Iris Yamane

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.

Comparison of central corneal edema and visual recovery between liquefaction and conventional phacoemulsification in soft cataracts

PURPOSE: The aim of the present study is to assess central corneal edema and visual recovery after cataract surgery performed according to two technologies: conventional ultrasonic and liquefaction (Aqualase®). METHODS:This is a prospective contralateral study in wich 20 patients with comparable preoperative conditions were submitted to cataract surgery were evaluated. Preoperative assessment involved complete ophthalmological examination and the study included patients with bilateral cataracts up to grade 2, according to the Lens Opacity Classification System II. The same cristaline fracture technique was used in all cases, and surgical procedures were performed by the same experienced surgeon, using two technologies: liquefaction or conventional phacoemulsification. Postoperative central corneal edema was measured by corneal optical pachymetry (Orbscan II®) on the 1st, 3rd, 7th and 10th postoperative days. RESULTS:None of the 20 patients submitted to surgery was lost during the postoperative follow-up or excluded from the analysis. On the first postoperative, the visual acuity average was 0.031 logMAR in the Aqualase® group and 0.043 logMAR in the conventional surgery group. No statistical difference was detected in the assessment of visual acuity throughout the postoperative period. Central corneal pachymetry varied from 543.93 + 34.69 preoperatively to 545.08 ± 25.67 on the last day of follow-up in the Aqualase® group, and from 543.13 + 30.62 to 536.08 + 34.89 in the conventional technique group, without statistical significance. CONCLUSION:This study suggests that both techniques are equally effective for surgery on lenses with grade I or II cataract, and that they provide similar results in terms of visual recovery and central corneal edema.

Comparação entre capsulotomia assistida por laser de femtossegundo e capsulorrexe curvilínea contínua guiada por imagem digital

Purpose: To measure and compare size and shape parameters of femtosecond laser capsulotomy with manually continuous curvilinear digital guided capsulorhexis (CCC) and their refractive outcomes. Methods: Laser capsulotomies in 40 eyes of 40 patients were performed using LenSx femtosecond laser device (Alcon, Forthworth, US) and its results were compared with the CCC digital guided carried out in 40 eyes of 40 patients using the Callisto Eye digital image system (Zeiss, Germany). Capsulorhexis circularity, shape and capsule overlap were measured using Adobe Photoshop (Adobe Systems Inc.) and postoperative refraction outcomes were evaluated in both groups. Results: Highly accurate and predictable capsulotomy diameter, size and shape were achieved with femtosecond laser capsulotomy compared with capsulorhexis and showed statistical difference between groups. Spherical equivalent comparison between groups showed no statistical difference. Conclusions: Femtosecond laser anterior capsulotomy with programed circularity had the intended diameter with average standard deviation values, indicating higher reproducible outcomes. Capsulorhexis performed by an experienced surgeon with auxiliary image guide and appropriate settings provides similar results our results suggest that different techniques are equally effective.

Elaboração e validação do questionário de satisfação dos pacientes pseudofácicos em português

PURPOSE: Development and validation of quality of life questionnaire in pseudophakic patients in Portuguese. METHODS: The modified Cataract TyPESpecification questionnaire was specifically developed to assess quality of life after cataract surgery, functional status evaluated with 10 items and contains 18 questions. All questions were applied by a single examiner, with the goal of graduating visual satisfaction from 0 to 10 (0 means very dissatisfied, 5 neutral, 10 very satisfied).This prospective comparative study included 142 eyes of 71 patients in Sao Paulo University. The ophthalmologic evaluation performed included near, intermediate and distance corrected and uncorrected visual acuity and quality of life questionaire. The minimum follow-up was 6 months. RESULTS: The mean age of patients was 60.7± 6.6 years in theTecnis®MF, 63.1 ±4.4 years in-groupRestor®63.7±4.2 years in-group SN60AT/SN60WF. Uncorrected and distance-corrected near visual acuity were statistically higher in theRestor® and Tecnis® groups compared to the SN60AT/SN60WF group (p<0.001). There were no statistical differences between groups comparing uncorrected and best-corrected distance visual acuity (p=0.56). Satisfaction questionnaire showed high glasses independence fortheTecnis®MF (9.3 /10) and Restor® (8.7 /10), but with more unsatisfied of halos (18.8% Restor®, Tecnis®21, 7%) and glare (Restor® 25%;Tecnis®26.1%) than the group SN60AT/SN60WF. CONCLUSION: Cataract patients who received multifocal (Restor®; Tecnis®MF) IOLs at time of surgery obtained better uncorrected and distance corrected near visual acuity and reported better overall vision, less limitation in visual function, less spectacle dependency, and more glare or halo than those who received monofocal (SN60AT; SN60WF) IOLs. Cataract TyPESpecification questionnaire was a strong predictor of change in patient satisfaction caused by cataract surgery.

