateral cataract extractions, 1 including intraocular lens placement; 21 were cases of bilateral glaucoma surgeries, including goniotomy, trabeculotomy, and filtering tube placement. Bilateral sur...

Extension of the capsulotomy into the periphery is a well-known complication of cataract surgery in young patients with intumescent cataracts. We report such a case successfully treated preoperatively with a neodymium:YAG laser anterior capsulotomy. PMID:12954318

A study of 132 cases of aphakic retinal detachment (ARD) following mainly intracapsular cataract surgery has been made. Forty-nine cases (37%) were found to have vitreous incarcerated into the cataract section out of a total of 54 (41%) cases who had suffered a vitreous complication during cataract ...

A patient with retinitis pigmentosa showed visual disturbances following successful cataract surgery. He had a dense asteroid hyalosis in the eye before cataract surgery. After the surgery he noticed that his vision became worse. The visual disturbance was explained as being caused by the progressio...

Abstract Purpose: To show the evolution of anterior chamber structures 6 years after cataract surgery in a case with Acanthamoeba keratitis (AK). Methods: A 37-year-old woman with AK receiving long-term treatment with chlorhexidine, propamidine isethionate and steroids developed a white cataract and iris atrophy. Penetrating keratoplasty and cataract surgery were performed with subsequent intraocular pressure elevation requiring Molteno shunt implantation. Two years after the last surgery, endothelial decompensation developed and another penetrating keratoplasty was performed. Intraoperatively, the anterior and posterior capsules were completely transparent. Results: Six years after cataract surgery, the intraocular lens was centered with clear anterior and posterior capsules without lens ...

PURPOSE OF REVIEW: To summarize current understanding of antibiotic prophylaxis in cataract surgery, with particular emphasis on available evidence and change in practice patterns over the past decade. RECENT FINDINGS: Povidone-iodine application prior to cataract surgery remains a universal practice, and is backed by good quality evidence. Subsequent to the results of the European multicenter trial documenting decreased risk of endophthalmitis with intracameral cefuroxime injection at the end of surgery, similar benefit with intracameral antibiotic use has been reported in studies with large sample sizes from multiple centers around the world. There has been a distinct change in practice patterns in many countries, with intracameral antibiotic use becoming part of routine protocol. In the USA, topical fluoroquinolone application remains the most popular mode of antibiotic prophylaxis. A promising approach is the development of novel drug delivery methods like polymeric devices designed for sustained antibiotic release. SUMMARY: Based on current evidence, the recommended measures for endophthalmitis prophylaxis are preoperative topical instillation of povidone-iodine and intracameral antibiotic injection at the end of cataract surgery. PMID:23080014

PurposeTo evaluate the effect of intracameral dexamethasone during pediatric cataract surgery on the incidence of postoperative glaucoma. SettingClinical and Academic Department of Ophthalmology, Great Ormond Street Hospital, London, United Kingdom. DesignRetrospective case series. MethodsThis case-note review comprised all infants who had cataract surgery with intraocular lenses between January 1, 2007, and December 31, 2008, and were given preservative-free intracameral dexamethasone intraoperatively. The definition of glaucoma was an intraocular pressure (IOP) of 21 mm Hg or greater on more than 2 occasions or moderate or firm digital IOP with 1 of the following: myopic shift, increased cup-to-disc ratio, increased horizontal corneal diameter, or corneal edema. ResultsEighteen patients ...

Purpose: The purpose of this study was to investigate the causative organisms, the clinical characteristics, visual outcomes, and the incidence of acute endophthalmitis after cataract surgery. Materials and Methods: In this retrospective study, a chart review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. During the study period, 62 additional patients with acute postoperative endophthalmitis were referred to and treated in this center. Therefore the cohort comprised 70 patients (8 of whom underwent cataract surgery at our center, and 62 who were referred). Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. Porganism isolated. Positive cultures were more frequently found in patients with RAPD. The “gram-positive coagulase-negative” and “no growth” groups had the best visual outcome. Associated keratitis and avoiding intraocular steroids were associated with the risk of evisceration. Conclusion: The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final corrected visual acuity of ?20/200. Therefore, better treatment strategies are warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation. In addition, RAPD, as an objective test, may complement VA for predicting the prognosis and planning the course of treatment. PMID:3317183

The visual acuity of 4 infants with congenital cataracts was measured serially during the first year of life by a preferential looking technique. Two infants with bilateral cataracts and no measurable acuity before surgery showed rapid development of acuity to normal levels for age after surgery and...

... truck driver from Chandler, Arizona, is having cataract surgery today on his left eye. A month ago ... anesthesia to numb the eye area. With microscopic surgery the surgeon can make a very small incision, ...

The human eye is a favored target for laser surgery due to its accessibility via the optically transparent ocular tissue. Femtosecond lasers with confined tissue effects and minimized collateral tissue damage are primary candidates for high precision intraocular surgery. The advent of compact diode-pumped femtosecond lasers, coupled with computer controlled beam delivery devices, enabled the development of high precision femtosecond laser for ophthalmic surgery. In this article, anterior segment femtosecond laser applications currently in clinical practice and investigation are reviewed. Corneal procedures evolved first and remain dominant due to easy targeting referenced from a contact surface, such as applanation lenses placed on the eye. Adding a high precision imaging technique, such as optical coherence tomography (OCT), can enable accurate targeting of tissue beyond the cornea, such as the crystalline lens. Initial clinical results of femtosecond laser cataract surgery are discussed in detail in the latter portion part of the article.

PurposeTo describe and quantify the pattern of corneal astigmatism in cataract surgery candidates and to provide information for cataract surgeons and intraocular lens (IOL) manufacturers. SettingZhongshan Hospital, Fudan University, Shanghai, China. DesignCross-sectional study. MethodsThe datasets of cataract surgery candidates acquired between November 1, 2009, and November 30, 2011, were collected and analyzed. Keratometry values were optically measured by partial coherence interferometry (IOLMaster) before cataract extraction. Spearman rank correlation coefficients were used to estimate bivariate correlations. The power vector method, J0 and J45 values, and linear regression models were used to assess the association between age and astigmatism. ResultsThe study evaluated the keratomet...

Abstract. Purpose:- It is necessary to develop tools for patient selection to target cataract surgery to patients with the best expected outcomes. We used visual acuity, visual functioning 14 (VF-14) test, the 15-dimension health-related quality-of-life questionnaire (15D) and the New Zealand priority criteria to evaluate the criteria for cataract surgery in a post hoc setting. Material and methods:- Ninety-three consecutive patients living in a defined rural area in Finland had cataract surgery as a part of the Pyhjrvi Cataract Study in 2003. Success of cataract surgery was defined as improvement of visual acuity by at least 2 lines and/or improvement of visual function measured by questionnaires. Results:- The patients with a visual acuity of 0.30 logMAR (0.5 Snellen decimal) or worse in...

A dense cataract prevents detailed fundus examination which may lead to delayed diagnosis of undiscovered intraocular pathology before cataract surgery. We report two cases where large choroidal melanomas were diagnosed after cataract surgery and/or Nd:Yag laser capsulotomy. In the first case, a dense cataract prevented proper examination of the fundus of an 84-year-old female. A brownish choroidal lesion was seen after cataract surgery and diagnosed as postoperative choroidal detachment. As this lesion persisted over months, the patient was sent to our hospital for evaluation where a diagnosis of choroidal melanoma with extrascleral growth was made and an enucleation with implantation of a dermis-fat graft was performed without complication 10?days later. In the second case, a 58-year-old...

Transverse astigmatic keratotomy is a surgical technique to correct preoperative corneal astigmatism during cataract surgery. The operative technique is described and the results of my first 40 cases are reviewed. The average keratometric astigmatism for this group before surgery was 2.6 dipoters (D). The average reduction in astigmatism was 1.5 D, which yielded a final residual average astigmatism of 1.1 D after surgery. Cases of substantial astigmatism showed the most improvement. Less improvement was seen in cases of minimal preoperative astigmatism. No increase in net keratometric astigmatism was seen in any of the eyes studied. Minor complications were limited to several small corneal abrasions created by the front-cutting diamond blade and one late temporary wound dehiscence. The only serious complication was one case of corneal macroperforation. Recommendations for handling this complication and future high astigmatism cases are given. PMID:2921733

A patient with retinitis pigmentosa showed visual disturbances following successful cataract surgery. He had a dense asteroid hyalosis in the eye before cataract surgery. After the surgery he noticed that his vision became worse. The visual disturbance was explained as being caused by the progression of retinal degeneration. Although the electroretinogram was non-recordable, the degeneration of macular area appeared relatively small. We considered that dense asteroid hyalosis was responsible for his visual disturbances, and pars plana vitrectomy (PPV) was performed to remove the asteroid hyalosis. After the PPV, rapid improvement of his visual acuity was observed. Cataract surgery may affect the status of asteroid hyalosis and cause rapid visual loss. PPV should be considered for retinitis pigmentosa patients with dense asteroid hyalosis, especially when a large decrease in visual acuity is noted shortly after cataract surgery. PMID:21941506

Background: Globally, cataract is the leading cause of blindness and impaired vision. Cataract surgery is an attractive treatment option but it remains unavailable in sufficient quantity for the vast majority of the world population living in areas without access to specialized health care. Reducing...

Globally, cataract is the leading cause of blindness and impaired vision. Cataract surgery is an attractive treatment option but it remains unavailable in sufficient quantity for the vast majority of the world population living in areas without access to specialized health care. Reducing blindness from cataract requires solutions that can be applied outside operating theatres. Cataract is a protein conformational disease characterized by accumulation of light absorbing, fluorescent and scattering protein aggregates. The aim of the study was to investigate whether these compounds were susceptible to photobleaching by a non-invasive procedure and whether this would lead to optical rejuvenation of the lens.

AIM To analyze the factors that influence the prediction error (PE) after intraocular lens (IOL) implantation in pediatric cataract. METHODS The medical records of cataract patients of no more than 14 years old who had primary IOL implantation were reviewed from 2006 to 2010. The PE, absolute value of PE (APE), and predictability between in different axial length, mean corneal curvature, corneal astigmatism, and age at the surgery were analyzed. RESULTS Seventy-five children (119 eyes) were included, with a mean age of (5.09±2.54) years. At the follow-up of (1.19±0.69) months, the mean postoperative PE was (-0.22±1.12) D, and APE was (0.87±0.73)D. The PE in eyes with an axial length >20mm but ?22mm were significantly under-corrected than that in eyes with longer axis, and the APE in eyes with an axial length ?20mm was more obvious compared with the others. The correlations between PE and axial length, as well as corneal astigmatism, and between APE and axial length were significant. The predictability was significantly poorer in the eyes with an axial length ?20mm than the others. CONCLUSION The axial length is closely related with the PE after IOL implantation in pediatric cataract patients, especially when it is ?20mm, PE is more significant. The formula that is more suitable to very short axial length should be explored.

AIM—To determine the long term visual and refractive results, and stability and complications of primary polypseudophakia using poly(methylmethacrylate) (PMMA) intraocular lenses (IOLs) for cataract surgery in hypermetropic eyes.?METHODS—Prospective study of 15 short or hypermetropic eyes undergoing...

This book provides the general ophthalmologist with a guide to the clinical applications of specular microscopy. Important material is included on laser injury, cataract surgery, corneal transplants, glaucoma, uveitis, and trauma.

A five year study on the ocular complications of diabetes compared results of eye examinations and biochemical analyses of diabetics with eye disease to nondiabetics with the same prognoses. For the same two populations, results of cataract surgery and po...

... approved amount for one pair of eyeglasses or contact lenses after each cataract surgery with an intraocular lens, and the Part B deductible does apply. You pay any additional cost for upgraded frames. E 25 Section 2:What ...

... Keratitis Bell's Palsy Blepharitis Cataracts Conjunctivitis (Pink Eye) Contact Lens-Related Infections Detached & Torn Retina Diabetic Retinopathy Dry ... Vision Tearing See all Symptoms > Glasses, Contacts & LASIK Contact Lenses Eyeglasses IOLs Refractive Surgery & LASIK Sunglasses Living EyeSmart ...

... Keratitis Bell's Palsy Blepharitis Cataracts Conjunctivitis (Pink Eye) Contact Lens-Related Infections Detached & Torn Retina Diabetic Retinopathy Dry ... Vision Tearing See all Symptoms > Glasses, Contacts & LASIK Contact Lenses Eyeglasses IOLs Refractive Surgery & LASIK Sunglasses Living EyeSmart ...

... may lead to secondary glaucoma include • eye surgery • advanced cataracts • eye injuries • certain eye tumors • uveitis (eye ... for any particular treatment plan. Like any printed material, it may become out of date over time. ...

Purpose: To describe the prevalence of lens opacities and cataract surgery in an older Malay population in Singapore. Methods: The Singapore Malay Eye Study is a population-based cross-sectional study of 3280 (78.7% response rate) Malay adults aged 40-80 years. Participants underwent a standardized clinical eye examination. Digital slit-lamp and retroillumination photographs were taken of both eyes of each participant and graded for age-related nuclear, cortical and posterior subcapsular (PSC) cataract, following the Wisconsin Cataract Grading System. Other lens opacities, including retrodots and vacuoles, were also graded. Information on medical and lifestyle factors was collected using questionnaires. The study sample was directly age-standardized to the Malay population in Singapore using the 2000 Singapore population census. Results: A total of 3054 (97.7%) and 3113 (99.6%) participants had gradable Topcon slit lamp and Neitz photographs, respectively. The overall age-adjusted prevalence of any cataract was 29.1%, and that of nuclear, cortical and PSC cataract were 12.9% (95% confidence interval, CI, 11.2-13.1%), 21.2% (95% CI 19.8-22.7%) and 9.7% (95% CI 8.8-10.8%), respectively. Age-adjusted prevalence of cataract surgery was 4.7% (95% CI 4.2-5.4%). Prevalence of all three cataract types and cataract surgery increased with age. Age-adjusted prevalence for retrodots and vacuoles were 19.7% (95% CI 18.3-21.1%) and 64.3% (95% CI 61.1-67.6%), respectively. Retrodots were found to be associated with prevalence of all three cataract types, while vacuoles were associated with cortical and PSC cataract prevalence. Conclusion: Lens opacities were common in this urban Malay population. Retrodots and vacuoles were found to be associated with age-related cataract. PMID:23171207

Cataractous-opacification of the lens is one of the leading causes of blindness in India. The situation can be managed by surgical removal of the cataractous lens. Various pharmacological strategies have been proposed for the prevention and treatment of cataract. Information on possible benefits of putative anticataract agents comes from a variety of approaches, ranging from laboratory experiments, both in vitro and in vivo, to epidemiological studies in patients. This review deals with the various mechanisms, and possible pharmacological interventions for the prevention of cataract. The article also reviews research on potential anticataractous agents, including aldose reductase inhibitors, glutathione boosters, antiglycating agents, vitamins and various drugs from indigenous sources. PMID:7998987

Cataract is the most common complication of vitrectomising surgery in the phakic eye. Progressive nuclear sclerosis (NS) causes a myopic shift. This change in refractive status can predispose to the development of monovision in presbyopic individuals. Recognition of adaptation to monovision is important when undertaking sequential cataract surgery. Our case describes a patient whose adaptation to monovision was only recognised after its reversal. Predisposing factors are discussed and lessons highlighted. PMID:22878623

Cataract is the most common complication of vitrectomising surgery in the phakic eye. Progressive nuclear sclerosis (NS) causes a myopic shift. This change in refractive status can predispose to the development of monovision in presbyopic individuals. Recognition of adaptation to monovision is important when undertaking sequential cataract surgery. Our case describes a patient whose adaptation to monovision was only recognised after its reversal. Predisposing factors are discussed and lessons highlighted.

Objective To clarify possible associations between cataract surgery and progression of age-related macular degeneration (AMD). Design Clinic-based cohort. Participants We followed cataract surgical patients aged 65+ years in the Australian Cataract Surgery and Age-related Macular Degeneration (CSAMD) study. Patients who remained unilaterally phakic for at least 24 months after recruitment were included. Methods We performed annual examinations with retinal photography. We assessed AMD using side-by-side grading of images from all visits. Paired comparisons between operated and nonoperated fellow eyes (defined as nonoperated or operated <12 months previously) were made using generalized estimating equation models. Main Outcome Measures Incident early AMD was defined as the new appear...

OBJECTIVES--To compare the cost effectiveness and safety of inpatient cataract surgery (with one night in hospital postoperatively) with ambulatory day case surgery under local anaesthesia. DESIGN--Prospective study of patients receiving inpatient (group 1) or day case (group 2) surgery. SETTING--On...

PurposeTo present patients who had the onset of strabismus or the recurrence of strabismus after converting to a monovision system of seeing. DesignRetrospective interventional case series. MethodsClinical records of 12 patients from the private practice of the corresponding author of this paper (Z.F.P.) were reviewed. Patients obtaining monovision via contact lenses, LASIK, and cataract surgery with posterior chamber intraocular lenses were studied if their monovision produced a new strabismus or was related to the recurrence of a previous strabismus. ResultsAll patients were first treated by converting the monofixing near eye to distance vision and then using reading glasses for near work. Of the 12 patients, 7 regained their fusion by doing away with monovision and 5 required surgery to...

PurposeTo evaluate the outcomes of 360-degree suture trabeculotomy in childhood glaucoma with poor prognosis. MethodsA nonrandomized, retrospective chart review was performed on pediatric patients (younger than 18 years of age) treated with a 360-degree suture trabeculotomy for glaucoma. The cases were categorized into the following groups: (1) primary congenital glaucoma with birth-onset presentation accompanied by corneal clouding noted at birth, (2) primary congenital glaucoma with onset or presentation after 1 year of age, (3) primary congenital glaucoma with previous failed goniotomy surgery, (4) infantile-onset glaucoma following congenital cataract surgery, and (5) infantile-onset glaucoma with associated ocular/systemic anomalies. ResultsA total of 45 eyes of 33 patients were analy...

Purpose To directly compare intraoperative and clinical parameters using a torsional handpiece through microincision and standard clear corneal cataract wounds with appropriately configured tips and sleeves. Setting Duke University Eye Center, Durham, North Carolina, USA. Methods Cataracts in both eyes of 32 patients needing bilateral surgery were extracted using the OZil torsional handpiece. Tips and sleeve selections were optimized for the incision chosen. Right eyes had cataract surgery using a standard method consisting of a 2.8 mm incision with a 0.9 mm tapered 30-degree bevel Kelman configuration tip with a Microsleeve. Left eyes had cataract surgery through a 2.2 mm microincision using a 0.9 mm miniflared 45-degree bevel Kelman configuration tip with an Ultrasleeve. Intraoperative m...

