RESUMOObjetivo: Avaliar as alterações que ocorrem na sensibilidade corneanas após as cirurgias de LASIK e PRK Métodos: Estudo prospectivo onde foram avaliados 60 olhos de 30 pacientes submetidos a LASIK bilateral simultaneamente e mais 30 olhos de 15 pacientes submetidos a PRK bilateral simultaneamente. De acordo com a quantidade de ablação intra-operatórias, os olhos foram divididos em dois grupos: Grupo 1 (menor que 40 µm) e Grupo 2 (Maior que 40 µm). A sensibilidade corneana foi medida na região central da córnea pelo estesiometro Cochet Bonnet ® no pré operatório e após 30, 90 e 180 dias da cirurgias. Resultados: A sensibilidade corneana na LASIK apresentouse diminuída durante os três primeiros meses retornando as valores pré operatórios aos 6 meses; E de acordo com a quantidade de ablação o Grupo 1 apresentou diferença estatisticamente significante em relação ao Grupo 2 durante os três primeiros meses; No entanto a PRK recuperou seus valores pré operatório aos três meses e de acordo com a quantidade de ablação o Grupo 1 apresentou diferença estatisticamente significante somente no primeiro mês de pós operatório. Conclusão: A LASIK apresentou sensibilidade menor em relação ao PRK durante os 3 primeiros meses e somente aos 6 meses os valores da sensibilidade corneana foram similares; Os resultados também sugerem que a quantidade de ablação está relacionada com a diminuição da sensibilidade corneana durante os primeiros meses em ambas as técnicas cirúrgicas, principalmente na LASIK.Descritores: Miopia/fisiopatologia; Miopia/cirurgia; Córnea/inervação; Ceratomileuse assistida por excimer laser in situ; Ceratectomia fotorrefrativa; Lasers de excimer; Sensação/fisologia; Técnicas de diagnostico oftalmológico/instrumentação
Introduction: Phacoemulsification (PE) cataract surgery is the gold standard in ophthalmology, being effective in improving vision in more than 90.0% of patients. In this context, authors found that PE was associated with 16.67% of endothelial cell loss, which correlated with the degree of trauma during surgery. Endothelial changes are considered an important parameter for assessing trauma and for estimating the safety of a surgical technique. In this sense, more modern PE machines are capable of removing cataracts using optimized parameters such as high vacuum, aspiration flow, and low amount of ultrasonic energy. Objective: It was to present and discuss the main phacoemulsification techniques for optimizing the treatment of cataracts, in an attempt to reduce the loss of corneal endothelial cells. Methods: Experimental and clinical studies were included (case reports, retrospective, prospective, and randomized studies) with qualitative and/or quantitative analysis. Initially, the keywords were determined by searching the DeCS tool (Descriptors in Health Sciences, BIREME base) and later verified and validated by MeSH Terms. The search literature was carried out from January to April 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Results: A total of 122 articles involving phacoemulsification and endothelial cells were found. Initially, the existing title and duplications were excluded according to the interest described in this work. After this process, the abstracts were evaluated and a new exclusion was performed. A total of 80 articles were evaluated in full and 59 were included and discussed in this study. At the beginning of treatment with PE, without the endothelial protection of viscoelastic agents and the use of ultrasound in the anterior chamber, the endothelial loss was greater than in extracapsular cataract extraction. With the modernization of PE, the use of viscoelastic agents, the emergence of techniques for fracture of the nucleus within the capsular bag, and the use of ultrasound in the posterior chamber, the loss of endothelial cells reduced from 7 to 12% on average. Conclusion: Endothelial changes are considered an important parameter to assess trauma and estimate the safety of a surgical technique. Highlighted, the main predictors associated with the loss of corneal endothelial cells are the duration of the ultrasound used in the surgery, the turbulence of the liquid in the anterior chamber, and the mechanical trauma.
Introduction: In the liposculpture scenario, and at the cellular and molecular level, tissue engineering has numerous advantages that meet the needs of the injured tissue or organ for the regeneration process or fillings and contours. Biological microenvironments enable cell recognition and signaling cascades for neovascularization and stabilization of fat grafting. Objective: A concise systematic review was carried out on the use of potential biostimulators (cells and molecules) and the biochemical and physiological mechanisms that can contribute to the successful process of cervicofacial liposculpture, to promote neovascularization and stabilization of fat grafting or fat reduction. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from February to April 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 96 articles were found. A total of 36 articles were fully evaluated and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 11 studies at high risk of bias and 37 studies that did not meet the GRADE. The present study showed that the use of potential bio stimulators such as stromal vascular fraction cells and mesenchymal stem cells from adipose tissue, exosomes, microRNA, and PRP, as well as the molecules secreted by these cells, can contribute to the successful process of cervicofacial liposculpture, to promote neovascularization and stabilization of fat grafting or fat reduction. Furthermore, studies have shown that the use of adipose tissue plus PRP led to the presence of more pronounced inflammatory infiltrates and greater vascular reactivity, increased vascular permeability, and certain reactivity of the nervous component, noting that the addition of 20% PRP activated with calcium to adipose tissue grafts can enhance the results of regenerative and aesthetic facial surgeries.
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