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1.
Curr Opin Ophthalmol ; 31(3): 161-166, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32235250

RESUMO

PURPOSE OF REVIEW: A variety of techniques exist for secondary intraocular lens (IOL) implantation. Of note, scleral fixated intraocular lenses have become more popular with a variety of techniques, both with and without use of sutures. Herein, we focus on reviewing recently published studies describing the long-term outcomes of scleral fixation techniques. RECENT FINDINGS: Although initial papers describing novel techniques often report short-term outcomes, several studies have recently described intermediate and long-term outcomes for scleral fixated IOLs, albeit all being retrospective case series. Suture fixation methods with long-term follow-up, up to a minimum of 50 months, report dislocation rates between 0 and 15%. Sutureless scleral fixation techniques have increased in popularity the past several years. Although they appear to have a lower rate of IOL dislocation: several studies have reported 0% and one study 8%. The follow-up period for sutureless scleral fixation technique studies, however, is shorter with most studies reporting follow-up of less than a year. Rates of retinal detachment vary between individual studies, but are similar for both suture fixation and sutureless with the majority of studies reporting a rate between 0 and 5%. These studies show that long-term outcomes are important considerations in surgical decision-making. SUMMARY: Scleral fixation techniques have shown long-term durability and safety in recent retrospective studies. Comparison of techniques has been limited, and more robust studies may be required to provide stronger anatomic, functional, and comparative data.


Assuntos
Implante de Lente Intraocular/métodos , Lentes Intraoculares , Esclera/cirurgia , Técnicas de Sutura , Humanos
2.
Medicine (Baltimore) ; 99(16): e19623, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311932

RESUMO

To report on the characteristics and outcome of management of Coats' disease, and to describe a novel surgical technique for management of stage 3B with total retinal detachment (RD) by scleral external drainage with anterior chamber (AC-maintainer) placement before the drainage without pars plana vitrectomy.A retrospective study of 26 eyes from 25 Coats' patients. Outcome measures included: demographics, presentation, laterality, stage, treatment, and outcome.The median age at diagnosis was 3.5 years. Twenty patients (80%) were males, and all except 1 girl had unilateral disease. The presenting complaint was impaired vision in 13 (50%) eyes, leukocoria in 6 (23%) eyes, and strabismus in 7 (27%) eyes. Based on the Shields classification; 3(12%) eyes were stage 1, 9 (35%) eyes were stage 2, 10 (38%) eyes were stage 3, 2 (8%) eyes were stag e4, and 2 (8%) eyes were stage 5. Primary management included cryotherapy (54%), laser photocoagulation (27%), intravitreal anti-vascular endothelial growth factor (23%), intravitreal steroids (23%), and surgical drainage (12%). The 3 eyes in stage 3B (with total exudative RD) underwent subretinal fluid drainage with AC maintainer, and all had the retina reattached completely for 6 months follow up after the surgery. At mean follow up 21 months, 4 (15%) eyes were enucleated, 19 (73%) eyes had improvement or stabilization in visual acuity.Coats' disease usually presents at advanced stage with poor visual prognosis, individualized management with close follow up are mandatory to save the eye. Subretinal fluid drainage with AC maintainer is a safe and useful technique for repairing total RD in eyes with stage 3B Coats' disease.


Assuntos
Crioterapia , Drenagem/instrumentação , Fotocoagulação a Laser , Descolamento Retiniano/terapia , Telangiectasia Retiniana/terapia , Adolescente , Câmara Anterior/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Injeções Intravítreas , Masculino , Descolamento Retiniano/etiologia , Telangiectasia Retiniana/complicações , Estudos Retrospectivos , Esclera/cirurgia , Índice de Gravidade de Doença , Esteroides/administração & dosagem , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Transtornos da Visão/etiologia , Acuidade Visual
3.
Curr Opin Ophthalmol ; 31(1): 50-60, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31789971

RESUMO

PURPOSE OF REVIEW: To review current, effective and more popular techniques for scleral fixation of intraocular lens (IOLs) and IOL-capsular bag complex. RECENT FINDINGS: Scleral fixation of IOLs became popular, originally with sutured scleral fixated IOLs and later the Scharioth technique of intrascleral haptic fixation. This was further developed as the Glued IOL technique which enjoys widespread adoption all over the world. Recently the Yamane technique has also become popular and is being widely adopted as well. SUMMARY: Scleral fixated IOLs have evolved in the last 2 decades with technical modifications, extended indications and improvised instrumentation. Though sutured and sutureless techniques have been growing equally, the sutureless scleral fixation techniques have attracted special interest. Reduced suture-related complications, technical ease and high-quality functional outcomes may be possible reasons. Sutureless capsular bag fixation also has distinct advantages.


