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Purpose: Compare the safety and efficacy of wavefront-guided photorefractive keratotomy (PRK) 6 months after cross-linking (CXL) to wavefront-guided PRK alone for refractive correction in patients with bilateral asymmetric corneal topography. Methods: Prospective randomized clinical trial with 16 patients (32 eyes). CXL with subsequent PRK after 6 months in one eye, and PRK alone was performed in contralateral eyes. The follow-up was 10 years. We analyzed visual outcomes, Scheimpflug topography, and corneal haze evaluation. Results: Eyes in the PRK group showed better results than in the CXL + PRK group. Mean postoperative CDVA was 0.044 logmar (SD, 0.073) in the PRK group and 0.1 logmar (SD, 0.21) in the CXL + PRK group, the mean sphere was + 0.21 (SD, 0.6) D in the PRK group and 0.87 (SD, 2.3) D in the CXL + PRK group, and mean SE was -0.35 (SD, 0.65) D in the PRK group and 0.62 (SD, 2.32) D in the CXL + PRK group. In one patient, a steepening of 2.5 D and a thinning of 17 µm occurred in PRK alone group. Two patients in the CXL + PRK group presented corneal haze. The overall complication rate was 18,75% (haze and ectasia). Conclusion: Non-simultaneous CXL and PRK procedures yielded good refractive results, but worse than those obtained with PRK alone. Although one patient in the PRK group developed corneal ectasia, the CXL + PRK group had a higher loss of vision lines, indicating less safety.
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Reticulación Corneal , Opacidad de la Córnea , Humanos , Topografía de la Córnea , Dilatación Patológica , Estudios de Seguimiento , Estudios ProspectivosRESUMEN
A 47-year-old male ultramarathon runner presented with persistent discomfort in the anterior region of the left leg. The patient reported a snapping sensation in his left leg four weeks earlier while running an ultramarathon, followed by ecchymosis and functional impairment the next day. Physical examination revealed a palpable area of fibrosis in his anterior left leg. Ultrasound of the left leg identified a partially organized rupture of the distal third of the tibialis anterior muscle. The rupture had an extension of 36 x 10 x 27mm with associated muscle edema. The patient was treated non-surgically with a customized rehabilitation program and later returned to ultramarathon running. This case illustrates the importance of proper differential diagnosis and individualized rehabilitation programs to achieve optimum clinical and functional results.
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Objective: Anaerobic work capacity (AWC) is understood as the maximum power that the athlete can withstand over time, conditioned by high intensityeffort and it is important to interpret it for the performance improvement. In addition, the muscle oxygen saturation (SmO2) provides information onmuscle metabolism and hemodynamics. Likewise, critical oxygenation (CO) is the highest metabolic rate that results in a fully oxidative energy supplythat reaches a stable state at the substrate level. The main problem is that SmO2 generally offers a traditional laboratory interpretation withoutapplication in field tests, Therefore, the purpose of this study is to provide the use of CO as an indicator of AWC performance in high intensity exercise. Methods: Twenty-two male rugby players participated. Peak torques during an isokinetic fatigue test and muscle oxygen consumption (mVO2) and SmO2in the vastus lateralis were measured. A correlation and multiple regression analysis were applied to find an explanatory prediction model of the AWC. Results: A greater SmO2 amplitude and CO would mean less anaerobic work (r = -0.58 and r=-0.63) and less force production. In addition, CO along withweight (kg) can explain the AWC by 64% during high intensity exercise. Conclusion: The measurement of critical oxygenation is associated with the AWC, so should be considered a performance factor. These parameters couldbe included in NIRS sensors to evaluate muscle metabolism.(AU)
