Are Elderly Patients Optimally Corrected with Spectacles in the Longer Term after Cataract Surgery?

SIGNIFICANCE: Our study suggests that patients would benefit from adjusting their distance spectacles several years after cataract surgery. This may lead to a better quality of life for these patients. PURPOSE: The purpose of this study was to determine whether patients' distance vision is optimally corrected with spectacles 6 to 7 years after cataract surgery and whether patients with glaucoma who regularly visit an ophthalmologist have more correct power in their spectacles. METHODS: A total of 153 patients (153 eyes) who underwent cataract surgery with phacoemulsification at Oslo University Hospital were examined 6 to 7 years after surgery. Patients with better or equal best-corrected distance visual acuity in the study eye compared with the other eye were included (n = 90; 59%). Vision-related outcomes were measured and analyzed, including a modified version of the visual function questionnaire, Visual Function-14 (VF-14). RESULTS: A significant difference was found in the logMAR score between the patients' habitual correction (if any) and those with best-corrected distance visual acuity measured at the postoperative study examination (0.20 ± 0.40 and 0.10 ± 0.39, respectively; P < .0001). Patients with glaucoma (n = 17) did not have more correct power of their spectacles than did patients without glaucoma (n = 73; P = .38). The overall mean VF-14 score was 89%, with a statistically significant correlation between a high VF-14 score and a good habitual distance correction (r = -0.82; P < .0001). CONCLUSIONS: This study indicates that, although the patients are quite satisfied with their visual function 6 to 7 years after cataract surgery, many patients are not making the most of their visual potential. Thus, there seems to be a need for better monitoring of patients' distance refraction and spectacle use for an extended period after cataract surgery.

Collagen crosslinking with conventional and accelerated ultraviolet-A irradiation using riboflavin with hydroxypropyl methylcellulose.

PURPOSE: To evaluate corneal collagen crosslinking (CXL) with conventional and accelerated ultraviolet-A (UVA) irradiation using riboflavin with methylcellulose. SETTING: Department of Ophthalmology, Oslo University Hospital, Oslo, Norway. DESIGN: Prospective randomized case series. METHODS: Patients with keratoconus were randomized to have CXL using conventional 3 mW/cm2 UVA irradiation for 30 minutes (CXL30) or accelerated 9 mW/cm2 UVA irradiation for 10 minutes (CXL10). In both groups, a solution of riboflavin 0.1% with hydroxypropyl methylcellulose 1.1% (methylcellulose-riboflavin) was used. The endothelial cell density (ECD), visual acuity, and tomography were measured at baseline and after 12 months. Anterior segment optical coherence tomography and in vivo confocal microscopy (IVCM) were performed after 1 month. RESULTS: The study comprised 40 patients (40 eyes). A complete absence of keratocytes in all eyes at 100 µm depths was found on IVCM. At 300 µm, 400 µm, and preendothelial levels, the differences were 83.3% versus 31.3% (P = .02), 64.7% versus 20.0% (P = .01), and 42.1% versus 5.9% (P = .02) in the CXL30 and CXL10 groups. No statistically significant differences were found in the change in visual acuity or maximum keratometry between the groups after 12 months. There was no relationship between the depth of keratocyte absence and the ECD change after 12 months. CONCLUSIONS: Marked deep structural changes with an absence of keratocytes occurred when CXL was used with conventional or accelerated UVA irradiation; however, the changes were more pronounced with the use of conventional UVA irradiation. The use of methylcellulose-riboflavin might explain the deep alterations and raises a long-term safety concern.

Glaucoma and Intraocular Pressure in Patients Operated for Late In-the-bag Intraocular Lens Dislocation: A Randomized Clinical Trial.

