Upper Eyelid Necrosis Secondary to Hordeolum: A Case Report.

We reported a case of upper eyelid necrosis initially misdiagnosed as a preseptal cellulitis following a hordeolum externum resulting in great damage to the upper eyelid (anterior lamella). The infection was successfully treated with surgical cleansing, drainage, and endovenous antibiotics. Early treatment may avoid severe complications such as eyelid deformity, systemic involvement, and blindness.

Refractive and visual outcomes after Ferrara corneal ring segment implantation at a 60% depth in keratoconic eyes: case series / Resultados refrativos e visuais após a inserção do anel de Ferrara a uma profundidade de 60% em olhos com ceratocone: série de casos

ABSTRACT Purpose: This report addresses refractive, topographic, visual acuity, and optical coherence tomography outcomes 12 months after femtosecond, laser-assisted insertion of Ferrara intrastromal corneal ring segments in keratoconic eyes at a depth of 60%. Methods: Interventional, prospective, non-comparative case series. We performed femtosecond, laser-assisted insertion of Ferrara intrastromal corneal ring segments in 15 keratoconic eyes. We included patients with documented keratoconus who voluntarily signed informed consents if they had best spectacle-corrected visual acuity ≥0.30 logMAR and corneal thickness ≥400 μm. We excluded patients with previous ocular surgery or corneal curvatures >65 diopters (D). Our main outcome measures were best spectacle-corrected visual acuity and corneal topographic parameters (flattest, steepest and average keratometry [K]), evaluated at baseline and at 1-,3-,6-, and 12-month follow-ups. Results: The mean ± standard deviation baseline uncorrected visual acuity and best spectacle-corrected visual acuity were 1.03 ± 0.46 and 0.42 ± 0.13, respectively; the 12-month mean standard deviation uncorrected visual acuity and best spectacle-corrected visual acuity were 0.72 ± 0.37 and 0.31 ± 0.16, respectively, without significant differences (p=0.05 for both). The mean best spectacle-corrected visual acuity improvements were statistically significant after 3- (p=0.02) and after 6-months (p=0.02). The mean baseline flattest (K1), steepest (K2), and overall keratometries (mean power) were 48.35 ± 3.65 D, 53.67 ± 3.38 D, and 50.84 ± 3.36 D, respectively. The 12-month mean ± standard deviations for flattest-K1, steepest-K2, and overall K were 46.53 ± 3.70 D, 49.83 ± 3.50 D, and 48.12 ± 3.49 D respectively, with statistically significant differences for all three topographic parameters (p=0.01). Conclusions: Ferrara intrastromal corneal ring segment insertions at a depth of 60% yield satisfactory visual, refractive, and keratometric results in keratoconic eyes.

RESUMO Objetivos: Este estudo aborda os resultados refrativos, topográficos, acuidade visual e tomografia de coerência óptica, 12 meses após a inserção do segmento de Anel de Ferrara em túnel corneano a 60% de profundidade com o laser de femtosegundo, em pacientes com ceratocone. Métodos: Série de casos não comparativos, prospectivos e intervencionistas. Realizamos a inserção do Anel de Ferrara através de incisão com o laser de femtosegundo em 15 olhos ceratocônicos. Foram incluídos pacientes com ceratocone documentado que voluntariamente assinaram consentimentos informados que tivessem melhor acuidade visual corrigida ≥0.30 tabela logMAR, espessura corneana ≥400µm. Foram excluídos pacientes com cirurgia ocular prévia ou curvatura corneana > 65 dioptrias (D). As principais variáveis medidas foram acuidade visual corrigida e os parâmetros topográficos da córnea (ceratometria mais plana (K1), mais curva (K2) e ceratometria média (K médio), avaliadas no pré-operatório e com 1, 3, 6 e 12 meses de seguimento. Resultados: A média ± desvio padrão da acuidade visual sem correção e acuidade visual corrigida foi 1.03 ± 0.46 e 0.42 ± 0.13, respectivamente; o desvio padrão médio de 12 meses, a acuidade visual sem correção e acuidade visual corrigida foram de 0.72 ± 0.37 e 0.31 ± 0.16, respectivamente, sem diferenças significativas (p=0,05 para ambos). A melhora da acuidade visual corrigida foi estatisticamente significante após 3 meses (p=0,02), e após 6 meses (p=0,02). Os valores médios da linha de base K1, K2, e média (K médio) foram 48,35 ± 3,65D, 53,67 ± 3,38D, e 50,84 ± 3,36D, respectivamente. A média de 12 meses ± desvio padrão para K1, K2, e K médio foi 46,53 ± 3,70D, 49,83 ± 3,50 D, e 48,12 ± 3,49D respectivamente, com diferença estatisticamente significativas para todos os 3 parâmetros topográficos (p=0,01). Conclusões: A inserção do Anel de Ferrara a uma profundidade de 60% no estroma corneano produz resultados visuais, refracionais e ceratométricos satisfatórios em olhos com ceratocone.

