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Irineu Ribeiro De Melo Jnr,1 Wilson Takashi Hida,1– 3 Bernardo Kaplan Moscovici,4,5 Cesar Vilar,1,2 Antonio Francisco Pimenta Motta,1 Andre Lins de Medeiros,1 Mario Augusto Pereira Dias Chaves,1 Jonathan Clive Lake,1 Walton Nose,4 Pedro Carlos Carricondo3 1Department of Ophthalmology, Hospital Oftalmológico De Brasília, Brasília, DF, Brazil; 2Department of Ophthalmology, Renato Ambrosio Eye Research Center, Brasília, DF, Brazil; 3Department of Ophthalmology, University of Sao Paulo, São Paulo, SP, Brazil; 4Department of Ophthalmology, Federal University of Sao Paulo UNIFESP, São Paulo, SP, Brazil; 5Department of Ophthalmology, Hospital Visão Laser, Santos, SP, BrazilCorrespondence: Bernardo Kaplan Moscovici, Email bernardokaplan@yahoo.com.brPurpose: Validate a novel approach for assessing residual astigmatism’s impact on visual acuity in pseudophakic patients using defocus curves and spherical equivalent compensation.Materials and Methods: Thirteen patients over 40 with cataracts and normal ophthalmological examinations were enrolled in a prospective, non-randomized cohort study. The defocus curve method was employed, wherein visual acuity was measured with spherical lenses ranging from − 2.50 to +2.50 diopters in 0.5 diopter increments based on subjective refraction. Cylindrical lenses (+1, +2, and +3 diopters) were introduced at each spherical diopter’s 90° and 180° axes. Curves’ results were compared at each defocus point to assess the impact of astigmatism. The Kruskal–Wallis test was used to determine if astigmatism significantly affected visual acuity post-phacoemulsification surgery with intraocular lens implantation.Results: Significant p-values were observed only for defocus curve points of − 0.5, 0, +0.5, and +1, indicating rejection of the hypothesis of no difference between the 90° and 180° groups at these points. Although statistical significance was not achieved, the against-the-rule (ATR) group was inclined toward improved near and intermediate visual acuity. In contrast, the with-the-rule (WTR) group tended to enhance distance visual acuity and myopic tolerance.Conclusion: This novel methodology is both reproducible and valuable. It offers potential insight into residual astigmatism tolerance in pseudophakic patients. Its application may aid in surgical planning and intraocular lens decision-making.Keywords: cataract, astigmatism, visual acuity, treatment result

Wilson Takashi Hida,1,2 Cesar Vilar,1,3 Bernardo Kaplan Moscovici,4,5 Antonio Francisco Pimenta Motta,3 Pedro Carlos Carricondo2 1Department of Ophthalmology, Hospital Oftalmológico de Brasília HOB, Brasilia, DF, Brazil; 2Department of Ophthalmology, University of Sao Paulo(USP), Rio de Janeiro, RJ, Brazil; 3Department of Ophthalmology, Renato Ambrosio Research Center CEORA, Rio de Janeiro, RJ, Brazil; 4Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; 5Department of Ophthalmology, Hospital Visão Laser, Santos, SP, BrazilCorrespondence: Wilson Takashi Hida, S GAS II St. de Grandes Áreas Sul 607 - Asa Sul, Brasília, DF, 70200-670, Brazil, Tel + 55 61 3686-4586, Email Takashi.doc@gmail.comPurpose: To validate a new methodology to evaluate the impact of astigmatism in pseudophakia using an astigmatic defocus curve.Setting: Hospital Oftalmológico de Brasilia, Brazil.Design: Non-randomized cohort study.Methods: For every point of the defocus curve, from − 2.00 to +3.00 with 0.50D intervals, visual acuity was assessed with optically induced astigmatism (0.50D, 1.00D and 1.50D at 90 and 180 degrees) in pseudophakic patients implanted with a refractive-enhanced intraocular lens.Results: Twelve patients were analyzed. A statistically significant difference was found between the 90° (ATR) and 180°(WTR) axis with 1.50D astigmatism, providing better visual acuity in ATR astigmatism (p < 0.05).Conclusion: This new methodology is reproducible, useful and may predict residual astigmatism tolerance in pseudophakic patients, which may help with surgery planning and IOL decision-making.Keywords: cataract, surgery, phacoemulsification, optics, residual astigmatism, visual performance