Objetivo: La capacidad de trabajo anaeróbico (AWC) se entiende como la potencia máxima que el deportista puede soportar a lo largo del tiempo,condicionada por un esfuerzo de alta intensidad y es importante interpretarla para la mejora del rendimiento. Además, la saturación de oxígenomuscular (SmO2) proporciona información sobre el metabolismo muscular y la hemodinámica. Asimismo, la oxigenación crítica (OC) es la tasametabólica más alta que da como resultado un suministro de energía completamente oxidativo que alcanza un estado estable a nivel de sustrato. Elprincipal problema es que SmO2 generalmente ofrece una interpretación de laboratorio tradicional sin aplicación en pruebas de campo, por lo tanto, elpropósito de este estudio es proporcionar el uso de OC como indicador del rendimiento de AWC en ejercicio de alta intensidad. Métodos: Participaron 22 jugadores masculinos de rugby. Se midieron los picos máximos después de una prueba de fatiga isocinética y el consumo deoxígeno muscular (mVO2) y SmO2 en el musculo vasto lateral. Se aplicó un análisis de correlación y regresión múltiple para encontrar un modelo depredicción explicativo del AWC. Resultados: Una mayor amplitud de SmO2 y OC supondría un menor trabajo anaeróbico (r = -0,58 y r=-0,63) y una menor producción de fuerza. Además,el CO junto con el peso (kg) pueden explicar el AWC en un 64 % durante el ejercicio de alta intensidad. Conclusión: La medición de la oxigenación crítica está asociada a la AWC, por lo que debe considerarse un factor de rendimiento. Estos parámetrospodrían incluirse en sensores NIRS para valorar el metabolismo muscular.(AU)
Objetivo: A capacidade anaeróbica de trabalho (AWC) é entendida como a potência máxima que o atleta pode suportar ao longo do tempo, condicionadapor um esforço de alta intensidade, sendo importante interpretá-la para melhorar o desempenho. Além disso, a saturação muscular de oxigênio (SmO2)fornece informações sobre o metabolismo muscular e a hemodinâmica. Da mesma forma, a oxigenação crítica (OC) é a taxa metabólica mais alta queresulta em um suprimento de energia totalmente oxidativo atingindo um estado estável no nível do substrato. O principal problema é que o SmO2geralmente oferece uma interpretação laboratorial tradicional sem aplicação em testes de campo, portanto, o objetivo deste estudo é fornecer o uso doCO como indicador de desempenho de AWC em exercícios de alta intensidade. Métodos:Participaram 22 jogadores de rugby do sexo masculino. Foram medidos os picos máximos após um teste de fadiga isocinética e o consumo deoxigênio muscular (mVO2) e SmO2 no músculo vasto lateral. Uma análise de correlação e regressão múltipla foi aplicada para encontrar um modeloexplicativo de predição do AWC. Resultados: Uma maior amplitude de SmO2 e CO implicaria em menor trabalho anaeróbio (r = -0,58 er = -0,63) e menor produção de força. Além disso, oCO junto com o peso (kg) pode explicar a AWC em 64% durante o exercício de alta intensidade. Conclusão: A medida oxigenação crítica prevê AWC, portanto, deve ser considerada um fator de desempenho. Esses parâmetros podem ser incluídos emsensores NIRS para a medição do metabolismo muscular.(AU)
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Humanos , Masculino , Adulto Joven , Adulto , Anaerobiosis , Umbral Anaerobio , Oxigenación , Consumo de Oxígeno , Análisis de la Demanda Biológica de Oxígeno , Hemodinámica , Músculo Esquelético , Metabolismo Energético , Flujo Sanguíneo Regional , Medicina Deportiva , Rendimiento Atlético , Rendimiento Físico Funcional , 51654 , Prueba de Esfuerzo , Entrenamiento de Fuerza , Ejercicio Físico , Fútbol Americano , FatigaRESUMEN
A 63-year-old female patient, with a past history of rheumatoid arthritis, presented with insidious pain on the left foot second and third metatarsophalangeal joints, associated with swelling and morning stiffness (mean time: four hours). Physical examination evidenced a tender and soft nodularity in the third intermetatarsal space, along with sharp pain, consistent with Morton's neuroma. Foot ultrasound suggested Morton's neuroma, but not excluding the possibility of rheumatoid arthritis involvement. Foot magnetic resonance imaging suggested the possibility of extensive synovitis of the third metatarsophalangeal joint, but not excluding the coexistence of Morton's neuroma because of the mass effect. Finally, the patient underwent an ultrasound-guided needle biopsy of the nodule, which confirmed metatarsophalangeal joint synovitis. The foot is a common location of rheumatoid arthritis manifestation, and metatarsophalangeal joint synovitis can mimic Morton's neuroma. After a definite diagnosis, the patient recovered lower limb functional impairment after introducing adalimumab and a rehabilitation program. This case highlights the importance of an accurate differential diagnosis, pharmacological rheumatoid arthritis control, and physical medicine and rehabilitation programs to optimal clinical and functional improvement.
