Pediatric cataracts: clinical aspects, frequency of strabismus and chronological, etiological, and morphological features / Catarata pediátrica: aspectos clínicos, frequência de estrabismo e características cronológicas, etiológicas e morfológicas

Purpose: This study aimed to evaluate the frequency of strabismus and chronological, etiological, and morphological features in patients with pediatric cataracts. Methods: Medical records of pediatric patients were evaluated at the Congenital Cataract Section, Department of Ophthalmology, Federal University of São Paulo, from 2001 to 2011. Patients with congenital cataract or developmental cataract were included. The patients with traumatic cataract, cataract secondary to uveitis, radiation or drugs, aphakic or pseudophakic patients who underwent surgery in another hospital, patients with glaucoma, non-lenticular leukocorias (retinoblastoma, retinopathy of prematurity, prelenticular leukocorias), and lens subluxation were excluded from the study. The following outcomes were evaluated: frequency of chronological, etiological, and morphological features, laterality, and occurrence of associated strabismus. Results: A total of 207 patients were included. One hundred and seventeen patients (56.5%) had congenital cataract and 90 patients (43.5%) had developmental cataract. One hundred and nine patients (52.6%) had unilateral cataract. In terms of morphology, 72 children (33.8%) had zonular cataract and 66 (31.9%) had total cataract. Idiopathic cataract affected 150 patients (72.5%). There were 108 patients (52.2%) with strabismus, mainly secondary esotropia. Conclusion: Idiopathic etiology was the most frequent cause in this group of patients. Zonular cataract was the main morphological type of cataract in the study. Unilateral cataract occurred more frequently in patients with persistent fetal vasculature (PFV). Strabismus presented in 52% of the patients. The current analysis may help establish an earlier and more accurate diagnosis of pediatric cataracts. .

Objetivos: Avaliar as frequências do estrabismo e as características cronológica, etiológica e morfológica das cataratas pediátricas. Método: Estudo retrospectivo dos prontuários de crianças atendidas no Ambulatório de Catarata Congênita do Departamento de Oftalmologia da Universidade Federal de São Paulo no período entre 2001 e 2011. Foram incluídos pacientes com diagnóstico de catarata congênita ou de desenvolvimento. Foram excluídos os pacientes com catarata traumática; secundárias a uveíte, radiação ou medicamentos; pacientes operados em outro serviço; pacientes com glaucoma; leucocorias não cristalinianas (retinoblastoma, retinopatia da prematuridade, leucocorias pré-cristalinianas), e com sub-luxação do cristalino. Foram avaliadas: as frequências cronológicas, etiológicas e morfológicas das cataratas; a lateralidade e a ocorrência de estrabismo associado nestes pacientes. Resultados: Foram incluídos 207 pacientes. Cento e dezessete (56,5%) apresentavam catarata congênita e 90 (43,5%) apresentavam catarata de desenvolvimento. Cento e nove (52,6%) pacientes eram portadores de catarata unilateral. Quanto à morfologia, 72 crianças (33,8%) apresentavam catarata zonular e 66 (31,9%) apresentavam catarata total. A etiologia idiopática foi a mais frequente (72,5%) afetando 150 pacientes. Foram observados 108 pacientes (52,2%) com estrabismo associado, especialmente endotropias secundárias. Conclusões: A etiologia idiopática foi a mais frequente neste estudo. O tipo morfológico zonular foi o mais frequentemente diagnosticado. Cataratas unilaterais ocorreram mais frequentemente em pacientes com persistência da vasculatura fetal. O estrabismo associado ocorreu em 52% dos pacientes. A análise dos resultados deste estudo pode ...

Análisis de costo-efectividad del uso de lentes intraoculares tóricos frente a los lentes monofocales tradicionales en pacientes con catarata y astigmatismo corneal preexistente / Cost-effectiveness analysis of toric intraocular lenses use versus traditional monofocal lenses in cataract patients with pre-existent corneal astigmatism

Objetivo: evaluar la costo-efectividad del uso de lentes intraoculares (LIO) tóricos en la cirugía de pacientes con catarata con astigmatismo corneal pre-existente (> 0.75 D) versus el uso de lentes intraoculares (LIO) monofocales. Método: mediante un modelo tipo árbol de decisión se compararon las intervenciones desde la perspectiva del tercero pagador. El modelo tuvo un horizonte temporal de cinco años. La medida del resultado analizado fue la agudeza visual acumulada de 20/32 o mejor expresada en tiempo de visión normal a distancia libre de soporte adicional. Se aplicó una tasa de descuento del 3% anual para costos y desenlaces clínicos. La efectividad fue tomada de un estudio clínico controlado multicéntrico. Resultados: en el caso base la razón de costo-efectividad incremental (RCEI) para los LIO tóricos fué de (USD) $534,83 por cada año de visión normal a distancia libre de soporte adicional comparados con los LIO monofocales. Se observó que la RCEI mejora si el astigmatismo es mayor antes de la cirugía, así para rangos de dioptría <1.50, >1.50 <2.00 y >2.00 la RCEI fué de (USD) $712.40, (USD) $416.75 y (USD) $382.16, respectivamente. Según el análisis de sensibilidad univariado la probabilidad de quedar sin astigmatismo debido al LIO monofocal, es la variable de mayor impacto en la RCEI. Conclusiones: los LIO tóricos demostraron ser costo-efectivos para el tratamiento de los pacientes con catarata y con astigmatismo corneal preexistente, siendo mejor su beneficio en pacientes con mayor compromiso visual.