Desempenho visual dos pacientes pseudofácicos com diferentes lentes intraoculares

OBJETIVO: Comparar a performance visual dos pacientes submetidos ao implante das lentes intraoculares multifocais difrativas Tecnis® MF ZM900, Acrysof® Restor® SN60D3, Acrysof® SN60WF e Acrysof® SN60AT. METODOS: Estudo prospectivo comparativo, nao randomizado, que incluiu 142 olhos de 71 pacientes com catarata, provenientes do ambulatorio de oftalmologia do HC-FMUSP. A avaliacao oftalmologica contou com medida da acuidade visual para longa, intermediaria e curta distância, sem correcao e com a melhor correcao optica, teste de sensibilidade ao contraste, pupilometria e analise de frente de onda por meio do aberrometro. Todos os exames foram realizados com seis meses de pos-operatorio. RESULTADOS: A media de idade dos pacientes foi de 60,7±6,6 anos no grupo Tecnis, 63,1±4,4 anos no grupo Restor e 63,7±4,2 anos no grupo monofocal (SN60AT no olho contralateral SN60WF). A acuidade visual para perto nao corrigida e corrigida para longe foi estatisticamente superior nos grupos multifocal Restor e multifocal Tecnis em comparacao ao grupo monofocal SN60AT/SN60WF (p<0,001). Nao houve diferenca estatistica entre os grupos na comparacao da acuidade visual para longe (p=0,56). A sensibilidade ao contraste fotopica monocular foi estatisticamente inferior nos grupos Restor e Tecnis (p<0,001). A SN60AT apresentou maior aberracao esferica comparada a todas as outras lentes (p<0,001). A Tecnis se mostrou com menores valores medios de aberracoes esfericas na comparacao com a Restor (p<0.001). CONCLUSAO: A Restor e Tecnis apresentaram melhor acuidade visual para perto do que o grupo monofocal SN60AT/SN60WF. Todas as lentes intraoculares promoveram boa visao para longe. O grupo da Tecnis apresentou melhor sensibilidade de contraste, menos aberracoes opticas e melhor visao intermediaria que o grupo Restor.

Lente intraocular multifocal refrativa: a performance visual e qualidade de vida em implantes bilaterais versus unilaterais

OBJETIVO: O objetivo desse estudo e comparar acuidade visual, sensibilidade ao contraste, velocidade de leitura e a qualidade de vida pos-operatoria de pacientes pseudofacicos unilaterais ou bilaterais com lentes intraoculares multifocais ReZoom. METODOS: Estudo comparativo, prospectivo, nao aleatorio incluindo 38 olhos de 24 pacientes, separados em um grupo com implante bilateral (14 pacientes) e outro com implante unilateral (10 pacientes). O exame oftalmologico completo incluiu acuidade visual nao corrigida pre-operatoria para perto, intermediario e para longe, acuidade visual com melhor correcao, topografia corneal, sensibilidade ao contraste, velocidade de leitura e escala de satisfacao realizado 60 dias apos a cirurgia. A analise estatistica foi realizada por meio dos testes de Kruskal-Wallis, Mann-Whitney e Qui-quadrado. RESULTADOS: Os resultados comparando funcao visual, sensibilidade ao contraste, velocidade de leitura e escala de satisfacao foram semelhante entre os grupos. CONCLUSAO: Nao houve diferenca estatistica entre os resultados comparando funcao visual, sensibilidade ao contraste, velocidade de leitura e escala de satisfacao entre os grupos.

