Introdução: A catarata é uma patologia ocular muito comum e uma das principais causas de cegueira corrigível. O tratamento é cirúrgico, e consiste na remoção do cristalino opacificado e implante de uma lente intraocular. As lentes intraoculares monofocais são as mais utilizadas, corrigindo apenas a visão de longe. Vários estudos comparam os diferentes tipos de lentes em termos de acuidade visual e satisfação dos doentes, mas a literatura é escassa na caracterização da qualidade da visão padrão dos doentes com lentes monofocais. O nosso objetivo principal é caracterizar o padrão de normalidade de qualidade de visão em doentes com lente intraocular monofocal pós cirurgia de catarata e acuidade visual normal.Métodos: Estudo observacional transversal, que incluiu 50 olhos com catarata senil, submetidos a cirurgia com implante da lente intraocular monofocal Acrysof® SN60AT. Foram avaliadas, no pós-operatório final, a acuidade visual de longe e perto com e sem correcção, refracção esfero-cilíndrica, velocidade de leitura, sensibilidade ao contraste, biomicroscopia da superfície ocular, segmentos anterior e posterior, tonometria, topografia/tomografia da córnea, aberrometria e pupilometria. Foram aplicados dois questionários: Catquest e Qualidade de Visão. Foi realizada análise estatística descritiva para cada variável e o teste Qui-Quadrado e o V de Cramer para procurar correlação entre as variáveis. O questionário da Qualidade de Visão foi analisado pelo Partial Credit Model.Resultados: Incluíram-se 50 olhos de 29 pacientes com idade média de 69,4 anos. 21 doentes foram operados aos dois olhos (n=42), 8 doentes foram operados a um olho (n=8). A velocidade média de leitura foi 116,66 palavras/minuto. A média da acuidade visual para longe não corrigida foi LogMAR=0,03, e corrigida LogMAR=0,002. A função de sensibilidade ao contraste mostrou uma curva descendente para frequências espaciais mais elevadas. Queixas de disfotópsia negativa ocorreram em 16% dos doentes. A pontuação média no questionário Qualidade de Visão Patient Location Estimate foi -2.404, sendo a visão enevoada o sintoma mais prevalente, seguido dos riscos estrelados; a pontuação média no Catquest foi 94,13%.Discussão: A satisfação geral dos doentes encontrou-se correlacionada com a velocidade de leitura, sensibilidade ao contraste e equivalente esférico da refração final. Todavia, não foi encontrada qualquer relação com a disfotopsia negativa nem aberrometria. As expectativas dos doentes têm influência na sua satisfação. A principal fraqueza deste estudo é a falta de dados sobre a sensibilidade ao contraste. Caracterizamos a qualidade da visão dos nossos pacientes, o que nos ajudará a prever resultados futuros em condições semelhantes.

Introdução: A catarata é uma das causas de cegueira mais prevalente no mundo, passível de ser corrigida cirurgicamente com substituição do cristalino por uma lente intraocular, conferindo ao doente uma melhoria imediata da sua acuidade visual no pós-operatório. Diferentes tipos de lentes intraoculares (LIO) traduzem diferentes níveis de acuidade visual para as várias distâncias, com diferentes efeitos adversos, percecionados pelos doentes como deslumbramentos (“glares”) e halos. Recentemente, foi introduzido um novo tipo de lente - AcrySof® IQ Vivity® (EDOF). O objetivo do nosso estudo foi avaliar os resultados visuais e funcionais de lentes já inseridas na prática clínica do serviço de Oftalmologia do CHUC - LIO Alcon Clareon (monofocal) e LIO Alcon PanOptix (trifocal), e compará-los com a nova LIO Alcon Vivity (EDOF). Materiais e Métodos: O estudo teve um caráter observacional, não tendo havido interferência por parte dos investigadores na seleção da lente a implantar. Foram considerados no estudo um total de 14 participantes, 4 com a Alcon Clareon e 10 com a Alcon PanOptix, submetidos a facoemulsificação da catarata com implantação bilateral de LIO, sem intercorrências durante o procedimento nem comorbilidades oculares associadas. Para efeitos do estudo, procedeu-se à avaliação da acuidade visual para visão ao perto, intermédia e ao longe, da sensibilidade ao contraste, e da presença de disfotópsias, um mês após a cirurgia, no âmbito de consulta. Para avaliação e comparação das LIO Vivity recorreu-se ao estudo da Alcon – “Clinical Outcomes of a Novel Non-Diffractive Extended Vision IOL”. Resultados: Os resultados do nosso estudo demonstram que a LIO Alcon Vivity (EDOF) é capaz de ultrapassar as principais lacunas da Alcon Clareon e da Alcon PanOptix. A primeira, de design monofocal, demonstrou melhor acuidade visual para visão ao longe, com menos efeitos indesejáveis associados, enquanto a segunda, de design trifocal, alcançou melhores resultados para distâncias intermédias e ao perto, mas com mais efeitos adversos. Discussão: A LIO Alcon Vivity tem, potencialmente, melhores resultados visuais que a LIO Alcon Clareon para as distâncias intermédia e ao perto, mantendo uma taxa de efeitos indesejáveis baixa, ao contrário da LIO Alcon PanOptix. Assim, podemos inferir que a nova LIO Alcon Vivity irá permitir uma maior flexibilidade ao médico nas suas alternativas de escolha para substituição do cristalino, aquando da consulta pré-operatória, e abre a porta a novas abordagens e estudos para a comunidade científica.

