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- ItemAcesso aberto (Open Access)Achados oculares em pacientes com mais de 99 anos(Conselho Brasileiro de Oftalmologia, 2006-10-01) Cypel, Marcela Colussi [UNIFESP]; Palácio, Guilherme [UNIFESP]; Dantas, Paulo Elias Correa; Lottenberg, Cláudio Luis [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia de São Paulo Departamento de Oftalmologia Setor de Urgência e Pronto Socorro; Santa Casa de Misericórdia de São Paulo Departamento de Oftalmologia Seção de Córnea e Doenças Externas; Hospital Albert Einstein Instituto Israelita de Ensino e PesquisaPURPOSE: To determine vision conditions and ocular findings in patients older than 99 years. METHODS: Patients were recruited by media advertisement and examined at the Vision Institute of UNIFESP. The following examinations were performed: visual acuity, ectoscopy, refraction, biomicroscopy, tear film break-up time, Schirmer basal test, tonometry, direct and indirect ophthalmoscopy. Complementary examinations such as optical coherence tomography were performed when indicated. RESULTS: Thirty patients older than 99 years were identified. Mean age of 101.5±1.8, 25 females and 5 males. Most common systemic disease, according to history, was arterial hypertension. In 11 patients (55%), the best corrected far visual acuity was 20/100 or better. The best corrected near visual acuity was J4 or better also in 55% (11 patients) and 63.0% (7 patients) of these were the ones that had not been submitted to cataract surgery. The most frequent visual complaint was low vision for reading (55%) and other 8 patients (40%) reported no disturbance (satisfied with their vision). Lens opacity was present in 9 patients (60%) and 8 patients (40%) had previous cataract surgery (5 aphakic eyes, 9 pseudophakic eyes). Cataract was identified as important for impairment of vision in 5 patients but only 2 of them wanted to be submitted to surgery. The main cause of visual impairment was age-related macular degeneration, present in all patients, 95% with no exudative form. Vision improved with new refractive prescription in 4 patients. CONCLUSION: Once we understand the needs we can plan specific diagnostic and treatment strategies. This sample showed that most were female (83.3%), with good general health (35%), most with systemic arterial hypertension (40%), complaining of low vision for reading (55%) because of age-related macular degeneration (100%, 95% dry form). Only 40% had been previously submitted to cataract surgery. Most of the patients with cataract said to be satisfied with their vision; of the 5 patients that could be operated only 2 decided to do it. Low vision for reading, AMD and cataract were the main findings.
- ItemSomente MetadadadosAcuidade de resolução e mudanças no erro refrativo em crianças até três anos de idade(Universidade Federal de São Paulo (UNIFESP), 1990) Salomão, Solange Rios [UNIFESP]; Ventura, Dora Selma Fix [UNIFESP]
- ItemSomente MetadadadosAcuidade visual de resolução medida pelo teste dos cartões de acuidade: normas populacionais e aplicações em triagem e na clínica(Universidade Federal de São Paulo (UNIFESP), 1993) Salomão, Solange Rios [UNIFESP]; Ventura, Dora Selma Fix [UNIFESP]
- ItemAcesso aberto (Open Access)Acuidade visual e achados de eletrorretinografia de campo total em pacientes com retinose pigmentária(Universidade Federal de São Paulo, 2023-01-16) Benyhe, Evelyn Santana [UNIFESP]; Sacai, Paula Yuri [UNIFESP]; Berezovsky, Adriana [UNIFESP]; http://lattes.cnpq.br/1336685192142760; http://lattes.cnpq.br/6877836442964718; http://lattes.cnpq.br/9893956477529122Objetivo: Retinose pigmentária inclui um grupo de distrofias retinianas progressivas, hereditárias caracterizada por nictalopia, perda progressiva de campo visual periférico e alteração funcional da retina. O objetivo deste estudo foi analisar o perfil demográfico, acuidade visual e achados eletrorretinográficos em pacientes com retinose pigmentária atendidos em um serviço universitário. Métodos: Estudo observacional retrospectivo descritivo foi realizado a partir da revisão de prontuários dos pacientes com retinose pigmentária atendidos no Setor de Eletrofisiologia Visual Clínica do Departamento de Oftalmologia e Ciências Visuais da Unifesp, nos últimos 5 anos. Os critérios de inclusão foram pacientes