Comparison of endothelial cell loss in diabetic patients after conventional phacoemulsification and femtosecond laser-assisted cataract surgery.

PURPOSE: This study aims to comparatively evaluate the morphological changes of the cornea after phacoemulsification (PHACO) and femtosecond laser-assisted cataract surgery (FLACS) without intercurrences in patients with type 2 diabetes mellitus. METHODS: A total of 95 diabetic patients with moderate cataracts (N2 + and N3+), 47 undergoing PHACO and 48 undergoing FLACS, were selected randomly for the study. Surgeries were performed by a single surgeon between July 2021 and December 2021. Cumulative dissipated energy (CDE) and total balanced saline solution (BSS) data were obtained at the end of each surgery. Changes in corneal endothelial cell density (ECD) and central corneal thickness (CCT) at three months postoperatively were investigated. RESULTS: After three months, evidence is lacking between groups in the CCT measures; the difference was neither statistically nor clinically relevant. However, for ECD, a significant and clinically significant difference was found; if all patients were treated with laser, the mean ECD would be 423.55 greater (RSE: 86.09; p-value < 0.001; 95% CI: 254.81-592.29) than the ECD potential means of 1656.423 among the conventional group (RSE: 74.90; p-value < 0.001; 95% CI: 1509.62-1803.23). CONCLUSIONS: Diabetic patients under treatment with moderate cataracts may predispose themselves to a more significant loss of endothelial cells after conventional phacoemulsification than femtosecond laser-assisted cataract surgery. TRIAL REGISTRATION: It was registered at The Brazilian Registry of Clinical Trials (ReBEC) with the code RBR-6d8whb5 (UTN code: U1111-1277-6020) on 17/05/2022.

Aumento das aberrações de alta ordem pós-ceratectomia fotorrefrativa guiada por frente de onda: relato de caso / Increased high-order aberrations after wavefront-guided photorefractive keratectomy: case report

RESUMO Ao remodelar a córnea usando um perfil de ablação individualizado para cada olho obtido por meio de aberrometria de frente de onda, o tratamento guiado por frente de onda tenta reduzir aberrações preexistentes e induzidas cirurgicamente, minimizando as aberrações de alta ordem (HOAs) visualmente significativas. No entanto, o aumento de HOA ainda é uma preocupação, mesmo com ablações personalizadas. Na cirurgia refrativa a laser miópica, como o feixe de laser entra na periferia, algumas partes são refletidas, e o feixe circular se torna elíptico, resultando em diminuição na eficácia da energia do laser. A subablação da córnea periférica pode ser induzida por esses fatores que aumentam a HOA, especialmente a aberração esférica. Este relato tem por finalidade mostrar uma paciente alto míope submetida à PRK guiada por frente de onda que evoluiu com aumento das HOAs.

ABSTRACT By reshaping the cornea using an individualized ablation profile for each eye obtained through wavefront aberrometry, wavefront guided treatment attempts to reduce preexisting and surgically induced aberrations while minimizing visually significant higher-order aberrations (HOAs). However, HOA enhancement is still a concern, even with custom ablations. In the myopic laser refractive surgery, as the laser beam enters the periphery, some parts are reflected, and the circular beam becomes elliptical, resulting in a decrease in the effectiveness of the laser energy. Peripheral corneal subablation can be induced by these factors that increase HOA, especially spherical aberration. This report aims to show a high myopic patient undergoing wavefront-guided PRK, who evolved with an increase in HOAs.

