Presenile Cataract Research Articles

A rare association of congenital fibrosis of extraocular muscles with keratoconus and bilateral sensorineural hearing loss: A co-incidence or some syndrome?

Congenital fibrosis of extraocular muscles (CFEOM) is an inherited restrictive ocular motility disorder characterized by unilateral or bilateral horizontal and/or vertical gaze impairment with ptosis. Keratoconus is a bilateral asymmetrical corneal ecstatic disease with multifactorial etiology, including complex interaction of both genetic and environmental factors. We report a case of a 29-year-old female who presented with chief complaints of bilateral diminution of vision and drooping of eyelids since early childhood with a history of seizures for 1 year. Visual acuity at presentation was hand movement close to face with accurate projection of rays in both the eyes. Contrast-enhanced magnetic resonance imaging of the brain and orbit revealed partially empty sella, neurocysticercosis, and bilateral atrophy of extraocular muscles. On detailed examination, she was found to have CFEOM type 1A (CFEOM1A, autosomal dominant inheritance) with bilateral advanced keratoconus, bilateral sensorineural hearing loss, bilateral presenile cataract, and neurocysticercosis. The association of CFEOM1A, keratoconus, and sensorineural hearing loss is not reported in the literature to date. Whether this association is co-incidental or part of some new syndrome needs to be evaluated further.

Risk factors and visual outcome in presenile cataract

Objective: To study the risk factors and visual outcome in patients of presenile cataract. Materials and Methods: A cross sectional observational study was conducted between January 2016 and January 2017 at a tertiary health care centre. Patients with cataract between age 35 and 55 years were selected. Risk factors like diabetes mellitus, high myopia, dermatological diseases and tobacco consumption were noted. Visual acuity was recorded and a detailed examination of anterior and posterior segments was done. Patients underwent cataract surgery with intraocular lens implantation. Postoperative best-corrected visual acuity was noted. Result: Out of 120 patients there were 47 males (mean age 45.43 ± 6.79 years) and 73 females (mean age 47.33 ± 6.08 years), mostly with bilateral eye involvement (n= 103). Most of the cases were idiopathic (65.9%) whereas association of other risk factors in order of frequency was: tobacco consumption (10.8%), high myopia and diabetes mellitus (7.5% each), prolonged period of outdoor work and long-term steroid use (3.3% each), and dermatological diseases (1.7%). Using Annova test, a significant difference preoperative and postoperative vision was found amongst all age groups (p= 0.032). Conclusion: Tobacco consumption is a strong risk factor for cataractogenesis above diabetes mellitus and high myopia in presenile age group. A significant visual improvement results after cataract surgery and lens implantation. Keywords: Presenile cataract, Tobacco consumption, Diabetes mellitus, High myopia.

Linking the Landscape of MYH9-Related Diseases to the Molecular Mechanisms that Control Non-Muscle Myosin II-A Function in Cells.

The MYH9 gene encodes the heavy chain (MHCII) of non-muscle myosin II A (NMII-A). This is an actin-binding molecular motor essential for development that participates in many crucial cellular processes such as adhesion, cell migration, cytokinesis and polarization, maintenance of cell shape and signal transduction. Several types of mutations in the MYH9 gene cause an array of autosomal dominant disorders, globally known as MYH9-related diseases (MYH9-RD). These include May-Hegglin anomaly (MHA), Epstein syndrome (EPS), Fechtner syndrome (FTS) and Sebastian platelet syndrome (SPS). Although caused by different MYH9 mutations, all patients present macrothrombocytopenia, but may later display other pathologies, including loss of hearing, renal failure and presenile cataracts. The correlation between the molecular and cellular effects of the different mutations and clinical presentation are beginning to be established. In this review, we correlate the defects that MYH9 mutations cause at a molecular and cellular level (for example, deficient filament formation, altered ATPase activity or actin-binding) with the clinical presentation of the syndromes in human patients. We address why these syndromes are tissue restricted, and the existence of possible compensatory mechanisms, including residual activity of mutant NMII-A and/or the formation of heteropolymers or co-polymers with other NMII isoforms.

