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1.
Rev. bras. oftalmol ; 81: e0011, 2022. tab, graf
Article in English | LILACS | ID: biblio-1360921

ABSTRACT

ABSTRACT Purpose: This study set out to examine the impact of surgical treatment of senile cataract on visual acuity and quality of life in patients operated in a public teaching hospital. Methods: Prospective study including patients aged over 60 years with clinical indications for cataract surgery treated at a medical residency service. The National Eye Institute Visual Function Questionnaire 25 was applied. Corrected distance visual acuity was measured before and after cataract surgery. Correlations between National Eye Institute Visual Function Questionnaire 25 scores and corrected distance visual acuity were investigated. Surgeons in charge, and surgical complications were also reported. Results: A total of 69 patients (89 eyes) were enrolled in this study. Patients were submitted to unilateral (52) or bilateral (17) surgery. Mean patient age was 70.8 ± 7.3 (52 to 95) years. Mean preoperative and postoperative National Eye Institute Visual Function Questionnaire 25 scores were 77.4 ± 15.3 (25.7 to 98.2) and 89.7 ± 14.0 (28.2 to 100) respectively. The larger differences in National Eye Institute Visual Function Questionnaire 25 subscale scores were associated with general vision (from 34.4 to 48.6). Mean preoperative and postoperative corrected distance visual acuity were 0.7 ± 0.39 (0.3 to 1.3) LogMAR and 0.24 ± 0.19 (0.1 to 1.0) LogMAR respectively. Comparative analysis of preoperative and postoperative findings revealed significant (p<0.001) improvements in quality of life and corrected distance visual acuity. Most surgeries (70%, 74 eyes) were performed by surgeons in training. Comparative analysis between patients submitted to unilateral and bilateral surgery revealed significantly (p=0.016) larger visual acuity gains in patients requiring surgery in both eyes. However, questionnaire scores did not differ significantly (p=2.48). Complications were observed in 13 eyes (14.6%), posterior capsule tear being the most common. Even in these cases, total National Eye Institute Visual Function Questionnaire 25 scores and corrected distance visual acuity increased significantly (p<0.001). Conclusion: Cataract surgery performed in teaching hospital settings improved patient quality of life and visual acuity. Therefore, public health agencies should ensure access to cataract surgery.


RESUMO Objetivo: Avaliar o efeito da cirurgia de catarata na acuidade visual e na qualidade de vida em adultos submetidos à cirurgia de catarata em hospital público de ensino. Métodos: Estudo prospectivo, que incluiu pacientes acima de 60 anos com indicação clínica para cirurgia de catarata em um serviço de residência médica. O National Eye Institute Visual Function Questionnaire 25 foi aplicado, e a acuidade visual corrigida à distância foi avaliada antes e após a cirurgia de catarata. Foram realizadas correlações entre o escore do National Eye Institute Visual Function Questionnaire 25 e a acuidade visual. Cirurgiões e complicações cirúrgicas também foram descritos. Resultados: Foram incluídos neste estudo 89 olhos de 69 pacientes, em um total de 52 cirurgias unilaterais e 17 bilaterais. A idade média foi de 70,8±7,3 anos (52 a 95), e a pontuação média do National Eye Institute Visual Function Questionnaire 25 antes da cirurgia foi 77,4±15,3 (25,7 a 98,2) e, depois, de 89,7±14,03 (28,2 a 100). A maior diferença entre os subdomínios do National Eye Institute Visual Function Questionnaire 25 foi a visão geral (34,4 a 48,6). A acuidade visual corrigida à distância média antes do procedimento foi de 0,70±0,39 (0,3 a 1,3) LogMAR e, depois, foi de 0,24±0,19 (0,1 a 1,0) LogMAR. Comparando os resultados antes e após a cirurgia de catarata, houve melhora significativa na qualidade de vida (p<0,001) e na acuidade visual (p<0,001). Dentre as cirurgias, 70% (74 olhos) foram realizadas por cirurgiões em treinamento. A análise comparativa entre os grupos de pacientes de cirurgias unilaterais e bilaterais apresentou um ganho na acuidade visual maior no grupo que operou ambos os olhos, com significância estatística (p=0,016). No entanto, o aumento na pontuação do questionário, observado em ambos os grupos, não representou diferença estatisticamente significante (p=٢,٤٨٩). Complicações foram observadas em ١٣ olhos (١٤,٦٪), sendo a ruptura de cápsula posterior a mais frequente. Mesmo esses pacientes obtiveram aumento no escore total do National Eye Institute Visual Function Questionnaire 25 (p<0,001) e na acuidade visual corrigida à distância (p<0,001). Conclusão: A cirurgia de catarata realizada em ambiente hospitalar de ensino proporciona melhora na qualidade de vida e na acuidade visual, sendo fundamental que os órgãos de saúde pública garantam o acesso da população a esse procedimento.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Quality of Life , Cataract Extraction , Visual Acuity , Phacoemulsification , Brazil , Prospective Studies , Surveys and Questionnaires , Hospitals, Public , Hospitals, Teaching
2.
Rev. bras. oftalmol ; 81: e0022, 2022. tab
Article in English | LILACS | ID: biblio-1365730

