Phaco-Chop versus Divide-and-Conquer in Patients Who Underwent Cataract Surgery: A Systematic Review and Meta-Analysis.

Background: Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due to its safety and efficiency. We evaluated the advantages and disadvantages of two phacoemulsification techniques: phaco-chop and divide-and-conquer. Methods: PubMed, Cochrane, Embase, and Web of Science databases were queried for randomized controlled trial (RCT), prospective and retrospective studies that compared the phaco-chop technique over the divide-and-conquer technique and reported the outcomes of (1) Endothelial cell count change (ECC); (2) Ultrasound time (UST); (3) Cumulated dissipated energy (CDE); (4) Surgery time; and (5) Phacoemulsification time (PT). Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Results: Nine final studies, (6 prospective RCTs and 3 observational), comprising 837 patients undergoing phacoemulsification. 435 (51.9%) underwent the phaco-chop technique, and 405 (48.1%) underwent divide-and-conquer. Overall, the phaco-chop technique was associated with several advantages: a significant difference in ECC change postoperatively (Mean Difference [MD] -221.67 Cell/mm2; 95% Confidence Interval [CI] -401.68 to -41.66; p < 0.02; I2=73%); a shorter UST (MD -51.16 sec; 95% CI -99.4 to -2.79; p = 0.04; I2=98%); reduced CDE (MD -8.68 units; 95% CI -12.76 to -4.60; p < 0.01; I2=84%); a lower PT (MD -55.09 sec; 95% CI -99.29 to -12.90; p = 0.01; I2=100). There were no significant differences in surgery time (MD -3.86 min; 95% CI -9.55 to 1.83; p = 0.18; I2=99%). Conclusion: The phaco-chop technique proved to cause fewer hazards to the corneal endothelium, with less delivered intraocular ultrasound energy when compared to the divide-and-conquer technique.

Ocular complications in adults with psoriasis: a cross-sectional study in a referral center in Brazil.

PURPOSE: There is limited literature on the ocular manifestations in patients with psoriasis. Therefore, this study aimed to identify the prevalence of and factors associated with ocular manifestations in adults with psoriasis. METHODS: This cross-sectional study included Brazilian adults with psoriasis. The dermatological evaluation included diagnosis, clinical form, Psoriasis Area and Severity Index (PASI) measurement, and location of the lesions. Patients underwent a full ophthalmological examination, including the Schirmer I test, Rose Bengala staining, and tear breakup time tests. The results were analyzed using chi-square and Pearson's linear correlation tests. RESULTS: Of the 130 patients assessed, 118 (90.8%) exhibited ocular abnormalities, with meibomian gland dysfunction (MGD) being the most prevalent (59.2%), followed by dry eye disease (DED) (56.2%). A significant correlation was observed between MGD and PASI (p = 0.05), and between MGD and certain treatment modalities. DED was significantly associated with PASI (p < 0.05). Concurrent use of acitretin was identified as an independent predictor of MGD (odds ratio [OR] = 3.5, p < 0.05), whereas PASI was a protective factor against DED (OR = 0.39, p < 0.01). CONCLUSION: Given the high prevalence of eye disease among individuals with psoriasis, routine ophthalmological assessments are recommended to prevent possible ocular complications.

A Morphometric Study of the Pars Plana of the Ciliary Body in Human Cadaver Eyes.

This study aimed to determine the pars plana length in postmortem human eyes using advanced morphometric techniques and correlate demographics to ocular metrics such as age, sex, ethnicity, and axial length. Between February and July 2005, we conducted a cross-sectional observational study on 46 human cadaver eyes deemed unsuitable for transplant by the SBO Eye Bank. The morphometric analysis was performed on projected images using a surgical microscope and a video-microscopy system with a 20.5:1 correction factor. The pars plana length was measured three times per quadrant, with the final value being the mean of these measurements. Of the 46 eyes collected, 9 were unsuitable for the study due to technical constraints in conducting intraocular measurements. Overall, the average axial length was 25.20 mm. The average pars plana length was 3.8 mm in all quadrants, with no measurements below 2.8 mm or above 4.9 mm. There were no statistically significant variations across quadrants or with age, sex, axial length, or laterality. Accurately defining the pars plana dimensions is crucial for safely accessing the posterior segment of the eye and minimizing complications during intraocular procedures, such as intravitreal injections and vitreoretinal surgeries.

