Early outcomes of 21-gauge needle-guided ab interno tube sulcus placement of a non-valved implant in pseudophakic eyes

We report the early outcomes and describe an ab interno 21?G needle technique of sulcus placement of the Aurolab aqueous drainage implant (AADI) tube in nine pseudophakic eyes. IOP reduced from a preoperative mean (SD) of 28.33 (9.80) to 11.56 (2.65) mm Hg and the mean (SD) number of preoperative medications reduced from 3.0 (0.7) to 0.4 (0.9) at 3 months. There were no intraoperative complications noted. This technique of sulcus placement of the AADI tube is a precise technique of tube insertion. It may be an alternative to existing ab externo procedures of tube sulcus placement, limiting multiple blind entries.

Exactitud de las fórmulas de cálculo del poder de Lente Intraocular en Cirugía de Cataratas. Comparación de 8 fórmulas / Accuracy of formulas for Intraocular Lens power calculation in Cataract Surgery. A comparison of 8 formulas

Introducción: La cirugía de cataratas tiene como objetivo restablecer la función visual comprometida por la opacificación del cristalino; con el implante del Lente Intraocular se pretende obtener la mejor agudeza visual posible sin corrección adicional. Objetivos: Comparar la exactitud de 8 fórmulas de cálculo de Lentes Intraoculares en la predicción de la refracción postoperatoria con un único dispositivo de biometría óptica en pacientes operados de cirugía de catarata con técnica de facoemulsificación. Materiales y métodos: Serie de casos consecutivos retrospectivos. 100 pacientes fueron sometidos a cirugía de catarata no complicada con de Lente Intraoculares por un único cirujano; del 1 mayo del 2017 al 1 de mayo del 2018; donde la cirugía fue realizada por córnea clara facoemulsificación. En el período preoperatorio todos los pacientes fueron medidos con biometría óptica. La refracción manifiesta se obtuvo al mes de realizada la cirugía. Resultados: La fórmula más precisa y con mejor desempeño general fue PANACEA con un DRA de 0,18 D; cuando consideramos ojos cortos y largos la fórmula Barrett Universal 2 obtuvo menor error de predicción. HAIGIS y LADAS obtuvieron el mejor desempeño en ojos con cámaras estrechas y profundas respectivamente. Conclusión: No se encontraron diferencias en el defecto refractivo absoluto entre las fórmulas tradicionales de tercera generación y las de reciente desarrollo. Algunas fórmulas tuvieron mejor desempeño al considerar ciertas características anatómicas particulares. Es importante personalizar la elección de la fórmula para cada caso específico.

Introduction: Cataract surgery aims to reestablish visual function compromised by lens opacification; Intraocular Lens implantation the aim is to achieve the best visual acuity without additional correction. In recent years, new Intraocular Lens calculation formulas have appeared that could be more accurate than traditional formulas. Objectives: To compare the accuracy of 8 intraocular lens calculation formulas in the prediction of postoperative refraction with a single optical biometry device in patients undergoing cataract surgery with phacoemulsification technique. Materials and methods: Consecutive retrospective case series. Between May 1 2017 and May 1 2018; 100 patients undergo uncomplicated cataract surgery with Intraocular Lens implantation using the phacoemulsification technique. One surgeon did the cases. Optical Biometry was performed using the IOL Master 500 device. Manifest refraction was obtained one month after the surgery. Results: PANACEA was the most accurate formula; with an Absolute Refractive Defect of 0,18 D. When Considering only short and long eyes Barrett Universal 2 got the smallest defect. HAIGIS and LADAS performed better in eyes with narrow and deep anterior chamber respectively. Conclusion: No differences in Absolute Refractive Defect were found between traditional third-generation formulas and those of recent development. Some formulas performed better when considering certain particular anatomical features. It is important to customize the choice of the formula for each specific case.

