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Previous Cataracts Research: 2002-2006   
The Cataracts File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Cataracts, click HERE.
 

Latest Research on Cataracts
     
Br J Ophthalmol. 2008 Aug;92(8):1092-6. Epub 2008 Jun 20.
Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction.
Zeng M, Liu X, Liu Y, Xia Y, Luo L, Yuan Z, Zeng Y, Liu Y.
Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou 510060, People's Republic of China.

AIM: To evaluate the efficacy and safety of phacoemulsification using torsional modality with different parameter settings for hard nucleus cataract extraction. DESIGN: A prospective, randomised clinical study. METHODS: A clinical practice study conducted at the Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, and Guangzhou. One eye each from 198 consecutive patients with cataract density grade IV according to the Emery-Little system classification system, requiring phacoemulsification and intraocular lens implantation, was included. Eyes were randomly assigned to the Linear Torsional combined with Ultrasound power group (Linear Tor+US group, n = 66), 100% Fixed Torsional group (Fixed Tor group, n = 65) and conventional Ultrasound burst group (US group, n = 67). All surgeries were performed by a single experienced surgeon and outcomes evaluated by another surgeon masked to treatment. Intraoperative parameters were Ultrasound Time (UST), Cumulative Dissipated Energy (CDE) and surgical complications. Patients were examined on post-op days 1, 7 and 30. Postoperative outcomes were final best corrected visual acuity (BCVA), average central and incisional corneal thickness and central endothelial cell counts. RESULTS: The mean UST was lower in the Fixed Tor group than in the US group and in the Lin US+Tor group (p<or=0.0001). The mean CDE was lower in the Lin Tor+US group and in the Fixed Tor group than in the US group (p<or=0.0001). Comparing with the two Tor group, the US group had a lower average BCVA on post-op 1, 7 (p<or=0.0001) and 30 (p>0.01), greater average central corneal and incisional thickness on days 1, 7 (p<or=0.0001) and 30 (p>0.01), and higher average corneal endothelial cell losses on day 7 and 30 days (p<or=0.0001). CONCLUSIONS: Torsional combined with ultrasound power or high fixed torsional amplitude can yield more effective hard nucleus phacoemulsification than conventional ultrasound modality.

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Br J Ophthalmol. 2008 Jul;92(7):883-7.
The effect of glasses on visual function following cataract surgery in a cataract camp.
Maki J, Kusakul S, Morley K, Sanguansak T, Seddon J, Hartung L, Morley M.
Harvard Medical School, Boston, MA, USA.

AIM: To investigate visual and functional impact of glasses following cataract surgery in a high-volume cataract camp as measured by the World Health Organization Prevention of Blindness Visual Function Questionnaire (WHO/PBD-VFQ-20). METHOD: Subjects were administered the WHO/PBD-VFQ three times: (1) preoperatively; (2) 3 months postoperatively, before glasses; and (3) 6 months postoperatively, after 3 months with glasses. Patients were given prescription glasses or +2.50 readers at the 3-month follow-up. RESULTS: 315 patients enrolled in the study; 113 patients had complete WHO/PBD-VFQ and visual acuity data from all three administrations. The mean preoperative visual acuity in the surgical eye was 20/327. Following cataract surgery but before glasses, visual acuity improved to 20/57. Total WHO/PBD-VFQ and subscale scores improved significantly at the 3-month point. With glasses, visual acuity improved to 20/43. Total WHO/PBD-VFQ scores did not change following glasses, although the overall and near vision subscales did improve significantly. Glasses were worn once per week or less in 56% of patients. CONCLUSION: Postoperative glasses result in modest improvements in visual acuity. Total WHO/PBD-VFQ scores did not change significantly following glasses, but the overall and near vision subscales did improve. The net beneficial effect of glasses was small relative to cataract surgery itself.

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J Cataract Refract Surg. 2008 Jul;34(7):1145-51.
DisCoVisc versus the soft-shell technique using Viscoat and Provisc in phacoemulsification: randomized clinical trial.
Praveen MR, Koul A, Vasavada AR, Pandita D, Dixit NV, Dahodwala FF.
Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India.

PURPOSE: To compare the effects and outcomes of DisCoVisc (hyaluronic acid 1.6%-chondroitin sulfate 4.0%) with those of the soft-shell technique using Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) and Provisc (sodium hyaluronate 1.0%) in phacoemulsification. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective randomized clinical trial comprised 100 eyes having phacoemulsification by the same surgeon using a standardized technique. Eyes were randomly assigned to DisCoVisc (Group 1) or Viscoat and Provisc (Group 2). Preoperative and postoperative examinations included absolute change in pachymetry, percentage difference in endothelial cell density (ECD) and coefficient of variation (CV), and anterior segment inflammation. RESULTS: The mean postoperative central corneal thickness (CCT) in Group 1 and Group 2 was 590.96+/-46.05 microm and 586.94+/-50.57 microm, respectively, at 1 day; 554.14+/-35.45 microm and 551.65+/-37.69 microm, respectively, at 7 days; and 533.74+/-29.12 microm and 536.44+/-35.59 microm, respectively, at 1 month. The between-group differences in CCT were not statistically significant. At 3 months, the mean ECD was 2427.06+/-243.26 cells/mm2 and 2475.30+/-222.83 cells/mm2, respectively, and the mean CV, 42.38+/-7.94 cells/mm2 and 41.66+/-7.71 cells/mm2, respectively. There was no significant difference in the mean ECD between preoperatively and 3 months postoperatively or in corneal thickness between preoperatively and 1, 7, and 30 days postoperatively. CONCLUSION: A single injection of DisCoVisc was effective, and its postoperative outcomes were comparable to those of combined Viscoat and Provisc.

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J Cataract Refract Surg. 2008 Jul;34(7):1133-5.
Effect of gauge thickness on wound-width measurements in microincision cataract surgery.
Kimura K, Tanaka T, Koshika S, Usui M.
Kosei Chuo Hospital, Meguro, and the Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo, Japan. k-kimura770128@m5.gyao.ne.jp

PURPOSE: To evaluate the effect of gauge thickness on wound-width measurement values in microincision cataract surgery (MICS). SETTING: Kosei Chuo Hospital, Tokyo, Japan. METHODS: For intraocular lens (IOL) implantation, the incision was enlarged with 1 of 2 knives of different widths. Before and after IOL insertion, the wound width was measured with a 0.15 mm thick gauge (F-gauge), which was the same thickness as both types of knife, and a commercially available 0.35 mm thick gauge (A-gauge). RESULTS: In the 2.2 mm incision group, the mean wound width before IOL insertion was 2.20 mm+/-0.03 (SD) measured with the F-gauge and 2.16+/-0.05 mm measured with the A-gauge; the difference was statistically significant (P=.002). The mean wound width after IOL insertion was 2.41+/-0.08 mm using the F-gauge and 2.35+/-0.09 mm using the A-gauge; the difference was statistically significant (P<.0001). In the 2.4 mm incision group, the mean wound width before IOL insertion was 2.39+/-0.04 mm using the F-gauge and 2.31+/-0.06 mm using the A-gauge (P<.0001); the mean wound width after IOL insertion was greater than 2.5 mm in both groups. CONCLUSIONS: In MICS, when the wound-width gauge thickness exceeded the knife thickness, the potential for measurement errors increased. Thus, a similar thickness between the 2 instruments may be preferable.

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Surv Ophthalmol. 2008 Jul-Aug;53(4):359-67.
Cataract surgery and the development or progression of age-related macular degeneration: a systematic review.
Bockelbrink A, Roll S, Ruether K, Rasch A, Greiner W, Willich SN.
Institute for Social Medicine, Epidemiology, and Health Economics, Charité-University Medical Center, Berlin, Germany. angelina.bockelbrink@charite.de

Age-related macular degeneration and cataract are the most frequent eye disorders of elderly people worldwide. The aim of this systematic review was to evaluate the effect of cataract surgery on the development and progression of age-related macular degeneration. Data were collected by means of a systematic literature search in 28 databases and an additional update in Pubmed. Search results were evaluated using pre-defined inclusion and exclusion criteria. All relevant publications were rated in terms of scientific quality and analyzed regarding their results. The literature search generated a total of 2,827 hits. Seven publications on five observational studies and two non-randomized clinical trials were eligible for analysis. The observational studies provided some evidence for an increased incidence of late age-related macular degeneration, respectively, for a promoting influence of cataract surgery on the progression of early types of age-related macular degeneration. The clinical trials did yield inconsistent results. In conclusion, only a small number of published studies investigated the development or progression of age-related macular degeneration following cataract surgery. The scientific level of evidence of these articles was not high and results were inconsistent, nevertheless a promoting influence of cataract surgery on the progression of early age-related macular degeneration can be assumed.

