Birgitte Haargaard

Risk of Glaucoma after Pediatric Cataract Surgery

PURPOSE To determine the risk of glaucoma after surgery for pediatric cataract and to evaluate risk factors for glaucoma. METHODS A population-based cohort of all children in Denmark aged 0 to 17 years during the period 1977 to 2001, who underwent surgery for pediatric cataract, was established by retrospective chart review. Glaucoma cases were defined as those in which glaucoma surgery (trabeculectomy and/or diode laser transscleral cyclophotocoagulation) was performed and/or permanent medical therapy prescribed after cataract surgery. RESULTS Of 946 eyes (595 patients) undergoing pediatric cataract surgery, 72 eyes (48 patients) had subsequent development of glaucoma. Early surgery (<9 months of age) was associated with a 7.2-fold increased risk of glaucoma compared with late surgery (> or =9 months of age). Ten years after cataract surgery, glaucoma developed in 31.9% (95% confidence interval [CI], 24.4-41.1) of children undergoing surgery before 9 months of age compared with 4.1% (95% CI, 2.4 to 6.8) of children aged > or =9 months at the time of surgery. Glaucoma cases continued to occur more than 10 years after cataract surgery. After adjustment for age at surgery, no other risk factor appeared important. CONCLUSIONS The risk of glaucoma after surgery for pediatric cataract is substantial and particularly high for those below 9 months of age at the time of surgery. Because the increased risk persists for many years after surgery, careful continuous monitoring for glaucoma is mandatory.

Perinatal risk factors for strabismus

BACKGROUND Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype. METHODS Orthoptists reviewed ophthalmological records for Danish National Birth Cohort (DNBC) children examined for strabismus in hospital ophthalmology departments or by ophthalmologists in private practice. Information on perinatal characteristics was obtained from national registers. We used log-linear binomial regression and polytomous logistic regression to estimate risk ratios for strabismus overall and by strabismus subtype, respectively. RESULTS Among 96,842 DNBC children born in Denmark between 1996 and 2003, we identified 8783 children who had been evaluated for strabismus. Ophthalmological records were available for 5655 of these children, of whom 1321 were diagnosed with strabismus. In multivariable analysis, low birth weight, prematurity, large head circumference and presence of congenital abnormalities were all associated with increased risk of strabismus. Presence of congenital abnormalities was more strongly associated with exotropia than with esotropia. Of 183 exotropia cases, 40 (22%) had congenital abnormality. Although not associated with esotropia, delivery by Caesarean section was associated with exotropia (relative risk = 1.65; 95% confidence interval 1.16-2.34). After adjustment for birth weight, Apgar score at 5 min, multiple gestation and parental ages were not associated with strabismus overall. CONCLUSIONS Congenital abnormalities, low birth weight, prematurity and large head circumference were independent risk factors for strabismus. Differences in risk factors for esotropia and exotropia suggest that strabismus subtypes may have different underlying aetiologies. The proportion of exotropic children with congenital abnormalities suggests that a large angle constant exotropia in an infant should alert physicians to the possibility of a congenital abnormality.

The Effect of Cataract Surgery on Circadian Photoentrainment: A Randomized Trial of Blue-Blocking versus Neutral Intraocular Lenses

