RESUMO
The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring. AIM: to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). MATERIAL AND METHODS: We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). RESULTS: Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. CONCLUSION: The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.
Assuntos
Aniridia , Ferimentos Oculares Penetrantes , Implante de Lente Intraocular , Procedimentos Cirúrgicos Refrativos , Adulto , Aniridia/diagnóstico , Aniridia/etiologia , Aniridia/cirurgia , Segmento Anterior do Olho/diagnóstico por imagem , Segmento Anterior do Olho/lesões , Segmento Anterior do Olho/cirurgia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/reabilitação , Feminino , Humanos , Iris/diagnóstico por imagem , Iris/cirurgia , Implante de Lente Intraocular/instrumentação , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/reabilitação , Lentes Intraoculares , Masculino , Procedimentos Cirúrgicos Refrativos/métodos , Procedimentos Cirúrgicos Refrativos/reabilitação , Federação Russa , Resultado do Tratamento , Acuidade VisualRESUMO
BACKGROUND Cataract surgery is associated with the development of late-onset age-related macular degeneration (AMD). The pathogenic mechanism is still not fully established. The purpose of this study was to evaluate the possible changes in central macula thickness (CMT) and subfoveal choroid thickness (SCT) after uneventful cataract surgery. MATERIAL AND METHODS A total of 65 eyes of 65 patients who underwent phacoemulsification and intracapsular lens implantation were included in this prospective study. Patients had not undergone previous ocular surgery and had no other ocular abnormality. CMT and SCT were measured at baseline and postoperatively at week 1 and months 1, 3, 6 and 12 via spectral domain optical cohorence tomography (SD-OCT). RESULTS CMT was 252.4±27.6 µm (mean ±SD) preoperatively, then 253.5±29.8, 256.1±28.7, 257.4±27.2, 253.18±23.7, and 252.8±21.7 µm at postoperative week 1 and postoperative months 1, 3, 6, and 12, respectively. There were insignificant changes in CMT, and it returned to baseline at six months after surgery (all p>0.05). SCT was 237.4±21.6 µm preoperatively, and 240.5±24.8, 241.2±25.7, 242.7±26.3, 243.1±24.2, and 244.2±21.4 µm at postoperative week 1 and postoperative months 1, 3, 6, and 12, respectively. Although there was an increase in SCT during follow-up, the difference between preoperative and postoperative values was not significant (p>0.05). CONCLUSIONS Uncomplicated phacoemulsification induces subclinical changes in CMT, probably due to the inflammatory insult of surgery, and CMT returns to baseline value. There were slight, insignificant increases in choroid thickness during follow-up, and this did not return to baseline during follow-up. Changes in the choroid after cataract surgery may provide clues to the development of late-onset AMD.
Assuntos
Catarata/patologia , Corioide/patologia , Idoso , Idoso de 80 Anos ou mais , Catarata/terapia , Feminino , Humanos , Implante de Lente Intraocular/reabilitação , Macula Lutea/patologia , Degeneração Macular/complicações , Edema Macular/patologia , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Período Pós-Operatório , Estudos Prospectivos , Tomografia de Coerência Óptica/métodosRESUMO
INTRODUCTION: One of the remaining challenges in cataract surgery is to compensate for lost accommodative function. The purpose of our study is to evaluate reading ability with a combination of two different aspheric intraocular lenses. PATIENTS AND METHODS: This retrospective study included 40 eyes (20 patients). The control group (28 eyes, 14 patients) received two negative aspheric intraocular lenses (Acrismart 36A(®), Carl Zeiss Meditec), while the aspheric-optimized group (12 eyes, six patients) received an AcriSmart 36A(®) in the dominant eye and a zero-aspheric intraocular lens (Acrismart 46 LC(®), Carl Zeiss Meditec) in the fellow eye. Patients with corneal asphericity between 0.15 and 0.30 µm and a bilateral monocular postoperative visual acuity of at least 20/20 were eligible for inclusion. Uncorrected and best corrected visual acuity was measured for near, intermediate and distance vision. Corneal and total higher-order aberrations, monocular and binocular defocus curve, and stereoscopic performance were assessed. RESULTS: Postoperative spherical equivalent and best corrected distance visual acuity were not significantly different between the two groups (P=0.11 and P=0.82 respectively). However, the aspheric-optimized group (36A(®)/46 LC(®)) exhibited better near and intermediate visual acuity (P<0.05), and better stereoscopic vision (P=0.027). DISCUSSION: The depth of field results in pseudophakes implanted with "mix-and-match" aspheric lenses demonstrates that the binocular combination of two different aspheric profiles seems to improve near vision without affecting stereoscopic vision.
Assuntos
Extração de Catarata/reabilitação , Percepção de Profundidade/fisiologia , Implante de Lente Intraocular/reabilitação , Lentes Intraoculares , Leitura , Acomodação Ocular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Pessoa de Meia-Idade , Miopia/fisiopatologia , Miopia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
In order to study the features of visual system (VS) recovery after multifocal correction we examined in dynamics visual functions and subjective satisfaction with sight quality in 64 patients (mean age 52 +/- 2.5 years) at different time after binocular implantation of apodized refractive-diffractive intraocular lens (IOL) Acrysof Restor. These patients before surgery and 30 healthy subjects (60 eyes, mean age 48 +/- 4.5 years) served as controls. Over 6 months after surgery progressive improvement of mean visual acuity in the main distances (40, 70-80 cm and 5 m), contrast sensitivity and subjective satisfaction were observed. Gradual increasing of VS resolution suggests the need of search of postoperative rehabilitation methods that would provide faster adaptation to new optical conditions.
