Risk factors for posterior capsule rupture in mature cataract surgery: A study of 1302 cases

Purpose: To identify the risk factors predisposing posterior capsule rupture (PCR) during mature cataract surgery. Methods: A total of 1302 consecutive mature cataract cases were included in this retrospective study. A detailed examination was performed for each patient and risk factors including age, gender, systemic diseases, ocular comorbidities, surgeon, and surgery method were recorded. Cases with PCR during surgery were classified as complicated. Multivariate logistic regression analysis with a generalized estimating equations method was applied for statistical analysis. Results: The overall rate of PCR was 7.30% (n=95 eyes). After adjusting for confounders, factors that remained significant on multivariate analysis were strabismus (odds ratio [OR]: 5.70, 95% confidence interval [CI]: 2.17–14.97; P < 0.001), phacodonesis (OR: 4.62, 95% CI: 2.59–8.22; P < 0.001), history of trauma (OR: 4.46, 95% CI: 1.64–12.12; P = 0.003), surgery method (extracapsular cataract extraction/phacoemulsification) (OR: 2.61, 95% CI: 1.60–4.26; P < 0.001), and pseudoexfoliation (OR: 1.94, 95% CI: 1.20–3.16; P = 0. 007). Conclusion: Strabismus, phacodonesis, history of trauma, extracapsular cataract extraction method, and pseudoexfoliation were found to be important risk factors for developing PCR. Appropriate preoperative and perioperative precautions for these higher?risk cases can reduce complications

The study of demographic profile of patients of senile mature cataract attending the eye OPD of GMC Jammu, India

Background: Age related cataract also called as senile cataract is the commonest type of acquired cataract affecting people over the age of 50 years. In developing countries like India, many times patients with cataract report to the hospitals very late, when it has become mature. Keeping this in mind this study was undertaken to study the demographic profile of patients of senile mature cataract attending the OPD of GMC Jammu and to see if there is correlation between demographic factors and time of seeking medical attention.Methods: This study was conducted on 41 patients of senile mature cataract who attended OPD of GMC Jammu from August 2019 to November 2019. All patients were subjected to detailed history taking and ocular examination. Socio-economic status and education level of all patients was assessed. All patients were admitted and underwent cataract surgery with IOL implantation.Results: In study the mean age of patients was 62.46 years with 58.53% patients being females. Majority of patients were from rural background with low socio-economic status and low education levels.Conclusions: From this study we concluded that female sex, low socio-economic status, comorbidities and lower literacy levels are associated with patients seeking medical attention for cataract at an advanced stage.

Visual Prognosis and Satisfaction of Advanced Cataract Patients Unable to be Evaluated by Fundus Imaging

PURPOSE: We evaluated the surgical prognoses of patients with advanced cataract who were unable to be evaluated by fundus imaging and their satisfaction with daily life.METHODS: We retrospectively reviewed 748 eyes of 480 patients who underwent cataract surgery from January 2015 to December 2017. Preoperative factors, surgical technique, degree of cataract, and the best-corrected visual acuity for 1 and 6 months after surgery were analyzed. Among 91 eyes of 78 patients with advanced cataract who were unable to be evaluated by fundus imaging, the degree of discomfort before surgery and postoperative satisfaction were evaluated.RESULTS: Hypertension was positively correlated with visual acuity after cataract surgery (p = 0.004). Low corneal endothelial cell count, primary open-angle glaucoma, a history of trabeculectomy due to glaucoma, corneal dystrophy or corneal opacity, advanced cataract unable to be evaluated by fundus imaging, hypermature cataract, extracapsular cataract extraction, and intracapsular cataract extraction and visual acuity <0.5 after 1 month showed negative correlations with the visual outcomes after 6 months (p = 0.019, p = 0.002, p = 0.037, p = 0.001, p = 0.004, p = 0.012, p = 0.00, and p = 0.00, respectively). The risk of a final visual acuity <0.5 after cataract surgery was 3.18-fold higher in cases of advanced cataract, unable to be evaluated by fundus imaging (p = 0.003). Ten patients with 10 eyes postponed surgery due to poor prognoses, which was expected, and six patients (60%) had a best-corrected visual acuity <0.5 after 6 months. Six patients (60%), expected to have a poor prognosis were satisfied after surgery and the postoperative satisfaction was high when compared with a poor visual outcome.CONCLUSIONS: Poor surgical prognoses were expected in advanced cataract patients unable to be evaluated by fundus imaging. However, advanced cataract patients, who postponed surgery due to an unfavorable visual prognosis, showed a higher subjective satisfaction when compared with the postoperative visual acuity.

A Study of Profile of Patients with Cataract.

