ABSTRACT
El queratocono es una ectasia corneal bilateral asimétrica, en etapas iniciales no se evidencia la afectación binocular. El conocimiento del grado de asimetría en el queratocono pediátrico permite tomar decisiones oportunas en el manejo de los pacientes. Se realizó este trabajo con el objetivo de describir las características clínicas y el tratamiento de tres casos pediátricos con diferente grado de asimetría interocular del queratocono, atendidos en la consulta provincial de ectasias corneales pediátricas en Ciego de Ávila. Los pacientes mostraron diferencia entre ambos ojos de los signos clínicos, la refracción y las variables topográficas. Al paciente dos se le diagnosticó queratocono en un ojo, sin evidencias clínicas ni topográficas de la enfermedad en el ojo contralateral. Todos los pacientes mostraron astigmatismo miópico compuesto en ambos ojos y se les indicó corrección óptica. Al paciente uno se le corrigió con cristales, al dos con lentes de contacto rígidos de gas permeable y al tercero con piggyback en un ojo y lentes de contacto rígidos de gas permeable en el otro. Presentaron, además, una ambliopía asociada y se les orientó tratamiento oclusivo y tareas de visión cercana en los pacientes dos y tres. Es frecuente encontrar asimetría interocular en pacientes pediátricos con queratocono por la diferencia de progresión entre ambos ojos. El seguimiento periódico permite diagnosticar la enfermedad en el ojo contralateral en pacientes con diagnóstico de queratocono en un ojo, indicar una corrección óptica individualizada, sobre todo en presencia de anisometropía, y monitorizar la evolución de la ambliopía refractiva asociada con frecuencia(AU)
Keratoconus is an asymmetric bilateral corneal ectasia, in early stages binocular involvement is not evident. Knowledge of the degree of asymmetry in pediatric keratoconus allows timely decisions in patient management. This research was carried out with the objective of describing the clinical characteristics and the treatment of three pediatric cases with different degree of interocular asymmetry of keratoconus, treated in the provincial consultation of pediatric corneal ectasia in Ciego de Avila. Patients showed difference between both eyes in clinical signs, refraction and topographic variables. Patient two was diagnosed with keratoconus in one eye, with no clinical or topographic evidence of the disease in the contralateral eye. All patients showed compound myopic astigmatism in both eyes and optical correction was indicated. Patient one was corrected with glasses, patient two with rigid gas permeable contact lenses and patient three with piggyback in one eye and rigid gas permeable contact lenses in the other eye. They also presented an associated amblyopia and were directed occlusive treatment and near vision tasks in patients two and three. It is common to find interocular asymmetry in pediatric patients with keratoconus due to the difference in progression between the two eyes. Periodic follow-up makes it possible to diagnose the disease in the contralateral eye in patients diagnosed with keratoconus in one eye, to indicate individualized optical correction, especially in the presence of anisometropia, and to monitor the evolution of frequently associated refractive amblyopia(AU)
Subject(s)
Humans , Male , Female , Child , Astigmatism/etiology , Keratoconus/diagnosisABSTRACT
Objetivo: Determinar las aberraciones corneales en pacientes con indicación de cirugía refractiva con láser de excímeros. Métodos: Se realizó un estudio retrospectivo, transversal, descriptivo, con 161 ojos de 81 pacientes adultos, de ambos sexos con indicación de cirugía con láser de excímeros para la corrección de su defecto refractivo. Se definieron como variables edad, sexo, desenfoque, astigmatismo, coma, trefoil y aberración esférica, las que se determinaron por el estudio topográfico de rutina con el topógrafo KeratronTM Scout, Optikon. Resultados: Se obtuvieron los siguientes valores promedios: desenfoque -4,17 ± 0,29 D (-16,15 a 8,5 D) y absoluto 4,94 ± 0,199 (10 a 16,5 D), astigmatismo -1,56 ± 0,09 D (-9,44 a -0,09 D), coma 0,25 ± 0,016 (0,01 a 1,5 D), trefoil 0,204 ± 0,016 (0,01 a 1,18 D) y aberración esférica 0,316 ± 0,018 D (0,0 a 1,27D). En el 75 por ciento de los casos los valores absolutos de desenfoque fueron inferiores a 6,56, de astigmatismo inferior a 0,33 D, de coma menor que 0,33, trefoil inferior a 0,25 y aberraciones esféricas menores que 0,32 D. Conclusiones: Los valores promedio de las aberraciones corneales desenfoque, astigmatismo, coma, trefoil y aberración esférica se encuentran en el rango de los valores reportados en la literatura científica y la distribución de los valores de las aberraciones corneales presentan desplazamiento de la mayoría de los casos hacia los valores más bajo del rango de determinación(AU)
Objective: To determine corneal aberrations in patients indicated for excimer laser refractive surgery. Methods: A retrospective, cross-sectional and descriptive study was carried out with 161 eyes of 81 adult patients of both sexes with indication of excimer laser surgery for the correction of their refractive defect. Age, sex, defocus, astigmatism, coma, trefoil and spherical aberration were defined as variables, determined by routine topographic study with the KeratronTM Scout topographer, Optikon. Results: The following average values were obtained: defocus of -4.17 ± 0.29 D (-16.15 to 8.5 D) and absolute of 4.94 ± 0.199 (10 to 16.5 D), astigmatism of -1.56 ± 0.09 D (-9.44 to -0.09 D), coma of 0.25 ± 0.016 (0.01 to 1.5 D), trefoil of 0.204 ± 0.016 (0.01 to 1.18 D) and spherical aberration of 0.316 ± 0.018 D (0.0 to 1.27D). In 75 percent of the cases, the absolute values for defocus were lower than 6.56; for astigmatism, lower than 0.33 D; for coma, lower than 0.33; for trefoil, lower than 0.25; and for spherical aberrations, lower than 0.32 D. Conclusions: The average values of corneal aberrations for defocus, astigmatism, coma, trefoil and spherical aberration are in the range of values reported in the scientific literature, while the distribution of corneal aberrations values present displacement of most of the cases towards the lower values of the determination range(AU)
Subject(s)
Humans , Astigmatism/etiology , Corneal Topography/methods , Refractive Surgical Procedures/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Objetivo: Determinar los resultados motores post cirugía refractiva corneal con láser de excímero en pacientes miopes con o sin astigmatismo asociado. Método: Se realizó un estudio preexperimental del tipo antes y después, en el que fueron incluidos 81 pacientes (162 ojos) tratados con LASEK-MMC (65 pacientes) o PRK-MMC (16 pacientes) seguidos por tres meses. Se les realizó un examen oftalmológico completo y se evaluaron las siguientes variables: punto próximo de convergencia, la amplitud de convergencia, divergencia y el alineamiento ocular precirugía y poscirugía. Resultados: Con la cirugía se observó un incremento significativo del punto próximo de convergencia (LASEK-MMC: p = 0,000 y PRK-MMC: p = 0,021). La amplitud de convergencia de cerca y de lejos, así como la amplitud de divergencia tendieron a disminuir, pero la diferencia no fue significativa (p > 0,05). Aumentó el porcentaje de pacientes con exodesviaciones de cerca, después de la cirugía LASEK-MMC (26,2 por ciento â 60,0 por ciento, p = 0,000) y de la PRK-MMC (18,8 por ciento â 81,3 por ciento, p = 0,000), y predominaron las heteroforias pequeñas en ambos casos (LASEK-MMC: 52,3 por ciento y PRK-MMC: 75,0 por ciento). Conclusiones: Con la cirugía fotoablativa con láser, aumentaron las exodesviaciones en el posoperatorio, pero se trató fundamentalmente de heteroforias pequeñas, aunque un número reducido de pacientes desarrolló nuevas exodesviaciones(AU)