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Acta Ophthalmol. 2008 Jun;86(4):401-3.
Apolipoprotein E genotype and risk for development of cataract and age-related macular degeneration.
Utheim ØA, Ritland JS, Utheim TP, Espeseth T, Lydersen S, Rootwelt H, Semb SO, Elsås T.
Eye Department, Ullevål University Hospital, Oslo, Norway. utyg@uus.no

PURPOSE: To study whether apolipoprotein E (APOE) genotypes are associated with risk for developing cataract and age-related macular degeneration (AMD). METHODS: A sample of 88 healthy adults (50-75 years) genotyped for polymorphisms of APOE underwent an eye examination which included visual acuity (VA) testing, slit-lamp cataract evaluation, optical coherence tomography (OCT) and fundus photography, the last of which was analysed and graded for macular pathology at the Reading Centre, Moorfields Eye Hospital, London. Two-by-two cross tables were analysed using the Fisher-Boschloo unconditional full multinomial test. Two-sample t-tests were used for comparing means of scale variables. RESULTS: Thirty-two participants were diagnosed with cataract or had undergone cataract surgery in one or both eyes, and 56 participants demonstrated no signs of cataract. We found that APOE4 carriers were less likely to have cataract than non-APOE4 carriers (p = 0.039). No correlation between APOE genotypes and morphologic changes in the macular region was revealed. However, APOE3 carriers disclosed significantly higher average macular thickness in both eyes than non-APOE3 carriers (p = 0.012), and APOE3 carriers also had significantly better VA than non-APOE3 carriers (p = 0.041). CONCLUSIONS: We found no association between AMD and APOE polymorphism in a population of 96 individuals aged 50-75 years. A weak negative association between APOE4 and cataract was uncovered in the same population. Apolipoprotein E3 may be a protective factor against the loss of nerve fibres in the macular region.

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Am J Clin Nutr. 2008 Jun;87(6):1899-905.
Antioxidant nutrient intake and the long-term incidence of age-related cataract: the Blue Mountains Eye Study.
Tan AG, Mitchell P, Flood VM, Burlutsky G, Rochtchina E, Cumming RG, Wang JJ.
Department of Ophthalmology, Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia.

BACKGROUND: Oxidative stress has been implicated in cataractogenesis. Long-term intake of antioxidants may offer protection against cataract. OBJECTIVE: We investigated relations between antioxidant nutrient intakes measured at baseline and the 10-y incidence of age-related cataract. DESIGN: During 1992-1994, 3654 persons aged >or=49 y attended baseline examinations of the Blue Mountains Eye Study (82.4% response). Of these persons, 2464 (67.4%) participants were followed >or=1 time after the baseline examinations (at either 5 or 10 y). At each examination, lens photography was performed and questionnaires were administered, including a 145-item semiquantitative food-frequency questionnaire. Antioxidants, including beta-carotene, zinc, and vitamins A, C, and E, were assessed. Cataract was assessed at each examination from lens photographs with the use of the Wisconsin Cataract Grading System. Nuclear cataract was defined for opacity greater than standard 3. Cortical cataract was defined as cortical opacity >or= 5% of the total lens area, and posterior subcapsular (PSC) cataract was defined as the presence of any such opacity. RESULTS: Participants with the highest quintile of total intake (diet + supplements) of vitamin C had a reduced risk of incident nuclear cataract [adjusted odds ratio (OR): 0.55; 95% CI: 0.36, 0.86]. An above-median intake of combined antioxidants (vitamins C and E, beta-carotene, and zinc) was associated with a reduced risk of incident nuclear cataract (OR: 0.51; 95% CI: 0.34, 0.76). Antioxidant intake was not associated with incident cortical or PSC cataract. CONCLUSION: Higher intakes of vitamin C or the combined intake of antioxidants had long-term protective associations against development of nuclear cataract in this older population.

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J Cataract Refract Surg. 2008 Jun;34(6):991-5.
Prospective randomized controlled trial to compare the effect on the macula of AquaLase liquefaction and ultrasound phacoemulsification cataract surgery.
Barsam A, Chandra A, Bunce C, Whitefield LA.
Moorfields Eye Hospital, London, United Kingdom. abarsam@hotmail.com

PURPOSE: To compare the effect of ultrasound (US) phacoemulsification and AquaLase liquefaction (Alcon Laboratories) cataract surgery on the macula using optical coherence tomography (OCT). SETTING: Department of Ophthalmology, Queen Mary's Hospital, London, United Kingdom. METHODS: Sixty-three patients having cataract surgery were randomized to receive US phacoemulsification or AquaLase liquefaction cataract surgery. Macular thickness and volume were evaluated by OCT preoperatively and 2 and 6 weeks postoperatively. The primary outcomes were OCT central macular thickness and best corrected visual acuity at 6 weeks. Secondary outcomes were OCT macular volume and perioperative and postoperative complications. RESULTS: Over the 6-week study, the median increase in foveal thickness in the study eye compared with that in the fellow eye was 11 microm (interquartile range [IQR] -21 to 23 microm) in the AquaLase group and 17 microm (IQR -11 to 33 microm) in the phacoemulsification group (P = .229). A subgroup analysis of diabetic patients found a median increase in foveal thickness in the study eye versus the fellow eye of 2 microm (IQR -14 to 23 microm) in the AquaLase group and 29 microm (IQR 11 to 41 microm) in the phacoemulsification group (P = .07). CONCLUSIONS: The results in this study suggest that AquaLase liquefaction cataract extraction is as safe as standard US phacoemulsification cataract extraction and may carry less risk for the development of postoperative cystoid macular edema. This may be most evident in diabetic patients.

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Health Qual Life Outcomes. 2008 Jan 24;6(1):10 [Epub ahead of print]
Patient-reported benefit of ReSTORA(R) multi-focal intraocular lenses after cataract surgery: results of Principal Component Analysis on clinical trial data.
Berdeaux G, Viala M, Roborel de Climens A, Arnould B.

ABSTRACT: BACKGROUND: Restoration of functional distance and near vision independently of additional correction remains a goal for cataract surgery. ReSTORA(R), a new multi-focal intraocular lens (IOL) addresses this issue with an improvement in both distance and near vision, often without need for glasses. This analysis attempted to discuss the patient-reported benefit of ReSTORA(R) using a full but organised representation of data. METHODS: Two non-randomised, open-label clinical trials conducted in Europe and the United-States were conducted to compare the efficacy of ReSTORA(R) to AcrySofA(R) mono-focal IOLs. A total of 710 patients in need of bilateral cataract extraction were included in the pooled study. The TyPE, a patient questionnaire, was fully completed by 672 of them before and after each eye surgery. The TyPE, composed of 67 items measuring overall visual functioning in both conditions (with and without wearing glasses), evaluates limitations, troubles and satisfaction in distance and near vision. A principal component analysis (PCA) of the TyPE questionnaire was performed on pooled data from baseline and post-surgery observations in order to fully represent the change in the TyPE data over time. ReSTORA(R) and mono-focal groups were used as illustrative variables. The coordinates of the first 2 factors were compared between visits and between IOLs (ReSTORA(R) vs. mono-focal), using paired t-tests and t-tests, respectively. RESULTS: The first factor of the PCA explained 55% of the variance and represented visual functioning and patient satisfaction. The second factor explained 6% of the variance and was interpreted as independence from glasses. An overall difference in factorial coordinates in both factors was seen between baseline and the first eye surgery, and between the first and the second eye surgery. No difference between ReSTORA(R) and mono-focal IOL groups was observed at baseline. After surgery, ReSTORA(R) treated-patients had higher coordinates on both visual functioning and satisfaction and independence from glasses factors. Findings observed on the factorial plan were supported by statistical comparisons of factorial coordinates. CONCLUSIONS: Both mono-focal and ReSTORA(R)-implanted patients improved their visual functioning after bilateral cataract surgery. Moreover, ReSTORA(R) patients reported an additional benefit in independence from glasses as well as in visual functioning and patient satisfaction.