Assuntos
Implante de Lente Intraocular/métodos , Esclera/cirurgia , Técnicas de Sutura , Extração de Catarata , Humanos , Lentes Intraoculares , Pseudofacia/fisiopatologia , Acuidade Visual/fisiologia
4.
Ulus Travma Acil Cerrahi Derg ; 25(6): 631-634, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701505

RESUMO

Globe rupture is a major postoperative complication after penetrating keratoplasty (PK). Because the corneal wound is never comparable with that of healthy corneal tissue, globe rupture following blunt trauma occurs at the corneal graft-host junction. In this study, we report a case of scleral rupture that arose from blunt trauma occurring after PK. A 60-year-old female presented with loss of vision, redness and pain in the left eye, which was the consequence of blunt trauma, was our case in this study. Slit-lamp examination revealed ecchymosis on the eyelids, diffuse subconjunctival hemorrhage and total hyphema. The donor cornea was intact. The right eye showed PK, the cornea was transparent, and the sclera was blue. A 2 mm rupture behind the limbus extending from 3 o'clock to 9 o'clock in the upper half of the sclera was observed during exploratory surgery. She did not report any coexisting medical conditions except for systemic hypertension. The differential diagnosis of the bluish discoloration of her sclera was investigated. In detailed anamnesis, the patient reported that she had been treated for severe allergic eye disease during childhood. Vernal keratoconjunctivitis complication was diagnosed. It should be kept in mind that closed scleral perforation may occur in the patient with PK and blue sclera due to blunt trauma.


Assuntos
Traumatismos Oculares , Ceratoplastia Penetrante , Ruptura , Esclera , Ferimentos não Penetrantes , Acidentes , Traumatismos Oculares/patologia , Traumatismos Oculares/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Ruptura/patologia , Ruptura/cirurgia , Esclera/lesões , Esclera/patologia , Esclera/cirurgia , Acuidade Visual , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia
5.
Asia Pac J Ophthalmol (Phila) ; 8(5): 366-370, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513040

RESUMO

BACKGROUND: Myopia has become a global public health problem. High myopia is linked to pathologic myopia (PM). As the severity of myopia increases, excessive axial elongation of the globe exerts a biomechanical stretch on the posterior pole, followed by a series of retinopathy which can lead to marked visual impairment. Posterior scleral reinforcement (PSR) is the only way that may have the potential to prevent the progression of axial elongation. Some scholars expressed satisfaction with the efficacy and safety of PSR. In contrast, other surgeons had negative conclusions on the outcomes for the surgery. OBJECTIVES: The aims of this review are to provide an update on the current knowledge of posterior scleral reinforcement to prevent progression of high myopia and to discuss clinical trials examining the potential utility of PSR in treating this disease. METHODS: We searched Ovid MEDLINE, Embase, PubMed and China National Knowledge Infrastructure (CNKI) (all years to 1 July 2019). We also conducted a gray literature search and handsearched reference lists of included studies and pertinent review articles. RESULTS: 26 clinical trials were included. 20 trials were designed as only one eye of each patient had posterior scleral reinforcement surgery. After 3 to 5 years of follow-up, the results are very satisfactory. 6 randomized controlled trials, which have conservatively treated groups, showed statistically significant differences between the eyeball axial length progression in the study group and the control group, where surgery was not performed. Most clinical trials reached a positive influence. But the efficacy of different clinical trials varies greatly. CONCLUSIONS: PSR, is safe and effective to slowdown myopia progression, especially for high myopia.


Assuntos
Comprimento Axial do Olho/diagnóstico por imagem , Miopia Degenerativa/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Esclera/cirurgia , Acuidade Visual , Progressão da Doença , Humanos , Miopia Degenerativa/diagnóstico , Miopia Degenerativa/fisiopatologia
6.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519722

RESUMO

Monocular elevation deficit can result from either inferior rectus restriction, superior rectus palsy or from supranuclear causes. We report a case of monocular elevation deficit after scleral perforation repair which was managed by surgery on contra lateral eye. This improved elevation of the affected eye with no diplopia in the postoperative period.


