Influence of pupillary dynamics on the defocus curve of eyes implanted with diffractive multifocal lenses: a randomized study / Influência da dinâmica pupilar na curva de desfoco de olhos implantados com lentes multifocais difrativas: um estudo randomizado

ABSTRACT Purpose: To evaluate the influence of pupil dynamics on the defocus profile and area-of-focus of eyes implanted with a diffractive multifocal intraocular lens (IOL). Methods: This prospective randomized trial was conducted at the Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. Thirty-eight patients were randomly assigned to receive the multifocal SN6AD1 (n=20) or the aspheric monofocal SN60WF (aIOL) (n=18) IOLs bilaterally. Dynamic pupillometry, visual acuity for distance and near, corrected and uncorrected, and a defocus profile were assessed postoperatively. The area-of-focus was calculated using an empirical polynomial model of the defocus profile. Results: Sixteen patients (32 eyes) in the multifocal SN6AD1 group and 17 patients (34 eyes) in the aspheric monofocal SN60WF group completed the 1-year follow-up. There were no significant between-group differences in monocular uncorrected distance or near visual acuity. The defocus profiles of the mfIOL group showed a double peak, whereas those of the aspheric monofocal SN60WF group showed only one peak, which is typical for a monofocal intraocular lens. The area-of-focus of the aIOL group (4.66 ± 1.51 logMARxD) was significantly different from that of the multifocal SN6AD1 (1.99 ± 1.31 logMARxD). Pupil size at maximum contraction after exposure to a flash of 30 cd/m2 for 1 second was significantly correlated with a better area-of-focus in the multifocal SN6AD1 group (r=0.54; p=0.0017), whereas this was not the case in the aspheric monofocal SN60WF group. Conclusion: These findings indicate that in eyes implanted with an multifocal SN6AD1, the smaller the pupil size, the better is the area-of-focus and hence the better is the visual performance. This correlation was not found for the aspheric monofocal SN60WF.(AU)

RESUMO Objetivo: Avaliar a influência da dinâmica pupilar na curva de desfoco de olhos implantados com lente intraoculares multifocais difrativas. Métodos: Estudo prospectivo e randomizado realizado na Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Departamento de Oftalmologia. Trinta e oito pacientes foram aleatoriamente designados para receber bilateralmente lentes intraoculares SN6AD1 (n=20) (mfIOL) ou SN60WF (n=18) (aIOL). Além da acuidade visual para longe e perto, corrigida e não corrigida, e curva de desfoco, foi ainda realizada pupilometria dinâmica. A área sob a curva de desfoco foi calculada usando um modelo polinomial empírico. Resultados: Um total de 16 e 17 pacientes (n=32 e 34 olhos) completaram 1 ano de seguimento nos grupos mfIOL e aIOL, respectivamente. Não houve diferenças significativas entre grupos para as acuidades visuais seja para longe ou perto. As curvas de desfoco do grupo mfIOL mostraram um pico duplo; enquanto o SN60WF mostrou apenas um pico, típico para uma lente intraoculares monofocal. A média da área sob a curva de desfoco do grupo aIOL foi (4,66 ± 1,51 logMAR.dp), e essa é estatisticamente significante diferente da métrica do grupo mfIOL (1,99 ± 1,31 logMAR.dp). A pupila na contração máxima após a exposição a um flash de 30 cd/m2 por 1 segundo foi significativamente correlacionada com uma melhor área de foco no grupo mfIOL (r=0,54; p=0,0017), essa relação não foi observada para o grupo aIOL. Conclusão: Estes dados indicam que quanto menor a pupila durante contração, melhor é a área sob a curva de desfoco e, portanto, o desempenho visual dos olhos implantados com essa mfIOL. Esta correlação não foi encontrada para lentes intraoculares monofocais.(AU)

Influence of pupillary dynamics on the defocus curve of eyes implanted with diffractive multifocal lenses: a randomized study.