Refractive and visual outcomes after Ferrara corneal ring segment implantation at a 60% depth in keratoconic eyes: case series.

PURPOSE: This report addresses refractive, topographic, visual acuity, and optical coherence tomography outcomes 12 months after femtosecond, laser-assisted insertion of Ferrara intrastromal corneal ring segments in keratoconic eyes at a depth of 60%. METHODS: Interventional, prospective, non-comparative case series. We performed femtosecond, laser-assisted insertion of Ferrara intrastromal corneal ring segments in 15 keratoconic eyes. We included patients with documented keratoconus who voluntarily signed informed consents if they had best spectacle-corrected visual acuity ≥0.30 logMAR and corneal thickness ≥400 µm. We excluded patients with previous ocular surgery or corneal curvatures >65 diopters (D). Our main outcome measures were best spectacle-corrected visual acuity and corneal topographic parameters (flattest, steepest and average keratometry [K]), evaluated at baseline and at 1-,3-,6-, and 12-month follow-ups. RESULTS: The mean ± standard deviation baseline uncorrected visual acuity and best spectacle-corrected visual acuity were 1.03 ± 0.46 and 0.42 ± 0.13, respectively; the 12-month mean standard deviation uncorrected visual acuity and best spectacle-corrected visual acuity were 0.72 ± 0.37 and 0.31 ± 0.16, respectively, without significant differences (p=0.05 for both). The mean best spectacle-corrected visual acuity improvements were statistically significant after 3- (p=0.02) and after 6-months (p=0.02). The mean baseline flattest (K1), steepest (K2), and overall keratometries (mean power) were 48.35 ± 3.65 D, 53.67 ± 3.38 D, and 50.84 ± 3.36 D, respectively. The 12-month mean ± standard deviations for flattest-K1, steepest-K2, and overall K were 46.53 ± 3.70 D, 49.83 ± 3.50 D, and 48.12 ± 3.49 D respectively, with statistically significant differences for all three topographic parameters (p=0.01). CONCLUSIONS: Ferrara intrastromal corneal ring segment insertions at a depth of 60% yield satisfactory visual, refractive, and keratometric results in keratoconic eyes.

A case of recurrent keratitis caused by Paecilomyces lilacinus and treated by voriconazole / Uso do voriconazol na ceratite recorrente causada por fungo Paecilomyces lilacinus

ABSTRACT - We describe here a case of a 21-year-old woman who presented with low visual acuity, pain, and hyperemia in the left eye for 45 days. Her eye had extensive corneal infiltrate, with melting and a central perforation that was glued with cyanoacrylate, but with Seidel (+). She underwent tectonic corneal transplantation, and anterior chamber lavage with subconjunctival infiltration with voriconazole, as well as intracameral injections of amphotericin B. Laboratory tests revealed Paecilomyces lilacinus as the infectious agent. The patient was then maintained with oral voriconazole and eye drops for three months, after which the infection was considered cured. However, in the sixth postoperative month she presented with endothelial rejection, and two weeks later signs of recurrence of the fungal infection. She was treated with two further washes of the anterior chamber and subconjunctival injection of voriconazole, followed by intravenous voriconazole that was replaced with drops after ten days. The infection initially worsened, but then regressed, and at last follow-up, the patient was still infection-free.

RESUMO - Descrevemos aqui um caso de uma mulher de 21 anos que apresentou baixa acuidade visual, dor e hiperemia no olho esquerdo por 45 dias. O olho apresentava infiltrado corneano extenso, com fusão e perfuração central colada com cianoacrilato, mas com Seidel (+). Ela foi submetida a transplante de córnea tectônica e lavagem de câmara anterior com infiltração subconjuntival com voriconazol, além de injeções intracamerais de anfoterecina B. Testes laboratoriais revelaram Paecilomyces lilacinus como agente infeccioso. A paciente foi então mantida com voriconazol oral e colírio por período de três meses, após o qual a infecção foi considerada curada. No entanto, no sexto mês de pós-operatório, ela apresentou rejeição endotelial e, duas semanas após, sinais de recidiva de infecção fúngica. Ela foi tratada com mais duas lavagens de câmara anterior e injeção subconjuntival de voriconazol, seguida por voriconazol intravenoso que foi substituído por gotas após 10 dias. A infecção piorou inicialmente, mas depois regrediu e, no último seguimento, o paciente ainda estava livre de infecção.

A case of recurrent keratitis caused by Paecilomyces lilacinus and treated by voriconazole.

