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1.
Int Ophthalmol ; 38(3): 1103-1110, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28550347

RESUMO

PURPOSE: To assess the correlations between preoperative Scheimpflug-based lens densitometry and effective phacoemulsification time (EPT) in age-related nuclear cataracts. DESIGN: Retrospective consecutive study. METHODS: The setting was the Ophthalmology Department, Hospital de Braga, Portugal. The study population included 50 eyes (42 patients) with age-related nuclear cataracts submitted to uneventful phacoemulsification surgery. Different analysis methods of Scheimpflug-based lens densitometry were performed: Pentacam Nucleus Staging (PNS) score with an ordinal scale from 0 to 5 and three-dimensional (3D), linear and region of interest (ROI) methods, which are displayed on an absolute scale (from 0 to 100%). EPT was calculated for the cataract surgery, which was performed by the same surgeon. Correlations between lens densitometry variables and EPT were determined using Pearson or Spearman correlation coefficients according to data normality. RESULTS: There were significant correlations between EPT and average density and maximum density variables derived from the 3D (r = 0.596, p < 0.001; r = 0.632, p < 0.001, respectively) and ROI (r = 0.527, p < 0.001; r = 0.575, p < 0.001, respectively) methods. The average density was the only parameter derived from the linear analysis that showed a significant correlation with EPT (r = 0.293, p = 0.039). The PNS score did not show a significant correlation with EPT (rho = 0.124, p = 0.390). CONCLUSION: The densitometric parameters based on the 3D method showed the highest correlations with EPT. The referred lens densitometric analysis approach may be used in preoperative assessment in order to predict EPT more efficiently in age-related nuclear cataracts.


Assuntos
Catarata/diagnóstico , Densitometria/métodos , Cristalino/química , Facoemulsificação/métodos , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Catarata/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Ophthalmic Plast Reconstr Surg ; 30(5): 384-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24777264

RESUMO

PURPOSE: To measure the effect of müllerectomy from posterior approach on the amplitudes of spontaneous blinking and downward eyelid saccades. METHODS: Spontaneous blinks and downward upper eyelid saccadic movements of 16 patients (23 eyelids) with Graves orbitopathy were measured before and after müllerectomy from posterior approach. A new video system was used to continuously register the blinking activity while subjects viewed a commercial movie for 5 minutes. Downward eyelid saccades (30° of downgaze) were also measured with the video system. RESULTS: Müllerectomy had no effect on the amplitude of the blink. However, as the eyelid margins were significantly lowered by the surgery, the amplitude of the blink movements relative to the pupil center increased substantially. The number of movements occluding the pupil center increased from 0% to 13%. Due to the increased efficiency of blinking, the blink rate decreased. Surgery induced a mean increase of 1.1 mm of downward saccades. CONCLUSIONS: The effects of müllerectomy on the blinks are indirect and related to correction of eyelid retraction. The relative amplitude of blink movements increases and blink rate decreases. Müllerectomy does affect the downward eyelid saccades increasing the ability of the upper eyelid to relax on downgaze.


Assuntos
Doenças Palpebrais/cirurgia , Oftalmopatia de Graves/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Movimentos Sacádicos/fisiologia , Adulto , Idoso , Doenças Palpebrais/fisiopatologia , Feminino , Oftalmopatia de Graves/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Adulto Jovem
4.
Cureus ; 16(5): e60277, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38872649

RESUMO

The purpose of this clinical report is to describe a 10-year clinical outcome of advanced surface ablation with photorefractive keratectomy (PRK) in a patient who had been previously incorrectly diagnosed with keratoconus (KC). Corneal ectasia is a rare but extremely relevant complication of laser vision correction, and KC represents a major contraindication for these procedures. Nonetheless, some surface ablation procedures, such as PRK, might be a valid option for particular patients with atypical corneal topography or subclinical or mild forms of KC. Patient education and complete preoperative refractive multimodal imaging are essential for a more conscious therapeutic decision, minimizing iatrogenic ectasia, as well as decreasing the number of patients who are incorrectly denied refractive surgery, as was the patient presented in this study.

