Calidad visual y de vida en la cirugía refractiva bilateral simultánea del cristalino en pacientes hipermétropes / Visual quality and quality of life in simultaneous bilateral refractive lens surgery in hyperopic patients

Introducción: La cirugía actual de la catarata no comprende solo restablecer la visión en su mayor cantidad posible, sino que incluye además la psicofísica de la visión. Objetivo: Evaluar los resultados de la cantidad, calidad visual y de vida en la cirugía refractiva bilateral simultánea del cristalino en pacientes hipermétropes. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo de serie de casos en 108 ojos de 54 pacientes con catarata bilateral e hipermetropía operados por cirugía bilateral simultánea en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" desde noviembre 2018 hasta abril 2022. Se emplearon los porcentajes y los números absolutos para resumir las variables cualitativas. En el caso de las cuantitativas se usó la media con su desviación estándar (DE) y el intervalo de confianza del 95 por ciento. Resultados: Fue más frecuente el sexo femenino con una edad media de 69,1 ± 8,1 años. El 55,11 por ciento de los pacientes tuvo dureza NO3. La agudeza visual monocular mejoró en el 97,2 por ciento y el 100 por ciento la mejoró de forma bilateral. Hubo una pérdida celular endotelial de 10,19 por ciento. La visión de colores y la sensibilidad al contraste mostraron de igual manera mejoría significativa. Conclusiones: La cirugía bilateral simultánea del cristalino en pacientes hipermétropes contribuye de manera significativa a la mejoría de la visión en cantidad y calidad, por lo que permite recuperar la calidad de vida(AU)

Introduction: Current cataract surgery does not comprise only restoring vision to its greatest possible quantity, but also includes the psychophysics of vision. Objective: To evaluate the results of quantity, visual quality and quality of life in simultaneous bilateral refractive surgery of the crystalline lens in hyperopic patients. Methods: A prospective longitudinal descriptive case series prospective study was performed in 108 eyes of 54 patients with bilateral cataract and hyperopia operated by simultaneous bilateral surgery at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" from November 2018 to April 2022. Quality of life was also taken into account by the FV-14 survey. Percentages and absolute numbers were used to summarize the qualitative variables. In the case of quantitative variables, the mean with standard deviation (SD) and 95 percent confidence interval were used. Results: The female gender was more frequent with an average age of 69.1±8.1 years. 55.11 percent of patients had NO3 hardness. Monocular visual acuity improved in 97.2 percent and 100 percent improved bilaterally. There was an endothelial cell loss of 10.19 percent. Color vision and contrast sensitivity likewise showed significant improvement. Conclusions: Simultaneous bilateral lens surgery in hyperopic patients, contributes significantly to the improvement of vision in quantity and quality, thus allowing recovery of quality of life(AU)

Microbiota conjuntival preoperatoria de pacientes diabéticos candidatos a cirugía de catarata / Preoperative Conjunctival Microbiota of Diabetic Patients who are Candidates for Cataract Surgery

Introducción: La microbiota conjuntival en pacientes con catarata puede afectar el posoperatorio, lo que se puede hacer más complejo en pacientes con diabetes mellitus. Objetivos: Determinar la microbiota conjuntival en los pacientes diabéticos de la línea preoperatoria pendiente a cirugía de catarata en el Instituto Cubano Oftalmología "Ramón Pando Ferrer" desde septiembre de 2018 hasta diciembre de 2019. Método: Se realizó una investigación observacional, descriptiva, de corte transversal con 45 pacientes diabéticos diagnosticados de catarata senil, que fueran atendidos en el período y hospital antes mencionado. A todos los pacientes se les realizó hisopado conjuntival en cultivo correspondiente. Se realizó anamnesis para recoger datos sobre la diabetes. Los datos obtenidos (matriz en Excel) se analizaron con software SPSS 21, y los resultados se presentan en tablas de frecuencias. Se utilizó ji cuadrado para la correlación entre variables. Resultados: De los 45 pacientes, predominaron las mujeres (57,8 por ciento), con edades de 60 años y más (68,9 por ciento), y sin antecedentes patológicos oculares (82,2 por ciento). Hubo crecimiento bacteriano en el 66,7 por ciento (p < 0,002). El germen más frecuente fue Staphylococcus coagulasa negativa (48,3 por ciento). Conclusiones: El estudio de la microbiota conjuntival preoperatoria garantiza, en parte, el éxito de la cirugía de catarata(AU)

