Anterior Subcapsular Opacities Research Articles

Methotrimeprazine-induced Corneal Deposits and Cataract Revealed by Urine Drug Profiling Test

Two schizophrenic patients who had been taking medication for a long period presented with visual disturbance of 6-month duration. Slit-lamp examination revealed fine, discrete, and brownish deposits on the posterior cornea. In addition, bilateral star-shaped anterior subcapsular lens opacities, which were dense, dust-like granular deposits, were noted. Although we strongly suspected that the patient might have taken one of the drugs of the phenothiazine family, we were unable to obtain a history of medications other than haloperidol and risperidone, which were taken for 3 yr. We performed a drug profiling test using urine samples and detected methotrimeprazine. The patient underwent surgery for anterior subcapsular lens opacities. Visual acuity improved in both eyes, but the corneal deposits remained. We report an unusual case of methotrimeprazine-induced corneal deposits and cataract in a patient with psychosis, identified by using the urine drug profiling test.

Fixed Dilated Pupil (Urrets-Zavalia Syndrome) After Deep Anterior Lamellar Keratoplasty

To report 4 cases that developed fixed dilated pupil after deep anterior lamellar keratoplasty (DALK) for treating keratoconus and granular corneal dystrophy. Four patients underwent DALK (either Melles's manual dissection or Anwar's big-bubble technique) with diagnosis of keratoconus (2 cases) and granular corneal dystrophy (2 cases). In Melles's technique, the anterior chamber was fully filled with air at the beginning of procedure. When corneal dissection was complete, air was replaced with balanced salt solution. In Anwar's technique, a large bubble was formed between Descemet's membrane and the deepest stroma. Viscoelastic was not used within the anterior chamber in either technique. For microperforation, air was left in the anterior chamber for a couple of days. Two patients developed severe fibrinous anterior uveitis that was controlled with intense topical and systemic steroid. Other two patients developed high intraocular pressure that was controlled with antiglaucoma medications. After 1-2 weeks, all 4 DALK patients developed fixed dilated pupil and posterior synechiae; 2 patients developed a faint anterior subcapsular opacity. Of 286 patients who underwent DALK, 6 patients had microperforation (2%) and 4 patients developed fixed dilated pupil (1.4%). Best-corrected visual acuity (BCVA) decreased in all patients; most of them complained about visual symptoms like glare and halo at night. Fixed dilated pupil (Urrets-Zavalia syndrome) is an uncommon but rather serious complication of corneal transplantation. Iris ischemia is the most common proposing mechanism. Decreased BCVA and visual symptoms at night (glare and halo) are late sequelae.A fixed dilated pupil with iris atrophy (Urrets-Zavalia syndrome) is an uncommon postoperative complication that was originally described after penetrating keratoplasty for keratoconus. In these cases, the iris is fixed and dilated and adheres to anterior lens capsule. Prepupillary iris atrophy is usually seen and may be accompanied by a severe fibrinous reaction and anterior subcapsular lens opacity.

Anterior subcapsular opacities and cataracts 5 years after surgery in the visian implantable collamer lens FDA trial

Anterior subcapsular opacities and cataracts 5 years after surgery in the visian implantable collamer lens FDA trial

Abstracts: 39th Annual Meeting of the American College of Veterinary Ophthalmologists, Boston, MA, USA, October 15–18, 2008

