Evaluation of balance and fear of falling in elderly individuals before and after senile cataract surgery / Avaliação do equilíbrio e do medo de quedas em homens e mulheres idosos antes e após a cirurgia de catarata senil

Abstract Introduction: During aging there is a close relationship between visual deficits, imbalance and falls, and eye surgery can be an efficient treatment option for elderly persons. Objective: Evaluate the influence of visual conditions on patients suffering from senile cataract with increasing imbalance. Method: A descriptive and analytical study using a quantitative longitudinal cohort technique was conducted. The study included 30 individuals who were evaluated before and 30 and 60 days after surgery. The Mini Mental State Examination (MMSE), Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), International Falls Efficacy Scale adapted for Brazil (FES-I) and a medical history questionnaire were used to collect data. Statistical analysis involved the Chi-squared, Student's t and Mann-Whitney tests. Values of p<0.05 were considered significant. Results: The SPPB found that of 15 elderly women, 13 (87%) achieved moderate performance of the lower limbs while the performance of two (13%) remained poor, after 60 postoperative days. The FES-I revealed that three (20%) elderly persons were mildly worried about falls 60 days post-surgery. Of the 15 elderly male subjects evaluated by BBS, before and at 30 and 60 days after surgery, one (7%), managed to maintain some balance but needed assistance; while 14 (93%) maintained good balance. The SPPB found that the performance of five elderly persons (33%) was moderate and that of nine (67%) was good. Conclusion: Senile cataract surgery had positive preventative effects on lower limb performance, balance and fear of falling among the elderly studied, preventing the falls and fractures that are common during aging.

Resumo Introdução: Com o envelhecimento, existe uma relação estreita entre deficit visuais, desequilíbrios e quedas, sendo a cirurgia ocular uma alternativa eficiente para idosos. Objetivo: Avaliar a influência das condições visuais em pacientes com catarata senil em relação aos desequilíbrios corporais. Método: Estudo descritivo e analítico realizado por meio de pesquisa quantitativa de coorte longitudinal. Participaram do estudo 30 idosos, 15 homens e 15 mulheres, os quais foram avaliados antes da cirurgia de catarata, 30 e 60 dias após a intervenção. Utilizou-se para a coleta de dados, o Miniexame do Estado Mental (MEEM), a Escala de Equilíbrio de Berg (EEB), o Short Physical Performance Battery (SPPB), a Escala Internacional de Eficácia de Quedas adaptada ao Brasil (FES-I-Brasil) e questionário de anamnese. A análise estatística empregou o teste Qui-quadrado, teste t Student e teste Mann-Whitney. Foram considerados significantes valores de p<0,05. Resultados: Das 15 idosas, pelo SPPB, em 60 dias de pós-operatório, 13 (87%) conseguiram desempenho moderado e duas (13%) mantiveram baixo desempenho de membros inferiores (MMII). Pelo teste FES-I-Brasil, em 60 dias pós-cirúrgico, três (20%) idosas mantiveram leve preocupação com as quedas. Dos 15 idosos avaliados pela EEB, antes e após 30 e 60 dias de cirurgia, um (7%) conseguiu manter algum equilíbrio, mas necessitando assistência; e 14 (93%) idosos mantiveram bom equilíbrio. Pelo teste SPPB, após 60 dias de cirurgia, cinco idosos (33%) tiveram desempenho moderado e nove (67%) obtiveram bom resultado. Conclusão: A cirurgia de catarata senil possibilitou melhora no desempenho funcional de MMII, no equilíbrio e medo de quedas nos idosos investigados prevenindo caimentos e fraturas, comuns no envelhecimento.

Ceratoplastia lamelar anterior profunda pela técnica da "big-bubble" / Deep anterior lamellar keratoplasty by big-bubble technique

OBJETIVO: Avaliar a eficácia, segurança e as complicações da técnica de ceratoplastia lamelar anterior profunda (CLAP) realizada através da técnica da "big-bubble". MÉTODOS: Foram avaliados prospectivamente pacientes submetidos à CLAP pela técnica da "big-bubble". Após o procedimento cirúrgico, foi avaliada a acuidade visual sem correção (AVSC), acuidade visual com correção (AVCC), equivalente esférico (EE), topografia corneana, contagem endotelial (CE) e as complicações intra e pós-operatórias. RESULTADOS: Foram avaliados 59 olhos de 55 pacientes. A média de seguimento foi de 16 ± 7,4 meses. A AVSC e AVCC média (logMAR) pré-operatória eram de 1,60 ± 0,33 e 1,00 ± 0,43, respectivamente. Após 12 meses da cirurgia, a AVSC e AVCC média melhoraram para 0,86 ± 0,39 e 0,17 ± 0,14, respectivamente. O EE médio melhorou de -8,21 ± 3,91 para -1,82 ± 3,62 e o astigmatismo topográfico também apresentou melhora de -7,9 ± 3,7 para -2,21 ± 1,7 ao final de 12 meses de seguimento. A média pré-operatória da CE era de 2.377,98 ± 263,56 céls/mm², após 12 meses da cirurgia a média da CE reduziu para 1.851,32 ± 397,61 céls/mm². A presença de microperfurações ocorreu em 6 casos (10,2 por cento). Em apenas um paciente foi observado à ocorrência de rejeição estromal e em um caso a presença de midríase paralítica (Urrets-Zavalia) após a cirurgia lamelar. CONCLUSÃO: Apesar de tecnicamente mais complexa a cirurgia de CLAP apresenta-se como uma excelente opção de tratamento para pacientes com alterações corneanas que apresentam seu endotélio normal. ClinicalTrials.gov Identifier: NCT00887900.

