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- ItemAcesso aberto (Open Access)Complicações iniciais do uso de dois microceratótomos automatizados(Conselho Brasileiro de Oftalmologia, 2001-06-01) Passos, Monica Do Carmo [UNIFESP]; Takahashi, Ricardo [UNIFESP]; Mori, Edson S. [UNIFESP]; Suzuki, César K. [UNIFESP]; Schor, Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To describe per- and postoperative complications which occurred with the first use of two automated microkeratomes for the performance of LASIK. Methods: Retrospective study of first surgeries performed with two automated microkeratomes. Seventy eyes from 54 patients using Chiron's® microkeratome, Automated Corneal Shaper (ACS) model, from April 1997 to April 1998 and 100 eyes from 82 patients using automated microkeratome Moria® Carriazo-Barraquer (CB), from February 1999 to June 1999. Refractive ablation was performed with the Summit Apex Plus Excimer Laser (193 nm). We evaluated the per- and postoperative complications up to one month of follow-up. Results: Photoablation was not performed in three cases (4.3%) using ACS microkeratome and in one case (1%) using CB microkeratome. Most frequent complications found with ACS were: failure of automated return of microkeratome (7.1%), partial keratotomy (4.3%), presence of stromal folds (14.3%), central de-epithelialization (4.3%). With CB there were: descentered flap (3%), central desepitheliazation (5%), stromal folds (28%) and Sahara Sands syndrome (6%). Conclusions: Initial use of both microkeratomes was related to important per- and postoperative complications, which did not lead to loss of vision. Clinical knowledge of the alterations which occurred with the use of these instruments and a better experience of their utilization may reduce these complications.
- ItemAcesso aberto (Open Access)Primeiro censo brasileiro em cirurgia refrativa(Conselho Brasileiro de Oftalmologia, 2005-12-01) Victor, Gustavo; Urbano, Andreia [UNIFESP]; Marçal, Sônia; Porto, Ricardo; Francesconi, Claudia Maria [UNIFESP]; Forseto, Adriana dos Santos [UNIFESP]; Barth, Breno; Alves, Milton Ruiz; Nosé, Walton [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Eye Clinic Day Hospital; Universidade Metropolitana de SantosPURPOSE: To perform the first Brazilian refractive surgery survey. METHODS: Between August 2001 and February 2002, a questionnaire was mailed to 7890 Brazilian ophthalmologists. The questionnaire presented questions about demographic aspects, technology, instruments, market, trends, practice patterns and cost of refractive surgery. RESULTS: Nine hundred and twenty questionnaires (11.67%) were answered. LASIK is the preferred technique for correction between +5.00 and -7.00 D. The mostly used excimer laser is Nidek® EC 5000, and Hansatome is the mostly used microkeratome. Others aspects like: demographic, techniques, practice patterns, trends, market, and pre-, intra- and postoperative care, were analyzed. CONCLUSION: With this survey, the Brazilian ophthalmologists can observe and monitor these aspects of refractive surgery in Brazil, and compare them with others surveys.
- ItemAcesso aberto (Open Access)Refractional results of LASIK retreatment with wavefront-guided ablation versus standard ablation(Consel Brasil Oftalmologia, 2008-09-01) Urbano, Andreia Peltier [UNIFESP]; Nose, Walton [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To evaluate refractive outcomes of wavefront-guided LASIK (Zyoptix, Bausch & Lomb) versus standard LASIK (PlanoScan, Bausch & Lomb) in retreatment of primary LASIK for myopia and myopic astigmatism. Methods: A prospective, randomized trial with paired eye control of 74 eyes from 37 patients who underwent LASIK retreatment was performed. Each patient underwent retreatment using Zyoptix LASIK in 1 eye and Planoscan LASIK in the contralateral eye. A complete ophthalmologic examination was performed, including evaluation of high contrast visual acuity and manifest refraction, with a follow-up of 6 months. Results: Both Zyoptix and Planoscan groups had similar values of high contrast visual acuity, gain and loss of best spectacle-corrected visual acuity, safety and efficacy indexes, percentage of eyes with spherical equivalent within +/- 0,50 D and +/- 1,00 D in the postoperative period of 6 months. in the Zyoptix group, the values of spherical component and spherical equivalent of manifest refraction were more hyperopic than in the Planoscan group in the postoperative periods of 1 week, 1, 3 and 6 months. the predictability of spherical equivalent correction was better for the Zyoptix group than for the Planoscan group at 6 months. Conclusions: Wavefront-guided LASIK with Zyoptix produces superior refractive outcomes than standard LASIK with Planoscan in retreatment of refractive errors after primary LASIK. High contrast visual acuity measures are not sensitive in showing the best technique.
