Accuracy of partial coherence interferometry in patients with large inter-eye axial length difference.

BACKGROUND: To determine accuracy of partial coherence interferometry (PCI) in patients with large inter-eye axial eye length (AEL) difference. METHODS: Patients undergoing cataract surgery at two academic medical centers with an inter-eye axial eye length (AEL) difference of > 0.30 mm were identified and were matched to control patients without inter-eye AEL difference > 0.30 mm on the basis of age, sex, and AEL. The expected post-operative refraction for the implanted IOL was calculated using SRK/T, Holladay II, and Hoffer Q formulae. The main outcome measures were the refractive prediction error and the equivalence of the refractive outcomes between the subjects and controls. RESULTS: Review of 2212 eyes from 1617 patients found 131 eyes of 93 patients which met inclusion criteria. These were matched to 131 control eyes of 115 patients. The mean AEL was 24.92 ± 1.50 mm. The mean absolute error (MAE) ranged from 0.47 D to 0.69 D, and was not statistically different between subjects and controls. The refractive prediction error was equivalent between the cases and controls, with no significant difference between the MAE for any formula, nor in the number of cases vs. controls with a refractive prediction error of at least 0.50 D or 1.00 D. CONCLUSIONS: Among eyes in our study population, good-quality PCI data was equally accurate in patients with or without an inter-eye AEL difference > 0.30 mm. Confirmatory AEL measurements using different AEL measuring modalities in patients with a large inter-eye AEL difference may not be necessary.

Cataract surgery in Kinshasa-Is there a place for "Monovision"?

OBJECTIVES: Monovision is a method of correcting presbyopia where one eye is focused for far and the other for near vision. It is a simple, cost-effective approach to overcome the loss of accommodation with age and to become spectacles independent. METHODOLOGY: About 50 patients, where bilateral cataract extraction was indicated, were included in this study performed at the St. Joseph's Eye Hospital in Kinshasa (DR Congo). Small incision cataract surgery technique (SICS) was applied with the implantation of 6 mm PMMA lenses in the capsular bag. IOL refractive power choice was made to achieve a post-operative refraction of -0.5 dpt for the eye selected for far vision. The second eye received an implant heading for a post-operative myopia of -1.5 dpt suitable for intermediated and near vision. According to the literature, monovision criteria have been regarded as fulfilled when (a) far vision was 0.5 (logMAR) or better and (b) near vision was P3 (0.40, Decimal 32 cm) or better. Spectacle dependence after bilateral cataract surgery heading for monovision was analysed using a dedicated questionnaire. RESULTS: Out of all 50 patients 22 (44%) fulfilled the above defined criteria of monovision in terms of post-operative refraction and visual acuity. About 19 out of these 22 (86.3%) patients were happy without glasses. Two of them used bifocal spectacles, whereas the remaining patient refused spectacles. About 28 patients did not fulfill monovision criteria. Out of these 28 patients, however, 9 (32.1%) of them are happy without glasses. CONCLUSION: In view of the described local circumstances aiming for monovision after bilateral cataract surgery is a suitable approach to optimise cataract surgical outcomes with no extra costs for surgery but considerable improvement of patient's visual performance in daily life.

Evaluation of the optical performance for aspheric intraocular lenses in relation with tilt and decenter errors.

