[Corneal endothelial evaluation of diabetic patients after phacoemulsification]. / Évaluation endothéliale cornéenne des patients diabétiques après une phacoémulsification.

PURPOSE: To determine whether phacoemulsification with intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients compared to non-diabetic patients. MATERIALS AND METHODS: This study compared the endothelial status in 32 diabetics with good glycemic control and 32 non-diabetic patients before and after uneventful phacoemulsification. Central corneal thickness (CCT), central corneal endothelial cell density (CD), hexagonal cell percentage (HEX), and percent coefficient of variation (% CV) were measured using a specular microscope. RESULTS: Data were matched by age and sex. Diabetics showed a significantly higher loss of endothelial cells compared to non-diabetics. After 3 months, there was a decline of 165 endothelial cells (SD 97) in the diabetic group and 114 (SD 45) in the control group. This was statistically significant (P=0.0065). In addition, diabetics showed a slower recovery trend of endothelial healing as evidenced by a lower CV variation. The CV change was 4.7 in the control group and 3.2 in the diabetic group, which was statistically significant (P=0.023). A significant correlation was found between the energy used and the change in endothelial count as well as the CV in both groups. CONCLUSION: Despite good glycemic control, diabetics have significantly more endothelial damage compared to non-diabetics with a similar nuclear classification and phacoemulsification energy used. This justifies a more careful use of phacoemulsification energy in diabetics.

Novel Gonioscopy Score and Predictive Factors for Intraocular Pressure Lowering After Phacoemulsification.

PURPOSE: To evaluate a novel gonioscopy score as a potential predictor for intraocular pressure (IOP) reduction after cataract surgery. MATERIALS AND METHODS: This was a prospective study that included consecutive patients with or without glaucoma, either with open or narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Eyes with intraoperative complications and secondary glaucoma were excluded. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants (range, 0 to 16). To determine variables associated with IOP change at 6 months, univariate and multivariate linear mixed-effects regression analysis was performed adjusting for age, sex, and preoperative IOP. RESULTS: In total, 188 eyes from 137 patients were enrolled. The mean age of the patients was 75.0 (±8.5) years and the average preoperative IOP was 15.6 (±3.6) mm Hg with 0.7 (range, 0 to 4) glaucoma medications. The mean IOP reduction after phacoemulsification was 3.0 (±2.6) mm Hg at postoperative month 6. After multivariate analysis, preoperative IOP [ß=0.49 (0.41-0.58), P<0.0001], gonioscopy score [ß=-0.17 (-0.24 to -0.09), P<0.0001], anterior chamber depth (ACD) [ß=-0.88 (-1.64 to -0.14), P=0.02], and IOP/ACD ratio [ß=0.45 (0.07 to 0.83) P=0.021] were associated with IOP reduction at 6 months. CONCLUSIONS: Preoperative predictors for IOP reduction after cataract surgery were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.

[Clinical and functional results of one-step phaco surgery and central descemetorhexis for cataract and Fuchs primary endothelial corneal dystrophy]. / Kliniko-funktsional'nye rezul'taty khirurgicheskogo lecheniia katarakty i pervichnoi éndotelial'noi distrofii rogovitsy Fuksa metodom odnomomentnoi fakoémul'sifikatsii i tsentral'nogo destsemetoreksisa.

