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1.
Curr Opin Ophthalmol ; 31(1): 23-27, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31770165

RESUMO

PURPOSE OF REVIEW: Corneal diseases are often associated with lens opacity. The present article reviews the recent advances in the management of cataract and corneal transplant. RECENT FINDINGS: Thanks to the development of lamellar transplant techniques and the evolution of cataract surgery, we now have several strategies to address corneal diseases and cataract including 'lamellar triple procedure'. Numerous precautions have been identified to have a successful surgery with good visual recovery. SUMMARY: Corneal diseases associated with cataract can be successfully managed using separate or combined surgical procedures, as appropriate. In most cases the intraocular lens power can be calculated with a predictable outcome.


Assuntos
Extração de Catarata , Catarata/complicações , Doenças da Córnea/complicações , Transplante de Córnea/métodos , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Implante de Lente Intraocular , Humanos
2.
Rom J Ophthalmol ; 63(3): 277-280, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687632

RESUMO

Purpose. to report malignant glaucoma and infectious crystalline keratopathy as complications after an uneventful Descemet Membrane Endothelial Keratoplasty (DMEK), and corneal clearance despite graft detachment after the surgery in a patient with pseudophakic bullous keratopathy. Method. A 81-year-old patient with high Intraocular Pressure (IOP) and flat anterior chamber with patent iridotomies after DMEK was diagnosed of malignant glaucoma. The medical approach being insufficient, the patient required a pars-plana vitrectomy, capsulo-hyaloidectomy, and surgical iridectomy. Results. The IOP was reduced and anterior chamber was repositioned after surgical management. Corneal clearance was observed despite graft detachment. The patient developed an infectious crystalline keratopathy after the resolution of malignant glaucoma. Conclusions. malignant glaucoma is a rare complication following DMEK. Corneal clearance can be attained despite graft detachment after DMEK probably due to an unintentional Descemet Membrane Endothelial Transfer (DMET). However, in low dosage, steroid treatment remains a risk factor for developing ICK. Abbreviations: PBK = Pseudophakic Bullous Keratopathy, DMEK = Descemet Membrane Endothelial Keratoplasty, DMET = Descemet Membrane Endothelial Transfer, IOP = Intraocular Pressure, BCVA = Best Corrected Visual Acuity, AC = Anterior Chamber, MG = Malignant Glaucoma, ICK = Infectious Crystalline Keratopathy.


Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Glaucoma/etiologia , Pressão Intraocular/fisiologia , Complicações Pós-Operatórias , Pseudofacia/complicações , Acuidade Visual , Idoso de 80 Anos ou mais , Doenças da Córnea/complicações , Doenças da Córnea/diagnóstico , Feminino , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Pseudofacia/cirurgia
3.
Middle East Afr J Ophthalmol ; 26(2): 101-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543668

RESUMO

BACKGROUND: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria. METHODS: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed. RESULTS: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4; P < 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016. CONCLUSION: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys.


Assuntos
Cegueira/epidemiologia , Assistência à Saúde/estatística & dados numéricos , Baixa Visão/epidemiologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Catarata/complicações , Doenças da Córnea/complicações , Assistência à Saúde/organização & administração , Feminino , Glaucoma/complicações , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Exame Físico , Prevalência , Erros de Refração/complicações , Baixa Visão/etiologia
5.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2547-2558, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31363832

