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1.
Vestn Oftalmol ; 136(4. Vyp. 2): 214-218, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880142

RESUMO

The article presents a clinical case of a functioning hyaloid artery in a 69-year-old patient. The results of OCT-angiography made it possible to detect the presence of blood flow in the projection of the persistent hyaloid artery (PHA) on the cross-section and en-face images. The vascular bed of PHA spreading along the posterior surface of the lens in the form of separate branches was visualized by slit-lamp biomicroscopy. The uniqueness of this clinical case lies in the low probability of such findings in the elderly. The presence of a developing cataract indicates the need for an individual approach in determining treatment strategies. In our opinion, the consistent use of laser coagulation technologies and laser photodestruction of PHA will minimize the risk of hemophthalmos and tractional retinal detachment during the upcoming cataract surgery.


Assuntos
Extração de Catarata , Catarata , Cristalino , Vítreo Primário Hiperplásico Persistente , Descolamento Retiniano , Adulto , Idoso , Humanos
2.
Vestn Oftalmol ; 136(4. Vyp. 2): 289-295, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880153

RESUMO

Postsurgical macular edema, known as Irvine-Gass syndrome, is one of the possible causes of reduced visual acuity in ophthalmic surgery. The article reviews and summarizes data on the main approaches to the treatment of this pathology, discusses the main groups of drugs used to manage postoperative macular edema.


Assuntos
Extração de Catarata , Edema Macular/tratamento farmacológico , Humanos , Injeções Intravítreas , Acuidade Visual , Vitrectomia
3.
Medicine (Baltimore) ; 99(36): e22121, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899096

RESUMO

RATIONALE: Patients with bullous keratopathy (BK) treated by Descemet stripping automated endothelial keratoplasty (DSAEK) have a compromised cornea, due to the administration of topical steroid, postsurgical use of contact lenses, and impaired barrier function of the corneal epithelium by BK. We report a case of Exophiala lecanii-corni (E lecanii-corni) keratitis presenting as a serpiginous pigmented superficial lesion after DSAEK. PATIENT CONCERNS: An 81-year-old woman who had undergone cataract surgeries, suffered from decreased vision in the left eye. She was diagnosed BK and she underwent DSAEK. Two months after DSAEK, a pigmented superficial lesion developed on the left cornea. The lesion migrated and recurred repeatedly and she was referred to our department. Best corrected vision was 20/220. DIAGNOSES: Light microscopy of a corneal scraping revealed branching fungal hyphae. Fungal culture showed growth of a black colony, identified as E lecanii-corni by ribosomal DNA sequencing. INTERVENTIONS: We started topical treatment with 1% voriconazole and 1.5% levofloxacin. Antifungal susceptibility testing showed that the minimum inhibitory concentration of voriconazole was 0.06 µg/mL. OUTCOMES: The lesion scarred after treatment for 3 months, and left best corrected vision improved to 20/40. LESSONS: Genus Exophiala is known as 1 of the "black molds" and a cause of chromomycosis. This is the first description of E lecanii-corni keratitis, and pigmented corneal epithelial lesions may be characteristic of this fungal genus.


Assuntos
Córnea/microbiologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Exophiala , Infecções Oculares Fúngicas/etiologia , Ceratite/etiologia , Idoso de 80 Anos ou mais , Extração de Catarata/efeitos adversos , Feminino , Humanos , Ceratite/microbiologia
4.
Zhonghua Yan Ke Za Zhi ; 56(7): 530-535, 2020 Jul 11.
Artigo em Chinês | MEDLINE | ID: mdl-32842336

