Reabilitação visual com lentes de contato após transplante de córnea / Visual reabilitation with contact lenses after corneal keratoplasty

Resumo A adaptação de lentes de contato após o transplante de córnea tem sido considerada um desafio na reabilitação visual. Atualmente existe a possibilidade de adaptação de lentes de contato de vários tamanhos, diversos desenhos e com diferentes espessuras e materiais, como por exemplo lentes gelatinosas, lentes corneanas rígidas gás-permeáveis, lentes córneo-esclerais, mini esclerais e esclerais. O objetivo deste estudo foi apresentar uma revisão da literatura atual que possa exemplificar a utilização de alguns dos diferentes tipos de lentes de contato que possam ser usadas após o transplante de córnea. Foi realizada uma revisão integrativa da literatura médica na língua inglesa, utilizando como base de dados para a pesquisa, Pubmed e Mendeley. Como critério de inclusão, foi estabelecido a relevância do artigo de acordo com a experiência da equipe. Foram selecionados 26 artigos, com ano de publicação entre 2001 e 2018. Dentre os artigos selecionados, cinco possuem como principal assunto o transplante de córnea, nove artigos sobre lentes de contato em geral, e 12 artigos sobre lentes de contato esclerais ou mini esclerais. Devido a maior transmissibilidade de oxigênio para a córnea, o uso das lentes corneanas rígidas gás-permeáveis mostrou-se mais seguro e com probabilidade de uso por um período maior de tempo.

Abstract Contact lens fitting after corneal transplantation has been considered a challenge in visual rehabilitation. There is currently the possibility of adapting contact lenses of various sizes, various designs and with different thicknesses and materials, such as gelatinous lenses, gas-permeable rigid corneal lenses, corneal-scleral lenses, mini-scleral and scleral lenses. The objective of this study was to present a review of current literature that may exemplify the use of some of the different types of contact lenses that can be used after corneal transplantation. An integrative review of the medical literature in the English language, using as a database for the research, Pubmed and Mendeley. Twenty six articles were selected, with year of publication between 2001 and 2018, as inclusion criterion, the relevance of articles according to the authors' experience was used. Five articles were selected that have as main subject corneal transplantation, nine articles on contact lenses in general, and 12 articles on scleral or mini scleral contact lenses. Due to the greater transmissibility of oxygen to the cornea, the use of rigid gas-permeable corneal lenses was shown to be safer and more likely to be used for a longer period of time.

Fatores clínicos e cirúrgicos e as complicações intraoperatórias em pacientes que realizaram ceratoplastias penetrantes / Clinical and surgical factors and intraoperative complications in patients who underwent penetrating keratoplasty / Factores clínicos y quirúrgicos y las complicaciones intraoperatorias en pacientes que realizaron queratoplastias penetrantes

Objetivo identificar as principais complicações intraoperatórias dos pacientes que realizaram ceratoplastias e sua relação com fatores clínicos e cirúrgicos. Método estudo transversal, observacional. Realizou-se um censo dos pacientes submetidos a ceratoplastias que totalizou 258 procedimentos. Resultados foram registradas 22 complicações intraoperatórias, todas em ceratoplastias penetrantes. Do total, 59,09% foram realizadas em pacientes do sexo masculino com idade média de 58,5 anos. A principal complicação intraoperatória notificada foi a perda vítrea (36,36%). Encontrou-se relação estatisticamente significativa entre a variável "complicação intraoperatória" e as variáveis "cirurgia prévia", "ceratoplastia combinada com extração de catarata" e "botão corneano do receptor maior que 8,0 mm". Conclusão identificar as principais complicações intraoperatórias da ceratoplastia possibilita à enfermagem compreender quais fatores podem interferir nesses procedimentos, apontar possíveis fatores preditores das complicações e buscar medidas de controles para que tais complicações não ocorram.

Objective to identify the main intraoperative complications of patients who underwent keratoplasty and relationship between these complications and clinical and surgical factors. Method cross-sectional observational study. A census of the patients submitted to keratoplasty was carried out, which totaled 258 procedures. Results twenty-two intraoperative complications were recorded, all in penetrating keratoplasty surgeries, of which 59.09% were performed in male patients with a mean age of 58.5 years. The main intraoperative complication was vitreous loss (36.36%). A statistically significant relationship was found between the variable "intraoperative complication" and the variables "previous surgery", "combined keratoplasty and cataract extraction" and "corneal host button greater than 8.0 mm". Conclusion identifying the main intraoperative complications of keratoplasty enables nurses to understand which factors may interfere with these procedures, point out possible predictors of complications, and seek control measures so that such complications do not occur.