Objective: To determine the eye movement outcomes after excimer laser corneal refractive surgery in myopic patients with or without associated astigmatism. Methods: A preexperimental, before-and-after study was carried out with 81 patients (162 eyes) treated with laser-assisted subepithelial keratectomy (LASEK) (65 patients) or photorefractive keratectomy (PRK) (16), with intraoperative application of mitomycin-C (MMC) in both cases, and followed for three months. A complete ophthalmologic examination was performed and the following variables were evaluated before and after the surgery: near convergence point, convergence amplitude, divergence and ocular alignment. Results: With surgery, a significant increase in the near point of convergence was observed (LASEK-MMC: P=0.000; PRK-MMC: P=0.021). The near and far convergence amplitude tended to decrease, but the difference was not significant (P > 0.05). The percentage of patients with near exodeviations increased after LASEK-MMC (26.2 percent â 60.0 percent, P=0.000) and PRK-MMC (18.8 percent â 81.3 percent, P=0.000), while small heterophorias predominated in both cases (LASEK-MMC: 52.3 percent and PRK-MMC: 75.0 percent). Conclusions: With laser photoablative surgery, exodeviations increased after surgery, but these were primarily small heterophorias, although a small number of patients developed new exodeviations(AU)
Subject(s)
Humans , Astigmatism/etiology , Refractive Surgical Procedures , Lasers, Excimer , Strabismus , Photorefractive KeratectomyABSTRACT
Objetivo: Analizar la recuperación y la calidad visual posoperatoria en la cirugía bilateral del cristalino por facoemulsificación. Métodos: Se realizó un estudio prospectivo y analítico de serie de casos en 40 pacientes con el diagnóstico de catarata bilateral, operados por cirugía bilateral simultánea del cristalino, atendidos en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", durante el periodo comprendido desde noviembre del año 2018 hasta marzo de 2020. Se analizaron las variables edad, sexo, dureza nuclear según LOCS III, mejor agudeza visual con y sin corrección, astigmatismo medio inducido, visión de colores, sensibilidad al contraste, velocidad de lectura y estudio de la calidad de vida por la encuesta FV-14. Se emplearon los porcentajes y los números absolutos para resumir las variables cualitativas. En el caso de las cuantitativas se usó la media con su desviación estándar y el intervalo de confianza del 95 por ciento. Resultados: Fue más frecuente el sexo femenino en el 65 por ciento; la edad media fue de 69,1 ± 8,1 años. El 55,11 por ciento de los pacientes tuvo dureza NO3. La media de la mejor agudeza visual sin corrección mejoró a 0,89 ± 0,25; la mejor agudeza visual con corrección mejoró a 0,96 ± 0,03; el resto de las variables estudiadas mostró mejoría significativa. Conclusiones: La cirugía bilateral simultánea del cristalino personalizada contribuye de manera significativa a la mejoría de la visión en cantidad y calidad, lo que permite recuperar la calidad de vida de los pacientes(AU)
Objective: Analyze postoperative recovery and visual quality in bilateral crystalline lens surgery by phacoemulsification. Methods: An analytical prospective study was conducted of a case series of 40 bilateral cataract patients undergoing simultaneous bilateral crystalline lens surgery at the Center for Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology from November 2018 to March 2020. The variables analyzed were age, sex, nuclear hardness by LOCS III, best visual acuity with and without correction, induced medial astigmatism, color vision, contrast sensitivity, reading speed and quality of life by the VF-14 survey. Percentages and absolute numbers were used to summarize qualitative variables, whereas mean and standard deviation were used for quantitative variables, with a 95 percent confidence interval. Results: Female sex prevailed with 65 percent; mean age was 69.1 ± 8.1 years. Hardness was NO3 in 55.11 percent of the patients examined. Mean best visual acuity without correction improved to 0.89 ± 0.25; best corrected visual acuity improved to 0.96 ± 0.03; the remaining variables studied showed significant improvement. Conclusion: Simultaneous personalized bilateral crystalline lens surgery significantly contributes to visual improvement both quantitatively and qualitatively, making it possible for patients to recover their quality of life(AU)
Subject(s)
Humans , Female , Aged , Astigmatism/etiology , Cataract/diagnosis , Phacoemulsification/methods , Microsurgery/methods , Quality of Life , Prospective Studies , Color VisionABSTRACT
Objetivo: Comparar los resultados refractivos del implante secundario de lentes intraoculares rígidos de la cámara anterior con apoyo angular y de lentes intraoculares plegables de la cámara posterior suturados a iris. Métodos: Se realizó un estudio casi experimental con control no equivalente (cohorte histórica). Se estudiaron 50 pacientes (50 ojos) con afaquia e inadecuado soporte capsular después de la cirugía de catarata, a quienes se les realizó implante secundario de lente intraocular con dos técnicas diferentes: lente intraocular en la cámara anterior con apoyo angular (25 ojos) y lente intraocular plegable de la cámara posterior suturado a iris (25 ojos). Resultados: Se observó que en el grupo de pacientes tratados con lente intraocular suturado a iris el porcentaje de pacientes con una visión de 20/40 o más fue significativamente superior (96,0 por ciento vs. 60,0 por ciento, p= 0,000) en los resultados refractivos obtenidos según el grupo de tratamiento. En el grupo A predominaron los pacientes que quedaron emétropes, seguidos de los pacientes miopes. En el grupo B predominaron los pacientes miopes y a diferencia del grupo anterior ningún paciente quedó hipermétrope. Conclusiones: La lente intraocular plegable de la cámara posterior suturada a iris mostró ser más eficaz, indujo menos astigmatismo y fue mejor en la predictibilidad de la esfera en un rango estricto de ± 1,00 dioptrías(AU)
Objective: Compare the refractive results of secondary implantation of rigid angle-supported intraocular lenses in the anterior chamber and foldable iris-suture-fixated intraocular lenses in the posterior chamber. Methods: A quasi-experimental non-equivalent control (historical cohort) study was conducted of 50 patients (50 eyes) with aphakia and inadequate capsular support after cataract surgery, who underwent secondary intraocular lens implantation with two different techniques: angle-supported intraocular lens in the anterior chamber (25 eyes) and foldable iris-suture-fixated intraocular lens in the posterior chamber (25 eyes). Results: In the group treated with iris-suture-fixated intraocular lens implantation the percentage of patients with 20/40 vision or more was significantly higher (96.0 percent vs. 60.0 percent, p= 0.000) in the refractive results obtained for each treatment group. In Group A a predominance was found of emmetropic, followed by myopic patients. In Group B myopic patients prevailed and unlike the other group no patient was hyperopic. Conclusions: Foldable iris-suture-fixated posterior chamber intraocular lenses proved more effective, induced less astigmatism and displayed better sphere predictability in a strict range of ± 1.00 diopters(AU)
Subject(s)
Humans , Aphakia/etiology , Astigmatism/etiology , Lens Implantation, Intraocular/methods , Anterior Chamber/surgery , Cohort StudiesABSTRACT
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.
