Senile Cataract Follow-up
- Author: Vicente Victor D Ocampo, Jr, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc more...
Further Outpatient Care
On the first postoperative day, visual acuity should be consistent with the refractive state of the eye, the clarity of the cornea and media, and the visual potential of the retina and optic nerve. Mild edema of the eyelid may be evident, as well as some conjunctival injection. The cornea is normally clear with minimal edema and striae. The anterior chamber should be deep with mild cellular and flare reaction. It is important to check whether the posterior capsule is intact and whether the IOL is positioned properly. The red reflex must be strong and clear and the intraocular pressures should be within normal limits. Transient intraocular pressure elevations may be observed and attributed to retained viscoelastic.
Significant improvement of these initial findings is to be expected in subsequent postoperative evaluation as the ocular inflammation subsides typically within 2 weeks. Topical steroids and antibiotics are tapered accordingly. Refraction is believed to be stable at the sixth to eighth postoperative week, at which time corrective lenses can be prescribed. Significant postoperative astigmatism following ECCE or ICCE can be addressed by suture removal after the sixth postoperative week as guided by keratometry, refraction, or corneal topography.
In a prospective, randomized, double-masked trial involving 59 patients undergoing cataract surgery, use of a tapered-release dexamethasone punctum plug after surgery, compared with the use of a placebo plug (Dextenza, Ocular Therapeutix), resulted in fewer cells in the anterior chamber (ie, less evidence of ocular inflammation), lower use of additional anti-inflammatory medications, and less light sensitivity.
The mean pain score in the dexamethasone group on the first day following surgery was three times below that in the placebo group (0.6 vs 2.0), while the ocular pain score on day 14 was 11 times lower than that in the placebo patients. No long-term, plug-associated intraocular pressure spikes or adverse events were observed.
Further Inpatient Care
Most cataract surgeries are performed on an outpatient basis, especially with the widespread adoption of phacoemulsification performed under topical anesthesia. Often, patients are discharged from the clinic as soon as they have recovered from the emotional stress of the procedure. Patients are sent home on topical steroids, NSAIDs, and antibiotics either separately or in combination. An optional eye shield is placed on the newly operated eye and removed a few hours later.
Inpatient & Outpatient Medications
During the postoperative period, the patient is prescribed a topical steroid such as 1% prednisolone acetate, which is applied every hour for the first day, then tapered depending on the inflammatory state of the eye. Studies have shown that topical ketorolac tromethamine provides adequate postoperative control of intraocular inflammation without the risk of increased intraocular pressure, which may be associated with steroid use. A broad-spectrum topical antibiotic also is given 4-6 times a day for 1-2 weeks.
Age is believed to be the most significant risk factor for senile cataract and, as such, it is essentially inevitable that some degree of lens opacity develops as one becomes older. No study has established firmly whether avoidance of some of the risk factors for senile cataract (eg, UV exposure, hypercholesterolemia, tobacco use, diabetes mellitus) will lessen the chance of developing a senile cataract.
Major intraoperative complications encountered during cataract surgery include the following:
Shallow or flat anterior chamber
Suprachoroidal hemorrhage or effusion
Expulsive choroidal hemorrhage
Retained lens material
Vitreous disruption and incarceration into wound
Retinal light toxicity
Major immediate postoperative complications encountered during cataract surgery often seen within a few days or weeks after the operation include the following:
Flat or shallow anterior chamber due to wound leak
Stromal and epithelial edema
Brown-McLean syndrome (peripheral corneal edema with a clear central cornea most frequently seen following ICCE)
Vitreocorneal adherence and persistent corneal edema
Delayed choroidal hemorrhage
Elevated intraocular pressure (often due to retained viscoelastic)
Cystoid macular edema - Studies have shown that diclofenac was more effective than topical steroids in preventing CME. 
Retinal detachment - Significant risk factors include axial length greater than 25 mm, age younger than 65 years, and intraoperative complications. 
