OBJECTIVE: To compare postoperative social costs of two cataract surgical techniques, phacoemulsification (PHACO) and extracapsular extraction (ECCE). METHODS: Prospective randomized intervention study including 205 patients, of which 101 underwent PHACO and 104 ECCE in the public service, in the city of São Paulo, Southeastern Brazil, in 2002. The socioeconomic impact of these surgical procedures was assessed based on postoperative costs for patients, employers and social security. Comparisons between the two groups studied were performed using the chi-square test or Mann-Whitney test, when appropriate. A 5% significance level was set. RESULTS: Hospital and eyeglasses costs for PHACO were lower than for ECCE patients, with a mean difference of US$ 16.74. Costs to employers related to medical leave for the first 15 days of absence and costs of caregivers in the form of absence from work to attend postoperative follow-up visits were on average US$ 0.18 lower in PHACO compared to ECCE group. The estimated Social Security expenditure per patient undergoing surgery was US$ 6.57 and US$ 51.15 in PHACO and ECCE groups, respectively. CONCLUSIONS: The average saving with PHACO compared to ECCE technique was US$ 61.50 for employers, patients, caregivers and Social Security.

INTRODUCTION: Pediatric cataract is one of the leading preventable causes of blindness worldwide. Timely diagnosis and treatment of the cataract are crucial to avoid irreversible visual effects. The visual axis opacification (VAO) is the most frequent complication arising from pediatric cataract surgery. According to most scientific evidence, an anterior and posterior continuous curvilinear capsulorhexis with anterior vitrectomy (AV) is recommended to prevent VAO. The necessity of its inclusion in the treatment of pediatric cataracts, however, is still questioned. Secondary glaucoma, one of the most feared complications, can occur at any moment after surgery, demanding a life-long follow-up. PURPOSE: To describe a large Portuguese pediatric cataract cohort and determine whether the VAO is prevented by AV and access glaucoma development. METHODS: A review of 340 eyes from 245 individuals of pediatric age who underwent pediatric cataract surgery at Centro Hospitalar e Universitário de Coimbra (CHUC) between 1990 and 2019. A retrospective, non-interventional statistical analysis was carried. For sub-analysis of the impact of AV in OEV, need for reoperation or YAG-laser due to it, and occurance of inflammatory membranes, the sample was divided into 3 groups regarding age at surgery: < 2 years; 2 to 5 years; and >5 years. For sub-analysis of the association of glaucoma with age at surgery we considered 4 groups regarding age at surgery: <1 month, 1 to 12 months, 1 to 5 years, and >5 years; and 3 groups to study the association with follow-up duration: <1 year, 1 to 5 years, and >5 years; respectively. The association of glaucoma with primary intraocular lens implantation (pIOL) was studied. RESULTS: The median age at surgery was 39,33 months, with a mean follow-up time of 66,44 months. Most patients had congenital cataract (67,7% n=157) and 51,9 % were bilateral (n=123). Primary IOL implantation was performed in 55,7% (n=206) and was associated with lower glaucoma rates (1,1% vs 9,0%, p=0,001). Patients who underwent AV (76,5% of eyes, n=235) had lower postoperative complications and VAO rates (39,3% vs 65,3%, p=0,001 and 4,7% vs 16,8%, p=0,001, respectively) and less reoperation or YAG-laser rates due to VAO (3,4% vs 15,3%, p=0,001). Glaucoma (total incidence of 5,3%, n=18) was associated with premature surgery (p=0,005) - higher on the first month - and longer follow-up (p<0,001) – higher with 5 or more years of follow-up. CONCLUSION: The inclusion of anterior vitrectomy has proven to be a better approach to prevent postoperative complications, visual axis opacification, and the need for reoperation or YAG-laser due to this complication. A lifelong follow-up is crucial to evaluate the long-term outcomes and late complications, namely glaucoma.

