ABSTRACT
PURPOSE: To analyze and report the long-term outcomes in terms of efficacy and safety of eyes implanted with the spherical version of a foldable iris-fixated phakic intraocular lens (pIOL) for the correction of myopia. METHODS: Retrospective analysis of the results of 56 eyes of 32 patients (age, 19-45 years) who underwent implantation of the spherical model of the Artiflex pIOL (Ophtec B.V., Groningen, The Netherlands) for the correction of myopia. Visual, refractive, biometric, intraocular pressure (IOP) and corneal endothelial changes were evaluated during a long-term follow-up: 2, 7, 10 and 12 years for more than 50, 30, 20 and 10 eyes, respectively. RESULTS: At 4 weeks postoperatively, a significant reduction of manifest sphere and spherical equivalent (SE), with a significant improvement of uncorrected distance visual acuity were found (all p < 0.001). No significant changes were found during the rest of follow-up in sphere (p ≥ 0.072). The percentage of eyes with SE within ± 1.00 D was over 83% during the whole follow-up. A non-significant trend to IOP increase was observed at 4 weeks postoperatively (p = 0.530), with a significant reduction at 1 year after (p = 0.039) and no significant changes during the rest of follow-up (p = 0.180). There was a significant reduction of anterior chamber depth at 4 weeks after surgery (p < 0.001), with no significant changes during the following 9 years of follow-up (p = 0.118). However, an additional significant decrease of this parameter was observed between 10 and 13 years after surgery (p = 0.027). Mean endothelial cell loss changed from 2.01 ± 4.49% at 4 weeks after surgery to 9.11 ± 2.24% at the end of the follow-up. No complications were reported during the follow-up. CONCLUSIONS: Myopia correction with the Artiflex pIOL is an effective and safe procedure in the long term.
Subject(s)
Myopia , Phakic Intraocular Lenses , Humans , Young Adult , Adult , Middle Aged , Lens Implantation, Intraocular/methods , Retrospective Studies , Follow-Up Studies , Prospective Studies , Myopia/surgery , Refraction, Ocular , Iris/surgeryABSTRACT
PURPOSE: To analyse long-term efficacy, safety, visual and refractive stability and physiological changes of Artiflex Myopia and Toric phakic intraocular lenses (pIOL) separately throughout an 8-year follow-up. DESIGN: Retrospective cohort study. METHODS: A total of 67 eyes of 37 patients underwent Artiflex Myopia (47 eyes) or Artiflex Toric (20 eyes) implantation for correcting myopia and/or astigmatism. Follow-up evaluations were performed 1, 3, 5 and 8 years after surgery. Preoperative and postoperative data included corrected (CDVA) and uncorrected distance visual acuity (UDVA), manifest refraction, endothelial cell density (ECD) and intraocular pressure (IOP) assessments. Efficacy and safety indexes were analysed. The vectorial analysis was performed using the Thibos method. RESULTS: Mean CDVA and UDVA of both pIOLs significantly improved from preoperative to 1 year after implantation, and then it remained stable over the 8-year follow-up. The efficacy and safety indexes after 8 years were 0.94 ± 0.16 and 1.07 ± 0.18 for Artiflex Myopia and 1.00 ± 0.11 and 1.10 ± 0.15 for Artiflex Toric, respectively. The spherical equivalent (SE) significantly improved after surgery. J0, J45 and SE refractive components showed no changes between postoperative visits. A total ECD loss of 4.8% (p < 0.001) and 10.4% (p = 0.005) was found after 8 years for Artiflex Myopia and Toric, respectively. CONCLUSIONS: Artiflex Myopia and Toric pIOLs are a safe, efficient and predictable option for the correction of myopia and/or astigmatism. The vectorial analysis showed excellent rotation stability for the toric version.
