Outcomes of phacoemulsification in patients with uveitis at a tertiary center in São Paulo, Brazil: a review of cases from 2007 to 2012 / Resultado da facoemulsificação em pacientes com uveíte em um centro terciário em São Paulo, Brasil: revisão de casos de 2007 a 2012

ABSTRACT Purpose: To evaluate the outcomes of phacoemulsification with intraocular lens (IOL) implantation in eyes with uveitis. Methods: Consecutive patients with uveitis and cataracts who had phacoemulsification and acrylic IOL implantation during 2007-2012 were evaluated for visual outcomes, etiology, and complications. Inflammation was controlled for at least 3 months before surgery, and oral prednisone (0.5 mg/kg/day) was administered to patients with non-infectious uveitis. Results: This study investigated 45 eyes in 38 patients with a mean age of 52 ± 12.5 years. The most common etiologies among non-infectious causes (n=32; 73.3%) were Vogt-Koyanagi-Harada disease (n=9), Fuchs heterochromic iridocyclitis (n=4), and sympathetic ophthalmia (n=3). Four cases were idiopathic. Among infectious cases (n=13; 28.9%), the most common causes were toxoplasmosis (n=6) and presumed ocular tuberculosis (n=4). An acrylic IOL was implanted in-the-bag in all cases. After 1-year follow-up, an improvement in visual acuity of two or more lines was observed in 38 eyes (84.4%), and 28 eyes (62.2%) achieved a postoperative visual acuity of ≥0.5. Posterior capsule opacification was observed in 10 eyes (22.2%). Persistent postoperative inflammation (of >6 months) was observed in seven eyes (15.5%) and recurrence occurred in four eyes (8.8%). IOL was explanted in one eye. Intraocular hypertension was observed in six eyes (13.3%). Conclusions: Phacoemulsification with IOL implantation improved vision in most patients with coexisting cataracts and uveitis. Good preoperative and postoperative control of inflammation plays an important role in achieving favorable visual outcomes. Furthermore, the final visual outcome depends on the posterior segment status.

RESUMO Objetivos: Avaliar os resultados da facoemulsificação com implante de lente intraocular em olhos com uveíte. Métodos: Foram incluídos pacientes consecutivos com catarata e uveíte, submetidos a facoemulsificação com implante de lente intraocular acrílica no período de 2007 a 2012, onde avaliou-se resultados visuais, etiologia e complicações. A inflamação estava quiescente por pelo menos três meses e foi usado prednisona oral (0,5 mg/kg/dia) em pacientes com uveíte não infecciosa. Resultados: Este estudo incluiu 45 olhos de 38 pacientes com idade media de 52±12.5 anos. As etiologias mais frequentes, entre as causas não-infecciosas (n=32; 73,3%), foram doença de Vogt-Koyanagi-Harada (n=9), idiopáticas (n=4), iridociclite heterocrômica de Fuchs (n=4) e oftalmia simpática (n=3). Entre as causas infecciosas (n=13; 28,9%), as mais frequentes foram toxoplamose (n=6) e tuberculose ocular presumida (n=4). Uma lente de acrílico foi implantada no saco capsular em todos os casos. Com um ano de seguimento, 38 olhos (84,4%) melhoraram 2 ou mais linhas; 28 olhos (62,2%) atingiram uma acuidade visual pós-operatória de 0,5 ou melhor. Opacidade de cápsula posterior foi observada em 10 olhos (22,2%). Inflamação pós-operatória persistente (>6 meses) foi observada em 7 olhos (15,5%) e a recorrência ocorreu em 4 olhos (8,8%). Houve necessidade de explante da lente em um olho. Hipertensão intraocular foi observada em 6 olhos (13,3%). Conclusões: Facoemulsificação com implante de lente intraocular melhorou a visão na maioria dos pacientes com catarata e uveíte. O controle adequado pré e pós-operatório da inflamação desempenha um papel reconhecidamente importante para obtenção de bons resultados visuais. O resultado visual final depende de alterações prévias do segmento posterior.

