Satisfação de pacientes submetidos à cirurgia refrativa de PresbiLASIK / Satisfaction of patients submitted to PresbyLASIK refractive surgery

Resumo Objetivos: Avaliar a satisfação dos pacientes submetidos à cirurgia de Presbilasik central e determinar a prevalência de sintomas relatados após a cirurgia. Métodos: Este é um estudo descritivo, observacional, transversal, com dados obtidos de pacientes submetidos previamente ao PresbiLASIK. Resultados: A amostra consistiu de 45 pacientes, com média de idade de 57,7 (±7,19) anos. A nota média atribuída para a satisfação visual com o procedimento foi 8.9 (±1.0). A qualidade visual após a cirurgia foi classificada como igual ou melhor que a esperada por 84,5% dos pacientes e 31% apresentaram sintomas noturnos, como halos e raios de cometa. Conclusão: A qualidade de visão após o procedimento de PresbiLASIK foi altamente satisfatória para os pacientes. Fator determinante dessa satisfação é o processo de manejo das expectativas pré-operatórias dos pacientes, informando das possibilidades terapêuticas disponíveis, e, no caso da escolha cirúrgica, acerca das vantagens e limitações.

Abstract Objectives: Toassess the satisfaction of patients undergoing central Presbilasik surgery and to determine the age of patients who undergo PresbiLASIK and the prevalence of symptoms reported after surgery. Methods: This is a descriptive, observational, cross-sectional study with data collected from patients previously submitted to PresbiLASIK. Results: The sample consisted of 45 patients, with a mean age of 57.7 (±7,19) years. The average score attributed to visual satisfaction with the procedure was 8.9 (±1.0). Visual quality after surgery was classified as equal to or better than expected by 84.5% of the patients and 31% complained of nocturnal symptoms such as halos and comet rays. Conclusion: The quality of vision after the PresbiLASIK procedure was highly satisfactory for the patients. A determining factor for this satisfaction is the process of managing patients' preoperative expectations, informing them about the therapeutic possibilities available, and, in the case of surgical choice, about its advantages and limitations.

Clinical experience after tetrafocal intraocular lens implantation "PANOPTIX" / Experiência clínica após implantação de lentes intraoculares tetrafocais "PANOPTIX"

Abstract Purpose: To assess long, intermediate and near uncorrected visual acuity after a tetrafocal diffractive intraocular lens implantation, presence of dystopic phenomenon and patient satisfaction after surgery. Methods: Retrospective, observational study performed in Puerta de Hierro Specialties Hospital, in Jalisco, México. That included 100 eyes after phacoemulsification surgery by femtosecond assistance, followed by tetrafocal diffractive intraocular lens implantation due to cataract. Long, intermediate and near visual acuity without correction was measured, and presence or absence of dystopic phenomenon, plus patient satisfaction after surgery. Results: A total of 100 eyes in 50 patients who underwent cataract surgery with phacoemulsification by femtosecond assistance were evaluated. 100% underwent bilateral phacoemulsification. Long, intermediate, and near visual acuity after three months was in the most patients 20/20 (46%), 20/15 (44%) and Jaeger 1 (48%) respectively. The percentage or patients who refers halos was 7%; and other associated symptoms in 18%, being astenopia the most prevalent. The removal of the lens was not required in any case. Conclusion: Tetrafocal diffractive intraocular lenses provides excellent intermediate vision (at 60 centimeters) and satisfactory near (30 centimeters) and long (6 meters) visual acuity.

Resumo Objetivo: Avaliar a acuidade visual de longe, intermediária e de perto após o implante de lente intra-ocular difrativa tetrafocal, presença de fenômenos distópicos e satisfação do paciente após a cirurgia. Métodos: Estudo retrospectivo, observacional, realizado em Puerta de Hierro Hospital de Especialidades, em Jalisco, México. Isso incluiu 100 olhos após a cirurgia de facoemulsificação pela presença de laser de femtosegundo, seguida por implante de lente intra-ocular difrativa tetrafocal devido à catarata ou cirurgia facorrefractiva. Foi medida a acuidade visual de longe, intermediária e de perto, e a presença ou ausência de fenômenos distópicos, além da satisfação do paciente após a cirurgia. Resultados: Um total de 100 olhos em 50 pacientes submetidos à cirurgia de catarata com facoemulsificação por femtosegundo foram avaliados. 100% foram submetidos a facoemulsificação bilateral. A acuidade visual para longe, intermediária e de perto após três meses foi na maioria dos pacientes 20/20 (46%), 20/15 (44%) e Jaeger 1 (48%) respectivamente. A porcentagem ou pacientes que se referem a halos foi de 7%; e outros sintomas associados em 18%, sendo a astenopia a mais prevalente. A remoção da lente não foi necessária em nenhum caso. Conclusão: A lente intra-ocular difrativa tetrafocal fornece excelente visão intermediária (a 60 centímetros) e acuidade visual satisfatória de perto a (30 centímetros) e de longe (6 metros).

