Citation network analysis of the various types of multifocal intraocular lenses. / Análisis de redes de citación sobre los diversos tipos de lentes intraoculares multifocales.

BACKGROUND AND OBJECTIVE: The implantation of multifocal intraocular lens (IOL) has increased in recent years, allowing patients to achieve good quality vision at all distances, independence from use of glasses, and consequently, an increase in quality of life. The main purpose of this study was to analyse the links between publications and authors via citation networks, as well to as identify the different research areas and determine the most cited publications. MATERIAL AND METHODS: The publication search was performed through the Web of Science database, using the terms «Multifocal intraocular lens¼, «Bifocal intraocular lens¼, «Trifocal intraocular lens¼, «Diffractive intraocular lens¼, «Refractive intraocular lens¼, «Accommodative intraocular lens¼ and «Extended depth of focus intraocular lens¼, for a time interval from 1989 to August 2020. The software used to analyse the publications was the Citation Network Explorer. RESULTS: A total of 1293 publications were found, with 11730 citations generated in the network, and 2019 had the highest number of publications of any year. The most cited publication was «European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens¼ by Kohnen et al., published in 2006. Four groups about different research areas in this field were found using the Clustering functionality: visual quality, IOL designs, ocular aberrations, or defocus curves. CONCLUSIONS: The citation network offers an objective and comprehensive analysis of the main articles on the different designs and classes of multifocal IOL.

Citation network analysis of the various types of multifocal intraocular lenses.

BACKGROUND AND OBJECTIVE: The implantation of multifocal intraocular lens (IOL) has increased in recent years, allowing patients to achieve good quality vision at all distances, independence from use of glasses, and consequently, an increase in quality of life. The main purpose of this study was to analyse the links between publications and authors via citation networks, as well to as identify the different research areas and determine the most cited publications. MATERIAL AND METHODS: The publication search was performed through the Web of Science database, using the terms «Multifocal intraocular lens¼, «Bifocal intraocular lens¼, «Trifocal intraocular lens¼, «Diffractive intraocular lens¼, «Refractive intraocular lens¼, «Accommodative intraocular lens¼ and «Extended depth of focus intraocular lens¼, for a time interval from 1989 to August 2020. The software used to analyse the publications was the Citation Network Explorer. RESULTS: A total of 1293 publications were found, with 11,730 citations generated in the network, and 2019 had the highest number of publications of any year. The most cited publication was «European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens¼ by Kohnen et al., published in 2006. Four groups about different research areas in this field were found using the Clustering functionality: visual quality, IOL designs, ocular aberrations, or defocus curves. CONCLUSIONS: The citation network offers an objective and comprehensive analysis of the main articles on the different designs and classes of multifocal IOL.

Lens-based surgical correction of presbyopia. Where are we in 2020? / Corrección de la presbicia tras cirugía cristaliniana. ¿Dónde nos encontramos en 2020?

INTRODUCTION: Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists impulsed by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years. MATERIAL AND METHODS: This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodative, refractive, and diffractive multifocal lenses, and finally the most recent extended depth of focus/field lenses known as EDOFs. RESULTS: Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients. CONCLUSIONS: It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.

Phakic intraocular lenses: Recent advances and innovations. / Lentes intraoculares fáquicas: recientes avances e innovaciones.

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.

Characterization of optical performance with defocusing curve: Analysis of two refractive intraocular lens models with high and medium addition.

PURPOSE: To characterize the optical performance of two models of refractive bifocal intraocular lenses, with medium and high addition, using defocus curves. METHODS: 20 eyes from 20 subjects were included in this study. 10 eyes underwent caratact surgery with an implant of a medium addition refractive bifocal intraocular lens (IOL) (Lentis LS-313 MF20) and the other 10 eyes underwent cataract surgery with an implant of a high addition refractive bifocal IOL (Lentis LS-313 MF30). Six weeks after surgery, subjective refraction and defocus curve were made. RESULTS: Mean final residual refraction in spherical equivalent was +0.10±0.07D in the LS-313MF30 group and +0.12±0.10D in the LS-313MF20 group. Defocus curve showed a different optical performance in intermediate/near distance depending on the IOL model. The medium addition IOL provided good visual acuity (VA) at far and intermediate distance up to 50cms, and the high addition IOL provided better VA in near distance up to 25cms. CONCLUSIONS: The high addition intraocular lens provides better visual acuity in the spatial range from infinity to the point close to 25cm. The medium addition intraocular lens provides excellent visual acuity in far and intermediate vision. The defocus curve seems to be a valid and reproducible tool for evaluating the optical behavior of multifocal sector refractive lenses.

A systematic review about the impact of phakic intraocular lenses on accommodation.

Phakic intraocular lenses (pIOL) are the main treatment for patients who have either high ametropia or contraindications for laser refractive surgery. The main feature that makes this kind of lenses suitable for its implantation in young adults searching for independence of optical prescription is the conservation of accommodation, since lens extraction is not required. A systematic review has been performed to evaluate the scientific literature on the effect of pIOL implantation on accommodation. Critical assessment of the articles included in the review was achieved using the tool Critical Appraisal Skills Programme in its Spanish form (CASPe). After revising the complete text of 10 articles pre-selected, two quasi-experimental pre-post studies evaluating the outcomes of a specific model of posterior chamber pIOL were included in the systematic review. The CASPe scoring of both studies were 5/11. According to this outcome, the evidence describing the impact of the pIOL implantation on the accommodative function can be defined poor. Some trends are reported as the decrease in the amplitude of accommodation, a decrease positive relative accommodation and improvement of accommodation. However, these results should be confirmed in future controlled studies.