5.
Case Rep Ophthalmol ; 15(1): 532-541, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39015239

RESUMO

Introduction: The purpose of this clinical report was to describe an unprecedented case of bilateral pressure-induced stromal keratopathy (PISK) following corneal photorefractive keratectomy, associated with presumed herpetic keratitis, and to present tomographic and biomechanical findings before and after appropriate treatment. Case Presentation: A 33-year-old male patient was referred to our clinic with suspected delayed corneal epithelial healing 3 weeks after an uncomplicated PRK. A central layer of corneal opacity with a presumed fluid-filled interface area was observed upon slit lamp biomicroscopy. Scheimpflug images from the Pentacam® revealed a hyperreflective area beneath the central cornea. Scheimpflug-based corneal tomography, biomechanical assessment using the Pentacam® AXL Wave, and the Corvis ST® were conducted. Goldmann applanation tonometry measured 23/13 mm Hg, while noncontact tonometry intraocular pressure measured with the Corvis ST® (Corvis ST IOPnct) was 40.5/43.5 mm Hg. Treatment with oral valacyclovir, combined with ocular hypotensive therapy, led to a significant reduction in IOP and improved corneal deformation parameters after 1 month. Conclusion: Surgeons should be aware of the inaccuracy of Goldmann applanation tonometry in PISK, which can occur after LASIK or surface ablation.

6.
J Refract Surg ; 29(5): 356-8, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23496019

RESUMO

PURPOSE: To report the tomographic and biomechanical findings before and after treatment of a case of pressure-induced stromal keratopathy (PISK), which was misdiagnosed as diffuse lamellar keratitis (DLK). METHODS: A case report of a referred patient with supposed diagnosis of DLK after LASIK in the right eye. Scheimpflug-based corneal tomography and biomechanical assessment were provided by the Pentacam HR and CorVis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany). RESULTS: A layer of corneal opacity beneath the flap with a presumably fluid-filled interface area was observed on slit-lamp biomicroscopy. Scheimpflug image from Pentacam revealed a hyperreflective area underneath the flap interface. Goldmann applanation tonometry was 12 mm Hg, whereas CorVis intraocular pressure was 53.5 mm Hg with deformation amplitude of 0.42 mm. Two days after starting oral and topical ocular hypotensive therapy, CorVis intraocular pressure was 14 mm Hg and deformation amplitude was 1.02 mm. CONCLUSIONS: Ocular hypertension in PISK was associated with lower deformation response, along with steepening and thickening of the cornea.


Assuntos
Doenças da Córnea/etiologia , Substância Própria/patologia , Pressão Intraocular/efeitos dos fármacos , Ceratomileuse Assistida por Excimer Laser In Situ , Hipertensão Ocular/induzido quimicamente , Prednisolona/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Fenômenos Biomecânicos/fisiologia , Doenças da Córnea/diagnóstico , Paquimetria Corneana , Elasticidade/fisiologia , Humanos , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Hipertensão Ocular/tratamento farmacológico , Fotografação , Tomografia , Tonometria Ocular
7.
Curr Opin Ophthalmol ; 24(4): 310-20, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23680761

RESUMO

PURPOSE OF REVIEW: To review the principles and clinical applications of Scheimpflug corneal and anterior segment imaging with special relevance for laser refractive surgery. RECENT FINDINGS: Computerized Scheimpflug imaging has been used for corneal and anterior segment tomography (CASTm) in different commercially available instruments. Such approach computes the three-dimensional image of the cornea and anterior segment, enabling the characterization of elevation and curvature of the front and back surfaces of the cornea, pachymetric mapping, calculation of the total corneal refractive power and anterior segment biometry. CASTm represents a major evolution for corneal and anterior segment analysis, beyond front surface corneal topography and single point central corneal thickness measurements. This approach enhances the diagnostic abilities for screening ectasia risk as well as for planning, evaluating the results, managing complications of refractive procedures, and selecting intraocular lens power, type, and design. In addition, dynamic Scheimpflug imaging has been recently introduced for in-vivo corneal biomechanical measurements and has also been used for anterior segment imaging of femtocataract surgery. SUMMARY: Scheimpflug imaging has an important role for laser refractive surgery with different applications, which continuously improve due to advances in technology.


