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  • 1.
    Artzén, Ditte
    et al.
    S:t Erik Eye Hospital, Stockholm.
    Lundström, Mats
    EyeNet Sweden, Blekinge Hospital, Karlskrona.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Stenevi, Ulf
    Sahlgrenska University Hospital, Mölndal, .
    Lydahl, Eva
    Lake Mälare Hospital, Eskilstuna.
    Montan, Per
    St. Erik Eye Hospital, Stockholm.
    Capsule complication during cataract surgery: Case-control study of preoperative and intraoperative risk factors: Swedish Capsule Rupture Study Group report 2.2009In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, ISSN ISSN 0886-3350, Vol. 35, no 10, p. 1688-1693Article in journal (Refereed)
    Abstract [en]

    Abstract

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

  • 2.
    Beckman Rehnman, Jeannette
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Janbaz, Chris C.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Spatial distribution of corneal light scattering after corneal collagen crosslinking2011In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 37, no 11, p. 1939-1944Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess the spatial distribution and time course of increased corneal light scattering after corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A irradiation.

    Setting: Umeå University Hospital Eye Clinic, Umeå, Sweden.

    Design: Case series.

    Methods: Eyes with keratoconus were examined with Scheimpflug photography before and 1 and 6 months after CXL. Corneal light scattering was quantified throughout the corneal thickness at 8 measurement points 0.0 to 3.0 mm from the central cornea.

    Results: The study comprised 11 eyes of 11 patients. Central corneal light scattering increased significantly 1 month after CXL (P<.001). At 6 months, it decreased (P=.002); however, it was still higher than pretreatment values (P<.001). Light scattering at 1 month was more pronounced in the superficialstroma, gradually diminishing to zero at 240 μm depth. It was greater at the corneal center than 1.0 to 3.0 mm from the center. At 6 months, a second peak of light scattering occurred between 240 μm and 340 μm depth. No increased light scattering deeper than 340 μm was seen at either time point.

    Conclusions: Corneal light scattering after CXL showed distinctive spatial and temporal profiles. Analysis of corneal light scattering may give an impression of tissue changes, the depth of the CXL treatment effect, and the corneal response to the treatment. Scheimpflug photography appears to be useful for this purpose.

  • 3.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Phacoemulsification in spherophakia with corneal touch2002In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 28, no 1, p. 189-191Article in journal (Refereed)
    Abstract [en]

    A phacoemulsification procedure with implantation of a foldable acrylic intraocular lens in a 31-year-old man with spherophakia is described. The procedure was necessitated by anterior dislocation of the spherophakic lens, with corneal endothelial contact and development of central corneal edema. With a careful approach, the procedure was uneventful and the outcome successful. Modern small-incision cataract surgery techniques are of great benefit in this type of complicated case.

  • 4.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Cochener, Beatrice
    Luis Gueell, Jose
    Kodjikian, Laurent
    Mencucci, Rita
    Nuijts, Rudy M. M. A.
    Pleyer, Uwe
    Rosen, Paul
    Szaflik, Jacek P.
    Tassignon, Marie-Jose
    Endophthalmitis prophylaxis in cataract surgery: Overview of current practice patterns in 9 European countries2013In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 39, no 9, p. 1421-1431Article, review/survey (Refereed)
    Abstract [en]

    Data on practice patterns for prophylaxis against infectious postoperative endophthalmitis (IPOE) during cataract surgery in 9 European countries were searched in national registers and reviews of published surveys. Summary reports assessed each nation's IPOE rates, nonantibiotic prophylactic routines, topical and intracameral antibiotic use, and coherence to the European Society of Cataract & Refractive Surgeons (ESCRS) 2007 guidelines. Although the reliability and completeness of available data vary between countries, the results show that IPOE rates differ significantly. Asepsis routines with povidone iodine and postoperative topical antibiotics are generally adopted. Use of preoperative and perioperative topical antibiotics as well as intracameral cefuroxime varies widely between and within countries. Five years after publication of the ESCRS guidelines, there is no consensus on intracameral cefuroxime use. Major obstacles include legal barriers or persisting controversy about the scientific rationale for systematic intracameral cefuroxime use in some countries and, until recently, lack of a commercially available preparation.

  • 5.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Cochener-Lamard, Beatrice
    Gueell, Jose
    Kodjikian, Laurent
    Mencucci, Rita
    Nuijts, Rudy
    Pleyer, Uwe
    Rosen, Paul
    Szaflik, Jacek
    Tassignon, Marie-Jose
    Surgical, antiseptic, and antibiotic practice in cataract surgery: results from the European Observatory in 20132015In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 41, no 12, p. 2635-2643Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To report the results from the first iteration of the European Observatory of Cataract Surgery, which was initiated to track changes in surgical, antiseptic, and antibiotic practices in cataract surgery over the coming years. SETTING: Practicing European cataract surgeons (n = 479). DESIGN: Internet-based declarative questionnaire or telephone questionnaire. METHODS: The questionnaire comprised 37 questions divided into 8 categories as follows: screening, surgeon profile, surgical procedure used, product use before arrival at the operating room, techniques for mydriasis and anesthesia, product use during the surgery, product use after the patient leaves the operating room, and surgeon's attitude to guidelines. RESULTS: Cataract surgeons (n = 2700) were initially contacted, of whom 479 (17.7%) were included in the survey. The current baseline survey revealed considerable variation between countries in their implementation of infectious postoperative endophthalmitis (IPOE) prophylaxis. In some countries, adoption of intracameral cefuroxime is almost universal, whereas in others, the use of such prophylaxis is below one half. When intracameral cefuroxime is used, it is generally cefuroxime powder designed for parenteral use. A preparation specifically registered for intracameral use is now available, and this formulation is more commonly used in countries in which intracameral cefuroxime was most widely adopted. CONCLUSION: The baseline results from this ongoing survey suggest a considerable level of heterogeneity between European countries in IPOE prophylaxis. Further iterations of this survey will monitor whether a consensus begins to emerge. Financial Disclosures: This work was supported by Laboratoires Thea, under the supervision of the expert group. Members of the expert group were remunerated by Laboratoires Thea J.F. Stolz, MD, PhD, provided editorial assistance in manuscript preparation, for which he was remunerated by Laboratoires Thea Anders Behndig, Rita Mencucci, and Jacek P. Szaflik report no relevant conflicts of interest.