Objetivo identificar las principales complicaciones intraoperatorias de los pacientes que realizaron queratoplastias y su relación con factores clínicos y quirúrgicos. Método estudio transversal, observacional. Se realizó un censo de los pacientes sometidos a las queratoplastias que tuvo un total de 258 procedimientos. Resultados fueron registradas 22 complicaciones intraoperatorias, todas en queratoplastias penetrantes. Del total, 59,09% fueron realizadas en pacientes del sexo masculino con edad media de 58,5 años. La principal complicación intraoperatoria notificada fue la pérdida vítrea (36,36%). Fue encontrada relación estadísticamente significativa entre la variable "complicación intraoperatoria" y las variables "cirugía previa", "queratoplastia combinada con extracción de catarata" y "botón corneal del receptor mayor que 8,0 mm". Conclusión identificar las principales complicaciones intraoperatorias de la queratoplastia posibilita a la enfermería comprender cuáles factores pueden interferir en estos procedimientos, apuntar posibles factores predictores de las complicaciones y buscar medidas de controles para que tales complicaciones no ocurran.

Intraocular pressure measurements and corneal biomechanical properties using a dynamic Scheimpflug analyzer, after several keratoplasty techniques, versus normal eyes.

PURPOSE: To evaluate the biomechanical properties of the cornea and their impact on intraocular pressure (IOP) measurement after lamellar keratoplasty, compared to healthy eyes, using a non-contact tonometer with a Scheimpflug camera. METHODS: This study, from 2014 to 2015, included 22 primary DSAEK, 5 DALK, 6 DSAEK after PK, and 50 control eyes. Using a non-contact tonometer with a high-speed Scheimpflug camera (CORVIS ST, Oculus Optikgeräte GmbH, Wetzlar, Germany), several biomechanical parameters were recorded, including radius at highest concavity (Rhc) and defomation amplitude (DA). Central corneal thickness (CCT) and uncorrected IOP, were also recorded. For the control eyes only, a corrected IOP was calculated, based on age, central corneal thickness, and biomechanical parameters. RESULTS: Rhc was significantly lower after DALK (Rhc=5.54±0.71, P=0.007) and DSAEK (Rhc=6.26±0.77, P=0.042) compared to control eyes (Rhc=6.82±0.76). DA was higher after DALK and DSAEK, but not significantly (respectively 1.24±0.09 P=0.41 and 1.22±0.15, P=0.923) compared to normal eyes (1.18±0.15). Uncorrected IOP was not significantly different between post-keratoplasty and control eyes. In control eyes, the corrected IOP (15.23±1.88) was lower than the uncorrected IOP (16.10±2.34); a statistically significant positive correlation between Rhc and CCT (R2=0.6020, P<0001), and a significant negative correlation between DA and CCT (R2=-0.641, P<0.0001) were found. CONCLUSION: Our study showed that, after lamellar keratoplasty, corneal biomechanics are altered. Corneas with higher ocular rigidity will show a lower DA and a higher Rhc.

Desenlaces en pacientes operados con queratoprótesis boston tipo 1 en un centro oftalmológico especializado en la ciudad de Medellín / Outcomes in patients with boston type 1 keratoprosthesis in a specialized center in Medellín