Subject(s)
Humans , Astigmatism , Astigmatism/etiology , Biometry , Blepharoplasty , Lenses, Intraocular , Refraction, Ocular , Brazil , Cornea/surgery , Cornea/diagnostic imaging , Corneal Topography , Blepharoplasty/adverse effects , Lens Implantation, Intraocular , EyelidsABSTRACT
RESUMO Objetivo: Avaliar retrospectivamente a influência da espessura do anel intracorneano na redução do astigmatismo corneano em pacientes portadores de ceratocone. Métodos: De um banco de dados com 2.033 olhos submetidos à cirurgia de implante de anel corneano, foi selecionada uma amostra de 90 olhos com características semelhantes em relação à ceratometria e ao astigmatismo. Todos os olhos deste estudo receberam dois segmentos de comprimento de arco tradicional de aproximadamente 160°, com espessuras variadas: Grupo A recebeu dois segmentos de 150µm; Grupo B recebeu dois segmentos de 200µm, e Grupo C recebeu dois segmentos de 250µm. As variáveis analisadas foram ceratometria média e astigmatismo corneano pré e pós-operatório. Resultados: Nos olhos que receberam dois segmentos de anel de 150µm de espessura (Grupo A), houve redução média de 5,0D (10%) em relação à ceratometria média e redução média de 3,26D (57,69%) em relação ao astigmatismo corneano. Na amostra em que foram utilizados dois segmentos de 200µm (Grupo B), foi observada redução da ceratometria média de 7,0D (14,28%) e do astigmatismo corneano de 3,53D (63,6%). Já na amostra que recebeu dois segmentos de anel de 250µm de espessura (Grupo C), a redução média da ceratometria foi de 10D (20,4%) e de seu astigmatismo corneano de 2,09D (38,99%). Conclusão: Nos pacientes com ceratocone submetidos à cirurgia de anel corneano, o aumento da espessura dos segmentos implantados promove maior aplanamento da córnea, mas não o aumento em sua capacidade de reduzir o astigmatismo ceratométrico. Seria interessante a análise de uma amostra maior de pacientes, aliada a cálculos vetoriais de astigmatismo, para comprovar os achados deste estudo.
ABSTRACT Objective: To retrospectively evaluate the influence of intracorneal ring thickness on reduction of corneal astigmatism in patients with keratoconus. Methods: From a database of 2,033 eyes submitted to corneal ring implant surgery, a sample of 90 eyes with similar keratometry and astigmatism characteristics was selected. All eyes in this study received two segments of traditional arc length of approximately 160°, with varying thicknesses: Group A received two segments of 150 µm; Group B received two segments of 200 µm, and Group C received two segments of 250 µm. The variables analyzed were mean keratometry and corneal astigmatism before and after surgery. Results: In the eyes that received two 150-µm ring segments (Group A), there was a mean reduction of 5.0 D (10%) in relation to mean keratometry, and a mean reduction of 3.26 D (57.69%) in relation to corneal astigmatism. In the sample in which two 200-µm segments (Group B) were used, there was a mean reduction in keratometry of 7.0 D (14.28%) and in corneal astigmatism of 3.53 D (63.6%). In the sample receiving two 250-µm ring segments (Group C), the mean reduction in keratometry was 10 D (20.4%) and in corneal astigmatism was 2.09 D (38.99%). Conclusion: In keratoconus patients undergoing corneal ring surgery, increased thickness of the implanted segments promotes greater flattening of the cornea, but does not enhance their ability to reduce corneal astigmatism. It would be interesting to analyze a larger sample of patients, combined with vector calculations of astigmatism, to confirm the findings of this study.
