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Background In this study, the characteristics and prognostic factors associated with the progression of myopic traction maculopathy (MTM) were evaluated in a Mexican population. Methods This is a retrospective observational study that analyzed patients with MTM who underwent optical coherence tomography (OCT). Clinical-ocular information, the MTM classification, and initial and final visual acuity (VA) were recorded. Results In total, 101 eyes of 84 patients (mean age 63.5 ± 10.7 years) were included (88.1% female and 11.9% male). The mean spherical equivalent was -16.8 ± 6.4 D, axial length was 29.6 ± 2.1 mm, and mean initial VA was 0.8 ± 0.5 logMAR. The mean follow-up time was 25.7 ± 27.6 months. The change in final VA from diagnosis to the last follow-up was +0.1 (0.2) (p = 0.001). Overall, 24.8% of patients progressed, 72.3% did not progress, and 3% showed regression. The patient-year progression rate was 0.20 ± 0.44. Factors associated with progression were initial logMAR VA (p= 0.012) and staphyloma (p= 0.001). Conclusions One in four patients with MTM progressed, and the patient-year progression rate was 0.5. The factors associated with disease progression were initial VA and the presence of staphyloma. The characteristics of Mexican patients with MTM are similar to those described in other populations.

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Comments about endothelial cell loss after posterior chamber phakic intraocular lens are provided, with a particular emphasis on the importance of determining progressive postoperative cell density reduction, excluding that related to surgical trauma.

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BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events. RESULTS: A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%). CONCLUSION: PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.

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PURPOSE: To assess the relationship between macular choroidal thickness (CT) measurements and retinal sensitivity (RS) in eyes with myopia and different stages of myopic maculopathy. METHODS: A masked, cross-sectional, and consecutive study involving patients with emmetropia/myopia (control group) and high myopia (HM) eyes. Automated choroidal thickness (CT) and manual outer retinal layer (ORL) thickness were acquired using swept-source optical coherence tomography, while retinal sensitivity (RS) assessed by microperimetry (MP3) in all regions of the macular Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Comparisons were made between groups, and correlations were performed among these measurements, demographic and ocular parameters and myopic maculopathy classification. RESULTS: A total of 37 (74 eyes) patients were included in the study. The mean age was 39 ± 13 years, and 28 patients (76%) were female. HM eyes exhibited inferior best-corrected visual acuity and a more advanced myopic maculopathy classification compared to the control group. The mean macular CT were 255 and 179 µm in the control and HM eyes (P < 0.001), respectively. In the HM eyes, superior ETDRS region presented the greatest values. Mean RS in control and HM groups was 28 and 24 dB (P = 0.001), respectively. Inner temporal followed by superior, were the regions of higher RS. Mean ORL thickness was 83 and 79 µm (P < 0.001), in the control and HM groups, respectively. The inner temporal ETDRS region presented the thickest measure. CT correlated significantly with RS (r = 0.41, P < 0.001) and ORL thickness, (r = 0.58, P < 0.001), which also correlated with RS (r = 0.40, P < 0.001). Spherical equivalent, axial length and myopic maculopathy stage were the parameters that most correlated with CT, RS and ORL thickness. For every 100 µm increase in thickening of CT there was an average increase of 3.4 µm in ORL thickness and 2.7 dB in RS. Myopic maculopathy classification demonstrated influence only with CT. CONCLUSION: Myopia degree is related to ORL and choroidal thinning and deterioration of retinal sensitivity in some ETDRS regions of the macula. Choroidal thinning is associated to with a decline of retinal sensitivity, thinning of ORL, and worsening of myopic maculopathy classification, so new treatments are necessary to prevent myopia progression.

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BACKGROUND: Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM. METHODS: To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1. RESULTS: Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group. CONCLUSION: Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary. TRIAL REGISTRATION: Retrospectively registered.

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A correction about phakic intraocular lens power calculation process, as it was stated by Li, Song & Song, is provided. It is explained that this calculation is based on the Van der Heijde formula and not on biometric formulas. A comment about the mechanisms of late endothelial cell loss following phakic intraocular lenses is done.