ABSTRACT

ABSTRACT Introduction: It is estimated that 23% of the Brazilian population does not have access to an ophthalmologist, mainly because of the irregular geographical distribution of experts. It may be expensive to train ophthalmologists in Brazil. Objective: To estimate the cost of training an ophthalmologist and the labor market conditions so that the provider recovers the investment. Methods: Epidemiological study in databases from governmental sources and institutions related to the eye health system regulation. Results: The cost for training an ophthalmologist would be equal to R$ 592.272,00. After specialization, if the provider pledged all his/her income to recover the amount spent on training, it would take 5.2 years to reach the point of equilibrium. Conclusion: Young doctors from families unable to afford the cost of their education and support for at least 14 years after the beginning of the undergraduate course will hardly be able to specialize in Ophthalmology if they are unable to carry out their studies in public educational institutions. And those who can specialize are likely to choose to practice their profession in large urban centers, where most of the job opportunities are available, to at least recover the financial investment in training in the medium term.


RESUMO Introdução: Estima-se que 23% da população brasileira não tenha acesso ao oftalmologista, devido, principalmente, à falta de recursos do Sistema Público de Saúde e à distribuição geográfica irregular dos especialistas. É possível que seja caro formar oftalmologistas no Brasil. Assim, é compreensível que a maioria dos profissionais optem para ficar próximos dos grandes centros consumidores, onde estão as melhores remunerações. Objetivo: Estimar o custo para a formação de um oftalmologista e as condições do mercado de trabalho para que ele recupere o investimento. Métodos: estudo epidemiológico em bases de dados de fontes governamentais e de instituições relacionadas à regulamentação do sistema de saúde ocular. Resultados: Estimou-se que o custo para formação de um oftalmologista seja de R$ 592.272,00. Após a especialização, caso ele empenhe todo seu rendimento para reaver o valor gasto em sua formação, precisaria de 5,2 anos para atingir o ponto de equilíbrio. Conclusão: Jovens médicos oriundos de famílias incapazes de arcar com o custo de sua formação e de seu sustento, por pelo menos 14 anos após o início da graduação, dificilmente conseguirão se especializar em Oftalmologia, se não conseguirem realizar seus estudos em instituições públicas de ensino. E aqueles que conseguem se especializar, provavelmente optem por exercer a profissão em grandes centros urbanos, onde está a maior parte das oportunidades de trabalho, a fim de, a médio prazo, conseguir, pelo menos, recuperar o investimento financeiro na formação.


Subject(s)
Ophthalmology/education , Education, Medical/economics , Ophthalmologists/education , Students, Medical , Brazil , Costs and Cost Analysis , Education, Medical, Graduate/economics , Inservice Training/economics , Internship and Residency/economics
3.
Arq. bras. oftalmol ; 84(4): 316-323, July-Aug. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1285290

ABSTRACT

ABSTRACT Purpose: The purpose of this study was to analyze the safety of primary intraocular lens implantation in a large number of eyes in children aged <24 months. Methods: The medical records of patients aged 5-24 months, who underwent primary intraocular lens implantation in the capsular bag, were reviewed. A foldable three-piece acrylic intraocular lens was implanted by the same surgeon using a single surgical technique. Patients who had <1 year of follow-up after the surgery were excluded. The main outcome measurements included visual acuity, myopic shift, follow-up complications, and additional surgeries. Results: Sixty-eight patients (93 eyes) were analyzed. The mean age of the patients at the time of surgery was 15.06 ± 6.19 months (range: 5-24 months), and the spherical equivalent 1 month after surgery was 3.62 ± 2.32 D. After 5.67 ± 3.10 years, the spherical equivalent was -0.09 ± 3.22 D, and the corrected distance visual acuity was 0.33 ± 0.33 and 0.64 ± 0.43 logMAR in bilateral and unilateral cases, respectively (p=0.000). The highest myopic shift was observed in infants who underwent surgery at ages 5 and 6 months. The most frequent complications included visual axis opacification and corectopia. Glaucoma and retinal detachment were not reported. Conclusion: Primary in-the-bag intraocular lens implantation in children aged 5-24 months is safe, and is associated with low rates of adverse events and additional surgery.


