Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 119
Filter
1.
Rev. bras. oftalmol ; 81: e0006, 2022. tab, graf
Article in Portuguese | LILACS | ID: biblio-1360917

ABSTRACT

RESUMO Objetivo: Identificar se há mudança refracional significativa após realização de capsulotomia posterior com laser Nd:YAG em olhos pseudofácicos. Métodos: Estudo retrospectivo com análise de prontuários de pacientes atendidos em um hospital com diagnóstico de opacificação de cápsula posterior do cristalino tratada com capsulotomia posterior com laser Nd:YAG no período de outubro de 2019 a março de 2021. A comparação entre a refração antes e após o procedimento foi realizada calculando-se o equivalente esférico. Também foi avaliada a mudança da acuidade visual, aferida por LogMAR. Resultados: Foram analisados 90 prontuários, totalizando 140 olhos, de pacientes submetidos à capsulotomia posterior com laser Nd:YAG. O equivalente esférico médio pré-procedimento foi de -0,07±0,89D, mínimo de -3,0D e máximo de +2,5D, mediana (intervalo interquartil) de 0,0D (-0,50D a +0,375D). A média pós-procedimento foi de -0,18±0,86D, mínimo de -3,5D e máximo de +2,25D, mediana (intervalo interquartil) de -0,125D (-0,50D a 0,0D). com p<0,0082. Dos 140 olhos, 66 sofreram miopização e 37 hipermetropização. A média de alteração do equivalente esférico geral foi de -0,12±0,51D, mínimo de -2,50D e máximo de +1,25D, mediana (intervalo interquartil) de 0,0D (-0,375D a +0,125D). Ao se comparar a diferença entre o equivalente esférico antes e após o procedimento do grupo de olhos que sofreu miopização (n=66) ou hipermetropização (n=37), separadamente, ambos obtiveram p<0,0001. Ao se compararem todos os olhos que sofreram alguma alteração refracional (n=103), foi encontrado p=0,008. A acuidade visual média pré-procedimento foi de 0,23±0,32, mínimo de 0,0 e máximo de 2,3. Pós-procedimento, a média foi de 0,06±0,13, mínimo de -0,12 e máximo de 0,7, com p<0,0001. Conclusão: A capsulotomia posterior com laser Nd:YAG gerou melhora significativa da acuidade visual nos pacientes do estudo, porém também gerou alteração refracional significativa após o procedimento, tanto para miopização (a mais frequente), quanto para hipermetropização.


ABSTRACT Objective: To identify if there is a significant change on refraction after Nd:YAG laser posterior capsulotomy in pseudophakic eyes. Methods: A retrospective study with analysis of medical records of patients treated at a hospital, with diagnosis of opacification of posterior lens capsule treated with Nd:YAG laser posterior capsulotomy, from October 2019 to March 2021. The comparison of refraction before and after the procedure was performed by calculating the spherical equivalent. Changes in visual acuity (VA), measured by LogMAR, were also evaluated. Results: A total of 90 medical records (140 eyes) of patients submitted to Nd:YAG laser posterior capsulotomy were analysed. The mean pre-procedure spherical equivalent was -0.07±0.89D, minimum of -3.0D and maximum of +2.5D, median (interquartile range) of 0.0D (-0.50D to +0.375D). The post-procedure mean was -0.18±0.86D, minimum of -3.5D and maximum of +2.25D, median (interquartile range) of -0.125D (-0.50D to 0.0D), with p <0.0082. Of the 140 eyes, 66 underwent myopia and 37 hyperopia, the mean change in the general spherical equivalent was -0.12±0.51D, minimum -2.50D and maximum +1.25D, median (interquartile range) of 0.0D (-0.375D to +0.125D). When comparing the difference between the spherical equivalent before and after the procedure of the group of eyes that underwent myopia (n=66) or hyperopia (n=37), separately, both obtained p<0.0001. When comparing all eyes that suffered any change on refraction (n=103), the p value was 0.008. The mean pre-procedure visual acuity was 0.23±0.32, minimum of 0.0 and maximum of 2.3. After the procedure, the mean was 0.06±0.13, minimum of -0.12 and maximum of 0.7, p<0.0001. Conclusion: Nd:YAG laser posterior capsulotomy significantly improved visual acuity of patients in this study; however, it also led to a significant change on refraction after the procedure, both for myopization, which was more frequent, and for hyperopization.


Subject(s)
Humans , Male , Female , Aged , Refraction, Ocular , Lasers, Solid-State/therapeutic use , Posterior Capsulotomy/adverse effects , Posterior Capsulotomy/methods , Cataract Extraction/adverse effects , Medical Records , Retrospective Studies , Phacoemulsification/adverse effects , Pseudophakia/surgery , Laser Therapy/methods , Capsule Opacification/surgery , Capsule Opacification/etiology
2.
Arq. bras. oftalmol ; 83(6): 478-484, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1153081

ABSTRACT

ABSTRACT Purpose: To investigate the impact of different sizes of steep meridian clear corneal incisions for phacoemul sification on anterior corneal higher-order aberrations. Methods: Medical records of patients who underwent 2.2-mm coaxial micro-incision cataract surgery or 2.75-mm coaxial small-incision cataract surgery were retrospectively reviewed. Only patients with preexisting anterior corneal astigmatism <2.00 diopters (D) and ≥0.50 D who underwent a steep meridian clear corneal incision were included. Primary outcomes were 3rd- to 6th-order anterior corneal higher-order aberrations with an 8-mm pupil. Anterior corneal astigmatism and effective phaco time were evaluated as secondary outcomes. Preoperative and 3-month postoperative outcomes were evaluated. Results: Anterior corneal astigmatism significantly decreased after both procedures; however, there was no significant difference found in surgically induced anterior corneal astigmatism between the two procedures (p=0.146). Although the total higher-order aberrations did not significantly change after both procedures, the group comparison showed a significant difference in surgically induced total higher-order aberrations (a decrease of 0.337 ± 1.156 mm in 2.2-mm coaxial micro-incision cataract surgery and an increase of 0.106 ± 0.521 mm in 2.75-mm coaxial small-incision cataract surgery, p=0.046). Spherical aberrations significantly decreased after 2.2-mm coaxial micro-incision cataract surgery (p=0.001), whereas they did not change significantly after 2.75-mm coaxial small-incision cataract surgery (p=0.564). Coma did not significantly change after either of the procedures. Trefoil did not significantly change after 2.2-mm coaxial micro-incision cataract surgery (p=0.361), whereas it significantly increased after 2.75-mm coaxial small-incision cataract surgery (p<0.001). There was no significant difference shown in effective phaco time between the procedures. A significantly positive correlation was shown between surgically induced anterior corneal astigmatism and coma in 2.75-mm coaxial small-incision cataract surgery (r=0.387, p=0.006). There was no significant correlation found between any surgically induced higher-order aberration changes and effective phaco time. Conclusions: The results showed that 2.2-mm coaxial micro-incision cataract surgery and 2.75-mm coaxial small-incision cataract surgery did not significantly degrade the total higher-order aberrations of the anterior cornea. However, the surgically induced changes in total higher-order aberration showed a significant difference between the two procedures, with a slight reduction after 2.2-mm coaxial micro-incision cataract surgery and a slight increase after 2.75-mm coaxial small-incision cataract surgery. Phaco time and power used during surgery had no impact on corneal aberrations.


