Iane Stillitano

Long-term Follow-up of Orthokeratology Corneal Reshaping Using Wavefront Aberrometry and Contrast Sensitivity

Purpose. To evaluate changes in ocular wavefront aberrations and contrast sensitivity during 1-year follow-up of overnight orthokeratology. Methods. Prospective study of 26 eyes that underwent orthokeratology with the BE lens design. Wavefront measurements were analyzed at baseline and after 1, 8, 30, 90, 180, and 365 nights of orthokeratology for a 6.5-mm pupil diameter. Contrast sensitivity 1 year after orthokeratology was compared to the baseline value under photopic conditions and mesopic conditions, with and without glare, in the spatial frequencies of 1.5, 3, 6, 12, and 18 cycles/degree. A P value of less than 0.05 was statistically significant. Results. Higher-order aberration root-mean-square (HOA-RMS) increased statistically significantly from 0.41 ± 0.12 &mgr;m to 1.04 ± 0.32 &mgr;m up to night 8. Defocus (Z4) decreased until night 8 and then stabilized. Astigmatism (Z3 + Z5) did not change. There was a sevenfold increase in spherical aberration (Z12) until night 8, which subsequently remained unchanged (P<0.001). Coma (Z7 + Z8) increased until night 90 and then stabilized (P<0.001). Other Zernike modes showed stability at night 1, with the exception of quadrafoil (Z14) (P=0.048). Mesopic contrast sensitivity, with and without glare, at 18 cycles/degree, decreased but failed to reach statistical significance (P=0.922 and P=0.827, respectively). Conclusions. Most optical aberrations stabilized within the first week after beginning orthokeratology with BE lens. There was not a statistically significant reduction in contrast sensitivity 1 year after treatment.

Impacto econômico do custo de colírios no tratamento do glaucoma

ABSTRACT Purpose: To evaluate the daily cost of antiglaucoma eyedropsand the economic impact related to the minimal wage; to com-pare the cost of drug association in the single presentation inrelation to separate presentations; to analyze the additionalpercent antiglaucoma drug cost related to standard therapy(generic timolol maleate). Methods: Fifteen eyedrop bottles ofeach one of the twenty antiglaucoma products were used. Thenumber and mean eyedrop size per bottle of drug were measu-red and the duration and treatment costs calculated. Results:A large variation in the mean daily cost, respectively: R

Stability of wavefront aberrations during the daytime after 6 months of overnight orthokeratology corneal reshaping.

0.077for generic timolol maleate (cheapest) and R

Wavefront-guided refractive surgery results of training-surgeons

1.910 for Xala-com ® (most expensive), was observed. It should be noted thatthe product of minimal economic impact, as related to the mini-mal wage, was the standard eyedrop therapy with 1.2% to1.6%, while the association of Xalatan ® with Timoptol XEshowed a variation of 21.7% to 30.0%. The cost of Cosopt ® and Xalacom ® was greater than the associations of, respecti-vely: Trusopt

Bubble and corneal dimple formation after the first overnight wear of an orthokeratology lens: a case series.

PURPOSE To evaluate the stability of wavefront aberrations during the daytime after 6 months of overnight orthokeratology corneal reshaping. METHODS A prospective study of 26 eyes using the Ultravision BE lens design during 6 months of overnight wear. Uncorrected visual acuity (UCVA), cycloplegic refraction, and wavefront aberrometry were measured at 8 AM (within 1 hour after awakening and removing lenses), 1 PM (5 to 6 hours after lens removal), and 6 PM (10 to 12 hours after lens removal). RESULTS There was no significant difference in UCVA between 8 AM, 1 PM, and 6 PM (P=.383). Spherical power from wavefront aberrometry showed significant regression from 8 AM to 1 PM (P<.001) and stabilized near zero diopters. Total root-mean-square (RMS) increased and higher order aberration RMS and defocus (Z4) decreased between 8 AM and 1 PM (P<.001) but did not change for the rest of the day (P>.001). There was no statistically significant change in astigmatism (Z3 and Z5) (P=.449) and coma (Z7 and Z8) (P=.145) between 8 AM, 1 PM, and 6 PM. Spherical aberration (Z12) showed regression throughout the day (P<.001). CONCLUSIONS After 6 months of overnight orthokeratology wear, some optical aberrations showed regression during the day. Despite no significant change in UCVA during 10 to 12 hours, there was a significant increase in defocus (Z4) within the first 5 hours after removing the orthokeratology lens and a decrease in spherical aberration (Z12) throughout the day.

