Results of intrastromal corneal ring implantation in advanced keratoconus With the aim of postpoing or avoiding corneal transplantation.

PURPOSE: To evaluate the safety and efficacy of the surgery of intracorneal ring segment implantation with 320° of arc (320-ICRS) in patients with advanced keratoconus stage IV and maximum keratometry (Kmax) above 60 D. METHODS: A prospective, interventional case series study evaluating 25 eyes of 19 patients with keratoconus stage IV and Kmax > 60D in which 320-ICRS were implanted using VisuMax® femtosecond. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometric values (mean - mean-K, flat - K1, and steep - K2), maximum keratometry (Kmax), tomographic astigmatism, refractive astigmatism and asphericity (Q) were assessed preoperatively and at 3, 6 and 12 months after the procedure. RESULTS: The UDVA improved from 1.03 ± 0.28 LogMAR (20/200) to 0.54 ± 0.21 LogMAR (20/60), (p < 0.001), the CDVA (with glasses) improved from 0.63 ± 0.29 LogMAR (20/80) to 0.31 ± 0.16 LogMAR (20/40),(p = 0.004), K1 reduced from 54.41 ± 4.46 D to 49.36 ± 4.11 D (p < 0.001), K2 reduced from 61.15 ± 4.37 D to 53.715 ± 4.05 D, (p < 0.001), mean-K reduced from 57.55 ± 4,17 D to 51.44 ± 3,94 D (p < 0.001), Kmax reduced from 69.80 ± 8.20 D to 63.43 ± 6.31 D (p < 0.001) and asphericity (Q) changed from -1.57 ± 0.35 to -0.77 ± 0.56 (p < 0.001). A total of 89.9% patients reached BCVA wearing scleral contact lens  0.2 LogMAR(20/25). CONCLUSION: 320-ICRS to treat advanced keratoconus appears to be an efficacious and safe procedure, being a surgical alternative to delay or even prevent corneal transplantation.

Role of Corneal Epithelial Measurements in Differentiating Eyes with Stable Keratoconus from Eyes that Are Progressing.

Purpose: To evaluate measures of corneal epithelium in eyes that showed documented signs of keratoconus (KC) progression and compare with stable eyes and healthy controls. Also, to determine the correlation of these epithelial parameters with maximum keratometry (K max) and pachymetry. Design: Prospective, observational, comparative study. Participants: One-hundred and fifty eyes from 150 patients. The study included 50 eyes from patients with documented KC progression, 50 eyes with stable KC, and 50 clinically normal eyes to serve as controls. Methods: A spectral-domain (SD)-OCT imaging was obtained in all eyes, and mean values were compared between the groups. The correlation of epithelial parameters with K max and thinnest pachymetry was also investigated. Main Outcome Measures: For the purposes of this study, the epithelial measures maximum, minimum, superior, and inferior values as well as the difference between the minimum and maximum (min-max) and epithelial standard deviation were considered, obtained from SD-OCT and compared between groups. Measurements of the thinnest point and min-max in pachymetry were also recorded. Results: The only epithelial parameter that presented a statistically significant difference between stable and progressive KC was epithelium min-max. Although stable KC presented epithelium min-max mean values of -18.2 ± 6.6, progressive KC eyes presented mean values of -23.4 ± 10.3 (P < 0.0001). Epithelial maximum (P = 0.16), minimum (P = 0.25), superior (P = 0.28), inferior (P = 0.23), and standard deviation (P = 0.25) values were not significantly different between stable and progressive eyes. Difference min-max pachymetry points in stable (-108.3 ± 33.5) and progressive KC (-115.2 ± 56.0) were not significantly different (P = 0.723). There was no significant correlation between epithelium min-max with corneal thinning (P = 0.39) or K max (P = 0.09) regardless of disease progression. Conclusions: Epithelial measures are useful to identify KC eyes that are progressing; the parameters that measure the difference between min-max epithelium points were significantly different between stable and progressive groups, unlike this difference in pachymetry. Finally, this epithelial parameter seems to be independent of corneal thinning and K max. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.

