Observational study of intraocular lens tilt in sutureless intrascleral fixation versus standard transscleral suture fixation determined by ultrasound biomicroscopy.

BACKGROUND: The position of the intraocular lens (IOL) is a major factor that affects the final visual acuity after cataract surgery. However, no prospective study has compared the IOL positions associated with the sutureless intrascleral technique and the standard transscleral suturing technique. The current study compared the IOL positions in the two techniques using ultrasound biomicroscopy (UBM) in vivo. METHODS: Twenty-one eyes of 21 patients were included in this observational study conducted between February and May 2015. Eleven patients underwent the sutureless intrascleral technique, and 10 patients underwent transscleral fixation with suturing. Ophthalmologic examination and UBM were performed in all patients. Optic tilt was measured in relation to the iris plane. The haptic location was defined. Mann-Whitney test and multiple linear regression were used to analyze the vertical and horizontal gradients. Significant differences were considered when p ≤ 0.05. RESULTS: The most common indication for scleral fixation was a complication during phacoemulsification (81.81% in the sutureless group and 60% in the suture group). The mean vertical and horizontal tilts were, respectively, 0.24 ± 0.21 and 0.25 ± 0.19 mm in the sutureless group and 0.14 ± 0.17 and 0.23 ± 0.16 mm in the suture group. No significant differences were seen in the vertical tilt and horizontal tilt (p = 0.888 and p = 0.148, respectively) between the groups. Gender (p = 0.835), age (p = 0.888), follow-up time (p = 0.915), and surgical duration (p = 0.094) were not associated with optic tilt. Of the 22 haptics in the sutureless group, 21 (95.45%) were in the intrascleral tunnel; of the 20 haptics in the suture group, 13 (65%) were posterior to the ciliary body, four (20%) anterior to the ciliary body, and three (15%) in the ciliary sulcus. CONCLUSION: This study showed that there are no significant differences in the IOL positions between the two techniques.

Comparisons of choroidal nevus measurements obtained using 10- and 20-MHz ultrasound and spectral domain optical coherence tomography.

PURPOSE:: To compare measurements of lesions clinically diagnosed as choroidal nevi using spectral domain optical coherence tomography (SD-OCT) and 10- and 20-MHz ultrasound (US). METHODS:: This prospective study, which was conducted between May 2011 and December 2011, evaluated eyes diagnosed with choroidal nevus via photographic documentation using 10- or 20-MHz A- and B-mode US (experienced examiner using both the transpalpebral technique and direct contact) or SD-OCT in the enhanced depth imaging mode (performed by a different examiner blinded to the US results). Anteroposterior (AP) and transverse (T) US sections corresponded to sections adjusted perpendicularly on SD-OCT. RESULTS:: We evaluated 14 eyes from 12 patients (six males, mean patient age= 64.5 years) diagnosed with choroidal nevus. The choroidal nevi of all samples had a melanocytic profile. Moreover, eight nevi were located at the equator, five nevi were located in the posterior pole (peripapillary in one sample), and one nevus shifted from the equator to the periphery. On SD-OCT, the maximum measurable dimension was 9 mm. The lesions in the posterior pole were easier to evaluate, and image acquisition of lesions located more peripherally was possible depending on patient cooperation. The accurate assessment of height was difficult. Baseline dimensions on 10- and 20-MHz US were larger than those determined via OCT. No significant differences in height were observed between US and SD-OCT. All parameters were statistically similar between 10- and 20-MHz US measurements. CONCLUSIONS:: No significant difference in the AP and T diameters was observed between 10- and 20-MHz US measurements; however, these measurements (AP and T) were significantly higher than those obtained using OCT. No significant differences in height were observed among the techniques adopted.

