[The latest IC3D classification of corneal dystrophies-Overview and changes of the 3rd edition]. / Die aktuelle IC3D-Klassifikation der Hornhautdystrophien ­ Übersicht und Änderungen der 3. Auflage.

The International Committee on Classification of Corneal Dystrophies (IC3D) was founded in 2005 to address difficulties arising from the outdated nomenclature for corneal dystrophies (CD) and to correct misconceptions in the literature. For each of the 22 CDs, a separate template was created to represent the current clinical, pathological and genetic knowledge of the disease. In addition, each template contains representative clinical photographs as well as light and electron microscopic images and, if available, confocal microscopic and coherence tomographic images of the respective CD. After the first edition was published in 2008, the revised version followed in 2015. The third edition of the IC3D was published as open access in February 2024. The latest edition is intended to serve as a reference work in everyday clinical practice and facilitate the diagnosis of CD, which might sometimes be difficult. This article provides an overview of the diagnostic and treatment principles of CD and presents the IC3D and its changes over time.

An Eye into the Aorta: The Role of Extracellular Matrix Regulatory Genes ZNF469 and PRDM5, from Their Previous Association with Brittle Cornea Syndrome to Their Novel Association with Aortic and Arterial Aneurysmal Diseases.

The extracellular matrix is a complex network of proteins and other molecules that are essential for the support, integrity, and structure of cells and tissues within the human body. The genes ZNF469 and PRDM5 each produce extracellular-matrix-related proteins that, when mutated, have been shown to result in the development of brittle cornea syndrome. This dysfunction results from aberrant protein function resulting in extracellular matrix disruption. Our group recently identified and published the first known associations between variants in these genes and aortic/arterial aneurysms and dissection diseases. This paper delineates the proposed effects of mutated ZNF469 and PRDM5 on various essential extracellular matrix components, including various collagens, TGF-B, clusterin, thrombospondin, and HAPLN-1, and reviews our recent reports associating single-nucleotide variants to these genes' development of aneurysmal and dissection diseases.

Iridocorneal Endothealial Syndrome. Case Reports.

AIM: Iridocorneal endothelial (ICE) syndrome is a rare disease characterized by abnormal proliferation and structural changes of the endothelium, obliteration of the iridocorneal angle, and anomalies of the iris. The consequence of these changes is secondary glaucoma and corneal decompensation. The etiology is unclear, and the syndrome more commonly affects middle-aged women. CASE REPORTS: In this article we present two different case studies of young patients diagnosed with ICE syndrome with complications. The first case report is about a young woman in whom surgical treatment of glaucoma and corneal edema was successful. On the other hand, the second report presents a complicated case of a 29-year-old patient whose treatment was not successful despite repeated interventions. CONCLUSION: This text highlights the complexity of ICE syndrome, the difficulty of its therapy and the importance of early diagnosis.

Recent advances in corneal neovascularization imaging.

Corneal neovascularization (CoNV) is a vision-threatening ocular disease commonly secondary to infectious, inflammatory, and traumatic etiologies. Slit lamp photography, in vivo confocal microscopy, angiography, and optical coherence tomography angiography (OCTA) are the primary diagnostic tools utilized in clinical practice to evaluate the vasculature of the ocular surface. However, there is currently a dearth of comprehensive literature that reviews the advancements in imaging technology for CoNV administration. Initially designed for retinal vascular imaging, OCTA has now been expanded to the anterior segment and has shown promising potential for imaging the conjunctiva, cornea, and iris. This expansion allows for the quantitative monitoring of the structural and functional changes associated with CoNV. In this review, we emphasize the impact of algorithm optimization in anterior segment-optical coherence tomography angiography (AS-OCTA) on the diagnostic efficacy of CoNV. Through the analysis of existing literature, animal model assessments are further reported to investigate its pathological mechanism and exhibit remarkable therapeutic interventions. In conclusion, AS-OCTA holds broad prospects and extensive potential for clinical diagnostics and research applications in CoNV.

Systemic treatment and surgical intervention in inflammatory Terrien disease.

This case report presents a unique instance of a 55-year-old male patient exhibiting features of both Terrien marginal degeneration (TMD) and Fuchs' superficial marginal keratitis. Characterized by peripheral corneal thinning vascularization, and a pseudopterygium, the patient experienced recurrent photophobia, redness, and tearing over 15 years. This case challenges the traditional distinction between TMD and Fuchs' superficial marginal keratitis, suggesting a potential common underlying disorder. Mycophenolate mofetil provided a partial response, while pseudopterygium removal led to sustained remission, emphasizing its therapeutic significance. This case highlights the first documented use of mycophenolate in TMD and supports the notion of shared vasculitic origins between TMD and Fuchs' keratitis, raising intriguing questions about targeted therapeutic interventions.

