Quaternary knot technique: suture knot burial without scleral flap or incision for trans-scleral fixation

Despite the introduction of novel sutureless posterior chamber intraocular lens (IOL) fixation techniques, some conditions still require suture-assisted scleral fixation. If the scleral fixation suture knot is left directly under the conjunctiva, it may become exposed, resulting in an increased risk of endophthalmitis. To avoid this problem, we offer a new alternative, simple, and safe way for burying the end of the suture using knots in this report.

Advances in interdisciplinary medical and engineering research of intraocular lens surface modifications to prevent posterior capsule opacification / 中南大学学报(医学版)

Posterior capsule opacification (PCO), a common complication after cataract surgery, impacts a patient's long-term visual quality to various degrees. Although a neodymium:yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy is a very effective treatment, it may lead to a serial of complications. Accordingly, the search for simple, safe, and effective methods to prevent PCO has received widespread attention. Various researchers are committed to the interdisciplinary collaboration between medicine and engineering fields, such as functionalizing the surface of the intraocular lens (IOL) via supercritical fluid impregnation, coating the surface of the IOL, high-concentration drug immersion, and application of a drug delivery system, to effectively reduce the incidence and severity of PCO.

Refractive changes after intraocular lens implantation in post-cataract extraction children in a Philippine Tertiary Hospital

Objective@#To determine refractive changes in children post-cataract extraction and intraocular lens (IOL) implantation at a Philippine tertiary hospital. @*Methods@#This is a retrospective cohort study involving patients aged 1 to 10 years in the Department of Ophthalmology of a Philippine tertiary hospital who underwent cataract extraction and IOL implantation between 2004 to 2013. @*Results@#We included 55 eyes of 34 patients in the analysis. Thirty-eight eyes (69%) eyes underwent primary IOL implantation. The mean duration of follow-up was 3.5 ± 2.1 years. The median refractive changes were -2.00 (-2.50, -0.50) diopters (D) for the 1- to 3-year-old group, -1.25 (-1.50, -0.25) D for the 4- to 7-year-old group, and -1.00 (-1.63, -0.25) D for the 8- to 10-year-old group. Only the 1- to 3-year-old group had significant difference between the initial post-operative refraction and the latest follow-up refraction (p<0.001). For the primary implantation group, patients in the 1- to 3-year-old group had the highest median refractive change at -2.00 (-3.125, -1.00) D while patients in the 8- to 10-year-old group had the highest median refractive change at -2.12 (-2.56, -1.69) D in the secondary implantation group. Refractions of eyes with IOL-implanted and normal eyes showed a median difference of -1.00 (-0.25, -3.5) D. @*Conclusion@#The determination of the power of IOL implants in pediatric patients who underwent cataract extraction remains challenging despite availability of recommendations.

Equivalent keratometer reading para cálculo biométrico em córneas assimétricas: série de casos / Equivalent keratometer reading tool for biometric calculation in asymmetric corneas: case series

RESUMO A acurácia do cálculo da lente intraocular não é perfeita, podendo ser comuns erros refrativos pós-operatórios, especialmente em pacientes submetidos à cirurgia refrativa prévia ou na presença de córneas assimétricas. O poder corneano após cirurgia refrativa pode ser medido com maior acurácia utilizando o mapa de poder óptico total na zona central de 4mm, com Orbscan II ou pelo mapa equivalent keratometric reading disponível no pentacam, com medidas centrais de 1,0, 2,0, 3,0 e 4,5mm. O objetivo desta série de casos é demonstrar a abordagem de quatro olhos em condições especiais corneanas, por meio do equivalent keratometric reading do pentacam para mensuração do poder corneano e o utilizando na biometria, em comparação com possíveis resultados obtidos com outras estratégias. Os quatro olhos foram submetidos a procedimentos refrativos prévios, e a lente intraocular escolhida a partir do uso do poder corneano calculado pelo equivalent keratometric reading mostrou excelentes resultados pós-operatórios.

ABSTRACT The accuracy of the intraocular lens calculation is not perfect, and postoperative refractive errors are common, especially in patients who have undergone previous refractive surgery or in presence of asymmetric corneas. Corneal power after refractive surgery can be more accurately measured using the total optical power map in the 4-mm central zone, by means of Orbscan II or equivalent keratometric reading map available on pentacam, with central measurements of 1.0, 2.0, 3.0 and 4.5 mm. The purpose of this case series is to demonstrate four approaches performed in special corneal conditions, using pentacam equivalent keratometric reading to measure corneal power and biometrics, and comparing with possible results obtained with other strategies. The four eyes were submitted to previous refractive procedures, and the intraocular lens chosen from the use of the corneal power calculated by equivalent keratometric reading showed excellent postoperative results.

