Epithelial and stromal remodeling after corneal collagen cross-linking evaluated by spectral-domain OCT.

PURPOSE: To evaluate changes in corneal epithelial and stromal thickness after corneal collagen cross-linking (CXL) in eyes with keratoconus and postoperative corneal ectasia using spectral-domain optical coherence tomography (SD-OCT). METHODS: Anterior segment SD-OCT (RTVue-100; Optovue, Inc., Fremont, CA) was used to compare regional corneal epithelial and stromal thickness in eyes with keratoconus and ectasia before CXL and 1 and 3 months after CXL. The anterior surface of the cornea, epithelium-Bowman's layer interface, and posterior reflective surface were used as anatomical landmarks to measure epithelial and stromal thickness, respectively. Regional thickness was assessed centrally and at 21 points 0.5 mm apart across the central 6 mm of the corneal vertex in the horizontal and vertical meridians. RESULTS: Thirty-one eyes from 30 patients were evaluated, including 17 eyes (17 patients) with keratoconus and 14 eyes (13 patients) with ectasia. Preoperatively, a highly irregular epithelial thickness profile and distribution was observed in both groups. After CXL, epithelial thickness was significantly thinner 2.5 and 2 mm below and 1.5 mm above the corneal apex (49.26 ± 5.69 µm; range: 43 to 62 µm), and 2.5 and 1 mm nasal and 2 mm temporal to the corneal apex (46.66 ± 4.53 µm; range: 39 to 57 µm) compared to preoperative values (P < .05 for all measurements). Epithelial thickness standard deviations were significantly lower (by 3 to 6 µm) 3 months after CXL, compared to ranges before CXL in both the vertical and horizontal meridians for keratoconus and ectasia (P = .048). No significant differences were found between epithelial remodeling in keratoconus and corneal ectasia (P = .98). No significant or consistent stromal changes were found for either group. CONCLUSIONS: Significant epithelial remodeling occurs after CXL in eyes with keratoconus and corneal ectasia, creating a similar, more regularized thickness profile in all meridians in the early postoperative period. This pattern of remodeling may facilitate interpretation of corneal curvature and thickness changes after CXL and may be related to visual acuity after CXL.

Gestaçäo: orientaçöes básicas / Pregnancy: basic orientations

Com a constataçäo, por meio dos prontuários, da existência de alto índice de gravidez na regiäo da Unidade Básica de Saúde do Jardim Tókio, em Londrina, e por ser uma das questöes que preocupam a direçäo da unidade, o grupo de alunos do GIM5, de 1996, resolveu estudar e empreender uma açäo de acompanhamento e orientaçäo às mulheres grávidas da regiäo. Os acadêmicos também visitaram um colégio, onde conversaram sobre sexualidade e gravidez na adolescência com alunos do 2§ Grau. Os estudos dos membros do GIM5 compreenderam planejamento familiar, controle de doenças sexualmente transmissíveis, aleitamento materno e até preparo físico pré-parto. O ginecologista e a direçäo da UBS dera, cobertura a estes estudos e, ao final, foi organizada uma atividade com a participaçäo das mulheres grávidas , para o repasse das informaçöes de seu interesse