RESUMO
Comments about endothelial cell loss after posterior chamber phakic intraocular lens are provided, with a particular emphasis on the importance of determining progressive postoperative cell density reduction, excluding that related to surgical trauma.
Assuntos
Perda de Células Endoteliais da Córnea , Endotélio Corneano , Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Humanos , Lentes Intraoculares Fácicas/efeitos adversos , Perda de Células Endoteliais da Córnea/etiologia , Perda de Células Endoteliais da Córnea/diagnóstico , Endotélio Corneano/patologia , Contagem de Células , Implante de Lente Intraocular/efeitos adversos , Implante de Lente Intraocular/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Miopia/cirurgia , Acuidade VisualRESUMO
ABSTRACT Objective: To describe a new surgical maneuver to position the graft in a Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK) surgery. Methods: Case series. Results: This technique allows a correct repositioning of the graft in a minimally invasive way. Conclusion: This new surgical maneuver was successful in manipulating the graft in DSAEK surgery and therefore might be effective and safe.
RESUMO Objetivo: Descrever uma nova manobra cirúrgica para posicionar o enxerto em uma cirurgia de ceratoplastia endotelial automatizada com desnudamento da Descemet. Métodos: Série de casos. Resultados: A técnica permitiu o correto reposicionamento do enxerto de forma minimamente invasiva. Conclusão: Esta nova manobra cirúrgica foi bem-sucedida para manipular o enxerto na cirurgia ceratoplastia endotelial automatizada com desnudamento da Descemet e, portanto, pode ser eficaz e segura.
Assuntos
Humanos , Endotélio Corneano/transplante , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/instrumentação , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Agulhas , Retalhos Cirúrgicos , Técnicas de Sutura , Procedimentos Cirúrgicos Minimamente Invasivos , Córnea/cirurgia , Doenças da Córnea/cirurgia , Lâmina Limitante Posterior/cirurgia , Perda de Células Endoteliais da Córnea/prevenção & controle , Rejeição de Enxerto/prevenção & controleRESUMO
PURPOSE: To evaluate the endothelial cell loss in patients with iris-claw phakic lenses (Artisan®) in a long-term follow-up. METHODS: We analyzed the medical records of patients who had undergone iris-claw phakic lens implantation and who had at least 5 years of follow-up. RESULTS: We included 67 eyes with myopic errors (follow-up 9.6 ± 3.0 years) and 10 eyes with mixed astigmatism or hyperopic errors (follow-up 8.8 ± 2.5 years). The mean total endothelial density loss at the last follow-up visit was 18.5% ± 17.0% and 10.5% ± 12.3%, respectively. 29.9% of the eyes in the myopic group and 20% in the hyperopic group lost more than 25% of the preoperative endothelial cell density. During the postoperative follow-up period, 60.8% of the eyes in the myopic group and 40% of the eyes in the hyperopic group lost a higher percentage than the expected physiological loss. Two eyes in the myopic group (3.0%) had a final cell density of less than 1200 cells/mm2. None of the variables studied had a statistically significant association with the percentage of annual endothelial loss in the postoperative period. Three phakic lenses were explanted: two by cataract and one by cataract and severe decrease of the endothelial density (862 cells/mm2). CONCLUSIONS: There is a significant endothelial cell loss in a low percentage of the eyes with Artisan® lenses in the long term, and it can decrease to critical levels. Periodic endothelial density evaluations are required for these patients. The selection criteria of surgical candidates could be reevaluated.
Assuntos
Perda de Células Endoteliais da Córnea/etiologia , Endotélio Corneano/patologia , Iris/cirurgia , Implante de Lente Intraocular/efeitos adversos , Miopia/cirurgia , Lentes Intraoculares Fácicas/efeitos adversos , Refração Ocular/fisiologia , Adulto , Contagem de Células , Perda de Células Endoteliais da Córnea/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Miopia/fisiopatologia , Complicações Pós-Operatórias , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Acuidade Visual , Adulto JovemRESUMO
PURPOSE: To describe the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed by cornea fellows during their initial learning curve. METHODS: This prospective study included the first consecutive series of 53 DMEK surgeries performed by 14 corneal fellows at Sorocaba's Ophthalmological Hospital. Best spectacle-corrected visual acuity, endothelial cell density (ECD), and complications were evaluated. RESULTS: Of the eyes without ocular comorbidities and with complete visual acuity measurements, 97% of 33 eyes achieved a best spectacle-corrected visual acuity of ≥20/40 in 6 months. The mean (SD) preoperative donor ECD was 2453 (361) cells/mm, and at 6 months postoperatively, the in vivo mean ECD (SD) was found to be 1300 (587) cells/mm, an average loss of 47%. Preparation of the DMEK graft by the cornea fellows was successful in all cases. There were 9 eyes (17%) that experienced partial graft detachment requiring rebubbling. A total of 3 eyes (5.7%) failed to clear the cornea, all of which were managed with successful secondary endothelial keratoplasty. None of the eyes experienced pupillary block. CONCLUSIONS: Establishing DMEK in a fellowship program was successful with the supervision of an experienced DMEK surgeon. Even without the facility of a prestripped DMEK graft by an eye bank and with no backup tissue, no surgery was canceled because of graft preparation failure. Good visual outcomes were achieved with satisfactory ECD at 6-month follow-up, with an acceptable complication rate. Even the 3 eyes that failed to clear the cornea evolved well after secondary endothelial keratoplasty by the cornea fellows.
Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Endotélio Corneano/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda de Células Endoteliais da Córnea , Lâmina Limitante Posterior/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/educação , Bolsas de Estudo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acuidade VisualRESUMO
In epithelial layers in culture, immediately after an injury a fast calcium wave (FCW) propagates from the wound borders toward the rest of the monolayer. We show here that similarly to other tissues, during the FCW in bovine corneal endothelial (BCE) cells in culture many cells exhibit calcium oscillations mediated by IP3 signaling. In this study we perform a detailed characterization of this oscillatory behavior and explore its possible role in the process of wound healing. In previous work we showed that, in BCE cells in culture, the healing cells undergo two stages of caspase-dependent apoptosis, at approximately two and eight hours after wounding. We determined that inhibition of the FCW greatly increases the apoptotic rate of the two stages, suggesting that the wave prevents excessive apoptosis of the healing cells. Taking this into account, we investigated the possible participation of the calcium oscillations during the FCW in apoptosis of the healing cells. For this, we employed ARL-67156 (ARL), a weak competitive inhibitor of ecto-ATPases, and the calcium chelator EGTA. We show here that, in healing BCE cells, ARL enhances cellular calcium oscillations during the FCW, while EGTA decreases oscillations. We found that ARL produces a significant decrease (to about half the control value) in the apoptotic index of the first stage of apoptosis, while EGTA increases it. Neither drug noticeably affects the second stage. We have interpreted the effect of ARL on apoptosis as due to the maintenance of moderately risen ATP levels during the FCW, which is in turn the cause for the enhancement of ATP-dependent calcium oscillations. Correspondingly, EGTA would increase the apoptotic index of the first stage by promoting a decrease in the calcium oscillatory rate. The fact that the second stage of apoptosis is not affected by the drugs suggests that the two stages are at least partially subject to different signaling pathways.
Assuntos
Sinalização do Cálcio/genética , Cálcio/metabolismo , Perda de Células Endoteliais da Córnea/metabolismo , Cicatrização/genética , Animais , Apoptose/genética , Bovinos , Células Cultivadas , Perda de Células Endoteliais da Córnea/genética , Perda de Células Endoteliais da Córnea/patologia , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Endotélio Corneano/metabolismo , Endotélio Corneano/patologia , Células Epiteliais/metabolismo , Células Epiteliais/patologiaRESUMO
The aim of this study was to investigate the acute effects of atracurium besylate on cellular damage in corneal endothelium of chickens. Twenty healthy chicken eyes were assigned to the following groups: Group 1 (G1), experimental group (n=10); and Group 2 (G2), control (n=10). Excised corneoscleral buttons were immediately placed on glass microscopy slides with endothelial region faced up. Corneal endothelium of eyes in G1 were covered with AB (0.2mL, 10mg/mL) for 3 min and then rinsed with balanced salt solution (BSS), while the corneal endothelium of eyes in G2 were covered with BBS for 3 min. Corneas from both groups were stained with alizarin red/trypan blue and visualized by light microscopy. Ten random photographs were taken from each cornea. The area of cellular damage was measured by software in all samples and cell loss of each group was averaged and compared. Endothelial area of denudation and Descemet's membrane exposure were higher in G1 than G2. In conclusion, atracurium besylate induced an acute damage on corneal endothelium of chickens.(AU)'
Objetivou-se avaliar os efeitos agudos do besilato de atracúrio sobre o endotélio corneano de galinhas. Vinte olhos saudáveis de galinhas foram aleatoriamente separados em dois grupos com 10 olhos cada, sendo G1 o grupo controle e G2 o grupo tratamento. Imediatamente após a excisão dos botões corneoesclerais estes foram colocados em lâminas de microscopia de vidro com o lado endotelial voltado para cima. No Grupo 1, o endotélio corneano foi recoberto com 0,2ml de besilato de atracúrio (10mg/ml) durante 3 minutos e depois lavado com solução salina balanceada. No Grupo 2, o endotélio corneano foi recoberto apenas com solução salina balanceada durante 3 min. As córneas de ambos os grupos foram coradas com vermelho de alizarina e azul de tripano e visualizadas com microscópio óptico. Foram obtidas dez fotografias aleatórias de cada amostra. As imagens foram analisadas e com auxílio de um software as áreas com ausência de células endoteliais calculadas. A perda celular endotelial foi significativamente maior no grupo tratamento comparativamente ao grupo controle. Com base nos resultados apresentados foi possível concluir que o besilato de atracúrio induziu dano agudo nas células do endotélio da córnea de galinhas.(AU)