P0086FOCAL SEGMENTAL GLOMERULOSCLEROSIS AND TROMBOCYTOPENIA WITHOUT BLEEDING DIATHESIS: WHEN GENETICS MATTER

Abstract Background and Aims A 45-year old patient presented to our renal unit because of increased serum creatinine (2 mg/dL), proteinuria (2g/24h collection) and haematuria; platelets were 12000/mcL. His family history was negative. He had already undergone cataract surgery and was wearing a hearing device. Alport syndrome was suspected and kidney biopsy performed. Light microscopy showed focal segmental glomerulosclerosis (FSGS), while immunofluorescence was negative. Electron microscopy was not available. No specific treatment was undertaken and he progressed to end-stage renal disease (ESRD) in 10 years. The patient chose peritoneal dialysis. He was considered at high risk of bleeding but the Tenchkoff catheter was inserted without problems. After 3 months he received kidney transplant and again no pathological bleeding occurred. Method A genetic test was requested using next generation sequencing (NGS). Results A mutation of myosin heavy chain 9 (MYH9) gene which encodes the non-muscle myosin heavy chain-IIA (NMMH-IIA) was found. This mutation is associated with thrombocytopenia and proteinuria; platelets are giant and display normal aggregation, even in those patients who have a very low count. Proteinuria can be mild or in the nephrotic range, with or without microhaematuria. Kidney involvement is highly heterogeneous and leads to ESRD in half of the cases. Light microscopy shows FSGS as the prevalent pattern whereas electron microscopy is characterized by podocyte foot process effacement. In fact, NMMH-IIA is expressed in podocytes and controls cytoskeleton and cell migration. The differential diagnosis with Alport disease is challenging because additional features of MYH9 mutation are sensorineural deafness and pre-senile cataract. For all these reasons, accurate kidney biopsy study, family history and genetics are decisive. Conclusion Genetic testing has a pivotal role in understanding kidney diseases and should be more and more used.

Scanning and transmission electron microscopy study of anterior lens epithelium in presenile cataract.

To study the structure of lens epithelial cells (LECs) in the anterior lens epithelium of presenile cataract and to further explore the possible reasons for presenile cataract development. The anterior lens capsules (aLCs) of patients with presenile cataracts and patients with ordinary age-related cataracts were obtained from routine cataract surgery, and the 5-5.5mm circles of the central aLC were cut in half and prepared for transmission electron microscopy (TEM) and scanning electron microscopy (SEM). The most obvious structural changes in the LECs observed in both cataract groups by TEM were uneven thickness of the anterior lens epithelium, vacuolated cytoplasm and elongated nuclei. SEM showed abnormal structural changes in the LECs, with swollen cells and spheres on the anterior lens epithelium observed in both groups and holes formed by the LECs stretching observed only in the presenile cataract patients. The degeneration of the anterior lens epithelium and the structural changes in the LECs were observed more prominently in presenile cataract patients. Abnormal and prominently affected structural features of LECs were observed in the presenile compared to age-related cataract patients by TEM and SEM. We suppose that ultrastructural pathological changes in the anterior lens epithelial cells are one of the important reasons for the development of presenile and age-related cataract.