Purpose: The aim of this study was to evaluate the ocular features and intraocular pressure (IOP) in adult Red Drum Fish (Sciaenops ocellatus). Methods: All fish were anesthetized with tricaine methanesulfonate (MS-222, Western Chemicals, Ferndale, WA, USA) at 70 parts per million. The anterior segment of all fish eyes were examined with a Finnoff transilluminator and slit-lamp biomicroscopy. Binocular indirect ophthalmoscopy was performed in all eyes to observe the posterior segment. IOP was measured and recorded in both eyes of 13/18 fish and in the right eye only in 1/18 fish using applanation tonometry (27/36 total eyes). Tonometry readings were discarded in 4 fish (8 eyes) due to poor anesthesia and inadequate restraint. The horizontal corneal diameter was measured in all eyes. Results: There were 9 male and 9 female fish, all of which were 5 years old. Ophthalmic examination of the anterior segment revealed a horizontal oval-shaped immobile pupil. A characteristically large spherical lens and shallow anterior chamber often exhibiting an aphakic crescent medially was observed. The retina was anangiotic and the fundus ranged in color from white-gray to dark yellow-gray. The optic nerve papilla was horizontally elongated and associated with a prominent hyaloid vessel projecting anteriorly into the vitreous. In 2/36 eyes, 2 mm white translucent cysts in the anterior chamber were identified. Seventeen of the fish had anterior subcapsular opacities in both eyes. These lens opacities were between 1 and 5 mm in diameter and ranged in density from faint to prominent. The subcapsular opacities were central to paraxial. One eye had multifocal lens opacities. The mean horizontal corneal diameter of both eyes was 20.83 ± 1.42 mm. The mean IOP for the right and left eye of fish was 8.69 ± 3.29 mmHg and 6.82 ± 3.19 mmHg, respectively. Mean fish length was 99.05 ± 4.33 cm. Conclusions: The ocular features of a group of adult Red Drum Fish were identified. In this population of red drum, anterior subcapsular cataracts were a common finding. The average IOP this population of fish was determined to be 7.82 ± 2.82 mmHg.

Anterior Subcapsular Opacities and Cataracts 5 Years After Surgery in the Visian Implantable Collamer Lens FDA Trial

Purpose To use the techniques of survival analysis to analyze the incidence of anterior subcapsular opacities (symptomatic and asymptomatic) and clinically significant cataract in the US Food and Drug Administration clinical trial of the Visian Implantable Collamer Lens (ICL). Methods Five hundred twenty-six eyes were followed for an average of 4.7 years; 89% (468 eyes), 73% (384 eyes), and 59% (311 eyes) were seen at 3, 4, and 5 years or later, respectively. Anterior subcapsular opacities were defined as trace or more (⩾0.6 LOCS III opacity). Clinically significant cataract required loss of 2 or more lines of best spectacle-corrected visual acuity (BSCVA), a significant increase in glare symptoms, or cataract extraction. Kaplan-Meier analyses of opacities and cataract were performed. Results The Kaplan-Meier cumulative probability estimate for anterior subcapsular opacities over 7+ years of follow-up was 7% whereas 31 (5.9%) eyes were actually observed. Anterior subcapsular opacities generally occurred early with 58% seen in the first year, 68% in the first 2 years, and 74% in the first 3 years. The cumulative probability estimate for clinically significant cataracts over the 7+ years of follow-up was 2% whereas 7 (1.3%) were actually observed. The difference between the Kaplan-Meier estimate and the actual observed percentage is due to the fact that the former takes into account the differences in postoperative follow-up time of individual eyes. Preoperative myopia (>12.00 diopters) and patient age (>40 years) were significant factors in the development of cataract. No loss of BSCVA was observed in any eye following cataract extraction. Conclusions Approximately 6% to 7% of eyes develop anterior subcapsular opacities at 7+ years following ICL implantation but only 1% to 2% progress to clinically significant cataract during the same period, especially very high myopes and older patients. Visual outcome following cataract extraction was good. [ J Refract Surg . 2008;24:566–570.]

Unilateral electric cataract: Scheimpflug imaging and review of the literature

A 22-year-old man presented with diminution of vision in the left eye 1 month after sustaining an injury from a high-voltage electric current to the left side of his head. Slitlamp examination and Scheimpflug imaging confirmed the typical anterior subcapsular lenticular opacities in the left eye and also documented early anterior subcapsular vacuoles in the right eye. Based on history, the electric shock wound, and the typical appearance of the opacities, an electric cataract was diagnosed. The difference in lens density between the 2 eyes was also documented. The best corrected visual acuity (BCVA) was 20/20 in the right eye and counting fingers at 1 foot in the left eye. Phacoaspiration and posterior chamber intraocular lens implantation were performed in the left eye. Postoperatively, the BCVA improved to 20/20. The developmental mechanisms of these opacities after exposure to an electric current and the role of Scheimpflug imaging in assessing the earliest subclinical manifestations of electric cataract injuries are discussed.

