Cataract surgery in patients with underlying keratoconus: focused review.

An underlying diagnosis of keratoconus (KC) can complicate cataract surgery. In this study, the results of a focused review of the literature pertaining to cataract surgery in patients with KC are detailed. Topics essential for the appropriate management of this patient population are discussed. First, the individual and shared epidemiology and pathophysiology of cataract and KC are reviewed. Then, the theory and approach to intraocular lens power calculation are discussed, highlighting particularities and pitfalls of this exercise when performed in patients with KC. Finally, several special-although not uncommon-management scenarios and questions are addressed, such as surgical planning in cases where corneal stabilization or tissue replacement interventions are also necessitated.

Efficacy and Safety of Sodium Hyaluronate/chondroitin Sulfate Preservative-free Ophthalmic Solution in the Treatment of Dry Eye: A Clinical Trial.

Purpose: To evaluate the efficacy of a preservative free sodium hyaluronate/chondroitin sulfate ophthalmic solution (SH/CS-PF) in patients with dry eye disease (DED).Methods: This was a randomized phase IV, multicentric, prospective, double-blind clinical trial. Intent-to-treat (ITT) and per-protocol (PP) analyses were performed. Patients were assigned to receive either SH/CS-PF, Systane® Ultra (PEG/PG) or Systane® Ultra PF (PEG/PG-PF) for 90 days. A total of 326 patients were included in the ITT, and 217 in the PP analysis. Efficacy endpoints were goblet cell density, Nelson's grades (conjunctival impression cytology), tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), and Schirmer's test. Other parameters included were tolerability, measured by the ocular symptomatology; and safety, measured through corneal staining, intraocular pressure, visual acuity and adverse events.Results: In the ITT, there was a significant increase in mean goblet cell density in all treatments compared with their baseline (28.4% vs 21.4% and 30.8%), without difference between arms (p = .159). Eyes exposed to SH/CS-PF, PEG/PG and PEG/PG-PF showed Grade 0-I squamous metaplasia (85.5%, 87.9% and 93.2%, respectively). Similar improvements were observed for TBUT (1.24 ± 2.3s vs 1.27 ± 2.4s and 1.39 ± 2.3s) and OSDI scores at day 90 (-8.81 ± 8.6 vs -7.95 ± 9.2 and -8.78 ± 9.8), although no significant intergroup difference was found. Schirmer's test also presented improvement compared to baseline (1.38 ± 4.9 vs 1.50 ± 4.7 and 2.63 ± 5.9), with a significantly higher variation for PEG/PG-PF. There were no significant differences between treatments for any tolerability and safety parameter, nor between ITT and PP analyses for any outcome.Conclusions: The topical application of SH/CS-PF is as effective, safe and well tolerated as that of PEG/PG or PEG/PG-PF. The results suggest that SH/CS-PF may lead to normalization of clinical parameters and symptom alleviation in patients treated for DED.

Our experience after 1765 intravitreal injections of bevacizumab: the importance of being part of a developing story.

This retrospective report describes our 20 months'experience using intravitreal injections of bevacizumab for the treatment of several retinal diseases. We describe our experience after 1765 intravitreal injections of bevacizumab in the treatment of different proliferative retinopathies - retinopathy of prematurity, choroidal neovascularization, diabetic retinopathy, among others. We believe that the findings reported in this study move us closer to a better treatment for different pathologies. However, further studies need to be performed in order to determine the safety and long-term efficacy of intravitreal bevacizumab either as first line therapy, after failure of conventional therapy, or in combination with conventional therapy.

Confocal microscopy of corneal flap microfolds after LASIK.

PURPOSE: To describe the morphological characteristics of microfolds that appear at the corneal flap after LASIK, as seen under confocal microscopy. METHODS: Twenty-one eyes that had undergone LASIK were examined, all within 3 weeks to 1 month after surgery. A central scan of the total corneal thickness was obtained by using confocal microscopy in vivo. Confocal images were captured and digitized. The longitudinal orientation (vertical, horizontal, and oblique) and morphological characteristics of the microfolds were described and recorded. RESULTS: Six eyes had folds at the central corneal flap, visible as linear distortions in the confocal images: one fold had a vertical orientation, two were horizontal, and three were oblique. The folds were visible from the epithelial basal cell layer to the stromal portion of the flap and were deeper than Bowman's layer. CONCLUSIONS: Confocal microscopy allowed visualization of microfolds after LASIK. With the appropriate software, it is possible to analyze the morphological characteristics of these folds. Flap microfolds after LASIK are deeper than Bowman's layer.

A corneal diffuse neurofibroma as a manifestation of von recklinghausen disease.

PURPOSE: To report a case of a primary corneal diffuse neurofibroma in a patient with von Recklinghausen disease (NF-1). METHODS: Case report. A physical examination and histopathology were performed. The immunohistochemical studies were performed using an avidin-biotin-peroxidase complex technique on formalin-fixed and paraffin-embedded tissue. Histologic sections from corneal tissue were incubated with primary antibodies against vimentin and S-100 protein. A complementary ultrastructural study of the same formalin-fixed and paraffin-embedded tissue was made. RESULTS: The ophthalmologic examination revealed a yellowish-white elevated mass that involved the supratemporal cornea but not the limbus. Histologic study showed a tumor of the peripheral nerve sheath, a diffuse neurofibroma in the corneal stroma, and proliferation of spindle cells with markedly elongated nuclei. Cells comprising the tumor reacted with vimentin and S-100 protein, and the ultrastructural studies revealed myelinated nerve fibers confirming the diagnosis. CONCLUSION: The development of a primary diffuse neurofibroma in the cornea of patients with von Recklinghausen disease is possible. The present case supports the statement that neurofibromas arising from the peripheral nerve sheath may involve any part of the body.

Cambios en el estroma corneal in vivo secundarios a quemadura por álcali / In vivo corneal stroma changes secondary to alkali burn

Objetivo: Observar y describir, mediante microscopía confocal, los cambios asociados al proceso de cicatrización de quemadura por álcali, en córneas sanas de conejo. Método: Se realizó microscopía confocal (ConfoScan 2.0, Fortune Technologies Srl.,Italy) para el análisis morfológico del proceso de cicatrización corneal secundaria a quemadura por álcali, previo a la quemadura, a la semana, al mes y a los tres meses. Resultados: Se observó una cicatriz subepitelial cuya densidad aumenta al profundizar al estroma anterior, desde la primer semana hasta 3 meses después. El epitelio se encontró re-epitelizado desde la primer semana a la quemadura por álcali. Conclusiones: La microscopía confocal demuestra la pronta recuperación del epitelio corneal de los conejos, no obstante se requiere de un estudio a mayor largo plazo para determinar si existen cambios en el proceso de cicatrización del estroma corneal.

Microscopia confocal de la córnea / Confocal microscopy of the cornea

Objetivo: Analizar las estructuras celulares corneales mediante microscopia confocal en córneas aparentemente sanas. Método: Se realizó microscopia confocal (ConfoScan 2.0, Fortune Tecnologies Srl., Italy) para el análisis morfológico de las diferentes estructuras corneales, in vivo, de manera no invasiva y en tiempo real a 10 córneas. Resultados: Se observó el epitelio superficial, las células basales epiteliales, el plexo nervioso subepitelial, el estroma y el endotelio corneal. Conclusiones: Hemos demostrado la utilidad del microscopio confocal para observar y analizar la población celular corneal, lo cual tiene un papel potencial en la valoración de los cambios dinámicos y estructurales de importancia en el diagnóstico y evaluación del paciente.