Pediatric keratoconus epidemiology: a systematic scoping review.

BACKGROUND: Pediatric keratoconus (pediatric KC) causes progressive deformation of the cornea in children and adolescents, leading to a gradual loss of vision and a need for rehabilitation. However, new treatments may halt the disease and prevent worse outcomes that require penetrating keratoplasty and its associated morbidity and high cost, irreversible loss of vision, and amblyopia. Few systematic reviews focus on keratoconus-and even fewer, on pediatric KC. METHODS: Here, we report a systematic scoping review of pediatric KC epidemiology and discuss the studies reporting data on pediatric KC. We used PRISMA-ScR methodology and checklists in the elaboration of the manuscript. The inclusion criteria were: English language; publication between August 7, 1998, and August 7, 2019 (20 years); theme of the study pediatric KC epidemiology. The search strategy: searches of the PubMed-MEDLINE database and Cochrane Database of Systematic Reviews, using eight combinations of the following MeSH terms: keratoconus; child; incidence; prevalence; pediatrics; adolescent; epidemiology. RESULTS: We charted and reviewed the selected articles. Initial searches included 1802 records; after the exclusion of article duplicates, we screened 777 records, read 97 articles in full text, and included 76 articles in this review. CONCLUSIONS: Recent epidemiological studies with better methodologies demonstrated increased prevalence rates in comparison to the older literature. This effect may be due to better diagnostic methods and better sample selection than those in historical studies. Diagnosis remains a major challenge as the early disease is usually asymptomatic. Economic and social aspects of pediatric KC remain understudied in the pediatric literature. Global, inclusive, and proactive screening studies in schools are imperative to better understand the great impact of this disease in the young.

Ablação personalizada guiada por frente de onda após complicação na dissecção lamelar de FemtoLasik / Personalized wavefront-guided ablation after complication in FemtoLasik lamella dissection

RESUMO O FemtoLasik é uma das técnicas mais empregadas em cirurgia refrativa, por seus bons resultados refracionais, sua previsibilidade, sua reprodutibilidade e sua segurança. Tem alto grau de satisfação, com rápida recuperação visual. Apesar de as taxas de complicações do FemtoLasik serem pequenas, intercorrências podem existir. O objetivo deste trabalho foi relatar um caso de uma complicação na dissecção da lamela por Lasik com laser de femtossegundo com consequente rasgadura da lamela, sendo aplicado Excimer Laser com mitomicina C 0,02%. O retratamento foi realizado com ablação de superfície (ceratectomia fotorrefrativa) guiada por frente de onda, evoluindo com boa qualidade visual final.

ABSTRACT Femtolasik is one of the most used techniques in refractive surgery due to good refractive results, predictability, reproducibility, and safety, achieving excellent results and a high degree of satisfaction. Although the complication rates are small, it is worth noting that there may be intercurrences. The objective of this work is to report a case of complication in the dissection of the lamella of laser in situ keratomileusis (Lasik) with Femtosecond laser, and subsequent lamella tear. Excimer Laser was applied with mitomycin 0.02% and re-approached with wavefront guided surgery, evolving with good final visual quality.

Comparison between optical coherence tomography angiography and fluorescein angiography findings in retinal vasculitis.

BACKGROUND: To describe optical coherence tomography angiography (OCT-A) findings in patients with retinal vasculitis and to compare them to current fluorescein angiography (FA) findings. METHODS: This was an observational case series. Nineteen eyes in 10 patients with retinal vasculitis of various etiologies were imaged with FA (TRC-50DX, Topcon) and OCT-A (SD-OCT, Optovue). The images were reviewed and analyzed. RESULTS: The mean age was 36 years (range 24-67 years); there were three males and seven females. The primary vessels involved were veins (89%). Fourteen eyes (74%) had active inflammatory disease during the study period, with signs of vascular sheathing and perivascular leakage on FA. Interestingly, in this group, OCT-A was not able to detect clear signs of active inflammation around the affected vessels. Nevertheless, OCT-A was able to detect secondary lesions in fourteen eyes (74%), including some findings not clearly shown on FA. Most of these were within the macular area. OCT-A was particularly effective in cases of capillary dropout, increased foveal avascular zone, telangiectasias, shunts, and areas of neovascularization. CONCLUSION: FA remains an essential complementary exam for detection of retinal vasculitis. However, OCT-A extends FA findings and affords better assessment of secondary complications.

