Hypermature Cataract Research Articles

The prevalence of pseudoexfoliation syndrome and possible systemic associations in patients scheduled for cataract surgery at the Military Medical Academy in Belgrade

Pseudoexfoliation syndrome (PEX) is an age-related systemic degenerative disorder characterized by the production and progressive accumulation of extracellular fibrillar eosinophilic material in the anterior segment of the eye. The aim of the study was to evaluate several clinical aspects of PEX, such as frequency of PEX and pseudoexfoliation glaucoma (PEXG), intraocular pressure (IOP), the type of lens opacity, and the possible relationship of PEX and systemic diseases. All 674 cataract patients had a comprehensive eye examination, including slitlamp biomicroscopy before and after mydriasis, IOP measurement, and fundus examination. The patients were classified into two groups: the PEX and the non-PEX group. The overall prevalence of PEX syndrome was found to be 17.5% (118 patients). The mean age of PEX patients (79.7 +/- 6.1 years) was significantly higher when compared with those without PEX (73.5 +/- 9.1 years) (p = 0.000). The prevalence of PEX syndrome was found to increase with age, from 7.3% in the 7th decade of life to 27% in patients older than 80 years (p < 0.001). The most common cataract type in the PEX patients was mature cataract observed in 40.7% of patients. The rest of the patients had mixed (30.5%), nuclear (25.4%), cortical (1.7%) and hypermature cataract (1.7%). Among the PEX patients 44 (37.2%) had glaucoma. Intraocular pressure was significantly higher in eyes with pseudoexfoliations than in eyes without it (17.8 +/- 3.2 mmHg and 15.8 +/- 2.8 mmHg, respectively; p = 0.001). Moreover, the prevalence of coronary heart disease was found to be higher in PEX patients. PEX syndrome is a common problem among Serbian patients scheduled for cataract surgery. It represents one of the major glaucoma risk factors and probably associated with ischemic heart disease, intraoperative and postoperative problems in cataract surgery.

Femtosecond Laser-assisted Cataract Surgery

Despite improvements in surgical technique, certain aspects of manual cataract surgery are performed with limited precision. Femtosecond laser technology enables precise incisions in the cornea and minimizes manipulations and energy required to fragment and emulsify the lens, resulting in less damage to surrounding tissues compared with manual techniques. The technique also results in superior geometric precision and centration, with reported better capsule strength compared with manual capsulotomy. Femtosecond laser-assisted cataract surgery (FLACS) is particularly advantageous in difficult cases, including hypermature and white cataracts. However, it is still not known how technical advantages translate into functional benefits. Over the past 2 years, four unique laser platforms have been introduced. This article summarizes current literature relating to the efficacy and safety of FLACS and compares currently available laser platforms.

Ciliary Body and Choroidal Pseudomelanoma from Ultrasonographic Imaging of Hypermature Cataract in 20 Cases

To describe a series of 20 patients with opaque media, referred with uveal melanoma, but subsequently found to have pseudomelanoma from oblique imaging of hypermature cataract on ultrasonography. Case series. Twenty patients. Retrospective chart review. Ultrasound imaging. All eyes had opaque media from hypermature cataract with no view of the fundus. All were referred because of suspected uveal melanoma, based on ultrasonographic imaging. The echogenic mass appeared to be in the ciliary body (n = 17) or choroid (n = 3). The median patient age was 54 years (range, 17-86 years). Most patients were white (n = 13) or black (n = 4). There was a history of eye trauma (n = 3) and ocular surgery (n = 1). Visual acuity was light perception to hand movements (n = 18) and 20/50 to 20/100 (n = 2). The cataract was in an anatomic position (n = 18) or subluxated (n = 2). On B-scan ultrasonography, the mass was dome-shaped (n = 10) or elliptical (n = 10), displayed an acoustically hollow center with a dense rim (n = 20), and was located in the ciliary body (n = 17) or choroid (n = 3). The mean thickness was 7.2 mm and the mean base was 9.3 mm. Features suggestive of cataract rather than melanoma included a lack of contiguity with the uvea (n = 20) on videoimaging using standard ultrasonography and ultrasound biomicroscopy, a lack of a transillumination shadow, and a lack of a sentinel vessel. For those in the ciliary body region, an additional feature was the ultrasonographic presence of mass in all 4 quadrants (n = 17), representing oblique imaging of the lens equator. For those in the choroid region, the pseudomelanoma shifted when the patient was imaged in a reclined compared with an upright position. After cataract surgery, the lack of melanoma was confirmed. Dense cataract can preclude a fundus view, necessitating ultrasonography for imaging the posterior segment of the eye. Ultrasonographic confusion with a ciliary body and choroidal melanoma can occur because the dome-shaped cataract can simulate a dome-shaped melanoma.