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Objetivo: Determinar la seguridad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de implantados. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128 (31 con ambos ojos y 5 con un solo ojo). Se determinó preoperatorio y posoperatorio: tensión ocular, pérdida celular endotelial según conteo, coeficiente de variación celular y hexagonalidad. Además de complicaciones posoperatorias y posición del lente respecto a endotelio y cristalino. El análisis estadístico se realizó con la prueba T para datos pareados, con una significación del 95 por ciento. Resultados: Edad media 28,06 ± 6,14 (25 mujeres y 11 hombres). Las complicaciones inmediatas fueron hipotonía OD: 1 (3,03 por ciento), OI: 1 (2,94 por ciento). La irregularidad de la pupila se presentó OD: 1 (3,03 por ciento), OI: 1 (2,94 por ciento) mediata y OD: 1 (3,03 por ciento), OI: 2 (5.88 por ciento) tardía. Tensión ocular promedio total preoperatorio 14,09 ± 2,51 y posoperatorio 14,22 ± 2,64 (p = 0,90). El conteo celular preoperatorio 2667,27 ± 228,72 y posoperatorio 2591,96 ± 301,21, con 2,94 por ciento pérdida endotelial total 75,31 ± 237,41 (p = 0,06). No hubo diferencias en el coeficiente de variación (p = 0,60) ni la hexagonalidad (p = 0,57). Posición del lente respecto al endotelio 2,09 mm y al cristalino 1,08 mm. Conclusiones: El implante de lente fáquica ACR-128 en la corrección de la alta miopía es un tratamiento seguro al no existir complicaciones posquirúrgico ni modificaciones en la tensión ocular y en el endotelio corneal tras un año del implante(AU)

Objective: Determine the safety of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lens implants (31 in both eyes and 5 in one eye). Pre- and postoperative determination was made of ocular tension, endothelial cell loss by count, cell variation coefficient and hexagonality, as well as of postoperative complications and lens position with respect to the endothelium and the crystalline lens. Statistical analysis was based on the paired T-test with a significance level of 95 percent Results: Mean age was 28.06 ± 6.14 (25 women and 11 men). An immediate complication was hypotonia: RE: 1 (3.03 percent), LE: 1 (2.94 percent). Pupil irregularity was mediate: RE: 1 (3.03 percent), LE: 1 (2.94 percent) and late: RE: 1 (3.03 percent), LE: 2 (5.88 percent). Total average ocular tension was 14.09 ± 2.51 preoperative and 14.22 ± 2.64 postoperative (p = 0.90). Cell count was 2667.27 ± 228.72 preoperative and 2591.96 ± 301.21 postoperative, with 2.94 percent total endothelial loss 75.31 ± 237.41 (p = 0.06). Differences were not found in the variation coefficient (p = 0.60) or in hexagonality (p = 0.57). Lens position was 2.09 mm with respect to the endothelium and 1.08 mm with respect to the crystalline lens. Conclusions: ACR-128 phakic lens implantation for high myopia correction is a safe procedure with no postoperative complications or modifications in ocular tension or the corneal endothelium after one year's follow-up(AU)

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Introducción: El implante de una lente intraocular fáquico para corregir defectos de la refracción presenta una serie de ventajas respecto a otras técnicas como la cirugía refractiva corneal o la extracción de cristalino transparente. Objetivo: Describir los cambios en la calidad de vida relacionados con la función visual en la corrección de alta miopía con implante de lente fáquico ACR-128. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo con análisis estadístico separado por ojos. La muestra total se correspondió con 91 ojos (46 derechos y 45 izquierdos) de 49 pacientes a los que se les implantó lente fáquico ACR-128 para la corrección de miopía. Mediante el test de Pelli-Robson se determinó la sensibilidad al contraste binocular a varias frecuencias espaciales y se les aplicó el cuestionario NEI-VFQ-25 antes de la cirugía (pretest) y a los tres meses de realizada la misma (postest). El análisis estadístico se realizó con la prueba T para datos pareados, con una significación del 95 por ciento. Resultados: Edad media 28,73 ± 5,85 años. Predominio del sexo femenino (71,43 por ciento). Hubo diferencias significativas en todas las frecuencias espaciales de la sensibilidad al contraste binocular entre el pre- y posoperatorio (p < 0,01). Al comparar el pretest y el postest (valoración retrospectiva de la calidad de vida prequirúrgica) no se encontraron diferencias significativas, lo que indicó que no hubo recalibración y que las diferencias con el postest que fueron significativas corroboren el verdadero cambio en la calidad de vida de estos pacientes tras la cirugía. Conclusiones: El implante de lentes fáquicos ACR-128 para la corrección de la alta miopía mejora la calidad de vida relacionada con la función visual sin cambios en su percepción antes y después de la cirugía(AU)

