Comparison of mini-simple limbal epithelial transplantation and conjunctival-limbal autograft for the treatment of primary pterygium: a randomised controlled trial.

PURPOSE: The purpose of this double-masked, parallel randomised controlled trial was to compare the recurrence rate and other outcomes between conjunctival-limbal autograft (CLAu) and mini-simple limbal epithelial transplantation (mini-SLET) after excision of pterygium. METHODS: Eligibility criteria for participants was the presence of a primary nasal pterygium extending equally to or greater than two millimetres on the cornea on its horizontal axis from the nasal limbus. The participants were allocated into two groups (CLAu and mini-SLET) using simple randomisation with a table of random numbers. Participants and the outcome assessor were masked to the intervention. The study protocol is listed and available on https://clinicaltrials.gov (Identifier: NCT03363282). RESULTS: A total of 61 eyes were enrolled in the study, 33 underwent CLAu (group 1) and 28 mini-SLET (group 2), all eyes were analysed in each group. At 2, 3, 6 and 12 months the CLAu group exhibited a recurrence of 0%, 6.1%, 8.1% and 8.1%, while the mini-SLET exhibited a recurrence of 0%, 17.9%, 50% and 53.5% (p<0.05). There were no intraoperative or postoperative complications in either of the two groups. CONCLUSION: The findings of this study suggest that mini-SLET has a higher recurrence rate and provides no advantage over CLAu in the treatment of primary pterygium.

Aspectos clínicos de implantes de membrana amniótica no reparo da córnea em cães com úlceras complicadas / Clinical aspects of amniotic membrane implants in corneal repair in dogs with complicated ulcers

Background: Among numerous disorders treated by veterinary ophthalmology, therapies employed to solve corneal ulcers stand out. Amniotic membrane transplantation is an effective surgical technique for the treatment of complicated corneal ulcers in the dog, with highly satisfactory visual and cosmetic outcomes. However, in veterinary ophthalmology, reports on the use of the amniotic membrane and its corneal reconstructive potential are scarce. The objective of this work was to evaluate, for 21 days, the clinical aspects and the effectiveness of transplantation of canine amniotic membrane for corneal healing in two cases of complicated ulcers in dogs. Cases: Two Shih-Tzu dogs were diagnosed with complicated corneal ulcer. They underwent surgical treatment with the use of a glycerin-preserved canine amniotic membrane implant, which was secured on the cornea or the limbus. A surgical microscope at a magnification of 16x was used. The devitalized tissues at the periphery of the ulcer were excised, and multiple layers of amniotic membranes were sutured onto the cornea and near the limbus with interrupted absorbable suture. Protection of the canine amniotic membrane implants was performed with a scarified third eyelid flap, which was attached to the upper eyelid, and maintained for 14 days. During the first 14 days after the procedure, topical treatment with antibiotic eye drops was administered; protease inhibitors were also used. Antibiotics were used systemically for 10 days. Between days 14 and 21 after the transplantation procedure, protease inhibitors, corticosteroids, and lubricant were administered topically. Healing and clinical aspects were evaluated on days 0, 14, and 21. The parameters evaluated were blepharospasm, dazzle and direct pupillary reflexes, and consensual and threat responses. Corneal vascularization, hypopyon, synechia, opacity, and fluorescein dye penetration into the...(AU)

Aspectos clínicos de implantes de membrana amniótica no reparo da córnea em cães com úlceras complicadas / Clinical aspects of amniotic membrane implants in corneal repair in dogs with complicated ulcers

Background: Among numerous disorders treated by veterinary ophthalmology, therapies employed to solve corneal ulcers stand out. Amniotic membrane transplantation is an effective surgical technique for the treatment of complicated corneal ulcers in the dog, with highly satisfactory visual and cosmetic outcomes. However, in veterinary ophthalmology, reports on the use of the amniotic membrane and its corneal reconstructive potential are scarce. The objective of this work was to evaluate, for 21 days, the clinical aspects and the effectiveness of transplantation of canine amniotic membrane for corneal healing in two cases of complicated ulcers in dogs. Cases: Two Shih-Tzu dogs were diagnosed with complicated corneal ulcer. They underwent surgical treatment with the use of a glycerin-preserved canine amniotic membrane implant, which was secured on the cornea or the limbus. A surgical microscope at a magnification of 16x was used. The devitalized tissues at the periphery of the ulcer were excised, and multiple layers of amniotic membranes were sutured onto the cornea and near the limbus with interrupted absorbable suture. Protection of the canine amniotic membrane implants was performed with a scarified third eyelid flap, which was attached to the upper eyelid, and maintained for 14 days. During the first 14 days after the procedure, topical treatment with antibiotic eye drops was administered; protease inhibitors were also used. Antibiotics were used systemically for 10 days. Between days 14 and 21 after the transplantation procedure, protease inhibitors, corticosteroids, and lubricant were administered topically. Healing and clinical aspects were evaluated on days 0, 14, and 21. The parameters evaluated were blepharospasm, dazzle and direct pupillary reflexes, and consensual and threat responses. Corneal vascularization, hypopyon, synechia, opacity, and fluorescein dye penetration into the...

