Corticosteroids for reversal of myopic regression after photorefractive keratectomy.

With the aim of reversing myopic regression laser photorefractive keratectomy (PRK) after excimer, the effect of high-dose topical corticosteroids in modulating changes in refraction and corneal transparency was assessed prospectively. Twenty-four eyes of 23 patients (mean preoperative spherical equivalent refraction -7.36 diopters (D); range, -4.12 D to -19.25 D), demonstrating myopic regression ranging between 1.00 D and 6.88 D (mean: 2.64 D), were treated according to the same therapeutic protocol. Changes in corneal haze, corneal topography, and refraction were evaluated over 6 months. Eighteen eyes (78.26%) showed 1.00 D or more reversal of myopic regression. Sixteen eyes (69.56%) regained the attempted correction present when corticosteroids were first stopped (+/- 1.00 D). The difference between mean refraction before reintroducing corticosteroids (-2.64 D; range, -1.00 D to -6.88 D) and when stabilization occurred (-0.60; range, +1.50 D to -4.50 D) was statistically significant (P < 0.01). The improvements in corneal haze and spectacle corrected visual acuity were also significant (both P < 0.01). Stabilization occurred between 1 to 4 months after surgery (mean, 2.22). In five eyes (21.74%) increased intraocular pressure of more than 20 mm Hg were reduced with beta-blockers. Topical corticosteroid therapy can modulate refractive changes after PRK, appearing to reduce myopic regression. However, a longer follow up will be necessary to determine the final refractive outcome of these eyes.

Effect of photorefractive keratectomy on visual functioning and quality of life.

The authors present the results of the psychosocial outcomes of 45 patients undergoing excimer laser photorefractive keratectomy (PRK). The patients were evaluated by means of self-report questionnaires preoperatively and 6 months after surgery to determine the effect of uncorrected vision change on the patients quality of life. The measurements include the following variables: clinical end points (spherical equivalent refraction); visual function (night driving, day driving, near vision, far vision, glare disability); functional status (physical, social, and role functioning, mental status); general well-being (health perceptions, personal well-being, overall quality of life); and satisfaction with surgery (expectations, satisfaction with medical staff, postoperative pain, satisfaction with treatment outcomes). Preliminary results indicate that changes of uncorrected vision after PRK are reflected by improvement in each of the quality-of-life functions.

[Future developments in ocular fluorophotometry instrumentation]. / Futuros desenvolvimentos na instrumentação em fluorofotometria ocular.

The scope of ocular fluorometry is to monitor exogenous and endogenous fluorophores in ocular tissues, in relation with ophthalmic and systemic diseases using the unique optical prospectives of the eye. The elderly population and the incidence of blindness are increasing rapidly due to more cases of diabetes, glaucoma, cataract and age-related macular degeneration. Monitoring changes in specific fluorophores in the eye may help identify the high risk groups in these diseases. New developments in instrumentation include differential fluorometry and introduction of confocal optics. Differential fluorometry has already achieved significant progress for the study of the autofluorescence of the lens and cornea and measurements in the aqueous. Improved spatial resolution obtained with improved optics opens interesting possibilities like measurement of corneal endothelial permeability and retinal vascular permeability. The results already obtained will be presented with particular incidence on measurements of lens fluorescence (normals--336.2 +/- 56.3; diabetes--659.9 +/- 123.9; age group--40-50 y) and corneal endothelial permeability (normals--3.14 +/- 60.10(-1) cm-1).

Effect of calcium dobesilate on the blood-retinal barrier in early diabetic retinopathy.

The effect of calcium dobesilate on the alteration of the blood-retinal barrier was studied in 41 adult-onset, non-insulin dependent diabetic patients with minimal or no retinopathy, randomly assigned to receive either oral calcium dobesilate (1000 mg twice daily) or a placebo for 12 months. The posterior vitreous value and the penetration ratio, determined by vitreous fluorophotometry, reflected stabilisation of blood-retinal barrier permeability in the calcium dobesilate patients and deterioration of blood retinal barrier in those given placebo. During the relatively short period of the study, one year, no significant change in microaneurysm and capillary closure gradings was observed. No side effects were associated with calcium dobesilate.

[Functional evaluation of the corneal endothelium using anterior segment fluorophotometry]. / Evaluation fonctionnelle de l'endothélium cornéen par la fluorophotométrie du segment antérieur.

The AA have studied the permeability of the corneal endothelium by anterior segment fluorophotometry using instillation of fluorescein. The Fluorotron Master TM has been modified with the introduction of a new slit (58.4 microns) and of the voltage output (6.5 v) has also been increased. The resolution has been improved from 2.39 mm to 0.59 mm. Of this study, we have examined 20 patients submitted to extracapsular cataract extraction with intraocular lens implantation (ECCE + IOL). The patients have been divided in two groups, according to the surgical technic used: "can-open" and intracapsular. Each patient have been submitted before surgery and 1 week after to an ophthalmologic examination, paquimetry and anterior segment fluorophotometry. The permeability coefficient (PAC) increases with the duration of surgery and when using "can-opener" instead of endocapsular.