Assuntos
Animais , Atracúrio/efeitos adversos , Endotélio Corneano/patologia , Midríase/veterinária , Galinhas , Perda de Células Endoteliais da Córnea/veterináriaRESUMO
The aim of this study was to investigate the acute effects of atracurium besylate on cellular damage in corneal endothelium of chickens. Twenty healthy chicken eyes were assigned to the following groups: Group 1 (G1), experimental group (n=10); and Group 2 (G2), control (n=10). Excised corneoscleral buttons were immediately placed on glass microscopy slides with endothelial region faced up. Corneal endothelium of eyes in G1 were covered with AB (0.2mL, 10mg/mL) for 3 min and then rinsed with balanced salt solution (BSS), while the corneal endothelium of eyes in G2 were covered with BBS for 3 min. Corneas from both groups were stained with alizarin red/trypan blue and visualized by light microscopy. Ten random photographs were taken from each cornea. The area of cellular damage was measured by software in all samples and cell loss of each group was averaged and compared. Endothelial area of denudation and Descemet's membrane exposure were higher in G1 than G2. In conclusion, atracurium besylate induced an acute damage on corneal endothelium of chickens.(AU)'
Objetivou-se avaliar os efeitos agudos do besilato de atracúrio sobre o endotélio corneano de galinhas. Vinte olhos saudáveis de galinhas foram aleatoriamente separados em dois grupos com 10 olhos cada, sendo G1 o grupo controle e G2 o grupo tratamento. Imediatamente após a excisão dos botões corneoesclerais estes foram colocados em lâminas de microscopia de vidro com o lado endotelial voltado para cima. No Grupo 1, o endotélio corneano foi recoberto com 0,2ml de besilato de atracúrio (10mg/ml) durante 3 minutos e depois lavado com solução salina balanceada. No Grupo 2, o endotélio corneano foi recoberto apenas com solução salina balanceada durante 3 min. As córneas de ambos os grupos foram coradas com vermelho de alizarina e azul de tripano e visualizadas com microscópio óptico. Foram obtidas dez fotografias aleatórias de cada amostra. As imagens foram analisadas e com auxílio de um software as áreas com ausência de células endoteliais calculadas. A perda celular endotelial foi significativamente maior no grupo tratamento comparativamente ao grupo controle. Com base nos resultados apresentados foi possível concluir que o besilato de atracúrio induziu dano agudo nas células do endotélio da córnea de galinhas.(AU)
Assuntos
Animais , Atracúrio/efeitos adversos , Endotélio Corneano/patologia , Midríase/veterinária , Galinhas , Perda de Células Endoteliais da Córnea/veterináriaRESUMO
PURPOSE: To quantify endothelial cell loss (ECL) caused by orientation stamps on prestripped and preloaded Descemet membrane endothelial keratoplasty (DMEK) grafts, and to examine a method for reducing ECL using a smaller stamp. METHODS: Ten prestripped and 10 preloaded DMEK grafts were prepared with S-stamps. Ten additional preloaded DMEK grafts were prepared with both an S-stamp and a smaller F-stamp in different paracentral areas of the graft. The footprint of each stamp was measured using ink on cardstock. DMEK grafts were stored in viewing chambers filled with 20 mL of Optisol-GS for 3 days at 4°C. ECL was quantified using Calcein-AM staining and FIJI Weka Segmentation. RESULTS: S-stamps on prestripped DMEK grafts contributed an average ECL of 1.1% ± 0.5% (range: 0.6%-2.2%) toward total graft damage, whereas S-stamps on preloaded DMEK grafts contributed approximately twice that amount (average ECL: 2.0% ± 0.7%, range: 1.3%-3.1%, P = 0.004). Overall ECL for prestripped grafts (average: 7.1% ± 3.3%, range: 3.3%-13.7%) and preloaded grafts (average: 11.3% ± 4.2%, range: 6.9%-19.4%) was similar to previous reports. The footprint of the S-stamp was approximately 45% larger than that of the F-stamp. In 10 preloaded grafts marked with both stamps, the S-stamp caused an average ECL of 1.9% ± 0.6% (range: 1.2%-3.2%), whereas the smaller F-stamp caused an average ECL of 1.0% ± 0.2% (range: 0.8%-1.4%, P = 0.0002). CONCLUSIONS: Loss of endothelial cells associated with graft-stamping was greater in preloaded tissue than in prestripped tissue and was less with a smaller F-stamp than with a larger S-stamp. Using a smaller stamp could help minimize ECL in prestripped and preloaded DMEK grafts.