To Study the Outcome of Cataract Surgery in a Rural Indian Population Which Primarily Depends on Camps and NGOs for a Free Cataract Surgery

The present study was conducted as a rapid assessment of avoidable blindness survey by cluster sampling, aimed primarily to assess the outcome of cataract surgery in a rural Indian population. MethodsAn Observational Point Prevalence study including 407 pseudophakic eyes of 382 subjects, screened through Survey across District in Rural Wardha and admitted in the eye ward of a Rural Tertiary Care Teaching Centre, who gave informed consent were included in this study. History of cataract surgery (time, place, cost and provision of glasses), diabetes mellitus, past history of laser capsulotomy was recorded. Visual acuity and thorough ocular examination including grading of PCO were done. Ocular findings were recorded on pre-tested proforma. ResultsPrevalence of PCO among the pseudophakic eyes was 31.4%. Mean age of study population was 68.1 +8.3 years (range 14-86 years). Rates of PCO are noted to be minimum (21.4%) in the age group 55 - 59 years and maximum (36.1%) in the age group 75 - 79 years. Mean duration since surgery in eyes with PCO among the total 407 pseudophakic eyes included in the study was 27.9 +23.7 months (range 1 - 120 months), 14.9% eyes developed visually significant PCO in <12 months since surgery. Prevalence of PCO ranged from 14.9% in <12 months since surgery to 32.0% at <60 months since surgery (c2=23.99, p<0.05). In the study group which included 5 (23.9%) eyes with a Foldable IOL, developed PCO as compared to 133 (34.5%) in the eyes implanted with PMMA IOL. Prevalence of PCO was higher in PMMA IOL. In the study group, 45 (59.2%) eyes with a Decentered IOL had PCO as compared to 93 (28.1%) eyes within the Bag placed IOL group. There was a higher prevalence of visually significant PCO in eyes with decentered IOL, as compared to eyes within the Bag IOL placement. (c2=26.71, DF=1, p=0.00000). Out of 407 pseudophakic eyes included in the study, history of diabetes was noted in 14 persons, of whom 14 (3.4%) pseudophakic eyes were included in this study and 9 (64.3%) of these developed PCO. The prevalence of PCO was significantly higher among diabetic patients (c2=4.65, p<0.05). The presence of uveitis in pseudophakic eyes was significantly related to higher PCO rates as compared to pseudophakic eyes without uveitis. (c2=24.68, DF=1, p=0.000001). ConclusionsVisually Significant PCO is seen in 1/3rd of eyes following cataract surgery. Duration since cataract surgery is a major factor influencing its genesis. IOL material, cataract surgery type, and IOL position are also important factors. Role of diabetes and uveitis needs to be studied further.

Pseudophakic Pupillary Block after Toxic Anterior Segment Syndrome

PURPOSE: We report a case of pseudophakic pupillary block after toxic anterior segment syndrome (TASS). CASE SUMMARY: An 84-year-old woman underwent phacoemulsification and intraocular lens implantation in the posterior chamber. Six days after surgery, anterior chamber inflammation was seen. Twenty-five days after surgery, a sudden increase in intraocular pressure (IOP) associated with pupillary block was observed. Despite the use of IOP-lowering medication, the IOP was not controlled. Peripheral laser iridotomy failed. After surgical peripheral iridectomy, IOP decreased significantly and was controlled. CONCLUSIONS: Despite the rarity of TASS combined with pseudophakic pupillary block, clinicians must be aware of this condition in patients showing prolonged inflammatory state and IOP elevation after surgery.

A visão em pseudofácicos com ametropia residual após instilação de pilocarpina a 2% / Pseudophakic Vision with residual ametropia after pilocarpine 2% instillation

Resumo Objetivo: Avaliar modificações de acuidade visual, refração, campo visual e diâmetro pupilar, em pacientes pseudofácicos, após a instilação de pilocarpina a 2%. Métodos: Ensaio clínico, controlado, mascarado e randomizado realizado entre maio de 2015 e setembro de 2016 no Hospital Universitário Gaffrée e Guinle, RJ, Brasil. Quarenta pacientes divididos em 2 grupos foram acompanhados em pós-operatório de facectomia com implante de LIO. No grupo de casos houve aplicação de uma gota de pilocarpina a 2%, no grupo controle, uma gota de lubrificante no olho operado. Foram avaliadas antes e 1 hora após a instilação do colirio: a acuidade visual para longe e perto com e sem correção; a refração; o diâmetro pupilar e o campo visual. Resultados: No grupo de casos, a acuidade visual s/c para longe aumentou de 0,33 para 0,57 (p = 0,0001) e para perto melhorou também, 13 pacientes (59,09%) possuíam acuidade visual de J1 ou J2 antes da instilação e depois o número aumentou para 18 ou 81,81% (p = 0,0054). O diâmetro pupilar reduziu de 2,00mm para 1,85mm (p < 0,0001). Não houve alteração do campo visual central. No grupo controle, não houve variação estatisticamente ou clinicamente significativa de qualquer um dos parâmetros medidos. Conclusão: A administração tópica de uma gota de pilocarpina a 2% melhorou a visão de pacientes pseudofácicos com ametropia residual para longe e para perto. Estudos de dose-efetividade adicionais podem indicar melhores concentrações e posologias para alcançar maiores melhoras de acuidade visual.