Toxic anterior segment syndrome (TASS), a noninfectious acute inflammatory reaction to particulate, chemical, or toxic matter placed in the anterior chamber during surgery - Most commonly implicated are sterile denatured lens proteins retained by surgical instruments, epinephrine solutions that contain bisulfites, and powder from surgical gloves; many mini-epidemics of TASS reveal no obvious proven cause despite intensive investigation
Uveitis-glaucoma-hyphema (UGH) syndrome
Major late postoperative complications seen weeks or months after cataract surgery include the following:
Pupillary capture, decentration, or iris atrophy
Decentration and dislocation of the IOL
Corneal edema and pseudophakic bullous keratopathy
Wrong power of IOL used
At any postoperative stage, the risk of uveitis, noninfectious endophthalmitis, and infectious endophthalmitis exists. Noninfectious endophthalmitis is believed to be a multifactorial process or an idiosyncratically variable response to a common factor, similar to a hypersensitivity reaction. Treatment may range from the use of topical, transseptal, or oral steroids to the rare explantation of the intraocular lens.
Although of low incidence, infectious endophthalmitis may lead to severe vision loss and blindness. Staphylococcus epidermidis is the most commonly isolated organism in acute cases, and rupture of the posterior capsule is one of the most common risk factors. Of late, a significant increase in the incidence of gram-positive bacteria in bacterial isolates from postoperative eyes suspected of having endophthalmitis has been observed. Furthermore, a significant increase in resistance to ciprofloxacin and other fluoroquinolones has occurred. Seemingly, the spectrum of bacteria causing postcataract endophthalmitis is changing, partly perhaps because of an increased resistance to mainstay antibiotics in the prevention of endophthalmitis. Delayed-onset infectious endophthalmitis is most commonly caused by Propionibacterium acnes.
In the absence of any other accompanying ocular disease prior to surgery that would affect significantly the visual outcome (eg macular degeneration or optic nerve atrophy), a successful uncomplicated standard ECCE or phacoemulsification carries a very promising visual prognosis of gaining at least 2 lines in the Snellen distance vision chart. The main cause of visual morbidity postoperatively is CME. A major risk factor affecting visual prognosis is the presence of diabetes mellitus and diabetic retinopathy.
To date, no established guidelines are available for the prevention of senile cataracts. Education programs are geared toward early detection and surgical intervention when vision is impaired functionally. With the advent of phacoemulsification, patients are advised against delaying lens extraction to the point when the cataract is hard and mature and the likelihood of postoperative complications increases.
Congdon N, Vingerling JR, Klein BE, West S, Friedman DS, Kempen J, et al. Prevalence of cataract and pseudophakia/aphakia among adults in the United States. Arch Ophthalmol. 2004 Apr. 122(4):487-94. [Medline].
You QS, Xu L, Yang H, Wang YX, Jonas JB. Five-Year Incidence of Visual Impairment and Blindness in Adult Chinese The Beijing Eye Study. Ophthalmology. 2011 Jan 4. [Medline].
Liang YB, Friedman DS, Wong TY, Zhan SY, Sun LP, Wang JJ. Prevalence and causes of low vision and blindness in a rural chinese adult population: the Handan Eye Study. Ophthalmology. 2008 Nov. 115(11):1965-72. [Medline].
Maberley DA, Hollands H. The prevalence of low vision and blindness in Canada. Eye(Lond). 2006/03. 20(3):341-6.
Iwase A, Araie M, Tomidokoro A, Yamamoto T, Shimizu H, Kitazawa Y. Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study. Ophthalmology. 2006 Aug. 113(8):1354-62. [Medline].
Buch H, Vinding T, Nielsen NV. Prevalence and causes of visual impairment according to World Health Organization and United States criteria in an aged, urban Scandinavian population: the Copenhagen City Eye Study. Ophthalmology. 2001 Dec. 108(12):2347-57. [Medline].
Limburg H, Barria von-Bischhoffshausen F, Gomez P, Silva JC, Foster A. Review of recent surveys on blindness and visual impairment in Latin America. Br J Ophthalmol. 2008 Mar. 92(3):315-9. [Medline].
Murthy GV, Vashist P, John N, Pokharel G, Ellwein LB. Prevelence and causes of visual impairment and blindness in older adults in an area of India with a high cataract surgical rate. Ophthalmic Epidemiol. 2010 Aug. 17(4):185-95. [Medline].
Meddings DR, Marion SA, Barer ML, Evans RG, Green B, Hertzman C, et al. Mortality rates after cataract extraction. Epidemiology. 1999 May. 10(3):288-93. [Medline].
Hirsch RP, Schwartz B. Increased mortality among elderly patients undergoing cataract extraction. Arch Ophthalmol. 1983 Jul. 101(7):1034-7. [Medline].
