Diferentes concentraciones de mitomicina C en la prevención del haze en la queratectomía fotorrefractiva / Different concentrations of mitomycin C for haze prevention in photorefractive keratectomy

Objetivo: Evaluar la utilidad de dos concentraciones de mitomicina C para la prevención del haze en la queratectomía fotorrefractiva. Métodos: Se realizó un estudio experimental aleatorizado en 26 ojos de 17 pacientes con defectos miópicos. Los pacientes fueron asignados a dos grupos según las dosis de mitomicina C (0,02 por ciento grupo 1 y 0,002 por ciento grupo 2). La variable de respuesta principal fue la presencia de haze. Se buscó correlación entre la magnitud del haze con grado de ametropía tratada, profundidad de ablación, microscopia endotelial y resultados visuales y refractivos. Resultados: A los 6 meses la mayoría de los pacientes del grupo 1 no presentó haze (ocho ojos / 57 por ciento), y del grupo 2 mantuvieron haze 0,5 (6 ojos / 50 por ciento). En la ametropía severa el haze en el grupo 2 fue mayor que en el grupo 1 durante todo el posoperatorio, y se observó la mayor diferencia al sexto mes con 0,5 ± 0,4 vs. 1,5 ± 0,32. En ablaciones > 75 micras el grupo dos terminó con más haze que el uno, con 0,5 ± 0,44 vs. 1,75 ± 0,76. La agudeza visual sin corrección se vio más afectada en el grupo 2. No hubo daño endotelial en ningún grupo. Conclusión: La presencia de haze predomina en los casos tratados con dosis 0,002 por ciento de mitomicina C, comparada con la dosis 0,02 por ciento, aunque en este caso ambos grupos mantuvieron un resultado visual y refractivo adecuado y baja toxicidad endotelial.

Objective: Evaluate the usefulness of two concentrations of mitomycin C for haze prevention in photorefractive keratectomy. Methods: An experimental randomized study was conducted of 26 eyes of 17 patients with myopic defects. The patients were divided into two groups according to their mitomycin C doses (Group 1: 0.02 percent and Group 2: 0.002 percent). The main response variable was the presence of haze. Verification was performed of the correlation between haze magnitude and the degree of the ametropia treated, ablation depth, endothelial microscopy, and visual and refractive results. Results: At six months most patients in Group 1 did not have any haze (eight eyes / 57 percent), whereas 0.5 (6 eyes / 50 percent) in Group 2 still had haze. In severe ametropia, haze was larger in Group 2 than in Group 1 throughout the postoperative period, the greatest difference being observed in the sixth month with 0.5 ± 0.4 vs 1.5 ± 0.32. In ablations > 75 microns, Group 2 ended with more haze than Group 1, with 0.5 ± 0.44 vs 1.75 ± 0.76. Uncorrected visual acuity was more affected in Group 2. No endothelial damage occurred in either group. Conclusion: The presence of haze prevails in cases treated with 0.002 percent doses of mitomycin C, as compared with 0.02 percent doses, though in this case both groups maintained an appropriate visual and refractive result and low endothelial toxicity(AU)

Calidad de vida y visual en pacientes con implante de lente intraocular fáquico / Visual acuity and quality of life of patients undergoing phakic intraocular lens implantation

RESUMEN Los errores refractivos altos son difíciles de corregir óptica y quirúrgicamente. Los pacientes que los padecen se encuentran incómodos con las gafas, ya que la calidad de su visión es deficitaria. Las lentes de contacto proporcionan mejor agudeza visual; sin embargo, en ocasiones requieren diseños especiales para ser adaptadas y pueden asociarse a complicaciones severas. La cirugía refractiva como subespecialidad busca mejorar la agudeza visual no corregida y disminuir la dependencia a gafas o lentes de contacto. Las opciones van desde los procedimientos queratorrefractivos hasta el implante de una lente intraocular, ya sea con la extracción del cristalino transparente o en un ojo fáquico. Este último ofrece ventajas al mantener la acomodación, obtener una mejor calidad óptica y cierta reversibilidad. En el mundo se han realizado múltiples trabajos en pacientes con lentes fáquicos de diferentes modelos y estos han demostrado que son seguros y confiables, aunque no son muchos los estudios sobre la calidad de vida a largo plazo; de ahí la motivación para realizar una búsqueda actualizada de diversos artículos publicados, con el objetivo de describir los resultados visuales y la calidad de vida en pacientes con implante de lentes fáquicos. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores(AU)