RESUMO

PURPOSE: To evaluate the effectiveness of temporary keratoprosthesis combined with vitreoretinal surgery and penetrating keratoplasty in patients with or without trauma. METHODS: This retrospective study included 49 eyes in 49 non-trauma patients and 51 eyes in 48 ocular trauma patients who underwent penetrating keratoplasty and vitreoretinal surgery with Eckardt temporary keratoprosthesis between 2009 and 2016, with a follow-up of at least 12 months. Study variables included previous corneal, glaucoma, or retinal surgeries; various intraoperative surgical maneuvers; lens status; vitreoretinal and corneal pathology; functional outcomes; anatomical retinal reattachment; graft clarity; and need for glaucoma surgery or treatment. RESULTS: The mean age was 56 years in the non-trauma group and 42 years in the ocular trauma group. A total of 45% of the non-trauma cases and 24% of the ocular trauma cases had a single functional eye. Pseudophakic and aphakic keratopathy was diagnosed in 41% of the non-trauma group and corneal laceration in 65% of the ocular trauma group. In the ocular trauma group, injuries were open globe injury in 78%, closed globe injury in 12%, and intraocular foreign body in 10%. Retinal detachment with proliferative vitreoretinopathy was present in 39% of patients in the non-trauma group and in 35% of the ocular trauma group. Improvement or stability of visual acuity was higher among ocular trauma patients (86%) than in non-trauma patients (78%). The rate of clear corneal grafts was 49% in both groups. Retinal attachment was achieved in 90% and 78% of patients in the non-trauma and ocular trauma groups, respectively. The use of retinotomy had a positive influence on the final attached retina (p = 0.016). The placement of a scleral buckle significantly increased the risk of glaucoma (p = 0.004). Poor functional outcome was related to persistent retinal detachment (10% versus 16% in the non-trauma and ocular trauma groups, respectively), phthisis (25% versus 12%), hypotony (33% versus 18%), corneal graft end failure (51% in both groups), and secondary glaucoma (18% versus 24%). CONCLUSION: In patients with both vitreoretinal and corneal pathology, the use of Eckardt temporary keratoprosthesis combined with vitreoretinal surgery and penetrating keratoplasty resulted in improvement of visual acuity, particularly in the groups of ocular trauma and monocular patients. The high rate of retinal reattachment and the low rate of graft rejection was probably related to the use of new vitreoretinal techniques, including retinotomy in selected patients.


Assuntos
Córnea/cirurgia , Doenças da Córnea/cirurgia , Traumatismos Oculares/complicações , Ceratoplastia Penetrante/métodos , Próteses e Implantes , Doenças Retinianas/cirurgia , Cirurgia Vitreorretiniana/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Córnea/patologia , Doenças da Córnea/complicações , Traumatismos Oculares/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Doenças Retinianas/complicações , Estudos Retrospectivos , Acuidade Visual , Adulto Jovem
7.
J Fr Ophtalmol ; 42(3): 295-302, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30857801

RESUMO

Penetrating keratoplasty is the most commonly performed tissue transplant in the world. However, its success depends on the health of the ocular surface and the intact immune privilege of the eye. In the absence of these two conditions, corneal transplants have an increased failure rate and result in corneal blindness. For more than two hundred years, researchers have been trying to find the best design of the artificial cornea in order to address these cases of severe corneal blindness. Despite previous difficulties, interest in the field has recently been revived, and considerable progress has been made over the last 20 years, to the point where the keratoprosthesis is now considered a primary procedure for some indications and is no longer always a surgery of last resort. In this review, we describe the global and personal experience with Boston keratoprosthesis type 1. It is a relatively new treatment for severe corneal blindness in the context of multiple failed corneal transplants and high-risk conditions. In the last decade, changes in the design, surgical technique, and postoperative management have increased the success rate and popularity of the Boston keratoprosthesis and decreased its complications substantially, making it a safe and effective alternative for certain corneal pathologies. However, some complications persist and require management to improve the visual prognosis of patients with corneal blindness.


Assuntos
Doenças da Córnea/cirurgia , Transplante de Córnea/métodos , Ceratoplastia Penetrante/métodos , Cegueira/epidemiologia , Cegueira/etiologia , Cegueira/cirurgia , Doenças da Córnea/complicações , Doenças da Córnea/epidemiologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Próteses e Implantes , Implantação de Prótese/métodos
9.
Int Ophthalmol ; 39(5): 1027-1035, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29619650