Avaliação da qualidade óptica de lentes de contato gelatinosas na correção de miopia

PURPOSE: To evaluate the optical performance of eyes fitted with two different soft contact lenses: Acuvue® 2 (Vistacon JJ 3; 6 e 18 spatial frequencies for both soft contact lenses, but no difference was found between them. Regarding wavefront analysis, no difference was found between both soft contact lenses. There were not significantly differences in the Strehl indices and MTF for both soft contact lenses. CONCLUSION: World Vision Disposable Asferica Wave Front® soft contact lenses had a better performance regarding high contrast visual acuity. However, low contrast visual acuity, wavefront analysis and contrast sensitivity were similar for both soft contact lenses.

Técnica Tied Out Open Sky: fixação iriana de lente intraocular combinada com transplante penetrante de córnea

To describe a new method for iris fixation of intraocular lens in the absence of capsular support during penetrating keratoplasty. Its a new technique of iris fixation of intraocular lens without capsular support during penetrating keratoplasty. This technique is used in cases with a healthy iris and partial or total absence of capsular support during penetrating keratoplasty. Tied Out Open Sky is a technique easy to perform for iris fixation of intraocular lens during penetrating keratoplasty. The big advantage is being able to tie off the intraocular lens off the eye and fasten it securely.

Comparação do efeito nas culturas de humor aquoso de gatifloxacina 0,3% aplicado três dias antes de facoemulsificação e e antes do pré-operatório

Purpose: To determine the effect on human aqueous humor cultures of topical gatifloxacin 0.3% applied four times a day three days before phacoemulsification compared to topical gatifloxaxin 0.3% applied and same-day surgery. METHODS: Thirty-seven patients with cataract without other ocular diseases were randomly assigned to Groups A and B before phacoemulsification. Group A received topical gatifloxacin 0.3% same-day surgery and Group B received gatifloxacin 0.3% four times a day three days before phacoemulsification. After the procedure the aqueous humor was aspirated for cultures on agar-blood, agar-chocolate, saboraud and TSB and smeared for bacterioscopy. RESULTS: Group A presented 40% of the bacterioscopies with cocci gram +, Group B presented 17.6% of the bacterioscopies with cocci gram +. These results are not statistically significant (p=0,098). Five cases (25%) from Group A presented positive cultures for S. epidermidis, which was significantly higher than Group B, which did not present positive cultures for any bacteria or fungus (p=0,027). CONCLUSION: Gatifloxacin 0.3% applied three days before phacoemulsification significantly lowered the rate of positive aqueous humor cultures when compared to immediate application of this antibiotic before surgery in this study.

Alterações na tela de Amsler entre pacientes com catarata senil

PURPOSE: To assess the influence of some forms of lenticular opacification in the Amsler grid test among patients suffering from senile cataract. METHODS: Randomized, prospective interventional trial. Two hundred patients with senile cataract were evaluated with Amsler grid, measurement of best corrected visual acuity for near distance and far distance, biomicroscopy of the anterior segment and macular region. RESULTS: With a two months minimum of follow-up, the average visual acuity after surgery for far distance among the 200 patients was 0.48 logMAR, 11 (5.5%) had changes in the Amsler grid test before surgery. After surgery, from the 11 subjects with changes in the preoperative Amsler grid test, 10 had no more changes in the Amsler grid. These 10 subjects had postoperative best corrected visual acuity of 20/20, and Jaeger 1, no abnormalities of the fundus having been detected. Under this study conditions, the prevalence of changes in the Amsler grid test was 5.5%, and in 5% of the patients these changes were likely related to cataract whereas in 0.5% they were related to vitreous opacification. CONCLUSION: Some patient with cataract showed changes in the Amsler grid test that can be directly related to cataract, in the absence of clinically detected macular disorders.