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Ten-Year Longitudinal Visual Function and Nd: YAG Laser Capsulotomy Rates in Patients Less Than 65 Years at Cataract Surgery

Published:November 18, 2009DOI:https://doi.org/10.1016/j.ajo.2009.08.029

      Purpose

      To investigate the longitudinal subjective and objective visual functional results in adult cataract patients younger than 65 years at surgery. To evaluate the 10-year cumulative incidence of neodymium–yttrium-aluminum-garnet (Nd:YAG) laser treatment.

      Design

      A prospective, longitudinal, population-based cohort study.

      Methods

      The study comprised 116 patients younger than 65 years who had cataract surgery during 1 year at Norrlands University Hospital, Umeå, Sweden. Most patients (94%) had received implantation with a hydrophobic acrylic intraocular lens. Evaluated were visual acuity (VA) and visual function questionnaire (VF-14) results before and after surgery. A comparison with patients 65 years or older at surgery was made. Ten years later, 102 survivors were offered eye examinations and again asked to fill out the questionnaire. Past Nd:YAG laser treatment, as well as high- and low-contrast VA results, were analyzed.

      Results

      Ten years postoperatively, 37% of the patients under 65 at surgery had been treated with Nd:YAG in comparison to 20% of the older patients. The cumulative incidence for not having Nd:YAG over 10 years was 72% for those under 65 and 85% for the patients 65 years or more at surgery. Eighteen percent of the younger patients had lost more than 0.1 logarithm of the minimal angle of resolution (logMAR) units of the operated eye, compared with 37% of the older (P = .00003). A reduction in VF-14 score of 10 points or more was found in 9% of the younger and 28% of the older cataract surgery patients (P = .00004).

      Conclusion

      Ten years after surgery, subjective and objective visual function remained stable in most patients younger than 65 years at surgery. More than one-third had received a posterior capsulotomy. Only a few patients with posterior capsular opacification requiring Nd:YAG were untreated at the 10-year follow-up.
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      References

        • Apple D.
        • Peng Q.
        • Visessook N.
        • et al.
        Surgical prevention of posterior capsule opacification.
        J Cataract Refract Surg. 2000; 26: 180-187
        • Dholakia S.
        • Vasavada A.
        • Singh R.
        Prospective evaluation of phacoemulsification in adults younger than 50 years.
        J Cataract Refract Surg. 2005; 31: 1327-1333
        • Chen S.
        • Lin K.
        • Chao A.
        • Kuo Y.
        • Ho J.
        Nuclear sclerotic cataract in young patients in Taiwan.
        J Cataract Refract Surg. 2003; 29: 983-988
        • Allen D.
        • Vasavada A.
        Cataract and surgery for cataract.
        BMJ. 2006; 333: 128-132
        • Hosal B.M.
        • Biglan A.W.
        Risk factors for secondary membrane formation after removal of paediatric cataract.
        J Cataract Refract Surg. 2002; 28: 302-309
        • Schaumberg D.
        • Dan M.
        • Christen W.
        • Glynn R.
        A systematic overview of the incidence of posterior capsule opacification.
        Ophthalmology. 1998; 105: 1213-1221
        • Cleary G.
        • Spalton D.
        • Koch D.
        Effect of square-edged intraocular lenses on neodymium:YAG laser capsulotomy rates in the United States.
        J Cataract Refract Surg. 2007; 33: 1899-1906
        • Desai P.
        • Reidy A.
        • Minassian D.C.
        • et al.
        Gains from cataract surgery: visual function and quality of life.
        Br J Ophthalmol. 1996; 80: 868-873
        • Steinberg E.P.
        • Tielsch J.M.
        • Schein O.D.
        • et al.
        The VF-14: An index of functional impairment in patients with cataract.
        Arch Ophthalmol. 1994; 112: 630-638
        • Mönestam E.
        • Kuusik M.
        • Wachtmeister L.
        Topical anesthesia for cataract surgery: a population-based perspective.
        J Cataract Refract Surg. 2001; 27: 445-451
        • Lundqvist B.
        • Mönestam E.
        Longitudinal changes in subjective and objective visual function 5 years after cataract surgery.
        J Cataract Refract Surg. 2006; 32: 1944-1950
        • Alonso J.
        • Espallargues M.
        • Andersen T.F.
        • et al.
        International applicability of the VF-14; an index of visual function in patients with cataracts.
        Ophthalmology. 1997; 104: 799-807
        • Steinberg E.P.
        • Tielsch J.M.
        • Schein O.D.
        • et al.
        National study of cataract surgery outcomes; variation in 4-month postoperative outcomes as reflected in multiple outcome measures.
        Ophthalmology. 1994; 101 (discussion 1140–1141): 1131-1140
        • Holladay J.T.
        • Prager T.C.
        Mean visual acuity.
        Am J Ophthalmol. 1991; 111 (guest editorial): 372-374
        • Robin A.L.
        • Smith S.D.
        • Natchiar G.
        • et al.
        The initial complication rate of phacoemulsification in India.
        Invest Ophthalmol Vis Sci. 1997; 38: 2331-2337
        • Richter-Mueksch S.
        • Zhetmayer M.
        • Radner W.
        • et al.
        Influence of sex, visual acuity, and systemic disease on delayed presentation for cataract surgery in Austria.
        J Cataract Refract Surg. 2001; 27: 1999-2005
        • Mönestam E.
        • Wachtmeister L.
        Cataract surgery from a gender perspective – a population based study in Sweden.
        Acta Ophthalmol Scand. 1998; 76: 711-716
        • Fagerholm P.
        • Fitzsimmons T.
        • Harfstrand A.
        • Schenholm M.
        Reactive formation of hyaluronic acid after small and large lens injury.
        Acta Ophthalmol Scand. 1992; 70: 58-64
        • Hayashi H.
        • Hayashi K.
        • Nakao F.
        • Hayashi F.
        Quantitative comparison of posterior capsule opacification after polymethylmethacrylate, silicone, and soft acrylic intraocular lens implantation.
        Arch Ophthalmol. 1998; 116: 1579-1582
        • Vock L.
        • Menapace R.
        • Stifter E.
        • Georgopoulos M.
        • Sacu S.
        • Buhl W.
        Posterior capsule opacification and neodymium:YAG laser capsulotomy rates with a round-edged silicone and a sharp-edged hydrophobic acrylic intraocular lens 10 years after surgery.
        J Cataract Refract Surg. 2009; 35: 459-465

      Biography

      Britta Lundqvist, MD, is a senior consultant at the Department of Ophthalmology, Umeå University Hospital, Sweden. Her sub-specialities are cataract surgery and glaucoma, and her main research interests are cataract surgery outcomes.