Assuntos
Segmento Anterior do Olho/patologia , Cirurgia da Córnea a Laser , Técnicas de Diagnóstico Oftalmológico , Fotografação/métodos , Biometria , Humanos , Refração Ocular , Tomografia
8.
Am J Ophthalmol ; 251: 126-142, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36549584

RESUMO

PURPOSE: To optimize artificial intelligence (AI) algorithms to integrate Scheimpflug-based corneal tomography and biomechanics to enhance ectasia detection. DESIGN: Multicenter cross-sectional case-control retrospective study. METHODS: A total of 3886 unoperated eyes from 3412 patients had Pentacam and Corvis ST (Oculus Optikgeräte GmbH) examinations. The database included 1 eye randomly selected from 1680 normal patients (N) and from 1181 "bilateral" keratoconus (KC) patients, along with 551 normal topography eyes from patients with very asymmetric ectasia (VAE-NT), and their 474 unoperated ectatic (VAE-E) eyes. The current TBIv1 (tomographic-biomechanical index) was tested, and an optimized AI algorithm was developed for augmenting accuracy. RESULTS: The area under the receiver operating characteristic curve (AUC) of the TBIv1 for discriminating clinical ectasia (KC and VAE-E) was 0.999 (98.5% sensitivity; 98.6% specificity [cutoff: 0.5]), and for VAE-NT, 0.899 (76% sensitivity; 89.1% specificity [cutoff: 0.29]). A novel random forest algorithm (TBIv2), developed with 18 features in 156 trees using 10-fold cross-validation, had a significantly higher AUC (0.945; DeLong, P < .0001) for detecting VAE-NT (84.4% sensitivity and 90.1% specificity; cutoff: 0.43; DeLong, P < .0001) and a similar AUC for clinical ectasia (0.999; DeLong, P = .818; 98.7% sensitivity; 99.2% specificity [cutoff: 0.8]). Considering all cases, the TBIv2 had a higher AUC (0.985) than TBIv1 (0.974; DeLong, P < .0001). CONCLUSIONS: AI optimization to integrate Scheimpflug-based corneal tomography and biomechanical assessments augments accuracy for ectasia detection, characterizing ectasia susceptibility in the diverse VAE-NT group. Some patients with VAE may have true unilateral ectasia. Machine learning considering additional data, including epithelial thickness or other parameters from multimodal refractive imaging, will continuously enhance accuracy. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.


Assuntos
Ceratocone , Humanos , Estudos Retrospectivos , Topografia da Córnea/métodos , Ceratocone/diagnóstico , Inteligência Artificial , Dilatação Patológica/diagnóstico , Paquimetria Corneana/métodos , Estudos Transversais , Córnea/diagnóstico por imagem , Curva ROC , Tomografia/métodos
9.
J Refract Surg ; 38(6): 339-347, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35686710

RESUMO

PURPOSE: To compare visual, refractive, and safety outcomes of toric posterior chamber Implantable Collamer Lens (T-ICL) (STAAR Surgical) and toric iris-fixated foldable phakic intraocular lens (IOL) (T-Artiflex; Ophtec BV) implantation for the correction of myopic astigmatism. METHODS: This retrospective cohort study included 312 eyes of 312 patients who had phakic IOL implantation for myopic astigmatism. Two groups were defined: 205 eyes that underwent T-ICL implantation and 107 eyes that underwent T-Artiflex implantation. Safety, efficacy, and predictability outcomes were evaluated preoperatively and at 12 months postoperatively. Refractive and corneal astigmatic vector analysis were performed using the Alpins method. RESULTS: One year postoperatively, uncorrected distance visual acuity was 0.05 ± 0.18 (T-ICL) and 0.10 ± 0.16 (T-Artiflex) logMAR, with efficacy indexes of 1.16 ± 0.27 and 1.05 ± 0.31, respectively (P < .001). Safety indexes were 1.28 ± 0.30 and 1.21 ± 0.31, respectively (P = .04). Spherical equivalent was within ±0.50 diopters (D) of emmetropia in 165 (80.5%) and 88 (82.2%) eyes, respectively. Refractive astigmatic analysis showed an index of success of 0.28 ± 0.33 (T-ICL) and 0.31 ± 0.26 (T-Artiflex) (P = .07). Surgically induced corneal astigmatism was 0.48 ± 0.74 and 0.81 ± 0.61 D, respectively (P < .001). Mean endothelial loss was 1.11% and 2.05%, respectively (P = .42). Six (2.9%) eyes in the T-ICL group and 1 (0.9%) eye in the T-Artiflex group had phakic IOL repositioning due to significant misalignment. No vision-threatening complications occurred. CONCLUSIONS: Both the T-ICL and T-Artiflex groups showed high visual and refractive efficacy with a good safety profile for the correction of myopic astigmatism. T-ICL implantation demonstrated significantly better efficacy and safety indexes after 12 months. Vector analysis showed similar refractive astigmatic correction in both groups, but T-Artiflex implantation revealed higher surgically induced corneal astigmatism. [J Refract Surg. 2022;38(6):339-347.].


