Orientador: Antonio Carlos Lottelli Rodrigues / Resumo: RESUMO Objetivo: o presente estudo teve como objetivo geral avaliar os resultados visuais, satisfação e qualidade de vida de pacientes submetidos a implante bilateral de LIO multifocal e como objetivos específicos, a avaliação da acuidade visual (AV) para longe, perto e intermediária, do teste de sensibilidade ao contraste e da qualidade de vida destes pacientes por meio de questionário (NEI-VFQ 25). Métodos: foi realizado um estudo prospectivo e intervencionista que incluiu 20 pacientes portadores de catarata senil bilateral, em acompanhamento no setor de Catarata dos Hospital das Clínicas da Faculdade de Medicina de Botucatu. Os critérios de exclusão foram astigmatismo corneano maior que 1,5 D, olho único, história de cirurgia intraocular prévia ou doença ocular que cause redução da AV, falta de motivação do paciente em realizar o procedimento cirúrgico bilateralmente, complicações intra-operatórias e recusa em assinar o TCLE. Os pacientes foram submetidos a implante bilateral da LIO multifocal EyeDiff®, da Eyeol UK®, e foram avaliados no 1o, 3o e 6o mês de pós-operatório com medidas da AV (longe, intermediária e perto, monocular e binocular, sob condições fotópicas e mesópicas), qualidade de visão (avaliação da sensibilidade ao contraste) e qualidade de vida através de um questionário de satisfação. Resultados: todos os olhos apresentaram AV monocular e binocular de 0,3 LogMAR ou melhor para longe e J3 ou melhor para perto com a melhor correção para longe, sob condições fo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: ABSTRACT Purpose: the present study had as main goal to evaluate visual outcomes, satisfaction and quality of life of patients submitted to bilateral implant of multifocal intraocular lens (IOL), and as specific aims, evaluation of distance, intermediate and near visual acuity (VA), contrast sensitivity and quality of life of these patients using a questionnaire (NEI-VFQ 25). Methods: this was a prospective and interventionist study, that included 20 patients with bilateral senil cataract, followed at Botucatu Medicine School. Exclusion criteria were corneal astigmatism superior to 1,50 D, single eye, previous intraocular surgery or ocular disease, intra-operatory complications and refuse in signing the consent form. Patients were submitted to bilateral implant of multifocal IOL EyeDiff® Eyeol UK® and were evaluated at 1o, 3o and 6o month, postoperatively, with VA testing (for distance, intermediate and near, monocular and binocular, under fotopic and mesopic conditions), eyesight quality (contrast sensitivity evaluation) and quality of life through a satisfaction questionnaire. Results: all eyes presented monocular and binocular CDVA of 0,3 LogMar or better and DCNVA of J3 or better, under photopic and mesopic conditions. Defocus curve showed best performance at +2,50 D. Contrast sensitivity were in the minimum level of normality for low and high special frequencies and under normal limits for intermediate special frequency. The quality of life questionnaire had average scor... (Complete abstract click electronic access below) / Mestre

Submitted by RODOLFO DE LIMA FACHINELLI null (r_fachinelli@hotmail.com) on 2018-04-04T18:54:51Z No. of bitstreams: 1 DISSERTAÇÃO - RODOLFO FACHINELLI.pdf: 1066915 bytes, checksum: 93987ac1254ae543ed84ff519a438005 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-04-06T13:56:06Z (GMT) No. of bitstreams: 1 fachinelli_rl_me_bot.pdf: 1066915 bytes, checksum: 93987ac1254ae543ed84ff519a438005 (MD5) / Made available in DSpace on 2018-04-06T13:56:06Z (GMT). No. of bitstreams: 1 fachinelli_rl_me_bot.pdf: 1066915 bytes, checksum: 93987ac1254ae543ed84ff519a438005 (MD5) Previous issue date: 2018-02-22 / Objetivo: Comparar a ceratometria média aferida (KA) sob narcose em crianças submetidas à facectomia, por catarata congênita ou do desenvolvimento, com a ceratometria média obtida por cálculo teórico (KC), utilizando o poder dióptrico da lente intraocular (LIO) implantada e dados refracionais e biométricos pós-operatórios, a fim de evidenciar possíveis erros de aferição