Cataract Research Articles

A case report of iridoschisis and cataract: a challenging diagnosis.

To report the cataract surgery of a 79-year-old female patient with iridoschisis and senile nuclear cataracts. Ophthalmologic examination of the 79-year-old female patient who came to our clinic with complaints of decreased vision in the right eye was observed to have a grade-3 senile nuclear cataract and iridoschisis in quadrants 2-3, 4-7, and 10-11 of the iris in the right eye and a grade-2 senile nuclear cataract and iridoschisis in quadrants 5-7 in the left eye to a lesser extent compared to the right eye. The iris fibrils were not connected to the corneal endothelium. A safe surgical area was created by administering the viscoelastic material several times during cataract surgery. Although iridoschisis has a low incidence rate, it is important to also consider comorbid ocular pathologies when treating iridoschisis patients. Since cataract surgery for these patients is more specialized than for uncomplicated cases, the necessary surgical planning must be paid due diligence.

Association of Alpha-Crystallin with Human Cortical and Nuclear Lens Lipid Membrane Increases with the Grade of Cortical and Nuclear Cataract.

Eye lens α-crystallin has been shown to become increasingly membrane-bound with age and cataract formation; however, to our knowledge, no studies have investigated the membrane interactions of α-crystallin throughout the development of cataracts in separated cortical membrane (CM) and nuclear membrane (NM) from single human lenses. In this study, four pairs of human lenses from age-matched male and female donors and one pair of male lenses ranging in age from 64 to 73 years old (yo) were obtained to investigate the interactions of α-crystallin with the NM and CM throughout the progression of cortical cataract (CC) and nuclear cataract (NC) using the electron paramagnetic resonance spin-labeling method. Donor health history information (diabetes, smoker, hypertension, radiation treatment), sex, and race were included in the data analysis. The right eye lenses CM and NM investigated were 64 yo male (CC: 0), 68 yo male (CC: 3, NC: 2), 73 yo male (CC: 1, NC: 2), 68 yo female (CC: 3, NC: 2), and 73 yo female (CC: 1, NC: 3). Similarly, left eye lenses CM and NM investigated were 64 yo male (CC: 0), 68 yo male (CC: 3, NC: 2), 73 yo male (CC: 2, NC: 3), 68 yo female (CC: 3, NC: 2), and 73 yo female (CC: 1, NC: 3). Analysis of α-crystallin binding to male and female eye lens CM and NM revealed that the percentage of membrane surface occupied (MSO) by α-crystallin increases with increasing grade of CC and NC. The binding of α-crystallin resulted in decreased mobility, increased order, and increased hydrophobicity on the membrane surface in male and female eye lens CM and NM. CM mobility decreased with an increase in cataracts for both males and females, whereas the male lens NM mobility showed no significant change, while female lens NM showed increased mobility with an increase in cataract grade. Our data shows that a 68 yo female donor (long-term smoker, pre-diabetic, and hypertension; grade 3 CC) showed the largest MSO by α-crystallin in CM from both the left and right lens and had the most pronounced mobility changes relative to all other analyzed samples. The variation in cholesterol (Chol) content, size and amount of cholesterol bilayer domains (CBDs), and lipid composition in the CM and NM with age and cataract might result in a variation of membrane surface mobility, membrane surface hydrophobicity, and the interactions of α-crystallin at the surface of each CM and NM. These findings provide insight into the effect of decreased Chol content and the reduced size and amount of CBDs in the cataractous CM and NM with an increased binding of α-crystallin with increased CC and NC grade, which suggests that Chol and CBDs might be a key component in maintaining lens transparency.