RESUMO Objetivo: O objetivo deste estudo foi analisar a segurança do implante de lente intraocular primária em um grande número de olhos em crianças <24 meses. Métodos: Foram revisados os prontuários de pacientes com idade entre 5-24 meses, submetidos a implante primário de lente intraocular no saco capsular. Uma lente intraocular acrílica de três peças dobrável foi implantada pelo mesmo cirurgião usando uma única técnica cirúrgica. Pacientes que tiveram <1 ano de acompanhamento após a cirurgia foram excluídos. Os principais resultados incluíram medidas de acuidade visual, mudança miópica, complicações pós operatórias e cirurgias adicionais. Resultados: Foram analisados 68 pacientes (93 olhos). A média de idade dos pacientes no momento da cirurgia foi de 15,06 ± 6,19 (5 a 24) meses, e o equivalente esférico 1 mês após a cirurgia foi de 3,62 ± 2,32 D. Após 5,67 ± 3,10 anos, o equivalente esférico foi de -0,09 ± 3,22 D, e a acuidade visual corrigida à distância foi de 0,33 ± 0,33 e 0,64 ± 0,43 logMAR em casos bilaterais e casos unilaterais, respectivamente (p=0,000). A maior mudança míopica foi observado em bebês submetidos à cirurgia aos 5 e 6 meses de idade. As complicações mais frequentes incluíram opacificação do eixo visual e corectopia. Glaucoma e descolamento de retina não foram relatados. Conclusão: O implante primário de lente intraocular no saco capsular em crianças de 5-24 meses é seguro e está associado à baixas taxas de eventos adversos e cirurgias adicional.

5.
Arq. bras. oftalmol ; 84(2): 103-106, Mar,-Apr. 2021. tab
Article in English | LILACS | ID: biblio-1153118

ABSTRACT

ABSTRACT Purpose: To evaluate the relationship between the incidence of complications and functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia. Methods: We enrolled 22 functionally monocular patients (11 males and 11 females; group 1) and 19 age- and sex-matched controls (6 males and 13 females; group 2) in this prospective, interventional, cross-sectional, case control study. Demographics data, including age, sex, and educational background, were collected. Surgeries were performed by the same surgeon, and during surgery, the patients' vital signs (blood pressure and heart rate) and surgical events (duration, body movements, signs of increased vitreous cavity pressure, difficulty in performing capsulorhexis, and complications) were noted. Pre- and postoperative visual acuity was also analyzed. Results: The mean age of group 1 was 73.05 ± 13.31 years and of group 1 was 69.74 ± 16.81 years. There was no significant between-group difference in systolic and diastolic blood pressures. The average heart rate was similar in both groups, too. During surgery, the surgeon's perception of excessive eye, eyelid, or head movements in both groups was similar, in addition to signs of increased vitreous cavity pressure. Conclusion: It is safe to perform phacoemulsification under topical anesthesia in functionally monocular patients, who apparently behave similarly to binocular patients.(AU)


RESUMO Objetivo: Avaliar a relação entre a incidência de complicações e reações emocionais durante a cirurgia de catarata sob anestesia tópica em pacientes funcionalmente monoculares. Métodos: Estudo prospectivo, transversal, caso-controle de vinte e dois pacientes monoculares e dezenove controles pareados por idade e sexo . Dados demográficos foram analisados: idade, sexo e escolaridade. As cirurgias foram realizadas pelo mesmo cirurgião e durante o procedimento os sinais vitais dos pacientes (como pressão arterial sistêmica e frequência cardíaca) e eventos cirúrgicos (duração da cirurgia, movimentos corporais, sinais de aumento da pressão vítrea, dificuldade de realização da capsulorrexis e complicações) foram coletados. A acuidade visual pré e pós foi analisada. A distribuição normal dos dados foi confirmada com o teste de Shapiro-Wilk. Os dados foram expressos como média ± DP e porcentagem. A comparação dos diferentes testes clínicos entre os grupos foi realizada utilizando Student's t-test e ANOVA com correção de Bonferroni. O qui-quadrado foi usado para comparar dados demográficos. Valor de p<0,05 foi considerado estatisticamente significante. Resultados: Este estudo incluiu vinte e dois olhos de 22 pacientes funcionalmente monoculares (6 homens e 13 mulheres) e dezenove olhos de 19 controles (11 homens e 11 mulheres). A média de idade foi de 73,05 ± 13,31 anos nos indivíduos monoculares e 69,74 ± 16,81 no controle. Considerando-se os sinais vitais não houve diferença significativa entre os grupos (p>0,05). Durante o procedimento, a percepção do cirurgião em relação aos movimentos excessivos de olho, pálpebra ou cabeça em ambos os grupos foi semelhante, assim como sinais de aumento da pressão vítrea (p=0,2 e p=0,1, respectivamente). Conclusão: Este estudo sugere que é seguro realizar a extração de catarata com anestesia tópica em pacientes funcionalmente monoculares. Esses pacientes aparentemente se comportam de maneira semelhante aos pacientes binoculares.(AU)