PurposeTo compare the development of posterior capsule opacification (PCO) for idiopathic epi-retinal membrane cases between 20- and 23-gauge phacovitrectomy.MethodsCataract surgery of phacoemulsification with the SA60AT implantation and 20- or 23-gauge vitrectomy was performed for 20 patients in both groups. Cataract surgery alone was performed for 50 patients as the control. The PCO density values were measured using Scheimpflug video photography at 1 week, 1, 3, 6, 12, 18, and 24 months after surgery. The number of eyes that required Nd:YAG laser capsulotomy was also examined.ResultsThe mean PCO value in the 20-gauge phacovitrectomy group increased significantly with time (Psurgery group did not show any significant change. Furthermore, the PCO value in the 20-gauge phacovitrectomy group was significantly greater than that in the 23-gauge phacovitrectomy group at 6, 12, 18 (Psurgery. The PCO value in the 23-gauge phacovitrectomy group was significantly greater than that in the cataract surgery group 24 months after surgery (Psurgery group (P=0.007), whereas there was no significant difference between the 23-gauge phacovitrectomy group and the cataract surgery group.ConclusionPCO rate in eyes with the 23-gauge phacovitrectomy was lower than in those with the 20-gauge phacovitrectomy, and PCO rate even in the 23-gauge phacovitrectomy was higher than in those with cataract surgery. PMID:23018664

Purpose. To determine whether phacoemulsification cataract surgery with intraocular lens (IOL) implantation interferes with measuring optic nerve head (ONH) topography using the Heidelberg Retina Tomograph (HRT). Methods. The study population consisted of 31 women and 12 men aged 63-81 years with no previous history of eye diseases, surgery, laser procedures, or medication. The patients underwent first eye cataract surgery for senile cataract. The HRT II with software version 1.6 was used to obtain 3-dimensional images of the ONH as a part of a comprehensive ocular examination. The quality of the HRT image was assessed using topography standard deviation (TSD). Topography measurements are considered to be unreliable if TSD is more than 50 µm. Re-examination took place 1 month after surgery. Results. Before surgery, the topography measurements were unreliable in 35% (15/43) of the eyes; in 3 of these cases, ONH topography could not be calculated at all. One month after cataract surgery, the ONH topography could be calculated in all eyes and only one displayed unreliable topography measurements. The mean TSD was 40 µm before and 22 µm after surgery when calculated for all eyes with measurable topographies. The change in TSD was statistically significant (palignment between the HRT examinations before and after surgery was excellent in 67% (26/39). Magnification changes occurred in 21% (8/39). Conclusions. Phacoemulsification cataract surgery with IOL implantation improves the image quality of the HRT. However, because of magnification changes and image misalignment, HRT follow-up of the ONH after cataract surgery is often unreliable. PMID:22729441

Purpose:? The purpose of this study was to model the influence of cataract on Spectral Domain Optical Coherence Tomography (SDOCT) image quality and Retinal Nerve Fibre Layer (RNFL) thickness measurements. Methods:? SDOCT images, made with two different devices (3DOCT-1000, Topcon and Cirrus HD-OCT), before and after cataract surgery were compared and judged against measurements from normal subjects using artificial filters simulating the effects of cataract. Optical density of the images was calculated based on a mathematical model described previously. Results:? In total, forty-eight eyes were included for pre- and postoperative cataract extraction measurements. OCT image quality significantly (p?optical density and change in RNFL thickness (R?=?0.941, p?optical density of cataract and the cataract-induced underestimation was however limited, and mean difference?±?SD between predicted and measured RNFL thickness were 1.68?±?7.55 (3DOCT-1000) and 3.71?±?2.97 (Cirrus HD-OCT) micron. Conclusions:? A linear relationship exists between OCT-effective optical density of cataract and underestimation of RNFL thickness measured with OCT. This finding holds promise to correct for cataract-induced changes in RNFL measurements, but will differ for each type of OCT device. PMID:23106951

Abstract Background:- To determine if gender inequities exist in Latin America in regard to cataract surgery. Design:- Meta-analysis. Participants:- Total of 38-992 subjects participating in epidemiological surveys; summary measures were used (not patient-level data). Methods:- A literature search and knowledge of rapid assessment of cataract surgical services/rapid assessment of avoidable blindness studies carried out in Latin America found 11 studies with complete cataract surgical coverage (CSC) data. Using summary original study data, a meta-analysis (random effects model) was conducted to analyse the differences in CSC between males and females. Results were adjusted for design effect. Main Outcome Measures:- Odds ratio (OR) of receiving cataract surgery comparing women with men. Resu...

Purpose To evaluate differences in visual recovery after phacoemulsification with direct or tilted surgical microscope illumination using a macular photostress test. Setting Western Eye Hospital, Imperial College Health Care National Health Service Trust, London, United Kingdom. Methods This randomized double-masked controlled trial enrolled patients presenting to a daycare unit for single-eye cataract surgery. Inclusion criteria were no ocular pathology other than cataract, corneal keratometric astigmatism less than 1.50 diopters, intended target of emmetropia in the operated eye, and cataract grade 1 to 3 (Lens Opacification Classification System II). Exclusion criteria were an abnormal preoperative photostress test. Patients were randomized to have phacoemulsification with the operating...

PURPOSE: To investigate intraretinal changes after successful cataract surgery in patients with previous pars plana vitrectomy (PPV) and indocyanine green-assisted peeling of epiretinal membrane and internal limiting membrane (ILM). DESIGN: Prospective nonrandomized controlled clinical study. METHODS: Twenty eyes of 20 patients with cataract with previous 23-gauge PPV and ILM peeling (PPV group) and 15 consecutive eyes with senile cataract with a healthy macula (control group) were included. Best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography (OCT), infrared fundus imaging, and biomicroscopy were performed at baseline and at week 1, month 1, and month 3 after cataract surgery. OCT raster scans were further analyzed regarding the central millimeter thickness (CMMT), area of retinal thickening size on the topographic map, and changes in retinal structural morphology. RESULTS: The baseline mean visual acuity in the PPV group was 0.3 ± 0.18 Snellen lines, which improved significantly to 0.85 ± 0.18 (P < .05) 3 months after cataract surgery. CMMT was 393 (± 44) ?m at baseline and increased to 408 (± 47) ?m at month 3 (P < .05). One patient was not seen at the final visit, so data of 19 patients was used. In the PPV group, 8 of 19 patients (42%) developed an increase in CMMT more than 35 ?m 1 month after cataract surgery; 5 of these 8 patients (26%) developed macular edema with cyst formation. Three months after surgery, the area of retinal thickening was significantly larger in most patients compared with baseline values. No cystoid macular edema was observed in the control group. CONCLUSIONS: This study provides evidence that patients with previous PPV and membrane and ILM peeling often develop macular edema after successful cataract surgery. PMID:23036567

We present a patient who developed acute visual loss and light flashes at retrobulbar anesthesia for cataract extraction. Vision improved only slightly after cataract surgery. Although traumatic optic neuropathy was suspected, the patient was diagnosed one year later with an optic nerve sheath meningioma (ONSM). ONSM is a rare, slow growing, benign tumour with highly variable clinical features. Diagnosis is often delayed. This case report demonstrates the diagnostic difficulty of this tumour. PMID:15510723

PurposeTo evaluate whether changes in internal wound architecture after phacoemulsification can be measured quantitatively by analysis of scanning electron micrographs. SettingBaylor College of Medicine, Houston, Texas, USA. DesignExperimental study. MethodsTwo comparative studies in human cadaver eyes were performed using coaxial small-incision cataract surgery (SICS), bimanual microincision cataract surgery (MICS), coaxial MICS, and a variety of phacoemulsification tips (MicroSurgical Technologies, Microphaco Tapered, Microtip Turbosonics, and Microphaco Mackool). After surgery, the cornea and scleral rims were harvested and digital scanning electron micrographs were taken. The internal corneal wound was analyzed using measurement software to determine the area of endothelial cell loss a...

PurposeTo determine quantitative changes in endothelial cell loss and corneal thickness in patients having cataract surgery and implantation of a light-adjustable intraocular lens (IOL) to correct residual postoperative refractive errors by application of a spatially profiled near-ultraviolet (UV) light. SettingRuhr University Eye Clinic, Bochum, Germany. DesignCohort study. MethodsThe light-adjustable IOLs were implanted after phacoemulsification cataract surgery and treated with spatial-intensity-profiled UV light at 365 nm to induce a targeted refractive change. Once the desired correction was achieved, the light-adjustable IOL was treated again to lock-in the lens power. Noncontact computer-assisted endothelial cell microscopy and corneal pachymetry were performed before surgery; after...

Cataract surgery after corneal refractive surgery can be challenging for the ocular surgeon due to the difficulty with accurate intraocular lens (IOL) power determination and unexpected refractive surprises. As clinicians have done more work, a number of error sources have been determined. Furthermo...

... eye, history of eye trauma and prior cataract surgery. Laser and cryoprobe treatments for retinal tears are very ... detachment has developed that is too big for laser or cryo treatment, ... eye • Scleral buckle: surgery to place a band around the eye • Vitrectomy: ...

Abstract in portuguese OBJETIVO: Identificar dificuldades na vida diária percebidas por pacientes com catarata senil, antes e após a cirurgia de catarata no segundo olho. MÉTODOS: Estudo longitudinal prospectivo de 84 pacientes consecutivos atendidos por "Projeto Catarata", com acuidade visual maior ou igual a 20/30 no olho pseudofácico e menor ou igual a 20/40 with the best possible optical correction no olho com catarata. Aplicou-se questionário por entrevista. RESULTADOS: Antes da cirur (more) gia 60,7% declararam dificuldade visual (média ou muita); após, 92,8% nenhuma dificuldade. Atividades rotineiras, de mobilidade e lazer alteraram-se significativamente após a cirurgia (p= 0,001). CONCLUSÃO: Na percepção dos pacientes, após a cirurgia de catarata do segundo olho houve redução importante das dificuldades visuais. Abstract in english OBJECTIVE: To identify daily life difficulties perceived by patients suffering from senile cataract before and after second eye cataract surgery. METHODS: Longitudinal prospective study with 84 patients consecutively seen within the framework of the Cataract Project, with visual acuity equal to or higher than 20/30 in the pseudophakic eye, and equal to or lower than 20/40 with the best possible optical correction in the cataractous eye. A questionnaire was applied during (more) an interview. RESULTS: Before surgery, 60.7% complained about visual impairment (moderate or marked); after surgery, 92.8% had no difficulty. Routine activities, mobility, and leisure activities were significantly altered after surgery (P =.001). CONCLUSION: According to the patients' perceptions, there was a significant reduction in visual difficulties after second eye cataract surgery.

Cataract--opacification of the lens--is closely related to diabetes as one of its major late complications. This review deals with three molecular mechanisms that may be involved in the development of diabetic cataract: nonenzymatic glycation of eye lens proteins, oxidative stress, and activated polyol pathway in glucose disposition. Implications resulting from these mechanisms for possible pharmacological interventions to prevent diabetic cataract are discussed. The article reviews research on potential anticataract agents, including glycation inhibitors, antioxidants, and aldose reductase inhibitors. Information on possible benefits of putative anticataract agents comes from a variety of approaches, ranging from laboratory experiments, both in vitro and in vivo, to epidemiological studies in patients. PMID:15120709

Purpose To evaluate the impact of full correction vs undercorrection on the magnitude of the myopic shift and postoperative visual acuity after unilateral intraocular lens (IOL) implantation in children. Design Retrospective case control study. Methods The medical records of 24 children who underwent unilateral cataract surgery and IOL implantation at 2 to <6 years of age were reviewed. The patients were divided into 2 groups based on their 1-month-postoperative refraction: Group 1 (full correction) ?1.0 to +1.0 diopter (D) and Group 2 (undercorrection) ?+2.0 D. The main outcome measures included the change in refractive error per year and visual acuity for the pseudophakic eyes at last follow-up visit. The groups were compared using the independent groups t test and W...

During the past years, the wish to become independent of spectacles has been growing among cataract and presbyopic patients due to many factors, such as the increase in near visual demands, the aesthetic need for a spectacle-free image and ageing of refractive surgery patients, among others. This review assesses recently published studies that analyse visual and optical performance through different metrics of eyes implanted with multifocal intraocular lenses (IOLs), particularly hybrid IOL designs. The published evidence suggests that hybrid multifocal IOLs provide very good outcomes in a number of visual and optical performance parameters. Patients implanted with this type of IOL obtain a satisfactory full range of visual functions, including patients of particular characteristics such as highly ametropic or post-LASIK. PMID:20880314

Purpose To study the incidence, characteristics, and results of retinal detachment (RD) after cataract surgery with a capsule complication. Setting Ten ophthalmic surgery departments in Sweden. Methods In this case-control study, data on cataract surgery cases with a capsule complication (study group) or with no complication (control group) in 2003 were extracted from the Swedish National Cataract Register. Patients with RD during a 3-year follow-up were identified. Results The study group comprised 324 patients and the control group, 331 patients. Retinal detachment occurred in 13 study group patients, for a 3-year incidence of 4.0%. In the control group, 1 patient (0.3%) had RD. Multivariate analysis showed an adjusted odds ratio (OR) of 14.8 for RD after capsule complication (95% confid...

Objective To evaluate cataract risk in eyes of patients with AIDS and cytomegalovirus (CMV) retinitis and to identify risk factors. Design Prospective cohort study. Participants Patients with AIDS and CMV retinitis. Methods Patients 13 years of age and older were enrolled between 1998 and 2008. Demographic and clinical characteristics, slit-lamp biomicroscopy findings, and dilated ophthalmoscopy results were documented at quarterly visits. Cataract status was determined at the initial visit (prevalence) and at follow-up visits (incidence). Main Outcome Measures For cataract, a high grade of lens opacity by biomicroscopy to which best-corrected visual acuity worse than 20/40 was attributed. Eyes that had undergone cataract surgery before enrollment or between visits also were counted as hav...

Purpose: To investigate clinical settings, treatments, antibiotic sensitivities, and visual outcomes associated with endophthalmitis caused by Citrobacter species. Methods: Data were collected for organisms, surgical intervention, antibiotic sensitivity patterns, and final visual acuity. Results: Six eyes of 6 patients with culture-proven C. freundii (n = 4) or C. koseri(n = 2) endophthalmitis were identified. Clinical settings included cataract surgery (1 eye), cataract surgery combined with trabeculectomy (1), trauma (2), penetrating keratoplasty (1), and presumably endogenous source (1). Primary or secondary evisceration was performed in 3 eyes. Initial pars plana vitrectomy with intravitreal antibiotics was performed in 3 eyes. Final visual acuity was no light perception in 5 eyes, and...

Patient hospitalized for angle closure glaucoma in right eye underwent trabeculectomies in both eyes. In the right eye, six months after surgery, he presented intraocular hypertension, shallow anterior chamber and cataract, considered to be intumescent cataract. The left eye (operated six months after the right eye) showed same signs two weeks after surgery. Diagnosis was malignant glaucoma in spite of missing of ultrasound signs- pooling of aqueous in vitreous body. Note the relapse episodes of intraocular hypertension, shallow anterior chamber in left eye, with complete resolution after cicloplegics-mydratics drops only. PMID:16524122

Purpose To assess the prognosis and complications after pars plana vitrectomy (PPV) combined with lensectomy as a primary procedure for visual correction of complicated cataract. Setting Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA. Methods This retrospective study reviewed the preoperative, intraoperative, and postoperative clinical features in eyes that had PPV combined with lensectomy as a primary procedure for complicated cataract without severe posterior segment pathology (study group). The corrected distance visual acuity (CDVA), reoperations, retinal detachment (RD), and cystoid macular edema (CME) were ascertained. Results were compared with those in a control group of eyes having combined PPV and lensectomy for uncomplicated cataract. Results In the study ...

The Heimann-Bielschowsky phenomenon (HBP) refers to coarse vertical oscillation of the eye with impaired vision. The ocular movements are strictly monocular, occurring only in the eye with amblyopia. The vertical oscillation is of equal velocity in both vertical directions, or may sometimes be greater in the downward than upward direction. HBP develops several years after loss of vision. It can be differentiated from dissociated nystagmus in spasmus nutans, congenital nystagmus and internuclear ophthalmoplegia based on the strict unilaterality, vertical direction and low frequency. Previously, only a few reports described the development of oscillopsia due to HBP after cataract surgery, which resolved spontaneously or responded to gabapentin. However, visual impairments due to diplopia or oscillopsia from HBP after cataract surgery have received little attention. We report a man who developed persistent vertical diplopia and oscillopsia due to HBP after a cataract operation, which markedly impaired his vision. PMID:18815421

Cataract is a leading cause of blindness worldwide and is responsible for ?40-80% of the estimated 45 million cases of blindness that occur across the globe. In addition to providing refractive properties to the lens for focusing the image, it is believed that the molecular chaperone function of ?-crystallin is essential in preventing the light scattering due to aggregation of other proteins and thus in the maintenance of lens transparency and thereby prevention of cataract. By now, it is fairly acknowledged that chaperoning ability of ?-crystallin is instrumental in the maintenance of crystalline lens transparency, and decreased chaperone-like activity of ?-crystallin is associated with various types and stages of cataract. A better pharmacological targeting of safeguarding the ?-crystallin chaperone activity may aid the development of therapeutic strategies that could evade the need for cataract surgery and revive lens transparency of the cataractous lenses. This article originally summarizes the significance of modulation and enhancing of ?-crystallin chaperone activity with imidazole-containing dipeptides N-acetylcarnosine, carnosine and carcinine in consequence to prevent, delay or dissolve the human cataract. A growing evidence and discussion of recent patents are presented in this study that demonstrate the ability of N-acetylcarnosine (lubricant eye drops) or carcinine (lubricant eye drops) (universal antioxidant and deglycation agent) resistant to enzymatic hydrolysis with carnosinase to act as pharmacological chaperones, to decrease oxidative stress and ameliorate oxidative and excessive glycation stress-related eye disease phenotypes, suggesting that the field of chaperone therapy might hold novel treatments for age-related cataracts, age-related macular degeneration (AMD) and ocular complications of diabetes (OCD). The therapeutic strategies are highlighted in the study for identifying potential chaperone compounds and for experimentally demonstrating chaperone activity in in vitro and in vivo models of human age-related eye disease, such as cataracts and advanced glycation tissue proteins - engineered systems. PMID:22436026

... effects of the diabetes I've had five strokes. I've had eight stents put into my heart. I've had open heart surgery, partial amputation of both feet. I have cataracts and glaucoma now and high blood pressure and I have high cholesterol. That's before I ...

Aim To compare the mean central corneal thickness (CCT) among aphakic and pseudophakic patients following congenital cataract surgery with age matched controls. Methods This study included 43 eyes of 43 aphakic and pseudophakic patients following congenital cataract surgery. 44 healthy, age and sex matched volunteers were recruited for comparison with the patients. After a complete eye examination, corneal thickness and intraocular pressure were measured. Results In the study group, 33 eyes were aphakic, and the remaining 10 eyes were pseudophakic. The median CCT was 556.0??m (range 490–640??m) in the control group and 626??m (range 523–870??m) in the study group (p<0.05). There was a significant difference in CCT between aphakic and pseudophakic eyes in which an intraocular lens (IOL) had been implanted at the time of congenital cataract surgery (p?=?0.011). The same difference was not observed between aphakic and pseudophakic eyes in which an IOL had been implanted secondarily (p?=?0.835). The median age of the patients at the time of lensectomy was 24?months (range 1?week to 120?months). There was a negative correlation between the age at lensectomy and CCT (r?=??0.485, p?=?0.001). Conclusion Aphakic and pseudophakic patients have significantly thicker corneas than age matched controls. This difference can have an important effect on interpreting intraocular pressures in these patients. It is also important to assess the effects of early surgery for congenital cataracts, as well as those of primary and secondary IOL implantation, on CCT. PMID:15851679

AIMS--This study examined the effects on intraocular pressure, pulse rate, and blood pressure of low dose intravenous sedation with propofol. METHODS--Twenty adult patients who were scheduled to undergo cataract surgery were given a single intravenous bolus (0.98 (SEM 0.4) mg/kg) of propofol for sed...