PURPOSE: To evaluate the efficacy, safety, and complications related to the deep anterior lamellar keratoplasty (DALK) using the big-bubble technique. METHODS: A prospective study of patients submitted to DALK using the big-bubble technique was conducted. After the procedure, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), corneal topography, endothelial cell density, and intraoperative and postoperative complications were evaluated. RESULTS: Fifty-nine eyes of 55 patients were included in this study. Mean follow-up period was 16 ± 7.4 months. Baseline mean UCVA (logMAR) and BCVA was 1.60 ± 0.33 and 1.00 ± 0.43, respectively. After 12 months, the mean UCVA and BCVA improved to 0.86 ± 0.39 and 0.17 ± 0.14, respectively. Mean SE improved from -8.21 ± 3.91 to -1.82 ± 3.62 at 12 months. Mean topographic astigmatism improved from -7.9 ± 3.7 to -2.21 ± 1.7 at 12 months. Mean preoperative endothelial cell density was 2,377.98 ± 263.56 cells/mm², after 12 months of surgery the mean endothelial cell density reduced to 1,851.32 ± 397.61 cells/mm². Intraoperative microperfuration occurred in 6 cases (10.2 percent). One patient developed stromal rejection, and one patient developed fixed dilated pupil (Urrets-Zavalia Syndrome) after the procedure. CONCLUSION: Nevertheless, deep anterior lamellar keratoplasty is more technically challenging, yet rewarding choice of surgery for keratoplasty patients who have a healthy endothelial cell count. ClinicalTrials.gov Identifier: NCT00887900.

[Deep anterior lamellar keratoplasty by big-bubble technique]. / Ceratoplastia lamelar anterior profunda pela técnica da "big-bubble".

PURPOSE: To evaluate the efficacy, safety, and complications related to the deep anterior lamellar keratoplasty (DALK) using the big-bubble technique. METHODS: A prospective study of patients submitted to DALK using the big-bubble technique was conducted. After the procedure, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), corneal topography, endothelial cell density, and intraoperative and postoperative complications were evaluated. RESULTS: Fifty-nine eyes of 55 patients were included in this study. Mean follow-up period was 16 ± 7.4 months. Baseline mean UCVA (logMAR) and BCVA was 1.60 ± 0.33 and 1.00 ± 0.43, respectively. After 12 months, the mean UCVA and BCVA improved to 0.86 ± 0.39 and 0.17 ± 0.14, respectively. Mean SE improved from -8.21 ± 3.91 to -1.82 ± 3.62 at 12 months. Mean topographic astigmatism improved from -7.9 ± 3.7 to -2.21 ± 1.7 at 12 months. Mean preoperative endothelial cell density was 2,377.98 ± 263.56 cells/mm², after 12 months of surgery the mean endothelial cell density reduced to 1,851.32 ± 397.61 cells/mm². Intraoperative microperfuration occurred in 6 cases (10.2%). One patient developed stromal rejection, and one patient developed fixed dilated pupil (Urrets-Zavalia Syndrome) after the procedure. CONCLUSION: Nevertheless, deep anterior lamellar keratoplasty is more technically challenging, yet rewarding choice of surgery for keratoplasty patients who have a healthy endothelial cell count. ClinicalTrials.gov Identifier: NCT00887900.

Visual Performance of Tecnis ZM900 Diffractive Multifocal IOL after 2500 Implants: A 3-Year Followup.

