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      Resultados del implante múltiple de lentes intraoculares en la cirugía de catarata en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" Translated title: Results of the multiple intraocular lenses implantation in the cataract surgery performed at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology

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          Abstract

          OBJETIVO: Valorar los resultados visuales de los pacientes operados con la técnica de piggy back o implantes múltiples de lentes intraoculares. MÉTODOS: Se realizó un estudio descriptivo retrospectivo de corte transversal en el que se tomaron 32 ojos de 30 pacientes del universo operado de catarata, con la técnica antes descrita, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el período comprendido entre enero de 2000 hasta diciembre de 2006. Fueron evaluadas algunas variables demográficas, como edad y sexo, así como agudeza visual y refracción preoperatorio y posoperatoria con cristales y sin ellos. Reportamos las complicaciones transquirúrgicas y posquirúrgicas asociadas a las diferentes técnicas quirúrgicas empleadas para la extracción del cristalino. RESULTADOS: La edad promedio obtenida fue mayor de 50 años, y predominó el sexo femenino. Parte de los pacientes tuvieron una agudeza visual corregida superior a 20/40. La complicación más frecuente fue la opacidad de la cápsula posterior y solo en la tercera parte de los pacientes se obtuvo una buena corrección refractiva. CONCLUSIONES: La técnica de piggy back permitió la recuperación de cuatro líneas en la cartilla de Snellen en la agudeza visual corregida, mientras que en la agudeza visual sin corrección solo aumentó en dos líneas. Se encontró igual número de pacientes hipocorregidos y bien corregidos.

          Translated abstract

          OBJECTIVE: To asses the visual results of patients operated on by piggy back technique or multiple implantation of intraocular lenses METHODS: A retrospective cross-sectional descriptive study was conducted in 32 eyes from 30 patients operated on from cataract, using the above-mentioned technique, at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology in the period January 2000 through December 2006. Some demographic variables as age and sex as well as visual acuity and preoperative and postoperative refraction with/without lenses were evaluated. Trans-surgical and post-surgical complications associated with the various surgical techniques for the crystalline extraction were reported. RESULTS: Average age was 50 years, being the females predominant. One part of the patients had corrected visual acuity over 20/40. The most frequent complication was posterior capsule opacity and only one third of patients showed good refractive correction. CONCLUSIONS: Piggy back technique allowed recovering four lines in corrected visual acuity in Snellen´s chart whereas uncorrected visual acuity increased two lines only. The number of hypocorrected and well-corrected patients was the same.

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          Most cited references34

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          The Beaver Dam Eye Study: Visual Acuity

          Ophthalmology, 98(8), 1310-1315
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            Prevalence and causes of visual impairment in The Barbados Eye Study.

            To determine the prevalence and causes of low vision and blindness in a predominantly black population. Population-based prevalence study of a simple random sample of Barbados-born citizens aged 40 to 84 years. Four thousand seven hundred nine persons (84% participation). The standardized protocol included best-corrected visual acuity (with a Ferris-Bailey chart), automated perimetry, lens gradings (LOCS II), and an interview. Participants with visual acuity of worse than 20/30, other positive findings, and a 10% sample also had an ophthalmologic examination that evaluated the cause and extent of vision loss (resulting from that cause), if any. Low vision and blindness were defined as visual acuity in the better eye between 6/18 and 6/120 and visual acuity worse than 6/120, respectively (World Health Organization [WHO] criteria). Of the 4631 participants with complete examinations, 4314 (93%) reported their race as black, 184 (4%) reported their race as mixed (black and white), and 133 (3%) reported their race as white or other. Low vision was found in 5.9% of the black, 2.7% of the mixed, and 3.0% of white or other participants. Bilateral blindness was similar for black and mixed race participants (1.7% and 1.6%, respectively) and was not found in whites. Among black and mixed participants, the prevalence of low vision increased with age (from 0.3% at 40-49 years to 26.8% at 80 years or older). The prevalence of blindness was higher (P < 0.001) for men than women at each age group (0.5% versus 0.3% at ages 40-49 and 10.9% versus 7.3% at 80 years or more). Sixty percent of blindness was due to open-angle glaucoma and age-related cataract, each accounting for more than one fourth of cases. Other major causes were optic atrophy or neuropathy and macular and other retinal diseases. Few cases of blindness were due to diabetic retinopathy (1.4%), and none were due to age-related macular degeneration. Using the WHO criteria, prevalence of visual impairment was high in this African-origin population, particularly at older ages. Most blindness was due to open-angle glaucoma and cataract, with open-angle glaucoma causing a higher proportion of blindness than previously reported. The increased prevalence of blindness in men may be due to the increased male prevalence of glaucoma in this population and warrants further investigation. Results underline the need for blindness prevention programs, with emphasis on effective treatment of age-related cataract and enhancing strategies for early detection and treatment of open-angle glaucoma.
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              Standardizing constants for ultrasonic biometry, keratometry, and intraocular lens power calculations.