RESUMO Objetivo: Investigar o impacto de diferentes ta manhos de incisões em córnea clara com meridiano íngreme para facoemulsificação com aberrações de mais alta ordem da córnea anterior. Métodos: Foram retrospectivamente revisados os prontuários médicos de pacientes que se submeteram a cirurgias de catarata com microincisões coaxiais de 2,2 mm ou com incisões coaxiais pequenas de 2,75 mm. Foram apenas incluídos pacientes com astigmatismo preexistente da córnea anterior <2,00 dioptrias (D) e ³0,50 D, e submetidos a incisões em córnea clara com meridiano íngreme. Os desfechos primários foram aberrações da córnea anterior da 3ª à 6ª ordem com uma pupila de 8 mm. O astigmatismo da córnea anterior e o tempo efetivo de facoemulsificação foram avaliados como desfechos secundários. Os desfechos pré-operatório e pós-operatório aos 3 meses também foram avaliados. Resultados: O astigmatismo da córnea anterior diminuiu significativamente após ambos os procedimentos, mas não se encontrou nenhuma diferença significativa entre os dois procedimentos quanto ao astigmatismo da córnea anterior, induzido pela cirurgia (p=0,146). Embora as aberrações totais de mais alta ordem não se tenham alterado significativamente após ambos procedimentos, a comparação entre os grupos revelou uma diferença significativa nas aberrações totais de mais alta ordem, induzidas pela cirurgia (uma diminuição de 0,337 ± 1,156 mm na cirurgia de catarata por microincisão coaxial de 2,2 mm e um aumento de 0,106 ± 0,521 mm na cirurgia de catarata por incisão coaxial pequena de 2,75 mm; p=0,046). A aberração esférica diminuiu significativamente após cirurgia de catarata por microincisão coaxial de 2,2 mm (p=0,001), mas não se alterou significativamente após cirurgia de catarata por incisão coaxial pequena de 2,75 mm (p=0,564). A aberração de coma não mudou significativamente após qualquer dos procedimentos. O trifólio não se alterou significativamente após cirurgia de catarata por microincisão coaxial de 2,2 mm (p=0,361), mas aumentou significativamente após cirurgia de catarata por incisão coaxial pequena de 2,75 mm (p<0,001). Nenhuma diferença significativa se evidenciou quanto ao tempo efetivo de faco-emulsificação entre os dois procedimentos. Houve uma correlação positiva significativa entre o astigmatismo da córnea anterior, induzido pela cirurgia e a aberração de coma na cirurgia de catarata por incisão coaxial pequena de 2,75 mm (r=0,387, p=0,006). Não foi encontrada correlação significativa entre as alterações nas aberrações totais de mais alta ordem, induzidas pela cirurgia e o tempo efetivo de faco-emulsificação. Conclusões: Nem a cirurgia de catarata por microincisão coaxial de 2,2 mm, nem aquela por incisão coaxial pequena de 2,75 mm degradaram significativamente as aberrações totais de mais alta ordem da córnea anterior. Porém, as alterações nas aberrações totais de mais alta ordem, induzidas pela cirurgia mostraram uma diferença significativa entre os dois procedimentos, com uma ligeira redução na cirurgia de catarata por microincisão coaxial de 2,2 mm e um pequeno aumento na cirurgia de catarata por incisão coaxial pequena de 2,75 mm. O tempo de facoemulsificação e a potência utilizada durante a cirurgia não tiveram impacto nas aberrações corneanas.


Subject(s)
Humans , Astigmatism , Cataract , Cataract Extraction , Phacoemulsification , Astigmatism/surgery , Astigmatism/etiology , Retrospective Studies , Phacoemulsification/adverse effects , Cornea/surgery , Corneal Topography , Lens Implantation, Intraocular
4.
Arq. bras. oftalmol ; 83(1): 55-61, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088946

ABSTRACT

ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-ste­roidal anti-inflammatory drugs with corticosteroids.


RESUMO Objetivo: Avaliar a taxa de desenvolvimento do edema macular cistóide em pacientes submetidos à cirurgia de catarata em quatro esquemas terapêuticos diferentes. Métodos: O presente estudo é uma análise retrospectiva de 5.380 olhos após facoemulsificação não complicada na Wake Forest University. O período do estudo foi entre julho de 2007 e dezembro de 2012. Os pacientes receberam um dos quatro esquemas: cetorolaco genérico pós-operatório 0,4% e prednisolona 1%, cetorolaco 0,45% pós-operatório e prednisolona 1%, bromfenac 0,09% e a prednisolona 1% pós-operatório, bromfenaco 0,09% no pré-operatório e isoladamente no pós-operatório. Uma análise estatística foi realizada para avaliar as diferenças na taxa de desenvolvimento do edema macular cistóide entre os quatro diferentes regimes terapêuticos. O diagnóstico de edema macular cistóide exigiu uma piora da visão e uma evidência de aumento da espessura macular na tomografia de coerência óptica. Resultados: A taxa global de edema macular cistóide foi de 0,82%. O tratamento com cetorolaco genérico pós-operatório 0,45% e prednisolona 1% demonstrou a maior taxa de desenvolvimento de edema macular cistóide (2,20% dos casos). O cetorolaco 0,45% e a prednisolona 1% no pós-operatório exibiram taxas intermediárias de desenvolvimento de edema macular cistóide (0,90% dos casos). A administração de bromofenac 0,09% e de prednisolona 1% no pós-operatório apresentou taxas interme­diárias de desenvolvimento de edema macular cistóide (0,44% dos casos). O bromfenac 0,09% no pré e pós-operatório isoladamente resultou na menor taxa de desenvolvimento de edema macular cistóide (0,09% dos casos). A taxa de edema macular cistóide foi significativamente menor quando o bromfenac foi utilizado isoladamente em relação ao esquema onde cetorolaco e a prednisolona foram usados (OR 0,043, 95% CI 0,002 a 0,312; p<0,001). Conclusões: O edema macular cistóide pós-cirurgia de catarata desenvolveu-se com menor frequência após o tratamento tópico de medicamentos anti-inflamatórios não esteroidais, comparado às outras terapias avaliadas. Bromfenac, sem corticosteróides, alcançou taxas mais baixas de edema macular cistóide vs. Várias combinações em comparação com as várias combinações de drogas anti-inflamatórias não esteroidais com corticosteróides.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Benzophenones/therapeutic use , Bromobenzenes/therapeutic use , Prednisolone/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Macular Edema/prevention & control , Phacoemulsification/adverse effects , Cataract , Macular Edema/etiology , Retrospective Studies , Drug Therapy, Combination
5.
Arq. bras. oftalmol ; 82(6): 460-462, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1038702

ABSTRACT

ABSTRACT Purpose: To analyze the outcomes of in-the-­bag toric intraocular lens implantation for anterior capsular tears during phacoemulsification. Methods: The cohort of this re­trospective, consecutive, interventional case series included eight patients. One patient was excluded as the tear was used to enlarge the rhexis. The mean preoperative astigmatism was -1.67D (± 0.98) and the mean preoperative unaided logMAR visual acuity was 0.62 (± 0.76). The mean angle between the anterior capsule tear and the closest intraocular lens haptic was 51.25° (range, 30°-90°). Results: The final unaided logMAR visual acuity was 0.16 (± 0.21) and the final cylinder was -1.1 D (± 0.59). The mean follow-up duration was about 2 ± 1.2 months. In this case series, no lens had to be explanted or rotated postoperatively. Placement of a toric intraocular lens in the presence anterior capsule tear was safe in all patients. An angle of at least 30° remained between the tear and the intraocular lens haptic. Conclusion: Placement of toric intraocular lens in the presence of an anterior capsule tear may be safe, at least in cases with a 30° angle between the anterior capsule tear and the intraocular lens haptic.