Purpose. To evaluate visual performance for near, intermediate, and distant vision; complaints of photic phenomena, and patient satisfaction with the new diffractive multifocal IOL used in eyes which underwent phacoemulsification. Methods. Two thousand and five hundred consecutive eyes undergoing Tecnis ZM900 multifocal IOL implantation were included in this retrospective analysis. The minimum followup of 3 months was required after the surgery. Patients were assessed for uncorrected near visual acuity (UNVA) at a fixed distance (33 cm), uncorrected intermediate visual acuity (UIVA) at 60 cm, and uncorrected distance visual acuity (UDVA). Using a subjective questionnaire, patients satisfaction, their independence from using glasses, and the perception of glare and halo phenomena were also evaluated at the last follow-up. Results. Two thousand and five hundred eyes of 1558 patients underwent cataract surgery and Tecnis ZM900 multifocal IOL implantation. Four hundred and eighty seven patients (31.3%) were men, and 1071 (68.7%) were women. The mean age of the patients was 66.17 years. A UDVA of 20/30 or better was achieved by 85% of eyes. A UNVA of J1 was achieved by 93.7% of eyes and that of J2 or better was achieved by 98%. A UIVA of J4 or better was achieved by 65% and J5 or better was achived by more than 82.8% of the eyes in the study. Glare and halos were reported as severe by only 6.1% and 2.12% of patients, respectively. Ninety seven percent reported complete spectacle independence and 88% stated that they are totally satisfied with their quality of vision and would choose to have the same lens implanted again after the first implant. Five percent of the eyes in the study needed a second procedure (enhancement) to achieve a better visual result. No patient underwent lens exchange. Conclusion. Excellent near, intermediate, and distant vision was observed in patients implanted with the Tecnis ZM900 diffractive multifocal IOL. Spectacle independence and a minimum occurrence of photic phenomena make this IOL an excellent option in patients with cataract.

Desempenho visual após implante de uma lente intraocular asférica multifocal difrativa / Visual performance after implantation of an aspheric multifocal diffractive intraocular lens

OBJETIVO: Avaliar a acuidade visual a distancia, intermediária e perto após o implante de uma lente intraocular (LIO) asférica multifocal difrativa AcrySof® ReSTOR® SN6AD1. MÉTODOS: Estudo prospectivo de 50 pacientes com catarata submetidos à facoemulsificação e implante de LIO AcrySof® ReSTOR®. Foram avaliados acuidade visual sem correção (AVSC), acuidade visual com correção (AVCC) para longe, acuidade visual para perto corrigida para longe (AVPC) e acuidade visual intermediária corrigida para longe (AVIC). Um questionário de satisfação e fenômenos visuais foi administrado ao final do estudo. RESULTADO: Após três meses de cirurgia, a média das acuidades (logMAR) era: AVSC, 0,05 ± 0,07; AVCC, 0,00 ± 0,01; AVPC, 0,00 ± 0,0, e AVIC, 0,15 ± 0,05. A AVCC e AVPC era de 20/25 ou melhor em todos os pacientes, sendo a AVIC J3 ou melhor em 83 por cento dos pacientes. Pacientes relataram excelente desempenho visual nas questões relacionadas a atividades para distância, intermediário, e perto com pouca ou nenhuma dificuldade. Nenhum paciente relatou halos ou 'glare' severos, sendo os mesmos caracterizados entre nenhum a moderado. CONCLUSÃO: A LIO asférica AcrySof® ReSTOR® SN6AD1 mostrou excelentes resultados na visão para longe, perto e intermediário, além de apresentar uma baixa incidência de fenômenos visuais.

PURPOSE: To evaluate distance, intermediate, and near vision after aspheric multifocal diffractive AcrySof® ReSTOR® SN6AD1 intraocular lens (IOL) implantation. METHODS: Prospective study of 50 patients with cataract that had phacoemulsification and AcrySof® ReSTOR® IOL implantation. Uncorrected distance vision acuity (UDVA), corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), and distance-corrected intermediate visual acuity (DCIVA) were measured postoperatively. A patient-satisfaction and visual phenomena questionnaire was administered at the end of the study. RESULTS: Three months postoperatively, the mean acuities (logMAR) were: UCDV, 0,05 ± 0,07; CDVA, 0,00 ± 0,01; DCNVA, 0,00 ± 0,0, and AVIC, 0,15 ± 0,05. The CDVA and DCNVA were 20/25 or better in all patients, with DCIVA of J3 or better in 83 percent of the patients. Patients reported good performance for distance, intermediate, and near visual tasks with no or minimal difficulty with specific tasks. No patient reported severe visual phenomena; halos and glare were rated as none to moderate. CONCLUSION: The aspheric IOL AcrySof® ReSTOR® SN6AD1 provide good functional vision at far, intermediate, and near distance, and a low incidence of visual disturbances.

