Crystalline lens decentration and tilt in eyes with different axial lengths and their associated factors

Purpose: To analyze crystalline lens decentration and tilt in eyes with different axial lengths (ALs) using a swept?source anterior segment optical coherence tomography (SS?AS?OCT). Methods: Patients with normal right eyes who visited our hospital between December 2020 and January 2021 were included in this cross?sectional study. Data on crystalline lens decentration and tilt, AL, aqueous depth (AD), central corneal thickness (CCT), lens thickness (LT), lens vault (LV), anterior chamber width (ACW), and angle ? were collected. Results: A total of 252 patients were included and divided into normal (n = 82), medium–long (n = 89), and long (n = 81) AL groups. The average age of these patients was 43.63 ± 17.02 years. The crystalline lens decentration (0.16 ± 0.08, 0.16 ± 0.09, and 0.20 ± 0.09 mm, P = 0.009) and tilt (4.58° ± 1.42°, 4.06° ± 1.32°, and 2.84° ± 1.19°, P < 0.001) were significantly different among the normal, medium, and long AL groups. Crystalline lens decentration was correlated with AL (r = 0.466, P = 0.004), AD (r = 0.358, P = 0.006), ACW (r = ?0.004, P = 0.020), LT (r = ?0.141, P = 0.013), and LV (r = ?0.371, P = 0.003). Crystalline lens tilt was correlated with age (r = 0.312, P < 0.001), AL (r = ?0.592, P < 0.001), AD (r = ?0.436, P < 0.001), ACW (r = ?0.018, P = 0.004), LT (r = 0.216, P = 0.001), and LV (r = 0.311, P = 0.003). Conclusion: Crystalline lens decentration was positively correlated with AL, and tilt was negatively correlated with AL

Prediction of vault after implantable collamer lens implantation and its research progress / 国际眼科杂志(Guoji Yanke Zazhi)

Myopia is considered to be a disease occurred under the influence of genetic and environmental factors, and it can only be restored by corrective surgeries. The current surgical methods include laser surgeries and phakic intraocular lens(PIOL)implantation, and PIOL has the advantages of wide range of correction, repeatable procession and small damage to corneal tissue. Furthermore, good visual acuity can be achieved after implantation of intraocular lens. Implantable collamer lens(ICL)is the most common surgical method in this group. The vertical distance between the highest point of the posterior central surface of the implanted lens and the anterior surface of the crystalline lens is called vault. It will cause serious complications if the vault turns out to be abnormal. Up to now, there is no optimal prediction method. This research focuses on vault, discusses the ideal range of postoperative vault, the safety and effectiveness of this surgery, and analyzes the existing prediction methods to provide directions for future clinical research.

Result of implantation of scleral-fixated posterior chamber intraocular lenses / Шинэ санаа Шинэ нээлт

Purpose@#The aim of this study was to determine the surgical and visual outcomes of scleral fixated intraocular lens implantation in eyes with as subluxated and dislocated crystalline lens or traumatic aphakic eyes.@*Methods@#A retrospective and short-term prospective cohort study was carried out in 45 eyes of 43 individuals who underwent SFIOL implantation surgery in First Central Hospital of Mongolia between January 2017 and January 2020 and had a minimum follow-up of 3 months. Pre-operative and post-operative best corrected visual acuity, postoperative outcomes and complications were summarized. Patients after the implantation of a scleral fixated PCIOL were evaluated for the disease etiology, pre- and post-operative best corrected visual acuity, and occurrence of postoperative complications.@*Results@#The analysis included 45 eyes from 43 patients. Thirty-two (74.4%) patients were men and eleven (24.6%) were women . The mean age at implantation was 57.2 ± 20.0. Indications for the IOL implantation included ocular trauma (48.9%), pseudoexfoliation syndrome (22.2%) and Marfan syndrome (15.6%). Disease etiology and age group were compared and results were Marfan syndrome is mostly diagnosed in 20-29 years of age, ocular trauma is usually diagnosed in 30-69 years of age and pseudoexfoliation syndrome is occurred in 70 and above of age. Post-operative visual acuity was improved in all cases from which 35 of patients (77.77%) visual outcome was 6/12 and above. </br> The mean preoperative best corrected visual acuity (BCVA) was 0.083 ± 0.088, which improved to 0.569 ± 0.221 (p<0.001) third month postoperatively and these were statistically significant.</br> The most frequent complication was induced astigmatism, which occurred in 6 eyes which successfully corrected with glasses. Suture erosion occurred in three eyes which successfully relocate it. The most serious complications such as vitreous hemorrhage, retinal detachment, suprachoroidal hemorrhage, endophthalmitis and suture degradation or breakage was not seen.@*Conclusion@#Ab externo SFIOL implantation is a reasonable technique for the management of eyes with aphakia or absence of capsular support, with relatively high visual outcomes and few serious complications.</br> The most frequent cause of aphakia and absence of capsular support was ocular trauma thus, pseudoexfoliation and Marfan syndrome were the most common in elderly and in young age, respectively.