Introduction: Modern intraocular lens (IOL) power calculation formulas depend on a set of mandatory biometric parameters (axial length, keratometry, anterior camera depth), but also allow the introduction of optional biometric parameters that may not be measurable by older optical biometry devices. As an example, Barrett Universal II (UII) and Kane formulas include optional parameters such as crystalline lens thickness and white white distance or crystalline lens thickness and central corneal thickness, respectively. Given the current scientific gap regarding the effect of these optional variables on refractive outcomes, we compare the results of uncomplicated cataract surgery with and without the use of optional parameters. Materials and Methods: Observational retrospective consecutive case study of eyes submitted to uncomplicated cataract surgery with trifocal diffractive IOL implantation (Alcon PanOptix®, Alcon Labs TX, USA) in which we compared the spherical equivalent (SE) predicted for the implanted lens, obtained by Barrett UII and Kane formulas, with the postoperative SE obtained by subjective refraction 6 to 12 weeks after surgery. To evaluate the influence of the optional parameters on Barrett UII and Kane formulas, we performed a back-calculation with and without those variables. Primary outcomes included mean absolute error (MAE), median absolute errors (MedAE), mean arithmetic error and standard error, obtained with and without the inclusion of optional parameters for both formulas. Results: Seventy nine eyes from 79 patients were included (n=79). After optimization, the MAE obtained was 0.208 through the Barrett UII formula and 0.191 through the Kane formula (p>0.05) without including optional variables. The MedAE was 0.144 and 0.166, respectively (p>0.05). With the inclusion of both optional parameters, the postoperative SE prediction changed by more than 0.1 D (absolute values) in only 15.2% (n=12) and 17.7% (n=14) of the eyes, respectively. Only half of these cases showed improvement of the postoperative prediction of refractive power (n=6 and n=7, respectively), with a worse prediction in the remaining 50%. Discussion: These results show that it is possible to obtain good results without using optional parameters, which are not measured by some older biometers still used. Conclusion: In our study, the inclusion of optional biometric parameters in the Barrett UII and Kane formulas provided no significant refractive benefit.

Introdução: A refração subjetiva é o resultado refrativo natural avaliado na cirurgia de catarata moderna. Contudo, é, por definição, subjetiva e pode constituir uma fonte de ruído que é difícil de remover e controlar durante a avaliação dos resultados refrativos. Alguns dispositivos de análise de frente de onda por traçado de raios são capazes de derivar a refração esferocilíndrica a partir da aberrometria total ocular e podem ser capazes de estimar o erro refrativo pós-operatório de uma forma menos dependente do paciente e do operador. Neste trabalho comparamos ambas as técnicas para a avaliação refrativa pós-operatória após cirurgia de catarata.Métodos: Estudo prospetivo incluindo olhos consecutivos submetidos a cirurgia de catarata não complicada com implantação de uma lente intraocular Alcon AcrySof SN60AT. Todos os pacientes foram submetidos a biometria ótica (Allegro Biograph) e o equivalente esférico pós-operatório (EE) foi estimado utilizando as fórmulas Barrett Universal II e Kane. A refração subjetiva pós-operatória (com o alvo de vermelho igual a verde no teste do duocromo) foi obtida 6-12 semanas pós-operatoriamente. No mesmo dia foi obtida refração aberrométrica (média de duas medições) em condições mesópicas sem dilatação utilizando o dispositivo Tracey iTrace. Erros de previsão para ambas as fórmulas foram obtidos subtraindo a estimativa pré-operatória do EE ao EE pós-operatório utilizando ambas as técnicas.Resultados: Vinte e quatro olhos foram incluídos. A esfera pós-operatória foi semelhante utilizando ambas as técnicas (0.03 ± 0.38D vs 0.09 ± 0.26D, p=0.440). Contudo, o cilindro medido foi significativamente mais baixo na refração subjetiva (-0.57 ± 0.31D vs -0.86 ± 0.44D, p=0.014). O EE subjetivo pós-operatório foi ligeira mas significativamente menor do que o EE aberrométrico (-0.21 ± 0.27D vs -0.38 ± 0.30D, p=0.029), o que pode ser explicado pelo maior cilindro medido por aberrometria. Os erros de previsão médios para ambas as fórmulas foram mais elevados utilizando a refração subjetiva (Barrett: 0.410 ± 0.288D vs 0.230 ± 0.206D; Kane: 0.471 ± 0.314D vs 0.291 ± 0.285D; ambos p=0.029). Discussão e Conclusão: Neste estudo exploratório, propomos que a refração aberrométrica possa ser usada enquanto uma forma fácil de obter medições de resultados suplementares e independentes de operador e paciente, para avaliação dos erros de previsão biométricos e resultados refrativos a seguir à cirurgia de catarata. As diferenças encontradas entre métodos sugerem que a refração aberrométrica pode aproximar-se mais das previsões pré-operatórias das fórmulas modernas.

