今日の臨床サポート

白内障

著者: 江口秀一郎 江口眼科病院

監修: 沖波聡 倉敷中央病院眼科

著者校正済:2021/11/24
現在監修レビュー中
患者向け説明資料

概要・推奨   

薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
江口秀一郎 : 特に申告事項無し[2021年]
監修:沖波聡 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行い、原発閉塞隅角緑内障治療手段としての白内障手術について加筆を行った。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 白内障とは、水晶体が混濁した状態をいい、混濁の原因、混濁部位や形状、混濁の発症時期、混濁の進行程度により、種々に分類される。
  1. 白内障を原因により分類すると、先天性と後天性に分類され、後天性には加齢に伴う加齢白内障、他の眼疾患に伴う併発白内障、外傷性白内障、放射線による白内障、ステロイド薬などの薬剤による白内障、さらには、アトピー性や糖尿病白内障などがある。
  1. 原因分類のなかで、最も頻度の高い加齢白内障は、50歳代では60%に、60歳代では80%に、90歳代では100%の被験者に認められるとした報告もある[1][2]
  1. 先天性白内障、特に片眼例では、早期の手術加療と術後の適切な屈折矯正を行わないと視性刺激遮断弱視を生ずる。
  1. 水晶体の混濁部位により分類すると、皮質白内障、核白内障、後嚢下白内障に分類され、水晶体混濁の程度により初発白内障、未熟白内障、成熟白内障、過熟白内障に分類される。
  1. 自覚症状には視力低下、霧視、羞明、単眼複視、三重視、進行すると眼位異常や眼振を生ずることもある。著しく進行した過熟白内障では、水晶体過敏性眼内炎や水晶体融解性緑内障を続発することがあり、手術治療を急ぐ。
 
  1. Clinical Question:水晶体は加齢に伴いどのように変化するか(推奨度2Rs)
  1. 水晶体は年齢とともに少しずつ厚くなりその割合は0.02mm/年といわれている。また、加齢に伴い水晶体の弾性は低下し、水晶体は黄色または白色に着色し網膜照度の低下や色覚の変化をもたらす。
  1. 水晶体は加齢に伴いその形、弾性、色調、透明性が変化する。水晶体は年齢とともに少しずつ厚くなりその割合は0.02mm/年といわれている[3]。厚さの変化は水晶体前面の皮質浅層部の厚さの増加が主体である[4]。水晶体の厚さには人種差があり、欧米人に比べ東洋人では水晶体がやや厚い。白内障が生じてくると水晶体軸方向の水晶体厚の増加量は低下し、水晶体混濁の種類によっては水晶体が薄くなる場合もある。一般に透明水晶体に比べ白内障眼では皮質混濁水晶体は薄く、角混濁白内障は厚い傾向がある。水晶体厚の増加に伴い、水晶体前面曲率は急峻になるが水晶体後面曲率の変化は僅かである。
  1. 加齢に伴い水晶体の弾性は低下し、水晶体は黄色または白色に着色し網膜照度の低下や色覚の変化をもたらす。水晶体の着色に密接に関係しているのはトリプトファンであるとされている[5]。水晶体でのトリプトファン代謝は主にキヌレニン経路によると考えられており、太陽光の長波長紫外線によりトリプトファンがN-ホルムキヌレニンに変換され、次いでキヌレニンに加水分解され、さらにさまざまな蛍光物質に代謝されることにより水晶体が黄色を呈する。水晶体の散乱光強度を測定すると45歳以降、その増加率が大きくなり水晶体の透明性が損なわれてくる。加齢により水晶体散乱光強度が増加する部位は水晶体前嚢、前成人核、中心間層に頻度が高い。
問診・診察のポイント  
  1. 白内障患者の主訴、現病歴、既往歴を問診するとともに、患者に視力低下の自覚状態を表現してもらう。

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文献 

著者: J S Deane, A B Hall, J R Thompson, A R Rosenthal
雑誌名: Ophthalmic Epidemiol. 1997 Dec;4(4):195-206.
Abstract/Text PURPOSE: To describe the distribution of the 11 features assessed by the Oxford Clinical Cataract Classification and Grading System (OCCCGS) in a population-based study.
METHODS: The Melton Eye Study is an English community-based epidemiological study of the natural history of eye disease in people aged 55 to 74 years. Both lenses of 560 subjects were graded at the slit lamp using a decimalised version of the OCCCGS. Subject prevalences were estimated by logistic regression and the extent, when present, against normal errors regression.
RESULTS: White nuclear scatter (WNS), brunescence, cortical spoke (CS), anterior subcapsular opacity (ASC), fibre folds (FF), waterclefts (WC) and perinuclear retro-dots all increased with age (p < 0.05). Posterior subcapsular opacity (PSC), vacuoles, focal dots (FD) and coronary flakes (CF) did not significantly increase with age. Subject prevalences of the features and the mean Oxford scores when present were: WNS (1.33), brunescence (0.88), CS 36% (0.34), PSC 11% (0.52), ASC 2% (0.53), FF 18% (0.53), WC 17% (0.29), retro-dots 11% (1.15), vacuoles 59% (0.43), FD 98% (1.79) and CF 39% (1.24). Significantly more common in women were both coronary flakes (p < 0.001) and waterclefts (p < 0.05).
CONCLUSIONS: These are the first data on the distribution of these minor lesions in a population-based study. Coronary flakes and waterclefts are more common in women.

PMID 9500154  Ophthalmic Epidemiol. 1997 Dec;4(4):195-206.
著者: M Dubbelman, G L van der Heijde, H A Weeber
雑誌名: Optom Vis Sci. 2001 Jun;78(6):411-6.
Abstract/Text Commonly, measurements of lens thickness are performed using A-scan ultrasonography or slitlamp Scheimpflug photography. Both techniques have their drawbacks in the study of presbyopia: ultrasonography requires the velocity of sound in the lens which may change with age, whereas Scheimpflug photography requires knowing the refractive index of the lens to enable correction of the photographs for the distortion due to the refraction of the cornea and lens. By combining Scheimpflug photography and axial optical eye-length measurements, we were able to individually correct the Scheimpflug images for distortion and calculate the refractive index and thickness of the human lens. Lens thickness of 90 subjects ranging in age between 16 and 65 years was measured, and an average increase of 24 microm/year was found. This value is consistent with ultrasonographic measurements assuming an age-independent velocity of sound in the lens of 1641 m/s. The posterior lens surface recedes from the cornea with age, and this backward movement does not differ significantly from the forward movement of the anterior lens surface.

PMID 11444630  Optom Vis Sci. 2001 Jun;78(6):411-6.
著者: Kazuyuki Sasaki, Hiroshi Sasaki, Fridbert Jonasson, Masami Kojima, Hong Ming Cheng
雑誌名: Ophthalmic Res. 2004 Nov-Dec;36(6):332-40. doi: 10.1159/000081636.
Abstract/Text PURPOSE: To investigate racial differences of lens transparency properties and the prevalence of lens opacification by age.
METHODS: Lenses of randomly selected Asian (1,038 Japanese and 517 Singaporeans) and Caucasian (1,045 Icelanders) subjects were evaluated for their lens transparency property (LTP). The prevalence of lens opacification was determined with a newly proposed WHO cataract classification system.
RESULTS: LTP increased with aging for all nationalities. Light scattering intensity was significantly higher in the Singaporeans followed by the Icelandic subjects. The prevalence of cortical opacification in Singaporeans was significantly higher than those of the other nationalities up to the age of 60, and the prevalence in Asians was significantly higher than that in Caucasians aged 60-69. Cortical opacification was more prevalent than the other types for both Japanese and Icelanders in their 50s, 60s and 70s. Regarding the central optical zone, the prevalence in the Singaporeans was significantly higher than in the other two groups in their 50s and 60s. The prevalence of nuclear opacification in Singaporeans was markedly higher than those of the two other groups for all ages. Subcapsular cataract was the least prevalent type for all age groups and nationalities; however, the highest prevalence was observed in Singaporeans.
CONCLUSIONS: Lens transparency decreased with age in the Singaporeans more markedly than in the other two groups. The high prevalence of nuclear opacification in Singaporeans is considered to be due to environmental rather than race-specific factors.

Copyright 2004 S. Karger AG, Basel.
PMID 15627834  Ophthalmic Res. 2004 Nov-Dec;36(6):332-40. doi: 10.1159・・・
著者: A J Bron, G F Vrensen, J Koretz, G Maraini, J J Harding
雑誌名: Ophthalmologica. 2000 Jan-Feb;214(1):86-104. doi: 27475.
Abstract/Text The human lens grows by a process of epithelial cell division at its equator and the formation of generations of differentiated fibre cells. Despite the process of continuous remodelling necessary to achieve growth within a closed system, the lens can retain a high level of light transmission throughout the lifetime of the individual, with the ability to form sharp images on the retina. Continuous growth of the lens solves the problem imposed by terminal differentiation within a closed, avascular system, from which cells cannot be shed. The lens fibre tips arch over the equator to meet anteriorly and posteriorly and form branching sutures of increasing complexity. The stages of branching may create the optical zones of discontinuity seen on biomicroscopy. The lens is exposed to the cumulative effects of radiation, oxidation and postranslational modification. These later proteins and other lens molecules in such a way as to impair membrane functions and perturb protein (particularly crystallin) organisation, so that light transmission and image formation may be compromised. Damage is minimised by the presence of powerful scavenger and chaperone molecules. Progressive insolublisation of the crystallins of the lens nucleus in the first five decades of life, and the formation of higher molecular weight aggregates, may account for the decreased deformability of the lens nucleus which characterises presbyopia. Additional factors include: the progressive increase in lens mass with age, changes in the point of insertion of the lens zonules, and a shortening of the radius of curvature of the anterior surface of the lens. Also with age, there is a fall in light transmission by the lens, associated with increased light scatter, increased spectral absorption, particularly at the blue end of the spectrum, and increased lens fluorescence. A major factor responsible for the increased yellowing of the lens is the accumulation of a novel fluorogen, glutathione-3-hydroxy kynurenine glycoside, which makes a major contribution to the increasing fluorescence of the lens nucleus which occurs with age. Since this compound may also cross-link with the lens crystallins, it may contribute to the formation of high-molecular-weight aggregates and the increases in light scattering which occur with age. Focal changes of microscopic size are observed in apparently transparent, aged lenses and may be regarded as precursors of cortical cataract formation.