PURPOSE: To evaluate and compare the effect of misalignment and tilt on the optical performance of different aspheric intraocular lens (IOL) designs. METHODS: Three aspheric IOLs with a different quantity of spherical aberration (SA) have been designed and the effect of IOL misalignment and tilt on the imaging quality of an eye model has been numerically assessed using a commercial optical design software. The prototypes have been manufactured by lathe turning and tested in vitro using the same optical bench (PMTF, Lambda-X) that complies with International Organization for Standardization standard 11979-2 requirements. Image quality was evaluated from the modulation transfer functions (MTFs), through-focus modulation transfer functions (TF-MTFs), root mean square (RMS) values of defocus, astigmatism and coma, and images of the United States Air Force (USAF) target were taken. A comparison with the optical performance of spherical IOLs has also been performed. RESULTS: Intraocular lens misalignment and tilt increased wavefront aberrations; the effect of misalignment on root mean square (RMS) astigmatism and coma was positively correlated with the spherical aberration of the IOL. Aberration-free IOLs showed the highest MTF for all misalignment values and for IOLs with negative SA correction the MTF decays below 0.43 when they are decentered 0.50 mm. CONCLUSIONS: Aspherical IOLs are more sensitive than spherical IOLs to misalignment or tilt, depending on their SA correction. The optical degradation caused by IOL misalignment had a greater effect on IOL designs with a higher amount of negative spherical aberration. In contrast, the effect of tilt on the optical performance was less sensitive to the IOL design.

Which intraocular lens would ophthalmologists choose for themselves?

PURPOSE: Contemporary cataract surgery is increasingly customizable with the advent of presbyopia-correcting intraocular lenses (IOLs) and the femtosecond laser. The purpose of this study was to determine the types of IOLs ophthalmologists choose for themselves and whether demographic characteristics, surgical experience, and attitudes of ophthalmologists might influence their decision-making. Additional goals included evaluating the use of femtosecond laser use in cataract surgery and investigating surgeon IOL preferences for their patients. METHODS: We distributed a 29-question Survey Monkey survey to senior ophthalmology residents and practicing ophthalmologists and received 347 responses during a 1-month period. We analyzed 328 surveys using chi-square tests and Fisher's exact tests. RESULTS: Main outcome measures included surgeons' personal preferences for choice of IOL, femtosecond laser-assisted cataract surgery, and IOL preference for patients. In the setting of no astigmatism, 61.3% of respondents would choose a monofocal IOL set for either distance or monovision for their own surgery. For corneal astigmatism >1.25 D, 60.3% of respondents would choose a toric monofocal lens and only 6.9% would want a femtosecond laser or manual LRI for their own surgery. Of the respondents, 34.6% perform femtosecond laser-assisted cataract surgery, but only 15.3% would want femtosecond cataract surgery performed on themselves. Also, 67.7% implant presbyopia-correcting IOLs (diffractive echelette, multifocal, or accommodative). When correcting for patients' corneal astigmatism >1.25 D, 65.7% of respondents preferred a toric monofocal IOL. CONCLUSION: Ophthalmologists value quality of vision and are risk averse. Overall, a surgeons' personal preference for their own surgery is correlated with past surgical experience with patients.

The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis.

OBJECTIVE: This meta-analysis aims to evaluate the incidence of secondary glaucoma in patients under the age of 2 years who underwent congenital cataract surgery with or without primary intraocular lens (IOL) implantation. METHODS: An electronic literature search was performed in Medline, EMBASE, and Web of Science databases to retrieve studies between January 2011 and November 2018. Patients with congenital cataract who did primary IOL implantation, aphakia, or secondary IOL implantation followed by receiving extraction surgery were included in this study. Relevant studies meeting defined eligibility criteria were selected and reviewed systematically by meta-analysis. Long-term incidences of secondary glaucoma, which developed at least one year after cataract surgery, were considered and discussed as clinical outcomes in each cohort. The pooled data were analyzed according to a random effects model. RESULTS: Eight publications involving 892 eyes were included in the current meta-analysis. In the general population of eyes with congenital cataract, the long-term incidence of secondary glaucoma was lower (P = 0.06) in eyes with primary IOL (9.5%) than in eyes without primary IOL (15.1%), including aphakia and secondary IOL. The pooled risk ratio (RR) favors primary IOL implantation in all patients (RR = 0.63). For bilateral congenital cataract, the incidence was 6.7% in eyes with primary IOL implantation, which is significantly lower than the 16.7% in eyes with aphakia and secondary IOL implantation (P<0.05, RR = 0.44). However, for unilateral congenital cataract surgery, the incidence was very similar in eyes with and without primary IOL (12.4% vs 12.0%, P = 0.61, RR = 0.87). CONCLUSIONS: In patients under 2 years of age, primary IOL implantation for bilateral congenital cataract surgery is associated with a lower risk of secondary glaucoma.

