Endophthalmitis, an inflammation of the eye due to perioperative infection, may occur after cataract surgery. Intraocular lenses (IOLs) loaded with an antibiotic have been proposed as an alternative to the conventional postoperative endophthalmitis prophylaxis, since the antibiotic is delivered directly to the target site. In this work, an IOL-based antibiotic releasing system was prepared from a copolymer used in the production of IOLs and a fluoroquinolone used in endophthalmitis prophylaxis (moxifloxacin, MFX). Argon plasma-assisted grafting with 2-hydroxyethyl methacrylate (HEMA) in the presence of MFX was the approach selected for surface modification, with MFX loaded both by entrapment in the grafted polyHEMA coating and by soaking. Surface and bulk properties were evaluated before and after surface modification and the MFX release profiles were obtained both in batch mode (sink conditions) and under hydrodynamic conditions, employing a purpose-built microfluidic cell, which simulated the hydrodynamic conditions around the eye lens. The effect of storage on the release profile of the best system was also assessed. The best system released MFX for ca. 15 days above the minimum inhibitory concentration for Staphylococcus aureus and Staphylococcus epidermidis. The released MFX showed antimicrobial activity against these bacteria and was non-cytotoxic against corneal endothelial cells.

Cataracts is the treatable eye diseases that cause most blindness in the world. The effective treatment is surgical and phacoemulsification the most applied technique. Some complications are associated with the procedure as corneal opacities, uveitis and fibrin deposits. The presence of fibrin in the anterior chamber is associated with the formation of synechia and secondary glaucoma low visual recovery of patients. Some medications, as TPA (Tissue Plasminogen Activator) which acts in the degradation of fibrin, seeing being used to soften these deposits. Tenecteplase is a third generation of the synthetic TPA and have a longer half-life than the others with application in ophthalmology without damage to the cornea and retina of rabbits and humans. The study was conducted on 15 rabbits of New Zealand race, share in three groups GC, GT and GNT. The GNT and GT were surgery by phacoemulsification technics, GT was treated with 0.1 ml intracameral tenecteplase (50 μg) transoperative. The rabbits were evaluated in M0 moments - when selected, underwent phacoemulsification surgery and reassessed in M1d – 1th day M3d – 3th day M7d – 7th day M15d - 15th day and M21d – 21th days. In the clinical evaluation of the use of intracameral tenecteplase in transoperative and postoperative complications were observed, emphasizing the change in IOP, the corneal edema, fibrin deposits, hyphema, aqueous flare and synechia incidences. In the M21d animals were sacrificed, and samples of aqueous humor were collected for physical-chemical analysis (pH, density, concentration of chloride ions and total proteins). No statistical differences were observed in the clinical evaluation of the GC and GNT within the recommended parameters. In physical-chemical analysis of aqueous humor showed no statistical difference between the three groups in terms of pH and concentration of chloride ion. The density values and total protein concentration between the GC and the other groups.

OBJECTIVES: We aimed to evaluate the effects of cataract surgery on cardiac autonomic modulation. METHODS: A cross-sectional and analytical study was conducted at the Hospital Maria Braido in the city of Sa˜o Caetano do Sul, Sa˜o Paulo, between 2015 and 2016. We investigated 19 patients of both sexes who were all over 50 years old; all patients had a diagnosis of senile or bilateral cataracts and were recommended to undergo implantation of the intraocular lens. Heart rate variability (HRV) was evaluated before, during and after cataract surgery. RESULTS: There were no significant changes in the time and geometric domains of HRV before, during or after surgery. The high-frequency (HF) band in normalized units (nu) on the spectral analysis significantly increased (p=0.02, Cohen’s d=0.9, large effect size). However, the low-frequency (LF) band in nu significantly decreased during surgery (p=0.02, Cohen’s d=0.9, large effect size). CONCLUSION: Throughout the intraocular lens implantation cataract surgery, there was an increase in parasympathetic modulation and a decrease in the sympathetic component of the heart rate (HR). We propose that this result is attributable to the supine position of the patients during surgery and the trigeminal reflex.

OBJECTIVE: To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns. METHODS: Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated. RESULTS: The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group. CONCLUSIONS: The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.

