Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population

OBJECTIVE

To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery.

METHODS

Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes).

RESULTS

Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69).

CONCLUSIONS

This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.

Prevalence of pseudophakia: U.S. population-based study

PURPOSE

To determine the current prevalence and trends of pseudophakia in a well-defined U.S. population, calculating values for Olmsted County, Minnesota, from 1988 through 2018.

SETTING

Mayo Clinic, Rochester, Minnesota.

DESIGN

Population-based cohort study.

METHODS

Rochester Epidemiology Project (REP) databases were used to identify all cases of pseudophakia in Olmsted County, Minnesota, between January 1, 1988, and December 31, 2018. Age- and sex-specific prevalence rates were calculated in 1988, 1998, 2008, and 2018 using REP census population estimates and mortality counts. Poisson regression analysis was used to assess changes in prevalence over time. Mortality rates were estimated by Kaplan-Meier analysis.

RESULTS

In 2018, 10 024 county residents were pseudophakic in at least 1 eye, for a total population prevalence of 6.5%. The prevalence increased 67% in the last 10 years and 590% in the last 30 years (P < .001). By 2018, 51% of residents aged 75 years and 88% of residents aged 85 years and older were pseudophakic in at least 1 eye, 53% of residents with pseudophakia aged 65 years and older were bilaterally pseudophakic, and 29% of residents with pseudophakia had lived with pseudophakia for more than 10 years. The prevalence was higher among women than men and increased with age (P < .001). Overall, pseudophakia had a lower all-cause mortality compared with the general Minnesota population (P < .001).

CONCLUSIONS

In 2018, most residents aged 75 years and older were pseudophakic in at least 1 eye. These numbers underscore the changing visual status of older adults and the large number of adults who benefit from cataract surgery.

Cataract Surgery in Children from Birth to Less than 13 Years of Age: Baseline Characteristics of the Cohort

OBJECTIVE

To describe baseline characteristics, initial postoperative refractive errors, operative complications, and magnitude of the intraocular lens (IOL) prediction error for refractive outcome in children undergoing lensectomy largely in North America.

DESIGN

Prospective registry study of children from birth to <13 years of age who underwent lensectomy for any reason within 45 days preceding enrollment.

PARTICIPANTS

Total of 1266 eyes of 994 children; 49% female and 59% white.

METHODS

Measurement of refractive error, axial length, and complete ophthalmic examination.

MAIN OUTCOME MEASURES

Eye and systemic associated conditions, IOL style, refractive error, pseudophakic refraction prediction error, operative and perioperative complications.

RESULTS

Mean age at first eligible lens surgery was 4.2 years; 337 (34%) were <1 year of age. Unilateral surgery was performed in 584 children (59%). Additional ocular abnormalities were noted in 301 eyes (24%). An IOL was placed in 35 of 460 eyes (8%) when surgery was performed before 1 year of age, in 70 of 90 eyes (78%) from 1 to <2 years of age, and in 645 of 716 eyes (90%) from 2 to <13 years of age. The odds of IOL implantation were greater in children ≥2 years of age than in those <2 years of age (odds ratio = 29.1; P < 0.001; 95% confidence interval: 19.6-43.3). Intraoperative complications were reported for 69 eyes (5%), with the most common being unplanned posterior capsule rupture in 14 eyes, 10 of which had an IOL placed. Prediction error of the implanted IOL was <1.00 diopter in 54% of eyes, but >2.00 diopters in 15% of eyes.

CONCLUSIONS

Lensectomy surgery was performed throughout childhood, with about two-thirds of cases performed after 1 year of age. Initial surgery seemed safe, with a low complication rate. IOL placement was nearly universal in children 2 years of age and older. The immediate postoperative refraction was within 1 diopter of the target for about one-half of eyes.

National surveys of avoidable blindness and visual impairment in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay

OBJECTIVE

Describe the rationale and methodology of the Rapid Assessment of Avoidable Blindness applied in surveys at the national level in 2011-2013 in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay.

