RESUMO
Objective: To report a case of hypercorrection of astigmatism (Cyl) after implantation of 2 segments of short arch ring for keratoconus treatment and to describe its replacement by long arch segment. Methods: This is a case report of a patient with keratoconus and no adaptation to glasses or contact lenses, who was implanted 2 ring segments: upper nasal (155º/ 200µm) and inferior temporal (155º/ 250µm). Results: First postoperative month: CVA = 20/ 50 (-10.50-2.50x135°) and SimK K1 = 48.4x143° and K2 = 51.2x53° (Cyl 2,8D). In the 3rd year: CVA 20/ 30 (-6.00-2.50x135º), with inversion of the axes: K1 = 49,5x60º and K2 = 52,0x150º (Cyl 2,6D). The hypercorrection increased up to the 8th year: CVA = 20/40 (-4,50-6,00x75º) and SimK 47,8x51º/ 60,4x141º (Cyl 12,6D). The 2 segments were replaced for a single segment (320º/ 300µm) and after 1 month: CVA = 20/ 25 (-5,75 spherical) with SimK 46,8x38º/ 48,9x128º (Cyl 2,1D). Conclusion: The ring aims to flatten the most curved meridian, but surpassing the previous value induces astigmatism in the opposite meridian. The hypercorrection of the 2 short segments must occur due to its movement of the extremities, which does not occur with the single long arc segment (≥ 300º). Abbreviations: CVA = Corrected visual acuity, SimK = Simulated keratometry, LE = Left eye, RE = Right eye.
Assuntos
Astigmatismo/terapia , Lentes de Contato , Córnea/cirurgia , Óculos , Ceratocone/cirurgia , Complicações Pós-Operatórias/terapia , Refração Ocular/fisiologia , Adulto , Astigmatismo/etiologia , Astigmatismo/fisiopatologia , Córnea/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Ceratocone/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Fatores de Tempo , Acuidade VisualRESUMO
OBJETIVO: describir los resultados de la queratoplastia lamelar profunda en el tratamiento quirúrgico del queratocono en el Servicio de Córnea del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". MÉTODOS: se realizó un estudio descriptivo prospectivo en 7 ojos con queratocono operados de queratoplastia lamelar profunda. Se analizaron las variables edad, sexo, grado de queratocono, agudeza visual preoperatoria y posoperatoria, astigmatismo posquirúrgico, paquimetría y queratometría topográfica a la semana, al mes y a los tres meses de la intervención. La información se procesó a través de frecuencias absolutas, relativas, medias y desviación estándar. RESULTADOS: en el sexo masculino, el 42,9 % tenía entre 18 y 39 años de edad al igual que el grupo de 40-50 años en el sexo femenino. El 57,2 % de los casos presentó queratocono avanzado. En el posoperatorio se encontró que el 71,4 % de los casos poseía una agudeza visual corregida entre 0,1-0,3 y 5-10 dioptrías de astigmatismo posquirúrgico; la paquimetría fue superior a 560 µm en el 85,6 %; la queratometría promedio en el meridiano más fuerte fue de 47,77 y en el meridiano más débil, de 40,01. CONCLUSIONES: la queratoplastia lamelar predescemética es una técnica quirúrgica que ofrece ventajas superiores en relación con las queratoplastias penetrantes.
OBJECTIVE: to describe the results of deep lamellar keratoplasty in the surgical treatment of keratoconus in the Corneal Service of "Ramón Pando Ferrer" Cuban Institute of Ophthalmology. METHODS: a prospective descriptive study of 7 eyes with moderate keratoconus who underwent predescemetic lamellar keratoplasty. The universe consisted of 7 eyes fom patients who met the criteria for deep lamellar keratoplasty surgery. The variables age, sex, degree of keratoconus, pre-and postoperative visual acuity, postoperative astigmatism, topographic keratometry and pachymetry after a week, a month and three months of the surgery. Data were analyzed by using absolute, relative, mean frequencies and standard deviations. RESULTS: the 18-36 year age group in males represented 42,9 % as the 40-50 years-old group in females. In the studied group, 57,2 % of patients had advanced keratoconus. On the third postoperative month, 71,4 % of patients had visual acuity ranging 0,1 to 0,3 and 5-10 postsurgical astigmatism diopters. Pachymetry observed in 85,6 % of patients was higher than 560 um. The average keratometric value in the strongest meridian was 59,43 preoperatively and 47,77 postoperatively. In the weakest meridian, average keratometry was 50,28 and postoperative average amounted to 40,01. CONCLUSIONS: predescemetic lamellar keratoplasty is a surgical technique providing greater advantages if compared to penetrating keratoplasty.
