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1.
Clin Exp Ophthalmol ; 44(9): 797-802, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27311978

RESUMEN

BACKGROUND: To identify and classify materials in the vitreous observed during phacoemulsification cataract surgery (phaco). DESIGN: Prospective, consecutive, observational case series at one ophthalmic day surgery in Sydney, Australia. PARTICIPANTS: A total of 767 consecutive phaco cases. Cases were excluded if there was posterior capsule rupture or vitreous loss intraoperatively. METHODS: For each patient, age, gender, baseline corrected distance visual acuity, presence of pseudoexfoliation, nuclear sclerosis grade and phacoemulsification ultrasound time were recorded. The relationship between these variables and materials in the vitreous was evaluated with regression analysis. Two patients with materials in the vitreous developed an acute intraoperative rock-hard eye syndrome. In these two patients, pars plana needle aspiration of retrolenticular fluid was performed to re-establish normal intraocular pressure. Histology was undertaken to compare this fluid with known lens material retrieved from the Fluid Management System bags in two unrelated cases. MAIN OUTCOME MEASUREMENTS: Presence of materials in the vitreous during phaco. RESULTS: Materials in the vitreous were observed in either Berger's space or the anterior vitreous in 386 eyes (50.3% of cases); the majority was putatively lens material (46.5% of all cases). Pigment and ophthalmic viscoelastic device were seen in the anterior vitreous in 9.8% and 1.7% of cases, respectively. Logistic regression analysis demonstrated that higher nuclear sclerosis grade (P = 0.025), male gender (P = 0.003) and greater age (P = 0.016) were predictive of the presence of materials in the vitreous. Histological assessment with light microscopy and birefringence techniques identified the materials in the vitreous as lens material. CONCLUSION: Materials in the vitreous were seen in 50.3% of phaco cases. It has been histologically demonstrated that lens materials can be introduced into the anterior vitreous during phaco.


Asunto(s)
Cuerpos Extraños en el Ojo/diagnóstico , Facoemulsificación , Cuerpo Vítreo/patología , Anciano , Femenino , Humanos , Incidencia , Edema Macular/diagnóstico , Edema Macular/etiología , Masculino , Estudios Prospectivos , Factores de Riesgo , Tomografía de Coherencia Óptica , Agudeza Visual/fisiología
2.
Ophthalmic Plast Reconstr Surg ; 30(6): 473-5, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24777266

RESUMEN

PURPOSE: To study the hypothesis that in normal patients, changes in eyelid elasticity may occur asymmetrically and in relation to the side on which the individual sleeps. DESIGN: Prospective, consecutive, single-center study within a large, tertiary-referral ophthalmology department within a university hospital. METHODS: This prospective study was carried out consecutively on 262 normal patients. The 3 inclusion criteria were 1) age≥55 years, 2) absence of facial nerve palsy, and 3) absence of eyelid trauma or surgery. Immediately before the ocular plastic surgeon assessed the patient, each patient was questioned in a separate consulting room by the attending orthoptist as to his or her customary side of sleeping. After detailed explanation, the "history-masked" ocular plastic surgeon then assessed the patient's upper eyelid laxity, the main outcome measurement. This was performed by asking the seated patient to look down and then gently grasping the upper eyelids close to the eyelid margin, just medial to the lateral commissure. The ocular plastic surgeon, with thumbs pronated, simultaneously distracted both upper eyelids superiorly, laterally, and anteriorly. The measured separation of the upper eyelid from the globe conjunctiva was obtained using calipers. Eyelid laxity grading was designated as grade 1: 0 to 1.9 mm; grade 2: 2.0 to 3.9 mm; grade 3: 4 to 9 mm; and grade 4: floppy. RESULTS: Two hundred sixty-two patients (58% females) who consecutively satisfied the selection criteria were evaluated, of which 70.22% (183/262) patients had significantly greater laxity of the upper eyelid that corresponded to the side on which they customarily slept. An unpaired t test used to compare the eyelid laxity between the sleeping side and nonsleeping side was statistically significant (p<0.001). CONCLUSION: Normal patients demonstrate a correlation between the side on which they historically or customarily sleep and the laxity of their ipsilateral upper eyelid.


Asunto(s)
Párpados/fisiopatología , Lateralidad Funcional/fisiología , Hipotonía Muscular/fisiopatología , Músculos Oculomotores/fisiopatología , Sueño/fisiología , Anciano , Anciano de 80 o más Años , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
4.
J Refract Surg ; 38(5): 298-303, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35536707

