Progression Of Lens Opacities Research Articles

Cataract Progression dan Lens Drop after Pars Plana Vitrectomy and Gas Tamponade : A Case Report

Introduction : Vitreous Hemorrhage (VH) in proliferative diabetic retinopathy (PDR) is common cause of acute vision loss.If the retina cannot be visualized and the etiology of the VH is unknown, pars plana vitrectomy (PPV) is indicated. 1Intraocular gases like SF6 or C3F8 are one of the most useful adjuncts in vitreoretinal surgery. Exposure to intraocular gases additionally increases retrolental oxygen levels, resulting in development of lens opacities.
 Case Illustration : Patient female 52 y.o, came with sudden blurry vision in the left eye since two weeks ago. History of Diabetes Mellitus 10 years with insulin treatment. From the examination left eye visual acuity 1/60, zonulysis, VH, and negative fundus reflect. On ultrasonography found vitreous opacity. The patient was diagnosed with left eye VH ec advanced PDR and scheduled PPV with C3F8 gas tamponade. Patient difficult to maintain prone position after surgery. 2 month after the surgery the patient scheduled with phacoemulsification surgery because progressive lens opacity. While prepare to the second operation, the lens found drop to the vitreous. The second surgery done with lens evacuation and Intraocular lens implantation. Last follow up, best correction visual acuity was 6/18.
 Discussion : PPV and Gas tamponade are presdisposing lens opacity progression. Lens opacity after gas tamponade include longer intraocular longevity gas and patients who fail to maintain a prone position. Risk factors for zonulysis in this patient increase the occurrence of lens drop after PPV with gas tamponade.
 Conclusion : Regular slit-lamp examination needs to be performed for early detection of cataract after PPV with gas tamponade.

Efficacy of a new fragmentation pattern in femtosecond laser-assisted cataract surgery with the Ziemer FEMTO LDV Z8.

To determine the efficacy of different fragmentation patterns in femtosecond laser-assisted cataract surgery (FLACS) using Ziemer FEMTO LDV Z8. We compared three different types of surgery: conventional cataract surgery (CCS), FLACS with conventional radial slices (named No-Spiderweb), and FLACS with a novel fragmentation pattern (radial slices combined with one or two rings) called "Spiderweb." Visual acuity (VA), nuclear opacity (NO) according to the Lens Opacities Classification System (LOCS lll), effective phacoemulsification time (EPT) and vacuum time were obtained for 845 eyes. Using FLACS (Spiderweb + No-Spiderweb), EPT was significantly reduced by 26% compared to CCS (FLACS: 2.46 ± 2.60s; CCS: 3.34 ± 2.89s; ΔM = - 0.88s, p < .001). Furthermore, EPT as a function of progression of lens opacity was found to be not only lower in Spiderweb compared to CCS, but also in comparison with No-Spiderweb. At NO3, a significant reduction of 65% in EPT was observed by using Spiderweb compared to CCS (Spiderweb:0.68 ± 1.23 s; CCS: 1.96 ± 1.53 s; ΔM = - 1.28 s, p <.001). Interestingly, EPT at NO3 was also significantly reduced by 57% in Spiderweb compared to No-Spiderweb (Spiderweb:0.68 ± 1.23 s; No-Spiderweb: 1.57 ± 1 .59 s; ΔM = - 0.90 s, p <.001). The use of Spiderweb only marginally extends the vacuum time compared to No-Spiderweb by 11s (Spiderweb:209.13 ± 35.83s; No-Spiderweb: 198.35 ± 36.84s; p = .003) and the postoperative improved VA showed no significant difference among the different types of surgery (all ps ≥ .05). FLACS significantly reduces EPT compared to CCS. Furthermore, the novel Spiderweb pattern significantly reduces EPT in patients with a cataract of NO3 compared to CCS, but also to FLACS with the existing radial pattern (No-Spiderweb).

Predicting speed of progression of lens opacification after pars plana vitrectomy with silicone oil.