ABSTRACT High refractive errors are difficult to correct both optically and surgically. Patients suffering from them feel uncomfortable with their eyeglasses, since their visual quality is poor. Contact lenses provide better visual acuity, but they sometimes require special designs to be adjusted and may be associated to severe complications. The subspecialty of refractive surgery seeks to improve uncorrected visual acuity and reduce dependence on eyeglasses or contact lenses. Options range from keratorefractive procedures to intraocular lens implantation, be it with removal of the transparent crystalline lens or in phakic eyes. The latter provides the advantages of maintaining accommodation, obtaining better visual quality and affording a certain degree of reversibility. A great many studies have been conducted worldwide of patients with phakic lenses of various models, and these have proved to be safe and reliable. However, not many studies are available about long-term quality of life. Hence the motivation to perform an updated search for published papers about the subject, with the purpose of describing the visual results and quality of life of patients with phakic lens implants. Use was made of the Infomed platform, particularly the Virtual Health Library with all its search engines(AU)

A visão em pseudofácicos com ametropia residual após instilação de pilocarpina a 2% / Pseudophakic Vision with residual ametropia after pilocarpine 2% instillation

Resumo Objetivo: Avaliar modificações de acuidade visual, refração, campo visual e diâmetro pupilar, em pacientes pseudofácicos, após a instilação de pilocarpina a 2%. Métodos: Ensaio clínico, controlado, mascarado e randomizado realizado entre maio de 2015 e setembro de 2016 no Hospital Universitário Gaffrée e Guinle, RJ, Brasil. Quarenta pacientes divididos em 2 grupos foram acompanhados em pós-operatório de facectomia com implante de LIO. No grupo de casos houve aplicação de uma gota de pilocarpina a 2%, no grupo controle, uma gota de lubrificante no olho operado. Foram avaliadas antes e 1 hora após a instilação do colirio: a acuidade visual para longe e perto com e sem correção; a refração; o diâmetro pupilar e o campo visual. Resultados: No grupo de casos, a acuidade visual s/c para longe aumentou de 0,33 para 0,57 (p = 0,0001) e para perto melhorou também, 13 pacientes (59,09%) possuíam acuidade visual de J1 ou J2 antes da instilação e depois o número aumentou para 18 ou 81,81% (p = 0,0054). O diâmetro pupilar reduziu de 2,00mm para 1,85mm (p < 0,0001). Não houve alteração do campo visual central. No grupo controle, não houve variação estatisticamente ou clinicamente significativa de qualquer um dos parâmetros medidos. Conclusão: A administração tópica de uma gota de pilocarpina a 2% melhorou a visão de pacientes pseudofácicos com ametropia residual para longe e para perto. Estudos de dose-efetividade adicionais podem indicar melhores concentrações e posologias para alcançar maiores melhoras de acuidade visual.

Abstract Objective: Evaluate the visual acuity, refraction, visual field changes and pupillary diameter in pseudophakic patients after instillation of 2% pilocarpine eye drops. Methods: Controlled, masked and randomized clinical trial carried out between May, 2015 and September, 2016 at the Gaffrée and Guinle University Hospital, RJ, Brazil. Forty patients, divided into 2 groups, were followed up in the postoperative period of a facectomy with intraocular lens implant. The patients in the group of cases were submitted to a drop of 2% pilocarpine and those of the control group to a drop of lubricant in the operated eye. Before eye drop instillation nd one hour after it, the authors evaluated: visual acuity for distance and near; refraction; pupillary diameter and visual field. Results: In case group visual acuity increased from 0.33 to 0.57 for far (p = 0.0001)and also increased for near, 13 patients (59.09%) had visual acuity of J1 or J2 before instillation and 18 or 81.81% after it (p = 0.0054). The median pupillary diameters raised from 2.00 mms to 1.85 mm(p <0.0001). Central visual fields did not have significant alteration. In the control group, there were no statistically or clinically significant changes in any of the measured parameters. Conclusion: Topical administration of a 2% pilocarpine eye drop was effective to improve pseudophakic patients vision with residual ametropia for far and near. Additional dose-effectiveness studies may indicate better concentrations and dosages to achieve greater improvements in visual acuity.

Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity / Avaliação dos resultados após 2 anos de injeção de bevacizumab intravítreo para retinopatia da prematuridade posterior agressiva