Introduction: Phakic intraocular lens implantation to correct refraction defects has a number of advantages with respect to techniques such as corneal refractive surgery or clear lens extraction. Objective: Describe the changes in vision-related quality of life resulting from high myopia correction by ACR-128 phakic lens implantation. Methods: A prospective longitudinal descriptive study was conducted with independent statistical analysis for each eye. The total sample was 91 eyes (46 right and 45 left) of 49 patients undergoing ACR-128 phakic lens implantation for myopia correction. The Pelli-Robson test was used to determine binocular contrast sensitivity at various spatial frequencies, and the NEI VFQ-25 questionnaire was applied before surgery (pre-test) and three months after surgery (post-test). Statistical analysis was based on the paired T-test with a significance level of 95 percent. Results: Mean age was 28.73 ± 5.85 years. Female sex prevailed (71.43 percent). Significant differences were found in all the spatial frequencies of binocular contrast sensitivity between the pre- and postoperative periods (p < 0.01). Comparison of pre- and post-test results (retrospective assessment of presurgical quality of life) did not find any significant differences, indicating that there was no recalibration. Significant differences with respect to the post-test confirm the actual change in these patients' quality of life after surgery. Conclusions: ACR-128 phakic lens implantation for high myopia correction improves vision-related quality of life without changes in its perception before and after surgery(AU)

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AIM: To evaluate the clinical results after implantation of a new intrastromal corneal ring segment (ICRS) associated with photorefractive keratectomy (PRK) to correct high myopia (HM) patients with thin corneas. METHODS: We evaluated 42 eyes of 23 HM patients that had ICRS implantation followed by PRK. The mean age of patients was 29.1±7.12y (range 18 to 40 years old). Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry, spherical equivalent, pachymetry, and aberrometry were compared using ANOVA with repeated measurements evaluated preoperatively and at last follow-up visit after the procedures. The refractive predictability and simulated/real corneal ablation were also assessed. RESULTS: The mean follow-up time after PRK was 6.8±1.6mo. The mean preoperative UCVA improved from 20/800 preoperative to 20/100 after ICRS and 20/35 after PRK. The mean preoperative BCVA was 20/25 (range from 20/30 to 20/20) and remained unchanged after ICRS implantation. Following the PRK the mean BCVA was 20/25 (range from 20/30 to 20/20). The mean spherical equivalent decreased from -7.25±1.12 (range -5.00 to -9.00) preoperatively to -3.32±1.0 (range -2.00 to -5.00) postoperatively (P<0.001) after ICRS implantation and decreased from -2.44±1.51 preoperatively to 0.32±0.45 (range -0.625 to 0.875) postoperatively (P<0.001) after PRK. The change in BCVA and topographic astigmatism was statistically significant (P<0.0001). CONCLUSION: ICRS in HM associated with PRK can be a tissue saving procedure and an alternative surgical option for correction of moderate to high myopia.

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Introducción: La corrección de ametropías moderadas-severas mediante lentes fáquicas permite conservar la acomodación, además, de obtener una mejor calidad óptica, reversibilidad del procedimiento y la opción de corregir defectos refractivos residuales mediante cirugía corneal mínima invasiva. Objetivo: Determinar la efectividad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de su implante. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128. Se determinaron las características biométricas y refractivas por ojo, relación entre el componente esférico esperado y el observado, distribución por ojos el componente esférico esperado y el observado, relación entre cilindro queratométrico pre y posoperatorio y relación entre la agudeza visual sin corrección y la agudeza visual mejor corregida en el pre y posoperatorio. Resultados: La edad media fue 28,06 ± 6,14(25 mujeres, 11 hombres) el equivalente esférico preoperatorio OD promedio de -10,77 ± 4,23 dioptrías y OI promedio de -10,77 ± 3,72 dioptrías. El componente esférico en dioptrías esperado (-0,56 ± 0,38) y observado (-0,43 ± 0,69) sin diferencias estadísticamente significativas (p = 0,14). El cilindro queratométrico en dioptrías, pre (1,41 ± 0,74) y posoperatorio (1,24 ± 0,88) sin astigmatismo inducido (p = 0,12). El 100 por ciento tenía agudeza visual sin corrección preoperatoria ≤ 0,1 y posoperatoria ≥ 0,5. Conclusiones: Un año después del implante de lente fáquica ACR-128 en la corrección de la alta miopía el tratamiento continúa efectivo, pues reduce el componente esférico al deseado y mantenerlo, no inducir astigmatismo y mantener mejor agudeza visual(AU)