Effect of crystalline lens rise on the vault after implantation of phakic posterior chamber implantable collamer lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the relationship between crystalline lens rise(CLR)measured by anterior segment-optical coherence tomography(AS-OCT)and parameters of the anterior segment. And also measure the effects of CLR on the vault after phakic posterior chamber implantable collamer lens(PPC-ICL)implantation.<p>METHODS:The study included 80 eyes of 40 patients who underwent PPC-ICL implantation at the Department of Ophthalmology, the Second Affiliated Hospital of Anhui Medical University, from July 2017 to July 2018, to measure the sulcus-to-sulcus(hSTS)distance of the eyes using a Compact Touch STS ultrasound biomicroscope and lens curvature(LC), Pentacam was used to measure horizontal-white-to-white(hWTW), anterior chamber depth(ACD)and the vault one year after the operation. Moreover, AS-OCT was used to measure the CLR and horizontal iridocorneal angle-to-iridocorneal angle diameter(ATA).<p>RESULTS:CLR was negatively correlated with ACD(<i>r</i>= -0.706, <i>P</i><0.01)and vault one year after the operation(<i>r</i>= -0.509, <i>P</i><0.01); however, it was positively correlated with LC(<i>r</i>=0.667, <i>P</i><0.01). There was no correlation between CLR and hWTW(<i>r</i>=0.123, <i>P</i>=0.275), ATA(<i>r</i>=0.208, <i>P</i>=0.065)and hSTS(<i>r</i>=0.147, <i>P</i>=0.194). One year after the operation, there was a positive correlation between the vault and ACD(<i>r</i>=0.680, <i>P</i><0.01).<p>CONCLUSION:CLR has obvious correlation with ACD and LC, arch height after PPC-ICL and has a specific effect on the prediction of the vault after PPC-ICL implantation.

Effect of silencing SIAH1 gene on H2O2-induced apoptosis of human lens epithelial cells / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of silencing SIAH1 gene on H2O2-induced apoptosis of human lens epithelial cells.<p>METHODS: The human lens epithelial cell line HLE-B3 was cultured and divided into normal group, H2O2 group(cultured with medium containing 400μmol/L H2O2)and H2O2+siR-SIAH1 group(transfected with SIAH1 interference sequence, followed by cultured with medium containing 400μmol/L H2O2)and siR-NC group(transfected with negative control sequence, followed by cultured with medium containing 400μmol/L H2O2). The expression of SIAH1 gene in cells was detected by real-time fluorescent quantitative PCR. The apoptosis rate was detected by flow cytometry. The expressions of p38 MAPK, p-p38 MAPK, Bcl-2 and Bax proteins were detected by Western blot.<p>RESULTS: The relative expression levels of SIAH1 mRNA in the H2O2 group, siR-NC group and H2O2+siR-SIAH1 group were higher than that in the normal group(<i>P</i><0.05). The relative expression level of SIAH1 mRNA in H2O2+siR-SIAH1 group was lower than those in the H2O2 group and siR-NC group(<i>P</i><0.05). The apoptosis rates in the H2O2 group, siR-NC group and H2O2+siR-SIAH1 group were higher than that in the normal group(<i>P</i><0.05). The apoptosis rate in the H2O2+siR-SIAH1 group was lower than those in the H2O2 group and siR-NC group(<i>P</i><0.05). The expression levels of p38 MAPK and Bcl-2 proteins in the H2O2 group, siR-NC group and H2O2+siR-SIAH1 group were lower than those in the normal group, while the expression levels of p-p38 MAPK and Bax proteins were higher than those in the normal group(<i>P</i><0.05). The expression levels of p38 MAPK and Bcl-2 proteins in the H2O2+siR-SIAH1 group were higher than those in the H2O2 group and siR-NC group, while the expression levels of p-p38 MAPK and Bax proteins were lower than those in the H2O2 group and siR-NC group(<i>P</i><0.05).<p>CONCLUSION: Down-regulation the expression of SIAH1 gene could inhibit H2O2-induced apoptosis of human lens epithelial cell line HLE-B3, which might be related to inhibition of p38 MAPK signaling pathway activation.