An increasing number of posterior segment disorders is routinely managed with pars plana vitrectomy (PPV). In older, phakic patients cataract formation is expected within the first two years after surgery. For younger patients its progression is individually fluctuating. This study uses an objective quantitative measurement for lens-status-monitoring after PPV with silicone oil to derive predictions for progression and severity of post-operative lens opacification evaluated in patients with rhegmatogenous retinal detachment (RRD). Data acquisition was performed prospectively between March 2018 and March 2021. PentacamHR® Nucleus Staging mode (PNS) was used to objectively gather data about nuclear cataracts after PPV at different time points. Data was grouped into training and test sets for a mathematical prediction model. Via backward variable selection method a mathematical formula was set up by means of which predictions about lens densitometry (LD) can be calculated. 20 males [58.8%] and 14 females [41.2%] matched the inclusion criteria (mean age 50.6 years [23-75; ±12.3]). Average follow-up was 8.1 months (3,4-17.4; ±3.4). Mean baseline LD of the treated and fellow eye before surgery was 11.1% (7.7%-17.6%; ±2.0) and 11.2% (7.7%-14.8%; ±1.5), respectively. Predicted LD values by the model for five pre-selected patients closely match the observed data with an average deviation of 1.06%. Using an objective parameter like LD delivered by the PentacamHR® PNS mode additionally to the patient's age allows us to make an individual prediction for any time after PPV with silicone oil due to RRD for all ages. The accuracy of the model was stronger influenced by baseline LD as cofactor in the equation than patient's age. The application for the prediction lens opacification [which can be accessed for free under the following link (https://statisticarium.com/apps/sample-apps/LensDensityOil/)] can help vitreoretinal surgeons for patient consultation on the possibility to combine PPV with cataract surgery.

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Evaluation of factors related to Anaesthesia-induced Lens opacity in experimental mice

To investigate conditions that cause temporal lens opacity, we tested chemical and physical factors, such as anaesthesia dose, ocular surface dryness, and infrared (IR) light exposure in anaesthetised C57BL/6 N mice. Mice were anaesthetised with a low (80%; tiletamine/zolazepam 32 mg/kg and xylazine 8 mg/kg, intraperitoneal injection) or high (120%; 48 mg/kg and 12 mg/kg) dose of anaesthetic and examined every 5 min from 10 to 30 min after anaesthesia was induced. Lens opacity levels were assessed and graded (1–6) using the standard classification system. Regardless of the anaesthetic dose, lens opacity grade was 1–2 in moisturised eyes with application of 0.5% carboxymethylcellulose, and 5–6 in dry ocular surface conditions. Lens opacity in mice with high-dose anaesthetic in the dry ocular surface condition was not different from that of mice with low-dose anaesthetic. Lens opacity grade 1–2 was noted in eyes in the wet ocular surface condition, regardless of IR light exposure. During IR light exposure in eyes in the dry ocular surface condition, lens opacity (grade 6) in mice with high-dose anaesthetic was not different from that (grade 6) in mice with low-dose anaesthetic. We demonstrated that ocular surface dryness might be a relevant factor for the formation and progression of lens opacity in anesthetized C57BL/6 N mice. Anaesthesia dose and IR light exposure did not strongly influence lens opacity formation. Furthermore, eyes with corneal dryness-induced lens opacity recovered to normal status without additional intervention.

Levels of Trace Elements in the Aqueous Humor of Cataract Patients Measured by the Inductively Coupled Plasma Optical Emission Spectrometry.

Trace elements play an important role in the pathogenesis of several serious ophthalmological disorders, such as glaucoma, age-related macular degeneration (AMD), diabetic retinopathy, cataract, etc. This study aimed to measure alterations of chemical elements’ (67) levels in the aqueous humor of patients undergoing cataract surgery. The pilot study included 115 patients, (age 74 ± 7.27, female 64.35%, male 35.65%). The aqueous levels of elements were measured by the use of the inductively coupled plasma optical emission spectrometry (ICP-OES), quality controlled with certified standards. The classification of elements based on their concentration was achieved by hierarchical cluster analysis. This is the first screening study that quantifies over 60 elements which are present in the fluid from the anterior chamber of the eye of cataract patients. The obtained results can be suitable for understanding and identifying the causes that may play a role in the initiation and progression of lens opacity.