Population-based Incidence of Intraocular Lens Exchange in Olmsted County, Minnesota.

PURPOSE: To determine the population-based incidence of pseudophakic intraocular lens exchange in Olmsted County, Minnesota. DESIGN: Retrospective review of a population-based cohort. METHODS: Patients undergoing pseudophakic intraocular lens exchange in Olmsted County, Minnesota, between January 1, 1986 and December 31, 2016 were identified from the Rochester Epidemiology Project medical record linkage system. Indications and outcomes were determined, and the incidence rate was calculated as cases per 1 000 000 person-years. Poisson regression analysis was used to assess changes in incidence over time, and the cumulative probability of needing a lens exchange was estimated by Kaplan-Meier analysis. RESULTS: Eighty cases of intraocular lens exchange were identified, yielding an overall age- and sex-adjusted incidence rate of 28.4 per million (confidence interval [CI], 22.1-34.7), which increased over the study period (P = .04). The 30-year cumulative probability of intraocular lens exchange among patients undergoing cataract surgery was 1.5% (CI, 0.6%-2.4%), increasing at a relatively constant rate. Dislocated lenses accounted for 72.5% of lens exchanges. Unplanned refractive outcome of primary cataract surgery and uveitis-glaucoma-hyphema syndrome from squared-edged haptics emerged as newer indications for intraocular lens exchange. CONCLUSIONS: The population-based incidence of pseudophakic intraocular lens exchange has increased over the last 30 years, and can be explained by the increase in incidence rate of cataract surgery over the same period. Surgeons should be aware of emerging indications of intraocular lens exchange, which reflect changes in lens design and increasing expectations of refractive outcomes.

How close are we? An audit of biometry of a tertiary care hospital in Karachi.

OBJECTIVE: To evaluate the accuracy of biometry in the post-op phase of cataract surgery. METHODS: This study was conducted at Liaquat National Hospital, Karachi, from June 2015 to July 2016, and comprised the audit of patients who underwent cataract surgery during the period. Keratometry was done on Haag-Strait manual keratometer and A-scan was done by applanation contact method on SonoMed machine. Theoretic-T formula was used to calculate desired intraocular lens power for all kinds of axial lengths. A single surgeon operated upon the same Alcon Constellation phacoemulsification machine. Postoperative follow-up was done by monitoring auto refraction and visual acuity on days 1, 7, 30 and 90. SPSS 21 was used for data analysis.. RESULTS: Of 244 patients, 121(49.60%) were males and 123(50.40%) were females. There were 123(50.40%) right eyes and 121(49.60%) left eyes. Overall, 132(54.10%) achieved postoperative refraction within ±0.5 D of target and 193(79.10%) within ±1 D of target. Age, gender and laterality had no significant effect on outcomes (p>0.05 each). CONCLUSIONS: Postoperative refraction corresponded quite closely with global recommendations.

Catarata posuveítis: algunas consideraciones / Some considerations about cataract after uveitis

La catarata constituye una causa frecuente y obligada de consulta en los pacientes con enfermedades inflamatorias por la mala visión que produce y para la evaluación del tratamiento quirúrgico. En estos pacientes la cirugía es más complicada. Realizamos una revisión actualizada del tema en los últimos diez años. Se plantean algunas consideraciones sobre los protocolos de tratamiento pre, trans y posquirúrgicos para la cirugía de la catarata, las dificultades y los elementos a tener en cuenta para el mejor tratamiento e implante de lente intraocular. Las opciones de tratamiento, el control pre y posquirúrgico, así como de evitar las complicaciones transquirúrgicas, son fundamentales para el mejor pronóstico de pacientes con uveítis. Nos propusimos realizar una revisión del tema en la literatura publicada en los últimos diez años, así como exponer nuestras experiencias y los elementos a tener en cuenta para el mejor resultado de la cirugía de catarata(AU)

