[Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation]. / Sistema zritel'noi reabilitatsii patsientov s obshirnymi defektami struktur perednego otrezka glaznogo iabloka na osnove implantatsii iridokhrustalikovoi diafragmy.

The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring. AIM: to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). MATERIAL AND METHODS: We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). RESULTS: Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. CONCLUSION: The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.

Long-Term Changes in Subfoveal Choroidal Thickness After Cataract Surgery.

BACKGROUND Cataract surgery is associated with the development of late-onset age-related macular degeneration (AMD). The pathogenic mechanism is still not fully established. The purpose of this study was to evaluate the possible changes in central macula thickness (CMT) and subfoveal choroid thickness (SCT) after uneventful cataract surgery. MATERIAL AND METHODS A total of 65 eyes of 65 patients who underwent phacoemulsification and intracapsular lens implantation were included in this prospective study. Patients had not undergone previous ocular surgery and had no other ocular abnormality. CMT and SCT were measured at baseline and postoperatively at week 1 and months 1, 3, 6 and 12 via spectral domain optical cohorence tomography (SD-OCT). RESULTS CMT was 252.4±27.6 µm (mean ±SD) preoperatively, then 253.5±29.8, 256.1±28.7, 257.4±27.2, 253.18±23.7, and 252.8±21.7 µm at postoperative week 1 and postoperative months 1, 3, 6, and 12, respectively. There were insignificant changes in CMT, and it returned to baseline at six months after surgery (all p>0.05). SCT was 237.4±21.6 µm preoperatively, and 240.5±24.8, 241.2±25.7, 242.7±26.3, 243.1±24.2, and 244.2±21.4 µm at postoperative week 1 and postoperative months 1, 3, 6, and 12, respectively. Although there was an increase in SCT during follow-up, the difference between preoperative and postoperative values was not significant (p>0.05). CONCLUSIONS Uncomplicated phacoemulsification induces subclinical changes in CMT, probably due to the inflammatory insult of surgery, and CMT returns to baseline value. There were slight, insignificant increases in choroid thickness during follow-up, and this did not return to baseline during follow-up. Changes in the choroid after cataract surgery may provide clues to the development of late-onset AMD.

Piggy Back primario: una alternativa en la cirugía de pacientes portadores de hipermetropías elevadas: presentación de un caso / Primary piggyback: an alternative surgical treatment for patients with high hypermetropia: a case report

En nuestro país la hipermetropía es el defecto refractivo más frecuente. La mejor manera de corregir el defecto constituye un problema serio para el oftalmólogo y para el propio paciente, sobretodo en defectos elevados. Se presenta el caso de un paciente masculino de 45 años de edad con antecedentes patológicos personales oculares de hipermetropía elevada en ambos ojos; es un trabajador agrícola, el cual manifestó serias dificultades para la adaptación a sus cristales ya que le pesan mucho y su visión es borrosa con ellos, por lo que los cambia con frecuencia. Se analizaron las diferentes formas de tratar su defecto y se optó por el implante de dos lentes intraoculares (piggy back) con lo cual el paciente logró mejoría en su agudeza visual y la desaparición del defecto refractivo sin la aparición de ninguna complicación trans ni posoperatoria. La hipermetropía elevada es algo poco frecuente en los pacientes hipermétropes, por lo que esta técnica es poco utilizada en nuestro medio, razones por las que se decidió la presentación del caso(AU)

Hypermetropia is the most common refractive disorder in our country. Finding the best procedure to correct this defect is a serious problem for the ophthalmologist and the patient, especially those with severe defects. The case of a 45-year-old patient with a history of high hypermetropia in both eyes is presented. He is an agricultural worker who had serious difficulties adapting to the lenses as they were too heavy and caused him blurry vision, leading to their frequent change. After analyzing the different ways to correct his defect, it was decided to implant two (piggyback) intraocular lenses, which resulted in increased visual acuity and elimination of the refractive disorder without occurrence of intraoperative and postoperative complications. High hypermetropia is uncommon in hypermetropic patients, thus this technique is not frequently used in our setting, which lead to the presentation of this case(AU)

[Use of "mix-and-match" aspheric intraocular lenses in cataract surgery to enhance depth of field and stereoscopic performance]. / Intérêt d'une bascule d'asphéricité pour une plus grande multifocalité dans la chirurgie de la cataracte.