METHODS

The survey includes individuals aged 50 years and older, minimizing required sample sizes, which vary from 2 000 to 5 000 people. It uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. It is relatively inexpensive, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff. Reports are generated by the assessment software package.

RESULTS

Indicators measured are prevalence of blindness and of moderate and severe visual impairment (broken down into avoidable causes and cataracts); prevalence of aphakia or pseudophakia; cataract surgical coverage; visual outcome of cataract surgeries; causes of poor outcomes; access barriers to cataract surgery; and cataract surgery service indicators. Results of each survey will be published sequentially in successive issues of the Journal, and a final summary article will analyze results as a whole and in comparison with the other surveys in this group and with those previously published, which will provide a current picture of the situation in this group of countries.

CONCLUSIONS

The Rapid Assessment of Avoidable Blindness is a robust, simple, and inexpensive methodology to determine prevalence of blindness and visual impairment as well as eye health service coverage and quality. It is a very valuable tool for measuring progress by blindness prevention programs and their impact on the population.

Rapid assessment of avoidable blindness in Uruguay: results of a nationwide survey

OBJECTIVE

To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay.

METHODS

All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction.

RESULTS

Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) and glaucoma (14.3%) were the main causes of blindness. Prevalence of SVI and MVI was 0.9% (95% CI: 0.5-1.3) and 7.9% (95% CI: 6.0-9.7) respectively. Cataract was the main cause of SVI (65.7%), followed by uncorrected refractive error (14.3%), which was the main cause of MVI (55.2%). Cataract surgical coverage was 76.8% (calculated by eye) and 91.3% (calculated by individual). Of all eyes operated for cataract, 70.0% could see ≥ 20/60 and 15.3% could not see 20/200 post-surgery.

CONCLUSIONS

Prevalence of blindness in Uruguay is low compared to other Latin American countries, but further reduction is feasible. Due to Uruguay's high cataract surgical coverage and growing proportion of people ≥ 50 years old, the impact of posterior pole diseases as a contributing factor to blindness might increase in future.

[Pseudophakic retinal detachment: how to manage?]

INTRODUCTION

Retinal detachment, a common complication of cataract surgery, requires urgent surgical treatment. The external approach combining retinopexy with scleral buckling remains the gold standard in the surgical management of pseudophakic retinal detachment (RD) without marked proliferative vitreoretinopathy (PVR), although intraocular surgery is currently preferred by most of the authors. The purpose of this study is to compare the anatomical and functional results obtained with both techniques.

PATIENTS AND METHODS

This study compares the results of two techniques for treating pseudophakic retinal detachment: external surgery (group I), and vitrectomy with internal tamponade (group II). Ab-externo surgery was performed in 24 patients (24 eyes), while 22 patients (22 eyes) underwent primary vitrectomy. In order to make both groups comparable, we excluded recurrences of RD, vitreous hemorrhage and other media opacities, giant tears and initial grade C PVR. Minimum follow-up was 12 months. Postoperative variables analyzed and compared were the rate of initial and final anatomical success, final visual acuity, and causes of failure of the initial surgery.

RESULTS

The retina was reattached with a single operation in 21 eyes in group I (87.5%) and 19 eyes in group II (86.4%) (P=0.91). The causes of anatomical failure in both groups were proliferative vitreoretinopathy (4 cases) and secondary tears or tears not seen on initial examination (2 cases). For patients in group I, secondary surgery consisted of total vitrectomy with encircling buckle. Patients in group II underwent an additional vitrectomy (peeling of vitreoretinal proliferation, and silicone oil tamponade as necessary). After a mean follow-up of 12 months, the final examination noted a reattached retina in 23 eyes in group I (95.84%) and 21 eyes in group II (95.45%) (P=0.95). The final visual results were identical at comparable follow-up periods. Indeed, the final visual acuity was similar in the two groups with nearly 40% of patients having recovered visual acuity between 1/10 and 5/10 (P=0.98).