Assuntos
Perda de Células Endoteliais da Córnea/prevenção & controle , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Bancos de Olhos/métodos , Coleta de Tecidos e Órgãos/métodos , Idoso , Sobrevivência Celular , Perda de Células Endoteliais da Córnea/patologia , Lâmina Limitante Posterior/citologia , Lâmina Limitante Posterior/cirurgia , Endotélio Corneano/citologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Phacoeresis is the procedure through which the lens is surgically removed to treat cataracts. A corneal endothelial loss is a recognized sequel. Although several factors associated with this harm have been described, the surgeons prior experience has been scarcely evaluated. OBJECTIVES: To assess the association between the surgeons experience and other variables associated with a corneal endothelial cell loss in the context of phacoeresis. METHODS: Clinical records of 198 patients undergoing cataract operations were prospectively reviewed. The experience of the surgeon and other variables were recorded, including cumulative dissipated energy, viscoelastic type, the use of trypan blue, amount of fluidics, ultrasound time, combined phacoemulsification energy, and pre- and postoperative corneal endothelial cell counts. RESULTS: No differences were observed in the postoperative corneal endothelial cell count between surgeons with more or less than five years of experience. Nevertheless, ophthalmologists with more than five years experience used less trypan blue, but more cumulative dissipated energy in each procedure, while less experienced ophthalmologists used less fluidics. CONCLUSIONS: Although there were differences in the surgical management regarding the surgeons experience in factors known to influence corneal endothelial cell loss, no differences in endothelial cell loss were observed as an outcome.
INTRODUCCIÓN: La facoéresis es el procedimiento en que se extrae quirúrgicamente el cristalino para tratar las cataratas. La pérdida endotelial corneal es una complicación reconocida. Si bien se han descrito diversos factores asociados a este daño, la experiencia del cirujano ha sido poco explorada. OBJETIVOS: Evaluar la asociación entre la experiencia del cirujano y otras variables asociadas a la pérdida celular endotelial en el contexto de la facoéresis. MÉTODOS: Se analizaron registros clínicos de 198 cirugías de cataratas, evaluando el efecto de la experiencia del cirujano y otras variables asociadas: energía disipada acumulada, tipo de viscoelástico empleado, uso de azul tripán, cantidad de fluídica, tiempo de ultrasonido, energía de facoemulsificación combinada y recuento celular endotelial pre y postoperatorio. RESULTADOS: No se observaron diferencias en el conteo postoperatorio de células endoteliales. Los oftalmólogos con más de cinco años de experiencia presentaron menor uso de azul tripán pero mayor cantidad de energía disipada acumulada en cada procedimiento, mientras que los oftalmólogos con menor experiencia utilizaron mayor cantidad de fluídica. CONCLUSIONES: Aunque hubo diferencias en el manejo de algunos factores influyentes sobre la pérdida endotelial cornal según la experiencia de los oftalmólogos, no se hallaron diferencias en relación a dicha pérdida como resultado final.
Assuntos
Extração de Catarata/efeitos adversos , Perda de Células Endoteliais da Córnea/etiologia , Facoemulsificação/efeitos adversos , Complicações Pós-Operatórias/patologia , Idoso , Idoso de 80 Anos ou mais , Catarata/patologia , Extração de Catarata/métodos , Feminino , Humanos , Masculino , Oftalmologistas , Facoemulsificação/métodos , Estudos ProspectivosRESUMO
PURPOSE: Preloaded, trifolded grafts in Descemet membrane endothelial keratoplasty require transfer of the trifolding process from the corneal transplant surgeon to the eye bank technician. We sought to assess whether trifolding may be safely conducted by an eye bank technician with cell loss comparable to standard peeling and lifting. METHODS: A total of 10 grafts were stained, peeled, and transferred directly onto a bed of Calcein-AM and Amvisc Plus by an eye bank technician. Five grafts were removed and stained as a scroll, and 5 grafts were trifolded with the endothelium in before transfer. Photographs were acquired with an inverted fluorescence microscope, and image segmentation was performed. A t test was conducted to compare differences in endothelial cell loss across groups. RESULTS: Mean cell loss in the scroll group was 18.5% [95% confidence interval (CI): 15.2%-21.9%] compared with 7.6% of the trifolded group (95% CI: 1.7%-13.5%). A 2-tailed t test indicated decreased cell loss in the trifolded group (P = 0.013). CONCLUSIONS: Despite additional manipulation of the graft, trifolding of Descemet membrane and endothelium may be performed by an eye bank technician without significantly increased cell loss relative to graft preparation as a scroll.
Assuntos
Lâmina Limitante Posterior/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Endotélio Corneano/transplante , Bancos de Olhos/métodos , Coleta de Tecidos e Órgãos/métodos , Adulto , Idoso , Perda de Células Endoteliais da Córnea/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To evaluate the complications and clinical results of Descemet membrane endothelial keratoplasty (DMEK) in patients with endothelial failure that occurred during the learning curve of a surgeon. METHODS: Fifty eyes of 50 patients with DMEK and ≥6 months of follow-up were included. The patients were divided into the first 25 (group 1) and the second 25 (group 2) procedures performed by the surgeon. Best corrected visual acuity (BCVA), central corneal thickness (CCT), unfolding time of the Descemet membrane (DM) graft, and intraoperative and postoperative complications were compared between groups. RESULTS: The differences in postoperative increase of BCVA (p=0.595) and decrease of CCT (p=0.725) in the two groups were not significant. The unfolding time of the DM was longer in group 1 than in group 2 (p=0.001). Primary graft failure occurred in three patients in group 1 and none in group 2. At the last visit, 42 (85.7%) of patients' corneas were clear, with significant difference between groups (p=0.584). A patient in group 1 with a history of pars plana vitrectomy, inferior iridectomy, and fluid as a tamponade experienced drop of the DM graft into the iridectomy space. All other intraoperative complications occurred in group 1. CONCLUSIONS: Occurrence of intraoperative and postoperative complications was increased in patients with coexisting ocular pathology or complicated endothelial dysfunction and during the surgeon's learning curve of DM endothelial keratoplasty procedures.
