Risk Factor For Cataract Formation Research Articles

Be aware of cataracts following Pars Plana Vitrectomy (PPV): what should be considered?

Background: Pars Plana Vitrectomy (PPV) is a vitreoretinal surgical technique that allows access to the posterior part of the eye, with an average of 225,000 vitrectomies performed annually in the United States. However, there is an incline with the number of cataract formation as a complication following PPV surgery. In a study in the UK involving 2000 eyes after the PPV procedure, the risk of cataracts was found to be 40%, and 52% of patients would undergo cataract surgery within the first year. The development of cataracts after PPV is associated with several risk factors; however, the risk factors for developing cataracts are still unclear. Therefore, a systematic review was conducted regarding the risk factors for developing cataracts after PPV. Methods: This systematic review followed the Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines. Studies were identified through an electronic systematic search of PubMed, Embase (Elsevier), Cochrane Central (Wiley), Scopus (Elsevier), manual searching, and ClinicalTrials.gov. The search keywords used were related to “cataract”, “pars plana vitrectomy”, and “risk factor” using the Boolean operator AND and OR. We limited the studies from 2013 until 2023. All studies that discussed cataract risk factors after PPV surgery using English language will be included. Result: From 495 studies, based on inclusion and exclusion criteria, we included 6 studies with a total sample of 2.902 eyes. Risk factors associated with cataracts after PPV surgery were preoperative (older age, RRD with involvement of macular, lens status) and intraoperative (type of tamponade). It took 24 months after PPV surgery for the patient to undergo cataract surgery. Conclusion: Preoperative conditions and surgical intervention might affect the formation and progression of cataracts. Therefore, an ophthalmologist should consider several risk factors for cataract formation after PPV.

Causal association between 25-hydroxyvitamin D status and cataract development: A two-sample Mendelian randomization study.

Vitamin deficiencies are linked to various eye diseases, and the influence of vitamin D on cataract formation has been noted in prior research. However, detailed investigations into the causal relationship between 25-(OH)D status and cataract development remain scarce. To explore a possible causal link between cataracts and vitamin D. In this study, we explored the causal link between 25-(OH)D levels and cataract development using Mendelian randomization. Our analytical approach included inverse-variance weighting (IVW), MR-Egger, weighted median, simple mode, and weighted mode methods. The primary analyses utilized IVW with random effects, supplemented by sensitivity and heterogeneity tests using both IVW and MR-Egger. MR-Egger was also applied for pleiotropy testing. Additionally, a leave-one-out analysis helped identify potentially impactful single-nucleotide polymorphisms. The analysis revealed a positive association between 25-(OH)D levels and the risk of developing cataracts (OR = 1.11, 95%CI: 1.00-1.22; P = 0.032). The heterogeneity test revealed that our IVW analysis exhibited minimal heterogeneity (P > 0.05), and the pleiotropy test findings confirmed the absence of pleiotropy within our IVW analysis (P > 0.05). Furthermore, a search of the human genotype-phenotype association database failed to identify any potentially relevant risk-factor single nucleotide polymorphisms. There is a potential causal link between 25-(OH)D levels and the development of cataracts, suggesting that greater 25-(OH)D levels may be a contributing risk factor for cataract formation. Further experimental research is required to confirm these findings.

Conformational stability of the deamidated and mutated human βB2-crystallin

Previous studies propose that genetic mutations and post-translational modifications in protein crystallins promote protein aggregation and are considered significant risk factors for cataract formation. The βB2-crystallin (HβB2C) forms a high proportion of proteins in the human eye lens. Different congenital mutations and post-translational deamidations in βB2-crystallin have been reported and linked to cataract formation. In this work, we employed extensive all-atom molecular dynamics simulations to evaluate the conformational stability of deamidated and mutated HβB2C. Our results show critical changes in the protein surface and its native contacts due to a modification in the conformational equilibrium of these proteins. The double deamidated (Q70E/Q162E) and single deamidated (Q70E) impact the well compact conformation of the HβB2C. These post-translational modifications allow the exposure of the protein hydrophobic interface, which lead to the exposure of electronegative residues. On the other hand, our mutational studies showed that the S143F mutation modifies the hydrogen-bond network of an antiparallel β-sheet, unfolding the C-terminal domain. Interestingly, the chain termination mutation (Q155X) does not unfold the N-terminal domain. However, the resultant conformation is more compact and avoids the exposure of the hydrophobic interface. Our results provide valuable information about the first steps of HβB2C unfolding in the presence of deamidated amino acids that have been reported to appear during aging. The findings reported in this work are essential for the general knowledge of the initial steps in the cataract formation mechanism, which may be helpful for the further development of molecules with pharmacological potential against cataract disease.