El trasplante de córnea en Villa Clara: diez años transcurridos de la primera intervención quirúrgica / Corneal transplantation in Villa Clara: after ten years the first surgical intervention

Introducción: La córnea constituye el elemento más importante del sistema óptico, al ser el primer medio transparente del ojo; tiene la finalidad de mejorar la calidad de la imagen que se forma en la retina, por lo que su transparencia es imprescindible para poder obtener una buena agudeza visual. Cuando sus capas están afectadas por diferentes enfermedades, se requiere sustituir este tejido dañado; este procedimiento, denominado trasplante de córnea o queratoplastia, tiene diferentes finalidades. Objetivo: Caracterizar los resultados de la cirugía de trasplante de córnea tras diez años del primer procedimiento quirúrgico en la provincia de Villa Clara. Métodos: Se realizó un estudio observacional descriptivo longitudinal retrospectivo, con una muestra de 204 pacientes operados de trasplante de córnea en el Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» de Villa Clara, en el período comprendido entre 2008 y 2018. Las variables estudiadas fueron: sexo, finalidad del procedimiento, diagnóstico y complicaciones. Resultados: Predominó el sexo masculino (53,4 %); la finalidad más frecuente del trasplante tuvo fines ópticos (85,8 %); principal diagnóstico: la queratopatía bullosa (42,7 %); dentro de las complicaciones más frecuentes estuvieron: el rechazo al injerto, el defecto epitelial y el glaucoma secundario. Conclusiones: La cirugía de trasplante de córnea en la provincia de Villa Clara significa un gran avance en el desarrollo y perfeccionamiento para el tratamiento de múltiples afecciones corneales. Los diagnósticos más frecuentes fueron: la queratopatía bullosa y las opacidades corneales; las complicaciones más frecuentes, el rechazo al injerto, la aparición de defectos epiteliales y el glaucoma secundario.

Introduction: the cornea constitutes the most important element of the optical system, being the first transparent medium of the eye; its purpose is to improve the quality of the image that is formed on the retina, so its transparency is essential to obtain good visual acuity. When its layers are affected by different diseases, it is required to replace this damaged tissue; this procedure called cornea transplant or keratoplasty has different purposes. Objective: to characterize the results of corneal transplant surgery ten years after the first surgical procedure in Villa Clara province. Methods: a retrospective, longitudinal, descriptive and observational study was carried out with a sample of 204 patients who underwent corneal transplant surgery at "Arnaldo Milián Castro" Clinical and Surgical University Hospital in Villa Clara between 2008 and 2018. Age, purpose of the procedure, diagnosis and complications were the variables studied. Results: male gender predominated (53.4%); the most frequent purpose of the transplant was for optical purposes (85.8%); bullous keratopathy (42.7%) was the main diagnosis as well as, graft rejection, epithelial defect and secondary glaucoma were among the most frequent complications. Conclusions: corneal transplant surgery in Villa Clara province means a great advance in the development and improvement for the treatment of multiple corneal conditions. The most frequent diagnoses were bullous keratopathy and corneal opacities; graft rejection, the appearance of epithelial defects and secondary glaucoma were the most frequent complications.

The application of high-throughput sequencing technology in corneal diseases.

High-throughput sequencing technology, also known as next-generation sequencing technology, can explore new biomarkers and specific gene mutations. It has a pivotal role in promoting the gene research, which can limit the detection area, lessen the time needed for sequencing. Also, it can quickly screen out the suspected pathogenic genes of patients, gain the necessary genetic data, and provide the basis for clinical diagnosis and genetic counseling. In the research of corneal diseases, through the DNA sequencing of patients' diseased cells, it can provide a deeper understanding of corneal diseases and improve the diagnosis, classification and treatment alternatives of various corneal diseases. This article will introduce the application progress of high-throughput sequencing technology in corneal diseases, which will help to understand the application of this technology in various corneal diseases.

Unveiling the Web: Exploring the Multifaceted Role of Neutrophil Extracellular Traps in Ocular Health and Disease.

Neutrophil extracellular traps (NETs) play an essential role in antimicrobial defense. However, NETs have also been shown to promote and mediate a wide spectrum of diseases, including cancer, diabetes mellitus, cardiovascular diseases, and ocular diseases. Data regarding NETs in ocular diseases remain limited. In physiological conditions, NETs protect the eye from debris and cleave proinflammatory cytokines, including several interleukins. On the other hand, NETs play a role in corneal diseases, such as dry eye disease and ocular graft-versus-host disease, where they promote acinar atrophy and delayed wound healing. Additionally, NET levels positively correlate with increased severity of uveitis. NETs have also been described in the context of diabetic retinopathy. Although increased NET biomarkers are associated with an increased risk of the disease, NETs also assist in the elimination of pathological blood vessels and the regeneration of normal vessels. Targeting NET pathways for the treatment of ocular diseases has shown promising outcomes; however, more studies are still needed in this regard. In this article, we summarize the literature on the protective roles of NETs in the eye. Then, we describe their pathogenetic effects in ocular diseases, including those of the cornea, uvea, and retinal blood vessels. Finally, we describe the therapeutic implications of targeting NETs in such conditions.

The Role of Rho Kinase Inhibitors in Corneal Diseases.