Introduction: The conjunctival microbiota in cataract patients may affect the postoperative course, which may become more complex in patients with diabetes mellitus. Objectives: To determine the conjunctival microbiota in diabetic patients in the preoperative line pending cataract surgery at the Cuban Ophthalmology Institute "Ramón Pando Ferrer" from September 2018-2019. Methods: An observational, descriptive, cross-sectional, descriptive research was conducted, 45 diabetic patients, diagnosed with senile cataract, who were treated in the period and hospital mentioned above. All patients underwent conjunctival swabbing and corresponding culture. Anamnesis was performed to collect data on diabetes. The data obtained (matrix in Excel) were analyzed with SPSS 21 software, and the results were presented in frequency tables. Chi-square was used for correlation between variables. Results: Out of the 45 patients, women predominated (57.8 percent), aged 60 years and older (68.9 percent), and with no ocular pathological history (82.2 percent). There was bacterial growth in 66.7 percent (p < 0.002). The most frequent germ was coagulase-negative Staphylococcus (48.3 percent). Conclusions: The study of the preoperative conjunctival microbiota, guarantees, in part, the success of cataract surgery(AU)

Catarata bilateral congénita en recién nacido con síndrome de Down / Congenital bilateral cataract in a newborn with Down syndrome / Catarata congênita bilateral em recém-nascido com síndrome de Down

Las cataratas son una causa importante de discapacidad visual en la población pediátrica en todo el mundo y pueden afectar significativamente el neurodesarrollo de un niño. Constituyen un problema fundamental en cuanto a su manejo y una de las causas más relevantes de ceguera tratable en los países desarrollados y en vías de desarrollo. La trisomía 21 es la cromosomopatía más frecuente, de características fenotípicas determinadas con un 60% de anormalidades oculares, entre las que se destacan las ametropías, queratocono y las cataratas. El diagnóstico clínico y la identificación temprana del tipo de cataratas, junto con intervenciones clínicas y tratamientos precoces, son claves para lograr resultados óptimos. Se presenta el caso de un recién nacido con síndrome de Down y catarata congénita bilateral y su manejo inicial.

Cataracts are a major cause of visual impairment in the pediatric population worldwide and can significantly affect a child's neurobiological development. Congenital cataract management can become a very important problem and is one of the most important causes of blindness in developed and developing countries. Trisomy 21 is the most common chromosomal disease and it has certain phenotypic characteristics and 60% ophthalmic abnormalities, such as, ametropia, keratoconus and cataracts. The diagnosis is fundamentally clinical. Early identification, diagnosis, and appropriate clinical care are key to achieve optimal results. We present the case of a newborn with Down syndrome who was diagnosed with an early bilateral congenital cataract.

A catarata é uma das principais causas de deficiência visual na população pediátrica no mundo e pode afetar significativamente o neurodesenvolvimento de uma criança, além de constituir um problema fundamental em termos de sua gestão e é uma das causas mais relevantes de cegueira tratável em países desenvolvidos e em desenvolvimento. Trissomia 21 é a cromossomopatia mais frequente e tem determinadas características fenotípicas com 60% de alterações oculares, como a ametropia, ceratocone e catarata. O diagnóstico clínico e a identificação precoce do tipo de catarata, juntamente com intervenções clínicas e tratamento precoces, são fundamentais para alcançar os melhores resultados. Apresentamos o caso de um recém-nascido com síndrome de Down e catarata congênita bilateral e seu manejo inicial.

Facoemulsificación en pacientes con uveítis / Phacoemulsification in Patients with Uveitis

Objetivo: Describir el comportamiento de la cirugía de catarata mediante la técnica de facoemulsificación en pacientes con uveítis. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo. La muestra la constituyeron todos los pacientes con uveítis sometidos a cirugía de catarata mediante la técnica de facoemulsificación, atendidos en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el período de septiembre 2018 a septiembre 2019. Resultados: El grupo etario que predominó corresponde a la séptima década de la vida, el sexo se comportó de forma equitativa, prevaleció el color de la piel blanca. Predominaron las cataratas secundarias a uveítis de etiologías no infecciosas y el glaucoma secundario fue la enfermedad ocular asociada más frecuente. Un preoperatorio adecuado influyó en la mejoría de los resultados visuales y en el control adecuado de la respuesta inflamatoria, un transoperatorio óptimo minimizó las complicaciones, redundando en menos inflamación y mejores resultados visuales, y un control adecuado de la respuesta inflamatoria durante el posoperatorio evitó que se perpetuaran o aparecieran complicaciones que incidieran en los resultados finales. Conclusiones: En la cirugía de catarata mediante la técnica de facoemulsificación existe una estrecha relación entre la preparación perioperatoria y los resultados finales(AU)