Subject(s)
Humans , Male , Female , Visual Acuity , Phacoemulsification/psychology , Capsulorhexis/methods , Anesthetics, Local/administration & dosage , Vision, Monocular , Cross-Sectional Studies/instrumentation , Prospective Studies
10.
Rev. bras. oftalmol ; 79(1): 42-45, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092659

ABSTRACT

Abstract Purpose: To determine the impact of neodymium:YAG (Nd:YAG) laser posterior capsulotomy on quality of life and visual acuity in adults. Methods: A prospective study that included patients over 65 years old with clinical indications for Nd: YAG laser capsulotomy. On the day of the procedure, corrected distance visual acuity tests, slit-lamp examination and posterior capsule opacification (PCO) photo documentation were performed, followed by application of the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The PCO rate was evaluated with Evaluation of Posterior Capsule opacification (EPCO 2000) software. Four weeks after the posterior capsulotomy, corrected distance visual acuity was measured, and the NEI-VFQ-25 was applied again. Complications were also reported. Results : Sixty eyes from 45 patients were enrolled in the study. The mean age was 71.51 ± 6.38 years (65 to 93). Comparing the results before and after the Nd:YAG laser capsulotomy, there was a statistically significant improvement in quality of life according to the NEI-VFQ-25 (p<0.001) and in visual acuity (p=0.0). The mean score in NEI-VFQ-25 Questionnaire before capsulotomy was 62.07 ± 20.90 (16.81-95.90) and after was 83.95±19.49 (20.68 - 100.0). The mean CDVA before the procedure was 0.75 ± 0.35 LogMAR (0.1-1.3) and after was 0.21 ± 0.20 LogMAR (0.0-1.3). The mean PCO rate measured by the EPCO software was 0.688 ± 0.449. There was a positive correlation between the EPCO score and the total score of quality of life after Nd: YAG laser capsulotomy (r=0.845, p=0.00). Damage to intraocular lens was the only complication observed in six eyes (10%). Conclusion: Nd: YAG laser capsulotomy, in addition to improving visual acuity, is able to improve quality of life.


Resumo Objetivo: Determinar o impacto da capsulotomia posterior com laser de neodímio: YAG (Nd: YAG) na qualidade de vida e na acuidade visual em adultos. Métodos: Estudo prospectivo que incluiu pacientes acima de 65 anos com indicação clínica para capsulotomia com laser de Nd: YAG. No dia do procedimento, foram realizados testes de acuidade visual corrigida, exame com lâmpada de fenda e fotodocumentação da opacificação da cápsula posterior (OCP), seguido da aplicação do National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). A taxa de OCP foi avaliada utilizando o software de avaliação de opacificação de cápsula posterior (EPCO 2000). Quatro semanas após a capsulotomia posterior, a acuidade visual corrigida foi medida, e o NEI-VFQ-25 foi aplicado novamente. Complicações também foram relatadas. Resultados: Sessenta olhos de 45 pacientes foram incluídos no estudo. A idade média foi de 71,51±6,38 anos (65 to 93). Comparando os resultados antes e após a capsulotomia com laser Nd: YAG, houve melhora estatisticamente significante na qualidade de vida de acordo com o NEI-VFQ-25 (p <0,001) e na acuidade visual (p = 0,0). A média do escore total do questionário NEI-VFQ-25 pré capsulotomia foi de 62.07 ± 20.90 (16.81-95.90) e pós foi de 83.95 ±19.49 (20.68 - 100.0). A AVCC antes do procedimento foi 0.75 ± 0.35 LogMAR (0.1-1.3) e após foi 0.21 ± 0.20 LogMAR (0.0-1.3). A taxa média de OCP medida pelo software EPCO foi de 0,688 ± 0,449. Houve correlação positiva entre o escore EPCO e o escore total de qualidade de vida após a capsulotomia com laser de Nd: YAG (r = 0,845, p = 0,00). O dano à lente intraocular foi a única complicação observada em seis olhos (10%). Conclusão: A capsulotomia com laser Nd: YAG, além de melhorar a acuidade visual, é capaz de melhorar a qualidade de vida.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Quality of Life , Capsule Opacification/surgery , Posterior Capsulotomy/psychology , Cataract Extraction , Visual Acuity , Prospective Studies , Surveys and Questionnaires , Lens Implantation, Intraocular , Laser Therapy/methods , Lasers, Solid-State , Posterior Capsule of the Lens/surgery , Posterior Capsule of the Lens/pathology , Posterior Capsulotomy/methods , Lenses, Intraocular , Neodymium
11.
Clinics ; 75: e1604, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133462