Copyright 2000 S. Karger AG, Basel
PMID 10657747  Ophthalmologica. 2000 Jan-Feb;214(1):86-104. doi: 27475・・・
著者: W Smith, P Mitchell, S R Leeder
雑誌名: Arch Ophthalmol. 1996 Dec;114(12):1518-23.
Abstract/Text OBJECTIVE: To assess the associations between stage of age-related maculopathy (ARM) and current, past, and passive smoking.
METHODS: A cross-sectional study of 3654 subjects from a defined geographic area west of Sydney, Australia, identified subjects with late age-related macular degeneration (AMD) and early ARM by ocular examination and detailed grading of retinal photographs. Interviewer-administered questionnaires provided data about smoking history for subjects and spouses. Logistic regression, adjusting for age and sex, and 2-way analysis of variance were used to assess associations.
RESULTS: Current tobacco smoking was significantly associated with late AMD (odds ratio [OR], 3.92), including neovascular AMD (OR, 3.20) and geographic atrophy (OR, 4.54), and early ARM (OR, 1.75). Having ever smoked was significantly associated with late AMD (OR, 1.83) but not early ARM. Passive smoking was associated with increased but insignificant odds for late AMD. The risk was slightly higher among women compared with men for most exposure categories.
CONCLUSIONS: These findings provide convincing evidence that smoking may be causally associated with ARM. The strongest risk was found for current smokers, suggesting potential benefits of targeting education to older people who are current smokers and have signs of early ARM.

PMID 8953988  Arch Ophthalmol. 1996 Dec;114(12):1518-23.
著者: Anselm J Hennis, Suh-Yuh Wu, Barbara Nemesure, Leslie Hyman, Andrew P Schachat, M Cristina Leske, Barbados Eye Studies Group
雑誌名: Ophthalmology. 2009 Aug;116(8):1461-8. doi: 10.1016/j.ophtha.2009.02.017. Epub 2009 Jun 4.
Abstract/Text OBJECTIVE: To describe the 9-year incidence of visual impairment and primary causes of blindness among black participants of the Barbados Eye Studies (BES).
DESIGN: Population-based prospective cohort study.
PARTICIPANTS: The BES followed a nationally representative cohort selected by simple random sampling, aged 40 to 84 years at baseline, with reexaminations after 4 years (Barbados Incidence Study of Eye Diseases [BISED]) and 9 years (BISED II). BISED II included 2793 (81%) of those eligible.
METHODS: Cumulative 9-year incidence rates were estimated by the Product-Limit approach. The study was reviewed and approved by the institutional review boards of collaborating institutions.
MAIN OUTCOME MEASURES: Best-corrected visual acuity (VA) was assessed by the Ferris-Bailey chart, following a modified Early Treatment of Diabetic Retinopathy Study protocol. Low vision and blindness were defined by World Health Organization (WHO) criteria as VA <6/18 to 6/120, and <6/120, respectively, in the better eye, and by U.S. criteria as VA < or =20/40 and < or =20/200, respectively. Vision loss was defined as a decrease of 15 letters or more read correctly in the better eye between baseline and follow-up examinations.
RESULTS: The 9-year incidence was 1.0% and 2.1% for blindness and 6.0% and 9.0% for low vision, by WHO and U.S. criteria, respectively. Older age at baseline was associated with higher incidence of low vision and blindness, reaching 23.0% (95% confidence interval [CI], 18.8-28.0) and 4.3% (95% CI, 2.7-6.9) at age 70 years or more, based on WHO criteria. The primary causes of incident bilateral blindness (U.S. criteria) in 126 eyes were age-related cataract (48.3%), open-angle glaucoma (OAG) (14.3%), combined cataract and OAG (6.3%), diabetic retinopathy (8.7%), and optic atrophy (7.1%). Age-related macular degeneration (2.4%) rarely caused blindness.
CONCLUSIONS: Incident visual impairment is exceedingly high in this population. Cataract, OAG, and diabetic retinopathy remain the major causes of blindness, underpinning the clinical and public health significance of these conditions in this and similar populations.

PMID 19500851  Ophthalmology. 2009 Aug;116(8):1461-8. doi: 10.1016/j.o・・・
著者: R Klein, B E Klein, K L Linton, D L De Mets
雑誌名: Ophthalmology. 1991 Aug;98(8):1310-5.
Abstract/Text Few current population-based data on visual impairment are available. Visual acuity and impairment were measured in 4926 people between the ages of 43 and 86 years in the defined population participating in the Beaver Dam Eye Study. Visual acuity was measured after refraction, using standardized protocols. Of a possible maximum score of 70 (20/10), the mean number of letters correctly identified (right eye) varied from 55.7 (20/20, n = 1515) in people between the ages of 43 and 54 years to 41.2 (20/40, n = 795) in people 75 years of age or older. Age-specific mean visual acuity scores were consistently and significantly lower in women, who identified three fewer letters on the average than men. Rates of any visual impairment (20/40 or worse in the better eye) or legal blindness (20/200 or worse in the better eye), increased from 0.8% and 0.1%, respectively, in people between the ages of 43 and 54 years to 21.1% and 2.0%, respectively, in people 75 years of age or older. Multivariate analyses showed both sex (women) and age (older) to be significant and independent predictors of poorer visual acuity.

PMID 1923372  Ophthalmology. 1991 Aug;98(8):1310-5.
著者: J M Tielsch, A Sommer, J Katz, H Quigley, S Ezrine
雑誌名: Arch Ophthalmol. 1991 May;109(5):637-41.
Abstract/Text The Baltimore Eye Survey is a population-based study of ocular disorders conducted in East Baltimore, Md, designed to determine the prevalence and severity of vision loss and ocular disease and their relationships to socioeconomic and other risk factors. This survey comprised 5300 subjects (2911 whites and 2389 blacks). Visual impairment was associated with age, race, general health status, educational level, income, and employment status. An identified association of race with blindness and visual impairment was reduced, but not eliminated, after adjustment for these socioeconomic factors, indicating that socioeconomic status itself is an important determinant of visual impairment.

PMID 2025164  Arch Ophthalmol. 1991 May;109(5):637-41.
著者: Aya Kim, Kenichiro Bessho, Yoshitaka Okawa, Naoyuki Maeda, Yasuo Tano, Yoko Hirohara, Toshifumi Mihashi, Takashi Fujikado
雑誌名: Ophthalmic Physiol Opt. 2006 Jan;26(1):65-70. doi: 10.1111/j.1475-1313.2005.00352.x.
Abstract/Text PURPOSE: To determine whether wavefront analysis using a Hartmann-Shack (H-S) aberrometer can reveal the cause of monocular triplopia in eyes with mild cataracts.
METHODS: Six patients (nine eyes; age range 38-58 years; average 49.8 +/- 6.9 years) who complained of monocular triplopia at the Osaka University Hospital between January and December 2003 were examined. Wavefront analyses of ocular and corneal aberrations of the central 4 mm diameter were performed using a H-S aberrometer equipped with a Placido ring videokeratoscope. The ocular and corneal higher-order wavefronts were fitted with a fourth-order Zernike expansion.
RESULTS: All nine eyes showed mild nuclear cataract and had a mean spherical refractive error of -10.3 +/- 3.5 D. The visual acuity was > or = 20/40 except in one eye with glaucoma. For the Zernike polynomials, the trefoil aberration (C3-3) and the spherical aberration (C40) were significantly higher than those of age-matched normal controls (p < 0.001). The simulated retinal image of a Landolt C showed that the combination of trefoil aberration and the spherical aberration can cause an image with a triple configuration.
CONCLUSIONS: Monocular triplopia was reported by middle-aged patients with mild nuclear cataract and high myopia. Wavefront analyses suggested that the triple configuration was caused by the combined increase of the trefoil and spherical aberration in lenses with mild nuclear cataracts.

PMID 16390484  Ophthalmic Physiol Opt. 2006 Jan;26(1):65-70. doi: 10.1・・・
著者: Takashi Fujikado, Hiroshi Shimojyo, Jun Hosohata, Yoko Hirohara, Toshifumi Mihashi, Naoyuki Maeda, Yasuo Tano
雑誌名: Am J Ophthalmol. 2006 Jun;141(6):1138-1140. doi: 10.1016/j.ajo.2005.12.040.
Abstract/Text PURPOSE: To determine whether higher-order aberrations can explain the monocular diplopia reported by a patient.
DESIGN: Observational case report.
METHODS: A patient complaining of monocular diplopia was examined with the Hartmann-Shack aberrometer to determine if the higher-order wavefront aberrations could account for the diplopia. The patient had a mild cortical cataract, and measurements were made before and after lensectomy. In addition, the retinal image was simulated using Zernike polynomials.
RESULTS: Spherical aberration (0.20 microm for 4-mm pupil) and secondary astigmatism (-0.12 microm) were increased in the eye. The simulated retinal image had a double configuration that was approximately the same as the subjective image reported by the patient. After cataract surgery, the diplopia disappeared, and the spherical aberrations and secondary astigmatism were considerably decreased.
CONCLUSIONS: The monocular diplopia probably stemmed from the combined effects of spherical aberration and secondary astigmatism caused by the cortical cataract.

PMID 16765690  Am J Ophthalmol. 2006 Jun;141(6):1138-1140. doi: 10.101・・・
著者: M C Leske, S Y Wu, A Hennis, A M Connell, L Hyman, A Schachat
雑誌名: Ophthalmology. 1999 Jan;106(1):35-41.
Abstract/Text OBJECTIVE: The increased cataract prevalence of black populations, especially of cortical cataract, remains unexplained. The authors evaluate the relationships of diabetes, hypertension, and obesity patterns to lens opacities, by age, among 4314 black participants in the Barbados Eye Study.
DESIGN AND PARTICIPANTS: Prevalence study of a random sample of the Barbados population, ages 40 to 84 years (84% participation).
MAIN OUTCOME MEASURES: Associations with age-related lens changes (grade > or = 2 in the Lens Opacities Classification System II at the slit lamp) were evaluated in logistic regression analyses by age (persons < 60 years and > or = 60 years). Results are presented as odds ratios (OR) with 95% confidence intervals.
RESULTS: Of the 1800 participants with lens changes, most had cortical opacities. Diabetes history (18% prevalence) was related to all lens changes, especially at younger ages (age < 60 years: OR = 2.23 [1.63, 3.04]; age > or = 60 years: OR = 1.63 [1.22, 2.17]). Diabetes also increased the risk of cortical opacities (age < 60 years: OR = 2.30 [1.63, 3.24]; age > or = 60 years: OR = 1.42 [1.03, 1.96]); additional risk factors were high diastolic blood pressure (age < 60 years: OR = 1.49 [1.00, 2.23]) and higher waist/hip ratio (all ages: OR = 1.36 [1.00, 1.84]). Diabetes was also related to posterior subcapsular opacities. Glycated hemoglobin levels were positively associated with cortical and posterior subcapsular opacities. Overall, 14% of the prevalence of lens changes could be attributed to diabetes.
CONCLUSIONS: The high prevalence of cortical opacities was related to diabetes, hypertension, and abdominal obesity, which also are common in this and other black populations. Interventions to modify these risk factors, especially in populations in which they are highly prevalent, may have implications to control visual loss from cataract, which is the first cause of blindness worldwide.

