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1.
Ophthalmology ; 127(4S): S29-S42, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32200823

RESUMO

OBJECTIVE: (1) To report the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy rate (%) of eight rigid and foldable intraocular lens (IOL) designs in a series of 5416 pseudophakic human eyes obtained postmortem, accessioned in our center between January 1988 and January 2000. (2) To identify factors that are instrumental in reducing the incidence of posterior capsule opacification, (PCO, secondary cataract) and hence the need for Nd:YAG laser posterior capsulotomy. DESIGN: Comparative autopsy tissue analysis. PARTICIPANTS: A total of 5416 globes with posterior chamber intraocular lens (PC-IOLs) obtained postmortem received from Lions Eye Banks between 1988 and 2000. METHODS: Miyake-Apple posterior photographic technique. Special reference was given to the presence or absence of Nd:YAG laser posterior capsulotomy orifice on the posterior capsule of each eye. MAIN OUTCOME MEASURES: The Nd:YAG laser posterior capsulotomy rate (%) as of January 2000 was documented. In addition, the Nd:YAG laser posterior capsulotomy rate for each lens was plotted on a monthly basis for the same period, creating a computerized trend or "timeline" for each IOL style. RESULTS: Relatively high Nd:YAG laser posterior capsulotomy rates ranging from 20.3% to 33.4% were noted with four relatively older designs (high incidence of implantation between 1988 and the early 1990s). Four modern foldable lOLs manufactured from silicone and acrylic materials had significantly lower Nd:YAG laser posterior capsulotomy rates ranging from 0.9% (Alcon Acrysof) to 17.1%. The difference in Nd:YAG rates among the eight IOL designs was found to be significant (P < 0.0001, chi-square test). Comparing foldable versus rigid designs, the foldable IOLs were associated with a much lower Nd:YAG laser posterior capsulotomy rate (14.1% vs. 31.1%). CONCLUSIONS: By use of the six factors regarding surgical technique and IOL choice described in this article, we strongly believe that the overall incidence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing from rates as high as 50% in the 1980s to early 1990s. Surgical tools and IOLs are now available to bring these rates down to single digits. Careful application and use of these tools by surgeons can genuinely lead in the direction of virtual eradication of secondary cataract, the second most common cause of visual loss worldwide.


Assuntos
Opacificação da Cápsula/prevenção & controle , Terapia a Laser/estatística & dados numéricos , Lasers de Estado Sólido/uso terapêutico , Capsulotomia Posterior/estatística & dados numéricos , Pseudofacia/etiologia , Idoso , Autopsia , Documentação , Feminino , Humanos , Implante de Lente Intraocular , Lentes Intraoculares , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos
2.
Arch Phys Med Rehabil ; 92(3): 457-63, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21353827

RESUMO

OBJECTIVE: To examine differences in perceived quality of life (QOL) at 1 year postinjury between people with tetraplegia who required mechanical ventilation assistance at discharge from rehabilitation and those who did not. DESIGN: Prospective cross-sectional examination of people with spinal cord injury (SCI) drawn from the SCI Model Systems National Database. SETTING: Community. PARTICIPANTS: People with tetraplegia (N=1635) who sustained traumatic SCI between January 1, 1994, and September 30, 2008, who completed a 1-year follow-up interview, including 79 people who required at least some use of a ventilator at discharge from rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Satisfaction With Life Scale (SWLS); Craig Handicap Assessment and Reporting Technique (CHART)-Short Form Physical Independence, Mobility, Social Integration, and Occupation subscales; Patient Health Questionnaire-9 (PHQ-9), Medical Outcomes Study 36-Item Short-Form Health Survey self-perceived health status. RESULTS: Significant differences were found between the ventilator-user (VU) group and non-ventilator-user (NVU) group for cause of trauma, proportion with complete injury, neurologic impairment level, and number of rehospitalizations. The NVU group had significantly higher SWLS and CHART Social Integration scores than the VU group after controlling for selected covariates. The NVU group also had more positive perceived health status compared with a year previously and a lower incidence of depression assessed by using the PHQ-9 than the VU group. There were no significant differences between groups for perceived current health status. CONCLUSIONS: People in this study who did not require mechanical ventilation at discharge from rehabilitation post-SCI reported generally better health and improved QOL compared with those who required ventilator assistance at 1 year postinjury. Nonetheless, the literature suggests that perceptions of QOL improve as people live in the community for longer periods.


