Análise das indicações, das técnicas e das complicações de troca de lente intra-ocular em pacientes submetidos a cirurgia de catarata
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Data
2007
Autores
Marques, Frederico França [UNIFESP]
Orientadores
Belfort, Rubens Junior [UNIFESP]
Tipo
Tese de doutorado
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Objetivo: Analisar as principais indicações para a troca de lente intra-ocular. A técnica utilizada, o intervalo de tempo entre a primeira cirurgia e troca da lente intraocular, a melhor acuidade visual pré e pós-operatória e as complicações pósoperatórias. Material e Métodos: Trata-se de um estudo retrospectivo de uma série de casos envolvendo 49 olhos de 49 pacientes adultos submetidos à troca de lente intra-ocular (LIO), em período de 14 anos, pelo mesmo cirurgião. Destes pacientes, 55,1% do sexo feminino com idade média 70 anos. O seguimento médio foi de 35,6 meses e a média de intervalo de tempo entre a cirurgia inicial e a manifestação dos sintomas foram de 53,8 meses. Os pacientes foram divididos em dois grupos de acordo com o tipo de lente que possuíam antes da sua troca: lente de câmara anterior (CA) e lente de câmara posterior (CP). Resultados: Quinze olhos tinham LIO CA e 34 tinham LIO CP, não houve diferença estatística relacionada à idade e seguimento destes pacientes. O intervalo entre cirurgias foi de 83,2 meses no grupo de LIO CA e 37,9 meses no de LIO CP. As principais indicações ao explante no grupo de LIO CA foi edema macular cistóide (33,34%) e no grupo de LIO CP foi a descentralização (85,3%). A acuidade visual corrigida (AVC) foi semelhante em ambos os grupos com manutenção ou melhora em aproximadamente 80%. Das complicações pós-operatórias encontradas, a ceratopatia bolhosa do pseudofácico foi a de pior prognóstico. Conclusão: A principal indicação de troca de LIO no grupo com LIO CA foi edema macular cistóide (33,34%) e descentralização (85,3%) no de LIO CP. O intervalo para manifestação do sintoma justificando a troca do implante foi maior no grupo de LIO CA com tempo médio de 83,2meses contra 37,9meses do grupo de LIO CP. No grupo de LIO CA, a vitrectomia foi realizada em 80%, fratura de háptico 33,4%; por sua vez, no grupo de LIO CP a vitrectomia ocorreu em 61,8% e fratura de háptico em 8,8% dos casos. Como principal complicação responsável pela piora da AVC pré-operatória temos o ceratopatia bolhosa do pseudofácico..
Purpose: To analyze of the main indications for IOL exchange, the interval between the first IOL implantation and the IOL exchange, the preoperative and postoperative best corrected visual acuity and the postoperative complications. Material and Methods: It is a retrospective study with 49 eyes of 49 adult patients undergone to IOL exchange from 1986 to 2002 by the same surgeon. 55.1% was female, the mean age was 70 years old. The mean follow-up period was 35.6 months and the mean interval between surgeries was 53.8 months. The patients were divided preoperatively in two groups according to the type of IOL inserted: anterior chamber IOL (ACIOL) and posterior chamber IOL (PCIOL). Results: Fifteen eyes had ACIOL and 34 PCIOL, the mean age and follow-up were not statistically significant between groups. The mean interval between surgeries was 82.3 months at the ACIOL group and 37.9 months at the PCIOL group. The main reason for IOL exchange was CME at the ACIOL group (33.34%) and decentration at the PCIOL group (85.3%). The BCVA was similar in both groups with maintenance or improvement in 80%. Regarding the postoperative complications, the pseudophakic bulhous keratopathy (PBK) was the worst prognosis. Conclusion: The main indication for IOL exchange at the ACIOL group was cystoid macular edema (33.34%) and decentration (85.3%) at the PCIOL. The mean interval between surgeries was higher at the ACIOL group (83.2months) when compared to 37.9m at the PCIOL group. The vitrectomy was performed in 80% in the ACIOL group and 61.8% in the PCIOL group, the need for haptic fracture was 33.4% in the ACIOL group and 8.8% in the PCIOL group. The main reason for reduced preoperative BCVA was PBK in both groups (2.9% PCIOL group, 6.7% ACIOL group).
Purpose: To analyze of the main indications for IOL exchange, the interval between the first IOL implantation and the IOL exchange, the preoperative and postoperative best corrected visual acuity and the postoperative complications. Material and Methods: It is a retrospective study with 49 eyes of 49 adult patients undergone to IOL exchange from 1986 to 2002 by the same surgeon. 55.1% was female, the mean age was 70 years old. The mean follow-up period was 35.6 months and the mean interval between surgeries was 53.8 months. The patients were divided preoperatively in two groups according to the type of IOL inserted: anterior chamber IOL (ACIOL) and posterior chamber IOL (PCIOL). Results: Fifteen eyes had ACIOL and 34 PCIOL, the mean age and follow-up were not statistically significant between groups. The mean interval between surgeries was 82.3 months at the ACIOL group and 37.9 months at the PCIOL group. The main reason for IOL exchange was CME at the ACIOL group (33.34%) and decentration at the PCIOL group (85.3%). The BCVA was similar in both groups with maintenance or improvement in 80%. Regarding the postoperative complications, the pseudophakic bulhous keratopathy (PBK) was the worst prognosis. Conclusion: The main indication for IOL exchange at the ACIOL group was cystoid macular edema (33.34%) and decentration (85.3%) at the PCIOL. The mean interval between surgeries was higher at the ACIOL group (83.2months) when compared to 37.9m at the PCIOL group. The vitrectomy was performed in 80% in the ACIOL group and 61.8% in the PCIOL group, the need for haptic fracture was 33.4% in the ACIOL group and 8.8% in the PCIOL group. The main reason for reduced preoperative BCVA was PBK in both groups (2.9% PCIOL group, 6.7% ACIOL group).
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MARQUES, Frederico França. Análise das indicações, das técnicas e das complicações de troca de lente intra-ocular em pacientes submetidos à cirurgia de catarata. 2007. 92 f. Tese (Doutorado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2007.