Senile Cataract

Cataracts may be described as the opacity of crystalline lenses present in the eye. The translucent crystalline lens is a part of the human eye. It possesses all the physical characteristics of a biconvex lens. The eye’s lens performs similar functions to a camera’s lens. The lens directs light rays entering the eye to the retina’s sensitive layers. Any factor that increases the absorption of scattering of light by the lens reduces its transparency. The opacity of the lens or its capsule, whether developmental or acquired, is called a cataract. Cataracts vary in degree of density and site and assume various forms. Cataract is the leading cause of reversible visual impairment and blindness globally. There are several classifications of cataracts based on morphologic and/or etiologic criteria. However, in epidemiologic studies, the simplified system of three types based on localization of lens opacities is most commonly used: Nuclear cataract is the most common type, followed by cortical cataract and posterior subcapsular cataract. This most prevalent form of acquired cataract, also known as an “age-related cataract,” affects people of both sexes equally and typically develops after age 50. More than 90% of people experience senile cataracts by age 70. Although one eye is almost always afflicted before the other, the disorder is typically bilateral. In the available literature, there is no mention of any such drug that could reverse the opacity of the lens (cataract) once it occurred and make it clear and transparent again. Only replacement of opaque lenses with artificial transparent Intraocular lens (IOL) is successful treatment of cataracts. This review focuses on senile cataracts and the best possible management of senile cataracts.

Study of risk factors for cataracts in a chronically exposed population cohort

BACKGROUND: The likelihood of developing cataracts is influenced by many factors, such as age, gender, ethnicity, the presence of somatic pathology (diabetes mellitus, hypertension), dietary habits and lifestyle (obesity, level of education), etc.
 AIM: To study the risk of developing cataracts in exposed people in the long term after chronic radiation exposure, taking into account the influence of radiation dose and non-radiation factors.
 MATERIAL AND METHODS: The total study group consisted of 14,751 people examined in the hospital of the Ural Scientific and Practical Center for Radiation Medicine from 1955 to 2019. Cataracts were diagnosed in 4,658 people. The statistical methods were based on case-control. To assess the association of the studied factors with the risk of developing cataracts, the odds ratio (OR) and 95% confidence interval (CI) were calculated. Morbidity rates were calculated using medical statistics methods per 1000 people. When studying the incidence of cataracts, individualized indicators of radiation dose to the lens of the eye were used.
 RESULTS: The study revealed an increase in the incidence of cataracts as the cohort ages. There was a tendency for the risk of cataracts to increase (OR=1.10; 95% CI=1.00–1.21) with increasing radiation dose. The incidence of cataracts was associated with the presence of arterial hypertension (OR=2.01; 95% CI=1.81–2.22), diabetes mellitus (OR=1.36; 95% CI=1.17–1.58), cerebrovascular diseases (OR=1.14; 95% CI=1.03–1.26), increased body mass index (OR=1.61; 95% CI=1.45–1.78), as well as belonging to Turkic group (OR=1.58; 95% CI=1.44–1.71), living in the city (OR=1.26; 95% CI=1.15–1.38), having no family (OR=1.72; 95% CI=1.63–1.97), employment primarily in mental work (OR=1.34; 95% CI=1.22–1.48).
 CONCLUSION: A tendency for the influence of radiation dose on an increase in the risk of cataracts has been established, medical and social factors that increase the likelihood of developing senile cataracts have been identified.

Smurf1 Modulates Smad Signaling Pathway in Fibrotic Cataract Formation.

TGF-β/BMP signaling pathway plays a significant role in fibrotic cataract. Smurf1, a ubiquitin protein ligase, regulates the TGF-β/BMP signaling pathway through the ubiquitin-proteasome system (UPS). This study aims to investigate the role of Smurf1 in the progression of fibrotic cataract and its underlying mechanism. We used a mouse model of injury-induced anterior subcapsular cataract (ASC) and administered the Smurf1 inhibitor A01 for in vivo investigations. RNA sequencing was performed to examine global gene expression changes. Protein levels were assessed by Simple Western analysis. The volume of subcapsular opacity was determined using whole-mount immunofluorescence of lens anterior capsules. Lentivirus was utilized to establish cell lines with Smurf1 knockdown or overexpression in SRA01/04. Lens epithelial cell (LEC) proliferation was evaluated by CCK8 and EdU assays. Cell cycle profile was determined by flow cytometry. LEC migration was measured using Transwell and wound healing assays. The mRNA levels of genes associated with cell proliferation, migration, epithelial-mesenchymal transition (EMT), TGF-β/BMP pathway, and UPS were upregulated in mouse ASC model. Smurf1 mRNA and protein levels were upregulated in lens capsules of patients and mice with ASC. Anterior chamber injection of A01 inhibited ASC formation and EMT. In vitro, Smurf1 knockdown reduced proliferation, migration and TGF-β2-induced EMT of LECs, concomitant with the upregulation of Smad1, Smad5, and pSmad1/5. Conversely, overexpression of Smurf1 showed opposite phenotypes. Smurf1 regulates fibrotic cataract progression by influencing LEC proliferation, migration, and EMT through the modulation of the Smad signaling pathway, offering a novel target for the fibrotic cataract treatment.

