[Phakic intraocular lens for presbyopia correction]. / Avaliação de lente intra-ocular fácica para a correção da presbiopia.

PURPOSE: To evaluate clinical and refractive results of anterior chamber multifocal phakic intraocular lens Newlife for presbyopia correction considering uncorrected far and near visual acuity and refraction data and also to evaluate safety of this intraocular lens considering distance and near corrected visual acuity, endothelial cell count and complications. METHODS: Retrospective analysis of a clinical database of 30 patients (51 eyes) who had received a foldable anterior chamber multifocal intraocular lens for presbyopia correction. Data were collected before surgery and at 1, 3, 6, 12 months after the procedure. Statistical variance analysis and multiple comparisons were used to verify possible associations. All complications were described. RESULTS: After surgery the mean spherical equivalent was -0.046 D (+/-0.48) and 87.5% of the eyes could read Parinaud 3 or better (equivalent to J2 or better) without the need of near glasses. Endothelial cell loss was 7.57%. The intraocular lens was explanted in 6 (11.5%) eyes for different reasons. Cataracts were the major cause of lens removal. CONCLUSION: Improvement of mean uncorrected visual acuity and refraction data after multifocal phakic intraocular lens Newlife implantation for presbyopia correction was observed. Established safety criteria (distance and near corrected visual acuity, endothelial cell count and complications) did not confirm the safety of the procedure in the follow-up period.

Ophthalmoscopy simulation: advances in training and practice for medical students and young ophthalmologists.

OBJECTIVE: To describe and appraise the latest simulation models for direct and indirect ophthalmoscopy as a learning tool in the medical field. METHODS: The present review was conducted using four national and international databases - PubMed, Scielo, Medline and Cochrane. Initial set of articles was screened based on title and abstracts, followed by full text analysis. It comprises of articles that were published in the past fifteen years (2002-2017). RESULTS: Eighty-three articles concerning simulation models for medical education were found in national and international databases, with only a few describing important aspects of ophthalmoscopy training and current application of simulation in medical education. After secondary analysis, 38 articles were included. CONCLUSION: Different ophthalmoscopy simulation models have been described, but only very few studies appraise the effectiveness of each individual model. Comparison studies are still required to determine best approaches for medical education and skill enhancement through simulation models, applied to both medical students as well as young ophthalmologists in training.

Evaluation of a simulation tool in ophthalmology: application in teaching funduscopy.

PURPOSE: The aim of this study was to evaluate the Eye Retinopathy Trainer® as a teaching tool for direct ophthalmoscopy examination by comparing it with the traditional method using volunteers. METHODS: Fourth year medical students received training in direct ophthalmoscopy using a simulation tool and human volunteers. Ninety students were randomized into a Simulation Group or a Control Group by the inclusion or absence of the simulation model in classroom practice. Differences between the groups were analyzed using unpaired Student's t-test. RESULTS: The Simulation Group was superior to the Control Group, with 51.06% successful in performing fundus examination in both the anatomical model simulation and the human model in comparison with 21.15% in the Control Group. CONCLUSION: The Eye Retinopathy Trainer® appears to be an effective teaching tool for practice and improvement of ophthalmologic examination among fourth year medical students.

Ocular adverse effects after facial cosmetic procedures: a review of case reports.

To review indexed literature concerning adverse ocular effects of the most common aesthetic facial procedures (light-emitting therapy, dermal fillers injection, and botulinum toxin). Literature search using three online databases - PubMed, SciELO, and Capes - selecting case reports, series of cases and reviews, with no language restriction, published in a period of the last twenty years (1995-2015). After reviewing 48 case reports and most recent reviews, the authors found the most common ocular adverse effects of dermal fillers were related to vascular occlusion; light-emitting therapy was associated with pigmented tissue damage leading to anterior uveitis and iris atrophy, and ptosis presented the higher relative risk associated with botulinum toxin. Even though ocular adverse effects are not very frequent, some of them can lead to permanent ocular dysfunction and visual impairment. Professionals involved in cosmetic procedures should be aware of the risks.

Anterior chamber optical coherence tomography study of human natural accommodation in a 19-year-old albino.

Anterior segment optical coherence tomography is a new method to explore the anterior chamber. The target can be focused and defocused with positive or negative lenses to reproduce the conditions of natural accommodation. We studied accommodation in an albino patient because the absence of pigment allows the infrared beam to penetrate the iris and explore the modifications of the ciliary body and the crystalline lens during natural accommodation in a human subject.