Poor visual function associated with Fuchs endothelial corneal dystrophy (FECD) is one of the main indications for keratoplasty. Reports of successful visual rehabilitation of patients with spontaneous or scheduled removal of the Descemet's membrane and the endothelium or donor material adhesion failure, suggest this research direction perspective. AIM: to evaluate the potential as well as clinical and functional outcomes of phacoemulsification with central circular descemetorhexis in patients with Fuchs endothelial corneal dystrophy. MATERIAL AND METHODS: A total of 19 patients aged 51-84 years were included. The preoperative best corrected visual acuity averaged 0.32±0.19, endothelial cells density - 629.6±336.9 cells/mm2, and central corneal pachymetry - 587.8±44.8 µm. After phacoemulsification with IOL implantation, a 4 mm tap was created from the epithelial side of the cornea. Central circular descemetorhexis was done using a microhook. The membrane was removed with microforceps. RESULTS: On day 1, there was central corneal edema matching the circular defect in the Descemet's membrane. As many as 26.3% of patients demonstrated rapid responses to the treatment, which implies that corneal transparency and visual improvement were achieved by the end of the first month after surgery. In other 26.3% of patients, full corneal transparency was not achieved and, therefore, endothelium transplantation had to be performed. The main group included 12 patients. At 12 months, the best corrected visual acuity was 0.66±0.29, central pachymetry - 569.27±63.74 µm, endothelial cells density - 634.00±170.41 cells/mm2. CONCLUSION: In 63.8% of patients, visual rehabilitation was achieved without endothelial transplantation, which provides new prospects for tissue-saving technologies in patients with endothelial corneal dystrophy.

[Trabeculotomy Combined with Cataract Surgery in Glaucoma: Outcome in a Rural Setting]. / Trabekulotomie kombiniert mit Phakoemulsifikation als operative Glaukomtherapie: Ergebnisse im ländlichen Versorgungsbereich.

Purpose: Intensive postoperative care is essential for the outcome of trabeculectomy. However, in a rural setting, repeated visits to the operating theatre are often not requested or possible. The objective of this study was to examine the outcome of trabeculotomy combined with cataract surgery in patients with glaucoma. Patients and Methods: 142 patients with glaucoma and cataract were included in a retrospective clinical study. All patients were operated on from November 2005 to December 2008 by a single surgeon and with a minimum follow-up of 2 months. Intraocular pressure (IOP), number of antiglaucomatous medications and surgical success rate were assessed at 2 months and at the longest follow-up (at least 1 year). Results: IOP was significantly reduced from 24.1 ± 8.3 mmHg preoperatively to 14.9 ± 3.3 mmHg at 2 months (p < 0.0001) and to 15.1 ± 3 mmHg at the longest follow-up (3.71 ± 1.5 years). The number of IOP-lowering medications was lowered from 1.35 ± 1 preoperatively to 0.73 ± 1 at the longest follow-up. Complete surgical success (no IOP-lowering medications, longest follow-up) was achieved in 51.3 % (IOP < 22 mmHg) and 47.5 % (IOP < 19 mmHg) of patients, respectively. Conclusions: Trabeculotomy combined with cataract surgery is a safe and effective surgical option to treat combined cataract and glaucoma without the need of intensified postoperative treatment.

[Ways of life quality improvement among elderly and older patients after phacoemulsification of cataract in postoperative period].

The article is devoted to the literature review of modern methods of diagnosis and surgical treatment of age-related cataract. The comparative analysis of morphologic characteristics of corneal endothelial cell before and after phacoemulsification in the age aspect has been given. The results of surgical treatment of this disease have been analyzed. The methods of prevention and therapy of the postoperative complications have been described. Drug administration scheme in the postoperative period is presented. The influence of peptides on the cellular immunity indices and stimulation of regenerative processes in eye's tissues in different diseases and pathological conditions after surgical operation are considered. It has been given the estimation of the ratio of visual function and quality of life in the elderly.

[Results of intraocular lens implantation on top of the anterior capsule in cases of phaco complications].