Satisfação de pacientes após cirurgia refrativa de monovisão avançada / Satisfaction of patients after advanced mono-refractive surgery

Resumo Objetivo: Monovisão é um conceito que descreve a correção propositadamente desigual da visão de em um olho para longe e outro olho para perto, sendo utilizada principalmente para correção da presbiopia. O objetivo principal foi avaliar a satisfação dos pacientes com a cirurgia refrativa de monovisão avançada. Os objetivos secundários foram avaliar a necessidade de uso de óculos após a cirurgia, e analise do perfil dos participantes. Métodos: Foi realizado um estudo transversal observacional de série de casos baseado na revisão de prontuários de participantes submetidos a cirurgia refrativa de monovisão em uma clínica oftalmológica privada. A população estudada foi do tipo não-probabilistica com n de 50 participantes. A amostragem foi por conveniência, sendo selecionados os prontuários dos últimos 50 participantes que retornaram para consulta de revisão após a cirurgia refrativa realizada até novembro de 2016. Resultados: Foram analisados 50 prontuários. Quando questionados sobre a satisfação com o procedimento, a nota média atribuída foi 9,4 ± 0,6 dentro de uma escala de 0 a 10. Sobre a necessidade do uso de óculos após o procedimento, 92% dos pacientes referiram não necessitar. Os demais 8% que referiram utilizar eventualmente óculos para perto eram hipermetropes antes da cirurgia Conclusão: Concluímos que o índice de satisfação com a cirurgia de monovisão na amostra estudada foi alto e a maioria dos participantes referiu não necessitar de óculos após o procedimento. A amostra foi composta majoritariamente por mulheres com média de idade de 52 anos, hipermetropes, que realizaram a cirurgia em ambos os olhos. Nossa amostra foi distinta de outros estudos devido ao fato de incluirmos maior parte de participantes hipermetropes.

Abstract Objective: Monovision is a concept that describes the purposely unequal correction of vision from one eye to the other and eye to eye, and is mainly used to correct presbyopia. The main objective was to evaluate patients' satisfaction with advanced monovision refractive surgery. The secondary objectives were to evaluate the need for glasses after surgery, and to analyze the profile of the participants. Methods: A cross-sectional observational study of a series of cases was carried out based on the review of medical records of participants submitted to refractive surgery of monovision in a private ophthalmologic clinic. The population studied was of the non-probabilistic type with n of 50 participants. Sampling was for convenience, and the medical records of the last 50 participants who returned for revision consultation after refractive surgery performed until November 2016 were selected. Results: Fifty patients were analyzed. When questioned about satisfaction with the procedure, the mean score assigned was 9.4 ± 0.6 on a scale of 0 to 10. Regarding the need for glasses after the procedure, 92% of the patients reported not needing it. Conclusion: We concluded that the satisfaction index with monovision surgery in the sample studied was high and most of the participants reported that they did not require glasses after the procedure. The sample consisted mainly of women with mean age of 52 years, hypermetropes, who underwent surgery in both eyes. Our sample was different from other studies due to the fact that we included most participants with hypermetropes.

Complete depigmentation of a small aperture corneal inlay implanted for compensation of presbyopia / Despigmentação completa de um implante corneano de pequena abertura para correção da presbiopia

ABSTRACT We describe a case of late-onset remarkable depigmentation of a small aperture corneal inlay implanted for presbyopia compensation. The patient was a participant in a clinical trial designed to evaluate the safety and efficacy of the AcuFocusTM ACU-10R160, which is a 10 µm-thick polyimide film tinted with an organic dye. Inlay implantation occurred under mechanical microkeratome Lasik flaps set for a depth of 120 µm. The patient returned to the clinic 11 years after surgery and reported loss of near-vision acuity. Clinical examination showed the complete absence of pigments in the device and the total loss of the initial effect on near vision, despite normal distance vision. Manifest refraction remained stable during the follow-up period. Scheimpflug images characterized the loss of the small aperture effect on incoming light. Confocal analysis revealed small hyper-reflective round images on the endothelium and no signs of inflammation.