Cataract development in Norwegian patients with congenital aniridia

Editor, Congenital aniridia is caused by mutation of the PAX 6 gene, the so-called master gene in ocular development. Although cataract has been reported in several aniridia cohorts (Nelson et al. 1984; Sale et al. 2002; Hingorani & Moore 20082009; Abouzeid et al. 2009; Park et al. 2010; He et al. 2012), the timing and detailed phenotype of cataract in aniridia have not been well described. Here, we report the onset of cataract, timing of cataract surgery and phenotypic features of cataract in a Norwegian aniridia cohort. A cohort of 26 Norwegian patients (52 eyes) with ngenital aniridia was examined on a single occasion, after obtaining written informed consent and ethical approval from the Regional Committee for Medical and Health Research Ethics, Oslo. Medical records were examined to detail cataract presence and surgical intervention. Digital slit lamp photographs of the lens and visual assessment were used to analyse the type and development of cataract, and aniridia-associated keratopathy (AAK) was characterized according to our previously published grading scale (Eden et al. 2012). Mean patient age was 29 years (range: 4–63 years). Only three eyes were phakic with clear lenses; the remaining eyes had either cataract or had been operated on for cataract. The youngest individual with cataract was 4 years old at examination, but congenital or early onset cataract was documented in medical records of five patients (six eyes). Of 12 patients with nonoperated cataract, five (nine eyes) had lens luxation upwards. Of 14 patients, 27 eyes had glaucoma. Those least affected presented with a discrete posterior polar cataract. In other cases, a discrete subcapsular opacification of varying density or opacification extending radially from the mid-periphery of the posterior capsule was found in addition to the polar cataract. A posterior subcapsular mid-peripheral ring of opacification was observed, in some also combined with a more substantial polar cataract. The size and density of the opaque ring varied (Fig. 1). Findings in other patients included nuclear cataract (both turbid and yellow-brownish), one generalized subcapsular oedema (mature cataract) and one with a dehydrated opaque lens (hypermature cataract) (Fig. 1). In two patients, an anterior polar cataract was identified one of which had an additional posterior subcapsular opacification (Fig. 1). Fig 1 Developmental patterns of cataract in aniridia patients. (A) Early stage discrete posterior subcapsular cataract. (B–E) The posterior subcapsular cataract is denser. A posterior subcapsular opacification develops on the capsule in the ... Of the 52 eyes examined, 25 had had surgical intervention (cataract, glaucoma or both). Nine patients (13 eyes) had cataract surgery only, six patients (eight eyes) both cataract and glaucoma surgery and three patients (four eyes) glaucoma surgery only. At the time of cataract surgery, 7 of 12 operated patients were under the age of 19 years and 4 of these were under the age of 10. Secondary cataract was observed in four patients (six eyes).Of the 25 eyes with surgical intervention, eight eyes (30%) had AAK affecting visual acuity compared to 8/25 eyes (32%) in the group of eyes without intraocular surgery. No clear trend could be found towards an increased prevalence of AAK in operated eyes. Cataract is common in aniridia, with over 90% prevalence in our cohort, similar to a Korean cohort with 60 eyes where 88% had cataract or were operated for cataract (Park et al. 2010). Cataract prevalence in aniridia in the literature varies from 50 to 85% (Nelson et al. 1984). Patients in our cohort not operated for cataract showed a distribution of lens opacities that could be interpreted as a pattern of cataract development. A discrete posterior polar opacity seems to emerge first. The posterior location of polar opacities has been reported previously (Yamn et al. 2011; Jin et al. 2012). The next phase is an additional subcapsular opacification in the mid-periphery. These opacities then increase in density and size, radiate to the polar region and are always limited to the posterior subcapsular region. They eventually form a ring on the posterior capsule.