Objetivo: reportar las características y descenlaces de pacientes con queratoprótesis Boston tipo 1. Diseño: estudio observacional descriptivo de corte transversal. Método: se incluyeron los pacientes operados con queratoprótesis Boston tipo 1 residentes en Colombia, mayores de 17 años, sin queratoprótesis previas y que tuviera más de 6 meses de seguimiento, para un total de 39 ojos de 39 pacientes. La cirugía se indicó en los casos con o sin queratoplastia previa que tuvieran agudeza visual (AV) igual o inferior a cuenta dedos y déficit de limbo bilateral o vascularización corneal profunda en más de 3 cuadrantes. Se recolectó y analizó la información de la historia clínica en forma retrospectiva y prospectiva. Las variables principales fueron: agudeza visual, retención del dispositivo y complicaciones. Se realizó un análisis univariado presentando los resultados en frecuencias absolutas y porcentajes para las variables categóricas y para las variables cuantitativas como promedio y desviación estándar (DE) si tienen distribución normal o como mediana y rango intercuartil si no tienen distribución normal. Resultados: La mediana de seguimiento fue de 53.5 meses (rango 6 meses a 10 años). La mayoría de pacientes (66.7%) habían tenido previamente queratoplastia penetrante. El diagnóstico de base fue en 53.8% condiciones no inflamatorias yen 46.2% condiciones inflamatorias. La AV preoperatoria en todos los ojos estaba entre percepción de luz y cuenta dedos; posterior a la cirugía el 97.4% tuvieron mejoría de la AV. Para el fi nal del seguimiento la AV permaneció mejor que la preoperatoria en 53.8%, fue igual a esta en 17.94% y peor que esta en 28.2%. Hubo necrosis periprostética en 28.2%, y 38.5% tuvieron recambio del dispositivo. Al final del seguimiento 89.7% de los pacientes tenían una queratoprótesis in-situ. Conclusión: la queratoprótesis Boston tipo 1 es una opción viable para mejorar la AV en pacientes con trasplantes de córnea fallidos o en quienes se prevé alta tasa de fallo o rechazo de este. En la gran mayoría de los pacientes se logra mejoría inicial significativa de la AV, la cual se mantiene al final del seguimiento en más de la mitad de ellos. Refinamientos progresivos en la técnica quirúrgica y el manejo postoperatorio disminuirán las complicaciones que llevan a la perdida visual progresiva

Purpose: to report characteristics and outcomes in patients with Boston type 1 keratoprosthesis. Design: observational descriptive cross-sectional study. Method: Patients with Boston type 1 queratoprosthesis who were living in Colombia, 17 years or older, without previous keratoprosthesis and with more than 6 months follow up were included, for a fi nal of 39 eyes from 39 patients. Surgery was indicated for those with or without previous keratoplasty who had visual acuity (VA) of counting fi ngers or worse and bilateral limbal stem cell deficiency or deep corneal vascularization in more than 3 quadrants. Information was collected retrospectively and prospectively from medical registries and was analyzed. Main variables were: visual acuity, device retention and complications. An univariate analysis was conducted and results are presented in absolute frequencies and percentages for categoric variables and for quantitative variables in average and standard deviation (SD) if they have normal distribution and in median and interquartile range if they do not have normal distribution. Results: Median follow up was 53.5 months (range 6 months to 10 years). Most patients (66.7%) had previous penetrating keratoplasty. Baseline diagnoses were in 53.8% non-infl ammatory conditions and in 46.2% inflammatory conditions. Preoperative VA ranged between light perception and counting fingers in all eyes; aft er surgery 97.4% had improvement in VA. By the end of follow up VA remained better than preoperative in 53.8%, was the same as preoperative in 17.94% and worse than preoperative in 28.2%. There was periprosthetic necrosis in 28.2%, and 38.5% had keratoprothesis exchange. At the end of follow up 89.7% of patients had a keratoprosthesis in-situ. Conclusion: Boston type 1 keratoprosthesis is a viable option to improve VA in patients with previously failed corneal transplants or in cases that anticipate bad prognosis for keratoplasty. In most patients there was a signifi cant initial improvement in vision, and more than half of them retained better than initial VA on their last follow up. Further refinements in surgical technique and postoperative care would decrease complications that lead to progressive visual loss.

Measurement of visual function among patients undergoing corneal transplantation using the VF-14 index in Morocco.

OBJECTIVE: To validate the Moroccan version of the VF-14 in candidates for keratoplasty and to assess their quality of life using this tool before and after transplantation. METHODS: This is a longitudinal prospective study that assessed 57 patients who underwent penetrating keratoplasty, recruited in the ophthalmology service in Marrakech over 5 years. The original VF-14 questionnaire was adapted into Moroccan dialect. The questionnaire was administered before and 2 years after transplantation. The VF-12 questionnaire was also used, deleting the last two items. Data analysis was performed using SPSS 16.0 software. Comparisons of VF-14 scores before and after transplantation used the Wilcoxon test for paired samples. RESULTS: In total, 57 patients participated in the study. The most frequent indication for surgery was keratoconus (44%). All patients underwent penetrating keratoplasty. Chronbach's alpha value was 0.989 for VF-14 and 0.990 for VF-12. The two scores were negatively correlated with logMAR visual acuity. The strongest correlation was found with VA in the fellow eye. The average best-corrected visual acuity of the eye scheduled for keratoplasty was 1.1±0.16 logMAR. The average of VF-14 was 53±3. After keratoplasty, the average best-corrected visual acuity of operated eye was 0.34±0.31. The average postoperative astigmatism was 3 D. After keratoplasty, an increase in VF-14 score was observed from 53.5 to 81.92 (P<0.001). In postoperative follow-up, graft rejection was noted in two patients and maculopathy in a single patient. DISCUSSION: Graft transparency, absence of complications, minimal astigmatism, and good visual acuity have long been indicators of a successful corneal transplant. However, this does not provide information on visual quality and its impact on everyday life. It is in this sense that the VF-14 was adapted into several languages, as reliable, valid and sensitive as the original Anglo-American version, to assess objectively and subjectively the quality of life of patients after keratoplasty. CONCLUSION: With advances in techniques and availability of better materials, surgical success in performing keratoplasty is increasing. At the same time, vision-related quality of life of corneal graft recipients deserves more attention from ophthalmologists.