Static and dynamic analysis of the anterior segment with optical coherence tomography.

PURPOSE: To study biometric modifications of the anterior segment with accommodation and age and determine possible applications in areas of anterior segment surgery, particularly implantation of refractive lenses. SETTING: Clinique Monticelli, Marseille, France. METHOD: The study comprised subjects between 7 years of age and 82 years of age in whom anterior chamber biometry was evaluated using 1,310 nm wavelength optical coherence tomography (OCT). The equipment has a fixation target that can be focused and defocused with negative lenses to stimulate natural accommodation. All measurements were performed by the same operator. The horizontal diameter of the AC, the anterior chamber depth (ACD), the horizontal pupil diameter, and the horizontal radius of curvature of the crystalline lens' anterior pole were measured in the unaccommodated state and after stimulating accommodation. RESULTS: Fifty-six subjects (104 eyes) were included; the refractions ranged from +5.0 diopters (D) to -5.0 D. The static and dynamic measurements were compared with ametropia, age, and accommodation. At rest, the mean AC diameter was 12.334 mm, the mean ACD was 3.106 mm, and the mean pupil diameter was 4.258 mm. With 1.0 D of accommodation, the anterior pole moved forward by a mean of 30 microm, the radius of curvature decreased 0.3 mm, and the pupil diameter decreased 0.15 mm. CONCLUSIONS: The AC OCT is a user-friendly instrument for evaluating the anterior segment and examining the AC (cornea, iris, crystalline lens, and iridocorneal angle). The 1,310 nm light wavelength is blocked by pigments, preventing examination behind the iris. However, the AC OCT is capable of good image quality and visualization of the anatomical relationships in the anterior segment, even behind an opaque cornea.

Contact between 3 phakic intraocular lens models and the crystalline lens: an anterior chamber optical coherence tomography study.

Three phakic intraocular lens (IOL) models were implanted in 3 different patients. With the usual slitlamp examination, it was not possible to determine whether there was contact between the IOLs and the natural crystalline lens. Using the anterior chamber optical coherence tomography (AC OCT) scanner, direct contact between the natural crystalline lens and the 3 phakic IOLs was revealed. A dynamic study of the contact was performed during accommodation. These observations show that examination of the anterior segment with the AC OCT scanner provides new data about the status of the anterior segment after implantation of phakic IOLs.

Correction of presbyopia with refractive multifocal phakic intraocular lenses.

PURPOSE: To evaluate the efficacy of and specify the conditions required for implantation of an anterior chamber multifocal phakic intraocular lens (IOL) to correct presbyopia. SETTING: Monticelli Clinic, Marseilles, France. METHOD: Fifty-five eyes of 33 patients (21 women, 12 men) had implantation of a foldable anterior chamber multifocal phakic IOL. The initial refraction was between -5.00 diopters (D) and +5.00 D. The IOL had an addition of +2.50 D. An uncorrected distance acuity of 0.6 or better (decimal scale) and an uncorrected near acuity (Parinaud scale) of 3 or better (Parinaud 2 approximately equal to Jaeger 1) was considered a successful postoperative result. RESULTS: The mean follow-up was 42.6 weeks +/- 18 (SD). Postoperatively, the mean refraction was -0.12 +/- 0.51 D, the mean decimal uncorrected distance acuity was 0.78 +/- 0.20, and the mean Parinaud uncorrected near acuity was 2.3 +/- 0.6. Eighty-four percent of eyes achieved an uncorrected distance acuity of 0.60 or better and an uncorrected near acuity of Parinaud 3 or better. The IOL was explanted in 4 eyes for different, but essentially optical, reasons. No significant anatomic complications were observed. CONCLUSIONS: Implantation of an anterior chamber multifocal phakic IOL to correct presbyopia was effective and gave good predictability. The procedure is reversible in cases of patient intolerance to the IOL, unwanted optical phenomena, or complications. Strict inclusion criteria should be used for patient selection.

Simulation models applied to practical learning and skill enhancement in direct and indirect ophthalmoscopy: a review.