Patient selection to optimize near vision performance with a low-addition trifocal lens.

PURPOSE: To assess the impact of ocular biometric variables on the visual performance achieved with a low addition trifocal intraocular lens (MIOL). METHODS: Retrospective observational study including 34 eyes. Preoperative measured variables included mean corneal power (Km), corneal regular astigmatism (RA), anterior chamber depth (ACD), axial length (AXL), total irregular astigmatism (IA), spherical aberration (SA) and distance from pupil center to vertex normal (µ). Same variables were retrieved from the three month visit follow-up in addition to the actual lens position (ALP), the calculated effective addition (EA), the IOL centration from vertex normal (d), and the visual acuity defocus curve. The area under the defocus curve was computed along the total curve (TAUC) and ranges for far (FAUC), intermediate (IAUC) and near vision (NAUC). The sample was split in two groups of 17 eyes with TAUCs above and below the mean, and the differences among groups for different ocular parameters were assessed. RESULTS: The group of eyes above TAUC of 2.03 logMAR*m-1 showed significantly lower Km and greater AXL and SA. Km was negatively correlated with TAUC and NAUC. NAUC was negatively correlated with IA and positively with d. A multiple lineal regression model including Km, d, and IA predicted NAUC (r-square = 34%). No significant differences between IA and SA were found between preoperative and postoperative values but µ significantly decreased after surgery. CONCLUSIONS: The mean corneal power, irregular astigmatism, and centration from vertex normal should be considered for optimizing the near visual performance with this MIOL.

Lente multifocal de tres piezas con captura de la óptica, como manejo de ruptura de la cápsula posterior en paciente sometida a cirugía facorrefractiva / Three-piece multifocal intraocular lens with optic capture as management of posterior capsule rupture in a patient undergoing refractive lens exchange

Se presenta el caso de una paciente sometida a cirugía facorrefractiva que sufre una ruptura de la cápsula posterior en la cirugía del primer ojo. Ante la imposibilidad de usar un lente trifocal de una pieza como inicialmente se tenía planteado, se realiza implante de lente multifocal de tres piezas en el sulcus con captura pupilar. Se reportan las imágenes de Scheimpflug y de retroiluminación del lente de tres piezas de un ojo y el lente de una pieza del ojo contralatera

We present the case of a female patient who suffered a posterior capsule rupture while undergoing refractive lens exchange. In view of the impossibility of using a single piece intraocular lens as was initially planned, a three-piece multifocal intraocular lens with an optic capture was positioned. Scheimpflug and retro-illumination images are presented.

Caracterización del implante secundario de una lente intraocular plegable suturada al iris en la afaquia / Characterization of Second Implantation of a Foldable Intraocular Lens Sutured to the Iris in Aphakia

Objetivo: Caracterizar los resultados refractivos del implante de una lente intraocular plegable de cámara posterior suturada al iris en la afaquia sin o con inadecuado soporte capsular. Métodos: Se realizó un estudio descriptivo, prospectivo y longitudinal, en el que se incluyeron 30 pacientes (30 ojos) seguidos por un período de un año de septiembre de 2019 a septiembre de 2021, después del implante de una lente intraocular de cámara posterior suturada al iris en la afaquia. Se les realizó examen oftalmológico completo y se evaluaron variables como mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, astigmatismo inducido, densidad celular y complicaciones. Resultados: La mejor agudeza visual sin corrección en el preoperatorio fue del 93,3 por ciento (<0,1) y con corrección de 0,66, al año del posoperatorio fue de 0,493/0,890, respectivamente. La presión intraocular preoperatoria fue de 20,7 mmHg, y al año 19,7 mmHg. La densidad celular en el preoperatorio fue de 1755,7 cél/mm2 y al año fue de 1363,8 cél/mm2, y en los pacientes bien corregidos al mes del posoperatorio fue de 73,4 por ciento y al año de 70 por ciento. El astigmatismo inducido en el posoperatorio al año fue de -0,51 D. Conclusiones: La agudeza visual sin corrección y con corrección mejoran después del implante de una lente intraocular plegable de cámara posterior suturada al iris en la afaquia sin o con inadecuado soporte capsular. Predominan los pacientes bien corregidos, sin cambios en la presión intraocular y la complicación más frecuente fue el edema corneal(AU)

Objective: To characterize the refractive outcomes of implanting a posterior chamber foldable intraocular lens sutured to the iris in aphakia without or with inadequate capsular support. Methods: A descriptive, prospective and longitudinal study was carried out, including 30 patients (30 eyes) followed up for a period of one year, from September 2019 to September 2021, after being implanted a posterior chamber intraocular lens sutured to the iris in aphakia. Complete ophthalmologic examination was performed and variables were assessed, such as best visual acuity without correction, with correction, refractive results, intraocular pressure, induced astigmatism, cell density and complications. Results: The best visual acuity without correction in the preoperative period was 93.3 % (<0.1) and 0.66 with correction; while one-year postoperative visual acuity was 0.493 and 0.890, respectively. Preoperative intraocular pressure was 20.7 mmHg, while it was 19.7 mmHg at one year. Preoperatively cell density was 1755.7 cells/mm2, and it was 1363.8 cells/mm2 at one year it; while in well-corrected patients, it was 73.4 percent at one month postoperatively and 70 percent at one year. Postoperative induced astigmatism at one year was -0.51 D. Conclusions: Both uncorrected and corrected visual acuity improve after implantation of a posterior chamber foldable intraocular lens sutured to the iris in aphakia without or with inadequate capsular support. Well-corrected patients predominate, with no change in intraocular pressure, while the most frequent complication was corneal edema(AU)