Introduction: Correction of moderate-severe ametropia with phakic lenses makes it possible to preserve accommodation and provides better optical quality, reversibility of the procedure and the option of correcting residual refractive defects by minimally invasive corneal surgery. Objective: Determine the effectiveness of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lenses. Determination was made of the biometric and refractive characteristics of each eye, the relationship between the expected and the observed spherical component, the distribution of the expected and the observed spherical component per eye, the relationship between the pre- and postoperative keratometric cylinder, and the relationship between pre- and postoperative uncorrected and best corrected visual acuity. Results: Mean age was 28.06 ± 6.14 (25 women, 11 men). Average preoperative spherical equivalent was -10.77 ± 4.23 diopters RE and -10.77 ± 3.72 diopters LE. Spherical component in diopters: expected (-0.56 ± 0.38) and observed (-0.43 ± 0.69), without statistically significant differences (p= 0.14). Keratometric cylinder in diopters: preoperative (1.41 ± 0.74) and postoperative (1.24 ± 0.88), without induced astigmatism (p = 0.12). In 100 percent visual acuity without correction was #8804; 0.1 preoperative and ≥ 0.5 postoperative. Conclusions: One year after ACR-128 phakic lens implantation for high myopia correction, the treatment remains effective, reducing the spherical component and maintaining it at the desired level, not inducing astigmatism and preserving best visual acuity(AU)

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RESUMEN Los errores refractivos altos son difíciles de corregir óptica y quirúrgicamente. Los pacientes que los padecen se encuentran incómodos con las gafas, ya que la calidad de su visión es deficitaria. Las lentes de contacto proporcionan mejor agudeza visual; sin embargo, en ocasiones requieren diseños especiales para ser adaptadas y pueden asociarse a complicaciones severas. La cirugía refractiva como subespecialidad busca mejorar la agudeza visual no corregida y disminuir la dependencia a gafas o lentes de contacto. Las opciones van desde los procedimientos queratorrefractivos hasta el implante de una lente intraocular, ya sea con la extracción del cristalino transparente o en un ojo fáquico. Este último ofrece ventajas al mantener la acomodación, obtener una mejor calidad óptica y cierta reversibilidad. En el mundo se han realizado múltiples trabajos en pacientes con lentes fáquicos de diferentes modelos y estos han demostrado que son seguros y confiables, aunque no son muchos los estudios sobre la calidad de vida a largo plazo; de ahí la motivación para realizar una búsqueda actualizada de diversos artículos publicados, con el objetivo de describir los resultados visuales y la calidad de vida en pacientes con implante de lentes fáquicos. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores(AU)

ABSTRACT High refractive errors are difficult to correct both optically and surgically. Patients suffering from them feel uncomfortable with their eyeglasses, since their visual quality is poor. Contact lenses provide better visual acuity, but they sometimes require special designs to be adjusted and may be associated to severe complications. The subspecialty of refractive surgery seeks to improve uncorrected visual acuity and reduce dependence on eyeglasses or contact lenses. Options range from keratorefractive procedures to intraocular lens implantation, be it with removal of the transparent crystalline lens or in phakic eyes. The latter provides the advantages of maintaining accommodation, obtaining better visual quality and affording a certain degree of reversibility. A great many studies have been conducted worldwide of patients with phakic lenses of various models, and these have proved to be safe and reliable. However, not many studies are available about long-term quality of life. Hence the motivation to perform an updated search for published papers about the subject, with the purpose of describing the visual results and quality of life of patients with phakic lens implants. Use was made of the Infomed platform, particularly the Virtual Health Library with all its search engines(AU)

