Reverse order method for teaching cataract surgery to residents.

OBJECTIVE: To implement a method to train residents in the performance of phacoemulsification surgery, with the steps completed in reverse chronological order and with the easiest step being undertaken first. METHODS AND ANALYSIS: We created a method for training ophthalmology residents in which we taught phacoemulsification surgery in a series of steps learnt in reverse order. Each resident advanced through the teaching modules only after being approved in the final step and then progressed to the complete performance of surgeries. We analysed the rates of complications in the 2 years after introducing the new method. RESULTS: The new method allowed for a standardised approach that enabled replicated teaching of phacoemulsification regardless of instructor or student. After implementing the new method, residents performed 1817 phacoemulsification surgeries in the first year and 1860 in the second year, with posterior capsule rupture rates of 8.42% and 7.9%, respectively. CONCLUSIONS: Teaching residents to perform the steps of phacoemulsification in a standardised reverse order resulted in low rates of complications.

Ultrasound Biomicroscopy Comparison of Ab Interno and Ab Externo Intraocular Lens Scleral Fixation.

Purpose. To compare ab interno and ab externo scleral fixation of posterior chamber intraocular lenses (PCIOL) using ultrasound biomicroscopy (UBM). Methods. Randomized patients underwent ab externo or ab interno scleral fixation of a PCIOL. Ultrasound biomicroscopy was performed 3 to 6 months postoperatively, to determine PCIOL centration, IOL distance to the iris at 12, 3, 6, and 9 hours, and haptics placement in relation to the ciliary sulcus. Results. Fifteen patients were enrolled in the study. The ab externo technique was used in 7 eyes (46.6%) and the ab interno in 8 eyes (53.3%). In the ab externo technique, 14 haptics were located: 4 (28.57%) in the ciliary sulcus; 2 (14.28%) anterior to the sulcus; and 8 (57.14%) posterior to the sulcus, 6 in the ciliary body and 2 posterior to the ciliary body. In the ab interno group, 4 haptics (25.0%) were in the ciliary sulcus, 2 (12.50%) anterior to the sulcus, and 10 (75.0%) posterior to the sulcus, 4 in the ciliary body and 6 posterior to the ciliary body. Conclusions. Ab externo and ab interno scleral fixation techniques presented similar results in haptic placement. Ab externo technique presented higher vertical tilt when compared to the ab interno.

Grooved and nongrooved clear corneal incisions in phacoemulsification: permeability study.

PURPOSE: To detect the inflow of trypan blue through grooved and nongrooved sutureless self-sealing clear corneal incisions at the end of phacoemulsification as compared to a control group. METHODS: A prospective randomized masked trial considered 52 eyes randomized into 3 groups in which phacoemulsification was performed: group A, nongrooved incisions; group B, grooved incisions; and group C, controls. By the end of each surgery, trypan blue was instilled on the ocular surface in groups A and B and rinsed out after 2 minutes. A sample of the anterior chamber content was collected and analyzed by high-performance liquid chromatography to identify and quantify the trypan blue concentration. The presence of trypan blue was expressed as a specific single peak graphic image. The mean areas of these peaks were used to assess the groups using a nonparametric Mann-Whitney test. RESULTS: There was a statistically significant difference between the nongrooved incisions group and the control group (p = 0.0448). No significant difference was observed between group B (grooved incision) and controls (p = 0.1800). CONCLUSIONS: Trypan blue was detected in the anterior chamber when nongrooved clear corneal incision was used. There was no trypan blue detection in the group with grooved clear corneal main incisions.

In vitro antimicrobial analysis of aqueous humor after topical application of moxifloxacin hydrochloride 0.5%.

PURPOSE: To evaluate the in vitro antimicrobial activity of aqueous humor in patients who had preoperative topical application of moxifloxacin hydrochloride 0.5%. SETTING: Department of Ophthalmology, Santa Casa de Misericórdia de São Paulo, Brazil. DESIGN: Comparative case series. METHODS: Twenty-nine eyes from 29 cataract surgery patients were included in this study. In the study group (n = 15 eyes), 3 topical applications of moxifloxacin hydrochloride 0.5% were administered preoperatively; in the control group (n = 14 eyes), no topical applications were administered. Aqueous humor samples were collected and stored in sterile microtubes at -80°C until analysis. Antimicrobial analysis was performed using standard strains with standard sterile filter paper disks. Inhibition halos were measured in millimeters, and both bactericidal and bacteriostatic effects were analyzed. RESULTS: Inhibition halos were observed on most of the study group plates except those with Streptococcus pneumoniae: Escherichia coli (13.93 mm ± 0.64 [SD]), Klebsiella pneumoniae (10.63 ± 0.61 mm), Staphylococcus aureus (7.47 ± 0.68 mm), and S epidermidis (4.20 ± 3.33 mm) The differences between the mean inhibition halo diameters were statistically significant (P < .0001) in all samples. No bactericidal effect was observed against any of the microorganisms studied. CONCLUSIONS: After topical application of moxifloxacin 0.5%, aqueous humor showed bacteriostatic effect against E coli, K pneumoniae, S aureus, and S epidermidis. No bactericidal effect was observed against any of the microorganisms evaluated. No antimicrobial effect against S pneumoniae was observed. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Visco-fracture technique for soft lens cataract removal.