de ambos os sexos que apresentavam diagnóstico confirmado de retinose pigmentária pelo prontuário eletrônico do Hospital São Paulo e avaliação clínica por médico oftalmologista especialista em retina. Além disso, levou-se em consideração se os achados eletrofisiológicos, comparando-os com normas descritas na literatura, juntamente com o exame de fundoscopia e outros exames relacionados (angiofluoresceinografia, campo visual, visão de cores) estavam de acordo com o diagnóstico de retinose pigmentária. Resultados: De um total de 436 pacientes novos, foram elegíveis 36 pacientes com retinose pigmentária (19 homens), com idades variando entre 6 a 67 anos (média = 36,4±15,9; mediana 37,3 anos. Consanguinidade familiar foi encontrada em 9 (23,7%) dos pacientes. Os principais sintomas foram perda de campo visual periférico e dificuldade de visão noturna (nictalopia) progressiva relatados por todos pacientes e fotofobia em 23 pacientes (63,9%). A acuidade visual no melhor olho variou de 0 a 2,3 logMAR (média: 0,70 logMAR ± 0,61; mediana: 0,5 logMar). No olho de pior visão a acuidade variou de 0,1 a 2,8 logMAR (média: 0,87 logMAR ± 0,66; mediana: 0,6 logMar). As respostas para bastonetes foram não detectáveis em 29 (80,5%) e resposta combinada em 16 (44,4%). Não houve correlação entre AV e amplitude da resposta de cones (r= 0,009; p=0,956) e da AV e resposta de flicker (r= 0,087; p=0,604) do melhor olho. As respostas fotópicas de cones foram não detectáveis em 13 (36,1%) e 12 (33,3%) para o flicker a 30Hz.Todos os casos com amplitudes de cones dentro da normalidade (8,3%) para resposta fotópica de cones e flicker a 30Hz (13,8%) apresentaram atraso no tempo de resposta. Os limiares de adaptação ao escuro mostraram-se maior do que 30dB em 12 pacientes (33,33%) dos casos que colaboraram e elevados em 52,78%. Conclusões: Neste pequeno grupo de pacientes com retinose pigmentária, 19,4% apresentaram AV de 20/32 ou melhor. As respostas escotópicas de bastonetes foram na grande maioria ausentes (80,5%) e reduzida (19,5%) e as respostas de cones foram ausentes em aproximadamente 35% e atrasadas nos casos com amplitudes normais nesta amostra estudada. A maioria dos pacientes adultos teve acesso ao conhecimento com ensino fundamental completo (82,7%) e a maioria dos pacientes (89%) estava inserido em atividades ocupacionais/ laborais.
- ItemAcesso aberto (Open Access)Acuidade visual e eletrorretinografia de campo total em pacientes com síndrome de Usher(Conselho Brasileiro de Oftalmologia, 2005-04-01) Mendieta, Luana [UNIFESP]; Berezovsky, Adriana [UNIFESP]; Salomão, Solange Rios [UNIFESP]; Sacai, Paula Yuri [UNIFESP]; Pereira, Josenilson Martins [UNIFESP]; Fantini, Sérgio Costa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: Usher's syndrome (US) is a group of genetically distinct autossomal conditions, characterized by sensorineural hearing loss accompanied by a retinal dystrophy indistinguishable from retinitis pigmentosa (RP). The purpose of this study was to analyze full-field electroretinography (ERG) and visual acuity (VA) among patients with type I and II Usher's syndrome. METHODS: Electroretinography responses and visual acuity were studied in 22 patients (mean age at test = 26.8±16.8 years). Seventeen patients had SU type I and 5 patients were diagnosed as Usher's syndrome type II. RESULTS: Mean visual acuity was 0.9 logMAR (20/160, Snellen equivalent) for patients with Usher's syndrome type I and 0.4 logMAR (20/50, Snellen equivalent) for patients with Usher's syndrome type II. Scotopic rod and maximal responses were non-detectable in both groups. Mean amplitude for oscillatory potentials was 14.5 µV ±6.1 in Usher's syndrome type I and 12.6 µV±5.2 in Usher's syndrome type II. Cone responses were non-detectable in 95% of the patients with Usher's syndrome I and in 100% of patients with Usher's syndrome II. Mean amplitude for 30 Hz flicker photopic cone response was 3.1 µV±4.1 for Usher's syndrome type I and 1.0 µV±0.6 for type II with mean implicit time of 34.0 ms±6.2 (US I) and 35.8 ms±3.1 (type II). CONCLUSIONS: Visual acuity was relatively preserved in both groups, however Usher's syndrome II group showed better visual acuity results. Electroretinography findings were severely reduced in both groups, with most patients showing non-detectable rod and cone responses.
