Biomedical subjects

Frederico F Marques

Publications and source records attributed to Frederico F Marques.

9 recordsLinked to original sources

PubMed2006

Fate of anterior capsule tears during cataract surgery.

PURPOSE: To determine the incidence of anterior capsule tears, at what stage of surgery they occurred, and their intraoperative behavior. SETTING: Ambulatory surgery center, Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: This 5-year retrospective study was of patients having phacoemulsification with posterior chamber intraocular lens (IOL) implantation complicated by unplanned peripheral extension of the capsulorhexis tear or a radial anterior capsule tear. The operative notes and a videotape of the surgery were reviewed. The stage at which the tear was initially observed and when it extended were identified, as was whether the tear extended to the posterior capsule. Anterior vitrectomy and the design and location of the IOL implanted were also analyzed. RESULTS: A discontinuous anterior capsulorhexis or a break in the anterior capsule rim was observed in 21 eyes of 2646 cases, for an overall incidence of 0.79%. Anterior capsule tears were identified during ophthalmic viscosurgical device injection in 1 eye, capsulorhexis in 13 eyes, hydrodissection in 2 eyes, phacoemulsification in 3 eyes, irrigation/aspiration (I/A) in 1 eye, and implantation of a prosthetic iris device in 1 eye. Seven of the 13 tears identified during the capsulorhexis were managed by redirecting the second edge of the "safety" capsulorhexis to incorporate the tear. In 14 eyes, the tear in the anterior capsule extended into the zonules; 4 of these tears were limited. Ten tears extended around the equator and through the posterior capsule, occurring during the hydrodissection in 1 eye, phacoemulsification in 2 eyes, I/A in 1 eye, and IOL implantation in 6 eyes. An anterior vitrectomy was required in 4 eyes that had posterior capsule involvement. Endocapsular fixation of a 1-piece acrylic IOL was achieved in 18 eyes. Three eyes required implantation of a 3-piece acrylic IOL in the ciliary sulcus. CONCLUSIONS: Extension of an anterior capsule tear can complicate cataract surgery at any stage. Extension of the tear through the posterior capsule occurred in almost half the eyes with an anterior capsule tear, often requiring an anterior vitrectomy. Managing an anterior capsule tear can be challenging yet compatible with implantation of a posterior chamber IOL.

Capsulorhexis↗

PubMed2004

Subtle signs of zonular damage.

PURPOSE: To describe 5 subtle signs of zonular damage. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Three patients with a history of ocular trauma and 1 patient with Marfan's syndrome are described. During the preoperative examination, subtle signs of zonular damage were detected. As a result of the early recognition, critical modifications in cataract surgery technique and technology were made. RESULTS: The signs of zonular damage identified in the patients were visibility of the lens equator during eccentric gaze, decentered nucleus in primary position, iridolenticular gap, changes in the contour of the lens periphery, and focal iridodonesis. CONCLUSION: Identification of subtle but important signs of zonular damage will better prepare the surgeon for a challenging surgical procedure.

Adult↗

PubMed2004

Early uncorrected visual acuity as a measurement of the visual outcomes of contemporary cataract surgery.

PURPOSE: To determine the uncorrected visual acuity (UCVA) on the first postoperative day and the fifth week after routine slow-motion phacoemulsification with posterior chamber intraocular lens (IOL) implantation. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: This retrospective chart review performed by 3 research fellows analyzed the UCVA 1 day and 5 weeks postoperatively in 100 consecutive best-case scenario eyes of 99 patients who had routine slow-motion phacoemulsification with implantation of an AcrySof single-piece IOL (Alcon). Reasons for UCVAs worse than 20/40 were sought. The stability of the visual result was analyzed. RESULTS: The UCVA was 20/40 or better in 98% of eyes at 1 day. Ninety-seven percent had a UCVA of at least 20/40 by 5 weeks, confirming stability of acuity. The percentage of patients with a UCVA of 20/20 or 20/25 increased from 49% at 1 day to 77% at 5 weeks. CONCLUSIONS: The UCVA 1 day after slow-motion phacoemulsification was 20/40 or better in 98% of eyes and remained stable to the last measurement at 5 weeks. Early UCVA can serve as a more sensitive measurement than best corrected visual acuity for assessing new surgical technologies and techniques.

Acrylic Resins↗

PubMed2004

Intraocular lens exchange assisted by preoperative neodymium:YAG laser haptic fracture.

We present 3 cases of intraocular lens (IOL) exchange in which a neodymium:YAG (Nd:YAG) laser was used before surgery to fracture a haptic and make intraocular manipulations easier and safer. Strategic placement of the fracture facilitates maneuvering to explant the IOL segments. Delaying pupil dilation until after the Nd:YAG laser is used and prudent positioning of the patient's head minimize the risk that freed IOL segments will damage the cornea or subluxate posteriorly into the vitreous cavity. Neodymium:YAG laser IOL fracture before explantation/ exchange is a viable combined procedure.

Aged↗

PubMed2004

Three-step technique for staining the anterior lens capsule with indocyanine green or trypan blue.