We describe here a case of a 21-year-old woman who presented with low visual acuity, pain, and hyperemia in the left eye for 45 days. Her eye had extensive corneal infiltrate, with melting and a central perforation that was glued with cyanoacrylate, but with Seidel (+). She underwent tectonic corneal transplantation, and anterior chamber lavage with subconjunctival infiltration with voriconazole, as well as intracameral injections of amphotericin B. Laboratory tests revealed Paecilomyces lilacinus as the infectious agent. The patient was then maintained with oral voriconazole and eye drops for three months, after which the infection was considered cured. However, in the sixth postoperative month she presented with endothelial rejection, and two weeks later signs of recurrence of the fungal infection. She was treated with two further washes of the anterior chamber and subconjunctival injection of voriconazole, followed by intravenous voriconazole that was replaced with drops after ten days. The infection initially worsened, but then regressed, and at last follow-up, the patient was still infection-free.

Use of the Ishikawa diagram in a case-control analysis to assess the causes of a diffuse lamellar keratitis outbreak.

PURPOSE: To identify the causes of a diffuse lamellar keratitis (DLK) outbreak using a systematic search tool in a case-control analysis. METHODS: An Ishikawa diagram was used to guide physicians to determine the potential risk factors involved in this outbreak. Coherence between the occurrences and each possible cause listed in the diagram was verified, and the total number of eyes at risk was used to calculate the proportion of affected eyes. Multivariate analysis was performed using logistic regression to determine the independent effect of the risk factors, after controlling for confounders and test interactions. RESULTS: All DLK cases were reported in 2007 between June 13 and December 21; during this period, 3,698 procedures were performed. Of the 1,682 flap-related procedures, 204 eyes of 141 individuals presented with DLK. No direct relationship was observed between the occurrence of DLK and the presence of any specific factors; however, flap-lifting enhancements, procedures performed during the morning shift, and non-use of therapeutic contact lenses after the surgery were significantly related to higher occurrence percentages of this condition. CONCLUSIONS: The Ishikawa diagram, like most quality tools, is a visualization and knowledge organization tool. This systematization allowed the investigators to thoroughly assess all the possible causes of DLK outbreak. A clear view of the entire surgical logistics permitted even more rigid management of the main factors involved in the process and, as a result, highlighted factors that deserved attention. The case-control analysis on every factor raised by the Ishikawa diagram indicated that the commonly suspected factors such as biofilm contamination of the water reservoir in autoclaves, the air-conditioning filter system, glove powder, microkeratome motor oil, and gentian violet markers were not related to the outbreak.

Use of the Ishikawa diagram in a case-control analysis to assess the causes of a diffuse lamellar keratitis outbreak / Aplicando o diagrama de Ishikawa em uma análise caso-controle para identificar as causas de um surto de ceratite lamelar difusa

ABSTRACT Purpose: To identify the causes of a diffuse lamellar keratitis (DLK) outbreak using a systematic search tool in a case-control analysis. Methods: An Ishikawa diagram was used to guide physicians to determine the potential risk factors involved in this outbreak. Coherence between the occurrences and each possible cause listed in the diagram was verified, and the total number of eyes at risk was used to calculate the proportion of affected eyes. Multivariate analysis was performed using logistic regression to determine the independent effect of the risk factors, after controlling for confounders and test interactions. Results: All DLK cases were reported in 2007 between June 13 and December 21; during this period, 3,698 procedures were performed. Of the 1,682 flap-related procedures, 204 eyes of 141 individuals presented with DLK. No direct relationship was observed between the occurrence of DLK and the presence of any specific factors; however, flap-lifting enhancements, procedures performed during the morning shift, and non-use of therapeutic contact lenses after the surgery were significantly related to higher occurrence percentages of this condition. Conclusions: The Ishikawa diagram, like most quality tools, is a visualization and knowledge organization tool. This systematization allowed the investigators to thoroughly assess all the possible causes of DLK outbreak. A clear view of the entire surgical logistics permitted even more rigid management of the main factors involved in the process and, as a result, highlighted factors that deserved attention. The case-control analysis on every factor raised by the Ishikawa diagram indicated that the commonly suspected factors such as biofilm contamination of the water reservoir in autoclaves, the air-conditioning filter system, glove powder, microkeratome motor oil, and gentian violet markers were not related to the outbreak.