PURPOSE Cataract decreases blue light transmission. Because of the selective blue light sensitivity of the retinal ganglion cells governing circadian photoentrainment, cataract may interfere with normal sleep-wake regulation and cause sleep disturbances. The purpose was to investigate the effect of cataract surgery on circadian photoentrainment and to determine any difference between blue-blocking and neutral intraocular lenses (IOLs). DESIGN The study was a single-center, investigator-driven, double-masked, block-randomized clinical trial. PARTICIPANTS One eye in 76 patients with bilateral age-related cataract eligible for cataract surgery was included. METHODS Intervention was cataract surgery by phacoemulsification. Patients were randomized to receive a blue-blocking or neutral IOL. MAIN OUTCOME MEASURES Primary outcome was activation of intrinsic photosensitive ganglion cells using post-illumination pupil response (PIPR) to blue light from 10 to 30 seconds after light exposure as a surrogate measure. Secondary outcomes were circadian rhythm analysis using actigraphy and 24-hour salivary melatonin measurements. Finally, objective and subjective sleep quality were determined by actigraphy and the Pittsburgh Sleep Quality Index. RESULTS The blue light PIPR increased 2 days (17%) and 3 weeks (24%) after surgery (P < 0.001). The majority of circadian and sleep-specific actigraphy parameters did not change after surgery. A forward shift of the circadian rhythm by 22 minutes (P = 0.004) for actigraphy and a tendency toward an earlier melatonin onset (P = 0.095) were found. Peak salivary melatonin concentration increased after surgery (P = 0.037). No difference was detected between blue-blocking and neutral IOLs, whereas low preoperative blue light transmission was inversely associated with an increase in PIPR (P = 0.021) and sleep efficiency (P = 0.048). CONCLUSIONS Cataract surgery increases photoreception by the photosensitive retinal ganglion cells. Because of inconsistency between the significant findings and the many parameters that were unchanged, we can conclude that cataract surgery does not adversely affect the circadian rhythm or sleep. Longer follow-up time and fellow eye surgery may reveal the significance of the subtle changes observed. We found no difference between blue-blocking and neutral IOLs, and, because of the minor effect of surgery in itself, an effect of IOL type seems highly unlikely.

In-Utero Exposure to Smoking, Alcohol, Coffee, and Tea and Risk of Strabismus

In a prospective, population-based cohort study, the authors investigated the effect of in-utero exposure to maternal smoking and consumption of alcohol, coffee, and tea on the risk of strabismus. They reviewed medical records for children in the Danish National Birth Cohort identified through national registers as possibly having strabismus. Relative risk estimates were adjusted for year of birth, social class, maternal smoking, maternal age at birth, and maternal coffee and tea consumption. The authors identified 1,321 cases of strabismus in a cohort of 96,842 Danish children born between 1996 and 2003. Maternal smoking was associated with a significantly elevated risk of strabismus in the child, increasing with number of cigarettes smoked per day (<5 cigarettes/day: relative risk (RR) = 0.95, 95% confidence interval (CI): 0.80, 1.14; 5-<10 cigarettes/day: RR = 1.38, 95% CI: 1.12, 1.70; > or =10 cigarettes/day: RR = 1.90, 95% CI: 1.57, 2.30). Nicotine replacement therapy was not associated with strabismus risk (RR = 1.22, 95% CI: 0.92, 1.61). Light maternal alcohol consumption was inversely associated with strabismus risk, whereas maternal coffee and tea drinking were not associated with strabismus risk. In conclusion, smoking during pregnancy is associated with an increased risk of strabismus in the offspring. Conversely, light alcohol consumption is associated with decreased risk.

Down's syndrome and early cataract.

Aims: To estimate the occurrence of early cataract among patients with Down’s syndrome and to evaluate the clinical characteristics of the cases. Methods: Cases with Down’s syndrome were ascertained from a cohort of all Danish children between 0 and 17 years of age, who were diagnosed with cataract during the period 1977–2001 (n = 1027). Information on the patients was obtained from the medical records. Results: Of the total of 1027 cases with non-traumatic, non-acquired cataract there were 29 cases (13 males, 16 females) with Down’s syndrome (2.8%). This corresponds to an occurrence of early cataract among patients with Down’s syndrome of 1.4%; 27 had bilateral cataract and two had unilateral cataract. Half of the patients (n = 14) underwent cataract surgery, of whom two had bilateral primary lens implantation. 10 patients had bilateral cataract observed soon after birth, and five of these underwent cataract surgery within the first 6 months of life. Conclusion: The frequency of early cataract among children with Down’s syndrome is estimated to be 1.4%, with cataracts requiring surgery during childhood being even rarer. In one third of the 29 cases, bilateral cataract was detected in the neonatal period.

