Avaliação da eficácia de um novo marcador cirúrgico para capsulorrexe anterior / Effectiveness evaluation of a new surgical marker for anterior capsulorhexis

RESUMO Objetivo: Avaliar a eficácia de um novo marcador cirúrgico para ajudar na confecção da capsulorrexe anterior analisando o seu dimensionamento e formato, comparando com a capsulorrexe confeccionada manualmente de maneira livre. Métodos: Como experimento, 3 residentes (R3) de Oftalmologia do Hospital Universitário Onofre Lopes (HUOL) e 1 oftalmologista em treinamento, voluntários, realizaram (cada um) 10 capsulorrexes em olhos de porco enucleados. Em 5 olhos foi utilizado o marcador e em outros 5, não. Todos os olhos foram fotografados tendo ao lado uma régua para orientar e calibrar um aplicativo para a avaliação morfométrica do procedimento. O diâmetro alvo foi de 5 mm, cujo perímetro correspondente é 15,7 mm e a área 19,652 mm2. Foram avaliados em cada procedimento: os diâmetros máximo, mínimo e médio, o perímetro, a área e o desvio em relação ao diâmetro e quanto ao aspecto ideal. Resultados: No grupo utilizando o marcador o diâmetro médio foi 5,44mm (±0,89) contra 6,37mm (±0,67) (p=0,001), no grupo no qual não se utilizou o marcador; quanto ao perímetro, 17,52mm (±1,92) no grupo utilizando o marcador contra 20,14mm (±2,09) (p<0,001) sem o marcador e quanto a área, 24,73mm2 (±1,92) com o marcador, contra 32,62mm2 (±6,32) (p<0,001), sem o marcador. Em relação ao aspecto da capsulorrexe 1,26mm (±0,12), contra 1,21mm (±0,7) (p=0,09) e em relação ao desvio de curvatura: 0,87 (±0,05), contra 0,9 (±0,04), (p=0,06) respectivamente. Conclusão: O trabalho mostrou que o marcador avaliado é eficaz para auxiliar a confecção da capsulorrexe conduzindo a resultados melhores que o método a mão livre.

ABSTRACT Purpose: To evaluate the effectiveness of a surgical device that intented to help in the preparation of the anterior capsulorhexis analyzing the design and shape, comparing with capsulorhexis made by free hand. Methods: Three ophthalmology residents(R3) at the HUOL and one surgeon in training, participate in this research as volunteers. Each surgeon perform 5 capsulorhexis in porcine eyes using the device, and five others by free hand as a control. All capsulorhexis were photographed having a ruler as reference to guide and calibrate a computer application for morphometric evaluation (Cambuí Labs, Natal, Brazil). All surgeons aimed to produce a circular continuous capsulorhexis of 5 mm diameter that represents 15,7mm in perimeter and 19,652mm2 in area. Each wet-lab capsulorhexis was evaluated in regard to these criteria: diameter (mean, maximum and minimum), perimeter, area, deviation from the ideal diameter and ideal shape. Results: Compare to control groups, capsulorhexis with the aid of the surgical device showed: 5,44mm ±0,89 vs 6,37mm ±0,67, for capsulorhexis diameter (p=0,001); 17,52mm ±1,92 vs 20,14mm ±2,09 for capsulorhexis perimeter (<0.001); 24,73mm2 ±1,92 vs 32,62mm2 ±6,36 for capsulorhexis area (p<0,001). A tendency for better result with the aid of the surgical device was observed for deviation of an ideal diameter or ideal aspect were appreciated: 0,87mm ±0,05 vs 0,9 ±0,04 for deviation of a curve (p=0,06); 1,26mm ±0,12 vs 1,21mm ±0,7 for the capsulorhexis aspect (p=0,09). Conclusion: Capsulorhexis produced with the aid of the surgical device, significantly improved wet-lab capsulorhexis performance.

Completion rates of anterior and posterior continuous curvilinear capsulorrhexis in pediatric cataract surgery for surgery performed by trainee surgeons with the use of a low-cost viscoelastic.

Context: Pediatric cataract surgery is traditionally done with the aid of high-molecular-weight viscoelastics which are expensive. It needs to be determined if low-cost substitutes are just as successful. Aims: The study aims to determine the success rates for anterior and posterior capsulorrhexis and intraocular lens (IOL) implantation in the bag for pediatric cataract surgery performed with the aid of a low-molecular-weight viscoelastic. Settings and Design: Nonrandomized observational study. Materials and Methods: Children less than 6 years of age who underwent cataract surgery with IOL implantation in the period May 2008–May 2009 were included. The surgeries were done by pediatric ophthalmology fellows. A standard procedure of anterior capsulorrhexis, lens aspiration with primary posterior capsulorrhexis, anterior vitrectomy, and IOL implantation was followed. Three parameters were studied: successful completion of anterior and posterior capsulorrhexis and IOL implantation in the bag. Results: 33 eyes of 28 children were studied. The success rate for completion was 66.7% and 88.2 % for anterior and posterior capsulorrhexis, respectively. IOL implantation in the bag was successful in 87.9%. Conclusions: 2% hydroxypropylmethylcellulose is a viable low-cost alternative to more expensive options similar to high-molecular-weight viscoelastics. This is of great relevance to hospitals in developing countries.

The Effect of Capsular Tension Ring on Posterior Capsular Opacity in Cataract Surgery

This study was performed to evaluate the efficacy and safety of the capsular tension ring on posterior capsular opacity in comparison with cases undergoing intraocular lens (IOL) implantation alone. We analyzed 127 eyes which had undergone cataract surgery, including capsular tension ring insertion, along with 127 eyes which had undergone IOL implantation alone by the same surgeon from September 1998 to March 2003. In the insertion group, 41 eyes (group A) had been followed up for more than one year after silicone IOL implantation, as had 40 eyes (group B) in the control group. We compared the incidence, type, and degree of capsular opacity between A and B groups and also endothelial cell loss after surgery between the two groups. For insertion group A, the frequency of posterior capsular opacity was lower (7.3%), the duration to development was longer, and the energy required for Nd-Yag capsulotomy of PCO was less than for control group B (25%) (p=0.037). The endothelial cell count loss rate was not significantly different between the two groups (p=0.522). The capsular tension ring is associated with a significantly reduced incidence of posterior capsular opacity and is a safe procedure.