Vitrectomia transconjuntival 25 gauge via pars plana para opacidade vítrea persistente em pacientes com implante de lentes multifocais / Transconjunctival sutureless 25-gauge vitrectomy for visually significant vitreous floaters in patients with multifocal intraocular lens

OBJETIVO: O objetivo do presente estudo é relatar o resultado visual obtido após realização de vitrectomia via pars plana 25 gauge (VVPP-25-gauge) em pacientes com opacidades vítreas persistentes e debilitantes previamente submetidos à cirurgia de facectomia com implante de lente intraocular (LIO) multifocal. MÉTODOS: Estudo prospectivo de 14 olhos com implante de LIO multifocal e presença de opacidade vítrea submetidos à VVPP-25-gauge. Foram avaliados acuidade visual sem correção (AVSC), acuidade visual com correção (AVCC) para longe, acuidade visual para perto corrigida para longe (AVPC) e equivalente esférico (EE) antes e 3 meses pós-vitrectomia. Um questionário de satisfação e melhora visual foi administrado antes e após a realização da vitrectomia para avaliar a satisfação dos pacientes. RESULTADO: Após três meses da VVPP25-gauge, a média das acuidades (logMAR) era: AVSC, 0,10 ± 0,14;AVCC, 0,02 ± 0,08;AVPC, 0,00 ± 0,0; EE, +0,16 ± 0,34. Treze olhos (92,9 por cento) apresentavam AVSC de 20/40 ou melhor, e 11 (78,5 por cento) de 20/25 ou melhor. Dez (90,9 por cento) pacientes demonstraram satisfação com o procedimento cirúrgico, obtendo eliminação de todos os floaters em 13 olhos (92,8 por cento). Apenas um paciente apresentou insatisfação com o resultado visual final devido ao aparecimento de edema macular cistóide pós-vitrectomia. CONCLUSÃO: A remoção das opacidades vítreas, usando a VVPP-25-gauge se mostrou segura, e resultou em alto nível de satisfação dos pacientes, com resolução dos sintomas na sua quase totalidade, e uma melhora subjetiva da qualidade funcional da visão.

PURPOSE: The aim of this study was to evaluate the role of 25-gauge transconjuntival sutureless vitrectomy (TSV) in patients with persistent vitreous floaters who underwent multifocal intraocular lens (IOL) implantation. METHODS: Fourteen eyes of 11 patients with multifocal IOL implant associated with vitreous opacities that underwent 25-gauge vitrectomy were prospectively analyzed. Information collected included near (UCNVA) and distance uncorrected visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), and the spherical equivalent (SE) before and 3 months after vitrectomy. Patients were questioned about surgery satisfaction and visual improvement after vitrectomy. RESULTS: Three months after 25-gauge TSV the mean visual acuities were: UCDVA, 0,10 ± 0,14; BCDVA, 0,02 ± 0,08; UCNVA, 0,00 ± 0,0; SE, +0,16 ± 0,34. Thirteen eyes (92.9 percent) had a UCDVA of 0.5 (20/40) or better, and 11 (78.5 percent) achieved a UCDVA of 0.8 (20/25) or better. Ten (90.9 percent) patients demonstrated satisfaction with surgery, and floaters have gone away in thirteen eyes (92.8 percent), while one patient expressed no satisfaction with her postoperative visual acuity because of the cystoid macular edema that occurred. CONCLUSION: 25-gauge TSV was a safe and accurate option for patients with multifocal lens and visual disturbing vitreous floaters providing subjective improvement of symptoms.

Multifocal intraocular lens optic anteriorization capture to correct residual refractive error.

PURPOSE: To evaluate the efficacy and safety of capturing the intraocular lens (IOL) optic through the anterior capsulorhexis opening in eyes with multifocal IOLs and a residual refractive error. SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Eyes with previous cataract surgery and Tecnis ZM900 multifocal IOL implantation were prospectively analyzed. After at least 1 month, patients had second surgery in which the IOL optic was captured through the anterior capsulorhexis opening to correct the residual refractive error. Preoperative and postoperative examinations at 1 day and 3 months included spherical equivalent (SE); uncorrected distance (UDVA), near (UNVA), and intermediate (UIVA) visual acuities; and corrected distance visual acuity (CDVA). RESULTS: The study included 16 eyes of 14 patients. The mean UDVA was 0.32 logMAR preoperatively and 0.10 logMAR after anterior optic capture and the mean SE, +1.09 diopters (D) and +0.26 D, respectively; both improvements were statistically significant (P<.001). The change in CDVA and UNVA from before anterior optic capture to the last follow-up was not statistically significant. The UIVA was significantly worse postoperatively (P = .011). No eye lost lines of CDVA. One eye (6.25%) developed glaucoma postoperatively. At the last follow-up, 13 patients (92.85%) were spectacle-independent for near and distance vision. CONCLUSION: Early outcomes indicate that anterior optic capture is a safe, accurate procedure in eyes with multifocal IOLs and a mild hyperopic residual refractive error postoperatively.