ABSTRACT

OBJECTIVE: To compare the effects of hydrophobic and hydrophilic materials in square-edged acrylic intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. METHODS: Patients were randomly assigned to group 1 (hydrophobic acrylic square-edged IOLs; 13 eyes) or group 2 (hydrophilic acrylic square-edged IOLs; 13 eyes). The study evaluated PCO rates using Evaluation of Posterior Capsule Opacification (EPCO) 2000 software at one, three, six and 12 months postoperatively. Postoperative measurements also included corrected distance visual acuity (CDVA), neodymium:yttrium‐aluminum‐garnet (Nd:YAG) capsulotomy and postoperative complications other than PCO. RESULTS: Both groups had significant increases in PCO rates after one year. Comparison of the groups showed no significant differences in the EPCO scores at three (group 1, 0.007±0.016 vs group 2, 0.008±0.014; p=0.830), six (group 1, 0.062±0.103 vs group 2, 0.021±0.023; p=0.184), or twelve months postoperatively (group 1, 0.200±0.193 vs group 2, 0.192±0.138; p=0.902). We also found no significant group differences regarding the change (delta, Δ) in EPCO scores between three and six months (group 1, 0.055±0.09 vs group 2, 0.013±0.02; p=0.113) or between six and twelve months postoperatively (group 1, 0.139±0.14 vs group 2, 0.171±0.14; p=0.567). Twenty-three percent of patients required Nd:YAG capsulotomy at the twelve-month visit. CONCLUSIONS: No differences in PCO rates were found between hydrophobic and hydrophilic acrylic square-edged IOLs in children between five and twelve years of age at one year of follow-up.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Cataract , Capsule Opacification , Lenses, Intraocular , Postoperative Complications , Prosthesis Design , Acrylic Resins , Prospective Studies , Phacoemulsification , Lens Implantation, Intraocular
12.
Clinics ; 75: e2201, 2020.
Article in English | LILACS | ID: biblio-1133390

Subject(s)
Humans , Ophthalmologists , Brazil
13.
Arq. bras. oftalmol ; 82(4): 329-331, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1019407

ABSTRACT

ABSTRACT Intraoperative and postoperative cataract surgery in eyes with anterior megalophthalmos are challenging procedures. Herein we describe the case of a 53-year-old male with anterior megalophthalmos who developed unilateral Urrets-Zavalia Syndrome following cataract surgery.


RESUMO O intraoperatório e o pós-operatório de cirurgia de catarata em olhos com megaloftalmo anterior é desafiador. Descrevemos o caso de um homem de 53 anos com megaloftalmo anterior que desenvolveu a Síndrome de Urrets-Zavalia unilateral após cirurgia de catarata.


Subject(s)
Humans , Male , Middle Aged , Eye Diseases, Hereditary/surgery , Pupil Disorders/etiology , Phacoemulsification/adverse effects , Genetic Diseases, X-Linked/surgery , Postoperative Complications , Syndrome , Visual Acuity , Eye Diseases, Hereditary/complications , Pupil Disorders/pathology , Genetic Diseases, X-Linked/complications , Intraocular Pressure , Anterior Chamber/surgery
14.
Clinics ; 74: e1294, 2019. tab, graf
Article in English | LILACS | ID: biblio-1039549

