Armando Stefano Crema

Femtosecond Laser-assisted Cataract Surgery in Patients With Marfan Syndrome and Subluxated Lens.

PURPOSE To report femtosecond laser-assisted cataract surgeries in patients with Marfan syndrome with mild, moderate, and severe lens subluxation. METHODS Case reports. RESULTS Two patients with Marfan syndrome underwent femtosecond laser-assisted cataract surgery (Alcon LenSx Lasers Inc., Aliso Viejo, CA). One patient had a mild lens subluxation in one eye and a moderate lens subluxation in the fellow eye. The other patient had a severe lens subluxation in one eye. In all eyes, the laser was able to perform a circular and free-floating anterior capsulotomy and lens fragmentation. In two of the eyes it was also helpful in decreasing corneal astigmatism by making corneal intrastromal relaxing incisions. There were no postoperative complications. CONCLUSIONS Femtosecond laser-assisted cataract surgery is an effective approach for cataract surgery in patients with Marfan syndrome with mild, moderate, and even severe lens subluxation, with the benefits of causing minimal further zonular damage and being able to treat corneal astigmatism with relaxing incisions.

Visual outcomes of eyes implanted with a toric multifocal intraocular lens.

PURPOSE To investigate the predictability, efficacy, and safety of a ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX). METHODS This retrospective, noncomparative case study included 70 eyes of 44 patients implanted with a ReSTOR toric multifocal IOL (Alcon Laboratories, Inc., Fort Worth, TX). Patients were examined preoperatively and approximately 3 months postoperatively. Uncorrected and distance-corrected distance and near visual acuities were measured. Refractive and topographic astigmatism were recorded. Improvement, number of lines gained and lost, and correlation of attempted and achieved astigmatic correction values were also investigated as measurements of efficacy, safety, and predictability. RESULTS Mean follow-up time was 2.3 ± 1.2 months. Postoperative values of uncorrected distance and near visual acuity were 0.02 ± 0.05 logMAR (20/21 ± 20/22 Snellen) and 0.01 ± 0.04 logMAR (20/20 ± 20/22 Snellen), respectively. Statistical analyses revealed a significant improvement when comparing preoperative and postoperative values of manifest refraction spherical equivalent (P < .0001), uncorrected distance visual acuity (P < .0001), and astigmatism (P < .0001); 95.7% of eyes were 20/25 or better and 100% of eyes were 20/30 or better. At the last follow-up visit, none of the examined eyes had lost any lines. One hundred percent of the eyes remained unchanged or improved after surgery. Mean postoperative manifest refraction spherical equivalent was -0.06 ± 0.27 at the last follow-up visit. The residual manifest astigmatism was 0.22 ± 0.21. There was a highly significant correlation between preoperative attempted topographic astigmatism and postoperative achieved refractive astigmatism. CONCLUSIONS The study provides clinical evidence that the new toric multifocal IOL seems to be predictable, safe, and effective, providing satisfactory visual acuity for far and near and correcting astigmatism.

Facectomia na infância: quem são nossos pacientes?

OBJECTIVE: To analyze the profile of the patients who were submitted to phakectomy at the cataract service of the Hospital da Piedade, under the age of 10 years old, evaluating the main indications, the socioeconomic and gestational profiles in the relevant cases. METHODS: Data of 60 patients under the age of 10 years old submitted to lensectomy, were retrospectively analyzed, during the period between January of 2006 and December of 2007. All the surgeries were performed at the cataract service of the Hospital da Piedade, by the same surgeon. RESULTS: Of the 60 patients, 25 were female (42%) and 35 were male (58 %). 42 patients (70%) had the diagnostic of congenital cataract, 8 (13%) had subluxated lens and 10 (17%) had lensectomy for traumatic cataract. Considering congenital cataract patients mothers, 40 (95%) underwent prenatal exams with more than 5 appointments, 9 (22.5%) of them were infected by rubella virus during the pregnancy. In subluxation cases, 8 had Marfans syndrome. 10 cases of trauma occurred in boys. CONCLUSION: It was possible to verify that the majority of our patients submitted to phakectomy had congenital cataract and there is an important number of cases that still associated to rubella. Decreasing time since the suspect until the specialized consultation, will improve the visual prognosis of the children.

Delayed Descemet's membrane detachment after successful cataract surgery: a case report

O descolamento da membrana de Descemet pode ser uma complicacao grave apos a cirurgia de catarata, resultando em edema de cornea e reducao da acuidade visual. Este relato descreve um caso raro de descolamento da membrana de Descemet seis meses apos cirurgia de catarata com facoemulsificacao sem intercorrencias, documentado com tomografia de coerencia optica do segmento anterior (OCT; RTVue, Optovue). Foram realizadas descemetopexia pneumatica e sutura corneana, com resolucao do descolamento e recuperacao visual. Este relato procura alertar os medicos que o edema de cornea tardio pode estar relacionado ao descolamento tardio da membrana de Descemet, que exige tratamento adequado para evitar descompensacao corneana permanente.

Confirmação do cálculo de lente intraocular através da refração intraoperatória

This paper describes the intraoperative refraction for intraocular lens (IOL) power calculation. Report a case of a 67 year-old male patient reporting a progressive loss of visual acuity in the left eye (OS). Examination revealed best corrected visual acuity (BCVA) of 20/60 (-21,50 -4,00 X 170) related to adherence of silicone oil to the IOL optic. IOL exchange was proposed, however biometry was variable and doubtful. Intraoperative refraction confirmed the IOL power and the patient underwent uneventful IOL explantation and exchange with a three-piece acrylic IOL. After surgery, examination revealed BCVA OS of 20/30 (-1,25 -1,25 X 180). Analysis of explanted IOL confirmed adherence of silicone oil to the IOL optic. Intraoperative refraction is useful to confirm IOL power calculation.

Diagnóstico e tratamento do lenticone anterior

Case report of a 18-year-old male patient with Alports syndrome, who presented with renal failure and hearing loss reporting a progressive loss of vision acuity. Slitlamp examination revealed bilateral anterior lenticonus. The patient underwent pre and post-operative corneal and anterior segment tomography with a rotating Scheimpflug system (Pentacam), integrated whole eye (individual laser beam ray tracing) and corneal surface (Placido) wavefront aberrometry (i-Trace). Phacoemulsification and single piece hydrophobic IOL implantation (Acrysof® SN60AT) was performed uneventfully in both eyes. Pre op Scheimpflug well decomented the anterior lenticonus. Total aberrometry showed myopic astigmatisms with high negative spherical aberrations OU; higher order aberrations (HOAs) greatly influenced the conversion of Snellen E letters. Total aberrations and corneal topographies integration maps OU demonstrated high levels of intraocular aberrations which had more similarity with whole eye aberrations than anterior corneal aberrations. After surgery, BCVA was 20/20 in both eyes. Scheimpflug images revealed topic intraocular lens and the differential maps showed resolution of myopia and decrease of the total ocular HOAs as well as from the internal optics. Adjunctive advanced diagnostic tools were useful to demonstrate the anterior lenticonus and its optical impact along with the resolution of the aberrations post operatively.