Cataract represents a common cause of medical consultation in patients with inflammatory illnesses because of the visual problems it brings about and the evaluation of the surgical treatment. Surgery is more complicated to be performed in these patients. A literature review on this topic in the last ten years was made. Some considerations were put forward about the treatment protocols before, during and after cataract surgery, the difficulties and elements to be taken into account for best treatment and implantation of the intraocular lens. The treatment choices, the preoperative and postoperative control as well as the prevention of transoperative complications are fundamental for better prognosis of patients with uveitis. We intended to make a literature review on this topic using the articles published in the last ten years as well as to present our experiences and the elements to take into account to achieve best results in the cataract surgery(AU)

[Explantation of Multifocal Intraoular Lenses - Frequency, Causes and Course]. / Häufigkeit, Ursachen und Verlauf von Explantationen multifokaler Intraokularlinsen.

PURPOSE: Multifocal intraocular lenses (MF-IOL) are implanted for visual rehabilitation after cataract operation and refractive lens exchange (RLE). In this retrospective study, the frequency, causes and course of MF-IOL explantation are investigated. SETTING: Private eye clinic, Cologne, Germany. METHODS: Between 2009 and 2014, a total of 1438 eyes were supplied with a hydrophobic, aspherical, diffractive, multifocal posterior chamber lens (PCL) of type: Acrysof ReSTOR and ReSTOR toric, with near additions of + 2.5, + 3.0 and + 4.0 (Alcon, Fort Worth, USA). 78 % (n = 1116 eyes) were indicated because of a cataract and 22 % (n = 322 eyes) as RLE. All procedures were either performed by OK or GG, as ultrasound phacoemulsification under topical anaesthesia. Since 2013, a femtosecond laser (LensX, Alcon, Fort Worth the USA) has been used in some cases. Data analysis was performed with the help of the digital patient's recordings. RESULTS: In a total of 12 cases, the MF-IOL needed to be explanted. Causes for the explantation were strong deviations from the expected target refraction (4 eyes), epiretinal gliosis accompanied by surgically membrane peeling (2 eyes), optical discomfort (waxy vision, 4 eyes), unstable toric lens due to a vast zonulolysis (1 eye), and 5 years post-implantation glistening (1 eye). The overall frequency of MF-IOL explantationen was 0.83 %. The frequency of explantations due to specific optical side effects and discomfort was 0.28 %. In all cases, 12 months post MF-IOL explantation recovery was achieved to full visual acuity. CONCLUSIONS: Diffractive MF-IOL of the type Alcon Acrysof ReSTOR are generall very well accepted. In only 0.28 % of all cases, was an explantation performed on grounds of optical discomfort. In the other cases, the causes for explantation were not related to the optical geometry of the MF-IOL.

Wrong intraocular lens events-what lessons have we learned? A review of incidents reported to the National Reporting and Learning System: 2010-2014 versus 2003-2010.

PurposeTo identify the causal factors in wrong intraocular lens (IOL) events from a national data set and to compare with similar historical data (2003-2010) prior to mandatory checklist use, for the purpose of developing strategies to prevent never events.MethodsData from wrong IOL patient safety incidents (PSIs) submitted to the National Reporting and Learning System (2010-2014) were reviewed by thematic analysis and compared with the data previously collected by the group using the same methodology.ResultsOne hundred and seventy eight wrong IOL PSIs were identified. The contributory factors included: transcription errors (n=26); wrong patient biometry (n=21); wrong IOL selection (n=16); changes in planned procedure (n=16); incorrect IOL brought into theatre (n=11); left/right eye selection errors (n=9); communication errors (n=9); and positive/negative IOL power errors (n=9). In 44 PSIs, no causal factor was reported, limiting the learning value of such reports. Compared with the data from previous years, biometry errors were much reduced but IOL transcription and documentation errors were greater, particularly if further checks did not refer to the original source documentation. IOL exchange surgery was reported in 45 cases.ConclusionsThe selection and implantation of the correct IOL is a complex process which is not adequately addressed by existing checking procedures. Despite the introduction of surgical checklists, wrong IOL incidents continue to occur and are probably under-reported. Human or behavioural factors are heavily implicated in these errors and need to be addressed by novel approaches, including simulation training. There is also scope to further improve the quality and detail of incident reporting and analysis to enhance patient safety.

