Síndrome de contracción capsular bilateral / Bilateral capsule contraction syndrome

El síndrome de contracción capsular se describe como una reducción progresiva y acelerada del diámetro de la capsulorrexis y del saco capsular tras la extracción extracapsular del cristalino. Se reporta el caso de una paciente femenina, con antecedentes de miopía elevada, a quien se le realizó cirugía de catarata de ambos ojos sin complicaciones transquirúrgicas, y regresa con síndrome de contracción capsular bilateral al mes de operada. Se comenta la conducta seguida en ambos ojos(AU)

Capsule contraction syndrome is described as progressive, accelerated reduction in capsulorhexis and capsular bag diameter after extracapsular crystalline lens extraction. A case is presented of a female patient with a history of high myopia who underwent cataract surgery of both eyes without any intraoperative complication. One month after surgery the patient presents with bilateral capsule contraction syndrome. Comments are made on the clinical management of each eye(AU)

The effects of functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia / A influência das reações emocionais durante a facoemulsificação com anestesia tópica em pacientes de olho único

ABSTRACT Purpose: To evaluate the relationship between the incidence of complications and functionally monocular patients' emotional reactions during phacoemulsification under topical anesthesia. Methods: We enrolled 22 functionally monocular patients (11 males and 11 females; group 1) and 19 age- and sex-matched controls (6 males and 13 females; group 2) in this prospective, interventional, cross-sectional, case control study. Demographics data, including age, sex, and educational background, were collected. Surgeries were performed by the same surgeon, and during surgery, the patients' vital signs (blood pressure and heart rate) and surgical events (duration, body movements, signs of increased vitreous cavity pressure, difficulty in performing capsulorhexis, and complications) were noted. Pre- and postoperative visual acuity was also analyzed. Results: The mean age of group 1 was 73.05 ± 13.31 years and of group 1 was 69.74 ± 16.81 years. There was no significant between-group difference in systolic and diastolic blood pressures. The average heart rate was similar in both groups, too. During surgery, the surgeon's perception of excessive eye, eyelid, or head movements in both groups was similar, in addition to signs of increased vitreous cavity pressure. Conclusion: It is safe to perform phacoemulsification under topical anesthesia in functionally monocular patients, who apparently behave similarly to binocular patients.(AU)

RESUMO Objetivo: Avaliar a relação entre a incidência de complicações e reações emocionais durante a cirurgia de catarata sob anestesia tópica em pacientes funcionalmente monoculares. Métodos: Estudo prospectivo, transversal, caso-controle de vinte e dois pacientes monoculares e dezenove controles pareados por idade e sexo . Dados demográficos foram analisados: idade, sexo e escolaridade. As cirurgias foram realizadas pelo mesmo cirurgião e durante o procedimento os sinais vitais dos pacientes (como pressão arterial sistêmica e frequência cardíaca) e eventos cirúrgicos (duração da cirurgia, movimentos corporais, sinais de aumento da pressão vítrea, dificuldade de realização da capsulorrexis e complicações) foram coletados. A acuidade visual pré e pós foi analisada. A distribuição normal dos dados foi confirmada com o teste de Shapiro-Wilk. Os dados foram expressos como média ± DP e porcentagem. A comparação dos diferentes testes clínicos entre os grupos foi realizada utilizando Student's t-test e ANOVA com correção de Bonferroni. O qui-quadrado foi usado para comparar dados demográficos. Valor de p<0,05 foi considerado estatisticamente significante. Resultados: Este estudo incluiu vinte e dois olhos de 22 pacientes funcionalmente monoculares (6 homens e 13 mulheres) e dezenove olhos de 19 controles (11 homens e 11 mulheres). A média de idade foi de 73,05 ± 13,31 anos nos indivíduos monoculares e 69,74 ± 16,81 no controle. Considerando-se os sinais vitais não houve diferença significativa entre os grupos (p>0,05). Durante o procedimento, a percepção do cirurgião em relação aos movimentos excessivos de olho, pálpebra ou cabeça em ambos os grupos foi semelhante, assim como sinais de aumento da pressão vítrea (p=0,2 e p=0,1, respectivamente). Conclusão: Este estudo sugere que é seguro realizar a extração de catarata com anestesia tópica em pacientes funcionalmente monoculares. Esses pacientes aparentemente se comportam de maneira semelhante aos pacientes binoculares.(AU)

