Biomedical subjects

César Lipener

Publications and source records attributed to César Lipener.

5 recordsLinked to original sources

PubMed2005

[Keratoconus: prognosis factors].

PURPOSE: To study keratoconus disease carrier patients in an age range under the usual one and try to detect any factor which can influence in disease evolution and prognosis. METHODS: Patients under 15 years old with a keratoconus diagnosis where analyzed. All of them answered a questionnaire, and were submitted to ocular examination and also computerized keratoscopy. These patients were divided into three groups and went through a contact lens test: 1) it was possible for this group to adapt to contact lenses; 2) a cornea transplant for this group was recommended; 3) for this group it was suggested that they use glasses. RESULTS: Patients who had 20/40 or greater visual acuity usually did not progress to transplant in the studied period. On the other hand, patients who had 20/60 or less acuity, progress to a deep transplant very quickly. Other cases, related to a lower age range (10-15 years old) progressed to a transplant. We can observe that the cornea apex has a very unsteady location, which explains the different difficulty levels regarding adaptation to contact lenses. In all patients who had a superior out of place apex and values greater than 66 D adaptation was successful. In the central apex eyes the adaptation was easier. In the inferior apex eyes it was not possible to set a standard to indicate the person for surgery. In the eyes which were adapted to the contact lenses and whose curvature was smaller than 51.10 D there were fewer chances of evolution to a cornea transplant, on comparison with patients who had a curvature of 57.60 or even greater. CONCLUSION: Patients who have curvatures greater than 57.40, acuity lower than 20/60 and are under 18 years old have more chances to evolve to a cornea transplant. When the keratocone apex is central the contact lens adaptation becomes easier.

Adolescent↗

PubMed2005

[Contact lens fitting after refractive surgery].

PURPOSE: To evaluate the fitting and use of contact lens in patients submitted to refractive surgery. METHODS: This was a retrospective study in 53 patients submitted to refractive surgery who later started to use contact lens, from 1999 to 2003. The parameters were: previous ametropia, refractive surgery procedure, ametropia after surgery, postoperative spherical equivalent, postoperative keratometry, base curve of fitted contact lens, contact lens design, final visual acuity with spectacles after surgery, final visual acuity with contact lens, complications and the reason for stopping the use. The follow-up of patients ranged from 1 month to 84 months (average of 42.5 months). RESULTS: Of 53 evaluated patients, 19 patients had undergone LASIK (Laser Assisted in Situ Keratomileusis), 29 patients had undergone RK (radial keratotomy), 4 patients had undergone PRK (photorefractive keratectomy) and in one patient it was not possible to know which surgery was performed. 61.29% of the patients (57 eyes of a total of 93 eyes) were fitted with rigid gas-permeable lenses. There was an improvement of visual acuity in 60.21% of the cases (VA>20/40), with few complications. CONCLUSION: Due to the great number of performed refractive surgery, an increase in the number of patients unhappy with the postoperative result is expected, and for these patients, many times the use of contact lens is the best option. The fitting of contact lenses after refractive surgery demands knowledge, dedication and has good results principally regarding better visual acuity.

Adaptation, Physiological↗

PubMedDate not supplied

[Comparative analysis of visual function and the quality of life index with eyeglasses or a progressive contact lens].

PURPOSE: To compare the visual function and the answers to a questionnaire of quality of life of patients wearing a progressive contact lens or eyeglasses. METHODS: The Focus Progressive contact lens had been fitted in 35 patients with far visual acuity with progressive-addition eyeglasses equal to zero (log MAR) and near J1 (Jaeger). The far and near visual acuities and the measurement of contrast sensitivity were compared when the patients were wearing the eyeglasses or the contact lens and the patients' results of the scores of the quality of life questionnaire (NEI VFQ-25) were analyzed statistically considering the type of ametropy and the age. RESULTS: The far and near visual acuities and the contrast sensitivity measurement were worse with the contact lens than with eyeglasses. The answers to the questionnaire did not differ when were comparing the same patients wearing eyeglasses or contact lens, no matter the type of ametropy. The myopic and the hyperopic subgroups had worse answers to the quality of life questionnaire when corrected with the contact lens than with eyeglasses, both with age equal to or less than their median. CONCLUSIONS: The visual function was worse with the contact lens. The type of ametropy did not influence the answers to the quality of life questionnaire considering the optical correction, but age did.

Adult↗

PubMedDate not supplied

[Refractional astigmatism prevalence and its relationship with grating acuity in children 2 to 36 months of age].

PURPOSE: To evaluate refractional astigmatism prevalence and its relationship with grating acuity in a cohort of non-verbal children. METHODS: 482 normal children, aged from 2 to 36 months, were submitted to ophthalmological examination. Fourteen subjects were excluded due to ocular disease and the sample remained with 468 subjects (936 eyes); 230 (49%) males e 238 (51%) females. Grating acuity was assessed binocularly and monocularly with Teller acuity cards. All children underwent eye examination including cycloplegic retinoscopy and fundus by indirect ophthalmoscopy. RESULTS: Astigmatism was found in 222 (47.43%) of the children, with the hyperopic and with the rule types most frequently found in all ages. Concerning magnitude, this condition was equal or greater than 1.00 cylindric diopter in 24.35% of the children; equal or greater than 2.00 cylindric diopter in 5.55%; lower than 1.00 in 26.92% and between 1.00 and 2.00 in 18.73%. Grating acuity was normal in 219 of the subjects, despite magnitude, type and orientation of astigmatism. CONCLUSION: Visual acuity assessed by the acuity card procedure was not influenced by astigmatism.

Astigmatism↗

PubMedDate not supplied

[Keratoconus special soft contact lens fitting].

PURPOSE: To evaluate the fitting and use of a soft contact lens in keratoconic patients. METHODS: Retrospective study on 80 eyes of 66 patients, fitted with a special soft contact lens for keratoconus, at the Contact Lens Section of UNIFESP and private clinics. Keratoconus was classified according to degrees of disease severity by keratometric pattern. Age, gender, diagnosis, keratometry, visual acuity, spherical equivalent (SE), base curve and clinical indication were recorded. RESULTS: Of 66 patients (80 eyes) with keratoconus the mean age was 29 years, 51.5% were men and 48.5% women. According to the groups: 15.0% were incipient, 53.7% moderate, 26.3% advanced and 5.0% were severe. The majority of the eyes of patients using contact lenses (91.25%) achieved visual acuity better than 20/40. To 88 eyes 58% were tihed with lens with spherical power (mean -5.45 diopters) and 41% with spherocylinder power (from -0.5 to -5.00 cylindrical diopters). The most frequent base curve was 7.6 in 61% of the eyes. The main reasons for this special lens fitting were due to reduced tolerance and poor fitting pattern achieved with other lenses. CONCLUSION: The special soft contact lens is useful in fitting difficult keratoconic patients by offering comfort and improving visual rehabilitation that may allow more patients to postpone the need for corneal transplant.

Adolescent↗