RESUMO
A 51-year-old man was referred for refractive surgery evaluation. Spectacle dependence and poor visual quality in both eyes was his chief complaint. He cannot tolerate contact lenses. Corrected distance visual acuity (CDVA) was 20/40 in both eyes. Manifest refraction was +5.25 -2.25 @ 90 (20/40) in the right eye and +6.25 -2.25 @ 105 (20/40) in the left eye. The patient had a history of radial keratotomy (RK) almost 30 years ago in both eyes and at the slitlamp presented 8 RK incisions, proportionally spaced between one another. All incisions were closed, and there were no relevant signs of scarring. The patient denied any history of ocular trauma, systemic disease, or medications. Corneal topography with different technologies revealed an irregular pattern with marked central flattening in both eyes, with some points below 30 diopters (D) (Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A862 and http://links.lww.com/JRS/A863, respectively). There were no signs of cataract, and fundus examination was normal. Optical coherence tomography (OCT) of the right eye revealed a more homogeneous thickness pattern, little variation between the thinnest and thickest areas, and adequate transparency (Figure 1JOURNAL/jcrs/04.03/02158034-202306000-00018/figure1/v/2023-05-31T172126Z/r/image-tiff). In the left eye, there is wide variability between the thinnest and thickest stromal points, with annular thinning and central thickening (Figure 2JOURNAL/jcrs/04.03/02158034-202306000-00018/figure2/v/2023-05-31T172126Z/r/image-tiff). Both eyes show marked epithelial irregularity. Considering this patient's current ocular status, how would you reach visual rehabilitation? Because he is contact lens intolerant, would you consider surface ablation, for example, photorefractive keratectomy (PRK) with mitomycin-C (MMC)? If that were the case, would you think of an optimized or a topography-guided (TG) treatment? Would you immediately consider a corneal transplant option? Would you instead consider a more conservative approach? Which one and why?
Assuntos
Anormalidades do Olho , Hiperopia , Ceratotomia Radial , Ceratectomia Fotorrefrativa , Masculino , Humanos , Pessoa de Meia-Idade , Ceratotomia Radial/efeitos adversos , Hiperopia/cirurgia , Hiperopia/etiologia , Lasers de Excimer/uso terapêutico , Ceratectomia Fotorrefrativa/métodos , Anormalidades do Olho/cirurgia , Córnea/cirurgia , Refração OcularRESUMO
ABSTRACT Purposes: To evaluate the relationship of changes in hypermetropia and ocular alignment in patients with accommodative esotropia. Methods: The medical records of consecutive patients diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10 D with full hyperopic correction) were retrospectively reviewed. Cycloplegic refractions culled from medical records were converted into spherical equivalents. Presence of amblyopia, changes in refractive error and ocular alignment at admission and after the follow-up period were evaluated. Results: Seventy patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean follow-up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 prismatic diopters at admission. The average decrease per year in near and distance deviations with glasses was 1.71 ± 3.96 prismatic diopters/year and 1.09 ± 3.25 prismatic diopters/year, respectively. The total myopic shift of the right and left eyes was 1.08 ± 1.35 D and 1.20 ± 1.40 D, respectively. Myopic shift/year was 0.22 D/year and 0.26 D/year, respectively. The correlation between the rate of myopic shift and rate of change in corrected near deviation was weak. The correlation for the rate of myopic shift was not high for the right and left eyes (r=0.18; p=0.15). Conclusion: The amount of deviation and hypermetropia gradually decreased in accommodative esotropia during follow-up. On the other hand, it may be incorrect to assure patients that the amount of deviation will decrease in parallel with the refractive error.(AU)
RESUMO Objetivo: Avaliar a relação entre alterações na hipermetropia e o alinhamento ocular em pacientes com esotropia acomodativa. Métodos: Foram analisados retrospectivamente prontuários médicos de pacientes consecutivos diagnosticados com esotropia acomodativa refrativa (com esotropia eliminada ou reduzida a menos de 10 D com correção completa da hipermetropia). As medidas de refração em cicloplegia obtidas dos prontuários foram convertidas em equivalentes esféricos. Avaliaram-se ainda a presença de ambliopia, alterações do erro refrativo e o alinhamento ocular à admissão e depois do período de acompanhamento. Resultados: Setenta pacientes (média de idade=6,01 ± 5,41 anos, 60,6% do sexo feminino, acompanhamento médio de 5,8 ± 3 anos) apresentaram esotropia de 40 ± 20 dioptrias prismáticas (DP) para perto à admissão. A diminuição média anual no desvio para perto e para longe com o uso de óculos foi de 1,71 ± 3,96 DP/ano e 1,09 ± 3,25 DP/ano, respectivamente. Os desvios miópicos totais dos olhos direito e esquerdo foram de 1,08 ± 1,35 D e 1,20 ± 1,40 D, respectivamente. Os desvios miópicos anuais foram de 0,22 D/ano e 0,26 D/ano para os olhos direito e esquerdo, respectivamente. A correlação entre a taxa de desvio miópico e a taxa de alteração do desvio para perto corrigido foi fraca. A correlação da taxa de desvio miópico não foi alta para os olhos direito e esquerdo (r=0,18, p=0,15). Conclusão: A quantidade de desvio e a hipermetropia diminuem gradualmente na esotropia acomodativa durante o acompanhamento. Por outro lado, pode não ser apropriado garantir aos pacientes que o desvio diminuirá em paralelo ao erro refrativo.(AU)
Assuntos
Humanos , Refração Ocular , Esotropia/fisiopatologia , Acomodação Ocular , Hiperopia/etiologia , Estudos RetrospectivosRESUMO
RESUMEN El coloboma de iris es un defecto congénito, que se describe como un orificio, fisura o hendidura en dicha estructura. Esta condición tiene la posibilidad de ser hereditaria o aparecer sin historia familiar previa. Se presenta un caso de un paciente de 51 años de edad con coloboma bilateral de iris asimétrico e hipermetropía, quien acudió a la consulta médica con el deseo de independizarse de su corrección óptica habitual. Se propuso cirugía facorrefractiva de ambos ojos con pupiloplastia del ojo derecho, en el que se obtuvieron resultados visuales satisfactorios después de la intervención quirúrgica(AU)
