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Purpose The aim of this study was to compare the visual outcomes and subjective visual quality between bilateral implantation of an extended depth of focus intraocular lens, JJ postoperative CDVA was -0.05 and 0.06 logMAR (P

Purpose To compare intraoperative parameters between venturi and peristaltic pump in WhiteStar Signature® phacoemulsification machine using the bevel-down technique. Setting Hospital Oftalmologico de Brasilia, Brasilia, Federal District, Brazil. Design Prospective, comparative, patient-masked study. Methods Three hundred eyes were randomly assigned to have a phacoemulsification procedure with WhiteStar Signature® using either peristaltic (n=150 eyes) or venturi (n=150 eyes) pumps by a single surgeon (WTH). Elliptical ultrasound setting and prefracture (prechop or preslice) techniques were used in all cases. Cataract nucleus density was graded using lens opacities classification system III and Pentacam Nucleus Staging classification. Clinical measurements included preoperative- and postoperative- corrected visual acuity, preoperative and 2-month postoperative endothelial cell counts, and preoperative and 1-day postoperative central corneal thickness. Intraoperative measurements at the end of the case were phaco time, fluid used, total case time, and Efx energy. Results There were no statistically significant differences between groups regarding age, cataract density, and phaco time (P>0.05). Intraoperatively, we observed significantly less ultrasound energy (P=0.011), case time (P=0.0001), and balanced saline solution (P=0.001) usage in the venturi group. Clinically, both fluidic settings can provide similar clinical outcomes and visual recovery, regarding corrected distance visual acuity, endothelial cell count, and central corneal thickness. Conclusion Our data show that to minimize fluid use, case time, and energy with the prefracture technique, the venturi pump was the most efficient system and was statistically superior to peristaltic pump.

Purpose To compare intraoperative parameters between venturi and peristaltic pump in WhiteStar Signature® phacoemulsification machine using the bevel-down technique. Setting Hospital Oftalmológico de Brasília, Brasília, Federal District, Brazil. Design Prospective, comparative, patient-masked study. Methods Three hundred eyes were randomly assigned to have a phacoemulsification procedure with WhiteStar Signature® using either peristaltic (n=150 eyes) or venturi (n=150 eyes) pumps by a single surgeon (WTH). Elliptical ultrasound setting and prefracture (prechop or preslice) techniques were used in all cases. Cataract nucleus density was graded using lens opacities classification system III and Pentacam Nucleus Staging classification. Clinical measurements included preoperative- and postoperative- corrected visual acuity, preoperative and 2-month postoperative endothelial cell counts, and preoperative and 1-day postoperative central corneal thickness. Intraoperative measurements at the end of the case were phaco time, fluid used, total case time, and Efx energy. Results There were no statistically significant differences between groups regarding age, cataract density, and phaco time (P>0.05). Intraoperatively, we observed significantly less ultrasound energy (P=0.011), case time (P=0.0001), and balanced saline solution (P=0.001) usage in the venturi group. Clinically, both fluidic settings can provide similar clinical outcomes and visual recovery, regarding corrected distance visual acuity, endothelial cell count, and central corneal thickness. Conclusion Our data show that to minimize fluid use, case time, and energy with the prefracture technique, the venturi pump was the most efficient system and was statistically superior to peristaltic pump.

Wilson Takashi Hida,1–4 Patrick Frenzel Tzelikis,1–3 César Vilar,1,2 Mario Augusto Pereira Dias Chaves,1,2,5 Antônio Francisco Pimenta Motta,1–3 Pedro Carlos Carricondo,1–3 Bruna Vieira Ventura,1,2,4,6 Renato Ambrosio Junior,1–3 Walton Nosé,1,2,4 Milton Ruiz Alves1–3 1Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District, 2Renato Ambrosio Research Center (CEORA), Brasília, Federal District, 3Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP), São Paulo, 4Department of Ophthalmology of São Paulo Federal University (UNIFESP) School of Medicine, São Paulo, 5ProVisão Hospital, João Pessoa, Paraíba, 6Pernanbuco Eye Hospital (HOPE), Recife, Pernambuco, Brazil 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. Keywords: FLACS, ultrasound, aspiration