Assuntos
Nível de Saúde , Quadriplegia/psicologia , Qualidade de Vida/psicologia , Respiração Artificial/psicologia , Traumatismos da Medula Espinal/psicologia , Adulto , Estudos Transversais , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Quadriplegia/etiologia , Quadriplegia/reabilitação , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Índices de Gravidade do Trauma
3.
Ophthalmology ; 115(1): 73-9, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17498804

RESUMO

OBJECTIVE: To define and classify the major types of intraocular lens (IOL) calcification. DESIGN: Retrospective observational case series with clinicopathologic correlation. PARTICIPANTS: More than 400 IOLs explanted because of opacification. METHODS: The authors reviewed the clinical information and histologic findings of all IOLs that had been explanted because of opacification or calcification of the IOLs accessioned in their laboratory between January 1999 and December 2004. MAIN OUTCOME MEASURE: The proposed mechanism that led to calcification of each IOL design. RESULTS: Three major types of calcification were identified: (1) primary calcification, (2) secondary calcification, and (3) false-positive calcification or pseudocalcification. The primary form refers to calcification that is inherent in the IOL, that is, is based on possible inadequate formulation of the polymer, fabrication of the IOL, or issues with its packaging process. The calcification presumably occurs in otherwise normal eyes and generally is not associated with preexisting diseases. The secondary form refers to deposition of calcium onto the surface of the IOL most likely the result of environmental circumstances (e.g., changes in the aqueous milieu surrounding the implanted IOL associated with preexisting or concurrent diseases or indeed any condition that has disrupted the blood-aqueous barrier). By definition, it is not related to any problem with the IOL itself. The false-positive or pseudocalcification refers to those cases in which other pathology is mistaken for calcification or false-positive staining for calcium occurs. CONCLUSIONS: When evaluating the pathogenesis and nature of IOL calcification in or on any given design, one should categorize it according to these types. Primary calcification is IOL related and the IOL should be withdrawn or modified to correct the problem. After the cause is identified and the lens is implanted again, patients should be followed up for up to 2 years to be sure the problem is alleviated. Secondary calcification is by definition not IOL related; it may occur with virtually all IOL designs implanted under various adverse circumstances. No IOL, hydrophilic or hydrophobic, is immune to secondary calcification. The false-positive form is recognized readily in the laboratory and this erroneous diagnosis is avoided.


Assuntos
Calcinose/classificação , Lentes Intraoculares/classificação , Materiais Biocompatíveis , Calcinose/etiologia , Remoção de Dispositivo , Humanos , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos
4.
Ophthalmic Surg Lasers Imaging ; 39(3): 214-6, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18556942

RESUMO

BACKGROUND AND OBJECTIVE: To investigate the surface light scatter and optical quality of AcrySof lenses (Alcon Laboratories, Inc., Fort Worth, TX) following simulated aging of 20 years. MATERIALS AND METHODS: AcrySof lenses were exposed to exaggerated thermal conditions to simulate up to 20 years of aging and were tested for surface light scatter and optical quality (modulation transfer function). RESULTS: There were no significant differences from baseline for either the surface light scatter or optical quality of the lenses over time. CONCLUSION: The current study demonstrated that surface light scatter on AcrySof lenses did not increase under conditions simulating 20 years of aging. Because the simulated aging environment contained no protein, this work indirectly supports the finding that surface light scatter is due to the deposition of a biomaterial on the lens surface rather than changes in the material. Optical performance integrity of the test lenses was maintained under severe environmental conditions.