RESUMO Objetivos: Identificar as causas de um surto de ceratite lamelar difusa (DLK) uti­lizando uma ferramenta de busca sistemática em uma análise de caso-controle. Métodos: O diagrama de Ishikawa foi usado para orientar os médicos a identificar os potenciais fatores de risco envolvidos neste surto. Coerência entre as ocorrências e cada causa possível listada no diagrama foi verificada. O número total de olhos em risco foi usada para calcular a percentagem de olhos afetados. A análise multivariada foi realizada por meio de regressão logística para determinar o efeito independente dos fatores de risco, controle de fatores de confusão e interações de teste. Resultados: Todos os casos de ceratite lamelar difusa foram relatados em 2007 entre 13 de junho e 21 de dezembro, durante este tempo foram realizados no total 3.698 procedimentos. De um total de 1.682 procedimentos relacionados a confecção de um flap, 204 olhos de 141 indivíduos apresentaram ceratite lamelar difusa. Não foi observada relação direta entre a ocorrência de ceratite lamelar difusa e a presença de qualquer fator específico; no entanto, procedimentos que incluíam um novo levantamento do flap, procedimentos realizados no turno da manhã, e o não-uso de lentes de contato terapêuticas após a cirurgia foram significativamente relacionados com a ocorrência desta complicação. Conclusão: O diagrama de Ishikawa é uma ferramenta de visualização e organização do conhecimento. Essa sistematização permitiu aos investigadores pesquisar todas as possíveis causas do surto de ceratite lamelar difusa. Uma visão clara de toda a logística cirúrgica permitiu a gestão mais rígida dos principais fatores envolvidos no processo. A análise de caso-controle em relação a cada fatores levantados pelo diagrama indicou que fatores sempre suspeitos, tais como: contaminação do biofilme da água do reservatório das autoclaves, sistema de filtro de ar-condicionado, pó de luva, óleo de motor do microcerátomo e marcador violeta de genciana, não foram relacionados com o surto.

Keratoconus progression is not inhibited by reducing eyelid muscular force with botulinum toxin A treatment: a randomized trial.

PURPOSE:: To evaluate whether reducing eyelid muscular force through the administration of botulinum toxin type A (BTX-A) to the orbicularis oculi muscles of patients with keratoconus affected corneal parameters indicative of disease progression. METHODS:: In this prospective parallel randomized clinical trial, 40 eyes of 40 patients with keratoconus were randomized into equally sized control and BTX-A groups. Patients in the BTX-A group received subcutaneous BTX-A injections into the orbicularis muscle. The control group received no intervention. Palpebral fissure height, best spectacle-corrected visual acuity (BSCVA), and corneal topographic parameters were evaluated at baseline and at 3-, 6-, 12-, and 18-month follow-ups. RESULTS:: The mean ± standard deviation vertical palpebral fissure heights were 9.74 ± 1.87 mm and 9.45 ± 1.47 mm at baseline in the control and BTX-A groups, respectively, and 10.0 ± 1.49 mm and 9.62 ± 1.73 mm at 18 months, with no significant difference between the groups (p=0.337). BSCVA values were 0.63 ± 0.56 and 0.60 ± 0.27 at baseline in the control and BTX-A groups (p=0.643), and 0.52 ± 0.59 and 0.45 ± 0.26 at 18 months, again with no significant difference between the groups (p=0.452). In addition, there were no statistical differences between the groups at 18 months for the three keratometry topographic parameters: flattest (K1), steepest (K2), and mean (Km) keratometry (p=0.562). CONCLUSION:: BTX-A inhibition of eyelid force generation did not result in detectable changes in corneal parameters in keratoconic patients during 18 months of follow-up.

Incidence of anterior segment neovascularization during intravitreal treatment for macular edema secondary to central retinal vein occlusion.

PURPOSE:: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). METHODS:: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. RESULTS:: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. CONCLUSION:: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.

Keratoconus progression is not inhibited by reducing eyelid muscular force with botulinum toxin A treatment: a randomized trial / A progressão do ceratocone não é inibida reduzindo a força palpebral com o uso da toxina botulínica tipo A: ensaio clínico randomizado

ABSTRACT Purpose: To evaluate whether reducing eyelid muscular force through the administration of botulinum toxin type A (BTX-A) to the orbicularis oculi muscles of patients with keratoconus affected corneal parameters indicative of disease progression. Methods: In this prospective parallel randomized clinical trial, 40 eyes of 40 patients with keratoconus were randomized into equally sized control and BTX-A groups. Patients in the BTX-A group received subcutaneous BTX-A injections into the orbicularis muscle. The control group received no intervention. Palpebral fissure height, best spectacle-corrected visual acuity (BSCVA), and corneal topographic parameters were evaluated at baseline and at 3-, 6-, 12-, and 18-month follow-ups. Results: The mean ± standard deviation vertical palpebral fissure heights were 9.74 ± 1.87 mm and 9.45 ± 1.47 mm at baseline in the control and BTX-A groups, respectively, and 10.0 ± 1.49 mm and 9.62 ± 1.73 mm at 18 months, with no significant difference between the groups (p=0.337). BSCVA values were 0.63 ± 0.56 and 0.60 ± 0.27 at baseline in the control and BTX-A groups (p=0.643), and 0.52 ± 0.59 and 0.45 ± 0.26 at 18 months, again with no significant difference between the groups (p=0.452). In addition, there were no statistical differences between the groups at 18 months for the three keratometry topographic parameters: flattest (K1), steepest (K2), and mean (Km) keratometry (p=0.562). Conclusion: BTX-A inhibition of eyelid force generation did not result in detectable changes in corneal parameters in keratoconic patients during 18 months of follow-up.