RESUMO

PURPOSE: To describe the outcomes of endothelial keratoplasty (EK) for bullous keratopathy in eyes with a retained angle-supported anterior chamber intraocular lens (acIOL). METHODS: Among 263 consecutive EK procedures, 7 DMEK and 11 DSAEK procedures were identified in eyes with an acIOL and included in the present retrospective case series. Pre- and postoperative status including ocular history, anatomical outcome and complications as well as best-corrected visual acuity was evaluated. RESULTS: Ocular history included complicated cataract surgery (n = 11), ocular trauma (n = 4) and primary intracapsular cataract extraction (n = 3). Surgery-related complications included primary graft failure (n = 1), graft detachment (n = 1), endophthalmitis (n = 1) and allograft rejection (n = 1). A clear cornea at the final examination (14 ± 4 months) was observed in 14/18 (78%), while the visual outcome was limited due to significant ocular comorbidity in 9 out of 14 uncomplicated procedures. CONCLUSION: The presented short-term outcomes suggest that both DMEK and DSAEK are feasible in eyes with an angle-supported acIOL yielding an acceptable graft survival rate in the first postoperative year.


Assuntos
Afacia Pós-Catarata/cirurgia , Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Lentes Intraoculares , Acuidade Visual , Adulto , Idoso , Idoso de 80 Anos ou mais , Câmara Anterior , Afacia Pós-Catarata/complicações , Doenças da Córnea/complicações , Doenças da Córnea/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Vet Ophthalmol ; 22(4): 485-492, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30365226

RESUMO

OBJECTIVE: To analyze a study population of dogs with primary corneal endothelial degeneration (PCED) for information on the patterns of disease and to report the efficacy of superficial keratectomy (SK) for resolution of non-healing corneal ulcers associated with PCED. ANIMALS STUDIED: Primary corneal endothelial degeneration was diagnosed in 238 dogs between 1998 and 2017. Corneal ulceration associated with PCED was present in 89 dogs (109 eyes), of which 47 eyes were treated with SK. PROCEDURES: A retrospective assessment of medical records was performed to determine the signalment patterns of PCED, and the success rate of the SK procedure for resolving PCED-associated corneal ulceration. Descriptive statistics were reported on the signalment of PCED cases, with odd ratios and confidence intervals calculated to detect breed predispositions. RESULTS: Primary corneal endothelial degeneration was diagnosed in 238 dogs, 40.8% were female and 59.2% were male, with a mean age at diagnosis of 11.4 years. Dachshunds, Dalmatians, English Springer Spaniels, Welsh Springer Spaniels, Chihuahuas, Cocker Spaniels, and Golden Retrievers were significantly over-represented. All PCED-affected Dalmatians developed associated corneal ulceration. Follow-up information was available for 41/47 eyes treated with SK. At the first reassessment, 87.8% were healed which increased to 97.6% with subsequent monitoring. Four eyes (9.8%) had late corneal ulcer occurrence following SK, at a median time following SK of 182 weeks post-surgery. CONCLUSIONS: Superficial keratectomy was an effective option for resolving painful non-healing corneal ulcers associated with PCED. Dalmatians may be at increased risk of developing PCED-associated corneal ulceration.


Assuntos
Doenças da Córnea/veterinária , Úlcera da Córnea/veterinária , Doenças do Cão/cirurgia , Ceratectomia/veterinária , Animais , Doenças da Córnea/complicações , Doenças da Córnea/cirurgia , Úlcera da Córnea/etiologia , Úlcera da Córnea/cirurgia , Cães , Feminino , Masculino , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 97(51): e13367, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572441

RESUMO

RATIONALE: Pigmented lesions of conjunctiva and cornea can be observed in various conditions, from the benign nevus to malignant melanoma. Pigmented acquired melanosis (PAM) is one of them, which is a neoplastic proliferation with malignant transformation potential of melanocytes. However, to our knowledge, there has been no report as to a disturbance of corneal barrier function caused by PAM. Here we report a case of corneal PAM which led to recurrent corneal erosions. PATIENT CONCERNS: A 60-year-old woman was referred with a 4-month history of intractable recurrent epithelial erosions in the left eye. She denied any history of ocular trauma or surgery. Slit-lamp examination showed small epithelial defects and loose epithelium of overlying pigmented corneal lesions. The pigmentations were scattered in the corneal epithelial layer, from limbus to the central cornea. DIAGNOSIS: Conservative treatment with therapeutic contact lens and oral doxycycline did not completely cure the corneal erosion. En bloc resection of the pigmented epithelium with cryotherapy and temporary amniotic membrane transplantation were performed. Histopathologic examination demonstrated pigmented melanocytes with mild atypia, scattered mainly in the corneal basal epithelium. Immunohistochemically, the cells were positive for Melan A/MART-1 and negative for CD68 and S100. The Ki-67 proliferation index was low. Therefore, it was diagnosed as primary acquired dysplastic melanosis causing epithelial barrier dysfunction. INTERVENTIONS: We performed en bloc resection of the pigmented epithelium with cryotherapy and temporary amniotic membrane transplantation. OUTCOMES: After the resection, recurrent corneal erosions and epithelial loosening were completely resolved. Although some pigmented lesions were recurred in the limbal epithelium at 8 o'clock, corneal erosion did not recur during the follow-up for 9 months. LESSONS: Our report suggests that primary acquired dysplastic corneal melanosis may cause epithelial dysfunction resulting in recurrent corneal epithelial erosions.