Corrección de la afaquia postraumática en niños con lentes plegables suturadas al iris / Correction of Posttraumatic Aphakia in Children with Folding Lenses Sutured to the Iris

Objetivo: Caracterizar resultados visuales del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos. Métodos: Se realizó un estudio preexperimental, prospectivo, longitudinal con 17 niños, con seguimiento de un año. Se les realizó examen oftalmológico completo y se evaluaron variables como edad, sexo, lateralidad, mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, y complicaciones. Resultados: La edad promedio fue de 13,2 años, masculinos fueron el 64,7 por ciento. La mejor agudeza visual sin corrección en el preoperatorio fue del 47,1 por ciento <0,1 y con corrección de 0,7, al año del posoperatorio fue de 0,43/0,78, respectivamente. La presión intraocular preoperatoria fue de 14,1 mm Hg, y al año 14,71 mm Hg. La densidad celular en el preoperatorio fue de 2559.76 células/mm2 y al año de 2475,88 células/mm2. La hexagonalidad preoperatorio fue del 53,12 por ciento y al año del 56,94 por ciento. El cilindro preoperatorio -1,35 D y el 23,5 por ciento presentó astigmatismo inducido al año del posoperatorio. Conclusiones: La aplicación del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos logra mejorar su agudeza visual y la complicación más frecuente fue el edema corneal(AU)

Objective: To characterize visual outcomes of iris-sutured posterior chamber foldable intraocular lens implantation in traumatic aphakia in pediatric patients. Methods: A pre-experimental, prospective, longitudinal, pre-experimental study was performed with 17 children, with a one-year follow-up. A complete ophthalmologic examination was performed and variables such as age, sex, laterality, best visual acuity without correction, with correction, refractive results, intraocular pressure and complications were evaluated. Results: The average age was 13.2 years, 64.7 percent were male. The best visual acuity without correction preoperatively was 47.1 percent <0.1 and with correction 0.7, one year postoperative visual acuity was 0.43/0.78, respectively. Preoperative intraocular pressure was 14.1 mm Hg, and at one year 14.71 mm Hg. Cell density preoperatively was 2559.76 cells/mm2 and at one year 2475.88 cells/mm2. The preoperative hexagonality was 53.12 percent and at one year 56.94 percent. Preoperative cylinder -1.35 D and 23.5 percent presented induced astigmatism at one year postoperatively. Conclusions: The application of posterior chamber foldable intraocular lens implant sutured to the iris in traumatic aphakia in pediatric patients achieves improved visual acuity and the most frequent complication was corneal edema(AU)

Surgical outcomes of primary intraocular lens implantation for the treatment of aphakia in pediatric cataracts in the Brazilian public health system / Resultados cirúrgicos do implante primário de lente intraocular no Sistema Único de Saúde (SUS) para tratamento da afacia na infância, em catarata pediátrica

ABSTRACT Purpose: To evaluate primary intraocular lens implantation in the treatment of children's aphakia in the Brazilian public health system and compare the outcomes among different age groups. Methods: Children aged 0-12 years old with unilateral or bilateral congenital/developmental cataracts and underwent primary intraocular lens implantation were included. Results: A total of 108 eyes from 68 children were evaluated, and the children were divided into four age groups (<7 months [mo]; 7 mo-2 years old [y/o]; 2-5 y/o, and >5 y/o) were evaluated. Nineteen eyes (17.59%) presented visual axis opacification as a postoperative complication, which was more frequently observed in the <7 mo age group (37.93%). The difference was significant between the <7 mo and >5 y/o age groups (p=0.002). Visual axis opacification was divided into two categories: pupillary membrane and lens cell proliferation. Eight eyes presented pupillary membrane, whereas 14 showed lens cell proliferation. Out of eight eyes with pupillary membrane, seven occurred in the <7 mo age group. The difference between the <7 mo age group and the 2-5 y/o or >5 y/o age group was significant (p=0.01). Lens cell proliferation was more frequent in the <7 mo and 2-5 y/o age groups, but the difference was significant only between the < 7 mo age group and >5 y/o age group (p=0.040). Glaucoma and glaucoma suspect cases were not observed during the follow-up period. Conclusions: The main complication found in the study was visual axis opacification, which had a higher incidence in children operated on or before the age of 7 months.