RESUMO Descrevemos um caso de importante despigmentação de início tardio de implante corneano de pequena abertura implantada para compensação de presbiopia. O paciente foi um dos participantes de ensaio clínico destinado a avaliar a segurança e eficácia do AcuFocusTM ACU-10R160, uma película de poliimida de 10 microns de espessura, tingida com um corante orgânico. A implantação ocorreu sob um flap de Lasik criado por microcerátomo mecânico ajustado para profundidade de 120 µm. O caso aqui descrito foi avaliado 11 anos após a cirurgia, relatando diminuição de acuidade de visão para perto. O exame clínico mostrou ausência total de pigmentos no dispositivo e perda total do efeito inicial na visão de perto, apesar da visão normal para distância. A refração manifesta permaneceu estável durante o período de seguimento. As imagens de Scheimpflug caracterizaram a perda do efeito da abertura pequena na luz entrante. A análise de microscopia confocal revelou pequenas imagens hiper-reflexivas redondas sobre o endotélio, sem sinais de inflamação.

Resultados a largo plazo en pacientes con implante de lente intraocular acomodativo de una optica crystalens HDTM / Long-term results in patients implanted with single-optics intraocular accommodative crystalens HD

Objetivo: evaluar los resultados visuales a 30 + 3 meses del implante binocular del lente intraocular Crystalens HDTM. Diseño: serie de casos. Métodos: en seis pacientes (12 ojos) con implante binocular del lente intraocular Crystalens HDTM se evaluó la agudeza visual no corregida (AVSC), la agudeza visual corregida (AVCC) en visión cercana (40 cm), intermedia (80cm) y lejana (4mts), amplitud de acomodación, test de sensibilidad al contraste, biomicroscopía y encuesta de satisfacción. Resultados: los 6 pacientes evaluados con edades de 62.5 + 16 años presentaron AVSC a 40 cm de +0.1 LogMAR a distancia intermedia de -0.1 LogMAR y a 4 mts fué de 0.0 LogMAR; la AVCC fué de +0.1 LogMAR a 40 cm, 0.0 LogMAR a 80cm y a 4m permaneció sin cambios (0.0 LogMAR). La amplitud de acomodación fué de 4.00 +/- 1.00 dioptrías (D), la sensibilidad al contraste disminuyó en condiciones mesópicas con glare. De los 6 pacientes, 3 (50%) requirieron capsulotomía Nd-YAG laser y sólo 2 (33%) de los pacientes refirieron presencia de halos y glare. Según la encuesta de satisfacción, 5 pacientes (83%) fueron capaces de realizar sus actividades cotidianas sin dificultad ni requerimiento de corrección. Conclusión: el lente intraocular acomodativo de una óptica Crystalens HDTM logra resultados visuales adecuados a distancia lejana e intermedia, requiriendo +0.65 D (rango +0.50 a +1.75) de adición para cerca. En condiciones mesópicas presenta bajo desempeño y presenta un alto porcentaje de opacidad de capsula posterior.

Purpose: to evaluate the visual outcomes of intraocular lens Crystalens HDTM after 30 months of binocular implantation. Design: case series. Methods: in 6 patients (12 eyes) with binocular implant of Crystalens HDTM, we assessed uncorrected (UVA) and corrected (CVA) visual acuity at near (40 cm), intermediate (80cm) and distance (4m), accommodative amplitude, contrast sensitivity, biomicroscopy and satisfaction survey. Results: age of six evaluated patients was 62.5 + 16 years, mean UCVA at 40 cm was +0.1 LogMAR, at intermediate was -0.1 LogMAR and distance VA was 0.0 LogMAR. Mean BSCVA was 0.0 LogMAR at 40 cm, 0.0 LogMAR at 80cm and remained unchanged at distance (0.0 LogMAR). The accommodative amplitude was 4.00 + / - 1.00 diopters, the contrast sensitivity was diminished under mesopic conditions with glare. Of the 6 patients, 4 (66%) patients required Nd-YAG laser capsulotomy and only 2 (33%) of the patients reported presence of halos and glare. Regarding satisfaction survey, 83% were able to perform daily activities without difficulty or correction requirement. Conclusions : the intraocular accommodative lens Crystalens HDTM, restores distance and intermediate vision requiring +0.65 D (range +0.50 to +1.75) at near distance. There is low vision quality under mesopic conditions and a high percentage of posterior capsule opacity.

