Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Rejeição de Enxerto/prevenção & controle , Paracentese/métodos , Lâmina Limitante Posterior/cirurgia , Endotélio Corneano/cirurgia , Humanos , Complicações Pós-Operatórias/prevenção & controleRESUMO
PURPOSE: To assess the relationship between age, corneal astigmatism, and ocular dimensions with reference to astigmatism correction during cataract surgery. METHODS: In this cross-sectional study of right eyes of 2247 consecutive patients attending cataract surgery preassessment, data on patient demographics, axial length (AL), anterior chamber depth (ACD), and keratometric astigmatism were collected. Astigmatism was further analyzed as against-the-rule (ATR: steepest meridian 180±30°), with-the-rule (WTR: 90±30°), and oblique (OB: 30-60°or 120-150°). RESULTS: Mean age, AL, and ACD were 72.28±13.84 years, 23.99±1.85 mm and 3.08 ±0.52 mm, respectively. In all, 20.4% eyes had ≤0.50 diopters (D), 55.2% had 0.51-1.50 D, 7.9% had 2.01-3.00 D, and 3.7% eyes had >3.00 D of astigmatism. Overall, 44.2% of eyes had corneal astigmatism >1.00 D. Average astigmatism in age ranges 40-49, 50-59, 60-69, 70-79, 80-89, and 90+ years were 0.82, 1.04, 1.04, 1.02, 1.15 and 2.01 D, respectively. The magnitude of preoperative astigmatism positively correlated with age (P<0.0001), with increasing and decreasing prevalence of ATR and WTR astigmatism, respectively, with advancing age. The magnitude of ATR astigmatism inversely correlates to AL (P<0.0001). ATR astigmatism is more prevalent with increasing magnitude of astigmatism (P<0.0001). CONCLUSIONS: A majority of patients for cataract surgery have astigmatism between 0.51 and 1.5 D. ATR astigmatism increases, whereas WTR decreases with age. ATR astigmatism inversely correlates to AL. With increasing age, the magnitude of astigmatism increases and ATR astigmatism becomes increasingly prevalent. The likelihood of a patient requiring astigmatic correction increases with age.
Assuntos
Envelhecimento/fisiologia , Astigmatismo/fisiopatologia , Comprimento Axial do Olho/fisiopatologia , Córnea/fisiopatologia , Facoemulsificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Câmara Anterior , Biometria , Criança , Estudos Transversais , Feminino , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
This review aims to assess the efficacy and safety of epithelial removal (ER) and transepithelial (TE) corneal collagen crosslinking (CXL) for the treatment of keratoconus. We used MEDLINE to identify all ER and TE CXL studies on keratoconic eyes (n≥20, follow-up ≥12 months). Ex vivo and studies for non-keratoconus indications or in conjunction with other procedures were excluded. Data on uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refractive cylinder, maximum keratometry (Kmax), and adverse events were collected at the latest follow-up and 1 year. Only one randomised controlled trial (RCT) qualified inclusion. Forty-four ER and five TE studies were included. For logMAR UDVA, CDVA, mean spherical equivalent, refractive cylinder and Kmax, at latest follow-up 81, 85, 93, 62, and 93% ER studies vs 66.7, 80, 75, 33, and 40% TE studies reported improvement, respectively. Whereas at 1 year, 90, 59, and 91% ER studies vs 80, 50, and 25% TE studies reported improvement, respectively. The majority of studies showed reduced pachymetry in both groups. Treatment failure, retreatment rates, and conversion to transplantation were reported to be up to 33, 8.6, and 6.25%, respectively, in ER studies only. Stromal oedema, haze, keratitis, and scarring were only reported in ER studies, whereas endothelial cell counts remained variable in both groups. Both ER and TE studies showed improvement in visual acuity, refractive cylinder but Kmax worsened in most TE studies. Adverse events were reported more with ER studies. This review calls for more high quality ER and TE studies with comparable parameters for further assessment of safety and efficacy.