Unexpectedly high corneal flap thickness and ectasia after mechanical LASIK / Espessura inesperadamente alta do flap corneano e ectasia após LASIK mecânico

ABSTRACT LASIK is a refractive surgical procedure in which a corneal flap is created to expose the corneal stromal bed. Preoperative estimation of corneal flap thickness is necessary to calculate the percentage tissue altered in LASIK, an important quantitative risk factor for ectasia. The objective of this study was to assess flap thickness and calculate percentage tissue altered to check if unexpectedly thicker flaps and higher percentage tissue altered could pose as risk factors of ectasia. Four subjects (eight eyes) were submitted to mechanical LASIK in 2009 and 2010. Pre and postoperative clinical and tomographic data were reviewed. Mean preoperative estimated percentage tissue altered was 39.18±1.31%, which was borderline for increased ectasia risk when considering the limit of 40%. However, when considering the postoperatively measured flap thickness, the actual mean percentage tissue altered turned out to be 45.17 ± 4.13%, which was significantly higher than predicted preoperatively (p=0.002). Unexpectedly higher postoperative percentage tissue altered may be responsible for corneal ectasia after mechanical LASIK.

RESUMO A LASIK é um procedimento cirúrgico refrativo, no qual um retalho corneano é criado para expor o leito estromal corneano. A estimativa pré-operatória da espessura do retalho corneano é necessária para calcular o percentual de tecido alterado no LASIK, um importante fator de risco quantitativo para ectasia. O objetivo deste estudo foi avaliar a espessura do retalho e calcular o percentual de tecido alterado para verificar se retalhos inesperadamente mais espessos e percentuais de tecido alterado mais altos poderiam representar fatores de risco de ectasia. Quatro indivíduos (oito olhos) foram submetidos à LASIK mecânica em 2009 e 2010. Dados clínicos e tomográficos pré e pós-operatórios foram revisados. A média de percentual de tecido alterado pré-operatória estimada foi de 39,18±1,31%, limítrofe para risco aumentado de ectasia quando considerado o limite de 40%. No entanto, ao considerar a espessura do retalho medida no pós-operatório, o percentual de tecido alterado médio real foi de 45,17±4,13%, ou seja, significativamente maior do que o previsto no pré-operatório (p=0,002). O percentual de tecido alterado pós-operatóriao inesperadamente mais alto pode ser responsável pela ectasia da córnea após LASIK mecânico.

Analysis of the thickness of conjunctival autograft in pterygium surgery with the Moscovici dissection technique compared with manual dissection / Análise da espessura do autoenxerto conjuntival na cirurgia de pterígio com a técnica de dissecção de Moscovici comparada com a dissecção manual

ABSTRACT Objective Compare the thickness of conjunctival autografts in pterygium surgery using the Moscovici dissection technique with manual dissection and assess the difficulty of the techniques. Methods In this randomized clinical trial, 30 eyes of 30 patients undergoing pterygium surgery were divided into the Moscovici Dissection Technique Group and the Manual Dissection Group. The patients were treated at the Hospital Oftalmológico Visão Laser (Santos, São Paulo, Brazil). Optical coherence tomography was performed to measure graft thickness three months postoperatively. Three images were obtained from each eye, and three measurements were taken at a distance of 1.5mm perpendicular to the limbus in each capture. The surgeon graded the difficulty of obtaining the graft with the technique performed from one (lowest difficulty) to four (highest difficulty). Results We found statistically significant difference between the difficulty of the two techniques and the mean conjunctival autograft thickness in the two groups (p=0.01 e p=0.05, respectively). The average difficulty rating for the Moscovici Dissection Technique Group (Air Group) was 1.47, while that for the Manual Dissection Group (MD group) was 2.20. The mean thickness of the three measurements was 252µ in the Air Group and 298µ in the MD Group, with medians of 250µ and 278µ, respectively. Conclusion Our study showed that the Moscovici technique results in thinner grafts and can be performed with greater surgical ease.