RESUMO Objetivo: Analisar os resultados do implante de lentes intraoculares tóricas para rupturas capsulares anterio­res durante a facoemulsificação. Métodos: A coorte desta série re­trospectiva, consecutiva e intervencional de casos que inclui 8 pacientes. Um paciente foi excluído quando a lágrima foi usada para aumentar a rexe. O astigmatismo pré-operatório médio foi de -1,67 D (± 0,98) e a média da acuidade visual logMAR sem intervenção pré-operatória foi de 0,62 (± 0,76). A média do ângulo entre a ruptura da cápsula anterior e o háptico mais próximo da lente intraocular foi de 51,25° (variação, 30°-90°). Resultados: A acuidade visual logMAR final sem ajuda foi de 0,16 (± 0,21) e o cilindro final foi de -1,1 D (± 0,59). O tempo médio de acompanhamento foi de aproximadamente 2 ± 1,2 meses. Nesta série de casos, nenhuma lente teve que ser removida ou rotacionada no pós-operatório. A colocação de uma lente intraocular tórica na presença de uma ruptura da cápsula anterior mostrou-se segura em todos os pacientes. Um ângulo de pelo menos 30° permaneceu entre a ruptura e o háptico da lente intraocular. Conclusão: A colocação de lente intraocular tórica na presença de uma ruptura da cápsula anterior pode ser segura, pelo menos em casos com um ângulo de 30° entre a ruptura da cápsula anterior e o háptico da lente intraocular.


Subject(s)
Humans , Female , Middle Aged , Phacoemulsification/adverse effects , Lens Implantation, Intraocular/methods , Anterior Capsular Rupture, Ocular/surgery , Anterior Capsular Rupture, Ocular/etiology , Lenses, Intraocular , Refraction, Ocular , Time Factors , Visual Acuity , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Anterior Capsular Rupture, Ocular/physiopathology
6.
Arq. bras. oftalmol ; 82(6): 495-500, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038698

ABSTRACT

ABSTRACT Purpose: To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. Methods: We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. Results: We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. Conclusion: Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.


RESUMO Objetivo: Avaliar a relação entre a síndrome de pseudoexfoliação e a prevalência de complicações e fatores clínicos relacionados em pacientes submetidos à cirurgia de catarata. Métodos: Foi realizado um estudo retrospectivo de coorte de 503 de 551 pacientes que se submeteram à cirurgia de facoemulsificação durante 2 anos em um distrito de saúde no noroeste da Espanha. No total, 120 dos 681 olhos submetidos ao procedimento apresentavam síndrome de pseudoexfoliação. Dados sobre o procedimento cirúrgico e complicações associadas foram obtidos dos prontuários médicos. As complicações incluíram qualquer combinação de ruptura da cápsula posterior, perda de humor vítreo, diálise zonular e luxação do núcleo ou do cristalino. Resultados: Encontramos uma associação significativa entre síndrome de pseudoexfoliação e diálise zonular (razão de probabilidade [RP]: 6,89; IC 95%, 2,27-20,93), a miose perioperatória (RP: 2,15; IC 95%, 1,10-4,22) e luxação do cristalino >1,5 mm (RP: 9,49; IC 95%, 0,85-105,54). Porém, ao ajustar para o risco global de complicações em pacientes com síndrome de pseudoexfolição em consideração à miopia, uso de anticoagulantes ou α-agonistas, midríase prévia e comprimento da câmara anterior, a RP diminuiu para 1,02 (IC 95%, 0,47-2,21) e não foi, portanto, significativo. Conclusão: A diálise zonular e a miose intraoperatória foram complicações intraoperatórias em pacientes submetidos à cirurgia de catarata com síndrome de pseudoexfoliação quando comparados aos controles.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Cataract/complications , Exfoliation Syndrome/complications , Phacoemulsification/adverse effects , Intraoperative Complications/epidemiology , Postoperative Complications/epidemiology , Spain/epidemiology , Time Factors , Cataract/physiopathology , Cataract/epidemiology , Visual Acuity , Logistic Models , Prevalence , Retrospective Studies , Risk Factors , Follow-Up Studies , Exfoliation Syndrome/physiopathology , Exfoliation Syndrome/epidemiology , Statistics, Nonparametric
7.
Rev. bras. oftalmol ; 78(5): 334-337, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1042385

ABSTRACT

Abstract We herein report a patient without risk factors who presented acute bilateral Irvine-Gass syndrome after uneventful phacoemulsification. The novelty of our case lies on the fact that the patient presented acute bilateral Irvine-Gass syndrome without a predisposing systemic disease. Even though Cystoid Macular Edema (CME) was somehow expected in the first eye because of the ocular history of trauma, prophylactic measures were not strong enough to avoid its development. Furthermore, those measures could not avoid developing CME in the second eye. A 44-years-old male who underwent cataract surgery in both eyes presented bilateral Irvine-Gass syndrome. Despite prophylactic measures, both eyes developed CME after uneventful cataract surgery. Regular treatment options could not solve the situation and intravitreal Anti-VEGF injections were needed. Bilateral cases of Irvine-Gass Syndrome are rare and generally associated with systemic risk factors. Patients who developed CME following their first cataract surgery should be counseled about the risks of developing the condition following surgery on the contralateral eye. On top of that, aggressive prophylactic measures should be encouraged to prevent CME in these cases.


Resumo Relatamos aqui um paciente sem fatores de risco que apresentou síndrome de Irvine-Gass bilateral aguda após facoemulsificação sem intercorrências. A novidade do nosso caso reside no fato de o paciente apresentar síndrome de Irvine-Gass bilateral aguda sem doença sistêmica predisponente. Embora o Edema Macular Cistoide (EMC) fosse de alguma forma esperado no primeiro olho por causa do histórico ocular de trauma, as medidas profiláticas não foram suficientemente fortes para evitar seu desenvolvimento. Além disso, essas medidas não puderam evitar o desenvolvimento de EMC no segundo olho. Homem de 44 anos submetido a cirurgia de catarata em ambos os olhos apresentou síndrome de Irvine-Gass bilateral. Apesar das medidas profiláticas, ambos os olhos desenvolveram EMC após a cirurgia de catarata sem intercorrências. As opções de tratamento regular não conseguiram resolver a situação e foram necessárias injeções intravítreas de Anti-VEGF. Casos de Síndrome de Irvine-Gass bilateral são raros e geralmente associados a fatores de risco sistêmicos. Os pacientes que desenvolveram EMC após a primeira cirurgia de catarata devem ser avisados sobre os riscos de desenvolver a doença após a cirurgia no olho contralateral. Além disso, medidas profiláticas agressivas devem ser incentivadas para evitar a EMC nesses casos.