Objective: To describe the performance of cataract surgery using the phacoemulsification technique in patients with uveitis. Methods: A prospective longitudinal descriptive study was performed. The sample consisted of all patients with uveitis who underwent cataract surgery using the phacoemulsification technique, treated at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" in the period from September 2018 to September 2019. Results: The predominant age group corresponds to the seventh decade of life, gender behaved equally, white skin color prevailed. Cataracts secondary to uveitis of non-infectious etiologies predominated and secondary glaucoma was the most frequent associated ocular disease. An adequate preoperative period influenced the improvement of visual results and the adequate control of the inflammatory response, an optimal transoperative period minimized complications, resulting in less inflammation and better visual results, and an adequate control of the inflammatory response during the postoperative period prevented the perpetuation or appearance of complications that affected the final results. Conclusions: In cataract surgery using the phacoemulsification technique there is a close relationship between perioperative preparation and final results(AU)

Resultados del cálculo de la lente intraocular con fórmula Holladay 2 y Barret Universal 2 / Results of Intraocular Lens Calculation with Holladay 2 and Barret Universal 2 formula

Objetivo: Determinar los resultados refractivos con las fórmulas Holladay 2 y Barret Universal 2 a partir del cálculo de la lente intraocular en pacientes operados de catarata. Métodos: Se realizó un estudio descriptivo prospectivo y longitudinal con 60 ojos de 50 pacientes operados de catarata mediante la técnica de facoemulsificación. Se empleó para el cálculo de la lente el IOL Master 700 y el Pentacam AXL con la fórmula Holladay 2 y Barret Universal 2, respectivamente. Resultados: Predominó el sexo femenino y el grupo etario mayor de 60 años. Los ojos mayores de 26 mm mostraron la mayor diferencia entre el poder dióptrico de la lente intraocular que se implantó según Holladay y en menores de 22 mm según Barret Universal. Ambos grupos presentaron una disminución del equivalente esférico, siendo superior a 7 y 5 dioptrías en ojos mayores de 26 mm en el posoperatorio de ambas fórmulas. Posterior a la cirugía se observó una mejoría en la agudeza visual sin corrección y corregida de más de 4 líneas en la cartilla de Snellen, independiente de la longitud axial, para ambos grupos en estudio. Sin cambios significativos en el cilindro queratométrico. En el 70,0 por ciento de los casos, el resultado refractivo final estuvo en rango de la emetropía para el grupo Holladay 2 y el 66,7 por ciento para el grupo Barret Universal 2. Conclusiones: Ambas fórmulas resultan útiles para el cálculo de la lente intraocular en todos los rangos de longitud axial(AU)

Objective: To determine refractive outcomes with the Holladay 2 and Barret Universal 2 formulas from intraocular lens calculation in cataract surgery patients. Methods: A prospective and longitudinal descriptive study was performed with 60 eyes of 50 patients who underwent cataract surgery by phacoemulsification. The IOL Master 700 and Pentacam AXL with the Holladay 2 and Barret Universal 2 formula, respectively, were used to calculate the lens. Results: Female gender and age group older than 60 years predominated. Eyes larger than 26 mm showed the greatest difference between the dioptric power of the intraocular lens implanted according to Holladay and those smaller than 22 mm according to Barret Universal. Both groups presented a decrease of the spherical equivalent, being higher than 7 and 5 diopters in eyes larger than 26 mm postoperatively in both formulas. Postoperatively, there was an improvement in uncorrected and corrected visual acuity of more than 4 lines in the Snellen chart, independent of axial length, for both groups under study. No significant changes in keratometric cylinder. In 70.0 percent of the cases, the final refractive result was in the emmetropia range for the Holladay 2 group and 66.7 percent for the Barret Universal 2 group. Conclusions: Both formulas are useful for the calculation of the intraocular lens in all axial length ranges(AU)

Resultados de la cirugía de catarata en pacientes longevos / Outcomes of Cataract Surgery in Long-lived Patients