Combined Endoscopic Cyclophotocoagulation and Phacoemulsification Versus Phacoemulsification Alone in the Glaucoma Treatment: A Systematic Review and Meta-Analysis.

The complete safety and efficacy of endoscopic cyclophotocoagulation (ECP) remain unclear in the literature and, to our knowledge, there are no current meta-analyses on phaco-ECP versus phacoemulsification alone to date. Thus, we conducted a systematic review and meta-analysis comparing these two strategies through studies, assessing the effectiveness and safety of outcomes in a population with glaucoma. The protocol for this systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42023482376). We systematically searched PubMed, Embase, and Web of Science from inception to December 2023. A random-effects model was used for all analyses due to heterogeneity. Review Manager 5.3 (Cochrane Centre, The Cochrane Collaboration, Denmark) was used for statistical analysis. Finally, nine studies were included in this comprehensive review and a total of 5389 eyes were analyzed in our study. In comparison to the ECP and phacoemulsification group, those receiving phacoemulsification alone showed better results in best-corrected visual acuity (MD 0.09; CI 95% 0.03 to 0.16; I²=0%), but worse outcomes in intraocular pressure (IOP) (MD -1.49; 95% CI -2.29 to -0.68; I²=29%) and use medications (MD -0.75; 95% CI -0.94 to -0.56; I²=0%) in the last visit. Complication rates, both general and serious, were significantly different between the groups, indicating the potential impact of combined procedures on patient outcomes. Thus, combining ECP with phacoemulsification for glaucoma treatment showed sustained IOP reduction and decreased medication dependence. However, higher complication rates suggest careful consideration of risks. More extensive research with larger trials and longer follow-ups is needed to validate findings and address limitations, providing valuable insights into this treatment approach.

Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis.

Introduction: Corneal ectasia leads to progressive irregular corneal curvature and reduced visual acuity. Objective: To assess the safety and effectiveness of corneal collagen cross-linking (CXL) for managing corneal ectasia resulting from refractive laser surgery (RSL). Methods: A systematic review and meta-analysis were realized according to PRISMA guidelines. We searched PubMed, EMBASE, Cochrane, and Web of Science databases for studies on CXL in patients with ectasia after RLS. The outcomes of interest included visual acuity, refractive outcomes, topographic parameters (Kmax, index surface variance (ISV), index of Vertical Asymmetry (IVA), keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD) and Rmin (minimum sagittal curvature)), central corneal thickness, endothelial cell count, and possible adverse events. Statistical analysis was performed using the R software (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria). Results: 15 studies encompassing 421 patients (512 eyes) were included. The mean age was 32.03 ± 4.4 years. The pooled results showed a stable uncorrected visual acuity post-CXL, with a significant improvement in corrected distance visual acuity (SMD = 0.09; 95% CI: -0.07 to 0.26). The spherical equivalent decreased significantly (SMD = -0.09; 95% CI: -0.35, -0.02). The topographic parameter Kmax decreased significantly (SMD = 0.15; 95% CI:0.01 to 0.28); however, the other parameters, ISV, IVA, KI, CKI, IHA, IHD, and Rmin, did not change significantly. Central corneal thickness decreased significantly (SMD = 0.24; 95% CI:0.07 to 0.41), and the endothelial cell count remained stable The complications were rare. Conclusion: CXL is a safe and effective technique for managing corneal ectasia after RLS.

Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift.

Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea.

Effect of blue staining of expandable hydrophilic intraocular lenses on contrast sensitivity and glare vision.

PURPOSE: To evaluate the effect of trypan blue staining of expandable hydrophilic acrylic intraocular lenses (IOLs) on contrast sensitivity and glare. SETTING: Department of Ophthalmology, Federal University, and Oculistas Associados, Rio de Janeiro, Brazil. METHODS: Phacoemulsification with expandable hydrophilic IOL implantation was performed in 19 eyes. Group 1 (stained group) consisted of 12 eyes with the IOL unintentionally stained by trypan blue 0.1% solution during surgery; Group 2 (unstained group) consisted of 7 eyes with IOLs that were not stained because trypan blue was not used during surgery. The eyes were examined postoperatively for Snellen best corrected visual acuity (BCVA), contrast sensitivity BCVA, and glare vision. The examiners were masked to whether the IOL was stained by trypan blue. Inclusion criteria included a BCVA of 20/30 or better 1 month postoperatively. Patients who had other ocular pathology or previous ocular surgery were excluded from the study. RESULTS: The mean postoperative BCVA was 20/24 in the stained group and 20/23 in the unstained group (P =.73). The mean contrast sensitivity visual acuity was 20/31 in the stained group and 20/26 in unstained group (P =.10). The mean glare visual acuity was 20/75 and 20/33, respectively (P =.03). CONCLUSIONS: Patients with expandable hydrophilic acrylic IOLs stained with trypan blue performed significantly worse on a glare vision test than patients whose IOLs were not stained. Cataract surgeons should avoid using trypan blue with this IOL type.

