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PubMed1991

National outcomes of cataract extraction. Endophthalmitis following inpatient surgery.

We analyzed the likelihood of rehospitalization for endophthalmitis in 338,141 Medicare beneficiaries over age 65 years who were admitted to US hospitals for cataract extraction in 1984. This cohort represents approximately one half of all persons who underwent cataract extraction under the Medicare program in 1984. Extracapsular extraction was performed in 195,587 (58%) of cases, intracapsular cataract extraction in 99,971 (30%), and phacoemulsification in 28,474 (8%). The risk of rehospitalization for endophthalmitis in the year following surgery was 0.17% for intracapsular cataract extraction compared with 0.12% for extracapsular extraction or phacoemulsification (P less than .002). The risk of endophthalmitis at 1 month was higher for intracapsular cataract extraction than for extracapsular extraction or phacoemulsification (0.11% vs 0.085%), although the difference did not reach statistical significance. Cataract surgery accompanied by anterior vitrectomy increased the 1-month risk of rehospitalization for endophthalmitis to 0.41%, more than a four-fold increase over that for cataract surgery alone (0.09%; P less than .05). The rates of endophthalmitis at 1 year were 0.58% and 0.13%, respectively, for cataract surgery with anterior vitrectomy and cataract surgery alone (P less than .0001). No significant differences in the rate of rehospitalization for endophthalmitis were observed based on the use of an intraocular lens, age, or race. Endophthalmitis within 1 year of surgery was 1.2 times more frequent in men than in women (0.16% vs 0.13%; P = .03). Overall, the likelihood of postoperative endophthalmitis from a national sample is consistent with case series previously reported.

Actuarial Analysis↗
PubMed1995

Cataract extraction comparative study of ocular Behçet's disease and idiopathic uveitis.

A retrospective clinical trial was performed to review the management and discuss the outcome of cataract extraction in eyes with complicated cataract due to ocular Behçet's disease (BD) (n = 55) and idiopathic uveitis (IU) (n = 43). The aim was to find the best method of treatment in each pathology. The surgical methods were intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE), ECCE + intraocular lens (ECCE + IOL), and ECCE + trabeculectomy (ECCE + T). The postoperative visual prognosis was found to be significantly worse in eyes with ocular BD, than in those with IU because of the severe posterior segment complications of ocular BD, particularly optic atrophy (p < 0.05). When the outcome was evaluated with regard to the individual surgical techniques, the prognosis was found to be significantly better in eyes with IU undergoing ECCE than in those with BD undergoing the same operation (p < 0.05). No significant differences were observed between the groups with regard to the other surgical treatment modalities (p < 0.05).

Adolescent↗
PubMed2001

Simultaneous bilateral cataract extraction.

PURPOSE: To assess the visual outcome and safety of simultaneous bilateral cataract extraction. SETTING: Department of Ophthalmology, Queen's Hospital, Burton on Trent, Staffordshire, United Kingdom. METHODS: Simultaneous bilateral cataract extraction was performed in 288 eyes of 144 patients over 10 years in a single department in selected cases. Case notes were retrospectively analyzed for final best corrected visual acuity (BCVA) and intraoperative and postoperative complication rates. RESULTS: The final BCVA was 6/9 or better in 87.0% of eyes. The incidence of intraoperative complications was 2.42%. These included posterior capsule rupture without vitreous loss (0.69%) and with vitreous loss (1.04%). Postoperative complications occurred in 10.05% of eyes and included raised intraocular pressure (IOP) (3.82%), iris prolapse (0.69%), uveitis (0.69%), and suture abscess (0.35%). There were no major bilateral complications such as endophthalmitis or corneal decompensation. CONCLUSION: The outcome of simultaneous bilateral cataract extraction was comparable to that of single-eye cataract surgery, indicating that the procedure is safe under strict surgical protocol and beneficial in selected cases.

Adult↗
PubMed1997

Intracapsular cataract extraction: experience of a general surgeon in Niger, West Africa.

BACKGROUND: Cataract is the major cause of blindness in the world and affects an estimated 20 million persons globally. In Africa, there is an incidence of half a million new cases of cataract blindness annually, with a backlog of 3 million persons requiring sight-restoring surgery. The burden of this form of curable blindness resides mainly in less developed nations, which typically have limited numbers of ophthalmologists and medical resources. The experience and results of a general surgeon working in rural West Africa, without prior ophthalmic skills but with limited training in the field, are reported. METHODS: Data on all consecutive planned intracapsular cataract extractions performed between January 1994 and July 1995 inclusive were collected prospectively and the visual outcome as well as surgical complications were analysed. RESULTS: A total of 243 planned intracapsular cataract extractions were performed. Data were incomplete or missing in five cases leaving 238 for analysis. All the patients were blind pre-operatively, with visual acuities of 3/60 or less. Functional vision (6/60 or better) was restored in 95% of all cases. CONCLUSIONS: General surgeons can be satisfactorily trained in the art of intracapsular cataract extractions, with good visual outcomes. This is very useful in the setting of undeveloped countries where there are severe limitations of resources, and the recruitment of trained general surgeons will help reduce the burden of curable blindness in these regions.