The purpose of this review was to analyze and describe simulation methods for practical learning and training of the ophthalmoscopy exam and to organize them into specific topics relative to each principle of operation, while evaluating their preliminary results. A critical review of articles that described and evaluated simulated models for ophthalmoscopy published in the last ten years (2004-2014) was performed. One hundred articles about ophthalmology and simulation were found in national and international periodicals, but only a few discussed the examination of the posterior pole of the eye. For this study, 25 articles were considered; those articles described simulation methods, general concepts, and its actual use in ophthalmoscopy. There were many different simulation methods described, but only few articles proved their efficacy or performed a comparison between models. Review of this topic may give information for the critical analysis of the simulation devices and ideas for the development of new ones.

Application of anterior segment optical coherence tomography in pediatric ophthalmology.

Purpose. Application of anterior segment optical coherence (AS-OCT) in pediatric ophthalmology. Methods. Retrospective clinical study case series of 26 eyes of 19 pediatric patients throughout a 21-month period, presenting anterior segment pathologies, were submitted to AS-OCT examination (OCT Visante, 1310 nm, Zeiss), noncontact technique, no sedation requirement. Results. AS-OCT images were obtained from 19 patients (range: 2 months to 12 years). Clinical diagnosis of anterior segment abnormalities included cornea disease (n = 7), congenital anterior segment conditions (n = 10), ocular trauma (n = 1), anterior segment surgeries (n = 2), iridocorneal angle abnormalities (n = 4), intermediate uveitis (n = 2). The most common OCT findings were corneal hyperreflectivity and thickening (n = 15), shallow anterior chamber with iris-lens diaphragm anterior displacement (n = 4), atypical corneal curvature (n = 4), corneal thinning (n = 4), peripheral synechiae with angle closure (n = 3), increased anterior chamber depth (n = 2), and proximal portion of glaucoma drainage tube (n = 2). Conclusion. In the present study, noncontact AS-OCT demonstrated to be a feasible technique to evaluate the anterior segment providing anatomic details and useful to clarify diagnosis in the pediatric population.

Phototherapeutic keratectomy for the treatment of corneal opacities after epidemic keratoconjunctivitis.

PURPOSE: To assess visual results and compare methods of measuring central corneal thickness (CCT) and corneal opacity thickness (COT) in patients with corneal opacities induced by epidemic keratoconjunctivitis (EKC) and treated with phototherapeutic keratectomy (PTK) using low-dose mitomycin C (MMC). DESIGN: Prospective consecutive case series. METHODS: Patients with chronic adenoviral corneal opacity underwent transepithelial PTK with MMC 0.002% for 1 minute. The presence of photophobia, the best spectacle-corrected visual acuity (BSCVA), and the contrast sensitivity were evaluated. CCT measurements were obtained with ultrasound pachymeter (US), ultrasound biomicroscopy (UBM), Scheimpflug tomography (Pentacam Oculus), and optical coherence tomography (OCT Visante). COT measurements were obtained with UBM, Pentacam, and OCT. RESULTS: Thirty-one eyes of 23 patients, comprising 15 women (65.2%) and 8 men (34.8%), mean age 41.8 years, were enrolled in the study. Duration of visual disturbance was 19.1 ± 14 months. The number of patients with photophobia was reduced from 100% to 29% after surgery. BSCVA improved 2 or more lines in 78% of the patients at 12 months. A hyperopic shift of 1.52 ± 0.91 diopters was achieved. Contrast sensitivity improved in both photopic and mesopic conditions. For each of the instruments, the CCT postoperative mean was significantly smaller than the preoperative measurement (P < .0001) and COT values were significantly reduced in comparison to the preoperative values (P < .001). CONCLUSION: Improvements in photophobia, BSCVA, and contrast sensitivity were observed in patients treated using excimer laser PTK with low-dose MMC for subepithelial infiltrates.

Analgesia preemptiva com dipirona versus ibuprofeno na fotocoagulação a laser da retina / Preemptive analgesia of metamizole versus ibuprofen in retinal laser photocoagulation

RESUMO Objetivo: Comparar a efetividade da dipirona versus o ibuprofeno para a redução da dor na fotocoagulação da retina (FR). Método: Foi realizado um estudo controlado, duplo cego e randomizado englobando trinta e quatro pacientes com retinopatia diabética separados em dois grupos. Grupo A recebeu 1000mg de dipirona e o grupo B recebeu 600mg de ibuprofeno. A dor foi avaliada pela escala visual analógica. Resultado: A média do escore da dor nos grupos A e B foi de 5,2 ± 2.6 e 4,5 ± 1,4, respectivamente. Não houve diferença estatística entre os grupos (p=0,34). O mesmo foi observado quanto à analise entre dor leve, moderada e grave (p=0,09). Os grupos foram semelhantes quanto à idade e sexo. Conclusão: Os medicamentos foram equivalentes ou equipotentes em reduzir a dor ocular durante a fotocoagulação a laser da retina.

