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Mönestam, Eva
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Publications (10 of 29) Show all publications
Mönestam, E. (2019). Frequency of Intraocular Lens Dislocation and Pseudophacodonesis, 20 Years After Cataract Surgery: A Prospective Study. American Journal of Ophthalmology, 198, 215-222
Open this publication in new window or tab >>Frequency of Intraocular Lens Dislocation and Pseudophacodonesis, 20 Years After Cataract Surgery: A Prospective Study
2019 (English)In: American Journal of Ophthalmology, ISSN 0002-9394, E-ISSN 1879-1891, Vol. 198, p. 215-222Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To examine the incidence and trends of late intraocular lens (IOL) dislocation/decentration and the frequency of pseudophakodonesis. DESIGN: Prospective, population-based cohort study. METHODS: A total of 800 patients were examined before cataract surgery in 1997-1998. Twenty years later, 100 of 133 survivors (75%) participated in the follow-up. An eye examination was performed including assessment for pseudophakodonesis and dislocation of the IOL. The medical records of all included patients at baseline were studied. Main outcome measures were previous IOL exchange or repositioning surgery, significant IOL dislocation, degree of pseudophakodonesis, and visual acuity. RESULTS: Twenty years after the original cataract surgery, 10 of the 800 patients at risk (1.2%) had needed dislocation surgery. Before cataract surgery, 39% of all patients had pseudoexfoliations (PXF). Mean time from cataract surgery to dislocation surgery was 12 years 6 months (range 3 years 9 months to 19 years 3 months). The cumulative incidence over 20 years was 6% in patients with PXF and 2% without PXF at surgery (P = .035). Mean age at cataract surgery in the 10 dislocated cases was 68.3 years (range 58-80). Twenty years after surgery, 5 of 98 (5%) patients had moderate/pronounced pseudophakodonesis. CONCLUSIONS: In this population-based cohort, the 20-year cumulative incidence of IOL dislocation needing surgical attention was significantly higher in patients with PXF than without PXF before surgery. The individual patient seems to have a low risk of being affected by this complication, but dislocated IOLs may cause a relatively large public health care burden, because of the large number of people in society with previous cataract surgery.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-162513 (URN)10.1016/j.ajo.2018.10.020 (DOI)000458095500026 ()30691613 (PubMedID)
Available from: 2019-08-21 Created: 2019-08-21 Last updated: 2019-08-21Bibliographically approved
Forsell, S. & Mönestam, E. (2018). Frequency of Retinal Redetachment after Cataract Surgery in Eyes with Previous Scleral Buckling Surgery. Ophthalmology Retina, 2(1), 4-9
Open this publication in new window or tab >>Frequency of Retinal Redetachment after Cataract Surgery in Eyes with Previous Scleral Buckling Surgery
2018 (English)In: Ophthalmology Retina, ISSN 2468-7219, Vol. 2, no 1, p. 4-9Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To determine the cumulative risk and outcome of retinal redetachment after cataract surgery, in eyes with a history of retinal detachment repair by scleral buckling techniques.

DESIGN: Population-based, retrospective cohort study.

PARTICIPANTS: All phakic patients without previous ocular surgery or significant trauma who underwent scleral buckling surgery for rhegmatogenous retinal detachment between January 1, 2001, and December 31, 2010, at Norrlands University Hospital, Sweden (n = 537).

METHODS: International Classification of Diseases 10 diagnosis codes corresponding to rhegmatogenous retinal detachment were used to identify all cases. Medical charts of all patients identified were reviewed to confirm the diagnosis. Any recurrence of retinal detachment and the visual outcome in these cases were examined. The frequency of redetachment and the time span from cataract surgery to redetachment surgery were analyzed.

MAIN OUTCOME MEASURES: Any redetachment surgery after cataract surgery, best-corrected visual acuity (BCVA).

RESULTS: Three hundred and one (56%) male and 236 (44%) female patients were identified. During the follow-up period, 145 of 537 patients (27%) had phacoemulsification surgery, with a median time span of 3.4 years after the retinal detachment repair. Male patients had cataract surgery significantly more often (31% vs. 22%; P = 0.036), and at an earlier age, than female patients (65.6 vs. 69.4 years; P = 0.013). Recurrence of retinal detachment occurred in 3 patients (3/145; 2.1%), at 2.4, 3.9, and 6.9 years after cataract extraction, and their final BCVA was 20/70, 20/25, and 20/30, respectively. The cumulative percentage of redetachment surgery after phacoemulsification was 1% up to 10 years after the scleral buckling surgery, as calculated by life table analyses. Ten years after cataract surgery, the cumulative percentage of redetachment surgery was 5% in eyes with previous scleral buckling surgery.