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The aim of this study was to analyse the effect of four types of re-warm-up (R-WU) activity, namely rest in normoxia (RN) at FiO2 = 20.9%, rest in hypoxia (RH) at FiO2 = 15%, activity (4 × 5 jumps/15 s) in normoxia (AN) and activity in hypoxia (AH) on physical performance. Ten elite male rugby players completed a 15-min warm-up followed by one of the 15-min randomized R-WU strategies. After R-WU, countermovement jump (CMJ), 20 m sprint and repeat sprint ability (RSA) tests were assessed. Compared to passive strategies (RN and RH), tympanic temperature was higher after active R-WU (AN and AH) (p = 0.016). Higher values of CMJ height (p = 0.037) and 20 m sprint (p = 0.02) were found in AH than in RN. In addition, mean RSA was lower (p = 0.008) in AH than in RN and RH. Blood lactate concentration was higher (p = 0.007) after RN and AN strategies than after AH. Muscle O2 saturation (p = 0.021) and total Hb (p = 0.042) were higher after AH than after the other three conditions and after RN, respectively. Therefore, an active R-WU under hypoxia could be useful to elite rugby players, once it had attenuated the decline in tympanic temperature during a 15-min period after warm-up, improving jump, sprint and RSA performance.
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Rendimiento Atlético , Fútbol Americano , Carrera , Ejercicio de Calentamiento , Humanos , Hipoxia , Masculino , Carrera/fisiologíaRESUMEN
AIMS: To evaluate the safety and efficacy of corneal cross-linking (CXL) followed by photorefractive keratectomy (PRK) for refractive correction in patients with bilateral asymmetric topography. METHODS: Forty-four patients (88 eyes) were enrolled in this prospective randomised clinical trial. CXL with subsequent PRK after 6 months was performed in one eye (study group), and PRK alone was performed in contralateral eyes (control group). Patients were followed for 24 months after PRK. Outcome measures investigated included visual acuity (VA), refraction, aberrometry, topography, pachymetry and endothelial cell count. Groups were compared with linear mixed regression and repeated measures logistic regression. Multiple comparison adjustment with the Holm procedure was performed. RESULTS: At baseline, the logMAR VA (best spectacle corrected) in study and control groups was 0.12±0.13 (mean±SD) and 0.08D±0.14, respectively, and axial inferior-superior index (IS) (topographic IS) in study and control groups were 0.59D±0.31D and 0.58D±0.32D, respectively. After 24 months, a mean under correction of -0.50D was observed in both groups. Change from baseline in logMAR VA in study and control groups was 0.00D±0.08D and -0.02D±0.10D, respectively. Frequency of haze at 30 months in study and control group eyes was, respectively, 18.2% and 4.6% (p=0.05). There was no statistical difference between groups in spherical aberration and coma after adjustment for multiple comparisons. CONCLUSIONS: Non-simultaneous CXL followed by PRK may be performed safely, and refractive results over a 2-year follow-up are highly similar in virgin and previously cross-linked corneas. Despite using mitomycin C, corneal haze can be significantly higher in the first year after PRK in eyes pretreated with CXL.
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Córnea/cirugía , Queratocono/terapia , Fotoquimioterapia/métodos , Queratectomía Fotorrefractiva/métodos , Adulto , Colágeno/metabolismo , Topografía de la Córnea , Reactivos de Enlaces Cruzados/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Queratocono/fisiopatología , Láseres de Excímeros/uso terapéutico , Masculino , Persona de Mediana Edad , Fármacos Fotosensibilizantes/uso terapéutico , Estudios Prospectivos , Refracción Ocular/fisiología , Riboflavina/uso terapéutico , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To evaluate stromal demarcation lines following corneal cross-linking (CXL) using anterior segment optical coherence tomography in patients with keratoconus and nonkeratoconic asymmetric topography. METHODS: Fifth-nine eyes of 59 patients were enrolled in a retrospective comparative case series, of which 19 eyes had keratoconus and 40 eyes had asymmetric topography. Eyes with asymmetric topography were treated in preparation for photorefractive keratectomy. One month after CXL, a stromal demarcation line was evaluated at 5 standardized corneal points using anterior segment optical coherence tomography. RESULTS: Mean stromal demarcation line depths were measured at 5 points on the cornea, namely, centrally, 3.0 mm temporally, 1.5 mm temporally, 3.0 mm nasally, and 1.5 mm nasally. For the keratoconus group, the values were 178 ± 47, 123 ± 15, 152 ± 47, 125 ± 23, and 160 ± 43 µm, respectively. For the asymmetric corneal topography group (without keratoconus), they were 305 ± 64, 235 ± 57, 294 ± 50, 214 ± 54, and 285 ± 58 µm, respectively. There was no correlation between central corneal pachymetry and stromal demarcation line depth in all 5 measured corneal points in both groups. CONCLUSIONS: CXL treatment profiles are similar in keratoconic and nonkeratoconic eyes with asymmetric topography.