INTRODUCTION: One of the remaining challenges in cataract surgery is to compensate for lost accommodative function. The purpose of our study is to evaluate reading ability with a combination of two different aspheric intraocular lenses. PATIENTS AND METHODS: This retrospective study included 40 eyes (20 patients). The control group (28 eyes, 14 patients) received two negative aspheric intraocular lenses (Acrismart 36A(®), Carl Zeiss Meditec), while the aspheric-optimized group (12 eyes, six patients) received an AcriSmart 36A(®) in the dominant eye and a zero-aspheric intraocular lens (Acrismart 46 LC(®), Carl Zeiss Meditec) in the fellow eye. Patients with corneal asphericity between 0.15 and 0.30 µm and a bilateral monocular postoperative visual acuity of at least 20/20 were eligible for inclusion. Uncorrected and best corrected visual acuity was measured for near, intermediate and distance vision. Corneal and total higher-order aberrations, monocular and binocular defocus curve, and stereoscopic performance were assessed. RESULTS: Postoperative spherical equivalent and best corrected distance visual acuity were not significantly different between the two groups (P=0.11 and P=0.82 respectively). However, the aspheric-optimized group (36A(®)/46 LC(®)) exhibited better near and intermediate visual acuity (P<0.05), and better stereoscopic vision (P=0.027). DISCUSSION: The depth of field results in pseudophakes implanted with "mix-and-match" aspheric lenses demonstrates that the binocular combination of two different aspheric profiles seems to improve near vision without affecting stereoscopic vision.

[Recovery of visual functions after multifocal intraocular lens implantation].

In order to study the features of visual system (VS) recovery after multifocal correction we examined in dynamics visual functions and subjective satisfaction with sight quality in 64 patients (mean age 52 +/- 2.5 years) at different time after binocular implantation of apodized refractive-diffractive intraocular lens (IOL) Acrysof Restor. These patients before surgery and 30 healthy subjects (60 eyes, mean age 48 +/- 4.5 years) served as controls. Over 6 months after surgery progressive improvement of mean visual acuity in the main distances (40, 70-80 cm and 5 m), contrast sensitivity and subjective satisfaction were observed. Gradual increasing of VS resolution suggests the need of search of postoperative rehabilitation methods that would provide faster adaptation to new optical conditions.

[Long-term results of posterior chamber phakic intraocular lens implantation for correction of high ametropia]. / Résultats à long terme de l'implantation phaque de chambre postérieure pour la correction des amétropies fortes.

PURPOSE: To assess efficacy, stability and safety of posterior chamber phakic intraocular lens implantation with STAAR Visian ICL for correction of high ametropia, with a mean follow-up of 5 years (3.5-10 years). PATIENTS AND METHODS: Ninety eyes of 53 highly ametropic patients (45 myopia, ten hyperopia and 35 with mixed astigmatism) were included in a retrospective single-surgeon study, using primarily the V4 ICL model (87 eyes). We studied pre- and postoperative refractive efficacy, endothelial cell density, crystalline lens opacification and intraocular clearances within the various compartments of the eye. RESULTS: Mean uncorrected visual acuity was 0.77 at the 12th postoperative month; 17 of 90 eyes required adjunctive photoablation for residual astigmatism. Forty-eight percent of eyes gained at least one line of best corrected visual acuity. After implantation, the decrease in endothelial cell density remained stable at 0.69%/year, and 91% of eyes showed no opacification of the crystalline lens. Mean endothelium-ICL and ICL-crystalline lens distances were 2.41 mm and 0.52 mm respectively. Overall patient satisfaction achieved was 96% at 36 months postoperatively. DISCUSSION AND CONCLUSION: These results demonstrate efficacy, stability and safety of the ICL V4 phakic IOL for the correction of high ametropia. Long-term follow-up did not show a significant increase in cataract formation in implanted eyes.

Cálculo biométrico y resultados refractivos: estudio de 250 casos operados de catarata / Biometric calculation and refractive results: a study of 250 cases of patients operated for cataract

Fundamento: el implante de lentes intraoculares en la cirugía de catarata significa un avance en la corrección refractiva de la afaquia. Pero sin el estudio previo a la cirugía y el correcto cálculo de la lente intraocular, los resultados no serían satisfactorios. Objetivo: evaluar el cálculo biométrico y la refracción posquirúrgica de pacientes operados de cataratas. Metodos: estudio descriptivo realizado en el Centro de Oftalmología del Estado de Anzoátegui, Venezuela, que incluyó 250 pacientes sometidos a cirugía de catarata, a quienes previamente se les realizó refracción, queratometría, biometría y cálculo de lente intraocular. Después de la cirugía se determinó: refracción esperada por el cálculo biométrico, error refractivo posoperatorio, agudeza visual posquirúrgica sin corrección y con corrección. Resultados: predominó el sexo femenino y el grupo de edad entre 60 y 69 años. El valor más registrado de la queratometría osciló de 43 a 44 dioptrías. El valor de la longitud axial más destacado fue de 22 a 24 mm. Las lentes intraoculares más usadas fueron de 16 a 20 dioptrías y las de 21 a 25 dioptrías. El mayor por ciento de la refracción esperada estuvo en el grupo de 0,00 a 0, 50. El error refractivo que predominó fue el de 0,50 a 1,00. En la refracción realizada al mes de la cirugía, sin cristales, más de la mitad de los pacientes obtuvo visiones entre 20/30 y 20/25. Conclusiones: se demostró la efectividad del cálculo de la lente intraocular previo a la cirugía de catarata(AU)