Objetivo: Evaluar los resultados clínico-quirúrgicos de la cirugía de catarata del primer ojo y su efecto en la calidad de vida de pacientes longevos. Métodos: Se realizó una investigación longitudinal prospectiva, del tipo series de casos en pacientes de 80 y más años de edad (longevos) sometidos a cirugía de catarata en un primer ojo con implante de lente intraocular. Se compararon los resultados visuales y la calidad de vida autopercibida, antes y después de la cirugía. Se identificaron las causas oculares en los casos con impedimento visual posoperatorio. Resultados: Se estudiaron 88 pacientes con una edad promedio de 87,97 años. Predominaron los pacientes femeninos (63,63 por ciento), de color de piel blanca (75 por ciento), con hipertensión arterial (61,36 por ciento) y diabetes mellitus (23,86 por ciento). El 18,18 por ciento tenía antecedentes oculares de glaucoma. Se utilizó la facoemulsificación en el 52,27 por ciento como técnica quirúrgica. El síndrome de iris fláccido intraoperatorio y la hipertensión ocular fueron las complicaciones intraoperatorias más frecuentes. El edema corneal predominó como complicación posquirúrgica (10,2 por ciento). La función visual (agudeza visual sin corrección y agudeza visual mejor corregida), así como la calidad de vida autopercibida mejoraron significativamente en el posoperatorio (p < 0,001). La degeneración macular asociada a la edad y la membrana epiretiniana fueron las principales causas, en ese orden, de impedimento visual posoperatorio. Conclusiones: La cirugía de catarata del primer ojo mejora la función visual y la calidad de vida autopercibida de pacientes longevos. La degeneración macular asociada a la edad es la principal causa del impedimento visual posoperatorio de estos pacientes(AU)

Objective: To evaluate the clinical-surgical outcomes of cataract surgery of the first eye and its effect on quality of life in long-lived patients. Methods: A prospective, longitudinal, case series type investigation was performed in patients 80 years of age and older (long-lived) who underwent first eye cataract surgery with intraocular lens implantation. Visual outcomes and self-perceived quality of life before and after surgery were compared. Ocular causes were identified in cases with postoperative visual impairment. Results: We studied 88 patients with an average age of 87.97 years. Female patients predominated (63.63 percent), with white skin color (75 percent), with arterial hypertension (61.36 percent) and diabetes mellitus (23.86 percent). 18,18 percent had an ocular history of glaucoma. Phacoemulsification was used as a surgical technique in 52.27 percent. Intraoperative flaccid iris syndrome and ocular hypertension were the most frequent intraoperative complications. Corneal edema predominated as a postoperative complication (10.2 percent). Visual function (uncorrected visual acuity and best corrected visual acuity) as well as self-perceived quality of life improved significantly postoperatively (p < 0.001). Age-related macular degeneration and epiretinal membrane were the main causes, in that order, of postoperative visual impairment. Conclusions: First eye cataract surgery improves visual function and self-perceived quality of life in long-lived patients. Age-related macular degeneration is the main cause of postoperative visual impairment in these patients(AU)

Incidentes de seguridad del paciente relacionados con la cirugía de catarata / Patient safety incidents related to cataract surgery

La cirugía de catarata es uno de los procedimientos más costo-efectivos practicados en el mundo. Sin embargo, no está exenta de riesgos porque en ella interviene un equipo con funciones de diverso grado de complejidad cuya práctica puede dañar al paciente. Se realizó una revisión sistemática sobre incidentes de seguridad del paciente en la cirugía de catarata, mediante búsqueda avanzada en bases de datos biomédicas (PubMed, Science Direct, Google académico, HONcode, Cochrane y SciELO). Se incluyeron artículos con datos primarios sobre este tipo de incidente o errores médicos relacionados con este procedimiento quirúrgico. Dos revisores de manera independiente evaluaron la calidad de los estudios y extrajeron los datos. El número de investigaciones sobre incidentes de seguridad del paciente en cirugía de catarata fue escaso, especialmente en países en desarrollo. Existió variabilidad en el uso y clasificación de los términos de seguridad del paciente. La observación directa fue el único método que permitió detectar cuasiincidentes. Los incidentes sin daño no fueron reportados. Los eventos adversos intraoperatorios, especialmente los sistémicos anestésicos y los errores en el implante de lente intraocular, fueron los más comunes. El grado de daño fue poco evaluado. Los resultados de los eventos adversos fueron mostrados de forma incompleta y no permitieron conocer todo su impacto en pacientes e instituciones(AU)