CONCLUSION

With regard to surgical treatment of pseudophakic retinal detachment, vitrectomy with internal tamponade provides anatomical and functional results comparable to those obtained with external surgery.

Pseudophakic/aphakic corneal edema--morphometric predisposing factors analysis based on the fellow eye examination

PURPOSE

To find morphometric factors predisposing to the development of corneal decompensation following cataract surgery.

MATERIAL AND METHODS

Study group consisted of 50 patients after keratoplasty performed as pseudophakic/aphakic corneal edema (PCE/ACE) treatment. Control group formed 50 patients after cataract removal without signs of corneal decompensation. Specific subgroups were analyzed too. The morphometric data of the fellow eye anterior chamber were obtained with Visante OCTTM.

RESULTS

Anterior chamber depth and anterior chamber angle width were significantly smaller in study group (p < 0.00001, U-test). With excluded preoperative risk factors: Fuchs dystrophy, acute angle closure glaucoma attack history the significant differences were also observed (p < 0.01). In Fuchs' dystrophy and intraoperative complication subgroups comparison these two anterior chamber parameters were smaller too (p < 0.001). Anterior chamber width was also smaller in study group with p = 0.001. Central corneal thickness was higher in study group with p = 0.013. After exclusion of patients with Fuchs' dystrophy there was no difference in comparison (p = 0.34). The difference in total axial length comparison was insignificant (p = 0.18). Relative anterior microphthalmos was diagnosed in 31 patients of study group (62%) and in 17 of control (34%).

CONCLUSIONS

Small anterior chamber dimensions and higher central corneal thickness due to Fuchs' dystrophy are factors influencing the risk of PCE/ACE development.

Outcome of cataract surgery in Nigeria: visual acuity, autorefraction, and optimal intraocular lens powers--results from the Nigeria national survey

OBJECTIVE

To describe presenting and corrected visual acuities after cataract surgery in a nationally representative sample of adults. Another objective was to describe refractive errors in operated eyes and to determine the optimal range of intraocular lens (IOL) powers for this population.

DESIGN

Cross-sectional, population-based survey.

PARTICIPANTS

Adults aged 40 years and more were selected using multistage stratified sampling and proportional to size procedures. A sample size of 15027 was calculated, and clusters were selected from all states.

METHODS

Individuals who had undergone cataract surgery were identified from interview and examination. All had their presenting visual acuity (VA) measured using a reduced logarithm of the minimum angle of resolution chart and underwent autorefraction. Corrected VAs were assessed using the autorefraction results in a trial set. An ophthalmologist conducted all examinations, including slit-lamp and dilated fundus examination. Causes of visual loss were determined for all eyes with a presenting VA <6/12 using the World Health Organization recommendations. Biometry data were derived from 20449 phakic eyes using the SRK-T formula after excluding those with poor VA or corneal opacities.

MAIN OUTCOME MEASURES

Presenting and corrected visual acuities in pseudo/aphakic individuals and autorefraction findings; biometry profile of Nigerian adults.

RESULTS

Data from 288 eyes of 217 participants were analyzed. Only 39.5% of eyes had undergone IOL implantation at surgery. Only 29.9% of eyes had a good outcome (i.e., ≥6/18) at presentation, increasing to 55.9% with correction. Use of an IOL was the only factor associated with a good outcome at presentation (odds ratio 9.0; 95% confidence interval, 4.3-18.9; P=0.001). Eyes undergoing cataract surgery had a higher prevalence and degree of astigmatism than phakic eyes. Biometry data reveal that posterior chamber IOL powers of 20, 21, and 22 diopters (D) (A constant 118.0) will give a postoperative refraction range of -2.0 D to emmetropia in 71.4% of eyes, which increases to 82.6% if 19 D is also included.

CONCLUSIONS

Postoperative astigmatism needs to be reduced through better surgical techniques and training, and use of biometry should be standard of care.