Correlation of hair cortisol and interleukin 6 with structural change in the active progression of keratoconus.

PURPOSE: To evaluate interleukin (IL) and hair cortisol concentrations (HCCs) in progressive keratoconus (KC) and compare them with KC-stable eyes and healthy control, and to determine the correlation of these inflammatory mediators and HCCs and their relationship with structural damage represented by increased corneal curvature. SETTING: University of Sao Paulo, Brazil. DESIGN: Prospective observational comparative study. METHODS: 133 eyes of 74 patients were included. The concentrations of tear cytokines: IL1B, IL6, IL8, IL10, IL12p70, and tumor necrosis factor α were obtained by capillary flow and measured using a flow cytometer. HCCs were determined from the most proximal hair segment as an index of cumulative secretion and measured by liquid chromatography mass spectrometry. RESULTS: 133 eyes of 74 patients. Only IL6 was increased in progressive KC tears compared with stable KC (6.59 ± 3.25 pg/mL vs 4.72 ± 1.91 pg/mL; P < .0001) with a positive correlation between IL6 and maximum keratometry (Kmax) (P < .0001). Progressive KC exhibited significantly higher HCC than stable KC (0.624 ± 0.160 ng/mg vs 0.368 ± 0.0647 ng/mg; P < .0001) and healthy controls (0.624 ± 0.160 ng/mg vs 0.351 ± 0.0896 ng/mg; P < .0001). There was a significant correlation between HCC and Kmax (P < .0001). CONCLUSIONS: KC eyes that are progressing have a higher concentration of IL6 and long-term cortisol than patients with stable forms of KC; second, there is a significant correlation between this increase in IL6 and cortisol with corneal structural damage. Finally, there is a meaningful relationship between this interleukin and the previous few months' cortisol levels.

Xeroderma Pigmentosum: Ocular Findings in an Isolated Brazilian Group with an Identified Genetic Cluster.

PURPOSE: Xeroderma pigmentosum (XP) is a rare autosomal recessive genetic disorder characterized by increased susceptibility to UV radiation- (UVR-) induced skin pigmentation, skin cancers, ocular surface disease, and, in some patients, sunburn and neurological degeneration. Eight different genes are affected, and the prevalence of the disease differs across the world. The present study describes the main ophthalmologic features and symptoms in patients with XP in this case series. METHODS: Patients were examined consecutively at the University Hospital of the Federal University of Goias between January 2016 and June 2018. All patients underwent ophthalmologic examination and were asked about their ophthalmological history and the presence of ocular symptoms. RESULTS: Twenty-one patients with genetic confirmation were evaluated. The genetic variants XPV and XPC were detected in the patients. The most prevalent findings include eyelid changes, observed in 80.9% of the patients, and ocular surface changes as punctate keratopathy, occurring in 16 patients (76.2%), corneal neovascularization, and corneal opacities. Six patients (28.5%) presented corneoconjunctival tumor. More than half of patients had previous history of treatment of ocular neoplasia. Ocular burning was the most reported symptom. CONCLUSIONS: The ocular characteristics identified in this study corroborate the existing literature, mainly related to the surface. Concerning the XP variant and the gravity of ocular signs, XPC has earlier and more severe symptoms than XPV. Due to their relative rarity, publications of XP cases are important to understand the possible damages caused by the disease in the eyes and surrounding area.