Assuntos
Resinas Acrílicas , Lentes Intraoculares , Óptica e Fotônica , Espalhamento de Radiação , Propriedades de Superfície , Proteínas do Olho/metabolismo , Humanos , Luz , Ligação Proteica
5.
Ophthalmic Surg Lasers Imaging ; 39(3): 209-13, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18556941

RESUMO

BACKGROUND AND OBJECTIVE: To investigate the cause of light scatter measured on the surface of AcrySof intraocular lenses (Alcon Laboratories, Inc., Fort Worth, TX) retrieved from pseudophakic postmortem human eyes. MATERIALS AND METHODS: Ten intraocular lenses (Alcon AcrySofModel MA60BM) were retrieved postmortem and analyzed for light scatter before and after removal of surface-bound biofilms. RESULTS: Six of the 10 lenses exhibited light scatter that was clearly above baseline levels. In these 6 lenses, both peak and average pixel density were reduced by approximately 80% after surface cleaning. CONCLUSION: The current study demonstrates that a coating deposited in vivo on the lens surface is responsible for the light scatter observed when incident light is applied.


Assuntos
Resinas Acrílicas , Lentes Intraoculares , Óptica e Fotônica , Pseudofacia/complicações , Espalhamento de Radiação , Propriedades de Superfície , Proteínas do Olho/metabolismo , Humanos , Luz , Ligação Proteica
6.
Neurorehabil Neural Repair ; 21(6): 539-50, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17507642

RESUMO

OBJECTIVE: To demonstrate criterion (concurrent and predictive) and construct validity of the Walking Index for Spinal Cord Injury (WISCI) scale and other walking measures in the Spinal Cord Injury Locomotor Trial (SCILT). DESIGN: Prospective multicenter clinical trial of a walking intervention for patients with acute traumatic spinal cord injury (SCI). PARTICIPANTS/ METHODS: Body weight-supported treadmill training was compared to overground mobility training in 146 patients with incomplete SCI (C4 to L3) enrolled within 8 weeks of onset and treated for 12 weeks. Primary outcome measures were the Functional Independence Measure (FIM), 50-foot walking speed (50FW-S), and 6-minute walking distance (6MW-D), tested 3, 6, and 12 months after entry. Secondary measures were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), WISCI, and FIM locomotor score (LFIM), assessed at 6 centers by blinded observers. Data for the 2 arms were combined since no significant differences in outcomes had been found. RESULTS: Correlations with WISCI at 6 months were significant with BBS (r = .90), LEMS (r = .85), LFIM (r = .89), FIM (r = .77), 50FW-S (r = .85), and 6MW-D ( r = .79); similar correlations occurred at 3 and 12 months. Correlations of change scores from baseline WISCI were significant for change scores from baseline of LEMS/BBS/LFIM. Correlation of baseline LEMS and WISCI at 12 months were most significant (r = .73). The R(2) of baseline LEMS explained 57% of variability of WISCI levels at 3 months. CONCLUSION: Concurrent validity of the WISCI scale was supported by significant correlations with all measures at 3, 6, and 12 months. Correlation of change scores supports predictive validity. The LEMS at baseline was the best predictor of the WISCI score at 12 months and explained most of the variance, which supported both predictive and construct validity. The combination of the LEMS, BBS, WISCI, 50FW-S, and LFIM appears to encompass adequate descriptors for outcomes of walking trials for incomplete SCI.


Assuntos
Avaliação da Deficiência , Terapia por Exercício/normas , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Caminhada/normas , Adolescente , Adulto , Idoso , Muletas , Teste de Esforço/métodos , Teste de Esforço/normas , Terapia por Exercício/métodos , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Andadores
7.
Br J Ophthalmol ; 91(8): 1070-2, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17135340

