Cataract Cases Research Articles

Dexamethasone implant for refractory macular edema secondary to diabetic retinopathy and retinal vein occlusion.

To evaluate the efficacy, timing of retreatment and safety of dexamethasone (DEX) implant on macular edema (ME) secondary to diabetic retinopathy (DME) and retinal vein occlusion (RVO-ME) patients who were refractory to anti-vascular endothelial growth factor (VEGF) treatment. This retrospective study included 37 eyes received at least one DEX implant treatment for DME or RVO-ME between January 1, 2019, and January 1, 2023. These refractory DME and RVO-ME cases received at least 5 anti-VEGF injections and failure to gain more than 5 letters or a significant reduction in central retinal thickness (CRT). The best corrected visual acuity (BCVA) and CRT were measured at baseline, and at 1, 3, 4 and 6mo post-DEX implant injection. Adverse events such as elevated intraocular pressure (IOP) and cataract were recorded. For RVO cases (n=22), there was a significant increase in BCVA from 0.27±0.19 to 0.35±0.20 at 6mo post-DEX injection (P<0.05) and CRT decreased from 472.1±90.6 to 240.5±39.0 µm at 6mo (P<0.0001). DME cases (n=15) experienced an improvement in BCVA from 0.26±0.15 to 0.43±0.20 at 6mo post-DEX implant injection (P=0.0098), with CRT reducing from 445.7±55.7 to 271.7±34.1 µm at 6mo (P<0.0001). Elevated IOP occurred in 45.9% of patients but was well-controlled with topical medications. No cases of cataract or other adverse events were reported. DEX implants effectively improve BCVA and reduce CRT in refractory DME and RVO-ME. Further research with larger cohorts and longer follow-up periods is needed to confirm these findings and assess long-term outcomes.

Risk and protective factors of late in-the-bag intraocular lens dislocations – a systematic review

Topic: This article aimed to identify and review published articles addressing risk and protective factors of late in-the-bag (ITB) intraocular lens (IOL) dislocations. Clinical relevance: Prevention of this complication is of great importance considering the great number of cataract cases and its vision threatening capacity. Methods: A structured search on PubMed (MEDLINE) using both Medical Subject Headings (MeSH) and key words was conducted. Additionally, the reference lists of the resulting articles were screened for further publications. Articles were eligible if they included 20 or more patients. Hazard and odds ratios were analyzed if they were calculated in the original study. The relative frequency of risk factors was recorded if hazard or odds ratios were not available. The threshold for clinical significance was set at 10%. Risk-of-bias in individual studies was evaluated using the revised Cochrane risk-of-bias tool in randomized trials (RoB 2.0) and the Cochrane risk-of-bias in non-randomized studies of interventions tool. Results: Database search identified 3474 records and no further records were obtained from the reference lists. After exclusion of records not related to the topic, 177 articles were assessed for eligibility. Of these, 39 were considered eligible and read in full. Three studies were prospective, while all other investigations were retrospective. In total, 18 614 cases of late ITB dislocations were analyzed across all studies. The risk of bias within studies was considerable, as only three studies were prospective and statistical significance of risk factors was assessed in only five studies. Conclusions: Typical patient age of this condition is between 70 and 85 years and there appears to be a slight male predominance. Risk factors with a good level of evidence include preoperative trauma and zonular dehiscence, previous vitrectomy, retinitis pigmentosa, pseudoexfoliation, high myopia, glaucoma/previous glaucoma surgery, corneal endothelial damage, and uveitis. Hydrophilic, quadripode and haptic-angulation IOLs are further risk factors. Capsular tension rings, Nd:YAG capsulotomy, three-piece IOLs and IOLs with large optic diameters protect from ITB dislocations. Typically, no risk factors can be identified in approximately one-fourth of patients.

Femtosecond laser assisted cataract surgery in a cataract patient with low vaulted ICL following LASIK: a case report

BackgroundApart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management.Case presentationA 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient’s history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0.ConclusionsOur report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully.

