Search

Purpose: To evaluate the Perfect Capsule sealed-capsule irrigation device (Milvella Pty., Ltd.) using 3 substances in young rabbit eyes., Setting: St. Erik's Eye Hospital, Stockholm, Sweden., Methods: Thirty 4-week-old rabbits had clear lens extraction in both eyes. In 1 randomly selected eye, the Perfect Capsule was applied and the lens capsule was irrigated for 5 minutes with 1 of 3 substances: balanced salt solution (BSS), distilled deionized water (DDW), or 5-fluorouracil (5-FU) 50 mg/mL. In the other eye, no sealed capsule irrigation was used. Forty days postoperatively, the animals were killed and the eyes fixed in formalin for histologic analysis. After-cataract was evaluated in 3 ways: clinically, from photographs, and histologically. Central posterior capsule thickness was evaluated using a microscope, camera, and computer., Results: The Perfect Capsule sealed-capsule irrigation system could be used in all selected eyes. The vacuum to the anterior capsule was tight, and the system was sealed in all eyes. After-cataract developed in the BSS group and DDW group, but not in the 5-FU group. The 5-FU group had significantly less after-cataract than the other 2 groups (P<.05). There was no difference between the groups in capsule thickness., Conclusions: The Perfect Capsule sealed-capsule irrigation system could be used in small eyes. Distilled deionized water did not prevent after-cataract in rabbit eyes with highly proliferative cells, but 5-FU was effective in preventing after-cataract.

Purpose: To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye., Setting: Filatov Institute, Odessa, Ukraine., Methods: Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed., Results: Children in the younger age group (

Aim: To evaluate the efficacy of two different Swedish screening procedures for early detection of congenital cataracts in comparison with no screening., Methods: Children born between January 1992 and December 1998 in Swedish regions with an established eye-screening routine procedure, diagnosed with congenital cataract, and operated on before 1 y of age, were included in a retrospective study. Age at referral and age at time of the operation were compared between regions using different screening procedures: screening in the maternity wards (Region 1), at the well-baby clinics (Region 2) and one region without any screening (Region 3)., Results: Seventy-two children were included in the study. Concerning early diagnosis and surgery, Region 1 differed significantly from Regions 2 and 3, which were more similar and were combined for further analysis. The difference in detected cases was greatest at 21 d of age (55% vs 18%; p < 0.001), but persisted even at 100 d of age (78% vs 64%; p < 0.02). Region 1 screening resulted in more and earlier cases detected than the other two regions (22 vs 15 per 100,000 births). In 72% of all cases, surgery was performed in response to referrals from either the maternity wards (36%), or the well-baby clinics (36%). However, half of the cases from the well-baby clinics were detected too late, i.e. at > 100 d., Conclusion: Eye screening in the maternity ward is preferable to well-baby clinic screening and to no screening at all, since it leads to early detection. Screening should also be performed routinely at well-baby clinics within the period when successful treatment is possible.

Purpose: To evaluate after-cataract formation, ocular growth, and intraocular lens (IOL) behavior in lensectomized infant rabbit eyes implanted with a downsized heparin-surface-modified poly(methyl methacrylate) (HSM PMMA) IOL with long haptics or a 3-piece AcrySof(R) IOL (Alcon Laboratories, Inc.)., Setting: St. Erik's Eye Hospital, Stockholm, Sweden., Methods: Clear lens extraction was performed in both eyes of 3-week-old rabbits. In Group 1 (n = 9), a downsized HSM PMMA IOL with long haptics was implanted in 1 eye and in Group 2 (n = 9), a 3-piece AcrySof IOL was implanted in 1 eye. The fellow eyes remained aphakic., Results: The amount of after-cataract was significantly less in the eyes with the IOLs than in the aphakic eyes. The eyes with the HSM PMMA IOL had significantly less after-cataract than those with the AcrySof IOL. No significant difference in axial length was noted between the IOL eyes and the aphakic eyes in either group. In the eyes with the 3-piece AcrySof IOL, there was anterior movement of the optic with occlusion of the pupil., Conclusions: Eyes with the HSM PMMA IOL and the AcrySof IOL had less after-cataract than the aphakic eyes. The HSM PMMA IOL, however, inhibited after-cataract production significantly better than the AcrySof IOL. The 3-piece AcrySof IOL was seriously deformed in the infant rabbit eyes and caused occlusion of the pupil. Surgeons should be cautious in implanting this AcrySof IOL in the eyes of newborns or in eyes with severe microphthalmia.

Purpose: To evaluate long-term functional outcome after treatment of congenital unilateral cataract., Methods: The records of 30 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. The patients were followed until 4-9.5 years of age. Linear Snellen visual acuity (VA), occlusion therapy compliance, and the presence of nystagmus, strabismus and other complications are reported., Results: Six children achieved VA of 0.1 or better. They were all operated on before 3 months of age. Of the 12 infants operated on before 6 weeks of age, four have VA between 0.3 and 0.4 and eight have VA of finger counting or less. Four developed severe secondary glaucoma within 6 months of cataract extraction. Two of these had persistent fetal vasculature. Three eyes developing glaucoma became amaurotic. Occlusion therapy was abandoned before the age of 2.5 years in 21 children., Conclusion: Good levels of VA were achieved only in children who underwent cataract surgery before 3 months of age and who adhered to the occlusion therapy schedule. Severe secondary glaucoma developed in four out of 12 children operated on within 6 weeks. Full compliance with the occlusion therapy programme was uncommon.