Purpose To compare the anti-inflammatory efficacy of ketorolac of tromethamine 0.4% and nepafenac 0.1% eye drops for prophylaxis of cystoid macular oedema (CME) after small-incision cataract extraction. Methods Patients were assigned randomly to three groups. Group 1 patients received a topical artificial tear substitute (placebo); group 2 received ketorolac tromethamine 0.4% (Acular LS, Allergan) and group 3 received nepafenac 0.1% (Nevanac, Alcon). The incidence and severity of CME were evaluated by retinal foveal thickness on optical coherence tomography (OCT) after 1, 4 and 12 weeks. Results One hundred and twenty-six eyes of 126 patients were included in this study. The between-group differences in visual outcomes, central corneal thickness and endothelial cell density were not statistically significant. In all retinal thickness measurements, an increase was detected starting from the postoperative first week until 12 weeks. There was no statistically significant difference between the three groups in any measurement performed by spectral-domain OCT. Conclusions Used prophylactically after uneventful cataract surgery, non-steroidal anti-inflammatory drugs were not efficacious in preventing macular oedema compared with placebo. Trial registration number ClinicalTrials: NCT02084576.

Purpose: To assess the postoperative outcomes of a novel toric multifocal in traocular lens (IOL) in patients with cataract and corneal astigmatism. Methods: This prospective nonrandomized study included patients with cataract, corneal astigmatism, and a motivation for spectacle independence. In all patients, a Rayner M-flex® T toric IOL was implanted in the capsular bag. Three months after surgery, the distance, intermediate, and near visual acuities; spherical equivalent; residual refractive astigmatism; defocus curve; and contrast sensitivity were evaluated. A patient satisfaction and visual phenomena questionnaire was administered to all patients. Results: Thirty-four eyes of 18 patients were included in this study. Three months after surgery, the mean corrected distance visual acuity (logMAR) was 0.00 ± 0.08 at 6 m, 0.20 ± 0.09 at 70 cm, and 0.08 ± 0.11 at 40 cm. Uncorrected distance vision acuity was 20/40 or better in 100% eyes. The preoperative mean refractive cylinder (RC) was -2.19 (SD: ± 0.53). After a 3-month follow-up, the average RC was -0.44 D (SD: ± 0.27; p

