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Lens density measurement with Scheimpflug camera in vitrectomised eyes
Densidad critaliniana medida con cámara de Scheimpfug en ojos vitrectomizados
M.A. Ibáñez-Ruiz
, P. Beneyto-Martin, M.T. Pérez-Martínez
Corresponding author
Secciones de Retina y Polo anterior, Hospital Virgen de la Salud, Toledo, Spain
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Autofluorescence and optical coherence tomography" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "391" "paginaFinal" => "396" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1468 "Ancho" => 1500 "Tamanyo" => 288107 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">After performing fluorescein angiography, hyperfluorescence can be seen at the level of the previously described macular lesions in all times. The upper image shows angiography at 1:02<span class="elsevierStyleHsp" style=""></span>min, while the lower part is at 8:30. The periphery does not exhibit significant angiographic alterations.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Rocha Cabrera, L. Cordovés Dorta, M. González Hernández" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Rocha Cabrera" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Cordovés Dorta" ] 2 => array:2 [ "nombre" => "M." 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Slow growth retinoblastoma in both eyes, group B and B as per international retinoblastoma classification in a patient with 13q–[del(13)(q14,11q31)] syndrome. (A) right eye; (B) left eye.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Ossandón, M. Zanolli, J.P. López, F. Benavides, V. Pérez, G.M. Repetto" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Ossandón" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Zanolli" ] 2 => array:2 [ "nombre" => "J.P." "apellidos" => "López" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Benavides" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Pérez" ] 5 => array:2 [ "nombre" => "G.M." 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Beneyto-Martin, M.T. Pérez-Martínez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "Ibáñez-Ruiz" "email" => array:1 [ 0 => "oftalmologia.mariba@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Beneyto-Martin" ] 2 => array:2 [ "nombre" => "M.T." "apellidos" => "Pérez-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Secciones de Retina y Polo anterior, Hospital Virgen de la Salud, Toledo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Densidad critaliniana medida con cámara de Scheimpfug en ojos vitrectomizados" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 936 "Ancho" => 1605 "Tamanyo" => 147717 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Lens linear density measurements obtained with Oculus-Pentacam.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the technical developments in retina and vitreous surgery, cataracts remain as the most frequent post-surgery complication. Apparently, up to 80–90% of patients would require post-vitrectomy cataract surgery within 2 years after surgery.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most frequently described lens changes in relation to vitrectomy consist in a generally temporary posterior subcapsular opacification followed by a progressive and permanent nuclear sclerosis. As in senile cataracts, lens proteins become insoluble or folded, but this occurs at a higher rate than in senile cataracts.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cataracts have been studied with predominantly subjective methods, among which the most widely utilized is the LOCS III classification.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> Said method is based on the interpretation of slit lamp photographs or images, although the reproducibility of this method could be compromised.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3,4</span></a> Objective methods are based on obtaining various lens parameters such as light dispersion, fluorescence and phosphorus metabolites, without said parameters being subject to observer interpretation, consequently enabling greater reproducibility.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The Pentacam device (Oculus-Pentacam, Wetzlar, Germany) consists of 2 cameras: a central camera that controls fixation and automatically corrects ocular movements, and a second camera assembled on a wheel that turns 360° around the central axis of the eye, obtaining 50 sections with 25,000 elevation points (500 per section) in 2<span class="elsevierStyleHsp" style=""></span>s utilizing blue LED monochromatic light (475<span class="elsevierStyleHsp" style=""></span>nm wavelength free of UV light) in the form of a slit and applying the Scheimpflug principle. Saved images, corrected in relation to a reference point (central point of the cornea) are processed jointly to create a 3-D model of the anterior segment.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5,7–9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In what concerns lens density, Bouguer and Lambert describe it as loss of radiation or light when passing through a medium. Beer found that this lost radiation could be proportional to the molarity or concentration of the substances in said medium. Accordingly, optical density would be proportional to molarity. On the basis of this premise, optical density increase could be correlated to the development of cataract.