Subject(s)
Humans , Male , Adult , Macular Edema/etiology , Phacoemulsification/adverse effects , Visual Acuity , Macular Edema/drug therapy , Macular Edema/diagnostic imaging , Lens Implantation, Intraocular , Angiogenesis Inhibitors/administration & dosage , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Tomography, Optical Coherence , Intravitreal Injections
8.
Rev. bras. oftalmol ; 78(4): 264-267, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1013683

ABSTRACT

ABSTRACT We here in report the case of a patient subjected to cataract surgery through phacoemulsification under local anesthetic block, without intra-operative complications. The patient presented important visual impairment in the first post-operative day. Fundoscopy showed pallor resembling cherry-red spots at the macula. Fluorescein angiography did not depict signs of vascular occlusion and the spectral-domain optical coherence tomography showed increased reflectivity in the inner layers of the retina, thus suggesting local thickening and edema. The current case led to the diagnostic hypothesis of transient retinal arterial occlusion.


RESUMO Relatamos um caso de um paciente submetido a facectomia por facoemulsificação sob bloqueio anestésico peribulbar, sem intercorrências per-operatória, que apresentou no primeiro dia de pós-operatório baixa visual significativa. À fundoscopia observou-se palidez em aspecto de mácula em cereja. A angiofluoresceinografia não demonstrou sinais de oclusão vascular e a tomografia de coerência óptica mostrou aumento da refletividade das camadas internas da retina, sugerindo espessamento e edema local. No caso descrito foi aventada hipótese diagnóstica de oclusão arterial retiniana transitória.


Subject(s)
Humans , Male , Aged , Retinal Artery Occlusion/etiology , Phacoemulsification/adverse effects , Anesthesia, Local/adverse effects , Bupivacaine/administration & dosage , Retinal Artery Occlusion/diagnosis , Cataract Extraction/methods , Visual Acuity , Phacoemulsification/methods , Lens Implantation, Intraocular , Tomography, Optical Coherence , Hyaluronoglucosaminidase/administration & dosage , Intraocular Pressure/drug effects , Anesthetics, Local/administration & dosage , Lidocaine/administration & dosage
9.
Arq. bras. oftalmol ; 82(4): 289-294, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1019413

ABSTRACT

ABSTRACT Purpose: To evaluate whether training medical residents with the Eyesi® cataract surgery simulator reduces the occurrence of intraoperative complications. Methods: This was a retrospective study in which the first 10 phacoemulsification surgeries performed by two groups of second-year ophthalmology residents were evaluated, during 2014 and 2015. The first Group consisted of seven residents from 2014 who had not had previous training with the simulator. The second Group was formed of seven residents in 2015, who had completed the C-level (intermediate) training with the simulator before beginning surgery on patients. We then compared these two groups regarding the frequency of occurrence of the four main intraoperative surgical complications: posterior capsule rupture, aphakia, and nucleus fragment dislocation into the vitreous, and extracapsular conversion. Results: A total of 140 surgeries were performed, 70 by Group 1 and 70 by Group 2. The total number of complications was 19 (27.14%) in Group 1 and nine (12.86%) in Group 2, and this reduction was significant (p=0.031). Fourteen (20%) surgeries in Group 1 and seven (10%) in Group 2 had complications. The complications were 13 posterior capsule ruptures (18.57%) in Group 1 and seven (10%) in Group 2; three eyes had nucleus fragment dislocations (4.29%) in Group 1, but only one (1.43%) in Group 2; two extracapsular conversions (2.86%) occurred in Group 1 and one (1.43%) in Group 2; and there was one aphakia (1.43%) in Group 1. Conclusions: The training with the Eyesi® cataract surgery simulator significantly reduced the total number of intraoperative complications in the first 10 phacoemulsification cataract surgeries performed by ophthalmology residents.


RESUMO Objetivo: Avaliar se o treinamento de residentes médicos com o simulador de cirurgia de catarata Eyesi® reduz a ocorrência de complicações intraoperatórias. Métodos: Estudo retrospectivo em que foram avaliadas as primeiras 10 cirurgias de facoemulsificação realizadas por dois grupos de residentes de Oftalmologia do segundo ano, no período de 2014 a 2015. O primeiro Grupo foi formado por sete residentes de 2014 que não tiveram treinamento prévio no simulador. O segundo Grupo foi formado por sete residentes de 2015, que completaram o treinamento até o nível C (intermediário) no simulador antes de iniciar a cirurgia em pacientes. Em seguida, comparamos esses dois grupos em relação à frequência de ocorrência das quatro principais complicações cirúrgicas intraoperatórias: ruptura da cápsula posterior, afacia e deslocamento de fragmentos de núcleo para o vítreo e conversão para extracapsular. Resultados: Foram realizadas 140 cirurgias, sendo 70 pelo Grupo 1 e 70 pelo Grupo 2. O número total de complicações foi de 19 (27,14%) no Grupo 1 e nove (12,86%) no Grupo 2, e esta redução foi significativa (p=0,031). Quatorze (20%) cirurgias no Grupo 1 e sete (10%) no Grupo 2 tiveram complicações. As complicações foram 13 rupturas de cápsula posterior (18,57%) no Grupo 1 e sete (10%) no Grupo 2, três olhos com luxação de fragmento de núcleo para o vítreo (4,29%) no Grupo 1 e um (1,43%) no Grupo 2, duas conversões extracapsulares (2,86%) no Grupo 1 e uma (1,43%) no Grupo 2 e uma afacia (1,43%) no Grupo 1. Conclusões: O treinamento com o simulador de cirurgia de catarata Eyesi® reduziu significativamente o número total de complicações intraoperatórias nas primeiras 10 cirurgias de catarata por facoemulsificação realizadas por residentes de oftalmologia.


Subject(s)
Humans , Phacoemulsification/education , Phacoemulsification/adverse effects , Simulation Training/methods , Intraoperative Complications/prevention & control , Medical Staff, Hospital/education , Ophthalmology/education , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Internship and Residency/methods
10.
Arq. bras. oftalmol ; 82(4): 329-331, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1019407

ABSTRACT

ABSTRACT Intraoperative and postoperative cataract surgery in eyes with anterior megalophthalmos are challenging procedures. Herein we describe the case of a 53-year-old male with anterior megalophthalmos who developed unilateral Urrets-Zavalia Syndrome following cataract surgery.


RESUMO O intraoperatório e o pós-operatório de cirurgia de catarata em olhos com megaloftalmo anterior é desafiador. Descrevemos o caso de um homem de 53 anos com megaloftalmo anterior que desenvolveu a Síndrome de Urrets-Zavalia unilateral após cirurgia de catarata.