Purpose: Compare the OPD-scan results and the contrast sensitivity in patients who had implantation of the AcrySof SN60D3 multifocal IOL, the AcrySof SA60AT spheric monofocal IOL and the AcrySof SN60AT aspheric monofocal IOL. Methods: Thirty-two eyes received the multifocal IOL, 32 eyes received the spheric monofocal IOL and 32 eyes received the aspheric monofocal IOL. They were closely paired in age, sex, pre-operative wavefront analysis and contrast sensitivity. All patients was tested with the OPD-scan aberrometer, ETDRS chart at 100% and 9% contrasts and contrast sensitivity. Results: Statistically significant differences were detected more total aberration in SN60AT group (KW = 9.42; p=0.009) when compared to SN60D3 group (p=0.016) and SN60WF group (p=0.0047). The SN60AT group (KW = 16.20; p=0.0003) showed with high spherical aberration values compared to the SN60WF (p=0.00046) and SN60D3 (p=0.0014) group. No significant differences were found between groups in far-distance VA measured using ETDRS at 100% and 9% contrast. The SN60D3 group compared to SN60AT group (p=0.016) had low contrast sensitivity (log units) with statistical difference in 6.0 cpd (KW = 7.84; p=0.0199), but no statistical difference between SN60WF and SN60AT group (p=0.91) and SN60WF and SN60D3 group (p=0.051). The SN60D3 group had low contrast sensitivity performed under mesopic conditions (KW = 10.79; p=0,0045) in 6cpd spatial frequency compared to the SN60AT group (p=0.011) and to the SN60WF group (p=0.007) with statistical significant differences. Conclusion: In all analyzed parameters of OPD-scan aberrometry the aspheric and the multifocal IOLs provided less total and spherical aberrations than spheric IOLs. All IOLs provided an excellent high and low contrasts vision, the multifocal IOL was as good as the spheric and aspheric monofocal IOLs. Objetivo: Comparar a sensibilidade ao contraste e análise de "wavefront" com OPD-scan em pacientes submetidos a cirurgia de facoemulsificação com implantes de lentes intraoculares AcrySof SN60D3 multifocal, AcrySof SN60WF monofocal asférica e AcrySof SA60AT monofocal esférica. Métodos: Trinta e dois olhos com a lente intraocular multifocal, 32 olhos com a lente intraocular monofocal asférica e 32 olhos com a lente intraocular monofocal esférica. A avaliação oftalmológica foi realizada no primeiro, terceiro, sétimo, e nonagésimo dia pós-operatório. Todos os exames foram padronizados, realizada por um único examinador sob condições controladas de luminosidade fotópicas estabelecidas em 85 cd/m², medida por meio de tabelas de ETDRS, sensibilidade ao contraste e análise de aberrometria com OPD-Scan. Resultados: As médias de aberração total foi superior no grupo SN60AT (KW = 9.42; p=0.009) quando comparada com o grupo SN60D3 (p=0.016) e o grupo SN60WF (p=0.0047). O grupo SN60AT (KW = 16.20; p=0.0003) apresentou superioridade nas medias de aberração esférica comparada com o grupo SN60WF (p=0.00046) e o grupo SN60D3 (p=0.0014). Nenhuma diferença significante foi encontrada na acuidade visual para longe com e sem correção óptica com a tabela de ETDRS a 100% e 9% de contraste. O grupo SN60D3 comparada a SN60AT (p=0.016) apresentou baixa sensibilidade ao contraste em condições fotópicas com diferença estatística a 6.0 cpg (KW = 7.84; p=0.0199), mas sem diferença estatística entre os grupos SN60WF e SN60AT (p=0.91) e entre os grupos SN60WF e SN60D3 (p=0.051). O grupo SN60D3 apresentou baixa sensibilidade ao contraste em condições mesópicas (KW = 10.79; p=0,0045) a 6cpg quando comparada com o grupos SN60AT (p=0.011) e SN60WF (p=0.007). Conclusão: As lentes intraoculares multifocais e asféricas apresentaram menos aberração esférica quando comparadas à lente intraocular esférica, além da prevista multifocalidade sem correção para longe e perto. Entretanto, o grupo multifocal apresentou baixa sensibilidade ao contraste.