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Sustancia Propia/patología , Queratocono/tratamiento farmacológico , Fármacos Fotosensibilizantes/uso terapéutico , Adolescente , Adulto , Colágeno/metabolismo , Paquimetría Corneal , Sustancia Propia/metabolismo , Topografía de la Córnea , Reactivos de Enlaces Cruzados , Femenino , Humanos , Queratocono/metabolismo , Masculino , Persona de Mediana Edad , Queratectomía Fotorrefractiva , Estudios Retrospectivos , Riboflavina/uso terapéutico , Tomografía de Coherencia Óptica , Rayos Ultravioleta , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To compare the efficacy and tolerability of a fixed-dose combination of 0.3% gatifloxacin and 1% prednisolone formulation versus the same agents administered separately for prophylaxis in a laser-assisted in situ keratomileusis (LASIK) population. METHODS: In a prospective, randomized, double-masked, parallel-group study, 97 patients were evaluated for signs and symptoms of ocular infection or inflammation after bilateral LASIK. Group 1 (50 patients, 100 eyes) received a combined formulation of 0.3% gatifloxacin + 1% prednisolone acetate (Zypred(®)) plus placebo. Group 2 (47 patients, 94 eyes) received conventional treatment with the same agents from separate vials. The cohorts were similar in age, sex, race, and refractive error. Baseline and postoperative assessments were made on surgery days -2, 1, 3, and 15 and consisted of visual acuity; intraocular pressure; severity of inflammation of eyelids, conjunctiva, and cornea; tearing; ocular discomfort (foreign-body sensation, itching, or photophobia); and ocular pain. The posterior segment was evaluated at the screening and exit visits. RESULTS: No ocular infection or persistent inflammation was detected in either group at any time. All objective and subjective criteria of efficacy were similar regardless of treatment, with no significant differences between the groups. More patients who were dosed with the combined agent complained of mild ocular discomfort on day 3, but this difference had disappeared by day 15. CONCLUSION: Post-LASIK topical prophylaxis with combined gatifloxacin + prednisolone eye drops (Zypred(®)) was well tolerated. This formulation appears to be therapeutically equivalent to conventional dosing with gatifloxacin and prednisolone from individual bottles for topical prophylaxis after laser refractive surgery.
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Úlcera de la Córnea , Infecciones Bacterianas del Ojo , Infecciones por Moraxellaceae , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/tratamiento farmacológico , Úlcera de la Córnea/microbiología , Quimioterapia Combinada , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Moraxella/aislamiento & purificación , Infecciones por Moraxellaceae/diagnóstico , Infecciones por Moraxellaceae/tratamiento farmacológico , Infecciones por Moraxellaceae/microbiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To evaluate the efficacy of topical cyclosporine-A 0.05% (CsA) in the treatment of dry eye syndrome in ocular graft-versus-host disease after bone marrow transplantation (BMT) of hematopoietic stem cells. METHODS: One-hundred five patients were enrolled in a retrospective, comparative, interventional case series. Eighty-one patients received topical CsA starting 1 month before BMT (treatment group), and 24 patients did not receive CsA until at least 6 months after the transplantation (control group). Mean follow-up time was 17.5 ± 11.0 months (range: 6.0-49.0 months). Clinical history, ocular surface disease index questionnaire, slit-lamp examination, lissamine green and fluorescein staining of the ocular surface, tear breakup time, and Schirmer test with topical anesthesia were obtained to create a composite dry eye-grading score. RESULTS: Dry eye symptoms were significantly more severe in the control group at 3 months, 1 year, and 2 years (P < 0.05). There was no correlation with type of stem cell transplant (related vs. unrelated donor), presenting indication for BMT, or concurrent systemic immunosuppressive medications. CONCLUSIONS: Pre-BMT initiation of topical CsA may reduce the inflammatory response in the lacrimal glands that may be responsible for the development of post-BMT keratitis sicca.
