Quality of life assessment for nuclear, cortical, posterior subcapsular patients before and after cataract surgery / Evaluación de la calidad de vida de pacientes nucleares, corticales y subcapsulares posteriores antes y después de la cirugía de cataratas

Purpose: The impact of visual outcomes of cataract surgery can be measured using a questionnaire. The aim of our study was to evaluate how patient quality of life changes after cataract surgery and if there are differences between the responses of patients with nuclear, cortical, and posterior subcapsular cataracts, which has not been studied before. Method: We studied 210 cataract patients who were divided into 3 cataract groups based on their cataract type: nuclear (n = 80), cortical (n = 70), and posterior subcapsular (PSC) (n = 60). The patients completed the Visual Function Index (VF-14) questionnaire before, 2 weeks and 1 month after bilateral cataract surgery. The results were analysed using one-way ANOVA (significance level 5 %) and were compared over time and between the cataract groups. Results: Before the cataract surgery, cortical cataract patients had the lowest questionnaire score compared to nuclear and posterior subcapsular cataract groups (p = 0.08). After cataract surgery, cortical cataract patients experienced the greatest improvement in near distance daily activities, while PSC cataract patients experienced the greatest improvement in far distance daily activities (p = 0.38). Before surgery, nuclear cataract patients had the highest questionnaire scores compared to the other cataract groups (p = 0.08). Conclusion: At the 1 month follow-up, there were no statistically significant differences in questionnaire scores between the cataract groups for any of the questions. Overall, cortical cataract patients showed a trend to experience the greatest subjective improvement in quality of life after cataract removal, followed by nuclear and posterior subcapsular patients.(AU)

Rasgo de zónula anterior larga, lecciones aprendidas acerca de una infrecuente forma de cierre angular secundario: comunicación de un caso / Long anterior zonule trait, lessons learned about an uncommon form of secondary angle closure: A case report

Una mujer de raza negra de 62 años de edad que presentaba glaucoma crónico de ángulo estrecho no controlado en tratamiento con tres fármacos fue sometida a faco-esclerectomía profunda no perforante (facoEPNP) de su ojo izquierdo (OI). Durante la cirugía se puso de manifiesto que presentaba rasgo de zónula larga. Precisó goniopunción y desbridamiento de la ampolla posteriormente, presentando una sinequia de iris en la goniopunción que pudo ser reducida de forma conservadora. Este rasgo debe sospecharse en aquellos pacientes que presentan un ángulo estrecho combinado con un síndrome de dispersión pigmentaria. El manejo de la hipertensión ocular y el glaucoma que puede aparecer asociado a este rasgo no está protocolizado. En esta comunicación se reflexiona acerca de la mejor actuación ante esta infrecuente forma de glaucoma.(AU)

A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris synechia on the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.(AU)

Actualización clínica en nanoftalmos: características, enfermedades y complicaciones asociadas / Clinical update in nanophthalmos: Features, diseases and complications associated

El nanoftalmos es una condición congénita infrecuente del globo ocular que se caracteriza por un menor tamaño de los segmentos anterior y posterior en ausencia de una malformación ocular definida. Tradicionalmente se han descrito alteraciones anatómicas asociadas como una longitud axial corta, esclera engrosada, córnea con menor diámetro, cámara anterior estrecha y aumento de la relación entre el volumen del cristalino y el globo ocular. La causa se desconoce, aunque se han descrito múltiples mutaciones que podrían estar asociadas. En la actualidad, falta todavía una definición y una clasificación consensuada. Su relevancia clínica deriva de la asociación con múltiples afecciones oculares que pueden limitar la función visual como son hipermetropía elevada, ambliopía, glaucoma de ángulo cerrado, desprendimiento de retina y catarata. Asimismo, tanto la cirugía de catarata como la de glaucoma siguen constituyendo un desafío en estos ojos en los que el riesgo de numerosas complicaciones tanto intraoperatorias como postoperatorias es significativamente más elevado. El tratamiento del nanoftalmos tiene una doble orientación. Es preciso tratar las enfermedades asociadas y, además, reducir y controlar las complicaciones quirúrgicas. Esta revisión pretende realizar una actualización de lo publicado en los últimos años en relación con esta enfermedad. (AU)

