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We report herein a case of fitting with a photochromic silicone hydrogel contact lens under a rigid gas-permeable lens (piggyback system) for photophobia and low vision correction after traumatic aniridia and aphakia. A 40-year-old woman was referred to our practice for contact lens fitting in her right eye, which was left aphakic after an open globe injury. She also presented traumatic aniridia in the right eye, and her left eye had been previously eviscerated. A successful fitting was obtained with a photochromic silicone hydrogel (senofilcon A) contact lens, with a Dk/t of 121 × 10-9, under an aspheric design, +13.00 D rigid gas-permeable lens. The patient displayed visual acuity and contrast sensitivity improvement and reported decreased photophobia.

Thales Antonio Abra De Paula, Fernando Betty Cresta, Milton Ruiz Alves University of São Paulo USP, Ophthalmology, Medical School, São Paulo, Brazil
Correspondence: Thales Antonio Abra De Paula 
 Rua Apeninos 800,apt 1004, São Paulo, SP 04104-020, BrasilEmail thalesaap@hotmail.comPurpose: This study compared riboflavin penetration in porcine corneas using two different solutions: dextran and hydroxypropyl methylcellulose (HPMC).Methods: Porcine corneas were de-swollen and after prepared in an artificial anterior chamber with balanced saline solution. The pressure was checked with a portable tonometer. We used 0.1% riboflavin in 20% dextran for 30 min or 0.1% riboflavin in 1% HPMC for 10 min. The fluorescence intensity in multiphoton microscopy was used to evaluate concentration into the cornea, and ultrasonic pachymetry was performed before and after using riboflavin.Results: Riboflavin concentration up to 340 μm was higher in the HPMC group (p 0.146). From 340 microns to 500 μm, the concentration was higher in the dextran group (p 0.248). There was no statistically significant difference between the groups when considering all the corneal thickness studied (p 0.528). Pachymetric measurements in the group with dextran showed a 12.9% corneal thickness decrease after 30 min, while the HPMC group showed a 9.1% increase after 10 min.Conclusion: We concluded that 1% HPMC riboflavin for 10 min had the same level of safety when compared to the Dresden protocol with dextran riboflavin for 30 min. Ultrasonic pachymetry during corneal crosslinking has fundamental importance in controlling corneal hydration due to changes in thickness caused by different types of riboflavin. This study used different methods than previous studies to better simulate corneal physiological conditions and used 1% HPMC concentration which differs from previous studies performed with 1.1% HPMC.Keywords: crosslinking, fluorescence, riboflavin

Purpose To assess outcomes and glaucoma management in eyes with aniridia following Boston type 1 Keratoprosthesis (KPro) implantation. Design Retrospective, interventional comparative case series. Methods The population included patients with aniridia and patients with other preoperative diagnoses (excluding Stevens-Johnson syndrome, mucous membrane pemphigoid, and congenital disorders) who underwent KPro implantation at Massachusetts Eye and Ear with at least 2 years of follow-up. One eye per patient was selected based on the longer follow-up time. The main outcome was intermediate and long-term outcomes related to glaucoma. Results The aniridia (n = 22) and comparison (n = 61) groups had similar preoperative visual acuity (VA, mean ± standard deviation, 1.86 ± 0.52 logMAR, P = .33) and follow-up time (65.6 ± 26.3 months, P = .25). Before KPro implantation, eyes with aniridia had more glaucoma (76.2%) and glaucoma surgery (57.1%) than comparison eyes (51.8%, P = .053; 23.2%, P = .005, respectively). More Ahmed valves were co-implanted with KPro in aniridia (47.6%) vs comparison eyes (17.9%, P = .008). At final follow-up, more aniridia eyes had glaucoma (90.5%) than comparison eyes (64.3%, P = .02), but the 2 groups had similar percentages of eyes with cup-to-disc ratio (CDR) >0.8 (23.8% vs. 30.4%, P = .57) or CDR progression of ≥0.2 (42.9% vs 44.6%, P = .89, respectively). None of the eyes with prophylactic tube implantation developed glaucoma. Eyes with and without aniridia did not differ in post-KPro VA improvement (72.7%, 72.1%, P = .96), and final VA (1.28 ± 0.79 logMAR, 1.23 ± 0.98 logMAR, P = .51). Conclusion Despite a higher glaucoma prevalence, eyes with aniridia achieved similar VA as comparison eyes with more than 5 years of mean follow-up time. Boston KPro offers satisfactory visual rehabilitation in aniridia when glaucoma is managed aggressively.