Pseudophakic monovision is an important surgical approach to being spectacle-free.

There are few studies on pseudophakic monovision even though it is widely applied. We reviewed the published literature on pseudophakic monovision. Surgeons select patients who not only have a strong desire to be free of glasses after surgery, but also fully understand monovision design and its drawbacks. However, other criteria adopted for pseudophakic monovision are very different. Both traditional monovision and cross monovision are used in pseudophakic monovision, and the target binocular anisometropia ranges from –1.0 D to –2.75 D. Postoperative results were acceptable in every study and most patients were satisfied, with vision being improved and presbyopia corrected. Complications were decreased stereopsis, contrast sensitivity, and visual fields, similar to other types of monovision. The term “pseudophakic monovision” should include more than just monocular intraocular lens implantation in two eyes, and further studies are required.

Cirugía refractiva: indicaciones, técnicas y resultados / Refractive surgery: indications, techniques and results

La cirugía refractiva se ha constituido en una desafiante subespecialidad de la Oftalmología. Importantes avances tecnológicos permiten la opción de tratamiento quirúrgico de los vicios de refracción. Las cirugías de miopía, hipermetropía y astigmatismo, han logrado excelentes resultados en eficacia, estabilidad y seguridad; permitiendo reducir o eliminar la dependencia de anteojos y lentes de contacto. Las técnicas más utilizadas son las queratorefractivas con láser excimer, especialmente la queratomileusis in situ con láser (LASIK) y la queratectomía fotorefractiva (PRK). Ambas dominan el campo del tratamiento quirúrgico de las ametropías bajas y moderadas. En las altas ametropías, y en pacientes con córneas de grosor insuficiente para el tratamiento con láser, está aumentando el uso de las técnicas intraoculares. Una de estas técnicas es el implante de lentes intraoculares fáquicos, en que se conserva el cristalino natural del paciente, y se utiliza hasta alrededor de los 50 años. Los vicios de refracción también se pueden corregir con lentes intraoculares seudofáquicos, que reemplazan el cristalino del paciente, y se usan de rutina en cirugía de catarata. En el área refractiva, están restringidos más bien a pacientes mayores de 50 años. Estos lentes tienen la posibilidad adicional, en casos seleccionados, de corregir la presbicia, que es, aún, el último desafío a ser resuelto en Cirugía Refractiva.

Refractive surgery has become a challenging subspeciality in Ophthalmology. Important technological advances, currently allow the option of surgical treatment of refractive errors. Surgical treatments of myopia, hyperopia, and astigmatism, have achieved excellent results in efficacy, stability and safety; allowing to reduce or eliminate the dependence on glasses and contact lenses. The most used techniques are keratorefractive with excimer laser, specially laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Both dominate the field of surgical treatment for low and moderate refractive errors. In high refractive errors or patients with insufficient corneal thickness for laser treatment, the intraocular techniques are increasingly used. One of these techniques is the phakic intraocular lens implantation, in which the natural lens is preserved. That implant is used in patients up to 50 years of age. Refractive errors can be also corrected with pseudophakic intraocular lenses that replace the natural lens, and are used always in cataract sugery. Their refractive indication is usually restricted to patients 50 years or older. These lenses have the additional possibility, in selected cases, to correct the presbyopic condition, that to date is still the last challenge to be resolved in Refractive Surgery.