ABSTRACT Objective: To compare the effectiveness of metamizole versus ibuprofen for the reduction of pain in retinal photocoagulation (RP). Method: A double-masked randomized controlled study was performed. Thirty-four patients with diabetic retinopathy were enrolled. The patients were randomized into two groups. Group A received oral 1000 mg metamizole. Group B received an oral intake of 600 mg ibuprofen. Pain during RP was assessed using a visual analog scale. Results: The mean pain scores for groups A and B were 5.2±2.6 and 4.5±1.4 (p=0.34). There were no significant differences in the mean pain scores between the two groups. The same is observed when analyzing by low, medium and high pain (p=0.09). The groups were similar in age and gender. Conclusion: Both drugs were equivalents or equipotent in reduce ocular pain during retinal photocoagulation.

Evaluation of a simulation tool in ophthalmology: application in teaching funduscopy / Avaliação do uso de um instrumento de simulação em oftalmologia: aplicação no ensino da fundoscopia

Purpose: The aim of this study was to evaluate the Eye Retinopathy Trainer® as a teaching tool for direct ophthalmoscopy examination by comparing it with the traditional method using volunteers. Methods: Fourth year medical students received training in direct ophthalmoscopy using a simulation tool and human volunteers. Ninety students were randomized into a Simulation Group or a Control Group by the inclusion or absence of the simulation model in classroom practice. Differences between the groups were analyzed using unpaired Student’s t-test. Results: The Simulation Group was superior to the Control Group, with 51.06% successful in performing fundus examination in both the anatomical model simulation and the human model in comparison with 21.15% in the Control Group. Conclusion: The Eye Retinopathy Trainer® appears to be an effective teaching tool for practice and improvement of ophthalmologic examination among fourth year medical students. .

Objetivo: O objetivo desse estudo foi avaliar o Eye Retinopathy Trainer® como ferramenta didática complementar ao treinamento do exame ocular, em comparação ao método tradicional, baseado na aprendizagem com voluntários. Métodos: Noventa estudantes receberam treinamento em oftalmoscopia direta utilizando um modelo de simulação e voluntários humanos. Os alunos foram divididos em grupo Simulação e em grupo Controle mediante a inclusão ou ausência do simulador no treinamento em aula prática. Diferenças entre os grupos foram analisadas por teste t de Student não pareado. Resultados: O desempenho prático do Grupo Simulador mostrou-se superior ao Grupo Controle, evidenciando que 51,06% dos alunos do primeiro grupo foram bem sucedidos ao realizar a fundoscopia tanto no modelo anatômico de simulação quanto no modelo humano, comparado a 21,15% dos alunos grupo Controle. Conclusão: O simulador Eye Retinopathy Trainer® mostrou ser uma ferramenta didática efetiva para a prática e aprimoramento do exame oftalmológico entre estudantes do quarto ano de medicina. .

Simulation models applied to practical learning and skill enhancement in direct and indirect ophthalmoscopy: a review / Modelos de simulação aplicados ao ensino prático e aprimoramento de habilidades em oftalmoscopia direta e indireta: uma revisão

The purpose of this review was to analyze and describe simulation methods for practical learning and training of the ophthalmoscopy exam and to organize them into specific topics relative to each principle of operation, while evaluating their preliminary results. A critical review of articles that described and evaluated simulated models for ophthalmoscopy published in the last ten years (2004-2014) was performed. One hundred articles about ophthalmology and simulation were found in national and international periodicals, but only a few discussed the examination of the posterior pole of the eye. For this study, 25 articles were considered; those articles described simulation methods, general concepts, and its actual use in ophthalmoscopy. There were many different simulation methods described, but only few articles proved their efficacy or performed a comparison between models. Review of this topic may give information for the critical analysis of the simulation devices and ideas for the development of new ones.