Disparities in cataract surgical training at the University of Toronto based on sex and medical school graduate type

ObjectiveTo compare sex and medical school graduate type differences in cataract surgical training volumes at Canada's largest residency program, the University of Toronto (UoT). DesignRetrospective cohort study ParticipantsOphthalmology residents completing cataract surgical training from 2015 to 2020. MethodsData collected from surgical logbooks at the main cataract surgical teaching site at UoT were analyzed from July 1, 2015, to June 30, 2020. Data collected included stage of resident training and degree of participation for each case. The main outcome measure was mean number of complete cataract cases as a function of resident sex, medical school graduate type, and level of training. ResultsThirty-five (19, 54.3% female) residents completed cataract surgical training during the study period. There were 24 (68.6%) Canadian medical graduates (CMGs) and 11 (31.4%) international medical graduates (IMGs). Female residents performed a lower mean number of complete cataract cases compared to males (464.2 versus 504.8, respectively). IMGs completed on average 110.0 (22.8%) fewer cataract cases compared to CMGs. Compared to all residents, female IMGs had the lowest number of complete cataract cases (mean of 380.8 versus 465.7, respectively). The greatest difference occurred between male CMGs and female IMGs, with male CMGs performing 153.8 (40.4%) more complete cases (534.6 vs 380.8, respectively). ConclusionThe greatest difference in surgical volumes occurred between CMGs and IMGs. Female IMGs had the lowest complete cataract case volumes compared to all residents. Our study highlights novel medical school graduate type disparities in cataract surgical training warranting further exploration.

Bilateral electricity-induced cataract with dissimilar morphology in a young electrician

This report documents a rare case of bilateral electricity-induced cataracts presenting with dissimilar morphology in each eye following an electrocution incident, underscoring the significance of recognizing electrical injury as a causative factor for varied cataract presentations. A 22-year-old electrician experienced decreased vision in his left eye 11 months post electrocution. A comprehensive ophthalmic evaluation, including best-corrected visual acuity (BCVA), slit-lamp examination, and ultrasonography, was conducted to assess the cataracts’ morphological characteristics. Uniquely, the patient presented with a posterior subcapsular cataract in the right eye and a milky white cataract with snowflake-like anterior subcapsular opacifications in the left eye, confirming the diagnosis of bilateral electricity-induced cataracts with dissimilar morphology. This case highlights the critical need for an exhaustive ophthalmological assessment in electrocution victims, facilitating the early detection and management of varied ocular complications, including diverse cataract morphologies.

Comparison of dosimetric parameters for predicting radiation-induced cataract in paediatric patients.

This study compared the predictive ability of radiation-induced cataract between maximum point dose of the lens (Lens Dmax) ≥7 Gy, mean lens dose (Lens Dmean) ≥7 Gy, Lens Dmax ≥10 Gy, and Lens Dmean ≥10 Gy. Patients aged 3-18 years received cranial irradiation or radiation therapy at head and neck area between January 2010 and December 2019 at our institute were included. Patients without baseline and/or follow-up eye examination were excluded. Receiver operating characteristic (ROC) curves identified potential predictors and Cox regression analysed correlations between potential factors and cataract occurrence. Sixty-three patients (122 eyes) were analysed. Cataracts were detected in 14 eyes (11.5%). Median follow-up time was 4 years (range 0.5-10 years), with cataract developing in a median of 2.5 years (range 0.3-7 years). Three patients (21.4%) developed grade ≥3 cataract. Lens Dmean ≥10 Gy was associated with cataract formation. Lens Dmean ≥10 Gy showed the highest ability for predicting radiation-induced cataract in paediatric patients. Net reclassification improvement (NRI) suggested that changing lens dose constraint from Dmax <7 Gy to Dmean <10 Gy would miss 7% of cataract cases but avoid 28% of unnecessary restrictions. Adopting a mean lens dose <10 Gy was suggested as a constraint for lens dose.

