RESUMO
PURPOSE: To determine whether treatment with oral gabapentin reduces postoperative pain after photorefractive keratectomy (PRK). METHODS: This prospective, randomized, double-blind, placebo-controlled study comprised 40 patients scheduled for bilateral PRK. Exclusion criteria were previous refractive surgery; diseases that could affect epithelial healing; use of antihistamines, nonsteroidal anti-inflammatory drugs, or steroids; and use of mitomycin C during PRK. Patients were divided into two groups: 20 patients received gabapentin capsules (300 mg) and 20 patients received identical placebo capsules. Visual acuity, slit-lamp examination, and a 12-question, 10-point visual numerical scale questionnaire were evaluated at each postoperative follow-up. Main outcome measures were the severity of pain at each follow-up and during the previous 24 hours. Secondary outcome measures were maximum and minimum severity of pain, healing time, uncorrected distance visual acuity, and the rating of other symptoms and potential side effects. RESULTS: The gabapentin group had less pain during the first 72 hours (P=.024 to .001). A significant difference in favor of gabapentin was found for the first 48 hours regarding minimum pain severity (P=.005 and .01 for 24 and 48 hours, respectively) and for the first 72 hours for maximum pain severity (P=.014, .007, and .001 for 24, 48, and 72 hours, respectively). No significant differences were observed for side effects, symptoms, or healing time except discomfort in favor of gabapentin during the first 24 hours (P=.043). CONCLUSIONS: Gabapentin significantly reduced postoperative pain after PRK compared to placebo, with no increase in reported side effects.
Assuntos
Aminas/uso terapêutico , Analgésicos/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Dor Ocular/tratamento farmacológico , Dor Pós-Operatória , Ceratectomia Fotorrefrativa , Ácido gama-Aminobutírico/uso terapêutico , Administração Oral , Adulto , Aminas/efeitos adversos , Analgésicos/efeitos adversos , Ácidos Cicloexanocarboxílicos/efeitos adversos , Método Duplo-Cego , Dor Ocular/etiologia , Feminino , Gabapentina , Humanos , Lasers de Excimer/uso terapêutico , Masculino , Estudos Prospectivos , Acuidade Visual/fisiologia , Adulto Jovem , Ácido gama-Aminobutírico/efeitos adversosRESUMO
PURPOSE: To assess the safety to the corneal endothelium of ultraviolet (UV) light treatment to a light-adjustable intraocular lens (IOL). SETTING: Codet Vision Institute, Tijuana, Mexico. DESIGN: Cohort study. METHODS: The study evaluated consecutive patients scheduled for phacoemulsification cataract surgery with implantation of a light-adjustable IOL. Endothelial cell density (ECD), variation in the size of endothelial cells, and the percentage of hexagonal cells were determined centrally with a specular microscope preoperatively, 1 week postoperatively (before UV treatment), and 6 months postoperatively. Two adjustments and 2 lock-in procedures were performed with a light-delivery system between 2 weeks and 4 weeks postoperatively. RESULTS: The study enrolled 10 patients. Specular microscopy showed a mean ECD of 2344 cells/mm(2) preoperatively. The mean overall central ECD was 2047 cells/mm(2) 1 week postoperatively and 2130 cells/mm(2) at 6 months, representing an endothelial cell loss of 12.6% and 9.1%, respectively, from preoperative values. There was no statistically significant difference in the coefficient of variation or percentage of hexagonal cells at either postoperative evaluation. CONCLUSIONS: The endothelial cell loss at 6 months correlated well with previous reports of endothelial damage after phacoemulsification with IOL implantation. The light-adjustable IOL irradiation protocol for adjustment and lock-in procedures did not seem to add to the endothelial damage caused by the cataract surgery, indicating the protocol is safe to the corneal endothelium.
Assuntos
Endotélio Corneano/efeitos da radiação , Lentes Intraoculares , Segurança , Raios Ultravioleta/efeitos adversos , Idoso , Extração de Catarata/efeitos adversos , Extração de Catarata/métodos , Contagem de Células , Estudos de Coortes , Endotélio Corneano/patologia , Feminino , Humanos , Implante de Lente Intraocular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Desenho de PróteseRESUMO
PURPOSE: The management of preoperative and residual astigmatism is critical to obtain optimized uncorrected visual acuity. The aim of this study was to determine whether residual astigmatism could be precisely corrected postoperatively using the Light Adjustable Lens (LAL, Calhoun Vision Inc) and to determine the stability of the adjusted refraction. METHODS: Ten eyes of 10 patients with cataract and corneal astigmatism between 1.00 and 2.00 diopters (D) were included. After standard phacoemulsification and implantation of the LAL, adjustment and lock-in procedures were completed. Before adjustment and 2 weeks, 6 months, and 1 year after lock-in, a full ophthalmic examination including uncorrected distance acuity (UDVA) and corrected distance visual acuity (CDVA), autorefraction, and manifest refraction was performed. RESULTS: All surgeries, adjustments, and lock-in procedures were performed with no complications. All eyes achieved ±0.50 D of the targeted cylindrical adjustment. Mean spherical equivalent refraction was 0.03±0.84 D before adjustment and -0.06±0.25 D at final follow-up. The cylinder axis remained the same in 60% of eyes and all eyes were stable within 10° rotation at 12-month follow-up. Seven of 10 eyes achieved UDVA of 20/25 or better whereas all eyes achieved UDVA of 20/32 or better. Corrected distance visual acuity remained stable in all eyes. CONCLUSIONS: In this pilot study, the LAL proved to be an efficient, predictable, and stable method of managing astigmatism in cataract patients.