The cornea, as the outermost layer of the eye, plays a crucial role in vision by focusing light onto the retina. Various diseases and injuries can compromise its clarity, leading to impaired vision. This review aims to provide a thorough overview of the pharmacological properties, therapeutic potential and associated risks of Rho-associated protein kinase (ROCK) inhibitors in the management of corneal diseases. The article focuses on four key ROCK inhibitors: Y-27632, fasudil, ripasudil, and netarsudil, providing a comparative examination. Studies supporting the use of ROCK inhibitors highlight their efficacy across diverse corneal conditions. In Fuchs' endothelial corneal dystrophy, studies on the application of Y-27632, ripasudil, and netarsudil demonstrated noteworthy enhancements in corneal clarity, endothelial cell density, and visual acuity. In pseudophakic bullous keratopathy, the injection of Y-27632 together with cultured corneal endothelial cells into the anterior chamber lead to enhanced corneal endothelial cell density and improved visual acuity. Animal models simulating chemical injury to the cornea showed a reduction of neovascularization and epithelial defects after application of fasudil and in a case of iridocorneal endothelial syndrome netarsudil improved corneal edema. Addressing safety considerations, netarsudil and ripasudil, both clinically approved, exhibit adverse events such as conjunctival hyperemia, conjunctival hemorrhage, cornea verticillata, conjunctivitis, and blepharitis. Monitoring patients during treatment becomes crucial to balancing the potential therapeutic benefits with these associated risks. In conclusion, ROCK inhibitors, particularly netarsudil and ripasudil, offer promise in managing corneal diseases. The comparative analysis of their pharmacological properties and studies supporting their efficacy underscore their potential therapeutic significance. However, ongoing research is paramount to comprehensively understand their safety profiles and long-term outcomes in diverse corneal conditions, guiding their optimal application in clinical practice.

Descemet's membrane endothelial keratoplasty for primary graft failure after penetrating keratoplasty / Transplante endotelial de membrana de Descemet para falência primária após transplante penetrante

ABSTRACT Primary graft failure (PGF) is a known complication following penetrating keratoplasty (PKP). The usual approach to treat this complication is to repeat a penetrating keratoplasty. Here, we report a case of Descemet's membrane endothelial keratoplasty (DMEK) for the treatment of PGF after PKP. A patient that underwent PKP, developed PGF with persistent graft edema and very poor visual acuity despite aggressive steroid use and a proof anti-viral treatment. Three months after the initial surgery, a DMEK was performed under the PKP graft. There was progressive early corneal clearing and, by the end of the first month, the patient already had no corneal edema. Uncorrected visual acuity (UCVA) improved to 20/40 and best corrected visual acuity (BCVA) to 20/20. DMEK may be an alternative to a second PKP for the treatment of PGF. This technique is a less invasive option when compared to the standard PKP procedure.

RESUMO A falência primária do enxerto é uma complicação conhecida que pode ocorrer após o transplante penetrante de córnea. O tratamento usual dessa complicação é com um novo transplante penetrante. Apresentamos um caso em que foi usado o transplante endotelial de membrana de Descemet (DMEK - do inglês Descemet membrane endo-thelial keratoplasty) para o tratamento da falência primária após o transplante penetrante. Uma paciente submetida a transplante penetrante evoluiu com falência primária do enxerto a despeito do uso intenso de corticoide tópico e uma prova terapêutica de antivirais. Três meses após a cirurgia inicial, foi optado pela realização do transplante endotelial de membrana de Descemet sob o transplante penetrante. Houve um clareamento precoce e progressivo do enxerto com melhora importante da visão. Após um mês, a visão sem correção era de 20/40 melhorando para 20/20 com refração. O transplante endotelial de membrana de Descemet pode ser uma alternativa a um novo transplante penetrante como tratamento da falência primária.

Deep anterior lamellar keratoplasty versus penetrating keratoplasty: comparison of clinical outcomes in contralateral eyes / Ceratoplastia lamelar anterior profunda versus ceratoplastia penetrante: comparação dos resultados clínicos em olhos contralaterais

ABSTRACT Purpose: This study aimed to compare the clinical outcomes following deep anterior lamellar keratoplasty and penetrating keratoplasty in contralateral eyes of the same patients. Methods: In this retrospective, comparative case series, clinical outcome data included best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, endothelial cell density, endothelial cell loss, central corneal thickness, and intraocular pressure, which were evaluated at 6, 12, 24, and 36 months after deep anterior lamellar keratoplasty and penetrating keratoplasty. Additionally, complications were assessed. Results: Fifty-two eyes (26 patients) were included, of which 19 patients had keratoconus, 6 had stromal dystrophy, and 1 had post-laser-assisted in situ keratomileusis ectasia. The mean follow-up was 44.1 ± 10.5 months in the deep anterior lamellar keratoplasty Group and 47.9 ± 11.9 months in the penetrating keratoplasty Group. No significant differences were observed in the mean best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, and central corneal thickness between the deep anterior lamellar keratoplasty and penetrating keratoplasty Groups during follow-up. The endothelial cell density was significantly higher in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.022 and 0.013, respectively). Endothelial cell loss was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.025 and 0.001, respectively). Intraocular pressure was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Grroup at 6 months postoperatively (p=0.015). Microperforation occurred in 4 eyes (15%) during deep anterior lamellar keratoplasty surgery; however, penetrating keratoplasty was not required. No endothelial rejection occurred in the penetrating keratoplasty Group during follow-up. Conclusions: Over the 3-year follow-up, endothelial cell loss and intraocular pressure in the deep anterior lamellar keratoplasty Group were significantly lower than those in the penetrating keratoplasty Group, while visual and refractive results were similar.

