Tadayoshi Kaiya

Anterior capsular contraction after cataract surgery in eyes of diabetic patients

AIM To investigate change in the area of anterior capsular opening (ACO) after cataract surgery and its relation to the degree of postoperative anterior inflammation in patients with diabetes mellitus (DM). METHODS 31 eyes of 31 patients with DM and 30 eyes of 30 normal controls scheduled to undergo cataract surgery were examined prospectively. The area of ACO was measured with an anterior eye segment analysis system (EAS-1000) on the day following surgery and 3, 6, and 12 months after surgery. Comparative analyses were made on the area of ACO relative to the presence of DM and diabetic retinopathy (DR). The percentage reduction of area of ACO was calculated from values 1 day and 12 months after surgery, and multiple regression analysis was performed on the presence of DM, patient age, ACO area on the first postoperative day, and aqueous flare intensity 1 day and 12 months after surgery. RESULTS The area was significantly smaller in the DM group at 3 (p=0.015, Studentst test), 6 (p=0.011), and 12 (p=0.010) months postoperatively. Patients having DR showed significantly smaller ACO area than the non-DR group 3 (p=0.039), 6 (p=0.033), and 12 (p=0.028) months after surgery. Multiple regression analysis revealed that presence of DM (p=0.003) and aqueous flare intensity 12 months after surgery (p=0.039) significantly correlated with the percentage reduction of area of ACO. Age, ACO area at 1 day postoperatively, and aqueous flare intensity immediately after surgery were not relevant to ACO contraction. CONCLUSIONS Anterior capsular contraction after cataract surgery was greater in eyes of DM patients, especially in those with DR and increased permeability of the blood-aqueous barrier.

Observation of blood-aqueous barrier function after posterior chamber intraocular lens implantation

ABSTRACT Fluorophotometry was performed on 306 eyes of 306 patients who had posterior chamber intraocular lens implantation after phacoemulsification or planned extracapsular cataract extraction procedures to compare the ratio of fluorescein concentration in the anterior chamber of operated eyes and of unoperated fellow eyes for age, postoperative period, and operative procedure. In this study, the breakdown and reestablishment of the blood‐aqueous barrier after posterior chamber intraocular lens implantation was observed for a long period.

Risk factors for contraction of the anterior capsule opening after cataract surgery.

Purpose: To investigate the factors contributing to contraction of the anterior capsule opening (ACO) after cataract surgery in normal eyes. Setting: Department of Ophthalmology, University of Tokyo, School of Medicine, Tokyo, and Kaiya Eye Clinic, Hamamatsu, Japan. Methods: This study included 141 eyes of 141 patients scheduled to have cataract surgery. The area of the ACO was determined by diaphanoscopy using the EAS‐1000 anterior eye segment analysis system 1 day and 9 months postoperatively, after which the percentage reduction in the ACO area was calculated. Aqueous flare intensity was measured with a laser flare‐cell meter 1 week and 9 months after surgery. Multiple regression analysis was performed to determine which factors were correlated with the percentage reduction in the ACO area. Variables tested included patient age, axial length, the ACO area on the first postoperative day, and flare values 1 week and 9 months after surgery. Results: Patient age (r = 0.193, P = .029) and flare intensity 9 months after surgery (r = 0.255, P = .007) were significantly correlated with the percentage reduction in the ACO area (R2 = 0.133). The axial length, ACO area 1 day postoperatively, and flare value at 1 week were not correlated with ACO contraction. Conclusion: Contraction of the ACO after cataract surgery is related to instability of the blood‐aqueous barrier.

Glycemic control and lens transparency in patients with type 1 diabetes mellitus.

