This study investigated the effect of a natural tomato extract (TE) on cataract formation in two animal models. A TE containing 5% lycopene was included in the diet of diabetic sand rats at 0.2%, and Sprague Dawley rats were fed a high-galactose diet (30 g/100 g of diet), supplemented with either the lycopene-rich extract at concentrations of 0.2, 0.4, and 0.8% or BHT (0.2%). TE had no significant effect on plasma glucose levels or cataract development in sand rats; however, in rats maintained on a diet rich in galactose, both BHT and TE decreased cataract incidence, and grades were lower than in control animals. In addition, lens protein and reduced glutathione levels were higher and aldose reductase activity was lower than in the control group. The results suggest that antioxidants act as protective agents when oxidative stress is a primary cause of cataract formation but may be less effective in preventing cataracts in hyperglycemic animals.

PURPOSE: To report that uveitis may be a manifestation of poststreptococcal syndrome.METHODS: Case report. Documented attacks of bilateral uveitis were clearly associated with streptococcal infection,RESULTS: Group A streptococcal infection was evident in all bilateral uveitis attacks, which were treated With local or systemic corticosteroids and penicillin. The frequency and severity of the attacks were reduced by penicillin prophylaxis and tonsillectomy.CONCLUSIONS: Uveitis should be included as a possible manifestation of poststreptococcal syndrome. If coexisting streptococcal infection is demonstrated, penicillin prophylaxis should be considered. (Am J Ophthalmol 1998;126: 317-318. (C) 1998 by Elsevier Science Inc. All rights reserved.).

BACKGROUND AND OBJECTIVEProgression of age-related macular degeneration (AMD) following cataract surgery has been described. The aim of this study was to investigate whether an uneventful postoperative maculopathic course in one eye (the first eye) may predict a similar prognosis for the fellow eye (the second eye).PATIENTS AND METHODSThirty-three patients with bilateral, similar, early AMD (defined by the presence of drusen and/or pigmentary abnormalities on fundal examinations and by the absence of late leakage as documented by fluorescein angiography) who had undergone unilateral cataract surgery, had had a stable postoperative maculopathic course following the first operation, and were scheduled for cataract surgery in the second eye were prospectively observed for at least 1 year after the second operation. The course of maculopathy of the second eye was compared with that of the first eye during the follow-up period of the second eye.RESULTSA total of 9 of the second eyes (27.2%) showed progression to wet AMD. Of these, 1 patient (3%) had progression in both eyes and 8 patients (24.2%) had progression in the second eye only. The conditions of 2 of the first operated on eyes (6.1%) deteriorated (P < .05). Hypertension (P < .05), soft drusen (P < .01), and Nd:YAG laser capsulotomy (P < .05) were risk factors for development of wet AMD.CONCLUSIONIn this study, 24.2% of the patients with early AMD who underwent bilateral cataract surgery and had an uneventful maculopathic course in the first eye had wet AMD in the second eye. Thus, patients with early AMD and soft drusen undergoing bilateral cataract surgery should be monitored for early detection of progression of maculopathy. Further prospective studies are needed to determine the course of maculopathy following cataract surgery.

Progression of nonischemic central retinal vein occlusion (CRVO) to ischemic CRVO occurs in up to 5-20% of patients with nonischemic CRVO. Eyes presenting with nonischemic CRVO and exhibiting an increase in intraretinal hemorrhages together with angiographic findings of aggravation of venule wall staining were assumed to be showing early signs of progression. Eight eyes of 7 patients were followed prospectively and when they exhibited signs of progression they were assigned to either follow-up or early laser treatment. Four eyes received grid and early panretinal laser photocoagulation. Three of them showed regression of retinopathy and 1 eye progressed to ischemic CRVO. The other 4 eyes did not receive early panretinal photocoagulation; 2 of them received no laser treatment at all and the other 2 received only grid laser photocoagulation. All of these 4 eyes progressed to ischemic CRVO.

PURPOSE:To report a patient with paroxysmal nocturnal hemoglobinuria who complained of transient obscurations of vision and exhibited bilateral papilledema with retinal hemorrhages.METHODS:Case report. Computed tomography did not demonstrate any abnormality but magnetic resonance imaging disclosed signs of cerebral venous sinus thrombosis.RESULTS:The patient was treated with subcutaneous low molecular weight heparin and intravenous corticosteroids. Symptoms improved within one week and ophthalmoscopic signs resolved within four months.CONCLUSION:Bilateral papilledema with extensive retinal hemorrhages may be a sign of cerebral venous sinus thrombosis, a reported devastating complication of paroxysmal nocturnal hemoglobinuria. Thus, any patient with suspected cerebral venous sinus thrombosis should undergo magnetic resonance imaging, even when results of computed tomography are normal.