RESUMO Objetivo: Este estudo teve como objetivo comparar os resultados clínicos após ceratoplastia lamelar anterior profunda e ceratoplastia penetrante nos olhos contralaterais dos mesmos pacientes. Métodos: Nesta série de casos comparativa e retrospectiva, avaliaram-se os seguintes dados de resultados clínicos: melhor acuidade visual corrigida, equivalente esférico refrativo, astigmatismo refrativo, densidade de células endoteliais, perda de células endoteliais, espessura central da córnea e pressão intraocular. Esses dados foram avaliados aos 6, 12, 24 e 36 meses após ceratoplastia lamelar anterior profunda e ceratoplastia penetrante. Também foram avaliadas as complicações. Resultados: Foram incluídos 52 olhos (26 pacientes), sendo que 19 pacientes apresentavam ceratocone, 6 apresentavam distrofia estromal e 1 apresentava ectasia após ceratomileuse in situ assistida por laser. O tempo médio de acompanhamento foi de 44,1 ± 10,5 meses no grupo da ceratoplastia lamelar anterior profunda e 47,9 ± 11,9 meses no grupo da ceratoplastia penetrante. Nenhuma diferença significativa foi observada nas médias da melhor acuidade visual corrigida, equivalente esférico refrativo, astigmatismo refrativo e espessura central da córnea entre os grupos da ceratoplastia lamelar anterior profunda e da ceratoplastia penetrante durante o acompanhamento. A densidade de células endoteliais foi significativamente maior no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 24 e 36 meses de pós-operatório (p=0,022 e 0,013, respectivamente). A perda de células endoteliais foi significativamente menor no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 24 e 36 meses de pós-operatório (p=0,025 e 0,001, respectivamente). A pressão intraocular foi significativamente menor no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 6 meses de pós-operatório (p=0,015). Ocorreu microperfuração em 4 olhos (15%) durante a cirurgia de ceratoplastia lamelar anterior profunda; entretanto, a ceratoplastia penetrante não foi necessária. Não ocorreu nenhuma rejeição endotelial no grupo da ceratoplastia penetrante durante o período de acompanhamento. Conclusões: Durante o acompanhamento de 3 anos, a perda de células endoteliais e a pressão intraocular foram significativamente menores no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante, mas os resultados visuais e refrativos foram semelhantes.

Masquerade syndrome in ocular surface squamous neoplasia / Síndrome mascarada em neoplasia escamosa da superfície ocular

ABSTRACT The aim of this study was to alert the ophthalmic community to an atypical manifestation of ocular surface squamous neoplasia, which may delay diagnosis and treatment and result in a guarded visual prognosis and significant sequelae. A 61-year-old immunocompetent man presented with an initial diagnosis of necrotizing scleritis in the right eye for 3 months. He was treated with systemic prednisone but experienced persistent pain and low visual acuity. Conjunctival biopsy of the affected region confirmed the diagnosis of invasive ocular surface squamous neoplasia, which progressed with intraocular and orbital invasion; thus, exenteration was performed. Masquerade syndrome should be suspected in patients with nodulo-ulcerative lesions of the conjunctiva and sclera. This clinical can be more aggressive, with a greater likelihood of intraocular and orbital involvement. The earlier the diagnosis and treatment, the better the patient prognosis.

RESUMO O objetivo é alertar a comunidade oftalmológica sobre uma manifestação atípica de neoplasia escamosa da superfície ocular (OSSN) que pode levar a um atraso no diagnóstico e tratamento, evoluindo com prognóstico reservado e significativas sequelas. Homem, imunocompetente, 61 anos com diagnóstico inicial de esclerite necrosante em olho direito há 3 meses, em tratamento com prednisona sistêmica porém com persistência da dor e baixa acuidade visual. Realizado biópsia conjuntival em região acometida e diagnosticado como neoplasia escamosa da superfície ocular invasiva. Evolui com invasão intraocular e orbital sendo submetido a exenteração. Assim sendo, deve-se suspeitar de síndrome mascarada frente a um paciente com lesões nódulo-ulcerativas da conjuntiva e esclera. Essa forma clínica pode ser mais agressiva, com maior chance de comprometimento intraocular e orbital. Quanto mais precoces o diagnóstico e o tratamento, melhor o prognóstico para o paciente.

Clinical outcomes of epithelial ingrowth following laser in situ keratomileusis with mechanical debridement and compressed heating air flow: a case series / Resultado visual do tratamento do crescimento epitelial após laser in situ ceratomileuse através da remoção mecânica e aplicação de ar comprimido aquecido: série de casos

ABSTRACT Purpose: To describe the clinical outcomes of manual scraping of epithelial ingrowth followed by compressed heating air flow after laser in situ keratomileusis (LASIK). Methods: We underwent a retrospective, noncomparative, and interventional case series. Twenty eyes of 17 patients were included in this study. Each patient with a history of LASIK underwent epithelial removal with mechanical debridement followed by compressed heating air flow. Our primary outcome was the recurrence of epithelial ingrowth after 3 months of follow-up, while our secondary outcomes were uncorrected distance visual acuity, corrected distance visual acuity, and complications after surgery. Results: Ten patients (58.8%) were male, and eight eyes of seven (41.2%) patients underwent primary LASIK surgery, while12 eyes of 10 patients had flap-lift retreatment LASIK; sixteen eyes (80.0%) underwent mechanical microkeratome LASIK and four (20.0%) underwent femtosecond laser-assisted LASIK. Mean age at surgical removal of epithelial ingrowth was 37.0 years ± 9.3 years (range 24 to 55 years). There was recurrence of ingrowth in two eyes (10%) after 3 months of follow-up. The mean corrected distance visual acuity of patients before surgery was 0.07 ± 0.09 logMAR, and after the last follow-up was 0.02 ± 0.04 logMAR (p=0.06). The odds ratio of presenting with epithelial ingrowth after LASIK enhancement compared to primary LASIK was 29.41. Conclusion: Manual scraping followed by compressed heating air flow is a safe and effective treatment of clinically significant epithelial ingrowth after LASIK. At the last follow-up, no eye lost any line in corrected distance visual acuity.

