Progression Of 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.

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...

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.

Racial differences in lens opacity incidence and progression: the Salisbury Eye Evaluation (SEE) study.

To evaluate racial differences in nuclear and cortical lens opacity incidence and progression over a 2-year period in an older American population. Prospective population-based cohort study of a multiethnic population of 2520 people (26% African-American and 74% Caucasian), 65 to 84 years of age, living in Salisbury, Maryland. Data at baseline included race, education level, past steroid use, smoking status, alcohol status, sunlight exposure, and history of hypertension and diabetes. Lens photographs were taken at baseline and at 2-year follow-up and were graded using the Wilmer grading scheme. Multiple logistic regression models were used to examine the independent associations between race, as well as other risk factors, and incidence and progression of cortical and nuclear opacities. AFRICAN-AMERICANS HAD LOWER RATES OF NUCLEAR OPACITY INCIDENCE (ODDS RATIO [OR]: 0.52; 95% Confidence Interval [CI]: 0.35-0.76) and nuclear opacity progression (OR: 0.60; 95% CI: 0.38-0.92) compared with Caucasians. African-Americans had higher rates of cortical opacity incidence (OR: 1.90; 95% CI: 1.21-2.98) and cortical opacity progression (OR: 1.72; 95% CI: 1.21-2.45) compared with Caucasians. Additionally, nuclear opacity incidence was associated with age, female sex, and current smoking status. Nuclear progression was associated with past smoking and current smoking. Cortical opacity incidence was associated with female sex, Ultraviolet-B exposure, and a history of diabetes. Cortical opacity progression was associated with current smoking status. Differences by race in the type of cataract incidence and progression, even adjusting for personal and environmental risk factors, deserve further exploration.

Contact Lens-Induced Regression of Lisch Epithelial Corneal Dystrophy

To describe the use of soft contact lenses (CL) to reduce the epithelial opacities of Lisch epithelial corneal dystrophy (LECD). First presentation of confocal microscopy in LECD. Two unrelated female patients with LECD demonstrated a central gray opacity with distinct visual impairment. The first patient wore a daily hydroxyethlmethacrylate (HEMA) CL for 3 months and the second, a daily silicone hydrogel CL for 1 month. Pre-CL and post-CL appearances of the cornea were photodocumented at the slit lamp. Additionally, in the second patient, a confocal microscopic evaluation of LECD was performed. In both patients, the wearing of CL resulted in a distinct reduction of central corneal opacification with a visual improvement. Discontinued wearing of CL induced again a progression of opacity. The confocal microscopy disclosed the typical intracytoplasmatic vacuolization of the involved epithelial cells. Wearing CL for a longer duration causes a significant regression of corneal opacities in LECD. The etiology of this phenomenon is interpreted as a CL-induced thinning of corneal epithelium and reduction of epithelial layers.

Inhalational Lung Injury Due to Nitrogen Dioxide

Chest radiographic and high-resolution computed tomography findings of 3 patients with inhalational lung injury due to nitrogen dioxide were reported. Chest radiographs showed ill-defined round opacities which tended to coalesce in both lung with inner lung predominance. High-resolution computed tomography showed ground-glass attenuation and ill-defined centrilobular nodules distributed predominantly in the inner and middle lung zones. One patient showed progression of opacities, which corresponded to the findings of acute respiratory distress syndrome.

Centrum Use and Progression of Age-Related Cataract in the Age-Related Eye Disease Study: A Propensity Score Approach. AREDS Report No. 21

To evaluate the effect of the multivitamin Centrum on the development and progression of age-related lens opacities. Clinic-based prospective cohort study. Four thousand five hundred ninety individuals with at least one natural lens and photographic follow-up (median, 6.3 years) were assessed for development or progression of lens opacities. Progression of "any" lens opacity or type-specific opacity was ascertained from lens photographs taken at baseline and at annual visits beginning at year 2. The Age-Related Eye Disease Study (AREDS) showed no statistically significant effect of a high-dose antioxidant formulation on progression of lens opacities. Centrum also was provided to approximately two thirds of the study participants. Because Centrum use was elective, a logistic regression model of baseline characteristics was used to generate a propensity score for Centrum use. Repeated-measures logistic regression, adjusted for propensity score and other covariates, was used to evaluate associations of Centrum use and lens opacity. Centrum use, adjusted for propensity score and other covariates, was associated with a reduction in "any" lens opacity progression (odds ratio [OR] = 0.84, 95% confidence interval [CI] = 0.72-0.98, P = 0.025). Results for individual lens opacity types suggested that Centrum use was protective for nuclear opacity events (OR = 0.75, 95% CI = 0.61-0.91, P = 0.004). Observational data from the AREDS and other studies suggest that use of a multivitamin may delay the progression of lens opacities. A National Eye Institute-sponsored clinical trial scheduled for completion in 2007 will provide additional data on Centrum use and cataract development.

