Hiperplasia endotelial papilar intravascular (tumor de Masson) de la conjuntiva. Ubicación inusual de un tumor vascular endotelial raro / Intravascular papillary endothelial hyperplasia (Masson's tumor) of the conjunctiva. Unusual location of a rare vascular tumor

La hiperplasia endotelial papilar intravascular (IPEH) se caracteriza por la proliferación de células endoteliales generalmente producida dentro de una malformación vascular previa o un tumor. La IPEH suele afectar cuello, cabeza y extremidades inferiores, se han publicado pocos casos en la órbita ocular y párpados. Presentamos un caso único, un hombre de 48 años con una lesión conjuntival púrpura, elevada y multilobular de tres semanas de duración que se sometió a una biopsia excisional. Las características patológicas revelaron una hiperplasia endotelial papilar intravascular (tumor de Masson) (AU)

Intravascular papillary endothelial hyperplasia (IPEH) is characterized by proliferation of endothelial cells usually occurring within a long-standing vascular malformation or tumor. IPEH usually affects neck, head and lower extremities, and few orbital and eyelid cases have been reported. We present a unique case, a 48-year-old man with a purple, elevated, multilobular conjunctival lesion of three-weeks duration that underwent an excisional biopsy. Pathological features revealed intravascular papillary endothelial hyperplasia (Masson's tumor) (AU)

Intravascular papillary endothelial hyperplasia (Masson's tumor) of the conjunctiva. Unusual location of a rare vascular tumor.

Intravascular papillary endothelial hyperplasia (IPEH) is characterized by proliferation of endothelial cells usually occurring within a long-standing vascular malformation or tumor. IPEH usually affects neck, head and lower extremities, and few orbital and eyelid cases have been reported. We present a unique case, a 48-years-old man with a purple, elevated, multilobular conjunctival lesion of three-weeks duration that underwent an excisional biopsy. Pathological features revealed intravascular papillary endothelial hyperplasia (Masson's tumor).

Resultados de Femto-LASIK obtenidos por un fellow durante un programa de formación en cirugía refractiva / Femto-LASIK outcomes obtained by a fellowship trainee during a refractive surgery training program

Objetivo Informar por primera vez sobre los resultados clínicos y la satisfacción de los pacientes operados de cirugía refractiva con láser por un fellow durante un programa de formación en cirugía corneal y refractiva en Latinoamérica. Métodos En este estudio prospectivo e intervencionista se revisaron las historias clínicas de los primeros 100 casos consecutivos de cirugía refractiva realizados por un solo fellow del departamento de córnea de la Asociación para Evitar la Ceguera en México entre marzo de 2018 y junio de 2018. La técnica LASIK asistida por femtosegundo se realizó en todos los ojos. Los resultados visuales y refractivos se evaluaron durante el primer año de seguimiento. La satisfacción del paciente se midió 6 meses después de la cirugía con 5 preguntas creadas por el autor. Resultados Se evaluaron datos de 100 ojos de 50 pacientes consecutivos. Después de 12 meses de la cirugía, la agudeza visual no corregida (AVNC) fue de 0,01logMAR. El equivalente esférico pasó de –3,91±2,28D preoperatoriamente a –0,22±0,28D. No se perdieron líneas en la agudeza visual mejor corregida (AVMC). La refracción manifiesta se mantuvo estable durante el primer año después de la cirugía. Las 5 preguntas creadas por el autor revelaron un alto grado de confianza y satisfacción del paciente. Conclusiones Los resultados refractivos y visuales obtenidos mediante Femto-LASIK por un fellow de cirugía corneal y refractiva fueron buenos. Del mismo modo se demostró una alta satisfacción y confianza del paciente en el cirujano en periodo de aprendizaje en un centro formativo de cirugía refractiva en Latinoamérica (AU)