Long-term results of photorefractive keratectomy for myopia and myopic astigmatism

PURPOSE To assess clinical outcomes and changes on higher-order aberrations (HOA) after wavefront-guided laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for correction of myopia and myopic astigmatism performed by training-surgeons. METHODS One hundred and seventy patients had customized LASIK (207 eyes) and PRK (103 eyes) performed by surgeons in-training using the LADARVision 4000 (Alcon, Fort Worth, TX). Preoperative and 1, 3, 6 and 12 months postoperative data of spherical equivalent (SE), best spectacle-corrected visual acuity (BSCVA) and uncorrected visual acuity (UCVA) were analysed. Wavefront changes were determined using the LADARWave Hartmann-Shack wavefront aberrometer and the pupil size was scaled for 6.5 mm. RESULTS The mean SE in the LASIK group was -3.04 ±1.07 D and in the PRK group was -1.60 ± 0.59 D. At 1-year follow-up, (80.6%) (LASIK) and (66.7%) (PRK) were within ± 0.50 D of the intended refraction. The UCVA was 20/20 or better in (58.1%) (LASIK) and (66.7%) (PRK) of the operated eyes. A statistically significant positive correlation was found between achieved versus attempted refractive correction in both groups: LASIK (r=0.975, P<0.0005) and PRK (r=0.943, P<0.005). The higher-order aberrations (HO) RMS and coma did not changed significantly in the PRK group between preoperative and 1-year follow-up. In the LASIK group the HO RMS and coma changed between preoperative and 1-month postoperative but remained statistically unchanged during 1-year follow-up. The spherical aberration showed statistically significant changes in both groups. CONCLUSIONS Wavefront-guided LASIK and photorefractive keratectomy performed by training-surgeons were found to be similarly effective, predictable and stable.

Custo do tratamento de drogas antiglaucomatosas: latanoprost, travoprost, bimatoprost e unoprostona isopropílica

Purpose. To report the first documented case series of bubbles and corneal dimples associated with corneal reshaping after the first overnight wear of an orthokeratology lens. Methods. Three cases of transient corneal dimples are described after the first overnight use of the Be Free orthokeratology lens (BE; Ultravision Pty. Ltd., Brisbane, Australia) related to bubble formation under the posterior lens surface. Results. The corneal dimples were located most centrally and peripherally in correspondence to the reverse curve and did not produce a significant change in best-corrected visual acuity except in one patient, who had many bubbles in the central cornea. Conclusions. The current findings suggest that the precorneal tear film between the corneal surface and the posterior orthokeratology contact lens surface plays a role in the development of bubbles and corneal dimples.

Corneal Changes and Wavefront Analysis after Orthokeratology Fitting Test

PURPOSE To assess the long-term refractive outcomes of photorefractive keratectomy in myopia and myopic astigmatism. METHODS A retrospective study of 120 photorefractive keratectomy operated eyes with at least four-year follow-up (maximum of 96 months, mean follow-up 55 months). We divided patients into group 1 (G1) spherical equivalent (SE) up to -4.00 diopters (D) and group 2 (G2) SE >-4.00 D. The Summit Apex Plus excimer laser was used for ablation. All eyes were analyzed in terms of uncorrected and best spectacle corrected visual acuity (UCVA/BSCVA) and cycloplegic refraction. Data were analyzed using the Refractive Surgery Consultant Elite database software. RESULTS G1 with 85 eyes (49 patients) presented mean SE -2.42 D and G2 with 35 eyes (22 patients) and mean SE of -4.45 D. Ninety-four percent of eyes in G1 and 82.9% of G2 were within +/-1.00 D of emmetropia at 4 years. The UCVA was 20/30 or better in 82.0% of G1 eyes and 77.0% of G2 in the last postoperative follow-up. No patient lost more than one line in G2 compared to 13.0% in G1. Eyes that gained one or more lines after 4-year follow-up were 11.9% G1 and 2.9% in G2, respectively. A statistically significant positive correlation was found between achieved versus attempted refractive correction in both groups (r=0.925, p<0.0005). CONCLUSIONS Photorefractive keratectomy was a safe and stable surgical procedure to correct myopic refractive errors, with no significant change in mean postoperative spherical equivalent refraction in the long-term follow-up.

Impacto econmico do custo de colrios no tratamento do glaucoma

PURPOSE: To determine the cost of clinical antiglaucoma treatment with drugs with uveo-scleral action, considering number of eye drops, average drop size as well as maximum duration of treatment per bottle. METHODS: An experimental study was performed using eight bottles of each of four antiglaucoma drugs: latanoprost, travoprost, bimatoprost and unoprostone isopropyl. The number and average eyedrop size per bottle of drug were measured and the duration and costs of the antiglaucoma treatment calculated. RESULTS: The average number of eye drops varied widely regarding the four studied drugs: latanoprost, with an average of 110.87 (±5.35) drops per 2.5 ml, had the highest count followed by travoprost with 102.62 (±4.27) eye drops; bimatoprost with 91.50 (±3.77) eye drops per 2.5 ml, had the lowest count. The average eye drop volume for the four drugs was 25.13 µl. Concerning duration of treatment, latanoprost and travoprost lasted the longest, with 55.43 and 51.31 days, respectively, while bimatoprost and unoprostone isopropyl had the shortest, that is, 45.45 and 45.75 days. It was found that unoprostone isopropyl had the lowest daily cost at R

Astigmatismo induzido após facoemulsificação: efeito das incisões near-clear de 5, 2 mm

0,81. The annual cost of treatment would thus be: latanoprost R