ABSTRACT The iris coloboma is a congenital defect, present since birth, which is described as a hole, fissure or cleft in the mentioned structure. This condition has the possibility of being inherited or can appear without previous family history. The case is presented of a 51-year-old patient with bilateral asymmetric iris coloboma and farsightedness. The patient went to the doctor's office with the desire to become independent of his usual optical correction. Facorrefractive surgery of both eyes with pupilloplasty of the right eye was proposed, in which satisfactory visual results were obtained after the intervention(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Coloboma/diagnóstico , Procedimentos Cirúrgicos Refrativos/métodos , Hiperopia/etiologiaRESUMO
Objetivos: Describir la calidad de vida relativa a la función visual en pacientes hipermétropes présbitas después de la extracción del cristalino con fines refractivos, así como las características sociodemográficas y los resultados refractivos pre y poscirugía. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo a 70 pacientes hipermétropes présbitas, operados en el período de enero a diciembre del año 2016, a quienes se les aplicó el cuestionario NEI VFQ-25, por primera vez usado en Cuba, y que permitió conocer la respuesta clínica y el grado de satisfacción del paciente. Resultados: la edad promedio fue de 54,67 años; predominó el sexo femenino y la piel blanca. Hubo una mejoría evidente de la visión y de la calidad de vida mostrada en los resultados de todos los elementos explorados en la prueba realizada, los cuales fueron mejores en el posoperatorio. Fue un estudio clínico y estadísticamente significativo. Conclusiones: los pacientes hipermétropes présbitas, operados de lensectomía refractiva, mejoran clínica y estadísticamente su calidad visual y su calidad de vida relativa a la función visual. La prueba de calidad de vida relativa a la función visual utilizada permite evaluar ambos parámetros(AU)
Objectives: crystalline lens surgery has become refractive surgery. The present study is aimed at describing vision-related quality of life in presbyopic hyperopic patients after crystalline lens removal for refractive purposes, as well as the sociodemographic characteristics and refractive outcomes before and after surgery. Methods: a prospective longitudinal descriptive study was conducted of 70 presbyopic hyperopic patients undergoing surgery from January to December 2016, who were given the questionnaire NEI VFQ-25, used for the first time in Cuba, to obtain information about clinical response and degree of patient satisfaction. Results: mean age was 54.67 years; female sex and white skin prevailed. Results show obvious improvement in both vision and vision-related quality of life, made evident by the results of tests conducted in the postoperative period. The study was clinically and statistically significant. Conclusions: presbyopic hyperopic patients undergoing refractive lensectomy experience clinical and statistical improvement of their vision and vision-related quality of life. The vision-related quality of life test used allows evaluation of both parameters(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Qualidade de Vida , Procedimentos Cirúrgicos Refrativos/métodos , Hiperopia/etiologia , Epidemiologia Descritiva , Estudos Prospectivos , Estudos LongitudinaisRESUMO
RESUMO O DSAEK (Descemet stripping automated endotelial Keratoplasty) é um dos procedimentos de escolha para tratamento das doenças que acometem o endotélio corneano. Apesar do sucesso terapêutico, o procedimento pode induzir uma hipermetropia residual. Em média a refração se estabiliza em um perído que varia de 6 a 12 meses após o transplante. O objetivo desse relato é descrever a evolução dessa opção terapêutica utilizada em um paciente de 54 anos portador de Distrofia de Fuchs. O paciente foi submetido ao transplante de córnea (DSAEK) e a remoção do cristalino no mesmo tempo cirúrgico o que resultou em hipermetropia residual. Após 3 anos de acompanhamento apresentava-se com a melhor visão corrigida de 20/20 (Snellen) no olho operado com uma refração de +3,25 -1,00 (5º). Optou-se por realização de LASIK (Laser assisted in situ Keratomileusis) hipermetrópico, obtendo um resultado visual satisfatório.
ABSTRACT DSAEK (Descemet stripping automated endothelial keratoplasty) is one of the options for corneal endothelium disease, which in some patients can result in a residual hyperopia after the procedure. Usually 6 to 12 months after corneal transplantation refraction is already stable. This report describes a therapeutic option used in a 54 years old patient with Fuchs' endothelial dystrophy submitted to cataract and corneal transplant that resulted in residual hyperopia, three years after the procedure the best corrected vision was 20/20 with a refraction of +3.25 -1.00 (5 º) treated with Hyperopic - LASIK (Laser-assisted In Situ Keratomileusis) with satisfactory visual result.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Hiperopia/cirurgia , Hiperopia/etiologia , Distrofia Endotelial de Fuchs/cirurgia , Facoemulsificação/métodos , Implante de Lente Intraocular/métodos , Tomografia de Coerência Óptica , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Hiperopia/diagnósticoRESUMO
OBJECTIVE: Evaluate the predictability of the postoperative refraction and refractive changes in pediatric pseudophakia. METHODS: Prospective, longitudinal follow-up on patients under the age of 15 years operated on for a cataract with intraocular lens, with 5 continuous years of follow-up. The patients were divided into 4 groups according to age at the time of the surgery: group from 0 to 2 years old, from 3 to 5 years old, from 6 to 8 years old, and 9 years and over. Error prediction and refractive change were studied. Statistical analysis was performed using the Student t and ANOVA test. RESULTS: A total of 60 eyes were included (44 patients). No significant differences were found between the unilateral and bilateral group. The prediction error in the 0 to 2 years group was 1.5±1.8 D, significantly higher than in the other groups (ANOVA P=.01). Refractive change in 5 years of the group of 0 to 2 years was -4.7±3.4 D (ANOVA P=.0002), while in the other groups it was significantly lower, with no differences between them. CONCLUSIONS: The 0 to 2 years group was less hyperopic than expected, 100% within the accepted of 2 standard deviations, but with a high variability. The refractive change observed in this group coincides with previous reports that the largest growth and increase in axial length occurs during the first 2 years. The calculation and use of an IOL in children has a better immediate refractive prediction, and at long term in those older than 2 years of age.
