Application of polishing anterior capsule and equator in phacoemulsification and intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the application value of polishing anterior capsule and equator in the phacoemulsification and intraocular lens implantation. <p>METHODS: Totally 112 cases of cataract patients in our hospital from May 2012 to January 2015 were selected as research objects. They were divided into unpolished and polished group according to whether the anterior capsule and equatorial part polished or not with the informed consents, 56 cases in each group. The patients were followed up for 18mo after phacoemulsification and intraocular lens implantation. The clinical efficacy of the two groups was compared.<p>RESULTS: The complication rates of the two groups were 7.1% and 16.1%, that of the polished group was lower and the difference was statistically significant(<i>P</i><0.05). The lens position(effective lens position, ELP), refractive state, uncorrected visual acuity compared with unpolished group were statistically significant(<i>P</i><0.05). <p>CONCLUSION: Polishing anterior capsule and equator can significantly improve the effect of phacoemulsification combined with intraocular lens implantation in the treatment of cataract.

Discovering the healthcare beliefs and practices of rural mestizo Ecuadorians. An ethnonursing study / Creencias y prácticas del cuidado de salud de mestizos que habitan en zona rural de Ecuador: Un estudio de etnoenfermería / Crenças e práticas do cuidado de saúde de mestiços que habitam em zona rural do Equador: Um estudo de etno-enfermagem

Objetivo. Describir y entender las creencias y prácticas del cuidado de salud de mestizos que habitan en zona rural de Ecuador. Metodología. Se desarrolló un estudio con el método de etnoenfermería de Leininger. Fueron entrevistados 28 informantes en Tosagua, Ecuador. Resultados. El análisis de los datos reveló cuatro temas: (a) la espiritualidad y la oración son necesarias para la salud y el bienestar, (b) Compartir la vida con la gente afecta positivamente la salud y el bienestar, (c) La incorporación de la medicina tradicional y la moderna es esencial para la salud (d) el contexto ambiental está más allá del control de las personas y afecta en gran medida la salud y el bienestar. Conclusión. Los resultados son consistentes con la cultura de los ecuatorianos mestizos que habitan zonas rurales y que viven en comunidad. Las enfermeras y otros trabajadores de la salud deben proveer un cuidado que sea aceptable, culturalmente congruente y que promueva la salud en el Ecuador rural.

Objetive. To discover and understand the healthcare beliefs and practices of mestizo Ecuadorians within rural Ecuador. Methodology. An ethnonursing method developed by Leininger was used to guide this study and four phases of qualitative data analysis. 28 informants were interviewed in Tosagua, Ecuador. Results. Data analysis revealed four themes (a) Spirituality and prayer necessary for health and well-being, (b) Sharing life with people positively affects health and well-being, (c) Incorporation of both traditional and modern medicine is essential to health (d) Environmental context beyond the control of the people greatly affect health and well-being. Conclusion. The findings are consistent with the cultural life ways of rural mestizo Ecuadorians who live in community with one another. These results can be used to enable nurses and other healthcare workers to provide care that is acceptable, culturally congruent and promotes health in rural Ecuador.

Objetivo. Descrever e entender as crenças e práticas do cuidado de saúde de mestiços que habitam em zona rural do Equador. Metodologia. Desenvolveu-se um estudo com o método de etno-enfermagem de Leininger. Foram entrevistados 28 informantes em Tosagua, Equador. Resultados. A análise dos dados revelou quatro temas (a) a espiritualidade e a oração são necessárias para a saúde e o bem-estar, (b) Compartilhar a vida com as pessoas afeta positivamente à saúde e ao bem-estar, (c) A incorporação da medicina tradicional e a moderna é essencial para a saúde (d) o contexto ambiental está além do controle das pessoas e afeta em grande parte à saúde e ao bem-estar. Conclusão. Os resultados são consistentes com a cultura dos equatorianos mestiços que habitam zonas rurais e que vivem em comunidade. As enfermeiras e outros trabalhadores da saúde devem prover um cuidado que seja aceitável, culturalmente congruente e que promova a saúde no Equador rural.

