Mats Lundström

Six-year incidence of endophthalmitis after cataract surgery: Swedish national study.

Purpose To report the nationwide incidence and risk factors for endophthalmitis after cataract surgery in Sweden. Setting Swedish National Cataract Register containing reports on cataract operations from all Swedish ophthalmic surgical units. Design Prospective epidemiologic study. Methods Endophthalmitis case reports were collected from 2005 through 2010. Case and control parameters pertaining to patient characteristics and surgical technique were generated from the database. In addition, information from annual surveys regarding the topical prophylactic protocol was analyzed. Results The reports showed 135 endophthalmitis cases in 464 996 operations, equaling an incidence of 0.029%. Patient age over 85 years, perioperative communication with the vitreous and, above all, nonuse of intracameral cefuroxime showed a statistically significant association with endophthalmitis in the logistic regression. Short‐term topical antibiotics given as add‐on prophylaxis to the intracameral regimen before, after, or before and after the operation did not confer a clear‐cut benefit. Groups with topical treatment were small, comprising 14% of the sample. Conclusions The incidence of endophthalmitis after cataract surgery in Sweden is declining, which appears to be explained by a fall in the frequency of major risk factors. Operating earlier in the cataract course, avoiding capsule breakage, and giving intracameral antibiotics universally should further reduce the endophthalmitis rate. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

One million cataract surgeries: Swedish National Cataract Register 1992-2009.

This review summarizes data collected by the Swedish National Cataract Register, which now contains data pertaining to more than a million cataract surgery procedures, representing 95.6% of the surgeries performed in Sweden during 1992-2009. During this period, the rate of cataract surgery rose from 4.47 to 9.00 per 1000 inhabitants. The mean patient age increased until 1999 but has slowly decreased since then. Preoperative visual acuity has risen steadily. The distribution between the sexes was stable until 2000, after which the proportion of women slowly decreased. Registration of subjective benefit has brought new knowledge regarding indications and expectations. An improved questionnaire, Catquest-9SF has been used since 2008. The outcome register generally shows good results from the surgery. Endophthalmitis has decreased from 0.10% to below 0.040%.

Capsule complication during cataract surgery: Case-control study of preoperative and intraoperative risk factors : Swedish Capsule Rupture Study Group report 2

PURPOSE: To identify preoperative and intraoperative factors associated with a capsule complication; that is, a capsule tear or a zonular dehiscence during cataract surgery. SETTING: Ten ophthalmic surgery departments in Sweden. METHODS: A retrospective review of files of patients with a capsule complication and control patients with no complication operated on in 2003 was performed. RESULTS: The review comprised 324 patients with a capsule complication and 331 control patients. In the logistic regression analyses, preoperative conditions associated with a capsule complication were previous trauma, white and brunescent/hard cataract, and phacodonesis. The intraoperative factors of loose zonules, the use of trypan blue, and miosis were all statistically significantly overrepresented in the capsule complication group. The same was true for eyes operated on by surgeons with the least experience. CONCLUSIONS: By preoperatively identifying cataract cases with the identified risk factors and allocating them to surgeons with the longest experience, the number of capsule complications could be kept low. Operating early in the course of the disease to prevent the cataract from becoming a poor surgical risk and improving training of junior surgeons should further reduce the frequency of capsule complications.

Late dislocation of in-the-bag and out-of-the bag intraocular lenses: Ocular and surgical characteristics and time to lens repositioning

PURPOSE: To characterize patients with late intraocular lens (IOL) dislocation to evaluate possible risk factors, determine the time between cataract surgery and IOL repositioning, describe the surgical management, and estimate the incidence. SETTING: Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden. DESIGN: Case series. METHODS: Medical records from the cataract surgery and IOL repositioning were reviewed. RESULTS: The study enrolled 84 eyes, 63 with in‐the‐bag IOL dislocation and 21 with out‐of‐the‐bag IOL dislocation. The prevalence of pseudoexfoliation (PXF) was 60% and of glaucoma, 36%. A high proportion of eyes with IOL dislocation (37%) had zonular dehiscence at cataract surgery. The median time from cataract surgery to IOL repositioning surgery was significantly shorter in eyes with out‐of‐the‐bag IOL dislocation (3.2 years) than in eyes with in‐the‐bag IOL dislocation (6.7 years) (P = .029). The interval was also significantly shorter in eyes with zonular dehiscence. Using data from the National Cataract Register, the calculated incidence of IOL repositioning surgery per pseudophakic individuals in western Sweden was 0.050%. CONCLUSIONS: The possible major predisposing factors for late IOL dislocation were PXF, glaucoma, and cataract surgery complicated by zonular dehiscence. Primary placement of the IOL in the ciliary sulcus was associated with earlier IOL dislocation. Intraocular lens repositioning surgery using a posterior or anterior approach was successful in many cases. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

EVOLUTION OF DESCENDING OPTIC ATROPHY

Fundus changes following severe trauma to the intracranial optic nerve were followed by means of serial fundus photography. The eye was completely blind. Little change was seen during the first 4 weeks. The retinal nerve fibre layer disappeared gradually during weeks 4 to 8. At the same time the retinal vessels turned narrow, and vascular pseudo‐sheathing appeared close to the optic disc. Disc pallor was not maximal until the 12th week, when the peripapillary retina also had acquired a mottled appearance.