Assuntos
Diplopia/etiologia , Transtornos da Motilidade Ocular/cirurgia , Oftalmoplegia/etiologia , Esclera/lesões , Adulto , Diagnóstico Diferencial , Diplopia/diagnóstico , Diplopia/prevenção & controle , Movimentos Oculares/fisiologia , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/patologia , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Oftalmoplegia/fisiopatologia , Período Pós-Operatório , Esclera/patologia , Esclera/cirurgia , Perfuração Espontânea/cirurgia , Resultado do Tratamento
7.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2481-2487, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31485731

RESUMO

PURPOSE: Both trabeculotomy (TE) as well as transscleral endodiode laser cyclophotocoagulation (CPC) are common approaches in glaucoma surgery. The purpose of this study was to perform an intraindividual comparison of these procedures carried out by the same surgeon in the same patient on the same day. METHODS: An observational monocentric retrospective cohort study was conducted. Patients with a bilateral refractory open-angle glaucoma who underwent trabeculectomy in one eye and transscleral endodiode laser cyclophotocoagulation in the fellow eye simultaneously were included and followed up with over the course of 1 year. RESULTS: Eighty-two eyes of 41 patients were included. Seventeen patients (41.5%) were men and 24 (58.5%) women. The mean age was 68.7 ± 9.5 years. The diagnosis comprised 33 (80.5%) patients with a primary open-angle glaucoma, five (12.2%) patients with pseudoexfoliation glaucoma, and three (7.3%) patients with pigment dispersion glaucoma. A reduction in intraocular pressure (IOP) was seen in both after TE (from 26.2 ± 13.2 to 10.6 ± 4.1 mmHg, 52 weeks post-treatment) as well as CPC (from 24.2 ± 9.9 to 15.0 ± 5.4 mmHg, 52 weeks post-treatment). In comparison to each other, TE was significantly more effective in lowering the IOP (10.6 ± 4.1 vs. 13.4 ± 5.0; p = 0.0030, 52 weeks post-treatment) and needed antiglaucomatous medications (0.45 ± 0.80 vs. 1.24 ± 1.13; p = 0.0009, 52 weeks post-treatment). Consistently, the achievement rate of an IOP ≤ 16 mmHg without antiglaucomatous medications was significantly higher in TE-treated eyes (65.8% vs. 31.6%; p = 0.0019). Re-interventions, including 10 secondary TEs, were commonly required in those eyes undergoing CPC, especially in younger patients. CONCLUSIONS: Trabeculectomy was demonstrated to be more effective in reducing IOP in comparison to fellow eyes receiving CPC. In particular, in younger patients, an additional TE in the CPC-treated eyes was necessary. The outcome of those secondary TEs however was comparable to the primarily performed TEs. Our study thus supports the use of CPC as tool to control IOP, especially in the context of bilateral refractive glaucoma.


Assuntos
Corpo Ciliar/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/fisiologia , Fotocoagulação a Laser/métodos , Esclera/cirurgia , Trabeculectomia/métodos , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Semin Ophthalmol ; 34(7-8): 488-496, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390915

RESUMO

Background. Implantation of sutureless, scleral-fixated posterior chamber intraocular lenses (SSFIOL) is a promising option in the surgical management of patients unable to undergo standard cataract surgery due to insufficient capsular support. The purpose of this study was to describe the indications, visual outcomes and complications of SSFIOL implantation.Methods. Retrospective, investigational cohort study of 112 consecutive SSFIOL implantations between July 2013 and August 2017. Pre-operative ocular morbidity, operative indications, postoperative outcomes, complications, and reinterventions were summarized. Visual and refractive outcomes were compared between the pre- and latest postoperative visit using Wilcoxon signed-ranked test.Results. Mean follow-up: 13.0 ± 10.4 months. Primary surgical indication was dislocated IOL due to zonular weakness (77 eyes (68.8%)). At latest follow-up, there was improvement in uncorrected visual acuity (1.3 ± 0.8 to 0.64 ± 0.60 logMAR, p < .01), best-corrected visual acuity (BCVA) (0.6 ± 0.5 logMAR to 0.36 ± 0.40 logMAR, p < .01). Postoperative complications included transient IOP elevation >30 mmHg (26.8%), cystoid macular edema (CME) (14.3%), transient hypotony (13.4%), iris capture (12.5%), uveitis-glaucoma-hyphema (UGH) syndrome (11.6%), vitreous hemorrhage (VH) (6.3%). Operative reinterventions included SSFIOL exchange (3.6%), SSFIOL repositioning (5.4%), SSFIOL removal (2.7%). Ten (8.9%) patients required multiple re-interventions.Conclusion. SSFIOL implantation is a reasonable option for eyes with inadequate capsular support, resulting in visual improvement in most patients. Many of the surgical complications were related to a floppy iris-lens diaphragm (UGH syndrome, iris capture), which were predisposed in eyes with complex pathology. Surgical modifications can be made to minimize the iris-related complications.