RESUMO

AIM: To evaluate the R-INJ-04 soft-tipped injector, a new injector with an integral round nozzle manufactured by Rayner Intraocular Lenses, England. METHODS: 16 Rayner C-flex intraocular lenses (IOLs; Rayner Intraocular lenses, England) ranging between +10 and +30 D (2 for each power) were tested. An ophthalmic viscoelastic device (Healon, AMO, Santa Ana, California, USA) was applied to the injectors. The IOLs were loaded according to the company injector's instructions for use and were injected into a Petri dish. After the injection, all the IOLs and nozzles were evaluated by gross (macroscopic) and microscopic analyses and photographed under a light microscope. One lens of each power and the cartridge used for the implantation were then sent for further analysis by scanning electron microscopy (SEM). The rest of the IOLs were tested for power and modulation transfer function (MTF). RESULTS: All the injections were successful. No damage to the IOLs or to the injectors was found by gross examination, light microscopy and SEM. No deposits were found on the IOL optical surfaces or haptics. Power and MTF analysis showed a close match with the original measurements. CONCLUSION: Our results suggest that the R-INJ-04 soft-tipped injector is safe for the implantation of the C-flex IOL with power range from 10 to 30 D. No structural damage to the IOLs or to the injectors was found, and the lens power and light transmission properties were not damaged in any way by the injection process.


Assuntos
Implante de Lente Intraocular/instrumentação , Lentes Intraoculares , Humanos , Instrumentos Cirúrgicos/normas
8.
J Cataract Refract Surg ; 33(1): 81-7, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17189798

RESUMO

PURPOSE: To study the 360-degree barrier effect of an intraocular lens (IOL) with a square edge at the optic and an enhanced square edge at the optic-haptic junctions (Rayner 570C C-flex) on centripetal migration of lens epithelial cells (LECs) over a 2-year period. SETTING: Department of Ophthalmology, Scarborough Hospital, Scarborough, United Kingdom. METHODS: In a prospective study of 40 consecutive eyes, a C-flex IOL was implanted in the bag after phacoemulsification surgery. Eyes with intraoperative complications, requiring additional procedures, without 360-degree overlap of the optic, or with capsule block syndrome were excluded. Follow-up was at 6, 10, 18, and 24 months. At each visit, high-magnification retroillumination digital photographs were taken using a slitlamp-attached digital camera. The barrier effect to LEC migration across the optic edge and the enhanced square edge at the optic-haptic junction was graded as complete (no epithelial pearls or sheet), partial (few epithelial pearls without sheet), and minimal/none (epithelial sheet behind the IOL optic). RESULTS: Twenty-four patients came to the final follow-up at 24 months. Fifteen of these eyes (63%) had a complete barrier effect throughout the 360 degrees of the IOL. Three eyes (13%) had a partial barrier effect throughout the 360 degrees of the IOL. Three eyes had a complete optic barrier effect but a partial optic-haptic junction barrier effect. Three eyes had a partial optic barrier effect but a complete optic-haptic junction barrier effect. No eye had epithelial sheets extending behind the optic at any location. CONCLUSIONS: This study showed the barrier effect of the edge design of the C-flex IOL and the efficacy of the enhanced edge in preventing LEC migration at the optic-haptic junction. The enhanced edge was as effective as a sharp square edge in restricting the LEC migration.


Assuntos
Movimento Celular/fisiologia , Células Epiteliais/fisiologia , Implante de Lente Intraocular , Cristalino/citologia , Lentes Intraoculares , Facoemulsificação , Resinas Acrílicas , Catarata/prevenção & controle , Seguimentos , Humanos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Desenho de Prótese
9.
Ophthalmology ; 113(4): 591-7, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16581421

RESUMO

PURPOSE: To describe a new modification of the Miyake-Apple posterior video photographic technique and its 2 variations. We have developed a new endoscopic technique that is especially amenable for observation of modern specialized intraocular lenses (IOLs). DESIGN: Laboratory study. PARTICIPANT: Three cadaver eyes obtained postmortem. METHODS: Human eyes obtained postmortem were prepared according to our modified preparation technique used for analyses of whole globes. An intraocular endoscope was utilized to demonstrate all aspects of the interior of an experimentally implanted IOL, with specialized reference to anterior segment structures, obtaining posterior, oblique, and side view images. MAIN OUTCOME MEASURES: Different interior dynamic views of the anterior segment structures before and after implantation of an IOL. RESULTS: High-magnification images of different intraocular structures both before and after device insertion as well as the device itself were obtained. Oblique and side view images from different locations were also available and informative. These images helped to create a 3-dimensional view of these objects and their relations to the surrounding structures. CONCLUSION: The combination of the intraocular endoscope with the closed-system technique is a useful addition to our 3 previously described techniques: (1) the original Miyake-Apple posterior video/photograph technique and the (2) closed system and (3) side/oblique view (keyhole technique) modifications.