Blindness↗
PubMed1988

Cataract extraction. Risk factors in a health maintenance organization population under 60 years of age.

Risk factors for cataract extraction in a young (less than 60 years of age) urban health maintenance organization population were evaluated in a case-control study. The subjects (72 case-control pairs) subscribed to the Kaiser Permanente Medical Care Program in the San Francisco Bay area and had cataract extraction between 1976 and 1980. All patients had visual acuity of at least 20/40 OU, documented before development of cataracts. Thirty-six (50%) of the 72 cataract extraction patients had at least one known risk factor for cataract formation, including trauma, intraocular inflammation, diabetes mellitus, syphilis, oral or topical steroid use, or previous eye surgery. Male patients were found to be a mean of 4.3 years younger than female patients, and diabetics were found to be a mean of 3.5 years older than nondiabetics. Variables found to be related to cataract extraction in univariate analysis included diagnosis of diabetes mellitus, a family history of cataracts, pulse rate, white blood cell count, and syphilis.

Adolescent↗
PubMedDate not supplied

[Possibilities of prophylaxis of the induced "suture" astigmatism in cataract extraction].

Due to a number of reasons, the traditional methods of cataract extraction, i.e. through 8-12 mm limbic incisions, are still widely used in the clinical practice. A frequent occurrence of a high postoperative astigmatism, even if the operation is successful, is the main shortcoming of different variations of the traditional method of cataract extraction. Possibilities of how to neutralize the induced "suture-like" corneal astigmatism were investigated in this study by using two methods: A. a modified technique of applying a continuous corneal Pirs' suture with elements of an accentuated impact in the projection of the horizontal meridian. B. Meridian keratorraphia--application, in the cornea, of an additional compensatory suture in the projection of the horizontal meridian. Studies were made in two groups of patients after extracapsular cataract extraction (ECE) with intraocular lens (IOL) implantation--a total of 30 patients, 30 eyes. The main group was divided into two subgroups--A and B--(10 patients and 10 eye in each) in accordance with a used method of compensating the induced astigmatism. 10 patients were in the control group. A comparative evaluation of changes of a degree of the original astigmatism, which occurred under the influence of the sealing suture, showed that the parameters of induced astigmatism in the control group essentially and reliably (p < 0.001) exceeded the similar parameters registered in both subgroups of the main group; finally, the efficiency of method B in respect to neutralizing the "suture" astigmatism out did the possibilities of method A (p < 0.01).

Astigmatism↗
PubMed1993

Can second eye cataract extraction be justified?

A prospective study was carried out to test the null hypothesis that there is no additional benefit to be gained from second eye cataract extraction. Twenty-nine patients with unilateral cataract but contralateral pseudophakia completed a questionnaire enquiring into their visual disability and underwent testing of monocular and binocular visual acuity, contrast sensitivity, glare disability, fusion and stereopsis. These tests were repeated 4 months after second eye cataract extraction and lens implantation. Patients universally considered their vision to have been improved by second eye surgery and the prevalence of all symptoms were significantly reduced by this procedure. Normal binocular summation and stereopsis were restored following second eye cataract extraction. Symptomatic patients may benefit from second eye cataract extraction with lens implantation.

Aged↗
PubMed2003

Cataract extraction and cognitive function in older women.

BACKGROUND: Oxidative damage is critical in the etiology of cataract. Therefore, associations between cataract and other health endpoints may suggest the shared etiologic role of oxidative stress. METHODS: To assess any role of oxidative stress in cognitive function and early cognitive decline, we investigated the relation between cognition and cataract extraction in 16,197 community-dwelling women age 70-79 years from the Nurses' Health Study. Six cognitive tests were administered by telephone from 1995 to 2000; second interviews are ongoing and have been completed for 12,995 women. In total, 3,597 women reported cataract extraction prior to their baseline cognitive assessment. We used logistic regression to calculate multivariate-adjusted relative risks of a low score and of substantial decline, comparing those with and without cataract extraction. RESULTS: Using a global score that combines the results of the cognitive tests, there was no relation between cataract and either low score (RR = 0.99; 95% CI = 0.87-1.13) or substantial decline from baseline to second interview (RR = 1.08; CI = 0.93-1.25). CONCLUSION: Cataract extraction does not appear to be related to cognitive function in these women.

Aged↗
PubMed1997

Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings.