Assuntos
Implante de Lente Intraocular , Facoemulsificação/efeitos adversos , Complicações Pós-Operatórias , Transtornos da Visão , Catarata/fisiopatologia , Feminino , Humanos , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/reabilitação , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Facoemulsificação/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Recuperação de Função Fisiológica , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Transtornos da Visão/cirurgia , Testes Visuais/métodosRESUMO
PURPOSE: To assess efficacy, stability and safety of posterior chamber phakic intraocular lens implantation with STAAR Visian ICL for correction of high ametropia, with a mean follow-up of 5 years (3.5-10 years). PATIENTS AND METHODS: Ninety eyes of 53 highly ametropic patients (45 myopia, ten hyperopia and 35 with mixed astigmatism) were included in a retrospective single-surgeon study, using primarily the V4 ICL model (87 eyes). We studied pre- and postoperative refractive efficacy, endothelial cell density, crystalline lens opacification and intraocular clearances within the various compartments of the eye. RESULTS: Mean uncorrected visual acuity was 0.77 at the 12th postoperative month; 17 of 90 eyes required adjunctive photoablation for residual astigmatism. Forty-eight percent of eyes gained at least one line of best corrected visual acuity. After implantation, the decrease in endothelial cell density remained stable at 0.69%/year, and 91% of eyes showed no opacification of the crystalline lens. Mean endothelium-ICL and ICL-crystalline lens distances were 2.41 mm and 0.52 mm respectively. Overall patient satisfaction achieved was 96% at 36 months postoperatively. DISCUSSION AND CONCLUSION: These results demonstrate efficacy, stability and safety of the ICL V4 phakic IOL for the correction of high ametropia. Long-term follow-up did not show a significant increase in cataract formation in implanted eyes.
Assuntos
Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Cápsula Posterior do Cristalino/cirurgia , Erros de Refração/terapia , Adolescente , Adulto , Seguimentos , Humanos , Implante de Lente Intraocular/efeitos adversos , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/reabilitação , Implante de Lente Intraocular/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Erros de Refração/epidemiologia , Erros de Refração/reabilitação , Procedimentos Cirúrgicos Refrativos/instrumentação , Procedimentos Cirúrgicos Refrativos/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto JovemRESUMO
The cataract or opacification of the lens raises, in the child, two problems: of clinical diagnosis but especially of action to be taken therapeutic in particular surgical in front of a juvenille lens. This leads to a step and a therapeutic strategy, which must, individually, weigh the advantages and the disadvantages of the surgery. It is a frequent cause of visual handicap in the child. In the event of unilaterality, the major risks are the amblyopia and the aniseiconia. The elements to be analyzed are linked or the bilaterality, the type and the importance of opacity, local or general associated malformations, precocity diagnoses, and with regard to the treatment, the potential surgical complications, the quality of the optical correction, the postoperative assumption of responsibility and the cooperation of the parents. In all the cases, it will always be necessary to treat the functional part of the amblyopia.
Assuntos
Extração de Catarata , Catarata/terapia , Assistência ao Convalescente , Ambliopia/etiologia , Ambliopia/prevenção & controle , Ambliopia/reabilitação , Catarata/congênito , Catarata/diagnóstico , Catarata/etiologia , Catarata/reabilitação , Extração de Catarata/métodos , Criança , Pré-Escolar , Técnicas de Diagnóstico Oftalmológico , Gerenciamento Clínico , Diagnóstico Precoce , Traumatismos Oculares/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/reabilitação , Cristalino/embriologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Acuidade VisualRESUMO
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
Assuntos
Humanos , Anestesia Local , Anestesia Local/tendências , Facoemulsificação/métodos , Facoemulsificação/reabilitação , Facoemulsificação/tendências , Implante de Lente Intraocular/reabilitaçãoRESUMO
Os autores estudaram 5 olhos, de 3 pacientes, submetidos a facoemulsificaçäo com implante de lente intraocular alguns anos após ceratotomia radial. Foram avaliadas as fórmulas mais comumente utilizadas para cálculo da lente intraocular (Holladay, SRK II, SRKT) e diferentes maneiras de se obter as medidas ceratométricas tentando-se determinar o que seria adequado para ser empregado nestes pacientes. As fórmulas Holladay e SRKT foram as que apresentaram menor margem de erro. Valores ceratométricos pós ceratotomia radial foram menos precisos para o cálculo da lente intraocular do que os dados que foram obtidos subtraindo-se o valor da mundança refracional induzida pela Ceratotomia Radial da medida ceratométrica pré ceratotomia radial. Näo foi observado um aplanamento corneano significativo após a facoemulsificaçäo, como relatado por outros autores, provavelmente por ter sido usada uma técnica com incisäo em túnel escleral e atraumática. Os autores concluem que apesar de um número cada vez maior de pacientes submetidos a ceratotomia radial necessitarem de dacectomia com implante de lente intraocular devido ao desenvolvimento de uma catarata senil, as fórmulas atuais de cálculo das dioptrias da lente intraocular ainda näo têm se mostrado totalmente adequadas a estes pacientes.