Two patients with glaucoma, who underwent uneventful trabeculectomy and extracapsular cataract extraction with posterior chamber intraocular lens implantation, experienced late and recurrent choroidal detachment. Both patients received aqueous suppressant therapy before and after surgery. Hypotony and choroidal detachment occurred 7 months and 15 months after the combined surgery. There was no shallowing of the anterior chamber or leakage from the filtering blebs, and there were no signs of inflammation. The choroidal detachment completely resolved in the two patients 4 days and 4 weeks following discontinuation of the aqueous suppressant therapy.

Purpose: To evaluate the course of age-related maculopathy after cataract surgery.Methods: Included were 47 patients with bilateral, symmetric, early age-related macular degeneration (AMD), documented by fluorescein angiography, who underwent extracapsular cataract extraction with intraocular lens implantation in one eye. The fellow eye served as the control. The patients were retrospectively reviewed or prospectively followed.Results: Wet AMD developed in nine eyes (19.1%) that were treated with surgery compared with two fellow eyes (4.3%), It was detected within 3 months of surgery in four (44.4%) of the nine affected eyes and within 6 to 12 months of surgery in four other eyes (44.4%). Progression to wet AMD occurred significantly more often in men than in women (P < 0.05). Soft drusen were found as a significant ocular risk factor (P < 0.05). The final visual outcome was poor in all eyes with such progression.Conclusions: In this study, progression of AMD occurred more often in the surgical eyes compared with the fellow eyes. However, the reasons for the progression of AMD after cataract surgery are still uncertain. Further prospective studies are needed to investigate this observation.

BACKGROUND AND OBJECTIVE:To evaluate the postoperative recovery of the anterior segment and the course of diabetic retinopathy following a combined procedure of an extracapsular cataract extraction with posterior chamber intraocular lens implantation and trabeculectomy in diabetic patients with glaucoma.PATIENTS AND METHODS:The records of diabetic patients with uncontrolled glaucoma and cataract, who underwent a combined procedure in one eye, were retrospectively reviewed.RESULTS:Eleven patients were included. The mean intraocular pressure and the amount of antiglaucomatous medications required to control it were both reduced postoperatively. Anterior segment complications included hyphema in 4 eyes (37%), fibrin formation in 4 eyes (37%), and posterior synechia in 3 eyes (27%). The hyphema resolved spontaneously and the fibrin disappeared following increased administration of steroids. Development of diabetic retinopathy occurred in 1 eye (9%). Cystoid macular edema without other evidence of diabetic retinopathy was observed in 1 eye (9%).CONCLUSION:The control of intraocular pressure is improved in diabetic patients who have undergone this combined procedure. The postoperative course in these diabetic patients is similar to that previously described in the general population.

This study investigated the effect of antioxidants on cataract formation in galactosemic rats. Two antioxicants were compared: lycopene, a carotenoid derived from tomato, and butylated hydroxytoluene (BHT), a known antioxidant substance. The control group was fed with galactose 30%. The experimental groups received, in addition to galactose 30%, either lycopene 0.8% or BHT 0.2%. Cataractogenesis was evaluated by the incidence of cataract, grading of cataract, histology of the lenses, aldose reductase (AR) activity, protein levels, and reduced glutathione (GSH) contents in the lens. In both experiemtal groups: 1) the incidence and grading of cataract were lower, 2) the protein levels and GSH content were higher, and 3) the AR was decreased compared to the control group. In conclusion, "natural antioxidants" such as lycopene derived from tomato have a similar effect as BHT in delaying cataractogenesis in rats.

Circumferential argon laser photocoagulation was administered as preventive treatment for retinal detachment in 53 eyes with extensive areas of lattice degeneration and/or retinal breaks and at least one additional high-risk factor for retinal detachment. Laser burns were applied in several continuous rows 360 degrees around the peripheral retina at the junction between the posterior border of the lesions and the unaffected retina. The retina posterior to the treated areas remained attached in 51 eyes (96.2%) during a mean follow-up period of 85.8 months (range 6 months to 18 years). The treatment did not affect visual acuity. The only complication was the appearance in 2 eyes (3.8%) of a delicate epiretinal membrane which, however, did not require surgical intervention.

