Ocular Cataract Research Articles

Eye disorders spectrum: a tertiary hospital pediatric ophthalmology clinic based in Ethiopia

BackgroundEpidemiological studies to determine the pattern of eye disorders among children are important for proper health care planning and management. This study aimed to document the spectrum and frequency of eye diseases in children who attended the pediatric ophthalmology clinic of a tertiary teaching hospital in Addis Ababa, Ethiopia.MethodsA cross-sectional and convenient sample of 1237 male and female children (16 years and below) with ocular disorders presenting for the first time and those children with a settled diagnosis coming for a follow-up visit between June 1, 2018, and May 31, 2019, were included in the study. Data on presentation age, sex, and diagnosis were collected and analyzed. Eye disorders were classified into various categories. Children were grouped into four age groups. Ratios, percentages, and chi-square associations were calculated. P < 0.05 was considered statistically significant.ResultsOf the children, 60% were male. The mean age (standard deviation) of the children was 4.26 (± 4.1) years. Patients aged 0– < 6 years old were the largest group, constituting 70.5%. Ocular motility imbalances were the most common ocular disorders seen (32.8%), followed by childhood cataract (18.4%) and infection and inflammation of the eye and adnexa (8.3%). Ocular motility imbalances were observed more frequently and statistically significantly (p < 0.001) in children aged 1- < 6 years. Within the childhood cataract category, congenital cataracts were more prominent (7.1%). Within the infection and inflammation category, corneal/scleral infections were more common (3.7%).ConclusionsThe study highlights common eye disorders seen in children in a specialized hospital ophthalmic clinic. Ocular motility imbalance, childhood cataracts, infection and inflammation of the eye and adnexa were the most commonly occurring disorders. Early presentation was common, and males were more affected than females.

Neurological manifestations in Patau syndrome

Patau syndrome (Trisomy 13) is a chromosomal abnormality due to the presence of an extra chromosome 13. It is a polymalformative syndrome characterized by the association of several cerebral malformations such as holoprosencephaly, facial dysmorphy, ocular anomalies, postaxial polydactyly, visceral malformations and a very severe psychomotor delay. This work aims to highlight the neurological problems associated with Patau syndrome.&#x0D; We report the case of an 8-month-old female infant. She presents ocular cataract, posterior cleft palate and post axial polydactyly. Abdominal ultrasound and CT scan were normal. The orbital ultrasonography showed bilateral congenital cataract and bilateral temporal cristalo-postoral vitreous band. The electroencephalogram (EEG) showed a total disorganization of the background activity with a chaotic, anarchic aspect, replaced by diffuse, bilateral, synchronous discharges of hypsarrhythmic type and the Doppler echocardiography showed an AIC ostium secundum of 6 mm. The constitutional karyotype showed a free and homogeneous trisomy 13 (47,XX,+13). Patau syndrome is defined by a triad: microphthalmia/anophthalmia, cleft lip and palate, and postaxial polydactyly. Confirmation is obtained by cytogenetic testing. The malformations affect midline development including the nervous system such as corpus callosum anomalies, ventriculomegaly, neural tube defects, hydrocephalus, holoprosencephaly, cerebellar dysplasia, olfactory aplasia, and cortical dysplasia. The neurological presentation is severe: hypotonia, hyporeactivity and epilepsy. Nonspecific EEGs have been reported, including diffuse epileptic discharges, focal slowing, spike-wave/polypoint-wave complexes and a predominant theta rhythm. Patients with Patau syndrome may have brain malformations with an increased risk of seizures and variable treatment response. The genetic counseling is important to assist family members.&#x0D; Keywords: Trisomy 13, Patau syndrome, cerebral malformations, hypsarrhythmia, seizures.

Structural changes of Gap junction visualized in simulation utilizing a double membrane

Gap junctions are ubiquitous throughout the body, being present in all but one human tissue. They are essential for many body functions including, fetal development, cardiac muscle contraction, and functional neural networks. Numerous pathologies, such as wound healing, ocular cataracts, and heart disease have been linked to Gap junctions. However, there is still much that is unknown regarding Gap junction regulation and internalization. We are looking at the structural changes in Gap junction models using a Cx26/Cx43 hybrid structure caused by phosphorylation, ubiquitylation, and interaction of key residues with regulatory proteins MAPK, PKC, and Nedd4-E3-Ub-ligase.