Air pollution and human health: a phenome-wide association study

ObjectivesTo explore the associations of long-term exposure to air pollution with onset of all human health conditions.DesignProspective phenome-wide association study.SettingDenmark.ParticipantsAll Danish residents aged ≥30 years on 1 January 2000 were...

Noninvasive screening of ocular surface disease in otherwise healthy patients scheduled for cataract surgery.

To evaluate prevalence and characteristics of pathological ocular surface findings in healthy patients undergoing cataract surgery using a noninvasive ocular surface workup and a validated questionnaire. Prospective single-centre study (sub-analysis clinical trial no. NCT05754437). Healthy patients undergoing senile cataract surgery were screened preoperatively by Oculus Keratograph (K5 M; Oculus GmbH, Wetzlar, Germany) for the evaluation of tear meniscus height (TMH), non-invasive keratograph break-up time (NIKBUT), and meibomian gland dropout. Ocular discomfort symptoms were scored by ocular surface disease index (OSDI) questionnaire. 120 eyes of 120 patients (62 females, 58 males; mean age 73.85 years, range 47-91 years) were included. All patients had at least 1 abnormal finding, while 19 (15.8%; 95% CI [0.09-0.22]) had alterations of all parameters. In detail, 39 patients (32.5%; 95% CI [0.24-0.41]) had pathological TMH (mean 0,15 mm [0.03 SD]), 102 (85%; 95% CI [0.79-0.91]) had pathological NIKBUT (mean 3.64 s [2.63 SD]), 117 (97.5%; 95% CI [0.95-1]) had some degree of gland dropout (mean 1.62 [0.70 SD]), 78 patients (65%; 95% CI [0.56-0.74]) had pathological OSDI scores (mean 28.63 [15.08 SD]). Using TFOS DEWS II criteria, 66 patients (55%; 95% CI [0.42-0.60]) resulted affected by dry eye. This quick noninvasive screening documented the high prevalence of pathological ocular surface parameters in patients without risk factors or previous diagnosis of dry eye who are scheduled for cataract surgery.

The effect of cataract surgery on quality of life and sleep in geriatric patient group

Aim: Investigation of the effects of cataract surgery on quality of life and sleep in geriatric patient group Methods: Ninety four patients who were diagnosed with cataract and operated were included. Preoperative and postoperative best corrected visual acuity (BCVA) was measured with the Snellen chart. Cataract types were divided into 3 categories as nuclear, cortical and posterior subcapsular. The VFQ-25 (vision-related quality of life) questionnaire and the Pittsburgh Sleep Quality Questionnaire were administered to the patients before and after the surgery. Results: One hundred thirty-eight eyes of 94 patients were operated. 45.7% of the patients had nuclear, 16% had cortical, 38.3% had posterior subcapsular cataracts. VFQ 25 questionnaire scores increased from 70.70±3.46 (42-89) to 85.65±7.09 (70-97) postoperatively (p<0.001). While the preoperative Pittsburgh sleep quality index (PSQI) score of the patients was 8.70±2.99 (2-17), it was 6.26±3.19 (1-17) postoperatively (p<0.001). There was a positive correlation between the increase in postoperative visual acuity (?) and the VFQ 25 questionnaire score increase (?) (r=0.891, p=0.000). ?VFQ 25 and ? PSQI values were higher in patients who underwent bilateral cataract surgery, but this difference was not statistically significant (p=0.199, p=0.808). ?VFQ 25 after posterior subcapsular cataract surgery was greater than nuclear and cortical type. ? PSQI values were similar in nuclear, posterior subcapsular and cortical cataracts. Conclusion: Geriatric patients with posterior subcapsular cataracts had a higher postoperative vision-dependent quality of life than patients with other cataract types. Cataract surgery has positive effects on sleep quality of geriatric patients, regardless of cataract type and laterality (bilateral/unilateral).

