OBJECTIVETo understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing.

METHODSFrom a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery.

RESULTSAt the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery.

CONCLUSIONSThe data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.

Aged ; Aging ; pathology ; Animals ; Cataract ; complications ; physiopathology ; Cataract Extraction ; utilization ; China ; Female ; Follow-Up Studies ; Humans ; Male ; Urban Population ; Vision Disorders ; etiology ; physiopathology

PURPOSE: To evaluate the long-term efficacy and rotational stability of the AcrySof toric intraocular lens (IOL) in correcting preoperative astigmatism in cataract patients. METHODS: This prospective observational study included 30 eyes from 24 consecutive patients who underwent implantation of an AcrySof toric IOL with micro-coaxial cataract surgery between May 2008 and September 2008. Outcomes of visual acuity, refractive and keratometric astigmatism, and IOL rotation after 1 day, 1 month, 3 months, and long-term (mean, 13.3+/-5.0 months) follow-up were evaluated. RESULTS: At final follow-up, 73.3% of eyes showed an uncorrected visual acuity of 20/25 or better. The postoperative keratometric value was not different from the preoperative value; mean refractive astigmatism was reduced to -0.28+/-0.38 diopter (D) from -1.28+/-0.48 D. The mean rotation of the toric IOL was 3.45+/-3.39 degrees at final follow-up. One eye (3.3%) exhibited IOL rotation of 10.3 degrees, the remaining eyes (96.7%) had IOL rotation of less than 10 degrees. CONCLUSIONS: Early postoperative and long-term follow-up showed that implantation of the AcrySof toric IOL is an effective, safe, and predictable method for managing corneal astigmatism in cataract patients.
*Acrylic Resins ; Adult ; Aged ; Aged, 80 and over ; Astigmatism/complications/physiopathology/*surgery ; Cataract/*complications/physiopathology ; Cataract Extraction/*methods ; Female ; Follow-Up Studies ; Humans ; *Lenses, Intraocular ; Male ; Middle Aged ; Prospective Studies ; Prosthesis Design ; Refraction, Ocular ; Time Factors ; Treatment Outcome ; Visual Acuity

PURPOSE: To evaluate the clinical characteristics and outcomes of cataract surgery in highly myopic Korean subjects. METHODS: We retrospectively reviewed the medical records of 694 eyes of 694 patients who underwent cataract surgery. The case group included 347 eyes of 347 patients whose axial lengths (AXL) were > or =26.00 mm, and the control group included 347 eyes of 347 patients with AXL between 22.00 and 25.99 mm. Cataract density was determined preoperatively using the Pentacam Scheimpflug imaging system. We compared age at operation, cataract type, coexisting disease, visual prognosis, and complications. RESULTS: The mean age at the time of the operation was 59.60 +/- 12.28 years in the case group and 67.47 +/- 11.36 years in the control group. The case group had a larger proportion of nuclear cataracts and posterior subcapsular cataracts (PSC), 40.63% and 26.22%, respectively, versus 25.07% and 11.82%, respectively, in the control group. Postoperative corrected visual acuity showed a negative correlation with AXL (R2 = 0.172), and severe funduscopic findings were related to poor visual prognosis (p = 0.05). The incidence of retinal detachment in the case group after cataract surgery was 1.72%, compared with 0.28% in the control group. CONCLUSIONS: Highly myopic eyes tend to develop cataracts earlier than normal eyes and to have a higher prevalence of coexisting disease and complications, such as retinal detachment. Nuclear cataracts and PSC were more common in the highly myopic group. Poor visual prognosis was associated with longer axial length and retinal myopic degeneration.
Aged ; *Asian Continental Ancestry Group ; Cataract/*complications/epidemiology/physiopathology ; *Cataract Extraction ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myopia/*complications/epidemiology/physiopathology ; Postoperative Period ; *Refraction, Ocular ; Republic of Korea/epidemiology ; Retrospective Studies ; *Visual Acuity