Impacto de la cirugía de catarata en la calidad de vida de pacientes del Hospital Central de la Policía / Cataract surgery impact in quality of life in patients at Hospital Central de la Policía

Objetivo: evaluar el impacto de la cirugía de catarata en la calidad de vida de los pacientes del Hospital Central de la Policía. Diseño del estudio: estudio cuasi experimental. Métodos: se incluyeron pacientes del servicio de oftalmología del Hospital Central de la Policía con diagnóstico de catarata a quienes se les realizo encuesta de calidad de vida (SF-36) previo a la cirugía, con obtención de consentimiento informado para participar en el estudio y con aprobación de la junta institucional. Luego de la cirugía se aplicó de nuevo la encuesta de calidad de vida a cada paciente a los 3 y 6 meses. Se realizó el análisis univariado y se determinaron las correlaciones existentes entre las variables de interés del estudio y la calidad de vida, se utilizó el paquete estadístico SPSS 22.0 de IBM. Resultados: se incluyeron 41 pacientes a quienes se les realizó cirugía de catarata. El puntaje de calidad de vida promedio paso de 63 antes de la cirugía a 78 y 81 en los 3 y 6 meses respectivamente posteriores a la cirugía demostrando gran mejoría en la calidad de vida de los pacientes. Conclusiones: en cuanto al puntaje de cuestionario SF-36, se encontró aumento del puntaje de calidad de vida posterior a la cirugía de catarata tanto a los 3 y 6 meses, pasando de calidad de vida regular a bueno.

Objective: to evaluate the impact of cataract surgery on quality of life of patients in the Central Police Hospital. Methods: a quasi-experimental study. Patients of the ophthalmology department of the Central Police Hospital with a diagnosis of cataract where included and the instrument to measure quality of life was applied (SF-36) before surgery; informed consent was obtained to participate in the study and approval the institutional review board was granted. After surgery the instrument was applied again for each patient at 3 and 6 months. Responses were considered for univariate analysis and correlations, the SPSS 22.0 statistical package was used. Results: 41 patients were included in whom cataract surgery was done. The quality of life score average pace of 63 before surgery to 78 and 81 at 3 and 6 months respectively after surgery showing great improvement in the quality of life of patients. Conclusions: It was evident the improvement on the score of the SF-36 instrument at both 3 and 6 months, ranging form regular quality of life to good quality of life.

Pseudoexfoliación y catarata / Pseudoexfoliation and cataract

El síndrome de pseudoexfoliación es un desorden sistémico de la matriz extracelular relacionado con la edad, que no solo causa glaucoma crónico de ángulo abierto y catarata, sino que también se relaciona con complicaciones intraoculares espontáneas y quirúrgicas. Las investigaciones recientes han permitido entender sus efectos en tejidos oculares al mejorar los criterios diagnósticos, aplicar nuevos tratamientos y desarrollar nuevas estrategias preventivas para disminuir las complicaciones quirúrgicas. Los nuevos conceptos de patología genética describen al síndrome de pseudoexfoliación como una microfibrilopatía que involucra al factor de crecimiento B-1, el estrés oxidativo y el daño a los mecanismos de protección celular. Se hace una valoración clínica y quirúrgica del glaucoma y la catarata en presencia de pseudoexfoliación.

Pseudoexfoliation syndrome is an age-related generalized fibrotic matrix disorder, which may not only cause chronic open angle glaucoma and cataract, but also a range of other serious spontaneous and surgical intraocular complications. Recent research studies have led to better understanding of effects of the pseudo exfoliation process on ocular tissues by refining diagnostic criteria, applying new therapeutic regimes, and by developing new preventive strategies to reduce surgical complications. The new pathogenetic concepts describe pseudoexfoliation syndrome as microfibrillopathy involving transforming growth factor-B1, oxidative stress, and impaired cellular protection mechanisms. A clinical and surgical evaluation of glaucoma and cataract in patients with pseudoexfoliation was presented in this article.