Autoinjerto limboconjuntival con membrana amniótica en la insuficiencia límbica total unilateral / Limbal-conjunctival autograft with amniotic membrane to treat total unilateral limbal stem cell deficiency

Se presentan tres ojos de tres pacientes con insuficiencia límbica total por quemadura alcalina grave (n= 2), con enfermedad de Coats y antecedentes de cirugía de desprendimiento de retina (n= 1). Los casos uno y dos tenían una evolución de las quemaduras de 2 años y 8 meses respectivamente, y el caso tres de 8 meses. A todos los pacientes se les realizó la misma técnica quirúrgica: peritomía a 360º, extirpación de la membrana corneal fibrovascular, autoinjerto limboconjuntival (donante del ojo homólogo sano) y la implantación de membrana amniótica. El caso 1, con agudeza visual corregida preoperatoria de percepción de luz y sentido cromático en el ojo derecho, alcanzó a los 12 meses una agudeza visual corregida de 0,3 y a los 13 años, con +1,50-0,50 x 90º, una visión de 0,9. El caso 2, con agudeza visual preoperatoria de bultos a 20 centímetros, logró a los dos años una agudeza visual de 0,6; y el caso 3, con visión preoperatoria de percepción de luz, alcanzó una visión de 0,05 (20/500). En todos los casos el autoinjerto limbo-conjuntival del ojo homólogo sano con implantación de membrana amniótica constituyó una excelente alternativa para la mejoría visual y la rehabilitación laboral de los dos primeros pacientes. En el caso uno se logró un resultado extraordinario. El caso 3 logró una reepitelización corneal total y una evidente mejoría de la transparencia corneal, pero por la enfermedad de base la agudeza visual solo mejoró discretamente(AU)

Three eyes of three patients with grave alkali burns (n-2) and with Coats disease after retinal detachment surgery (n-1). All of the cases presented a total limbal stem cells deficiency. Cases 1 and 2 had an burning evolution of 2 years and 8 months respectively, and the case 3 an evolution of 8 months before surgery. All patients underwent the same operation: Peritomy 360º, keratectomy of corneal fibrovascular membrane, limbo-conjuntival autograft from the healthy fellow eye and implantation of amniotic membrane. Case number 1 with preoperatory visual acuity of light perception and projection improved to 0,3 his visual acuity after 12 months and with +1,50-0,50 x 90 a visual acuity 0,9 after 12 years. Case 2 with preoperatory visual acuity of counter finger at 20 centimeters improved his visual acuity 0,6 after two years, and case 3 with preoperatory visual acuity of light perception improved to 0,05 (20/500). In all cases, limbal-conjunctival autograft of the healthy fellow eye with amniotic membrane transplantation resulted an excellent option for improving visual acuity and laborer rehabilitation in cases 1 and 2 (achieving case 1 excellent visual acuity). Case 3 had a total corneal epithelization and an evident improvement in corneal transparency, but visual acuity had a little improvement due to base disease(AU)

Comparison of clinical outcomes between limbal relaxing incisions and toric intraocular lenses in eyes with astigmatic corneas / Comparação de resultados clínicos entre incisões relaxantes limbares e lentes intraoculares tóricas em olhos com córneas astigmáticas