ABSTRACTPurpose:To evaluate 2-year outcomes following intravitreal bevacizumab (IVB) as monotherapy for aggressive posterior retinopathy of prematurity (APROP).Methods:Medical records of 40 infants were retrospectively reviewed. Group I included infants who had received IVB injections for APROP. Group II included infants who underwent laser treatment for APROP. Anatomic and refractive outcomes and the presence of anisometropia and strabismus were assessed at follow-up examinations.Results:Group I included 48 eyes of 25 infants (11 males) with a mean gestational age (GA) of 26.40 ± 1.82 weeks and a mean birth weight (BW) of 901.40 ± 304.60 g. Group II included 30 eyes of 15 infants (6 males) with a mean GA of 27.30 ± 1.82 weeks and a mean BW of 941.00 ± 282.48 g. GA, BW, and gender distributions were similar between groups (P=0.187, P=0.685, and P=1.000, respectively). Refractive errors were significantly less myopic in group I (0.42 ± 3.42 D) than in group II (-6.66 ± 4.96 D) at 2 years (P=0.001). Significantly higher rates of anisometropia and strabismus were observed in group II than in group I (P=0.009 and P=0.036, respectively).Conclusions:The study demonstrated that IVB monotherapy can be useful in the treatment of APROP. The decreased incidence of early unfavorable refractive and functional outcomes in the IVB group compared with the laser group showed a potential benefit for patients treated with IVB, and this needs to be better evaluated in future prospective studies.

RESUMOObjetivo:Avaliar a evolução de 2 anos em crianças que receberam bevacizumab intravítreo (IVB) como monoterapia para retinopatia da prematuridade posterior agressiva (APROP).Métodos:Arquivos médicos de 40 crianças foram revisados retrospectivamente. Grupo I incluiu as crianças que tiveram injeções IVB para APROP. Grupo II foi composto por crianças que se submeteram a tratamento a laser para APROP. Os resultados anatômicos e refracionais, presença de anisometropia e estrabismo foram avaliados durante exames de acompanhamento.Resultados:Grupo I incluiu 48 olhos de 25 crianças (11 do sexo masculino) com média de idade gestacional (GA) de 26,40 ± 1,82 semanas, e média de peso ao nascimento (BW) de 901,40 ± 304,60 g. Grupo II incluiu 30 olhos de 15 crianças (6 do sexo masculino) com GA de 27,30 ± 1,82 semanas e BW de 941,00 ± 282,48 g. GA, BW e distribuição por sexo foram semelhantes entre os grupos (p=0,187, p=0,685, p=1,000, respectivamente). Nenhuma anormalidade anatômica foi observada em ambos os grupos. Erro refrativo foi significativamente menos míope no grupo I (0,42 ± 3,42 D) do que o grupo II (-6,66 ± 4,96 D) em exames aos 2 anos (p=0,001). Houve significativamente maior taxa de anisometropia e estrabismo no grupo II em relação ao grupo I (p=0,009, p=0,036, respectivamente).Conclusões:O estudo demonstrou que a monoterapia IVB pode ser útil no tratamento de APROP. A diminuição da incidência de resultados refracionais e funcionais desfavoráveis precoces no grupo IVB em comparação com o grupo do laser mostraram um benefício potencial para os pacientes tratados com IVB, e isto tem de ser melhor avaliado em estudos prospectivos no futuro.

Características in vivo del epitelio corneal versus magnitud del defecto refractivo, posterior a tratamiento con láser de excímeros / In vivo characteristics of the corneal epithelium vs size of the refractive error after Excimer laser treatment

Objetivo: describir las características in vivo del epitelio corneal y su relación con la magnitud del defecto refractivo tratado posterior al tratamiento quirúrgico de LASIK. Método: estudio descriptivo, prospectivo-longitudinal con 24 pacientes 48 ojos con astigmatismo miópico intervenidos con el ESIRIS Schwind-Alemania por la técnica quirúrgica LASIK con microquerátomo pendular. Se analizaron los resultados a partir de técnicas de estadística descriptiva. Se utilizó el microscopio confocal ConfoScan 4 de NIDEK para la obtención y estudio de las imágenes in vivo de tejido corneal. Resultados: el grosor epitelial central medio en el preoperatorio fue 34,7 mm, a los 7 días del posoperatorio hubo un incremento del 36 por ciento en pacientes con defectos refractivos inferiores a 4D y un incremento del 44 por ciento en pacientes con defectos refractivos de 4 D o más. El promedio de densidad de células del epitelio basal a los 7 días fue de 5 098,3±1 654 células/mm², tuvo variaciones mínimas inferiores a la unidad porcentual durante la etapa de estudio. Conclusiones: existió incremento del grosor epitelial posterior a LASIK que fue superior en defectos refractivos mayores de 4 dioptrías. La densidad celular del epitelio basal no tuvo variaciones significativas y fue independiente a la magnitud del defecto refractivo tratado

