Incidence Of Posterior Subcapsular Cataract Research Articles

Posterior subcapsular cataracts are a late effect after acute exposure to 0.5 Gy ionizing radiation in mice

Purpose The long-term effect of low and moderate doses of ionizing radiation on the lens is still a matter of debate and needs to be evaluated in more detail. Material and Methods We conducted a detailed histological analysis of eyes from B6C3F1 mice cohorts after acute gamma irradiation (60Co source; 0.063 Gy/min) at young adult age of 10 weeks with doses of 0.063, 0.125, and 0.5 Gy. Sham irradiated (0 Gy) mice were used as controls. To test for genetic susceptibility heterozygous Ercc2 mutant mice were used and compared to wild-type mice of the same strain background. Mice of both sexes were included in all cohorts. Eyes were collected 4 h, 12, 18 and 24 months after irradiation. For a better understanding of the underlying mechanisms, metabolomics analyses were performed in lenses and plasma samples of the same mouse cohorts at 4 and 12 h as well as 12, 18 and 24 months after irradiation. For this purpose, a targeted analysis was chosen. Results This analysis revealed histological changes particularly in the posterior part of the lens that rarely can be observed by using Scheimpflug imaging, as we reported previously. We detected a significant increase of posterior subcapsular cataracts (PSCs) 18 and 24 months after irradiation with 0.5 Gy (odds ratio 9.3; 95% confidence interval 2.1–41.3) independent of sex and genotype. Doses below 0.5 Gy (i.e. 0.063 and 0.125 Gy) did not significantly increase the frequency of PSCs at any time point. In lenses, we observed a clear effect of sex and aging but not of irradiation or genotype. While metabolomics analyses of plasma from the same mice showed only a sex effect. Conclusions This article demonstrates a significant radiation-induced increase in the incidence of PSCs, which could not be identified using Scheimpflug imaging as the only diagnostic tool.

Риск катаракты различных типов в когорте работников, подвергшихся профессиональному хроническому облучению

Purpose: To assess cataract type specific risks in a cohort of workers occupationally exposed to ionizing radiation over prolonged periods.
 Material and methods: The present retrospective cohort study included 22,377 workers first employed at a nuclear production facility in 1948–1982 and followed up till the end of 2008. By the end of the follow-up period in the study worker cohort 3123 cases of cortical cataract, 1239 cases of posterior subcapsular cataract (PSC) and 2033 cases of nuclear cataracts were registered over 486,245, 489,162, 492,004 person-years of follow-up, respectively.
 Results: The incidence of PSC, cortical and nuclear cataracts was significantly linearly associated with the cumulative radiation dose. The excess relative risk per unit dose of external gamma-ray exposure (ERR/Sv) was 0.91 (95 % CI: 0.67–1.20) for PSC, 0.63 (95 % CI: 0.49–0.76) for cortical cataracts and 0.47 (95 % CI: 0.35–0.60) for nuclear cataracts. Exclusion of an adjustment for neutron dose and inclusion of additional adjustments for body mass index and smoking index reduced ERRs/Sv for all types of cataracts. However, an additional adjustment for glaucoma increased the incidence risks of cortical and nuclear cataracts just modestly (but not for PSC). Inclusion of an adjustment for diabetes mellitus reduced the ERR/Sv of external gamma-ray exposure only for PSC incidence. Increased incidence risks of all cataract types were observed in both males and females of the study cohort, but ERR/Sv was significantly higher in females (p < 0.001), especially for PSC.
 Conclusion: The incidence of various types of cataracts in the cohort of workers occupationally chronically exposed to ionizing radiation was associated with the cumulative dose of external gamma-ray exposure.

Incidence, progression and risk factors of age-related cataract in Malays: The Singapore Malay Eye Study.

