[Choroidal thickness in children with myopia and its changes after surgical strengthening of the sclera]. / Tolshchina khorioidei u detei s miopiei i ee izmeneniya posle khirurgicheskogo ukrepleniya sklery.

PURPOSE: To study the choroidal thickness (CT) in children with myopia and hyperopia and its changes after sclera reinforcement surgeries addressing the progression of myopia. MATERIAL AND METHODS: The study involved 133 patients: 78 children (average age 12.5±0.35 years) with mild hyperopia, low, moderate and high myopia and 55 children with moderate and high myopia who received low invasive scleroplasty (LSP, average age 12.31±0.49 years), or bandaging scleroplasty (BSP, average age 12.59±0.24 years) according to Snyder-Thompson technique and were examined prior to and after the procedure. All patients underwent standard ophthalmologic examination and had choroidal thickness manually measured with EDI-SD-OCT; 55 patients were examined before and 1 week after scleroplasty. RESULTS: A reduction of CT with refraction growth and axial elongation was found in 78 patients. Among the 55 patients, changes in CT were statistically significant: in the operated eyes, CT increased by 42.5±3.17 µm after LSP and by 62.1±1.06 µm after BSP. In fellow eyes, CT showed an increase of 26.1±1.79 µm after LSP and 33.7±0.55 µm after BSP. CONCLUSION: In the early period after sclera strengthening, CT significantly increased both in the operated and in the fellow eye. An increase of CT seems to stimulate the collagen biosynthetic activity of the scleral matrix and the collagen synthesis, and to boost the inhibitory effect that scleroplasty has on the myopia progression.

Sclerokeratoplasty for the early management of acquired anterior staphyloma.

Objective: To report a case of acquired anterior staphyloma after trauma and its first surgical management. Methods: This is a case report of a 17-year-old man who had a history of trauma by insect on the right eye, without a previous history of eye conditions, and evolved with local pain and low visual acuity. The ophthalmological exam showed light perception visual acuity in right eye and 1,0 in left eye, anterior staphyloma and impossibility to blink. The first surgical procedure proposed was sclerokeratoplasty and the second one an optical transplantation but, after step one, the patient did not return to the service and missed the follow-up. Results: Sclerokeratoplasty was proposed once the posterior segment and the crystalline were preserved in topical position. The anterior tumor was excised in free-cut and corneal-scleral graft sutured in single points with 10-0 mononylon. Gatifloxacin 0.3% with Prednisolone Acetate 1%, Epitezan® and Atropine 1% were prescribed immediately postoperative. After 60 postoperative days, he maintained the use of Dexamethasone 0.1% and Atropine 1% and the patient had visual acuity of perception of hand movement in the affected eye. Conclusion: Few treatment options are alternatives to evisceration. In this case report, the sclerokeratoplasty was the chosen technique for the initial management. The second step was not possible due to loss of follow-up. Despite the uncomplicated procedure, we need greater compliance by the patient to conclude the treatment.

[SMILE: Re-Treatment Options - Techniques and Results]. / SMILE: Techniken und Ergebnisse von Nachoperationen.

With a rate of less than 2 %, retreatment after SMILE is rare. If a touch-up is required, there are different options to choose from: surface ablation (PRK/LASEK) with Mitomycin C, the standard femto-flap procedure with the same parameters, the CIRCLE procedure, which extends the previous SMILE interface into a flap, or the innovative but off-label capless SMILE procedure, which preserves all the advantages of SMILE.

Acquired anterior staphyloma after corneal ulcer associated with the use of crack.

We describe an unusual case of acquired anterior staphyloma in a patient addicted to crack cocaine. At the beginning of his crack cocaine abuse, he noticed redness and irritation of his eyes. Over the next 4 months, the patient also noticed the onset of decreasing visual acuity in his right eye (OD). Initially, his visual acuity was light perception in OD, and slit-lamp examination revealed a corneal infiltrate with a peripheral perforation and an iris prolapse. The patient was hospitalized to ensure compliance with the prescribed treatment and was advised to undergo therapeutic keratoplasty; however, the patient left the hospital against medical advice and was lost to follow-up for the next 6 months. He returned with complaints of photophobia and the inability to close his right eyelids. At this time, his cornea had developed an anterior staphyloma and required a sclerokeratoplasty. Following surgery, the patient was again lost to follow-up.

