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Abstract

OBJETIVO: O objetivo deste estudo foi analisar a segurança do implante de lente intraocular primária em um grande número de olhos em crianças <24 meses.
MÉTODOS: Foram revisados os prontuários de pacientes com idade entre 5-24 meses, submetidos a implante primário de lente intraocular no saco capsular. Uma lente intraocular acrílica de três peças dobrável foi implantada pelo mesmo cirurgião usando uma única técnica cirúrgica. Pacientes que tiveram <1 ano de acompanhamento após a cirurgia foram excluídos. Os principais resultados incluíram medidas de acuidade visual, mudança miópica, complicações pós operatórias e cirurgias adicionais.
RESULTADOS: Foram analisados 68 pacientes (93 olhos). A média de idade dos pacientes no momento da cirurgia foi de 15,06 ± 6,19 (5 a 24) meses, e o equivalente esférico 1 mês após a cirurgia foi de 3,62 ± 2,32 D. Após 5,67 ± 3,10 anos, o equivalente esférico foi de -0,09 ± 3,22 D, e a acuidade visual corrigida à distância foi de 0,33 ± 0,33 e 0,64 ± 0,43 logMAR em casos bilaterais e casos unilaterais, respectivamente (p=0,000). A maior mudança míopica foi observado em bebês submetidos à cirurgia aos 5 e 6 meses de idade. As complicações mais frequentes incluíram opacificação do eixo visual e corectopia. Glaucoma e descolamento de retina não foram relatados.
CONCLUSÃO: O implante primário de lente intraocular no saco capsular em crianças de 5-24 meses é seguro e está associado à baixas taxas de eventos adversos e cirurgias adicional.

Keywords: Catarata pediátrica; Lente intraocular; Implante primário LIO; Mudança miópica; Catarata congênita

Abstract

Objetivo: Avaliar o implante de lente intraocular primária para tratamento da afacia pediátrica no Sistema Único de Saúde (SUS) e comparar os resultados em diferentes faixas etárias.
Métodos: Foram incluídas crianças com catarata congênita e do desenvolvimento unilateral ou bilateral de 0-12 anos de idade e submetidas a implante de lente intraocular primária.
Resultados: Cento e oito olhos de 68 crianças divididas em quatro grupos de idade (<7m; 7m-2a; 2-5a e > 5a) foram avaliados. Dezenove olhos (17,59%) apresentaram opacificação do eixo visual como complicação pós-operatória. Essa complicação foi mais frequente na faixa etária <7 meses (37,93%). A diferença foi significativa entre os grupos de idade <7 meses e > 5 anos (p=0,002). A opacificação do eixo visual foi dividida em duas categorias: membrana pupilar e proliferação de células do cristalino. Oito olhos apresentaram membrana pupilar e 14 proliferação de células do cristalino. Dos oito olhos com membrana pupilar, sete ocorreram na faixa etária <7 meses. A diferença entre o grupo de idade <7 meses e os grupos de 2-5 anos e > 5 anos foi significativa (p=0,01). A proliferação de células do cristalino foi mais frequente nos grupos de idade <7 meses e 2-5 anos, mas significativa apenas quando comparados o grupo de idade <7 meses com o grupo> 5 anos de idade (p=0,040). Glaucoma e suspeitos de glaucoma não foram observados durante o acompanhamento.
Conclusões: A principal complicação encontrada no estudo foi a opacificação do eixo visual. Sua incidência foi maior em crianças operadas antes dos 7 meses de idade.

Keywords: Extração de catarata; Lentes intraoculares; Complicações intraoperatórias; Glaucoma; Segmento anterior do olho; Criança.