Long-term data on age-related cataract, a leading cause of blindness and visual impairment, is scarce in Asian populations. We report the 6-year incidence and progression of age-related cataract and associated risk factors in Malay adults living in Singapore. Population-based cohort study. A total of 3280 Malays aged 40+ years participated in baseline examinations of the Singapore Malay Eye Study (2004-2006). Six years later, 1901 (72.1% of eligible) baseline participants were re-examined. Cataract was assessed using lens photos, taken during eye examinations, following the Wisconsin Cataract Grading System. Incidence and progression of cortical, nuclear and posterior subcapsular (PSC) cataract. Poisson regression models and generalized estimating equations models (with Poisson link) were used to assess factors associated with cataract incidence and progression, respectively, adjusting for age, sex and other risk factors. Age-adjusted 6-year incidence of cortical, nuclear and PSC cataract was 14.1%, 13.6% and 8.7%, respectively, and was strongly age-related (P for trend <.001 for all types). Diabetes (relative risk [RR], 1.97; 95% confidence intervals [CI], 1.46-2.67) was associated with incident cortical cataract, hypertension was associated with PSC cataract incidence (RR, 2.09; 95% CI, 1.22-3.61), after multivariable adjustment. Progression occurred in 20.4%, 5.9% and 40.6% of baseline cortical, nuclear and PSC cataract cases, respectively. Similar to other elderly populations, incidence and progression of cataract were common in this Malay population. Diabetes and hypertension were important modifiable risk factors for cataract, highlighting the importance of systemic health on eye disease.

Vitamin D deficiency and posterior subcapsular cataract.

PurposeTo evaluate risk factors associated with posterior subcapsular cataract (PSC) development and the relationship between vitamin D deficiency and etiology of PSC.MethodsOf 195 consecutive patients from a private ophthalmology practice, diagnosed with PSC, serum vitamin D3 (25-OH D) levels were obtained for 175, and associations among risk factors, comorbidities, and PSC were assessed.ResultsIn all 175 PSC patients, mean 25-OH D levels were low (24 ng/mL ±11 SD) compared with age/sex-matched standards. Significant differences in 25-OH D levels were noted between PSC subjects taking/not taking calcium supplements, systemic steroids, osteoporosis medications, etc. Alone, smoking status and calcium channel blockers and/or topical steroids use made no significant difference in PSC subjects 25-OH D levels, but two or more of these factors were associated with lowered levels of 25-OH D (P<0.001). Low vitamin D was correlated with female sex, autoimmune disease, and non-skin cancer diagnosis, but not with age, or other comorbidities or medication use. In five early-stage PSC patients taking 5,000 IU of 25-OH D daily for vitamin D deficiency, there was resolution of their cataracts during the 2-year follow-up period.ConclusionVitamin D levels for most PSC patients fell below the 30 ng/mL calcium homeostasis threshold. Some comorbidities and non-ophthalmic interventions are associated with the development of PSC at less depressed levels of 25-OH D. In this series, vitamin D deficiency was associated with PSC cataract, suggesting that raising the level of vitamin D intake may reduce PSC incidence.

Hypertension and risk of cataract: a meta-analysis.

BackgroundCataract is the major cause of blindness across the world. Many epidemiologic studies indicated that hypertension might play an important role in the development of cataract, while others not. We therefore conducted this meta-analysis to determine the relationship between risk of cataract and hypertension.MethodsRetrieved studies on the association of hypertension with cataract risk were collected from PubMed, Web of Science and the Cochrane Library during June 2014 and were included into the final analysis according to the definite inclusion criteria. Odds ratio (OR) or risk ratio (RR) were pooled with 95% confidence interval (CI) to evaluate the relationship between hypertension and cataract risk. Subgroup analyses were carried out on the basis of cataract type, race and whether studies were adjusted for main components of metabolic syndrome (MS).ResultsThe final meta-analysis included 25 studies (9 cohort, 5 case-control and 11 cross-sectional) from 23 articles. The pooled results showed that cataract risk in populations with hypertension significantly increased among cohort studies (RR 1.08; 95% CI: 1.05–1.12) and case-control or cross-sectional studies (OR 1.28; 95% CI: 1.12–1.45). This association was proved to be true among both Mongolians and Caucasians, and the significance was not altered by the adjustment of main components of MS. Subgroup analysis on cataract types indicated that an increased incidence of posterior subcapsular cataract (PSC) resulted among cohort studies (RR 1.22; 95% CI: 1.03–1.46) and cross-sectional/case-control studies (OR 1.23; 95% CI: 1.09–1.39). No association of hypertension with risk of nuclear cataract was found.ConclusionsThe present meta-analysis suggests that hypertension increases the risk of cataract, especially PSC. Further efforts should be made to explore the potential biological mechanisms.

Serum homocysteine, vitamin B12, and folate, and the prevalence and incidence of posterior subcapsular cataract.