Perfil psicomotor de escolares com deficiência intelectual: por que avaliar? / Psychomotor profile of students with intellectual disabilities

O interesse pela deficiência intelectual (DI) não é recente. Como resultado, há quantidade considerável de estudos que abordam diferentes aspectos do desenvolvimento de indivíduos com esse transtorno. Entretanto, pode se dizer que a investigação do perfil psicomotor de escolares que frequentam ensino fundamental é escassa. OBJETIVOS: Avaliar o perfil psicomotor de escolares do ensino fundamental com diagnóstico de DI. Especificamente, foi analisado o perfil psicomotor em função das seguintes variáveis: a) frequência (ou não) em sala de recursos multifuncional (SRM); b) classificação da DI; c) idade; c) raça/cor; d) série escolar MÉTODO: Participaram do estudo 15 alunos de uma escola pública de uma cidade do interior do estado de São Paulo. Para avaliação do perfil psicomotor, foram utilizados os seguintes instrumentos: Teste de Proficiência Motora de Bruininks-Oseretsky (BOT-2), versão breve; Avaliação Psicomotora RESULTADOS: Os dados obtidos mostraram que a maioria dos sujeitos apresentou desempenho "muito abaixo do esperado" em todos os subtestes que compõem o BOT-2. Do mesmo modo, desempenho inferior à idade cronológica foi identificado na Avaliação Psicomotora. Não foram encontradas diferenças estatisticamente significativas nos subtestes do BOT-2 quando se analisou frequência (ou não) em SRM, gênero e raça/cor. Contrariamente, melhor desempenho em algumas habilidades psicomotoras foi encontrado em função da idade, série escolar e classificação da DI CONCLUSÃO: As autoras discutem a relação entre desenvolvimento psicomotor e aprendizagem e chamam a atenção para a necessidade de se utilizar os pressupostos da Psicomotricidade no contexto escolar, principalmente na SRM. Com isso, pode-se auxiliar as crianças com deficiência intelectual a maximizar as suas potencialidades e, como resultado, possibilitar melhora no seu desenvolvimento global (cognitivo, afetivo, social

The intellectual disability (ID) interest is not recent. As a result, there is considerable quantity of studies that tackle different individual aspects of development with this disorder. Therefore, we can say that students psychomotor profile investigation who attend elementary school are rare. OBJECTIVES: To assess the elementary school psychomotor students with intellectual disability diagnosis. Specifically, was assessed analyzed the psychomotor profile based on to follow the alternatives: a) to classify the disability, b) frequency (or not) in classroom of multifunctional resource METHODS: Fifteen students from a public school in a city in the state of São Paulo attended the study. To the psychomotor assessment were used the following instruments: Bruininks-Oseretsky Motor Proficiency - BOT-2, short version; Psychomotor Assessment RESULTS: The data obtained showed most people demonstrated very low performance than expected in all subtests that form the BOT-2. The same way inferior performance according to chronological age was identified on the Psychomotor Assessment. Were not find statistically significant difference on BOT-2 subtests when were analyzed the frequency (or not) on classroom of multifunctional resource, gender and race/color. On the opposite, better performance on some psychomotor abilities was find because of age, school level and DI classification CONCLUSION: The authors argue the relation between psychomotor development and learning and ask the attention to the necessity to use the Psychomotricity assumption in the school context, mainly on classroom of multifunctional resource. Therewith, the disabled children can be helped with their intellectual disability to expand their potential and as a result enable global better development (cognitive, emotional, and social

Lipid corneal degeneration after trabeculectomy with mitomicin 0. 02%

ABSTRACT One patient with a history of trabeculectomy with Mitomicin C 0.02%, but no history of systemic disorders, exhibited unilateral corneal lipid infiltrates, together with deep stromal vascularization. She was treated with a bevacizumab injection and penetrating keratoplasty. No sign of recurrence was noted after one year post-operative.

RESUMO Um paciente com história de trabeculectomia com Mitomicina C 0,02%, sem doenças sistêmicas pré-existentes, apresentou infiltrado lipídico corneano unilateral associado à vascularização intraestromal profunda. Injeção subconjuntival de Bevacizumabe foi realizada e posterior ceratoplastia penetrante. Não houve sinais de recorrência em um ano.