A study of ocular morbidity of patients attending a satellite clinic in Bhaktapur, Nepal

A community based retrospective study was conducted in the satellite clinic of Nepal Medical College Teaching Hospital at Jhaukhel VDC of Bhaktapur, from March 2007 to February 2008. A total of 395 patients were examined, where males comprised of 135 patients (32.9%) and females 265 patients (67.1%). The common ocular diseases observed in this study were refractive errors 22.5%, age related cataract 17.5%, extra ocular diseases like conjunctivitis 14.9%, conjunctival degenerations 10.8%.

Male Sex as a Risk Factor for Pseudophakic Retinal Detachment after Cataract Extraction in Taiwanese Adults

PURPOSE

To investigate the role of sex in modifying risk factors for retinal detachment (RD) after cataract surgery.

DESIGN

Prospective cohort study based on medical records and insurance claims from Taiwan's Bureau of National Health Insurance (BNHI).

PARTICIPANTS

Nine thousand three hundred eighty-eight patients who underwent extracapsular cataract extraction (CE), including phacoemulsification procedures, between August 1999 and December 2001.

METHODS

Medical charts and claims submitted by insurance beneficiaries who underwent CE and intraocular lens implantation were collected from the sixth branch of the BNHI. Data recorded for analysis included each patient's demographic characteristics, medical history, refractive status, axial length (AL), type of CE, and intraoperative complications. Posterior capsulotomy, diagnostic procedures, and treatments for retinal complications and other ocular diseases were identified on the basis of codes from physicians' billing records at the end of 2005.

MAIN OUTCOME MEASURES

Incidence of RD in the full study group and in subgroups defined by sex, age, AL, type of CE procedure, concurrent systemic diseases, presence of intraoperative complications, and subsequent posterior capsulotomy.

RESULTS

The mean follow-up time of patients at the time of analysis was 54.99+/-15.53 months. The rate of lost follow-up was 11.55%. Cumulative 6-year RD rates were 1.16% in the full study group, 1.90% in the male subgroup, and 0.56% in the female subgroup at the end of the follow-up period. Gender distribution had a significant influence on the occurrence of RD after CE (P<0.001). Factors that were found to have a significant effect on the risk of pseudophakic RD included age under 50 years (P = 0.002), AL (P<0.001), and history of RD (P = 0.003). Surgical types (extracapsular vs. phacoemulsification) were not correlated significantly with RD, and neither were such systemic diseases as diabetes and hypertension. Subgroup analysis indicated that the significance of age, AL, and history of RD as risk factors persisted in the male subgroup but not in the female subgroup.

CONCLUSIONS

The impact of axial myopia, age, and RD history as risk factors for pseudophakic RD was seen predominantly in males.

Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey

AIM

To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged >or=30 years in Pakistan.

METHODS

Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers.

RESULTS

16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery.

CONCLUSION

Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3,560000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified.

Longitudinal rates of cataract surgery

OBJECTIVE

To determine the cumulative probability of cataract surgery and factors accounting for such surgery.

METHODS

Respondents to the Asset and Health Dynamics Among the Oldest Old survey, a national longitudinal panel, were interviewed in 1998, 2000, and 2002 to determine whether they had undergone cataract extraction since the previous interview (N = 8363 in 1998). Multivariate analysis was used to identify factors affecting cataract surgery rates.

RESULTS

The annual incidence of cataract surgery from January 1, 1995, to December 31, 2002, was 7.4%. The prevalence of unilateral pseudophakia increased from 7.6% in 1998 to 9.8% in 2002; the prevalence of bilateral pseudophakia increased from 10.5% in 1998 to 22.3% in 2002. The self-reported vision of persons undergoing cataract surgery improved related to that of others (a difference of 0.4 on a 9-point scale; P<.001). Black individuals were less likely to undergo cataract surgery than white individuals (P<.01). The highest rates of surgery were for persons who were 65 years or older in 1998. However, persons with Medicare parts A and B coverage underwent more procedures than those with primary private employer-based coverage or the uninsured.