Assuntos
Doenças da Córnea/complicações , Neoplasias Oculares/complicações , Melanose/complicações , Doenças da Córnea/diagnóstico , Doenças da Córnea/patologia , Doenças da Córnea/terapia , Diagnóstico Diferencial , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/patologia , Neoplasias Oculares/terapia , Feminino , Humanos , Melanose/diagnóstico , Melanose/patologia , Melanose/terapia , Pessoa de Meia-Idade , Recidiva
12.
Med Sante Trop ; 28(4): 439-442, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30499448

RESUMO

INTRODUCTION: Among the 1.4 million blind children in the world, 300,000 live in Africa. The causes of blindness vary from one country to another. The purpose of our study was to report the causes of childhood blindness and visual impairment in children attending the only school for the blind in Mali (National Institute for the Blind in Mali, INAM). MATERIALS AND METHODS: All children attending the INAM were examined. Blindness was defined as visual acuity less than 3/60 (20/400 or 0.05). Visual impairment was moderate when the visual acuity was less than 6/18 (20/70 or 0.30), but greater than or equal to 6/60 (20/200 or 0.1), and severe when visual acuity was less than 6/60 (20/200 or 0.1), but greater than or equal to 3/60 (20/400 or 0.05). RESULTS: The study included a total of 104 children. The average age of our patients was 12 years with a M/F sex-ratio of 1.12. In all, 85.6 % of the children were blind and 14.4 % visually impaired. The main causes of blindness were corneal opacities (26 %), and whole globe lesions and conditions (19.2 %). Ametropia accounted for 60 % of visual impairment. DISCUSSION: According to WHO, corneal and retinal damage are the leading cause of blindness (50.6 %) in children. In our series, corneal diseases were the leading cause, following by damage to the whole globe. CONCLUSION: The results of our study indicate that avoidable and treatable causes of childhood blindness are the leading causes of blindness of children at INAM.


Assuntos
Cegueira/etiologia , Adolescente , Deficiência de Vitaminas/complicações , Catarata/congênito , Criança , Pré-Escolar , Doenças da Córnea/complicações , Feminino , Humanos , Lactente , Masculino , Mali , Sarampo/complicações , Estudos Prospectivos , Erros de Refração/complicações
13.
Sci Rep ; 8(1): 16168, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30385884

RESUMO

We compared complications between Ex-PRESS implantation and trabeculectomy for 2 years after surgery. Sixty-four open-angle glaucoma eyes were randomly assigned to treatment with trabeculectomy (n = 32) or Ex-PRESS implantation (n = 32). The primary outcomes were postoperative complications, including reduction of the endothelial cell density (ECD) of the cornea, cataract progression and the frequency of other late postoperative complications. The Ex-PRESS group had significantly greater reduction of postoperative corneal ECD than the trabeculectomy group did at 2 years after surgery (P = 0.026). Among the corneal areas measured using specular microscopy, the superior area, where the Ex-PRESS tube was inserted, had significantly more severe corneal ECD reduction than the inferior area after 2 years (-17.6% in superior area and -11.7% in inferior area, P = 0.04). More cataract progression occurred in the trabeculectomy group than in the Ex-PRESS group (P = 0.04). Twelve eyes (37.5%) in the trabeculectomy group and 4 eyes (12.5%) in the Ex-PRESS group underwent cataract surgery (P = 0.019). The total number of other postoperative complications between 3 months and 2 years was significantly higher in the trabeculectomy group than in the Ex-PRESS group (P = 0.02). Although Ex-PRESS implantation might be associated with an increased rate of corneal endothelial cell loss compared with trabeculectomy, it is beneficial for preventing cataract progression after filtering surgery.


