Efficacy of Standard and Accelerated (10 Minutes) Corneal Crosslinking in Keratoconus Stabilization

Purpose: To evaluate whether Accelerated CXL for 10 minutes is as effective as standard CXL for 30 minutes for the treatment of progressive keratoconus. Patients and Methods: Eighty-two eyes of 62 patients with keratometry examinations performed before and 6 months after surgery were studied. A total of 39 eyes underwent standard CXL with UVA irradiation of 3 mW/cm2 for 30 minutes and 32 eyes underwent Accelerated CXL UVA irradiation of 9 mW/cm2 for 10 minutes. The eyes of all patients had corneal thicknesses of at least 450 microns (400 microns after epithelium removal). Results: The means of the keratometry measurements in the preoperative period for the eyes subjected to standard CXL were 46.27 dioptres (D) on the flat axis (K1) and 48.93 D on the steep axis (K2). Postoperatively, K1 was 46.21 D and K2 was 48.97 D, a difference without statistical significance (p = 0.47 and p = 0.48, respectively). In the Accelerated CXL protocol, the preoperative measurements were 44.55 D and 46.19 D for K1 and K2, respectively. In the postoperative period, K1 was 43.37 D, and K2 was 46.64 D (p = 0.38 and p = 0.27, respectively). In the standard group, the mean maximum keratometry (Kmax) preoperatively was 55.87 D, with no statistical significance (p = 0.29). In the preoperative period, the Kmax of the Accelerated group was 51.15 D, with no statistical significance (p = 0.32). Conclusion: Based on the keratometry results, the accelerated protocol was as effective as the standard protocol for keratoconus stabilization.

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Surgical debridement of corneal shield ulcers in pediatric patients: two case reports and a review of the literature

Ocular allergy is a common disease, especially in the pediatric population, with unpleasant and long-term consequences, including corneal complications and decreased visual acuity. This study reports two cases of corneal shield ulcer due to vernal keratoconjunctivitis, with good results of surgical debridement performed after failure of long-term clinical treatment. Furthermore, this study highlights that this therapeutic approach, although less common, is efficient in treating refractory cases that cause suffering in pediatric patients.

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Objetivo: Descrever os atendimentos oftalmológicos realizados em uma unidade geral de pronto atendimento. Métodos: Estudo prospectivo, observacional e descritivo cuja coleta de dados foi realizada em prontuários de pacientes atendidos na unidade por queixas oftalmológicas no período entre julho e novembro de 2018. Resultados: Foram revisados 445 prontuários de pacientes oftalmológicos, representando 2,18% do número total de pacientes atendidos no período. Foram encontrados 182 (40,89%) pacientes com diagnóstico de conjuntivite, 139 (31,23%) de trauma ocular e 78 (17,52%) com outros diagnósticos. Dentre os pacientes com trauma ocular, 115 (82,73%) eram do sexo masculino e 42 resultaram de acidente de trabalho. Conclusões: Conclui-se que a maioria dos pacientes oftalmológicos foi atendida com diagnóstico de conjuntivite ou trauma ocular e parte desses não faziam uso de EPI no momento da ocorrência. Os resultados permitem inferir que os médicos plantonistas precisam ter noções sobre as doenças oftalmológicas prevalentes na unidade de pronto atendimento e que desponta a necessidade de se promover campanhas para a prevenção de acidentes de trabalho junto às empresas da região, acompanhadas de fiscalização, para reduzir o acometimento de pacientes com trauma ocular resultante da não observância das normas de proteção.

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Phacoemulsification: an alternative for prophylaxis of a glaucomatous crisis

Glaucomatous crisis is an eye disease that is manifested as a sudden rise in intraocular pressure and is accompanied by intense and continuous pain due to blockade of the humor aqueous flow. This block occurs due to a narrowing of the angle between the iris and cornea, primarily due to cataract formation. The discovery of iridotomy for the treatment and prevention of glaucomatous crisis caused by narrow-angle glaucoma, as a minimally invasive procedure, greatly contributed to its acceptance and diffusion among ophthalmologists. However, how to best treat patients with narrow-angle glaucoma and glaucomatous crisis remains controversial. This research, which was performed in a private clinic, suggests that cataract surgery with phacoemulsification is superior to peripheral iridotomy, a laser procedure in the iris aimed at avoiding glaucomatous crisis. Thus, a patient treated with phacoemulsification as the first choice will benefit from both greater comfort because they do not need to be subjected to multiple procedures and lower costs due to the dispersion of fewer medications after the procedure.

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Comparison of macular thickness by optical coherence tomography measurements after uneventful phacoemulsification using ketorolac tromethamine, nepafenac, vs a control group, preoperatively and postoperatively

Introduction: Cataracts remain the leading cause of blindness in the world, and cataract surgery is one of the most frequently performed surgical procedures. Cystoid macular edema (CME) is the most common cause of visual impairment related to the postoperative period of uncomplicated cataract surgery. CME has a low incidence of 0.1%–2.35%;1 occurs between the fourth and tenth postoperative week; and can manifest as visual blurring, image distortion, photophobia, or some combination therein.2,3 There are two types of CME: one is a subclinical type, in which macular thickening is observed normally on optical coherence tomography (OCT) and with no reduction of visual acuity; the other type is associated with the reduction of visual acuity.