Acquired anterior staphyloma after corneal ulcer associated with the use of crack / Estafiloma anterior adquirido após úlcera de córnea associado a uso de crack

ABSTRACT We describe an unusual case of acquired anterior staphyloma in a patient addicted to crack cocaine. At the beginning of his crack cocaine abuse, he noticed redness and irritation of his eyes. Over the next 4 months, the patient also noticed the onset of decreasing visual acuity in his right eye (OD). Initially, his visual acuity was light perception in OD, and slit-lamp examination revealed a corneal infiltrate with a peripheral perforation and an iris prolapse. The patient was hospitalized to ensure compliance with the prescribed treatment and was advised to undergo therapeutic keratoplasty; however, the patient left the hospital against medical advice and was lost to follow-up for the next 6 months. He returned with complaints of photophobia and the inability to close his right eyelids. At this time, his cornea had developed an anterior staphyloma and required a sclerokeratoplasty. Following surgery, the patient was again lost to follow-up.

RESUMO Descrevemos um raro caso de estafiloma anterior adquirido em um paciente viciado em crack. No início do uso do crack, paciente observou hiperemia e irritação nos seus olhos. Durante os próximos 4 meses, evoluiu com piora progressiva da visão em seu olho direito (OD). Inicialmente, sua visão no OD era de percepção luminosa e ao exame de biomicroscopia observava-se um importante infiltrado corneano com uma perfuração periférica e hérnia de íris. O paciente foi hospitalizado para garantir seu correto tratamento e indicado ceratoplastia terapêutica; no entanto, o paciente abandou o hospital e ficou 6 meses sem acompanhamento. Após esse período, paciente retornou queixando-se de importante fotofobia e inabilidade em ocluir o OD. Neste momento, sua córnea havia desenvolvido um importante estafiloma anterior e necessitou de uma escleroceratoplastia no OD. Após a cirurgia, mais uma vez o paciente abandonou o tratamento e perdeu o seguimento pós-operatório.

[Surgical treatment for optic neuropathy in high myopia].

AIM: To improve the effectiveness of surgical treatment for optic neuropathy in high-degree myopia. MATERIAL AND METHODS: A total of 54 patients (96 eyes) aged 18-30 with high myopia and signs of optic neuropathy were observed. The main group consisted of 20 patients (28 eyes) who underwent meridional scleral reinforcement with type I collagen-based implant placed over the posterior segment. The control group included 34 patients (68 eyes) who were given a 10-day vitamin and vascular therapy course. In most of the controls (21 patient, 21 eyes) indirect revascularization with ligation of the superficial temporal artery was performed. Ophthalmological examination was done before the beginning of the treatment and then at 1, 6, and 12 months. Results. At the end of the follow-up period best corrected visual acuity in the main group was 19.2% higher, on average, than baseline values, but remained unchanged in the controls. Light sensitivity of the retina in both group increased by 7% and 2% respectively. Electrically evoked phosphene thresholds decreased by 22.5% and 10.4% respectively. The main group also demonstrated a near-constant mean peripapillary nerve fiber layer (RNFL) thickness and a 16.4% higher than baseline blood flow velocity in the ophthalmic artery. In the control group the latter parameter showed no change. CONCLUSIONS: Scleral reinforcement surgery in patients with high myopia complicated by optic neuropathy enables improvement of visual functions and regional blood flow as well as stabilization of RNFL thickness and volume, thus, preventing subsequent development of optic nerve atrophy.