Objective: to evaluate the cost-effectiveness of toric intraocular lenses (IOL) use in surgery of patients with cataract and preexisting corneal astigmatism (> 0.75 D) versus the use of monofocal intraocular lenses (IOL) from the perspective of third party payer. Method: interventions were compared using a decision tree model from a third party payer's perspective. The model had a time horizon of 5 years. The measured outcome was the cumulative visual acuity of 20/32, which was expressed in normal vision time without additional support. A discount rate of 3% per annum was applied to costs and clinical outcomes. The effectiveness was taken from a controlled multicenter clinical study. Results: in base case, the incremental costeff ectiveness ratio (ICER) for the toric IOL was (USD) $ 534.83 for each year of normal vision without additional support compared with monofocal IOL. It was noted that the ICER improved if the astigmatism was high before surgery, so in different diopter ranges: <1.50, > 1.50 < 2.00 and > 2.00 the ICER was (USD) $ 712.40, (USD) $ 416.75 and (USD) $ 382.16 respectively. According to univariate sensitivity analysis the probability to end without astigmatism due to monofocal IOL was variable with the greatest impact on the ICER. Conclusion: toric IOLs proved to be cost-effective for the treatment of patients with cataract and preexisting astigmatism.

Resultados del implante de lente intraocular en nuestro medio / Results of the intra-ocular lens implant in our center

Se realizó un estudio observacional descriptivo de 2181 pacientes a los cuales se les realizó implante de lente intraocular en el servicio de Oftalmología del Hospital Provincial Docente Dr Antonio Luaces Iraola de Ciego de Ávila en el período comprendido de 1º de junio del 2002 al 31 de diciembre del 2006, con el objetivo de conocer su comportamiento. Se analizaron las variables edad, sexo, sitio y tipo de implante y las complicaciones transoperatorias. En el análisis de los resultados se observó que el sexo masculino tuvo un ligero predominio en los casos estudiados, mientras que en relación a la edad la mayor incidencia correspondió a los grupos etáreos a partir de los 60 años. El implante primario de lente intraocular en cámara posterior fueron el tipo y sitio del implante respectivamente de mayor predominio. La ruptura de la cápsula posterior con o sin vitreorragia fue la complicación transoperatoria más frecuente encontrada.

There has been done a decriptive observational study of 2181 patients who received intra-ocular lens implant in the Oftalmology service of General Hospital Dr Antonio Luaces Iraola of Ciego de Avila since June1st, 2002 to December 31st, 2006 , with the purpose to know its behaviour, there were analized the age, sex, place and kind of implant and the transoperatories complications. In the results´analysis was observed that, in the studied cases, there was a predominance of masculine sex, while the major incidences of age were in groups from 60 years old on. The primary implants the IOL in posterior camera of major predominance were the kind and the place of the implant respectively. The break of the posterior capsule, with or without vitreous haemorrhage, was the most frequent complication transoperatory found.

Resultados del implante de lente intraocular en nuestro medio / Results of the intra-ocular lens implant in our center

Se realizó un estudio observacional descriptivo de 2181 pacientes a los cuales se les realizó implante de lente intraocular en el servicio de Oftalmología del Hospital Provincial Docente Dr Antonio Luaces Iraola de Ciego de Ávila en el período comprendido de 1º de junio del 2002 al 31 de diciembre del 2006, con el objetivo de conocer su comportamiento. Se analizaron las variables edad, sexo, sitio y tipo de implante y las complicaciones transoperatorias. En el análisis de los resultados se observó que el sexo masculino tuvo un ligero predominio en los casos estudiados, mientras que en relación a la edad la mayor incidencia correspondió a los grupos etáreos a partir de los 60 años. El implante primario de lente intraocular en cámara posterior fueron el tipo y sitio del implante respectivamente de mayor predominio. La ruptura de la cápsula posterior con o sin vitreorragia fue la complicación transoperatoria más frecuente encontrada (AU)

There has been done a decriptive observational study of 2181 patients who received intra-ocular lens implant in the Oftalmology service of General Hospital Dr Antonio Luaces Iraola of Ciego de Avila since June1st, 2002 to December 31st, 2006 , with the purpose to know its behaviour, there were analized the age, sex, place and kind of implant and the transoperatories complications. In the results´analysis was observed that, in the studied cases, there was a predominance of masculine sex, while the major incidences of age were in groups from 60 years old on. The primary implants the IOL in posterior camera of major predominance were the kind and the place of the implant respectively. The break of the posterior capsule, with or without vitreous haemorrhage, was the most frequent complication transoperatory found (AU)