Change in Central corneal thickness after Phacoemulsification

Purpose: To determine changes in central corneal thickness after phacoemulsification at first post-operative day, one week and one month.
 Study Design: Descriptive Observational study.
 Place and Duration of Study: Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad. From June 2018 to March 2019.
 Material and Methods: Ninety-two patients with ages between 35 and 72 years presenting with senile and pre-senile cataract were selected by non-probability convenience sampling. Patients with previous ocular surgery, ocular trauma, Glaucoma, Uveitis, Contact lens wear and long-term use of ocular medication were excluded. The patients were subdivided into three groups depending on variability in their corneal thickness. Patients with preoperative central corneal thickness (CCT) from 480 to 529µm were placed in group 1 (Thin), group 2 included patients with CCT ranging between 530 and 569µm (Moderate), patients with CCT from 570-640µm were placed in group 3 (Thick). Preoperative CCT was measured before extraction of cataract via phacoemulsification and then repeated on first post-operative day and then on one week and one month.
 Results: Preoperative mean central corneal thickness increased by 10.2% on first post-operative day. It reduced to 3.1% on seventh post-operative day. It further reduced to 0.7% on 30th post-operative day. Central corneal thickness reduced to mean value of 548.8µm on 30th post-operative day, which was statistically non-significant as compared with preoperative mean value (544.96µm).
 Conclusion: There was no statistically significant change in CCT one month after phacoemulsification when compared with the pre-operative CCT.

EFFECT OF NIRGUNDI (VITEX NEGUNDO LINN.) PATRA ARKA AS ASCHOTHANA (EYE DROPS) IN CATARACT-A CLINICAL STUDY

Purpose: Age-related cataract is one of the leading causes of blindness and avoidable visual impairment in the world. There is no time-tested, FDA-approved, or clinically proven medical treatment exists till date to delay, prevent, or reverse the progression of senile cataract. Nirgundi (Vitex negundo) is a Chakshushya single drug mentioned in Ayurvedic classics. Various animal experimental study and invitro studies in recent years using flavonoids extracted from leaves of Vitex negundo on selenite induced cataract models proved to be beneficial in arresting the progression of cataract. Hence a clinical study with Vitex negundo eye drops in the form of Arka was planned with primary objective to assess the effect of Nirgundi patra arka as Aschotana (eye drops) in pre senile cataract. Methods: The study design was interventional pre and post evaluation without control. Patients were advised to instill Nirgundi patra arka two drops thrice daily i.e. 6 am, 12 pm and 6pm for a period of 6months. Log mar visual acuity score and contrast sensitivity score were recorded before treatment, 3rd month of treatment, after treatment, 9th month (1st follow up) and 12th month (2nd follow up). Slit lamp photographs were recorded before treatment and 12th month. Study and follow up were done in 31 eyes. Result: The intervention is statistically significant while considering visual acuity and contrast sensitivity. All the 27 cases of nuclear cataract responded to the intervention, while only 83.3% of posterior sub capsular cataract and 60% of cortical cataract showed response. But the change was not significant statistically. Conclusion: The intervention was effective in improving visual acuity and contrast sensitivity in all types of pre senile cataract. Clinical assessment revealed the study was effective in preventing the progression of pathogenesis in early stage of nuclear cataract.

Functional Rescue of Cataract-Causing αA-G98R-Crystallin by Targeted Compensatory Suppressor Mutations in Human αA-Crystallin.

The G98R mutation in αA-crystallin is associated with the onset of presenile cataract and is characterized biochemically by an increased oligomeric mass, altered chaperone function, and loss of structural stability over time. Thus, far, it is not known whether the inherent instability caused by gain-of-charge mutation could be rescued by a compensatory loss of charge mutation elsewhere on the protein. To answer this question, we investigated whether αA-G98R-mediated instability could be rescued through suppressor mutations by introducing site-specific "compensatory" mutations in αA-G98R-crystallin, αA-R21Q/G98R, αA-G98R/R116C, and αA-R157Q/G98R. The recombinant proteins were expressed, purified, characterized, and evaluated by circular dichroism (CD), intrinsic fluorescence, and bis-ANS-binding studies. Chaperone-like activities of recombinant proteins were assessed using alcohol dehydrogenase (ADH) and insulin as unfolding substrates. Far-UV CD studies revealed an increased α-helical content in αA-G98R in comparison to αA-WT, αA-R21Q, R157Q, and the double mutants, αA-R21Q/G98R, and αA-R157Q/G98R. Compared to αA-WT, αA-R21Q, and αA-G98R, the double mutants showed an increased intrinsic tryptophan fluorescence, whereas the highest hydrophobicity (bis-ANS-binding) was shown by αA-G98R. Introduction of a second mutation in αA-G98R reduced its bis-ANS-binding activity. Both αA-R21Q/G98R and αA-R157Q/G98R showed greater chaperone-like activity against ADH aggregation than αA-G98R. However, among the three G98R mutants, only αA-R21Q/G98R protected ARPE-19 cells from H2O2-induced cytotoxicity. These results suggest that the lost chaperone-like activity of αA-G98R-crystallin can be rescued by another targeted mutation and that substitution of αA-R21Q-crystallin at the N-terminal region can rescue a deleterious mutation in the conserved α-crystallin domain of the protein.