Protective Effects of Trimetazidine in Retarding Selenite-Induced Lens Opacification

ABSTRACTPurpose: Cataracts are the leading cause of vision loss worldwide, and the over-production of reactive oxygen species (ROS) is the foremost underlying cause of cataracts. Reducing ROS levels can efficiently prevent lens opacification, as evidenced by many studies. Here, we inhibited ROS overproduction with trimetazidine (TMZ), which is an antioxidant, to explore the therapeutic effects of TMZ and the mechanism of lens opacification.Materials and methods: Sodium selenite-induced cataract formation resulted in a significant loss of lens transparency. This effect could be efficiently rescued by TMZ, which was further found to be an inhibitor of ROS production, as determined by assaying oxidative stress-related parameters (SOD activity, MDA, ·OH and H2O2 levels) during cataract formation. The experimental protocols involving animal research were approved by the Animal Care and Ethics Committee of Wenzhou Medical University and conducted according to the Association for Research in Vision and Ophthalmology under the guidelines of the Animal Welfare Act (SYXK 2015–0009).Results: Our study found that TMZ can retard the onset and progression of lens opacification in vivo in experiments using Sprague-Dawley (SD) suckling rats and can rescue the morphology of HLEB3 cells in vitro. The flow cytometry and DNA fragmentation assays showed that TMZ could prevent sodium selenite-induced apoptosis. The western blot analysing showed that the levels of apoptosis-associated Bcl-2 and Nrf2 were dramatically decreased following the sodium selenite treatment. In addition, the bisulfate DNA sequencing revealed that the demethylation of CpGs in the promoter region of Keap1 was stimulated, and that this demethylation could be inhibited by TMZ by rescuing the Nrf2 expression level.Conclusions: Our findings indicate that the antioxidant TMZ strongly reduces ROS production, which ultimately delays the progression of cataract formation, suggesting that treatment with TMZ represents a novel, promising antioxidant protection to retard cataract formation.

Changes in mitochondrial cytochrome c oxidase mRNA levels with cataract severity in lens epithelia of Japanese patients.

We previously reported that the collapse of ATP production via mitochondrial damage causes ATPase dysfunction, resulting in the onset or progression of lens opacification in cataracts in model rats. In the present study, it was investigated whether the mRNA expression levels of the three subtypes of mitochondrial cytochrome c oxidase (MTCO)1, 2 and 3 and ATP content change with the type and severity of cataracts in human lens. Samples of lens epithelium were collected from Japanese patients during cataract surgery, and the type and severity of the cataracts (grade) were determined according to the WHO classification [cortical (COR), nuclear (NUC), posterior subcapsular (PSC) opacification]. The MTCO1‑3 mRNA expression levels in patients with grade‑1 COR, NUC and PSC opacification were significantly enhanced compared with those of normal patients. The enhanced MTCO1‑3 mRNA levels subsequently decreased in patients with COR, and the MTCO1‑3 mRNA levels and ATP levels in patients with grade‑3 COR were similar to those in normal patients. However, the mRNA expression levels of MTCO3 in patients with grade 3‑NUC opacification and MTCO1‑3 in patients with grade‑3 PSC opacification, along with the ATP content, were significantly lower than in patients without cataracts. In conclusion, it was revealed that ATP production in lens epithelium is enhanced in early‑stage cataracts (grade‑1) in Japanese patients with COR, NUC and PSC opacification. In addition, in severe cataracts (grade‑3), ATP production and content are strongly decreased in Japanese patients with PSC opacification. ATP depletion in human lens epithelium with PSC opacification may promote lens opacification by ATPase dysfunction.