Assuntos
Astigmatismo , Miopia , Lentes Intraoculares Fácicas , Astigmatismo/etiologia , Seguimentos , Humanos , Iris/cirurgia , Implante de Lente Intraocular/métodos , Miopia/complicações , Miopia/cirurgia , Lentes Intraoculares Fácicas/efeitos adversos , Estudos Retrospectivos
10.
Eur J Ophthalmol ; : 11206721221131889, 2022 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-36214139

RESUMO

PURPOSE: To compare visual, refractive, and safety outcomes of posterior chamber Implantable Collamer Lens (ICL) implantation for the correction of myopia according to the preoperative anterior chamber depth (ACD). METHODS: Retrospective, comparative study, patients submitted to implantation of myopic posterior-chamber phakic Implantable Collamer Lens (ICL), model V4C/V5, minimum follow-up of 12 months; two groups were created: Group 1 (ACD 2.80 to 2.99 mm) and Group 2 (ACD equal to or greater than 3.00 mm). The parameters evaluated were uncorrected and corrected visual acuity, subjective refraction, efficacy and safety index, predictability, endothelial cell density, central vault, anterior chamber angle and postoperative complications. A total of 558 eyes from 298 patients were evaluated: 111 eyes (19.9%) in group 1 and 447 eyes (80.1%) in group 2. RESULTS: At 12 months, the efficacy index was similar in both groups (p = 0.264); the safety index was higher in group 1 (p = 0.031); the mean central Vault was significantly lower in group 1 (212.8 vs 410.6 µm; p < 0.001). Respectively, 93 (83.8%) and 366 (84.1%) eyes were within ±0.50 D of targeted refraction. Anterior chamber angle significantly decreased during follow-up in both groups (p < 0.001; p < 0.001). Intraocular pressure did not change significantly (p = 0.310 and p = 0.446, respectively). There were no significant differences in endothelial cell density loss (p = 0.278) or in the rate of complications observed (p = 0.733). CONCLUSIONS: ICL implantation is an effective and safe procedure in eyes with shallow anterior chambers, with visual and refractive results and complication rates identical to those obtained in deeper anterior chambers.

11.
Clin Ophthalmol ; 16: 153-159, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35082482

RESUMO

PURPOSE: To evaluate the effect of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy on intraocular lens (IOL) position and anterior segment parameters with a new swept-source anterior segment optical coherence tomography (AS-OCT) device (Anterion®, Heidelberg Engineering GmbH). PATIENTS AND METHODS: A total of 50 eyes from 50 consecutive patients were included. All patients had visually significant posterior capsular opacification (PCO) after uneventful phacoemulsification surgery with manual capsulorhexis and single-piece C-loop acrylic IOL implantation (AcrySof® SA60AT) and were treated with Nd:YAG laser. Anterior segment images were captured with Anterion® in non-dilated conditions before and one month after the procedure. In the "Metrics App", we collected data of the anterior chamber angle (ACA) 3 and 9 o'clock, the anterior chamber depth (ACD), the anterior chamber volume (ACV), and the central corneal thickness (CCT). We also collected demographic and clinical data [age, gender, months from surgery to Nd: YAG capsulotomy, pre- and post-capsulotomy corrected distance visual acuity (CDVA) and spherical equivalent, and axial length]. RESULTS: We did not find a statistically significant difference in ACD after the Nd:YAG capsulotomy (3.96 ± 0.55 vs 3.97 ± 0.55 mm, p = 0.10). In 28 patients, we noted a backward movement of the IOL; in the remaining 22, the IOL moved forward or did not change at all. We did not observe significant changes in ACA at the 3 and 9 o'clock reference points, ACV, or CCT. There was an improvement in CDVA after the procedure (0.37 ± 0.21 vs 0.12 ± 0.27 logMAR, p = 0.015), without statistically significant differences in SE (-0.15 ± 0.84 vs -0.25 ± 0,93, p = 0.42). Axial length was not correlated with ACD variations after the procedure (p = 0.67). CONCLUSION: Our results show that Nd:YAG laser capsulotomy does not change the axial position of a single-piece C-loop acrylic IOL inside the capsular bag, as well as other anterior chamber parameters.