CONCLUSIONS

At 5.3%, the cataract surgery incidence is similar to that given in previous reports. Persons undergoing cataract surgery more often had low self-reported vision before surgery, and their vision improved on average relative to others after surgery.

Relationship between retinal detachment and biometry in 4262 cataractous eyes

PURPOSE

To assess risk factors for retinal detachment (RD) in eyes that previously underwent cataract surgery.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Four thousand two hundred sixty-four eyes of 3094 patients who underwent extracapsular cataract extraction with intraocular lens (IOL) implantation at the Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam.

METHODS

From January 1, 1993, through March 31, 1999, 3094 patients (4262 cases) of extracapsular cataract extraction with IOL implantation were enrolled. Through review of ophthalmic patient records, the role of preoperative and intraoperative data as well as neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy was assessed with respect to development of an RD.

MAIN OUTCOME MEASURES

Axial length (AL), anterior chamber depth (ACD), crystalline lens thickness, mean keratometric power, spherical equivalent, intraoperative complications, Nd:YAG laser posterior capsulotomy, RD.

RESULTS

Of 4262 eyes that underwent cataract extraction, 3921 eyes (2794 patients) were available for analysis. Twenty-two patients experienced RD after surgery, resulting in an overall cumulative incidence of 0.62%. Multivariate binary logistic regression analyses showed the following factors to be associated with an increased risk of RD after cataract surgery: an accidental posterior capsular rupture at the time of surgery (odds ratio [OR] = 16.26; P<0.001), an increased AL (OR = 1.25; P = 0.013), and a deeper anterior chamber (OR = 4.02; P = 0.016). Older age was found to be a protective factor for the development of RD (OR = 0.95; P = 0.003).

CONCLUSIONS

Cataract surgery at a young age with an accidental posterior capsular rupture and a deeper ACD are the most important predisposing conditions for pseudophakic RD after cataract surgery. The overall cumulative incidence of 0.62% for postoperative RD is low.

AXIAL MYOPIA IS AN EXTREMELY SIGNIFICANT RISK FACTOR FOR YOUNG-AGED PSEUDOPHAKIC RETINAL DETACHMENT IN TAIWAN

PURPOSE

To investigate the possible risk factors of retinal detachment (RD) after cataract extraction and intraocular lens implantation in a geographic defined racially uniform population.

METHODS

Submitted claim records and charts of 9398 insurance beneficiaries who underwent cataract extraction and intraocular lens implantation between August 1999 and December 2001 were consecutively collected from the Bureau of National Health Insurance (BNHI). At the end of 2003, any ophthalmologic diagnosis and related treatment based on procedure and diagnosis codes listed in physician bills were evaluated.

RESULTS

The cumulative risk of RD in our study group was 0.76% at the end of follow-up. The mean follow-up time was 36.92 +/- 8.89 months. Sex distribution had no significant effect on the occurrence of RD after cataract extraction, whereas age distribution showed significant influence on the risk of RD after cataract surgery (P = 0.0307), as did the history of RD (P < 0.0001) and Nd-YAG laser posterior capsulotomy (P = 0.0001). Axial length also had a significant effect on the risk of RD after cataract extraction (P < 0.0001). The longer the axial length, the more impact on the risk of RD carried by young age.

CONCLUSIONS

The results showed that axial myopia is an extremely significant risk factor for young-aged pseudophakic RD in Taiwan.

Demand incidence of retinal detachment in Brazil

AIM

To evaluate the epidemiological characteristics of retinal detachment in a defined urban population in the Southeast of Brazil.

METHODS

A retrospective study of patients consulted at the Department of Ophthalmology, State University of Campinas, São Paulo, Brazil, with retinal detachment between June 1, 2003 and July 31, 2004. Data were entered into the Statistical Package for the Social Sciences (version 10.0).