Trasplante de córnea en queratocono: queratoplastia penetrante versus queratoplastia lamelar anterior profunda con técnica de Melles / Corneal transplantation in keratoconus: Penetrating keratoplasty versus deep anterior lamellar keratoplasty with Melles technique

OBJETIVOS: Evaluar la eficacia de la queratoplastia lamelar anterior profunda (DALK) mediante técnica de Melles (técnica B) en pacientes con queratocono avanzado en comparación con la técnica clásica de queratoplastia penetrante (QPP) (técnica A). METODOLOGÍA: Estudio retrospectivo descriptivo comparativo entre la técnica A y la técnica B en grupos homogéneos. RESULTADOS: La agudeza visual con corrección (test de Snellen, escala decimal) ha sido de 0,77 ± 0,32 para el grupo A y de 0,62 ± 0,29 para el grupo B, no siendo diferencias estadísticamente significativas. El defecto refractivo esférico medio en el grupo A fue de −1,73 ± 5,1 dioptrías y el equivalente esférico medio de −3,92 ± 5,1 dioptrías. El grupo B presentó valores de −2,67 ± 4,02 dioptrías y −4,55 ± 4,08 dioptrías, respectivamente, no habiendo diferencias para estas variables en ambos grupos. El cilindro residual una vez retiradas las suturas fue de 4,47 ± 2,47 dioptrías para el grupo A y de 3,77 ± 1,63 dioptrías para el grupo B, sin ser estadísticamente significativas. CONCLUSIÓN: No se han encontrado diferencias estadísticamente significativas para ninguna de las variables estudiadas al comparar ambos grupos mediante la t de Student para muestras independientes. Más estudios acerca de la homogeneidad del lecho estromal residual y del espesor del mismo pueden aportar las claves para que esta técnica se acerque a las agudezas visuales de una QPP o una DALK mediante técnica descemética

OBJECTIVES: To evaluate the effectiveness of deep anterior lamellar keratoplasty (DALK) using Melles technique (technique B) in patients with advanced keratoconus versus a classic technique, penetrating keratoplasty (technique A). METHODOLOGY: Retrospective descriptive comparative study between technique A and technique B in homogeneous groups. RESULTS: Best corrected visual acuity (Snellen test decimal scale) was 0.77 ± 0.32 for group A and 0.62 ± 0.29 for group B, with no statistically significant differences. The mean spherical final refraction in group A was 1.73 ± 5.1 diopters, and the mean spherical equivalent was −3.92 ± 5.1. Technique B group gave values -2.67 ± 4.02 diopters and −4.55 ± 4.08 diopters, respectively, with no statistically significant differences. The residual cylinder after removal of the sutures was 4.47 ± 2.47 diopters for group A and 3.77 ± 1.63 for group B, with no statistically significant differences. CONCLUSION: No statistically significant differences were found for any of the studied variables when comparing both groups using the t -test for independent samples. More studies on the homogeneity and residual stromal bed thickness could provide the key to determine whether this technique is closer to the visual acuity of penetrating keratoplasty or DALK by a descemet technique

Características clínicas y resultados del trasplante de córnea en Villa Clara / Clinical characteristics and results of the corneal transplantation in Villa Clara province

OBJETIVO: describir algunas características clínicas y resultados visuales en pacientes operados de trasplante corneal en el Centro Oftalmológico del Hospital Universitario "Arnaldo Milián Castro". MÉTODOS: se realizó un estudio observacional, descriptivo y transversal, con un universo de 47 pacientes operados de trasplante corneal en el Centro Oftalmológico del Hospital Universitario "Arnaldo Milián Castro", de la provincia de Villa Clara, entre enero de 2010 y diciembre de 2012. Las variables estudiadas fueron: edad, sexo, causa del trasplante corneal, objetivo de la cirugía y agudeza visual mejor corregida antes y después del trasplante. RESULTADOS: los grupos etarios que predominaron fueron los comprendidos entre 60 y 69 años y 70 y 79 años en uno y otro sexos. La causa más frecuente de la queratoplastia fue la queratopatía bullosa pseudofáquica, seguida del leucoma corneal y el rechazo al injerto. CONCLUSIONES: después del trasplante de córnea hay un aumento significativo de la agudeza visual mejor corregida. El trasplante corneal contribuye de manera importante a ofrecer un adecuado nivel de recuperación visual en pacientes con opacidades corneales y prevención de ceguera de origen corneal.

