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Purpose: To validate a new methodology to evaluate the impact of astigmatism in pseudophakia using an astigmatic defocus curve. Setting: Hospital Oftalmológico de Brasilia, Brazil. Design: Non-randomized cohort study. Methods: For every point of the defocus curve, from -2.00 to +3.00 with 0.50D intervals, visual acuity was assessed with optically induced astigmatism (0.50D, 1.00D and 1.50D at 90 and 180 degrees) in pseudophakic patients implanted with a refractive-enhanced intraocular lens. Results: Twelve patients were analyzed. A statistically significant difference was found between the 90° (ATR) and 180°(WTR) axis with 1.50D astigmatism, providing better visual acuity in ATR astigmatism (p < 0.05). Conclusion: This new methodology is reproducible, useful and may predict residual astigmatism tolerance in pseudophakic patients, which may help with surgery planning and IOL decision-making.

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Phacoemulsification is the standard of care in cataract surgery in the developed world, with patients having high expectations regarding visual results. Postoperative dissatisfaction due to negative dysphotopsia (ND) ranges from rare to very frequent; its etiology is unclear, and it affects postoperative satisfaction. Since one of the most frequently used strategies to avoid ND is related to intraocular lens (IOL) haptic orientation, we conducted a prospective interventional study that enrolled 197 patients who underwent standard phacoemulsification. All patients had a one-piece hydrophobic acrylic IOL implanted; in one group, the haptics were placed in any meridional axis except inferotemporal (IT) meridians, and in the other group, the IOL was implanted with the haptics in an IT position. Our results showed no statistically significant differences between groups when analyzing the correlation between the position of IOL haptics and the presence of ND in week one and month one. Also, pupillary diameter showed no statistically significant differences between patients with or without ND. Despite some studies claiming that haptic orientation prevents ND, we found that haptic orientation does not correlate with ND incidence and that ND decreases from day 1 to month 1. Our results support previous findings on the decrease in ND over time and that haptic orientation should not be considered an intraoperative strategy to avoid this unwanted phenomenon.

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PURPOSE: The main purpose of our study is to compare the adverse events occurrence, complications, and postoperative outcomes of Femtosecond Laser-Assisted Cataract Surgery (FLACS) versus conventional phacoemulsification surgery (CPS) in adult patients undergoing cataract surgery. METHODS: We conducted our research using PubMed, Scopus, and MEDLINE through EBSCOhost from 2012 to July 2022 with English and Spanish language restriction, including only Randomized Controlled Trials (RCTs). The PRISMA guidelines were observed for data abstraction, including a random-effects model for each outcome. RESULTS: We analyzed 4844 eyes from 23 RCTs with some low risk of bias according to RoB 2 tool. We found statistically significant differences between the FLACS and CPS groups for the mean absolute error (MD = -0.12, 95% CI:-0.22-[-0.02], p = 0.01), the circularity of capsulorhexis (MD = 0.04, 95% CI: 0.04-0.05, p ≤ 0.00001), IOL centration (D = -0.07, 95% CI:-0.09-[-0.05], p ≤ 0.00001), CDE count (MD = -1.75, 95% CI: -2.75-[-0.74], p = 0.0006), mean phacoemulsification time (MD = -12.90, 95% CI:-20.89-[-4.92], p = 0.002), EPT (MD = -0.93, 95% CI: -1.68-[-0.019], p = 0.01) and endothelial cell density loss ((MD = -0.6, 95% CI: -1-[-0.19], p = 0.004). Also, the safety analysis showed a lower incidence of posterior capsule tear (PCT) in the FLACS group (OR =0.29, 95% CI: 0.09-1, p = 0.05). CONCLUSIONS: Our results suggest that FLACS might be helpful for patients with relatively dense cataracts and low preoperative endothelial cell values.

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RESUMO Objetivo: Avaliar o filme lacrimal e os sintomas de olho seco antes e após a realização da facoemulsificação. Métodos: Participaram deste estudo clínico 51 pacientes diagnosticados com catarata (55% mulheres; 78% brancos; 71,2 ± 6,5 anos de idade; sem uso de colírio lubrificante) que foram submetidos à facoemulsificação em um hospital na cidade de Aparecida (SP). A análise do filme lacrimal foi feita pelo teste de ruptura do filme lacrimal, e os sintomas de olho seco foram avaliados pelo Índice de Doença da Superfície Ocular, ambos antes da cirurgia e 30 e 60 dias de pós-operatório. Resultados: Na análise pré-operatória, 25,5% dos pacientes tinham olho seco pelo critério subjetivo (Índice de Doença da Superfície Ocular ≥ 25%), enquanto a proporção de pacientes com olho seco foi de 92,2% pelo critério objetivo (teste de ruptura do filme lacrimal < 10 segundos). Não houve correlação entre o teste de ruptura do filme lacrimal e o Índice de Doença da Superfície Ocular (r = −0,14; p = 0,33). Não foi observada redução dos sintomas de olho seco (15,9 ± 17,6 versus 12,2 ± 13,2 versus 7,8 ± 11,5; p < 0,001) e nem do tempo de ruptura do filme lacrimal (6,2 ± 2,2 vs. 4,3 ± 2,0 versus 6,9 ± 2,0 segundos; p < 0,001) no pré, 30 e 60 dias após a cirurgia. Conclusão: A facoemulsificação desencadeia sintomas de olho seco e altera os valores do teste de ruptura do filme lacrimal e do Índice de Doença da Superfície Ocular, havendo melhora depois da cirurgia, com o passar dos dias. Observou-se que, após os 60 dias, os sintomas de olho seco avaliados pelo Índice de Doença da Superfície Ocular apresentaram melhora. Em relação ao filme lacrimal, avaliado pelo teste de ruptura do filme lacrimal, observou-se que houve piora estatisticamente significativa aos 30 dias, seguida de melhora no pós-operatório de 60 dias. Os resultados sugerem que a análise clínica do olho seco deve ser realizada por diferentes métodos, preferencialmente objetivos.

