Efectividad del implante de lente fáquica ACR-128 tras un año de seguimiento / Effectiveness of an ACR-128 phakic lens implant after one year's follow-up

Introducción: La corrección de ametropías moderadas-severas mediante lentes fáquicas permite conservar la acomodación, además, de obtener una mejor calidad óptica, reversibilidad del procedimiento y la opción de corregir defectos refractivos residuales mediante cirugía corneal mínima invasiva. Objetivo: Determinar la efectividad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de su implante. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128. Se determinaron las características biométricas y refractivas por ojo, relación entre el componente esférico esperado y el observado, distribución por ojos el componente esférico esperado y el observado, relación entre cilindro queratométrico pre y posoperatorio y relación entre la agudeza visual sin corrección y la agudeza visual mejor corregida en el pre y posoperatorio. Resultados: La edad media fue 28,06 ± 6,14(25 mujeres, 11 hombres) el equivalente esférico preoperatorio OD promedio de -10,77 ± 4,23 dioptrías y OI promedio de -10,77 ± 3,72 dioptrías. El componente esférico en dioptrías esperado (-0,56 ± 0,38) y observado (-0,43 ± 0,69) sin diferencias estadísticamente significativas (p = 0,14). El cilindro queratométrico en dioptrías, pre (1,41 ± 0,74) y posoperatorio (1,24 ± 0,88) sin astigmatismo inducido (p = 0,12). El 100 por ciento tenía agudeza visual sin corrección preoperatoria ≤ 0,1 y posoperatoria ≥ 0,5. Conclusiones: Un año después del implante de lente fáquica ACR-128 en la corrección de la alta miopía el tratamiento continúa efectivo, pues reduce el componente esférico al deseado y mantenerlo, no inducir astigmatismo y mantener mejor agudeza visual(AU)

Introduction: Correction of moderate-severe ametropia with phakic lenses makes it possible to preserve accommodation and provides better optical quality, reversibility of the procedure and the option of correcting residual refractive defects by minimally invasive corneal surgery. Objective: Determine the effectiveness of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lenses. Determination was made of the biometric and refractive characteristics of each eye, the relationship between the expected and the observed spherical component, the distribution of the expected and the observed spherical component per eye, the relationship between the pre- and postoperative keratometric cylinder, and the relationship between pre- and postoperative uncorrected and best corrected visual acuity. Results: Mean age was 28.06 ± 6.14 (25 women, 11 men). Average preoperative spherical equivalent was -10.77 ± 4.23 diopters RE and -10.77 ± 3.72 diopters LE. Spherical component in diopters: expected (-0.56 ± 0.38) and observed (-0.43 ± 0.69), without statistically significant differences (p= 0.14). Keratometric cylinder in diopters: preoperative (1.41 ± 0.74) and postoperative (1.24 ± 0.88), without induced astigmatism (p = 0.12). In 100 percent visual acuity without correction was #8804; 0.1 preoperative and ≥ 0.5 postoperative. Conclusions: One year after ACR-128 phakic lens implantation for high myopia correction, the treatment remains effective, reducing the spherical component and maintaining it at the desired level, not inducing astigmatism and preserving best visual acuity(AU)

Effects of two different contact lenses on ocular physiological parameters and tear function tests / Efeitos de duas lentes de contacto diferentes nos parâmetros fisiológicos oculares e nos testes de função lacrimal

Abstract Objective: To investigate the effects of two types of contact lenses made of two different types of silicone hydrogel material on ocular physiological parameters and tear function tests. Methods: The contact lenses with the appropriate diopters were supplied to the volunteering patients. The patients were evaluated before wearing the contact lenses (visit0:V0), at the first month(visit1:V1) and at the thirth month(visit2:V2) following their wear. At all visits a detailed biomicroscopic examination was done, ocular physiological variables were collected, the tear function tests were performed and the tear meniscus area (TMA) was visualized and measured with anterior segment optical coherence tomography (AS-OCT). Results: The results of Schirmer 1 test were 12.07 ± 1.51 [9-16] mm for the right eyes (samfilcon A group) and 12.09 ± 1.5 [9-16] mm for the left eyes (senofilcon A group) at V0. (p=0.950) At V2, the mean Schirmer 1 test results were 11.92±1.34 [9-15] mm in the samfilcon A group and 12.2±1.41 [9-16] mm in the senofilcon A group (p=0.239). The mean TMA dimensions in the AS-OCT images were 338.42±47.1 [241-401] microns in the samfilcon A group and 338.42±47.1 [241-401]microns in the senofilcon A group at V0. (p>0.05). At V2, the mean TMA dimensions were 337.2±45.53 [241-402] microns in thesamfilcon A group and 340.31±48.22 [240-411] microns in the senofilcon A group (p=0.728). Conclusions: Our study has demonstrated that contact lenses containing samfilcon A and senofilcon A silicone hydrogel material do not cause meaningful ocular surface problems.