Objective: to describe the in vivo characteristics of the corneal epithelium and their association with the size of the treated refractive defect after LASIK. Methods: a prospective, longitudinal and descriptive study of 24 patients (48 eyes) with myopic astigmatism, who were operated on by using ESIRIS (Schwind-Germany) and LASIK technique with pendular microketatome. Summary statistic techniques served to analyze results. NIDEK´s ConfoScan 4 microscope was used to obtain and to study in vivo corneal tissue images. Results: mean central epithelial thickness measured in the preoperative stage was 34.7 mm, but increased by 36 percent seven days after surgery in patients with refractive defects fewer than 4D and by 44 percent in patients with refractive defects equal to or over 4D. The average cell density of the basal epithelium 7 days postoperatively was 5 098.3±1 654 cell/mm² and showed minimal changes below 1 percent during the study period. Conclusions: the central corneal epithelium thickness increased after LASIK surgery and it was higher in refractive defects over 4D. Cell density of the basal epithelium did not show significant changes and was not associated to the size of the treated refractive defect

Prevalence of refractive errors in Möbius sequence / Prevalência de erros refrativos na sequência de Möbius

PURPOSE: To assess the prevalence of refractive errors in Möbius sequence. METHODS: This study was carried out during the Annual Meeting of the Brazilian Möbius Society in November 2008. Forty-four patients diagnosed with the Möbius sequence were submitted to a comprehensive assessment, on the following specialties: ophthalmology, neurology, genetics, psychiatry, psychology and dentistry. Forty-three patients were cooperative and able to undertake the ophthalmological examination. Twenty-two (51.2 %) were male and 21 (48.8%) were female. The average age was 8.3 years (from 2 to 17 years). The visual acuity was evaluated using a retro-illuminated logMAR chart in cooperative patients. All children were submitted to exams on ocular motility, cyclopegic refraction, and fundus examination. RESULTS: From the total of 85 eyes, using the spherical equivalent, the major of the eyes (57.6%) were emmetropics (>-0.50 D and <+2.00 D). The prevalence of astigmatism greater than or equal to 0.75 D was 40%. CONCLUSION: The prevalence of refractive errors, by the spherical equivalent, was 42.4% in this studied group.

OBJETIVO: Avaliar a prevalência de erros refrativos em crianças portadoras da sequência de Möbius. MÉTODOS: Trabalho realizado durante o encontro anual da Associação Möbius do Brasil (AMoB) em novembro de 2008. Quarenta e quatro pacientes com diagnóstico de sequência de Möbius foram submetidos a avaliação multidisciplinar: oftalmológica, neurológica, genética, psiquiátrica, psicológica e odontológica. Quarenta e três pacientes colaboraram com exame oftalmológico. Vinte e dois (51,2 %) eram do sexo masculino e 21 (48,8 %) do sexo feminino. A idade média foi de 8,3 anos (2 a 17 anos). A medida da acuidade visual foi realizada com tabela logMAR retro-iluminada, nos pacientes que colaboravam. Todas as crianças foram submetidas a exame da motilidade ocular, refração sob cicloplegia e fundo de olho. RESULTADOS: Do total de 85 olhos estudados, usando o equivalente esférico, a maioria dos olhos (57,6%) são emétropes (>-0,50 D e <+2,00 D). A prevalência de astigmatismo maior que 0,75D foi 40%. CONCLUSÃO: A prevalência de erros refrativos, pelo equivalente esférico, no grupo estudado foi de 42,4%.

Achados oculares em pacientes com mucopolissacaridoses / Ocular findings in patients with mucopolysaccharidosis

OBJETIVO: O objetivo deste estudo foi determinar a prevalência e gravidade das complicações oculares em pacientes com mucopolissacaridoses (MPS). MÉTODOS: Vinte e nove pacientes com diagnóstico de mucopolissacaridoses foram estudados. Foram avaliados: idade, sexo, acuidade visual, presença de estrabismo, erros refrativos, exame de fundo de olho, pressão intraocular, espessura corneal central e ultrassonografia ocular. RESULTADOS: Foram avaliados três pacientes com MPS I (12 por cento), 11 pacientes com MPS II (37,9 por cento), um paciente com MPS III (3,4 por cento) e 14 pacientes com MPS VI (48,3 por cento). A média de idade foi de 9,5 anos (DP 5,5). Observou-se hipermetropia em 88,5 por cento (23 pacientes) e astigmatismo em 51,7 por cento (15 pacientes). A média da acuidade visual corrigida foi de 0,45 logMAR (DP 0,68). A média do equivalente esférico foi +3,57 D (DP 2,46) e da pressão intraocular foi 17 mmHg (DP 3,9). Os achados mais comuns foram: espessamento palpebral 24,1 por cento (7 pacientes); opacidade da córnea, 55,2 por cento dos casos (16 pacientes); atrofia do nervo óptico, 23,1 por cento (6 pacientes); dobras radiais na retina 24 por cento (7 pacientes). O fundo de olho não foi examinado em 3 pacientes devido à opacidade de córnea. A média da espessura do complexo esclera-retina-coroide (ERC) medida por ultrassom foi de 1,78 mm (DP 0,51). CONCLUSÃO: Os achados oftalmológicos mais proeminentes foram espessamento palpebral, diminuição da acuidade visual, hipermetropia moderada, opacidade da córnea, dobras radiais na retina perimacular e atrofia do nervo óptico.