Aspectos epidemiológicos das crianças com queimaduras internadas no pronto socorro para queimaduras de Goiânia-Goiás / Epidemiologic aspects of children with burns hospitalized in the first aid clinic for burns of Goiânia-Goiás / Aspectos epidemiológicos de los niños con quemaduras hospitalizados en primeros auxilios para quemaduras de Goiânia–Goiás

As crianças são as vítimas mais frequentes das queimaduras e estas a segunda causa de morte acidental na infância. O objetivo deste trabalho foi investigar as características epidemiológicas de crianças de 0 a 14 anos,vítimas de queimaduras, internadas no Pronto Socorro para Queimaduras de Goiânia - Goiás. Para isto, dados obtidos no Banco de Dados do hospital e prontuários das crianças internadas no período de 1º de junho de 2005 a 1º de junho de 2007 foram analisados. As crianças foram divididas em dois grupos: Grupo I (0-4 anos) e Grupo II (5-14 anos). Em ambos os grupos o sexo masculino foi predominante e a maioria dos atendimentos ocorreu via convênio do hospital com o Sistema Único de Saúde. O principal local dos acidentes foi na residência. O agente causal mais comum no Grupo I foram os líquidos superaquecidos e no Grupo II, as chamas (p<0,001). Quarenta e dois por cento das crianças tiveram de 10 a 19% da superfície corporal queimada. Sugere-se a inclusão de programas educativos na comunidade, nas Unidades Básicas de Saúde, nas escolas de educação infantil e creches, que auxiliem na conscientização dos cuidadores quanto às formas de prevenção das queimaduras.

Children are the most frequent victims of burns, and these are the second cause of accidental infant mortality. The objective of this work was to investigate the epidemiologic characteristics of children between 0 and 14 years old, victims of burns, hospitalized in the First Aid Clinic for Burns of Goiânia ? Goiás. For that, data from the database of the hospital and registries of the hospitalized children in the period of June 1st, 2005 to June 1st, 2007 were analyzed. The children were divided in two groups: Group I (0-4 years old) and Group II (5-14 years old). In both groups the male sex was predominant and the majority of attendances happened through accord between the hospital and the Single Healthcare System. The main accident place was at home. The most common causal agent in Group I were the overheated liquids and in Group II, the flames (p<0.001). Forty-two percent of the children had from 10 to 19% of the body surface burnt. It is suggested to include educative programs in the community, in the Basic Healthcare Units, in infant education schools and nursery schools, to help awareness of carers about how to prevent burns.

Los niños son las víctimas más frecuentes de las quemaduras y estas son la segunda causa de muerte accidental en la infancia. El objetivo de este trabajo fue identificar las características epidemiológicas de niños de 0 a 14 años, víctimas de quemaduras, internadas en el Primero Auxilio para Quemaduras de Goiânia - Goiás. Para esto, se analizaron los datos en la base de datos de los registros hospitalarios y médicos de los niños hospitalizados entre el 1 de junio de 2005 y 1 de junio de 2007. Los niños fueron divididos en dos grupos: Grupo I (0-4 años) y Grupo II (4-14 años). En ambos grupos el sexo masculino fue predominante. La mayoría de las atenciones fueron realizadas por convenio entre el hospital y el Sistema Único de Salud. El principal lugar de los accidentes fue en la residencia. La causa más común en el Grupo I fueron los líquidos extremadamente calientes, y en el Grupo II, las llamas (p<0,001). El cuarenta y dos por ciento de los niños sufrieron quemaduras entre el 10% y el 19% de la superficie corporal. Se sugiere incluir programas educativos en la comunidad, Unidades Básicas de Salud, escuelas de educación infantil y guarderías, para auxiliar la concientización de los custodios como medios para la prevención de quemaduras.

Transtorno de déficit de atenção com hiperatividade: abordagem neurobiológica / Attention deficit with hyperativity disorder: neuropsychological approach

O distúrbio do déficit de atenção com hiperatividade (TDAH) se caracteriza por dificuldade de manutenção do autocrontrole, dificuldades em manter a atenção e modular os impulsos. Baseado em vivência clínica e de pesquisa, os autores discutem a correlação neurofuncional, neuropsicológica e fonoaudiológica em crianças escolares com TDAH.