Navegando por Palavras-chave "Ceratoplastia penetrante"
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- 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)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.
- ItemAcesso aberto (Open Access)Comparação entre os resultados pós-operatórios de pacientes submetidos ao procedimento tríplice e transplante de córnea combinado a fixação secundária de lente intra-ocular(Conselho Brasileiro de Oftalmologia, 2006-08-01) Leão, Daniela Maggioni Pereira; Sousa, Luciene Barbasa De [UNIFESP]; Universidade de Alfenas; Hospital Oftalmológico de Sorocaba setor de Córnea e Doenças Externas; Universidade Federal de São Paulo (UNIFESP); Hospital Oftalmológico de SorocabaPURPOSE: To compare the outcomes of two surgical techniques of penetrating keratoplasty with different surgical time, regarding the crystalline and the intraocular lens. METHODS: This retrospective study included 37 patients' eyes divided into 2 groups: extracapsular cataract extraction, posterior chamber intraocular lens implantation and penetrating keratoplasty (Group 1, G1) and transscleral fixation of posterior chamber lens and penetrating keratoplasty (Group 2, G2). The following parameters were recorded: visual acuity, intraocular pressure, refractive astigmatism, complication and keratometric astigmatism. RESULTS: Visual acuity improved in the two groups (G1 p<0.001 and G2 p=0.008). In G2 a significant change for the worse of intraocular pressure outcome was observed when compared with the other group (p=0.014). Regarding refractive and keratometric astigmatism no significant differences between the groups were found. The follow-up was 11 months. CONCLUSION: The most important negative prognostic factor affecting visual acuity was the postkeratoplasty corneal curvature which can not be predicted accurately and the most important negative factor affecting intraocular pressure was the loss of integrity of the anterior and posterior segments.
- ItemAcesso aberto (Open Access)Contaminação de halos doadores córneo-esclerais em ceratoplastia penetrante no Hospital de Clínicas de Porto Alegre(Conselho Brasileiro de Oftalmologia, 2008-02-01) Borowsky, Cláudia Martins; Wallau, Anelise Dutra [UNIFESP]; Reetz, Aline; Kwitko, Sérgio [UNIFESP]; Rymer, Samuel; Locatelli, Claudete Inês; Universidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre; Universidade Federal de São Paulo (UNIFESP); Universidade de Passo Fundo; Hospital de Clínicas de Porto Alegre; UFRGS Faculdade de Medicina; UFRGS Hospital de Clínicas de Porto Alegre; UFRGSPURPOSE: To determine the incidence of positive corneoscleral rim cultures preserved in Optisol GS medium, to identify pathogens involved and possible recipient eye infection. METHODS: A hundred sixty-three corneoscleral rim cultures penetrating keratoplasties performed from January 2001 to January 2003 in the Hospital de Clínicas de Porto Alegre were reviewed. Enucleations and corneal storage were done as aseptic as possible and gentamicin 0.3% was instilled. Corneoscleral rim was divided into two segments, half was inoculated into Sabouraud broth and the other half into thioglycolate broth; inoculation into blood agar, chocolate agar and MacConkey agar was done later if necessary for pathogen identification. The receiver's eye data were reviewed. RESULTS: There were eleven positive cultures (6.7%) out of 163 evaluated corneoscleral rim cultures. Of these, four were Staphylococcus epidermidis, one was Staphylococcus aureus, one was Serratia sp., one was Pseudomonas aeruginosa and the other four were different subtypes of Candida (two Candida sp., one Candida albicans and one Candida parapapilosis). All pathogens were resistant to gentamicin. None of the eleven cases of positive corneoscleral rim cultures resulted in ocular infection at the receiver's eyes (six months follow-up). CONCLUSIONS: We found low rates of positive corneoscleral rim cultures after penetrating keratoplasty at the Porto Alegre Clinical Hospital. The most frequent involved pathogens were Staphylococcus sp and Candida sp. Although we did not identify any postoperative infection at the receiver's eyes, we recommend corneoscleral rim culture for guidance of postoperative infection, a rare but possible devastating ocular event.
- ItemAcesso aberto (Open Access)Endoftalmite por Candida albicans após transplante penetrante de córnea: relato de caso(Conselho Brasileiro de Oftalmologia, 2004-04-01) Godoy, Glaucio De; Wahab, Sâmia Ali; Hofling-Lima, Ana Luisa [UNIFESP]; Moreira, Hamilton [UNIFESP]; Hospital de Olhos do Paraná; Instituto de Pesquisas Médicas; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Paraná; Faculdade Evangélica do ParanáThe authors report a case of a patient submitted to penetrating corneal graft for keratoconus with an exaggerated inflammatory response during the postoperative period. The patient was suspected of having an atypical rejection to the donor button. There were periods of improvement, followed by periods of worsening of the inflammation at each attempt of reducing the topical corticosteroid. After initiating immunosuppressive therapy with cyclosporin and high doses of topical corticosteroid, the patient developed Candida albicans endophthalmitis affecting the anterior segment of the eye and the vitreous body, but sparing the chorioretina. The patient improved after three injections of 5 µg intravitreal amphotericin B, 400 mg oral ketoconazole daily and topical clotrimazole every four hours. The authors also discuss the main possibilities of contamination of the patient, the infectious picture probably being related to the surgical procedure.