Abstract Objective: Evaluate the visual acuity, refraction, visual field changes and pupillary diameter in pseudophakic patients after instillation of 2% pilocarpine eye drops. Methods: Controlled, masked and randomized clinical trial carried out between May, 2015 and September, 2016 at the Gaffrée and Guinle University Hospital, RJ, Brazil. Forty patients, divided into 2 groups, were followed up in the postoperative period of a facectomy with intraocular lens implant. The patients in the group of cases were submitted to a drop of 2% pilocarpine and those of the control group to a drop of lubricant in the operated eye. Before eye drop instillation nd one hour after it, the authors evaluated: visual acuity for distance and near; refraction; pupillary diameter and visual field. Results: In case group visual acuity increased from 0.33 to 0.57 for far (p = 0.0001)and also increased for near, 13 patients (59.09%) had visual acuity of J1 or J2 before instillation and 18 or 81.81% after it (p = 0.0054). The median pupillary diameters raised from 2.00 mms to 1.85 mm(p <0.0001). Central visual fields did not have significant alteration. In the control group, there were no statistically or clinically significant changes in any of the measured parameters. Conclusion: Topical administration of a 2% pilocarpine eye drop was effective to improve pseudophakic patients vision with residual ametropia for far and near. Additional dose-effectiveness studies may indicate better concentrations and dosages to achieve greater improvements in visual acuity.

Factors predicting response of pseudophakic cystoid macular edema to topical steroids and nepafenac

Purpose: The purpose of this study is to determine factors predicting resolution of acute pseudophakic cystoid macular edema (PCME) after 6 weeks of topical prednisolone and nepafenac application. Methods: Case records of patients with a clinical and optical coherence tomography (OCT)-based diagnosis of acute PCME were retrospectively reviewed for best-corrected visual acuity and OCT-based parameters at the time of presentation with PCME. In addition, demographic variables, intraoperative and early postoperative factors, and type of treatment prescribed (tapering vs. nontapering prednisolone, generic vs. branded prednisolone and nepafenac) were recorded from case records for analysis. Complete and any successes were defined and baseline factors predicting complete success at 6 weeks were analyzed. Results: We analyzed 69 eyes of 69 patients out of which complete success with topical medications was seen in 37 eyes (54%) and any success was seen in 55 eyes (80%) at 6 weeks. Multivariable logistic regression showed that eyes with lower vision at presentation had a significantly lower likelihood of experiencing both, complete (odds ratio [OR] = 0.83 with one-line decrement in baseline vision, 95% confidence interval [CI] = 0.61�89, P = 0.003) and any success (OR = 0.61, 95% CI = 0.4�9, P = 0.007). Baseline OCT thickness did not influence success rates. Conclusion: Topical prednisolone and nepafenac lead to resolution in PCME in half of the eyes at 6 weeks. Baseline vision is the only factor predicting rates of success and PCME resolution with topical medications.

Dislocated Posterior Chamber Intraocular Lens (PCIOL) in Patients with Retinitis Pigmentosa (RP)

Subluxation or dislocation of PCIOL is one of the complications of cataract operation in RP patients. This paper reports the presentation of PCIOL dislocation and subluxation and the management and outcome in 3 eyes of 2 RP patients. Two medical records of patients with RP who developed dislocated or subluxated PCIOL and subsequently underwent explantation of the dropped IOL were evaluated. Two patients had bilateral eye cataract operation done and had PCIOL implanted. Patient 1 developed left eye subluxated PCIOL inferiorly after 2 years of the cataract operation and right eye dislocated PCIOL anteriorly 4 years after cataract operation. Patient 2 develop right eye subluxated PCIOL inferiorly after 12 years of the cataract operation. Patient 1 with right eye dislocated PCIOL underwent intraocular lens (IOL) explantation and was left aphakic as her visual prognosis was poor due to advanced RP. The left IOL remained within the visual axis despite subluxation and no intervention has been done. Patient 2 with right eye subluxated PCIOL underwent IOL explantation and anterior chamber intraocular lens (ACIOL) implantation. ACIOL remained stable and visual acuity improved post-operation. Both the operations were uneventful. Post-operatively, there was no elevated intraocular pressure and no prolonged ocular inflammation, which required prolonged anti-inflammatory and no retinal detachment was seen. Both patient and surgeon should be aware of potential PCIOL subluxation or dislocation in RP. The presentation may be as late as more than a decade after the cataract operation.

