Posterior Subcapsular Cataract Research Articles

Gonioscopy-assisted transluminal trabeculotomy as a primary surgical option for glaucoma in Fuchs uveitis syndrome: A case series.

Fuchs uveitis syndrome (FUS) is a chronic intraocular inflammatory disease. It can lead to glaucoma which can be intractable to both medical and surgical treatment. In the present report, we describe our experience with GATT as a primary surgical option in the treatment of glaucoma secondary to FUS. Four consecutive patients with FUS-associated glaucoma underwent GATT in a single institution. Case 1 was a 28-year-old pseudophakic male with a preoperative intraocular pressure (IOP) of 43 mmHg had unsuccessful circumferential cannulation; his IOP remained high after GATT and received trabeculectomy followed by Ahmed glaucoma valve (AGV) implantation to control IOP. Although IOP was stable following AGV, he required descemet membrane endothelial keratoplasty due to persistent corneal decompansation. He had a stable IOP of 12 mmHg over 21 months. Case 2 was a 42-year-old male with preoperative IOP of 35 mmHg and posterior subcapsular cataract had 360-degree GATT combined with phacoemulsification; his IOP reduced to 14 mmHg over 18 months. Case 3 was an 52-year-old pseudophakic male with a preoperative IOP of 28 mmHg had 360-degree GATT; his IOP remained stable at 10 mmHg over 18 months. Case 4 was an 47-year-old pseudophakic female with a preoperative IOP of 39 mmHg had 360-degree GATT; her IOP remained stable at 14 mmHg over 12 months. GATT may be used as an initial approach in secondary glaucoma due to FUS. But, further evidence is still warranted to better ascertain the usefulness of GATT in this specific patient population.

Correlation of Dysfunctional Lens Index with Lens Opacification System III in Age Related Cataract

Purpose:  Age-Related changes in crystalline lens opacity and lens density contribute to formation of higher order aberrations resulting in reduced quality of vision. Precise quantification of cataract is important for predicting phacodynamics and educating patient. The iTrace(a ray-tracing aberrometer) provides Dysfunctional Lens Index (DLI). This study from Pakistan investigates the relationship between LOCS III and DLI in senile cataract. Study Design:  Correlational study. Place and Duration of Study:  Hashmanis Hospital, Karachi from March 2021 to May 2021. Methods:  This study included 44 patients with age-related cataract. Demographic characteristics and complete ophthalmic examination of eyes including Best Corrected Visual Acuity (BCVA) and slit lamp biomicroscopy were performed. Age related cataracts were graded using the Standard technique of LOCS III. I-Trace was utilized for wave front analysis to calculate DLI. Results:  BCVA and LOCS III nuclear opalescence score had strongest positive linear correlation (r=0.433, P<0.01). DLI displayed a strong significant negative correlation to LOCS III Cortical Cataract (C) and LOCS III Posterior Sub-Capsular Cataract (P) score (r=-0.415 and r=-0.694; respectively). Conclusion:  BCVA had insignificant and small to no correlation to LOCS III C score and P score. Whereas, DLI showed the strongest significant correlation to LOCS III C score and P score. Patient's optical quality determined by visual symptoms are more closely associated to DLI parameter as compared to LOCS III classification. DLI can provide a better objective way to elevate age related cataract, monitor the progression and determine phacodynamics.

Long-term complications of permanent hypoparathyroidism in adults: prevalence and associated factors.

