Orientador: Antônio Carlos Lottelli Rodrigues / Banca: Carlos Roberto Padovani / Banca: André Messias / Resumo: OBJETIVO. Avaliar o comprimento axial (AL), profundidade da câmara anterior (ACD) e espessura do cristalino (LT) de olhos de crianças a termo com catarata congênita e do desenvolvimento não complicada e fornecer estimativas específicas por idade. MÉTODO. Estudo retrospectivo de crianças submetidas à facectomia entre junho de 2011 e janeiro de 2014. Foram incluídas crianças com catarata não complicada sem patologias oculares e idade inferior a dez anos. Dados biométricos foram obtidos com biômetro de imersão. Procedeu-se a análise estatística dos dados e a regressão linear com o logaritmo da idade para modelar a relação do AL com a idade. RESULTADOS. Todos os olhos de 41 crianças foram incluídos na análise, com média de idade de 37,3 meses. A idade teve relação significativa com as medidas de AL (p<0,01). Eram 23 do sexo masculino (56%). Tiveram média de idade de 32,1 meses no sexo masculino e 44 meses no feminino, com baixa relação de AL segundo o sexo (p>0,05). As médias e desvio padrão de AL em olhos com catarata unilateral (n=16) e um dos olhos aleatoriamente selecionado (n=25) nos casos bilaterais foram de 20,37 mm ± 2,11 e 20,54 mm ± 1,97 respectivamente. Medidas de AL tiveram relação linear positiva com ACD e LT. Olhos com catarata unilateral tiveram AL menor que olhos sadios contralaterais. CONCLUSÃO. Medidas de AL alteram significativamente com a idade, principalmente nos 6 primeiros meses. O estudo prediz valores de AL nas diversos grupos etários, contribuindo para o cálculo do poder de lente intraoculares em crianças / Abstract: PURPOSE. To evaluate the axial length (AL), anterior chamber depth (ACD) and lens thickness (LT) of eyes of full-term infants with congenital and development cataracts uncomplicated and provide specific estimates by age. METHOD. Retrospective study of children undergoing cataract surgery between June 2011 and January 2014. Children with uncomplicated cataract without ocular pathologies and less than ten years old were included. Biometric data were obtained with immersion biometer. Proceeded to statistical analysis and linear regression with logarithm of age to model the relationship of AL with age. RESULTS. All eyes of 41 children were included in the analysis, with a mean age of 37.3 months. Age had a significant relationship with measures of AL (p< 0.01). 23 were male (56%). Had a mean age of 32.1 months for males and 44 months in females, with low ratio of AL according to gender (p>0.05). The mean and standard deviation of AL in eyes with unilateral cataract surgery (n=16) and randomly selected one eye in bilateral cases (n=25) were 20.37 ± 2.11 mm and 20.54 mm ± 1.97 respectively. AL measures had a positive linear relationship with ACD and LT . Eyes with unilateral cataract had smaller AL than the contralateral healthy eyes. CONCLUSION. AL measures change significantly with age, especially in the first six months. The study predicts values of AL in various age groups, contributing to the calculation of intraocular lens power in children / Mestre

M.Phil. / Cataracts have been identified as one of the leading causes of blindness, especially in the developing world. The only presently known effective treatment for this growing problem is surgical removal of the opaque lens followed by replacement with an artificial intra ocular lens. Newer methods have brought greater success, and greater costs. For people in the developing world, these newer methods are not always an option. Together with the increased cost, there is a growing demand because of this worldwide problem. This increased need for surgery has lead to the development of waiting lists in the state funded hospitals. To qualify for a cataract extraction in most state funded hospitals, a best visual acuity of 6/60 is required, compared to the 6/12 to 6/24 levels required in the industrial countries and private practices. With these levels of visual impairment in the developing world, many patients are left functionally blind for long periods of time until cataract extraction can be performed. Older methods such as extra-capsular cataract extraction are still being used in the developing world. This is mostly due to the increased density of the cataracts at the time when the extraction can be performed because of the long waiting time leading to further maturation of the cataract. This method requires a large corneal incision, which is normally closed with nylon sutures. With this method of surgery meticulous wound closure is very important, and in many cases surgically induced astigmatism is one of the unwanted consequences. It was therefore decided, for the purpose of this study, to use autokeratometric data to explore the refractive effects of two different methods of corneal wound closure following planned extra-capsular cataract extraction (ECCE). Astigmatism is a major problem associated with extra capsular cataract extraction, especially when the wound is closed by means of sutures. Studies by Minassian et al. (2001), Jacobi (2003) and Dowler et al. (2000) all show that newer methods of cataract extraction making use of smaller incisions and therefore fewer sutures show faster recovery and less astigmatism. These methods are however mostly restricted to private practice, and therefore potentially unsuited for use in developing countries. The type of material used for wound closure is another very important factor. Depending on the method of suturing wound gape and wound compression can cause increased amounts of astigmatism. Using a method of wound closure that would cause less traction on the cornea could therefore cause less of a problem postoperatively. Tissue adhesives such as Tisseel® fibrin glue could be such an alternative. Studies by Henrick et al. (1987), Kim and Kharod (2007) and Bhatia (2006) show that fibrin glue forms a watertight, non irritating wound while promoting the healing process by the cross linking of collagen fibres.