da KA devido a narcose. Métodos: Estudo retrospectivo realizado a partir da análise de dados coletados de prontuários de pacientes com catarata bilateral, congênita ou do desenvolvimento, que receberam tratamento cirúrgico no HC-FMB. Foram analisados 73 olhos de crianças que possuíam pelo menos um exame pós-operatório completo, cada momento em que determinado olho foi examinado foi considerado um elemento do conjunto amostral, totalizando 165 momentos. KC foi obtida a partir de fórmula teórica para cálculo de LIO, utilizando os dados biométricos pós-operatórios (AL e ACD), refratometria automatizada pós-operatória e poder dióptrico da LIO implantada. Foi calculada a diferença entre KA e KC (Desvio = KA – KC). Para análise estatística dos desvios encontrados e comparação entre KA e KC, foi realizado o teste de associação de Goodman e o teste não paramétrico de Kruskal-Wallis. Resultados: A média de idade no momento da cirurgia do primeiro olho foi 954,62 dias, com desvio padrão de ±794,14 dias, mediana de 953 dias, sendo a idade mínima de 44 dias e a máxima de 2659 dias. Vinte e três eram do sexo masculino (62,16%) e 14 eram do sexo feminino (37,84%). KA variou de 40,62D a 51,50D, com mediana de 45,25D, média de 45,32D e desvio padrão de ±2,37D. KC variou de 39,40D a 52,26D, com mediana de 44,49D, média de 44,54D e desvio padrão de ±2,41D. Os desvios (Desvio = KA – KC) variaram de -2,28D a 3,81D, com mediana de 0,83D, média de 0,79D e desvio padrão de ±1,18D. A relação entre KC e KA pode ser representada pela equação KA = 1,0172 Kc. Conclusão: A comparação entre KC e KA em crianças sob narcose evidenciou que há superestimação do valor aferido em relação ao calculado. A análise dos desvios encontrados mostrou tendência para maior superestimação quanto maior a KA com diferença significativa (p<0,05) nas aferições acima de 44,0D. / Purpose: To compare the mean keratometry measured (KA) in children under anesthesia to receive surgical treatment for congenital or developmental cataract with a mean keratometry obtaeined by a theoretical formula (KC), using the implanted intraocular lens (IOL) power value and postoperative refractional and biometric data, in order to check possible observational erros of KA due to general anesthesia. Methods: A retrospective study analysing records of patients with congenital or developmental bilateral cataract who underwent surgical treatment at HC-FMB. Seventy-three children’s eyes that had at least one full postoperative exam were analyzed, each time one eye was assessed was considered one element of the sample group, and the total amount was 165 elements. KC was determined by a theoretical formula for calculating IOL power using postoperative biometric data (AL e ACD), postoperative automatic refractometery and refractive power of the implanted IOL. The KA observational error value was obtained by subtracting KC from KA (Error = KA - KC). Statistical analysis of the observational erros and the comparison between KA and KC were made by Goodman’s test and Kruskal-Wallis’ non-parametric test. Results: the mean age at the moment of the first surgery was of 954,62 days, the standard deviation was ±794,14 days, the median was 953 days, the minimum age was 44 days and the maximum age was 2659 days. Twenty-three (62,16%) patients were male and 14 (37,84%) female. KA ranged from 40,62D to 51,50D, the median was 45,25D, the mean was 45,32D and the standard deviation was ±2,37D. KC ranged from 39,40D to 52,26D, the median was 44,49D, the mean was 44,54D and the standard deviation was ±2,41D. Observational errors ranged from -2,28D to 3,81D, the median was 0,83D, the mean was 0,79D and the standard deviation was ±1,18D. The rate between KC and KA can be represented by the equation KA = 1.0172 KC. Conclusion: The comparison between KC and KA in children under general anesthesia showed that there is an overestimation of the value measured when compared to the calculated one. The analysis of the observational errors showed there is a tendency to greater overestimation the higher the KA, with significant difference (p <0.05) in the measurements over 44.0D.