Triploidy effects growth, life history strategies, and bone health in Arctic char (Salvelinus alpinus), but does not impact cataract incidence

Skeletal deformities and ocular cataracts have limited the farm performance of sterile triploid salmonids, but have not been assessed in Arctic char (Salvelinus alpinus). We repeatedly radiographed mixed-sex diploid and triploid char (n = 110/ploidy) of Hammerfest (Norway) origin reared on a natural photoperiod and temperature in freshwater over a 3-year period and assessed cataracts at termination. At the population level, triploids were significantly (p < 0.001) heavier at tagging, but lighter at harvest (mass (g) ± SE; tagging, 48 ± 2 vs 67 ± 3; harvest, 2015 ± 83 vs 1639 ± 71, in diploids and triploids, respectively). These growth differences were mainly related to sex and life history, as immature fish were generally smaller than those that matured, and triploids showed lower levels of sexual maturation throughout (mature (%); diploid males, 20 and 65; diploid females, 12 and 83; triploid males, 2 and 40; triploid females 0 and 0, after 2 and 3 years, respectively). In addition, males grew quicker than females, irrespective of ploidy. When comparing fish of the same sex and life history, there was no significant growth disadvantage of triploidy. However, survival was significantly lower in triploids (p < 0.001: 94 vs 86% from tagging to harvest in diploids and triploids, respectively) and they had a significantly higher incidence of fish with one or more deformed vertebra throughout (p < 0.001, 99 vs 71% in 3 year-old diploid and triploids, respectively). Cataract prevalence was high (>90% in both ploidy), but severity was low (on average, <10% of the lens shrouded) and not affected by ploidy (p > 0.1). Based on the average wet body mass of immature fish and losses due to sexual maturation and mortality, mono-sex stocks of male triploid fish gave the highest return per 100 juveniles stocked, followed by diploid males, diploid females, and triploid females (87.5, 83.0, 80.8, and 69.3 kg, respectively) at the earliest opportunity to harvest (i.e. when the fish first reached 0.7–1.0 kg). Therefore, all-male triploids may provide benefits to char aquaculture although their skeletal health should be addressed.

Traumatic Anterior Dislocation of Ocular Cataract Lens.

Case presentationA 33-year-old male presented to the emergency department following a motor vehicle collision with complaints of right eye pain after hitting his head on the steering wheel. Point-of-care ultrasound (POCUS) revealed retinal detachment and an anterior lens dislocation.DiscussionLens dislocations following blunt head trauma can often be diagnosed using POCUS. Anterior ocular lens dislocation is a rare but vision-threatening result of head trauma. This case highlights how POCUS can facilitate early detection of ocular pathology, such as lens dislocation, and improves patient outcomes.

Triploidy leads to a mismatch of smoltification biomarkers in the gill and differences in the optimal salinity for post-smolt growth in Atlantic salmon

