Correlations between subfoveal choroidal thickness, macular thickness, and visual outcome in neovascular age-related macular degeneration using swept source OCT: insights from intravitreal aflibercept treatment.

BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of visual impairment among individuals aged 50 and above, often resulting in irreversible vision loss (1). Currently, antiangiogenic therapy is the primary treatment approach for neovascular AMD (2). The choroid has gained significant attention in recent years due to its involvement in various ocular pathologies (7). The objective of this study was to evaluate visual acuity and correlate pre-treatment variables, such as foveal thickness and choroidal thickness, with post-treatment outcomes. MATERIALS AND METHODS: This study was designed as a prospective interventional study to investigate the changes in choroidal and macular thickness in patients with neovascular AMD who received intravitreal aflibercept injections. The study utilized medical records and employed Swept Source Optical Coherence Tomography (OCT-SS) for evaluation. The data was collected from patients treated in Presidente Prudente, Brazil, during a three-month load dose period. RESULTS: The best-corrected mean visual acuity significantly improved from 1.0 logarithm of the minimum resolution angle (logMAR) units to 0.55 logMAR after treatment with aflibercept (p < 0.001). Patients undergoing treatment exhibited a significant decrease in average macular thickness from 323 µm to 232 µm (p = 0.001), as well as a reduction in choroidal thickness from 206 µm to 172 µm (p = 0.031), while maintaining intraocular pressure within the normal range (p = 0.719) without significant variation. Statistically significant associations were found between the difference in pre- and post-treatment choroidal thickness and the pretreatment values of macular thickness (p = 0.005) and choroidal thickness (p = 0.013). There was also a statistically significant correlation between the difference in pre- and post-treatment macular thickness and the pretreatment macular thickness value (p < 0.001). CONCLUSION: In this study, aflibercept exhibited remarkable effectiveness in reducing macular and choroidal thickness, as evaluated using OCT-SS, and significantly improved visual acuity in patients with neovascular AMD. The assessment of both choroidal and macular changes, as well as their correlations, can provide valuable insights for clinicians, enabling them to make well-informed therapeutic decisions and effectively monitor treatment outcomes. Notably, this study contributes to the existing body of literature as the first to establish a correlation between pretreatment foveal thickness, variation in choroidal thickness, and post-treatment choroidal thickness.

Long-term Safety and Efficacy of Corneal Collagen Crosslinking in a Pediatric Group With Progressive Keratoconus: A 7-year Follow-up.

PURPOSE: To assess effectiveness and safety of corneal crosslinking (CXL) to reduce keratoconus (KC) progression and improve visual acuity among children with progressive KC and to analyze the use of 20% dextran-based (Dextran) and 1% hydroxypropyl methylcellulose-based (HPMC) riboflavin. DESIGN: Prospective, clinical cohort study METHODS: Standard CXL (SCXL) was performed in 74 eyes (58 patients, 45 males, mean age 13.0 ± 2.1 years): 53 eyes with HPMC and 21 with Dextran. Examinations were performed at baseline, 3 and 6 months, and 1, 2, 3, 4, 5, and 7 years of follow-up, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), a complete ophthalmologic examination, anterior segment ocular coherence tomography, Scheimpflug corneal tomography, and specular microscopy. RESULTS: UDVA and CDVA improved at all periods with statistically significant differences in CDVA at 1, 2, and 3 years. Compared with baseline, maximum K (Max K) reduced throughout the 7-year follow-up. Mean thinnest pachymetry (Th Pachy) decreased significantly at 3 months and remained low; in the Dextran group, the Th Pachy mean value returned to baseline 6 months postoperatively. After CXL, 1.5 diopter progression in max K was 1.4% to 14.6% of eyes; worsening was found at 4 to 7 years postoperatively. CONCLUSION: SCXL reduced KC progression in children up to 7 years of follow-up and revealed improvement and stability of UDVA and CDVA in 82% of eyes. For visual acuity and KC stability, no statistically significant difference was observed between Dextran-HPMC. The HPMC group showed persistent cornea thinning, raising concerns about its use in SCXL.

Pediatric Crosslinking: Current Protocols and Approach.

