ABSTRACT
PURPOSE: To compare visual outcomes, corneal astigmatism, and keratometric readings in patients with keratoconus who underwent intrastromal corneal ring implantation (ICRSI) alone with those who underwent ICRSI combined with ultraviolet A riboflavin-mediated corneal collagen crosslinking (CXL). METHODS: Pre- and post-operative best-corrected distance visual acuity (BCDVA), spherical error, cylindrical error, and mean keratometry were retrospectively compared over a period of 2 years in patients with keratoconus who underwent only ICRSI (group 1) versus those in patients who underwent combined ICRSI-CXL (group 2). RESULTS: Thirty-two eyes of 31 patients were evaluated. CXL was performed in 10 cases (31%), and there were no complications or need for ring repositioning. BCDVA improved from 0.54 to 0.18 in the group 1 and from 0.56 to 0.17 in the group 2. Spherical and cylindrical errors and mean keratometry values significantly decreased in both groups. No patient postoperatively had visual acuity (VA) of less than 20/60 on refraction, and 78% exhibited VA better than or equal to 20/40 with spectacles (72% of group 1 and 90% of group 2). Improvement in the spherical equivalent (SE) value was observed in the group 1 (from -5.89 ± 3.37 preoperatively to -2.65 ± 2.65 postoperatively; p<0.05) and group 2 (from -6.91 ± 1.93 preoperatively to -2.11 ± 3.01 postoperatively; p<0.05). CONCLUSION: Both techniques can be considered safe and effective in improving VA and refractive SE values, in decreasing the curvature of the cone apex in the topographical analysis, and in decreasing corrected diopters postoperatively in patients with keratoconus.
Subject(s)
Corneal Stroma/surgery , Corneal Surgery, Laser/methods , Cross-Linking Reagents/therapeutic use , Keratoconus/surgery , Prosthesis Implantation/methods , Adolescent , Adult , Collagen/therapeutic use , Combined Modality Therapy , Corneal Topography , Female , Humans , Male , Middle Aged , Photosensitizing Agents/therapeutic use , Prostheses and Implants , Retrospective Studies , Riboflavin/therapeutic use , Statistics, Nonparametric , Treatment Outcome , Ultraviolet Rays , Visual Acuity/physiology , Young AdultABSTRACT
Purpose: To compare visual outcomes, corneal astigmatism, and keratometric readings in patients with keratoconus who underwent intrastromal corneal ring implantation (ICRSI) alone with those who underwent ICRSI combined with ultraviolet A riboflavin-mediated corneal collagen crosslinking (CXL). Methods: Pre- and post-operative best-corrected distance visual acuity (BCDVA), spherical error, cylindrical error, and mean keratometry were retrospectively compared over a period of 2 years in patients with keratoconus who underwent only ICRSI (group 1) versus those in patients who underwent combined ICRSI-CXL (group 2). Results: Thirty-two eyes of 31 patients were evaluated. CXL was performed in 10 cases (31%), and there were no complications or need for ring repositioning. BCDVA improved from 0.54 to 0.18 in the group 1 and from 0.56 to 0.17 in the group 2. Spherical and cylindrical errors and mean keratometry values significantly decreased in both groups. No patient postoperatively had visual acuity (VA) of less than 20/60 on refraction, and 78% exhibited VA better than or equal to 20/40 with spectacles (72% of group 1 and 90% of group 2). Improvement in the spherical equivalent (SE) value was observed in the group 1 (from -5.89 ± 3.37 preoperatively to -2.65 ± 2.65 postoperatively; p<0.05) and group 2 (from -6.91 ± 1.93 preoperatively to -2.11 ± 3.01 postoperatively; p<0.05). Conclusion: Both techniques can be considered safe and effective in improving VA and refractive SE values, in decreasing the curvature of the cone apex in the topographical analysis, and in decreasing corrected diopters postoperatively in patients with keratoconus. .