Cigarette smoking and duration of sun exposure as risk factor for cataract formation

Cataract is the most common cause of vision loss in Indonesia. It involves many risk factors, such as age, trauma, persistent intra-ocular inflammation, ultraviolet radiation, diabetes mellitus, hypoparathyroidism, prolonged corticosteroid administration, and high body mass index. However, the role of smoking and sun exposure in cataracts has received less attention despite of the high number of cigarette smokers in Indonesia and this country also has strong sunshine all year round. The aim of this study was to investigate the relationship of cigarette smoking and duration of sun exposure with senile cataracts in Jakarta, Indonesia. This was a cross-sectional study without knowing risk factor before. A total of 100 patients participated in this study selected with consecutive sampling technique. They were divided into two groups: first was the case group consisting of 50 subjects aged more than 40 years old and diagnosed with senile cataracts and the second was the control group consisting of subjects aged more than 40 years old without cataract disease. All participants had to complete the questionnaire related to the history of smoking and duration of outdoor activity per day as it related to sun exposure. The sample was taken from the eye screening program in Puskesmas Cawang, East Jakarta. This research discovered a relationship between cigarette smoking and duration of sun exposure more than seven hours per day with the incidence of senile cataract (p=0.001) Statistical tests also showed an association between smoking duration more than 20 years and incidence of senile cataract (OR 7.25, 95% CI: 1.43 - 36.6; p = 0.02). However, the results revealed that there was no relationship between the number of cigarettes smoked per day with the incidence of senile cataract (p = 0.915). Overall, cigarette smoking and its duration appear to increase the risk of senile cataract formation.

Ocular Complications in School-Age Children and Adolescents after Allogeneic Bone Marrow Transplantation

To determine the ocular complications in school-age children and adolescents surviving at least 1 year following allogeneic bone marrow transplantation. Retrospective cohort study. In this institutional study, 162 patients (7-18 years old) met our inclusion criteria with a mean age of 13.4 years at bone marrow transplantation. Follow-up ranged from 13months to 12 years (mean 4 years; median 3.2 years). Patient charts were screened for cataract formation, dry eye, and other anterior and posterior segment diseases. Cataract formation was noted in 57 patients. Univariate analysis showed that fractionated total body irradiation, race, and use of cytarabine significantly increased the incidence of cataract formation (P < 0.05). Multivariate analysis of significant variables showed that total body irradiation was a risk factor for cataract formation. Of the 57 patients (97 eyes) who developed cataracts after bone marrow transplantation, 4 patients (6 eyes) required cataract surgery. After surgery, all patients had visual acuities of 20/20 to 20/25. Of the 162 patients, 51 developed dry eyes. Univariate analysis showed that age at transplantation; steroid use, chronic graft-versus-host disease; use of fludarabine, melphalan, and thiotepa; and receiving no pre-transplantation conditioning regimen prior to bone marrow transplant significantly increased the risk of dry eye syndrome (P < 0.05). In multivariate analysis, chronic graft-versus-host disease was a significant risk factor for dry eye syndrome. Due to the high incidence of cataract formation and dry eye disease in this population, this study proposes these patients be screened using examinations by a pediatric or general ophthalmologist at least every year.

