Avaliação dos dados pré e resultados pós operatórios de facotrabeculectomia em seguimento mínimo de cinco anos / Evaluation of preoperative data and post-operative results of phacotrabeculectomy in minimum five-year follow-up

RESUMO Objetivo: Avaliar os resultados da facotrabeculectomia em seguimento igual ou superior a 5 anos. Métodos: Estudo retrospectivo, de intervenção e analítico realizado no centro cirúrgico da clínica de olhos de Juazeiro do Norte com pacientes operados no período de 2006 a 2013. Foram envolvidos na investigação 34 olhos de 29 pacientes com catarata senil e glaucoma primário de ângulo aberto submetidos à facotrabeculectomia. Foi criado um escore de risco de dano glaucomatoso variando de 0 a 5 ao avaliar pressão intraocular, escavação do disco óptico, número de drogas hipotensoras utilizadas para o tratamento do glaucoma e a idade do paciente em anos. A amostra foi de conveniência e pareada. Foi utilizado o teste de Wilcoxon pareado para a verificação de diferenças entre médias. Foi aceito p< 0,05 para a rejeição da hipótese de nulidade. O estudo foi aprovado pelo comitê de ética da plataforma Brasil e segue a resolução 466 do Conselho Nacional de Saúde. Resultados: A média da acuidade visual foi significantemente maior após o seguimento de 5 anos (média pré-operatória 0,42 +/- 0,23 ver-sus média pós-operatória 0,62 +/- 0,29 - p=0,0031). A média dos escores de risco para dano glaucomatoso após 5 anos de seguimento foi significativamente menor quando comparado ao pré-operatório (media pré-operatória: 9,47 +/- 1,61 versus média pós-operatória 6,55 +/- 2,21) p < 0,0001, considerado extremamente significante. Conclusão: A facotrabeculectomia foi significantemente efetiva na melhora da acuidade visual e na redução do risco de dano glau-comatoso após seguimento pós-operatório igual ou superior a 5 anos.

ABSTRACT Objective: To evaluate the results of phacotrabeculectomy in a follow-up of five years or more. Methods: Retrospective, interventional and analytical study that was carried out in the surgical center of clínica de olhos do juazeiro with patients operated on from 2006 to 2013. 34 eyes of 29 patients with senile cataract and primary open-angle glaucoma, who underwent phacotrabeculectomy were involved in the investigation. A risk score for glaucomatous dam-age ranging from 0 to 5 when evaluating intraocular pressure, excavation of the optic disc, number of hypotensive drugs used to treat glaucoma and the patient's age in years. The sample was of convenience and paired. The paired Wilcoxon test was used to verify differences be-tween means. P <0.05 was accepted for the rejection of the null hypothesis. The study was approved by the ethics committee of the Brazil platform and follows the principles of resolu-tion 466 of the National Health Council. Results: The mean visual acuity was significantly higher after a five-year follow-up (preoperative average 0.42 +/- 0.23 versus postoperative average 0.62 +/- 0.29 - p = 0.0031). The average risk score for glaucomatous damage after five years of follow-up was significantly lower when compared to the preoperative (preoperative mean: 9.47 +/- 1.61 versus postoperative mean 6.55 +/- 2, 21) p <0.0001, considered extremely significant. Conclusion: Phacotrabeculectomy was significantly effective in improving visual acuity and reducing the risk of glaucomatous damage after a five-year postoperative follow-up.

Evaluation of balance and fear of falling in elderly individuals before and after senile cataract surgery / Avaliação do equilíbrio e do medo de quedas em homens e mulheres idosos antes e após a cirurgia de catarata senil

Abstract Introduction: During aging there is a close relationship between visual deficits, imbalance and falls, and eye surgery can be an efficient treatment option for elderly persons. Objective: Evaluate the influence of visual conditions on patients suffering from senile cataract with increasing imbalance. Method: A descriptive and analytical study using a quantitative longitudinal cohort technique was conducted. The study included 30 individuals who were evaluated before and 30 and 60 days after surgery. The Mini Mental State Examination (MMSE), Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), International Falls Efficacy Scale adapted for Brazil (FES-I) and a medical history questionnaire were used to collect data. Statistical analysis involved the Chi-squared, Student's t and Mann-Whitney tests. Values of p<0.05 were considered significant. Results: The SPPB found that of 15 elderly women, 13 (87%) achieved moderate performance of the lower limbs while the performance of two (13%) remained poor, after 60 postoperative days. The FES-I revealed that three (20%) elderly persons were mildly worried about falls 60 days post-surgery. Of the 15 elderly male subjects evaluated by BBS, before and at 30 and 60 days after surgery, one (7%), managed to maintain some balance but needed assistance; while 14 (93%) maintained good balance. The SPPB found that the performance of five elderly persons (33%) was moderate and that of nine (67%) was good. Conclusion: Senile cataract surgery had positive preventative effects on lower limb performance, balance and fear of falling among the elderly studied, preventing the falls and fractures that are common during aging.