ABSTRACT

OBJECTIVES: To compare the amount of ultrasound energy and irrigation volume in conventional phacoemulsification cataract surgery versus femtosecond laser-assisted phacoemulsification at different nuclear-cortical cataract grades. METHOD: This was a prospective, consecutive, investigator-masked nonrandomized parallel cohort study. Patients were divided into 4 groups (Phaco1, Phaco2, Femto1 and Femto2) according to the surgical technique (conventional phacoemulsification [Group Phaco] or femtosecond laser-assisted cataract surgery [Group Femto]) and the Lens Opacity Classification System III (LOCS) grade (LOCS<11 [group 1] or LOCS≥11 [group 2]). The measured outcomes were effective phacoemulsification time (EPT), indicating the ultrasound energy, and balanced salt solution (BSS) use, indicating the irrigation volume, to indirectly estimate the damage to the corneal endothelium caused by the cataract surgery. RESULTS: A total of 160 eyes from 109 patients were included: 87 eyes in Group Phaco, 73 eyes in Group Femto, 76 eyes in group 1 and 84 eyes in group 2. The EPT mean in Femto1 was 53% less (2.73±1.88, 0.1 to 8.65) than that in Phaco1 (5.80±2.86) (p=0.00) and in Femto2 (8.38±9.32) was 33% less than that in Phaco2 (12.55±8.38) (p=0.00). No significant differences in mean LOCS grades between the Phaco1 (8.21±1.44) and Femto1 (7.90±1.90) groups (p=0.73) or between the Phaco2 (13.15±2.55) and Femto2 (12.72±2.18) groups (p=0.95) were found. There were no significant differences in the mean BSS use between the Phaco1 (55.73±12.45) and Femto1 (59.37±10.93) groups (p=0.48) or between the Phaco2 (64.34±21.00) and Femto2 (65.71±17.60) groups (p=0.47). CONCLUSIONS: Compared to conventional phacoemulsification at different nuclear-cortical cataract grades, femtosecond laser-assisted cataract surgery provides an EPT reduction but does not influence the BSS use.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cataract Extraction/methods , Phacoemulsification/methods , Visual Acuity , Prospective Studies , Cohort Studies , Treatment Outcome
15.
Clinics ; 74: e966, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011924

ABSTRACT

OBJECTIVES: To compare long-term postoperative complications of pediatric cataract surgery with primary intraocular lens (IOL) implantation associated with posterior capsulotomy (PC) and anterior vitrectomy (AV) between patients treated with a corneal or pars plicata/pars plana approach. METHODS: Children who underwent cataract surgery with in-the-bag primary IOL implantation were divided into two groups according to PC and AV surgical approach: a corneal approach (group 1) and a pars plicata/pars plana approach (group 2). Only patients with a follow-up duration of more than two years were included. Long-term surgical outcomes were retrospectively reported. RESULTS: The mean follow-up period was 10.00±3.13 years. No cases of glaucoma or retinal detachment were reported. The mean age at surgery was 34.57±22.66 months. Forty-six children were included (27 eyes in group 1 and 29 eyes in group 2). The most frequent postoperative complication was corectopia, followed by visual axis opacification. Both complications occurred more frequently in group 1 (p<0.001). After cataract surgery, the rate of additional surgeries in group 1 was 51.9%, while in group 2, the rate was 27.6% (p=0.1132). CONCLUSION: The pars plicata/pars plana approach with PC and vitrectomy with primary in-the-bag IOL implantation for pediatric cataracts is a safe procedure.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cataract/congenital , Cataract Extraction/methods , Lens Implantation, Intraocular/methods , Postoperative Complications , Vitrectomy , Cataract Extraction/adverse effects , Retrospective Studies , Follow-Up Studies , Lens Implantation, Intraocular/adverse effects , Posterior Capsulotomy
16.
Arq. bras. oftalmol ; 81(6): 529-538, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-973859

ABSTRACT

ABSTRACT A retrospective and analytical study was conducted by using data from the National Transplantation System on 184,575 corneal transplantations performed between January 2001 and December 2016 in order to analyze thetrends in corneal transplantation from 2001 to 2016 in Brazil. The Cochran-Armitage test, analysis of variance, and Duncan's multiple comparisons were used to verify the existence of trends, compare the mean values between regions, and verify the mean differences, respectively. A significance level of 5% was used for all tests. The analysis showed that there was a 2.4-fold increase in the number of corneal transplantations (from 6,193 [35.2 per million people (pmp)] to 14,641 [71 pmp]; p<0.001), a 50.7% increase in the efficacy of meeting the population's demand for corneal transplantation (from 35.3% to 53.2%; p<0.001), an 11-fold increase in the number of corneal transplantation centers (from 32 to 356), and a 2.5-fold increase in the number of corneal transplantation teams (from 276 to 688) in Brazil during the period studied. The waiting list for corneal transplantation decreased by 45.4% (from 23,549 [123 pmp] to 12,865 [62.4 pmp]; p<0.001), and the corneal transplantation teams performed about 19 corneal transplantations per year. The best indices were observed in the southern, midwestern, and southeastern regions, and the worst indices were in the northern and northeastern regions. Brazil has been improving its capacity to perform corneal transplantation in the past 16 years, although this improvement varies across regions. However, the population's demand for corneal transplantation is yet to be satisfactorily met, primarily due to the low number of corneal donations.