RESUMO Objetivo: Descrever os resultados clínicos do tratamento do crescimento epitelial através da técnica de remoção manual seguido da utilização de um compressor de ar comprimido aquecido após a cirurgia de laser in situ keratomileusis (LASIK). Métodos: Vinte olhos de 17 pacientes foram incluídos no estudo. Cada paciente havia sido submetido a cirurgia de LASIK com presença de crescimento epitelial e foi submetido a tratamento cirúrgico para sua retirada. O objetivo primário foi identificar a presença de crescimento epitelial recorrente ao final de 3 meses de seguimento. Os objetivos secundários foram as medidas de acuidade visual sem correção, acuidade visual com correção, e complicações pós-operatórias. Resultados: Dez pacientes (58,8%) eram homens e 7 mulheres. Oito olhos de sete (41,2%) pacientes apresentavam cirurgia de LASIK primária e 12 olhos de 10 pacientes tinham cirurgia de LASIK com retratamento; dezesseis olhos (80%) utilizaram microcerátomo manual e quatro (20%) laser de femtosegundo. A média de idade no momento da cirurgia de remoção do epitélio era de 37,0 anos ± 9,3 (DP) (variando de 24 a 55 anos). Ocorreu recidiva do crescimento epithelial em dois olhos (10%) após 3 meses de seguimento. A acuidade visual sem correção antes da cirurgia era de 0,07 ± 0,09 logMAR, e após a cirurgia passou para 0,02 ± 0,04 logMAR (p=0,06). A chance (odds ration) de aparecimento do crescimento epithelial após uma reoperação de LASIK é 29,41 vezes maior do que no LASIK primário. Conclusão: A técnica de remoção epitelial manual seguida da utilização de ar comprimido aquecido é segura e efetiva no tratamento do crescimento epitelial após LASIK. Ao final do último acompanhamento, nenhum olho apresentou perda de linhas de visão.

Analysis of ocular surface and quality of life in patients with corneal and conjunctival tumors / Análise da superfície ocular e qualidade de vida em pacientes com tumores córneo-conjuntivais

ABSTRACT Purpose: To evaluate the impact of corneal and conjunctival tumors on the ocular surface and quality of life of patients before and after surgical treatment. Methods: This prospective study conducted a preoperative and 30- and 90-day postoperative assessment of patients diagnosed with conjunctival and corneal tumors. Demographic data were collected preoperatively. The 12-Item Short-Form Health Survey (SF-12) and Ocular Surface Disease Index (OSDI) questionnaires were applied to assess patients' quality of life and perception of their vision-related functions. The tear breakup time and Schirmer tests were performed for ocular surface evaluation. The tumor extensions were measured using ImageJ image analysis software. Results: Twenty-three patients were enrolled. The mean age at examination was 52.8 ± 17.3 years (range: 27-9 years). The most common tumor type was squamous cell carcinoma (61.5%). The patients' visual acuity improved significantly at 1 month and 3 months (p=0.018 and p=0.036, respectively). No significant differences were found between tear breakup time and Schirmer tests preoperatively and at 3 months postoperatively (p=0.150 and p=0.490, respectively). The SF-12 scores demonstrated significant differences between the preoperative and 30- and 90-day postoperative mental components (p=0.008 and p=0.026, respectively). Tumor extension was 868.7 ± 344.9 pixels (range, 224.6-1481.6 pixels) and were significantly correlated with the preoperative (p=0.011), 30-day postoperative (p=0.017), and 90-day postoperative (p=0.012) SF-12 mental components, as well as the emotional component at the 30th postoperative day (p=0.016). Conclusion: Patients with corneal and conjunctival tumors improved their ocular symptoms, visual acuity, and the emotional component of their quality of life after surgical excision of the tumor.

RESUMO Objetivo: Avaliar o impacto dos tumores cór­neo-conjuntivais na superfície ocular e na qualidade de vida dos pacientes antes e após o tratamento cirúrgico. Métodos: Este estudo prospectivo conduziu uma avaliação pré-operatória e com 30 e 90 dias de pós-operatório de pacientes com diagnóstico de tumores de córnea e conjuntiva. Os dados demográficos foram coletados no pré-operatório. Os questionários Health Survey Short-Form (SF-12) e Ocular Surface Disease Index (OSDI) foram aplicados para avaliar a qualidade de vida dos pacientes e a percepção de suas funções relacionadas à visão. Os testes tear break-up time (TBUT) e Schirmer foram realizados para avaliação da superfície ocular. A extensão do tumor foi medida usando o programa ImageJ. Resultados: Vinte e três pacientes foram incluídos. A média de idade foi de 52,8 ± 17,3 anos (27-79 anos). O tipo mais comum de tumor foi o carcinoma de células escamosas (61,5%). A acuidade visual dos pacientes melhorou significativamente em 1 mês e 3 meses (p=0,018 e p=0,036, respectivamente). Não houve diferenças significativas entre os testes tear break-up time e Schirmer no pré-operatório e com 3 meses de pós-operatório (p=0,150 e p=0,490, respectivamente). Os escores do SF-12 demonstraram que o componente mental apresentou diferença estatisticamente significante entre o pré-operatório e no 30 e 90 dias de pós-operatório (p=0,008 e p=0,026, respectivamente). A extensão do tumor foi de 868,7 ± 344,9 pixels (intervalo, 224,6-1481,6 pixels) e foram significativamente correlacionados com o componente mental de SF-12 no pré-operatório (p=0,011), 30 (p=0,017) e 90 dias de pós-operatório (p=0,012), e o componente emocional no 30º dia de pós-operatório (p=0,016). Conclusão: Pacientes com tumores córneo-conjuntivais melhoraram os sintomas oculares, a acuidade visual e o componente emocional da qualidade de vida após a excisão cirúrgica do tumor.