RESUMO

Objective: To evaluate the operability and clinical application effects of femtosecond laser-assisted cataract surgery systems of LenSx and LenSAR. Methods: This was a randomized controlled study. A total of 86 patients (90 eyes) who underwent femtosecond laser-assisted cataract surgery in Wuhan Aier Eye Hospital from April 2018 to November 2018 were enrolled and divided into two groups randomly, including 44 patients (45 eyes) in the LenSx group and 42 patients (45 eyes) in the LenSAR group. During the operation, the following observation indexes were obtained. Operational indicators included the number of docking attempts, anterior capsulotomy time, nucleus pre-treatment time, total femtosecond laser emission time, and total vacuum suction duration. Clinical outcome indicators included changes in the patient's intraocular pressure during femtosecond laser surgery, the rate of subconjunctival hemorrhage, capsulotomy integrity (yes/no), roundness and centricity of the anterior capsule opening (yes/no), the rate of anterior capsule opening tear, and the rate of posterior capsule rupture. The t-test, rank-sum test or chi-square test were used for statistical analysis. Results: There were no significant differences between groups in the age and the lens density (both P>0.05). The number of docking attempts in the LenSx group was 1 (1 to 4) and in the LenSAR group was 1 (1 to 2); there was statistically significant difference (Z =-2.23, P<0.05). The difference in the anterior capsulotomy time between the two groups was statistically significant [13.00 (10.00 to 22.00) s compared with 3.00 (1.00 to 3.00) s, Z=-8.71, P<0.05]. The femtosecond laser pre-nucleation time and total femtosecond laser emission time of the LenSx group were (16.67±3.36) s and (30.49±3.53) s, and those of the LenSAR group were (12.38±4.36) s and (15.36±4.29) s, respectively; the differences between the two groups were statistically significant (t=-5.23, -18.26; both P<0.05). The total vacuum suction duration in the LenSx group was (97.23±19.96) s, shorter than that in the LenSAR group [(123.76±16.81) s] (t=6.82, P<0.05). The intraocular pressure after femtosecond laser surgery in both groups was higher than that before surgery. The increase of intraocular pressure in the LenSAR group was (5.64±5.42) mmHg (1 mmHg=0.133 kPa), higher than that in the LenSx group [(2.99±4.66) mmHg] (t=-2.49, P<0.05). The rate of subconjunctival hemorrhage in the LenSx group was 33.3% (15/45), while it was 8.9% (4/45) in the LenSAR group; the difference between the two groups was statistically significant (χ²=6.67, P<0.05). There were no significant differences between groups in capsulotomy integrity, roundness and centricity of the anterior capsule opening, the rate of anterior capsule opening tear, and the rate of posterior capsule rupture (all P>0.05). Conclusion: The docking process of the LenSAR system is convenient, and there is less subconjunctival hemorrhage; the total vacuum suction duration of LenSx is short, and the increase of intraocular pressure is low. (Chin J Ophthalmol, 2020, 56: 530-535).


Assuntos
Extração de Catarata , Catarata , Terapia a Laser , Facoemulsificação , Capsulorrexe , Humanos , Implante de Lente Intraocular , Acuidade Visual
5.
Zhonghua Yan Ke Za Zhi ; 56(8): 615-620, 2020 Aug 11.
Artigo em Chinês | MEDLINE | ID: mdl-32847337

RESUMO

Objective: To analyze the reasons that restrict the growth of cataract surgery service capacity in public hospitals in Shanghai in recent years. Methods: The status of surgeries performed in public hospitals are analyzed based on the data related to cataract surgery collected from the database of Shanghai Eye Disease Treatment. Meanwhile, the surgeries performed by ophthalmologists working in the public hospitals are studied based on the National ophthalmology service capacity questionnaire. Results: The cataract surgery volume performed in public hospitals of Shanghai increased from 45 480 in 2013 to 51 941 in 2015. In 2014, the year on year growth rate of cataract surgery volume in tertiary hospitals was 8.54%, while in 2015, it was -0.21% on an annual basis. More than 70% cataract surgeries were performed in tertiary public hospitals. For those performed in tertiary public hospitals, 80% were performed in urban area. The actual surgeons in tertiary account for 70% of the actual surgeons in all public hospitals. Among all cataract surgeries performed in secondary hospitals, half were performed in urban areas. The volume of cataract surgery by cataract surgeon and the number of the ophthalmologist were higher than those in secondary hospitals. The average cataract surgery volume of tertiary hospitals in urban areas and the average annual cataract surgery volume of the actual surgeons are much higher than those of the secondary hospitals in the urban areas, but it is contrary in exurban areas. Conclusion: The excessive density of tertiary hospitals in urban area and poor ophthalmology service capacity in secondary hospitals in suburban and exurban areas have restricted the rapid growth rate of cataract surgery and even a decline in Shanghai public hospitals. (Chin J Ophthalmol, 2020, 56: 615-620).