UNLABELLED: Posterior capsule rupture during cataract extraction requires that the intraocular lens (IOL) implanted on top of the capsular bag was stable and well-centered. The objective of this study was to evaluate the results of Rayner C-flex aspheric and M-flex aspheric (United Kingdom) IOLs implantation on top of the capsular bag and their stability in patients with phaco complications. MATERIAL AND METHODS: A total of 2556 phacoemulsification cases were analyzed. Posterior capsule rupture as a complication occurred in 7 cases, that is 0.27%. In all patients Rayner C-flex (5) and M-flex (6) IOLs were implanted on top of the capsular bag according to the initial calculations and with no modifications in the procedure. The 2nd-year follow-up included measurement of the corneal compensated intraocular pressure (IOP) and B-mode and 3D grey-scale ultrasound in order to assess the structures of the anterior segment and to check the position of the IOL. RESULTS: All surgeries yielded positive clinical results. In 2 years after the intervention uncorrected visual acuity averaged 0.7-0.13, corrected-- 0.91+0.07; clinical refraction: sphera-- +0.46 +/- 0.26 diopters, cylinder-- 0.71 +/- 0.29 diopters. The shape and other parameters of Rayner IOLs contribute to their long-term stability. Postoperative lOP in the treated eye was higher than in the fellow nonoperated eye (13.9 +/- 0.76 and 11.8 +/- 0.59 mmHg correspondingly) but the difference lied within the range of normal asymmetry. CONCLUSION: The 3D ultrasound technology is an informative mean of monitoring the position of the IOL in case of its extracapsular implantation; a comparatively higher IOP in the operated eye does not exceed the range of normal asymmetry between the two eyes; Rayner C-flex and M-flex IOLs remain stable and well-centered after being implanted on top of the capsular bag.

Valoración de la rotación de lentes intraoculares tóricos con OPD Scan III y su repercusión en medidas de calidad visual en pacientes con cirugía de catarata por facoemulsificación / Evaluation of toric intraocular lenses axis rotation with OPD Scan III and its effect on visual quality measurements in cataract phacoemulsifi cation patients

El buen desempeño de los LIOs (Lentes Intraoculares) tipo tóricos, se basa en que la rotación del implante sea mínima y en la adecuada selección preoperatoria de los pacientes. En este estudio, se describió el comportamientos de estos LIOs en nuestra población, por medio de la medición de diferentes parámetros de calidad visual aportados por el OPD Scan III, teniendo en cuenta la técnica quirúrgica y demarcación de un solo cirujano. Aunque la muestra no fue lo suficientemente grande para permitir resultados estadísticamente significativos, estos demuestran una relación directamente proporcional de la rotación con las aberrometrías de alto orden e inversamente proporcional con las agudezas visuales, a pesar de que la rotación máxima fue sólo de 15 grados. Se sugiere continuar este estudio con otro de tipo analítico e incluyendo LIO multifocales para la medición de descentramiento y su repercusión sobre parámetros de calidad visual medidos con el OPD Scan III.

The good performance of toric intraocular lens is based on implant minimal rotation and appropriate preoperative patient selection. In this study, we described the results of these IOLs in our population, by measuring different visual quality parameters provided by the OPD Scan III, considering the surgical technique and demarcation of a single surgeon. Although the sample was not large enough to allow statistically signifi cant results, these show a directly proportional relationship of the rotation with high order aberrations and inversely proportional to visual acuity, even though the maximum rotation was only 15 degrees. This study should continue with analytical studies including multifocal IOLs to describe descentration and its impact on visual quality parameters measured with the OPD Scan III.

Validity of first post-operative day automated refraction following dense cataract extraction.

BACKGROUND: The aim of this study was to assess the refractive stability and validity of automated refraction obtained at day one after surgery for dense cataracts in a developing country setting, where patient follow-up is often erratic. METHODS: In a prospective study in rural Kenya, we compared automated refraction and visual acuity (VA) after manual small incision cataract surgery (SICS) and phacoemulsification cataract surgery (Phaco) at day one with autorefraction and subjective refraction obtained at a later visit. RESULTS: Ninety eyes of 83 patients fulfilled the ultimate inclusion criteria (21 SICS eyes and 69 Phaco eyes). The correlation between refraction at day one and at a later follow-up was moderately good for both SICS and Phaco (R1 = 0.61 and R2 = 0.58). Spherical equivalent (SE) values measured at day one were within one dioptre of those obtained later in 68 eyes (72 per cent); (SICS: 67 per cent; Phaco: 74 per cent) and within two dioptres in 83 eyes (92 per cent); (SICS: 86 per cent; Phaco: 94 per cent). At post-operative days 14, 28 and more than 42 for SICS and Phaco eyes, the mean SE was 0.58 and 0.48, 0.55 and 0.19, and 0.9 and 0.31 more hypermetropic than the mean SE of post-operative day one, respectively. First-day accuracy was higher in eyes with better pre-operative VA, softer cataracts and lower post-operative prediction error. The surgical technique (SICS versus Phaco) had no influence on first-day accuracy in our set-up. CONCLUSION: Refractive data from the early post-operative period can provide useful data for qualitative control and monitoring of post-operative refractive outcomes in a setup, where 'better' data are often not available; however, its accuracy is limited and, ultimately, there is no alternative to good follow up of operated patients.

