Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Phacoemulsification"

Navegando por Palavras-chave "Phacoemulsification"

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Acesso aberto (Open Access)
Análise de custo dos materiais usados para realizar as técnicas anestésicas na cirurgia programada de extração de catarata por facoemulsificação
(Conselho Brasileiro de Oftalmologia, 2004-02-01) Barreiro, Jefferson; Barreiro, Telma Pereira [UNIFESP]; Rehder, José Ricardo Carvalho Lima; Fundação Universitária do ABC Faculdade de Medicina Setor de Catarata; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina do ABC
PURPOSE: To compare the costs of local anaesthesia (retrobulbar block, peribulbar block, sub-Tenon and topical) to perform phacoemulsification cataract extraction. METHODS: We studied the costs of the materials that are necessary to perform the local anaesthesia (retrobulbar block, peribulbar block, sub-Tenon and topical). We adopted the standard technique used for the Cataract Sector of the Department of Ophthalmology, ABC University. For each technique the total price of the each item to perform the above described local anaesthesia was analyzed. Prices were obtained from three different stores which sell hospitals materials and we considered for this study the item with a lower price. RESULTS: The costs of topical anaesthesia were 0.06 reais, for the retrobulbar it was 7.42 reais, 24.96 reais for the peribulbar was and 48.12 reais for the sub-Tenon. CONCLUSIONS: 1. Topical anaesthesia showed the lowest cost. 2. Retrobulbar anaesthesia showed low cost when compared with the peribulbar and sub-Tenon 3. Sub-Tenon's anaesthesia showed the highest cost.
Acesso aberto (Open Access)
Application of different scheimpflug-based lens densitometry methods in phacodynamics prediction
(Dove medical press ltd, 2016) Faria-Correia, Fernando; Lopes, Bernardo T.; Ramos, Isaac C.; Monteiro, Tiago; Franqueira, Nuno; Ambrosio, Renato, Jr. [UNIFESP]
Purpose: To evaluate the correlations between preoperative Scheimpflug-based lens densitometry metrics and phacodynamics. Methods: The Lens Opacities Classification System III (LOCS III) was used to grade nuclear opalescence (NO), along with different methods of lens densitometry evaluation (absolute scale from 0% to 100%): three-dimensional (3D), linear, and region of interest (l)l modes. Cumulative dissipated energy (CDE) and total ultrasound (US) time were recorded and correlated with the different methods of cataract grading. Significant correlations were evaluated using Pearson or Spearman correlation coefficients according to data normality. Results: A positive correlation was detected between the NO score and the average density and the maximum density derived from the 3D mode (r-0.624, P<0.001
Acesso aberto (Open Access)
Clinical results in phacoemulsification using the SRK/T formula
(Conselho Brasileiro de Oftalmologia, 2009-04-01) Lagrasta, Juliana Marques de Souza [UNIFESP]; Allemann, Norma [UNIFESP]; Scapucin, Luciana [UNIFESP]; Moeller, Cecilia Tobias de Aguiar [UNIFESP]; Ohkawara, Lilian Emi [UNIFESP]; Melo Junior, Luiz Alberto Soares [UNIFESP]; Soriano, Eduardo Sone [UNIFESP]; Casanova, Fabio Henrique [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
PURPOSE: To evaluate the prediction of refraction using the SRK/T formula for intraocular lens (IOL) calculation in eyes with medium axial length after phacoemulsification. METHODS: This prospective study enrolled 33 eyes with nuclear cataract that underwent phacoemulsification. All procedures were performed by one surgeon with the intraocular lens placed within the capsular bag. The same technician who was unaware of the purpose of the study made all the measurements. The achieved refractive error one month after surgery was compared to the predicted postoperative refractive error by the SRK/T formula. RESULTS: The ocular axial length varied between 22.2 mm and 24.5 mm. The mean predicted refraction was -0.431 ± 0.181 D and the mean achieved postoperative spherical equivalent was -0.220 ± 0.732 D. Eighteen eyes (55%) had a refractive error between ± 0.50 D and thirty eyes (91%) between ± 1.00 D of the predicted refraction. There was a tendency toward hyperopic shift (mean ± SD: 0.211 ± 0.708 D, p=0.009). CONCLUSION: The SRK/T formula demonstrated a satisfactory accuracy to calculate the error of refraction in eyes with medium axial length.