RESULTS

There were a total population of 3 389 294 in the 42 cities of Campinas catchment area. A total of 313 patients fitted the inclusion criteria. The overall demand incidence of retinal detachment was 9.2:100,000. The number of males peaked in the 50-79 age group, whereas that of the females peaked in the 60 to 80+ age group. The ages ranged from 4 months to 84 years (mean 49.3). The female-to-male ratio was 1:2.1. Nontraumatic phakic detachments had the highest demand incidence of 7.1:100,000. The demand incidence of nontraumatic aphakic detachments was very low at 0.09:100,000. Almost one third of all patients seeking treatment presented inoperable cases of retinal detachments.

CONCLUSIONS

This is the first study of demand incidence of retinal detachment in Latin Americans. The age-specific demand incidence increases with age. Nontraumatic phakic detachments were the most common type of detachment. The incidence of the traumatic types of detachment was higher in males than that in females. Such data are important to plan and implement vitreoretinal services taking into account the population likely to be served.

Pseudophakic retinal detachment with ruptured posterior lens capsule

The relationship between retinal detachment and posterior lens capsule rupture in pseudophakic patients was studied. Records of patients with pseudophakic retinal detachment who were admitted to Siriraj Hospital from 1992 to 2004 were reviewed. The patients were divided into 2 main groups: 1) The study group (pseudophakic retinal detachment) 79 eyes (78 cases) which was subdivided into group 1a) pseudophakic retinal detachment with intact posterior lens capsule (50 eyes), and group 1b) pseudophakic retinal detachment with ruptured posterior lens capsule (29 eyes); 2) The control group 99 eyes (90 cases) which was subdivided into group 2a) pseudophakic patients with intact posterior lens capsule (83 eyes), and group 2b) pseudophakic patients with ruptured posterior lens capsule (16 eyes). The relationship between pseudophakic retinal detachment and posterior lens capsule rupture was analyzed by Chi-square test, and risk factors were analyzed by multiple logistic regression. Retinal detachment in pseudophakic patients was found more often in males more than in females, and the average age was 57.9 +/- 11.8 years, the retinal detachment was related to posterior lens capsule rupture (p = 0.003). Patients with pseudophakic retinal detachment with a ruptured posterior lens capsule had a risk 5.7 times greater than pseudophakic patients with an intact posterior lens capsule (adjusted Odds ratio = 5.716, 95% CI = 2.118-15.427). The present study showed that posterior lens capsule rupture increased the risk of retinal detachment. Ophthalmologists should be aware of retinal detachment development after YAG capsulotomy, especially in patients who have other risk factors such as myopia, lattice degeneration, retinal break, or previous retinal detachment surgery.

Glaucoma in aphakia and pseudophakia in the Chennai Glaucoma Study

AIM

To determine the prevalence of glaucoma among aphakes and pseudophakes in a rural population of southern India.

METHODS

3924 subjects aged 40 years or above underwent complete ophthalmic examination. Glaucoma in aphakia/pseudophakia was diagnosed using International Society of Geographical and Epidemiological Ophthalmology criteria in aphakic/pseudophakic people.

RESULTS

54 subjects (37 aphakes, 17 pseudophakes) (1.38% of 3924 subjects, 11.2% of 482 aphakes/pseudophakes) had glaucoma in aphakia/pseudophakia. Aphakia, age, intraocular pressure (IOP), pseudoexfoliation, and peripheral anterior synechiae greater than or equal to 180 degrees of the angle were risk factors for glaucoma on univariate analysis. On multivariate analysis, IOP and aphakia were independent risk factors for glaucoma. 39 people (72.22%) with glaucoma had normal IOP at presentation. None of the people with glaucoma were aware of the disease. Blindness in one or both eyes was seen in 12 subjects (10 unilateral and two bilateral)-that is, 22.22% of people with glaucoma in aphakia/pseudophakia.

