RESUMO
Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.
Assuntos
Afacia , Extração de Catarata , Catarata , Cristalino , Lentes Intraoculares , Humanos , Afacia/cirurgiaRESUMO
PURPOSE: To determine whether impaired or absent stereopsis affects the ability to perform simulated microsurgical tasks. SETTING: University of Edinburgh, United Kingdom. DESIGN: Prospective randomized cross-over study. METHODS: Visual acuity and stereoacuity were measured. A band-pass filter was placed over the nondominant eye to reduce stereoacuity to 150 seconds of an arc (partial stereopsis), or the nondominant eye was completely occluded (absent stereopsis). Participants completed a computerized surgical simulator task 3 times with a randomized testing order (normal stereopsis, absent stereopsis, and partial stereopsis). The task involved using forceps to grasp and position objects in the anterior chamber. Outcomes included area of ocular injury, time to task completion, and overall score. RESULTS: Ocular damage area was significantly worse with partial stereopsis (P = .002) and worse still when stereopsis was absent (P < .001 for normal vs absent stereopsis and P = .005 for partial vs absent stereopsis). The median ocular damage area was 3.55 mm (interquartile range [IQR], 1.21-5.88 mm) with normal stereopsis, increasing to 6.10 mm (IQR, 3.96-12.47 mm) with stereopsis reduced to 150 seconds of an arc and to 9.25 mm (IQR, 4.93-18.70 mm) with no stereopsis. Time taken to complete the task increased and overall score decreased as stereopsis was reduced. The overall score decreased from 53% (IQR, 22.5-82%) under normal stereopsis to 0% (IQR, 0-43.5%) with absent stereopsis. CONCLUSIONS: Impaired stereopsis was associated with worse microsurgical performance, which may have implications for surgical training. The absence of stereopsis resulted in worse performance than partial reduction in stereopsis.
Assuntos
Extração de Catarata , Simulação por Computador , Percepção de Profundidade/fisiologia , Microcirurgia/métodos , Transtornos da Percepção/fisiopatologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Estudos Prospectivos , Análise e Desempenho de Tarefas , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adulto JovemRESUMO
We describe 2 cases of contact lens-related microbial keratitis caused by infection with Pseudomonas aeruginosa in which perineural infiltrates were observed at presentation. In both cases, examination by confocal microscopy was negative for Acanthamoeba cysts but bacterial cultures and microscopy of corneal scrapings were positive for P aeruginosa. Both cases responded rapidly to treatment with topical levofloxacin with no significant long-term sequelae. These observations indicate that perineural infiltrates may occur in Pseudomonas keratitis without underlying Acanthamoeba infection and are, therefore, not pathognomonic of Acanthamoeba infection.
Assuntos
Córnea/inervação , Úlcera da Córnea/microbiologia , Doenças dos Nervos Cranianos/microbiologia , Infecções Oculares Bacterianas/microbiologia , Nervo Oftálmico/microbiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Lentes de Contato Hidrofílicas/microbiologia , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/tratamento farmacológico , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Humanos , Levofloxacino/uso terapêutico , Microscopia Confocal , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológicoRESUMO
Iris prolapse is not an uncommon occurrence during cataract surgery. It usually occurs through the main incision during hydrodissection and is commonly associated with floppy-iris syndrome; however, it can manifest in cases with no known predisposition and can occur at any stage during surgery. The mechanism is explained by the Bernoulli principle and its effect on iris position during the movement of fluid within the eye. Predisposing factors are iris configuration, anterior chamber depth, and position and architecture of the corneal tunnel. Strategies for prevention and management include the use of pharmacological agents, ophthalmic viscosurgical devices, and iris retractors. These strategies can be augmented by alteration and adaptation of the surgeon's technique.
Assuntos
Complicações Intraoperatórias , Doenças da Íris/cirurgia , Facoemulsificação , Capsulorrexe , Córnea/cirurgia , Humanos , Pressão Intraocular , Doenças da Íris/etiologia , Doenças da Íris/prevenção & controle , Prolapso , Fatores de Risco , ViscossuplementosRESUMO
AIMS: To evaluate the functional and cosmetic success rate of combined canalicular laceration and eyelid avulsion repairs using the bi-canalicular Crawford stent, without the concomitant placement of a medial traction suture to repair medial canthal tendon (posterior limb) avulsion. METHODS: Retrospective, non-comparative consecutive case series of 40 consecutive patients with traumatic eyelid avulsion injuries associated with canalicular laceration from 1997 to 2003 who underwent surgical repair using the bi-canalicular Crawford stent were included. All patients underwent surgical repair of the canalicular laceration under general anaesthesia using the bi-canalicular stent. Meticulous anastomosis of the torn canaliculus was undertaken. No attempt was made to suture the avulsed medial canthal tendon (posterior limb) to the periosteum of the posterior lacrimal crest. RESULTS: Blunt trauma was the most common mechanism of injury and the inferior canaliculus was most commonly involved. Of the 37 patients who attended postoperative follow-up, 24 patients had no subjective symptoms of epiphora. Minimal, mild and moderate epiphora was present in seven, five and one patient respectively. Thirty-three patients had excellent cosmetic repositioning of the lid; two developed medial ectropia and a further two patients had lid margin notching but good lid position. Eight patients had premature stent loss. CONCLUSIONS: Bi-canalicular stenting achieved excellent cosmetic results in eyelid avulsion injuries, by facilitating adequate tissue realignment without the need for a posterior lacrimal crest fixation suture. Good functional results were achieved and were comparable with previous studies.