CONCLUSIONS: In patients with a history of previous scleral buckling surgery, the risk of redetachment after cataract surgery is low. In these patients, phacoemulsification can be performed safely and there is no need for extended postoperative attention. It is, however, important to inform all patients with previous retinal detachment surgery to seek prompt medical care if they experience symptoms of redetachment. This is important even several years after the cataract surgery was performed.

National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-158710 (URN)10.1016/j.oret.2017.03.014 (DOI)31047301 (PubMedID)
Available from: 2019-05-08 Created: 2019-05-08 Last updated: 2019-05-15Bibliographically approved
Mönestam, E. (2018). Long-time outcome of cataract surgery-20 years results from a prospective study. Paper presented at Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), APR 29-MAY 03, 2018, Honolulu, HI. Investigative Ophthalmology and Visual Science, 59(9)
Open this publication in new window or tab >>Long-time outcome of cataract surgery-20 years results from a prospective study
2018 (English)In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 59, no 9Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Purpose: This study reports the change, over a 20-year period, in best-corrected visual acuity (BCVA), subjective visual function (VF-14 questionnaire), and YAG-frequency after cataract surgery.

Methods: This population-based prospective study reviewed 106 patients (79% of survivors), who underwent cataract surgery during a 1-year period 20 years previously (1997). All patients answered the same visual function questionnaire (VF-14) preoperatively, 4 months postoperatively, 5, 10, 15 and 20 years after surgery. Most patients (90%; 95/106; 70% of survivors) also had a routine ocular examination including BCVA and low contrast visual acuity (VA) 10% and 2.5%. Mean age at the time of surgery was 59 years (range 36-79) and 95% had a three-piece Acrysof® MA60BM implanted.

Results: Twenty years after surgery the median BCVA of the operated eye had deteriorated to a median of 0.06 (logMAR) (Snellen acuity: 20/23) from 0.0 (logMAR) (20/20) postoperatively, (p=0.001). Sixty-one percent of the patients (58/95) had less than 0.1 logMAR units worsening of BCVA compared with postoperatively. Seventeen percent of the patients (16/95) had worse BCVA 20 years after surgery compared with the preoperative VA. Forty-two percent (45/106) had no deterioration in subjective visual function (VF-14), and mean VF-14 score 20 years after surgery was 92 (range 33-100). The majority of patients (78%;82/106) had 10 points decline or less and 6 percent of the patients (6/106) had a worsening of more than 30 points. 61% of the patients (58/95) had never had Nd:YAG laser capsulotomy. In 7% of the patients (7/95) no cataract surgery had occurred in the fellow eye.

Conclusions: These prospective population-based, follow-up data provides estimates of extended long-term visual results. The effectiveness of cataract extraction, in offering good long-term visual rehabilitation for the majority of the patients, is confirmed. The extent and distribution of loss in subjective visual function is comparable to the outcome 10 and 15 years after surgery. Age-related macular degeneration remained the most common comorbidity causing large functional loss also 20 years after cataract surgery. Surprisingly, despite the low age at cataract surgery and the long time span, only a minority of patients had needed treatment for posterior capsular opacification.

Place, publisher, year, edition, pages
The Association for Research in Vision and Ophthalmology, 2018
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-152421 (URN)000442932804254 ()
Conference
Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), APR 29-MAY 03, 2018, Honolulu, HI
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2018-10-05Bibliographically approved
Westborg, I. & Mönestam, E. (2017). Optimizing number of postoperative visits after cataract surgery: Safety perspective. Journal of cataract and refractive surgery, 43(9), 1184-1189
Open this publication in new window or tab >>Optimizing number of postoperative visits after cataract surgery: Safety perspective
2017 (English)In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 43, no 9, p. 1184-1189Article in journal (Refereed) Published
Abstract [en]

Purpose: To evaluate safety perspectives when the standard routine after cataract surgery is no planned postoperative visit.

Setting: Eye Clinic, Sunderby Hospital, Lulea, Norrbotten County, Sweden.