12.
Ophthalmologica ; 225(4): 211-21, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21336001

RESUMO

BACKGROUND/AIMS: To compare retrospectively the incidence of arterial thromboembolic events (ATEs) in patients treated with bevacizumab or ranibizumab for exudative age-related macular degeneration. METHODS: Charts of 378 patients treated with at least 1 intravitreal injection of ranibizumab or bevacizumab were reviewed to calculate the incidence of ATEs. Only patients under monotherapy were analyzed. RESULTS: ATEs occurred in 15 patients: 12 (12/97) with bevacizumab (12.4%) and 3 (3/219) with ranibizumab (1.4%) - odds ratio 10.16; 95% confidence interval 2.80-36.93; p < 0.0001. ATEs in the bevacizumab and ranibizumab cohorts included stroke, myocardial infarction, angina pectoris, peripheral thromboembolic disease, transient ischemic attack, sudden death and lethal stroke. CONCLUSION: In this series, bevacizumab raised the risk of ATEs when compared to ranibizumab. In an elderly population with multiple cardiovascular risk factors, the new ATEs may not be attributed exclusively to the intravitreal bevacizumab administration. These findings raise an issue that must be confirmed in randomized clinical trials.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Doença Arterial Periférica/induzido quimicamente , Tromboembolia/induzido quimicamente , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Bevacizumab , Feminino , Seguimentos , Humanos , Incidência , Injeções Intravítreas , Masculino , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Portugal/epidemiologia , Ranibizumab , Estudos Retrospectivos , Tromboembolia/diagnóstico , Tromboembolia/epidemiologia , Degeneração Macular Exsudativa/complicações , Degeneração Macular Exsudativa/diagnóstico
13.
J Cataract Refract Surg ; 47(1): 11-17, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32902932

RESUMO

PURPOSE: To evaluate the clinical outcomes of topography/wavefront-guided (TWFG) photorefractive keratectomy (PRK) using a new high-definition aberrometer combined with epithelium-off crosslinking (CXL-Plus). SETTING: Centro Oculistico Bresciano, Brescia, Italy. DESIGN: Prospective case series study. METHODS: Patients with grade I or II keratoconus, according to the Amsler-Krumeich classification, were included in this prospective case series. All cases underwent TWFG PRK using the VISX STAR S4 IR excimer laser and the new iDesign 2.0 system, followed by accelerated epithelium-off CXL. Visual, refractive, ocular aberrometric, and safety outcomes were evaluated during a 6-month follow-up. RESULTS: Thirty-five eyes of 19 patients were included. A significant improvement was observed in the uncorrected and corrected distance visual acuities (P < .001). Manifest sphere and cylinder were reduced significantly (P ≤ .001), with a total of 20 eyes (57%) and 30 eyes (86%) having a postoperative spherical equivalent within ±0.50 and ±1.00 diopter, respectively. Most corneal irregularity indexes and the level of ocular higher-order aberrations, primary coma, and trefoil (P < .05) were significantly reduced postoperatively. No significant corneal haze or safety issues were observed. CONCLUSIONS: TWFG PRK, using the iD2 system with simultaneous CXL, regularized the cornea by correcting the spherocylindrical error and minimizing the amount of higher-order aberrations in mild-to-moderate keratoconus.