Objetivo: Comparar os resultados visuais, astigmatismo corneano e ceratometria em pacientes com ceratocone submetidos a implante de anel corneano intraestromal (ICRSI) e quando em combinação com radiação ultravioleta associado ao crosslinking do colágeno corneano mediada pela riboflavina (CXL). Métodos: Comparou-se retrospectivamente pacientes com ceratocone submetidos somente a implante de anel corneano intraestromal (grupo 1) versus o mesmo procedimento associado ao crosslinking em um período de 2 anos. Avaliou-se acuidade visual com correção, equivalente esférico, ápice do cone na topografia e adaptação com lentes de contato pré e pós operatórios. Resultados: O estudo avaliou 32 olhos de 31 pacientes. Em 10 casos (31%) foi realizado crosslinking corneano, não havendo complicações ou necessidade de reposicionamento do anel. Acuidade visual corrigida pré e pós-operatória, componentes esférico e cilíndrico da refração e valores de ceratometria media diminuíram significativamente em ambos os grupos. Após o implante, nenhum paciente apresentou acuidade visual pior que 20/60 e 78% apresentaram acuidade corrigida melhor ou igual a 20/40 (72% do grupo 1 e 90% do grupo 2). Observou-se diminuição no valor do equivalente esférico no grupo 1 (de -5,89 ± 3,37 pré-operatório para -2,65 ± 2,65 pós-operatório; p<0,05) e no grupo 2 (de -6,91 ± 1,93 pré-operatório para -2,11 ± 3,01 pós-operatório; p<0,05). Conclusão: Ambas as técnicas podem ser consideradas seguras e eficazes na melhora da acuidade visual e equivalente esférico, diminuição do ápice de curvatura do cone na análise topográfica e na redução de dioptrias a serem corrigidas no pós-operatório de pacientes com ceratocone. .
Subject(s)
Humans , Alcohols/pharmacology , Anti-Infective Agents, Local/pharmacology , Enterococcus/drug effects , Hand Disinfection , Colony Count, Microbial , Hand/microbiology , Infection Control , Vancomycin ResistanceABSTRACT
OBJETIVO: O espessamento médio-intimal (EMI) na artéria carótida comum é considerado fator de risco cardiovascular e marcador de doença arterial coronariana precoce. O objetivo deste trabalho foi investigar a existência de correlação entre o EMI nas artérias carótidas e na origem da artéria subclávia direita, e avaliar o EMI na artéria subclávia como um marcador mais precoce para avaliação de risco cardiovascular. MÉTODOS: Cento e seis pacientes consecutivos, 52 homens e 54 mulheres, com média de idade de 51 anos, foram submetidos à avaliação das artérias carótidas e subclávia direita pela ultra-sonografia vascular com Doppler colorido. Para avaliar a associação entre EMI das artérias carótidas e subclávia direita calcularam-se o coeficiente de correlação de Pearson e o intervalo de 95 por cento de confiança para esse coeficiente. A qualidade da medida do EMI da artéria subclávia direita para diagnóstico de espessamento precoce, considerando-se o espessamento da carótida como padrão de referência (> 0,8 mm), foi descrita por valores de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia. Pontos de corte para o EMI da artéria subclávia foram sugeridos pela Curva ROC. Valores de p < 0,05 foram considerados estatisticamente significantes. RESULTADOS: Na associação entre 41 artérias carótidas sem EMI, 30 (73 por cento) artérias subclávias direitas apresentavam EMI > 0,8 mm. O valor médio de EMI obtido na artéria carótida foi de 0,87 mm (DP = 0,23) e na artéria subclávia direita foi de 1,17 mm (DP = 0,46), com coeficiente de correlação de 0,31 (95 por cento IC: 0,12 ; 0,47). A avaliação pela curva ROC demonstrou um valor de corte de 0,7 mm para EMI da artéria subclávia direita, tendo como padrão de referência o valor de corte de EMI da artéria carótida de 0,8 mm (sensibilidade 91 por cento, especificidade 27 por cento, VPP 66 por cento, VPN 65 por cento e acurácia 66 por cento). CONCLUSÃO: Existe boa correlação entre o EMI...
