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BACKGROUND: Higher or equal rates of mortality are associated with cataract surgery compared with the general population. Cataract surgery has advanced, and the clinical characteristics of the patient undergoing cataract surgery have changed. AIMS: To reinvestigate survival following cataract surgery. METHOD: Survival data were gathered up to the end of 2006 on 933 consecutive patients who underwent cataract surgery between December 2000 and February 2001. These data were compared with national and regional mortality figures, and standardised mortality ratios (SMR) were calculated. RESULTS: After adjusting for age and sex, there was a statistically significant reduced mortality compared with national (SMR = 0.88 (95% CI 0.79 to 0.99)) and regional figures (SMR = 0.87 (95% CI 0.78 to 0.98)). CONCLUSION: All previous studies found decreased survival among cataract surgery cohorts. These data differ from data at earlier times, as cataract surgery seems to be associated with increased survival. This illustrates the need for continual re-evaluation of accepted medical knowledge in the light of changes in practice and population demographics. [ABSTRACT FROM AUTHOR]

Aim: To determine the long term intraocular pressure (IOP) response to phacoemulsification in patients with and without exfoliation syndrome (XFS). Methods: Prospective, multicentre, cohort study with the following inclusion criteria: age over 50 years, open iridocorneal angle, and cataract. Two groups were enrolled: those with XFS and those without. The main outcome was mean IOP reduction 2 years after phacoemulsification cataract extraction (PCE). Univariate and multivariate analyses were performed. Results: 183 patients were enrolled, 71 with and 112 without XFS. There were 29 patients with glaucoma in both groups. Mean baseline IOP was higher in XFS compared to control eyes (17.60 (SD 3.23) mm Hg v 16.08 (3.18) mm Hg, p=0.002). Overall IOP reduction was significantly greater in the XFS group at the 2 year time point (-1.85 mmHg v -0.62 mmHg in the controls (p=0.0037)). Multivariate analysis demonstrated that the IOP lowering effect in the XFS group may be related to irrigation volume at the time of surgery. In the subgroup analyses IOP lowering was significantly greater in the XFS and XFG patients than in controls without glaucoma, and POAG controls, respectively. The percentage of patients with a postoperative IOP spike was similar and relatively high in both XFS and control groups (34% v 25%; p=0.54). Conclusion: IOP decreases more in patients with XFS following PCE compared to control eyes without XFS. This effect is more pronounced in glaucoma patients and persists for at least 2 years. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the combined phacoemulsification with acrylic intraocular lens implantation and trabeculectomy with releasable sutures, without the use of antimetabolites, performed by one surgeon. Methods: A retrospective analysis was performed on 251 eyes of 198 patients after a combined phaco/trabeculectomy procedure, followed up for an average of 16 months for vision, intraocular pressure (IOP), and number of glaucoma medications. Cox proportional hazard regression analysis provided measures of relative risk (RR) or hazards ratios and 95% confidence intervals (Cls) associated with the occurrence of several conditions or complications of surgery. Results: Mean preoperative variables were best corrected vision, 0.6 (SD 0.4) logMAR (20/80 Snellen); IOP, 18.7 (4.9) mmHg; and number of glaucoma medications, 1.7 (0.8). Mean postoperative results were best corrected vision, 0.2 (0.4) logMAR (20/32 Snellen); IOP, 15.1 (3.2) mmHg; and number of glaucoma medications, 0.3 (0.6). Postoperatively, the mean decreases from baseline were 19.2% for IOP and 84.1% for number of glaucoma medications; 85% of eyes required fewer glaucoma medications and 78% of eyes were medication free, with IOP control. There were no significant operative or postoperative complications. Conclusion: Combined phacoemulsification and trabeculectomy with releasable sutures, in the absence of antimetabolites, is a safe, effective, and stable alternative for patients with cataracts and glaucoma. [ABSTRACT FROM AUTHOR]

Background/aim: The authors previously demonstrated a decrease in complication rate with an increase in volume of cases performed by a surgeon. All studies of volume and outcome are potentially hampered by the issue of case mix, in that some lower volume surgeons may in fact do fewer cases because they have more complex patients. This study was designed to assess the influence of case mix on the volume-outcome relation in phacoemulsification surgery that had previously been demonstrated. Methods: This study took place wholly in Sunderland Eye Infirmary. 667 cases from between 1996 and 2001 were randomly selected from the operative lists of the six surgeons involved in a previous study. The case complexity was assessed using a potential difficulty score (PDS) devised from preoperative data predictive of potential surgical difficulty. The PDS was validated by a retrospective analysis of a sample of 100 cases. Results: 528 complete sets of notes were retrieved. The overall PDS scores ranged from 1 to 6. There was a difference between the proportions of patients with each PDS value (p = 0.015) in the two groups, which suggested that the low volume surgeons were doing potentially more difficult cases. The median PDS for each volume group were the same ( = 1.0). Retrospective validation analysis of the PDS score revealed higher mean and median values in complicated cases compared to uncomplicated cases. Conclusion: This follow up study re-emphasises the importance of case mix adjustment in comparative assessment of healthcare quality. These results may explain in part the trend previously demonstrated of lower complication rates for higher volume surgeons. [ABSTRACT FROM AUTHOR]