Victor Andrighetti Coronado Antunes,1 José de Mello Rosatelli Neto,2,3 Bernardo Kaplan Moscovici,2,4,5 Daniel Filipe Oliveira Rabelo,2 Victor Akio Sano,3 Richard Yudi Hida2,6 1Instituto de Olhos de Assis (IOA), Assis, São Paulo, Brazil; 2Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil; 3HOFTALMED – Eye Hospital, São José dos Campos, São Paulo, Brazil; 4Department of Ophthalmology, Hospital Visão Laser, Santos, São Paulo, Brazil; 5Instituto Suel Abujamra, São Paulo, São Paulo, Brazil; 6Department of Ophthalmology, Universidade de São Paulo (USP), São Paulo, São Paulo, BrazilCorrespondence: Bernardo Kaplan Moscovici, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), Rua Cayowwa 854, ap 82, São Paulo, São Paulo, 05018-001, Brazil, Tel +55 11996140730, Email bernardokaplan@yahoo.com.br.brPurpose: We describe an alternative automated technique that consists of simultaneous anterior capsule puncture and decompression of the capsular bag by using an insulin needle attached to the aspiration tubing of the phacoemulsification device to prevent the occurrence of the “Argentinian Flag sign” during capsulorhexis in intumescent cataract.Setting: Instituto de Olhos de Assis and Center of Specialties Hoftalmed, located in the state of São Paulo, Brazil.Design: Prospective interventional study.Methods: Eighty-eight eyes of 88 patients with white or intumescent cataracts were included in this study. Routine clear cornea incision, capsule staining with trypan blue, intracameral anesthesia, and ophthalmic viscoelastic device were used before the procedure. A 26-gauge needle was connected to the phacoemulsification aspiration tubing using a double male Luer connector for irrigation, and aspiration was inserted into the anterior chamber through a new paracentesis incision with the bevel facing down. Immediately after insertion, automated aspiration of the liquefied cortex was performed to remove anterior intralenticular material and achieve capsular decompression. Compression of the nucleus with the needle tip was performed to remove any liquefied material trapped between the posterior surface of the nucleus and the posterior capsule. All surgeries were performed using the same phacoemulsification and parameters. The rate of complete continuous capsulorhexis was observed and noted.Results: No complications were observed in any of the cases. A single-stage, continuous, and well-centered capsulorhexis was achieved in 100% of cases.Conclusion: We conclude that a simultaneous puncture and decompression of the capsular bag using an insulin needle attached to the aspiration tubing of the phacoemulsification machine effectively avoided the “Argentinian Flag sign” in intumescent cataract surgery.Keywords: intumescent cataract, complication, white cataract, capsulorhexis, capsulotomy, cataract surgery, Argentinian flag

Guilherme Novoa Colombo-Barboza,1– 4 Marcello Novoa Colombo-Barboza,1– 3 Luiz Roberto Colombo-Barboza,1 Maria Margarida Colombo-Barboza,1 Fernanda Daroz Paulo Colombo-Barboza,1 Adamo Lui-Netto,2 José Eduardo Lutaif Dolci,2 Bernardo Kaplan Moscovici,1– 3 Denise de Freitas3 1Department of Ophthalmology, Hospital Visão Laser, Santos, Brazil; 2Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil; 3Department of Ophthalmology and Vision Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; 4Department of Ophthalmology, Universidade Metropolitana de Santos (UNIMES), Santos, BrazilCorrespondence: Guilherme Novoa Colombo-Barboza, Av. Conselheiro Nebias 355, Santos, SP, CEP 11015-001, Brazil, Tel +55 13 2104-5000, Email Guilhermecolombo@hotmail.comAim: To evaluate the vision-related quality of life with the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire in patients with astigmatism secondary to radial keratotomy surgery who underwent topography-guided photorefractive keratectomy.Methods: Prospective non-randomized clinical trial. This study included 15 patients (30 eyes) aged > 21 years, mean age 55.1 (SD, 3.5) years, 53.3% female, with astigmatism ≤ - 6.00 D resulting from radial keratotomy, which could have been associated with hyperopia ≤ + 6.00 D. Photorefractive keratectomy with topography-guided custom ablation treatment was used in all cases. The patients answered the NEI-RQL questionnaire preoperatively and at 4 and 48 months after topography-guided photorefractive keratectomy. The following data were collected: age, sex and education level, pre-operative refraction data, visual acuity with or without correction, pachymetry, and keratometry.Results: There was a significant difference between pre-and postoperative NEI-RQL scores for the domains clarity of vision, near vision, far vision, diurnal fluctuation, activity limitations, glare, symptoms, correction dependence, appearance, and satisfaction with correction (p < 0.001).Conclusion: Topography-guided photorefractive keratectomy improved vision-related quality of life in patients with a history of irregular astigmatism secondary to radial keratotomy.Keywords: quality of life, radial keratotomy, NEI-RQL, topography-guided photorefractive keratectomy