Resumo Objetivo: Investigar os efeitos de dois tipos de lentes de contacto feitas de dois tipos diferentes de material de hidrogel de silicone nos parâmetros fisiológicos oculares e testes de função lacrimal. Métodos: As lentes de contacto com as dioptrias apropriadas foram fornecidas aos pacientes voluntários. Os pacientes foram avaliados antes do uso das lentes de contacto (visita0: V0), no primeiro mês (visita1: V1) e no terceiro mês (visita2: V2), após o uso destas. Em todas as visitas, foi realizado um exame biomicroscópico detalhado, as variáveis fisiológicas oculares foram recolhidas, os testes de função lacrimal foram realizados e a área do menisco lacrimal (TMA) foi visualizada e medida com tomografia de coerência óptica do segmento anterior (AS-OCT). Resultados: Os resultados do teste de Schirmer 1 foram 12,07 ± 1,51 [9-16] mm para os olhos direitos (grupo samfilcon A) e 12,09 ± 1,5 [9-16] mm para os olhos esquerdos (grupo senofilcon A) em V0. (p = 0,950) Em V2, os resultados médios do teste de Schirmer 1 foram 11,92 ± 1,34 [9-15] mm no grupo samfilcon A e 12,2 ± 1,41 [9-16] mm no grupo senofilcon A (p = 0,239). As dimensões médias do TMA nas imagens AS-OCT foram 338,42 ± 47,1 [241-401] mícrons no grupo samfilcon A e 338,42 ± 47,1 [241-401] mícrons no grupo senofilcon A em V0. (p> 0,05).> Em V2, as dimensões médias do TMA foram 337,2 ± 45,53 [241-402] mícrons no grupo samfilcon A e 340,31 ± 48,22 [240-411] mícrons no grupo senofilcon A (p = 0,728). Conclusões: O nosso estudo demonstrou que as lentes de contacto que contêm material de hidrogel de silicone de samfilcon A e senofilcon A não causam problemas significativos na superfície ocular.

control-matched comparison of flap off and flap on laser-assisted subepithelial keratectomy [LASEK] for the treatment of myopia and myopic astigmatism

Purpose: To compare the visual and refractive outcomes of flap off and flap on, Laser Assisted Subepithelial Keratectomy [LASEK] for low to moderate myopia

Methods: A prospective non-randomized control-matched study was conducted in which 53 patients underwent LASEK for the treatment of low to moderate myopia and myopic astigmatism. Right eye of each patient had the flap removed [flap off] while in the left eye the flap was recapped [flap on]. Equal number [N = 53] of flap on was matched with flap off having preoperative manifest refraction spherical equivalent within +/- 0.75 Diopters [D]. Primary outcome variables included uncorrected visual acuity [UCVA], best spectacle-corrected visual acuity [BSCVA] and manifest refraction

Results: Preoperatively, the mean spherical equivalent [SE] was -3.59 +/- 1.46 D for flap off and -3.67 +/- 1.51 D for flap on [p = 0.779]. The mean preoperative sphere was -3.32 +/- 1.58 D for flap off group and -3.36 +/- 1.61 D for flap on group [p = 0.338] whereas, the mean preoperative cylinder was -0.55 +/- 0.70 D and -0.63 +/- 0.68 D for flap removal and flap preservation groups respectively [p = 0.576]. Postoperatively, the mean LogMAR UCVA was -0.035 +/- 0.079 for flap off and -0.043 +/- 0.085 for flap on. The percentages of eyes that had UCVA of 20/40 or better were 98.1% for flap off group and 100% for flap on group [p = 0.317]. Mean postoperative SE was 0.00 +/- 0.19 D for flap off group and -0.03 +/- 0.43 D for flap on group. In flap removal group, 100% eyes were within +/- 0.50 D of the intended correction while in flap preservation group, 92.5% and 100% eyes were within +/- 0.50 D and +/- 1.00 D of the intended correction, respectively. Mean postoperative LogMAR BSCVA was -0.013 +/- 0.044 for flap removal group and -0.016 +/- 0.049 for flap preservation group [p = 0.727]