Cataract surgery is one of the most cost-effective procedures practiced in the world. However, it is not risk-free because it involves a team with functions of varying degrees of complexity whose practice may harm the patient. A systematic check on patient safety incidents in cataract surgery was carried out through an advanced search in biomedical databases (PubMed, ScienceDirect, Google Scholar, HONcode, Cochrane and SciELO). Articles with primary data on this type of incident or medical errors related to this surgical procedure were included. Two reviewers independently assessed the quality of the studies and extracted the data. The number of investigations on patient safety incidents in cataract surgery was scarce, especially in developing countries. There was variability in the use and classification of patient safety terms. Direct observation was the only method that allowed detection of near misses. Non-harmful incidents were not reported. Intraoperative adverse events, especially systemic anesthetic and intraocular lens implantation errors, were the most common. The degree of harm was poorly assessed. The results of adverse events were incompletely shown and did not allow us to know their full impact on patients and institutions(AU)

Trauma ocular a globo cerrado en la edad pediátrica / Closed globe injuries in pediatric age

Los traumas oculares son frecuentes en las urgencias de oftalmología. El tratamiento constituye un reto para el oftalmólogo, pues se enfrenta a un daño integral y complejo. Se presenta un paciente de 16 años, el cual fue hospitalizado en el Instituto Cubano de Oftalmología Ramón Pando Ferrer hace cuatro años por haber recibido un trauma contuso en ojo derecho el cual provocó hifema total. Durante su estadía hospitalaria se realiza lavado de cámara anterior ya que no se logró la reabsorción espontánea del mismo. Al visualizarse todas las estructuras oculares se diagnostican complicaciones como subluxación del cristalino, catarata, panuveítis, hemovítreo, desgarro retiniano y glaucoma traumáticos. Se bloquea el desgarro con láser y una vez compensado el cuadro inflamatorio, es egresado bajo tratamiento y seguimiento por oftalmología pediátrica. No se logra controlar el glaucoma y se implanta dispositivo de drenaje Molteno lo que estabiliza la tensión ocular. Se realiza posteriormente cirugía de catarata, manteniéndose compensado del glaucoma sin tratamiento y con calidad visual(AU)

Ocular traumas are frequent in ophthalmology emergencies. Treatment is a challenge for the ophthalmologist, as he faces a comprehensive and complex damage. A 16-year-old patient is presented, who was hospitalized at the Cuban Institute of Ophthalmology Ramón Pando Ferrer 4 years ago for having received a blunt trauma to the right eye which caused total hyphema. During his hospital stay, anterior chamber lavage was performed since spontaneous reabsorption was not achieved. When all ocular structures are visualized, complications such as lens subluxation, cataract, panuveitis, hemovitreous, traumatic retinal tear and glaucoma are diagnosed. The tear was blocked with a laser and once the inflammatory condition was compensated, he was discharged under treatment and monitoring by pediatric ophthalmology. The glaucoma could not be controlled and a Molteno drainage device was implanted, which stabilizes the ocular tension. Cataract surgery was subsequently performed, keeping the glaucoma compensated without treatment and with visual quality(AU)

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

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

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

Alteração refracional após capsulotomia posterior com laser Nd: YAG / Change on refraction after Nd: YAG laser posterior capsulotomy

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.

Postoperative anterior uveitis in a patient submitted to combined treatment with cataract surgery and iStent inject®. How to manage? / Uveíte anterior no pós-operatório de facectomia combinada com implante de iStent inject®. Como manejar?

ABSTRACT Minimally invasive glaucoma surgeries are surgical treatment alternatives for glaucoma aimed at reducing intraocular pressure with a better safety profile compared to traditional trabeculectomy. However, in spite of less invasive techniques, complications may develop in any surgical procedure. To the best of our knowledge, this is the first case report of anterior uveitis following combined treatment with cataract surgery and iStent inject® which addresses the management of postoperative inflammation.

RESUMO As cirurgias minimamente invasivas para glaucoma consistem em uma opção de tratamento cirúrgico para glaucoma, a qual promove redução da pressão intraocular com melhor perfil de segurança do que a trabeculectomia. Todavia, complicações são inerentes à realização de procedimentos cirúrgicos, apesar do uso de técnicas menos invasivas. Este é o primeiro relato que apresenta um caso de uveíte anterior após cirurgia combinada de catarata e iStent inject®, além de orientações quanto ao manejo do quadro inflamatório.

