Priscilla de Almeida Jorge

Late opacification in hydrophilic acrylic intraocular lenses: Analysis of 87 eyes in a random sample of 102 patients

Purpose To report the incidence of late postoperative opacification of a hydrophilic acrylic foldable intraocular lens (IOL). Setting Altino Ventura Foundation, Pernambuco, Brazil. Design Cross‐sectional study. Methods Patients were examined 4 years after phacoemulsification with Ioflex IOL implantation in the rural areas of Pernambuco, Brazil, as part of a community campaign for underprivileged people. The patients had a detailed ophthalmic examination to detect late IOL opacification. The patients’ charts were reviewed for preexisting ocular pathology and corrected distance visual acuity (CDVA) before and 1 month after surgery. The IOL opacification was classified according to its location and severity. Results All surgeries were uneventful intraoperatively and postoperatively. Six (7%) of the 87 eyes (58 patients) examined had a diagnosis of late IOL opacification; asteroid hyalosis and high myopia were associated ocular findings in 2 of the eyes. The preoperative CDVA ranged from hand motions (HM) to 20/80. The postoperative CDVA ranged from 20/20 to 20/40 except in 1 eye with posterior segment disease. Over the 4‐year follow‐up, 2 of the 6 eyes had a decrease in visual acuity to HM and 20/80, respectively, as a result of late IOL opacification. They had IOL replacement and CDVA improved to 20/60 and 20/20, respectively. A third eye with severe late opacification was not referred for IOL replacement because of macular disease. Conclusion Intraocular lens opacification was observed in 7% of the eyes studied. No risk factors could be determined. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Corneal involvement in systemic inflammatory diseases.

Abstract: Corneal involvement in patients with systemic inflammatory disorders may be sight threatening, and it may be associated with a life-threatening disease. Significant systemic inflammatory diseases in this context are autoimmune connective tissue diseases, systemic autoimmune dermatological disorders, and autoimmune diseases of the lacrimal system. Keratoconjunctivitis sicca is usually the most common ocular finding in these patients. Peripheral ulcerative keratitis is a rare condition usually associated with increased ocular morbidity and also mortality, as it might act as an indicator of a more widespread vasculitis. Corneal biomechanical properties may also be altered in connective tissue diseases. Although recent studies suggest that the risk for corneal complications after ocular surgery in patients with quiescent autoimmune disease is minimal, caution is still recommended, as the knowledge about the corneal wound-healing process and the corneal biomechanical properties in these patients is not yet fully understood. This article reviews corneal abnormalities and characteristics in the setting of systemic inflammatory diseases.

Efeito terapêutico do crosslinking corneal na ceratite infecciosa

PURPOSE: To evaluate the effect of corneal crosslinking (CXL) in the treatment of infectious keratitis resistant to medical treatment, and investigate the relation with the CXL outcome to the etiologic agent. METHODS: The study included 11 patients who were diagnosed with bacterial (seven eyes) or fungal keratitis (four eyes) at Altino Ventura Foundation from october 2011 to may 2012. All patients were using antibiotic eye drops for at least 7 days and have had no infection improvement. Patients were evaluated prior to CXL and the postoperative period until healing of the keratitis. For CXL, eyes were first instilled with a solution containing 0.1% riboflavin and 20% dextran for 30 min at a 5-minutes interval. Riboflavin-soaked eyes were then irradiated with UVA light (370ηm ± 5ηm) at 3mW/cm2 for 30 minutes. RESULTS: Eyes with bacterial infection exhibited improvement of infectious symptoms after CXL whereas eyes with fungal keratitis showed no improvement. Thus, there was a statistically significant correlation (p = 0.003) between the etiologic agent and the effectiveness of healing. CONCLUSION: CXL was effective in the treatment of bacterial keratitis resistant to clinical treatment, eliminating the need for surgery. However, CXL was not effective in managing fungal keratitis.

Long-term efficiency of cataract surgery with hydrophilic acrylic Ioflex intraocular lens

OBJECTIVE: To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns. METHODS: Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated. RESULTS: The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group. CONCLUSIONS: The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.

Consequences of cataract surgery public policies run by private contractors

In 1998, on the initiative of the Brazilian Council of Ophthalmology (CBO) and the Health Ministry, with the support of medical schools, the National Cataract Campaign was established. Access to treatment was made easy with nationwide campaigns conducted for diagnosis and later for surgery (Cataract Projects). This action had the greatest impact on visual health in Brazil as the number of performed surgeries has almost doubled. By means of epidemiologic studies, the effectiveness and safety of cataract surgeries performed in university hospitals on a large scale were confirmed and Cataract Projects were improved. Nevertheless, in 2006, the Health Ministry discontinued the National Campaign due to lack of funds for all surgeries, and public hospitals were granted limited quotas for surgical procedures. This measure negatively impacted progression in the number of surgeries performed annually by reducing the use of the installed cataract surgery capability in public hospitals; thus, an additional barrier was created to limit the access of the needy population to corrective surgery: limitation of surgical offering. Despite the clinical evidence demonstrated by published epidemiologic studies that the methodology used in the National Campaign for blindness eradication by cataract surgery was successful in Brazil, the National Government and several municipalities have opted for a new strategy to deal with the problem. Currently, many public health projects for cataract surgery are implemented by means of bidding, in which private companies, some with mobile surgical units, negotiate the least value for quotas on thousands of surgeries. The analysis and interpretation of epidemiological data on total cataract surgeries performed by the public health system in Brazil from January 2000 to December 2015 demonstrated that the number of surgeries between 2010 and 2015 has increased by approximately 246%, while the amount spent annually on surgeries increased by 371% over the same period (Table 1). The number of cataract surgeries performed at the Hospital das Clínicas of the Medical School of the University of São Paulo (HCFMUSP, a reference public teaching hospital) has decreased by approximately 23%, from 2005 to 2015 (Table 2).

Intraocular lenses and clinical treatment in paediatric cataract

A catarata pediatrica e a causa mais comum de cegueira tratavel em criancas. Prevalencia, etiologia e morfologia variam conforme o desenvolvimento socioeconomico. O tratamento tem como objetivo diminuir a ambliopia, sendo de dificil manejo principalmente em casos unilaterais. A decisao sobre afacia ou implante primario de lente intraocular deve ser individualizado, assim como a correcao com lente de contato ou oculos. As lentes intraoculares acrilicas hidrofobicas de peca unica sao as mais implantadas em criancas com preferencia de implante no saco capsular. A formula biometrica Sanders-Retzlaff-Krafftheoretic (SRK/T) e a mais precisa em pacientes pediatricos, seguida de Holladay I e SRK II, com recomendacao de sob correcao de +6 a +8.0 dioptrias, devido ao esperado crescimento rapido do globo ocular. A opacidade de capsula posterior e a complicacao mais frequente e varia com o material da lente a ser implantada e o glaucoma e a complicacao pos-operatoria mais grave e depende da idade da crianca na cirurgia, implante primario de LIOs e da duracao do acompanhamento pos-cirurgico. A adesao ao tratamento oclusivo e fundamental para o prognostico visual, sendo determinado de acordo com a idade da crianca e a lateralidade da catarata. Mesmo com a melhora do tratamento cirurgico e das lentes intraoculares o prognostico visual final ainda nao e o desejavel.