Influência da correção cirúrgica da catarata na percepção laborativa / Influence of cataract surgical correction on working perception

Objetivo: Analisar o benefício gerado nas atividades profissionais após a cirurgia de catarata. Métodos: Foi realizado um estudo prospectivo, randomizado, no Hospital das Clínicas da Universidade de São Paulo. Os pacientes foram submetidos à facoemulsificação (FACO) e à extração extracapsular (EECP). Resultados: A amostra foi composta de 205 pacientes, destes, 101 realizaram cirurgia pela técnica de facoemulsificação. A média de idade no grupo da facoemulsificação foi de 68,3 anos ± 9 anos e de 69,1 anos ± 8,5 anos no grupo da extração extracapsular (p=0,70). A porcentagem de pacientes empregados no grupo facoemulsificação foi de 16,83 por cento, e no outro grupo de 13,46 por cento. A maioria dos pacientes que não remunerados formalmente sentiu-se motivada a procurar trabalho. A maioria dos analisados relatou aumento da produtividade no trabalho após a cirurgia, 82,50 por cento no grupo facoemulsificação e 78,60 por cento no grupo extração extracapsular (p=0,20). Conclusão: A cirurgia de catarata por ambas as técnicas proporcionou melhora da produtividade no trabalho, e estimulou indivíduos economicamente inativos a procurar trabalho remunerado.

Purpose: To analyze the benefits after cataract surgery in professional activities. Methods: A prospective, randomized study was conducted at the Clinical Hospital of the University of São Paulo. The patients had cataract surgery by phacoemulsification (PHACO) and by extracapsular extraction (EECP). Results: The sample consisted of 205 patients, 101 of these, submitted to phacoemulsification. The mean age in phacoemulsification group was 68.3 years ± 9 years and 69.1 years ± 8.5 years in extracapsular extraction group (p=0.70). The percentage of patients employed in phacoemulsification group was 16.83 percent, and in the extracapsular extraction group of 13.46 percent. Most patients who were not employed felt motivated to seek work. Most of the patients increased their productivity at work after surgery, 82.50 percent in the phacoemulsification group, and 78.60 percent in the other group (p=0.20). Conclusion: Cataract surgery of both techniques has improved the productivity at work and encouraged economically inactive individuals to seek employment.

Facoemulsificação em cães, com e sem implante de lente intra-ocular em piggyback: estudo clínico da inflamação pós-operatória / Phacoemulsification in dogs with and without intraocular lens implantation in piggyback: Clinical study of postoperative inflammation

A uveíte peri e pós-operatória é o maior problema da cirurgia para extração de catarata no cão, sendo considerada o fator mais importante para o sucesso cirúrgico, imediato e tardio. Diversos protocolos pré e pós-operatórios utilizando agentes anti-inflamatórios esteroidais e não-esteroidais têm sido empregados na tentativa de controle da uveíte cirurgicamente induzida. O objetivo do presente estudo foi avaliar a reação inflamatória pós-operatória, clinicamente e por meio da pressão intraocular (PIO), após a cirurgia de facoemulsificação para extração de catarata em cães, com e sem implante de lente intraocular (LIO) em piggyback. Empregaram-se, 25 cães portadores de catarata, subdivididos em dois grupos: G1 (com implante de LIO), G2 (sem implante de LIO). A técnica cirúrgica adotada foi a facoemulsificação bimanual unilateral. Avaliações clínicas e mensurações da PIO foram aferidas antes do procedimento cirúrgico (0) e nos tempos 3, 7, 14, 21, 28 e 60 dias após o ato cirúrgico. Cães do grupo G1 apresentaram sinais clínicos de uveíte visivelmente mais intensos, relativamente aos do G2. Entretanto, a PIO não demonstrou diferença significativa entre os dois grupos analisados, nem entre os olhos operados e os contralaterais. A utilização de duas LIOs humanas em piggyback no cão é exequível, porém suscita mais inflamação e complicações no pós-operatório.