Sterile triploid Atlantic salmon (Salmo salar) show inconsistent seawater grow-out, but the reason why remains unclear. The purpose of this study was to determine the salinity optima of triploid post-smolts. Diploids and triploids were assessed for smoltification status during an underyearling smolt regime before being transferred to one of four different salinities, 0, 11, 23 and 35 ppt at 12 °C and under 24 h continuous light for 83 days. During this period, fish growth, plasma biochemistry, and production traits (vertebral deformities, ocular cataracts, sexual maturation) were monitored. Molecular biomarkers in the gill (nkaα1a, nkaα1b, nkcc1a) suggested triploids reached peak smolt earlier than diploids and began the desmoltification process before the start of the salinity treatments, however this was not reflected in gill Na+/K+-ATPase enzyme activity. At the initiation of the salinity treatments triploids were significantly larger than diploids (mean weight g ± SE: 71 ± 0.7 and 87.2 ± 0.8 for diploids and triploids, respectively) and there was a ploidy effect on post-smolt growth, with body weight showing a clearer positive trend with salinity in diploids (0 < 11 = 23 = 35 ppt) than in triploids (0 < 11 < 35 = 23 ppt) (final mean weight g ± SE: 255.2 ± 7.4, 303.9 ± 9, 313.9 ± 9 and 342.4 ± 12 for diploids and 322.9 ± 9.7, 361.7 ± 10.7, 425.9 ± 12.1, 415.2 ± 12.2 for triploids at 0, 11, 23, and 35 ppt, respectively). Plasma Na+ and Cl− increased, but plasma pH decreased, with increasing salinity in both ploidy. However, ploidy only had transient effects on plasma biochemistry depending on the salinity treatment. There was no ploidy effect on vertebral deformities (21% of both ploidy had one or more deformed vertebra). In contrast, triploids had a significantly higher prevalence of ocular cataracts (84 vs 98% in diploids and triploids, respectively) with a higher mean cataract score (mean ± SE: 1.93 ± 0.1 and 2.78 ± 0.1 for diploids and triploids, respectively), but a significantly lower prevalence of pubertal male post-smolts (15 vs 2% in diploids and triploids, respectively). Salinity treatment had no effect on vertebral deformities, cataracts, or post-smolt sexual maturation. In summary, there was a ploidy mismatch for smoltification biomarkers in the gill and salinity had a strong effect on post-smolt growth, but the effects were ploidy dependent.

English

BACKGROUND Traumatic cataract is one of the common sequelae following ocular injury. It is one of the leading causes of preventable blindness. Ocular trauma leading to traumatic cataract, if managed early gives good visual outcome. Associated ocular structure involvement has much bearing on the management and prognosis of traumatic cataract. We wanted to study the visual outcome of cataract surgery in traumatic cataract. METHODS All patients included in this prospective study were subjected complete ocular examination, intra ocular lens (IOL) power calculation and small incision cataract surgery (SICS) with IOL implantation. Visual outcome was assessed after 1st week, 2 nd week, 6th week and 6 months. Postoperative visual outcome and post-operative complications were assessed. RESULTS Out of 50 cases studied, 56 % of cases were in the age group of less than 20 years. Male: Female ratio was 2.57 : 1. Traumatic cataract was higher in patients of rural background as compared to urban background (64 % vs 32 %). In 58 % of cases, penetrating injury was the type of trauma. 60 % of patients had visual acuity of less than 3/60 at presentation. Corneal injuries (34 %), scleral tear in (22 %) and iris related problems (18 %) were the most common associated findings. All the patients were treated with SICS with IOL implantation. Most common intra-operative complication was posterior capsule rupture seen in 14 % of cases, 34 % of patients had anterior uveitis as early post-operative complication and 24 % of patients developed PCO as late post-operative complication; 68 % of the patients achieved visual acuity of above 6/18. CONCLUSIONS Timely management and involvement of other structures in traumatic cataract determines the visual prognosis of cataract surgery in traumatic cataract. Thus, our study showed that traumatic cataract can be successfully managed surgically with intraocular lens implantation with good visual outcome, unless there is associated corneal opacity or posterior segment involvement. More emphasis should be laid on the preventive measures like mass health education and awareness about risk of ocular trauma, and need to adopt safety measures should be focused, especially during playground, and at workplace. KEYWORDS Traumatic Cataract, Small Incision Cataract Surgery, IOL, Visual Acuity

Cognitive Consequences of Cataract Surgery: A Cross-sectional Study

Background and Objective: The age-related cataract is a leading cause of vision loss, and cataract surgery is the most common intraocular surgery. Patients with cataracts may develop mild cognitive impairment due to blurred vision and vision problems. In this regard, the improvement of vision after cataract surgery may affect their cognitive function. Materials and Methods: This cross-sectional descriptive study was conducted on 32 patients aged 40-60 years who were referred to the ophthalmology clinic of Farshchian Hospital in Hamadan with a diagnosis of bilateral cataracts within 2019-2020. Cognitive function was assessed in patients with Mini-Mental-State-Examination (MMSE) test and clock-drawing test before and after ocular cataract surgery. Patient data were analyzed in SPSS software (version 16) using paired t-test at a 95% confidence level. Results: The mean age of patients was 53.91±4.51 years, and the majority of them (62.5%)were male. Before and after cataract surgery, the mean scores of the MMSE test were 25.09±3.25 and 26.19±2.69, and the mean scores of the clock-drawing test were reported as 3.34±1.49 and 3.72±1.32 (P=0.001). Based on the MMSE and clock-drawing test, 54.4% and 65.6% of patients, respectively, had improved cognitive function, as compared to before the surgery. Conclusions: Cognitive function in patients with cataracts was significantly improved by cataract surgery.