To evaluate the influence of preoperative mitomycin C (MMC) on the proliferative behavior of fibroblasts and fibrovascular tissue derived from the primary pterygium using the immunohistochemical method (Ki67 and CD34). Randomized clinical trial. Sixty-five patients with primary pterygium were randomly selected and divided into one of three groups. The control group had 29 patients that were only submitted to pterygium removal. The group that received the MMC injection a month before surgery had 16 patients, and the group that received the MMC 2 weeks before surgery had 20 patients. Each patient only had one eye operated on. Sixty-five patients were selected to undergo pterygium excision surgery. We randomly placed the patients into three groups: one without MMC (n = 29), one with MMC application 1 month before surgery (n = 16) and another with MMC application 2 weeks before surgery (n = 20). Subconjunctival injection was applied with 0.1 ml of 0.02% MMC in the pterygium body, and patients were followed for 2 years. Proliferative behavior of fibroblasts and fibrovascular tissue using the immunohistochemical method (Ki67 and CD34) comparing the three groups. Of the total 29 patients (44.6%) in the control group (without MMC application), 11 cases had recurrence (37.9%), of which seven (63.6%) were within 3 months of follow-up and four (36.3%) within 6 months of follow-up. The mean proliferation index of the recurrent cases was 4.5%, and of the cases without recurrence, it was 6.1%. There were 16 patients (24.6%) in the MMC application group 1 month before surgery, in which one case (6.25%) recurred at 6 months. In the group with MMC application 2 weeks before surgery, of the total of 20 patients (30.7%), there was one case of recurrence (5%) at 6 months. The proliferation index of the group that had MMC administered and did not have a recurrence was 7.2%, and in the group with recurrence, it was 6.4%. The CD34-labeled cell count was 5.8% among cases with recurrence and 5.6% in cases without recurrence. No side effects of MMC application were reported during the study follow-up period. MMC was efficient to reduce the recurrence index despite the absence of a direct relation with its antimitotic and antiangiogenic effect in the samples that were analyzed.

Mario Augusto Pereira Dias Chaves,1–3 André Lins de Medeiros,1,2 César Martins Cortez Vilar,1,2,4 Klayne Rafaella Pereira Magalhães,2 Michelle Rodrigues Gonçalves,3 Patrick Frenzel de Moraes Tzelikis,1,2,5 Wilson Takashi Hida,1,2,5,6 Pedro Carlos Carricondo,2,5 Milton Ruiz Alves2,5 1Brasília Ophthalmologic Hospital (HOB), Department of Cataract, João Pessoa, Paraíba, Brazil; 2Renato Ambrosio Ophthalmologic Study Center (CEORA), Brasília, Federal District, Brazil; 3Provisão Paraíba Ophthalmologic Hospital, João Pessoa, Paraíba, Brazil; 4Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA; 5São Paulo University School of Medicine (FM-USP), Department of Ophthalmology, São Paulo, Brazil; 6São Paulo Federal University of School of Medicine (UNIFESP), Department of Ophthalmology, São Paulo, Brazil Purpose: To assess the stability and reliability of femtosecond laser-assisted cataract surgery (FLACS) incisions design and dimensions using anterior segment optical coherence tomography (AS-OCT) imaging.Setting: Renato Ambrósio Ophthalmologic Study Center from Hospital Oftalmológico de Brasília, Brasília, Brazil.Design: Prospective nonrandomized controlled case series.Methods: Eyes undergoing FLACS with triplanar main temporal clear corneal incision (CCI) were evaluated at the end of the case. Eyes that required any incision hydration, surgical complications or lacked follow-up were excluded. The AS-OCT was performed after femtosecond delivery; at the end of the case; at 1 day and at 30 days after surgery. Data of pachymetry, endothelial and epithelial gaps, Descemet detachment and CCI architecture were compared.Results: Eleven eyes from 11 patients completed follow-up. Corneal thickness was statistically different between after femtosecond delivery and the end of the case (P-value

