Bruna Vieira Ventura

Purpose: To evaluate the efficacy of oral riboflavin and sunlight exposure in stabilizing keratoconus progression. Methods: In this prospective interventional study with a retrospective historical control group, patients with progressive keratoconus received 60 mg/day of oral riboflavin and 30 min/day of sunlight exposure for three months. A historical control group included patients with similar characteristics who were awaiting cross-linking or keratoplasty. Ophthalmological exams and corneal topography were conducted at baseline, 6 months, and 12 months post-treatment. A sub-analysis was performed for patients with corneal stromal thickness (CST) ≥ 400 µm and < 400 µm. Results: Fifty patients [91 eyes; 31 (62%) males] with a mean age of 18.7 ± 4.4 years (range, 11–31) and a mean maximum keratometry (Kmax) of 57.9 ± 8.3 D comprised the treatment group. Kmax flattened (−1.22 ± 4.78 D; P = 0.003) in treated eyes; however, it steepened (+0.32 ± 11.96 D; P = 0.455) in controls at 6 months. Keratoconus progression occurred in 27.5% of treated eyes versus 49.5% in controls (P = 0.002). Eyes with CST ≥ 400 µm had a 3.85-fold higher risk of progression in the control group than in treated eyes (95% CI: 1.6–9.3; P = 0.001). Conclusion: After one year, 72.5% of treated eyes remained stable following the use of oral riboflavin and sunlight exposure, with a significantly lower risk of progression in eyes with normal CST.

A new technique is described that enables in-the-bag implantation of an intraocular lens (IOL) in infants with microspherophakia and congenital cataract. In this technique, partial amputation of both haptics of a 3-piece IOL allows its in-the-bag implantation in pediatric eyes with a crystalline lens with reduced equatorial diameter. In the reported case, a 6-month-old baby with bilateral microspherophakia (equatorial lens diameter of 6.5 mm in both eyes) underwent surgery for congenital cataracts. There was no phacoiridodonesis before the procedure. After phacoaspiration, posterior capsulotomy, and anterior vitrectomy, a 3-piece IOL with both haptics partially amputated was implanted in the bag. During the 2-year follow-up, the IOL remained centered and without pseudophacodonesis. Vision improved from light perception to within the normal range for her age. There were no signs of glaucoma development.

PURPOSE: To assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency. METHODS: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated. RESULTS: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator's cataract challenges (p<0.696). CONCLUSION: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic.

To compare the long-term ocular findings of children that were operated of congenital cataract before the age of two and that received an intraoperative intracameral triamcinolone injection or used postoperative oral prednisolone to modulate ocular inflammation. All patients who had previously participated in a clinical trial that analyzed the 1-year surgical outcomes of congenital cataract surgery utilizing intracameral triamcinolone (study group) or oral prednisolone (control group) were eligible to participate in this prospective cohort research. Patients’ medical records were reviewed, and the children underwent a complete ophthalmologic exam on final follow-up. Biomicroscopic findings, intraocular pressure, central corneal thickness, the need for additional surgical interventions, and findings compatible with glaucoma were the primary end measures. Twenty-six eyes (26 patients) were included (study group = 11 eyes; control group = 15 eyes). The mean follow--up was 8.2 ± 1.2 years and 8.1 ± 1.7 years in the study and control groups, respectively (p=0.82). All eyes presented a centered intraocular lens. There was no statistically significant difference between the groups with regards to the presence of posterior synechia (p=0.56), intraocular pressure (p=0.49), or central corneal thickness (p=0.21). None of the eyes fulfilled the glaucoma diagnostic criteria, presented secondary visual axis obscuration, or were reoperated. The long--term ocular findings of children that underwent congenital cataract surgery and received an intraoperative intracameral triamcinolone injection were similar to those that used postoperative oral prednisolone to modulate ocular inflammation. This suggests that intracameral triamcinolone may substitute oral prednisolone in congenital cataract surgery, facilitating the postoperative treatment regimen and compliance.