Comparisons of choroidal nevus measurements obtained using 10- and 20-MHz ultrasound and spectral domain optical coherence tomography / Comparação entre a medida de nevus de coroide obtida com 10-MHz e 20-MHz e tomografia de coerência óptica de domínio espectral

ABSTRACT Purpose: To compare measurements of lesions clinically diagnosed as choroidal nevi using spectral domain optical coherence tomography (SD-OCT) and 10- and 20-MHz ultrasound (US). Methods: This prospective study, which was conducted between May 2011 and December 2011, evaluated eyes diagnosed with choroidal nevus via photographic documentation using 10- or 20-MHz A- and B-mode US (experienced examiner using both the transpalpebral technique and direct contact) or SD-OCT in the enhanced depth imaging mode (performed by a different examiner blinded to the US results). Anteroposterior (AP) and transverse (T) US sections corresponded to sections adjusted perpendicularly on SD-OCT. Results: We evaluated 14 eyes from 12 patients (six males, mean patient age= 64.5 years) diagnosed with choroidal nevus. The choroidal nevi of all samples had a melanocytic profile. Moreover, eight nevi were located at the equator, five nevi were located in the posterior pole (peripapillary in one sample), and one nevus shifted from the equator to the periphery. On SD-OCT, the maximum measurable dimension was 9 mm. The lesions in the posterior pole were easier to evaluate, and image acquisition of lesions located more peripherally was possible depending on patient cooperation. The accurate assessment of height was difficult. Baseline dimensions on 10- and 20-MHz US were larger than those determined via OCT. No significant differences in height were observed between US and SD-OCT. All parameters were statistically similar between 10- and 20-MHz US measurements. Conclusions: No significant difference in the AP and T diameters was observed between 10- and 20-MHz US measurements; however, these measurements (AP and T) were significantly higher than those obtained using OCT. No significant differences in height were observed among the techniques adopted.

RESUMO Objetivo: Comparar as medidas obtidas de lesões diagnosticadas clinicamente como nevus de coroide através da tomografia de coerência óptica de domínio espectral (Spectralis, Heidelberg Engineering, Inc.), ultrassonografia com 10 MHz e de 20 MHz. Métodos: Estudo prospectivo realizado entre maio e dezembro de 2011, avaliou olhos com diagnóstico de nevus de coroide, utilizando documentação fotográfica, ultrassonografia com transdutor 10-MHz e 20-MHz A- e B-mode e SD-OCT em modo de EDI, por um examinador diferente para cada técnica. Os cortes realizados perpendiculares entre si, correspondentes ao corte ântero-posterior e latero-lateral à ultrassonografia. Resultados: Foram avaliados 14 olhos de 12 pacientes (6 do sexo masculino), com média de idade média de 64,5 anos. Todos os nevus tinham um perfil melanocítico. Observou-se 8 nevus no equador, 5 no polo posterior (peripapilar em uma amostra), e 1 deslocado a partir do equador para a periferia. Em SD-OCT, a dimensão máxima mensurável foi de 9 mm. As lesões no polo posterior eram mais fáceis de avaliar e aquisição de imagens de lesões mais periféricas era possível, dependendo da colaboração do paciente. A avaliação precisa da altura era difícil. As dimensões usando transdutor 10-MHz e 20-MHz US foram maiores que as encontradas pelo SD-OCT. Não foram observadas diferenças significativas na altura entre métodos SD-OCT e US. Todas as medidas foram estatisticamente semelhantes entre 20-MHz e 10-MHz. Conclusão: Para o parâmetro AP e T não foi detectada diferença entre as medidas utilizando US de 10-MHz e de 20-MHz. Porém estas medidas se mostraram significativamente maiores em relação à medida obtida com OCT. Para a altura, não foram detectadas diferenças estatística em relação à técnica utilizada, US 10-MHz e 20-MHz e SD-OCT.

