To investigate the association between elevated intraocular pressure (IOP) and accelerated cataract formation in patients treated with intravitreal triamcinol one. Analysis of longitudinal data from a randomized, doub...To investigate the association between elevated intraocular pressure (IOP) and accelerated cataract formation in patients treated with intravitreal triamcinol one. Analysis of longitudinal data from a randomized, double-masked, placebo-c ontrolled trial of intravitreal triamcinolone for age-related macular degenerat ion (the Intravitreal Triamcinolone Study). Patients with phakic eyes who partic ipated in a randomized clinical trial of intravitreal triamcinolone for age-rel ated macular degeneration were studied. There were 57 phakic eyes in the treatme nt group and 54 phakic eyes in the control group. One eye per patient was studie d. Four milligrams of intravitreal triamcinolone or 1 ml subconjunctival saline. Intraocular pressure rise of at least 5 mmHg (IOP responders) and progression o f posterior subcapsular cataract by 2 or more grades using photographic standard s from the Age Related Eye Disease Study. Progression of posterior subcapsular c ataract (PSC) by 2 or more grades in the treatment group was significantly highe r among 16 IOP responders (51%after 2 years) than among 37 nonresponders (3%; P < 0.0001, log-rank test). There was no significant progression of PSC in the placebo group or the opposite eye of the treatment group. Progression of cortica l cataracts also was significantly higher among responders than nonresponders (1 5%vs. 3%; P=0.015, log-rank test). The progression of nuclear cataracts (13% vs. 3%) was not significantly different between IOP responders and nonresponders (P=0.3, log-rank test). Although steroid-relate d cataracts are unlikely to develop in eyes that do not experience elevated IOP after intravitreal triamcinolone, those eyes that do also have a very high risk of rapidly experiencing posterior subcapsular lens opacification. This strong as sociation suggests that the mechanism responsible for the development of steroid -induced PSC cataract and raised IOP may be similar.展开更多
PURPOSE: To evaluate complications and results of intravitreal triamcinolone acetonide for treatment of macular edema. DESIGN: Interventional, consecutive, retrospective case series. METHODS: Ninety-three eyes with ma...PURPOSE: To evaluate complications and results of intravitreal triamcinolone acetonide for treatment of macular edema. DESIGN: Interventional, consecutive, retrospective case series. METHODS: Ninety-three eyes with macular edema arising from retinovascular etiologies were treated with 4 mg intravitreal triamcinolone. Eyes were monitored after injection for visual acuity changes and complications, including cataract formation and increase in intraocular pressure (IOP). Cataract progression was analyzed by linear regression analysis of lens scores from lens opacity standards. RESULTS: The mean visual acuity improved from 20/125 to- 1 to 20/100+ 2 by one to two months after injection (P < .001) and was 20/100 at the final examination (P=.006) at a mean of 1.2 years after injection. Complications included a severe, culture-negative inflammatory reaction in one eye (1.1% ). IOP increased to 30 mm Hg or more in nine (9.7% ) of 93 eyes between 1 and 140 days after injection and wasmore frequent in eyes receiving one or more preinjection glaucoma drops (two of 13 eyes, 15.4% , vs seven of 80 eyes, 8.75% , without preinjection glaucoma drops). Nuclear sclerosis increased at a rate of 0.175 U per year, posterior subcapsular cataracts at 0.423 U per year, and cortical cataracts at 0.045U per year. Posterior subcapsular cataract increased by ≥ 1 U or required cataract surgery in 45.2% of eyes followed at least one year. CONCLUSIONS: Intravitreal triamcinolone improves visual acuity in most eyes but eyes must be monitored carefully for increase in IOP. Posterior subcapsular cataract formation becomes visually significant in almost half of eyes by one year after injection.展开更多
Purpose: To explore the relationship between creatinine clearance, an estimate of glomerular filtration rate, and5- year incidence of cataract and cataract surgery. Design: Population- based cohort study. Participants...Purpose: To explore the relationship between creatinine clearance, an estimate of glomerular filtration rate, and5- year incidence of cataract and cataract surgery. Design: Population- based cohort study. Participants: Of the 3654 participants (aged 49 years or older) of the Blue Mountains Eye Study (BMES I) baseline examination (during 1992 to 1994), 2334 (75% )were reexamined after5 years from 1997 to 1999 (BMES II). Method: Risk factor data were collected for all participants at baseline (BMES I). Assessment of renal function was based on estimated creatinine clearance (CCr) calculated with the Cockcroft- Gault formula, adjusted for body surface area, and expressed in ml/minute/1.73 m2. Cataract incidence was determined from graded photographs. The