A Demographic Study of Cataract Cases of Chattogram Hill Districts with Their Surgical Outcomes

A Demographic Study of Cataract Cases of Chattogram Hill Districts with Their Surgical Outcomes

Hypoparathyroidism: A dark horse differential in young age cataracts

In India, cataracts account for the lion’s share of cases of blindness. Age is still the single most important risk factor for cataracts. Cataracts in the young adult age group are less common and are usually secondary to various local and systemic conditions. The aetiology may be a challenging one to ascertain in certain cases of young-age cataracts. A rapidly developing cataract in a young age individual may further add to the diagnostic dilemma especially when the patient presents with multi-system affection necessitating the widening of the horizons of suspected local and systemic pathologies at play. Therefore, we report a case of a 25-year-old lady who presented with a history of seizures, headache, disc oedema and progressive bilateral blurring of vision due to rapidly developing cataracts over 4 months in a case of primary hypoparathyroidism. Correction of the underlying abnormalities resulted in the resolution of disc oedema and headache. Furthermore, the patient had no episodes of seizures in the 1½ years of follow-up. In addition, full visual recovery was achieved after bilateral cataract surgery. Awareness of this rare presentation can help in the early diagnosis and evaluation of cataracts, besides correction of the systemic pathologies for an overall better patient outcome.

Isolated posterior capsule rupture secondary to blunt ocular trauma: Case presentation and literature review

IntroductionAn isolated posterior capsule rupture (PCR) is a rare complication associated with traumatic cataracts. We report our findings in three cases of traumatic cataracts with isolated PCR caused by blunt ocular trauma. Presentation of casesCase 1: A 1.5-year-old boy was examined after his parents noticed that the center of the pupil of the left eye was white. The mother reported that the boy had fallen and bruised his left forehead 4 months earlier. Case 2: An 18-year-old boy had a traumatic cataract that developed one month after a blow to his eye. Case 3: A 13-year-old boy was treated for hyphema and high intraocular pressure after blunt trauma to his eye. Ten days later, a total cataract developed. Anterior segment optical coherence tomography revealed an isolated PCR with a protruding lens cortex, and ultrasonography showed vitreous opacities. DiscussionAn isolated PCR was observed intraoperatively in the center of the posterior lens capsule. The lens cortex was prolapsed into the PCR or into the vitreous cavity in Case 3. An intraocular lens (IOL) was implanted in the lens capsule or to the ciliary sulcus after vitrectomy in Case 3. Vision improved in all eyes. ConclusionsOur findings indicated that the external force by a trauma to the eye can lead to an isolated PCR with a protruded lens cortex in young patients. These PCRs can be successfully treated with the IOL implanted in or out of the capsular bag.

Endoscopic Surgery for Congenital or Acquired Cataract Associated with Persistent Fetal Vasculature: A Case Series.

Persistent fetal vasculature (PFV) is a congenital malformation caused by a failure in regression of the primary vitreous and hyaloid vessels. An abnormal PFV occurs in the anterior and posterior segments of the eye. Surgery for PFV carries the risk of retinal detachment. We report four cases of cataracts associated with PFV, in which our novel surgical technique with an intraocular endoscope was safely performed. Lensectomy and vitrectomy were performed in cases 1, 3, and 4, while lensectomy, vitrectomy, and intraocular lens implantation using an endoscope were performed in case 2. In all cases, after lens removal, a slit at the posterior lens capsule was created to avoid the retrolental fibrovascular membrane using underwater electric coagulation. Moreover, the endoscope was inserted, by which the intraocular region was observed to determine the treatment method for the fibrovascular membrane and vitreous stalk. No additional surgeries were required for complications before or after any of the surgeries. Using an endoscope during cataract surgery associated with PFV, observing the vitreous stalk at high magnification and ensuring safe treatment were possible. Endoscopic surgery could be considered an effective method for treating PFV-associated cataracts.