RESUMO Objetivos: Avaliar a sensibilidade, especificidade e acuracia da refratometria obtida atraves do aparelho photoscreener 2WIN® como metodo de rastreio de ametropias com indicacao de prescricao de oculos pelos criterios da Sociedade Brasileira de Oftalmopediatria em criancas assintomaticas, de origem extra-hospitalar, de 6 a 36 meses de idade, e determinar se a cicloplegia influencia a capacidade de rastreio do aparelho. Metodos: Cento e setenta e oito (178) de criancas com idades entre 6 e 36 meses tiveram sua refratometria mensurada pelo metodo padrao-ouro, a retinoscopia manual sob cicloplegia, e pelo metodo em teste, o photoscreener 2WIN®, antes e apos a cicloplegia. Resultados: O photoscreener 2WIN® e capaz de identificar aqueles pacientes que deveriam receber prescricao de oculos pelos criterios da Sociedade Brasileira de Oftalmopediatria com sensibilidade de 100%, especificidade de 93,18% e acuracia de 93,26%, quando comparado a retinoscopia estatica. Sob cicloplegia, o 2WIN® mantem sensibilidade de 100%, porem aumenta sua especificidade para 96,59% e a acuracia para 96,63%. Conclusao: O photoscreener 2WIN® se mostrou altamente sensivel, especifico e acurado para uso como equipamento de triagem daqueles pacientes de 6 a 36 meses que se beneficiariam do uso de oculos pelos criterios da Sociedade Brasileira de Oftalmopediatria, com discreto aumento da especificidade e acuracia quando aplicado em pacientes cicloplegiados.

We report a case of two twins for whom advanced keratoconus is present in one of the siblings and no clear sign of the disease could be found for the other.

Inflammation and oxidative stress accompany aging. This study investigated the interplay between oxidative stress and inflammation in the lacrimal gland. C57BL/6 mice were used at 2 to 3, 12, and 24 months of age. Nuclear factor erythroid derived-2–related factor 2 (Nrf2)(−/−) and corresponding wild-type mice were used at 2 to 3 and 12 to 13 months of age. A separate group of 15.5 to 17 months of age C57BL/6 mice received a diet containing an Nrf2 inducer (Oltipraz) for 8 weeks. Aged C57BL/6 lacrimal glands showed significantly greater lymphocytic infiltration, higher levels of MHC II, IFN-γ, IL-1β, TNF-α, and cathepsin S (Ctss) mRNA transcripts, and greater nitrotyrosine and 4-hydroxynonenal protein. Young Nrf2(−/−) mice showed an increase in IL-1β, IFN-γ, MHC II, and Ctss mRNA transcripts compared with young wild-type mice and greater age-related changes at 12 to 13 months of age. Oltipraz diet significantly decreased nitrotyrosine and 4-hydroxynonenal and decreased the expression of IL-1β and TNF-α mRNA transcripts, while decreasing the frequency of CD45(+)CD4(+) cells in lacrimal glands and significantly increasing conjunctival goblet cell density compared with a standard diet. The findings provide novel insight into the development of chronic, low-grade inflammation and oxidative stress in age-related dry eye. New therapies targeting oxidative stress pathways will be valuable in treating age-related dry eye.