UNLABELLED: We describe a visco-fracture technique for soft nucleus phacoemulsification. Following continuous curvilinear capsulorhexis, cortical cleavage hydrodissection, and hydrodelineation, an ophthalmic viscosurgical device (OVD) is delivered into the eye through a hydrodissection cannula. A small amount of pressure is used to introduce the cannula into the nucleus. The OVD is then gently injected, creating a small central crack. The surgeon can explore this initial crack, enlarging it in both directions to create a complete fracture of the nucleus. The maneuver can be repeated by rotating the nucleus 90 degrees, creating additional fractures in the same way. Each quadrant can then be emulsified using an auxiliary second instrument. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

[Reliability of predictable postoperative visual acuity of cataracts as measured by Heine Lambda 100 retinometer preoperatively]. / Confiabilidade da previsão da acuidade visual pós-operatória de catarata mediante medição da acuidade visual pré-operatória utilizando o retinômetro Heine Lambda 100.

PURPOSE: To assess the relationship between potential visual acuity obtained before cataract surgery using Heine Lambda 100 retinometer with best corrected visual acuity 3 months postoperatively, as well as its correlation with the morphological pattern of the dominant cataract and the intensity of nuclear opacification. METHODS: Prospective study executed in the Ophthalmology Hospital Laser Vision in Santos of 121 eyes of 70 patients who underwent cataract surgery (phacoemulsification with intraocular lens implantation), from April to July, 2009. In the preoperative period, Heine retinometer test was performed under mydriasis and its results were compared to postoperative best corrected visual acuity three months after surgery and correlated with the morphological classification of cataracts, being considered a satisfactory result those who did not vary more than two lines in Snellen chart. RESULTS: The satisfactory cases found in our study were 86.78%, with results of visual acuity with Heine retinometer equal to the postoperative visual acuity in 34.7% of the cases. Predominant nuclear opacity N1+ has a higher reliability than N2+ and N3+ (50%, 31.3% and 26.7%, respectively). Regarding all studied eyes, statistical significance was noted (p<0.0001). CONCLUSION: In most cases Heine retinometer underestimated or maintained best corrected visual acuity 3 months postoperatively in patients who underwent cataract surgery. With respect to the morphological classification of cataracts, the higher the opacity of the nuclear lens, the greater the visual acuity underestimation.

Confiabilidade da previsão da acuidade visual pós-operatória de catarata mediante medição da acuidade visual pré-operatória utilizando o retinômetro Heine Lambda 100 / Reliability of predictable postoperative visual acuity of cataracts as measured by Heine Lambda 100 retinometer preoperatively

Objetivo: Utilizar o retinômetro de Heine Lambda 100 para avaliar a relação da acuidade visual obtida no pré-operatório de cirurgia de catarata com a acuidade visual obtida 3 meses no pós-operatório com correção óptica, bem como, sua correlação com a classificação morfológica dominante da catarata e com a intensidade da opacificação quando do tipo nuclear. Métodos: Trata-se de um estudo prospectivo realizado no Hospital Oftalmológico Visão Laser, em Santos, envolvendo 121 olhos de 70 pacientes avaliados de abril a julho 2009, submetidos à cirurgia de catarata sob a técnica de facoemulsificação com implante de lente intraocular. No período pré-operatório, foi realizado o retinômetro de Heine sob midríase e seu resultado foi comparado à melhor acuidade visual pós-operatória do terceiro mês e correlacionado com a classificação morfológica da catarata, quando do tipo nuclear, sendo denominado satisfatório aquele resultado que não variou mais do que duas linhas na tabela de Snellen. Resultados: Os resultados satisfatórios em nosso estudo foram de 86,78 por cento, apresentando resultados de acuidade visual com retinômetro de Heine igual ao resultado da acuidade visual pós-operatória em 34,7 por cento. A opacidade predominantemente nuclear N1+ tem um porcentual de acerto maior do que N2+ e N3+ (50 por cento, 31,3 por cento e 26,7 por cento, respectivamente). Em relação ao total de olhos, observamos um teste extremamente significante (p<0,0001). Conclusão: O retinômetro de Heine hipoestimou ou manteve a acuidade visual pós-operatória corrigida após 3 meses dos pacientes submetidos à facectomia, na maioria dos casos. Ao correlacionar com a classificação morfológica da catarata, observamos que, quanto maior a opacidade do cristalino do tipo nuclear, maior a hipoestimação da acuidade visual.