Sperduto RD, Hiller R. The prevalence of nuclear, cortical, and posterior subcapsular lens opacities in a general population sample. Ophthalmology. 1984 Jul. 91(7):815-8. [Medline].
Nishikiori T, Yamamoto K. Epidemiology of cataracts. Dev Ophthalmol. 1987. 15:24-7. [Medline].
Martinez GS, Campbell AJ, Reinken J, Allan BC. Prevalence of ocular disease in a population study of subjects 65 years old and older. Am J Ophthalmol. 1982 Aug. 94(2):181-9. [Medline].
Kulaksızoglu S, Karalezli A. Aqueous Humour and Serum Levels of Nitric Oxide, Malondialdehyde and Total Antioxidant Status in Patients with Type 2 Diabetes with Proliferative Diabetic Retinopathy and Nondiabetic Senile Cataracts. Can J Diabetes. 2015 Sep 18. [Medline].
Yousefi R, Javadi S, Amirghofran S, Oryan A, Moosavi-Movahedi AA. Assessment of structure, stability and aggregation of soluble lens proteins and alpha-crystallin upon non-enzymatic glycation: The pathomechanisms underlying cataract development in diabetic patients. Int J Biol Macromol. 2015 Oct 23. [Medline].
West SK, Valmadrid CT. Epidemiology of risk factors for age-related cataract. Surv Ophthalmol. 1995 Jan-Feb. 39(4):323-34. [Medline].
Miglior S, Marighi PE, Musicco M, Balestreri C, Nicolosi A, Orzalesi N. Risk factors for cortical, nuclear, posterior subcapsular and mixed cataract: a case-control study. Ophthalmic Epidemiol. 1994 Jun. 1(2):93-105. [Medline].
Richter GM, Choudhury F, Torres M, Azen SP, Varma R. Risk factors for incident cortical, nuclear, posterior subcapsular, and mixed lens opacities: the Los Angeles Latino eye study. Ophthalmology. 2012 Oct. 119(10):2040-7. [Medline]. [Full Text].
Johns KJ, Feder RS, Rosenfeld SI, et al. Lens and cataract. American Academy of Ophthalmology Basic and Clinical Science Course. 1999-2000. Vol. 11.:
Al-Ghadyan AA, Cotlier E. Rise in lens temperature on exposure to sunlight or high ambient temperature. Br J Ophthalmol. 1986 Jun. 70(6):421-6. [Medline].
Kanthan GL, Mitchell P, Burlutsky G, Rochtchina E, Wang JJ. Pseudoexfoliation syndrome and the long-term incidence of cataract and cataract surgery: the blue mountains eye study. Am J Ophthalmol. 2013 Jan. 155(1):83-88.e1. [Medline].
Costello MJ, Oliver TN, Cobo LM. Cellular architecture in age-related human nuclear cataracts. Invest Ophthalmol Vis Sci. 1992 Oct. 33(11):3209-27. [Medline].
Van den Bruel A, Gailly J, Devriese S, Welton NJ, Shortt AJ, Vrijens F. The protective effect of ophthalmic viscoelastic devices on endothelial cell loss during cataract surgery: a meta-analysis using mixed treatment comparisons. Br J Ophthalmol. 2011 Jan. 95(1):5-10. [Medline].
Lundström M, Barry P, Henry Y, et al. Visual outcome of cataract surgery; study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg. 2013 May. 39(5):673-9. [Medline].
Pullen LC. Ocular Comorbidity Predicts Poor Cataract Surgery Outcomes. Medscape Medical News. May 1 2013. [Full Text].
Zhao LQ, Zhu H, Zhao PQ, Wu QR, Hu YQ. Topical Anesthesia versus Regional Anesthesia for Cataract Surgery: A Meta-Analysis of Randomized Controlled Trials. Ophthalmology. 2012 Feb 22. [Medline].
Douglas D. Cataract Surgery in Both Eyes May Boost Benefits. Medscape. Feb 4 2013. Available at http://www.medscape.com/viewarticle/778757. Accessed: Apr 17 2013.
Lee BS, Munoz BE, West SK, Gower EW. Functional Improvement after One- and Two-Eye Cataract Surgery in the Salisbury Eye Evaluation. Ophthalmology. 2013 Jan 25. [Medline].