Conclusions: The differences in the visual and refractive results between flap preservation and flap removal groups were not clinically significant. Both procedures seemed safe and effective for the treatment of myopia and myopic astigmatism

Spectacle compliance amongst rural secondary school children in Pune district, India.

Background: Refractive errors (RE) are the most common cause of avoidable visual impairment in children. But benefits of visual aids, which are means for correcting RE, depend on the compliance of visual aids by end users. Aim: To study the compliance of spectacle wear among rural school children in Pune district as part of the sarva siksha abhiyan (education for all scheme) after 6 - 12 months of providing free spectacles. Settings and Design: Cross-sectional follow-up study of rural secondary school children in western India. Materials and Methods: The students were examined by a team of optometrists who collected the demographic details, observed if the child was wearing the spectacles, and performed an ocular examination. The students were asked to give reasons for non-wear in a closed-ended questionnaire. Statistical Analysis: Chi-square test and multiple logistic regression used for data analysis. Results: Of the 2312 students who were dispensed spectacles in 2009, 1018 were re-examined in 2010. 523 students (51.4%) were female, the mean age was 12.1 years 300 (29.5%) were wearing their spectacles, 492 (68.5%) students claimed to have them at home while 211 (29.4%) reported not having them at all. Compliance of spectacle wear was positively associated to the magnitude of refractive error (P < 0.001), father's education (P = 0.016), female sex (P = 0.029) and negatively associated to the visual acuity of the better eye (P < 0.001) and area of residence (P < 0.0001). Of those that were examined and found to be myopic (N = 499), 220 (44%) wore their spectacles to examination. Factors associated with compliance to spectacle usage in the myopic population included increasing refractive error (P < 0.001), worsening visual acuity (P < 0.001), and higher academic performance (P < 0.001). The causes for not wearing spectacles were ‘lost spectacles’ 67(9.3%), ‘broken spectacles’ 125 (17.4%), ‘forgot spectacles at home’ 117 (16.3%), ‘uses spectacles sometimes’ 109 (15.2%), ‘teased about spectacles’ 142 (19.8%) and ‘do not like the spectacles’ 86 (12%). Conclusion: Spectacle compliance was poor amongst school children in rural Pune; many having significant vision loss as a result.

efficacy, predictability, and safety of Epi-Lasik for the correction of myopia

To report the refractive and visual results of epithelial laser in situ keratomileusis [Epi-LASIK] for the treatment of myopia. Retrospective non-comparative consecutive case series. Sixty nine eyes of 40 patients had Epi-LASIK for the treatment of low myopia or myopic astigmatism. All epithelial separations were performed with the Visijet/Gebauer microkeratome. Primary outcome variables included uncorrected visual acuity [UCVA], best spectacle-corrected visual acuity [BSCVA], manifest refraction, epithelization time, pain, haze and complications. Preoperatively, the mean spherical equivalent [SE] was -3.9 diopters [D] +/- 1.6 D [range -.75 to -7.00 D] and the mean LogMAR BSCVA was 0.0131 +/- 0.04l [range -0.10 to 0.12]. On the final visit, the mean SE was -0.27+0.53D [range -2.50 to 0.50D], the mean logMAR UCVA was -0.079 +/- 0.13 [range -0.48 to 0.12] and the mean LogMAR BSCVA was 0.0039 +/- 0.053 [range -0.18 to 0.1]. 95.1% of eyes achieved a vision of 20/40 or better, and 70.5% achieved a vision of 20/25 or better. 73.8% and 95.1% of eyes were within +0.5D and+1.0D, respectively. Complete epithelialization occured in 6.2 +/- 1.4 days [range 3 to 8 days]; 93.4% of eyes had clear corneas or only trace haze at the final postoperative visit; 94.7% of eyes had no or minimal pain. Epi-LASIK is a safe, effective and predictable method for the treatment of low to moderate myopia and myopic astigmatism