Spherical aberration and contrast sensitivity in eyes implanted with aspheric and spherical intraocular lenses: a comparative study.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified anterior aspheric surface results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. DESIGN: Prospective, comparative, interventional case series. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9001; Advanced Medical Optics, Santa Ana, California, USA; group 1) was compared with biconvex lens with spherical surfaces (ClariFlex; Advanced Medical Optics; group 2). Ocular aberrations for a 5.0-mm pupil and 6.0-mm pupil were measured with Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed up for three months. RESULTS: No statistically significant difference in postoperative uncorrected and best-corrected distance vision acuity after a follow-up of three months existed between the groups. Postoperative contrast sensitivity testing revealed significant differences between the groups under photopic and mesopic conditions. These differences reached statistical significance under photopic conditions at three spatial frequencies and under mesopic conditions at all spatial frequencies. When analyzing higher-order aberrations, the difference between the groups was statistically significant at the 5.00-mm and 6.00-mm pupil diameters, with the group 1 inducing less higher-order aberration and also less spherical aberration compared with group 2. CONCLUSIONS: Results show the Tecnis Z9001 IOL with a modified anterior aspheric surface induced significantly less higher-order aberration and spherical aberration compared with the ClariFlex IOL. Contrast sensitivity revealed better values under photopic and mesopic conditions with the Tecnis Z9001 IOL.

Primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens: case series.

PURPOSE: To assess the postoperative outcomes of primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens (IOL) (Advanced Medical Optics). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Patients who had phacoemulsification with primary piggyback IOL implantation were analyzed prospectively. In all cases, a Tecnis ZM900 multifocal IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included near and distance uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the spherical equivalent (SE) before and after the surgery. RESULTS: Twenty eyes of 12 patients were included in the study. They were followed for 6 months. The mean preoperative distance UCVA was 20/400. At the last follow-up (6 months), the mean distance UCVA was 20/29, significantly better than before referral (P<.001). The mean preoperative SE was +6.35 diopters (D) +/- 2.25 (SD). Six months after surgery, the mean SE was -0.25 +/- 0.40 D (range -1.00 to +0.50 D), significantly better than before referral (P<.001). No patient lost lines of BCVA after surgery. At the last follow-up, 90% of the eyes achieved a near UCVA of J1 and 83.3% of patients were spectacle independent for near and distance vision. A second refractive procedure was performed in 2 eyes. CONCLUSIONS: Primary piggyback implantation using the Tecnis ZM900 multifocal IOL was a simple, safe, and accurate option for patients with high hyperopia who wanted to reduce their dependency on spectacles.

Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified posterior aspherical surface (AcrySof IQ, Alcon Surgical Laboratories) results in reduced ocular aberrations (spherical aberration) and improved contrast sensitivity after cataract surgery. SETTING: Brasilia Ophthalmologic Hospital, Brasilia, and Sao Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified posterior surface (AcrySof IQ) was compared with a biconvex IOL with spherical surfaces (AcrySof Natural, Alcon). Ocular aberrations with a 5.0 mm and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed for 3 months. RESULTS: There were no statistically significant differences between eyes in postoperative uncorrected and best corrected distance visual acuities after a follow-up of 1 month and 3 months. Postoperatively, there was a statistically significant between-group difference in contrast sensitivity under photopic conditions without glare at 18 cycles per degree (cpd) (P = .04) and under mesopic conditions without glare at all spatial frequencies (3 cpd, 6 cpd, 12 cpd, and 18 cpd; P = .03, P = .009, P = .003, and P = .003, respectively) and with glare at 3 cpd and 6 cpd (P = .001 and P = .02, respectively). The difference in higher-order aberration (HOA) values between groups was statistically significant with a 5.0 mm and 6.0 mm pupil, with the AcrySof IQ IOL inducing less HOA than the AcrySof Natural IOL. Eyes with an AcrySof IQ IOL also had statistically significant less spherical aberration than eyes with an AcrySof Natural IOL with both pupil diameters (P<.001). CONCLUSIONS: The AcrySof IQ IOL with a modified posterior surface induced significantly less HOA and spherical aberration than the AcrySof Natural IOL. Contrast sensitivity was better under mesopic conditions with the AcrySof IQ IOL.

Afilamento escleral em paciente com rinosporidiose conjuntival / Scleral thinning in a patient with conjunctival rhinosporidiosis

Os autores descrevem um caso de rinosporidiose conjuntival acompanhado de afilamento escleral, tratado cirurgicamente com enxerto escleral. São analisadas semelhanças e diferenças com outros casos descritos na literatura.

The authors report a case of conjunctival rhinosporidiosis associated with scleral thinning treated surgically with scleral graft. The similarities and differences with other reported cases in the literature are analyzed.

[Preliminary results of Artisan phakic intraocular lens implantation to correct myopia]. / Resultados preliminares do implante de lente intra-ocular fácica Artisan para correção de miopia.