- ItemAcesso aberto (Open Access)Estudo retrospectivo e comparativo de quarenta e três olhos com hidropisia aguda em quinhentos e sessenta e sete casos de ceratocone(Conselho Brasileiro de Oftalmologia, 2003-01-01) Pena, Frederico Valadares De Souza [UNIFESP]; Pena, Ari De Souza; Araújo, Patrícia Garcia De; Universidade Federal de São Paulo (UNIFESP); Universidade Federal Fluminense Serviço de Oftalmologia; Hospital da PiedadePURPOSE: To compare clinical characteristics and surgical out comes between keratoconus cases with and without acute hydrops (AH). METHODS: All keratoconus cases followed up at the Hospital Universitário Antônio Pedro - UFF and at Clinica Oftamológica Souza Pena between 1982 and 2000 were reviewed. Main analyzed outcome parameters were: visual acuity, follow-up time since diagnosis, type of visual correction, morphological and keratometric classification, and surgical results. RESULTS: The overall acute hydrops incidence was 5.8%. Gender, keratoconus family history, atopy did not differ significantly between the two groups. Among acute hydrops cases, 72.7% were classified as peripheral cones, against 21.4% of the control cases (p < 0.05). Overall, 19% of the patients needed penetrating keratoplasty (PK). Out of 1062 eyes that did not develop acute hydrops, 8.4% underwent PK, compared to 88.4 % of the acute hydrops eyes (p < 0.05). Surgical outcomes showed no significant difference between the two groups. CONCLUSION: Peripheral cones were more frequently related to acute hydrops, and consequently, to PK. Keratoconus surgical treatment results were similar in cases with and without acute hydrops.
- ItemAcesso aberto (Open Access)Influência da lista única de uma regional de transplantes de córnea em um Banco de Olhos vinculado a um hospital escola(Conselho Brasileiro de Oftalmologia, 2003-10-01) Oliveira, Lauro Augusto De; Corrêa, Beatriz Soares [UNIFESP]; Almeida Jr, Gildásio Castello De; Ferrari, Marta Teixeira; Kashiwabuchi, Luiz Kazuo; Faculdade de Medicina de São José do Rio Preto Departamento de Oftalmologia; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina de São José do Rio Preto Departamento de Oftalmologia Setor de Córnea e Moléstias Externas; Faculdade de Medicina de São José do Rio Preto serviço de OftalmologiaPURPOSE: To evaluate how the implantation of a single regional list for corneal transplants influenced an eye bank of a university hospital. To analyze the influence of the regional list on the corneas (procurement and destiny), the number of transplantations made and the average waiting time for surgery. METHODS: A retrospective study was made to compare the records of patients who underwent penetrating keratoplasty and also the data of the eye bank of the Medical School of São José do Rio Preto, São Paulo, Brazil. The study compared the data of the service one year before and one year after the creation of the single regional list. RESULTS: The number of transplantations increased from 60 to 92 procedures. The monthly average of directly acquired corneas increased from 13.83 + 6.57 to 18.16 + 4.8 (p-value = 0.07). The number of corneas sent to other institutions was greater than the number of corneas received from other eye banks (p-value = 0.003). There was no significant difference between the waiting time for surgery before and after the creation of the list except for the period of adaptation. CONCLUSIONS: This eye bank served as a supplier of corneas for other institutions. By the end of the first year of operation of the single regional list, there was no alteration in the waiting time as compared to that before its creation. Nonetheless, a tendency of homogenization in the waiting time for penetrating keratoplasty among the patients was observed.
- ItemAcesso aberto (Open Access)MALKS®: especificações e desenvolvimento(Conselho Brasileiro de Oftalmologia, 2006-04-01) Victor, Gustavo; Sousa, Sidney Julio De Faria E; Alves, Milton Ruiz; Nosé, Walton [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Universidade Metropolitana de Santos Departamento de OftalmologiaPURPOSE: To describe the characteristics of a new artificial anterior chamber (MALKS®, Loktal, São Paulo, Brasil). METHODS: Characteristics analysis and description of a new artificial anterior chamber MALKS® (Micro automated lamellar keratoplasty system). RESULTS: MALKS®is composed of eight parts: a) artificial chamber; b) cornea's fix ring; c) nut to join the cornea's fix ring; d) rail and adjuster of lamellar diameter; e) flatteners, to pre-determine lamellar diameter; f) infusion system, that allows the digital objective peroperative control of the intracameral pressure; g) automated microkeratome, and h) marker. CONCLUSION: MALKS® uses the same automated microkeratome developed for LASIK, can allow corneal lamella obtention with predetermined thickness and diameter, as well as the digital objective peroperative control of the intracameral pressure. This new artificial anterior chamber can be an important tool for superficial and endothelial keratoplasty.
- ItemAcesso aberto (Open Access)Topoplastia de Cvintal assistida por laser de femtossegundo(Sociedade Brasileira de Oftalmologia, 2013-06-01) Ishizaki, Alexandre Takayoshi; Guerra, Frederico; Ramos, Issac; Ambrósio Junior, Renato [UNIFESP]; Instituto Benjamin Constant Serviço de Oftalmologia; Instituto Benjamin Constant Setor de Córnea; Instituto de Olhos Renato Ambrósio; Universidade Federal de São Paulo (UNIFESP)We present a case of late high progressive astigmatism following penetrating keratoplasty for keratoconus, which was associated with peripheral thinning in the donor-receptor area, which may be recognized as recurrence of ectasia. Treatment was accomplished with Cvintal's Topoplasty assisted by femtosecond laser for a top hat, followed by resuture with peroperative adjustment guided by ceratoscopy.