PURPOSE: To assess the incidence and risk factors of Descemet membrane detachment due to laser application in femtosecond laser-assisted cataract surgery (FLAGS). METHODS: In this retrospective case series, all patients who underwent FLAGS with the LenSx system (Alcon Laboratories, Inc) were eligible to participate. The medical records were reviewed to collect data regarding potential risk factors related to Descemet membrane detachment, including patient's demographics, Laser parameters, and ocular measurements. The eyes were separated into two groups based on the clinical diagnosis of Descemet membrane detachment as the femtosecond laser was performing the corneal incisions. RESULTS: Five hundred ten eyes (304 patients) were included. Descemet membrane detachment occurred in 20 13.9%) eyes of 16 (5.3%) patients. Four (1.3%) patients had a detachment in both eyes. In 16 (3.1%) eyes, the Descemet membrane detachment occurred in the secondary incision site. The eyes that had a detachment had a statistically lower mean endothelial cell density (2,193.40 +/- 313.37 versus 2,385.08 +/- 357.80 cells/mm(2); P = .019), and a statistically higher prevalence of corneal guttata (25.0% versus 8.8%; P = .015). None of the other analyzed variables statistically differed between the groups (P > .051. The risk of having Descemet membrane detachment was statistically higher among eyes with guttata (odds ratio = 3.47; P = .015) and in those with an endothelial cell density of less than 2,000 cells/mm(2) (odds ratio = 3.26; P = .014). CONCLUSIONS: The incidence of Descemet membrane detachment due to laser application in FLACS was 3.9%, with the associated risk factors being endothelial cell density of less than 2,000 cells/mm(2) and corneal guttata.

To assess the prevalence of macular abnormalities not suspected by the biomicroscopic fundus examination and identified only by macular optical coherence tomography (OCT) in the preoperative evaluation for cataract surgery in a large series of Brazilian patients. Private practice, Recife, Brazil. Retrospective case series. All eyes that had cataract surgery by the same physician between August 2014 and July 2016 were eligible. Excluded were eyes with a previous diagnosis of macular abnormalities, with a suspicious biomicroscopic fundus examination, and without OCT results. Based on the preoperative macular OCT, patients were divided into the following 2 groups: those with a normal OCT and those with an abnormal OCT. Nine hundred fifty-two eyes (614 patients) were included in the study. Macular OCT identified abnormalities in 47 eyes (4.9%) of 44 patients (7.2%). Thirty-one eyes (3.3%) had epiretinal membrane, 7 (0.7%) had age-related macular degeneration, 4 (0.4%) had intraretinal cysts, 4 (0.4%) had a lamellar hole, and 1 (0.1%) had a macular hole. Patients with an abnormal OCT had a statistically significant higher mean age (P = .004). In the preoperative evaluation for cataract surgery in Brazilian patients, 7.2% of those with a normal biomicroscopic fundus examination had macular abnormalities that were identified only by OCT.

Purpose: To assess the efficacy of using a nonsteroidal anti-inflammatory drug preoperatively and of applying the re-dilation technique when necessary to minimize pupil size variation when comparing the degree of mydriasis before femtosecond laser pretreatment with that at the beginning of phacoemulsification. Methods: This retrospective study included patients who underwent cataract surgery using the LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Our routine dilating regimen with flurbiprofen, tropicamide, and phenylephrine was used. The re-dilation technique was applied on eyes that manifested with a pupillary diameter that was smaller than the programmed capsulotomy diameter after laser pretreatment. The technique consists of overcoming pupillary contraction by instilling tropicamide and phenylephrine before phacoemulsification. Pupil size was assessed before femtosecond laser application and at the beginning of phacoemulsification. Results: Seventy-five eyes (70 patients) were included. Nine (12%) eyes underwent the re-dilation technique. There was no significant difference in mean pupillary diameter and mean pupillary area between the two studied surgical time points (p=0.412 and 0.437, respectively). The overall pupillary area constriction was 2.4 mm(2). Immediately before opening the wounds for phacoemulsification, none of the eyes presented with a pupillary diameter 6 mm. Conclusion: Preoperative administration of nonsteroidal anti-inflammatory drug and the re-dilation technique resulted in no significant pupil size variation in eyes that were pretreated with the femtosecond laser, when comparing the measurements made before the laser application and at the beginning of phacoemulsification. This approach can avoid the need to proceed with cataract extraction with a constricted pupil.