Assuntos
Segmento Anterior do Olho/anatomia & histologia , Endoscopia/métodos , Implante de Lente Intraocular , Lentes Intraoculares , Fotografação/métodos , Humanos
10.
Surv Ophthalmol ; 51(6): 561-75, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17134646

RESUMO

Marfan syndrome is a widespread disorder of connective tissue. It is characterized by systemic and ocular features due to mutations in the fibrillin gene. Awareness and prompt recognition of the ocular complications of Marfan syndrome may enable improvement and preservation of sight. Studies have been performed in the last few years that enable a better understanding of the genetics of the syndrome, earlier diagnosis, and improvement in the surgical techniques and options.


Assuntos
Oftalmopatias/etiologia , Síndrome de Marfan/complicações , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Humanos , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/terapia
11.
Am J Ophthalmol ; 142(4): 557-62, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17011844

RESUMO

PURPOSE: To evaluate the pattern of lens epithelial cell (LEC) ingrowth behind the intraocular lens (IOL) optic in patients implanted with the AcrySof SA60AT one-piece IOL. DESIGN: Retrospective case series. METHODS: Patients implanted with the AcrySof SA60AT one-piece IOL with complete overlap of the capsulorrhexis and IOL optic and no ocular pathology were selected from the practices of six surgeons. High-resolution digital images of the distribution of LECs were captured. Circumferential location and extent of LEC growth behind the optic were measured. RESULTS: Mean +/- SD follow-up was 13.2 +/- 1.7 months for 40 patients (mean age 72 years). LEC migration beyond the edge of the IOL optic was displayed by 57.5% (23/40) of patients. LECs migrated into the visual axis in 22.5% (9/40) of patients, leading to a visual acuity of <6/9 (20/30) in 10% (4/40) of patients. Cell migration was located preferentially at the optic-haptic junction. Serial photographs were used to monitor LEC migration over time. In some cases, LECs extended from the opposing optic-haptic junctions to converge in the center of the IOL, creating a path across the optic. CONCLUSIONS: The optic-haptic junction of the AcrySof one-piece IOL is a point of weakness in the barrier effect of the square-edge IOL design that provides migrating LECs access to the posterior capsule.


Assuntos
Resinas Acrílicas , Movimento Celular/fisiologia , Células Epiteliais/fisiologia , Cristalino/patologia , Lentes Intraoculares , Idoso , Idoso de 80 Anos ou mais , Catarata/patologia , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Cápsula do Cristalino/patologia , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Fotografação , Complicações Pós-Operatórias , Estudos Retrospectivos
12.
J Cataract Refract Surg ; 32(10): 1722-6, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17010874

RESUMO

PURPOSE: To evaluate the survival of the capsular bag without the support of functional lens epithelial cells (LECs). SETTING: David J. Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: One hundred slides of cadaver pseudophakic eyes (from 1991 to 2000) stained with hematoxylin and eosin were analyzed to determine the presence of Soemmering's ring, integrity of the capsular bag, fixation configuration of the haptics, and presence and functionality of the LECs. RESULTS: A Soemmering's ring was present in 69% of cases. The capsular bags were intact in 100% of cases. In-the-bag fixation was seen in 44% of cases. In 89% of cases, either no cells or nonfunctional LECs were found. CONCLUSION: Results suggest the capsular bag can survive anatomically without the support of functioning LECs.


Assuntos
Células Epiteliais/citologia , Cápsula do Cristalino/fisiologia , Seguimentos , Humanos , Cápsula do Cristalino/citologia , Cápsula do Cristalino/cirurgia , Pseudofacia/complicações
13.
J Cataract Refract Surg ; 32(8): 1385-7, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16863980

RESUMO

The iris-claw intraocular lens (IOL) was recently approved by the U.S. Food and Drug Administration for the correction of refractive disorders. Previous reports are not uniform regarding its potential to induce inflammatory reaction. We report the case of a young healthy patient who experienced persistent and intolerable iritis after implantation of an iris-claw IOL. The iritis was resolved only after explantation of the IOL.