Subject(s)
Humans , Male , Middle Aged , Eye Diseases, Hereditary/surgery , Pupil Disorders/etiology , Phacoemulsification/adverse effects , Genetic Diseases, X-Linked/surgery , Postoperative Complications , Syndrome , Visual Acuity , Eye Diseases, Hereditary/complications , Pupil Disorders/pathology , Genetic Diseases, X-Linked/complications , Intraocular Pressure , Anterior Chamber/surgery
11.
Rev. cuba. oftalmol ; 32(2): e736, abr.-jun. 2019. tab
Article in Spanish | LILACS | ID: biblio-1093693

ABSTRACT

RESUMEN Objetivo: Evaluar el costo en la cirugía de catarata por facoemulsificación bilateral simultánea vs. facoemulsificación bilateral secuencial, con implante de lente intraocular. Métodos: Se realizó un estudio analítico de evaluación económica en 762 pacientes mayores de 50 años, intervenidos de catarata con la cirugía de facoemulsificación bilateral simultánea (grupo I), y 762 pacientes operados de catarata con la cirugía de facoemulsificación bilateral secuencial (grupo II), en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, del año 2014 al 2019. Se evaluaron los costos en recursos humanos, materiales e indirectos, así como los costos totales de ambos grupos después de la intervención quirúrgica, partiendo de la demostración científica de que ambos procedimientos son igualmente eficaces. Resultados: Predominó la edad de 61 a 80 años y el sexo femenino (75 por ciento) en ambos grupos. Los costos unitarios relacionados con los recursos humanos disminuyeron en 1,69 pesos para el grupo I, mientras que los costos totales y unitarios en relación con los recursos materiales fueron similares en ambos grupos. Los costos unitarios indirectos disminuyeron en 3,63 pesos en el grupo I. Finalmente, el costo unitario total para el grupo de cirugía bilateral simultánea resultó 6,19 pesos menor que el de cirugía bilateral secuencial. Conclusiones: La cirugía de catarata por facoemulsificación bilateral simultánea tiene menores costos que la facoemulsificación bilateral secuencial(AU)


ABSTRACT Objective: Evaluate the cost of simultaneous bilateral phacoemulsification cataract surgery vs. sequential bilateral phacoemulsification with intraocular lens implantation. Methods: An analytic economic evaluation was conducted of 762 patients aged over 50 years undergoing simultaneous bilateral phacoemulsification cataract surgery and 762 patients undergoing sequential bilateral phacoemulsification cataract surgery at Ramón Pando Ferrer Cuban Institute of Ophthalmology in the period 2014-2019. Evaluation was performed of costs incurred on human resources and materials, indirect costs, and total costs for the two groups after surgery, starting from the scientific certainty that both procedures are equally effective. Results: The 61-80 years age group and female sex (75 percent) prevailed in both groups. Human resources unit costs decreased 1.69 CUP in group I, whereas material resources total and unit costs were similar in both groups. Indirect unit costs decreased 3.63 CUP in group I. Total unit cost was 6.19 CUP lower in the simultaneous bilateral surgery group than in the sequential bilateral surgery group. Conclusions: Simultaneous bilateral phacoemulsification cataract surgery is more cost-effective than sequential bilateral phacoemulsification(AU)


Subject(s)
Humans , Female , Middle Aged , Aged , Cost Efficiency Analysis , Phacoemulsification/adverse effects
12.
Rev. cuba. oftalmol ; 32(1): e703, ene.-mar. 2019. tab
Article in Spanish | LILACS | ID: biblio-1093669

ABSTRACT

RESUMEN Objetivo: Evaluar el comportamiento de la presión intraocular posterior a la cirugía de catarata por facoemulsificación en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Métodos: Se realizó un estudio descriptivo y prospectivo de serie de casos en pacientes atendidos en el Servicio de Microcirugía Ocular en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en dos años. La muestra estuvo conformada por 63 ojos operados por un mismo cirujano y que cumplieron los criterios de inclusión y exclusión. Las variables del estudio fueron presión intraocular preoperatoria y posoperatoria, mejor agudeza visual con corrección y sin ella, antecedentes patológicos personales y oculares de glaucoma, sexo, dureza del cristalino según LOCS III, equivalente esférico esperado y obtenido y astigmatismo medio inducido por la cirugía. Resultados: En el estudio predominaron los pacientes del sexo femenino, sin antecedente de glaucoma ni de hipertensión arterial, con dureza del cristalino III y IV. La presión intraocular media más elevada se observó a las 24 horas posterior a la cirugía (p= 0,002), para los grupos de dureza del cristalino ll, lll y lV, la cual disminuyó en los pacientes con antecedentes de glaucoma desde el posoperatorio inmediato. No se encontró relación entre la variación de la presión intraocular media y el antecedente de hipertensión arterial. La mejor agudeza visual corregida posoperatoria mejoró significativamente (p= 0,000). El componente esférico obtenido no presentó diferencias significativas respecto al esperado. La diferencia de la media del cilindro preoperatorio y posoperatorio fue significativa (p= 0,000). Conclusión: La facoemulsificación reduce de modo efectivo la presión intraocular en sujetos glaucomatosos y no glaucomatosos(AU)


ABSTRACT Objective: Evaluate the behavior of intraocular pressure after phacoemulsification cataract surgery. Methods: A prospective descriptive case-series study was conducted of patients attending the Ocular Microsurgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology in a period of two years. The sample was 63 eyes operated on by the same surgeon and meeting the inclusion and exclusion criteria. The study variables were pre- and postoperative intraocular pressure, best visual acuity with and without correction, personal pathological antecedents, a history of ocular glaucoma, sex, crystalline lens hardness by LOCS III, expected and obtained spherical equivalent, and surgery-induced medial astigmatism. Results: A predominance was found of female patients without a history of glaucoma or hypertension and a crystalline lens hardness of III and IV. The highest mean intraocular pressure was observed 24 hours after surgery (p= 0.002) in crystalline hardness groups II, III and IV. Mean intraocular pressure decreased in patients with glaucoma antecedents as of the immediate postoperative period. No relationship was found between mean intraocular pressure variation and hypertension antecedents. The best corrected postoperative visual acuity improved significantly (p= 0.000). No significant differences were observed between the expected and the obtained spherical component. The difference between the mean pre- and post-operative cylinder was significant (p= 0.000). Conclusion: Phacoemulsification effectively reduces intraocular pressure in glaucoma and non-glaucoma patients(AU)


Subject(s)
Humans , Male , Female , Cataract Extraction/methods , Phacoemulsification/adverse effects , Intraocular Pressure/physiology , Epidemiology, Descriptive , Prospective Studies
13.
Arq. bras. oftalmol ; 82(2): 149-151, Mar.-Apr. 2019. graf
Article in English | LILACS | ID: biblio-989392

ABSTRACT

ABSTRACT - Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.


RESUMO - Síndrome do bloqueio capsular é uma complicação incomum da cirurgia de facoemulsificação com capsulorrexis curvilínea contínua e implante de lente intraocular. Nós relatamos um caso de síndrome de bloqueio capsular de início tardio que se desenvolveu após 13 anos da extração da catarata e apresenta a abordagem cirúrgica utilizada para o sucesso do tratamento.