Optical quality evaluation of pseudophakic eyes implanted different materials of IOL by optical quality analysis system / 中华实验眼科杂志

Background Phacoemulsification with IOL implantation can reduce the light scattering caused by cataract,but many patients with IOLs implantation complained of glare or blurred vision.IOLs from different materials will affect IOL refractive index (RI) and optical design,which affect the value of scattered light of IOLs implantation.Objective This study was to analyze the effect of IOL materials on optical quality in pseudophakic eyes with optical quality analysis system (OQAS).Methods The clinical data of 95 eyes from 65 patients with age-related cataract who received phacoemulcification with IOL implantation in Tianjin Eye Hospital from March to Octomber were retropectively analyzed.Three types of lOL,including AR40e,Acrysof SA60 AT and Rayner 620H,were implanted in 32 eyes,30 eyes and 33 eyes,respectively.The visual quality indexes were detected and evaluated using OQAS,including uncorrected distance visual acuity (UCDVA,LogMAR),objective scatter index (OSI),modulation transfer function cut off (MTF cut off),strehl ratio (SR),Profile width at 50％ point scatter function (PSF),Profile width at 10％ PSF and contrast visual acuity under the 100％,20％,9％ contrasts.Results The UCDVA was ≥ 0.3 in the eyes of AR40e group,SA60AT group and 620H group 1 month after surgery.No significant difference was found in the best corrected distance visual acuity (BCDVA,LogMAR) among three groups (F =1.362,P =0.246).The OSI was 1.72±1.11,1.89±1.07 and 2.13±1.13 in the AR40e group,SA60AT group and 620H group,with a significant difference among the groups (F =3.638,P =0.045),and the OSI was significantly lower in the AR40e group than that in the SA60AT group or 620H group (both at P＜0.05).No considerable difference in MTF cut off among the groups (F =2.401,P =0.192).The SR value was significantly elevated and the PSF at both 50％ and 10％ was declined in the AR40e group compared with the SA60AT group and 620H group (all at P＜0.05).A significant difference was found in 9％ contrast visual acuity among the three groups (F=3.866,P=0.038),and 9％ contrast visual acuity was better in the AR40e group than that in the SA60At group or the 620H group (both at P＜ 0.05).Negative correlations were found betwee OSI and BCDVA in the AR40e group,SA60AT group and 620H group (r=-0.275,P=0.041;r=-0.287,P=0.042;r=-0.233,P=0.037).Conclusions OQAS can evaluate optical quality of cataract patients after opeartion objectively.Material and RI of IOL have a great effect on visual quality after phacoemulcification with IOL implantation,especially under the low contrast environment.The operated eyes implanted hydrophobic acrylic IOLs with a lower RI can get better optical quality in comparison with the eyes implanted hydrophilic IOLs.

Astigmatic Correlation between the Automated Refractometry and Dual Scheimpflug Analyzer in Pseudophakic Eyes

PURPOSE: To examine the relationship between the refractive astigmatism by automated refractometry and the corneal astigmatism by a dual Scheimpflug analyzer in pseudophakic eyes. METHODS: Prospectively, 75 patients (100 eyes) were enrolled in the present study. Refractive astigmatism was obtained by automated refraction. Corneal astigmatism was obtained using automated keratometry (ARK-530A®) and dual Scheimpflug scanning analysis (Galilei G4®). All refractive values were converted to the power vector components J0 and J45 for comparison and regression analysis of refractive versus corneal astigmatism. Bland-Altman plots were created to estimate the agreement between measurements. RESULTS: The average astigmatism from each measurement was -1.11 ± 1.44 D (refractive astigmatism from automated refraction), -0.77 ± 1.06 D (corneal astigmatism from automated keratometry), -0.93 ± 1.02 D (simulated K from Galilei G4®), and -1.11 ± 1.48 D (total corneal power from Galilei G4®). Refractive J0 and keratometric J0 were significantly correlated (r = 0.557, p ≤ 0.001), as well as the corresponding J45 values (r = 0.655, p = 0.025). Refractive astigmatism and total corneal power components were also significantly correlated (J0: r = 0.618, p ≤ 0.001; J45: r = 0.608, p = 0.04). In the Bland-Altman plots, keratometric J0 and total corneal power J0 showed the best agreement. CONCLUSIONS: The accuracy of measurements for corneal refraction and astigmatism in pseudophakic eyes is higher using the dual Scheimpflug analyzer, especially for total corneal power. This value of astigmatism can take into account the refractive astigmatism of pseudophakic eyes and can be used in evaluating postoperative corneal astigmatism.