Responsiveness of the National Eye Institute Visual Function Questionnaire to Progression to Advanced Age-Related Macular Degeneration, Vision Loss, and Lens Opacity

To describe the ability of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to detect meaningful change over time (responsiveness) to the primary Age-Related Eye Disease Study outcomes. The 25-item NEI-VFQ plus appendix was administered at 2 visits at 1- to 4-year intervals to 4119 participants in the Age-Related Eye Disease Study. Events evaluated were progression to advanced age-related macular degeneration (AMD), visual acuity (VA) loss of at least 15 letters, and lens opacity progression. Responsiveness was measured by the t statistic, effect size (ES), responsiveness statistic, and area under the receiver operating characteristic curve. Variance components were used to estimate the contributions of events to variability of the NEI-VFQ score. Overall NEI-VFQ score was responsive to AMD progression (t = 14.0; P< .001; ES = 0.81) and VA (t = 16.2; P< .001; ES = 0.74). Mean changes ranged from 11 to 25 points for the subscales of general vision, near and distance activities, social functioning, mental health, role difficulties, dependency, and driving. The NEI-VFQ was unresponsive to lens opacity progression, although when the event occurred in the eye with the best vision at the first administration, the lens opacity ES was moderate for the color vision (ES = 0.62) and driving subscales (ES = 0.66). Progression to advanced AMD and VA loss contributed significantly to the variation in the mean difference in overall VFQ score. Changes in the NEI-VFQ overall and subscale scores of 10 points or more are associated with clinically significant changes in vision and AMD. This finding may assist the design of interventional studies of AMD and VA loss that include the NEI-VFQ as an outcome measure.

Incidence and progression of lens opacities in the Barbados Eye Studies

Objective To provide 4-year cumulative incidence and progression rates of age-related lens opacities in a population ≥40 years of age, which is mainly of African origin. Design Cohort study that reexamined surviving members of the population-based Barbados Eye Study 4 years after baseline. Participants Three thousand four hundred twenty-seven members of the Barbados Eye Study cohort (85% of those eligible). Main outcome measures The Lens Opacities Classification System II (LOCS II) was used at the slit lamp. Cumulative incidence was defined as the development of any nuclear, cortical or posterior subcapsular (PSC) opacities (LOCS II scores ≥2) among persons without that opacity type at baseline. Cumulative progression was defined by at least two-step increases in scores among persons with preexisting lens opacities. Results The incidence of cortical opacities was about five times greater in black than white participants (age–gender adjusted relative risk = 4.7; 95% confidence interval: 1.9–11.4). In the black population, the 4-year incidence rates were 22.2% (20.4%–24.0%) for any cortical, 9.2% (8.2%–10.4%) for any nuclear, and 3.3% (2.7%–4.0%) for any PSC opacities; rates increased greatly with age. Four-year progression rates were 12.5% for cortical, 3.6% for nuclear, and 23.0% for PSC opacities, without consistent pattern by age. Women had a greater risk of cortical and nuclear opacities ( P < 0.05) than men and greater progression of nuclear opacities. The presence of PSC opacities at baseline seemed to at least double the incidence and progression rates of other opacities. In persons initially opacity free, single cortical opacities were the predominant type to develop at followup. Visual acuity loss frequently accompanied incident opacities. Conclusions This longitudinal study provides new population-based data on the natural history of lens opacities. Incidence and progression of opacities, especially of cortical opacities, were high. After 4 years of followup, 1 in 4 to 5 participants developed cortical opacities, 1 in 11 developed nuclear opacities, and 1 in 30 developed PSC opacities. The information obtained attests to the public health impact of age-related cataract, as well as its extent, in this and similar black populations.

The impact of early lens opacity progression on visual acuity and refraction.

The purpose of the present study was to evaluate the change in visual acuity and refraction taking place in eyes with progressing early lens opacities. Four hundred and ten hypercholesterolemic men in Eastern Finland who participated in the Kuopio Atherosclerosis Prevention Study were followed up for 3 years. Lens opacities were graded using the lens opacity classification system II (LOCS II). The change of visual acuity and refractive error from baseline to a 36-month examination was compared for different types of lens opacities. During the 3-year period, progression in the LOCS II was observed in 9.2% of the eyes for nuclear, in 4.8% for cortical and in 0.5% of the eyes for posterior subcapsular opacities. Increasing nuclear sclerosis reduced visual acuity statistically significantly both with and without correction. Hypermetropization was seen to continue in eyes with no lens opacity progression. Myopization was more common in eyes with lens opacity progression, although this was not statistically significant.

Cigarette smoking and risk for progression of nuclear opacities.

To examine the relationships between smoking and the 5-year incidence of new nuclear opacities and between smoking and the progression of nuclear opacities in a prospective study of a cohort of Chesapeake Bay watermen. A total of 442 men (age, > or = 30 years in 1985) with paired, gradable lens photographs in at least one eye in both 1985 and 1990 were studied. Photographs were graded by two readers who used the grading scheme of the Wilmer Institute, Baltimore, Md, with severity ranging in decimal units between 0.0 and 4.0. Data on the smoking history of the subjects were collected by personal interviews that were conducted in 1985 and updated in 1990. The incidence and progression of opacities increased with age. A nonsignificant association was observed between smoking (for both current and ex-smokers) and the incidence of a nuclear opacity. The risk of progression of nuclear opacities of less than grade 3 at baseline to grade 3 or worse was 2.4-fold higher among current smokers in 1985, compared with that among ex-smokers and nonsmokers (95% confidence limits: 1.0, 6.0) after adjustment for age, baseline opacity status, and alcohol use. An 18% increased risk of progression was significantly associated with each pack-year that a subject smoked between 1985 and 1990. These data confirm previous findings that smoking is associated with a nuclear opacity, particularly with progression to severe opacities.