  • 6.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Korobelnik, Jean-Francois
    Mydriatic insert and intracameral injections compared with mydriatic eyedrops in cataract surgery: Controlled studies2015In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 41, no 7, p. 1503-1519Article, review/survey (Refereed)
    Abstract [en]

    Mydriatic eyedrops are the standard method for pupil dilation in cataract surgery, but their limitations have prompted a search for alternative techniques. Two alternatives an ophthalmic insert containing phenylephrine and tropicamide and intracameral injections of various combinations of lidocaine, cyclopentolate, and phenylephrine, with or without epinephrine in the irrigating solution have been assessed in prospective controlled studies, including randomized controlled trials (RCTs). We reviewed the safety and efficacy of mydriatic ophthalmic inserts and intracameral mydriatic injections compared with the safety and efficacy of mydriatic eyedrops using a systematic Pub Med search (1963 to 2014). We identified 9 prospective studies (7 RCTs, 637 patients) of the mydriatic ophthalmic insert and 15 prospective studies (14 RCTs, 1020 patients) of intracameral mydriatic injections; 7 of the RCTs compared intracameral mydriatic injections and mydriatic eyedrops and 7 RCTs studied the optimum intracameral mydriatic injection protocol. The latter showed that a lidocaine and phenylephrine based solution, without irrigating epinephrine, was optimum for intracameral mydriatic injections. The mydriatic ophthalmic insert and intracameral mydriatic injections were consistently shown to be safe and as effective as mydriatic eyedrops. Each method has distinct advantages and limitations. 

  • 7.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Aqueous humor lidocaine concentrations in topical and intracameral anesthesia1998In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 24, no 12, p. 1546-1647Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess aqueous humor lidocaine concentrations in 2 common regimens of topical anesthesia and after intracameral injection of the anesthetic agent. SETTING: University hospital eye clinic. METHODS: Twenty patients having routine cataract surgery were randomized into 3 groups: 1 given 3 drops of lidocaine 4% before surgery; 1 given 6 drops; 1 given 3 drops plus an intracameral injection of 0.1 mL lidocaine 1%. Lidocaine concentration was measured in aqueous humor samples taken before surgery. RESULTS: With 3 drops, aqueous lidocaine concentration was 1.4 micrograms/mL +/- 0.5 (SD) and with 6 drops, 4.3 +/- 1.5 micrograms/mL (P = .0015). With an intracameral injection, it was 341.8 +/- 152.6 micrograms/mL. CONCLUSION: Measurable amounts of lidocaine entered the anterior chamber in topical anesthesia, and more entered when more drops were given. It is likely that concentrations in this range could anesthetize the iris, but they are far lower than concentrations after an intracameral injection.

  • 8.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Lundberg, Björn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Mydriatic response to different concentrations of intracameral phenylephrine in humans2010In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 36, no 10, p. 1682-1686Article in journal (Refereed)
    Abstract [en]

    Results show that phenylephrine injected intracamerally does not have a linear mydriatic dose-response relationship in humans. At very high concentrations, phenylephrine may bind to and stimulate receptors other than the α(1)-receptor, explaining this phenomenon.

  • 9.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Lundberg, Björn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Transient corneal edema after phacoemulsification: comparison of 3 viscoelastic regimens2002In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 28, no 9, p. 1551-1556Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the effect of different viscoelastic substances on the grade and time course of postoperative corneal edema. SETTING: Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden. METHODS: This study comprised 62 patients with otherwise healthy eyes who had routine phacoemulsification and intraocular lens (IOL) implantation. Patients were divided into 3 groups. Group 1 was given Healon GV (sodium hyaluronate 1.4%) at phacoemulsification and IOL implantation. Group 2 was given Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) at phacoemulsification and Healon GV at IOL implantation. Group 3 was given Viscoat at phacoemulsification and Provisc (sodium hyaluronate 1.0%) at lens implantation. The central corneal thickness was measured with ultrasonic pachymetry before surgery and 5 and 24 hours, 1 week, and 1 month after surgery. RESULTS: The mean increase in corneal thickness was significantly greater in Group 1 than in the other 2 groups 5 and 24 hours and 1 week after surgery. CONCLUSIONS: The transient postoperative increase in central corneal thickness was greater in patients receiving Healon GV during phacoemulsification than in patients receiving Viscoat. The use of Provisc or Healon GV for IOL implantation did not affect the postoperative corneal thickness when Viscoat was used for phacoemulsification. The time course of the edema may be explained by a difference between the 2 agents in endothelial protection from ultrasonic, mechanical, or irrigation trauma.