The ingestion of oral fluorescein in 38 consecutive cases 6 to 7 weeks after cataract surgery with and without iris clip lens implantation permitted satisfactory fluorography to detect all cases of clinical cystoid macular oedema. There were no adverse reactions from any test subject.

This paper documents a rare nonprogressive developmental disorder—bilateral circumscribed posterior keratoconus—in a 60-year-old man referred for a cataract surgery. For the first time ultrasound biomicroscopy was used to visualise the local anterior bulging of the posterior corneal surface with con...

Background/aim: Povidone-iodine (PI, Betadine) is routinely used as a preoperative topical antiseptic in cataract surgery as it has been shown to reduce the incidence of postoperative endophthalmitis. However, the concentration used clinically is variable. In vitro studies have shown that PI is para...

Corneal relaxing incisions combined with microincisions cataract surgery allow correction of preexisting congenital astigmatism. Limbal relaxing incisions and opposite clear corneal incisions were the main surgical techniques in use during last decade. However, corneal wound healing variations particularly at epithelial level are associated with poor refractive results predictability. New generations of toric intraocular lenses have a good stability in the capsular bag with less risks of secondary rotation. Well positioned in the right axis, toric intraocular lenses have potentially better accuracy and predictability than relaxing corneal surgery to correct preexisting congenital astigmatism. Combined corneal surgery progressively lost its indications for a simple refractive microincision cataract surgery with implantation of toric intraocular lenses. PMID:22789651

Cataract formation represents a serious problem in the elderly and has a large impact on healthcare budget. Aging and cataract formation are relatively complex phenomena, both in vivo and in vitro. Telomeres are special structures at the end of chromosomes. They shorten during each round of replication, and this has been characterized as a mitotic counting mechanism. Our review analysis in this work shows that the rate of telomere shortening in human lens epithelial cells during aging and cataract formation is modulated by oxidative stress as well as by differences in antioxidative defense capacity of the normal and cataractous crystalline lenses. Presented in this review studies suggest that telomere shortening in human lens cells and increased oxidative stress are the result of the peroxidative damage to the lens cell membranes and biomolecules induced in the lack of reductive detoxification of phospholipid hydroperoxides as the triggering mechanism of cataractogenesis. Lipid peroxidation (LPO) is a causative factor of cataract. The increased concentrations of primary molecular LPO products (diene conjugates, lipid hydroperoxides) and end fluorescent LPO products were detected in the lipid moieties of the aqueous humor samples obtained from patients with senile and complicated cataracts when compared to normal donors. The progressive accumulation of oxidative damage may act as an important mechanism for organism aging and cataractogenesis. The oxidative stress form and intensity might determine the lens senescence rate and cataract type, making efforts in the cataract prevention challenge more complex. The analyzed challenge in this work is that the reduction in telomere shortening rate and damages in telomeric DNA make an important contribution to the anticataract and life-extension effect of carnosine administered systemically in the formulations stabilizing a dipeptide from the enzymatic hydrolysis with carnosinase, or topically administered to the eye with carnosine ophthalmic prodrug N-acetylcarnosine and lubricant formulations thereof including corneal absorption promoters. Telomere length in the human crystalline lens cells is a reflection of aging, cataractogenesis, and lifespan in biogerontological studies. PMID:20412312

Despite the interest in developing improved formulas for intraocular lens power calculation, there are several sources of uncertainty that may well give rise to a significant residual refractive error. Those concerning the estimation of the corneal power are reviewed. In addition, we explore the possibility of introducing changes in some unconventional parameters of the eye to compensate for defocus and illustrate their effectiveness in two cases: a natural eye and an eye that has undergone previous surgical actions (anterior refractive surgery and cataract surgery with an intraocular lens implant). The results show that changes in the refractive index, thickness, or posterior radius of the cornea have relatively little effect on the overall refractive error. However, small changes in the refractive indexes of the aqueous or the vitreous humors are highly effective, much more so than a similar amount of change in the anterior curvature of the cornea. This fact opens new and attractive possibilities to compensate for refractive error through the introduction of changes in degrees of freedom so far considered unconventional.

PurposeTo evaluate and compare patient-reported visual function, spectacle independence, and quality of life before and after cataract surgery with bilateral diffractive multifocal or monofocal intraocular lens (IOL) implantation. SettingDepartment of Ophthalmology, Henry Ford Health System, Taylor Branch, Detroit, Michigan, USA. DesignProspective cohort study. MethodsThis study evaluated consecutive cataract patients having bilateral implantation of Acrysof Restor SN60D3 multifocal IOLs or monofocal Acrysof SN60WF IOLs, the latter as monovision, between July 2007 and June 2009. Parameters analyzed 3 months postoperatively included binocular uncorrected distance, intermediate, and near visual acuities; stereo vision; spectacle independence; subjective visual symptoms; and patient satisfact...

PurposeTo assess the separate mydriatic effect of lidocaine hydrochloride (Xylocaine), cyclopentolate, and phenylephrine after intracameral injection and evaluate whether intracameral Xylocaine and phenylephrine without cyclopentolate provide sufficient pupil dilation for cataract surgery.SettingDepartment of Clinical Science/Ophthalmology, Umea University Hospital, Umea, Sweden.MethodsThis prospective randomized double-masked study included 56 patients with age-related cataract scheduled for unilateral phacoemulsification. In 16 patients, Xylocaine 1%, phenylephrine 1.5%, and cyclopentolate 0.1% were injected one after the other. Phenylephrine and cyclopentolate were randomized to switch in order, creating 2 study groups. An additional 40 patients were randomized to receive intracameral X...

The method is based on eye fundus photography using a fundus-camera with a digital camera being built in. With its use, the diagnosis of cataract is based on the instrumental determination of the extent of darkening of the eye fundus shown in the color photograph depending on the degree of opacity the lens through which the eye fundus is photographed. This diagnostic technique rules out visual (by eye) determination of lenticular opacity. Solution of the set technical problem makes it possible to diagnose optically significant cataract and hence to define indications for anticataract surgery. PMID:17650603

PurposeTo investigate the role of sex in modifying risk factors for retinal detachment (RD) after cataract surgery.DesignProspective cohort study based on medical records and insurance claims from Taiwan’s Bureau of National Health Insurance (BNHI).ParticipantsNine thousand three hundred eighty-eight patients who underwent extracapsular cataract extraction (CE), including phacoemulsification procedures, between August 1999 and December 2001.MethodsMedical charts and claims submitted by insurance beneficiaries who underwent CE and intraocular lens implantation were collected from the sixth branch of the BNHI. Data recorded for analysis included each patient’s demographic characteristics, medical history, refractive status, axial length (AL), type of CE, and intraoperative comp...

Purpose To investigate intraocular concentrations and pharmacokinetics of ranibizumab after a single intravitreal injection in humans. Design Prospective, noncomparative, interventional case series. Methods We included 18 nonvitrectomized eyes of 18 patients (age range, 61–85 years) that were diagnosed with both clinically significant cataract and macular edema secondary to either exudative age-related macular degeneration, diabetic maculopathy, or retinal vein occlusion. Each eye received a single intravitreal injection of 0.5 mg ranibizumab. An aqueous humor sample was obtained during cataract surgery between 1 and 37 days after injection. Concentrations of unbound ranibizumab in these samples were quantified by enzyme-linked immunosorbent assay. Results Ranibizumab concentration ...

Purpose: To describe the prevalence of lens opacities and cataract surgery in an older Malay population in Singapore. Methods: The Singapore Malay Eye Study is a population-based cross-sectional study of 3280 (78.7% response rate) Malay adults aged 40-80 years. Participants underwent a standardized clinical eye examination. Digital slit-lamp and retroillumination photographs were taken of both eyes of each participant and graded for age-related nuclear, cortical and posterior subcapsular (PSC) cataract, following the Wisconsin Cataract Grading System. Other lens opacities, including retrodots and vacuoles, were also graded. Information on medical and lifestyle factors was collected using questionnaires. The study sample was directly age-standardized to the Malay population in Singapore usi...

Background Precise IOL calculation in post-refractive surgery patients is still a challenge for the cataract surgeon. The purpose of this study is to test whether adding Orbscan II values into the double-K method improves IOL calculation in this group of patients. Methods A prospective study with 43 eyes previously submitted to refractive surgery that underwent cataract extraction. IOL calculation was performed with double-K method. Post-K value was derived from Orbscan total-mean power map. The average corneal curvature of the general population (43.8D) was used as the pre-K value. Refraction results 30 days after surgery were compared with refraction that would be obtained if we used: (1) post-K values from keratometry, (2) post-K values from topography, and (3) pre-K values from Orbscan...

PurposeTo determine whether a regimen of topical moxifloxacin hydrochloride ophthalmic solution 0.5% (Vigamox) administered on the day of cataract surgery reduces conjunctival bacterial flora.SettingIladevi Cataract & IOL Research Centre, Ahmedabad, India.MethodsSeventy-four patients were prospectively randomized to receive Vigamox 4 times 1 day before surgery plus 1 drop 2 hours preoperatively (Group 1) and 74 patients, to receive Vigamox 2 hours before surgery and every 15 minutes in the first hour only (Group 2). Conjunctival swabs from the upper and lower lid margins and lower fornix were taken before and after Vigamox instillation. Aliquots were spread on chocolate blood, anaerobic basal, and nutrient agars. The number of bacterial colony-forming units (CFU) on the plates was counted ...

Abstract in portuguese Objetivou-se avaliar a relevância das complicações de facectomias como causa de baixa acuidade visual na população > 50 anos em Campinas, São Paulo, Brasil. Uma avaliação dos serviços de cirurgia de catarata foi conduzida utilizando amostragem aleatória de agrupamentos populacionais, sendo composta por 60 agrupamentos de 40 pessoas > 50 anos. Na amostra de 2.400 indivíduos, 92,67% foram examinados. Dos 2.224 examinados, 75 (3,37%) apresentaram baixa acuidade vi (more) sual bilateral, 164, unilateral. e um total de 314 (7,06%) olhos apresentou baixa acuidade visual. Trezentos e cinqüenta e dois olhos tinham sido submetidos a facectomias. As causas de baixa acuidade visual pós-cirurgia foram doenças oculares concomitantes (56%), complicações cirúrgicas (28,8%) e erros refrativos (15,2%). Complicações de cirurgias de catarata foram a quinta causa mais importante de baixa acuidade visual. Outras causas principais foram catarata, doenças oculares do segmento posterior, retinopatia diabética e glaucoma. Estes resultados sugerem que complicações de cirurgias de catarata é uma importante causa de baixa acuidade visual na população em estudo. Sua prevenção e tratamento precisam fazer parte das políticas de saúde pública. Abstract in english The purpose of this study was to measure the extent to which complications relating to cataract surgery are a cause of visual impairment in a population aged 50 and over from the city of Campinas, São Paulo State, Brazil. An assessment of cataract surgery services was conducted using random cluster sampling, with the sample composed of 60 clusters of 40 people aged 50 years or older. Of the selected sample of 2,400 subjects, 92.67% were examined. Of these 2,224 examined (more) subjects, 75 (3.37%) presented bilateral visual impairment and 164 unilateral, while a total of 314 (7.06%) eyes presented visual impairment. 352 eyes had undergone cataract surgery. The causes of visual impairment after surgery were concurrent eye disease (56%), surgical complications (28.8%) and refractive errors (15.2%). Cataract surgery complications represented the 5th most important cause of visual impairment. The other main causes were cataract, posterior segment disorders, diabetic retinopathy and glaucoma. These results suggest cataract surgery complications are a major cause of visual impairment in this population. Their prevention and treatment must be part of public health care policies.

Introduction A rapid assessment of avoidable blindness (RAAB) was conducted in Southern Zambia to establish the prevalence and causes of blindness in order to plan effective services and advocate for support for eye care to achieve the goals of VISION 2020: the right to sight. Methods Cluster randomisation was used to select villages in the survey area. These were further subdivided into segments. One segment was selected randomly and a survey team moved from house to house examining everyone over the age of 50 years. Each individual received a visual acuity assessment and simple ocular examination. Data was recorded on a standard proforma and entered into an established software programme for analysis. Results 2.29% of people over the age of 50 were found to be blind (VA correction). The major cause of blindness was cataract (47.2%) with posterior segment disease being the next main cause (18.8%). 113 eyes had received cataract surgery with 30.1% having a poor outcome (VA surgical coverage showed that men (72%) received more surgery than women (65%). Discussion The results from the RAAB survey in Zambia were very similar to the results from a similar survey in Malawi, where the main cause of blindness was cataract but posterior segment disease was also a significant contributor. Blindness in this part of Zambia is mainly avoidable and there is a need for comprehensive eye care services that can address both cataract and posterior segment disease in the population if the aim of VISION 2020 is to be achieved. Services should focus on quality and gender equity of cataract surgery. PMID:2172992

Background The purpose of this study was to evaluate nepafenac ophthalmic suspension 0.1% (Nevanac®; Alcon Research Ltd) in the prevention of macular edema following cataract surgery in diabetic retinopathy patients. Methods This was a multicenter, randomized, double-masked, vehicle-controlled study of 263 adult diabetic patients with nonproliferative diabetic retinopathy requiring cataract surgery. Patients were randomized (1:1) to instill nepafenac or vehicle three times daily beginning 1 day prior to surgery through day 90. Efficacy included the percentage of patients who developed macular edema (?30% increase in central subfield macular thickness from baseline) and the percentage of patients with decreases of more than five letters in best-corrected visual acuity from day 7 to 90. Results A significantly lower percentage of patients in the nepafenac group developed macular edema relative to patients in the vehicle group (3.2% versus 16.7%; P macular thickness and mean percent change from baseline in macular volume were also significantly lower in the nepafenac group versus the vehicle group at days 14 through 90 (P ? 0.005). No safety issues or trends were identified when dosing was increased to 90 days that negatively impacted the favorable benefit/risk profile of nepafenac. Conclusion Nepafenac demonstrated statistically significant and clinically relevant advantages compared with vehicle in preventing macular edema and maintaining visual acuity in diabetic patients following cataract surgery. These advantages were seen at multiple time points over the course of the 90-day therapy period. There was no clinically relevant increase in risk from 90 days dosing compared with 14 days. Therefore, with a similar safety profile and benefit in preventing macular edema and maintaining vision, the risk/benefit to the diabetic patient undergoing cataract surgery appears to be positive. PMID:18585469

Abstract in portuguese OBJETIVO: Determinar as características sócioeconômicas dos pacientes operados de catarata em hospital universitário, avaliar o acesso à unidade terciária e determinar o tempo de espera até o tratamento cirúrgico. MÉTODOS: Estudo transversal, realizado através da revisão de prontuários de 148 pacientes operados de catarata escolhidos aleatoriamente durante o primeiro semestre de 2007. RESULTADOS: Os pacientes apresentaram idade mediana de 70,5 anos, com maior (more) prevalência de mulheres (60,1%), da raça branca (48,0%), com baixo grau de instrução (ensino fundamental incompleto, 50,7%), acuidade visual igual ou pior a 20/200 (57,4%) e diagnóstico realizado em consulta regular no hospital universitário (47,8%). Apenas 9,4% dos pacientes operados foram diagnosticados na campanha de catarata. O tempo médio entre o diagnóstico e a cirurgia foi 3,5 meses e relacionou-se principalmente à realização dos exames oftalmológicos e clínicos pré-operatórios. CONCLUSÃO: Os pacientes com baixa renda familiar são os principais usuários do Sistema Único de Saúde (SUS) e o acesso ao tratamento cirúrgico é demorado, resultando em visão subnormal incapacitante. Ressalta-se a importância da campanha de catarata no ingresso de pacientes carentes ao hospital de alta complexidade. Abstract in english PURPOSE: To determine the socio-economic characteristics of the patients who were submitted to cataract surgery in a university hospital, to evaluate the accessibility to the tertiary health service and to determine the waiting time for cataract surgery. METHODS: A cross-sectional study of medical charts from 148 random patients who underwent cataract surgery during the first semester of 2007. RESULTS: The patients in this study had median of age of 70.5 years, and the ma (more) jor prevalence was of female (60.1%), caucasian (48.0%), with low educational level (incomplete fundamental study, 50.7%), best corrected visual acuity 20/200 or worst; the diagnosis of cataract was done at the University Hospital in a routine appointment (47.8%). Only 9.4% of patients submitted to the surgery had his diagnosis done in a cataract campaign. The average time between the diagnosis and the surgery was 3.5 months and the delay was mainly due to pre operative exams. CONCLUSION: The majority of patients in the Brazilian Public Health System have low family income. The system takes a long time to access surgical procedures that need to be addressed in a proper time manner. The result of the long wait is subnormal vision. It is important to highlight the cataract campaign in order to enroll patients with low income in a hospital of high complexity.

PurposeTo use ray tracing to determine the influence of corneal aberrations on the prediction of the optimum intraocular lens (IOL) power for implantation in normal eyes and eyes with previous laser in situ keratomileusis (LASIK). SettingHospital Universitario Virgen de la Arrixaca, Murcia, Spain. DesignCase series. MethodsThe optimum IOL power was calculated by ray tracing using a patient-customized eye model in cataract surgery cases. The calculation can be performed with or without inclusion of the patients corneal aberrations. Standard predictions were also generated using current state-of-the-art IOL power calculation techniques. The results for all predictions were compared with the optimum IOL power after cataract surgery. ResultsFor patients without previous LASIK (n = 18), the sta...

Abstract in spanish Se realizó un estudio descriptivo retrospectivo y se describen las cirugías de catarata realizadas en Cuba, agrupadas por año, para Ciudad de La Habana y el resto del país, clasificadas según la utilización de lentes intraocualres. Se calculó la tasa de cirugía de catarata; los datos fueron obtenidos del reporte anual realizado por los Grupos Provinciales de Oftalmología. Abstract in english A descriptive and retrospective study was conducted. The cataract surgeries performed in Cuba, grouped by year for Havana City and the rest of the country and classified according to the use of intraocular lens, were described. The cataract surgery rate was calculated. Data were obtained from the annual report issued by Provincial Groups of Ophthalmology.

BACKGROUND: Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population worldwide. Many observational and preclinical studies have implicated vascular endothelial growth factor (VEGF) in the pathogenesis of DR, and recent successes with anti-VEGF therapy for age-related macular degeneration (AMD) have prompted research into the application of anti-VEGF drugs to DR. Here we review the numerous early studies that suggest an important potential role for anti-VEGF agents in the management of diabetic retinopathy. CONCLUSIONS: For diabetic macular edema, phase II trials of intravitreal pegaptanib and intravitreal ranibizumab have shown short-term benefit in visual acuity. Intravitreal bevacizumab also has been shown to have beneficial short-term effects on both visual acuity and retinal thickness. For proliferative diabetic retinopathy (PDR), early studies suggest that intravitreal bevacizumab temporarily decreases leakage from diabetic neovascular lesions, but this treatment may be associated with tractional retinal detachment (TRD). Furthermore, several studies indicate that bevacizumab is likely to prove a helpful adjunct to diabetic pars plana vitrectomy (PPV) for TRD. Finally, three small series suggest a potential beneficial effect of a single dose of bevacizumab to prevent worsening of DME after cataract surgery. Use of anti-VEGF medications for any of these indications is off-label. Despite promising early reports on the safety of these medications, we eagerly await the results of large, controlled trials to substantiate the safety and efficacy of anti-VEGF drugs for diabetic retinopathy. PMID:20174816

This paper documents a rare nonprogressive developmental disorder—bilateral circumscribed posterior keratoconus—in a 60-year-old man referred for a cataract surgery. For the first time ultrasound biomicroscopy was used to visualise the local anterior bulging of the posterior corneal surface with concomitant thinning of the stroma. The amount of localized posterior depression, corneal thickness and the refractive power of both the posterior and anterior corneal curvature were measured using slit-scanning topography analysis (Orbscan).