Patients with Chronic hypoparathyroidism (CHPT) receiving conventional treatment are exposed to several long-term complications including basal ganglia calcifications, posterior subcapsular cataract, kidney stones, and renal insufficiency. The aim of this study was to assess the prevalence and the associated factors of these complications in patients with CHPT. We conducted a cross-sectional study including 58 patients with CHPT. All participants underwent physical examination, biochemical assessment (total serum calcium, serum phosphorus, serum albumin, intact-PTH, serum magnesium, 25-hydroxy-vitamin D, serum creatinine, thyroid stimulating hormone (TSH), and 24-hour urinary calcium), slit lamp examination, brain computed tomography scan (CT-scan), and renal ultrasound. Participants had a mean age of 52.6 ± 16.4 years and a gender ratio (women/men) of 3.5. Fahr syndrome, cataract, urolithiasis, and renal failure were found in 55%, 62%, 12%, and 17% of cases, respectively. CHPT duration >15 years (Adjusted-OR = 43.1, 95-CI: 2.63-703.06, p = 0.008) and poor adherence to treatment (Adjusted-OR = 8.04, 95%-CI: 1.52-42.42, p = 0.014) were independently associated with the risk of Fahr syndrome. Age >55 years (adjusted-OR = 5.07, 95-CI: 1.10-23.42, p = 0.037), disease duration >15 years (adjusted-OR = 20.21, 95-CI: 1.54-265.84, p = 0.022), and magnesium level <0.8 mmol/l (adjusted-OR = 36.46, 95-CI: 3.75-354.08, p = 0.002) were independently associated with the risk of subcapsular cataract. Only hypercalciuria (Adjusted-OR = 21.27, 95-CI: 2.31-195.91, p = 0.007) was an independent risk factor for kidney stones. Renal failure was not associated with kidney stones (p = 1). However, creatinine clearance was negatively correlated with age (r = -0.784; p < 10-3) and disease duration (r = -0.352; p = 0.007). Our results revealed high prevalences of neurological, ocular, and renal complications in patients with CHPT and emphasized the importance of regular biological monitoring, therapeutic adjustments, screening, and adherence to treatment in the prevention of these complications.

ORAL CORTICOSTEROIDS AND THE LONG-TERM RISK OF CATARACT: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: A cataract can lead to visual deterioration, resulting in reduced vision capacity and partial or complete reversible vision loss. The most commonly associated risk factors for cataract include aging, diabetic retinopathy, glaucoma, and some medications such as glucocorticoids. Glucocorticoids are utilized in a variety of disorders, as long- and short-term, treatment such as topical ocular steroid usage, allergic rhinitis and inflammatory bowel disease as a result, the chance of cataract may increase and put a significant burden in countries. The aim: This study aims to show about oral corticosteroids and the long-term risk of cataract. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 79 articles, whereas the results of our search on SagePub brought up 208 articles, on Google Scholar brought up 26.000 articles. The results of the search conducted for the last year of 2014 yielded a total 25 articles for PubMed, 73 articles for SagePub, and 18.000 articles for Google Scholar. The result based on title screening, a total 2 articles for PubMed, 36 articles for SagePub, and 397 for Google Scholar. In the end, we get a total of 10 papers. We included five research that suitable the criteria. Conclusion: Using glucocorticoids either as inhaler and/or orally will increase the risk and prevalence of posterior subcapsular cataract and other ocular complications such as glaucoma.

Ab Externo Scleral-Fixated Intraocular Lens As A Management in Aphakic Eye

Introduction : Varied technique of secondary intraocular lens (IOL) implantation are exist. Scleral-fixated IOL implantation become popular both with or without sutures. The one of sutures technique is ab externo&#x0D; Case Illustration : A 68 year old man came with blurry vision on left eye (LE) since one month ago. He had history of primary angle closure suspect and posterior subcapsular cataract on LE and managed with Intracapsular Cataract Extraction in January 2021. Ophthalmology examination of LE revealed uncorrected visual acuity (UCVA) 1/60, irregular updrawn pupil with diameter 7.4mm x 5.3 mm, and aphakic lens. The best corrected visual acuity (BCVA) with S+12.00 C-0.75 x 80 was 0.4f. The patient underwent secondary IOL by using 3 pieces IOL with ab externo scleral- fixated on his left eye (Figure 1). Power IOL determined was +24.00 diopter with target of refraction was emmetropia. One day postoperatively, the UCVA was 0.08 pinhole 0.125 with good centration of scleral fixation IOL. First month postoperatively, BCVA with S-1.75 C-1.00 x 50 was 0.4 on snellen chart.&#x0D; Discussion : Aphakia with inadequate capsular support can be seen in several conditions. Technique of introducing two suture loops for scleral fixation of an IOL by ab externo procedure, which proved safe and effective. Scleral fixation of IOL in the posterior chamber, although technically demanding, allows good visual outcomes.&#x0D; Conclusion : Ab externo scleral-fixated IOL implantation is an effective rescue procedure for eyes with deficient capsular support.