Ruptura de la cápsula posterior en la cirugía del cristalino / Posterior capsule rupture in crystalline lens surgery

RESUMEN La cirugía de catarata constituye hoy en día un reto para el cirujano oftalmólogo. Cada año se someten a este proceder miles de pacientes con el único propósito de mejorar su calidad visual, y por tanto su calidad de vida. Es por esto que lograr un acto quirúrgico libre de complicaciones es vital para que este procedimiento se pueda efectuar sin contratiempos. El advenimiento de nuevas técnicas quirúrgicas y de la tecnología de punta hace que el cirujano de catarata esté constantemente tratando de satisfacer las exigencias de los pacientes que se someten a esta intervención. Teniendo en cuenta que dentro de las complicaciones transoperatorias una de las más frecuentes y temidas es la ruptura de la cápsula posterior, se realizó una búsqueda de diversos artículos publicados en los últimos diez años, utilizando la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con el objetivo de conocer los principales factores de riesgo, el diagnóstico, el manejo y las complicaciones asociadas a la ruptura capsular tras la cirugía del cristalino(AU)

ABSTRACT Cataract surgery is nowadays a challenge for eye surgeons. Thousands of patients undergo cataract surgery every year with the sole purpose of improving their visual quality and thus their quality of life. It is therefore crucial that complications do not occur during surgery, so that the procedure may be conducted without any mishap. Cataract surgeons should be aware of the new surgical techniques and state-of-the-art technology in the field to meet the demands of patients undergoing this surgical procedure. Bearing in mind that posterior capsule rupture is one of the most common and feared intraoperative complications, a search was conducted of papers published on the Infomed platform, particularly the Virtual Health Library, in the past ten years, with the purpose of collecting information about the main risk factors, diagnosis, management and complications associated to capsule rupture after lens surgery(AU)

La ectopia lentis y las soluciones quirúrgicas en la cirugía de catarata / Ectopia lentis and surgical solutions in cataract surgery

RESUMEN La extracción del cristalino en pacientes con ectopia lentis se convierte en una cirugía desafiante para el cirujano. En el pasado surgieron serias complicaciones asociadas a esta intervención quirúrgica, como desprendimiento de retina y glaucoma. El avance de las técnicas quirúrgicas en las últimas décadas ha brindado mayor seguridad para la cirugía de esta afección del cristalino. Se presenta una paciente femenina de 47 años aquejada de disminución de la visión. Al examen oftalmológico se encuentra subluxación superior del cristalino bilateral. Previa discusión con la paciente de los posibles escenarios a presentarse durante la cirugía, se le sugiere una facoemulsificación bilateral secuencial del cristalino conservando el saco capsular mediante la colocación de un anillo de tensión capsular fijado a la esclera más implante de lente intraocular plegable en el saco capsular. Se realiza primeramente cirugía del ojo izquierdo y se presenta un desgarro radial de la rexis con extensión posterior, por lo que se varía el abordaje quirúrgico y se fija el implante al iris. Un mes después se realiza cirugía del ojo derecho siguiendo el plan quirúrgico inicial sin complicaciones. La recuperación visual fue satisfactoria (0,7 en cartilla de Snellen) en ambos ojos y se demostró la efectividad de ambas alternativas quirúrgicas. La planificación correcta de la técnica quirúrgica y de las posibles modificaciones ante circunstancias sobrevenidas, así como la oportuna información preoperatoria y la experiencia del cirujano resultan fundamentales para alcanzar el éxito quirúrgico, la recuperación funcional y la satisfacción del paciente(AU)

ABSTRACT Crystalline lens removal in patients with ectopia lentis is a challenge for eye surgeons. Serious complications, such as retinal detachment and glaucoma, were associated in the past to this surgical procedure. However, the progress in surgical techniques achieved in recent decades provides greater safety in the surgical treatment of this lens disorder. A female 47-year-old patient attends consultation complaining of vision reduction. Ophthalmological examination reveals bilateral crystalline lens upper subluxation. The possible scenarios to occur during surgery are discussed with the patient, and it is suggested that she undergoes sequential bilateral lens phacoemulsification preserving the capsular bag with the placement of a capsular tension ring fixed to the sclera plus implantation of a foldable intraocular lens in the capsular bag. The first eye to be operated on is the left eye, and radial tear of the rhexis with posterior extension occurs. Therefore, the surgical approach is changed and the implant is fixed to the iris. Surgery of the right eye is performed one month later, following the initial surgical plan without any complications. Visual recovery was satisfactory (0.7 by the Snellen chart) in both eyes, proving the effectiveness of both surgical alternatives. Correct planning of the surgical technique and its possible modifications in response to unexpected circumstances, alongside timely preoperative information and the surgeon's experience, are all crucial to achieve surgical success, functional recovery and patient satisfaction(AU)

Facoemulsificación del cristalino transparente en pacientes con alta miopía / Phacoemulsification applied to transparent crystalline lens in high myopic patients