  • 10.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Montan, Per
    St Eriks ögonsjukhus, Karolinska Institutet, Stockholm.
    Stenevi, Ulf
    Department of Ophthalmology, Sahlgrenska University Hospital, Molndal.
    Kugelberg, Maria
    St Eriks ögonsjukhus, Karolinska Institutet, Stockholm.
    Lundstrom, Mats
    EyeNet Sweden, Blekinge Hospital, Karlskrona, € Sweden.
    One million cataract surgeries: Swedish National Cataract Register 1992-20092011In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 37, no 8, p. 1539-1545Article in journal (Refereed)
    Abstract [en]

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

  • 11.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Montan, Per
    Stenevi, Ulf
    Kugelberg, Maria
    Zetterström, Charlotta
    Lundström, Mats
    Aiming for emmetropia after cataract surgery: Swedish National Cataract Register study2012In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 38, no 7, p. 1181-1186Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess and analyze refractive outcome after cataract surgery in Sweden from 2008 though 2010. SETTING: Swedish cataract surgery units participating in outcome registration of National Cataract Register. DESIGN: Cohort study. METHODS: Planned and actual postoperative refractions were analyzed for cataract procedures and preoperative and postoperative corneal astigmatism for procedures performed in 2008 though 2010. Induced astigmatism was calculated with Naeser and Behrens polar coordinates. RESULTS: Postoperative refraction was analyzed for 17 056 procedures and corneal astigmatism for 7448 procedures. Emmetropia was targeted in 78.1% of eyes and achieved in 52.7%; 43.0% had less than 1.00 diopter (D) of astigmatism. "Reading myopia" of -3.5 to -1.6 D was targeted in 7.0% of eyes and achieved in 7.8%. Planned hyperopia greater than 1.0 D or myopia greater than -3.5 D was rare. The mean absolute biometry prediction error was 0.402 D +/- 0.338 (SD) in all eyes; however, astigmatic eyes and eyes planned for myopia or hyperopia had higher biometry prediction errors. Younger patients were more often astigmatic and planned for a more myopic outcome. Preoperatively, one third of eyes had more than 1.0 D of corneal astigmatism; postoperatively this figure was largely unaltered. The mean induced astigmatism was 0.525 +/- 0.804 D in all eyes. CONCLUSIONS: Emmetropia (spherical equivalent -0.5 to + 0.5 D and <1.0 D astigmatism) is the goal in most cataract cases but was reached in only 55% of eyes planned for emmetropia. Factors precluding emmetropia included remaining corneal astigmatism and biometry prediction errors in astigmatic and ametropic eyes.

  • 12.
    Behndig, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Mönestam, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Quantification of glistenings in intraocular lenses using Scheimpflug photography2009In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 35, no 1, p. 14-17Article in journal (Refereed)
    Abstract [en]

    We describe a method of quantifying glistenings in intraocular lenses (IOLs) using Scheimpflug photography. Glistenings in hydrophilic acrylic IOLs implanted over a 10-year period were quantified subjectively at the slitlamp and by digital image analysis of Scheimpflug photographs; the latter involved analysis of glistenings in the anterior and posterior IOL surfaces. Glistenings were seen in all IOLs, with more in those with a longer postoperative period. This association was stronger with Scheimpflug quantification (r(S) = 0.70; P<.000) than with subjective quantification (r(S) = 0.32; P = .11). Anterior and posterior IOL glistenings developed similarly over time. Scheimpflug photography had a higher degree of objectivity than subjective staging of IOL glistenings and also provided information about the axial localization of the glistenings. This investigation indicated that IOL glistenings continued to increase for up to 10 years.

  • 13.
    Blomstedt, Patric
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Cataract surgery in ancient Egypt2014In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 40, no 3, p. 485-489Article, review/survey (Refereed)
    Abstract [en]

    Ophthalmology was one of the most important specialties in Egyptian medicine, and more specialists are known in this field than in any other. This specialization seems, however, to have been of a purely noninvasive nature. Even though it has been claimed that cataract surgery was performed in pharaonic Egypt, careful analysis of the sources does not support the claim. No example of cataract surgery or of any other invasive ophthalmologic procedure can be found in the original sources.

  • 14. Chang, Anthony
    et al.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Ronbeck, Margrethe
    Kugelberg, Maria
    Comparison of posterior capsule opacification and glistenings with 2 hydrophobic acrylic intraocular lenses: 5-to 7-year follow-up2013In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 39, no 5, p. 694-698Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare posterior capsule opacification (PCO) and glistenings 5 to 7 years after cataract surgery with implantation of 2 hydrophobic acrylic intraocular lenses (IOLs) and evaluate the effects on corrected distance visual acuity (CDVA) and contrast sensitivity. SETTING: St. Erik Eye Hospital, Stockholm, Sweden. DESIGN: Randomized clinical trial. METHODS: Cataract surgery with standard phacoemulsification was performed in 1 eye of patients. The patients were randomized to an Acrysof SA60AT (1-piece IOL group) or a Sensar AR40e (3-piece IOL group), both hydrophobic acrylic IOLs with a sharp-edged design. Five to 7 years postoperatively, retroillumination images were obtained and the PCO area and severity (area affected within the capsulorhexis and severity) were evaluated using computer software. High-contrast (100%) and low-contrast (2.5%) CDVAs were measured. The neodymium:YAG laser capsulotomy rates were recorded. Scheimpflug images were obtained to evaluate glistenings, which were graded subjectively at the slitlamp and quantified objectively by digital image analysis using computer software. RESULTS: The study enrolled 80 patients. There were no significant differences in PCO between the 2 groups. The 3-piece IOL group had significantly fewer glistenings (P<.001). There was good correlation between the subjective grading of glistenings and objective computer-processed image grading. The glistenings were not correlated with IOL power, CDVA, or contrast sensitivity. CONCLUSIONS: There were no significant differences in PCO between the 2 acrylic hydrophobic IOLs 5 to 7 years postoperatively. The 1-piece IOL group developed more glistenings than the 3-piece IOL group.

  • 15.
    Claesson, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Johansson, Magdalena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Mydriasis with different preparations of topically administered lidocaine hydrochloride2009In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 35, no 2, p. 277-281Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To quantify the mydriatic effect and side effects of topical lidocaine hydrochloride with different pH values and concentrations in healthy volunteers.

    SETTING: Umeå University Hospital Eye Clinic, Umeå, Sweden.