Acesso aberto (Open Access)
Comparação do efeito nas culturas de humor aquoso de gatifloxacina 0,3% aplicado três dias antes de facoemulsificação e e antes do pré-operatório
(Sociedade Brasileira de Oftalmologia, 2011-02-01) Menezes, Paulo Augusto Hidalgo de; Hida, Wilson Takashi; Brasil, Alexandre Almeida; Peixoto, Diana Linhares Leins; Yamane, Iris de Souza; Vita Sobrinho, João Brasil [UNIFESP]; Nakano, Celso Takashi; Avakian, Amaryllis; Universidade de São Paulo (USP); Hospital Beneficência Portuguesa de São Paulo; Santa Casa de Misericórdia de São Paulo; Universidade Federal de São Paulo (UNIFESP)
Purpose: To determine the effect on human aqueous humor cultures of topical gatifloxacin 0.3% applied four times a day three days before phacoemulsification compared to topical gatifloxaxin 0.3% applied and same-day surgery. METHODS: Thirty-seven patients with cataract without other ocular diseases were randomly assigned to Groups A and B before phacoemulsification. Group A received topical gatifloxacin 0.3% same-day surgery and Group B received gatifloxacin 0.3% four times a day three days before phacoemulsification. After the procedure the aqueous humor was aspirated for cultures on agar-blood, agar-chocolate, saboraud and TSB and smeared for bacterioscopy. RESULTS: Group A presented 40% of the bacterioscopies with cocci gram +, Group B presented 17.6% of the bacterioscopies with cocci gram +. These results are not statistically significant (p=0,098). Five cases (25%) from Group A presented positive cultures for S. epidermidis, which was significantly higher than Group B, which did not present positive cultures for any bacteria or fungus (p=0,027). CONCLUSION: Gatifloxacin 0.3% applied three days before phacoemulsification significantly lowered the rate of positive aqueous humor cultures when compared to immediate application of this antibiotic before surgery in this study.
Acesso aberto (Open Access)
Correlação da destreza manual com taxa de complicação em cirurgia de catarata por facoemulsificação durante o período de residência em Oftalmologia
(Universidade Federal de São Paulo (UNIFESP), 2021) Vieira, Ibraim Viana [UNIFESP]; Siqueira, Wallace Chamon Alves De [UNIFESP]; Universidade Federal de São Paulo
Objective: To evaluate total and specific surgical complication rate in phacoemulsification throughout ophthalmology residency program and relate these rates to manual dexterity measured at the beginning of the residency program with an ophthalmology surgery simulator that uses virtual reality. Methods: Prospective cohort study involving 14 newly enrolled residents in the ophthalmology program at Escola Paulista de Medicina and Universidade Estadual Paulista – Botucatu campus. Residents underwent manual dexterity assessment with a surgery simulator that uses virtual reality called Eyesi® (VRmagic, Mannheim, Germany). The rates of surgical complication in phacoemulsification were calculated during the second and third year of training. Complications were divided into: incision, anterior capsule, posterior capsule, intraocular lens and others. Differences between groups with and without complications were assessed using the MannWhitney test. Through logistic regression, we evaluated the relationship between rates of surgical complications with: manual dexterity score, age and gender of patients and anesthetic and surgical techniques employed. Results: The manual dexterity score was 266.96 ± 80.59 (mean ± standard deviation) arbitrary units (UA). Throughout the study, 1227 surgeries were performed, with complications occurring in 251 (20.46%) of these. Procedures that presented complications related to the anterior capsule (p = 0.0005), posterior capsule (p = 0.0022) and intraocular lens (p = 0.0037) were associated with lower scores of dexterity when compared to uncomplicated procedures. Each unit of improvement in the initial score represented a 0.37% decrease in the chance of complication occurrence. Surgeries performed with anesthetic block or general anesthesia presented 1.75 times the chance of complication in relation to surgeries with topical anesthesia.Conclusion: Manual dexterity score assessed in the pre-training period was related to lower rates of intraoperative complications during the phacoemulsification learning period. The Eyesi® simulator could be used in the selection of candidates for residency in ophthalmology, and surgical fellowship, or in stratifying residents as to the chance of complication, allowing the development of individualized teaching programs. Both strategies could reduce training costs and provide less risk to patients.