PMID 9917778  Ophthalmology. 1999 Jan;106(1):35-41.
著者: Hani Levkovitch-Verbin, Zohar Habot-Wilner, Nirit Burla, Shlomo Melamed, Modi Goldenfeld, Shai M Bar-Sela, Dan Sachs
雑誌名: Ophthalmology. 2008 Jan;115(1):104-8. doi: 10.1016/j.ophtha.2007.03.058. Epub 2007 Jun 11.
Abstract/Text OBJECTIVE: To investigate whether eyes with glaucoma or exfoliation syndrome without glaucoma are prone to exhibit intraocular pressure (IOP) elevation shortly after cataract surgery and, if so, whether timolol maleate 0.5% reduces these spikes.
DESIGN: Prospective randomized double-masked clinical trial.
PARTICIPANTS: One hundred twenty-two patients with normal eyes, medically well-controlled glaucoma, or exfoliation syndrome who underwent uneventful phacoemulsification cataract extraction.
METHODS: Patients were randomly assigned to an immediately postoperative drop of either timolol maleate 0.5% or no treatment. Intraocular pressure was measured preoperatively and 4, 8, and 24 hours and 1 week later.
MAIN OUTCOME MEASURES: Intraocular pressure measurements.
RESULTS: The changes in postoperative IOP over time differed significantly between glaucoma, exfoliation syndrome, and normal (P = 0.005). Intraocular pressure was significantly lower in the normal group (n = 25) than in both the glaucoma (n = 18) and exfoliation syndrome (n = 19) groups (P<0.001). With 1 drop of prophylactic timolol maleate 0.5% at completion of surgery, the normal group (n = 25) again had IOP significantly lower than those of the glaucoma (n = 15) and exfoliation syndrome (n = 20) groups (P<0.001). Treatment with timolol maleate 0.5% significantly changed postoperative IOP over time in the glaucomatous eyes (P = 0.003), but it made no difference in the exfoliation syndrome (P = 0.4) or normal (P = 0.5) eyes. Intraocular pressure > 25 mmHg did not occur among normal eyes. Intraocular pressure > 25 mmHg and > 30 mmHg occurred in 10 (55%) and 5 (28%) glaucoma patients, respectively, and 5 (27%) and 2 (11%) exfoliation syndrome patients, respectively. Timolol maleate 0.5% eliminated IOP spikes > 30 mmHg and reduced the frequency of IOP > 25 mmHg in both groups to 14% in the glaucoma group and 5% in the exfoliation syndrome group. Most IOP elevation occurred at 4 hours postoperatively. The mean IOP was <20 mmHg in all groups 1 day postoperatively.
CONCLUSIONS: Medically well-controlled glaucoma patients and patients with exfoliation syndrome may experience IOP elevation shortly after cataract surgery. Instillation of timolol maleate 0.5% at the end of the procedure in this series eliminated IOP > 30 mmHg, but IOP elevation below that level can still occur.

PMID 17561259  Ophthalmology. 2008 Jan;115(1):104-8. doi: 10.1016/j.op・・・
著者: Inci Irak-Dersu, Chris Nilson, Norm Zabriskie, Jane Durcan, Horace J Spencer, Alan Crandall
雑誌名: Acta Ophthalmol. 2010 Feb;88(1):131-4. doi: 10.1111/j.1755-3768.2009.01569.x. Epub 2009 Sep 16.
Abstract/Text PURPOSE: To evaluate short- and long-term intraocular pressure (IOP) changes after temporal clear corneal phacoemulsification in normal eyes.
METHODS: The charts of 266 consecutive non-glaucoma patients who underwent uneventful cataract surgery were reviewed. We recorded preoperative and postoperative (1 day, 1 week, 1 month, 3 months, 6 months, 1 year and 2 years) IOP measurements as well as anatomical properties obtained using Zeiss Humphrey IOL Master (Zeiss Meditech, Dublin, California, USA).
RESULTS: Mean IOP reduction after cataract surgery was 8.2%, 4.6%, 6.7% and 7.8% at 3 months, 6 months, 1 year and 2 years, respectively. Lens thickness was the only anatomical characteristic that correlated significantly with IOP decrease after surgery.
CONCLUSION: Temporal clear corneal phacoemulsification results in a decrease in postoperative IOP that persists for 2 years following surgery.

PMID 19758400  Acta Ophthalmol. 2010 Feb;88(1):131-4. doi: 10.1111/j.1・・・
著者: Hoy Choong Shin, Visvaraja Subrayan, Iqbal Tajunisah
雑誌名: J Cataract Refract Surg. 2010 Aug;36(8):1289-95. doi: 10.1016/j.jcrs.2010.02.024.
Abstract/Text PURPOSE: To evaluate changes in anterior chamber depth (ACD) and intraocular pressure (IOP) after phacoemulsification in eyes with occludable angles and compare the results with those in eyes with normal open angles.
SETTING: Eye Clinic, Ipoh General Hospital, Ipoh, Perak, Malaysia.
METHODS: Patients with nonglaucomatous eyes with open angles or with occludable angles were recruited. Ocular biometric measurements (ACD, axial length [AL], lens thickness and position) and IOP (tonometry) were performed preoperatively and 1 day and 1, 4, 9, and 12 weeks postoperatively.
RESULTS: The open-angle group and occludable-angle group each comprised 35 patients. The occludable-angle group had a shallower ACD, shorter AL, thicker and relatively anterior lens position, and higher IOP preoperatively; postoperatively, there was a significant increase in ACD and a significant reduction in IOP (P<.01). Anterior chamber deepening was inversely related to preoperative ACD in the occludable-angle group (P<.01). The mean preoperative IOP was higher in the occludable-angle group (15.77 mm Hg +/- 2.20 [SD]) than in the open-angle group (14.52 +/- 2.65 mm Hg) (P<.05). The IOP dropped progressively and significantly over 12 weeks postoperatively; the mean decrease was 2.31 +/- 0.99 mm Hg in the occludable-angle group and 0.77 +/- 1.17 mm Hg in the open-angle group. The IOP decrease in the occludable-angle group was inversely related to the preoperative IOP (P<.01).
CONCLUSION: Phacoemulsification led to anterior chamber deepening and lower IOP in eyes with occludable angles, which suggests it is an option for preventing acute angle-closure attacks in eyes with occludable angles and cataract.
FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
PMID 20656150  J Cataract Refract Surg. 2010 Aug;36(8):1289-95. doi: 1・・・
著者: Atsushi Nonaka, Takehisa Kondo, Masashi Kikuchi, Kenji Yamashiro, Masashi Fujihara, Takuji Iwawaki, Kaoruko Yamamoto, Yasuo Kurimoto
雑誌名: Ophthalmology. 2005 Jun;112(6):974-9. doi: 10.1016/j.ophtha.2004.12.042.
Abstract/Text PURPOSE: To investigate the frequency of residual angle closure after resolution of pupillary blocking by laser peripheral iridotomy and the effects of subsequent cataract surgery to resolve angle closure completely.
DESIGN: Retrospective, consecutive, interventional study.
PARTICIPANTS: Among 70 eyes treated with laser iridotomy, 13 with residual angle closure were treated with cataract surgery.
METHODS: The provocative test of angle closure by prone position in a dark room for 1 hour was performed; increases in tension of > or =8 mmHg, 6 or 7 mmHg, and < or =5 mmHg were considered to be positive, suspected positive, and negative, respectively. Configuration of the anterior chamber was examined using ultrasound biomicroscopy (UBM).
MAIN OUTCOME MEASURES: Intraocular pressure (IOP), response to the dark room prone position test, and morphologic analysis by UBM were evaluated before and 3 months after cataract surgery.
RESULTS: Residual angle closure after iridotomy was seen in 27 (38.6%) of 70 eyes; this was confirmed functionally by the dark room prone position test and morphologically by UBM. Eyes with IOP of > or =20 mmHg or with a glaucomatous visual field defect before iridotomy had a significantly higher incidence of residual angle closure after iridotomy than eyes without these findings (P<0.05). In all the eyes with residual angle closure after iridotomy, the response to the prone position test became negative after cataract surgery, with significant lowering of IOP (P<0.01).
CONCLUSIONS: Residual angle closure after iridotomy was common, especially in eyes with primary angle closure and poorly controlled IOP or glaucomatous optic neuropathy. Cataract surgery was effective to resolve completely the residual angle closure after iridotomy and lower IOP.

PMID 15885784  Ophthalmology. 2005 Jun;112(6):974-9. doi: 10.1016/j.op・・・
著者: Yuji Takihara, Masaru Inatani, Takahiko Seto, Keiichiro Iwao, Minako Iwao, Toshihiro Inoue, Nanako Kasaoka, Akira Murakami, Ryusuke Futa, Hidenobu Tanihara
雑誌名: Arch Ophthalmol. 2011 Feb;129(2):152-7. doi: 10.1001/archophthalmol.2010.348.
Abstract/Text OBJECTIVE: To determine whether previous phacoemulsification adversely affects surgical prognosis of trabeculectomy with mitomycin for open-angle glaucoma.
METHODS: The study is a retrospective, consecutive, comparative case series. At 2 clinical centers, we reviewed 226 medical records of eyes with open-angle glaucoma undergoing initial trabeculectomy, including 175 phakic eyes (phakic group) and 51 pseudophakic eyes that had previously undergone phacoemulsification with superior conjunctival incision (pseudophakic group). Primary outcome was the probability of success after trabeculectomy. Surgical failure was defined as an additional glaucoma surgery or 1 of the following 3 criteria: intraocular pressure (IOP) of 21 mm Hg or greater (A); IOP of 18 mm Hg or greater (B); and IOP of 15 mm Hg or greater (C). Multivariable analysis was performed using the Cox proportional hazards model.
RESULTS: The mean follow-up period was 37.5 months. The probability of success for criteria A, B, and C at 1 and 3 years in the phakic vs the pseudophakic group was 97.8% and 92.6%, respectively, vs 78.6% and 65.1%, respectively, for criterion A (P < .001); 92.9% and 81.3%, respectively, vs 72.8% and 63.7%, respectively, for criterion B (P = .004); and 73.1% and 54.2%, respectively, vs 53.1% and 38.4%, respectively, for criterion C (P = .009). The multivariable model confirmed that pseudophakia independently contributes to surgical failure (criterion A relative risk, 4.59 [P < .001]; criterion B, 2.88 [P = .004]; and criterion C, 2.02 [P = .009]). The pseudophakic group required more postoperative laser suture lysis (P = .01).
CONCLUSION: Previous phacoemulsification is a prognostic factor for surgical failure of trabeculectomy with mitomycin for open-angle glaucoma.