RESUMO Objetivo: Avaliar o implante de lente intraocular primária para tratamento da afacia pediátrica no Sistema Único de Saúde (SUS) e comparar os resultados em diferentes faixas etárias. Métodos: Foram incluídas crianças com catarata congênita e do desenvolvimento unilateral ou bilateral de 0-12 anos de idade e submetidas a implante de lente intraocular primária. Resultados: Cento e oito olhos de 68 crianças divididas em quatro grupos de idade (<7m; 7m-2a; 2-5a e > 5a) foram avaliados. Dezenove olhos (17,59%) apresentaram opacificação do eixo visual como complicação pós-operatória. Essa complicação foi mais frequente na faixa etária <7 meses (37,93%). A diferença foi significativa entre os grupos de idade <7 meses e > 5 anos (p=0,002). A opacificação do eixo visual foi dividida em duas categorias: membrana pupilar e proliferação de células do cristalino. Oito olhos apresentaram membrana pupilar e 14 proliferação de células do cristalino. Dos oito olhos com membrana pupilar, sete ocorreram na faixa etária <7 meses. A diferença entre o grupo de idade <7 meses e os grupos de 2-5 anos e > 5 anos foi significativa (p=0,01). A proliferação de células do cristalino foi mais frequente nos grupos de idade <7 meses e 2-5 anos, mas significativa apenas quando comparados o grupo de idade <7 meses com o grupo> 5 anos de idade (p=0,040). Glaucoma e suspeitos de glaucoma não foram observados durante o acompanhamento. Conclusões: A principal complicação encontrada no estudo foi a opacificação do eixo visual. Sua incidência foi maior em crianças operadas antes dos 7 meses de idade.

Scleral fixation of iris-Intraocular lens complex (Reper®) with Canabrava double-flanged technique: a case report / Fixação escleral de um complexo íris-lente intraocular (Reper®) com técnica de flange duplo de Canabrava: relato de caso

ABSTRACT A 38-year-old patient who developed aphakia and aniridia secondary to trauma suffered from vision loss. To improve her vision, an iris-intraocular lens complex (Reper®) was fixed to the sclera with Canabrava's double-flanged technique. There was a satisfactory increase in the patient's visual acuity and no complications were observed during the 6-months follow-up. Canabrava technique simplifies and improves the fixation of the iris-intraocular lens complex to the sclera. It is a safe option that does not require scleral flaps or knots.

RESUMO Uma paciente de 38 anos desenvolveu afacia e ani­ridia secundárias a um trauma, levando à perda da visão. Para melhorar sua visão, um complexo de íris e lente intraocular (Reper®) foi fixado à esclera com a técnica de flange duplo de Canabrava. Houve um aumento satisfatório na acuidade visual do paciente e nenhuma complicação foi observada durante o acompanhamento de 6 meses. A técnica de Canabrava simplifica e melhora a fixação do complexo de íris e lente intraocular na esclera. É uma opção segura que não requer retalhos ou pontos esclerais.

Cataratas en pacientes sometidos a implante de lente intraocular fáquico: una ocurrencia muy poco habitual / Cataract in patients undergoing phakic intraocular lens implantation: an uncommon event

Se presenta el caso de dos pacientes con vault anormalmente bajo luego del implante de lentes intraoculares fáquicos. Se reportan las imágenes de Scheimpflug y retroiluminación que han permitido el diagnóstico temprano.

We present the cases of two patients who developed an abnormally low vault and subcapsular anterior cataracts after phakic intraocular lens implantation. Scheimpflug and retroillumination images are reported

Poder dióptrico del lente intraocular y dilatación en pacientes con catarata / Dioptric power of intraocular lens and dilatation in patients with cataract

ntroducción: la cirugía de catarata con implante de un lente intraocular es, hoy en día, el procedimiento quirúrgico más frecuente en todo el mundo. Su éxito depende de muchos factores, uno de los más importantes es el cálculo exacto del poder dióptrico del lente intraocular. Objetivo: comparar el cálculo del poder dióptrico del lente intraocular en los pacientes sin y con dilatación pupilar. Material y métodos: estudio longitudinal, en el que se determinó el cálculo del poder dióptrico del lente intraocular en pacientes con y sin dilatación pupilar. Las variables de estudio fueron: edad, género, ojo a estudiar, queratometría, longitud axial, profundidad de cámara anterior y poder dióptrico del lente intraocular. Se realizó estadística descriptiva y t de Student. Resultados: se estudiaron 37 pacientes, 23 mujeres y 14 hombres. La edad promedio fue de 68 ± 7.87 años. Se estudiaron 64 ojos, 30 fueron derechos y 34 izquierdos. Estadísticamente solo hubo diferencia significativa en K2 de la biometría ocular entre pacientes sin y con dilatación pupilar al obtenerse un valor de p ≤ 0.05. Conclusión: no existen cambios en el cálculo del poder dióptrico del LIO sin y con dilatación pupilar.

Background: Cataract surgery with intraocular lens implant is, nowadays, the most frequent surgical procedure in all the world. Its success depends on a lot of factors, one of the most important is the calculation of the exact dioptric power of intraocular lens. Objective: To compare the calculation of dioptric power of intraocular lens with and without dilatation in patients with cataract. Material and methods: Longitudinal study, the calculation of the dioptric power of the intraocular lens was determined in patients without and with pupillary dilation. The variables were age, gender, eye to study, keratometry, axial length, anterior chamber depth and dioptric power of the intraocular lens. Descriptive statistics and Student t test were performed. Results: There were 37 patients, 23 females and 14 males. The average age was 68 + 7.87 years. Sixty-four eyes were studied, 30 were right and 34 left. Statistically, there was only significant difference in K2 of the ocular biometry between patients without and with pupillary dilation when obtaining a value of p < 0.05. Conclusion: There are no changes in the calculation of the dioptric power of the Intraocular lens without and with pupillary dilation

Lentes intraoculares en pilotos aviadores: revisión del tema / Intraocular lenses in pilots: a review