Acesso aberto (Open Access)
Custo da facoemulsificação no projeto catarata em Itápolis, SP
(Conselho Brasileiro de Oftalmologia, 2005-02-01) Saad Filho, Roberto [UNIFESP]; Saad, Flávia Gondim Loureiro; Freitas, Lincoln Lemes De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia e Maternidade Dona Julieta Lyra
PURPOSE: To determine the average cost of cataract surgery using the phacoemulsification technique with intraocular lens implant (IOL). This study was conducted during a national campaign to treat patients with cataracts promoted by the Brazilian Council of Ophthalmology (CBO) and the Health Ministry in the city of Itápolis - SP from March to December, 2000. METHODS: All expenses related to the surgery were collected (pre-, intra-, and postoperative data) and analyzed. Fifty-eight patients with senile cataracts and without any other ocular findings were submitted to the procedure in a prospective study. RESULTS: The average cost of the surgery in this study was R$ 485.03 or US$ 248.05. This value represents the average cost of the surgery itself; in which some materials, equipment, taxes and other services were previously determined and used for this project. CONCLUSION: The phacoemulsification technique for cataract surgery has been used more and more, due to its effectiveness, being an excellent method to treat cataracts. Although this is an excellent technique, the economical aspect does not allow it to be used for part of the population
Somente Metadadados
Does the apodized diffractive intraocular lens Acrysof ReSTOR Natural (TM) interfere with FDT Matrix perimetry results?
(Consel Brasil Oftalmologia, 2009-11-01) Bojikian, Karine Duarte [UNIFESP]; Vita, Joao Brasil [UNIFESP]; Dal Forno, Catia Potira [UNIFESP]; Tranjan Neto, Alfredo [UNIFESP]; Moura, Christiane Rolim de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: To compare the effect of an apodized diffractive intraocular lens (IOL) (Acrysof ReSTOR Natural (TM)) and its yellow counterpart (Natural IQ (TM)) on frequency doubling technology (FDT) perimetry results. Methods: This study included 37 eyes from 22 patients at the Centro Oftalmologico Tranjan who had undergone uncomplicated phacoemulsification and intraocular lens implantation (17 Acrysof ReSTOR Natural (TM), 20 Natural IQ (TM)) performed by the same surgeon, at least three months prior to the study. Patients were subject to frequency doubling technology Matrix Perimeter testing. Results: The patients were between 41 to 79 years old (mean, 70.78 +/- 9.83) in the Natural IQ (TM) and 49 to 81 years old (mean, 67.11 +/- 11.48) in the Acrysof ReSTOR Natural (TM) group, and the mean IOP was 13.64 +/- 2.02 mmHg in the Natural IQ (TM) 12.94 +/- 1.39 mmHg in the Acrysof ReSTOR Natural (TM) group. The mean pupillary diameter under scotopic conditions was 6.63 +/- 1.16 mm in the Natural IQ (TM) group and 7.20 +/- 1.8 mm in the Acrysof ReSTOR Natural (TM) group (p = 0.20). The mean deviation was -1.83 +/- 3.46 dB in the Natural IQ (TM) group and -1.77 +/- 3.94 dB in the Acrysof ReSTOR Natural (TM) group (p = 0.28). The pattern standard deviation was 3.49 +/- 0.79 dB in the Natural IQ (TM) group and 3.20 +/- 0.86 dB in the Acrysof ReSTOR Natural (TM) group (p = 0.27). Conclusion: There was no difference in the results of FDT Matrix perimetry in eyes that received apodized diffractive IOLs implant or eyes that received monofocal intraocular lens implant.
Acesso aberto (Open Access)
Efficacy of a lutein-based dye (PhacodyneTM) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification
(Conselho Brasileiro de Oftalmologia, 2014-06-01) Vianna, Lucas Monferrari Monteiro [UNIFESP]; Cohen, Marcos J. [UNIFESP]; Muccioli, Cristina [UNIFESP]; Lima Filho, Acácio Alves de Souza [UNIFESP]; Sousa-Martins, Diogo [UNIFESP]; Maia, Maurício [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objetivos: Avaliar a eficácia e eficiência de um novo corante à base de luteína para coloração da cápsula anterior durante cirurgia de facoemulsificação em humanos. Métodos: Vinte e cinco olhos de 25 pacientes foram operados por 25 cirurgiões diferentes que realizaram capsulorrexis circular contínua e facoemulsificação após coloração da cápsula anterior com corante à base de luteína. Um questionário avaliou a opinião dos cirurgiões sobre a eficácia do corante. Exames pós-operatórios foram realizados nos dias 1, 7 e 30 por meio de exame oftalmológico completo, topografia/ paquimetria e contagem de células endoteliais. Resultados: De acordo com o questionário aplicado, o corante facilitou a cirurgia em todos os olhos. A classificação da catarata de acordo com o LOCS III foi de 3,24 ± 1,12. A acuidade visual pré-operatória com melhor correção foi de 0,89 ± 0,59 (logMAR), passando a 0,23 ± 0,22 no pós-operatório. A pressão intraocular (PIO) permaneceu estável e houve reação de câmara leve que desapareceu em todos os casos durante os primeiros 7 dias de pós-operatório. Não houve significância estatística comparando a paquimetria e PIO pré e pós-operatórios. Conclusão: O novo corante se mostrou eficiente e sem sinais de toxicidade ou efeitos adversos, após 30 dias, quando usado para auxiliar a cirurgia de facoemulsificação.