- ItemAcesso aberto (Open Access)Acuidade visual e função de bastonetes em pacientes com retinose pigmentária(Conselho Brasileiro de Oftalmologia, 2004-10-01) Berezovsky, Adriana [UNIFESP]; Pereira, Josenilson Martins [UNIFESP]; Sacai, Paula Yuri [UNIFESP]; Fantini, Sérgio Costa [UNIFESP]; Salomão, Solange Rios [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To investigate visual acuity and rod function, and correlate them to different clinical parameters in patients with retinitis pigmentosa (RP). METHODS: A cohort of 199 patients with retinitis pigmentosa (110 males and 89 females), aged 6-79 years (mean = 36.8±17.5) had their monocular visual acuity measured by the ETDRS chart and rod function assessed by full-field electroretinogram and dark-adapted thresholds. The distribution of different genetic subtypes of retinitis pigmentosa was 20.3% autosomal dominant, 14.2% X - linked, 24.2% autosomal recessive and 41.3% isolated. History of consanguinity was found in 41 (20.6%) patients. Forty-one patients (20.6%) were 20 years old or less, 77 (38.6%) ranged from 21 - 40 years, 61 (30.7%) from 41 - 60 years, and 20 (10.1%) were 61 years or older. Peak-to-peak amplitude and b-wave implicit time were measured and statistically analyzed (one-way ANOVA). Pearson correlation was performed between rod amplitude and dark-adapted thereshold and rod amplitude and visual acuity. RESULTS: Analyzing the visual acuity data according to genetic subtypes, without considering age, showed that as a group, patients with autosomal recessive and isolated retinitis pigmentosa have less severe impairment of visual acuity, than those with X-linked retinitis pigmentosa. Nyctalopia begun earlier in X-linked groups, compared with the remaining groups (p=0.011). A negative correlation was found between dark-adapted thereshold and scotopic rod amplitude (Pearson correlation coefficient = - 0.772 and P =0.000). There were no significant relationships between visual acuity and rod response by electroretinogram (Pearson correlation coefficient = 0.0815 and P = 0.286), P > 0.050. CONCLUSIONS: In a cohort of retinitis pigmentosa patients, 31.2% had vision of 20/40 or better. Rod function loss was highly correlated when assessed electrophysiologically (ERG) and psychophysically (dark-adapted thershold). No correlation was found between rod response measured by electroretinogram and visual acuity.
- ItemAcesso aberto (Open Access)Acuidade visual, sensibilidade ao contraste, acuidade estereoscópica: estudo de caso controle em escolares com baixo peso ao nascer(Universidade Federal de São Paulo (UNIFESP), 2016-01-04) Ferrari, Maria Valeria [UNIFESP]; Puccini, Rosana Fiorini [UNIFESP]; http://lattes.cnpq.br/1088228713801713; http://lattes.cnpq.br/4439963251732624; Universidade Federal de São Paulo (UNIFESP)Low birth weight (LBW) is one of the most important risk factors for neonatal mortality in addition to being one of the determinants of morbidity in childhood. The emergence of new technologies has provided a high survival rate in this group of infants with low birth weight, however, does not prevent the onset of sequelae that can lead to damage to neurodevelopment. Prematurity and congenital infections as well as intrauterine growth restriction are some factors related to LBW that can lead to intellectual, auditory and visual deficits. Objective: To evaluate the visual functions of visual acuity, contrast sensitivity and stereopsis tests of schoolchildren with low birth weight comparing them to school adequate weight and to analyze the association of visual changes to birth weight, gestational age and Apgar. Methods: Cross-sectional study of the case-control carried out in 520 children at 6 to 10 years old in the municipal Embu das Artes - SP - from August 2011 to March 2012. Results: We found that there was no difference statistically significant between the groups in the functions analyzed in relation to birth weight and Apgar, but in relation to gestational age there was poor results in visual acuity (P = 0.016) and stereo acuity (p = 0.006) in preterm school the which did not occur in the contrast sensitivity function (p = 0.636). Conclusions: Low birth weight is a risk factor for changes in visual functions although limited relevance, underscoring the need for more targeted attention to those students born with small gestational age caused by the marked immaturity of the visual system.