OBJECTIVE: to describe some clinical characteristics and visual outcomes in patients undergoing corneal transplants in the Eye Center "Arnaldo Milian Castro" University Hospital. METHOD: an observational, descriptive, cross-sectional study was carried out in 47 patients undergoing corneal transplants in the Eye Center "Arnaldo Milian Castro" University Hospital in Villa Clara province. The universe consisted of 47 patients. the variables studied were: age, sex, cause of corneal transplant surgery and lens best corrected visual acuity before and after transplantation. RESULTS: the predominant age groups were those between 60 and 69 years and 70 to 79 years in both sexes. The most frequent cause of keratoplasty was pseudophakic bullous keratopathy, followed by corneal scarring and graft rejection, and the goal of surgery that prevailed was the optician. CONCLUSIONS: after the cornea transplant there is a significant increase in best corrected visual acuity. Corneal transplantation contributes significantly to provide an adequate level of visual recovery in patients with corneal opacities and blindness prevention of corneal origin.

Queratoplastia lamelar predescemética para el tratamiento del queratocono / Predescemetic lamellar keratoplasty for treatment of keratoconus

OBJETIVO: describir los resultados de la queratoplastia lamelar profunda en el tratamiento quirúrgico del queratocono en el Servicio de Córnea del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". MÉTODOS: se realizó un estudio descriptivo prospectivo en 7 ojos con queratocono operados de queratoplastia lamelar profunda. Se analizaron las variables edad, sexo, grado de queratocono, agudeza visual preoperatoria y posoperatoria, astigmatismo posquirúrgico, paquimetría y queratometría topográfica a la semana, al mes y a los tres meses de la intervención. La información se procesó a través de frecuencias absolutas, relativas, medias y desviación estándar. RESULTADOS: en el sexo masculino, el 42,9 % tenía entre 18 y 39 años de edad al igual que el grupo de 40-50 años en el sexo femenino. El 57,2 % de los casos presentó queratocono avanzado. En el posoperatorio se encontró que el 71,4 % de los casos poseía una agudeza visual corregida entre 0,1-0,3 y 5-10 dioptrías de astigmatismo posquirúrgico; la paquimetría fue superior a 560 µm en el 85,6 %; la queratometría promedio en el meridiano más fuerte fue de 47,77 y en el meridiano más débil, de 40,01. CONCLUSIONES: la queratoplastia lamelar predescemética es una técnica quirúrgica que ofrece ventajas superiores en relación con las queratoplastias penetrantes.

OBJECTIVE: to describe the results of deep lamellar keratoplasty in the surgical treatment of keratoconus in the Corneal Service of "Ramón Pando Ferrer" Cuban Institute of Ophthalmology. METHODS: a prospective descriptive study of 7 eyes with moderate keratoconus who underwent predescemetic lamellar keratoplasty. The universe consisted of 7 eyes fom patients who met the criteria for deep lamellar keratoplasty surgery. The variables age, sex, degree of keratoconus, pre-and postoperative visual acuity, postoperative astigmatism, topographic keratometry and pachymetry after a week, a month and three months of the surgery. Data were analyzed by using absolute, relative, mean frequencies and standard deviations. RESULTS: the 18-36 year age group in males represented 42,9 % as the 40-50 years-old group in females. In the studied group, 57,2 % of patients had advanced keratoconus. On the third postoperative month, 71,4 % of patients had visual acuity ranging 0,1 to 0,3 and 5-10 postsurgical astigmatism diopters. Pachymetry observed in 85,6 % of patients was higher than 560 um. The average keratometric value in the strongest meridian was 59,43 preoperatively and 47,77 postoperatively. In the weakest meridian, average keratometry was 50,28 and postoperative average amounted to 40,01. CONCLUSIONS: predescemetic lamellar keratoplasty is a surgical technique providing greater advantages if compared to penetrating keratoplasty.