Dry eye disease (DED) is common in Rheumatoid Arthritis (RA) patients. The application of conjunctival goblet cell count as a clinical biomarker to diagnose and respond to treatment can take place in rheumatoid arthritis patients under TNF-inhibitors (TNFi) therapy. This study aimed to investigate the ocular surface parameters and the long-term effects of TNFi therapy on ocular surface features and goblet cell count of rheumatoid arthritis patients. At baseline, rheumatoid arthritis patients eligible to TNFi were compared to healthy controls (similar age/gender), regarding Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear break-up time test, vital dye staining of the ocular surface, and conjunctival impression cytology. DED severity grade, impression cytology score, and goblet cell count were analyzed. Rheumatoid arthritis patients were followed after three (3 M) and 12 months (12 M), during TNFi treatment. Sixteen rheumatoid arthritis patients and 24 controls were compared: a higher frequency of abnormal OSDI (68.8% vs. 16.7%, p = 0.002), Schirmer’s test p = 0.042), meibomian gland dysfunction (50% vs. 8.3%, p = 0.007), abnormal impression cytology (75% vs. 8.3%, p p 2 vs. 742 (562–863) cells/mm2, p = 0.004]. The presence of Meibomian gland dysfunction was associated with higher disease activity scores (p p = 0.001], and an improvement in impression cytology score [1 (0.5–2) vs. 1 (0–1), p = 0.031] and in goblet cell count [325 (274–707) vs. 931 (656–1,244), p p = 0.047]. Multifactorial DED is frequent in RA patients, comprising aqueous, lipid, and mucin components. TNFi prompt improves tear production and recovers the goblet cells, which can be a biomarker of the pathological process and response to therapy in this population.

Resumo Introducao: Os rastreamentos visuais realizados nas escolas sao, as vezes, a unica oportunidade de detecao dos erros de refracao nao corrigidos (ERN) causadores de baixa visual, prejuizo na aquisicao do conhecimento, evasao e repetencia escolar, habilidades motoras pobres, dificuldade na interacao social e baixa autoestima nos escolares. Objetivos: Comparar a deteccao de ERN em escolares do ensino fundamental por meio de rastreamento visual (medida da AV com a tabela de Snellen) e por photoscreener; avaliar a acuracia do SpotTM Vision Screener (Welch Allyn) como autorefrator comparando suas medidas de refracao com as do autorrefrator Topcon KR 8000 (Japao) e levantar a proporcao de oculos com a tecnologia ready to Clip™ que foram dispensados no momento da avaliacao dos escolares. Metodos: Duzentos e noventa e sete escolares foram submetidos a rastreamento visual (ponto de corte: AV monocular ≤ 0,7 e/ou diferenca duas linhas de Snellen entre os olhos), photoscreening (ponto de corte: hipermetropia ≥3,00D, miopia ≥0,75D e astigmatismo > 1D) e a mensuracao do erro de refracao sob cicloplegia com o photoscreener e o autorrefrator. Somente os dados de refracao do olho direito foram analisados. Os achados foram convertidos em vetores de magnitude para analise. Resultados: Os valores de sensibilidade e especificidade do metodo de rastreamento visual foram 67,2% e 63,5% e do photoscreening, foram 76,1% e 79,1%. A diferenca da refracao do SVS com o autorrefrator foi de +0,154 DE com -0,170 DC no eixo de 6 graus para o olho direito de cada paciente. Conclusoes: Na populacao avaliada o metodo de rastreamento refrativo por photoscreener foi mais efetivo que o do rastreamento visual. A comparacao dos resultados da refracao sob cicloplegia com o autorrefrator validou o uso do photoscreener como um metodo de refracao acurado para a mensuracao de erros refrativos em escolares. A maioria dos escolares receberam os oculos com a tecnologia ready to Clip™ no momento da prescricao.