Objective: To compare refractive and vectorial outcomes of limbal relaxing incisions (LRI) versus toric intraocular lenses (IOL) in the treatment of preexisting corneal astigmatism at the time of phacoemulsification. Methods: This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism between 0.75 and 2.50 diopters in both eyes. Patients were randomly assorted in two groups: one assigned to receive AcrySof Toric™ IOL in both eyes, and another one assigned to have AcrySof Natural™ IOL associated with LRI, also in both eyes. All patients were re-evaluated, postoperatively, at 1, 3 and 6 months, when refractive astigmatism analysis was performed using vectorial methods proposed by Thibos. Variability of outcomes within each group and between groups were assessed and compared. Results: Manifest refractive cylinder, in diopters (D), as means ± standard deviation, in the LRI group for 1-month, 3-month and 6-month re-evalutions were respectively -0.66 ± 0.30; -0.70 ± 0.21 and -0.74 ± 0.26 when compared to -0.58 ± 0.24; -0.63 ± 0.20, and -0.62 ± 0.17 in the toric IOL group. (p value ≥ 0.06). Vectorial analysis evidenced greater astigmatism reduction in the toric IOL group in the 6th postoperative month, when postoperative mean astigmatic power vector was 0.31 D, when compared to 0.37 D in the LRI group (p value = 0.00). Conclusions: A trend of slightly better refractive outcomes favoring toric IOL group was seen, although such a trend was not statistically significant. Vectorial analysis, however, suggests that the use of toric IOL may constitute a more advantageous approach in the treatment of pre-existing corneal astigmatism, simultaneously with phacoemulsification. .

Objetivo: Comparar os resultados refracionais e de análise vetorial, das incisões relaxantes limbares (IRL) versus lentes intraoculares (LIO) tóricas no tratamento do astigmatismo corneano pré-existente por ocasião da facoemulsificação. Métodos: Estudo observacional longitudinal (série de casos) no qual foram avaliados 62 olhos de 31 pacientes consecutivos de catarata com astigmatismo corneano pré-operatório entre 0,75 e 2,50 dioptrias para ambos os olhos. Os pacientes foram aleatoriamente distribuídos entre 2 grupos: um submetido a implante de LIO AcrySof Toric™ em ambos os olhos e outo grupo no qual seriam implantas LIO AcrySof Natural™ complementada por IRL, também em ambos os olhos. Todos os pacientes foram reavaliados com 1, 3 e 6 meses de pós-operatório, sendo feitas análises do astigmatismo refracional pelo métodos vetorial proposto por Alpins, interessando a variação de resultados dentro de cada grupo e entre os grupos. Resultados: O cilindro refracional manifesto, em dioptrias, expresso como média ± desvio padrão, para o grupo IRL, nas avaliações de 1, 3 e 6 meses, foram respectivamente -0,66 ± 0,30; -0,70 ± 0,21 e -0,74 ± 0,26 em comparação aos -0,58 ± 0,24; -0,63 ± 0,20 and -0,62 ± 0,17 do grupo LIO tórica (valor de p ≥ 0,06). A análise vetorial evidenciou maior redução no astigmatismo no grupo LIO tórica no 6º mês pós-operatório, para o qual vetor de poder astigmático médio foi de 0,31 D, comparado ao de 0,37 D do grupo IRL (valor de p = 0,00). Conclusões: Tendência a melhores resultados refracionais favorecendo o grupo LIO tórica foi encontrada, entretanto, significância estatística não foi evidenciada ao longo do estudo. A análise vetorial, sugere ...

Alpins and thibos vectorial astigmatism analyses: proposal of a linear regression model between methods / Análises vetoriais de alpins e thibos para o astigmatismo - proposta de modelo de regressão linear entre os métodos

PURPOSE: To determine linear regression models between Alpins descriptive indices and Thibos astigmatic power vectors (APV), assessing the validity and strength of such correlations. METHODS: This case series prospectively assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism between 0.75 and 2.50 diopters in both eyes. Patients were randomly assorted among two phacoemulsification groups: one assigned to receive AcrySof®Toric intraocular lens (IOL) in both eyes and another assigned to have AcrySof Natural IOL associated with limbal relaxing incisions, also in both eyes. All patients were reevaluated postoperatively at 6 months, when refractive astigmatism analysis was performed using both Alpins and Thibos methods. The ratio between Thibos postoperative APV and preoperative APV (APVratio) and its linear regression to Alpins percentage of success of astigmatic surgery, percentage of astigmatism corrected and percentage of astigmatism reduction at the intended axis were assessed. RESULTS: Significant negative correlation between the ratio of post- and preoperative Thibos APVratio and Alpins percentage of success (%Success) was found (Spearman's ρ=-0.93); linear regression is given by the following equation: %Success = (-APVratio + 1.00)x100. CONCLUSION: The linear regression we found between APVratio and %Success permits a validated mathematical inference concerning the overall success of astigmatic surgery.