Belin/Ambrósio Enhanced Ectasia Display in cataract surgery and relation to final visual acuity / Belin/Ambrósio Enhanced Ectasia Display na cirurgia de catarata e sua relação com a acuidade visual final

ABSTRACT Objective To analyze and describe the coefficients found on maximum Ambrósio Relational Thickness-Maximum (ART-Max) and Belin/Ambrósio Enhanced Ectasia Display total deviation (BAD-D) in eyes with normal corneal topography subjected to cataract surgery with premium intraocular lens implantation and correlated these data with final visual acuity. Methods ART-Max and BAD-D data from 103 eyes of patients subjected to implantation of diffractive bifocal intraocular lens, with normal corneal topography who achieved visual acuity of 20/20 or 20/25 without correction after cataract surgery were analyzed. The groups with normal and abnormal values were compared using the chi-square test. Results Thirty-two (31.1%) and 71 (68.9%) eyes presented normal and abnormal ART-Max values, respectively. The difference between these groups was significant (p=0.0002). Fifty-five (53.4%) and 48 (46.6%) eyes had normal and abnormal BAD-D, respectively, and intergroup difference was not significant (p=0.9576). Conclusion Among patients with normal corneal topography who underwent premium intraocular and had good final visual acuity of 20/20 or 20/25, suspicious or abnormal indices of ART-Max and BAD-D were frequent, providing evidence that it possibly should not be a contraindication.

RESUMO Objetivo Analisar e descrever os coeficientes numéricos encontrados nos exames Ambrósio Relational Thickness-Maximum (ART-Max) e desvio total do Belin/Ambrósio Enhanced Ectasia Display (BAD-D) em olhos com topografia normal submetidos ao implante de lente intraocular premium na cirurgia de catarata, correlacionando-os com a acuidade visual final pós-operatória. Métodos Foram analisados os resultados de ART-Max e BAD-D de 103 olhos de pacientes submetidos ao implante de lentes bifocais difrativas, que apresentavam exame topográficos normal e alcançaram acuidade visual 20/20 ou 20/25 sem correção visual no pós-operatório final. Para a análise estatística entre os grupos normais e anormais ou suspeitos, utilizou-se o teste do qui-quadrado. Resultados Foram encontrados 32 (31,1%) olhos com ART-Max normal e 71 (68,9%) com ART-Max suspeito/anormal. A diferença entre os grupos foi significativa (p=0,0002). Quanto ao BAD-D, foram encontrados 55 (53,4%) olhos com resultados normais e 48 (46,6%) com resultados suspeitos/anormais. A diferença entre os grupos não foi significativa (p=0,9576). Conclusão Entre os pacientes com topografia normal submetidos ao implante de lentes premium e que alcançaram acuidade visual 20/20 ou 20/25, os índices suspeitos ou anormais de ART-Max e BAD-D eram frequentes, não se configurando em contraindicação para a realização do implante.

Comparación entre las fórmulas SRK/T, Hoffer Q, Barrett Universal y HRBF para el cálculo del lente intraocular / Comparison of the formulas SRK/T, Hoffer Q, Barrett Universal and HRBF for intraocular lens calculation

Objetivo: Comparar la exactitud de las fórmulas SRK/T, Hoffer Q, Barrett Universal y HRBF en el cálculo del lente intraocular. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo de 70 ojos de 70 pacientes operados de cirugía de catarata con implante de lente intraocular, de junio del año 2018 a junio del 2019, utilizando el IOL Master 700, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Se determinó la exactitud de cada fórmula respecto al error de predicción del equivalente esférico y se compararon entre sí. Resultados: Los pacientes entre 60 y 80 años constituyeron el 70,00 por ciento de los casos y el sexo femenino representó el 61,43 por ciento. Los ojos de tamaño medio representaron el 91,43 por ciento del total. No hubo diferencias en el error de predicción absoluto medio entre de las fórmulas analizadas para el rango total de longitudes axiales. La fórmula de Barrett tuvo el 65,71 por ciento de ojos con un error de predicción dentro de ± 0,50 D. El mayor porcentaje de ojos con un error mayor a 1 dioptría recayó sobre la Hoffer Q (10,00 por ciento). Conclusiones: El grupo etario más representado está entre 60 y 80 años y el sexo femenino es mayoritario. Predominan los ojos de tamaño medio y las mensuraciones biométricas dentro de los valores promedio estándar. Las fórmulas HRBF, SRK/T, Hoffer Q y Barrett predicen el resultado refractivo posoperatorio con una exactitud similar para el rango total de longitudes axiales. La fórmula de Barrett logra el mayor porcentaje de ojos con errores de predicción posoperatorios dentro del rango de la emetropía(AU)

Objective: Compare the accuracy of the formulas SRK/T, Hoffer Q, Barrett Universal and HRBF for intraocular lens calculation. Methods: A prospective longitudinal descriptive study was conducted of 70 eyes of 70 patients undergoing cataract surgery with intraocular lens implantation from June 2018 to June 2019 at Ramón Pando Ferrer Cuban Institute of Ophthalmology. In all cases IOL Master 700 was used for lens calculation. Determination of the accuracy of each formula in error prediction of the spherical equivalent was followed by a comparison of the formulas. Results: Patients aged 60-80 years were 70.00 percent of the cases; female sex represented 61.43 percent. Medium sized eyes were 91.43 percent of the total eyes examined. Mean absolute prediction error did not show any difference between the formulas analyzed for the total range of axial lengths. The Barrett formula spotted 65.71 percent of the eyes with a prediction error within ± 0.50 D. The highest percentage of eyes with an error greater than 1 diopter corresponded to the Hoffer Q formula (10.00 percent ). Conclusions: The best represented age group was 60-80 years; female sex prevailed. A predominance was found of medium size and biometric measurements within standard mean values. The formulas HRBF, SRK/T, Hoffer Q and Barrett predict the postoperative refractive result with similar accuracy throughout the total range of axial lengths. The Barrett formula achieves the highest percentage of eyes with postoperative prediction errors within the range of emmetropia(AU)