Assuntos
Iris/cirurgia , Irite/etiologia , Implante de Lente Intraocular/efeitos adversos , Cristalino/fisiologia , Miopia/cirurgia , Remoção de Dispositivo , Feminino , Humanos , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Pessoa de Meia-Idade , Recidiva , Reoperação
14.
J Cataract Refract Surg ; 32(9): 1503-8, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16931263

RESUMO

PURPOSE: To analyze the clinical presentation and implications of cavity or schisis formation in the MemoryLens (CIBA Vision) intraocular lens (IOL) optic. SETTING: Eye Department, Red Cross Hospital, Munich, Germany. METHODS: This study was a retrospective chart review and slitlamp photography analysis of IOL schisis. RESULTS: Four patients with IOL schisis were identified and their charts analyzed. Clinically, the schisis presented as a sharply demarcated round structure. The aspect was clear on coaxial illumination, but on tangential illumination the schisis area was opaque. Patients experienced glare, foggy vision, and deteriorated visual function or had no symptoms. One patient lost visual acuity, and the IOL was explanted. CONCLUSIONS: Clinically, IOL schisis was easily differentiated from cases of IOL opacification due to calcification. The clinical implication was not uniform, ranging from no symptoms to great visual disturbance leading to explantation of the IOL. The cause of this complication remains unclear. A possible explanation is the impact of solvent-induced tensile stress on the IOL optic material during the manufacturing process.


Assuntos
Ofuscação , Lentes Intraoculares/efeitos adversos , Falha de Prótese , Transtornos da Visão/etiologia , Idoso , Remoção de Dispositivo , Feminino , Humanos , Masculino , Reoperação , Estudos Retrospectivos , Acuidade Visual
15.
J Cataract Refract Surg ; 32(5): 879-86, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16765810

RESUMO

We report 2 intraocular lenses (IOLs) manufactured from the same hydrophilic acrylic polymer by Ioltech that developed optic opacification. In both cases, the postoperative course after implantation of the IOLs was complicated by significant inflammatory reaction with fibrin formation in the anterior chamber. Pathologic analyses of the explanted IOLs were consistent with dystrophic calcification leading to optic opacification, but the pattern was different between the 2 IOL designs. Patient-related factors might have been responsible for this complication.


Assuntos
Resinas Acrílicas , Calcinose/etiologia , Lentes Intraoculares , Falha de Prótese , Idoso , Calcinose/patologia , Cálcio/análise , Remoção de Dispositivo , Microanálise por Sonda Eletrônica , Feminino , Humanos , Implante de Lente Intraocular , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Facoemulsificação , Fosfatos/análise , Reoperação
16.
J Cataract Refract Surg ; 32(10): 1717-21, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17010873

RESUMO

PURPOSE: To evaluate the ability and safety of a hydrophilic acrylic intraocular lens (IOL) as a drug-delivery system for commercially available gatifloxacin and moxifloxacin. SETTING: David J. Apple, MD, Laboratories for Ophthalmic Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: Thirty rabbits were divided into 2 similar groups. In Group A (15 rabbits, 30 eyes), hydrophilic acrylic IOLs (C-flex, Rayner Intraocular Lenses, Ltd.) presoaked for 24 hours in commercially available solutions of gatifloxacin 3 mg/mL or moxifloxacin 5 mg/mL were implanted after evacuation of the crystalline lens. Group B (15 rabbits, 30 eyes) had topical preoperative and postoperative cataract prophylaxis with gatifloxacin 3 mg/mL or moxifloxacin 5 mg/mL; IOLs that were not presoaked were also implanted after evacuation of the crystalline lenses. In both groups, aqueous humor samples were taken 4, 8, or 12 hours after IOL implantation (5 eyes at each time point) to determine the antibiotic concentrations. Clinical examinations were performed 24 hours postoperatively. RESULTS: The antibiotic concentrations in Group A (presoaked IOLs) were statistically significantly higher than those in Group B (topical) for both antibiotics in all postoperative samples except moxifloxacin at 12 hours. In both groups, there was no statistically significant difference between the concentrations of the 2 antibiotics. No eye showed signs of clinical toxicity. CONCLUSION: Results show the C-flex IOL is a safe and effective drug-delivery system for fourth-generation fluoroquinolones.


