The probable associations for corticocapsular adhesions in patients undergoing cataract surgery: A clinic-based
observational study

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Abstract

Background:

Corticocapsular adhesions (CCA) are frequently seen between lens capsule and adjacent cortical layer. During cataract surgery, in the presence of CCA, excessive efforts to rotate the nucleus can result in zonular damage. To reduce morbidity, identification of associations with CCA can be helpful in appropriately modifying the surgical procedure.

Aim:

To investigate probable associations with CCA in patients undergoing cataract surgery.

Setting and Design:

Iladevi Cataract and IOL research center. Case-control study.

Materials and Methods:

A single eye of 600 patients, 200 patients with CCA (cases) and 400 patients without CCA (controls) were considered. A CCA diagnosis was based on: (i) preoperative presence of CCA on slit- lamp examination with visualization of furry surface of cortex during surgery; (ii) preoperative absence of CCA on slit-lamp examination but intraoperative visualization of furry surface of cortex. Variables such as age, gender, type of cataract, grade of cataract, high myopia, diabetes mellitus and hypertension were studied.

Statistical Analysis:

Multivariate logistic regression was done. Results were presented as odds ratio (OR) with 95% CI.

Results:

Mean age was 64.71 ± 9.10 years in cases and 59.27 ± 8.79 years in controls. Presence of CCA increased with age from 22% (n = 59) in 45 to 49 years to 70% (n = 110) in 70 to 79 years. An increase in age was associated with CCA by 3.3% (OR = 3.3%, P = 0.028). The odds of CCA for females were 83% higher ( P = 0.027). Presence of anterior cortical cataract increased odds of CCA by 9.5 times ( P = 0.001), while posterior cortical cataract increased odds by 3.3 times ( P = 0.001).

Conclusion:

Corticocapsular adhesions were strongly associated with cortical cataracts, increased age and female gender.

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Most cited references 15

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The Lens Opacities Case-Control Study. Risk factors for cataract.

Leo T. Chylack, Ying Wu, M. Leske (1991)

The Lens Opacities Case-Control Study evaluated risk factors for age-related nuclear, cortical, posterior subcapsular, and mixed cataracts. The 1380 participants were ophthalmology outpatients, aged 40 to 79 years, classified into the following groups: posterior subcapsular only, 72 patients; nuclear only, 137 patients; cortical only, 290 patients; mixed cataract, 446 patients; and controls, 435 patients. In polychotomous logistic regression analyses, low education increased risk (odds ratio [OR] = 1.46) and regular use of multivitamin supplements decreased risk (OR = 0.63) for all cataract types. Dietary intake of riboflavin, vitamins C, E, and carotene, which have antioxidant potential, was protective for cortical, nuclear, and mixed cataract; intake of niacin, thiamine, and iron also decreased risk. Similar results were found in analyses that combined the antioxidant vitamins (OR = 0.40) or considered the individual nutrients (OR = 0.48 to 0.56). Diabetes increased risk of posterior subcapsular, cortical, and mixed cataracts (OR = 1.56). Oral steroid therapy increased posterior subcapsular cataract risk (OR = 5.83). Females (OR = 1.51) and nonwhites (OR = 2.03) were at increased risk only for cortical cataract. Risk factors for nuclear cataract were a nonprofessional occupation (OR = 1.96), current smoking (OR = 1.68), body mass index (OR = 0.76), and occupational exposure to sunlight (OR = 0.61). Gout medications (OR = 2.48), family history (OR = 1.52), and use of eyeglasses by age 20 years, which is an indicator of myopia (OR = 1.44), increased risk of mixed cataract. The results support a role for the nutritional, medical, personal, and other factors in cataractogenesis. The potentially modifiable factors suggested by this study merit further evaluation.

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Refractive associations with cataract: the Blue Mountains Eye Study.