Purpose To report, for the first time, the clinical outcomes and patient satisfaction of laser refractive surgery performed by a trainee during a corneal and refractive surgery fellowship program in Latin America. Methods This prospective and interventionist study reviewed the clinical charts of the first 100 consecutive refractive surgery cases performed by a single Cornea Fellowship trainee between March 2018 and June 2018 in the Blindness Prevention Association of Mexico (Asociación para Evitar la Ceguera en Mexico). Femtosecond LASIK was performed in all eyes. Visual and refractive outcomes were evaluated during the first year of follow-up. Patient satisfaction was measured using 5 author-created questions 6 months after surgery. Results Data of 100 eyes of 50 consecutive patients were evaluated. One year after the surgery, mean uncorrected distance visual acuity (UDVA) was 0.01logMAR. Spherical equivalent error passed from –3.91±2.28D preoperatively to –0.22±0.28D. No eyes lost lines in corrected distance visual acuity (CDVA). Manifest refraction maintained stable during the first year after surgery. The five author-created questions revealed a high level of confidence and patient satisfaction. Conclusions Femto-LASIK performed by a corneal and refractive surgery fellowship trainee showed good refractive and visual outcomes, as well as high patient satisfaction and confidence in a refractive surgery centre in Latin America (AU)

Femto-LASIK outcomes obtained by a fellowship trainee during a refractive surgery training program.

PURPOSE: To report, for the first time, the clinical outcomes and patient satisfaction of laser refractive surgery performed by a trainee during a corneal and refractive surgery fellowship program in Latin America. METHODS: This prospective and interventionist study reviewed the clinical charts of the first 100 consecutive refractive surgery cases performed by a single Cornea Fellowship trainee between March 2018 and June 2018 in the Blindness Prevention Association of Mexico (Asociación para Evitar la Ceguera en Mexico). Femtosecond LASIK was performed in all eyes. Visual and refractive outcomes were evaluated during the first year of follow-up. Patient satisfaction was measured using 5 author-created questions 6 months after surgery. RESULTS: Data of 100 eyes of 50 consecutive patients were evaluated. One year after the surgery, mean uncorrected distance visual acuity (UDVA) was 0.01 logMAR. Spherical equivalent error passed from -3.91 ± 2.28 D preoperatively to -0.22 ± 0.28 D. No eyes lost lines in corrected distance visual acuity (CDVA). Manifest refraction maintained stable during the first year after surgery. The five author-created questions revealed a high level of confidence and patient satisfaction. CONCLUSIONS: Femto-LASIK performed by a corneal and refractive surgery fellowship trainee showed good refractive and visual outcomes, as well as high patient satisfaction and confidence in a refractive surgery centre in Latin America.

Susceptibility of All Nymphal Stages of Bemisia tabaci Biotype B (Hemiptera: Aleyrodidae) to Three Brazilian Isolates of Cordyceps sp. (Hypocreales: Cordycipitaceae) in a Screenhouse Under Variable Temperature and Moisture Conditions.

The susceptibility of 1st to 4th instars of Bemisia tabaci (Gennadius, 1989) (Hemiptera: Aleyrodidae) to three isolates of Cordyceps sp. (Hypocreales: Cordycipitaceae) was evaluated in screenhouse experiments under variable temperatures and moisture conditions. No differences in susceptibility to the Cordyceps sp. isolates were observed among 1st, 2nd, and 3rd instar nymphs with respect to median lethal time (LT50) values. Confirmed mortalities ranged from 63.7 to 87.8% when the isolates were tested at 5 × 107 conidia mL-1. The 4th instar was the least susceptible to the fungal isolates (≤ 36.6% mortality). However, 60.0 to 99.5% of the adults that emerged from 4th instar nymphs previously treated with the fungus succumbed to the infection. Temperature was more detrimental to Cordyceps sp. virulence towards B. tabaci nymphs than relative humidity (RH). At similar RH, median LT50 for 1st instar (9.4 days) was higher than for 3rd instar (5.3 days) when the fungus was tested at 5 × 107 conidia mL-1; minimal temperatures of ≥ 12.6°C compared to ≥ 17.0°C were registered for experiments with 1st and 3rd instars, respectively. However, temperatures ≥ 35°C for 4 to 6 h daily did not affect the efficacy of the fungus against nymphs. Cordyceps sp. showed high virulence to all life stages of B. tabaci at relatively low RH, and an ability to grow extensively over the leaf surface and to produce high amounts of conidia on infected hosts. These attributes certainly boost its potential as an important pest control component of B. tabaci biotype B, especially for management of populations resistant to synthetic insecticides.

First record of epizootics in the ocola skipper, Panoquina ocola (Lepidopera: Hesperiidae), caused by Isaria tenuipes in flooded rice fields of Central Brazil.