English

INTRODUCTION: The cataract backlog is estimated to be around 12 million1 and annually increasing at an estimated rate of 3.8 million.2 Lens induced glaucoma (LIG) is also found to be fairly common in India.3, 4 Lens induced glaucoma (LIG) due to hyper mature cataracts are an important cause of secondary glaucoma in the developing world. There is an ever-increasing backlog of cataract due to the population explosion, increased life expectancy and low productivity in terms of utilization of the available surgical services. The uptake of eye care services by the rural community has also been suboptimal in countries like India where lens induced glaucoma (LIG) is a common cause of ocular morbidity.5 Pre-operative and post-operative morbidity is more in an eye with lens induced glaucoma than that with a simple uncomplicated cataract. Prognosis and visual outcome are also affected to some extent. Hence timely intervention is important in achieving good results. Each case depending on the mechanism by which glaucoma occurs, has to be managed in a different way. In general, after controlling the intraocular pressure, cataract extraction with IOL implantation should be performed preferably. The present study was undertaken and aimed at a clinical study of various lens induced glaucoma, their management, post operative visual outcome and intraocular pressure control as practiced in the department of ophthalmology, Dr. B. R. Ambedkar Medical College Hospital, Bangalore.

New Insights Into Pathophysiological Mechanisms Regulating Conventional Aqueous Humor Outflow

The aim of the article was to overview the pathophysiology of the conventional outflow pathway, trabecular meshwork, and intraocular pressure and to discuss the options of future glaucoma treatment directed to improvement in aqueous outflow. The literature search in the Medline, Embase, and Cochrane databases from April to May 2012 was performed; a total of 47 articles analyzed. The diminished conventional pathway may be altered by several pathophysiological mechanisms like TM obstruction caused by transforming growth factor-β2, clastic nondeformable cells, macrophages leaking from hypermature cataract, iris pigment, lens capsular fragments after YAG-laser posterior capsulotomy, proteins and their subfragments. It is known that trabecular meshwork contraction reduces outflow, and the actomyosin system is directly linked to this mechanism. New glaucoma drugs are still under investigation, but it is already proven that agents such as latranculin-B are effective in improving aqueous drainage. Selective Rho-associated coiled coilforming protein kinase inhibitors have been shown to cause a significant improvement in outflow facility and may become a new option for glaucoma treatment. Caldesmon negatively regulates actin-myosin interactions and thus increases outflow. Stem cells may replace missing or nonfunctional trabecular meshwork cells and hopefully will bring a new treatment solution. Pathophysiological mechanisms regulating conventional aqueous humor outflow are still not fully understood and require further investigations. Future treatment decisions should be directed to a specific mechanism regulating an elevation in intraocular pressure.

Visual outcome following extracapsular cataract extraction in mature cataracts with pseudoexfoliation syndrome: A retrospective study

Purpose/Objective:To report the best corrected visual acuity, at the end of one year, in 33 patients (35 eyes), who underwent extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation (PC-IOL) for mature and hypermature cataracts, with pseudoexfoliation (PEX).Design:Retrospective, non-comparative, single-institutional (Sultan Qaboos University Hospital) study.Participants:Thirty-three patients with mature and hypermature cataracts, with PEX operated upon between January 2007 and December 2008, by one surgeon (AM).Materials and Methods:Retrospective study of thirty-three patients (35 eyes) with mature and hypermature cataracts, with ocular PEX, evaluating the visual outcome at the end of 12 months following ECCE with PC-IOL.Results:Thirty eyes (85.71%) showed improvement in the best corrected visual acuity (BCVA) ranging from 0.2 to 1.0 Snellen lines. Four eyes (11.43%) had unchanged BCVA from the baseline. There were no intraoperative complications in any patient. One eye (2.86%) that did not improve developed retinal detachment at three months follow-up, and was referred to the Vireoretinal Unit and follow-up has been lost.Conclusion:Extracapsular cataract extraction is a safe and effective technique in eyes with mature and hypermature cataracts with PEX.

