Navegando por Palavras-chave "Intraocular Lens"

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    Correlação da destreza manual com taxa de complicação em cirurgia de catarata por facoemulsificação durante o período de residência em Oftalmologia
    (Universidade Federal de São Paulo (UNIFESP), 2021) Vieira, Ibraim Viana [UNIFESP]; Siqueira, Wallace Chamon Alves De [UNIFESP]; Universidade Federal de São Paulo
    Objective: To evaluate total and specific surgical complication rate in phacoemulsification throughout ophthalmology residency program and relate these rates to manual dexterity measured at the beginning of the residency program with an ophthalmology surgery simulator that uses virtual reality. Methods: Prospective cohort study involving 14 newly enrolled residents in the ophthalmology program at Escola Paulista de Medicina and Universidade Estadual Paulista – Botucatu campus. Residents underwent manual dexterity assessment with a surgery simulator that uses virtual reality called Eyesi® (VRmagic, Mannheim, Germany). The rates of surgical complication in phacoemulsification were calculated during the second and third year of training. Complications were divided into: incision, anterior capsule, posterior capsule, intraocular lens and others. Differences between groups with and without complications were assessed using the MannWhitney test. Through logistic regression, we evaluated the relationship between rates of surgical complications with: manual dexterity score, age and gender of patients and anesthetic and surgical techniques employed. Results: The manual dexterity score was 266.96 ± 80.59 (mean ± standard deviation) arbitrary units (UA). Throughout the study, 1227 surgeries were performed, with complications occurring in 251 (20.46%) of these. Procedures that presented complications related to the anterior capsule (p = 0.0005), posterior capsule (p = 0.0022) and intraocular lens (p = 0.0037) were associated with lower scores of dexterity when compared to uncomplicated procedures. Each unit of improvement in the initial score represented a 0.37% decrease in the chance of complication occurrence. Surgeries performed with anesthetic block or general anesthesia presented 1.75 times the chance of complication in relation to surgeries with topical anesthesia.Conclusion: Manual dexterity score assessed in the pre-training period was related to lower rates of intraoperative complications during the phacoemulsification learning period. The Eyesi® simulator could be used in the selection of candidates for residency in ophthalmology, and surgical fellowship, or in stratifying residents as to the chance of complication, allowing the development of individualized teaching programs. Both strategies could reduce training costs and provide less risk to patients.
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    Novo dispositivo para correção da afacia sem suporte capsular: prova de conceito
    (Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Bergamasco, Victor Dias [UNIFESP]; Campos, Mauro Silveira De Queiroz [UNIFESP]; Universidade Federal de São Paulo
    Introduction: According to the World Health Organization (WHO), cataract is a leading cause of visual impairment (best corrected visual acuity under 20/60) worldwide. Facectomy is one of the most performed surgeries in modern society. More than 30 million patients will go through cataract extraction in 2020. Even though it is a safe and predictable procedure still some complications may occur, for example the loss of capsular support resulting in impossibility to perform intraocular lens implant and aphakia. In those cases, other ocular tissues are used to support the lens in the absence of capsular bag support and many techniques have been described in the literature. The present techniques have several unmet needs; are technically difficult for most surgeons, require special lens and surgical instruments, multiple incisions and sutures, lead to intense inflammatory response and to short and long-term intraocular pressure disorders and IOL displacement and tilt. The ideal solution should be technically easy and accessible with no need of special lens or surgical instruments, minimally invasive and predictable and stable IOL positioning. Purposes: To develop a prototype device for aphakia without capsular bag support resolution. To describe the development methodology. To evaluate the prototyping technologies used. To evaluate the prototype clinical effectiveness through a proof of concept. Methods: For this technology development project a development cycle was created and applied. The cycle consisted in idealization, prototyping, evaluation and improvements proposition. Using this development cycle nine prototype versions were created and evaluated for the most relevant aspects for the concept. The evaluation consisted in grading each relevant aspect of each prototype version. To determine the best prototype the scores for each aspect of each version were added and resulted in a final score per prototype. The highest prototype score was considered the best prototype. Results: Nine prototypes were idealized and created. Versions V1P to V7P were developed for cadaveric porcine eyes testing. Versions V8H and V9H were tested in human cadaveric eyes. A simplified implant technic was developed and the version V9H had the highest score and was considered the most satisfactory for the evaluated aspects. Conclusions: It was possible to develop a prototype device for aphakia without capsular bag support resolution as well as to describe the development methodology. It was possible to successfully evaluate the prototyping technologies used and identify that the 3D printing technology was the best option available Although most of the aspects were successfully addressed in the best evaluated version, IOL positioning and stability remains unsatisfactory.