Orientador: Antonio Carlos Lottelli Rodrigues / Resumo: Objetivo: Comparar a ceratometria média aferida (KA) sob narcose em crianças submetidas à facectomia, por catarata congênita ou do desenvolvimento, com a ceratometria média obtida por cálculo teórico (KC), utilizando o poder dióptrico da lente intraocular (LIO) implantada e dados refracionais e biométricos pós-operatórios, a fim de evidenciar possíveis erros de aferição da KA devido a narcose. Métodos: Estudo retrospectivo realizado a partir da análise de dados coletados de prontuários de pacientes com catarata bilateral, congênita ou do desenvolvimento, que receberam tratamento cirúrgico no HC-FMB. Foram analisados 73 olhos de crianças que possuíam pelo menos um exame pós-operatório completo, cada momento em que determinado olho foi examinado foi considerado um elemento do conjunto amostral, totalizando 165 momentos. KC foi obtida a partir de fórmula teórica para cálculo de LIO, utilizando os dados biométricos pós-operatórios (AL e ACD), refratometria automatizada pós-operatória e poder dióptrico da LIO implantada. Foi calculada a diferença entre KA e KC (Desvio = KA – KC). Para análise estatística dos desvios encontrados e comparação entre KA e KC, foi realizado o teste de associação de Goodman e o teste não paramétrico de Kruskal-Wallis. Resultados: A média de idade no momento da cirurgia do primeiro olho foi 954,62 dias, com desvio padrão de ±794,14 dias, mediana de 953 dias, sendo a idade mínima de 44 dias e a máxima de 2659 dias. Vinte e três eram do sexo masculino (62,... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Purpose: To compare the mean keratometry measured (KA) in children under anesthesia to receive surgical treatment for congenital or developmental cataract with a mean keratometry obtaeined by a theoretical formula (KC), using the implanted intraocular lens (IOL) power value and postoperative refractional and biometric data, in order to check possible observational erros of KA due to general anesthesia. Methods: A retrospective study analysing records of patients with congenital or developmental bilateral cataract who underwent surgical treatment at HC-FMB. Seventy-three children’s eyes that had at least one full postoperative exam were analyzed, each time one eye was assessed was considered one element of the sample group, and the total amount was 165 elements. KC was determined by a theoretical formula for calculating IOL power using postoperative biometric data (AL e ACD), postoperative automatic refractometery and refractive power of the implanted IOL. The KA observational error value was obtained by subtracting KC from KA (Error = KA - KC). Statistical analysis of the observational erros and the comparison between KA and KC were made by Goodman’s test and Kruskal-Wallis’ non-parametric test. Results: the mean age at the moment of the first surgery was of 954,62 days, the standard deviation was ±794,14 days, the median was 953 days, the minimum age was 44 days and the maximum age was 2659 days. Twenty-three (62,16%) patients were male and 14 (37,84%) female. KA ranged from... (Complete abstract click electronic access below) / Mestre

L’Opacification Capsulaire Postérieure (OCP) est la fibrose de la capsule développée sur la lentille intraoculaire implantée (LIO) suite à la dé-différenciation de cellules épithéliales cristalliniennes (LECs) subissant une transition épithélio-mésenchymateuse (EMT). La littérature a montré que l'incidence de l’OCP est multifactorielle, dont l'âge ou la maladie du patient, la technique de chirurgie, le design et le matériau de la LIO. La comparaison des LIOs en acryliques hydrophiles et hydrophobes montre que les premières ont une OCP plus sévère, médiée par la transition EMT. En outre, il est également démontré que l'adhérence des LECs est favorisée sur des matériaux hydrophobes par rapport à ceux hydrophiles. Une stratégie biomimétique destinée à promouvoir l’adhérence des LECs sans dé-différenciation en vue de réduire le risque de développement de l’OCP est proposée. Dans cette étude, les peptides RGD, ainsi que les méthodes de greffage et de quantification sur un polymère acrylique hydrophile ont été étudiés. La surface fonctionnalisée des LIOs favorisant l'adhérence des LECs via les récepteurs de type intégrine peut être utilisée pour reconstituer la structure capsule-LEC-LIO en sandwich, ce qui est considéré dans la littérature comme un moyen de limiter la formation de l‘OCP. Les résultats montrent que le biomatériau innovant améliore l'adhérence des LEC, et présente également les propriétés optiques (transmission de la lumière , banc optique) similaires et mécaniques (force haptique de compression, force d'injection de la LIO) comparables à la matière de départ. En outre, par rapport au matériau hydrophobe IOL, ce biomatériau bioactif présente des capacités similaires vis à vis de l’adhérence des LECs, le maintien de la morphologie, et l'expression de biomarqueurs de l’EMT. Les essais in vitro suggèrent que ce biomatériau a le potentiel de réduire certains facteurs de risque de développement de l’OCP. / Posterior Capsular Opacification (PCO) is the capsule fibrosis developed onto the implanted IntraOcular Lens (IOL) by the de-differentiation of Lens Epithelial Cells (LEC) undergoing Epithelial-Mesenchymal Transition (EMT). Literature has shown that the incidence of PCO is multifactorial including patient’s age or disease, surgical technique, and IOL design and material. Reports comparing hydrophilic and hydrophobic acrylic IOLs show the former has more severe PCO after EMT transition. Additionally, the LEC adhesion is favored onto the hydrophobic materials compared to the hydrophilic ones. A biomimetic strategy to promote LEC adhesion without de-differentiation to reduce PCO development risk is proposed. RGD peptides, as well as their grafting and quantification methods on a hydrophilic acrylic polymer were investigated. The surface functionalized IOL promoting LEC adhesion via integrin receptors can be used to reconstitute the capsule-LEC-IOL sandwich structure, which is considered to prevent PCO formation in literature. The results show the innovative biomaterial improves LEC adhesion, and also exhibits similar optical (light transmittance, optical bench) and mechanical (haptic compression force, IOL injection force) properties comparing to the starting material. In addition, comparing to the hydrophobic IOL material, this bioactive biomaterial exhibits similar abilities in LEC adhesion, morphology maintenance, and EMT biomarker expression. The in vitro assays suggest this biomaterial has the potential to reduce some risk factors of PCO development.