White Mature Cataract Research Articles

Ultrasonographic assessment of vitreoretinal pathologies in white mature cataract

: To evaluate the incidence of significant posterior segment abnormalities in eyes with white mature cataract and to assess association of vitreoretinal pathologies with different ocular and systemic disorders. This cross-sectional study was conducted on 100 patients with white mature cataract presenting for cataract surgery. Detailed relevant history was noted. Complete ocular examination done and B-scan performed. Percentage of patients with abnormal B-scan findings in various groups were calculated and association of systemic/ ocular factors with vitreoretinal pathologies were evaluated using paired chi square test. : Mean age of patients was 60.78±9.001 years with a female preponderance (58%). 92% cases had senile mature cataract, 3% were presenile, 3% were traumatic and 2% were complicated mature cataract. Most common pathological finding on B-scan was vitreous opacity seen in 16% cases, followed by posterior vitreous detachment seen in 6%. Vitreous hemorrhage was seen in 3% cases while 69% cases showed normal posterior segment. Patients were grouped into two categories- one comprised patients with relevant systemic and/ or ocular history (47%), while other category belonged to patients with no such history (53%). On comparing the number of patients with abnormal B-scan findings in the two categories, no statistical significance was noted. (p value=0.105).B-scan ultrasonography is an important presurgical investigation in patients with dense cataracts for diagnosing posterior segment pathologies that may influence post operative visual outcome.

Visual Outcome and Complications in White Mature Cataracts after Phacoemulsification.

To identify risk factors and perioperative complications and assess postoperative visual outcome in patients of white mature cataracts undergoing phacoemulsification surgery. This cross-sectional study was conducted on 46 patients of white mature cataract undergoing phacoemulsification. Preoperatively, a detailed ocular examination was done, and anterior chamber depth (ACD) and lens thickness (LT) were measured on ultrasound biomicroscopy. Intraoperative and postoperative complications (on days 1, 7, and 30) and best-corrected visual acuity on postoperative day 30 were noted. The mean age of patients was 60.78 ± 9.001 years. The study group consisted of 41.3% of males and 58.7% of females. 8 (19.56%) cases encountered complications during phacoemulsification surgery. The intraoperative complications were capsulorhexis-related in 5 (10.86%) patients, posterior capsular rent in 2 (4.3%) patients, and 1 (2.17%) case had zonular dialysis. There was no difference in mean ACD and LT in cases who developed complications and those who underwent uneventful surgery (P > 0.05). The commonly observed postoperative complications on day 1 were corneal edema (41.3%), anterior chamber flare (45.65%), and cells (39.13%) which resolved with routine topical medications. All patients showed a significant reduction in postoperative intraocular pressure (P < 0.001). A total of 37 (80.43%) eyes regained vision between 6/6 and 6/9 postoperatively (P < 0.001). Phacoemulsification surgery is safe in white mature cataract that results in significant visual improvement. Common intraoperative complications are capsule related, while frequently encountered postoperative complications are corneal edema and anterior chamber reaction. Preoperative ACD and LT have no role in predicting intraoperative complications.

Neovascularisation of the lens capsule: a unique finding

A 62 year-old man consulted for progressive loss of vision in both eye. His past ophthalmological history was unremarkable and he denied any known systemic condition. On examination, his best corrected visual acuity was light perception oulus uterque (OU). Papillary reaction to light was sluggish oculus sinister (OS) and normal OU. Ocular motility was full OU with normal intra-ocular pressure. Slit-lamp examination showed bilateral white mature cataract with low pharmacological dilation. High magnification under dilation revealed a vascular network composed of fine vessels located nasally adjacent to the papillary border on the anterior capsule of the lens associated with pigment deposits and loss of the papillary frill (A). There was no evidence of neovascularisation of the iris (NVI) or the angle neurovascular assessment (NVA). Ocular ultrasound was negative for vitreous hemorrhage or retinal detachment. Ancilliary testing for diagnosis of common aetiologies of anterior segment neovascularisation was carried out and revealed type 2 diabetes. The patient was referred for evaluation and control of his newly diagnosed diabetes. After six months, we performed an uneventful cataract surgery by phacoemulsification. Fundus fluorescein angiography (FFA) showed posterior segment ischemia with neovascularisation elsewere (B). Neovascularisation spared the iris and the angle. Thus, nerve conduction velocity (NVC) was the solely sign of anterior segment neovascularisation.