PURPOSE: The objective of this study was to determine the prevalence and severity of ocular complications in patients with mucopolysaccharidosis (MPS). METHODS: Twenty-nine patients with diagnosis of mucopolysaccharidosis were studied. Age, gender, visual acuity, presence of strabismus, refractive error, fundus examination, intraocular pressure, central corneal thickness and ocular echography were assessed for each individual. RESULTS: There were three patients with MPS I (12 percent), eleven patients with MPS II (37.9 percent), one patient with MPS III (3.4 percent) and fourteen patients with MPS VI (48.3 percent). Mean age was 9.5 years (ranged from 1.2 to 20 years, DP 5.5). Refraction was available in 26 patients, from which 88.5 percent (23 patients) were hyperopic, and 53.8 percent (14 patients) presented astigmatism. Best corrected visual acuity was available in 18 patients and the mean was 0.45 logMAR (DP 0.68). The mean spherical equivalent was +3.57 D (SD 2.46) and intraocular pressure was 17 mmHg (SD 3.9). The most common findings were: eyelid thickening in 24.1 percent (7 patients); corneal opacity in 55.2 percent of cases (16 patients); optic nerve atrophy in 23.1 percent (6 patients); and radial folds in the retina in 24 percent (7 patients). The fundus was examined in 26 out of 29 patients because corneal opacity avoided the exam in 3 of them. The average thickness of the complex sclera-retina-choroid (SRC was 1.78 mm (SD 0.51). CONCLUSION: The most prominent ophthalmologic findings were eyelid thickening, decreased visual acuity, high hyperopia, corneal opacity, perimacular radial folds in the retina and optic nerve atrophy.

Laser in-situ keratomileusis for refractive error following radial keratotomy.

Aim: To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK). Design: Retrospective study. Materials and Methods: A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively. Statistical Software: STATA-9.0. Results: The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 (P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen's acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was –5.37 ± 4.83 diopters (D) and –0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK. Conclusion: LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap.

Visual impairment secondary to congenital glaucoma in children: visual responses, optical correction and use of low vision AIDS

INTRODUCTION: Congenital glaucoma is frequently associated with visual impairment due to optic nerve damage, corneal opacities, cataracts and amblyopia. Poor vision in childhood is related to global developmental problems, and referral to vision habilitation/rehabilitation services should be without delay to promote efficient management of the impaired vision. OBJECTIVE: To analyze data concerning visual response, the use of optical correction and prescribed low vision aids in a population of children with congenital glaucoma. METHOD: The authors analyzed data from 100 children with congenital glaucoma to assess best corrected visual acuity, prescribed optical correction and low vision aids. RESULTS: Fifty-five percent of the sample were male, 43 percent female. The mean age was 6.3 years. Two percent presented normal visual acuity levels, 29 percent mild visual impairment, 28 percent moderate visual impairment, 15 percent severe visual impairment, 11 percent profound visual impairment, and 15 percent near blindness. Sixty-eight percent received optical correction for refractive errors. Optical low vision aids were adopted for distance vision in 34 percent of the patients and for near vision in 6 percent. A manual monocular telescopic system with 2.8 × magnification was the most frequently prescribed low vision aid for distance, and for near vision a +38 diopter illuminated stand magnifier was most frequently prescribed. DISCUSSION AND CONCLUSION: Careful low vision assessment and the appropriate prescription of optical corrections and low vision aids are mandatory in children with congenital glaucoma, since this will assist their global development, improving efficiency in daily life activities and promoting social and educational inclusion.

Clinical evaluation of reprocessed blades in LASIK / Avaliação clínica da utilização de lâminas reprocessadas no LASIK

PURPOSE: To evaluate outcome and complications in LASIK with reprocessed blades. METHODS: Retrospective analysis of patients' charts submitted to complete custom LASIK from January 2004 to June 2005. Inclusion criteria comprised surgical description of blade use and minimum follow-up of 1 month. The blade was reprocessed following a clinic protocol, from 1 to 3 times (reprocessed group) and results compared with patients that underwent LASIK with first-use blades (first-use group). RESULTS: Two hundred fifty-one eyes of 135 patients were analyzed (spherical equivalent of -3.69 (D). There was no statistical differences between first-use group and reprocessed blade group regarding intraoperative (5.5 percent vs 8.8 percent), early (50.5 percent vs 49.5 percent) and late complications (33 percent vs 27.5 percent), respectively. Uncorrected visual acuity > 20/20 (68.1 percent vs 66.9 percent), aberrometry analysis (total RMS: 0.62 vs 0.64 µm) and safety (85.7 percent vs 83.1 percent) were similar between groups (p>0.05). CONCLUSION: Reprocessed blades following rigid sterilization protocol may have similar outcomes and complications rates in LASIK surgery compared to first-use blades.