Comparison of Functional Equator-Considering and Parks Methods in Bilateral Medial Rectus Recession for Esotropia

PURPOSE: To compare the surgical outcomes of functional equator-considering and Parks' methods in infantile esotropia and partially accommodative esotropia. METHODS: The medical records of 96 patients with infantile esotropia and partially accommodative esotropia who underwent bilateral medial rectus muscle recession by functional equator-considering and Parks' methods were reviewed retrospectively. The surgery success rate at 1 month, 3 months, 6 months and 12 months was compared by the deviation angle measurement. RESULTS: Overall success rates were not statistically different between the 2 groups. Additionally, there were no differences in surgical success rate of functional equator-considering and Parks' methods in infantile esotropia and partially accommodative esotropia. When the patients were divided into 2 groups based on 40 PD, no significant difference in success rate between the 2 groups was observed. When patients were divided into 2 groups based on 22 mm of axial length, there was no statistical difference observed. Postoperative overcorrection was 2 (4%) in the functional equator group and 3 (6.5%) in Parks' method group and postoperative undercorrection was 9 (18%, 19.6%) in each group. The incidence of undercorrection in the Parks' method group was significantly higher in the greater than 22 mm axial length group (7, 35.0%) than in the less than 22 mm group (2, 7.7%) (p = 0.029). CONCLUSIONS: There was no statistically significant difference in surgical success rate between the functional equator and Parks' methods in infantile esotropia and partially accommodative esotropia.

Bilateral Medial Rectus Recession Posterior to the Functional Equator in Esotropia Over 40 Prism Diopters

PURPOSE: To investigate bilateral medial rectus recession by considering functional equator as a surgical guideline in esotropia over 40 prism diopters (PD). METHODS: Forty-one patients who underwent bilateral medial rectus recession, and were followed-up for more than 12 months, were reviewed. The success rate was compared between group 1 and group 2, which were divided to recession site from the functional equator posterior, and also between the hyperopia group and myopia group according to refraction. RESULTS: According to preoperative deviation angle, 21 patients underwent recession to less than 10 mm posterior to the functional equator (group 1) and 20 patients had recession to 1.5 mm to 2.0 mm posterior to the functional equator (group 2). No significant difference in success rate between group 1 (71.4%) and group 2 (75.0%) was detected at the last follow-up. When divided into a hyperopia group (26 patients) and myopia group (15 patients), the success rate in the myopia group was higher than in the hyperopia group, as observed at the last follow-up, but the difference was not significant. There was 1 case of overcorrection in each group. CONCLUSIONS: A successful outcome was achieved in 30 patients (73.2%), and overcorrection in 2 patients (4.9%) when recessed to 2.0 mm posterior to functional posterior in esotropia over 40PD.

Surgical Outcome of Esotropia Considering the Functional Equator

PURPOSE: To predict the surgical outcome of esotropia by considering the axial length of the functional equator in addition to the preoperative deviation angle. METHODS: Forty patients with partially accommodative esotropia or infantile esotropia who had received bilateral medial rectus muscle recession were studied for axial length of the functional equator in addition to the preoperative near deviation angle. Patients were followed for more than 12 months. All patients were checked for near and far deviation angles at postoperative 1 week, 1 month, 6 months and 12 months. RESULTS Seventeen of the 40 patients had partially accommodative esotropia and 23 had infantile esotropia. The overall mean age was 4.1 years and the mean follow-up period was 14.1 months (12-18 months). Preoperative near and far deviation angles were respectively 30.6+/-8.1PD and 25.6+/-12.2PD in partially accommodative esotropia patients and 44.9+/-11.7PD and 43.1+/-13.5PD in infantile esotropia patients. The amount of mean medial rectus muscle recession was 5.15+/-0.87 mm in the former group and 6.26+/-1.12 mm in the latter. At the postoperative 12-month follow-up, 20 (86.9%) partially accommodative esotropia patients showed successful outcomes and 3 (13.1%) had under correction; the outcome was successful in 15 (88.2%) infantile esotropia patients while 2 (11.8%) showed under correction. CONCLUSIONS: A successful outcome was achieved in patients with partially accommodative esotropia and infantile esotropia with consideration of the functional equator.