Assuntos
Traumatismos Oculares/cirurgia , Pálpebras/lesões , Aparelho Lacrimal/lesões , Procedimentos de Cirurgia Plástica , Silicones , Stents , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura , Tendões/cirurgia , Adulto JovemRESUMO
OBJECTIVE: The influence of sex hormones on intraocular pressure (IOP) has been the focus of recent debate. Previous studies investigating the effects of hormone therapy (HT) on IOP in postmenopausal women have produced conflicting results but have been limited by small numbers of participants. The aim of our study was to compare IOP in women without glaucoma taking HT with those not taking HT. METHODS: A prospective cross-sectional study of postmenopausal women visiting a single ophthalmic medical practitioner was conducted. All women with a history of intraocular disease, a family history of glaucoma, or refractive error exceeding +/-5 diopters were excluded. Applanation tonometry was used to measure IOP, and participants were then asked if they were current HT users. RESULTS: A total of 263 participants were recruited, of whom 91 reported current use of HT; 172 had never used HT. Within the HT group, 33 were taking an estrogen-therapy and 58 were taking a estrogen-progesterone therapy. Mean IOP in the HT group was significantly lower than that in the non-HT group; the mean difference was 1.41 mm Hg (P < 0.001). This difference remained statistically significant after statistical correction for age, use of systemic beta-blockers, and time of IOP measurement. There was no significant difference in mean IOP between women taking combined versus those taking estrogen-only preparations. CONCLUSIONS: Our study showed that IOP was significantly lower in women taking HT than in those who had never taken HT, even after removing other possible influences on IOP. The IOP-lowering effect of HT deserves further investigation to explore whether it may represent a possible new therapeutic modality for glaucoma.
Assuntos
Terapia de Reposição de Estrogênios , Estrogênios/farmacologia , Pressão Intraocular/efeitos dos fármacos , Progesterona/farmacologia , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Tamsulosin is an alpha(1)-adrenergic antagonist known to be linked with intraoperative floppy-iris syndrome (IFIS), which is characterized by iris atonicity and a propensity toward progressive intraoperative pupil constriction and iris prolapse. We present 2 strategies for managing IFIS-associated iris prolapse. Placement of a single subincisional iris retractor following reposition of the prolapsed iris was the more successful approach. We recommend consideration of this approach in all cases of iris prolapse.
Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1 , Antagonistas Adrenérgicos alfa/efeitos adversos , Complicações Intraoperatórias , Doenças da Íris/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Idoso , Humanos , Doenças da Íris/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Facoemulsificação , Prolapso , Sulfonamidas/efeitos adversos , Síndrome , Tansulosina , Acuidade VisualRESUMO
PURPOSE: To report a case of silicone oil-induced corneal perforation following complex retinal detachment surgery. METHODS: Case report. RESULTS: Two months following a second retinal detachment repair, the patient presented to eye casualty with a corneal perforation secondary to silicone oil keratopathy. CONCLUSION: The pathophysiology of silicone oil-related perforation is not clearly understood. Poor corneal nutrition due to the presence of oil may be an important contributory factor. Close monitoring of patients for early signs of silicone oil keratopathy could preempt perforation.
RESUMO
OBJECTIVE: To determine the distribution of cell membrane proteins and extracellular matrix proteins around the limbal epithelial crypt (LEC) compared with adjacent limbus and corneal epithelium. METHODS: Serial histological sections of human corneoscleral limbus rims were stained with antibodies of interest by standard immunohistochemistry. RESULTS: Superficial cells of the limbus were desmoglein 3 positive, compared with the negative basal cells of the limbus that correspond to cells with more stemlike properties. The LEC had a much lower proportion of desmoglein 3 staining in comparison. Tenascin C staining demonstrated regional variations of the limbus depending on their association with the LEC. Limbus that was associated with or adjacent to the LEC had a greater tenascin C expression compared with normal limbus, whereas the LEC demonstrated the greatest tenascin C expression. CONCLUSIONS: Based on these and similar results previously reported for connexin 43, we propose a novel model on the mechanism of corneal surface epithelium maintenance involving 3 different limbal regions: zone 1, limbus including the LEC; zone 2, limbus associated with the LEC; and zone 3, limbus distant to the LEC. CLINICAL RELEVANCE: The noted limbal variations may influence the selection of the donor site for limbal grafts in the future.
Assuntos
Células Epiteliais/citologia , Epitélio Corneano/citologia , Limbo da Córnea/citologia , Células-Tronco/citologia , Desmogleína 3/metabolismo , Células Epiteliais/metabolismo , Epitélio Corneano/fisiologia , Proteínas do Olho/metabolismo , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Limbo da Córnea/metabolismo , Microscopia de Fluorescência , Modelos Biológicos , Regeneração , Células-Tronco/metabolismo , Tenascina/metabolismoRESUMO
A myopic 43-year-old woman with early nuclear sclerotic cataract developed more than 11.0 diopters (D) of astigmatism over a 6-month period. This was found to be lenticular in origin. Phacoemulsification with intraocular lens implantation was performed, resulting in residual astigmatism of 0.75 D. To our knowledge, this is the first case of rapidly progressive lenticular astigmatism in an otherwise healthy eye with early nuclear sclerotic cataract.