OBJECTIVE: To compare rates of cataract extraction in 2 prepaid health settings and in traditional fee-for-service (FFS) settings. DESIGN: A cross-sectional analysis using 1993 health maintenance organization (HMO) Medicare claims and encounter files, the Health Care Financing Administration (HCFA) 5% Medicare Part B provider/supplier file, and the HCFA October 1992 100% Medicare population file. SETTING: Southern California Medicare FFS settings and the staff-model and independent practice association (IPA) plans of a large California HMO. PATIENTS: 1993 Medicare beneficiaries aged 65 years and older. The study included 43387 staff-model HMO enrollees, 19050 IPA enrollees, and 47 150 FFS beneficiaries (a 5% sample of all Southern California FFS beneficiaries). MAIN OUTCOME MEASURE: Age and risk-factor adjusted rates of cataract extraction per 1000 beneficiary-years. RESULTS: After controlling for age, sex, and diabetes mellitus status, FFS beneficiaries were twice as likely to undergo cataract extraction as were prepaid beneficiaries (P<.01). Female FFS beneficiaries were nearly twice as likely to undergo the procedure as were male FFS beneficiaries (P<.001); there were no extraction rate differences by sex in the prepaid settings. CONCLUSION: Because of the potential implications for vision care in the elderly, the significantly different rates of cataract extraction in FFS and prepaid settings warrant further clinical investigation to determine whether there is overuse in FFS vs underuse in prepaid settings. Such investigations must assess the appropriateness of cataract surgery by evaluating its use relative to clinical need.

Age Distribution↗
PubMed1994

Extracapsular cataract extraction in eyes previously operated for glaucoma.

Extracapsular cataract extraction with IOL implantation was performed in 32 consecutive cases of glaucomatous eyes which previously had undergone trabeculectomy (group A). The only complication seen during surgery was one tear in the posterior capsule. The mean IOP on postoperative day 1 was 17.7 +/- 7.9 mmHg. After extracapsular cataract extraction in 68 glaucomatous eyes with no previous surgery (group B) the corresponding mean IOP was 21.7 +/- 7.5 mmHg (p = 0.015). However, the mean preoperative IOP level was lower in group A (group A: 14.3 +/- 4.0 mmHg, group B: 17.1 +/- 4.3 mmHg), so the increase in IOP was not significantly different in the two groups. In group A, 15.6% of the eyes had an IOP elevation exceeding 24 mmHg, compared to 30.9% of the eyes in group B. Four months postoperatively, the IOP was significantly reduced in group B and unchanged in group A (compared to preoperatively). Seventy-two percent of the eyes in group A and 79% of the eyes in group B achieved a visual acuity of 5/10 or better, respectively.

Aged↗
PubMed1992

Exfoliation syndrome and extracapsular cataract extraction with implantation of posterior chamber lens.

Extracapsular cataract extraction followed by implantation of a one-piece posterior chamber polymethylmethacrylate intraocular lens (IOL) into the capsular bag was performed in 25 eyes with exfoliation syndrome and 20 control eyes. The patients were investigated preoperatively and then 1 day, 1 week, 3, 6 and 12 months after surgery. Preoperatively, maximal pupil dilatation was significantly smaller in eyes with exfoliation syndrome compared to controls. During surgery the incidence of complications such as ruptures of the zonule or posterior lens capsule, were higher in eyes with exfoliation syndrome. Furthermore, postoperative complications, such as fibrinoid reaction anterior to the IOL followed by posterior synechias and cell deposits, were more common in eyes with exfoliation syndrome compared to control eyes. The results imply that compared to control eyes, eyes with exfoliation syndrome are likely to present more complications both during extracapsular cataract extraction with implantation of intraocular lenses and postoperatively.

Adult↗
PubMed1995

[Retinal detachment after intracapsular and extracapsular cataract extraction].

In a retrospective study we reviewed the postoperative incidence of retinal detachment in a consecutive series of 762 eyes operated on with intracapsular cataract extraction and a consecutive series of 1351 eyes operated on with extracapsular cataract extraction. Follow-up time was 2 1/2-4 1/2 years in both series. The incidence of retinal detachment was 0.79% after intracapsular cataract extraction and 0.44% after extracapsular cataract extraction. The difference was not statistically significant. Age below 70 years was not statistically significantly correlated to retinal detachment.

Aged↗
PubMed2002

Cataract extraction in high myopic eyes.