Principios para el cálculo de la lente intraocular tras cirugía refractiva corneal / Principles for the intraocular lens power calculation after corneal refractive surgery

Se estima que aproximadamente un millón o más de pacientes se realizan cirugía refractiva al año. Es por eso que con el envejecimiento son cada día más frecuentes los pacientes con catarata, a quienes previamente se les ha efectuado cirugía refractiva. El cálculo inexacto de la potencia dióptrica de la lente a implantar en la intervención de estos es también un problema de importancia creciente y con él la sorpresa refractiva. Este es mucho más complejo de lo normal, ya que existen dos fuentes de error: la incorrecta predicción de la posición efectiva de la lente por parte de la fórmula y la determinación errónea de la potencia de la córnea por parte de la queratometría. La corrección de estos dos factores permitirá realizar un cálculo correcto en estos ojos. De ahí la motivación para realizar una búsqueda actualizadas de los últimos diez años de diversos artículos publicados, con el objetivo de describir los principios para el cálculo de la lente intraocular tras cirugía refractiva corneal. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores(AU)

It is considered that approximately one million or more patients undergo refractive surgery every year. Due to aging, the number of patients with cataract, who had previously undergone refractive surgery, is increasingly higher. The inaccurate calculation of the dioptric power of the lens to be implanted is also a growing significant problem and thus the refractive surprise. This is a much more complex situation since two error sources exist: the incorrect prediction of the effective position of the lens based on the formula and the wrong determination of the corneal power through keratometry. The correction of these two factors will allow making a suitable power calculation. Hence the motivation for updated search of several articles published in the last ten years, with the objective of describing the principles for intraocular lens power calculation after corneal refractive surgery. The Infomed platform, mainly the Virtual Library of Health, was fully used(AU)

[Intraocular Lens Opacification Following Posterior Lamellar Keratoplasty]. / Kunstlinsentrübungen nach hinterer lamellärer Keratoplastik.

BACKGROUND: The opacification of an artificial intraocular lens is a rare but serious complication following cataract surgery as an exchange of the intraocular lens can become necessary. At our eye center we observed single cases of IOL opacifications following complicated posterior lamellar keratoplasty (Descemet stripping automated endothelial keratoplasty = DSAEK or Descemet membrane endothelial keratoplasty = DMEK). Therefore, we performed a retrospective analysis of all our digital charts regarding the incidence of this serious complication with respect to posterior lamellar keratoplasty, penetrating keratoplasty or sole cataract extraction. METHODS: We searched our digital patient database from 2003 to 2015 using the following headings: intraocular lens, artificial lens or IOL and opacification or calcification and selected only those patients who had undergone either DSAEK, DMEK, penetrating keratoplasty or sole cataract surgery (n = 19,565). RESULTS: In total we found five IOL opacifications out of 153 DSAEK and two out of 450 DMEK cases, respectively. Five of these seven cases had a complicated clinical course with repeated rebubbling or additional intraocular surgery (i.e., repeat DSAEK or DMEK or secondary penetrating keratoplasty). There were no documented IOL opacifications following penetrating keratoplasty or sole cataract extraction. In two cases intraocular lens exchange became necessary. All opacifications showed similar clinical appearance in form of small granular deposits on the surface of the intraocular lens. Almost all implanted lenses were made from hydrophilic acrylate. DISCUSSION: In total we found seven cases of intraocular lens opacification that have only been observed following DSAEK or DMEK. According to reports from the literature these opacifications are superficial calicifications of the hydrophilic lenses. As five of the seven cases had a complicated clinical course, the repeated air contact of the lens could be one major factor in inducing the calcification. Besides the air contact a breakdown of the blood-aqueous barrier could also play a role in the induction of calcium phosphate crystallisation on the intraocular lens. The risk of this serious complication in mainly hydrophilic intraocular lenses with respect to posterior lamellar keratoplasty should be kept in mind for the selection of the type of intraocular lens in patients with endothelial diseases or in patients undergoing combined cataract extraction and DSAEK/DMEK.