Assuntos
Humanos , Masculino , Feminino , Astigmatismo/terapia , Acuidade Visual , Transplante de Córnea/reabilitação , Ceratoplastia Penetrante/reabilitação , Paquimetria Corneana/efeitos adversos , Paquimetria Corneana/estatística & dados numéricos , Ceratocone/cirurgia , Epidemiologia Descritiva , Estudos ProspectivosRESUMO
Objetivo: evaluar la costo-efectividad del uso de lentes intraoculares (LIO) tóricos en la cirugía de pacientes con catarata con astigmatismo corneal pre-existente (> 0.75 D) versus el uso de lentes intraoculares (LIO) monofocales. Método: mediante un modelo tipo árbol de decisión se compararon las intervenciones desde la perspectiva del tercero pagador. El modelo tuvo un horizonte temporal de cinco años. La medida del resultado analizado fue la agudeza visual acumulada de 20/32 o mejor expresada en tiempo de visión normal a distancia libre de soporte adicional. Se aplicó una tasa de descuento del 3% anual para costos y desenlaces clínicos. La efectividad fue tomada de un estudio clínico controlado multicéntrico. Resultados: en el caso base la razón de costo-efectividad incremental (RCEI) para los LIO tóricos fué de (USD) $534,83 por cada año de visión normal a distancia libre de soporte adicional comparados con los LIO monofocales. Se observó que la RCEI mejora si el astigmatismo es mayor antes de la cirugía, así para rangos de dioptría <1.50, >1.50 <2.00 y >2.00 la RCEI fué de (USD) $712.40, (USD) $416.75 y (USD) $382.16, respectivamente. Según el análisis de sensibilidad univariado la probabilidad de quedar sin astigmatismo debido al LIO monofocal, es la variable de mayor impacto en la RCEI. Conclusiones: los LIO tóricos demostraron ser costo-efectivos para el tratamiento de los pacientes con catarata y con astigmatismo corneal preexistente, siendo mejor su beneficio en pacientes con mayor compromiso visual.
Objective: to evaluate the cost-effectiveness of toric intraocular lenses (IOL) use in surgery of patients with cataract and preexisting corneal astigmatism (> 0.75 D) versus the use of monofocal intraocular lenses (IOL) from the perspective of third party payer. Method: interventions were compared using a decision tree model from a third party payer's perspective. The model had a time horizon of 5 years. The measured outcome was the cumulative visual acuity of 20/32, which was expressed in normal vision time without additional support. A discount rate of 3% per annum was applied to costs and clinical outcomes. The effectiveness was taken from a controlled multicenter clinical study. Results: in base case, the incremental costeff ectiveness ratio (ICER) for the toric IOL was (USD) $ 534.83 for each year of normal vision without additional support compared with monofocal IOL. It was noted that the ICER improved if the astigmatism was high before surgery, so in different diopter ranges: <1.50, > 1.50 < 2.00 and > 2.00 the ICER was (USD) $ 712.40, (USD) $ 416.75 and (USD) $ 382.16 respectively. According to univariate sensitivity analysis the probability to end without astigmatism due to monofocal IOL was variable with the greatest impact on the ICER. Conclusion: toric IOLs proved to be cost-effective for the treatment of patients with cataract and preexisting astigmatism.
Assuntos
Catarata/terapia , Astigmatismo/terapia , Extração de Catarata/métodos , Implante de Lente Intraocular/tendênciasRESUMO
INTRODUCTION: Oculocutaneus albinism is a pigment-related inherited disorder characterized by hypopigmentation of the skin, hair and eyes, foveal hypoplasia and low vision. To date, 230 mutations in the TYR gene have been reported as responsible for oculocutaneus albinism type 1 worldwide. TYR gene encodes the enzyme tyrosinase involved in the metabolic pathway of melanin synthesis. OBJECTIVES: Mutations were identified in the TYR gene as responsible for oculocutaneous albinism type 1 in five Colombian individuals, and a new ophthalmic system was tested that corrected visual defects and symptoms in a patient with oculocutaneous albinism. MATERIALS AND METHODS: Samples were taken from 5 individuals, four of whom belong to a single family, along with a fifth individual not related to the family. Five exons in the TYR gene were sequenced to search for the gene carriers in the family and in the non-related individual. In addition, clinical ophthalmological evaluation and implementation of an new oculo-visual system was undertaken. RESULTS: A G47D and 1379delTT mutation was identified in the family. The unrelated individual carried a compound heterozygote for the G47D and D42N mutations. The oculo-visual corrective system was able to increase visual acuity and to diminish the nystagmus and photophobia. CONCLUSIONS: This is the first study in Colombia where albinism mutations are reported. The methods developed will enable future molecular screening studies in Colombian populations.
