PURPOSE: To study the association between after-cataract and secondary glaucoma after lensectomy and 5-fluorouracil treatment in an experimental infant rabbit model. SETTING: St Erik Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Lensectomy was performed in both eyes of 16 3-week-old rabbits. One randomly selected eye in each rabbit was injected with 2.5 mg of 5-fluorouracil (5-FU) at surgery and 5.0 mg the day after surgery to reduce the formation of after-cataract. Axial length, corneal thickness, corneal diameter, and intraocular pressure were measured preoperatively and 4 times during the 6 months following surgery. Six months after surgery, the wet weight of the after-cataract was determined. RESULTS: In 16 aphakic eyes treated with 5-FU, no or a minimal amount (0.10 g); 8 of these developed glaucoma. The other 6 eyes had no or minimal after-cataract and did not develop secondary glaucoma. The relationship between after-cataract and secondary glaucoma was statistically significant. CONCLUSION: A significant relationship between the amount of after-cataract and the development of secondary glaucoma was found in aphakic infant rabbit eyes.
PURPOSE: To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye. SETTING: Filatov Institute, Odessa, Ukraine. METHODS: Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed. RESULTS: Children in the younger age group (
PURPOSE: Cataract surgery is often followed by a posterior capsule opacification, usually treated with YAG laser capsulotomy, however, there are huge variations in the incidence figures available in the literature, from 18 to 50% (Sterling & Wood 1986). We have therefore analyzed the incidence of secondary cataracts in a population-based cohort of patients, as revealed by the number of YAG laser capsulotomies performed postoperatively. METHODS: Data for all patients undergoing cataract surgery from 1986 up to and including 1990 in the Lund Health Care District were prospectively recorded, and 4722 patients were retrieved for analysis, using only one eye per patient. The patients had been operated on with extracapsular extraction (phacoemulsification or planned large incision procedure) or a combined trabeculectomy and cataract extraction procedure leaving an intact capsule after surgery. Death dates for each patient were obtained from the Swedish Bureau of Census up to and including 1991. Different risk factors were considered such as sex, age, preoperative axial length, preoperative average keratometry, preoperative intraocular pressure, glaucoma history, diabetes history, uveitis history (including both anterior and posterior uveitis), history of age related macular degeneration and a history of rheumatoid arthritis. We also considered the influence of factors connected to the operation itself on the incidence of secondary capsular haze: extraction mode (ordinary ECCE versus phacoemulsification or trabeculectomy) and the type of implant and the surgeon's surgical activity. RESULTS: Besides age, four variables significantly influenced the risk of having postoperative YAG laser treatment. They were gender, iris sphincterotomy, operation date, and whether the patient came from a rural or an urban region. After about four to five years, the percentage of patients not having had a YAG laser capsulotomy was reduced to around 50% for women and 60% for men. These percentages were based on a survival analysis, minimizing the confounding effect of the limited life span of these elderly patients. CONCLUSIONS: In this material, the most important predisposing factors for YAG laser capsulotomy after extracapsular cataract surgery are: young age, female gender, if the patient was operated late in the period observed, and if the patient came from an urban area.
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden. Electronic address: firstname.lastname@example.org.
To investigate the change in proportion of high-volume cataract surgeons during the period 2007 to 2016 and determine the impact of operation volume per surgeon and clinical unit on the rate of capsule complications.
Retrospective, register-based study.
Patients undergoing and surgeons performing cataract surgery at Swedish ophthalmologic departments 2007-2016.
All cataract procedures performed during a 10-year period were analyzed, and the change in operation volume of individual surgeons over time was determined. The yearly incidence of capsule complications was correlated to the operation volume of individual surgeons and clinical units.
The number of cataract procedures yearly per surgeon and clinical unit, proportion of capsule complications, and change over time in operation volume and complication rate.
The proportion of high-volume (=500 procedures yearly) and very high-volume (=1000 procedures yearly) surgeons increased from 15.0% to 34.0% and 2.1% to 10.9%, respectively (P
PURPOSE: To evaluate the incidence of posterior capsule opacification after implantation of two different intraocular lenses (IOLs), AcrySof and Stabibag, by comparing the neodymium:YAG (Nd:YAG) laser capsulotomy rates. METHODS: The medical records of 596 patients (705 eyes) who underwent phacoemulsification and posterior chamber IOL implantation using either AcrySof (n = 335) or Stabibag (n = 370) IOLs during a 1-year (1999) period were reviewed. Eyes with secondary cataract, combined procedures or operative complications, such as capsule tears, were excluded from the study. The subjects' age, sex, surgeon (two surgeons), and time for Nd:YAG laser capsulotomy were recorded. RESULTS: The mean follow-up was 23 months in both IOL groups. There were no statistically significant differences within the two IOL groups regarding sex distribution or surgeon. The mean age in the AcrySof group was 77.0 years compared to 79.2 years in the Stabibag group (p = 0.001). Nd:YAG laser capsulotomy was performed in 7.6% of patients in the Stabibag group compared to 2.7% in the AcrySof group (i.e. at a significantly higher rate) (p = 0.004). Survival analyses demonstrated that age and type of IOL were the only independent predictors of the incidence of capsulotomy. CONCLUSIONS: This study shows that the frequency of eyes with posterior capsule opacification needing capsulotomy was significantly higher in eyes with Stabibag IOLs compared to eyes with AcrySof IOLs.
