Phacoemulsificatıon in eyes wıth cataract and high myopia / Facoemulsificação em olhos com catarata e alta miopia

ABSTRACTPurpose:To evaluate the outcomes and complications following phacoemulsification surgery in eyes with cataract and high myopia.Methods:We retrospectively evaluated the data of 43 eyes of 28 consecutive patients (12 males, 16 females) with cataract and high myopia who had undergone phacoemulsification and intraocular lens (IOL) implantation. The mean [± standard deviation (range)] age of the patients was 59.20 ± 11.08 (39-77) years.Results:The frequency of nuclear cataract was significantly higher than that of other cataract types (P=0.003). The mean axial length was 28.97 ± 1.99 (26-33) mm and the mean IOL power was 5.09 ± 4.78 (-3.0 to +14.0) diopters (D). The mean preoperative spherical equivalent (SE) was -16.48 ± 5.23 (-8.00 to -25.00) D and the mean postoperative SE was -1.46 ± 0.93 (0.00 to -3.00) D (P=0.00). The mean preoperative best-corrected visual acuity (BCVA) was 0.91 ± 0.37 (0.30 to -1.50) logMAR and the mean postoperative BCVA was 0.29 ± 0.25 (0.00-1.00) logMAR (P=0.00). Twenty-two eyes (51.2%) achieved the target postoperative refraction (±1.0 D). The eyes were divided into 3 groups according to the axial length. The mean biometric error was significantly higher in the group with the greatest axial length than in the other groups (P=0.007). Preoperative argon laser photocoagulation was performed in 7 eyes (16%) on account of retinal tears, retinal holes, or lattice degeneration. Postoperatively, retinal tears developed in 2 eyes (4%) and were treated with photocoagulation. One eye (2%) developed retinal detachment postoperatively, with the patient consequently referred for retinal surgery. Postoperatively, posterior capsule opacities developed in 11 eyes (25%), with all cases treated by laser capsulotomy.Conclusions:Good postoperative outcomes following phacoemulsification surgery were observed in patients with cataract and high myopia. However, clinicians should be aware of the risk of postoperative retinal tears and rhegmatogenous retinal detachment. Preoperative prophylactic argon laser photocoagulation treatment should be considered where necessary.

RESUMOObjetivo:Avaliação dos resultados e complicações associadas à cirurgia de facoemulsificação em olhos com catarata e miopia alta.Método:Quarenta e três olhos de 28 pacientes (12 homens, 16 mulheres) consecutivos com catarata e alta miopia, que haviam sido submetidos a facoemulsificação e implante de lentes intraoculares (LIO), foram avaliados retrospectivamente. A idade foi de 59,20 ± 11,08, (39-77) anos [média ± desvio padrão, (variação)].Resultados:A frequência de catarata nuclear foi significativamente maior do que os outros tipos (p=0,003). O comprimento axial foi 28,97 ± 1,99, (26-33) mm e o poder da LIO foi 5,09 ± 4,78, (-3,0 a 14,0) dioptrias (D). O equivalente esférico pré-operatório (SE) foi de -16,48 ± 5,23, (-25,00 a -8,00) D e o SE pós-operatório foi -1,46 ± 0,93, (0,00 a -3,00) D, (P=0,00). A melhor acuidade visual corrigida pré-operatória (BCVA) foi de 0,91 ± 0,37, (0,30 -1,50) logMAR e a BCVA pós-operatória foi de 0,29 ± 0,25, (0,00-1,00) logMAR, (P=0,00). Vinte e dois olhos (51,2%) estavam dentro de refração alvo pós-operatória (± 1,0 D). Os olhos foram divididos em três grupos, de acordo com o comprimento axial. O erro biométrico foi significativamente maior no terceiro grupo, em comparação com os outros grupos (p=0,007). Fotocoagulação pré-operatória por laser de argônio foi realizada em 7 olhos (16%) devido a roturas retinianas, buracos de retina ou degeneração látice. No pós-operatório, as roturas da retina ocorreram em dois olhos (4%); tratados com fotocoagulação. Um olho (2%) desenvolveu descolamento de retina no pós-operatório e foi encaminhado para cirurgia de retina. No pós-operatório, opacidades da cápsula posterior ocorreram em 11 olhos (25%) e estes foram tratados com capsulotomia a laser.Conclusões:A cirurgia de facoemulsificação permite bons resultados em pacientes com catarata e miopia alta. No entanto, devemos estar atentos para a possibilidade de roturas da retina pós-operatórias e para o descolamento de retina regmatogênico. Se necessário, devemos usar o tratamento profilático de fotocoagulação a laser antes da cirurgia.