Cataract development in children with Coats disease: risk factors and outcome

To describe the clinical features of cataract during the course of Coats disease and to determine its risk factors and effects on the long-term visual outcome. The medical records of consecutive patients with Coats disease followed for at least 2years were analyzed retrospectively. Ophthalmological examination, ancillary tests, and treatment modalities were reviewed. The time of cataract diagnosis and its management were recorded. Parameters influencing cataract development and final visual outcome were investigated using uni- and multivariate analysis. A total of 57 patients (mean age, 5.0±4.0years; 51 males) were included; cataract formation was observed in 16 (28%) during a mean follow-up of 7.1±3.7years. The mean time from diagnosis of Coats disease to cataract detection was 25±22months. Total white cataract developed in 12 patients (75%); posterior subcapsular cataract, in 4 (25%). Cataracts were surgically removed in 10 patients to improve fundus visualization and clinical follow-up. Presence of exudative retinal detachment at diagnosis was an independent risk factor for cataract formation (P=0.031). Cataract development was associated with more advanced disease stages (P<0.001). History of cataract was a significant predictor for worse final visual outcome (P<0.001), independent of disease stage (P=0.003) and presence of macular complication, such as atrophy, fibrosis, or tractional retinal detachment (P<0.001, adjusted R2=0.83). Cataract development is frequent in children with Coats disease and aggravates the visualprognosis. Exudative retinal detachment at diagnosis, present in more advanced disease stages, is an independent risk factor for cataract formation.

A cross-sectional study to compare the complications of cataract surgery with phacoemulsification in eyes with high and normal axial length

Introduction: High myopia is a risk factor for cataract formation. A relationship between myopia and higher complications in cataract surgeries has long been suggested. Materials and methods: After obtaining ethics committee clearance, this cross-sectional, case-control observational study was conducted in 100 participants of age above 18 years. They underwent cataract surgery. Participants were divided into two groups:- Group A & B - Participants with axial length between 21 and 26 mm and more than 26 mm respectively. Results and discussion: This shift of myopic individuals undergoing cataract surgery at an earlier age was found to be statistically significant. There was a statistically significant association between increasing age and PCR. Most common type of cataract in group A is cortical (30.8%) followed by nuclear (28.8%). Most common type of cataract in a group B is PSC (50%) followed by nuclear (22.9%). There was no statistical association between type of cataract and any complication. Conclusions: Intraoperative complications of cataract surgery do not increase significantly with increase in axial length. Myopic individuals are prone to develop cataracts earlier. NS and PSC type of cataracts are more common compared to cortical type of cataracts in emmetropic individuals.

Asociación de factores de riesgo ambientales en el desarrollo de las cataratas preseniles

PurposeTo determine if smoking, alcohol intake, presence of hypertension (HT) or diabetes are risk factors (RF) for cataract development. MethodsA retrospective study was performed evaluating the following 3 groups of patients: 72 subjects younger than 55 years who underwent to cataract surgery (presenile cataract group); 101 subjects older than 55 years with cataract surgery performed (senile cataract group) and 42 subjects older than 55 years without lens opacity (no cataract group). The presence of the RF previously appointed in each study group was analysed. ResultsThe comparison of the RF presence between presenile cataract group and senile cataract group showed a significant association between RF (smoking, alcohol intake and presence of hypertension) and the risk for developing cataracts at an early age (P<.01). The comparison between presenile cataract group and no cataract group demonstrated a strong statistical association between smoking and alcohol intake and risk of presenile cataract (P<.01). The comparison between senile cataract group and no cataract group showed that alcohol intake is a strong risk factor for cataract formation (P=.027). ConclusionsSmoking, alcohol intake and arterial hypertension are risk factors for presenile cataracts development in our population. Alcohol consumption is also involved in the formation of senile cataract.

