No abstract

The risk factors for intraoperative and early postoperative complications were evaluated in 351 consecutive cataract operations at the Oulu University Hospital in 1990. Bleeding into the anterior chamber during the operation was recorded in 8.6%, zonular rupture in 6.6%, posterior capsular rupture in 5.4% and vitreous loss in 3.2%, On account of the loss of capsular support an anterior chamber intraocular lens was implanted in 3.1%. Of the early postoperative complications, signs of fibrinous reaction were observed in 24.5%, corneal edema in 53.6% and rise of intraocular pressure to 30 mmHg or more in 27.6%. There was no difference in the complication rate between men and women or in relation to age. The use of anticoagulant (although discontinued before surgery) or antiplatelet medication increased the risk of intraoperative bleeding but no sight-threatening bleeding occurred. The use of acetylsalicylic acid was also associated with an increased risk of postoperative fibrinous reaction. Other systemic diseases like systemic hypertension, diabetes, asthma, or cardiac or mental disorders, or medications, did not increase the complication rate. Of the various ocular parameters, small pupil and exfoliation syndrome were the most important risk factors for both intra- and early postoperative complications, and the presence of glaucoma increased the risk of vitreous loss, postoperative pressure rise and corneal edema. General anesthesia did not seem to reduce the complications rate.

Postoperative visual outcome and factors related to poor visual acuity three months after cataract surgery were evaluated in 243 cataract patients operated on at the Oulu University Hospital in 1990. The surgical technique used was a planned extracapsular cataract extraction with implantation of an intraocular lens (IOL) in 240 cases: a posterior chamber IOL in 231 cases and an anterior chamber IOL in 9 cases. The postoperative visual acuity was 0.5 or better in 74.5% of the eyes, 11.9% (29 eyes) had low vision and 2.4% (6 eyes) were blind. The visual outcome was significantly related to age. The most common causes for low vision or blindness were age related macular degeneration and glaucoma. There was one case of postoperative endophthalmitis but other surgical complications did not result in visual loss. Visually significant posterior capsular opacification was observed in 2.5%, and significant postoperative astigmatism (> or = 3.5 D) was present in 11.1%.

Sociodemographic analysis of 351 consecutive cataract patients operated on at the Oulu University Hospital in 1990 revealed that 30.0% of the patients lived alone at home, 62.0% lived with some other person and 7.9% were in institutions. The mean age was 70.6 +/- 12.4 years, the sex distribution (62.7% women, 37.3% men) corresponded with that in the general population of the same age. 78.8% of the patients had had surgery on the first eye, 29.0% of them had low vision or blindness (visual acuity less than 0.3 in the better eye). In the second eye surgery group (21.2% of the patients) low vision or blindness was found in 13.0%. Low vision was more common in institutionalized patients and in those with restricted mobility. In 80.9% of the operated eyes and in 41.5% of the fellow eyes the visual acuity was less than 0.3. 76.6% of the patients had medication for cardiovascular diseases, diabetes, asthma or mental disorders. Based on this survey the demand for cataract surgery is expected to increase in coming years. The majority would be suitable for day case surgery, but for patients living alone, having restricted mobility, poor general health, poor vision in the fellow eye or long distance to the hospital, hospitalization still seems to be a better alternative.

The purpose of this study was to measure the change of neuroretinal rim area in patients with low tension glaucoma on- and off-treatment. Thirty-two patients were followed up for a mean of 2.6 years. Ten patients received treatment with nifedipine, 11 patients with acetazolamide and 11 patients had no treatment. The total change of rim area and the yearly rate of rim area change did not differ statistically significantly between the three groups. Seven patients in each group suffered from cold hands and feet. The response to cold provocation visual field testing was positive in 25% of patients. Neither the history of cold hands and feet nor the cold provocation test result affected the rate of progression of optic disc abnormalities. Nifedipine and acetazolamide treatment seemed to show no advantage over no-treatment in our patients.