RESUMO
The techniques and results of cataract surgery have changed dramatically during the past three decades. In the USA, we have moved from intracapsular cataract extraction as the preferred technique to almost exclusively extracapsular techniques. Smaller incisions have become the standard, with phacoemulsification now being the method of choice for most surgeons. Along with these advances have come improved intraocular lens materials and designs, especially well suited for use with smaller incisions. Phacoemulsification as a method to remove the cataractous lens was first proposed more than 20 years ago. Advances in techniques and equipment have led to a dramatic increase in the popularity of phacoemulsification with increased safety and efficiency. Viscoelastic agents have been developed synchronously with modern phacoemulsification techniques, playing an integral role in the success of this new technology. Improved surgical techniques for removing the anterior lens capsule have decreased the incidence of both intraoperative and postoperative capsular complications. Nucleus removal, formerly performed primarily in the anterior chamber, is now performed in the posterior chamber, decreasing damage to the corneal endothelium. Improved wound construction allows many wounds to be left unsutured, and smaller wounds allow shorter recovery time and greater intraoperative control and safety. Intraocular lenses can have smaller optic sizes and still maintain accurate centration. Foldable intraocular lenses can take advantage of the smaller incision, even further shortening the time to visual recovery. Continual evolution of this technology promises to further improve patient outcomes after cataract surgery.
Assuntos
Facoemulsificação/métodos , Anestesia Local/métodos , Capsulorrexe/história , Capsulorrexe/métodos , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História Medieval , Humanos , Implante de Lente Intraocular , Lentes Intraoculares , Facoemulsificação/história , Facoemulsificação/instrumentaçãoRESUMO
PURPOSE: To evaluate the change of intraocular pressure (IOP) after implantation of Intacs (KeraVision) corneal ring segments using Goldmann applanation tonometry (GAT). SETTING: Multicenter clinical trial for U.S. Food and Drug Administration application conducted at 10 U.S. sites. METHODS: One-year follow-up data from a phase III clinical trial (n = 359) were reviewed. Intraocular pressure was measured by GAT preoperatively and 1 week and 1, 3, 6, and 12 months after Intacs implantation. The untreated fellow eyes were controls. Change from baseline (preoperative) IOP was calculated and tested for correlation with age and change from baseline in mean keratometry, manifest refraction spherical equivalent (MRSE), and pachymetry (central corneal thickness). Mean IOP in treated and control groups was compared through month 6. RESULTS: At all postoperative examinations, mean IOP in the Intacs eyes was significantly lower (-0.39 to -1.75 mm Hg; all P =.02) than at baseline. Change from baseline in mean IOP of treated eyes did not correlate with age or change from baseline in mean keratometry values, MRSE, or central corneal thickness. At 1, 3, and 6 months, mean IOP was significantly less (-0.38 to -0.53 mm Hg; all P =.002) in Intacs eyes than in control eyes. CONCLUSIONS: Implantation of Intacs slightly lowered IOP measurements by GAT, without correlation to other tested parameters. Postoperative IOP differences between Intacs and control eyes were statistically but not clinically significant. Goldmann applanation tonometry accurately measured IOP at the center of the cornea in eyes with Intacs.
Assuntos
Substância Própria/cirurgia , Pressão Intraocular/fisiologia , Miopia/cirurgia , Implantação de Prótese , Tonometria Ocular/métodos , Adulto , Idoso , Substância Própria/fisiopatologia , Topografia da Córnea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/fisiopatologia , Próteses e Implantes , Acuidade VisualRESUMO
With the volume of laser in situ keratomileusis procedures growing exponentially, ophthalmologists and other eye-care providers are becoming aware of an uncommon postoperative condition, diffuse lamellar keratitis, that can affect an otherwise ideal outcome. We present our strategy for diagnosing and managing this syndrome, developed from experience in a high-volume refractive surgical practice. Understanding the time course of the disease, along with proper identification, staging, and intervention, can help eliminate visual loss associated with this condition.
Assuntos
Córnea/patologia , Glucocorticoides/administração & dosagem , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/etiologia , Córnea/cirurgia , Topografia da Córnea , Diagnóstico Diferencial , Humanos , Ceratite/etiologia , Pomadas , Soluções Oftálmicas , Resultado do Tratamento , Cicatrização/efeitos dos fármacosRESUMO
As we stand at the threshold of a new millennium, perhaps nowhere else in the field of ophthalmology is there such a feeling of excitement, enthusiasm, and anticipation as in the subspecialty of refractive surgery. What was once considered an experimental hobby, dabbled in by a few rogue physicians, has now gained a level of respect among patients and ophthalmologists that has surprised even its most vocal critics.
