RESUMEN
PURPOSE: To determine repeatability and reproducibility of A-scan biometry quantitative findings in order to uniformly evaluate lenticular cataract changes. MATERIALS AND METHODS: Seventeen eyes from seventeen cataract patients were examined by three (trainee ophthalmologists). Results (ratio of mean internal lens spikes height/lens anterior surface spike height) were compared using coefficient of variation (CV), repeatability coefficient (CR), and intraclass correlation coefficients (ICC). RESULTS: Intra-observer consistency was CV = 0.36, CR = 0.49, and ICC = 0.778 for the first operator; CV = 0.33, CR = 0.52, and ICC = 0.642 for the second operator; and CV = 0.32, CR = 0.53, and ICC = 0.567 for the third operator. Concerning inter-observer agreement: CV (in 6 of 7 eyes) was > 8%, CR was > 0.21, and intraclass correlation coefficient for all eyes was < 0.81. CONCLUSIONS: Regarding repeatability and reproducibility, although there is a tendency for statistical significance, variability of the results does not allow the use of the method as a complementary clinical tool for comparing results. Standardization of this procedure, in order to achieve higher test reliability, might be the aim of relevant future studies, although there are a number of points that have to be addressed.
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Biometría , Catarata/diagnóstico por imagen , Técnicas de Diagnóstico Oftalmológico , Anciano , Anciano de 80 o más Años , Ojo/diagnóstico por imagen , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los Resultados , UltrasonografíaRESUMEN
OBJECTIVE: To classify the white senile cataracts and report the results of phacoemulsification of white cataracts. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: One hundred eyes were included. INTERVENTION: White cataracts were examined biomicroscopically before surgery, and their acoustic structure was analyzed with standardized A-scan echography. White cataract surgery was performed with phacoemulsification via a superior temporal near-limbus corneal approach using a bimanual divide-and-conquer or stop-and-chop technique. Patients were followed after surgery for a period of 9 months. MAIN OUTCOMES MEASURES: The A-scan acoustic structure of white cataracts; successful accomplishment of capsulorrhexis; mean phacoemulsification time, power, and energy; intraoperative and postoperative complications of phacoemulsification; and visual acuity at 9 months after surgery. RESULTS: White senile cataracts were categorized into three different types. Type I included intumescent, white cataracts with cortex liquefaction and high internal acoustic reflections (44 eyes), type II included white cataracts with voluminous nuclei, little amount of whitish solid cortex, and low internal acoustic reflections (49 eyes), and type III included white cataracts with fibrosed anterior capsule and low internal echospikes (7 eyes). Circular capsulorrhexis was completed in 79 eyes and was significantly less successful in eyes with type I intumescent, white cataracts compared with type II white cataracts (P = 0.0034). Mean phacoemulsification time and energy were higher in type II and type III white cataracts. Posterior capsule rupture occurred in ten eyes, and three of these eyes were complicated by vitreous loss. In 95 eyes, the posterior chamber lens was implanted in the capsular bag and in five eyes in the sulcus. After surgery, a transient corneal edema developed in 31 eyes. At the final 6-month examination, the mean postoperative visual acuity was 20/30. CONCLUSION: Current phacoemulsification techniques can safely manage eyes with senile white cataracts. The increased risk of difficulty with continuous capsulorrhexis in type-I and type-III white cataracts and the substantial nuclear hardness in type-II and mainly type-III white cataracts would suggest that current phacoemulsification techniques might not be as successful in these patients as they are in ordinary earlier cataracts.
Asunto(s)
Catarata/clasificación , Catarata/diagnóstico por imagen , Facoemulsificación , Anciano , Anciano de 80 o más Años , Capsulorrexis , Catarata/patología , Femenino , Humanos , Implantación de Lentes Intraoculares , Lentes Intraoculares , Masculino , Persona de Mediana Edad , Facoemulsificación/métodos , Estudios Prospectivos , Resultado del Tratamiento , Ultrasonografía , Agudeza VisualRESUMEN
PURPOSE: This report describes the results of a prospective trial to evaluate the efficacy of pars plana vitrectomy (PPV) in conjunction with perfluoro-n-octane (PFO) as initial treatment of pseudophakic retinal detachment (RD) with no breaks diagnosed preoperatively. METHODS: Fourteen consecutive eyes presenting with pseudophakic RD in which retinal breaks could not be identified preoperatively underwent primary PPV, internal microsurgical identification of the retinal breaks with endoillumination and noncontact wide angle viewing system, PFO retinal reattachment, transscleral cryopexy or endolaser treatment of breaks, PFO-air exchange, and final injection of 20% sulfur hexafluoride. In five eyes, a scleral buckle was also used. Mean follow-up period was 18 months. RESULTS: In 13 of the 14 eyes in which no breaks had been identified preoperatively, breaks were diagnosed during surgery. Perfluoro-n-octane retinal attachment facilitated accurate microscopic treatment of retinal breaks. The retina was reattached with a single operation in all eyes. Eleven eyes had final visual acuity of 20/60 or better. Complications were minimal. CONCLUSIONS: Pars plana vitrectomy in conjunction with PFO expression of subretinal fluid is effective in the initial treatment of pseudophakic RD with no preoperative diagnosis of retinal breaks.