Spontaneous Resolution of Cataract and Medical Management of Corneal Opacity in an Indian Parrot—&amp;lt;i&amp;gt;Psittacula krameri manillensis&amp;lt;/i&amp;gt;

A 35-year-old Indian parrot (Psittacula krameri manillensis) was presented to the Department of Veterinary Surgery & Radiology, West Bengal University of Animal and Fishery Sciences with a history of blepharospasm and corneal lesion OS. Test with fluorescein dye was negative. The dense corneal opacity (macula) was identified as involving the posterior corneal layer. The further ophthalmic examination was done and hypermature phacolytic cataract was diagnosed. No other abnormality was detected. Medical management with topical nepafenac prednisolone and triple antibiotic was instituted. The corneal lesion subsided completely within one week followed by spontaneous resorption of the cataract. The treatment protocol was successfully eliminated the discomfort and intraocular lesions in the senile parrot.

Primary posterior capsular opacification in Indian rural population undergoing cataract surgery for hypermature senile cataract

AimTo find out the incidence of primary posterior capsular opacification (PCO) in rural patients with a hypermature senile cataract undergoing cataract surgery.SettingsTertiary eye care center in central India.DesignProspective, observational, noncomparative study.Materials and methodsTwo-hundred eyes of 200 patients presenting with a hypermature cataract underwent manual small incision cataract surgery. A single surgeon performed all surgeries under peribulbar anesthesia. After cortical clean-up, the capsular bag was inflated with viscoelastic. The presence or absence of opacity on the posterior lens capsule and location was noted. Postoperative follow-up was done for visual acuity and need for neodymium-doped yttrium aluminum garnet (ND:YAG) laser capsulotomy.ResultsPrimary PCO occurred in 76 eyes (incidence of 38%). It was peripheral in 58 eyes (76.3%) and central in 18 eyes (23.7%). At 6 weeks postoperatively, best corrected visual acuity for eyes with central primary PCO (n = 18) was 0.2–0.3 logMAR and 0–0.2 logMAR for eyes with peripheral primary PCO (n = 58). Best corrected visual acuity at the 6- and 12-month follow-up was 0–0.2 logMAR in both groups. Fibrotic primary PCO was seen in four patients. No predilection for the development of primary PCO to a particular quadrant of posterior capsule was observed. At 1 year postoperatively, eleven (14.5%) patients required ND:YAG laser capsulotomy, six (7.90%) of whom underwent ND:YAG laser capsulotomy at the 6-month follow-up. Seven patients with central primary PCO and four patients with peripheral primary PCO required ND:YAG laser capsulotomy.ConclusionA high incidence of primary PCO was noted in rural patients with a hypermature senile cataract undergoing cataract surgery. No serious intraoperative complications were noted. Visual outcome at 1-year follow-up was satisfactory. Need for early ND:YAG laser posterior capsulotomy should be explained to these patients before cataract surgery. No post ND:YAG capsulotomy complications were noted in any patient.

Fracture Risk After Cataract Surgery

To the Editor: Dr Tseng and colleagues conducted a retrospective study of the association of fracture risk after cataract surgery in a random 5% sample of Medicare beneficiaries. The authors noted that patients with decreased visual acuity have a higher incidence of fractures. Therefore, it is reasonable to propose that fracture risk would decrease after cataract surgery. When corrected for demographic data and comorbidities based on the Charlson Comorbidity Index (CCI) score, this relationship was confirmed for patients with a propensity score decile subgroup of 4 or higher (Table 5 in article) for patients aged 70 years or older, and for those with a CCI score of 3 or higher (Table 6). However, this benefit did not extend to younger and healthier patients who underwent cataract surgery. With a significance level of P .05, the odds ratio (OR) for any fracture was actually higher for propensity score deciles 1 to 3 (ORs: 1.28 and 1.08; P .02; Table 5) and for patients with a CCI score of 2 or lower (OR, 1.03; P=.04; Table 6). For the youngest patients in the study (aged 65-69 years), cataract surgery was linked to a higher OR of hip fracture and any fracture (ORs: 1.16 and 1.09; P .02; Table 6). These subgroups comprised a significant percentage of pseudophakic Medicare beneficiaries; 19.5% were aged 65 to 69 years and 62.8% had a CCI of 2 or lower (Table 1). Why would cataract surgery result in a higher OR of hip fracture and any fracture in younger and healthier patients? Should these patients with visual impairment secondary to cataracts be counseled against cataract surgery? Ophthalmologists, other physicians, and patients with cataracts who are considering surgery would benefit from discussion of this paradoxical observation. The sequence of the diagnoses is important given the premise of the study: fracture risk after cataract surgery. The authors acknowledged their inability to distinguish whether the fracture or cataract diagnosis was noted first if both diagnoses occurred in the same calendar year. Severe cataracts, which the authors designated as “posterior subcapsular cataracts, total or mature cataract, hypermature cataract, and combined forms of cataract,” can progress rapidly, especially if the patient has diabetes mellitus or Cushing syndrome or is taking systemic corticosteroids. In these cases, the fracture diagnosis may have preceded the cataract diagnosis in the same year, which may confound the robust, reported link between extraction of severe cataracts and subsequent fracture risk.