Achieving successful capsulorhexis in intumescent white mature cataracts to prevent Argentinian flag sign - A new multifaceted approach to meet the challenge.

Purpose:To present a case series of intumescent white cataract cases managed by a new surgical technique to attain a single stage Continuous Curvilinear Capsulorhexis (CCC).Methods:The series included 60 eyes of 60 patients with white cataract which underwent preoperative anterior chamber depth, lens thickness and ultrasonographic A-scan for intralenticular spikes. A partial size main port (~1.8mm) is created as the first entry into the anterior chamber (AC). A 30-gauge needle of insulin syringe entered through a limbal stab incision is used to decompress the anterior and posterior intralenticular compartments. Following which a standard size, one stage capsulorhexis was performed in a trypan blue stained capsule using microcapsulorhexis forceps entered through the partial sized trapezoidal main port. The main port was secondarily enlarged for phacoemulsification.Results:Based on the intraoperative findings, 43 eyes were categorized as Intumescent type-1 cataracts i.e., with presence of actual liquefied cortex aspirated using 30-gauge needle and 17 eyes as Intumescent type-2 cataracts, i.e., presence of swollen lens without any obvious liquefied cortex. Standard size, circular and centred CCC was achieved in 100% of the cases and no Argentinean flag sign was noted. Surgeon perceived raised intralenticular pressure in 41% of the cases in type-1 subset and 61% cases in type-2 subset (P-0.06). Posterior capsular plaque was observed in 22% of the cases, adherent cortex in 25% and anterior capsular plaque in 5% of the cases. At 6weeks follow up 92% patients had best corrected visual acuity of 20/40 or better.Conclusion:A multi-layered approach can help in attaining successful CCC in cases of white mature cataract with high intralenticular pressure.

A new technique of phacoemulsification without hydroprocedures

Purpose: We describe a new technique where phacoemulsification can be safely performed without doing hydroprocedure. Materials and Methods: We conducted a prospective, nonrandomized, noncomparative, single-center study where Group A had undergone phacoemulsification without hydroprocedure and Group B had undergone conventional phacoemulsification. After capsulorhexis, we insert the phacoemulsification tip into the eye without doing any hydroprocedure. First shaving of the cortex and epinucleus is done within the capsulorhexis area. Then, the tip is buried into the center of the nucleus and an anteroposterior crack is fashioned. Then, the tip is placed at 8 o'clock position to chop away a piece of nucleus and emulsified. A similar maneuver is done at 4 o'clock position. The phacoemulsification tip and the chopper are now positioned at the cracked site of the lower fragments. Using the two instruments, the fragments are pushed to the opposite direction and emulsified. Results: The mean age of the patients of Group A was 65.7 ± 8.16 years and Group B was 68.9 ± 9.85 years (P = 0.127). The mean best-corrected visual acuity in Group A improved from 0.92 ± 0.49 logarithm of the minimum angle of resolution (logMAR) to 00.01 ± 0.02 logMAR at 3 months postoperatively. The mean endothelial cell loss was 145 ± 123 cells/mm2 at 3 months postoperatively. There was no significant difference in postoperative outcomes between both the groups. Conclusion: The technique can be safely applied in all cataracts, especially posterior polar cataract and white mature cataract where hydrodissection is contraindicated.

Case series of deep anterior lamellar keratoplasty combined with phacoemulsification and intra-ocular lens implantation – a modified triple procedure