Fuchs’ uveitis syndrome in dark-colored eyes: a case report

Introduction : The prevalence of Fuchs’ uveitis syndrome (FUS), or Fuchs’ heterochromic iridocyclitis, tends to be higher in light colored-eyes population of developed countries, with iris heterochromia as one of the main features. That classic iris finding does not usually present in dark colored-eyes population like Indonesia, in such manner that FUS is often overlooked.&#x0D; Case Illustration : A 38-year-old male presented with decrease vision of right eye four months before admission. There was minimal anterior chamber reaction, dispersed non-pigmented stellate keratic precipitates (KP), moth-eaten iris, posterior subcapsular (PSC) cataract without posterior synechiae and grade 0.5 of vitreous cells. A diagnosis of FUS was made by presenting signs, then cataract surgery was safely performed, and vision significantly improved without exacerbation.&#x0D; Discussion : FUS is a typically mild unilateral uveitis, with iris heterochromia, cyclitis, and cataract without posterior synechiae as its classic findings. Otherwise, iris heterochromia is probably absent in dark- colored eyes, that iris may appear with nodules and or small diffuse atrophy called moth-eaten appearance. Misdiagnosis is mostly caused by holding that iris heterochromia should always be presented and inflammation should be limited in the anterior segment only. FUS responds poorly to steroid and mistreatment with it causes further complication. In addition, cataract surgery is considered safe in FUS.&#x0D; Conclusion : This case shows the importance of evaluating FUS’ atypical signs. Iris heterochromia is sometimes overvalued, and its absence often leads to misdiagnosis. Steroid treatment is controversial, moreover, cataract surgery is safe in this case.

Ocular complications in pediatric nephrotic syndrome treated with corticosteroids

Background Posterior subcapsular cataracts (PSC) and raised intraocular pressure (IOP) are the most common ocular complications of oral steroid administration, particularly following long-term use or treatment with high doses.&#x0D; Objective To evaluate the association between cumulative steroid dose and duration of treatment with the occurrence of PSC and raised IOP, as well as its associated factors in children with idiopatic nephrotic syndrome (INS).&#x0D; Methods This cross-sectional study included children aged 4–18 years with INS who received oral steroid therapy for at least six consecutive months. Patients underwent complete eye examinations by an ophthalmologist to evaluate their visual acuity as well as the occurrence of PSC and/or raised IOP. Results Of 92 subjects, 19.6% had PSC, 12% had raised IOP, and one had a best corrected visual acuity (BCVA) of &lt;6/20. The median cumulative steroid dose was 12,161 (range 1,795–81,398) mg and median treatment duration was 23 (range 6–84) months. There were significant positive associations between cumulative steroid dose as well as treatment duration and the occurrence of PSC, with cut-off points of 11,475 mg and 24 months, respectively, as determined by receiver operator characteristic (ROC) curves. Females were four times more likely to have PSC compared to males (PR 4; 95%CI 1.57 to 13.38; P=0.001). Cumulative steroid dose and duration of treatment were not associated with raised IOP.&#x0D; Conclusion Cumulative steroid dose of 11,475 mg or higher and/or duration of steroid therapy of 24 months of more were significantly associated with the occurrence of PSC, but not with raised IOP.

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.

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&lt;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&lt;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.

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.