Senile Cataract Formation Does Not Affect Crystalline Lens Thickness.

Characterizing lens thickness (LT) in patients with cataracts is important for better understanding the lens aging process and for designing new intraocular lens power formulas. This study aimed to analyze the influence of common senile cataract formation on the LT, anterior (ACS) and posterior (PCS) cortex space, and nuclear thickness (NT), controlling for sex, age, and axial length. A cross-sectional study was performed. A consecutive sample of 603 volunteers (403 women, 200 men) aged 59.1 ± 18.8years was recruited. The standardized Lens Opacification Classification System (LOCS)-III was used to classify eyes (randomly selected) into cataractous and non-cataractous groups. Also, they were classified according to the cataract location (presence or absence of cortical, nuclear, or posterior subcapsular cataract). Optical biometry was performed to measure LT, ACS, NT, and PCS. Propensity score was used to match participants one-to-one for sex, age, and axial length. Groups were compared using the Student's ttest or Yuen's test. The four classifications divided unmatched eyes into: 361 cataractous lenses and 242 non-cataractous, 226 cortical and 377 non-cortical cataractous, 313 nuclear and 290 non-nuclear cataractous and 242 subcapsular and 361 non-subcapsular cataractous. Before matching, cataractous eyes showed significantly higher LT (4.52 ± 0.39 vs. 3.94 ± 0.46mm, p < 0.001), ACS (0.75 ± 0.20 vs. 0.58 ± 0.23mm, p < 0.001), NT (3.34 ± 0.23 vs. 3.18 ± 0.25mm, p < 0.001) and PCS (0.42 ± 0.19 vs. 0.37 ± 0.19mm, p = 0.003). Matched lens, cortical, nuclear, and subcapsular cataract samples comprised 146, 258, 182, and 226 eyes, respectively. After matching, no significant differences were observed in LT (4.34 ± 0.37 vs. 4.33 ± 0.36mm, p = 0.94), ACS (0.72 ± 0.20 vs. 0.76 ± 0.19mm, p = 0.08), NT (3.31 ± 0.22 vs. 3.30 ± 0.23mm, p = 0.24) and PCS (0.42 ± 0.19 vs. 0.43 ± 0.16mm, p = 0.79). The presence of senile cortical, nuclear, and posterior subcapsular cataract have no effect on LT, ACS, NT, and PCS. Confounding factors should be controlled for when measuring LT and its main components.

Study of Serum Sodium and Potassium Levels in Senile Cataract Patients Versus Normal Controls at Tertiary Center

Aims: Senile cataract is a common eye condition that affects many older people and can lead to blindness if not treated. It is caused by the gradual thickening of the lens of the eye, which reduces the clarity of vision. One of the factors that may contribute to the development of senile cataract is the imbalance of serum electrolytes, which are minerals that help regulate the fluid balance in the body.&#x0D; Study Design: Hospital based prospective cross-sectional study.&#x0D; Methodology: The aim of this study was to compare the levels of serum sodium and potassium in senile cataract patients and healthy controls. The study involved 200 participants aged 50 to 80 years, 100 of whom had senile cataract and 100 of whom did not. The levels of serum electrolytes were measured using standard laboratory methods.&#x0D; Results: Senile cataract patients had significantly higher levels of serum sodium and potassium than healthy controls, while there was no significant difference in serum potassium levels between the two groups.&#x0D; Conclusion: The high levels of serum sodium and potassium may affect the concentration of these electrolytes in the aqueous humor, which is the fluid that fills the eye. This may overwhelm the ability of the lens to regulate its volume and lead to lens opacities. Therefore, serum sodium and potassium levels may be useful indicators of senile cataract risk. The study also suggested that reducing salt intake may help prevent or delay the onset of senile cataract.