PURPOSE To assess quantitatively the cumulative effect of hyperglycemia on lens transparency in patients with juvenile type 1 diabetes mellitus. METHODS Subjects were 30 patients (30 eyes) with type 1 diabetes mellitus who had well-documented records on the duration of diabetes mellitus and condition of glycemic control from the onset. They were 35 years of age or younger (mean, 26.0 years), had a history of type 1 diabetes mellitus at least 5 years (mean, 8.4 years), had corrected visual acuity of 20/20 or better, and showed no clinically apparent cataract on slit-lamp examination. Twenty-one eyes of 21 subjects served as age-matched normal controls. They were 35 years of age or younger (mean, 25.7 years), had no diabetes mellitus, had corrected visual acuity of 20/20 or better, and showed no signs of cataract on slit-lamp examination. The degree of lens opacity was quantified using the anterior eye segment analysis system based on the Scheimpflug principle. An index was created to represent the cumulative effect of long-term glycemic control (hyperglycemic accumulation) by multiplying the average hemoglobin A(1c) value and the number of months from the onset. RESULTS The patients with diabetes mellitus exhibited significantly greater degree of lens opacity than the normal controls (P =.017, Mann-Whitney U-test). Among the patients with diabetes mellitus, the lens opacity was greater in eyes with retinopathy than those without retinopathy (P =.011). Multiple regression analysis revealed that only the index of hyperglycemic accumulation significantly correlated with the degree of lens opacity (P =.042). CONCLUSION Accumulated effect of hyperglycemia is related to the lens transparency in patients with diabetes.

Relationship between anterior capsule contraction and posterior capsule opacification after cataract surgery in patients with diabetes mellitus

Purpose: To prospectively assess the relationship between contraction of the anterior capsule opening and posterior capsule opacification (PCO) after cataract surgery in patients with diabetes mellitus. Setting: Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Kaiya Eye Clinic, Hamamatsu, and Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaragi, Japan. Methods: This study comprised 45 patients (45 eyes) with diabetes mellitus who had cataract surgery. In all eyes, the anterior capsule opening area and degree of PCO were determined by diaphanoscopy using an anterior eye segment analysis system (EAS‐100, Nidek, Inc.) 1 day and 1 year postoperatively. Results: There was no correlation between the size of the anterior capsule opening area 1 day after surgery and the degree of PCO 1 year after surgery (Pearson correlation coefficient [r] = 0.041; P = .79). The percentage reduction in the anterior capsule opening area from 1 day to 1 year after surgery did not correlate with the degree of PCO 1 year after surgery (r = −0.08; P = .60). Conclusion: Contraction of the anterior capsule opening and PCO after cataract surgery cannot be explained by a common mechanism.

Influence of rapid glycemic control on lens opacity in patients with diabetes mellitus

PURPOSE To report the influence of rapid glycemic control on lens opacity in patients with diabetes mellitus. METHODS In a prospective study, nine patients with adult onset diabetes mellitus and glycosylated hemoglobin values over 9% were divided into two groups, rapid glycemic control and slow glycemic control groups, based on the time course of glycosylated hemoglobin values after the initiation of glycemic control. The lens thickness and opacity were measured using the anterior eye segment analysis system. RESULTS One week after onset of treatment, the lens in rapid glycemic control group became significantly thicker than in pretreatment, but returned to the baseline level at the subsequent measurement points. The lens opacity index in the rapid glycemic control group increased significantly (P <.01, paired t test) 4 months after the glycemic control, which persisted throughout the 1-year study period. The lens thickness and opacity in the slow glycemic control group did not change significantly. CONCLUSION It was suggested that rapid glycemic control can induce an irreversible increase in lens opacification.

Pupillary functions after cataract surgery using flexible iris retractor in patients with small pupil.

PURPOSE To quantitatively assess pupillary functions after small pupil cataract surgery using the flexible iris retractor. METHODS Subjects were 11 patients (12 eyes) with small pupils who underwent phacoemulsification and intraocular lens implantation. Pupils were enlarged using the flexible iris retractor intraoperatively, and postoperative iriscorder data were compared with the data of 20 normal controls who underwent standard phacoemulsification and intraocular lens implantation. RESULTS Although pupillary area before light stimulus did not differ between the groups, contraction rate after light stimulus was significantly lower in the small pupil group than in the normal controls. The velocity of contraction and dilation was also significantly slower in the small pupil group. Wider pupillary stretching during surgery resulted in deteriorated pupillary functions after surgery. Eyes of patients on long-term miotic therapy with pilocarpine showed poorer pupillary reaction postoperatively. CONCLUSION Inappropriate use of the flexible iris retractor causes an atonic, chronically enlarged postoperative pupil. To avoid postoperative pupillary complications, miotic pupils should not be stretched to larger than a 5.0 x 5.0 mm square.