An Observational Study on Morphological Types of Cataracts in Hypertensive Patients

Purpose: To evaluate common morphological types of cataracts in patients with hypertension (HTN) alone (hypertensive patients) planned for cataract surgery. Methods: It is a prospective cross-sectional study. It was conducted in the Department of Ophthalmology at a tertiary eye care centre from January 2022 to June 2022. Hypertensive patients, without any other systemic diseases, who presented with cataract in either of their eyes were included in the study. The classification of cataract was performed according to the Lens Opacities Classification System III. Results: Two hundred and eighty eyes of 140 patients were included in the study. The mean age of presentation was 64.9 ± 7.38 years(median 67 years; range 39.81 years). There were 63 (45%) males, and the rest were females. Of 140, 14 patients were below the age of 55 years, 2 patients were above 75 years, and the majority (42 patients) belonged to the age group between 67 and 70 years. Nuclear sclerosis (NS) cataract was the most common morphological type found in the eyes of hypertensive patients followed by posterior subcapsular cataract (PSC). PSC significantly correlated with HTN when compared to other types of cataracts excluding NS (P &lt; 0.0001). No significant relation was found between the grade of HTN and the grade of NS. Conclusion: Apart from the risk of formation of any type of cataract, NS and PSC were more commonly found in patients with HTN. Moreover, PSC was closely related to HTN when compared to other types of cataracts excluding NS.

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.

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.

Zespół Sticklera – opis przypadku i analiza literatury

PurposeTo present a case of patient with Stickler syndrome and retinal detachment with crystalline lens subluxation.Material and MethodsRetrospective case report.ResultsA 9-years-old patient approached Ophthalmology Department with retinal detachment in her right eye and proliferative vitreoretinopathy stage D2. Her medical history revealed previous cryotherapy of her right eye, high myopia (-14.5 D), bilateral glaucoma, bilateral posterior subcapsular cataracts and subluxated crystalline lens in her righteye. Further clinical examination of her right eye revealed best corrected visual acuity of light perception without localization, intraocular pressure 45 mmHg. Patient underwent pars plana vitrectomy with subluxated crystalline lens facoaspiration and silicone oil injection of her righteye. After 2 months pars plana vitrectomy was repeated with removal of silicon oil and further SF6 endotamponade. During control examination 6 months later right’s eye best corrected visual acuity was 5/16, intraocular pressure 23 mmHg. In USG of her right eye remains of silicon oil were noticed with retina attached.ConclusionsPars plana vitrectomy with silicon oil injection is effective method of treatment of retinal detachement in patients with Stickler syndrome. Those operations might be followed by many complications. Early diagnosis is essential in prevention of ocular complications in patient with Stickler syndrome.

Современные подходы к хирургии катаракт с высокой остротой зрения на основании анализа волнового фронта

Relevance. Until recently, visual acuity was the main criterion for determining the timing of surgery, but already in the early stages of cataract development, patients may suffer from reduced image quality, which affects the quality of life (“night” myopia, light scattering, blurring). Deterioration in visual function in these patients may be explained by refractive errors. Analysis of internal higher-order aberrations resulting from slight opacification of the lens is important for determining the effect of media opacity on wavefront aberrations (WF) and for determining the indications and timing of surgical treatment, especially in patients with high visual acuity. Purpose. Evaluate the optical system of the eye with initial cataracts and high visual acuity. Evaluate the wavefront and its aberrations, contrast sensitivity and Shtrel coefficient. Material and methods. The study included 111 eyes with cataracts and 42 eyes without signs of cataracts (control group). Patients aged on average 57±5.3 years. Wavefront analysis was performed using an iTrace ray tracing aberrometer (Tracey Tech., USA) in a dark room under maximum drug-induced mydriasis. In each group, total, corneal, and internal wavefront aberrations were measured at a pupil diameter of 6.0 mm. Higher order aberrations were analyzed using Zernike polynomials (3rd to 5th order). The modulation transfer function (MTF) at different spatial frequencies (0–30 c/deg) and the Strehl coefficient in patients in the study groups were also assessed. Results. Total and internal higher-order wavefront aberrations were significant in different cataract groups compared with control patients, while higher-order corneal aberrations were not statistically different. We noted a higher level of total and internal aberrations in the group of patients with posterior subcapsular cataract. In this regard, patients with posterior subcapsular cataract require surgical treatment at an earlier stage, despite high visual acuity. Conclusion. We recommend assessing the optical quality of vision and wavefront aberrations when observing early cataracts in order to decide whether to perform surgery at an earlier date. Key words: initial cataract, quality of vision, higher order aberrations, internal wavefront aberrations