Resumo Introdução: Com o envelhecimento, existe uma relação estreita entre deficit visuais, desequilíbrios e quedas, sendo a cirurgia ocular uma alternativa eficiente para idosos. Objetivo: Avaliar a influência das condições visuais em pacientes com catarata senil em relação aos desequilíbrios corporais. Método: Estudo descritivo e analítico realizado por meio de pesquisa quantitativa de coorte longitudinal. Participaram do estudo 30 idosos, 15 homens e 15 mulheres, os quais foram avaliados antes da cirurgia de catarata, 30 e 60 dias após a intervenção. Utilizou-se para a coleta de dados, o Miniexame do Estado Mental (MEEM), a Escala de Equilíbrio de Berg (EEB), o Short Physical Performance Battery (SPPB), a Escala Internacional de Eficácia de Quedas adaptada ao Brasil (FES-I-Brasil) e questionário de anamnese. A análise estatística empregou o teste Qui-quadrado, teste t Student e teste Mann-Whitney. Foram considerados significantes valores de p<0,05. Resultados: Das 15 idosas, pelo SPPB, em 60 dias de pós-operatório, 13 (87%) conseguiram desempenho moderado e duas (13%) mantiveram baixo desempenho de membros inferiores (MMII). Pelo teste FES-I-Brasil, em 60 dias pós-cirúrgico, três (20%) idosas mantiveram leve preocupação com as quedas. Dos 15 idosos avaliados pela EEB, antes e após 30 e 60 dias de cirurgia, um (7%) conseguiu manter algum equilíbrio, mas necessitando assistência; e 14 (93%) idosos mantiveram bom equilíbrio. Pelo teste SPPB, após 60 dias de cirurgia, cinco idosos (33%) tiveram desempenho moderado e nove (67%) obtiveram bom resultado. Conclusão: A cirurgia de catarata senil possibilitou melhora no desempenho funcional de MMII, no equilíbrio e medo de quedas nos idosos investigados prevenindo caimentos e fraturas, comuns no envelhecimento.

Caracterización clinicoepidemiológica de los pacientes con catarata senil en el estado venezolano de Sucre / Clinical and epidemiological characterization of patients with senile cataract in the Venezuelan state of Sucre

Se realizó un estudio descriptivo y transversal desde julio hasta diciembre de 2012 para caracterizar clínica y epidemiológicamente a 155 pacientes mayores de 50 años con catarata senil, atendidos en Centro de Diagnóstico Integral "El Peñón", perteneciente al municipio de Cumana en el estado venezolano de Sucre. Entre los principales factores de riesgo encontrados en ese grupo, sobresalieron: predominio de las mujeres (51,0%) y de las edades por encima de 75 años (43,9%), contaminación ambiental por el humo en todos, hábito de fumar en 71,6%, exposición prolongada al sol en 63,2%, así como alto consumo de esteroides y diuréticos (14,8 y 11,0%, respectivamente).

A descriptive and cross sectional study was carried out from July to December, 2012 to characterize clinically and epidemically 155 patients older than 50 years with senile cataract, assisted in "El Peñón" Center for Comprehensive Diagnosis, belonging to Cumana municipality in the Venezuelan state of Sucre. Among the main risk factors in this group, there were: prevalence of women (51.0%) and of ages above 75 years (43.9%), environmental pollution due to smoke in all cases, smoking habit in 71.6%, prolonged exposure to the sun in 63.2%, as well as high consumption of steroids and diuretics (14.8 and 11.0%, respectively).