Impact of cataract surgery on visual acuity and quality of life assessed using the National Eye Institute Visual Function Questionnaire 25 in a public teaching hospital in Brazil / Impacto da cirurgia de catarata na acuidade visual e na qualidade de vida usando o National Eye Institute Visual Function Questionnaire 25 em um hospital público de ensino no Brasil

ABSTRACT Purpose: This study set out to examine the impact of surgical treatment of senile cataract on visual acuity and quality of life in patients operated in a public teaching hospital. Methods: Prospective study including patients aged over 60 years with clinical indications for cataract surgery treated at a medical residency service. The National Eye Institute Visual Function Questionnaire 25 was applied. Corrected distance visual acuity was measured before and after cataract surgery. Correlations between National Eye Institute Visual Function Questionnaire 25 scores and corrected distance visual acuity were investigated. Surgeons in charge, and surgical complications were also reported. Results: A total of 69 patients (89 eyes) were enrolled in this study. Patients were submitted to unilateral (52) or bilateral (17) surgery. Mean patient age was 70.8 ± 7.3 (52 to 95) years. Mean preoperative and postoperative National Eye Institute Visual Function Questionnaire 25 scores were 77.4 ± 15.3 (25.7 to 98.2) and 89.7 ± 14.0 (28.2 to 100) respectively. The larger differences in National Eye Institute Visual Function Questionnaire 25 subscale scores were associated with general vision (from 34.4 to 48.6). Mean preoperative and postoperative corrected distance visual acuity were 0.7 ± 0.39 (0.3 to 1.3) LogMAR and 0.24 ± 0.19 (0.1 to 1.0) LogMAR respectively. Comparative analysis of preoperative and postoperative findings revealed significant (p<0.001) improvements in quality of life and corrected distance visual acuity. Most surgeries (70%, 74 eyes) were performed by surgeons in training. Comparative analysis between patients submitted to unilateral and bilateral surgery revealed significantly (p=0.016) larger visual acuity gains in patients requiring surgery in both eyes. However, questionnaire scores did not differ significantly (p=2.48). Complications were observed in 13 eyes (14.6%), posterior capsule tear being the most common. Even in these cases, total National Eye Institute Visual Function Questionnaire 25 scores and corrected distance visual acuity increased significantly (p<0.001). Conclusion: Cataract surgery performed in teaching hospital settings improved patient quality of life and visual acuity. Therefore, public health agencies should ensure access to cataract surgery.

RESUMO Objetivo: Avaliar o efeito da cirurgia de catarata na acuidade visual e na qualidade de vida em adultos submetidos à cirurgia de catarata em hospital público de ensino. Métodos: Estudo prospectivo, que incluiu pacientes acima de 60 anos com indicação clínica para cirurgia de catarata em um serviço de residência médica. O National Eye Institute Visual Function Questionnaire 25 foi aplicado, e a acuidade visual corrigida à distância foi avaliada antes e após a cirurgia de catarata. Foram realizadas correlações entre o escore do National Eye Institute Visual Function Questionnaire 25 e a acuidade visual. Cirurgiões e complicações cirúrgicas também foram descritos. Resultados: Foram incluídos neste estudo 89 olhos de 69 pacientes, em um total de 52 cirurgias unilaterais e 17 bilaterais. A idade média foi de 70,8±7,3 anos (52 a 95), e a pontuação média do National Eye Institute Visual Function Questionnaire 25 antes da cirurgia foi 77,4±15,3 (25,7 a 98,2) e, depois, de 89,7±14,03 (28,2 a 100). A maior diferença entre os subdomínios do National Eye Institute Visual Function Questionnaire 25 foi a visão geral (34,4 a 48,6). A acuidade visual corrigida à distância média antes do procedimento foi de 0,70±0,39 (0,3 a 1,3) LogMAR e, depois, foi de 0,24±0,19 (0,1 a 1,0) LogMAR. Comparando os resultados antes e após a cirurgia de catarata, houve melhora significativa na qualidade de vida (p<0,001) e na acuidade visual (p<0,001). Dentre as cirurgias, 70% (74 olhos) foram realizadas por cirurgiões em treinamento. A análise comparativa entre os grupos de pacientes de cirurgias unilaterais e bilaterais apresentou um ganho na acuidade visual maior no grupo que operou ambos os olhos, com significância estatística (p=0,016). No entanto, o aumento na pontuação do questionário, observado em ambos os grupos, não representou diferença estatisticamente significante (p=٢,٤٨٩). Complicações foram observadas em ١٣ olhos (١٤,٦٪), sendo a ruptura de cápsula posterior a mais frequente. Mesmo esses pacientes obtiveram aumento no escore total do National Eye Institute Visual Function Questionnaire 25 (p<0,001) e na acuidade visual corrigida à distância (p<0,001). Conclusão: A cirurgia de catarata realizada em ambiente hospitalar de ensino proporciona melhora na qualidade de vida e na acuidade visual, sendo fundamental que os órgãos de saúde pública garantam o acesso da população a esse procedimento.