Descemet's membrane perforation during deep anterior lamellar keratoplasty: Prognosis

To evaluate the functional and endothelial prognosis after Descemet's membrane perforation during deep anterior lamellar keratoplasty (DALK). Private practice, Siena, Italy. A retrospective study evaluated a series of 35 eyes that had DALK using the big-bubble technique. Intraoperative perforation occurred in 8 eyes (23%), in 5 eyes during manual deep dissection and in 1 eye each during trephination, as the air needle was introduced in the stroma, and as the big bubble was punctured. In all 8 eyes, DALK could be completed. In 1 case, pupillary block was caused by air left in the anterior chamber, resulting in permanent mydriasis and anterior subcapsular opacity. In another case, a double anterior chamber persisted and penetrating keratoplasty was later required. In the other 6 cases, the postoperative course was uneventful. The mean postoperative best spectacle-corrected visual acuity was 0.8 +/- 0.13 (SD) and the mean postoperative refractive astigmatism, 2.09 +/- 0.98 diopters. The mean endothelial cell loss, evaluated in 7 eyes, was 12% +/- 11% at 1 month (P<.05) and 14% +/- 12% at 12 months. The mean cell loss was 25% +/- 2.7% in eyes in which intraoperative reformation of the anterior chamber with air was required and 6% +/- 7.5% in eyes in which it was not (P< .05). Despite 2 complicated cases, intraoperative perforation during DALK had a good final functional prognosis. However, eyes in which the perforation required reformation of the anterior chamber had a mean endothelial cell loss greater than 20%. When air is left in the anterior chamber, close monitoring is required to avoid pupillary block.

Changes in the crystalline lens resulting from insertion of a phakic IOL (ICL) into the porcine eye

Insertion of a phakic IOL offers these advantages: the corneal optical zone is not dissected or resected; preservation of the crystalline lens results in preservation of the accommodation force; and since the phakic IOL is removable, any error or change in refraction can be countered by exchanging it. However, the cause of secondary cataracts has never been clarified or discussed to date. The following ICL lenses were inserted under general anaesthesia into 20 eyes of ten 3-month-old miniature pigs: a minus lens without holes into five eyes, a plus lens in two eyes, a minus lens with four holes around the lens haptics in three eyes, and a minus lens with a central hole in the optic in three eyes; and seven eyes were used as controls. The anterior segments were then photographed 1 week, 1 month and 3 months after surgery. At 3 months after surgery, Evans blue (EB) was infused into the vitreous under general anaesthesia, and after 30 min, the eyeball was enucleated, fixed and examined. In the case of the ICL without holes, the anterior subcapsular opacities were observed in all the eyes, and the anterior surfaces of the crystalline lenses were not stained with EB. Use of the ICL with four holes around the lens haptics resulted in light staining of the anterior surface of the crystalline lens, but the anterior subcapsular opacities observed were mild. As for the ICL with a hole in the centre of the optic, the anterior surface of the crystalline lens was stained and no anterior subcapsular opacities were observed. The results suggested that the insertion of an ICL brings about a change in the dynamics of the intraocular aqueous humour, reducing its circulation to the anterior surface of the crystalline lens. This is considered to cause a metabolic disturbance of the crystalline lens, resulting in anterior subcapsular opacification.