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Astigmatism/surgery , Prosthesis Implantation , Keratoconus/surgery , Prostheses and Implants , Astigmatism/etiology , Visual Acuity , Corneal Topography , Keratoconus/complicationsABSTRACT
ABSTRACT Purpose: To investigate the impact of different sizes of steep meridian clear corneal incisions for phacoemul sification on anterior corneal higher-order aberrations. Methods: Medical records of patients who underwent 2.2-mm coaxial micro-incision cataract surgery or 2.75-mm coaxial small-incision cataract surgery were retrospectively reviewed. Only patients with preexisting anterior corneal astigmatism <2.00 diopters (D) and ≥0.50 D who underwent a steep meridian clear corneal incision were included. Primary outcomes were 3rd- to 6th-order anterior corneal higher-order aberrations with an 8-mm pupil. Anterior corneal astigmatism and effective phaco time were evaluated as secondary outcomes. Preoperative and 3-month postoperative outcomes were evaluated. Results: Anterior corneal astigmatism significantly decreased after both procedures; however, there was no significant difference found in surgically induced anterior corneal astigmatism between the two procedures (p=0.146). Although the total higher-order aberrations did not significantly change after both procedures, the group comparison showed a significant difference in surgically induced total higher-order aberrations (a decrease of 0.337 ± 1.156 mm in 2.2-mm coaxial micro-incision cataract surgery and an increase of 0.106 ± 0.521 mm in 2.75-mm coaxial small-incision cataract surgery, p=0.046). Spherical aberrations significantly decreased after 2.2-mm coaxial micro-incision cataract surgery (p=0.001), whereas they did not change significantly after 2.75-mm coaxial small-incision cataract surgery (p=0.564). Coma did not significantly change after either of the procedures. Trefoil did not significantly change after 2.2-mm coaxial micro-incision cataract surgery (p=0.361), whereas it significantly increased after 2.75-mm coaxial small-incision cataract surgery (p<0.001). There was no significant difference shown in effective phaco time between the procedures. A significantly positive correlation was shown between surgically induced anterior corneal astigmatism and coma in 2.75-mm coaxial small-incision cataract surgery (r=0.387, p=0.006). There was no significant correlation found between any surgically induced higher-order aberration changes and effective phaco time. Conclusions: The results showed that 2.2-mm coaxial micro-incision cataract surgery and 2.75-mm coaxial small-incision cataract surgery did not significantly degrade the total higher-order aberrations of the anterior cornea. However, the surgically induced changes in total higher-order aberration showed a significant difference between the two procedures, with a slight reduction after 2.2-mm coaxial micro-incision cataract surgery and a slight increase after 2.75-mm coaxial small-incision cataract surgery. Phaco time and power used during surgery had no impact on corneal aberrations.
RESUMO Objetivo: Investigar o impacto de diferentes ta manhos de incisões em córnea clara com meridiano íngreme para facoemulsificação com aberrações de mais alta ordem da córnea anterior. Métodos: Foram retrospectivamente revisados os prontuários médicos de pacientes que se submeteram a cirurgias de catarata com microincisões coaxiais de 2,2 mm ou com incisões coaxiais pequenas de 2,75 mm. Foram apenas incluídos pacientes com astigmatismo preexistente da córnea anterior <2,00 dioptrias (D) e ³0,50 D, e submetidos a incisões em córnea clara com meridiano íngreme. Os desfechos primários foram aberrações da córnea anterior da 3ª à 6ª ordem com uma pupila de 8 mm. O astigmatismo da córnea anterior e o tempo efetivo de facoemulsificação foram avaliados como desfechos secundários. Os desfechos pré-operatório e pós-operatório aos 3 meses também foram avaliados. Resultados: O astigmatismo da córnea anterior diminuiu significativamente após ambos os procedimentos, mas não se encontrou nenhuma diferença significativa entre os dois procedimentos quanto ao astigmatismo da córnea anterior, induzido pela cirurgia (p=0,146). Embora as aberrações totais de mais alta ordem não se tenham alterado significativamente após ambos procedimentos, a comparação entre os grupos revelou uma diferença significativa nas aberrações totais de mais alta ordem, induzidas pela cirurgia (uma diminuição de 0,337 ± 1,156 mm na cirurgia de catarata por microincisão coaxial de 2,2 mm e um aumento de 0,106 ± 0,521 mm na cirurgia de catarata por incisão coaxial pequena de 2,75 mm; p=0,046). A aberração esférica diminuiu significativamente após cirurgia de catarata por microincisão coaxial de 2,2 mm (p=0,001), mas não se alterou significativamente após cirurgia de catarata por incisão coaxial pequena de 2,75 mm (p=0,564). A aberração de coma não mudou significativamente após qualquer dos procedimentos. O trifólio não se alterou significativamente após cirurgia de catarata por microincisão coaxial de 2,2 mm (p=0,361), mas aumentou significativamente após cirurgia de catarata por incisão coaxial pequena de 2,75 mm (p<0,001). Nenhuma diferença significativa se evidenciou quanto ao tempo efetivo de faco-emulsificação entre os dois procedimentos. Houve uma correlação positiva significativa entre o astigmatismo da córnea anterior, induzido pela cirurgia e a aberração de coma na cirurgia de catarata por incisão coaxial pequena de 2,75 mm (r=0,387, p=0,006). Não foi encontrada correlação significativa entre as alterações nas aberrações totais de mais alta ordem, induzidas pela cirurgia e o tempo efetivo de faco-emulsificação. Conclusões: Nem a cirurgia de catarata por microincisão coaxial de 2,2 mm, nem aquela por incisão coaxial pequena de 2,75 mm degradaram significativamente as aberrações totais de mais alta ordem da córnea anterior. Porém, as alterações nas aberrações totais de mais alta ordem, induzidas pela cirurgia mostraram uma diferença significativa entre os dois procedimentos, com uma ligeira redução na cirurgia de catarata por microincisão coaxial de 2,2 mm e um pequeno aumento na cirurgia de catarata por incisão coaxial pequena de 2,75 mm. O tempo de facoemulsificação e a potência utilizada durante a cirurgia não tiveram impacto nas aberrações corneanas.
Subject(s)
Humans , Astigmatism , Cataract , Cataract Extraction , Phacoemulsification , Astigmatism/surgery , Astigmatism/etiology , Retrospective Studies , Phacoemulsification/adverse effects , Cornea/surgery , Corneal Topography , Lens Implantation, IntraocularABSTRACT
RESUMO Relatamos um caso de astigmatismo residual, após cirurgia de catarata com implante de lente intra-ocular (LIO) tórica (Acrysof Toric, Alcon, Frot Worth TX). A refração residual (+1,25 -2,50 x 105º) e o posicionamento da LIO implantada neste olho, foram correlacionados com a aberrometria total obtida por ray tracing de pontos individuais integrada à da face anterior da córnea obtida por topografia de Plácido, para cálculo das aberrações internas (iTrace, Tracey, Technologies, Houston TX). O cálculo do eixo ideal da LIO, para minimizar a refração residual foi realizado de acordo com Berdahl & Hardten (astigmatismfix.com). A rotação da LIO foi realizada com sucesso 5 meses após a cirurgia inicial para o eixo indicado, reduzindo o erro residual para +0,25 -0,25 x 61º e promovendo reabilitação visual sem correção de 20/20.