RESUMO Objetivo: Avaliar se a administração da toxina botulínica tipo A (BTX-A) no músculo orbicular de pacientes com ceratocone a fim de reduzir a força muscular palpebral pode alterar os parâmetros corneanos indicativos de progressão da doença. Métodos: Ensaio clínico randomizado paralelo prospectivo. Quarenta olhos de 40 pacientes, randomizados em grupo controle ou grupo BTX-A na razão de 1:1. Pacientes do grupo BTX-A foram submetidos à injeção subcutânea da toxina botulínica tipo A no músculo orbicular. Os pacientes do grupo controle não sofreram nenhuma intervenção. Foram avaliados a medida da fenda palpebral, melhor acuidade visual corrigida, e topografia corneana nos momentos pré-operatório, e aos 3-,6-,12-, e 18 meses de seguimento. Resultados: Média ± DP (desvio padrão) da fenda palpebral no pré-operatório nos grupos controle e BTX-A foram 9,74 ± 187 e 9,45 ± 1,47 mm, respectivamente; aos 18 meses, a média da altura da fenda palpebral vertical nos grupos controle e BTX-A foram 10,0 ± 1,49 mm e 9,62 ± 1,73 mm, respectivamente, sem diferença significante entre os grupos (p=0,337). A média pré-operatória da melhor acuidade visual corrigida nos grupos controle e BTX-A foram 0,63 ± 0,56 e 0,60 ± 0,27, respectivamente (p=0,643); aos 18 meses, a média nos grupos controle e BTX-A foram 0,52 ± 0,59 e 0,45 ± 0,26, respectivamente, sem diferença significante entre os grupos (p=0,452). Não houve diferença estatística entre os grupos aos 18 meses para todos os parâmetros topográficos ceratométricos avaliados, mais plano-(K1), mais curvo-(K2), e ceratometria média Km (p≥0,562). Conclusão: A inibição da força muscular palpebral pela toxina botulínica tipo A não causou alterações detectáveis nos parâmetros corneanos em pacientes com ceratocone, com 18 meses de seguimento.

Incidence of anterior segment neovascularization during intravitreal treatment for macular edema secondary to central retinal vein occlusion / Incidência de neovasos de segmento anterior durante o tratamento de edema macular secundário a oclusão da veia central da retina

ABSTRACT Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Conclusion: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.

RESUMO Objetivo: Analisar as taxas de incidência de neovascularização do segmento anterior (NSA) e de glaucoma neovascular (GNV), em pacientes com edema macular secundário a oclusão de veia central da retina (OVCR), em tratamento com injeções intravítreas de triamcinolona (IVTA) ou bevacizumab (IVB). Métodos: Neste estudo prospectivo, randomizado, duplo mascarado e sham controlado, 35 pacientes com edema macular secundário a OVCR foram randomizados para IVB, IVTA ou para o grupo controle (sham), durante os 6 primeiros meses do estudo. O desfecho primário foi a taxa de incidência de NSA no mês 6. Os desfechos secundários foram alterações médias da acuidade visual corrigida (BCVA) e espessura foveal central (EFC) ao exame de tomografia de coerência óptica, até o mês 12. Resultados: NSA ocorreu em oito (22,86%) olhos, cinco (62,50%) olhos no grupo sham e três (37,50%) olhos no grupo tratado com injeções intravítreas de Triamcinolona, Não houve nenhum caso com NSA no grupo tratado com bevacizumab durante 12 meses de acompanhamento (p=0,009). A BCVA apresentou diferença estatisticamente significante (p<0,05) entre os grupos, somente no mês 1. A EFC não apresentou diferenças estatisticamente significantes (p<0,05) entre os grupos ao longo dos 12 meses. GNV ocorreu em um olho apesar do tratamento com laser e este paciente necessitou de intervenção cirúrgica. Conclusão: O tratamento precoce com injeções intravítreas de Anti VEGF podem diminuir as taxas de neovascularização do segmento anterior e glaucoma neovascular após oclusão de veia central da retina.

Amniotic membrane transplantation with narrow-strip conjunctival autograft vs conjunctival autograft for recurrent pterygia.