ABSTRACT Objective: To evaluate the tear film and dry eye symptoms before and after phacoemulsification. Methods: Fifty-one patients diagnosed with cataracts participated in this clinical study (55% female; 78% white; 71.2 ± 6.5 years old; without the use of lubricating eye drops) and underwent phacoemulsification at a hospital in Aparecida (SP). Tear film analysis was performed by the tear film break-up test and dry eye symptoms were assessed by the Ocular Surface Disease Index, both before surgery and 30 and 60 days after surgery. Results: In the preoperative analysis, 25.5% of the patients had dry eye according to the subjective criterion (Ocular Surface Disease Index ≥ 25%), while the proportion of patients with dry eye was 92.2% according to the objective criterion (tear film break-up test < 10 seconds). There was no correlation between tear film break-up test and Ocular Surface Disease Index (r = −0.14; p = 0.33). There was no reduction in dry eye symptoms (15.9 ± 17.6 versus 12.2 ± 13.2 versus 7.8 ± 11.5; p<0.001) nor in tear film break-up time (6.2 ± 2.2 versus 4.3 ± 2.0 versus 6.9 ± 2.0 seconds; p < 0.001) before, 30 and 60 days after surgery. Conclusion: Phacoemulsification triggers dry eye symptoms and changes Ocular Surface Disease Index and tear film break-up test values, with improvement over the postoperative days. Sixty days after surgery, the symptoms of dry eye assessed according to the Ocular Surface Disease Index improved. Regarding the tear film, evaluated by tear film break-up test, it was observed that there was a statistically significant worsening at 30 days, followed by an improvement in the postoperative period of 60 days. The results suggest that the clinical analysis of dry eye should be performed using different methods, preferably objective ones.

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ABSTRACT Purpose: To assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency. Methods: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated. Results: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator's cataract challenges (p<0.696). Conclusion: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic.

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ABSTRACT Purpose: To present long-term results of pars plana vitrectomy combined with pan-retinal endolaser photocoagulation, Ahmed glaucoma valve implantation, and/or phacoemulsification in patients with complicated neovascular glaucoma. Methods: The study comprised 15 eyes from 15 patients with neovascular glaucoma as a complication of diabetic retinopathy and owing to ischemic central retinal vein occlusion. There was a vitreous hemorrhage n all of the patients. Furthermore, 8 of the cases showed varying degrees of hyphema. All subjects received an intravitreal injection of bevacizumab three days before surgery. In 12 phakic patients, phacoemulsification, pars plana vitrectomy, and Ahmed glaucoma valve implantation were performed. Pars plana vitrectomy and Ahmed glaucoma valve implantation were performed in 3 pseudophakic patients. Perioperative and postoperative complications, intraocular pressure values, and best-corrected visual acuity scores were also recorded. Results: The mean follow-up was 24.4 ± 14.56 months. The mean preoperative intraocular pressure was 50.06 ± 7.6 mmHg. At 1 day, 7 days, and 1-, 3-, 6-, 12-month, and last visit following surgery, the mean intraocular pressure was 11.06 ± 8.22, 12.66 ± 7.27, 13.8 ± 7.73, 18.64 ± 7.05, 19.28 ± 4.61, 16.28 ± 1.68, and 16.92 ± 2.12 mmHg, respectively (p=0.001 for every follow-up visit). The mean visual acuity on the most recent appointment was 1.18 ± 0.42 logMar (p=0.001 for each subsequent visit). As postoperative early complications, varying degrees of hyphema and fibrin reactions were recorded. During follow-up, one patient developed phthisis bulbi. In 4 cases, Ahmed glaucoma valve revision surgery was required. Conclusions: In patients with complicated neovascular glaucoma, combined surgical procedures are safe, effective, and preferable both in terms of controlling high intraocular pressure and providing reasonable visual abilities.

