Cataract surgery: emotional reactions of patients with monocular versus binocular vision / Cirurgia de catarata: aspectos emocionais de pacientes com visão monocular versus binocular

PURPOSE: To analyze emotional reactions related to cataract surgery in two groups of patients (monocular vision - Group 1; binocular vision - Group 2). METHODS: A transversal comparative study was performed using a structured questionnaire from a previous exploratory study before cataract surgery. RESULTS: 206 patients were enrolled in the study, 96 individuals in Group 1 (69.3 ± 10.4 years) and 110 in Group 2 (68.2 ± 10.2 years). Most patients in group 1 (40.6%) and 22.7% of group 2, reported fear of surgery (p<0.001). The most important causes of fear were: possibility of blindness, ocular complications and death during surgery. The most prevalent feelings among the groups were doubts about good results and nervousness. CONCLUSION: Patients with monocular vision reported more fear and doubts related to surgical outcomes. Thus, it is necessary that phisycians considers such emotional reactions and invest more time than usual explaining the risks and the benefits of cataract surgery.Ouvir.

OBJETIVO: Verificar reações emocionais relacionadas à cirurgia de catarata entre pacientes com visão monocular (Grupo 1) e binocular (Grupo 2). MÉTODOS: Foi realizado um estudo tranversal, comparativo por meio de um questionário estruturado respondido por pacientes antes da cirurgia de catarata. RESULTADOS: A amostra foi composta de 96 pacientes no Grupo 1 (69.3 ± 10.4 anos) e 110 no Grupo 2 (68.2 ± 10.2 anos). Consideravam apresentar medo da cirugia 40.6% do Grupo 1 e 22.7% do Grupo 2 (p<0.001) e entre as principais causas do medo, a possibilidade de perda da visão, complicações cirúrgicas e a morte durante o procedimento foram apontadas. Os sentimentos mais comuns entre os dois grupos foram dúvidas a cerca dos resultados da cirurgia e o nervosismo diante do procedimento. CONCLUSÃO: Pacientes com visão monocular apresentaram mais medo e dúvidas relacionadas à cirurgia de catarata comparados com aqueles com visão binocular. Portanto, é necessário que os médicos considerem estas reações emocionais e invistam mais tempo para esclarecer os riscos e benefícios da cirurgia de catarata.

Cancelamento de cirurgias de catarata em um hospital público de referência / Cancellation of cataract surgery in a public hospital

OBJETIVO: Analisar a incidência e causas de cancelamento de cirurgias de catarata em um hospital público de referência. MÉTODOS: Trata-se de um estudo retrospectivo em que foram analisados o número de cancelamentos de facectomias durante o ano de 2009. Foram analisados sexo, idade, tipo de procedimento suspenso (facoemulsificação ou extração extracapsular do cristalino), tipo de anestesia, convênio (Sistema Único de Saúde ou convênio/particular) e motivo de suspensão da cirurgia (causas clínicas, institucionais ou pessoais). RESULTADOS: Foram agendadas no período 2.965 cirurgias de catarata, havendo 650 cancelamentos (21,92%). Dentre as principais razões para a suspensão do procedimento destacaram-se as causas clínicas (86,90%). Os meses de inverno apresentaram os maiores índices de suspensão de cirurgias de catarata. CONCLUSÃO: A taxa de cancelamento de cirurgia de catarata em serviços públicos parece ser a mesma que há 10 anos. A principal causa de suspensão deve-se por condições clínicas (hipertensão, diabetes, falta de exames, etc.).

PURPOSE: To report the incidence and causes of cataract surgery cancellations in a public hospital. METHODS: This is a retrospective study, which examined the number of cancellations of cataract surgery during 2009. We analyzed the type of procedure suspended (phacoemulsification or extracapsular extraction), type of anesthesia, gender, age, covenant (public/private) and the main reasons for suspension of the surgeries (clinical causes, institutional or personal). RESULTS: We analyzed 2,965 scheduled cataract surgeries, with 650 cancellations (21.92%). The main reason for the suspension of the procedure was clinical causes (86.90%). The winter months had the highest suspension rates of cataract surgery. CONCLUSION: The cancellation rate of cataract surgery in Brazilian public system seems to be the same as 10 years ago. The main cause of the suspension should be in clinical conditions (hypertension, diabetes, lack of exams, etc.).

Microscopic analysis of opacification in Ioflex® hydrophilic acrylic intraocular lenses / Análise microscópica da opacificação de lentes intraoculares acrílicas hidrofílicas Ioflex®

Five cases of intraocular lens (IOL) opacification in patients implanted with the Mediphacos Ioflex® IOL are described. Clinical data in each case was obtained from the patient's medical record. The five explanted IOLs underwent gross and light microscopic analysis. Selected lenses were processed for further evaluation and multiple sagittal cuts were stained with the alizarin red and von Kossa methods. Light microscope analysis confirmed the presence of deposits on and within the lens, which stained positive for calcium. The reason why calcification has occurred in these cases remains unclear, but surgeons should be aware of this potential late postoperative complication.

