ABSTRACT
ABSTRACT Primary graft failure (PGF) is a known complication following penetrating keratoplasty (PKP). The usual approach to treat this complication is to repeat a penetrating keratoplasty. Here, we report a case of Descemet's membrane endothelial keratoplasty (DMEK) for the treatment of PGF after PKP. A patient that underwent PKP, developed PGF with persistent graft edema and very poor visual acuity despite aggressive steroid use and a proof anti-viral treatment. Three months after the initial surgery, a DMEK was performed under the PKP graft. There was progressive early corneal clearing and, by the end of the first month, the patient already had no corneal edema. Uncorrected visual acuity (UCVA) improved to 20/40 and best corrected visual acuity (BCVA) to 20/20. DMEK may be an alternative to a second PKP for the treatment of PGF. This technique is a less invasive option when compared to the standard PKP procedure.
RESUMO A falência primária do enxerto é uma complicação conhecida que pode ocorrer após o transplante penetrante de córnea. O tratamento usual dessa complicação é com um novo transplante penetrante. Apresentamos um caso em que foi usado o transplante endotelial de membrana de Descemet (DMEK - do inglês Descemet membrane endo-thelial keratoplasty) para o tratamento da falência primária após o transplante penetrante. Uma paciente submetida a transplante penetrante evoluiu com falência primária do enxerto a despeito do uso intenso de corticoide tópico e uma prova terapêutica de antivirais. Três meses após a cirurgia inicial, foi optado pela realização do transplante endotelial de membrana de Descemet sob o transplante penetrante. Houve um clareamento precoce e progressivo do enxerto com melhora importante da visão. Após um mês, a visão sem correção era de 20/40 melhorando para 20/20 com refração. O transplante endotelial de membrana de Descemet pode ser uma alternativa a um novo transplante penetrante como tratamento da falência primária.
ABSTRACT
ABSTRACT Purpose: The aim of this study was to validate the Portuguese version of Catquest-9SF through its application in a native Brazilian population with cataracts and to determine the correlation of the questionnaire scores with preoperative visual acuity. Methods: A prospective study was conducted to validate the Catquest-9SF questionnaire, which was translated and back-translated, generating a final version in Portuguese. A total of 120 Brazilian patients awaiting cataract surgery were recruited to answer the questionnaire and to document their preoperative data and visual acuity. The Rasch analysis was used to assess the instrument's psychometric properties. Results: The Portuguese version of Catquest-9SF demonstrated an acceptable adjustment of the items (item fit statistics ranging from 0.7 to 1.3), unidimensionality (principal component analysis), and good organization in the item response categories (thresholds of the categories: -2.79, 0.57, and 2.22, respectively). The questionnaire contains items with stable relationships if considered at the same level of visual impairment in the comparison between the two groups (absence of differential item functioning). The separation of people (person separation index, 3.07) was adequate. The visual acuity in the logarithm of the minimum angle of resolution (logMAR) in the best eye with the best optical correction showed a statistically significant correlation with the Catquest-9SF logit score (r=0.282 and p=0.004). Conclusions: The Portuguese version of Catquest-9SF presents evidence of validity and reliability, in addition to being linguistically and culturally understandable for Portuguese-speaking patients born in Brazil. The questionnaire is easy to understand and quick to apply, as it could adequately estimate the subjective visual functioning in patients with cataracts. We found a significant correlation between visual acuity and the questionnaire score.
RESUMO Objetivos: Validar a versão em português do Catquest-9SF através de sua aplicação em uma população nativa do Brasil com catarata e determinar a correlação da pontuação obtida no questionário com a acuidade visual pré-operatória. Métodos: Realizou-se um estudo prospectivo para validação de questionário. O Catquest-9SF foi traduzido e retro traduzido gerando uma versão final em português. Um total de 120 pacientes brasileiros que aguardavam realização de cirurgia de catarata foram recrutados para responder ao questionário e para documentação de dados pré-operatórios e acuidade visual. Análise Rasch foi utilizada para acessar as propriedades psicométricas do instrumento. Resultados: A versão em português do Catquest-9SF demonstrou ajuste aceitável dos itens (item fit statistics variando entre 0,7 e 1,3), unidimensionalidade (Principal Component Analisis) e boa organização nas categorias de resposta dos itens (limiares das categorias: -2,79; 0,57; 2,22). O questionário contém itens com relação estável, se considerado um mesmo nível de deficiência visual, na comparação entre dois grupos (ausência de differential item functioning). Existe adequada separação de pessoas (Person Separation Index 3,07). A acuidade visual em LogMAR no melhor olho com melhor correção óptica mostrou correlação estatisticamente significativa com a pontuação em logit do Catquest-9SF (r=0,282 e p=0,004). Conclusões: A versão em português do Catquest-9SF apresenta evidência de validade e confiabilidade, além de ser linguística e culturalmente compreensível para pacientes de língua portuguesa naturais do Brasil. Trata-se de questionário de fácil entendimento e rápida aplicação, sendo capaz de estimar de maneira adequada o funcionamento visual subjetivo em pacientes com catarata. Existe correlação significativa com a acuidade visual e a pontuação obtida no questionário.