Hipermetropia pós-cerototomia radial / Hyperopia after radial keratotomy

Objetivo: Avaliar a incidência, característica e possíveis fatores de risco para desenvolvimento de hipermetropia pós-ceratotomia radial. Método: Estudo retrospectivo envolvendo 201 olhos submetidos a ceratotomia radial no período de 1983 a 1995, com acompanhamento médio de 88.3 meses (variando de 30 a 192 meses). Todas as cirurgias foram realizadas pelo mesmo cirurgião (AG), utilizando incisões radiais centrífugas - técnica americana, na qual as incisões eram realizadas do centro para a periferia. O trabalho foi realizado na Clínica particular de um dos autores. Resultados: No primeiro ano de pós-operatório, 4,2 por cento dos olhos apresentavam hipermetropia que variava de +0.50 a +1.50 dioptrias (D) (média de +1.20D). Do primeiro ao quinto ano pós-operatório essa proporção aumentou para 9,8 por cento e, entre o quinto e o décimo ano pós-operatório, para 32 por cento. Num acompanhamento maior que dez anos (n=50), 49 por cento dos olhos apresentavam hipermetropia variando de +0.50 a +5.75D (média de +2.21D). Conclusão: Há uma tendência significativa para hipermetropização pós-ceratotomia radial ao longo do tempo. Enquanto no primeiro ano apenas 4,2 por cento dos casos apresentaram hipermetropia, num período superior a 10 anos, essa proporção subiu para 49 por cento. Diversos fatores de risco puderam ser apontados para a hipermetropização pós-ceratotomia radial, tais como: menor tamanho da zona óptica, presença de incisões arqueadas e menor espessura corneana no pré-operatório.

Síndrome do Nevo Cutâneo de Jadassohn / Nevus Sebaceous of Jadassohn's Syndrome

Objetivo: Relatar um caso de uma síndrome pouco comum na literatura, que envolve manifestações oftalmológicas variadas e complexas. Local: Departamento de Oftalmologia da Universidade Federal do Rio de Janeiro - UFRJ, Hospital Universitário Clementino Fraga Filho. Método: Relato de caso. Conclusão: A síndrome de nevo cutâneo de Jadassohn, de expressividade alta e sobrevida elevada, é relatada neste trabalho. Mesmo sendo uma síndrome rara, precisa de atenção devido ao grande risco de malignização das lesões cutâneas e ao grande acometimento da função visual.

Aspectos clínico-tomográficos da mucocele com invasão orbitária / Clinical and computed tomography aspects of mucocele with orbital invasion

OBJETIVO: Avaliar e relacionar os achados clínico-radiológicos da mucocele orbitária. MÉTODOS: Análise clínica e de imagem referente a 166 pacientes com lesöes expansivas da órbita examinadas com o tomógrafo Somaton DR da marca Siemens de terceira geração num período de 10 anos consecutivos em Hospital Universitário de referência. RESULTADOS: Os achados clínicos mais comuns foram tumoraçäo e proptose do globo ocular. A tomografia computadorizada, o achado típico foi de massa com baixa densidade, originando-se em seios paranasais, com destruiçäo óssea adjacente, invasäo da órbita e deslocamento do globo ocular. CONCLUSÄO: O desenvolvimento da tomografia computadorizada foi decisivo no estudo da órbita pois propicia, por meio de exame radiológico altamente especializado, imagens de incrível fidelidade anatômica revelando informaçöes sobre o processo patológico como sua localizaçäo, sua relaçäo com as estruturas adjacentes e sua vascularizaçäo

Tendências atuais da cirurgia de catarata no Brasil - 2002 / Current trends of cataract surgery in Brazil - 2002