AIMS: We report the first occurrence of an epizootic of the ascomycete fungus, Isaria tenuipes (teleomorph Cordyceps takaomontana), on the ocola skipper Panoquina ocola (Lepidoptera: Hesperiidae), an insect pest affecting rice in Brazil. METHODS AND RESULTS: Field surveys in flooded rice fields in the state of Goiás in Brazil were conducted, and a fungal pathogen of a caterpillar pest (P. ocola) was serendipitously found. This fungus inflicted high infection levels (average 86·2%) mainly to the pupal stage during warm, humid growing conditions. Typically, mycosed pupal cadavers produced milky-white to pale yellow synnemata bearing an average of 1·1 ± 0·2 × 109 conidia per cadaver. Based on phylogenetic analysis using beta-tubulin gene sequences, we confirmed that all 12 isolates obtained from field-mummified pupae were identifiable as I. tenuipes. CONCLUSIONS: Our data expand our knowledge on the host and geographical ranges of this mycopathogen and underscore its epizootic potential to affect a lepidopterous insect pest on rice in Brazil. This finding may facilitate the exploitation of this fungus as a mycoinsecticide. SIGNIFICANCE AND IMPACT OF THE STUDY: Isaria tenuipes may be used as an effective and environmentally friendly bioinsecticide against agricultural caterpillar pests due to its epizootic potential, as well as explored for medicinal purposes by pharmaceutical industry.

Análisis de nervios estromales en pacientes con queratocono / Comparison of stromal corneal nerves between normal and keratoconus patients using confocal microscopy

OBJETIVO: Evaluar las diferencias de los nervios del estroma de la córnea entre sujetos normales y pacientes con queratocono. MÉTODOS: Un total de 140 ojos de 70 sujetos normales (grupo A) y 122 ojos de 87 pacientes con queratocono (grupo B), fueron evaluados con el microscopio confocal, realizando un rastreo central del espesor total de la córnea. La morfología y el espesor de los nervios fueron evaluados utilizando el programa Navis V. 3.5.0. El espesor de los nervios se obtuvo del promedio de la porción más delgada y la más gruesa de cada nervio. RESULTADOS: Los nervios del estroma se observaron como estructuras lineales de alta reflexión e irregulares, con porciones gruesas y angostas en todos los casos. El promedio del espesor de los nervios en el grupo A fue de 5,7 ± 1,7 (rango de 3,3 a 10,4 μ), en el grupo B fue de 7,2 ± 1,9 (rango de 3,5 a 12,0 μ). La diferencia en el espesor de los nervios entre el grupo A y el grupo B fue estadísticamente significativa (p < 0,05). CONCLUSIONES: La morfología de los nervios del estroma de la córnea fue similar en ambos grupos; el espesor de estos fue mayor en los pacientes con queratocono

OBJECTIVE: To evaluate the differences in stromal corneal nerves between normal patients and keratoconus patients. MATERIAL AND METHODS: A total of 140 eyes of 70 normal patients (group A) and 122 eyes of 87 keratoconus patients (group B) were examined with the confocal microscope, with a central scan of the total corneal thickness being taken. The morphology and thickness of the corneal stromal nerves were evaluated by using the Navis V. 3.5.0. software. Nerve thickness was obtained from the mean between the widest and the narrowest portions of each stromal nerve. RESULTS: Corneal stromal nerves were observed as irregular linear hyper-reflective structures with wide and narrow portions in all cases. Mean corneal stromal nerves thickness in group A was 5.7 ± 1.7 (range from 3.3 to 10.4 μ), mean corneal stromal nerves thickness in group B was 7.2 ± 1.9 (range from 3.5 to 12.0 μ). There was a statistical significant difference (P<0.05) in stromal corneal nerves thickness between group A and group B. CONCLUSION: Stromal corneal nerves morphology was similar in both groups, but stromal nerves were thicker in keratoconus patients

Comparison of stromal corneal nerves between normal and keratoconus patients using confocal microscopy.

OBJECTIVE: To evaluate the differences in stromal corneal nerves between normal patients and keratoconus patients. MATERIAL AND METHODS: A total of 140 eyes of 70 normal patients (group A) and 122 eyes of 87 keratoconus patients (group B) were examined with the confocal microscope, with a central scan of the total corneal thickness being taken. The morphology and thickness of the corneal stromal nerves were evaluated by using the Navis v. 3.5.0. software. Nerve thickness was obtained from the mean between the widest and the narrowest portions of each stromal nerve. RESULTS: Corneal stromal nerves were observed as irregular linear hyper-reflective structures with wide and narrow portions in all cases. Mean corneal stromal nerves thickness in group A was 5.7±1.7 (range from 3.3 to 10.4 µ), mean corneal stromal nerves thickness in group B was 7.2±1.9 (range from 3.5 to 12.0 µ). There was a statistical significant difference (P<.05) in stromal corneal nerves thickness between group A and group B. CONCLUSION: Stromal corneal nerves morphology was similar in both groups, but stromal nerves were thicker in keratoconus patients.