Assuntos
Resinas Acrílicas , Antibacterianos/administração & dosagem , Compostos Aza/administração & dosagem , Sistemas de Liberação de Medicamentos , Fluoroquinolonas/administração & dosagem , Lentes Intraoculares , Quinolinas/administração & dosagem , Animais , Antibacterianos/farmacocinética , Humor Aquoso/metabolismo , Compostos Aza/farmacocinética , Disponibilidade Biológica , Feminino , Fluoroquinolonas/farmacocinética , Gatifloxacina , Implante de Lente Intraocular , Cristalino/cirurgia , Moxifloxacina , Quinolinas/farmacocinética , Coelhos
17.
J Cataract Refract Surg ; 32(4): 652-4, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16698489

RESUMO

PURPOSE: To evaluate the ability of a hydrophilic acrylic intraocular lens (IOL) to serve as a drug-delivery system for commercially available gatifloxacin and moxifloxacin. SETTING: David J. Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Hydrophilic acrylic IOLs (C-flex, Rayner Ltd.), presoaked for 24 hours in commercially available solutions of gatifloxacin (Zymar) or moxifloxacin (Vigamox), were implanted in the capsular bag of 6 rabbits for a total of 12 eyes (6 in each group). Aqueous humor samples were taken 2, 4, and 6 hours after implantation. One rabbit served as a control and had nonpresoaked C-flex IOLs implanted. At the end of the operation, 1 drop of Vigamox was applied to the right eye and 1 drop of Zymar was applied to the left eye of the control rabbit. RESULTS: High concentrations of both antibiotics were found in all the samples of the eyes implanted with the presoaked IOLs. The concentrations of the antibiotics decreased over time, but even the 6-hour sample concentrations were markedly higher than the concentrations found in the control rabbit after 4 hours. CONCLUSION: The results suggest that the Rayner C-flex IOL can be effective as a drug-delivery system for fourth-generation fluoroquinolones.


Assuntos
Resinas Acrílicas , Anti-Infecciosos/administração & dosagem , Compostos Aza/administração & dosagem , Sistemas de Liberação de Medicamentos , Fluoroquinolonas/administração & dosagem , Lentes Intraoculares , Quinolinas/administração & dosagem , Animais , Anti-Infecciosos/farmacocinética , Humor Aquoso/metabolismo , Compostos Aza/farmacocinética , Disponibilidade Biológica , Fluoroquinolonas/farmacocinética , Gatifloxacina , Implante de Lente Intraocular , Masculino , Moxifloxacina , Projetos Piloto , Quinolinas/farmacocinética , Coelhos
18.
J Cataract Refract Surg ; 32(11): 1932-7, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17081899

RESUMO

PURPOSE: To report the clinicopathologic features of 4 intraocular lenses (IOLs) composed of 3 different hydrophilic biomaterials explanted from children who had postoperative opacification of the IOL optic. SETTING: David J Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: The IOLs were explanted 20, 11, 22, and 25 months postoperatively from children aged 10, 3, 36, and 20 months old, respectively, at IOL implantation. Clinical data were obtained to correlate the findings with possible associated risk factors. The explanted IOLs were examined by gross and light microscopy. They were further analyzed with a stain for calcium, alizarin red 1%. Scanning electron microscopy and energy dispersive X-ray spectroscopy (EDS) were also performed. RESULTS: The primary reason for cataract surgery in Case 1 and Case 2 was persistent hyperplastic primary vitreous (PHPV); 1 patient received a B-Lens IOL (Hanita) and the other a Centerflex IOL (Rayner). The primary reason in Case 3 was familial bilateral congenital cataract and in Case 4, rubella cataract; both patients received a Hydroview IOL (Bausch & Lomb). All 4 IOLs had surface deposits on the optic, but the morphology of the deposits on the B-Lens and Centerflex IOLs was different than that in previously reported cases. The deposits in all four cases stained positive with alizarin red and consisted of calcium and phosphorus when imaged with EDS. CONCLUSIONS: Calcified deposits on 2 Hydroview IOLs explanted from children were similar to those seen in adults with the same IOL. The deposits on the B-Lens and Centerflex IOLs were probably secondary to a breakdown of the blood-aqueous barrier caused by preexisting PHPV.