Keratoconus (KC) is likely to be more aggressive in the pediatric population, with a higher risk of progression and visual loss. Several techniques have been proposed for corneal crosslinking (CXL) so far. The standard CXL (SCXL) technique, or the Dresden Protocol, originally developed by Wollensak et al., has been shown to be safe and effective in the pediatric KC group. With similar efficacy to the conventional method, the accelerated CXL (ACXL) protocols proposed a reduced UVA exposure time by increasing the intensity of UVA irradiation. Transepithelial CXL (TCXL), considered an "epithelium-on" method, emerged as a strategy to improve safety and reduce postoperative complications and discomfort. For thinner corneas, we can highlight the use of hypoosmolar riboflavin and new studies, such as contact lens-assisted CXL (CACXL), the epithelial-island CXL (EI-CXL), and the Sub400 protocol. In addition to the different protocols used, another factor that changes CXL results is the type of carrier used: dextran-based or hydroxypropyl methylcellulose-based (HPMC) riboflavin solutions. There are several ways to perform a CXL surgery, and it is still unclear which method is the safest and most effective in the pediatric group. This review of the literature in English, available in PubMed, provides an update on corneal CXL in the pediatric KC group, exploring the data on the techniques currently used and under investigation, including their advantages, efficacy, safety profiles, risks, and cost analyses.

Correlation between Placido-disc and rotating Scheimpflug keratometric findings before and after corneal crosslinking in children with keratoconus.

PURPOSE: To evaluate correlation between Placido-disc and rotating Scheimpflug keratometric findings in children with progressive keratoconus (KC) before and after corneal crosslinking (CXL) and investigate whether these limits of agreement varied according to disease severity. SETTING: Department of Ophthalmology of São Paulo Hospital, São Paulo, Brazil. DESIGN: Prospective nonrandomized open study. METHODS: Data obtained using rotating Scheimpflug-based tomography and Placido-disc-based topography devices were collected from preoperative and last follow-up postoperative children with KC operated on using standard CXL protocol. Correlation and agreement analyses were performed between the 2 devices before and after CXL to obtain keratometric (K) findings. RESULTS: 44 eyes from 44 patients aged 8 to 16 years were analyzed at all timepoints. All parameters were found to be strongly correlated before ( r = 0.84 to 0.99, P < .001) and after ( r = 0.93 to 0.99, P < .001) CXL. The mean Scheimpflug measurements of flat K, steep K, Kmax, mean K, and corneal astigmatism were higher than Placido-disc measurements in a preoperative period. This mean difference decreased in postoperative, but, with exception of Kmax and corneal astigmatism, Scheimpflug measurements remained higher. The mean parameter measurements from both devices decreased after CXL; 95% limits of agreement between instruments were wide for all parameters and decreased in postoperative and in mild KC. CONCLUSIONS: Keratometry measurements obtained using rotating Scheimpflug and Placido-disc technology were found to be closely correlated but not interchangeable before and after CXL in pediatric patients. Agreement between devices was better after CXL and in mild KC than in advanced KC.

Sequence of focal choroidal excavation types in a patient with bilateral central serous chorioretinopathy / Sequência dos tipos de escavação focal de coroide em um paciente com coriorretinopatia serosa central bilateral

ABSTRACT A 39-year-old policeman complained of decreased bilateral central vision over the last two years. On examination, visual acuity was 20/40 and 20/400 in the right (OD) and left eye (OS), respectively, and fundoscopy revealed a bilateral hypopigmented macular lesion. Fluorescein and indocyanine green angiography demonstrated leakage and hyperintense spots, respectively, within the macular areas. At baseline, optical coherence tomography showed subretinal fluid in the OD and a conforming focal choroidal excavation in the OS. Focal choroidal excavation converted from conforming to nonconforming type at 4-month follow-up and then reversed to conforming type at 12-month follow-up, and was associated with incomplete retinal pigment epithelium and outer retina atrophy over the area of excavation. Pachyvessels were also evidenced in the choroid, without neovascularization. We report for the first time a case of focal choroidal excavation that progressed from conforming to nonconforming type and then reverted to its primary configuration (conforming type) in a patient with concurrent bilateral central serous chorioretinopathy.