Asociación de membranas epirretinianas con edema macular en pars planitis / Association of epiretinal membranes with macular edema in pars planitis

INTRODUCCIÓN: La pars planitis (PP) es una uveítis intermedia idiopática que presenta múltiples complicaciones en el segmento posterior, las cuales incluyen el edema macular quístico o cistoideo (EM) y la formación de membranas epirretinianas (MER). Comúnmente se decide realizar tratamiento antiinflamatorio o inmunosupresor ante la presencia de EM. Sin embargo, este puede coexistir con la presencia de MER y, por lo tanto, existe la posibilidad de que el enfoque del tratamiento deba ser diferente. OBJETIVOS: Determinar la asociación que existe entre la presencia de MER con EM en PP. MATERIALES Y MÉTODOS: Serie de casos y controles donde se analizaron de manera retrospectiva los expedientes de pacientes con PP, todos ellos seguidos con angiografía con fluoresceína (AF) y tomografía de coherencia óptica de dominio espectral (SD-OCT). Se determinó la presencia de MER por SD-OCT, mientras que el EM fue determinado por AF. Se realizaron tablas de contingencia para determinar cómo influyen las MER como factores de riesgo para desarrollar EM. RESULTADOS: 31 ojos presentaron MER. 16 ojos presentaron EM. La razón de riesgo para presentar EM por MER fue de 0,971 con un valor de p determinada por χ2 de 0,77. CONCLUSIONES: No existe una asociación significativa entre la formación de MER y el desarrollo de EM. No existe evidencia que sugiera considerar un abordaje quirúrgico como primera línea de tratamiento ante la presencia de MER en PP

INTRODUCTION: Pars planitis (PP) is a form of intermediate uveitis that manifests with several posterior segment complications, including cystoid macular edema (CME) and epiretinal membrane formation (ERM). On the presence of CME the patient is usually treated with anti-inflammatory and/or immunosuppressive drugs. However the presence of CME may coexist with ERM formation, and therefore the treatment could be different. PURPOSE: To determine the association between ERM and CME in PP. MATERIALS AND METHODS: Case control series. The charts of patients diagnosed with PP were retrospectively reviewed. All patients had fluorescein angiogram (FA) and spectral domain optical coherence tomography (SD-OCT). Presence of ERM was determined by SD-OCT, while CME was determined by FA. Contingency tables were used to determine the risk of developing CME with ERM. RESULTS: 31 eyes presented ERM. 16 eyes presented CME. Relative risk to have CME and ERM was 0.971, with a P value of 0.77 (χ2). CONCLUSIONS: There is no association between ERM formation and the development of CME. There is no evidence to suggest a surgical approach as first line of treatment with the presence of ERM in PP

[Association of epiretinal membranes with macular edema in pars planitis]. / Asociación de membranas epirretinianas con edema macular en pars planitis.

INTRODUCTION: Pars planitis (PP) is a form of intermediate uveitis that manifests with several posterior segment complications, including cystoid macular edema (CME) and epiretinal membrane formation (ERM). On the presence of CME the patient is usually treated with anti-inflammatory and/or immunosuppressive drugs. However the presence of CME may coexist with ERM formation, and therefore the treatment could be different. PURPOSE: To determine the association between ERM and CME in PP. MATERIALS AND METHODS: Case control series. The charts of patients diagnosed with PP were retrospectively reviewed. All patients had fluorescein angiogram (FA) and spectral domain optical coherence tomography (SD-OCT). Presence of ERM was determined by SD-OCT, while CME was determined by FA. Contingency tables were used to determine the risk of developing CME with ERM. RESULTS: 31 eyes presented ERM. 16 eyes presented CME. Relative risk to have CME and ERM was 0.971, with a P value of 0.77 (χ(2)). CONCLUSIONS: There is no association between ERM formation and the development of CME. There is no evidence to suggest a surgical approach as first line of treatment with the presence of ERM in PP.