OBJETIVO: Estabelecer modelos de regressão linear entre os índices propostos por Alpins com os vetores astigmáticos de Thibos, avaliando a validade e a força dessas correlações. MÉTODOS: Série de casos na qual foram avaliados prospectivamente 62 olhos de 31 pacientes de catarata com astigmatismo corneano pré-operatório entre 0,75 e 2,50 dioptrias para ambos os olhos. Os pacientes foram aleatoriamente distribuídos entre 2 grupos: um submetido a implante de lente intraocular (LIO) AcrySof ToricTM em ambos os olhos e outro grupo, no qual seriam implantadas LIO AcrySof NaturalTM complementada por incisões relaxantes limbares, também em ambos os olhos. Todos os pacientes foram reavaliados aos 6 meses de pós-operatório, sendo feitas análises do astigmatismo refracional tanto pelo método vetorial proposto por Alpins, quanto pelo proposto por Thibos. A razão entre os vetores astigmáticos pós e pré-operatórios de Thibos (VApós/pré), bem como a correlação linear com o percentual de sucesso da cirurgia do astigmatismo, o percentual de astigmatismo corrigido e o percentual de redução do astigmatismo no eixo pretendido, propostos por Alpins, foram avaliados. RESULTADOS: Foi encontrada correlação negativa significativa entre a VApós/pré de Thibos e o percentual de sucesso da cirurgia do astigmatismo (%Successo), de Alpins (ρ de Spearman=-0.93); regressão linear dada pela seguinte equação: %Successo = (-VApós/pré + 1,00)x100. CONCLUSÃO: A regressão linear encontrada entre VApós/pré e %Successo permite uma inferência matemática validada a respeito do sucesso de cirurgia do astigmatismo em termos gerais.

Alteraciones en el endotelio corneal después de la facoemulsificación por técnica de pre chop versus extracción tunelizada esclerocorneal del cristalino / Alterations of the corneal endothelium after prechop phacoemulsification versus tunnelized scleracorneal extraction of the crystalline

Objetivo: evaluar los cambios endoteliales y resultados visuales en los ojos de pacientes con diagnóstico de catarata senil, operados por técnica de facoemulsificación por pre chop o extracción extracapsular del cristalino por túnel esclerocorneal.Métodos: se realizó un estudio descriptivo y prospectivo de 100 pacientes (ojos) atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, de septiembre a diciembre de 2010. La mitad fueron operados por facoemulsificación y el resto por túnel esclerocorneal. Se analizaron las variables: mejor agudeza visual corregida y sin corrección, dureza del cristalino, conteo celular endotelial, hexagonalidad, coeficiente de variabilidad, astigmatismo medio inducido y tiempo efectivo de ultrasonido...

Objective: to evaluate the endothelial changes occurred and the visual results achieved in the eyes of patients diagnosed with senile cataract, who were operated on either by the prechop phacoemulsification technique or by the extracapsular extraction of the crystalline through the scleracorneal tunnel.Methods: a prospective and descriptive study of 100 patients (eyes) seen at Ramón Pando Ferrer Cuban Institute of Ophthalmology from September to December 2010 was conducted. One half was operated on by phacoemulsification whereas the other underwent scleracorneal tunnelized extraction. The analyzed variables were: best uncorrected and corrected visual acuity, endothelial cellular count, hexagonality, variability coefficient, mean induced astigmatism and effective phaco time...

Restoration of the rabbit corneal surface after total epithelial debridement and complete limbal excision.

How is the corneal epithelium restored when all of it plus the limbus have been eliminated? This investigation explored the possibility that this may be achieved through the conjunctival epithelium. The corneal epithelium of the right eye of 12 rabbits (Oryctolagus cuniculus) was totally scraped followed by surgical excision of the limbus plus 1.0-1.5 mm of the adjacent conjunctiva. Antibiotics and corticosteroids were applied for 1 week after surgery. Histological and immunohistochemical techniques were used to monitor the events taking place on the eye surface 2 weeks and 1, 3 and 6 months thereafter. Initially, the corneal surface was covered by conjunctival-like epithelium. After 1 month and more prominently at 3 and 6 months an epithelium displaying the morphological features of the cornea and reacting with the AE5 antibody was covering the central region. It is likely that the corneal epithelium originated from undifferentiated cells of the conjunctiva interacting with the corneal stroma.

Cytological features of live limbal tissue donor eyes for autograft or allograft limbal stem cell transplantation.