Caracterización de pacientes operados de catarata por la técnica de Blumenthal / Characterization of patients operated on for cataract through Blumenthal technique

Introducción: la catarata es la afección ocular más frecuente en todo el mundo, y representa 47,8 % de todas las causas de ceguera. Así, el progresivo envejecimiento de la población ha aumentado su prevalencia, y actualmente el único tratamiento eficaz y reparador es el quirúrgico. Objetivo: caracterizar a los pacientes operados de catarata por la técnica de Blumenthal. Métodos: se realizó un estudio descriptivo longitudinal y retrospectivo en los 149 afectados de catarata, que fueron intervenidos quirúrgicamente durante el primer semestre del 2013 en el Centro Oftalmológico del Estado Apure, en Venezuela. Resultados: en la serie predominaron el grupo etario de 60-69 años (41,6 %) y el sexo masculino (61,7 %); igualmente, se observó una primacía de la catarata senil (67,1 %), así como de la retinopatía diabética (26,1 %) y la miopía (22,9 %) como antecedentes patológicos oculares, y de la hipertensión arterial (44,2 %) y la diabetes mellitus como enfermedades sistémicas. La ruptura de la cápsula posterior (51,8 %) y su opacidad (45,6 %) constituyeron las complicaciones preponderantes, mientras que la agudeza visual más frecuente antes de la intervención fue de 0,1-0,3 (55,0 %) y posterior al procedimiento resultó de 0,8-1,0 y de 0,4-0,7 (54,0 y 30,0 %, respectivamente). Conclusiones: se apreció una concordancia entre lo obtenido en esta investigación y lo notificado en la bibliografía nacional e internacional en cuanto a las variables clinicoepidemiológicas descritas.

Introduction: cataract is the most frequent ocular disorder in the whole world, and it represents 47.8% of all the causes of blindness. Thus, the progressive aging of the population has increased its prevalence, and at present the only effective and repairing treatment is the surgical one. Objective: to characterize the operated patients through the Blumenthal technique. Methods: a longitudinal and retrospective descriptive study was carried out in the 149 patients affected with cataract who were surgically treated during the first semester of 2013 in the Ophthalmological Center of Apure State, Venezuela. Results: the group 60-69 years (41.6%) and the male sex (61.7%) prevailed in the series; likewise, a primacy of the senile cataract was observed (67.1%), as well as of diabetic retinopathy (26.1%) and myopia (22.9%) as ocular pathological history, and of hypertension (44.2%) and diabetes mellitus as systemic diseases. The rupture of the posterior capsule (51.8%) and its opacity (45.6%) constituted the predominant complications, while the most frequent visual acuity before the surgery was of 0.1-0.3 (55.0%) and after the procedure it was 0.8-1.0 and 0.4-0.7 (54.0 and 30.0%, respectively). Conclusions: a concordance was observed between what was obtained in this investigation and what was notified in the national and international as for the clinical and epidemiological variables described.

Calidad de vida en pacientes operados de catarata senil / Life quality in patients operated for senile cataract

Se realizó un estudio cuasiexperiemental, de intervención terapéutica, en 95 pacientes operados de catarata mediante la técnica de Blumenthal e implante del lente intraocular en el Hospital "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde abril de 2012 hasta marzo de 2013, a fin de caracterizarles según variables de interés para la investigación (edad, sexo, convivencia y agudeza visual antes y después de la cirugía), así como estimar la magnitud de la modificación de la calidad de vida según aspectos psicosociales y físicos. En la casuística predominaron las féminas de 60-69 años y las personas que viven acompañadas. Luego de la cirugía se logró una recuperación visual satisfactoria y, de hecho, una mejor la calidad de vida.

A quasi-experimental study, of therapeutic intervention was carried out in 95 operated patients for cataract by means of the Blumenthal technique and implant of intraocular lens in "Dr. Juan Bruno Zayas Alfonso" Hospital in Santiago de Cuba, from April, 2012 to March, 2013, in order to characterize them according to variables of interest for the investigation (age, sex, coexistence and visual acuity before and after the surgery), as well as to estimate the magnitude of the life quality modification according to psychosocial and physical aspects. Females from 60-69 year and people who live accompanied by others prevailed in the case material. After the surgery a satisfactory visual recovery was achieved and, in fact, a better life quality.