Incidência de lesão de córnea em terapia intensiva: um estudo de coorte / Incidencia de lesión en la córnea en terapia intensiva: un estudio de cohorte / Incidence of corneal injury in intensive care: a cohort study

Resumo Objetivo Identificar a incidência de lesão de córnea em pacientes internados na unidade de terapia intensiva e associar os principais fatores de risco com a ocorrência de lesão de córnea em pacientes internados na unidade de terapia intensiva. Métodos Estudo de coorte prospectivo, no qual foram incluídos 40 pacientes internados na unidade de terapia intensiva, no período de dezembro de 2019 a fevereiro de 2020. A análise de dados ocorreu de forma descritiva e inferencial, por testes estatísticos e medidas de efeito. Resultados A amostra foi composta por 40 pacientes. A lesão de córnea se desenvolveu em 20% (n=8) dos participantes e está significativamente associada aos seguintes fatores: tempo de internação de dois a sete dias (70%; n=28), Glasgow < 13 (50%; n=7), uso de sedativo (33,3%; n=8),uso de broncodilatador (36,8%; n=7), uso de Traqueostomia (TQT) (50%; n=6) e Ventilação Mecânica Invasiva (VMI) (58,3%; n=7), o piscar menos de cinco vezes (61,5%; n=8), o fechamento parcial da pálpebra(38,9%;n=7), a hiperemia (34,8%; n=8), o edema palpebral(41,2%; n=7), o edema conjuntival (50%; n=7) e o ressecamento(50%; n=5). Conclusão O paciente internado em unidade de terapia intensiva está exposto a diversos fatores de risco para o desenvolvimento de lesão na córnea, com destaque para ventilação mecânica e Glasgow menor que 13 sendo necessária a implementação de medidas profiláticas para lesão de córnea, mediante o controle e mitigação dos fatores de risco e exposição do paciente.

Resumen Objetivo Identificar la incidencia de lesión en la córnea en pacientes internados en una unidad de cuidados intensivos y asociar los principales factores de riesgo con los episodios de lesión de córnea en pacientes internados en una unidad de cuidados intensivos. Métodos Estudio de cohorte prospectivo, en el que se incluyeron 40 pacientes internados en una unidad de cuidados intensivos, en el período de diciembre de 2019 a febrero de 2020. El análisis de los datos se realizó de forma descriptiva e inferencial, mediante pruebas estadísticas y medidas de efecto. Resultados La muestra estuvo compuesta por 40 pacientes. La lesión en la córnea se presentó en el 20 % (n=8) de los participantes y está significativamente asociada a los siguientes factores: tiempo de internación de dos a siete días (70 %; n=28), Glasgow < 13 (50 %; n=7), uso de sedante (33,3 %; n=8), uso de broncodilatador (36,8 %; n=7), uso de traqueotomía (TQT) (50 %; n=6) y ventilación mecánica invasiva (VMI) (58,3 %; n=7), parpadear menos de cinco veces (61,5 %; n=8), cierre parcial del párpado (38,9 %; n=7), hiperemia (34,8 %; n=8), edema palpebral (41,2 %; n=7), edema conjuntival (50 %; n=7) y resecamiento (50 %; n=5). Conclusión Los pacientes internados en una unidad de cuidados intensivos están expuestos a diversos factores de riesgo para contraer lesión en la córnea, con énfasis en la ventilación mecánica y Glasgow menor a 13, para lo cual es necesario implementar medidas profilácticas para lesión en la córnea mediante el control y mitigación de los factores de riesgo y exposición de los pacientes.

Abstract Objective To identify the incidence of corneal injury in patients hospitalized in the Intensive Care Unit and associate the main risk factors with the occurrence of corneal injury in patients hospitalized in the Intensive Care Unit. Methods This is a prospective cohort study, in which 40 patients admitted to the Intensive Care Unit were included, from December 2019 to February 2020. Data analysis was descriptive and inferential, using statistical tests and effect measures. Results The sample consisted of 40 patients. Corneal injury developed in 20% (n=8) of participants and is significantly associated with the following factors: length of stay from two to seven days (70%; n=28), Glasgow < 13 (50%; n= 7), use of sedatives (33.3%; n=8), use of bronchodilators (36.8%; n=7), use of tracheostomy (TCT) (50%; n=6) and invasive mechanical ventilation (IMV) (58.3%; n=7), blinking less than five times (61.5%; n=8), partial eyelid closure (38.9%; n=7), hyperemia (34.8%; n=8), eyelid edema (41.2%; n=7), conjunctival edema (50%; n=7) and dryness (50%; n=5). Conclusion Patients admitted to the Intensive Care Unit are exposed to several risk factors for developing corneal injury, with emphasis on mechanical ventilation and Glasgow less than 13, requiring the implementation of prophylactic measures for corneal injury, through the control and mitigation of risk factors and patient exposure.