Resumen Objetivo: Revisar en la literatura las diferentes posturas de las agencias reguladoras de la aviación sobre la implantación de lentes intraoculares multifocales (MIOLs) en pilotos aviadores civiles que han desarrollado catarata, además de evidencia científica que podría generar una revisión de los lineamientos vigentes. Resultados: Se encontraron el 50% (3 de 6) de agencias revisadas con postura en contra de los MIOLs. Además, se revisaron dos estudios a favor de los MIOLs, en el que implantarlos brinda una mayor independencia de lentes respecto a los monofocales para las tareas visuales dentro y fuera de la cabina, así como un rendimiento sin diferencias en simuladores de vuelo versus los pilotos con lentes intraoculares monofocales. Limitaciones: Existen pocos estudios de MIOLs en pilotos aviadores. Originalidad: No se ha reportado ninguna revisión de las agencias reguladoras respecto a la prohibición o permisión de los MIOLs en pilotos aviadores, tocando evidencia que pudiera consolidar una postura unánime respecto a este tema, como en su momento fue la cirugía refractiva con láser excimer que actualmente no está restringida.

Abstract Objective: To review the literature on the different stands of aviation regulatory agencies on the implantation of multifocal intraocular lenses (MIOLs) in civilian aviators who have developed cataract, as well as scientific evidence that could generate a revision of the current guidelines. Results: 50% (3 of 6) of agencies reviewed were found to be against MIOLs. In addition, two studies were reviewed in favour of MIOLs, in which implanting MIOLs provides greater lens independence from monofocals for visual tasks in and out of the cockpit, as well as no difference in performance in flight simulators versus pilots with monofocal intraocular lenses. Limitations: There are few studies of MIOLs in aviator pilots. Originality: No review of regulatory agencies regarding the prohibition or permission of MIOLs in airline pilots has been reported, touching on evidence that could consolidate a unanimous position on this issue, as was once the case with excimer laser refractive surgery, which is currently unrestricted.

Intraocular lens power estimation for future emmetropia in pediatric cataract surgery / Estimativa do poder da lente intraocular para emetropia futura em cirurgias de catarata pediátrica

ABSTRACT Purpose: Creating models, in pediatric cataracts, to estimate kerotometry and axial length values at future ages, based on kerotometry and axial length measured at surgery, to estimate the intraocular lens power for emmetropia in future ages. Methods: Eyes with bilateral cataract and kerotometry and axial length measured at surgery and at least one postoperative examination with kerotometry and axial length measurements, were considered for this study. The models to estimate future kerotometry and axial length values were created considering (1) kerotometry and axial length measured at surgery, (2) the average slope of kerotometry and axial length logarithmic regression created for every single eye and (3) age at surgery. The intraocular lens for future ages can be estimated using these values in third generation formulas. The estimation errors for kerotometry, axial length and intraocular lens were also calculated. Results: A total of 57 eyes from 29 patients met the inclusion criteria. The average age at the surgery and follow-up was 36.96 ± 32.04 months and 2.39 ± 1.46 years, respectively. The average slope of logarithmic regression created for every single eye were -3.286 for kerotometry and +3.189 for axial length. The average absolute estimation errors for kerotometry and axial length were respectively: 0.61 ± 0.54 D and 0.49 ± 0.55 mm, and for intraocular lens using SRK-T, Hoffer-Q and Holladay I formulas were: 2 . 04 ± 1 . 73 D , 2 . 49 ± 2 . 10 D and 2 . 26 ± 1 . 87 D, respectively. Conclusions: The presented models could be used to estimate the intraocular lens power for emmetropia at future ages to guide the choice of the intraocular lens power to be implanted in pediatric cataract.

RESUMO Objetivo: Criar modelos, em catarata pediátrica, para estimar valores futuros de ceratometria e comprimento axial, com base na ceratometria e no comprimento axial medidos na cirurgia, para previsão do poder da lente intraocular para emetropia em idades futuras. Métodos: Olhos com catarata bilateral, ceratometria e comprimento axial medidos na cirurgia e pelo menos um exame pós-operatório com medidas de ceratometria e comprimento axial foram considerados para este estudo. Os modelos para estimar futuras ceratometrias e comprimentos axiais foram criados considerando (1) ceratometria e comprimento axial medidos na cirurgia, (2) a inclinação média da regressão logarítmica da ceratometria e comprimento axial criada para cada olho e (3) a idade na cirurgia. A lente intraocular para emetropia em idades futuras pode ser estimada usando esses valores em fórmulas de terceira geração. Os erros de estimativa da ceratometria, comprimento axial e poder da lente intraocular, usando os modelos, também foram calculados. Resultados: 57 olhos de 29 pacientes preencheram os critérios de inclusão. A idade média na cirurgia e acompanhamento foram de 36,96 ± 32,04 meses e 2,39 ± 1,46 anos, respectivamente. A inclinação média da regressão logarítmica criada para cada olho foi de -3.286 para ceratometria e + 3.189 para o comprimento axial. Os erros médios de estimativa absoluta para ceratometria e comprimento axial foram respectivamente: 0,61 ± 0,54 D e 0,49 ± 0,55 mm, e para o poder da lente intraocular usando as fórmulas SRK-T, Hoffer-Q e Holladay I foram: 2,04 ± 1,73 D, 2,49 ± 2,10 D e 2,26 ± 1,87 D, respectivamente. Conclusões: Os modelos apresentados podem ser utilizados para estimar o poder da lente intraocular que levaria a emetropia em idades futuras e orientar a escolha do poder da lente intraocular a ser implantada na catarata pediátrica.