Introdução: Os efeitos do controlo glicémico no poder refrativo ocular e a associação entre diabetes mellitus e o desenvolvimento de catarata são há muito conhecidos. Contudo, existe pouca evidência relativamente à avaliação completa do estado refrativo do sistema ótico em diabéticos através da aberrometria. Este estudo teve como objetivos: utilizar o método de aberrometria por ray tracing para comparar as aberrações de frente de onda do olho fáquico e pseudofáquico diabético com controlos saudáveis e avaliar o efeito da cirurgia de catarata estimando a contribuição relativa do cristalino em doentes diabéticos. Pretendemos ainda avaliar a influência do tipo de catarata nas aberrações de frente de onda e a correlação das aberrações com a acuidade visual.Métodos: Realizámos um estudo prospetivo observacional com 15 doentes (6 diabéticos tipo 2 sem retinopatia diabética e 9 não diabéticos) propostos para cirurgia de catarata no Centro de Responsabilidade Integrado de Oftalmologia do Centro Hospitalar e Universitário de Coimbra, entre dezembro de 2017 e janeiro de 2018. Para além das variáveis demográficas que foram colhidas pré-operatoriamente, recolhemos variáveis oftalmológicas (acuidade visual e tipo de catarata, entre outras) e dados da aberrometria por ray tracing antes e 4 semanas após a facoemulsificação do cristalino com colocação de lente intraocular monofocal. Para a análise estatística utilizámos o software IBM SPSS Statistics.Resultados: A mediana de idade da amostra era 76 anos, sendo que 86,7% eram indivíduos do sexo feminino e 40% diabéticos. Dos 15 olhos estudados, 26,7% apresentavam cataratas ligeiras, 46,7% moderadas e 26,7% densas e, com exceção da acuidade visual sem correção pré-operatória, os diabéticos mostraram piores acuidades visuais. A diferença entre as aberrações de frente de onda do grupo diabético e do não diabético não foi estatisticamente significativa, contudo observámos valores medianos superiores no primeiro grupo em todas as variáveis com exceção de RMS defocus, RMS HO total, RMS spherical, RMS secondary astigmatism e RMS trefoil pré-cirúrgicos e RMS coma, RMS defocus e na RMS trefoil pós-cirúrgicos. Houve uma redução estatisticamente significativa dos valores pré para os pós-operatórios das variáveis RMS total, na RMS LO total e na RMS spherical, no grupo não diabético, e na variável RMS coma, no grupo dos diabéticos. A acuidade visual sem correção pós-operatória influenciou significativamente a RMS total dos diabéticos, enquanto a com correção pré-operatória influenciou significativamente a RMS HO total, no total dos indivíduos. Já o tipo de catarata não se correlacionou de forma estatisticamente significativa com as aberrações de frente de onda.Discussão e Conclusão: A acuidade visual e a cirurgia de catarata influenciam de forma significativa as aberrações de frente de onda, já a DM e o tipo de catarata não parecem ter impacto significativo. Acreditamos que, apesar do tamanho reduzido da amostra, as diferenças encontradas têm significância clínica e justificam a sua investigação em estudos subsequentes.

With the development of new surgical techniques, instrumentation and pharmacological advances, corneal transplant procedures can undergo changes directly in the clinical profile of patients with the indication for penetrating keratoplasty technique. The aim of this study was to identify the clinical profile of patients undergoing penetrating keratoplasty and the main indicating conditions at a university hospital in Northeast Brazil. This is an epidemiological, cross-sectional, descriptive study performed using data from medical records of 241 patients who underwent keratoplasty between January/2010 and December/2014. From the total keratoplasties performed in the hospital during the study period, 88.37% were carried out by penetrating technique. Of these, 50.44% were performed in male patients with an average age of 55.2 years. The main indications were keratoconus, followed by bullous keratopathy and keratitis. Preexisting clinical conditions for penetrating keratoplasty were found, such as changes in vascularization, glaucoma, previous surgery, aphakic and pseudophakic eyes and keratoplasties combined with other types of surgeries. Knowledge of the clinical profile of patients who underwent penetrating keratoplasty enabled identification of the main ocular diagnoses that result in this type of transplant as a therapeutic indication. From this, it is possible to point out the main pre-existing medical conditions of penetrating keratoplasty that may represent potential risk factors for complications in the postoperative period and even lead to graft failure. We suggest that further studies be carried out on a thematic.