PURPOSE: To evaluate the influence of pupil dynamics on the defocus profile and area-of-focus of eyes implanted with a diffractive multifocal intraocular lens (IOL). METHODS: This prospective randomized trial was conducted at the Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. Thirty-eight patients were randomly assigned to receive the multifocal SN6AD1 (n=20) or the aspheric monofocal SN60WF (aIOL) (n=18) IOLs bilaterally. Dynamic pupillometry, visual acuity for distance and near, corrected and uncorrected, and a defocus profile were assessed postoperatively. The area-of-focus was calculated using an empirical polynomial model of the defocus profile. RESULTS: Sixteen patients (32 eyes) in the multifocal SN6AD1 group and 17 patients (34 eyes) in the aspheric monofocal SN60WF group completed the 1-year follow-up. There were no significant between-group differences in monocular uncorrected distance or near visual acuity. The defocus profiles of the mfIOL group showed a double peak, whereas those of the aspheric monofocal SN60WF group showed only one peak, which is typical for a monofocal intraocular lens. The area-of-focus of the aIOL group (4.66 ± 1.51 logMARxD) was significantly different from that of the multifocal SN6AD1 (1.99 ± 1.31 logMARxD). Pupil size at maximum contraction after exposure to a flash of 30 cd/m2 for 1 second was significantly correlated with a better area-of-focus in the multifocal SN6AD1 group (r=0.54; p=0.0017), whereas this was not the case in the aspheric monofocal SN60WF group. CONCLUSION: These findings indicate that in eyes implanted with an multifocal SN6AD1, the smaller the pupil size, the better is the area-of-focus and hence the better is the visual performance. This correlation was not found for the aspheric monofocal SN60WF.

Costs and outcomes of phacoemulsification for cataracts performed by residents.

PURPOSE: To describe costs and outcomes of phacoemulsification for cataracts performed by ophthalmology residents. METHODS: We obtained medical records from patients operated on in 2011 by third year residents (R3) using phacoemulsification (n=576). Our expenses estimation included professionals' and hospital costs (fees, materials, medications, and equipment). The study outcomes included spectacle-corrected visual acuities before and six months after the operation, rate of intraoperative complications, and total number of postoperative visits. We compared outcome variables with those from extracapsular cataract extraction procedures (n=274) performed by R3 residents in 1997. RESULTS: The mean total cost for phacoemulsification was US$ 416, while an overall estimation indicated the extracapsular cataract extraction cost at US$ 284 (as of December 30, 2011). The mean preoperative spectacle-corrected visual acuity was worse for eyes scheduled for extracapsular cataract extraction (1.73 ± 0.62), than for eyes scheduled for phacoemulsification (0.74 ± 0.54 logMAR) (p<0.01); the mean postoperative visual acuity was better for phacoemulsification (0.21 ± 0.36 logMAR), than for extracapsular cataract extraction (0.63 ± 0.63 logMAR) (p<0.01). Most patients undergoing phacoemulsification (85%) achieved postoperative spectacle-corrected visual acuities ≥0.30 logMAR, while only 45% of those undergoing extracapsular cataract extractions achieved the same postoperative visual acuity (p<0.01). The rate of intraoperative complications was significantly higher after extracapsular cataract extractions (21%) than it was after phacoemulsifications (7.6%) (p<0.01), and the mean number of postoperative visits was also higher after extracapsular cataract extractions (5.6 ± 2.3) than after phacoemulsifications (4.5 ± 2.4) (p<0.01). CONCLUSION: These data indicate that cataract surgery performed by in-training ophthalmologists using phacoemulsification is expensive, but compared to extracapsular cataract extraction results, teaching phacoemulsification leads to an approximate three-fold lower complication rate, smaller number of postoperative visits and, most importantly, better visual acuities.

Phacoemulsification with big-bubble deep anterior lamellar keratoplasty: Variant of the triple procedure.

The surgical treatment of patients with combined advanced ectasia and cataract present is challenging. The most common approach is a corneal graft followed by cataract surgery at a later date. A second option is simultaneous corneal grafts with cataract extraction and intraocular lens implantation. This triple procedure has several benefits, which include a shorter period of visual disability and less cost to the patient than the 2-stage technique. There have been attempts to combine phacoemulsification and deep anterior lamellar keratoplasty (DALK) to maximize the advantages of both procedures in a single sitting. Some authors suggest a triple procedure in which the big-bubble DALK technique is performed before phacoemulsification; however, they recommend that phacoemulsification be performed with extreme caution to prevent Descemet membrane rupture. We describe a variant of the triple procedure in which phacoemulsification is followed by a corneal graft using the big-bubble DALK technique.

Haigis and SRKT formulae accuracy for intentional myopic overcorrection.