The role of a femtosecond laser in congenital cataract associated with aniridia / O papel do laser de femtosegundo na catarata congênita associada à aniridia

ABSTRACT A patient with bilateral aniridia and progressive congenital cataract was treated at the age of 7 years through phacoaspiration with femtosecond laser capsulotomy, in-the-bag intraocular lens implantation, and pars plana vitrectomy (combined with posterior capsulotomy). The diameter of the planned anterior capsulotomy was 4.7 mm; however, due to elevated tension in the young capsular bag, the capsulotomy diameter increased (to around 6 mm) shortly after release of the tension by the laser. In addition, the patient had a very flat and small cornea, causing the formation of air bubbles in the curved laser interface. This was addressed by filling the gap by using a viscoelastic. A very similar situation was observed in both eyes. Use of the femtosecond laser facilitated a successful outcome in a complex congenital cataract case with a safe capsulotomy that ensured in-the-bag intraocular lens placement.

RESUMO Paciente com aniridia bilateral e catarata congê­nita progressiva foi tratado com a idade de 7 anos através de facoemulsificação com capsulotomia anterior por laser de femtosegundo, implante de lente intra-ocular e vitrectomia via pars plana (combinada com capsulotomia posterior). O diâmetro da capsulotomia anterior prevista foi de 4,7mm, porém, devido à elevada tensão do saco capsular jovem, o diâmetro da capsulotomia aumentou (para cerca de 6mm) logo após a liberação da tensão pelo laser. Além disso, o paciente tinha uma córnea muito plana e pequena, causando a formação de bolhas de ar na interface do laser. Isso foi resolvido preenchendo a lacuna usando um viscoelástico. Uma situação muito semelhante foi observada em ambos os olhos. O uso do laser de femtosegundo facilitou um resultado bem-sucedido em um caso complexo de catarata congênita com uma capsulotomia anterior segura que garantiu a colocação da lente intra-ocular dentro do saco capsular.

Posterior argentinean flag-like sign during primary posterior continuous curvilinear capsulorhexis / Sinal da bandeira argentina- like durante capsulorrexis posterior primária

ABSTRACT We describe a unique complication during primary posterior continuous curvilinear capsulorhexis (PCCC) in a patient with megalocornea scheduled for phacoemulsification with toric multifocal intraocular lens (IOL) implantation. After nucleus emulsification and cortex removal, the capsular bag was filled with cohesive viscoelastic in preparation for PCCC to achieve reverse optic capture of the IOL, thus ensuring stability. However, as soon as the initial puncture was made using a 27-gauge needle to start the capsulotomy, the posterior capsule opening extended peripherally from 0º-180º. This capsule extension was similar to the Argentinean-flag sign in hypermature cataracts, and both are caused by excessive intracapsular pressure. Careful bimanual manipulation was performed to implant the IOL on the desired axis, which occurred uneventfully. At a postoperative visit, the patient exhibited excellent uncorrected visual acuity with a well-aligned IOL.

RESUMO Os autores demonstram uma complicação durante a realização de uma capsulo tomia circular contínua posterior (CCCP) em um paciente com megalocórnea programado facoemulsificação com implante de lente intraocular (LIO) tórica multifocal. Após a remoção do núcleo e córtex, o saco capsular foi preenchido por viscoelástico coesivo com finalidade de prepará-lo para realização da CCCP e com isso assegurar o correto alinhamento do implante no eixo desejado. Entretanto, assim que a agulha de 27-gauge foi utilizada para confecção puntura inicial da capsulotomia, imediatamente a cápsula posterior se abriu até periferia de 0-180 graus, similar à lesão capsular vista no sinal da Bandeira Argentina em cataratas hipermaduras, ambos causados por pressão excessiva intracapsular. Manipulação cuidadosa foi realizada para implantação da lente no eixo correto, a qual aconteceu sem intercorrências. No pós-operatório, a paciente apresentou uma excelente acuidade visual sem correção com LIO corretamente alinhada no eixo desejado.