OBJETIVO: Analisar os resultados e complicações do uso de lâminas reprocessadas em cirurgias refrativas com a técnica de LASIK. MÉTODOS: Estudo retrospectivo dos prontuários dos pacientes submetidos a LASIK personalizado durante janeiro de 2004 a junho de 2005. Foram incluídos pacientes que apresentavam relatório transoperatório completo (uso da lâmina) e seguimento mínimo de 1 mês após a cirurgia. O grupo controle foi constituído das lâminas com uso único enquanto no grupo das lâminas reprocessadas poderia variar de 2 a 4 vezes de uso. RESULTADOS: Duzentos e cinqüenta e um olhos de 135 pacientes foram analisados e o equivalente esférico pré-operatório médio foi de -3,69 (D). Não houve diferença significativa entre o número de complicações transoperatórias (5,5 por cento vs 8,8 por cento), pós-operatórias imediatas (50,5 por cento vs 49,5 por cento) e tardias (33 por cento vs 27,5 por cento) entre o grupo de lâminas com uso único e reprocessadas, respectivamente. Os resultados de AV sem correção pós-operatória > 20/20 (68,1 por cento vs 66,9 por cento), aberrometria (RMS total: 0,62 vs 0,64 µm) e segurança (85,7 por cento vs 83,1 por cento) foram similares entre os grupos (p>0,05). CONCLUSÃO: O uso de até 4 vezes da lâmina metálica, seguindo reprocessamento adequado pode apresentar resultados e taxa de complicações semelhantes às cirurgias de LASIK realizadas com lâminas de uso único.

Estado refractivo en pacientes sometidos a facoemulsificación de catarata con situaciones especiales / Refractive state in patients with phacoemulsification of cataract in uncommon situations

BACKGROUND: We undertook this study to determine the refractive state in patients who underwent non-complicated phacoemulsification under unusual situations. METHODS: This was a clinical, open, transversal, prospective and comparative study. Patients had the following conditions: congenital cataracts, hyperopia, myopia, and emetropia with previous corneal transplantation or vitreous cavity filled with silicone oil. RESULTS: Thirty-six eyes were included in our study vs. control group (52 emetropic eyes). There was no statistical significance in spherical equivalent 6 weeks postoperatively, with 59% of patients within +1.00 D, 73% +2.00 D and 28% > +2.00 D. CONCLUSIONS: Refractive state was favorable with an average of 0.96 D +/- 6.27.

Contact lens induced corneal ulcer management in a tertiary eye unit in Oman - a descriptive study

The corneal disease is a priority problem in Oman. We present patients with contact lens [CL] induced severe keratitis, admitted in the corneal unit of Al Nahdha Hospital in Oman. The study was conducted in 2005-2006. Ophthalmologists examined the eyes using slit lamp bio-microscope. Visual acuity was noted using Snellen's distance vision chart. Specimens of corneal scraping and CLs were sent for culture and sensitivity tests. Patients with severe keratitis were admitted and treated with medicines. Corneal and visual statuses were noted at the time of discharge from hospital and after six weeks. Numbers, percentages and their 95% confidence intervals were calculated. Pre- and post-treatment vision were compared using a scattergram. The 52 eyes of 15 males and 37 female patients with corneal ulcers were examined. Thirty-two patients were between 20 to 30 years of age. Only 13 [25%] patients had visited an ophthalmologist within 24 hours of developing severe keratitis. Seventeen [33%] had central ulcers and six [11.5%] had ulcer >/= 5 mm in size. Pseudomonas was found in 29 [55.8%] of CL and corneal material scraped from the eyes of 15 [28.8%] patients. Vision was < 6/60 [legally blind] in 12 [23.1%] eyes before and in five [9.6%] eyes after treatment. Twenty-six [50%] patients were lost to follow up. CL related severe keratitis causes visual disabilities. Prevention and proper records are essential. Treatment improves vision and hence facilities for management should be strengthened

case series study of leber's congenital amaurosis: Clinical description and ERG findings

