Refractive surgery with excimer laser has been a very common surgical procedure worldwide during the last decades. Currently, patients who underwent refractive surgery years ago are older, with a growing number of them now needing cataract surgery. To establish the power of the intraocular lens to be implanted in these patients, it is essential to define the true corneal power. However, since the refractive surgery modified the anterior, but not the posterior surface of the cornea, the determination of the corneal power in this group of patients is challenging. This article reviews the different sources of error in finding the true corneal power in these cases, and comments on several approaches, including the clinical history method as described originally by Holladay, and a modified version of it, as well as new alternatives based on corneal tomography, using devices that are able to measure the actual anterior and posterior corneal curvatures, which have emerged in recent years to address this issue.
- MeSH
- laserová modelace rohovky pod rohovkovou lamelou * MeSH
- lasery excimerové MeSH
- lidé MeSH
- refrakce oka * MeSH
- rohovka chirurgie MeSH
- rohovková topografie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Introduction: Spasm of the near reflex usually includes accommodative spasm, esophoria/tropia, and different degrees of miosis. Patients usually refer to distance blurred and fluctuating vision, ocular discomfort, and headaches. The diagnosis is established with refraction with and without cycloplegia; most of the cases have a functional etiology. However, some cases require neurological conditions to be ruled out; cycloplegics have an important diagnostic and therapeutic role. Purpose: To describe a case of bilateral severe accommodative spasm in a healthy 14-year-old teenager. Case presentation: A 14-year-old boy with progressive diminished visual acuity attended for YSP consultation. The diagnosis of bilateral spasm of the near reflex was made, based on a gap refraction of 9.75 D between retinoscopy with and without cycloplegia and esophoria with normal keratometry and axial length. The spasm was eliminated with 2 drops of cycloplegic in each eye separated by 15 days; no clear etiology was found other than the start of school. Conclusion: Clinicians should be aware of pseudomyopia, especially in children with acute changes in visual acuity, who are usually exposed to myopigenic environmental factors that induce overstimulation of the parasympathetic third cranial nerve’s innervation.
- MeSH
- akomodace oka * MeSH
- atropin aplikace a dávkování terapeutické užití MeSH
- esotropie diagnóza etiologie MeSH
- lidé MeSH
- mladiství MeSH
- mydriatika MeSH
- reflex fyziologie MeSH
- refrakce oka MeSH
- spasmus farmakoterapie patofyziologie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Purpose: To describe clinical visual outcomes, spectacle independence, and patient satisfaction after cataract surgery with blending implantation of ReSTOR (Alcon laboratories) multifocal intraocular lenses. Material and Methods: A single-arm, non-randomized prospective study assessed patients undergoing cataract surgery with ReSTOR® +2.50 intraocular lens in the dominant eye and +3.00 add in the fellow eye between January 2015 to January 2020. Results: In total, 47 patients (94 eyes) were enrolled, 28 women and 19 men. The average age at surgery time was 64 ±8 years, average postoperative follow-up was 45.4 ±7.0 months, with a minimum of 18.9 months. Postoperative binocular uncorrected distance visual acuity (UDVA) was on average 0.07 logMar (Snellen 20/24), uncorrected binocular intermediate visual acuity at 65 cm was 0.07 logMar (20/24), uncorrected binocular near visual acuity at 40 cm was 0.06 logMar (20/23). Contrast sensitivity under photopic and scotopic conditions, with and without glare, remained at the upper limit of normality. 98% of patients were quite satisfied or very satisfied. 87% did not require glasses for any activities, either at distant vision, nor at near vision. Conclusions: Cataract surgery with ReSTOR® IOL blended vision showed medium-term satisfactory visual results, achieving spectacle independence and a high level of satisfaction.
- MeSH
- citlivost na kontrast MeSH
- extrakce katarakty * metody MeSH
- fakoemulzifikace metody MeSH
- implantace nitrooční čočky metody MeSH
- katarakta komplikace terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nitrooční čočky MeSH
- prospektivní studie MeSH
- senioři MeSH
- spokojenost pacientů MeSH
- vidění binokulární MeSH
- zraková ostrost MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Aims: To describe the aetiology and microbial susceptibility profile of endophthalmitis cases treated at an ophthalmological referral centre in Colombia. Material and Methods: A retrospective descriptive study was carried out with all endophthalmitis cases referred to the Fundación Oftalmológica de Santander FOSCAL (Floridablanca, Colombia) from 1 January 2012 to 31 December 2015. Results: 121 eyes of 121 patients were evaluated. 77.7% of them were male and the mean age was 42.9 years. Five of them (4.1%) corresponded to endogenous endophthalmitis, and 116 (95.9%) to exogenous endophthalmitis. Of the latter, 66.9% were associated with trauma (almost one-half of them associated with intraocular foreign body), and 29.5% with intraocular surgery. The most common isolated microorganisms in the exogenous endophthalmitis group corresponded to methicillin-resistant and methicillin-sensitive strains of Staphylococcus epidermidis and Staphylococcus aureus, which were mostly susceptible to imipenem, vancomycin and moxifloxacin and resistant to ceftazidime. Conclusion: Endophthalmitis is a potentially sight-threatening condition, especially in cases of inadequate treatment. Therefore, antimicrobial therapy should be guided by vitreous humour culture to assure that the causative microorganism is susceptible to the selected agent. The results of our study lead us to propose vancomycin, moxifloxacin or imipenem as first-line antimicrobial options.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- endoftalmitida * epidemiologie etiologie MeSH