A 3-step technique for staining the anterior lens capsule was developed to optimize the use of a capsule dye (trypan blue or indocyanine green) during capsulorhexis. After the injection of a viscoadaptive ophthalmic viscosurgical device (OVD) (sodium hyaluronate 2.3% [Healon 5]), which fills the anterior chamber, balanced salt solution (BSS) is gently injected onto the anterior capsule, creating a wafer-thin, fluid-filled space beneath the OVD. The dye is slowly injected through a 27-gauge cannula (Duckworth & Kent), selectively mixing with the BSS and allowing relatively accurate painting of the anterior capsule, approximating the size and shape of the intended capsulorhexis. This 3-step technique avoids the use of air as well as the uncontrolled dispersion and excessive accumulation of dye within the OVD.

Capsulorhexis↗

PubMed2004

Empty-bag technique for acrylic intraocular lens implantation using Healon5.

PURPOSE: To determine how often the empty-bag technique (EBT) for injecting an acrylic foldable intraocular lens (IOL) into the capsular bag using Healon5 (sodium hyaluronate 2.3%) will require a 2-compartment technique to remove the ophthalmic viscosurgical device (OVD) and compare this with that of a standard injection method using Healon5. SETTING: Cincinnati Eye Institute and Ambulatory Surgical Center, Cincinnati, Ohio, USA. METHODS: Forty-one eyes of 40 patients were randomly assigned to 1 of 2 groups. In Group A, standard capsular bag expansion was performed with Healon5 before implantation of an acrylic posterior chamber (PC) IOL. In Group B, Healon5 was placed in the anterior chamber followed by balanced salt solution expansion of the capsular bag before acrylic PC IOL implantation. In all patients, complete OVD removal was attempted with the automated aspiration tip anterior to the optic (rock 'n roll technique). The number of patients in each group who required placement of the aspiration tip posterior to the optic for complete removal was compared. Early postoperative intraocular pressure (IOP) was also compared. RESULTS: In Group A, 15 (75%) of 20 eyes required placement of the aspiration tip posterior to the optic for complete OVD removal and in Group B, 1 (0.05%) of 20 eyes. The postoperative IOP was similar in both groups. CONCLUSIONS: The EBT decreased the likelihood that a 2-compartment OVD removal method would be necessary when using Healon5 for acrylic PC IOL implantation. The limitations of this new technique must be fully understood before it is used.

Acrylic Resins↗

PubMed2003

Focal multistriae: postoperative finding in posterior lenticonus patients.

A brother and sister presented with a history of difficulty reading fine print and an intolerance to glare. Family history was positive for bilateral posterior lenticonus in the mother. Biomicroscopy confirmed that each sibling had bilateral posterior lenticonus that was more easily diagnosed in the brother. Uneventful phacoemulsification was performed in each eye with a foldable acrylic posterior chamber intraocular lens (IOL) placed vertically within the capsular bag in 3 eyes and horizontally in 1 eye. On the day after surgery, biomicroscopy revealed vertical wrinkles limited to the central 2.0 mm of the posterior capsule corresponding to the cone in the eyes in which the IOLs had been vertically placed. We hypothesize that these striae occurred within the cone as a result of redistributing the usual mechanical forces associated with capsule stretch between the most distal contact points of the haptics. We believe that the appearance of these multiple striae limited to the central posterior capsule represents an unreported postoperative finding associated with posterior lenticonus.

Acrylic Resins↗

PubMed2003

Modified capsular tension ring for patients with congenital loss of zonular support.

PURPOSE: To evaluate the results of implantation of a modified capsular tension ring (MCTR) and a posterior chamber intraocular lens (PC IOL) in patients with congenitally subluxated crystalline lenses. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Ninety eyes of 57 patients with congenital loss of zonular support (Weill-Marchesani syndrome, idiopathic ectopia lentis, and Marfan's syndrome) had phacoemulsification with PC IOL and MCTR implantation. The preoperative examination included best corrected visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration, and vitreous prolapse. The postoperative evaluation included BCVA and the presence or absence of pseudophacodonesis, PC IOL centration, and posterior capsule opacification (PCO). RESULTS: At the last postoperative examination, the BCVA was 20/40 or better in 80 eyes (88.9%); 1 eye (1.1%) lost 1 line of acuity. Preoperatively, 18 eyes (20%) had phacodonesis; 1 eye had postoperative pseudophacodonesis. Decentration before surgery was present in 86 eyes (95.6%); 6 eyes (6.7%) developed late symptomatic PC IOL decentration a median of 17.84 months +/- 10.73 (SD) after surgery. Other complications were increased intraocular pressure (2.2%), persistent iritis (3.3%), broken suture (10.0%), retinal detachment (1.1%), and PCO (20.0%). CONCLUSIONS: Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.

Adult↗

PubMed2003

Techniques for managing common complications of cataract surgery.

Cataract surgery has evolved dramatically over the last two decades, largely as a result of technological advances. As a result, visual outcomes and patient convalescence have improved significantly. A second consequence of increased instrumentation and technology, however, is increased complexity of cataract surgery and the advent of complications unique to these advances. Cataract surgeons must be aware and capable of managing the many possible adverse events that can occur during cataract surgery. This review identifies many of the common complications of cataract surgery, describes methods to avoid these complications and discusses techniques to address complications that do occur. It is the ability to avoid, quickly identify, and properly manage complications that defines the accomplished cataract surgeon.

Cataract Extraction↗