OBJECTIVE: To identify in adult patients suffering from cataract the perceptions regarding the disease and its surgical treatment. MATERIALS AND METHODS: An exploratory survey was conducted among adult patients suffering from cataract and participating in a large-scale cataract management program at the University of São Paulo General Hospital in 2004. The interviews were conducted by research assistants previously trained to pose questions and record answers. RESULTS: The sample consisted of 170 men and women (43.5% and 56.5%, respectively), aged between 40 and 88 years. Of the 170 participants, 43.5% were from the State of São Paulo, 14.7% from the State of Bahia, 12.4% from the State of Minas Gerais, 5.9% from the State of Pernambuco, 1.8% from other countries, and the remaining 21.7% were from other Brazilian states. Of those who were actively working (n = 87), 43.7% had an occupational level corresponding to nonspecialized manual labor, 27.6% were in specialized manual labor jobs, 25.3% had routine nonmanual occupations, 1.1% supervised manual labor, and 2.3% had low-ranking supervision or inspection jobs over nonmanual occupations. Of those who were not actively working (n = 82), 53.6% were retired, 45.2% were housewives, and 1.2% were unemployed. Concerning conceptions about cataract, 79.0% referred to it as "a small skin fold that gradually covers the eye" and 32.4% mentioned, in addition, other conceptions. Concerning the cause, of the alternatives presented to them, 80% reported aging, 47.1% blamed "overusing the eyes in the workplace or at home", 7.1% believed they had cataract due to some kind of "spell." Of the associated answers, 94.1% referred to "blurred vision" in people suffering from cataract, 72.4% thought the person may become blind, and 66.5% believed that the patients suffering from cataract are depressed because they cannot see. Regarding surgery, 28.8% were afraid of undergoing surgery; of those, 16.3% cited with the fear of dying during surgery, 55.1% thought they might become blind, 40.8% believed the surgery would be painful, and 8.2% followed religious practices that do not permit surgery. CONCLUSION: Some misconceptions were identified, and the fear of blindness was the most mentioned reason for not seeking cataract surgery, which indicates the need for orientation.

PURPOSE: Identification of emotional factors related to daily difficulties and surgical treatment among patients with cataract at a university hospital. METHODS: A cross-sectional study was carried out by means of a questionnaire, elaborated based on a previous study. The sample consisted of patients seen at the cataract unit of the ophthalmology clinic of a university hospital. RESULTS: The sample consisted of 110 individuals of both sexes (34.5% men; 65.5% women) between the ages of 43 and 89 (average 69.0 ± 10.3 years); 26.4% had never attended school, 59.1% had primary education, and 87.3% had no payed occupation. Most of the patients reported daily difficulties due to their ocular condition (82.7%), and 54.0% reported fear of visual loss. Doubt as to the outcome (32.7%), distress (26.4%), and sadness (25.5%) were reported. CONCLUSIONS: Most of the patients reported difficulties in daily activities as a consequence of cataract. Fear was the predominant feeling related to undergoing surgery. The findings suggest the need for implementing intervention courses for emotional preparation for facing daily activities and cataract surgery.

OBJECTIVE: This study sought to compare the effects and outcomes of two ophthalmic viscosurgical devices, 1.6% hyaluronic acid/4.0% chondroitin sulfate and 2.0% hydroxypropylmethylcellulose, during phacoemulsification. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that received phacoemulsification performed by the same surgeon using a standardized technique. Patients were randomly assigned to receive either 1.6% hyaluronic acid/4.0% chondroitin sulfate or 2.0% hydroxypropylmethylcellulose on the first eye. The other eye was treated later and received the other viscoelastic agent. Preoperative and postoperative examinations (5, 24 and 48 hours; 7 and 14 days; 3 and 6 months) included measurements of the total volume of the ophthalmic viscosurgical device, ultrasound and washout times to completely remove the ophthalmic viscosurgical device, intraocular pressure, central corneal thickness and best-corrected visual acuity. The corneal endothelial cell count was measured at baseline and at six months postoperatively. ClinicalTrials.gov: NCT01387620. RESULTS: There were no statistically significant differences between groups in terms of cataract density or ultrasound time. However, it took longer to remove 2.0% hydroxypropylmethylcellulose than 1.6% hyaluronic acid/ 4.0% chondroitin sulfate, and the amount of viscoelastic material used was greater in the 2.0% hydroxypropylmethylcellulose group. In addition, the best-corrected visual acuity was significantly better in the hyaluronic acid/ chondroitin sulfate group, but this preferable outcome was only observed at 24 hours after the operation. There were no statistically significant differences between the two ophthalmic viscosurgical devices regarding the central corneal thickness or intraocular pressure measurements at any point in time. The corneal endothelial cell count was significantly higher in the hyaluronic acid/chondroitin sulfate group. CONCLUSION: The ophthalmic viscosurgical device consisting of 1.6% hyaluronic acid/4.0% chondroitin sulfate was more efficient during phacoemulsification and was easier to remove after IOL implantation than 2.0% hydroxypropylmethylcellulose. In addition, the corneal endothelial cell count was significantly higher following the use of hyaluronic acid/chondroitin sulfate than with hydroxypropylmethylcellulose, which promoted an improved level of corneal endothelium protection.