Belin/Ambrósio Enhanced Ectasia Display in cataract surgery and relation to final visual acuity / Belin/Ambrósio Enhanced Ectasia Display na cirurgia de catarata e sua relação com a acuidade visual final

ABSTRACT Objective To analyze and describe the coefficients found on maximum Ambrósio Relational Thickness-Maximum (ART-Max) and Belin/Ambrósio Enhanced Ectasia Display total deviation (BAD-D) in eyes with normal corneal topography subjected to cataract surgery with premium intraocular lens implantation and correlated these data with final visual acuity. Methods ART-Max and BAD-D data from 103 eyes of patients subjected to implantation of diffractive bifocal intraocular lens, with normal corneal topography who achieved visual acuity of 20/20 or 20/25 without correction after cataract surgery were analyzed. The groups with normal and abnormal values were compared using the chi-square test. Results Thirty-two (31.1%) and 71 (68.9%) eyes presented normal and abnormal ART-Max values, respectively. The difference between these groups was significant (p=0.0002). Fifty-five (53.4%) and 48 (46.6%) eyes had normal and abnormal BAD-D, respectively, and intergroup difference was not significant (p=0.9576). Conclusion Among patients with normal corneal topography who underwent premium intraocular and had good final visual acuity of 20/20 or 20/25, suspicious or abnormal indices of ART-Max and BAD-D were frequent, providing evidence that it possibly should not be a contraindication.

RESUMO Objetivo Analisar e descrever os coeficientes numéricos encontrados nos exames Ambrósio Relational Thickness-Maximum (ART-Max) e desvio total do Belin/Ambrósio Enhanced Ectasia Display (BAD-D) em olhos com topografia normal submetidos ao implante de lente intraocular premium na cirurgia de catarata, correlacionando-os com a acuidade visual final pós-operatória. Métodos Foram analisados os resultados de ART-Max e BAD-D de 103 olhos de pacientes submetidos ao implante de lentes bifocais difrativas, que apresentavam exame topográficos normal e alcançaram acuidade visual 20/20 ou 20/25 sem correção visual no pós-operatório final. Para a análise estatística entre os grupos normais e anormais ou suspeitos, utilizou-se o teste do qui-quadrado. Resultados Foram encontrados 32 (31,1%) olhos com ART-Max normal e 71 (68,9%) com ART-Max suspeito/anormal. A diferença entre os grupos foi significativa (p=0,0002). Quanto ao BAD-D, foram encontrados 55 (53,4%) olhos com resultados normais e 48 (46,6%) com resultados suspeitos/anormais. A diferença entre os grupos não foi significativa (p=0,9576). Conclusão Entre os pacientes com topografia normal submetidos ao implante de lentes premium e que alcançaram acuidade visual 20/20 ou 20/25, os índices suspeitos ou anormais de ART-Max e BAD-D eram frequentes, não se configurando em contraindicação para a realização do implante.

Epidemiology of corneal transplantation before achieving the Zero Queue / Epidemiologia do transplante de córnea antes de atingir a Fila Zero

ABSTRACT Objective: To outline the epidemiological profile of cornea donors and recipients before reaching queue zero. Methods: Epidemiological study, of quantitative approach, with transversal, analytical design, analyzing database records from the Health Secretary of the State of Ceará, from 2013 to 2015. Results: We obtained 1,558 cornea donors and 2,287 cornea recipients from 2013 to 2015. Most donors were male, capital residents, from 21 to 40 years old. Of donated eyeballs, 14.52% were disposed, due to poor condition, infiltration or positive serology. The recipients were predominantly women over 60 years old. The procedures were mostly elective, due to bullous keratopathy (28%). Regarding emergency transplants, ulcer (38.51%) and retransplant (35.14%) were most prevalent. Predominantly, transplants were funded by the Unified Health System. Conclusion: The majority of patients who were submitted to corneal transplantation are senile, especially females, therefore should be cautiously observed. On the other hand, donors are mainly male and young, reflecting the high number of tragic accidents. The surgery for bullous keratopathy is the most frequent among elective transplants, while the ulcer surgery is the main cause of emergency procedures. The fact that most surgeries were financed by the Unified Health System reflects the importance of this system.