association between renal function and incidence of cataract and cataract surgery was analyzed by logistic regression. Main OutcomeMeasures: Incidence of nuclear, cortical, and posterior subcapsular cataract, and cataract surgery. Results: Mean CCr± standard deviation was 60± 13 ml/minute/1.73 m2. The overall5- year incidence of nuclear, cortical, and posterior subcapsular cataract was 35.7% (417 of 1167 participants at risk), 16.7% (274 of 1641), and4.3% (77 of 1790), respectively. Cataract surgery was performed in 6.8% (144 of 2123) of participants. There were no significant associations of renal function with incident nuclear (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.99- 1.02), cortical (OR, 1.0; CI, 0.98- 1.01), and posterior subcapsular cataract (OR, 1.0; CI, 0.99- 1.04) after adjusting for multiple risk factors. After adjusting for age, gender, and dark brown iris color, moderate or worse renal impairment (CCr <60 ml/minute/1.73 m2) compared with normal or mildly impaired function (CCr ≥ 60 ml/minute/1.73 m2) was significantly associated with incident cataract surgery (P< 0.05), but the effect depended on age. Participants younger than 60 years of age with moderate to severe renal impairment had increased odds of incident cataract surgery (OR,展开更多
To quantify the risk for age-related cortical cataract and posterior subcapsu lar cataract (PSC) associated with having an affected sibling after adjusting fo r known environmental and personal risk factors. Sibling c...To quantify the risk for age-related cortical cataract and posterior subcapsu lar cataract (PSC) associated with having an affected sibling after adjusting fo r known environmental and personal risk factors. Sibling cohort study. Participa nts in the ongoing Salisbury Eye Evaluation (SEE) study (m=321; mean age, 78.1± 4.2 years) and their locally resident siblings (m=453; mean age, 72.6±7.4 years ) were recruited at the time of Rounds 3 and 4 of the SEE study. Retroilluminati on photographs of the lens were graded for the presence of cortical cataract and PSC with the Wilmer grading system. The residual correlation between siblings’ cataract grades was estimated after adjustment for a number of factors (age; gen der; race; lifetime exposure to ultraviolet-B light; cigarette, alcohol, estrog en, and steroid use; serum antioxidants; history of diabetes; blood pressure; an d body mass index) suspected to be associated with the presence of cataract. The average sibship size was 2.7 per family. Multivariate analysis revealed the mag nitude of heritability (h2) for cortical cataract to be 24%(95%CI, 6%-42%), whereas that for PSC was not statistically significant (h2 4%; 95%CI, 0%-11 %) after adjustment for the covariates. The model revealed that increasing age, female gender, a history of diabetes, and black race increased the odds of cort ical cataract, whereas higher levels of provitamin A were protective. A history of diabetes and steroid use increased the odds for PSC. This study is consistent with a significant genetic effect for age-related cortical cataract but not PS C.展开更多
文摘To investigate the association between elevated intraocular pressure (IOP) and accelerated cataract formation in patients treated with intravitreal triamcinol one. Analysis of longitudinal data from a randomized, double-masked, placebo-c ontrolled trial of intravitreal triamcinolone for age-related macular degenerat ion (the Intravitreal Triamcinolone Study). Patients with phakic eyes who partic ipated in a randomized clinical trial of intravitreal triamcinolone for age-rel ated macular degeneration were studied. There were 57 phakic eyes in the treatme nt group and 54 phakic eyes in the control group. One eye per patient was studie d. Four milligrams of intravitreal triamcinolone or 1 ml subconjunctival saline. Intraocular pressure rise of at least 5 mmHg (IOP responders) and progression o f posterior subcapsular cataract by 2 or more grades using photographic standard s from the Age Related Eye Disease Study. Progression of posterior subcapsular c ataract (PSC) by 2 or more grades in the treatment group was significantly highe r among 16 IOP responders (51%after 2 years) than among 37 nonresponders (3%; P < 0.0001, log-rank test). There was no significant progression of PSC in the placebo group or the opposite eye of the treatment group. Progression of cortica l cataracts also was significantly higher among responders than nonresponders (1 5%vs. 3%; P=0.015, log-rank test). The progression of nuclear cataracts (13% vs. 3%) was not significantly different between IOP responders and nonresponders (P=0.3, log-rank test). Although steroid-relate d cataracts are unlikely to develop in eyes that do not experience elevated IOP after intravitreal triamcinolone, those eyes that do also have a very high risk of rapidly experiencing posterior subcapsular lens opacification. This strong as sociation suggests that the mechanism responsible for the development of steroid -induced PSC cataract and raised IOP may be similar.