PURPOSE: To observe the preliminary results based on the efficacy, stability and safety of Artisan anterior chamber intra-ocular lens for the correction of myopia in the first 6 months. METHODS: A retrospective study of 18 patients (34 eyes) that received the implantation of Artisan anterior chamber intraocular lens for the correction of myopia was conducted. Best visual preoperative acuity, best visual postoperative acuity, dynamic preoperative and postoperative refraction, loss and improvement of lines of vision and complications were evaluated. RESULTS: Eighteen patients (34 eyes) were included in this study. Fourteen patients were females (77.8%) and 4 were males. The mean age was 30 years (SD +/- 7.3), range from 21 to 46 years. They were followed up for an average of 8.5 months (SD +/- 3.6). The mean endothelial cell loss was 4.75% at 6 months follow-up. The average preoperative uncorrected visual acuity was 0.02 (20/800) range from 0.01 to 0.13. The average preoperative spherical equivalent was -13.25 D, range from -5.75 D to -19,75 D. On the last follow-up, uncorrected visual acuity was 0.64 (20/32), range from 0.33 to 1.00; the average spherical equivalent was -1.18 D (DP +/- 0.92) range from +0.25 to -3.0. Complications were observed in 1 case (3.4%) of our study, in one patient who had a dislocation of the lens after an ocular trauma. CONCLUSION: The use of Artisan anterior chamber intraocular lens in phakic eyes for the correction of myopia was safe, effective and predictable. However, a larger prospective study with a higher number of cases and longer follow-up is necessary to determine long-term safety of the lens.

Resultados preliminares do implante de lente intra-ocular fácica artisan para correção de miopia / Preliminary results of artisan phakic intraocular lens implantation to correct myopia

OBJETIVOS: Avaliar os resultados preliminares quanto à eficácia, estabilidade e segurança da lente intra-ocular de câmara anterior Artisan em olhos fácicos para correção de miopia. MÉTODOS: Foi analisado retrospectivamente o resultado de 34 olhos fácicos que receberam o implante de lente intra-ocular Artisan para correção de miopia. Os parâmetros avaliados foram: contagem endotelial pré e pós-operatória, acuidade visual sem correção pré e pós-operatória, melhor acuidade visual com correção pré e pós-operatória, equivalente esférico pré e pós-operatório, ganho e perda de linhas de visão e complicações. RESULTADOS: Dezoito pacientes (34 olhos) foram incluídos neste estudo. Quatorze eram do sexo feminino (77,8 por cento) e 4 do sexo masculino. A idade média dos pacientes era de 30 anos (DP ± 7,3), variando de 21 a 46 anos. O período médio de seguimento foi de 8,5 meses (DP ± 3,6). A média de perda endotelial foi de 4,75 por cento em 6 meses. A acuidade visual sem correção pré-operatória era de 0,02 (20/800) variando de 0,01 a 0,13. O equivalente esférico médio pré-operatório na refração dinâmica era de -13,25 D, variando de -5,75 D a -19,75 D. No último seguimento a acuidade visual sem correção era de 0,64 (20/32) variando de 0,33 a 1,00. O equivalente esférico médio na refração dinâmica era de -1,18 D (DP ± 0,92) variando de + 0,25 a -3,0. Entre as complicações observadas em nosso estudo 1 (3,4 por cento) paciente apresentou deslocamento da lente por trauma necessitando de uma segunda intervenção para reposicionamento. CONCLUSÃO: O uso de lente fácica de câmara anterior Artisan para correção de miopia no presente estudo se mostrou seguro, eficaz e com boa previsibilidade. No entanto, estudo prospectivo com maior número de casos e maior seguimento é necessário para determinar a segurança do procedimento a longo prazo.

PURPOSE: To observe the preliminary results based on the efficacy, stability and safety of Artisan anterior chamber intra-ocular lens for the correction of myopia in the first 6 months. METHODS: A retrospective study of 18 patients (34 eyes) that received the implantation of Artisan anterior chamber intraocular lens for the correction of myopia was conducted. Best visual preoperative acuity, best visual postoperative acuity, dynamic preoperative and postoperative refraction, loss and improvement of lines of vision and complications were evaluated. RESULTS: Eighteen patients (34 eyes) were included in this study. Fourteen patients were females (77.8 percent) and 4 were males. The mean age was 30 years (SD ± 7.3), range from 21 to 46 years. They were followed up for an average of 8.5 months (SD ± 3.6). The mean endothelial cell loss was 4.75 percent at 6 months follow-up. The average preoperative uncorrected visual acuity was 0.02 (20/800) range from 0.01 to 0.13. The average preoperative spherical equivalent was -13.25 D, range from -5.75 D to -19,75 D. On the last follow-up, uncorrected visual acuity was 0.64 (20/32), range from 0.33 to 1.00; the average spherical equivalent was -1.18 D (DP ± 0.92) range from +0.25 to -3.0. Complications were observed in 1 case (3.4 percent) of our study, in one patient who had a dislocation of the lens after an ocular trauma. CONCLUSION: The use of Artisan anterior chamber intraocular lens in phakic eyes for the correction of myopia was safe, effective and predictable. However, a larger prospective study with a higher number of cases and longer follow-up is necessary to determine long-term safety of the lens.