Assuntos
Extração de Catarata , Catarata/epidemiologia , Oftalmologia , China , Hospitais Públicos , Humanos
8.
PLoS One ; 15(7): e0235699, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645065

RESUMO

Despite significant evidence around barriers hindering timely access to cataract surgery in low- and middle-income countries (LMICs), little is known about the strategies necessary to overcome them and the factors associated with improved access. Despite significant evidence that certain groups, women for example, experience disproportionate difficulties in access, little is known about how to improve the situation for them. Two reviews were conducted recently: Ramke et al., 2018 reported experimental and quasi-experimental evaluations of interventions to improve access of cataract surgical services, and Mercer et al., 2019 investigated interventions to improve gender equity. The aim of this systematic review was to collate, appraise and synthesise evidence from studies on factors associated with uptake of cataract surgery and strategies to improve the uptake in LMICs. We performed a literature search of five electronic databases, google scholar and a detailed reference review. The review identified several strategies that have been suggested to improve uptake of cataract surgery including surgical awareness campaigns; use of successfully operated persons as champions; removal of patient direct and indirect costs; regular community outreach; and ensuring high quality surgeries. Our findings provide the basis for the development of a targeted combination of interventions to improve access and ensure interventions which address barriers are included in planning cataract surgical services. Future research should seek to examine the effectiveness of these strategies and identify other relevant factors associated with intervention effects.


Assuntos
Extração de Catarata , Acesso aos Serviços de Saúde , Oftalmologia/organização & administração , Extração de Catarata/economia , Extração de Catarata/estatística & dados numéricos , Países em Desenvolvimento , Feminino , Humanos , Gestão da Saúde da População , Pobreza , Sexismo
9.
PLoS One ; 15(7): e0236137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687526

RESUMO

This retrospective study was aimed to compare prediction errors from various combinations of biometric data generated using optical coherence tomography (OCT) and develop a new intraocular lens (IOL) formula using biometric data. 145 eyes from 145 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) were enrolled to the present study and they were divided into a training set (n = 92) and a test set (n = 53). Preoperative axial length (AL) and corneal radius were measured using partial coherence interferometry. The anterior chamber depth (ACD), lens meridian parameter (LMP), lens thickness (LT), thickness of anterior and posterior parts of the crystalline lens (aLT and pLT), and anterior segment length were measured by OCT. From a training set, we developed eight regression equations and analyzed the predictive accuracy. The regression equation using AL, LMP, and pLT (-1.143 + 0.148*AL + 0.428*LMP + 0.254*pLT) showed the strongest correlation with effective lens position (ELP) and smallest standard deviation of ELP prediction error. IOL formula generated using AL, LMP, and pLT yielded the highest predictive accuracy. In a test set, the new IOL formula also produced narrowest range of prediction error, smallest median absolute error, and highest percentages within ±0.25, ±0.50 than existing IOL formulas. The IOL formula considering AL, LMP and pLT will help to improve predictive accuracy in FLACS.


Assuntos
Biometria , Imageamento Tridimensional , Lentes Intraoculares , Tomografia de Coerência Óptica , Idoso , Idoso de 80 Anos ou mais , Extração de Catarata , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Vestn Oftalmol ; 136(3): 93-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32504483

RESUMO

The article describes the factors affecting the target refraction of pseudophakic eyes of children after extraction of congenital cataracts. The factors include features of the echobiometric parameters of the eye, refraction, comorbidity of congenital cataracts and ocular pathologies, margins of error in calculating strength of the intraocular lens, localization and structure of the artificial lens, as well as correction of obscure or refractive amblyopia in pseudophakic eyes. Development of the algorithm for correction of residual refraction of pseudophakic eyes in children both before and after IOL implantation with consideration of each of those factors currently remains a relevant problem.


Assuntos
Extração de Catarata , Catarata , Lentes Intraoculares , Criança , Seguimentos , Humanos , Implante de Lente Intraocular , Pseudofacia , Refração Ocular
11.
Cochrane Database Syst Rev ; 6: CD012648, 2020 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-32584432