Objetivo: evaluar los resultados de la facoemulsificación del cristalino transparente en pacientes con alta miopía. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo en el Hospital Enrique Cabrera, entre agosto del año 2006 y agosto de 2009. El universo estuvo constituido por pacientes altos miopes (³ 6 dioptrías) quienes acudieron a la consulta de Oftalmología durante el período señalado. La muestra fue de 110 ojos de 61 pacientes a quienes se le realizó extracción del cristalino transparente por la técnica de facoemulsificación con implante de lente intraocular, igual o mayores de 40 años, que cumplían con los criterios de inclusión y exclusión y que dieron su consentimiento informado. Resultados: el 60 por ciento de los ojos intervenidos mejoraron la agudeza visual sin corrección. De los 110 ojos intervenidos, 108 conservaron una mejor agudeza visual corregida posoperatoria igual o superior a la preoperatoria. El equivalente esférico obtenido en más del 95 por ciento de los ojos quedó en el rango esperado, lo que demostró una elevada predictibilidad de la fórmula (SRK/T) utilizada para el cálculo de la potencia del lente intraocular implantado. El astigmatismo inducido fue mínimo. No se registraron complicaciones transoperatorias y las posoperatorias fueron pocas. Conclusión: la facoemulsificación del cristalino transparente en pacientes con alta miopía es una alternativa de tratamiento quirúrgico segura y eficaz(AU)

Objective: to evaluate the results of phacoemulsification technique in treating high myopic patients. Methods: a prospective, longitudinal and descriptive study was conducted in Enrique Cabrera hospital in the period of August 2006 to August 2009. The universe was made up of high myopic patients (³ 6 dioptries), who went to the ophthalmology service in this period. The sample was 110 eyes from 61 forty years-old and older patients who had undergone transparent crystalline lens extraction by the phacoemulsificación technique with intraocular lens implantation, met the inclusion criteria and given their informed consent. Results: sixty percent of surgical eyes improved their uncorrected visual acuity. Of 110 operated eyes, 108 kept best corrected visual acuity equal or better than preoperative one after the surgery. The spheral equivalent obtained in more than 95 percent of the eyes was within expected range, showing high predictability of the formula (SRK/T) used for the calculation of the intraocular lens power. Induced astigmatism was minimal. No perioperative complications were reported whereas postoperative ones were few. Conclusions: it can be concluded that phacoemulsification in high myopic patients is a safe and effective surgical treatment option(AU)

AppIication of capsuIar tension ring in phacoemuIsification / 国际眼科杂志(Guoji Yanke Zazhi)

· Application of capsular tension ring ( CTR ) in phacoemulsification has become a common method to increase the stability of the capsular bag. CTR can effectively reduce the posterior capsular opacification ( PCO) , prevent intraocular lens ( lOL ) decentration and tilt, not cause lOL degree deviation and aberration increase.ln this review, we summarized the development overview of CTR in phacoemulsification.

Inadvertent Intralenticular Dexamethasone Implant for Diabetic Macular Edema Unresponsive to Bevacizumab

PURPOSE: To report a case of inadvertent intralenticular slow-release dexamthasone implant (Ozurdex(R), Allergan Inc., Irvine, CA, USA) for diabetic macular edema unresponsive to bevacizumab. CASE SUMMARY: A 71-year-old woman presented with proliferative diabetic retinopathy. During follow-up, diabetic macular edema developed in both eyes and did not improve with intravitreal bevacizumab injections. For refractory diabetic macular edema, slow-release dexamthasone implant (Ozurdex(R)) was to be injected at the vitreous cavity of her left eye, but it was inadvertently injected into the crystalline lens. The patient was followed closely for 10 months. Diabetic macular edema completely resolved 1 month after the injection and did not recur during follow-up. There were no severe complications except mild cataract formation. Best-corrected visual acuity for the left eye improved from 0.1 to 0.2. The Ozurdex(R) implant slightly decreased after 10 months, but was still observed in the crystalline lens. CONCLUSIONS: The inadvertent intralenticular dexamthasone implant was a rare complication but effective for diabetic macular edema.