PURPOSE: To compare amniotic membrane transplantation (AMT) associated with narrow-strip conjunctival autograft vs conjunctival autograft alone for the treatment of recurrent pterygium. METHODS: In this prospective consecutive interventional study, patients with recurrent pterygium were randomly divided into one of 2 groups; group 1: patients undergoing AMT associated with autologous conjunctival graft; and group 2: patients undergoing conjunctival autograft alone. RESULTS: Of the 80 operated eyes included in this study, 39 (group 1, mean patient age 52.1 ± 11.7 SD years) underwent AMT associated with narrow-strip conjunctival autograft and 41 (group 2, mean patient age 45.8 ± 12.9 SD years) underwent conjunctival autograft alone. In group 1, 6 eyes (15.4%) had grade 1 pterygium, 19 eyes (48.7%) had grade 2 pterygium, and 14 eyes (35.9%) had grade 3 pterygium. In the second group, 5 eyes (12.2%) had grade 1 pterygium, 18 eyes (43.9%) had grade 2 pterygium, and 14 eyes (35.9%) had grade 3 pterygium. No statistically significant difference was found between the 2 groups (p = 0.752). Of the 39 eyes in group 1, recurrent pterygium was observed in 7 cases (17.9%). However, of the 41 eyes in group 2, recurrent pterygium was observed in only 4 cases (9.75%). No statistically significant difference was found between the 2 groups (p = 0.2684). CONCLUSIONS: The results of this study indicate that conjunctival autograft alone might be a better surgical choice for the treatment of recurrent pterygia than combining it with AMT; however, this second option provides a good surgical alternative in cases where little conjunctival donor tissue is available.

Impact of botulinum toxin-A on corneal curvature assessed with Scheimpflug and Placido systems.

PURPOSE: To evaluate the effect of eyelid spasm treatment with botulinum toxin-A (BTX-A) on corneal curvature assessed with Scheimpflug (Pentacam) and Placido (Atlas) systems. SETTING: Federal University of São Paulo, São Paulo, Brazil. DESIGN: Prospective interventional case series. METHODS: Patients with hemifacial spasm were evaluated. Steep keratometry (K) and corneal astigmatism (magnitudes and treatment-induced astigmatism) obtained with the Placido and Scheimpflug systems were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months. RESULTS: The study evaluated 48 eyes (24 affected and 24 normal contralateral eyes) of 24 patients. The mean steep K and astigmatism values obtained with the Placido system on the affected side before treatment were 46.91 diopters (D) ± 3.57 (SD) and 2.63 ± 2.46 D, respectively. A significant decrease in steep K (45.14 ± 1.20 D) and astigmatism (1.01 ± 0.58 D) was observed 2 months (P = .003 and P = .0004, respectively) and 3 months (45.64 ± 1.77 D and 1.36 ± 1.31 D, respectively) (P = .03 and P = .01, respectively) after treatment. The Scheimpflug system did not show significant changes in steep K measurements during the 4-month period. The mean astigmatism in the affected eye before treatment was 1.27 ± 0.88 D. A significant reduction was observed at 15 days (1.16 ± 1.16 D) and at 4 months (0.91 ± 0.59 D) (P = .02 and P = .03, respectively). CONCLUSION: The Placido system was more sensitive in detecting a temporary reduction in corneal curvature after eyelid-spasm treatment. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Daily Optical Coherence Tomography Examinations after First Antivascular Endothelial Growth Factor Injections: An Interventional Case Series.

Purpose. To evaluate daily spectral-domain optical coherence tomography (SD-OCT) changes in naive-treatment patients with diagnosis of exudative age-related macular degeneration (AMD) treated with intravitreous bevacizumab (1.25 mg), during a 30-day follow-up period. Methods. In prospective, interventional study, SD-OCT was performed daily for 30 days after the first intravitreal injection. The baseline, initial-decrease, minimal, and final central retinal thicknesses (CRTs) were assessed. Results. Nine eyes of nine patients with neovascular AMD were enrolled. The mean baseline CRT was 625.3 ± 182.5 µm, and the mean final CRT was 383.4 ± 163.0 µm (mean difference, 206.1 ± 167.6 µm), a difference that reached significance (P = 0.006). After the first injection, the initial decrease in the CRT was seen as an average of one day after injection (mean CRT, 503.6 ± 189.10 µm; P = 0.0431). The speed of the reduction in the CRT tended to decrease by day 17. The mean CRT was 336.5 ± 105.44 µm and the mean minimal CRT on day 30 was 320.75 ± 96.38 µm. Conclusion. The CRT decreased early after the first injection. We observed a tendency for reductions in the speed with which the CRT decreased by day 17 after the first injection, which may affect retreatment regime.