Cirugía facorrefractiva en la alta miopía y sus complicaciones / Phaco-refractive surgery in high myopia and its complications

La miopía es un grave problema de salud pública por su alta y creciente prevalencia en distintas áreas geográficas. La cirugía facorrefractiva consiste en la extracción del contenido transparente o esclerosado del cristalino y el implante de una lente intraocular, con el objetivo posoperatorio de alcanzar o acercarse a la emetropía. Ha demostrado un resultado predecible y estable en el tiempo, pero no está exenta de complicaciones. Se presenta un paciente de 44 años de edad con antecedentes de oftalmológicos de miopía elevada, glaucoma secundario y cirugía facorrefractiva en ambos ojos, refracción dinámica de -3,50-100 x 200 con agudeza visual mejor corregida de 0,8 por cartilla de Snellen en el ojo derecho y -5,25 -1,25 x 1600 con agudeza visual mejor corregida de 0,6 en el ojo izquierdo. En el examen biomicroscópico se observó afaquia quirúrgica, opacidad de la cápsula posterior con capsulotomía láser central amplia y presencia de vítreo en la cámara anterior en ambos ojos con cifras de tensión ocular elevadas. Se realizó implante secundario de lente intraocular en ambos ojos. La refracción dinámica a los 3 meses fue para el ojo derecho de: -0,50 -0,50 x 400 con agudeza visual mejor corregida de 0,9 por cartilla de Snellen y para el ojo izquierdo de: -1,00 -0,75 x 1600 con agudeza visual mejor corregida de 0,6 por cartilla de Snellen. A los dos años presentó desprendimiento de retina subclínico en el ojo derecho, que fue tratado con terapia láser, y daño glaucomatoso en el ojo izquierdo. Se le realizó trabeculectomía, trabeculoplastia selectiva láser y posteriormente implante de drenaje valvulado en el ojo izquierdo(AU)

Myopia is a serious public health problem, due to its high and increasing prevalence in various geographic regions. Phaco-refractive surgery consists in extraction of the clear or sclerosed content of the crystalline lens and implantation of an intraocular lens with the postoperative objective of achieving or approaching emmetropia. The procedure has shown to obtain predictable results stable in time, but it is not exempt from complications. A case is presented of a male 44-year-old patient with an ophthalmologic history of high myopia, secondary glaucoma and phaco-refractive surgery in both eyes, dynamic refraction of -3.50-100 x 200 with best corrected visual acuity of 0.8 on the Snellen chart in the right eye and -5.25 -1.25 x 1600 with best corrected visual acuity of 0.6 in the left eye. Biomicroscopic examination found surgical aphakia, posterior capsule opacity with large central laser capsulotomy, presence of vitreous in the anterior chamber of both eyes and high ocular pressure values. Secondary intraocular lens implantation was performed in both eyes. Dynamic refraction at three months was -0.50 -0.50 x 400 for the right eye with best corrected visual acuity of 0.9 on the Snellen chart, and -1.00 -0.75 x 1600 for the left eye with best corrected visual acuity of 0.6 on the Snellen chart. At two years the patient experienced subclinical retinal detachment in the right eye, which was treated with laser therapy, and glaucomatous damage in the left eye, for which the treatment indicated was trabeculectomy, selective laser trabeculoplasty, and then valved drainage implantation in the left eye(AU)

Implante secundario de lente en cámara anterior con apoyo angular versus lente suturado a iris / Secondary implantation of angle-supported lens in the anterior chamber versus iris-suture-fixated lens

Objetivo: Comparar los resultados del implante secundario de lentes intraoculares de cámara anterior rígido con apoyo angular y de lentes intraoculares plegables de cámara posterior suturados a iris, en cuanto a efectividad, seguridad y calidad de vida relacionada con la función visual (cuestionario NEI VFQ-23). Métodos: Se realizó un estudio cuasi experimental de 50 ojos de pacientes afáquicos sin soporte capsular, después de la cirugía de catarata, divididos en dos grupos según el tratamiento. Resultados: Se observó que en el grupo de pacientes tratados con lente intraocular suturado a iris el porcentaje de pacientes con una visión de 20/40 o más fue significativamente superior (96,0 vs. 60,0 , p = 0,000), mientras que los resultados del cuestionario de calidad de vida fueron menores en cuanto a la frecuencia de pacientes con visión de 20/200 o menos (0,0 vs. 16,0 por ciento, p = 0,110); la inducción de astigmatismo, la disminución de la densidad de células endoteliales (361,6 ± 220,5 vs. 556,1 ± 340, p = 0,021) y el porcentaje de pacientes con complicaciones (36,0 vs. 52,0 por ciento, p = 0,254). Conclusiones: Se logran mejores resultados con el implante de lente intraocular plegable suturado a iris(AU)