Effect of subconjunctival steroid injection on intraocular inflammation and blood glucose level after cataract surgery in diabetic patients

Purpose: To prospectively evaluate the usefulness of a subconjunctival steroid injection given at the completion of cataract surgery in patients with diabetes mellitus. Setting: University of Tokyo School of Medicine, Tokyo, Kaiya Eye Clinic, Hamamatsu, and Jyosai Hospital, Tokyo, Japan. Methods: One hundred four eyes of 104 diabetic patients having routine small incision cataract surgery were randomized into 2 groups. One group received a subconjunctival injection of dexamethasone and the other group did not. Aqueous flare intensity was measured with the laser flare meter preoperatively and 1, 2, 5, 7, and 14 days postoperatively. Another 19 diabetic patients having routine cataract surgery were randomized to receive a subconjunctival steroid injection or not; blood glucose concentration was measured 4 times a day for 3 days postoperatively. Results: There was no significant difference between the 2 groups in aqueous flare values at any postoperative time. The subconjunctival steroid injection induced a transient but significant increase in blood glucose on the day of surgery. Conclusion: A subconjunctival steroid injection given at the completion of cataract surgery in diabetic patients had no beneficial effects.

Optic disc and retinal nerve fiber layer analysis with scanning laser tomography after LASIK.

PURPOSE To examine whether LASIK induces changes in the optic disc and retinal nerve fiber layer using scanning laser tomography. METHODS Prospective, consecutive study of 53 myopic eyes in 38 patients (mean age: 35.7 +/- 10.4 years; range: 22 to 58 years). Preoperative average refractive error was -6.0 +/- 2.4 diopters (D) (spherical equivalent) (range: -2.0 to -10.0 D). Optic disc morphology and retinal nerve fiber layer thickness were evaluated with scanning laser tomography preoperatively and at 7 and 13 months postoperatively. RESULTS No statistically significant differences were noted between the pre- and postoperative optic disc and retinal nerve fiber layer measurements. CONCLUSIONS Our results suggest that transient extreme elevation of intraocular pressure during LASIK does not affect the optic disc morphology or retinal nerve fiber layer thickness in normal myopic eyes for at least 1 year after surgery.

Immunohistologic study of interleukin-1, transforming growth factor-β, and α-smooth muscle actin in lens epithelial cells in diabetic eyes

PURPOSE: To assess the effects of the cytokines interleukin‐1 (IL‐1), transforming growth factor‐β (TGF‐β), and α‐smooth muscle actin (α‐SMA) in lens epithelial cells (LECs) in normal and diabetic eyes. SETTING: Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan. METHODS: Ten eyes of 10 patients with diabetic mellitus and 20 normal eyes of 20 patients with senile cataract were studied. The anterior lens capsules with LECs obtained by capsulotomy during cataract surgery were cultured. The LECs obtained immediately after surgery and on the third day of culture were immunohistologically studied to assess the activities of the cytokines. RESULTS: Interleukin‐1 and TGF‐β staining showed a low level activity in some LECs in diabetic eyes but only a minimum level of activity in those in normal eyes. During culture, LECs in diabetic eyes became small and transformed into fusiform and fibroblast‐like cells, and these cells were strongly stained for IL‐1 and TGF‐β. Normal eyes showed little changes in cell morphology and were weakly stained for IL‐1 and TGF‐β. Both with culture and with no culture, α‐SMA showed only minimal activity in both diabetic and normal eyes, with no difference. CONCLUSION: Lens epithelial cells after cataract surgery had low IL‐1 and TGF‐β activities, and these activities increased during culture. Diabetic eyes showed higher cytokine activities and more marked morphologic changes than normal eyes, suggesting that increased proliferative activity and increased cytokine activity of LECs contribute to strong anterior capsule contraction in diabetic eyes.