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.

Analise dos dados biométricos gerados por interferometria comparada com Scheimpflug / Analysis of biometric data generated by interferometry compared with Scheimpflug

Resumo Objetivo: Observar o grau de concordância das variáveis analisadas entre os dispositivos IOL Master 500 e Pentacam AXL e descrever as medias Métodos: Foram analisados 35 prontuários, totalizando 61 olhos. Todos os pacientes se submeteram à avaliação biométrica nos dois dispositivos, no período de agosto de 2018 a agosto de 2019. Os dados coletados foram: idade, sexo, profundidade da câmara anterior, comprimento axial, K1, K2, poder dióptrico da LIO e alvo refracional. Resultados: As médias das variáveis analisadas entre os dispositivos de biométricos óptica em questão tiveram diferença estatisticamente significante (p<0,05). A regressão linear não apontou influência de nenhuma das variáveis da câmara anterior na diferença de valores do poder dióptrico da LIO e do alvo refracional entre os dispositivos. Conclusão: Não houve concordância estatística entre os dispositivos para as variáveis analisadas. Portanto, deve se evitar intercambiar o uso do Pentacam AXL com o IOL Master 500.

Abstract Objective: Observe the agreement between IOL Master 500 and Pentacam AXL and describe the averages. Methods: We analyzed 35 medical records, totaling 61 eyes. All patients underwent biometric evaluation on both devices from August 2018 to August 2019. The data collected were: age, gender, anterior chamber depth, axial length, K1, K2, biometrics and IOL target. Results: The averages of the variables analyzed between the optical biometric devices in question had a statistically significant difference (p <0.05). Linear regression showed no influence of any anterior chamber variables on the difference in biometrics and target values between the devices. Conclusion: There was no statistical agreement between the devices for the analyzed variables. Therefore, the interchange of Pentacam AXL with IOL Master 500 should be avoided.

Mensurações do bulbo ocular e cálculo do poder dióptrico da lente intraocular em miniporcos / Ocular bulb measurements and diopter power calculation of the lens in minipigs

Objetivou-se com este trabalho determinar o poder dióptrico da lente intraocular (LIO) em miniporco e as dimensões do bulbo do olho. Foram utilizados 17 miniporcos, sadios, adultos, machos e fêmeas, com peso médio de 70kg. Em todos os olhos foram realizadas a ultrassonografia modo A, a ceratometria e a medida da distância limbo a limbo. O cálculo do poder dióptrico da LIO foi obtido utilizando-se as fórmulas Haigis, Hoffer Q, SRK/T, Holladay I e Holladay II e o software Holladay IOL Consultant(r). Na comparação entre o sexo e a lateralidade do olho, não houve diferença nas variáveis biométricas e poder da LIO. A aplicação das fórmulas (Haigis, Holladay II, Holladay I, SRK/T e Hoffer Q) possibilitou o cálculo do poder da LIO. A Holladay II, fórmula que melhor individualiza o bulbo do olho do miniporco, estima valor dióptrico ao redor de 41 D. Os miniporcos têm potencial como modelo experimental em oftalmologia, relacionado ao seu menor porte e à facilidade no manejo, especialmente em experimentos de longa duração.

The aim of this study was to determine the refractive power of intraocular lens (IOL) of mini pigs and the dimensions of the eyeball. A total of 17 (34 eyes) healthy, adult, males and female animals, with average weight of 70kg were used. For every eye, A-mode ultrasound, keratometry and the measurement of limbo-to-limbo distance were conducted, all variables for calculating the refractive power of the IOL. The value was obtained using different formulas and Holladay IOL Consultant(r) Software. Additionally, the ocular measurements were compared per sex, laterality of the eye and the different formulas used in this study (Haigis, Hoffer Q, SRK / T, Holladay I and Holladay II). In the comparison between sex and laterality of the eye, there was no difference in biometric variables and power of the IOL. The application of the employed formulas (Haigis, Holladay II, Holladay I, SRK / T and Hoffer Q) allowed the IOL power calculation for this specie, and the observed value ranged between 39.58±2.15 and 46.60±2.81 diopters. Mini pigs play an important and growing role as an experimental model for study and practice of ophthalmic procedures, specially related to their smaller size and easy management in long-term experiments.