Assuntos
Perda de Células Endoteliais da Córnea/etiologia , Perda de Células Endoteliais da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Complicações Intraoperatórias , Implante de Lente Intraocular/efeitos adversos , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
ABSTRACT Purpose: To evaluate the complications and clinical results of Descemet membrane endothelial keratoplasty (DMEK) in patients with endothelial failure that occurred during the learning curve of a surgeon. Methods: Fifty eyes of 50 patients with DMEK and ≥6 months of follow-up were included. The patients were divided into the first 25 (group 1) and the second 25 (group 2) procedures performed by the surgeon. Best corrected visual acuity (BCVA), central corneal thickness (CCT), unfolding time of the Descemet membrane (DM) graft, and intraoperative and postoperative complications were compared between groups. Results: The differences in postoperative increase of BCVA (p=0.595) and decrease of CCT (p=0.725) in the two groups were not significant. The unfolding time of the DM was longer in group 1 than in group 2 (p=0.001). Primary graft failure occurred in three patients in group 1 and none in group 2. At the last visit, 42 (85.7%) of patients' corneas were clear, with significant difference between groups (p=0.584). A patient in group 1 with a history of pars plana vitrectomy, inferior iridectomy, and fluid as a tamponade experienced drop of the DM graft into the iridectomy space. All other intraoperative complications occurred in group 1. Conclusions: Occurrence of intraoperative and postoperative complications was increased in patients with coexisting ocular pathology or complicated endothelial dysfunction and during the surgeon's learning curve of DM endothelial keratoplasty procedures.
RESUMO Objetivo: Avaliar as complicações e os resultados clínicos da queratoplastia endotelial da membrana de Descemet (DMEK) em indivíduos com insuficiência endotelial, durante a curva de aprendizado de um cirurgião. Métodos: Cinquenta olhos de 50 pacientes submetidos ao procedimento queratoplastia endotelial da membrana de Descemet com pelo menos 6 meses de acompanhamento foram incluídos neste estudo. Os pacientes foram divididos em dois grupos: como os primeiros 25 casos do cirurgião (grupo 1) e como os 25 casos seguintes (grupo 2). A melhor acuidade visual corrigida (MAVC), a espessura corneana central (ECC), o tempo de desdobramento do enxerto da membrana de Descemet (MD), as complicações intraoperatórias e pós-operatórias foram apresentadas e comparadas entre os grupos. Resultados: Os grupos não diferiram estatisticamente em relação ao aumento pós-operatório de melhor acuidade visual corrigida (p=0,595) ou à diminuição da espessura corneana central (p=0,725). O tempo de desdobramento dos enxertos de membrana de Descemet no grupo 1 foi maior do que no grupo 2 (p=0,001). Falha do enxerto primário foi observada em 3 pacientes do grupo 1 e em nenhum do grupo 2. Na última visita, 42 (85,7%) das córneas dos pacientes estavam claras e não foram observadas diferenças estatisticamente significativas entre os grupos (p=0,584). Na cirurgia de um paciente do grupo 1, com história de vitrectomia pars plana (PPV) com iridectomia inferior e fluido como tamponamento, observou-se queda do enxerto de membrana de Descemet no local da iridectomia. Além disso, todas as demais complicações intraoperatórias ocorreram no grupo 1. Conclusões: As complicações intraoperatórias e pós-operatórias foram maiores em pacientes com coexistência de outra patologia ocular ou com disfunção endotelial complicada durante as curvas de aprendizado dos cirurgiões no procedimento queratoplastia endotelial da membrana de Descemet.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias , Implante de Lente Intraocular/efeitos adversos , Perda de Células Endoteliais da Córnea/cirurgia , Perda de Células Endoteliais da Córnea/etiologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Complicações Intraoperatórias , Acuidade Visual , Estudos Retrospectivos , Resultado do Tratamento , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodosRESUMO
Resumen Introducción La facoéresis es el procedimiento en que se extrae quirúrgicamente el cristalino para tratar las cataratas. La pérdida endotelial corneal es una complicación reconocida. Si bien se han descrito diversos factores asociados a este daño, la experiencia del cirujano ha sido poco explorada. Objetivos Evaluar la asociación entre la experiencia del cirujano y otras variables asociadas a la pérdida celular endotelial en el contexto de la facoéresis. Métodos Se analizaron registros clínicos de 198 cirugías de cataratas, evaluando el efecto de la experiencia del cirujano y otras variables asociadas: energía disipada acumulada, tipo de viscoelástico empleado, uso de azul tripán, cantidad de fluídica, tiempo de ultrasonido, energía de facoemulsificación combinada y recuento celular endotelial pre y postoperatorio. Resultados No se observaron diferencias en el conteo postoperatorio de células endoteliales. Los oftalmólogos con más de cinco años de experiencia presentaron menor uso de azul tripán pero mayor cantidad de energía disipada acumulada en cada procedimiento, mientras que los oftalmólogos con menor experiencia utilizaron mayor cantidad de fluídica. Conclusiones Aunque hubo diferencias en el manejo de algunos factores influyentes sobre la pérdida endotelial cornal según la experiencia de los oftalmólogos, no se hallaron diferencias en relación a dicha pérdida como resultado final.