Intraocular straylight before and after low myopic photorefractive keratectomy with and without mitomycin C.

PURPOSE: To evaluate ocular straylight before and after photorefractive keratectomy (PRK) for low myopia with and without topical mitomycin (MMC) treatment. METHODS: Patients who underwent PRK for low myopia were enrolled into the study. PRK without MMC was performed in 21 eyes (12 patients), whereas PRK with topical 0.02% MMC was performed in 25 eyes (14 patients). Both groups were treated using the NIDEK EC5000 excimer laser. Measurements were performed using the C-Quant straylight meter preoperatively and at two and four months postoperatively. RESULTS: The mean patient age was 30 ± 4 years, and the mean spherical equivalent refractive error was -2.2 ± 0.75 D. The mean preoperative intraocular straylight values were 1.07 ± 0.10 in the PRK without MMC group and 1.07 ± 0.11 log(s) in the PRK with topical MMC group. At two months after surgery, there was a decrease in mean intraocular straylight values in both groups. However, a significant difference was only reached in the PRK with MMC group [0.98 ± 0.09 log(s), p=0.002] compared with preoperative values, which was likely due to a greater scatter of measurements in the PRK without MMC group [1.03 ± 0.13 log(s), p=0.082]. At four months postoperatively, ocular straylight values were not significantly different compared with those at baseline in either the PRK without MMC group [1.02 ± 0.14 log(s), p=0.26] or in the PRK with topical MMC group [1.02 ± 0.11 log(s), p=0.13]. CONCLUSION: PRK for low myopia decreases ocular straylight, and MMC application further reduces straylight in the early postoperative period. However, ocular straylight values do not significantly differ at four months after surgery compared with those at baseline.

Predictors of Early Postoperative Pain After Photorefractive Keratectomy.

PURPOSE: To compare the profiles of postoperative photorefractive keratectomy (PRK) pain between both eyes under the same conditions and to verify the preoperative predictors of pain such as gender, anxiety, knowledge of the procedure, and spherical equivalent refractive error (SERE). METHODS: This prospective study included 86 eyes of 43 patients with myopia who underwent PRK in both eyes at an interval of 14 days between the procedures. Before surgery, subjects answered the State Anxiety Inventory. After surgery, usual PRK pain treatment was given. Subjects answered the Visual Analog Scale, the Brief Pain Inventory (BPI), and the McGill Pain Questionnaire at 1, 24, 48, 72, and 96 hours after surgery. Pain scores and anxiety were compared between each eye using the Wald test and paired Student t test, respectively. The Wald test was performed for gender and SERE for each eye separately. RESULTS: There were no statistically significant differences between both eyes for all time points regarding the Visual Analog Scale, BPI, and McGill Pain Questionnaire-Pain Rating Index pain scores. Subjects were less anxious on average before the second surgery compared with before the first surgery (P < 0.001); however, it was not related to pain ratings after surgery. Gender did not significantly affect any scale of pain, and the SERE between -3 diopters (D) and -5 D (P = 0.035) revealed effects on the BPI. CONCLUSIONS: The profiles of postoperative pain after PRK were similar between both eyes under the same conditions. In this study, a high SERE was the only predictor for increased pain after PRK.

Intraocular straylight before and after low myopic photorefractive keratectomy with and without mitomycin C / Dispersão de luz intraocular antes e depois da ceratectomia fotorrefrativa para baixa miopia com e sem mitomicina C