Actinomyces bowdenii ulcerative keratitis in a dog

A 5-year-old spayed female diabetic mixed-breed dog underwent phacoemulsification and intraocular lens implantation to correct bilateral hypermature cataracts. Two months postsurgery, the patient presented with ulcerative keratitis and multifocal stromal abscessation OD, which was controlled, but never resolved, with topical fluoroquinolone therapy. The patient re-presented 2 months later with a new, raised, white gritty corneal opacity associated with hyperemia, chemosis, and blepharospasm OD. Cytology of the right cornea revealed filamentous bacteria, suggestive of Actinomyces spp. Actinomyces bowdenii was subsequently isolated in pure culture and identified via 16s rDNA sequencing. Actinomyces bowdenii has never before been described as a cause of ocular infection. An immunosuppressed corneal environment likely contributed to this opportunistic Actinomycosis. The infection was not controlled with fluoroquinolone therapy, and the isolate, in vitro, was resistant to three fluoroquinolones (ciprofloxacin, ofloxacin, and levofloxacin), which also has not been previously reported for this species of Actinomyces. A superficial keratectomy with conjunctival graft was employed to successfully manage the infection.

Posterior assisted levitation (PAL) by using Akahoshi/Wahab irrigating pars plana levitator.

To assess the outcome of irrigating Akahoshi/Wahab pars plana levitator for posterior assisted levitation in dropped nucleus during phacoemulsification. A case series. Ophthalmology Unit-III, Dow University of Health Sciences at Sindh Government Lyari General Hospital and Al-Noor Eye Hospital, Karachi, from January 2008 to December 2009. Cases of dropped nucleus during phacoemulsification were recruited. Predisposing factors and stage of phacoemulsification at which dropped nucleus were recognized. Levitator was inserted through pars plana after vitrectomy around nucleus and levitation was carried out. Follow-up was done till 6 months. Thirty two patients including 18 males (56.3%) and 14 females (43.8%) underwent pars plana levitation. Predisposing factors were pupillary miosis in 9 cases, Brunescent cataract in 7 cases, pseudoexfoliation in another 7 cases, hypermature cataract in 5 cases and extended capsulorrhexis in 4 cases. Posterior capsular rent occurred in 22 (68.8%) cases while zonular dehiscence / rupture were found in 10 cases (31.3%). Nuclei were dropped during quadrant aspiration in 10 cases (31.3%) and during chopping in 8 cases (25%). Another 5 cases (15.6%) occurred during each hydrodissection and chopping while 4 cases (12.5%) were found during sculpting of nuclei. Final best corrected visual acuity was 6/12 and better in 22 cases (68.8%) while in 10 cases (31.3%) it was 6/18 to 6/36. No complication related to pars plana levitator was observed. Posterior assisted levitation of dropped nucleus during phacoemulsification by irrigating Akahoshi/Wahab pars plana levitator is a fast and safe surgical technique.