Comparison of Accuracy in Intraocular Lens Power Calculation by Measuring Axial Length with Immersion Ultrasound Biometry and Partial Coherence Interferometry.

OBJECTIVE: To re-examine relative accuracy of intraocular lens (IOL) power calculation of immersion ultrasound biometry (IUB) and partial coherence interferometry (PCI) based on a new approach that limits its interest on the cases in which the IUB's IOL and PCI's IOL assignments disagree. MATERIAL AND METHOD: Prospective observational study of 108 eyes that underwent cataract surgeries at Taksin Hospital. Two halves ofthe randomly chosen sample eyes were implanted with the IUB- and PCI-assigned lens. Postoperative refractive errors were measured in the fifth week. More accurate calculation was based on significantly smaller mean absolute errors (MAEs) and root mean squared errors (RMSEs) away from emmetropia. The distributions of the errors were examined to ensure that the higher accuracy was significant clinically as well. RESULTS: The (MAEs, RMSEs) were smaller for PCI of (0.5106 diopter (D), 0.6037D) than for IUB of (0.7000D, 0.8062D). The higher accuracy was principally contributedfrom negative errors, i.e., myopia. The MAEs and RMSEs for (IUB, PCI)'s negative errors were (0.7955D, 0.5185D) and (0.8562D, 0.5853D). Their differences were significant. The 72.34% of PCI errors fell within a clinically accepted range of ± 0.50D, whereas 50% of IUB errors did. CONCLUSION: PCI's higher accuracy was significant statistically and clinically, meaning that lens implantation based on PCI's assignments could improve postoperative outcomes over those based on IUB's assignments.

Efectividad de la biometría de inmersión para el cálculo del poder dióptrico de la lente intraocular / Effectiveness of immersion biometry for the calculation of intraocular lens dioptric power

Objetivo: determinar la efectividad de la biometría de inmersión para el cálculo del lente intraocular. Métodos: se realizó un estudio observacional descriptivo, prospectivo. El universo estuvo constituido por los pacientes operados de catarata en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre enero y septiembre de 2011. La muestra estuvo conformada por 39 ojos de 34 pacientes que cumplieron con los criterios de inclusión establecidos para la investigación y fueron operados por la técnica de facoemulsificación con previo cálculo del lente intraocular por biometría de inmersión e interferometría de coherencia óptica. Resultados: el promedio de edad fue de 72,33 años, con un predominio del sexo femenino. La diferencia de longitud axial promedio entre los pacientes calculados por inmersión y los de IOL Máster fue de 0,09 mm, mientras que la diferencia de profundidad de la cámara anterior fue de 0,19 mm. Se obtuvo una diferencia de 0,13 D y no existió diferencia significativa en cuanto al cálculo del poder del lente intraocular entre ambos métodos.Conclusiones: los valores de longitud axial y de profundidad de cámara anterior obtenidos mediante biometría de inmersión pueden ser utilizados para calcular con efectividad el poder del lente intraocular de los pacientes que serán sometidos a cirugía de cataratas, lo que demuestra ser una alternativa en ausencia del IOL Máster(AU)

