Mitomycin-C supplemented trabeculectomy, phacoemulsification, and foldable lens implantation

Purpose: To evaluate the outcome of combined mitomycin-C filtering surgery, phacoemulsification, and foldable intraocular lens (IOL) implantation. Setting: Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Methods: This retrospective study evaluated 182 eyes of 174 patients who had combined mitomycin-C trabeculectomy, phacoemulsification, and insertion of a foldable IOL through a 3.5 mm incision. Success of the combined procedure was defined as intraocular pressure (IOP) below 21 mm Hg, with or without medications, and no serious complication. Success rates were calculated using the Kaplan-Meier actuarial method. Results: Mean follow-up was 16.7 months ± 5.4 (SD). The probability of success at 6, 12, 18, and 24 months was 98.3, 95.6, 90.6, and 88.0%, respectively. When compared with preoperativety, visual acuity improved one or more lines in 148 eyes (81.3%) and worsened one or more lines in 15 (8.2%); 111 eyes (61.0%) achieved visual acuity of 20/40 or better. The most frequent complication was posterior capsule opacification requiring capsulotomy, which occurred in 22 cases (12.0%). Conclusion: The 1 year and 2 year IOP control rate of combined mitomycin-C filtering procedures and phacoemulsification in glaucoma patients was high.

Correlación entre el resultado refractivo post-catarata con la predicción biométrica pre-operatoria

La cirugía de cataratas por Facoemulsificación es tal vez uno de los procedimientos más realizados en la práctica de oftalmología general, sin embargo el resultado refractivo de esta cirugía no siempre llena las expectativas del oftalmólogo y del paciente, es por esto que es de gran importancia observar los resultados post quirúrgicos obtenidos y las distintas variables que pudieron influir en dicho resultado. Objetivo: determinar la capacidad predictiva de la formula biométrica empleada en el preoperatorio con el resultado refractivo post operatorio expresada en porcentajes. Materiales y métodos: se realizó un estudio de correlación basándose en la refracción prevista por la biometría y la refracción encontrada en el post operatorio. Se analizó los diferentes grupos de pacientes miopes, hipermétropes y emétropes en de los rangos de 0,50D, 0,75 D y 1,00D. Resultados: el porcentaje de pacientes que presento 0,50D de diferencia con el previsto fue de 57,7% para el total, 100% para hipermétropes, 53,1% para emétropes, 56,3% para miopes. En el rango de 0,75D 71,2% para el total, 62,5% para emétropes y 81,3% para miopes. En el rango de 1,00D 82,7% para el total, 75% para emétropes y 93,8% para miopes. Conclusiones: la formula SRK/T presento un buen desempeño en todos los grupos encontrándose resultados concordantes con los descritos en la literatura.

In vivo chromatic aberration in eyes implanted with intraocular lenses

Purpose. To measure in vivo and objectively the monochromatic aberrations at different wavelengths, and the chromatic difference of focus between green and infrared wavelengths in eyes implanted with two models of intraocular lenses (IOL).


Methods. Eighteen eyes participated in this study: nine implanted with Tecnis ZB99 1-Piece acrylic IOL and nine implanted with AcrySof SN60WF IOL. A custom-developed laser ray tracing (LRT) aberrometer was used to measure the optical aberrations, at 532 nm and 785 nm wavelengths. The monochromatic wave aberrations were described using a fifth-order Zernike polynomial expansion. The chromatic difference of focus was estimated as the difference between the equivalent spherical errors corresponding to each wavelength.


Results. Wave aberration measurements were highly reproducible. Except for the defocus term, no significant differences in high order aberrations (HOA) were found between wavelengths. The average chromatic difference of focus was 0.46 ± 0.15 diopters (D) in the Tecnis group, and 0.75 ± 0.12 D in the AcrySof group, and the difference was statistically significant (P < 0.05). Chromatic difference of focus in the AcrySof group was not statistically significantly different from the Longitudinal chromatic aberration (LCA) previously reported in a phakic population (0.78 ± 0.16 D). The impact of LCA on retinal image quality (measured in terms of Strehl ratio) was drastically reduced when considering HOA and astigmatism in comparison with a diffraction-limited eye, yielding the differences in retinal image quality between Tecnis and AcrySof IOLs not significant.