CONCLUSIONS

Glaucoma is an important cause of ocular morbidity among aphakes and pseudophakes in this rural population of south India. This glaucoma, responsible for unilateral or bilateral blindness in 22.2% of those affected, was entirely undetected in this study population.

Prognosis of pseudophakic retinal detachment

PURPOSE

To compare preoperative and postoperative findings in phakic and pseudophakic patients operated on for rhegmatogenous retinal detachment (RD).

SETTING

Herlev University Hospital, Copenhagen, Denmark.

METHODS

This retrospective review comprised 120 pseudophakic patients and 280 phakic patients who had RD surgery during a 4-year period. An identical scleral buckling procedure was used for primary surgery in both groups. Cataract surgery had been performed using extracapsular cataract extraction (ECCE) in most eyes; phacoemulsification was used in 67.5% of the pseudophakic eyes. The mean follow-up was 13.5 months.

RESULTS

Pseudophakic patients with RDs presented with significantly worse preoperative visual acuity than phakic patients due to a higher frequency of total RDs and macula-off RDs. Retinal breaks were found significantly less frequently and reoperations were performed with a higher frequency in pseudophakic patients than in phakic patients. At 6 months, no differences between pseudophakic and phakic patients were found. The overall anatomic reattachment rate was 94% and 96% in the 2 groups, and the visual outcome was also identical, with a visual acuity better than 0.4 in about 60% of patients.

CONCLUSIONS

Pseudophakic patients presented with more extended RDs and with the macula detached more frequently. Retinal breaks were found less frequently. Despite these findings, the anatomic and visual prognosis of pseudophakic detachments was identical to that of phakic detachments.

Cataract surgery and subtype in a defined, older population: the SEECAT Project

AIM

To describe the distribution of cataract subtypes present before surgery among a defined population of older, bilaterally pseudophakic individuals.

METHODS

This was a cohort study of bilaterally pseudophakic individuals participating in the Salisbury Eye Evaluation (SEE), and their locally resident siblings. Subjects underwent slit lamp and retroillumination photography and grading using the Wilmer Cataract Grading System. For all individuals determined to be bilaterally pseudophakic, an attempt was made to determine for each eye the type(s) of cataract present before surgery, based on previous SEE photographs (for SEE participants) and/or medical records obtained from the operating ophthalmologist (for both SEE participants and their siblings).

RESULTS

The mean age of 223 participants providing data in this study was 78.7 (SD 5.2) years, 19.3% of subjects were black and 60.1% female. The most common surgically removed cataract subtype in this population was pure nuclear (43.5%), followed by nuclear combined with posterior subcapsular cataract (PSC) (20.6%), and nuclear combined with cortical (13.9%); less common types were pure cortical (4.9%), pure PSC (4.5%), and PSC combined with cortical (2.7%). Factors such as sex and source of lens data (study photograph versus clinical record) did not significantly affect the distribution of lens opacity types, while PSC was significantly (p = 0.01) more common among younger people and nuclear cataract was significantly (p = 0.001) more common among white compared to black people.

CONCLUSION

Epidemiological studies have suggested that the different subtypes of cataract are associated with different risk factors. As studies begin to identify new prevention strategies for cataract, it would appear likely that different strategies will be efficacious against different types of cataract. In this setting, it will be helpful to know which cataract types are most frequently associated with surgery. Among this older, majority white population, nuclear cataract showed a clear predominance among individuals having undergone surgery in both eyes. This may be contrasted with both clinic and population based studies of younger people, which have generally found PSC cataract to predominate.

[The French national waiting list for keratoplasty created in 1999: patient registration, indications, characteristics, and turnover]

PURPOSE

To evaluate the French waiting list and the indications of registered patients, to compare the rates of registration, graft, and procurement between French regions.