Dry eye disease can compromise the patient’s quality of life. Few studies assessed the ocular surface (OS) in Ankylosing Spondylitis (AS) patients. This study aimed to evaluate the clinical and cytological findings of the OS in patients with AS, classify dry eye disease (DED) severity grade and conjunctival impression cytology (IC), and the effects of TNF inhibitors (TNFi) in a one-year follow-up. A baseline (BL) evaluation included 36 AS patients and 39 healthy controls. They fulfilled the Ocular Surface Index Disease questionnaire and underwent the Schirmer I test, break-up time, vital staining, and conjunctival IC. A DED severity grade, as well as IC rating, was applied. Fourteen of these patients received TNFi and analysis of ocular and systemic AS disease parameters occurred at BL and three months (3 M), and 12 months (12 M) after treatment. The AS patients presented a higher frequency of DED (p = 0.01), a worse score of severity (p = 0.001), and a higher frequency of altered IC (p = 0.007) when compared to controls. The 14 patients under TNFi presented an improvement in all the clinical disease activity parameters throughout the one-year treatment (p

Resumo Objetivos: Comparar a aniseiconia e a estereopsia em escolares anisometropes do primeiro ano do ensino fundamental corrigidos com lentes oftálmicas de estoque com curvas-base selecionadas para minimizar a diferença de tamanho interocular das imagens retínicas e com lentes iseicônicas sugeridas pelo software Aniseikonia Inspector 3 e verificar a preferência dos escolares por uma destas formas de correção. Métodos: Dezenove escolares com anisometropia ≥ 1,5 D em meridianos correspondentes no uso de óculos com lentes oftálmicas de estoque e com lentes iseicônicas foram avaliados para aniseiconia (software Aniseikonia Inspector 3) e estereopsia (teste Stereo Fly test com símbolos LEA. A preferência por uma das formas de correção foi verificada após 40-50 dias de uso dos óculos. Resultados: As médias e os desvios-padrão das aniseiconias vertical e horizontal no uso de óculos com lentes oftálmicas de estoque e com lentes iseicônicas foram, respectivamente, -1,05% ± 2,20% e -1,37% ± 2,36% (p=0,82739) e -0,895% ± 2,23% e -1,16% ± 2,03% (p=0,77018). 31,6% dos escolares corrigidos com lentes iseicônicas e 21,1% dos escolares corrigidos com lentes oftálmicas de estoque identificaram os optotipos que sugerem estereopsia < 100 segundos de arco (p= 0,475). Em relação à preferência, 4/15 (26,7%) escolheram os óculos com lentes iseicônicas, 2/15 (13,3%) escolheram os óculos com lentes oftálmicas de estoque e para 9/15 (60%) a escolha foi indiferente. Conclusão: A aniseiconia induzida nos escolares anisometropes corrigidos com lentes iseicônicas sugeridas pelo software Aniseikonia Inspector 3 foi similar ao obtido na correção com lentes oftálmicas de estoque com curvas-base selecionadas para minimizar a diferença de tamanho interocular das imagens retínicas. Abstract Objectives: To compare the aniseikonia and the stereopsis in school children anisometropes of the first-year of elementary school corrected with stock ophthalmic lenses with base curve selected to minimize the interocular size difference of retinal images and with size lenses suggested by the software Aniseikonia Inspector 3, and to check the preference of them for one of these forms of correction. Methods: Nineteen school children with anisometropia ≥ 1.5 D in corresponding meridians, in the use of glasses with stock ophthalmic lenses and with size lenses were evaluated for aniseikonia (software Aniseikonia Inspector 3) and stereopsis (Stereo Fly test with LEA symbols). The preference for one of the forms of correction was verified after 40-50 days of wearing glasses. Results: The mean and standard deviations of the vertical and horizontal aniseikonia in the use of glasses with stock ophthalmic lenses and with size lenses were, respectively, -1.05% ± 2.20% and-1.37% ± 2.36% (p = 0,82739) and -0.895% ± 2.23% and -1.16% ± 2.03% (p = 0,77018). 31.6% of the school children corrected with size lenses and 21.1% of the students corrected with stock ophthalmic lenses identified the optotypes that suggest stereopsis less than 100 seconds of arc (p = 0.475). Regarding the preference, 4/15 (26.7%) of the students chose the glasses with size lenses, 2/15 (13.3%) chose the glasses with stock ophthalmic lenses, and for 9/15 (60%) the choice was indifferent. Conclusion: The induced aniseikonia in school children with anisometropia corrected with size lenses suggested by the software Aniseikonia Inspector 3 was similar to that obtained in the correction with stock ophthalmic lenses with base curves selected to minimize the difference of interocular size of retinal images.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of Spot Vision ScreeningTM as an autorefractor by comparing refraction measurements to subjective clinical refractometry results in children and adult patients. METHODS: One-hundred and thirty-four eyes of 134 patients were submitted to refractometry by Spot and clinical refractometry under cycloplegia. Patients, students, physicians, staff and children of staff from the Hospital das Clínicas (School of Medicine, University of São Paulo) aged 7-50 years without signs of ocular disease were examined. Only right-eye refraction data were analyzed. The findings were converted in magnitude vectors for analysis. RESULTS: The difference between Spot Vision ScreeningTM and subjective clinical refractometry expressed in spherical equivalents was +0.66±0.56 diopters (D), +0.16±0.27 D for the vector projected on the 90 axis and +0.02±0.15 D for the oblique vector. CONCLUSIONS: Despite the statistical significance of the difference between the two methods, we consider the difference non-relevant in a clinical setting, supporting the use of Spot Vision ScreeningTM as an ancillary method for estimating refraction.