O objetivo desta revisão foi analisar e descrever os métodos de simulação, apresentados em um conjunto de artigos, sobre o ensino prático e treinamento no exame de oftalmoscopia e organizá-los em tópicos específicos, referentes aos seus princípios de funcionamento, avaliando resultados preliminares. Uma revisão crítica de artigos que tratam sobre modelos de simulação para oftalmoscopia que foram criados nos últimos dez anos (2004-2014) foi realizada. Após a análise de 100 artigos, encontrados em periódicos nacionais e internacionais, sobre oftalmologia e simulação, percebemos o pouco material existente em relação ao exame de fundo de olho. Para este estudo, apenas 25 foram considerados, os quais descrevem métodos de simulação, conceitos gerais e seu uso atual na oftalmoscopia. Vários métodos de simulação já foram descritos, mas poucos artigos provam sua eficácia ou realiza uma comparação entre diferentes modelos. Uma revisão deste tópico pode contribuir para possíveis análises críticas de dispositivos de simulação já existentes e ideias para criação de outros.

Avaliação de lente intra-ocular fácica para a correção da presbiopia / Phakic intraocular lens for presbyopia correction

OBJETIVO: Avaliar os resultados clínicos e refrativos, bem como as complicações pós-operatórias, da cirurgia de implante de uma lente fácica multifocal de suporte angular para a correção da presbiopia. MÉTODOS: Estudo retrospectivo de análise de prontuários de 30 pacientes dos quais 51 olhos foram submetidos a implante de lente intra-ocular fácica Newlife® para a correção da presbiopia. Os pacientes foram avaliados em visita pré-operatória e em um mês, 3, 6 e 12 meses após a cirurgia. A análise descritiva das variáveis do estudo e os testes estatísticos foram realizados e as complicações pós-operatórias foram descritas. RESULTADOS: Após o procedimento, o equivalente esférico médio foi de -0,046 (± 0,48 D) e 87,5 por cento dos pacientes podiam ler P3 (equivalente a J2) sem necessidade de óculos. A perda de células endoteliais, após seguimento de 12 meses, foi de 7,57 por cento. A lente intra-ocular foi retirada em 6 (11,5 por cento) olhos por diferentes razões, sendo a catarata a causa mais freqüente de retirada de lente. CONCLUSÕES: O implante da lente intra-ocular fácica Newlife® para a correção da presbiopia melhorou significativamente a acuidade visual sem correção e a refratometria no grupo de olhos estudados. Os critérios de avaliação adotados (acuidade visual com correção, contagem endotelial e existência de complicações) não permitiram afirmar a segurança do procedimento de implante da lente intra-ocular fácica Newlife® para o período de acompanhamento analisado.

PURPOSE: To evaluate clinical and refractive results of anterior chamber multifocal phakic intraocular lens Newlife® for presbyopia correction considering uncorrected far and near visual acuity and refraction data and also to evaluate safety of this intraocular lens considering distance and near corrected visual acuity, endothelial cell count and complications. METHODS: Retrospective analysis of a clinical database of 30 patients (51 eyes) who had received a foldable anterior chamber multifocal intraocular lens for presbyopia correction. Data were collected before surgery and at 1, 3, 6, 12 months after the procedure. Statistical variance analysis and multiple comparisons were used to verify possible associations. All complications were described. RESULTS: After surgery the mean spherical equivalent was -0.046 D (+/-0.48) and 87.5 percent of the eyes could read Parinaud 3 or better (equivalent to J2 or better) without the need of near glasses. Endothelial cell loss was 7.57 percent. The intraocular lens was explanted in 6 (11.5 percent) eyes for different reasons. Cataracts were the major cause of lens removal. CONCLUSION: Improvement of mean uncorrected visual acuity and refraction data after multifocal phakic intraocular lens Newlife® implantation for presbyopia correction was observed. Established safety criteria (distance and near corrected visual acuity, endothelial cell count and complications) did not confirm the safety of the procedure in the follow-up period.

Técnicas cirúrgicas para correção da presbiopia em pacientes fácicos / Presbyopia surgery in phakic patients

A presbiopia é a afecção ocular mais freqüente e é definida como a perda progressiva da amplitude acomodativa relacionada à idade. Atualmente, tentativas de correção cirúrgica da presbiopia em paciente fácicos e afácicos têm recebido considerável atenção, sendo campo vasto de pesquisa. O objetivo deste artigo é discutir as técnicas cirúrgicas propostas para correção da presbiopia em pacientes fácicos publicadas na literatura até o presente momento.