Composition of intraocular foreign bodies: experimental study of ultrasonographic presentation / Composição de corpos estranhos intraoculares: estudo experimental da apresentação ultrassonográfica

PURPOSE: To investigate the reliability of ultrasound in determining the size and identify the sonographic features and artifacts generated by intraocular foreign bodies of different materials. METHODS: Experimental study using 36 enucleated porcine eyes. Fragments of nine different compositions (wood, glass, plastic, cardboard, iron, aluminum, lead, powder and concrete) and similar dimensions (4 mm) were implanted via scleral incision into the vitreous cavity of 36 porcine eyes, four eyes were used for each material. Ultrasound examination was performed in all eyes using the contact technique, conductive gel and 10-MHz transducer (EZScan, Sonomed). RESULTS: Considering the material fragments of gunpowder, lead, concrete, aluminum, wood and glass, the size determined by ultrasound was considered statistically similar to the actual size. The material iron presented ultrasound-determined dimension statistically smaller than its actual size. Cardboard and plastic materials showed ultrasound-determined measurements far greater than the actual. All fragments of intraocular foreign bodies demonstrated hyper-reflective interfaces, irrespective of their composition. Whereas the artifacts generated by different materials, it was found that the materials iron, aluminum and lead showed reverberation of great extent. The material wood showed no reverberation. The length of the reverberation artifact for the materials iron, glass, aluminum and cardboard was lower when compared to other materials. All materials presented posterior shadowing artifact, with the exception of aluminum. CONCLUSION: Ultrasonography was considered a reliable technique to determine the size of intraocular foreign bodies in pigs, with little influence caused by its composition. Ultrasound artifacts generated were considered material-dependent and can assist the examiner to identify the nature of a foreign body of unknown etiology. Ultrasonography aided the surgeon to identify, locate and measure the intraocular foreign body, directing appropriate surgical planning.

OBJETIVO: Investigar a confiabilidade da ultrassonografia em determinar a dimensão e identificar as características ultrassonográficas e os artefatos gerados por corpos estranhos intraoculares de materiais diferentes. MÉTODOS: Estudo experimental, utilizando 36 olhos enucleados de origem suína. Fragmentos de nove diferentes composições (madeira, vidro, plástico, papelão, ferro, alumínio, chumbo, pólvora e concreto) e de dimensões similares (4 mm) foram implantados cirurgicamente via incisão escleral na cavidade vítrea de 36 olhos porcinos, 4 olhos para cada tipo de material. O exame ultrassonográfico foi realizado em todos os olhos utilizando-se a técnica de contato, gel condutor e transdutor de 10 MHz (EZScan, Sonomed). RESULTADOS: Considerando os fragmentos dos materiais pólvora, chumbo, concreto, alumínio, madeira e vidro, a dimensão determinada pela ultrassonografia foi considerada estatisticamente similar à dimensão real. O material ferro apresentou dimensão ultrassonográfica estatisticamente menor que sua dimensão real. Papelão e plástico demonstraram medida maior que o real. Todos fragmentos de corpos estranhos intraoculares demonstraram interfaces hiper-refletivas, independentemente da sua composição. Considerando os artefatos gerados pelos diferentes materiais, verificou-se que os materiais ferro, alumínio e chumbo apresentaram reverberação de grande extensão. O material madeira não apresentou reverberação. O comprimento do artefato de reverberação dos materiais ferro, vidro, alumínio e papelão foi menor quando comparado aos outros materiais. Todos materiais apresentaram artefato de sombreamento posterior, com exceção do alumínio. CONCLUSÃO: A ultrassonografia foi considerada uma técnica confiável para determinar a dimensão de corpos estranhos intraoculares em porcinos, com pouca influência causada pela sua composição. Artefatos gerados à ultrassonografia foram considerados material-dependentes e podem auxiliar o examinador a identificar a natureza de um corpo estranho de etiologia desconhecida. O auxílio diagnóstico nestes casos permite ao cirurgião identificar, localizar e dimensionar o corpo estranho intraocular, orientando um planejamento cirúrgico adequado.

[Pilot project of computerization of charts of the extrinsic ocular motility sector of the Santa Casa of São Paulo]. / Projeto piloto de informatização dos prontuários do setor de motilidade ocular extrínseca da Santa Casa de São Paulo.