Objective: Compare the results of secondary implantation of rigid angle-supported intraocular lenses in the anterior chamber versus foldable iris-suture-fixated intraocular lenses in the posterior chamber, in terms of effectiveness, safety and vision-related quality of life (questionnaire NEI VFQ-23). Methods: A quasi-experimental study was conducted of 50 eyes of aphakic patients without capsular support after cataract surgery, who were divided into two groups according to the treatment indicated. Results: It was found that in the group treated with iris-suture-fixated intraocular lens implantation the percentage of patients with 20/40 vision or more was significantly higher (96.0 vs. 60.0 percent, p = 0.000), whereas the results of the quality of life questionnaire were lower in terms of frequency of patients with 20/200 vision or less (0.0 vs. 16.0 percent, p = 0.110), induction of astigmatism, endothelial cell density reduction (361.6 ± 220.5 vs. 556.1 ± 340, p = 0.021) and percentage of patients with complications (36.0 vs 52.0 percent, p = 0.254). Conclusions: Better results were obtained with the implantation of foldable iris-suture-fixated intraocular lenses(AU)

Lupus eritematoso sistémico / Systemic lupus erythematosus

El lupus eritematoso sistémico es una enfermedad autoinmune, de curso crónico con afectación multisistémica. Las manifestaciones oculares del lupus eritematoso sistémico pueden afectar cualquier estructura del ojo. La formación de catarata y la aparición de la diabetes secundaria asociada con el tratamiento esteroideo prolongado es frecuente en estos pacientes. Se presenta el caso de una paciente femenina de 69 años, con antecedentes de lupus eritematoso sistémico de más de 20 años de evolución, tratada con 5 mg diarios de prednisona oral en dosis de mantenimiento. Refiere, además, diabetes mellitus tipo 2 controlada de más de 10 años de evolución. Asiste a la consulta de Oftalmología por disminución de la visión y se diagnostica catarata en el ojo derecho. Se realiza facoemulsificación con implante de lente intraocular plegable, previa profilaxis para la endoftalmitis. La catarata asociada a la diabetes secundaria en los pacientes con lupus eritematoso sistémico justifica el uso de profilaxis antinflamatoria con esteroides tópicos y sistémicos para asegurar una mínima inflamación posoperatoria y mejorar el pronóstico visual(AU)

Systemic lupus erythematosus is a chronic autoimmune disease of multisystemic involvement. Ocular manifestations of systemic lupus erythematosus may present in any structure of the eye. Cataract formation and the appearance of secondary diabetes associated to prolonged steroid therapy are common in these patients. A case is presented of a female 69-year-old patient with a history of systemic lupus erythematosus of more than 20 years' evolution, treated with 5 mg daily of oral prednisone at maintenance doses. The patient also reports controlled diabetes mellitus type 2 of more than ten years' evolution. Her main concern in attending Ophthalmology consultation is vision reduction. Cataract is diagnosed in her right eye. The treatment indicated is phacoemulsification with foldable intraocular lens implantation following prophylaxis for endophthalmitis. Cataract associated to secondary diabetes in patients with systemic lupus erythematosus justifies the use of anti-inflammatory prophylaxis with topical and systemic steroids to ensure minimum postoperative inflammation and improve visual prognosis(AU)

Long-term results of in-the-bag primary intraocular lens implantation in children younger than 24 months / Resultados a longo prazo de implante primário de lente intraocular no saco capsular em crianças menores que 24 meses

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

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

Fórmula Barrett True K en pacientes con catarata operados de cirugía refractiva corneal / The Barrett True-K formula in cataract patients undergoing corneal refractive surgery

Objetivo: Determinar los resultados refractivos en pacientes operados de catarata con cirugía refractiva corneal, según el cálculo del poder dióptrico de la lente intraocular con la fórmula Barrett True K. Métodos: Se realizó un estudio pre-experimental, del tipo antes y después, en el cual fueron incluidos 18 pacientes (31 ojos). En ellos se analizaron variables demográficas y clínicas. La principal variable de salida fue la predictibilidad del componente esférico ± 0,50 D, ± 1,0 D según la longitud axial. Resultados: Fueron estudiados pacientes con un promedio de edad de 59,4 años, predominantemente del sexo femenino (66,7 por ciento). El 77,4 por ciento fue operado con queratotomía radial. Con la cirugía de catarata se produjo una mejora ostensible de la agudeza visual no corregida (mediana preoperatoria: 0,12 y mediana posoperatoria: 0,60). Solo el 9,7 por ciento de los ojos analizados presentó una agudeza visual sin corregir de 20/20 y el 90,3 por ciento de 20/40 o más. La cantidad de ojos con un equivalente esférico de ± 0,50 disminuyó en la medida en que aumentó la longitud axial (corta: 100 por ciento; normal: 57,1 por ciento; larga: 22,7 por ciento), no así la predictibilidad del componente esférico de ± 0,50, que aumentó (corta: 50,0 por ciento; normal: 57,1 por ciento; larga: 63,6 por ciento). Conclusiones: La fórmula Barrett True K resulta útil para el cálculo de la lente intraocular en pacientes operados de catarata y cirugía refractiva corneal previa(AU)

