Lincoln Lemes Freitas

Postoperative wavefront analysis and contrast sensitivity of a multifocal apodized diffractive IOL (ReSTOR) and three monofocal IOLs.

PURPOSE To compare visual acuity, total and high order wavefront aberrations (coma, spherical aberration, and other terms of high order aberration), and contrast sensitivity in 105 eyes implanted with 4 different types of intraocular lenses (IOLs) (1 multifocal apodized diffractive IOL and 3 monofocal IOLs). METHODS A prospective study comparing four types of IOLs (Alcon ReSTOR [50 eyes], Alcon Acrysof MA30AC [20 eyes], Alcon Acrysof SA60AT [20 eyes], and Mediphacos Acqua IOL [15 eyes]) was carried out. All eyes were targeted for emmetropia. Complete ophthalmological examination, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sensitivity (Pelli-Robson chart), and wavefront analysis, was performed 2 months postoperatively. RESULTS All eyes in all groups had BSCVA > or = 20/32 postoperatively. Mean total aberration root-mean-square (RMS) values were: 0.72 +/- 0.25 microm (ReSTOR), 0.94 +/- 0.26 microm (MA30), 0.84 +/- 0.23 microm (SA60), and 2.04 +/- 0.77 microm (Acqua). Mean higher order aberration values were: 0.35 +/- 0.15 microm (ReSTOR), 0.41+/- 0.12 microm (MA30), 0.43 +/- 0.13 microm (SA60), and 0.85 +/- 0.50 microm (Acqua). The Acqua IOL showed statistically significant more total and higher order aberrations when compared with the other IOLs (P < .05). The ReSTOR IOL showed statistically significant less induction of spherical aberration when compared to the monofocal IOLs (P < .05). Mean contrast sensitivity values were: 1.64 +/- 0.08 (ReSTOR), 1.72 +/- 0.08 (MA30), 1.70 +/- 0.07 (SA60), and 1.65 +/- 0.11 (Acqua). CONCLUSIONS Different types of IOLs resulted in measurably different postoperative higher order aberration patterns. The multifocal apodized diffractive IOL (ReSTOR) induced significantly less spherical aberration compared to the monofocal IOLs. Contrast sensitivity revealed better values with MA30 and SA60 IOLs when compared to ReSTOR. The integration of wavefront technology in evaluating pseudophakic patients represents a step towards better understanding and analyzing postoperative visual quality.

Limbal Relaxing Incisions to Correct Corneal Astigmatism During Phacoemulsification

PURPOSE To evaluate the safety and efficacy of limbal relaxing incisions for the correction of corneal astigmatism during phacoemulsification. METHODS Fifty eyes of 37 patients (mean age 66.5 years, range: 45 to 80 years) with cataract and coexisting topographic astigmatism were included in the study. Eyes were randomly divided into two groups: eyes that underwent cataract surgery with limbal relaxing incisions (cataract LRI group) and eyes that underwent cataract surgery only (control group). All limbal relaxing incisions were performed during phacoemulsification. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), and corneal topography were recorded preoperatively and 1, 3, and 6 months postoperatively. RESULTS A statistically significant improvement in BSCVA was seen in the cataract LRI eyes from 0.9 +/- 0.7 preoperatively to 0.1 +/- 0.1 at 1, 3, and 6 months postoperatively (P < .01). A statistically significant improvement in BSCVA was seen in control eyes from 0.8 +/- 0.6 before surgery to 0.2 +/- 0.2 at 1, 3, and 6 months after surgery (P < .01). No difference in postoperative BSCVA was noted between the groups. A statistically significant reduction in the mean topographic astigmatism was seen in the cataract LRI eyes from 1.93 +/- 0.58 diopters (D) preoperatively to 1.02 +/- 0.60 D 6 months postoperatively (P < .05). The control eyes did not show a statistically significant change in topographic astigmatism. CONCLUSIONS Limbal relaxing incisions performed during phacoemulsification surgery appear to be a safe, effective, and stable procedure to reduce pre-existing corneal astigmatism.