PURPOSE: To develop a system of support to the research in the field of the computer science, based on the automatic search of information, on the percentage of patients with certain characteristics and the crossing of this information among themselves. METHODS: A computer with Pentium III 650 MHz processor, 128 MB RAM, 32 MB video plate, free 20 MB in the hard disk and fitted with Windows 98/2000/XP. The data base used to store the information is Interbase version 6.1 and the program was developed in Delphi 5.0 language. Three hundred and four charts of esotropia-operated patients were registered in the Extrinsic Ocular Motility Sector of the Departament of Ophthalmology of the College of Medical Sciences of the Santa Casa of Misericórdia of São Paulo, in the period from 07/02/1976 to 03/09/1992. To include the patients in the program, a questionnaire was elaborated, with the relevant clinical variations of this type of misalignment. Examples of totalizations and crossings of information were presented. RESULTS: This new program will be able to contribute to scientific research, accelerating data collection. After registering the patients any type of survey, election of a specific group of patients or crossing of data may be obtained in seconds. CONCLUSION: This can be made for all ophthalmologic specialties, varying the questionnaire in accordance with each specialty.

Projeto piloto de informatização dos prontuários do setor de motilidade ocular extrínseca da Santa Casa de São Paulo / Pilot project of computerization of charts of the extrinsic ocular motility sector of the Santa Casa of São Paulo

OBJETIVO: Desenvolver um sistema de apoio à pesquisa no campo da informática, baseado na busca automática de informações sobre a porcentagem de pacientes com determinadas características e o cruzamento dessas informações entre si. MÉTODOS: Utilizou-se um computador com processador Pentium III 650 MHz, 128 MB de RAM, placa de vídeo de 32 MB, 20 MB livres em disco rígido e capacitado com Windows 98/2000/XP. O banco de dados utilizado para armazenar as informações é o Interbase versão 6.1 e o programa foi desenvolvido em linguagem Delphi 5.0. Foram cadastradas 304 fichas dos pacientes operados de esotropia no setor de Motilidade Ocular Extrínseca do Departamento de Oftalmologia da Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, no período de 02/07/76 a 09/03/92. Para cadastrar os pacientes no programa, foi elaborado um questionário, com as possíveis variações clínicas relevantes para esse tipo de desvio. Foram apresentados exemplos de totalizações e cruzamentos de informações. RESULTADOS: Esse novo programa poderá contribuir para a pesquisa científica, agilizando o levantamento de dados. Após o cadastro dos pacientes, qualquer tipo de levantamento, seleção de um grupo específico de pacientes ou cruzamento de dados poderá ser obtido em segundos. CONCLUSÃO: Pode ser feito em todas as especialidades oftalmológicas, variando o questionário de acordo com cada especialidade. Assim um relatório atual poderá ser acessado instantaneamente quando se deseja fazer uma pesquisa ou consulta.

PURPOSE: To develop a system of support to the research in the field of the computer science, based on the automatic search of information, on the percentage of patients with certain characteristics and the crossing of this information among themselves. METHODS: A computer with Pentium III 650 MHz processor, 128 MB RAM, 32 MB video plate, free 20 MB in the hard disk and fitted with Windows 98/2000/XP. The data base used to store the information is Interbase version 6.1 and the program was developed in Delphi 5.0 language. Three hundred and four charts of esotropia-operated patients were registered in the Extrinsic Ocular Motility Sector of the Departament of Ophthalmology of the College of Medical Sciences of the Santa Casa of Misericórdia of São Paulo, in the period from 07/02/1976 to 03/09/1992. To include the patients in the program, a questionnaire was elaborated, with the relevant clinical variations of this type of misalignment. Examples of totalizations and crossings of information were presented. RESULTS: This new program will be able to contribute to scientific research, accelerating data collection. After registering the patients any type of survey, election of a specific group of patients or crossing of data may be obtained in seconds. CONCLUSION: This can be made for all ophthalmologic specialties, varying the questionnaire in accordance with each specialty.