To compare the antiinflammatory efficacy of topical nepafenac 0.3% for prophylaxis of macular edema after cataract extraction.São Paulo University, São Paulo, Brazil.Prospective randomized clinical trial.Patients with bilateral cataract were included in this study. Each patient was assigned randomly to receive nepafenac 0.3% drops in 1 eye and a placebo in the fellow eye. The primary outcome measure was the change in the mean spectral-domain optical coherence tomography central subfield thickness 5 weeks postoperatively. The secondary outcome measures were the total macular volume 1, 5, and 12 weeks postoperatively; the percentage of patients in both groups who developed macular edema, and the corrected distance visual acuity within 5 weeks and 12 weeks after cataract surgery.The study comprised 224 eyes of 112 patients. For all retinal thickness measurements, a significant increase in both groups was detected starting from the first postoperative week until 12 weeks. At 5 weeks, there was a statistically significant difference in central subfield thickness and total macular volume between the nepafenac group and control group (P = .01 and P .001, respectively). At the fifth postoperative week, no eye in the nepafenac group and 4 eyes (3.57%) in the control group had macula edema, highlighting a trend toward a greater incidence in the control group. The between-group differences in visual outcomes were not statistically significant.Used prophylactically after cataract surgery, nepafenac 0.3% was efficacious in reducing macular thickness compared with a placebo 5 weeks postoperatively, without a difference in final visual acuity.

Resumo Pterigios sao lesoes geralmente benignas que na maioria dos casos nao requer tratamento especifico. E um crescimento fibrovascular sobre a cornea, geralmente a partir do lado nasal. Sua causa ainda nao foi elucidada, mas parece estar relacionada a exposicao aos raios ultravioleta. Quando os sintomas nao sao controlados com tratamento conservador, a cirurgia e indicada, porem o indice de recidiva ainda e alto, e os esforcos tem sido no sentido de reduzir esse indice. A mitomicina C (MMC) e uma opcao de adjuvante a cirurgia por ser um inibidor da proliferacao de fibroblastos, diminuindo o risco de recorrencia do pterigio. Relatamos aqui um caso que descreve cirurgia de pterigio realizada em ambos os olhos de uma mesma paciente, sendo um com MMC e outro sem ela. Os resultados e o indice de proliferacao celular dos dois olhos foram comparados entre si.