Comparison of prediction accuracy of five different biometric formulas / Comparação da acurácia preditiva de cinco fórmulas biométricas diferentes

ABSTRACT Objective To compare the performance of Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function formulas to calculate intraocular lens power in eyes with normal axial length, in terms of predicting target refraction by using partial coherence interferometry technology. Methods Phacoemulsification and intraocular lens implantation were performed in 135 eyes of 135 patients with an axial length between 22 and 24.5 mm. Axial length, keratometry, and anterior chamber depth were measured by intraocular lens Master 500. Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function formulas were used for intraocular lens power calculations. The difference between the expected postoperative refraction and the mean absolute prediction error was calculated for each eye. Statistical significance was evaluated at the level of p<0.05. Results The study included 135 subjects. The mean axial length, anterior chamber depth, keratometry, and intraocular lens power were 23.2±1.2 (22 to 24.5) mm, 3.2±0.4 (2.4 to 4.4) mm, 43.5±1.5 (40.8 to 46.2) diopter, 21.5±1.8 (18.5 to 25.5) diopter, respectively. The mean absolute prediction error for Sanders-Retzlaff-Kraft/Theoretical, Hoffer Q, Barrett Universal II, Kane, and Hill-radial basis function was 0.306±0.291, 0.312±0.257, 0.314±0.268, 0.299±0.206 and 0.308±0.280, respectively (p>0.05). Conclusion The study showed the third-generation (Sanders-Retzlaff-Kraft/Theoretical and Hoffer Q), fourth-generation (Barrett Universal II) and new-generation (Kane and Hill-radial basis function) intraocular lens power calculation formulas had similar performances regarding calculation of intraocular lens power to predict target refraction after phacoemulsification in eyes with normal axial length.

RESUMO Objetivo Comparar o desempenho das fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function (RBF) para cálculo de poder dióptrico das lentes intraoculares, em olhos com comprimento axial normal, em termos de predição da refração alvo, utilizando a tecnologia de interferometria de coerência parcial. Métodos Facoemulsificação e implante de lentes intraoculares foram realizados em 135 olhos de 135 pacientes com comprimento axial entre 22 e 24.5 mm. Comprimento axial, ceratometria, e profundidade da câmara anterior foram medidos por lente intraocular Master 500. As fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function foram empregadas para cálculo de poder dióptrico das lentes intraoculares. A diferença entre a refração esperada no pós-operatório e a média dos erros absolutos preditivos foi calculada para cada olho. Os valores de p<0,05 foram considerados estatisticamente significativos. Resultados O estudo incluiu 135 sujeitos. As médias de comprimento axial, profundidade da câmara anterior, ceratometria, e poder dióptrico das lentes intraoculares foram 23,2±1,2 (22 a 24,5) mm, 3,2±0,4 (2,4 a 4,4) mm, 43,5±1,5 (40,8 a 46,2) dioptria, 21,5±1,8 (18,5 a 25,5) dioptria, respectivamente. A média de erro absoluto preditivo para as fórmulas Sanders-Retzlaff-Kraft/Teórica, Hoffer Q, Barrett Universal II, Kane, e Hill-radial basis function foi 0,306±0,291, 0,312±0,257, 0,314±0,268, 0,299±0,206 e 0,308±0,280, respectivamente (p>0,05). Conclusão O estudo mostrou que as fórmulas de terceira geração (Sanders-Retzlaff-Kraft/Teórica e Hoffer Q), de quarta geração (Barrett Universal II) e as da nova geração (Kane e Hill-radial basis function) para cálculo de poder dióptrico das lentes intraoculares, têm desempenhos semelhantes para cálculo do poder dióptrico das lentes intraoculares, para predizer a refração alvo após facoemulsificação em olhos com comprimento axial normal.

Capsulotomía posterior en el Hospital General Docente Dr. Agostinho Neto, Guantánamo 2015-2019 / Capsulotomia posterior no Hospital General Docente Dr. Agostinho Neto / Capsulotomy outcomes at the Hospital General Docente Dr. Agostinho Neto

Introducción: La opacificación de la cápsula posterior continúa siendo la complicación posoperatoria tardía más frecuente tras la cirugía de catarata. Objetivo: Determinar los resultados visuales en la realización de la capsulotomía posterior con el equipo NIDEK YAG C-1800 a 75 pacientes que desarrollaron opacidad de la cápsula posterior (150 ojos); los cuales asistieron al Centro Oftalmológico del Hospital General Docente "Dr. Agostinho Neto", provincia Guantánamo, en el período comprendido entre abril de 2015 a abril de 2019. Método: Se efectuó un estudio longitudinal, prospectivo y descriptivo en pacientes diagnosticados con opacidad de la cápsula posterior, a los cuales se les realizó capsulotomía posterior en dicho centro antes mencionado. Las variables estudiadas fueron: edad, sexo, agudeza visual corregida con cristales (AV.cc) a los tres meses posteriores a la cirugía y complicaciones encontradas. Resultados: El 57,3 % presentó una edad mayor a los 75 años, el sexo femenino quedó representado en un 62 %. La metaplasia fibrosa con un 57,3 % fue la opacidad de cápsula posterior más frecuente después de la aplicación del láser y el 74,7 % de los pacientes evolucionó con una buena agudeza visual, mayor o igual a 0,6. La complicación más frecuente fue la elevación transitoria de la tensión ocular con un 32,7 %. Conclusiones: La capsulotomía posterior con NIDEK YAG C-1800 demuestra ser un procedimiento quirúrgico efectivo en los pacientes diagnosticados con opacidad de la cápsula posterior, la mayoría de los pacientes alcanzó una agudeza visual mayor a 0,5. Existieron pocas complicaciones relacionadas con el proceder.