- ItemAcesso aberto (Open Access)Adaptação de lente de contato gelatinosa especial para ceratocone(Conselho Brasileiro de Oftalmologia, 2006-08-01) Yamazaki, Ester Sakae [UNIFESP]; Silva, Vanessa Cristina Batista Da [UNIFESP]; Morimitsu, Vagner [UNIFESP]; Andrade Sobrinho, Marcelo Vicente de [UNIFESP]; Fukushima, Nelson [UNIFESP]; Lipener, César [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the fitting and use of a soft contact lens in keratoconic patients. METHODS: Retrospective study on 80 eyes of 66 patients, fitted with a special soft contact lens for keratoconus, at the Contact Lens Section of UNIFESP and private clinics. Keratoconus was classified according to degrees of disease severity by keratometric pattern. Age, gender, diagnosis, keratometry, visual acuity, spherical equivalent (SE), base curve and clinical indication were recorded. RESULTS: Of 66 patients (80 eyes) with keratoconus the mean age was 29 years, 51.5% were men and 48.5% women. According to the groups: 15.0% were incipient, 53.7% moderate, 26.3% advanced and 5.0% were severe. The majority of the eyes of patients using contact lenses (91.25%) achieved visual acuity better than 20/40. To 88 eyes 58% were tihed with lens with spherical power (mean -5.45 diopters) and 41% with spherocylinder power (from -0.5 to -5.00 cylindrical diopters). The most frequent base curve was 7.6 in 61% of the eyes. The main reasons for this special lens fitting were due to reduced tolerance and poor fitting pattern achieved with other lenses. CONCLUSION: The special soft contact lens is useful in fitting difficult keratoconic patients by offering comfort and improving visual rehabilitation that may allow more patients to postpone the need for corneal transplant.
- ItemAcesso aberto (Open Access)Adaptação de lentes de contato após cirurgia refrativa(Conselho Brasileiro de Oftalmologia, 2005-02-01) Renesto, Adimara Da Candelária [UNIFESP]; Lipener, César [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the fitting and use of contact lens in patients submitted to refractive surgery. METHODS: This was a retrospective study in 53 patients submitted to refractive surgery who later started to use contact lens, from 1999 to 2003. The parameters were: previous ametropia, refractive surgery procedure, ametropia after surgery, postoperative spherical equivalent, postoperative keratometry, base curve of fitted contact lens, contact lens design, final visual acuity with spectacles after surgery, final visual acuity with contact lens, complications and the reason for stopping the use. The follow-up of patients ranged from 1 month to 84 months (average of 42,5 months). RESULTS: Of 53 evaluated patients, 19 patients had undergone LASIK (Laser Assisted in Situ Keratomileusis), 29 patients had undergone RK (radial keratotomy), 4 patients had undergone PRK (photorefractive keratectomy) and in one patient it was not possible to know which surgery was performed. 61.29% of the patients (57 eyes of a total of 93 eyes) were fitted with rigid gas-permeable lenses. There was an improvement of visual acuity in 60.21% of the cases (VA>20/40), with few complications. CONCLUSION: Due to the great number of performed refractive surgery, an increase in the number of patients unhappy with the postoperative result is expected, and for these patients, many times the use of contact lens is the best option. The fitting of contact lenses after refractive surgery demands knowledge, dedication and has good results principally regarding better visual acuity.
- ItemAcesso aberto (Open Access)Age norms for monocular grating acuity measured by sweep-VEP in the first three years of age(Conselho Brasileiro de Oftalmologia, 2008-08-01) Salomão, Solange Rios [UNIFESP]; Ejzenbaum, Fábio [UNIFESP]; Berezovsky, Adriana [UNIFESP]; Sacai, Paula Yuri [UNIFESP]; Pereira, Josenilson Martins [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To determine age norms for grating visual acuity and interocular acuity differences measured by the sweep-visually evoked potentials (VEP) technique in the first three years of life. METHODS: Monocular grating visual acuity was measured using the sweep-VEP in 67 healthy normal infants and children in the first 36 months of life. RESULTS: Sweep-VEP grating acuity ranged from 0.80 logMAR (20/125 Snellen equivalent) in the first month of life to 0.06 logMAR (20/20 Snellen equivalent) at 36 months of age. Lower normal limits (95th percentile limit) ranged from 0.95 logMAR (20/180) to 0.12 logMAR (20/25) with a progression of approximately 3 octaves in the first 36 months of age. The largest acceptable interocular acuity difference for clinical purposes was 0.10 logMAR. CONCLUSIONS: Age norms for grating acuity along with interocular acuity differences were determined using the sweep-VEP technique. These norms should be incorporated in clinical practice for precise diagnosis of visual status in infants and preverbal children.