PURPOSE: To evaluate by impression cytology (IC) the corneal surface of live limbal tissue donor eyes for autograft or allograft limbal stem cell transplantation (LSCT). METHODS: Twenty limbal donors were enrolled (17 for autograft LSCT and 3 for allograft). Impression cytology was performed before transplantation of superior and inferior limbal grafts and after the third postoperative month. RESULTS: Impression cytology analysis showed sheets of corneal epithelial cells and goblet cell absence beyond the edge of the keratectomy sites in all patients, suggesting that conjunctival invasion towards the center did not occur in any eye. Partial conjunctivalization within 2 to 3 clock hours, confirmed by the presence of goblet cells, was limited to the keratectomy site in 10% of the cases. CONCLUSION: A clear central corneal surface was demonstrated in all eyes following surgery leading to the conclusion that limbal donation was a safe procedure in this group of patients. A small percentage of eyes can have donor sites re-epithelized with conjunctival cells at the periphery of the cornea.

Cytological features of live limbal tissue donor eyes for autograft or allograft limbal stem cell transplantation / Características citológicas do tecido límbico de doador vivo para transplante autólogo ou alógeno de células-tronco epiteliais corneais

PURPOSE: To evaluate by impression cytology (IC) the corneal surface of live limbal tissue donor eyes for autograft or allograft limbal stem cell transplantation (LSCT). METHODS: Twenty limbal donors were enrolled (17 for autograft LSCT and 3 for allograft). Impression cytology was performed before transplantation of superior and inferior limbal grafts and after the third postoperative month. RESULTS: Impression cytology analysis showed sheets of corneal epithelial cells and goblet cell absence beyond the edge of the keratectomy sites in all patients, suggesting that conjunctival invasion towards the center did not occur in any eye. Partial conjunctivalization within 2 to 3 clock hours, confirmed by the presence of goblet cells, was limited to the keratectomy site in 10 percent of the cases. CONCLUSION: A clear central corneal surface was demonstrated in all eyes following surgery leading to the conclusion that limbal donation was a safe procedure in this group of patients. A small percentage of eyes can have donor sites re-epithelized with conjunctival cells at the periphery of the cornea.

OBJETIVO: Avaliar pela citologia de impressão a superfície da córnea de doador vivo para transplante autólogo ou alógeno de células-tronco epiteliais. MÉTODOS: Vinte pacientes doadores de tecido límbico foram avaliados (17 para transplante autólogo e 3 para alógeno). Os exames citológicos foram realizados em dois momentos: antes da ceratectomia, que removeu tecido límbico dos quadrantes superior e inferior, e após o terceiro mês pós-operatório. RESULTADOS: Invasão de células da conjuntiva em direção ao centro além da margem da ceratectomia não ocorreu em nenhum olho estudado. Uma pequena área de conjuntivalização parcial, confirmada pela presença de células caliciformes, foi detectada dentro do limite da ceratectomia em 10 por cento dos casos. CONCLUSÃO: A superfície central da córnea manteve-se transparente demonstrando que a manipulação de tecido límbico em doador vivo foi um procedimento seguro neste grupo de pacientes. Uma pequena porcentagem dos olhos pode ter o local do sítio da ceratectomia re-epitelizado com células da conjuntiva sobre a periferia da córnea.

Rosai-Dorfman disease manifesting as an epibulbar ocular tumour.

The authors report a rare case of extranodal Rosai-Dorfman disease without systemic involvement. A 14-year-old girl presented with a slowly progressive, non-tender, well-circumscribed, perilimbal nodule in the right eye. Excisional biopsy was performed and histopathologic and immunohistochemical analysis established the diagnosis. Systemic evaluation revealed no other masses. After complete excision of the epibulbar lesion, the patient is asymptomatic and remains on regular follow up with no signs of recurrence. Rosai-Dorfman disease is an infrequent, benign histiocytic disorder that can rarely manifest as an exclusive extranodal mass. We report a case of solitary epibulbar Rosai-Dorfman disease, successfully treated with complete surgical excision of the lesion.

Corneal reconstruction with tissue-engineered cell sheets composed of human immature dental pulp stem cells.