Objective: Determine refractive outcomes in patients undergoing cataract corneal refractive surgery based on intraocular lens dioptric power calculation with the Barrett True-K formula. Methods: A pre-experimental before/after study was conducted of 18 patients (31 eyes). Demographic and clinical variables were analyzed. The main output variable was spherical component predictability ± 0.50 D, ± 1.0 D according to axial length. Results: Mean age was 59.4 years; female sex prevailed (66.7 percent). Of the patients studied, 77.4 percent underwent radial keratotomy. Cataract surgery led to notable uncorrected visual acuity improvement (preoperative mean: 0.12; postoperative mean: 0.60). Only 9.7 percent of the eyes examined had an uncorrected visual acuity of 20/20, whereas 90.3 percent had 20/40 or more. The number of eyes with a spherical equivalent of ± 0.50 fell as axial length rose (near: 100 percent; normal: 57.1 percent; far: 22.7 percent), unlike ± 0.50 spherical component predictability, which rose from near: 50.0 percent; normal: 57.1 percent; far: 63.6 percent. Conclusions: The Barrett True-K formula is useful for intraocular lens calculation in patients undergoing previous cataract and corneal refractive surgery(AU)

Control de la progresión del astigmatismo en la facoemulsificación / Control of the progression of astigmatism in phacoemulsification

Objetivo: Determinar cómo controlar la progresión del astigmatismo en la facoemulsificación para mejorar sus resultados. Métodos: Se realizó un estudio descriptivo, prospectivo, de serie de casos en 43 ojos de pacientes con diagnóstico de catarata, operados por la técnica de facoemulsificación por prechop con implante de lente intraocular plegable, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" desde noviembre del año 2018 hasta abril de 2020. Se emplearon los porcentajes y números absolutos para las variables cualitativas, las cuantitativas, la media y la desviación estándar, con un intervalo de confianza del 95 por ciento. Resultados: La edad media fue de 69,4 ± 8,3 años (51,16 por ciento); la dureza NO3; la mejor agudeza visual sin corrección mejoró en el 76,75 por ciento entre 0,8 a 1,0; la queratometría media pre- vs. posoperatoria no mostró diferencias estadísticamente significativas; el cilindro refractivo posoperatorio fue menor de 0,5 dioptrías en el 72,09 por ciento; el 51,17 por ciento de los ojos en el preoperatorio tenían astigmatismo refractivo contra la regla, lo cual mejoró según esta al mes de operado en el 60,47 por ciento de los pacientes. La calidad de vida en el 100 por ciento de los casos fue muy buena al mes de operados, según FV-14. Conclusiones: La corrección del astigmatismo con las incisiones personalizadas en la facoemulsificación ofrece buena predictibilidad y mejora su calidad visual y de vida(AU)

Objective: Determine how to control the progression of astigmatism in phacoemulsification to improve its results. Methods: A descriptive prospective study was conducted of a case series of 43 eyes of cataract patients undergoing prechop phacoemulsification with foldable intraocular lens implantation at Ramón Pando Ferrer Cuban Institute of Ophthalmology from November 2018 to April 2020. Percentages and absolute numbers were used for qualitative variables, and mean and standard deviation for quantitative variables, with a confidence interval of 95 percent. Results: Mean age was 69.4 ± 8.3 years (51.16 percent); hardness was NO3; in 76.75 percent best uncorrected visual acuity improved 0.8-1.0; pre- vs. postoperative mean keratometry did not show any statistically significant differences; in 72.09 percent the postoperative refractive cylinder was smaller than 0.5 diopters; 51.17 percent of the eyes had preoperative refractive against-the-rule astigmatism, improving at one month postoperative in 60.47 percent. Quality of life by the VF-14 survey was very good in 100 percent of the patients one month after surgery. Conclusions: Correction of astigmatism with personalized incisions in phacoemulsification provides good predictability and improves visual quality and quality of life(AU)

Calidad de vida en pacientes con visión monocular posterior a la cirugía de catarata / Quality of life in patients with monocular vision after cataract surgery

Objetivo: Evaluar la calidad de vida relacionada con la visión, en pacientes con catarata tratados con monovisión inducida con lente intraocular monofocal. Métodos: Se realizó un estudio experimental antes y después con un solo grupo. Para esto fueron reclutados 50 pacientes tributarios de cirugía de catarata, que presentaban presbiopía. Se evaluó la visión funcional (agudeza visual de cerca y de lejos), sin corrección, mejor corregida y la calidad de vida relacionada con la visión (cuestionario VF-14) antes y después de la cirugía. Resultados: El promedio de edad fue de 59,6 años y predominó el sexo femenino (60,0 por ciento). La mediana de la agudeza visual sin corrección en el ojo dominante poscirugía fue de 0,80 y la del equivalente esférico de -0,16 dioptrías, mientras que en el no dominante fue de 0,50 y de -1,68 dioptrías, respectivamente. La mediana de la agudeza visual sin corrección de cerca fue de 0,80. El 86,0 por ciento de los pacientes no requirió espejuelos después de la cirugía. La puntuación promedio del VF-14 precirugía ubicaba el 50 por ciento de los pacientes con una incapacidad parcial para desarrollar una actividad por causa visual. Después de la cirugía la totalidad de los pacientes no presentaba esta limitación visual. Conclusiones: La cirugía de catarata mejora la calidad de vida relacionada con la visión(AU)