PURPOSE: To compare the visual outcome, contrast sensitivity and wavefront analysis of patients that underwent cataract surgery and implantation of AcrySof SN60D3 multifocal intraocular lens with those who received the AcrySof SN60AT monofocal IOL. METHODS: This was a prospective clinical trial of forty eyes that received the multifocal IOL and thirty-two eyes that received the monofocal IOL after phacoemulsification. RESULTS: Values for total and spherical aberrations in the multifocal group were statistically lower than in the monofocal group. In the monofocal group, 75% achieved uncorrected intermediate visual acuities between Jaeger 1 and 6. In the multifocal group, 75% of the eyes achieved more than Jaeger 6. At least 87.5% of the multifocal group and 6.3% of the monofocal group achieved monocular uncorrected near acuity of 20/30 (J2, N5) or better. And 90.0% of the eyes in the multifocal group and 37.5% in the monofocal group achieved an uncorrected near acuity of 20/40 (J3, N6) or better. The mean spherical error was 0.11 D in the multifocal group and -0.18 D in the monofocal group (p=0.0379). The SN60D3 group compared to SN60AT group had low contrast sensitivity (log units) with statistically significant differences in 6.0 cpd in photopic conditions (p=0.014) and the SN60D3 group compared to SN60AT group had higher contrast sensitivity (log units) under mesopic conditions (p=0.044). CONCLUSION: The multifocal IOLs induced less spherical aberration than monofocal IOLs and predictably good uncorrected distance and uncorrected near acuities. However, contrast sensitivity was lower in the multifocal group.OBJETIVO: Comparar a performance visual, sensibilidade ao contraste e de wavefront com OPD-Scan em pacientes submetidos a cirurgia de facoemulsificação com implante de lente intraocular AcrySof SN60D3 multifocal e AcrySof SA60AT monofocal. MÉTODOS: Quarenta olhos com a lente intraocular multifocal e trinta e dois olhos com a lente intraocular monofocal. A avaliação oftalmológica contou com medida da acuidade visual para longe, intermediária e curta distância, sem correção e com a melhor correção óptica, teste de sensibilidade ao contraste e análise de frente de onda por meio do aberrômetro OPD-Scan. RESULTADOS: As aberração total e aberração esférica no grupo multifocal foi estatisticamente inferior comparada com o grupo monofocal. No grupo monofocal 75% apresentaram acuidade visual monocular intermediária sem correção entre Jaeger 1 e 6, no grupo multifocal 75% apresentaram mais que Jaeger 6. Aproximadamente 87,5% do grupo multifocal e 6,3% do grupo monofocal apresentaram acuidade visual monocular sem correção para perto de 20/30 (J2, N5), ou melhor, e 90,0% dos olhos do grupo multifocal e 37,5% do grupo monofocal apresentaram acuidade visual monocular sem correção para perto de 20/40 (J3, N6) ou melhor. A média de erro esférico foi de 0,11 D no grupo multifocal e -0,18 D no grupo monofocal (p=0,0379). O grupo monofocal apresentou superioridade estatística na sensibilidade ao contraste em condições fotópicas (p=0,014) e mesópicas (p=0,0044) a 6 cpg quando comparada ao grupo multifocal. CONCLUSÃO: A lente intraocular multifocal apresentou menos aberração esférica comparada à lente intraocular monofocal, da prevista multifocalidade sem correção para longe e perto. Entretanto, o grupo multifocal apresentou baixa sensibilidade ao contraste.

O implante de lentes intra-oculares (LIOs) multifocais é um grande avanço na reabilitação de pacientes permitindo boa acuidade visual sem correção óptica para longe e perto. Contudo pacientes com alguns graus de astigmatismo corneano tem indicação limitada. Este artigo relata três pacientes que foram submetidas a facoemulsificação com implante de lentes intra-oculares multifocais (AcrySof® Restor®, Alcon Labs) após incisão relaxante limbar (IRL) no olho dominante e incisão no eixo mais curvo da topografia no olho contralateral. Não foi encontrado nenhuma análise relacionada a dominância ocular e relaxante limbar na literatura. Acredita-se que essa associação pode ampliar as indicações de implante das lentes intra-oculares multifocais em pacientes com astigmatismo corneano significativo, devendo-se confirmar esta possibilidade por meio de futuros estudos.The use of multifocal intraocular lenses (IOLs) is a great advance in the treatment of patients with cataract allowing near and distance uncorrected visual acuity recovery. However patients with some degrees of corneal astigmatism have some limitations. We present 3 cases that were indicated for phacoemulsitfication and multifocal intraocular lens implant (AcrySof® Restor®, Alcon Labs) after limbal relaxing incision (LRI) in the dominant eye and axis topographic incision in the fellow eye. There was no similar case report in the literature. It is believed that this association can extend the indications for multifocal intraocular lens implants in patients with significant corneal astigmatism and this possibility should be confirmed by future studies.