Resultados refractivos y selección del poder del lente intraocular en cirugía de catarata por facoemulsificación / Refractive outcomes and intraocular lens power selection in cataract surgery with phacoemulsification

Introducción: La catarata es una de las principales causas de ceguera reversible a nivel mundial. La cirugía de catarata con implante de lente intraocular (LIO) además de ser la cirugía oftalmológica más frecuentemente realizada a nivel mundial, le permite a la mayoría de los pacientes recuperar su visión. Para obtener un óptimo resultado refractivo y la mejor visión posible en el paciente, es fundamental realizar una adecuada selección del lente, basada en un examen confiable de biometría. Objetivo: Describir el resultado refractivo postoperatorio de los pacientes operados de cirugía de catarata por facoemulsificación en el Hospital de San José. Además, determinar la precisión de la biometría. Estos resultados se evaluaron de acuerdo a la longitud axial. Diseño: Estudio descriptivo, de corte transversal. Métodos: Se revisaron y analizaron las historias clínicas de los pacientes operados de cirugía de catarata por facoemulsificación con implante de LIO entre julio de 2011 y junio de 2013. Para las variables cuantitativas se utilizaron medidas de tendencia central y de dispersión y para las variables cualitativas, se utilizaron frecuencias absolutas y relativas. La precisión de la biometría se calculó con base en la diferencia entre el target de la biometría escogido por el cirujano y el resultado refractivo postoperatorio dado en equivalente esférico. Resultados: Se analizaron 612 ojos. Se obtuvo un resultado refractivo en el rango de ±1.00D en el 77% (471) de los ojos y en el rango de ±0.50D en el 50.7% (310) de los ojos. La precisión de la biometría fue del 81% (495) para el rango ±1.00D y del 58% (355) para el rango ±0.50 D. Conclusiones: La precisión de la biometría fue satisfactoria y al igual que el resultado refractivo, también favorable y es comparable con otros estudios publicados en la literatura. Consideramos que los resultados refractivos hubieran podido ser aún mejores si el cirujano hubiera escogido el target sugerido por la biometría.

Introduction: Cataract is one of the main causes of reversible blindness worldwide. Cataract surgery is the most frequent ophthalmological surgery performed in the world and allows the majority of patients to recover their vision. To obtain an optimal refractive result and the best possible visual acuity, it is essential to adequately select IOL, based on a reliable biometric test. Objective: To describe the postoperatory refractive results of patients operated with phacoemulsification at Hospital San José. Additionally, to determine the accuracy of biometry based on the difference between the biometric target (objective refraction) chosen by the surgeon and the postoperatory refractive result. Design: Descriptive study Methods: The medical records of patients who underwent cataract surgery by phacoemulsification technique with IOL implant between July 2011 and June 2013 were reviewed and analyzed. For quantitative variable, central and dispersion tendencies were measured, and for qualitative variables, absolute and relative frequencies were used. The biometry precision was obtained from the difference between the target and postoperative refractive result. Results: 612 eyes were analyzed. 77% of eyes obtained a postoperatory refractive result between ±1.00 D and 50.7% (310) were in the optimal refractive result group, between±0.50D. Conclusions: The biometry accuracy was satisfactory and as the postoperative refractive result, also favorable, is similar to other studies published, as well as postoperative refractive result. We consider that the refractive results could have been better if the surgeon would have chosen the target suggested by biometry.

Avaliação ultrassonográfica do bulbo ocular em cães submetidos à facoemulsificação com ou sem implante de lente intraocular / Ocular bulb ultrasonographic evaluation in dogs submitted to facectomy by facoemulsification with or without intraocular lens implants

Este trabalho objetivou descrever e comparar as alterações ultrassonográficas encontradas em bulbos oculares de cães submetidos à facoemulsificação, com ou sem implante de lente intraocular (LIO), no intuito de auxiliar no diagnóstico de alterações decorrentes da cirurgia e do implante da LIO, bem como sua correspondência com alterações clínicas. Dezenove cães portadores de catarata (21 olhos) foram submetidos ao procedimento de facoemulsificação e avaliados no pós-operatório tardio, aos cinco anos de evolução. Constituíram-se três grupos experimentais: afácicos (CA), formados por 11 cães; pseudofácicos (PP), com implante de duas LIOs em piggyback (n=5); e pseudofácicos (PL), com implante de uma LIO veterinária (n=5). Após exame oftálmico, todos foram submetidos ao exame ultrassonográfico, sob anestesia tópica, com transdutor linear multifrequencial de 10MHz; adicionalmente foram avaliadas medidas biométricas dos bulbos do olho. As principais alterações observadas foram: luxação da LIO, descolamento de retina, hialose asteroide e degeneração vítrea. O exame ultrassonográfico mostrou-se como excelente ferramenta diagnóstica e possibilitou a confirmação e a classificação dessas alterações. Na biometria ocular, pelas medidas entre o corpo ciliar e a câmara vítrea, o implante em piggyback resultou em redução destas em relação aos demais procedimentos instituídos, não havendo diferença ente o comprimento axial e a câmara anterior.