Avaliação da eficácia de um novo marcador cirúrgico para capsulorrexe anterior / Effectiveness evaluation of a new surgical marker for anterior capsulorhexis

RESUMO Objetivo: Avaliar a eficácia de um novo marcador cirúrgico para ajudar na confecção da capsulorrexe anterior analisando o seu dimensionamento e formato, comparando com a capsulorrexe confeccionada manualmente de maneira livre. Métodos: Como experimento, 3 residentes (R3) de Oftalmologia do Hospital Universitário Onofre Lopes (HUOL) e 1 oftalmologista em treinamento, voluntários, realizaram (cada um) 10 capsulorrexes em olhos de porco enucleados. Em 5 olhos foi utilizado o marcador e em outros 5, não. Todos os olhos foram fotografados tendo ao lado uma régua para orientar e calibrar um aplicativo para a avaliação morfométrica do procedimento. O diâmetro alvo foi de 5 mm, cujo perímetro correspondente é 15,7 mm e a área 19,652 mm2. Foram avaliados em cada procedimento: os diâmetros máximo, mínimo e médio, o perímetro, a área e o desvio em relação ao diâmetro e quanto ao aspecto ideal. Resultados: No grupo utilizando o marcador o diâmetro médio foi 5,44mm (±0,89) contra 6,37mm (±0,67) (p=0,001), no grupo no qual não se utilizou o marcador; quanto ao perímetro, 17,52mm (±1,92) no grupo utilizando o marcador contra 20,14mm (±2,09) (p<0,001) sem o marcador e quanto a área, 24,73mm2 (±1,92) com o marcador, contra 32,62mm2 (±6,32) (p<0,001), sem o marcador. Em relação ao aspecto da capsulorrexe 1,26mm (±0,12), contra 1,21mm (±0,7) (p=0,09) e em relação ao desvio de curvatura: 0,87 (±0,05), contra 0,9 (±0,04), (p=0,06) respectivamente. Conclusão: O trabalho mostrou que o marcador avaliado é eficaz para auxiliar a confecção da capsulorrexe conduzindo a resultados melhores que o método a mão livre.

ABSTRACT Purpose: To evaluate the effectiveness of a surgical device that intented to help in the preparation of the anterior capsulorhexis analyzing the design and shape, comparing with capsulorhexis made by free hand. Methods: Three ophthalmology residents(R3) at the HUOL and one surgeon in training, participate in this research as volunteers. Each surgeon perform 5 capsulorhexis in porcine eyes using the device, and five others by free hand as a control. All capsulorhexis were photographed having a ruler as reference to guide and calibrate a computer application for morphometric evaluation (Cambuí Labs, Natal, Brazil). All surgeons aimed to produce a circular continuous capsulorhexis of 5 mm diameter that represents 15,7mm in perimeter and 19,652mm2 in area. Each wet-lab capsulorhexis was evaluated in regard to these criteria: diameter (mean, maximum and minimum), perimeter, area, deviation from the ideal diameter and ideal shape. Results: Compare to control groups, capsulorhexis with the aid of the surgical device showed: 5,44mm ±0,89 vs 6,37mm ±0,67, for capsulorhexis diameter (p=0,001); 17,52mm ±1,92 vs 20,14mm ±2,09 for capsulorhexis perimeter (<0.001); 24,73mm2 ±1,92 vs 32,62mm2 ±6,36 for capsulorhexis area (p<0,001). A tendency for better result with the aid of the surgical device was observed for deviation of an ideal diameter or ideal aspect were appreciated: 0,87mm ±0,05 vs 0,9 ±0,04 for deviation of a curve (p=0,06); 1,26mm ±0,12 vs 1,21mm ±0,7 for the capsulorhexis aspect (p=0,09). Conclusion: Capsulorhexis produced with the aid of the surgical device, significantly improved wet-lab capsulorhexis performance.