PURPOSE: To investigate the influence of preoperative biometric parameters on the accuracy of Haigis and SRKT formulae in predicting postoperative target refraction. METHODS: Retrospective analysis of 108 eyes (70 patients) underwent uneventful phacoemulsification surgery with implant of Alcon-SN60WF intraocular lens (IOL). Forty-five eyes were intentionally targeted to myopia (-0.75 to -1.25 dpt), while the others targeted between 0 and -0.75 dpt. Preoperative axial length and keratometry (K) were measured with optical biometry (LENSTAR-Haag-Streit). Postoperative spherical equivalent was assessed 3 ± 2 months after surgery. RESULTS: There is a significant correlation between the mean keratometry (K) and the Haigis-SRKT prediction differences (P < 0.001; r = 0.749). Linear regression indicates that a decrease of 1 diopter (D) on K implies an increase of 0.23 D on the difference between formulae prediction. K alone does not influence the prediction error for both formulas. The difference between the two formulae is dependent on K (r = -0.75; P < 0.01). Moreover, eyes with K <43.75 targeted at myopia (n = 23) showed a significant myopic shift of -0.26 ± 0.09 dpt (P < 0.05) with Haigis, but a hyperopic shift of 0.24 ± 0.09 dpt (P < 0.05) with SRKT. CONCLUSION: Divergences between Haigis and SRKT formulae cause uncertainty in choosing the IOL. Our results indicate that, in eyes with lower preoperative K, an IOL targeted at myopia might result in a small, but significant myopic shift with the Haigis formula, while a hyperopic shift with the SRKT formula.

Clinical study of pain sensation during phacoemulsification with and without cryoanalgesia.

PURPOSE: To compare the analgesic efficacy of 2 types of anesthetic techniques-topical and topical associated with cryoanalgesia-during cataract surgery. SETTING: Department of Ophthalmology, University of São Paulo, Ribeirão Preto, Brazil. DESIGN: Prospective randomized study. METHODS: Patients with symmetrical bilateral cataract had phacoemulsification with the use of an intraocular irrigation solution at room temperature in 1 eye and a cold (4°C) solution in the contralateral eye (Group 2). The pain related to the procedure was assessed using a visual analog scale ranging from 0 to 100, with 0 representing no pain and 100 the worst pain. In addition, endothelial cell loss, the change in corneal thickness, and visual acuity were evaluated 30 days ± 2 (SD) after each surgery. The surgery duration, total irrigation volume, phacoemulsification time, and ultrasound power used were analyzed. RESULTS: The study enrolled 25 patients (50 eyes). There was no statistically significant difference in the mean pain score between Group 1 (26.0 ± 3.7) and Group 2 (21.3 ± 3.6) (P = .2016, paired t test). No significant difference was found in the mean corneal endothelial cell loss (Group 1: 10.0% ± 0.4%; Group 2: 9.9% ± 0.3%; P = .7576), corneal thickness increase (Group 1: 1.5 ± 1.0 µm; Group 2: 1.4 ± 0.9 µm; P = .9340), or visual acuity gain (Group 1: 0.54 ± 0.06 logMAR; Group 2: 0.55 ± 0.09 logMAR; P = .8208). CONCLUSION: There is no difference in the intensity of pain during phacoemulsification with the use of topical anesthesia or topical anesthesia associated with cryoanalgesia. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Viral contamination during sequential phacoemulsification surgeries in an experimental model.

PURPOSE: To determine the incidence of Piry virus contamination among surgical instruments used with disposable accessories for phacoemulsification during sequential surgeries. METHODS: An experimental model was created with 4 pigs' eyes that were contaminated with Piry virus and 4 pigs' eyes that were not contaminated. Phacoemulsification was performed on the eyes, alternating between the contaminated and non-contaminated eyes. From one surgery to another, the operating fields, gloves, scalpel, tweezers, needles, syringes, tips and bag collector from the phacoemulsification machine were exchanged; only the hand piece and the irrigation and aspiration systems were maintained. RESULTS: In the collector bag, three samples from the contaminated eyes (3/4) were positive, and two samples from the non-contaminated (2/4) eyes were also positive; at the tip, one sample from the contaminated eyes (1/4) and two samples of the non-contaminated eyes (2/4) yielded positive results. In the irrigation system, one sample from a non-contaminated eye (1/4) was positive, and in the aspiration system, two samples from contaminated eyes (2/4) and two samples from non-contaminated eyes (2/4) were positive. In the gloves, the samples were positive in two samples from the non-contaminated eyes (2/4) and in two samples from the contaminated eyes (2/4). In the scalpel samples, three contaminated eyes (3/4) and none of the non-contaminated eyes (0/4) were positive; finally, two samples from the anterior chambers of the non-contaminated eyes gathered after surgery were positive. CONCLUSIONS: In two non-contaminated eyes, the presence of genetic material was detected after phacoemulsification surgery, demonstrating that the transmission of the genetic material of the Piry virus occurred at some point during the surgery on these non-contaminated eyes when the hand piece and irrigation and aspiration systems were reused between surgeries.