Somente Metadadados
Estudo Das Vias De Sinalização Intracelular Envolvidas Na Atividade Citoprotetora Do Lopap (Lonomia Obliqua Prothrombin Activator Protease) E Peptídeos Derivados
(Universidade Federal de São Paulo (UNIFESP), 2017-08-31) Malavazzi, Gustavo Ricci [UNIFESP]; Nose, Walton [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objective: To develop and implement a systematic method for the training of residents to perform the phacoemulsification surgery (PHACO), used for the treatment of cataracts, in a medical residency service in ophthalmology, based on stepwise evolution in chronological reverse order (reverse chaining), and in increasing degrees of difficulty; to develop a logbook for the registering of the completed steps by the residents, and to describe the preliminary results of the teaching method in a teaching unit comparing the period before and after the implementation. Methods: A method of training residents of ophthalmology in the PHACO technique was created, in which the procedures are described as steps in a learning process, in reverse chronological order, and in which one can advance in the teaching modules only when the learning of each one has been completed; thus moving from the final step to the start of surgery. The rates of possible surgery complications, especially posterior capsule rupture, were evaluated descriptively in the two years and compared with the period before the implementation of the teaching program. Results: The method of reverse chaining teaching was created and the logbook was developed. Before this, 392 medical records were analyzed in the institution, and the posterior capsule rupture rate was 19.89% in surgeries performed by second and third year residents. In 2009, after the method implementation, 1,817 PHACO surgeries were performed in the service, and other 1,860 in 2010 (total: 3,677 procedures). The average was 151 surgeries per month in 2009 and 155 in 2010. The absolute frequency of posterior capsule rupture was 153 events in 2009 and 147 in 2010, with rates of 8.42% and 7.9% of the surgeries performed, respectively. The posterior capsule rupture rate in the period before the introduction of the new training method (2007) compared to the years after (2009 and 2010) had a significant decrease (p < 0.001; chi-square test). When the resident is trained by the new method, the chance of the patient suffering a posterior capsule rupture is 63% (2009) and 65% (2010) lower. Conclusions: This study shows that controlling the steps when teaching PHACO techniques to residents results in low rates of intraoperative complications comparable to those in the literature. The method is sustainable and should be tested in other teaching facilities in Brazil.
Acesso aberto (Open Access)
Estudo do endotélio corneano em cirurgias de cataratas duras: extração extracapsular planejada da catarata e facoemulsificação
(Conselho Brasileiro de Oftalmologia, 2006-08-01) Stumpf, Simone [UNIFESP]; Nosé, Walton [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Metropolitana de Santos Departamento de Oftalmologia; Eye Clinic Day Hospital
PURPOSE: To evaluate and compare the endothelial damage after planned extracapsular cataract extraction (ECCE) and phacoemulsification of very hard cataracts. METHODS: In this prospective, randomized study, 41 patients with age-related and very hard cataract were divided into two groups: in group 1 (21 patients) an extracapsular cataract extraction was performed and in group 2 (20 patients), phacoemulsification. In both groups, intraocular lenses were implanted in the capsular bag. Preoperatively and 1, 3 and 6 months postoperatively, a complete ophthalmological examination, endothelial specular microscopy, and ultrasonic pachymetry were done. Endothelial cell loss, pleomorphism, polymegathism and corneal thickness were studied. RESULTS: Both groups presented an endothelial cell loss in the postoperative time, as compared with the preoperative values, but there were no significant differences among the postoperative values (1, 3 and 6 months). Six months after surgery, mean cell loss was 28.50% in group 1 and 34.77% in group 2. There were no differences among the indexes of pachymetry, polymegathism and pleomorphism between the two groups. CONCLUSIONS: Endothelial response was not statistically different between the two studied groups.