Capsule complication during cataract surgery: Retinal detachment after cataract surgery with capsule complication: Swedish Capsule Rupture Study Group report 4.

PURPOSE: To study the incidence, characteristics, and results of retinal detachment (RD) after cataract surgery with a capsule complication. SETTING: Ten ophthalmic surgery departments in Sweden. METHODS: In this case‐control study, data on cataract surgery cases with a capsule complication (study group) or with no complication (control group) in 2003 were extracted from the Swedish National Cataract Register. Patients with RD during a 3‐year follow‐up were identified. RESULTS: The study group comprised 324 patients and the control group, 331 patients. Retinal detachment occurred in 13 study group patients, for a 3‐year incidence of 4.0%. In the control group, 1 patient (0.3%) had RD. Multivariate analysis showed an adjusted odds ratio (OR) of 14.8 for RD after capsule complication (95% confidence interval [CI], 1.9‐114; P = .01). Subgroup analysis of the study group using a binary logistic regression model showed that male sex (OR, 8.5; 95% CI, 1.7‐43.8; P = .001) and lens remnants in the vitreous (OR, 14.4; 95% CI 2.6‐78.8; P = .002) were additional risk factors. Axial myopia was significantly associated with an increased risk as a single factor but not as a multiple factor. In general, the final visual outcome for RD after a capsule complication was poor; 3 eyes had a visual acuity of 0.50 or better. Eight eyes (62%) had a final visual acuity worse than 0.10 and 6 eyes, 0.02 or worse. CONCLUSIONS: The risk for RD after cataract surgery increased significantly when a capsule complication occurred, leading to poor final visual acuity in most cases.

330 TRABECULECTOMIES — A FOLLOW‐UP STUDY THROUGH ½‐3 YEARS

In 1967 a new microsurgical procedure for glaucoma known as trabeculectomy was introduced. This method is reported to have few early complications and a good pressure‐reducing effect. Our material presents the results of 330 consecutive trabeculectomies with a follow‐up period of ½‐3 years. The following items are discussed: IOP, visual acuity, visual fields, surgical complications, and need of re‐operation and medical postoperative therapy. We conclude that trabeculectomy is a safe and efficient antiglaucoma operation, recommended as an attractive alternative to heavy medication.

330 TRABECULECTOMIES A LONG TIME STUDY (3–5½ YEARS)

281 eyes out of 330 were followed during 3 to 5½ years after trabeculectomy. 32 eyes were drop‐outs due to death and 17 eyes due to inability to participate in the examination program. The mean age at time of surgery was 66 years. A mean pre‐operative IOP of 31 mmHg dropped to a mean post‐operative level of 18 mmHg. In 57% a single trabeculectomy was considered enough to control the glaucoma. Post‐operative medical treatment was considered necessary in 35%. In 87% the pre‐operative progress of the field defect was arrested. A reoperation was performed in 8%. The early complications were very few, but in 25% a slowly developing cataract was observed. A cataract extraction was performed in 29 eyes post trabeculectomiam with a favourable visual outcome. This study confirms the opinion that trabeculectomy is an atraumatic and efficient surgical procedure and a necessary therapeutic measure when the tolerable combination of antiglaucoma drugs proves insufficient to control the glaucoma.

Capsule complication during cataract surgery: Long-term outcomes: Swedish Capsule Rupture Study Group report 3

PURPOSE: To describe the long‐term outcomes after cataract extractions with a capsule rupture included in the Swedish Capsule Rupture Study. SETTING: Ten ophthalmic surgery departments in Sweden. METHODS: From the cohort of patients originally selected for inclusion in the Swedish Capsule Rupture Study, cases with a capsule complication (study group) and cases without a complication (control group) were examined approximately 3.5 years postoperatively. Visual acuity and objective and subjective parameters were registered. RESULTS: The study group comprised 171 patients and the control group, 198 patients. Patients with a capsule complication had a significantly worse visual outcome and a doubled risk for no improvement in preoperative visual acuity. Pupil distortion, iris damage, synechias, and subjective complaints related to the eye were significantly more common in patients with a capsule complication. CONCLUSION: Capsule complications decreased the probability of good postoperative visual acuity and in general yielded a worse long‐term outcome after phacoemulsification surgery.

Trabeculectomy Combined with Cataract Extraction

In a combined trabeculectomy and cataract extraction procedure on 17 eyes of 16 patients, there was a 50% average decrease in intraocular pressure. Visual acuity improved in 14 eyes, remained unchanged in two eyes, and declined in one eye. The postoperative complications were few and appreciable in only two cases. According to our follow-up findings, the combined technique is no more traumatic than an ordinary cataract extraction.