Viral contamination during sequential phacoemulsification surgeries in an experimental model / Contaminação viral durante cirurgias sequenciais de facoemulsificação em um modelo experimental

PURPOSE: To determine the incidence of Piry virus contamination among surgical instruments used with disposable accessories for phacoemulsification during sequential surgeries. METHODS: An experimental model was created with 4 pigs' eyes that were contaminated with Piry virus and 4 pigs' eyes that were not contaminated. Phacoemulsification was performed on the eyes, alternating between the contaminated and non-contaminated eyes. From one surgery to another, the operating fields, gloves, scalpel, tweezers, needles, syringes, tips and bag collector from the phacoemulsification machine were exchanged; only the hand piece and the irrigation and aspiration systems were maintained. RESULTS: In the collector bag, three samples from the contaminated eyes (3/4) were positive, and two samples from the non-contaminated (2/4) eyes were also positive; at the tip, one sample from the contaminated eyes (1/4) and two samples of the non-contaminated eyes (2/4) yielded positive results. In the irrigation system, one sample from a non-contaminated eye (1/4) was positive, and in the aspiration system, two samples from contaminated eyes (2/4) and two samples from non-contaminated eyes (2/4) were positive. In the gloves, the samples were positive in two samples from the non-contaminated eyes (2/4) and in two samples from the contaminated eyes (2/4). In the scalpel samples, three contaminated eyes (3/4) and none of the non-contaminated eyes (0/4) were positive; finally, two samples from the anterior chambers of the non-contaminated eyes gathered after surgery were positive. CONCLUSIONS: In two non-contaminated eyes, the presence of genetic material was detected after phacoemulsification surgery, demonstrating that the transmission of the genetic material of the Piry virus occurred at some point during the surgery on these non-contaminated eyes when the hand piece and irrigation and aspiration systems were reused between surgeries.

OBJETIVO: Determinar a incidência de contaminação com o vírus Piry entre os instrumentos cirúrgicos e acessórios usados durante cirurgias sequenciais de facoemulsificação. MÉTODOS: Um modelo experimental foi realizado com quatro olhos de porcos que foram contaminados com o vírus Piry e quatro olhos de porcos não contaminados. A facoemulsificação foi realizada alternando um olho contaminado para outro olho não contaminado. Entre as cirurgias, os campos de operação, luvas, bisturi, pinças, agulhas, seringas, pontas e bolsa coletora foram trocados, mantendo somente a caneta e os sistemas de irrigação e aspiração do facoemulsificador. RESULTADOS: No saco coletor, três amostras de olhos contaminados (3/4) foram positivos, e duas amostras de olhos não contaminados (2/4) também foram positivos; na ponta do facoemulsificador, uma amostra dos olhos contaminados (1/4) e duas amostras de olhos não contaminados (2/4) apresentaram resultados positivos. No sistema de irrigação, uma amostra de um olho não contaminado (1/4) foi positivo, e no sistema de aspiração, duas amostras de olhos contaminados (2/4) e duas amostras de olhos não contaminados (2/4) foram positivos. Nas luvas, as amostras foram positivos em dois olhos não contaminados (2/4) e duas amostras de olhos contaminados (2/4). Nas amostras de bisturi, três olhos contaminados (3/4) e nenhum dos olhos não contaminados (0/4) foram positivos e, finalmente, duas amostras da câmara anterior dos olhos não contaminados (2/4) reunidos após a cirurgia foram positivos. CONCLUSÕES: Em dois olhos não contaminados, a presença de material genético foi detectado após a cirurgia de facoemulsificação, demonstrando que a transmissão do material genético do vírus Piry ocorreu em algum ponto durante a cirurgia para estes olhos não contaminados, quando a caneta de facoemulsificação e o sistema de irrigação e aspiração foram reutilizados entre as cirurgias.

Capsulorhexis rescue after peripheral radial tear-out: quick-pull technique.