Perioperative and postoperative uveitis is the main problem in cataract surgery in dogs, affecting short-term and long-term postoperative success. Numerous therapeutic methods involving both steroidal and non-steroidal anti-inflammatory agents have been used to reduce surgically-induced uveitis. The purpose of this study was to investigate the postoperative inflammatory reaction and intraocular pressure after phacoemulsification surgery for cataract extraction with and without intraocular piggyback lens (IOL) implantation in dogs. A total of 25 dogs were divided into two groups: Group 1 (with IOL implantation) and Group 2 (without IOL implantation). The performed surgical technique consisted of unilateral bimanual phaco-emulsification. Clinical assessment and intraocular pressure were measured before surgery (0) and at 3, 7, 14, 21, 28, 60 days after the surgery. Clinical assessment revealed inflammatory reaction more severe in dogs of G1 when compared to G2. Intraocular pressure did not differ significantly either between G1 and G2 or operated and non-operated eyes. Intraocular lens (IOL) implantation using piggyback technique with human IOL is a possible method to be performed in canine ophthalmology. However, nursing care is necessary as the the procedure induces inflammation and complications in the postoperative period.

[Influence of cataract surgical correction on working perception]. / Influência da correção cirúrgica da catarata na percepção laborativa.

PURPOSE: To analyze the benefits after cataract surgery in professional activities. METHODS: A prospective, randomized study was conducted at the Clinical Hospital of the University of São Paulo. The patients had cataract surgery by phacoemulsification (PHACO) and by extracapsular extraction (EECP). RESULTS: The sample consisted of 205 patients, 101 of these, submitted to phacoemulsification. The mean age in phacoemulsification group was 68.3 years ± 9 years and 69.1 years ± 8.5 years in extracapsular extraction group (p=0.70). The percentage of patients employed in phacoemulsification group was 16.83%, and in the extracapsular extraction group of 13.46%. Most patients who were not employed felt motivated to seek work. Most of the patients increased their productivity at work after surgery, 82.50% in the phacoemulsification group, and 78.60% in the other group (p=0.20). CONCLUSION: Cataract surgery of both techniques has improved the productivity at work and encouraged economically inactive individuals to seek employment.

Spectacle use after routine cataract surgery.

AIMS: To measure spectacle dependence following bilateral monofocal intraocular lens (IOL) implantation and assess how it is predicted by postoperative refraction. METHODS: 300 cataract patients had bilateral phacoemulsification surgery with monofocal IOL implantation. A spherical equivalent of 0 to -0.5 D was targeted. Three months after surgery, patients answered a questionnaire and had a spectacle refraction. Refractions were converted into vector notation. Logistic regression was used to evaluate whether spectacle dependence for near and distance was related to overall refractive error, spherical error, signed spherical error and astigmatic error. RESULTS: 169 patients attended for assessment. 38 wore distance glasses, and 160 wore reading glasses either some or all of the time. The mean right spherical equivalent was -0.03 D, and the mean right cylinder was -0.64 D. Left outcomes were similar. Patients were 34 times more likely to always use distance glasses per dioptre of astigmatic error in the better eye (p<0.003), but there was no significant increase in the likelihood of wearing distance glasses with spherical error (odds ratio = 3.85, p>0.15). Similar effects were seen for both the better and worse eyes. Near-spectacle use was not dependent on astigmatic error (odds ratio = 0.22, p>0.12). It was only related to the signed spherical error in the worse eye with hypermetropic patients 6.74 times more likely to always wear spectacles per dioptre of positive spherical error (p<0.005). CONCLUSIONS: Following bilateral monofocal intraocular lens implantation, small levels of overall refractive error, in either eye, particularly astigmatism, predict distance-spectacle dependence, whereas spherical ammetropia in the range of +/-1.0 D does not. Hypermetropia in the worse eye, but not astigmatism, predicts reading-spectacle dependence.