Assuntos
Calcinose/etiologia , Lentes Intraoculares , Complicações Pós-Operatórias , Falha de Prótese , Antraquinonas , Materiais Biocompatíveis , Calcinose/diagnóstico , Cálcio/análise , Pré-Escolar , Remoção de Dispositivo , Microanálise por Sonda Eletrônica , Humanos , Lactente , Masculino , Microscopia Eletrônica de Varredura , Fósforo/análise , Reoperação , Coloração e Rotulagem/métodos
19.
J Cataract Refract Surg ; 31(9): 1826-8, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16246792

RESUMO

We present a 3-year-old patient who developed extensive noninflammatory fibrous membrane formation in the anterior chamber involving the present iris-fixated intraocular lens (IOL), with subsequent need for explantation. The child had had repair of a corneal injury, crystalline lens extraction and Artisan iris-claw IOL (Ophthec) implantation after a penetrating injury 2 months before. Histopathologic analyses were consistent with a retrocorneal membrane that originated from the corneal stroma and formed a "cocoon" membrane on the iris-claw IOL.


Assuntos
Câmara Anterior/patologia , Ferimentos Oculares Penetrantes/cirurgia , Iris/cirurgia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Complicações Pós-Operatórias , Pré-Escolar , Lesões da Córnea , Remoção de Dispositivo , Fibrose , Humanos , Cristalino/lesões , Masculino , Membranas/patologia
20.
J Cataract Refract Surg ; 31(4): 805-11, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15899460

RESUMO

PURPOSE: To evaluate the outcome of posterior capsule opacification (PCO) after implantation in rabbit eyes of currently available 3-piece and 1-piece hydrophobic acrylic intraocular lenses (IOLs) with square optic edges. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: The 3-piece designs evaluated were the AR40e (Advanced Medical Optics Inc.) and the MA60AC (Alcon, Inc.); the 1-piece designs were the SA60AT and the SA30AT (Alcon, Inc.). Nine lenses of each type were implanted in a randomized manner by the same surgeon in 18 Dutch Belted pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and analyses of the enucleated eyes were performed from the posterior or Miyake-Apple view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was scored from 0 to 4. The area of Soemmering's ring formation was also scored from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL anterior surface, IOL centration, fixation, and presence of striae. Results from the posterior view were complemented by histopathologic evaluation of the eyes. RESULTS: No statistically significant difference was found between the 4 groups of IOLs in the parameters analyzed from the posterior view. When cell ingrowth occurred with the 1-piece designs, causing peripheral and central PCO formation, it was more likely to start at the optic-haptic junctions, as observed during the clinical follow-up with slitlamp examination and confirmed by gross and histopathologic analyses of the enucleated eyes. CONCLUSIONS: The square, truncated optic edge is the most important IOL design feature for PCO prevention. The optic-haptic junctions of the 1-piece designs appear to be sites where the barrier effect of the truncated optic edge is less effective.


Assuntos
Resinas Acrílicas , Catarata/etiologia , Cápsula do Cristalino/patologia , Implante de Lente Intraocular , Lentes Intraoculares/efeitos adversos , Complicações Pós-Operatórias , Animais , Materiais Biocompatíveis , Catarata/patologia , Células Epiteliais/patologia , Interações Hidrofóbicas e Hidrofílicas , Desenho de Prótese , Coelhos
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