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BACKGROUND: To determine the accuracy of the T2 formula as applied to highly myopic eyes, to compare the T2 formula to the SRK/T and Holladay 1 formulas, and to describe possible ways to improve the estimation of corneal height and prediction error in two settings, the Hadassah Hospital, Ophthalmology Department, Jerusalem, Israel and Clínica Barraquer, Bogotá, Colombia. METHODS: In this retrospective case series, optical biometer measurements were taken for 63 highly myopic patients (> 25 mm) undergoing uneventful crystalline lens phacoemulsification and insertion of an acrylic intraocular lens. Prediction errors were obtained, with estimations of ±0.50 D, ± 1.00 D, and greater than ±2.00 D. A method to improve the corneal height calculation is described. RESULTS: The SRK/T formula (mean absolute error [MAE] = 0.418; median absolute error [MedAE] = 0.352) was the most accurate, followed by the T2 (MAE = 0.435; MedAE = 0.381) and Holladay 1 (MAE = 0.455; MedAE = 0.389) formulas. Both the SRK/T and T2 formulas overestimated corneal height, but values were higher with the T2 formula. Corneal height was more precisely estimated using an alternative method that, when combined with axial length optimization, resulted in lower MAE (0.425) and MedAE (0.365) values than when applying the T2 formula alone. CONCLUSIONS: The T2 formula seems to be less accurate than the SRK/T formula in highly myopic eyes. An improved corneal height estimation method is described for the the T2 formula.

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RESUMEN Objetivo: Describir los resultados visuales en la corrección de la alta miopía con implante de lente fáquica ACR-128. Métodos: Se realizó un estudio descriptivo, observacional longitudinal y prospectivo en 60 ojos de 32 pacientes con miopía corregida con lente fáquica ACR-128. Se determinó el componente esférico esperado y observado, el cilindro queratométrico, las agudezas visuales sin corrección y mejor corregidas en el pre y en el posoperatorio y el astigmatismo inducido. El análisis estadístico se realizó con la Prueba T para datos pareados, con una significación del 95 por ciento. Resultados: La edad media fue 27,41 ± 5,91 años, el equivalente esférico preoperatorio -11,54 ± 3,20 dioptrías y el 68,75 por ciento eran femeninas. El componente esférico en dioptrías esperado (-0,53 ± 0,37) y observado (-0,42 ± 0,47) sin diferencias (p= 0,0742). Entre ± 1,00 el 91,67 por ciento y entre ± 0,50 el 70 por ciento. Ningún ojo quedó por encima de +0,50 dioptrías. El cilindro queratométrico en dioptrías, pre (1,44 ± 0,76) y posoperatorio (1,49 ± 0,84) sin astigmatismo inducido (p= 0,6377). El 100 por ciento tenía agudeza visual sin corrección preoperatoria ≤ 0,1 y posoperatoria ≥ 0,3. Después de la cirugía el 10 por ciento alcanzaba 1,0 y 71,6 por ciento ≥ 0,5. Solo el 28,33 por ciento tenía la unidad en el preoperatorio, y el 70 por ciento en el posoperatorio (98,33 por ciento ≥ 0,7). Conclusiones: El implante de lente fáquica ACR-128 proporciona corrección refractiva y predictibilidad favorables para el paciente, al reducir el componente esférico al deseado, no inducir astigmatismo y mejorar la agudeza visual, todo lo que se traduce en un adecuado resultado visual(AU)

ABSTRACT Objective: Describe the visual results of correction of high myopia with ACR-128 phakic lens implantation. Methods: An observational descriptive longitudinal prospective study was conducted of 60 eyes of 32 patients with myopia corrected with the ACR-128 phakic lens. Determination was made of the expected and observed spherical component, the keratometric cylinder, uncorrected and best corrected visual acuity in the pre- and postoperative periods, and induced astigmatism. Statistical analysis was based on the paired T-test with a significance level of 95 percent. Results: Mean age was 27.41 ± 5.91 years, preoperative spherical equivalent was -11.54 ± 3.20 diopters, and 68.75 percent of the patients were female. Spherical component in diopters expected (-0.53 ± 0.37) and observed (-0.42 ± 0.47) without differences (p= 0.0742). Between ± 1.00 diopters 91.67 percent and between ± 0.50 diopter 70 percent. No eye was above +0.50D. Keratometric cylinder in diopters, preoperative (1.44 ± 0.76) and postoperative (1.49 ± 0.84) without induced astigmatism (p=0.6377). In 100 percent visual acuity without correction ≤ 0.1 preoperative and ≥ 0.3 postoperative. After surgery 10 percent reached 1.0 and 71.6 percent ≥ 0.5. Only 28.33 percent had the unit corrected in the preoperative period and 70 percent in the postoperative period (98.33 percent ≥ 0.7). Conclusions: ACR-128 phakic lens implantation provides patients with favorable refractive correction and predictability. This is achieved by reducing the spherical component to desired values, not inducing astigmatism and improving visual acuity, all of which leads to an adequate visual result(AU)