Desprendimiento de retina / Retinal detachment

El desprendimiento de retina (DR) consiste en la separación entre la retina neurosensorial y el epitelio pigmentario subyacente. Su forma más frecuente es el DR regmatógeno, causado por una rotura en la retina. Se manifiesta generalmente como un defecto en el campo visual o mala visión. Si se pesquisa y trata oportunamente tiene buenas posibilidades de éxito. No obstante, sigue siendo una causa importante de mala visión y ceguera, por lo que su prevención tiene un rol fundamental

Retinal detachment is a separation of the neurosensory retina from the retinal pigment epithelium. The most common form is rhegmatogenous retinal detachment, which occurs as the result of a full-thickness retinal break. Usually it is presented as a visual field defect or decreased visual acuity. With prompt diagnosis and treatment, it has a high success rate. However, retinal detachment continues to be an important cause of reduced visual acuity and blindness, therefore, its prevention is a worthy goal

Técnica para injeção intravítrea de drogas no tratamento de doenças vítreorretinianas / Technique of intravitreal drug injection for therapy of vitreoretinal diseases

A injeção intravítrea é atualmente a técnica mais utilizada no tratamento de várias doenças vítreorretinianas. Neste artigo serão discutidas a técnica e complicações da injeção intravítrea de drogas no tratamento de doenças vítreorretinianas. Em resumo, a técnica envolve várias etapas. Inicialmente dias antes da injeção pode-se realizar aplicação de antibióticos e acetazolamida para prevenção de infecção e redução da pressão intra-ocular. Antes do procedimento deve-se dilatar a pupila e executar anestesia tópica com colírios ou gel anestésico. A antissepsia pré-operatória envolve aplicação de colírios de iodo-povidona 5 por cento no fundo de saco conjuntival ao menos 10 minutos antes do procedimento. A injeção deve ser realizada no centro cirúrgico com uso de luvas estéreis e máscara pelo cirurgião. O olho deve ser exposto com blefarostato estéril, e proteção com "sterile-drape" para evitar contato entre a agulha e pálpebras/cílios. A agulha deve ser posicionada no momento da injeção a 3,5 - 4 mm do limbo, e leve mobilização da conjuntiva com um cotonete estéril ou uma pinça facilitam a penetração da agulha através da conjuntiva e esclera. A agulha deve ser inserida gentilmente para dentro da cavidade vítrea até 6 mm de profundidade. Imediatamente após a injeção o paciente deve ser examinado por técnica de oftalmoscopia binocular indireta. Caso a acuidade visual seja ausência de percepção luminosa ou oclusão vascular arterial retiniana seja observada, terapias para diminuição da pressão como paracentese na camada anterior ou massagem por oculopressão diretamente sobre o globo ocular devem ser imediatamente tomadas. A alta ambulatorial deve ser realizada quando o cirurgião estiver ciente da ausência de complicações intra-operatórias; o paciente deverá sair do centro cirúrgico com curativo oclusivo. O paciente deve ser submetido a exame oftalmológico completo no primeiro dia pós-operatório quando associação de antibióticos com corticosteróides...

Intravitreal injections are the standard technique applied in the treatment of some vitreoretinal diseases. In this paper the technique and complications of intravitreal injections are presented. In summary, the procedure involves various consecutive steps. Initially, days before the treatment topical antibiotics and acetazolamide may be prescribed for reduction of the ocular flora and intraocular pressure. Before the injection, the pupil should be dilated and topical anesthesia should be achieved. Injection shall be performed in the operating room under sterile conditions, the surgeon should wear surgical gloves and mask. The eye is then exposed with sterile blepharostat and sterile-drape thereby providing protection of the needle against the contact with contaminated lashes and lids. Injection is done 3.5 mm from the limbus through the pars plana. The needle should be inserted up to 6 mm into the vitreous cavity. Immediately after injection the patient must be examined by indirect ophthalmoscopy to verify central artery perfusion and complications as vitreous hemorrhage. Visual acuity better than light perception should be detected right after injection. If persistent central retinal artery occlusion is diagnosed, anterior chamber paracentesis should be performed. The patient may be discharged with an occlusive patch. Examination at the first postoperative day should exclude various complications such as endophthalmitis, and topical steroid and antibiotics should be prescribed for 7 days. Some complications encountered after intravitreal injections include retinal detachment, vitreous hemorrhage, cataract, uveitis, ocular hypertension, or endophthalmitis.