ABSTRACT We report a case of residual astigmatism after cataract surgery with toric intraocular lens (IOL) implantation (Acrysof Toric, Alcon, Frot Worth TX). Residual refraction (+1,25 -2,50 x 105º) and IOL positioning were correlated with total ray-tracing wavefront aberrometry integrated with anterior corneal surface Placido-based topography to calculate internal aberrations (iTrace, Tracey Technologies, Houston TX). The ideal IOL axis to minimize residual refraction was calculated with Berdahl & Hardten (astigmatismfix.com). IOL rotation to the indicated axis was successfully performed 5 months after initial surgery, reducing residual error to +0,25 -0,25 x 61º, promoting visual reabilitation, with final uncorrected distance visual acuity 20/20.
Subject(s)
Humans , Female , Aged , Astigmatism/surgery , Astigmatism/etiology , Rotation/adverse effects , Lens Implantation, Intraocular/adverse effects , Lenses, Intraocular/adverse effects , Postoperative Complications , Refraction, Ocular/physiology , Reoperation , Astigmatism/diagnosis , Cataract , Case Reports , Visual Acuity , Phacoemulsification , Aberrometry , Slit Lamp MicroscopyABSTRACT
ABSTRACT Purpose: To investigate the relationship between biomechanical properties of the cornea and postoperative refractive changes in patients with low-level astigmatism after cataract surgery. Methods: This prospective study recruited patients undergoing cataract surgery involving 2.8-mm superior incisions. Biomechanical properties of the cornea were evaluated preoperatively using the Ocular Response Analyzer, and corneal profiles were evaluated using a Scheimpflug system (Pentacam HR). Topographic astigmatism, total corneal aberrations (TCA) and higher-order corneal aberrations (HOCA) analyses were performed preoperatively and during 1- and 3-month postoperative exams. The incidences of surgically-induced astigmatism (SIA) and HOCAs were calculated using vector analyses. Associations of the preoperative biomechanical properties of the cornea with SIA and HOCAs were evaluated. Results: This study included 28 eyes of 28 patients. The preoperative corneal hysteresis (CH) was 8.68 ± 1.86 mmHg, and the corneal resistance factor (CRF) was 8.66 ± 1.61 mmHg. At the 1-month postoperative evaluation, significant changes were observed in HOCAs (p=0.023), TCAs (p=0.05), astigmatism (p=0.02), and trefoil (p=0.033); in contrast, differences in coma (p=0.386) and spherical aberration (SA) were not significant (p=0.947). At the 3-month visit, significant changes were only observed in TCAs (p=0.02) and HOCAs (p=0.012). No relationships between the preoperative corneal hysteresis and corneal resistance factor and postoperative SIA and HOCA were identified, other than a positive correlation between the 3-month postoperative incidence of corneal hysteresis and spherical aberration. Conclusions: Despite the observed lack of relationships of preoperative biomechanical properties of the cornea with SIA and postoperative aberrations (except for SA), further studies involving larger patient groups are needed to explore the unexpected refractive deviations after cataract surgery.
RESUMO Objetivo: Investigar a relação entre as propriedades biomecânicas da córnea e as mudanças refrativas pós-operatórias em pacientes com baixa astigmatismo após a cirurgia de catarata. Método: Neste estudo prospectivo, recrutamos os pacientes submetidos a cirurgia de catarata com incisões superiores de 2,8 mm. As propriedades biomecânicas da córnea foram avaliadas no pré-operatório pelo Ocular Response Analyzer (ORA, Reichert, EUA) e o perfil corneano foi avaliado por um sistema Scheimpflug (Pentacam HR, Oculus Optikgeräte, GmbH). As avaliações do astigmatismo topográfico e das aberrações corneanas de alta ordem (HOCA) foram feitas no pré-operatório e no 1º e 3º mês pós-operatório. O astigmatismo induzido cirurgicamente (SIA) e aberrações corneanas de alta ordem foram calculados pela análise vetorial. Associações das propriedades biomecânicas da córnea no pré-operatório com astigmatismo induzido cirurgicamente e aberrações corneanas de alta ordem foram avaliadas. Resultados: O estudo foi realizado em 28 olhos de 28 pacientes. A histerese corneana (CH) pré-operatória foi 8,68 ± 1,86 mmHg, e o fator de resistência da córnea (CRF) foi de 8,66 ± 1,61 mmHg. No pós-operatório de 1 mês houve mudanças significativas aberrações corneanas de alta ordem (p=0,023), aberração total (p=0,05), astigmatismo (p=0,02) e trifóglio (p=0,033), mas as diferenças em coma (p=0,386) e aberração esférica (SA) foram insignificantes (p=0,947). No terceiro mês, a única mudança significativa foi em RMS total (p=0,02) e aberração total (p=0,012). Não houve relação entre histerese corneana e o fator de resistência da córnea pré-operatórios e astigmatismo induzido cirurgicamente e aberrações corneanas de alta ordem pós-operatórios, além de uma correlação positiva entre o histerese corneana e o aberração esférica do 3º mês pós-operatório. Conclusões: Apesar de não haver relação entre as propriedades biomecânicas pré-operatórias da córnea e astigmatismo induzido cirurgicamente e aberrações (exceto SA) após a cirurgia em nosso estudo, são necessários mais estudos com grupos de pacientes maiores de explicar os erros refrativos inesperados após a cirurgia de catarata.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Postoperative Complications/etiology , Astigmatism/etiology , Cataract Extraction/adverse effects , Cornea/surgery , Lens Implantation, Intraocular/adverse effects , Corneal Wavefront Aberration/etiology , Postoperative Period , Biomechanical Phenomena , Prospective Studies , Preoperative PeriodABSTRACT
ABSTRACT Purpose: To evaluate the outcomes of three different surgical techniques for foldable posterior chamber intraocular lens (PCIOL) implantation in vitrectomized eyes without capsular support. Methods: A total of 60 patients with aphakic and vitrectomized eyes without capsular support were enrolled. All patients underwent three-piece foldable PCIOL implantation into the posterior chamber through a small corneal incision. Transscleral fixation (TSF), iris fixation (IF), and intrascleral tunnel fixation (ISF) surgical techniques were performed. Results: Postoperative PCIOL subluxation or dislocation occurred in one case in the TSF group and two cases in the ISF group. Intraoperative PCIOL dislocation occurred in two patients in the IF group. The incidence of temporary postoperative complications, such as mild intraocular hemorrhage and cystoid macular edema, was higher in the ISF group. No statistically significant difference in PCIOL-related astigmatism was observed between groups. Visual acuity improved in all groups. Conclusions: Postoperative outcomes were comparable between TSF, IF, and ISF for PCIOL in vitrectomized eyes without capsular support.