Importance of Early Intervention of Traumatic Cataract in Children

Aim: To evaluate the intraoperative complications &amp; post- operative outcome of early intervention of traumatic cataract in children due to open globe injuries.  Materials and Methods: 40 cases of unilateral cataract having repair of open globe injuries previously were included in this prospective study. Primary repair of corneal injuries were done with 10-0 Nylon under general anesthesia. Secondary intervention with IOL implantation were done within 4 weeks of primary repair. Age range was 4-14 years and minimum follow up 3 months. Intraoperative and postoperative complications and final best-corrected visual outcome were recorded.  Results: All cases had pre-existing anterior capsular tear and flocculent lens matter in anterior chamber. IOL were implanted in the bag in 90% cases. Intra-operatively 4 cases revealed pre-existing posterior capsular hole and IOL were implanted in the sulcus. Synechiolysis was done in 3 cases. There was no iatrogenic PC rent. Postoperatively no cases showed synechiae formation, pupil capture and IOL displacement. Visual acuity was 6/9 to 6/60 in all cases and intraocular pressures were digitally normal. No optic atrophy and RD were noticed at last follow up. Most common causes of decreased vision were corneal scar and astigmatism.  Conclusion: Early cataract surgery with IOL implantation after repair of open globe injuries carries favorable intraoperative and postoperative outcome.

Bilateral developmental cataracts in a child with familial lipodystrophy

Bilateral developmental cataracts are usually caused due to hereditary metabolic disorder or intrauterine infections. Familial lipodystrophy type 7 has variable phenotypes with early-onset cataracts and lower limb spasticity, with most reports showing the onset of cataracts in the second decade of life. We report a rare case of bilateral congenital cataract in a child aged 3 years and 9 months with genetically proven familial partial lipodystrophy type 7. Bilateral developmental cataracts need complete physical examination and genetic analysis to detect unusual and rare causes like familial partial lipodystrophy.

Doughnut capsulorhexis: Pioneering advancements in cataract surgery to sidestep Argentinian flag sign

Background: For a successful capsulorhexis, it is crucial to use controlled centripetal and tangential vector forces in the rhexis border to counteract the centrifugal forces of the zonular component. Unfortunately, in hypermature cataracts, these maneuvers do not prove successful due to the raised intralenticular pressure, leading to an Argentinian flag sign. Among several techniques, this method of doughnut capsulorhexis is one such technique to perform successful capsulorhexis in cases with high intralenticular pressure. Purpose: In this video, we highlight this new method of capsulorhexis to prevent undue capsule-related complications in hypermature cataracts, as this plays a crucial role in successful surgical outcomes. Synopsis: The lens capsule usually experiences centrifugal vector forces exerted by the zonules, but in hypermature cataract cases, there is an additional factor of raised intralenticular pressure. In such cases, the attempts to make a 5 mm capsulorhexis might lead to the propagation of the rhexis to the periphery due to the combined mechanism of the two vector forces. Therefore, the technique of performing a smaller 2 to 3 mm rhexis is performed. This reduces the centrifugal force involved and prevents undue extension of the rhexis. Following this, decompression of the capsular bag is performed by aspirating the liquefied cortex using a bimanual irrigation and aspiration cannula, followed by controlled extension of the rhexis using a cystitome, which is performed for a successful surgical outcome. The second knick is made parallel to the first rhexis,1 mm away from the rhexis border, and a flap is raised. The rhexis can either be completed using a cystitome or a microrhexis forceps. Highlights: This technique does not require any additional instrumentation or training. It can be performed using the cystitome and microrhexis forceps. Surgeons of all calibers can efficiently perform it. This series of videos shows the successful outcome of continuous curvilinear capsulorhexis using the Doughnut method. Video Link: https://youtu.be/x0dTklOaMqg

Clinical Results of Prosthetic Eye Wear in Patients with Congenital Microphthalmos