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)

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

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

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

Sorpresa refractiva tras la cirugía de catarata en paciente con lente fáquica / Refractive surprise after cataract surgery in a patient with a phakic lens implant

El implante de una lente intraocular fáquica puede resultar una opción lógica para los pacientes sumamente miopes que buscan liberarse de las gafas y de los lentes de contacto. Esta es una alternativa para corregir los grados de miopía extremos, y se diseñaron para permanecer dentro del ojo por muchos años. Con el cursar del tiempo, fisiológicamente comienza a opacarse el cristalino. Ante la necesidad de removerlo y de calcular una lente de potencia adecuada para el saco capsular y así conseguir la emetropía, surge un nuevo reto. El cálculo inexacto de la potencia dióptrica de la lente a implantar en la intervención quirúrgica es un problema y con él aparece la sorpresa refractiva; de ahí el objetivo de presentar con este caso la causa más frecuente de sorpresa refractiva tras la cirugía de catarata en un paciente miope con lente fáquica implantada. Se destaca la importancia de la longitud axil, sobre todo si esta se modifica después del implante de la lente fáquica para el correcto cálculo de la lente a implantar, así como el método ideal para su obtención: la interferometría óptica, sin olvidar la historia clínica previa al implante de la lente fáquica(AU)

Phakic intraocular lens implantation may be a logical option for extremely myopic patients who wish to get rid of their eyeglasses and contact lenses. This alternative was developed to correct extremely high degrees of myopia and remain inside the eye for many years. However, with the passing of time and due to physiological processes, the crystalline lens tends to become opaque. A new challenge is posed by the need to remove it and select a lens with an optical power appropriate to the capsular sac, thus achieving emmetropia. Inaccurate calculation of the dioptric power of the lens to be implanted in the surgical intervention is a problem leading to refractive surprise. Hence the interest in presenting a case illustrating the most common cause of refractive surprise after cataract surgery in a myopic patient with a phakic lens implant. The importance of axial length is highlighted, particularly whether it is modified after phakic lens implantation for accurate calculation of the lens to be implanted and the ideal method to obtain it: optical interferometry, without disregarding the medical record data preceding the phakic lens implantation(AU)

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

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

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

Seguridad del uso combinado de lidocaína y fenilefrina como midriáticos intracamerales en la cirugía de catarata / Safety of the combined use of lidocaine and phenylephrine as intracameral mydriatics in cataract surgery

Objetivo: Evaluar la seguridad ocular y sistémica de una combinación de lidocaína 2 por ciento y fenilefrina 1 por ciento administrada por vía intracameral para provocar midriasis intraoperatoria en la cirugía de catarata. Métodos: Se realizó un estudio prospectivo de serie de casos en 70 ojos de igual número de pacientes sometidos a facoemulsificación con implante de lente intraocular. El grupo midriasis intraoperatoria en la cirugía lo conformaron 35 pacientes dilatados con una inyección intracameral de lidocaína y fenilefrina antes de la cirugía, mientras otros 35 ojos se dilataron de manera tradicional, con un colirio midriático previo. Para la seguridad ocular se evaluaron múltiples parámetros del examen oftalmológico pre- y posoperatorio. Resultados: La presión intraocular, el espesor corneal central, la densidad celular del endotelio corneal y el edema corneal posoperatorio como hallazgo del segmento anterior se comportaron de manera similar en ambos grupos de estudio. Se reportó una complicación transoperatoria en el grupo de manera tradicional y un caso con edema quístico macular posoperatorio en el grupo midriasis intraoperatoria en la cirugía que no representaron diferencias significativas. Conclusión: La inyección de lidocaína más fenilefrina intracameral es una opción segura tanto ocular como sistémica para provocar midriasis durante la facoemulsificación(AU)