PURPOSE: To compare intraocular pressure (IOP) and IOP-lowering treatment requirements in patients with late in-the-bag intraocular lens (IOL) dislocation operated with 2 different methods, and to assess whether an IOP decrease after surgery can be expected. DESIGN: Prospective, randomized, parallel-group clinical trial. METHODS: In our university clinic, 104 patients (eyes) were randomly assigned to IOL repositioning by scleral suturing (n = 54) or IOL exchange with a retropupillar iris-claw lens (n = 50). The main outcome measure was 6-month postoperative IOP change. RESULTS: Overall IOP was 18.0 ± 6.2 mm Hg before surgery and 15.7 ± 4.8 mm Hg 6 months after surgery (P < .001). IOP changed by -1.2 ± 5.8 mm Hg (P = .18) in the Repositioning group and -3.8 ± 6.4 mm Hg (P < .001) in the Exchange group (group difference: P = .05). Before surgery, 62 patients had either preexisting glaucoma (n = 39) or high IOP (≥22 mm Hg) with suspected glaucoma (n = 23), of whom several required preoperative IOP-lowering treatment. In the postoperative period, 28% and 21% of the patients in each operation group, respectively, required IOP-lowering treatment with glaucoma medications added, adjunctive laser trabeculoplasty, cyclodiode laser, or filtering surgery. Only 0 and 3 patients, respectively, discontinued their IOP-lowering medication. CONCLUSIONS: This trial showed an IOP decrease after late in-the-bag IOL dislocation surgery that seemed to be more pronounced with IOL exchange. However, associated high IOP was not resolved by dislocation surgery in many patients, and increased IOP-lowering treatment in the postoperative course was commonly required.

Late In-the-Bag Intraocular Lens Dislocation: A Randomized Clinical Trial Comparing Lens Repositioning and Lens Exchange.

PURPOSE: To compare the efficacy and safety of 2 operation methods for late in-the-bag intraocular lens (IOL) dislocation. DESIGN: Prospective, randomized, parallel-group surgical trial. PARTICIPANTS: Patients referred to Oslo University Hospital (tertiary referral center). METHODS: We randomly assigned 104 patients (104 eyes) either to IOL repositioning by scleral suturing (n = 54) or to IOL exchange with retropupillary fixation of an iris-claw IOL (n = 50). One surgeon performed all operations. Patients were evaluated comprehensively before surgery, and most patients (82%) attended an examination 6 months after surgery. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA) 6 months after surgery. RESULTS: The mean postoperative BCVA was 0.24±0.29 logarithm of the minimum angle of resolution (logMAR) units (range, -0.18 to 1.16 logMAR) in the repositioning group and 0.35±0.54 logMAR (range, -0.20 to 3.0 logMAR) in the exchange group (P = 0.23). A BCVA of 20/40 or better (Snellen) was reached by 61% and 62% of the patients, respectively (P = 0.99). The mean postoperative corneal cylinder was 1.2±1.0 and 1.2±0.8 diopters, respectively (P = 0.84), and the postoperative endothelial cell density changes were -3±10% (P = 0.07) and -10±14% (P = 0.001), respectively (group difference, P = 0.04). Repositioning had a longer mean surgical time than exchange (P < 0.001). There were 2 (4%) and 0 cases of perioperative fluid misdirection syndrome, respectively. Postoperative complications were intraocular pressure (IOP) increase (n = 12), cystoid macular edema (CME; n = 3), and nonarteritic anterior ischemic optic neuropathy (n = 1) in the repositioning group, and IOP increase (n = 9), pupillary block (n = 1), choroidal effusion (n = 2), CME (n = 4), and redislocation (n = 1) in the exchange group. CONCLUSIONS: We found satisfactory and not significantly different outcomes for BCVA 6 months after surgery in the 2 groups. Both operation methods seemed safe, with low frequencies of serious perioperative and postoperative complications. However, some of the observed differences in complications should be taken into consideration when selecting the most suitable method in clinical practice.

Does cataract surgery reduce the long-term risk of glaucoma in eyes with pseudoexfoliation syndrome?

PURPOSE: To compare glaucoma development and intraocular pressure (IOP) in the longer term following phacoemulsification cataract surgery in eyes with and without pseudoexfoliation syndrome (PEX). METHODS: Fifty-one patients with PEX were compared with 102 age- and gender-matched controls without PEX. Patients were re-examined a mean of 76 (SD 5.4) months after cataract surgery, recording IOP, glaucoma diagnosis, glaucoma treatment and LogMAR. Data from the preoperative visit (baseline) and IOP on the first postoperative day were obtained from medical records. A glaucoma parameter was predefined as patients developing glaucoma or needing increased glaucoma treatment during the postoperative time period. RESULTS: One new glaucoma case in each group was diagnosed postoperatively, yielding glaucoma incidences of 0.47 cases per 100 person-years [95% confidence interval (CI) 0.006-2.61] and 0.17 cases per 100 person-years (CI 0.002-0.95) in the PEX and control groups respectively (p = 0.53). IOP declined by 2.6 (SD 4.0) mmHg in the PEX group (p < 0.001) and 1.9 (SD 3.5) mmHg in the control group (p < 0.001) from baseline to the re-examination, with a non-significant group difference (p = 0.310). IOP spike (≥6 mmHg increase) was significantly associated with the glaucoma parameter, both within the PEX (p = 0.034) and the control group (p = 0.044). CONCLUSION: The number of newly diagnosed glaucoma cases was lower than expected 6-7 years following cataract extraction, especially in the PEX group, which indicates that PEX eyes benefit particularly from cataract surgery in terms of IOP and glaucoma development.