Duration of self assessed benefit of cataract extraction: a long term study.

AIM: To investigate how long patients' improved visual function lasts after a cataract extraction. METHODS: Patients' self assessed visual function was evaluated using the Catquest questionnaire both before and 6 months after a cataract extraction. The study population consisted of 615 patients undergoing a cataract extraction during 1995-2002. A final follow up with a new questionnaire was performed in 2003, between 1 year and 8 years after surgery. RESULTS: 445 (72.4%) patients were alive at follow up and agreed to participate in the study. The number of subjects still showing improved visual function after surgery decreased with longer follow up. After 7 years, 80% had improved visual function compared with before surgery. 50% of all originally operated subjects were alive 7 years postoperatively and enjoyed better visual function than they had done before surgery. Ocular co-morbidity in the operated eye or self assessed poor visual function before surgery was significantly related to deteriorated visual function at follow up. CONCLUSION: The number of subjects who experienced improved visual function after a cataract extraction decreased over the course of time postoperatively. Presence of ocular co-morbidity was significantly related to worsened function.

Catarata nigra e facoemulsificação / Nigra cataract in phacoemulsification

Objetivos: Analisar os resultados da facoemulsificação em olhos portadores de catarata nigra. Local: Instituto de Moléstias Oculares - São Paulo - SP. Material e métodos: Estudo retrospectivo de olhos portadores de catarata nigra submetidos à facoemulsificação no período de 01/1999 a 03/2001. A técnica cirúrgica consistiu de anestesia peribulbar com incisão corneana a hora 10, coloração da cápsula com Azul Tripan o,1 por cento, faco stop and chop e implante de lente acrílica dobrável. Resultados: 13 pacientes com catarata nigra unilateral e 1 com catarata nigra bilateral. Em 13 olhos foi realizado facoemulsificação e 2 olhos foram convertidos para EEC. A prevalência de complicações foi de 13,3 por cento. A medidia de perda celular do endotélio corneano após 90 dias foi de 25,59 por cento. Conclusão: A experiência do cirurgião, o bom senso e a presença de patologias associadas deverão nortear a indicação de facoemulsificação nestes olhos.

Facectomia Transcornneana (Clear corneal sugery) / Clear corneal sugery

Os autores apresentaram a técnica de facoemulsificaçäo com incisäo temporal em córnea clara e com implante de lente intra-ocular dobrável de silicone, sob anestesia tópica. Abordam as dificuldades de adaptaçäo à incisäo temporal, aconselhando-se o uso de maca especial e um colar de fixaçäo da cabeça para apoio das mäos. Ressaltam, no entanto, a grande vantagem de uma melhor visualizaçäo do reflexo retiniano. advertem para a maior precisäo da incisäo corneana e a pouca margem de erro da técnica, pois, as complicaçöes säo de mais difíceis soluçöes. No entanto, a incisäo sendo auto-selantre, näo necessita de pontos. Apresentaram a técnica de injeçäo subtenoniana de anestésico, como alternativa para a anestesis tópica. Ressaltam a grande vantagem da recuperaçäo precoce da visäo e da estabilidade mais cedo da refraçäo

Extraçäo de cristalino transparente: facoaspiraçäo refrativa no tratamento da alta miopia / Clear lens extraction: refractive phacoaspiration as treatment for high myopia

Os autores objetivam mostrar seus resultados na extraçäo do cristalino transparente como tratamento refrativo nos altos míopes. Realizaram estudo prospectivo entre 10/93 e 10/95 no qual 27 olhos foram submetidos à facoemulsificaçäo do cristalino transparente. Houve reduçäo da miopia no pós-operatório. A média pré-operatória foi de -17.851 (ñ3,841) enquanto que o pós-operatório foi de -1,25(ñ2.0D). Näo houve descolamento de retina no pós-operatório, com follow up de 1 a 3 anos. Os autores concluem tratar-se de uma técnica previsível, reproduzível, segura e viável, economicamente