Assuntos
Colágeno/metabolismo , Substância Própria/metabolismo , Reagentes de Ligações Cruzadas , Desbridamento/métodos , Epitélio Corneano/cirurgia , Ceratocone/tratamento farmacológico , Fármacos Fotossensibilizantes/uso terapêutico , Contagem de Células , Paquimetria Corneana , Endotélio Corneano/patologia , Humanos , Ceratocone/metabolismo , Riboflavina/uso terapêutico , Segurança , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To investigate patient risk factors and to look for potential causes of sterile infiltrates following an unexpected cluster of sterile keratitis after a routine collagen cross-linking (CXL) list. METHODS: The records of all 148 cases of CXL were reviewed retrospectively. The equipment and solutions used and our clinic's standard operating procedure for CXL were reviewed. An in-vitro experiment to explore the variation in ultraviolet A (UVA) irradiance from fluctuations in the working distance of the UVA lamp was conducted. RESULTS: The four patients who developed sterile infiltrates had steeper maximum corneal curvatures (68.0±7.3 D) and thinner pachymetry (389.9±49.0 µm) than the 144 who did not (57.0±8.2 D, P=0.05; 454.6±45.4 µm, P=0.08). A corneal curvature of >60 Dand a pachymetry of <425 µm were significant risk factors. All four affected cases obtained a complete resolution with topical antibiotics and steroids. The unaided VA and the maximum K improved from their pre-operative levels in three out of four patients. A 2-mm reduction in distance of the VEGA C.B.M. X-Linker from a treated surface increased irradiance to 3.5-3.7 mW/cm(2), which is above the threshold for endothelial toxicity. CONCLUSION: Patients with thinner and steeper corneas are at an increased risk of developing sterile keratitis. The visual outcomes despite this complication are good.
Assuntos
Colágeno/metabolismo , Reagentes de Ligações Cruzadas , Ceratite/etiologia , Ceratocone/tratamento farmacológico , Fármacos Fotossensibilizantes/uso terapêutico , Complicações Pós-Operatórias , Riboflavina/uso terapêutico , Adolescente , Adulto , Antibacterianos/uso terapêutico , Paquimetria Corneana , Substância Própria/metabolismo , Feminino , Glucocorticoides/uso terapêutico , Humanos , Ceratite/tratamento farmacológico , Ceratocone/metabolismo , Masculino , Estudos Retrospectivos , Fatores de Risco , Raios Ultravioleta , Adulto JovemRESUMO
PURPOSE: To measure optic shift (OS) of a single piece monofocal intraocular lens (IOL) with varying relationships between anterior capsule cover and IOL optic. METHODS: This is a prospective randomized masked study of 150 eyes undergoing phacoemulsification. Eyes received either option: 360 degrees total capsule cover (group I); partial cover (group II); or no cover (group III). OS was calculated as difference in anterior chamber depth after administration of cyclopentolate 1% and pilocarpine 2% on IOLMaster at separate visits at 6 months follow-up. Subsequently, using retro-illumination photographs, percentage area of capsule cover was calculated. OS within and between groups I and II was analyzed. The impact of one quartile change in area of capsule cover on percentage change in OS was measured for both groups. Unpaired t-test, correlation, and regression were applied. RESULTS: In groups I, II, and III, mean age of patients was 56.68+/-6.38, 57.09+/-7.34, 59.15+/-6.35 years, respectively; mean OS (mm) was 1.25+/-0.28, 1.20+/-0.24; 0.95+/-0.26 (P=0.013), respectively; and percentage area of capsule cover (%) was 47.35+/-10.48, 33.83+/-10.11, 0.16+/-0.13 (P=0.001), respectively. Mean percentage area of capsule cover in group I vsgroup II was significant (P=0.001). OS was 1.22+/-0.26 mm in groups I and II (combined) vs0.95+/-0.26 mm in group III (P=0.004, (0.06, 0.33)). OS in group I vsgroup II was not significant (P=0.46). Correlation coefficient was r=0.38 (P<0.001). With every increment on quartile (a quartile is any of the three values which divide the sorted data set into four equal parts, so that each part represents one-fourth of the sample or population) class of area of capsule cover the OS increased by 0.12 mm. CONCLUSION: The OS differed significantly between total and partial cover groups combined vsno cover group.
Assuntos
Cápsula do Cristalino/patologia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Facoemulsificação/métodos , Resinas Acrílicas , Adulto , Idoso , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Estudos Prospectivos , Acuidade VisualRESUMO
We report a case of live adult Bancroftian Filarial nematode removed from the sub conjunctival tissue of a 58-year-old woman from the temporal limbus of her left eye.