RESUMO Objetivo: Avaliar os resultados de três diferentes técnicas cirúrgicas para implantação da lente intraocular de câmara posterior (PCIOL) dobrável em olhos vitrectomizados sem apoio capsular. Métodos: Um total de 60 olhos de 60 pacientes afácicos vitrectomizados, sem apoio capsular foram inscritos. Todos os pacientes foram submetidos ao implante de PCIOL dobrável de três peças na câmara posterior, através de uma pequena incisão na córnea. Foram utilizados as técnicas cirúrgicas de fixação transescleral (TSF), fixação iriana (IF) e túnel de fixação intraescleral (ISF). Resultados: Subluxação ou luxação da PCIOL ocorreu em um caso no grupo TSF e em dois casos no grupo ISF. Deslocamentos intraoperatórios da PCIOL ocorram em dois pacientes no grupo IF. Frequência de complicações pós-operatórias temporárias como hemorragia intraocular leve e edema macular cistóide foi maior no grupo ISF. Não houve diferença estatisticamente significativa do astigmatismo relacionado à PCIOL entre os grupos. A acuidade visual melhorou em todos os grupos. Conclusões: Nenhuma das três técnicas cirúrgicas teve destaque em termos de resultados cirúrgicos comparativos.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aphakia/surgery , Vitrectomy/methods , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Postoperative Complications , Astigmatism/etiology , Sclera/surgery , Time Factors , Vitrectomy/adverse effects , Visual Acuity , Iris/surgery , Retrospective Studies , Suture Techniques , Treatment Outcome , Statistics, Nonparametric , Cornea/surgery , Lens Implantation, Intraocular/adverse effectsABSTRACT
ABSTRACTPurpose:To evaluate and compare corneal topographic changes following pars plana vitrectomy with the 23-gauge (G) and 25-G transconjuntival sutureless vitrectomy system as well as the standard 20-G vitrectomy system.Methods:We prospectively evaluated corneal topographic changes in 45 eyes of 45 patients divided into three groups according to vitrectomy system used (20-, 23-, and 25-G). All patients underwent computer-assisted videokeratography using an EyeSys System 3000 topographer preoperatively and at one week, one month, and three months postoperatively.Results:In the 20-G vitrectomy group, we found statistically significant postoperative changes in corneal curvature parameters with an average steepening of 0.98 ± 0.18 D (P<0.001) and 0.93 ± 0.21 D (P<0.001) at one week and one month, respectively. No statistically significant difference was observed at the three-month follow-up visit. In the 23- and 25-G groups, no statistically significant changes in corneal curvature parameters were observed at any postoperative follow-up visit.Conclusion:Twenty-three-gauge and 25-gauge transconjunctival sutureless vitrectomy did not induce topographic corneal changes following surgery, whereas 20-G vitrectomy was found to induce transient topographic corneal changes that had returned to preoperative levels at three months postoperatively.
RESUMOObjetivos:Avaliar e comparar as alterações topográficas da córnea após a vitrectomia via pars plana com o sistema transconjuntival sem suturas de 23 gauge (g) e 25 g e com o sistema tradicional de vitrectomia via pars plana 20 g.Método:Neste estudo prospectivo, as alterações topográficas da córnea foram avaliadas em 45 olhos de 45 pacientes, divididos em 3 grupos de acordo com o sistema de vitrectomia utilizado (20, 23 e 25 g). Todos os pacientes foram submetidos a topografia corneana computadorizada utilizando-se o topógrafo EyeSys System 3000 antes da cirurgia, e com 1 semana, 1 mês e 3 meses após a cirurgia.Resultados:No período pós-operatório, no grupo de vitrectomia 20 g, foram encontradas alterações estatisticamente significativas nos parâmetros da curvatura corneana estudados, com um aumento médio da curvatura de 0,98 ± 0,18 D (p<0,001) e 0,93 ± 0,21D (p<0,001) após uma semana, e um mês, respectivamente. Não se observou diferença estatisticamente significativa na visita realizada 3 meses após a cirurgia. Nos grupos 23 g e 25 g, não se observaram alterações estatisticamente significativas nos parâmetros da curvatura corneana em nenhum dos momentos analisados no pós-operatório.Conclusão:A vitrectomia transconjuntival sem suturas 23 g e 25 g não induziu alterações topográficas da córnea após a cirurgia, enquanto que a vitrectomia 20 g induziu alterações topográficas da córnea transitórias que retornaram aos níveis pré-operatórios três meses após a cirurgia.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cornea/surgery , Corneal Topography/methods , Vitrectomy/methods , Astigmatism/etiology , Cornea/pathology , Postoperative Complications , Postoperative Period , Preoperative Period , Prospective Studies , Reference Values , Retinal Diseases/etiology , Suture Techniques , Time Factors , Treatment Outcome , Visual Acuity , Vitrectomy/adverse effectsABSTRACT
PURPOSE: To determine effectiveness of laser-assisted in situ keratomileusis (LASIK) in the treatment of astigmatism following penetrating keratoplasty (PK). METHODS: We performed a retrospective review of medical records of patients who underwent LASIK following PK and had over 1 year of follow-up data. RESULTS: Twenty-six patients (26 pairs of eyes) underwent LASIK following PK. Mean age of the patients at the time of LASIK was 40.7 years (range, 26 to 72 years). Following LASIK, the mean cylinder was reduced by 2.4 diopters and mean reduction of cylinder after LASIK was 65.4% from the preoperative values at the last follow-up visit. Uncorrected visual acuity became 20 / 50 or better in 69.2% of the eyes after LASIK. Best-corrected visual acuity became 20 / 50 or better in 73.1% of the eyes after LASIK. All of them were intolerable to contact lenses before LASIK. After LASIK, 6 pairs (23.1%) did not need to use contact lenses and 18 pairs (69.2%) were tolerable to using contact lenses or spectacles. There were no significant endothelial cell density changes 12 months after LASIK (p = 0.239). CONCLUSIONS: LASIK is effective in the treatment of astigmatism following PK and increases contact lens and spectacle tolerance.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Astigmatism/etiology , Contact Lenses/statistics & numerical data , Corneal Topography , Keratomileusis, Laser In Situ/methods , Keratoplasty, Penetrating/adverse effects , Lasers, Excimer/therapeutic use , Refraction, Ocular/physiology , Retrospective Studies , Vision, Binocular/physiology , Visual Acuity/physiologyABSTRACT
Apresentamos um relato de astigmatismo tardio progressivo pós-transplante de córnea para ceratocone, associado à afinamento periférico na junção doador-receptor, o que presumidamente pode ser considerado como recorrência da ectasia. O caso foi tratado por meio de Topoplastia de Cvintal assistida por laser de femtossegundo para a confecção da incisão com geometria "top hat", seguido de sutura com ajuste per-operatório guiado por ceratoscopia...