Características clínicas y resultados del trasplante de córnea en Villa Clara / Clinical characteristics and results of the corneal transplantation in Villa Clara province

Objetivo: describir algunas características clínicas y resultados visuales en pacientes operados de trasplante corneal en el Centro Oftalmológico del Hospital Universitario Arnaldo Milián Castro. Métodos: se realizó un estudio observacional, descriptivo y transversal, con un universo de 47 pacientes operados de trasplante corneal en el Centro Oftalmológico del Hospital Universitario Arnaldo Milián Castro, de la provincia de Villa Clara, entre enero de 2010 y diciembre de 2012. Las variables estudiadas fueron: edad, sexo, causa del trasplante corneal, objetivo de la cirugía y agudeza visual mejor corregida antes y después del trasplante.Resultados: los grupos etarios que predominaron fueron los comprendidos entre 60 y 69 años y 70 y 79 años en uno y otro sexos. La causa más frecuente de la queratoplastia fue la queratopatía bullosa pseudofáquica, seguida del leucoma corneal y el rechazo al injerto. Conclusiones: después del trasplante de córnea hay un aumento significativo de la agudeza visual mejor corregida. El trasplante corneal contribuye de manera importante a ofrecer un adecuado nivel de recuperación visual en pacientes con opacidades corneales y prevención de ceguera de origen corneal(AU)

Objective: to describe some clinical characteristics and visual outcomes in patients undergoing corneal transplants in the Eye Center Arnaldo Milian Castro University Hospital. Method: an observational, descriptive, cross-sectional study was carried out in 47 patients undergoing corneal transplants in the Eye Center "Arnaldo Milian Castro" University Hospital in Villa Clara province. The universe consisted of 47 patients. the variables studied were: age, sex, cause of corneal transplant surgery and lens best corrected visual acuity before and after transplantation. Results: the predominant age groups were those between 60 and 69 years and 70 to 79 years in both sexes. The most frequent cause of keratoplasty was pseudophakic bullous keratopathy, followed by corneal scarring and graft rejection, and the goal of surgery that prevailed was the optician. Conclusions: after the cornea transplant there is a significant increase in best corrected visual acuity. Corneal transplantation contributes significantly to provide an adequate level of visual recovery in patients with corneal opacities and blindness prevention of corneal origin(AU)

Queratoplastia lamelar predescemética para el tratamiento del queratocono / Predescemetic lamellar keratoplasty for treatment of keratoconus

Objetivo: describir los resultados de la queratoplastia lamelar profunda en el tratamiento quirúrgico del queratocono en el Servicio de Córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer.Métodos: se realizó un estudio descriptivo prospectivo en 7 ojos con queratocono operados de queratoplastia lamelar profunda. Se analizaron las variables edad, sexo, grado de queratocono, agudeza visual preoperatoria y posoperatoria, astigmatismo posquirúrgico, paquimetría y queratometría topográfica a la semana, al mes y a los tres meses de la intervención. La información se procesó a través de frecuencias absolutas, relativas, medias y desviación estándar. Resultados: en el sexo masculino, el 42,9 por ciento tenía entre 18 y 39 años de edad al igual que el grupo de 40-50 años en el sexo femenino. El 57,2 por ciento de los casos presentó queratocono avanzado. En el posoperatorio se encontró que el 71,4 por ciento de los casos poseía una agudeza visual corregida entre 0,1-0,3 y 5-10 dioptrías de astigmatismo posquirúrgico; la paquimetría fue superior a 560 µm en el 85,6 por ciento; la queratometría promedio en el meridiano más fuerte fue de 47,77 y en el meridiano más débil, de 40,01. Conclusiones: la queratoplastia lamelar predescemética es una técnica quirúrgica que ofrece ventajas superiores en relación con las queratoplastias penetrantes(AU)

Objective: to describe the results of deep lamellar keratoplasty in the surgical treatment of keratoconus in the Corneal Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology.Methods: a prospective descriptive study of 7 eyes with moderate keratoconus who underwent predescemetic lamellar keratoplasty. The universe consisted of 7 eyes fom patients who met the criteria for deep lamellar keratoplasty surgery. The variables age, sex, degree of keratoconus, pre-and postoperative visual acuity, postoperative astigmatism, topographic keratometry and pachymetry after a week, a month and three months of the surgery. Data were analyzed by using absolute, relative, mean frequencies and standard deviations. Results: the 18-36 year age group in males represented 42,9 percent as the 40-50 years-old group in females. In the studied group, 57,2 percent of patients had advanced keratoconus. On the third postoperative month, 71,4 percent of patients had visual acuity ranging 0,1 to 0,3 and 5-10 postsurgical astigmatism diopters. Pachymetry observed in 85,6 percent of patients was higher than 560 um. The average keratometric value in the strongest meridian was 59,43 preoperatively and 47,77 postoperatively. In the weakest meridian, average keratometry was 50,28 and postoperative average amounted to 40,01. Conclusions: predescemetic lamellar keratoplasty is a surgical technique providing greater advantages if compared to penetrating keratoplasty(AU)

