Emir Amin Ghanem

Iridectomy of the anterior iris stroma using the vitreocutter during phacoemulsification in patients with iridoschisis

We present a technique to manage iridoschisis. This technique for anterior iridectomy of the affected iris fibers avoids intraoperative obstruction of the phaco tip and prevents postoperative complications such as corneal decompensation and glaucoma. Before the capsulorhexis is created, a vitreocutter is inserted in the anterior chamber and used to cut the iris strands at the site of the iridoschisis, making an anterior sectorial stromal iridectomy and preserving the iris pigment epithelium. Phacoemulsification is then performed. After the pupil is constricted with carbacol, remnants of the loose anterior iris fibers are excised with the vitreocutter and the scleral incision is sutured.

Corneal wavefront-guided photorefractive keratectomy with mitomycin-C for hyperopia after radial keratotomy: Two-year follow-up

PURPOSE: To assess corneal wavefront‐guided photorefractive keratectomy (PRK) to correct hyperopia after radial keratotomy (RK). SETTING: Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil. DESIGN: Case series. METHODS: Excimer laser corneal wavefront‐guided PRK with intraoperative mitomycin‐C (MMC) 0.02% was performed. Main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, spherical equivalent (SE), corneal aberrations, and haze. RESULTS: The mean time between RK and PRK in the 61 eyes (39 patients) was 18.8 years ± 3.8 (SD). Before PRK, the mean SE was +4.17 ± 1.97 diopters (D); the mean astigmatism, −1.39 ± 1.04 D; and the mean CDVA, 0.161 ± 0.137 logMAR. At 24 months, the mean values were 0.14 ± 0.99 D (P<.001), −1.19 ± 1.02 D (P=.627), and 0.072 ± 0.094 logMAR (P<.001), respectively; the mean UDVA was 0.265 ± 0.196 (P<.001). The UDVA was 20/25 or better in 37.7% of eyes and 20/40 or better in 68.9%. The CDVA improved by 1 or more lines in 62.3% of eyes. Two eyes (3.3%) lost 2 or more lines, 1 due to corneal ectasia. Thirty eyes (49.2%) were within ±0.50 D of intended SE and 45 (73.8%) were within ±1.00 D. From 6 to 24 months, the mean SE regression was +0.39 D (P<.05). A significant decrease in coma, trefoil, and spherical aberration occurred. Three eyes developed peripheral haze more than grade 1. CONCLUSION: Corneal wavefront‐guided PRK with MMC for hyperopia after RK significantly improved UDVA, CDVA, and higher‐order corneal aberrations with a low incidence of visually significant corneal haze. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Ceratectomia fotorrefrativa baseada em topografia para correção da hipermetropia secundária à ceratotomia radial

PURPOSE To describe a topographically guided photorefractive keratectomy technique for the management of secondary hyperopia following radial keratectomy. METHODS A retrospective study was carried out in patients where a topographically guided photorefractive keratectomy technique was performed for the management of secondary hyperopia following radial keratectomy. The patients had preoperatively at least 3 diopters of hyperopia. The minimum follow-up was 3 months. RESULTS Twenty-four eyes of 21 patients were evaluated. The mean age was 45.54+/-6.03 years (range 36 to 55 years). The average follow-up was 7.71+/-4.6 months (range 3 to 17 months). Preoperatively the average spherical equivalent was +3.92+/-1.57 (range +1.25 D to +7.75 D), and postoperatively it was -0.29+/-1.43 (range -3.75 D to +2.50 D) (p<0.01). Visual acuity of 20/25 or better was achieved in 45.83% of the eyes, 20/40 or better in 83.33% and 20/60 or better in 100%. All patients were satisfied with the results and stated subjective improvement in visual quality. CONCLUSION Considering that it is a retreatment procedure performed in unstable and irregular corneas with high degrees of hyperopia, topographically guided photorefractive keratectomy showed good results and was safe and effective for the management of secondary hyperopia following radial keratectomy.

Sudden decrease in vision caused by liquefied after-cataract

We report a case of sudden decrease to unilateral visual acuity in a 39-year-old patient who had extracapsular cataract surgery 5 years earlier. The decrease was caused by involvement of the visual axis because of a rare complication known as liquefied after-cataract. Treatment with a neodymium:YAG (Nd:YAG) laser was successfully performed. Although there was no rupture in the posterior capsule, the opacity disappeared and the visual acuity improved to 20/20. This new form of after-cataract can cause a sudden decrease in vision, and Nd:YAG laser treatment, even without a posterior capsule rupture, can be performed successfully.

Ceratectomia fotorrefrativa com mitomicina-C personalizada pela frente de onda corneana para o tratamento de hipermetropia após ceratotomia radial