CHANGE IN THE QUALITY OF LIFE OF CHILDREN AFTER SURGICAL TREATMENT OF RETINAL DETACHMENT

Aim.The study was designed for the evaluation of the quality of life of children with retinal detachment during vitrectomy.Materials and methods. 23 children with retinal detachment aged from 10 to 17 years were treated. Surgical treatment consisted of a three-port vitrectomy and a laser endocoagulation of the retina. 3 groups were formed with the help of a random sampling. During the surgical treatment of group I (n=8), only balanced non-oxidant solutions of salts (Balsed Salt Solution − BSS) were used. Tablets of antioxidant preparations were not assigned. Saline solutions with antioxidants (BSS plus) were used to carry out surgery for group II (n=8). Group III (n=7) was additionally taking antioxidant preparations peros for 3 months in the postoperative period . The quality of life was studied using the abridged Russian version of the VFQ-25 questionnaire. 10 children of the same age with no indications of surgical treatment of retinal detachment were selected for the control group. Statistical analysis of the obtained data was carried out using a set of programs for applied statistical analysis Analyst Soft, Bio Stat 2007.Results.A week after the surgical treatment, no increase in visometric data was observed. Six months later, a significant increase in visual acuity was revealed. The highest visometric data were observed in group II due to the minimal progression of lens opacities. Group I patients had the lowest values of this index.Conclusion.The positive effect of the surgical treatment of retinal detachment positively influenced the patients’ quality of life in the early and late postoperative period.

25-gauge lens-sparing vitrectomy with dissection of retrolental adhesions on the peripheral retina for familial exudative vitreoretinopathy in infants.

To evaluate the clinical outcome of 25-gauge lens-sparing vitrectomy with dissection of retrolental adhesions on the peripheral retina for familial exudative vitreoretinopathy in infants. Fifty-one eyes of 39 infants with familial exudative vitreoretinopathy associated with retrolental adhesions on the peripheral retina, retinal fold with macular detachment, and partial lens opacity. A 25-gauge lens-sparing vitrectomy was performed, and retrolental adhesions between the peripheral retina and the posterior lens capsule were surgically dissected. Lens opacification, as assessed or graded by Lens Opacities Classification System III, and the retinal reattachment rate were observed and recorded monthly for up to 7months postoperatively. After 7months, the detached retina along the retinal fold was reattached in 42/51 (82.4%) eyes; the macula was reattached completely in 26/51 (51.0%) eyes and partially in 15/51 (29.4%) eyes. There was no statistically significant change in the lens opacity of the posterior capsule or cortex before or after surgery (P > 0.05, paired t test) or in postoperative progression of lens opacity (P > 0.05, modified McNemar's test) according to Lens Opacities Classification System III scores. A 25-gauge lens-sparing vitrectomy with dissection of peripheral retinal retrolental adhesions is helpful for preservation of the lens and reattachment of the macula in infants with FEVR.

Long-term safety and efficacy of ziv-aflibercept in retinal diseases

AimsTo investigate the long-term safety of intravitreal ziv-aflibercept in eyes receiving six or more intravitreal injections of ziv-aflibercept, an off-label substitute to the approved aflibercept.MethodsConsecutive patients with retinal disease receiving...

Contribution of the Nurses' Health Study to the Epidemiology of Cataract, Age-Related Macular Degeneration, and Glaucoma.

To review the contribution of the Nurses' Health Study (NHS) to understanding the genetic and lifestyle factors that influence the risk of cataract, age-related macular degeneration, and glaucoma. We performed a narrative review of the publications of the NHS between 1976 and 2016. The NHS has helped to elucidate the roles of genetics, lifestyle factors (e.g., cigarette smoking associated with cataract extraction and age-related macular degeneration), medical conditions (e.g., diabetes associated with cataract extraction and glaucoma), and dietary factors (e.g., greater carotenoid intake and lower glycemic diet associated with lower risk of age-related macular degeneration) in the etiology of degree and progression of lens opacities, cataract extraction, age-related macular degeneration, primary open-angle glaucoma, and exfoliation glaucoma. The findings from the NHS, combined with those of other studies, have provided compelling evidence to support public health recommendations for helping to prevent age-related eye diseases: abstinence from cigarette smoking, maintenance of healthy weight and diabetes prevention, and a healthy diet rich in fruits and vegetables.