RESUMO Objetivo Comparar a espessura de autoenxertos conjuntivais em cirurgia de pterígio utilizando a técnica de dissecção de Moscovici com a de dissecção manual e avaliar a dificuldade das técnicas. Métodos Neste ensaio clínico randomizado, 30 olhos de 30 pacientes submetidos à cirurgia de pterígio foram divididos em um Grupo de Técnica de Dissecção de Moscovici e um Grupo de Dissecção Manual. Os pacientes foram tratados e avaliados no Hospital Oftalmológico Visão Laser (Santos, São Paulo, Brasil). A tomografia de coerência óptica foi realizada para medir a espessura do enxerto 3 meses após a cirurgia. Três imagens foram obtidas de cada olho, e três medidas foram realizadas a uma distância de 1,5mm perpendicular ao limbo em cada captura. O cirurgião classificou a dificuldade de obtenção do enxerto com a técnica realizada de um (menor dificuldade) para quatro (maior dificuldade). Resultados Encontramos diferenças estatisticamente significantes entre a dificuldade das duas técnicas e a espessura média do autoenxerto conjuntival nos dois grupos (p=0,01 e p=0,05, respectivamente). A classificação média de dificuldade para o Grupo de Técnica de Dissecção de Moscovici foi de 1,47, enquanto a do Grupo de Dissecção Manual foi de 2,20. A espessura média das três medidas foi de 252μ no Grupo de Técnica de Dissecção de Moscovici e de 298μ no Grupo de Dissecção Manual, com medianas de 250μ e 278μ, respectivamente. Conclusão Nosso estudo mostrou que a técnica de Moscovici resulta em enxertos mais finos e pode ser realizada com maior facilidade cirúrgica.

Síndrome do ápice orbitário, apresentação aguda e implicações tardias: uma série de casos / Orbital apex syndrome, acute presentation and late implications: a series of cases

RESUMO O ápice orbitário é uma região na qual estão contidas estruturas ósseas, vasculares e neurais. Patologias que acometem essa região podem desencadear um conjunto de sinais e sintomas característicos, dando origem a síndrome do ápice orbitário. É uma entidade rara, que consiste em sinais de envolvimento das estruturas nervosas, que atravessam o forame óptico e a fissura orbitária superior, comprometendo os nervos oculomotor, troclear, abducente; a divisão oftálmica do nervo trigêmeo e o nervo óptico. Suas causas incluem afecções neoplásicas, vasculares, traumáticas, infecciosas, inflamatórias e idiopáticas. Muitas vezes, nós nos deparamos com patologias sem tratamento curativo, portanto deve-se atentar para o controle da sintomatologia e a prevenção das possíveis implicações tardias. O objetivo desta série de casos é relatar algumas das causas da síndrome do ápice orbitário e sua apresentação clínica aguda, além de alertar sobre as possíveis implicações crônicas.

ABSTRACT Orbital apex is a region involving bone, vascular and neural structures. Pathologies involving this region may lead to several symptoms and signals and to orbital apex syndrome. It is a rare syndrome that is characterized by signals involving nervous ocular motor nerves through the optic foramen and the superior orbital fissure. This can affect the oculomotor, the third canal and abducens nerves; the ophthalmic division of the fifth cranial nerve and the optic nerve. Its causes include neoplastic, vascular, traumatic, infectious, inflammatory, and idiopathic conditions. We often deal with conditions with no treatment, so it is necessary to control the symptoms and prevent late implications. The purpose of this case series is to report on the causes of orbital apex disease and its potential chronic implications.

Perfil epidemiológico e melhora visual após cirurgia de catarata realizada em hospital oftalmológico de referência em Santos / Epidemiological profile and visual improvement after cataract surgery performed at a reference ophthalmological hospital in Santos