Toric intraocular lenses (IOLs) are designed to reduce spectacle dependency by correcting corneal astigmatism at the time of surgery. However, these IOLs are reliant on the accurate prediction of post-operative corneal astigmatism through reliable ocular biometry and the accurate calculation of surgically induced astigmatism. In the thesis the repeatability of assessing corneal curvature was assessed using six commercially available keratometers. The results question the validity of corneal biometry and infer that much of the apparent change in corneal shape usually associated with surgically induced astigmatism may be due to measurement error. The use of the oblique cross cylinder formulae for the calculation of post-operative corneal curvature was also investigated. This formula is incorporated into all commercially available toric IOL calculators and is utilised in every toric IOL implantation. The results from this thesis indicate that the formula is not applicable to the human cornea and that the use of the calculator does not increase the effectivity of the toric correction. Furthermore, the thesis queries the assumption that post-operative corneal astigmatism is directly proportional to post-operative refractive error. The disparity between both the magnitude and axis of astigmatism measured by keratometry and manifest refraction in a pseudophakic population was investigated. The axis measurements in particular showed very poor agreement; far outside an acceptable level of misalignment, significantly decreasing the effective correction provided if the lens was aligned with the keratometry readings. Inclusion of the posterior corneal curvature and thickness, along with a smaller chord length may lead to a more accurate assessment of corneal power. Despite the difficulty in providing an effective toric IOL correction, it was found that the correction of corneal astigmatism at the time of cataract surgery might decrease the risks of falls. Uncorrected astigmatism and cataract both cause a reduction in stability when stepping oven an obstacle, which is one of the most common causes of trips and falls in the elderly population.

The purpose of this descriptive exploratory study was to describe specific self-care behaviours related to the provision of eye care and performance of daily living activities, of postsurgical cataract patients during their first few weeks at home following cataract extraction. The twenty subjects who comprised the study sample were all over sixty years of age, were English speaking, had a best corrected visual acuity in the unoperated eye of 20/50 or less, and had undergone uncomplicated unilateral standard cataract surgery without lens implant. Subjects were interviewed in their homes on two occasions. Difficulties that were experienced and concerns that were expressed by subjects and family members in the performance of eye care procedures, and management of daily living routines were recorded; and factors which influenced the ability of subjects to manage their care at home were identified. Observations were made of the instillation of eyedrops, the application of a protective eye shield, and the status of the operated eye. The findings suggest a high degree of adherence to the prescribed medication regime, and to the precautionary measures that were to be followed. Difficulties were reported or observed in several areas such as administering eyedrops, applying the eye shield, reading instructions, opening eyedrop containers, and obtaining prescriptions or supplies. The majority of concerns expressed were related to the performance of eye care procedures, and to the prospective visual outcome of the surgery. Examples of factors identified as affecting home self-care were: the availability of direct assistance and emotional support from family and community resources; the understanding of the surgical procedure and recovery process; the knowledge, and the timing of the receipt of knowledge, of expected behaviours; and the possession of adequate manual skills to perform the eye care procedures with competence and confidence. Implications for nursing, medical, and pharmacist's practice are discussed, and areas for further research are identified. / Applied Science, Faculty of / Nursing, School of / Graduate