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Ciclosporina/administración & dosificación , Síndromes de Ojo Seco/tratamiento farmacológico , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Inmunosupresores/administración & dosificación , Administración Tópica , Adolescente , Adulto , Anciano , Trasplante de Médula Ósea , Niño , Preescolar , Síndromes de Ojo Seco/etiología , Síndromes de Ojo Seco/metabolismo , Femenino , Fluoresceína , Estudios de Seguimiento , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/metabolismo , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Colorantes Verde de Lisamina , Masculino , Persona de Mediana Edad , Neoplasias/terapia , Estudios Retrospectivos , Encuestas y Cuestionarios , Lágrimas/química , Lágrimas/metabolismo , Resultado del TratamientoRESUMEN
PURPOSE: To compare the integrity of clear corneal incisions closed with fibrin (Tisseel) and n-butyl-2-cyanoacrylate (Histoacryl) tissue adhesives to those closed with conventional sutures. METHODS: Four replicate experiments were performed on porcine eyes with each of the following conditions: three limbal clear corneal incision sizes (3.0 mm, 4.5 mm, and 6.0 mm), three incision closure techniques (fibrin adhesive, n-butyl-2-cyanoacrylate adhesive, and 10-0 interrupted nylon sutures)-1, 2, and 3 sutures at the 3.0-mm, 4.5-mm, and 6.0-mm incision sizes, respectively. Wound integrity was then measured by elevating the intraocular pressure of the eye to the point where wound leakage (IOP(L)) occurred. Two-way repeated measures analysis of variance (ANOVA) was used to analyze the IOP(L) data. RESULTS: Incision closure technique and incision size showed significant interaction in the ANOVA model (p = 0.0008). Fibrin adhesive demonstrated higher IOP(L) compared to suture closure at the 3.0-mm incision size (p < 0.0001). There was no significant difference in IOP(L) when comparing wound closure with fibrin adhesive and sutures at the 4.5-mm and 6.0-mm incision sizes (p = 0.52 and p = 0.56, respectively). There was no significant difference between the three closure techniques for the 6.0-mm incisions (p > 0.15). When comparing the wound closure techniques for all incision sizes, the mean IOP(L) significantly increased in the following order: suture(s), fibrin adhesive, n-butyl-2-cyanoacrylate glue. CONCLUSIONS: Fibrin or n-butyl-2-cyanoacrylate tissue adhesive may be used as a more stable alternative to conventional sutures in the closure of clear corneal incisions.
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Córnea/cirugía , Enbucrilato/administración & dosificación , Adhesivo de Tejido de Fibrina/administración & dosificación , Dehiscencia de la Herida Operatoria/prevención & control , Técnicas de Sutura , Adhesivos Tisulares/administración & dosificación , Cicatrización de Heridas/efectos de los fármacos , Animales , Queratoplastia Endotelial de la Lámina Limitante Posterior , Presión Intraocular , Hipertensión Ocular , Dehiscencia de la Herida Operatoria/fisiopatología , Porcinos , Cicatrización de Heridas/fisiologíaRESUMEN
PURPOSE: To ascertain if the polymerization reaction also contributes additionally to the antibacterial effects of two commonly used cyanoacrylate tissue adhesives. MATERIALS AND METHODS: Fresh liquid ethyl-cyanoacrylate (EC) and N-butyl-cyanoacrylate (BC) adhesives were applied onto 6-mm sterile filter paper discs. In the first group, the adhesive-soaked discs were immediately placed onto confluent monolayer cultures of bacteria, allowing the polymerization reaction to proceed while in culture. In the second group, the adhesive-soaked disc was allowed to first polymerize prior to being placed onto the bacterial cultures. Four types of bacteria were studied: Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. Immediately after the discs were applied, the cultures were incubated at 35 degrees C for 24 h. Bacterial inhibitory halos were measured in the cultures at the end of the incubation period. RESULTS: For EC, exposure of the bacteria to the cyanoacrylate polymerization reaction increased the bacterial inhibitory halos in Streptococcus pneumonia, Staphylococcus aureus and Escherichia coli. For BC, it increased the bacterial inhibitory halos in Staphylococcus aureus and Streptococcus pneumoniae. No inhibitory halos were observed in Pseudomonas aeruginosa. The bactericidal effect was higher in actively polymerizing EC, compared to previously polymerized EC in Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli; however, no such differences were observed for BC. CONCLUSIONS: The polymerization reaction may also be an important factor in the antibacterial properties of EC and BC.