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Am J Ophthalmol. 2008 Jan 10 [Epub ahead of print]
Blue Light-Filter Intraocular Lenses in Vitrectomy Combined with Cataract Surgery: Results of a Randomized Controlled Clinical Trial.
Falkner-Radler CI, Benesch T, Binder S.
Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria (C.I.F.-R., S.B.).

PURPOSE: To evaluate the effect of the blue light-filter intraocular lenses (IOLs) in vitrectomy combined with cataract surgery, focusing on the surgeon's ability to perform specific vitreoretinal procedures and on the patients' outcome. DESIGN: Randomized clinical trial. METHODS: Sixty patients, recruited from our outpatient department, were assigned randomly to receive an ultraviolet-filter IOL (clear IOL group) or a blue light-filter IOL (yellow IOL group) combined with a vitreoretinal procedure. Main outcome measures were intraoperative conditions for the surgeon and the functional outcome. Second outcome measures were complication rates and vitreoretinal diagnoses. RESULTS: The questionnaire responses showed that the blue light-filter IOLs did not represent an impediment to vitreoretinal surgery (P > .05). No intraoperative complications were encountered in either group. Patients in both IOL groups showed comparable functional results with respect to visual acuity, contrast sensitivity, color vision, and glare effect (P > .05). The functional outcome was influenced significantly by the vitreoretinal diagnosis (P < .01). CONCLUSIONS: With the possible advantage of macular protection and no intraoperative or functional disadvantage, the routine use of the blue light-filter IOL in combined surgery can be recommended.

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J Cataract Refract Surg. 2008 Jan;34(1):64-9.
Effect of prophylactic nonsteroidal antiinflammatory drugs on cystoid macular edema assessed using optical coherence tomography quantification of total macular volume after cataract surgery.
Almeida DR, Johnson D, Hollands H, Smallman D, Baxter S, Eng KT, Kratky V, ten Hove MW, Sharma S, El-Defrawy S.
Department of Ophthalmology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada.

PURPOSE: To evaluate the efficacy of prophylactic administration of the topical nonsteroidal antiinflammatory drug (NSAID) ketorolac tromethamine 0.5% on acute (within 4 weeks of surgery) cystoid macular edema (CME) and total macular volume (TMV) in patients having phacoemulsification cataract surgery. SETTING: Department of Ophthalmology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada. METHODS: This open-label nonmasked randomized (random number assignment) study comprised 106 eyes of 98 patients. Exclusion criteria included hypersensitivity to the NSAID drug class, aspirin/NSAID-induced asthma, and pregnancy in the third trimester. Ketorolac tromethamine 0.5% was administered starting 2 days before surgery and for 29 days after surgery for a total of 31 days. The outcome measure was macular swelling, which was quantified by the optical coherence tomography. RESULTS: At 1 month, there was a statistically significant difference in TMV between the control g
roup (0.4420 mm3) and the ketorolac group (0.2392 mm3), with the ketorolac group having 45.8% less macular swelling (P = .009). Multiple linear regression with backward selection indicated a 44.3% (P = .013) and 46.1% (P = .030) reduction in macular swelling in the ketorolac group at 1 week and 1 month, respectively. CONCLUSION: Used prophylactically after cataract surgery, ketorolac 0.5% was efficacious in decreasing postoperative macular edema.

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Curr Opin Ophthalmol. 2008 Jan;19(1):66-70.
Nutrition and the prevention of cataracts.
Fernandez MM, Afshari NA.
Duke University Eye Center, Durham, North Carolina 27710, USA.

PURPOSE OF REVIEW: Oxidative stress is a major cause of cataract development. Numerous studies have been published regarding the effects of nutritional supplementation on cataract progression. RECENT FINDINGS: Basic science research has demonstrated a protective effect of antioxidants on lens tissue, and supplementation with vitamin C and lutein/zeaxanthin has been associated with a decreased risk of cataract formation in multiple observational studies. One large interventional trial demonstrated a significant difference in participants treated with high-dose vitamin C versus placebo, but a more recent interventional study did not replicate these findings. In a review of the carotenoids lutein and zeaxanthin, the Food and Drug Administration concluded there is insufficient evidence to suggest that supplementation with these carotenoids lowers the risk of cataract formation. While high doses of multivitamins, antioxidants, or lutein and zeaxanthin are unlikely to be of significant ophthalmic benefit to the general public, these nutrients may help individuals exposed to high oxidative stress, such as heavy smokers, and those with poor nutrition. SUMMARY: Supplementation with vitamin C, lutein, zeaxanthin, or a multivitamin may help certain populations, but is unlikely to affect the progression of cataracts in most patients.

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Curr Opin Ophthalmol. 2008 Jan;19(1):5-9.
Patient-centered care and refractive cataract surgery.
Talley-Rostov A.
Northwest Eye Surgeons, Seattle, Washington 98133, USA. Atalley-rostov@nweyes.com

PURPOSE OF REVIEW: Cataract surgery has evolved significantly during the last few years. The introduction of aspheric, presbyopic correcting and toric intraocular lenses have shifted the emphasis of cataract surgery from just treating patients' functional symptoms to optimizing the refractive outcome of the procedure. RECENT FINDINGS: Studies emphasizing patient satisfaction and refractive visual outcomes have shifted the focus of cataract surgery to a more patient-centered approach. Refractive surgical technologies such as limbal relaxing incisions, laser-assisted in-situ keratomileusis, photorefractive keratectomy and conductive keratoplasty can be used in conjunction with traditional cataract surgical techniques. The wide array of intraocular lens choices has broadened the scope of refractive cataract surgery providing surgeons and patients with more options in determining refractive outcomes. SUMMARY: Cataract surgery has expanded into the realm of refractive surgery and there is a new emphasis on patient-centered care and an optimization of the refractive outcome of the procedure. This trend will continue as newer presbyopic correcting intraocular lenses become available.

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Curr Opin Ophthalmol. 2008 Jan;19(1):22-6.
Perioperative antibiotics and anti-inflammatory agents in cataract surgery.
DeCroos FC, Afshari NA.
Duke University Eye Center, Duke University Medical Center, Durham, North Carolina 27710, USA.

PURPOSE OF REVIEW: Cataract surgery has benefited from great technical advances but no consensus exists as regards optimal perioperative medical management of inflammation and infection prophylaxis. RECENT FINDINGS: The present article primarily reviews recent evidence about the most advantageous antibiotic regimen to minimize endophthalmitis, and the utility of steroids or nonsteroidal anti-inflammatory drugs (NSAIDs) in management of both postoperative inflammation and cystoid macular edema. Prospective data from Europe supports the efficacy of intracameral cephalosporins in reducing the incidence of endophthalmitis. We compare this with retrospective data from the United States describing a low incidence of endophthalmitis when using fourth-generation fluoroquinolones as chemoprophylaxis. Other studies demonstrate the anti-inflammatory effect of multiple perioperative topical NSAIDs. Further important questions remain, however, including whether NSAIDs exhibit a superior side-effect profile relative to corticosteroids, whether benefit exists to combination NSAID/corticosteroid therapy, as well as whether NSAIDS can reduce the incidence of cystoid macular edema. SUMMARY: New evidence clarifies the use of intracameral antibiotics, and other studies support a niche anti-inflammatory role for NSAIDs.

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Ophthalmology. 2007 Dec 31 [Epub ahead of print]
Incidence of Age-Related Cataract over a 15-Year Interval The Beaver Dam Eye Study.
Klein BE, Klein R, Lee KE, Gangnon RE.
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

OBJECTIVE: To describe the long-term incidence of nuclear cataract, cortical cataract, and posterior subcapsular cataract (PSC) and to evaluate age and cohort effects on these rates. DESIGN: Population-based study. PARTICIPANTS: Members of the Beaver Dam Eye Study cohort. METHODS: Subjects were seen in study offices for examinations (slit lamp, checking for occludable angles, dilation of pupils, lens photographs, measurement of blood pressures, and study interview). MAIN OUTCOME MEASURES: Lens photographs were taken with specially modified cameras that have been maintained over the course of all study examinations. Photographs were graded according to standard protocols that have been continued throughout all the examinations. RESULTS: Cumulative incidence of nuclear cataract was 29.7% (95% confidence interval [CI], 28.0-31.4); cortical cataract, 22.9% (95% CI, 21.3-24.5); PSC, 8.4% (95% CI, 7.4-9.4); and cataract surgery, 17.7% (95% CI, 16.4-19.0). The cumulative incidence increased with age and was greater for women after accounting for competing events. The relationship between age and incidence of cataracts was quadratic for nuclear cataract, cubic for cortical cataract, and linear for PSC. For persons with similar ages at time of examination, those in more recent birth cohorts were less likely to have any type of prevalent cataract; the effect was significant for nuclear cataract and for cataract surgery, and the effect persisted after controlling for relevant confounders. There were apparent cohort effects on cataract incidence. CONCLUSIONS: Age-adjusted incidence of all cataract types increased with increasing age, although the age effect was not linear for all 3 types. More recent birth cohorts are relatively protected relative to persons born earlier. Further follow-up is needed to verify the trends we report here and to determine whether cohort effects on 10-year incidence are significant.

