RESUMO
OBJECTIVE: To determine the advantages and complication rate of capsulotomy performed with femtosecond laser in white complex cataract cases. STUDY DESIGN: Retrospective case series. PARTICIPANTS: Sixteen eyes of 16 patients. METHODS: This was a single-center retrospective review of white cataract surgery cases in which the femtosecond laser (LenSx, Alcon Laboratories, Fortworth, Texas, USA) was used between May 2019 and February 2021. Outcome measures included an assessment of the capsulotomy, identification of tags, surgical time, cumulative dispersed energy (CDE) and postoperative management. RESULTS: Sixteen eyes of 16 patients were included in this study; capsule tags occurred in six patients (37.5%). In 2 patients, the capsule presented small adhesions that were identified and removed. One patient presented a very significant contraction of the anterior capsule with an incomplete cut zone of 2 to 4hours. In a patient with nystagmus, the capsulotomy was performed without complications under peribulbar anesthesia. CONCLUSIONS: The femtosecond laser permitted capsulotomies of better shape, size and regularity in complex cases of white cataract and in combination with conditions such as nystagmus and prior corneal transplantation. The microadhesions and untreated areas were identified with trypan blue, which is essential to use in these cases to avoid associated complications.
Assuntos
Extração de Catarata , Catarata , Terapia a Laser , Facoemulsificação , Humanos , Estudos Retrospectivos , Terapia a Laser/efeitos adversos , Extração de Catarata/efeitos adversos , Catarata/complicações , LasersRESUMO
PURPOSE: Intraocular lens (IOL) calculation and biometry have evolved significantly in recent decades. However, present outcomes are still suboptimal. Our objective is to summarize the results reported in the literature with regard to a new variable, the value of the relationship between anterior and posterior corneal curvature in the biometric calculation of IOL power. METHODS: We have created a narrative revision of the existing evidence regarding the posterior to anterior corneal curvature ratio in IOL calculation. RESULTS: The corneal posterior/anterior ratio (P/A ratio), also called Gullstrand ratio, has a standard deviation of 2.4% in normal people, hence causing a possible IOL power miscalculation error of up to 0.75 diopters (D). This error is magnified in pathological corneas or in those with previous refractive surgery. Including the P/A ratio in the IOL formula reduces errors in the calculation of IOL power. CONCLUSIONS: Measurement of the posterior corneal surface should be recommended prior to IOL calculation, given the demonstrated results regarding the P/A ratio for IOL power calculation. Regarding toric IOL calculation, we suggest incorporation of all internal astigmatic vectors, for instance, posterior corneal surface, IOL tilt induced toricity, and retinal astigmatism. All of these factors may improve surgical outcomes.
Assuntos
Astigmatismo , Lentes Intraoculares , Facoemulsificação , Astigmatismo/cirurgia , Biometria , Córnea , Topografia da Córnea , Humanos , Implante de Lente Intraocular , Óptica e Fotônica , Refração Ocular , Estudos RetrospectivosRESUMO
In order to avoid radial tearing of the anterior capsule while performing continuous circular capsulorhexis (CCC) in a white intumescent cataract, called the "Argentinian flag sign" when CCC is associated with a previous capsular stain with trypan blue, an initial puncture of the anterior capsule is performed with a 30G needle as the first step of the surgical procedure, that means, prior to any previous aperture of the anterior chamber. This act seems to allow the pressure of the intracrystalline space and the pressure of the anterior chamber to be equalized, as the liquefied content of the intumescent white cataract is released into a presumably hermetic anterior chamber, avoiding the dreaded anterior capsular radial tear. This technique, called "white-puncture", has been used in 174 cases without any associated complications.