PURPOSE: To determine the outcome of the use of a tissue-engineered cell sheet composed of human undifferentiated immature dental pulp stem cells (hIDPSC) for ocular surface reconstruction in an animal model of total limbal stem cell deficiency (LSCD). METHODS: LSCD was induced by the application of 0.5 M NaOH to the right eye of rabbits for 25 seconds (mild chemical burn [MCB]) and for 45 seconds (severe chemical burn [SCB]). After 1 month, a superficial keratectomy was performed to remove the fibrovascular pannus that covered the animals' burned corneas. A tissue-engineered hIDPSC sheet was transplanted onto the corneal bed and then covered with deepithelialized human amniotic membrane (AM). In the respective control groups, the denuded cornea was covered with AM only. After 3 months, a detailed analysis of the rabbit eyes was performed with regard to clinical aspect, histology, electron microscopy, and immunohistochemistry. RESULTS: Corneal transparency of the rabbit eyes that underwent hIDPSC transplantation was improved throughout the follow-up, while the control corneas developed total conjunctivalization and opacification. Rabbits from the MCB group showed clearer corneas with less neovascularization. The clinical data were confirmed by histologic analysis that showed healthy uniform corneal epithelium, especially in the MCB group. The presence of hIDPSC was detected using an anti-hIDPSC antibody. The corneal tissue also showed positive immunostaining with anti-human antibodies. In the control corneas, none of these antigens were detected. CONCLUSIONS: Overall, these data showed that transplantation of a tissue-engineered hIDPSC sheet was successful for the reconstruction of corneal epithelium in an animal model of LSCD.

Effect of amniotic membrane transplantation on corneal healing and proteoglycan expression in an experimental model of limbal deficiency in rabbits.

PURPOSE: Amniotic membrane transplantation (AMT) has been used as a graft or as a dressing in ocular surface reconstruction, facilitating epithelization, maintaining normal epithelial phenotype, and reducing inflammation, vascularization, and scarring. The corneal transparency is due, at least in part, to the arrangement in orthogonal lamellae of collagen fibrils, surrounded by proteoglycans (PGs). These PGs regulate fibrilogenesis, the matrix assembly, and ultimately the corneal transparency. The purpose of the present study was to investigate the effects of AMT upon the corneal PGs after severe limbal injury. METHODS: Experiments were performed on the right corneas of 22 New Zealand female albino rabbits, and their left corneas were used as matched controls. These animals were divided into 3 groups: G1 (n=10): total peritomy and keratolimbectomy, followed by application of 0.5 M NaOH; G2 (n=10): submitted to the same trauma as G1, and treated by AMT; G3: no trauma, only AMT (n=2). The right corneas of G2 and G3 were covered by DMSO4 cryopreserved human amniotic membrane, fixed by interrupted 9-0 mononylon sutures, with its stromal face toward the ocular surface. After 7 or 30 days, the corneas were removed and PGs were extracted. RESULTS: Normal corneas contained approximately 9 mg of PGs per gram of dry tissue. AMT on intact cornea (G3) did not cause any changes in the concentration of PGs. In contrast, injured corneas contained much less PGs, both on the seventh and on the 30th day posttrauma. The PG concentration was even lower in injured corneas treated by AMT. This decrease was due almost exclusively to dermatan sulfate PGs, and the structure of dermatan sulfate was also modified, indicating changes in the biosynthesis patterns. CONCLUSIONS: Although beneficial effects have been observed on clinical observation and concentration of soluble proteins after AMT, the normal PG composition of cornea was not attained, even 30 days postinjury, indicating that the normal ocular surface reconstruction, if possible, is a long-term process.

[Limbal relaxing incision or the more curved meridian incision associated to phacoemulsification with multifocal intraocular lens implant: three case reports]. / Incisões relaxantes limbares ou incisões no meridiano mais curvo associadas a facoemulsificação com implante de lente intra-ocular multifocal: relato de três casos.

The use of multifocal intraocular lenses (IOLs) is a great advance in the treatment of patients with cataract allowing near and distance uncorrected visual acuity recovery. However patients with some degrees of corneal astigmatism have some limitations. We present 3 cases that were indicated for phacoemulsitfication and multifocal intraocular lens implant (AcrySof Restor, Alcon Labs) after limbal relaxing incision (LRI) in the dominant eye and axis topographic incision in the fellow eye. There was no similar case report in the literature. It is believed that this association can extend the indications for multifocal intraocular lens implants in patients with significant corneal astigmatism and this possibility should be confirmed by future studies.

Proliferation of the vascular endothelium of the iris following total debridement of the corneal epithelium and limbal excision of rabbits.