Assuntos
Córnea/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/tendências , Procedimentos Cirúrgicos Refrativos , Córnea/fisiopatologia , Humanos , Erros de Refração/fisiopatologiaRESUMO
PURPOSE: To assess the safety and efficacy of laser in situ keratomileusis (LASIK) for hyperopia and hyperopic astigmatism and develop a LASIK nomogram for primary hyperopia or hyperopia secondary to myopic refractive surgery using the VISX STAR S2. METHODS: Prospective evaluation of LASIK in 46 primary eyes and 29 secondary eyes with fogged manifest sphere from +0.5 diopters (D) to +6.0 D and cylinder from 0 to +5.0 D. RESULTS: Mean manifest spherical equivalent (SE) in patients with primary hyperopia was +2.50 D +/- 0.93 preoperatively and +0.70 D +/- 1.19 at 6 months. At 6 months, 79% of primary hyperopes had uncorrected visual acuity (UCVA) of 20/40 or better; 63% were within +/- 1 D of emmetropia. One primary hyperope lost 2 lines of best spectacle-corrected vision (BCVA) at 1 month. Complications included transient epithelial defect (6.5%), epithelial cells in the interface (4.3%), diffuse lamellar keratitis (4.3%), haze (2.2%), and mild irregular astigmatism (2.2%). In those with secondary hyperopia, mean manifest SE was +1.70 D +/- 0.82 preoperatively and -0.27 D +/- 0.95 at 6 months. At 6 months, 83% of secondary hyperopes had UCVA of 20/40 or better; 74% were within +/- 1 D of emmetropia. No secondary hyperope lost > or = 2 lines of BCVA. Complications included intraoperative bleeding (3.4%), intraoperative epithelial defect (3.4%), transient interface debris (3.4%), significant dry eye (3.4%), blood in interface (3.4%), irregular astigmatism (6.9%), slight decentration (6.9%), trace haze (6.9%), mild epithelial ingrowth not requiring removal (3.4%), or corneal irregularity (3.4%). CONCLUSION: These early data suggest that LASIK for hyperopia from +0.5 to +6 D and astigmatism from 0 to +5 D using the VISX STAR S2 benefits from a nomogram adjusted for preoperative refraction, age, and prior refractive surgery and is safe and effective. Patients with secondary hyperopia achieved more correction than those with primary hyperopia, although the accuracy and predictability of LASIK in both groups has improved with the nomogram adjustments.
Assuntos
Astigmatismo/cirurgia , Córnea/cirurgia , Hiperopia/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Refração Ocular , Reprodutibilidade dos Testes , Segurança , Resultado do Tratamento , Acuidade VisualAssuntos
Alumínio , Doenças da Túnica Conjuntiva/etiologia , Criocirurgia/efeitos adversos , Corpos Estranhos no Olho/etiologia , Idoso , Doenças da Túnica Conjuntiva/patologia , Criocirurgia/instrumentação , Microanálise por Sonda Eletrônica , Corpos Estranhos no Olho/patologia , Humanos , Masculino , Perfurações Retinianas/cirurgia , Acuidade VisualAssuntos
Anti-Inflamatórios/administração & dosagem , Cicatriz/diagnóstico , Córnea/patologia , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Administração Tópica , Cicatriz/etiologia , Cicatriz/prevenção & controle , Córnea/cirurgia , Glucocorticoides , Humanos , Ceratite/etiologia , Pomadas , Reoperação , Índice de Gravidade de Doença , Resultado do Tratamento , Cicatrização/efeitos dos fármacosRESUMO
PURPOSE: To assess the safety and efficacy of laser in situ keratomileusis (LASIK) for secondary hyperopia and hyperopic astigmatism and to develop a VISX STAR S2 LASIK nomogram (VISX Inc., Santa Clara, CA) for consecutive hyperopia after prior myopic refractive surgery. DESIGN: Prospective, nonrandomized, self-controlled interventional study. PARTICIPANTS: Thirty patients with consecutive hyperopia or hyperopia and astigmatism after LASIK, photorefractive keratectomy, automated lamellar keratoplasty, or radial keratotomy. INTERVENTION/METHODS: Prospective evaluation of LASIK in 30 secondary eyes with fogged manifest sphere from +0.5 to +6.0 diopters (D) and cylinder from 0 to +5.0 D. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalent (SE). RESULTS: Mean manifest SE was +1.73 +/- 0.79 D before surgery, -0.13 +/- 1.00 D at 6 months after surgery, and -0.18 +/- 1.08 D at 1 year after surgery. At 6 months, 84% of patients with secondary hyperopia had UCVA of 20/40 or better; 76% were within +/-1 D of emmetropia. At 1 year, 85% had UCVA of 20/40 or better and 85% were within +/-1 D of emmetropia. No patients with secondary hyperopia lost 2 or more lines of BCVA at 1 year. Complications included intraoperative bleeding (3.3%), intraoperative epithelial defect (3.3%), transient interface debris (3.3%), significant dry eye (3.3%), blood in interface (3.3%), irregular astigmatism (6.7%), slight decentration (6.7%), trace haze (6.7%), or mild epithelial ingrowth not requiring removal (3.3%). CONCLUSIONS: These early data suggest that LASIK for consecutive hyperopia from +0.5 to +5.50 D and astigmatism from 0 to +2.75 D using the VISX STAR S2 benefits from a nomogram adjusted for preoperative refraction, age, and prior refractive surgery, and is safe and effective.