Objetivo: Registrar as tendências atuais dos cirurgiões de catarata no Brasil e alertar para a importância da documentação estatística em prol de um melhor controle e aperfeiçoamento dessa especialidade em nosso país. Além disso, comparar as tendências nacionais com as tendências internacionais. Material e Métodos: Foram distribuídos 1500 questionários durante o VI Congresso Internacional de Catarata e Cirurgia Refrativa realizado em abril de 2002 em São Paulo, SP. A distribuição dos questionários foi aleatória e o mesmo era respondido de forma anônima. O questionário foi elaborado com perguntas diretas e opções pré-determinadas com o objetivo de facilitar o preenchimento. Resultados: Foram respondidos 29,3 por cento dos questionários distribuídos. Destes, a maioria era representada por participantes do sexo masculino (76,2 por cento), com idade média de 37,8 anos (variando de 24 a 67 anos). Foi evidenciado que 81,3 por cento dos participantes praticam a facoemulsificação de rotina enquanto 18,7 por cento praticam a extracapsular convencional. A técnica de dividir e conquistar e realizada em 57,2 por cento dos casos e a lente intra-ocular dobrável é utilizada de rotina por 58,7 por cento dos participantes. A maioria das cirurgias realizadas (57,1 por cento) são em pacientes ligados a planos de saúde, enquanto 36,7 por cento são em pacientes do SUS e 12,0 por cento em pacientes particulares. Conclusão: O presente estudo retrata as tendências da cirurgia de catarata no Brasil, sendo importante na melhor caracterização e orientação para o continuo desenvolvimento dessa especialidade em nosso país.

Diagnóstico de câncer de pulmão através de exame oftalmológico / Diagnoses of an occult lung cancer by ophthalmologic examination

Objetivo: Relatar um caso de diagnóstico de câncer de pulmão através do exame oftalmológico, bem como salientar a importância do exame oftalmológico completo. Método: Relato de caso. Resultados: Paciente de 54 anos, masculino e previamente hígido, procurou atendimento oftalmológico queixando-se de diminuição da acuidade visual e metamorfopsia. A oftalmoscopia indireta evidenciou alterações sugestivas de metástase coroidal. Exames complementares oftalmológicos corroboraram com esta hipótese diagnóstica. O paciente foi, então, encaminhado ao oncologista que, após minuciosa avaliação, constatou tratar-se de câncer de pulmão com metástase para coróide, fígado, rim e tecido ósseo. Conclusão: A lesão coroidal pode ser o primeiro sinal de neoplasia maligna sistêmica e sua detecção pode ser o primeiro passo para a determinação do tumor primário, interferindo no tratamento e prognóstico do paciente.

OCT em glaucoma / OCT in glaucoma

Objetivos: Apresentar uma nova tecnologia, Tomografia de Coerência Óptica (Optical Coherence Tomography - OCT), a qual pode ser um instrumento clínico útil para a detecção precoce do glaucoma e de sua progressão. Local: New England Eye Center/ Tufts University School of Medicine, Hospital das Clínicas da Universidade de São Paulo e Instituto Benjamin Constant. Métodos: Discussão sobre a tecnologia do OCT e interpretação de imagens de pacientes glaucomatosos e normais. Resultados: Demonstrar o uso do OCT, um método qualitativo e quantitativo de estudo da camada de fibras nervosas, no diagnóstico de glaucoma. Conclusão: OCT é uma tecnologia com potencial para auxiliar no diagnóstico e tratamento do glaucoma.

Aspectos tomográficos na celulite orbitária / Orbital cellulitis - CT aspects

Objetivo: Avaliar e correlacionar os achados clinico-radiológicos da celulite orbitária. Local: Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, e Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Método: Análise retrospectiva de 166 pacientes com lesöes excpansivas da órbita examinadas com o tomógrafo SOMATON DR da marca SIEMENS de terceira geraçäo. Resultados: Os principais achados encontrados foram aumento de tecidos moles e proptose. Outros achados foram velamento do seio paranasal, velamento da gordura retrobulbar, comprometimento muscular, gás e comprometimento da lândula lacrimal. Ptose palpebral, lacrimejamento, fotofobia, cefaléia, febre, náuseas, vômitos, edema de pálpebra e hiperemia conjuntival foram os achados clínicos que corroboraram para o diagnóstico. Conclusäo: O desenvolvimento da tomografia computadorizada foi decisivo no estudo da órbita pois propicia, através de um exame radiológico altamente especializado, imagens de incrível fidelidade anatômica revelando informaçöes sobre o processo patológico como sua localizaçäo, sua relaçäo com as estruturas adjacentes e sua vascularizaçäo.