Estudio mediante biomicroscopia ultrasónica de pacientes intervenidos de esclerectomía profunda no perforante con implante supraciliar / An ultrasound biomicroscopy study after deep sclerectomy with supraciliary implant

OBJETIVO: Evaluar a pacientes 24 meses después de ser intervenidos mediante esclerectomía profunda no perforante (EPNP) con implante supraciliar y determinar la existencia de factores predictivos de la eficacia de la técnica mediante la exploración biomicroscópica (BMU). MATERIAL Y MÉTODOS: Se incluyen 26 ojos de 23 pacientes explorados con UBM 24 meses después de ser intervenidos mediante EPNP con implante de hema supraciliar. RESULTADOS: Se ha encontrado un descenso significativo de la presión intraocular (PIO) de 25,6 ± 6,4 mmHg a 16,2 ± 3,4 mmHg y en el número de medicaciones antiglaucomatosas de 2,5 ± 0,6 por paciente a 0,5 ± 0,5 (p < 0,001). No se evidenciaron cambios significativos en la agudeza visual. Mediante BMU no se ha podido correlacionar la PIO con el diámetro horizontal (r = −0,05; p = 0,71) ni vertical (r = −0,1; p = 0,63) del lago intraescleral, su altura (r = 0,28; p = 0,25) ni volumen (r = −0,08; p = 0,79), el grosor de la MBTD (r = −0,07; p = 0,73) ni su longitud (r = 0,39; p = 0,13), la presencia de ampolla filtrante (p = 0,3) ni de un área hipogénica en el espacio supracoroideo (p = 0,2). CONCLUSIONES: La inserción del implante de hema en el espacio supraciliar durante la cirugía no perforante del glaucoma es segura y efectiva en el glaucoma de ángulo abierto (GAA) pero no hemos podido establecer factores

OBJETIVE: To evaluate patients 24 months after deep sclerectomy (DE) with supraciliary implant, and identify any predictive success factors by examination with ultrasound biomicroscopy (UBM). MATERIAL AND METHODS: This study included 26 eyes of 23 patients evaluated by UBM 24 months after a deep sclerectomy with a supraciliary hema implant. RESULTS: There was a significant reduction in intraocular pressure (IOP), changing from a preoperative mean of 25.6 ± 6.4 mmHg to a postoperative mean of 16.2 ± 3.4 mmHg (P<.001). The number of preoperative glaucoma medications also decreased from 2.5 ± 0.6 drugs per patient to 0.5 ± 0.5 (P<.001). No change was observed in the best-corrected visual acuity. The anatomical characteristics of the surgical area, and its relationship with IOP were examined using UBM. There was no correlation between the level of IOP at the time of UBM and the horizontal (r=−.05: P=.71) and vertical diameter (r=−.1; P=.63), the height (r=.28; P=.25) and the volume of intrascleral space (r=−.08; P=.79), the thickness (r=−.07;P=.73) and the length (r=.39; P=.13) of trabeculo-Descemet's membrane (TDM), the presence of filtering bleb (P=.30) and the hypoechoic area in the supraciliary space (P=.24). CONCLUSIONS: The insertion of a hema implant in the supraciliary space is an effective and safe surgery for patients with open angle glaucoma (OAG). No predictive success factors for supraciliary implant were found using the UBM study

[Successful treatment of Fusarium-associated keratitis with multiresistant pathogen and multimorbid patient]. / Erfolgreiche Therapie einer Fusarium-assoziierten Keratitis bei multiresistentem Erreger und multimorbidem Patienten.

A 75-year-old man (not a contact lens wearer) presented with Fusarium-associated hypopyon keratitis. After several weeks of empirical and subsequently targeted antimycotic treatment, no considerable improvement was observed. However, after sclerokeratoplasty (11.2 × 11.2 mm) combined with prolonged antimycotic therapy a good local result with relapse-free long-term follow-up was achieved.

Medical devices; ophthalmic devices; classification of the scleral plug. Final rule.