Acesso aberto (Open Access)
Estudo prospectivo comparativo de duas técnicas cirúrgicas de extração extra-capsular planejada de catarata com implante de lente intra-ocular: incisão limbar e incisão escleral tunelizada
(Conselho Brasileiro de Oftalmologia, 2001-06-01) Freitas, Lincoln Lemes [UNIFESP]; Di Martino, Daniel Sánchez [UNIFESP]; Mori, Edson [UNIFESP]; Mendonça, Marcelo; Casanova, Fábio Henrique Cacho [UNIFESP]; Abreu, Mariza Toledo De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Nacional de Assunção Faculdade de Medicina Departamento de Oftalmologia; Hospital do Olho de Rio Preto Setor de Glaucoma; Faculdade de Medicina de Mogi das Cruzes Departamento de Oftalmologia
Purpose: Cataract is the main cause of blindness throughout the world, affecting more than 15 million people worldwide. There are different techniques for extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation. This study aims to compare limbal incision and scleral tunnel incision in planned ECCE. Methods: Fifty-four consecutive patients (59 eyes) with follow-up of 6 months were studied prospectively. ECCE with limbal incision was performed in 30 patients (Group I), and with scleral tunnel incision in 29 patients (Group II). Corrected visual acuity, intraocular inflammation (cells and flare), surgical time, specular microscopy, induced astigmatism and pachymetry were assessed. Results: Surgical time, endothelial cells loss and induced astigmatism were statistically greater in group I than in group II. No significant differences were found between groups when comparing the corrected visual acuity, intraocular inflammation and pachymetry. Conclusions: ECCE with scleral tunnel incision technique offers advantages regarding surgical time, endothelial cells loss and induced astigmatism if compared with limbal incision technique. Surgical steps used in this technique help in transition for phacoemulsification with low cost and a safer way.
Acesso aberto (Open Access)
Facoemulsificação, vitrectomia via pars plana e implante de lente intra-ocular em olhos com retinopatia diabética proliferativa
(Conselho Brasileiro de Oftalmologia, 2004-06-01) Mattos, Armando Belfort [UNIFESP]; Bonomo, Pedro Paulo [UNIFESP]; Freitas, Lincoln Lemes [UNIFESP]; Farah, Michel Eid [UNIFESP]; Flynn Jr, Harry; Pereira, Maurício Bastos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Miami Bascom Palmer Eye Institute
PURPOSE: To evaluate the outcomes and the best technique for a combined phacoemulsification (PHACO), pars plana vitrectomy (PPV) and posterior chamber intraocular lens insertion (PCIOL) in one single procedure for patients with proliferative diabetic retinopathy. METHODS: We reviewed charts of 47 (53 eyes) patients with proliferative diabetic retinopathy who underwent combined phacoemulsification with posterior chamber intraocular lens implant and pars plana vitrectomy performed between January 1991 and September 1998 at the Bascom Palmer Eye Institute, eye hospital affiliated with the University of Miami. The study was done in conjunction with the Federal University of São Paulo. A total of 43 eyes from 40 patients were elected to participate in the study. RESULTS: The follow-up range was three to 60 months (mean 20 months). The age ranged from 37 to 77 years with a mean of 59. Preoperative visual acuity improved two lines or more in 26 (60.4%) eyes, remained the same in 9 (20.9%) and got worse in 8 (18.6%). In 10 (23.2%) eyes visual acuity improved to 20/40. The study showed to be statistically significant for the improvement of the final visual acuity. Recurrent vitreous hemorrhage was the most frequent postoperative complication found in 12 (27.9%) eyes and it was followed by transient anterior chamber reaction in 9 (20.9%) eyes. Intraoperative and postoperative complications related to phacoemulsification were rare. IOL capture was found in 2 (4.6%) eyes and intraocular lens subluxation in 1 (2.3%) eye. CONCLUSION: Combined phacoemulsification with posterior chamber intraocular lens implant and pars plana vitrectomy in proliferative diabetic retinopathy is a feasible procedure, well-tolerated and usually presents significant visual acuity improvement. One single procedure, to remove the cataract and to perform pars plana vitrectomy, instead of performing a second surgery that would be only to remove the cataract after the pars plana vitrectomy is safe, improves visual acuity and is also less aggressive for the patient. The potential for improving final visual acuity is limited by the severity of retinopathy.