Yes / Purpose: We systematically reviewed the literature to investigate when refraction is stable following routine cataract surgery implanting monofocal intraocular lenses. Current advice recommends obtaining new spectacles 4–6 weeks following surgery. Due to advancements in surgical techniques, we hypothesised that refractive stability would be achieved earlier, which could have major short-term improvements in quality of life for patients. Methods: Medline, CINAHL, AMED, Embase, Web of Science and the Cochrane Library were searched with key words chosen to find articles, which assessed refraction following uncomplicated cataract surgery. Citation chains and the reference lists of all included papers were searched. Unpublished literature was identified using OpenGrey (www.opengrey.eu). The review considered studies that measured refraction at regular intervals following surgery until stability was achieved. Results: The search identified 6,680 papers. Two reviewers independently screened the abstracts and nine papers were found to fit the criteria, of which five were included in the meta-analysis. The quality of the papers was evaluated using the Methodological Index for Non-Randomised Studies (MINORS) instrument. Meta-analysis of 301 patients’ data of spherical, cylindrical and spherical equivalent correction were performed using Review Manager 5 (RevMan 5.3) (https://revman.cochrane.org/). Refraction at 1-week versus the gold standard of 4-weeks showed no significant difference for sphere data (effect size and 95% confidence interval of; ES = 0.00, 95% CI: −0.17, 0.17; p = 1.00), cylindrical data (ES = +0.06; 95% CI: −0.05, 0.17; p = 0.31), and spherical equivalent (ES = −0.01; 95% CI: −0.12, 0.10; p = 0.90). Heterogeneity was non-significant (I2

Yes / Purpose To determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors. Methods Self-reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Six-month falls rates were determined using self-reported retrospective data. Results The number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ2 = 19.14, p < 0.001), but the reduction in the number of patients who fell in the 6-months post surgery was not significant (23% vs 20%; χ2 = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Conclusions Dizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery. / This work was supported by The Dunhill Medical Trust(grant number SA14/0711).