Nanophthalmos is a rare congenital condition of the eyeball that is characterized by a smaller size of the anterior and posterior segments without associated ocular malformations. Typical features that have traditionally been described in these eyes are short axial length, thickened sclera, cornea with a smaller diameter, narrow anterior chamber, and an increased lens to globe volume ratio. However, at present, there is still a lack of recognized diagnostic criteria for nanophthalmos and a classification of its severity. Its clinical relevance stems from the increased risk of multiple ocular conditions, such as high hyperopia, amblyopia, angle-closure glaucoma, retinal detachment, and cataracts. Likewise, in relation to surgery in these eyes, there are particularities in cataract and glaucoma surgery and with a greater risk of associated intra- and postoperative complications. In this way, the treatment of nanophthalmos focuses on controlling the associated eye conditions and reducing and controlling surgical complications. This review aims to update what has been published in recent years regarding nanophthalmos. (AU)

Refraction and defocus curves in eyes with monofocal and multifocal intraocular lenses

Several clinical techniques have been described to evaluate visual performance and optical quality with intraocular lenses (IOL). However, subjective refraction remains one of the most important methods for assessing post-surgery results, taking decisions about retreatments, advanced spectacle prescription and the refinement of the constant for the formula used in the IOL power calculation. Beyond clinical refraction, defocus curve measurement has been described as a complementary tool for assessing visual performance and taking clinical decisions. However, to date, there are no clinical guidelines or evidence-based protocols published in the scientific literature recommended for pseudophakic patients implanted with either monofocal or multifocal IOLs. This narrative review highlights the importance of clinical refraction in pseudophakic eyes, its utility in the decision of different types of IOL implantation, and describes a clinical refraction protocol for eyes implanted with monofocal and multifocal IOLs. (AU)

Self-reported driving difficulty in patients with bilateral cataract

Purpose: The presence of cataract causes reduction in visual acuity (VA) and contrast sensitivity (CS) and thus can affect individual's daily activities. The aim of this study was to investigate self-reported driving difficulty in patients with bilateral cataract.MethodsA total of 99 participants aged 50 and above, with bilateral cataract, who possessed a valid driving license and drove regularly were chosen for this cross-sectional study that looked into their visual functions (VA and CS) and driving difficulty using the self-reported Driving Difficulty Questionnaire.ResultsThe mean age of the participants was 65.04±7.22 years old. Results showed that the mean composite driving difficulty score was 83.18±11.74 and most of the participants were having difficulty for driving in the rain (73.7%) and at night (85.9%). Furthermore, the study found that there was a significant correlation between driving difficulty score and CS (rs = 0.40, p = 0.03). However, there was no significant correlation between driving difficulty score and VA (rs = -0.14, p = 0.17). A linear regression was calculated to predict driving difficulty score based on binocular CS and a significant regression equation was found (F (1,28) = 8.115, p = 0.008) with R² of 0.225. Drivers with bilateral cataract will most likely experience some forms of difficulty, especially when driving under low contrast conditions.ConclusionThe findings of this study demand that a comprehensive eye examination should be made compulsory for older adult drivers when issuing or renewing their driving license for the safety of all road users. (AU)

Visual and satisfaction results with implantation of the trifocal Panoptix (R) intraocular lens in cataract surgery

Purpose: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens.Methods: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied.Results: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results.Conclusions: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses. (AU)

Complicaciones oculares secundarias a depilación de las cejas con láser diodo / Ocular complications secondary to diode laser-assisted eyebrow epilation

Se describen dos casos clínicos de complicaciones oftalmológicas secundarias a depilación con láser diodo de las cejas.Los dos pacientes incluidos son mujeres que, horas después de someterse a un procedimiento de depilación con láser diodo en la zona de las cejas, presentan fotofobia y visión borrosa. Ambas son diagnosticadas de uveítis anterior aguda y tratadas con corticoides tópicos y midriáticos. En el seguimiento se constata la presencia de secuelas (midriasis y corectopia en ambas pacientes, catarata en la segunda) derivadas del procedimiento láser.El tratamiento con láser depilatorio de las cejas puede inducir daños oculares irreversibles. Es necesario informar a los usuarios de estas técnicas de los riesgos que conllevan y utilizar dispositivos de seguridad.Destacamos la importancia de los efectos secundarios oftalmológicos derivados del uso de estos láseres (AU)

We describe two cases of ocular complications secondary to Diode laser assisted eyebrow epilation.Both included patients were women who underwent an eyebrow epilation procedure with Diode laser. A few hours after the procedure they started complaining with photophobia and blurred vision. They were diagnosed with anterior acute uveitis and treated with topical steroids and mydriatics. During the follow-up the presence of sequelae derived from the laser procedure (mydriasis and corectopia in both patients, cataract in the second one) was confirmed.Laser hair removal of the eyebrows can induce irreversible eye damage. Complete and reliable information regarding the potential side effects of this procedure and proper use of appropriate safety devices is mandatory.We point out the importance of the potential ocular side effects associated with these cosmetic devices (AU)