ABSTRACT: This study examined the efficacy of an intravitreal dexamethasone-loaded device for the control of postoperative ocular inflammation in dogs following phacoemulsification. Twenty dogs with bilateral mature senile cataracts were prepared for surgery using routine protocols. A biodegradable poly (lactic-co-glycolic acid) copolymer device was inserted through the pars plana into the vitreous chamber immediately before phacoemulsification (device group [DG], n=20). Following surgery, a conventional group (CG) received local and systemic steroids, mydriatics, and antibiotic therapy. The same treatment protocol was adopted in DG, except for steroids. All eyes were examined before surgery and at various times after phacoemulsification. Ultrasonography showed gradual device shrinkage, with only remnants remaining at postoperative day (POD) 60. Signs of uveitis were observed in 35% of the DG on POD 7, but by POD 14, 50% of eyes showed signs of uveitis and these eyes required local steroid therapy. The intraocular pressure (IOP) was higher in the DG than in the CG immediately after surgery. IOP did not differ on POD 7 and POD 14, but was lower during the late postoperative period (POD 30 to 90). Flare values were greater in the DG than in the CG immediately following surgery, but showed no subsequent differences. In summary, the intravitreal dexamethasone device did not adequately control intraocular inflammation in dogs undergoing phacoemulsification.

The pseudophakic eye lacks the ability to produce a refractive change in response to object proximity. Thus, individual anatomical features such as the pupil size play an important role in achieving functional vision levels. In this work, the range of pupil sizes at varying object distance was measured in pseudophakic participants. Furthermore, the impact of the measured values on eye optical quality was investigated using a computer simulation model. A binocular eye-tracker was used to measure the participants’ pupil sizes at six object distances, ranging from 0.33 m (i.e., vergence of 3.00 D) to 3.00 m (i.e., vergence of 0.33 D), while observing a Maltese cross with a constant angular size of 1 ◦ . In total, 58 pseudophakic participants were enrolled in this study (age mean ± standard deviation: 70.5 ± 11.3 years). The effects of object distance and age on pupil size variation were investigated using linear mixed effects regression models. Age was found to have a small contribution to individual variability. The mean infinite distance pupil size (intercept) was 4.45 (95% CI: 2.74, 6.17) mm and the mean proximal miosis (slope) was −0.23 (95% CI: −0.53, 0.08) mm/D. The visual acuity (VA) estimation for a distant object ranged from −0.1 logMAR (smallest pupil) to 0.04 logMAR (largest pupil) and the near VA (0.33 m) when mean proximal miosis was considered ranged from 0.28 logMAR (smallest pupil) to 0.42 logMAR (largest pupil). When mean distance pupil was considered, proximal miosis individual variability produced a variation of 0.04 logMAR for the near object and negligible variation for the distant object. These results support the importance of distance pupil size measurement for the prediction of visual performance in pseudophakia, while suggesting that proximal miosis has a negligible impact in VA variability