Diverse presentations of phenytoin toxicity-presenile cataract, encephalopathy and peripheral neuropathy: a case series

<p class="abstract">One of the most commonly used antiepileptic drugs, phenytoin, has a narrow therapeutic index, high plasma protein binding, non-linear pharmacokinetics and inter-individual variability. It can also present with adverse drug reactions due to phenytoin toxicity with diverse presentations mimicking symptoms of other diseases thus causing diagnostic predicament. This case series reports three such cases of uncommon presentation of phenytoin toxicity like presenile cataract, fluctuating encephalopathy with diurnal variation and peripheral neuropathy. Monitoring of serum drug levels in such cases aids in confirming drug toxicity. Adverse drug reaction monitoring helps in early detection and appropriate management of drug related morbidity.</p>

Presenile cataract and its risk factors: A case control study.

Purpose:Early onset opacification of the lens (cataract) has been observed to be on the rise globally. This study was conducted to determine the various types of presenile cataract and to determine the probable risk factors associated with the occurrence of presenile cataract.Materials and Methods:Patients in the age group of 18–40 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were recruited as cases. An equal number of consecutive patients of the same age group were included in the control group. Those who gave consent to participate in the study were interviewed through a preformed questionnaire and underwent a complete ocular examination and set of blood investigations. The type of cataract was noted, data obtained were compiled, and examination and investigations done were documented and analyzed using frequency distribution and Chi-squared test.Results:In total, 90 cases and 90 controls that fulfilled the inclusion criteria were recruited. Most common type of cataract was found to be posterior subcapsular cataract. Presenile cataract was observed to be significantly associated with tobacco intake (P = 0.035), hypercholesterolemia (P = 0.002), fuel exposure (P = 0.004), and lower socioeconomic status (P = <0.001).Conclusions:Tobacco chewing, hypercholesterolemia, and excessive fuel exposure are risk factors for early development of cataract.

MYH9-related disorders display heterogeneous kidney involvement and outcome.

BackgroundMYH9-related diseases (MYH9-RD) are autosomal dominant disorders caused by mutations of the MYH9 gene encoding the non-muscle myosin heavy chain IIA. They are characterized by congenital thrombocytopenia, giant platelets and leucocyte inclusions. Hearing impairment, pre-senile cataract and nephropathy can also occur. We aimed to evaluate renal involvement and outcome in MYH9-RD patients followed-up by nephrologists.MethodsWe conducted a retrospective multicentre observational study of 13 patients among 9 families with MYH9 mutation diagnosed by genetic testing and immunofluorescence assay referred to nephrologists.ResultsAt initial referral, median age was 30 (range 14–76) years. Median estimated glomerular filtration rate was 66 mL/min/1.73 m2 (0–141) and two patients had already end-stage renal disease (ESRD). Renal presentation associated proteinuria (n = 12), haematuria (n = 6) and hypertension (n = 6). Three patients developed a rapid onset ESRD whereas five others had a relatively stable kidney function over a 3-year median follow-up (1–34). Extra-renal features varied widely, with hearing impairment in six patients, cataract in two and mild liver dysfunction in seven. Thrombocytopenia existed at referral in 11 patients. Time to diagnosis varied from 0 to 29 years (median 3 years). Initial diagnoses such as idiopathic thrombocytopenic purpura (n = 4) and focal segmental glomerulosclerosis (n = 1) led to corticosteroid administration (n = 4), intravenous immunoglobulins (n = 3), cyclophosphamide (n = 1) and splenectomy (n = 1).ConclusionsRenal involvement and outcome in MYH9-RD are heterogeneous. The diagnosis is often delayed and misdiagnoses can lead to unnecessary treatments. MYH9-RD should be considered in any patient with glomerular involvement associated with a low or slightly decreased platelet count and/or hearing loss and liver dysfunction.