We present a case of late high progressive astigmatism following penetrating keratoplasty for keratoconus, which was associated with peripheral thinning in the donor-receptor area, which may be recognized as recurrence of ectasia. Treatment was accomplished with Cvintal's Topoplasty assisted by femtosecond laser for a "top hat", followed by resuture with peroperative adjustment guided by ceratoscopy...
Subject(s)
Humans , Female , Middle Aged , Astigmatism/etiology , Keratoconus/surgery , Keratoplasty, Penetrating/adverse effects , Cornea/pathology , Laser Therapy/methods , Dilatation, Pathologic , Postoperative Complications , Recurrence , Visual AcuityABSTRACT
We report a 63-year-old male who had undergone left eye optical penetrating keratoplasty for central leucomatous corneal opacity 10 years earlier. The eye had clear donor graft with residual astigmatism of –6.50 diopter cylinder (DC) at 30°. The patient underwent clear corneal phacoemulsification with implantation of +6.0 D spherical equivalent AcrySof SN60T9 intraocular lens (IOL). Postoperatively, at 10 months, the patient had distance corrected visual acuity of 20/30 with –2.00 DC at 20°. AcrySof toric IOL offers an effective treatment option for post-keratoplasty high corneal astigmatism in patients with cataract.
Subject(s)
Acrylic Resins , Astigmatism/etiology , Astigmatism/surgery , Cataract/complications , Corneal Opacity/complications , Corneal Opacity/surgery , Follow-Up Studies , Humans , Keratoplasty, Penetrating/adverse effects , Lenses, Intraocular , Male , Middle Aged , Phacoemulsification , Prosthesis Design , Refraction, Ocular , Visual AcuityABSTRACT
PURPOSE: To evaluate the changes of refractive astigmatism after horizontal rectus muscle surgery in intermittent exotropic children. METHODS: Sixty-nine exotropic patients were retrospectively reviewed. Of those, 35 patients received unilateral lateral rectus recession (BLR group, 35 eyes) and 34 patients received unilateral lateral rectus recession and medial rectus resection (R&R group, 34 eyes). Non-cycloplegic refractions were measured until 6 months postoperatively. Spherical equivalent (SE), J0 and J45 using power vectors were calculated to determine and compare the changes of refractive astigmatism and axis in both groups. RESULTS: SE significantly decreased after surgery for the first week and did not changed thereafter in both groups (p = 0.000 and p = 0.018, respectively). In BLR group, J0 showed significant changes at the first week and 1 month after surgery (p = 0.005 and p = 0.016, respectively), but in R&R group, J0 changed significantly between 1 week and 3 months postoperatively (p = 0.023 and p = 0.016, respectively). J45 did not change significantly as time passed in both groups (all p > 0.05). There was no statistically significant difference in the magnitude of changes in SE, J0 and J45 between the two groups after the 6-month follow-up (p = 0.500, p = 0.244 and p = 0.202, respectively). CONCLUSIONS: Horizontal rectus muscle surgery in intermittent exotropic children tends to induce a statistically significant change in astigmatism in the with-the-rule direction and myopic shift in SE. This astigmatism change seems to occur within the first 3 months after surgery. Thus, astigmatism induced by surgery should be checked and corrected at least 3 months after horizontal strabismus surgery.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Astigmatism/etiology , Exotropia/complications , Eye Movements , Follow-Up Studies , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures/methods , Retrospective Studies , Treatment Outcome , Vision, Binocular/physiologyABSTRACT
The changes of higher-order aberrations (HOAs) after bilateral lateral rectus muscle recession were evaluated. Forty eyes of 20 children were enrolled and their wavefront information was assessed until postoperative 3 months. Even though the root mean square (RMS) of total aberration was not changed, the RMS of HOA was transiently increased at postoperative 1 week and returned to baseline level after 1 month. Among individual Zernike coefficient, secondary astigmatism, quadrafoil, secondary coma, secondary trefoil, and pentafoil showed similar tendency with the RMS of HOA. However, coma, trefoil, and spherical aberration were not changed. Regarding recession amount, it did not correlate with any Zernike coefficient. In summary, our data imply that the HOAs are transiently increased after lateral rectus recession surgery. These results are in collusion with previous reports that strabismus surgery induced transient corneal astigmatism.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Astigmatism/etiology , Exotropia/surgery , Postoperative Care , Postoperative Complications/epidemiology , Vision TestsABSTRACT
OBJETIVO: Avaliar a eficácia, previsibilidade e estabilidade da ceratectomia fotorrefrativa (PRK) guiada pela frente de onda corneana para o tratamento da hipermetropia secundária à ceratotomia radial. MÉTODOS: Este estudo prospectivo analisou 60 olhos de 36 pacientes consecutivos, submetidos a PRK personalizado com o laser Esiris-Schwind. A técnica constou de desepitelização mecânica, fotoablação e utilização de mitomicina-C 0,02 por cento. Os pacientes foram acompanhados por 12 meses. RESULTADOS: O intervalo médio entre a ceratotomia radial e o PRK foi de 18,4 anos ± 3,8 (DP); o equivalente esférico (EE) médio antes da ceratotomia radial era -4,35 dioptrias (D) ± 1,55. As medidas prévias ao PRK mostraram grau esférico médio de +5,00 D ± 2,28, astigmatismo médio de -1,47 D ± 1,06, EE médio de +4,27 D ± 2,18 e AV corrigida (AVcc) média de 0,174 ± 0,139 (logMAR). O EE médio programado no laser foi +4,74 D ± 2,11. Os resultados encontrados um ano após a cirurgia foram: EE médio de +0,04 D ± 1,03 (P<0,001), astigmatismo médio de -1,03 ± 0,75 D (P=0,015), AV média sem correção de 0,265 ± 0,197 e AVcc de 0,079 ± 0,105 (P<0,001). A AVcc mostrou ganho médio de uma linha; 20 olhos (33,3 por cento) melhoraram duas ou mais linhas e somente um olho perdeu duas linhas. Ocorreu redução estatisticamente significante do coma (P=0,002), trefoil (P=0,004), aberração esférica (P<0,001) e quatrefoil (P=0,002). Houve 48 olhos (80 por cento) entre ± 1,00 D do EE planejado. A regressão média entre seis e 12 meses foi de +0,17 ± 0,67 D. CONCLUSÃO: O PRK personalizado pela frente de onda corneana foi eficaz, previsível e estável pelo período de um ano para a redução da hipermetropia após a ceratotomia radial. No pós-operatório, observou-se melhora significativa da AVsc, AVcc e das aberrações corneanas. Número do ClinicalTrials.gov:NCT00917657