Purpose: To report the long-term clinical outcomes of non-surgical treatment involving prosthetic eye wear in patients diagnosed with congenital microphthalmos.Methods: A retrospective review of the medical records of 20 patients was conducted. In total, 21 eyes were diagnosed with congenital microphthalmos between May 2008 and December 2022 at Seoul St. Mary’s Hospital in Korea.Results: This study included 20 patients (12 males and 8 females) with an average age of 4 months at diagnosis. The observed ophthalmic anomalies included two cases of congenital cataract, one of posterior embryotoxon, one of corneo-iris strand, four of iris coloboma, five of central corneal opacity, one of Peter's anomaly, and one of retrobulbar cyst. Accompanying systemic abnormalities were noted, such as lateral ventricle atrophy, corpus callosum atrophy, patent ductus arteriosus, atrial septal defect, and developmental language disorder. Genetic anomalies included anti SS-A/Ro antibody positivity, a 1:100 titer of anti-nuclear antibody, and a PAX6 mutation identified through next-generation sequencing. No specific family histories or pregnancy-related factors were noted. The average follow-up duration was 5.94 years (range: 1 month to 18 years), the average corneal diameter was 4.6 mm, the average axial length was 17.44 mm, the average age for first artificial eye trial was 5.96 years (range: 7 months to 19 years), and the average interval for artificial eye replacement was 22 months (range: 4 months to 5 years and 8 months).Conclusions: Twenty patients with congenital microphthalmos underwent gradual expansion of their prosthetic eyes by regular replacement and size increase without severe complications. This approach led to aesthetically and emotionally positive outcomes for the patients.

The Better Operative Outcomes Software Tool (BOOST) Prospective Study: Improving the Quality of Cataract Surgery Outcomes in Low-Resource Settings

ABSTRACT Purpose Post-operative vision impairment is common among patients who have undergone cataract surgery in low-resource settings, impacting quality of clinical outcomes and patient experience. This prospective, multisite, single-armed, pragmatic validation study aimed to assess whether receiving tailored recommendations via the free Better Operative Outcomes Software Tool (BOOST) app improved surgical outcomes, as quantified by post-operative unaided distance visual acuity (UVA) measured 1–3 days after surgery. Methods During the baseline data collection round, surgeons in low and middle-income countries recorded clinical characteristics of 60 consecutive cataract cases in BOOST. Additional data on the causes of poor outcomes from 20 consecutive cases with post-operative UVA of <6/60 (4–12 weeks post-surgery) were entered to automatically generate tailored recommendations for improvement, before 60 additional consecutive cases were recorded during the follow-up study round. Average UVA was compared between cases recorded in the baseline study round and those recorded during follow-up. Results Among 4,233 cataract surgeries performed by 41 surgeons in 18 countries, only 2,002 (47.3%) had post-operative UVA 6/12 or better. Among the 14 surgeons (34.1%) who completed both rounds of the study (1,680 cases total), there was no clinically significant improvement in post-operative average UVA (logMAR units ±SD) between baseline (0.50 ± 0.37) and follow-up (0.47 ± 0.36) rounds (mean improvement 0.03, p = 0.486). Conclusions Receiving BOOST-generated recommendations did not result in improved UVA beyond what could be expected from prospective monitoring of surgical outcomes alone. Additional research is required to assess whether targeted support to implement changes could potentiate the uptake of app-generated recommendations and improve outcomes.