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Subjective evaluation of uncorrected vision in patients undergoing cataract surgery with (diffractive) multifocal lenses and monovision

Introduction: Cataract surgery is currently considered to be a refractive procedure, as in addition to restoring vision, it provides the patient with greater independence from glasses. Multifocal intraocular lenses (IOLs) represent a major breakthrough in quality of life and visual expectations, especially with regard to independence from glasses. Evaluation studies of patient satisfaction regarding distance and near vision have shown high levels of satisfaction after the implantation of multifocal lenses.1–3 Despite the benefits of corrected visual acuity at multiple distances, multifocal lenses are associated with certain disadvantages, with halos and glares being the most frequent complaints.4 Furthermore, most of these lens modes are not available to all patients due to their high costs.5 Monovision is a technique that became common after the emergence of refractive surgery in which one eye, usually the dominant one, is focused for distance vision and the other for near vision.6 This mode eliminates or significantly reduces dependence on glasses and contact lenses for most daily activities and is slightly better than the multifocal IOLs in terms of intermediate vision. In addition, it costs much less and is a good alternative for some patients. Retrospective studies of monovision have revealed a success rate of 73%.7 However, one concern is the loss of binocularity, which does not commonly occur when using multifocal IOLs.8

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Ergoftalmologia em escritórios de contabilidade: a síndrome visual do computador (SVC)

Resumo: Este trabalho objetivou averiguar a presença dos sintomas da Síndrome Visual dos Computadores (SVC) trabalhadores de escritórios de contabilidade. Métodos: Como instrumentos de pesquisa utilizou-se um questionário baseado no conjunto de sintomas da SVC, avaliado por Escala Likert (1-5), e foram realizadas observações no local de trabalho baseadas na Avaliação Ergonômica de Postos de Trabalho. Resultados: Os participantes que trabalhavam com o ângulo de visão menor do que 10° em relação à tela foram os que apresentaram mais sintomas sobretudo de dor na parte posterior do pescoço e nas costas (p=0,0460). Aqueles que usavam iluminação diferente de 450 e 699 lux reportaram sintomas significativos para dor de cabeça (p=0,0045) e ressecamento ocular (p=0,0329). Os mais jovens apresentaram mais dor de cabeça (p=0,0182) e aqueles com menor tempo de trabalho mais sintomas de dor de cabeça e ressecamento ocular (respectivamente p=0,0164 e p=0,0479). A falta de recebimento de orientações sobre prevenção foi confirmada por 37% participantes que referiram mais sintomas de dor na parte posterior do pescoço e nas costas (p=0,0936). Conclusão: Os participantes mais jovens, com menor tempo de trabalho, que não haviam recebido informações sobre o uso de computador, não utilizavam iluminação entre 450 e 699 lux ou trabalhavam com o ângulo de visão menor do que 10º apresentaram mais sintomas da síndrome visual do computador.

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Acute corneal hydrops during pregnancy with spontaneous resolution after corneal cross-linking for keratoconus: a case report

Background: Keratoconus is a multifactorial, noninflammatory degeneration of the cornea that causes a loss of stability. It is clinically characterized by central thinning of the cornea and irregular astigmatism, which reduce visual acuity (VA). The treatment for keratoconus depends on its severity, and corneal collagen cross-linking (CXL) is an excellent treatment option in cases of disease progression [1]. We report a case of a pregnant patient who progressed to acute corneal hydrops after completing CXL treatment with an unusual resolution that occurred in 8 days without scarring. Resolution normally occurs within 5 to 36 weeks with scarring [2].

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Infectious crystalline keratopathy caused by Cladosporium sp. after penetrating keratoplasty: a case report

Background: Infectious keratitis is a frequent cause of blindness and ocular morbidity in developing countries.1 Infectious crystalline keratopathy (ICK) is a rare, progressive infection characterized by the insidious progression of branches and crystalline corneal opacities with minimal or no inflammation. Predisposing factors most commonly include topical corticosteroids, previous corneal surgery, herpetic keratitis, neurotrophic keratopathy, and topical anesthetic abuse. The appearance and evolution of ICK are typically the results of clusters of bacterial colonies, particularly streptococcus viridan colonies.2,3 This is the first description of a case of Cladosporium sp.-induced infectious crystalline keratopathy, although other forms of keratitis caused by Cladosporium have been described.

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Adição do selamento entre conjuntiva e cápsula de Tenon em cirurgia de pterígio primário

Resumo: Objetivo: Avaliar os resultados de uma abordagem cirúrgica alternativa na excisão de pterígio primário por meio da observação das taxas de recidiva e de complicações intraoperatórias e pós-operatórias. Métodos: Estudo retrospectivo e transversal realizado a partir da revisão de prontuários de pacientes submetidos à cirurgia de pterígio com transplante autólogo de conjuntiva, cola de fibrina e aplicação intraoperatória de mitomicina C. Além disso, foi realizado através de sutura, o selamento da lacuna entre a conjuntiva e cápsula de Tenon. No total, 36 olhos de 35 pacientes foram submetidos à técnica. As variáveis do estudo foram complicações da cirurgia e taxas de recidiva durante um período mínimo de 6 meses de seguimento. Resultados: Não foram constatadas recidivas durante o tempo de seguimento. Um enxerto (2,8%) desenvolveu retração parcial, sem posterior recorrência do pterígio, e um olho (2,8%) apresentou aumento da pressão intraocular, que foi controlada clinicamente. Conclusão: A criação de uma barreira entre a conjuntiva e cápsula de Tenon, por meio do selamento da lacuna, mostrou ausência de recidiva na amostra estudada. Necessita-se, no entanto, de um estudo prospectivo randomizado com grupo controle para uma conclusão mais precisa da eficácia da técnica.

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