Bell CM, Hatch WV, Fischer HD, Cernat G, Paterson M, Gruneir A, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009 May 20. 301(19):1991-6. [Full Text].
Baker PS, Spirn MJ, Chiang A, et al. 23-Gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. Am J Ophthalmol. 2011 Oct. 152(4):624-7. [Medline].
Klein BE, Howard KP, Lee KE, Iyengar SK, Sivakumaran TA, Klein R. The Relationship of Cataract and Cataract Extraction to Age-related Macular Degeneration: The Beaver Dam Eye Study. Ophthalmology. 2012 Aug. 119(8):1628-33. [Medline]. [Full Text].
Calladine D, Evans JR, Shah S, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2012 Sep 12. 9:CD003169. [Medline].
Lewis R. FDA Approves Tecnis Toric Intraocular Lens. Medscape Medical News. Available at http://www.medscape.com/viewarticle/782778. Accessed: May 2, 2013.
Brooks M. FDA OKs First Gel Sealant for Use in Cataract Surgery. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/818977. Accessed: January 20, 2014.
Laidman J. Alfuzosin for BPH linked to fewer snags in cataract surgery. Medscape Medical News. February 13, 2014. [Full Text].
Chang DF, Campbell JR, Colin J, Schweitzer C. Prospective Masked Comparison of Intraoperative Floppy Iris Syndrome Severity with Tamsulosin versus Alfuzosin. Ophthalmology. 2013 Dec 4. [Medline].
Sarkar S, Mondal KK, Roy SS, Gayen S, Ghosh A, De RR. Comparison of preoperative nepafenac (0.1%) and flurbiprofen (0.03%) eye drops in maintaining mydriasis during small incision cataract surgery in patients with senile cataract: A randomized, double-blind study. Indian J Pharmacol. 2015 Sep-Oct. 47 (5):491-5. [Medline].
Pullen LC. Experimental Plug Aids Recovery From Cataract Surgery. Medscape Medical News. Oct 27 2014. [Full Text].
Asano S, Miyake K, Ota I, Sugita G, Kimura W, Sakka Y, et al. Reducing angiographic cystoid macular edema and blood-aqueous barrier disruption after small-incision phacoemulsification and foldable intraocular lens implantation: multicenter prospective randomized comparison of topical diclofenac 0.1% and betamethasone 0.1%. J Cataract Refract Surg. 2008 Jan. 34(1):57-63. [Medline].
Szijarto Z, Schvoller M, Poto L, Kuhn F, Kovacs B. Pseudophakic retinal detachment after phacoemulsification. Ann Ophthalmol (Skokie). 2007 Jun. 39(2):134-9. [Medline].
Cao X, Liu A, Zhang J, Li Y, Jie Y, Liu W, et al. Clinical analysis of endophthalmitis after phacoemulsification. Can J Ophthalmol. 2007 Dec. 42(6):844-8. [Medline].
Rabin SM. Medicolegal concerns of cataract surgeons. Management and Care of the Cataract Patient. 1992. 331-8.
Belkin M, Jacobs DR, Jackson SM, Zwick H. Senile cataracts and myopia. Ann Ophthalmol. 1982 Jan. 14(1):49-50. [Medline].
Bellows JG, Bellows RT. Crosslinkage theory of senile cataracts. Ann Ophthalmol. 1976 Feb. 8(2):129-35. [Medline].
Bilge AH, Aykan U, Akin T, Unsal U. Review of sterile, postoperative, anterior segment inflammation following cataract extraction and intraocular lens implantation. Eur J Ophthalmol. 2005 Mar-Apr. 15(2):224-7. [Medline].
Bunce GE, Kinoshita J, Horwitz J. Nutritional factors in cataract. Annu Rev Nutr. 1990. 10:233-54. [Medline].
Burgess CA, Sowers M. Systemic hypertension and senile cataracts: an epidemiologic study. Optom Vis Sci. 1992 Apr. 69(4):320-4. [Medline].
Cataracts continue to be leading cause of vision loss and blindness in the United States. Prevent Blindness America. Available at http://www.preventblindness.org/.
Charakidas A, Kalogeraki A, Tsilimbaris M, Koukoulomatis P, Brouzas D, Delides G. Lens epithelial apoptosis and cell proliferation in human age-related cortical cataract. Eur J Ophthalmol. 2005 Mar-Apr. 15(2):213-20. [Medline].