Providing Primary Care to Children Diagnosed with Myosin Heavy Chain 9-Related Platelet Disorder: A Case Report and Review of Literature

Introduction:Myosin-heavy chain 9 (MYH9)-related platelet disorders are a group of rare inherited thrombocytopenias, encompassing four syndromes, such as May-Hegglin anomaly, Epstein syndrome, Fechtner syndrome and Sebastian platelet syndrome. Typically diagnosed in adulthood, this disorder presents with chronic thrombocytopenia in all affected individuals with varying bleeding tendencies. Other clinical manifestations may include nephritis leading to end-stage renal disease, sensorineural hearing impairment and presenile cataracts. It is often misdiagnosed as autoimmune thrombocytopenia, which can lead to inappropriate treatment with corticosteroids or intravenous immunoglobulin for many years before the correct diagnosis is made.1 This case report describes the unique role of a pediatric hematologist to facilitate multidisciplinary care and services for a child diagnosed with MYH9-related disorder and illustrates the complex health care needs of this rare diagnosis in the pediatric populations.Case description:A 4-year-old girl of Mexican origin with a history of bilateral hearing loss and speech delay was first evaluated by audiology. Upon referral for a genetic evaluation, she was incidentally found to have asymptomatic thrombocytopenia. In the next four months, she received an extensive hematologic and infectious disease workup for the unexplained thrombocytopenia, while she was treated simultaneously for immune thrombocytopenia with corticosteroids or intravenous IgG. Neither of the interventions helped to normalize her persistently low platelet count (6,000-31,000), but instead led to sporadic intervals of undesirable weight gain and mood irritability. Further genetic testing with whole genome sequencing revealed a heterozygous pathogenic variant of MYH-9 mutation in the patient, who inherited the polymorphism from her father. Specifically, her variant exhibits complete penetrance for early-onset renal failure.As a result of the patient's platelet disorder and her frequent clinic visits to hematology, a close physician-patient relationship was developed thereafter. Her pediatric hematologist assumes the role of a primary care provider and coordinates multiple specialist visits to address her complex health care issues, including general pediatrics, speech therapy, audiology, otolaryngology, nephrology and medical genetics. Longitudinal care for this patient is mostly supportive: (1) platelet transfusion is required if she experiences any prolonged bleeding episodes; (2) prophylaxis with desmopressin is provided for dental and surgical procedures; (3) parents are counseled on child safety and limitations on major contact sports. Lastly, due to the identification of a pathogenic variant in both the patient and father, patient's brother and sister are both at increased risk of inheriting the platelet disorder. In our patient's case, since her family is limited by financial means for an evaluation with molecular testing, her siblings' platelet counts and sizes can be assessed instead with a CBC and peripheral blood smear.Discussion:The complexity of an inherited hematologic disorder involves multidisciplinary, longitudinal and lifelong care for optimal health care delivery and improved clinical outcomes. When approaching a pediatric patient diagnosed with a rare platelet disorder, the role of a hematologist becomes essential to be the primary care provider and to coordinate specialist visits for the patient without delays. Efficient care coordination with a focus on the patient's needs can avoid unnecessary duplication of tests and services.2 Children affected by rare genetic disorders, such as MYH-9 disorders, have complex unmet health needs and frequently experience unique barriers to care. Longitudinal surveillance is necessary to assess the progress of the MYH9 disease, and supportive care should be provided accordingly.