Abstract

PURPOSE: The purpose of this study was to assess visual outcomes and patient satisfaction following cataract surgery involving the implantation of quad-loop intraocular lenses, including trifocal, bifocal, and toric variants.
METHODS: Information was obtained from both physical and electronic medical records of patients who underwent phacoemulsification cataract surgery with implantation of different intraocular lenses between January 1, 2022, and December 31, 2023. The study included individuals aged over 18 who received bilateral implantation of bifocal, trifocal, or monofocal toric intraocular lenses. Visual acuity was assessed at various postoperative time points using the logMAR scale. Quantitative variables were analyzed using mean and standard deviation.
RESULTS: A total of 92 eyes received premium intraocular lenses: 4 bifocal, 32 trifocal, 52 toric monofocal, and 4 trifocal toric lenses. The average preoperative corrected visual acuity was logMAR 0.478 ± 0.259. On the first postoperative day, the average uncorrected visual acuity was logMAR 0.301 ± 0.207. By day 30, 67.4% of eyes achieved uncorrected distance visual acuity of logMAR 0.2 or better. Patient satisfaction was high, with few reports of glare or halos.
CONCLUSION: Quad-loop intraocular lenses-including trifocal, bifocal, and toric models-demonstrated effective improvement in visual acuity and high levels of patient satisfaction. These lenses represent a suitable option for enhancing visual outcomes after cataract surgery. Additional studies with larger cohorts are recommended to confirm these results.

Keywords: Cataract extraction; Aberrometry/methods; Lenses, intraocular; Lens implantation, intraocular; Prosthesis design

Abstract

PURPOSE: To evaluate whether two simplified modifications of flanged intrascleral fixation techniques (Yamane and Canabrava) provide comparable refractive outcomes and complication rates while reducing surgical complexity in trocar-assisted vitrectomy.
METHODS: This retrospective observational study included 88 patients who underwent flanged fixation surgery with vitrectomy. In the modified Yamane technique, a single-path sclerotomy with bilateral symmetry was performed instead of an angled sclerotomy. In the modified Canabrava technique, the intraocular lens was inserted first, followed by the creation of a circular polypropylene loop with 2-mm flange spacing. Postoperative refractive parameters, including intraocular lens astigmatism, and complications such as intraocular lens iris capture were analyzed.
RESULTS: Of the 88 patients, 70 underwent the modified Yamane technique, and 18 underwent the modified Canabrava technique. No significant differences were observed between the two techniques regarding refractive outcomes or postoperative complications, except for surgical duration, which was significantly shorter (p<0.001) in one technique. Mean intraocular lens astigmatism was −0.675 D for Yamane and −0.666 D for Canabrava.
CONCLUSION: Optimizing needle engagement for symmetry in the Yamane technique and narrowing flange spacing while ensuring a circular polypropylene configuration in the Canabrava technique may reduce surgical complexity and improve postoperative outcomes.

Keywords: Polypropylenes; Yamane technique; Vitrectomy; Astigmatism; Lenses, intraocular; Postoperative complications; Suture techniques; Iris.

Abstract

PURPOSE: Endophthalmitis is one of the most important adverse events after cataract surgery, as it can lead to total vision loss. This study aimed to describe the occurrence of endophthalmitis after phacoemulsification with intraocular lens implantation in patients treated in a community setting in Porto Velho, Rondônia, Brazil.
METHODS: This retrospective cohort study was conducted using a database of 649 medical records of patients who underwent surgery and were followed for three months. Poisson regression analysis was used to estimate relative risks and 95% confidence intervals (95% CIs).
RESULTS: The incidence of confirmed endophthalmitis was 11.94% (95% CI, 9.50-14.76), while the incidence of confirmed and probable cases was 20.50% (95% CI, 17.52-23.73). For confirmed cases, bilateral surgery and the use of lens model 3 were identified as risk factors for endophthalmitis, whereas age over 70 yr and preoperative antibiotic use were protective factors. For confirmed and probable cases, brown and yellow skin color, bilateral surgery, and the use of lens model 3 were also identified as risk factors. Gram-negative bacteria were the predominant etiological agents, and corneal edema was the main clinical manifestation. The mean duration of treatment was eight days, and 27.12% of patients used antibiotics.
CONCLUSION: The incidence observed was substantially higher than that reported in the literature, with a predominance of Gram-negative agents and an association with bilateral surgeries and the Eyeol intraocular lens model. These findings reinforce the need for continuous epidemiological surveillance and the implementation of specific biosafety and infection control protocols during cataract surgery campaigns.