A transcriptomic analysis of diploid and triploid Atlantic salmon lenses with and without cataracts

To avoid negative environmental impacts of escapees and potential inter-breeding with wild populations, the Atlantic salmon farming industry has and continues to extensively test triploid fish that are sterile. However, they often show differences in performance, physiology, behavior and morphology compared to diploid fish, with increased prevalence of vertebral deformities and ocular cataracts as two of the most severe disorders. Here, we investigated the mechanisms behind the higher prevalence of cataracts in triploid salmon, by comparing the transcriptional patterns in lenses of diploid and triploid Atlantic salmon, with and without cataracts. We assembled and characterized the Atlantic salmon lens transcriptome and used RNA-seq to search for the molecular basis for cataract development in triploid fish. Transcriptional screening showed only modest differences in lens mRNA levels in diploid and triploid fish, with few uniquely expressed genes. In total, there were 165 differentially expressed genes (DEGs) between the cataractous diploid and triploid lens. Of these, most were expressed at lower levels in triploid fish. Differential expression was observed for genes encoding proteins with known function in the retina (phototransduction) and proteins associated with repair and compensation mechanisms. The results suggest a higher susceptibility to oxidative stress in triploid lenses, and that mechanisms connected to the ability to handle damaged proteins are differentially affected in cataractous lenses from diploid and triploid salmon.

Association between tamoxifen and cataract risk in breast cancer patients: Analysis of a national health insurance database.

e24072 Background: Tamoxifen is often used for hormone-positive breast cancer. Recent trials suggested that ten years of tamoxifen use improves recurrence rate and death. Ocular side effects and cataracts were reported in previous trials. We revealed the risk of cataracts from real-world data of the Taiwan national health insurance research database. Methods: We retrieved data from the Taiwan National health insurance research database. Female breast cancer patients from 2000-2005 were enrolled in this study. Patients receiving cataract surgery were enrolled and matched with non-cataract surgery patients for comparison in the analysis. Age, cumulative days, chemotherapy, and the time interval between breast cancer and index date were included and as controlled variables. Results: Among 23,957 female breast cancer patients, a total of 1,578 patients receiving cataract surgery were enrolled and matched with patients without cataract surgery until the end of 2013. Age in patients undergoing cataract surgery group was significantly higher than the non-surgery group (59.9 and 58.3, respectively, P &lt; 0.001). Multiple regression analyses showed an adjusted odds ratio of 1.02 (95% CI:1.01-1.03, P&lt; 0.001). However, more prolonged exposure of tamoxifen (≧3 years) also had a higher risk of cataract development requiring surgery (adjusted odds ratio=1.32, 95% CI: 1.03–1.70, P = 0.030). Conclusions: Besides age, there is a significantly higher risk of cataract development requiring surgery among female breast cancer patients with long term tamoxifen use. Information from this study may provide further clinical surveillance efforts in cancer survivors. [Table: see text]