Subject(s)
Astigmatism , Myopia , Phakic Intraocular Lenses , Astigmatism/surgery , Follow-Up Studies , Humans , Lens Implantation, Intraocular/methods , Myopia/surgery , Refraction, Ocular , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the clinical outcomes obtained after cataract or crystalline lens surgery with implantation of a new continuous transitional focus intraocular lens (IOL). SETTING: San Rafael Hospital, Madrid, Spain. DESIGN: Nonrandomized prospective case series. METHODS: Uncomplicated phacoemulsification cataract surgery was performed with bilateral implantation of the continuous transitional focus IOL Precizon Presbyopic. Visual, refractive, and contrast sensitivity outcomes were evaluated during a 6-month follow-up. Likewise, the incidence of postoperative disturbing photic phenomena was recorded. RESULTS: Sixty-two eyes of 31 patients (mean age: 61.3 years) were enrolled. Mean 6-month postoperative binocular uncorrected distance (UDVA), intermediate (UIVA), and near visual acuity (UNVA) were 0.01 ± 0.03, 0.17 ± 0.04, and 0.02 ± 0.04 logarithm of the minimum angle of resolution (logMAR), respectively. A total of 98.4% (61) and 93.5% (58) of eyes achieved 20/25 monocular UDVA and UNVA or better, respectively, whereas all eyes (100%) achieved 20/30 UIVA or better. Mean corrected visual acuity of 0.14 ± 0.05, 0.15 ± 0.06, and 0.19 ± 0.02 logMAR were obtained for the defocus levels of -1.00, -1.50, and -2.00 diopters. Mean 6-month postoperative log contrast sensitivity was 1.22 ± 0.18 and 0.75 ± 0.10 for 12 and 18 cycles per degree, respectively. A total of 9.7% (3) and 6.5% (2) of patients reported disturbing halos and glare. CONCLUSIONS: This presbyopia-correcting IOL provided a complete visual rehabilitation after cataract surgery, maintaining excellent levels of visual quality. Specifically, the IOL generated a continuous range of functional vision from distance to near, with minimal levels of photic phenomena associated.
Subject(s)
Lens Implantation, Intraocular , Lenses, Intraocular , Phacoemulsification , Presbyopia/rehabilitation , Pseudophakia/physiopathology , Aged , Aged, 80 and over , Astigmatism/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Presbyopia/physiopathology , Prospective Studies , Refraction, Ocular/physiology , Treatment Outcome , Vision, Binocular/physiology , Visual Acuity/physiologyABSTRACT
Fundamento y objetivo: La fórmula Modification of Diet in Renal Disease (MDRD) es la recomendada por la mayoría de las sociedades científicas para el cálculo del filtrado glomerular estimado (FGe). Recientemente el grupo Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) ha publicado una nueva ecuación con mayor exactitud y precisión. Hemos analizado su comportamiento en un grupo de pacientes pluripatológicos (PP) comparándola con la versión clásica MDRD-4. Pacientes y método: Estudio multicéntrico, observacional, descriptivo y transversal. Se calculó el FGe por MDRD-4 y CKD-EPI en 425 PP. A cada uno se le asignó un estadio según su FGe: 1: > 90; 2: 60-89; 3: 30-59; 4: 15-29; y 5: < 15 ml/min/1,73m2. Se analizó la concordancia entre ambas y la reclasificación de pacientes por CKD-EPI. Resultados: La edad media (DE) fue de 81,7 (7,9) años. El 55,3% eran mujeres. La media del FGe fue de 58,6 (26,3) ml/min/1,73m2 según MDRD-4 y de 52,7 (23,0) ml/min/1,73m2 según CKD-EPI (p < 0,001; coeficientes de correlación Rho de Spearman y de concordancia de Lin: 0,993 y 0,948, respectivamente). Los gráficos de Bland-Altman reflejaban valores inferiores de FGe para la ecuación CKD-EPI. En el estadio 2, el 21,2% eran reasignados por CKD-EPI al estadio 3, siendo las mujeres mayores de 83 años el subgrupo más desfavorecido, con el 27,3% de reclasificación. Conclusiones: La CKD-EPI aplicada al cálculo del FGe en PP empeora los resultados de la estimación mediante MDRD-4. Origina, de forma general, valores de FGe inferiores e incrementa el grado de insuficiencia renal, en especial en mujeres más añosas (AU)
Background and objective: The Modification of Diet in Renal Disease (MDRD) equation is recommended by most scientific societies to calculate the estimated glomerular filtration rate (GFR). Recently the group Chronic Kidney Disease Epidemiology Collaboration (CKP-EPI) has published a new, more precise and accurate equation. We have analyzed its behavior in a group of polypathological patients (PP) and compared it with the classic MDRD-4.version Patients and method: Multicenter, observational, descriptive and transversal study. We calculated GFR by MDRD-4 and CKD-EPI in 425 PP. Each stage was assigned according to the GFR: 1: > 90; 2: 60-89; 3: 30-59; 4: 15-29; and 5 < 15 ml/min/1.73m2. We analyzed the correlation between both and the patients reclassified by CKD-EPI. Results: Mean age was (mean [SD]) 81.7 (7.9) years. 55.3% were women. The mean estimated GFR was 58.6 (26.3) ml/min/1,73m2 by MDRD-4 and 52.7 (23.0) ml/min/1.73m2 by CKD-EPI (P < .001; Spearman's Rho correlation and Lin concordance coefficients: 0.993 and 0.948). The Bland-Altman plots reflected lower values for GFR for CKD-EPI equation. In the stage 2, 21.2% were reclassified by CKD-EPI to the stage 3, with women older than 83 years being the more disadvantaged subgroup with 27.3% or reclassification. Conclusion: CKD-EPI equation applied to PP worsens the results of MDRD-4. In general, it originates low values of GFR and increases the degree of renal insufficiency, especially in older women (AU)