Surgical Outcome of Esotropia Considering the Functional Equator

PURPOSE: To predict the surgical outcome of esotropia by considering the axial length of the functional equator in addition to the preoperative deviation angle. METHODS: Forty patients with partially accommodative esotropia or infantile esotropia who had received bilateral medial rectus muscle recession were studied for axial length of the functional equator in addition to the preoperative near deviation angle. Patients were followed for more than 12 months. All patients were checked for near and far deviation angles at postoperative 1 week, 1 month, 6 months and 12 months. RESULTS Seventeen of the 40 patients had partially accommodative esotropia and 23 had infantile esotropia. The overall mean age was 4.1 years and the mean follow-up period was 14.1 months (12-18 months). Preoperative near and far deviation angles were respectively 30.6+/-8.1PD and 25.6+/-12.2PD in partially accommodative esotropia patients and 44.9+/-11.7PD and 43.1+/-13.5PD in infantile esotropia patients. The amount of mean medial rectus muscle recession was 5.15+/-0.87 mm in the former group and 6.26+/-1.12 mm in the latter. At the postoperative 12-month follow-up, 20 (86.9%) partially accommodative esotropia patients showed successful outcomes and 3 (13.1%) had under correction; the outcome was successful in 15 (88.2%) infantile esotropia patients while 2 (11.8%) showed under correction. CONCLUSIONS: A successful outcome was achieved in patients with partially accommodative esotropia and infantile esotropia with consideration of the functional equator.

The Study of Axial Length and Functional Equator in Strabismus Surgery

PURPOSE: We are to know the distribution of the axial lengths and functional equators in strabismus patients and to establish surgical formula considering axial lengths in addition to the preoperative deviation angle. METHODS: Included were 100 eyes of 50 strabismus children under 12 years old who do not have other organic disorders and received strabismus surgery under general anesthesia. We measured axial lengths and calculated functional equators. RESULTS: Mean value of axial length was 22.01 +/- 0.97 mm. The distances from limbus to the functional equators of medial and lateral rectus muscles were 11.35 +/- 0.67 mm and 18.48 +/- 0.94 mm each and direct distance for that were 10.86 +/- 0.62 mm and 16.40 +/- 0.79 mm. CONCLUSIONS: By the conventional amount of both medial rectus muscle recession in esotropia patient, the recession for the preoperative deviation angle of 40 prism diopter locates medial rectus muscle at the functional equator. So taking both axial length and preoperative deviation angle into account, we proposed new surgical formula for esotropia as follows. For the preoperative deviation angle of 40 prism diopter, we are to recess both medial rectus muscles to the functional equator calculated by axial length and for the preoperative deviation angle smaller or larger than 40 prism diopter, recess to the site anterior or posterior to the functional equator proportionally.

Anatomical Barrier for Anterior and Posterior Capsular Tear Extension

We examined the anatomical barrier for both anterior capsular tear extension and posterior capsular rupture extension which are the most serious intraoperative complications during cataract surgery, using 28 human eyes obtained postmortem. An experimental radial tear, about 1.0 mm in size, was created on the 5.0 mm capsulorhexis margin in the 1st group(7 eyes). Lens nucleus was removed mechanically with hydrodissection and viscoexpression technique. Radial tear extension did not extend over the lens equator in six eyes, and in one eye stopped in front of Wieger's ligament. In the 2nd group(7 eyes), after making zonular rupture around 90 degrees, same procedures were performed. Radial tear extension stopped at the equator in four eyes, and in three eyes stopped in front of Wiegel's ligament. In the 3rd group(7 eyes), we performed capsulorhexis and routine phacoemulsification for lens nucleus and cortex removal. Then we created only a posterior capsule rupture with intact anterior hyaloid membrane and vitreous pressure was increased. Posterior capsular rupture extension stopped in front of Wieger's ligament in all seven eyes. In the 4th group(7 eyes), after creating the rupture of the posterior capsule including anterior hyaloid membrane, intraocular lens was inserted into the empty capsular bag as a perpendicular direction to the axis of the tear. Posterior capsular rupture extension passed Wieger's ligament in only one eye, but did not reach equator or anterior capsule. In this study, we found that zonules, equator portion of the capsular bag and Wieger's ligament act as anatomical barriers for anterior capsular teal extension as well as for posterior capsular rupture extension.