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Acta Ophthalmol Scand. 2007 Dec 11 [Epub ahead of print]
Two-year follow-up of posterior capsule opacification after implantation of a hydrophilic or hydrophobic acrylic intraocular lens.
Kugelberg M, Wejde G, Jayaram H, Zetterström C.
Department of Clinical Neuroscience, St Erik’s Eye Hospital, Karolinska Institute, Stockholm, Sweden.

Purpose: To evaluate posterior capsule opacification (PCO) 2 years after cataract surgery following implantation of a hydrophilic or a hydrophobic single-piece acrylic intraocular lens (IOL) with a sharp edge. Methods: Phacoemulsification cataract surgery was performed in one eye of 120 patients with senile cataract in this prospective study. They were randomized to implantation of either a hydrophilic acrylic IOL (BL27; Bausch & Lomb, Rochester, NY, USA) or a hydrophobic acrylic IOL (AcrySof((R)) SA60AT; Alcon Laboratories, Fort Worth, TX, USA). Two years after surgery, retroillumination images were obtained and PCO area and severity were evaluated using pocoman software. Best corrected visual acuity (VA) (both high-contrast [100%] and low-contrast [2.5%]), glare, laser flare and intraocular pressure were measured. Capsulotomy rates were recorded. Results: Patients implanted with the hydrophilic IOL had a greater percentage area and severity of PCO compared with patients with the hydrophobic IOL (p < 0.001). There was no difference in PCO between men and women in the hydrophilic group. However, in the hydrophobic group, women had significantly more PCO than men (p < 0.05). Patients with the hydrophobic acrylic IOL had better high- and low-contrast visual activity (VA) (p < 0.01) and less glare (p < 0.001) than those with a hydrophilic acrylic IOL. Of the patients with the hydrophilic IOL, 42% underwent capsulotomy, compared with 10% in the hydrophobic group (p < 0.001). Conclusions: Two years after surgery, patients with the SA60AT hydrophobic acrylic IOL had less PCO and better high- and low-contrast VA than patients with the BL27 hydrophilic acrylic IOL.

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J Ocul Pharmacol Ther. 2007 Nov 14; [Epub ahead of print]
The Systemic Safety of Bromfenac Ophthalmic Solution 0.09%
Stewart RH, Grillone LR, Shiffman ML, Donnenfeld ED, Gow JA; for the Bromfenac Ophthalmic Solution 0.09% Study Group.
Houston Eye Associates, Conner Glaucoma Center, Houston, TX.

Study Objective: The aim of this study was to evaluate the systemic safety of a commercially available bromfenac ophthalmic solution 0.09% for the treatment of postoperative inflammation and reduction of ocular pain in subjects who have undergone cataract extraction. Design: Two phase III, multicenter, randomized, double-masked, parallel, placebo-controlled, clinical trials were conducted under a common protocol. These data were pooled for analysis. Setting: The setting for this study was a series of multicentered, private, and university-affiliated ophthalmology clinics in the United States. Subjects: A total of 527 subjects were sequentially assigned, according to a computer-generated randomization list (2:1) to either bromfenac (n = 356) or placebo (n = 171). Potential subjects were excluded if using nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, anticoagulants, or with uncontrolled ocular or systemic disease, preexisting ocular inflammation, surgical complications, or liver chemistry values of >/=Grade 1 according to World Health Organization Common Toxicity Criteria scoring. Intervention: Subjects who underwent cataract surgery without prior anti-inflammatory treatment and had a postsurgical Summed Ocular Inflammation Score (SOIS) of >/=3 were treated with either bromfenac or placebo. Subjects self-instilled 1 drop of the assigned test agent twice-daily for 14 days and were followed for an additional 14 days for safety evaluation.

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Ophthalmologe. 2007 Nov 14; [Epub ahead of print]
[First results with a new aberration correcting bifocal intraocular lens.]
[Article in German]
Kaymak H, Mester U.
Bundesknappschaftskrankenhaus, An der Klinik 10, 66280, Sulzbach, Deutschland, HKaymakMD@aol.com.

OBJECTIVE: To investigate the functional results with a new bifocal intraocular lens. METHODS: The *Acri.LISA (*Acri.Tec) was implanted bilaterally in 20 patients after uneventful cataract surgery. The new bifocal IOL has a light distribution of 65% for distance and 35% for the near range. The diffractive optics of the lens are designed to be independent of pupil size. Smooth steps in diffractive structure should reduce glare. An aspheric design of the posterior optic surface is engineered to counteract the asphericity of the cornea (-0.26). Postoperative evaluation included 6 weeks after surgery: uncorrected (UCVA) and best corrected (BCVA) visual acuity for distance (ETDRS charts) and near (C.A.T. charts, Birkhäuser charts) monocular and binocular, defocus curve, contrast sensitivity under photopic and mesopic lighting conditions (F.A.C.T.), and subjective assessment of halos RESULTS: At the 6-week follow-up mean binocular UCVA and BCVA (LogMAR) were -0.02+/-0.10 and -0.07+/-0.09, respectively, for distance. Near UCVA (LogMAR) was 0.09+/-0.16; distance corrected near VA was 0.04+/-0.13. Visual acuity was significantly superior when tested binocularly compared to monocular testing (p<0.01). The depth of field showed an intermediate decimal VA of 0.6+/-0.21 at 70 cm and a pseudoaccommodation range of 5.5 D. Of 20 patients, 16 reported slight halos, but no patient was seriously impaired. CONCLUSIONS: The *Acri.LISA showed very good visual performance 6 weeks after bilateral surgery.

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J Cataract Refract Surg. 2007 Nov;33(11):1925-9.
Ketorolac tromethamine LS 0.4% versus nepafenac 0.1% in patients having cataract surgery Prospective randomized double-masked clinical trial.
Duong HV, Westfield KC, Chalkley TH.
From a private practice (Duong, Westfield, Chalkley), Las Vegas, and Nevada State College (Duong), Henderson, Nevada, USA.

PURPOSE: To compare the clinical, subjective, and objective outcomes of the use of 2 topical nonsteroidal antiinflammatory drugs-ketorolac tromethamine LS 0.4% (Acular) and nepafenac 0.1% (Nevanac)-in patients having cataract surgery. SETTING: Single-center private practice, Las Vegas, Nevada, USA. METHODS: One hundred eighty-three patients (193 eyes) with visually significant cataract were recruited for the study. Consenting patients were randomized to a standard regimen of Acular, gatifloxacin 0.3% (Zymar), and prednisolone acetate 1% (Pred Forte) (ketorolac group) or Nevanac, moxifloxacin hydrochloride 0.5% (Vigamox), and prednisolone acetate (Econopred) (nepafenac group). Analysis included subjective complaints (burning, itching, foreign-body sensation, pain level after surgery) and objective findings (visual function, degree of inflammation in the anterior segment, complications). RESULTS: The ketorolac group consisted of 94 patients (100 eyes) and the nepafenac group, 89 patients (93 eyes). The between-group differences in visual outcomes and anterior chamber inflammation were not statistically significant (mean P = .33). There was a higher incidence of posterior capsule opacification in the nepafenac group (P = 0.019). Patient satisfaction, patient compliance, and postoperative pain control were statistically significantly better in the ketorolac group (P = .022, P = .023, and P = .025, respectively). CONCLUSION: Ketorolac tromethamine was statistically significantly better than nepafenac in terms of patient satisfaction, compliance, and postoperative pain control.