Background: Patients presenting with corneal pathology and cataract present a surgical challenge to the operating surgeon. Some Ophthalmologists prefer to perform combined keratoplasty and cataract surgery simultaneously, while some prefer to perform sequentially. Purpose: To describe performing deep anterior lamellar keratoplasty and phacoemulsification surgery on two patients with corneal opacity and cataract. Setting: National Eye Hospital, Colombo Methodology: We report two patients who underwent Deep Anterior Lamellar Keratoplasty (DALK) and cataract surgery.The first patient was a 66-year male patient. He had hand movement vision in both eyes. The right eye had diffuse corneal haze (corneal depositions) and a white mature cataract. The left eye also had corneal haze and a mature cataract. The fundi could not be visualized but the B scan showed an attached retina. The intra-ocular pressure of both eyes were normal.The second patient was a 54-year female with right eye 6/60 due to diffuse corneal opacity (old interstitial keratitis) and mature cataract in the right eye. The left eye had a clear cornea and had IOL and the Best corrected visual acuity was 6/6. The fundus of the right eye was poorly visualized, but the B scan showed attached retina and the Intra-ocular pressure was normal.Surgery was performed in the sequence of lamellar keratoplasty followed by phacoemulsification and Intraocular lens implantation and finally completion of corneal deep anterior lamellar keratoplasty with manual dissection. Both patients achieved good visual outcomes over 6 months postoperatively. Conclusion: Corneal pathology with cataracts can be operated on as a simultaneous surgery. However, preoperative planning for surgical surprises and the suitable sequalae of surgical steps, with proper IOL power calculation leads to good visual outcomes.

FEMTOSECOND LASER-ASSISTED CATARACT SURGERY IN EYES WITH WHITE MATURE CATARACT

Purpose: To compare the results of femtosecond laser-assisted cataract surgery with manual cataract surgery in eyes with white mature cataract. Material and Methods: Thirty-four eyes of 34 patients with white mature cataract who had undergone femtosecond laser-assisted cataract surgery (FLACS) were compared retrospectively with 34 eyes of 34 patients with white mature cataract who had undergone manual cataract surgery. Results: In respect to age and sex, there was no significant difference between two groups. There was no significant difference between the mean preoperative and postoperative uncorrected distance visual acuity (UCVA) and best corrected visual acuity (BCVA) of the first and second group (P values, 0.659, 0.634, 0.603 and 0.557, respectively). The percentages of radial tears, posterior capsule rupture and vitreous loss were higher in the second group than in the first group, but the differences were not significant statistically (p values, 0.06, 0.06 and 0.113, respectively). Conclusion: FLACS is a safe and effective surgery for white mature cataract. When compared with manual phacoemulsification surgery, although the percentages of some intraoperative complications such as radial tears and posterior capsule ruptures are higher in manual phacoemulsification surgery, the differences are not significant statistically.

Phacomulsification in senile white mature cataracts;its safety and efficacy

Abstract&#x0D; Purpose &#x0D; To evaluate the intraoperative difficulty, complications and post operative outcome in patients with white mature cataracts undergoing phacomulsification and foldable intraocular lens implantation and to develop a strategy for achieving continuous curvilinear capsulorhexis in these cases.&#x0D; Study design&#x0D; Descriptive case series&#x0D; Place and duration &#x0D; Ophthalmology department of Holy family hospital, Rawalpindi in six months interval since January 2017 to June 2017&#x0D; Material and Methods &#x0D; 50 Patients who had senile white mature cataract were enrolled in this prospective study .Detailed preoperative and intraoperative notes were made. A small capsulorhexis was attempted initially after staining capsule with trypan blue .An initial cut was made with cystotome and it was enlarged with utrata forceps. Endophacomulsification was done with stop and chop technique. Intraoperative difficulties related to continuous curvilinear capsulorhexis, phacomulsification and post operative visual outcomes were analyzed.post operative examinations were done at day 1,1st week,1st month and 3rd month.&#x0D; Results&#x0D; There were 28 males (56%) and 22 females (44%).The mean age was 63.18±7.997 standard deviation years(48-78).The mean preoperative best corrected visual acuity BCVA was 0.0276±0.013 (SD)Snellen, decimal(0.01-0.05) and the mean post operative BCVA was 0.638±0.305 (SD) Snellen, decimal(0.1-1.0) .Mean phaco time was 4.08±1.03 (SD)mins(2.08-6.66).The mean preoperative intraocular pressure IOP was 15.90±1.799 (SD)mmHg (12-22) and mean post op IOP was 11.98±2.035 (SD) mmHg(10-18) .Posterior capsular rupture occurred in 3 (6%) , vitreous loss occurred in 1 (2%) patients. 5 (10%) cases were converted to extra capsular cataract extraction (ECCE). Postoperatively 10 (20%) patients had transient corneal edema, 3 patients (6%) had persistent corneal edema and corneal burn treated with steroids and hyper osmotic agents.&#x0D; Conclusion &#x0D; The intraoperative and postoperative complications rate is higher in white mature cataracts. White mature cataract is a challenge for cataract surgeon, yet by means of additional dyes and proper techniques and expertise, the rate of complications can be reduced.&#x0D; Keywords&#x0D; Phacomulsification, continuous curvilinear capsulorhexis, senile mature cataract, trypan blue, posterior capsular rupture, persistent corneal edema

A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil.