Chatterjee A, Milton RC, Thyle S. Prevalence and aetiology of cataract in Punjab. Br J Ophthalmol. 1982 Jan. 66(1):35-42. [Medline].
Chylack LT Jr. Mechanisms of senile cataract formation. Ophthalmology. 1984 Jun. 91(6):596-602. [Medline].
Eckerskorn U, Hockwin O, Muller-Breitenkamp R, Chen TT, Knowles W, Dobbs RE. Evaluation of cataract-related risk factors using detailed classification systems and multivariate statistical methods. Dev Ophthalmol. 1987. 15:82-91. [Medline].
Emery JM, Wilhelmus KA, Rosenberg S. Complications of phacoemulsification. Ophthalmology. 1978 Feb. 85(2):141-50. [Medline].
Fujiwara H, Takigawa Y, Suzuki T, Nakata K. Superoxide dismutase activity in cataractous lenses. Jpn J Ophthalmol. 1992. 36(3):273-80. [Medline].
Ghafour IM, Allan D, Foulds WS. Common causes of blindness and visual handicap in the west of Scotland. Br J Ophthalmol. 1983 Apr. 67(4):209-13. [Medline].
Gibson JM, Rosenthal AR, Lavery J. A study of the prevalence of eye disease in the elderly in an English community. Trans Ophthalmol Soc U K. 1985. 104 (Pt 2):196-203. [Medline].
Gibson JM, Shaw DE, Rosenthal AR. Senile cataract and senile macular degeneration: an investigation into possible risk factors. Trans Ophthalmol Soc U K. 1986. 105 (Pt 4):463-8. [Medline].
Hirneiss C, Neubauer AS, Kampik A, Schönfeld CL. Comparison of prednisolone 1%, rimexolone 1% and ketorolac tromethamine 0.5% after cataract extraction: a prospective, randomized, double-masked study. Graefes Arch Clin Exp Ophthalmol. 2005 Aug. 243(8):768-73. [Medline].
Hollows F, Moran D. Cataract--the ultraviolet risk factor. Lancet. 1981 Dec 5. 2(8258):1249-50. [Medline].
Hu TS, Lao YX. An epidemiologic survey of senile cataract in China. Dev Ophthalmol. 1987. 15:42-51. [Medline].
Imbach P, Odavic R, Bleher EA, Bucher U, Deubelbeiss KA, Wagner HP. [Autologous bone marrow reimplantation in children with advanced tumor. First experiences of feasibility]. Schweiz Med Wochenschr. 1979 Feb 24. 109(8):283-7. [Medline].
Jacques PF, Chylack LT Jr, McGandy RB, Hartz SC. Antioxidant status in persons with and without senile cataract. Arch Ophthalmol. 1988 Mar. 106(3):337-40. [Medline].
Javitt JC, Taylor HR. Cataract and latitude. Doc Ophthalmol. 1994-1995. 88(3-4):307-25. [Medline].
Kador PF. Overview of the current attempts toward the medical treatment of cataract. Ophthalmology. 1983 Apr. 90(4):352-64. [Medline].
Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS, et al. The Framingham Eye Study. I. Outline and major prevalence findings. Am J Epidemiol. 1977 Jul. 106(1):17-32. [Medline].
Kamei A. Characterization of water-insoluble proteins in normal and cataractous human lens. Jpn J Ophthalmol. 1990. 34(2):216-24. [Medline].
Kamei A. Glutathione levels of the human crystalline lens in aging and its antioxidant effect against the oxidation of lens proteins. Biol Pharm Bull. 1993 Sep. 16(9):870-5. [Medline].
Katoh N, Sasaki K, Shibata T, Obazawa H, Fujiwara T, Kogure F, et al. Case-control study of senile cataract in Japan: a preliminary report. Jpn J Ophthalmol. 1993. 37(4):467-77. [Medline].
Ke Y, Jiang J, Chen P, Weng Y, Yang Y. Phacoemulsification and posterior chamber intraocular lens implantation. Zhonghua Yan Ke Za Zhi. 1996 Mar. 32(2):85-91. [Medline].
Kini MM, Leibowitz HM, Colton T, Nickerson RJ, Ganley J, Dawber TR. Prevalence of senile cataract, diabetic retinopathy, senile macular degeneration, and open-angle glaucoma in the Framingham eye study. Am J Ophthalmol. 1978 Jan. 85(1):28-34. [Medline].