Conclusions. LRT aberrometry at different wavelengths is a reproducible technique to evaluate the chromatic difference of focus objectively in eyes implanted with IOLs. Replacement of the crystalline lens by the IOL did not increase chromatic difference of focus above that of phakic eyes in any of the groups. The AcrySof group showed chromatic difference of focus values very similar to physiological values in young eyes.

Sexo, peso e conformação anatômica do olho sobre cálculode poder dióptrico de lentes intra-oculares no cão

A catarata, especialmente na espécie canina, é uma doença oftálmica importante. Seu tratamento é eminentemente cirúrgico, mas a perda do cristalino resulta em alta hipermetropia, e a visão fica comprometida. A correção pode ser feita com a utilização de lente intra-ocular (LIO). Este estudo teve por objetivo colher dados que pudessem fornecer subsídios métricos para a produção de LIOs a serem aplicadas em cães facectomizados, visando a restauração de visão adequada nos animais acometidos por catarata. Foram selecionados 120 cães de ambos os sexos, sadios ao exame clínico e sem evidência de doença ocular ao exame oftálmico de rotina. Foram realizados estudos ceratométrico e biométrico, pela ultra-sonografia modo-A. Uma fórmula específica foi utilizada para a determinação do poder dióptrico de uma LIO utilizada para substituir o cristalino extraído. O poder dióptrico da LIO foi correlacionado com o peso e o sexo dos animais, e entre os olhos direito e esquerdo. Baseado nestas correlações, concluiu-se que o poder dióptrico adequado para uma LIO a ser implantada em um cão facectomizado é influenciado principalmente pelo peso do animal, apesar de apresentar discretas diferenças quando comparado entre os olhos direito e esquerdo e entre machos e fêmeas.

Mensurações do bulbo ocular e cálculo do poder dióptrico de lentes intraoculares em coelhos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Subluxation of the crystalline lens: A no-ring approach

Purpose: To report the surgical technique and outcomes of a no-ring approach to posterior chamber intraocular lens (IOL) implantation in children and young adults with subluxation of the crystalline lens. Methods: A three-piece 5.5-mm hydrophobic acrylic IOL was implanted in which the optic and one haptic were inside the capsular bag and the other haptic was in the ciliary sulcus. The implantations were done in 13 eyes of 10 patients with lens subluxation. One haptic was fixated in the ciliary sulcus by passing it through an operculum-shaped opening in the capsular bag edge, made between 2 and 3 clock hours, clockwise from the middle point of the subluxated area. Results: The mean age of the 10 patients was 12.61 ± 8.04 years and the mean follow-up was 21.38 ± 11.29 months. The mean preoperative and postoperative best-corrected visual acuity (BCVA) was 1.15 ± 0.58 and 0.37 ± 0.17 logarithm of the minimum angle of resolution, respectively, in 11 measured eyes. The postoperative BCVA was 20/40 or better in 4 eyes (36.36%), between 20/40 and 20/60 in 6 eyes (54.54%), and between 20/80 and 20/100 in 1 eye (9.09%). The BCVA improved in all eyes. Postoperative IOL decentration between 1.0 and 1.5 mm occurred in 3 of 13 eyes (23.08%). Conclusion: The results indicate that the no-ring technique allows centration of an IOL implanted into a subluxated capsular bag without using capsule tension rings. © SLACK Incorporated.

