In Vivo Corneal Confocal Microscopy: Pre- and Post-operative Evaluation in a Case of Corneal Neurotization.

In this report, we analyse the pre- and post-operative corneal changes observed using in vivo confocal corneal microscopy in a patient with neurotrophic keratitis submitted to a corneal reinnervation surgical procedure. We describe favourable trophic changes observed at different levels of the patient's cornea, particularly in the sub-basal nerve plexus; complete absence of these neurological structures was observed before surgery, but appeared largely restored six months thereafter.

Atypical Bilateral Fuchs Uveitis: Diagnostic Challenges.

UNLABELLED: Bilateral Fuchs uveitis associated with vitreous infiltration and posterior segment involvement requires a thorough diagnostic evaluation. The lack of well-defined diagnostic criteria makes identification of this entity difficult. The aim of this case report was to present the characteristics of a patient with atypical Fuchs uveitis and the procedures needed to rule out the differential diagnosis with specific attention to the utility of in vivo confocal microscopy (IVCM). CASE REPORT: One case of chronic bilateral uveitis with severe vitreous opacities is presented. After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology. IVCM of the cornea revealed the presence of dendritiform keratic precipitates. CONCLUSION: The diagnosis of Fuchs uveitis is based on clinical findings as no confirmatory laboratory tests are available. A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations. Auxiliary tests such as IVCM may aid the clinician in the diagnosis of Fuchs uveitis.

Retinal upregulation of inflammatory and proangiogenic markers in a model of neonatal diabetic rats fed on a high-fat-diet.

BACKGROUND: The contemporary peak of diabetes seems to be related to obesity, sedentary lifestyle and diet. Diabetic retinopathy is the most leading cause of blindness in adulthood in industrialized countries. Our purpose was to evaluate the effect of a high-fat-diet (HFD) on the retina of diabetic rats. METHODS: Two groups of Wistar rats were injected with streptozotocin (STZ) two days after birth using 45 and 90 mg/kg, respectively. At 8 weeks the group on lower doses started to be fed on a HFD. Animals were sacrificed at 37 weeks of diabetes. A control group was made up of non-diabetic rats. Retinal flat mounts were examined using the trypsin digestion technique. Pericytes counts were compared between diabetic and control rats. Cross retinal sections were analyzed by histological techniques and immunohistochemistry and immunofluorescent technique. Primary antibodies against inflammatory and proangiogenic mediators such as RAGE, GFAP, 5-LO, VEGF and TNF-α were used for immunohistochemistry and Western Blot (WB) analyses. RESULTS: In the two diabetic groups we observed GFAP-positive cells with a morphology and spatial organization similar to those seen in Müller cells. Both diabetic groups had a significantly lower number of pericytes than non-diabetic animals.Increased retinal immunoreactivity of GFAP, RAGE, TNF-α, VEGF and 5-LO was seen in diabetic animals fed on HFD compared to the other groups of animals. WB analysis revealed a higher expression of 5-LO, VEGF, TNF-α and RAGE in the retina of diabetic rats on HFD than in controls and diabetics fed on a normal diet. The percentage of RAGE-stained ganglion cells and ganglion cells was found to be significantly lower in animals on a HFD than in the other animals. CONCLUSIONS: Diabetic animals fed on a HFD showed an increased upregulation of inflammatory and proangiogenic markers. This animal model may be useful to study mechanisms of diabetic retinopathy and therapeutic targets.

Oncocytic carcinoma of the lacrimal gland in a patient with neurofibromatosis.

Oncocytic carcinoma (OCA) is rare, and although its occurrence in the lacrimal gland has been documented, clinical and histologic data are lacking. The authors report the first case of OCA of the lacrimal gland histologically proven in a patient with neurofibromatosis (NF). An 81-year-old man affected by type 1 NF presented with a 2-year history of left proptosis and visual loss. Orbital CT scan showed a mass in the lacrimal gland fossa infiltrating the globe, lateral rectus muscle, and bone. An incisional biopsy revealed a primary high-grade malignancy, and the patient underwent orbital exenteration followed by postoperative adjunctive radiotherapy. Six months after the operation, the patient was alive, without evidence of recurrent or metastatic disease. OCA is a high-grade neoplasm with infiltrative growth pattern and tendency to recur and metastasize. Its occurrence in association with NF has not been documented before, but clinicians should be aware of this possibility when evaluating proptosis in NF patients. Radical surgical excision, followed by adjunctive radiotherapy, is considered the treatment of choice, but the prognosis remains guarded.

Preparation of platelet-rich plasma as a tissue adhesive for experimental transplantation in rabbits.

PURPOSE: Platelet-rich plasma (PRP) is an autologous substance with adhesive properties. We aimed at developing and testing the efficacy of a method for PRP preparation in rabbits. MATERIALS AND METHODS: An in vitro study was carried out to obtain PRP from forty rabbits and to analyze the number of platelets and type of substance needed to trigger platelet activation. To induce platelet activation, 5%, 10%, 25% and 50% CaCl solutions were used. Then, an in vivo study was performed in twelve rabbits to test PRP adhesiveness in lamellar corneal graft. A control group made up of six rabbits underwent corneal transplantation without using PRP. RESULTS: 5% CaCl was the most effective concentration in activating PRP, with a mean time of 19 minutes. An attached corneal flap was seen 3 months after surgery. A detached corneal button was seen in all controls. CONCLUSION: Our method was able to produce rabbit-derived PRP with suitable properties for soft tissue adhesion. These results could be useful for researchers of the growing fields of tissue repair and experimental transplantation.

Queratotomía radial: cicatrización de las incisiones / Radial keratotomy: cicatrization of the incisions

Se efectuaron una serie de queratotomías radiales en vivo en ojos de felinos y caninos. La profundidad planeada fue el 100 por ciento y 90 por ciento. Las córneas fueron evaluadas histologicamente para determinar el processo de reparación y la profundidad lograda. La cicatrización era casi completa después del mes de realizada la cirugía. La profundización planeada de la incisión (media corregida) fue del 95,8 por ciento (100 y 90 por ciento). La profundización media de las incisiones a nivel histológico fue del 86,8 por ciento y del 84,2 por ciento de los valores planeados. De acuerdo a estos resultados la profundización media a obtener con cuchillete de diamante es de aproximadamente el 85 por ciento del espesor solicitado

Uveítis simpática: complicaciones de la cirugía del segmento posterior / Sympathetic uveitis: complications of the posterior segmentsurgery

La oftalmía simpática es una uveítis difusa bilateral granulomatosa, secundaria a un traumatismo ocular penetrante accidental o quirúrgico. Se considera de origen inmunológico. La forma de presentación clínica posterior es rara. Evoluciona con recurrencias. Requiere del tratamiento corticoesteroidaly/o inmunosupresor. Su histopatología muestra infiltración linfocitaria y de células epiteloideas uveal difusa con diversas otras respuestas histológicas agregadas. Se presenta un caso clínico en una mujer miope de 47 años, portadora de desprendimiento de retina, intervenida con cirugía vitreo-retinal que, un año y medio más tarde, hace una oftalmía simpática, cuyo estudio histopátologico confirmóla sospecha clínica