A deep network DeepOpacityNet for detection of cataracts from color fundus photographs

BackgroundCataract diagnosis typically requires in-person evaluation by an ophthalmologist. However, color fundus photography (CFP) is widely performed outside ophthalmology clinics, which could be exploited to increase the accessibility of cataract screening by automated detection.MethodsDeepOpacityNet was developed to detect cataracts from CFP and highlight the most relevant CFP features associated with cataracts. We used 17,514 CFPs from 2573 AREDS2 participants curated from the Age-Related Eye Diseases Study 2 (AREDS2) dataset, of which 8681 CFPs were labeled with cataracts. The ground truth labels were transferred from slit-lamp examination of nuclear cataracts and reading center grading of anterior segment photographs for cortical and posterior subcapsular cataracts. DeepOpacityNet was internally validated on an independent test set (20%), compared to three ophthalmologists on a subset of the test set (100 CFPs), externally validated on three datasets obtained from the Singapore Epidemiology of Eye Diseases study (SEED), and visualized to highlight important features.ResultsInternally, DeepOpacityNet achieved a superior accuracy of 0.66 (95% confidence interval (CI): 0.64–0.68) and an area under the curve (AUC) of 0.72 (95% CI: 0.70–0.74), compared to that of other state-of-the-art methods. DeepOpacityNet achieved an accuracy of 0.75, compared to an accuracy of 0.67 for the ophthalmologist with the highest performance. Externally, DeepOpacityNet achieved AUC scores of 0.86, 0.88, and 0.89 on SEED datasets, demonstrating the generalizability of our proposed method. Visualizations show that the visibility of blood vessels could be characteristic of cataract absence while blurred regions could be characteristic of cataract presence.ConclusionsDeepOpacityNet could detect cataracts from CFPs in AREDS2 with performance superior to that of ophthalmologists and generate interpretable results. The code and models are available at https://github.com/ncbi/DeepOpacityNet (https://doi.org/10.5281/zenodo.10127002).

Characterisation of cataracts and other ophthalmic findings in various species of captive penguins.

The identification of ophthalmic diseases that affect vision and/or cause discomfort should be a priority in captive penguins to improve their overall health and quality of life. A routine ophthalmological examination was performed on 80 clinically normal penguins (160 eyes), and any lesions observed were recorded. Ocular lesions were frequent (56% of penguins), with cataracts being the most common (48.8% of penguins). Cortical cataracts (63% of eyes) and posterior subcapsular cataracts (27.4%) were the most commonly occurring. All maturation stages were found; incipient cataracts (52.1% of eyes with cataracts) were predominant, while Morgagnian cataracts (8.2%) were the least frequent. A correlation existed between lenticular changes and increasing age. Uveitis was present in 43.8% of eyes with cataracts, and ectropion uveae was the predominant clinical sign. Other ocular findings included blepharitis (3.8% of all eyes), corneal leukoma (5.6%) and posterior lens subluxation (7.5%). The small number of birds of some species prevented the comparison of ophthalmic findings between species. This study corroborates the high prevalence of ocular lesions in captive penguins. Cataracts were frequent and age related. Most cataracts were cortical, and the predominant maturation stage was incipient. Lens-induced uveitis was a common finding. Lowered intraocular pressure was related to cataract formation.