Modified Capsular Tension Ring Scleral Fixation and Toric Intraocular Lens Implantation in a Patient with Homocystinuria

PURPOSE: Purpose: To report a case of modified capsular tension ring scleral fixation and in-the-bag toric intraocular lens (IOL) implantation in a pediatric patient with severe crystalline lens subluxation due to homocystinuria. CASE SUMMARY: A 9-year-old male diagnosed with homocystinuria and crystalline lens subluxation presented with progressive decrease of visual acuity. Uncorrected distant visual acuity (UDVA) and corrected distant visual acuity were 0.03 and 0.6 in the right eye and 0.01 and 0.5 in the left eye, respectively. Slit-lamp examination showed severe crystalline lens subluxation toward the inferiomedial side in both eyes. Corneal astigmatism in the right eye and left eye was 2.75 diopters (D) and 3.00 D, respectively based on keratometry. A combination of subluxated crystalline lens aspiration, scleral-fixated modified capsular tension ring insertion and in-the-bag toric IOL implantation were performed in both eyes. After continuous curvilinear capsulorhexis, nucleus and cortex of the crystalline lens were removed by irrigation and aspiration. A modified capsular tension ring with 2 fixation hooks (Model 2-L) was inserted into the capsular bag and fixed at the scleral wall. Next, toric IOL was inserted into the capsular bag. UDVA was 0.8 in the right eye and 0.9 in the left eye and 3 months postoperatively, the IOL rotation was less than 3 degrees from intended axis in both eyes. CONCLUSIONS: In a patient with severe congenital crystalline lens subluxation and moderate to severe corneal astigmatism, scleral fixation of modified capsular tension ring and in-the-bag toric IOL implantation is a possible surgical option.

Effects of ultra-shortwave irradiation on the expression of the apoptosis-related genes Bcl-2 and Bax in the lens epithelial cells of the eye / 中华物理医学与康复杂志

Objective To observe the effects of low-dose ultra-shortwaves radiationon the expression of apoptosis-related genes Bcl-2 and Bax in lens epithelial cells(LECs) of rats.Methods Thirty-six Wistar rats were divided into a normal group(n=8 eyes),a control group(n=32 eyes) and an experiment group(n=32 eyes) randomly.Both eyes of each rat in the experiment group were exposed to a low-dose ultra-shortwave radiation for 7min,once a day until the end of experiment,while the control groups were not.Rats were executed after 1 w,3w,6w and 9w.Both eyes were resected,and lens were separated under a microscope and sectioned in paraffin.After Streptavidin-Biotin Complex (SABC) staining,Bcl-2 and Bax expression in the LECs were detected using an image analysis technique,and the data were analyzed using the software of SPSS 13.0.Results The average integral optical density (AIOD) of Bcl-2 expression in the experiment group was (0.391 ± 0.014) after 1 week,(0.4470.006) after2,(0.417 ±0.011) after3 and (0.275 ±0.007) after4 weeks.The corresponding AIODs for Bax expression were (0.180 ±0.015),(0.155 ± 0.007),(0.167 ± 0.003) and (0.251 ± 0.016) respectively.After l w of daily radiation,no significant difference was found in the expressions of Bcl-2 and Bax protein between the experimental and the other 2 groups(P ＞ 0.05).Three weeks after the radiation,however,the expression of Bcl-2 protein in the experimental group was significantly higher than the control groups(P＜0.001),with that of Bax being significantly lower(P＜0.001).However,the expressions of Bcl-2 protein was significantly down-regulated and the expression of Bax protein was significantly up-regulated 6w later compared with those after3 w of exposure in the experiment group(P＜0.001) After9w,in the experimental group,the expressions of Bcl-2 protein was obviously down-regulated and significantly lower than the control group.Moreover,the expression of Bax protein increased significantly compared to the control group (P＜0.01).And there was no significant difference between the control and normal group(P＞0.05) in the expression of Bcl-2 and Bax.Conclusions Low doses of ultra-shortwave radiation may protect LECs against apoptosis for a few days,but they may cause damage with repeated exposure.

Estudio densitométrico del cristalino y su relación con el sistema LOCS III / Densitometric study of the crystalline lens and its relationship with the LOCS III system

Objetivo: determinar la dureza nuclear del cristalino clasificada por el Lens Opacities Classification System (LOCS III) y su relación con la densitometría del cristalino. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer, desde enero de 2011 hasta diciembre de 2011, en 290 pacientes diagnosticados con catarata y operados con la técnica de facoemulsificación por pre chop, más implante de lente intraocular. Resultados: los núcleos cristalineanos (N) clasificados del N1 al N6 aumentaron la densitometría del cristalino hasta un valor de 46,5 por ciento, con tiempo efectivo de facoemulsificación de 0,54 min relacionado a la dureza nuclear, al igual que las clasificadas de P2 a P5 donde la densitometría fue hasta 66,1 por ciento con valores de tiempo efectivo de facoemulsificación de 0,46 min. La edad media fue de 63,8 años de edad, se planificó una refracción esperada para -0,16 D, el equivalente esférico posoperatorio fue de 0,50 D y el astigmatismo medio inducido de -0,56 D. La mejor agudeza visual sin corrección mejoró a 0,81 en el posoperatorio y la corregida final fue de 0,96. Conclusiones: el estudio densitométrico del cristalino, como valor objetivo de su dureza, le permite al cirujano trazarse una estrategia quirúrgica adecuada en cada paciente para lograr una verdadera cirugía refractiva personalizada del cristalino y resultados visuales óptimos