RESUMO Um policial de 39 anos se queixava de diminuição bilateral da visão central nos últimos 2 anos. A acuidade visual era 20/40 e 20/400 no olho direito (OD) e esquerdo (OE) e a fundoscopia revelou lesão macular hipopigmentada bilateral. A angiografia fluoresceínica e com indocianina verde revelaram, respectivamente, vazamento do corante e áreas hiperintensas nas regiões maculares. A tomografia de coerência óptica evi denciou fluido sub-retiniano no OD e escavação focal de coroide do tipo conformacional no OE. Após 4 meses, a escavação focal de coroide mudou de conformacional para não conformacional e, aos 12 meses, reverteu para conformacional associado a atrofia incompleta do epitélio pigmentar da retina e da retina externa na região da escavação. Também foi evidenciado paquicoroide, sem neovascularização. Relatamos pela primeira vez uma escavação focal de coroide que evoluiu de conformacional para não conformacional e, em seguida, retornou à configuração primária (conformacional) em um paciente com coriorretinopatia serosa central bilateral.

Sequence of focal choroidal excavation types in a patient with bilateral central serous chorioretinopathy.

A 39-year-old policeman complained of decreased bilateral central vision over the last two years. On examination, visual acuity was 20/40 and 20/400 in the right (OD) and left eye (OS), respectively, and fundoscopy revealed a bilateral hypopigmented macular lesion. Fluorescein and indocyanine green angiography demonstrated leakage and hyperintense spots, respectively, within the macular areas. At baseline, optical coherence tomography showed subretinal fluid in the OD and a conforming focal choroidal excavation in the OS. Focal choroidal excavation converted from conforming to nonconforming type at 4-month follow-up and then reversed to conforming type at 12-month follow-up, and was associated with incomplete retinal pigment epithelium and outer retina atrophy over the area of excavation. Pachyvessels were also evidenced in the choroid, without neovascularization. We report for the first time a case of focal choroidal excavation that progressed from conforming to nonconforming type and then reverted to its primary configuration (conforming type) in a patient with concurrent bilateral central serous chorioretinopathy.

Nodular anterior scleritis associated with Berger's disease.

A 45-year-old female patient presented with a complaint of right eye redness and pain for 7 days. She was under investigation for urinary abnormalities and reported a previous history of recurrent oral ulcers and ocular hyperemia in both eyes. Best-corrected visual acuity was 20/30 and 20/20 in the right and left eyes, respectively. Slit-lamp biomicroscopy of the ocular surface of the right eye revealed nasal scleral hyperemia that persisted after instillation of topical phenylephrine 10%, reinforcing the diagnosis of anterior scleritis. Renal biopsy showed immunoglobulin A immune complexes and confirmed the suspected diagnosis of Berger's disease. Maintenance immunosuppressive therapy with azathioprine following a 6-month induction of remission with cyclophosphamide was necessary after pulse therapy with methylprednisolone. Scleritis is usually related to systemic autoimmune diseases, such as rheumatoid arthritis, and polyangiitis. Herein, we describe a rare case of unilateral anterior scleritis associated with Berger's disease.

Nodular anterior scleritis associated with Berger's disease / Esclerite anterior nodular associada à doença de Berger

ABSTRACT A 45-year-old female patient presented with a complaint of right eye redness and pain for 7 days. She was under investigation for urinary abnormalities and reported a previous history of recurrent oral ulcers and ocular hyperemia in both eyes. Best-corrected visual acuity was 20/30 and 20/20 in the right and left eyes, respectively. Slit-lamp biomicroscopy of the ocular surface of the right eye revealed nasal scleral hyperemia that persisted after instillation of topical phenylephrine 10%, reinforcing the diagnosis of anterior scleritis. Renal biopsy showed immunoglobulin A immune complexes and confirmed the suspected diagnosis of Berger's disease. Maintenance immunosuppressive therapy with azathioprine following a 6-month induction of remission with cyclophosphamide was necessary after pulse therapy with methylprednisolone. Scleritis is usually related to systemic autoimmune diseases, such as rheumatoid arthritis, and polyangiitis. Herein, we describe a rare case of unilateral anterior scleritis associated with Berger's disease.

RESUMO Paciente de 45 anos, sexo feminino queixava-se de hiperemia e dor no olho direito há sete dias. Encontrava-se sob investigação de alterações urinárias e relatou história pregressa de úlceras orais e hiperemia ocular bilateral recorrentes. A acuidade visual corrigida era de 20/30 no olho direito e 20/20 no esquerdo. A biomicroscopia da superfície ocular do olho direito revelou intensa hiperemia escleral em região nasal que persistiu após a instilação de fenilefrina tópica a 10%, reforçando o diagnóstico clínico de esclerite anterior unilateral. A biópsia renal revelou a presença de imunocomplexos de IgA e confirmou a hipótese de doença de Berger. Uma terapia imunossupressora de manutenção com azatioprina após 6 meses de indução de remissão com ciclofosfamida foi necessária após pulsoterapia com metilprednisolona. A esclerite geralmente está relacionada a doenças autoimunes sistêmicas, como artrite reumatoide e poliangeite. Descrevemos aqui um caso raro de esclerite anterior unilateral associada à doença de Berger.

Unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strongly positive purified protein derivative test / Epiteliopatia pigmentar placóide multifocal posterior aguda unilateral na presença de reação forte positiva para o teste tuberculínico

ABSTRACT A 27-year-old man presented with a complaint of decreased visual acuity in the right eye. Best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Right eye fundoscopy revealed mild vitritis, multifocal yellowish lesions, and macular serous retinal detachment. Left eye evaluation was normal. Acute posterior multifocal placoid pigment epitheliopathy was diagnosed in the right eye. Complementary exams revealed a strong reaction to the Mycobacterium tuberculosis purified protein derivative test, thus treatment for tuberculosis was initiated. Baseline fluorescein angiography of the right eye revealed early hypofluorescence and late staining of the lesions. Optical coherence tomography of the right eye demonstrated the accumulation of subretinal and intraretinal fluid associated with cystoid macular edema. During follow-up, the retinal fluid and cysts disappeared, which was followed by disorganization of foveal interdigitation and ellipsoid zones. This is the second described case of unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strong positive result to the M. tuberculosis purified protein derivative test.

RESUMO Um homem de 27 anos apresentou uma queixa de diminuição da acuidade visual no olho direito. A acuidade visual melhor corrigida foi 20/60 no olho direito e 20/20 no olho esquerdo. A fundoscopia do olho direito revelou vitreíte leve, lesões amareladas multifocais e descolamento seroso da retina em região macular. A avaliação do olho esquerdo foi normal. Epiteliopatia pigmentar placóide multifocal posterior aguda foi diagnosticada no olho direito. Os exames complementares revelaram forte reação ao teste do derivado proteico purificado Mycobacterium tuberculosis, iniciando terapia antibiótica contra tuberculose. A angiografia fluoresceínica basal do olho direito revelou hipofluorescência precoce e tardia das lesões. A tomografia de coerência óptica do olho direito demonstrou fluído sub- e intrarretiniano associado a edema macular cistóide. Durante o seguimento, os fluídos e cistos retinianos desapareceram, seguido da desorganização das zonas de interdigitação e elipsóide em região foveal. Este é o segundo caso descrito de epiteliopatia pigmentar placóide multifocal posterior aguda unilateral em um paciente com um forte resultado positivo para o teste tuberculínico.

Unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strongly positive purified protein derivative test.

A 27-year-old man presented with a complaint of decreased visual acuity in the right eye. Best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Right eye fundoscopy revealed mild vitritis, multifocal yellowish lesions, and macular serous retinal detachment. Left eye evaluation was normal. Acute posterior multifocal placoid pigment epitheliopathy was diagnosed in the right eye. Complementary exams revealed a strong reaction to the Mycobacterium tuberculosis purified protein derivative test, thus treatment for tuberculosis was initiated. Baseline fluorescein angiography of the right eye revealed early hypofluorescence and late staining of the lesions. Optical coherence tomography of the right eye demonstrated the accumulation of subretinal and intraretinal fluid associated with cystoid macular edema. During follow-up, the retinal fluid and cysts disappeared, which was followed by disorganization of foveal interdigitation and ellipsoid zones. This is the second described case of unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strong positive result to the M. tuberculosis purified protein derivative test.

Bevacizumab Injection in Patients with Neovascular Age-Related Macular Degeneration Increases Angiogenic Biomarkers.