Hallazgos tempranos por microscopia confocal en cross-linking / Early confocal microscopy findings after cross-linking treatment

Objetivo: Valorar in vivo los efectos en la córnea del tratamiento con cross-linking. Métodos: Dieciocho ojos de 18 pacientes con queratocono fueron tratados con cross-linking mediante el uso de solución de rivoflavina al 0,1% y radiados con luz ultravioleta A radiados a 370nm, 3mW/cm2 por 30 min. Se realizó microscopia confocal in vivo previo al tratamiento y a la semana y al mes después de la aplicación de cross-linking. Resultados: A la semana del tratamiento se encontró activación de queratocitos y organización de las fibras de colágena, observándose como estructuras hiperreflécticas desde la primera imagen subepitelial, hasta una profundidad del estroma corneal de 275,1 ± 85,9μm. Al mes del tratamiento se observaron queratocitos activados, así como organización de las fibras de colágeno desde la primera imagen subepitelial, hasta una profundidad del estroma corneal de 324,9 ± 66,0μm. Al mes del tratamiento, las estructuras hiperreflécticas más profundas se mostraron en forma de líneas gruesas hiperreflécticas. Conclusiones: La microscopia confocal in vivo en humanos tratados con cross-linking mostró cambios estromales a la semana y al mes del tratamiento, excediendo la profundidad de 300μm en algunos casos (AU)

Objective: To determine the effects of in vivo cross-linking treatment of the cornea. Methods: Eighteen eyes of eighteen keratoconus patients underwent cross-linking treatment using a 0.1% riboflavin solution and ultraviolet A radiation at 370nm at 3 mW/cm2 for 30minutes. In vivo confocal microscopy was performed before, and at 1 week and 1 month after treatment. Results: At 1 week after treatment, keratocyte activation and collagen fiber organization showed as hyper-reflective structures and were observed from the first sub-epithelial image to a corneal stromal depth of 275.1 ± 85.9μm. At 1 month after treatment, activated keratocytes and fiber organization were also observed from the first sub-epithelial image to a corneal stromal depth of 324.9 ± 66.0μm. The deepest hyper-reflective structures at 1 month showed as thick, linear-shaped hyper-reflective structures. Conclusion: In vivo confocal microscopy in humans showed corneal stromal changes at 1 week and 1 month after cross-linking treatment, in some cases at depths in excess of 300μm (AU)

Early confocal microscopy findings after cross-linking treatment.

OBJECTIVE: To determine the effects of in vivo cross-linking treatment of the cornea. METHODS: Eighteen eyes of eighteen keratoconus patients underwent cross-linking treatment using a 0.1% riboflavin solution and ultraviolet A radiation at 370 nm at 3 mW/cm² for 30 minutes. In vivo confocal microscopy was performed before, and at 1 week and 1 month after treatment. RESULTS: At 1 week after treatment, keratocyte activation and collagen fiber organization showed as hyper-reflective structures and were observed from the first sub-epithelial image to a corneal stromal depth of 275.1 ± 85.9 µm. At 1 month after treatment, activated keratocytes and fiber organization were also observed from the first sub-epithelial image to a corneal stromal depth of 324.9 ± 66.0 µm. The deepest hyper-reflective structures at 1 month showed as thick, linear-shaped hyper-reflective structures. CONCLUSION: In vivo confocal microscopy in humans showed corneal stromal changes at 1 week and 1 month after cross-linking treatment, in some cases at depths in excess of 300 µm.

Life cycle of Glyphepomis spinosa Campos & Grazia (Hemiptera: Pentatomidae): a new pest of rice in Brazil.

Nymph and adult biology of Glyphepomis spinosa Campos & Grazia (Hemiptera: Pentatomidae) was studied on rice plants under laboratory and greenhouse conditions. The full life cycle of G. spinosa lasted 50.1 day. Nymph development ranged from 2.7 days for the first instar up to 11.9 days for the fifth instar. The egg stage showed the highest per capita rate of mortality (0.16). Nearly 13% of all eggs were laid on the same day. The sex ratio was 0.5. The average hatching rate was 58.0%. Pre-oviposition, oviposition, and post-oviposition periods took 12.9, 34.4, and 6.2 days, respectively.

First record of Teratopactus nodicollis (Coleoptera: Curculionidae) in dry bean (Phaseolus vulgaris).