RESUMO

BACKGROUND: Presbyopia occurs when the lens of the eyes loses its elasticity leading to loss of accommodation. The lens may also progress to develop cataract, affecting visual acuity and contrast sensitivity. One option of care for individuals with presbyopia and cataract is the use of multifocal or extended depth of focus intraocular lens (IOL) after cataract surgery. Although trifocal and bifocal IOLs are designed to restore three and two focal points respectively, trifocal lens may be preferable because it restores near, intermediate, and far vision, and may also provide a greater range of useful vision and allow for greater spectacle independence in individuals with presbyopia. OBJECTIVES: To assess the effectiveness and safety of implantation with trifocal versus bifocal IOLs during cataract surgery among participants with presbyopia. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 9); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 26 September 2019. We searched the reference lists of the retrieved articles and the abstracts from the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) for the years 2005 to 2015. SELECTION CRITERIA: We included randomized controlled trials that compared trifocal and bifocal IOLs among participants 30 years or older with presbyopia undergoing cataract surgery. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. MAIN RESULTS: We identified five studies conducted in Europe with a total of 175 participants. All five studies assessed uncorrected distance visual acuity (primary outcome of the review), while some also examined our secondary outcomes including uncorrected near, intermediate, and best-corrected distance visual acuity, as well as contrast sensitivity. Study characteristics All participants had bilateral cataracts with no pre-existing ocular pathologies or ocular surgery. Participants' mean age ranged from 58 to 64 years. Only one study reported on gender of participants, and they were mostly women. We assessed all the included studies as being at unclear risk of bias for most domains. Two studies received financial support from manufacturers of lenses evaluated in this review, and at least one author of another study reported receiving payments for delivering lectures with lens manufacturers. Findings All studies compared trifocal versus bifocal IOL implantation on visual acuity outcomes measured on a LogMAR scale. At one year, trifocal IOL showed no evidence of effect on uncorrected distance visual acuity (mean difference (MD) 0.00, 95% confidence interval (CI) -0.04 to 0.04; I2 = 0%; 2 studies, 107 participants; low-certainty evidence) and uncorrected near visual acuity (MD 0.01, 95% CI -0.04 to 0.06; I2 = 0%; 2 studies, 107 participants; low-certainty evidence). Trifocal IOL implantation may improve uncorrected intermediate visual acuity at one year (MD -0.16, 95% CI -0.22 to -0.10; I2= 0%; 2 studies, 107 participants; low-certainty evidence), but showed no evidence of effect on best-corrected distance visual acuity at one year (MD 0.00, 95% CI -0.03 to 0.04; I2= 0%; 2 studies, 107 participants; low-certainty evidence). No study reported on contrast sensitivity or quality of life at one-year follow-up. Data from one study at three months suggest that contrast sensitivity did not differ between groups under photopic conditions, but may be worse in the trifocal group in one of the four frequencies under mesopic conditions (MD -0.19, 95% CI -0.33 to -0.05; 1 study; I2 = 0%, 25 participants; low-certainty evidence). In two studies, the investigators observed that participants' satisfaction or spectacle independence may be higher in the trifocal group at six months, although another study found no evidence of a difference in participant satisfaction or spectacle independence between groups. Adverse events Adverse events reporting varied among studies. Two studies reported information on adverse events at one year. One study reported that participants showed no intraoperative or postoperative complications, while the other study reported that four eyes (11.4%) in the bifocal and three eyes (7.5%) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy. The certainty of the evidence was low. AUTHORS' CONCLUSIONS: There is low-certainty of evidence that compared to bifocal IOL, implantation of trifocal IOL may improve uncorrected intermediate visual acuity at one year. However, there is no evidence of a difference between trifocal and bifocal IOL for uncorrected distance visual acuity, uncorrected near visual acuity, and best-corrected visual acuity at one year. Future research should include the comparison of both trifocal IOL and specific bifocal IOLs that correct intermediate visual acuity to evaluate important outcomes such as contrast sensitivity and quality of life.


Assuntos
Extração de Catarata , Lentes Intraoculares Multifocais , Presbiopia/reabilitação , Acuidade Visual , Opacificação da Cápsula/etiologia , Intervalos de Confiança , Sensibilidades de Contraste , Feminino , Humanos , Implante de Lente Intraocular/efeitos adversos , Implante de Lente Intraocular/métodos , Masculino , Pessoa de Meia-Idade , Lentes Intraoculares Multifocais/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fatores de Tempo
12.
Curr Opin Ophthalmol ; 31(4): 284-287, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487810

RESUMO

PURPOSE OF REVIEW: Intraocular lens (IOL) calculations in patients with keratoconus and other keratoectatic disorders continues to be a challenge for today's cataract surgeon. In this article, we review data published over the past 18 months (June 2018 to January 2020). RECENT FINDINGS: Cataract surgery in keratoconus patients has the potential to greatly improve patients' vision. However, keratoconic eyes are notorious for unpredictable outcomes because of difficulty in obtaining proper preoperative biometry and lack of data and consensus on IOL calculation formulas that can reliable in providing the desired outcome. Recent studies suggest the Barrett II Universal calculation is the most accurate in mild-to-moderate keratoconic eyes. All studies note the level of predictability decreases with the steepness of keratometric readings. Historically, the SRK/T has been shown to provide the most reliable calculations. SUMMARY: There is still no consensus on which formula is best for IOL calculation in keratoconic eyes. On the basis of the most recent literature, we recommend using the Barrett II Universal in conjunction with the SRK/T formula for mild-to-moderate eyes. Preoperative counseling of expectations with the patient is the key to achieving a satisfied patient and avoiding an unpleasant situation in the result of refractive surprise.