- ItemAcesso aberto (Open Access)Alterações encontradas no potencial visual evocado por padrão reverso em pacientes com esclerose múltipla definida(Conselho Brasileiro de Oftalmologia, 2007-12-01) Andrade, Eric Pinheiro De; Sacai, Paula Yuri [UNIFESP]; Berezovsky, Adriana [UNIFESP]; Salomão, Solange Rios [UNIFESP]; Universidade de Santo Amaro; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Multiple sclerosis is an idiopathic demyelinating disease that may affect the optic nerve leading to acute unilateral visual loss, which could be observed by means of evoked visual potential (VEP). This exam is much valued for studying prechiasmatic visual paths in multiple sclerosis. PURPOSE: To analyze the findings of pattern reversal VEP in patients with prior diagnosis of multiple sclerosis and to compare them to visual acuity. METHODS: Twenty-four patients with a definite diagnosis of multiple sclerosis were submitted to pattern reversal VEP from October 2001 to March 2007. RESULTS: In P100 component response, at 15' and 1º stimuli, 19 eyes presented latency response up to 115 ms in both stimuli, which coincided in 6 eyes with latency response between 116 and 135 ms; 11 eyes had a latency response higher than 135 ms, and four eyes did not respond to stimuli. Correlating visual acuity with P100 latency for 15', in Pearson r correlation, r=0.85 with p=0.000000123, and for 1º, r = 0.87 with p=0.0000000338. CONCLUSION: Approximately 60.4% of patients presented abnormalities. However, the correlation between the P100 latency (15' and 1º) and visual acuity was statistically significant; therefore the better the visual acuity, the better the response to stimuli of the pattern-reversal VEP.
- ItemSomente MetadadadosAmbliopia e déficit de acuidade visual de resolução de grades avaliados pelos potenciais visuais evocados de varredura na catarata congênita(Universidade Federal de São Paulo (UNIFESP), 2005) Ejzenbaum, Fábio [UNIFESP]; Salomão, Solange Rios [UNIFESP]Objetivos: Determinar o déficit de acuidade visual de resolução de grades e a ambliopia nas crianças operadas de catarata congênita, unilateral e bilateral, correlacionando o déficit com a presença de atraso do desenvolvimento neuropsico-motor, intensidade da opacidade, idade da correção cirúrgica, tipo de correção óptica pós-operatória, estrabismo e nistagmo. Métodos: A acuidade visual foi medida pelo potencial visual evocado de varredura em 55 pacientes operados de catarata congênita, 27 com cataratas unilaterais, 20 com cataratas bilaterais (36 olhos) e 8 pacientes com cataratas bilaterais e presença de atraso do desenvolvimento neuro-psico-motor (15 olhos). Foi utilizado como grupo controle 65 crianças sadias que tiveram a acuidade visual medida entre 1 e 36 meses de idade para o estabelecimento de normas de acuidade visual de resolução de grades. Resultados: A média do déficit de acuidade visual no grupo unilateral (0,71 ± 0,18 IogMAR ) foi estatisticamente maior do que os casos bilaterais (0,52 ± 0,19 IogMAR; p<0,001). A diferença interocular de acuidade do grupo unilateral (0,58 ± 0,2 IogMAR ) foi estatisticamente maior do que os casos bilaterais (0,10 ± 0,10 IogMAR; p<0,001). Nos grupos unilateral e bilateral sem atraso houve correlação positiva moderada e significante entre o déficit de acuidade visual , a intensidade da opacidade e a idade no momento da cirurgia. Nos casos de catarata unilateral, não houve diferença significante entre o déficit dos pacientes afácicos (0,70 ± 0,17 IogMAR) e pseudofácicos (0,73 ± 0,21 IogMAR; p =0,70). Nos casos de catarata congénita bilateral sem atraso não houve diferença significante no déficit entre os subgrupos com nistagmo (0,53 ± 0,21 logMAR) e sem nistagmo (0,50 ± 0,17 logMAR; p=0,20). Os casos com atraso (0,76 ± 0,24 IogMAR) apresentaram déficit estatisticamente maior do que os casos sem atraso (0,52 ± 0,19 IogMAR; p=0,004). No grupo unilateral não houve diferença no déficit entre os casos com estrabismo (0,59 IogMAR ± 0,18) e sem desvio (0,67 ± 0,27 IogMAR; p=0,355). No grupo bilateral sem atraso não houve diferença estatisticamente significante do déficit entre os subgrupos com estrabismo(0,54?0,21 logMAR) e sem desvio (0,55?0,13 logMAR); p=0,855). Conclusões: O déficit de acuidade visual dos casos unilaterais foi estatisticamente maior que os bilaterais sem atraso. A ambliopia (diferença interocular de acuidade) foi maior nas cataratas unilaterais do que nas bilaterais sem atraso. O déficit de acuidade foi maior quanto mais intensa a opacidade e quanto mais tardia a idade da correção cirúrgica tanto nos pacientes com catarata congênita unilateral e bilateral sem atraso. Não houve diferença significante do déficit de acuidade visual de pacientes com catarata congênita unilateral entre os pacientes afácicos e pseudofácicos, nos casos com e sem estrabismo e nos casos com e sem nistagmo. Os pacientes com atraso no desenvolvimento neuro-psico-motor e catarata bilateral tiveram déficit de acuidade maior qo que os com desenvolvimento neurológico normal#4#Catarata/co