This issue of ACTA, printed and electronic

The cover illustration is a schematic drawing showing surgical technique for retinal vein cannulation and tissue plasminogen injection. This is reported by van Overdam et al. in this issue of Acta. Chan et al. in China review conflicting reports on the efficacy of corneal collagen cross-linking in infectious keratitis. Klefter et al. in Denmark measure increased retinal oxygen extraction in hyperglycaemia in patients with diabetes. van den Akken-van Marle et al. in Leiden recommend a risk factor guided screening programme for retinopathy of prematurity. Lin et al. in Taiwan correlate diabetic polyneuropathy and retinopathy in a nationwide study. vRezar et al. in Vienna report long-term benefits from anti-VEGF treatment for macular oedema in BRVO. Early treatment gives better visual outcome. Hautamäki et al. in Helsinki suggest that interleukin-8 may play a role in neovascularization in AMD. Fauser et al. in Köln measured elevated local inflammatory cytokines in neovascular AMD eyes. van Overdam et al. in Rotterdam show a surgical technique for retinal vein cannulation and tissue plasminogen injection in CRVO. Peters et al. in Sweden associate visual field index under 50% and/or mean defect worse than 18 dB with poor quality of life. Matlach et al. in Germany find trabeculectomy to reduce IOP more than canaloplasty, but with more complications. Rönnback et al. in Copenhagen and Singapore find genotype–phenotype heterogeneity in autosomal dominant optic atrophy. Mathew et al. in Houston and Uppsala find lamellar splitting in histological examination of keratoconus. Ekström and Taube in Uppsala suggest that pseudoexfoliation is a risk factor for cataract formation. Aclimandos et al. in UK, Belgium, France and Switzerland inform us about EBO's subspeciality examinations. Pérez-Cambrodí et al. in Spain and Poland review cataract aspiration with hollow needle in antiquity. The following articles are published in the electronic issue of ACTA and are accessible on www.actaophtalmologica.com, where you can also access the printed articles. Anitua et al. in Spain and USA examine the use of blood derived formulations used for the treatment of ocular surface disorders. Aptel et al. in France find great variation in progression visual field damage in POAG. Pillunat et al. in Germany stress nocturnal blood pressure dips in patients with glaucoma and relate this to daytime blood pressure measurements. Hussnain et al. in USA found more decline in corneal hysteresis in patients with glaucoma, but diabetes had no impact. Sheu et al. in Taiwan examined the effect of anti-VEGF drugs on retinal pigment epithelial cells and found variable effects on mitochondrial bioenergetics. Murakami et al. in Japan found reduced blood flow in macula to be associated with visual deterioration. Achiron et al. in Israel quantify metamorphopsia in DME and other macular diseases. Petrovic et al. in Slovenia and Czeck Republic relate a gene for reactive oxygen species modulation to the progression of diabetic retinopathy. García et al. in Spain and USA confirm the role of complement factor H gene in AMD and found variable effects of different haplotypes. Vagge et al. in Italy used near-infrared reflectance to image choroidal lesions in neurofibromatosis. Stemplewitz et al. in Germany found reduce macular volume and retinal nerve fibre thickness in patients with Parkinson's disease. Hoskin et al. in Australia emphasize the risk of fishing accidents and the need for eye protection. Vestergaard et al. in Odense find penetrating eye injuries to be most common in young men. Kuiper et al. in Utrecht discuss aqueous humour versus vitreal measurements of interleukins in diagnosis of ocular lymphoma. Tachibana et al. in Japan find improvement in horizontal but not vertical metamorphopsia following epiretinal membrane peeling. Suh et al. in Korea connect a connective tissue growth factor gene with pseudoexfoliation. Tode et al. in Germany use anti-interleukin-6 treatment for necrotizing scleritis. Örnek et al. in Turkey report transient thinning of choroid with bevacizumab injections for DME. Fonollosa et al. in Spain used a kinase inhibitor, vemurafenib to treat macular oedema in uveitis. Schäffer et al. in Austria relate anterior vitreous attachment and pseudophakic retinal detachments. I wish you a Merry Christmas, happy holidays and a prosperous New Year!

Risk Factors for Cataract Formation after Implantable Collamer Lens Implantation: Over a Mean 7.5-Year Follow-Up Period

Purpose: To determine the risk factors and incidence of cataract formation over a long-term mean follow-up of 7.5 years after type V4 implantable collamer lens (ICL) implantation. Methods: We analyzed the preoperative, 3-month postoperative, 3-year postoperative, and last follow-up data of 228 eyes (118 patients) with mean preoperative spherical equivalent of -12.7 D and minimum postoperative follow-up of 3 years. Additionally, we determined the risk factors for cataract formation and calculated the 10.3 year cumulative cataract formation rate and 10.3 year cumulative cataract surgery rate using a survival curve. Results: After type V4 ICL implantation with minimum follow-up of 3 years, the calculated 10.3 year cumulative cataract formation rate was 20% and actual cataracts developed in 34 eyes (14.9%). The 10.3 year cumulative cataract surgery rate was 12% based on a survival curve and actual cataract surgery was performed in 12 eyes (5.3%). The risk factors for cataract formation were age (odds ratio [OR] = 1.10, p = 0.00), preoperative spherical equivalent (OR = 0.90, p = 0.00), crystalline lens thickness (OR = 9.54, p = 0.00), axial length (OR = 1.33, p = 0.00), 3 months postoperative vault (OR = 0.50, p = 0.03), and existence of peripheral touch between ICL optic margin and crystalline lens at last follow-up (OR = 7.84, p = 0.00). Conclusions: We suggest one of the main risk factors for cataract formation after ICL implantation is decreased central vault and peripheral touch between ICL optic margin and crystalline lens. J Korean Ophthalmol Soc 2015;56(6):835-846