ABSTRACT Purpose: To evaluate ocular straylight before and after photorefractive keratectomy (PRK) for low myopia with and without topical mitomycin (MMC) treatment. Methods: Patients who underwent PRK for low myopia were enrolled into the study. PRK without MMC was performed in 21 eyes (12 patients), whereas PRK with topical 0.02% MMC was performed in 25 eyes (14 patients). Both groups were treated using the NIDEK EC5000 excimer laser. Measurements were performed using the C-Quant straylight meter preoperatively and at two and four months postoperatively. Results: The mean patient age was 30 ± 4 years, and the mean spherical equivalent refractive error was -2.2 ± 0.75 D. The mean preoperative intraocular straylight values were 1.07 ± 0.10 in the PRK without MMC group and 1.07 ± 0.11 log(s) in the PRK with topical MMC group. At two months after surgery, there was a decrease in mean intraocular straylight values in both groups. However, a significant difference was only reached in the PRK with MMC group [0.98 ± 0.09 log(s), p=0.002] compared with preoperative values, which was likely due to a greater scatter of measurements in the PRK without MMC group [1.03 ± 0.13 log(s), p=0.082]. At four months postoperatively, ocular straylight values were not significantly different compared with those at baseline in either the PRK without MMC group [1.02 ± 0.14 log(s), p=0.26] or in the PRK with topical MMC group [1.02 ± 0.11 log(s), p=0.13]. Conclusion: PRK for low myopia decreases ocular straylight, and MMC application further reduces straylight in the early postoperative period. However, ocular straylight values do not significantly differ at four months after surgery compared with those at baseline.

RESUMO Objetivo: Avaliar a dispersão de luz intraocular antes e depois da ceratectomia fotorrefrativa (PRK) para baixa miopia com e sem a aplicação tópica de mitomicina C. Métodos: Pacientes submetidos à PRK para baixa miopia foram selecionados para o estudo. PRK sem MMC foi realizado em 21 olhos (12 pacientes) e PRK com MMC tópica a 0,02% foi realizado em 25 olhos (25 pacientes). Ambos os grupos foram tratados com o excimer laser da Nidek EC5000. Avaliações foram realizadas usando o medidor de dispersão de luz C-Quant no pré-operatório e com 2 e 4 meses de pós-operatório. Resultados: A média de idade dos pacientes foi 30 ± 4 anos e a média do equivalente esférico foi -2,2 ± 0,75 D. As médias da dispersão de luz intraocular no pré-operatório foram 1,07 ± 0,10 no grupo PRK sem MMC e 1,07 ± 0,11 log(s) no grupo PRK com MMC tópica. Após 2 meses da cirurgia houve uma diminuição na média da dispersão de luz intraocular em ambos os grupos. Entretanto uma diferença estatisticamente significante, comparado com os valores pré-operatórios, foi observada apenas no grupo PRK com MMC (0,98 ± 0,09 log(s), p=0,002), provavelmente devido as medidas com maior espalhamento de luz no grupo sem MMC (1,03 ± 0,13 log(s), p=0,082). Após 4 meses de pós-operatório, os valores de dispersão de luz não apresentavam diferença estatisticamente significantes quando comparados com os valores iniciais, tanto no grupo sem MMC (1,02 ± 0,14 log(s), p=0,26) quanto no grupo com MMC tópica (1,02 ± 0,11 log(s), p=0,13). Conclusão: PRK para baixa miopia diminui a dispersão de luz ocular e a aplicação de MMC contribui para uma ainda menor dispersão de luz no período pós-operatório inicial. Entretanto, quatro meses após a cirurgia a dispersão de luz intraocular não é significantemente diferente das medidas pré-operatórias.

Improved Evaluation of Postoperative Pain After Photorefractive Keratectomy.

PURPOSE: Postoperative pain remains an important limiting factor to the selection of photorefractive keratectomy (PRK). There is a consensus in neurology pain research that pain should be evaluated as a multidimensional concept, which differs from current practice in ophthalmology. The purpose of this paper was to validate the use of multidimensional questionnaires, such as the Brief Pain Inventory (BPI) and the McGill Pain Questionnaire (MPQ), to provide an improved analysis of pain after PRK and to better describe its temporal profile. METHODS: This prospective study included 43 eyes of 43 myopic patients who underwent unilateral PRK. After surgery, usual pain treatment was administered. All of the participants responded to the Visual Analogue Scale (VAS), the BPI and the MPQ 1, 24, 48, 72, and 96 hours after surgery. The internal consistency was evaluated, different postoperative periods were compared, and convergent validity was assessed using correlation testing. RESULTS: The Cronbach alpha test showed high internal consistency for each of the questionnaire subscales. Patients reported higher postoperative pain values at the first measurement of the VAS (4.93 ± 2.38), MPQ-pain rating index (26.95 ± 10.58), BPI-pain severity index (14.53 ± 7.36), and BPI-pain interference index (22.30 ± 15.13). Almost all of the scales and subscales showed a statistically significant direct correlation with the VAS at all of the evaluation periods. CONCLUSIONS: This study validated the utility of multidimensional questionnaires to expand the assessment of the PRK postoperative pain profile, including intensity and other qualitative aspects.