              J Holladay (1997)
              To provide a method and values that facilitate standardization of constants for ultrasonic biometry, keratometry, and intraocular lens (IOL) power calculations. University of Texas Medical School, Houston, Texas, USA. Keratometry and ultrasonic biometry provide the two measured input variables for the six variable vergence equations used to calculate the appropriate IOL power for a specific patient with a cataract. A review of the literature reflecting the past 156 years of research and development reveals the appropriate index of refraction to be used with the keratometer for net optical corneal power, the location of the principal planes of the cornea, the nominal value for retinal thickness, and the appropriate velocities for ultrasonic measurement of the axial length. The relationship of the thick IOL to the thin IOL is derived along with the physical location of the thick lens. Two methods are described that provide the best IOL constant to be used by a manufacturer to minimize the prediction error for a surgeon using the lens for the first time. The formulas for phakic IOLs and secondary piggyback IOLs are also derived and applied to methods described above for standard IOLs. Using a standardized net index of refraction of 4/3 for the cornea eliminates a variability of 0.56 diopter (D) in the predicted refraction. Using a standardized 1532 m/s velocity for axial length measurements and adding a value of 0.28 mm reduces the tolerance of axial length measurements to +/-0.03 mm for any length eye. The physical location of the thick IOL's secondary principal plane must be anterior to the thin lens equivalent by approximately the separation of the principal planes of the thick lens. For biconvex poly(methyl methacrylate) IOLs, the separation in the principal planes is approximately 0.10 mm. Using these relationships, the physical position of the thick lens within the eye can be used to confirm the lens constant for any IOL style. Standardizing the constants for keratometry, ultrasonic biometry, and IOL power calculations can significantly improve the predictability of refractive outcomes. Back-calculating and physically measuring the position of the lens within the eye can provide surgeons with an initial lens constant known to have a standard error of the mean of +/-0.05 mm (+/-0.10 D). Other parameters such as the cardinal points of a lens, the shape factor, the lens-haptic plane, and the center lens thickness would allow further refinement of IOL power calculations.

                Author and article information

                Journal
                oft
                Revista Cubana de Oftalmología
                Rev Cubana Oftalmol
                Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                0864-2176
                1561-3070
                June 2010
                : 23
                : 1
                : 78-87
                Affiliations
                [01] Ciudad de La Habana orgnameInstituto Cubano de Oftalmología Ramón Pando Ferrer Cuba ermont@ 123456infomed.sld.cu
                Article
                S0864-21762010000100008 S0864-2176(10)02300108
                b6f2394e-a4a5-4793-b213-22503eaf5918

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 23 October 2008
                : 10 January 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 10
                Product

                SciELO Cuba

                Categories
                TRABAJOS ORIGINALES

                equivalente esférico,sorpresa refractiva,Piggy back,spheral equivalent,refractive surprise

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