Does Corneal Collagen Cross-linking Reduce the Need for Keratoplasties in Patients With Keratoconus?

PURPOSE: To investigate whether the introduction of corneal collagen cross-linking (CXL) influences the frequency of keratoplasties in patients with keratoconus. METHODS: Data were obtained from a cohort of patients from our corneal transplant registry. Two different periods were compared, 2005 to 2006 (period 1) and 2013 to 2014 (period 2). Patients during period 1 had surgery before the introduction of CXL treatment, and patients in period 2 had surgery after this treatment was well established in our department. Age and gender were registered, and the Amsler-Krumeich classification system was applied to grade the degree of keratoconus. RESULTS: The total number of keratoplasties performed during period 1 was 137, and keratoconus was the cause of surgery in 55 eyes (55 patients). The corresponding numbers in period 2 were 231 and 26 eyes (26 patients), respectively. The difference in the number of keratoplasties for keratoconus in both periods was statistically significant (P = 0.003). There were no significant differences in the distributions of age and gender between both periods. In period 1, 63.6% of the eyes were graded as stage 4 in the Amsler-Krumeich classification, compared with 96.2% in period 2 (P = 0.001). CONCLUSIONS: The frequency of keratoplasty for keratoconus has been more than halved in our department over the last decade. There is reason to believe that this reduction is for a great part caused by the introduction of CXL treatment.

Posterior capsular opacification in patients with pseudoexfoliation syndrome: a long-term perspective.

PURPOSE: To compare posterior capsular opacification in patients with and without pseudoexfoliation syndrome 6-7 years following surgery. METHODS: Forty-four eyes of 44 patients with pseudoexfoliation syndrome who underwent cataract surgery with phacoemulsification in 2001 and 2002 were available for follow-up in 2008. These patients were compared to 86 age- and gender-matched patients (86 eyes) without pseudoexfoliation syndrome who had surgery during the same time period. Posterior capsule opacification was assessed using digital retroillumination photography. The images were analysed with a software program (POCOman) to determine the extent and severity of the capsular opacification. RESULTS: Percentage and severity of posterior capsular opacification within the central 4.0 and 1.3 mm of the optical zone were compared in eyes with and without pseudoexfoliation syndrome. Neither of these results were statistically significant. Before the re-examination in 2008, neodymium:yttrium-aluminium-garnet laser posterior capsulotomy had been conducted in 16% (n = 7) of eyes with pseudoexfoliation syndrome, as well as in 16% (n = 14) of eyes without pseudoexfoliation syndrome. CONCLUSION: Our study indicates that, with phacoemulsification, development of long-term posterior capsular opacification is not increased in patients with pseudoexfoliation syndrome after uncomplicated cataract surgery.

Endophthalmitis following cataract surgery: the role of prophylactic postoperative chloramphenicol eye drops.

PURPOSE: The main aim of the study was to assess whether omitting prophylactic postoperative topical antibiotics (chloramphenicol) influenced the risk of developing endophthalmitis after cataract surgery. METHODS: We conducted a retrospective study including all patients who had cataract surgery at our outpatient cataract unit between 2004 and 2011. Postoperative topical antibiotics (chloramphenicol) were omitted from 2007 onwards, as was the first postoperative day review. Patients with a diagnosis of endophthalmitis after cataract surgery were extracted, and the rate of postoperative endophthalmitis (PE) before and after changing these routines was compared. The diagnosis of PE was defined as severe intraocular inflammation requiring prompt vitreous sampling for culture. RESULTS: Seven thousand one hundred and twenty-three and 8131 cataract surgeries were performed in the following periods: January 2004 through December 2006 (period 1) and January 2007 through December 2010 (period 2), respectively. Five cases of PE were identified in period 1 (0.070%) and four patients in period 2 (0.049%). The median time between cataract surgery and onset of symptoms was 6 days in period 1 and 4.5 days in period 2. Median time for intervention was 7 and 5 days postsurgery, respectively. CONCLUSION: We found no difference in the frequency of PE following cataract surgery when changing the postoperative topical medication from a mixture of corticosteroids and antibiotics to only corticosteroids.