Early corneal pachymetry maps after cataract surgery and influence of 3D digital visualization system in minimizing corneal oedema.

PURPOSE: To describe the early topography of corneal swelling occurring after cataract surgery and to evaluate the impact of the three-dimensional (3D) digital visualization system in minimizing corneal oedema. METHODS: Prospective observational, single-centre, consecutive case series of 134 patients undergoing cataract surgery performed by the same surgeon, with either 3D or conventional visualization systems. Eyes were assigned to two groups based on their anterior chamber depth (group ACD ≤3 mm and group ACD >3 mm). Optical coherence tomography was performed to evaluate postoperative corneal swelling. RESULTS: Three corneal swelling profiles were identified on the first postoperative day type 1, limited corneal oedema near peripheral corneal incisions; type 2, dome-shaped corneal swelling spreading from the principal corneal incision and reaching the paracentral cornea; type 3, continuous oedema spreading from the principal incision to central cornea, with a generalized oedema predominating in the upper part of the cornea. On the first day after surgery, in group ACD ≤3 mm, visual acuity was significantly better in patients undergoing surgery with 3D visualization (0.023 vs 0.072 logMar, p = 0.014) with reduced central corneal thickening 17.3 µm (±3.2) in comparison with conventional visualization 44.0 µm (±9.3) (p = 0.0082). In group ACD >3 mm, no significant association was found between the use of the 3D system and pachymetry changes and early visual rehabilitation. On day 21 after surgery, no significant differences in corneal pachymetry values were observed between the two surgical approaches in both groups. CONCLUSIONS: We describe early postoperative corneal map profiles providing insight into the pathogenesis of postoperative corneal swelling and possible prevention strategies. By improving visualization of the narrow surgical space in patients with shallow anterior chambers, the 3D system could help to minimize postoperative corneal oedema.

Age at onset of generalized anxiety disorder in older adults.

OBJECTIVE: The authors explored the distribution and correlates of age-at-onset of late-life generalized anxiety disorder (GAD). METHODS: Authors examined the distribution of age at onset in a sample of 67 older adults with GAD recruited for a psychotherapy study. They compared those with an early onset of symptoms (before age 50) to those with a late onset (after 50) on demographic variables and measures of psychopathology and health-related quality of life. RESULTS: There was a bimodal distribution of age at onset, with 57% reporting early onset and 43% reporting a late onset. Patients with an early onset of symptoms had a higher rate of psychiatric comorbidity and psychotropic medication use and more severe worry. Patients with a late onset of symptoms reported more functional limitations due to physical problems. CONCLUSIONS: Although most older GAD patients report an onset in childhood or adolescence, almost half develop the disorder in late life. Older adults with an early onset of GAD appear to have a more severe course, characterized by pathological worry, than those with a later onset. Role disability may be a risk factor for onset of GAD in late life.

DSM-IV criteria for generalized anxiety disorder in older adults: distinguishing the worried from the well.

This study compared 36 older adults with generalized anxiety disorder (GAD), 22 older adults with subsyndromal anxiety symptoms, and 32 normal controls on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) for GAD. GAD patients reported more frequent and uncontrollable worry, somewhat different worry content, higher prevalence of most associated symptoms, and more distress or impairment than the subsyndromal group or normal controls. Individuals with subsyndromal anxiety reported more excessive, frequent, and uncontrollable worry than asymptomatic individuals, along with more sleep disturbance, fatigue, and distress or impairment. Results indicate that the key features of late-life GAD are distress and impairment, frequency and uncontrollability of worry, muscle tension, and sleep disturbance and that clinicians treating older adults with GAD should monitor and treat residual symptoms.