Acesso aberto (Open Access)
Intracapsular dexamethasone implant in patients undergoing phacoemulsification and intraocular lens implantation
(Conselho Brasileiro de Oftalmologia, 2013-08-01) Vianna, Lucas Monferrari Monteiro [UNIFESP]; Freitas, Lincoln Leme [UNIFESP]; Nosé, Walton [UNIFESP]; Kanecadan, Liliane Andrade Almeida [UNIFESP]; Soriano, Eduardo Sone [UNIFESP]; Muccioli, Cristina [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
PURPOSE: To relate the outcomes of 7 eyes of 7 patients in which a dexamethasone 0.7 mg implant (Ozurdex®) was placed inside the capsule bag after phacoemulsification and intraocular lens (IOL) implantation and compare with the fellow eyes, that were operated by the same technique and received dexamethasone eyedrops in the post-operatory. METHODS: Report review of 7 eyes of 7 patients who received dexamethasone 0.7 mg implant after phacoemulsification and IOL, comparing them to the fellow eyes. All the patients underwent bilateral cataract surgery, with one month interval, by the same technique and by experienced surgeons, without complications. Post operatory medication consisted of moxifloxacin eye drops for all the 14 eyes and topic dexamethasone for the 7 eyes that did not received the implant. RESULTS: Nuclear cataract classification (according to LOCS III) was 3.28 ± 0.69 in the implant eye group and 3.14 ± 0.83 in the fellow eye group. Postoperative best spectacle correct visual acuity (BSCVA) was 0.85 ± 0.12 and 0.87 ± 0.13, respectively in the implant and fellow eye groups. The intraocular pressure remained stable and similar to the pre-operative measurements. Anterior chamber reaction and cornea edema were similar in both groups in the follow-up. Two of the four no sutured pellet migrated to the anterior chamber during the first post-operative week and had to be repositioned. Another no sutured pellet dislocated and remained partially inside the capsule bag. The 3 patients with IOL haptic-sutured pellet had no complications. CONCLUSIONS: In the present study, dexamethasone 0.7mg implant were effective in controlling the inflammation after phacoemulsification and IOL implantation, with no significant side effects.
Acesso aberto (Open Access)
Metodologia para implantação de programa de manutenção de um aparelho de facoemulsificação
(Conselho Brasileiro de Oftalmologia, 2004-04-01) Aragaki, Wagner Koji [UNIFESP]; Scarpi, Marinho Jorge [UNIFESP]; Linzmayer, Eduardo; Universidade Federal de São Paulo (UNIFESP); Faculdade de Engenharia Mauá
PURPOSE: To implement a plan of preventive maintenance developed for users of the phacoemulsification machine. METHODS: In order to implement a maintenance program for a phacoemulsification machine, Alcon's Legacy 20000 was chosen. Its operating manual was used as a primary search, so that the probability of equipment malfunction or breakdown could be quantified. The maintenance condition of Legacy 20000 was checked in some hospitals in São Paulo through an interview with the responsible clinical engineers. Surgeons working at the Cataract Sector of UNIFESP (Universidade Federal de São Paulo (UNIFESP)) were asked their opinion about the functioning of Legacy 20000 , in order to indentify the main sources of malfunction. After research had been carried out in hospitals and with the surgeons, a maintenance manual for the Legacy 20000 was proposed, based on preventive maintenance tools. RESULTS: The analysis regarding error messages showed that most potential problems and corrective measures to be taken are due to problems of connection or fixation of the cables. The Legacy 20000 main sources of malfunction were identified in the São Paulo Hospital, which had acquired its own piece of equipment. In most cases they were related to broken ultra-sound handpiece, broken electronic and mechanical components, faulty setup and problems of priming, vacuum and aspiration. The interview with the cataract surgeons of the Universidade Federal de São Paulo (UNIFESP) showed lack of technical knowledge due to their lack of familiarity with the manual and no training regarding equipment functions. CONCLUSIONS: There is no complete plan of preventive maintenance for the Legacy 20000 in the hospitals considered for this research only corrective maintenance. The manual of preventive maintenance item proposed for Legacy 20000 was prepared based on the research results using preventive maintenance tools.