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Bacterias/efectos de los fármacos , Infecciones Bacterianas/prevención & control , Cianoacrilatos/farmacología , Enbucrilato/farmacología , Infección de la Herida Quirúrgica/prevención & control , Adhesivos Tisulares/farmacología , Bacterias/crecimiento & desarrollo , Infecciones Bacterianas/microbiología , Recuento de Colonia Microbiana , Humanos , Infección de la Herida Quirúrgica/microbiologíaRESUMEN
PURPOSE: To evaluate the long-term outcomes of combined penetrating keratoplasty (PKP) with scleral-sutured posterior chamber intraocular lens (PC-IOL) implantation. METHODS: Medical records from patients with aphakic and pseudophakic bullous keratopathy were retrospectively reviewed for preoperative indications and postoperative results of 105 consecutive patients (105 eyes) who underwent combined PKP and scleral-sutured PC-IOL implantation over a 13-year period. Main outcomes measures were graft survival rate, visual acuity, and intraoperative and postoperative complications. RESULTS: The principal indications for PKP were pseudophakic and aphakic corneal edema. Graft survival rates were 97% at 1 year, 91% at 2 years, 75% at 5 years, and 68% at 7 years. Mean postoperative follow-up was 44.8 +/- 37.0 months (range 1-156). The best-corrected visual acuity improved at least 1 line on the Snellen chart in 59.0% of the patients, with 42.9% of the eyes achieving acuities of 20/100 or better. Postoperative complications included new glaucoma in 21.4%, worsening of pre-existing glaucoma in 28.6%, cystoid macular edema in 17%, infectious endophthalmitis in 3.8%, and intraocular lens dislocation in 1.9%. No intraoperative complications were encountered. CONCLUSIONS: PKP combined with scleral-sutured PC-IOL implantation can achieve acceptable outcomes with a low rate of intraocular lens dislocation, but may be associated with significant short and long-term complications.
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Queratoplastia Penetrante , Implantación de Lentes Intraoculares/métodos , Esclerótica/cirugía , Técnicas de Sutura , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Afaquia Poscatarata/complicaciones , Afaquia Poscatarata/cirugía , Enfermedades de la Córnea/complicaciones , Enfermedades de la Córnea/cirugía , Femenino , Estudios de Seguimiento , Supervivencia de Injerto/fisiología , Humanos , Complicaciones Intraoperatorias , Lentes Intraoculares , Masculino , Persona de Mediana Edad , Polipropilenos , Complicaciones Posoperatorias , Estudios Retrospectivos , Suturas , Resultado del Tratamiento , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To evaluate the safety, efficacy, and stability of excimer laser photorefractive keratectomy (PRK) and mitomycin-C (MMC) 0.02% for consecutive hyperopia after radial keratotomy (RK). METHODS: A prospective, nonrandomized, noncomparative interventional case series of 35 eyes (22 patients) with consecutive hyperopia after RK. All eyes were treated with PRK, using a single intraoperative topical application of MMC 0.02% for 60 seconds. Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, slit-lamp evidence of corneal haze, and endothelial cell counts were evaluated for up to 18 months after surgery. RESULTS: Postoperative follow-up was 9.6 +/- 5.5 months (ranged from 3 to 18 months). The mean spherical equivalent was +3.36 +/- 1.94 diopters preoperatively and +0.27 +/- 1.38 diopters 12 months after surgery. The uncorrected visual acuity was > or =20/30 in 37.1% of the eyes at 1 month and 78.6% of the eyes at 12 months. At 12 months, 14% of the eyes lost up to 1 line of Snellen acuity in the best spectacle-corrected visual acuity. No corneal haze was observed and the endothelial cell counts remained unchanged postoperatively (P > 0.05). CONCLUSION: PRK with MMC 0.02% for consecutive hyperopia after RK seems to be a safe and effective procedure at least in the short-term period of 6 months.