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Acta Ophthalmol Scand. 2007 Nov;85(7):698-710.
Paediatric cataract surgery.
Zetterström C, Kugelberg M.
Ullevål University Hospital, University of Oslo, Norway.

Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is non-progressive, while lamellar cataract usually develops later and is progressive. Prompt surgery has to be performed in cases with dense congenital cataract: if nystagmus has developed, the amblyopia is unfortunately irreversible. A treatment regime based on surgery within 2 months of life, combined with prompt optical correction of the aphakia and occlusion therapy with frequent follow-up, have been successful in both unilateral and bilateral cases. The surgery ought to include anterior and posterior capsulorexis in all children at the present time. Intraocular lens implantation has been safely performed below the age of 1 year and has also been successfully performed in bilateral cases. Anterior dry vitrectomy should be performed in preschool children to avoid visual axis opacification. Visual axis opacification is the most common complication found after cataract surgery in children. Secondary glaucoma is by far the most sight-threatening complication and is, unfortunately, common in the newborn so lifelong follow-up is essential in these cases.

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Eye. 2007 Oct;21(10):1301-9.
Advances in the management of congenital and infantile cataract.
Lloyd IC, Ashworth J, Biswas S, Abadi RV.
Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK. lloydic@yahoo.co.uk

Congenital and infantile cataracts produce deprivation amblyopia and can thus cause lifelong visual impairment. Successful management is dependent on early diagnosis and referral for surgery when indicated. Accurate optical rehabilitation and postoperative supervision are essential.The timing of surgery and its relationship to the duration of deprivation is important. Unilateral congenital cataract surgery within 6 weeks of birth produces the best outcomes. The equivalent 'latent' period for bilateral visual deprivation may be longer at around 10 weeks.Visual deprivation has a significant impact on the development of fixation stability. Major form deprivation, even after early surgery, leads to nystagmus. This is mostly manifest latent nystagmus (MLN). The latent period for fixation stability may be as short as 3 weeks. Preoperative congenital nystagmus (CN) can convert to more benign MLN after surgery.Infantile IOL implantation is becoming increasingly accepted. A satisfactory long-term refractive result requires that allowance be made for childhood axial growth and myopic shift. In a series of 25 infants (33 eyes) implanted before 12 months of age, the mean myopic shift at 12 months was 4.83 D. This increased to 5.3 D in infants implanted before 10 weeks. The initial desired refractive outcome following IOL implantation is thus hypermetropia, with the degree dependent on the age of the child.Glaucoma or ocular hypertension is a common complication following paediatric cataract surgery. Microphthalmia and surgery in early infancy are risk factors. Tonometry results may be influenced by the increased corneal thickness seen in aphakic and pseudophakic children. The long-term prognosis of eyes with aphakic glaucoma is not necessarily poor but intraocular pressure control may require three or more medications. Surgical intervention appears to be necessary in over a quarter of eyes.Posterior capsule opacification (PCO) is common in infants undergoing primary lens implantation. Primary capsulotomy and anterior vitrectomy reduce the risk of PCO. In the absence of anterior vitrectomy, primary posterior capsulotomy does not prevent visual axis opacification.Further developments will continue to be driven by clinical research. The prevention of capsule opacification and cellular proliferation may in future be achieved by the use of devices to specifically target epithelial cells at surgery.

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J Refract Surg. 2007 Sep;23(7):639-48.
Prospective randomized study of clinical performance of 3 aspheric and 2 spherical intraocular lenses in 250 eyes.
Caporossi A, Martone G, Casprini F, Rapisarda L.
Department of Ophthalmology and Neurosurgery, University of Siena, Sienao, Italy.

PURPOSE: To compare the quality of vision with aspheric and spherical intraocular lenses (IOLs) in pseudophakic patients. METHODS: This prospective, comparative, randomized study included 250 eyes of 125 patients with bilateral cataracts. Patients were randomly assigned to receive either IOLs with a spherical biconvex optic (Acrysof SN6OAT [Alcon] or Sensar AR40e [Advanced Medical Optics, AMO]) or IOLs with an aspheric optic (Acrysof IQ SN6OWF [Alcon], Tecnis Z9000 [AMO], or Sofport L161AO [Bausch & Lomb]). Ophthalmologic examination including best spectacle-corrected visual acuity, pupil size, ocular dominance investigation, contrast sensitivity under mesopic and photopic conditions, and wavefront analysis was performed 2 months postoperatively. RESULTS: Aspheric IOLs showed better contrast sensitivity compared to spherical IOLs at spatial frequencies of 6, 12, and 18 cycles per degree (cpd) under photopic conditions and at all spatial frequencies under mesopic conditions. There was no significant difference among the three aspheric IOLs at all spatial frequencies under either photopic or mesopic conditions. Mean total spherical aberration was statistically lower in dominant eyes with aspheric IOLs (0.05 +/- 0.06, 0.11 +/- 0.1, and 0.19 +/- 0.08 pm for the Tecnis Z9000, Acrysof IQ SN6OWF, and Sofport L161AO, respectively) compared with eyes with spherical IOLs (0.62 +/- 0.24 and 0.46 +/- 0.19 microm for the Acrysof SN6OAT and Sensar AR40e, respectively) for a 5-mm pupil diameter. CONCLUSIONS: The aspheric IOLs had less wavefront aberrations and performed better under both photopic and mesopic contrast sensitivity compared to the spherical IOLs. These findings confirm it is possible to improve the optical performance of IOLs by modifying the surfaces.

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Ophthalmic Epidemiol. 2007 Jul-Aug;14(4):173-8.
Epidemiology of cataract: accomplishments over 25 years and future directions.
West S.
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. shwest@jhmi.edu

The purpose of this review is to highlight the advances made by epidemiologic research into cataract. Considerable progress has been made in characterizing phenotypes, determining the prevalence and incidence in various population groups, and understanding risk factors for cataract. Cataract surgery research has documented functional improvements following surgery and has identified aspects of surgery delivery that could be made. Cataract is an independent marker of early mortality, providing a possible system for studying the aging process. Promising future work in cataract epidemiology is highlighted. Despite the availability of cataract surgery, cataract is still the leading cause of blindness worldwide. From a public health standpoint, research that can identify ways to delay onset or progression, or achieve the holy grail of prevention of cataract, should remain a leading priority.

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Ophthalmology. 2007 Jun;114(6):1089-93.
Natural course of intraocular pressure after cataract surgery with sodium hyaluronate 1% versus hydroxypropylmethylcellulose 2%.
Rainer G, Schmid KE, Findl O, Sacu S, Kiss B, Heinzl H, Menapace R.
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. georg.rainer@meduniwien.ac.at

PURPOSE: To investigate the natural course of intraocular pressure (IOP) after small-incision cataract surgery with sodium hyaluronate 1% versus hydroxypropylmethylcellulose 2%. DESIGN: Randomized clinical trial. PARTICIPANTS: Eighty eyes of 40 consecutive patients with bilateral age-related cataract. METHODS: The patients were assigned randomly to receive sodium hyaluronate 1% or hydroxypropylmethylcellulose 2% during cataract surgery in the first eye. The second eye received the other ophthalmic viscosurgical device. The IOP was measured preoperatively and 30 minutes; 1, 2, 3, 4, 6, 8, and 20 to 24 hours; and 1 week postoperatively. MAIN OUTCOME MEASURE: Postoperative IOP increase. RESULTS: The highest mean IOP increase occurred at 8 hours postoperatively (5.3+/-6.4 mmHg) in the sodium hyaluronate 1% group and at 2 hours postoperatively (7.8+/-6.1 mmHg) in the hydroxypropylmethylcellulose 2% group. Overall, the IOP increase was higher with hydroxypropylmethylcellulose 2% (P = 0.005). Intraocular pressure spikes to > or =30 mmHg occurred in 5 eyes (13%) in the sodium hyaluronate 1% group and 13 eyes (33%) in the hydroxypropylmethylcellulose 2% group. CONCLUSIONS: Sodium hyaluronate 1% and hydroxypropylmethylcellulose 2% caused significant IOP increases during the first 8 hours after cataract surgery. A single measurement at 6 hours postoperatively could detect all IOP spikes in the sodium hyaluronate 1% group. In the hydroxypropylmethylcellulose 2% group, a single measurement at 2 hours postoperatively could detect two thirds of IOP spikes.