PMID 21320958  Arch Ophthalmol. 2011 Feb;129(2):152-7. doi: 10.1001/ar・・・
著者: Farzin Forooghian, Elvira Agrón, Traci E Clemons, Frederick L Ferris, Emily Y Chew, Age-Related Eye Disease Study Research Group
雑誌名: Ophthalmology. 2009 Nov;116(11):2093-100. doi: 10.1016/j.ophtha.2009.04.033. Epub 2009 Aug 22.
Abstract/Text OBJECTIVE: To evaluate visual acuity outcomes after cataract surgery in patients with varying degrees of age-related macular degeneration (AMD).
DESIGN: Cohort study.
PARTICIPANTS: A total of 4757 participants enrolled in the Age-Related Eye Disease Study (AREDS), a prospective, multicenter, epidemiological study of the clinical course of cataract and AMD and a randomized controlled trial of antioxidants and minerals.
METHODS: Standardized lens and fundus photographs, performed at baseline and annual visits, were graded by a centralized reading center using standardized protocols for severity of AMD and lens opacities. History of cataract surgery was obtained every 6 months. Analyses were conducted using multivariate logistic regression.
MAIN OUTCOME MEASURE: The change in best-corrected visual acuity (BCVA) after cataract surgery compared with preoperative BCVA.
RESULTS: Visual acuity results were analyzed for 1939 eyes that had cataract surgery during AREDS. The mean time from cataract surgery to measurement of postoperative BCVA was 6.9 months. After adjustment for age at surgery, gender, type, and severity of cataract, the mean change in visual acuity at the next study visit after the cataract surgery was as follows: Eyes without AMD gained 8.4 letters of acuity (P<0.0001), eyes with mild AMD gained 6.1 letters of visual acuity (P<0.0001), eyes with moderate AMD gained 3.9 letters (P<0.0001), and eyes with advanced AMD gained 1.9 letters (P = 0.04). The statistically significant gain in visual acuity after cataract surgery was maintained an average of 1.4 years after cataract surgery.
CONCLUSIONS: On average, participants with varying severity of AMD benefited from cataract surgery with an increase in visual acuity postoperatively. This average gain in visual acuity persisted for at least 18 months.

PMID 19700198  Ophthalmology. 2009 Nov;116(11):2093-100. doi: 10.1016/・・・
著者: Jie Jin Wang, Ronald Klein, Wayne Smith, Barbara E K Klein, Sandy Tomany, Paul Mitchell
雑誌名: Ophthalmology. 2003 Oct;110(10):1960-7.
Abstract/Text PURPOSE: To assess whether cataract surgery in older persons increases risk for the development of late-stage age-related maculopathy (ARM).
DESIGN: Combined analysis of longitudinal data from two population-based cohorts, the Beaver Dam Eye Study and Blue Mountains Eye Study.
PARTICIPANTS: The Beaver Dam Eye Study examined 4926 persons aged 43 years or older at baseline and re-examined 3684 after 5 years. The Blue Mountains Eye Study examined 3654 persons aged 49 years or older at baseline and re-examined 2335 after 5 years.
METHODS: The two studies used similar protocols for retinal photography and photographic grading. We defined incident late-stage ARM as the development of neovascular ARM or geographic atrophy in eyes without either lesion type at baseline that was confirmed by consensus between the study investigators. Nonphakic eyes included eyes that were aphakic or pseudophakic at baseline. Eye-specific data were analyzed. Age- and study site-adjusted relative risks were calculated using the Cochran-Mantel-Haenszel method. Multivariate-adjusted odds ratios (ORs) were also estimated using generalized estimating equation models.
RESULTS: Of the 6019 participants examined after 5 years, 11,391 eyes were considered at risk for developing late-stage ARM, including 315 nonphakic and 11,076 phakic eyes. Late-state ARM (either neovascular ARM or geographic atrophy) developed in 6.0% to 7.5% of nonphakic eyes (10 of 168 right and 11 of 147 left eyes), compared with 0.7% of phakic eyes (40 of 5504 right and 37 of 5572 left eyes) during the 5-year period. Age- and study site-adjusted 5-year relative risks were 2.8 (95% confidence interval [CI], 1.6-5.1) for right and 3.7 (95% CI, 2.1-6.4) for left eyes. After further adjustment for gender, smoking, and the presence of indistinct or reticular drusen or pigmentary abnormalities at baseline, nonphakic eyes had a substantially higher risk for developing either late-stage ARM lesion compared with phakic eyes, OR = 5.7 (95% CI, 2.4-13.6).
CONCLUSIONS: Pooled findings from these two large population-based cohorts support the hypothesis that cataract surgery in older persons may be associated with an increased subsequent risk for developing late-stage ARM, particularly neovascular ARM.

PMID 14522772  Ophthalmology. 2003 Oct;110(10):1960-7.
著者: Lintje Ho, Sharmila S Boekhoorn, Liana, Cornelia M van Duijn, André G Uitterlinden, Albert Hofman, Paulus T V M de Jong, Theo Stijnen, Johannes R Vingerling
雑誌名: Invest Ophthalmol Vis Sci. 2008 Nov;49(11):4795-800. doi: 10.1167/iovs.08-2066. Epub 2008 Jul 3.
Abstract/Text PURPOSE: To investigate still-controversial associations between prior cataract surgery and aging macula disorder (AMD) in a general population.
METHODS: Baseline lens status and risk of incident AMD (iAMD) were examined in participants of the prospective population-based Rotterdam Study at risk for AMD (n = 6032). Slit lamp examination was used to determine lens status and stereoscopic color fundus photography to determine the presence of AMD. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated with generalized estimating equation (GEE) models. Stratified analyses were also performed for CFH Y402H genotype.
RESULTS: After adjusting for age, sex, follow-up time, and the correlation between eyes, a history of cataract surgery was associated with incident dry late AMD (OR, 3.43; 95% CI, 1.82-6.49). This association remained significant after additional adjustment for smoking status and AMD stage at baseline (OR, 3.44; 95% CI, 1.68-7.08). No statistically significant association was found between prior cataract surgery and the incidence of wet late AMD or early AMD. Homozygous CFH Y402H carriers had higher risks for all types of AMD compared to heterozygotes and noncarriers after cataract surgery, particularly for dry AMD.
CONCLUSIONS: The findings imply that cataract surgery increases the risk of dry AMD, particularly in homozygous CFH Y402H carriers. The risk of AMD progression should be considered before recommending cataract surgery to patients with cataract and early AMD.

PMID 18599571  Invest Ophthalmol Vis Sci. 2008 Nov;49(11):4795-800. do・・・
著者: Emily Y Chew, Robert D Sperduto, Roy C Milton, Traci E Clemons, Gary R Gensler, Susan B Bressler, Ronald Klein, Barbara E K Klein, Frederick L Ferris
雑誌名: Ophthalmology. 2009 Feb;116(2):297-303. doi: 10.1016/j.ophtha.2008.09.019. Epub 2008 Dec 16.
Abstract/Text PURPOSE: To assess the risk of advanced age-related macular degeneration (AMD) developing after cataract surgery.
DESIGN: Cohort study.
PARTICIPANTS: Four thousand five hundred seventy-seven participants (8050 eyes) from a multicenter, controlled, randomized clinical trial, the Age-Related Eye Disease Study (AREDS).
METHODS: Development of advanced AMD, either neovascular (NV) AMD or geographic atrophy (GA), was evaluated with annual fundus photographs, and history of cataract surgery was assessed every 6 months. Cox proportional hazard models with time-dependent covariates were conducted for NV AMD and GA separately.
MAIN OUTCOME MEASURES: Neovascular AMD, GA, and central GA (CGA; involving the center of the macula).
RESULTS: The Cox proportional hazards model of right eyes showed nonsignificant hazard ratios of 1.20 (95% confidence interval [CI], 0.82-1.75) for NV AMD, 0.80 (95% CI, 0.61-1.06) for GA, and 0.87 (95% CI, 0.64-1.18) for CGA. Similar results were obtained for left eyes: 1.07 (95% CI, 0.72-1.58) for NV AMD, 0.94 (95% CI, 0.71-1.25) for GA, and 0.86 (95% CI, 0.63-1.19) for CGA. For participants with advanced AMD in 1 eye (AREDS category 4), the hazard ratios for fellow eyes were 1.08 (95% CI, 0.65-1.72) for NV AMD and 0.98 (95% CI, 0.64-1.49) for CGA.
CONCLUSIONS: The AREDS results showed no clear effect of cataract surgery on the risk of progression to advanced AMD.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

PMID 19091420  Ophthalmology. 2009 Feb;116(2):297-303. doi: 10.1016/j.・・・
著者: Li Ming Dong, Walter J Stark, Joan L Jefferys, Selwa Al-Hazzaa, Susan B Bressler, Sharon D Solomon, Neil M Bressler
雑誌名: Arch Ophthalmol. 2009 Nov;127(11):1412-9. doi: 10.1001/archophthalmol.2009.152.
Abstract/Text OBJECTIVE: To document age-related macular degeneration (AMD) progression after cataract surgery.
METHODS: Surgeons prospectively enrolled patients with nonneovascular AMD who were awaiting cataract surgery. Fluorescein angiography was performed preoperatively and at the postoperative week 1, month 3, and month 12 visits. Incidence of neovascular AMD development within 12 months after operation was the primary outcome measure.
RESULTS: A total of 108 subjects were enrolled. Of 86 eyes with preoperatively photographically confirmed nonneovascular AMD, 71 had gradable images by month 12. Neovascular AMD was observed in 9 of 71 eyes (12.7%; 95% confidence interval, 6.0%-22.7%). The progression rate between week 1 and month 12 decreased to 3 of 65 eyes (4.6%; 95% confidence interval, 1.0%-12.9%) after excluding 5 neovascular events identified on the postoperative week 1 visit and 1 case with missing photographs at this visit.
CONCLUSION: The low incidence rate of neovascular AMD development between 1 week and 1 year after cataract surgery did not support the hypothesis that cataract surgery increases the risk of AMD progression. Several eyes appeared to have disease progression on postsurgery week 1 fluorescein angiograms, suggesting that many cases of presumed progression to neovascular AMD following cataract surgery may have been present prior to cataract surgery, but not recognized owing to lens opacity.

PMID 19901205  Arch Ophthalmol. 2009 Nov;127(11):1412-9. doi: 10.1001/・・・
著者: Shinichiro Ohtani, Susumu Gekka, Masato Honbou, Yasushi Kataoka, Keiichiro Minami, Kazunori Miyata, Tetsuro Oshika
雑誌名: Am J Ophthalmol. 2009 Jun;147(6):984-9, 989.e1. doi: 10.1016/j.ajo.2008.12.037. Epub 2009 Mar 13.
Abstract/Text PURPOSE: To conduct longitudinal, intrapatient comparisons of aspherical and spherical silicone intraocular lenses (IOL) of the same material and platform in patients undergoing bilateral cataract surgery.
DESIGN: Prospective, randomized study.
METHODS: Sixty-two eyes of 31 patients were randomized to receive a silicone aspherical IOL (Tecnis Z9000; AMO Inc, Santa Ana, California, USA) in 1 eye and a silicone spherical IOL (CeeOn 911A; AMO Inc) in the other eye. Best spectacle-corrected visual acuity (BSCVA); corneal and ocular wavefront aberrations; contrast sensitivity under photopic (180 lux), intermediate (75 lux), and scotopic (15 lux) illumination; amount of IOL decentration and tilt; and degree of posterior capsular opacification were measured at 1, 3, 6, and 12 months after surgery. All-distance visual acuity (VA) was measured 3 months after surgery.
RESULTS: There were no significant differences between IOLs with regard to BSCVA, amount of IOL decentration and tilt, degree of posterior capsule opacification, and all-distance VA at any point after surgery. Regarding corneal wavefront aberrations, there was no difference in third- and fourth-order root mean square (RMS). In ocular wavefront aberrations, aspherical IOLs showed significantly lower fourth-order RMS (P < .001) than spherical IOLs throughout the study, but not in third-order RMS. Contrast sensitivity under photopic and mesopic conditions was not different between IOLs, but contrast sensitivity under scotopic conditions was significantly better with aspherical IOLs than with spherical IOLs (P < .01) at all measurement points.
CONCLUSIONS: The silicone aspherical IOL (Tecnis Z9000; AMO Inc) significantly reduced ocular spherical aberration and improved scotopic contrast sensitivity, and these results were consistent through the 1-year follow-up.