    METHODS: In this intraindividual comparison double-masked randomized study, healthy volunteers were given topical lidocaine 8%, lidocaine 8% pH 6.0, or a placebo 3 times at 90-second intervals. Thereafter, a drop of tropicamide 0.5% or placebo was given (tropicamide setting). Another group of healthy volunteers was given topical lidocaine 4%, 8%, or 16% 3 or 6 times at 90-second intervals (dose-response setting). Before and 15, 30, 60, and 180 minutes after eyedrop instillation, the near point was determined and Scheimpflug photography was performed.

    RESULTS: The tropicamide setting comprised 26 volunteers (mean age 23.5 years) and the dose-response setting, 10 volunteers (mean age 24.5 years). The direct mydriatic effect of lidocaine was larger at pH 6.0 (mean peak effect 0.61+/-0.06 [SEM] versus 0.42+/-0.04 mm) (P< .05), and the augmentation of tropicamide mydriasis was larger at pH 6.0. Lidocaine 8% had a better direct mydriatic effect than lidocaine 4% and lidocaine 16% (mean peak effect 0.60+/-0.09 mm versus 0.19+/-0.08 mm and 0.28+/-0.10 mm, respectively) (P< .01). Lidocaine 16% given 6 times caused corneal side effects.

    CONCLUSIONS: Lidocaine 8% with pH 6.0 had a maximum direct mydriatic effect and gave maximum augmentation of tropicamide mydriasis without causing unwanted corneal side effects and thus should be preferable for topical anesthesia in cataract surgery.

  • 16.
    Engren, Anna-Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Anterior chamber depth, intraocular lens position, and refractive outcomes after cataract surgery2013In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 39, no 4, p. 572-577Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess postoperative intraocular lens (IOL) position in relation to the cornea and iris, compare 2 devices for anterior chamber depth (ACD) measurement, and assess the impact of these factors on postoperative refraction in phacoemulsification. SETTING: Department of Clinical Sciences/Ophthalmology, Umea University Hospital, Umea Sweden. DESIGN: Evaluation of diagnostic test or technology. METHODS: Biometry and measurement of the anterior segment were performed preoperatively and postoperatively with the partial coherence interferometry (PCI)-based IOLMaster and the Pentacam HR Scheimpflug device. Predicted refraction was calculated with ACD estimations according to the Haigis formula and was compared with the actual postoperative refraction. Changes in ACD and the distance between the cornea-iris and the iris-lens/IOL were assessed from Scheimpflug images. The theoretical refractive impact of differences in ACD was calculated. RESULTS: The mean preoperative ACD and refractive prediction error, respectively, was 3.22 mm +/- 0.37 (SD) and 0.41 +/- 0.43 diopters (D) for the PCI device and 3.21 +/- 0.35 mm and 0.41 +/- 0.41 D for the Scheimpflug device; the difference was not statistically significant. The mean ACD, cornea-iris distance, and iris-lens/IOL distance changes were 1.62 +/- 0.38 mm, 0.78 +/- 0.29 mm, and 0.85 +/- 0.27 mm, respectively. The mean predicted refractive outcome from a 1.0 mm difference in ACD was 0.32 D. CONCLUSIONS: No difference was found between the measurement devices. Although the exact postoperative IOL position is difficult to predict, its impact on postoperative refraction was comparatively small compared with the impact of minor corneal curvature or axial length measurement errors.

  • 17. Jakobsson, Gunnar
    et al.
    Montan, Per
    Zetterberg, Madeleine
    Stenevi, Ulf
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Lundström, Mats
    Capsule complication during cataract surgery: Retinal detachment after cataract surgery with capsule complication: Swedish Capsule Rupture Study Group report 4.2009In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 35, no 10, p. 1699-1705Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study the incidence, characteristics, and results of retinal detachment (RD) after cataract surgery with a capsule complication.

    SETTING: Ten ophthalmic surgery departments in Sweden.

    METHODS: In this case-control study, data on cataract surgery cases with a capsule complication (study group) or with no complication (control group) in 2003 were extracted from the Swedish National Cataract Register. Patients with RD during a 3-year follow-up were identified.

    RESULTS: The study group comprised 324 patients and the control group, 331 patients. Retinal detachment occurred in 13 study group patients, for a 3-year incidence of 4.0%. In the control group, 1 patient (0.3%) had RD. Multivariate analysis showed an adjusted odds ratio (OR) of 14.8 for RD after capsule complication (95% confidence interval [CI], 1.9-114; P = .01). Subgroup analysis of the study group using a binary logistic regression model showed that male sex (OR, 8.5; 95% CI, 1.7-43.8; P = .001) and lens remnants in the vitreous (OR, 14.4; 95% CI 2.6-78.8; P = .002) were additional risk factors. Axial myopia was significantly associated with an increased risk as a single factor but not as a multiple factor. In general, the final visual outcome for RD after a capsule complication was poor; 3 eyes had a visual acuity of 0.50 or better. Eight eyes (62%) had a final visual acuity worse than 0.10 and 6 eyes, 0.02 or worse.

    CONCLUSIONS: The risk for RD after cataract surgery increased significantly when a capsule complication occurred, leading to poor final visual acuity in most cases.