BACKGROUND: According to the high prevalence of myopia in Taiwan, we analyze the adopted cataract extractions, identify predicting factors for postoperative vision, and to assess the incidence of retinal complications after Nd: YAG laser capsulotomy in high myopic eyes. METHODS: One hundred and twenty-five eyes, which the axial lengths were longer than 26 mm, following cataract extraction were enrolled. Surgeries adopted included phacoemulsification with intraocular lens implantation, extracapsular cataract extraction with intraocular lens implantation, phacoemulsification, and extracapsular cataract extraction. Logistic regression was utilized to assess predictive factors for postoperative vision. RESULTS: Postoperative vision of 41 eyes (32.8%) of the 125 high myopic eyes improved at least 4 lines of Snellen acuity. Thirty-two eyes (25.6%) achieved good postoperative vision (BCVA > or = 20/40), and 26 eyes (20.8%) demonstrated poor postoperative vision (BCVA < 20/200). Younger age and shorter axial length were appreciated for better visual outcome (p < 0.05). Nd: YAG laser capsulotomy is required for posterior capsular opacity. Three in 125 eyes (2.4%) developed retinal complications and 2 of them had retinal detachment subsequently within one month after Nd: YAG laser capsulotomy. CONCLUSION: Most high myopic patients achieved visual improvement after cataract surgeries. Age and axial length are the predictive factors in high myopic patients. It is crucial to examine retina prior to Nd: YAG laser capsulotomy to prevent retinal complication.

Adult↗
PubMed1996

Excimer laser phototherapeutic keratectomy before cataract extraction and intraocular lens implantation.

PURPOSE: To determine whether sequential excimer laser phototherapeutic keratectomy (PTK) followed by cataract extraction and intraocular lens (IOL) implantation with power calculation based on the new corneal curvature is effective in managing superficial corneal disease. METHODS: Of a consecutive series of 18 eyes of 16 patients who received PTK, extracapsular cataract extraction, and posterior chamber IOL insertion, twelve eyes had spheroidal degeneration and six eyes, calcific band keratopathy. The PTK was done with either a Summit ExciMed laser or a Visx 20/20 laser using a 5.0 to 6.0 mm diameter ablation zone. Intraocular lens calculations were done a mean of 3.3 months after PTK. Cataract surgery was by extracapsular cataract extraction with posterior chamber IOL implantation. Patients were followed up for a mean of 14 months. RESULTS: Eighteen eyes completed follow-up examinations. Mean time between PTK and cataract surgery was 3.3 months. Phototherapeutic keratectomy was completed in one surgery session using one ablation treatment (ablation and slitlamp microscopy) in five eyes, two treatments in seven eyes, and three to seven treatments in six eyes. Eleven (61%) of 18 eyes had a final spherical equivalent refraction within +/- 1.00 diopter. Two eyes developed moderate to marked subepithelial reticular corneal haze from PTK. No vision-threatening complications occurred. CONCLUSION: Excimer laser PTK followed by cataract extraction and posterior chamber IOL implantation can safely and effectively treat eyes with superficial corneal disease and age-related cataract. Calculation of the IOL power after the cornea has healed from the PTK compensates for changes in corneal curvature.

Aged↗
PubMed1987

[Development of lens opacity in children's eyes following extracapsular cataract extraction].

In a group of 14 children who underwent extracapsular cataract extraction for cataract of the posterior pole, a reopacification of the posterior capsule was observed in all 18 eyes treated. Only in four eyes, in which rupture of the posterior capsule had occurred intraoperatively, was a reoperation unnecessary. In ten eyes satisfactory removal of the opacifications was accomplished using McIntyre's aspiration cannula; in four cases lensectomy was performed because of severe fibrosis. During a follow-up period of two to eight months after the posterior capsule had been rendered clear, transparency was found to be good in eight out of ten eyes.

Cataract↗
PubMed1996

Increased incidence of cataract extractions in women above 70 years of age. A population based study.

During 1987 and 1988 all patients undergoing a cataract extraction at the eye Clinic of Sahlgrenska University Hospital were registered to determine the yearly incidence of cataract extractions according to sex and age. We found that after the age of 70 years the incidence of cataract extractions was higher for females than males. This difference was most pronounced for operations of the first eye. In this case the relative risk to undergo a cataract extraction for a woman compared to a man was 1.71 with 95% confidence interval 1.51-1.94, which showed a significantly increased risk. The preoperative VA of the best eye at the time of the first operation did not differ significantly between older men and women, indicating that women had no tendency to come earlier to operation. Our results show that after the age of 70 years the operation incidence of women is significantly higher than for men. This probably reflects a generally increased prevalence of various stages of cataract among females above 70 years in a Nordic population.

Age Factors↗
PubMed1985

Trabeculectomy, cataract extraction and intra-ocular lens implantation.

Seventeen cases of open-angle glaucoma requiring cataract extraction underwent intracapsular cataract extraction, trabeculectomy posterior to the scleral spur, and MK9 intraocular lens insertion. Approximately 50 per cent of the patients achieved intraocular pressures of 18 mm Hg or less without medication two years later. Though implantation reduces the surgical success of the combined operation, it is safe, easy to perform and does not worsen pre-operative levels of intraocular pressure and/or control.

Cataract Extraction↗