Purpose: To evaluate long-term functional outcome after treatment of dense congenital bilateral cataract., Methods: The records of 22 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. Linear Snellen visual acuity (VA) at last check, presence of stereoacuity, nystagmus, strabismus and other complications are accounted for. Subject age at last check ranged from 4 to 9 years., Results: Visual acuity could be estimated in 19 children: the median VA of the better eye was 0.4 (range: counting fingers - 0.8) and of the fellow eye 0.15 (range: amaurosis - 0.8). In nine otherwise healthy children who were operated on early (by 1 month of age), VA varied from 0.4 to 0.8 in the better eye. Four of these children achieved stereopsis. Pupillary block glaucoma developed in five eyes (in three children). Chronic glaucoma developed in eight eyes (in five children). Glaucoma occurred predominantly in children who underwent cataract extraction during the first week of life. Two of the latter had marked microphthalmos., Conclusion: Good postoperative VA was achieved in most healthy children with dense bilateral congenital cataract when surgery was performed early (before 6-8 weeks of age). Chronic glaucoma developed predominantly when cataract extraction was performed during the first week of life.

Purpose: To study the association between after-cataract and secondary glaucoma after lensectomy and 5-fluorouracil treatment in an experimental infant rabbit model., Setting: St Erik Eye Hospital, Karolinska Institute, Stockholm, Sweden., Methods: Lensectomy was performed in both eyes of 16 3-week-old rabbits. One randomly selected eye in each rabbit was injected with 2.5 mg of 5-fluorouracil (5-FU) at surgery and 5.0 mg the day after surgery to reduce the formation of after-cataract. Axial length, corneal thickness, corneal diameter, and intraocular pressure were measured preoperatively and 4 times during the 6 months following surgery. Six months after surgery, the wet weight of the after-cataract was determined., Results: In 16 aphakic eyes treated with 5-FU, no or a minimal amount (<0.001 g) of after-cataract developed. None of the eyes showed signs of secondary glaucoma. Of 16 aphakic eyes not treated with 5-FU, 10 developed considerable amounts of after-cataract (>0.10 g); 8 of these developed glaucoma. The other 6 eyes had no or minimal after-cataract and did not develop secondary glaucoma. The relationship between after-cataract and secondary glaucoma was statistically significant., Conclusion: A significant relationship between the amount of after-cataract and the development of secondary glaucoma was found in aphakic infant rabbit eyes.

Ocular axial length and thickness were measured in 12 children (age 4 to 418 days, median 103 days) with unilateral congenital cataract who were referred to St. Erik's Eye Hospital during 1991-1994. The measurements were performed in both eyes with A-scan ultrasonography before cataract extraction. In 4 children measurement of the axial length was repeated 1 to 4 months after the unilateral cataract extraction. All eyes with congenital cataract were shorter than the normal fellow eye. The individual axial length differences showed a mean value +/- SEM of 1.03 +/- 0.16 mm. This difference was statistically significant (P < 0.01). In the 4 children where measurement of the axial length was repeated, the difference between the eyes after unilateral cataract extraction had become greater than before. In addition, the thickness of the cataractous lens was 0.63 +/- 0.17 mm (mean +/- SEM) less than the non-operated clear lens. This difference was statistically significant (p < 0.01). In conclusion, in children with unilateral congenital cataract the affected eye has a shorter axial length and a thinner lens.

Purpose: Comparison of the after-cataract formation in newborn rabbits implanted with a heparin-surface-modified (HSM) intraocular lens (IOL), a silicone IOL, or no IOL., Methods: Two groups of 3-week-old rabbits were used. In Group 1 (n = 11), lensectomy was performed in both eyes. One eye was selected at random and an HSM IOL was implanted in the capsular bag; the other eye was left aphakic. In Group 2 (n = 13), lensectomy was performed in both eyes. An HSM IOL was implanted in one eye, a silicone IOL in the other. The wet mass of the dissected after-cataract was determined 3 months after surgery in both groups., Results: In Group 1, the wet mass of the dissected after-cataract was 17.0 +/- 6.5 mg (mean +/- SEM) in eyes implanted with an HSM IOL and 159.7 +/- 17.0 mg in aphakic eyes. This difference was statistically significant (P < .01). In Group 2, the wet mass of the dissected after-cataract was 18.3 +/- 4.3 mg in eyes implanted with an HSM IOL and 25.7 +/- 5.2 mg in eyes implanted with a silicone IOL. No statistically significant difference was found., Conclusions: In young rabbits, implantation of an IOL in the capsular bag following lensectomy reduced cell proliferation.

Several studies have indicated that operation during the first months of life in children with dense congenital cataract improves the final visual acuity. In the current study seven otherwise healthy children operated on before the age of fifty-six days are compared with seven children operated on after the age of three months. The patients were followed by a team consisting of a paediatric ophthalmologist, a contact lens optician and an orthoptist. They were treated with contact lenses, spectacles with near addition and occlusion therapy when needed. Visual acuity was initially tested with preferential looking technique and later with Snellen optotypes. In the early treated group the visual development was almost normal with a final visual acuity of 20/20, while in the late treated group no patient obtained better visual acuity than 20/100. The findings indicate that dense congenital cataract should be treated before the age of three months.