Objective: to characterize the functional capacity and the quality of life of the elderly people with macular degeneration and low vision who were seen at Ramon Pando Ferrer Cuban Institute of Ophthalmology from January to June 2013. Methods: Cross-sectional and descriptive study that included the following variables: age, sex, race, best corrected near visual acuity using Zeiss chart before and after visual rehabilitation, visual disability, functional capacity for daily life activities, clinical type of macular degeneration, risk factors for the disease, reason for visual rehabilitation and prescribed optical and non-optical aids. Results: the disease prevailed in females (55,2 percent), 75-79 years-old age group and Caucasians. Predominant visual disability was mild to moderate low vision; the mostly found functional capacity was independence with some limitations. Dry macular degeneration was present in 82,7 percent of cases; the most frequent risk factor was smoking (82,7 percent); reading and writing was the main motivation and a large number of patients improved their visual acuity after rehabilitation. The optical and non-optical aids that were mostly prescribed included microscopes and lighting. Conclusions: females, 75-79 years-old age group and Caucasians are the risk factors that cause the highest number of cases with macular degeneration and low vision. Visual disability prevailed among those classified as mild to moderate low vision patients. Dry macular degeneration was present in almost all the cases. The most frequent risk factors were smoking, heredity and cardiovascular diseases. Most of the patients improved their condition after visual rehabilitation(AU)

Efectividad de la biometría de inmersión para el cálculo del poder dióptrico de la lente intraocular / Effectiveness of immersion biometry for the calculation of intraocular lens dioptric power

OBJETIVO: determinar la efectividad de la biometría de inmersión para el cálculo del lente intraocular. MÉTODOS: se realizó un estudio observacional descriptivo, prospectivo. El universo estuvo constituido por los pacientes operados de catarata en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre enero y septiembre de 2011. La muestra estuvo conformada por 39 ojos de 34 pacientes que cumplieron con los criterios de inclusión establecidos para la investigación y fueron operados por la técnica de facoemulsificación con previo cálculo del lente intraocular por biometría de inmersión e interferometría de coherencia óptica. RESULTADOS: el promedio de edad fue de 72,33 años, con un predominio del sexo femenino. La diferencia de longitud axial promedio entre los pacientes calculados por inmersión y los de IOL Máster fue de 0,09 mm, mientras que la diferencia de profundidad de la cámara anterior fue de 0,19 mm. Se obtuvo una diferencia de 0,13 D y no existió diferencia significativa en cuanto al cálculo del poder del lente intraocular entre ambos métodos. CONCLUSIONES: los valores de longitud axial y de profundidad de cámara anterior obtenidos mediante biometría de inmersión pueden ser utilizados para calcular con efectividad el poder del lente intraocular de los pacientes que serán sometidos a cirugía de cataratas, lo que demuestra ser una alternativa en ausencia del IOL Máster.

OBJECTIVE: to characterize the functional capacity and the quality of life of the elderly people with macular degeneration and low vision who were seen at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology from January to June 2013. METHODS: Cross-sectional and descriptive study that included the following variables: age, sex, race, best corrected near visual acuity using Zeiss chart before and after visual rehabilitation, visual disability, functional capacity for daily life activities, clinical type of macular degeneration, risk factors for the disease, reason for visual rehabilitation and prescribed optical and non-optical aids. RESULTS: the disease prevailed in females (55,2 %), 75-79 years-old age group and Caucasians. Predominant visual disability was mild to moderate low vision; the mostly found functional capacity was independence with some limitations. Dry macular degeneration was present in 82,7 % of cases; the most frequent risk factor was smoking (82,7 %); reading and writing was the main motivation and a large number of patients improved their visual acuity after rehabilitation. The optical and non-optical aids that were mostly prescribed included microscopes and lighting. CONCLUSIONS: females, 75-79 years-old age group and Caucasians are the risk factors that cause the highest number of cases with macular degeneration and low vision. Visual disability prevailed among those classified as mild to moderate low vision patients. Dry macular degeneration .

Complexities and challenges of surgical data collection from cataract patients: comparison of cataract surgery rates between 2001 and 2008 in all provinces of Argentina.