A 40y-old white woman, with controlled type 1 diabetes, presented with transient “no light perception vision” in her right eye immediately following uncomplicated cataract surgery. She had vitrectomy for diabetic retinal detachment years ago. The use of intracameral unpreserved lidocaine in a vitrectomized eye may have facilitated the posterior diffusion of the drug in this case. Patient full recovery of vision suggests the relative lack of retinal toxicity of lidocaine in small intracameral concentrations.

Collagen cross-linking (CXL) is the process of formation of covalent bonds within and between the collagen molecules of the corneal stroma. Studies have shown that CXL was able to stabilize keratoconus and postrefractive ectasia for a period of 1–5 years after treatment. The procedure and its technical variations are still controversial. The aim of this study was to present a review on the safety and efficacy of the most commonly used technical variations of CXL.

“Whoever chose the pursuit cannot refuse the crossing” (Guimaraes Rosa) The World Health Organization (WHO) estimates that 285 million people have visual impairment (VI) worldwide, and of these, 39 million are blind. Poor populations and older adults are most severely affected; 82% of the blind individuals and 65% of the moderately-to-severely blind individuals are aged ≥50 years. VIs, including blindness, are preventable in approximately 80% of the cases.1 Data from the Brazilian Census of Geography and Statistics (Instituto Brasileiro de Geografia e Estatistica, 2000) indicate that VI is the predominant type of disability in the 24.5 million individuals with disabilities in Brazil, accounting for 48.1% of all reported cases.2 The estimated loss of gross domestic product in Brazil due to uncorrected refractive errors is 0.18% (approximately R$ 8.7 billion).3 Therefore, VIs, including blindness, in individuals, families, and communities have a significant social importance because they cause severe social, economic, and educational problems (failures and dropouts) and subsequently difficulties in social or inadequate insertion in the labor market. Demographic explosion, population aging, and increased demand for social inclusion together with the increasing semiological and therapeutic means surpass the available resources. Therefore, it is essential to carefully evaluate which problems will be thoroughly addressed, partially addressed, or postponed.4 As part of its commitment to ensure access of the Brazilian population to ocular health, the Brazilian Council of Ophthalmology (CBO) has established the Increased Access to Ocular Health Program (Programa Mais Acesso a Saude Ocular),5 which is a proposal for the national expansion of ophthalmologic care, particularly for the poor population, wherein healthcare is limited. CBO proposes the following actions to assist this population and increase their access to ocular health: 1) encourage the installation of ophthalmological centers in priority areas for the Unified Health System (SUS); 2) include ophthalmology in the primary care of SUS; 3) create a differentiated remuneration table at priority locations for SUS; 4) combine actions to stimulate the formation of medical residencies and internships in unassisted areas; 5) include technologies to monitor the primary causes of blindness and poor vision, and 6) implement a national health quality assessment system. The WHO Global Action Plan 2014–2019 intends to prevent VI due to preventable causes to enable individuals to reach their full potential and provide universal access to comprehensive ophthalmologic care services.1 CBO, via the Increased Access to Ocular Health Program, is aligned with WHO’s 2014–2019 plan of action and has contributed to the improvement of structured, efficient, and equitable health systems, which are crucial for the promotion of the quality of life.

The prevalence of myopia worldwide has been increasing significantly over the past decades, and it is currently a leading cause of visual impairment worldwide. This severe and significant public health problem has been addressed at the community level with the use of atropine eye drops at a concentration of 0.01% (one drop daily). This regimen appears to offer an appropriate balance between costs and benefits, indicated by a 50% reduction in the annual myopia progression rate in children without resulting in clinically significant adverse effects. The therapeutic use of atropine eye drops to slow myopia progression in children is scientifically recognized and it has been proven to be effective.