Assuntos
Hiperopia/etiologia , Miopia/etiologia , Complicações Pós-Operatórias/etiologia , Pseudofacia/fisiopatologia , Refração Ocular , Adolescente , Catarata/reabilitação , Criança , Pré-Escolar , Córnea/crescimento & desenvolvimento , Seguimentos , Previsões , Humanos , Hiperopia/epidemiologia , Hiperopia/fisiopatologia , Lactente , Recém-Nascido , Lentes Intraoculares , Miopia/epidemiologia , Miopia/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos ProspectivosRESUMO
OBJETIVO: Verificar as variações entre manhã e tarde da refração, da acuidade visual, das medidas da pressão ocular e dos parâmetros biomecânicos da córnea em pacientes operados de ceratotomia radial e interesse em retratamento refrativo; correlacionar os parâmetros biomecânicos da córnea com a refração, com a acuidade visual e com as suas variações. MÉTODOS: Foram examinados trinta e oito olhos de 19 pacientes pela manhã (9 am) e à tarde (6 pm), obtendo-se refração esfero-cilíndrica dinâmica, acuidade visual (logMAR) sem correção (AVsc) e corrigida (AVcc) e parâmetros do ORA (Ocular Response Analyzer): histerese corneana (corneal hysteresis - CH), fator de resistência da córnea (corneal resistance factor - CRF), pressão intraocular (intraocular pressure &- IOP) calibrada para o padrão Goldmann (IOPg) e pressão compensada da córnea (IOPcc). Considerando a não distribuição normal das variáveis (teste de Kolmogorov-Smirnov), o teste de Wilcoxon signed rank foi utilizado para verificar significância nas diferenças entre as medidas da manhã e as da tarde de cada variável. O teste de Spearman foi utilizado para verificar correlações das medidas do ORA com o estado refracional e com a acuidade visual pela manhã e à tarde, assim como para verificar as correlações entre as medidas do ORA pela manhã e à tarde e as variações da refração e da acuidade visual. RESULTADOS: Grau esférico (E), equivalente esférico (EE), equivalente desfoco (ED), AVsc, IOPcc e IOPg variaram significativamente (Wilcoxon, p<0,05) entre manhã e tarde, havendo maior hipermetropia, pior acuidade visual não corrigida, maior pressão ocular e menor CH pela manhã. Nas medidas pela manhã, observaram-se correlações positivas (Spearman, p<0,05) do EE e do ED com IOPcc (rs=0,39 e 0,34 respectivamente), mas não com IOPg. Nas medidas da tarde, não houve correlações significantes entre os parâmetros refracionais e os pressóricos. Observaram-se correlações negativas (Spearman, p<0,05) entre AVsc (logMAR) e CH pela manhã e à tarde (rs= -0,48 e rs= -0,51), entre E e CH pela manhã e à tarde (rs= -0,66 e -0,76), entre E e CRF pela manhã e à tarde (rs= -0,40 e -0,47), entre EE e CH pela manhã e à tarde (rs= -0,70 e -0,68), entre EE e CRF pela manhã e à tarde (rs= -0,41 e -0,46), entre ED e CH pela manhã e a tarde (rs= -0,64 e -0,54) e entre ED e CRF pela manhã e a tarde (rs= -0,35 e -0,34). Observou-se correlação significante e negativa do CRF pela manhã com a variação do ED (p = 0,05; rs = -0,30) e com a variação da AVsc (p = 0,04; rs = -0,33). CONCLUSÃO: Maior hipermetropia pela manhã foi associada a maior pressão compensada (IOPcc), mas não com IOPg em pacientes operados de ceratotomia radial, o que deve ser considerado no planejamento do retratamento refrativo. Parâmetros biomecânicos (CRF e CH) mais baixos foram associados com maior hipermetropia e pior acuidade visual. Uma tendência de haver maior flutuação relacionada com córneas mais fracas foi encontrada. Novos estudos envolvendo parâmetros biomecânicos derivados do sinal do ORA, além dos parâmetros CH e CRF (derivados das pressões de aplanamento do ORA), juntamente com dados tomográficos da córnea e de aberrometria total são necessários.
PURPOSE: To verify the morning to evening variations of refraction, visual acuity, intraocular pressure and biomechanical parameters on patients operated by radial keratotomy who presented for refractive re-treatments; and to correlate the biomechanical parameters with refraction, visual acuity and their variations among morning and evening. METHODS: 19 patients were examined, respectively thirty-eight eyes in the morning (9 am) and evening (6 pm), recording sphere-cylindrical dynamic refraction, visual acuity (logMAR) without correction (AVsc) and corrected (AVcc) and ORA (Ocular Response Analyzer) parameters: corneal hysteresis (CH), corneal resistance factor (CRF), intraocular pressure calibrated for Goldmann (IOPg) e corneal compensated (IOPcc). Variables had no normal distribution (Kolmogorov-Smirnov test), so that the Wilcoxon signed rank was used for testing the significance on the differences for each variable between morning and afternoon. The Spearman test was used for assessing the correlations between the ORA parameters and refraction, visual acuity in the morning and afternoon, as well as to verify the correlations between the ORA parameters and the variations on refraction and visual acuity. RESULTS: Sphere (E), spherical equivalent (EE), defocus equivalent (ED), AVsc, IOPcc e IOPg varied significantly (Wilcoxon, p<0.05) between morning and evening. There was more hyperopia, worse visual acuity, higher pressure and lower CH in the morning measurements. In the morning measurements, there was a positive correlation (Spearman, p<0.05) between EE and ED and IOPcc (rs=0.39 and 0.34 respectively), but not with IOPg. In the evening measurement, there were no correlations between the refractive and pressure measurements. Negative correlations were observed (Spearman, p<0.05) between AVsc (logMAR) and CH in the morning and in the evening (rs= -0.48 e rs= -0,51), between E and CH in the morning and in the evening (rs= -0.66 and -0.76), between E and CRF in the morning and in the evening (rs= -0.40 and -0.47), between EE and CH in the morning and in the evening (rs= -0.70 and -0.68), between EE and CRF in the morning and in the evening (rs= -0.41 and -0.46), between ED and CH in the morning and in the evening (rs= 0.64 and -0.54) and between ED and CRF in the morning and in the evening (rs= -0.35 and -0.34). There was a significant negative correlation between the morning measurement of CRF and the variation of defocus equivalent (p = 0.05; rs = -0.30) and the variation of AVsc (p = 0.04; rs = -0.33). CONCLUSION: More hyperopia was recorded in the morning which was associated with higher compensated pressure (IOPcc) but not with IOPg ten years after RK. Lower biomechanical parameters (CRF e CH) were associated with higher hyperopia and worse visual acuity. A trend was observed for having higher fluctuation on weaker corneas. New studies involving the variables derived from the waveform signals, beyond CH and CRF (derived from the applanation pressures) along with data from corneal tomography and wavefront aberrometry are necessary.
