[Clear lens extraction: visual outcomes and vitreoretinopathy frequence]. / Extração do cristalino translúcido: resultados visuais e freqüência de vítreo-retinopatias.

PURPOSE: To evaluate visual results and vitreoretinopathy and retinal detachment frequencies in patients with and without prophylactic pre-equatorial retinal photocoagulation, who underwent clear lens extraction (CLE) to correct myopia. METHODS: Thirty-five patients (60 eyes) that underwent clear lens extraction at the "Fundação Altino Ventura" had median follow-up of 20.5 months. They were classified into 3 groups: Group I that was submitted to preoperative 360 degrees preequatorial retinal photocoagulation; Group II that was submitted to prophylactic photocoagulation around predisposing lesions; and Group III that was not submitted to preoperative retinal photocoagulation. The presence of corrected visual acuity (CVA), refractional spherical equivalent (RSE) and choroidal neovascularization (CNV), predisposing lesions and retinal detachment (RD) was evaluated. RESULTS: Median corrected visual acuity value rose from 0.2 in the preoperative period to 0.5 in the postoperative period and refractional spherical equivalent decreased from -17SD to -1.7SD. There was no retinal detachment, but vitreous retinal traction areas appeared in 4 eyes (2 submitted to 360 degrees laser and 2 not submitted to laser) and 1 case of choroidal neovascularization also occurred. CONCLUSIONS: Clear lens extraction was an effective and predictable surgery to reduce myopias and an apparently safe procedure in patients with and without prophylactic preequatorial retinal photocoagulation. A longer follow-up in a larger group may validate its safety as a refractive surgery.

Extração do cristalino translúcido: resultados visuais e freqüência de vítreo-retinopatias / Clear lens extraction: visual outcomes and vitreoretinopathy frequence

OBJETIVO: Avaliar os resultados visuais e a freqüência de vítreo-retinopatias e descolamento de retina em pacientes, com e sem fotocoagulação profilática pré-operatória da retina pré-equatorial, submetidos à extração de cristalino translúcido (ECT) para correção de miopia. MÉTODOS: Trinta e cinco pacientes (60 olhos) foram submetidos à extração de cristalino translúcido na Fundação Altino Ventura com tempo mediano de acompanhamento de 20,5 meses, sendo divididos em 3 grupos: Grupo I (22 olhos) submetidos à fotocoagulação da retina periférica 360° pré-operatória; Grupo II (8 olhos) submetidos à fotocoagulação pré-operatória circundando lesões predisponentes e Grupo III (30 olhos) não submetidos à fotocoagulação pré-operatória. Foram avaliados a acuidade visual corrigida (AVL c/c), o equivalente esférico refracional (EE) e a presença de membrana neovascular sub-retiniana (MNVSR), lesões predisponentes e descolamento de retina (DR) pré e pós-operatórios. RESULTADOS: O valor mediano da acuidade visual corrigida AVLc/c melhorou de 0,2 no pré-operatório para 0,5 no pós-operatório e o equivalente esférico refracional EE de -17DE para -1,7DE. Não houve casos de descolamento de retina, mas surgiram áreas de tração vítreo-retiniana em 4 olhos (2 submetidos ao laser 360° e 2 olhos não submetidos ao laser) e 1 caso de membrana neovascular sub-retiniana. CONCLUSÃO: A extração de cristalino translúcido mostrou-se cirurgia eficaz e previsível nas reduções de altas miopias e, ainda, procedimento aparentemente seguro em pacientes com e sem fotocoagulação profilática da retina pré-equatorial. Tempo de acompanhamento maior dos pacientes e o aumento da amostra estudada podem ratificar sua segurança como procedimento refrativo.

PURPOSE: To evaluate visual results and vitreoretinopathy and retinal detachment frequencies in patients with and without prophylactic pre-equatorial retinal photocoagulation, who underwent clear lens extraction (CLE) to correct myopia. METHODS: Thirty-five patients (60 eyes) that underwent clear lens extraction at the "Fundação Altino Ventura" had median follow-up of 20.5 months. They were classified into 3 groups: Group I that was submitted to preoperative 360° preequatorial retinal photocoagulation; Group II that was submitted to prophylactic photocoagulation around predisposing lesions; and Group III that was not submitted to preoperative retinal photocoagulation. The presence of corrected visual acuity (CVA), refractional spherical equivalent (RSE) and choroidal neovascularization (CNV), predisposing lesions and retinal detachment (RD) was evaluated. RESULTS: Median corrected visual acuity value rose from 0.2 in the preoperative period to 0.5 in the postoperative period and refractional spherical equivalent decreased from -17SD to -1.7SD. There was no retinal detachment, but vitreous retinal traction areas appeared in 4 eyes (2 submitted to 360° laser and 2 not submitted to laser) and 1 case of choroidal neovascularization also occurred. CONCLUSIONS: Clear lens extraction was an effective and predictable surgery to reduce myopias and an apparently safe procedure in patients with and without prophylactic preequatorial retinal photocoagulation. A longer follow-up in a larger group may validate its safety as a refractive surgery.