Trasplante de córnea: enfoque social, más allá de los aspectos médicos / Transplantation of cornea: social approach, beyond the medical aspects

La córnea por sus privilegios inmunológicos es uno de los tejidos más trasplantados en el mundo. En Cuba se realiza este proceder en todas las provincias del país. En la actual investigación se describen los aspectos éticos, sociales, económicos y psicológicos del trasplante de córnea. Se obtuvo que el trasplante de córnea encuentra su justificación ética en el principio bioético de la beneficencia. Asimismo, se justifican los trasplantes de órganos, por los principios de autonomía y consentimiento informado. Debe prevalecer el principio de justicia distributiva, la cual permitiría el acceso a los beneficios de esta terapéutica a todos los sectores de la población, sin distingos de la situación económica de los pacientes, mediante la debida regulación estatal. El desarrollo vertiginoso de las nuevas técnicas quirúrgicas de trasplante de córnea, dentro y fuera de nuestro país, con vistas a mejorar la calidad de vida de nuestros pacientes, supone un reto desde el punto de vista ético-social en vistas a satisfacer el incremento de las demandas de salud en este sentido, acorde con los principios establecidos(AU)

The cornea, due to its immunological privileges, is one of the most transplanted tissues all over the world. In Cuba, this procedure is performed in every province of the country. Ethical, social, economic and psychological aspects regarding the transplantation of cornea were described in this current study. This procedure finds its ethical good reason supported on the bioethical principle of benefit. Likewise, organ transplantation is justified, following the principles of autonomy and informed consent. The principle of distributive justice must prevail, allowing the access to the benefits of this therapeutic to the whole population, not making differences with respect to the economical situation of patients, following the state regulations appropriately. The significant development of the new surgical procedures of cornea transplantation, inside and outside the country, aimed at improving the quality of life of these patients, which will mean a challenge from the ethical and social view points to satisfy the health service demands, according to the established principles(AU)

Tratamiento con concentrado plaquetario plasmático subconjuntival y tópico en el transplante de limbo / Subconjunctival and topic treatment of plasma platelet concentrate in limbal transplantion

Se ha valorado la eficacia del tratamiento subconjuntival ytópico de concentrados plaquetarios plasmáticos tras larealización de un transplante autólogo y otro heterólogohistocompatible de limbo en un ojo con insuficiencia limbartotal tras quemadura por ácido, en que había sidoinsuficiente un injerto previo.Resultado: Se observó un acortamiento en el tiempo deadaptación de los injertos, estabilización corneal y mejorade la agudeza visual en el ojo transplantado. Así mismo,una aceleración de la curación en el ojo donante tras aplicacióntópica de concentrados plaquetarios

It was evaluated the efficiency of the subconjunctival andtopic application of autologous platelet concentrate in oneocular burn after autologous and heterologous limbaltransplant. The eye had a deficit limbal by acid burn and aprevious autotransplant was insuficience.Result: were found a shorter period of time in limbal allographtadaptation; corneal stabilization and better visualacuity in the limbal trasnplants with subconjuctival andtopic plasma platelet concentrates treatment. And acelerationin donnor eye of the healing process with topic plateletconcetrate

Rejeiçäo corneana pós transplante de córnea: análise de dados do Banco de Olhos do Hospital Säo Paulo - Escola Paulista de Medicina / Corneal graft rejection after penetrating keratoplasty: analysis of the Eye Bank of the Hospital Säo Paulo - Escola Paulista de Medicina

Dentre todos os transplantes, o corneano tem sido o mais realizado na atualidade. Geralmente é bem mais bem sucedido, mas a rejeiçäo é estudada há muitos anos, já tem sido estabelecidos alguns fatores predisponentes. Este estudo tem como objetivo analisar os casos de rejeiçäo ocorridos em nosso serviço para detectar algum fator peculiar para a ocorrência da mesma. Métodos: Realizamos um estudo retrospectivo analisando 113 casos de transplante de córnea ópticos efetuados no ano de 1998. Destes, selecionamos todos os casos de rejeiçäo e avaliamos a patologia da base, presença de sinéquias, neovasos, aumento da pressäo intra-ocular, antecedente de transplante prévio, idade do doador, tempo de captaçäo e de preservaçäo da córnea, experiência do cirurgiäo. Resultados: Dos 113 transplantes realizados, 20 casos (17,69 por cento) apresentavam rejeiçäo do botäo transplantado. Destes 20 casos, 9 apresentavam sinéquias, 4 tinham neovasos, 8 apresentavam aumento de pressäo intra-ocular e 7 já haviam se submetido a transplante de córnea prévio.