Histopathological and Immunohistochemical Features of Vitreoretinopathy in Shih Tzu Dogs

Fifty cases of Shih Tzu ocular vitreoretinopathy were selected from the database of the Comparative Ocular Pathology Laboratory of Wisconsin. Cases with severe coexisting conditions (e.g. corneal disease, uveitis or endophthalmitis) were excluded. Microscopical changes were evaluated and immunohistochemistry was used to define spindle cells, gliosis and the presence of basement membranes in the vitreous. Expression of glial fibrillary acidic protein, vimentin and smooth muscle actin was also performed. The mean age of the 50 cases was 10.1 years (range 2.5-15 years). The most characteristic microscopical abnormalities (50/50 cases) were retinal detachment and extensive retinal tear. Additionally, extracellular, eosinophilic matrix material admixed with few spindle cells, and pre-iridal fibrovascular membrane, goniodysgenesis, secondary glaucoma, hypermature and subcapsular cataract were detected. The spindle cells within the collagen matrix were strongly labelled for expression of vimentin, with weaker expression of smooth muscle actin.

Operation for the hypermature stage cataract with the anterior chamber maintainer by a continuous circular capsulorhexis

Objective To explore the clinical effect of the operation for the hypermature stage cataract with the anterior chamber maintainer by a continuous curvilinear capsulorhexis (CCC).Methods 85cases ( 85 eyes) with hypermature stage cataract were enrolled in the study.Under continous perfusion of the anterior maintainer,the anterior capsule was incised by the discission needle and the intraocular lense (IOL) was implanted aftr CCC was completed and cataract was removed.Postoperatire vision,cornea,pupil and IOL status were recorded.Results CCC,cataract removal and IOL implantation were performed successfully in all cases.All patients had good postoperative vision with slight surgical reaction.Severe complications were not observed.Conclusion CCC with anterior chamber maintainer is an effective method for hypermature cataract surgery,which is easy to perform and has good effect. Key words: Cataract; Anterior chamber maintainer; Capsulorhexis,continuous curvilinear

Phacoemulsification and +14 diopter intraocular lens placement in a Saddlebred foal

A 2-month-old, 110-kg Saddlebred filly presented for evaluation of bilateral cataracts. A hypermature cataract in the left eye (OS) and an incipient nuclear cataract in the right eye (OD) were diagnosed. Electroretinography and ocular ultrasound revealed no contraindications for surgical removal of the cataractous lens OS. Phacoemulsification and implantation of a +14 diopter (D) intraocular lens (IOL) OS were performed at 4 months of age without complication, with the exception of a partial iridectomy performed on a small iris section that prolapsed through the corneal incision. Complete ophthalmic examinations, including ocular ultrasound and streak retinoscopy, were performed 1, 2, 6 weeks, 4 months, 1, and 2 years postoperatively. Diffuse corneal edema and a superficial corneal ulcer developed OS during the early postoperative period and resolved without complication. Dyscoria was identified owing to anterior synechia of the dorsomedial iris at the incision site. Two years after surgery, menace response, palpebral reflex, dazzle reflex, and pupillary light reflexes were present in both eyes (OU). The IOL remained centrally positioned within the capsule, with mild anterior tilting of the superior portion of the IOL and mild fibrosis of the lens capsule. The postoperative net refractive error was +0.31 D OS. Based on this report, a +14 D IOL may be the appropriate choice following lens extraction in a foal to achieve refraction near emmetropia at maturity. To our knowledge, this is the first report of phacoemulsification and IOL implantation in a foal with long-term follow-up.

Disseminated protothecosis diagnosed by evaluation of CSF in a dog

A 5-year-old female spayed Shetland Sheepdog Mix dog was evaluated for a history of recent seizure activity, progressive hind limb ataxia, polyuria, and polydipsia and no history of gastrointestinal signs. Physical examination findings included conscious proprioceptive deficits, ataxia, and anterior uveitis along with a hypermature cataract in the right eye. Results of a CBC, serum biochemical profile, urinalysis, and computed tomography scan of the brain were unremarkable. Cerebrospinal fluid (CSF) analysis revealed marked eosinophilic pleocytosis and rare organisms consistent with Prototheca spp within neutrophils and macrophages. On postmortem histologic examination, mononuclear inflammation and numerous intralesional algal organisms, similar to those seen on the cytologic preparation of CSF, were found in the brain, eyes, kidneys, and heart. Abnormalities were not detected on gross and histologic examination of the gastrointestinal tract. Cultures of CSF and subdural/olfactory bulb, but not intestinal tract, yielded growth of Prototheca spp, and PCR analysis and DNA sequencing confirmed the organism as Prototheca zopfii genotype 2. We have reported a rare case of disseminated protothecosis that was diagnosed by evaluation of CSF in a dog presented with neurologic signs and no overt enteric disease. Protothecosis should be considered as a rare cause of seizures, even in the absence of obvious enteric signs, and should be included in the differential diagnosis of eosinophilic pleocytosis.