Purpose: To compare the efficiency of surgical procedures using three phaco tip designs in torsional phacoemulsification using the bevel-down technique. Methods: In this prospective, comparative, masked study, patients were randomly assigned to have torsional coaxial microincision cataract surgery using the mini-flared 45-degree Kelman tip, reversed mini-flared 30-degree Kelman tip, or Sidewinder 30-degree Kelman tip. Clinical measurements included preoperative and 3-month postoperative corrected distance visual acuity (CDVA), endothelial cell counts (ECC), and preoperative and 1-day postoperative central corneal thickness (CCT). Intraoperative measurements included phaco time, torsional time, aspiration time, case time, cumulative dissipated energy (CDE), and balanced salt solution volume (BSS). Results: The study evaluated 150 eyes of 150 patients. Intraoperatively, there was no statistically significant difference in cumulative dissipated energy, case time, torsional time, and aspiration time between the three tip configurations. However, less phaco time was used with the mini-flared 45-degree Kelman tip (p=0.02) than that with the Sidewinder 30-degree Kelman tip or reversed mini-flared 30-degree Kelman tip. The mini-flared 45-degree Kelman tip and the reversed mini-flared 30-degree Kelman tip required significantly less balanced salt solution volume than that required by the Sidewinder 30-degree Kelman tip (p=0.009). There was no statistically significant difference in corrected distance visual acuity and endothelial cell counts between tips 3 months postoperatively (p>0.05). Conclusion: All three tips were effective with no intraoperative complications. When using torsional phacoemulsification through microincisions and the prefracture technique with the bevel-down technique, the mini-flared 45-degree Kelman tip required a lower mean phaco time than the reversed mini-flared 30-degree Kelman tip and the Sidewinder 30-degree Kelman tip. Objetivo: Comparar a eficácia cirúrgica da facoemulsificação com tecnologia torcional utilizando 3 modelos diferentes de ponteiras. Métodos: Neste estudo prospectivo, randomizado, mascarado, os pacientes foram aleatoriamente distribuídos para serem submetidos a cirurgia de facoemulsificação coaxial torcional utilizando a ponteira Kelman mini-flared de 45 graus, ou Kelman reversed mini-flared de 30 graus ou Kelman Sidewinder de 30 graus. Os parâmetros avaliados incluíram: acuidade visual com correção (AVCC) para longe; contagem de células endoteliais (CCE) pré-operatória e pós-operatória, ao final de 3 meses; espessura corneana central (ECC) pré-operatória e no primeiro dia pós-operatório. Medidas intraoperatórias incluíram tempo de facoemulsificação, tempo de energia torcional, tempo da aspiração, tempo cirúrgico, energia dissipada acumulada (CDE) e volume de solução salina balanceada (BSS). Resultados: Este estudo avaliou 150 olhos de 150 pacientes. No intraoperatório, não foram observadas diferenças significativas na energia dissipada acumulada, tempo de facoemulsificação, tempo de energia torcional, e tempo de aspiração entre os 3 modelos de ponteira. No entanto, foi utilizando menos tempo de faco com a ponteira Kelman mini-flared de 45 graus (p=0,02) quando comparado às ponteiras Kelman Sidewinder de 30 graus e reversa mini-flared de 30 graus. A ponteira Kelman mini-flared de 45 graus e a reversa mini-flared de 30 graus utilizaram menos solução salina balanceada quando comparado à ponteira Sidewinder de 30 graus (p=0,009). Não foram observadas diferenças significativas na acuidade visual com correção, contagem de células endoteliais e espessura corneana central entre as diferentes ponteiras ao final do estudo (p=0,05). Conclusão: As 3 ponteiras foram eficazes e não apresentaram complicacões intraoperatórias. Quando foi utilizando o faco torcional através de microincisão com a técnica da pré-fratura, a ponteira Kelman mini-flared de 45 graus obteve um desempenho melhor que as ponteiras de 30 graus e Sidewinder de 30 graus, com menor tempo de faco.

A 51-year-old woman with age-related cataract had an uneventful phacoemulsification and a Tecnis ZM900 multifocal intraocular lens (IOL) implantation in both eyes. During IOL implantation in the left eye, the optic was unintentionally reversed in the bag and left that way. The refraction surprise was not significant and six months postoperatively the corrected distance visual acuity in both eyes was 20/20 and neither complained of visual discomfort. In conclusion, we found that a reversed-optic Tecnis multifocal IOL in the present case resulted in good final visual acuity without significant differences in aberrations compared to the other eye, and a conservative management can be taken as a safe option.