Rapid glucose control was achieved by insulin therapy in a patient diagnosed to have gestational diabetes at 8 weeks of pregnancy. A decrease of the initially high hemoglobin A1c level (16.2%) to normal values (5.9%) was achieved within 12 weeks. At 31 weeks severe bilateral proliferative diabetic retinopathy developed. To our knowledge this case is the first report of a patient with gestational diabetes who developed de novo proliferative diabetic retinopathy.

The postoperative course of cataract extraction and IOL implantation combined with trabeculectomy in glaucoma patients and of cataract extraction with intraocular lens (IOL) in diabetic patients is more complicated than that of cataract extraction with IOL implantation in otherwise healthy eyes. The main complications are fibrin in the anterior chamber, pigment dispersion, and posterior synechiae. In an attempt to determine whether heparin-coated lenses reduce the rate of these complications, a prospective study was conducted on 19 glaucomatous eyes of 19 patients who underwent a combined procedure of trabeculectomy and extracapsular cataract extraction with IOL and 20 eyes of 20 diabetic patients subjected to extracapsular cataract extraction with IOL. In each category of patients, the early postoperative course in those who received heparin-coated lenses and those who received regular polymethyl methacrylate (PMMA) lenses was compared with respect to the inflammatory reaction, assessed by the amounts of cells and flare, and complications in terms of fibrin, posterior synechiae and pigment dispersion. The results of this preliminary study indicate a slightly higher rate of early postoperative complications with the heparin-coated lenses as compared to PMMA lenses.

The course of diabetic retinopathy following extracapsular cataract extraction with posterior chamber lens implantation in eyes previously treated by laser photocoagulation for diabetic retinopathy was retrospectively studied in 33 eyes (33 patients). In 20 eyes (61%) there was no change in the retinal status postoperatively. In 13 (39%) there was postoperative progression of diabetic retinopathy compared with the fellow non-operated eye, in which progression occurred in nine eyes (27%). The severity of the preoperative status affected the incidence of progression. Four eyes (12%) developed complications of diabetic retinopathy--that is, rubeosis iridis and vitreous haemorrhage--which regressed after lasering. Cystoid macular oedema developed in 13 eyes (39%) and its incidence varied according to the postoperative course of diabetic retinopathy. The majority of the eyes showed a postoperative improvement in vision.

The course of cystoid macular oedema (CMO) following extracapsular cataract extraction with posterior chamber intraocular lens implantation was prospectively studied in 44 eyes of 44 consecutive diabetic patients without preoperative CMO. In 50% of eyes CMO was observed 6 weeks after surgery and in 25% was still present at 1 year. The preoperative presence of diabetic retinopathy significantly affected the postoperative onset and persistence of CMO. CMO occurred postoperatively in only 32% of eyes without pre-existing diabetic retinopathy and in 81% of eyes with pre-existing diabetic retinopathy (p < 0.05). CMO persisted at 1 year after surgery in only 7% of eyes without pre-existing diabetic retinopathy and in 56% of eyes in which diabetic retinopathy persisted (p < 0.01). Angiographic CMO (that is, detectable only on fluorescein angiography) was more common than clinical CMO (detectable on ophthalmoscopic examination as well) in eyes with no pre-existing diabetic retinopathy, whereas clinical CMO was seen more often than angiographic CMO when diabetic retinopathy was present preoperatively (p < 0.01). The course and final visual outcome of angiographic CMO were more favourable than in clinical CMO. Final visual acuity of at least 6/12 was achieved in 86% of eyes with angiographic CMO and in only 33% of eyes with clinical CMO. On the basis of the above findings we believe that cataract extraction should not be recommended for eyes with pre-existing diabetic retinopathy until the vision has deteriorated to at least 6/30-6/60.

Neodymium:YAG laser capsulotomy was performed in 65 eyes of 65 patients because of vision loss due to posterior capsular opacification or wrinkling following uneventful extracapsular cataract extraction with intraocular lens implantation. Eyes with pre-existing macular pathology were excluded from this study. In all of the eyes the posterior capsule was successfully opened. None developed clinical or angiographic cystoid macular oedema. One eye developed retinal detachment nine months after capsulotomy.

The increasing range of indications for laser treatment and the development of new modalities of lasering have led to a growing tendency to extend this type of treatment to the pediatric population. Problems of compliance in this age group often necessitate the use of general anesthesia. This report describes the operative technique used in 11 children (13 eyes) under the age of 13 years, all of whom underwent laser treatment under general anesthesia for a variety of ocular conditions. Argon or krypton laser photocoagulation was performed in eight children (10 eyes), seven of whom were treated for various retinal pathologies and one for an iris cyst. The other three children underwent Nd:YAG posterior capsulotomy for secondary cataract.