The Manchester Uveitis Clinic: The first 3000 patients, 2: Uveitis Manifestations, Complications, Medical and Surgical Management

Purpose: To demonstrate the manifestations and complications of uveitis, and their medical and surgical management, in a very large group of patients attending the Manchester Uveitis Clinic (MUC), a specialist uveitis clinic in the Northwest of England, UK.Methods: Retrospective retrieval of data on a computerized database incorporating all new referrals to MUC from 1991 to 2013.Results: A total of 3000 new patients with uveitis were seen during a 22-year period, of which 25.2% had a single acute episode, 13.6% had acute recurrent uveitis, 20.2% had chronic fluctuating uveitis, and 41.0% had chronic unremitting uveitis. The commonest complications were cataract (35% of patients), macular edema (20.5%), and glaucoma (19.5%). Oral steroids were required in 36% of patients, oral immunosuppression in 16%, and biologic treatment in 2%. Major intraocular surgery was required in 28%.Conclusions: Oral steroid usage is not an independent risk factor for cataract formation in patients with uveitis. Oral immunosuppression usage has increased 4-fold during this study period.

Age-related reduction in calbindin-D28K expression in the Sprague-Dawley rat lens

Calcium levels in the lens rise with increasing age and increased intracellular calcium accumulation is known to be a risk factor for cataract formation. Calbindin-D28K (CALB1) is an intracellular calcium buffer. It is not clear whether CALB1 levels change in response to the Ca2+ accumulation in the lens that occurs with age. The present study investigated the distribution of CALB1 in the lenses of Sprague-Dawley (SD) rats and whether this changed with age. Lenses were isolated from SD rats at 1, 6, 12 and 18 months of age. CALB1 distribution was examined using immunohistochemistry. Lens epithelial cells were counted in median sagittal plane slices from the hematoxylin and eosin-stained lens and quantified using western blot analysis. Calb1 gene expression was examined using reverse transcription-quantitative polymerase chain reaction. CALB1 was distributed in the epithelial and fiber cells of the lens. CALB1 levels declined significantly with increasing age, whilst there was no significant accompanying decrease in the number of lens cells. A similar reduction was noted in CALB1 mRNA levels. To the best of our knowledge, this is the first study to demonstrate that CALB1 expression and CALB1 protein levels in SD rat lens decrease with age. This reduction does not reflect a reduction in lens cell numbers but a genuine reduction in gene expression within these cells. Thus, CALB1 may be important in changes occurring in the lens in older age, in particular in the development of cataracts.

One-year outcomes in eyes remaining phakic after Descemet membrane endothelial keratoplasty

To assess 1-year outcomes in patients remaining phakic after Descemet membrane endothelial keratoplasty (DMEK). Private clinic, Indianapolis, Indiana, USA. Interventional case series. Data on consecutive DMEK cases with retention of the crystalline lens were reviewed. The outcome measures were development or progression of postoperative lens opacity, performance of cataract extraction, endothelial cell loss, and corrected distance visual acuity (CDVA) at 1 year. The rate of and risk factors for cataract formation and extraction were analyzed using multivariate proportional hazards modeling and Kaplan-Meier survival analysis. Of the 49 eyes, 15 (31%) had trace nuclear sclerosis and 34 (69%) had clear lenses preoperatively. The median patient age was 50 years. Forty-eight eyes (98%) were treated for Fuchs dystrophy. The median follow-up after DMEK was 12 months. All grafts cleared and remained clear. Cataract progression occurred postoperatively in 37 eyes (76%); cataract surgery was performed in 16 eyes (33%). Patients older than 50 years had a higher risk for cataract progression after DMEK (P=.0094). The median endothelial cell loss was 25% within the first year. The median CDVA was 20/20 at 1 year. Descemet membrane endothelial keratoplasty accelerated the natural rate of cataract formation, consistent with data on other types of corneal transplantation including penetrating keratoplasty and Descemet-stripping automated endothelial keratoplasty. Patients older than 50 years had higher risk for cataract progression than younger patients. The majority of patients achieved 20/20 CDVA.