Risk factors of presenile nuclear cataract in health screening study

BackgroundTo identify risk factors for the development of presenile nuclear cataract in health screening test.MethodsThe cross sectional study included a total of 532 eyes of 266 participants aged 30 to 49 years of Samsung Medical Center from February 2013 to April 2015. Presence of nuclear cataract was defined when the log MAR visual acuity with correction was greater than or equal to 0.2 and one or more of the following were met: Pentacam Nuclear Staging (PNS) grading score ≥ 1, average value of nuclear density ≥ 15%, maximum value of nuclear density ≥ 30%. Possible risk factors were obtained from blood tests and questionnaires of a health screening test of Samsung Medical Center. Association between nuclear cataract and risk factors was investigated using univariate and multivariate logistic regression analysis by generalized estimating equation (GEE) models.ResultsFive factors were significantly associated with presenile nuclear cataract: current smoking [odds ratio (OR) = 2.80, 95% confidence interval (CI), 1.10–7.12, p = 0.0310], non-exercise and high amount of daily physical exercise (OR = 3.99, 95% CI, 1.27–12.52, p = 0.0178; OR = 2.92, 95% CI, 1.38–6.22, p = 0.0053), asthma (OR = 8.93, 95% CI, 1.12–71.15, p = 0.0386), tuberculosis (OR = 4.28, 95% CI, 1.36–13.50, p = 0.0131), and higher total iron binding capacity (OR = 1.01, 95% CI, 1.00–1.02, p = 0.0059).ConclusionsPresenile nuclear cataract is related to current smoking, non-exercise or high amount of physical exercise, asthma, tuberculosis, and iron deficiency status. The association of non-exercise group and presenile nuclear cataract seems to be related to co-morbidity. Patients with asthma, tuberculosis, or iron deficiency anemia are recommended to receive frequent ophthalmic examination to detect cataract.

MYH9-Related Thrombocytopenia: Four Novel Variants Affecting the Tail Domain of the Non-Muscle Myosin Heavy Chain IIA Associated with a Mild Clinical Evolution of the Disorder.

MYH9-related disease (MYH9-RD) is an autosomal-dominant thrombocytopenia caused by mutations in the gene for non-muscle myosin heavy chain IIA (NMMHC-IIA). Patients present congenital macrothrombocytopenia and inclusions of NMMHC-IIA in leukocytes, and have a variable risk of developing kidney damage, sensorineural deafness, presenile cataracts and/or liver enzymes abnormalities. The spectrum of mutations found in MYH9-RD patients is limited and the incidence and severity of the non-congenital features are predicted by the causative MYH9 variant. In particular, different alterations of the C-terminal tail domain of NMMHC-IIA associate with remarkably different disease evolution. We report four novel MYH9 mutations affecting the tail domain of NMMHC-IIA and responsible for MYH9-RD in four families. Two variants cause amino acid substitutions in the coiled-coil region of NMMHC-IIA, while the other two are a splicing variant and a single nucleotide deletion both resulting in frameshift alterations of the short non-helical tailpiece. Characterization of phenotypes of affected individuals shows that all of these novel variants are associated with a mild clinical evolution of the disease.