Lente de contato de material híbrido em pacientes com ceratocone e astigmatismo miópico composto / Hybrid material contact lens in keratoconus and myopic astigmatism patients

OBJETIVOS: Avaliar o desempenho visual e o conforto de lentes de contato de material híbrido, quanto ao apresentado por pacientes portadores de ceratocone e astigmatismo miópico composto, e comparar com a lente de contato rígida-gás-permeável nos dois grupos de pacientes. MÉTODOS: Foram submetidos à adaptação com lentes de contato 22 pacientes, sendo 8 portadores de astigmatismo miópico composto e 14 com diagnóstico de ceratocone. Entre os pacientes, 7 eram do sexo masculino e 15 do feminino, com idade média de 32,13 anos ± 8,12. Cada paciente recebeu uma lente de contato de material híbrido e, no contralateral, uma lente rígida-gás-permeável. A escolha da lente a ser adaptada no olho direito ou esquerdo foi feita aleatoriamente, sendo o trabalho duplo-mascarado. Os pacientes foram submetidos aos seguintes exames: medida do conforto por meio da escala visual analógica, tempo de ruptura do filme lacrimal, acuidade visual pela escala de Bailey-Lovie adaptada para quatro metros, sensibilidade ao contraste pelo "functional acuity contrast test" e análise das aberrações oculares pela análise de frentes de onda. RESULTADOS: Com relação ao conforto não houve associação com o tipo de lente (p=0,350). Houve variação no conforto referido ao longo do tempo até 7 dias (p=0,001), estabilizando-se após este período. A medida da acuidade visual sofreu aumento entre a adaptação e a medida obtida aos 7 dias, bem como desta para a medida de 15 dias, estabilizando-se então. A acuidade visual não apresentou diferenças com relação ao tipo de lente estudada. Verificou-se que não houve diferença no tempo de ruptura do filme lacrimal (p=0,989) com relação aos tipos de lentes, porém houve diminuição deste (p=0,001) quando comparadas as medidas antes do início do uso das lentes e com dois meses de uso. Os tipos de lentes não revelaram associação com a sensibilidade ao contraste e não diferiram das medidas feitas com o uso de óculos, exceto para a freqüência...

PURPOSE: To evaluate comfort and visual performance in relation to two different used contact lens types: hybrid material (HM) and rigid-gas-permeable (RGP), in patients with regular myopic astigmatism and with keratoconus. METHODS: A randomized, double masked, prospective study of 22 patients with the diagnosis of myopic astigmatism (8 with myopic astigmatism and 14 with keratoconus) was conducted. Fifteen patients were female and 7 were male, and mean age was: 32.13 ± 8.12 years. In one of the eyes a rigid-gas-permeable contact lens was adapted (DK 30), and in the other a hybrid material contact lens was adapted (DK 23). All patients were submitted to the following tests: measurement of comfort level by means of the analogical visual scale, tear break-up time, best corrected visual acuity with the Bailey-Lovie scale adapted for 4 meters, functional acuity contrast test (FACT) and wavefront analysis. RESULTS: In relation to comfort, there was no association with the evaluated contact lens type (p=0.350). There was a variation in comfort level during the first 7 days. The visual acuity increased between the 7th and the 15th day of adaptation. Visual acuity stabilized right after this period. The visual acuity did not show differences in relation to the studied lens type. It was verified that there was no difference in the tear break-up time (p=0.989) in relation to the studied lenses type and there was a decrease in the tear break-up time (p=0.001) when we compared the measurement before the use of the lenses and 2 months after their use. There was no difference in contrast sensitivity in the used lens type and between each type and the use of glasses (p<0.047). High order aberrations decreased significantly when comparing patients with and without contact lenses, except for spherical and coma aberrations (p=0.394). CONCLUSION: Comfort and visual performance when comparing hybrid material and rigid-gas-permeable contact lenses...