Assuntos
Afacia Pós-Catarata/cirurgia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Esclera/cirurgia , Procedimentos Cirúrgicos sem Sutura/métodos , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos
9.
J Craniofac Surg ; 30(6): 1782-1786, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31449214

RESUMO

: Orbital fractures can involve floor, lateral and medial wall. Surgical access depends on fracture's severity, ocular trauma and patient's age. Subciliary, subtarsal, infraorbital or transconjunctival approaches are the main access to the orbit. Surgical interventions in the eyelid may induce scar tissue formation and, consequently, the cicatricial scleral show. The authors present a study with the aim to evaluate the incidence of cicatricial scleral show in patients treated for orbital fractures with or without simultaneous Tarsal Sling Canthopexy in our Plastic Surgery Department. METHODS: The authors evaluated 50 patients divided in 2 groups: Group 1, subciliary approach and reconstruction of orbital floor without simultaneous Canthopexy Tarsal Sling; Group 2: reconstruction of orbital floor through subciliary approach with simultaneous Canthopexy Tarsal Sling. RESULTS: Patients, who underwent Canthopexy Tarsal Sling, did not have any scleral show. Instead patients, who did not undergo this prevention technique, had scleral show even if a minor entity. DISCUSSION: Although there was no muscle or skin removed, in our procedure, but only cutaneous incision, scleral show can appear as a complication. Canthal ligament and tarsus' elasticity influence the incidence of post-surgical scleral show, which is more frequent in elderly patients. Therefore, the authors suggest to prevent it routinely with Tarsal Sling Canthopexy. CONCLUSION: Canthopexy Tarsal Sling is procedure that stretch tarsal structure and it may help to prevent scleral show.


Assuntos
Fraturas Orbitárias/cirurgia , Esclera/cirurgia , Adolescente , Adulto , Idoso , Pálpebras/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Órbita/cirurgia , Estudos Retrospectivos , Adulto Jovem
10.
Ophthalmic Plast Reconstr Surg ; 35(4): 383-386, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283689

RESUMO

PURPOSE: To compare preoperative and postoperative lower eyelid scleral show in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis, analyze the factors correlated with them, and assess the rate of postoperative lower eyelid symmetry in both groups. METHODS: Patients (older than 5 years old) with unilateral MP (58) and AP (20) were included from June 2015 to April 2017. Excluded were patients with previous eyelid surgery, strabismus, levator function of ≤3, and associated procedures. Margin reflex distance (MRD) 1 and 2 and levator function were measured by the same observer before and at least 6 months after the ptosis repair. RESULTS: Lower scleral show was observed in 56.8% and 80% of MP and AP, respectively. Margin reflex distance 2 was significantly (r = -0.37, p = 0.002) associated with MRD1 in the MP group (multiple regression analysis). Both groups showed a significant improvement of MRD2, postoperatively resulting in symmetric MRD2 in 91.4% of MP and 80% of AP group. It was not changed in 43% of MP and 25% of AP group. Multiple regression analysis showed that preoperative MRD2 was the only significant factor associated with postoperative improvement of scleral show in the MP group. CONCLUSIONS: Lower scleral show was significantly improved after ptosis repair in both MP and AP. The more severe MP was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in the MP. No factor was significantly associated with MRD2 in the AP group.


Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Pálpebras/cirurgia , Músculos Oculomotores/cirurgia , Esclera/cirurgia , Adolescente , Adulto , Blefaroptose/etiologia , Pálpebras/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
11.
Cornea ; 38(10): 1239-1244, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299663