The Food and Drug Administration (FDA or Agency) is classifying the scleral plug into class II (special controls), and exempting the scleral plugs composed of surgical grade stainless steel (with or without coating in gold, silver, or titanium) from premarket notification (510(k)) and continuing to require premarket notification (510(k)) for all other scleral plugs in order to provide a reasonable assurance of safety and effectiveness of the device. The scleral plug is a prescription device used to provide temporary closure of a scleral incision during an ophthalmic surgical procedure.

Orbital, periorbital, and ocular reconstruction.

The repair and restoration of the eyelids and orbit can be a medical and surgical challenge. Inadequate orbital volume restoration could lead to poor functional and cosmetic defects. With advances in technology, our surgical techniques are constantly improving. This article focuses on ocular and orbital reconstruction following traumatic, iatrogenic, and acquired defects. Optimal outcomes can only be expected with appropriate diagnosis treatment planning in consultation with other specialists.

Biomechanical considerations: evaluating scleral reinforcement materials for pathological myopia.

OBJECTIVE: Scleral biomechanical weakness and thinness are known to be one of the main factors in the pathogenesis of progressive myopia. Posterior scleral reinforcement surgery remains the rational treatment for pathological myopia. We tested the biomechanical properties of 3 types of scleral reinforcement materials (artificial pericardium, human sclera, and all-dermal matrix) in an attempt to select the ideal material for the reinforcement of pathologic sclera. DESIGN: Experimental study. PARTICIPANTS: Forty-five adult Japanese white rabbits. METHODS: Animals were equally divided into 3 groups. For each group, 1 type of material was surgically implanted at the back of the globe. We harvested samples after 10 months of implantation, tested the elasticity modulus for both reinforced sclera and unreinforced control sclera, and assessed data by t test methods. Statistically significant differences were considered when p < 0.05. RESULTS: Rabbit sclera reinforced by artificial pericardium or human sclera showed significant increases in the elasticity modulus compared with control eyes. However, the rabbit sclera reinforced by all-dermal matrix showed no significant difference in the elasticity modulus compared with normal controls. CONCLUSIONS: The analysis of biomechanical considerations in scleral reinforcement materials presented here is a very helpful method to choose the best materials for treatment of myopia. Of all materials tested, the artificial pericardium and human foreign-body sclera provided the best biomechanical characteristics.

An experimental study on collagen content and biomechanical properties of sclera after posterior sclera reinforcement.

BACKGROUND: The development of pathological myopia is associated with reduced scleral collagen accumulation, scleral thinning, and loss of scleral tissue, in both humans and animal models. Posterior scleral reinforcement (PSR) was considered as an effective way for treating pathological myopia. Yet it is not well understood the possible role of collagen on the sclera reinforcement mechanisms in the PSR surgery. METHODS: PSR surgery was performed on the normal adult New Zealand white rabbits eyes. Human sclera was used as reinforcement materials. At 1, 2, 3, 6, 9 months after the PSR surgery, scleral hydroxyproline (Hyp) synthesis and collagen fibers arrangement were determined by enzymolysic hydrolysis assay and histological morphology technique. An Instron test machine was used to investigate the elastic modulus of sclera. FINDINGS: It was found that the elastic modulus and Hyp content of reinforced sclera were lower at first month after surgery, and then gradually up to physiological level in the following months. Those two indexes were close to that of the normal control groups at 9 months. INTERPRETATION: These findings indicate that sclera elastic modulus was associated with both change of Hyp content and collagen fibers arrangement after PSR. The therapeutic effect of PSR surgery was confirmed not only from biological but also biomechanical aspects.

[The biomechanical properties of sclera after posterior sclera reinforcement operation].

This study sought to characterize the biomechanical properties of rabbit sclera after posterior sclera reinforcement operation (PSR), which may provide valuable information for PSR in clinical setting. Uniaxial tension and ball-pressing methods were used. Different areas of the sclera samples from PSR were examined in pretest, relaxation and creep experiments respectively by using Instron5544 mechanical machine. The experimental results showed: When the implanted area of sclera samples was compared with that of other groups, the unit width stiffness coefficient increased remarkably at the linear stage, and the anti-deformation capacity was higher at the relaxation stage. However, the creep rate showed a significant decrease at the creep stage. That is to say, PSR could enhance the anti-deformation capacity of the weakened and thinned sections, reduce the sclera creep rate in the posterior sclera, and thus prevent the development of progressive myopia.