PURPOSE: The purpose of this study was to evaluate the visual and refractive outcomes and rotational stability of the new aspheric Precizon(®) toric intraocular lens (IOL) for the correction of corneal astigmatism in cataract surgery. SETTING: Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE and Hospital de Pedro Hispano, Matosinhos, Portugal. DESIGN: This was a prospective clinical study. PATIENTS AND METHODS: A total of 40 eyes of 27 patients with corneal astigmatism greater than 1.0 diopter (D) underwent cataract surgery with implantation of Precizon(®) toric IOL. IOL power calculation was performed using optical coherence biometry (IOLMaster(®)). Outcomes of uncorrected (UDVA) and best-spectacle corrected distance visual acuities (BCDVA), refraction, and IOL rotation were analyzed at the 1st week, 1st, 3rd, and 6th month's evaluations. RESULTS: The median postoperative UDVA was better than preoperative best-spectacle corrected distance visual acuity (0.02 [0.06] logMAR vs 0.19 [0.20] logMAR, P<0.001). At 6 months, postoperative UDVA was 0.1 logMAR or better in 95% of the eyes. At last follow-up, the mean spherical equivalent was reduced from -3.35±3.10 D to -0.02±0.30 D (P<0.001) with 97.5% of the eyes within ±0.50 D of emmetropia. The mean preoperative keratometric cylinder was 2.34±0.95 D and the mean postoperative refractive cylinder was 0.24±0.27 D (P<0.001). The mean IOL rotation was 2.43°±1.55°. None of the IOLs required realignment. CONCLUSION: Precizon(®) toric IOL revealed very good rotational stability and performance regarding predictability, efficacy, and safety in the correction of preexisting regular corneal astigmatism associated with cataract surgery.

Background: Cystoid macular edema (CME) due to Irvine-Gass syndrome (IGS) is one of the common causes of painless visual impairment post-cataract extraction. The treatment of recurrent cases remains unstandardized. Objective: To evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (0.2 µg/day; ILUVIEN®) in the off-label treatment of recurrent CME due to IGS. Methods: Retrospective 36-month case series in the Ophthalmology Department of Centro Hospitalar Universitário do Porto, Portugal. Consecutive eyes of patients with recurrent cystoid macular edema due to Irvine-Gass syndrome who underwent a single intravitreal injection of fluocinolone acetonide intravitreal implant were included. Best-corrected visual acuity (logMAR), central macular thickness (µm) and safety (intraocular pressure, mmHg) at baseline and at 6, 12, 24 and 36 months post-administration of the fluocinolone acetonide intravitreal implant were recorded. Results: Five eyes from three patients were included. The duration of cystoid macular edema was 67.8±25.9 months and all five eyes received more than 2 intravitreal injections of a corticosteroid (triamcinolone and/or dexamethasone implant) prior to fluocinolone acetonide intravitreal implantation. At baseline (median - interquartile range), best-corrected visual acuity was 0.3-0.3; central macular thickness was 492.0-38.0; and intraocular pressure was 16.0-0. By Month 36, best-corrected visual acuity was 0.4 -0.3; central macular thickness was reduced to 369.0-324.0 and intraocular pressure was 17.0-3.0. Four of five eyes had increased intraocular pressure and were managed with intraocular pressure-lowering eye drops. Conclusion: We report improved functional and anatomical outcomes after treatment with fluocinolone acetonide intravitreal implant, indicating its use as a therapeutic alternative in recurrent cases of cystoid macular edema due to Irvine-Gass syndrome. Additionally, in eyes with suboptimal response to intravitreal therapies, fluocinolone acetonide intravitreal implant may provide longer recurrence-free periods with reduced treatment burden.

Objective: The objective of this study was to compare systemic exposure to tropicamide/phenylephrine following intracameral or topical administration before cataract surgery. Patients and methods: Mydriatics exposure was calculated in patients randomized to intracameral fixed combination of mydriatics and anesthetic ([ICMA]: tropicamide 0.02%, phenylephrine 0.31%, and lidocaine 1%, N=271) or mydriatic eye drops ([EDs]: tropicamide 0.5% and phenylephrine 10%, N=283). Additional doses were permitted if required. Mydriatic plasma levels were determined by mass spectrometric HPLC in 15 patients per group before and after administration. Results: Most ICMA patients (73.6%) received a single dose (200 µL) representing an exposure to tropicamide of 0.04 mg and phenylephrine of 0.62 mg. None of these patients received additional mydriatics. In the control group (three administrations), the exposure was 0.45 (11.3-fold higher than ICMA) and 10.2 (16.5-fold higher) mg. When additional ED was used in this group (9.2% of patients), it was 37.5-fold higher for tropicamide (10 drops, 1.5 mg) and 54.8-fold higher for phenylephrine (10 drops, 34 mg) than the recommended ICMA dose. Tropicamide plasma levels were not detectable at any time point in ICMA patients while it was detectable in all ED patients at 12 and 30 minutes. Phenylephrine was detectable in 14.3% of ICMA patients compared to all ED patients at least at one time point. More ED patients experienced a meaningful increase in blood pressure and/or heart rate (11.2% vs 6.0% of ICMA patients; P=0.03). Conclusion: Systemic exposure to tropicamide/phenylephrine was lower and cardiovascular (CV) effects were less frequent with ICMA. This could be of particular significance in patients at CV risk.