Angle-supported phakic intraocular lenses in hyperopia

To evaluate the efficacy and safety of angle-supported phakic intraocular lenses (PIOLs) in hyperopia. Private practice, Siena, Italy. A prospective noncomparative single-surgeon interventional case series comprised 42 consecutive hyperopic eyes of 22 patients having implantation of a type PIOL (Morcher) through a sclero-corneal 5.5 mm x 3.0 mm tunnel along the steepest meridian, with surgical iridectomy. The mean preoperative defocus equivalent (DEQ) was 7.30 diopters (D) +/- 1.89 (SD). The mean spherical equivalent (SE) was 6.61 +/- 1.47 D (range 4.0 to 10.5 D), and the mean refractive astigmatism was 1.51 +/- 1.33 D (range 0 to 5 D). The mean age was 29.9 +/- 6.0 years (range 22 to 42 years). Thirteen patients (59%) were men. Postoperative mean SE was 0.38 +/- 0.52 D (range 0 to 2 D); mean DEQ 0.93 +/- 0.98 D; mean astigmatism 0.95 +/- 1.17 D; mean surgically induced astigmatism (vector analysis) 0.67 +/- 0.58 D (95% confidence interval, 0.49-0.85); 38 eyes (90%) were within +/-2 D of DEQ, 34 eyes (81%) within +/-1 D, and 24 eyes (57%) within +/-0.5 D. Safety index was 1.05; efficacy index 0.85. Complications were night halos 10%; pupil ovalization 7%; pupillary block reversed by neodymium:YAG laser 7%; monocular anterior subcapsular opacity 5%; monocular iridocyclitis 5%; and intraocular pressure rise due to topical steroids 2%. Endothelial cell loss at 12 month was 6% (range +2.5% to -11%). High hyperopia was corrected safely and predictably by an angle-supported PIOL with limited complications.

Traumatic cataract and other adverse events with the implantable contact lens

To evaluate the surgical outcome and adverse events associated with implantation of the implantable contact lens (ICL) for the correction of high myopia or high hyperopia. Helsinki University Eye Hospital, Helsinki, Finland. In this nonrandomized prospective clinical trial, the ICL V4 was implanted in 26 eyes of 13 patients with normal enrollment criteria (younger than 45 years, a clinically clear crystalline lens) (Group 1) and the V2, V3, or V4 were implanted in 38 eyes of 22 patients with heterogeneous criteria (older than 45 years or opacities in the crystalline lens) (Group 2). The main outcome measures were lens opacity classification system (LOCS II) assessment and transparency analysis of the lens. In Group 1, microdensitometric assessment showed no decrease in crystalline lens transparency and no statistically significant increase in crystalline lens density at any follow-up examination (P>.05). The incidence of anterior subcapsular (AS) opacities was 7.7%, and no eye developed clinically significant cataract during the mean follow-up of 13.2 months +/- 12.3 (SD). No myopic eye lost a line of best corrected visual acuity (BCVA); 50.0% of hyperopic eyes lost 1 line of BCVA. Sixty-eight percent of myopic eyes and 75.0% of hyperopic eyes were within +/-1.0 diopter of the predicted refraction. In Group 2, the incidence of AS opacities was 47.4% and 10 eyes (26.3%) developed clinically significant cataract during the mean follow-up of 30.9 +/- 18.0 months. The visual and refractive results were similar to those in Group 1 at 1 month, but due to progressive AS opacities in the crystalline lens, 23.4% of eyes lost BCVA lines during the follow-up. Intraoperative complications were few and insignificant. Implantation of the ICL for correction of high myopia or high hyperopia appears to be a safe procedure with good visual and refractive results immediately. There was no decrease in the transparency or increase in the density of the crystalline lens with the latest generation of the ICL device in the normal group, indicating enhanced safety. Progressive lens opacification in the heterogeneous group shows there are risk factors for cataract formation; ie, type V3 ICL, preexisting lens opacities, and older patient age. Anterior subcapsular opacities are most likely the result of trauma.

United States Food and Drug Administration clinical trial of the Implantable Collamer Lens (ICL) for moderate to high myopia: Three-year follow-up