Toxicidad ocular tras sobredosificación accidental de cefuroxima intracameral en cirugía de catarata / Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery

Objetivo Describir los efectos de la inyección de cefuroxima intracameral a una dosis más alta de la recomendada en cirugía de catarata. Métodos Estudio retrospectivo de 8 ojos de 8 pacientes operados de catarata en un mismo día que recibieron 12,5mg/0,1ml de cefuroxima intracameral de forma inadvertida al finalizar la cirugía, por un error en la dilución. A todos los pacientes se les realizó un seguimiento oftalmológico estrecho durante 6 meses. Resultado Todos los pacientes presentaron una inflamación marcada del segmento anterior con edema corneal que se resolvió en todos los casos (entre 5 días y 3 meses). A los 6 meses de seguimiento se constató una diferencia significativa en el recuento endotelial corneal de dichos ojos al compararlo con el ojo contralateral (p=0,038), siendo<1000cels/mm2 en 3 casos. Tres pacientes (37,5%) presentaron un edema macular precoz, dejando como secuela permanente la disrupción de la capa elipsoidal a nivel subfoveal en uno de los casos. Uno de los pacientes desarrolló una neuropatía óptica con defecto pupilar aferente asociado. Conclusiones Aunque la inyección de cefuroxima en cámara anterior a dosis de 1mg/0,1ml ha demostrado disminuir la incidencia de endoftalmitis, su sobredosificación puede tener efectos oculares potencialmente perjudiciales tanto en el segmento anterior como en el posterior (AU)

Purpose To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. Methods Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5mg/0.1ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. Results All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P=.038), being<1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. Conclusions Although 1mg/0.1ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments (AU)

Alteraciones oculares en submarinistas: Presentación de 2 casos clínicos y revisión de la literatura / Ocular alterations in divers: 2 case reports and literature review

El submarinismo puede practicarse de manera recreativa o profesional. En ambas modalidades el buceador puede verse expuesto a riesgos como el síndrome de descompresión y al consecuente uso de la cámara hiperbárica, la hiperoxigenación de la botella de gases, el barotrauma y la inmersión en circuitos cerrados. Estas situaciones tienen en común la exposición a una gran diferencia de presiones, lo que puede provocar una amplia gama de alteraciones, incluidas las oftalmológicas. El desarrollo de una miopía de índice y catarata de tipo nuclear son hallazgos oculares frecuentemente asociados al aumento de presión de oxígeno. En este contexto, se establece un desequilibrio entre especies oxidativas y defensas antioxidantes como el glutatión, que posee un papel clave en el mantenimiento de la transparencia del cristalino. Presentamos los casos de 2 pacientes jóvenes, pescadores de coral, que presentaron una miopización reciente y progresiva asociada a cataratas nucleares

Scuba diving can be practiced recreationally or professionally. In both modalities the diver can be exposed to risks such as decompression syndrome and thus, the use of a hyperbaric chamber, hyper-oxygenation of the gas cylinder, barotrauma, and immersion in closed circuits. These situations have some phenomena in common, such as the great pressure differences, which can cause a wide range of alterations, including ophthalmological ones. The development of index myopia and nuclear cataract are ocular findings frequently associated with increased oxygen pressure. In this context, an imbalance is established between oxidative species and antioxidant defences, such as glutathione, which has a key role in maintaining the transparency of the lens. The cases are presented of 2 young coral fisher patients, who had recently developed a progressive myopisation associated with nuclear cataracts

Ocular findings in patients affected by myotonic dystrophy / Hallazgos oculares en pacientes afectados por distrofia miotónica

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Diferencias en la visión intermedia: lente intraocular monofocal vs. lente intraocular monofocal de rango extendido / Differences in intermediate vision: monofocal intraocular lenses vs. monofocal extended depth of focus intraocular lenses