A 39-Year-Old Woman with Oculodermal Melanocytosis: A Case Report

Introduction: Nevus of Ota, also known as oculodermal melanocytosis (ODM), is characterized by macular pigmentation which localized to the forehead and periocular area. It usually shows a dermatomal distribution from the first two branches of the trigeminal nerve. We reported a case of oculodermal melanocytosis (ODM).&#x0D; Case presentation: A 39-year-old woman, came with complaints of her left eye rolling inwards for the past 5 years accompanied by a flat black spot on her forehead that spread to her left cheek. She was done macular OCT and orbital ultrasonography of the left eye. She was diagnosed with oculodermal melanocytosis in the left eye, moderate NPDR in both eyes, juvenile cataracts in both eyes, and esotropia in the left eye due to left-eye cranial nerve VI paralysis. Follow-up at 6 months was advised to the patient.&#x0D; Conclusion: Although this is a benign condition, patients are at risk of developing complications such as increased intraocular pressure and melanoma of the skin and/or uvea, ongoing evaluation with imaging methods is highly recommended even if only skin lesions may be repaired using laser for cosmetic reasons.

Topical and subconjunctival anesthesia versus topical anesthesia alone in patients with senile cataracts undergoing phacoemulsification: a double-blind randomized controlled trial

BackgroundThis study compared topical anesthesia to a combination of topical anesthesia and subconjunctival anesthesia for phacoemulsification.MethodsThis double-blinded parallel placebo-controlled randomized trial involved senile cataract patients scheduled for phacoemulsification between May and December 2022. Patients were randomly assigned to receive either topical anesthesia with 0.5% tetracaine hydrochloride and subconjunctival balanced salt solution injection (Control group) or topical anesthesia and subconjunctival injection with 2% lidocaine (Lidocaine group). Baseline parameters, cataract grades, and various outcomes were recorded, including pain scores at specific time points, patient cooperation scores, requests for additional anesthesia, and complications. Statistical methods included Fisher’s exact test, the t-test, ordinal logistic regression, and linear regression with robust standard errors.ResultsIn total, 176 patients were included in the study after excluding 33 patients. A significant reduction in immediate postoperative pain was achieved in the Lidocaine group (p < 0.001) and was maintained for 2 h (p = 0.011). Additionally, better cooperation was observed in this group (p = 0.038). However, patients in the Lidocaine group experienced more pain during the subconjunctival injection (p = 0.001) and a significant increase in subconjunctival hemorrhage related to the injection (p < 0.001). Despite this, the rates of surgical complications were comparable between the groups, and all phacoemulsification procedures were successfully completed using the assigned anesthetic technique.ConclusionsThe addition of subconjunctival lidocaine injection to topical anesthesia reduced postoperative pain and improved patient cooperation during phacoemulsification. However, the lidocaine injection was painful, and it carried a higher risk of spontaneous-relief subconjunctival hemorrhage.Trial registrationTrial Registration Number: TCTR20220804003, date of registration August 4, 2022, retrospectively registered.

