The results of this study suggest that routine medical testing before cataract surgery does not reduce the rate of complications during the perioperative period. The results also suggest it would be more efficient not to request routine preoperative tests unless indicated by patient history or physical examination.

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Purposes: To evaluate the main factors related to visual outcome after open globe injuries (excluding intraocular foreign bodies). Methods: Retrospective study analyzing consecutive ocular lacerations, primarily repaired in this institution, between January 1993 and January 2000. Of the 364 cases, 283 (77.75%) lacerations were statistically analyzed, correlating the preoperative variables with the postoperative visual acuity (VA). Excluded from this study were all patients with less than 6 months of follow-up, previous ocular surgery, unreliable information on VA, intraocular foreign bodies and endophthalmitis. When a bilateral injury was detected, only 1 eye was randomly chosen. Results: It was observed, after statistical analysis (multivariate analysis), that the most important factors related to postoperative poor VA (less than 20/100) were: the length of the laceration, the elapsed time between the injury and the surgery and the presence or absence of vitreous loss, cataract (lens damage), hyphema, laceration posterior to rectus muscle insertion and retinal detachment. Conclusion: With this study, it was possible to point out the most important factors related to visual prognosis in open globe injuries. The results found are similar to results previously reported.

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Com o objetivo de verificar as causas de suspensão de cirurgia de catarata e sugerir medidas para melhorar a eficiência do serviço prestado à população, foi realizado um estudo transversal no serviço de oftalmologia de um hospital universitário do Estado de São Paulo. A amostra foi composta por 200 indivíduos. A média de idade foi de 68± 11,4 anos. As causas de suspensão de cirurgia foram: condição clínica desfavorável (23,1%); horário cirúrgico insuficiente (35,9%); e não comparecimento do paciente (41%). Os fatores causadores foram, majoritariamente, as razões sociais e o funcionamento do hospital.

The objective of this clinical trial was to determine the frequency of medical tests considered unnecessary in routine preoperative evaluation for cataract surgery. Unnecessary costs with these tests were also evaluated. For patients assigned to the selective testing group, it was requested that no preoperative testing be performed unless the patient presented a new or worsening medical problem warranting medical evaluation with testing. For patients assigned to the routine testing group, three tests were requested: a 12-lead electrocardiogram, complete blood count, and serum glucose level. The costs of tests considered unnecessary were calculated. The sample of 1,025 patients consisted of 512 assigned to the routine testing group and 513 to the selective testing group. Cumulative rate of medical events was similar in the two groups (p=0.923). The selective group underwent 60.7% fewer tests. The results suggest that selective preoperative testing in cataract surgery does not harm patients in terms of peri-operative clinical complications and also represents a significant cost reduction compared to routine testing.

PurposeTo assess potential vascular, structural, and functional changes to the macula in patients with keratoconus that underwent ultraviolet A (UVA)–riboflavin-mediated corneal collagen cross-linking (CXL) therapy.Patients and methodsSeventeen eyes from 17 patients of age 16 years or older with keratoconus undergoing CXL treatment were studied. The same eye served as its own control (before CXL vs after CXL). Eyes were evaluated in terms of best-corrected visual acuity (BCVA), refractive error, intraocular pressure, Amsler grid, retinography, fluorescein angiography, autofluorescence, and spectral domain optical coherence tomography (SD-OCT) prior to CXL and 7 and 30 days after treatment. Multifocal electroretinography (mfERG) was recorded prior to and 7 days after CXL.ResultsMean (SD) BCVA by logMAR chart was 0.47 (±0.12) pre-CXL, 0.55 (±0.15) 7 days post-CXL (P=0.57), and 0.46 (±0.10) 30 days post-CXL (P=0.87). Mean (SD) SD-OCT central macular thickness (µm) was 253.62 (±20.9) pre-CXL, 260.5 (±18.7) 7 days post-CXL (P=0.48), and 256.44 (±21.6) 30 days post-CXL (P=0.69). In 12 eyes, mfERG revealed a statistically significant increase (P=0.0353) in P1 latency (ms) of ring four from the pre-CXL period (39.45±2.05) to 7 days post-CXL (41.04±1.28) period. Regression analysis showed that the increase in P1 latency was correlated with the increase in central macular thickness (P=0.027). Furthermore, nine patients experienced a significant decrease in P1 amplitudes of rings 1 (P=0.0014), 2 (P=0.0029), 3 (P=0.0037), 4 (P=0.0014), and 5 (P=0.0012) from pre-CXL to 7 days post-CXL. Conclusion: In this pilot study, most of the patients exhibited slight changes in their mfERG parameters and OCT thickness, despite a lack of vascular abnormalities observed on fluorescein angiography/autofluorescence imaging, no alteration in BCVA, and no reports of symptoms. These changes could, therefore, be categorized as a mild subclinical effect of the corneal cross-linking procedure.