The biomechanical properties of sclera after posterior sclera reinforcement operation / 生物医学工程学杂志

This study sought to characterize the biomechanical properties of rabbit sclera after posterior sclera reinforcement operation (PSR), which may provide valuable information for PSR in clinical setting. Uniaxial tension and ball-pressing methods were used. Different areas of the sclera samples from PSR were examined in pretest, relaxation and creep experiments respectively by using Instron5544 mechanical machine. The experimental results showed: When the implanted area of sclera samples was compared with that of other groups, the unit width stiffness coefficient increased remarkably at the linear stage, and the anti-deformation capacity was higher at the relaxation stage. However, the creep rate showed a significant decrease at the creep stage. That is to say, PSR could enhance the anti-deformation capacity of the weakened and thinned sections, reduce the sclera creep rate in the posterior sclera, and thus prevent the development of progressive myopia.

[Prevention of spontaneous scleral perforation during repeated surgery for regmatogenic retinal detachment].

Scleroplastic operations, such as circlage, filling, and their combination widely used in modern surgery so far, have a variety of advantages; however, their drawbacks may also cause severe complications. Among them, there is scleral decubitus (erosion) that is detectable at resurgery when the retina has failed to adjoin after the first operation or when recurrent retinal detachment has developed. The occurrence of this complication makes it impossible to perform an adequate pressing-in due to the fact that spontaneous scleral perforation may occur, which makes it necessary to conduct scleroplasty in this area. For this situation, the authors propose a procedure for surgically treating retinal detachment during re-interventions, which makes it possible to prevent spontaneous scleral perforation, to diminish surgical traumaticity, and to perform a necessary adequate pressing-in for blocking ruptures of the retina with its subsequent adjoining.

[Progressing myopia in children: does it need treatment or not?].

The purpose of the case study was to evaluate the remote consequences of a complex of laser and repeated surgical sclerorestorative procedures made in progressing myopia and its complications. Three hundred and forty-six children, aged 8-10, with rapidly progressing uncomplicated myopia of 4.25 to 9.5 D were shared between 2 groups. Two hundred and forty patients of the experimental group were made sclerorestorative procedures and transscleral low-energy laser stimulation of the ciliary muscle by means of infrared laser MACDEL-09. No such treatment was applied to patients of the control group. When indicated, preventive laser coagulation of the retina was made in both groups. The dynamic 10-year follow-up over the status of refraction and eye bottom showed that the complex scheme of repeated sclerorestorative procedures and low-energy laser treatment combined with preventive peripheral laser coagulation of the retina cut the rate of progressing myopia and prevented peripheral vitreoretinal dystrophy and retinal detachment in children and teenagers with progressing myopia.

[Long-term results of xenoscleroplasty of the posterior pole of the eyeball in the treatment of patients with progressive myopia].

The study deals with the development of an effective, atraumatic and easy-to-use treatment for patients with progressive myopia, by using a discoid xenograft. The treatment involves implantation of a discoid xenograft to the episclera of the posterior pole of the eye. The xenograft is a white disk prepared from the treated bovine pericardium and it has 2 mm in thickness and a diameter of 13 mm. Clinical studies were performed in 89 patients (161 eyes) operated on by the proposed procedure, by evaluating the stabilized progression of myopia 4 years later. In the late period of a follow-up, the stabilization effect was 88.3 to 92.6% in relation to the degree of myopia. There was evidence for increases in the thickness of the sclera (and its acoustic density) on the posterior pole of the eye, for improved regional hemodynamics and better electrophysiological functions of the retina in the postoperative period. Xenoscleroplasty of the posterior pole of the eye with a bovine pericardial xenograft is an easy-to-use, pathogenetically oriented, highly effective, and safe treatment in patients with progressive myopia.