Avaliação ultrassonográfica do bulbo ocular em cães submetidos à facectomia por facoemulsificação com ou sem implante de lente intraocular

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mensurações do bulbo ocular e cálculo do poder dióptrico de lentes intraoculares em coelhos (Oryctolagus cuniculus), LINNAEUS, 1758)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação da opacidade da cápsula posterior, após facoemulsificação e implante de lente intraocular modificada com plasma de flúor ou polietilenoglicol com coelhos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação ultrassonográfica do bulbo ocular em cães submetidos à facoemulsificação com ou sem implante de lente intraocular

This study aimed to describe and compare the ultrasonographic alterations in dogs' eyes submitted to facectomy with or without intraocular lens implant (IOL), to assist in the diagnosis of possible alterations related to the surgical procedure and IOL implantation. Nineteen dogs with cataract (21 eyes) were submitted to phacoemulsification and late postoperative evaluation (at five years). The animals were initially submitted to complete ophthalmological exams which preceded the sonogram. Dogs were divided in three groups: (CA) aphakic dogs (n= 11); (PP) pseudophakic dogs with implantation of two IOLs in piggyback (n=5) and (PL) pseudophakic dogs with implantation of a veterinary IOL (n = 5). The ultrasound was carried under the administration of a topic local anesthetic, with a multi frequency linear transducer of 10 MHz. Biometric eye measurements were also performed. The clinical alterations observed were IOL dislocation, retinal detachment, asteroid hyalosis, and vitreous degeneration. Ultrasound examination was an excellent diagnostic tool, as it was possible to confirm and classify these changes. The piggyback implant reduced the measurements between the ciliary body and the vitreous chamber obtained from the ocular biometry when compared to other usual procedures, with no difference between the axial length and the anterior chamber.

Condições do humor aquoso, quanto à contaminação, na facoemulsificação com implante de lente intraocular em cães

Pós-graduação em Cirurgia Veterinária - FCAV

Ocorrência de opacidade de cápsula posterior em cães pós-facoemulsificação, com ou sem a utilização de lente intraocular dobrável e efeitos do Nd: Yag Laser

Pós-graduação em Cirurgia Veterinária - FCAV

Biometria ocular na espécie Cebus apella

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Secondary intraocular lenses in eyes with aphakia or dislocated IOL: impact of suture fixation on early and late complications

BACKGROUND: Secondary intraocular lens (IOL) implantation is exposed to an increased risk of complications, including endophthalmitis and retinal detachment. The present analysis compares the outcomes and complications experienced in our own series of patients. PATIENTS AND METHODS: We retrospectively reviewed a consecutive series of secondary posterior chamber IOL implantations performed in a single centre, two surgeon setting over a period of 8 years and with a follow up-time of at least 4 months. RESULTS: Between 1997 and 2005, 75 patients received a sulcus-supported secondary IOL without suture fixation, whereas suture fixation was required in 137 instances. Visual acuity improved in both groups (group 1: from 0.36 +/- 0.39 (0.01-1.2) to 0.73 +/- 0.33 (0.02-1.0; p = 0.18); group 2: from 0.33 +/- 0.34 (0.02-1.0) to 0.46 +/- 0.33 (0.01-1.0; p = 0.006), but more pronounced in eyes not requiring suture fixation (p = 0.012). IOL placement was more likely to be combined with endophacoemulsification in the not suture-fixed IOLs (12.7 vs. 5.3 %). In contrast, retinal tears (10.6 vs. 8.6 %, respectively) and retinal detachment (5.3 vs. 2.2 %, respectively) were equally distributed. In the early postoperative phase, IOP was lower in suture-fixed eyes, which showed a higher incidence of minor intraocular haemorrhages and cystoid macular edema (5.3 vs. 8.0 %); late complications up to 5 years postoperatively were equally distributed. CONCLUSION: A preoperatively less complicated anterior segment situation and a lower incidence of postoperative macular edema may account for a better visual outcome after placement of a sulcus supported IOLs without suturing. If required, suture fixation may be performed without exposing the eye to an increased risk of late postoperative complications.