Ultrasound energy and endothelial cell loss with stop-and-chop and nuclear preslice phacoemulsification

PURPOSE: To evaluate ultrasound (US) energy and endothelial cell loss in cataract surgery using the stop‐and‐chop and nuclear preslice techniques. SETTING: Vision Institute, Federal University of São Paulo, São Paulo, Brazil. METHODS: This prospective clinical trial comprised 43 patients (50 eyes) with senile nuclear cataract who were randomly assigned to 1 of 2 groups: stop‐and‐chop (n=26) or nuclear preslice (n=24). The groups were divided according to nuclear density (NO3 NC3 and NO4 NC4) using the Lens Opacity Classification System III. A full ophthalmic examination including biometry, specular microscopy, and pachymetry was performed preoperatively and postoperatively. The following parameters were evaluated: age, anterior chamber depth, lens thickness, axial length, phaco time and power, effective phaco time (EPT), infusion volume, ocular inflammation, endothelial cell loss, and best corrected visual acuity (BCVA). RESULTS: Phacoemulsification time, power, and EPT were significantly higher in the stop‐and‐chop group. Infusion volumes did not vary significantly between the groups. A significant decrease in endothelial cell density occurred postoperatively and was similar with both techniques (stop‐and‐chop, 8.70%; nuclear preslice, 8.72%). The BCVA improved significantly in both groups. No significant correlations were found between endothelial cell loss and either technique. CONCLUSIONS: Ultrasound energy consumption was lower with the nuclear preslice technique. Both techniques had similar results including endothelial cell loss.

Longitudinal study of intraocular lens exchange

PURPOSE: To analyze the indications for intraocular lens (IOL) exchange, interval between the first IOL implantation and the exchange, type and mix of IOLs used, effect on vision, and frequency of complications. SETTING: Cincinnati Eye Institute‐Cincinnati‐Ohio‐USA. METHODS: This retrospective study comprised 49 eyes of 49 adult patients who had IOL exchange between 1986 and 2002 performed by the same surgeon. The mean age was 70 years old, and 55% were women. The mean interval between surgeries was 53.8 months and the mean follow‐up, 35.6 months. The patients were divided into 2 groups according to the type of IOL originally implanted: anterior chamber (AC) or posterior chamber (PC). RESULTS: There were 15 eyes with an AC IOL and 34 eyes with a PC IOL. The difference in mean age and follow‐up were not statistically significant between groups. The mean interval between the primary surgery and IOL explantation was 82.3 months in the AC IOL group and 37.9 months in the PC IOL group. The main reason for IOL exchange was inflammation (53.34%) and dislocation/decentration (85.30%), respectively. The preoperative best corrected visual acuity was similar in both groups, and visual acuity was maintained or improved in 80%. Vitreous prolapse was the main intraoperative complication. CONCLUSIONS: The primary indication for IOL exchange was intraocular inflammation in patients with an AC IOL and IOL malposition in patients with a PC IOL. The results confirm the safety and positive visual outcome in this complex group of patients.

Efficacy and tolerability of a combined moxifloxacin/dexamethasone formulation for topical prophylaxis and reduction of inflammation in phacoemulsification: a comparative, double masked clinical trial

ABSTRACT Purpose: To compare the efficacy and safety of a combined 0.5% moxifloxacin and 0.1% dexamethasone formulation (Vigadexa*) versus conventional dosing with 0.5% concomitant moxifloxacin (Vigamox*) and 0.1% dexamethasone (Maxidex*) for the prevention of infection and control of inflammation after cataract surgery. Setting: The ophthalmology clinic and outpatient surgery suite of a public hospital in Brazil. Methods: A prospective, randomized, double-masked, parallel-group study of 139 patients, all of which underwent phacoemulsification and intraocular lens (IOL) implantation. After random assignment, 64 eyes received the combination of topical 0.5% moxifloxacin/0.1% dexamethasone drop and 62 eyes received 0.5% moxifloxacin and 0.1% dexamethasone as separate solutions four times a day for 15 days. Baseline and postoperative assessments were made on surgery days –2, 1, 3, 8, and 15. Limitations of this study included its small size and relatively short duration of follow-up. Results: There was no sign of intraocular infection at any time and only minimal inflammation beyond day 3. Physicians rated bacterial infection to be absent in both groups on days 1, 3, 8 and 15. Ninety-seven percent of patients in each group had ≤ 5 cells by day 15. Objective and subjective parameters were essentially the same in both treatment groups ( p > 0.05). One patient in the conventional therapy group developed viral conjunctivitis unrelated to the surgery. Conclusion: Treatment with the combined moxifloxacin/dexamethasone eye drops was as effective as conventional treatment in preventing infection and controlling inflammation after phacoemulsification and IOL implantation.