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> The amount of reflected light captured by the camera would be proportional to optical density and could be quantified in a continuous grayscale, with zero being a totally transparent lens and 100 an opaque lens.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In a transversal study with 21 eyes, Kirkwood et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> registered 3 types of densitometric values:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Peak: registering the highest densitometry value.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Linear: registering density values on a line drawn in the area of the visual axis.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0045" class="elsevierStylePara elsevierViewall">3-D: registering the density of a 3<span class="elsevierStyleHsp" style=""></span>mm circular area.</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">It appears that the last of said 3 measures is more representative of lens opacity.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a> Most authors select a region or area of interest, calculating mean density, standard deviation and highest density peak<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3,11,12</span></a> for said area.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Postvitrectomy cataracts has been studied mainly with subjective methods, for which reason the application of an objective method such as Pentacam would be of interest due to its higher sensitivity and ability to detect changes at earlier stages. The hypothesis of this study is that, as cataracts is the most frequent complication in vitrectomy, higher lens density could be expected in vitrectomised eyes as compared with non-vitrectomised eyes.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects, material and method</span><p id="par0060" class="elsevierStylePara elsevierViewall">An observational, transversal, ambispective case and control study was carried out in which the dependent variable was the Scheimpflug optical density (DOS) lens measurement in vitrectomised eyes, and the independent variable was the lens DOS in non-vitrectomised eyes.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The population of reference were phakic eyes vitrectomised due to various vitreo-retinal diseases in the Retina Department of the Virgen de la Salud Hospital of Toledo, Spain, from January 1, 2010 up to July 1, 2014.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The study included eyes with lens in vitrectomy without corneal disease and sufficient cooperation to obtain quality images with the Pentacam device. Pseudophakic or aphakic eyes in vitrectomy were excluded, together with those who required silicone oil as postvitrectomy tamponade agent.</p><p id="par0075" class="elsevierStylePara elsevierViewall">A previous study<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a> was used as basis to assess sample size. Accordingly, for an estimated DOS increase of 1.5, a confidence level of 95% and a statistical power (1<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">β</span>) of 80%, the calculated sample size was 70 cases for comparison groups. Even so, the highest possible number of cases was selected.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Overall, the study included 121 vitrectomised phakic eyes, which were divided into groups: 81 that preserved the lens and 40 who were operated for postvitrectomy cataracts. The control group comprised 88 contralateral non-vitrectomised eyes. The number of cases and controls is not identical because in some patients the control eye was pseudophakic, aphakic or anophthalmic.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The lens DOS was obtained utilizing the Scheimpflug camera of the Oculus-Pentacam device. Measures were taken after dilating both eyes with tropicamide in a darkened room. Overall, 3–4 measurements were taken to obtain an image with a quality factor (QS section of the initial Pentacam screen) greater than 95%. The 270–290° section of the Scheimpflug image screen was used. Three types of DOS measurements were taken: peak, linear and area. In the first, the highest density point of the central area of the lens nucleus was selected, while in the second the measures obtained drawing a line in the central area of the nucleus with a length of 1950–2000<span class="elsevierStyleHsp" style=""></span>μm and registering the mean density, standard deviation and maximum and minimum values, while in the area measurement a rectangle was drawn covering the central nuclear area of the lens with a size of 450–500<span class="elsevierStyleHsp" style=""></span>μm width and 1950–2000<span class="elsevierStyleHsp" style=""></span>μm length. For this area the mean density, standard deviation and maximum value were recorded (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The mean evolution time between vitrectomy and DOS measurements was of 36.4 months (1–240 months). The mean surgical time was of 160.14<span class="elsevierStyleHsp" style=""></span>min (55–240<span class="elsevierStyleHsp" style=""></span>min). The vitrectomy operations were performed by 4 surgeons divided in 2 groups: expert surgeons (3 surgeons with over 5 years experience) and non-expert surgeons (one surgeon with a surgical experience under 5 years).