Knekt P, Heliövaara M, Rissanen A, Aromaa A, Aaran RK. Serum antioxidant vitamins and risk of cataract. BMJ. 1992 Dec 5. 305(6866):1392-4. [Medline].
Lee SM, Lin SY, Li MJ, Liang RC. Possible mechanism of exacerbating cataract formation in cataractous human lens capsules induced by systemic hypertension or glaucoma. Ophthalmic Res. 1997. 29(2):83-90. [Medline].
Lu M, Taylor A, Chylack LT Jr, Rogers G, Hankinson SE, Willett WC, et al. Dietary fat intake and early age-related lens opacities. Am J Clin Nutr. 2005 Apr. 81(4):773-9. [Medline].
Lydahl E. Infrared radiation and cataract. Acta Ophthalmol Suppl. 1984. 166:1-63. [Medline].
Moffat BA, Landman KA, Truscott RJ, Sweeney MH, Pope JM. Age-related changes in the kinetics of water transport in normal human lenses. Exp Eye Res. 1999 Dec. 69(6):663-9. [Medline].
Mozaffarieh M, Heinzl H, Sacu S, Wedrich A. Clinical outcomes of phacoemulsification cataract surgery in diabetes patients: visual function (VF-14), visual acuity and patient satisfaction. Acta Ophthalmol Scand. 2005 Apr. 83(2):176-83. [Medline].
Packer M, Fishkind WJ, Fine IH, Seibel BS, Hoffman RS. The physics of phaco: a review. J Cataract Refract Surg. 2005 Feb. 31(2):424-31. [Medline].
Papamatheakis DG, Demers P, Vachon A, Jaimes LB, Lapointe Y, Harasymowycz PJ. Thrombocytopenia and the risks of intraocular surgery. Ophthalmic Surg Lasers Imaging. 2005 Mar-Apr. 36(2):103-7. [Medline].
Recchia FM, Busbee BG, Pearlman RB, Carvalho-Recchia CA, Ho AC. Changing trends in the microbiologic aspects of postcataract endophthalmitis. Arch Ophthalmol. 2005 Mar. 123(3):341-6. [Medline].
Robertson JM, Donner AP, Trevithick JR. A possible role for vitamins C and E in cataract prevention. Am J Clin Nutr. 1991 Jan. 53(1 Suppl):346S-351S. [Medline].
Sack R, Cohen J. Comparative diets of a idiopathic senile cataract and normal population: dietary risk factors in cataractogenesis. Metab Pediatr Syst Ophthalmol. 1987. 10(1):9-13. [Medline].
Shaikh MR, Janjua MZ. Morphological and morphometrical study of human lens in senile cataract. J Pak Med Assoc. 1997 May. 47(5):141-4. [Medline].
Sharma YR, Vajpayee RB, Honavar SG. Sunlight and cortical cataract. Arch Environ Health. 1994 Sep-Oct. 49(5):414-7. [Medline].
Sommer A. Cataracts as an epidemiologic problem. Am J Ophthalmol. 1977 Mar. 83(3):334-9. [Medline].
Sommer A, Tielsch JM, Katz J, Quigley HA, Gottsch JD, Javitt JC, et al. Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med. 1991 Nov 14. 325(20):1412-7. [Medline].
Steinkuller PG. Cataract: the leading cause of blindness and vision loss in Africa. Soc Sci Med. 1983. 17(22):1693-702. [Medline].
Street DA, Javitt JC. National five-year mortality after inpatient cataract extraction. Am J Ophthalmol. 1992 Mar 15. 113(3):263-8. [Medline].
Tseng SH, Tang MJ. Na,K-ATPase in lens epithelia from patients with senile cataracts. J Formos Med Assoc. 1999 Sep. 98(9):627-32. [Medline].
Tseng SH, Yen JS, Chien HL. Lens epithelium in senile cataract. J Formos Med Assoc. 1994 Feb. 93(2):93-8. [Medline].
Worgul BV, Merriam GR Jr, Medvedovsky C. Cortical cataract development--an expression of primary damage to the lens epithelium. Lens Eye Toxic Res. 1989. 6(4):559-71. [Medline].
Wu TT, Amini L, Leffler CT, Schwartz SG. Cataracts and cataract surgery in mentally retarded adults. Eye Contact Lens. 2005 Mar. 31(2):50-3. [Medline].