Objective: Evaluate the ocular and systemic safety of a combination of 2 percent lidocaine and 1 percent phenylephrine administered intracamerally to achieve intraoperative mydriasis in cataract surgery. Methods: A prospective study was conducted of a case series of 70 patients (70 eyes) who underwent phacoemulsification with intraocular lens implantation. The intraoperative mydriasis group was composed of 35 patients dilated with an intracameral injection of lidocaine and phenylephrine before surgery, whereas another 35 eyes were dilated by the conventional method, with mydriatic eye drops. Ocular safety evaluation was based on the analysis of a wide variety of pre- and postoperative ophthalmological examination parameters. Results: Intraocular pressure, central corneal thickness, corneal endothelial cell density and postoperative corneal edema as an anterior segment finding, behaved in a similar manner in both study groups. An intraoperative complication was reported in the conventional method group and a case with postoperative cystoid macular edema in the intraoperative mydriasis group group, neither of them exhibiting significant differences. Conclusion: Intracameral lidocaine plus phenylephrine injection is a safe ocular and systemic option to achieve mydriasis during phacoemulsification(AU)

Criofacoemulsificación en la cirugía de catarata / Cryophacoemulsification in cataract surgery

Objetivo: Demostrar los resultados de la criofacoemulsificación en la cirugía de catarata, como una mejora en la calidad visual y de vida de los pacientes. Métodos: Se realizó un estudio prospectivo y analítico de serie de casos en 43 ojos con catarata. Se utilizaron técnicas estadísticas descriptivas como media y desviación estándar. En los resultados no comparados la prueba de chi cuadrado, con significación del 95 por ciento y un valor de p < 0,05 se consideró estadísticamente significativa. Resultados: El 67,44 por ciento de los pacientes no sintieron dolor y lo refirieron muy leve en la colocación del blefaróstato, en la incisión por córnea clara y durante la colocación del lente intraocular; el 62,79 por ciento fueron féminas, mayores de 70 años; el 51,16 por ciento tenía dureza nuclear NO3 por LOCSIII; la visión de colores mejoró en el 90,70 por ciento; la sensibilidad al contraste mejoró en el 58,14 por ciento; el cilindro refractivo en el 72,09 por ciento fue menor de 0,5 dioptrías; la agudeza visual mejor corregida en el 93,02 por ciento fue de 0,8 a 1,0; la paquimetría demostró diferencias significativas al final; la pérdida celular endotelial media fue de 274,16 cel. /mm2; la hexagonalidad media se redujo en un 3,42 por ciento y la encuesta FV-14 fue muy buena en el 100 por ciento de los pacientes al mes de operado. Conclusiones: La criofacoemulsificación es segura y efectiva, que disminuye los efectos inflamatorios de la cirugía sobre la córnea, con alto grado de satisfacción de los pacientes(AU)

ABSTRACT Objective: Demonstrate the effect of cryophacoemulsification in cataract surgery as a way to improve patient visual quality and quality of life. Methods: An analytical prospective study was conducted of a case series of 43 eyes with cataract. Statistical analysis was based on mean and standard deviation descriptive techniques. In results not compared, a chi-square test with 95 percent significance and p < 0.05 was considered to be statistically significant. Results: Of the patients studied, 67.44 percent did not feel any pain and reported very mild pain during blepharostat placement, clear corneal incision and intraocular lens placement; 62.79 percent were females aged over 70 years; 51.16 percent had NO3 nuclear hardness by LOCSIII; color vision improved in 90.70 percent; contrast sensitivity improved in 58.14 percent; in 72.09 percent the refractive cylinder was smaller than 0.5 diopters; in 93.02 percent best corrected visual acuity was 0.8-1.0; pachymetry showed significant differences at the end; mean endothelial cell loss was 274.16 cel/mm2; mean hexagonality was reduced 3.42 percent, and the VF-14 index was very good in 100 percent of the patients one month after surgery. Conclusions: Cryophacoemulsification is safe and effective, reduces the inflammatory effects of surgery on the cornea and achieves a high level of patient satisfaction(AU)

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

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

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