- imipenem terapeutické užití MeSH
- lidé MeSH
- moxifloxacin terapeutické užití MeSH
- oční infekce bakteriální farmakoterapie komplikace MeSH
- retrospektivní studie MeSH
- vankomycin terapeutické užití MeSH
- Check Tag
- lidé MeSH
Purpose: To determine the changes in endothelial cell density, refractive results, and risk factors associated with endothelial loss in patients with irisclaw phakic intraocular lenses for myopia/myopic astigmatism (Artisan). Methodology: Data collection was obtained from an existing database with information on patients with a phakic Artisan lens implant between 1998 and 2011 at the Virgilio Galvis Ophthalmology Centre, with at least 5 years of follow-up. As a second stage, an analysis was carried out to identify the change in endothelial cell density and its potential associated factors. Results: A total of 80 eyes with myopic errors were included with a follow-up of 11.9 + 3.48 years. The percentage of total loss of endothelial cells was greater than 25% of the preoperative density in 43.8% of the eyes. A postoperative annual loss > 1.6% was found in 47.0% of the eyes with that information available. 41 eyes (51%) had final endothelial density < 2000 cells/mm2, and 7 (8.8%) eyes had endothelial cell density < 1000 cells/mm2. Among the variables studied, no associated factors for long-term endothelial loss were found. During the course of the study, 8 (10%) phakic intraocular lenses were explanted, including 3 with accelerated endothelial loss, and another 2 with cataract associated and a significantly low endothelial density. The last mean spherical equivalent was -0.81 (±1.01 D), and the final uncorrected distance visual acuity was 0.45 logMar (Snellen 20/56). Conclusion: Artisan-type phakic lenses are a good alternative for the correction of high myopic defects, with predictable refractive results in the long term. However, there is an increased loss of endothelial cells in the long term in a high percentage of patients. Strict postoperative follow-up, including endothelial evaluation, is required, and further studies are warranted.
Purpose: To report the rare case of a 29-year-old male with a history of keratoconus, who presented with a primary iris stromal cyst which eventually showed spontaneous regression. Methods: Description of the clinical findings in the case of a 29-year-old male with a prior history of keratoconus, but no eye surgery or trauma, who consulted for an iris cyst in the left eye, diagnosed 9 months earlier. Case report: Slit-lamp examination revealed mild dyscoria, and a large cyst in the inferior quadrant of the iris. Ultrasound biomicroscopy and anterior segment optical coherence tomography of the left eye confirmed the presence of a giant iris cyst with thin walls, in contact with the corneal endothelium. Corneal endothelial cell density in the inferior cornea (close to the cyst) was 1805 cells/mm2 and 2066 cells/mm2 in the central area. After considering the risk of anterior chamber epithelial downgrowth following any surgical procedure of the cyst, the patient received conservative management. In the following months, the patient presented with 3 episodes of anterior uveitis, managed with topical corticosteroids. Finally, at approx. 21 months after the initial diagnosis, the cyst presented spontaneous regression. Anterior segment optical coherence tomography confirmed the absence of fluid inside the cyst remnants and the final endothelial cell densities evidenced endothelial cell loss (inferior cornea 738 cells/mm2 and central cornea 1605 cells/mm2). Conclusion: Conservative management should be considered in patients with cysts that show slow progression and are distant from the visual axis, in order to minimise the risk of complications following any surgical procedure of the cyst. In addition, the present case is one of the few of primary stromal iris cysts with spontaneous regression reported in the literature.
- MeSH
- akustická mikroskopie MeSH
- cysty * diagnostické zobrazování komplikace MeSH
- dospělí MeSH
- keratokonus diagnóza MeSH
- lidé MeSH
- nemoci duhovky * diagnóza komplikace MeSH
- přední komora oční MeSH
- spontánní regrese nádoru * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Excimer laser refractive surgery is a procedure performed worldwide to solve refractive errors and reduce dependence on glasses or contact lenses. There has been an increase in the number of procedures performed around the world. Myopia is the most common indication for corneal photorefractive surgery. Myopic patients have a higher risk of developing some type of glaucoma in their lifetime, such as primary open-angle glaucoma and others. Refractive surgery ablates central corneal stromal tissue, altering its thickness and biomechanics, which in turn makes it difficult to accurately measure intraocular pressure (IOP), since it underestimates it. This underestimation of IOP may delay the diagnosis of de novo glaucoma in patients with a history of refractive surgery. Each patient who wishes to undergo corneal refractive surgery should undergo a thorough glaucoma examination in order to monitor and detect the possible development and / or progression of glaucoma. A very useful practical approach is to perform a series of IOP measurements before and after surgery, when the eye is already stable, and the difference between the averages of the two sets of readings can then be used as a personalised correction factor for postoperative IOP monitoring in that eye. Also, if there is any suspicion of a possible glaucoma, paraclinical tests, such as coherent optical tomography of the retinal nerve fibre layer (RNFL), visual fields and photos of the optic nerve should be requested. All this data prior to refractive surgery should be provided to these patients, so that they can save it and give it to their treating ophthalmologists in the future.
- MeSH
- glaukom s otevřeným úhlem * chirurgie MeSH
- glaukom * chirurgie MeSH
- laserová modelace rohovky pod rohovkovou lamelou * MeSH
- lasery excimerové terapeutické užití MeSH
- lidé MeSH
- následné studie MeSH
- nitrooční tlak MeSH
- refrakční chirurgické výkony * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