Objective: To determine the nuclear hardness of the crystalline lens according to the Lens Opacities Classification System (LOCS III) and its relationship with the crystalline lens densitometry. Methods: A prospective, cross-sectional and descriptive study was conducted in 290 patients diagnosed with cataract and operated on by the prechop phacoemulsification technique plus intraocular lens implantation, at Ramon Pando Ferrer Cuban Institute of Ophthalmology from January to December, 2011. Results: The crystalline lens nuclei classified as N1 to N6 increased the lens crystalline densitometry up to 46.5 percent, with effective phacoemulsification time of 0.54min with respect to the .nucleus hardness; the densitometry value in the nuclei classified P2 to P5 rose to 66.1 percent where the effective phacoemulsification time was 0.46. The average patients' age was 63.8 years, the expected refraction was planned to be -0.16D, the postoperative spherical equivalent was 0.50 D and the mean induced astigmatism reached -0.56 D. The best uncorrected visual acuity improved by 0.81 in the postoperative period and the final corrected acuity was 0.96. Conclusions: The densitometric study of the crystalline lens, as concrete value of hardness, allows the surgeon to draw an adequate surgical strategy for each patient in order to make a real customized refractive surgery of the crystalline lens and to obtain the optimal visual results

Interpreting human eye accommodation from the perspective of morphological studies: A discussion with the author of ‘A novel concept of accommodation: Human eyes optical system based on hyperfocal distance-micro zoom ' / 中华实验眼科杂志

Accommodation of the human eye ian extremely complex and dynamiprocess,which iaccomplished by the interaction between the central nervousystem and variouoculastructurethaare relevanto accommodation.Varioumechanismof accommodation have been puforward since the beginning of the 19th century,among which Helmhohz'theory ithe mosfamous.However,iistill challenged by othetheories.So far,the mechanism of accommodation hanobeen fully understood.The mosdirecmethod to study accommodation ito observe changein the biometry of the oculastructureduring accommodation,which ialso the mosobjective interpretation of accommodative mechanisms.The rapid developmenof imaging technologiein regardto ophthalmology makethipossible.Thiarticle aimto describe the use of variouimaging technologiein oculaaccommodative studiein vivo from the perspective of morphology.

Resultados analgésicos de anestesia tópica-intracameral en cirugía de catarata senil / Analgesic results of topical- intracamera anesthesia in the surgery of senile cataract

Introducción: La catarata es la causa más frecuente de ceguera prevenible y su tratamiento es quirúrgico y aunque se perfeccionó la técnica con una incisión más pequeña y sin puntos, algunos pacientes refieren dolor, por tanto al cooperar menos puede haber mayor incidencia de complicaciones peripostoperatorias inmediatas en la extracción extracapsular del cristalino. Objetivos: Evaluar los resultados analgésicos de la anestesia tópica-intracameral en la extracción extracapsular de cristalino por técnica tunelizada de mininúcleo con implante de lente intraocular en catarata senil. Material y métodos: Se realizó estudio descriptivo prospectivo de corte longitudinal en una muestra de 333 pacientes con diagnóstico de catarata senil, que se les realizó extracción extracapsular de cristalino por técnica tunelizada de mininúcleo e implante de lente intraocular, bajo anestesia tópica-intracameral, desde marzo del 2009 hasta marzo del 2010. Se determinó la percepción de dolor durante el tratamiento quirúrgico mediante la Escala Análoga Visual. Se describieron las complicaciones intraoperatorias y postoperatorias inmediatas y la satisfacción del cirujano y el paciente durante el acto quirúrgico. La información fue recopilada en una hoja de encuesta y se resumió todos los datos mediante estadística descriptiva. Resultados: La media de la edad fue de 69 años, 213 pacientes (64 %) no tuvo ningún dolor y solo ocurrieron 19 (5.7 %) complicaciones oculares 17 (5.1%) que se asociaron a hipertensión arterial intraoperatoria. Conclusiones: La anestesia tópica-intracameral es una técnica segura para realizar cirugía tunelizada de catarata senil por extracción extracapsular de cristalino.