Thesis (PhD)--Stellenbosch University, 2001 / ENGLISH ABSTRACT: The eye is that biological instrument which conveys the light of the external world into the inner world of the mind, wherein we receive the miraculous gift of vision. So precious is this gift, that Science must search for ways to keep this portal clear for the flow of light. Indeed, Science is called upon to “make war upon the bloody tyrant, Time.” (Shakespeare W. Sonnet No. 16). For, in the course of ageing, the lens grows cloudy and cataractous. In this battle between Science and Time, we are fortunate to live in an era in which Science is uncovering the molecular basis for the various obstacles to vision. The question arises, whether or not, the ruinous hand of time can be stayed. Due to unrelenting, progressive lens opacification, most of the elderly are destined to be subjected to loss of vision and with passage of time, even blindness. Globally the cataract surgery rate is inadequate to keep pace with the ever growing demand on financial and human resources created by the cataract problem. An immense challenge therefore is directed to primary eye care: “Can cataract be prevented or can its onset at least be postponed?” This laudable ultimate aim can only be achieved once the etiology of cataractogenesis is well understood. This dissertation seeks to examine two previously unrecognized etiological aspects that, if correctly understood and managed, have the potential to achieve preventive ophthalmological goals that may indeed help to stay the ‘ruinous hand of time’. The first aspect deals with the role of lipids and was examined using a study group of dyslipidemic subjects. The first part of the study concluded that dyslipidemic patients develop cortical lens opacities more frequently and at an earlier age than the normal population, and that cortical lens opacities should be regarded as one of the most reliable clinical signs of dyslipidemia. Furthermore, an extremely strong correlation was found to exist between low HDL Cholesterol levels and the development of opacities. Below a HDL-Cholesterol level of 1,5mmol/l, subjects had more than seven-fold higher risk of falling in the lens opacity subgroup than those with HDLCholesterol levels above 1,5mmol/l. An equally strong correlation was demonstrated between high (>5) LDLHDL ratios and the development of lens opacities. Subjects with a LDL:HDL-C ratio below 5 possessed a 2.35 times greater risk of having lenticular opacities than the group with a LDL:HDL-C ratio greater than 5. The prevention or retardation of dyslipidemia associated lens opacities is therefore possible, provided patients with a genetic predisposition are detected early and their blood lipids managed adequately. The second aspect deals with the relationship between age related cataracts and the acetylation status of the individual. This study compellingly submits that the slow acetylator pheno- and genotype may be regarded as a genetic indicator of risk for age related cataract. The ability accurately to classify a patient genotypically and phenotypically, may henceforth be useful in health counseling since, if an individual is identified as being a slow acetylator, additional preventative and precautionary measures may be taken, i.e. the prevention of UVexposure to the eye and caution with the ingestion of xenobiotics like caffeine, commercial dyes, food preservatives, and drugs. Furthermore, such a finding should be taken into account in the long term therapeutic management of glaucoma, with special regard to carbonic anhydrase inhibitors which are sulphonamide-related drugs and totally dependent on the N-acetyltransferase pathway for metabolism. These drugs may accumulate in the slow acetylator over time and exert toxic effects intra-ocularly, conceivably including cataractogenesis. The search for genetic and metabolic mechanisms that may contribute to human cataractogenesis should be pursued with great enthusiasm. This endeavour may help Science to achieve its primary objective, ablate the effects of Time and really aid in preventing cataracts in man. / AFRIKAANSE OPSOMMING: Die wondergawe van visie word vir ons moontlik gemaak deur die oog wat as biologiese instrument die lig van die buitewereld inlaat na die binnewereld van die brein. So kosbaar is hierdie gawe dat die Wetenskap deurgaans moet poog om die poort oop te hou. Inteendeel, die Wetenskap word gemaan deur Shakespeare in sy Sonnet nommer 16 om “oorlog te maak teen die bloeddorstige tiran, Tyd”. Soos ‘n mens ouer word, word die lens dof en ‘n katarak mag vorm. Ten spyte van hierdie stryd tussen ‘Wetenskap’ en ‘Tyd’ leef ons in die gelukkige era waarin die Wetenskap meer en meer leer van die verskeie obstruksies tot visie. Die vraag ontstaan of die rinnewerende hand van ‘Tyd’ gestuit sal kan word. Vanwee ongenaakbare, progressiewe lensvertroebeling is die meeste bejaardes bestem om aan visie verlies, en met verloop van tyd selfs blindheid, te ly. Die wereldwye katarakchirurgie tempo is nie voldoende om by te hou by die immergroeiende finansiele en mannekrag eise wat deur die katarak probleem gestel word nie. Daar word dus ‘n reuse uitdaging aan primere oogsorg gestel naamlik: “Kan katarakte nie eerder voorkom of die aanvang daarvan ten minste uitgestel word nie?” Hierdie prysenswaardige doelwit kan nie bereik word alvorens die etiologie van kataraktogenese goed verstaan word nie. Hierdie tesis ondersoek twee voorheen onerkende etiologiese aspekte wat, indien hulle korrek verstaan en hanteer word, beslis die potensiaal het om die gemelde voorkomende doelwitte te bereik en sekerlik te kan bydrae om die rinnewerende hand van Tyd te stuit. Die eerste aspek spreek die rol van lipiede aan deur te kyk na 'n studiegroep van dislipidemiese persone. Die eerste deel van die studie kom tot die gevolgtrekking dat dislipidemiese pasiente kortikale lens opasiteite meer dikwels en op ‘n vroeer ouderdom ontwikkel as die normale populasie en dat sulke opasiteite beskou moet word as een van die mees betroubare kliniese tekens van dislipidemie. Daar is ook ‘n baie sterk korrelasie gevind tussen lae HDL cholesterol vlakke en die voorkoms van opasiteite. Persone in die studie met ‘n HDL cholesterol vlak laer as 1,5mmol/l het ‘n sewe keer hoer kans gehad om in die lensopasiteit subgroep te val as die met ‘n HDL cholesterol vlak laer as 1,5mmol/l. ‘n Sterk korrelasie tussen ‘n hoe (>5) LDLHDL verhouding en die voorkoms van lens opasiteite is ook gevind. Persone met ‘n LDLHDL verhouding >5 het ‘n 2.35 maal groter risiko gehad om lensopasiteite te he as die met ‘n LDL:HDL verhouding van <5. Die voorkoming of vertraging van dislipiedemie geassosieerde lens opasiteite is dus moontlik, solank persone met ‘n genetiese geneigdheid daartoe vroeg ontdek en hulle bloedlipiede voldoende beheer word. Die tweede deel van die tesis handel oor die verhouding tussen ouderdoms verwante katarakte en die asetilasie status van die individu. Met oortuiging kom hierdie studie tot die gevolgtrekking dat die stadige asetilator fenoen genotipe as 'n genetiese merker vir ouderdoms verwante katarakte beskou moet word. Die vermoe om ‘n individu beide genotipies en fenotipies akkuraat te klassifiseer mag voorts bruikbaar wees in gesondheidsraadgewing. Indien ‘n individu geTdentifiseer is as ‘n stadige asetileerder, kan addisionele voorsorg maatreels getref word soos bv. die voorkoming van blootstelling van die oog aan UV lig sowel as omsigtigheid met die inname van xenobiotika soos kaffei'ene, kleurstowwe, voedsel preserveermiddels en geneesmiddels. Hierdie bevinding moet ook in berekening gebring word in die langtermyn terapeutiese hantering van gloukoom. Die koolsuuranhidrase inhibitore, dikwels gebruik in die behandeling van gloukoom, is sulfonamied-agtige middels en dus totaal afhanklik van die N-asetieltransferase pad vir hulle metabolisme. Hierdie middels kan ophoop in die stadige asetileerder en gegewe genoeg tyd, bes moontlik toksiese intra-okulere effekte tot gevolg he. Die soeke na genetiese en metaboliese meganismes wat mag bydra tot menslike kataraktogenese behoort nagestreef te word met groot entoesiasme. Hierdie strewe mag dalk net vir die 'Wetenskap' bystaan om sy primere mikpunt te bereik, die effek van ‘Tyd’ te neutraliseer en te help om katarakte werklik te voorkom.