Efficacy of Eyesi surgical simulator training in improving high-tension capsules capsulorhexis performance / Eficácia do treinamento com simulador cirúrgico Eyesi em melhorar a capsulorrexe em cápsulas de alta tensão

ABSTRACT Purpose: To evaluate if Eyesi cataract surgical simulator training using its standard course curriculum is effective in improving performance of cataract surgery trainees on creating capsulorhexis on high-tension capsules on the simulator. Methods: We retrospectively analyzed training reports of ophthalmic surgery trainees (2nd and 3rd year residents and cataract fellowship trainees) that have accomplished the standard Eyesi cataract surgery simulator training course version 2.1 between May 2012 and August 2013 at Instituto de Diagnostico e Terapia Ocular, Rio de Janeiro, Brazil. We compared the mean score (from 0 to 100) attributed by the simulator on performing the same task, a capsulorhexis on a high-tension capsule, on the surgical simulator "before training" (during beginning of the course) and "after training" (at later stages of the course). Results: Thirty-seven trainees' reports were analyzed. Mean and standard deviation "before training" high-tension capsulorhexis score was 41.73 ± 27.08 points and the mean "after training" score was 72.55 ± 16.40 points, a difference of +30.82 points (p value <0.001 on Paired t test), representing a 73% improvement on performance. Conclusions: Eyesi surgical simulator training on course version 2.1 curriculum was effective in improving performance of cataract surgery trainees on creating capsulorhexis on high-tension capsules.

RESUMO Objetivos: Avaliar se o treinamento realizado com o simulador cirúrgico de catarata Eyesi e o seu currículo de exercícios padrão são efetivos em melhorar o desempenho de cirurgiões de catarata em formação na confecção de capsulorrexe em cápsulas de alta tensão realizadas no simulador. Métodos: Analisamos retrospectivamente relatórios de treinamento de residentes de 2º e 3º ano e fellows de catarata que realizaram o curso versão 2.1 de treinamento com o simulador cirúrgico de catarata Eyesi no período de maio de 2012 a agosto de 2013 no Instituto de Diagnóstico e Terapia Ocular, Rio de Janeiro, Brasil. Comparamos o escore médio (de 0 a 100 pontos) atribuído na confecção de capsulorrexe em cápsula de alta tensão no simulador "antes do treinamento" (durante início do curso) e "depois do treinamento" (nos estágios finais do curso). Resultados: Trinta e sete relatórios de cirurgiões em treinamento foram analisados. O escore médio e desvio padrão da capsulorrexe em cápsula de alta tensão "antes do treinamento" foi de 41,73 ± 27,08 pontos e "depois do treinamento" de 72,55 ± 16,40 pontos, uma diferença de +30,82 pontos (p <0.001 no teste t pareado), representando uma melhora de 73% no desempenho. Conclusão: O treinamento realizado com o simulador cirúrgico de catarata Eyesi seguindo o currículo do curso versão 2.1 foi eficaz em melhorar o desempenho de cirurgiões em treinamento na confecção de capsulorrexe em cápsulas de alta tensão.

Comparação entre capsulotomia assistida por laser de femtossegundo e capsulorrexe curvilínea contínua guiada por imagem digital / Comparison between femtosecond laser capsulotomy and manual continuous curvilinear digital image guided capsulorrhexis

Objetivo: Medir e comparar o tamanho e forma de capsulotomias realizadas com laser de femtossegundo com os de capsulorrexes curvilíneas contínuas (CCC) realizadas com auxilio guiado por imagem digital e avaliar o resultado refracional. Métodos: Durante cirurgia de catarata, 40 olhos de 40 pacientes tiveram a capsulotomia realizada com auxílio do laser de femtossegundo e seus resultados foram comparados com os de 40 olhos de 40 outros pacientes que tiveram a capsulorrexe guiada por sistema de imagem digital. Os parâmetros de circularidade, forma e overlap foram medidos usando o Adobe Photoshop (Adobe Systems Inc.) e os resultados refracionais pós-operatórios foram avaliados em ambos os grupos. Resultados: Os diâmetros, tamanho e forma de alta precisão e previsibilidade foram atingidos com laser de femtossegundo e houve diferença estatística entre os grupos. Quando comparado o equivalente esférico entre os grupos, não houve diferença estatística. Conclusão: As capsulotomias realizadas pelo laser de femtossegundo possuem circularidade programada, diâmetro pretendido e valores de desvio padrão médios, indicando resultados reprodutíveis mais elevados. No entanto, CCC realizada por um cirurgião experiente com auxílio guiado de imagem digital, com configurações apropriadas, fornece resultados semelhantes e sugere que diferentes técnicas são igualmente eficazes. .