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Alquilantes/administración & dosificación , Hiperopía/tratamiento farmacológico , Hiperopía/cirugía , Queratotomía Radial/efectos adversos , Láseres de Excímeros/uso terapéutico , Mitomicina/administración & dosificación , Queratectomía Fotorrefractiva , Adulto , Recuento de Células , Terapia Combinada , Endotelio Corneal/patología , Femenino , Estudios de Seguimiento , Humanos , Hiperopía/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Refracción Ocular/fisiología , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
We report 3 cases of blunt trauma causing rupture of the anterior lens capsule with cataract formation. The injuries were caused by a paintball gun, a ball-bearing air pistol, and an aluminum rivet. In all 3 cases, the anterior capsule tears were central and the posterior capsules and zonules intact; uneventful cataract extraction with implantation of an intraocular lens was performed. The postoperative visual acuities was 20/40 in 1 case and 20/20 in the other 2 cases. We propose that the anterior lens capsule may have been torn by direct contusion from rapid focal indentation of the cornea onto the lens (coup injury) or by a fluid-mechanical, anteriorly directed rebound of the vitreous, bursting open the anterior capsule (contrecoup injury).
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Extracción de Catarata , Catarata/etiología , Lesiones Oculares/complicaciones , Cápsula del Cristalino/lesiones , Heridas no Penetrantes/complicaciones , Adolescente , Adulto , Cámara Anterior/metabolismo , Humanos , Presión Intraocular , Corteza del Cristalino/metabolismo , Implantación de Lentes Intraoculares , Masculino , Rotura , Agudeza VisualRESUMEN
PURPOSE: To optimize the surgical technique for performing femtosecond laser-assisted keratoplasty (FLAK) using the IntraLase FS to cut both recipient and donor cornea buttons in eye bank globes. METHODS: FLAK was performed in six globes and six corneoscleral buttons for each of the following trephination patterns: top hat, mushroom, tongue-groove, and vertical. Manual trephination was performed as control. The wound integrity was tested in incisions closed with 8 sutures, 8 sutures with fibrin adhesive, and 16 sutures by measuring the intraocular pressure required to produce graft-host wound leakage (IOP(L)). Light microscopy (LM) and scanning electron microscopy (SEM) were performed to assess cut surface quality and graft-host interface regularity. RESULTS: Mushroom and top hat FLAK had significantly higher IOP(L) than vertical or manual trephination (p < 0.0001) for wounds closed with 16 sutures. There was no difference in IOP(L) between top hat, mushroom, and tongue-groove FLAK in wounds closed with 8 sutures with fibrin adhesive (p > 0.75). LM and SEM demonstrated cut surfaces with good quality and smooth edges. CONCLUSIONS: These preliminary studies show that FLAK produces precise trephination cuts of superior wound strength and stability to that of manual trephination. Adjuvant fibrin glue may further improve wound integrity.
Asunto(s)
Córnea/cirugía , Queratoplastia Penetrante/métodos , Terapia por Láser/métodos , Láseres de Excímeros/uso terapéutico , Córnea/ultraestructura , Bancos de Ojos , Adhesivo de Tejido de Fibrina/uso terapéutico , Humanos , Presión Intraocular/fisiología , Microscopía Electrónica de Rastreo , Modelos Biológicos , Dehiscencia de la Herida Operatoria/prevención & control , Técnicas de Sutura , Adhesivos Tisulares/uso terapéutico , Cicatrización de Heridas/fisiologíaRESUMEN
PURPOSE: To provide an update and review of femtosecond (FS) lasers in clinical ophthalmology. DESIGN: Perspective, literature review, and commentary. METHODS: Selected articles from the literature and the authors' clinical and laboratory studies. RESULTS: The FS laser employs near-infrared pulses to cut tissue with minimal collateral tissue damage. Although its major use at present is in the cutting of laser in situ keratomileusis flaps, the laser has proven its versatility in laser-assisted anterior and posterior lamellar keratoplasty, cutting of donor buttons in endothelial keratoplasty, customized trephination in penetrating keratoplasty, tunnel creation for intracorneal ring segments, astigmatic keratotomy, and corneal biopsy. Current laboratory studies include all-FS laser refractive keratomileusis sans flap, cutting corneal pockets for insertion of biopolymer keratoprostheses, noninvasive transscleral glaucoma surgery, retinal imaging and photodisruption, presbyopia surgery, and anterior lens capsulorrhexis. CONCLUSIONS: Advances in ultra-fast laser technology continue to improve the surgical safety, efficiency, speed, and versatility of FS lasers in ophthalmology.