  • 18.
    Johannesson, Gauti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Hallberg, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Koskela, Timo
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Linden, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Change in intraocular pressure measurement 2 years after myopic laser-assisted subepithelial keratectomy2012In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 38, no 9, p. 1637-1642Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate intraocular pressure (IOP) measurements 24 months after laser-assisted subepithelial keratectomy (LASEK) with 3 tonometry methods-Goldmann applanation tonometry (DCT), Pascal dynamic contour tonometry (DCT), and applanation resonance tonometry (ART)-and to compare them with measurements taken preoperatively and 3 and 6 months postoperatively. SETTING: Department of Ophthalmology, Umea University, lima Sweden. DESIGN: Prospective randomized single-center. METHODS: One randomized eye per person from myopic healthy individuals who had LASEK was included. Visual acuity, central corneal thickness (CCT), corneal curvature, and IOP were measured at all time points. Six IOP measurements were performed per method, with a 5-minute lapse between methods. RESULTS: The study evaluated 38 eyes. Two years after LASEK, dynamic ART was the only method that did not measure significantly lower IOP than before LASEK (mean -0.2 mm Hg +/- 1.6 [SD]). The greatest difference was with GAT (mean -1.9 +/- 1.7 mm Hg) followed by static ART (mean -1.2 +/- 1.6 mm Hg) and then DCT (mean -0.9 +/- 1.3 mm Hg). All methods measured significantly lower IOP at 3 months and 6 months. CONCLUSIONS: Dynamic ART, which analyses IOP measurement during indentation, showed no significant difference in measured IOP after 24 months. The convex tip of the ART device and the continuous sampling of data during corneal indentation seem to be factors in why dynamic ART was less affected by corneal properties and therefore more suitable for IOP measurement in LASEK-treated eyes, although this must be confirmed in larger trials.

  • 19. Johansson, Björn
    et al.
    Lundström, Mats
    Montan, Per
    Stenevi, Ulf
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Capsule complication during cataract surgery: Long-term outcomes: Swedish Capsule Rupture Study Group report 32009In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 35, no 10, p. 1694-1698Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe the long-term outcomes after cataract extractions with a capsule rupture included in the Swedish Capsule Rupture Study.

    SETTING: Ten ophthalmic surgery departments in Sweden.

    METHODS: From the cohort of patients originally selected for inclusion in the Swedish Capsule Rupture Study, cases with a capsule complication (study group) and cases without a complication (control group) were examined approximately 3.5 years postoperatively. Visual acuity and objective and subjective parameters were registered.

    RESULTS: The study group comprised 171 patients and the control group, 198 patients. Patients with a capsule complication had a significantly worse visual outcome and a doubled risk for no improvement in preoperative visual acuity. Pupil distortion, iris damage, synechias, and subjective complaints related to the eye were significantly more common in patients with a capsule complication.

    CONCLUSION: Capsule complications decreased the probability of good postoperative visual acuity and in general yielded a worse long-term outcome after phacoemulsification surgery

  • 20.
    Johansson, Björn
    et al.
    Division of Ophthalmology, Department of Neuroscience and Locomotion, Linköping University Hospital, Linköping.
    Sundelin, Staffan
    Wikberg-Matsson, Anna
    Unsbo, Peter
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Visual and optical performance of the Akreos Adapt Advanced Optics and Tecnis Z9000 intraocular lenses: Swedish multicenter study.2007In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 33, no 9, p. 1565-72Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare the subjective visual and objective optical performance of 2 aspherical intraocular lenses (IOLs), the Akreos Adapt Advanced Optics (AO) (Bausch & Lomb, Inc.) and the Tecnis Z9000 (Advanced Medical Optics, Inc.). SETTING: Four university hospitals in Sweden. METHODS: This study comprised 80 patients, 20 each from 4 university hospital centers in Sweden. All patients had bilateral clear corneal phacoemulsification with implantation of an Akreos Adapt AO IOL in 1 eye and Tecnis Z9000 IOL in the other eye according to a randomization protocol. Preoperatively, 90% contrast Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity was measured and the mesopic pupil sizes were determined. Ten to 12 weeks postoperatively, 12.5% and 90% contrast ETDRS visual acuities and photopic and mesopic Functional Acuity Contrast Test chart contrast sensitivities were determined. Wavefront analysis was performed with the Zywave II aberrometer (Bausch & Lomb, Inc.), and a questionnaire on the subjective quality of vision was completed by each patient. RESULTS: The Akreos AO IOL and Tecnis Z9000 IOL produced similar high- and low-contrast visual acuities as well as photopic and mesopic contrast sensitivities. The Tecnis Z9000 IOL resulted in lower spherical aberrations of the eye (mean 0.05 +/- 0.13 microm versus 0.35 +/- 0.13 microm root mean square, 6.0 mm pupil) (P<.001); however, the Akreos AO IOL provided a larger depth of field (mean 1.22 diopter [D] +/- 0.48 [SD] versus 0.86 +/- 0.50 D, 6.0 mm pupil) (P<.001). Patient satisfaction was generally high, although 68.8% of the patients reported some type of visual disturbance postoperatively. Twenty-eight percent of patients reported better subjective visual quality in the Akreos AO eye and 14%, in the Tecnis Z9000 eye (P<.0001). Accordingly, 33% perceived more visual disturbances in the Tecnis Z9000 eye and 11%, in the Akreos AO eye (P<.0001). CONCLUSIONS: Maximum reduction of spherical aberration did not maximize subjective visual quality. The higher perceived quality of vision with the Akreos AO IOL could be because of differences in depth of field, IOL material, or IOL design.

  • 21.
    Johansson, Magdalena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Lundberg, Björn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Optical coherence tomography evaluation of macular edema after phacoemulsification surgery with intracameral mydriatics.2007In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 33, no 8, p. 1436-41Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To quantify the macular edema induced by intracameral mydriatics in phacoemulsification surgery. SETTING: University hospital eye clinic, Umeå, Sweden. METHODS: In a randomized study of 22 patients, 11 patients were given 150 muL of a mixture of phenylephrine 1.5% and lidocaine 1% intracamerally for mydriasis and anesthesia. In a control group (n = 11), conventional topical mydriatics and intracameral lidocaine were given. Multiple preoperative, intraoperative, and postoperative variables were recorded. RESULTS: There were no differences in macular edema between the 2 treatments. A correlation was seen between macular edema and impaired visual acuity 1 week postoperatively. On the first postoperative day, a similar correlation was seen between corneal edema and the degree of visual improvement. CONCLUSIONS: Intracameral lidocaine and phenylephrine for mydriasis and anesthesia did not induce more significant macular edema than the standard regimen of topical mydriatics plus intracameral lidocaine. Macular edema limited visual improvement 1 week after phacoemulsification, while corneal edema appeared to have a larger effect immediately after surgery.