Acesso aberto (Open Access)
Nonarteritic anterior ischemic optic neuropathy after uneventful phacoemulsification: case report
(Conselho Brasileiro de Oftalmologia, 2007-06-01) Fontes, Bruno Machado [UNIFESP]; Jung, Liang Shih [UNIFESP]; Soriano, Eduardo Sone [UNIFESP]; Chicani, Carlos Filipe [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
To report a case of nonarteritic anterior ischemic optic neuropathy (NAION) after uneventful cataract extraction and intraocular lens implantation. Prospective, observational case report and literature review. We report the case history of a 74-year-old woman who underwent phacoemulsification and developed sudden loss of vision on the 13th postoperative day. After complete ocular and systemic evaluation the diagnosis of NAION was made. NAION can be associated with cataract extraction, and surgeons should be aware of this potentially blinding complication.
Acesso aberto (Open Access)
Outcomes of cataract surgery in diabetic patients: results of the PanAmerican Collaborative Retina Study Group
(Conselho Brasileiro de Oftalmologia, 2014-12-01) Gallego-Pinazo, Roberto; Dolz-Marco, Rosa; Berrocal, Maria; Wu, Lihteh; Maia, Maurício [UNIFESP]; Serrano, Martín; Alezzandrini, Arturo; Arévalo, J. Fernando; Díaz-Llopis, Manuel; University and Polytechnic Hospital La Fe Department of Ophthalmology; University of Puerto Rico Department of Ophthalmology; Instituto de Cirugía Ocular; Universidade Federal de São Paulo (UNIFESP); Clinica Oftalmologica Centro Caracas; Arevalo-Coutinho Foundation for Research in Ophthalmology; Universidad de Buenos Aires Cátedra de Oftalmologia; The King Khaled Eye Specialist Hospital Vitreoretinal Division; Johns Hopkins University The Wilmer Eye Institute Retina Division; University of Valencia Faculty of Medicine
Purpose:This study was designed to evaluate the visual and anatomical outcomes after cataract surgery in diabetic patients with different intraoperative therapeutic strategies.Methods:The research design comprised of a multicentric, retrospective, interventional study conducted at 6 centers in Argentina, Brazil, Costa Rica, Puerto Rico, Spain, and Venezuela. We included 138 diabetic patients with at least 6-month follow-up following phacoemulsification and intraocular lens implantation. Best-corrected visual acuity (BCVA) and central subfield thickness were collected at baseline and at 1-, 2-, 3-, and 6-month follow-up. Of these, 42 cases were not treated with any intraoperative coadjuvant medication (Group 1), 59 patients received intraoperative bevacizumab (Group 2) and 37 patients received intraoperative triamcinolone (4 mg/0.1 ml) (Group 3).Results:The mean logMAR [± standard deviation (SD)] BCVA improved from 0.82 (± 0.43) at baseline, to 0.14 (± 0.23) at 6-month follow-up (p<0.001) in Group 1; from 0.80 (± 0.48) to 0.54 (± 0.45) (p<0.001) in Group 2; and from 1.0 (± 0.40) to 0.46 (± 0.34) (p<0.001) in Group 3. The mean central subfield thickness increased from 263.57 µm (± 35.7) at baseline to 274.57 µm (± 48.7) at 6-month follow-up (p=0.088) in Group 1; from 316.02 µm (± 100.4) to 339.56 µm (± 145.3) (p=0.184) in Group 2; and from 259.18 µm (± 97.9) to 282.21 µm (± 87.24) (p=0.044) in Group 3.Conclusion:Diabetic patients may significantly benefit from cataract surgery. This study provides evidence to support the use of intravitreal triamcinolone or bevacizumab at the time of cataract surgery in cases with pre-existent diabetic macular edema or moderate-severe non-proliferative diabetic retinopathy.
Acesso aberto (Open Access)
Posterior argentinean flag-like sign during primary posterior continuous curvilinear capsulorhexis
(Consel Brasil Oftalmologia, 2017) Marques, Frederico Franca; Villano Marques, Daniela Mieira; Matsumoto, Fabio Kenji
We describe a unique complication during primary posterior continuous curvilinear capsulorhexis (PCCC) in a patient with megalocornea scheduled for phacoemulsification with toric multifocal intraocular lens (IOL) implantation. After nucleus emulsification and cortex removal, the capsular bag was filled with cohesive viscoelastic in preparation for PCCC to achieve reverse optic capture of the IOL, thus ensuring stability. However, as soon as the initial puncture was made using a 27-gauge needle to start the capsulotomy, the posterior capsule opening extended peripherally from 0 degrees-180 degrees. This capsule extension was similar to the Argentinean-flag sign in hypermature cataracts, and both are caused by excessive intracapsular pressure. Careful bimanual manipulation was performed to implant the IOL on the desired axis, which occurred uneventfully. At a postoperative visit, the patient exhibited excellent uncorrected visual acuity with a well-aligned IOL.
