A 3-year follow-up study of a new corneal inlay: clinical results and outcomes.

PURPOSE: Here, we report the results of a 3-year follow-up analysis of the outcomes of the Flexivue Microlens corneal inlay. PATIENTS: Non-dominant eyes (n=31) of emmetropic presbyopic patients (spherical equivalent: -0.5 to 1.00 dioptre). METHODS: A Flexivue Microlens corneal inlay was implanted after the creation of a 300 µm deep stromal pocket using a femtosecond laser. Patients were followed up according to a clinical protocol involving refraction, anterior segment imaging analysis (Oculyser), optical quality analysis (OPD-Scan), monocular binocular uncorrected and corrected visual acuity tests, contrast sensitivity measurements (photopic and mesopic), satisfaction questionnaire results and adverse event reporting. RESULTS: Thirty patients were examined at the 3-year follow-up in this ongoing study. The mean uncorrected near visual acuity improved to Jaeger 1 in 76.9% of eyes treated with the inlays (vs 87.1% at the 1-year follow-up). All eyes improved four lines in all visits, except for four patients for whom the inlay was explanted. Patients reported that their near vision was good or excellent in 73.3% of cases (vs 90.3% in the first year). The UDVA remained stable over time. Three patients were explanted due to blurred vision for near-point and far-point distances. One patient developed a superficial corneal ulcer after 20 months. Two patients underwent cataract removal. Four patients underwent inlay exchange to increase near power correction. CONCLUSIONS: The Presbia Flexivue Microlens provided presbyopia treatment by improving near vision. Manageable complications may occur over the long term. CLINICAL TRIAL REGISTRATION NUMBER: U1111-1185-5684 and 0310451200000550.

Agreement on the evaluation of glaucomatous optic nerve head findings by ophthalmology residents and a glaucoma specialist.

OBJECTIVES: To assess agreement among ophthalmology residents and a glaucoma expert in the evaluation of cross-sectional glaucomatous optic nerve head characteristics using stereoscopic photographs. METHODS: Twenty stereo photographs were analyzed by ophthalmology residents just after completion of their first (First-Year Group) or third (Third-Year Group) year of residency and by a glaucoma expert. The agreement was assessed using the kappa statistic (κ) and limits of agreement. RESULTS: Agreement among resident groups and the expert ranged from poor to moderate. Agreement between Third Years and the expert seems to be better than that between First Years and the expert, especially in the evaluation of "nasal cupping", "barring circumlinear vessel," "notching", and "retinal nerve fiber layer defect" criteria. However, no improvement was seen in the agreement with the expert regarding glaucomatous optic neuropathy, which was 64% (κ=0.19) for First Years and 63% (κ=0.20) for Third Years. CONCLUSION: Agreement between residents and the expert was poor to moderate and similar when comparing both groups. This may suggest that the residents learn how to identify glaucoma signals during the first year of training, and the results of this study may facilitate the creation of targeted teaching tools in residency training.

Assessment of fungal viability after long-wave ultraviolet light irradiation combined with riboflavin administration.

BACKGROUND: Corneal collagen cross-linking (CXL), a technique that combines riboflavin administration with long-wave ultraviolet light irradiation, was primarily developed to increase the biomechanical strength of collagen fibrils of the cornea to avoid the progression of keratoconus. Recently, this method has been proposed to treat selected cases of infectious keratitis. METHODS: To test the protocol used for progressive keratoconus in infectious keratitis, Candida albicans, and Fusarium solani, strains were exposed to irradiation using a wavelength of 365 nm at a power density of 3 mW/cm(2) for 30 min in the presence of riboflavin photosensitizer. All experiments were performed in triplicate. Qualitative and quantitative measurements of fungal viability used plate cultures and an automated trypan blue dye exclusion method respectively. Fungal cell diameter was also assessed in all groups. Statistical analyses were performed using the triplicate values of each experimental condition. RESULTS: Experimental findings of photodynamic therapy applied to the cell inactivation of both yeasts and filamentous fungi were compared with control groups. Qualitative results were corroborated with quantitative findings which showed no statistical significance between challenged samples (experimental groups) and the control group (p-value = 1). In comparison with a control group of live cells, statistical significance was observed when riboflavin solution alone had an effect on the morphologic size of filamentous fungi, while ultraviolet light irradiation alone showed a slight decrease in the cell structure of C. albicans. CONCLUSIONS: The impact of long-wave ultraviolet combined with riboflavin photosensitizer showed no antifungal effect on C. albicans and F. solani. The significant decrease in cell morphology of both filamentous fungi and yeasts submitted to photosensitizing riboflavin and exposure to ultraviolet light, respectively, may be promising in the development and standardization of alternatives for fungal cell inactivation, because of their minimal cytotoxic effects on the corneal surface. The methodological improvement in the preparation and application of individual chemical compounds, such as riboflavin, or physical systems, such as a long-wave light source, as antifungal agents may also assist in establishing promising therapeutic procedures for keratomycosis.