Fundus photograph-based cataract evaluation network using deep learning

Background: Our study aims to develop an artificial intelligence-based high-precision cataract classification and grading evaluation network using fundus images.Methods: We utilized 1,340 color fundus photographs from 875 participants (aged 50–91 years at image capture) from the Beijing Eye Study 2011. Four experienced and trained ophthalmologists performed the classification of these cases based on slit-lamp and retro-illuminated images. Cataracts were classified into three types based on the location of the lens opacity: cortical cataract, nuclear cataract, and posterior subcapsular cataract. We developed a Dual-Stream Cataract Evaluation Network (DCEN) that uses color photographs of cataract fundus to achieve simultaneous cataract type classification and severity grading. The accuracy of severity grading was enhanced by incorporating the results of type classification.Results: The DCEN method achieved an accuracy of 0.9762, a sensitivity of 0.9820, an F1 score of 0.9401, and a kappa coefficient of 0.8618 in the cataract classification task. By incorporating type features, the grading of cataract severity can be improved with an accuracy of 0.9703, a sensitivity of 0.9344, an F1 score of 0.9555, and a kappa coefficient of 0.9111. We utilized Grad-CAM visualization technology to analyze and summarize the fundus image features of different types of cataracts, and we verified our conclusions by examining the information entropy of the retinal vascular region.Conclusion: The proposed DCEN provides a reliable ability to comprehensively evaluate the condition of cataracts from fundus images. Applying deep learning to clinical cataract assessment has the advantages of simplicity, speed, and efficiency.

Canine cataracts

The intraocular lens is uniquely designed to aid focused vision, and diseases of the lens such as cataracts are a common cause of blindness in dogs. The causes of cataracts are discussed including the main aetiologies such as hereditary cataract, senile and diabetic cataracts. The article focuses on dogs, as cataracts are less common in cats, although traumatic cataracts and rarely, inherited, congenital and developmental cataracts do occur in felines. The article discusses ways to examine and classify a cataract; the best way to diagnose an early cataract is examination with a veterinary ophthalmologist. Early detection is important, as it is not advised to breed from dogs affected with hereditary cataracts. Surgical extraction is currently the only method to remove a cataract and restore vision, and the common complications of cataract surgery are also explored.

Aqueous Extract Analysis of Lens Epithelial Cells: Unraveling the Link between Oxidative DNA Damage and Malondialdehyde in Senile Cataract

Background and Aims: The purpose of this study was to examine the level of oxidative stress in people with cataracts, based on previous studies that indicated its role in causing DNA damage and cataract formation. The study also sought to determine the correlation between the degree of DNA damage and the concentration of malondialdehyde, a marker of lipid peroxidation, in patients with senile cataracts. Methods: The study involved 30 senile cataract patients aged 50-80 years and 12 cadaveric donors of corneal tissue who died in road accidents. They were selected from the ophthalmology ward of Acharya Vinoba Bhave Hospital. The aim was to measure DNA damage in human lens epithelial cells (HLECs) by Comet assay and malondialdehyde levels in the aqueous extract of HLECs. Results: The study found that the oxidative DNA damage level of human lens epithelial cells is not correlated with the malondialdehyde levels in the aqueous extract of HLECs in senile cataract patients. Conclusions: The study did not support the hypothesis that oxidative stress is a major factor in the development of cataracts. The results suggest that other mechanisms, such as genetic factors, environmental factors may be more relevant in the pathogenesis of cataracts.

A connection between levels of soluble Fas and Fas ligand in the aqueous humor and the parameters of structural and functional damage of glaucoma patients

Introduction/Objective. Fas ligant (FasL) induces apoptosis when interacting with the Fas-receptor. The aim was to determine the concentration of soluble Fas (sFas) and FasL (sFasL) in the aqueous humor of open-angle glaucoma patients, and establish a connection between these markers of apoptosis and the parameters of structural and functional glaucoma damage. Methods. This study examined 88 aqueous humor samples; 35 primary open-angle glaucoma with elevated intraocular pressure (POAG-HTG) patients, 24 open angle pseudoexfoliative glaucoma patients (XFG) and 29 patients with senile cataract (CAT). The concentration of sFas and sFasL was determined by commercial ELISA tests in the aqueous humor. Results. The conducted study showed that aqueous humor sFas concentration was the highest in XFG (720.14 ? 167.39 pg/ml), and slightly lower in POAG-HTG (713.43 ? 162.69 pg/ml), than in cataract patients (632.46 ? 217.11 pg/ml), without statistical significance. There was a significant negative correlation of sFas concentration and RNFL Inf thickness in POAG-HTG (p &lt; 0.05). The concentration of sFasL was the lowest in POAG-HTG (9.28 ? 0.551 pg/ml), higher in XFG (9.45 ? 0.61 pg/ml; p = 0.0566), and the highest in the cataract group (9.48 ? 0.73 pg/ml). A negative correlation of sFasL and MD in the POAG-HTG, and a negative correlation with RNFL Sup in the XFG were significant. Conclusion. sFasL has an active role in the regulation of the inflammatory process in glaucoma. sFas and sFasL, as markers of apoptosis, are associated with the parameters of structural, RNFL thinning, and functional glaucoma damage, namely visual field defects.