PURPOSE: To evaluate the expression of 19 angiogenic biomarkers in the aqueous humor before and after intravitreal bevacizumab injection (IVB) in eyes with neovascular age-related macular degeneration (AMD). DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-three eyes of 23 treatment-naïve patients with choroidal neovascularization (CNV) secondary to neovascular AMD. METHODS: Eyes were diagnosed with CNV secondary to neovascular AMD and were treated with 3 monthly IVBs. Aqueous humor samples were obtained by anterior chamber paracentesis at baseline and immediately before each intravitreal bevacizumab injection. MAIN OUTCOME MEASURES: Aqueous humor levels of 19 angiogenic biomarkers (angiopoietin 2, bone morphogenetic protein 9 [BMP-9], epidermal growth factor [EGF], endoglin, endothelin 1, fibroblast growth factor [FGF]-1 and FGF-2, follistatin, granulocyte colony-stimulating factor [GCSF], heparin-binding EGF-like growth factor [HB-EGF], hepatocyte growth factor [HGF], interleukin 8, leptin, placental growth factor [PLGF], vascular endothelial growth factor [VEGF]-A, VEGF-C, VEGF-D, and tissue inhibitor of metalloproteinases [TIMP]-1 and TIMP-2) were measured. Best-corrected visual acuity (BCVA), spectral-domain OCT parameters, and intraocular pressure also were evaluated. RESULTS: Baseline aqueous VEGF-A expression was elevated in all study eyes before treatment initiation. A statistically significant decrease of VEGF-A was observed at the 1- and 2-month follow-ups. A statistically significant increased concentration was observed in 7 biomarkers: VEGF-C, angiopoietin 2, endothelin 1, follistatin, HB-EGF, HGF, and interleukin 8. The other 11 study biomarker levels (VEGF-D, BMP-9, EGF, endoglin, FGF-1, FGF-2, GCSF, leptin, PLGF, TIMP-1, and TIMP-2) did not show any significant difference during follow-up. The BCVA statistically improved significantly at 2 months. Spectral-domain OCT parameters improved significantly at all follow-ups. Mean intraocular pressure values were not statistically different during the study period. CONCLUSIONS: Despite a decrease in VEGF-A, the aqueous levels of VEGF-C, angiopoietin 2, endothelin 1, follistatin, HB-EGF, HGF, and interleukin 8 increased significantly after intravitreal injection of bevacizumab. These upregulated angiogenic biomarkers may represent new therapeutic targets in exudative AMD.

Retinal and choroidal angiogenesis: a review of new targets.

Retinal and choroidal neovascularization are a major cause of significant visual impairment, worldwide. Understanding the various factors involved in the accompanying physiopathology is vital for development of novel treatments, and most important, for preserving patient vision. The intraocular use of anti-vascular endothelial growth factor therapeutics has improved management of the retinal and choroidal neovascularization but some patients do not respond, suggesting other vascular mediators may also contribute to ocular angiogenesis. Several recent studies examined possible new targets for future anti-angiogenic therapies. Potential targets of retinal and choroidal neovascularization therapy include members of the platelet-derived growth factor family, vascular endothelial growth factor sub-family, epidermal growth factor family, fibroblast growth factor family, transforming growth factor-ß superfamily (TGF-ß1, activins, follistatin and bone morphogenetic proteins), angiopoietin-like family, galectins family, integrin superfamily, as well as pigment epithelium derived factor, hepatocyte growth factor, angiopoietins, endothelins, hypoxia-inducible factors, insulin-like growth factors, cytokines, matrix metalloproteinases and their inhibitors and glycosylation proteins. This review highlights current antiangiogenic therapies under development, and discusses future retinal and choroidal pro- and anti-angiogenic targets as wells as the importance of developing of new drugs.

Aqueous vascular endothelial growth factor and clinical outcomes correlation after single intravitreal injection of bevacizumab in patients with neovascular age-related macular degeneration.

PURPOSE: To evaluate the concentration of vascular endothelial growth factor (VEGF) in aqueous humor after a single intravitreal injection of bevacizumab (IVB) in eyes with neovascular age-related macular degeneration (AMD). METHODS: In this prospective interventional case series study, 24 eyes of 24 patients with types 1 and 2 choroidal neovascularization secondary to neovascular AMD were treated with a single intravitreal injection of bevacizumab. Aqueous humor samples were obtained before the intravitreal injection and at one week, one month, and three months follow-up periods. Best-corrected visual acuity (BCVA) and three spectral-domain optical coherence tomography parameters (central retinal thickness, macular volume and macular area) were also analyzed and correlated with VEGF expression at the baseline and each follow-up period. RESULTS: All of the ninety-six aqueous humor study taps were well tolerated by the study patients without adverse events. Increased VEGF levels (mean ± SD = 179.7 ± 88.3 pg/mL) were observed in the aqueous humor of all study patients before the intravitreal injection of bevacizumab. At all follow-up periods, compared to baseline, levels of VEGF significantly reduced (P < 0.0001), and BCVA significantly improved (P < 0.005). The lowest VEGF expression was observed at 1 week, and the greatest BCVA improvement occurred 1 month after treatment. At 1 month, central retinal thickness (CRT), macular volume (MV), and macular area (MA) significantly reduced compared to baseline (P < 0.0001, P = 0.0005, P = 0.007, P = 0.009, respectively). At 1 week and 3 months, although without statistical significance (P > 0.005), CRT, MV and MA also reduced in comparison to baseline. CONCLUSIONS: Single intravitreal bevacizumab injection in eyes with neovascular AMD resulted in a substantial decrease of aqueous VEGF levels 1 week after treatment with the greatest improvement of clinical outcomes occurring at 1 month follow-up.