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La alta miopía es aquella igual o mayor a -6 dioptrías esféricas, no en función de la curvatura corneal elevada, como es el caso del queratocono, ni por la esclerosis del cristalino que ocurre en etapas preseniles, sino en dependencia de la longitud axial mayor de 25,5 o 26,0 mm. La corrección óptica de estos defectos altos es difícil, ya que es frecuente que los pacientes se sientan incómodos con el uso de gafas, pues no obtienen una buena calidad de visión, y con el fin de mejorarla se han desarrollado distintos procedimientos quirúrgicos. Se presenta una paciente de 26 años de edad con miopía elevada, quien no se adapta a los lentes de contacto y no desea continuar con los espejuelos; no es candidata a la cirugía refractiva corneal. Se le implantaron lentes fáquicas ACR IOL-128 (Soleko, Italia) sin complicaciones. El equivalente esférico preoperatorio -11,5 y -6 dioptrías disminuyó a -1,00 y -0,5 respectivamente, y la agudeza visual sin cristales de cuenta dedos y 0,1 a 0,8 y 0,9 respectivamente. Con este caso se evidencia que las lentes fáquicas son una opción con buenos resultados en la corrección de la alta miopía(AU)

The high myopia, by definition, is that equal or bigger to -6 spherical dioptrías; not in function of the bend high corneal, like it is the case of the queratocono, neither for the sclerosis of the crystalline lens that happens in stages preseniles, but in dependence of the axial longitude bigger than 25,5 or 26,0 mm. The optic correction of these high defects is difficult, since it is frequent that the patients feel uncomfortable with the glasses use, because they don't obtain a good quality of vision and with the purpose of improving it, different surgical procedures have been developed. Young patient 26 years old is presented with high myopia that doesn't adapt to the contact eyeglasseses and she doesn't want to continue with the espejuelos, she is not candidate to surgery refractive corneal and she is implanted eyeglasseses fáquica ACR IOL-128 (Soleko, Italy) without complications. The equivalent spherical preoperatorio -11,5 and -6 dioptrías diminish at -1,00 and - 0,5 respectively and the visual sharpness without glasses of bill fingers and 0,1 at 0,8 and 0,9 respectively. With this case it is evidenced that the lenses fáquicas are an option with good results in the correction of the high myopia(AU)

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La emergencia de las lentes intraoculares fáquicas en las pasadas décadas mostró una nueva alternativa para las ametropías extremas. Desde el año 1950 han sido diseñados diferentes modelos de lentes intraoculares fáquicas con distintos diseños y complicaciones. Se presenta un caso con antecedente de miopía elevada, quien posterior a la colocación de una lente intraocular fáquica de cámara anterior de fijación angular presentó como complicación en el posoperatorio abundante pigmentación iridiana sobre el lente y sinequias anteriores en 360 grados. Nos motivamos a publicar este caso y de esta forma proporcionar una actualización sobre las complicaciones de la colocación de estos lentes, así como ofrecer algunas recomendaciones para detectar a tiempo los posibles riesgos de este procedimiento(AU)

The emergence of the phakic intraocular lenses in the last decades showed a new alternative for the extreme ametropias. Since1950 different models of phakic intraoduclar lenses have been designed with different designs and complications. Here is a patient with a history of high myopia who, after having undergone the implantation of an anterior chamber phakic intraocular lens with angle fixation, presented with abundant iridian pigmentation over the lens and anterior sinechia at 360 degrees. The objectives of this report were to provide an update on the complications of the implantation of these lenses as well as making some recommendations to timely detect the possible risks of this procedure(AU)

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Objetivo: evaluar los resultados de la facoemulsificación del cristalino transparente en pacientes con alta miopía. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo en el Hospital Enrique Cabrera, entre agosto del año 2006 y agosto de 2009. El universo estuvo constituido por pacientes altos miopes (³ 6 dioptrías) quienes acudieron a la consulta de Oftalmología durante el período señalado. La muestra fue de 110 ojos de 61 pacientes a quienes se le realizó extracción del cristalino transparente por la técnica de facoemulsificación con implante de lente intraocular, igual o mayores de 40 años, que cumplían con los criterios de inclusión y exclusión y que dieron su consentimiento informado. Resultados: el 60 por ciento de los ojos intervenidos mejoraron la agudeza visual sin corrección. De los 110 ojos intervenidos, 108 conservaron una mejor agudeza visual corregida posoperatoria igual o superior a la preoperatoria. El equivalente esférico obtenido en más del 95 por ciento de los ojos quedó en el rango esperado, lo que demostró una elevada predictibilidad de la fórmula (SRK/T) utilizada para el cálculo de la potencia del lente intraocular implantado. El astigmatismo inducido fue mínimo. No se registraron complicaciones transoperatorias y las posoperatorias fueron pocas. Conclusión: la facoemulsificación del cristalino transparente en pacientes con alta miopía es una alternativa de tratamiento quirúrgico segura y eficaz(AU)