Assessing efficacy of combined riboflavin and UV-A light (365 nm) treatment of Acanthamoeba trophozoites.

PURPOSE: To assess the Acanthamoeba trophozoite viability in vitro and treatment of Acanthamoeba keratitis in a hamster model using ultraviolet light A (UV-A) and riboflavin (B2). METHODS: A sample of Acanthamoeba sp. cultured was transferred to a 96-well plate and exposed to B2 and the UV-A light (365 nm wavelength) at a power density of 3 mW/cm(2), 8 mm spot diameter, for 30 minutes. The exposure was done in triplicate. Control groups were prepared in triplicate as well: blank control, UV-A only, riboflavin only, and dead control. Cell viability assessment was done using the trypan blue dye exclusion method. Acanthamoeba keratitis was induced in Chinese hamsters; who were randomly assigned to one of the animal groups: UV-A + B2, propamidine isethionate (Brolene; Sanofi-Aventis, Ellerslie, Auckland, Australia), UV-A + B2 + propamidine isethionate (Brolene), only UV-A, only B2, and blank. Throughout the 14 days after treatment the animals were examined clinically. Histology and clinical scores of all groups were compared. RESULTS: The in vitro study showed no difference between the treatment group UV-A + B2 and the control groups. In the hamster keratitis model a significant improvement of clinical score was observed for the groups propamidine isethionate (Brolene) and UV-A + B2 + propamidine isethionate (Brolene) (P = 0.0067). Also a significant worsening of clinical score was observed in the other groups: UV-A + B2 group (P = 0.0084), only UV-A (P = 0.0078), B2 only (P = 0.0084), and blank (P = 0.0082). No difference was observed between propamidine isethionate (Brolene) and UV-A + B2 + propamidine isethionate (Brolene). CONCLUSIONS: The adjunctive use of UV-A and B2 therapy did not demonstrate antitrophozoite activity; in vivo UV-A and B2 did not demonstrate efficacy in this model.

Sectorial and annular quantitative area pachymetry with the Orbscan II.

PURPOSE: To present a new application of quantitative area pachymetry of the cornea. METHODS: Sectorial quantitative area pachymetry of small corneal zones located at the center and surrounding areas is possible by means of the statistical analysis device and tools menu of Orbscan II (Bausch and Lomb). RESULTS: Average pachymetry of 1 central zone and 12 small zones around the center may be shown in the pachymetry map by simply formatting the system. Average pachymetry, standard deviation, rate of thickness variation (slope), and volume of analyzed annular corneal zone can also be automatically shown in a data window. The examination results can be printed and kept on record. CONCLUSIONS: The method is simple and descriptive. This type of preoperative evaluation may guide the manual or laser preparation of channels for intracorneal segments and the corneal trephination for lamellar or penetrating keratoplasty.

Corneal infiltrates after excimer laser photorefractive keratectomy and LASIK.

PURPOSE: To determine the frequency and clinical characteristics of corneal infiltrates after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and to evaluate the efficacy of treatment. METHODS: We retrospectively reviewed the records of 8508 eyes treated with PRK or LASIK in a university-based clinic for the correction of refractive errors for 60 days postoperatively. RESULTS: Corneal infiltrates were observed in 35 (0.8%) of 4492 PRK-operated eyes and in 4 (0.1%) of 4016 LASIK-operated eyes. The mean time of diagnosis was 5.46 days. Among the 39 eyes with infiltrates, 10 (9 PRK, 1 LASIK) had culture-verified infectious keratitis. Coagulase-negative Staphylococcus was the most frequently isolated bacterium (50%), followed by S aureus (20%), Corynebacterium xerosis (10%), Streptococcus viridans (10%), and an unidentified gram-positive coccus (10%). Final visual acuity of > or = 20/30, without correction, was achieved in 79.5% of the 39 eyes. CONCLUSIONS: Corneal infiltrates occurred in 0.8% of PRK eyes and 0.1% of LASIK eyes. Bacterial smears were positive for several eyes. In all cases, prompt treatment was responsible for good visual outcome.