Monovisión con láser de excímeros en pacientes présbitas / Monovision with Excimer laser surgery in presbyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía con láser de excímeros en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, longitudinal prospectivo, con 60 pacientes, 18 miopes y 42 hipermétropes sometidos a cirugía con láser de excímeros para corregir la presbicia con el método de la monovisión en el Servicio de Córnea y Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ellas (lejos y cerca), y equivalentes esféricos. Para presentar la información se utilizó la media y desviación estándar de ambas. RESULTADOS: En el preoperatorio se observó que la agudeza visual promedio mejoraba de un valor de 0,1 y 0,3 sin corrección para miopes e hipermétropes, respectivamente a 0,94 y 0,97 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, lo cual corrige de esta manera equivalentes esféricos promedios de -4,63 dioptrías y +2,21 dioptrías en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 1 - 2 y los equivalentes esféricos promedios alcanzados para visión lejana fueron de -0,02 ± 0,27 dioptrías para miopes y +0,09 ± 0,34 dioptrías para hipermétropes; en visión cercana, o sea, en el ojo no dominante fue de -1,7 ± 0,22 dioptrías para el primer grupo y de -1,4 ± 0,38 dioptrías para el segundo grupo. CONCLUSIONES: Se halló mejoría de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias con la precisión en los resultados visuales antes previstos que caracterizan a la cirugía con láser de excímeros

OBJECTIVES: To describe the refractive results achieved with Excimer laser surgery in presbyopic patients, both hyperopic and myopic, with monovision. METHODS: A prospective, longitudinal and descriptive study was performed on 60 presbyopic patients, 18 myopic and 42 hyperopic, who underwent Excimer laser surgery to correct presbyopia based on the monovision method at the Corneal and Refractive Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables used were pre- and post-operative visual acuity with correction, visual acuity without binocular correction, both near and distant, and spheral equivalents. For presenting this information, the mean and standard deviation were used for all variables. RESULTS: In the preoperative phase, it was observed that average visual acuity improved from 0,1 and 0,3 for myopic and hyperopic patients without correction, to 0,94 and 0,97 binocular visual acuity without correction for the same groups in the postoperative phase, thus correcting their average spherical equivalent of 4,63 D and +2,21 D respectively. Average near visual acuity for both groups was Jeager (J) 1 - 2 and average spheral equivalents reached for distant vision were 0,02 ± 0, 27 D for myopic and +0.09 ± 0,34 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1.7 ± 0,22 D for myopic and 1.4 ± 0,38 D for hyperopic patients. CONCLUSIONS: After surgery both myopic and hyperopic patients experienced improvement in their visual acuity without correction for distant as well as for near vision. Spheral equivalents were widely modified in both groups for the dominant and non-dominant eyes, in order to facilitate the final visual result in both distances with the foreseen precision in the visual results that characterizes the Excimer laser surgery

Monovisión con lente intraocular monofocal en pacientes présbitas / Monovision with monofocal intraocular lens in prebyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía del cristalino en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, prospectivo, longitudinal con 21 pacientes, 13 miopes y 8 hipermétropes sometidos a cirugía del cristalino para corregir la presbicia con el método de la monovisión en el Servicio de Microcirugía del Instituto Cubano de Oftalmología Ramón Pando Ferrer entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ella, lejos y cerca, y equivalentes esféricos. Se utilizó la media y desviación estándar para presentar la información. RESULTADOS: En el preoperatorio la agudeza visual promedio mejoraba de un valor de 0,7 y 0,9 corregida para miopes e hipermétropes respectivamente a 0,88 y 0,94 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, corrigiendo de esta manera equivalentes esféricos promedios de -8,27 D y +6,26 D en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 2 y los equivalentes esféricos promedios alcanzados para visi¾n lejana fueron de -0,32 D para miopes y +0,26 D para hipermétropes; en visión cercana, o sea, en el ojo no dominante es de -1,6 D para el primer grupo y -1,3 D para el segundo grupo. CONCLUSIONES: Se halló mejoría indudable de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias. Los resultados obtenidos corroboran que la monovisión produce un mayor beneficio en la visión cercana que el perjuicio que provoca en la visión lejana lo que la hace muy exitosa para cierto grupo de pacientes

OBJECTIVES: To describe the refractive results achieved in presbyopic patients, both hyperopic and myopic, with monovision METHODS: A prospective, longitudinal and descriptive study was carried out in 21 patients, 13 myopic and 8 hyperopic, who underwent lens surgery to correct presbyopia based on the monovision procedure at the Microsurgery Service of the Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables were pre and postoperative visual acuity with/without correction, both near and distant, and spheral equivalents. Mean and standard deviation values were used to present all variables. RESULTS: It was found that average visual acuity with correction improved from 0,7 and 0,9 in myopic and hyperopic patients respectively to 0,88 and 0,94 of binocular visual acuity without correction in the postoperative phase, thus correcting their average spheral equivalents of 8,27 diopters (D) and +6,26 D in each group. The average visual acuity for near vision for both groups was Jeager (J) 2 and the average spheral equivalents reached for distant vision were -0,32 D for myopic and +0,26 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1,6 D for the first group and 1,3 D for the second group. CONCLUSIONS: After surgery there was an undoubted improvement in visual acuity without correction, in near as well as in distant vision. Spherical equivalents were widely modified for both groups in both the dominant and the non-dominant eye, improving vision at both distances. The achieved results corroborate that the benefits brought about by monovision in near vision are more important than the damages it causes in distant vision, making it very successful for certain groups of patients