Purpose: To measure and compare size and shape parameters of femtosecond laser capsulotomy with manually continuous curvilinear digital guided capsulorhexis (CCC) and their refractive outcomes. Methods: Laser capsulotomies in 40 eyes of 40 patients were performed using LenSx femtosecond laser device (Alcon, Forthworth, US) and its results were compared with the CCC digital guided carried out in 40 eyes of 40 patients using the Callisto Eye digital image system (Zeiss, Germany). Capsulorhexis circularity, shape and capsule overlap were measured using Adobe Photoshop (Adobe Systems Inc.) and postoperative refraction outcomes were evaluated in both groups. Results: Highly accurate and predictable capsulotomy diameter, size and shape were achieved with femtosecond laser capsulotomy compared with capsulorhexis and showed statistical difference between groups. Spherical equivalent comparison between groups showed no statistical difference. Conclusions: Femtosecond laser anterior capsulotomy with programed circularity had the intended diameter with average standard deviation values, indicating higher reproducible outcomes. Capsulorhexis performed by an experienced surgeon with auxiliary image guide and appropriate settings provides similar results our results suggest that different techniques are equally effective. .

Efficacy of a lutein-based dye (PhacodyneTM) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification / Eficácia de corante à base de luteína (PhacodyneTM) para observação da capsulorrexis anterior em cirurgia de facoemulsificação

Purpose: To evaluate the efficacy and safety of a novel lutein-based dye for the anterior capsulorhexis during phacoemulsification in cataract surgery in humans. Methods: Twenty-five eyes from 25 patients were operated by 25 different surgeons who performed continuous circular capsulorhexis (CCC) guided by a lutein-based dye (PhacodyneTM) during cataract surgery by phacoemulsification. A questionnaire assessed the surgeon's opinion regarding the efficacy of the dye. Follow-up examinations were performed at 1, 7, and 30 days post-surgery. Eyes were evaluated by full ophthalmic examination, corneal topography/pachymetry, and corneal endothelial cell count. Results: As revealed by the answers to the questionnaire, the dye facilitated the CCC procedure in all eyes. Baseline nuclear cataract classification (according to the Lens Opacities Classification System III; LOCS III) was 3.24 (± 1.12). Preoperative BCVA (logMAR) was 0.89 ± 0.59 and improved to 0.23 ± 0.22 on day 30 after surgery. The intraocular pressure (IOP) remained stable and the inflammatory reaction subsided in all cases within the first 7 days after surgery. The pre-operative values of corneal pachymetry and IOP were similar to those found on follow-up day 30. Loss in endothelial cell number was similar to earlier reports. Conclusion: PhacodyneTM was efficient when used for anterior capsulorhexis during cataract surgery by phacoemulsification and showed no signs of toxicity or side effects during the 30-day follow-up period. .

Objetivos: Avaliar a eficácia e eficiência de um novo corante à base de luteína para coloração da cápsula anterior durante cirurgia de facoemulsificação em humanos. Métodos: Vinte e cinco olhos de 25 pacientes foram operados por 25 cirurgiões diferentes que realizaram capsulorrexis circular contínua e facoemulsificação após coloração da cápsula anterior com corante à base de luteína. Um questionário avaliou a opinião dos cirurgiões sobre a eficácia do corante. Exames pós-operatórios foram realizados nos dias 1, 7 e 30 por meio de exame oftalmológico completo, topografia/ paquimetria e contagem de células endoteliais. Resultados: De acordo com o questionário aplicado, o corante facilitou a cirurgia em todos os olhos. A classificação da catarata de acordo com o LOCS III foi de 3,24 ± 1,12. A acuidade visual pré-operatória com melhor correção foi de 0,89 ± 0,59 (logMAR), passando a 0,23 ± 0,22 no pós-operatório. A pressão intraocular (PIO) permaneceu estável e houve reação de câmara leve que desapareceu em todos os casos durante os primeiros 7 dias de pós-operatório. Não houve significância estatística comparando a paquimetria e PIO pré e pós-operatórios. Conclusão: O novo corante se mostrou eficiente e sem sinais de toxicidade ou efeitos adversos, após 30 dias, quando usado para auxiliar a cirurgia de facoemulsificação. .