RESUMO Objetivo: Apresentar nossos resultados de longo período de vitrectomia pars plana combinada com fotocoagulação panretiniana com endolaser, implantação da válvula Ahmed para glaucoma e/ou facoemulsificação em pacientes com glaucoma neovascular complicado. Métodos: Foram incluídos no estudo 15 olhos de 15 pacientes com glaucoma neovascular como complicação da retinopatia diabética e devido à oclusão isquêmica da veia central da retina. Todos os casos tiveram hemorragia vítrea. Além disso, 8 dos casos apresentaram diferentes graus de hifema. A injeção intravítrea de bevacizumabe foi administrada em todos os casos 3 dias antes da cirurgia. Facoemulsificação, vitrectomia pars plana e implantação da válvula Ahmed para glaucoma foram realizadas em 12 pacientes fáquicos. A vitrectomia pars plana e a implantação da válvula Ahmed para glaucoma foram realizadas em 3 pacientes pseudofáquicos. Complicações perioperatórias e pós-operatórias, valores de pressão intraocular e valores de melhor acuidade visual corrigida pré-operatório e pós-operatório foram registrados. Resultados: O acompanhamento médio foi de 24,4 ± 14,56 meses. A média da pressão intraocular pré-operatória foi de 50,06 ± 7,6 mmHg. Em 1 dia, 7 dias e 1,3,6,12 meses, e última visita após cirurgia, a média da pressão intraocular foi de 11,06 ± 8,22, 12,66 ± 7,27, 13,8 ± 7,73, 18,64 ± 7,05, 19,28 ± 4,61, 16,28 ± 1,68 e 16,92 ± 2,12 mmHg, respectivamente (p=0,001 para cada visita de acompanhamento). A média da acuidade visual na última visita foi de 1,18 ± 0,42 logMar (p=0,001 para cada visita de acompanhamento). Vários graus de reações de hifema e fibrina foram registrados como complicações precoces pós-operatórias. Phthisis bulbi foi desenvolvido em um caso durante o acompanhamento. A cirurgia de revisão da válvula Ahmed para glaucoma foi necessária em 4 casos. Conclusões: Os procedimentos cirúrgicos combinados que realizamos são seguros, eficazes e preferenciais, tanto em termos de controle da alta pressão intraocular quanto fornecimento de habilidades visuais razoáveis em pacientes com glaucoma neovascular complicado.

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ABSTRACT A 59-year-old man presented with a unilateral blurring of vision in his left eye. His left eye's visual acuity was hand movements level. He underwent phacoemulsification surgery, and an intrastromal posterior chamber intraocular lens was implanted. The intrastromal intraocular lens was extracted and a new intraocular lens was implanted. Usinge the Snellen chart, the final best-corrected visual acuity was 20/40. With this case report, we wish to emphasize that a single stepwise clear corneal incision merged with wound-assisted intraocular lens injections can result in intraocular lens misdirection into the corneal stroma. As a result, while performing a misdirected intraocular lens removal, we recommend that the wound be carefully constructed.

RESUMO Um homem de 59 anos apresentou embaçamento visual unilateral no olho esquerdo. Sua acuidade visual nesse olho era no nível de movimentos da mão. O paciente havia se submetido a uma cirurgia de facoemulsificação em que foi feita a implantação intraestromal de uma lente intraocular de câmara posterior. Foi feita a extração dessa lente intraestromal intraocular e uma nova lente intraocular foi implantada. A melhor acuidade visual corrigida final foi de 20/40 pela tabela de Snellen. Com este relato de caso, os autores desejam apontar que uma incisão de degrau único em córnea clara, quando combinada com a injeção de uma lente ocular através da incisão, pode levar a um direcionamento incorreto da lente intraocular para dentro do estroma corneano. Portanto, recomenda-se uma construção cuidadosa da incisão ao se remover uma lente intraocular direcionada incorretamente.

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BACKGROUND: The purpose of this study was to compare the impact of intravitreal dexamethasone (DEX) implant during a 12-month period in nondiabetic and diabetic patients without diabetic retinopathy (DR) as a treatment for refractory pseudophakic cystoid macular edema (PCME) following prior treatment with topical nepafenac 0.1% and prednisolone 1%. METHODS: Forty-two consecutive medical records of patients diagnosed with PCME after uneventful cataract surgery were included. The outcomes measured included best corrected visual acuity (BCVA) and central foveal thickness (CFT). Linear regression analysis was statistically applied. RESULTS: Following topical treatment, nondiabetic and diabetic subjects presented a mean ± SD gain of - 0.11 ± 0.11 and - 0.18 ± 0.11 BCVA logMAR and a CFT reduction of - 43.42 ± 53.66 µm and - 58.76 ± 36.28 µm, respectively. The mean BCVA gain at month 12 subsequent to DEX implantation was - 0.35 ± 0.17 in nondiabetic (p < 0.001) and - 0.55 ± 0.26 in diabetic patients (p < 0.001), with CFT reductions of - 195.71 ± 93.23 µm (p < 0.001) and - 260.81 ± 198.69 µm (p < 0.001), respectively. Patients who responded with better VA after topical treatment presented better visual outcomes at month 12 following DEX implantation (r2 = 0.46; rho = - 0.71, p < 0.01). CONCLUSION: Nondiabetic and diabetic patients without DR demonstrated similar results after DEX implant after combined topical therapy, suggesting that selected diabetic patients may have a response comparable to that of nondiabetic patients with PCME.

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Objetivo: Determinar la pérdida celular endotelial corneal posterior a la cirugía de catarata por técnica de facoemulsificación. Métodos: Se realizó un estudio descriptivo de intervención prospectivo y longitudinal. Se estudiaron 51 ojos operados de catarata por la técnica de facochop. Se les realizó microscopia endotelial pre- y posoperatoria a los tres y seis meses de la intervención. También se estudiaron los parámetros facodinámicos. Resultados: La edad promedio fue de 66,7 ± 11,7 años, predominó el sexo femenino (53,7 %). Se observó una disminución significativa de los valores promedios de densidad celular y hexagonalidad a los tres y seis meses posteriores a la operación de catarata. El porcentaje de pérdida de células endoteliales posterior a la intervención fue de 19,6 ± 0,8 %. El tiempo total de ultrasonido medio fue de 11,8 ± 4,5 seg mientras el tiempo efectivo de facoemulsificación tuvo una media de 0,008 ± 0,001 seg. Conclusiones: El recuento de células endoteliales corneales muestra una disminución significativa de los valores promedios de densidad celular y hexagonalidad a los tres y seis meses posteriores a la operación de catarata, el porcentaje de pérdida de células endoteliales corneales a los seis meses posterior está dentro de los límites normales y se observa relación de dependencia entre el tiempo efectivo de facoemulsificación y el porcentaje de pérdida de células endoteliales.