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Am J Ophthalmol. 2007 Jun 1; [Epub ahead of print]
Reopening of Previously Closed Macular Holes After Cataract Extraction.
Bhatnagar P, Kaiser PK, Smith SD, Meisler DM, Lewis H, Sears JE.
Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

PURPOSE: To evaluate the frequency of reopening of macular holes after cataract extraction. DESIGN: Retrospective, comparative, consecutive case series. METHODS: Two hundred and eleven eyes with idiopathic macular holes closed by vitrectomy were divided into four groups: Group 1: prior cataract extraction; Group 2: vitrectomy then cataract extraction; Group 3: vitrectomy only; and Group 4: vitrectomy and cataract extraction as a combined procedure. The main outcome measure of macular hole reopening was evaluated in relationship to multiple variables. RESULTS: Two hundred and eleven eyes were included: Group 1: 56 eyes; Group 2: 86 eyes; Group 3: 41 eyes; and Group 4: 28 eyes. Twenty-four macular holes reopened (11%) (mean follow-up 26.6 months, range, three to 118 months). The greatest number of macular hole reopenings, 17 (20%), were in Group 2. Cox multivariate analysis failed to demonstrate an association between duration of hole, serum use, internal limiting membrane peeling, or stage and reopening of a macular hole. Cox analysis showed a four-fold increased risk of reopening in Group 2 eyes (95% confidence interval [CI]: 1.7 to 11.2; P = .002). Eyes with cystoid macular edema after cataract extraction had a seven-fold increased risk of macular hole reopening (7.72; 95% CI: 2.79 to 21.3; P < .0005). Kaplan-Meier analysis showed increased rates of macular hole reopening in Group 2 eyes compared to the other 3 groups combined (log-rank P < .00005). CONCLUSIONS: Cataract extraction after successful vitrectomy for macular hole, when complicated by cystoid macular edema (CME), may increase the risk of macular hole reopening.

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Eur J Ophthalmol. 2007 May-Jun;17(3):336-40.
Phacoemulsification in vitrectomized eyes under topical anesthesia.
Zaheer I, Taylor SR, Pearson RV.
Bristol Eye Hospital, Bristol - UK.

PURPOSE. To study phacoemulsification in vitrectomized eyes under topical anesthesia, assessing anesthetic and intraoperative characteristics and complications. METHODS. A prospective study was performed on 52 eyes of 51 patients who underwent phacoemulsification of cataract with intraocular lens implantation under topical anesthesia, having previously undergone pars plana vitrectomy. Surgical and anesthetic observations and complications were recorded, as were visual outcomes. RESULTS. Ninety-two percent of patients had improved visual acuity postoperatively with only one patient having visual loss as a result of surgery. The most common intraoperative observations were of a deep anterior chamber, posterior capsular plaques, posterior synechiae, and nuclear sclerotic cataracts. Topical anesthesia proved satisfactory in 96%, with only two patients requiring intracameral lignocaine 1%; no patients required conversion to injection anesthesia. There were no major operative or postoperative complications. CONCLUSIONS. Phacoemulsification in vitrectomized eyes can be challenging, but is visually rewarding. Topical anesthesia proved satisfactory for the vast majority of cases, with none of our patients requiring conversion to injection anesthesia.

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Clin Experiment Ophthalmol. 2007 May;35(4):324-9.
Outcomes of combined penetrating keratoplasty and cataract extraction compared with penetrating keratoplasty alone.
Green M, Chow A, Apel A.
Gold Coast Hospital, Southport, Queensland, Australia.

Purpose: To compare the rejection rates, graft failure rates, mean visual, keratometric and refractive outcomes of combined penetrating keratoplasty and cataract extraction with penetrating keratoplasty alone. Methods: A retrospective study of all patients who had combined keratoplasty and cataract extraction/intraocular lens insertion (49 eyes; mean age 65.3 years; mean follow up 17 months) compared with all patients who had keratoplasty only (58 eyes; mean age 64.0 years; mean follow up 14 months). Results: One hundred and seven eyes in 99 patients had keratoplasty in the period and were included in the study. The most common indication for keratoplasty in patients who had triple procedures was Fuchs' endothelial dystrophy (24.5%). During the study seven (6.5%) grafts failed and four (3.7%) had allogenic rejection without failure during this period. There was no statistical difference between the graft survival rates of the two study groups. The mean postoperative logMAR visual acuity (VA) was 0.42 and postoperative VA of 6/12 or better was seen in 71% of patients. Mean postoperative corneal curvature was 44.6 dioptres (D), mean corneal astigmatism was -4.0 D and was >/=5 D in 38%. Mean double-angle Cartesian coordinates for corneal astigmatism were x-0.87 D and y-0.29 D. Mean best sphere of postoperative refractions was -0.61 D and mean absolute refractive error was 2.2 D. There was no statistically significant difference in VA, keratometric or refractive outcome measures between the two study groups. Conclusion: Over a short follow up, keratoplasty combined with cataract extraction/intraocular lens insertion showed a similar risk of graft failure or allogenic graft rejection when compared with keratoplasty alone and we recommend the triple procedure for quicker visual recovery and less operative procedures.

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J AAPOS. 2007 May 25; [Epub ahead of print]
Comparison of anterior vitrectorhexis and continuous curvilinear capsulorhexis in pediatric cataract and intraocular lens implantation surgery: A 10-year analysis.
Wilson ME, Trivedi RH, Bartholomew LR, Pershing S.
Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina.

PURPOSE: To analyze the rate of inadvertent anterior lens capsular tears with vitrectorhexis or continuous curvilinear capsulorhexis (CCC) in pediatric cataract and intraocular lens (IOL) implantation surgery between January 1, 1997, and December 31, 2006. METHODS: Retrospective chart review, collecting for each eye: age at cataract surgery, type of anterior capsulotomy, any tearing of the capsule, and if yes, details of the tear. RESULTS: A total of 737 eyes were reviewed. Cases with a ruptured lens capsule that occurred prior to surgery were excluded. Eyes that received an anterior capsulotomy by any other method (n = 27) or eyes that did not receive an IOL (n = 100) were reviewed but excluded from final comparative analysis. Of the remaining 339 eyes, 19 eyes (5.6%) were noted to develop an anterior capsule tear (vitrectorhexis, 12 of 226 eyes, 5.3%; CCC, 7 of 113, 6.2%). These tears occurred during anterior capsulotomy in seven eyes, hydrodissection in one, cataract removal in three, and IOL insertion/manipulation in eight. In eyes operated for cataract at or before 72 months of age, the manual CCC technique was more likely to develop a tear (relative risk, 3.09) compared with eyes of older children (>72 months of age), where the vitrectorhexis technique was more likely to develop a tear (relative risk, 3.14). CONCLUSIONS: Vitrectorhexis is well suited for use in children less than 6 years of age due to their highly elastic anterior lens capsule. For children aged 6 years and older, manual CCC is the best technique because, by that age, capsule control and ease of capsulotomy completion has improved.

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Eye. 2007 May 4; [Epub ahead of print]
Change in health-related quality of life after cataract surgery in a population-based sample.
Chandrasekaran S, Wang JJ, Rochtchina E, Mitchell P.
1Department of Ophthalmology and the Westmead Millennium Institute, Centre for Vision Research, University of Sydney, Australia.

PurposeTo assess the long-term outcomes from cataract surgery on self-rated health, and health-related quality of life (HRQOL) in a population-based older sample.MethodsParticipants of the Blue Mountains Eye Study at the baseline (n=3654), 5 (n=2335), and 10-year follow-up (n=1952) were interviewed and examined. Questionnaires included an assessment of self-rated health and HRQOL using the 36-item Short-Form Health Survey (SF-36). Incident cataract surgery was defined if participants had cataract surgery since baseline, and confirmed via lens photographic grading.ResultsThere was no statistically significant difference in the proportions of participants who experienced a change in self-rated health between those who had incident cataract surgery (14.1% improvement; 29.1% deterioration) and non-surgical subjects (16.7% improvement; 27.0% deterioration). We found no association between incident cataract surgery and the odds for 10-year change in self-rated health, after multivariate adjustment. In contrast, participants who had incident cataract surgery had a significant improvement in the mean scores of 'mental health' domain of HRQOL (+1.60 vs-2.04, P=0.02) and in the mental component score (+1.43 vs-0.82, P=0.02) than participants who did not undergo surgery. Cataract surgery during follow-up had no significant influence on change in mean scores of other domains or in their physical component score of the SF-36 (-2.57 in participants who had incident surgery vs-2.29 in non-surgical participants, P=0.78).ConclusionsWe confirmed long-term improvement following cataract surgery in the mental but not in the physical domain of the SF-36 or in answers to a specific self-rated health question.Eye advance online publication, 4 May 2007;

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Klin Monatsbl Augenheilkd. 2007 Apr;224(4):288-91.
[Does cataract surgery increase the risk of exudative age-related macular degeneration? Results from a large retrospective case-control study]
[Article in German]
Menghini M, Sutter FK, Barthelmes D, Fleischhauer JC, Kurz-Levin MM, Boesch MM, Helbig H.
Augenklinik Universitätsspital Zürich, Schweiz.

