Functional complaints, visual acuity, spatial contrast sensitivity, and glare disability in preoperative and postoperative cataract patients.

PURPOSE: To quantify cataract patients' functional visual complaints and correlate them with their objective glare disability and spatial contrast sensitivity (SCS) scores. SETTING: Sir Mortimer B. Davis Jewish General Hospital. Montreal, Quebec, Canada. METHODS: Thirty patients scheduled for cataract surgery with a visual acuity of 20/70 or better at the time of patient selection and no other ocular pathology were evaluated objectively and subjectively for visual function preoperatively and within 3 months postoperatively. Objective measures of SCS and visual acuity in the presence and absence of glare were obtained with the Optec 3000 vision tester. Subjective visual function was evaluated with the Activities of Daily Vision Scale (ADVS), a questionnaire that evaluates patients' visual function by assessing the degree of difficulty they experience in performing tasks involving distance vision, near vision, and glare conditions. RESULTS: Preoperatively, patients had decreased visual acuity and SCS in the presence of glare. The ADVS scores were correlated with visual performance. Postoperatively, there was a statistically significant improvement in all dependent measures (i.e., visual acuity and SCS in the presence of glare) as well as in the subjective report of visual performance assessed by the ADVS. CONCLUSION: Spatial contrast sensitivity, glare disability, and the ADVS questionnaire should be considered as adjuncts to visual acuity testing in evaluating certain cataract patients.

Epidemic Bacillus endophthalmitis after cataract surgery I: acute presentation and outcome.

OBJECTIVE: The purpose of the study is to report the clinical outcome of acute Bacillus endophthalmitis after cataract surgery. DESIGN: The study design is a cohort study. PARTICIPANTS: Fourteen eyes of 14 patients with epidemic acute postoperative inflammation after exposure to bacteria-contaminated viscoelastic material were studied. INTERVENTION: Three patients with milder clinical presentations were treated without vitrectomy or antibiotics. Eleven patients with more severe infection were treated with vitrectomy as well as intravitreous and topical fortified antibiotics. MAIN OUTCOME MEASURES: Final visual acuities were obtained in all 14 study patients. Results of microbiologic studies of aqueous and vitreous specimens from 11 vitrectomized eyes also were analyzed. RESULTS: One patient with late presentation had severe inflammation and had phthisis bulbi develop with no light perception. The remaining 13 patients had successful resolution of inflammation after treatment by 1 month of follow-up. Twelve of these 13 patients, including 1 nonvitrectomized patient, had final visual acuities of 20/100 or better at 6 months' follow-up. Six patients, including two patients with nonvitrectomized eyes, had outcomes of 20/40 or better visual acuity. Bacillus species were grown from all 11 (100%) vitreous and 7 (88%) of 8 aqueous specimens obtained from vitrectomized patients, as well as from the contaminated viscoelastic material remaining in the operating room. CONCLUSIONS: Postoperative Bacillus endophthalmitis need not result in poor outcome. Results depend on factors including bacterial load, specific bacterial species, timing of treatment, and immune status of the patient.

Glare disability and contrast sensitivity before and after cataract surgery.

PURPOSE: To determine whether brightness-induced glare decreases spatial contrast sensitivity and visual acuity in preoperative cataract patients with functional visual complaints and to compare preoperative with postoperative results. SETTING: Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada. METHODS: Twenty patients with a visual acuity of 20/70 or better at the time of chart selection and no other ocular pathology who were referred for cataract surgery were evaluated with the Optec 3000 vision tester to assess contrast sensitivity and visual acuity in the presence and absence of glare. Testing was done preoperatively and 1 and 3 months postoperatively. RESULTS: An analysis of variance indicated that there were statistically significant double interactions between the preoperative/postoperative and glare/no-glare variables and between the preoperative/postoperative and spatial frequency variables. Postoperatively, visual acuity and contrast sensitivity improved to within normal limits. There were no statistically significant differences in visual acuity and spatial contrast sensitivity between 1 and 3 months postoperatively. CONCLUSION: Spatial contrast sensitivity and glare testing provided objective assessment of patients who had good visual acuity yet also had functional complaints.

Ocular reaction to the use of wet-pack versus dry-pack intraocular lenses.

This study confirms preliminary indications that dry-pack sterilized lenses cause a more marked anterior chamber reaction than wet-pack sterilized lenses during the immediate post-op period. After the first two weeks, this difference is not evident.

Pseudophakic bullous keratopathy. A clinical-pathologic analysis.

Of 226 patients who had an intraocular lens implanted over a three year period, 6.2% developed bullous keratopathy compared with 2.2% of 90 patients who had a standard cataract extraction performed by the same surgeon. An additional 4.0% of the lens implant patients developed peripheral or intermittent corneal edema. The factors related to the higher incidence of this complication in lens implant patients included corneal touch during implantation, prolonged postoperative iritis and, in cases of mild or peripheral corneal edema without bullous keratopathy, recurrent lens dislocation. The most consistent pathologic findings in 10 corneas that required keratoplasty were epithelial edema and loss of corneal endothelium. Means to prevent this complication are discussed.