Introduction: The cataract is the more frequent cause of preventable blindness and its treatment is surgical and although the technique was improved using an smaller incision and no sutures, some patients feel pain, thus with less cooperation more incidence of immediate perioperative complications could be present in the extracapsular extraction of crystalline lens. Objectives: To assess the analgesic results of the topical-intracamera anesthesia in the crystalline lens extraction by tunnel of mini-nucleus technique with intraocular implant in cases of senile cataract. Material and Methods: A longitudinal, prospective and descriptive study was conducted in 333 patients diagnosed with senile cataract underwent crystalline extracapsular extraction by tunnel of mini-nucleus technique and implant of ocular lens under topical-intra-camera anesthesia from March, 2009 to March, 2010. Authors determined the pain perception during surgical treatment according to Visual Analogue Scale. The immediate intraoperative and postoperative complications were described as well as the satisfaction of the surgeon and the patient during the surgical act. The information was registered in survey sheet grouping all data by descriptive statistics. Results: The mean age was of 69 years, 213 patients (64%) had not pain and only occurred 19 ocular complications (5,7%) 17 (5.1%) that were associated with an intraoperative high blood pressure. Conclusions: The topical-intra-camera anesthesia is a safe technique to carry out the tunnel surgery of senile cataract by extracapsular extraction of crystalline lens.

Effect of Preoperative Crystalline Lens Rise on Vaulting after Implantable Collamer Lens Implantation

PURPOSE: To evaluate the parameters affecting vaulting and correlation between preoperative crystalline lens rise and vaulting after implantable collamer lense (ICL) implantation. METHODS: A total of 53 eyes of 34 patients who underwent ICL implantation were examined retrospectively. White-to-white (WTW) and anterior chamber depth (ACD) were obtained from scanning topography (ORB scan) before surgery. Preoperative crystalline lens rise (CLR) and vaulting at 6 months after ICL implantation were measured using anterior segment optic coherence tomography (AS-OCT). Multiple regression analysis was performed to evaluate the factors affecting central vaulting. RESULTS: The mean preoperative crystalline lens rise was -120 +/- 219 microm, and mean central vaulting 6 months after surgery was 544 +/- 175 microm. Preoperative SE, WTW, ACD, and CLR were significantly correlated with vaulting at 6 months after surgery. With the use of meaningful variables, multiple regression analysis showed that CLR, WTW, ACD and SE, in that order of influence, had significant effects on vaulting and the multiple regression equation was obtained as follows: Vaulting (microm) = (160.913 x ACD (mm)) + (170.134 x WTW (mm)) + (-0.338 x CLR (microm)) + (-23.783 x SE (D)) - 2250.184. CONCLUSIONS: CLR had a stronger influence on vaulting after ICL implantation than the previously proven parameters: WTW, ACD, and SE. In addition to WTW, ACD and SE, CLR should also be considered a new criterion for estimating vaulting after ICL implantation.

Resultados anatómicos y funcionales en la cirugía de catarata mediante la técnica de extracción extracapsular del cristalino versus facoemulsificación / Anatomical and functional results in cataract's surgery by extracapsular extraction of crystalline lens versus phacoemulsification

OBJETIVOS: Evaluar resultados anatómicos y funcionales mediante las técnicas de extracción extracapsular del cristalino (tunelizada con viscoelástico) y facoemulsificación (facochop) e identificar las complicaciones transosoperatorias y posoperatorias más frecuentes. MÉTODOS: Se realizó una investigación observacional descriptiva longitudinal en 386 ojos con catarata sometidos a cirugía en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre enero y diciembre de 2009. Se estudiaron en dos grupos, según técnica quirúrgica empleada. En 140 ojos se realizó extracción extracapsular del cristalino (tunelizada con viscoelástico) y en 246 ojos se efectuó facoemulsificación (facochop). Se analizaron el tipo de catarata, la agudeza visual sin corrección y mejor corregida, así como el cilindro queratométrico preoperatorio y el posoperatorio, las complicaciones transoperatorias y las posoperatorias. Se realizó seguimiento posoperatorio durante tres meses. RESULTADOS: Predominaron mujeres de 60 - 80 años; la media de la agudeza visual sin corrección y mejor corregida posoperatoria fue similar en ambos grupos (0,6 y 0,8). La frecuencia de complicaciones transquirúrgicas y posoperatorias entre ambos grupos no difirió de modo significativo (10,7 vs. 8,5 por ciento; 13,5 vs. 6,5 por ciento). CONCLUSIONES: Ambas técnicas resultaron ser efectivas para lograr calidad visual en pacientes operados de catarata

OBJECTIVES: To assess the anatomical and functional results using the techniques of the crystalline extracapsular lens extraction (tunneled with viscoelasticity) and phacoemulsification (phacochop) and also to identify the more frequent complications trans- and postoperative. METHODS: A longitudinal, descriptive and observational research was conducted in 386 eyes with cataract operated on the Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to December, 2009 and studied in two groups according the surgical technique used. In 140 eyes a crystalline lens extraction was carried out (tunneled with viscoelasticity) and in 246 eyes with phacoemulsification (phacochop). Authors analyzed the type of cataract, the visual acuity without correction and better corrected, as well as the preoperative and postoperative keratometry cylinder, the transoperative and postoperative complications. There was a postoperative follow-up for three months. RESULTS: There was predominance of women aged 60-80; the mean of visual acuity without correction and better postoperative corrected was similar in both groups (0.6 and 0.8). The frequency of trans-surgical and postoperative complications between both groups not differed significantly (10.7 versus 8.5 percent; 13,5 versus 6.5 percent). CONCLUSIONS: Both techniques turned out to be effective to achieve visual quality in operated patients of cataract.