Keywords: Endophthalmitis; Disease outbreaks; Phacoemulsification; Lens implantation, intraocular; Lenses, intraocular; Cataract; Risk factors; Anti-bacterial agents

Abstract

The advantages and disadvantages of using perioperative subconjunctival steroid injections in dropless cataract surgery continue to be debated. A systematic review of PubMed, EMBASE, and the Cochrane Central database identified five studies—two randomized controlled trials and three non-randomized studies—encompassing 70,751 eyes. Among these, 12,319 eyes (17.4%) received subconjunctival steroid injections, while 58,432 eyes (82.6%) were managed with topical steroids. The Cochrane Collaboration’s RoB 2 tool was applied for bias assessments in randomized controlled trials, and heterogeneity was assessed using the I² statistics. No statistically significant differences were found between the two groups regarding macular edema (p=0.249), visual acuity (p=0.73), or laser flare count (p=0.45). Both subconjunctival injections and topical steroids demonstrated comparable efficacy and safety in controlling postoperative inflammation after cataract surgery. Additional research is warranted to validate these conclusions.

Keywords: Cataract extraction; Phacoemulsification; Lens implantation, intraocular; Postoperative care; Intravitreal injections; Anti-inflammatory agents, non-steroidal/administration & dosage; Glucocorticoids; Triamcinolone acetonide; Research design; Randomiz

Abstract

PURPOSE: Posterior capsule rupture is defined as an intraoperative posterior capsule tear resulting in vitreous loss. This study aimed to analyze the clinical characteristics, preoperative risk factors, intraoperative management strategies, and postoperative complications associated with posterior capsule rupture during phacoemulsification surgery.
METHODS: This was a retrospective observational cohort study of the medical records for 25,224 phacoemulsification surgeries performed at our tertiary eye care center between 2017 and 2022. We collected and collated the demographic characteristics and clinical findings of the patients in our cohort. Intraoperative management strategies and postoperative outcomes over a 1-year followup period were also recorded.
RESULTS: Posterior capsule rupture occurred in 351 eyes (351 patients), giving an overall posterior capsule rupture rate of 1.3%. The mean patient age was 68.6 ± 10.8 years. Pseudoexfoliation syndrome, mature cataracts, brown cataracts, and surgery performed by a resident were identified as risk factors for posterior capsule rupture (p<0.05 for each; the risk ratios were 2.70, 2.15, 2.44, 1.34, respectively). The most common intraoperative complications were dislocated lens fragments in the vitreous (8%) and iris damage (7.1%). The mean best-corrected visual acuity improved from 1.31 ± 0.84 (logMAR) postoperatively to 0.51 ± 0.56 at the end of the 1-year follow-up period (p<0.001). Corneal edema (55.6%) and elevated intraocular pressure (33.3%) were the most common early postoperative complications. Persistently elevated intraocular pressure (11.1%) and cystoid macular edema (5.1%) were the most common late postoperative complications.
CONCLUSION: Posterior capsule rupture is a common complication of phacoemulsification surgery that requires prolonged postoperative follow-up and a multidisciplinary approach. Despite the increased incidence of complications when rupture occurs, appropriate intraoperative and postoperative management can lead to satisfactory visual outcomes.