RESUMEN

PURPOSE: To examine the accuracy of the cylinder power choice for toric intraocular lenses (IOLs) using the Goggin Nomogram, which adjusts anterior keratometric astigmatic power values for the likely effect of posterior corneal and non-corneal, non-lenticular astigmatism. METHODS: A consecutive, retrospective case series was based at the Queen Elizabeth Hospital and Ashford Advanced Eye Care in Adelaide, Australia. A total of 586 consecutive eyes of 586 patients underwent phacoemulsification surgery with implantation of a Zeiss AT TORBI 709MP or AT LISA Tri Toric 939 MP toric IOL, calculated using the Goggin Nomogram. The median absolute magnitude of error and geometric mean astigmatic correction index in consecutive eyes with toric IOL cylinder powers of 1.00 to 3.00 diopters (D) were analyzed. RESULTS: Overall, all eyes receiving IOL cylinder powers of 1.00 to 3.00 D inclusive had a median magnitude of error value of 0.19 D (IQR: 0.31) and astigmatic correction index value of 1.03 (IQR: 0.33). For eyes with with-the-rule, against-the-rule, and oblique astigmatism, the median magnitude of error was 0.18 D (interquartile range [IQR]: 0.29), 0.19 D (IQR: 0.31), and 0.17 D (IQR: 0.39), respectively, and the astigmatic correction index was 1.06 (IQR: 0.28), 1.01 (IQR: 0.35) and 1.08 (IQR: 0.32), respectively. CONCLUSIONS: Goggin Nomogram adjusted keratometry provided optimal refractive astigmatic outcome in IOL cylinder powers of 1.00 to 3.00 D in eyes with with-the-rule, against-the-rule, and oblique astigmatism. Goggin Nomogram adjusted keratometry compensates for both posterior corneal astigmatism and any other source of ocular astigmatism. [J Refract Surg. 2022;38(5):298-303.].


Asunto(s)
Astigmatismo , Lentes Intraoculares , Facoemulsificación , Astigmatismo/cirugía , Biometría , Humanos , Implantación de Lentes Intraoculares , Nomogramas , Refracción Ocular , Estudios Retrospectivos
5.
J Refract Surg ; 38(9): 559-564, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36098395

RESUMEN

PURPOSE: To quantify the total eye astigmatism that is not accounted for by measurement of anterior corneal astigmatism and posterior corneal astigmatism and knowledge of intraocular lens (IOL) astigmatism and assess whether it is correlated with candidate sources of or correlates with leftover astigmatism. METHODS: Vector subtraction of anterior corneal, posterior corneal, and IOL astigmatism from total eye astigmatism as represented by spectacle astigmatism to yield a value of "leftover" astigmatism that is neither corneal nor lenticular. This value was derived in a series of eyes following cataract surgery. This novel entity was examined for correlation with candidate sources of or correlates with leftover astigmatism. RESULTS: In 103 pseudophakic eyes with known IOL toricity, mean leftover astigmatism was 0.71 ± 0.43 diopters. This was significantly correlated with against-the-rule anterior corneal astigmatism (P < .001). CONCLUSIONS: Leftover astigmatism is clinically substantial. Because it is included in IOL cylinder power calculations based on refractive outcome, it may explain why methods of IOL cylinder power calculation using refractive outcome-based adjustments to anterior corneal astigmatism (previously described as adjustments for "posterior corneal astigmatism") are more successful than adjustment on the basis of measured posterior corneal astigmatism. [J Refract Surg. 2022;38(9):559-564.].


Asunto(s)
Astigmatismo , Enfermedades de la Córnea , Facoemulsificación , Astigmatismo/diagnóstico , Astigmatismo/cirugía , Biometría/métodos , Enfermedades de la Córnea/cirugía , Humanos , Implantación de Lentes Intraoculares/métodos , Estudios Retrospectivos
7.
Eye (Lond) ; 34(11): 2098-2105, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32632297

RESUMEN

OBJECTIVES: To evaluate the therapeutic effect and safety profile of next generation mycophenolate sodium (MPS), which is different from mycophenolate mofetil with an enteric-coated formulation, in corticosteroid-refractory non-infectious inflammatory uveitis (CRU) patients. METHODS: Prospective, uncontrolled, open-label interventional case series. Forty consecutive patients at a tertiary uveitis referral centre received 6 months of oral MPS as the treatment regimen with follow-up 12 months. The main outcome measures were best-corrected visual acuity (BCVA), inflammatory index, steroid-sparing effect of tapering prednisone to ≤10 mg daily and side effects. RESULTS: Mean age of enroled patients was 49 (49 ± 13) years and 29 (72.5%) were female. Thirty-six (90.0%) had bilateral disease. There were 0 (0%) anterior uveitis, 2 (5.0%) intermediate uveitis, 22 (55.0%) posterior uveitis, and 16 (40.0%) panuveitis. Vogt-Koyanagi-Harada disease was the most common diagnosis (17/40, 42.5%), followed by idiopathic panuveitis (8/40, 20%) and idiopathic retinal vasculitis (5/40, 12.5%). LogMAR BCVA improved from 0.9 (SD = 0.09) to 0.31 (SD = 0.08) after 6 months of MPS with good steroid-sparing effect (p = 0.012). Further maintenance in LogMAR BCVA was evident after MPS discontinuation from 6th month to 12th month, from 0.31 (SD = 0.08) to 0.33 (SD = 0.07), respectively (p = 0.81). MPS was the only immunosuppressive drug needed to reach quiescent state in 29 patients (72.5%). The drug-related safety profile was satisfactory. CONCLUSION: MPS is an effective steroid-sparing drug for the treatment of CRU. The effect seen was not only during the 6 months of therapy, but also extended to 12 months to maintain BCVA and inflammation control. The side effects were acceptable.