文摘PURPOSE: To evaluate complications and results of intravitreal triamcinolone acetonide for treatment of macular edema. DESIGN: Interventional, consecutive, retrospective case series. METHODS: Ninety-three eyes with macular edema arising from retinovascular etiologies were treated with 4 mg intravitreal triamcinolone. Eyes were monitored after injection for visual acuity changes and complications, including cataract formation and increase in intraocular pressure (IOP). Cataract progression was analyzed by linear regression analysis of lens scores from lens opacity standards. RESULTS: The mean visual acuity improved from 20/125 to- 1 to 20/100+ 2 by one to two months after injection (P < .001) and was 20/100 at the final examination (P=.006) at a mean of 1.2 years after injection. Complications included a severe, culture-negative inflammatory reaction in one eye (1.1% ). IOP increased to 30 mm Hg or more in nine (9.7% ) of 93 eyes between 1 and 140 days after injection and wasmore frequent in eyes receiving one or more preinjection glaucoma drops (two of 13 eyes, 15.4% , vs seven of 80 eyes, 8.75% , without preinjection glaucoma drops). Nuclear sclerosis increased at a rate of 0.175 U per year, posterior subcapsular cataracts at 0.423 U per year, and cortical cataracts at 0.045U per year. Posterior subcapsular cataract increased by ≥ 1 U or required cataract surgery in 45.2% of eyes followed at least one year. CONCLUSIONS: Intravitreal triamcinolone improves visual acuity in most eyes but eyes must be monitored carefully for increase in IOP. Posterior subcapsular cataract formation becomes visually significant in almost half of eyes by one year after injection.
文摘Purpose: To explore the relationship between creatinine clearance, an estimate of glomerular filtration rate, and5- year incidence of cataract and cataract surgery. Design: Population- based cohort study. Participants: Of the 3654 participants (aged 49 years or older) of the Blue Mountains Eye Study (BMES I) baseline examination (during 1992 to 1994), 2334 (75% )were reexamined after5 years from 1997 to 1999 (BMES II). Method: Risk factor data were collected for all participants at baseline (BMES I). Assessment of renal function was based on estimated creatinine clearance (CCr) calculated with the Cockcroft- Gault formula, adjusted for body surface area, and expressed in ml/minute/1.73 m2. Cataract incidence was determined from graded photographs. The association between renal function and incidence of cataract and cataract surgery was analyzed by logistic regression. Main OutcomeMeasures: Incidence of nuclear, cortical, and posterior subcapsular cataract, and cataract surgery. Results: Mean CCr± standard deviation was 60± 13 ml/minute/1.73 m2. The overall5- year incidence of nuclear, cortical, and posterior subcapsular cataract was 35.7% (417 of 1167 participants at risk), 16.7% (274 of 1641), and4.3% (77 of 1790), respectively. Cataract surgery was performed in 6.8% (144 of 2123) of participants. There were no significant associations of renal function with incident nuclear (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.99- 1.02), cortical (OR, 1.0; CI, 0.98- 1.01), and posterior subcapsular cataract (OR, 1.0; CI, 0.99- 1.04) after adjusting for multiple risk factors. After adjusting for age, gender, and dark brown iris color, moderate or worse renal impairment (CCr <60 ml/minute/1.73 m2) compared with normal or mildly impaired function (CCr ≥ 60 ml/minute/1.73 m2) was significantly associated with incident cataract surgery (P< 0.05), but the effect depended on age. Participants younger than 60 years of age with moderate to severe renal impairment had increased odds of incident cataract surgery (OR,
文摘To quantify the risk for age-related cortical cataract and posterior subcapsu lar cataract (PSC) associated with having an affected sibling after adjusting fo r known environmental and personal risk factors. Sibling cohort study. Participa nts in the ongoing Salisbury Eye Evaluation (SEE) study (m=321; mean age, 78.1± 4.2 years) and their locally resident siblings (m=453; mean age, 72.6±7.4 years ) were recruited at the time of Rounds 3 and 4 of the SEE study. Retroilluminati on photographs of the lens were graded for the presence of cortical cataract and PSC with the Wilmer grading system. The residual correlation between siblings’ cataract grades was estimated after adjustment for a number of factors (age; gen der; race; lifetime exposure to ultraviolet-B light; cigarette, alcohol, estrog en, and steroid use; serum antioxidants; history of diabetes; blood pressure; an d body mass index) suspected to be associated with the presence of cataract. The average sibship size was 2.7 per family. Multivariate analysis revealed the mag nitude of heritability (h2) for cortical cataract to be 24%(95%CI, 6%-42%), whereas that for PSC was not statistically significant (h2 4%; 95%CI, 0%-11 %) after adjustment for the covariates. The model revealed that increasing age, female gender, a history of diabetes, and black race increased the odds of cort ical cataract, whereas higher levels of provitamin A were protective. A history of diabetes and steroid use increased the odds for PSC. This study is consistent with a significant genetic effect for age-related cortical cataract but not PS C.
