Prevalence of cataract type in relation to axial length in subjects with high myopia and emmetropia in an Indian population.

PURPOSE: To compare the prevalence of different types and densities of age-related cataract in subjects with high myopia and emmetropia in an Indian urban clinic-based population. DESIGN: Prospective, observational, clinic-based case-control study. METHODS: An observational case-control study of 800 healthy eyes was undertaken at Iladevi Cataract & IOL Research Center, Ahmedabad, India. Subjects with high myopia (axial length [AXL], > or = 26.0 mm; n = 400 eyes) and those with emmetropia (AXL, 21.0 to 23.99 mm) were examined (n = 400 eyes). The type of cataract was categorized as: nuclear, cortical, or posterior subcapsular cataract (PSC). Nuclear density was measured based on the Emery and Little classification. RESULTS: In all the age groups (40 years of age or more), nuclear cataract was encountered more often in subjects with high myopia (odds ratio, 3.8; 95% confidence interval, 2.9 to 5.2; P < .001); PSC and mixed cataracts were encountered frequently in subjects with emmetropia (P < .001). Prevalence of nuclear cataract was higher in subjects with high myopia with increasing AXL when compared with other types of cataract (P < .001). In all the age groups, the nuclear density was significantly higher than grade 3 in subjects with high myopia when compared with those with emmetropia (P < .001 in those younger than 70 years; P = .003 in those older than 70 years). CONCLUSIONS: Nuclear cataract was associated strongly with high axial myopia. The density of the cataract was higher in the high myopia group. No association was observed between PSC or cortical cataract and high axial myopia.

Preoperative prediction of posterior capsule plaque in eyes with posterior subcapsular cataract.

AIM: To determine whether the plaque on the posterior capsule can be predicted preoperatively, in patients with posterior subcapsular cataract (PSC), undergoing cataract surgery. MATERIALS AND METHODS: A prospective study of 140 consecutive eyes with PSC, who underwent cataract surgery, was conducted. The prediction of preoperative presence or absence of plaque within the PSC was noted on slit lamp examination, in dilated pupils. A single observer made the observations under oblique illumination, where the slit lamp was placed at an angle of 30 degrees to 45 degrees. Evaluation of the plaque through slit lamp examination was standardized in terms of illumination and magnification. The observations were recorded using a video camera (Image archiving system, Carl Zeiss, Jena Germany) attached to a slit lamp (Carl Zeiss, SL 120 Jena, Germany), keeping the illumination at 100%. The prediction of plaque was noted in terms of its presence or absence on the posterior capsule. All the patients received counseling regarding the presence of plaque. Capsule polishing of the posterior capsule in Cap Vac mode, was done in all cases. The posterior capsule was examined for presence or absence of plaque, either on the first postoperative day, or within a week, with maximal mydriasis. The observer's results were tabulated and later analyzed to judge the incidence of predictability of plaque in PSC. RESULTS: The mean age of the patients was 45+/-6.2 years (range 32-61 years); 104 (74.3%) were males. One hundred and eight (77.1%) patients were under 50 years. The presence or absence of plaque was predicted correctly in 124 (88.6%) eyes. The prediction of plaque was incorrect in 16 (11.4%) eyes. CONCLUSION: The prediction of presence or absence of plaque was accurate in 88.6% cases. We believe that counseling patients with posterior capsule plaque before the surgery is the key to avoiding unpleasant surprises.

Management of congenital bilateral subluxated cataract with Cionni ring.

Use of Cionni ring helped in the successful intraocular lens (IOL) implantation in a 30-year-old patient with bilateral congenital subluxated cataracts. The IOL was stable, well-centered without any iridodonesis or pseudophakodonesis.

Cataract surgery in relative anterior microphthalmos.

PURPOSE: To determine the prevalence of relative anterior microphthalmos (RAM) and evaluate intraoperative performance and surgical outcome in eyes with RAM undergoing cataract surgery. DESIGN: Nested case-control series. PARTICIPANTS: One thousand four hundred consecutive patients undergoing cataract surgery were evaluated to determine the prevalence of RAM. Relative anterior microphthalmos is defined as horizontal corneal diameter (HCD) < or =11 mm, anterior chamber depth (ACD) < or =2.2 mm, and axial length (AL) >20 mm, with no other morphologic malformation. METHODS: Patients were examined preoperatively for HCD, ACD, and AL. Horizontal corneal diameter was measured with calipers. Anterior chamber depth and AL were measured with immersion shell with water. Associated ocular pathologic conditions were recorded. Two control groups were identified. Group I (normal eyes; n = 84) had HCD >11 mm, ACD >2.2 mm, and AL >20 mm. Group II (eyes with small corneal diameter; n = 84) had HCD < or =11 mm, ACD >2.2 mm, and AL >20 mm. MAIN OUTCOME MEASURES: Patients with RAM and controls were evaluated for intraoperative performance and postoperative outcome. The 2-tailed Fisher exact test was applied to compare the performance of RAM with each of the control groups. The odds ratio (OR) with 95% confidence intervals (95% CI) was determined. RESULTS: The prevalence of RAM was 6% (84 of 1400 eyes; 95%CI, 0.048-0.074). Relative anterior microphthalmos was associated with the presence of small pupil, 34 (40.48%); corneal guttae, 31 (36.9%); glaucoma, 29 (34.5%); and pseudoexfoliation, 6 (7.14%). Intraoperatively, RAM was associated with overall surgical difficulty because of less working space in 59 eyes (70.24%; OR, 63.7; 95% CI, 18.3-221; P<0.001) compared with control groups I and II; uveal trauma in 12 (14.28%); Descemet's detachment in 5 (5.95%); and posterior capsule rupture in 2 (2.38%). Postoperatively, RAM was associated with transient corneal edema in 63 eyes (75%; OR, 9.0; 95% CI, 4.4-18.0; P<0.001; OR, 5.4; 95% CI, 2.7-10.5; P<0.001) on the first postoperative day. CONCLUSIONS: The prevalence of RAM was 6%. Relative anterior microphthalmos with its associations posed significant intraoperative difficulties. The occurrence of transient corneal edema was frequent.