RESUMO

PURPOSE: To investigate the efficacy and safety of interferon (IFN) alpha-2b eye drops in preventing pterygium recurrence after the bare sclera technique. METHODS: Sixty eyes in 53 patients who underwent treatment for primary pterygium (the length of corneal invasion ranged from 2 to 4 mm) were enrolled in this prospective study. All patients were divided in chronological sequence into 2 groups. The control group included the first 30 eyes, whereas the treatment group included the next 30 eyes. After treatment with the bare sclera technique, levofloxacin and 0.1% fluorometholone eye drops were used 4 times a day for 3 months after surgical excision in both groups. In addition, IFN alpha-2b eye drops were applied in the treatment group 4 times a day for 3 months. Throughout an 18-month follow-up period, all patients in both groups were examined 1 day, 10 days, 1 month, 3 months, 6 months, 12 months, and 18 months after surgery. The main outcome measures were pterygium recurrence, conjunctival redness and thickness, and neovascularization and complications (ie, delayed conjunctival healing, persistent corneal epithelial defection, conjunctival granuloma, and scleral melting and necrosis). RESULTS: The recurrence rates in the control group and the treatment group at the end of the sixth month were 29.2% and 3.7%, respectively, and the rates were significantly different between the 2 groups (P = 0.019). Up to 12 months after surgeries, the recurrence rate was 33.3% in the control group and 7.4% in the treatment group, and the difference between the 2 groups was statistically significant (P = 0.048). The rates at the end of 18 months were the same. During the follow-up period, no complications were observed except for 1 conjunctival granuloma (in the treatment group) and 2 corneal epithelial defects (one in the control group and the other in the treatment group). CONCLUSIONS: Administration of IFN alpha-2b eye drops after the bare sclera technique appear safe and effective in reducing the recurrence of pterygium.


Assuntos
Túnica Conjuntiva/anormalidades , Interferon alfa-2/administração & dosagem , Procedimentos Cirúrgicos Oftalmológicos/métodos , Pterígio/terapia , Esclera/cirurgia , Prevenção Secundária/métodos , Adulto , Idoso , Antineoplásicos/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Período Pós-Operatório , Estudos Prospectivos , Pterígio/diagnóstico , Recidiva , Fatores de Tempo , Resultado do Tratamento
12.
Exp Eye Res ; 186: 107717, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31265829

RESUMO

Scleral defects can result as a consequence of trauma, infectious diseases or cancer and surgical repair with allogeneic scleral grafts can be required. However, this method has limitations and novel alternatives are needed. Here, the efficacy of acellular nanostructured fibrin-agarose hydrogel-based substitutes (NFAH) in the repair of scleral defects in rabbits was studied. For this, scleral defects of 5-mm diameter were made on 18 adult-male New Zealand rabbits and repaired with acellular NFAH, NFAH crosslinked with genipin (NFAH-GP) or glutaraldehyde (NFAH-GA), allogeneic scleral grafts as control (C-CTR) or not repaired (negative control N-CTR) (n = 3 each). Macroscopic and histological analyses were performed after 40-days. Macroscopy confirmed the repair of all defects in a comparable manner than the C-CTR. Histology showed no degradation nor integration in C-CTR while NFAH-GP and NFAH-GA biomaterials were encapsulated by connective and inflammatory tissues with partial biodegradation. The NFAH were fully biodegraded and replaced by a loose connective tissue and sclera covering the defects. This in vivo study demonstrated that the NFAH are a promising biocompatible and pro-regenerative alternative to the use of allogeneic cadaveric grafts. However, large defects and long-term studies are needed to demonstrate the potential clinical usefulness of these substitutes.


Assuntos
Traumatismos Oculares/cirurgia , Adesivo Tecidual de Fibrina/administração & dosagem , Nanoestruturas/uso terapêutico , Esclera/cirurgia , Sefarose/administração & dosagem , Animais , Materiais Biocompatíveis/uso terapêutico , Masculino , Coelhos , Esclera/lesões
13.
Semin Ophthalmol ; 34(5): 398-402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31284800

RESUMO

Purpose: To compare the success rates and safety of transscleral cyclophotocoagulation (TSCPC) for the treatment of refractory glaucoma using the slow coagulation technique and the conventional technique. Methods: A retrospective, interventional case series of 44 patients (44 eyes) who underwent TSCPC using the slow coagulation technique (22 eyes) and conventional technique (22 eyes) in a tertiary hospital was done. The main outcome measures were success and complications. Success was defined as a final intraocular pressure (IOP) between 6 and 21 mmHg with or without IOP lowering medications with the cessation of oral carbonic anhydrase inhibitor at 12 months. Results: Preoperative characteristics were statistically similar with regard to age, sex, laterality, diagnosis, IOP, and the number of glaucoma medications used. Both procedures had similar success rates of 40.9% and 36.3% in the conventional technique group and slow coagulation group, respectively (p = .757). The slow coagulation group had less prolonged anterior chamber inflammation (p = .048). Conclusions: Diode laser TSCPC using the slow coagulation technique is a safe and effective technique for lowering IOP in patients with refractory glaucoma in Chinese eyes.