Assuntos
Doenças da Córnea/cirurgia , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Complicações Pós-Operatórias/cirurgia , Trabeculectomia/efeitos adversos , Idoso , Catarata/fisiopatologia , Extração de Catarata/métodos , Doenças da Córnea/complicações , Doenças da Córnea/fisiopatologia , Células Endoteliais/patologia , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/genética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Esclera/fisiopatologia , Tonometria Ocular , Resultado do Tratamento
14.
J Fr Ophtalmol ; 41(7): 642-649, 2018 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30170706

RESUMO

INTRODUCTION: Keratoprostheses offer a therapeutic alternative to patients with bilateral corneal blindness who cannot undergo corneal allograft. The goal of this work was to evaluate the indications and limitations of Boston keratoprosthesis. MATERIALS AND METHODS: Seven patients underwent unilateral implantation of a Boston type I keratoprosthesis between December 2012 and November 2016. The following data were collected: surgical indication, preoperative visual acuity, postoperative visual acuity at D1, D7, D30, 6 months and 12 months, complications and postoperative treatment. RESULTS: The mean age of implantation was 58.7±23.4 years. The surgical indications included 1 case of congenital bilateral aniridia, 2 cases of chemical burn and 4 graft decompensations after multiple keratoplasties. Preoperative visual acuity was limited to "light perception" in 6 cases and "hand motion" in one case. A gain in visual acuity was observed in 4 patients, which corresponded to a mean gain of 1.53 logMAR at last follow-up. Postoperative visual acuity averaged 2.33 logMAR. All patients experienced an improvement in their quality of life and independence. DISCUSSION: Patients should be selected carefully, favoring patients with a remaining functional potential and able to engage in close postoperative follow-up, in order to ensure the best possible treatment success. CONCLUSION: Boston keratoprosthesis provides improved vision and improved quality of life for patients suffering from bilateral corneal blindness.


Assuntos
Cegueira/cirurgia , Doenças da Córnea/cirurgia , Transplante de Córnea , Próteses e Implantes , Implantação de Prótese/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Doenças da Córnea/complicações , Transplante de Córnea/instrumentação , Transplante de Córnea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual , Adulto Jovem
16.
Asia Pac J Ophthalmol (Phila) ; 7(5): 291-295, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29993202

RESUMO

PURPOSE: This study aimed to examine the efficiency and sustainability of pain relief produced by corneal collagen cross-linking (CXL) in eyes with bullous keratopathy (BK) and to explore the histopathological changes in the stroma by using in vivo confocal microscopy. DESIGN: Prospective observational case series. METHODS: Fourteen eyes of 14 consecutive BK patients were treated with CXL with dehydration of the corneal stroma and followed up for 1 year after treatment. The best-corrected visual acuity (BCVA), intraocular pressure, and central corneal thickness (CCT) were examined before the treatments and up to 1 year after. The intensity and frequency of pain were graded on a scale from 0 (minimum) to 10 (maximum). At 1 year after CXL, the corneal stroma was observed using confocal microscopy at depths of 100 and 200 µm. RESULTS: The BCVA and CCT did not change significantly. The mean pain intensity and frequency scores were 5.6 and 4.6, respectively, before treatment. The intensity score significantly decreased at 1 week and onward, and the frequency score significantly decreased over 6 months after treatment. The confocal microscopy images showed that keratocytes and nerve fibers were rare and sparsely distributed in the stroma 1 year after CXL. CONCLUSIONS: The CXL efficiently relieved pain due to BK for 1 year after treatment. The in vivo confocal microscopy observations and unchanged CCT demonstrated that the persistence of pain relief was due to the inadequate regeneration of nerve fibers in the corneal stroma.