Aims: To estimate the risk of aphakic glaucoma alter lensectomy for congenital cataract and its association with surgery within the first month of life. Method: A retrospective case notes review was conducted of all patients who had lensectomy for congenital cataract during their first year of life at Great Ormond Street Hospital between 1994 and 1997. Patients with pre-existing glaucoma, anterior segment dysgenesis, and Lowe syndrome were excluded. The risk of aphakic glaucoma after surgery was estimated using Kaplan-Meier survival analysis. Results: 80 patients, undergoing 128 lensectomies were eligible. Of these, six patients (nine eyes) were lost to follow up. Based on eye count, the risk of glaucoma by 5 years after lensectomy was 15.6% (95% CI 10.2 to 23.4). Based on patient count, the 5 year risk of glaucoma in at least one eye following bilateral surgery was 25.1% (95% CI 15.1 to 40.0). The incidence of glaucoma remained at a constant level for the first 5 years after surgery. After early bilateral lensectomy, within the first month of life, the 5 year risk of glaucoma in at least one eye was 50% (95% CI 27.8 to 77.1) compared to 14.9% (95% CI 6.5 to 32.1) with surgery performed later (log rank test, p=0.012). There was no significant difference (Kolmogorov-Smirnov test: unilateral lensectomy p=0.587, bilateral lensectomy p=0.369) in 5 year visual outcomes between eyes operated before and after 1 month of age. Conclusion: Bilateral lensectomy during the first month of life is associated with a higher risk of subsequent glaucoma than with surgery performed later. The reason for this is unclear but it may be prudent, in bilateral cases, to consider delaying surgery until the infant is 4 weeks old. As the incidence of glaucoma is similar for each year after surgery, long term glaucoma surveillance is mandatory. [ABSTRACT FROM AUTHOR]

Aim: To report on the intraindividual and interindividual variability of tumour size (height and base diameter) measurements using standardised echography in a masked prospective study. Methods: 20 consecutive eyes of 20 patients were examined on four different visits by three experienced examiners using standardised echography. As common in standardised echography, tumour height was evaluated with A-scan technique, while transverse and longitudinal base diameter were calculated with B-scan. Results: Tumour height measurements using A-scan were more accurate than base diameter measurements using B-scan. The standard deviation for tumour height over all visits/measurements was 0.18 mm (A-scan), 0.79 mm for transverse, and 0.69 mm for longitudinal base diameters (B-scan). The interclass correlation coefficient (ICC) was much higher for tumour height measurements with A-scan (0.7735 for three examiners on one visit) than for transverse (0.6563) or longitudinal (0.4522) base diameter measurements with B-scan techniques. Conclusions: A-scan techniques for tumour height measurements provide very reproducible results with little intraindividual and interobserver variability. As B-scan techniques for tumour base evaluation are less accurate they should be used for topographic and morphological examinations. [ABSTRACT FROM AUTHOR]