Objective: To determine the loss of corneal endothelial cell after cataract surgery by the phacoemulsification technique. Methods: A prospective, longitudinal, descriptive and interventional study was conducted. Fifty-one eyes operated on for cataract by the phacoemulsification technique were studied. Preoperative, as well as postoperative endothelial microscopy at three and six months after the cataract surgery, was performed. Phacodynamic parameters were also studied. Results: The mean age was 66.7 ± 11.7 years and there was a predominance of the female sex (53.7%). A significant decrease in the mean values of cell density and hexagonality was observed at three and six months after the cataract surgery. The percentage of endothelial cell loss after surgery was 19.6% ± 0.8%. The mean total ultrasound time was 11.8 ± 4.5 secs, while the effective phacoemulsification time had a mean of 0.008 ± 0.001 secs. Conclusions: The count of corneal endothelial cell shows a significant decrease in the mean values of cell density and hexagonality at three and six months after the cataract surgery; the percentage of corneal endothelial cell loss at six months is within normal limits; and a dependent relationship is observed between the effective phacoemulsification time and the percentage of endothelial cell loss.

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BACKGROUND: Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). METHODS: An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. RESULTS: The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. CONCLUSIONS: The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.

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PURPOSE: This study aims to comparatively evaluate the morphological changes of the cornea after phacoemulsification (PHACO) and femtosecond laser-assisted cataract surgery (FLACS) without intercurrences in patients with type 2 diabetes mellitus. METHODS: A total of 95 diabetic patients with moderate cataracts (N2 + and N3+), 47 undergoing PHACO and 48 undergoing FLACS, were selected randomly for the study. Surgeries were performed by a single surgeon between July 2021 and December 2021. Cumulative dissipated energy (CDE) and total balanced saline solution (BSS) data were obtained at the end of each surgery. Changes in corneal endothelial cell density (ECD) and central corneal thickness (CCT) at three months postoperatively were investigated. RESULTS: After three months, evidence is lacking between groups in the CCT measures; the difference was neither statistically nor clinically relevant. However, for ECD, a significant and clinically significant difference was found; if all patients were treated with laser, the mean ECD would be 423.55 greater (RSE: 86.09; p-value < 0.001; 95% CI: 254.81-592.29) than the ECD potential means of 1656.423 among the conventional group (RSE: 74.90; p-value < 0.001; 95% CI: 1509.62-1803.23). CONCLUSIONS: Diabetic patients under treatment with moderate cataracts may predispose themselves to a more significant loss of endothelial cells after conventional phacoemulsification than femtosecond laser-assisted cataract surgery. TRIAL REGISTRATION: It was registered at The Brazilian Registry of Clinical Trials (ReBEC) with the code RBR-6d8whb5 (UTN code: U1111-1277-6020) on 17/05/2022.

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ABSTRACT Purpose: To evaluate the stability and efficacy of the double-flanged 5-0 polypropylene suture to fixate subluxated cataracts at 18 months and the possible complications of this new technique Methods: This technique uses a 5-0 polypropylene monofilament to create two flanges with a thermocautery, for fixation of a capsular tension segment to the sclera to fix the subluxated capsular bag. This technique was implemented in 17 eyes requiring intraocular lens implantation in a setting of zonular dialysis due to trauma, Marfan syndrome, microspherophakia, idiopathic disease, and post-phacoemulsification status. Results: Follow-up of the patients occurred at 18 months. Best-corrected visual acuity improved significantly from 0.85 to 0.39 (logMAR), whereas the spherical and cylindrical refractive errors and intraocular pressure remained stable from preoperation. No suture photodegradation or pseudophacodonesis were detected. Conclusion: The double-flanged 5-0 polypropylene suture transscleral bag fixation technique has shown favorable long-term outcomes in terms of bag intraocular lens/complex fixation and stability. In eyes with zonular weakness or dialysis, this technique appears to be a safe and knotless option for cataract surgery.

RESUMO Objetivo: Avaliar a estabilidade e eficácia da técnica double-flanged com sutura de 5-0 polipropileno para fixação de cataratas subluxadas aos 18 meses e as possíveis complicações desta nova técnica. Métodos: Esta técnica utiliza um monofilamento de polipropileno 5-0 para criar dois flanges com um termocautério para fixar um Segmento de Tensão Capsular na esclera a fim de estabilizar o saco capsular subluxado. Esta técnica foi implementada em 17 olhos que necessitavam do implante de lente intraocular em casos de diálise zonular devido a trauma, síndrome de Marfan, microesferofacia, subluxação idiopática ou pós-facoemulsificação que provocou subulxação do saco capsular intraoperatória. Resultados: O seguimento dos pacientes foi de 18 meses. A acuidade visual corrigida melhorou significativamente de 0,85 para 0,39 (logMAR), enquanto os erros de refração esféricos e cilíndricos e a pressão intraocular permaneceram estáveis. Nenhuma fotodegradação de sutura ou pseudofacodonese foi encontrada. Conclusão: A técnica double-flanged para fixação transescleral de saco capsular com sutura de 5-0 polipropileno mostrou resultados de estabilidade de longo prazo para o complexo lente/saco capsular. Então, aparenta ser uma opção segura para cirurgia de catarata, sem necessidade pontos, em olhos com fraqueza zonular ou diálise.