UNLABELLED: We describe a technique to rescue the continuous curvilinear capsulorhexis (CCC) in cases in which complete radial tears make it impossible to use normal traction forceps. A circumferential path and rapid movement are applied in the plane of the anterior capsule in the direction of the center pupil. This technique was used in 50 cases. In 47, the CCC could be completed; in 3, it could not and surgery was continued with low-parameter phacoemulsification. No other intraoperative complications occurred. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Effect of bevel position on the corneal endothelium after phacoemulsification / Efeito da posição do bisel da caneta de facoemulsificação no endotélio corneano

Purpose: To compare the extent of corneal endothelial (CE) cell loss changes in two groups of eyes submitted to phacoemulsification, with the conventional bevel-up tip position in one eye and with the bevel-down tip position in the fellow eye. Methods: This prospective clinical trial comprised 25 patients with bilateral cataracts subjected to lens removal by phacoemulsification with the conventional bevel-up tip position (GI) in one eye and with the bevel-down tip position (GII) in the fellow eye. The nuclei were graded clinically on the basis of hardness. The endothelial cell count (ECC) was evaluated preoperatively and 1, 3 and 6 months postoperatively. Total surgical time, effective ultrasound time and complications were also compared between the groups. Statistical analysis was performed by the Tukey Studentized Range test, with repeated measures for the selected periods. For the other parameters a paired t test was used. Data are presented as mean ± SD, with the level of significance set at p<0.05. Results: The mean effective ultrasound time was 8.08 ± 6.75 seconds in group I and 7.00 ± 5.75 seconds in GII (P=0.1792) and total surgical time was 10.01 ± 2.46 minutes in GI and 9.86 ± 2.17 minutes in GII (p=0.6267), respectively. The paired t test revealed no statistical differences between the groups. Complications were also similar between the groups. Mean endothelial cell count loss was 6.9 percent in GI and 2.8 percent in GII at one month; 6.9 percent in GI and 3.6 percent in GII at three months and 11.9 percent in GI and 7.6 percent in GII at six months postoperatively. Comparison of endothelial cell count (ECC) showed a statistically significant difference between the groups during the postoperative period. Conclusion: The conventional bevel-up tip position has a negative effect on corneal endothelial cells compared with the bevel-down position. Since the results of other surgical parameters were similar, the bevel-down tip position should be considered as an option in non-complicated phacoemulsification.

Objetivo: Comparamos duas técnicas de cirurgia de catarata. A técnica cirúrgica tradicional, em que direciona a abertura do bisel da ponteira de facoemulsificação para o endotélio corneano, com a técnica oposta, onde a reversão da posição de abertura permite o direcionamento da energia de emulsificação para o núcleo. Estudamos seus efeitos sobre a córnea e possíveis complicações. Métodos: O trabalho foi divido em quatro tempos: pré-operatório e após 30, 60 e 180 dias. Os pacientes foram divididos em dois grupos: o grupo 1, tratado com a técnica cirúrgica tradicional, com a abertura da ponteira direcionada para o endotélio, e grupo 2, que recebeu tratamento com técnica oposta, direcionada diretamente para o núcleo ou para os fragmentos nucleares. Após as cirurgias, foram estudados: perda endotelial após 30, 60 e 180 dias, tempo total de cirurgia e tempo efetivo de faco. Resultados: Os resultados intraoperatórios apresentaram o tempo efetivo de facoemulsificação no GI teve média de 8,08 segundos (DP=6,75) e no GII, média de 7,0 segundos (P=0,1792) e o tempo total de cirurgia de 10,01 ± 2,46 minutos no GI e 9,86 ± 2,17 minutos no GII (p=0,6267) respectivamente. O teste pareado não revelou diferença estatística entre os grupos. As complicações foram similares nos dois grupos. A média de perda de células endoteliais foi de 6,9 por cento no GI e2,8 por cento in GII com um mês; 6,9 por cento no GI e 3,6 por centonoGIIcom trêsmeses e 11,9 por cento no GI e 7,6 por cento no GII com seis meses de pós-operatório. Conclusão: Concluímos que a variação da manobra apresentada é segura e pode minimizar perdas no endotélio corneano, podendo ser uma opção na cirurgia da catarata, de acordo com as preferências pessoais do cirurgião.

Effect of bevel position on the corneal endothelium after phacoemulsification.