Indocyanine green mediated photothrombosis for the management of predominantly classic choroidal neovascularisation caused by age related macular degeneration.

AIMS: To study the effectiveness of indocyanine green mediated photothrombosis in the management of predominantly classic subfoveal choroidal neovascularisation associated with age related macular degeneration. METHODS: Prospective, non-comparative, interventional case series of nine patients with predominantly classic subfoveal choroidal neovascularisation secondary to age related macular degeneration who declined photocoagulation or verteporfin photodynamic therapy. Patients were submitted to one or more treatments with an intravenous injection of a small volume of high concentration indocyanine green solution followed by low irradiance, large spot 810 nm continuous laser application via a transpupillary approach. Main outcome measures were change in best corrected visual acuity and macular exudative manifestations. RESULTS: After 12 months of follow up, the final best corrected visual acuity was the same (plus or minus two ETDRS lines) in five eyes (55%), improved more than two ETDRS lines in three eyes (33%), and worsened by more than two lines in the remaining eye. The improved vision was probably related to partial or complete restoration of the macular architecture as a result of fluid resolution, whereas the worsened vision was primarily the result of treatment failure in achieving substantial choroidal neovascular occlusion. There were no complications related to the procedure. CONCLUSION: Indocyanine green mediated photothrombosis may be an effective alternative treatment for predominantly classic subfoveal choroidal neovascularisation caused by age related macular degeneration.

Choroidal neovascularization following laser in situ keratomileusis.

Two cases of choroidal neovascularization occurring after laser in situ keratomileusis (LASIK) are presented from two separate centers. In the first case, an extrafoveal choroidal neovascular membrane, apparently associated with age-related macular degeneration, occurred 3 months after a LASIK procedure was performed on a 64-year-old man with hyperopia. Argon laser treatment and subsequent photodynamic therapy were performed and resulted in stabilization of vision. The second case involved neovascularization 3 weeks following a LASIK procedure for myopia, apparently associated with the myopia. No treatment was recommended and the vision stabilized at 20/50. Although the cause is not clear, careful preoperative macular evaluation and attention to symptoms that might herald the presence of choroidal neovascularization are recommended for patients undergoing LASIK.

Enlarged diode laser spot using indirect ophthalmoscope delivery in conjunction with indocyanine green to treat large choroidal neovascularizations.

BACKGROUND AND OBJECTIVE: To evaluate the effectiveness of a new method of delivering diode laser (810 nm) spots through an indirect ophthalmoscope in conjunction with intravenous indocyanine green to treat choroidal neovascularizations (CNVs) larger than 5,400 microm. PATIENTS AND METHODS: A prospective, non-comparative, interventional case series study was conducted with 8 patients with CNV secondary to age-related macular degeneration. Laser pulses were applied to the CNV within 5 minutes of an intravenous injection of 25 mg of indocyanine green. The laser spot was enlarged up to one disc diameter by shortening the distance between the indirect ophthalmoscope and the 20-diopter viewing lens. The follow-up period was 3 months. RESULTS: Three eyes had an improvement in visual acuity of more than 2 lines, and fluorescein angiography showed stabilization of the membrane and reduction of the hemorrhages and subretinal fluid at the last follow-up. Three other eyes maintained the same visual acuity and two had a decrease in visual acuity of more than 2 lines at the 3-month follow-up examination. CONCLUSION: Laser treatment delivered through an indirect ophthalmoscope system may be used as a palliative treatment for CNVs larger than 5,400 microm.

Diode laser modifications for treatment of choroidal neovascularisation.

The aim of this paper is to describe various diode laser modifications and their use in treating choroidal neovascularisation in age-related macular degeneration. Diode lasers are used to treat selected choroidal neovascular membranes. Alterations in microprocessor connectivity, and parameters such as maximum spot size, light delivery time and coupled Joule meter, were made so that ophthalmic surgeons could specify treatment possibilities. A trimodal (photocoagulation, transpupillary thermotherapy and photodynamic therapy) application laser device coupled to a single light source has been developed. The new diode laser modifications were technically successful. Microprocessor connectivity was obtained, larger spot sizes were achieved, light delivery time could be extended and energy parameters were available at the display.

Fotocoagulaçäo de membrana neovascular coroideana no feixe inter papilo-macular / Photocoagulation of choroidal neovascular membrane in the papilo-macular bundle

Apresentamos uma paciente com estrias angióides senis, com cicatriz disciforme em OD, apresentando neovascularizaçäo sub-retiniana extensa no feixe inter papilo-macular, com borda desta a 300 mm da fovéola. A fotocoagulaçäo com laser de argônio verde resultou em completa resoluçäo da membrana, com pouco repercussäo na campimetria computadorizada macular, estando a paciente com AV de 20/40.