</p><p id="par0095" class="elsevierStylePara elsevierViewall">As regard statistical tests, the first was aimed at verifying whether the different types of DOS lens measurements of phakic patients after vitrectomy fit within normal distribution by means of the Kolmogorov–Smirnov test. If that is the case, the <span class="elsevierStyleItalic">T</span> for Student test would be applied for comparison of mean values. Otherwise, the Wilcoxon nonparametric test was applied.</p><p id="par0100" class="elsevierStylePara elsevierViewall">From the ethical viewpoint, all patients were informed and signed a consent to participate voluntarily in the present study. The ethical parameters of the study complied with the Helsinki declaration, and the study was approved by the Research Committee of the Virgen de la Salud Hospital.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no commercial interest in said study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0110" class="elsevierStylePara elsevierViewall">Seventy-one of all vitrectomised eyes belonged to males and 50 to females, with 43 males and 45 females in the non-vitrectomised group. Overall, 48.1% (39) of eyes were vitrectomised due to retina detachment, 20.9% (17) due to epiretinal membrane, 17.2% (14) due to complications in proliferative diabetic retinopathy, 8.6% (7) due to macular hole and 4.9% (4) due to vitreous hemorrhage of various etiologies, mainly retinal tears or Terson syndrome. No significant differences were found in the postvitrectomy area density vis-à-vis the control group, taking into account the diagnostic (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.260).</p><p id="par0115" class="elsevierStylePara elsevierViewall">In phakic patients, after vitrectomy (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>81) the following results were obtained:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1.</span><p id="par0120" class="elsevierStylePara elsevierViewall">Peak DOS: the mean peak DOS in vitrectomised eyes was 10.91 (±9.25) vs a density of 11.44 (±4.84) in non-vitrectomised eyes, without said difference being statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.59).</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2.</span><p id="par0125" class="elsevierStylePara elsevierViewall">Linear DOS: the mean linear DOS in vitrectomised eyes was 14.15 (±5.4) and in non-vitrectomised eyes of 11.08 (±3.06), with a statistically significant difference between both groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="par0130" class="elsevierStylePara elsevierViewall">The mean maximum value within the selected line was 19.53 (±8.57) in vitrectomised eyes and 14.52 (±4.68) in non-vitrectomised eyes, with a significant difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), as with the standard deviation difference between both groups (3.26<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.48 in vitrectomised vs 1.94<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.61 in non-vitrectomised; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="par0135" class="elsevierStylePara elsevierViewall">In contrast, the difference of the mean minimum value between vitrectomised eyes (8.88<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.75) and non-vitrectomised eyes (7.98<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.30) was not significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.15).</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3.</span><p id="par0140" class="elsevierStylePara elsevierViewall">Area DOS: the mean area DOS in vitrectomised patients was 13.54 (±4.77) and in non-vitrectomised patients of 10.63 (±3.06), with a statistically significant difference between both groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p></li></ul></p><p id="par0145" class="elsevierStylePara elsevierViewall">The mean and standard deviation in the vitrectomised group was 3.56 (±2.44) against 2.34 (±2.23) for the non-vitrectomised group, with a statistically significant difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="par0150" class="elsevierStylePara elsevierViewall">In what concerns the maximum value of the selected area, in vitrectomised patients of the value was 20.22 (±8.43) and 15.42 (±5.1) in non-vitrectomised patients. Likewise, the difference is significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The mean DOS values for the 3 types of measurements are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The present study utilized the lens DOS obtained with the Oculus-Pentacam Scheimpflug camera in order to study post-vitrectomy cataracts. This is an objective measurement method with high (98%) sensitivity (CI 95%: 88–100%) and 95% specificity (CI 95%: 83–100%) that enables reliable and reproducible measures with regard to LOCS III.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3,9,11,14,15</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The nuclear zone was selected for the DOS measurements because it is the lens zone which seems most frequently affected after vitrectomy and also because DOS measurements are more reliable and reproducible in that zone as compared to other lens areas.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5,11,14,16,17</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The lens area and linear mean DOS measures were significantly higher than in non-vitrectomised eyes (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Other authors who studied postvitrectomy lens density with other Scheimpflug cameras obtained similar results. Accordingly, Hsuan et al.