- ItemAcesso aberto (Open Access)Resultados a curto prazo de ceratotomia lamelar pediculada (LASIK) para correção de hipermetropia com o sistema Ladar Vision de excimer laser(Conselho Brasileiro de Oftalmologia, 2004-02-01) Nunes, Larissa Madeira [UNIFESP]; Francesconi, Cláudia Maria [UNIFESP]; Campos, Mauro Silveira de Queiroz [UNIFESP]; Schor, Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To analyze the efficacy and safety of hyperopic laser in situ keratomileusis using the Ladar Vision excimer laser system. METHODS: Twenty-eight eyes of 17 patients with hyperopia from +1.00 to +3.00 D (group 1), and 29 eyes of 18 patients with hyperopia from +3.25 to +6.00 D (group 2) that had LASIK for hyperopia with the Ladar Vision, were retrospectively analyzed. Uncorrected visual acuity, best spectacle-corrected visual acuity and cycloplegic refraction were evaluated 1 , 3 and 6 months after surgery. RESULTS: In group 1, the mean preoperative cycloplegic spherical equivalent (SE) was +2.14 ± 0.64 D and 6-month postoperative SE was +0.44 ± 0.38 D. In group 2, the mean preoperative SE was +4.26 ± 0.75 D and the 6-month postoperative SE was +1.14 ± 0.63 D. 3.4% of the eyes in group 2 and none of the eyes in group 1 lost 2 or more lines of best spectacle-corrected visual acuity in the first postoperative month. CONCLUSIONS: LASIK with the Ladar Vision excimer laser system is an effective and safe procedure to correct hyperopia. Patients in group 2 appear to be at greater risk for loss of lines of best spectacle-corrected visual acuity.
- ItemAcesso aberto (Open Access)Use of the Ishikawa diagram in a case-control analysis to assess the causes of a diffuse lamellar keratitis outbreak(Consel Brasil Oftalmologia, 2017) Lira, Luis Henrique [UNIFESP]; Hirai, Flavio E. [UNIFESP]; Oliveira, Marivaldo; Portellinha, Waldir; Nakano, Eliane Mayumi [UNIFESP]Purpose: To identify the causes of a diffuse lamellar keratitis (DLK) outbreak using a systematic search tool in a case-control analysis. Methods: An Ishikawa diagram was used to guide physicians to determine the potential risk factors involved in this outbreak. Coherence between the occurrences and each possible cause listed in the diagram was verified, and the total number of eyes at risk was used to calculate the proportion of affected eyes. Multivariate analysis was performed using logistic regression to determine the independent effect of the risk factors, after controlling for confounders and test interactions. Results: All DLK cases were reported in 2007 between June 13 and December 21 during this period, 3,698 procedures were performed. Of the 1,682 flap-related procedures, 204 eyes of 141 individuals presented with DLK. No direct relationship was observed between the occurrence of DLK and the presence of any specific factors however, flap-lifting enhancements, procedures performed during the morning shift, and non-use of therapeutic contact lenses after the surgery were significantly related to higher occurrence percentages of this condition. Conclusions: The Ishikawa diagram, like most quality tools, is a visualization and knowledge organization tool. This systematization allowed the investigators to thoroughly assess all the possible causes of DLK outbreak. A clear view of the entire surgical logistics permitted even more rigid management of the main factors involved in the process and, as a result, highlighted factors that deserved attention. The case-control analysis on every factor raised by the Ishikawa diagram indicated that the commonly suspected factors such as biofilm contamination of the water reservoir in autoclaves, the air-conditioning filter system, glove powder, microkeratome motor oil, and gentian violet markers were not related to the outbreak.