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Objetivo: Evaluar la seguridad de facoemulsificación asociada a la trabeculectomía gonioasistida modificada con tijeras. Métodos: Estudio experimental de intervención en 103 ojos (103 pacientes) con glaucoma primario de ángulo abierto. Se realizó facoemulsificación y trabeculectomía gonioasistida modificada con tijeras (51 ojos, casos) y facoemulsificación- trabeculectomía estándar (52 ojos, controles). En los casos se requirió tijera y pinza vítreo-retinal y se resecó trabéculo por abordaje interno. Se evaluó la agudeza visual, el astigmatismo inducido, la pérdida de células endoteliales y la aparición de complicaciones quirúrgicas en ambos grupos a los tres meses de seguimiento posoperatorio. Resultados: La AVSC se incrementó en ambos grupos a los tres meses postoperatorios. Sin embargo, fue mayor para la FACO-TGAM (0,81 ± 0,16vs. 0,71 ± 0,16), con diferencias significativas (p= 0,002). El astigmatismo inducido fue significativamente mayor en el grupo control (0,53 ± 1,14Dvs.1,8 ± 1,20D (p< 0.001). Las complicaciones quirúrgicas posoperatorias fueron más frecuentes en el grupo control (57 por ciento vs. 73 por ciento p= 0,14). La pérdida de células endoteliales no mostró diferencias significativas (p= 0,82). Conclusiones: La recuperación visual y el menor número de complicaciones ubican la facoemulsificación y trabeculectomía gonioasistida modificada con tijeras como técnica de elección para el tratamiento de pacientes con catarata y el glaucoma primario de ángulo abierto(AU)

Objective: To evaluate the safety of phacoemulsification associated with modified gonio-assisted trabeculectomy with scissors. Methods: Experimental intervention study in 103 eyes (103 patients) with primary open-angle glaucoma. Phacoemulsification and modified gonioassisted trabeculectomy with scissors (51 eyes, cases) and standard phacoemulsification-trabeculectomy (52 eyes, controls) were performed. In the cases, scissors and vitreoretinal forceps were required and trabeculum was resected by internal approach. Visual acuity, induced astigmatism, loss of endothelial cells and the appearance of surgical complications were evaluated in both groups at three months postoperative follow-up. Results: The uncorrected visual acuity increased at three postoperative months in both groups, however it was higher for the PHACO-TGAM (0.81 ± 0.16 vs 0.71 ± 0.16); with significant differences (p = 0.002). Induced astigmatism was significantly higher in the control group (0.53 ± 1.14 D vs. 1.8 ± 1.20 D, (p < 0.001). Postoperative surgical complications were more frequent in the control group (57 percent vs 73 pèrcent, p = 0.14), the endothelial cell loss did not show significant differences (p = 0.82). Conclusions: the visual recovery and the lower number of complications place phacoemulsification and modified gonio-assisted trabeculectomy with scissors as the technique of choice for the treatment of patients with cataract and primary open-angle glaucoma(AU)

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El síndrome de distensión de la bolsa capsular es una rara complicación de la cirugía de catarata. El objetivo principal fue exponer los principales hallazgos oftalmológicos de esta enfermedad, y las diferentes alternativas de diagnóstico y tratamiento para afrontar esta infrecuente y tardía complicación de la cirugía de catarata. Consiste en la adhesión del borde de la capsulorrexis al lente intraocular, colocado en un saco capsular. Tal aposición dificulta que el líquido fluya a través de la apertura de la cápsula anterior y se acumule en el saco capsular. Se presenta un paciente masculino de 71 años con antecedentes de cirugía de catarata por facoemulsificación en el ojo derecho. Refirió que desde hace 11 meses ha notado disminución de la visión. En el examen oftalmológico del ojo derecho se constató agudeza visual sin corrección de 0,3 por cartilla de Snellen, la cual mejoró a 1,0 con una corrección de -1,00 dioptría D. La exploración con lámpara de hendidura descartó cualquier tipo de inflamación del segmento anterior. Su presión intraocular fue de 18 mmHg. Mostró una cámara anterior poco profunda, con un desplazamiento anterior del iris y un saco capsular distendido. La cápsula posterior estaba separada de la superficie posterior del LIO con contenido líquido transparente. Se diagnosticó síndrome de distensión de la bolsa capsular. Se sometió a una capsulotomía posterior con láser Nd: YAG. En la evaluación posterior, el paciente mostró agudezas visuales no corregidas de 1,0 por cartilla de Snellen en ambos ojos. El síndrome de distensión de la bolsa capsular es una complicación tardía e infrecuente de cirugía de catarata con múltiples factores de riesgo, pero de rápida solución(AU)