Effects of ambient levels of traffic-derived air pollution on the ocular surface: analysis of symptoms, conjunctival goblet cell count and mucin 5AC gene expression.

PURPOSE: To quantify ocular symptoms, goblet cells (GC) and mucin 5AC (MUC5AC) gene expression on the conjunctiva of healthy subjects exposed to ambient levels of traffic-derived air pollution and to estimate its correlation with NO2 and particulate matter smaller than 2.5 µm (PM2.5) levels. METHODS: Twenty-one taxi drivers or traffic controllers were assessed with the Ocular Surface Disease Index (OSDI) questionnaire and conjunctival impression cytology. MUC5AC mRNA levels were determined based on the cytology of the right eye, and GC density was assessed based on the cytology of the left eye. Mean individual levels of 24-h NO2 and PM2.5 exposure were assessed the day before examination. Possible associations between NO2 or PM2.5 levels, OSDI scores, GC densities and MUC5AC mRNA levels were verified. RESULTS: The subjects were exposed to mean PM2.5 levels of 35±12 µg/m(3) and mean NO2 levels of 189±47 µg/m(3). OSDI scores were low (7.4±8) and GC densities were 521±257 and 782±322 cell/mm(2) on the bulbar and tarsal conjunctivas, respectively. The mean GC-derived MUC5AC mRNA expression was 14±7 fM/µg of total RNA. A significant and positive correlation was observed between MUC5AC mRNA levels and tarsal GC density (p=0.018). A trend toward association between PM2.5 levels and tarsal GC cell density (p=0.052) was found. CONCLUSION: Exposure to ambient levels of air pollution impacts conjunctival GC density. An increase in MUC5AC mRNA levels may be part of an adaptive ocular surface response to long-term exposure to air pollution.

Quality of vision in refractive and cataract surgery, indirect measurers: review article / Qualidade visual em cirurgia refrativa e catarata, medidores indiretos: artigo de revisão

Visual acuity is the measurement of an individual's ability to recognize details of an object in a space. Visual function measurements in clinical ophthalmology are limited by factors such as maximum contrast and so it might not adequately reflect the real vision conditions at that moment as well as the subjective aspects of the world perception by the patient. The objective of a successful vision-restoring surgery lies not only in gaining visual acuity lines, but also in vision quality. Therefore, refractive and cataract surgeries have the responsibility of achieving quality results. It is difficult to define quality of vision by a single parameter, and the main functional-vision tests are: contrast sensitivity, disability glare, intraocular stray light and aberrometry. In the current review the different components of the visual function are explained and the several available methods to assess the vision quality are described.

Qualidade Visual é a medida da capacidade individual de reconhecer detalhes de um objeto no espaço. Medições de função visual na clínica oftalmológica são limitadas por vários fatores, tal como máximo contraste e assim podem não refletir adequadamente as condições visuais reais, bem como os aspectos subjetivos da percepção do mundo pelo paciente. O sucesso em uma cirurgia está não apenas em restaurar linhas de visão, mas sim qualidade visual. Portanto, as cirurgias refrativas e de catarata têm a responsabilidade de alcançar resultados de qualidade. É difícil definir qualidade visual por um único parâmetro, sendo os principais testes de função visual: sensibilidade ao contraste; glare; dispersão intraocular da luz e aberrometria. Nesta revisão os diferentes componentes da função visual são explicados e os diversos métodos disponíveis para se avaliar a qualidade de visão são descritos.