Purpose To report on 3-year postoperative safety and efficacy outcomes with the Myopic Implantable Collamer Lens (ICL). Design Prospective nonrandomized clinical trial. Participants Five hundred twenty-six eyes of 294 patients with between 3.0 and 20.0 diopters (D) of myopia participating in the United States Food and Drug Administration clinical trial of the ICL for myopia. Intervention Implantation of the ICL. Main outcome measures Uncorrected visual acuity (VA), refraction, best spectacle-corrected VA (BSCVA), adverse events, operative and postoperative complications, lens opacity analysis, subjective satisfaction, and patient symptoms. Results At 3 years, 59.3% had 20/20 or better VA, and 94.7% had 20/40 or better uncorrected VA if BSCVA was 20/20 and patients were targeted for emmetropia; 67.5% of patients were within 0.5 D and 88.2% were within 1.0 D of predicted refraction. The mean improvement in BSCVA ranged between 0.5 and 0.6 lines. At 3 years postoperatively, 3 eyes (0.8%) decreased by ≥2 lines of BSCVA, in contrast to 40 eyes (10.8%) that improved by a similar amount. Contrast sensitivity improved postoperatively. Cumulative 3-year corneal endothelial cell loss was under 10%. Early largely asymptomatic, presumably surgically induced anterior subcapsular opacities (trace or greater) were seen in 14 eyes (2.7%), with only 2 being clinically significant. Five eyes (0.9%) of 3 patients developed nuclear opacities of grade >2 at 2 to 3 years postoperatively. Three (0.6%) ICL removals with cataract extraction and IOL implantation have been performed. Only 0.6% reported dissatisfaction; 97.1% of patients reported they would choose ICL implantation again. Incidences of patient symptoms, glare, halos, double vision, night vision problems, and night driving difficulties decreased or remained unchanged after ICL surgery. Conclusion Three-year results from this standardized, multicenter clinical investigation support the safety, efficacy, and predictability of ICL surgery to treat moderate to high myopic refractive errors.

Lens opacities after posterior chamber phakic intraocular lens implantation

Purpose To describe a case series to determine the incidence of lens opacities after posterior chamber phakic intraocular lens (IOL) implantation (STAAR Surgical, Monrovia, CA) for very high ametropias. Design Retrospective, noncomparative, interventional case series. Participants Fourteen eyes of 170 consecutive eyes with high ametropias in whom lens opacities developed after posterior chamber phakic IOL implant (PCPIOL). Intervention Posterior chamber phakic intraocular lens implant. Main outcome measures Lens opacity appearance, localization, and clinical course. Results Fourteen eyes developed lens opacities 125 ± 116 days after phakic IOL implant. All eyes had anterior subcapsular opacities, and two eyes also developed nuclear sclerosis. The anterior opacities did not extend posteriorly within the lens, and there were no posterior subcapsular cataracts. Seventy-one percent of opacities were first seen ≤3 months, and 86% were seen ≤7 months postoperatively. Seventy-nine percent of opacities were seen in the first or second implants of surgeons being trained; 19% of the first 16 cases and 0% of the next 43 cases of one surgeon developed opacities. Mean follow-up after opacity diagnosis was 9.1 ± 6.8 months. Nine of the 14 (64%) opacities were asymptomatic. Two eyes developed nocturnal glare, with no loss of best-corrected visual acuity (BCVA) and one had loss of BCVA. Two additional eyes with both nuclear sclerotic and anterior subcapsular lens opacities had visual symptoms and/or loss of BCVA and underwent phakic IOL explantation, cataract extraction by phacoemulsification, and PCPIOL implant with good visual outcome. In the entire series, 5 of 170 (2.3%) implantations had symptomatic opacities in which 111 implantations were the first or second case of the implanting surgeon. Conclusions Lens opacities are a potential complication of phakic IOL implantation. Most lens opacities were first seen in the early postoperative period and were most likely due to surgically induced trauma. The anterior subcapsular type was most common and tended not to be rapidly progressive during the follow-up period. The presence of nuclear sclerotic cataract was visually significant and progressive. Long-term follow-up is warranted to evaluate the rate of progression and course of lens opacities after phakic IOL implant surgery.

U.S. Food and Drug Administration clinical trial of the Implantable Contact Lens for moderate to high myopia