Design: Prospective case series.

Methods: All cataract surgery cases during a 1-year period were included. The study group had the standard routine at the clinic, that is, no planned postoperative visit for patients without comorbidity and uneventful surgery. For the control group, patients who had surgery during 1 month of the 1-year period were chosen. All these patients had a planned postoperative visit. All surgeons involved were experienced. The outcome measures were any planned postoperative visit, any complication and/or adverse event, postoperative corrected distance visual acuity (CDVA), and any postoperative control/contact initiated by the patient.

Results: The study comprised 1249 patients (1115 in the study group and 134 in the control group). No significant differences in demographics, postoperative CDVA, frequency of planned visits because of ocular comorbidity, or postoperative patient-initiated contacts were found between the 2 groups. Of the 1249 patients, 9% (117 patients) initiated a postoperative contact, of whom 26% (30 patients) also had a scheduled visit. The reasons for the patient-initiated contacts were visual disturbance, redness and/or chafing, pain, and anxiety. An evaluation of all medidal records 2 years postoperatively found no reports of missed adverse events.

Conclusions: It was possible to refrain from planned,postoperafive visits for patients having uncomplicated cataract surgery. However, preoperatively, patients with comorbidities should be provided with individual planning of their postoperative follow-up. Preoperative counseling is important, and the clinic must have resources to answer questions from patients and be prepared for additional unplanned postoperative visits.

Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Ophthalmology Surgery
Identifiers
urn:nbn:se:umu:diva-142002 (URN)10.1016/j.jcrs.2017.06.042 (DOI)000413889000010 ()28991615 (PubMedID)
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-10-31Bibliographically approved
Mönestam, E. & Behndig, A. (2016). Change in light scattering caused by glistenings in hydrophobic acrylic intraocular lenses from 10 to 15 years after surgery. Journal of cataract and refractive surgery, 42(6), 864-869
Open this publication in new window or tab >>Change in light scattering caused by glistenings in hydrophobic acrylic intraocular lenses from 10 to 15 years after surgery
2016 (English)In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 42, no 6, p. 864-869Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To analyze the long-term change in light scattering caused by glistenings in hydrophobic acrylic intraocular lenses (IOLs) and the clinical implications on high-contrast and low-contrast visual acuity.

SETTING: Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden.

DESIGN: Prospective longitudinal case series.

METHODS: The study comprised patients who had an Acrysof MA60BM IOL implanted between 1997 and 1998. Light scattering from the IOLs was assessed with digital analysis using Scheimpflug photography (Pentacam HR) from both the 10- year and 15-year follow-up. Associations were made between corrected distance visual acuity, low-contrast visual acuity (LCVA) 10.0%, LCVA 2.5%, and the degree of light scattering from the IOL.

RESULTS: At the 15-year follow-up, the majority of the 90 patients had an increased amount of light scattering in all parts measured in the IOL than the patients at the 10-year follow-up. A subgroup of 71 patients without coexisting ocular pathology was selected for the visual function analyses. There was no correlation between light scattering and dioptric power. No clinically relevant reduction in visual function was detected in eyes with more pronounced light scattering. Patients with a larger increase in total light scattering of the IOL at the 15-year follow-up had significantly worse LCVA 2.5% than at the 10-year follow-up (P = .042).

CONCLUSIONS: Glistenings continued to increase in hydrophobic acrylic IOLs from 10 to 15 years after surgery. At 15 years, most patients had severe glistenings with a high level of light scattering from the IOL. No clinically significant effect on everyday visual function was found.

FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Ophthalmology Surgery
Identifiers
urn:nbn:se:umu:diva-134185 (URN)10.1016/j.jcrs.2016.02.047 (DOI)000379888700011 ()27373393 (PubMedID)
Available from: 2017-04-28 Created: 2017-04-28 Last updated: 2018-06-09Bibliographically approved
Mönestam, E. (2016). Long-term outcomes of cataract surgery: 15-year results of a prospective study. Journal of cataract and refractive surgery, 42(1), 19-26
Open this publication in new window or tab >>Long-term outcomes of cataract surgery: 15-year results of a prospective study
2016 (English)In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 42, no 1, p. 19-26Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe the change over a 15-year period in corrected distance visual acuity (CDVA), subjective visual function, and neodymium:YAG (Nd:YAG) frequency after cataract surgery. SETTING: Eye Clinic, Norrlands University Hospital, Umea, Sweden. DESIGN: Prospective longitudinal population-based cohort study. METHODS: Patients who had cataract surgery during a 1-year period, 15 years previously (1997 to 1998), were included. All patients answered the same Visual Function-14 (VF-14) questionnaire preoperatively, 4 months postoperatively, and 5, 10, and 15 years after surgery. Most patients (88%; 168/190; 74% of survivors) also had an ocular examination. The CDVA was measured with logMAR charts. RESULTS: The study included 190 patients (83% of survivors). Fifteen years after surgery, the median CDVA in the operated eye had deteriorated from 20/20 postoperatively to 20/25 (P = .0001). Sixty percent of the patients had worsening of CDVA of less than 0.1 logMAR units compared with postoperatively. Fifty-four percent (103/190) had no deterioration in subjective visual function (VF-14), and 79% (150/190) had 10 points of decline or less. Previous Nd:YAG laser capsulotomy was more common in those younger than 65 years at surgery (49% versus 25%) (P = .002). CONCLUSIONS: The study confirms the effectiveness of cataract extraction, offering good long-term visual rehabilitation for the majority of the patients. The most common comorbidity causing large functional loss 15 years after surgery was age-related macular degeneration. Fifteen years after surgery, one half of the patients younger than 65 years at surgery had not required a posterior Nd:YAG laser capsulotomy. (C) 2016 ASCRS and ESCRS

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-119088 (URN)10.1016/j.jcrs.2015.07.040 (DOI)000372139200005 ()26948774 (PubMedID)
Available from: 2016-04-15 Created: 2016-04-11 Last updated: 2018-06-07Bibliographically approved
Mönestam, E. (2014). Asymptomatic capsular bag distension 10 years after cataract surgery. JCRS Online Case Reports, 2(3), 54-57
Open this publication in new window or tab >>Asymptomatic capsular bag distension 10 years after cataract surgery
2014 (English)In: JCRS Online Case Reports, ISSN 2214-1677, Vol. 2, no 3, p. 54-57Article in journal (Refereed) Published
Abstract [en]

Ten years after surgery, 120 patients who were part of a prospective longitudinal long-term study of cataract surgery outcome had a routine eye examination that included Scheimpflug photography (Pentacam HR). No patient had a previous posterior capsulotomy. Seven patients (6%) with distended capsular bags were found. None had experienced clinical symptoms. The distance between the intraocular lens (IOL) and the posterior capsule was between 300 μm and 740 μm. These cases suggest there is an asymptomatic timespan in cases with late-onset capsular bag distension syndrome. It is important to be aware of this syndrome when examining patients who had cataract surgery many years previously and no posterior capsulotomy. If there is a tendency for accumulation of fluid behind the IOL, most patients will need posterior capsulotomy within a few years, especially if the distance between the IOL and the posterior capsule is greater than 500 μm.

Place, publisher, year, edition, pages
Elsevier, 2014
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-117572 (URN)10.1016/j.jcro.2014.06.001 (DOI)
Available from: 2016-03-02 Created: 2016-03-02 Last updated: 2018-06-07Bibliographically approved
Westborg, I. & Mönestam, E. (2013). Intracameral anesthesia for cataract surgery: a population-based study on patient satisfaction and outcome. Clinical Ophthalmology (7), 2063-2068
Open this publication in new window or tab >>Intracameral anesthesia for cataract surgery: a population-based study on patient satisfaction and outcome
2013 (English)In: Clinical Ophthalmology, ISSN 1177-5467, E-ISSN 1177-5483, no 7, p. 2063-2068Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate if the standard anesthetic regimen - topical combined with intracameral anesthesia without sedation - in a population-based cohort of unselected cataract surgery cases is adequate, optimal, and good practice, or if improvements are necessary.

METHODS: We conducted a prospective, observational study on all cases of cataract surgery during a 1-year period at one institution (n=1249). Data were collected from the patients' records. Outcome measures were use of preoperative sedation, type of anesthesia, complications, and adverse events. In a subgroup of patients (n=124) satisfaction with the anesthetic regimen was evaluated using a short questionnaire.