Glutathione isopropyl ester (YM737) inhibits the progression of X-ray-induced cataract in rats.

The effect of glutathione (GSH) isopropyl ester on the progression of X-ray-induced cataract was investigated in rats. Intraperitoneal administration of 20 mg/kg GSH isopropyl ester, three times weekly, 1 day after a single irradiation dose delayed the progression of X-ray-induced cataracts significantly. The amount of non-protein SH groups and the Na+/K+ ratio in the lenses of drug-treated rats were maintained at the normal levels even 27 weeks after irradiation. Posttreatment with the drug resulted in a significantly lower level of malondialdehyde in the irradiated lenses than in the nontreated lenses. When 500 mg/kg GSH-isopropyl ester was administered by i.p. injection to normal rats, the GSH-ester was detected in plasma and aqueous humor after 15 min. In the lenses of the GSH-isopropyl ester-injected rats, the GSH level was 120% of that in the non-treated rats after 4 h, suggesting that GSH-isopropyl ester is transported from the aqueous humor to the lens and there converted to GSH after about 4 h. Our observations lead us to conclude that the delay of X-ray-induced lens opacity progression is due to maintenance of normal lenticular GSH levels achieved by post-irradiation administration of GSH-isopropyl ester. However, continuous administration of 100 mg/kg after irradiation had no effect on the progression of cataracts induced by X-rays.

Effects of Novel Hydantoin Derivatives with Aldose Reductase Inhibiting Activity on Galactose-Induced Cataract in Rats

Effects of novel aldose reductase inhibitors, M16209 (1-(3-bromobenzo[b]furan-2-y!sulfonyl)hydantoin) and M16287 (1 -(3-chlorobenzo[b]furan-2-ylsulfonyl)hydantoin), on galactose-induced cataract formation in rats were investigated. Rats fed a 30% galactose diet developed lenticular opacity in the peripheral region by the 6th day of galactose feeding and showed gradual progression of opacity from the equator to the center of lenses. Histological study on the 15th day showed apparent lens fiber swelling and vacuolation predominantly in the equatorial and anterior cortical regions. Biochemical changes such as accumulation of galactitol, depletion of myo-inositol and decrease in glutathione (GSH) content in lenses preceded the appearance of opacity. Remarkable increase in NADPH content and decrease in NADP+ content, in addition to elevation of the ratio of Na+/K+, in lenses were also observed on the 15th day. Both M16209 and M16287 (10, 30 and 100 mg/kg/day, p.o.) dose-dependently ameliorated these morphological and biochemical changes except that restoration of myo-inositol content was incomplete. These results indicate that M16209 and M16287 can prevent galactose-induced cataract formation through amelioration of metabolic disorders and thus have high potential for clinical use in the treatment of some diabetic complications.

Inhibition of galactose-induced alterations in ocular lens with sorbinil

Lens ultrastructure and Na- K-ATPase activity in the lenses of rats fed galactose and a galactose+sorbinil diet (aldose reductase inhibitor) were studied. Lenses of rats on the galactose diet exhibited development of peripheral opacity within 3–4 days. This opacity progressed with the continuation of the galactose feeding, and by 20 days mature cataracts were observed in these animals. The formation of vacuoles, cysts, membrane disruption in the epithelium and fibers, and swelling of fibers accompanied the development of opacity. With the progression of opacity there was a considerable drop in lens Na- K-ATPase activity in the galactose-fed animals. However, the lenses of rats that were treated with sorbinil did not show any of the alterations in the ultrastructure of the epithelium and fibers that accompany galactose cataractogenesis. The level of Na-K-ATPase activity in the sorbinil-treated animals was similar to that found in lenses from the laboratory chow-fed group of rats. These observations further substantiate the role of aldose reductase in sugar-cataract development.

Lens Opacification in Mice Exposed to 14-MeV Neutrons

The induction of lens opacification in mice exposed to 14-MeV neutrons was evaluated by counting the number of opacities observed in the posterior region of the lens using a slit-lamp microscope. The incidence of cataract formation in the anterior region of the lens was also observed. Serial observations were carried out from 3 up to 25 months after irradiation. Male hybrid mice (C54B1 X C3H), 75 days old at the time of the exposure, have been used. A linear progression of opacities was observed with age at a rate depending on the dose. By comparison with 250-kVp X rays the RBE was found to increase, with decreasing dose, from 9 to 21. The incidence of opacification in the anterior region of the lens gives an RBE value of 8. Split-dose irradiations were carried out with an interval of 24 hr between doses. There was very little difference in the number of opacities observed after single or fractionated neutron doses of approximately the same total amount. In contrast, fractionation of the X-ray dose reduced the effectiveness of the irradiation.