Técnica de Blumenthal en el tratamiento de la catarata senil en el Centro Oftalmológico Machala-Cuba Ecuador / Blumenthal technique for the treatment of senile cataract in Machala-Cuba Ophthalmologic Center in Ecuador

Objetivo: determinar los resultados de la aplicación de la técnica quirúrgica de Blumenthal en el tratamiento de la catarata senil. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo en el Centro Oftalmológico Machala-Cuba, en Ecuador, durante el año 2010. El universo estuvo constituido por 800 ojos con diagnóstico de catarata senil. Se seleccionó una muestra de 200 ojos mediante muestreo aleatorio simple. En la recogida de los datos se expusieron todas las variables de interés de la investigación como edad y sexo, agudeza visual preoperatoria y posoperatoria, técnica anestésica empleada, percepción del dolor y complicaciones transoperatorias más frecuentes. Los datos fueron procesados y analizados mediante técnicas estadísticas descriptivas y porcentuales. Resultados: predominó el sexo femenino y el grupo de edad de 80 años o más. El mayor porcentaje de los pacientes refirió percepción leve del dolor con el uso de la anestesia epibulbar. Se observaron pocas complicaciones y una buena agudeza visual posquirúrgica. Conclusiones: la aplicación de la técnica de Blumenthal tiene buenos resultados en los pacientes operados de catarata senil

Objective: to determine the results in the application of Blumenthal surgical technique in treating senile cataract.Methods: a prospective, longitudinal and descriptive study was performed in Machala-Cuba Ophthalmologic Center in Ecuador in 2010. The universe of study was 800 eyes diagnosed with senile cataract and, finally a sample of 200 eyes was selected by means of simple random analysis. The data collection covered all the variants of interest in the study such as age, sex, preoperative and postoperative visual acuity, anesthetic technique, pain perception, and the most frequent trans-operative complications. Data were then processed and analyzed through summary and percentage statistics.Results: females and 80 year-old patients and older predominated. A high number of patients mentioned feeling little pain when using epibulbar anesthesia for the surgery. Few complications and better visual acuity in the post-operative period were observed.Conclusions: the use of Blumenthal surgical technique has positive visual results in patients operated on from senile cataract

Comportamiento clínico-epidemiológico de la catarata senil en Gran Caracas / Clinical-epidemiologic behavior of the senile cataract in Gran Caracas

OBJETIVO: Caracterizar el comportamiento clínico-epidemiológico de la catarata senil en el área de salud "Gato Negro", en Gran Caracas, Venezuela, en el período de julio a septiembre de 2007. MÉTODOS: Se realizó un estudio descriptivo y transversal. El universo estuvo constituido por el total de pacientes de 60 o más años de edad (478) y la muestra quedó conformada por los 182 pacientes que presentaron diagnóstico de catarata senil, a quienes se les realizó examen ocular completo, previo consentimiento informado. RESULTADOS: Del total de pacientes estudiados, el 48.3 por ciento se encontraba en el grupo de edad de 70 a 79 años. Presentaron catarata bilateral el 79.1 por ciento y se encontró el 6.6 por ciento con agudeza visual menor de 0.1, lo que representó una prevalencia de ceguera de 2.51 por ciento. Se analizaron además las principales causas que han impedido la cirugía de catarata en estos pacientes, y resultó que el 34,6 por ciento no tenía tiempo para operarse y el 20.3 por ciento refirió desconocer la presencia de la enfermedad. CONCLUSIONES: La catarata senil es más frecuente en los pacientes entre 70 y 79 años de edad. Se presenta mayormente de forma bilateral y se relaciona con un deterioro de la agudeza visual.

OBJECTIVES: To characterize the clinical-epidemiological behavior of senile cataract in the "Gato Negro: health area in Gran Caracas, Venezuela, from July to September, 2007. METHODS: A cross-sectional and descriptive study was conducted. The universe included the total of patients aged 60 or more (478) and the sample included 182 diagnosed with senile cataract, who underwent a total ocular examination and the previous informed consent. RESULTS: The total of study patients (48.3 percent) was in the 70-79 years age group. The 79.1 percent had cataract and the 6.6 percent with a visual acuity less than 0.1, which accounted for a blindness of 2.51 percent. The main causes hindered the cataract's surgery were analyzed in these patients where the 34.6 percent had no time to be operated on and the 20.3 percent knew the presence of the disease. CONCLUSIONS: The senile cataract is more frequent in patients aged between 70 and 79. It is present mainly in a bilateral way and it is related to a deterioration of the visual acuity.