Keywords: Cataract extraction; Phacoemulsification; Posterior capsule rupture; Corneal edema; Risk factors; Postoperative complications; Intraoperative complications

Abstract

PURPOSE: To compare endothelial corneal cell changes following cataract surgery performed by phacoemulsification with intraocular lens implantation, conducted by surgeons with varying levels of experience.
METHODS: Two hundred and eighty-three eyes diagnosed with cataract were included. Lens opacity was classified into three categories (I, II, and III). Surgeons were categorized into four experience levels (1, 2, 3, and 4), based on years of practice and lifetime surgeries performed. Corneal endothelial characteristics were assessed using non-contact specular microscopy, with measurements taken before surgery and 30-60 days post-surgery.
RESULTS: Pre- and postoperative endothelial analysis showed no significant differences between surgeon levels regarding visual acuity achieved, corneal thickness, and endothelial hexagonality. However, the central endothelial cell density index showed a significantly greater reduction among level 1 surgeons (p=0.026). Grade II cataracts exhibited significant variations in the central endothelial cell density (p=0.011) and average cell size, with level 1 surgeons showing the largest increases (p=0.024).
CONCLUSIONS: The analysis revealed significant differences in visual acuity and endothelial indices between surgeon experience levels, with less experienced surgeons showing greater variations and poorer performance. Clinical protocols should consider these data to establish safer training protocols.

Keywords: Cataract extraction; Phacoemulsification; Endothelium; corneal; Lens implantation, intraocular; Visual acuity; Internship and residency; Surgeons

Abstract

Apesar dos recentes avanços na cirurgia moderna de catarata e da aplicação de uma ampla gama de novos dispositivos, o deslocamento tardio de uma lente intraocular dentro do saco capsular continua a ser uma complicação devastadora, ainda que rara. Várias técnicas cirúrgicas e não cirúrgicas têm sido usadas para tratar esta complicação. Este é o relato de um caso de reposicionamento espontâneo de uma lente intraocular sub-luxada anteriormente dentro do saco capsular do olho esquerdo. Este reposicionamento pode ter sido causado pelos efeitos opostos da aplicação tópica simultânea de brimonidina e prednisolona. O deslocamento foi tratado sem manipulação agressiva ou intervenção cirúrgica.

Keywords: Midríase; Miose; Lentes intraoculares; Subluxação do cristalino/induzido quimicamente; Subluxação do cristalino/cirurgia; Complicações pós-operatórias

Abstract

Relato de uma técnica que combina o implante de uma lente intraocular com fixação intraescleral sem sutura e uma ceratoplastia endotelial da membrana de Descemet em paciente com ceratopatia bolhosa pseudofácica anterior. Foram criados dois túneis esclerais. Foram feitas incisões na córnea e a lente intraocular dobrável foi cortada e removida da câmara anterior. Foi então efetuada uma vitrectomia anterior e uma lente intraocular dobrável de 3 peças foi implantada na câmara anterior. Um dos hápticos da lente intraocular foi pinçado com um fórceps e puxado para fora do túnel escleral. A extremidade do háptico foi cauterizada. Manobras semelhantes foram feitas no outro háptico. Foi preparado um tecido de doador com 8 mm de diâmetro e o tecido endotelial da área receptora foi removido do centro da córnea. O tecido preparado do doador foi injetado na câmara anterior. Após abertura e posicionamento adequados do tecido do doador, foi injetada uma bolha de ar abaixo do tecido. Não foi observada nenhuma complicação pós-operatória durante um mês de acompanhamento.

Keywords: Lâmina limitante posterior; Ceratoplastia penetrante; Implante de lente intraocular; Lentes intraoculares; Esclera/cirurgia; Humanos; Relatos de casos

Abstract

Uma paciente de 38 anos desenvolveu afacia e ani­ridia secundárias a um trauma, levando à perda da visão. Para melhorar sua visão, um complexo de íris e lente intraocular (Reper^®) foi fixado à esclera com a técnica de flange duplo de Canabrava. Houve um aumento satisfatório na acuidade visual do paciente e nenhuma complicação foi observada durante o acompanhamento de 6 meses. A técnica de Canabrava simplifica e melhora a fixação do complexo de íris e lente intraocular na esclera. É uma opção segura que não requer retalhos ou pontos esclerais.

Keywords: Afacia/etiologia; Aniridia; Implante de lente intrao­cular; Lentes intraoculares; Esclera/cirurgia; Acuidade visual; Humanos; Relatos de casos.