We report a case of iris atrophy and corneal endothelial decompensation following the inadvertent use of water-based ink for capsular staining during cataract surgery. The anterior chamber was thoroughly irrigated with balanced salt solution after the identification of the wrong dye. Phacoemulsification with minimal ultrasound energy and intraocular lens implantation were performed without complications, and the operation was completed. The patient finally developed bullous keratopathy and underwent penetrating keratoplasty 4 months later.

Three patients with cyclodialysis clefts, hypotony and hypotonic retinopathy subsequent to cataract surgery were treated with argon laser photocoagulation. The hypotony was reversed in each patient and their visual acuity was normalized. Laser photocoagulation is a noninvasive treatment that can be repeated easily and safely. The complications of the treatment are minor. A hypertensive episode commonly occurs in the early postoperative period. (au) 8 refs.

Abstract in portuguese OBJETIVO: Analisar os resultados visuais de uma série de crianças operadas de catarata unilateral. MÉTODOS: Um estudo retrospectivo foi realizado através da análise de 35 prontuários médicos do Serviço de Catarata Congênita da UNIFESP/EPM. RESULTADOS: Quanto à etiologia, a primeira causa de catarata foi idiopática, a segunda causa foi o trauma e a terceira foi a rubéola congênita. Em 51,4% dos olhos tinham acuidade visual pré-operatória de ausência de fixa (more) ção. E em 42,8% dos casos operados a acuidade visual final foi igual ou melhor que 20/200. DISCUSSÃO: Embora a cirurgia em catarata unilateral seja motivo de controvérsias entre os oftalmologistas, obteve-se melhora de acuidade visual em número significativo de casos. Abstract in english PURPOSE: To analyze the results in a series of children submitted to unilateral cataract surgery. METHODS: A retrospective study was conducted through the analysis of 35 patient files from the Congenital Cataract Service of UNIFESP/EPM. RESULTS: The main cause of unilateral cataract was idiopathic, the second cause was ocular trauma and the third cause was congenital rubella. Initial visual acuity was very poor in 51.4% of the cases (did not fix or follow), and the best c (more) orrected final visual acuity was better than 20/200 in 42.8% of the eyes. DISCUSSION: Although controversial, the surgical treatment of unilateral cataract, in this study, showed improvement in many cases.

Purpose. To determine if recent preoperative exposure to n-acetylcysteine (NAC), Mucomyst, increases postoperative blood loss in cardiac surgery patients. Methods. Retrospective review of cardiac surgery patients who underwent a cardiac catheterization within four days of surgery and whose ser...

Abstract in portuguese OBJETIVO: Avaliar, do ponto de vista técnico-econômico, o tratamento cirúrgico da correção do estrabismo. MÉTODOS: Procedeu-se um levantamento retrospectivo, de forma consecutiva, dos prontuários médicos da Fundação Altino Ventura - Recife/PE. Incluíram-se 100 pacientes submetidos à cirurgia de estrabismo (janeiro de 2001 a fevereiro de 2003) e 100 submetidos à cirurgia de catarata (janeiro de 2003). Observou-se o tempo para a realização dos procedimentos c (more) irúrgicos. Foi comparado o tempo para a realização das cirurgias de estrabismo com o tempo das cirurgias de catarata e a variabilidade de tempo dentre as diferentes cirurgias de estrabismo. RESULTADOS: Verificou-se que o tempo cirúrgico médio para a correção de estrabismo foi maior do que o de cirurgia de catarata (77,3±27,6 min vs 58,3±12,7 min;"t" =6,26; p Abstract in english PURPOSE: To evaluate, from the economic and technical point of view, the surgical treatment of strabismus. METHODS: A retrospective survey of available consecutive medical charts from the Altino Ventura Foundation - Recife/PE, Brazil was performed. Data on 100 patients who underwent strabismus surgery (from January of 2001 to February of 2003) and 100 patients who underwent cataract surgery (January of 2003) were analyzed. The times to performed these surgical procedures (more) were observed. The times to accomplish strabismus surgeries were compared to those of cataract surgeries. In addition the variability of time among different strabismus surgeries was also observed. RESULTS: Surgical mean time for strabismus correction was longer than that for cataract surgery (77.3±27.6 min versus 58.3±12.7 min; p

Hemorrhage into the crystalline lens is exceedingly rare but has been described following ocular trauma [1, 2], glaucoma surgery [3-5], laser iridotomy [6], pediatric cataract surgery [7], and also in the absence of an obvious pathology [8]. We describe a case of intra- and retro-lenticular organised bleed which presented 9 years following repair of open globe injury and which was treated using fugo blade-assisted lens aspiration. The fugo blade provided adequate endocoagulation of retrolenticular blood during posterior capsulotomy and prevented undue anterior segment hemorrhage. PMID:23129503

Abstract in spanish Introducción: Se ha realizado una revisión de 90 denuncias por actuaciones oftalmológicas presuntamente incorrectas. La mayoría de ellas son por intervenciones de cataratas (33%) y de cirugía refractiva (18%). En tercer lugar las intervenciones de cirugía oculoplástica (14%). El cuarto puesto las actuaciones relacionadas con el desprendimiento de retina (13 %), seguidas en quinto lugar por el grupo de miscelánea (10%), en sexto por el de urgencias oftalmológicas (more) (9%) y en séptimo y último puesto denuncias por actuaciones oftalmológicas relacionadas con el glaucoma (3%). Material y métodos: Se analizaron, dentro de cada subgrupo, las características de las denuncias, la información dada al paciente, los casos en los que existieron motivos para considerar incorrecta la actuación del oftalmólogo, y la resolución judicial que se adoptó. Resultados: Los grupos más frecuentes son cirugía de cataratas y refractiva, que conjuntamente representan más de la mitad de las denuncias. Encontramos en el 26% de los casos informes de otros facultativos criticando a posteriori la actuación profesional del oftalmólogo denunciado y documentos de consentimiento informado incorrectos o incompletos, así como pacientes que aseguran que su cirujano les hizo promesas de resultados o les minimizó los riesgos de la intervención propuesta. Conclusiones: En la inmensa mayoría de los casos la denuncia se plantea por una complicación típica, inherente a la técnica quirúrgica y que figuraba en el documento de consentimiento informado firmado por el paciente. También vemos una minoría de casos, generalmente intervenciones de cirugía refractiva, en los que se produce una complicación previsible y evitable, en cirugías incorrectamente indicadas. En estos casos excepcionales, el informe pericial suele ser desfavorable y hemos encontrado alguna condena. Es probable que un mayor cuidado en la información al paciente redujera el número de estas denuncias. Abstract in english Purpose: We reviewed 90 complaints for allegedly incorrect ophthalmic procedures. Most of these complaints (33%) were related to cataract and refractive surgery (18%). In third position in terms of frequency (14%) were complaints concerning oculoplastic surgery and in fourth position were complaints related to retinal detachment (13%). This was followed by a miscellaneous group, which represented 10% of complaints. About 9% of complaints were related to emergency ophthalm (more) ic procedures, while just 3% of complaints were related to glaucoma. Methods: We analysed within each subgroup the characteristics of the claims; the information given to the patient, those cases in which there existed grounds for considering the ophthalmologist?s performance as being incorrect, and court orders that were adopted. Results: The most common groups were cataract and refractive surgery, which together represented more than a half of the complaints. We found in 26% of cases, reports from other doctors criticising the professional performance a posteriori of an accused ophthalmologist, incorrect or incomplete documents of informed consent, as well as patients asserting that their surgeons made them promises of results, or minimized risks about the proposed operation. Conclusions: In the great majority of cases, the claim was settled due to a characteristic complication inherent in the surgical technique and present in the document of informed consent signed by the patient. We also observed a minority of cases, particularly in refractive surgery, in which a foreseeable and avoidable complication related to incorrectly prescribed surgical techniques was produced. In these exceptional cases, expert evidence is usually unfavorable and charges are typically laid. It is probable that improved information for patients would reduce the number of these claims.

Morphological and biophysical techniques described in this study have shown that membrane derangement occurs in human cataractous lenses. The data suggest that these disruptions were globules, vacuoles, multilamellar membranes and clusters of highly undulating membranes. Deleterious structural damage of the lens fibre cell plasma membranes serve as the primary light-scattering centres that cause the observed lens opacity. Nuclear cataract, a major cause of loss of lens transparency in the aging human, has been thought to be associated with oxidative damage, particularly at the site of the nuclear plasma membrane. Phospholipid molecules modified by oxygen accumulate in the lipid bilayer, change its geometry and impair lipid-lipid and protein-lipid interactions in lenticular fibre membranes. Lipid peroxidation (LPO) is a causative and pathogenic factor in cataract. Increased concentrations of primary molecular LPO products (diene conjugates, lipid hydroperoxides, oxy-derivatives of phospholipid fatty acids) and end-fluorescent LPO products have been detected in the lipid moieties of aqueous humour samples and human lenses obtained from patients with senile and complicated cataracts as compared with normal donors. In the present study, a rapid and simple high-performance liquid chromatographic (HPLC) assay for determination of imidazole-containing dipeptides in the aqueous humour of the eye was developed. The method was applied to determine the pharmacokinetic parameters and the time-course of N-acetylcarnosine and L-carnosine-related product in the eye, following a single dosage of topical ocular administration of peptide. Utilising data from pharmacokinetic studies and the specific purity of the N-acetylcarnosine (NAC) ingredient as a source of the pharmacological principle L-carnosine, we have created an ophthalmic time-release prodrug form including the US FDA-approved carboxymethylcellulose lubricant and other essential ingredients (Can-C, private label Nu-Eyes). This formulation increases the intraocular absorption of L-carnosine in the aqueous humour and optimises its specific antioxidant activity in vivo while reducing the toxic effects of lipid peroxides on the crystalline lens. L-carnosine that enters the aqueous humour can accumulate in the lens tissue for a reasonable period of time. The presence of L-carnosine in transparent crystalline lenses during normal aging was detected and its concentration in this case was about 25 microM. At different stages of cataract development, the level of L-carnosine drastically decreased, reaching about 5 microM in ripe human cataracts. However, administration of pure L-carnosine (1% solution) to the rabbit eye (instillation or subconjunctival injection) does not lead to accumulation of this natural compound in the aqueous humour at the time level over 30 minutes at a concentration exceeding that in placebo-treated matched eyes, and its effective concentration is exhausted more rapidly. Use of NAC prodrug eye drops optimises the clinical effects of L-carnosine in the treatment of ophthalmic disorders (such as prevention and reversal of cataracts in human and animal [canine] eyes). The data provided predict a clinical effect with NAC ophthalmic prodrug, and show that the magnitude and duration of this effect are directly related to the bioavailability of L-carnosine released from NAC in the aqueous humour of the anterior eye segment. The ophthalmic NAC drug shows promise in the treatment of a range of ophthalmic disorders that have a component of oxidative stress in their pathogenesis (including cataract, glaucoma, dry eye, vitreous floaters, inflammatory disorders, and corneal, retinal and systemic diseases [such as diabetes mellitus and its ophthalmic complications]). There is a need for further and better collaboration between Innovative Vision Products' cataract control and ophthalmic services, improved education of people affected by cataract, a commitment that N-acetylcarnosine eye drops will be the preferred treatment before orthodox cataract surgery is attempted, and con

A 49-year-old man with an uncorrected visual acuity (UCVA) of 20 / 1000, a best spectacle-corrected visual acuity (BSCVA) of 20 / 400, keratometric readings of K1 = 59.88 × 82° / K2 = 45.88 × 172°, and an inferior steepening that was consistent with keratoconus in his left eye was treated with clear-cornea phacoemulsification and an intraocular lens (IOL) implantation after insertion of keraring intrastromal corneal ring segments for severe keratoconus and cataract. An asymmetrical pair of kerarings was implanted with the assistance of a femtosecond laser in September 2008; the one segment was 250 µm and the other was 150 µm and both were placed at 70°. Three months after the kerarings were implanted, clear-cornea phacoemulsification and IOL implantation were performed on the left eye. After surgery, both the UCVA and the BSCVA of the left eye improved by eight lines. Postoperative central keratometry showed a decrease of 7.35 diopters in the left eye. Both the postoperative refraction (-0.75 -0.75 × 60°) and the keratometric reading (K1 = 50.05 × 93° / K2 = 48.83 × 3°) remained stable one month following the procedures. Thus, the sequential order of intrastromal corneal rings implantation and cataract surgery can be considered as a treatment option in patients with severe keratoconus and cataract. PMID:22670082

Lymphoma of the conjunctiva is rare. It presents in older patients as a mass lesion and usually remains localized. Surgery is limited to biopsy, and radiation therapy is the definitive treatment of choice. The entire conjunctiva is treated. Relatively high doses (approximately 30 Gy) are required for local control, which may lead to cataract formation. Twelve patients with conjunctival lymphoma were treated at the Massachusetts General Hospital between 1979 and 1988. Ten of 12 patients presented with a unilateral lesion; 2 of 12 with bilateral lesions. Two of 12 patients were found to have systemic disease at the time of presentation. One patient developed conjunctival lymphoma 5 years after the diagnosis of generalized disease. Using electron beam, all patients were treated with a single anterior circular field to total doses ranging from 24 Gy to 30 Gy delivered in 8 to 16 fractions over 9 to 20 days. In all cases, the lens was shielded by a specially designed plastic contact lens bearing a 12 mm diameter lead shield. The lens dose was determined at varying depths beneath the shield for 6 MeV and 9 MeV electron beams and ranged from a minimum of 5% to an absolute maximum of 18% of the total dose delivered to the tumor. Local control was maintained in all patients with follow-up to 9 1/2 years. One patient relapsed distantly 3 years after treatment. One of 12 patients died of systemic disease 4 years after treatment of the ocular lesion. Two patients developed cataracts 4 and 5 years after treatment; one had bilateral cataract, although only one eye had been treated. Both patients were over 75 years old. In both cases, the cataracts were felt to be senile cataracts which are ophthalmologically and radiographically distinguishable from radiation induced lesions.

Age-related cataract (ARC) is the leading cause of blindness in the world, particularly in developing countries. In contrast, cataract surgery has become the most frequent surgical procedure in people aged 65 years or older in the Western world, causing a considerable financial burden to the health care system. The development of cataracts is mainly an age-related phenomenon, although socioeconomic and lifestyle factors appear to influence their development, e.g. smoking has been found to directly influence ARC. A key role in the pathomechanism of the crystalline lens alteration is played by glucose metabolism and associated effected redox potential, which may induce oxidative damages. Aldose reductase blockers were able to prevent the development of diabetic cataracts in experimental studies, however clinical trials were interrupted due to unclear side effects. Other drugs with radical scavenging properties were effective in in vitro and in vivo experiments, but could not be proven to be efficient and safe in preclinical human trials. A number of epidemiological studies showed an increased risk of nuclear or cortical cataract in people with low blood levels of vitamin E. It is also known that the measured levels of ascorbic acid decline with increasing age in the lens. Beta-Carotin and other non-polar carotenoids seem to be missing and may therefore only play a minor role. Polarized carotenoid lutein and zeaxanthin are available in low concentrations and may therefore have some direct effects. The results of the present interventional studies are still controversial. While the Linxian studies indicated that the prevalence for nuclear cataract was reduced by the supplementation with retinol/zinc or vitamin C/molybdenum, the AREDS trial showed no effect of the antioxidant formulation on the development or progression of ARC. Again, while the REACT study demonstrated a statistically significant positive treatment effect 2 years after treatment for the US patients and for both subgroups (US & UK) after 3 years, no effect was observed in UK patients alone. In another US study, the Physician Health Study, no positive or negative effect of Beta-carotin was observed. Taken together, these studies suggest that any effect of antioxidants on cataract development is likely to be very small and probably is of no clinical or public health significance, thus removing a major rationale for 'anticataract' vitamin supplementation among health-conscious individuals. PMID:15604620

The aim of trabecular surgery is to selectively combat the diseased structure central to the pathogenesis of chronic open-angle glaucoma, thereby reducing potential hazards during and after conventional filtering procedures. This overview considers new techniques in ab interno trabecular surgery. Special emphasis is placed on the description of each novel technique, its instrumentation, presumed mechanism of action and clinical results. Trabecular aspiration is evaluated as a method of clearing intertrabecular spaces of extracellular debris in pseudoexfoliation glaucoma with or without simultaneous cataract surgery or goniocurettage, while laser trabecular ablation is discussed for the treatment of absolute glaucomas. Where corneal haze has formed visualisation of the anterior chamber angle structures and trabecular surgery is performed with the aid of a microendoscope. Although the results are very promising it should be understood that some of these procedures are still in the experimental phase and are undergoing careful clinical evaluation, leaving plenty of room for refinements and further developments. PMID:11026982

The European Society of Cataract & Refractive Surgeons Endophthalmitis Study published preliminary results in 2006 showing a near 5-fold decrease in the rates of postoperative endophthalmitis with the use of intracameral cefuroxime. The study findings have generated considerable controversy, and 1 year later its recommendations had been heeded by only 6% of American Society of Cataract and Refractive Surgery (ASCRS) members. This poll sought to gauge the uptake among surgeons in the United Kingdom and survey their response to its findings. Fifty-five percent of respondents were using intracameral cefuroxime; 48% had switched after publication of the ESCRS study. Of those remaining, 68% reported their main concern was the risk for dilution errors in the absence of a commercially preformulat...

PurposeTo assess the efficiency of ray-tracing intraocular lens (IOL) power calculation with anterior segment optical coherence tomography (AS-OCT) in normal eyes with cataract. SettingMiyata Eye Hospital, Miyakonojo, Miyazaki, Japan. DesignCase series. MethodsThe study comprised consecutive patients who had cataract surgery and obtained a corrected visual acuity of 0.15 logMAR or better postoperatively. Preoperatively, Placido topography and AS-OCT measurements were taken during a routine examination. The predicted postoperative refractions were obtained using 3 methods: the SRK/T formula with autokeratometry, ray-tracing calculation with Placido topography data, and ray-tracing calculations with AS-OCT measurement of both corneal surfaces. The refractive errors from the manifest refracti...

Objective To examine the associations of cataract and cataract surgery with early and late age-related macular degeneration (AMD) over a 20-year interval. Design Longitudinal population-based study of age-related eye diseases. Participants Beaver Dam Eye Study participants. Methods Persons aged 43 to 86 years participated in the baseline examination in 1988–1990. Participants were followed up at 5-year intervals after the baseline examination. Examinations consisted of ocular examination with lens and fundus photography, medical history, measurements of blood pressure, height, and weight. Values of risk variables were updated, and incidences of early and late AMD were calculated for each 5-year interval. Odds ratios were computed using discrete linear logistic regression modeling wi...