Assuntos
Glaucoma/cirurgia , Fotocoagulação a Laser/métodos , Procedimentos Cirúrgicos Oftalmológicos , Esclera/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
BMC Ophthalmol ; 19(1): 164, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357978

RESUMO

BACKGROUND: To investigate the long-term outcomes and complications of scleral-fixated intraocular lens (SFIOL) implantation without conjunctival peritomies and sclerotomy in patients with a history of ocular trauma with inadequate capsular support during primary pars plana vitrectomy or silicone oil removal. METHODS: Records of ocular trauma patients who underwent implantation of SFIOL without conjunctival peritomies and sclerotomy during primary pars plana vitrectomy or silicone oil removal. RESULTS: Sixty-nine eyes of 69 patients were included in this study. The median follow-up period was 34 months (range, 6-99 months). The average patient age at the time of surgery was 44 years old (range, 4-80 years). At the end of follow-up, the preoperative mean of best corrected visual acuity (BCVA) was 0.79 ± 0.86 log of the minimum angle of resolution (logMAR), which improved 0.20 ± 0.26 logMAR postoperatively (P = 0.01). BCVA improved or remained unchanged in 64 eyes (92.8%), VA decreased two lines in five eyes (7.2%). Early postoperative complications included transient corneal edema in seven eyes (10.1%), minor vitreous hemorrhage in four eyes (5.8%), transient elevated intraocular pressure (IOP) in one eye (1.4%), and hypotony in three eyes (4.3%). Late postoperative complications included persistent elevated IOP in five eyes (7.2%), epiretinal membrane formation in three eyes (4.3%), and cystoid macular edema noted in one eye (1.4%). CONCLUSIONS: Use of a scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients during either primary pars plana vitrectomy or second silicone oil removal is a valuable approach for the management of traumatic aphakia in the absence of capsular support.


Assuntos
Afacia/cirurgia , Traumatismos Oculares/complicações , Implante de Lente Intraocular/métodos , Esclera/cirurgia , Técnicas de Sutura , Acuidade Visual , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Afacia/diagnóstico , Afacia/etiologia , Criança , Pré-Escolar , Túnica Conjuntiva , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Vitrectomia , Adulto Jovem
15.
J Craniofac Surg ; 30(7): e590-e593, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31157636

RESUMO

PURPOSE: To compare the results of 3 evisceration techniques involving placement of an acrylic implant within the scleral shell without posterior sclerotomy (Group 1), posterior sclerotomy with placement of a porous implant within the intraconal space (Group 2) and posterior sclerotomy with placement of a acrylic implant within the intraconal space (Group 3) with respect to ocular mobility, implant complications and patient satisfaction. METHODS: Single-center, retrospective, interventional case series. A chart review of 72 patients undergoing evisceration between February 2013 and January 2018 was carried out. Thirty-five patients met the inclusion criteria having a normal or near normal size eye and at least 6 months follow-up. The horizontal movements of the implant and the artificial eye was measured by using a ruler. Data analyses were conducted using the Mann-Whitney U test for 2 independent samples. RESULTS: Neither infection nor prolapse of the implant had occurred in any of the patients. The mean implant sizes were 18 mm in Group 1, 20 mm in Group 2 and 20 mm in Group 3. Statistically, a significant difference was assessed between Group 1 and Group 2 in both nasal and temporal movement of the socket; nasal and temporal movement of the prosthesis. Statistically, a significant difference was assessed between Group 1 and Group 3 in both nasal and temporal movement of the socket; nasal and temporal movement of the prosthesis. However, there was no statistically significant difference between Group 2 and Group 3 in neither nasal and temporal movement of the socket nor nasal and temporal movement of the artificial eye. CONCLUSION: Group 1 showed the significantly better movement of both prosthesis and socket in adduction and abduction than Group 2 and 3. The likely explanation for this may be that preserving the scleral shell integrity allows more efficient transmission of muscle contraction to the socket and prosthesis.


Assuntos
Movimentos Oculares , Adolescente , Adulto , Idoso , Criança , Evisceração do Olho , Olho Artificial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Implantes Orbitários , Satisfação do Paciente , Porosidade , Complicações Pós-Operatórias , Implantação de Prótese/métodos , Estudos Retrospectivos , Esclera/cirurgia , Adulto Jovem
16.
Indian J Ophthalmol ; 67(7): 1200-1202, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238464

RESUMO

Herein, we report a case of in-the-bag dislocation of a WIOL-CF® polyfocal full-optics intraocular lens (IOL), without a history of trauma. A 56-year-old man was referred to our hospital with the chief complaint of sudden-onset visual disturbance in his left eye. He had undergone uneventful phacoemulsification with WIOL-CF® IOL implantation in the left eye at the local clinic 7 years prior. In fundus examination, IOL-capsular bag complex dislocated into the posterior vitreous was observed. We believe this is the first report of in-the-bag dislocation of a WIOL-CF® IOL that has been subluxated or dislocated in a characteristic pattern, not an in-the-bag pattern.