Introduction: Cataract surgery, is nowadays the most common surgical procedure performedin Sweden. Late in-the-bag intraocular lens dislocation (LITBILD), occurring many yearsafter uneventful surgery, is due to progressive zonular weakness and capsular shrinkage.Known risk factors include among others pseudoexfoliations (PXF), high myopia andprevious vitreoretinal surgery. LITBILD has been reported with an increasing frequency inrecent years. Thus, there is a value in further investigating this patient group and describerelated risk factors. Aim: Determine the 15-year cumulative risk of LITBILD after standard cataract surgery2003 in Örebro and describe possible risk factors causing LITBILD. Method: Retrospective nested case-control study examining patients who underwent cataractsurgery with phacoemulsification in 2003 at Örebro University Hospital. To locate patientswithin that group who sustained LITBILD ICD10 diagnosis codes relating to LITBILDcovering years 2003-2018 were assessed. Each case was matched with two controls ofidentical sex and age. Results: The LITBILD group was 9 patients out of 1499 operated with median age atLITBILD of 80 years (range 57-82). Median time between cataract surgery and LITBILDwas 134 months (range 39-167). Glaucoma before and/or after cataract surgery and highintraocular pressure before surgery were independently statistically significant risk factors forLITBILD. Conclusion: Patients who underwent cataract surgery 2003 had a cumulative risk of 0.6% todevelop LITBILD. 78% of patients with dislocation had one or more of the risk factorsstudied whilst the control group represented 40% (p=0.08).

Background Cataract surgery is the most common surgical procedure carried out in the developed world and surgery volumes have increased considerably during the last decades. Various aspects of the surgical procedure, including surgical incision size and intraocular lens materials, have changed substantially, improving the safety and the quality of the outcome. Previous research has primarily focused on the visual function results with a short follow-up time. Long-term population-based studies, exceeding a few years, presenting visual functional results postoperatively, have not been published. Aims To determine the effects of cataract surgery on subjectively experienced visual function and visual acuity in a defined population, and compare the results between sub-groups, on a long-term basis. Methods In this prospective, population-based investigation, all patients with presenile and senile cataract (n=810), operated on during a one-year period (1997-98), at Umeå University Hospital were included. The frequency of cataract surgery at that time, was 5.2 per 1000 population studied. Visual acuity was tested and an eye examination was performed before surgery, 4-8 weeks postoperatively, and five and ten years after surgery. Subjective visual function was assessed using self-administered questionnaires (VF-14) at all occasions. Statistical evaluations comprised analyses of variance, Mann-Whitney U-test, chi-square test, multiple linear regression, a life-table calculation, and Cox’s proportional hazard model. Results Five years after cataract surgery, subjective and objective visual function remained stable in most patients. The most frequent cause of deterioration of visual acuity and decrease in VF-14 scores was agerelated macular degeneration (ARMD). Two thirds of the patients in the cohort were women. They were significantly older than the men and more often operated on both eyes. After adjustment for age and visual acuity, women cataract surgery patients assessed their visual function worse than men both before surgery and 4 months postoperatively. Five years after surgery these differences were no longer significant. At baseline, 13% of the patients were diabetics. At the five-year followup, subjective and objective visual function remained stable in most surviving diabetics, and the longitudinal visual function was not significantly worse compared with the non-diabetics. Ten years after surgery, 28% had received treatment for posterior capsular opacification (PCO). A significantly larger proportion of patients less than 65 years at surgery (37%) compared with those 65 years or older (20%) had been treated. Conclusions Most patients sustain their level of visual acuity and visual function also five and ten years after cataract surgery. Ocular co-morbidity, such as ARMD, is the major cause of longitudinally reduced visual function. Patients suffering from diabetes did not have a significantly worse visual function after five years. A surprisingly large proportion of patients had received treatment for PCO after ten years.

published_or_final_version / Public Health / Master / Master of Public Health