RESUMO Objetivo Identificar o perfil epidemiológico e o benefício visual do paciente usuário do Sistema Único de Saúde, após realização de cirurgia de catarata. Métodos Trata-se de estudo descritivo, transversal e retrospectivo com análise de prontuários, no período entre outubro e novembro de 2020. Foram incluídos 573 olhos de 319 pacientes submetidos à cirurgia de catarata. Foram analisados: sexo, idade, classificação da catarata, acuidade visual corrigida pré e pós-cirurgia, tabagismo, presença de comorbidades e alterações oculares prévias. Resultados Das cirurgias de catarata realizadas, a média de idade foi de 70,5 anos (±7,1), com prevalência de 57,1% (n=182) no sexo feminino. Dos pacientes, 13,8% (n=44) eram tabagistas. A hipertensão arterial sistêmica foi a comorbidade mais recorrente, presente em 65,8% (n=210), e o glaucoma foi a alteração ocular mais comum, ocorrida em 57% (n=45) dos casos. No âmbito da classificação da catarata, a nuclear foi manifestada em 71,9% (n=412). A acuidade visual foi avaliada por meio da escala logMAR, tendo sido atribuído o valor de 3 aos pacientes conta dedos (CD) e movimentos de mão. A média da acuidade visual antes da cirurgia foi de 0,7, com desvio-padrão de 0,9 e, após a cirurgia, de 0,1, com desvio-padrão de 0,3, havendo redução estatisticamente significativa. Conclusão O conhecimento do perfil epidemiológico e do benefício visual após a cirurgia de catarata permite identificar os grupos de risco e a importância do procedimento para a melhoria da qualidade de vida. Ações públicas devem ser implementadas para aumentar o número de projetos que visam reduzir o número de catarata, visto que é a principal causa de cegueira reversível no mundo, interferindo no cotidiano da população.

ABSTRACT Objective To identify the epidemiological profile and visual benefit of the patient using the Unified Health System after cataract surgery. Methods This is a descriptive, cross-sectional and retrospective study with the analysis of medical records, between October and November 2020. We included 573 eyes of 319 patients that were selected for cataract surgery. Gender, age, cataract classification, pre-and post-surgery corrected acuity, smoking, presence of comorbidities, and previous ocular alterations were analyzed. Results Of the cataract surgeries performed, the mean age was 70.5 years (±7.1%), with a prevalence of 57.1% (n=182) in women; 13.8% (n= 44) were smokers. Systemic arterial hypertension was the most recurrent comorbidity, present in 65.8% (n=210), and glaucoma was the most common ocular alteration in 57% (n=45) of the cases. As for cataract classification, nuclear cataract was manifested in 71.9% (n=412). Visual acuity was evaluated by the logMAR scale, and counting fingers and hand motion were given the value of 3. Mean visual acuity before surgery was 0.7 with an SD of 0.9 and, after surgery, of 0.1, with an SD of 0.3, which was statistically significant. Conclusion Knowledge of the epidemiological profile and visual benefit after cataract surgery allows us to identify risk groups and the importance of the procedure to improve the quality of life. Public actions must be implemented to increase the number of projects that aim to reduce the number of cataracts, since it is the main cause of reversible blindness in the world, interfering with the daily life of the population.

Anterior scleritis treated with systemic corticosteroids in Chikungunya infection.

Background: Chikungunya is a matter of grave concern in Brazil. This case report describes a rare ocular manifestation in a patient with chikungunya. Case report: A 49-year old male diagnosed with chikungunya one month previously was being treated and followed up by a rheumatologist. He presented with complaints of pain and hyperemia in both eyes over the preceding seven days. Biomicroscopy of both eyes revealed bulbar conjunctival hyperemia 3+/4+ with 360° of ciliary injection, and no other abnormalities. The patient was prescribed 1 drop of loteprednol etabonate every 4 h, tapering every three days, and nimesulide 100 mg every 12 hours for 7 days. One week later, however, scleritis was worse and the medial sclera was elevated, particularly in the right eye. Intraocular pressure remained normal, and hyperemia increased to 4+/4+ in the right eye. Supplementary tests revealed positive serology for chikungunya IgG and IgM antibodies and other etiologies were ruled out. Treatment was then changed to oral prednisone 60 mg/day, tapering every three days. The patient was pain-free three days later with all signs and symptoms having disappeared within five days. Conclusion: Ocular abnormalities resulting from chikungunya virus infection require careful monitoring even after the acute phase of chikungunya infection has passed. The fact that patients usually stop being followed-up after they have been symptomless for some time delays diagnosis and the appropriate treatment of ocular manifestations. Consequently, chikungunya should be included in the differential diagnosis of ocular pathologies wherever the infection is endemic or epidemic.