Primary piggyback implantation using the ReSTOR intraocular lens: case series.

PURPOSE: To assess the postoperative outcomes of piggyback implantation using the AcrySof ReSTOR intraocular lens (IOL) (model SA60D3, Alcon Surgical Laboratories). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Thirteen eyes of 7 patients who had phacoemulsification with piggyback IOL implantation were analyzed prospectively. In all cases, a ReSTOR IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included uncorrected visual acuity (UCVA) at near and distance, best corrected visual acuity (BCVA), and spherical equivalent (SE) before and after surgery. RESULTS: The patients were followed for 12 months. The mean distance UCVA was 0.25 (20/80) preoperatively and 0.88 (20/23) at the last follow-up (1 year), which was significantly better than before surgery (P<.05). The mean SE was +4.25 diopters (D) +/- 1.5 (SD) preoperatively and +0.15 +/- 0.44 D (range -0.50 to +0.75 D) at 1 year, which was significantly better than preoperatively (P<.05). No patient lost lines of BCVA after surgery. At the last follow-up, all eyes had a near UCVA of J1 and none required spectacles for near or distance vision. CONCLUSION: Piggyback implantation using the ReSTOR IOL appeared to be a safe and efficient procedure providing high-quality visual acuity for near and distance vision in selected patients.

[Performance evaluation of NeoSoniX technology in cataract surgery]. / Avaliação do desempenho da tecnologia NeoSoniX em cirurgias de catarata.

PURPOSE: The techniques and results of cataract surgery have improved dramatically with technological advancements. One of the reasons for this improvement would be the reduced use of ultrasound with the new phacoemulsification devices. The objective of this study is to confirm the theoretical advantage of the NeoSoniX handpiece. METHODS: The authors compared the results of the parameters recorded by the Legacy phacoemulsification system during 300 cataract surgeries performed with the use of the conventional ultrasound handpiece and 100 performed with the innovative Neosonix. All surgeries were performed by the same senior surgeon, using the same surgical technique. The choice of handpiece was random. The handpieces were compared considering cataract grade of hardness, in relation to parameters of ultrasound time, amount of balanced saline solution, and percentage of average power used during surgery. RESULTS: The analysis performed retrospectively on a chronological series of cases showed that the time of ultrasound used with the NeoSoniX handpiece was inferior to that with the conventional handpiece, for any cataract grade of hardness (p<0.000001). The volume of balanced saline solution used during surgical procedures was smaller, favoring the NeoSoniX technology (p<0.000001). In relation to the percentage of ultrasound energy used with the different technologies, an inferior value was found in the group who underwent surgery with the use of the NeoSoniX handpiece (p<0.000001). CONCLUSIONS: Based on the information provided by these surgeries, we may claim that there was a significant superiority when using the NeoSoniX handpiece in comparison to the conventional Legacy machine handpiece in cataract surgeries, regardless of cataract grade.

Avaliação do desempenho da tecnologia NeoSoniX TM em cirurgias de catarata / Performance evaluation of NeoSoniX TM technology in cataract surgery

OBJETIVOS: As técnicas e resultados da cirurgia de catarata melhoraram drasticamente com o avanço tecnológico. Um dos motivos para melhoria seria a menor utilização de ultra-som com novos aparelhos de facoemulsificação. O objetivo deste estudo é confirmar na prática a vantagem teórica da caneta NeoSoniX TM. MÉTODOS: Foi realizada uma análise na qual os autores compararam resultados dos parâmetros registrados pelo aparelho de facoemulsificação Legacy durante 300 cirurgias de catarata realizadas com caneta de ultra-som (handpiece) convencional e 100 com a caneta NeoSoniX TM. Todas as cirurgias foram realizadas pelo mesmo cirurgião, com a mesma técnica cirúrgica. A escolha da "handpiece" foi aleatória, sendo comparadas, em relação ao grau de dureza das cataratas, os parâmetros de tempo do ultra-som, quantidade de solução salina balanceada e porcentagem de "average power" utilizadas durante as cirurgias. RESULTADOS: Foi realizada análise retrospectiva numa série cronológica de casos, mostrando que em qualquer que seja o grau de dureza da catarata, o tempo de utilização do ultra-som com a caneta NeoSoniX foi inferior ao da caneta convencional (p<0,000001). O volume de solução salina balanceada utilizado durante as cirurgias foi menor a favor da tecnologia NeoSoniX (p<0,000001). Em relação à porcentagem de potência do ultra-som utilizada com as diferentes tecnologias, encontrou-se valor inferior no grupo da caneta NeoSoniX (p<0,000001). CONCLUSÕES: Houve superioridade significativa no uso da caneta NeoSoniX comparada à caneta convencional do aparelho Legacy nas cirurgias de catarata, independente do seu grau.