Comportamiento clinicoepidemiológico de la catarata senil en la parroquia de Maiquetía (Venezuela, 2007) / Clinicoepidemiologic behavior of senile cataract present in residents of Maiquetía parich (Venezuela, 2007)

Se realizó un estudio descriptivo de corte transversal con el objetivo de describir el comportamiento clínico-epidemiológico de la catarata senil en la parroquia de Maiquetía, en el municipio de Vargas (Venezuela), en el 2007. Se investigaron 6020 pacientes mayores de 50 años de edad, 260 de los cuales tenían diagnóstico de catarata senil. Estos últimos conformaron el universo de trabajo, que a su vez coincide con el tamaño total de la muestra. Se rellenó una planilla de recolección de datos con las variables que se estudiarían. Los pacientes comprendidos entre 70 y 79 años y los del sexo femenino mostraron mayor tasa de prevalencia. La hipertensión arterial fue la patología sistémica más frecuente, y la patología ocular asociada fue la retinopatía diabética. El rango de agudeza visual que mayor cifra arrojó fue el comprendido entre 0,1 y 0,3 y hubo predominio de ceguera por catarata en los pacientes de 80 años y más.

A cross-sectional and descriptive study was made to describe Clinicoepidemiologic behavior of senile cataract present in residents of Maiquetía parish, Vargas municipality, Venezuela in 2007. A total of 6020 patients aged over 50 were studied, 260 had a diagnosis of senile cataract which conformed the work universe that in their turn, coincide to total size of sample. A data collection form was filled including variables that will be studied. Patients aged between 50 and 79 years old, and female sexes showed the greater prevalence rate. High blood pressure was the more frequent systemic pathology and the ocular one associated with diabetic retinopathy. The visual acuity rank with the greatest figure was that between 0,1 and 0,3, and there was a predominance of blindness from cataract in patients aged 80 or more.

Personalización de las fórmulas de cálculo de lente intraocular / Personalization of the intraocular lens calculation formulas

Este trabajo tiene la finalidad de evaluar los resultados refractivos que se alcanzan con la introducción de las constantes personalizadas en las fórmulas de tercera generación para el cálculo del lente intraocular. Se realizó un estudio descriptivo prospectivo cuyo universo está constituido por los pacientes con catarata senil y se seleccionó una muestra aleatoria de 597 casos. Los pacientes fueron clasificados en 7 grupos según las mediciones preoperatorios del promedio queratométrico y la longitud axial. Para dar salida al objetivo propuesto fueron utilizadas las siguientes variables: longitud axial, promedio queratométrico, componente esférico esperado (sep), componente esférico obtenido (ceo), dioptría de lente intraocular implantado (<16, de 17-19, 20-23, 24-27, 28-30) y resultados refractivos. El análisis estadístico de los resultados se realizó, mediante un análisis de varianza, la Prueba T de comparación de medias para datos pareados y Ji cuadrado. Para todo lo anterior se utilizó un nivel de confiabilidad del 95 %. La utilización de las constantes personalizadas en el cálculo de los lentes intraoculares, incrementó en más de un 20 % los buenos resultados refractivos, sin que existan diferencias en los diferentes grupos de pacientes, el tipo de fórmula utilizada y el poder dióptrico del lente. Los modelos de lente S3652 y S3602 presentaron un porcentaje elevado de hipocorrección. La agudeza visual alcanzada en todos los casos fue superior a 0.5 resultado comparable con los estudios internacionales recientes. La profundidad de la cámara anterior estimada preoperatoriamente se correspondió con el valor real posoperatorio, lo que habla de una posición efectiva del lente adecuada.

This paper is aimed at evaluating the refractive results attained with the introduction of personalized constants in the third generation formulas for the intraocular lens calculation. A descriptive and prospective study was conducted among the patients with senile cataract, and a randomized sample of 597 cases was selected. Patients were classified into 7 groups according to the preoperative measurements of the keratometric average and the axial longitude. To obtain the proposed objective, the following variables were used: axial longitude, keratometric average, expected spherical component (sep), obtained spherical component (ceo), dioptry of implanted ocular lens (<16, of 17-19, 20-23, 24-27, 28-30) and refractive results. The statistical analysis of the results was made by a varianze analysis, the T test of comparison of means for matched data and Ji square. A confidence level of 95.5 was used. The utilization of personalized constants in the calculation of intraocular lens increased by more than 20 % the good refractive results. No differences were observed in the diverse groups of patients, the type of formula used and the dioptric power of the lens.The S3652 and S3602 lens models presented a high percentage of hypocorrection. The visual acuity attained in all cases was over 0.5, a result that is comparable with that of recent international studies. The preoperatively estimated corresponded to the real postoperative value, which evidences an adequate effective position of the lens.