PURPOSE: To assess the efficacy, predictability and stability of corneal wavefront-guided photorefractive keratectomy (PRK) for correcting hyperopia and astigmatism after radial keratotomy. METHODS: In a prospective study, 60 eyes of 36 consecutive patients were treated with corneal wavefront-guided PRK with 0.02 percent mitomycin-C using an Esiris-Schwind excimer laser. Corneal epithelium was mechanically removed. All patients were followed-up for 12 months. RESULTS: The mean time between radial keratotomy and PRK was 18.4 years ± 3.8 (SD); mean spherical equivalent (SE) before radial keratotomy was -4.35 diopters (D) ± 1.55. Before PRK, the mean sphere was +5.00 D ± 2.28, mean astigmatism was - 1.47 D ± 1.06, mean SE was +4.27 D ± 2.18, and the mean best-corrected visual acuity (BCVA) was 0.174 ± 0.139 (logMAR). The planned laser SE correction was +4.74 D ± 2.11. No intraoperative complications were noted. At 12 months, mean SE was +0.04 D ± 1.03 (P<0.001), mean astigmatism was -1.03 ± 0.75 D (P=0.015), mean UCVA was 0.265 ± 0.197, and mean BCVA was 0.079 ± 0.105 (P<0.001). There was a mean gain of 1 line of BCVA and 20 eyes (33.3 percent) gained 2 or more lines. Only one eye lost 2 lines. A significant decrease in coma (P=0.002), trefoil (P=0.004), spherical aberration (P<0.001) and quatrefoil (P=0.002) was observed. Forty eight eyes (80 percent) were within ± 1.0 D of intended SE. Mean regression from 6 to 12 months was +0.17 ± 0.67 D. CONCLUSION: Corneal wavefront-guided PRK was effective, predictable and stable after one year of follow-up for the treatment of hyperopia after radial keratotomy. A significant improvement in UCVA, BCVA and corneal aberrations was obtained. ClinicalTrials.gov Identifier: NCT00917657
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Alkylating Agents/administration & dosage , Astigmatism/surgery , Hyperopia/surgery , Keratotomy, Radial/adverse effects , Mitomycin/administration & dosage , Photorefractive Keratectomy/methods , Astigmatism/etiology , Combined Modality Therapy , Corneal Topography , Follow-Up Studies , Hyperopia/etiology , Prospective Studies , Visual AcuityABSTRACT
PURPOSE: To evaluate the effects of wearing rigid gas permeable (RGP) contact lenses on the topographic changes in keratoconus. METHODS: Seventy-seven keratoconic eyes that wore multicurve RGP contact lenses and 30 keratoconic eyes that wore no contact lenses were retrospectively analyzed. The mean follow-ups were 22.6 and 20.5 months in the lens-wearing and control groups, respectively. Visual acuity, comfort, daily wearing time, and corneal staining were evaluated for both groups. The changes in topographic indices were compared between the lens-wearing and control groups. RESULTS: Multicurve RGP lens corrected logarithm of the minimum angle of resolution visual acuity of the lens-wearing group significantly improved from -0.016+/-0.065 to -0.032+/-0.10 at follow-up (p=0.05). In the lens-wearing group with advanced keratoconus, the Sim Kmax, Sim Kmin, apical power, astigmatic index, and anterior elevation significantly decreased from 57.68+/-4.26 diopter (D), 50.50+/-2.32 D, 62.79+/-5.11 D, 7.20+/-0.55 D and 67.36+/-16.30 microm to 55.51+/-4.28 D, 49.62+/-3.26 D, 60.31+/-5.41 D, 5.90+/-0.51 D and 60.61+/-16.09 microm, respectively (paired t-test, p<0.05). The irregularity index of 3 mm did not significantly change. Meanwhile, in the control group, the apical power and irregularity index increased from 55.56+/-7.25 D and 3.06+/-1.68 D to 57.11+/-7.75 D and 3.25+/-1.71 D, respectively (paired t-test, p=0.008, p=0.01). CONCLUSIONS: Properly fitted multicurve RGP contact lenses are not likely to contribute to the progression of keratoconus.
Subject(s)
Adult , Female , Humans , Male , Young Adult , Astigmatism/etiology , Contact Lenses , Cornea/pathology , Corneal Topography , Disease Progression , Follow-Up Studies , Keratoconus/complications , Prognosis , Prosthesis Design , Retrospective Studies , Time FactorsABSTRACT
PURPOSE: To evaluate the effect of epiblepharon surgery on visual acuity and with-the-rule astigmatism in children compared to patients without surgical treatment. METHODS: We undertook a retrospective case control study and reviewed the charts of 202 eyes treated with epiblepharon surgery and of 142 eyes without surgery. The surgical procedure for epiblepharon correction used rotating suture techniques. Data regarding age, best corrected visual acuity, and degree of astigmatism were recorded. Baseline and 1-, 3-, 6-, and 12-month postoperative data were collected. The chi-square test, Student's t-test and general linear model analysis for repeated measures were applied. RESULTS: The mean astigmatism in the surgical group decreased from 1.10 +/- 1.02 diopter (D) preoperatively to 0.84 +/- 1.05 D at 3 months after surgery (p < 0.05). However, there was no statistically significant difference compared to the non-surgical group during the first year. The general linear model analysis comparing the mean astigmatism between the two groups over time showed a significant group-time interaction (p < 0.05). Within the surgical group, the higher baseline astigmatic subgroup and the 5- to 8-year-old group demonstrated greater cylinder reduction over time. The change in mean visual acuity was not significant in either group. CONCLUSIONS: Significant astigmatic reduction was found after surgical correction in epiblepharon patients. Patients with higher baseline astigmatism exhibited greater astigmatic reduction after epiblepharon surgery. These results suggest that, in order to reduce astigmatism, an epiblepharon operation should be considered in patients with a high level of astigmatism.