Aaron P. Mitchell, Jennifer Lim, Jonathan R. Cumming (1999)

To assess the relationship between myopia and age-related cataract in a defined older population. A cross-sectional study of 3654 people aged 49 to 97 years was conducted in the Blue Mountains near Sydney, Australia, from 1992 through 1994. General medical, eye, and refractive history and information about confounders were collected by questionnaire. Participants had a detailed determination of refraction, and the spherical equivalent refraction of each eye was calculated. The Wisconsin Cataract Grading System was used in masked grading of slit lamp and retroillumination lens photographs, to assess presence and severity of nuclear, cortical, and posterior subcapsular (PSC) cataract. Data from both eyes were analyzed by the generalized estimating equation method, adjusting for cataract risk factors. Included in the analysis were 7308 eyes. A history of wearing distance glasses, excluding eyes with current hyperopic refraction, was used as a proxy for myopia. Subjects who had worn distance glasses were more likely to have nuclear cataract (odds ratio [OR] 1.3; confidence interval [CI] 1.0-2.1). After stratification by age at first wearing distance glasses, this relationship remained only for people who first wore distance glasses after age 40 years (OR 1.3; CI 1.0-1.8), which suggested a myopic refractive shift from developing nuclear opacity and was supported by the weak association found between current myopic refraction and nuclear cataract (OR 1.3; CI 1.0-1.6). Eyes with onset of myopia before age 20 years had the greatest PSC cataract risk (OR 3.9; CI 2.0-7.9). This was supported by the finding of an association between current myopic refraction and PSC cataract (OR 2.5; CI 1.6-4.1). PSC cataract was inversely associated with hyperopia (OR 0.6; CI 0.4-0.9). Refraction-related increasing odds were found between PSC cataract and myopia: low myopia (OR 2.1; CI 1.4-3.5), moderate myopia (OR 3.1; CI 1.6-5.7), and high myopia (OR 5.5; CI 2.8-10.9). High myopia was associated with PSC, cortical, and late nuclear cataract. Early-onset myopia (before age 20 years) may be a strong and independent risk factor for PSC cataract. The findings suggest the possibility of a dose response between levels of myopia and PSC cataract. Nuclear cataract was associated with presumed acquired myopia, whereas high myopia was associated with all three types of cataract.

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Ultraviolet light exposure and lens opacities: the Beaver Dam Eye Study.

Marina Klein, John Klein, Karen Cruickshanks (1992)

Exposure to sunlight may be a risk factor for the development of cataract. The relationships between exposure to sunlight and to the ultraviolet-B (UVB) component of light and the prevalence of lens opacities were examined in the Beaver Dam Eye Study. Persons 43 to 84 years of age residing in Beaver Dam, Wisconsin, were examined using standardized photographic assessments of lens opacities. A questionnaire about medical history and exposure to light was administered. After adjusting for other risk factors, men who had higher levels of average annual ambient UVB light were 1.36 times more likely to have more severe cortical opacities than men with lower levels. However, UVB exposure was not found to be associated with nuclear sclerosis or posterior subcapsular opacities in men. Moreover, no associations with UVB exposure were found for women, who were less likely to be exposed to UVB. Exposure to UVB light may be associated with the severity of cortical opacities in men. However, the lack of an association in women, the group more likely to have cortical opacities, suggests that other factors may be more important in the pathogenesis of lens opacities.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Ophthalmol

Journal ID (publisher-id): Indian Journal of Ophthalmology

Title: Indian Journal of Ophthalmology

Publisher: Medknow Publications (India )

ISSN (Print): 0301-4738

ISSN (Electronic): 1998-3689

Publication date (Print): Mar-Apr 2008

Volume: 56

Issue: 2

Pages: 103-108

Affiliations

Iladevi Cataract and IOL Research Center, Raghudeep Eye Clinic, Gurukul Road, Memnagar, Ahmedabad - 380 052, Gujarat, India

Author notes

Correspondence to Dr. Abhay R. Vasavada, Iladevi Cataract and IOL Research Centre, Raghudeep Eye Clinic, Gurukul Road, Memnagar, Ahmedabad - 380 052, Gujarat, India Email: icirc@ 123456abhayvasavada.com

Article

Publisher ID: IndianJOphthalmol_2008_56_2_103_39113

DOI: 10.4103/0301-4738.39113

PMC ID: 2636097

PubMed ID: 18292619

SO-VID: a7b2b45a-da18-4be2-8f75-065a418e3df2

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The probable associations for corticocapsular adhesions in patients undergoing cataract surgery: A clinic-based observational study

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Abstract

Background:

Aim:

Setting and Design:

Materials and Methods:

Statistical Analysis:

Results:

Conclusion:

Related collections

Karger: Ophthalmology

Most cited references 15

The Lens Opacities Case-Control Study. Risk factors for cataract.

Refractive associations with cataract: the Blue Mountains Eye Study.

Ultraviolet light exposure and lens opacities: the Beaver Dam Eye Study.

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