Background: the implantation of intraocular lenses in cataract surgery represents a step forward in refractive correction of aphakia. Nevertheless, without a study prior to surgery and the correct calculation of the intraocular lens, the results would not be satisfactory. Objective: To evaluate the biometric calculation and postoperative refraction in patients who underwent cataract surgery. Methods: A descriptive study was conducted in the Ophthalmology Center of the State of Anzoategui in Venezuela. It included 250 patients who underwent cataract surgery with previous refraction, keratometry, biometry and intraocular lens power calculation. After surgery, the following parameters were determined: biometrically calculated expected refraction, postoperative refractive error, uncorrected visual acuity and postoperative correction. Results: In general, females and patient between 60 and 69 years old predominated. The most commonly recorded value for keratometry ranged from 43 to 44 D. For axial length, values ranged from 22 to 24 mm. Most commonly used intraocular lenses were from 16 to 20 diopters and from 21 to 25 diopters. The largest percent of expected refraction was obtained in the group from 0.00 to 0, 50. Refractive error was predominant from 0.50 to 1.00. In the refraction performed without glasses one month after surgery, more than half of patients had vision between 20/30 and 20 / 25. Conclusions: We demonstrated the effectiveness of intraocular lens calculation prior to cataract surgery(AU)

[Infantile cataract and surgical management]. / La cataracte de l'enfant et sa stratégie chirurgicale.

The cataract or opacification of the lens raises, in the child, two problems: of clinical diagnosis but especially of action to be taken therapeutic in particular surgical in front of a juvenille lens. This leads to a step and a therapeutic strategy, which must, individually, weigh the advantages and the disadvantages of the surgery. It is a frequent cause of visual handicap in the child. In the event of unilaterality, the major risks are the amblyopia and the aniseiconia. The elements to be analyzed are linked or the bilaterality, the type and the importance of opacity, local or general associated malformations, precocity diagnoses, and with regard to the treatment, the potential surgical complications, the quality of the optical correction, the postoperative assumption of responsibility and the cooperation of the parents. In all the cases, it will always be necessary to treat the functional part of the amblyopia.

Facectomia Transcornneana (Clear corneal sugery) / Clear corneal sugery

Os autores apresentaram a técnica de facoemulsificaçäo com incisäo temporal em córnea clara e com implante de lente intra-ocular dobrável de silicone, sob anestesia tópica. Abordam as dificuldades de adaptaçäo à incisäo temporal, aconselhando-se o uso de maca especial e um colar de fixaçäo da cabeça para apoio das mäos. Ressaltam, no entanto, a grande vantagem de uma melhor visualizaçäo do reflexo retiniano. advertem para a maior precisäo da incisäo corneana e a pouca margem de erro da técnica, pois, as complicaçöes säo de mais difíceis soluçöes. No entanto, a incisäo sendo auto-selantre, näo necessita de pontos. Apresentaram a técnica de injeçäo subtenoniana de anestésico, como alternativa para a anestesis tópica. Ressaltam a grande vantagem da recuperaçäo precoce da visäo e da estabilidade mais cedo da refraçäo

Cálculo do poder dióptrico da lente intraocular para pacientes submetidos a facoemulsificaçäo após ceratotomia radial / Intraocular lens dioptric power calculations in patients submitted to phacoemulsification after radial keratotomy

Os autores estudaram 5 olhos, de 3 pacientes, submetidos a facoemulsificaçäo com implante de lente intraocular alguns anos após ceratotomia radial. Foram avaliadas as fórmulas mais comumente utilizadas para cálculo da lente intraocular (Holladay, SRK II, SRKT) e diferentes maneiras de se obter as medidas ceratométricas tentando-se determinar o que seria adequado para ser empregado nestes pacientes. As fórmulas Holladay e SRKT foram as que apresentaram menor margem de erro. Valores ceratométricos pós ceratotomia radial foram menos precisos para o cálculo da lente intraocular do que os dados que foram obtidos subtraindo-se o valor da mundança refracional induzida pela Ceratotomia Radial da medida ceratométrica pré ceratotomia radial. Näo foi observado um aplanamento corneano significativo após a facoemulsificaçäo, como relatado por outros autores, provavelmente por ter sido usada uma técnica com incisäo em túnel escleral e atraumática. Os autores concluem que apesar de um número cada vez maior de pacientes submetidos a ceratotomia radial necessitarem de dacectomia com implante de lente intraocular devido ao desenvolvimento de uma catarata senil, as fórmulas atuais de cálculo das dioptrias da lente intraocular ainda näo têm se mostrado totalmente adequadas a estes pacientes.