Ocular toxicity assessment of chronic sildenafil therapy for pulmonary arterial hypertension.

PURPOSE: The aim of this study was to investigate possible functional and structural ocular changes caused by chronic sildenafil therapy to treat pulmonary arterial hypertension (PAH). METHODS: Case-control study included patients with pulmonary arterial hypertension: chronically using sildenafil and without sildenafil treatment. A comprehensive ophthalmologic exam including ectoscopy, extrinsic ocular motility, logMAR visual acuity measurement, contrast sensitivity test, color test, anterior segment biomicroscopy, Schirmer test 1, intraocular pressure, fundus exam under pupil dilation, fundus pictures, time domain and spectral domain optical coherence tomography, ocular Doppler ultrasound were performed. Full-field electroretinography (ERG) was tested for each eye in a subgroup of sildenafil-treated patients. RESULTS: Twenty patients from each group were tested. Bilateral severe keratitis was found in seven (35 %) patients under sildenafil therapy. Lacrimal film break-up time (BUT) was significantly reduced (p = 0.006 respectively) and Doppler ultrasound showed a reduced resistance index of the central retinal artery in the group of sildenafil users (p = 0.019). No diffuse retinal functional abnormalities were found in ERG in treated patients. Visual acuity, contrast sensitivity and color discrimination were normal in both groups. No abnormalities were found in both time-domain and spectral-domain OCT for retinal parameters. CONCLUSIONS: One-third of the treated PAH group showed severe bilateral keratitis. This finding could be related to connective tissue abnormalities usually present in patients with this condition that might be exacerbated with the sildenafil usage. The resistance index of the central retinal artery was diminished in the chronic users group and it could be associated to the vasodilation caused by the medication in the choroidal vessels. An ophthalmic assessment for these patients is recommended to diagnose and treat possible ocular surface and choroidal blood flow abnormalities caused by sildenafil.

Influence of involuntary eyelid spasms on corneal topographic and eyelid morphometric changes in patients with hemifacial spasm.

BACKGROUND/AIMS: In patients with hemifacial spasm (HFS), treatment relieves eyelid spasms on the affected side, thus changes in corneal topography and eyelid morphometry may be observed after treatment. We aimed to evaluate these parameters during a 4-month period in patients with HFS treated with botulinum toxin A (BTX-A). METHODS: This prospective study evaluated eyelid morphometric and corneal topographic changes in patients with HFS before onabotulinum toxin A application, and after 15 days and 2, 3 and 4 months. RESULTS: 24 patients were treated with BTX-A. On the normal side, the mean palpebral fissure height (PF), interpalpebral surface area (ISA), steep K and astigmatism values were 8.7±1.98 mm, 122.09±39.37 mm2, 44.99±1.45 D and 0.9±0.64 D, respectively, before treatment. A statistically significant difference was not observed in these parameters after treatment (p>0.05). On the affected side, the mean PF, ISA, steep K and astigmatism were 5.5±1.77 mm, 67.68±28.49 mm2, 46.91±3.57 D and 2.63±2.46 D, respectively, before treatment. We observed a statistically significant (p<0.05) increase in the mean PF and ISA on the affected side 15 days (8.36±1.91 mm and 115.92±34.44 mm2, respectively), 2 months (8.18±1.80 mm and 112.22±33.57 mm2, respectively) and 3 months (7.27±1.65 mm and 95.48±27.80 mm2, respectively) after treatment. A statistically significant decrease in steep K and astigmatism was observed at 2 months (45.14±1.20 D and 1.01±0.58 D, respectively) and 3 months (45.64±1.77 D and 1.36±1.31 D, respectively) after treatment. CONCLUSIONS: The results suggest that treatment with BTX-A in patients with HFS leads to eyelid and corneal changes on the affected eye that are significant during the known period of action of the toxin. Thus, caution should be taken when performing ophthalmological examination in patients with HFS, since it may vary according to BTX-A period of action.

Differences in Corneal Parameters Between Affected and Normal Contralateral Eyes in Patients With Hemifacial Spasm Treated With Botulinum Toxin-A: Outcomes During One Complete Treatment Cycle.