RESUMO Objetivo: Traçar o perfil epidemiológico dos doadores e receptores de córnea antes de atingir a Fila Zero. Métodos: Estudo epidemiológico, de abordagem quantitativa, com delineamento transversal e analítico, analisando registros da base de dados da Secretaria de Saúde do Estado do Ceará, de 2013 a 2015. Resultados: Foram obtidos 1.558 doadores de córnea e 2.287 receptores de córnea, de 2013 a 2015. A maioria dos doadores era homem, procedente da capital, de 21 a 40 anos. Dentre os globos oculares doados, 14,52% foram descartados por má condição, infiltração ou sorologia positiva. Os receptores eram predominantemente mulheres acima de 60 anos de idade. Os procedimentos foram majoritariamente eletivos, devido à ceratopatia bolhosa (28%). Já para transplantes de emergência, a úlcera (38,51%) e o retransplante (35,14%) foram os mais prevalentes. Em geral, os transplantes foram custeados pelo Sistema Único de Saúde. Conclusão: A maioria dos pacientes submetidos a transplantes de córnea foram do grupo etário senil, principalmente do sexo feminino, devendo esse grupo ser observado com cautela. Em contrapartida, os doadores eram, principalmente, homens e jovens, refletindo o alto número de pessoas que morrem devido a acidentes trágicos. A cirurgia de ceratopatia bolhosa foi a mais frequente dentre os transplantes eletivos; já a de úlcera foi a principal causa dos procedimentos de emergência. O fato de a maioria das cirurgias ter sido financiada pelo Sistema Único de Saúde reflete a importância desse sistema.

Corneal crosslinking efficacy in patients with keratoconus under 18 years of age / Eficácia do crosslinking corneano em portadores de ceratocone com idade inferior a 18 anos

ABSTRACT Purpose: Keratoconus presents certain specificities in pediatric patients compared with adults. The greatest challenge is because the disease is typically more severe and progresses faster in children. This retrospective study aimed to report crosslinking procedure in patients under 18 years of age and their follow-up for at least 24 months after the procedure. Methods: Overall, 12 eyes from 10 patients were studied and data, such as visual acuity with and without correction, maximum keratometry, corneal thickness, foveal thickness, and endothelial microscopy, were assessed at both preoperative and postoperative visits. Corneal crosslinking was performed in all patients. Results: A tendency toward reduced Kmax and improved Corrected Distance Visual Acuity at all postoperative moments. Only one of the 12 eyes exhibited increased Kmax of more than 1 D during a time frame longer than 12 months. Regarding pachymetry, a tendency for corneal thinning was observed in the first four months after surgery. Conclusion: Encouraging results were obtained regarding the stabilization of the disease, progression, and procedural safety, corroborating to other authors' findings. The significance of early diagnosis and short-term follow-up were highlighted.

RESUMO Objetivo: O ceratocone na população pediátrica apresenta algumas particularidades em relação à população adulta. O maior desafio é devido à doença ser geralmente mais severa e rapidamente progressiva em crianças. Métodos: Este artigo utiliza uma análise retrospectiva para relatar o uso do crosslinking em jovens menores de 18 anos e sua evolução pelo menos 24 meses após o procedimento. Foram estudados 12 olhos de 10 pacientes, e dados como acuidade visual com e sem correção, ceratometria máxima, espessura corneana, espessura foveal e microscopia endotelial avaliados no pré e pós-operatórios. O crosslinking corneano foi realizado em todos os pacientes pelo mesmo cirurgião. Resultados: Observou-se uma tendência de redução do valor do Kmax e melhora da acuidade visual corrigida em todos os momentos de pós operatório. Com relação à paquimetria, observou-se afinamento corneano do ponto mais fino, nos primeiros quatro meses de pós-operatório. Conclusão: Resultados encorajadores foram obtidos com relação à estabilização da doença, progressão e segurança do procedimento, corroborando com as conclusões de outros autores. A importância do diagnóstico precoce e do acompanhamento a curto prazo do paciente deve ser destacada.

Limitations and advances in new treatments and future perspectives of corneal blindness / Limitações e avanços em novos tratamentos e perspectivas futuras na cegueira corneal

ABSTRACT This review is intended to describe the therapeutic approaches for corneal blindness, detailing the steps and elements involved in corneal wound healing. It also presents the limitations of the actual surgical and pharmacological strategies used to restore and maintain corneal transparency in terms of long-term survival and geographic coverage. In addition, we critically review the perspectives of anabolic agents, including vitamin A, hormones, growth factors, and novel promitotic and anti-inflammatory modulators, to assist corneal wound healing. We discuss the studies involving nanotechnology, gene therapy, and tissue reengineering as potential future strategies to work solely or in combination with corneal surgery to prevent or revert corneal blindness.(AU)

RESUMO O presente trabalho traz uma revisão das abordagens terapêuticas para a cegueira da córnea. O estudo detalha as etapas e os elementos envolvidos na cicatrização da córnea. Ele mostra as limitações das estratégias cirúrgicas e farmacológicas usadas para restaurar e manter a transparência da córnea em termos de sobrevida a longo prazo e alcance geográfico. As perspectivas dos agentes anabólicos, incluindo vitamina A, hormônios, fatores de crescimento e novos moduladores pró-mitóticos e anti-inflamatórios para auxiliar a cicatrização da ferida na córnea, são revisadas criticamente. Aqui, apresentamos estudos envolvendo nanotecnologia, terapia gênica e reengenharia de tecidos como possíveis estratégias futuras para atuar de maneira isolada ou combinada com a cirurgia da córnea para prevenir ou reverter a cegueira corneana.(AU)

Gemelarity-based diagnosis for subclinical keratoconus / Diagnóstico baseado em gemelaridade para ceratocone subclínico

ABSTRACT We report a case of two twins for whom advanced keratoconus is present in one of the siblings and no clear sign of the disease could be found for the other.

RESUMO Relatamos um caso de dois gêmeos em que o ceratocone avançado está presente em um dos irmãos e nenhum sinal da doença foi encontrado no outro.