Objective: to evaluate the results of phacoemulsification technique in treating high myopic patients. Methods: a prospective, longitudinal and descriptive study was conducted in Enrique Cabrera hospital in the period of August 2006 to August 2009. The universe was made up of high myopic patients (³ 6 dioptries), who went to the ophthalmology service in this period. The sample was 110 eyes from 61 forty years-old and older patients who had undergone transparent crystalline lens extraction by the phacoemulsificación technique with intraocular lens implantation, met the inclusion criteria and given their informed consent. Results: sixty percent of surgical eyes improved their uncorrected visual acuity. Of 110 operated eyes, 108 kept best corrected visual acuity equal or better than preoperative one after the surgery. The spheral equivalent obtained in more than 95 percent of the eyes was within expected range, showing high predictability of the formula (SRK/T) used for the calculation of the intraocular lens power. Induced astigmatism was minimal. No perioperative complications were reported whereas postoperative ones were few. Conclusions: it can be concluded that phacoemulsification in high myopic patients is a safe and effective surgical treatment option(AU)

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Objetivos: describir las características clínicas del fondo de ojo en niños con miopía alta y su relación con la edad. Métodos: se realizó un estudio observacional analítico, transversal, de 38 ojos con miopía alta de 24 menores de 18 años, atendidos en consulta en el año 2011. Se dividieron en dos grupos de edad: menores de 10 años y mayores o iguales a 10 años. Se describieron los hallazgos clínicos del fondo de ojo y se compararon la longitud axial, el equivalente esférico, la agudeza visual mejor corregida, el grosor macular central, la profundidad y el ancho del estafiloma posterior. Resultados: la edad media de los niños fue de 9 años; el equivalente esférico medio fue -8,94 D (entre -6 y -16,5 D) y la agudeza visual mejor corregida media 0,26 logMAR. La longitud axial media aumentó con la edad (p= 0,001). Hubo evidencia de correlación entre la longitud axial y el equivalente esférico (p= 0,008; rho= -0,436). Clínicamente el polo posterior fue normal en el 36,84 por ciento, fundamentalmente en menores de 10 años; predominó el estafiloma posterior en el 39,47 por ciento; todos fueron simples, seguido de la atrofia en semiluna temporal (36,84 por ciento). No hubo alteraciones foveales. La periferia retiniana se exploró en el 52,63 por ciento y el 85 por ciento no tuvo lesiones. Se encontraron diferencias significativas entre ambos grupos de edad en cuanto a longitud axial, el grosor macular central a 90° y la profundidad del estafiloma (p= 0,001, p= 0,02 y p= 0,036, respectivamente). Conclusiones: la frecuencia del fondo de ojo normal disminuye con la edad en los ojos de los niños con miopía alta. Predominan las formas simples de estafiloma y la atrofia peripapilar en semiluna temporal, sin lesiones foveales(AU)

Objectives: to describe the clinical characteristics of ocular fundus in children with high myopia and its relationship with the age. Methods: a cross-sectional, analytical and observational study of 38 high myopic eyes from 24 children under 18 years old seen at the outpatient service in 2011. They were divided into two groups (under 10 years and 10 years and over) to describe the clinical findings of the ocular fundus and to compare the axial length, the spherical equivalent, the best corrected visual acuity, the central macular thickness and width and depth of posterior staphyloma. Results: the mean age was 9 years old; mean spherical equivalent was -8,94 D (between -6 and -16,5 D) and mean best corrected visual acuity amounted to 0,26 logMAR. The mean axial length increases with the age (p= 0,001). There was evident correlation between axial length and spherical equivalent (p= 0,008; rho= -0,436). The posterior pole was normal in 36,84 percent. No foveal lesions were found. The retinal periphery was examined in 52,63 percent of cases and 85 percent of them had no lesions. Statistically significant differences in axial length, central macular thickness at 900 and staphyloma depth were found between both age groups (p= 0,001; p= 0,02 and p= 0,036, respectively). Conclusions: the frequency of normal ocular fundus decreases with the age in high myopic children´s eyes. The simple forms of posterior staphyloma and the temporal crescent peripapillary atrophy without foveal lesions predominated(AU)