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> detected in 35 eyes increased nuclear light dispersion compared to presurgery in eyes in which gas was utilized (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0012). In 95 eyes with macular hole in a central area of 1<span class="elsevierStyleHsp" style=""></span>mm, Wong<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> found an increase in nuclear in the group of vitrectomised eyes vis-à-vis the observed eyes (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001). In 42 vitrectomised eyes, Almony<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a> also found an increased lens DOS in the nuclear area of the operated eye vis-à-vis the contralateral eye.</p><p id="par0170" class="elsevierStylePara elsevierViewall">It must be pointed out that the mean peak DOS obtained in this study was not significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.59) vis-à-vis non-vitrectomised eyes. This could have occurred because, as pointed out by other authors<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">14,15</span></a> lens opacity is not homogeneous. Kirkwood<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> also pointed out that peak DOS seems less repeatable with regard to the area or 3-D measurements<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a> and Qian<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> indicated that with peak DOS opacification areas not affecting the visual axis could be excluded.</p><p id="par0175" class="elsevierStylePara elsevierViewall">In a vitrectomised eye, the elimination of the vitreous gel destroys the physical barrier against the diffusion of various substances and the physiological gradients thereof, facilitating their diffusion or uniform distribution within the posterior chamber, including oxygen. The lens is an avascular structure that depends from oxygen which, through diffusion, penetrates the lens from the vitreous and the aqueous humor. It is reasonable to believe that the higher oxygen concentration in the vitreous cavity would involve higher oxygen surface tension in the lens, and that this could facilitate the development of cataracts. Accordingly, Holekamp found in patients with ischemic diabetic retinopathy a significantly lower postvitrectomy lens DOS compared to non-ischemic eyes, possibly in relation to lower partial oxygen pressure in the vitreous cavity of ischemic eyes.<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">22–26</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In addition, when the vitreous is eliminated during vitrectomy a reduction of ascorbate takes place. Ascorbate is a vitreous antioxidant that could neutralize the excess of oxygen in the vitreous cavity. Lens catalase (antioxidant enzyme) could be deactivated due to the effect of light, both microscopically as well as from endo-illumination probes. It seems that the excess of oxygen could inhibit Na<span class="elsevierStyleSup">+</span>/K<span class="elsevierStyleSup">+</span> ATPase and alter the permeability of the lens posterior capsule.<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">22,23,27,28</span></a> Fluid means utilized during vitrectomy could also influence the permeability of the lens posterior capsule, affecting lens transparency.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> It appears that all these changes enhance lens protein oxidation and loss of transparency as well as increased fluorescence due to the formation and aggregation of chromophores.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">1,2,18</span></a> This would explain the importance of the vitreous for maintaining lens transparency. In fact, Sawa<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> did not find significant differences (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.63 and 0.83) in the lens DOS when utilizing a technique that does not extract the vitreous in posterior pole surgery.</p><p id="par0185" class="elsevierStylePara elsevierViewall">A possible strategy to prevent cataract development would consist in preserving the remains of the anterior vitreous in contact with the lens posterior capsule, as well as utilizing increasingly less invasive surgical techniques.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The authors consider that the best design would be a prospective cohort study with a significantly larger sample (only obtainable through large base multicenter studies) and a longer period of years or even decades. In addition postvitrectomy evolution time could determine increased post-surgery nuclear DOS.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> In the present study, the authors have included eyes with different post-surgery evolution times, which could influence the obtained results. The present study is an acceptable approach that could provide valuable working hypotheses for subsequent studies. Even so, the results could be improved by increasing sample size. In addition, the present results could include a bias because not all patients accepted to participate in the study.</p><p id="par0195" class="elsevierStylePara elsevierViewall">It seems that vitrectomy could have an influence in post-surgery lens densitometric changes. Due to the fact that reproducibility is less compromised, the Scheimpflug camera could be used for detecting incipient changes in the lens and studying its evolution. Similarly, it seems that the vitreous plays an important role in maintaining lens transparency.