RESUMO
According to the World Health Organization, cataract is the major cause of reversible visual impairment in the world. It is present as the cause of decreased visual acuity in 33% of the visual impaired citizens. With the increase of life expectancy in the last decades, the number of patients with cataract is expected to grow for the next 20 years. Nowadays, the only effective treatment for cataracts is surgery and its surgical outcomes have been increasingly satisfactory with the technological advancement.Pharmaceutical development has been also responsible for surgical outcomes enhancement. This includes the development of new ophthalmic viscoelastic devices (OVDs), intraocular dyes, mydriatics, miotics, anesthetics, irrigating solutions, and antibiotics. However, the increased costs and demand for cataract surgery may be hard to meet in the future unless clinical preventive and curative options are evaluated.In this chapter, we review the studies that addressed pharmacological applications in cataract.
Assuntos
Extração de Catarata , Catarata/tratamento farmacológico , Iris/patologia , Catarata/prevenção & controle , HumanosRESUMO
Os autores relatam um caso de mesotelioma pleural benigno. São abordados aspectos histológicos, etiopatogênicos, genéticos, epidemiológicos e clínicos, bem como a casuística estudada, a terapêutica instituída e o segmento obtido. Abordam os critérios para o diagnóstico, resultante da somação de vários fatores, dando ênfase ao quadro clínico compatível, confirmação histopatológica, imuno-histopatológicos compatíveis com resposta positiva clínico-radiográfica e eficaz após a cirurgia proposta.
Cases of benign mesothelioma of the pleura are reported by authors. Histological, etiopathogenic, genetic, epidemiological and clinical aspects are approached as well the casuistry that was studied, established therapy and the acquired segment. It approaches the criteria for diagnosis resulted from many factors emphasizing compatible clinical condition, histopathological confirmation, compatible immuno-histopathology, effective and positive clinical radiography answer after the proposed surgery.
Assuntos
Humanos , Tumor Fibroso Solitário Pleural/cirurgia , Tumor Fibroso Solitário Pleural/diagnóstico , Tumor Fibroso Solitário Pleural/patologia , Mesotelioma , Biópsia por Agulha/instrumentação , Toracotomia/métodosRESUMO
PURPOSE: To evaluate the visual performance of different types of intraocular lens (IOL) in eyes submitted to femtosecond laser (FSL) cataract surgery and to analyze whether this technology could result in spectacles independence. DESIGN: Retrospective comparative case series. METHODS: Consecutive eyes that were scheduled for FSL cataract surgery were included in this study. After one month postoperative, patients were divided into two groups: cases that required prescription for eyeglasses and cases that did not require prescription. In addition, the patients were analyzed according to the type of IOL that was implanted (monofocal, monofocal toric, multifocal and multifocal toric). RESULTS: Thirty-five cataract surgeries were analyzed. Twenty-three eyes had a monofocal IOL implanted, and 12 had a multifocal IOL implanted. After 1 month, 12 cases required prescription (Group 1), and 23 did not require prescription (Group 2). The proportion of eyes that did not require corrective lenses was significantly greater (P = 0.02) in eyes that received multifocal IOL (91.67%) compared with those that received monofocal IOL (47.83%). Additionally, 100% of eyes that received multifocal toric IOL did not require eyeglasses at one month postoperatively. CONCLUSION: The FSL surgical precision associated with modern IOL technology may be an important factor related to vision satisfaction after cataract surgery.
RESUMO
Objective:To evaluate the introduction of the femtosecond laser (FSL) to perform the key steps of the traditional cataract surgery process and the operational difficulties and safety of this new technology during routine use in an operating room in Brazil.MethodsA retrospective study was conducted using the first cases operated on at a single center using the laser platform LenSx/Alcon with a soft contact lens patient interface.All patients underwent a detailed preoperative assessment.The anterior capsulotomy, nuclear fragmentation, and corneal incisions were created with the FSL; then, the surgery was completed following the standard phacoemulsification procedure. The main outcome measurements were difficulties and complications related to the learning curve and an analysis of postoperative uncorrected distance visual acuity (UDVA).Results:Of 31 patients (40 eyes), 9 patients had FSL cataract surgery in both eyes.The mean age was 64 ± 12 years (ranging from 42 to 82), the mean cataract nuclear sclerosis was grading 2 ± 0.6 (ranging from 1 to 4), and the preoperative mean UDVA in logMAR was 0.4 ± 0.2 (ranging from 0.1 to 1.3). Anterior capsulotomy was complete in all patients, and scissors were not needed to cut off any intact portion. The postoperative corneal incisions were not completely linear and showed some irregularities. Laser phaco-fragmentation was effective, with the division of the nucleus into smaller segments easily performed before phacoemulsification.After 1 month, the postoperative mean UDVA in logMAR was 0.1 ± 0.1 (ranging from 0.0 to 0.4) (P < 0.0001).Conclusion:With increasing surgical cases and experience, the phacoemulsification steps are performed precisely and effectively with FSL pretreatment, resulting in a safe learning curve.
Objetivo:Avaliar a introdução do laser de femtossegundo (FSL) para realizar etapas fundamentais da cirurgia de catarata tradicional e as dificuldades e segurança desta nova tecnologia na rotina de um centro cirúrgico no Brasil.Métodos:Um estudo retrospectivo foi realizado com os primeiros casos operados em um único centro usando a plataforma de laser LenSx/Alcon, sendo utilizado lentes de contato gelatinosa na interface do paciente. Todos os pacientes foram submetidos a uma avaliação pré-operatória detalhada. Capsulotomia anterior, fragmentação nuclear e incisões na córnea foram criados com a FSL, em seguida, a cirurgia foi concluída com procedimento de facoemulsificação padrão. As principais medidas de desfecho foram dificuldades e complicações relacionadas à curva de aprendizado e análise da acuidade visual pós-operatória não corrigida à distância (UDVA).Resultados:Dos 31 pacientes (40 olhos), 9 realizaram cirurgia de catarata em ambos os olhos com FSL. A média de idade foi de 64 ± 12 anos (variando de 42 a 82), a média de classificação da catarata através da esclerose nuclear foi 2 ± 0,6 (variando de 1 a 4) e UDVA pré-operatória em logMAR foi de 0,4 ± 0,2 (variando de 0,1 a 1,3). A capsulotomia anterior foi completa em todos os pacientes e não precisou usar da pinça para cortar qualquer porção intacta. Incisões corneanas pós-operatórias não foram lineares, mostrando ainda algumas irregularidades. A facofragmentação a laser foi eficaz, com a divisão do núcleo em segmentos menores facilmente realizados antes da facoemulsificação. Após 1 mês de pós-operatório, UDVA em logMAR foi de 0,1 ± 0,1 (variando de 0,0 a 0,4) (P < 0,0001).Conclusão:Com o aumento do volume dos casos cirúrgicos e ganho de experiência, passos precisos da facoemulsificação são realizados com o pré-tratamento com o FSL, resultando em uma segura curva de aprendizagem.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Extração de Catarata , Terapia a Laser , Curva de Aprendizado , Facoemulsificação , Estudos RetrospectivosRESUMO
Relata-se um caso de mesotelioma pleural em paciente cuja principal e única queixa era dispnéia, que vinha se agravando há longo tempo e, embora tivesse procurado vários médicos, a causa de tal queixa näo tinha sido esclarecida até entäo