PurposeTo report a simple, effective technique for surgeons creating a capsulorhexis in patients with pupillary miosis and a dense, mature cataract.MethodsA single center, two-year retrospective chart review examined 1408 phacoemulsification cataract surgeries. The criteria for inclusion involved a dense, mature cataract and a pupil that was unresponsive to pharmacologic dilation preoperatively. A standardized technique was used for all cases consisting of a 1mm corneal paracentesis and 2.4mm temporal clear corneal incision. Synecholysis was performed if present, followed by the insertion of a 6.25mm malyugin ring under cohesive viscoelastic. The cohesive viscoelastic was removed via the irrigation aspiration tip. The paracentesis was sealed with a small amount of viscoelastic and an air bubble was placed in the anterior chamber. The anterior capsule was then painted with trypan blue. The air bubble and trypan blue were then replaced by a dispersive viscoelastic. Curvolinear capsulorrhexis was performed followed by standard phacoemulsion.ResultsNine patients ranging from 76 ± 12 years (mean ± standard deviation) met the criteria with a 4+ NS (n=5), white mature (n=3), or deep brunescent (n=1) cataract and 3mm pupil preoperatively. Pupillary miosis was caused by posterior synechia in 44.5% of the cases followed by pharmacologic interactions from tamsulosin and donepezil in 22.25% of cases respectively. One case involved idiopathic miosis likely from aging. Capsulorhexis formation was successful in all cases with no capsular tear, vitreous loss, or conversion to extracapsular cataract extraction (ECCE). However, one case had cortex retention requiring a second procedure for removal.ConclusionDense, mature cataracts and small pupils both compromise the view for the surgeon and may be significant risk factors for training ophthalmologists. Thus, good visualization of the anterior capsule and peripheral nucleus with our simple technique facilitates a reliable capsulorhexis, potentially limiting the risk of complications for ophthalmic surgeons.

Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report

To report a case of central retinal artery occlusion after Descemet membrane reposition by intracameral air. An otherwise healthy 60-year-old woman presented with white mature cataract in her left eye. Ocular exam of both eyes was within normal limits. After an uneventful topical phacoemulsification, a moderate-grade striate keratopathy and non-planar Descemet membrane detachment was noted on first postoperative day, which was confirmed on anterior segment optical coherence tomography. The Descemet membrane was repositioned within 24 h of cataract extraction by intracameral air tamponade (pneumatic descematopexy) under topical anesthesia, and partial air release was done after 2 h. The patient was evaluated for decreased immediate postoperative vision of perception of light. After pneumatic descematopexy, the stromal edema relatively cleared. The intraocular pressure before releasing the intracameral air was 38 mmHg and antiglaucoma medication was started. Dilated fundus exam showed retinal pallor and a cherry-red spot over the macula. A diagnosis of central retinal artery occlusion was confirmed, and thorough systemic workup was done. Systemic investigations were within normal limits. The patient was managed conservatively, but the final visual acuity remained at 1/60. Central retinal artery occlusion is not a reported complication after pneumatic descematopexy for Descemet membrane detachment management. The possible mechanism could be sudden increase in intraocular pressure due to pupil block by air, and thus, ocular surgeries with use of intracameral air for prolonged duration warrants close monitoring of intraocular pressure and its subsequent management.

Comparison of diathermic high-frequency capsulorhexis and continuous curvilinear capsulorrhexis in white cataract surgery.