A Prospective Observational Study to Analyze the Causes and Types of Presenile Cataract in Subhimalayn Area of West Bengal

A Prospective Observational Study to Analyze the Causes and Types of Presenile Cataract in Subhimalayn Area of West Bengal

Familial foveal aplasia

PurposeFoveal aplasia, or hypoplasia, refers to the lack of foveal depression with continuity of all neurosensory layers in the presumed location of the fovea. Whilst it is has been reported in cases of aniridia, albinism, microphthalmia and achromatopsia, foveal hypoplasia as an isolated entity is a rare phenomenon. We describe the presentation of a child and her mother with subsequent discussion on the spectrum of the disease.MethodsCase report and literary synthesis.ResultsA frustrated 16 year old girl was brought in by her mother for review following several attendances to opticians with best‐corrected visual acuity of 6/9 both eyes. Ophthalmic examination revealed bilateral subtle spoke like cataracts with a featureless macula. There was no nystagmus present. Optical coherence tomography demonstrated lack of a foveal pit without extrusion of the plexiform layers. There was appropriate outer segment lengthening with a widened outer nuclear layer. Although asymptomatic, examination of her mother demonstrated best corrected visual acuity of 6/7.5 both eyes, with foveal tomography confirming foveal aplasia.ConclusionsAlthough foveal aplasia typically presents with other ocular pathology, and most often exhibits nystagmus with decreased visual acuity, the entity can exist in isolation and without nystagmus. Familial cases, and those with pre senile cataracts, have been associated with PAX6 gene mutations and subsequent alterations in ocular morphogenesis.

Phacoémulsification versus chirurgie de cataracte par mini incision manuelle : résultats anatomiques et fonctionnels

Prospective randomised study to compare the impact of phacoemusification (PHACO) and small incision cataract surgery (SICS) on endothelial structure (cell density and morphology) and refractive results (visual acuity, induced astigmatism). Prospective study of 57 patients (63 eyes) over 20 months (May 2012-January 2014) undergoing surgery by 2 experienced surgeons. We included patients with senile or presenile cataracts, LOCS III class 2, 3 and 4. Patients were randomized into 2 groups based on their birth month (group 1: PHACO [33]; group 2: SICS [30]). All pre- intra- and postoperative data were collected prospectively. The minimum follow-up was 6 months. We used the SPSS 18.0 for statistical analysis. Statistical tests used included the test-t Student, the Anova test, the Mann-Witney non-parametric test and the Khi2 test. A threshold of significance was set at 0.05. The mean preoperative endothelial cell density was 2447.5±225c/mm2 with no significant difference between the two groups (P=0.207). The mean percentage of hexagonality was 55.5±8.2% in groups 1 and 2. The most significant cell loss was during the first immediate postoperative period for both groups. At Day 15 postoperative, the decrease in cell loss was significant (P<0.001) with a mean loss of 312.9±208.9c/mm2 (P<10-2). Postoperatively, the mean best-corrected visual acuity was 0.057 log MAR for all of our patients (P=0.170); no patient had an acuity ≤1/10. The mean astigmatism at the conclusion of follow-up was 1.08±0.42 D in group 1 and 1.51±0.55 D in group 2, with a significant difference (P=0.001). Both SICS and PHACO give excellent results, both anatomical and refractive. However, SICS appears to be more advantageous than PHACO in terms of speed, cost, and independence from technology, and appears to be better suited to dense cataracts and mass surgery.

Etiopathogenesis of presenile cataracts in Central Kerala: A cross-sectional observational study

Aim: The aim of this study was to determine the factors responsible for the development of presenile cataracts in patients between 18 and 50 years in Central Kerala. Materials and Methods: This cross-sectional observational study was done on patients diagnosed with presenile cataracts (age group 18–50 years) at Little Flower Hospital, Angamaly, Kerala, from March 2016 to June 2016. A detailed history including the risk factors such as residence and occupation, diabetes mellitus (DM), atopy, and thyroid disorders was taken. Cataract was graded according to the Lens Opacities Classification System III. Statistical analysis of descriptive data was done with bar charts and pie diagrams. Results: Out of 200 participants included in the study, there were 88 males and 112 females. The mean age of the study population was 41.88 years. Pre senile cataract was associated with Diabetes mellitus in 31%, with atopy in 8.5%and with thyroid disorders in 5%of cases. Posterior subcapsular cataract (42%) was the most common type of cataract found. Total cataract was present in 23.5%. The odds of developing cortical cataract was higher in those with thyroid disorder (odds ratio (OR) = 6.97), nuclear cataract was higher in those with uveitis (OR = 6.18) and high myopia (OR = 7.97), and total cataract was higher in those with a history of trauma (OR = 8.95). Conclusion: Apart from DM and atopy, the place of residence and occupation (and thus possibly exposure to ultraviolet radiations) is also associated with the development of presenile cataract. Posterior subcapsular cataract is the most common type of presenile cataract in Central Kerala.