Assuntos
Humanos , Complicações Pós-Operatórias , Ceratotomia Radial/efeitos adversos , Ritmo Circadiano/fisiologia , Córnea/patologia , Hiperopia/etiologia , Refração Ocular/fisiologia , Fenômenos Biomecânicos , Acuidade Visual/fisiologia , Estudos Retrospectivos , Córnea/cirurgia , Hiperopia/fisiopatologia , Pressão Intraocular/fisiologiaRESUMO
PURPOSE: To assess corneal wavefront-guided photorefractive keratectomy (PRK) to correct hyperopia after radial keratotomy (RK). SETTING: Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil. DESIGN: Case series. METHODS: Excimer laser corneal wavefront-guided PRK with intraoperative mitomycin-C (MMC) 0.02% was performed. Main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, spherical equivalent (SE), corneal aberrations, and haze. RESULTS: The mean time between RK and PRK in the 61 eyes (39 patients) was 18.8 years ± 3.8 (SD). Before PRK, the mean SE was +4.17 ± 1.97 diopters (D); the mean astigmatism, -1.39 ± 1.04 D; and the mean CDVA, 0.161 ± 0.137 logMAR. At 24 months, the mean values were 0.14 ± 0.99 D (P<.001), -1.19 ± 1.02 D (P=.627), and 0.072 ± 0.094 logMAR (P<.001), respectively; the mean UDVA was 0.265 ± 0.196 (P<.001). The UDVA was 20/25 or better in 37.7% of eyes and 20/40 or better in 68.9%. The CDVA improved by 1 or more lines in 62.3% of eyes. Two eyes (3.3%) lost 2 or more lines, 1 due to corneal ectasia. Thirty eyes (49.2%) were within ± 0.50 D of intended SE and 45 (73.8%) were within ± 1.00 D. From 6 to 24 months, the mean SE regression was +0.39 D (P<.05). A significant decrease in coma, trefoil, and spherical aberration occurred. Three eyes developed peripheral haze more than grade 1. CONCLUSION: Corneal wavefront-guided PRK with MMC for hyperopia after RK significantly improved UDVA, CDVA, and higher-order corneal aberrations with a low incidence of visually significant corneal haze.
Assuntos
Alquilantes/administração & dosagem , Aberrações de Frente de Onda da Córnea/cirurgia , Hiperopia/cirurgia , Ceratotomia Radial , Lasers de Excimer , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa , Complicações Pós-Operatórias , Adulto , Idoso , Terapia Combinada , Aberrações de Frente de Onda da Córnea/etiologia , Aberrações de Frente de Onda da Córnea/fisiopatologia , Feminino , Seguimentos , Humanos , Hiperopia/etiologia , Hiperopia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Refração Ocular/fisiologia , Acuidade Visual/fisiologiaRESUMO
A 33-year-old woman with corneal ectasia after radial and astigmatic keratotomy had corneal collagen crosslinking with resultant gaping of the inferior incisions (2 radials and 1 transverse) that required suturing. At 6 months, the incisions healed leaving fibrotic scars. Visual acuity, refractions, corneal photographs, and topographic and corneal wavefront measurements are presented. At 2.5 years, the topographic inferior corneal irregularity continued to improve.
Assuntos
Reagentes de Ligações Cruzadas/efeitos adversos , Hiperopia/cirurgia , Ceratotomia Radial , Deiscência da Ferida Operatória/etiologia , Adulto , Colágeno/metabolismo , Córnea/metabolismo , Córnea/patologia , Córnea/cirurgia , Topografia da Córnea , Dilatação Patológica/cirurgia , Feminino , Humanos , Hiperopia/etiologia , Fármacos Fotossensibilizantes/efeitos adversos , Riboflavina/efeitos adversos , Deiscência da Ferida Operatória/cirurgia , Técnicas de Sutura , Raios Ultravioleta , Acuidade Visual/fisiologiaRESUMO
PURPOSE: Nanophthalmos is a rare genetic ocular disorder in which the eyes of affected individuals are abnormally small. Patients suffer from severe hyperopia as a result of their markedly reduced axial lengths, but otherwise are capable of seeing well unlike other more general forms of microphthalmia. To date one gene for nanophthalmos has been identified, encoding the membrane-type frizzled related protein MFRP. Identification of additional genes for nanophthalmos will improve our understanding of normal developmental regulation of eye growth. METHODS: We ascertained a cohort of families from eastern Canada and Mexico with familial nanophthalmos. We performed high density microsatellite and high density single nucleotide polymorphism (SNP) genotyping to identify potential chromosomal regions of linkage. We sequenced coding regions of genes in the linked interval by traditional PCR-based Sanger capillary electrophoresis methods. We cloned and sequenced a novel cDNA from a putative causal gene to verify gene structure. RESULTS: We identified a linked locus on chromosome 2q37 with a peak logarithm (base 10) of odds (LOD) score of 4.7. Sequencing of coding exons of all genes in the region identified multiple segregating variants in one gene, recently annotated as serine protease gene (PRSS56), coding for a predicted trypsin serine protease-like protein. One of our families was homozygous for a predicted pathogenic missense mutation, one family was compound heterozygous for two predicted pathogenic missense mutations, and one family was compound heterozygous for a predicted pathogenic missense mutation plus a frameshift leading to obligatory truncation of the predicted protein. The PRSS56 gene structure in public databases is based on a virtual transcript assembled from overlapping incomplete cDNA clones; we have now validated the structure of a full-length transcript from embryonic mouse brain RNA. CONCLUSIONS: PRSS56 is a good candidate for the causal gene for nanophthalmos in our families.