Objective: Evaluate vision-related quality of life in cataract patients treated with induced monovision with monofocal intraocular lens. Methods: An experimental before-after one-group study was conducted. A selection was made of 50 presbyopic patients scheduled for cataract surgery. The variables evaluated were uncorrected and best corrected functional vision (near and far visual acuity) and vision-related quality of life (VF-14 questionnaire) before and after surgery. Results: Mean age was 59.6 years. Female sex prevailed (60.0 percent). Mean uncorrected postoperative visual acuity was 0.80 in the dominant eye and 0.50 in the non-dominant eye, whereas mean spherical equivalent was -0.16 diopters in the dominant eye and -1.68 diopters in the non-dominant eye. Mean uncorrected near visual acuity was 0.80. Of the patients studied, 86.0 percent did not require eyeglasses after surgery. Average preoperative VF-14 score showed that 50 percent of the patients had a partial disability to carry out an activity due to visual causes. After surgery no patient had such a visual limitation. Conclusions: Cataract surgery improves vision-related quality of life(AU)

Lente intraocular Premium: ¿opción o necesidad en la cirugía moderna de catarata? / Premium intraocular lenses: an option or a need in modern cataract surgery?

La catarata se presenta como la principal causa de ceguera prevenible en todo el mundo. La facoemulsificación con implante de lente intraocular es el procedimiento quirúrgico estándar más comúnmente utilizado. Las lentes intraoculares son consideradas prótesis de material biocompatible que se usan para sustituir el cristalino humano, y se han diseñado para limitar las aberraciones de orden superior y mejorar la calidad de la visión al conseguir la emetropía. Varias son las generaciones de lentes intraoculares diseñadas hasta este momento, con el fin de lograr su perfeccionamiento para ofrecerle al paciente una mayor independencia y excelentes resultados visuales después de la cirugía de catarata para todas las distancias. De ahí la motivación para realizar una búsqueda de diversos artículos publicados, con el objetivo de describir los lentes intraoculares Premium. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores(AU)

Cataract is the leading cause of preventable blindness worldwide. Phacoemulsification with intraocular lens implantation is the standard surgical procedure most commonly used. Intraocular lenses are biocompatible material prosthesis that replace the human crystalline lens. They have been designed to limit higher order aberrations and improve vision quality, achieving emmetropia. Several generations of intraocular lenses have been developed so far with the purpose of improving their quality and providing patients with greater independence and excellent visual results for all distances after cataract surgery. Hence the motivation to conduct a search for a variety of published papers, with the purpose of characterizing the Premium intraocular lenses. Use was made of the Infomed platform, particularly the Virtual Health Library with all its search engines(AU)

Resultados refractivos del implante secundario de lente en la cámara anterior con apoyo angular y de lente suturado a iris / Refractive results of anterior chamber angle-supported and iris-suture-fixated secondary lens implantation

Objetivo: Comparar los resultados refractivos del implante secundario de lentes intraoculares rígidos de la cámara anterior con apoyo angular y de lentes intraoculares plegables de la cámara posterior suturados a iris. Métodos: Se realizó un estudio casi experimental con control no equivalente (cohorte histórica). Se estudiaron 50 pacientes (50 ojos) con afaquia e inadecuado soporte capsular después de la cirugía de catarata, a quienes se les realizó implante secundario de lente intraocular con dos técnicas diferentes: lente intraocular en la cámara anterior con apoyo angular (25 ojos) y lente intraocular plegable de la cámara posterior suturado a iris (25 ojos). Resultados: Se observó que en el grupo de pacientes tratados con lente intraocular suturado a iris el porcentaje de pacientes con una visión de 20/40 o más fue significativamente superior (96,0 por ciento vs. 60,0 por ciento, p= 0,000) en los resultados refractivos obtenidos según el grupo de tratamiento. En el grupo A predominaron los pacientes que quedaron emétropes, seguidos de los pacientes miopes. En el grupo B predominaron los pacientes miopes y a diferencia del grupo anterior ningún paciente quedó hipermétrope. Conclusiones: La lente intraocular plegable de la cámara posterior suturada a iris mostró ser más eficaz, indujo menos astigmatismo y fue mejor en la predictibilidad de la esfera en un rango estricto de ± 1,00 dioptrías(AU)

Objective: Compare the refractive results of secondary implantation of rigid angle-supported intraocular lenses in the anterior chamber and foldable iris-suture-fixated intraocular lenses in the posterior chamber. Methods: A quasi-experimental non-equivalent control (historical cohort) study was conducted of 50 patients (50 eyes) with aphakia and inadequate capsular support after cataract surgery, who underwent secondary intraocular lens implantation with two different techniques: angle-supported intraocular lens in the anterior chamber (25 eyes) and foldable iris-suture-fixated intraocular lens in the posterior chamber (25 eyes). Results: In the group treated with iris-suture-fixated intraocular lens implantation the percentage of patients with 20/40 vision or more was significantly higher (96.0 percent vs. 60.0 percent, p= 0.000) in the refractive results obtained for each treatment group. In Group A a predominance was found of emmetropic, followed by myopic patients. In Group B myopic patients prevailed and unlike the other group no patient was hyperopic. Conclusions: Foldable iris-suture-fixated posterior chamber intraocular lenses proved more effective, induced less astigmatism and displayed better sphere predictability in a strict range of ± 1.00 diopters(AU)