BACKGROUND: Damage to the corneal epithelium causes not only a reaction for its repair but also affects other parts of the cornea as well as different components of the anterior segment of the eye. The purpose of this investigation was to analyze the consequences, following epithelial and limbal damage, to the iris of rabbits (Oryctolagus cuniculus). METHODS: The corneal epithelium was thoroughly scraped followed by surgical excision of the limbus. Next, (3)H-thymidine ((3)H-TdR) was injected intravitreally both into the right (experimental) and left (control) eyes which had their anterior segments processed for autoradiography at intervals of 2, 7 and 21 days after surgery (three rabbits per interval). The irises were also examined with scanning-electron and confocal microscopy after Evans blue injection. RESULTS: There was a high frequency of labeling in the cells of the iris blood vessels in the experimental eye, particularly the endothelial ones. The ratio of labeled cells between experimental and control irises was 40:1, with a population of nuclei increasing by 25% and remaining labeled up to 21 days. There was also an increase in the volume of the iris vasculature as shown by confocal microscopy. The high labeling frequencies of the vascular cells were observed throughout the iris from the ciliary to the pupillary regions. CONCLUSIONS: The lesions on the corneal epithelium elicit proliferation of the iris vascular cells, mainly its endothelium, as well as an early breakdown of the blood-aqueous barrier. The daughter cells resulting from the damage to the eye surface were detected up to 21 days after a single injection of (3)H-TdR, most likely due to their slow turnover. As a consequence of this proliferation, the vasculature of the iris increased in volume.

Incisões relaxantes limbares ou incisões no meridiano mais curvo associadas a facoemulsificação com implante de lente intra-ocular multifocal: relato de três casos / Limbal relaxing incision or the more curved meridian incision associated to phacoemulsification with multifocal intraocular lens implant: three case reports

O implante de lentes intra-oculares (LIOs) multifocais é um grande avanço na reabilitação de pacientes permitindo boa acuidade visual sem correção óptica para longe e perto. Contudo pacientes com alguns graus de astigmatismo corneano tem indicação limitada. Este artigo relata três pacientes que foram submetidas a facoemulsificação com implante de lentes intra-oculares multifocais (AcrySof® Restor®, Alcon Labs) após incisão relaxante limbar (IRL) no olho dominante e incisão no eixo mais curvo da topografia no olho contralateral. Não foi encontrado nenhuma análise relacionada a dominância ocular e relaxante limbar na literatura. Acredita-se que essa associação pode ampliar as indicações de implante das lentes intra-oculares multifocais em pacientes com astigmatismo corneano significativo, devendo-se confirmar esta possibilidade por meio de futuros estudos.

The use of multifocal intraocular lenses (IOLs) is a great advance in the treatment of patients with cataract allowing near and distance uncorrected visual acuity recovery. However patients with some degrees of corneal astigmatism have some limitations. We present 3 cases that were indicated for phacoemulsitfication and multifocal intraocular lens implant (AcrySof® Restor®, Alcon Labs) after limbal relaxing incision (LRI) in the dominant eye and axis topographic incision in the fellow eye. There was no similar case report in the literature. It is believed that this association can extend the indications for multifocal intraocular lens implants in patients with significant corneal astigmatism and this possibility should be confirmed by future studies.

[Surgical correction of astigmatism during cataract surgery]. / Correção do astigmatismo na cirurgia da catarata.

PURPOSE: To evaluate the effect of peripheral limbar relaxing incisions (PLRI) in the reduction of the astigmatism during cataract surgery. METHODS: We studied prospectively 103 eyes of 103 patients submitted to PLRI, using the Nichamim nomogram during cataract surgery by phacoemulsification. After the first and sixth month we analized the changes in astigmatism topography, induction of astigmatism and success rate. The patients were divided into two groups according to the astigmatism (with-the-rule and against-the-rule), and studied separately. RESULTS: There was a statistically significant change in the mean astigmatism topography in the preoperative and postoperative periods in both groups. There was an induction of 1.10 +/- 0.9 D and 37% of success rate in the with-the-rule group and 1.70 +/- 0.80 D and 51% of success rate in the against-the-rule group after six months of follow-up. CONCLUSIONS: The peripherical relaxing limbal incisions (PLRI) are effective in reducing the preoperative astigmatism during cataract surgery. The procedure is safe and easy. The Nichamin nomogram caused hypocorrection in both types of preoperative astigmatism.

Sclerocorneal limbal stem cell autograft transplantation in dogs / Transplante autógeno de células tronco do limbo esclerocorneal em cães