Correlations Between Allergen-Specific IgE Serum Levels in Patients With Ocular Allergy.

PURPOSE: To evaluate ocular allergies in patients at the Hospital do Servidor Publico Estadual de Sao Paulo (HSPE) and the correlations with serum allergen-specific immunoglobulin E levels. METHODS: We performed a longitudinal study of patients with ocular allergies who were treated at the Cornea and Immunology and Allergy Department. Patients underwent an ophthalmologic examination to identify their primary presenting signs and symptoms. The allergy types were divided into 4 groups. We conducted the following laboratory tests and measurements: blood count, eosinophil count, total serum IgE, and specific IgE. RESULTS: Among 61 patients, 16 (26.2%) had a clinical diagnosis of seasonal allergic conjunctivitis, 23 (37.7%) had perennial allergic conjunctivitis, 19 (31.1%) had vernal keratoconjunctivitis, and 3 (4.9%) had atopic keratoconjunctivitis. Mixed dust mites were positive in 94.9% of patients. Dermatophagoides pteronyssinus (dp) and Dermatophagoides farinae (df) antigens were positive in 93.2% of patients followed by Blattella germanica, Blomia tropicalis, and mixed animal epithelia (81%, 75.9%, and 25.8%, respectively). CONCLUSIONS: Perennial allergic conjunctivitis was the most prevalent disorder and demonstrated higher positivity in class V/VI for specific antigens (mixed dust mites, dp, and df), indicating high antigenicity. Dust mites, D. pteronyssinus, D. farinae, B. germanica, and B. tropicalis were the primary triggers of the studied ocular allergies.

[Application of corrective formula for intraocular pressure changes in patients that underwent LASIK]. / Aplicação de fórmula corretiva nas alterações da pressão intraocular dos pacientes submetidos a LASIK.

PURPOSE: To compare the intraocular pressure (IOP) pre and post LASIK, correlating it to changes in central corneal thickness (CCT) and average simulated keratometry (K), as well as verifying the results of a corrective formula previously proposed. METHODS: Longitudinal prospective study conducted in outpatients that underwent to LASIK. Patients underwent complete ophthalmic examination, previously and 2 months after the surgery. Intraocular pressure was evaluated with Goldmann applanation tonometer between 9 am and 11 am, average simulated keratometry was evaluated using corneal topography and central corneal thickness was measured with ultrasound pachymetry, been considered the average of three measurements. Two patients were excluded due to surgery or eye disease, and previous use of topical steroids over the past three months. The surgeries were performed according to standard procedures. The formula [real IOP = IOP measured + (540 - ECC)/71 + (43 - K)/2.7 + 0.75 mmHg] proposed for correcting intraocular pressure was used. RESULTS: Fifteen eyes of eight patients were evaluated, age ranged from 24 to 46 years (mean: 31.37 ± 7.27). There was a statistically significant difference between the measurements of intraocular pressure, central corneal thickness and average simulated keratometry pre and post-LASIK. (p=0.0001). It was observed that each 1D corrected underestimated the IOP 1.06 ± 0.59 mmHg (0.11 a 1.89 mmHg). The use of the corrective formula lead to 80% of eyes within 2.50 mmHg of preoperative intraocular pressure. Although, the two sets of data are statistically different (p=0.0266). CONCLUSIONS: Post LASIK eyes presented lower intraocular pressure than preoperatively. Intraocular pressure was moderately correlated to central corneal thickness and weakly correlated to average simulated keratometry. With the use of the corrective formula, we were able to determine that 80% were within 2.50 mmHg of the preoperative intraocular pressure.