BACKGROUND: Many epidemiological studies indicate a positive correlation between cataract surgery and the subsequent progression of age-related macular degeneration (AMD). Such a correlation would have far-reaching consequences. However, in epidemiological studies it is difficult to determine the significance of a single risk factor, such as cataract surgery. PATIENTS AND METHODS: We performed a retrospective case-control study of patients with new onset exudative age-related macular degeneration to determine if cataract surgery was a predisposing factor. A total of 1496 eyes were included in the study: 984 cases with new onset of exudative AMD and 512 control eyes with early signs of age-related maculopathy. Lens status (phakic or pseudophakic) was determined for each eye. RESULTS: There was no significant difference in lens status between study and control group (227/984 [23.1 %] vs. 112/512 [21.8 %] pseudophakic, p = 0.6487; OR = 1.071; 95 % CI = 0.8284-1.384). In cases with bilateral pseudophakia (n = 64) no statistically significant difference of the interval between cataract surgery in either eye and the onset of exudative AMD in the study eye was found (225.9 +/- 170.4 vs. 209.9 +/- 158.2 weeks, p = 0.27). CONCLUSIONS: Our results provide evidence that cataract surgery is not a major risk factor for the development of exudative AMD.

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Curr Opin Ophthalmol. 2007 Feb;18(1):58-61.
Status of toric intraocular lenses.
Horn JD.
Vision For Life, Nashville, Tennessee 37203, USA. jdh@comcast.net

PURPOSE OF REVIEW: To provide an update on the status of toric intraocular lenses. These lenses can be used as an alternative or adjunct to corneal astigmatic incisions for correcting preexisting astigmatism in patients with cataracts. They are a particularly attractive option in those cases where limbal-relaxing incisions are not powerful or predictable enough. Other toric lenses may correct astigmatism in addition to spherical refractive errors in phakic patients. RECENT FINDINGS: Toric lenses have continued to gain popularity with the US Food and Drugs Administration (FDA) approval of the Acrysof Toric intraocular lenses. This lens is designed to be implanted in patients undergoing cataract removal and who have significant preexisting corneal astigmatism. In the FDA clinical trial, study patients received one of the three cylindrical powers, and control patients received a standard monofocal intraocular lenses. The study found that the Acrysof Toric intraocular lenses provided excellent visual outcomes and exhibited excellent rotational stability. With the Acrysof Toric intraocular lenses, the average lens rotation was less than 4 degrees from the lens' initial placement at 6 months after surgery. SUMMARY: Toric intraocular lenses provide excellent vision for astigmatic cataract patients, and new designs are significantly improving visual acuity by minimizing the risk of rotation.

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Klin Monatsbl Augenheilkd. 2007 Jan;224(1):23-7.
[Visual Function with Blue Light Filter IOLs.]
[Article in German]
Wohlfart C, Tschuschnig K, Fellner P, Weiss K, Vidic B, El-Shabrawi Y, Ardjomand N.
Universitats-Augenklinik, Medizinische Universitat Graz, Osterreich (Leiter: Univ.-Prof. Dr. Andreas Wedrich).

BACKGROUND: Recently, intraocular lenses (IOLs) with a blue light filter have been introduced to protect the retina from age-related macular degeneration (AMD) after cataract extraction. A reduction of longitudinal chromatic aberration by filtering blue light may enhance patient's visual function. In this study we compared subjective and objective parameters of visual function following implantation of blue light filter (yellow) IOLs and IOLs of the same design without filter. PATIENTS AND METHODS: 21 patients (21 eyes) underwent implantation of an IOL with a blue light filter (AF-1 UY, Hoya, Japan), 22 patients (22 eyes) received an IOL without blue light filter (AF-1 UV, Hoya, Japan). Patients were examined three months postoperatively for uncorrected and best corrected spectacle visual acuity, mesopic and photopic contrast sensitivity, colour vision and subjective quality of vision by a standard questionnaire. RESULTS: Eyes with blue light filter IOLs did not show any significant difference in any parameter analysed when compared to eyes without the blue light filter IOL. Subjective quality of vision was considered to be high by all patients and no significant difference was observed between the two IOL groups. CONCLUSION: The visual function of patients with blue filter IOLs is not significantly different to those without blue light filter IOLs. Since blue light filter IOLs did not show any functional disadvantage, but potentially protect the macula from AMD, blue light filter IOLs may be considered as a reasonable alternative to traditional IOLs, especially in eyes with a high risk for the development of macular degeneration.

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Curr Opin Ophthalmol. 2007 Feb;18(1):9-12.
Is cataract surgery a risk factor for progression of macular degeneration?
Patel JI.
Ophthalmology Department, Royal Perth Hospital, Perth, Australia. jigs37@hotmail.com

PURPOSE OF REVIEW: There is a suggestion of increased risk or progression of age-related macular degeneration after cataract surgery, which is related to the increased exposure of the retina to short-wavelength light. RECENT FINDINGS: Cell culture and animal work has described retinal and retinal pigment epithelium phototoxicity on acute light exposure. Clinical studies suggest that the use of short-wavelength-blocking intraocular lenses can help but may also affect visual function and circadian rhythm. SUMMARY: Evidence to date fails to prove conclusively that light alone or cataract surgery can induce or cause the progression of age-related macular degeneration. A randomized clinical study of the use of short-wavelength (blue)-blocking lenses to prove or disprove the ability of these intraocular lenses to help in preventing progression of age-related macular degeneration is needed.

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Am J Clin Nutr. 2007 Jan;85(1):304S-307S.
Multivitamin-multimineral supplements and eye disease: age-related macular degeneration and cataract.
Seddon JM.
Epidemiology Unit, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA. jseddon@earthlink.net

The prevalence and effects of age-related macular degeneration (AMD) and cataract are increasing dramatically as the proportion of elderly in our population continues to rise. A multivitamin-multimineral supplement with a combination of vitamin C, vitamin E, beta-carotene, and zinc (with cupric oxide) is recommended for AMD but not cataract. Weak support exists for multivitamins or other vitamin supplements from observational studies of cataract. The results of observational studies suggest that a healthy lifestyle with a diet containing foods rich in antioxidants, particularly lutein and zeaxanthin, as well as n-3 fatty acids, appears beneficial for AMD and possibly cataract. The Age-Related Eye Disease Study II will evaluate some of these additional nutrients as dietary supplements in a randomized trial.

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Eur J Anaesthesiol. 2007 Jan 4;:1-3 [Epub ahead of print]
Levobupivacaine 0.75% vs. lidocaine 4% for topical anaesthesia: a clinical comparison in cataract surgery.
Di Donato A, Fontana C, Lancia F, Di Giorgio K, Reali S, Caricati A.
Concordia Hospital for Special Surgery, Department of Anesthesia, Resuscitation and Pain Management, Rome, Italy.

SummaryBackground: The aim of this study was to compare the efficacy of topical levobupivacaine drops 0.75% vs. lidocaine drops 4% in cataract surgery. Methods: We examined 203 patients undergoing cataract surgery by phacoemulsification. They were randomized into two groups: one received four drops of lidocaine 4% and the other received four drops of levobupivacaine 0.75%. The onset and offset times of sensory block were evaluated. Application, intraoperative and postoperative subjective pain was quantified by the patients using a verbal pain score. Complications, rates of supplemental anaesthesia, and the satisfaction of surgeon and patients were also recorded. Results: The mean sensory onset and offset times were significantly higher for the levobupivacaine group (P < 0.01). Pain score was lower in the levobupivacaine group than in the lidocaine one and the difference was statistically significant at all stages (P < 0.01). The mean satisfaction scores of patients and surgeon were also statistically higher for levobupivacaine (P < 0.01). No significant differences for complications and rates of supplemental anaesthesia were found. Conclusions: Topical levobupivacaine 0.75% shows the same efficacy and safety as lidocaine 4% in cataract surgery by phacoemulsification. There was an adequate block with a good level of satisfaction of surgeon and patients. Levobupivacaine 0.75% offers a new and acceptable choice for topical anaesthesia in cataract surgery.