Observations on the bioecology and damage of Teratopactus nodicollis Boheman on Phaseolus vulgaris were carried out on field samples by assessing the number of larvae and root damage in 40 ha of a dry bean field from the Federal District, Brazil (16°4'28.41"W; 47°30'21.13"S). Larvae caused the greatest damage at the stage of germination, emergence, and primary leaves, producing 50 % stand reduction. Most larvae pupated in August and September, and adult emergence occurred in middle October. Some larvae were infected with the fungus Metarhizium spp., a biological agent that would be naturally controlling this insect.

Distribución por diagnósticos de las cefaleas que acuden a los servicios de urgencias de atención primaria / Distribution by headache diagnosis of those who come to the primary care emergency service

Introducción: A pesar de que la bibliografía existente demuestra que la cefalea de tensión es la más frecuente en la población general, es la migraña la que demanda más atención facultativa. Muchos migrañosos no consideran su cefalea como una enfermedad, por lo que es posible que su médico desconozca el diagnóstico.Material y métodosEstudio descriptivo transversal con recogida de datos prospectiva en once servicios de urgencias de atención primaria (SUAP) de Cantabria sobre población consultante por cefalea. Cumplimentación de cuaderno de recogida de datos y valoración posterior de los siguientes ítems:• Diagnóstico de la cefalea según criterios de la International Headache SocietyMaterial y métodos• En las migrañas se valoró si habían consultado a su médico y si tenían “consciencia de enfermedad”.ResultadosCiento cuarenta y nueve pacientes consultaron por cefalea (118 mujeres y 31 varones). Edad media de 43 años. La migraña fue el diagnóstico más frecuente (72%) seguido por cefalea tensional (20%). Ochenta y cinco migrañosos (79%) habían consultado a su médico por cefalea. Setenta y nueve migrañosos (73%) tenían “consciencia de enfermedad”.ConclusionesLa migraña es la cefalea que más se consulta en los SUAP. Aunque es un proceso altamente invalidante, un porcentaje elevado de pacientes no había consultado previamente el problema con su médico. Estos datos se podrían explicar por la percepción que los pacientes tienen sobre su dolencia, ya que el 27% de los migrañosos que acudieron a los SUAP por migraña no consideraba que su cefalea fuese una enfermedad (AU)

Introduction: Even though the existing literature shows that the tension headache is the most common in the general population, the greatest demand comes from the migraine. Many migraine suffers do not consider their headaches as a disease, so that their physician may not be aware of its diagnosis.Material and methodsCross-sectional, descriptive study with data collection in 11 Primary Care Emergency Services (PCES) of Cantabria on the population consulting about headache. The case report form was filled out with the subsequent assessment of the following items:• Diagnosis of headache according to criteria of the IHS.Material and methods• In migraines, it was evaluated in the patient had consulted their doctor and if they were “aware of the illness.”ResultsIn total,149 patients consulted for headache (118 females and 31 males, with an average age of 43 years). Migraine was the most frequent diagnosis (72%), followed by tension headache (20%). A total of 85 migraineurs (79%) had consulted their doctor for headache and 79 migraineurs (73%) thought they had a “disease” (AU)

Twenty years of liver transplantation in Brazil.

This paper summarizes the 20 years of liver transplantation in Brazil, in the context of the Western world scenario. More than 5000 liver transplantations have been performed in the country since September 1, 1985. The living-donor liver transplantation, one of the landmarks in liver transplantation, was first described by our team in 1989. Brazil is the seventh country in number of liver transplants in the Western world and the first in Latin America. Almost 1000 procedures were performed in 2004, 19% of them involving living donors.

Premonitory and resolution symptoms in migraine: a prospective study in 100 unselected patients.

The nosology of migraine premonitory (PS) and resolution (RS) symptoms was studied in 100 migraineurs consulting their general physician. They were asked to fill in, for three attacks, a PS and RS questionnaire. 'True' PS/RS were those experienced the day before (or the day after) the headache had started only if they were not present in a questionnaire completed in a pain-free period. True PS and RS were experienced by 84% and 80%, respectively, of subjects for the first attack. The mean and range (per patient) of PS were 6.8 and 0-21 and of RS 4.7 and 0-15. Anxiety, phonophobia, irritability, unhappiness and yawning were the commonest PS, whereas asthenia, tiredness, somnolence and concentration difficulties were the most common RS. Gender, age and Migraine Disability Assessment scores did not influence PS and RS. Both PS and RS were more frequent in migraine with aura subjects. Patients on preventatives showed a decreased frequency of PS and, to a lesser degree, of RS. Severity of headache was associated with a higher frequency of RS. Individual RS and especially PS were quite consistent after three attacks. Almost two-thirds of the symptoms were noticed in at least two out of three attacks, while more than a half of PS and more than a quarter of RS repeated in three out of three attacks. In conclusion, around 80% of unselected migraineurs experience RS and PS. Migraine with aura and severe pain are risk factors for experiencing PS and RS, while preventatives were protective, especially for PS.