Background: Cataract blindness is a public health problem of major proportions in developing countries. Intra capsular cataract extraction with aphakic spectacles has been the standard surgical technique for restoring sight. Cataracts, the world's leading cause of blindness, are an enormous public health problem in both developing and industrialized countries. Objective: To study clinical profile of patients with cataract. Methods: After applying inclusion and exclusion criteria as well as after ethical consideration only patients having cataract were included in the study. In this way, it was possible to include the 1000 patients over a period of two years. Present study was hospital based cross sectional study. A pre tested, semi structured questionnaire was used to collect the data. Complete detailed history was taken as per the questionnaire. Thorough clinical examination was carried out. The collected data was entered in Microsoft Excel Sheet and analyzed with the help of proportions. Results: The prevalence of cataract was highest in the age group of 51-60 years i.e. 45.1%. The most common prevalent type of cataract was found to be mature cataract in 50.5% of cases followed by hyper-mature cataract in 34.7% of cases. The overall incidence of capsular rupture was 4.7%. Highest incidence of capsular rupture was seen in complicated cataract followed by intumescent cataract. Incidence of vitreous loss was most commonly present in intumescent cataract followed by complicated cataract. 51% of patients recovered to normal vision of 6/6. 41.2% of patients had corrected vision from 6/60 to 6/18. Conclusion: The prevalence of cataract is common above 50 years of age. The patients reporting to the hospital for the complaint of loss vision commonly have mature or hyper-mature cataract. Complications are less in the mature and hyper-mature type of cataract.

Clinical Results after Phacoemulsification in Mature Cataract

PURPOSE: To evaluate the clinical results after phacoemulsification in mature and immature cataracts. METHODS: Mature cataract was defined as a classification of C5 by Lens Opacities Classification System III compared with other types of cataracts as controls. The present study included 37 (37 eyes) patients diagnosed with mature cataracts that received phacoemulsification and were followed up for at least 1 year. Thirty-seven (37 eyes) patients with other types of cataracts were selected randomly as controls. Intraoperative factors and rate of complications during and after surgery were evaluated. Best corrected visual acuity (BCVA), corneal endothelial cell density and central macular thickness (CMT) were measured during the 1 year of follow-up and compared with the controls. RESULTS: Twenty-seven eyes (mature cataracts) and 36 eyes (controls) received a complete continuous curvilinear capsulorhexis (CCC). The success rate of complete CCC was significantly high in the control eyes (p = 0.025). However, in mature cataract patients, 3 cases of posterior capsule rupture occurred among the 6 cases of radial tear of the anterior capsule, resulting in implantation of the lens in the sulcus. Posterior capsular ruptures were observed in 4 patients with mature cataracts and in 1 control with no statistically significant difference in the occurrence rate. Total phacoemulsification time and effective phacoemulsification time were significantly longer in the mature cataract patients (p = 0.038 and p = 0.041, respectively). BCVA, the amount of corneal endothelial cell density reduction and CMT at postoperative 1 year was not different between the two groups. CONCLUSIONS: The success of complete CCC was a significant factor for the occurrence of intraoperative complications in mature cataract surgery. Based on the clinical results, the mature cataract patients and controls had a similar visual prognosis.

Surgical outcome of phacofragmentation and phacoemulsification in senile white mature cataract.

Purpose : To compare the effectiveness and safety of phacofragmentation and phacoemulsification techniques on senile white mature cataract. Methods : Prospective, double masked, randomized study comprises 32 eyes of senile white mature cataract randomly divided into 2 groups, 16 eyes had phacofragmentation (group I) and 16 eyes had phacoemulsification (group II). The evaluated safety parameters were pupil diameter pre surgery and prior to intra ocular lens (IOL) implantation, corneal thickness and flaremeter. Nucleus delivery, uncorrected visual acuity (UCVA) and surgically induced astigmatism (SIA) were the effectiveness parameters. Follow-up were scheduled for post-operative day 1,7,15 and 30. Results : prior to the surgery there were no significant differences in age, visual acuity, corneal thickness and flaremeter between two groups. Pre surgical and prior to IOL implantation mean pupilarry diameters in both groups were not significantly different. There was no significant difference in pupillary constriction on both groups. The mean of time to deliver the nucleus was significantly longer in the group II (4.38±2.51 min) than in the group I (1.98±1.61 min). There was significant difference on UCVA (p= 0.00067) and corneal thickness (p=0.0044) only on the first post-operative day. However, there was no significant difference on further evaluations (p>0.05). There were also no significant difference on flaremeter and SIA during follow -up. Conclusion : Both phacofragmentation and phacoemulsification techniques were effective and safe for cataract surgery on senile white mature cataract. Phacofragmentation technique therefore could be an alternative small incision cataract surgery.