To compare the corneal endothelial cell counts pre- and post-operation, ultrastructure of anterior lens capsule and surgical completion after diathermic high-frequency capsulorhexis (DHC) and continuous curvilinear capsulorrhexis (CCC) applied in phacoemulsification (PHACO) of white cataract surgery. Sixty-six eyes of 66 patients (33 males and 33 females) with cataract aged between 60 and 80y (mean 72.5±5.5) were recruited and undergone the surgery from June 2014 to November 2016. Anterior lens capsule, derived from two kinds of capsulorhexis, were randomly divided into two groups according to random number table. The ultrastructure of the capsule edge and its closer tissue were observed by transmission electron microscopy (TEM) and optical microscopy respectively. The surgical completion conditions and corneal endothelial cell counts were analyzed pre- and post-operation after two capsulorhexis. The capsule derived from CCC had smooth edge, well-organized cellular structure and the cells filling into the cutting edge under TEM and optical microscopy. The capsule derived from DHC had an approximate 60 banded area of cell degeneration and necrosis, with dentiform prominences at the edge of the capsule, and no cell structure was observed at this area. The corneal endothelial cell counts of both groups were slightly declined 1wk post-operation compared with that of pre-operation. There was no statistical difference between the two groups (t=1.63, P>0.05). DHC shows good clinical value in white mature and hypermature cataract surgery.

A comparative study of the efficacy and safety of Phacoemulsifacation in white mature and other types of senile cataracts

Introduction: Phacoemulsification in white mature cataract is one of the most difficult anterior segment procedure. Our purpose to conduct this study was to compare the outcome of Phacoemulsification in white mature and other type (immature cortical, nuclear, posterior subcapsular and mixed cataract) of senile cataract. Methods: This is a hospital based observational Study conducted on 100 patients of cataract (49 male and 51 female) in the upgraded department of Ophthalmology, SMS Medical college Jaipur subjected to clear corneal temporal phacoemulsification with foldable IOL. Postoperative outcome, intraoperative difficulties were analyzed between two groups. Postoperative examination were done at 1st, 3rd, 7th, 30th & 45thday. Results: Intraoperative difficulties, postoperative corneal oedema, mean IOP changes & postoperative BCVA were not significantly different between two groups (p>0.05). Mean effective phaco time between two groups was found to be significantly higher in white mature cataract group (p<0.01).Conclusion: The Phacoemulsification is equally safe and efficacious in white mature senile cataracts as in other senile cataracts.

Topical anesthesia for cataract surgery: the patients' perspective.

Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean stage 2 pain scores in both white mature cataract (WMC) and corticonuclear plus posterior subcapsular cataract (CN + PSC) groups were significantly higher than in the PSC-only (PSC) group (P < 0.05). Conclusion. Phacoemulsification with topical anesthesia is not a completely painless procedure. Pain intensity varies with cataract type and stage of surgery.

Incidence, management, and postoperative outcomes in pediatric eyes with coexisting posterior capsule plaque and cataract

To determine the incidence and evaluate the management and postoperative outcomes of posterior capsule plaque in pediatric eyes with cataract. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Cohort study. This study evaluated consecutive eyes of children aged 1 month to 15 years having cataract surgery. In cases of posterior capsule plaque, plaque peeling (smaller plaque) or posterior vitrectorhexis (larger plaque) was performed. Intraocular lenses (IOLs) were implanted in all except microphthalmic eyes. The postoperative observations included visual axis obscuration and IOL decentration. Posterior capsule plaque was observed in 90 (13.4%) of 670 eyes (63 [13.2%] of 475 children). Of eyes with posterior capsule plaque, 70 had total white mature cataract and 20 had posterior subcapsular cataract. Plaque peeling was performed in 41 eyes (45.5%) and partial excision of the plaque with a vitrectome in 49 eyes (54.4%). The mean follow-up was 24.03 months ± 2.68 (SD). Of the 60 eyes that had an IOL, 54 (90%) had in-the-bag implantation and 6 (10%) had ciliary sulcus implantation. Postoperatively, there was no IOL decentration. Visual axis obscuration developed in 6 eyes (6.7%). Posterior capsule plaque was frequently observed in pediatric cataractous eyes, especially in eyes with total cataract. After plaque peeling or plaque removal with a vitrectome, the IOL was stable in the capsular bag and the visual axis was clear.