Assuntos
Astigmatismo/cirurgia , Implante de Lente Intraocular , Lentes Intraoculares , Facoemulsificação , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/etiologia , Astigmatismo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Desenho de Prótese , Refração Ocular/fisiologia , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To compare postoperative pain associated with epi-LASIK versus photorefractive keratectomy (PRK). METHODS: This prospective observer-masked randomized study included 40 eyes of 20 patients with myopia and astigmatism who received epi-LASIK (Moria Epi-K) in one eye and PRK in the contralateral eye. Corneal ablation was done using the NIDEK EC-5000 excimer laser. Patients were seen at days 1, 3, and 6 to rate their pain via three measuring tools: 1) a global subjective rating, 2) a 10-cm visual analog scale, and 3) an 11-point numeric scale of pain. RESULTS: On postoperative day 1, 19 of 20 patients reported pain in both eyes. Using the global subjective rating scale, patients reported more pain for those eyes treated by PRK. Although clinically relevant, this difference was not statistically significant (P = .56). Based on the 11-point numeric scale of pain and visual analog scale, mean pain scores were similar for both groups. On day 3, using the global subjective rating scale, 11 of 12 patients who had pain reported more in the epi-LASIK treated eye (P = .0005). In addition, epi-LASIK eyes demonstrated higher mean pain scores based on the other two scales (visual analog scale, P = .045 and 11-point numeric scale of pain, P = .023). Only 6 patients reported minimal pain on day 6. It was more frequently reported and slightly more marked in epi-LASIK eyes, but did not reach statistical significance. CONCLUSIONS: Epi-LASIK and PRK have similar pain on postoperative day 1, but epi-LASIK demonstrated statistically more pain than PRK on days 3 and 6.
Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Dor Pós-Operatória/diagnóstico , Ceratectomia Fotorrefrativa , Seguimentos , Humanos , Lasers de Excimer , Medição da Dor , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do TratamentoRESUMO
PURPOSE: To analyze in vivo the architecture of clear corneal incisions (CCIs) for phacoemulsification using optical coherence tomography (OCT). SETTING: Anterior Segment Department, Asociacion Para Evitar la Ceguera en Mexico, Hospital Dr Luis Sanchez Bulnes, Mexico. METHODS: A prospective masked study analyzed 20 unsutured CCIs placed superiorly and created in a uniplanar fashion with a 3.2 mm slit-angled metal keratome. All wounds were evaluated with a retinal OCT model 1, 3, and 30 days postoperatively. Intraocular pressure (IOP) and incision leakage were checked. The architecture was described according to the angle of incidence, apposition of the epithelial and endothelial margins, and wound sealing. RESULTS: No leakage was detected. The angle varied from 33 to 85 degrees; angles greater than 75 degrees were done by a surgeon in training. Wound apposition at the epithelial margin was achieved in all cases. In contrast, imperfect apposition of the endothelial margin was seen in 45% of incisions on day 1 and in 15% on day 30. Incomplete sealing of the wound was seen by OCT in 25% of cases at 24 hours and persisted in 10% of all cases at 1 month. This gaping occurred on the endothelial side and never translated to the epithelial margin. No statistical correlation was found between gaping and the angle of the incision, IOP variations, or surgeon experience. CONCLUSIONS: Although in vivo CCIs caused minor anatomic imperfections, they were clinically stable independent of incision angle, IOP variation, and surgeon experience. Incision stability may be related to careful wound construction, epithelial viability, stromal edema, and efficient endothelial pumping.
Assuntos
Córnea/patologia , Córnea/cirurgia , Facoemulsificação/métodos , Tomografia de Coerência Óptica , Cicatrização , Feminino , Fluorofotometria , Humanos , Pressão Intraocular , Implante de Lente Intraocular , Masculino , Estudos Prospectivos , Tonometria OcularRESUMO
PURPOSE: To determine whether there is an increased risk to the corneal endothelium when mitomycin C (MMC) is administered after photorefractive keratectomy (PRK). DESIGN: Prospective, randomized, double-blind, placebo-controlled crossover trial. METHODS: Corneal endothelium was analyzed preoperatively and postoperatively in 18 eyes of nine patients who were administered either MMC- or balanced salt solution (BSS)-supplemented PRK at Codet Aris Vision, Tijuana, Mexico. After laser ablation, one eye was randomly assigned to intraoperative topical MMC 0.02% treatment for 30 seconds, and the fellow eye (the control eye) was treated in a standard fashion with topical BSS. Preoperative pachymetry and endothelial cell count were performed and compared with postoperative measurements after one month and three months. Main outcome measure studied was endothelial cell loss. RESULTS: There was no significant difference in the preoperative endothelial cell count between the 2 groups: MMC group 2835 +/- 395, control group 2779 +/- 492, P = .62. In the control group, at one month and three months the difference in the endothelial cell count was not statistically significant (P = .27, P = .14, respectively). However, in the MMC group the endothelial cell loss was statistically significant: at one month 14.7 +/- 5.1%, and at three months 18.2 +/- 9.0% (P = .0006, P = .002, respectively). CONCLUSIONS: The use of intraoperative topical MMC 0.02% for 30 seconds after PRK may affect the endothelial cell count.
Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Endotélio Corneano/efeitos dos fármacos , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa/métodos , Administração Tópica , Contagem de Células , Topografia da Córnea , Estudos Cross-Over , Método Duplo-Cego , Endotélio Corneano/patologia , Humanos , Cuidados Intraoperatórios/métodos , Lasers de Excimer , Estudos Prospectivos , Acuidade VisualRESUMO
PURPOSE: To assess the outcome of simultaneous implantable contact lens (ICL) removal and cataract extraction with pseudophakic intraocular lens (IOL) implantation. SETTING: CODET Aris Vision Institute, Tijuana, Mexico. METHODS: This retrospective noncomparative interventional case series evaluated 14 eyes of 12 patients with ICL implantations who developed a cataract and simultaneously had ICL removal and cataract extraction with IOL implantation. The follow-up time was at least 6 months (range 6 to 24 months). Visual acuity (logMAR), manifest refraction, intraocular pressure, and adverse events were recorded. RESULTS: Of the 12 patients (14 eyes), 10 patients (12 eyes) had ICL surgery to correct high myopia and 2 patients (2 eyes), to correct hyperopia. The mean uncorrected visual acuity after ICL implantation (before cataract development), before cataract surgery, and after cataract surgery were 0.48 +/- 0.32, 0.83 +/- 0.34, and 0.40 +/- 0.27, respectively. The mean best corrected visual acuity (BCVA) before ICL implantation, after ICL implantation, and after cataract surgery were 0.31 +/- 0.21, 0.28 +/- 0.19, and 0.27 +/- 0.21, respectively. The mean final manifest spherical equivalent was 0.30 diopters (D) +/- 1.07 (SD) (range +2.38 to 2.0 D). Ten eyes (71.4%) were within +/-1.0 D of the calculated target. One eye had a tear in the posterior capsule with vitreous loss during cataract surgery. No other intraoperative, perioperative, or postoperative complications were observed. No loss of BCVA was recorded at the last postoperative visit. CONCLUSIONS: Lens opacities and cataract formation are a potential complication of ICL surgery. The removal of the ICL and the cataract with IOL implantation was found to be safe, with predictable refractive results.
Assuntos
Catarata/etiologia , Lentes de Contato/efeitos adversos , Remoção de Dispositivo , Implante de Lente Intraocular , Facoemulsificação , Implantação de Prótese/efeitos adversos , Adulto , Humanos , Hiperopia/cirurgia , Pressão Intraocular , Pessoa de Meia-Idade , Miopia/cirurgia , Pseudofacia/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
PURPOSE: To evaluate the incidence of intraoperative complications using the NIDEK MK-2000 microkeratome during flap creation in LASIK. METHODS: The incidence of intraoperative flap complications during LASIK using the NIDEK MK-2000 microkeratome was retrospectively studied in 26,600 procedures performed in 5 outpatient excimer laser surgery centers. RESULTS: A total of 65 (0.244%) complications were identified: 23 (0.086%) eyes had free caps, 13 (0.049%) eyes had an incomplete pass, 13 (0.049%) eyes had an epithelial defect, 11 (0.041%) eyes had buttonhole, and 5 (0.019%) eyes had irregular flap. The remaining 26,535 (99.756%) eyes had uneventful flap creation. CONCLUSIONS: Use of the NIDEK MK-2000 microkeratome resulted in a low incidence of intraoperative complications, making it a safe and reliable device for creating flaps during LASIK.
Assuntos
Substância Própria/cirurgia , Complicações Intraoperatórias , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Procedimentos Cirúrgicos Refrativos , Retalhos Cirúrgicos , Falha de Equipamento , Humanos , Incidência , México/epidemiologia , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate the changes in ocular aberrations induced by corneal flap creation. DESIGN: Prospective interventional nonrandomized clinical trial. METHODS: This study included 15 patients who were scheduled for laser in situ keratomileusis. A nasal hinge flap was created, using the Nidek MK-2000 microkeratome and then replaced without performing laser ablation. The ocular aberrations were measured before and after flap creation using the Nidek Optical Path Difference Scanning System ARK-10000. RESULTS: The root mean square wavefront errors of the higher-order optical aberrations (third-, fourth-, fifth-, and sixth-order aberrations) were not significantly altered at 1 week postsurgery compared with the preoperative values (P >.35). CONCLUSIONS: Creating a corneal flap with the Nidek MK-2000 microkeratome did not induce changes in higher-order optical aberrations as measured with the Nidek Optical Path Difference Scanning System ARK-10000 during the early postoperative period.