Clinical Profile of Anterior Uveitis in Tertiary Eye Care Center

Purpose: To describe the clinical features, causes and management of patients with acute anterior uveitis. Methods: A prospective study of clinical features, complication and prognosis was done on anterior uveitis patients for a period of 10 months. Detailed history, complete ocular examination, systemic evaluation and relevant investigations were done in 64 patients, appropriate systemic and ocular management was done. Results: Of 64 patients, 65.6% were male and 34.3% female. Mean age of presentation was 42.6 years. 71.8% unilateral and 28.1% bilateral eye involvement was seen. Visual acuity was between 6/18-3/60 at the time of presentation. 21.8% had Tuberculosis, 9.3% had Trauma, 4.6% had UTI, 3.1% had ankylosing spondylitis (HLA B27 associated) and 3.1% had rheumatoid arthritis, 3.1% had sarcoidosis and 1.5% had toxoplasmosis. 53.1% were idiopathic. Complications were noted in 50% of cases, 25% had secondary glaucoma, 21.8% had posterior subcapsular cataract and 3.1% has cystoid macular edema. Appropriate medical management was started in patients. Conclusion: Idiopathic uveitis was higher in our study. Trauma was the most common non-infectious entity, Tuberculosis was most common infectious cause in our study, all patients responded well with medication. Keywords: Anterior uveitis, Etiology, Complications

Evaluation of Fundus Function in Mature Cataract Patients by Visual Electrophysiology

Purpose. To explore the value of visual electrophysiology in evaluating the fundus function of mature cataract patients. Methods. 124 mature cataract patients (153 eyes) were examined before cataract surgery; the examinations included best corrected visual acuity (BCVA), pattern visual evoked potential (PVEP), full-field electroretinogram (ffERG), and multifocal electroretinogram (mfERG). According to the postoperative fundus conditions, the subjects were divided into two groups: the no fundus disease group and the fundus disease group. Approximately one month after the operation, BCVA was measured, and visual electrophysiology was performed on subjects who had a stable fundus condition and had not received treatment for fundus disease. Results. One month after cataract surgery, BCVA ≤ 0.3 logMAR was found in 60 eyes (96.8%) without fundus disease and 59 eyes (64.8%) with fundus disease. Compared with the group without fundus disease, the preoperative electrophysiological examination of the group with fundus disease showed that the amplitude of ffERG waves and the amplitude density of the P1 wave in the 2nd to 5th rings of mfERG were decreased (all P  &lt; 0.05). ffERG and mfERG can be used for differential diagnosis of fundus disease (all P  &lt; 0.05), while PVEP has no significant diagnostic value for fundus disease (all P  &gt; 0.05). In the group without fundus disease, the amplitude of the PVEP 15′ P100 wave and the amplitude of dark-adapted (DA) 0.01 b-wave, DA 3.0 a-wave, and DA 10.0 a-wave were negatively correlated with postoperative logMAR BCVA (all P  &lt; 0.05). In the group with fundus disease, the amplitude of PVEP and ffERG and the amplitude density of mfERG were negatively correlated with postoperative logMAR BCVA (all P  &lt; 0.05). In the eyes of cortical cataracts, some parameters of PVEP, ffERG, and mfERG were significantly different before and after surgery. In the eyes of nuclear cataracts, some parameters of ffERG and mfERG were significantly different before and after surgery. In the eyes of posterior subcapsular cataracts, some parameters of PVEP and ffERG were significantly different before and after surgery. Conclusions. ffERG and mfERG can be used to detect fundus disease in mature cataract patients. The preoperative visual electrophysiological examination has high clinical value in predicting postoperative vision of mature cataract patients with fundus disease. Different types of cataracts have different effects on electrophysiological examination results. When interpreting the electrophysiological report, it is necessary to consider the existence of cataracts. This trial is registered with 2019-K068.