PURPOSE: To investigate possible temporary differences in corneal topographic parameters between affected and normal eyes in patients with hemifacial spasm (HFS) treated with botulinum toxin-A (BTX-A), over the course of 1 treatment cycle. METHODS: This prospective study evaluated corneal topographic differences between affected and normal contralateral eyes during a 4-month period in patients with HFS treated with BTX-A (the duration of action of BTX-A for HFS ranges from 2 to 4 months). Corneal topographic analysis was performed using a conventional topographer (Atlas; Carl Zeiss Meditec, Dublin, CA). Steep K and astigmatism measurements were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months. RESULTS: Twenty-four patients (16 women and 8 men) were evaluated. Steep K [46.9 ± 3.6 diopters (D)] and astigmatism values (2.6 ± 2.5 D) were significantly higher in affected eyes of HFS patients than in nonaffected eyes (45.0 ± 1.4 D and 0.9 ± 0.6 D) before treatment (P = 0.001 for steep K and P = 0.0003 for astigmatism). Astigmatism values also showed significant differences between the affected eye (1.4 ± 0.8 D) and nonaffected eye (0.9 ± 0.6 D) at 4 months (P = 0.006), whereas steep K showed significant differences between both eyes at 15 days (affected eye: 45.6 ± 1.5 D, nonaffected eye: 45.0 ± 1.4 D, P = 0.008), 3 months (affected eye: 45.6 ± 1.8 D, nonaffected eye: 45.1 ± 1.3 D, P = 0.03) and 4 months (affected eye: 45.8 ± 1.2 D, nonaffected eye: 45.1 ± 1.4 D, P = 0.003) after treatment. CONCLUSIONS: The differences in steep K, and especially in astigmatism values, between eyes tended to reduce during the period of action of BTX-A. At 4 months, when the BTX-A effect is considered to be over or very reduced, a significant difference between eyes for both parameters was noted again.

Comparison of Descemet-On Versus Descemet-Off Deep Anterior Lamellar Keratoplasty in Keratoconus Patients: A Randomized Trial.

PURPOSE: To compare the visual outcomes of Descemet membrane (DM)-on and DM-off after deep anterior lamellar keratoplasty (DALK) using the big-bubble (BB) technique in keratoconus patients. METHODS: In this prospective trial, keratoconic eyes undergoing DALK procedures with the BB technique were randomized into 2 groups: a donor cornea without DM (group 1; 29 eyes) or with DM (group 2; 30 eyes). These groups were compared with respect to best-corrected visual acuity and contrast sensitivity while wearing gas permeable contact lenses and also endothelial cell counts. RESULTS: There were no statistically significant differences between the 2 groups with regard to best-corrected visual acuity and contrast sensitivity using gas permeable contact lenses as well as endothelial cell counts at 3, 6, and 12 months. After 1 year, the mean (±SD) postoperative visual acuity CL (with contact lenses) was 0.05 (±0.01) in the DM-off group and 0.05 (±0.01) in the DM-on group (P = 0.956). Mean postoperative endothelial cell counts were 2425.0 (±123.7) and 2306.7 (79.9), respectively (P = 0.443), and corneal thicknesses were 527.9 (58.3) and 556.6 (47.3), respectively (P = 0.150). During the follow-up period, very few complications occurred and neither group had a predominance of adverse events at 3, 6, 12, or 24 months. CONCLUSIONS: In conclusion, DALK procedures using the BB technique for keratoconus with DM-on or DM-off presented no significant differences regarding the visual outcomes or endothelial cell counts.

Experience with Boston keratoprosthesis type 1 in the developing world.

OBJECTIVE: To report the experience of the Federal University of São Paulo, Brazil, in performing Boston keratoprosthesis type 1 implantation in the developing world. METHODS: We analyzed 30 eyes of 30 patients who underwent Boston type 1 keratoprosthesis surgery between 2008 and 2012 in a prospective interventional study. Preoperative, perioperative, and postoperative parameters were analyzed, including visual acuity (VA), keratoprosthesis stability, and postoperative complications. RESULTS: Preoperative diagnoses were failed grafts in 16 eyes (53.33%), chemical injury in 10 eyes (33.33%) and Stevens-Johnson syndrome in 4 eyes (13.33%). Also, 16 eyes (53.33%) had preoperative glaucoma. Preoperative best corrected VA ranged from 20/400 to light perception. With an average follow-up of 32 months (range 1-55 months), postoperative vision improved to >20/200 in 24 eyes (80%). Postoperative VA was statistically improved compared with the preoperative measurement during all postoperative follow-ups (up to 36 months). During the follow-up period (32 months), retention of the initial keratoprosthesis was 93.3%. The incidence of retroprosthetic membrane was 26.66%. Progression of glaucoma occurred in 7 of 16 eyes (43%). Three patients experienced development of glaucoma after keratoprosthesis implantation. One eye experienced development of infectious keratitis, and 2 eyes had retinal detachment. CONCLUSIONS: Performing Boston type 1 keratoprosthesis in a developing country is a viable option after multiple keratoplasty failures and conditions with a poor prognosis for keratoplasty. Our experience appears similar to major reports in the field from investigators in developed countries. Adjustments to postoperative management must be considered according to the particular location.