Bilateral spontaneous anterior dislocation of intraocular lens with the capsular bag in a patient with pseudoexfoliation.

We report a rare case of bilateral spontaneous anterior partial in‑the‑bag intraocular lens (IOL) dislocation in a 75‑year‑old man with pseudoexfoliation (PXF). He underwent uneventful phacoemulsification in both eyes with in‑the‑bag IOL implantation 9 years back. In the right eye, single piece poly (methyl methacrylate) (PMMA) IOL (+19 D) and in the left eye, single piece acrylic foldable IOL (+19 D) were implanted. An attempt at pharmacological IOL repositioning was unsuccessful. The dislocated IOLs were explanted and exchanged with scleral suture fixated PMMA IOLs. Vision improved to 20/30 in both eyes following surgery, without any associated ocular morbidity. We believe that zonular weakness secondary to PXF, capsular contraction, and myopia together were the predisposing factors for partial anterior dislocation of IOLs and IOL exchange with scleral suture fixation of IOL is a safe and effective treatment option.

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes / Remoção ou troca de lentes intraoculares: indicações, intervenções pós-operatórias e resultados

ABSTRACT Purpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). Conclusions: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity. .

RESUMO Objetivo: Analisar as indicações para a remoção ou troca de lentes intraoculares (IOL), que foram originalmente implantadas para a correção de afacia após a extração da catarata. Método: Todos os casos que envolveram remoção ou troca de lentes intraoculares em uma única instituição, entre janeiro de 2008 e dezembro 2014 foram analisados retrospectivamente. Resultados: No total, foram analisados 93 olhos de 93 pacientes. O intervalo de tempo médio entre o implante e a remoção das LIOs de câmara anterior (AC IOL) e de câmara posterior (PC IOL) foi 83,40 ± 83,14 meses (variando de 1 a 276 meses) e 55,14 ± 39,25 meses (variando de 1 a 168 meses), respectivamente. Ceratopatia bolhosa pseudofácica (17 olhos, 38,6%) e irite persistente (12 olhos, 27,8%) no grupo AC IOL, e deslocamento ou descentralização (30 olhos, 61,2%) e poder incorreto da IOL (nove olhos, 18,4%), no grupo PC IOL, foram as indicações mais comuns para a remoção das IOLs. A média logMAR da melhor acuidade visual corrigida (BCVA) melhorou significativamente a partir de 1,30 no pré-operatório para 0,62 no pós-operatório no grupo PC IOL (p<0,001), mas não melhorou significativamente no grupo AC IOL (p=0,186). Conclusões: A principal indicação para remoção ou troca de lentes intraoculares foi a ceratopatia bolhosa pesudofácica no grupo AC IOL e deslocamento ou descentralização no grupo PC IOL. A remoção ou troca de PC IOLs é segura e melhora a acuidade visual. .

Reproducibility of Peripapillary Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography in Pseudophakic Eyes

PURPOSE: To assess the reproducibility of circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurement (measurement agreement) and its color-coded classification (classification agreement) by Cirrus spectral domain optical coherence tomography (OCT) in pseudophakic eyes. METHODS: Two-hundred five participants having glaucoma or glaucoma suspected eyes underwent two repeated Cirrus OCT scans to measure cpRNFL thickness (optic disc cube 200 x 200). After classifying participants into three different groups according to their lens status (clear media, cataract, and pseudophakic), values of intra-class coefficient (ICC), coefficient of variance, and test-retest variability were compared between groups for average retinal nerve fiber layer (RNFL) thicknesses and that corresponding to four quadrant maps. Linear weighted kappa coefficients were calculated as indicators of agreement of color code classification in each group. RESULTS: ICC values were all excellent (generally defined as 0.75 to 1.00) for the average and quadrant RNFL thicknesses in all three groups. ICC values of the clear media group tended to be higher than those in the cataract and pseudophakic groups for all quadrants and average thickness. Especially in the superior and nasal quadrants, the ICC value of the cataract group was significantly lower than that of the clear media and pseudophakic groups. For average RNFL thickness, classification agreement (kappa) in three groups did not show a statistically significant difference. For quadrant maps, classification agreement (kappa) in the clear media group was higher than those in the other two groups. CONCLUSIONS: Agreement of cpRNFL measurement and its color code classification between two repeated Cirrus OCT scans in pseudophakic eyes was as good as that in eyes with clear crystalline lens. More studies are required to ascertain the effect of lens status on the reproducibility of Cirrus OCT according to different stages of glaucoma patients.