Spiroplasma infection as a cause of severe congenital keratouveitis, cataract and glaucoma

BackgroundOnly seven cases of ocular Spiroplasma infection have been reported to date, all presenting as congenital cataracts with concomitant intraocular inflammation. We describe the first case of Spiroplasma infection initially presenting as a corneal infiltrate.Case presentationA 1-month-old girl was referred for a corneal infiltrate in the left eye. She presented in our hospital with unilateral keratouveitis. Examination showed a stromal corneal infiltrate and dense white keratic precipitates in the left eye. Herpetic keratouveitis was suspected and intravenous acyclovir therapy was initiated. Two weeks later, the inflammation in the left eye persisted and was also noticed in the right eye. Acute angle-closure glaucoma and a cataract with dilated iris vessels extending onto the anterior lens capsule developed in the left eye. The inflammation resolved after treatment with azithromycin. Iridectomy, synechiolysis and lensectomy were performed. Bacterial metagenomic sequencing (16 S rRNA) and transmission electron microscopy revealed Spiroplasma ixodetis species in lens aspirates and biopsy. Consequently, a diagnosis of bilateral Spiroplasma uveitis was made.ConclusionsIn cases of congenital cataract with concomitant intraocular inflammation, Spiroplasma infection should be considered. The purpose of this case report is to raise awareness of congenital Spiroplasma infection as a cause of severe keratouveitis, cataract and angle-closure glaucoma in newborns. Performing molecular testing on lens aspirates is essential to confirm diagnosis. Systemic macrolides are suggested as the mainstay of treatment.

Comparison of Surgically Induced Astigmatism Following Manual Sics: Superior and Temporal Approach

Aim: The operable cataract cases in the developing world is high compared to the cataract surgical rate, and economical and effective methods are required to deal with this curable blindness, in order to provide the highest achievable uncorrected distance visual acuity. This study aimed to compare the surgically induced corneal astigmatism in patients undergoing manual small incision cataract surgery by superior (s-MSICS) and temporal (t-MSICS) scleral tunnel incisions. Methods: Prospective, interventional cases series of 60 eyes of 60 patients. Uncorrected distance visual acuity (UDVA), mean keratometry (KMean) and surgically induced astigmatism (SIA) were the main outcome measures which were compared between the two groups, s-MSICS and t-MSICS. Results: The mean patient age was 58.60 ± 7.11 years and 59.63 ± 8.39 years in the s-MSICS and t-MSICS groups respectively. Uncorrected distance visual acuity (UDVA) on day 90 was 0.27 ± 0.14 logMAR in the s-MSICS group and 0.18 ± 0.16 logMAR in the t-MSICS group (p=0.05). At the final assessment s-MSICS had 1.43 ± 0.99D of SIA and t-MSICS had 0.76 ± 0.66D of SIA (p=0.02). Four patients in the s-MSICS group and 25 patients in the t-MSICS group had WTR astigmatism (p&lt;0.001). Likewise, there were 26 cases of ATR and one case of ATR in the s-MSICS and t-MSICS respectively (p&lt;0.001). Conclusion: In this prospective study, t-MSICS had significantly lesser surgically induced astigmatism than s-MSICS. The temporal incision decreased against the rule astigmatism, as well, which is the astigmatism prevalent in the adult population.

B- Mode Ultrasonography of Ocular Abnormalities in Dogs

Background: Ultrasonography is a simple, safe and non-invasive method to examine the internal structures of eye in case of opacity of otherwise clear ocular medium like cornea, aqueous, lens, and vitreous. Methods: 123 dogs with ocular abnormalities from March 2021 to October 2022, presented to the Division of Veterinary Surgery and Radiology were included in this study. All of the animals underwent a thorough ophthalmic examination along with B-scan ultrasonography of both the eyes using a 7.5 MHz linear probe. Result: Ultrasonography revealed thin hyperechoic lines and a thin hyperechoic rim of the lens, indicating early cataract changes and cortical cataract, respectively. Sixty-two dogs were found to be affected by cataract; 20 dogs were affected by the disease Phthisis bulbi; 16 dogs had a complete retinal detachment showing a typical “morning glory” sign; 10 dogs had vitreous haemorrhage; 6 dogs had a damaged eye with lens dislocation; and 5 dogs had choroidal melanoma and intraocular tumours in 4 dogs out of 123 observed dogs. Further, out of 62 cataract cases, 16 dogs were affected by cortical cataracts, 41 had nuclear cataracts, and 5 dogs were affected by morgagnian cataracts. Therefore, B-scan ultrasonography of the eye was a quick, safe, and accurate way to examine the pathology, especially when opaque media inhibit direct examination or when exophthalmos is evident and the normal anatomy of the eye.