RESUMO Estudo retrospectivo e analítico, baseado em dados do Sistema Nacional de Transplantes de 184.575 transplantes de córnea realizados no período de janeiro de 2001 a dezembro de 2016, com o objetivo de analisar as tendências do transplante de córnea no Brasil de 2001 a 2016. Os testes de Cochran-Armitage, análise de variância e comparações múltiplas de duncan foram realizados para verificar a existência de tendência, comparação de médias entre regiões e verificação da diferença média, respectivamente. Um nível de significância de 5% foi utilizado em todos os testes. No Brasil, houve um aumento: de 2,4 vezes no número de transplantes de córnea (de 6.193 [35,2 pmp] para 14.641 [71 pmp] - p<0,001); de 50,7% na eficácia de atender a demanda populacional de transplantes de córnea (de 35,3% para 53,2% - p<0,001); de 11 vezes no número de centros de transplantes de córnea (de 32 para 356); e de 2,5 vezes no número de equipes transplantadoras de córnea (de 276 para 688). A lista de espera para o transplantes de córnea diminuiu em 45,4% (de 23.549 [123 pmp] para 12.865 [62,4 pmp] - p<0,001). A produtividade das equipes de córnea ao longo dos anos foi de 19 transplantes de córnea ao ano. Os melhores índices foram apresentados nas regiões Sul, Cen tro-Oeste e Sudeste e os piores no Norte e Nordeste. O Brasil, embora de forma heterogênea entre as regiões, vem melhorando a capacidade de realizar o transplante de córnea nos últimos 16 anos, porém a demanda populacional por transplante de córnea ainda não é adequadamente atendida, principalmente devido ao baixo número de doações de córnea.


Subject(s)
Humans , Corneal Transplantation/trends , Tissue Donors/statistics & numerical data , Tissue and Organ Procurement/organization & administration , Tissue and Organ Procurement/statistics & numerical data , Brazil , Retrospective Studies , Waiting Lists , Corneal Transplantation/statistics & numerical data , Efficiency
17.
Arq. bras. oftalmol ; 81(4): 348-353, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-950474

ABSTRACT

ABSTRACT Patients undergoing cataract surgery are generally elderly, and many take drugs with systemic effects. The surgeon must be aware of the risks of continuing or discontinuing such medications perioperatively. Antiplatelet drugs and anticoagulants, prescribed to reduce the incidence of thromboembolic events, are often used in this population. This paper aims to review the perioperative use of antiplatelet and anticoagulant drugs in the setting of cataract surgery. Topical or intracameral anesthesia is preferred over anesthesia injected with needles. Aspirin can be safely continued in patients undergoing cataract surgery. Warfarin has been extensively studied, and the risk of hemorrhage associated with cataract surgery is low if the international normalized ratio is in the therapeutic range. Only a few studies of direct oral anticoagulants are available, and therefore no definite recommendations regarding those agents can be made at this time. Anesthesia in cataract surgery carries a low risk, even for patients taking anticoagulant or antiplatelet drugs. The discontinuation of this class of drugs before cataract surgery may increase the risk of thromboembolism.


RESUMO Os pacientes submetidos à cirurgia de catarata são geralmente idosos e muitos deles usam drogas com efeitos sistêmicos. No entanto, o cirurgião deve estar ciente dos riscos em manter ou descontinuar medicamentos sistêmicos no pré-operatório da cirurgia de catarata, como os anticoagulantes e os antiplaquetários. Este artigo tem como objetivo revisar a classe de drogas antiplaquetárias e anticoagulantes e orientar o cirurgião de catarata. A classe de fármacos anticoagulantes e antiplaquetária reduz a incidência de eventos potencialmente tromboembólicos. A anestesia tópica ou intracameral nesses pacientes deve ser preferida em relação à anestesia com agulhas. Aspirina pode ser mantida com segurança nos pacientes submetidos à cirurgia de catarata. A varfarina foi amplamente estudada e os riscos na cirurgia de catarata são baixos, no entanto, o INR deve ser controlado. Mais estudos são necessários com anticoagulantes orais diretos. Anestesia na cirurgia de catarata tem baixo risco de complicações, mesmo em uso de anticoagulantes ou antiplaquetários sistêmicos. A descontinuação desta classe de medicamentos no pré-operatório da cirurgia de catarata pode aumentar os riscos sistêmicos tromboembólicos.