Assuntos
Biometria/métodos , Extração de Catarata , Ceratocone/complicações , Lentes Intraoculares , Óptica e Fotônica , Humanos , Ceratocone/fisiopatologia , Acuidade Visual/fisiologia
13.
Curr Opin Ophthalmol ; 31(4): 253-260, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487811

RESUMO

PURPOSE OF REVIEW: The subject of artificial intelligence has recently been responsible for the advancement of many industries including aspects of medicine and many of its subspecialties. Within ophthalmology, artificial intelligence technology has found ways of improving the diagnostic and therapeutic processes in cornea, glaucoma, retina, and cataract surgery. As demands on the modern ophthalmologist grow, artificial intelligence can be utilized to help address increased demands of modern medicine and ophthalmology by adding to the physician's clinical and surgical acumen. The purpose of this review is to highlight the integration of artificial intelligence into ophthalmology in recent years in the areas of cornea, refractive, and cataract surgery. RECENT FINDINGS: Within the realms of cornea, refractive, and cataract surgery, artificial intelligence has played a major role in identifying ways of improving diagnostic detection. In keratoconus, artificial intelligence algorithms may help with the early detection of keratoconus and other ectatic disorders. In cataract surgery, artificial intelligence may help improve the performance of intraocular lens (IOL) calculation formulas. Further, with its potential integration into automated refraction devices, artificial intelligence can help provide an improved framework for IOL formula optimization that is more accurate and customized to a specific cataract surgeon. SUMMARY: The future of artificial intelligence in ophthalmology is a promising prospect. With continued advancement of mathematical and computational algorithms, corneal disease processes can be diagnosed sooner and IOL calculations can be made more accurate.


Assuntos
Inteligência Artificial , Extração de Catarata , Doenças da Córnea/diagnóstico , Procedimentos Cirúrgicos Refrativos , Biometria/métodos , Humanos , Lentes Intraoculares , Óptica e Fotônica
14.
Curr Opin Ophthalmol ; 31(4): 261-267, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487813

RESUMO

PURPOSE OF REVIEW: As keratoconus is a chronic disease affecting young people, vision-related quality of life is often significantly impaired in patients with this disease. However, successful management of keratoconus, including visual rehabilitation strategies, can improve quality of life in these patients. This review will describe clinical approaches that improve vision-related quality of life in patients with stable keratoconus. RECENT FINDINGS: Several types of contact lenses including scleral lenses have been used successfully to manage keratoconus. Eyes with severe keratoconus, even those in which fitting with other types of lenses is challenging, can be successfully fitted with scleral lenses. Although laser ablative procedures, such as photorefractive keratectomy (PRK) have been traditionally contraindicated in patients diagnosed with or suspected of having keratoconus, PRK has been attempted to partially correct refractive errors in keratoconus. Although phototherapeutic keratectomy and radial keratotomy have been reported to be used in eyes with keratoconus, effectiveness and safety results have varied. Implantation of phakic intraocular lenses and intraocular lenses, including toric intraocular lenses, which primarily correct regular astigmatism, with cataract extraction or refractive lens exchange can improve vision-related quality of life in patients with keratoconus by significantly reducing cylinder while improving uncorrected visual acuity. SUMMARY: Appropriate selection and application of treatment options based on consideration of multiple factors will help patients with keratoconus, improving their vision-related quality of life and delaying or avoiding keratoplasty.


Assuntos
Ceratocone/terapia , Qualidade de Vida/psicologia , Transtornos da Visão/reabilitação , Extração de Catarata , Lentes de Contato , Cirurgia da Córnea a Laser , Humanos , Ceratocone/psicologia , Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Transtornos da Visão/psicologia , Acuidade Visual/fisiologia
17.
Indian J Ophthalmol ; 68(7): 1269-1276, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32587150

RESUMO

Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.


Assuntos
Betacoronavirus , Extração de Catarata/normas , Consenso , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Oftalmologia , Pandemias , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Equipamento de Proteção Individual/normas , Pneumonia Viral/transmissão
20.
J Cataract Refract Surg ; 46(5): 806, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32358294
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