Introduction: The opacification of the posterior capsule remains the most frequent late postoperative complication following cataract surgery. Objective: To determine the visual outcomes obtained in the performance of posterior capsulotomy with the NIDEK YAG C-1800 equipment in 75 patients with opacification of the posterior capsule (150 eyes) who were attended in the Ophthalmology Center setted at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo, from April 2015 to April 2019. Method: A longitudinal, prospective and descriptive study was carried out in patients diagnosed with posterior capsule opacity, who underwent posterior capsulotomy in the aforementioned center. Variables studied were as follow: age, sex, visual acuity corrected with glasses (VA.cc) (3 months after surgery), and complications encountered. Results: The 57.3% of the total were over 75 years of age, and 62% were female. Fibrous metaplasia was the most frequent posterior capsule opacity found after laser application (57.3%) and the 74.7% of patients evolved with good visual acuity (≥0,6). The most frequent complication was transient elevation of ocular pressure (32.7%). Conclusions: Posterior capsulotomy with NIDEK YAG C-1800 proved to be effective, as surgical procedure, in patients diagnosed with posterior capsule opacity, most patients achieved visual acuity over 0.5. There were minimum complications related to the procedure.

Introdução: A opacificação da cápsula posterior continua sendo a complicação pós-operatória tardia mais frequente após a cirurgia de catarata. Objetivo: Determinar os resultados visuais na realização da capsulotomia posterior com o equipamento NIDEK YAG C-1800 em 75 pacientes que desenvolveram opacidade da cápsula posterior (150 olhos); que frequentaram o Centro Oftalmológico do Hospital General Docente "Dr. Agostinho Neto", província de Guantánamo, no período de abril de 2015 a abril de 2019. Método: Foi realizado um estudo longitudinal, prospectivo e descritivo em pacientes com diagnóstico de opacidade da cápsula posterior, submetidos à capsulotomia posterior no referido centro. As variáveis estudadas foram: idade, sexo, acuidade visual corrigida por cristal (AV.cc) três meses após a cirurgia e complicações encontradas. Resultados: 57,3% tinham mais de 75 anos, o sexo feminino estava representado em 62%. Metaplasia fibrosa com 57,3% foi a opacidade da cápsula posterior mais frequente após a aplicação do laser e 74,7% dos pacientes evoluíram com boa acuidade visual, maior ou igual a 0,6. A complicação mais frequente foi a elevação temporária da tensão ocular com 32,7%. Conclusões: A capsulotomia posterior com NIDEK YAG C-1800 se mostra um procedimento cirúrgico eficaz em pacientes com diagnóstico de opacidade da cápsula posterior, a maioria dos pacientes alcançou acuidade visual maior que 0,5. Houve poucas complicações relacionadas ao procedimento.

Influence of pupillary dynamics on the defocus curve of eyes implanted with diffractive multifocal lenses: a randomized study / Influência da dinâmica pupilar na curva de desfoco de olhos implantados com lentes multifocais difrativas: um estudo randomizado

ABSTRACT Purpose: To evaluate the influence of pupil dynamics on the defocus profile and area-of-focus of eyes implanted with a diffractive multifocal intraocular lens (IOL). Methods: This prospective randomized trial was conducted at the Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. Thirty-eight patients were randomly assigned to receive the multifocal SN6AD1 (n=20) or the aspheric monofocal SN60WF (aIOL) (n=18) IOLs bilaterally. Dynamic pupillometry, visual acuity for distance and near, corrected and uncorrected, and a defocus profile were assessed postoperatively. The area-of-focus was calculated using an empirical polynomial model of the defocus profile. Results: Sixteen patients (32 eyes) in the multifocal SN6AD1 group and 17 patients (34 eyes) in the aspheric monofocal SN60WF group completed the 1-year follow-up. There were no significant between-group differences in monocular uncorrected distance or near visual acuity. The defocus profiles of the mfIOL group showed a double peak, whereas those of the aspheric monofocal SN60WF group showed only one peak, which is typical for a monofocal intraocular lens. The area-of-focus of the aIOL group (4.66 ± 1.51 logMARxD) was significantly different from that of the multifocal SN6AD1 (1.99 ± 1.31 logMARxD). Pupil size at maximum contraction after exposure to a flash of 30 cd/m2 for 1 second was significantly correlated with a better area-of-focus in the multifocal SN6AD1 group (r=0.54; p=0.0017), whereas this was not the case in the aspheric monofocal SN60WF group. Conclusion: These findings indicate that in eyes implanted with an multifocal SN6AD1, the smaller the pupil size, the better is the area-of-focus and hence the better is the visual performance. This correlation was not found for the aspheric monofocal SN60WF.(AU)