  • 22.
    Jonsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Pachymetric evaluation prior to laser in situ keratomileusis2005In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 31, no 4, p. 701-706Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To determine whether deviations in the localization of the cornea's thinnest point or the magnitude and localization of posterior corneal ectasia is associated with deviations in the spherical equivalent, the astigmatism, or the magnitude of an anterior corneal ectasia and whether corneas at risk for iatrogenic keratectasia can be identified without a pachymetry map of the cornea. SETTING: University hospital eye clinic. METHODS: Three hundred eight eyes of 156 healthy volunteers with various refractive errors were examined with Orbscan II and autorefractometer-keratometer. The corneal thickness was registered at the fixation point, at the geometrical center, and at the thinnest point of the cornea. Keratometry and refraction were determined for all subjects. RESULTS: The thinnest point of the cornea was predominantly located in the inferotemporal quadrant, and was significantly thinner than the fixation point (539.6 +/- 35.8 microm and 548.0 +/- 35.4 microm, respectively, P<.001). Interestingly, the larger this difference was, the longer the distance between these points. No relationship was found between the refractive or external surface measurements and the internal surface measurements. CONCLUSIONS: The absence of a clear relationship between the shape of the anterior corneal surface or the refractive error, and the shape of the posterior corneal surface, necessitates a thorough pachymetric evaluation of the cornea before a laser in situ keratomileusis procedure, with special attention to the inferotemporal area.

  • 23.
    Lundberg, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Intracameral mydriatics in phacoemulsification cataract surgery.2003In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 29, no 12, p. 2366-2371Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate intracameral injection of mydriatics in phacoemulsification cataract surgery and compare the results with those of conventional topical mydriatics. SETTING: Department of Clinical Science/Ophthalmology, Umeå University Hospital, Umeå, Sweden. METHODS: This prospective randomized double-blind study included 60 patients who were given topical (topical group) or intracameral (intracameral group) mydriatics. The topical mydriatics comprised 3 drops of cyclopentolate 1% and phenylephrine 10% given 15 minutes apart and 150 microL intracameral lidocaine hydrochloride 1% (Xylocaine) and the intracameral mydriatics, placebo eyedrops and 150 microL intracameral cyclopentolate 0.1%, phenylephrine 1.5%, and Xylocaine 1%. The pupil size was recorded preoperatively, throughout surgery, and 1 day and 1 month postoperatively. Preoperative and postoperative corneal endothelial morphology, corneal thickness, intraocular pressure, visual acuity, aqueous cells and flare, phacoemulsification energy, duration of surgery, pulse, blood pressure, and intraoperative sensation of pain and glare were also recorded. RESULTS: With intracameral mydriatics, mydriasis reached 95% +/- 3% (SD) of its final value within 20 seconds. In the intracameral group, the pupils were smaller than in the topical group (mean 6.7 +/- 1.0 mm versus 7.7 +/- 1.0 mm, P<.001) but did not contract intraoperatively. The pupils in the topical group tended to contract, and the difference between groups was significant (P =.0020). The intracameral group reported less glare during the procedure (P<.001). There was no difference in endothelial cell loss, inflammatory reaction, postoperative corneal swelling, or surgical performance between the groups. CONCLUSIONS: Intracameral mydriatics were a rapid, effective, and safe alternative to topical mydriatics in phacoemulsification. Their use can simplify preoperative routines and in certain high-risk groups, may reduce the risk for cardiovascular side effects.

  • 24.
    Lundberg, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Separate and additive mydriatic effects of lidocaine hydrochloride, phenylephrine, and cyclopentolate after intracameral injection.2008In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 34, no 2, p. 280-283Article in journal (Refereed)
  • 25.
    Lundqvist, Britta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Mönestam, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Longitudinal changes in subjective and objective visual function 5 years after cataract surgery: prospective population-based study2006In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 32, no 11, p. 1944-1950Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate the long-term outcomes of cataract surgery by analyzing data collected 5 years after surgery and comparing with preoperative and postoperative subjective and objective visual function results.

    SETTING: Norrlands University Hospital, Umeå, Sweden.

    METHODS: A prospective longitudinal population-based cohort study comprised 810 patients who had cataract surgery during a 1-year period within a geographically defined area. Evaluated were visual acuity data and Visual Function-14 questionnaire (VF-14) results before and after surgery. Five years later, the 590 patients still alive were offered eye examinations and asked to fill out the questionnaire.

    RESULTS: Of the 590 patients asked to participate at 5 years, 530 answered the questionnaire and 467 had eye examinations. The median VF-14 total score for all patients after surgery was 100; at 5 years, the score decreased to 96.7 (P = .001). Five years after surgery, 46% of patients had unchanged or better visual acuity in the operated eye, 37% had lost more than 0.1 logMAR unit, and 22% had a reduction in VF-14 score of 10 points or more. The two main reasons for the decline in visual acuity and VF-14 scores were age-related macular degeneration (ARMD) (47% and 60%, respectively) and glaucoma (12% and 11%, respectively). Age, co-morbidity, and VF-14 scores after surgery were independently associated with the VF-14 score 5 years after surgery.

    CONCLUSIONS: Subjective and objective visual function 5 years after cataract surgery remained stable in most patients. Co-morbidity, most commonly ARMD, was the most frequent cause of deterioration of visual acuity and decrease in VF-14 scores. Age and co-morbidity were independently associated with the VF-14 score 5 years after surgery.

