Visual Prognosis and Associated Factors of Phacoemulsification and Intraocular Lens Implantation in Different Uveitis Entities in Han Chinese.

PURPOSE: To address the visual prognosis and associated predictors of phacoemulsification and intraocular lens implantation in different uveitis entities in Han Chinese. METHODS: A retrospective review of the uveitis patients who underwent phacoemulsification and intraocular lens implantation in our center between 2004 and 2014. RESULTS: The 158 patients (226 eyes) included anterior uveitis (45 eyes), posterior/pan-uveitis (61 eyes), Vogt-Koyanagi-Harada disease (79 eyes) and Behçet disease (41 eyes). At 6 months after surgery, best-corrected visual acuity (BCVA) significantly improved (p < 0.001) in all uveitis groups with 134 (59.3%) eyes achieving 20/40 or better. The anterior uveitis and Behçet disease groups had significantly better and worse visual outcomes than other groups, respectively. Poor preoperative BCVA, macular lesions, and secondary glaucoma were independent variables that predicted a poor visual outcome. CONCLUSIONS: Our current study revealed a generally favorable outcome and associated predictors of phacoemulsification and intraocular lens implantation in uveitic cataracts in Han Chinese.

Long-term change in intraocular pressure after extracapsular cataract extraction with posterior chamber intraocular lens implantation versus phacoemulsification with posterior chamber intraocular lens implantation in Indians.

PURPOSE: The purpose of the study is to evaluate the long-term changes in intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation versus phacoemulsification with PCIOL implantation in otherwise normal cataract patients in India. MATERIALS AND METHODS: The study was conducted in the Department of Ophthalmology, King George's Medical College, Lucknow between August 2000 and August 2001. One hundred and seventeen eyes of 115 patients were included in the study. 84 patients were randomly selected for ECCE with PCIOL implantation (ECCE group) and 31 patients were selected for phacoemulsification with PCIOL implantation (Phaco group). IOP was measured pre-operatively and post-operatively, from the 1(st) month to the 12(th) month. Statistical significance was indicated by P > 0.05. RESULTS: There was a mean fall in IOP of 2.70 mm Hg (19.74%) in the ECCE group and 2.74 mm Hg (20.57%) in the phaco group. The decrease in the mean post-operative IOP from baseline was statistically significant (P > 0.01) at the end of 2 months in both groups. There was no statistically significant difference in post-operative IOP at any visit between groups (P < 0.05, all post-operative visits). After 4(th) monthpost-operatively, the IOP was mostly stable, but it was significantly lower than the pre-operative IOP. CONCLUSION: Significant IOP reduction may be expected after cataract surgery with either ECCE or phacoemulsification with IOL implantation. The lowering of IOP became statistically significant at about 2 months post-operatively, but became almost stable after the 4(th) month.

Pseudophakic rhegmatogenous retinal detachment in a large Asian tertiary eye centre: a cohort study.

BACKGROUND: To determine the incidence and identify risk factors for the development of rhegmatogenous retinal detachment in patients who had cataract surgery at the Singapore National Eye Centre between 2001 and 2003. DESIGN: Retrospective case-control study. PARTICIPANTS: All patients who had cataract surgery between 2001 and 2003 and subsequently retinal detachment surgery in the same eye, between 2001 and June 2008, at Singapore National Eye Centre. METHODS: Review of case records. MAIN OUTCOME MEASURES: Incidence of posterior capsular rupture and retinal detachment. RESULTS: Thirty-nine eyes, out of 24 846 cataract operations performed between 2001 and 2003, developed rhegmatogenous retinal detachment in the follow-up period from 2001 to 2008 (cumulative incidence 0.16%, 95% confidence interval 0.11-0.21%). Of the 508 eyes with posterior capsular rupture during cataract surgery, nine developed retinal detachment (cumulative incidence 1.77%, 95% confidence interval 0.87-3.23%). Men were more likely to develop retinal detachment (P < 0.001). On Kaplan-Meier survival analysis, younger patients had a higher probability of retinal detachment in comparison with older subjects (P < 0.001). Similarly, eyes with posterior capsular rupture during surgery had shorter interval duration to retinal detachment, compared with eyes that did not (P = 0.002). When compared with patients more than 70 years of age, younger patients had significantly higher hazard ratios of retinal detachment (hazard ratio 19.7, 95% confidence interval 3.6-107.3, P < 0.05). CONCLUSION: The incidence of pseudophakic retinal detachment in our institution is low. Posterior capsular rupture during surgery, men and younger age at time of surgery increases the risk of developing retinal detachment, and careful observation for the occurrence of retinal detachment may be warranted in these groups of patients.

Refractive shift in pseudophakic eyes during the second decade of life.

PURPOSE: To evaluate the refractive shift in pseudophakic eyes of children after their 10th birthday. SETTING: Storm Eye Institute, Charleston, South Carolina, USA. DESIGN: Case series. METHODS: One eye of each patient with at least 2 refractions at a minimum of a 1-year interval after the 10th birthday was analyzed. RESULTS: One hundred fourteen pseudophakic eyes (114 patients) were identified. The mean initial refraction was -0.65 diopter (D) ± 2.27 (SD) and the mean final refraction, -1.78 ± 2.82 D. The mean shift in refraction was -1.13 ± 1.36 D; the mean shift in refraction per year was -0.30 ± 0.38 D. Postoperative refraction could be predicted by regression analysis (P<.001). There was a myopic shift in refraction in 86.8% of eyes; 64.0% of eyes had up to a 0.50 D myopic shift per year. Age at the time of intraocular lens (IOL) implantation (before or after 10 years of age) did not influence the refractive shift in pseudophakic eyes of children after their 10th birthday. However, the refractive shift was significantly different between black patients and white patients (P=.006). In unilateral cases, 27 eyes had refraction data available for the fellow eye. The mean refractive shift per year was -0.19 D in the operated eye and -0.22 D in the fellow eye (P=.67). CONCLUSION: A myopic shift in refraction continued in children after 10 years of age, which has important implications for the use of multifocal IOLs in preteens and teenagers and for IOL power selection.