Tratamiento con ablación multifocal para presbicie asociada a hipermetropía / Multifocal corneal ablation for presbyopia

Objetivos: Evaluar resultados clínicos y complicaciones en pacientes sometidos a lasik con ablación multifocal para tratar la presbicia. Material y Método: En forma prospectiva seleccionamos 38 ojos en 19 pacientes con presbicia e hipermetropía hasta +3.0 D y astigmatismo hasta +1.0 D sin patologías ocular ni cirugía previa. El análisis wavefront fue realizado con el aberrómetroVISX Wavescan® y el tratamiento con el VISX Star S4 IR excimer laser. El perfil de ablación fue el CustomVue™Multifocal Ablation que produce una zona óptica central para visión intermedia y cerca y una periférica para lejos. Los resultados fueron evaluados según seguridad, eficacia, predictibilidad, estabilidad, complicaciones y cambios en las aberraciones de alto orden. Resultados: La edad promedio fue de 52 años. El Equivalente Esférico preoperatorio fue +2.00 D +/- 0.56 D. El seguimiento fue de 6 meses. El Equivalente Esférico postoperatorio fue de -0.25 +/-0.56 D. No se observaron complicaciones. Hubo una pérdida de la mejor agudeza visual para lejos de 1 línea en el 12.5 por ciento de los ojos. En términos de eficacia el 75 por ciento de los pacientes alcanzan > 20/20 y el 100 por ciento > 20/40 sin corrección para lejos. Para cerca sin corrección 100 por ciento de los pacientes obtienen > J5, 88 por ciento obtiene > J3 y un 50 por ciento > J1. 62.5 por ciento de los pacientes alcanzaron > 20/25 para lejos y > J3 para cerca. Conclusión: El tratamiento con Lasik CustomVue™ Multifocal Ablation para pacientes hipermétropes con presbicie es un procedimiento seguro y produce un alto grado de satisfación debido a la independencia a los lentes. Un seguimiento más prolongado es necesario para evaluar nuestros buenos resultados.

Purpose: To evaluate outcomes and complications in patients who underwent multifocal corneal ablation to treat presbyopia. Methods: In a prospective way we selected 38 eyes of 19 patients with presbyopia and hyperopia up to +3.0 D and astigmatism up to +1.0 D. Patients with ocular pathology or with previous ocular surgery were excluded. The wavefront analysis was performed with the VISX Wavescan® aberrometer, and the treatment with the VISX Star S4 IR excimer laser. The ablation profile was CustomVue™ Multifocal Ablation, that produces a central zone for intermediate and near vision and a periferic zone for distance vision. The clinical outcomes were evaluated based in standards terms of safety, efficacy, predictability, stability, complications and changes in higher order aberrations. Results: The average age was 52 years. The mean of the preoperative spherical equivalent was + 2.00 D +/- 0.56 D. The follow up was up to 6 months. The mean of postoperative spherical equivalet was -0.25 +/-0.56, that was relatively stable after the first 6 postoperative months and no complication was observed. 12.5 percent of the eyes lost 1 line of BSCVA for distance vision. No subjects had change in BSCVA for near vision at the end of follow up. In terms of efficacy, 75 percent of subjects achieved 20/20 or better UCVA for distance and 100 percent achieved 20/40 or better UCVA. For near vision 100 percent of subjects achieved J5 or better vision at the end of follow up, 88 percent achieved > J3 and 50 percent > J1. 62.5 percent of subjects achieved both 20/25 or better vision for distance and J3 or better for near vision. Conclusion: The treatment with Lasik CustomVue™ ultifocal Ablation for hyperopic patients with presbyopia is a safe procedure and procedure a high rate of satisfaction due to spectacles independency. A longer follow up is necessary to evaluate ours good outcomes.