This study aimed to describe and compare the ultrasonographic alterations in dogs' eyes submitted to facectomy with or without intraocular lens implant (IOL), to assist in the diagnosis of possible alterations related to the surgical procedure and IOL implantation. Nineteen dogs with cataract (21 eyes) were submitted to phacoemulsification and late postoperative evaluation (at five years). The animals were initially submitted to complete ophthalmological exams which preceded the sonogram. Dogs were divided in three groups: (CA) aphakic dogs (n= 11); (PP) pseudophakic dogs with implantation of two IOLs in piggyback (n=5) and (PL) pseudophakic dogs with implantation of a veterinary IOL (n = 5). The ultrasound was carried under the administration of a topic local anesthetic, with a multi frequency linear transducer of 10 MHz. Biometric eye measurements were also performed. The clinical alterations observed were IOL dislocation, retinal detachment, asteroid hyalosis, and vitreous degeneration. Ultrasound examination was an excellent diagnostic tool, as it was possible to confirm and classify these changes. The piggyback implant reduced the measurements between the ciliary body and the vitreous chamber obtained from the ocular biometry when compared to other usual procedures, with no difference between the axial length and the anterior chamber.

Resultados visuales con nuevo lente trifocal AT LISA® tri 839MP: serie de casos / Visual outcomes with new lens trifocal AT LISA® tri 839MP: case series

Objetivo: Evaluar los resultados visuales del implante de lente trifocal AT LISA® tri 839MP en pacientes con cataratas o presbicia. Métodos: reporte de serie de casos de 14 pacientes (24 ojos) en los que se realizó facoemulsificacion del cristalino e implante del lente trifocal AT LISA® tri 839MP. Resultado: en un periodo promedio de 6,3 meses se evaluó la visión la cercana y lejana con promedios de visión logMar sin corrección de 0,004 y 0,008 respectivamente y para la visión intermedia el promedio logMar fue 0,02; con 100% de los pacientes con independencia de gafas Los fenómenos visuales como halos estuvieron presentes en 8,4% de los ojos. Conclusiones: el lente evaluado produce excelentes resultados visuales en función visual lejos, intermedia y cerca con gran satisfacción del paciente.

Objective: to evaluate visual results in trifocal lens implant AT LISA tri 839MP® in patients with cataracts and presbyopia. Methods: this case series report comprised 14 patients (24 eyes) who had lens phacoemulsification and implantation of AT LISA tri 839MP® trifocal lens. Results: during an average period of 6.3 months, mean values of 0,004 and 0,008 logMar were obtained respectively for uncorrected near and distance vision and the average intermediate vision was assessed with logMAR scale at 0,02 ;100% of patients have independence of spectacles. Visual phenomena as halos were presented in 8.4 % of eyes. Conclusions: the evaluated lens produces excellent visual results in far, intermediate and near visual acuity, with great patient satisfaction.

Afecciones traumáticas del cristalino y de la lente intraocular / Traumatic lesions of the crystalline lens and of the intraocular lens

Los traumatismos oculares pueden provocar opacidad secundaria del cristalino, así como la pérdida de su posición anatómica o la de la lente intraocular. Estas son afecciones frecuentes con devastadoras consecuencias si no son atendidas correctamente. Con el desarrollo de las nuevas técnicas quirúrgicas, los resultados anatómicos y visuales de estos pacientes operados son cada día más sorprendentes; pero es mandatorio examinar exhaustivamente al paciente, el abordaje en el momento idóneo y la elección de la técnica quirúrgica adecuada.