Subject(s)
Humans , Female , Middle Aged , Phacoemulsification/adverse effects , Posterior Capsulotomy/methods , Lens Capsule, Crystalline/surgery , Lens Diseases/surgery , Lens Diseases/etiology , Postoperative Complications/surgery , Syndrome , Visual Acuity , Treatment Outcome , Tomography, Optical Coherence , Late Onset Disorders/etiology , Lens Capsule, Crystalline/diagnostic imaging , Lens Diseases/diagnostic imaging , Lenses, Intraocular/adverse effects
14.
Arq. bras. oftalmol ; 82(2): 111-118, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-989391

ABSTRACT

ABSTRACT Purpose: To assess the efficacy of using a nonste­roidal anti-inflammatory drug preoperatively and of applying the re-dilation technique when necessary to minimize pupil size variation when comparing the degree of mydriasis before femtosecond laser pretreatment with that at the beginning of phacoemulsification. Methods: This retrospective study included patients who underwent cataract surgery using the LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Our routine dilating regimen with flurbiprofen, tropicamide, and phenylephrine was used. The re-dilation technique was applied on eyes that manifested with a pupillary diameter that was smaller than the programmed capsulotomy diameter after laser pretreatment. The technique consists of overcoming pupillary contraction by instilling tropicamide and phenylephrine before phacoemulsification. Pupil size was assessed before femtosecond laser application and at the beginning of phacoemulsification. Results: Seventy-five eyes (70 patients) were included. Nine (12%) eyes underwent the re-dilation technique. There was no significant difference in mean pupillary diameter and mean pupillary area between the two studied surgical time points (p=0.412 and 0.437, respectively). The overall pupillary area constriction was 2.4 mm2. Immediately before opening the wounds for phacoemulsification, none of the eyes presented with a pupillary diameter <5 mm, and 61 (85.3%) eyes had a pupillary diameter >6 mm. Conclusion: Preoperative administration of nonsteroidal anti-inflammatory drug and the re-dilation technique resulted in no significant pupil size variation in eyes that were pretreated with the femtosecond laser, when comparing the measurements made before the laser application and at the beginning of phacoemulsification. This approach can avoid the need to proceed with cataract extraction with a constricted pupil.


RESUMO Objetivo: Avaliar a eficácia do uso de anti-inflamatório não-esteróide no pré-operatório e aplicação da técnica de re-dilatação quando necessária para minimizar a variação do tamanho pupilar ao comparar o grau de midríase antes do tra­tamento com laser de femtosegundo no início da facoemulsificação. Métodos: Esse estudo retrospectivo incluiu pacientes que foram submetidos à cirurgia de catarata usando o LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Nosso regime de di­latação de rotina com flurbiprofeno, tropicamida e fenilefrina foi usado. A técnica de re-dilatação doi aplicada em olhos que se manifestaram com um diâmetro pupilar menor do que o diâmetro da capsulotomia programado após o pré-tratamento a laser. A técnica consiste em superar a contração pupilar pela instilação de tropicamida e fenilefrina antes da facoemulsificação. O tamanho pupilar foi avaliado antes da aplicação do laser de femtosegundo e no inicio da facoemulsificação. Resultados: Setenta e cinco olhos (70 pacientes) foram incluídos. Nove (12%) olhos foram submetidos à técnica de re-dilatação. Não houve diferença significativa no diâmetro pupilar médio e na área pupilar média entre os dois tempos cirúrgicos estudados (p=0,412 e 0,437, respectivamente). A constrição global da área pupilar foi de 2,4 mm2. Imediatamente antes de abrir as incisões para a facoemulsificação, nenhum dos olhos apresentava diâmetro pupilar <5 mm e 61 (85,3%) olhos apresentavam um diâmetro pupilar >6 mm. Conclusões: O administração pré-operatória de anti-inflamatório não-esteróide e da técnica de re-dilatação resultaram em uma variação significativa do tamanho pupilar em olhos que foram pré-tratados com laser de femtosegundo, comparando as medidas realizadas antes da aplicação do laser e no inicio da facoemulsificação. Essa abordagem pode evitar a necessidade de prosseguir com a extração da catarata com uma pupila contraída.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Miosis/prevention & control , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Flurbiprofen/therapeutic use , Phacoemulsification/methods , Lasers , Mydriatics/therapeutic use , Phenylephrine/therapeutic use , Tropicamide/therapeutic use , Miosis/etiology , Miosis/pathology , Pupil/drug effects , Retrospective Studies , Phacoemulsification/adverse effects , Laser Therapy/methods , Intraocular Pressure , Intraoperative Complications/prevention & control
15.
Rev. Soc. Colomb. Oftalmol ; 52(2): 95-100, 2019. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1053029

ABSTRACT

Objetivo: determinar la frecuencia de complicaciones en pacientes con miopía axial alta y catarata, a los que se les realizó extracción de catarata por facoemulsificación. Diseño del estudio: observacional descriptivo de frecuencia. Método: se incluyeron 107 ojos de pacientes con miopía axial alta, a los que se les realizó extracción de catarata por facoemulsificación más implante de LIO, operados en 2015. Se realizó una revisión de historias clínicas y descripciones quirúrgicas de los pacientes seleccionados y se evaluó la presentación de complicaciones con un seguimiento a un año después de la cirugía. Resultados: 2 ojos presentaron ruptura de cápsula posterior (1,8 %). Otros 2 ojos presentaron diálisis zonular (1,8 %) y en 3 ojos se evidenció pérdida de vítreo (2,7 %). Durante el primer año postoperatorio de seguimiento se observó desprendimiento de retina en 1 ojo (0,9 %). No se reportaron casos de luxación del LIO a cámara anterior. Conclusión: La frecuencia de complicaciones es similar a la reportada en la literatura mundial e inclusive más baja en algunas variables como la ruptura de capsula posterior y el desprendimiento de retina.


Background: Cataract extraction by phacoemulsifi cation plus intraocular lens (IOL) implant is the most used treatment against the main cause of reversible blindness in the world; the cataract. It is a very successful procedure due to its low frequency of complications and its high reproducibility. However, patients with high axial myopia do not behave in this way and tend to present more complications. Objective: to determine the frequency of complications in patients with high axial myopia and cataract, who underwent cataract extraction by phacoemulsifi cation. Study design: observational descriptive. Method: 107 eyes of patients with high axial myopia were included. All underwent cataract extraction by phacoemulsification plus IOL implantation, in 2015. A review of clinical histories and surgical descriptions of all patients was performed to determine the frequency of complications during a follow-up time of one year aft er surgery. Results: 2 eyes presented posterior capsule rupture (1.8%). Two other eyes presented zonular dialysis (1.8%) and 3 eyes had vitreous loss (2.7%). During the first postoperative year of follow-up, retinal detachment was observed in 1 eye (0.9%). No cases of IOL dislocation to the anterior chamber were reported. Conclusion: The frequency of complications in this population is similar to the one reported in other studies and even lower in some variables such as posterior capsule rupture and retinal detachment.