An Oral Antioxidant Formulation Delaying and Potentially Reversing Canine Diabetic Cataract: A Placebo-controlled Double-masked Pilot Study

Background: The majority of dogs with diabetes mellitus develop blinding mature cataracts through the action of the enzyme aldose reductase producing sorbitol with osmotic action drawing water into the lens thus causing opacification. Here we evaluate the use of OcuGLO™ a formulation including the aldose reductase inhibitor alpha lipoic acid, grapeseed extract, carotenoids, omega-3-fatty acids, and coenzyme Q10 in the prevention of canine diabetic cataract in a prospective placebo-controlled double-masked study. Materials and methods: Dogs with diabetes mellitus but as yet without the development of blinding diabetic cataracts were given either OcuGLO™ or a placebo containing antioxidant vitamins. Dogs were examined monthly and their degree of lens opacification documented photographically using a Genesis D fundus camera at +10D. Time to progression of lens opacification was documented and compared between the OcuGLO™ group and the placebo group, using Kaplan Meier survival curve statistics. Results: Mean time without change in lens opacification was 278 ± 184 days with OcuGLO Rx™ and 77 ± 40 days in the placebo group this difference being statistically significant at p=0.0005. Twelve of 15 dogs taking the placebo developed significantly increased lens opacification while 5 of 15 dogs taking OcuGLO Rx™ developed significant cataract. of these five dogs four animals did not receive daily OcuGLO Rx™ as directed due to unrelated concurrent illness or owner non-compliance. The remaining dog progressed despite Ocu-GLO Rx™ administration. In two dogs, diabetic cataract was reversed with regained vision on Ocu-GLO Rx™. Discussion: This small preliminary study demonstrates that oral Ocu-GLO Rx™ has beneficial effects in delaying cataract formation in dogs with diabetes mellitus. We look forward to further studies with larger case populations but note that the statistical significance reached between placebo and supplement-treated group, even with a small study population, demonstrates the efficacy of this commercially available dietary supplement.

Changes in Lens Opacities on the Age-Related Eye Disease Study Grading Scale Predict Progression to Cataract Surgery and Vision Loss: Age-Related Eye Disease Study Report No. 34

To investigate whether the 2-year change in lens opacity severity on the Age-Related Eye Disease Study (AREDS) lens grading scale predicts progression to cataract surgery or loss of visual acuity by 5 years. Prospective cohort study within a randomized clinical trial of oral supplements. The AREDS participants whose eyes were phakic at baseline and free of late age-related macular degeneration throughout the study. Baseline and annual lens photographs of AREDS participants (n = 3466/4757; 73%) were graded for severity of cataracts using the AREDS system for classifying cataracts from photographs. Clinical examinations conducted semiannually collected data on cataract surgery and visual acuity. Association of the change in lens opacities at 2 years with these outcomes at 5 years was analyzed with adjusted Cox proportional hazard models. Progression of lens opacities on stereoscopic lens photographs at 2 years, cataract surgery, and visual acuity loss of 2 lines or more at 5 years. The adjusted hazard ratios (HRs) for association of progression to cataract surgery at 5 years were: nuclear cataract increase of 1.0 unit or more compared with less than 1.0-unit change at 2 years, 2.77 (95% confidence interval [CI], 2.07-3.70; P < 0.001); cortical cataract increase of 5% or more in lens opacity in the central 5 mm of the lens compared with less than 5% increase at 2 years, 1.91 (95% CI, 1.27-2.87; P = 0.002); and posterior subcapsular cataract increase of 5% or more versus less than 5% in the central 5 mm of the lens, 8.25 (95% CI, 5.55-12.29; P < 0.001). Similarly, HRs of vision loss of 2 lines or more at 5 years for this degree of lens changes at 2 years were the following: nuclear, 1.83 (95% CI, 1.49-2.25; P < 0.001); cortical, 1.13 (95% CI, 0.78-1.65; P = 0.519); and posterior subcapsular cataract, 3.05 (95% CI, 1.79-5.19; P < 0.001). Two-year changes in severity of lens opacities on the AREDS lens grading scale are predictive of long-term clinically relevant outcomes, making them potential surrogate end points in follow-up studies.

Pars plana vitrectomy versus three intravitreal injections of bevacizumab for nontractional diabetic macular edema. A prospective, randomized comparative study.