Staining of Lens Capsule with Trypan Blue for Capsulorrhexis in Eyes with White Cataract.

Objective: To evaluate the efficacy and safety of intracameral 0.1% Trypan blue dye for staining the anterior lens capsule during cataract surgery. Methods: 110 Patients who underwent Manual Small Incision Cataract Surgery (MSICS) and phacoemulsification for intumescent, mature or hypermature cataract in the Department of Ophthalmology, Tripura Medical College during the period of June 2009 to July 2010 were included in the study. Results: Satisfactory staining of the anterior lens capsule was seen in all cases with no major complications. Conclusion: Direct intracameral injection of trypan blue dye is an effective method for staining the anterior lens capsule during cataract surgery.

Completion rates of anterior and posterior continuous curvilinear capsulorrhexis in pediatric cataract surgery for surgery performed by trainee surgeons with the use of a low-cost viscoelastic.

Context: Pediatric cataract surgery is traditionally done with the aid of high-molecular-weight viscoelastics which are expensive. It needs to be determined if low-cost substitutes are just as successful. Aims: The study aims to determine the success rates for anterior and posterior capsulorrhexis and intraocular lens (IOL) implantation in the bag for pediatric cataract surgery performed with the aid of a low-molecular-weight viscoelastic. Settings and Design: Nonrandomized observational study. Materials and Methods: Children less than 6 years of age who underwent cataract surgery with IOL implantation in the period May 2008–May 2009 were included. The surgeries were done by pediatric ophthalmology fellows. A standard procedure of anterior capsulorrhexis, lens aspiration with primary posterior capsulorrhexis, anterior vitrectomy, and IOL implantation was followed. Three parameters were studied: successful completion of anterior and posterior capsulorrhexis and IOL implantation in the bag. Results: 33 eyes of 28 children were studied. The success rate for completion was 66.7% and 88.2 % for anterior and posterior capsulorrhexis, respectively. IOL implantation in the bag was successful in 87.9%. Conclusions: 2% hydroxypropylmethylcellulose is a viable low-cost alternative to more expensive options similar to high-molecular-weight viscoelastics. This is of great relevance to hospitals in developing countries.

New technique to demonstrate corneal magnification using trypan blue in cataract surgery / Nova técnica para demonstrar a magnificação corneana utilizando azul de tripan na cirurgia de catarata

PURPOSE: To demonstrate the corneal magnification using trypan blue in cataract surgery. METHODS: Eight eyes of eight patients undergoing phacoemulsification with an intraocular lens implantation were enrolled in this study. After staining the anterior capsule with Trypan Blue 0.1 percent and performing the capsulorhexis, the excised anterior capsule was placed on the corneal surface. By observing and measuring the relationship between the border of the excised anterior capsule and the intracameral capsulorhexis opening, the effect of corneal magnification was clearly demonstrated and calculated by linear method. RESULTS: The average magnification of the cornea was 20.88 percent using linear method with an average area magnification of 47.53 percent. CONCLUSION: The capsulorhexis stained by trypan blue is useful to demonstrate the magnification provided by the cornea helping to design an intended opening size.