PMID 19285656  Am J Ophthalmol. 2009 Jun;147(6):984-9, 989.e1. doi: 10・・・
著者: Takashi Fujikado, Teruhito Kuroda, Sayuri Ninomiya, Naoyuki Maeda, Yasuo Tano, Tetsuro Oshika, Yoko Hirohara, Toshifumi Mihashi
雑誌名: Am J Ophthalmol. 2004 Jul;138(1):143-6. doi: 10.1016/j.ajo.2004.01.051.
Abstract/Text PURPOSE: To compare the ocular and corneal higher-order aberrations (HA) in eyes of different ages.
DESIGN: Observational cross-sectional study.
METHODS: Sixty-six eyes of 66 normal subjects (age range 4-69 years; average 37.4 +/- 15.4 years) were examined. Wavefront aberrations of the whole eye (ocular) and cornea were measured for the central 4 mm using a Hartmann-Shack aberrometer.
RESULTS: Ocular Coma-like aberration (r = 0.270, P =.029), Spherical-like aberration (r = 0.531, P =.001), and total HA(r = 0.431, P =.001) were significantly correlated with age, whereas the corneal aberrations were not significantly correlated. The ocular total HA aberrations increased significantly after age 50 years.
CONCLUSIONS: After 50 years of age, ocular aberrations increased abruptly due to the increase of lenticular HA. Customized ablation should be carefully considered, especially in eyes of presbyopic age.

PMID 15234298  Am J Ophthalmol. 2004 Jul;138(1):143-6. doi: 10.1016/j.・・・
著者: Robert Montés-Micó, Teresa Ferrer-Blasco, Alejandro Cerviño
雑誌名: J Cataract Refract Surg. 2009 Jan;35(1):172-81. doi: 10.1016/j.jcrs.2008.09.017.
Abstract/Text We reviewed recently published studies that analyzed the visual and optical quality in eyes with different spherical and aspheric intraocular lenses (IOLs). Recent studies focused on visual quality metrics, such as visual acuity and contrast sensitivity, under photopic and mesopic lighting conditions and optical metrics, such as wavefront aberrations, especially spherical aberration. The results in this review were used in an attempt to understand whether there is a visual and/or optical benefit of implanting aspheric IOLs over implanting spherical IOLs.

PMID 19101441  J Cataract Refract Surg. 2009 Jan;35(1):172-81. doi: 10・・・
著者: Jack T Holladay, Patricia A Piers, Gabor Koranyi, Marrie van der Mooren, N E Sverker Norrby
雑誌名: J Refract Surg. 2002 Nov-Dec;18(6):683-91.
Abstract/Text PURPOSE: The aim of this study was to design and evaluate in the laboratory a new intraocular lens (IOL) intended to provide superior ocular optical quality by reducing spherical aberration.
METHODS: Corneal topography measurements were performed on 71 cataract patients using an Orbscan I. The measured corneal surface shapes were used to determine the wavefront aberration of each cornea. A model cornea was then designed to reproduce the measured average spherical aberration. This model cornea was used to design IOLs having a fixed amount of negative spherical aberration that partially compensates for the average positive spherical aberration of the cornea. Theoretical and physical eye models were used to assess the expected improvement in optical quality of an eye implanted with this lens.
RESULTS: Measurements of optical quality provided evidence that if this modified prolate IOL was centered within 0.4 mm and tilted less than 7 degrees, it would exceed the optical performance of a conventional spherical IOL. This improvement occurred without an apparent loss in depth of focus.
CONCLUSION: A new IOL with a prolate anterior surface, designed to partially compensate for the average spherical aberration of the cornea, is intended to improve the ocular optical quality of pseudophakic patients.

PMID 12458861  J Refract Surg. 2002 Nov-Dec;18(6):683-91.
著者: R F Steinert, C T Post, S F Brint, C D Fritch, D L Hall, L W Wilder, I H Fine, S B Lichtenstein, S Masket, C Casebeer
雑誌名: Ophthalmology. 1992 Jun;99(6):853-60; discussion 860-1.
Abstract/Text INTRODUCTION: Multifocal intraocular lenses (IOLs) have been designed to provide improved near visual acuity without spectacles compared with monofocal IOLs. Early studies have reported variables amounts of decreased visual acuity and contrast sensitivity with multifocal IOLs, and some patients have experienced halos and glare.
METHODS: The authors performed a prospective, double-masked, multicenter evaluation of 62 patients randomized between a new zonal-progressive optic multifocal IOL and a monofocal IOL.
RESULTS: Mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuity were similar between the two groups. Patients with a multifocal IOL achieved significantly better uncorrected near visual acuity than patients with monofocal IOLs (J3+ versus J7; P less than 0.0001). With distance correction only, mean near visual acuity was J2 versus J5- (P = 0.0001). Best-corrected near visual acuity was J1 for both groups, with 1.36 diopters (D) for the multifocal group versus 2.37 D for the monofocal group (P less than 0.0001). Regan contrast sensitivity was lower for the multifocal patients at all contrast levels, and achieved statistical significance at very low contrast (11% contrast; P = 0.0024). Fifty-two percent of patients with a multifocal IOL reported that they did not need spectacles at all or used them only for their fellow eye, compared with 25% of the patients with monofocal IOLs.
CONCLUSION: Both monofocal and multifocal implant patients were very satisfied with the results of their cataract extraction and IOL implant surgery. A small loss of contrast sensitivity with the multifocal IOL was demonstrated, consistent with theoretical predictions. The functional significance of the loss of contrast sensitivity appears to be small and counterbalanced by the advantage of improved uncorrected near visual acuity.

PMID 1630773  Ophthalmology. 1992 Jun;99(6):853-60; discussion 860-1.・・・
著者: M D Leyland, L Langan, F Goolfee, N Lee, P A Bloom
雑誌名: Eye (Lond). 2002 Jul;16(4):481-90. doi: 10.1038/sj.eye.6700077.
Abstract/Text AIMS: To evaluate the functional effect of bilateral implantation of two different multifocal intraocular lenses (IOL) compared with the standard monofocal IOL.
METHODS: Sixty-nine patients were recruited into a prospective, double-masked, randomised, controlled trial at a single hospital in the United Kingdom. Sixty completed follow-up; 16 implanted with monofocal IOLs, 29 with AMO 'ARRAY' multifocal IOLs and 15 with Storz 'TRUEVISTA' bifocal IOLs. Phacoemulsification and IOL implantation was performed to a standardised technique in both eyes within a 2-month period. The main outcome measures were distance and near visual acuity, depth of field and validated assessment of subjective function (TyPE questionnaire).
RESULTS: naided distance acuity was good, and equivalent across the three groups. Corrected distance acuity was significantly lower in the bifocal group. Patients with multifocal and bifocal IOLs could read smaller absolute print size than those in the monofocal group (P = 0.05), but at a closer reading distance such that mean unaided near acuity was equal in the three groups. Corrected near acuity was significantly higher in the monofocal control group (P < 0.05). Depth of field was increased in multifocal (P = 0.06) and bifocal (P = 0.004) groups. Overall visual satisfaction was equal in the three groups, while near visual satisfaction was higher in the multifocal group than the monofocal (P = 0.04). Spectacle independence was not seen in the monofocal group, but was achieved in 28% of multifocal IOL patients and 33% of bifocal patients (P < 0.001). Adverse symptoms such as glare and haloes were significantly more bothersome with multifocal (not bifocal) IOLs than monofocals (P = 0.01).
CONCLUSIONS: Multifocal and bifocal IOLs improved unaided near vision performance, with around one in three patients becoming spectacle-independent. The main adverse effect was an increased incidence of subjective glare and haloes in the multifocal IOL group.

PMID 12101459  Eye (Lond). 2002 Jul;16(4):481-90. doi: 10.1038/sj.eye.・・・
著者: Takushi Kawamorita, Hiroshi Uozato
雑誌名: J Cataract Refract Surg. 2005 Dec;31(12):2379-85. doi: 10.1016/j.jcrs.2005.10.024.
Abstract/Text PURPOSE: To investigate the relationship between pupil size and the modulation transfer function (MTF) of a multifocal intraocular lens (IOL) in vitro and to predict the visual effects in vivo.
SETTING: Department of Ophthalmology and Visual Science, Kitasato University Graduate School of Medical Sciences, Kitasato, Japan.
METHODS: A refractive multifocal IOL (Array SA-40N, Allergan) and a monofocal IOL (PhacoFlex SI-40NB, AMO) were evaluated using the OPAL Vector system and a model eye with a variable effective aperture. With effective pupil diameters of 2.1, 3.0, 3.4, 3.9, 4.6, 5.1, and 5.5 mm, the in-focus and defocus MTFs were measured in the multifocal and monofocal IOLs.
RESULTS: With increases in effective pupil diameter, the far MTF progressively decreased at all spatial frequencies. In contrast, the near MTF began to increase at effective pupil diameter 2.1 mm, showed a peak at 3.4 mm, and decreased at diameters greater than 3.4 mm. The ratio of near MTF to far MTF showed an increase with larger effective pupil diameters and at lower spatial frequencies.
CONCLUSIONS: With a zonal progressive multifocal IOL, the pupil size effected a trade-off between the far and near MTFs: The near MTF increased at the expense of the far MTF at large pupil sizes (effective pupil diameter >3.4 mm). To enhance near vision with a multifocal IOL, the desirable effective pupil diameter should be 3.4 mm or larger.

PMID 16473235  J Cataract Refract Surg. 2005 Dec;31(12):2379-85. doi: ・・・
著者: James A Davison, Michael J Simpson
雑誌名: J Cataract Refract Surg. 2006 May;32(5):849-58. doi: 10.1016/j.jcrs.2006.02.006.
Abstract/Text The ReSTOR intraocular lens presents a unique apodized diffractive design within a refractive foldable acrylic optic, which makes an unprecedented level of mulifocal optical performance available. We describe the history and principles of diffractive optics used in the development of this refractive-diffractive IOL.

