Patrick Frensel de Moraes Tzelikis

Spherical Aberration and Contrast Sensitivity in Eyes Implanted with Aspheric and Spherical Intraocular Lenses: A Comparative Study

PURPOSEnTo determine whether implantation of an intraocular lens (IOL) with a modified anterior aspheric surface results in reduced spherical aberration and improved contrast sensitivity after cataract surgery.nnnDESIGNnProspective, comparative, interventional case series.nnnMETHODSnIn an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9001; Advanced Medical Optics, Santa Ana, California, USA; group 1) was compared with biconvex lens with spherical surfaces (ClariFlex; Advanced Medical Optics; group 2). Ocular aberrations for a 5.0-mm pupil and 6.0-mm pupil were measured with Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed up for three months.nnnRESULTSnNo statistically significant difference in postoperative uncorrected and best-corrected distance vision acuity after a follow-up of three months existed between the groups. Postoperative contrast sensitivity testing revealed significant differences between the groups under photopic and mesopic conditions. These differences reached statistical significance under photopic conditions at three spatial frequencies and under mesopic conditions at all spatial frequencies. When analyzing higher-order aberrations, the difference between the groups was statistically significant at the 5.00-mm and 6.00-mm pupil diameters, with the group 1 inducing less higher-order aberration and also less spherical aberration compared with group 2.nnnCONCLUSIONSnResults show the Tecnis Z9001 IOL with a modified anterior aspheric surface induced significantly less higher-order aberration and spherical aberration compared with the ClariFlex IOL. Contrast sensitivity revealed better values under photopic and mesopic conditions with the Tecnis Z9001 IOL.

Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified posterior aspherical surface (AcrySof IQ, Alcon Surgical Laboratories) results in reduced ocular aberrations (spherical aberration) and improved contrast sensitivity after cataract surgery. SETTING: Brasilia Ophthalmologic Hospital, Brasilia, and Sao Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified posterior surface (AcrySof IQ) was compared with a biconvex IOL with spherical surfaces (AcrySof Natural, Alcon). Ocular aberrations with a 5.0 mm and 6.0 mm pupil were measured with a Hartmann‐Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed for 3 months. RESULTS: There were no statistically significant differences between eyes in postoperative uncorrected and best corrected distance visual acuities after a follow‐up of 1 month and 3 months. Postoperatively, there was a statistically significant between‐group difference in contrast sensitivity under photopic conditions without glare at 18 cycles per degree (cpd) (P = .04) and under mesopic conditions without glare at all spatial frequencies (3 cpd, 6 cpd, 12 cpd, and 18 cpd; P = .03, P = .009, P = .003, and P = .003, respectively) and with glare at 3 cpd and 6 cpd (P = .001 and P = .02, respectively). The difference in higher‐order aberration (HOA) values between groups was statistically significant with a 5.0 mm and 6.0 mm pupil, with the AcrySof IQ IOL inducing less HOA than the AcrySof Natural IOL. Eyes with an AcrySof IQ IOL also had statistically significant less spherical aberration than eyes with an AcrySof Natural IOL with both pupil diameters (P<.001). CONCLUSIONS: The AcrySof IQ IOL with a modified posterior surface induced significantly less HOA and spherical aberration than the AcrySof Natural IOL. Contrast sensitivity was better under mesopic conditions with the AcrySof IQ IOL.

Ceratocone unilateral associado a constante massagem ocular devido à obstrução da via lacrimal: relato de caso

To describe a possible case of unilateral keratoconus in a patient with continual eye rubbing due to an ipsilateral nasolacrimal obstruction in a 17-year-old woman complaint of progressing low visual acuity in the left eye. Presented with constant epiphora in the left eye throughout her life as a result of ipsilateral nasolacrimal obstruction, which required frequent wiping of this eye. Based on ocular examination, the patient was diagnosed as having unilateral keratoconus in the left eye. As in other studies, keratoconus is thought to be associated with persistent eye rubbing. This patient represents a case of unilateral keratoconus, where there is a confirmed history of habitual eye rubbing due to ipsilateral nasolacrimal obstruction, thereby suggesting a possible causal relationship between eye rubbing and keratoconus.

Tarsorrhaphy: applications in a Cornea Service

PURPOSEnTo evaluate the main indications for tarsorrhaphy in a Corneal Service, as well as success rate and possible complications.nnnMETHODSnAll patients who underwent tarsorrhaphy from January 1st, 2002 to December 30th, 2002, in São Geraldo Eye Hospital - Federal University of Minas Gerais were evaluated retrospectively. Reviewed data included patients sex and age, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time for epithelial healing after tarsorrhaphy, type of tarsorrhaphy, complications, follow-up time.nnnRESULTSnEighteen patients underwent tarsorrhaphy. The indications for a tarsorrhaphy were exposure keratopathy (27.8%), persistent epithelial defect associated with penetrating keratoplasty (38.8%), neurotrophic ulcer (11.1%), dry eye syndrome (5.6%), Stevens-Johnson syndrome (11.1%), and chemical burn (5.6%). The epithelial defect resolved completely in 15 patients (83.3%). Mean duration of signs and symptoms before tarsorrhaphy was 98.7+/-48.6 days, and time to heal after tarsorrhaphy was 53.2+/-22.8 days. Of the 18 procedures, two (11.1%) were temporary and 16 (88.9%) permanent. Complications after tarsorrhaphy were premature opening of the tarsorrhaphy, trichiasis and pyogenic granuloma.nnnCONCLUSIONnTarsorrhaphy is a simple procedure, being also very safe and effective in the management of nonhealing epithelial defects, with a success rate of 83.3% and with minor complications.