Assuntos
Colágeno/metabolismo , Doenças da Córnea/terapia , Reagentes para Ligações Cruzadas/uso terapêutico , Manejo da Dor/métodos , Dor Processual , Terapia Ultravioleta/métodos , Idoso , Idoso de 80 Anos ou mais , Córnea/patologia , Doenças da Córnea/complicações , Doenças da Córnea/fisiopatologia , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Riboflavina/uso terapêutico , Raios Ultravioleta , Acuidade Visual/fisiologia
17.
Cornea ; 37(9): 1198-1203, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29912039

RESUMO

PURPOSE: The purpose of this focused review was to explore the etiologies of corneal blindness worldwide and compare them with the indications and type of keratoplasties (eg, full-thickness penetrating keratoplasty, anterior lamellar keratoplasty, or endothelial keratoplasty) performed. METHODS: A literature search of the articles published in the top 10 journals (based on the Altmetrics score) relevant to corneal transplantation within the past 20 years was performed to determine how the focus within corneal transplantation has changed over time. These data were compared with the prevalence and etiology of corneal blindness in each respective region worldwide. RESULTS: The leading etiologies of corneal blindness worldwide are primarily due to anterior corneal pathology with a normal endothelium, and the prevalence is highest in developing countries. In addition, the number and type of corneal transplantations performed globally indicate that current practices are disproportionately skewed in favor of endothelial keratoplasty, which is targeted for the pathology prevalent in developed countries. Despite the large number of individuals who would benefit from anterior lamellar keratoplasty, this technique seems to be infrequently performed. CONCLUSIONS: Most corneal blindness worldwide is secondary to anterior corneal pathology because of infections and trauma. However, this does not align with the current trends and practices in the field of corneal transplantation. We discuss potential solutions to address the current leading causes of global corneal blindness, including increasing the number of anterior lamellar keratoplasties performed, using long-term preserved corneas by trained surgeons, and improving eye bank handling and distribution of procured tissues.


Assuntos
Cegueira/etiologia , Cegueira/reabilitação , Doenças da Córnea/complicações , Transplante de Córnea/métodos , Padrões de Prática Médica/estatística & dados numéricos , Doenças da Córnea/cirurgia , Bancos de Olhos , Saúde Global , Humanos , Obtenção de Tecidos e Órgãos
18.
Clin Exp Ophthalmol ; 46(9): 1028-1034, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29802759

RESUMO

IMPORTANCE: Glaucoma treatment has often been associated with adverse side-effects from preservatives that are included in the used eye drops. BACKGROUND: To evaluate changes in the ocular surface and the presence of prostaglandin-induced corneal disorders after being switched from latanoprost 0.005% to low preservative tafluprost 0.0015% ophthalmic solution. DESIGN: Single centre, prospective study. PARTICIPANTS: Patients with primary open-angle glaucoma or ocular hypertension that had received treatment with once daily latanoprost 0.005% ophthalmic solution for control of intraocular pressure (IOP) for 3 months, with a score of above 1 on the National Eye Institute (NEI) ocular surface staining scale. METHODS: Following the ≥3 month latanoprost treatment period, patients were switched to once daily low preservative tafluprost 0.0015% ophthalmic solution. Patients were followed for a minimum of 3 months. MAIN OUTCOME MEASURES: Ocular surface changes were assessed by fluorescein staining score (NEI scale). Additional evaluations included tear break-up time, hyperaemia score, subjective symptoms, changes in intraocular pressure and presence of adverse reactions. RESULTS: Out of 59 patients enrolled, 51 were included in the final analysis. Fluorescein staining scores at baseline, prior to treatment switch, were 6.9 ± 3.1 and 3.3 ± 2.7 at the end of the study period (change in scores was -3.6 ± 2.2 [P < 0.001]). At last follow-up, significant improvements were observed in tear break-up time, hyperaemia score and subjective symptoms (all P < 0.05). CONCLUSIONS AND RELEVANCE: The clinical signs of ocular surface disease and subjective symptoms of dry eyes improved following the switch to low preservative tafluprost and demonstrated comparable IOP lowering effectiveness.