Abstract. Purpose: Four cases of silicone intraocular lens (IOL) opacifications presented at a routine cataract service at a UK district general hospital. A systematic investigation was performed to identify and eliminate the causative factor. Methods: An experiment was set up to determine the role of a chemically induced IOL injury. Silicone IOLs were exposed to the various chemical agents used during cataract surgery. One IOL was not exposed to any chemicals and was used as a control. The samples were then photographed with the same camera settings against the same background in a medical photography studio. Results: All samples photographed using this technique were clear as the unexposed control IOL, except the IOLs that had come into contact with povidone iodine (PI). Exposure to high...

All current cataract incisions induce transient and permanent changes in corneal astigmatism. Typically, a two-phase astigmatic response is observed; an initial with-the-rule change is followed by an eventual and permanent against-the-rule shift from preoperative astigmatism. The earlier literature suggests that the magnitude of the net astigmatic swing approximates 6.0 diopters for large limbal wounds closed with interrupted sutures. However, applying the tenets of keratorefractive surgery to the cataract incision and its closure allows the surgeon to limit postoperative iatrogenic astigmatic swings. The reduced phacoemulsification incision size in combination with a scleral pocket closed with a continuous single knotted 10-0 monofilament nylon suture under tonometric and keratometric control significantly dampens the changes in corneal astigmatism during the early and late postoperative periods. My published reports, as evaluated in the present study, reveal that the net astigmatic swing may be reduced to less than 1.5 diopters, thereby affording rapid and stable optical results. PMID:2646432

Abstract in spanish Se realiza un RACSS (Rapid Assessment of Cataract Surgical Services), en Ciudad de La Habana, Cuba en el año 2005, en la población mayor de 50 años. Se determinó un tamaño de muestra de 2 760 personas distribuidos en 46 cluster (consultorios del médico de la familia) que fueron seleccionados aleatoriamente mediante un muestreo sistemático en todos los municipios de la Ciudad de La Habana. Para el cálculo del tamaño de muestra se tuvieron en consideración los sig (more) uientes criterios: prevalencia de ceguera esperada de 2,5 %, error aceptable de 3 % y un efecto de diseño de 70 %. Los indicadores estimados fueron: la prevalencia de de ceguera en mayores de 50 años según sexo, grupos de edad, y causa, la prevalencia de afáquicos y pseudofáquicos, la cobertura y resultados de la cirugía de catarata. El estudio tuvo una cobertura de 98,3 % de la muestra seleccionada. La prevalencia de ceguera fue de 2.4 % en total. La prevalencia de personas ciegas por edad aumenta desde 2,6 % con 50 años a 15,2 % con 80 años y más. Las causas más importantes de ceguera fueron catarata 50 %, glaucoma 26 % y retinopatía diabética 9 %. La prevalencia de ceguera por catarata según sexos es de 3,64 % para el sexo femenino y 4,06 % para el masculino; se estimó un total de 10 184 de ciegos, y de 47 529 ojos ciegos por catarata. Las principales barreras para la cirugía de la catarata fueron: el desconocimiento de la enfermedad en 4,4 % de los casos, 17,9 % esperaba por su maduración y 11,5 % presentaba una enfermedad que contraindicaba la cirugía. En total 70,7 % de los pseudoafáquicos o afáquicos tenían AVcc de 0,3 y más. En general 62,3 % de los pacientes tenían colocados lentes intraoculares Abstract in english A RACSS (Rapid Assessment of Cataract Surgical Services) was made on the population aged over 50 years in the City of Havana. A sampling size of 2 760 persons distributed into 46 clusters (family physician's offices), which were randomly selected by a systematic sampling from all the municipalities, was determined. For the estimation of the sample size, we considered the following criteria: expected prevalence rate of blindness of 2.5 %, allowable error of 3 % and design (more) effect of 70 %. Estimated indicators were the prevalence rate of blindness in persons over 50 years by sex, age groups and cause; the prevalence of aphakics and pseudoaphakics, and the coverage and results of cataract surgery. The study had a coverage of 98,3 % of the selected sample. The prevalence rate of blindness was 2,4% in all. The prevalence rate of blind persons by age increases from 2,6 % at 50 years to 15,2 % at 80 years and over. The most important causes of blindness were cataract (50 %), glaucoma(26 %) and diabetic retinopathy (9&). The prevalence rate of cataract-induced blindness by sex was 3,64 % for females and 4,06 % for males, for a total number of 10 184 blind people and 47 529 blind eyes from cataract. The main barriers for cataract surgery were: lack of knowledge about the disease in 4,4 % of cases, waiting for cataract maturation in 17,9 % of cases, and a disease in which performance of this surgery was contraindicated in 11,5 % of cases. In all, 70,7 % of pseudoaphakics or aphakics had visual acuity with correction of 0,3 or more. Generally speaking, 62,3 % of patients had intraocular lens

Abstract in portuguese OBJETIVO: Verificar a influência de alguns tipos de opacidade lenticular no teste da tela de Amsler entre portadores de catarata senil. MÉTODOS:Foram avaliados 200 pacientes portadores de catarata senil através da aplicação da tela de Amsler, antes e após a cirurgia. O estudo foi feito em um único centro, simples cego, randomizado e prospectivo. Os pacientes foram submetidos a exame de acuidade visual (AV) corrigida, para longe e perto, biomicroscopia do segmento a (more) nterior e da região macular. RESULTADOS:A acuidade visual média pré-operatória para longe dos 200 pacientes foi de 0,5 logMAR (20/60 Tabela de Snellen). Após a cirurgia, dos 11 pacientes que haviam apresentado alteração na tela de Amsler pré-operatória, dez não tiveram alteração no exame de reavaliação da tela. Os 10 indivíduos apresentaram acuidade visual pós-operatória, com a melhor correção óptica, para distância de 20/20 e para perto de J1. No presente estudo foi constatado 5,5% com alteração na tela de Amsler antes da cirurgia, em 5% dos pacientes estas alterações estavam diretamente relacionados a opacidade do cristalino e 0,5% relacionados a opacidade vítrea. CONCLUSÃO: Conclui-se que a alteração no exame da tela de Amsler pode ser diretamente relacionada à catarata, na ausência de alterações maculares clínicas. Abstract in english PURPOSE: To assess the influence of some forms of lenticular opacification in the Amsler grid test among patients suffering from senile cataract. METHODS: Randomized, prospective interventional trial. Two hundred patients with senile cataract were evaluated with Amsler grid, measurement of best corrected visual acuity for near distance and far distance, biomicroscopy of the anterior segment and macular region. RESULTS: With a two months minimum of follow-up, the average v (more) isual acuity after surgery for far distance among the 200 patients was 0.48 logMAR, 11 (5.5%) had changes in the Amsler grid test before surgery. After surgery, from the 11 subjects with changes in the preoperative Amsler grid test, 10 had no more changes in the Amsler grid. These 10 subjects had postoperative best corrected visual acuity of 20/20, and Jaeger 1, no abnormalities of the fundus having been detected. Under this study conditions, the prevalence of changes in the Amsler grid test was 5.5%, and in 5% of the patients these changes were likely related to cataract whereas in 0.5% they were related to vitreous opacification. CONCLUSION: Some patient with cataract showed changes in the Amsler grid test that can be directly related to cataract, in the absence of clinically detected macular disorders.

Data concerning cataract formation in experimental animals exposed to microwave irradiation is reviewed. Lens opacities have been induced by the continuous or pulsed wave irradiation of the eye at frequencies ranging from 2,450 to 10,000 MegaHertz. Microwave cataracts can be induced by a single incident exposure, or via a cumulative effect resulting from repeated single exposures with power values so low that a single exposure in itself is not harmful. The radiation dose required for opacity induction, expressed as power density times exposure duration, is not constant. Irradiation causes a intraocular temperature increase that is related to power density; however, lens opacity induction is not dependent upon critical temperature. The latent period between lens irradiation and opacity formation ranges from 1 to 6 days. Both lens susceptibility to microwave radiation damage and latent period duration are unrelated to animal age. Microwave cataracts are similar to cataracts induced by ionizing radiation as concerns development, morphology, and histopathology, constituting permanent lens transparency alterations. The author concludes that since opacities have been seen to develop in lenses removed immediately after irradiation and cultured in-vitro, it appears that microwave cataract formation is a direct result of radiation on the lens rather than of changes in the intraocular lens environment. During the latent period, two specific biological effects preceding the onset of lens opacity are the early marked reduction of ascorbic-acid concentrations and the inhibition of DNA synthesis and cell division in the lens epithelium. During initial opacity development, lens electrolyte and water concentrations increase, suggesting that a lens membrane permeability increase results from microwave irradiation.

Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers. PMID:22464623

In consideration of the use of fibrin glue in a general surgery department, authors analyze their last two years series. Operations on liver and biliary ducts, bowel and proctologic surgery, thyroid and breast surgery, abdominal wall hernias, fistulas and difficult wounds are considered with a literary review on fibrin sealant. KEY WORDS: Biological glue, Fibrin sealant, General surgery. PMID:23076453

PURPOSE: To assess the clinical outcomes after implantation of a new hydrophobic acrylic toric intraocular lens (IOL) to correct preexisting corneal astigmatism in patients having routine cataract surgery. SETTING: Four hospital eye clinics throughout Europe. DESIGN: Cohort study. METHODS: This study included eyes with at least 0.75 diopter (D) of preexisting corneal astigmatism having routine cataract surgery. Phacoemulsification was performed followed by insertion and alignment of a Tecnis toric IOL. Patients were examined 4 to 8 weeks postoperatively; uncorrected distance visual acuity (UDVA), corrected distance visual acuity, manifest refraction, and keratometry were measured. Individual patient satisfaction with uncorrected vision and the surgeon's assessment of ease of handling and performance of the IOL were also documented. The cylinder axis of the toric IOL was determined by dilated slitlamp examination. RESULTS: The study enrolled 67 eyes of 60 patients. Four to 8 weeks postoperatively, the mean UDVA was 0.15 logMAR ± 0.17 (SD) and the UDVA was 20/40 or better in 88% of eyes. The mean refractive cylinder decreased significantly postoperatively, from -1.91 ± 1.07 D to -0.67 ± 0.54 D. No significant change in keratometric cylinder was observed. The mean absolute IOL misalignment from the intended axis was 3.4 degrees (range 0 to 12 degrees). The good UDVA resulted in high levels of patient satisfaction. CONCLUSION: Implantation of the new toric IOL was an effective, safe, and predictable method to manage corneal astigmatism in patients having routine cataract surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. PMID:23158681

Abstract in portuguese A ceratopatia bolhosa caracteriza-se pelo edema corneano estromal acompanhado de bolhas epiteliais e subepiteliais devido à perda de células e/ou alterações da junção endotelial. Nos casos mais avançados, ocorre espessamento do estroma e presença de fibrose subepitelial e vascularização corneana. Apresenta baixa de acuidade visual devido à diminuição da transparência da córnea e pode estar acompanhada de sensação de corpo estranho, lacrimejamento e dor de (more) vido as alterações epiteliais como a presença de bolhas íntegras ou rotas. Ceratite bolhosa é uma das principais causas de transplante de córnea em diferentes regiões e países. A principal etiologia é a perda de células endoteliais, principalmente após cirurgia de catarata e na distrofia endotelial de Fuchs. Sabe-se que atualmente há cerca de 20 milhões de pessoas com catarata no mundo, e esta complicação pode afetar 1 a 2% das cirurgias de catarata. Este texto faz uma revisão sobre a etiopatogênese da ceratopatia bolhosa e sobre os tratamentos clínicos e cirúrgicos disponíveis para a doença. Abstract in english Bullous keratopathy is characterized by corneal stromal edema with epithelial or subepithelial bullae due to cell loss and endothelial decompensation. In more advanced cases, subepithelial fibrosis, formation of a posterior collagenous layer or retrocorneal fibrous membrane, and corneal vascularization can occur. Decreased vision is present because the loss of corneal transparency with symptoms like tearing and pain caused by epithelial bullae that can rupture. Currently, (more) bullous keratopathy is the most common indication for penetrating keratoplasty and regraft. The main etiology is the endothelial cell loss after ophthalmic surgeries as cataract surgery. Cataract affects approximately 20 million people worldwide, and this complication can occur in 1 to 2% of cataract surgeries. This study revised bullous keratopathy etiopathogenesis, clinical and surgical treatment available for this corneal disease.

Cataract is responsible for 50% of world blindness, with at present an estimated backlog of 13.5 million cases in need of surgery. Low-cost cataract surgery must be made more available in developing countries, making use of alternative approaches for outpatient surgery and optimal management of available resources. Trachoma control needs to be targeted at the worst affected areas in endemic countries, with more emphasis on behavioural, educational and community aspects of the disease. Vitamin A deficiency and xerophthalmia control are becoming matters of maternal and child health care, with early intervention during infancy in view of the mortality issue. There are good prospects for the prevention of blindness from onchocerciasis, through the availability of ivermectin, but large-scale distribution schemes are still needed in most of the African countries concerned. The early detection and management of open-angle glaucoma still poses a major problem in developing countries, and further development of appropriate technology is needed in this field. Another area where more efforts are needed is ocular trauma, which is commonly the cause of unilateral loss of vision. General preventive measures must be enforced and better training provided to health personnel to deal competently with such cases, in order to prevent late complications. Diabetes, finally, is on the increase in many developing countries, giving rise to problems in dealing effectively with the ensuing retinopathy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1389140

Background: In order to improve the sustainability of eye care programs including provision of surgical services, an understanding of a patient's capacity to contribute towards the costs relating to sight-restoring surgery is essential. Therefore, we investigated willingness to pay for cataract surgery in a hospital-based cross-sectional study in rural Malawi. Methods: We interviewed consecutive patients following surgery for senile cataract at Nkhoma Eye Hospital, Malawi. Patients were asked about their willingness to pay for surgery (in local currency, Kwacha, as well as surrogates for money). We also collected data on socio-demographic variables and pre- and post-operative visual acuity (VA). Results: A total of 212 participants were included (99.5% acceptance), of whom 82.0% were farmers. Mean age of participants was 68.2 years, and 89 (42.0%) were female. There were 136 (64.2%) who were willing to pay something. Median willingness to pay was 500 Kwacha (interquartile range 0-2,000; ~US$3.00, August 2011). Following adjustment for age, sex, family size and occupation, patients who were blind pre-operatively (pinhole-corrected VAratio 0.44, 95% confidence interval 0.20-0.96, P = 0.038) compared to those with VA>6/60. Conclusion: In this setting where people are used to free services, the median monetary amount elderly patients were willing to pay for surgery is well below the actual cost of screening, transport, accommodation and surgery. Substantial cost recovery will require pre-operative involvement of family members, but might slow down current screening practices and also lower acceptance rates. PMID:22978527

Although presbyopia is ostensibly an age-related disease of the lens, ciliary body, and zonular apparatus, surgeons have nonetheless persevered in their attempts to create a solution to the problem of diminished near vision by performing keratorefractive procedures. This article discusses two approaches of varying technological sophistication, beginning with surgically induced astigmatism and continuing through enhanced monovision. Sometimes simple solutions are the best, and the technological innovation in cataract and refractive surgery has met with unrivalled success in the last three decades. PMID:16500527

Financial DisclosureAccurate alignment of a toric intraocular lens (IOL) is a requisite to achieving the intended reduction in astigmatism at the time of cataract surgery. However, it requires a reasonably clear view of the limbal vascular anatomy, which is sometimes altered by chemosis from a subconjunctival anesthetic injection or a hemorrhage. We describe a technique that can quickly restore vascular anatomy and facilitate toric IOL alignment. Dr. Osher is a consultant to Sensomotoric Instruments GmbH. Dr. Avakian has no financial or proprietary interest in any material or method mentioned.

Abstract Background:- To compare keratometric values obtained with a manual keratometer (Topcon), an automated keratometer (Canon), an Orbscan II (Bausch & Lomb), the IOLMaster keratometer (Carl-Zeiss) and the Pentacam rotating Scheimpflug camera (Oculus) in cataract surgery, and to characterize the refractive outcomes generated using each device. Design:- Retrospective study conducted at a tertiary university hospital. Participants:- Sixty-nine eyes of 69 patients were analysed. Methods:- The keratometric values obtained with different devices (manual keratometer, automated keratometer, corneal topography, IOLMaster keratometer and Scheimpflug camera) were employed for intraocular lens power calculation. Multiple comparisons of averaged keratometric value were conducted, and the averaged ...

PurposeTo evaluate agreement in central corneal thickness (CCT), keratometry, and anterior and posterior elevation map measurements in normal corneas between a combined Placido-Scheimpflug system and a combined Placido-scanning-slit elevation topography system. SettingDepartment of Cataract & Refractive Surgery, Rothschild Foundation, Paris, France. DesignEvaluation of diagnostic test or technology. MethodsMeasurements were performed with a combined Placido-Scheimpflug system (TMS-5) and a combined Placido-scanning-slit system (Orbscan II). Ultrasound (US) pachymetry was used as the reference for CCT measurements. Bland-Altman plots were used to evaluate agreement between instruments. ResultsThe mean CCT measurements by US pachymetry, the Placido-Scheimpflug system, and the Placido-scannin...

We describe a technique to prevent milky liquefied cortical matter from obscuring the view of the anterior chamber and radial tears caused by high intracapsular pressure in eyes with hypermature or intumescent cataract. The continuous curvilinear capsulorhexis (CCC) is created in a sealed anterior chamber without capsule staining or viscoelastic material. Ninety-four consecutive CCCs were performed by a single surgeon over 24 months using the method. A successful CCC was achieved in all eyes. Four cases had complications that occurred late in the surgery and were not related to the CCC. PMID:12663001

PurposeTo report cases of intraocular inflammation after intracameral injection of a very high dose of cefuroxime at the end of uneventful cataract surgery. SettingDepartment of Ophthalmology, Bordeaux University Hospital, Bordeaux, France. DesignCase series. MethodsPatients were followed on an outpatient basis and were examined postoperatively at 1 and 5 days and 6 weeks. Central macular thickness, angiography, central corneal thickness (CCT), endothelial cell density (ECD), and electroretinography (ERG) were analyzed to evaluate ocular toxicity. ResultsOne day postoperatively, the mean corrected distance visual acuity (CDVA) was 0.95 logMAR +- 0.40 (SD). All the cases had moderate anterior inflammation. Retinal optical coherence tomography scans systematically showed extensive macular ed...

Purpose: To describe a case of unilateral intermediate uveitis, retained copper intraocular foreign body (IOFB) and fungus. Methods: Interventional case report. Results: Brown-orange discoloration of the iris, lens and opacified vitreous was observed. Computed tomography revealed a retained IOFB, which was composed of copper. IOFB was removed during vitrectomy and cataract surgery. Copper deposition was demonstrated on the anterior capsule. Incidentally, dimorphic fungus were found in the vitreous. Conclusions: The presence of intraocular copper might have reduced the virulence of the fungus preventing endophthalmitis.