Clinical Characteristics and Patient's Satisfaction in Pseudophakic Negative Dysphotopsia

PURPOSE: To investigate the clinical characteristics of patients with pseudophakic negative dysphotopsia after cataract surgery and to analyze the risk factors of pseudophakic negative dysphotopsia as well as the postoperative effects on patient's satisfaction. METHODS: This study included 1,020 eyes of 690 patients who underwent phacoemulsification and posterior chamber lens insertion between January 2010 and March 2012. Retrospective chart review was conducted to evaluate the prevalence of negative dysphotopsia according to the site of clear corneal incision during cataract surgery and the type of implanted intraocular lens (IOL). The clinical outcome of Neodymium:yttrium-aluminium-garnet (Nd:YAG) laser anterior capsulotomy in negative dysphotopsia patients was evaluated. Using a telephone survey, patients were asked to subjectively answer 18 questions regarding satisfaction after cataract surgery, the severity of visual symptoms and the effect of negative dysphotopsia in their daily life. RESULTS: Negative dysphotopsia developed in patients who underwent uneventful cataract surgery and successful implantation of IOL in the bag. The patients' vision was corrected up to 20/20 (0.00 log MAR) and HVF P60-4 showed no abnormality in their visual field. There were significantly more patients with the SN60WF IOL who reported negative dysphotopsia but no other factors associated with the prevalence of negative dysphotopsia. During the telephone survey, patients complained of difficulties in their daily life related to the negative dysphotopsia symptoms and reported decreased satisfaction after cataract surgery. CONCLUSIONS: Although negative dysphotopsia can decrease the patient's satisfaction after cataract surgery, the genesis of negative dysphotopsia and an objective method to test for negative dysphotopsia is necessary. Therefore, a prospective large study should be conducted to evaluate the cause and treatment of negative dysphotopsia.

Clinical Characteristics and Patient's Satisfaction in Pseudophakic Negative Dysphotopsia

PURPOSE: To investigate the clinical characteristics of patients with pseudophakic negative dysphotopsia after cataract surgery and to analyze the risk factors of pseudophakic negative dysphotopsia as well as the postoperative effects on patient's satisfaction. METHODS: This study included 1,020 eyes of 690 patients who underwent phacoemulsification and posterior chamber lens insertion between January 2010 and March 2012. Retrospective chart review was conducted to evaluate the prevalence of negative dysphotopsia according to the site of clear corneal incision during cataract surgery and the type of implanted intraocular lens (IOL). The clinical outcome of Neodymium:yttrium-aluminium-garnet (Nd:YAG) laser anterior capsulotomy in negative dysphotopsia patients was evaluated. Using a telephone survey, patients were asked to subjectively answer 18 questions regarding satisfaction after cataract surgery, the severity of visual symptoms and the effect of negative dysphotopsia in their daily life. RESULTS: Negative dysphotopsia developed in patients who underwent uneventful cataract surgery and successful implantation of IOL in the bag. The patients' vision was corrected up to 20/20 (0.00 log MAR) and HVF P60-4 showed no abnormality in their visual field. There were significantly more patients with the SN60WF IOL who reported negative dysphotopsia but no other factors associated with the prevalence of negative dysphotopsia. During the telephone survey, patients complained of difficulties in their daily life related to the negative dysphotopsia symptoms and reported decreased satisfaction after cataract surgery. CONCLUSIONS: Although negative dysphotopsia can decrease the patient's satisfaction after cataract surgery, the genesis of negative dysphotopsia and an objective method to test for negative dysphotopsia is necessary. Therefore, a prospective large study should be conducted to evaluate the cause and treatment of negative dysphotopsia.