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Introducción: actualmente, uno de los grandes retos de la oftalmología es hallar el tratamiento idóneo para los pacientes con miopía elevada. Objetivo: identificar la línea evolutiva de estos afectados de acuerdo con los resultados visuales y la presencia de complicaciones posoperatorias. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo de 22 pacientes (33 ojos) con miopía alta, entre -6,00 y -10,00 dioptrías, atendidos en el Servicio de Cirugía Refractiva del Centro Oftalmológico del Hospital General Docente "Enrique Cabrera" de La Habana, operados mediante la técnica de superficie LASEK desde enero del 2010 hasta junio del 2011. Resultados: predominaron el grupo etario de 20-29 años (54,5 %), las féminas (72,7 %) y el haze (45,5 %) como complicación posoperatoria. La mayoría de los pacientes (97,0 %) alcanzaron agudeza visual con corrección (entre 0,6 y 1,0) en el periodo posoperatorio; 60,6 % con equivalente esférico (entre -1,00 y 0,25 dioptrías) y 69,7 % con valores queratométricos de 39,05- 43,00 dioptrías. Conclusiones: el LASEK resultó efectivo en la corrección de la miopía alta, no exento de complicaciones, pero sin repercusión en la visión final alcanzada y en el grado de satisfacción después del proceder.

Introduction: at present, one of the great challenges of ophthalmology is to find the adequate treatment for the patients with high myopia. Objective: to identify the clinical course of these affected patients according to the visual results and the presence of postoperative complications. Methods: A descriptive, longitudinal and retrospective study of 22 patients (33 eyes) with high myopia, between -6,00 and -10,00 diopters, assisted in the Service of Refractive Surgery of the Ophthalmological Center from "Enrique Cabrera" Teaching General Hospital in Havana, operated by means of the LASEK surface technique was carried out from January, 2010 to June, 2011. Results: the age group 20-29 years (54.5%), the female sex (72.7%) and the haze (45.5%) as postoperative complication prevailed. Most of the patients (97.0%) reached a visual acuity with correction (between 0.6 and 1.0) in the postoperative period; 60.6% with spherical equivalent (between -1.00 and 0.25 diopters) and 69.7% with queratometric values of 39,05 - 43,00 diopters. Conclusions: the LASEK was effective in the correction of high myopia, with certain complications, but without negative result in the final vision reached and in the satisfaction after the procedure.

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Objetivo: determinar la variación que evidencia el endotelio corneal, en pacientes operados de alta miopía con la utilización de lentes intraoculares fáquicas de cámara anterior con soporte iridiano. Método: se realizó un estudio longitudinal, prospectivo y descriptivo en una muestra conformada por 26 ojos de 15 pacientes, operados de alta miopía con la utilización de lentes intraoculares fáquicas Artisan y Artiflex de cámara anterior con soporte iridiano, que se atendieron en el Servicio de Córnea y Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer de septiembre de 2009 a mayo de 2010. Resultados: se evidenció una pérdida celular endotelial posterior a la cirugía seis meses de 6,9 por ciento. En el posoperatorio la hexagonalidad y el coeficiente de variación disminuyeron, mientras que la paquimetría no mostró diferencias significativas. Conclusiones: en el presente estudio se observó la presencia de un daño mínimo en el endotelio corneal con el uso de lentes fáquicas de cámara anterior, en la corrección quirúrgica de las altas miópias

Objective: to determine the variation of the corneal endothelium in those patients operated on from high myopia, with the use of iris claw anterior chamber phakic intraocular lenses. Methods: a prospective, longitudinal and descriptive study was carried out in a sample of 26 eyes from 15 patients. They had been operated on from high myopia with the use of iris claw anterior chamber phakic intraocular lenses Artisan and Artiflex at the Cornea and Refractive Surgery Service of Ramon Pando Ferrer Cuban Institute of Ophthalmology from September 2009 through May 2010. Results: it was evinced that there was endothelial cell loss after surgery six months of 6.9 percent. In the postoperative phase, hexagonality and variation coefficient diminished whereas pakimetry did not show significant differences. Conclusions: the present study indicated the existence of minimal damage in the corneal endothelium with the use of the anterior chamber phakic lenses for the surgical correction of high myopias

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