Assuntos
Olho/fisiopatologia , Hiperopia/genética , Microftalmia/genética , Serina Proteases , Animais , Sequência de Bases , Canadá , Clonagem Molecular , Estudos de Coortes , Análise Mutacional de DNA , Éxons , Olho/patologia , Ligação Genética , Genótipo , Técnicas de Genotipagem , Heterozigoto , Homozigoto , Humanos , Hiperopia/etiologia , Hiperopia/patologia , Escore Lod , Proteínas de Membrana/genética , México , Camundongos , Microftalmia/complicações , Microftalmia/patologia , Dados de Sequência Molecular , Mutação , Linhagem , Serina Proteases/genéticaRESUMO
PURPOSE: To study the oculometric parameters of hyperopia in children with esotropic amblyopia, comparing amblyopic eyes with fellow eyes. METHODS: Thirty-seven patients (5-8 years old) with bilateral hyperopia and esotropic amblyopia underwent a comprehensive ophthalmic examination, including cycloplegic refraction, keratometry and A-scan ultrasonography. Anterior chamber depth, lens thickness, vitreous chamber depth and total axial length were recorded. The refractive power of the crystalline lens was calculated using Bennett's equations. Paired Student's t-tests were used to compare ocular biometric measurements between amblyopic eyes and their fellow eyes. The associations of biometric parameters with refractive errors were assessed using Pearson correlation coefficients and linear regression. Multivariable models including axial length, corneal power and lens power were also constructed. RESULTS: Amblyopic eyes were found to have significantly more hyperopic refraction, less corneal power, greater lens power, shorter vitreous chamber depth and shorter axial length, despite similar anterior chamber depth and lens thickness. The strongest correlation with refractive error was observed for the axial length/corneal radius ratio (r(36) = -0.92, p < 0.001 for amblyopic and r(36) = -0.87, p < 0.001 for fellow eyes). Axial length accounted for 39.2% (R(2)) of the refractive error variance in amblyopic eyes and 35.5% in fellow eyes. Adding corneal power to the model increased R(2) to 85.7% and 79.6%, respectively. A statistically significant correlation was found between axial length and corneal power, indicating decreasing corneal power with increasing axial length, and they were similar for amblyopic eyes (r(36) = -0.53, p < 0.001) and fellow eyes (r(36) = -0.57, p < 0.001). A statistically significant correlation was also found between axial length and lens power, indicating decreasing lens power with increasing axial length (r(36) = -0.72, p < 0.001 for amblyopic eyes and r(36) = -0.69, p < 0.001 for fellow eyes). CONCLUSIONS: We observed that the correlation among the major oculometric parameters and their individual contribution to hyperopia in esotropic children were similar in amblyopic and non-amblyopic eyes. This finding suggests that the counterbalancing effect of greater corneal and lens power associated with shorter axial length is similar in both eyes of patients with esotropic amblyopia.
Assuntos
Ambliopia/diagnóstico , Esotropia/diagnóstico , Hiperopia/diagnóstico , Erros de Refração/diagnóstico , Ambliopia/complicações , Ambliopia/fisiopatologia , Biometria/métodos , Criança , Pré-Escolar , Esotropia/fisiopatologia , Feminino , Humanos , Hiperopia/etiologia , Hiperopia/fisiopatologia , Masculino , Refração Ocular/fisiologia , Fatores de RiscoRESUMO
PURPOSE: To evaluate the safety of photorefractive keratectomy (PRK) with mitomycin-C (MMC) in eyes with hyperopia after radial keratotomy. METHODS: Sixty eyes of 36 consecutive patients treated with corneal wavefront-guided PRK using an Esiris-Schwind excimer laser were prospectively evaluated. Corneal epithelium was mechanically removed, followed by photoablation and use of 0.02% MMC for 20 or 40 seconds. In 16 eyes (26.7%), MMC was applied for 40 seconds. These eyes underwent ablations deeper than 100 micron or had previous corneal sutures. Patients were followed up for 12 months. RESULTS: The mean spherical equivalent (SE) before PRK was +4.27 D +/- 2.18, and the mean best corrected visual acuity (BCVA) was 0.174 +/- 0.139 (logMAR). The planned laser SE correction was +4.74 D +/- 2.11, resulting in an ablation depth of 78 +/- 28 microm (from 33 to 148). No intraoperative complications were observed. At one year, mean SE was +0.04 D +/- 1.03 (p<0.001) and mean BCVA was 0.079 +/- 0.105 (p<0.001). There was a gain of 2 or more lines of BCVA in 20 eyes (33.3%) and only one eye (1.7%) lost 2 lines. Correlation analysis showed that the improvement in BCVA was inversely related to preoperative BCVA (r=-0.694; p<0.001). Five eyes developed peripheral haze grade 2 or 3 and one eye had central trace haze. No significant correlation was found between central or peripheral haze and the number of radial incisions, depth of the ablation or postoperative BCVA. Mean preoperative endothelial cell count was 2,681 +/- 455 cel/ mm(2) and after one year was 2,481 +/- 378 cel/mm(2) (p=0.124). One eye developed keratectasia due to the progressive widening of an inferior radial incision, which was later sutured. CONCLUSION: PRK with MMC was safe after one year of follow-up for the reduction of hyperopia after radial keratotomy. A major improvement in BCVA was obtained with a small incidence of haze and other complications.