Effect of Intravitreal Injection as a Primary Treatment in Cystoid Macular Edema after Cataract Surgery

PURPOSE: To report the clinical manifestations of intravitreal triamcinolone injection as a primary treatment method for patients with cystoid macular edema after cataract surgery. METHODS: The present retrospective study was comprised of patients diagnosed with cystoid macular edema after cataract surgery performed between March 2006 and March 2008. To treat the edema, intravitreal triamcinolone injection was administered. Best corrected visual acuity (BCVA) and central macular thickness were measured, and complications as well as efficacy of the treatment were evaluated. RESULTS: Twelve eyes were selected for the present study with a mean patient age of 67.3 years. The average period between cataract surgery and diagnosis of cystoid macular edema was 7.6 weeks. All 12 eyes received an intravitreal triamcinolone injection, and the patients were followed up for an average of 6.7 months. BCVA (log MAR) was changed from 0.29 +/- 0.12 to 0.11 +/- 0.09, showing statistically significant improvement (p = 0.000). The OCT showed that the average CMT was statistically decreased from 390.58 +/- 94.98 microm to 165.17 +/- 39.95 microm (p = 0.001). No complications were reported after the procedure, and vision and edema improved after one month in all 12 eyes. CONCLUSIONS: After performing intravitreal triamcinolone injection as a primary treatment method for cystoid macular edema which developed after cataract surgery, rapid recovery and improvement of vision and macular thickness were confirmed in all 12 eyes.

Surgical Outcomes for Primary Rhegmatogenous Retinal Detachments in Patients with Pseudophakia after Phacoemulsification

PURPOSE: To evaluate the clinical features and surgical outcomes for primary rhegmatogenous retinal detachments (RDs) in patients with pseudophakia after phacoemulsification. METHODS: The medical records of patients with pseudophakia after phacoemulsification and intraocular lens implantation who had undergone surgery for primary rhegmatogenous RDs with a minimum duration of follow-up of 12 months were reviewed retrospectively. RESULTS: A total of 104 patients were enrolled in this study and 106 eyes were analyzed. Post-operative retinal attachment was achieved in 87 of the eyes (82.1%) and the final visual acuities (logarithm of the minimum angle of resolution) were improved to 0.65 +/- 0.49 from the baseline measurement of 1.51 +/- 1.14 (p < 0.001). Re-operations were performed in 24 of the eyes (22.6%) and there were no visible retinal breaks in 30 of the eyes (28.3%). The failure to identify a retinal break during surgery was associated with a lower rate of retinal reattachment, worse final visual acuity, and a higher rate of re-operation (p = 0.002, p = 0.02, and p = 0.002, respectively). The location of the identified retinal break was more common in the superotemporal quadrant than in the other quadrants. CONCLUSIONS: The inability to identify a retinal break during surgery was associated with a poor final outcome. Other factors were less important for the functional and anatomic success in patients with pseudophakic RDs.

Espessura central da córnea: catarata congênita, pseudofacia e afacia / Central corneal thickness: congenital cataracts, pseudophakia and aphakia

OBJETIVO: Comparação da espessura central da córnea entre crianças com cristalino transparente (controle), catarata, pseudofácicas e afácicas. Estudo prospectivo, observacional. MÉTODOS: Noventa e quatro olhos de 47 crianças foram submetidos à medida da espessura central corneana (ECC) e comparou-se o grupo controle (cristalino transparente) aos pacientes que apresentavam catarata, afacia ou pseudofacia. Pacientes com Síndrome de Down, aniridia, Síndrome de Marfan, glaucoma, anormalidades do segmento anterior ou pressão intraocular maior que 30 mmHg foram excluídos do estudo. RESULTADOS: Dos 94 olhos estudados, 52 faziam parte do grupo controle com ECC média 533,6 µm. No grupo com catarata (n=27) a ECC média foi de 532,3 µm, enquanto no grupo de afácicos (n=8) e pseudofácicos (n=12) de 585,63 µ e 585,7 µ, respectivamente. CONCLUSÃO: A espessura central da córnea é semelhante em olhos com catarata congênita e olhos fácicos, sendo mais espessa após a cirurgia de catarata com ou sem implante de lente intraocular.