Capsular bag distension syndrome is a rare complication of cataract surgery. The main objective was to expose the main ophthalmological findings of this disease and the different diagnostic and treatment alternatives to deal with this infrequent and late complication of cataract surgery. It consists of adhesion of the capsulorhexis rim to the intraocular lens, placed in a capsular bag. Such apposition makes it difficult for fluid to flow through the anterior capsule opening and accumulate in the capsular sac. We present a 71-year-old male patient with a history of cataract surgery by phacoemulsification in the right eye who 11 months ago reported decreased vision in the same eye. The ophthalmologic examination of the right eye showed an uncorrected visual acuity of 0.3 by Snellen chart, which improved to 1.0 with a correction of -1.00 D diopter. Slit lamp examination ruled out any type of anterior segment inflammation. His intraocular pressure was 18 mmHg. She showed a shallow anterior chamber, with an anterior displacement of the iris and a distended capsular sac. The posterior capsule was separated from the posterior surface of the IOL with clear fluid content. Capsular bag distension syndrome was diagnosed. He underwent posterior capsulotomy with Nd: YAG laser. On further evaluation, the patient had uncorrected visual acuities of 1.0 by Snellen chart in both eyes. Capsular bag distension syndrome is a late and infrequent complication of cataract surgery with multiple risk factors, but with rapid resolution(AU)

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PURPOSE: To evaluate the stability and the refractive error of the different intraocular lens (IOL) after cataract surgery. METHOD: Retrospective, observational and single-center study. Patients diagnosed with cataract and myopia who underwent a phacoemulsification surgery with intraocular lens placement without complications were included. All patients underwent a complete ophthalmological examination, ultrasound biomicroscopy was performed at 2 weeks, 1 and 3 months after surgery. Descriptive statistics were performed using measures of central tendency and comparative analyzes. A value of p < 0.05 was considered significant. RESULTS: Thirty-one subjects with a diagnosis of axial myopia and senile cataract were included, 20 women (64.5%) and 11 men (35.5%), with a mean age was 62.8 ± 13.14 years. The IOL displacement were not different for the upper, lower, temporal and nasal quadrants; however, we observed a tendency to inclination to the temporal sector (p = 0.054) between the first and third postoperative month. Therefore, the were no significant differences in spherical equivalent between groups postoperatively. CONCLUSIONS: The inclination of the IOL did not change over time after surgery, the changes were similar with the different three types of IOL.

OBJETIVO: Evaluar la estabilidad y el desplazamiento de diferentes lentes intraoculares (LIO) a los 3 meses y los cambios refractivos asociados después de la facoemulsificación. MÉTODO: Estudio retrospectivo, observacional y unicéntrico. Se revisaron expedientes de pacientes sometidos a cirugía de facoemulsificación con colocación de LIO. Se realizó un examen oftalmológico completo, ultrabiomicroscopía a las 2 semanas, 1 y 3 meses después de la cirugía. Se realizó estadística descriptiva y análisis comparativos. Se tomó como diferencia significativa un valor de p < 0.05. RESULTADOS: Se incluyeron 31 ojos con diagnóstico de miopía y catarata senil, 20 mujeres (64.5%) y 11 hombres (35.5%), con una edad media de 62.8 ± 13.14 años. En cuanto al desplazamiento de la LIO, no se observaron diferencias significativas para los cuadrantes superior, inferior, temporal y nasal. Se observa una tendencia hacia temporal (p = 0.054) entre el primer y el tercer mes posoperatorios. El equivalente esférico tampoco mostró diferencias. CONCLUSIONES: El desplazamiento de la LIO no cambió con el tiempo después de la facoemulsificación. Los cambios fueron similares con los tres diferentes tipos de LIO y al compararlos proporcionan estabilidad refractiva en pacientes miopes.

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PURPOSE: Compare 12-month (12 M) safety and efficacy of endoscopic cyclophotocoagulation (ECP) + cataract surgery (Group 1) versus ECP + cataract surgery + iStent inject trabecular micro-bypass implantation (Group 2) in Brazilian patients with open-angle glaucoma (OAG). METHODS: This prospective, multicenter, comparative case series included patients with OAG and cataract who were randomized to receive treatment in Group 1 or Group 2. Outcomes included mean and percent reduction versus preoperative in intraocular pressure (IOP) and number of glaucoma medications; visual acuity; occurrence of adverse events; and rate of secondary surgeries. RESULTS: Preoperatively, Groups 1 and 2 had similar mean IOP (mean ± standard deviation 22.1 ± 3.6 and 22.0 ± 2.5 mmHg, respectively) and mean number of medications (3.3 ± 0.6 and 3.4 ± 0.6 medications, respectively). At all follow-up timepoints through 12 M, both groups achieved significant IOP and medication reductions versus preoperative (IOP p < 0.001 and number of medications p < 0.001 for both groups). At 12 M, IOP reductions were 24.2% (Group 1) and 43.6% (Group 2) (p < 0.001); mean medication reductions were 50.2% and 71.5%, respectively. Mean postoperative IOP and number of medications were higher in Group 1 than Group 2 (IOP p < 0.01 all visits, medication p < 0.01 at 6 M and 12 M). Adverse events were generally mild and infrequent in both groups. CONCLUSION: Both treatment groups (ECP + phacoemulsification, with/without iStent inject implantation) achieved significant and safe reductions in IOP and medications versus preoperative in Brazilian OAG patients. Percent reductions were significantly greater, and mean IOP and medications were significantly lower, in the group receiving iStent inject. CLINICAL TRIAL REGISTRATION (CTR): CAAE project identification #20053019.5.0000.5078. Protocol #3.587.147. Clinical Trial Database of the Federal University of Goiás, Brazil. Registration Date: September 19, 2019.