Aims: To investigate the usefulness of ultrasound biomicroscopy for evaluating changes in the ciliary body in patients with Vogt-Koyanagi-Harada disease. Methods: Ultrasound biomicroscopy was used to evaluate 14 eyes of seven patients diagnosed with Vogt-Koyanagi-Harada disease. Cross sectional images of the ciliary body and thickness of the pars plana 3.0 mm posterior to the scleral spur were examined. Predicted thickness of the pars plana was obtained by multiple linear regression analysis of thickness in the acute phase and in the remission phase. Results: In the active phase, the cross sectional images showed a shallow anterior chamber in eight of the 14 eyes, ciliochoroidal detachment in five eyes, and a thickened ciliary body in all 14 eyes. Internal reflectivity of the ciliary stroma was Iow, with ciliary processes being unclear in 13 eyes. One month after steroid treatment, slit lamp examination findings were normal in 14 eyes. 10 eyes of five patients were examined by ultrasound biomicroscopy at this stage. Ciliochoroidal detachment was no longer seen in any eye. Internal reflection of the ciliary stroma became relatively homogeneous, and the ciliary processes were seen, though not clearly. However, the pars plana remained thickened. The actual thickness was greater at 1 month after steroid treatment than the predicted thickness for the remission phase. In the remission phase, the internal reflection was homogeneous and the ciliary processes were delineated clearly in all 14 eyes. Conclusion: Objective, quantitative evaluation of the ciliary body is possible with ultrasound biomicroscopy during the course of Vogt-Koyanagi-Harada disease. Ultrasound biomicroscopy is useful in determining disease activity in the anterior segment and in monitoring the clinical course, and it may improve evaluation of the efficacy of treatment. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of two preoperative steroid regimens for cataract surgery in patients with uveitis. Methods: 40 uveitis patients with cataract Underwent phacoemulsification and intraocular lens (IOL) implantation. Preoperatively they were randomised into two groups: group 1 (20 patients) received a single dose of intravenous methylprednisolone (15 mg/kg) half an hour before surgery, and group 2 (20 patients) received a 2 week course of oral prednisolone (0.5 mg/kg) which was tapered postoperatively. Preoperatively patients had aqueous flare and cells measured with the Kowa laser Hare meter. On days 1,7,28, and 90 aqueous flare and cells were measured, and on days 7 and 90 fluorescein angiography was performed to determine the incidence of cystoid macular oedema (CMO). Results: At all postoperative visits the mean increase in flare was greater For group 1 (intravenous steroid). Patients with posterior synechiae had greater blood-aqueous barrier damage (BAB) postoperatively. There were no statistically significant differences in logMAR visual acuity and incidences of CMO between the two groups at 7 and 90 days. Conclusion: A 2 week course of oral prednisolone, tapered postoperatively, produced a better recovery of the BAB than a single dose of intravenous methylprednisolone and is thus the recommended preoperative regimen. [ABSTRACT FROM AUTHOR]

The visual prognosis for children with congenital cataracts has improved dramatically since it was first recognized that cataract surgery during infancy is critical for a good visual outcome; however, the optimal time perform cataract surgery in a child with a congenital cataract is still in question. Anecdotal reports have noted excellent visual outcomes in neonates undergoing cataract surgery during the first week of life; however, a subsequent analysis of 45 children with dense unilateral cataracts, who underwent cataract surgery found that the visual outcome was performed during the first 6 weeks of life.

Background/aims Diagnosis of rejection in the mouse model of corneal transplantation is based on subjective judgement of loss of graft transparency. The aims of this study were to (1) evaluate a pachymetry technique to measure changes in mouse corneal thickness and (2) correlate increases in transplant thickness with clinical and histological features of rejection. Methods Orthotopic corneal allografts (C57BL/6 strain donor) and syngeneic grafts were performed in A/J mice. Graft transparency was graded and corneal thickness measured by pachymetry on alternate days. Transverse sections of donor cornea excised from eyes representative of clinical opacity grades 1-4 were prepared, photographed, graft section thickness measured and stromal graft-infiltrating cells counted. Intraobserver and interobserver variations in pachymetry were statistically tested. Results Graft thickness, as measured by pachymetry, increased with each clinical opacity grade. Thickness for opacity grades 0, 1 and 2 was less than 300 μm in all recipients. Graft thickness for grades 3 and 4 was greater than 300 μm in all cases. For measurements up to 400 μm, there was a good correlation between thickness as measured by in vivo pachymetry and in histopathological sections. The mean interobserver bias was -11.35 .μm, while the mean intraobserver bias was +3.96 μm. Stromal cellularity increased with increasing corneal thickness up to approximately 300 μm. Conclusion In vivo graft pachymetry provides a new and reliable way to objectively diagnose rejection in the mouse model of corneal transplantation. [ABSTRACT FROM AUTHOR]

The article reports that a consecutive series of 75 patients in whom trypan blue had been used routinely regardless of cataract type or density. A consecutive series of 94 patients who had routine phacoemulsification by the same surgeon were used as a control group. Apart from the use of trypan blue to facilitate cap sulorhexis, standard phacoemulsification techniques were used in both groups. The data from the two cohorts were compared using mean and standard deviations for continuous variables such as age, and proportions for categorical variables such as sex. For acuity a numeric ordinal score was created from 1 to 10 by placing all the recorded acuities in order.

Reports a case illustrating the use of ultrasonic biomicroscopy (UBM) as and investigative tool in the evaluation of suspected anterior segment ocular foreign bodies. Details of the case of a 51-year old fisherman; Subsurface images of the conjunctiva and sclera.