Estudo videoceratoscópico no pré e pós-operatório da cirurgia refrativa incisional / Computerized corneal topography and radial keratotomy: a clinical analysis

Objetivos: o objetivo deste estudo foi analisar a eficácia da videoceratoscopia computadorizada na detecçäo de ectasias corneanas nos candidatos à ceratotomia radial, avaliar a reprodutibilidade na análise destes mapas quando analisamos por diferentes examinadores e associar padröes topográficos pré-operatórios a padröes topográficos pós-operatórios. Métodos: foram analisados, através da videoceratoscopia computadorizada, 66 olhos submetidos a ceratotmoia radial no Departamento de Oftalmologia da UNIFESP-EPM no período entre maio de 1993 a setembro de 1994. A classificaçäo dos mapas pré e pós-operatórios foi realizada por 3 examinadores independentes. Resultados: os mapas topográficos do pós-operatório mantiveram-se estáveis ou evouiram para um padräo ..

Transplante autógeno de conjuntiva no tratamento de queimaduras graves / Limbal autograft transplantation for severe ocular burn

Dez pacientes com queimaduras oculares unilaterais graves, oito por agentes químicos e dois por agentes térmicos, foram submetidos ao transplante de conjuntiva limbar autógena. A técnica cirúrgica consistiu em transferir dois retalhos da conjuntiva limbar autôgena. A técnica cirúrgica consistiu em transferir dois retalhos da conjuntiva limbar do olho contralateral, para regiöes comprometidas do olho acometido. O acompanhamento variou de 8 a 48 meses. Todos os pacientes apresentaram melhora da acuidade visual, estabilidade epitelial e regressäo da neovascularizaçäo estromal. O transplante de conjuntiva limbar autógeno parece ser indicado para o tratamento de queimaduras oculares químicas ou térmicas severas, associadas à perda de células primordiais limbares.

Avaliaçäo clínica do tratamento cirúrgico da hipercorreçäo pós-ceratotomia radial / Surgical correction of hyperopia after radial keratotomy: a clinical evaluation

Hipermetropia secundária a ceratotomia radial pode resultar de uma hipercorreçäo inicial ou de um efeito contínuo da cirugia. Nós avaliamos o efeito do tratamento cirúrgico da hipermetropia pós-ceratotomia radial em 5 pacientes (6 olhos) que consistiu em reabertura e lavagem das incisöes radiais, e sutura das mesmas com pontos separados de náilon 10-0. Foram utilizados 4 ou 8 pontos colocados em zonas ópticas de 5 e/ou 7 mm. Os pacientes foram acompanhados por um período mínimo de 24 semanas. Todos os pacientes apresentaram reduçäo da hipermetropia e melhora da acuidade visual pré-operatória. O equivalente esférico foi reduzido de 4,87 + ou - 2,02 D para 1,16 + ou - 1,99 D e 2,60 + ou - 0,96 D para 38,02 + ou - 2,39 D e 37,00 + ou - 2,34 D, quatro e 24 semanas após a cirurgia. Todos os pacientes apresentaram variável grau de astigmatismo refracional, também detectado com a topografia corneana computadorizada. A sutura das incisöes radiais para tratamento da hipercorreçäo parece ser um tratamento efetivo para a hipercorreçäo após ceratotomia radial

Trauma ocular por Himenópteros: aspectos clínicos e histopatológicos / Ocular trauma by Himenopteros: clinical and hystopathological aspects

Säo apresentados 3 casos clínicos de trauma ocular por insetos da ordem dos Himenópteros. Tais acidentes säo pouco frequentes em grandes cidades. Os insetos inoculam nos tecidos oculares misturas de substâncias altamente tóxicas, como aminas, peptídeos, enzimas. Todos os casos apresentavam alteraçöes anatômicas e funcionais graves do segmento anterior do olho e foram submetidos a tratamento cirúrgico, tendo o exame anátomo-patológico revelado intensa destruiçäo tecidual da córnea e cristalino. Discutem-se ainda as açöes dos componentes do veneno sobre os tecidos humanos, concluindo-se que o trauma ocular por insetos Himenópteros pode determinar uma baixa acentuada de acuidade visual ou mesmo cegueira definitiva