Abstract in portuguese Objetivo: Analisar a evolução do número de cirurgias realizadas no centro cirúrgico ambulatorial de um hospital universitário e avaliar sua viabilidade financeira durante e após a interrupção da Campanha Nacional de Catarata em 2006. Métodos: Foi realizado um estudo analítico retrospectivo entre 2005 e 2009 no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) em que foram avaliados a viabilidade econômica do centro cirúrg (more) ico ambulatorial, o número de cirurgias de catarata realizados e o número de cirurgiões presentes diariamente naquela unidade. Resultados: Seria necessária a realização de pelo menos 400 procedimentos mensais para garantir a viabilidade financeira do centro cirúrgico ambulatorial. Este número ficou abaixo do esperado nos anos de 2008 e 2009 (média de 370,6 e 390,1 cirurgias respectivamente). O número de estagiários de catarata diminuiu de 13 em 2005 para 3 em 2009. Conclusão: O principal fator para a redução no número de cirurgias de catarata realizadas no centro cirúrgico ambulatorial após 2006 foi a dificuldade de acesso da população necessitada ao hospital, decorrente de restrições à realização de projetos de triagem. A maior utilização das salas cirúrgicas por outras clínicas e a diminuição na admissão de novos cirurgiões, adequaram e viabilizaram o centro cirúrgico ambulatorial para a nova realidade políticoeconômica. Abstract in english Purpose: To analyze the number of surgeries performed in outpatient surgical center at a university hospital and to assess its financial viability during and after the interruption of the Cataract National Campaign in 2006. Methods: Retrospective analytical study between 2005 and 2009 at the Clinical Hospital of the University of São Paulo (HC-FMUSP) which evaluated the economic viability of the outpatient surgical center, the number of cataract surgeries performed and t (more) he number of surgeons present daily in that unit. Results: It would be necessary to perform at least 400 procedures monthly to ensure the financial viability of the outpatient surgical center. This number was lower than the expected in the years of 2008 and 2009 (average of 370.6 and 390.1 surgeries respectively). The number of cataract fellows decreased from 13 in 2005 to 3 in 2009. Conclusion: The main factor for the reduction in the number of cataract surgeries performed in the outpatient surgical center after 2006 was the difficulty of access of the population to the hospital due to restrictions on the development of screening projects. The increased use of the operating rooms by other clinics and the decrease in the admission of new surgeons, made the outpatient surgical center appropriate and viable for the new political-economic reality.

...Computer-Assisted Personalized Sedation System; Ethicon Endo-Surgery, Incorporated's Petition for Review of the Food and Drug...personalized sedation system (SEDASYS) submitted by Ethicon Endo-Surgery Inc. (EES), the sponsor for SEDASYS. This meeting...

... may be needed to make an exact diagnosis. Surgery This document is for informational purposes and is ... com oc110104 Last reviewed: 01/10/2011 6 Surgery is usually done on primary brain tumors to ...

Introduction: In 1890 Ball defined hallucinations as perceptions without real object with sharp features and embodiment of that approach actual sensory perceptions. Objective and methods: We present the case of an elderly woman with cataract. Previously we maked a review of the literature and its controversies. Results: An 82 year old woman was referred to psychiatry for primary care physician for evaluation of visual hallucinations of 3 1/2 months of evolution. Among somatic background are collected: arterial hypertension, cataracts and increased intraocular tension. The detection of the picture is casual, for the comments that the patient makes to his daughter. She says that she sees her husband died 6 years ago, on the stairs. Reported to have a house full of people describing in detail...

Purpose To conduct a systematic review of literature evaluating efficacy of venous and arterial grafts for distal upper extremity bypass surgery. Methods A PubMed search using MeSH terms “veins/surgery” OR “arteries/surgery” AND “radial artery/surgery” OR “ulnar artery/surgery” yielded 794 studies. Manual review produced 42 studies based on inclusion criteria of reported distal upper extremity bypass surgery, complete information on graft type used, examined patency of reconstruction, and described method for determining patency. Studies meeting inclusion criteria underwent data extraction focusing on demographics, revascularization site, conduit type, microsurgical technique, subjective/objective outcomes, and postoperative anticoagu...

Abstract in portuguese OBJETIVO:Dar continuidade ao processo de atualização e aperfeiçoamento da cirurgia de catarata no Brasil, além de obter dados para uma análise comparativa das atuais tendências cirúrgicas nacionais e internacionais. MÉTODOS:Em maio de 2007, foram obtidos dados de 188 participantes de um congresso de Catarata e Cirurgia Refrativa através questionários autoaplicáveis, contendo perguntas objetivas a respeito da cirurgia de catarata. Análise estatística foi feita (more) através teste T e Qui-quadrado. RESULTADOS: Observou-se que 95,8% dos participantes praticam a facoemulsificação, enquanto somente 4,2% preferem usar a técnica extracapsular convencional. Para 73,4% dos participantes, o bloqueio peribulbar é preferido em relação ao uso de anestésico tópico (20,2%). A técnica de facoemulsificação mais realizada é a de dividir e conquistar (32,0%). A hidroximetilcelulose foi o viscoelástico de escolha para 60,8% dos colaboradores. O aparelho de facoemulsificação mais usado pelos participantes foi o Infiniti® (24,0%), seguido pelo Legacy® (19,8%). CONCLUSÃO:Os resultados deste estudo foram consistentes com o que era esperado, tendo como base pesquisas semelhantes. Destaca-se um aumento considerável do número cirurgiões adeptos à facoemulsificação e tendências no sentido de maior utilização de incisões corneanas temporais e anestesia tópica. Abstract in english Purpose: To continue the updating and improving process of the cataract surgery in Brazil, through recently pulled out and documented registries. In addition, we want to obtain data for a comparative analysis of the current national and international surgical trends. METHODS:In May 2007, data were obtained from 188 participants of a Congress of Cataract and Refrative Surgery who answered simple and multiple-response questions about cataract surgery. Data were analyzed by (more) statistic means of Chi-square test and T test. RESULTS:95.8% of respondents practice phacoemulsification, while only 4.2% perform the conventional planned extracapsular cataract extraction. For 73.4% of respondents, the periocular block is preferred instead of topical anesthesia (20.2%). The most practiced phacoemulsification technique is the 4-section divide and conquer (32.0%). The hidroximetilcelulosis is the ophthalmic viscosurgical device chosen by 60.8% of respondents. The most used phaco machine is Infiniti® (24.0%), followed by Legacy® (19.8%). CONCLUSION: According to this paper is possible to suggest a tendency to high the surgeons who practice clear corneal incision and topical anesthesia. Besides that it was possible to suggest that in ten years the phacoemulsification seems to be consolidated as the surgeons's procedure of choice.

Abstract Objective. To review the use of the left upper quadrant approach in benign gynecologic laparoscopic surgery over a nine-year period. Design. Retrospective review. Setting. University-affiliated hospital. Population. Women who underwent laparoscopic gynecologic surgery the upper quadrant approach between January 2002 and December 2010. Methods. Medical records were reviewed. Main outcome measures. Demographic data, past surgical histories, indications for surgery and the use of the left upper quadrant approach, intraoperative findings, diagnosis and any complications. Results. 143 patients were identified, accounting for 4.9% of all gynecologic laparoscopic surgery. The indications for using the left upper quadrant approach were: previous open abdominal surgery (113, 79.0%), surger...

BACKGROUND: To evaluate the intraocular lens (IOL) position by analyzing the postoperative axis of internal astigmatism as well as the higher-order aberration (HOA) profile after cataract surgery following the implantation of a diffractive multifocal toric IOL METHODS: Prospective study including 51 eyes with corneal astigmatism of 1.25D or higher of 29 patients with ages ranging between 20 and 61 years old. All cases underwent uneventful cataract surgery with implantation of the AT LISA 909 M toric IOL (Zeiss). Visual, refractive and corneal topograpy changes were evaluated during a 12-month follow-up. In addition, the axis of internal astigmatism as well as ocular, corneal, and internal HOA (5-mm pupil) were evaluated postoperatively by means of an integrated aberrometer (OPD Scan II, Nidek). RESULTS: A significant improvement in uncorrected distance and near visual acuities (p?alignment, the difference between the axes of postoperative internal and preoperative corneal astigmatisms was close to perpendicularity (12 months, 87.16°?±?7.14), without significant changes during the first 6 months (p???0.46). Small but significant changes were detected afterwards (p?=?0.01). Additionally, this angular difference correlated with the postoperative magnitude of manifest cylinder (r?=?0.31, p?=?0.03). Minimal contribution of intraocular optics to the global magnitude of HOA was observed. CONCLUSIONS: The diffractive multifocal toric IOL evaluated is able to provide a predictable astigmatic correction with apparent excellent levels of optical quality during the first year after implantation. PMID:22588290

PURPOSE: To determine risk factors for anesthesiologist intervention during routine cataract surgery performed with topical and intracameral anesthesia and establish a regression model to identify high-risk patients. SETTING: Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain. DESIGN: Prospective case series. METHODS: After cataract surgery at an ambulatory surgical center, anesthesia personnel completed a questionnaire to determine adverse medical events and risk factors related to anesthesiologist intervention. A Poisson regression model was used to calculate the interventional risks. Bootstrapping was performed for internal model validation. RESULTS: Of the 1010 cases, 50 (4.95%) required anesthesiologist intervention. Univariate analysis identified an association between anesthesiologist intervention and hypertension (Pblood pressure (Pblood pressure [mm Hg]). The area under the receiver-operating curve was 0.803 (95% confidence interval [CI], 0.721-0.886). The area under the curve found in the validation method was 0.813 (95% CI, 0.727-0.887). CONCLUSION: Hypertension was the main risk factor for anesthesiologist intervention. The regression model discriminated between patients at lower and higher risk for intraoperative intervention for monitored anesthesia care. The probability of anesthesiologist intervention was 11.7 times higher when the model obtained a high score. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. PMID:23084599

Purpose. To evaluate early and late postoperative anterior segment complications of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with cataract and coexisting vitreoretinal disease in diabetic and nondiabetic patients.?Setting. Department of Ophthalmology, Baskent University Hospital, Ankara, Turkey.?Methods. The records of 189 consecutive patients with cataract and posterior segment pathology necessitating phacovitrectomy were retrospectively analyzed. Patient profile, indications for surgery, preoperative findings, intraoperative and postoperative course, and postoperative outcome were evaluated. Phacoemulsification was performed through a clear corneal incision with IOL implantation prior to 23-G pars plana vitrectomy. ?Results. There were 97 (51.3%) diabetic and 92 (48.6%) nondiabetic patients. The most common indications for surgery were vitreous hemorrhage (57; 58.7%), tractional detachment (35; 36%), and premacular hemorrhage (5; 5.1%) in diabetic patients, and rhegmatogenous retinal detachment (40; 43.4%), macular hole (22; 23.9%), epiretinal membrane (20; 21.7%), and vitreomacular traction (10; 10.8%) in nondiabetic patients. Early (within 4 weeks) postoperative complications included elevation of intraocular pressure, fibrinous uveitis, corneal edema, and development of posterior synechia. Long-term (after 4 weeks) complications included migration of silicone oil into the anterior chamber, posterior capsule opacification, and decentered IOL. The ratio of fibrinous uveitis, posterior synechia, and posterior capsule opacification was found higher in the diabetic group (all pdiabetic and nondiabetic patients. Diabetic patients should be monitored more carefully for fibrinous uveitis and posterior synechia in the early postoperative period and for posterior capsular opacification in the late postoperative period. PMID:23065855

PurposeTo compare methods of corneal power estimation after myopic laser refractive surgery with back-calculated corneal power (K). SettingPrivate practice, Edmonton, Alberta, Canada. DesignCase series. MethodsPatients with previous myopic laser surgery followed by cataract extraction were studied. Back-calculated K obtained with the Holladay IOL Consultant was compared with that obtained by the clinical history method (CHM), the modified Maloney method, an adaptation of the Maloney method using individualized Orbscan IIz-derived posterior corneal power values, Orbscan IIz quantitative area topography, and the Gaussian optics formula. A mixed effects linear model was used for analysis. ResultsThe mean spherical equivalent (SE) before laser treatment was -6.43 diopters (D) +- 3.52 (SD). The...

Purpose To compare the safety and efficacy of 20- and 23-gauge pars plana vitrectomy (PPV) for the management of primary rhegmatogenous retinal detachment (RD) with proliferative vitreoretinopathy (PVR) grade B or less. Methods This comparative nested case-control study included 35 consecutive 23-gauge transconjunctival PPV cases matched (1:1) with 35 cases of 20-gauge PPV (from a prospective cohort of 1,150 patients) for the baseline visual acuity (VA), axial length, lens and macular status, the location and number of breaks, and PVR grade. All patients had complete PPV, cryotherapy, fluid?gas exchange, and a minimum follow-up of 6?months. The exclusion criteria were eyes with previous vitreoretinal surgery, combined vitrectomy and cataract surgery, RD secondary to trauma or macular hole,...

Financial DisclosureIris prolapse is not an uncommon occurrence during cataract surgery. It usually occurs through the main incision during hydrodissection and is commonly associated with floppy-iris syndrome; however, it can manifest in cases with no known predisposition and can occur at any stage during surgery. The mechanism is explained by the Bernoulli principle and its effect on iris position during the movement of fluid within the eye. Predisposing factors are iris configuration, anterior chamber depth, and position and architecture of the corneal tunnel. Strategies for prevention and management include the use of pharmacological agents, ophthalmic viscosurgical devices, and iris retractors. These strategies can be augmented by alteration and adaptation of the surgeons technique. No...

Background Cystoid macular edema (CME) is a well-known complication after cataract surgery, and diabetic retinopathy is reported to be an important risk factor for impaired visual recovery. In this prospective study, we compared visual outcome 6?months after surgery in eyes with moderate retinopathy and no previous ME with a control group, and observed the incidence of ME seen on fluorescein angiography (FA) and optical coherence tomography (OCT). Methods Thirty-four patients with type-2 diabetes and 35 controls were enrolled. Best-corrected visual acuity (VA) letters ETDRS was measured pre-op, at day 7, week 6 and month 6. FA performed pre-op and at week 6 was divided into three leakage patterns. OCT performed pre-op, at week 6 and month 6 was qualitatively divided into three types. Macul...

Abstract Purpose: To report 5 cases of advanced Coats' disease managed with pars plana vitrectomy and silicone oil tamponade. Methods: Five patients with advanced Coats' disease and serous or tractional retinal detachment underwent pars plana vitrectomy with internal drainage, endolaser photocoagulation and silicone oil tamponade. One patient had combined phacoemulsification-vitrectomy surgery. Of the 5 patients, 1 had intravitreal hemorrhage and a retinal macrocyst and 1 had a retinal cyst. Follow-up period was 1-6 years. Results: All patients had improved visual acuity after surgery. No intraoperative or postoperative complications were observed in any of the patients. The retina was attached and the disease was stable in all patients during follow-up. Two patients had cataract formation...

Abstract Purpose: The purpose of our study was to evaluate the effectiveness of preoperative and postoperative addition of topical diclofenac to chloramphenicol/dexamethasone in patients undergoing uneventful phacoemulsification cataract surgery. Methods: Patients were randomized to (1) chloramphenicol 0.5%???dexamethasone 0.1%, 1 drop 4 times a day (n=41), or (2) chloramphenicol 0.5%???dexamethasone 0.1%, 1 drop 4 times a day, plus diclofenac 0.1%, 1 drop 3 times a day (n=38). Patients in the second group also received diclofenac 0.1% for 3 days before surgery. Topical treatment was administered for 28 days after phacoemulsification. On postoperative days 1, 14, and 28, best corrected visual acuity, macular thickness, endothelial cell density, and central corneal thickness (CCT) were meas...

Abstract. Purpose:- To compare the visual outcomes in patients implanted with a diffractive silicone multifocal in one eye and a diffractive acrylic multifocal IOL in their fellow eye. Setting:- Augenklinik, Bad Hersfeld, Germany. Methods:- Forty-two eyes of 21 cataract surgery patients were randomized to undergo implantation with either a silicone diffractive multifocal IOL (Tecnis ZM900, Abbott Medical Optics, Santa Ana, CA, USA) or an acrylic diffractive multifocal IOL (Tecnis ZMA00, AMO). The two IOLs share the same design platform. Outcome measurements included uncorrected and best-corrected distance and near visual acuity, spherical equivalent, reading speed and reading acuity, as well as photic phenomena. Patients were followed for 6-months following surgery. Results:- The mean sphe...

Abstract in spanish Objetivo: El envejecimiento de la población ha provocado un aumento de la prevalencia de cataratas afectando a una amplia y creciente proporción de la población. El objetivo del presente estudio es describir la prevalencia de catarata a partir de estudios poblacionales mediante una revisión bibliográfica sistemática y exhaustiva. Métodos: Se realizó una búsqueda sistemática de estudios poblacionales de prevalencia e incidencia de cataratas, realizados en poblaci (more) ón sana no institucionalizada, mayor de 40 años, de raza blanca, con una muestra superior a 1.000 individuos y cuyo año de publicación estuviera entre 1980 y 2002. Resultados: Diez estudios cumplieron con los criterios de inclusión (3 europeos, 5 de Estados Unidos y 2 australianos), realizados entre 1984 y 2001. La prevalencia de catarata según opacificación del cristalino en los estudios que la describen estaba entre el 15 y 19%. Cuando se define catarata como opacificación y nivel de agudeza visual conjuntamente los estudios describen prevalencias entre el 15 y 30%. La prevalencia aumenta con la edad, alcanzando entre un 40% y más del 60% de la población a partir de los 70/75 años. Las mujeres tienen una prevalencia mayor que los hombres, con un aumento más pronunciado en edades más avanzadas. Conclusiones: No existe una forma estandarizada de medir la prevalencia de catarata, lo que dificulta la comparación entre los estudios. La prevalencia de catarata fue mayor en los grupos de mayor edad y entre las mujeres, en especial en edades mayores. La creciente prevalencia asociada a la edad muestra el aumento de la carga poblacional de las cataratas asociada al envejecimiento de la población. Abstract in english Objective: The prevalence of cataracts has increased due to the progressive ageing of the population and the fact that cataracts affect a wide and increasing proportion of the population. The goal of the present study was to describe the prevalence of cataracts through a systematic and exhaustive review of population-based studies. Methods: A systematic review of population-based studies of the prevalence and incidence of cataracts was performed. Inclusion criteria were: (more) a healthy non- institutionalised population, older than 40 years of age, of white race, with a sample size of greater than 1,000 and published between 1980 and 2002. Results: Ten studies met the inclusion criteria (3 European, 5 from the United States and 2 from Australia), and were performed between 1984 and 2001. The cataract prevalence, according to lens opacity criteria, ranged between 15% and 19%. When the cataract was defined as a lens opacity combined with a decreased visual acuity, the prevalence ranged from 15% to 30%. The overall prevalence increased with age, reaching 40% and more than 60% in populations older than 70 and 75 years respectively. The prevalence among women was higher than that among men, with a more marked increase being evident at older ages than for men. Conclusions: There were variations among the criteria used to measure the prevalence of cataract, which made it difficult to compare all the studies. Overall the prevalence was higher in the older population, especially among women. The increasing prevalence associated with age predicts an increasing burden of cataract to health services, this being particularly related to the ageing of the population.

Robotic surgery is an emerging technology that is conquering the surgery field by storm. It has found solid applications in general surgery, gynecological surgery, vascular surgery, and especially in urology and cardiothoracic surgery. Its application is however restricted in the various fields of plastic surgery. There is no doubt that robots have a potential to become an important toll in reconstructive plastic surgery, but the extent of their use in aesthetic surgery is constrained. A review of the literature showed that several centers are currently using surgical robots for reconstructive and microsurgery. Robotic surgery is feasible and technically advantageous, though very costly. There is a paucity of data however concerning the long-term benefits of robotics versus conventional te...