PURPOSE: To compare the extent of corneal endothelial (CE) cell loss changes in two groups of eyes submitted to phacoemulsification, with the conventional bevel-up tip position in one eye and with the bevel-down tip position in the fellow eye. METHODS: This prospective clinical trial comprised 25 patients with bilateral cataracts subjected to lens removal by phacoemulsification with the conventional bevel-up tip position (GI) in one eye and with the bevel-down tip position (GII) in the fellow eye. The nuclei were graded clinically on the basis of hardness. The endothelial cell count (ECC) was evaluated preoperatively and 1, 3 and 6 months postoperatively. Total surgical time, effective ultrasound time and complications were also compared between the groups. Statistical analysis was performed by the Tukey Studentized Range test, with repeated measures for the selected periods. For the other parameters a paired t test was used. Data are presented as mean ± SD, with the level of significance set at p≤0.05. RESULTS: The mean effective ultrasound time was 8.08 ± 6.75 seconds in group I and 7.00 ± 5.75 seconds in GII (P=0.1792) and total surgical time was 10.01 ± 2.46 minutes in GI and 9.86 ± 2.17 minutes in GII (p=0.6267), respectively. The paired t test revealed no statistical differences between the groups. Complications were also similar between the groups. Mean endothelial cell count loss was 6.9% in GI and 2.8% in GII at one month; 6.9% in GI and 3.6% in GII at three months and 11.9% in GI and 7.6% in GII at six months postoperatively. Comparison of endothelial cell count (ECC) showed a statistically significant difference between the groups during the postoperative period. CONCLUSION: The conventional bevel-up tip position has a negative effect on corneal endothelial cells compared with the bevel-down position. Since the results of other surgical parameters were similar, the bevel-down tip position should be considered as an option in non-complicated phacoemulsification.

Preoperative Nd:YAG laser anterior capsulotomy in white intumescent cataracts: report of 11 cases.

Creating a continuous curvilinear capsulorhexis in eyes with white intumescent cataracts is a challenge due to the high risk of extension of capsular tears to the lens periphery. Several approaches have been described to avoid this complication and preoperative Nd:YAG laser anterior capsulotomy has been little reported as an optional technique. Eleven patients with white intumescent cataracts were submitted to preoperative Nd:YAG laser anterior capsulotomy. All patients had some degree of cortex falling in anterior chamber after laser application. No patient developed later complications. Thus, preoperative Nd:YAG laser anterior capsulotomy represents a safe and easy option for white intumescent cataracts.

Preoperative Nd:YAG laser anterior capsulotomy in white intumescent cataracts: report of 11 cases / Capsulotomia anterior pré-operatória com Nd:YAG laser em cataratas brancas intumescentes: relato de 11 casos

Creating a continuous curvilinear capsulorhexis in eyes with white intumescent cataracts is a challenge due to the high risk of extension of capsular tears to the lens periphery. Several approaches have been described to avoid this complication and preoperative Nd:YAG laser anterior capsulotomy has been little reported as an optional technique. Eleven patients with white intumescent cataracts were submitted to preoperative Nd:YAG laser anterior capsulotomy. All patients had some degree of cortex falling in anterior chamber after laser application. No patient developed later complications. Thus, preoperative Nd:YAG laser anterior capsulotomy represents a safe and easy option for white intumescent cataracts.

A realização da capsulorrexis curvilínea contínua em olhos com catarata branca intumescente é ainda considerada um desafio pelo alto risco de extensão da capsulotomia para a periferia do cristalino. Apesar da descrição de diversas técnicas cirúrgicas voltadas para a prevenção de tal complicação, o uso de Nd:YAG laser no pré-operatório tem raros relatos na literatura internacional. Onze pacientes com cataratas brancas intumescentes foram submetidos a capsulotomia pré-operatória com Nd:YAG laser. Todos os pacientes apresentaram, após a aplicação do laser, a saída de córtex liquefeito para a câmara anterior. Nenhum paciente apresentou complicações cirúrgicas com o procedimento. Desta forma, a capsulotomia anterior com Nd:YAG laser representa uma opção técnica fácil e segura no manejo de cataratas brancas intumescentes.

Spontaneous late in-the-bag intraocular lens dislocation after can-opener capsulotomy: case report

Os autores relatam o caso de homem de 58 anos de idade que apresentou deslocamento espontâneo e tardio de lente intra-ocular dentro do saco capsular para o vítreo. O paciente havia sido submetido a facectomia extracapsular com capsulotomia do tipo abridor de latas e implante de lente de polimetilmetacrilato de três peças sem intercorrências e, dois anos após a cirurgia, desenvolveu síndrome de contração capsular com formação de um anel fibrótico na cápsula e subluxação da lente intra-ocular. Embora incomum e relacionada principalmente com capsulorexe curvilínea contínua, a síndrome de contração capsular pode ocorrer em pacientes submetidos a facectomia extracapsular com capsulotomia do tipo abridor de latas e implante de lente de polimetilmetacrilato e pode ser o fator causador do deslocamento da lente intra-ocular.