RESUMO Objetivo: Avaliar a influência da dinâmica pupilar na curva de desfoco de olhos implantados com lente intraoculares multifocais difrativas. Métodos: Estudo prospectivo e randomizado realizado na Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Departamento de Oftalmologia. Trinta e oito pacientes foram aleatoriamente designados para receber bilateralmente lentes intraoculares SN6AD1 (n=20) (mfIOL) ou SN60WF (n=18) (aIOL). Além da acuidade visual para longe e perto, corrigida e não corrigida, e curva de desfoco, foi ainda realizada pupilometria dinâmica. A área sob a curva de desfoco foi calculada usando um modelo polinomial empírico. Resultados: Um total de 16 e 17 pacientes (n=32 e 34 olhos) completaram 1 ano de seguimento nos grupos mfIOL e aIOL, respectivamente. Não houve diferenças significativas entre grupos para as acuidades visuais seja para longe ou perto. As curvas de desfoco do grupo mfIOL mostraram um pico duplo; enquanto o SN60WF mostrou apenas um pico, típico para uma lente intraoculares monofocal. A média da área sob a curva de desfoco do grupo aIOL foi (4,66 ± 1,51 logMAR.dp), e essa é estatisticamente significante diferente da métrica do grupo mfIOL (1,99 ± 1,31 logMAR.dp). A pupila na contração máxima após a exposição a um flash de 30 cd/m2 por 1 segundo foi significativamente correlacionada com uma melhor área de foco no grupo mfIOL (r=0,54; p=0,0017), essa relação não foi observada para o grupo aIOL. Conclusão: Estes dados indicam que quanto menor a pupila durante contração, melhor é a área sob a curva de desfoco e, portanto, o desempenho visual dos olhos implantados com essa mfIOL. Esta correlação não foi encontrada para lentes intraoculares monofocais.(AU)

Influence of upper blepharoplasty on intraocular lens calculation / A influência da blefaroplastia superior no cálculo da lente intraocular

ABSTRACT Purpose: To determine the effect of upper blepharoplasty on corneal topography and intraocular lens power calculation using Galilei and IOLMaster. Methods: Thirty patients submitted to upper blepharoplasty from May 2014 to March 2017 at the Hospital Oftalmológico de Sorocaba (São Paulo, Brazil) were included in this observational case series. All patients underwent imaging sessions with Galilei and IOLMaster preoperatively (baseline) and at 1 and 6 months postoperatively. Primary outcome measures using both devices included flattest, average, and steepest corneal curvature, corneal astigmatism, and blepharoplasty-induced corneal astigmatism. Determination of axial length and lens power calculation were performed using only IOLMaster (Holladay formula). Paired t-test and vectorial analysis were used for statistical analysis. Results: Sixty eyes from 30 patients were prospectively included. Vectorial analysis showed that 6 months after surgery, blepharoplasty induced on average 0.39 D and 0.31 D of corneal astigmatism, as measured with Galilei and IOLMaster, respectively. IOLMaster measurements showed that average corneal curvature (44.56 vs 44.64 D, p=0.01), steepest corneal curvature (45.17 vs 45.31, p=0.01) and corneal astigmatism (1.22 vs 1.34, p=0.03) were higher 6 months after surgery. IOLMaster measurements also showed that intraocular lens power was significantly smaller 6 months after surgery (22.07 vs 21.93, p=0.004). All other parameters showed no change for comparisons between baseline and 6 months (p>0.05 for all comparisons). Conclusion: Upper eyelid blepharoplasty influenced intraocular lens calculation using the IOLMaster. However, the influence was not clinically significant. No topographic changes were found using Galilei.

RESUMO Objetivo: Determinar o efeito da blefaroplastia superior na topografia corneana e no cálculo do poder das lentes intraoculares usando Galilei e IOLMaster. Métodos: Trinta pacientes submetidos a blefaroplastia superior de maio de 2014 a março de 2017 no Hospital Oftalmológico de Sorocaba, São Paulo, Brasil foram incluídos neste estudo de série de casos observacional. Todos os pacientes foram submetidos a sessões de imagem com Galilei e IOLMaster antes da cirurgia (exame de base) e no 1º e 6º mês pós-operatório. Os resultados primários utilizando os dois aparelhos incluíram ceratometria, astigmatismo corenano e astigmatismo corneano induzido pela blefaroplastia. O comprimento axial e o cálculo do poder da lente intraocular foram realizados unicamente com o IOLMaster (fórmula de Holladay). Teste-t pareado e análise vetorial foram usados na análise estatística. Resultados: Sessenta olhos de 30 pacientes foram incluídos prospectivamente. A análise vec­torial mostrou que após 6 meses da cirurgia, a blefaroplastia superior induziu na média 0,39 D de astigmatismo corneano medido com o Galilei e 0,31 D com IOLMaster. As medidas com o IOLMaster mostraram que a ceratometria média (44,56 vs 44,64 D, p=0,01), ceratometria máxima (45,17 vs 45,31, p=0,01) e o astigmatismo corneano (1,22 vs 1,34, p=0,03) foram maiores após 6 meses da blefaroplastia. As medidas com IOLMaster mostraram que o poder da lente intraocular foi significativamente menor 6 meses após a blefaroplastia (22,07 vs 21,93, p=0,004). Todos os outros parâmetros não mostraram mudanças entre o pré-operatório e o 6º mês da cirurgia (p>0,05 para todas as comparações). Conclusões: A blefaroplastia superior influenciou o cálculo da lente intrao­cular utilizando o IOLMaster. Contudo, a influência não foi cli­­nicamente significativa. Não foram encontradas mudanças topográficas com o Galilei.