- ItemAcesso aberto (Open Access)Análise dos efeitos da injeção subtenoniana posterior de triancinolona: série de casos(Conselho Brasileiro de Oftalmologia, 2006-08-01) Zajdenweber, Moysés Eduardo [UNIFESP]; Moraes, Remo Turchetti; Muccioli, Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Brasileiro de Oftalmologia Setor de Uveítes; Universidade Federal do Rio de Janeiro; IBOL Setor de RetinaPURPOSE: To evaluate the effects of posterior subtenon injection of triamcinolone acetonide in patients with intraocular inflammation. METHODS: Case series enrolling 24 patients (26 eyes) submitted to posterior subtenon injection of triamcinolone acetonide for intraocular inflammation treatment. Maleate timolol at 0.5% was prescribed for all patients for 30 days. RESULTS: Improvement of visual acuity was observed in 81% of the patients after a single injection of triamcinolone acetonide. Increase in the intraocular pression was not observed in the treated eyes. CONCLUSION: Posterior subtenon injection of triamcinolone acetonide proved to be a safe and effective way of treating intraocular inflammations.
- ItemAcesso aberto (Open Access)Analysis of the correlation between ophthalmic examination and quality of life outcomes following intracorneal ring segment implantation for keratoconus(Conselho Brasileiro de Oftalmologia, 2011-12-01) Paranhos, Juliane de Freitas Santos [UNIFESP]; Paranhos Junior, Augusto [UNIFESP]; Ávila, Marcos Pereira; Schor, Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Goiás Departamento de CirurgiaPURPOSE: To analyze the correlation between quantitative measurements outcomes and keratoconus patients' vision related quality of life (v-QoL) following intrastromal corneal ring segment implantation. METHODS: The NEI-RQL (National Eye Institute Refractive Error Quality of Life) was administered to patients requiring intrastromal corneal ring segment implantation, before and after surgery, wearing best correction for 40 days minimum. Visual acuity, refraction, corneal topography, aberrometry data (VOL-CT. software) and contrast sensitivity were recorded before and 3 months after surgery. The main outcome measures were best corrected visual acuity, refraction, steep keratometric value (Kmax), aberrometry, contrast sensitivity and v-QoL. RESULTS: There were 42 keratoconic patients (69 eyes): 19 male and 23 female, mean age 24.9 ± 5 years in this prospective study. Binocular best corrected visual acuity improved (0.13 ± 0.03 before to -0.01 ± 0.01 logMAR after surgery, p<0.001). There was a statistically significant improvement in mean spherical refraction (2.81 ± 0.44 to 1.71 ± 0.31), cylinder component (3.89 ± 0.22 to 1.82 ± 0.21), spherical equivalent (4.55 ± 0.46 to 2.40 ± 0.30), Kmax (55.92 D ± 0.62 to 52.16 D ± 0.58 D) and root mean square low order (p<0.001). Contrast sensitivity (CS) improved at all spatial frequencies: at 6 cpd improvement was higher. Root mean square higher order did not improved p=0.422. There was significant improvement across all NEI-RQL scales after surgery. Multivariate analysis showed that gender (males more satisfied than females), cylinder (1 D reduction improves 5 points in general NEI-RQL scores) and normal contrast sensitivity at 3 and 6 cpd were correlated with v-QoL. Other variables such as best corrected visual acuity, root mean square low order, root mean square higher order and Kmax did not show influence on NEI-RQL scores. CONCLUSIONS: The best patient response predictors with the NEI-RQL instrument were gender, normal CS at 3 and 6 cpd and cylinder reduction. The use of this questionnaire was crucial to assess the influence of optical tests on v-QoL in keratoconus patients who were referred for intrastromal corneal ring segment implantation.