Luxación de cristalino como presentación del síndrome del niño maltratado / Lens dislocation as a presentation of child abuse syndrome

El síndrome del niño maltratado o de Kempe es uno de los problemas más serios encontrados en el servicio de urgencias en pediatría, y las manifestaciones oculares son encontradas en la mayoría de los niños que sufren abuso físico.Se trata de un niño de 13 semanas de edad quien presenta trauma facial que le provoca luxación del cristalino, glaucoma y aumento de volumen del globo ocular derecho, presenta además fractura de fémur derecho antigua con encefalomalacia asociada, siendo manejado para evitar el desprendimiento de retina con vitrectomía pars plana y lensectomía.La luxación del cristalino debe ser considerada en el diagnóstico del síndrome de Kempe. Enfatizamos la necesidad de hacer un examen oftalmológico completo en cada caso donde se sospeche maltrato infantil.

Peripheral retinal changes: a survey of high school boys from Hail, Saudi Arabi

Purpose: A clinical study was carried out to document the prevalence of developmental degenerative changes in the peripheral retina which are sometimes precursors of retinal detachment. We examined the eyes of 330 normal, asymptomatic High School boys of Saudi Arabian origin at three schools in hail, Saudi Arabia. Peripheral cystoid degeneration was a very common finding. Lattice degeneration was found in 30[9.1%] subjects, 13 of whom had bilateral lattice degeneration. In seven eyes lattice degeneration was associated with atrophic holes. Retinal breaks were found in 21[6.4%] subjects; the majority [78.3%] were atrophic holes with 38.9% found within areas of lattice degeneration. Other retinal changes discovered were: white without pressure, retinal tufts, paving stone degeneration, meridional folds, and meridional complexes. Knowledge of these peripheral retinal changes is important in understanding the mechanism, management and, more importantly, the prevention of rhegmatogenous retinal detachment. Prophylactic treatment of the asymptomatic precursor tesions of retinal detachment is rarely indicated in the absence of high risk factors such as myopia, aphakia, retinal detachment in the other eye, or a family history of retinal detachment

Síndrome de necrosis retiniana aguda: reporte de un caso / Acute retinal necrosis syndrome: A case report

Se revisa la literatura y se presenta el caso de un paciente con diagnóstico clínico de síndrome de necrosis retiniana aguda, quien presentó un cuadro severo y fulminante caracterizado por una retinitis difusa acompañada de fenómenos vasculares oclusivos importantes y áreas de necrosis retiniana.

Changes in adhesive force between the retina and the retinal pigment epithelium by laser photocoagulation in rabbits

A closed eyeball model was designed to estimate the chorioretinal adhesion of the laser-photocoagulated region. We used it to measure the duration of development of retinal detachment during vitrectomy before and after killing the test rabbits. During testing, negative pressure was applied into the vitreous cavity of the pigmented rabbits. Laser burns were produced in the posterior retina by exposure to an argon blue-green laser beam with a focus diameter of 200 microns of 0.1 to 0.2 second duration and 150 to 250 mW intensity. One hour and one, two, five, seven and fourteen days following laser photocoagulation, vitrectomy was done with a cutting rate of 500 per minute, aspiration pressure of 50 mmHg and infusion pressure of 55.2 mmHg. After core vitrectomy, the rabbit was killed with an intravenous bolus of 100 mg sodium pentobarbital solution. After killing the rabbit, the vitreous cavity was continuously aspirated under the pressure of 25 mmHg while the infusion was stopped. The changes of the fundus, especially development of retinal detachment, were observed in the laser-treated and untreated regions before and after killing the rabbit. When retinal detachment was noted anywhere before killing the rabbit, this postmortem change was not observed. One hour following laser photocoagulation, the laser-treated retina was detached during core vitrectomy before killing the rabbit, and the untreated area was not detached. One day following photocoagulation, the retina was intact before killing the rabbit. After killing the rabbit, the laser-treated retina was detached in four minutes and the untreated retina in 18 minutes postmortem.

Oblique muscle myotomy, a prophylactic measure against retinal detachement

Oblique muscle myotomy was done in 7 cases of high myopic patients with history of retinal detachement in the other eye as a prophylactic measure and follow up for 3 years proved it safe and efficient. Discussion of relation of oblique muscle to retinal tears and other methods of prophylaxis is reported