OBJETIVO: Demonstrar a magnificação corneana utilizando o azul de tripan na cirurgia de catarata. MÉTODOS: Oito olhos de oito pacientes submetidos à facoemulsificação com implante de lente intraocular foram envolvidos neste estudo. Após corar a cápsula anterior do cristalino com azul de tripan 0,1 por cento e realizar a capsulotomia circular contínua, a cápsula excisada foi colocada sobre a superfície corneana. Após observar e aferir a relação entre a borda da cápsula anterior excisada e a abertura da cápsula intracameral, o efeito da magnificação corneana foi claramente demonstrada e calculada através do método linear. RESULTADOS: A média estimada da magnificação corneana foi de 20,88 por cento com uma média de magnificação de área de 47,53 por cento. CONCLUSÃO: A capsulorrexis corada pelo azul de tripan é útil na demonstração da magnificação corneana, auxiliando assim na correta confecção do seu tamanho.

Clear lens extraction and intraocular lens implantation in a case of microspherophakia with secondary angle closure glaucoma.

Phacoemulsification with implantation of single-piece acrylic foldable intraocular lens (IOL) in a 19-year-old boy with microspherophakia, high myopia and angle closure glaucoma is described. The associated myopia and angle closure glaucoma was severely compromising the quality of life. Post-surgical visual recovery was 20/20 with sustained normal intraocular pressure. Management of such cases at times calls for innovations in current surgical technique.

Preoperative Nd:YAG laser anterior capsulotomy in white intumescent cataracts: report of 11 cases / Capsulotomia anterior pré-operatória com Nd:YAG laser em cataratas brancas intumescentes: relato de 11 casos

Creating a continuous curvilinear capsulorhexis in eyes with white intumescent cataracts is a challenge due to the high risk of extension of capsular tears to the lens periphery. Several approaches have been described to avoid this complication and preoperative Nd:YAG laser anterior capsulotomy has been little reported as an optional technique. Eleven patients with white intumescent cataracts were submitted to preoperative Nd:YAG laser anterior capsulotomy. All patients had some degree of cortex falling in anterior chamber after laser application. No patient developed later complications. Thus, preoperative Nd:YAG laser anterior capsulotomy represents a safe and easy option for white intumescent cataracts.

A realização da capsulorrexis curvilínea contínua em olhos com catarata branca intumescente é ainda considerada um desafio pelo alto risco de extensão da capsulotomia para a periferia do cristalino. Apesar da descrição de diversas técnicas cirúrgicas voltadas para a prevenção de tal complicação, o uso de Nd:YAG laser no pré-operatório tem raros relatos na literatura internacional. Onze pacientes com cataratas brancas intumescentes foram submetidos a capsulotomia pré-operatória com Nd:YAG laser. Todos os pacientes apresentaram, após a aplicação do laser, a saída de córtex liquefeito para a câmara anterior. Nenhum paciente apresentou complicações cirúrgicas com o procedimento. Desta forma, a capsulotomia anterior com Nd:YAG laser representa uma opção técnica fácil e segura no manejo de cataratas brancas intumescentes.

Manual small incision cataract surgery under topical anesthesia with intracameral lignocaine: study on pain evaluation and surgical outcome.

The authors here describe manual small incision cataract surgery (MSICS) by using topical anesthesia with intracameral 0.5% lignocaine, which eliminates the hazards of local anesthesia, cuts down cost and time taken for the administration of local anesthesia. AIMS: To evaluate the patients' and surgeons' experience in MSICS using topical anesthesia with intracameral lignocaine in terms of pain, surgical complications, and outcome. SETTINGS AND DESIGN: Prospective interventional case series. MATERIALS AND METHODS: Ninety-six patients of senile cataract were operated by MSICS under topical anesthesia with intracameral lignocaine using "fish hook technique." The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience, and complications. STATISTICAL ANALYSIS USED: Statistical analysis software "Analyseit." RESULTS: There were 96 patients enrolled in the study. The mean pain score was 0.7 (SD +/- 0.97, range 0-5, median 0.0, and mode 0.0). Fifty-one patients (53%) had pain score of zero, that is, no pain. Ninety-one patients (approximately 95%) had a score of less than 3, that is, mild pain to none. All the surgeries were complication-free except one and the surgeon's experience was favorable in terms of patient's cooperation, anterior chamber stability, difficulty, and complications. The ocular movements were not affected, and hence, the eye patch could be removed immediately following the surgery. CONCLUSIONS: MSICS can be performed under topical anesthesia with intracameral lignocaine, which makes the surgery patient friendly, without compromising the outcome.