Ocular injuries can develop secondary opacity of the crystalline lens as well as the loss of its anatomical position or intraocular lens dislocation. These disorders can frequently lead to devastating consequences if not properly assisted. Recent surgical techniques have dramatically changed the visual prognosis of these patients, achieving amazing anatomical and functional success. However, thorough examination of the patient and the selection of the right surgical time and surgery technique are the keys to attaining good final visual results.

Efectividad de los lentes fáquicos Artisan en la corrección de la alta miopía / Effectiveness of Artisan phakic lenses in the correction of high myopia

OBJETIVO: Determinar la efectividad de los lentes intraoculares fáquicos Artisan en la corrección de la alta miopía en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el período de enero del 2006 a enero del 2009. MÉTODOS: Se realizó un estudio prospectivo, descriptivo. El universo estuvo constituido por el total de ojos (120) a los cuales se les implantó estos lentes. RESULTADOS: Se encontró un componente esférico de 0,5, no astigmatismo inducido y una mejoría de la agudeza visual corregida de 0,9. No se presentaron complicaciones transoperatorias y entre las posoperatorias mediatas predominó la iritis o uveítis (3,4 por ciento) así como la atrofia iridiana (5 por ciento) entre las tardías. CONCLUSIONES: Los resultados refractivos fueron favorables. Predominaron los pacientes sin complicaciones.

OBJECTIVE: To determine the effectiveness of Artisan phakic intraocular lenses in correcting high myopia at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology in January 2006 to January 2009 period. METHODS: A prospective descriptive study was made in which the universe of study was 120 eyes implanted with this type of lenses. RESULTS: Spheral component of 0.5; the induced astigmatism was not found and the corrected visual acuity improvement was 0.9. There were no transoperative complications; the predominant postoperative mediate complications were iritis or uveitis (3.4 percent) and iridic atrophy (5 percent) prevailed in the late ones. CONCLUSIONS: The refractive results were favourable. The uncomplicated patients predominated.

Biomicroscopia ultrasónica en nuestra experiencia con lentes fáquicos Artiflex para la corrección de alta miopía / The use of ultrasound biomicroscopy in our experience with Artiflex phakic lenses to correct high myopia

OBJETIVO: Determinar la relación de la posición de los LIOs Artiflex implantados con las estructuras del segmento anterior en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período de enero del 2006 a enero del 2008. MÉTODOS: Se realizó un estudio prospectivo, descriptivo. El universo estuvo constituido por el total de ojos (20) a los cuales se les implantó estos lentes. RESULTADOS: Se obtuvo en el 100 por ciento de los casos distancias LIO-córnea y LIO-cristalino =1,5mm y =0,3mm respectivamente. CONCLUSIONES: La posición de los lentes ofreció márgenes seguros con respecto a las estructuras del segmento anterior

OBJECTIVE: To determine the association of the position of the implanted Artiflex intraocular lenses and the anterior segment structures at Ramón Pando Ferrer Cuban Institute of Ophthalmology in January 2006 _ January 2008 period. METHODS: A prospective and descriptive study was carried out in which the universe of study was 20 eyes implanted with this type of lenses. RESULTS: In all the cases, the intraocular lenses- cornea and the intraocular lenses _ crystalline distances were =1,5mm y =0,3mm respectively. CONCLUSIONS: The position of the lenses provided safe margins with respect to the anterior segment structures

Traumatismo ocular con cuerpo extraño intraocular a propósito de un caso / Eye trauma with an intraocular foreign body: case presentation

Se presenta un caso de traumatismo ocular con cuerpo extraño intraocular en una paciente de 30 años, a quien se le iba a practicar una enucleación y luego de un análisis más profundo se decidió otra conducta, la cual es expuesta en el presente trabajo. Todos los datos fueron extraídos de su Historia clínica; se muestran fotos que ayudan a la comprensión del caso presentado, así como un cuadro resumen de los medicamentos que ella usó posterior al acto quirúrgico y durante toda la evolución. Se termina con unos breves comentarios acerca de esta entidad encontrados en la literatura consultada.

We present a case of an intraocular trauma with a foreign body in a 30 years old female patient, who was prepared for enucleating and after a more profound analysis we decided another conduct, which is exposed in the present article. All the data were collected from the clinical file, photos are shown that help the comprehension of the presented a case, therefore, a resume table of the medications used in the same patient after the surgical treatment and during the whole evolution. We end commenting about this entity with reviews found in the consulted literature.