Subjective evaluation of intraoperative performance of DisCoVisc in complex ocular environments

To subjectively evaluate the intraoperative characteristics of DisCoVisc during phacoemulsification in complex ocular environments. In this prospective observational study, two experienced surgeons (ARV and CZ) performed phacoemulsification on 100 consecutive patients with cataract associated with complex ocular environments. Inclusion criteria were eyes with shallow anterior chambers (anterior chamber depth (ACD) of <2.1 mm), inadequate pupillary dilation (3 mm), dense cataract, and white mature cataract. The surgeons subjectively assessed the endpoints at each phase of phacoemulsification and various behavioural aspects of the ophthalmic viscosurgical devices (OVDs) were subsequently evaluated. The distribution was as follows: eyes with white mature cataract (n=18), eyes with grades 4 and 5 cataract (n=56), eyes with co-existing shallow ACD <2 mm (n=24), and co-existing small pupil size <2 mm (n=18). DisCoVisc behaved like a moderately cohesive viscoelastic in 94% of the cases. Injection of viscoelastic was easy in 38 (38%) eyes and very easy in 62 (62%) eyes. Visualization after the viscoelastic injection was excellent in 74% of the eyes. During phacoemulsification, DisCoVisc was moderately dispersive at all the stages of emulsification. The bag maintenance during IOL implantation was excellent in 56% eyes; IOL implantation was easy in 26% of the eyes and difficult in 20% of the eyes. Surgeons found viscoelastic removal easy in 68% of the eyes. At the time of OVD removal, DisCoVisc behaved like both a dispersive and a cohesive viscoelastic in 96% of the eyes. DisCoVisc provides both cohesive and dispersive properties. DisCoVisc alone, even in complex ocular environments, enabled the surgeon to achieve good intraoperative performance.

Safety and Efficacy of Micro-Incisional Cataract Surgery with Bimanual Phacoemulsification for White Mature Cataract

Background: To evaluate the safety and efficacy of micro-incisional cataract surgery (MICS) with bimanual phacoemulsification for the management of white mature cataract. Methods: Twenty-five eyes in 25 patients with mature cataract were prospectively recruited to undergo MICS with bimanual phacoemulsification. Serial changes in best-corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell density (ECD) were compared using the Wilcoxon signed-rank test. Results: MICS was successfully performed in 24 (96%) of the 25 eyes, with 1 eye requiring conversion to extracapsular cataract extraction due to radial tear during continuous curvilinear capsulorhexis. The median preoperative BCVA was hand movement. On day 1 postoperatively, the median BCVA improved to 0.6 (p < 0.001 compared with baseline). All patients had BCVA of 0.6 or better at 3 months after surgery (p < 0.001 compared with baseline). The mean increase in CCT at day 1 and week 1 postoperatively was 11.5 and 7.1%, respectively. The change in mean CCT was no longer significant at month 3 postoperatively (p = 0.82). The mean reduction in ECD at 3 months postoperatively was 7.8% (p = 0.037). None of the patients developed any postoperative complications. Conclusions: MICS with bimanual phacoemulsification appeared to be a promising alterative for the management of white mature cataract.

Effect of trypan blue staining on the density and viability of lens epithelial cells in white cataract

To assess the effect of anterior capsule staining with trypan blue 0.0125% on the density and viability of the lens epithelial cells (LECs). Iladevi Cataract and IOL Research Center, Ahmedabad, India. This randomized prospective study comprised 40 eyes having phacoemulsification for white mature cataract. Patients were randomized to have the anterior capsule stained with 0.1 mL trypan blue 0.0125% solution before the anterior capsulorhexis (Group 1, n = 20) or to have no anterior capsule staining before the anterior capsulorhexis (Group 2, n = 20). The density and viability of LECs were analyzed. The first 20 samples (10 from Group 1, 10 from Group 2) were stained with hematoxylin-eosin for cell density analysis using image-analysis software. The remaining 20 samples (10 from each group) were stained with a solution containing 0.5 microM calcein AM and 5 microM propidium iodide for 10 minutes at 37 degrees C for viability assay. The mean cell density in Group 1 (with staining) was 3533.15 cells/mm(2) +/- 664.01 (SD). This was significantly lower than the mean of 4235.59 +/- 414.93 cells/mm(2) in Group 2 (no staining) (P = .01). The mean capsule area covered with LECs (80.75% +/- 8.04% versus 94.63% +/- 3.78%) and the mean live LECs in the covered area (51.69% +/- 11.54% versus 68.67% +/- 9.15%) were also significantly lower in Group 1 (P = .002). Staining the anterior capsule with trypan blue affected the density and viability of LECs.