Subject(s)
Humans , Male , Female , Renal Insufficiency, Chronic/epidemiology , Glomerular Filtration Rate/physiology , Comorbidity , Practice Patterns, Physicians' , Age and Sex Distribution , Reproducibility of Results , Sensitivity and Specificity , Kidney Function Tests/methodsABSTRACT
BACKGROUND AND OBJECTIVE: The Modification of Diet in Renal Disease (MDRD) equation is recommended by most scientific societies to calculate the estimated glomerular filtration rate (GFR). Recently the group Chronic Kidney Disease Epidemiology Collaboration (CKP-EPI) has published a new, more precise and accurate equation. We have analyzed its behavior in a group of polypathological patients (PP) and compared it with the classic MDRD-4.version PATIENTS AND METHOD: Multicenter, observational, descriptive and transversal study. We calculated GFR by MDRD-4 and CKD-EPI in 425 PP. Each stage was assigned according to the GFR: 1:>90; 2: 60-89; 3: 30-59; 4: 15-29; and 5 < 15 ml/min/1.73m(2). We analyzed the correlation between both and the patients reclassified by CKD-EPI. RESULTS: Mean age was (mean [SD]) 81.7 (7.9) years. 55.3% were women. The mean estimated GFR was 58.6 (26.3) ml/min/1,73m(2) by MDRD-4 and 52.7 (23.0) ml/min/1.73m(2) by CKD-EPI (P<.001; Spearman's Rho correlation and Lin concordance coefficients: 0.993 and 0.948). The Bland-Altman plots reflected lower values for GFR for CKD-EPI equation. In the stage 2, 21.2% were reclassified by CKD-EPI to the stage 3, with women older than 83 years being the more disadvantaged subgroup with 27.3% or reclassification. CONCLUSION: CKD-EPI equation applied to PP worsens the results of MDRD-4. In general, it originates low values of GFR and increases the degree of renal insufficiency, especially in older women.
Subject(s)
Algorithms , Glomerular Filtration Rate , Kidney Failure, Chronic/diagnosis , Renal Insufficiency, Chronic/physiopathology , Aged , Aged, 80 and over , Comorbidity , Cross-Sectional Studies , Female , Humans , Kidney Failure, Chronic/physiopathology , Male , Polypharmacy , Prospective Studies , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
CONTEXT: Decreased vitamin B12 concentration does not usually result in clinical or hematological abnormalities. Subacute combined spinal cord degeneration and pancytopenia are two serious and rarely displayed consequences that appear in severe deficits. CASE REPORT: We present the case of a patient with subacute combined spinal cord degeneration and pancytopenia secondary to severe and sustained vitamin B12 deficiency. Such cases are rare nowadays and have potentially fatal consequences. CONCLUSIONS: Vitamin B12 deficiency should be taken into consideration in the differential diagnosis in cases of blood disorders or severe neurological symptoms. Early diagnosis and treatment can avoid irreversible consequences.
Subject(s)
Pancytopenia/etiology , Subacute Combined Degeneration/etiology , Vitamin B 12 Deficiency/complications , Humans , Male , Middle Aged , Pancytopenia/drug therapy , Subacute Combined Degeneration/drug therapy , Treatment Outcome , Vitamin B 12/therapeutic use , Vitamin B 12 Deficiency/drug therapyABSTRACT
CONTEXT: Decreased vitamin B12 concentration does not usually result in clinical or hematological abnormalities. Subacute combined spinal cord degeneration and pancytopenia are two serious and rarely displayed consequences that appear in severe deficits. CASE REPORT: We present the case of a patient with subacute combined spinal cord degeneration and pancytopenia secondary to severe and sustained vitamin B12 deficiency. Such cases are rare nowadays and have potentially fatal consequences. CONCLUSIONS: Vitamin B12 deficiency should be taken into consideration in the differential diagnosis in cases of blood disorders or severe neurological symptoms. Early diagnosis and treatment can avoid irreversible consequences.
CONTEXTO: El descenso de la concentración de vitamina B12 no suele derivar en alteraciones clínicas o hematológicas. La degeneración combinada subaguda medular y la pancitopenia son dos consecuencias graves y poco frecuentes que aparecen en los déficit severos. CASO CLÍNICO: Presentamos el caso de un paciente con una degeneración combinada subaguda medular y pancitopenia secundarios a un déficit severo y mantenido de vitamina B12. Un caso poco común en nuestros días y con consecuencias potencialmente fatales. CONCLUSIONES: Debemos considerar el déficit de vitamina B12 dentro del diagnóstico diferencial en caso de alteraciones hematológicas o síntomas neurológicos graves. Su diagnóstico y tratamento precoz pueden evitar secuelas irreversibles.