PMID 16765805  J Cataract Refract Surg. 2006 May;32(5):849-58. doi: 10・・・
著者: D C Minassian, P Rosen, J K Dart, A Reidy, P Desai, M Sidhu, S Kaushal, N Wingate
雑誌名: Br J Ophthalmol. 2001 Jul;85(7):822-9.
Abstract/Text BACKGROUND: Cataract extraction constitutes the largest surgical workload in ophthalmic units throughout the world. Extracapsular cataract extraction (ECCE), through a large incision, with insertion of an intraocular lens has been the most widely used method from 1982 until recently. Technological advances have led to the increasing use of phacoemulsification (Phako) to emulsify and remove the lens The technique requires a smaller incision, but requires substantial capital investment in theatre equipment. In this randomised trial we assessed the clinical outcomes and carried out an economic evaluation of the two procedures.
METHODS: In this two centre randomised trial, 232 patients with age related cataract received ECCE, and 244 received small incision surgery by Phako. The main comparative outcomes were visual acuity, refraction, and complication rates. Resource use was monitored in the two trial centres and in an independent comparator centre. Costs calculated included average cost per procedure, at each stage of follow up.
RESULTS: Phako was found to be clinically superior. Surgical complications and capsule opacity within 1 year after surgery were significantly less frequent, and a higher proportion achieved an unaided visual acuity of 6/9 or better (<0.2 logMAR) in the Phako group. Postoperative astigmatism was more stable in Phako. The average cost of a cataract operation and postoperative care within the trial was similar for the two procedures. With the input of additional spectacles for corrected vision at 6 months after surgery, the average cost per procedure was pound359.89 for Phako and pound367.57 for ECCE.
CONCLUSION: Phako is clinically superior to ECCE and is cost effective.

PMID 11423457  Br J Ophthalmol. 2001 Jul;85(7):822-9.
著者: T Oshika, S Tsuboi, S Yaguchi, F Yoshitomi, T Nagamoto, K Nagahara, K Emi
雑誌名: Ophthalmology. 1994 Jul;101(7):1183-90.
Abstract/Text PURPOSE: To prospectively and comprehensively compare the clinical results of two small-incision cataract surgery procedures, silicone intraocular lens (refractive index of 1.46) implantation through a 3.2-mm incision and polymethylmethacrylate intraocular lens implantation through a 5.5-mm incision.
METHODS: Two hundred eyes with cataract randomly were assigned to either procedure. Except for incision size, identical surgical methods were used in every case. Data on uncorrected and corrected visual acuity, keratometry, corneal topography, flare-cell measurement, fluorophotometry, specular microscopy, glare disability measurement, and photographic examination of intraocular lens decentration were analyzed up to 6 months after surgery.
RESULTS: Eyes in the 3.2-mm incision group displayed significantly better uncorrected and corrected visual acuity in the early postoperative period, lower aqueous flare intensity and cell counts immediately after surgery, less operatively induced astigmatism throughout the study period, and less corneal topographic changes taken 3 months after surgery. No significant between-group differences were noted for other parameters. Complications in the two groups were few and comparable.
CONCLUSION: Both procedures of small-incision cataract surgery offered satisfactory clinical results, but 3.2-mm incision cataract surgery allowed significantly earlier recovery of visual function and better preservation of corneal shape.

PMID 8035981  Ophthalmology. 1994 Jul;101(7):1183-90.
著者: H V Gimbel, R Sun, B M DeBroff
雑誌名: Ophthalmic Surg Lasers. 1995 Nov-Dec;26(6):524-8.
Abstract/Text BACKGROUND AND OBJECTIVE: A prospective randomized investigation was performed to evaluate the effects of wound architecture and suture techniques on postoperative astigmatism after phacoemulsification and intraocular lens implantation.
PATIENTS AND METHODS: Two hundred eyes with preexisting with-the-rule astigmatism were randomized into four groups: (1) sutureless scleral tunnel frown incision, (2) scleral tunnel frown incision with a horizontal suture, (3) scleral tunnel frown incision with both a horizontal and a running suture, and (4) posterior limbal acute beveled cataract incision with a running suture. All the incisions were placed in the vertical steep meridian.
RESULTS: Data were analyzed from 128 cases with 1-year follow-up. The results revealed that at the 2-month postoperative visit, preexisting astigmatism was significantly reduced in group 1 (P = .029) and significantly increased in groups 3 (P = .020) and 4 (P = .005). There was no significant change in group 2 (P = .06). By the 1-year postoperative visit, there was no significant difference in astigmatism from preoperative levels for all four groups. Vector analysis revealed no significant difference in the mean surgically induced cylinder at 1 year in all four groups. The number of eyes with induced against-the-rule astigmatism, however, was significantly higher than the number of eyes with induced with-the-rule astigmatism in all four groups (P <.01).
CONCLUSION: The authors found that sutured wounds placed in the vertical steep meridian may initially increase with-the-rule astigmatism, whereas nonsutured wounds placed in the vertical steep meridian may initially reduce with-the-rule astigmatism. By 1 year, however, a mean flattening of the vertical steep meridian was observed in the three groups with sutures as well as in the group without sutures.

PMID 8746573  Ophthalmic Surg Lasers. 1995 Nov-Dec;26(6):524-8.
著者: Thomas A Ciulla, Michael B Starr, Samuel Masket
雑誌名: Ophthalmology. 2002 Jan;109(1):13-24.
Abstract/Text PURPOSE: To assess commonly used cataract surgery bacterial endophthalmitis prophylaxis techniques based on a systematic literature review and evidence rating.
CLINICAL RELEVANCE: Prophylactic techniques to decrease the risk of bacterial endophthalmitis related to cataract surgery are commonly used, but the evidence justifying their use is unclear.
LITERATURE REVIEWED: A MEDLINE search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words. Eighty-eight peer-reviewed papers were identified and judged worthy of review on the basis of predefined criteria.
RESULTS: No prophylactic technique received the highest of three possible clinical recommendations (A, crucial to clinical outcome). Preoperative povidone-iodine preparation received the intermediate clinical recommendation (B, moderately important to clinical outcome). All other reported prophylactic interventions, including postoperative subconjunctival antibiotic injection, preoperative lash trimming, preoperative saline irrigation, preoperative topical antibiotics, antibiotic-containing irrigating solutions, and the use of intraoperative heparin, received the lowest clinical recommendation (C, possibly relevant but not definitely related to clinical outcome) based on weak and often conflicting evidence justifying their use.
CONCLUSIONS: With regard to bacterial endophthalmitis prophylaxis in cataract surgery, current literature most strongly supports the use of preoperative povidone-iodine antisepsis.

PMID 11772573  Ophthalmology. 2002 Jan;109(1):13-24.
著者: David V Seal, Peter Barry, George Gettinby, Fiona Lees, Magnus Peterson, Crawford W Revie, Kirk R Wilhelmus, ESCRS Endophthalmitis Study Group
雑誌名: J Cataract Refract Surg. 2006 Mar;32(3):396-406. doi: 10.1016/j.jcrs.2006.02.014.
Abstract/Text PURPOSE: To present the development and design of the European Society of Cataract & Refractive Surgeons multicenter study of the prevention of postsurgical infective endophthalmitis after phacoemulsification and to describe the process for its successful implementation and conduct.
SETTING: Twenty-four ophthalmology units and eye clinics in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom, with an administrative office in Ireland, coordinating center in England, and data management and statistical unit in Scotland.
METHODS: This partially masked randomized placebo-controlled multinational clinical study was designed to evaluate prospectively the prophylactic effect of intracameral cefuroxime and/or perioperative topical levofloxacin on postoperative endophthalmitis after cataract surgery. Random allocation was based on a 2 x 2 factorial design that included participating centers as a class variable. Real-time electronic data collection monitored study progress and provided weekly outcome tables, monthly recruitment summaries, and quarterly analytical reports for the study's Data Monitoring Committee, which evaluated the safety and efficacy by Internet-based conferences.
RESULTS: A 2-year lead time was required to meet harmonized standards of clinical research in the European Union, obtain ministerial authorization in 3 countries, gain institutional approvals at 24 hospitals, and procure indemnity insurance for surgical centers. Informed consent instruments, designed to comply with national health policies, were translated into 8 languages. The use of information technology to collect study data enabled the organizers to evaluate individual eligibility at enrollment, adherence with study medications during and after surgery, and postoperative status during follow-up.
CONCLUSION: This international cooperative study provided the opportunity to estimate the current incidence of endophthalmitis after cataract surgery in Europe and determine whether 1 or both of 2 antimicrobial regimens reduces the risk for postsurgical intraocular infection.

PMID 16631046  J Cataract Refract Surg. 2006 Mar;32(3):396-406. doi: 1・・・
著者: Peter Barry, David V Seal, George Gettinby, Fiona Lees, Magnus Peterson, Crawford W Revie, ESCRS Endophthalmitis Study Group
雑誌名: J Cataract Refract Surg. 2006 Mar;32(3):407-10. doi: 10.1016/j.jcrs.2006.02.021.
Abstract/Text PURPOSE: To report results in the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study of the prophylaxis of endophthalmitis after cataract surgery.
SETTING: Twenty-four ophthalmology units and eye clinics in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom, with an administrative office in Ireland, coordinating center in England, and data management and statistical unit in Scotland.
METHODS: This partially masked randomized placebo-controlled multinational clinical study to evaluate prospectively the prophylactic effect of intracameral cefuroxime injection and/or perioperative levofloxacin eyedrops on the incidence of endophthalmitis after phacoemulsification cataract surgery began in September 2003 and was terminated early in January 2006. The study used random allocation of patients in a 2 x 2 factorial design.
RESULTS: By the end of 2005, complete follow-up records had been received for 13 698 study patients. Such a clear beneficial effect from the use of intracameral cefuroxime had been observed that it was agreed it would be unethical to continue the study and to wait for the completion of all follow-up procedures before reporting this important result. If total reported cases of endophthalmitis are considered, the incidence rate observed in those treatment groups not receiving cefuroxime prophylaxis (23 cases in 6862 patients) was almost 5 times as high (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.74-12.08; P = .002) as that in the groups receiving this treatment (5 cases in 6836 patients). If only cases proved to be due to infection are considered, the rate was more than 5 times as high (OR, 5.32; 95% CI, 1.55-18.26; P = .008) in the treatment groups not receiving cefuroxime. Although the use of perioperative levofloxacin eyedrops as prophylaxis was also associated with a reduction in the observed incidence rate of postoperative endophthalmitis, this effect was smaller and was not statistically significant, whether total reported cases or only cases proven to be due to infection are used in calculating the rates. As not all follow-up procedures are complete, it is possible that further cases of endophthalmitis may be reported; however, it is not expected that this will alter the main conclusion. Nevertheless, it is anticipated that successful completion of follow-up procedures in all patients will increase the total number in the study to approximately 16,000.
CONCLUSION: Intracameral cefuroxime administered at the time of surgery significantly reduced the risk for developing endophthalmitis after cataract surgery.

PMID 16631047  J Cataract Refract Surg. 2006 Mar;32(3):407-10. doi: 10・・・
著者: Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons
雑誌名: J Cataract Refract Surg. 2007 Jun;33(6):978-88. doi: 10.1016/j.jcrs.2007.02.032.
Abstract/Text PURPOSE: To identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study.
SETTING: Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom.
METHODS: A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 x 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated.
RESULTS: Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8).
CONCLUSIONS: Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs.