Clear lens phacoemulsification as a refractive procedure for productive age group

To assess phacoemulsification with or without posterior chamber intraocular lens [IOL] implantation as an effective technique for the correction of high myopia especially in productive age group [20-40 years]. Diagnostic Ophthalmology and Laser Treating Unit, Faculty of Medicine, Cairo University. A series of 30 eyes with myopia higher than -10 diopter [D] had clear lens phacoemulsification with or without IOL implantation in the capsular bag. Biometry done using SRK II formula. The subjective outcome in patients with another procedure in the other eye. The mean postoperative follow-up 6 months. No serious intra-operative complication occured. Visual acuity improved postoperatively by 3 up to 5 lines in Snellen's chart in all the cases except one case with biometric error, which was corrected by IOL exchange. The dramatic resbonse of the patients and there comment on the procedure, the visual acuity improvement and field improvement. Also it was clear that some of the patients show contrast improvement and improvement in colour perception. Phacoemulsification for high myopia is a promising, effective and relatively safe refractive procedure

Molecular characterization of Acanthamoeba isolated from amebic keratitis related to orthokeratology lens overnight wear

In an effort to characterize, on the molecular scale, the Acanthamoeba initially isolated from the cornea of an amoebic keratitis patient associated with overnight-wear orthokeratology lens in Korea, we conducted mitochondrial DNA restriction fragment length polymorphism, 18S rDNA sequencing, and drug sensitivity analyses on the isolate (KA/PE1). The patient was treated with polyhexamethylene biguanide, chlorhexidine and oral itraconazole, which resulted in resolution of the patient's ocular inflammation. The majority of the molecular characteristics of the KA/PE1 were determined to be identical, or quite similar, to those of A. castellanii Ma strain, which had been isolated also from amoebic keratitis. The risk of Acanthamoeba keratitis as a potential complication of overnight orthokeratology is briefly discussed.

Desempenho visual na correção de miopia com óculos e lentes de contato gelatinosas / Visual performance in myopic correction with spectales and soft contact lenses

Objetivos: Avaliar o desempenho visual, por meio da AV logMAR de alto contraste, sensibilidade ao contraste e análise de frentes de onda de indivíduos portadores de miopia com ou sem astigmatismo, corrigidos com óculos e com três diferentes LCG. / Objective: To evaluate the visual performance (VP) by high contrast visual acuity (VA) constrast sensitivity (CS) and wavefront in myopic patients with or without astigmatism corrected with...

Lentes intraoculares fáquicos PRL (R) para corrección de alta miopía / PRL (R) phakic intraocular lens for correction of high myopia

Objetivo: Evaluar la predictibilidad, eficacia, seguridad y complicaciones en el implante de PRL® en alta miopía. Pacientes y métodos: En 53 ojos de 39 pacientes con promedio de edad de 39 años, con equivalente esférico EE preoperatorio de -17, 27 ± 4,58 D (rango -31,50 a -8,75 D) y de Agudeza Visual con Corrección (AVCC) preoperatoria de 0,5 + 0,70 (según Equivalente log MAR) se implantó un PRL® promedio de -12,73 ± 2,87 D (rango -20,0 a -7,0 D). En ellos se evaluó en forma prospectiva en el pstoperatorio el equivalente Esférico (EE) la Agudeza Visual sin Corrección (AVSC), Índice de seguridad (IS), presión intraocular (PIO), ángulo iridocorneal y distancia PRL-Cristalino. Resultados: En promedio el seguimiento fue 7 meses y el EE postoperatorio -0,23 ± 1,05 D (rango -3,38 a + 2,75 D) con 71,2 por ciento de los casos en ± 1.0 D. El 60 por ciento obtuvo AVSC ≥ 20/40 con Índice de eficacia 1,1. El 88,2 por ciento logra AVCC ≥ 20/40 con Índice de seguridad 1.4. El 92,45 por ciento mantuvo o ganó alguna línea de AVCC y un 5,7 por ciento perdió más de 1 línea. No hubo cambio significativo en la PIO (p = 0,40) y la distancia PRL® Cristalino promedio fue de 370u por ecografía y 604u por Tomografía Óptica Coherente. Como complicación tardía hubo un caso de desprendimiento de retina y un caso de subluxación del lente. Conclusiones: El implante de PRL® en altos miopes es predecible y eficaz, pero siempre debe prevenirse y advertirse el riesgo de desprendimiento retinal. Creemos que la implantación del Lente PRL® debe ser reemplazado por otro lente fáquico, mientras no se conozca y corrija la causa de su sublaxación a largo plazo.