Subject(s)
Phacoemulsification/adverse effects , Cataract/diagnosis , Myopia/diagnosis
16.
Rev. cuba. oftalmol ; 31(2): 1-8, abr.-jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-985565

ABSTRACT

El desprendimiento coroideo es un factor predisponente y causa de hipotonía ocular marcada. Se describen dos pacientes operados de glaucoma por técnica de trabeculectomía simple, con más de 5 años de evolución, bajo régimen medicamentoso de timolol 0,5 por ciento colirio, 2 veces por día, intervenidos de catarata senil con técnica de facoemulsificación sin complicaciones trans ni posquirúrgicas inmediatas, quienes presentan disminución brusca de la agudeza visual a dos meses de la cirugía, por desprendimiento coroideo sin pérdida de cámara anterior, asociado a hipotonía ocular y maculopatía. Se analizan las posibles causas y se impone tratamiento adecuado. Finalmente se logra una evolución satisfactoria(AU)


Choroidal detachment is a cause of and predisposing factor for marked ocular hypotony. A description is provided of two patients undergoing glaucoma surgery by simple trabeculectomy technique, with more than five years of evolution, under drug treatment with 0.5 percent timolol collyrium twice daily, intervened for senile cataract with phacoemulsification technique, without any intra- or immediate post-operative complications, who presented with sudden visual acuity reduction two months after surgery, due to choroidal detachment without anterior chamber loss, associated to ocular hypotony and maculopathy. The possible causes are analyzed and appropriate treatment is indicated. Satisfactory evolution is finally achieved(AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Retinal Detachment/drug therapy , Ocular Hypotension/etiology , Phacoemulsification/adverse effects
17.
Arq. bras. oftalmol ; 81(2): 92-94, Mar.-Apr. 2018. tab
Article in English | LILACS | ID: biblio-950441

ABSTRACT

ABSTRACT Objective: To study the safety parameters associated with intracameral moxifloxacin application five weeks after cataract surgery. Methods: The study was a prospective case series set in a private hospital in Recife, Pernambuco, Brazil. A consecutive sample of 1,016 cataract surgeries was evaluated. The inclusion criteria were patients with indications for cataract surgery, a minimum of 55 years of age, and no history of allergy to quinolones. Patients were prepared for surgery using a 5% povidone solution diluted as a topical antiseptic agent. The operative technique was phacoemulsification with intraocular lens implantation. A 0.3-mL syringe was partially filled with moxifloxacin and 150 µg/0.03 mL of moxifloxacin was administered through the surgical incision at the end of the surgery. Postoperatively, patients were prescribed: (1) 0.5% moxifloxacin eyedrops 5 times daily for 1 week, and (2) 1% prednisolone acetate eyedrops 5 times daily for 1 week, followed by 4 times daily for 1 week and, subsequently, 2 times daily for 3 weeks. The outcomes were incidence of acute endophthalmitis, mean changes from baseline to 5 postoperative weeks in corneal endothelial cell density, corrected distance visual acuity and intraocular pressure. Results: The mean age was 67 ± 5 years, and 56.2% of the patients were female. There were no cases of endophthalmitis. The mean preoperative corrected distance visual acuity was 58 letters ± 10 (SD), and the mean postoperative corrected distance visual acuity was 80 letters ± 4 (SD). The mean change in corneal endothelial cell density was 249 cells/mm (-10.3%). There was almost no difference in intraocular pressure. No study-related adverse events were observed. Conclusion: The results suggest moxifloxacin is a safe option for intracameral use after cataract surgery.


RESUMO Objetivo: Estudar alguns parâmetros de segurança da moxifloxacino intracameral nas cinco semanas após a cirurgia de catarata. Métodos: O estudo foi uma série de casos prospectivos. O cenário era um hospital privado em Recife, Pernambuco, Brasil. Foi considerada uma amostra consecutiva de 1.016 cirurgias de catarata. Os critérios de inclusão foram pacientes com indicação para cirurgia de catarata, com pelo menos 55 anos de idade e sem história de alergia a quinolonas. Os pacientes foram preparados para cirurgia usando uma solução de povidona a 5% diluída como agente anti-séptico tópico. A técnica operatória foi a facoemulsificação com implante de lente intraocular. Uma seringa de 0,3 mL foi parcialmente preenchida com moxifloxacino. Os pacientes receberam 150 µg/0,03 mL de moxifloxacino através da incisão cirúrgica no final da cirurgia. No pós-operatório, os pacientes foram prescritos: (1) moxifloxacino 0,5% 5 vezes ao dia durante 1 semana e (2) colírio de acetato de prednisolona a 1% 5 vezes ao dia durante 1 semana, seguido de 4 vezes ao dia durante 1 semana e, posteriormente, 2 vezes diariamente por 3 semanas. Os desfechos foram a incidência de endoftalmite aguda, variações entre os valores basais e os na 5ª semana pós-operatória referente à densidade celular endotelial corneana, acuidade visual corrigida para longe e pressão intraocular. Resultados: A média da idade foi de 67 ± 5 anos, e 56,2% dos pacientes eram do sexo feminino. Não houve casos de endoftalmite. A acuidade visual corrigida para longe préoperatório médio foi de 58 letras ± 10 (SD), e a acuidade visual corrigida para longe pósoperatório médio foi de 80 letras ± 4 (SD). A alteração média na densidade celular endotelial corneana foi de 249 células/mm (10,3%). Não houve diferença na pressão intraocular. Não foram observados eventos adversos relacionados ao estudo. Conclusão: Os resultados sugerem que o moxifloxacino é uma opção segura para o uso intracameral após a cirurgia de catarata.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Endophthalmitis/etiology , Endophthalmitis/prevention & control , Phacoemulsification/adverse effects , Fluoroquinolones/administration & dosage , Injections, Intraocular/methods , Anti-Bacterial Agents/administration & dosage , Postoperative Complications/prevention & control , Visual Acuity/physiology , Endophthalmitis/physiopathology , Prospective Studies , Statistics, Nonparametric , Antibiotic Prophylaxis/methods , Lens Implantation, Intraocular/adverse effects , Moxifloxacin , Intraocular Pressure/physiology
18.
Medwave ; 18(6): e7314, 2018.
Article in English, Spanish | LILACS | ID: biblio-948393

ABSTRACT

Resumen Introducción La facoéresis es el procedimiento en que se extrae quirúrgicamente el cristalino para tratar las cataratas. La pérdida endotelial corneal es una complicación reconocida. Si bien se han descrito diversos factores asociados a este daño, la experiencia del cirujano ha sido poco explorada. Objetivos Evaluar la asociación entre la experiencia del cirujano y otras variables asociadas a la pérdida celular endotelial en el contexto de la facoéresis. Métodos Se analizaron registros clínicos de 198 cirugías de cataratas, evaluando el efecto de la experiencia del cirujano y otras variables asociadas: energía disipada acumulada, tipo de viscoelástico empleado, uso de azul tripán, cantidad de fluídica, tiempo de ultrasonido, energía de facoemulsificación combinada y recuento celular endotelial pre y postoperatorio. Resultados No se observaron diferencias en el conteo postoperatorio de células endoteliales. Los oftalmólogos con más de cinco años de experiencia presentaron menor uso de azul tripán pero mayor cantidad de energía disipada acumulada en cada procedimiento, mientras que los oftalmólogos con menor experiencia utilizaron mayor cantidad de fluídica. Conclusiones Aunque hubo diferencias en el manejo de algunos factores influyentes sobre la pérdida endotelial cornal según la experiencia de los oftalmólogos, no se hallaron diferencias en relación a dicha pérdida como resultado final.