ABSTRACT
PURPOSE: The aim of this study was to validate the Portuguese version of Catquest-9SF through its application in a native Brazilian population with cataracts and to determine the correlation of the questionnaire scores with preoperative visual acuity. METHODS: A prospective study was conducted to validate the Catquest-9SF questionnaire, which was translated and back-translated, generating a final version in Portuguese. A total of 120 Brazilian patients awaiting cataract surgery were recruited to answer the questionnaire and to document their preoperative data and visual acuity. The Rasch analysis was used to assess the instrument's psychometric properties. RESULTS: The Portuguese version of Catquest-9SF demonstrated an acceptable adjustment of the items (item fit statistics ranging from 0.7 to 1.3), unidimensionality (principal component analysis), and good organization in the item response categories (thresholds of the categories: -2.79, 0.57, and 2.22, respectively). The questionnaire contains items with stable relationships if considered at the same level of visual impairment in the comparison between the two groups (absence of differential item functioning). The separation of people (person separation index, 3.07) was adequate. The visual acuity in the logarithm of the minimum angle of resolution (logMAR) in the best eye with the best optical correction showed a statistically significant correlation with the Catquest-9SF logit score (r=0.282 and p=0.004). CONCLUSIONS: The Portuguese version of Catquest-9SF presents evidence of validity and reliability, in addition to being linguistically and culturally understandable for Portuguese-speaking patients born in Brazil. The questionnaire is easy to understand and quick to apply, as it could adequately estimate the subjective visual functioning in patients with cataracts. We found a significant correlation between visual acuity and the questionnaire score.
Subject(s)
Cataract , Humans , Reproducibility of Results , Prospective Studies , Portugal , Cataract/diagnosis , Cataract/epidemiology , Surveys and Questionnaires , Psychometrics , Quality of LifeABSTRACT
Primary graft failure (PGF) is a known complication following penetrating keratoplasty (PKP). The usual approach to treat this complication is to repeat a penetrating keratoplasty. Here, we report a case of Descemet's membrane endothelial keratoplasty (DMEK) for the treatment of PGF after PKP. A patient that underwent PKP, developed PGF with persistent graft edema and very poor visual acuity despite aggressive steroid use and a proof anti-viral treatment. Three months after the initial surgery, a DMEK was performed under the PKP graft. There was progressive early corneal clearing and, by the end of the first month, the patient already had no corneal edema. Uncorrected visual acuity (UCVA) improved to 20/40 and best corrected visual acuity (BCVA) to 20/20. DMEK may be an alternative to a second PKP for the treatment of PGF. This technique is a less invasive option when compared to the standard PKP procedure.
ABSTRACT
INTRODUCTION: Descemet membrane endothelial keratoplasty (DMEK) is the current gold standard surgical procedure to treat Fuchs endothelial keratoplasty. Cataract removal and intraocular lens (IOL) implantation can be safely combined with this corneal procedure. This paper presents a case series in which a toric intraocular lens (IOL) was used in combined DMEK and cataract surgery to correct corneal astigmatism. METHODS: Four eyes that had a toric IOL implanted in combined cataract and DMEK surgery were included. RESULTS: There was a reduction in manifest refractive cylinder and improvement in uncorrected and best-corrected vision in all cases. DISCUSSION: Surgeons may consider the use of toric IOLs in selected cases of combined DMEK and cataract surgery for Fuchs endothelial dystrophy.
ABSTRACT
PURPOSE: To evaluate the safety and efficacy of bilateral implantation of a supplementary small-aperture device to treat irregular corneal astigmatism. SETTING: Private practice. DESIGN: Retrospective consecutive case series. METHODS: Patients with bilateral irregular corneal astigmatism secondary to multiple causes and consented for implantation of the XtraFocus intraocular pinhole (IOPH) were enrolled. The mean follow-up was 27 months (range 5 to 66 months). Patients were assessed in their scheduled follow-up visits and monocular and binocular uncorrected and corrected distance and near visual acuities were recorded. Assessment of darkening vision complaints was also performed after implantation in the first eye and repeated after second-eye surgery. RESULTS: Thirty-two eyes of 16 patients were analyzed. The mean monocular and binocular uncorrected distance visual acuities improved from logMAR 1.091 ± 0.208 and 1.078 ± 0.259 preoperatively to 0.342 ± 0.091 (P < .001) and 0.342 ± 0.147 (P = .001) 1 year postoperatively. Three patients were excluded because of darkening vision complaints after surgery in the first eye. No major complications were noted after implantation of the IOPH. CONCLUSIONS: Bilateral implantation of the XtraFocus IOPH is a safe technique in a selected group of patients. There was improvement in visual acuity sustained over the analyzed period. Postoperative darkening vision complaints vary between individuals and can limit the application of this approach in certain patients.