Tranplante de membrana amniótica para reconstruçäo da superfície corneana e conjuntival / Amniotic membrane transplantation for corneal and conjunctival surface recostruction

A superfície ocular é revestida pelo epitélio corneano, límbico e conjuntival, cada um com um fenótipo celular distinto. A conjuntiva reveste as superfícies internas das pálpebras superior e inferior, e cobre a esclera anterior antes de terminar no epitélio do limbo, que é a transiçäo entre os epitélios corneano e conjuntival. O epitélio corneano, juntamente com filme lacrimal contribuem para a manutençäo da superfície opticamente regular da córnea, promovendo uma visäo nítida e adequada. Para assegurar uma superfície ocular íntegra é necessário que esta esteja constantemente coberta por um filme lacrimal estável. Recentemente, cinco importantes conceitos foram relatados para explicar como um sistema de defesa eficaz e organizado é estabelecido para se atingir este objetivo: 1) O bom estado da superfície ocular é assegurado por uma estreita relaçäo entre o epitélio da superfície ocular e o filme lacrimal; 2) A estabilidade do filme lacrimal é mantida por anexos externos; 3) O mecanismo de proteçäo em sua íntegra é controlado por uma integraçäo neuroanatômica eficaz; 4) As células germinativas (CG) epiteliais corneanas estäo localizadas no limbo; 5) A funçäo das células epiteliais da superfície ocular é mantida pela matriz e por fibroblastos do estroma.

Transplante de córnea em crianças / Corneal transplantation in children

Foram analisadas cirurgias de transplante penetrante de córnea em crianças com idade de três meses a quatorze anos, realizadas no Instituto de Olhos de Goiânia nos últimos anos. Este estudo mostrou nítida diferença de resultados obtidos entre crianças na faixa etária até dez anos e nos maiores de dez. Ocorreram maiores complicaçöes no primeiro grupo, comprometendo o sucesso da intervençäo. A seleçäo dos casos foi obrigatória, näo levando à cirurgia daqueles sem perspectiva de resultados funcionais. Das vinte e seis cirurgias, quinze (57,69 por cento) obtiveram sucesso (transplante plenamente transparente). Destas quinze, treze (86,66 por cento) ficaram com acuidade visual de 20/20 a 20/40. Os outros dois (13,33 por cento) com 20/50 e 20/200. O acompanhamento destes pacientes foi de vinte meses a onze anos

Perfuraçäo em degeneraçöes ectásicas da córnea / Perforation in ectatic corneal degenerations

A degeneraçäo marginal de Terrien, a degeneraçäo marginal pelúcida e o ceratoglobo säo patologias ectásicas da córnea. Essas degeneraçöes produzem áreas de afinamento periférico que causam ectasia, astigmatismo irregular e maior suscetibilidade a perfuraçöes corneanas. Säo apresentados 4 casos de degeneraçöes ectásicas com perfuraçäo corneana (1 casos de ceratoglobo, 2 casos de degeneraçäo marginal de Terrien, e 1 caso de degeneraçäo marginal pelúcida). O tratamento cirúrgico dessas degeneraçöes é controverso. As técnicas descritas säo pouco estudadas devido ao pequeno número de casos. Geralmente requerem grande habilidade do cirurgiäo. As perfuraçöes säo complicaçöes graves e de difícil manejo. Assim, justificam-se medidas preventivas

Queratocono agudo en un adolescente tratado con trasplante de córnea: revisión de la patología / Cornel transplant in an adolescent with acute keratoconus: review of the pathology

Se describe el caso de un adolescente quien desarrolló queratocono que fue necesario tratar quirúrgicamente con injerto de córnea y excelente resultado. Se discute la literatura sobre causas y curso del padecimiento y se señala la importancia de haber logrado buen éxito operando a un paciente joven en un medio con recursos modestos: San Cristóbal de las Casas, Chiapas