Assuntos
Ceratocone , Ceratectomia Fotorrefrativa , Topografia da Córnea , Reagentes de Ligações Cruzadas/uso terapêutico , Seguimentos , Humanos , Itália , Ceratocone/tratamento farmacológico , Ceratocone/cirurgia , Lasers de Excimer/uso terapêutico , Estudos Prospectivos , Refração Ocular , Riboflavina/uso terapêutico , Acuidade Visual
14.
Eur J Ophthalmol ; : 11206721211012861, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33887990

RESUMO

PURPOSE: To compare visual, refractive and safety outcomes of central-hole posterior chamber collamer phakic intraocular lens implantation for low and moderate-to-high myopia. SUBJECTS/METHODS: This retrospective cohort study included 338 eyes submitted to posterior chamber collamer phakic intraocular lens implantation that completed a 12-month postoperative follow-up. Two groups were defined depending on preoperative spherical equivalent: group 1 comprised 106 eyes with manifest spherical equivalent of -6.00 D or less; group 2 comprised 232 eyes with manifest spherical equivalent higher than -6.00 D. Effectiveness, predictability, stability and safety outcomes were compared preoperatively and at 1, 6 and 12 months postoperatively. RESULTS: At 1-year postoperative, uncorrected and corrected visual acuities were 0.02 ± 0.17 and -0.01 ± 0.12 logMAR (group 1) and 0.04 ± 0.20 and 0.01 ± 0.16 logMAR (group 2), with an efficacy index of 1.05 ± 0.17 and 1.17 ± 0.28. Respectively, 92 (86.8%) and 199 (85.8%) eyes were within ±0.50 D of targeted refraction, and postoperative manifest refraction changes were -0.07 ± 0.25 D and -0.07 ± 0.35 D. Intraocular pressure did not change significantly. The mean rate of endothelial cell loss was 1.12% and 1.10%, respectively. One case of anterior subcapsular cataract (group 2) was observed. ICL exchange occurred in one case (group 1) and three cases (group 2). No vision-threatening complications were reported. CONCLUSION: The posterior chamber collamer phakic intraocular lens implantation demonstrated high visual and refractive efficacy with an excellent safety profile for the correction of both low and moderate-to-high myopia, revealing equivalent 1-year outcomes regardless of the degree of preoperative myopia.

15.
J Cataract Refract Surg ; 47(6): 713-721, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33196572

RESUMO

PURPOSE: To evaluate the long-term effectiveness, safety, and stability of Ferrara-type intrastromal corneal ring segments (ICRS) by manual surgery implantation in patients with keratoconus. SETTING: Ophthalmology Department, Hospital de Braga, Braga, Portugal. DESIGN: Retrospective cohort study. METHODS: This study included 124 eyes that had ICRS implantation using the manual technique with a follow-up of 5 years. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), subjective refraction, keratometry, aberrometry, and pachymetry maps were evaluated preoperatively and at 6 months, 1 year, and 5 years postoperatively. A secondary analysis of all variables was performed comparing 2 subgroups of patients: a group younger than 30 years and a group of 30 years or older. RESULTS: At 5 years, both mean UDVA and CDVA improved significantly (P < .0001) from a preoperative value of 0.91 ± 0.36 to 0.46 ± 0.32 logMAR and 0.40 ± 0.27 to 0.22 ± 0.20 logMAR, respectively. Spherical equivalent, refractive cylinder, and all topography values significantly decreased postoperatively (P < .0001). No regression was observed in any visual or topographic parameter during the entire follow-up. Regarding the subgroup analysis, both younger and older patients demonstrated similar and stable results from the preoperative to the 5-year visit, except for minimum pachymetry value change over time. CONCLUSIONS: Ferrara-type ICRS implantation significantly improved visual acuity, refractive error, and topographic values; the improvement was stable throughout a 5-year follow-up period. This study confirms that ICRS implantation surgery for keratoconus is a stable procedure in a long-term follow-up, regardless of the preoperative patient's age.


Assuntos
Ceratocone , Substância Própria/cirurgia , Topografia da Córnea , Seguimentos , Humanos , Ceratocone/cirurgia , Próteses e Implantes , Implantação de Prótese , Refração Ocular , Estudos Retrospectivos
16.
J Refract Surg ; 37(6): 414-421, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34170770