PURPOSE: To evaluate central corneal thickness (CCT) in phakic children (controls) and in those with cataracts, pseudophakia and aphakia. Study prospective, observational METHODS: Central corneal thickness was measured in 94 eyes of 47 children. Subjects with Down Syndrome, aniridia, Marfan Syndrome, glaucoma, anterior segment abnormalities or intraocular pressure over 30 mmHg were excluded. Groups were compared for controls and for eyes with pediatric cataracts, pseudophakia and aphakia. RESULTS: Twenty-nine patients were male and eighteen female and the mean age was 5. 5 years (range, 1 month to 15 years). Of the 94 eyes, 52 were part of the control group and the CCT average was 533. 6 µm. The average measurement of the CCT for all patients with cataract was 532. 3 µm (n = 27). The average CCT aphakia the group was 585. 63 µm (n = 8) and pseudophakic was 585. 7 µm (n = 12). CONCLUSION: In the absence of factors known to affect CCT (Down syndrome, aniridia, and Marfan syndrome), CCT is similar in eyes with pediatric cataracts and normal controls and increases after cataracts surgery.

Pseudophakic monovision technique with Toric IOL using the SN60T5 platform

We demonstrate the combination of pseudophakic monovision technique with toric IOL in patients with relevant corneal astigmatism to reduce spectacle dependence after cataract surgery. All patients achieved UCDVA ³ 20/30 and UCNVA ³ J2 and none of them required spectacle correction on the 6th postoperative month.

Nós demonstramos a combinação da técnica de monovisão pseudofácica com lente intraocular tórica em pacientes com astigmatismo corneano relevante para reduzir a dependência de óculos após a cirurgia de catarata. Todos os pacientes apresentaram AVsc ³ 20/30 para longe e ³ J2 para perto, sendo que nenhum deles necessitou de correção ótica até o sexto mês pós-operatório.

Síndrome do bloqueio capsular precoce relato de caso e especulação sobre o tamanho da parte óptica da lente como fator de risco / Early caspsular block syndrome a case report and speculation about the size of the lens' optic as a risk factor

Apresentamos um caso de síndrome de bloqueio capsular precoce, tratado por reintervenção cirúrgica no segundo dia de pós-operatório. Comentamos as principais características da síndrome, os possíveis fatores predisponentes, as opções de tratamento e a importância do seu correto reconhecimento. Nós também especulamos sobre outro possível fator de risco, lentes intraoculares com parte óptica de 6mm ou maiores.

We present a case of early capsular block syndrome that was treated by re-operation on the second post operative day. We discuss the major characteristics of the syndrome, possible predisposing factors, therapeutic options and highlight the importance of its correct recognition. We also speculate about another possible risk factor, an intraocular lens with a optic part about 6mm or more.

Retinoscopia com luz em faixa em cães fácicos, afácicos e pseudofácicos / Streak retinoscopy in phakic, aphakic, and pseudophakic dogs

Avaliou-se o erro refracional em 40 cães submetidos ou não à facectomia por facoemulsificação, por meio de retinoscopia com luz em faixa. Distribuídos em quatro grupos de 10 animais cada, foram designados por cães fácicos, cães afácicos (CA), cães pseudofácicos com implante de duas lentes intra-oculares em piggyback (PP) e cães pseudofácicos com implante de uma lente intra-ocular veterinária de 41D (PL). As avaliações foram realizadas por ceratometria, ecobiometria ultra-sônica e retinoscopia. A média da curvatura corneana foi de 40,46±2,44D. O poder dióptrico obtido por retinoscopia foi de 18,50D no grupo CA, 5,25D no grupo PP e 2,00D no grupo PL. A retinoscopia com luz em faixa constituiu um método eficaz para avaliar a refração ocular em cães, mas foi dificultada quando da presença de opacidade de meios oculares. Todos os animais apresentaram-se hipermétropes, em diferentes graus; o astigmatismo ceratométrico cirurgicamente induzido foi discreto.

The refraction error in dogs submitted or not to phakectmy, by phakoemulsification by streak retinoscopy was evaluated. Forty dogs were distributed in four groups of 10 animals each, and were designated by phakic, aphakic (AD), pseudo-phakic with two piggyback intraocular lenses (PD), and pseudo-phakic with one intraocular 41D veterinary lens implant (LD). The evaluation was performed by keratometry, ultrasonic echobiometry, and retinoscopy. The mean corneal curvature was 40.46±2.44D. The dioptric power obtained by retinoscopy was 18.50D in AD group, 5.25D in PD group, and 2.00D in LD group. The retinoscopy was an efficient method to evaluate ocular refraction in dogs, but was more complex in ocular opacity presence. All animals presented different levels of hypermetropy, and the surgically induced astigmatism was discrete.