Asunto(s)
Ácido Micofenólico , Uveítis , Corticoesteroides , Adulto , Femenino , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento , Uveítis/tratamiento farmacológico , Agudeza Visual
9.
Case Rep Ophthalmol Med ; 2018: 2602487, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29967706

RESUMEN

PURPOSE: To report the efficacy of subconjunctival triamcinolone (Kenalog A-40, Alcon) and bevacizumab (Avastin, Genentech) injections in fraternal twins with blepharokeratoconjunctivitis (BKC) causing progressive, bilateral corneal neovascularization and scarring. METHODS: In this retrospective observational case series, two three-year-old male twins with BKC had presented with bilateral red eyes, photophobia, and frequent blinking. Examination of each child showed bilateral deep stromal and superficial corneal neovascularization, corneal infiltrates, multiple follicles on the palpebral conjunctiva bilaterally with blepharitis, and thick turbid sebum expressed from the Meibomian glands. Their disease progressed despite conventional treatment. Both twins were managed with subconjunctival triamcinolone injection and subconjunctival bevacizumab injection of each eye. RESULTS: The treatment resulted in improvement of symptoms, and examination over an 8-10-month period postinjections showed fading stromal corneal infiltrates, partially regressed corneal neovascularization, and reduced conjunctival injection without complications. CONCLUSION: This case series highlights the potential vision threatening complications of BKC. In addition to conventional management options, this report is the first published use of subconjunctival triamcinolone and bevacizumab injections for BKC in children in an attempt to minimize and improve corneal neovascularization and scarring and subsequently to retain useful vision.

12.
Artículo en Inglés | MEDLINE | ID: mdl-24972389

RESUMEN

Detachment of a hydrodissection cannula during a phacoemulsification procedure appeared to produce no adverse sequelae during surgery. Day 1 postoperatively, two nonpenetrating hemorrhagic retinal lesions were identified; there was no evidence of posterior capsular perforation. Day 6 postoperatively, the pupil was temporally peaked by a fine vitreous strand running to the main-port incision in the superotemporal cornea. This was divided with Nd:YAG laser, and argon laser was applied to encircle the two retinal lesions. Postoperative uncorrected visual acuity remained 6/4 at day 1, day 6, and week 4 (3 weeks after laser application) follow-up visits. Surgeons must accept responsibility for confirming the integrity of the cannula and syringe connection before beginning hydrodissection, which can be highly destructive to intracameral structures.


Asunto(s)
Cateterismo/instrumentación , Falla de Equipo , Cuerpos Extraños en el Ojo/etiología , Lesiones Oculares/etiología , Facoemulsificación/instrumentación , Hemorragia Retiniana/etiología , Anciano , Anestesia/métodos , Cateterismo/efectos adversos , Humanos , Masculino
13.
J Cataract Refract Surg ; 40(5): 799-804, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24684967

RESUMEN

PURPOSE: To evaluate the use of pars plana needle aspiration of retrolenticular fluid in the immediate management of an acute intraoperative rock-hard eye syndrome (AIRES). SETTING: Private practice, Sydney, Australia. DESIGN: Retrospective case series. METHODS: Data over an 18-month period were collected to evaluate efficacy, complications, and visual outcomes in patients who had pars plana needle aspiration for management of AIRES, which is an acute intraoperative shallowing of the anterior chamber and a marked increase in intraocular pressure (IOP) during phacoemulsification cataract surgery but without evidence of a choroidal hemorrhage. Preoperative and postoperative (1 day, 1 week, and 1 month) data were evaluated. Resolution of AIRES and postoperative posterior segment status, IOP, and corrected distance visual acuity (CDVA) were the main outcome measures. RESULTS: Acute intraoperative rock-hard eye syndrome occurred in 6 (1.45%) of 413 surgeries. All 6 patients were women with a mean age of 81 years. Four patients had dense nuclear cataracts. In each case, the anterior chamber depth and IOP normalized immediately after pars plana needle aspiration and the procedure concluded uneventfully. Mild vitreous hemorrhage was observed in 1 patient postoperatively. At 1 month, the IOP was normal in 5 of 6 cases, while the CDVA was 20/12 in 5 of 6 cases. CONCLUSION: Although the etiology of AIRES is iatrogenic, immediate resolution was achieved uneventfully with pars plana needle aspiration, which appears to be a safe management technique with satisfactory outcomes.


Asunto(s)
Drenaje/métodos , Oftalmopatías/etiología , Oftalmopatías/cirugía , Complicaciones Intraoperatorias , Facoemulsificación , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Cámara Anterior/patología , Oftalmopatías/diagnóstico , Femenino , Humanos , Presión Intraocular , Hipertensión Ocular/diagnóstico , Hipertensión Ocular/cirugía , Estudios Retrospectivos , Síndrome , Agudeza Visual/fisiología
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