Impact of COVID-19 on corneal esthesiometry.

Individuals with suspected COVID-19 symptoms (n=202) were tested using nasopharyngeal RT-qPCR. All individuals underwent corneal esthesiometry measurements using the Cochet-Bonnet esthesiometer during their first visit; 50 participants underwent an additional measurement at a mean interval of 32.5 (17.8) days. COVID-19 was confirmed in 101 subjects (50%) using nasopharyngeal PCR. The mean time from symptom onset to disease diagnosis and corneal esthesiometry was 4.2 (2.1) days. Mean corneal esthesiometry findings based on the positive and negative PCR status indicated no statistical difference. This study demonstrated that COVID-19 had no effect on corneal esthesiometry in individuals with acute-phase COVID-19.

Visual Field Characteristics of Type I Boston Keratoprosthesis Patients Without Glaucoma.

PURPOSE: To determine visual field findings in Boston type 1-KPro (BI-KPro) patients without glaucoma. Characterize normal threshold values and global indices using standard automated perimetry and characterize visual field amplitude using Goldmann's manual perimetry. METHODS: This cross-sectional prospective noninterventional study included patients (n=6 patients, 6 eyes) with BI-KPro who had normal optical coherence tomography and fundoscopic evaluation of the optic disc and retina. None had a previous history of glaucoma. Visual acuity, reliable and reproducible standard automated perimetry (24-2 and 30-2), and manual perimetry examinations were obtained from all patients. Each patient answered the National Eye Institute Visual Function Questionnaire, and the results were correlated with visual field indices. RESULTS: The mean visual acuity was 0.35±0.31 logMAR (0.84 to 0.10). All visual fields had good reliability indices. The standard automated perimetry mean deviation values were -7.25±3.63 decibels (dB) and -7.75±3.23 (24-2 and 30-2 values, respectively), whereas pattern SD values were 2.72±0.82 and 3.30±1.13 (24-2 and 30-2, respectively). The manual visual field mean values of the 4 quadrants (superior, temporal, inferior, and nasal), were 39.7±4.5, 61.8±6.2, 54.0±4.3, and 48.2±7.6 degrees, respectively. The authors found a significant correlation between the VFQ-25 indexes of general sight and close-range activities with the values of total deviation at 10 degrees. VFQ-25 peripheral vision indexes also correlated significantly with values of total deviation at 30 degrees (outermost locations in the 30-degree area). CONCLUSIONS: Patients with BI-KPro presented reliable and reproductive visual field measurements. The authors found a consistent reduction in visual field extension and a global sensitivity reduction in these patients. Despite visual field changes, our patients had a good quality of life scores. Overall, these results could be useful to improve early glaucoma diagnosis and to follow-up BI-KPro patients.

Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals?

PURPOSE: To investigate if a stress event can influence intraocular pressure (IOP) in a group of healthy individuals. DESIGN: Case-control study. PARTICIPANTS: A total of 28 healthy subjects were included: 17 in the stress group and 11 in the control group. METHODS: The Trier Social Stress Test (TSST) is a tool to evaluate cortisol response to psychologic stimulation based on the stress induced by public speaking. All participants underwent a modified diurnal tension curve (DTC) 1 week before the TSST, with 3 IOP measurements performed between 8:00 am and 2:00 pm. We evaluated the response to the TSST measuring the levels of salivary cortisol, IOP, and heart rate before, immediately after, and 40 minutes after TSST. The State Trait Anxiety Inventory (STAI) was applied to evaluate the levels of anxiety at the same time intervals. MAIN OUTCOME MEASURES: Changes in IOP (mmHg), salivary cortisol, heart rate, and STAI scores. RESULTS: At baseline, there were no significant differences between case and controls regarding age (52.2 ± 6.26 vs. 53.8 ± 8.4 years, P = 0.661), gender (52.94% male vs. 45.45% female, P = 0.669), and ethnicity. Salivary cortisol (6.8 nmol/l, P < 0.001) and heart rate (7.2 beats/min, P = 0.035) increased significantly after the TSST. We observed a mean IOP increase of 1.0 mmHg (right eye, P = 0.003) and 1.1 mmHg (left eye, P = 0.004) when comparing IOP measurements obtained during the DTC and immediately after TSST. In addition, 35% (6/17) of the subjects in the TSST group showed an IOP increase higher than 2 mmHg after the test compared with 18% (2/11) in the control group. The STAI state score significantly increased after the stress event compared with baseline (P = 0.026) and decreased from poststress to the recovery period (P = 0.006) in the TSST group. The control group did not show significant changes in IOP, heart rate, salivary cortisol levels, and STAI scores. CONCLUSIONS: Significant elevations of IOP, salivary cortisol, STAI scores, and heart rate occurred after inducing psychologic stress with TSST in a group of healthy individuals.

Boston Type I Keratoprosthesis: Antibacterial Resistance and Microbiota Evaluation of Soft Contact Lenses.