Subject(s)
Astigmatism , Lenses, Intraocular , Phacoemulsification , Astigmatism/surgery , Humans , Lens Implantation, Intraocular , Prosthesis Design , Retrospective Studies , Visual AcuityABSTRACT
PURPOSE: To evaluate the long-term effectiveness and safety of the XtraFocus intraocular pinhole (IOPH) when it is implanted inside the capsular bag. SETTING: Private practice. DESIGN: Retrospective consecutive case series. METHODS: Patients who had an IOPH implanted in the capsular bag together with the primary intraocular lens (IOL) to treat irregular corneal astigmatism secondary to multiple causes were enrolled. The mean follow-up was 16 months (range 7 to 48 months). Patients were assessed in their scheduled follow-up visits. The uncorrected and corrected distance visual acuities were recorded at each visit. An infrared slitlamp photograph was captured and analyzed to verify the presence of interlenticular membrane formation. RESULTS: Sixty eyes of 58 patients were analyzed. The mean uncorrected and corrected distance visual acuities improved from logarithm of the minimum angle of resolution 1.34 ± 0.338 and 0.57 ± 0.145 preoperatively to 0.14 ± 0.012 (P < .001) and 0.12 ± 0.008 (P = .001) at 1 year postoperatively, respectively. A mild pinhole decentration was noted in 5 eyes (8.3%). Interlenticular opacification (ILO) was not noted in any patient. CONCLUSIONS: Implantation of the XtraFocus IOPH inside the capsular bag was a safe technique. Improvement observed in both uncorrected and corrected distance visual acuities was significant and sustained over time. ILO did not occur when this implant was positioned in the capsular bag together with a primary IOL.
Subject(s)
Lenses, Intraocular , Phacoemulsification , Humans , Lens Implantation, Intraocular , Retrospective Studies , Visual AcuityABSTRACT
Descemet membrane endothelial keratoplasty (DMEK) is gaining popularity worldwide as a procedure to address corneal endothelial dysfunctions. Its perfect anatomical result improves outcomes and expedites visual recovery. This review addresses important aspects of safety, efficacy and patient selection.
ABSTRACT
This paper proposes a customized and versatile optical setup to evaluate the optical performance of different commercially available intraocular lenses (IOLs). The setup was used to measure the wavefront error induced by different IOL models, verifying and analyzing the magnitude of low- and high-order aberrations induced by currently available IOLs. Independent analyses included non-toric spherical and aspheric IOLs from three different manufacturers. Three different dioptric powers were tested: 15, 20, and 25 D from each model. Dioptric power, induced cylinder, and spherical aberration were measured in each tested lens. All lenses had dioptric power within the tolerated margin of error. Induced cylinder was also within the current standards and clinically irrelevant. Spherical aberration varied according to the analyzed dioptric power and to the IOL model. We reported on the importance of the plane where the spherical aberration is reported, IOL or cornea. All analyzed IOLs were within current standards for the dioptric power and induced cylinder. Spherical IOLs had higher spherical aberration measured at the IOL plane.
Subject(s)
Lenses, Intraocular , Optical Devices , Equipment Design , Humans , Quality ControlABSTRACT
We present a case in which a different approach was used to treat an eye with dense cataract associated with an irregular failed full-thickness corneal graft. After cataract surgery, a foldable intraocular pinhole was implanted in the capsular bag to treat the irregular corneal astigmatism. Next, a Descemet membrane endothelial keratoplasty graft was used to improve transparency in the failed penetrating keratoplasty. This approach addressed the cataract, irregular cornea, and failed graft through a standard 2.2 mm clear corneal phacoemulsification incision, thus avoiding open-sky surgical time and expediting visual rehabilitation.
Subject(s)
Astigmatism/surgery , Cataract/etiology , Descemet Stripping Endothelial Keratoplasty/methods , Graft Rejection/surgery , Keratoplasty, Penetrating/adverse effects , Lens Implantation, Intraocular , Phacoemulsification/methods , Corneal Topography , Female , Graft Rejection/etiology , Humans , Microscopy, Acoustic , Middle Aged , Treatment Failure , Visual Acuity/physiologyABSTRACT
PURPOSE: To analyze the optical performance of different implant strategies in simulated nanophthalmic eyes. METHODS: An optical design software was used. Analysis included eye models that required 30.00, 45.00, and 60.00 diopters (D) intraocular lenses (IOLs) to achieve emmetropia. Spherical and aspheric IOLs were designed. They were tested either with a single implant setting S or by splitting the power into two lenses. Setting P1 had an even split of the power between the lenses and setting P2 had an uneven power split with one-third of the power in the anterior lens and two-thirds in the posterior IOL. The area under the modulation transfer function (MTF) curve was calculated and spherical aberration was recorded in each setting. RESULTS: Setting S had the worst optical performance in the spherical group and the best performance in the aspheric group. A statistically significant difference was found between setting S and the piggyback options (settings P1 and P2) in all analyzed variables for the spherical and aspheric groups for the 45.00 and 60.00 D IOL requirement. No statistically significant difference was found between the piggyback settings. CONCLUSIONS: Single aspheric IOLs had better optical performance than piggybacking lower-power aspheric IOLs. In the spherical lenses group, the results were the opposite, with the piggyback options having higher optical quality than the single IOL. MTF shows that single aspheric lenses provide the highest contrast sensitivity among all of the analyzed settings.