PURPOSE: To compare the cataract surgical rate (CSR) in 2001 with that in 2008 in all Argentinean provinces using current reporting methods and verify the accuracy of CSRs by cross-checking these methods with the number of sold intraocular lenses (IOLs) within the country. METHODS: A longitudinal study including public and private set-ups was conducted, and it included 40 ophthalmologists from 22 provinces who provided cataract surgery data for 2001 and 2008. Other data were obtained from the Ministry of Health. Estimates were cross-checked against the market data for sold intraocular lens (IOLs) in 2008 and 2010. RESULTS: The number of cataract surgeries increased 2.7-fold, from 62,739 in 2001 to 169,762 in 2008, with increases in every province except Mendoza. Although the population also increased by 9.4% during the same time period, the apparent CSR jumped from 1,744 to 4,313 per million population. The number of IOLs sold in Argentina in 2008 was 186,652, suggesting that the number of cataract surgeries performed was slightly greater than anticipated. Cross-checks with other countries using IOL sales data did not show discrepancies when compared with previously reported CSRs. CONCLUSIONS: Although the CSR in Argentina increased considerably from 2001 to 2008 for several reasons, the main reason was that thorough cross-checking between the number of surgeries reported and the number of IOLs sold revealed that the number of surgeries performed annually were being underestimated as a result of incomplete reporting by private practitioners. Furthermore, the presence of multiple societies of ophthalmology in the country complicated the process of obtaining accurate data.

Factores de riesgo ocular y experiencia del cirujano en las complicaciones de la cirugía de catarata / Ocular risk factors and the surgeon's experience to manage complications in the cataract surgery

OBJETIVO: determinar influencia de factores de riesgo ocular y experiencia del cirujano en las complicaciones de 158 pacientes operados de catarata en el Centro Oftalmológico de Holguín entre abril y octubre de 2010. MÉTODOS: se realizó un estudio descriptivo de corte transversal donde se analizaron variables como edad, sexo, factores de riesgo ocular, complicaciones transoperatorias y posoperatorias inmediatas relacionadas con factores de riesgo y experiencia del cirujano. RESULTADOS: el grupo de edad que predominó fue el de 70-79 años con 38,6 % y el sexo femenino en 58,8 %. El factor de riesgo más frecuente fue la madurez e hipermadurez del cristalino en 51,2 %. La complicación transoperatoria que más incidió fue la ruptura de cápsula posterior con pérdida de vítreo en 8,2 % relacionada con madurez del cristalino y pupila pequeña. El edema corneal constituyó la complicación posoperatoria inmediata que predominó en 6,3 % relacionada fundamentalmente con pupila insuficiente y catarata madura. En la cirugía realizada por residentes predominaron las complicaciones en 15,8 %. CONCLUSIONES: la intervención de cataratas en etapas de madurez e hipermadurez asociada a pupilas insuficientes expuso a estos ojos a un riesgo mayor de ruptura de cápsula posterior con o sin pérdida de vítreo y al edema corneal. La cirugía de catarata en pacientes con factores de riesgo oculares fue más propensa a complicaciones cuando la realizaron residentes y oftalmólogos con menos entrenamiento y experiencia.

OBJECTIVE: to determine the influence of ocular risk factors and the surgeon's experience on complications affecting 158 patients operated on for cataract at the Ophthalmologic Center in Holguin from April to October, 2010. METHODS: cross-sectional descriptive study in which variables such as age, sex, ocular risk factors, immediate transoperative and postoperative complications related to risk factors and the surgeon's experience were analyzed.RESULTS: the 70-79 years-old group prevailed with 38,6 %, and the females accounted for 58,8 % in the group. The most frequent risk factors were the maturity and hypermaturity of the crystalline lens in 51,2 % of cases. The transoperative complication that mostly affected the patients was the rupture of the posterior capsule with vitreous loss in 8,2 % of cases, associated with maturity of the crystalline lens and the small pupil. The corneal edema represented the predominant immediate postoperative complication in 6,3 % of cases, due to insufficient pupil and mature cataract. The complications were more frequent in surgeries performed by residents in 15,8 % of patients. CONCLUSIONS: operating cataracts at maturity and hypermaturity stages due to insufficient pupils meant higher risk of the posterior capsule rupture with or without vitreous loss and of corneal edema. Cataract surgery in patients with ocular risk factors was proner to complications when they are performed by residents or by ophthalmologists with less training and experience in this field.