Assuntos
Hiperopia/etiologia , Hiperopia/cirurgia , Ceratotomia Radial/efeitos adversos , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
PURPOSE: To assess the efficacy, predictability and stability of corneal wavefront-guided photorefractive keratectomy (PRK) for correcting hyperopia and astigmatism after radial keratotomy. METHODS: In a prospective study, 60 eyes of 36 consecutive patients were treated with corneal wavefront-guided PRK with 0.02% mitomycin-C using an Esiris-Schwind excimer laser. Corneal epithelium was mechanically removed. All patients were followed-up for 12 months. RESULTS: The mean time between radial keratotomy and PRK was 18.4 years +/- 3.8 (SD); mean spherical equivalent (SE) before radial keratotomy was -4.35 diopters (D) +/- 1.55. Before PRK, the mean sphere was +5.00 D +/- 2.28, mean astigmatism was - 1.47 D +/- 1.06, mean SE was +4.27 D +/- 2.18, and the mean best-corrected visual acuity (BCVA) was 0.174 +/- 0.139 (logMAR). The planned laser SE correction was +4.74 D +/- 2.11. No intraoperative complications were noted. At 12 months, mean SE was +0.04 D +/- 1.03 (P<0.001), mean astigmatism was -1.03 +/- 0.75 D (P=0.015), mean UCVA was 0.265 +/- 0.197, and mean BCVA was 0.079 +/- 0.105 (P<0.001). There was a mean gain of 1 line of BCVA and 20 eyes (33.3%) gained 2 or more lines. Only one eye lost 2 lines. A significant decrease in coma (P=0.002), trefoil (P=0.004), spherical aberration (P<0.001) and quatrefoil (P=0.002) was observed. Forty eight eyes (80%) were within +/- 1.0 D of intended SE. Mean regression from 6 to 12 months was +0.17 +/- 0.67 D. CONCLUSION: Corneal wavefront-guided PRK was effective, predictable and stable after one year of follow-up for the treatment of hyperopia after radial keratotomy. A significant improvement in UCVA, BCVA and corneal aberrations was obtained. ClinicalTrials.gov Identifier: NCT00917657.
Assuntos
Alquilantes/administração & dosagem , Astigmatismo/cirurgia , Hiperopia/cirurgia , Ceratotomia Radial/efeitos adversos , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa/métodos , Adulto , Idoso , Astigmatismo/etiologia , Terapia Combinada , Topografia da Córnea , Feminino , Seguimentos , Humanos , Hiperopia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acuidade VisualRESUMO
OBJETIVO: Analisar a segurança da ceratectomia fotorrefrativa (PRK) com mitomicina-C (MMC) em olhos com hipermetropia consecutiva à ceratotomia radial. MÉTODOS: Foram avaliados prospectivamente 60 olhos de 36 pacientes consecutivos, submetidos à ceratectomia fotorrefrativa personalizada pela frente de onda corneana com o laser Esiris Schwind. Realizaram-se desepitelização mecânica, seguida da fotoabla ção, e utilização de MMC 0,02 por cento por 20 ou 40 segundos. Em 16 olhos (26,7 por cento) a MMC foi aplicada por 40 segundos. Estes foram submetidos a ablações mais profundas do que 100 micra ou apresentavam córneas submetidas a suturas prévias. Os pacientes foram acompanhados por um ano. RESULTADOS: O equivalente esférico (EE) médio antes do PRK era +4,27 D ± 2,18 e a acuidade visual corrigida (AVcc) média era 0,174 ± 0,139 (logMAR). O EE médio programado no laser foi +4,74 D ± 2,11, resultando em uma profundidade de ablação de 78 ± 28 µm (de 33 a 148). Não foram observadas complicações intraoperatórias. Após um ano observaram-se: EE médio de + 0,04 D ± 1,03 (p<0,001) e AVcc de 0,079 ± 0,105 (p<0,001). Observou-se melhora de duas ou mais linhas de AVcc em 20 olhos (33,3 por cento) e somente 1 olho (1,7 por cento) perdeu duas linhas. A análise de correlação mostrou que a melhora da AVcc foi inversa mente correlacionada à AVcc pré-operatória (r=-0,694; p<0,001). ''Haze'' periférico grau 2 ou 3 foi observado em cinco olhos e ''haze'' central discreto, em um olho. Não houve correlação significativa do ''haze'' central ou periférico com o número de incisões radiais, com a profun didade da fotoablação ou com a AVcc pós-operatória. A contagem endotelial média no pré-operatório foi de 2.681± 455 cel/mm2 e após 1 ano foi de 2.481 ± 378 cel/mm2 (p=0,124). Um olho desenvolveu ectasia corneana, devido ao alargamento progressivo de uma incisão radial inferior, e foi submetido à sutura da incisão. CONCLUSÃO: O PRK com MMC mostrou-se seguro após um ...
PURPOSE: To evaluate the safety of photorefractive keratectomy (PRK) with mitomycin-C (MMC) in eyes with hyperopia after radial keratotomy. METHODS: Sixty eyes of 36 consecutive patients treated with corneal wavefront-guided PRK using an Esiris-Schwind excimer laser were prospectively evaluated. Corneal epithelium was mechanically removed, followed by photoablation and use of 0.02 percent MMC for 20 or 40 seconds. In 16 eyes (26.7 percent), MMC was applied for 40 seconds. These eyes underwent ablations deeper than 100 micron or had previous corneal sutures. Patients were followedup for 12 months. RESULTS: The mean spherical equivalent (SE) before PRK was +4.27 D ± 2.18, and the mean bestcorrected visual acuity (BCVA) was 0.174 ± 0.139 (logMAR). The planned laser SE correction was +4.74 D ± 2.11, resulting in an ablation depth of 78 ± 28 µm (from 33 to 148). No intraoperative complications were observed. At one year, mean SE was +0.04 D ± 1.03 (p<0.001) and mean BCVA was 0.079 ± 0.105 (p<0.001). There was a gain of 2 or more lines of BCVA in 20 eyes (33.3 percent) and only one eye (1.7 percent) lost 2 lines. Correlation analysis showed that the improvement in BCVA was inversely related to preoperative BCVA (r=-0.694; p<0.001). Five eyes developed peripheral haze grade 2 or 3 and one eye had central trace haze. No significant correlation was found between central or peripheral haze and the number of radial incisions, depth of the ablation or postoperative BCVA. Mean preoperative endothelial cell count was 2,681 ± 455 cel/ mm² and after one year was 2,481 ± 378 cel/mm² (p=0.124). One eye developed keratectasia due to the progressive widening of an inferior radial incision, which was later sutured. CONCLUSION: PRK with MMC was safe after one year of follow-up for the reduction of hyperopia after radial keratotomy. A major improvement in BCVA was obtained with a small incidence of haze and other complications.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hiperopia/etiologia , Hiperopia/cirurgia , Ceratotomia Radial/efeitos adversos , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa/métodos , Estudos Prospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