Cinco casos de opacificação de lente intraocular (LIO) em pacientes implantados com a LIO Ioflex® da Mediphacos são descritos. Os dados clínicos dos pacientes foram obtidos a partir dos prontuários médicos. As cinco LIOs explantadas foram enviadas para análise macroscópica e sob microscopia óptica. Algumas lentes foram processadas para análise adicional e múltiplos cortes sagitais foram corados pelos métodos de vermelho de alizarina e von Kossa. A análise sob microscopia óptica confirmou a presença de depósitos na superfície e no corpo da lente, que coraram positivamente para cálcio. A razão pela qual a calcificação ocorreu nestes casos permanece obscura. Entretanto, cirurgiões devem estar atentos para esta potencial complicação tardia.

Influência da correção cirúrgica da catarata na percepção laborativa / Influence of cataract surgical correction on working perception

Objetivo: Analisar o benefício gerado nas atividades profissionais após a cirurgia de catarata. Métodos: Foi realizado um estudo prospectivo, randomizado, no Hospital das Clínicas da Universidade de São Paulo. Os pacientes foram submetidos à facoemulsificação (FACO) e à extração extracapsular (EECP). Resultados: A amostra foi composta de 205 pacientes, destes, 101 realizaram cirurgia pela técnica de facoemulsificação. A média de idade no grupo da facoemulsificação foi de 68,3 anos ± 9 anos e de 69,1 anos ± 8,5 anos no grupo da extração extracapsular (p=0,70). A porcentagem de pacientes empregados no grupo facoemulsificação foi de 16,83 por cento, e no outro grupo de 13,46 por cento. A maioria dos pacientes que não remunerados formalmente sentiu-se motivada a procurar trabalho. A maioria dos analisados relatou aumento da produtividade no trabalho após a cirurgia, 82,50 por cento no grupo facoemulsificação e 78,60 por cento no grupo extração extracapsular (p=0,20). Conclusão: A cirurgia de catarata por ambas as técnicas proporcionou melhora da produtividade no trabalho, e estimulou indivíduos economicamente inativos a procurar trabalho remunerado.

Purpose: To analyze the benefits after cataract surgery in professional activities. Methods: A prospective, randomized study was conducted at the Clinical Hospital of the University of São Paulo. The patients had cataract surgery by phacoemulsification (PHACO) and by extracapsular extraction (EECP). Results: The sample consisted of 205 patients, 101 of these, submitted to phacoemulsification. The mean age in phacoemulsification group was 68.3 years ± 9 years and 69.1 years ± 8.5 years in extracapsular extraction group (p=0.70). The percentage of patients employed in phacoemulsification group was 16.83 percent, and in the extracapsular extraction group of 13.46 percent. Most patients who were not employed felt motivated to seek work. Most of the patients increased their productivity at work after surgery, 82.50 percent in the phacoemulsification group, and 78.60 percent in the other group (p=0.20). Conclusion: Cataract surgery of both techniques has improved the productivity at work and encouraged economically inactive individuals to seek employment.

Phacoemulsification versus extracapsular extraction: governmental costs

PURPOSE: To evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country. METHODS: A prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques. RESULTS: Of the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated. CONCLUSION: Under the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.

Mini-rhexis for white intumescent cataracts

PURPOSE: To compare the intraoperative safety of two techniques of capsulorhexis for intumescent white cataracts: traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis. METHODS: This prospective comparative randomized study included two groups: the 1-CCC group (11 patients) received traditional one-stage continuous curvilinear capsulorhexis with 5-6 mm diameter, and the 2-CCC (13 patients) group received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged, or a two-stage continuous curvilinear capsulorhexis. Patients were stratified according to cataract subset, which was characterized echographically. Six patients were considered as type 1, fifteen as type 2 and three as type 3. Type 1 included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections, type 2 included white cataracts with voluminous nuclei, a small amount of whitish solid cortex, and minimal internal acoustic reflections, and type 3 included white cataracts with fibrous anterior capsules and few internal echo spikes. RESULTS: With the one-stage technique, 46.15 percent of patients had leakage of the liquefied cortex; in addition, the surgeon perceived high intracapsular pressure in 61.53 percent of cases. Anterior capsule tears occurred in 23.07 percent of cases, discontinuity of capsulorhexis in 30.79 percent of cases and no posterior capsular rupture occurred. With the two-stage technique, leakage of the liquefied cortex occurred in 45.45 percent of cases; additionally, the surgeon perceived high intracapsular pressure in 36.36 percent of cases. No anterior capsule tears, discontinuity of capsulorhexis or posterior capsular rupture occurred. Considering each cataract subset, there was a higher incidence of leakage for type 2 as compared to types 1 and 3. CONCLUSIONS: Two-stage continuous curvilinear capsulorhexis helps prevent unexpected ...