We assessed associations between serum levels of homocysteine, vitamin B12, and folate, and the prevalence and 5-year incidence of posterior subcapsular cataract (PSC) in Blue Mountains Eye Study participants. We examined 3508 participants aged 49+ years during 1997 to 2000, including 2334 (75.1% of survivors) original and 1174 (85.2% of those eligible) newly recruited subjects. Five years later (2002-2004), 1952 (76.6% of survivors) original participants were re-examined. Detailed examinations, including lens photographs and fasting blood tests, were conducted at both visits. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) after multivariable adjustment. In this population, those with PSC were older, less likely to have higher education, and more likely to have diabetes and myopia. The PSC prevalence was 5.7% (150/2644). Higher levels of homocysteine (per SD; OR, 1.17; 95% CI, 1.00-1.37) and lower levels of folate (per SD; OR, 1.24; 95% CI, 0.99-1.56) were associated with prevalent PSC. There was significant interaction (P < 0.05) between vitamin B12 and homocysteine; for B12 ≥125 pmol/L, 28% higher PSC prevalence was associated with homocysteine (per SD; OR, 1.28; 95% CI, 1.09-1.52); however, for B12 <125 pmol/L, nonsignificant lower PSC prevalence was associated with homocysteine (per SD; OR, 0.16; 95% CI, 0.02-1.57). The 5-year PSC incidence was 5.7% (n = 59/1030) with no significant associations with homocysteine, B12, and folate. Higher serum homocysteine level was associated with PSC prevalence in this population. Vitamin B12 status seemed to modify this association. Lack of longitudinal association could have resulted from insufficient study power.

Myopia and the long‐term incidence of cataract and cataract surgery: the Blue Mountains Eye Study

To assess the association between refractive errors and the 10-year incidence of cataract and cataract surgery. Population-based prospective study. Three thousand six hundred fifty-four persons aged 49+ years living in a well-defined geographical region were examined at baseline; 2564 were re-examined after 5 and/or 10 years. Baseline refractive error was measured using autorefraction with subjective refinement. Lens photographs were taken at each visit and assessed using the Wisconsin Cataract Grading System. Long-term incidence of cataract and cataract surgery. Compared with emmetropia, high myopia was associated with increased incidence of nuclear cataract (adjusted odds ratio 3.01, 95% confidence intervals 1.35-6.71). Low (odds ratio 1.86, confidence interval 1.03-3.35) and high myopia (odds ratio 7.80, confidence interval 3.51-17.35) were significantly associated with higher incidence of posterior subcapsular cataract. Low, moderate and high myopia were associated with increased incidence of cataract surgery (odds ratio 2.54, confidence interval 1.76-3.68; odds ratio 2.61, confidence interval 1.45-4.69; and odds ratio 4.81, confidence interval 2.33-9.93, respectively). Either any (odds ratio 1.35, confidence interval 1.08-1.69) or moderate hyperopia (odds ratio 1.76, confidence interval 1.32-2.34) was associated with increased incidence of nuclear cataract. Our longitudinal study confirms the association between myopia and an increased risk of nuclear and posterior subcapsular cataract. It also suggests that hyperopia may increase the risk of nuclear cataract.

Incidence and Risk Factors for Posttransplant Subcapsular Cataract: A Long-Term Retrospective Cohort Study

Background The occurrence and risk factors for posterior subcapsular cataract (PSC) after renal transplantation have received little attention. Objectives To analyze the cumulative incidence of PSC after renal transplantation and identify risk factors for the development of PSC. Methods Retrospective review of the records of the patients who underwent kidney transplantation between May 1986 and December 2008. Results We included 94 renal transplant recipients who showed PSC incidence at 5, 10, and 15 years of 3.5%, 40.5%, and 50.1%, respectively. Cumulative incidence of PSC during the follow-up was 37.2%. On multivariate analysis, age, body mass index (BMI) and cumulative corticosteroid dose were significantly associated with PSC. Recipient age above 50 years (hazard ratio [HR] = 2.88, 95% confidence interval [CI]: 1.42–5.83; P = .003), BMI above 25 kg/m 2 (HR = 2.28, CI: 1.09–4.78; P = .029), and prednisolone dose above 3 mg/kg/mo (HR = 7.79, CI: 3.34–18.99; P < .001) were independent risk factors for PSC. Diabetes, renal diagnosis, duration, and type of dialysis and posttransplant immunosuppressive regimen did not influence the occurrence of PSC. Conclusion The risk of PSC was low during the first years after transplantation reaching a plateau at 15 years posttransplantation. Among the risk factors for PSC, cumulative corticosteroid dose and body weight were the only modifiable risk factors.