OBJETIVO: Avaliar a eficacia, previsibilidade e estabilidade da ceratectomia fotorrefrativa (PRK) guiada pela frente de onda corneana para o tratamento da hipermetropia secundaria a ceratotomia radial. METODOS: Este estudo prospectivo analisou 60 olhos de 36 pacientes consecutivos, submetidos a PRK personalizado com o laser Esiris-Schwind. A tecnica constou de desepitelizacao mecânica, fotoablacao e utilizacao de mitomicina-C 0,02%. Os pacientes foram acompanhados por 12 meses. RESULTADOS: O intervalo medio entre a ceratotomia radial e o PRK foi de 18,4 anos ± 3,8 (DP); o equivalente esferico (EE) medio antes da ceratotomia radial era -4,35 dioptrias (D) ± 1,55. As medidas previas ao PRK mostraram grau esferico medio de +5,00 D ± 2,28, astigmatismo medio de -1,47 D ± 1,06, EE medio de +4,27 D ± 2,18 e AV corrigida (AVcc) media de 0,174 ± 0,139 (logMAR). O EE medio programado no laser foi +4,74 D ± 2,11. Os resultados encontrados um ano apos a cirurgia foram: EE medio de +0,04 D ± 1,03 (P<0,001), astigmatismo medio de -1,03 ± 0,75 D (P=0,015), AV media sem correcao de 0,265 ± 0,197 e AVcc de 0,079 ± 0,105 (P<0,001). A AVcc mostrou ganho medio de uma linha; 20 olhos (33,3%) melhoraram duas ou mais linhas e somente um olho perdeu duas linhas. Ocorreu reducao estatisticamente significante do coma (P=0,002), trefoil (P=0,004), aberracao esferica (P<0,001) e quatrefoil (P=0,002). Houve 48 olhos (80%) entre ± 1,00 D do EE planejado. A regressao media entre seis e 12 meses foi de +0,17 ± 0,67 D. CONCLUSAO: O PRK personalizado pela frente de onda corneana foi eficaz, previsivel e estavel pelo periodo de um ano para a reducao da hipermetropia apos a ceratotomia radial. No pos-operatorio, observou-se melhora significativa da AVsc, AVcc e das aberracoes corneanas. Numero do ClinicalTrials.gov:NCT00917657

Monoscleral fixation of IOL after extracapsular extraction of subluxated lenses in patients with Marfan syndrome

PURPOSE: To describe a technique of monoscleral fixation of the intraocular lens (IOL) after extracapsular extraction of subluxated lens in patients with Marfan syndrome. Design: Noncomparative, interventional case series. METHODS: A retrospective study was conducted on 14 eyes of 7 consecutive patients with subluxated lens associated with Marfan syndrome. Surgery was indicated when: 1) a lens border was observed in the pupil area with the pupil under normal lighting causing glare; or 2) the best corrected visual acuity was less than 20/70; or 3) the patient complained of monocular diplopia. Patients with a history of glaucoma, retinal detachment, trauma or other systemic diseases were excluded. RESULTS: The mean postoperative follow-up was 15.43 ± 9.33 months (range, 6 to 30 months). The best spectacle-corrected visual acuity varied from 20/25 to 20/60, where 71.43% reached 20/30 or better. No case showed a worsening of visual acuity, nor were there any intraoperative or postoperative complications (intraocular lens decentration, pupilar block, glaucoma or retinal detachment). The most frequent postoperative complication was astigmatism, observed in 3 eyes (21.43%) presenting values greater than 1.5 D. CONCLUSIONS: This technique showed very good surgical and visual results and few complications, providing a surgical option for cases of ectopia lentis associated with Marfan syndrome, especially in some countries or regions where phacoemulsification is not available.

Predictability and Vector Analysis of Laser In Situ Keratomileusis for Residual Errors in Eyes Implanted With Different Multifocal Intraocular Lenses.

Purpose: To investigate potential differences in predictability, efficacy, and safety of corneal excimer laser to correct residual myopia, hyperopia, and astigmatism in eyes previously implanted with multifocal intraocular lenses using distinct optical surfaces and platforms for multifocality. Methods: This prospective comparative study included 37 eyes submitted to laser in situ keratomileusis correction for residual errors after implantation of either an apodized diffractive–refractive (Restor) or a full-diffractive (Tecnis) multifocal intraocular lens. Data analysis included investigation of predictability, efficacy, and safety of excimer laser surgery to correct residual errors. A double-angle plot, using vector analysis, was also created to evaluate predictability of astigmatism correction. Results: At 6-month follow-up, statistical analyses revealed a significant improvement when comparing preoperative (0.51 ± 0.25 and 0.44 ± 0.18) and postoperative values (0.17 ± 0.10 and 0.09 ± 0.07) of uncorrected distance visual acuity (P < 0.0001 and <0.0001), preoperative (0.92 ± 0.61 and 1.02 ± 0.45) and postoperative values (0.33 ± 0.23 and 0.19 ± 0.17) of manifest refractive spherical equivalent (P = 0.0006 and <0.0001), and preoperative (−1.08 ± 0.70 and −0.65 ± 0.42) and postoperative values (−0.25 ± 0.28 and −0.14 ± 0.21) of astigmatism (P < 0.0001 and <0.0001) in eyes implanted with Restor and Tecnis, respectively. Vector analysis revealed a predictable correction of astigmatism in all groups. Ninety-two percent of total eyes achieved a manifest refractive spherical equivalent within ±0.5 of emmetropia. Conclusions: Corneal excimer laser refractive surgery seems to be equally effective to correct different residual errors, including astigmatism, in eyes implanted with intraocular lenses with various platforms for multifocality.

Catarata polar anterior piramidal deslocada para a câmara anterior causando edema de córnea: relato de caso

Pyramidal anterior polar cataracts are conical opacities that project into the anterior chamber from the anterior capsule of the lens. In the vast majority of patients the opacity remains bound and stable throughout life. We report an unusual complication of this type of cataract: spontaneous dehiscence of the pyramids to the anterior chamber causing bilateral endothelial damage and corneal edema. 66-year-old white woman presented with inferior corneal edema in the right eye and diffuse corneal edema in the left eye. A white nodular lesion was observed in the inferior angle in both eyes compatible with the pyramidal pole of the anterior polar cataract. The anterior pyramid can remain unabsorbed in the anterior chamber for long periods because it is composed of dense collagen, causing progressive endothelial cell loss and corneal edema. Therefore, it is an indication for extraction of the cataract and its anterior pole. In addition, we remind of the possibility of ambliopia, which is related to the size of opacity, symmetry of opacities, and superimposed cortical component.

Topographically supported customized ablation for the treatment of decentered laser in situ keratomileusis: report of three cases

Three cases of decentered laser in situ keratomileusis were successfully treated with the topographically supported customized ablation.