RESUMO
Purpose: The ability to predict corneal edema and understand its relationship with imaging parameters enables optimization of decision-making in terms of cataract surgery. Therefore, we aimed to elucidate the immediate tomographic alterations after phacoemulsification. Patients and Methods: In this prospective study, we evaluated clinical and corneal tomographic data of 30 patients with cataracts, obtained using a rotating Scheimpflug tomographic system before and after cataract surgery with a phacoemulsification system. Corneal thickness and volume were measured, and Pentacam Nucleus Staging, keratometry, and specular microscopy were performed preoperatively and immediately postoperatively. The Wilcoxon signed-rank test was used to compare pre-and postoperative values. We calculated the correlations between the changes in these values and multiple parameters related to phacodynamics, including "ultrasound (US) elapsed" (phaco time), "US average" (average power used), and "US absolute" (energy effectively dissipated, a product of the other two parameters). Results: There were increases in corneal volume (p<0.0001) and pachymetry (p<0.0001), and a decrease in endothelial cell count (p<0.0001) after surgery. The mean differences in pre- and postoperative specular microscopy, corneal volume, and pachymetry were -335.13±236.21 cells/mm3, 1.33±0.56 mm3, and 61.33±23.73 microns, respectively. The difference in pre-and postoperative corneal volume in patients with US elapsed ≥40 s was 0.75 mm3 greater than that in patients with US elapsed <40 s (95% confidence interval [CI]: 0.24-1.25; p=0.005); that of pachymetry in patients with US elapsed ≥40 s was 31.76 microns greater than that in patients with US elapsed <40 s (95% CI: 9.55-53.97; p=0.007). Spearman correlation revealed that, for every 1% increase in cataract density, the US average value increased by 0.31% (coef.: 0.3110; 95% CI: 0.0741-0.5490; p=0.012). Conclusion: Knowledge of Pentacam Nucleus Staging and the effect of US elapsed on differences in corneal volume and pachymetry before and after cataract surgery should be of particular value for surgeons who routinely encounter patients with hard cataracts.
RESUMO
A iridosquise é a separação dos folhetos da íris, uma condição rara que afeta idosos do sexo feminino, sendo tipicamente bilateral. Este artigo é um relato de caso de facoemulsificação (faco) em uma paciente com iridosquise e catarata branca. Acuidade visual (AV) em decimal com correção ótica (cc) olho esquerdo (OE) apresentava-se 0.001. Foi utilizada a técnica "stop and chop" com quatro afastadores (ganchos) de íris e utilizado lente intraocular (LIO) acrílica dobrável hidrofóbica de três peças sendo introduzida dentro do saco capsular. A paciente evoluiu no pós-operatório (PO) com córnea clara, pressão intraocular (PIO) controlada e estável. Após 30 dias de cirurgia apresentava AV de 1.0 com correção. O implante de ganchos de íris tem papel fundamental no sucesso cirúrgico de pacientes com catarata e iridosquise.
The iridoschisis is the separation of the brochures of the iris. Rare condition that affects typically both eyes of aged woman. The present study is case report of phacoemulsification in patient with iridoschisis and white cataract. Best corrected visual acuity (BCVA) of the left eye was 0.001. The used technique was stop and chop with the use of four hooks of iris and IOL was a folding three pieces hydrophobic acrylic being introduced inside of the capsular bag. Patient evolved in the postoperative with clear cornea , intraocular pressure controlled and steady. After 30 days of surgery he presented BCVA 1.0. The implantation of iris hooks is essential in the surgical success in patient with iridoschisis and cataract.