Bilateral spontaneous rupture of anterior lens capsules in a middle-aged woman

Hypermature cataracts are commonly seen in developing countries. Spontaneous rupture of the anterior capsule, resulting in dislocation of the lens nucleus into the anterior chamber, presents rarely in hypermature cataracts. We describe a middle-aged woman who presented with spontaneous anterior dislocation of the nucleus in both eyes. The presence of calcification spots in the posterior capsule at the pupillary edge strongly suggested that our patient had hypermature cataracts. It is important to highlight this uncommon cause of nucleus dislocation in a patient with no previous history of ocular trauma.

Lenticular Neovascularization Subsequent to Traumatic Cataract Formation

To report a series of cases involving neovascularization within the human crystalline lens-a normally avascular structure-after ocular trauma. This is a retrospective, consecutive observational case series with review of the prevailing literature. Four individuals with a history of ocular trauma and subsequent cataract development were examined between May 2004 and April 2007. All had hypermature cataracts and intraocular inflammation, presumably secondary to phacolysis; two of the four had concurrent hyphema and ocular hypertension in the involved eye. All subjects in this series were found to display a discrete network of blood vessels within the structure of the crystalline lens, just beneath the anterior lens capsule. Neovascularization of the crystalline lens has received little attention in the ophthalmic literature, having been described only rarely in individual case reports. This manuscript details the first known case series involving lenticular neovascularization, and offers insight into its possible developmental mechanism.

Epidemiology of canine glaucoma presented to University of Zurich from 1995 to 2009. Part 2: secondary glaucoma (217 cases)

To investigate the epidemiology of canine secondary glaucomas in the cases presented to the University of Zurich, Vetsuisse Faculty (UZH) from 1995 to 2009 focusing on possible risk factors for developing secondary glaucoma in this population of dogs. Information was obtained from the computer database of patients examined by members of the UZH Ophthalmology Service, between January 1995 and August 2009. Secondary glaucoma was diagnosed based on the presence of antecedent eye conditions. The data was evaluated for breed, gender, age at presentation, and for antecedent eye conditions known to cause glaucoma including anterior uveitis of unknown cause (AU), lens luxation (LL), intraocular surgery (SX), intraocular neoplasia (IN), unspecified trauma to the globe (T), ocular melanosis (OM), hypermature cataract (PY), hyphema (HY), and six other less frequent conditions. A total of 217 dogs were diagnosed with secondary glaucoma from 1995 to 2009. The age of the dogs with secondary glaucoma ranged between 88 days and 19 years (mean 7.7 ± 3.6 years). Data suggested a predisposition for secondary glaucoma in the Cairn Terrier and the Jack Russell Terrier breeds from 2004 to 2009. Common causes of secondary glaucoma from 1995 to 2009 were AU (23.0%), LL (22.6%), SX (13.4%), IN (10.6%), T (8.3%), OM and PY (both 6.9%) and HY (3.23%). The report presents the epidemiology of secondary glaucomas presented to UZH from 1995 to 2009. Fourteen risk factors were recorded for secondary glaucoma. This is the first paper documenting OM in the Swiss Cairn Terrier dog population.

Bilateral Cataract in a Cynomolgus Monkey

Severe bilateral cataract was found in a 7 year-old naïve female cynomolgus monkey (Macaca fascicularis) 3 months before necropsy. During macroscopic examination, severe opacity and thinning of the lens were observed in both eyes. Histopathology revealed that the lens nuclei and majority of cortex lens fibers had disappeared and become excavated, while the lens fibers in the subcapsular area were swollen and distorted. Other observations included atrophy and vacuolation in the lens epithelial cells and proliferation of spindle cells and collagen fiber beneath the anterior capsule of the right eye. Immunohistochemical staining of these spindle cells revealed the presence of vimentin, cytokeratin and α-smooth muscle actin (α-SMA), which were considered to be derived from lens epithelial cells. This is a rare case of spontaneous, bilateral, hypermature cataract in a cynomolgus monkey.