OBJETIVO: Avaliar a eficácia, previsibilidade e estabilidade da ceratectomia fotorrefrativa (PRK) guiada pela frente de onda corneana para o tratamento da hipermetropia secundária à ceratotomia radial. MÉTODOS: Este estudo prospectivo analisou 60 olhos de 36 pacientes consecutivos, submetidos a PRK personalizado com o laser Esiris-Schwind. A técnica constou de desepitelização mecânica, fotoablação e utilização de mitomicina-C 0,02 por cento. Os pacientes foram acompanhados por 12 meses. RESULTADOS: O intervalo médio entre a ceratotomia radial e o PRK foi de 18,4 anos ± 3,8 (DP); o equivalente esférico (EE) médio antes da ceratotomia radial era -4,35 dioptrias (D) ± 1,55. As medidas prévias ao PRK mostraram grau esférico médio de +5,00 D ± 2,28, astigmatismo médio de -1,47 D ± 1,06, EE médio de +4,27 D ± 2,18 e AV corrigida (AVcc) média de 0,174 ± 0,139 (logMAR). O EE médio programado no laser foi +4,74 D ± 2,11. Os resultados encontrados um ano após a cirurgia foram: EE médio de +0,04 D ± 1,03 (P<0,001), astigmatismo médio de -1,03 ± 0,75 D (P=0,015), AV média sem correção de 0,265 ± 0,197 e AVcc de 0,079 ± 0,105 (P<0,001). A AVcc mostrou ganho médio de uma linha; 20 olhos (33,3 por cento) melhoraram duas ou mais linhas e somente um olho perdeu duas linhas. Ocorreu redução estatisticamente significante do coma (P=0,002), trefoil (P=0,004), aberração esférica (P<0,001) e quatrefoil (P=0,002). Houve 48 olhos (80 por cento) entre ± 1,00 D do EE planejado. A regressão média entre seis e 12 meses foi de +0,17 ± 0,67 D. CONCLUSÃO: O PRK personalizado pela frente de onda corneana foi eficaz, previsível e estável pelo período de um ano para a redução da hipermetropia após a ceratotomia radial. No pós-operatório, observou-se melhora significativa da AVsc, AVcc e das aberrações corneanas. Número do ClinicalTrials.gov:NCT00917657
PURPOSE: To assess the efficacy, predictability and stability of corneal wavefront-guided photorefractive keratectomy (PRK) for correcting hyperopia and astigmatism after radial keratotomy. METHODS: In a prospective study, 60 eyes of 36 consecutive patients were treated with corneal wavefront-guided PRK with 0.02 percent mitomycin-C using an Esiris-Schwind excimer laser. Corneal epithelium was mechanically removed. All patients were followed-up for 12 months. RESULTS: The mean time between radial keratotomy and PRK was 18.4 years ± 3.8 (SD); mean spherical equivalent (SE) before radial keratotomy was -4.35 diopters (D) ± 1.55. Before PRK, the mean sphere was +5.00 D ± 2.28, mean astigmatism was - 1.47 D ± 1.06, mean SE was +4.27 D ± 2.18, and the mean best-corrected visual acuity (BCVA) was 0.174 ± 0.139 (logMAR). The planned laser SE correction was +4.74 D ± 2.11. No intraoperative complications were noted. At 12 months, mean SE was +0.04 D ± 1.03 (P<0.001), mean astigmatism was -1.03 ± 0.75 D (P=0.015), mean UCVA was 0.265 ± 0.197, and mean BCVA was 0.079 ± 0.105 (P<0.001). There was a mean gain of 1 line of BCVA and 20 eyes (33.3 percent) gained 2 or more lines. Only one eye lost 2 lines. A significant decrease in coma (P=0.002), trefoil (P=0.004), spherical aberration (P<0.001) and quatrefoil (P=0.002) was observed. Forty eight eyes (80 percent) were within ± 1.0 D of intended SE. Mean regression from 6 to 12 months was +0.17 ± 0.67 D. CONCLUSION: Corneal wavefront-guided PRK was effective, predictable and stable after one year of follow-up for the treatment of hyperopia after radial keratotomy. A significant improvement in UCVA, BCVA and corneal aberrations was obtained. ClinicalTrials.gov Identifier: NCT00917657
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alquilantes/administração & dosagem , Astigmatismo/cirurgia , Hiperopia/cirurgia , Ceratotomia Radial/efeitos adversos , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa/métodos , Astigmatismo/etiologia , Terapia Combinada , Topografia da Córnea , Seguimentos , Hiperopia/etiologia , Estudos Prospectivos , Acuidade VisualRESUMO
PURPOSE: To evaluate the efficacy and safety of capturing the intraocular lens (IOL) optic through the anterior capsulorhexis opening in eyes with multifocal IOLs and a residual refractive error. SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Eyes with previous cataract surgery and Tecnis ZM900 multifocal IOL implantation were prospectively analyzed. After at least 1 month, patients had second surgery in which the IOL optic was captured through the anterior capsulorhexis opening to correct the residual refractive error. Preoperative and postoperative examinations at 1 day and 3 months included spherical equivalent (SE); uncorrected distance (UDVA), near (UNVA), and intermediate (UIVA) visual acuities; and corrected distance visual acuity (CDVA). RESULTS: The study included 16 eyes of 14 patients. The mean UDVA was 0.32 logMAR preoperatively and 0.10 logMAR after anterior optic capture and the mean SE, +1.09 diopters (D) and +0.26 D, respectively; both improvements were statistically significant (P<.001). The change in CDVA and UNVA from before anterior optic capture to the last follow-up was not statistically significant. The UIVA was significantly worse postoperatively (P = .011). No eye lost lines of CDVA. One eye (6.25%) developed glaucoma postoperatively. At the last follow-up, 13 patients (92.85%) were spectacle-independent for near and distance vision. CONCLUSION: Early outcomes indicate that anterior optic capture is a safe, accurate procedure in eyes with multifocal IOLs and a mild hyperopic residual refractive error postoperatively.