PURPOSE: To evaluate factors associated with the direction of horizontal deviation in the sensory strabismus of patients with unilateral organic amblyopia. METHODS: The medical charts of 53 patients who had been diagnosed with sensory strabismus between 2000 and 2009 were reviewed retrospectively. The underlying ocular disease, time of onset and the duration of vision impairment, refractive error and axial length of the fixing eye, and the direction and angle of deviation were analyzed to determine the distribution of underlying diseases and any factors relevant to determining the direction of the horizontal deviation. RESULTS: Congenital cataracts were the most common underlying disease, found in 33 patients, followed by acquired cataracts, optic nerve disorders, retinal detachment, glaucoma and lens subluxation. Among the 50 patients with horizontal strabismus, 11 had esotropia and 39 had exotropia. The incidence of esotropia was significantly higher when the fixing eye had hyperopia or emmetropia, than when the eye was myopic. Age of onset of vision deterioration and at diagnosis of sensory strabismus, and the axial length of the fixing eye had no relationship to the direction of horizontal deviation. In addition, the duration of visual impairment had no significant relationship with the direction or extent of horizontal deviation. CONCLUSIONS: The most common cause of sensory strabismus was congenital cataracts and the most frequent type of strabismus was exotropia. With respect to the direction of horizontal strabismus, esotropia occurred significantly more often when the refractive error of the fixing eye was hyperopia or emmetropia than when the fixing eye was myopic.
Adolescent ; Adult ; Amblyopia/*complications/physiopathology ; Cataract/complications/congenital/physiopathology ; Child ; Child, Preschool ; Eye Movements/*physiology ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Male ; Oculomotor Muscles/*physiopathology ; Refractive Errors ; Retrospective Studies ; Risk Factors ; Strabismus/etiology/*physiopathology ; Visual Acuity ; Young Adult

PURPOSE: This study was conducted to compare post-operative astigmatic outcomes of two groups, with-the-rule (WTR) and against-the-rule (ATR) astigmatism patients, according to the haptic axis of intraocular lenses (IOLs) inserted in cataract surgery. METHODS: Seventy-two eyes with WTR astigmatism and 79 eyes with ATR astigmatism had cataract surgery through a clear corneal temporal incision. These two groups of eyes were then each divided into 2 groups based on whether the haptic axis of the inserted IOL was at 180degrees or 90degrees. For ATR patients, the outcomes were analyzed according to the three types of IOLs. RESULTS: There was no difference in corneal astigmatism, but WTR patients with a 180degrees haptic axis of the inserted IOL and ATR patients with a 90degrees hepatic axis of the inserted IOL had a significant decrease in postoperative refractive astigmatism (p < 0.05). The changes in ATR astigmatism according to the IOL type were more effective in single-piece acrylic IOLs than in the three-piece polymethylmethacrylate haptic IOL group. CONCLUSIONS: Insertion of the IOL at the 180degrees haptic axis in WTR patients and at 90degrees in ATR patients during cataract surgery may have an effect in reducing pre-existing astigmatism. This observed effect was not consistent among the different types of IOLs.
Astigmatism/classification/*etiology/*physiopathology ; Cataract Extraction/*adverse effects ; Equipment Design ; Humans ; Lens Implantation, Intraocular/*methods ; *Lenses, Intraocular ; *Postoperative Complications ; Treatment Outcome

BACKGROUNDTrabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract.

METHODSThis is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication.

RESULTSAfter 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59 ± 7.94) vs. (24.85 ± 14.39) mmHg, P = 0.614), complete success rate (88% vs. 71%, P = 0.370), formation rate of functioning blebs (65% (11/17) vs. 93% (13/14), P = 0.094), and complications (41% (7/17) vs. 57% (8/14), P = 0.380). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group.

CONCLUSIONPhacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

Aged ; Cataract Extraction ; Female ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Phacoemulsification ; adverse effects ; methods ; Postoperative Complications ; etiology ; Trabeculectomy ; adverse effects ; methods ; Visual Acuity

PURPOSE: To report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa (RP). METHODS: A 45-year-old male with RP presented with elevated intraocular pressure (IOP) in the right eye and was treated with laser iridotomy (LI). After LI, complete crystalline lens dislocation into the anterior chamber occurred. Surgical intervention, including anterior vitrectomy, intracapsular cataract extraction (ICCE), and IOL scleral fixation was performed. Two years later, the same episode occurred in his left eye and a similar treatment was done. RESULTS: Surgery was successful in both eyes. CONCLUSIONS: This is the first report of bilateral spontaneous anterior lens dislocation in a RP patient.
*Anterior Chamber ; Cataract/complications/diagnosis ; Cataract Extraction ; Electroretinography ; Follow-Up Studies ; Humans ; Iris/surgery ; Laser Therapy/adverse effects ; Lens Implantation, Intraocular/methods ; Lens Subluxation/diagnosis/*etiology/surgery ; Male ; Middle Aged ; Ocular Hypertension/complications/physiopathology/surgery ; Retinitis Pigmentosa/*complications/diagnosis/surgery ; Sclera/surgery ; Suture Techniques ; Visual Fields ; Vitrectomy

PURPOSE: To investigate the causes and characteristics of glaucoma in children following cataract surgery. METHODS: Twenty-four patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma after cataract surgery were studied retrospectively. Variables included cataract morphology, surgical techniques, post-operative complications, time to the onset of glaucoma, gonioscopic findings, presence of microcornea and the histopathologic characteristics of the filtration angle (in one case). RESULTS: There was a bimodal onset of glaucoma after cataract surgery. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayed-onset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (p=0.018) more likely to be due to angle closure than delayed-onset glaucoma. With delayed-onset glaucoma, the filtration angle was open in 86% of eyes and significantly (p=0.006) more eyes in the delayed-onset group had microcornea. Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P<0.001). CONCLUSIONS: The onset of glaucoma after cataract surgery during infancy follows a bimodal pattern that is correlated with the configuration of the filtration angle. The early-onset glaucoma group had high incidence of angle closure requiring surgical treatment, while in the delayed-onset group non-surgical treatment was sufficient to control intraocular pressure. Prophylactic iridectomy in eyes at risk for pupillary block is recommended. Eyes with delayed-onset glaucoma have open filtration angles yet also have findings of incomplete development of filtration structures. Microcornea is a risk factor for delayed-onset glaucoma.
Time Factors ; Risk Factors ; Retrospective Studies ; Postoperative Complications ; Male ; Intraocular Pressure ; Infant ; Humans ; Gonioscopy ; Glaucoma, Open-Angle/diagnosis/*etiology/physiopathology ; Glaucoma, Angle-Closure/diagnosis/*etiology/physiopathology ; Follow-Up Studies ; Female ; Child, Preschool ; Child ; Cataract Extraction/*adverse effects ; Cataract/congenital ; Age Factors ; Adult ; Adolescent

PURPOSE: The purpose of this study was to evaluate the visual outcomes and complications of unilateral scleral fixation of posterior chamber intraocular lenses (SF-PCIOLs) in pediatric complicated traumatic cataracts without capsular support. METHODS: This study involved five eyes of five children who underwent unilateral SF-PCIOL. All patients had a unilateral complicated traumatic cataract associated with anterior or posterior segment injury. Visual acuity (VA), IOL position, and postoperative complications were assessed during follow-up. RESULTS: The mean age of patients at the time of SF-PCIOL was 90 months (range, 66-115). The mean duration of follow-up time after surgery was 22 months (range, 5-55). In all patients, the best-corrected VA was either improved or was stable at last follow-up following SF-PCIOL implantation. There were no serious complications. CONCLUSIONS: Unilateral scleral fixation of PCIOL can be a safe and effective procedure for pediatric, unilateral, complicated traumatic cataracts without capsular support in selected cases.
Anterior Eye Segment/injuries ; Aphakia, Postcataract/*surgery ; Cataract/*etiology/physiopathology ; Child ; Child, Preschool ; Endophthalmitis/etiology ; Eye Injuries/*complications ; Female ; Follow-Up Studies ; Humans ; Lens Implantation, Intraocular/*methods ; Male ; Postoperative Period ; Retrospective Studies ; Sclera/*surgery ; *Suture Techniques ; Visual Acuity