Perception of difficulties with vision-related activities of daily living among patients undergoing unilateral posterior capsulotomy

OBJECTIVES: To assess the influence of Nd:YAG (neodymium: yttrium-aluminum- garnet) laser unilateral posterior capsulotomy on visual acuity and patients' perception of difficulties with vision-related activities of daily life. METHODS: We conducted an interventional survey that included 48 patients between 40 and 80 years of age with uni- or bilateral pseudophakia, posterior capsule opacification, and visual acuity <0.30 (logMAR) in one eye who were seen at a Brazilian university hospital. All patients underwent posterior capsulotomy using an Nd:YAG laser. Before and after the intervention, patients were asked to complete a questionnaire that was developed in an exploratory study. RESULTS: Before posterior capsulotomy, the median visual acuity (logMAR) of the included patients was 0.52 (range 0.30-1.60). After posterior capsulotomy, the median visual acuity of the included patients improved to 0.10 (range 0.0-0.52). According to the subjects' perceptions, their ability to perform most of their daily life activities improved after the intervention (p<0.05). CONCLUSIONS: After patients underwent posterior capsulotomy with an Nd:YAG laser, a significant improvement in the visual acuity of the treated eye was observed. Additionally, subjects felt that they experienced less difficulty performing most of their vision-dependent activities of daily living.

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 ...

Avaliação do uso do anel endocapsular modificado em casos de subluxação traumática do cristalino / Evaluation of the modified capsular tension ring in cases of traumatic lens subluxation

OBJETIVO: Avaliar o comportamento do anel modificado de tensão capsular em cataratas traumáticas com subluxação, analisando a acuidade visual, centração do saco capsular, pseudofacodonese, seguimento pós-operatório, e complicações intra e pós-operatórias. LOCAL: Cincinnati Eye Institute, Cincinnati, Ohio, USA. MÉTODOS: Vinte e dois olhos de 22 pacientes com perda traumática de suporte zonular foram submetidos à facoemulsificação utilizando lente intra-ocular de câmara posterior e o implante do anel capsular modificado. O exame pré-operatório incluiu melhor acuidade visual corrigida (MAVC), a presença ou ausência de facodonese, descentração do cristalino e prolapso vítreo. A avaliação pós-operatória incluiu MAVC, presença de pseudofacodonese, centração do implante, necessidade de vitrectomia e outras complicações. RESULTADOS: Vinte e um olhos (95,45 por cento) tiveram melhora da MAVC. O exame pré-operatório revelou facodonese em 11 olhos (50 por cento) e nenhum olho apresentou pseudofacodonese. No exame pré-operatório, a descentração sintomática estava presente em 10 olhos (45,45 por cento). Todos os olhos apresentaram centração do complexo saco capsular/LIO no pós-operatório. Prolapso vítreo foi diagnosticado antes da cirurgia em 9 olhos (40,90 por cento) e a vitrectomia foi necessária em 11 olhos (50 por cento). CONCLUSÃO: O uso do anel modificado de tensão capsular resultou em boa centração do complexo saco capsular/lente intra-ocular nos olhos estudados com catarata traumática e perda de suporte zonular.

PURPOSE: To evaluate the behavior of the modified capsular tension ring (MCTR) in traumatic subluxated cataracts analyzing the visual acuity, centration of the capsular bag, pseudophacodonesis, postoperative follow-up and intra- and postoperative complications. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Twenty-two eyes of 22 patients with traumatic loss of zonular support had phacoemulsification using PCIOL and MCTR implantation. The preoperative examination included best correct visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration and vitreous prolapse. The postoperative evaluation included BCVA, the presence of pseudophacodonesis, PCIOL centration, necessity of vitrectomy and other complications. RESULTS: 21 eyes (95.45 percent) had an improvement in BCVA. The preoperative examination disclosed phacodonesis in 11 eyes (50 percent) and no eye presented pseudophacodonesis in the postoperative period. Preoperatively, symptomatic decentration was presented by 10 eyes (45.45 percent) and 22 eyes (100 percent) had no decentration after surgery. The preoperative examination revealed vitreous prolapse in the anterior chamber in 9 eyes (40.90 percent). Vitrectomy was required in 11 eyes (50 percent). CONCLUSIONS: The use of the MCTR resulted in a good centration of the capsular bag and the PC IOL in 22 eyes with traumatic cataract and loss of zonular support.