Implante intra-ocular de lentes dobráveis piggyback em paciente portador de catarata congênita no primeiro ano de vida: relato de caso / Piggyback foldable intraocular lens implant in patient with congenital cataract in the first year of life: case report

No presente relato os autores descrevem um caso de catarata congênita unilateral tratada cirurgicamente com implante intra-ocular de lentes dobráveis "piggyback", ainda não descrito na literatura nacional. São analisadas as diferenças e semelhanças com outros casos descritos na literatura.

Ferrara intracorneal ring implantation and cataract surgery for the correction of pellucid marginal corneal degeneration.

We report a case of Ferrara intracorneal ring (Mediphacos) implantation and cataract surgery for the correction of pellucid marginal corneal degeneration. Preoperatively, the patient's uncorrected visual acuity (UCVA) was 0.05 in the right eye and 0.10 in the left eye. The best spectacle-corrected visual acuity (BSCVA) was 0.50 with -2.00 -11.25 x 80 in the right eye and 0.60 with -2.00 -5.50 x 95 in the left eye. One month postoperatively, the UCVA was 0.50 in the right eye and 0.30 in the left eye. The BSCVA was 0.80 with -1.00 in the right eye and 0.60 with -0.75 -1.25 x 160 in the left eye. Ferrara intrastromal rings and cataract surgery resulted in a more regular corneal shape with a reduction in astigmatism for good visual recovery.

Acuidade visual em implantes bilaterais de lentes intra-oculares monofocais e multifocais / Visual acuity of bilateral implants of monofocal and multifocal intraocular lenses

Objetivo: Comparar a acuidade visual de longe e perto de pacientes submetidos á facoexuulsificação binocular não simultânea com implante de lentes multifocais ou monofocais. Métodos: Foram selecionados 20 pacientes com lentes multifocais bilaterais e outros 20 pacientes com lentes monofocais também bilaterais, com acuidade visual sem correção melhor ou igual a 0,63 (20/30), medidos separadamente, nos três primeiros meses de pois-operatório, Foi medida a acuidade visual para longe e perto com e sem correção e testes de sensibilidade ao contraste e ofuscamento. Resultados: A acuidade visual sem correção para longe no grupo das monofocais teve média de 0,82 (DPñ 0,16) e no grupo das multifocais, 0,94 (DPñ0,12), valor de p 0,001. Os dois grupos de lentes tiveram visão com correção para longe igual a 1. No grupo das multifocais; 75 por cento tiveram J1 e 100 por cento tiveram J3 ou melhor sem correção. No grupo das lentes monofocais, 10 por cento tiveram J1 e 10 por cento tiveram J3 ou melhor sem correção. Não houve diferença significante na avaliação com o teste de sensibilidade ao contraste entre os grupos pesquisados. No teste de ofuscamento, os dois grupos tiveram redução da visão, que foi mais acentuada no grupo dos pacientes com lentes multifocais. Conclusão: A acuidade visual para longe com correção nos pacientes com implante multifocal foi semelhante a dos pacientes com implantes monofocais, embora a acuidade visual para perto no grupo em que foi implantado lente multifocal foi bastante superior ao grupo da lente monofocal. A sensibilidade ao contraste manteve-se semelhante nos dois grupos, já ,o ofuscamento ("glare test") no grupo multifocal foi maior que no grupo monofocal.

Resultados visuais e incidência de complicaçöes em facoemulsificaçäo com LIO por residentes / Visual results and complications of phacoemulsifications with intraocular lens implantation performed by residents

Os autores analisaram retrospectivamente a evoluçäo visual e a incidência de complicaçöes em 48 olhos submetidos à facoemulsificaçäo por 4 residentes do terceiro ano. Em todos os casos foi implantada uma lente de 7,0mm de zona óptica com a supervisäo de um assistente. As incidências de rotura de cápsula posterior e perda vítrea foi 6,25 p/cento (2/48) e 10,40 p/cento (5/48), respectivamente. O momento da rotura capsular ocorreu em 60 p/cento dos casos (3 pacientes) durante a emulsificaçäo do núcleo e em 2 (40 p/cento) olhos ao se aspirar o córtex automaticamente. A acuidade visual foi 20/40 em 89,60 p/cento dos casos com folow-up médio de 5,4 meses. Estes resultados säo comparáveis ao desempenho de residentes fazendo extra-capsular publicado em trabalhos anteriores. Nós acreditamos que, com treinamento apropriado e supervisäo de cirurgiöes