Background:The aim of this study was to compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with three, monthly, intravitreal bevacizumab (IVB) injections for refractory diabetic macular edema.Materials and Methods:This was a prospective, randomized, comparative, interventional study. Forty-four patients were enrolled and randomized in two groups. Twenty-two eyes enrolled in Group I received three IVB injections at monthly interval. Twenty-two eyes were enrolled in Group II which underwent PPV with ILM removal. The primary outcomes measured were: (1) Best corrected logMAR visual acuity (BCVA) using Snellen's visual acuity chart. (2) Central macular thickness (CMT) on optical coherence tomography. The secondary outcome measures were: Complication rates like (1) progression of lens opacities, (2) high intraocular pressure needing further treatment/procedure, (3) development of vitreous hemorrhage related to the procedure employed, (4) retinal detachment and (5) severe inflammation/endophthalmitis.Results:In Group I (IVB): 3 (13.6%) eyes showed no change in BCVA; 3 (13.6%) eyes reported decrease in BCVA and 16 (72.8%) eyes showed improvement in BCVA; (P = 0.0181). In Group II (PPV): 4 (18.2%) eyes showed no change in BCVA; 5 (22.7%) eyes showed decrease and 13 (59.1%) eyes showed improvement in BCVA (P = 0.0281). Mean decrease in CMT in IVB group was 108.45 μ, whereas mean decrease in CMT in PPV group was 161.36 μ. No major complications were seen in either group.Conclusion:Posttreatment decrease in CMT was more in PPV group and vision improvement more in IVB group. However, no statistically significant difference between the two methods was found.

Dexamethasone intravitreal implant as adjunct therapy for patients with wet age-related macular degeneration with incomplete response to ranibizumab

PurposeTo evaluate the visual and anatomical outcomes of dexamethasone intravitreal implant (DXI; 700 μg, Ozurdex; Allergan, Irvine, California, USA) as adjunctive therapy for patients with refractory wet age-related macular degeneration...

The use of Ozurdex intravitreal implant to treat post-RVO macular edema

This reports on the efficacy and safety of Ozurdex intravitreal implant (1 up to 3 injections) in different types of retinal vein occlusion (RVO) was based on examination data of 26 patients, referred to the ophthalmology clinic of the First Pavlov Sate Medical University of St. Petersburg. Ophthalmic examination, fluorescein angiography, optical coherence tomography, fundus photography, and microperimetry were all routinely used to follow these patients. Intravitreal injections of Ozurdex in post-RVO macular edema resulted in a statistically significant visual acuity improvement and decrease in retinal thickness. No cases of lens opacity progression were observed. Ocular hypertension was transient and controlled by topical IOP-lowering therapy. In cases of ischemic central retinal vein occlusions, to prevent and treat neovascular complications it is necessary to resort to additional treatment methods.

Local safety of repeated intravitreal Ozurdex

Sir, The article entitled ‘Twelve-month experience with Ozurdex for the treatment of macular edema associated with retinal vein occlusion'1 highlights the significant cataract progression in eyes receiving more than one Ozurdex implant. We retrospectively reviewed the charts of all patients with macular edema secondary to retinal vein occlusion (RVO) refractory to current therapies and treated with Ozurdex from April 2010 until March 2012. The mean age of patients with branch RVO (n=33) was 72.4. In eyes receiving a second Ozurdex implant, four out of the five phakic eyes showed progression of cataract requiring surgery. We registered one case of anterior chamber migration resulting in a bullous keratopathy.2 The mean age of patients with CRVO (n=23) was 68.3. In eye receiving a second Ozurdex implant, four out of the six phakic eyes showed progression of cataract requiring surgery. Real-life studies are necessary in order to better define the safety and efficacy of new therapeutic approaches. Although the GENEVA study3 reported an incidence of 29.8% of cataract progression in eyes receiving a second Ozurdex intravitreal implant, Mayer et al1 found a significant higher proportion of these eyes in their study after a third implant (50.0%), and we also evidenced a higher progression of lens opacity in patients with macular edema secondary to RVO refractory to conventional therapies receiving a second implant (75.0% in branch RVO and 66.7% in central RVO). These data should be taken into account when an individualized strategy is planned for patients with RVO.