Abstract in portuguese Objetivo: Avaliar as alterações da microbiota conjuntival e palpebral após o uso tópico de colírios de lomefloxacina ou tobramicina a 0,3% no preparo de pacientes a serem submetidos à cirurgia de catarata e cirurgia refrativa e avaliar a sensibilidade das bactérias isoladas da conjuntiva e pálpebra a estes antibióticos. Métodos: Realizou-se um estudo prospectivo de análise da microbiota conjuntival e palpebral de pacientes submetidos à cirurgia de catarata e c (more) irurgia refrativa (PRK ou LASIK). O estudo da microbiota conjuntival e palpebral foi realizado antes das cirurgias, sem uso de agentes para profilaxia, no período pós-operatório durante o uso de profilaxia, e após a suspensão dos antibióticos. Resultados: O uso tópico de tobramicina e lomefloxacina reduziu o número de colheitas positivas na conjuntiva e pálpebra nos indivíduos submetidos à cirurgia de catarata e cirurgia refrativa. Em ambos os grupos de pacientes ocorreu maior resistência dos microrganismos à tobramicina. No grupo submetido à cirurgia de catarata, pacientes tratados profilaticamente com tobramicina tiveram uma recuperação da microbiota mais lenta após a suspensão do antibiótico do que com a lomefloxacina, ocorrendo o oposto no grupo submetido à cirurgia refrativa. Conclusão: Tanto a lomefloxacina quanto a tobramicina foram eficazes em diminuir o número de culturas positivas da conjuntiva e da pálpebra enquanto estavam sendo administrados, sendo esta diminuição mais acentuada na conjuntiva. Houve maior resistência à tobramicina na maioria das colheitas realizadas. A lomefloxacina apresentou número menor de bactérias resistentes do que a tobramicina durante o uso da antibioticoterapia tópica profilática. O uso de antibiótico reduziu o número de amostras positivas. Abstract in english Purpose: To determine the changes in the conjunctival and palpebral flora after topical use of 0.3% lomefloxacin and 0.3% tobramycin eye drops in the preoperative management of patients submitted to cataract and refractive surgery and to assess the chemosensitivity of bacterial isolates from the conjunctiva and eyelid to these antibiotics. Methods: A prospective study of the conjunctival and palpebral flora of patients submitted to cataract or to refractive (PRK or LASIK) (more) surgery was performed. An analysis of the conjunctival and palpebral flora was carried out in patients before surgery without prophylaxis, after surgery during the use of prophylaxis (0.3% lomefloxacin or 0.3% tobramycin qid) and after discontinuation of the antibiotic. Results: Tobramycin and lomefloxacin reduced the number of positive cultures in specimens from the conjunctiva and eyelid of individuals submitted to cataract and refractive surgery. In both groups, isolated microorganisms displayed a greater resistance to tobramycin. In the group submitted to cataract surgery, patients treated with prophylactic tobramycin showed a slower recovery of the flora after discontinuation of the antibiotic than those treated with lomefloxacin, with the opposite occurring in the group submitted to refractive surgery. Conclusion: Both lomefloxacin and tobramycin were effective in reducing conjunctival and palpebral flora during drug administration. This reduction was more marked in the conjunctiva. Among the various bacterial isolates, there was a greater resistance to tobramycin than to lomefloxacin. The use of antibiotics reduced the incidence of positive cultures more for the conjunctiva than the eyelids.

Abstract in portuguese OBJETIVO: Identificar percepções de adultos portadores de catarata em relação à doença e ao tratamento cirúrgico. MATERIAIS E MÉTODOS: Foi realizada uma pesquisa exploratória entre pacientes adultos portadores de catarata presentes em mutirão em hospital universitário no ano de 2004. Auxiliares de pesquisa previamente treinados para formulação das questões e registros das respostas, encarregaram-se das entrevistas. RESULTADOS: A amostra foi composta por 170 (more) sujeitos de ambos os sexos (43,5% do sexo masculino e 56,5% do sexo feminino) com idade entre 40 e 88 anos. Dos 170 participantes, 43,5% eram nascidos no estado de São Paulo, 14,7% na Bahia, 12,4% em Minas Gerais, 1,8% nasceram em outros paises e os demais sujeitos, em outros estados brasileiros.Da população ativa no mercado de trabalho (n=87), encontravam-se em nível de ocupação manual não especializada 43,7%; ocupação manual especializada 27,6%; ocupação de rotina não manual 25,3%; supervisão de trabalho manual 1,1%; posição baixa de supervisão ou inspeção , considerando ocupações não manuais,2,3 %. Entre a população inativa no mercado de trabalho (n=82), 53,6% eram aposentados, 45,2% donas de casa e 1,2% desempregados. Em relação a concepção sobre catarata, 79,0% referiram ser uma "pelezinha que vai cobrindo os olhos" e 32,4% além da "pelezinha", mencionaram outras concepções. Em relação a causa , entre as opções fornecidas, 80% relacionam a velhice; 47,1% "por usar muito as vistas no serviço ou em casa"; 7,1% acreditam que tem catarata devido a "mau olhado". Dentre as respostas associadas, 94,1% referiram que a "visão fica embaçada" na pessoa que tem catarata, 72,4% acham que a pessoa pode ficar cega e 66,5% acham que os portadores de catarata ficam com depressão por não enxergarem. Vinte e oito por cento tem medo de se submeter a cirurgia, desses, 16,3% atribuem ao fato de poderem morrer na cirurgia; 55,1% acham que podem ficar cego; 40,8% crêem que a cirurgia dói e 8,2% tem medo de operar pois a religião não permite. CONCLUSÃO: Foram evidenciados alguns conhecimentos incorretos, o medo de ficar cego se fez presente entre as razões para não operar a catarata, indicando necessidade de provimento de orientação. Abstract in english OBJECTIVE: To identify in adult patients suffering from cataract the perceptions regarding the disease and its surgical treatment. MATERIALS AND METHODS: An exploratory survey was conducted among adult patients suffering from cataract and participating in a large-scale cataract management program at the University of São Paulo General Hospital in 2004. The interviews were conducted by research assistants previously trained to pose questions and record answers. RESULTS: T (more) he sample consisted of 170 men and women (43.5% and 56.5%, respectively), aged between 40 and 88 years. Of the 170 participants, 43.5% were from the State of São Paulo, 14.7% from the State of Bahia, 12.4% from the State of Minas Gerais, 5.9% from the State of Pernambuco, 1.8% from other countries, and the remaining 21.7% were from other Brazilian states. Of those who were actively working (n = 87), 43.7% had an occupational level corresponding to nonspecialized manual labor, 27.6% were in specialized manual labor jobs, 25.3% had routine nonmanual occupations, 1.1% supervised manual labor, and 2.3% had low-ranking supervision or inspection jobs over nonmanual occupations. Of those who were not actively working (n = 82), 53.6% were retired, 45.2% were housewives, and 1.2% were unemployed. Concerning conceptions about cataract, 79.0% referred to it as "a small skin fold that gradually covers the eye" and 32.4% mentioned, in addition, other conceptions. Concerning the cause, of the alternatives presented to them, 80% reported aging, 47.1% blamed "overusing the eyes in the workplace or at home", 7.1% believed they had cataract due to some kind of "spell." Of the associated answers, 94.1% referred to "blurred vision" in people suffering from cataract, 72.4% thought the person may become blind, and 66.5% believed that the patients suffering from cataract are depressed because they cannot see. Regarding surgery, 28.8% were afraid of undergoing surgery; of those, 16.3% cited with the fear of dying during surgery, 55.1% thought they might become blind, 40.8% believed the surgery would be painful, and 8.2% followed religious practices that do not permit surgery. CONCLUSION: Some misconceptions were identified, and the fear of blindness was the most mentioned reason for not seeking cataract surgery, which indicates the need for orientation.

Abstract in spanish Objetivo: Comparar la eficacia y los efectos secundarios de la rimexolona 1% y de la dexametasona 0,1% en el tratamiento postoperatorio de la cirugía de catarata. Material y métodos: Estudio de cohortes prospectivo en el que se ha seleccionado una muestra de 37 pacientes intervenidos de cataratas mediante facoemulsificación, sin complicaciones intraoperatorias, en el Hospital Clínico San Carlos, y se han dividido en dos grupos. El grupo DEX, de 19 pacientes se trato c (more) on dexametasona al 0,1% tópica como tratamiento antiinflamatorio y el grupo RIMEX, de 18 pacientes se trató con rimexolona 1% tópica siguiendo la misma pauta en ambos casos. En todos los pacientes se han estudiado la agudeza visual, la hiperemia conjuntival, las células en cámara anterior, el flare, la presión intraocular, el grosor corneal y la presencia de edema macular a las 24 horas y al mes de la cirugía. Resultados: Al comparar ambos fármacos mediante el test de medidas repetidas a las 24 horas y al mes de la cirugía se obtuvieron diferencias estadísticamente significativas en el tyndall (p = 0,001) y en el flare (p= 0,034), siendo la reducción de éstos parámetros mayor en el grupo dexametasona, mientras que no se observaron cambios significativos en el resto de los parámetros evaluados. Conclusiones: La Rimexolona ha resultado ser un fármaco útil y seguro, al igual que la dexametasona, como tratamiento postoperatorio de la cirugía de catarata. Abstract in english Purpose: To compare the efficiency and secondary effects of using 1% rimexolone or 0.1% dexamethasone as postoperative treatment for cataract surgery. Materials and methods: A prospective study performed on a cohort of 37 patients undergoing cataract surgery by phacoemulsification with no intraoperative complications at the Hospital Clínico San Carlos, Madrid. After surgery, 19 of the patients were randomly assigned to receive topical 0.1% dexamethasone (DEX group) as in (more) flammatory treatment and the remaining 18 subjects were treated with 1% rimexolone ( RIMEX group) following the same regime. Twenty four hours and one month after surgery, visual acuity, conjunctival hyperaemia, anterior chamber cells, anterior chamber flare, intraocular pressure, corneal thickness and macular edema were determined in each patient. Results: The repeated measures test performed on 24 hours and 1 month data revealed a significant difference between the two treatments in terms of Tyndall (p = 0.001) and flare (p= 0.034) values; these variables being lower in the dexamethasone group. No differences were observed in the remaining variables examined. Conclusions: Rimexolone is as efficient and safe as dexamethasone for the treatment of patients undergoing cataract extraction.

Abstract in portuguese OBJETIVO: O tipo de ambliopia mais grave é o de privação, deste a causa mais comum é a catarata congênita. O objetivo deste estudo foi avaliar a função visual binocular de crianças operadas de julho de 2006 a junho de 2008 por cataratas da infância (congênita ou infantil). MÉTODOS: Todas as crianças possuíam idade acima de 4 anos, operadas em idade tardia. Foram avaliadas 6 crianças e realizados testes de acuidade visual, motilidade ocular extrínseca, teste (more) s de Titmus e Luzes de Worth (perto e longe). RESULTADOS: A média da idade do diagnóstico da catarata foi de 5,58 anos e o da primeira cirurgia de 8,83 anos. Cinquenta e 67% das crianças alcançaram acuidade visual pós-operatória maior que 0,4 em olhos direito e esquerdo, respectivamente. Apenas uma criança não apresentou estereopsia e fusão aos testes de função sensorial. Todas as demais apresentaram fusão às luzes de Worth. No teste de Titmus, 2(33,3%) apresentaram estereopsia grosseira e 3(50%) boa ou ótima. Houve diferença estatísticamente significante (p=0,043) entre as acuidades visuais pré e pós- operatórias entre os olhos. CONCLUSÃO: Assim, neste estudo as crianças portadoras de catarata congênita ou infantil precoce de desenvolvimento lento e de catarata infantil tardia, apresentaram bom prognóstico visual após cirurgia com implante de lente intraocular no mesmo tempo cirúrgico, mesmo em idade avançada. Abstract in english OBJECTIVE: The privation ambliopia is the worst type of all. Among these, the most common cause is congenital cataract.The purpose of this study is to evaluate the visual function of children who had surgery between July 2006 and June 2008 for pediatric cataract. METHODS: All children were above 4 years old and had surgery at advanced age.We evaluated 6 children and submitted them to visual acuity, extrinsic ocular movement,Titmus and Worth lights tests. RESULTS: The mean (more) age at the time of diagnosis was 5,58 years old and at the first surgery was 8,83 years old. Fifty and 67% of children achieved post operative visual acuity above 0,4 in right and left eyes, respectively. Just one (16,7%) child did not achieve stereopsy and fusion on the sensorial function tests.The others presented fusion on Worth light test. At Titmus test, 2(33,3%) showed gross stereopsy and 3(50%) good. There was statistically significant difference between pre and post visual acuity. CONCLUSION: Therefore, in this study, children with congenital or pediatric cataract whith late development showed a good visual prognosis after surgery using intraocular implans lens, even at advanced age.

Abstract in portuguese OBJETIVO: Avaliar a relação da acuidade visual (AV) obtida pelo "potential acuity meter" (PAM) no pré-operatório de cirurgia de catarata com a acuidade visual obtida no pós-operatório, bem como, sua correlação com a classificação morfológica dominante da catarata. MÉTODOS: Trata-se de um estudo prospectivo realizado no setor de Catarata do Centro de Estudos do Hospital Monumento envolvendo 63 olhos de 45 pacientes avaliados de julho a setembro de 2006, submeti (more) dos à cirurgia de catarata sob a técnica de facoemulsificação com implante de lente intra-ocular, sendo posteriormente excluído 1 olho. No período pré-operatório, foi realizado o PAM sob midríase e seu resultado foi comparado à melhor acuidade visual pós-operatória do terceiro mês e correlacionado com a classificação morfológica da catarata, sendo denominado satisfatório aquele resultado que não variou mais do que duas linhas na tabela de Snellen. RESULTADOS: A média de idade foi de 45,3 anos com média da acuidade visual obtida pelo PAM de 0,64 logMAR. No terceiro mês pós-operatório, a média da melhor acuidade visual corrigida (MAVC) foi de 0,09 logMAR. O PAM hiperestimou o resultado da MAVC em 8 olhos (13%), hipoestimou em 41 olhos (66%) e nos 13 olhos restantes (21%), as acuidades foram idênticas. Este apresentou uma fidelidade inversamente proporcional à intensidade de opacidade do cristalino no caso da catarata nuclear (1+ com 75,5% e 4+ com 33,3%), entretanto esta acurácia foi maior nos casos de subcapsular posterior (85,7%). CONCLUSÃO: O PAM hipoestimou ou manteve da acuidade visual na maioria dos casos (87%). Apresentou uma fidelidade inversamente proporcional à intensidade de opacidade do cristalino no caso da catarata nuclear, 1+ com 75,5% e 4+ com 33,3%; entretanto esta acurácia foi maior nos casos de subcapsular posterior (85,7%). Abstract in english PURPOSE: To evaluate the correlation between the preoperative visual acuity (VA) obtained by the potential acuity meter (PAM) and the postoperative VA in a patient submitted to cataract surgery, as well as its correlation with the dominant morphologic classification of the cataract. METHODS: This is a prospective study performed at the Hospital Monumento Study Center. Sixty-three eyes of 45 patients submitted to phacoemulsification with intraocular lens implantation were (more) enrolled in this study and 1 eye had been excluded. Besides the complete examination in the preoperative period, PAM was used and its results were compared with the VA at the third postoperative month and correlated with the dominant morphologic cataract classification. The result was called satisfactory when the variation was equal to or less than two lines at the Snellen chart. We transformed the AV into logMAR for comparison with the literature. RESULTS: The mean age was 45.3 years with a mean VA of 0.64 logMAR by the PAM. At the third postoperative month, the mean best corrected visual acuity (BCVA) was 0.09 logMAR. The PAM overestimated the BCVA in 8 eyes (13%), underestimated it in 41 eyes (66%) and in 13 eyes (21%) the BCVA were the same. The satisfactory results regarding nuclear cataract were reduced in cases of higher density (1+/4 with 75.5% e 4+/4 with 33.3%) and increased in the posterior subcapsular cataracts (85.7%). CONCLUSION: PAM revealed an underestimation or maintenance of the BCVA in most cases (87%). Its fidelity was inversely proportional in the nuclear cataracts (1+/4 with 75.5% e 4+/4 with 33.3%) and higher in the posterior subcapsular cataracts.

Introduction Laparoscopic techniques have induced a tremendous revolution in the field of general surgery. Recent multicenter trials have demonstrated similar patient-oriented and oncologic outcomes for laparoscopic colon and rectal resections compared with their open counterparts. Meanwhile, robotic technology has gradually entered the field of general surgery, allowing increased dexterity, improved operative view, and optimal ergonomics. The objective of this study was to review the current status of clinical robotic applications in colorectal surgery. Methods A systematic review of the literature using the PubMed search engine was undertaken to identify relevant articles. The keywords used in all possible combinations were: surgical robotics, robotic surgery, computer-assisted surgery, ...

Abstract in portuguese OBJETIVO: Determinar a prevalência e causas de deficiência visual, cegueira além dos resultados de cirurgia de catarata numa população idosa de baixa renda de São Miguel Paulista, distrito da cidade de São Paulo. MÉTODOS: Estudo observacional no qual a acuidade visual apresentada e com a melhor correção óptica foi medida em 801 indivíduos com 60 anos ou mais anos, bem como realizado exame oftalmológico. Definição de cegueira e deficiência visual seguiu est (more) udos prévios realizados no Nepal, China e Índia. RESULTADOS: As prevalências de acuidade visual apresentada e com a melhor correção óptica pior do que 20/400 em ambos os olhos foram 1,38% (intervalo de confiança de 95%: 0,69% - 2,45%) e 1,25% (intervalo de confiança de 95%: 0,60% - 2,29%). As de deficiência visual considerando a acuidade visual apresentada e com a melhor correção óptica foram, respectivamente, 24,16% (intervalo de confiança de 95%: 21,22% - 27,28%) e 12,77% (intervalo de confiança de 95%: 10,53% - 15,28%). Catarata foi a principal causa de cegueira (30,00%) e deficiência visual (54,90%). Cirurgia prévia de catarata foi realizada em 54 participantes (6,74%) e 35,12% mostraram acuidade visual com a melhor correção óptica melhor do que 20/60 em ambos os olhos. Houve considerável diminuição nas prevalências de deficiência visual e cegueira após a correção óptica. CONCLUSÃO: Catarata foi a principal causa de cegueira. Os resultados visuais ruins nos olhos operados reforçam a necessidade de serviços de boa qualidade e de seguimento pós-operatório cuidadoso. Abstract in english PURPOSE: To determine prevalence and causes of visual impairment, blindness, ocular disorders and cataract surgery outcomes in a low-income elderly population from a metropolitan area in the city of São Paulo, Brazil. METHODS: Observational study where 801 individuals of 60 years and older underwent presented and best corrected visual acuity measurements as well as ophthalmologic examination. Definition of blindness and visual impairment followed studies conducted in Nep (more) al, China and India. RESULTS: The prevalence of presented and best-corrected visual acuity worse than 20/400 in both eyes was 1.38% (95% CI: 0.69% - 2.45%) and 1.25% (95% CI: 0.60% - 2.29%). Prevalence of visual impairment considering presented and best-corrected visual acuity was, respectively, 24.16% (95% CI: 21.22% - 27.28%) and 12.77% (95% CI: 10.53% - 15.28%). Cataract was the main cause of blindness (30.00%) and visual impairment (54.90%). A total of 54 participants (6.74%) had previous cataract surgery and, with best-corrected visual acuity, 35.12% showed visual acuity better than 20/60 in both eyes. Rates of visual impairment and blindness in this low-income elderly population were high. There was a considerable decrease in prevalence after optical correction emphasizing the importance of uncorrected refractive errors. CONCLUSION: Cataract was the main cause of blindness; poor visual outcomes in eyes previously operated for cataract reinforce the need to seek good quality cataract services and to provide careful postoperative follow-up.