Contraindicaciones de la cirugía de catarata en pacientes del municipio Maracaibo / Cataract surgery contraindications for patients from Maracaibo municipality

Se hizo un estudio descriptivo y transversal de 76 pacientes con catarata, que no pudieron ser intervenidos quirúrgicamente en el Centro Oftalmológico del municipio de Maracaibo, perteneciente al estado de Zulia (Venezuela), desde junio hasta julio del 2009, a fin de identificar las principales causas que estaban contraindicando la operación de esa oftalmopatía, para lo cual se examinó un ojo de cada integrante de la serie. En la casuística predominaron el grupo etario de 60-69 años y el sexo masculino, así como la agudeza visual por debajo de 0,3 y el diagnóstico prequirúrgico de catarata senil. La degeneración macular asociada a la edad prevaleció como la enfermedad más frecuente que invalidara la cirugía, con primacía de la opacidad lenticular nuclear en cuanto a la clasificación morfológica. Se concluyó que no siempre la opacidad del cristalino causa la mala visión, por lo que es necesario realizar un detallado examen oftalmológico.

A descriptive and cross-sectional study of 76 patients with cataract, who could not be surgically treated at the Ophthalmological Center from Maracaibo municipality, belonging to Zulia State (Venezuela), was carried out from June to July, 2009 in order to identify the main causes that were contraindicating the ophthalmopathy surgery, for which each participant's eye was examined. The 60-69-year-old age group and male sex, as well as the visual sharpness under 0,3 and pre-surgical diagnosis of senile cataract, were predominant in the case material. Macular degeneration associated with age prevailed as the most frequent disease invalidating the surgery, giving some priority to nuclear lenticular opacity according to morphological classification. It was concluded that opacity of crystalline lens does not always cause bad vision, thus it is necessary to carry out a detailed ophthalmological test.

Protective Effect of Catechin on Apoptosis of the Lens Epithelium in Rats with N-methyl-N-nitrosourea-induced Cataracts

PURPOSE: To investigate the effect of catechin on apoptotic cell death in the lens epithelium of rats with cataract. METHODS: Cataract was induced by intraperitoneal injection of 100 mg/kg N-methyl-N-nitrosourea (MNU) to ten day-old Sprague-Dawley rats. The neonatal rats were randomly divided into five groups (n=15 in each group): a control group, and four cataract-induction groups, treated with either 0, 50, 100, 200 mg/kg catechin. We performed slit-lamp biomicroscopic analysis, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, Western-blot for Bcl-2 and Bax, and immunohistochemistry for caspase-3. RESULTS: Apoptotic cell death in lens epithelial cells that increased following cataract formation in rats was suppressed by cathechin. CONCLUSIONS: Catechin inhibited cataract-induced apoptotic cell death in the lens epithelium and may prove useful for the prevention of cataract progression.

El cristalino para el médico general / The crystalline lens for the general practitioner

El cristalino es un componente fundamental del órgano de la visión, y una de sus enfermedades, la catarata, es la primera causa de ceguera en el mundo. Actualmente contamos con técnicas quirúrgicas seguras y efectivas para solucionar esta patología. Es fundamental que el profesional de atención primaria provea la información adecuada al paciente, para que lo guíe en su búsqueda de la solución de su catarata. En este artículo revisamos libros de texto reconocidos y empleando Medline, algunos artículos representativos sobre este tema. Mostramos un panorama general del estado actual, clínico e investigativo, de la cirugía de catarata [Galvis V, Tello A, Carreño N. El cristalino para el médico general. MedUNAB 2008; 11:225-230].

Crystalline lens is a basic component of the vision organ and one of its diseases, the cataract, is the first cause of blindness in the world. Currently there are safe and effective surgical techniques to solve this pathological condition. It is fundamental that primary care physician provides adequate information to the patients, so that he/she can guide them in the search of the solution to cataract. In this article we reviewed recognized textbooks and using Medline we found some representative articles on this subject. We provide an overview of the current clinical and research status of cataract surgery. [Galvis V, Tello A, Carreño N. The Crystalline Lens for the General Practitioner. MedUNAB 2008; 11:225-230].