Cystatin C, other markers of kidney disease, and incidence of age-related cataract.

To investigate the 15-year incidence of 3 specific types of age-related cataract as related to cystatin C and other measures of kidney function. Examinations of a population-based cohort (n = 4926) occurred at 5-year intervals for 15 years. Assessment of medical history, examination, and photographs of the lens after pupil dilation were performed at each examination. Protocols for photography and grading were used. Laboratory measures were from specimens collected at baseline. In multivariable analyses, a 1-SD increase in the logarithm of cystatin C was associated with 15-year incidence of cortical (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09-1.41) and posterior subcapsular (OR, 1.24; 95% CI, 1.02-1.50) cataracts. One SD increase in the logarithm of blood urea nitrogen and creatinine were associated with 15-year incidence of posterior subcapsular cataract (OR, 1.22; 95% CI, 1.04-1.42 and OR, 1.26; 95% CI, 1.03-1.54, respectively). Increased levels of cystatin C are associated with increased risk of specific types of age-related cataract. Whether the associations are due to the metabolic changes associated with decreased renal function, common genes, or both awaits further research.

Cataract and Ocular Hypertension in Children on Inhaled Corticosteroid Therapy

Purpose: To ascertain the incidence of posterior subcapsular cataract and ocular hypertension in a cohort of children ⩽ 12 years on inhaled steroid therapy. Patients and Methods: In this prospective study, a detailed history regarding corticosteroid therapy was obtained for children attending an asthma clinic. The presence and type of lens changes (cataract) was recorded and intraocular pressure (IOP) was measured. The children underwent another eye examination 2 years later. Results: Ninety-five patients were enrolled in the study. Mean patient age was 7±3 years, and mean duration of inhaled steroid therapy was 2±1 years. Thirty-six percent of patients received inhaled steroids exclusively, 61% received inhaled steroids with a short course of oral steroids, and 3% received inhaled steroids with a long course of oral steroids. Only 3 (3%) patients had cortical changes that were not visually significant, and none had posterior subcapsular or nuclear cataract. There was no significant differences between children with cataract and those without cataract with respect to age; duration of asthma; and duration, average daily dose, and cumulative dose of inhaled steroids. IOP ranged from 11 to 20 mm Hg (mean, 16±3 mm Hg). None of the children had ocular hypertension or glaucoma. Ninety patients underwent eye examination 2 years later; none was found to develop posterior subcapsular cataract or increased IOP. Conclusion: This study indicates the use of inhaled steroids in children with asthma is probably safe as far as not inducing posterior subcapsular cataract or ocular hypertension. J Pediatr Ophthalmol Strabismus 2005;42:23–27.

Catarata subcapsular posterior em pacientes com pênfigo e penfigóide tratados com corticoterapia oral

FUNDAMENTO: O tratamento mais utilizado para pacientes com dermatoses bolhosas crônicas é a corticoterapia oral, muitas vezes em altas doses e por períodos prolongados. Como efeitos colaterais dessa terapêutica, freqüentemente ocorrem: hipertensão arterial, diabete, osteoporose, infecções e distúrbios hidroeletrolíticos. A catarata subcapsular posterior é raramente citada na literatura como efeito colateral da corticoterapia em pacientes com doenças bolhosas. OBJETIVO: Avaliar a prevalência de catarata subcapsular posterior como efeito colateral da corticoterapia oral. MÉTODOS: Trata-se de um estudo retrospectivo incluindo 49 pacientes com dermatoses bolhosas crônicas em uso de corticoterapia acompanhados entre janeiro de 1987 e dezembro de 1997 no ambulatório de Dermatoses Bolhosas do Departamento de Dermatologia da Unifesp/EPM e regularmente submetidos à avaliação oftalmológica em busca de catarata cortisônica. RESULTADOS: No período de 1987 a 1997, 49 pacientes foram avaliados, tendo apresentado prevalência de catarata subcapsular posterior como efeito colateral da corticoterapia oral de 28,57%. CONCLUSÕES: 1) a prevalência de catarata foi de 28,57%; 2) o tempo médio de tratamento até o surgimento de catarata foi de 45,71 meses; 3) a média da dose máxima de corticosteróide utilizada pelos pacientes foi de 78,57mg/dia.

Alteration of cadherin in dexamethasone-induced cataract organ-cultured rat lens.