Visual function and subjective quality of life in Chinese cataract patients after implantation with aspheric intraocular lenses.

PURPOSE: To evaluate and compare the objective and subjective visual function after implantation of 2 aspheric intraocular lenses (IOLs) in Chinese cataract patients. METHODS: Forty-one eyes of 28 patients with cataract were randomly assigned to receive either the MC X11 ASP IOL or the AcrySof IQ IOL. Three months postoperatively, best-corrected visual acuity (BCVA), contrast sensitivity, wavefront aberrations, and subjective visual quality were measured. The degree of posterior capsule opacification (PCO) was recorded at last follow-up. RESULTS: Postoperative mean monocular BCVA was 0.05±0.13 logMAR in the MC X11 group and 0.05±0.08 logMAR in the IQ group. There was no significant difference in visual acuity, contrast sensitivity, subjective visual quality, and degree of PCO between the 2 groups. For a 6-mm pupil diameter, the mean spherical aberration (Z40) was 0.075±0.076 µm in the MC X11 group and 0.056±0.111 µm in the IQ group. However, 45.5% and 57.9% of the eyes in the MC X11 and IQ groups had values >0.10 µm, respectively. The mean RMS values of the high-order aberrations were similar between the 2 groups except the higher fifth- and sixth-order aberrations, which were significantly higher in the MC X11 group. CONCLUSIONS: Both IOLs provided similar and good visual outcomes. However, the data suggest that the amount of negative spherical aberration generated by current available aspheric IOLs might not be optimal for Chinese eyes.

Impact of glaucoma, lens opacities, and cataract surgery on visual functioning and related quality of life: the Barbados Eye Studies.

PURPOSE: To determine the relationship of open-angle glaucoma (OAG) and lens opacities to visual functioning and related quality of life (QOL), by using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) in a population of African origin. METHODS: The study included 962 black participants of the Barbados Eye Studies with known glaucoma, prior cataract surgery, visual acuity (VA)

Visual acuity outcomes after cataract extraction in adult latinos. The Los Angeles Latino Eye Study.

PURPOSE: To determine prevalence, primary causes, and risk indicators of visual impairment in cataract-operated eyes. DESIGN: Population-based cross-sectional study of adult Latinos. PARTICIPANTS: Two hundred sixty-one participants with cataract extraction. METHODS: Participants underwent an in-home interview and a comprehensive ophthalmologic examination. Visual impairment in the cataract-operated eye was defined by presenting visual acuity (PVA) of 20/40 or less or best-corrected visual acuity (BCVA) of 20/40 or less. The association of cataract extraction status (aphakic, pseudophakic) and severity of visual impairment was evaluated. Risk indicators associated with visual impairment by BCVA in the worse-seeing cataract-operated eye were evaluated. MAIN OUTCOME MEASURES: Visual acuity, causes of visual impairment, and risk indicators associated with visual impairment. RESULTS: Of the 261 participants with at least one cataract extraction and a complete clinical examination, 100 (38%) participants had undergone a unilateral extraction and 161 (62%) had undergone bilateral extractions. The prevalence of visual impairment was 41% (n = 107) defined by BCVA and 60.5% (n = 158) defined by PVA in the worse-seeing cataract-operated eye, and 32.2% (n = 136) defined by BCVA versus 48.1% (n = 203) defined by PVA in all cataract-operated eyes. Uncorrected refractive error, age-related macular degeneration, and diabetic retinopathy were the primary causes of visual impairment, accounting for 49% in worse-seeing cataract-operated eyes and 57% in all cataract-operated eyes. Self-reported history of glaucoma, barriers to eye care, and unmarried participants were independent risk indicators associated with visual impairment (P<0.05). CONCLUSIONS: Despite cataract surgery, a significant proportion of participants had residual visual impairment. Refractive correction eliminated visual impairment in 15% to 20% of the participants, demonstrating the need for regular ophthalmologic examinations in cataract-operated patients.

Prevalence of cataract and pseudophakia/aphakia among adults in the United States.

OBJECTIVES: To determine the prevalence of cataract and pseudophakia/aphakia in the United States and to project the expected change in these prevalence figures by 2020. METHODS: Summary prevalence estimates of cataract and of pseudophakia/aphakia were prepared separately for black, white, and Hispanic persons (for whom only cataract surgery data were available) in 5-year age intervals starting at 40 years for women and men. The estimates were based on a standardized definition of various types of cataract: cortical, greater than 25% of the lens involved; posterior subcapsular, present according to the grading system used in each study; and nuclear, greater than or equal to the penultimate grade in the system used. Data were collected from major population-based studies in the United States, and, where appropriate, Australia, Barbados, and Western Europe. The age-, gender-, and race/ethnicity-specific rates were applied to 2000 US Census data, and projected population figures for 2020, to obtain overall estimates. RESULTS: An estimated 20.5 million (17.2%) Americans older than 40 years have cataract in either eye, and 6.1 million (5.1%) have pseudophakia/aphakia. Women have a significantly (odds ratio = 1.37; 95% confidence interval, 1.26-1.50) higher age-adjusted prevalence of cataract than men in the United States. The total number of persons who have cataract is estimated to rise to 30.1 million by 2020; and for those who are expected to have pseudophakia/aphakia, to 9.5 million. CONCLUSION: The number of Americans affected by cataract and undergoing cataract surgery will dramatically increase over the next 20 years as the US population ages.