Thickness of the crystalline lens does not depend on cataract formation

Aims/Purpose: To assess the influence of cataract formation on the lens thickness (LT), anterior (ACS) and posterior (PCS) cortex space and nuclear thickness (NT).Methods: A prospective cross‐sectional study including patients seeking for cataract surgery was performed. The standardized Lens Opacification Classification System (LOCS)‐III was used to classify lens opacities. A control group composed of non‐cataractous patients was also created. In addition, cataract patients were also classified according to the cataract location (presence or absence of cortical, nuclear or posterior subcapsular cataract). Optical biometry was performed to measure LT, ACS, NT and PCS. Propensity score was used to match cataract and non‐cataract patients one‐to‐one for sex, age and axial length. Groups were compared using the Student's t‐test or Yuen's test.Results: A sample of 603 volunteers (403 females, 200 males) aged 59.1 ± 18.8 years was recruited. Before matching, the lens cataract and the non‐cataract group was composed of 361 cataractous and 242 non‐cataractous volunteers. Also, all participants were classified into cortical and non‐cortical cataract groups (226 vs. 377), nuclear and non‐nuclear cataract groups (313 vs. 209) and into subcapsular and non‐subcapsular cataract groups (242 vs. 361). Before matching, cataract groups showed significant (p ≤ 0.003) higher LT (4.52 ± 0.39 vs. 3.94 ± 0.46 mm), ACS (0.75 ± 0.20 vs. 0.58 ± 0.23 mm), NT (3.34 ± 0.23 vs. 3.18 ± 0.25 mm) and PCS (0.42 ± 0.19 vs. 0.37 ± 0.19 mm). After matching, the lens, cortical, nuclear and subcapsular cataract samples were composed of 146, 258, 182 and 226 participants, respectively. Then, no significant (p ≥ 0.08) differences were found for LT, ACS, NT and PCS.Conclusions: Thickness of the lens and/or its main components is not changed due to cataract formation. The progressive lens growth associated to aging might be the main confounding factor misleading the outcomes of previous studies that reported differences in LT between cataractous and non‐cataractous patients.

Vitreous haemorrhage revealing haemophilia C

Aims/Purpose: To report a rare case of vitreous haemorrhage revealing factor XI deficiency in 83‐year‐old man.Results: A 83‐year‐old man presented with 6 months history of painless visual loss in the right eye (OD). There was no prior ophthalmic history, trauma or unusual bleeding tendency. Ophthalmic examination showed a best corrected visual acuity limited to hand motion in OD and 20/40 in the left eye (OS). Slit examination revealed the presence of bilateral grade 3 nuclear cataract. Fundus examination was unremarkable in OS but could not be visualized in OD. B scan ultrasonography revealed vitreous haemorrhage without retinal detachment. Etiological assessment revealed prolonged activated partial thromboplastin time. Further investigations revealed the presence of a hereditary coagulopathy, namely, haemophilia C or factor XI deficiency (factor XI level &lt; 1%). The patient underwent successful cataract extraction and pars plana vitrectomy with silicone oil tamponade without prophylactic treatment. Peri‐operative fundus examination revealed superior branch retinal vein occlusion. Partial visual recovery was noted. No bleeding events were observed during follow‐up.Conclusions: Factor XI deficiency is a rare disorder. Haemorrhagic symptoms are variable since there is no correlation between haemorrhagic risk and factor level. In severely affected patients, cataract extraction and vitrectomy can be performed safely without prophylactic treatment.