RESUMO

PURPOSE: To evaluate an automated method for detecting the cone shape characteristics and to assess the cornea specialists' subjective variability of these measures using different maps. METHODS: Topographic images of the anterior and posterior surface of each eye were presented to 12 clinicians in two different types of map: tangential curvature and relative elevation to the best-fit sphere. They were asked to mark the cone center and its boundaries in the two maps without knowing that they belonged to the same patient. The results between the maps were compared to assess the subjective variability dependent on the map type and the automated method was compared against both estimations to assess its accuracy. RESULTS: Considering the results of anterior and posterior surfaces, there was low agreement between the cone center estimations using different types of maps for 10 of the 12 cases (P < .05), whereas the comparison between the automated method and the two map estimations did not show differences in 11 of the 12 cases (P > .05). There was high variability, up to 55%, among clinicians' estimations of the cone area. The results of the automated method were within the range of the expert's estimations. CONCLUSIONS: An objective, mathematically derived method of determining morphological dimensions of the cone was consistent with clinicians' evaluations. Although there was high variability among the experts' subjective estimates, which were highly influenced by the type of map, the objective method provided a reliable evaluation of the keratoconus shape independent of maps or color scale. [J Refract Surg. 2021;37(6):414-421.].


Assuntos
Córnea , Ceratocone , Topografia da Córnea , Humanos , Ceratocone/diagnóstico
17.
J Refract Surg ; 36(6): 358-365, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32521022

RESUMO

PURPOSE: To compare clinical outcomes between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) photorefractive keratectomy (PRK) in fellow eyes of myopic patients. METHODS: Forty-six eyes of 23 patients who underwent PRK were included. WFO ablation was performed in one eye (WFO group) and TCAT in the fellow eye (TCAT group). The customized treatment plan was based on the Topolyzer Vario topography system (Alcon Laboratories, Inc) data. The patients were observed for 12 months after the procedure. RESULTS: One year after the surgery, there was no significant difference in the manifest refraction spherical equivalent, sphere, or cylinder variables between the two groups (P > .05). In both groups, 96% of eyes achieved an uncorrected distance visual acuity of 20/20 or better at 12 months postoperatively. Accuracy, safety, and efficacy of the refractive and visual outcomes were similar in the two groups. The postoperative higher order aberrations magnitude was lower in the TCAT group, but this was not statistically significant (P > .05). During the 12-month follow-up, no patient described any symptoms related to glare, halos, or starbursts in either eye. Other postoperative complications, such as infection or cor-neal infiltrates, did not occur in either group. CONCLUSIONS: TCAT and WFO ablations provided similar outcomes after PRK for myopia and myopic astigmatism correction. There were no statistically significant differences in postoperative corneal wavefront analysis. [J Refract Surg. 2020;36(6):358-365.].


Assuntos
Astigmatismo/cirurgia , Topografia da Córnea , Aberrações de Frente de Onda da Córnea/cirurgia , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Adulto , Astigmatismo/fisiopatologia , Aberrações de Frente de Onda da Córnea/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Miopia/fisiopatologia , Complicações Pós-Operatórias , Estudos Prospectivos , Refração Ocular/fisiologia , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
18.
Am J Ophthalmol ; 197: 7-16, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30201341

RESUMO

PURPOSE: To test the accuracy of the Tomographic and Biomechanical Index (TBI) for ectasia detection in an independent population from the original study. DESIGN: Retrospective case-control study. METHODS: Subjects: Patients were grouped according to clinical diagnosis including corneal topography (front-surface curvature): Normal group, including 1 eye randomly selected from 312 patients with normal corneas; Keratoconus group, including 1 eye randomly selected from 118 patients with keratoconus; a nonoperated ectatic eye from 57 patients with very asymmetric ectasia (57 eyes, VAE-E group), and the nonoperated fellow eye with normal topography (57 eyes, VAE-NT group). MAIN OUTCOME MEASURES: The ability of TBI to distinguish normal and ectatic corneas; and comparison with other indexes, including the Belin/Ambrósio Deviation Index (BAD-DI) and the Corvis Biomechanical Index (CBI), considering the areas under receiver operating characteristic curves (AUCs). RESULTS: The AUC of the TBI was statistically higher than all other tested parameters (DeLong, P < .001). Considering all cases, the cut-off value of 0.335 for the TBI provided a sensitivity of 94.4% and a specificity of 94.9% (AUC = 0.988; 95% confidence interval [CI] 0.982-0.995). Considering the VAE-NT group, optimized TBI cut-off value of 0.295 provided a sensitivity of 89.5% and a specificity of 91.0% (AUC = 0.960; 95% CI 0.937-0.983). CONCLUSION: The TBI was more accurate than all parameters tested for differentiating normal from ectatic corneas. The TBI may epitomize ectasia susceptibility and distinguish cases with fruste disease from true unilateral cases among the eyes with normal-topography VAE.