Purpose To assess the safety and efficacy of the Implantable Contact Lens (ICL) to treat moderate to high myopia. Design Prospective nonrandomized clinical trial. Participants Five hundred twenty-three eyes of 291 patients with between 3 and 20.0 diopters (D) of myopia participating in the U. S. Food and Drug Administration clinical trial of the ICL for myopia. Intervention Implantation of the ICL. Main outcome measures Uncorrected visual acuity (UCVA), refraction, best spectacle-corrected visual acuity (BSCVA), adverse events, operative and postoperative complications, lens opacity analysis (Lens Opacity Classification System III), subjective satisfaction, and symptoms. Results Twelve months postoperatively, 60.1% of patients had a visual acuity of 20/20 or better, and 92.5% had an uncorrected visual acuity of 20/40 or better. Patients averaged a 10.31-line improvement in UCVA, 61.6% of patients were within 0.5 D, and 84.7% were within 1.0 D of predicted refraction. Only one case (0.2%) lost > 2 lines of BSCVA. Gains of 2 or more lines of BSCVA occurred in 55 cases (11.8%) at 6 months and 41 cases (9.6%) at 1 year after ICL surgery. Early and largely asymptomatic, presumably surgically induced anterior subcapsular (AS) opacities were seen in 11 cases (2.1%); an additional early AS opacity (0.2%) was seen because of inadvertent anterior chamber irrigation of preservative-containing solution at surgery. Two (0.4%) late (≥ 1 year postoperatively) AS opacities were observed. Two (0.4%) ICL removals with cataract extraction and intraocular lens implantation have been performed. Patient satisfaction (very/extremely satisfied) was reported by 92.4% of subjects on the subjective questionnaire; only four patients (1.0%) reported dissatisfaction. Slightly more patients reported an improvement at 1 year over baseline values for the following subjective symptoms: quality of vision, glare, double vision, and night driving difficulties. Only a 3% difference between pre-ICL and post-ICL surgery was reported for haloes. Conclusions The results support the safety, efficacy, and predictability of ICL implantation to treat moderate to high myopia.

Myopic implant of the posterior chamber using a flexible Collamer lens

The purpose of this study was to report results, effectiveness and safety of implanting a negative collagen/HEMA copolymer posterior chamber phakic intraocular lens in moderate to highly myopic eyes. 23 eyes from 12 patients with a mean preoperative spherical equivalent refraction of - 10.94 +/- 5.97 D underwent a refractive procedure with the Staar ICL trade mark posterior chamber phakic intraocular lens. The average follow-up was 12.9 +/- 7.4 months (range 4 - 24 months). Preoperative and postoperative uncorrected and best corrected visual acuity, subjective refraction, intraocular pressure, keratometry, ICL trade mark centration and anterior subcapsular opacities were evaluated. Postoperative uncorrected visual acuity improved in all eyes. The best corrected visual acuity increased from 0.82 +/- 0.39 preoperatively to 1.05 +/- 0.24 postoperatively. The gain in visual acuity was statistically significant (Student t-test, p = 0.0097). The mean postoperative spherical equivalent refraction was - 0.82 +/- 1.42 D (p < 0,0001). The mean postoperative intraocular pressure was 15.65 +/- 2.72 mm Hg. The intraocular contact lens remained well centred in all eyes and no anterior subcapsular opacities were observed. Three patients underwent transcient complication without affecting the visual outcome. The use of a posterior chamber phakic intraocular lens in myopic eyes is a safe procedure to correct moderate to high myopia. Long-term results are still unknown.

Abnormal electroretinogram and abnormal electrooculogram after lightning-induced ocular injury

PURPOSE: To report a case of abnormal electrooculogram and abnormal electroretinogram after lightning-induced ocular injury. DESIGN: Interventional case report. METHODS: A 39-year-old man was struck on the left forehead by a bolt of lightning. After resuscitation, he regained consciousness. RESULTS: Ophthalmic examination disclosed a best-corrected visual acuity of right eye (RE): 20/25 and left eye (LE): 20/50, burned eyelashes, punctate keratitis, iridocyclitis, anterior subcapsular lens opacity, missing foveolar reflex, and macular pigment epithelial defect LE. Fluorescein angiography revealed only an area of punctate leaking in the left eye. Electrooculogram showed reduced amplitudes, in the left eye. Arden ratio was RE: 2.04 and LE: 1.52. The amplitudes of scotopic and photopic electroretinogram b-waves were reduced in the left eye. After uneventful cataract surgery in the left eye, the follow-up electrooculogram and electroretinogram still showed reduced amplitude in the left eye. CONCLUSION: Lightning is an uncommon cause of ocular injury. This is the first report of abnormal electro-oculogram and abnormal electroretinogram after lightning-induced ocular injury.

Muscarinic receptor antagonist-induced lenticular opacity in rats.