PMID 17531690  J Cataract Refract Surg. 2007 Jun;33(6):978-88. doi: 10・・・
著者: Daniel M Gore, Romesh I Angunawela, Brian C Little
雑誌名: J Cataract Refract Surg. 2009 Apr;35(4):770-3. doi: 10.1016/j.jcrs.2009.01.004.
Abstract/Text The European Society of Cataract & Refractive Surgeons Endophthalmitis Study published preliminary results in 2006 showing a near 5-fold decrease in the rates of postoperative endophthalmitis with the use of intracameral cefuroxime. The study findings have generated considerable controversy, and 1 year later its recommendations had been heeded by only 6% of American Society of Cataract and Refractive Surgery (ASCRS) members. This poll sought to gauge the uptake among surgeons in the United Kingdom and survey their response to its findings. Fifty-five percent of respondents were using intracameral cefuroxime; 48% had switched after publication of the ESCRS study. Of those remaining, 68% reported their main concern was the risk for dilution errors in the absence of a commercially preformulated preparation, with 67% stating they would switch if such a product became available. Sixty-eight percent considered the lack of a subconjunctival cefuroxime treatment arm within the study a major methodology flaw. Sixty-seven percent said they do not consider penicillin allergy a contraindication to intracameral cefuroxime use, with the remaining 33% opting for alternative antibiotic prophylaxis. The majority of United Kingdom and Ireland Society of Cataract and Refractive Surgeons members have switched to intracameral cefuroxime, despite the absence of previously preferred practice in the study design. The major barrier to its further use appears to be the lack of a commercially available preformulated preparation.

PMID 19304103  J Cataract Refract Surg. 2009 Apr;35(4):770-3. doi: 10.・・・
著者: S P Chee, S E Ti, M Sivakumar, D T Tan
雑誌名: J Cataract Refract Surg. 1999 Sep;25(9):1280-5.
Abstract/Text PURPOSE: To quantitatively compare postoperative inflammation after extracapsular cataract extraction (ECCE) with that after phacoemulsification in an Asian population.
SETTING: Singapore National Eye Center, Singapore.
METHODS: In this prospective, randomized, double-masked clinical trial, patients having cataract surgery were randomized to receive ECCE (n = 16) or phacoemulsification (n = 18). Diabetics were excluded. Two surgeons performed both types of surgery and implanted a 6.0 mm optic intraocular lens. Inflammation was assessed qualitatively by slitlamp grading of cells and flare and quantitatively using the Kowa flare meter. One independent postoperative investigator performed the slitlamp examination and laser flare meter readings.
RESULTS: The ECCE and phacoemulsification groups were comparable (P > .05) in age, sex, ethnicity, and preoperative flare levels. The combined slitlamp inflammatory scores (anterior chamber cells and flare) and mean laser flare meter readings showed the ECCE group had significantly higher mean flare measurements than the phacoemulsification group at days 4 (P = .0012), 8 (P = .0013), 15 (P = .0013), 30 (P = .0004), and 60 (P = .0164). Flare levels in the ECCE group returned to preoperative values by the second month; the phacoemulsification group achieved preoperative levels by 1 month. The clinical inflammatory assessment score correlated closely to the flare level readings.
CONCLUSION: Phacoemulsification induced less inflammation than ECCE, with the difference most marked in the first month after surgery.

PMID 10476515  J Cataract Refract Surg. 1999 Sep;25(9):1280-5.
著者: C G Laurell, C Zetterström, B Philipson, S Syrén-Nordqvist
雑誌名: Acta Ophthalmol Scand. 1998 Oct;76(5):573-8.
Abstract/Text PURPOSE: To compare the blood-aqueous barrier (BAB) breakdown after endocapsular phacoemulsification and extracapsular cataract extraction (ECCE).
METHODS: Forty-two patients (64-82 years) enrolled for cataract surgery were randomly assigned to phacoemulsification (group I) or ECCE (group II). Patients with pseudoexfoliation syndrome, small pupils, glaucoma, uveitis, dark brown irides, diabetes, treatment with eye drops or anti-inflammatory drugs were excluded. In group I the patients were operated with continuous curvilinear capsulorhexis (CCC), phacoemulsification and implantation of a poly-(methyl methacrylate) (PMMA) intraocular lens (IOL) through a 5.2 mm self-sealing incision. In group II linear capsulotomy, nucleus expression and PMMA IOL implantation through a large incision (10-11 mm) were performed. The incision was sutured. Before surgery and three days and three months after surgery postoperative inflammation and BAB reaction were measured by laser flare photometry and anterior chamber fluorophotometry after intravenous administration of fluorescein. The BAB diffusion coefficient was calculated. Laser flare photometry was performed also after one and two years.
RESULTS: According to fluorophotometry, ECCE induced significantly more postoperative BAB breakdown than did phacoemulsification at three days (p=0.00016) and three months (p=0.00829). Laser flare photometry showed more inflammation in the ECCE group than in the phacoemulsification group at three days postoperatively (p=0.00005).
CONCLUSIONS: This study suggests that cataract surgery performed with a small, self-sealing incision, CCC and phacoemulsification induces a reduced surgical trauma with less BAB breakdown compared to ECCE using a large sutured incision, linear capsulotomy and nucleus expression.

PMID 9826042  Acta Ophthalmol Scand. 1998 Oct;76(5):573-8.
著者: T Oshika, K Yoshimura, N Miyata
雑誌名: J Cataract Refract Surg. 1992 Jul;18(4):356-61.
Abstract/Text A one-year prospective study was conducted in 120 patients to assess the time course of changes in intraocular inflammation after three cataract surgery procedures: planned extracapsular extraction with poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation (11 mm incision group), phacoemulsification with PMMA IOL implantation (7 mm incision group), and phacoemulsification with foldable silicone single-piece IOL implantation (4 mm incision group). Each group was carefully matched for patients' ophthalmologic and systemic backgrounds. Patients with hard nuclei were excluded. The degree of inflammation was evaluated by quantitating aqueous flare intensity and cell count with the laser flare-cell meter. In the early postoperative period, both aqueous flare intensity and cell count were highest in the 11 mm incision group followed, in decreasing order, by the 7 mm and 4 mm incision groups. Significant between-group differences were observed at one, two, and seven postoperative days for flare and one day through one week for cells. Both parameters in each group decreased to a similar level one month after surgery, but flare intensity in all groups remained significantly higher than that of age-matched normal controls up to six months postoperatively.

PMID 1501087  J Cataract Refract Surg. 1992 Jul;18(4):356-61.
著者: K D Teichmann, A A al-Rajhi, M H Jabak, S R Antonios, S Haddab, S D Smith
雑誌名: Int Ophthalmol. 1997;21(1):19-25.
Abstract/Text OBJECTIVE: To study the outcome of phacoemulsification (PE) compared to standard extracapsular surgery before the introduction of state-of-the-art techniques (capsulorhexis, hydrodissection, nuclear cracking, nuclear chopping, sutureless incisions) and sophisticated equipment.
STUDY DESIGN: Charts from 375 patients (453 eyes) undergoing PE between 1984 and 1989 were randomly selected and studied retrospectively. A minimum age of 35 years, and a minimum follow-up of three months were required.
SETTING: A large eye hospital in the Kingdom of Saudi Arabia staffed with an international faculty of ophthalmic surgeons.
PATIENTS: Patients over 35 years of age undergoing PE for immature, mature and traumatic cataract.
MAIN OUTCOME MEASURES: Postoperative visual acuity, and rate or frequency of intraoperative complications.
RESULTS: 66.5% achieved visual acuity of 20/40 or better, which compares favourably with the 36.5% of eyes reaching this level of visual acuity after mainly standard extracapsular cataract surgery in another study at our hospital. Posterior capsule ruptures occurred in 7.5% and vitreous loss in 5.5%. Other ocular disease (odds ratio 7.51 confidence interval 4.43-12.7) and intraoperative complications (odds ratio 2.97 confidence interval 1.38-6.42) were statistically significant predictors for final visual acuity of under 20/40 (p = < 0.001 and 0.005 respectively).
CONCLUSION: The outcome of PE was better than that of standard extracapsular cataract extraction in the same setting. However, since PE appeared to be used selectively, no clear advantage compared to extracapsular cataract extraction is evident in the period before the introduction of modern state-of-the-art PE-techniques.

PMID 9298419  Int Ophthalmol. 1997;21(1):19-25.
著者: G W Lazenby, G Broocker
雑誌名: Ophthalmic Surg. 1981 Sep;12(9):646-9.
Abstract/Text Intracapsular cataract extraction with insertion of anterior chamber intraocular lens was carried out on 40 subjects. In 21 procedures, balanced salt solution or air was used to deepen the anterior chamber. In 19 procedures, Hyaluronic Acid (Healon) was used to deepen the anterior chamber. In the two groups, no significant difference was noted in the endothelial cell count or in the corneal thickness. The surgeon felt that Healon made the surgery much easier, gave better control and greatly decreased the possibility of serious complications.

PMID 6763175  Ophthalmic Surg. 1981 Sep;12(9):646-9.
著者: P Percival
雑誌名: Trans Ophthalmol Soc U K. 1981;101(1):77-8.
Abstract/Text The use of sodium hyaluronate (Healon) presents a major new advance in facilitating lens implantation and improving safety margins during anterior segment surgery. Of 102 consecutive cases of extracapsular cataract extraction with lens implantation, 54 with the use of Healon, it was found that Healon could induce a reduction of central corneal endothelial cell loss from 29 to 17 per cent and that the only associated complication was a one-day rise of intraocular pressure.

PMID 6964243  Trans Ophthalmol Soc U K. 1981;101(1):77-8.
著者: R Superstein, D Boyaner, O Overbury
雑誌名: J Cataract Refract Surg. 1999 Apr;25(4):575-81.
Abstract/Text PURPOSE: To quantify cataract patients' functional visual complaints and correlate them with their objective glare disability and spatial contrast sensitivity (SCS) scores.
SETTING: Sir Mortimer B. Davis Jewish General Hospital. Montreal, Quebec, Canada.
METHODS: Thirty patients scheduled for cataract surgery with a visual acuity of 20/70 or better at the time of patient selection and no other ocular pathology were evaluated objectively and subjectively for visual function preoperatively and within 3 months postoperatively. Objective measures of SCS and visual acuity in the presence and absence of glare were obtained with the Optec 3000 vision tester. Subjective visual function was evaluated with the Activities of Daily Vision Scale (ADVS), a questionnaire that evaluates patients' visual function by assessing the degree of difficulty they experience in performing tasks involving distance vision, near vision, and glare conditions.
RESULTS: Preoperatively, patients had decreased visual acuity and SCS in the presence of glare. The ADVS scores were correlated with visual performance. Postoperatively, there was a statistically significant improvement in all dependent measures (i.e., visual acuity and SCS in the presence of glare) as well as in the subjective report of visual performance assessed by the ADVS.
CONCLUSION: Spatial contrast sensitivity, glare disability, and the ADVS questionnaire should be considered as adjuncts to visual acuity testing in evaluating certain cataract patients.