Assuntos
Hiperopia/cirurgia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Capsulorrexe , Topografia da Córnea , Feminino , Humanos , Hiperopia/etiologia , Hiperopia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Estudos Prospectivos , Reoperação , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To evaluate the safety, efficacy, and stability of excimer laser photorefractive keratectomy (PRK) and mitomycin-C (MMC) 0.02% for consecutive hyperopia after radial keratotomy (RK). METHODS: A prospective, nonrandomized, noncomparative interventional case series of 35 eyes (22 patients) with consecutive hyperopia after RK. All eyes were treated with PRK, using a single intraoperative topical application of MMC 0.02% for 60 seconds. Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, slit-lamp evidence of corneal haze, and endothelial cell counts were evaluated for up to 18 months after surgery. RESULTS: Postoperative follow-up was 9.6 +/- 5.5 months (ranged from 3 to 18 months). The mean spherical equivalent was +3.36 +/- 1.94 diopters preoperatively and +0.27 +/- 1.38 diopters 12 months after surgery. The uncorrected visual acuity was > or =20/30 in 37.1% of the eyes at 1 month and 78.6% of the eyes at 12 months. At 12 months, 14% of the eyes lost up to 1 line of Snellen acuity in the best spectacle-corrected visual acuity. No corneal haze was observed and the endothelial cell counts remained unchanged postoperatively (P > 0.05). CONCLUSION: PRK with MMC 0.02% for consecutive hyperopia after RK seems to be a safe and effective procedure at least in the short-term period of 6 months.
Assuntos
Alquilantes/administração & dosagem , Hiperopia/tratamento farmacológico , Hiperopia/cirurgia , Ceratotomia Radial/efeitos adversos , Lasers de Excimer/uso terapêutico , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa , Adulto , Contagem de Células , Terapia Combinada , Endotélio Corneano/patologia , Feminino , Seguimentos , Humanos , Hiperopia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Refração Ocular/fisiologia , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To determine whether residual hyperopia could be corrected postoperatively using the light adjustable lens technology in patients undergoing cataract surgery and light adjustable lens implantation. DESIGN: Prospective, nonrandomized clinical trial. METHODS: Fourteen eyes of 14 patients were studied. The manifest refraction, uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA) were determined with follow-up time to determine the achieved refractive corrections and their stability. RESULTS: Of 14 eyes, 13 eyes (92.9%) achieved +/- 0.25 diopters (D) of the target refraction at one day post lock-in, with 100% of the eyes achieving the targeted refractive adjustment within 0.5 D or better up to six months postoperative follow-up. All eyes treated show no change in manifest spherical refraction >0.25 D between one day post lock-in, and three and six months postoperative visits. The data demonstrate the stability of the achieved refractive change after the adjustment and lock-in procedures. The mean rate of change was 0.006 D per month, which is six times more stable than that of refractive procedures. CONCLUSIONS: Residual hyperopia errors in the range of +0.25 to +2.0 D were successfully corrected with precision and significant improvement in UCVA and without compromising BCVA using the light adjustable intraocular lens technology.
Assuntos
Hiperopia/cirurgia , Implante de Lente Intraocular , Lentes Intraoculares , Facoemulsificação , Complicações Pós-Operatórias , Idoso , Biometria , Feminino , Humanos , Hiperopia/etiologia , Hiperopia/fisiopatologia , Masculino , Estudos Prospectivos , Desenho de Prótese , Refração Ocular/fisiologia , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To evaluate topography-guided photorefractive keratectomy (PRK) for correcting hyperopia and astigmatism after radial keratotomy (RK). METHODS: Prospective study of 12 consecutive patients (19 eyes) who were treated with topography-guided PRK with 0.02% mitomycin C using an Asclepion-Meditec MEL-70 excimer laser with a 9.5-mm ablation zone. All eyes were operated by the same surgeon and followed for 1 year. RESULTS: Thirteen eyes had complete epithelialization by day 7 and all eyes by day 10. At 1 year, uncorrected visual acuity was 20/25 or better in 42.1% of eyes and 20/40 or better in 68.4%. Preoperative mean spherical equivalent refraction was +3.80+/-2.47 diopters (D) and +0.24+/-2.36 D (P<.001) 1 year postoperative, with 47.4% of eyes being within +/-1.00 D and 73.7% within +/-2.00 D. Preoperative mean cylinder was -2.30+/-1.41 D and -0.62+/-0.73 D (P<.001) 1 year postoperative. At 1 year, 68.4% of eyes gained at least 1 line of best-spectacle corrected visual acuity, 36.8% gained more than 1 line, and only 2 eyes lost 1 line (one due to corneal haze). Three eyes developed central haze. Mean regression from 6 to 12 months in these 3 eyes was +1.83 D and in the remaining 16 eyes was -0.50 D. CONCLUSIONS: Topography-guided PRK with mitomycin C was safe and reasonably effective for the treatment of hyperopia after RK.
Assuntos
Alquilantes/administração & dosagem , Topografia da Córnea/métodos , Hiperopia/cirurgia , Ceratotomia Radial/efeitos adversos , Lasers de Excimer/uso terapêutico , Mitomicina/administração & dosagem , Ceratectomia Fotorrefrativa/métodos , Adulto , Astigmatismo/etiologia , Astigmatismo/cirurgia , Terapia Combinada , Feminino , Seguimentos , Humanos , Hiperopia/etiologia , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
BACKGROUND: We undertook this study to determine the refractive state in patients who underwent non-complicated phacoemulsification under unusual situations. METHODS: This was a clinical, open, transversal, prospective and comparative study. Patients had the following conditions: congenital cataracts, hyperopia, myopia, and emetropia with previous corneal transplantation or vitreous cavity filled with silicone oil. RESULTS: Thirty-six eyes were included in our study vs. control group (52 emetropic eyes). There was no statistical significance in spherical equivalent 6 weeks postoperatively, with 59% of patients within +1.00 D, 73% +2.00 D and 28% > +2.00 D. CONCLUSIONS: Refractive state was favorable with an average of 0.96 D +/- 6.27.