Assuntos
Doenças da Córnea/diagnóstico , Topografia da Córnea/métodos , Técnicas de Diagnóstico Oftalmológico , Dilatação Patológica/diagnóstico , Adulto , Área Sob a Curva , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
19.
Arq Bras Oftalmol ; 81(6): 471-474, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30304089

RESUMO

PURPOSE: To evaluate the effect of superior blepharoplasty on the tear film using the corneal topographer Keratograph 5M. METHODS: A prospective study was performed of 27 eyes of 14 patients with superior dermatochalasis who underwent superior blepharoplasty between May and June 2016. Conservative upper eyelid blepharoplasty was performed by an en bloc resection of anterior lamellar tissue that included skin, subcutaneous tissue, and the orbicularis oculi muscle. All the eyes were imaged using the noninvasive tear breakup time tools of the Keratograph 5M. The following parameters were recorded in each patient before and 6 weeks after surgery: first noninvasive Keratograph 5M tear breakup time (the time at which the first breakup of tears occurs) and average noninvasive Keratograph 5M tear breakup time (the average time of all breakup incidents). The exclusion criteria were ophthalmological pathology, previous eyelid surgery, use of eye drops, systemic pathology, and medication that interferes with lacrimal tears. RESULTS: The mean age of the patients was 65.1 years (range, 51-84); 86% were female. Student's t-test was used to compare the values of first and average noninvasive Keratograph 5M tear breakup times before and after surgery. The values for first noninvasive Keratograph 5M tear breakup time evaluated before and after surgery were not significantly different (9.04 and 8.71, respectively; p=0.926). The values for average noninvasive Keratograph 5M tear breakup time evaluated before and after surgery were also not significantly different (13.01 seconds and 13.14 seconds, respectively; p=0.835). CONCLUSIONS: The results of this pilot study suggest that upper blepharoplasty does not affect tear breakup time according to the objective evaluation of breakup time with the Keratograph 5M.


Assuntos
Blefaroplastia , Topografia da Córnea/métodos , Lágrimas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Síndromes do Olho Seco/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Lágrimas/fisiologia
20.
J Refract Surg ; 34(3): 188-194, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29522229

RESUMO

PURPOSE: To compare the predictability of intrastromal tunnel depth creation for intrastromal corneal ring segments (ICRS) implantation between manual dissection and femtosecond laser using a high-resolution anterior segment optical coherence tomography (AS-OCT). METHODS: This multicenter study included patients with keratoconus who had Ferrara-type ICRS implantation at Hospital de Braga using manual dissection and at the Fernandez-Vega Ophthalmological Institute using the femtosecond laser technique. The intended depth of implantation was compared to the achieved postoperative ICRS depth of each case, measured using a swept-source AS-OCT (CASIA SS-1000; Tomey Corporation, Nagoya, Japan) at three points (proximal, central, and distal end of the implant). RESULTS: The study included 105 eyes in the manual group and 53 eyes in the femtosecond laser group. The differences of the intended versus the achieved depth were statistically higher in the manual group for all positions measured (Wilcoxon ranked-sum, P < .001). In the manual group, there were significant differences between the mean values of intended and achieved depth after surgery for the three locations measured (Wilcoxon signed-rank, P < .05), whereas there were no significant differences in the femtosecond laser group. In the manual group, the proximal part of the stromal tunnel was significantly shallower (-40.87 ± 69.03 µm) than the central (-25.54 ± 71.00 µm) and distal (-26.52 ± 73.22 µm) parts (Friedman test, P < .05). CONCLUSIONS: ICRS implantation assisted by a femtosecond laser provides a more precise procedure considering dissection depth when compared with the manual dissection technique. Such an advantage may provide more predictable clinical results and safer procedures with the femtosecond laser. [J Refract Surg. 2018;34(3):188-194.].


Assuntos
Substância Própria/patologia , Ceratocone/cirurgia , Terapia a Laser/métodos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Implantação de Prótese , Ferida Cirúrgica/patologia , Adulto , Substância Própria/diagnóstico por imagem , Substância Própria/cirurgia , Topografia da Córnea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato , Estudos Prospectivos , Próteses e Implantes , Refração Ocular/fisiologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
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