METHODS

In France, each patient with an indication for penetrating keratoplasty should be registered on the waiting list with his or her clinical characteristics. Those registered during 2000 and 2001 were included in the study. Data on transplantation activity from the waiting list were compared to data collected by a questionnaire on graft and procurement activities completed each year by medical teams.

RESULTS

In 2000 and 2001, 6093 and 5505 waiting patients, respectively, were registered. For the same years, 3984 and 3457 keratoplasties were declared for the patients registered, but the questionnaires reported 4514 and 4388 grafts, respectively. The national registration rate was 96 per million population (pmp). The extreme values between regions ranged from 53 to 143 pmp. There was a significant correlation between regional procurement and transplantation rates (r=0.75, p=0.001) but not for registration and procurement rates, and not for registration and transplantation rates. The national registration rate was 27 pmp for pseudophakic and aphakic corneal edema, with extreme values of 12-64 pmp. The national registration rate was 24 pmp for keratoconus (11-37 pmp). A high patient turnover was observed between regions. Among the 11,598 patients registered, the most common indications were pseudophakic and aphakic corneal edema (27.7%), keratoconus (25.3%), and Fuchs'endothelial dystrophy (9.1%). Mean recipient age was 57+/-22 years (0-103 years). Among these patients, 14.1% had already received transplants at least once for the same eye (7.8% for keratoconus, 14.3% for pseudophakic and aphakic corneal edema, and 6.1% for Fuchs'dystrophy).

DISCUSSION

Ophthalmologists will be able to register their patients directly on the waiting list, which will improve data quality for transplantation notification. Regional policies should be developed to decrease the inequalities of graft shortages between regions.

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Removal of the crystalline lens increases the risk of rhegmatogenous retinal detachment (RD) by creating changes in the ocular environment that predispose to development of retinal breaks. The evolution of cataract surgery from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and phacoemulsification has reduced the incidence of RD, while advances in vitreoretinal surgery have resulted in improved outcomes when retinal detachment does occur. The incidence of RD varies between 0.4-3.6% for ICCE and between 0.55-1.65% for ECCE. In eyes having undergone phacoemulsification the incidence is similar to those of ECCE and ranges between 0.75-1.65%. In this article the authors review the incidence and risk factors associated with pseudophakic and aphakic RD. The risk factors discussed include pre-operative risk factors such as age, status of the fellow eye and myopia, and surgical risk factors such as vitreous loss, posterior capsular integrity and Nd : YAG capsulotomy.

Prevalence, correlates, and natural history of epiretinal membranes surrounding idiopathic macular holes. Virectomy for Macular Hole Study Group

OBJECTIVE

To report on the prevalence, correlates, and natural history of epiretinal membranes (ERM) in eyes with stage II or III/IV macular holes.

DESIGN

A subgroup analysis arising from a multicentered, controlled, randomized clinical trial.

SETTING

Community and university-based ophthalmology clinics.

PATIENTS

Two hundred twenty four eyes with stage II or III/IV macular holes.

INTERVENTIONS

No intervention for 100 eyes randomly assigned to observation.

OUTCOME MEASURES

Grade of ERM determined by stereoscopic examination of fundus photographs at baseline and at 3, 6, 12, and 24 months of follow-up.

RESULTS

The prevalence of ERM was 65% (145 of 224 eyes), was greater in pseudophakic than in phakic eyes (80% vs. 63%, P = 0.10), and increased with increasing severity of the hole (P < 0.0001). Stage III/IV eyes with ERM had a significantly larger hole size than did eyes without ERM (P < 0.01); however, no association between presence of ERM and visual acuity was found (P > 0.5). In the 100 phakic eyes that were randomly assigned to observation, there was a significant increase in the severity of ERM over follow-up (P < 0.0001).

CONCLUSIONS

ERM are common in eyes with full-thickness idiopathic macular holes. Although ERM prevalence increases with severity and size of the macular hole, the presence of ERM are not closely correlated with visual acuity. These factors may be important in considering the removal of ERM during vitrectomy for macular hole.