Abstract Introduction Phacoeresis is the procedure through which the lens is surgically removed to treat cataracts. A corneal endothelial loss is a recognized sequel. Although several factors associated with this harm have been described, the surgeon's prior experience has been scarcely evaluated. Objectives To assess the association between the surgeon's experience and other variables associated with a corneal endothelial cell loss in the context of phacoeresis. Methods Clinical records of 198 patients undergoing cataract operations were prospectively reviewed. The experience of the surgeon and other variables were recorded, including cumulative dissipated energy, viscoelastic type, the use of trypan blue, amount of fluidics, ultrasound time, combined phacoemulsification energy, and pre- and postoperative corneal endothelial cell counts. Results No differences were observed in the postoperative corneal endothelial cell count between surgeons with more or less than five years of experience. Nevertheless, ophthalmologists with more than five years' experience used less trypan blue, but more cumulative dissipated energy in each procedure, while less experienced ophthalmologists used less fluidics. Conclusions Although there were differences in the surgical management regarding the surgeons' experience in factors known to influence corneal endothelial cell loss, no differences in endothelial cell loss were observed as an outcome.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Postoperative Complications/pathology , Cataract Extraction/adverse effects , Phacoemulsification/adverse effects , Corneal Endothelial Cell Loss/etiology , Cataract/pathology , Cataract Extraction/methods , Prospective Studies , Phacoemulsification/methods , Ophthalmologists
19.
Rev. cuba. oftalmol ; 30(4): 1-11, oct.-dic. 2017.
Article in Spanish | LILACS | ID: biblio-901394

ABSTRACT

La extracción de la catarata produce una significante y sustancial reducción de la presión intraocular en individuos con glaucoma de ángulo abierto, hipertensión ocular y glaucoma por cierre angular. Remover la catarata mejora la interpretación de las pruebas perimétricas. Es recomendable restablecer las imágenes de base del nervio óptico, así como el campo visual después de la extracción de la catarata. La secuencia de cirugía de catarata y cirugía de glaucoma disminuye la probabilidad de complicaciones y aumenta el éxito quirúrgico. Tiene múltiples beneficios realizar la cirugía de catarata antes que la cirugía de glaucoma, mientras que la cirugía de catarata después de la trabeculectomía incrementa el riesgo de fallo de la filtración. Como la cirugía de glaucoma mínimamente invasiva continúa mejorando en términos de eficacia, esta juega un rol importante en la cirugía combinada de glaucoma y catarata en pacientes con glaucoma en estadios inicial y moderado. La combinación de cirugía de catarata con implante valvular o trabeculectomía por uno o dos sitios, también ofrece ventajas en pacientes con glaucoma avanzado. La presente revisión tiene como objetivo resumir el papel de la cirugía de catarata en el tratamiento del glaucoma teniendo en cuenta el efecto en la presión intraocular y las ventajas que ofrece en aquellos pacientes con ambas condiciones(AU)


Cataract extraction produces a significant, substantial reduction in intraocular pressure in people with open-angle glaucoma, ocular hypertension and angle closure glaucoma. Cataract removal improves the interpretation of perimetric tests. After cataract extraction it is advisable to re-establish the base optic nerve images and the visual field. The cataract surgery - glaucoma surgery sequence reduces the chances of complications and increases surgical success. It is very beneficial to perform cataract surgery before glaucoma surgery, whereas cataract surgery following trabeculectomy increases the risk of filtration failure. Minimally invasive glaucoma surgery continues to improve in terms of efficacy, thus playing an important role in combined glaucoma-cataract surgery in patients with early-stage, moderate glaucoma. Combined cataract surgery and valve implant or one- or two-site trabeculectomy is also advantageous in patients with advanced glaucoma. The present review is aimed at summarizing the role of cataract surgery in the treatment of glaucoma in terms of its effect on intraocular pressure and its advantages for patients with both conditions. Key words: phacoemulsification, cataract, glaucoma, trabeculectomy, combined surgery, MIGS(AU)


Subject(s)
Humans , Combined Modality Therapy/adverse effects , Glaucoma, Open-Angle/therapy , Phacoemulsification/adverse effects , Trabeculectomy/methods
20.
Rev. cuba. oftalmol ; 30(4): 1-11, oct.-dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-901396

ABSTRACT

Paciente masculino de 75 años de edad con antecedentes de hipertensión arterial y glaucoma por 30 años. Acudió a la Consulta de Baja Visión del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el año 2016 y refirió disminución progresiva de la visión en el ojo izquierdo. Al fondo de ojo se observó daño glaucomatoso avanzado y degeneración macular seca en evolución. Después de combinar 3 fármacos para ambos ojos a dosis máxima, los valores de la presión intraocular no eran protectores. Se implantó válvula de Ahmed en temporal inferior del ojo izquierdo. A la semana, la agudeza visual se limitaba a movimiento de manos; la presión intraocular era de 6 mmHg y la atalamia grado 4. Se drenó desprendimiento coroideo seroso y se reformó la cámara anterior. Se indicó tratamiento antinflamatorio tópico, sistémico y midriático ciclopléjico. A los 15 días la agudeza visual mejor corregida era de 0,2 y la presión intraocular de 12 mmHg, sin atalamia. Tres meses después se realizó facoemulsificación y se colocó lente intraocular plegable en saco capsular. La agudeza visual mejor corregida era de 0,6 y la presión intraocular de 11 mmHg. La presión intraocular nunca ha superado los 15 mmHg; no se ha detectado progresión del daño glaucomatoso y se ha conservado la agudeza visual(AU)


A male 75-year-old patient with a 30-year history of hypertension and glaucoma presented at the Low Vision Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology in the year 2016 and stated experiencing progressive vision reduction in his left eye. Funduscopy revealed advanced glaucomatous damage and dry macular degeneration in progress. After combining 3 drugs for both eyes at a top dosage, intraocular pressure values were not protective. An Ahmed valve was implanted in the inferior temporal quadrant of the left eye. One week later, visual acuity was limited to hand movement, intraocular pressure was 6 mmHg and athalamia was grade 4. The serous choroidal detachment was drained and the anterior chamber was reformed. Topical antiinflammatory, systemic and mydriatic cycloplegic treatment was indicated. Fifteen days later best corrected visual acuity was 0.2 and intraocular pressure was 12 mmHg, without athalamia. Phacoemulsification was performed three months later and a foldable intraocular lens was placed in the capsular sac. Best corrected visual acuity was 0.6 and intraocular pressure was 11 mmHg. Intraocular pressure has never exceeded 15 mmHg, glaucomatous damage has not been found to progress, and visual acuity has been preserved(AU)


Subject(s)
Humans , Male , Aged , Cataract Extraction/adverse effects , Glaucoma/diagnosis , Macular Degeneration/therapy , Phacoemulsification/adverse effects , Intraocular Pressure , Visual Acuity
SELECTION OF CITATIONS
SEARCH DETAIL