Analysis of current status of in eye community based nurse-led clinics

Objective To explore the advantages and disadvantages of a new management model of eye community based nurse-led clinics. Methods From March 2016 to March 2018, a community clinic of a tertiary eye hospital, Qingdao Eye Hospital was analyzed. The situation of staff and equipment allocation and adjustment in the Clinic during the two years was also reviewed. Results A total of 17042 patients were admitted to the community clinic of a tertiary eye hospital in the past two years, among whom 44.9% were over 65 years old. Ocular surface diseases (34.4%, 5862), cataracts (31.6%, 5382), and refractive errors (17.2%, 2928) were the top three causes of patient visits. The waiting time for NLC patients was 1~114 (8.5±8.5) min, and the waiting time for outpatients in the main hospital area was 32.0~61.0 (42.4±7.1) min. The difference was statistically significant (Z=-135.172, P<0.01). The per capita cost of NLC patients was ¥ 4.0~153.2 (64.9±22.0), and the per capita cost of outpatients in the main hospital area was ¥ 110.0~586.9 (291.0±160.0), the difference was statistically significant (Z=-136.531, P<0.01). NLC scored higher than the main hospital area in consultation, timeliness and convenience of the disease(Z=-7.278, -7.462, -12.677, P<0.01), and was lower than the main hospital in the disease-solving project (Z=-3.188, P<0.01). Conclusion The NLC model is a new management model that can meet the needs of community clinics and also is a new challenge for nursing staff under the health care reform. Key words: Nurses; Community health services; Clinics

Economic Burden of Non-Infectious Inflammatory Eye Disease (NIIED) in a Commercially-Insured Population in the United States

ABSTRACT Purpose: To assess the economic burden of non-infectious inflammatory eyedisease (NIIED) in a commercially-insured population in the United States Methods: Adult patients with a NIIED diagnosis between 2006 and 2015 were selected from a de-identified, privately insured claims database and were matched 1:1 to a non-NIIED control. Ophthalmologic complications, direct healthcare resource use and costs, and indirect work loss (from the payer perspective) were calculated for a 12-month period and compared across the 2 cohorts. Results: Among the 14 876 matched pairs, NIIED patients were significantly more likely than controls to experience ocular complications, including glaucoma and cataracts (p < 0.001). NIIED patients had significantly higher healthcare resource utilization and costs compared with matched controls (relative difference 40%, p < 0.001). NIIED patients missed 12.2 days of work ($2925 annual work-loss costs), 46% more than non-NIIED patients (p < 0.001). Conclusion: NIIED imposes a significant clinical and economic burden, suggesting an unmet need for expanded access to alternative treatment options.

Ciliary body melanoma manifesting as unilateral ocular hypertension and early cataract

Ciliary body melanoma manifesting as unilateral ocular hypertension and early cataract

Axial length elongation in adults with long-standing unilateral traumatic cataract

Background: Unilateral eye elongation with resultant axial myopia has been reported to occur secondary to visual deprivation from birth or early childhood. Acquired axial length elongation secondary to visual deprivation in adults has rarely been reported.Aim: To report acquired axial myopia in adults with visual deprivation due to long-standing unilateral traumatic cataract.Methods: Eleven consecutive adult patients who presented for cataract surgery with unilateral, long-standing, mature, traumatic cataracts and an interocular axial length difference of more than 1 mm were studied. Patients with a post-operative best corrected visual acuity (BCVA) of &lt; 6/12 were excluded to rule out possible pre-existing anisometropic amblyopia.Results: Of the 11 patients with significant interocular axial length difference, 5 patients were excluded on the basis of possible pre-existing amblyopia. The remaining 6 patients had final BCVA of 6/12 or better. The median length of the cataractous eyes was 2.83 mm longer than the fellow eyes (range 1.12 mm – 3.52 mm). The intraocular lens power required for emmetropia was 6.8 dioptres (range 3.5 dioptres – 11.5 dioptres) less in the cataractous eyes. A refractive outcome within 1 dioptre of the target refraction was achieved in all patients. The median delay between ocular trauma and cataract surgery was 20 years (range 8–24 years).Conclusion: Significant unilateral axial length elongation may occur in adults with longstanding traumatic cataracts and visual deprivation. A potential correlation may exist between delay to surgery and degree of axial length difference. This rare phenomenon must be considered when determining intraocular lens power to avoid post-operative refractive surprises.