Body mass index influences age-related cataracts: an updated meta-analysis and systemic review.

Visual impairment and blindness caused by cataracts are major public health problems. Several factors are associated with an increased risk of age-related cataracts, such as age, smoking, alcohol consumption, and ultraviolet radiation. This meta-analysis aimed to assess the association between body mass index and age-related cataracts. Studies on weight and age-related cataracts published from January 2011 to July 2020 were reviewed by searching PubMed, Medline, and Web of Science databases. The random-effects and fixed-effects models were used for the meta-analysis, and the results were reported as odd ratios. A total of nine studies were included in the meta-analysis. No correlation was found between underweight and nuclear cataracts (OR=1.31, 95% CI [-0.50 to 3.12], p=0.156). The results of the random-effects model showed that overweight was significantly associated with age-related cataracts and reduced the risk of age-related cataracts (OR=0.91, 95% CI [0.80-1.02], p<0.0001; I2=62.3%, p<0.0001). Significant correlations were found between overweight and cortical, nuclear, and posterior subcapsular cataracts (OR=0.95, 95% CI [0.66-1.24], p<0.0001; OR=0.92, 95% CI (0.76-1.08), p<0.0001; OR=0.87, 95% CI [0.38-1.02], p<0.0001). Significant correlations were found between obesity and cortical, nuclear, and posterior subcapsular cataracts (OR=1.00, 95% CI [0.82-1.17], p<0.0001; OR=1.07, 95% CI [0.92-1.22], p<0.0001; OR=1.14, 95% CI [0.91-1.37], p<0.0001). This finding suggested a significant correlation between body mass index and age-related cataracts, with overweight and obesity reducing or increasing the risk of age-related cataracts, respectively.

Objective and independent measurement of scattering caused by the cornea and crystalline lens

meritxell.vilaseca@upc.eduThere are several methods that provide information on the intraocular scattering. Procedures based on the observation of the lens through the slit lamp from which a gradation of the state of every cataract is assessed (e.g. lens opacities classification system III ‐ LOCS III) are the most widely used in clinics. Nevertheless, they provide information related to the back‐scattered light and not forward scattering, which is responsible for the degradation of vision. To do so, a procedure that assess retinal straylight using a device based on a psychophysical compensation‐comparison approach was proposed, in which the subject's task is a forced‐choice between two half fields to decide which one flickers more intensely. From these measurements, a psychometric function is fitted and used to determine the straylight compensation level log(s) on the basis of a few stimuli responses.As an alternative approach, some attempts have been made to use the double‐pass as a means of objectively estimating forward scattering. The double‐pass technique is a procedure that is able to capture the complete optical information of the eye, including the effect of higher‐order aberrations and intraocular scattering within a small visual angle. Artal et al. proposed the Objective Scatter Index (OSI) calculated from double‐pass images for estimating scattering with the intention to grade cataracts. This technique was also used successfully to account for scattered light in patients with keratitis and uveitis, and those undergoing refractive surgery. More recently, a new Frequency Scatter Index (FSI3) based on the analysis of double‐pass retinal images in the frequency domain has also been suggested, as a means of minimizing the impact of optical aberrations on the results obtained.Nevertheless, all of the former methods provide information on the total scattered light in the eye, which consists of the combined contributions originating from different ocular structures. In this regards, we recently proposed a technique for the objective and independent assessment of scattering caused by the cornea and the lens based on the analysis of the contrast of the third and fourth Purkinje images. The technique was preliminarily validated first by using artificial eyes with different levels of corneal and lens scattering; second, it was validated in eyes wearing customized contact lenses to simulate corneal scattering and eyes with nuclear cataracts. Finally, it was tested on a larger population of eyes with cataracts and corneal disorders to prove its clinical usefulness.In this work, we review all the above‐mentioned techniques that have been proposed for objective intraocular scattering assessment, putting especial emphasis on the last one based on Purkinje images, and compare their results and clinical performance.