Abstract Introduction Phacoeresis is the procedure through which the lens is surgically removed to treat cataracts. A corneal endothelial loss is a recognized sequel. Although several factors associated with this harm have been described, the surgeon's prior experience has been scarcely evaluated. Objectives To assess the association between the surgeon's experience and other variables associated with a corneal endothelial cell loss in the context of phacoeresis. Methods Clinical records of 198 patients undergoing cataract operations were prospectively reviewed. The experience of the surgeon and other variables were recorded, including cumulative dissipated energy, viscoelastic type, the use of trypan blue, amount of fluidics, ultrasound time, combined phacoemulsification energy, and pre- and postoperative corneal endothelial cell counts. Results No differences were observed in the postoperative corneal endothelial cell count between surgeons with more or less than five years of experience. Nevertheless, ophthalmologists with more than five years' experience used less trypan blue, but more cumulative dissipated energy in each procedure, while less experienced ophthalmologists used less fluidics. Conclusions Although there were differences in the surgical management regarding the surgeons' experience in factors known to influence corneal endothelial cell loss, no differences in endothelial cell loss were observed as an outcome.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/patologia , Extração de Catarata/efeitos adversos , Facoemulsificação/efeitos adversos , Perda de Células Endoteliais da Córnea/etiologia , Catarata/patologia , Extração de Catarata/métodos , Estudos Prospectivos , Facoemulsificação/métodos , OftalmologistasRESUMO
PURPOSE: To investigate the effects of pterygium on corneal endothelial cell density in patients with unilateral pterygium. METHODS: We performed a cross-sectional analysis of data from patients with unilateral pterygium who were selected from September 1, 2015 to July 31, 2016 at Hospital de Base do Distrito Federal to assess the corneal endothelial cell density, coefficient of variation in the cell area, hexagonality, and corneal pa-chymetric results. In all patients, noncontact specular microscopy was performed in both eyes and a minimum endothelial cell count of 75 cells/mm2 was required for inclusion in the study. The contralateral eye served as the control. RESULTS: Sixty-one patients were included in the study. Twenty-nine (47.5%) patients were men and 32 (52.5%) were women (mean age, 50.84 ± 13.8). The percentage of pterygium that invaded the cornea ranged from 4.87% to 24.59% (median, 9.70% ± 4.99%). The mean corneal endothelial cell density (cells/mm) was lower in the pterygium eyes than in the controls (2451.83 ± 284.96 vs. 2549.95 ± 268.94, respectively; p=0.04). No differences in the mean coefficients of variation of cell size, hexagonality, and corneal pachymetric results were observed between the patients and controls. The Pearson correlation test showed a significant negative linear relationship between pterygium invasion and endothelial cell density [p<0.001, n=61, r=-0.553 (95% CI, -0.34 to -0.73)]. CONCLUSION: Compared with the contralateral eyes, those of patients with unilateral pterygium were associated with a decrease in corneal endothelial cell density.
Assuntos
Perda de Células Endoteliais da Córnea/patologia , Células Endoteliais/patologia , Endotélio Corneano/patologia , Pterígio/patologia , Adulto , Idoso , Estudos de Casos e Controles , Contagem de Células , Paquimetria Corneana , Estudos Transversais , Feminino , Humanos , Masculino , Microscopia/métodos , Pessoa de Meia-Idade , Fotografação , Estatísticas não ParamétricasRESUMO
PURPOSE: To evaluate the outcomes of the first cases of Descemet membrane endothelial keratoplasty (DMEK) performed by an anterior segment surgeon, learning the procedure, including graft preparation, primarily from watching YouTube videos. DMEK surgery was not learned during fellowship training; there was no attendance at DMEK courses, no witnessing of live surgery, and no supervision by an experienced DMEK surgeon. All graft tissue was prepared by the surgeon on the day of surgery. METHODS: This is a retrospective review of the 3-month postoperative results of the first 40 consecutive cases. The success rate of graft preparation, intraoperative and postoperative complications, spectacle-corrected visual acuity, endothelial cell density, and central corneal thickness were evaluated. RESULTS: Grafts were successfully prepared in all cases with no loss of donor tissue. DMEK surgery was successful in 39 of 40 eyes with the one failure occurring in a vitrectomized eye without an intact iris-lens diaphragm. Spectacle-corrected visual acuity was ≥6/6 in 23 of the 25 eyes without comorbidity. Mean endothelial cell density was 1515 (±474) cells/mm. Mean central corneal thickness decreased from 624 (±40) µm preoperatively to 513 (±34) µm postoperatively. CONCLUSIONS: Although formal training is desirable, good results can be obtained by an anterior segment surgeon learning DMEK, including graft preparation, without it. DMEK should no longer be considered a procedure with a long learning curve in routine cases.
Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/educação , Educação Médica Continuada/métodos , Internet , Mídias Sociais , Coleta de Tecidos e Órgãos/educação , Adulto , Idoso , Idoso de 80 Anos ou mais , Córnea/patologia , Perda de Células Endoteliais da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/normas , Feminino , Humanos , Complicações Intraoperatórias , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/normas , Acuidade Visual , Adulto JovemRESUMO
ABSTRACT Purpose: To investigate the effects of pterygium on corneal endothelial cell density in patients with unilateral pterygium. Methods: We performed a cross-sectional analysis of data from patients with unilateral pterygium who were selected from September 1, 2015 to July 31, 2016 at Hospital de Base do Distrito Federal to assess the corneal endothelial cell density, coefficient of variation in the cell area, hexagonality, and corneal pachymetric results. In all patients, noncontact specular microscopy was performed in both eyes and a minimum endothelial cell count of 75 cells/mm2 was required for inclusion in the study. The contralateral eye served as the control. Results: Sixty-one patients were included in the study. Twenty-nine (47.5%) patients were men and 32 (52.5%) were women (mean age, 50.84 ± 13.8). The percentage of pterygium that invaded the cornea ranged from 4.87% to 24.59% (median, 9.70% ± 4.99%). The mean corneal endothelial cell density (cells/mm) was lower in the pterygium eyes than in the controls (2451.83 ± 284.96 vs. 2549.95 ± 268.94, respectively; p=0.04). No differences in the mean coefficients of variation of cell size, hexagonality, and corneal pachymetric results were observed between the patients and controls. The Pearson correlation test showed a significant negative linear relationship between pterygium invasion and endothelial cell density [p<0.001, n=61, r=-0.553 (95% CI, -0.34 to -0.73)]. Conclusion: Compared with the contralateral eyes, those of patients with unilateral pterygium were associated with a decrease in corneal endothelial cell density.
RESUMO Objetivo: Investigar os efeitos do pterígio na densidade de células endoteliais corneanas em pacientes com pterígio unilateral. Métodos: Foi realizado um estudo do tipo transversal envolvendo pacientes com pterígio unilateral selecionados entre 1 de setembro de 2015 a 31 de julho de 2016 no Hospital de Base do Distrito Federal para avaliar a densidade de células endoteliais corneanas, coeficiente de variação da área celular, hexagonalidade, e paquimetria corneana. Em todos os pacientes foram realizadas microscopias especulares de não-contato em ambos os olhos, sendo necessário obter uma contagem endotelial mínima de 75 células/mm2 para que o paciente fosse incluído no estudo. O olho contralateral funcionou como grupo controle. Resultados: Um total de 61 pacientes foram incluídos no estudo. Vinte e nove (47,5%) eram homens e 32 (52,5%) mulheres. A média de idade era de 50,84 ±13,8. O percentual de invasão do pterígio na córnea variou entre 4,87% a 24,59%, com uma mediana de 9,70% ± 4,99%. A media de densidade de células endoteliais corneanas foi menor nos olhos com pterígio quando comparados ao grupo controle (2451,83 ± 284,96 vs 2549,95 ± 268,94; p=0,04). Não foram encontradas diferenças entre os casos e controles em relação à média do coeficiente de variação da área celular, hexagonalidade, e paquimetria. Teste de correlação de Pearson mostrou uma relação linear negativa entre a invasão do pterígio e a densidade de células endoteliais corneanas [p<0,001, n=61, r=-0,553 (95% CI -0,34 a -0,73)]. Conclusão: Em pacientes com pterígio unilateral, o olho com pterígio está associado a uma menor densidade de células endoteliais corneanas quando comparado ao olho contralateral.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pterígio/patologia , Endotélio Corneano/patologia , Células Endoteliais/patologia , Perda de Células Endoteliais da Córnea/patologia , Fotografação , Estudos de Casos e Controles , Contagem de Células , Estudos Transversais , Estatísticas não Paramétricas , Paquimetria Corneana , Microscopia/métodosRESUMO
PURPOSE: To evaluate outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous trabeculectomy or a drainage device. METHODS: This is a retrospective study of 108 consecutive DMEK performed between October 2013 and December 2015. All eyes were divided into 3 groups: surgical treatment (ST) group, medical treatment (MT) group, and control group. Visual improvement, endothelial cell loss, and postoperative complications, including rejection, graft failure, and intraocular pressure elevation (≥25 mm Hg) were evaluated. RESULTS: The length of follow-up was 9.7 ± 7.3 months. Best-corrected visual acuity (BCVA) improved postoperatively in 85.3% of the ST group, 100% of the MT group, and 93% of the control (P = 0.24). Significantly more lines of BCVA were gained in the ST and MT groups (8.1 ± 8.1 and 9.2 ± 6.3 lines, respectively) than in the control (4.8 ± 5.6 lines, P < 0.05). The mean time to BCVA was 2.9 ± 2.8 months for the ST group, 4.7 ± 5.3 months for the MT group, and 3.0 ± 3.3 months for the control (P = 0.75). Endothelial cell loss was greater in the ST group (44.6 ± 17.8%) than in the MT group (29.9 ± 12.0%) and the control group (32.7 ± 11.3%, P = 0.001). There was one primary failure and no secondary graft failures. The overall rejection rate was 0.9%. Postoperative intraocular pressure elevation was less common in the ST group (14.7%) and control (23.3%) than in the MT group (50.0%, P = 0.04). There was no difference in the air injection rate among all groups (P = 1.0). CONCLUSIONS: DMEK in eyes with previous trabeculectomy and drainage device can result in very good short-term outcomes.
Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Trabeculectomia , Idoso , Contagem de Células , Doenças da Córnea/fisiopatologia , Perda de Células Endoteliais da Córnea/fisiopatologia , Endotélio Corneano/patologia , Feminino , Sobrevivência de Enxerto/fisiologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To compare outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) when an experienced DSAEK surgeon transitions to DMEK while following 2 published endothelial keratoplasty surgical techniques. METHODS: This is a retrospective review of 200 eyes of 132 patients with Fuchs corneal dystrophy that underwent endothelial keratoplasty performed by one surgeon. Published, standardized techniques were followed for both DSAEK and DMEK. Postoperative complications were recorded. Best spectacle-corrected visual acuity (BSCVA), intraocular pressure, and central endothelial cell loss (ECL) were evaluated at 6 months postoperatively. RESULTS: There were no intraoperative complications. One DSAEK and 5 DMEK grafts developed graft detachment requiring rebubbling (P = 0.097). No iatrogenic primary graft failures occurred in the DSAEK group compared with one in the DMEK group. No pupil block episodes occurred in the DSAEK group compared with one in the DMEK group. Posterior synechiae formation occurred 15 times in the DMEK group and did not occur in the DSAEK group (P < 0.001). At 6 months, BSCVA was better in the DMEK group than in the DSAEK group (20/24; logMAR = 0.0844-20/32; logMAR = 0.2063) (P < 0.001). More eyes reached 20/20 or better BSCVA in the DMEK group compared with DSAEK (54.5%-13%) (P < 0.011). At 6 months, ECL was higher in the DMEK group than in the DSAEK group (31.9%-19.9%) (P < 0.001). CONCLUSIONS: Complications can be minimized and excellent outcomes can be achieved, without a steep learning curve, when an experienced DSAEK surgeon transitions to DMEK following a standardized technique. Six-month vision outcomes are better in the DMEK group; however, the rate of a newly described complication, posterior synechiae formation, and 6-month ECL are higher in the DMEK group than in the DSAEK group.
Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Distrofia Endotelial de Fuchs/cirurgia , Curva de Aprendizado , Oftalmologistas , Idoso , Contagem de Células , Perda de Células Endoteliais da Córnea/fisiopatologia , Endotélio Corneano/patologia , Feminino , Distrofia Endotelial de Fuchs/fisiopatologia , Sobrevivência de Enxerto/fisiologia , Humanos , Pressão Intraocular/fisiologia , Complicações Intraoperatórias , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To evaluate outcomes after Descemet stripping automated endothelial keratoplasty in eyes with glaucoma drainage devices. METHODS: This is a retrospective review of 24 cases performed by a single surgeon (S.B.H.) on 20 eyes. Data were gathered on demographics, ocular history, surgical details, and postoperative outcomes. Outcome measures included primary graft failure, secondary graft failure, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure, and visual acuity. RESULTS: With a mean follow-up of 30.3 ± 19.6 months, there was no occurrence of primary graft failure, and the rate of secondary graft failure was 29%. Survival rates at 1, 2, and 3 years, respectively, were 87% [95% confidence interval (CI): 65%-96%], 80% (95% CI: 55%-92%), and 70% (95% CI: 39%-88%). Compared with ECD of the donor lenticule, endothelial cell loss was 49 ± 16% (n = 21) at postoperative month 3, 59 ± 16% (n = 20) at month 6, 61 ± 20% (n = 16) at month 12, and stabilized at 75 ± 17% (n = 9) by month 18. Compared with CCT during the visit before surgery, CCT decreased to 83 ± 18% (n = 18) at postoperative month 3 and gradually increased to 95 ± 11% (n = 6) at month 24. There were 4 (17%) cases of intraocular pressure elevation above 25 mm Hg. Improved visual acuity occurred in 71% of patients. CONCLUSIONS: Descemet stripping automated endothelial keratoplasty in eyes with corneal edema secondary to endothelial dysfunction in the presence of a previous glaucoma drainage device is a successful procedure. However, intermediate term endothelial cell loss is significant, as is the graft failure rate.