Assuntos
Compostos de Benzalcônio/administração & dosagem , Doenças da Córnea/complicações , Glaucoma de Ângulo Aberto/tratamento farmacológico , Latanoprosta/administração & dosagem , Hipertensão Ocular/tratamento farmacológico , Prostaglandinas F Sintéticas/administração & dosagem , Prostaglandinas F/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Córnea/patologia , Doenças da Córnea/diagnóstico , Doenças da Córnea/tratamento farmacológico , Substituição de Medicamentos , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/complicações , Hipertensão Ocular/fisiopatologia , Uso Off-Label , Soluções Oftálmicas/administração & dosagem , Conservantes Farmacêuticos/administração & dosagem , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
19.
Indian J Ophthalmol ; 66(5): 620-629, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29676302

RESUMO

Keratoprosthesis (Kpro) forms the last resort for bilateral end-stage corneal blindness. The Boston Type 1 and 2 Kpros, the modified osteo-odonto Kpro and the osteo-Kpro are the more frequently and commonly performed Kpros, and this review attempts to compile the current data available on these Kpros worldwide from large single-center studies and compare the indications and outcomes with Kpros in the Indian scenario. Although the indications have significantly expanded over the years and the complications have reduced with modifications in design and postoperative regimen, these are procedures that require an exclusive setup, and a commitment toward long-term follow-up and post-Kpro care. The last decade has seen a surge in the number of Kpro procedures performed worldwide as well as in India. There is a growing need in our country among ophthalmologists to be aware of the indications for Kpro to facilitate appropriate referral as well as of the procedure to enable basic evaluation during follow-ups in case the need arises, and among corneal specialists interested to pursue the field of Kpros in understanding the nuances of these surgeries and to make a judicious decision regarding patient and Kpro selection and more importantly deferral.


Assuntos
Órgãos Artificiais , Cegueira/cirurgia , Córnea/cirurgia , Doenças da Córnea/cirurgia , Próteses e Implantes , Cegueira/etiologia , Doenças da Córnea/complicações , Humanos , Índia
20.
BMC Ophthalmol ; 18(1): 92, 2018 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-29653558

RESUMO

BACKGROUND: Pellucid marginal corneal degeneration is a non-inflammatory disorder complicated by severe inferior corneal thinning. The central portion of the cornea, consequently, appears to protrude outwards, decreasing vision by means of an irregular stigmatism. Additionally, acute hydrops can occur in case of Descemet's membrane rupture. CASE PRESENTATION: A 41-year-old Japanese woman presenting with severe visual loss in the left eye was examined and observed to have had full thickness corneal perforation as well as a Descemet membrane rupture with massive edema in the corneal stroma. Anterior segment optical coherence tomography-based corneal topography revealed a distorted crab claw sign indicating pellucid marginal corneal degeneration. The Descemet membrane rupture allowed acute hydrops to occur which was especially noteworthy given the scale of edema present within the stroma, rotating 180 degrees along the limbus, causing a smiley-face like lesion. We visualized it via a gonioscopic three-dimensional optical coherence tomography to build a three-dimensional video. Patient history revealed a previous acute hydrops in the right eye as well, which was ultimately treated with anterior lamellar keratoplasty, suggesting the pellucid marginal corneal degeneration had a classic bilateral involvement, which was also characterized with bilateral acute hydrops. CONCLUSION: This appears to be a very rare and interesting presentation of bilateral pellucid marginal degeneration, wherein not only acute hydrops formed bilaterally, but the cavity within the cornea stroma was exceptionally large with an unusual shape. Using the gonioscopic three-dimensional optical coherence tomography imaging, we were able to easily visualize the massive intrastromal cavern, and appropriately planned the crescent-shaped anterior lamellar keratoplasty. The 3d video constructed using this data is particularly elucidative compared to 2d images. As such, we recommend utilizing 3d imaging in cases where more conventional topography is not as explanatory with respect to precise nature of deformation.


Assuntos
Edema da Córnea/patologia , Adulto , Doenças da Córnea/complicações , Lâmina Limitante Posterior/patologia , Feminino , Humanos , Tomografia de Coerência Óptica/métodos
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