Pre-Senile Cataract in Diabetic Patients: Prevalence and Early Diagnosis

Hypothesis: Since cataract is more prevalent in the diabetic population, the authors compared the findings of the gold standard Lens Opacity Classification System III (LOCSIII) with the Scheimpflug objective measures in a presenile population. Methods: This was a cross-sectional study of diabetic patients between 50 and 60 years old. Patients answered a questionnaire about clinical conditions, complications, medications in use and demographics, and were submitted to a complete non-dilated and dilated ophthalmological evaluation, including a Scheimpflug lens densitometry (Pentacam Nucleus Staging) and the Lens Opacity Classification System III (LOCSIII) based evaluation. All patients signed an informed consent term. Results: Eighty-six eyes from 43 patients were enrolled; 96.5% had some degree of cataract, as classified by LOCS III and 46.5% by Pentacam. Most of the patients had corrected visual acuity of 20/20 (74.4%) and 25.6% had corrected visual acuity of 20/40 or worse. Conclusions: Corrected visual acuity in the majority of patients was normal and they mostly had non-proliferative diabetic retinopathy. LOCS III remains an earlier and less expensive method of cataract diagnosis. Different cataract morphology seems to relate to different systemic complication, although this finding must be confirmed by further studies.

Pattern of eye surgeries in a state specialist hospital: A 4-year review

Background: Provision of affordable eye care including eye surgery is one of the cardinal programs of the Osun State government of Nigeria. The objective of this study is to assess the pattern of eye surgeries performed in a secondary specialist hospital, Osogbo over a 4-year period. Materials and Methods: Hospital records of patients who had eye surgery from May 2006 to July 2010 were reviewed and the results analyzed with the Statistical Package for the Social Sciences version 20.0 software (SPSS Inc., Chicago, IL, United States). Results: A total of 434 patients were operated at the center during the period under review. The mean age was 59.6 (standard deviation 18.9) with age range from 5 to 99 years. There were 221 (50.9%) males and 213 (49.1%) females. In addition, 362 (83.4%) were blind, 40 (9.2%) visually impaired, and 32 (7.4%) were of normal vision. Although 384 (88.5%) were admitted for surgery only 50 (11.5%) had their surgery performed as a day case. Most, 420 (96.8%), were performed under local anesthesia, whereas 14 (3.2%) had general anesthesia. The most common diagnosis necessitating surgery was cataract with senile cataract accounting for 65% (282), presenile cataract 10.6% (46), complicated cataract 2.3% (10), and congenital cataract 2.1% (9). Pterygium and glaucoma also accounted for 9.0% (39) and 3.9% (17), respectively. Expectedly, extracapsular cataract extraction with posterior chamber intraocular lens implantation accounted for the greatest number of surgery performed (333 (76.7%)). This was followed by pterygium excision with primary closure with 26 (6.0%), trabeculectomy 17 (3.9%), and pterygium excision with conjunctival auto graft 11 (2.5%). Evisceration was the least performed surgery (1 (0.2%)) at the center. Conclusion: Preventable causes of blindness were quite common among the patients; hence, there is need for the government to make these sight saving/restoring surgeries more accessible to the populace by making more facilities available and subsidizing the cost of surgery.