Highlights of This Issue

In the United States, primary care physicians play a central role in implementing cancer screening guidelines because many cancer screens require a referral to a specialist. Yabroff and colleagues assessed primary care physicians' use of system strategies in cancer screening, including screening reminders, screening rate performance reports, and implementation of practice guidelines. They found that only 10% of primary care physicians in the United States used systems strategies to support breast, cervical, and colorectal cancer screening. This is the case despite extensive evidence on the effectiveness of these strategies to improve patient care. This report highlights the need for more primary care practices to implement systems strategies to improve the use and quality of cancer screening.The Risk for Ovarian Malignancy Algorithm (ROMA) is a tool that uses serum levels of human epididymis protein 4 (HE4) and CA125 to determine the risk of epithelial ovarian cancer (EOC) in patients with a pelvic mass. In this study, Bandiera and colleagues analyzed the diagnostic and prognostic value of HE4 and CA125 alone or combination (ROMA) to evaluate EOC risks. In both pre- and postmenopausal women, the high specificity of HE4 helped discriminate benign cysts from EOC, and the high sensitivity of CA125 was important for detecting EOC. Elevated HE4 and ROMA were both independent prognostic factors for shorter overall survival. Future multicenter studies will be necessary for further assessment of HE4, CA125, and ROMA to monitor EOC.Although solar UV radiation is a risk factor for cataract formation, the major health benefit of UV radiation exposure is the production of vitamin D, which is implicated in protection against several cancers. In this population-based case–control study, Lurie and colleagues examined the association of ovarian cancer risk with cataract formation as an indicator of high long-term UV radiation exposure. The authors report that a history of cataracts was significantly associated with reduced risk for ovarian cancer, adding indirect evidence to the hypothesis that lifetime vitamin D exposure may be inversely associated with the risk of ovarian cancer.Genetic polymorphisms of Toll-like receptors (TLR) may influence the outcome of Helicobacter pylori infection and play roles in gastric cancer. Zeng and colleagues conducted a population-based study to screen the genetic variants of TLR2 and TLR5 and evaluate their associations with gastric cancer. The authors detected 9 genetic variants within the promoters and exons of TLR2 and TLR5 that either decreased or increased the risk of gastric cancer and/or H. pylori infection. These findings suggest that TLR2 and TLR5 gene variants may influence H. pylori–related gastric cancer carcinogenesis.

Rate and risk factors for cataract formation and extraction after Descemet stripping endothelial keratoplasty

PurposeTo assess the rate and risk factors for cataract formation and extraction after Descemet stripping endothelial keratoplasty (DSEK).MethodsAn initial, consecutive series of 1050 primary DSEK procedures was reviewed to identify...

Cataract Formation after Penetrating Keratoplasty

Purpose: To evaluate the risk factors for cataract formation and cataract extraction after penetrating keratoplasty to determine whether a combined surgery should be performed. Methods: Variables from 189 phakic eyes that underwent penetrating keratoplasty from April 1992 to November 2004 were analyzed for the possibility of cataract extraction after penetrating keratoplasty according to sex, age, diagnosis, accompanied glaucoma, preoperative vision and steroid use. The mean interval between penetrating keratoplasty and cataract extraction was also studied. Results: Cataract extraction was performed in 27 eyes (14.3%) and the mean interval between keratoplasty and cataract extraction was 24.5 months. Age was determined to be the most important independent risk factor for cataract extraction (p=0.0009) associated glaucoma also shown to be a risk factor (p=0.0011). Sex and corneal disease before keratoplasty were not shown to be risk factors. In the mean interval cataract extraction following penetrating keratoplasty, no statistically significant difference was found according to age, sex and diagnosis. Posterior subcapsular cataract was predominant (55.6%) and the mean visual acuity improved from 0.10 to 0.42. Conclusions: The likelihood of cataract formation and cataract extraction subsequent to penetrating keratoplasty increased with age and associated glaucoma. The results from this study can help surgeons to determine whether combined surgery should be performed and help them to counsel patients on the risk of cataract formation.