Subject(s)
Humans , Platelet Aggregation Inhibitors/administration & dosage , Cataract Extraction/methods , Anticoagulants/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Cataract Extraction/adverse effects , Risk Factors , Venous Thromboembolism/prevention & control , Intraoperative Period , Anticoagulants/adverse effects
19.
Clinics ; 72(9): 543-546, Sept. 2017. tab
Article in English | LILACS | ID: biblio-890729

ABSTRACT

OBJECTIVE: To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns. METHODS: Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated. RESULTS: The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group. CONCLUSIONS: The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Acrylic Resins/economics , Acrylic Resins/therapeutic use , Lens Implantation, Intraocular/methods , Lenses, Intraocular/economics , Phacoemulsification/methods , Capsule Opacification/etiology , Costs and Cost Analysis , Follow-Up Studies , Lens Implantation, Intraocular/adverse effects , Lens Implantation, Intraocular/economics , Lenses, Intraocular/adverse effects , Phacoemulsification/adverse effects , Phacoemulsification/economics , Postoperative Complications , Prosthesis Design , Reproducibility of Results , Time Factors , Treatment Outcome , Visual Acuity
20.
Arq. bras. oftalmol ; 80(2): 93-96, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838788

ABSTRACT

ABSTRACT Purpose: We aimed to report and analyze topographic and refractive outcomes following corneal collagen crosslinking (CXL) in patients with progressive keratoconus (KC). Methods: We performed a retrospective, analytical, and observational study of 100 eyes from 74 progressive KC patients who underwent CXL at the Eye Hospital of Paraná. Keratometric values were analyzed preoperatively as well as 3 and 12 months postoperatively. Results: For a total of 100 eyes, 68 belonged to male patients. The mean age of our study population was 19.9 ± 5.61 years. The average visual acuity and topographic parameters overall were stable after 1 year (p<0.05). After 3 months, steepest keratometry reading (K2) and maximum keratometry (Kmax) were significantly decreased (p<0.05). Regarding topographic astigmatism (dK), there was no significant difference between the 3-month and 12-month follow-ups. When we made comparisons between genders following CXL, there were no significant differences related to the changes in Kmax, K2, and spectacle-corrected distance visual acuity (SCDVA). Conclusions: CXL promoted stabilization or improvement of keratometric values and visual acuity. We found that keratoconus apex stability may be achieved 3 months after the procedure. There was no significant difference in keratometric and refractive values measured between male and female patients.


RESUMO Objetivos: Relatar e analisar os resultados topográficos e refracionais após crosslinking de colágeno corneano (CXL) em pacientes com ceratocone (KC) progressivo. Métodos: Estudo retrospectivo analítico e observacional incluindo 100 olhos de 74 pacientes com KC progressivo submetidos a CXL no Hospital de Olhos do Paraná. Valores ceratométricos foram analisados no pré-operatório, 3 e 12 meses de pós-operatório. Resultados: Em um total de 100 olhos, 68 eram do sexo masculino. A idade média foi de 19,9 ± 5,61. As médias de parâmetros topográficos e acuidade visual em geral, tiveram estabilidade após 1 ano de follow-up (p<0,05). Após 3 meses, a ceratometria mais curva (K2) e a ceratometria máxima (Kmax) tiveram reduções estatisticamente significativas (p<0,05). Em relação ao astigmatismo topográfico (dK), não houve diferença estatisticamente significativa aos 3 e 12 meses de seguimento. Comparando ambos os sexos após o procedimento, não houve diferenças estatisticamente significativas relacionadas às mudanças em Kmax, K2 e acuidade visual corrigida. Conclusões: CXL promoveu a estabilidade ou melhora dos valores ceratométricos e da acuidade visual. Encontramos que a estabilidade do ápice do KC pode ser obtida nos três primeiros meses de follow-up. Não houve diferença estatisticamente significativa nos valores topográficos e refracionais medidos entre pacientes do sexo masculino e feminino.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Collagen/therapeutic use , Corneal Topography/statistics & numerical data , Cross-Linking Reagents/therapeutic use , Keratoconus/therapy , Refraction, Ocular/physiology , Ultraviolet Therapy/methods , Preoperative Care , Visual Acuity/physiology , Sex Factors , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Disease Progression , Keratoconus/physiopathology
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