- ItemAcesso aberto (Open Access)Apresentação atípica de degeneração marginal pelúcida: relato de caso(Conselho Brasileiro de Oftalmologia, 2005-12-01) Santos, Frederico Xavier Dos; Mocelin, Sheila; Machado, Renato; Santos, Fernando Henrique Xavier Dos; Sousa, Luciene Barbosa De [UNIFESP]; Hospital Oftalmológico de Sorocaba; Hospital Oftalmológico de Sorocaba Setor de Córnea; Hospital Oftalmológico de Sorocaba Setor de Córnea e Doenças Externas; Pontifícia Universidade Católica de Sorocaba; Universidade Federal de São Paulo (UNIFESP)The authors report an unusual clinical presentation of pellucid marginal degeneration with 360º peripheral corneal thinning diagnosed in a younger male patient. We discuss the findings of topographic maps, ultrasound pachymetry and the proposed treatment.
- ItemAcesso aberto (Open Access)Avaliação da exeqüibilidade, eficácia e segurança do transplante lamelar semi-automatizado de córnea(Conselho Brasileiro de Oftalmologia, 2006-12-01) Maia, Nubia Cristina de Freitas [UNIFESP]; Chamon, Wallace [UNIFESP]; Branco, Bruno Castelo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the feasibility, efficacy and safety of a manual microkeratome and an artificial anterior chamber for lamellar keratoplasty (ALTK® system). METHODS: Twenty-one eyes with superficial corneal opacities were submitted to semi-automated lamellar keratectomy. In recipient eyes keratectomy was performed as in refractive surgery. The donor flap was removed from the preserved corneal shell using the same microkeratome and an artificial anterior chamber. Lamella thickness was measured through ultrasound biomicroscopy (UBM) after surgery. RESULTS: The surgeries were accomplished successfully in 19 eyes. 80% of the flaps obtained in donated corneas and 84.2% of the flaps in recipient eyes had an up to 0.5 mm variation variation of the desired diameter. A high similarity in flap thickness between the donor flap and the recipient cornea was obtained. Postoperative visual acuity of 20/40 or better was observed in 52.6% of the eyes. Complications such as undesired diameter of the flap, a case of perforation in the recipient eye and a case of cornea ectasia were observed. CONCLUSION: The semi-automated lamellar keratoplasty ALTK® system showed to be feasible due to the predictability and reproducibility regarding lamella thickness and diameter, efficient in the improvement of postoperative visual acuity and safe due to the low level surgical complication.
- ItemSomente MetadadadosAvaliação da função macular em pacientes portadores de catarata com o "superpinhole" de McIntyre(Universidade Federal de São Paulo (UNIFESP), 1989) Moreira, Hamilton [UNIFESP]; Belfort, Rubens Junior [UNIFESP]
- ItemAcesso aberto (Open Access)Avaliação da função visual em pacientes com distrofia de cones(Conselho Brasileiro de Oftalmologia, 2003-06-01) Sato, Marta [UNIFESP]; Sacai, Paula Yuri [UNIFESP]; Berezovsky, Adriana [UNIFESP]; Salomão, Solange Rios [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate visual function by full-field electroretinography (ERG) and visual acuity in patients with cone dystrophy. METHODS: 23 (7 male and 16 female) patients with suspicion of cone dystrophy were evaluated at the Clinical Electrophysiology of Vision Laboratory of the Universidade Federal de São Paulo (UNIFESP). Inclusion criteria were: clinical history, visual acuity measured by ETDRS or Snellen charts and retinal function assessed by full-field electroretinography. The peak-to-peak amplitude and b-wave implicit time values were compared with previously published age norms. RESULTS: Visual acuity measurement in the best eye ranged from 0.07 to 3.00 logMAR (HM to 20/25) with mean VA of 0.85±0.64 logMAR (20/140). Mean peak-to-peak amplitude for scotopic rod-response was 144.29±80.05 µV (normal for age) and mean of implicit time was 92.85±9.02 ms (normal for age). Mean peak-to-peak amplitude for single-flash cone response was 5.06±8.59 µV (reduced for age) and mean implicit time was 43.4±14.4ms (reduced for age) for detectable responses; for 30 Hz-flicker mean amplitude was 5.00±9.00 µV (reduced for age) and the mean of implicit time was 34.9±10.9 ms (reduced for age). CONCLUSION: Mean visual acuity was 0.85 logMAR (20/140) in this group of patients with cone dystrophy. Photophobia was the main complaint, followed by decreased vision and defective colour vision. Ten of 23 (10/23) patients had their final diagnosis only after full-field electroretinography recording, since the fundus examination was normal.