Phacoemulsification with phakic intraocular lens

Sir, The new-onset or the progression of lens opacity is most likely to occur after phakic intra-ocular lens (pIOL) implantation.[1] Further more endothelial decompensation with progressive cell loss is a common complication of pIOLs implantation and a major concern during the post-operative period.[2–4] The most common technique is to remove first the phakic IOLs, and then to perform the cataract surgery with posterior chamber IOL implant in the capsular bag. Moreover, even in uneventful cases, the micro-incision cataract surgery induces corneal endothelial cell loss similar to a standard phacoemulsification due to the ultrasonic energy as well as the fluidic currents in the eye.[5] In phakic eye with pIOLs implantation the surgery will generate then a further endothelial cell loss. We describe a new surgical approach to avoid further endothelial cell loss performing the cataract surgery with pIOLs in place. The technique uses the pIOLs as shields for endothelial cells during the cataract surgery. Our technique involves the injection of adhesive viscoelastic such as Healon GV (Abbott Medical Optics Inc. (AMO), Santa Ana, CA) or Viscoat (Alcon, Fort Worth, TX) between the endothelium and pIOLs and a cohesive viscoelastic such as Provisc (Alcon, Fort Worth, TX) between pIOLs and lens. [Fig. 1a] We then perform anterior continuous curvilinear capsulorhexis and all the steps of the cataract surgery behind the pIOLs [Fig. ​[Fig.1b1b–d]. The pIOLs will be removed as last step before the posterior chamber IOL implant in the capsular bag. Figure 1 The technique involves the injection of adhesive viscoelastic between the endothelium and pIOLs and a cohesive viscoelastic between pIOLs and lens. (a) Then the anterior continuous curvilinear capsulorhexis, (b) phacoemulsification, (c) and aspiration ... We performed the above-described technique in 7 myopic eyes of 7 patients (mean age 46, SD 5.8) who had undergone phakic IOL implant years before (mean 6.2 years, SD 2.4). The original mean refractive error was-14.5 diopters (SD 4.0). All 7 eyes presented with late-onset anterior subcapsular cataract, probably related to IOL-crystalline lens contact. Mean endothelial count was 1950 (SD 385) cells/mm2 before our combined procedure of phacomulsification, phakic IOL removal and posterior IOL implant in the bag. Pupillary dilatation was obtained with phenylephrine 10% and atropine 1% eye drops. The pupillary dilatation was wider than 6 mm in all cases. Three months post-operative, the loss of endothelial cells was not statistically significant (P = 0.2), the mean endothelial count being 1828 (SD 340) cells/mm2. The best corrected visual acuity, assessed on Snellen chart pre-operatively and three months post-operatively, improved from 0.35 (SD 1.5) to 0.85 (SD 2). This surgical technique is safe for phacoemulsification in patients with phakic intra-ocular lenses and corneal decompensation, which may prevents further endothelial cell loss.

Nicotine Exposure Exacerbates Development of Cataracts in a Type 1 Diabetic Rat Model

Diabetes and smoking are known risk factors for cataract development. In this study, we evaluated the effect of nicotine on the progression of cataracts in a type 1 diabetic rat model. Diabetes was induced in Sprague-Dawley rats by a single injection of 65 mg/kg streptozotocin. Daily nicotine injections were administered subcutaneously. Forty-five rats were divided into groups of diabetics with and without nicotine treatment and controls with and without nicotine treatment. Progression of lens opacity was monitored using a slit lamp biomicroscope and scores were assigned. To assess whether systemic inflammation played a role in mediating cataractogenesis, we studied serum levels of eotaxin, IL-6, and IL-4. The levels of the measured cytokines increased significantly in nicotine-treated and untreated diabetic animals versus controls and demonstrated a positive trend in the nicotine-treated diabetic rats. Our data suggest the presence of a synergistic relationship between nicotine and diabetes that accelerated cataract formation via inflammatory mediators.