Investigations on compound A, an M2-sparing M3 muscarinic receptor antagonist, showed that focal polar anterior subcapsular lenticular opacities, characterized by focal epithelial proliferation, developed in Sprague-Dawley rats. The incidence and bilateral localization of this change increased generally with dose and time, though plateauing after 8 months of treatment; however the severity progressed very slightly. Over a 1-year period, no anterior cortical lens fiber changes or other histological ocular changes developed. A decreased severity of the change and apoptosis suggested some regression after a 26-week recovery period. Two nonselective muscarinic receptor antagonists, atropine and tolterodine, induced similar lenticular changes in rats. A hypothesis in relation to an indirect effect of the drug, such as increased illumination of the lens due to mydriasis observed with all these compounds, was investigated and disproven. Because these opacities are induced by structurally unrelated muscarinic receptor antagonists (atropine and tolterodine), it is likely that these lenticular changes are the result of muscarinic receptor inhibition. However, hypotheses regarding a direct effect of the drug on muscarinic receptors in the lens epithelium, possibly mediated by drug and/or metabolite(s) in the aqueous humor and/or lens epithelium, remain to be investigated. This lenticular opacity is similar to that observed spontaneously in Sprague-Dawley rats, although the latter occur at a lower incidence. No such lenticular opacities have been reported in other animal species, including man, after treatment with muscarinic receptor antagonists.

Visual functions and adverse ocular effects in patients with amiodarone medication.

To study visual functions and ocular adverse effects of long-term amiodarone medication. We performed an eye examination of 22 patients with long-term amiodarone medication. In addition to corrected visual acuity, colour vision was studied with the Standard Pseudoisochromatic Plates part 2 and Farnsworth-Munself 100 hue test. Contrast sensitivity was examined with the Pelli-Robson chart. Visual fields were tested by Goldmann and Friedmann perimetry. Two patients with otherwise healthy eyes had abnormal blue colour vision test results. Otherwise colour vision, contrast sensitivity, and visual field test results were within normal range or could be explained by eye diseases such as cataract. Corneal drug deposits were found in 100% of the examined eyes. Slight anterior subcapsular lens opacities were found in 22.2%. Dry eyes were diagnosed in 9.1%. The eye fundi did not reveal any abnormalities that could be thought of as caused by amiodarone. The slight blue colour vision defect found in two patients with otherwise healthy eyes might represent an early sign of the optic nerve impairment which is a rare complication of amiodarone medication. The number of corneal and lens changes as well as dry eyes were found at levels previously described.

Laser in situ keratomileusis and photorefractive keratectomy for residual refractive error after phakic intraocular lens implantation.

To determine the visual and refractive outcome of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in eyes with prior posterior chamber phakic intraocular lens implantation for high myopia. We studied a series of 37 consecutive eyes of 31 patients who underwent LASIK or PRK for residual refractive error following collamer posterior chamber intraocular lens (IOL) (Staar Surgical Implantable Contact Lens) implantation into a phakic eye. Twenty-eight eyes had LASIK and nine eyes had PRK. Mean follow-up was 8.1 +/- 4.7 months after laser ablation (range, 3 to 18 mo). The preoperative mean spherical equivalent refraction prior to phakic posterior chamber IOL implantation was -17.74 +/- 4.89 D (range, -9.75 to -28.00 D). Following phakic IOL implantation and prior to LASIK or PRK, mean spherical equivalent refraction was -2.56 +/- 2.34 D (range, -0.25 to -8.75 D). One month following LASIK or PRK, mean spherical equivalent refraction was -0.24 +/- 0.52 D (range, -1.50 to +1.50 D), 3 months following LASIK or PRK, mean spherical equivalent refraction was -0.19 +/- 0.50 D (range, -1.50 to +1.00 D). The refraction was within +/-1.00 D of emmetropia in 36 eyes (97.2%) and within +/-0.50 D in 31 eyes (83.7%). Three eyes developed anterior subcapsular opacities several weeks after laser ablation, one eye developed macular hemorrhage 4 weeks after laser ablation, and one eye had corticosteroid induced ocular hypertension. LASIK or PRK can be used to treat the residual refractive error following posterior chamber phakic IOL implantation.