Smoking and cataract: Review of causal association

Several risk factors for the development of cataract have been identified. This review evaluates epidemiologic literature that has examined tobacco smoking as a risk factor for cataract formation using established causality criteria. Twenty-seven studies were included in this review. Evidence suggests that smoking has a 3-fold increase on the risk for incident nuclear cataract development. There was also evidence of dose response, temporal relationship, and reversibility of effect. There was limited evidence of an association between smoking and posterior subcapsular cataract, but little or no association with cortical cataract. Thus, the literature review indicated a strong association between smoking and the development of cataract, particularly nuclear cataract. The association fulfills the established criteria for causality. The association between smoking and other types of cataract is less distinct and requires further evaluation.

Traumatic cataract and other adverse events with the implantable contact lens

To evaluate the surgical outcome and adverse events associated with implantation of the implantable contact lens (ICL) for the correction of high myopia or high hyperopia. Helsinki University Eye Hospital, Helsinki, Finland. In this nonrandomized prospective clinical trial, the ICL V4 was implanted in 26 eyes of 13 patients with normal enrollment criteria (younger than 45 years, a clinically clear crystalline lens) (Group 1) and the V2, V3, or V4 were implanted in 38 eyes of 22 patients with heterogeneous criteria (older than 45 years or opacities in the crystalline lens) (Group 2). The main outcome measures were lens opacity classification system (LOCS II) assessment and transparency analysis of the lens. In Group 1, microdensitometric assessment showed no decrease in crystalline lens transparency and no statistically significant increase in crystalline lens density at any follow-up examination (P>.05). The incidence of anterior subcapsular (AS) opacities was 7.7%, and no eye developed clinically significant cataract during the mean follow-up of 13.2 months +/- 12.3 (SD). No myopic eye lost a line of best corrected visual acuity (BCVA); 50.0% of hyperopic eyes lost 1 line of BCVA. Sixty-eight percent of myopic eyes and 75.0% of hyperopic eyes were within +/-1.0 diopter of the predicted refraction. In Group 2, the incidence of AS opacities was 47.4% and 10 eyes (26.3%) developed clinically significant cataract during the mean follow-up of 30.9 +/- 18.0 months. The visual and refractive results were similar to those in Group 1 at 1 month, but due to progressive AS opacities in the crystalline lens, 23.4% of eyes lost BCVA lines during the follow-up. Intraoperative complications were few and insignificant. Implantation of the ICL for correction of high myopia or high hyperopia appears to be a safe procedure with good visual and refractive results immediately. There was no decrease in the transparency or increase in the density of the crystalline lens with the latest generation of the ICL device in the normal group, indicating enhanced safety. Progressive lens opacification in the heterogeneous group shows there are risk factors for cataract formation; ie, type V3 ICL, preexisting lens opacities, and older patient age. Anterior subcapsular opacities are most likely the result of trauma.