  • 26.
    Lundqvist, Britta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Mönestam, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Longitudinal changes in subjective and objective visual function in diabetics 5 years after cataract surgery: Prospective population-based study.2006In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 32, no 11, p. 1944-1950Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate the long-term outcomes of cataract surgery by analyzing data collected 5 years after surgery and comparing with preoperative and postoperative subjective and objective visual function results. SETTING: Norrlands University Hospital, Umeå, Sweden. METHODS: A prospective longitudinal population-based cohort study comprised 810 patients who had cataract surgery during a 1-year period within a geographically defined area. Evaluated were visual acuity data and Visual Function-14 questionnaire (VF-14) results before and after surgery. Five years later, the 590 patients still alive were offered eye examinations and asked to fill out the questionnaire. RESULTS: Of the 590 patients asked to participate at 5 years, 530 answered the questionnaire and 467 had eye examinations. The median VF-14 total score for all patients after surgery was 100; at 5 years, the score decreased to 96.7 (P = .001). Five years after surgery, 46% of patients had unchanged or better visual acuity in the operated eye, 37% had lost more than 0.1 logMAR unit, and 22% had a reduction in VF-14 score of 10 points or more. The two main reasons for the decline in visual acuity and VF-14 scores were age-related macular degeneration (ARMD) (47% and 60%, respectively) and glaucoma (12% and 11%, respectively). Age, co-morbidity, and VF-14 scores after surgery were independently associated with the VF-14 score 5 years after surgery. CONCLUSIONS: Subjective and objective visual function 5 years after cataract surgery remained stable in most patients. Co-morbidity, most commonly ARMD, was the most frequent cause of deterioration of visual acuity and decrease in VF-14 scores. Age and co-morbidity were independently associated with the VF-14 score 5 years after surgery.

  • 27. Lundstrom, Mats
    et al.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Kugelberg, Maria
    Montan, Per
    Stenevi, Ulf
    Thorburn, William
    Decreasing rate of capsule complications in cataract surgery Eight-year study of incidence, risk factors, and data validity by the Swedish National Cataract Register2011In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 37, no 10, p. 1762-1767Article in journal (Refereed)
    Abstract [en]

    Purpose: To define the incidence of capsule complication and its risk factors in Sweden over an 8-year period.

    Setting: Fifty-two ophthalmic surgery units in Sweden.

    Design: Database study.

    Methods: Data were collected prospectively in the Swedish National Cataract Register (NCR) from 2002 through 2009. The NCR contains 97.3% of the total number of cataract extractions in Sweden over the 8-year study period. One mandatory variable in the register is capsule complications during surgery. As a means to validate the accuracy of register data on capsule complications, a randomly selected sample of 2400 registrations was compared with corresponding medical records.

    Results: The analyses were based on 602 553 cataract extractions reported to the NCR. A capsule complication was reported in 12 574 cataract extractions, corresponding to a frequency of 2.09%. The incidence of this complication consistently decreased each year from 2002 to 2006, after which it stabilized. Poor corrected distance visual acuity in the surgical eye (≤ 0.1), the occurrence ofglaucoma, diabetic retinopathy, and age were among the parameters significantly related to a capsule complication. Some of these parameters also decreased over time. However, even after adjusting for this, there was an obvious decrease in capsule complications over time. The validity test showed a certain underreporting of capsule complications to the registry, but it was not significant and did not change over time.

    Conclusion: The incidence of capsule complications decreased over time. This may be partly the result of fewer risk factors and of better surgical quality.

    Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

  • 28.
    Lundström, M
    et al.
    EyeNet Sweden, Blekinge Hospital, SE-371 85 Karlskrona.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Montan, Per
    Artzén, D
    Jakobsson, G
    Johansson, B
    Thorburn, William
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Stenevi, Ulf
    Inst för klinisk neurovetenskap, Sektionen för oftalmologi, Sahlgrenska universitetssjukhuset/Mölndal.
    Capsule complication during cataract surgery: Background, study design, and required additional care: Swedish Capsule Rupture Study Group report 1.2009In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 35, no 10, p. 1679-1687Article in journal (Refereed)
    Abstract [en]

    Purpose: To report the selection procedure of complicated and uneventful cataract extractions included in the Swedish Capsule RuptureStudy and to describe the additional care required after a capsule complication during cataract surgery.

    Setting: Ten ophthalmic surgery departments in Sweden.

    Methods: Consecutive cataract extractions with a reported capsule complication were selected from the national database. Surgical data and data from the matching ophthalmic records at the participating clinics were analyzed. Controls were selected as the first uneventful procedure in the database after each procedure with a complication.

    Results: Data on 655 cataract extractions were studied for evaluation of risks and additional care; a capsule complication occurred in 324 procedures and no complication in 331 procedures. Using these records, 369 patients were recruited for a follow-up examination of the outcomes 3 years after the original cataract extraction. The records showed a substantial increase in additional care after a capsule complication, including more visits after surgery, increased need for in-patient care, and a significantly greater percentage of reoperations than after the uneventful surgery. With additional care, the average cost of a procedure with a capsule complication was approximately double the cost of an uneventful cataract extraction.

    Conclusions: The combined study of the database and matching medical records showed a substantial increase in additional care after a capsule complication. Using the database allowed identification of a large number of capsule complication cases and uneventful cases, indicating that national databases are excellent sources of data for studying unusual complications.

  • 29.
    Mönestam, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Long-term outcomes of cataract surgery: 15-year results of a prospective study2016In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 42, no 1, p. 19-26Article in journal (Refereed)
    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

  • 30.
    Mönestam, Eva
    et al.
    Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden.
    Behndig, Anders
    Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden.
    Change in light scattering caused by glistenings in hydrophobic acrylic intraocular lenses from 10 to 15 years after surgery2016In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 42, no 6, p. 864-869Article in journal (Refereed)
    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.