To evaluate the incidence of Leber's Congenital Amaurosis [LCA] in low vision children referred to electrophysiology ward of Farabi Eye Hospital, and review the clinical features of disease and Electroretiongraphy [ERG] test values to confirm the diagnosis and severity of the disease in Iran. Prospective observational case series. Two-hundred and fifteen cases of low vision infants and young children were referred to electrophysiology ward of Farabi Eye Hospital during 18 months. Clinical LCA diagnosis was made and ERG tests were done and LCA diagnosis was confirmed. The symptoms, signs and the results of eye examination and ERG findings were recorded. The mean age of the patients was 27.43 [range, 1-120 months]. Among low vision patients fourteen percent of patients had LCA. Fifty-four percent of the patients were female. Nystagmus and low vision were the two most common clinical manifestations of these patients. Hyperopia was the main refractive error [54.80%] and mild abnormalities in fundus examinations were found in 67.70% of cases. In nearly 90% of cases consanguinity was found. ERG was flat or unrecordable in more than 90% of cases, but in less than 10% of cases with recordable curves, severe decrease in amplitude of waves was encountered. ERG confirmed LCA diagnosis in 31 out of 37 patients [positive predictive value of 83.7%]. The incidence of LCA in low vision children is similar to other studies. ERG helped in confirmation of presence or absence of overall retinal dysfunction in the majority 31/37 [83.7%] of LCA patients. It can differentiate these cases from other cases with poor vision in infantile age but genetic testing is recommended

Estudio de las aberraciones de alto orden inducidas por la cirugía Lasik y Lasek en el láser Nidek CX-5000 / Study of higher order aberrations after Lasik and Lasek surgery using Nidek laser

Objetivos: Evaluar las diferencias en la inducción de aberraciones de alto orden, coma, trefoil, aberración esférica y astigmatismo irregular entre pacientes operados con Lasik y Lasek, con ablación personalizada y con ablación convencional. Diseño: Retrospectivo. Participantes: 78 ojos pertenecientes a 51 pacientes, 31 mujeres y 20 hombres, miopes hasta 8 dioptrías, hipermétropes hasta 5 dioptrías, astigmatismo hasta 3 dioptrías. Cirugía: Se utilizó el láser Cx-5000 de Nidek; el programa Final- Fit versión 1.05 para la cirugía personalizada: el queratómetro MK_2000 de corte nasal, para la preparación del flap en el Lasik. La cirugía Lasek se practicó con alcohol absoluto al 18 por ciento con un máximo de 40 seg. Mediciones: Se seleccionaron retrospectivamente las topografías y aberrometrías obtenidas en el Nidek OPD-Scan. Los valores de Coma, Trefoil, Astigmatismo de Alto Orden, y Aberración esférica fueron tabulados. Se utilizó la prueba de Chi-Cuadrado para determinar la normalidad de los datos y la prueba de Fisher para determinar el nivel de significancia. Resultados: Las aberraciones de alto orden aumentaron significativamente con el Lasik convencional. Las aberraciones disminuyeron con el Lasek personalizado. Las aberraciones tipo coma aumentan con el Lasik personalizado, más que con las otras técnicas quirúrgicas. Conclusiones: Las aberraciones de alto orden sufren un menor aumento con la técnica de Lasek y ablación personalizado al usar el equipo quirúrgico de Nidek. Existe una tendencia a inducir coma al utilizar Lasik y ablación personalizada con este sistema.

Erros refracionais e sua influência no aprendizado de jovens escolares da Cidade de Manaus / Refractional errors and learning disabilities in young students from the city of Manaus

Objetivo: Relacionar erros de refração associados a déficit de acuidade visual e problemas de aprendizado em crianças do ensino fundamental de escolas públicas da cidade de Manaus, Brasil. Local: Universidade Luterana do Brasil - Amazonas, Instituto de Olhos do Amazonas. Métodos: Selecionamos dois grupos de 65 crianças cada, com idade variando entre 6 e 11 anos, um com crianças portadoras de erros de refração associados à baixa significativa da acuidade visual, e o outro, controle, com crianças sem problemas refracionais e acuidade visual normal. A estas crianças foi aplicado questionário direcionado para detectar problemas de aprendizado, buscando identificar deficiência de processamento ou compreensão das informações, de linguagem, de discriminação visual funcional, de coordenação motora, de atenção, de aprendizagem e de orientação espacial e temporal. Resultados: Encontramos associação estatisticamente significativa (p < 0,05) entre o grupo de portadores de baixa da acuidade visual e alteração de orientação espacial (p = 0,004), além de discriminação visual (p = 0,026); entre miopia e problemas de compreensão (p = 0,029), expressão oral (p = 0,021), problema visual funcional (0,014) e coordenação motora (p = 0,008); entre hipermetropia e problemas de compreensão (p = 0,012) e de aprendizagem (p = 0,013); e entre astigmatismo e coordenação motora (p = 0,024). Conclusão: A pesquisa conseguiu encontrar associação significativa entre erros de refração que geram baixas de acuidade visual e problemas de aprendizado.