Assuntos
Migração do Implante de Lente Intraocular/diagnóstico , Extração de Catarata/efeitos adversos , Lentes Intraoculares Multifocais/efeitos adversos , Esclera/cirurgia , Acuidade Visual , Migração do Implante de Lente Intraocular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Técnicas de Sutura
17.
J Fr Ophtalmol ; 42(8): 834-838, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31196663

RESUMO

PURPOSE: To describe didactically the local, regional and systemic spread of choroidal melanoma. PATIENTS AND METHODS: Two patients who had undergone primary enucleation for the management of choroidal melanoma in 2018 at the University Hospital of Nice were included. Extrascleral extension and invasion of the vortex veins were evaluated, as well as synchronous and metachronous metastases, based on our database. RESULTS: Patient 1 was diagnosed with large choroidal melanoma with partial scleral invasion and vortex vein involvement. Cytogenetic analysis demonstrated a loss of chromosome 3, and a gain of chromosome 8q. Systemic work-up was unremarkable. Patient 2 was diagnosed with a large choroidal melanoma with extrascleral extension and vortex vein involvement. Cytogenetic analysis demonstrated a loss of chromosome 3 and a gain of chromosome 8q. Systemic work-up revealed several liver metastases. A total of 1762 patients were included in our database. Eighty-five patients (4.8 %) and 46 patients (2.6 %) experienced vortex vein invasion and extrascleral extension respectively. Patients with vortex vein invasion were diagnosed with synchronous and metachronous liver metastases in 1.2 % and 18.8 % respectively. Patients with extrascleral extension had synchronous and metachronous liver metastases in 6.5 % and 30.4 % respectively. The mean follow-up was 49.4 months (1-180). CONCLUSION: Extrascleral extension and vortex vein invasion illustrate the local, regional and systemic spread of choroidal melanoma. The latter are often associated with genetically aggressive tumours associated with high metastatic risk.


Assuntos
Neoplasias da Coroide/patologia , Melanoma/patologia , Idoso , Neoplasias da Coroide/genética , Neoplasias da Coroide/cirurgia , Enucleação Ocular , França , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Melanoma/genética , Melanoma/secundário , Melanoma/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Metástase Neoplásica , Estudos Retrospectivos , Esclera/patologia , Esclera/cirurgia , Doenças da Esclera/patologia , Doenças da Esclera/cirurgia , Neoplasias Uveais/genética , Neoplasias Uveais/patologia , Neoplasias Uveais/secundário , Neoplasias Uveais/cirurgia , Neoplasias Vasculares/genética , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia
18.
Cornea ; 38(7): 855-858, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31170103

RESUMO

PURPOSE: To investigate the success and failure of scleral lens fitting in patients with keratoconus with resolved hydrops. METHODS: Retrospective case series of patients with keratoconus who attended the Ophthalmology Department at Antwerp University Hospital, Belgium, and developed acute hydrops between January 1, 2015, and June 30, 2018. The exclusion criteria included amblyopia, mental retardation, and insufficient follow-up. RESULTS: Of the 25 patients with keratoconus with acute hydrops, 14 patients (16 eyes) were included in this study. Median age was 31 years (range 19-52 years). Before hydrops, the median maximum keratometry value of affected eyes was 81.3 D (range 66.3-108.3 D). Acute hydrops was managed medically in 5 eyes (31.3%), by observation in 5 eyes (31.3%), by application of bandage contact lens in 1 eye (6.3%), and compression corneal sutures in 5 eyes (31.3%). Contact lens fitting after hydrops was not necessary for 2 patients (2 eyes; 12.5%) because of excellent vision in the fellow eye. Of the remaining patients, 11 (68.8%) were successfully fitted with mini-scleral lenses, with a median visual acuity of 0.7 (0.5-0.9; decimal Snellen). Three patients (3 eyes; 18.8%) proceeded to graft surgery because of limited visual acuity with scleral lenses (n = 2) or persistent edema (n = 1). CONCLUSIONS: Scleral lenses are effective for providing satisfactory visual acuity after corneal hydrops in keratoconus. A scleral lens trial is advised before listing patients for graft surgery.