Tumor de hipófise em paciente com hidrocefalia: um desafio diagnóstico / Pituitary tumor in a patient with hydrocephalus: a diagnostic challenge

RESUMO A hidrocefalia é definida como a dilatação ventricular pelo aumento da pressão intraventricular e intracraniana quando não tratada ou por insucesso do tratamento. Muitas vezes, leva ao dano das vias ópticas, podendo causar atrofia óptica, devido à proximidade dessas vias com o ventrículo lateral quando ocorre a dilatação. Assim como a hidrocefalia pode levar à atrofia óptica, outras patologias também podem. Tumores hipofisários compartilham desse mesmo sinal, além de causar hemianospsia bitemporal quando o tumor comprime quiasma óptico. Ademais, a hemianopsia bitemporal é o distúrbio visual mais comum encontrado em pacientes com tumor de hipófise. Os tumores de hipófise, por exemplo, geram manifestações clínicas que podem estar relacionadas à disfunção da glândula ou aos efeitos mecânicos da expansão tumoral. Sinais e sintomas visuais estão mais ligados ao efeito mecânico do tumor. Assim, muitas vezes, o paciente procura o oftalmologista antes do endocrinologista. Neste caso, analisaremos uma paciente portadora de hidrocefalia que apresentava, concomitantemente, um tumor hipofisário, e a investigação oftalmológica fez toda a diferença no tratamento da paciente.

ABSTRACT Hydrocephalus is defined as ventricular dilation caused by increased intraventricular and intracranial pressure when untreated or due to treatment failure. Optical pathways can often cause optic atrophy due to the proximity to the lateral hazard when dilation occurs. Hydrocephalus can lead to optic atrophy, as well as other pathologies. Pituitary tumors share this same sign, in addition to causing bitemporal hemianopia when it compresses the optic chiasm. In addition, bitemporal hemianopia is the visual disturbance most commonly found in patients with pituitary tumors. Pituitary tumors, for example, have clinical manifestations that may be related to gland dysfunction, or to mechanisms of tumor expansion. Visual signs and symptoms are more linked to the mechanical effect of the tumor. Therefore, the patient usually seeks the ophthalmologist before the endocrinologist. In this case, we analyzed a patient with hydrocephalus who presented, at the same time, a pituitary tumor, and the ophthalmological investigation made all the difference in the treatment of the patient.

Author Correction: Low dose of chlorine exposure exacerbates nasal and pulmonary allergic inflammation in mice.

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Low dose of chlorine exposure exacerbates nasal and pulmonary allergic inflammation in mice.

Work-exacerbated asthma (WEA) is defined as preexisting asthma that worsens with exposure to irritants [e.g., chlorine (Cl2) derivatives] in the workplace. The maximum allowable concentration in the workplace of Cl2 exposure is 3 mg/ m3 (described in OSHA). We investigated in an experimental asthma model in mice the effects of a single exposure to a sodium hypochlorite dose with this allowed chlorine concentration and a tenfold higher dose. Acute chlorine exposure at 3.3 mg/m3 in the OVA-sensitized group increased eosinophils in the peribronquial infiltrate, cytokine production, nasal mucus production and the number of iNOS positive cells in the distal lung compared to only sensitized mice. The exposure to a higher dose of 33.3 mg/m3 in the OVA-sensitized group resulted in an increase in respiratory system elastance, in the total and differential numbers of inflammatory cells in bronchoalveolar lavage fluid, IL-4, IL-5, and IL-17 in the lungs, eosinophils in peribronquial infiltrate and mucus content in nasal compared to non-exposed and sensitized animals. In this asthma model, chorine exposures at an allowable dose, contributed to the potentiation of Th2 responses. The functional alterations were associated with increased iNOS and ROCK-2 activation in the distal lung.