Ocular copper deposition associated with monoclonal gammopathy of undetermined significance: case report

To report a case of ocular copper deposition in both eyes at the level of Descemets membrane associated with a monoclonal gammopathy of undetermined significance (MGUS). A 49-year-old white woman had golden-brown metallic dust-like deposits on Descemets membrane of both eyes. A systemic examination revealed an elevated serum copper, normal serum ceruloplasmin and a normal level of total protein. Serum protein electrophoresis demonstrated a single peak (M-spike) in the gamma region (M-protein in serum = 11 g/l). Flow cytometric analysis of the marrow aspirate identified a monoclonal plasma cell population that represents approximately 2% of the total marrow cells consistent with the diagnosis of monoclonal gammopathy of undetermined significance. Copper deposits at the level of Descemets membrane may be a finding in a patient with monoclonal gammopathy of undetermined significance.

Asymptomatic Intracranial Gumma in a Patient with Syphilitic Uveitis and Human Immunodeficiency Virus Infection

The case is described of a 51-y-old man with uveitis as the first clinical manifestation of syphilis and in whom laboratory work-up disclosed human immunodeficiency virus infection and asymptomatic brain gummata. The case illustrates the need for a comprehensive work-up in previously asymptomatic patients with uveitis.

Coloboma ocular: alterações oculares e sistêmicas associadas

PURPOSE: To verify and compare with the literature the profile of patients with ocular coloboma, and also to verify visual acuity, ocular and systemic abnormalities. METHODS: Retrospective analysis of 18 patients with a definite diagnosis of ocular coloboma at the Low Vision Department of the Sao Geraldo Eye Hospital of the Federal University of Minas Gerais. Patients underwent a complete ophthalmologic evaluation: sex, age, race, family history, prenatal and birth history, complete or incomplete coloboma, location, microphthalmos or anophthalmos, other ocular and systemic abnormalities, and visual acuity. RESULTS: 10 (55.6%) patients were women. The age was from 4 to 57, and the mean was 9.5 years. Only three (16.7%) patients had a family history of coloboma. All patients had negative prenatal and birth history. The coloboma was bilateral in 100% of the patients, and associated with microphthalmos in 6 (33.3%) cases. The coloboma was considered typical in 14 (77.8%) patients, with retinochoroidal coloboma being the most frequent, 16 (88.9%) patients. 50% of the patients had coloboma as an isolated ocular anomaly, while the other 50% presented association with systemic anomalies. In 14 (77.8%) patients other ocular abnormalities were found. CONCLUSION: The complete ophthalmologic examination is extremely important for both the diagnosis and prognosis of the patients with coloboma, since the coloboma may be associated with important low visual and also systemic anomalies and syndromes.

Afilamento escleral em paciente com rinosporidiose conjuntival

Os autores descrevem um caso de rinosporidiose conjuntival acompanhado de afilamento escleral, tratado cirurgicamente com enxerto escleral. Sao analisadas semelhancas e diferencas com outros casos descritos na literatura.

Técnica para preparação e conservação de olhos de porco para cirurgia experimental

PURPOSES: To evaluate Dextran 40 10% efficacy to maintain pig eye corneal transparency in order to indicate the best method (0.9% physiological saline, Dextran 40 10% and the mixture of both at equal parts) of conservation to maintain the transparency. METHODS: Twenty pig eyes, all of them prepared with Dextran injection in the anterior chamber and soaked in this solution for 20 minutes. Four groups, each group with five eyes and kept at 6oC in the following solutions: Group 1 (0.9% physiological saline), Group 2 (Dextran 40 10% + 0.9% physiological saline at equal parts), Group 3 (Dextran 40 10%), Group 4 (humid chamber - control group). The eyes were observed after 12, 24, 48, 56, 72 hours and then classified according to their transparency. RESULTS: Corneal transparency occurred in 100% of the eyes with Dextran solution. 0.9% physiological saline and Dextran at equal parts achieved a longer period of transparency. CONCLUSIONS: Dextran 40 10% is an efficient solution to promote corneal transparency in post mortem pig eyes. The mixture of equal parts 0.9% physiological saline and Dextran can be used to keep feasible the prepared eyes for a period as long as 72 hours.

Nucleofragmentação horizontal: uma nova técnica para a cirurgia de catarata

PURPOSE: To study in vitro the efficacy of a pair of instruments designed to capture and split human nuclei obtained from extracapsular surgeries. METHODS: The sample is a compound of 47 cataract nuclei. They were classified as mature (4+) and immature (1 to 3+), and the visual acuity ranged from 20/60 to light perception. The instruments were used to split the nuclei. A methylcellulose over a gel base was made for this purpose. RESULTS: The average age was 67,38 years. Most patients (66%), had a visual acuity less than 20/400. 42,6% of the cataracts were mature. The capturing and splitting was easily done in over 90% of the nuclei. CONCLUSIONS: The designed instruments are effective to capture and split cataract nuclei.