Evaluación del postoperatorio tardío en cataratas infantiles operadas / Evaluation of late postoperative infantile cataracts

Objetivo: Evaluar postoperatorio tardío en cataratas infantiles operadas. Material: Estudio retrospectivo de 38 niños operados, antes del 2004 que acuden a citación. Se completa registro. Resultados: Dieciocho (56 por ciento) son mujeres, rango 5-14 años. 42 por ciento cataratas totales, 82 por ciento visión consignada menor 0,1 y 16 por ciento abandonan tratamiento. Veinte casos bilaterales (56 por ciento), 5 antecedentes familiares y 1 Síndrome Down. 29 ojos (73 por ciento) con implanta LIO, logrando 14 visión mayor 0,5 (34 por ciento consignados). 18 (75 por ciento) capsulotomía, primaria (12) o YAG (6). Cuatro (22 por ciento) microftalmia-nistagmo tienen peor pronóstico visual (biometría 75 por ciento <16 mm). Terminan 4 casos (20 por ciento) estrabismo y 2 (10 por ciento) glaucoma. Dieciocho unilaterales (46 por ciento), 61 por ciento visiones consignadas menor 0.1, 50 por ciento catarata total. 11 traumatismos (edad operatoria 6 años vs unilateral 2 años). 12 ojos (67 por ciento) con capsulotomía y 11 implante LIO (53 por ciento aumenta 72 por ciento trauma). 27 por ciento visión final mayor 0,5 y una visión cero (trauma PVR). Conclusiones: Peor pronóstico en casos bilaterales con microftalmia y unilaterales sin trauma ni implante de LIO. Apoyo visión subnormal.

Objective: To evaluate late postoperative infantile cataracts. Material: A retrospective study of 38 children operated before 2004 that come to an appointment. Registration is completed. Results: Eighteen (56 percent) females, range 5-14 years. 42 percent were total cataracts, 82 percent had vision less than 0.1 and 18 percent abandon treatment. Twenty were bilateral cases (56 percent), 5 had family history and one had Down syndrome. 29 eyes (73 percent) had IOLs implanted, 14 achieving vision greater than 0.5 (34 percent recorded). 18 (75 percent) had primary capsulotomy (12) or YAG (6). NIne (45 percent) microphthalmia, nystagmus had worse visual prognosis (biometrics 75 percent<16mm). 4 cases (20 percent) end up with strabismus and 2 (10 percent) glaucoma. Eighteen unilateral (46 percent) 61 percent visions less than 0.1, 50 percent had total cataract. 11 injuries (surgical age 6 years old vs unilateral surgical 2). 12 eyes (67 percent) with capsulotomy and 11 IOL implantation (53 percent increase 72 percent trauma). 27 percent final vision o, 5 or higher and 1 case with zero vision (trauma PVR). Conclusions: Worse Prognosis in bilateral or unilateral microphthalmia without trauma or IOL implantation. Low vision support.

Evaluation of phakic posterior chamber intraocular implantable contact lens for high myopia

To evaluate efficacy, predictability and safety of the surgical correction of high myopia using the phakic posterior chamber implantable collamer lens. A prospective, nonrandomized, non-comparative interventional case series. Twenty seven eyes of fifteen patients aged from 20 to 46 years having high myopia were included. STAAR modified collamer implantable contact lenses [version 4] were implanted for correction of high myopia. Uncorrected visual acuity [UCVA] best-corrected visual acuity [BCVA], intraocular pressure, lens opacity analysis, postoperative inflammation and distance between the ICL and crystalline lens assessed at slit-lamp and other postoperative complications. The mean postoperative spherical equivalent [SE] was -0.629 +/- 0.98 D [range -2.25 to +1.25] for 27 eyes with mean preoperative SE -16.667 +/- 3.43 D [range 10-22 D]. 74.07% of eyes had SE +/- 1.00 D. The mean postoperative UCVA was 0.58+0.22 Snellen decimal visual acuity [from 0.2-1.00 Snellen visual acuity]. 25.9% had IOP >21 mmHg at 1 month interval. 11.11% had lens opacity with 3.7% having significant lens opacity requiring surgery. The implantation of modified collamer posterior chamber implantable contact lenses for high myopia shows adequate safety, predictability and stability. The main concerns over potential cataract formation and changing anterior segment dimensions still exist and needs long term follow-up. No financial disclosure of author in STAAR ICL

Cataract surgical rate in Yemen

To estimate cataract surgical rate [CSR] in 2003 in the 20 Governorates of Yemen in order to identify their needs to reduce cataract related blindness. To estimate the cataract surgical rate in 2003, a standardized questionnaire was sent to the 162 eye units in governmental, university military and private clinics and hospitals. The response rate to the survey was 96.9 percent and the data are summarized. During the 12-month period, a total of 31,258 cataract surgeries were performed by 203 ophthalmology specialists and residents. The cataract surgical rate was 1,560 operations per million inhabitants per year. Intraocular lens implantation was performed on 71.6 percent of the cases. There is a need to increase the cataract surgical rate in Yemen mainly in rural areas. Inadequate number of eye surgeons, limited accessibility of cataract surgical services in rural areas and the affordability of surgery to large sections of society are major constraints that has to be addressed. The information from this study will also enable Ministry of Health to more equitably disperse trained ophthalmic personnel