Custo da facoemulsificação no projeto catarata em Itápolis, SP

PURPOSE: To determine the average cost of cataract surgery using the phacoemulsification technique with intraocular lens implant (IOL). This study was conducted during a national campaign to treat patients with cataracts promoted by the Brazilian Council of Ophthalmology (CBO) and the Health Ministry in the city of Itapolis - SP from March to December, 2000. METHODS: All expenses related to the surgery were collected (pre-, intra-, and postoperative data) and analyzed. Fifty-eight patients with senile cataracts and without any other ocular findings were submitted to the procedure in a prospective study. RESULTS: The average cost of the surgery in this study was R

Avaliação do uso do anel endocapsular modificado em casos de subluxação traumática do cristalino

485.03 or US

Anterior capsule staining using 0.025% trypan blue in cataracts without red reflex

248.05. This value represents the average cost of the surgery itself; in which some materials, equipment, taxes and other services were previously determined and used for this project. CONCLUSION: The phacoemulsification technique for cataract surgery has been used more and more, due to its effectiveness, being an excellent method to treat cataracts. Although this is an excellent technique, the economical aspect does not allow it to be used for part of the population

Epilens membrane simulating cataract in children with uveitis: a report of three cases

PURPOSE: To evaluate the behavior of the modified capsular tension ring (MCTR) in traumatic subluxated cataracts analyzing the visual acuity, centration of the capsular bag, pseudophacodonesis, postoperative follow-up and intra- and postoperative complications. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Twenty-two eyes of 22 patients with traumatic loss of zonular support had phacoemulsification using PCIOL and MCTR implantation. The preoperative examination included best correct visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration and vitreous prolapse. The postoperative evaluation included BCVA, the presence of pseudophacodonesis, PCIOL centration, necessity of vitrectomy and other complications. RESULTS: 21 eyes (95.45%) had an improvement in BCVA. The preoperative examination disclosed phacodonesis in 11 eyes (50%) and no eye presented pseudophacodonesis in the postoperative period. Preoperatively, symptomatic decentration was presented by 10 eyes (45.45%) and 22 eyes (100%) had no decentration after surgery. The preoperative examination revealed vitreous prolapse in the anterior chamber in 9 eyes (40.90%). Vitrectomy was required in 11 eyes (50%). CONCLUSIONS: The use of the MCTR resulted in a good centration of the capsular bag and the PC IOL in 22 eyes with traumatic cataract and loss of zonular support.

Acetylcholine chloride 1% usage for intraoperative cataract surgery miosis

Purpose: To describe the use of anterior capsule staining in cataracts without red reflex using a 0.025% trypan blue solution. Methods: Six eyes of 6 patients with cataracts without red reflex were submitted to phacoemulsification using a direct injection of 0.2 to 0.5 ml of 0.025% trypan blue in the anterior chamber previous to viscoelastic injection. All patients had an ophthalmologic examination prior to surgery, as well as pre and postoperative corneal endothelial cell count. Results: In all cases the capsule became stained with a faint blue color that enabled an adequate visibility of the flap during the continuous curvilinear anterior capsulotomy (CCC). There were no intra-or postoperative complications. The endothelial cell loss varied between 1.8% and 26.6% (mean 12.8%). Conclusion: Staining the anterior capsule with 0.025% trypan blue solution allows a good visibility of the capsular flap and facilitates the confection of CCC in cataracts without red reflex.