Objetivo: Medir e comparar o tamanho e forma de capsulotomias realizadas com laser de femtossegundo com os de capsulorrexes curvilíneas contínuas (CCC) realizadas com auxilio guiado por imagem digital e avaliar o resultado refracional. Métodos: Durante cirurgia de catarata, 40 olhos de 40 pacientes tiveram a capsulotomia realizada com auxílio do laser de femtossegundo e seus resultados foram comparados com os de 40 olhos de 40 outros pacientes que tiveram a capsulorrexe guiada por sistema de imagem digital. Os parâmetros de circularidade, forma e overlap foram medidos usando o Adobe Photoshop (Adobe Systems Inc.) e os resultados refracionais pós-operatórios foram avaliados em ambos os grupos. Resultados: Os diâmetros, tamanho e forma de alta precisão e previsibilidade foram atingidos com laser de femtossegundo e houve diferença estatística entre os grupos. Quando comparado o equivalente esférico entre os grupos, não houve diferença estatística. Conclusão: As capsulotomias realizadas pelo laser de femtossegundo possuem circularidade programada, diâmetro pretendido e valores de desvio padrão médios, indicando resultados reprodutíveis mais elevados. No entanto, CCC realizada por um cirurgião experiente com auxílio guiado de imagem digital, com configurações apropriadas, fornece resultados semelhantes e sugere que diferentes técnicas são igualmente eficazes. Purpose: To measure and compare size and shape parameters of femtosecond laser capsulotomy with manually continuous curvilinear digital guided capsulorhexis (CCC) and their refractive outcomes. Methods: Laser capsulotomies in 40 eyes of 40 patients were performed using LenSx femtosecond laser device (Alcon, Forthworth, US) and its results were compared with the CCC digital guided carried out in 40 eyes of 40 patients using the Callisto Eye digital image system (Zeiss, Germany). Capsulorhexis circularity, shape and capsule overlap were measured using Adobe Photoshop (Adobe Systems Inc.) and postoperative refraction outcomes were evaluated in both groups. Results: Highly accurate and predictable capsulotomy diameter, size and shape were achieved with femtosecond laser capsulotomy compared with capsulorhexis and showed statistical difference between groups. Spherical equivalent comparison between groups showed no statistical difference. Conclusions: Femtosecond laser anterior capsulotomy with programed circularity had the intended diameter with average standard deviation values, indicating higher reproducible outcomes. Capsulorhexis performed by an experienced surgeon with auxiliary image guide and appropriate settings provides similar results our results suggest that different techniques are equally effective.

We describe a modification of the original standard radial aspiration technique. The modified technique—hurricane 1-step continuous circular cortical aspiration—has the potential to improve this part of phacoemulsification surgery with benefits in surgical time and possible decreases in fluid, corneal edema, and traction on the zonular fibers through better distribution of tractional forces. The first results were encouraging and without complications. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE: The aim of the present study is to assess central corneal edema and visual recovery after cataract surgery performed according to two technologies: conventional ultrasonic and liquefaction (Aqualase®). METHODS:This is a prospective contralateral study in wich 20 patients with comparable preoperative conditions were submitted to cataract surgery were evaluated. Preoperative assessment involved complete ophthalmological examination and the study included patients with bilateral cataracts up to grade 2, according to the Lens Opacity Classification System II. The same cristaline fracture technique was used in all cases, and surgical procedures were performed by the same experienced surgeon, using two technologies: liquefaction or conventional phacoemulsification. Postoperative central corneal edema was measured by corneal optical pachymetry (Orbscan II®) on the 1st, 3rd, 7th and 10th postoperative days. RESULTS:None of the 20 patients submitted to surgery was lost during the postoperative follow-up or excluded from the analysis. On the first postoperative, the visual acuity average was 0.031 logMAR in the Aqualase® group and 0.043 logMAR in the conventional surgery group. No statistical difference was detected in the assessment of visual acuity throughout the postoperative period. Central corneal pachymetry varied from 543.93 + 34.69 preoperatively to 545.08 ± 25.67 on the last day of follow-up in the Aqualase® group, and from 543.13 + 30.62 to 536.08 + 34.89 in the conventional technique group, without statistical significance. CONCLUSION:This study suggests that both techniques are equally effective for surgery on lenses with grade I or II cataract, and that they provide similar results in terms of visual recovery and central corneal edema.