The effects of sclerocorneal limbal stem cell autograft transplantation in dogs with corneal wounds were studied. Eighteen dogs were divided in two groups (GI and GII). The animals of GI (n=12) underwent limbal transplantation 30 days after the destruction of limbal stem cells. The dogs of GII (n=6) only underwent destruction of stem cells (control group). Light microscopy examination of the right eye was performed on days 3, 7, 14, 30, 60, and 120 after limbal transplantation (GI), and on days 33, 37, 44, 60, 90, and 150 after limbal destruction (GII). Results showed a complete destruction of limbal stem cells with loss of corneal transparency. Limbal transplantation prevented conjunctivalization in grafted area. Corneal vascularization and a 360º corneal conjunctivalization were noted in the control dogs (GII). Corneal transparency was restored from day 60th after surgery. Histological examination did not distinguish the transition between the graft and the normal corneal epithelium at anytime. Goblet cells were found in control animals (GII) on 33, 37, 60, and 150 days, whereas a single grafted dog (GI) presented a few goblet cells on day 60th post-transplantation. Limbal autograft transplantation was effective in restoring corneal clarity with no development of ocular complications(AU)

Avaliaram-se os efeitos do transplante de células tronco autógenas do limbo esclerocórneo de cães, sobre lesões córneo-limbais. Empregaram-se 18 cães, distribuídos em dois grupos, GI e GII. Nos animais do GI (n=12), foram realizados transplantes de limbo, após 30 dias da destruição das células tronco-límbicas. Nos do GII (n=6), realizou-se apenas a destruição do limbo (controle). Aos 3, 7, 15, 30, 60 e 120 dias do transplante de limbo (GI) e aos 33, 37, 45, 60, 90 e 150 dias da destruição do limbo (GII), os olhos foram coletados por enucleação subconjuntival, para estudos em microscopia de luz. A destruição do limbo resultou em completa excisão das células tronco, com perda da transparência corneal. O transplante do limbo evitou a conjuntivalização na área em que foi realizado. Os animais do grupo-controle manifestaram conjuntivalização em 360º e vascularização corneal. Na anatomopatologia, em nenhum dos períodos foi possível distinguir o enxerto do epitélio corneal normal. As células caliciformes foram observadas nos animais do GII, nos períodos 33, 37, 60, 150 dias. No GI, apenas um cão manifestou células caliciformes de forma discreta, aos 60 dias do transplante. O transplante autógeno foi eficiente em possibilitar a melhoria da transparência córnea, sem intercorrências oculares(AU)

Sclerocorneal limbal stem cell autograft transplantation in dogs

The effects of sclerocorneal limbal stem cell autograft transplantation in dogs with corneal wounds were studied. Eighteen dogs were divided in two groups (GI and GII). The animals of GI (n=12) underwent limbal transplantation 30 days after the destruction of limbal stem cells. The dogs of GII (n=6) only underwent destruction of stem cells (control group). Light microscopy examination of the right eye was performed on days 3, 7, 14, 30, 60, and 120 after limbal transplantation (GI), and on days 33, 37, 44, 60, 90, and 150 after limbal destruction (GII). Results showed a complete destruction of limbal stem cells with loss of corneal transparency. Limbal transplantation prevented conjunctivalization in grafted area. Corneal vascularization and a 360º corneal conjunctivalization were noted in the control dogs (GII). Corneal transparency was restored from day 60th after surgery. Histological examination did not distinguish the transition between the graft and the normal corneal epithelium at anytime. Goblet cells were found in control animals (GII) on 33, 37, 60, and 150 days, whereas a single grafted dog (GI) presented a few goblet cells on day 60th post-transplantation. Limbal autograft transplantation was effective in restoring corneal clarity with no development of ocular complications

Avaliaram-se os efeitos do transplante de células tronco autógenas do limbo esclerocórneo de cães, sobre lesões córneo-limbais. Empregaram-se 18 cães, distribuídos em dois grupos, GI e GII. Nos animais do GI (n=12), foram realizados transplantes de limbo, após 30 dias da destruição das células tronco-límbicas. Nos do GII (n=6), realizou-se apenas a destruição do limbo (controle). Aos 3, 7, 15, 30, 60 e 120 dias do transplante de limbo (GI) e aos 33, 37, 45, 60, 90 e 150 dias da destruição do limbo (GII), os olhos foram coletados por enucleação subconjuntival, para estudos em microscopia de luz. A destruição do limbo resultou em completa excisão das células tronco, com perda da transparência corneal. O transplante do limbo evitou a conjuntivalização na área em que foi realizado. Os animais do grupo-controle manifestaram conjuntivalização em 360º e vascularização corneal. Na anatomopatologia, em nenhum dos períodos foi possível distinguir o enxerto do epitélio corneal normal. As células caliciformes foram observadas nos animais do GII, nos períodos 33, 37, 60, 150 dias. No GI, apenas um cão manifestou células caliciformes de forma discreta, aos 60 dias do transplante. O transplante autógeno foi eficiente em possibilitar a melhoria da transparência córnea, sem intercorrências oculares