PMID 10198867  J Cataract Refract Surg. 1999 Apr;25(4):575-81.
著者: K Pesudovs, D J Coster
雑誌名: Br J Ophthalmol. 1998 Jun;82(6):617-24.
Abstract/Text AIMS/BACKGROUND: The construction and validation of an instrument for the assessment of subjective visual disability in the cataract patient is described. This instrument is specifically designed for measuring the outcome of cataract surgery with respect to visual disability.
METHODS: Visually related activities thought to be affected by cataract were considered for the questionnaire. These were reduced by pilot study and principal components analysis to 18 items. A patient's assessment of his/her ability to perform each task was scored on a four point scale. Scores were averaged to create an overall index of visual disability, as well as subscale indices for mobility related disability, distance/lighting/reading related disability, and near and related tasks visual disability. The questionnaire, administered verbally is entitled "The Visual Disability Assessment (VDA)". Reliability testing included test-retest reliability, interobserver reliability (p, the intraclass correlation coefficient), and internal consistency reliability (Cronbach's alpha). Construct validation, the process for proving that a test measures what it is supposed to measure, included consideration of content validity, comparison with the established Activities of Daily Vision Scale (ADVS) and empirical support with factor analysis.
RESULTS: For the four indices, interobserver reliability varied from 0.92 to 0.94, test-retest reliability varied from 0.96 to 0.98, and internal consistency reliability varied from 0.80 to 0.93. The VDA compared favourably with the ADVS by correlation, but Bland-Altman analysis demonstrated that the two instruments were not clinically interchangeable. Factor analysis suggests that all test items measure a common theme, and the subgroupings reflect common themes.
CONCLUSIONS: The VDA is easy to administer because it has a short test time and scoring is straightforward. It has excellent interobserver, test-retest, and internal consistency reliability, and compares favourably with the ADVS, another test of visual disability. Factor analysis demonstrated that the 18 items measure a related theme, which can be assumed to be visual disability. The VDA is a valid instrument which provides a comprehensive assessment of visual disability in cataract patients and is designed to detect changes within a patient over time.

PMID 9797660  Br J Ophthalmol. 1998 Jun;82(6):617-24.
著者: I A Adamsons, S Vitale, W J Stark, G S Rubin
雑誌名: Arch Ophthalmol. 1996 May;114(5):529-36.
Abstract/Text BACKGROUND: It has been shown in our previous studies that early cataracts affect vision in ways that can be measured by objective means and that this objective impairment in visual acuity, glare, and contrast sensitivity can be successfully reversed by cataract surgery.
OBJECTIVE: To evaluate the association of subjective visual function with objective measures of acuity, glare, and contrast sensitivity in patients who were symptomatic from early cataract.
METHODS: We administered a task-oriented questionnaire prior to and 4 months after cataract surgery to patients who were symptomatic from early cataract (median preoperative ETDRS [Early Treatment Diabetic Retinopathy Study] visual acuity of 20/40 [range, 20/20 to 20/80]); ETDRS visual acuity, disability glare, and contrast sensitivity were also measured at those times.
RESULTS: Uncomplicated cataract surgery resulted in resolution or improvement of subjective symptoms for the great majority of subjects, and in a few subjects new symptoms developed or current symptoms worsened. We found a positive association between postoperative improvement in subjective visual function (as measured by the questionnaire) and postoperative improvement in objective visual function (as measured by visual acuity and contrast sensitivity). We also found that the greater the degree of preoperative impairment in objective visual function (as measured by visual acuity and contrast sensitivity), the greater the postoperative improvement in subjective visual function (as measured by the questionnaire). No such association was found for our disability glare test.
CONCLUSIONS: Cataract surgery for symptomatic individuals with mild impairment in visual acuity does relieve visual symptoms, and preoperative measurement of contrast sensitivity can help determine who with early cataract is most likely to report subjective improvement in vision.

PMID 8619761  Arch Ophthalmol. 1996 May;114(5):529-36.
著者: S D Cassard, D L Patrick, A M Damiano, M W Legro, J M Tielsch, M Diener-West, O D Schein, J C Javitt, E B Bass, E P Steinberg
雑誌名: Arch Ophthalmol. 1995 Dec;113(12):1508-13.
Abstract/Text OBJECTIVES: To assess the test-retest reliability and responsiveness of the VF-14, which is an index of functional impairment in patient with cataracts.
DESIGN: Observational longitudinal study. Patients were enrolled prior to undergoing their first cataract surgery between July 15 and December 15, 1991, and they were followed up for 1 year after surgery.
SETTING: Patients were recruited from 72 ophthalmologists' practices in three US cities.
PATIENTS: Five hundred fifty-two patients who had undergone a surgical procedure in only one eye by the 4-month postoperative follow-up (responsiveness analyses) and a subset of these (n = 426) who had not subsequently undergone surgery for the second eye by the 12-month postoperative follow-up (reproducibility analyses).
MAIN OUTCOME MEASURES: Two health status measures (the VF-14 and the Sickness Impact Profile, two global measures of a patient's trouble and satisfaction with his or her vision, and best corrected visual acuity in each eye.
RESULTS: The VF-14 is highly reproducible, with an intraclass correlation coefficient of .79 when patient-rated criteria are used to define stable patients. The intraclass correlation coefficient was lower (.57 to .71) when various measures of visual acuity were used to define stable patients. The VF-14 is also about three times more responsive to a change in vision than the Sickness Impact Profile, which is a generic health status measure (effect size of approximately 1.00 vs 0.30). Estimates of the responsiveness of the VF-14 and the Sickness Impact Profile were not associated with preoperative visual acuity in the operated on or better eye. Responsiveness of the VF-14, however, was higher in patients with greater self-rated trouble with vision preoperatively.
CONCLUSIONS: The VF-14 was reproducible in stable patients during an 8-month period, and it was more responsive to clinically significant changes in vision than was a generic health status measure (ie, the Sickness Impact Profile).

PMID 7487617  Arch Ophthalmol. 1995 Dec;113(12):1508-13.
著者: C M Mangione, R S Phillips, J M Seddon, M G Lawrence, E F Cook, R Dailey, L Goldman
雑誌名: Med Care. 1992 Dec;30(12):1111-26.
Abstract/Text To develop a method for the evaluation of visual function in subjects with cataracts, the authors identified 20 visual activities and categorized them into five subscales (distance vision, near vision, glare disability, night driving, and daytime driving) that comprised the Activities of Daily Vision Scale (ADVS). Each subscale in the ADVS was scored between 100 (no visual difficulty) and 0 (inability to perform the activity because of visual difficulty). In 334 subjects scheduled for cataract extraction (mean age 75 +/- 9 years, 67% women), ADVS scores (mean +/- standard deviation) for each subscale ranged from 44 +/- 31 for night driving to 72 +/- 24 for near vision activities. When administered by telephone, inter-rater reliability coefficients (r) were 0.82 to 0.97 (P < 0.001) for each of the subscales, and test-retest reliability was 0.87 for the scale overall. Cronbach's coefficient alpha was very high for both the in-person (alpha = 0.94) and telephone (alpha = 0.91) formats. Criterion validity, the correlation between visual loss and ADVS score, was -0.37 (P < 0.001) when the ADVS was administered in person and -0.39 (P < 0.001) when it was administered by telephone. Content validity as assessed with factor analysis showed that 88% of the variance of the principal components weighted on one factor. The authors conclude that substantial visual disability is not captured by routine visual testing and that the ADVS is a reliable and valid measure of patient's perception of visual functional impairment.

PMID 1453816  Med Care. 1992 Dec;30(12):1111-26.
著者: J K Tobacman, B Zimmerman, P Lee, L Hilborne, H Kolder, R H Brook
雑誌名: Ophthalmology. 1998 Sep;105(9):1745-50. doi: 10.1016/S0161-6420(98)99048-0.
Abstract/Text PURPOSE: This study aimed to determine the relationship between visual function impairment in 776 patients who had extracapsular cataract extraction with posterior chamber intraocular lens implantation and gender, age, preoperative visual acuity (VA) of both the operative and the contralateral eye, and presence of other ocular disease in the operative eye.
DESIGN: Retrospective cross-sectional study.
PARTICIPANTS: 1139 patients whose medical records were abstracted and who had cataract surgery performed at 1 of 10 participating academic medical centers in 1990.
MAIN OUTCOME MEASURE: In the 776 patients who had explicit statements about impairment of visual function documented in their medical records, univariate and multivariable logistic analyses were used to assess the above relationship.
RESULTS: The most severe visual functional deficit that justified the cataract operation varied in relation to gender, age, and VA. On bivariate analysis, men were more likely to have impairment with employment, driving, and glare, whereas women were more likely to have impairment with activities of daily living and recreational activities. Significant findings between visual impairment and the independent variables from the logistic regression models included: (1) employment limitation and male gender (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.08-3.40); (2) employment limitation and younger age (OR, 0.12; 95% CI, 0.050-0.28 for ages 70-79); (3) recreational impairment and older age (OR, 2.77; 95% CI, 1.64-4.70 for ages 80+); (4) impairment in performing activities of daily living and female gender (OR, 0.72; 95% CI, 0.53-0.98 for male gender); (5) impairment in performing activities of daily living and worse VA in the operative eye (OR, 5.13; 95% CI, 2.93-9.00 for VA < 20/100); (6) glare-associated impairment and younger age (OR, 0.40; 95% CI, 0.24-0.69 for age 80+); and (7) glare-associated impairment and better VA (OR, 0.16; 95% CI, 0.067-0.38 for VA < 20/100).
CONCLUSION: When deciding whether to perform cataract surgery, functional impairment must be considered in relation to the age and the gender of the patient, for the type of functional impairment varies in association with age and gender.

PMID 9754186  Ophthalmology. 1998 Sep;105(9):1745-50. doi: 10.1016/S0・・・
著者: D Taylor, K W Wright, L Amaya, L Cassidy, K Nischal, I Russell-Eggitt, S Lightman, P McCluskey
雑誌名: Br J Ophthalmol. 2001 Sep;85(9):1120-6.
Abstract/Text
PMID 11520768  Br J Ophthalmol. 2001 Sep;85(9):1120-6.
著者: K P Cheng, D A Hiles, A W Biglan, M C Pettapiece
雑誌名: Ophthalmology. 1991 Jun;98(6):903-10.
Abstract/Text The authors reviewed the records of 25 consecutive patients who had been operated on for unilateral congenital cataracts at 1 year of age or younger and who had been followed for a period of 5 years or longer. Excluded were patients who demonstrated retinal and optic nerve anomalies. Five eyes achieved 20/40 or better Snellen visual acuity, 5 eyes achieved 20/50 to 20/100 visual acuity, and 15 eyes had 20/200 or less visual acuity. All patients with visual acuity of 20/40 or better had cataract surgery performed before 17 weeks of age, the critical period, and surgery was scattered within this time frame. For surgery performed between 17 weeks and 1 year of age, the best achieved visual acuity in children with surgically significant unilateral congenital cataracts was between 20/50 and 20/100. There was no correlation between the age at the time of surgery and the attainment of these visual levels in this patient subset.

PMID 1866144  Ophthalmology. 1991 Jun;98(6):903-10.

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