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J Cataract Refract Surg. 2007 Jan;33(1):53-8.
Nepafenac ophthalmic suspension 0.1% for the prevention and treatment of ocular inflammation associated with cataract surgery.
Lane SS, Modi SS, Lehmann RP, Holland EJ.
slane@associatedeyecare.com

PURPOSE: To determine whether nepafenac ophthalmic suspension 0.1% decreases the incidence and severity of inflammation and pain after cataract surgery with posterior chamber intraocular lens implantation. SETTING: Twenty-one ophthalmology clinics in the United States. METHODS: A randomized double-blind vehicle-controlled trial was conducted in which adult patients were randomly assigned to receive nepafenac 0.1% or vehicle beginning 1 day before surgery and continuing on the day of surgery (day 0) for 14 days. Patients were evaluated on days 1, 3, 7, and 14. The primary efficacy variable was the percentage of patients cured at day 14 (cure defined as aqueous cells score + aqueous flare score = 0). Other efficacy variables included percentage of patients who were pain free at all visits and aqueous cells, flare, and cells plus flare scores. RESULTS: The mean age of the 476 patients (243 nepafenac, 233 vehicle) was 70 years (range 27 to 93 years). At day 14, 152 patients (62.6%) in the nepafenac group and 40 (17.2%) in the vehicle group were cured (P<.0001). A higher percentage of patients in the nepafenac group was pain free at all visits (P<.0001). Throughout the study, most nepafenac-treated patients were pain free (83.1% to 93.0%) compared with less than half the vehicle-treated patients (41.6% to 46.4%). The nepafenac group had lower mean aqueous cells, flare, and cells plus flare scores at all visits (P<.0001). No treatment-related ocular adverse events occurred in either group. CONCLUSION: Nepafenac ophthalmic suspension 0.1% was safe and effective for preventing and treating ocular inflammation and pain associated with cataract surgery.

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Br J Ophthalmol. 2006 Dec 19; [Epub ahead of print]
Refractive outcomes following primary intraocular lens implantation in infants.
Ashworth JL, Maino AP, Biswas S, Lloyd IC.
Manchester Royal Eye Hospital, United Kingdom.

BACKGROUND/AIMS: Intraocular lens implantation is becoming increasingly accepted as a primary procedure in infants. This study aimed to evaluate the accuracy of intraocular lens power calculation, the rate of myopic shift and the refractive outcome following primary intraocular lens implantation in infants less than 12 months old at the time of cataract surgery. METHOD: A retrospective case review of 25 patients (8 with bilateral cataracts and 17 with unilateral) who underwent cataract surgery with primary intraocular lens implantation at less than 12 months old. Outcomes measured were actual early post-operative refraction, lens power calculation error, myopic shift and refractive outcome. RESULTS: Actual post-operative refraction was within 2 dioptres of the target refraction in 83% of cases. Lens power calculation error did not depend on axial length, age at surgery or target refraction. Mean myopic shift was 5.43 +/- 3.7 dioptres in the first 12 months following surgery, but was significantly greater when surgery was performed at less than 10 weeks of age. CONCLUSION: This study demonstrates that IOL power can be calculated with reasonable accuracy in infants using current formulae. Factors such as age at the time of surgery, axial length, whether surgery is unilateral or bilateral, and the presence of systemic pathologies do not appear to influence the accuracy of lens power calculation or myopic shift by 36 months of age.

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Curr Med Res Opin. 2006 Dec;22(12):2591-602.
A comparison of patient-reported outcomes from an apodized diffractive intraocular lens and a conventional monofocal intraocular lens.
Lehmann R, Waycaster C, Hileman K.
Baylor College of Medicine, Houston, TX, USA.

OBJECTIVE: The primary objective of this research was to compare cataract patient-reported outcomes of subjects bilaterally implanted with apodized diffractive intraocular lenses (AD-IOL) to subjects bilaterally implanted with conventional monofocal intraocular lenses (CM-IOL). A secondary objective was to establish the relationship between uncorrected visual acuity and patient-reported outcomes. METHODS: This was a prospective non-randomized, open-label clinical trial consisting of 339 patients bilaterally implanted with the AD-IOL and 156 bilaterally implanted with the CM-IOL. The outcomes of both groups were assessed 6 months postoperatively after second eye implantation. Assessed endpoints included patient-reported outcomes and visual acuity. Limitations of this study include the lack of random assignment to treatment groups and lack of masking of both the physicians and patients. RESULTS: AD-IOL patients demonstrated significantly better uncorrected near visual acuity (UCNVA) compared to CM-IOL patients (0.02 versus 0.41 log MAR [logarithm of the minimum angle of resolution], respectively; p < 0.0001). UCNVA was significantly correlated with nine patient-reported outcomes in the AD-IOL group and two patient-reported outcomes in the CM-IOL group. Significantly more AD-IOL patients reported spectacle independence compared to CM patients (80% versus 8% respectively; p < 0.0001). AD-IOL patients reported their vision quality as better than CM-IOL patients (p < 0.0001). AD-IOL patients were more satisfied with their daytime (p < 0.0001), nighttime (p < 0.0001), and overall (p < 0.0001) vision than CM-IOL patients. AD-IOL patients reported less trouble with their daytime (p < 0.0001) and nighttime (p = 0.0238) vision compared to CM-IOL patients. Furthermore, AD-IOL patients reported less distance vision limitation (p = 0.0282), less near vision limitation (p < 0.0001), and less social limitation (p < 0.0001) than CM-IOL patients. CONCLUSIONS: The patient reported near vision benefits of the AD-IOL coupled with its high rate of spectacle independence significantly improved cataract patients' health-related quality-of-life, compared to a CM-IOL.

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J Cataract Refract Surg. 2006 Dec;32(12):2043-9.
Seven-year follow-up of combined cataract extraction and viscocanalostomy.
Wishart MS, Dagres E.
Department of Ophthalmology, Warrington Hospital, North Cheshire NHS Trust, Warrington, United Kingdom. manijeh.wishart@nch.nhs.uk

PURPOSE: To investigate the long-term success and complications of phacoemulsification combined with viscocanalostomy (phacoviscocanalostomy) in eyes with coexisting cataract and medically uncontrolled glaucoma. SETTING: Department of Ophthalmology, Warrington Hospital, Warrington, United Kingdom. METHODS: A prospective nonrandomized study evaluated 165 consecutive eyes (114 patients) that had phacoviscocanalostomy. The main outcome measures were intraocular pressure (IOP), visual acuity, requirement for topical antiglaucoma medication, and the presence or absence of drainage blebs or bleb complications. RESULTS: The mean follow-up was 38.7 months +/- 19.3 (SD) (range 12 to 90 months). There was a statistically significant decrease in IOP, from 24.1 +/- 5.1 mm Hg preoperatively to 13.8 +/- 8.1 mm Hg 1 day after surgery (P<.001), 16.0 +/- 4.1 mm Hg at 5 years (P<.001), and at all evaluations to the last follow-up. The mean number of medications per eye decreased significantly from 2.5 +/- 0.9 before surgery to 0.1 +/- 0.5 at last follow-up (P<.001). At the final follow-up, IOP was reduced by 33.2% (16.2 mm Hg versus 24.1 mm Hg). Complete success, defined as an IOP reduction of more than 30% from preoperative level without medications, was achieved in 48.5% of eyes, with 42% of eyes having an IOP of less than 16 mm Hg. The percentage fall in IOP was linearly related to the preoperative IOP level (P<.001). No eye developed a trabeculectomy-type bleb, and there were no bleb-related complications. CONCLUSIONS: Phacoviscocanalostomy was safe and effective for the management of eyes with coexisting cataract and medically uncontrolled glaucoma. It provided a stable and sustained reduction in IOP with a minimum requirement for topical medication.
  
Previous Cataracts Research: 2002-2006   
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