PURPOSE: To evaluate microbiota colonizing soft contact lenses (CL) in eyes with Boston type I keratoprosthesis (BKPro), and determine the prevalence of resistance to fourth-generation fluoroquinolone (FQ). DESIGN: Prospective, observational study. SUBJECTS: Patients with BKPro using CL as routine who were in postoperative follow-up in the Department of Ophthalmology of the Federal University of Sao Paulo, and volunteered to participate in the study. All patients were under a prophylactic scheme of topical 0.5% moxifloxacin 3 times a day and topical 5% povidone-iodine (PI) at the time of CL exchange. METHODS: Patients on scheduled replacement scheme of CL had their lenses removed and sent for microbiological analysis. Standard culture methods were used for microorganism identification and susceptibility to different antibiotics was tested. Main outcome measure was prevalence of resistance to fourth-generation FQ. RESULTS: Among the 19 eyes, 12 eyes (63%) had at least 1 positive bacterial culture. The most prevalent isolates were Staphylococcus epidermidis and other coagulase-negative staphylococci. Actinomyces viscosus was isolated in 1 CL. Fungal cultures were all negative. Of the 12 eyes with culture bacterial growth, resistance to fourth-generation FQ (0.5% moxifloxacin) was identified in 6 different eyes (50%). None presented infectious complications. CONCLUSIONS: FQ-resistant bacteria were isolated in some patients. Although our prophylactic antibiotic regimen has been efficient in preventing bacterial infection, this analysis demonstrated that prophylaxis with PI and low FQ dose might increase resistance to antibiotics. Investigations in this field may help to outline future changes of prophylactic guidelines and therapeutic strategies.

Clinic-cytologic study of conjunctivochalasis and its relation to thyroid autoimmune diseases: prospective cohort study.

PURPOSE: To determine the prevalence of conjunctivochalasis in patients with immune thyroid diseases, to determine whether there is any association between the 2 diseases, and to determine cytologic study of conjunctivochalasis through the cytology impression test. METHODS: A clinical prospective cohort study carried out by the External Diseases Department in the Ophthalmology Sector and the Thyroid Department in the Endocrinology Sector at Federal University of Sao Paulo (UNIFESP). The patients included were divided into 2 groups following these inclusion criteria: a control group of 25 patients without thyroid diseases, confirmed after clinical and laboratory examinations (thyroid hormones), or any other ocular diseases. The study group consisted of 31 patients with thyroid diseases, the diagnosis of which was confirmed by the Endocrinology Sector. The thyroidopathies included were autoimmune diseases but excluded nonautoimmune diseases. A protocol endorsed by the UNIFESP was followed, using clinical and ophthalmological history, biomicroscopy, and impression cytology. RESULTS: Fifty-two percent of patients without thyroid diseases and 88% of patients with thyroid diseases presented with conjunctivochalasis. The risk ratio was 1.705 (Pr > chi(2) = 0.0038), indicating that there is an association between them. For the impression cytology in inferior bulbar conjunctiva, there was an association between the result of the impression cytology and conjunctivochalasis (Pearson chi(2) = 10.1190 Pr = 0.006). CONCLUSION: The prevalence of conjunctivochalasis in patients with autoimmune thyroid diseases was 88%. Patients with autoimmune thyroidopathy presented higher percentages of conjunctivochalasis than the control group, confirming the association between them. The cytologic study showed the highest prevalence of abnormal surface features in eyes with conjunctivochalasis.

Comparison of Descemet-On Versus Descemet-Off Deep Anterior Lamellar Keratoplasty in Keratoconus Patients: A Randomized Trial.

PURPOSE: To compare the visual outcomes of Descemet membrane (DM)-on and DM-off after deep anterior lamellar keratoplasty (DALK) using the big-bubble (BB) technique in keratoconus patients. METHODS: In this prospective trial, keratoconic eyes undergoing DALK procedures with the BB technique were randomized into 2 groups: a donor cornea without DM (group 1; 29 eyes) or with DM (group 2; 30 eyes). These groups were compared with respect to best-corrected visual acuity and contrast sensitivity while wearing gas permeable contact lenses and also endothelial cell counts. RESULTS: There were no statistically significant differences between the 2 groups with regard to best-corrected visual acuity and contrast sensitivity using gas permeable contact lenses as well as endothelial cell counts at 3, 6, and 12 months. After 1 year, the mean (±SD) postoperative visual acuity CL (with contact lenses) was 0.05 (±0.01) in the DM-off group and 0.05 (±0.01) in the DM-on group (P = 0.956). Mean postoperative endothelial cell counts were 2425.0 (±123.7) and 2306.7 (79.9), respectively (P = 0.443), and corneal thicknesses were 527.9 (58.3) and 556.6 (47.3), respectively (P = 0.150). During the follow-up period, very few complications occurred and neither group had a predominance of adverse events at 3, 6, 12, or 24 months. CONCLUSIONS: In conclusion, DALK procedures using the BB technique for keratoconus with DM-on or DM-off presented no significant differences regarding the visual outcomes or endothelial cell counts.