Purpose: To assess the relationship between potential visual acuity obtained before cataract surgery using Heine Lambda 100 retinometer with best corrected visual acuity 3 months postoperatively, as well as its correlation with the morphological pattern of the dominant cataract and the intensity of nuclear opacification. Methods: Prospective study executed in the Ophthalmology Hospital Laser Vision in Santos of 121 eyes of 70 patients who underwent cataract surgery (phacoemulsification with intraocular lens implantation), from April to July, 2009. In the preoperative period, Heine retinometer test was performed under mydriasis and its results were compared to postoperative best corrected visual acuity three months after surgery and correlated with the morphological classification of cataracts, being considered a satisfactory result those who did not vary more than two lines in Snellen chart. Results: The satisfactory cases found in our study were 86.78 percent, with results of visual acuity with Heine retinometer equal to the postoperative visual acuity in 34.7 percent of the cases. Predominant nuclear opacity N1+ has a higher reliability than N2+ and N3+ (50 percent, 31.3 percent and 26.7 percent, respectively). Regarding all studied eyes, statistical significance was noted (p<0.0001). Conclusion: In most cases Heine retinometer underestimated or maintained best corrected visual acuity 3 months postoperatively in patients who underwent cataract surgery. With respect to the morphological classification of cataracts, the higher the opacity of the nuclear lens, the greater the visual acuity underestimation.

[Effect of honey and autologous serum on corneal epithelial healing in rabbits]. / Efeito do mel e do soro autólogo na cicatrização do epitélio corneano em coelhos.

PURPOSE: To evaluate the efficacy of pure honey and 20% autologous serum and BSS in corneal epithelial healing in rabbits after 48 hours. METHODS: All solutions were applied after an epithelial removal of 13-millimeters diameter area. Areas of epithelial healing were studied at 12, 24 and 48 hours. The eyes were treated every four hours during 2 days. All treated eyes were assigned to a control group (contralateral eye) treated with a balanced saline solution. RESULTS: All studied groups were not significantly different. In group one, the eyes treated with honey and the control were similar (p<0.87). In the second group the eyes treated with autologous serum and the control presented no difference in the mean score (p<0.072). CONCLUSION: Corneal epithelial healing in rabbits did not show improvement after application of either honey or autologous serum. It was possible to establish that the autologous serum treated eyes were clinically better than the control group but without statistical significance.

Efeito do mel e do soro autólogo na cicatrização do epitélio corneano em coelhos / Effect of honey and autologous serum on corneal epithelial healing in rabbits

OBJETIVO: Avaliar a eficácia de substâncias consideradas estimulantes da cicatrização, como o mel puro e o soro autólogo a 20 por cento na cicatrização do epitélio corneal de coelhos. MÉTODOS: Foi realizada a remoção do epitélio corneal de dois grupos de coelhos que receberam a instilação de solução de mel puro (G1) ou soro autólogo (G2) a cada 4 horas. O olho contralateral foi usado como controle e submetido ao mesmo procedimento de remoção do epitélio, recebendo a instilação de BSS®. A área de desepitelização corneal foi avaliada 12, 24 e 48 horas após a indução do defeito epitelial. RESULTADOS: Os grupos estudados foram estatisticamente semelhantes: mel (48 horas) e controle (48 horas) p<0,87; soro autólogo (48 horas) e controle (48 horas) p<0,072. CONCLUSAO: Mesmo constatando-se discreta melhora clínica no uso tópico do soro autólogo, a cicatrização do epitélio corneal não foi significativamente diferente durante este estudo em nenhum dos grupos estudados.

Efeito terapêutico da aplicação intra-ocular de ozônio em modelo experimental de endoftalmite por Staphylococcus epidermidis em coelhos / Therapeutic effect of intraocular application of ozone in experimental Staphylococcus epidermidis endophthalmitis

OBJETIVO: Avaliar a ação antiinflamatória e antimicrobiana da injeção intravítrea de ozônio diluído em solução salina balanceada (BSS) em modelo experimental de endoftalmite por Staphylococcus epidermidis. MÉTODOS: Dezessete coelhos da raça Nova Zelândia receberam inoculação no olho direito de 0,1 ml de uma solução de 10(5) bactérias (S. epidermidis) por ml para indução de endoftalmite. Sete coelhos receberam injeção intravítrea de 0,1ml de BSS como controle e os outros dez coelhos receberam injeção intravítrea de 0,1ml de BSS com ozônio diluído a 2 ppm. Os dados foram quantificados de acordo com parâmetros clínicos e histopatológicos e computados numericamente para cada coelho após 24 horas de evolução. As médias e os desvios-padrão (DP) foram calculados e comparados por meio de teste t com duas amostras. RESULTADOS: A média da quantificação clínica dos olhos dos coelhos do grupo controle foi de 11,14 com DP de 1,04. A média clínica dos olhos tratados com ozônio foi de 4,90 com DP de 1,29. A média dos olhos tratados com ozônio foi significativamente menor do que os não tratados (P<0,01). A média da quantificação histopatológica dos olhos dos coelhos do grupo controle e do grupo tratado com ozônio foi de 17,00 (DP=0,57) e de 10,20 (DP=1,30), respectivamente. A resposta inflamatória do grupo tratado foi significativamente menor do que o não tratado (P<0,01). CONCLUSAO: O ozônio diminuiu significativamente a reação inflamatória no modelo de endoftalmite pesquisado. Isto ocorreu possivelmente devido à redução da carga bacteriana provocado pelo ozônio. Ainda é necessário estudar vias de administração e concentrações de ozônio mais eficazes em outros modelos de infecção.