Curative radiation therapy for primary orbital lymphoma

Purpose: To review our institutional experience with primary orbital lymphoma and determine prognostic factors for survival, local control and distant metastases. In addition, we also analyzed the risk factors for complications in the radiotherapeutic management of this tumor. Materials and Methods: Tumor registry records of 91 patients (pts) with orbital lymphoma from 1973 to 1998 treated at one institution were reviewed. Pts were excluded from the study if they had pseudolymphoma, intraocular lymphoma, metastases to the orbit, palliative radiation therapy or follow-up of less than 6 months. A total of 47 pts with primary orbital lymphoma were treated for cure with radiation therapy. There were 18 males and 29 females with a median age of 69 years (range, 32 to 89 years). Four pts had bilateral involvement. Tumor was located in the eyelid and extraocular muscles in 58%, lacrimal gland 21% and conjunctiva in 21%. Histology was low grade in 68%, intermediate in 30% and high grade in 2%. All pts were stage IAE. Median dose for low grade tumors was 3000 cGy with a range of 2000 – 4020 cGy, while the median dose for intermediate and high grade tumors was 4140 cGy with a range of 3000 – 5100 cGy. Fraction size was 200 cGy in 32 pts, 180 cGy in 14 pts and 170 cGy in 1 patient. Beam energy was 4 MV photons in 62%, 6 MV in 13%, 1.25 MV in 8% and orthovoltage in 2%. Electrons were used in 9% of pts. A single anterior field was employed in 32% pts; the remaining pts were treated with a two field technique that included an anterior and an oblique field or two oblique fields. Pts with bilateral involvement were treated with two lateral fields. Lens sparing technique was used in 34% of pts. None of the pts received chemotherapy for initial management of the tumor. Median follow-up time was 55 months (range 6 to 232 months). Log rank analysis was performed to determine the factors which influenced overall survival and distant metastases. Multivariate logistic regression analysis was employed to determine risk factors for cataract formation and corneal injury. Lens and corneal complications were graded according to objective portion of the SOMA scale of the Late Effects of Normal Tissue (LENT) Scoring System. Results: Local control was 100% in the 51 orbits treated. The overall survival at 5 years was 73.6%. Tumor grade and location within the orbit had no prognostic significance for overall survival or distant metastases. Seven pts developed distant metastases. Sites of metastases included mediastinum, abdomen, extremity and CNS. Cataracts were LENT grade 1 in 8 and grade 2 / 3 in 4 pts. Corneal toxicity was LENT grade 1 in 17 and grade 3 in 1 patient. All pts who had corrective surgery had grade 2 or 3 complications. On multivariate analysis, only male gender predicted for increased risk of cataract formation. Age, radiation dose, fraction size, steroid use and lens sparing technique did not affect the rate of complications. None of the pts who had a lens block had a grade 2 or 3 complication or required surgical correction. Conclusion: Radiation therapy alone is a highly effective modality in the curative management of primary non-Hodgkin’s lymphoma of the orbit. Excellent local control is achievable with radiation doses of 3000 cGy in low-grade and 4000 cGy in intermediate/high grade tumors using conventional fractionation. Although the use of lens sparing technique did not influence cataractogenesis, we continue to recommend lens blocks whenever possible because our experience indicates a higher grade of toxicity and corrective surgery in pts treated without lens sparing technique.

The Reykjavik Eye Study – Prevalence of Lens Opacification with Reference to Identical Japanese Studies

Purpose: A population-based cataract epidemiological study, the Reykjavik Eye Study, was conducted to determine the prevalence and characteristics of lens opacities in Iceland. The results were compared with those from previous surveys in Japan to determine the influence of race and environmental factors. Methods: 1,635 randomly selected residents of Reykjavik, Iceland, were enrolled, and among them, 1,045 responded and took part in the study. The subjects received ophthalmological examination of both the anterior and the posterior segments. Changes in the crystalline lens were examined and photographed under maximal pupillary dilation. Classification of the opacity types and grading of the extent of lens opacificiation were done using a standardized scheme, and the data were analyzed with Student’s test, the χ² test and the Mantel-Haenszel test. Results: The prevalence of lens opacities in subjects in their 50s, 60s, 70s and in those 80 years and older was 42.7, 61.0, 85.3 and 100%, respectively. Grade II and III lens opacities were found in 2.2% of subjects in their 50s and in 10.5, 35.9 and 62.3% in their 60s, 70s, and over 80 years, respectively. Cortical opacities predominated in all age groups followed by nuclear opacities; subcapsular opacities, on the other hand, were quite rare. A unique type of opacity, i.e., granular opacity, seldom seen among the Japanese, was found in 6.6% of the Icelandic subjects. Conclusions: Our results show that cortical opacity is the major type of opacity in Icelandic subjects, although its prevalence was lower than that in the Japanese subjects. Interestingly, the first appearance of lens opacities of grades II and III in Icelanders was delayed by 10 years compared to the Japanese suggesting fewer or less severe risk factors for cataract formation in Iceland.