Abstract

We present a case report detailing the successful phacoemulsification surgery with artificial iris implantation for two individuals with oculocutaneous albinism. These women suffered from cataracts, resulting in reduced visual acuity and heightened photophobia due to iris pigmentary epithelium deficiency. The patients underwent phacoemulsification along with prosthetic artificial iris implantation into the posterior chamber. This intervention resulted in improved visual acuity, reduced photophobia and glare, and an overall enhanced quality of life. Our report highlights two cases of successful phacoemulsification and artificial iris implantation in patients with oculocutaneous albinism and cataracts, leading to improved visual acuity, reduced photophobia, and enhanced quality of life. Notably, there are no prior records in South American literature of cataract surgery combined with artificial iris implantation for oculocutaneous albinism patients up to the time of this publication.

Keywords: Cataract extraction; Albinism, oculocutaneous; Lens implantation, intraocular

Abstract

Um homem de 59 anos apresentou embaçamento visual unilateral no olho esquerdo. Sua acuidade visual nesse olho era no nível de movimentos da mão. O paciente havia se submetido a uma cirurgia de facoemulsificação em que foi feita a implantação intraestromal de uma lente intraocular de câmara posterior. Foi feita a extração dessa lente intraestromal intraocular e uma nova lente intraocular foi implantada. A melhor acuidade visual corrigida final foi de 20/40 pela tabela de Snellen. Com este relato de caso, os autores desejam apontar que uma incisão de degrau único em córnea clara, quando combinada com a injeção de uma lente ocular através da incisão, pode levar a um direcionamento incorreto da lente intraocular para dentro do estroma corneano. Portanto, recomenda-se uma construção cuidadosa da incisão ao se remover uma lente intraocular direcionada incorretamente.

Keywords: Implante de lente intraocular; Lentes intraocular; Facoemulsificação; Cicatrização; Catarata; Acuidade visual

Abstract

Angle-closure glaucoma is a major cause of visual impairment worldwide, with Plateau iris syndrome presenting management challenges. We present a case report of a 58-year-old woman with advanced, uncontrolled angle-closure glaucoma and Plateau iris. Her history included laser peripheral iridotomy and three glaucoma medications in both eyes. Different treatments were implemented. For the eye with lower intraocular pressure, fewer peripheral anterior synechiae, and milder disease: phacoemulsification with intraocular lens implantation. For the eye with more advanced disease, a two-step approach was used: slow-coagulation transscleral cyclophotocoagulation using the double-arc protocol, followed by phacoemulsification with intraocular lens implantation 2 months later. Both eyes achieved improved visual acuity and intraocular pressure control with fewer medications, without significant complications. This case highlights transscleral cyclophotocoagulation followed by phacoemulsification as an alternative to combined surgeries in uncontrolled angle-closure glaucoma with Plateau iris, offering a simpler technique, more predictable refractive and pressure-control outcomes, and more straightforward postoperative management.

Keywords: Glaucoma, angle-closure/surgery; Iris diseases/surgery; Laser coagulation/methods; Phacoemulsification; Lens implantation, intraocular; Case reports

Abstract

Aging and face sagging have many causes, and various techniques are used for treatment, including noninvasive procedures, such as focused ultrasound, which uses the principle of collagen regeneration by coagulative necrosis of the dermis layers using radiofrequency, but this procedure has complications. We reported a case of a 54-year-old female patient who complained of poor visual acuity in her right eye three days after a focused ultrasound facial aesthetic procedure, with the best visual acuity of 20/60. Biomicroscopy of the right eye revealed an acute cataract with three points of fibrosis extending from the posterior to the anterior capsule. The patient underwent phacoemulsification surgery with visual rehabilitation and improved vision of 20/20. We hypothesized that the occurrence of acute cataract was related to the inappropriate use of focused ultrasound.

Keywords: Cosmetic techniques; Skin aging; Rejuvenation; Ultrasonic therapy/adverse effects; High-intensity focused ultrasound ablation/methods; Cataract/etiology; Phacoemulsification; Lens implantation, intraocular; Visual acuity; Humans; Middle age; Female; Case