Influence of upper blepharoplasty on intraocular lens calculation / A influência da blefaroplastia superior no cálculo da lente intraocular

ABSTRACT Purpose: To determine the effect of upper blepharoplasty on corneal topography and intraocular lens power calculation using Galilei and IOLMaster. Methods: Thirty patients submitted to upper blepharoplasty from May 2014 to March 2017 at the Hospital Oftalmológico de Sorocaba (São Paulo, Brazil) were included in this observational case series. All patients underwent imaging sessions with Galilei and IOLMaster preoperatively (baseline) and at 1 and 6 months postoperatively. Primary outcome measures using both devices included flattest, average, and steepest corneal curvature, corneal astigmatism, and blepharoplasty-induced corneal astigmatism. Determination of axial length and lens power calculation were performed using only IOLMaster (Holladay formula). Paired t-test and vectorial analysis were used for statistical analysis. Results: Sixty eyes from 30 patients were prospectively included. Vectorial analysis showed that 6 months after surgery, blepharoplasty induced on average 0.39 D and 0.31 D of corneal astigmatism, as measured with Galilei and IOLMaster, respectively. IOLMaster measurements showed that average corneal curvature (44.56 vs 44.64 D, p=0.01), steepest corneal curvature (45.17 vs 45.31, p=0.01) and corneal astigmatism (1.22 vs 1.34, p=0.03) were higher 6 months after surgery. IOLMaster measurements also showed that intraocular lens power was significantly smaller 6 months after surgery (22.07 vs 21.93, p=0.004). All other parameters showed no change for comparisons between baseline and 6 months (p>0.05 for all comparisons). Conclusion: Upper eyelid blepharoplasty influenced intraocular lens calculation using the IOLMaster. However, the influence was not clinically significant. No topographic changes were found using Galilei.

RESUMO Objetivo: Determinar o efeito da blefaroplastia superior na topografia corneana e no cálculo do poder das lentes intraoculares usando Galilei e IOLMaster. Métodos: Trinta pacientes submetidos a blefaroplastia superior de maio de 2014 a março de 2017 no Hospital Oftalmológico de Sorocaba, São Paulo, Brasil foram incluídos neste estudo de série de casos observacional. Todos os pacientes foram submetidos a sessões de imagem com Galilei e IOLMaster antes da cirurgia (exame de base) e no 1º e 6º mês pós-operatório. Os resultados primários utilizando os dois aparelhos incluíram ceratometria, astigmatismo corenano e astigmatismo corneano induzido pela blefaroplastia. O comprimento axial e o cálculo do poder da lente intraocular foram realizados unicamente com o IOLMaster (fórmula de Holladay). Teste-t pareado e análise vetorial foram usados na análise estatística. Resultados: Sessenta olhos de 30 pacientes foram incluídos prospectivamente. A análise vec­torial mostrou que após 6 meses da cirurgia, a blefaroplastia superior induziu na média 0,39 D de astigmatismo corneano medido com o Galilei e 0,31 D com IOLMaster. As medidas com o IOLMaster mostraram que a ceratometria média (44,56 vs 44,64 D, p=0,01), ceratometria máxima (45,17 vs 45,31, p=0,01) e o astigmatismo corneano (1,22 vs 1,34, p=0,03) foram maiores após 6 meses da blefaroplastia. As medidas com IOLMaster mostraram que o poder da lente intraocular foi significativamente menor 6 meses após a blefaroplastia (22,07 vs 21,93, p=0,004). Todos os outros parâmetros não mostraram mudanças entre o pré-operatório e o 6º mês da cirurgia (p>0,05 para todas as comparações). Conclusões: A blefaroplastia superior influenciou o cálculo da lente intrao­cular utilizando o IOLMaster. Contudo, a influência não foi cli­­nicamente significativa. Não foram encontradas mudanças topográficas com o Galilei.

Comparison of prediction accuracy of five different biometric formulas / Comparação da acurácia preditiva de cinco fórmulas biométricas diferentes

ABSTRACT Objective To compare the performance of Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function formulas to calculate intraocular lens power in eyes with normal axial length, in terms of predicting target refraction by using partial coherence interferometry technology. Methods Phacoemulsification and intraocular lens implantation were performed in 135 eyes of 135 patients with an axial length between 22 and 24.5 mm. Axial length, keratometry, and anterior chamber depth were measured by intraocular lens Master 500. Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function formulas were used for intraocular lens power calculations. The difference between the expected postoperative refraction and the mean absolute prediction error was calculated for each eye. Statistical significance was evaluated at the level of p<0.05. Results The study included 135 subjects. The mean axial length, anterior chamber depth, keratometry, and intraocular lens power were 23.2±1.2 (22 to 24.5) mm, 3.2±0.4 (2.4 to 4.4) mm, 43.5±1.5 (40.8 to 46.2) diopter, 21.5±1.8 (18.5 to 25.5) diopter, respectively. The mean absolute prediction error for Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function was 0.306±0.291, 0.312±0.257, 0.314±0.268, 0.299±0.206 and 0.308±0.280, respectively (p>0.05). Conclusion The study showed the third-generation (Sanders-Retzlaff-Kraft/Theoretical and Hoffer Q), fourth-generation (Barrett Universal II) and new-generation (Kane and Hill-radial basis function) intraocular lens power calculation formulas had similar performances regarding calculation of intraocular lens power to predict target refraction after phacoemulsification in eyes with normal axial length.