- ItemSomente MetadadadosAvaliação da função visual por meio de questionário VFQ 25 em relação a ametropia pre-operatória e diâmetro pupilar em pacientes submetidos a cirurgia ceratorrefrativa a laser(Universidade Federal de São Paulo (UNIFESP), 2012) Andrade, Eduardo Marcelo Moron de [UNIFESP]; Chamon, Wallace [UNIFESP]Esse estudo tem como objetivos avaliar se ametropia pre-operatoria, zona optica, zona de transicao e o comportamento do diametro pupilar sob diferentes condicoes de iluminacao, estao correlacionados com a satisfacao dos pacientes, atraves da utilizacao questionario VFQ 25 no pre e pos-operatorio como ferramenta da medida de satisfacao do paciente. Materiais e metodos: Foram analisados 77 pacientes submetidos a cirurgia ceratorrefrativa a laser (LASIK). Foi utilizado um pupilometro automatizado com captura atraves de camera infravermelha acoplada a cabeca optica de um sistema videoceratografico para avaliacao do diametro pupilar. Os pacientes foram submetidos a avaliacao oftalmologica completa e documentacao do comportamento pupilar sob diferentes intensidades de iluminacao, simulando as situacoes do dia-a-dia. Utilizou-se no pre e pos-operatorio o questionario de funcao visual (VFQ 25) traduzido anteriormente para a lingua portuguesa, como ferramenta para avaliacao da funcao visual em diversas situacoes do cotidiano. Resultados: Todos os pacientes estudados, independentemente do diametro pupilar sob diferentes condicoes de iluminacao (escotopicas, mesopicas e fotopicas), apresentaram melhora em todos os subgrupos do VFQ 25 em maior ou menor intensidade. Conclusoes: Nesse estudo, apesar do pupilometro infravermelho com captura automatizada ter se mostrado uma ferramenta util na documentacao e entendimento do comportamento pupilar, um conjunto de fatores tais como perfil psicossocial dos pacientes, ametropia pre-operatoria tratada e ametropia residual final, contribuiu de forma decisiva para determinar o grau de satisfacao dos pacientes submetidos ao LASIK
- ItemAcesso aberto (Open Access)Avaliação do desempenho visual da lente intraocular difrativa multifocal - Zeiss AT Lisa 809 MTM(Sociedade Brasileira de Oftalmologia, 2014-04-01) Vianna, Lucas Monferrari Monteiro [UNIFESP]; Oliveira, Filipe de [UNIFESP]; Pedro, Abujamra [UNIFESP]; Jung, Liang [UNIFESP]; Brenner, Luis Felipe [UNIFESP]; Yogi, Milton [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose:To evaluate the visual function of patients with bilateral implantation of multifocal diffractive IOL AT Lisa 809MTM by visual acuity with and without correction, contrast sensitivity curve, defocus curve and visual function questionnaire (39 VQF).Methods:Interventional clinical prospective study, which evaluated the results of 20 eyes of 10 patients who underwent phacoemulsification and IOL implantation between february and june 2012.Results:The average of residual postoperative ametropia was 0.05 ± 0.42 (-0.75 to +1.25 D) spherical diopters and -0.30 ± 0.42 (0 to -1.25 D) cylindrical diopters. In the mono and binocular defocus curve, the best visual acuity was obtained with 0.00 D of defocus (far VA). The second peak was obtained with -3.00 D (near vision at 33 cm) and among these peaks, it was observed a loss of visual performance with -2.00 D, which corresponds to intermediate vision at 50 cm. Contrast sensitivity was similar to those reported in the literature with this type of IOL, both with and without glare, and is shown in the figures. The visual function questionnaire (VFQ-39) had a mean value of 91.91 + - 6.82.Conclusion:The diffractive multifocal IOL-AT LISA 809M presented results consistent with the literature as measured by tests of visual acuity with and without optical correction, contrast sensitivity curve, defocus curve and visual function questionnaire (39 VQF).