Purpose: To compare the accuracy of a newly developed intraocular lens (IOL) power formula (VRF-G) with twelve existing formulas (Barret Universal II, EVO 2.0, Haigis, Hill-RBF 2.0, Hoffer Q, Holladay 1, Kane, Næeser 2, PEARL-DGS, SRK/T, T2 and VRF). Methods: Retrospective case series including 828 patients having uncomplicated cataract surgery with the implantation of a single IOL model (SN60WF). Using optimised constants, refraction prediction error of each formula was calculated for each eye. Subgroup analysis was performed based on the axial length (short ≤22.0mm; medium >22.0mm to <26.0mm; long ≥26.0mm). Main outcomes included mean prediction error (ME) mean (MAE) and median absolute error (MedAE), in diopters (D), and the percentage of eyes within ±0.25D, ±0.50D, ±0.75D and ±1.00D. Results: Formulas absolute errors were statistically different among them (p<0.001), with Kane having the lowest MAE of all formulas, followed by EVO 2.0 and VRF-G, which had the lowest MedAE. The Kane formula had the highest percentage of eyes within ±0.25D (47.0%) and ±1.00D (97.7%) and the VRF-G formula had the highest percentage of eyes within ±0.50D (79.5%). For all AL subgroups, Kane, EVO 2.0 and VRF-G formulas had the most accurate performances (lowest MAE). Conclusion: New generation formulas may help us in achieving better refractive results, lowering the variance in accuracy in extreme eyes - Kane, EVO 2.0 and VRF-G formulas are promising candidates to fulfil that goal.

Introdução: A presença de cataratas em cães é considerada a principal causa de cegueira nesta espécie. Actualmente, a técnica cirúrgica de eleição é a Facoemulsificação. Objectivos: Estudar quais os factores prévios à cirurgia de cataratas por facoemulsificação que podem influenciar o tempo de recuperação pós-operatório em cães. Material e Métodos: Foram analisados 84 bolbos oculares. Todos os animais foram submetidos à cirurgia pelo mesmo cirurgião. Para cada bolbo ocular foi determinada a pressão intra-ocular (PIO), o grau de inflamação e o grau de visão em várias consultas de acompanhamento realizadas às 4, 24, 48, 72 horas, 15 dias, 1 mês, 3 e 6 meses de pós-operatório. As variáveis foram analisadas com o recurso a testes estatísticos, sendo assumido um nível de significância de 0,05. Resultados: Foram encontradas diferenças significativas nas curvas de recuperação ao longo do tempo em função da raça, idade e etiologia das cataratas. Essas diferenças não foram encontradas em função do género, do estadio de desenvolvimento da catarata e do grau de inflamação associado à catarata previamente à cirurgia. Conclusões: É necessário avaliar estes factores antes da cirurgia e adaptar a terapêutica a cada animal individualmente.

ABSTRACT - Nutraceuticals are natural compounds which include supplements and functional foods with potential health benefits. Little is known about their use, namely regarding veterinary ophthalmology. The aim of the present study was to estimate the prevalence of its usage in veterinary ophthalmology in a studied sample. A retrospective study was developed resorting to the database of the Teaching Hospital of the FMV-ULisbon between 2021 and 2023. All the animals who attended a consultation in this period, and, after a complete ophthalmological evaluation, reached a diagnosis of at least one of the five groups of ophthalmic diseases: (1) glaucoma, (2) retinopathies, (3) diseases of the lens or crystalline, (4) ocular surface diseases and (5) nonspecific vision loss, were included in the sample. From these cases, all the animals to which at least one nutraceutical was administered, as therapeutical adjuvant to an ophthalmic disease, were selected. The used nutraceutical compounds were registered. For the recollection and analysis of the data Microsoft Office Excel 2007® and descriptive statistis were used. 1005 clinical cases, of which 90% (907/1005) were dogs, fulfilled the selection criteria. The most common ophthalmic affection in the sample were diseases of the lens (60%, 603/1005), following by retinopathies (17%, 169/1005), ocular surface diseases (15%, 152/1005), glaucoma (5%, 53/1005), and nonspecific vision loss (3% 28/1005). Nutraceuticals were used in 278 animals, representing 28% of prevalence of the use of these compounds in the studied sample. The ophthalmic disease in which nutraceuticals were more frequently prescribed were nonspecific vision loss (100%), followed by retinopathies (43%), ocular surface diseases (34%), glaucoma (25%), and cataracts (18%). The most used nutraceutical was an antioxidant enriched with omega-3 fatty acids and carotenoids, prescribed in 107 cases; followed by another antioxidant enriched with magnesium (91 cases), vitamin A (65 cases), Ginkgo Biloba extract (19 cases), and other supplements including Ursodeoxycholic Acid, Selenium, and Coenzyme Q10. Nowadays, nutraceuticals are being used as therapeutical adjuvants in several ophthalmic diseases such as nonspecific vision loss, retinopathies, ocular surface diseases, glaucoma, and cataracts. However, more clinical studies to assess the indications, effects, safety, and dosage of these compounds should be performed. A well-stablished regulation and control of the commercialization and administration of nutraceuticals is also needed