RESUMO Objetivo Comparar o desempenho das fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function (RBF) para cálculo de poder dióptrico das lentes intraoculares, em olhos com comprimento axial normal, em termos de predição da refração alvo, utilizando a tecnologia de interferometria de coerência parcial. Métodos Facoemulsificação e implante de lentes intraoculares foram realizados em 135 olhos de 135 pacientes com comprimento axial entre 22 e 24.5 mm. Comprimento axial, ceratometria, e profundidade da câmara anterior foram medidos por lente intraocular Master 500. As fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function foram empregadas para cálculo de poder dióptrico das lentes intraoculares. A diferença entre a refração esperada no pós-operatório e a média dos erros absolutos preditivos foi calculada para cada olho. Os valores de p<0,05 foram considerados estatisticamente significativos. Resultados O estudo incluiu 135 sujeitos. As médias de comprimento axial, profundidade da câmara anterior, ceratometria, e poder dióptrico das lentes intraoculares foram 23,2±1,2 (22 a 24,5) mm, 3,2±0,4 (2,4 a 4,4) mm, 43,5±1,5 (40,8 a 46,2) dioptria, 21,5±1,8 (18,5 a 25,5) dioptria, respectivamente. A média de erro absoluto preditivo para as fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function foi 0,306±0,291, 0,312±0,257, 0,314±0,268, 0,299±0,206 e 0,308±0,280, respectivamente (p>0,05). Conclusão O estudo mostrou que as fórmulas de terceira geração (Sanders-Retzlaff-Kraft/Teórica e Hoffer Q), de quarta geração (Barrett Universal II) e as da nova geração (Kane e Hill-radial basis function) para cálculo de poder dióptrico das lentes intraoculares, têm desempenhos semelhantes para cálculo do poder dióptrico das lentes intraoculares, para predizer a refração alvo após facoemulsificação em olhos com comprimento axial normal.

Efectividad del implante de lente fáquica ACR-128 tras un año de seguimiento / Effectiveness of an ACR-128 phakic lens implant after one year's follow-up

Introducción: La corrección de ametropías moderadas-severas mediante lentes fáquicas permite conservar la acomodación, además, de obtener una mejor calidad óptica, reversibilidad del procedimiento y la opción de corregir defectos refractivos residuales mediante cirugía corneal mínima invasiva. Objetivo: Determinar la efectividad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de su implante. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128. Se determinaron las características biométricas y refractivas por ojo, relación entre el componente esférico esperado y el observado, distribución por ojos el componente esférico esperado y el observado, relación entre cilindro queratométrico pre y posoperatorio y relación entre la agudeza visual sin corrección y la agudeza visual mejor corregida en el pre y posoperatorio. Resultados: La edad media fue 28,06 ± 6,14(25 mujeres, 11 hombres) el equivalente esférico preoperatorio OD promedio de -10,77 ± 4,23 dioptrías y OI promedio de -10,77 ± 3,72 dioptrías. El componente esférico en dioptrías esperado (-0,56 ± 0,38) y observado (-0,43 ± 0,69) sin diferencias estadísticamente significativas (p = 0,14). El cilindro queratométrico en dioptrías, pre (1,41 ± 0,74) y posoperatorio (1,24 ± 0,88) sin astigmatismo inducido (p = 0,12). El 100 por ciento tenía agudeza visual sin corrección preoperatoria ≤ 0,1 y posoperatoria ≥ 0,5. Conclusiones: Un año después del implante de lente fáquica ACR-128 en la corrección de la alta miopía el tratamiento continúa efectivo, pues reduce el componente esférico al deseado y mantenerlo, no inducir astigmatismo y mantener mejor agudeza visual(AU)

Introduction: Correction of moderate-severe ametropia with phakic lenses makes it possible to preserve accommodation and provides better optical quality, reversibility of the procedure and the option of correcting residual refractive defects by minimally invasive corneal surgery. Objective: Determine the effectiveness of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lenses. Determination was made of the biometric and refractive characteristics of each eye, the relationship between the expected and the observed spherical component, the distribution of the expected and the observed spherical component per eye, the relationship between the pre- and postoperative keratometric cylinder, and the relationship between pre- and postoperative uncorrected and best corrected visual acuity. Results: Mean age was 28.06 ± 6.14 (25 women, 11 men). Average preoperative spherical equivalent was -10.77 ± 4.23 diopters RE and -10.77 ± 3.72 diopters LE. Spherical component in diopters: expected (-0.56 ± 0.38) and observed (-0.43 ± 0.69), without statistically significant differences (p= 0.14). Keratometric cylinder in diopters: preoperative (1.41 ± 0.74) and postoperative (1.24 ± 0.88), without induced astigmatism (p = 0.12). In 100 percent visual acuity without correction was #8804; 0.1 preoperative and ≥ 0.5 postoperative. Conclusions: One year after ACR-128 phakic lens implantation for high myopia correction, the treatment remains effective, reducing the spherical component and maintaining it at the desired level, not inducing astigmatism and preserving best visual acuity(AU)