Aplicação de fórmula corretiva nas alterações da pressão intraocular dos pacientes submetidos a LASIK / Application of corrective formula for intraocular pressure changes in patients that underwent LASIK

OBJETIVO: Comparar a pressão intraocular (PIO) pré e pós-LASIK, correlacionando-as com as mudanças da espessura corneana central (ECC) e ceratometria simulada média (K), assim como verificar o resultado de fórmula corretiva proposta anteriormente. MÉTODOS: Estudo longitudinal, prospectivo, realizado em pacientes submetidos a LASIK. Os pacientes foram submetidos ao exame oftalmológico completo, no pré operatório e após 2 meses da cirurgia. A pressão intraocular foi avaliada com tonômetro de aplanação de Goldmann entre 9 h e 11 h da manhã, a ceratometria simulada média foi avaliada por meio de topografia corneana e a espessura corneana central foi aferida por paquímetro ultrassônico, sendo considerada a média de três aferições. Foram excluídos dois pacientes com cirurgias ou doenças oculares prévias, e uso prévio de corticosteróide tópico nos últimos três meses. As cirurgias foram realizadas de acordo com os procedimentos-padrão. Foi utilizada a fórmula [PIO real = PIO aferida + (540 - ECC)/71 + (43 - K)/2,7 + 0,75 mmHg] proposta para correção da pressão intraocular pós-operatória. RESULTADOS: Quinze olhos de oito pacientes foram avaliados, a idade variou de 24 a 46 anos (média: 31,37 ± 7,27). Foi observada diferença estatisticamente significante entre as medidas da pressão intraocular, de ceratometria simulada média e da espessura corneana central pré e pós-LASIK. (p=0,0001). Foi observado que para cada 1D corrigida, há uma subestimação, em média, de 1,06 ± 0,59 mmHg (0,11 a 1,89 mmHg). A aplicação da fórmula corretiva levou a 80 por cento dos olhos com a tonometria estimada entre ± 2,50 mmHg da pré-operatória, no entanto, quando comparada com a tonometria pré-operatória, estas são estatisticamente diferentes (p=0,0266). CONCLUSÕES: Os olhos submetidos a LASIK apresentaram PIO pós-operatória menor do que a pré-operatória. A pressão intraocular pôde ser moderadamente correlacionada com a espessura corneana central e fracamente com a ceratometria simulada média. Não houve correlação entre a profundidade de ablação e a variação da pressão intraocular, no pós-operatório. Usando a fórmula proposta, pudemos averiguar que 80 por cento dos pacientes apresentaram pressão intraocular entre ± 2,50 mmHg da pré-operatória.

PURPOSE: To compare the intraocular pressure (IOP) pre and post LASIK, correlating it to changes in central corneal thickness (CCT) and average simulated keratometry (K), as well as verifying the results of a corrective formula previously proposed. METHODS: Longitudinal prospective study conducted in outpatients that underwent to LASIK. Patients underwent complete ophthalmic examination, previously and 2 months after the surgery. Intraocular pressure was evaluated with Goldmann applanation tonometer between 9 am and 11 am, average simulated keratometry was evaluated using corneal topography and central corneal thickness was measured with ultrasound pachymetry, been considered the average of three measurements. Two patients were excluded due to surgery or eye disease, and previous use of topical steroids over the past three months. The surgeries were performed according to standard procedures. The formula [real IOP = IOP measured + (540 - ECC)/71 + (43 - K)/2.7 + 0.75 mmHg] proposed for correcting intraocular pressure was used. RESULTS: Fifteen eyes of eight patients were evaluated, age ranged from 24 to 46 years (mean: 31.37 ± 7.27). There was a statistically significant difference between the measurements of intraocular pressure, central corneal thickness and average simulated keratometry pre and post-LASIK. (p=0.0001). It was observed that each 1D corrected underestimated the IOP 1.06 ± 0.59 mmHg (0.11 a 1.89 mmHg). The use of the corrective formula lead to 80 percent of eyes within 2.50 mmHg of preoperative intraocular pressure. Although, the two sets of data are statistically different (p=0.0266). CONCLUSIONS: Post LASIK eyes presented lower intraocular pressure than preoperatively. Intraocular pressure was moderately correlated to central corneal thickness and weakly correlated to average simulated keratometry. With the use of the corrective formula, we were able to determine that 80 percent were within 2.50 mmHg of the preoperative intraocular pressure.