  • 31.
    Mönestam, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Lundqvist, Britta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Long-term visual outcome after cataract surgery: Comparison of healthy eyes and eyes with age-related macular degeneration.2012In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 38, no 3, p. 409-414Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare the long-term longitudinal visual acuity outcomes after cataract surgery in eyes with age-related macular degeneration (AMD) at surgery and eyes without comorbidity. SETTING: University-based eye clinic. DESIGN: Longitudinal cohort study. METHODS: Patients having cataract surgery were evaluated over 1 year. A clinical eye examination and corrected distance visual acuity (CDVA) measurement were performed preoperatively and postoperatively as well as 5 and 10 years postoperatively for eligible patients. The patients were divided into functional groups depending on postoperative signs of macular degeneration and postoperative CDVA. RESULTS: The study evaluated 810 patients. The rate of CDVA decline with age was faster in AMD patients than in patients without comorbidity. The slope of the visual acuity decline was similar in the 2 subgroups with AMD (almost normal CDVA and reduced CDVA postoperatively). After adjustment for age, there was a mean loss of 2.3 logMAR letters in patients with no comorbidity and 6.4 letters in patients with AMD at surgery for each decade of increasing age. More than 75% of AMD patients had better CDVA 10 years after surgery than before surgery. CONCLUSIONS: Patients with signs of AMD at cataract surgery had a longitudinally worse visual outcome than patients without clinical signs of AMD. However, there is no reason to discourage patients with concurrent visually significant cataract and AMD from having surgery because most AMD patients had better CDVA 10 years after surgery than before surgery. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

  • 32. Nuijts, Rudy M. M. A.
    et al.
    Mencucci, Rita
    Viaud-Quentric, Karen
    Elena, Pierre-Paul
    Olmiere, Celine
    Behndig, Anders
    Umeå university hospital.
    Ocular tolerance in rabbits after intracameral administration of a fixed combination of tropicamide, phenylephrine, and lidovaine with and without rinsing2017In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 43, no 5, p. 673-679Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate the safety and tolerability of a single intracameral administration of a combined mydriatic (tropicamide and phenylephrine) and anesthetic (lidocaine) formulation (Mydrane) with or without rinsing. Setting: Iris Pharma, La Gaude, France. Design: Experimental study. Methods: Sixty pigmented rabbits received 100 mu L or 200 mu L of the combination product or a placebo (sodium chloride 0.9%) by intracameral injection. For the combination product, separate groups were included with and without rinsing after administration. From day 1 day to day 7, assessments included general clinical and ocular observations, pupil diameter measurements, corneal assessments, confocal microscopy, and electroretinography (ERG). Necropsy examinations were performed at study completion at day 8. Results: Rapid mydriasis, stable 24 minutes after injection and returning to baseline levels by day 1, was induced in all groups that received the combination mydriatic and anesthetic drug. Rinsing had no effect. The combination product induced no adverse effects on the anterior or posterior segment of the eye (ie, no increased corneal thickness and endothelial cell loss, no abnormalities in ERG). Slitlamp examination showed slightly increased anterior chamber inflammation with rinsing in both the study group and placebo group. This observation was not confirmed by aqueous flare examination. No toxic effects of the products were found on histological evaluation. Conclusion: The combination mydriatic and anesthetic drug administered to pigmented rabbits as a single intracameral injection at volumes of 100 mu L and 200 mu L was well tolerated with no ocular adverse effects and no effect on the corneal endothelium.

  • 33.
    Westborg, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Mönestam, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Optimizing number of postoperative visits after cataract surgery: Safety perspective2017In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 43, no 9, p. 1184-1189Article in journal (Refereed)
    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.

  • 34. Zetterström, Charlotta
    et al.
    Behndig, Anders
    Kugelberg, Maria
    Montan, Per
    Lundström, Mats
    Changes in intraocular pressure after cataract surgery: analysis of the Swedish National Cataract Register Data2015In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 41, no 8, p. 1725-1729Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To analyze changes in intraocular pressure (IOP) after cataract surgery based on data from the Swedish National Cataract Register (NCR).

    SETTING: Ophthalmic surgery units in Sweden.

    DESIGN: Prospective database study.

    METHODS: Data for 2012 through 2014 were obtained prospectively from the NCR. The outcome register of the NCR has collected data on IOP before and a mean of 37.7 days ± 29.1 (SD) after cataract surgery since 2012.

    RESULTS: The analyses were based on 20 437 cataract extractions reported during 1 month each year to the outcome registry of the NCR. Cataract surgery was found to reduce IOP by a mean of 1.46 mm Hg, which was statistically significant (P < .001). A larger IOP reduction was seen in cases with a higher preoperative IOP (r = 0.557, P < .001). Older patients and shorter eyes had a greater IOP reduction after surgery (P < .001 and P = .001, respectively). Women had a greater IOP reduction than men (P = .04) When high IOP was given as an indication for surgery, the IOP reduction after cataract surgery was 5.50 mm Hg compared with a reduction of 1.40 mm Hg in patients for whom this indication was not given (P < .001). Patients with glaucoma or pseudoexfoliation (PXF) had a more pronounced IOP reduction than patients without these diagnoses (P < .001).

    CONCLUSION: Cataract surgery had an IOP-lowering effect, in particular in older patients, women, short eyes, eyes with high preoperative IOP, and eyes with glaucoma or PXF.

    FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

  • 35. Öhrstrom, Arne
    et al.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Silicone oil bubbles in ophthalmic viscosurgical devices.2002In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 28, no 3, p. 389-Article in journal (Refereed)
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