OBJETIVO: El objetivo de este estudio es analizar si una lente intraocular (LIO) monofocal (TECNIS Eyhance®, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) de foco extendido proporciona una mejor agudeza visual (AV) intermedia que otras LIO monofocales (TECNIS 1-pieza®, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) de la misma plataforma. MÉTODOS: Se realizó un estudio observacional prospectivo y aleatorizado con pacientes que necesitaban cirugía de cataratas en ambos ojos. Un grupo de pacientes recibió el implante con la LIO TECNIS 1-pieza y otro grupo recibió la LIO Eyhance de foco extendido monofocal. Un mes desde la cirugía en el segundo ojo se evaluó la AV intermedia corregida (66 cm) y se obtuvieron las curvas de desenfoque. También se exploró la correlación de aberraciones de orden elevado y esféricas con AV intermedia, tamaño pupilar con AV intermedia y edad con AV intermedia. RESULTADOS: El estudio analizó a 30 pacientes (60 ojos), 15 de ellos en el grupo TECNIS 1-pieza y 15 en el grupo Eyhance. Ambos grupos consiguieron una AV lejana de 0,00 logMAR. En contraste, para la visión intermedia la AV fue mejor con las LIO Eyhance de foco extendido monofocal (0,16 ± 0,12 LogMAR), siendo la diferencia estadísticamente significativa (p < 0,001). Además, se observó que la AV intermedia binocular guardaba una correlación significativa con las aberraciones corneales (6 mm) RMS de alto orden (ρ 0,476) y Z40 (ρ 0,483) con la LIO Eyhance. CONCLUSIONES: La nueva LIO monofocal de foco extendido (Eyhance) ofrece suficiente profundidad de foco para proporcionar a los pacientes una visión confortable sin afectar la visión lejana

PURPOSE: The purpose of this study was to analyse whether an extended depth of focus (EDOF) monofocal intraocular lens (IOL) (TECNIS Eyhance™, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) provides better intermediate visual acuity (VA) than another monofocal IOL (TECNIS 1-piece™, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) from the same platform. METHODS: Randomised prospective observational study. Patients who required cataract surgery in both eyes were included. Patients in one group were implanted with Tecnis 1-piece IOL and those in the other group with Eyhance EDOF monofocal IOL. One month after surgery in the second eye, we assessed the corrected intermediate VA (66 cm) and obtained defocus curves. We also explored the correlation of: high-order and spherical aberrations with intermediate VA, pupil size with intermediate VA and age with intermediate VA. RESULTS: We analysed 30 patients (60 eyes), 15 patients in the TECNIS 1-piece group and 15 in the Eyhance group. Both groups achieved a far VA of 0.00 logMAR. In contrast, for intermediate vision, VA was better with the Eyhance EDOF monofocal IOLs (0.16 ± 0.12 LogMAR), the difference being statistically significant (p < 0.001). In addition, binocular intermediate VA was found to be significantly correlated with corneal (6 mm) RMS high-order aberrations (ρ 0.476) and Z40 (ρ 0.483) with the Eyhance IOL. CONCLUSIONS: The new EDOF monofocal IOL (Eyhance) offers sufficient depth of focus to provide patients with comfortable vision without impairing far vision

Diagnóstico ecográfico de catarata / Ultrasound diagnosis of a cataract

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¿Antibióticos tópicos postoperatorios en cirugía de catarata en adultos? / Postoperative topical antibiotics in cataract surgery in adults?

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Catarata en árbol de navidad en la enfermedad de Steinert / Christmas tree cataract in Steinert disease

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Cirugía combinada de catarata y queratoplastia lamelar endotelial en el síndrome iridocórneo endotelial / Combined cataract surgery and lamellar endothelial keratoplasty in iridocorneal endothelial síndrome

Reportamos el caso de una mujer de 59 años, que refería disminución de agudeza visual (AV) en el ojo izquierdo (OI). Mediante la exploración, se objetivó en dicho ojo una AV corregida de cuenta dedos a 30 cm, y en la lámpara de hendidura se observó la presencia de edema corneal moderado, con pliegues en la membrana de Descemet. También se apreciaron sinequias iridianas anteriores, atrofia de iris y corectopia. Se diagnosticó de síndrome iridocórneo endotelial (ICE). Se decidió un abordaje terapéutico quirúrgico mediante una cirugía combinada de catarata y queratoplastia endotelial automatizada con disección de la membrana de Descemet (DSAEK). No se reportaron complicaciones intraoperatorias. La recuperación anatómica y funcional fue exitosa, presentando una AV corregida al año de 0,8. Este resultado apoya la eficacia de la DSAEK en el síndrome ICE animando a la realización de más estudios que soporten igualmente su eficacia en este síndrome

The case is reported of a 59-year-old woman, who reported decreased visual acuity (VA) in the left eye (LE). On examination, a corrected VA of finger count/ 30cm was observed in LE. Corneal oedema and folds in the Descemet's membrane were observed using the slit lamp. Anterior synechiae, iris atrophy, and corectopia were also found. ridocorneal endothelial syndrome (ICE) was diagnosed. The treatment option was a combination of cataract surgery and automated endothelial keratoplasty with Descemet's membrane dissection (DSAEK). There were no complications during the operation, with a successful anatomical and functional recovery, with a VA of 0,8 being observed after one year. This result supports the efficacy of DSAEK in ICE syndrome, encouraging more studies to be carried out that should also support its efficacy in this syndrome