RESULTS: Most cases (90%, 1125/1249) had combined topical and intracameral anesthesia without sedation. Patients who chose preoperative sedation (midazolam hydrochloride sublingually) were significantly younger and more often female (P=0.0001 and P=0.011, respectively). In the questionnaire subgroup, the median pain score after surgery was 0.7 (visual analog scale, 0-10). A pain score of 1.9 or less was reported by 76% of the patients. Patients reporting a pain score of 2 or more had sedation and additional anesthetics more often. No significant difference was found regarding age, sex, pulse rate, oxygen saturation, first or second eye surgery, or adverse intraoperative events for patients with pain scores of 1.9 or less and 2 or more.

CONCLUSION: This large population-based series of small-incision phacoemulsification surgery shows that combined topical and intracameral anesthesia without sedatives is well tolerated for most phacoemulsification patients. It is also effective in cases when complications or adverse events occur. It is important to be responsive to the individual patient's needs and adjust operating procedures if necessary, as there were a few patients who experienced insufficient anesthesia.

Place, publisher, year, edition, pages
Dove Medical Press Ltd, 2013
Keywords
anesthesia, local/methods, phacoemulsification, cataract extraction, humans, prospective observational studies
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-90954 (URN)10.2147/OPTH.S51409 (DOI)24204107 (PubMedID)
Available from: 2014-07-04 Created: 2014-07-04 Last updated: 2018-10-31Bibliographically approved
Westborg, I. & Mönestam, E. (2013). Optimizing number of postoperative visits after cataract surgery - a safety perspective. Paper presented at 2013 European Association for Vision and Eye Research Conference. Acta Ophthalmologica, 91
Open this publication in new window or tab >>Optimizing number of postoperative visits after cataract surgery - a safety perspective
2013 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 91Article in journal, Meeting abstract (Other academic) Published
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-90484 (URN)10.1111/j.1755-3768.2013.4454.x (DOI)000336552300705 ()
Conference
2013 European Association for Vision and Eye Research Conference
Note

Supplement: 252 Meeting Abstract: 4454

Available from: 2014-07-04 Created: 2014-06-23 Last updated: 2018-06-07Bibliographically approved
Lundqvist, B. & Mönestam, E. (2012). Longitudinal changes in subjective and objective visual function in diabetics 5 years after cataract surgery.. Acta Ophthalmologica, 90(3), 215-220
Open this publication in new window or tab >>Longitudinal changes in subjective and objective visual function in diabetics 5 years after cataract surgery.
2012 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 90, no 3, p. 215-220Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate and compare the long-term subjective and objective visual functional results of phacoemulsification in diabetics and non-diabetics. Methods: A prospective, longitudinal, population-based study comprising 57 diabetics and 473 non-diabetics, who had cataract surgery during a 1-year period at Norrlands University Hospital, Umeå, Sweden. Visual acuity data, visual function questionnaire (VF-14) responses, and level of diabetic retinopathy were recorded pre- and postoperatively as well as 5 years after surgery. Results: Four months postoperatively, the median VF-14 total score for both the diabetics and the non-diabetics was 100; at 5 years, the score decreased to 96.4 and 97.2, respectively (p = 0.81). The median best corrected visual acuity (BCVA) of the operated eye was logMAR 0.046 (Q1:Q3 = 0:0.15) for both the diabetics and the non-diabetics 4-8 weeks postoperatively. Five years later, the BCVA for the diabetics was logMAR 0.14 (Q1:Q3 = 0.02:0.34) and for the non-diabetics 0.1 (Q1:Q3 = 0.02:0.3), (p = 0.34). Five years after surgery, 26% of the diabetics and 22% of the non-diabetics had a reduction in VF14-score of 10 points or more (p = 0.64) compared with 4 months postoperatively. One-third of both the diabetics (18/57) and the non-diabetics (149/473) had lost more than 0.1 log MAR unit in BCVA of the operated eye (p = 0.86). Conclusion: Subjective and objective visual function 5 years after cataract surgery remained stable in most surviving diabetics and non-diabetics. The longitudinal visual function in diabetics was not significantly worse compared with non-diabetics.

Place, publisher, year, edition, pages
Malden, MA: Wiley-Blackwell, 2012
Keywords
cataract surgery, visual function, longitudinal changes
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-35441 (URN)10.1111/j.1755-3768.2010.01905.x (DOI)000303311400013 ()20491694 (PubMedID)
Available from: 2010-08-18 Created: 2010-08-18 Last updated: 2018-06-08Bibliographically approved
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