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RESUMO Objetivo Identificar o perfil epidemiológico e o benefício visual do paciente usuário do Sistema Único de Saúde, após realização de cirurgia de catarata. Métodos Trata-se de estudo descritivo, transversal e retrospectivo com análise de prontuários, no período entre outubro e novembro de 2020. Foram incluídos 573 olhos de 319 pacientes submetidos à cirurgia de catarata. Foram analisados: sexo, idade, classificação da catarata, acuidade visual corrigida pré e pós-cirurgia, tabagismo, presença de comorbidades e alterações oculares prévias. Resultados Das cirurgias de catarata realizadas, a média de idade foi de 70,5 anos (±7,1), com prevalência de 57,1% (n=182) no sexo feminino. Dos pacientes, 13,8% (n=44) eram tabagistas. A hipertensão arterial sistêmica foi a comorbidade mais recorrente, presente em 65,8% (n=210), e o glaucoma foi a alteração ocular mais comum, ocorrida em 57% (n=45) dos casos. No âmbito da classificação da catarata, a nuclear foi manifestada em 71,9% (n=412). A acuidade visual foi avaliada por meio da escala logMAR, tendo sido atribuído o valor de 3 aos pacientes conta dedos (CD) e movimentos de mão. A média da acuidade visual antes da cirurgia foi de 0,7, com desvio-padrão de 0,9 e, após a cirurgia, de 0,1, com desvio-padrão de 0,3, havendo redução estatisticamente significativa. Conclusão O conhecimento do perfil epidemiológico e do benefício visual após a cirurgia de catarata permite identificar os grupos de risco e a importância do procedimento para a melhoria da qualidade de vida. Ações públicas devem ser implementadas para aumentar o número de projetos que visam reduzir o número de catarata, visto que é a principal causa de cegueira reversível no mundo, interferindo no cotidiano da população.

ABSTRACT Objective To identify the epidemiological profile and visual benefit of the patient using the Unified Health System after cataract surgery. Methods This is a descriptive, cross-sectional and retrospective study with the analysis of medical records, between October and November 2020. We included 573 eyes of 319 patients that were selected for cataract surgery. Gender, age, cataract classification, pre-and post-surgery corrected acuity, smoking, presence of comorbidities, and previous ocular alterations were analyzed. Results Of the cataract surgeries performed, the mean age was 70.5 years (±7.1%), with a prevalence of 57.1% (n=182) in women; 13.8% (n= 44) were smokers. Systemic arterial hypertension was the most recurrent comorbidity, present in 65.8% (n=210), and glaucoma was the most common ocular alteration in 57% (n=45) of the cases. As for cataract classification, nuclear cataract was manifested in 71.9% (n=412). Visual acuity was evaluated by the logMAR scale, and counting fingers and hand motion were given the value of 3. Mean visual acuity before surgery was 0.7 with an SD of 0.9 and, after surgery, of 0.1, with an SD of 0.3, which was statistically significant. Conclusion Knowledge of the epidemiological profile and visual benefit after cataract surgery allows us to identify risk groups and the importance of the procedure to improve the quality of life. Public actions must be implemented to increase the number of projects that aim to reduce the number of cataracts, since it is the main cause of reversible blindness in the world, interfering with the daily life of the population.

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RESUMO Ao longo da vida, o cristalino produz novas fibras dispostas de forma concêntrica, que aumentam seu diâmetro anteroposterior e peso, tornando seu núcleo mais compacto e endurecido. A catarata hipermadura é uma forma de progressão avançada dessa proliferação de fibras, que pode desencadear uma variedade de complicações. A ruptura espontânea da cápsula anterior do cristalino, evoluindo com deslocamento anterior do núcleo, é uma complicação rara e com poucos casos publicados na literatura. Descrevemos o caso de uma paciente do sexo feminino, 68 anos, que apresentou ruptura espontânea da cápsula anterior do cristalino com deslocamento anterior do núcleo em olho esquerdo sem histórico de trauma ocular. A paciente foi submetida à facoemulsificação do cristalino e ao controle da pressão intraocular, evoluindo com melhora do quadro clínico.

ABSTRACT Throughout life, the lens produces new fibers arranged concentrically, which increase its anteroposterior diameter and weight, making its nucleus more compact and hardened. Hypermature cataract is an advanced stage of this fiber proliferation, which can trigger a variety of complications. Spontaneous rupture of the anterior lens capsule evolving with anterior displacement of the nucleus is a rare complication, with few cases published in the literature. We describe the case of a 68-year-old female patient, who presented spontaneous rupture of the anterior lens capsule with anterior displacement of the nucleus in the left eye, without a history of ocular trauma. The patient underwent phacoemulsification and clinical control of intraocular pressure, improving her condition.