OBJECTIVE: Common carotid artery intima-media thickness (IMT) is considered a factor of cardiovascular risk and an early marker of coronary artery disease. This study aimed to investigate the existence of a correlation between IMT in the carotid arteries and at the origin of the right subclavian artery, as well as to evaluate IMT in the subclavian artery as an earlier marker of cardiovascular risk. METHODS: One hundred and six consecutive patients, 52 males and 54 females, average age 51 years, underwent color Doppler ultrasonography to evaluate carotid and right subclavian arteries. The relationship between carotid IMT and right subclavian IMT was assessed using the Pearson's correlation coefficient analysis and a 95 percent confidence interval. Reliability of right subclavian artery IMT measurement for the diagnosis of early thickening (considering a > 0.8 mm carotid thickness as reference) was described as to sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Cut-off values for the right subclavian IMT were indicated by the ROC curve, and p values < 0.05 were considered statistically significant. RESULTS: Out of the 41 patients whose carotid arteries were IMT-free, 30 (73 percent) had right subclavian artery IMT values > 0.8 mm. The mean IMT value for the carotid artery was 0.87 mm (SD = 0.23) and for the subclavian artery, 1.17 mm (SD = 0.46), with a 0.31 correlation coefficient (95 percent CI: 0.12; 0.47). The ROC curve analysis indicated a cut-off value of 0.7 mm for the right subclavian artery IMT, using as reference a 0.8 mm cut-off value for the carotid artery (91 percent sensitivity, 27 percent specificity, 66 percent PPV, 65 percent NPV, and 66 percent accuracy). CONCLUSION: Our study showed that carotid artery IMT correlates well with right subclavian artery IMT. With a 0.7 mm cut-off value, it is possible to detect IMT in the right subclavian artery earlier than in the carotid arteries. The IMT at the...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Carotid Artery, Common/pathology , Coronary Disease/pathology , Subclavian Artery/pathology , Tunica Intima/pathology , Tunica Media/pathology , Biomarkers , Carotid Artery, Common , Coronary Disease , Predictive Value of Tests , Reference Values , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Subclavian Artery/ultrastructure , Tunica Intima , Tunica MediaABSTRACT
OBJECTIVE: Common carotid artery intima-media thickness (IMT) is considered a factor of cardiovascular risk and an early marker of coronary artery disease. This study aimed to investigate the existence of a correlation between IMT in the carotid arteries and at the origin of the right subclavian artery, as well as to evaluate IMT in the subclavian artery as an earlier marker of cardiovascular risk. METHODS: One hundred and six consecutive patients, 52 males and 54 females, average age 51 years, underwent color Doppler ultrasonography to evaluate carotid and right subclavian arteries. The relationship between carotid IMT and right subclavian IMT was assessed using the Pearson's correlation coefficient analysis and a 95% confidence interval. Reliability of right subclavian artery IMT measurement for the diagnosis of early thickening (considering a > 0.8 mm carotid thickness as reference) was described as to sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Cut-off values for the right subclavian IMT were indicated by the ROC curve, and p values < or = 0.05 were considered statistically significant. RESULTS: Out of the 41 patients whose carotid arteries were IMT-free, 30 (73%) had right subclavian artery IMT values > 0.8 mm. The mean IMT value for the carotid artery was 0.87 mm (SD = 0.23) and for the subclavian artery, 1.17 mm (SD = 0.46), with a 0.31 correlation coefficient (95% CI: 0.12; 0.47). The ROC curve analysis indicated a cut-off value of 0.7 mm for the right subclavian artery IMT, using as reference a 0.8 mm cut-off value for the carotid artery (91% sensitivity, 27% specificity, 66% PPV, 65% NPV, and 66% accuracy). CONCLUSION: Our study showed that carotid artery IMT correlates well with right subclavian artery IMT. With a 0.7 mm cut-off value, it is possible to detect IMT in the right subclavian artery earlier than in the carotid arteries. The IMT at the origin of the right subclavian artery can be considered an earlier marker for the assessment of cardiovascular risk.