Miopia patológica / Myopia

Os autores fazem uma revisão bibliográfica sobre a miopia patológica, sua incidência, fisiopatologia, prognóstico e tratamento

Miopia na infância / Myopia in children

As miopias se dividem em primárias e secundárias. As formas primárias se subdividem em fisiológicas, intermediárias, patológicas e por curvatura. As formas secundárias decorrem de alterações estruturais no globo ocular, como por exemplo as secundárias ao alongamento do globo, como no glaucoma juvenil. Os vários tipos de miopia primária podem ser diferenciados pelo comprimento axial do globo ou, mais frequentemente, por seu estado refratométrico: aqueles com miopia abaixo de -3,00 dioptrias (D) são portadores de miopia fisiológica; os que apresentam entre -3,00 e -5,00D apresentam tanto miopia fisilógica como intermediária e aqueles com refrações entre -5,00 e -8,00D possuem miopia intermediária ou patológica. Indivíduos com miopia superior a -8,00D são portadores, invariavelmente, de miopia patológica.

Efecto en el patrón topográfico postoperatorio con y sin secado transoperatorio del lecho estromal en Lasik / Effect of \"in site\" stromal transoperative drines in postoperative topographic patterns after Lasik

Se estudiaron un total de 60 ojos con diagnóstico de miopía con equivalente esférico mayor o igual a 8 DP y menor o igual a 11 DP, los cuales fueron sometidos a queratectomía fotorrefractiva con técnica de Lasik utilizando el equipo láser excimer Technolas 217 de Chiron y el microqueratomo automatizado Hansatome de Chiron, dividiéndose en dos grupos, a uno de los cuales se le efectuó secado transoperatorio del lecho estromal al 50 por ciento del tratamiento con esponja de merocel, y al segundo grupo no. Se practicaron estudios topográficos de elevación (Orbsacan) preoperatoria, a las 24 horas y 7 días de postoperatorio, se empleó como parámetro de evaluación del patrón de irregularidades el mapa de mejor adaptación a una esfera, tomando como referencia la esfera preoperatoria de base

Aplicación de láser excimer en pacientes operados de queratotomía radiada / Excimer laser ablation in subjects with previous radial karetotomy

Se reportan los resultados visuales del tratamiento por medio de láser excimer de superficie para pacientes con residual miópico y astigmático operados de queratotomía radiada (QR) y con estabilidad en su refracción. Los resultados muestran que es un procedimiento seguro, predecible y estable (a un año de seguimiento) para pacientes de residual baja. La mayoría de los pacientes (90 por ciento) alcanzaron una visión satisfactoria de 20/30 o mejor, con la técnica tradicional de PRK, (queratectomía fotorrefractiva, por sus siglas en inglés)

Alteraçöes biométricas induzidas por lentes intra-oculares de câmara anterior para o tratamento da alta miopia em olhos fácicos / Biometric changes induced by phakic myopic anterior chamber intraocular lenses

Objetivo: avaliar a influência do implante de uma LIO com suporte no ângulo da câmara anterior em olhos fácicos alto miopes, na estimativa do seu comprimento axila pela biometria ultra-sônica. Material e métodos: foi realizado a medida do comprimento axial de 20 olhos alto míopes submetidos à implante de LIO miópica de Baikoff. As medidas foram realizadas no pré-operatório com os MODOS fácico e pseudofácico. Resultados: utilizando-se o mesmo MODO (fácico), o implante da LIO levou à superestimaçäo do comprimento axial médio de 30,55 mm para 30,70mm (p<0,025), no entanto näo houve diferença estatística entre as medidas pré-operatórias e aquelas realizadas no MODO pseudo-fácico (p=0,143, bicaudal). Utilizando-se o delta percentual para avaliar o quanto a medida do comprimento axial no pós-operatório é diferente do pré-operatório, nota-se que as medidas no MODO fácico