SIRT1 Protects Human Lens Epithelial Cells Against Oxidative Stress by Inhibiting p53-Dependent Apoptosis

ABSTRACTPurpose: This study aims to test the hypothesis that sirtuin type 1 (SIRT1) plays a role in modulating resistance against oxidative stress in lens epithelial cells (LECs), and to determine its mechanism if this hypothesis is found to be true.Methods: Cultured LECs were treated with resveratrol (RES, an activator of SIRT1) or nicotinamide (NAM, a SIRT1 inhibitor) and incubated with H2O2. Changes in SIRT1, p53, and acetyl-p53 expressions were measured. Cell proliferation was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay. TUNEL assay was used to evaluate apoptosis. Pifithrin-α (PFT-α) was applied to block the p53 pathway.Results: SIRT1 expressions significantly increased with H2O2 treatment and further increased with RES treatment in a dose-dependent manner. RES eliminated cellular morphological changes related to H2O2 treatment, increased cell proliferation, and inhibited apoptosis under oxidative stress. In contrast, NAM enhanced cell apoptosis under oxidative stress and decreased cell proliferation. RES caused a dose-dependent decrease in acetyl-p53 levels under oxidative stress, while NAM increased p53 acetylation. Under oxidative conditions, PFT-α, a p53 pathway inhibitor, eliminated the destructive effect of NAM. PFT-α decreased the morphological changes in LECs compared to NAM treatment and increased cell proliferation and inhibited apoptosis.Conclusions: SIRT1 protected LECs from oxidative stress via the inhibition of the p53 pathway. SIRT1 or SIRT1 activators could potentially be used to prevent ocular aging and cataract in the future.

The analysis of the etiological factors and the treatment methods of exogenous endophthalmitis

Objective To investigate the etiological factors and treatment methods of exogenous endophthalmitis. Methods Data of all cases of infectious endophthalmitis treated between August 2006 and December 2013 were reviewed retrospectively and compared with our earlier published report.One hundred and sixteen eyes of 116 cases aged from 18 to 90 years with mean (48.16±15.56) years were enrolled, including 77 male and 39 female patients.95.69% cases accepted vitrectomy and intravitreal antibiotics injection. The follow-up period was from 1 to 12 months. Results Endophthalmitis was in 83 eyes(71.55%) caused by penetrating injury, in 24 eyes (20.69%) caused by cataract surgery, in 5 eyes (4.31%) caused by anti-glaucoma surgery, in 2 eyes (1.72%) caused by vitrectomy and in 2 eyes(1.72%)caused by corneal ulcer perforation. Compared with our earlier report. the percentage of Gram-positive cocci isolates increased which occurred in 48 eyes accounting for 87.27%, while the percentage of the Gram-positive bacilli isolates was 5.45% which occurred in 3eyes and the percentage of Gram-negative bacilli isolates was 7.27% which occurred in 4eyes, both of which decreased. After vitrectomy and intravitreal antibiotics injection, postoperative visual acuity were ≥0.02 in 91 eyes(78.45%)and ≥0.3 in 38 eyes(32.76%). Conclusion Penetrating ocular injury and cataract surgery are the most common causes of infective endophthalmitis. Staphylococcus epidermidis was the predominant pathogen. Combined vitrectomy and intravitreal antibiotics injection was an effective treatment for endophthalmitis. Key words: Etiologic factors; Endophthalmitis, exogenous; Ocular trauma, penetrating; Surgery, cataract extraction; Vitrectomy

Meliponini biodiversity and medicinal uses of pot-honey from El Oro province in Ecuador

Ecuadorian stingless bees (Apidae, Meliponini) have ethnomedicinal interest because their products are used in healing. Diverse remedies consist on pot-honey alone or mixed with infusions. This set of medicinal uses were informed in El Oro province by Ecuadorian stingless bee keepers –known as meliponicultors− in Latin America: bruises, tumors, ocular cataracts, pterygium, inflammation, infections, varicose veins, cleaning blood after childbirth, kidney diseases, tumor, wound healing, and soothing balm before sleeping. Scaptotrigona ederi named “catiana” or “catana” is the most frequent bee in the visited cantons Las Lajas, Balsas, Pinas, and Zaruma. Other important stingless bees are Melipona indecisa “cananambo”, Melipona mimetica “bermejo”, Nannotrigona cf. perilampoides “piton”, and Paratrigona aff. eutaeniata “pirunga”. A bioprospective research will follow to value this ancient tradition and the honey processed in cerumen pots, with sound inclusion in the Ecuadorian honey regulation NTE INEN 1572, currently under revision.