Acesso aberto (Open Access)
Precisão ecobiométrica da fórmula SRK/T na facoemulsificação
(Conselho Brasileiro de Oftalmologia, 2001-06-01) Corrêa, Zélia Maria da Silva [UNIFESP]; Kronbauer, Fernando Leite; Goldhardt, Raquel; Marcon, Ítalo Mundialino [UNIFESP]; Bakowicz, Felipe; Santa Casa Setor de Ecografia; Universidade Federal de São Paulo (UNIFESP); Santa Casa Serviço de Oftalmologia
Purpose: To determine the accuracy of intraocular lens (IOL) power calculation with the SRK/T formula in phacoemulsification. Methods: Retrospective review of 119 patients treated with phacoemulsification in 1999 in a University Hospital. Patients with incomplete charts and with intraoperative complications were excluded from this study. Eighty-one patients were selected to establish the accuracy of the SRK/T formula to predict the postoperative refractive error after phacoemulsification and intraocular lens implantation. All biometries were performed by the same technician using the same equipment. All procedures were performed by third-year residents. Results: Comparing the final refraction planned by the surgeon, based on biometry with the SRK/T formula, and the postoperative spherical equivalent, patients were divided in to 4 groups: Group 1 - patients with refractive errors up to ± 0.50 diopters (n=33 (40.7 %)). Group 2 - patients with refractive errors between ±0.51 and ±1.25 diopters (n=29 (35.7 %)). Group 3 - patients with refractive errors between ±1.26 and ±2.00 diopters (n=8 (9.87%)). Group 4 - patients with refractive errors above ±2.01 diopters (n=11 (13.5%)). Conclusions: The postoperative refractive results were satisfactory, the majority of patients (n=62 (76.4%)) presented residual refractive errors after phacoemulsification up to ±1.25 diopters.
Acesso aberto (Open Access)
Pseudophakic monovision technique with Toric IOL using the SN60T5 platform
(Sociedade Brasileira de Oftalmologia, 2010-04-01) Marques, Frederico França [UNIFESP]; Marques, Daniela Meira Villano [UNIFESP]; Faculdade de Medicina do ABC Department of Ophthalmology; Universidade Federal de São Paulo (UNIFESP)
We demonstrate the combination of pseudophakic monovision technique with toric IOL in patients with relevant corneal astigmatism to reduce spectacle dependence after cataract surgery. All patients achieved UCDVA ³ 20/30 and UCNVA ³ J2 and none of them required spectacle correction on the 6th postoperative month.
Acesso aberto (Open Access)
Safety and efficacy of intracameral moxifloxacin injection for prophylaxis of endophthalmitis after phacoemulsification
(Consel Brasil Oftalmologia, 2017) Vieira, Ibraim Viana [UNIFESP]; Boianovsky, Celso; Saraiva, Thais Jones; de Godoy, Rodolfo Bregion; Lake, Jonathan
Purpose: To evaluate the safety and efficacy of 0.05 mL intracameral injection of moxifloxacin in patients who underwent phacoemulsification and intraocular lens (IOL) implant. Methods: Retrospective study comprising patients who underwent phacoemulsification and IOL implant between January 2009 and December 2013. Patients were divided into two groups. Group A followed standard endophthalmitis prevention protocol and group B followed the same protocol plus intracameral injection of 0.05 mL of moxifloxacin hydrochloride at 5.45 mg/mL, immediately after IOL implant. Results: Medical records from 7,195 eyes of 3,751 patients (median age: 67.8 +/- 8.96, range: 48-83 years, 53.8% female) were evaluated. Group A included 3,515 eyes of 1,838 patients and group B included 3,680 eyes of 1,913 patients. The incidence of endophthalmitis in group A was 0.22% (8: 3,515 eyes) and in group B was 0.03% (1: 3,680 eyes, p= 0.0198, Fischer's exact test). No toxicity or inflammation related to the use of moxifloxacin was observed. Conclusions: There was a 7.3-fold lower ratio of endophthalmitis in the group that received moxifloxacin intracameral injection. This study provides further evidence that moxifloxacin is an effective intracameral prophylactic antibiotic.

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