A side effect associated with long-term treatment of various diseases with steroids is a high incidence of posterior subcapsular cataracts (PSC). To understand the mechanism underlying steroid-induced cataract, the cultured lens model was developed, and the expression of potential candidate proteins during opacity formation was examined. Rat lenses were carefully dissected from the surrounding ocular tissue and incubated in medium 199. Dexamethasone was then added to the medium. The lenses were cultured for 7 days and photographed daily to record the development of opacity. Differential expression of candidate proteins was examined by Western blot analysis. Various degrees of opacity were observed on the posterior subcapsular region as early as 5 days after incubation with dexamethasone. The expression of E-cadherin and N-cadherin decreased in the cultured rat lenses during the development of opacity. The pattern of opacity that developed in cultured rat lenses closely resembled that observed in patients with PSC. The results suggest that the decrease in E-cadherin plays a role in the formation of steroid-induced cataract.

Cardiovascular disease, vascular risk factors and the incidence of cataract and cataract surgery: The Blue Mountains Eye Study

PURPOSE To assess whether an association exists between cardiovascular disease, vascular risk factors and incident cataract and cataract surgery. METHODS The Blue Mountains Eye Study examined 3654 participants =49 years of age during 1992–4, then 2335 survivors (75.1%) after five years. Trained interviewers administered a vascular history questionnaire; height, weight and blood pressure were measured. Lens photographs from both examinations were graded for presence of cortical, nuclear or posterior subcapsular cataract. RESULTS Obesity (body mass index =30kg/m 2 ) was significantly associated with increased incidence of both cortical [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.2–2.2] and posterior subcapsular cataract (OR 2.1, CI 1.2–3.7). Hypertensive participants using medication and aged less than 65 years at baseline had a higher incidence of posterior subcapsular cataract (OR 3.4, 95% CI 1.3–8.4) than normotensive subjects. A history of angina was associated with higher cataract surgery incidence (OR 2.1, 95% CI 1.3–3.5). CONCLUSIONS These longitudinal data provide some evidence supporting a relationship between cardiovascular disease, vascular risk factors and incident cataract and cataract surgery. The findings confirm a number of associations previously documented in cross-sectional data.

Cataracts after autologous bone marrow transplantation in children

We recorded the incidence and degree of posterior subcapsular cataract (PSC) in 29 children who had undergone autologous (n = 28) or syngeneic (n = 1) bone marrow transplantation (BMT) due to haematologic or lymphoid malignancy. Conditioning prior to transplantation consisted either of a combination of chemotherapy and total body irradiation (TBI) (n = 21) or of chemotherapy only (n = 8). TBI was given in one fraction of 7.5 Gy. Nine patients had received previous cranial irradiation. The patients were followed for 4-10y (median 8 y) after transplantation. Of 29 patients, 22 developed PSC, all within 4 y after BMT. With the exception of one patient who developed unilateral PSC, all had received TBI. Conversely, 100% of those who received TBI developed PSC. In this group (+TBI), eight patients (38%) developed significant PSC, defined as best corrected visual acuity <0.8 in either eye. Six patients (10 eyes) have since needed surgical repair consisting of extracapsular cataract extraction and intraocular lens implantation. There was no clear relationship between previous cranial irradiation and cataract development, nor any other obvious baseline differences between those in the +TBI group who developed significant PSC and those who did not. Although effects of previous therapy cannot be ruled out, TBI appears to be the main cause of PSC in this group of patients. Twelve patients in the +TBI group had well-preserved visual acuity throughout the study, reflecting a slow progression of PSC. This compares favourably with previous reports of allogeneic BMT, possibly owing to less need for corticosteroids after autologous BMT. We conclude that the incidence of PSC was high after autologous BMT where the conditioning regimen included total body irradiation.