The purpose of this study was to measure the extent to which complications relating to cataract surgery are a cause of visual impairment in a population aged 50 and over from the city of Campinas, São Paulo State, Brazil. An assessment of cataract surgery services was conducted using random cluster sampling, with the sample composed of 60 clusters of 40 people aged 50 years or older. Of the selected sample of 2,400 subjects, 92.67% were examined. Of these 2,224 examined subjects, 75 (3.37%) presented bilateral visual impairment and 164 unilateral, while a total of 314 (7.06%) eyes presented visual impairment. 352 eyes had undergone cataract surgery. The causes of visual impairment after surgery were concurrent eye disease (56%), surgical complications (28.8%) and refractive errors (15.2%). Cataract surgery complications represented the 5th most important cause of visual impairment. The other main causes were cataract, posterior segment disorders, diabetic retinopathy and glaucoma. These results suggest cataract surgery complications are a major cause of visual impairment in this population. Their prevention and treatment must be part of public health care policies.

BACKGROUND AND OBJECTIVES: The objective of the present study was to evaluate the degree of sedation, intraocular pressure, and hemodynamic changes with premedication with low doses of oral clonidine, 100 μg and 200 μg, in outpatient cataract surgeries. METHODS: This is a randomized, double-blind, clinical study undertaken at the Universidade Federal de São Paulo with 60 patients of both genders, physical status ASA 1 and 2, ages 18 to 80 years. Patients were separated into three groups: placebo, clonidine 100 μg, and clonidine 200 μg. Intraocular pressure, heart rate, and blood pressure besides assessment of sedation were measured before and 90 minutes after the administration of clonidine. Sedation levels were classified according to the Ramsay sedation scale. RESULTS: Patients who received placebo and 100 μg of clonidine did not show reduction in heart rate, while a reduction in heart rate was observed in patients who received 200 μg of clonidine, and this difference was statistically significant. Patients who received 200 μg of clonidine also had a reduction in systolic and diastolic blood pressure (p < 0.05). One patient who received 200 μg of clonidine developed severe hypotension, with systolic pressure < 80 mmHg. Patients treated with clonidine had a reduction in intraocular pressure (p < 0.05). Ninety minutes after the oral administration of placebo and 100 μg and 200 μg of clonidine, 25%, 60%, and 80% of the patients respectively were classified as Ramsay 3 or 4. CONCLUSIONS: Clonidine 100 μg can be indicated as premedication for fasciectomies, being effective in sedation and reduction of intraocular pressure, without adverse effects on blood pressure and heart rate.

Objetivo: identificar as principais complicações intraoperatórias dos pacientes que realizaram ceratoplastias e sua relação com fatores clínicos e cirúrgicos. Método: estudo transversal, observacional. Realizou-se um censo dos pacientes submetidos a ceratoplastias que totalizou 258 procedimentos. Resultados: foram registradas 22 complicações intraoperatórias, todas em ceratoplastias penetrantes. Do total, 59,09% foram realizadas em pacientes do sexo masculino com idade média de 58,5 anos. A principal complicação intraoperatória notificada foi a perda vítrea (36,36%). Encontrou-se relação estatisticamente significativa entre a variável “complicação intraoperatória” e as variáveis “cirurgia prévia”, “ceratoplastia combinada com extração de catarata” e “botão corneano do receptor maior que 8,0 mm”. Conclusão: identificar as principais complicações intraoperatórias da ceratoplastia possibilita à enfermagem compreender quais fatores podem interferir nesses procedimentos, apontar possíveis fatores preditores das complicações e buscar medidas de controles para que tais complicações não ocorram.