Quality of vision in refractive and cataract surgery, indirect measurers: review article.

Visual acuity is the measurement of an individual's ability to recognize details of an object in a space. Visual function measurements in clinical ophthalmology are limited by factors such as maximum contrast and so it might not adequately reflect the real vision conditions at that moment as well as the subjective aspects of the world perception by the patient. The objective of a successful vision-restoring surgery lies not only in gaining visual acuity lines, but also in vision quality. Therefore, refractive and cataract surgeries have the responsibility of achieving quality results. It is difficult to define quality of vision by a single parameter, and the main functional-vision tests are: contrast sensitivity, disability glare, intraocular stray light and aberrometry. In the current review the different components of the visual function are explained and the several available methods to assess the vision quality are described.

Ocular surface adverse effects of ambient levels of air pollution.

It is widely recognized today that outdoor air pollution can affect human health. Various chemical components that are present in ambient pollution may have an irritant effect on the mucous membranes of the body, particularly those of the respiratory tract. Much less attention has been focused on the adverse effect on the ocular surface, despite the fact that this structure is even more exposed to air pollution than the respiratory mucosa since only a very thin tear film separates the corneal and conjunctival epithelia from the air pollutants. So far, clinical data are the more widespread tools used by ophthalmologists for assessing possible aggression to the ocular surface; however, clinical findings alone appears not to correlate properly with the complaints presented by the patients pointing out the need for further clinical and laboratory studies on the subject. The purpose of this study is to review signs and symptoms associated with chronic long-term exposure to environmental air pollutants on the ocular structures currently defined as the ocular surface and to review clinical and laboratory tests used to investigate the adverse effects of air pollutants on such structures. We also review previous studies that investigated the adverse effects of air pollution on the ocular surface and discuss the need for further investigation on the subject.

Ocular surface adverse effects of ambient levels of air pollution / Efeitos adversos na superfície ocular relacionados à poluição ambiental

It is widely recognized today that outdoor air pollution can affect human health. Various chemical components that are present in ambient pollution may have an irritant effect on the mucous membranes of the body, particularly those of the respiratory tract. Much less attention has been focused on the adverse effect on the ocular surface, despite the fact that this structure is even more exposed to air pollution than the respiratory mucosa since only a very thin tear film separates the corneal and conjunctival epithelia from the air pollutants. So far, clinical data are the more widespread tools used by ophthalmologists for assessing possible aggression to the ocular surface; however, clinical findings alone appears not to correlate properly with the complaints presented by the patients pointing out the need for further clinical and laboratory studies on the subject. The purpose of this study is to review signs and symptoms associated with chronic long-term exposure to environmental air pollutants on the ocular structures currently defined as the ocular surface and to review clinical and laboratory tests used to investigate the adverse effects of air pollutants on such structures. We also review previous studies that investigated the adverse effects of air pollution on the ocular surface and discuss the need for further investigation on the subject.

Sabe-se hoje que a poluição ambiental pode afetar a saúde humana. Vários componentes químicos presentes na poluição atmosférica podem acarretar uma irritação nas mucosas, particularmente no trato respiratório. Pouca ênfase tem sido dada à superfície ocular, embora esta estrutura seja até mais exposta à poluição ambiental do que o trato respiratório visto que apenas uma fina camada de filme lacrimal separa a córnea e a conjuntiva dos poluentes presentes no ar. Até o momento, a avaliação clínica é o método mais utilizado pelos oftalmologistas para se detectar uma possível agressão à superfície ocular; entretanto esta avaliação apenas não parece correlacionar-se com as queixas e sinais apresentados pelos pacientes demonstrando a necessidade de mais estudos clínicos e laboratoriais sobre o assunto. O objetivo deste estudo é revisar os sinais e sintomas associados à exposição crônica aos poluentes ambientais no ar nas estruturas oculares definidas atualmente como superfície ocular e revisar os testes clínicos e laboratoriais usados para investigar os efeitos adversos dos poluentes em tais estruturas. Também revisamos estudos prévios que analisaram os efeitos adversos da poluição do ar na superfície ocular e discutimos a necessidade de mais estudos sobre o assunto.