Monitoreo de cirugía de catarata, realizadas en el Servicio de Oftalmología del Hospital Clínico Regional de Concepción / Cataract surgery monitoring in a public health system

Objetivo: Determinar la utilidad del monitoreo de las cirugías de catarata en un servicio publico para evaluar las causas de mala visión. Material y Método: Estudio retrospectivo de pacientes operados de catarata en el Hospital Clínico Regional de Concepción, durante el mes de abril de los años 2005, 2006 y 2007. Para su análisis se uso programa "Monitoring Cataract Outcome". Resultados: De un total de 225 cirugías se analizaron 180 fichas (80 por ciento). El 57 por ciento fueron mujeres, un 82,2 por ciento mayor de 60 años y un 21 por ciento tiene patología ocular asociada. Se realizó en un 91 por ciento facoemulsificación, un 96 por ciento con implante de LIO y en un 14 por ciento se consignan complicaciones quirúrgicas. La agudeza visual mejoro con el tiempo, lográndose un 86,2 por ciento una mejor visión corregida mayor a 5/15 y un 8,8 por ciento terminó con una visión menor a 5/50. Esta mala visión esta asociado a una patología previa como retinopatía diabética (28 por ciento) o Glaucoma (21 por ciento). Un 88 por ciento completo seguimiento mayor de 8 semanas. Conclusiones: Los resultados obtenidos en el monitoreo de catarata son cercanos a los resultados sugeridos por la Organización Mundial de la Salud. No debemos descuidar la selección de casos y mejorar la agudeza visual final de presentación con una adecuada biometría y receta de lentes.

Onjective: To determine the usefulness, of cataract surgery monitoring in a public health system to evaluated causes of poor vision. Material and Method: A retrospective study of patients who underwent cataract surgery in "Hospital Regional de Concepción-Chile", during April 2005, 2006 and 2007. For the analysis the "Cataract Outcome" program was used. Results: Out of 225 procedures, 180 cases were analyzed (80 percent). 57 percent were women; 82.2 percent older than 60 years old and a 21 percent have some kind of ocular disease associated. 91 percent underwent facomulsification, 96 percent with IOL implantation and we had 14 percent surgical complications. Visual acuity improved with time, 86.2 percent of patients obtained vision greater to 6/18 (corrected visual acuity) and only 8.8 percent ended up with less than 6/60. This poor vision outcome was related to existing ocular diseases such as diabetic Retinopathy (28 percent) or Glaucoma (21 percent). 88 percent of the cases completed the 8 weeks or more follow-up. Conclusions: The results obtained by the cataract monitoring are close to the results suggested by the World-wide Organization of the Health. We should not neglect the case selection process and we should improve the final visual acuity with a proper biometry and lens prescription.

effect of trypan blue anterior capsular stainning on lens epithelial cells: a histopathological study

The aim of the present study is to detect the histopathological impact of trypan blue dye on anterior capsular epithelial cells of the anterior capsules stained with trypan blue dye during phacoemulsification. Twenty cataractous eyes underwent anterior capsule staining using 1 mL typan blue dye 0.5%, under air as apart of a routine phacoemulsification of the cataractous lens. Anterior capsulorhexis was done and the obtained anterior capsule flaps were sent for histopathological examination. As a control group, 20 cataractous eyes underwent phacoemulsification without capsular staining and the flaps were sent for histological examination compareing the findings in both groups. The histopathological examination of the stained capsules demonstrate, focally ragged and irregular outer limit of the capsule with reduction of thickness and considerable loss of cells and change in the viability of the residual epithelial cells compared with the unstained capsules. Staining the anterior lens capsule during cataract surgery using the most popular trypan blue dye appears not only to facilitate capsular visualization but also can attack the lens epithelial cells, the main source for capsule opacification. Further studies and clinical correlation is mandatory to further evaluate the cytotoxic effect of the dye on different ocular structures and its effect on posterior capsule opacification

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.