OBJETIVO: Comparar a análise da frente de onda e a sensibilidade de contraste pós-operatórias em pacientes submetidos à facoemulsificação com implante de lentes intra-oculares esféricas num olho e asféricas no olho contralateral. MÉTODOS: Este estudo prospectivo comparativo, randomizado, duplo-cego, incluiu 32 olhos de 16 pacientes. Uma avaliação oftalmológica completa foi realizada durante as visitas antes e depois da cirurgia (no primeiro, terceiro, sétimo, e nonagésimo dias pós-cirúrgicos), que incluiu acuidade visual, teste de sensibilidade ao contraste, aberrometria. Todos exames (menos aberrometr=ia) foram feitos monocularmente com pupilas não dilatadas. Os pacientes foram submetidos a facectomia ultra-sônica convencional com implante de uma lente asférica SN60WF num olho e esférica SN60ATno outro. RESULTADOS: A acuidade visual média com a melhor correção foi -0,146 LogMAR no grupo da lente intra-ocular esférica, e -0.165 logMAR no grupo da lente intra-ocular asférica sob condições fotópicas, -0,003 LogMAR sob condições mesópicas. A sensibilidade ao contraste foi semelhante em ambos os grupos tanto em condições fotópicas e mesópicas. Em relação às aberrações ópticas ocorreu uma diferença significativa nas aberrações totais (1,09 ± 0,56 no grupo asférico e 1,52 ± 1,19 no grupo esférico) e no componente esférico das aberrações de alta ordem(0,422 ± 0,202 no grupo asférico e 0,124 ± 0,087 no grupo esférico). CONCLUSÃO: As duas lentes intra-oculares promoveram uma excelente visão em situações de alto contraste, e os olhos implantados com a lente asférica tiveram menos aberrações totais e esféricas que aqueles implantados com a lente esférica. PURPOSE: Compare the wavefront and contrast sensitivity of bilateral pseudophakic patients with aspheric in one eye and spheric intraocular lenses in the other. METHODS: This prospective, comparative, randomized study, double masked, included 32 eyes of 16 patients. A complete ophthalmic evaluation was done before, and after surgery at days 1,3, 7 and 90, and included best corrected visual acuity, the contrast sensitivity, under photopic and mesopic conditions, and aberrometry. Almost all exams were done monocularly with undilated pupils (aberrometry under pharmacological dilatation). The patients eyes were operated with conventional phacoemulsification, with aspheric intraocular lenses in one eye, and spherical in the other. RESULTS: The visual acuity with the best correction was -0.146 in the spheric group, and -0.165 logMAR in the aspheric group in photopic conditions, and 0.024 and -0.003 LogMAR under mesopic conditions. The contrast sensitivity under photopic and mesopic conditions was similar comparing the two groups. In regard to optical aberrations there was a significant diference between the total (1.09 ± 0.56 in the aspheric, and 1.52± 1.19 in the spherical group) and spherical component of high order aberrations (0.422± 0.202 in spheric group and 0.124 ± 0.087 in the aspheric group). CONCLUSION: Both groups reached excellent postoperative visual acuity in high contrast situations, however aspheric intraocular lenses group had lower total and spherical aberrations, comparing to the spheric intraocular lenses group.