This review covers the important publications in adult cardiac surgery in the last few years, including the current evidence base for surgical revascularisation and the use of off-pump surgery, bilateral internal mammary arteries and endoscopic vein harvesting. The changes in conventional aortic valve surgery are described alongside the outcomes of clinical trials and registries for transcatheter aortic valve implantation, and the introduction of less invasive and novel approaches of conventional aortic valve replacement surgery. Surgery for mitral valve disease is also considered, with particular reference to surgery for asymptomatic degenerative mitral regurgitation. PMID:22965796

Purpose To present our treatment experience in delayed orbitozygomatic fracture with enophthalmos and compare the results of traditional surgery, navigation-guided surgery, and 3-dimensional (3D) model–guided surgery in the Departments of Oral and Maxillofacial Surgery and Ophthalmology, Shanghai Ninth People's Hospital, Shanghai, China. Patients and Methods This is a retrospective review of a consecutive clinical case series. From 2008 to 2010, 64 patients diagnosed with delayed orbitozygomatic fractures with enophthalmos were treated in the departments. Computed tomography (CT) scan and ophthalmologic examination were performed before surgery. Traditional surgery and computer-assisted treatment (navigation and 3D model) were used for zygoma reduction. Three materials were applied ...

Abstract in portuguese OBJETIVOS: Estudar in vitro a eficácia de um par de instrumentos na divisão de núcleos extraídos por meio da técnica extracapsular. MÉTODOS: A amostra foi constituída de 47 núcleos obtidos de facectomias extracapsulares. Foram classificados em maduros (4+) e imaturos (1 a 3 +), de pacientes com acuidade visual variando de 20/60 à percepção luminosa. Um par de instrumentos, desenvolvido por um dos autores, foi utilizado para fragmentação. Para tal, foi idealiz (more) ado suporte constituído de gel e metilcelulose sobrejacente. RESULTADOS: A média de idade foi de 67,38 anos sendo que a maior parte dos pacientes (66%) possuía acuidade visual inferior a 20/400. Um percentual de 42,6% das cataratas eram maduras. A fixação e segmentação foram fáceis em 95,7% e 91,5% dos núcleos, respectivamente. CONCLUSÃO: O par de instrumentos idealizados é eficaz em executar a fixação e segmentação dos núcleos. Abstract in english PURPOSE: To study in vitro the efficacy of a pair of instruments designed to capture and split human nuclei obtained from extracapsular surgeries. METHODS: The sample is a compound of 47 cataract nuclei. They were classified as mature (4+) and immature (1 to 3+), and the visual acuity ranged from 20/60 to light perception. The instruments were used to split the nuclei. A methylcellulose over a gel base was made for this purpose. RESULTS: The average age was 67,38 years. M (more) ost patients (66%), had a visual acuity less than 20/400. 42,6% of the cataracts were mature. The capturing and splitting was easily done in over 90% of the nuclei. CONCLUSIONS: The designed instruments are effective to capture and split cataract nuclei.

Objective To determine the trends of conjunctival sac bacterial flora isolated from patients prior to cataract surgery. Subjects and methods The study comprised 579 patients (579 eyes) who underwent cataract surgery. Specimens were collected by lightly rubbing the inferior palpebral conjunctival sac with a sterile cotton swab 2 weeks before surgery, and then cultured for isolation of bacteria and antimicrobial sensitivity testing. The bacterial isolates and percentage of drug-resistant isolates were compared among age groups and according to whether or not patients had diabetes mellitus, hyperlipidemia, dialysis therapy, oral steroid use, dry eye syndrome, or allergic conjunctivitis. Results The bacterial isolation rate was 39.2%. There were 191 strains of Gram-positive cocci, accounting for the majority of all isolates (67.0%), among which methicillin-sensitive coagulase-negative staphylococci was the most frequent (127 strains, 44.5%), followed by methicillin-resistant coagulase-negative staphylococci (37 strains, 12.7%). All 76 Gram-positive bacillary isolates (26.7%) were from the genus Corynebacterium. Among the 16 Gram-negative bacillary isolates (5.9%), the most frequent was Escherichia coli (1.0%). The bacterial isolation rate was higher in patients >60 years old, and was lower in patients with dry eye syndrome, patients under topical treatment for other ocular disorders, and patients with hyperlipidemia. There was no significant difference in bacterial isolation rate with respect to the presence/absence of diabetes mellitus, steroid therapy, dialysis, or a history of allergic conjunctivitis. Methicillin-resistant coagulase-negative staphylococci showed a significantly higher detection rate in diabetic patients than nondiabetic patients (20.3% versus 7.0%, P bacterial isolation rate in patients >60 years old and the high methicillin-resistant coagulase-negative staphylococci isolation rate in patients with diabetes are important to consider for prevention of perioperative infections. PMID:18721704

The phenotypically heterogeneous, autosomal recessive Vici syndrome was first described in 1988 in a sister and brother with oculocutaneous albinism, agenesis of the corpus callosum, cataract, cardiomyopathy, cleft lip, and immunodeficiency. Only 14 cases of Vici syndrome have yet been reported, several involving morphologic and functional defects in addition to those described in the initial case. We report on a 3-month-old Turkish girl with Vici syndrome associated with laryngomalacia, further expanding the clinical spectrum. We also review clinical features in all 15 Vici syndrome patients, to distinguish general from less common signs. To the best of our knowledge, this report is the first of a Turkish patient with Vici syndrome.

Clinical manifestations of ocular toxoplasmosis are reviewed. Findings of congenital and acute acquired ocular toxoplasmosis include retinal scars, white-appearing lesions in the active phase often associated with vitritis. Complications can include fibrous bands, secondary serous or rhegmatogenous retinal detachments, optic neuritis and neuropathy, cataracts, increased intraocular pressure during active infection, and choroidal neovascular membranes. Recurrences in untreated congenital toxoplasmosis occur in teenage years. Manifestations at birth are less severe, and recurrences are fewer in those who were treated promptly early in the course of their disease in utero and in the first year of life. Severe retinal involvement is common at diagnosis of symptomatic congenital toxoplasmosis i...

Abstract in english Carotenoids are natural dyes synthesized by plants, algae and microorganisms. Application in many sectors can be found, as food dyeing and supplementation, pharmaceuticals, cosmetics and animal feed. Recent investigations have shown their ability to reduce the risks for many degenerative diseases like cancer, heart diseases, cataract and macular degeneration. An advantage of microbial carotenoids is the fact that the cultivation in controlled conditions is not dependent o (more) f climate, season or soil composition. In this review the advances in bio-production of carotenoids are presented, discussing the main factors that influence the microbial production of these dyes in different systems.

Werner syndrome (WS) ("Progeria of the adult"; entry *27770 (1)) was originally defined by Dr. Otto Werner in 1904 on the basis of "scleroderma-like" thin, tight skin and bilateral cataracts in a sibship (2). Among the many systemic clinical features of WS, the various progeroid features have drawn special attention. WS is caused by a mutation at the Werner syndrome gene (WRN) locus, which belongs to the family of RecQ helicases (GenBank accession number L76937)(3). This review focuses on the comparative aspects of WRN, including differential gene action within humans and the potential differences between species, particularly the mouse and human. PMID:10757074

Abstract in spanish La cirugía de catarata ha llegado a un nivel de perfección que no existen barreras para no realizar una facoemulsificación. Nuestra principal motivación para la realización de este trabajo, es estudiar los resultados en casos especiales y su comportamiento en nuestro medio. Los casos especiales comprenden severa miopía e hipermetropía, poscirugía refractiva, pupila pequeña, uveítis, catarata congénita, catarata subluxada, trauma, catarata hipermadura, catarata (more) combinada con vitrectomía, queratoplastia penetrante y glaucoma. En todos estos casos las técnicas de facoemulsificación se han perfeccionado y se han introducido instrumentos accesorios que contribuyen al éxito quirúrgico y a disminuir al mínimo las complicaciones derivadas de la cirugía en ojos, que son potencialmente complicados para el preoperatorio. Entre las causas más frecuentes de pupila pequeña incluyen, agentes miótico usados de forma crónica, síndrome exfoliativo, síndrome de Horner, secundarias a traumas e inflamaciones .Se realizó un estudio descriptivo, prospectivo de corte trasversal, cuyo universo estuvo constituido por 39 pacientes (ojos) del Centro de Microcirugía Ocular (CMO) del Instituto Cubano de Oftalmología “Ramón Pando Ferrer” seleccionados mediante un muestreo simple aleatorio, cuya edad promedio fue de 61 años. La mayoría de los pacientes presentaron dureza del cristalino altos y tiempo promedio de ultrasonido bajos. La agudeza visual preoperatoria y posoperatoria promedio con corrección mejoró significativamente en cuatro líneas de la cartilla de Snellen. El astigmatismo inducido por la cirugía fue bajo. Finalmente se analizaron las complicaciones y se detallaron los accidentes que ocurrieron durante el acto quirúrgico, y se observó que la ruptura de cápsula posterior y la salida de vítreo fueron los eventos los más frecuentes Abstract in english Cataract surgery has come to an improvement level that today there are no barriers to phacoemulsification. Our main reason for this paper is to study the results achieved in special cases and their performance in our context. The special cases cover severe myopia and hypermetrophy, refractive postsurgery, small pupilla, uveitis, congenital cataract, subluxed cataract, trauma, hypermature cataract, vitrectomy-combined cataract, penetrating keratoplasty and glaucoma. In all (more) these cases, phacoemulsification techniques has been upgraded and auxiliary instruments have been introduced to contribute to surgical success and to reduce to minimum eye surgery complications that are potentially complex in the preoperative phase. Among the most frequent causes of small pupillae are the occurence of miotic agents, exfoliative syndrome, Horner´s syndrome secondary to trauma and inflammation. A prospective cross-sectional descriptive study was undertaken in a universe of 39 patients (eyes) seen at the Ocular Microsurgery Center of “Ramón Pando Ferrer” Cuban Institute of Ophthalmology. They had been selected through a simple randomized sampling and their average age was 61 years. The majority of patients presented with hard crystalline lens and low average time of ultrasound application. Average preoperative and postoperative visual acuity with correction significantly improved by 4 lines of Snellen´s chart. Surgically-induced astigmatism was low. Finally, the complications were analyzed, the accidents occured during surgery were detailed and the rupture of posterior capsula and vitreous detachment were the most frequent events found

Abstract in spanish El perfeccionamiento y aplicación de una industria destinada a modernizar las lentes intraoculares y el instrumental quirúrgico ha impulsado un conjunto de adelantos que han permitido optimizar, corregir y refinar las técnicas quirúrgicas para la cirugía de la catarata y en especial la facoemulsificación. El punto más importante en esta cadena de adelantos está enmarcado y encaminado a disminuir el tamaño de la incisión quirúrgica que permita solucionar un núm (more) ero importante de complicaciones que con relativa frecuencia se presentan con la aplicación de las técnicas quirúrgicas convencionales extracapsular e intracapsular con incisiones mayores a los 10 mm. Actualmente se han desarrollado técnicas quirúrgicas conocidas como cirugía de la catarata por microincisiones .Se realizó un estudio descriptivo y retrospectivo, cuyo universo estuvo constituido por 27 pacientes (ojos) con diagnóstico de catarata presenil y senil, que recibieron tratamiento quirúrgico con la técnica de facoemulsificación por microinsiciones e implante de lente intraocular de cámara posterior de una pieza, plegable de acrílico, de un tamaño de 11 x 6 mm de óptica, modelo Acri. Smart 46 S con inyector, en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología “Ramón Pando Ferrer”, en el período comprendido desde enero 2004 hasta enero 2005. Se encontró que la mayoría de los casos tenían más de 50 años, se alcanzó una recuperación significativa de la mejor agudeza visual corregida en el posoperatorio, el astigmatismo inducido fue bajo. En cuanto a los parámetros facodinámicos utilizados, el poder de ultrasonido fue como promedio bajo. Las complicaciones presentadas fueron pocas, salida de vítreo secundaria a rotura de la cápsula posterior ocurrió más frecuentemente. Se concluye que la técnica quirúrgica MICS con implante de lente Acri.Smart 46 S constituye una opción válida, segura y eficaz en el tratamiento de la catarata, también permitiría desarrollar en el futuro materiales y tecnologías que abrirían nuevos caminos para la cirugía oftalmológica, y la aplicación de parámetros facodinámicos óptimos conllevaría a un bajo porcentaje de complicaciones. Abstract in english Improvement and application of an industry devoted to modernize intraocular lenses and surgical tools have prompted a set of advances that allow optimizing, correcting and refining the surgical techniques for cataract surgery, particularly phacoemulsification. The most important aspect in this chain of advacements is aimed at reducing the surgical incision size in order to avoid a significant number of complications that are relatively frequent when using conventional ext (more) racapsular and intracapsular surgeries with over 10mm incisions. At present, new surgical techniques such as microincision cataract surgery have been developed. A retrospective and descriptive study was performed in 27 patients (eyes) diagnosed with pre-senile and senile cataract, who were surgically treated with microincision phacoemulsification and received the implant of an ACRi Smart 46.S 11 x 6mm acrylic intraocular lens in the posterior chamber at the Ocular Microsurgery Center of “Ramón Pando Ferrer” Ophthalmology Institute in the period from January 2004 to January 2005. It was found that most of cases were older than 50 years; the best corrected visual acuity recovered significantly in the postoperative period and induced astigmatism was low. Regarding the used phacodynamic parameters, the ultrasound power was generally low. There were few complications, being vitreous detachment secondary to break in the posterior capsule. It was concluded that microincision cataract surgery with Acri Smart 46 S lens implant is a valid, safe and effective choice of catract treatment that will allow developing in the future materials and technologies which would open up new paths for eye surgery, and also the use of optimal phacodynamic parameters would lead to a low number of complications.

A new fiber optic probe developed for determining transport properties of sub-micron particles in fluid experiments in a microgravity environment has been applied to study different parts of an eye. The probe positioned in front of an eye, delivers a low power (approximately few microW) light from a laser diode into the eye and guides the light which is back scattered by different components (aqueous humor, lens, and vitreous humor) of the eye through a receiving optical fiber to a photo detector. The probe provides rapid determination of macromolecular diffusivities and their respective size distributions in the eye lens and the gel-like materials in the vitreous humor. In a clinical setting, the probe can be mounted on a standard slit-lamp apparatus simply using a Hruby lens holder. The capability of detecting cataracts, both nuclear and cortical, in their early stages of formation, in a non invasive and quantitative fashion, has the potential in patient monitoring and in developing and testing new drugs or diet therapies to 'dissolve' or slow down the cataract formation before the surgery becomes necessary. The ability to detect biochemical and macromolecular changes in the vitreous structure can be very useful in identifying certain diseases of the posterior chamber and their complications, e.g., posterior vitreous detachment and diabetic retinopathy.

A new fiber optic probe development for determining transport properties of sub-micron particles in fluids experiments in a microgravity environment has been applied to study different parts of the eye. The probe positioned in front of an eye, delivers a low power (approximately a few mu W) light from a laser diode into the eye and guides the light which is back scattered by different components (aqueous humor, lens, and vitreous humor) of the eye through a receiving optical fiber to a photo detector. The probe provides rapid determination of macromolecular diffusivities and their respective size distributions in the eye lens and the gel-like material in the vitreous humor. For a clinical use, the probe is mounted on a standard slit-lamp apparatus simply using Hruby lens holder. The capability of detecting cataracts, both nuclear and cortical, in their early stages of formation, in a non invasive and quantitative fashion, has the potential in patient monitoring and in developing and testing new drugs or diet therapies to 'dissolve' or slow down the cataract formation before the surgery becomes necessary. The ability to detect biochemical and macromolecular changes in the vitreous structure can be very useful in identifying certain diseases of the posterior chamber and their complications, e.g., posterior vitreous detachment and diabetic retinopathy.

Progressive outer retinal necrosis (PORN) syndrome is a form of the Varicella zoster virus (VZV) chorioretinitis found almost exclusively in people with the acquired immunodeficiency syndrome (AIDS). This destructive infection has an extremely rapid course that may lead to no light perception in affected eyes within days or weeks. Attempts at its treatment have had limited success. Rhegmatogenous retinal detachments often occur after the development of atrophic retinal holes, and silicone oil temponade has been found to be the most successful reattachment procedure. Unfortunately, cataract formation is common after such surgery. PORN needs to be differentiated from acute retinal necrosis (ARN) syndrome, a necrotizing retinitis that can also be caused by VZV. PORN and ARN are found at opposite ends of the spectrum of necrotizing herpetic retinopathies (NHR), where its clinical presentation depends upon immune system status. After a brief case presentation, the distinguishing clinical characteristics of PORN, its differentiation from ARN, attempts at its treatment, the role of the immune system status on its clinical appearance and treatment, and management of complications such as retinal detachment and subsequent cataracts are discussed. PMID:11137426

Phaco chop is a bimanual phacoemulsification technique to remove cataracts. The technique was first presented at the 1993 3rd American-International Congress on Cataract, IOL, and Refractive Surgery in Seattle by Dr Kunihiro Nagahara. He compared the lens with a block of wood and by applying chopping forces parallel to the natural planes of the lens lamellae, as one does in splitting wood, a nucleus can be cleaved with surprisingly little force and time. Dr Nagahara used the phaco tip to impale and high vacuum to hold the nucleus while a second instrument, or chopper, hooked the equator and was pulled centrally, splitting the nucleus along its natural cleavage planes. This was a breakthrough for surgeons who had been utilizing several minutes of phaco energy sculpting grooves and bowls in a lens. Studies have shown that compared with four-quadrant 'divide and conquer', the phaco chop technique uses less phaco time and energy, significantly reducing endothelial cell damage. Other advantages of phaco chop include reduction of zonular and capsular stress because forces are directed toward an opposing instrument and the phaco tip is kept in a central 'safe zone' in the middle of the pupil. This technique has also been successfully adapted to the canine phacoemulsification procedure. The larger canine lens requires some modifications, and lenses with hard nuclear and cortical material may not be amenable to this procedure. PMID:15310295

Same-day, or immediately sequential, bilateral cataract surgery (ISBCS) is being practiced with increasing frequency worldwide. It provides many advantages including convenience for the patient and the patient's family. ISBCS repairs the visual system, not merely one eye, restoring normal binocularity as well as unilateral clarity, creates a much more relaxed surgical atmosphere in harried operating rooms, and saves money for society. It is often preferred by busy professionals. The purported risks of ISBCS have been unsupported by the literature, including bilateral retinal detachment, bilateral corneal decompensation, bilateral diabetic macular edema, bilateral severe cystoid macular edema, significant IOL power errors in the first eye that could be refined and thereby prevented in the second eye, and toxic anterior segment syndrome. The greatest fear of ISBCS has been possible simultaneous bilateral endophthalmitis, which did not occur in a series of nearly 100,000 ISBCS cases and has only occurred elsewhere when complete separation of the two eyes and strict sterile protocol were not followed. The International Society of Bilateral Cataract Surgeons (www.isbcs.org) has prepared the "iSBCS General Principles for Excellence in ISBCS," which should be followed for safe ISBCS. PMID:22995967