Working conditions and health effects of ethylene oxide exposure at hospital sterilization sites.

Ethylene oxide (EtO) is a powerful disinfectant and sterilant for heat-sensitive surgical items and instruments. Its use in hospitals constitutes an important source of occupational exposure that is sometimes underestimated, such as in cases of EtO device malfunction when the safety rules of procedure are not strictly followed or when individual or collective protective equipment is lacking. We carried out a descriptive study of the health care workers who were assigned to EtO sterilization units of the Lille University Hospital Centre in Lille, France (n = 16). Before the modification of the sterilization units in the development of a single, central sterilization site, we studied the workplaces, occupational conditions, and work procedures of the health care workers exposed to EtO. The aim was to assess the risk of EtO overexposure of the workers in order to improve workers' health and security in the future sterilization center. The study was based on a physical examination, a questionnaire covering each subject's personal and occupational history, and a complete ocular examination. For occupational conditions, the studies of each workplace were also performed by the occupational physician. Area and personal breathing air samplings were performed at each exposure site. Fourteen of the 16 operators had posterior and anterior subcapsular lens opacities, three of which seemed to be directly and primarily related to occupational exposure; the other ten seemed to be rather common and compatible with age. High levels of EtO exposure were reported in the oldest site (90 parts per million [ppm] during the changing of the gas bottle), where exposure often exceeded French threshold limits (permissible exposure limit: 1 ppm 8-hour time-weighted average (TWA) in air; short-term excursion limit: 5 ppm 15-minute TWA in air), or the current US recommended and legal exposure limits for EtO advocated by the Occupational Safety and Health Administration and the American Conference of Governmental Industrial Hygienists (permissible exposure limit: 1 ppm 8-hour TWA in air; excursion limit: 5 ppm 15-minute TWA in air), and the National Institute for Occupational Safety and Health standard (recommended exposure limits: 0.1 ppm 8-hour TWA in air; 5 ppm 10-minute TWA in air). The faults in the work processes, such as interruption of the sterilization cycle and disregard for the use of protective devices, were very common.

Schizophrenia, psychotropic medication, and cataract

Objective To compare the distribution of cataract types between psychiatric patients diagnosed with schizophrenia and the general population not exposed to psychotropic medication, and to compare cataract prevalence between users and nonusers of various psychotropic medications in the general community. Design Case-control. Participants A total of 151 (93%) eligible patients from a community mental health service and 3271 (83%) eligible residents from the Melbourne Visual Impairment Project (VIP) were examined. Main outcome measures All patients 40 years of age and older from a community mental health service and residents of nine randomly selected areas of Melbourne were eligible. Best-corrected distance visual acuity was determined using a 4-m logarithm of the minimum angle of resolution (LogMAR) chart. The presence of cataract was determined by photographs or slit-lamp examination using direct and indirect retroillumination. Anterior, cortical, nuclear, and posterior subcapsular cataracts were measured. Participants from the Melbourne VIP were classified as to whether they had taken benzodiazepams, phenothiazines, thioxanthenes, butyrophenols, tricyclic antidepressants, or monoamine oxidase inhibitors for at least 12 months during their lifetime. Results The distribution of cataract type varied between persons with and without schizophrenia. Anterior subcapsular (ASC) cataract was significantly more prevalent (26%) in participants with schizophrenia from the community mental health service than Melbourne VIP participants (0.2%) not exposed to psychotropic medication (chi-square, 1 degree of freedom = 605.5, P = 0.001). This remained significant after controlling for age (odds ratios = 250, 95% confidence interval = 83.3, 1000). The distribution of the age-related cataract was similar across all groups of psychotropic medication users with the exception of the phenothiazine users. They had less of all types of the age-related cataracts, despite being slightly older than the control group (mean age, 60.0 vs. 58.4, t test = 0.85, P = 0.40). However, only cortical cataract in the phenothiazine group was statistically lower (chi-square, 1 degree of freedom = 3.96, P = 0.047). Conclusion This study has identified the need to investigate whether other newer agents, especially high-potency medications, cause ASC opacities if a certain threshold of exposure to psychotropic medications must be attained to develop cataract, or if schizophrenia itself is associated with cataract formation.