ASSOCIATION ORAL CORTICOSTEROIDS AND LONG-TERM RISK OF CATARACT: A SYSTEMATIC REVIEW AND META-ANALYSIS STUDY

Background: Cataracts are a significant health concern, particularly in aging populations, impacting vision, mental well-being, and overall quality of life. Corticosteroid use has been linked to cataract development. This study aims to explore the relationship between oral corticosteroid (OCS) exposure and the long-term risk of cataract. Method: Following PRISMA guidelines, a systematic review and meta-analysis were conducted to investigate this association. Relevant studies were identified through comprehensive searches across multiple databases. Data included cataract incidence/prevalence and OCS therapy. Results: A total of 1,270 articles were retrieved from online databases (PubMed, SagePub, SpringerLink and Google Scholar). After three rounds of screening, five articles directly relevant to the systematic review were selected for full-text reading and analysis. These five studies collectively involved 27,250 cases of cataract following oral corticosteroid (OCS) exposure, while 47,267 controls did not develop cataracts. No statistically significant association is found between OCS and cataract formation (OR 0.117, CI 95 0.0085 to 1.6021, p0.11). Conclusion: Cataracts in oral corticosteroid (OCS) users result from abnormal lens cell movement and protein composition changes due to protein adduct formation. Increased OCS dosage and frequency correlate with higher cataract risk. However, evidence quality was deemed low to moderate, highlighting the need for well-designed RCTs to minimize bias and heterogeneity.

Based on the relationship between anxiety of existential meaninglessness, hope level, and fear of progression, explored the effect of preoperative nursing with Orem theory in the senile cataract population.

Cataracts, characterized by a decrease in vision due to the clouding of the lens, can progress to blindness in advanced stages. The rising incidence of cataract cases has led to a significant number of patients experiencing negative emotions associated with vision loss, thereby diminishing their quality of life. In clinical practice, it is imperative for healthcare professionals to consider the psychological well-being of cataract patients. Currently, there is a scarcity of research focusing on psychological evaluations, such as assessing feelings of meaninglessness among individuals with cataracts. This study aims to investigate the factors influencing the anxiety of existential meaninglessness and to explore the relationships among existential anxiety, Herth hope index levels and fear of progression in the elderly cataract-affected population. Additionally, it evaluates the effectiveness of Orem's nursing care strategies. Utilizing a sociodemographic questionnaire, the Existential Meaninglessness Anxiety Scale (EM-A), Herth Hope Index Level Scale, and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), this research employed convenience sampling for a cross-sectional and intervention study. The retrospective study sample comprised 1,029 individuals, while the intervention study included 317. The intervention design assessed psychological changes in existential meaninglessness following Orem's preoperative nursing interventions. Multiple linear regression analysis was employed to ascertain the determinants of EM-A within the population of elderly patients with senile cataracts. Pearson correlation analysis elucidated the relationship between EM-A, levels of hope, and the FoP-Q-SF among this demographic. Subsequent investigations, utilizing a t-test, evaluated the effects by comparing the data before and after the implementation of the interventions. The correlation between EM-A, hope levels, and FoP-Q-SF was statistically significant (p < 0.05). Factors such as age, education level, alcohol consumption habits, hope levels, and FoP-Q-SF scores significantly affected EM-A scores (p < 0.05). Orem's nursing framework significantly reduced existential anxiety (p < 0.05). Among elderly patients with cataracts, existential anxiety was generally moderate. Hope levels and fear of progression were closely associated with the EM-A. The novel Orem preoperative care model effectively addresses clinical issues. In clinical practice, it is crucial to address psychological problems and enhance patients' quality of life.