Assuntos
Albinismo Oculocutâneo/genética , Monofenol Mono-Oxigenase/genética , Mutação de Sentido Incorreto , Mutação Puntual , Deleção de Sequência , Albinismo Oculocutâneo/epidemiologia , Albinismo Oculocutâneo/terapia , Astigmatismo/complicações , Astigmatismo/cirurgia , Astigmatismo/terapia , Criança , Colômbia/epidemiologia , Lentes de Contato , Análise Mutacional de DNA/métodos , Éxons/genética , Feminino , Genótipo , Haplótipos/genética , Humanos , Ceratectomia Subepitelial Assistida por Laser , Masculino , Pessoa de Meia-Idade , Monofenol Mono-Oxigenase/deficiência , Nistagmo Patológico/complicações , Nistagmo Patológico/terapia , Linhagem , Reação em Cadeia da Polimerase , Análise de Sequência de DNA , Adulto JovemRESUMO
PURPOSE: The aim of this study was to evaluate both the indications for and results of fitting the Jupiter Scleral Lens in patients with corneal abnormalities. METHOD: This was a retrospective case review of 63 patients (107 eyes) fitted with scleral lenses between October 2009 and March 2011 at the UC Davis Eye Center. RESULTS: Sixty-three percent of 107 eyes were in patients with keratoconus. Other conditions included high postkeratoplasty astigmatism and corneal scarring. The improvement in best-corrected visual acuity compared with previous contact lens or glasses correction was a mean gain of 3.5 Snellen lines (SD=2.6). Seventy-eight percent of patients found the scleral lenses to be comfortable or comfortable. Twenty-five eyes discontinued the wear after at least 3 months. CONCLUSIONS: Jupiter Scleral lenses are a good alternative for patients with corneal abnormalities and for those who failed other types of lens rehabilitation. Seventy-seven percent of eyes fit with Jupiter Scleral Lenses were still wearing after a follow-up of 3 months.
Assuntos
Lentes de Contato , Doenças da Córnea/terapia , Esclera , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/etiologia , Astigmatismo/terapia , Criança , Cicatriz/etiologia , Cicatriz/terapia , Doenças da Córnea/fisiopatologia , Transplante de Córnea/efeitos adversos , Feminino , Seguimentos , Humanos , Ceratocone/terapia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Acuidade Visual/fisiologia , Adulto JovemRESUMO
AIM: To determine if residual cylindrical refractive error after cataract surgery can be adjusted using the light-adjustable lens (LAL). METHODS: The LAL is a photosensitive silicone intraocular lens whose power can be adjusted post-operatively using UV light at 365 nm. A digital light delivery device (DLD) is used to adjust LAL power in situ to correct residual refractive errors non-invasively. Profiles developed to correct residual cylindrical and spherical errors were tested on five patients, with postoperative toric refractive errors of 1.25-1.75 D. At 2 weeks post-implantation, best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA) and residual refractive errors were measured. RESULTS: Toric error was reduced in each of the patients and refractions remained stable for the 9 month follow-up period. Achieved spherical equivalent manifest refraction (MRSE) was within 0.25 D of targeted emmetropia. All five patients improved their UCVA to >or=20/25 (Assuntos
Astigmatismo/terapia
, Lentes Intraoculares
, Facoemulsificação
, Idoso
, Idoso de 80 Anos ou mais
, Astigmatismo/etiologia
, Astigmatismo/fisiopatologia
, Humanos
, Pessoa de Meia-Idade
, Projetos Piloto
, Cuidados Pós-Operatórios/métodos
, Complicações Pós-Operatórias/terapia
, Desenho de Prótese
, Acuidade Visual
RESUMO
PURPOSE: This study explores the relationship between the recalled age of first distance prescription and the final myopic refractive error developed in adults. METHODS: Adult office workers, sent for a general health check-up without refractive selection, completed a questionnaire about age of first distance prescription, years of university study, and parental history of myopia, and were subjectively refracted by an ophthalmologist. RESULTS: Average age of the 397 consecutive myopic subjects was 42.6 +/- 9.6 years and 80.6% were males. The median age of first prescription was 20 years. In the group with earlier first distance prescription (ages 3 to 10), 25.6% developed low final refractive errors (-0.50 to -3.0 diopters), 38.5% developed moderate myopia (< -3.0 to -6.0 diopters), and 35.9% developed high myopia (< -6.0 diopters), while in the groups with later first distance prescription (ages 23 to 30), 90-100% developed low final refractive errors. CONCLUSIONS: Subjects developing myopia after age 20 had low myopia. Those subjects with an early recalled age of first prescription had a broad spectrum of myopic refractive errors, including a high proportion (approximately 2/3) of moderate to high myopia, and approximately 1/3 of low myopia.