Assuntos
Lentes de Contato , Edema da Córnea/cirurgia , Ceratocone/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Esclera/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Ophthalmol Retina ; 3(6): 468-472, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31174667

RESUMO

PURPOSE: To report refractive outcomes of scleral-fixated intraocular lens (IOL) implantation with Gore-Tex (W.L. Gore & Associates, Newark, DE) suture and combined pars plana vitrectomy and compare predicted refractive outcomes among 5 IOL power calculation formulas. DESIGN: Retrospective case series. PARTICIPANTS: Patients undergoing scleral-fixated IOL implantation with Gore-Tex suture at our institution between January 2015 and June 2018. METHODS: Comparison of preoperative biometrics with postoperative refraction and calculation of predicted refractive outcome with 5 different IOL formulas. MAIN OUTCOME MEASURES: Prediction error and absolute error to compare postoperative refraction with refraction predicted by lens power calculation formulas. RESULTS: Thirty-one eyes of 31 patients were included. All power calculations assumed in-the-bag position of the IOL. The Akreos A060 (Bausch & Lomb, Rochester, NY) was implanted in 23 eyes and the CZ70BD (Alcon, Fort Worth, TX) in 8 eyes, and all lenses were sutured 3 mm behind the limbus. Average postoperative spherical equivalent (SE) was -0.79±0.95 diopters (D). Average prediction error (postoperative SE refraction minus target refraction) was -0.19±0.72 D. Postoperative SE was within 1.0 D of target in 25 of 31 patients (81%) and 2.0 D of target in 31 of 31 patients (100%). The repeated-measures analysis of variance of absolute error by lens power formula was significant (P = 0.012), with Haigis demonstrating greater error. There was no significant difference among Barrett II, Sanders-Retzlaff-Kraff theoretical (SRK/T), Holladay 2, or Hoffer Q. CONCLUSIONS: For eyes undergoing pars plana vitrectomy with scleral-sutured IOL implantation, assumption of in-the-bag IOL position when calculating lens power leads to acceptable refractive outcomes. Barrett II, SRK/T, Holladay 2, and Hoffer Q formulas were noninferior to each other.


Assuntos
Oftalmopatias/cirurgia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Óptica e Fotônica , Refração Ocular/fisiologia , Esclera/cirurgia , Técnicas de Sutura/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Câmara Anterior/cirurgia , Biometria , Oftalmopatias/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Desenho de Prótese , Estudos Retrospectivos , Suturas , Resultado do Tratamento , Acuidade Visual , Vitrectomia/métodos
20.
Indian J Ophthalmol ; 67(7): 1036-1039, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238403

RESUMO

Purpose: To study the changes in corneal astigmatism before and after pterygium excision as well as with differences between various surgical techniques (bare sclera, conjunctival autograft, amniotic membrane graft). Methods: The study population included 71 patients with primary pterygium who underwent surgery. The surgical techniques used differed among the study population. All the patients were preoperatively assessed for visual acuity, anterior and posterior segments, autorefraction, and autokeratometry. After surgery, the patients were assessed for visual acuity, autorefraction, and autokeratometry on day 5, 1 month, and 3 months and the results were analyzed. Paired and unpaired t-tests were used to compare the variables. The probability level of 0.05 was considered as statistically significant. Results: The reduction in the mean preoperative astigmatism of 3.47 ± 1.74 Diopters (D) to 1.10 ± 0.78 D 3 months after surgery was statistically significant (P < 0.0001). Bare sclera, conjunctival autograft, and amniotic membrane graft techniques exhibited changes in astigmatism amounting to 1.85 ± 0.88 D, 2.55 ± 1.26 D, and 2.67 ± 1.44 D, respectively. Pterygium excision surgeries using amniotic membrane graft and conjunctival autograft techniques were more effective than pterygium excision surgery using bare sclera technique in reducing astigmatism. Conclusion: Pterygium excision results in significant reduction in astigmatism which leads to improvement in visual acuity. Amniotic membrane graft and conjunctival autograft are better surgical techniques than bare sclera as far as reducing astigmatism is concerned.


Assuntos
Astigmatismo/diagnóstico , Procedimentos Cirúrgicos Oftalmológicos/métodos , Pterígio/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Adulto , Astigmatismo/etiologia , Autoenxertos , Curativos Biológicos , Túnica Conjuntiva/transplante , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Pterígio/complicações , Esclera/cirurgia , Microscopia com Lâmpada de Fenda , Resultado do Tratamento , Adulto Jovem
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