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres693578" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec702572" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres693579" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec702571" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Subjects, material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-31" "fechaAceptado" => "2016-01-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec702572" "palabras" => array:5 [ 0 => "Crystalline" 1 => "Vitrectomy" 2 => "Densitometry" 3 => "Scheimpflug" 4 => "Cataracts" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec702571" "palabras" => array:5 [ 0 => "Cristalino" 1 => "Vitrectomía" 2 => "Densitometría" 3 => "Scheimpflug" 4 => "Cataratas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine whether vitrectomised eyes have a higher lens optical density, when measured with a Scheimpflug camera, compared to non-vitrectomised eyes.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The peak and linear Scheimpflug optical density (DOS), and area of both eyes were measured in a sample size of 81 vitrectomised phakic patients. A comparison was made between the DOS of the vitrectomised eye lens and the contralateral non-vitrectomised eye using the Student's <span class="elsevierStyleItalic">t</span>-test.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A significantly higher linear DOS and area was obtained in the 81 vitrectomised phakic eyes when compared to the non-vitrectomised eyes (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The peak DOS is not significantly increased in respect to non-vitrectomised eyes (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.59).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The lens DOS in vitrectomised eyes is higher than in non-vitrectomised eyes. The importance of the vitreous in the maintenance of lens transparency is emphasized.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar si los ojos vitrectomizados presentan una mayor densidad óptica cristaliniana, medida con cámara Scheimpflug, con respecto a los ojos no vitrectomizados.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se selecciona a 81 pacientes fáquicos vitrectomizados a los que se les mide la densidad óptica Scheimpflug (DOS) pico, lineal y de área, de ambos ojos. Comparamos las medias de DOS del cristalino del ojo vitrectomizado y del contralateral no vitrectomizado, mediante el test t de Student.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En 81 ojos fáquicos vitrectomizados se han obtenido unas DOS medias, lineales y de área posvitrectomía significativamente mayores respecto a los ojos no vitrectomizados (p < 0,001). La DOS pico no resultó significativamente mayor con respecto a los ojos no vitrectomizados (p = 0,59).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En ojos vitrectomizados encontramos mayor DOS cristaliniana que en ojos no vitrectomizados. El gel vítreo resultaría importante en el mantenimiento de la transparencia del cristalino.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ibáñez-Ruiz MA, Beneyto-Martin P, Pérez-Martínez MT. Densidad critaliniana medida con cámara de Scheimpfug en ojos vitrectomizados. Arch Soc Esp Oftalmol. 2016;91:385–390.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 936 "Ancho" => 1605 "Tamanyo" => 150198 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lens peak density measurement obtained with Oculus-Pentacam.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 936 "Ancho" => 1605 "Tamanyo" => 147717 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Lens linear density measurements obtained with Oculus-Pentacam.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 934 "Ancho" => 1604 "Tamanyo" => 186649 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Area density obtained with Oculus-Pentacam.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Densities \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vitrectomised \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Non-vitrectomised \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peak MD (±6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.91 (±9.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.44 (±4.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.595 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Linear MD (±6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.15 (±5.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.08 (±3.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Area MD (±6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.54 (±4.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.63 (±3.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1133095.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mean peak, linear and area densities in vitrectomised and non-vitrectomised eyes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitrectomy surgery increases oxygen exposure to the lens: a possible mechanism for nuclear cataract formation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2018 February | 16 | 0 | 16 |
| 2018 January | 16 | 4 | 20 |
| 2017 December | 14 | 2 | 16 |
| 2017 November | 15 | 1 | 16 |
| 2017 October | 20 | 1 | 21 |
| 2017 September | 6 | 6 | 12 |
| 2017 August | 12 | 1 | 13 |
| 2017 July | 14 | 4 | 18 |
| 2017 June | 9 | 4 | 13 |
| 2017 May | 5 | 5 | 10 |
| 2017 April | 16 | 6 | 22 |
| 2017 March | 11 | 32 | 43 |
| 2017 February | 18 | 5 | 23 |
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