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OBJECTIVE: Acknowledging the rates of endophthalmitis after cataract surgery is very important to understand the seriousness of the disease. Until now, there is no data of this situation in Argentina. The aim of this study was to estimate the incidence of postoperative endophthalmitis after cataract surgery at a tertiary hospital, a medical facility which provides a high degree of subspecialty expertise, in Buenos Aires, Argentina. METHOD: Retrospective cohort study of adult patients who underwent cataract phacoemulsification surgery between 2006 and 2020 at Hospital Italiano de Buenos Aires, was performed. Patients with endophthalmitis diagnosis within the first 6 weeks after surgery were included. Those who underwent extracapsular surgery or combined surgeries were excluded. RESULTS: A total of 29 326 cataract surgeries were performed in ten years. The annual incidence of acute postoperative endophthalmitis after cataract surgery was 0.102% (95% CI 0.069-0.146). Thirty cases of endophthalmitis were diagnosed. The main microorganism was Pseudomonas aeruginosa (45.4%). Final visual acuity was higher than 0.3 (LogMAR) in 46.6% of the patients. CONCLUSION: The incidence of endophthalmitis after cataract surgery in this hospital is within the range reported globally. Knowing the regional incidence contributes to decide if new prophylaxis measures are necessary.

OBJETIVO: Conocer las tasas de endoftalmitis después de la cirugía de cataratas es muy importante para comprender la gravedad de la enfermedad. Hasta el momento, no hay datos de su situación en Argentina. El objetivo de este estudio fue estimar la incidencia de endoftalmitis postoperatoria tras cirugía de catarata en un hospital de tercer nivel o alta complejidad de Buenos Aires, Argentina. Método: Se realizó un estudio de cohorte retrospectivo de pacientes adultos operados de facoemulsificación de cataratas entre 2006 y 2020 en el Hospital Italiano de Buenos Aires. Se incluyeron pacientes con diagnóstico de endoftalmitis dentro de las primeras 6 semanas posteriores a la cirugía. Se excluyeron los pacientes que se sometieron a cirugía extracapsular o cirugías combinadas. RESULTADOS: En diez años se realizaron un total de 29.326 operaciones de cataratas. La incidencia anual de endoftalmitis postoperatoria aguda después de la cirugía de cataratas fue del 0.102% (IC del 95%: 0.069-0.146). Treinta casos de endoftalmitis fueron identificados. El principal microorganismo fue Pseudomonas aeruginosa (45.4%). La agudeza visual final fue superior a 0.3 (LogMAR) en el 46.6% de los pacientes. Conclusión: La incidencia de endoftalmitis después de la cirugía de cataratas en este hospital está dentro del rango reportado a nivel mundial. Conocer la incidencia regional contribuye a decidir si son necesarias nuevas medidas de profilaxis.

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Un resultado refractivo no esperado luego de una cirugía de catarata puede tener múltiples causas, ya sean preoperatorias, operatorias y posoperatorias. Como las más importantes se han descrito los errores en el cálculo biométrico en el preoperatorio y también las menos probables o infrecuentes como: inadecuada selección del poder del LIO, ausencia de precisión en la manufactura de los LIOs, intervención quirúrgica en paciente equivocado o en el ojo equivocado y el uso de un lente de contacto blando al momento de la biometría. Presentamos el caso de un paciente operado de catarata por facoemulsificación con implante de lente intraocular (LIO) monofocal plegable en saco capsular, que a los 30 días posoperatorios presentó un astigmatismo total o refractivo de - 1.00 dioptrías (D) x 110° pero a los 90 días de la cirugía, regresó por disminución de la agudeza visual con un astigmatismo refractivo de -5.50 D x 165° que no se relacionaba con el astigmatismo corneal medido por queratometría y topografía (-0.94 D x 82°). El ojo tenía medios transparentes y sin reportes de complicaciones posoperatorias inmediatas y mediatas. En este caso encontramos un mecanismo de inclinación del LIO provocado por una háptica deficientemente desplegada al momento de la inserción del LIO que no se evidenció en el acto quirúrgico asociado a desplazamiento de este, ocasionado por la fibrosis y contracción pupilar manifestando un efecto astigmático de manera tardía. Esto fue corroborado por ecografía con ultrabiomicroscopía y reposición quirúrgica del LIO logrando solucionar el caso(AU)

An unexpected refractive outcome after cataract surgery may have multiple causes, whether preoperative, operative or postoperative. The most important ones have been described as errors in the preoperative biometric calculation and also the less probable or infrequent ones such as: inadequate selection of IOL power, lack of precision in the manufacture of IOLs, surgical intervention in the wrong patient or in the wrong eye and the use of a soft contact lens at the time of the biometry test. We present the case of a patient who underwent cataract surgery by phacoemulsification with a monofocal foldable intraocular lens (IOL) implantation in the capsular bag, who 30 days after the operation presented a total or refractive astigmatism of - 1.00 diopters (D) x 110°. Sometime later, 90 days after surgery, he returned due to decreased visual acuity with a refractive astigmatism of -5.50 D x 165° which was not related to the corneal astigmatism measured by keratometry and topography (-0.94 D x 82°). The eye had clear mediums and showed no reports of immediate and gradual postoperative complications. In this case we found a mechanism of IOL tilt caused by a poorly deployed haptic at the time of IOL insertion that was not evident at the time of surgery associated with IOL displacement caused by fibrosis and pupillary contraction, which generated a late astigmatic effect. This was corroborated by ultrasound with ultrabiomicroscopy and surgical repositioning of the IOL, which allowed the case to be solved(AU)

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