The Role of Ultraviolet Radiation in the Ocular System of Mammals

With decreasing levels of ozone in the atmosphere, we are being exposed to higher levels of ultraviolet radiation (UVR) than ever before. UVR carries higher energy than visible light, and its effects on tissues include DNA damage, gene mutations, immunosuppression, oxidative stress and inflammatory responses. In the eye, UVR is strongly associated with the development of basal and squamous cell carcinoma of the eyelid, pterygium, photokeratitis, climatic droplet keratopathy, ocular surface squamous neoplasia, cataracts, and uveal melanoma, and is weakly associated with age-related macular degeneration. Despite overwhelming evidence regarding the deleterious effects on UVR, public health measures to encourage UV protection of the eyes is generally lacking. Options for photoprotection include sunglasses, wide brim hats, windshields, plastic films for side windows in cars, UV blocking contact lenses, and following the UV Index report daily. The American National Standards Institute currently has regulations regarding properties of UV blocking sunglasses; however, compliance in the US is not mandatory. On the other hand, UVR does have therapeutic applications in the eye, particularly, riboflavin activated by ultraviolet A light (UVA) radiation is used clinically to slow the progression of keratoconus, post-LASIK keratectasia, and bullous keratopathy by crosslinking corneal collagen fibers. Additionally, riboflavin activated by UVA has been shown to have antibacterial, antiviral, and antiparasitic effects. This is clinically relevant in the treatment of infectious keratitis. Finally, exposure to low levels of light in the UV spectrum has been found to regulate the growth of the eye and lack of adequate exposure may increase the risk of development and progression of myopia.

Difluprednate in ophthalmic practice

The present note deals with the use of drug difluprednate in ophthalmic practice. In last few years, prednisolone acetate and betamethasone are strong steroids in use. Currently, the most widely prescribed strong topical corticosteroids in the US is prednisolone acetate 1%. While it controls inflammation effectively, it has not been shown to consistently address postoperative pain and discomfort in a large clinical trial.3 Chances of side effects like ocular hypertension and cataract formation are higher with these steroids. In june 2008 difluprednate ophthalmic emulsion 0.05% was approved by the US Food and Drug Administration (FDA) for the treatment of inflammation and pain associated with ocular surgery. This was the first ophthalmic steroid approved by the FDA since 1973 as it is high in potency and has good safety profile as well as the ability to reduce postoperative pain.

High prevalence of undiagnosed diabetes and high risk for diabetes using HbA1c criteria in middle-aged patients undergoing cataract surgery

AimThis study assessed the prevalence of undiagnosed diabetes and a high risk for diabetes using glycated haemoglobin (HbA1c) values in middle-aged patients undergoing cataract surgery. MethodsThe study comprised 137 consecutive patients, aged 40 to 65 years, with no known diabetes undergoing cataract surgery at a French national eye centre. Fasting glucose, obesity parameters, and vascular and ocular cataract risk factors were recorded. HbA1c was measured on the day of cataract surgery. Prevalence of undiagnosed diabetes (HbA1c≥6.5%) and a high risk of diabetes (≥6.0% but<6.5%) in the study population was compared with recently published estimates from general French, Dutch and US populations. ResultsIn the study population, undiagnosed diabetes was found in 12 patients (9%; 95% CI: 4–14%) and a high risk for diabetes in 47 (34%; 95% CI: 26–42%). These prevalences were four to 11 times higher than the corresponding population-based estimates, whereas obesity parameters recorded in the general populations and in our study population were similar according to HbA1c subcategories. Of the 125 patients with HbA1c less than 6.5%, values were higher in patients without ocular cataract risk factors (n=73; 58%) than in those with cataract risk factors (n=52; 42%) at 5.92±0.30% and 5.57±0.29%, respectively (P<0.001), thereby suggesting a significant role for blood glucose levels in cataractogenesis. ConclusionMiddle-aged patients undergoing cataract surgery showed a high prevalence of diabetes and a high risk for diabetes not recognized before surgery, suggesting that this patient population should be targeted for diabetes screening and prevention.