Comparison of visual outcomes after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of an extended depth of focus intraocular lens with a diffractive bifocal intraocular lens André Lins de Medeiros,1–4 André Gustavo de Araújo Rolim,1,2 Antonio Francisco Pimenta Motta,2,5 Bruna Vieira Ventura,3,6 César Vilar,1,2,7 Mário Augusto Pereira Dias Chaves,1–3,8 Pedro Carlos Carricondo,2,5 Wilson Takashi Hida1,2,5 1Cataract Department, Hospital Oftalmológico de Brasília, 2Cataract Department, Centro de Estudos Oftalmológicos Renato Ambrósio, Brasília, 3Cataract Department, Fundação Altino Ventura, Recife, Brazil; 4Cataract Department, University of Edinburgh, Edinburgh, UK; 5Cataract Department, Universidade de São Paulo, São Paulo, 6Cataract Department, Hospital de Olhos de Pernambuco, Recife, 7Cataract Department, Hospital de Olhos Francisco Vilar, Teresina, 8Cataract Department, ProVisão, João Pessoa, Brazil Purpose: The purpose of this study was to compare the visual outcomes and subjective visual quality between bilateral implantation of a diffractive trifocal intraocular lens, Alcon Acrysof IQ® PanOptix® TNFT00 (group A), and blended implantation of an extended depth of focus lens, J&J Tecnis Symfony® ZXR00 with a diffractive bifocal intraocular lens, J&J Vision Tecnis® ZMB00 (group B).Methods: This prospective, nonrandomized, consecutive, comparative study included the assessment of 40 eyes in 20 patients implanted with multifocal intraocular lens. Exclusion criteria were existence of any corneal, retina, or optic nerve disease, previous eye surgery, illiteracy, previous refractive surgery, high axial myopia, expected postoperative corneal astigmatism of >1.00 cylindrical diopter (D), and intraoperative or postoperative complications. Binocular visual acuity was tested in all cases. Ophthalmological evaluation included the measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), and uncorrected intermediate visual acuity (UIVA), with the analysis of contrast sensitivity (CS), and visual defocus curve.Results: Postoperative UDVA was 0.01 and −0.096 logMAR (p<0.01) in groups A and B, respectively; postoperative CDVA was −0.07 and −0.16 logMAR (p<0.01) in groups A and B, respectively; UIVA was 0.14 and 0.20 logMAR (p<0.01) in groups A and B, respectively; UNVA was −0.03 and 0.11 logMAR (p<0.01) in groups A and B, respectively. Under photopic conditions group B had better CS at low frequencies with and without glare.Conclusion: Both groups promoted good quality of vision for long, intermediate, and short distances. Group B exhibited a better performance for very short distances and for intermediate and long distances ≥−1.50 D of vergence. Group A exhibited a better performance for UIVA at 60 cm and for UNVA at 40 cm. Keywords: trifocal, multifocal, pseudophakia, cataract

Purpose: The purpose of this study was to compare intraoperative parameters between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification using Centurion^® Vision System with Active Fluidics. Setting: This study was performed at Brasília Ophthalmologic Hospital, Brasília, Federal District, Brazil. Patients and methods: This was a prospective randomized comparative study. Patients with the diagnosis of cataract and surgical extraction programmed were divided into two groups: conventional phacoemulsification and FLACS. Intraoperative data were collected and submitted for statistical analysis. Results: A total of 400 eyes were enrolled, 200 in each group. There were no surgical complications. Groups were statistically equivalent in age and nucleus density. Cumulative dissipated energy and torsional time were significantly reduced in the FLACS group. Conventional surgery had less fluid usage, total case time and aspiration (ASP) time. Conclusion: FLACS with Active Fluidics System can reduce the ultrasound energy use during cataract surgery, in spite of increasing case time, fluid usage and ASP time.

We report an unusual case of a 65-year old patient that developed localized bilateral Descemet membrane detachment during non-simultaneous femtosecond laser-assisted cataract surgery (FLACS). The detachment occurred when the laser was performing the secondary incision. In the operating room, the isolate-and-release technique was used to effectively manage this complication. To the best of our knowledge, this is the first reported case of bilateral Descemet membrane detachment during FLACS