The aims of this study were to determine the 5-year incidence of posterior capsule opacification (PCO) requiring Nd:YAG laser capsulotomy in a representative mixed cohort of cataract patients, to determine risk factors for PCO and to investigate possible association with growth of human lens epithelial cells (HLEC) in vitro.
Pieces of the anterior lens capsule and adhering HLEC were obtained at cataract surgery and cultured individually. After one and two weeks respectively, cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester (CFDA SE), after which image processing software was used to determine the area of the confluent cell layer. The 5-year incidence of Nd:YAG laser capsulotomy in this cohort was determined through medical records and by mail or telephone interviews. For statistic analyses Mann-Whitney U-test, Fisher's exact test and binary logistic regression were used.
Data on treatment/no treatment for PCO was obtained from 270 patients with a median follow-up time of 57 months (range 50-64 months). The three-year cumulative incidence of PCO was 5.2% and the cumulative 5-year incidence was 11.9%. Patients who had undergone Nd:YAG laser capsulotomy were significantly younger (median 71 years) than patients who did not receive treatment for PCO (median 75 years, p?=?0.022). Logistic regression demonstrated that apart from younger age, follow-up time and type of intraocular lens (IOL) were associated with risk of PCO, with hydrophilic 1-piece IOLs conferring a higher risk than hydrophobic acrylic 1-piece or 3-piece IOLs (adjusted OR?=?9.4, 95% CI 2.5-35.7, p?=?0.001). Of the 270 patients from whom information could be retrieved regarding PCO treatment, in vitro cell culture could be established and quantified from 185 patients. No significant difference in cell growth in vitro was shown between patients subsequently requiring/not requiring Nd:YAG laser capsulotomy.
The cumulative 5-year incidence of 11.9% is comparable or slightly higher than reported in other recent studies. The type of IOL was the most important risk factor for PCO in this study, whereas intrinsic proliferative capacity of the individual's lens epithelial cells seems to be less important for subsequent PCO development.
Four different posterior chamber lens designs were used in 1,845 consecutive, unselected extracapsular cataract extractions performed over a 31-month period in Vejle, Denmark. Ninety-seven eyes (5.3%) required a posterior capsulotomy during a postoperative observation period ranging from two to 32 months. At 16 months postoperatively, the cumulative capsulotomy rate was 7.1% with plano-convex anterior lenses, but only 1.7% with meniscus lenses and 1.8% with continuous ridged lenses. These results suggest that close contact between the posterior capsule and the optic could induce early posterior capsule opacification.
PURPOSE: To find out whether there is a "hidden" group of patients with posterior capsule opacification (PCO) 5 years after cataract surgery and to establish the incidence of PCO. SETTING: Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden. METHODS: A random sample (n = 164) was selected among patients who had extracapsular cataract extraction (ECCE) with intraocular lens implantation in 1991 (N = 1672). All surgically treated cases that required neodymium:YAG (Nd:YAG) laser capsulotomy (n = 37) within the first 5 years after surgery were recorded. Patients still alive 5 years after surgery who had not had Nd:YAG treatment were offered an eye examination to determine whether PCO requiring capsulotomy existed. RESULTS: Thirty-seven of 110 patients (34%) alive 5 years after surgery had an Nd:YAG capsulotomy during the first 5 postoperative years. Follow-up was possible in 51 of 73 untreated patients (70%). Clinically significant PCO according to specified criteria was found in 7 cases (14%). Half of them would benefit from treatment; the other half had visual impairment from other eye disease. CONCLUSIONS: The estimated incidence of PCO 5 years after ECCE was 43%. Five years after surgery, there was an untreated group with clinically significant PCO, approximately 9% of the surgically treated population. This hidden group must be considered in PCO studies.
PURPOSE: To compare posterior capsule opacification (PCO) after phacoemulsification and implantation of heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) in the capsular bag in patients with diabetes mellitus with that in a control group. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This prospective study comprised 26 patients with diabetes mellitus and 26 control patients without diabetes. Those with glaucoma, exfoliation syndrome, uveitis, and pupil size smaller than 6.0 mm after dilation were excluded. All patients received the same standardized phacoemulsification procedure with implantation of an HSM PMMA IOL in the capsular bag. Posterior capsule opacification was scored 1 and 2 years after surgery by evaluating retroillumination images taken with a Scheimpflug camera (Nidek Anterior Eye Segment Analysis System) after pupil dilation with phenylephrine 10% and cyclopentolate 1%. The PCO density behind the IOL optic was graded clinically from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, 4 = severe) and scored using the Evaluation of Posterior Capsule Opacification medical software developing system. RESULTS: No differences in PCO were found between the diabetic and control groups 1 year after surgery. The total PCO score was significantly less in diabetic than in control eyes 2 years after surgery (P