Cataracts after autologous bone marrow transplantation in children

We recorded the incidence and degree of posterior subcapsular cataract (PSC) in 29 children who had undergone autologous (n = 28) or syngeneic (n = 1) bone marrow transplantation (BMT) due to haematologic or lymphoid malignancy. Conditioning prior to transplantation consisted either of a combination of chemotherapy and total body irradiation (TBI) (n = 21) or of chemotherapy only (n = 8). TBI was given in one fraction of 7.5 Gy. Nine patients had received previous cranial irradiation. The patients were followed for 4-10 y (median 8y) after transplantation. Of 29 patients, 22 developed PSC, all within 4 y after BMT. With the exception of one patient who developed unilateral PSC, all had received TBI. Conversely, 100% of those who received TBI developed PSC. In this group (+TBI), eight patients (38%) developed significant PSC, defined as best corrected visual acuity < 0.8 in either eye. Six patients (10 eyes) have since needed surgical repair consisting of extracapsular cataract extraction and intraocular lens implantation. There was no clear relationship between previous cranial irradiation and cataract development, nor any other obvious baseline differences between those in the +TBI group who developed significant PSC and those who did not. Although effects of previous therapy cannot be ruled out, TBI appears to be the main cause of PSC in this group of patients. Twelve patients in the +TBI group had well-preserved visual acuity throughout the study, reflecting a slow progression of PSC. This compares favourably with previous reports of allogeneic BMT, possibly owing to less need for corticosteroids after autologous BMT. We conclude that the incidence of PSC was high after autologous BMT where the conditioning regimen included total body irradiation.

Exposure to diagnostic x-rays and incident age-related eye disease

OBJECTIVE. The purpose of this study was to evaluate whether a self-reported history of computed tomography or other x-rays of the head were associated with the incidence of age-related cataracts and maculopathy five years later. METHOD. A 5-year longitudinal follow-up of the Beaver Dam Eye Study cohort (n=3,684, 43-86 years at baseline). RESULTS. There was no evidence of a relationship between the x-ray exposures and the incidence of nuclear or cortical cataracts, or early maculopathy. There was a significant relationship to the incidence of posterior subcapsular cataract after adjusting for age only. CONCLUSIONS. Adult patients in whom medical conditions warrant diagnostic x-rays of the head appear to be at little or no increased risk of age-related cataract or maculopathy. However, research efforts with more precise measures of x-ray exposure, longer follow-up, and further attempts to define uncontrolled confounders are warranted.

Posterior Subcapsular Cataract Formation Associated with Multiple Lumbar Epidural Corticosteroid Injections

Posterior Subcapsular Cataract Formation Associated with Multiple Lumbar Epidural Corticosteroid Injections

Ocular complications in renal transplant patients.

One hundred and seventy-six patients who received a renal transplant between 1982 and 1988 were examined for ocular complications of steroid therapy. Posterior subcapsular cataracts (PSC) were present in 60 patients (34.1%). Patients were classified into three groups (HS, LS, NoS) depending on their maintenance immunosuppression therapy. The HS group received high doses of steroids after renal transplantation. LS had low steroid doses, and NoS had no steroids. The incidence of PSC was 21 of 38 in HS (55.3%), 33 of 117 in LS (28.2%), and 1 of 16 in NoS (6.2%). The difference between HS and LS was statistically significant (chi 2 = 8.1, P < 0.01). Grading the severity of PSC (PSC 0, PSC +, PSC > ++) showed a significant correlation between the degree of PSC and the steroid therapy. In the HS group, five patients had PSC +, and 16 had PSC > ++ (76%), compared to 19 patients with PSC +, 14 patients with PSC > ++ (42%) in the LS group (chi 2 = 4.6; P < 0.05). There was no correlation between the incidence of PSC and use of steroids for more than three months before dialysis. Comparison with the results of our earlier series (1973-1981) using high doses of steroids showed a similar incidence of PSC with HS (40.7% Series 1; 55.3% Series 2) but a lower incidence with LS and NoS.

Posterior subcapsular cataract in nephrotic children receiving steroid therapy.

Posterior subcapsular cataract (PSC) was observed in ten of 35 nephrotic children (28.5%) treated with corticosteroid hormone. It was noted that the larger the dose of the hormone used and the longer the duration of treatment, the higher the incidence of PSC. Irrespective of reduction or withdrawal of therapy, the opacities, once developed, remained unchanged during the period of observation. Compared with adults, children tend to develop PSC while receiving a much smaller steroid dose and during a shorter period of treatment. Regular ophthalmological examinations are strongly recommended.

Ocular complications in renal transplant recipients

The ocular complications in renal transplant recipients were evaluated in 44 patients and in 22 control patients with renal failure. Of the 44 patients 33 showed some ocular abnormality, but only posterior subcapsular cataracts which occurred in 34 per cent of post-transplant patients could be related to post-transplant corticosteroid therapy. There was no correlation between posterior subcapsular cataracts and either the duration of daily doses or total doses of corticosteroids in patients under 25 years of age in whom the incidence of posterior subcapsular cataracts tended to be higher than in older patients. There appeared to be a significant correlation between the duration of therapy and the total corticosteroid dose and the incidence of posterior subcapsular cataracts in the older age group.