Reduced expression of 1-cys peroxiredoxin in oxidative stress-induced cataracts

1-cys peroxiredoxin (1-cysPrx), a member of the peroxiredoxin family with a single conserved cysteine residue, reduces a broad spectrum of hydroperoxides. This study was undertaken to examine changes in 1-cysPrx expression in human cataract samples, human lens epithelial (HLE B3) cell line, and rat organ-cultured lenses in response to oxidative insult induced by H 2O 2 or transforming growth factor-beta1 (TGF-β1). Expression of 1-cysPrx mRNA and protein in HLE B3 cells increased in response to 2–8 ng ml −1 TGF-β1 and 50–75 μ m H 2O 2 and then decreased below the control level at high doses (10 ng ml −1 TGF-β1 and 100–150 μ m H 2O 2), as determined by Northern blot and immunoblot analysis. This reduction coincided with the decrease of cell viability. Immunoreactive 1-cysPrx protein was measured in capsulorrhexis specimens obtained from patients with anterior subcapsular cataract (ASC), nuclear sclerosis (NS), cortical spokes (CS), posterior subcapsular cataract (PSC), or white mature cataract (WC) at the time of cataract surgery. Significant reduction of 1-cysPrx protein was observed in ASC, PSC, and WC samples, but there was no statistical difference in CS and NS samples relative to normal control. Also, rat lens explants were cultured with 10 ng ml −1 TGF-β1 for ∼5 days or 500 μ m H 2O 2 for ∼2 days. Subsequently, expression of 1-cysPrx mRNA and protein in the lens capsules was evaluated. Rat lens explants treated with TGF-β1 or H 2O 2 developed a cataract similar to human ASC or WC, respectively, which resulted in a markedly decreased expression of 1-cysPrx mRNA and protein. Collectively, these findings show that expression patterns of 1-cysPrx gene in the lens are changed in response to oxidative stress, a major factor in the etiology of cataract.

A prospective study on trypan blue capsule staining under air vs under viscoelastic

To compare the safety and effectiveness of trypan blue capsule staining under air vs under viscoelastic. A total of 52 consecutive patients planned for phacoemulsification of white mature cataract were randomly assigned to trypan blue staining under air or under viscoelastic. Perioperative changes in best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were compared between the two groups. The differences in operating and phacoemulsification times, staining pattern, and complications between the two groups were also recorded. Phacoemulsification of white mature cataract was performed in 50 (96%) eyes. The median preoperative BCVA was hand movement. No significant differences in the baseline characteristics were found between the two groups. At 3 months after phacoemulsification, the median BCVA improved to 0.8. The mean CCT returned to preoperative level by 1 month postoperatively and the mean ECD loss was 11.9% 3 months postoperatively. No significant differences in median BCVA, mean phacoemulsification and operation times, mean CCT, and mean ECD were found between the two groups. Trypan blue staining of the anterior lens capsule under air or under viscoelastic were similarly effective and safe methods for the phacoemulsification of white mature cataract.

Automated Irrigation/Aspiration Before Phacoemulsification in Eyes With White Cataracts

A white mature cataract still presents a significant challenge for the cataract surgeon. Because of the reduced visibility and increased intracapsular pressure in such cases, it is difficult to consistently achieve controlled continuous curvilinear capsulorhexis. Several simple procedures for treatment of eyes with white mature cataract are described. Seven consecutive patients (7 eyes) with white cataracts were enrolled for cataract surgery from July 2002 to February 2003. A small, central anterior capsular opening was created after carefully filling the anterior chamber with viscoelastic agents. Automated irrigation/aspiration by lowering of a connected bottle of balanced salt solution was used to aspirate the liquefied milky lens contents and decrease intracapsular pressure. All patients obtained controlled capsulorhexis, safe cataract phacoemulsification, and in-the-bag intraocular lens implantation. Automated irrigation/aspiration before phacoemulsification is safe and effective for eyes with white cataracts.