O implante de lentes intra-oculares (LIOs) multifocais é um grande avanço na reabilitação de pacientes permitindo boa acuidade visual sem correção óptica para longe e perto. Contudo pacientes com alguns graus de astigmatismo corneano tem indicação limitada. Este artigo relata três pacientes que foram submetidas a facoemulsificação com implante de lentes intra-oculares multifocais (AcrySof® Restor®, Alcon Labs) após incisão relaxante limbar (IRL) no olho dominante e incisão no eixo mais curvo da topografia no olho contralateral. Não foi encontrado nenhuma análise relacionada a dominância ocular e relaxante limbar na literatura. Acredita-se que essa associação pode ampliar as indicações de implante das lentes intra-oculares multifocais em pacientes com astigmatismo corneano significativo, devendo-se confirmar esta possibilidade por meio de futuros estudos.

PURPOSE: To compare the visual outcome, contrast sensitivity and wavefront analysis of patients that underwent cataract surgery and implantation of AcrySof SN60D3 multifocal intraocular lens with those who received the AcrySof SN60AT monofocal IOL. METHODS: This was a prospective clinical trial of forty eyes that received the multifocal IOL and thirty-two eyes that received the monofocal IOL after phacoemulsification. RESULTS: Values for total and spherical aberrations in the multifocal group were statistically lower than in the monofocal group. In the monofocal group, 75% achieved uncorrected intermediate visual acuities between Jaeger 1 and 6. In the multifocal group, 75% of the eyes achieved more than Jaeger 6. At least 87.5% of the multifocal group and 6.3% of the monofocal group achieved monocular uncorrected near acuity of 20/30 (J2, N5) or better. And 90.0% of the eyes in the multifocal group and 37.5% in the monofocal group achieved an uncorrected near acuity of 20/40 (J3, N6) or better. The mean spherical error was 0.11 D in the multifocal group and -0.18 D in the monofocal group (p=0.0379). The SN60D3 group compared to SN60AT group had low contrast sensitivity (log units) with statistically significant differences in 6.0 cpd in photopic conditions (p=0.014) and the SN60D3 group compared to SN60AT group had higher contrast sensitivity (log units) under mesopic conditions (p=0.044). CONCLUSION: The multifocal IOLs induced less spherical aberration than monofocal IOLs and predictably good uncorrected distance and uncorrected near acuities. However, contrast sensitivity was lower in the multifocal group. OBJETIVO: Comparar a performance visual, sensibilidade ao contraste e de wavefront com OPD-Scan em pacientes submetidos a cirurgia de facoemulsificação com implante de lente intraocular AcrySof SN60D3 multifocal e AcrySof SA60AT monofocal. MÉTODOS: Quarenta olhos com a lente intraocular multifocal e trinta e dois olhos com a lente intraocular monofocal. A avaliação oftalmológica contou com medida da acuidade visual para longe, intermediária e curta distância, sem correção e com a melhor correção óptica, teste de sensibilidade ao contraste e análise de frente de onda por meio do aberrômetro OPD-Scan. RESULTADOS: As aberração total e aberração esférica no grupo multifocal foi estatisticamente inferior comparada com o grupo monofocal. No grupo monofocal 75% apresentaram acuidade visual monocular intermediária sem correção entre Jaeger 1 e 6, no grupo multifocal 75% apresentaram mais que Jaeger 6. Aproximadamente 87,5% do grupo multifocal e 6,3% do grupo monofocal apresentaram acuidade visual monocular sem correção para perto de 20/30 (J2, N5), ou melhor, e 90,0% dos olhos do grupo multifocal e 37,5% do grupo monofocal apresentaram acuidade visual monocular sem correção para perto de 20/40 (J3, N6) ou melhor. A média de erro esférico foi de 0,11 D no grupo multifocal e -0,18 D no grupo monofocal (p=0,0379). O grupo monofocal apresentou superioridade estatística na sensibilidade ao contraste em condições fotópicas (p=0,014) e mesópicas (p=0,0044) a 6 cpg quando comparada ao grupo multifocal. CONCLUSÃO: A lente intraocular multifocal apresentou menos aberração esférica comparada à lente intraocular monofocal, da prevista multifocalidade sem correção para longe e perto. Entretanto, o grupo multifocal apresentou baixa sensibilidade ao contraste.