Mini-rhexis for white intumescent cataracts

PURPOSE: To compare the intraoperative safety of two techniques of capsulorhexis for intumescent white cataracts: traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis. METHODS: This prospective comparative randomized study included two groups: the 1-CCC group (11 patients) received traditional one-stage continuous curvilinear capsulorhexis with 5-6 mm diameter, and the 2-CCC (13 patients) group received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged, or a two-stage continuous curvilinear capsulorhexis. Patients were stratified according to cataract subset, which was characterized echographically. Six patients were considered as type 1, fifteen as type 2 and three as type 3. Type 1 included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections, type 2 included white cataracts with voluminous nuclei, a small amount of whitish solid cortex, and minimal internal acoustic reflections, and type 3 included white cataracts with fibrous anterior capsules and few internal echo spikes. RESULTS: With the one-stage technique, 46.15 percent of patients had leakage of the liquefied cortex; in addition, the surgeon perceived high intracapsular pressure in 61.53 percent of cases. Anterior capsule tears occurred in 23.07 percent of cases, discontinuity of capsulorhexis in 30.79 percent of cases and no posterior capsular rupture occurred. With the two-stage technique, leakage of the liquefied cortex occurred in 45.45 percent of cases; additionally, the surgeon perceived high intracapsular pressure in 36.36 percent of cases. No anterior capsule tears, discontinuity of capsulorhexis or posterior capsular rupture occurred. Considering each cataract subset, there was a higher incidence of leakage for type 2 as compared to types 1 and 3. CONCLUSIONS: Two-stage continuous curvilinear capsulorhexis helps prevent unexpected ...

Refractive Change Caused Silicone Oil Adhesion to the Intraocular Lens Following Nd:YAG Posterior Capsulotomy

A 32-year-old female who had undergone the silicone oil removal procedure presented with visual disturbance in her left eye. Several months previous, she had cataract surgery in a private clinic, and a month later she had a Nd:YAG laser procedure for posterior capsulotomy. The slit-lamp examination revealed silicone oil droplets that had adhered to the intraocular lens where the posterior capsulotomy was performed. She had experienced high myopia as a manifestation of the resulting refractive changes. We replaced the previous intraocular lens with a new acrylic intraocular lens with resulting improvement to her vision. Here we report the case of a female patient with a history of silicone oil removal surgery where the resulting silicone bubbles had not been removed thoroughly and remained in the vitreous cavity. These bubbles subsequently adhered to the intraocular lens following YAG laser posterior capsulotomy, resulting in refractive changes. We recommend that implanting a silicone intraocular lens in anyone with a history of the silicone oil removal procedure or who has a possible history of silicone oil use should be avoided.

Clinical Outcomes of Surgical Techniques in Congenital Cataracts

PURPOSE: To investigate the general clinical features of congenital cataracts and to determine their relationship to visual prognosis and surgical complications according to age at operation and surgical procedure adopted. METHOD: We retrospectively evaluated 92 eyes in 61 patients with congenital cataracts who underwent cataract surgery between January 1996 and December 2006. The demographic data, surgical technique, post-operative complications, and final visual prognosis were evaluated. RESULTS: The average age at surgery was 3.17 years (range 1 month to 11 years), and the mean follow-up was 40.02 months (range 6 to 46 months). Of the 56 eyes that could be checked for visual acuity after cataract extraction, 29 (51.7%) had a BCVA of > or =0.5 at last visit. Unilateral congenital cataracts (p=0.025) and congenital cataracts with strabismus (p=0.019) showed significantly poorer visual outcomes. Patients with nystagmus also experienced a poor visual outcome; 6 patients (67%) had a BCVA of <0.1. Posterior cataracts had the worst visual prognosis (p=0.004). No statistically significant differences in posterior capsular opacity (p=0.901) or synechia formation (p=0.449) were observed between surgical techniques, but children younger than one year showed a higher tendency for PCO and synechia formation. CONCLUSIONS: Anterior vitrectomy did not reduce postoperative complications. Higher rates of complications (PCO, posterior synechia) developed in children younger than one year of age.