Central nervous system involvement after herpes zoster ophthalmicus

Purpose:  To report central nervous system involvement after varicella zoster virus infection.

Time Trends in Indication for Cataract Surgery

Background: Due to the increasing proportion of elderly citizens the need for cataract surgery is expected to increase markedly within the next two decades but also the indication level for cataract surgery will influence the need for surgery. The aim of the present study was to examine if the indication for cataract surgery has remained stable over an eight year period in a university clinic setting in the Capitol Region of Copenhagen, Denmark. Methods: All pre-operative visits from 2002 to 2010 were evaluated yielding a total of 14,701 eyes (9,474 first eye surgeries and 5,227 second eye surgeries). Information was drawn from a database where pre-, peri- and postoperative data regarding all cataract surgeries (except for congenital and childhood cataract) performed at the clinic had been entered at the time of examination/surgery. Evaluation of the indication level for cataract surgery was assessed primarily based on visual acuity. Results: In the 8 year period, mean visual acuity increased significantly from 0.18 to 0.24 Snellen (corresponding to 0.74 to 0.62 logMAR) in the eyes that underwent surgery first and in second eyes from 0.29 to 0.41 Snellen (corresponding to 0.54 to 0.39 LogMAR, respectively, p-values <0.0001) and concomittantly the mean age of patients at the time of surgery decreased from 75.4 to 71.6 years in females and 72.1 to 69.1 years in males. Conclusion: During the time period from 2002 to 2010 the indication for cataract surgery changed towards patients being operated at better visual acuities and at younger ages. In the same time period, there was an increase in life expectancy by 2 years. Expectedly, the need for surgery will increase dramatically not only because of an increased proportion of elderly citizens but also because of a tendency towards surgery earlier in the disease process.

Risk of Retinal Detachment After Pediatric Cataract Surgery

PURPOSE To determine the long-term risk of retinal detachment following pediatric cataract surgery and to identify risk factors for retinal detachment. METHODS We included all children (aged 0 to 17 years) who during the time period of 1977 to 2005 underwent pediatric cataract surgery in Denmark, excluding cataract cases caused by trauma, or acquired systemic or acquired ocular pathology, and cases with ocular anomalies associated with the development of retinal detachment. Cases of cataract were ascertained from the mandatory Danish National Patient Register, and information on retinal detachment was based on medical chart review. RESULTS Among 1043 eyes of 656 children undergoing surgery for pediatric cataract, 25 eyes (23 children) developed retinal detachment at a median time of 9.1 years after surgery. The overall 20-year risk of retinal detachment was 7% (95% confidence interval [CI]: 3%-11%) among cataract patients. In otherwise normal children having isolated cataract, the risk was 3% (95% CI: 0%-7%). A significantly higher risk of developing retinal detachment was found in children with mental retardation (23% [95% CI: 9%-35%]) or in cataract cases with other ocular or systemic anomalies (16% [95% CI: 6%-24%]). CONCLUSIONS The estimated overall risk of retinal detachment 20 years after pediatric cataract surgery was 7%, but only 3% for isolated cataract. Particularly high risks of retinal detachment after cataract surgery were associated with mental retardation and having other ocular or systemic diseases.

Congenital cataract screening in maternity wards is effective: evaluation of the Paediatric Cataract Register of Sweden

To study which eye‐screening protocol prevails in Swedish maternity/neonatal wards, evaluate efficacy in a prospective study and compare results with earlier Swedish retrospective results.

The effect of blue-blocking and neutral intraocular lenses on circadian photoentrainment and sleep one year after cataract surgery

To compare the long‐term effect on circadian photoentrainment and sleep in patients implanted with neutral and blue‐blocking intraocular lenses 1 year after cataract surgery.