Posterior corneal surface changes after refractive surgery.

OBJECTIVE: To determine the frequency of changes in posterior corneal surface after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). DESIGN: Nonrandomized, comparative trial. PARTICIPANTS: Ninety-five eyes (71 patients) that underwent PRK (n = 45) or LASIK (n = 50). CONTROLS: Twenty nonsurgery eyes were used to validate the method of analysis of the posterior corneal curvature (PCC). Seventy nonsurgery eyes were used for comparisons. METHODS: Float, apex-fixed best fit corneal curvature (ABC), and posterior elevation difference were evaluated in 20 elevation topography maps at 6 zone diameters (3-7 and 10 mm) and at two time points. Corneal elevation maps before and after PRK or LASIK were analyzed by the ABC and float methods and compared with a nonsurgery group. MAIN OUTCOME MEASURES: Posterior corneal curvature change (mm) was classified as flattening, steepening, or no change. RESULTS: Flattening of more than 0.12 mm was found in 22.2% of eyes (n = 10) in the PRK group, a change of +/-0.12 mm was found in 53.3% of eyes (n = 24), and steepening of more than 0.12 mm was found in 24.4% of eyes (n = 11) using the float method and in 28.9% of eyes (n = 13), 35.6% of eyes (n = 16), and 35.6% eyes (n = 16), respectively, using the ABC method. In the LASIK group, the float method registered flattening in 20% of eyes (n = 10), no change in 52% of eyes (n = 26), and steepening in 28% of eyes (n = 14), whereas the ABC method registered flattening in 30% of eyes (n = 15), no change in 40% of eyes (n = 20), and steepening in 30% of eyes (n = 15). The nonsurgery group showed a similar change in PCC at two different time points similar to that of the PRK and the LASIK groups. CONCLUSIONS: The differences observed in the PCC after PRK or LASIK were not statistically significantly different from those observed over time in the nonsurgery control group.

Confocal microscopy of cystic disorders of the corneal epithelium.

OBJECTIVE: This study aimed to describe the morphology of cystic disorders of the corneal epithelium by confocal microscopy. DESIGN: The study design was a prospective evaluation of confocal microscopic images of patients with cystic corneal disorders. PARTICIPANTS: Thirteen patients (19 eyes) were included. The corneal disorders included four patients with corneal decompensation (Fuchs' dystrophy), five patients with epithelial basement membrane dystrophy (e.g., Cogan's microcystic and map-dot dystrophies), one patient with Meesmann's dystrophy, and three patients with recurrent erosion syndrome of unknown etiology. Confocal images of diseased corneas were compared with those of ten normal control eyes (ten subjects). INTERVENTION: All patients were examined by slit-lamp biomicroscopic analysis and confocal microscopic analysis (Tomey, Erlangen-Temmenlohe, Germany). Image analysis was used to identify the corneal epithelial structures correlated with the corresponding pathology. MAIN OUTCOMES MEASURES: Confocal microscopy was used to assess the size, shape, light scatter, and reflection of the cysts. RESULTS: Slit-lamp examination results showed corneal epithelial cystic lesions in all cases. Confocal microscopy was able to identify cystic lesions in 9 (69.2%) of 13 patients. Of the four patients in whom lesions could not be found by confocal microscopy, three had recurrent erosion syndrome and the other one had epithelial basement membrane dystrophy. The confocal images were compatible with the clinical and histologic pictures of the disease. Normal control eyes did not show any epithelial lesion, either by biomicroscopy or confocal microscopy. CONCLUSIONS: Confocal microscopy provides an in vivo evaluation of cystic epithelial corneal lesions. This study shows that confocal microscopy is suitable for examining cystic lesions of the corneal epithelium. Nevertheless, it is not as sensitive as biomicroscopy in detecting cystic lesions in certain corneal conditions.