Refractive changes after horizontal extraocular muscle surgery

A prospective study on the refractive changes after horizontal extraocular muscle surgery was conducted involving 51 eyes of 41 subjects. Three variables were measured: axis, cylinder power, and sphere power up to 30 days postoperatively. The behavior and progression of these variables were also evaluated in the postop period Mean changes in axis and cylinder power were found to be significant between the preop and 1 day postop. Mean changes in sphere power were only significant between the 1 day postop and 15 days postop. Mean changes of the three variables between preop and 30 days postop were not significant. The results showed that the effects of horizontal extraocular muscle surgery on the refractive state were only transient and it decreased over time. (Author)

LASIK após cirurgia para descolamento de retina / LASIK after retinal detachment surgery

Objetivo: Determinar a segurança, eficácia, previsibilidade e estabilidade da cirurgia de laser in situ keratomileusis (LASIK) para corrigir miopia e astigmatismo miópico em olhos previamente operados de descolamento de retina com buckle escleral. Local: Instituto de Olhos de Goiânia - Goiânia - GO. Métodos: Catorze olhos de 13 pacientes, 9 homens e 4 mulheres, submetidos à retinopexia com buckle escleral para descolamento de retina e que apresentaram erro refracional residual significativo, foram incluídos neste estudo. Não foram necessárias modificações na técnica convencional de LASIK. O tempo mínimo entre a cirurgia de descolamento de retina e o LASIK foi de 12 meses. Todos os pacientes foram acompanhados por, pelo menos, 24 meses após o LASIK. Para a cirurgia refrativa foram utilizados o microcerátomo Chiron Automated Corneal Shaper e o excimer laser Chiron Technolas 217. Resultados: Seis meses após a cirurgia refrativa, a média do equivalente esférico diminuiu de -6,49 D (variando de -10,87 até -1,75 D) para -0,18 D (variando de +0,25 até -1,25 D) e, aos 24 meses, para de -0,16 D (variando de +0,75 até -0,87). A média do astigmatismo pré-operatório diminuiu de -1,10 D (variando de zero até -3,00 D) para -0,25 D (variando de zero até -0,75 D), chegando aos 24 meses com a média de -0,21 D (variando de zero até -0,75). Pela tabela de Snellen, a acuidade visual sem correção melhorou em todos os olhos e ganhou, pelo menos, 5 linhas em 12 olhos. A acuidade visual com correção permaneceu estável em 6 olhos e melhorou em 6 olhos, sendo melhor ou igual a 20/100 em 8 olhos. A taxa de complicações foi baixa, não tendo sido encontradas rasgaduras ou descolamento de retina em nenhum paciente durante os 24 meses de acompanhamento. Conclusão: Neste estudo, o LASIK reduziu efetivamente a pequena, moderada e alta miopia, além do astigmatismo miópico após a retinopexia com buckle escleral. Um estudo mais prolongado é necessário para confirmação dos resultados.

Prevalence and causes of visual acuity defect in male school children in Al-Khobar area

The prevalence of distance visual acuity defect was determined using a Snellen 'E' Chart on a random sample of 1188 school children aged 6-19 years old in the AI-Khobar area, Saudi Arabia. The study revealed that 27.2% of the children had a visual acuity of 6/9 or less in one or both eyes, and 11.9% had a visual acuity of 6/12 or less. The main causes of visual impairment were found to be ametropia, amblyopia or both. Nearly three-quarters of the screened students had never had a previous ophthalmic check-up. Visual acuity defect did not seem to have any adverse effects on the academic performance of the students. Students from non-consanguineous parents were found to have a high rate of visual acuity defect. The need to improve health school services and ophthalmic training is discussed. The need for regular screening of visual acuity defects and the role of primary health centres is also stressed. A nationwide study of visual acuity defect in school children is recommended

Ambliopia: detecção e prevenção no paciente pediátrico / Amblyopia detection and prevention in pediatric patient

A ambliopia frequentemente unilateral, é a maior causa de déficit visual no Brasil. O diagnóstico precoce feito por exame oftalmológico, em crianças pequenas (em torno de três anos ou antes), é de fundamental para se fazer o tratamento. Estrabismo (mal alinhamento dos eixos visuais), ametropia (vícios refracionais), anisometria (diferença significativa no erro refracional dos dois olhos) e privação (obstrução para se formar uma imagem nítida alcançando a fóvea), são as causas mais frequentes da ambliopia. O tratamento, que não responde bem após os seis ou sete anos de idade, consiste em remoção de qualquer opacidade no eixo visual, oclusão de olho adelfo e correção com óculos ou lente de contato, implantação de uma lente intra-ocular, a colocação de uma córnea humana doadora torneada com o grau desejado (epiceratofacia), ou a correção óptica através da ceratomileusis "in situ".