Anterior stromal puncture in Brown-McLean syndrome.

We describe 2 cases of Brown-McLean syndrome with corneal edema successfully treated by anterior stromal puncture (ASP). Ophthalmologic examinations showed peripheral edema and aphakia in both patients. The patients had ASP to control the severe foreign-body sensation. The procedure was effective over a long-term follow-up, suggesting that peripheral ASP may be an effective therapeutic option for patients with symptomatic Brown-McLean syndrome.

Randomized trial comparing multilayer amniotic membrane transplantation with scleral and corneal grafts for the treatment of scleral thinning after pterygium surgery associated with beta therapy.

PURPOSE: The aim of this study was to compare the use of multilayer amniotic membrane transplantation (AMT) with lamellar corneal transplantation (LCT) and lamellar scleral transplantation (LST) for the treatment of scleral thinning after pterygium surgery associated with beta therapy. METHODS: Twenty-six eyes from 26 different patients with scleral thinning as a consequence of beta therapy after pterygium surgery were evaluated at the Federal University of São Paulo, Brazil. Ophthalmologic examination and ultrasound biomicroscopy were performed to assess scleral thinning before the transplant surgery and then repeated at 30, 90, and 180 days after surgery. An increase in scleral thickness, epithelialization of the ocular surface, and preservation of the ocular globe were the main outcome measures. RESULTS: Irrespective of the surgical technique used (AMT, LCT, or LST), no clinical or statistical changes in corrected distance visual acuity were found in any of the patients during this study. The median preoperative scleral thickness was similar in all 3 groups: AMT = 0.45 mm, LST = 0.48 mm, and LCT = 0.52 mm (P = 0.257); however, 6 months after surgery, the median thickness in the AMT group (0.19) was significantly less than that of the LCT group (0.57) (P = 0.27) or the LST group (0.76) (P = 0.19). Epithelialization occurred in all the patients. CONCLUSIONS: LCT was the best option for the structural treatment of scleral thinning, followed by LST with a conjunctival flap. A high rate of reabsorption was found with AMT, which was the least effective of the 3 therapeutic options and should not be used for this condition.

Light and transmission electronic microscopy evaluation of lyophilized corneas.

PURPOSE: Cornea storage for longer periods is still a challenge for corneal surgeons. The purpose of this study was to find a method to lyophilize corneas for anterior lamellar transplant and to evaluate them by light and transmission electronic microscopy. METHODS: Corneal flaps were created by using a microkeratome. Corneas were lyophilized with a cryoprotectant (2.3 mol sacarousis for 40 minutes) and without a cryoprotectant in a lyophilization machine (Modulyon D). The corneas were rehydrated with distilled water, balanced saline solution (BSS), and phosphate-buffered saline, after which they were evaluated by microscopy. A cornea that did not undergo lyophilization served as a control. RESULTS: Lyophilization without a cryoprotectant did not preserve the corneal structure. This finding was also observed when lyophilizing and rehydrating the corneas with distilled water or phosphate-buffered saline. We found that lyophilizing corneas and rehydrating them with 11 mL of BSS for 30 minutes preserved the general corneal structure, the parallelism of the collagen fibers, the Bowman layer, and the epithelial basement membrane for 15 and 30 days and for as long as 1 year or more. CONCLUSIONS: Lyophilization with sacarousis and rehydration with BSS may be a good method for anterior lamellar transplantation.

Caratite infecciosa pós-transplante de córnea / Infectious keratitis after keratoplasty

Objetivo: Estudar os casos de ceratite infecciosa pós-transplante de córnea do Setor de Doenças Externas Oculares e Córnea da Universidade Federal de Säo Paulo - UNIFESP-EPM. Pacientes e Métodos: Foram revisados os registros de 255 pacientes submetidos a transplante de córnea no período de janeiro de 1995 a junho de 1997. Aqueles que desenvolveram infecçäo foram avaliados quanto: (1) indicaçäo do transplante, (2) tempo entre a cirurgia e o aparecimento da infecçäo, (3) fatores desencadeantes da infecçäo, (4) microorganismo causal e (5) repercusäo final na acuidade visual. Resultados: Foram identificados dez casos de ceratite infecciosa pós-transplante de córnea resultando em uma incidência de 3,9 por cento. Problemas relacionados à sutura, olho seco, ceratite herpética e defeito epitelial crônico foram os fatores desencadeantes identificados. Os principais microrganismos envolvidos foram Streptococcus pneumoniae e Straphylococcus aureus. A perda visual foi grave em 80 por cento dos casos e, apenas dois pacientes tiveram acuidade visual final de 20/40 e 20/60. Conclusäo: Deve ser dado especial atençäo na avaliaçäo tanto pré-operatória como pós-operatória à presença de fatores predisponentes ao desenvolvimento de infecçäo no pós-operatório de transplante, pois embora seja uma complicaçäo infrequente pode comprometer gravemente o prognóstico visual