Asunto(s)
Enfermedades de la Córnea/cirugía , Cirugía Laser de Córnea/instrumentación , Láseres de Estado Sólido/uso terapéutico , Humanos , Oftalmología/instrumentación , Estudios ProspectivosRESUMEN
Lamellar keratoplasty consists of transplanting partial-thickness donor cornea onto a complementary recipient bed. Manual lamellar dissection is technically very difficult, time-consuming, and imprecise. Also, the manually-dissected lamellar interface often has topographical irregularities that may optically degrade the best-corrected visual acuity. The femtosecond clinical laser (IntraLase FS Laser, Irvine, CA) is a recent innovation that can be programmed to produce bladeless, precise lamellar cuts at any depth with accompanying trephination cuts for both anterior and posterior lamellar transplantation. Posterior laser cuts may be used to assist in deep lamellar endothelial keratoplasty or Descemet's stripping automated endothelial keratoplasty.
Asunto(s)
Opacidad de la Córnea/cirugía , Trasplante de Córnea/métodos , Disección/métodos , Endotelio Corneal/trasplante , Terapia por Láser/métodos , Animales , Humanos , ConejosRESUMEN
We report 2 patients who developed delayed-onset isolated central Descemet membrane (DM) blister-like detachment following phacoemulsification. The detachments were not associated with a DM tear or inadvertent injection of fluid under DM, and no fluid tracks from the periphery were present. When the detachments failed to resolve spontaneously over several months, intracameral air or C(3)F(8) gas was injected. In 1 patient, a therapeutic paracentral puncture in DM was also performed to facilitate escape of the entrapped fluid. Although a small residual detachment (confirmed by optical coherence tomography) remained in both cases, the visual acuity improved to 20/25 in 1 patient and 20/30 in the other. We think these unique focal detachments in DM may be associated with an underlying preexisting weakness in the DM attachment to the stroma.
Asunto(s)
Enfermedades de la Córnea/etiología , Lámina Limitante Posterior/patología , Facoemulsificación , Complicaciones Posoperatorias , Anciano , Aire , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/cirugía , Femenino , Fluorocarburos/administración & dosificación , Humanos , Persona de Mediana Edad , Rotura Espontánea , Tomografía de Coherencia ÓpticaRESUMEN
Lamellar keratoplasty consists of transplanting partial-thickness donor cornea onto a complementary recipient bed. Manual lamellar dissection is technically very difficult, time-consuming, and imprecise. Also, the manually-dissected lamellar interface often has topographical irregularities that may optically degrade the best-corrected visual acuity. The femtosecond clinical laser (IntraLase FS LaserTM, Irvine, CA) is a recent innovation that can be programmed to produce bladeless, precise lamellar cuts at any depth with accompanying trephination cuts for both anterior and posterior lamellar transplantion. Posterior laser cuts may be used to assist in deep lamellar endothelial keratoplasty or Descemet's stripping automated endothelial keratoplasty.
A ceratoplastia lamelar consiste em transplante de espessura parcial da córnea doadora em um leito receptor complementar. A dissecção lamelar manual é técnica de difícil realização, imprecisa e que demanda tempo. Além disso, a interface lamelar freqüentemente apresenta irregularidade topográfica que pode comprometer a acuidade visual final. O laser clínico "femtosecond" (IntraLase FS LaserTM, Irvine, CA) é uma recente inovação que pode ser utilizado para produzir cortes lamelares precisos em qualquer profundidade da córnea, acompanhados de cortes verticais tanto para transplantes lamelares anteriores como posteriores sem a utilização de lâminas. Os cortes posteriores podem ser utilizados para a realização de ceratoplastia endotelial lamelar profunda ou ceratoplastia endotelial com remoção da membrana de Descemet.