Biomedical subjects

Carlos Vergés

Publications and source records attributed to Carlos Vergés.

4 recordsLinked to original sources

PubMed2005

Accommodative intraocular lens tilting.

PURPOSE: To report an unusual complication of accommodative intraocular lens (IOL) implantation after clear lens extraction for hyperopia correction. DESIGN: Observational case report. METHOD: A 48-year-old woman underwent clear lens exchange for the correction of moderate hyperopia. A Crystalens Model AT-45 Accommodating Posterior Chamber IOL (AT-45 IOL) was implanted to allow optimal distance and near vision. At the 3-week follow-up appointment, she complained of monocular diplopia. Ocular examination showed an increased astigmatism, causing decreased visual acuity. Scheimpflug Pentacam Image and Wave Front Analysis supported the diagnosis of IOL tilting. RESULTS: IOL repositioning was unsuccessful because of fibrosis of the haptics. It was necessary to replace AT 45 IOL with a monofocal acrylic sulcus-fixated IOL. CONCLUSION: Control of capsular fibrosis should be a major concern, especially in this type of IOL. Accommodating IOL exchange appears to be a safe alternative to manage this complication.

Accommodation, Ocular↗

PubMed2005

Corneal endothelium evaluation after phacoemulsification with continuous anterior chamber infusion.

PURPOSE: To determine if the use of continuous anterior chamber infusion (CACI) during conventional phacoemulsification can damage the corneal structure by adding an additional hydrodynamic stress to the corneal endothelium intraoperatively and to use this option routinely in small-incision phacoemulsification to soften its learning curve. METHODS: We performed a prospective, interventional, case series of patients with cataract who underwent phacoemulsification. Patients were previously classified into 2 groups based on whether CACI was used (group 2) intraoperatively or not (group 1). Pachymetry and endothelial cell (EC) density were evaluated before and after surgery, and data were compared between the 2 groups. Eyes with values of EC density less than 1000 cells/mm or showing previous corneal structural alterations were excluded from the study. RESULTS: Sixty-seven eyes were included in our study from September 2002 to January 2003. Group 1 included 31 eyes (mean pachymetry 520.4 microm and EC density 2883), and group 2 included 36 eyes (mean pachymetry 519.0 and EC density 2627). Multivariate analysis of postoperative data following a multiple regression model showed an increase in pachymetry for both groups at 24 hours after surgery that progressively diminished until the last visit 4 weeks postoperatively, and no statistically significant differences were found between the groups. EC density displayed an abrupt loss for both groups, especially for group 2, that reached statistical significance at day 7 after surgery (P = 0.020). EC density experienced an increase for both groups in follow-up visits, and it was not statistically different at last postoperative control (P = 0.361). CONCLUSIONS: : The trend in modern cataract surgery is to reduce postoperative ocular trauma, and this can be achieved by small-incision phacoemulsification. But it requires a learning curve that we believe can be softened by using some surgical maneuvers such as continuous anterior chamber infusion, which minimizes the risk for anterior chamber collapse during the intervention. Comparing postoperative pachymetry and EC density between group 1 and 2, we found that the use of CACI does not add any additional damage to corneal structures because the initial statistically significant EC loss at day 7 postoperatively has a prompt recovery in subsequent visits, and then the EC loss remains similar in both groups. Transition from conventional to bimanual phacoemulsification can be simplified by using CACI, and it does not increase postoperative corneal damage.

Aged↗

PubMed2003

Laser cataract surgery: technique and clinical results.

PURPOSE: To study the effectiveness of an erbium:YAG (Er:YAG) laser in removing nuclei of various densities. SETTING: University clinic. METHODS: This nonrandomized prospective clinical study included 147 consecutive cataractous eyes: Group 1 (n = 71) had conventional ultrasound, and Group 2 (n = 76) had surgery with the Er:YAG laser. The 2 groups were further classified by cataract density. Patients were examined 6 months postoperatively to evaluate surgical time, intraocular pressure (IOP), pachymetry, endothelial cell loss, and visual acuity. RESULTS: With ultrasound cataract surgery, there were no significant changes in IOP compared with the preoperative measurements. Laser treatment of 3+ and 4+ cataracts resulted in IOP increases of 12.6% and 18.2%, respectively, compared with 1+ and 2+ cataracts (P<.001). Slight endothelial cell losses occurred in all cases. With ultrasound, the mean decrease was 2.8%, and with laser surgery, the results were similar except for a significant decrease of 13.4% with 4+ cataracts. There was a correlation between pachymetry and surgical time when the trauma related to surgical time and hydrodynamic flow in the anterior chamber was assessed. With ultrasound, the visual acuity was similar with all types of cataract; with the laser, similar normal values were seen with 1+ and 2+ cataracts but decreased values were seen with 3+ cataracts and lower values with 4+ cataracts-0.43 compared to 0.84 best corrected visual acuity with same-density cataracts treated with ultrasound (P<.0005). Patients with 4+ cataracts treated with the laser developed more complications than those treated with ultrasound. CONCLUSIONS: The Er:YAG laser was as effective and reliable as ultrasound in removing soft and medium-density cataracts. With dense cataracts, the surgical length produced more trauma and complications during laser treatment than during ultrasound treatment.

Aged↗

PubMed2002

Laser-assisted deep sclerectomy.

PURPOSE: To study the clinical effectiveness of deep sclerectomy using the erbium:YAG (Er:YAG) laser in patients with open-angle glaucoma (OAG). SETTING: Department of Ophthalmology, Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain. METHODS: This nonrandomized prospective clinical study was performed in 46 consecutive eyes with OAG. Seventeen patients had not received any treatment for glaucoma. Eight had received 1 medication; 14, 2 medications; and 7, 3 medications. The mean duration of treatment was 18.3 months +/- 9.4 (SD). After mitomycin-C 0.02% was administered for 2 minutes, a superficial 4.0 mm x 4.0 mm scleral flap was created and a deep 3.0 mm x 3.0 mm scleral ablation was performed with the Er:YAG laser. Schlemm's canal was removed, and the cornea was dissected to Descemet's membrane until aqueous humor percolated. The scleral flap and conjunctiva were closed. Postoperative follow-up examinations were done at 1, 3, and 7 days, 2, 3, and 4 weeks, and then every 3 months up to 15 months. RESULTS: The mean preoperative intraocular pressure (IOP) was 28.3 +/- 6.1 mm Hg. The mean postoperative IOP was 14.1 +/- 3.5 mm Hg at 24 hours, 16.3 +/- 4.2 mm Hg at 3 months, and 15.3 +/- 2.7 mm Hg at 15 months (P <.001). There were no statistically significant differences in IOP by sex or age. There was a statistically significant difference between patients receiving no medication and those who received more than 2 medications and a treatment period longer than 1 year preoperatively (P <.006). The presence of a filtering bleb was associated with a longer period of decreased IOP (P <.007). The success rate (IOP < or =18 mm Hg without medication) was 93.47% at 1 month and 84.78% at 15 months. The number of complications was significantly lower than in previous reports of trabeculectomy. One patient lost 2 lines of visual acuity because of cystoid macular edema. CONCLUSIONS: Deep sclerectomy using the Er:YAG laser was safe and effective in eyes with OAG. More studies are needed to analyze the mechanism of lowering IOP.

Adult↗