Wilson Takashi Hida,1–4 Patrick Frenzel Tzelikis,1–3 César Vilar,1,2 Mario Augusto Pereira Dias Chaves,1,2,5 Antônio Francisco Pimenta Motta,1–3 Pedro Carlos Carricondo,1–3 Bruna Vieira Ventura,1,2,4,6 Renato Ambrosio Junior,1–3 Walton Nosé,1,2,4 Milton Ruiz Alves1–3 1Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District, 2Renato Ambrosio Research Center (CEORA), Brasília, Federal District, 3Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP), São Paulo, 4Department of Ophthalmology of São Paulo Federal University (UNIFESP) School of Medicine, São Paulo, 5ProVisão Hospital, João Pessoa, Paraíba, 6Pernanbuco Eye Hospital (HOPE), Recife, Pernambuco, Brazil Purpose: The purpose of this study was to compare intraoperative parameters between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification using Centurion® Vision System with Active Fluidics. Setting: This study was performed at Brasília Ophthalmologic Hospital, Brasília, Federal District, Brazil. Patients and methods: This was a prospective randomized comparative study. Patients with the diagnosis of cataract and surgical extraction programmed were divided into two groups: conventional phacoemulsification and FLACS. Intraoperative data were collected and submitted for statistical analysis. Results: A total of 400 eyes were enrolled, 200 in each group. There were no surgical complications. Groups were statistically equivalent in age and nucleus density. Cumulative dissipated energy and torsional time were significantly reduced in the FLACS group. Conventional surgery had less fluid usage, total case time and aspiration (ASP) time. Conclusion: FLACS with Active Fluidics System can reduce the ultrasound energy use during cataract surgery, in spite of increasing case time, fluid usage and ASP time. Keywords: FLACS, ultrasound, aspiration

In Brazil, the greatest barrier to the routine intracameral use of prophylactic antibiotics at the end of cataract surgery is the lack of a commercially available antibiotic preparation for intracameral use approved by the National Sanitary Surveillance Agency (ANVISA). The Literature Review Group of the Brazilian Society for Cataract and Refractive Surgery (ABCCR/BRASCS) chose this topic for update aiming to review aspects regarding the spectrum of activity, dosage, preparation, safety and efficacy of moxifloxacin, cefuroxime, and vancomycin, which are deemed the safest antibiotics for intracameral use.

The intracameral use of antibiotics following cataract surgery significantly reduces the risk of postoperative endophthalmitis when compared to the pre- or postoperative use of topical antibiotics. The prophylactic use of this therapeutic regimen is a current practice in Europe and in a large number of countries around the world. It is not routinely followed in the US because no commercial antibiotic for intracameral use has been approved by the Food and Drug Administration. With this update on the topic, the Brazilian Society for Cataract and Refractive Surgery intends to show the positive impact of the intracameral use of antibiotics on reducing the rates of endophthalmitis following cataract surgery and highlights evidence of good outcomes that reinforce the safety and efficacy of this prophylactic therapeutic regimen.

OBJECTIVE: To compare the efficacy of visual screening using the Snellen chart to that of refractive screening using the Spot ™ Vision Screener for detecting the causal factors for amblyopia in a pre-school-aged population (4–6-year-old children). METHODS : In total, 97 pre-school-aged children enrolled in city and state day care centers underwent visual screening exams [uncorrected monocular visual acuity (VA) cut-off point of ≤0.7 and/or a difference in VA of two or more lines between the two eyes] and refractive screening exams (cut-off points: hypermetropia ≥ +3.00 D, myopia ≥ −0.75 D, and astigmatism ≥ −0.75 D). All children then underwent a complete ophthalmologic exam, and the refractive error was measured using cycloplegic manual retinoscopy. RESULTS: Among the children with refractive errors above the adopted cut-off point, the estimated percentages of those who were not referred for a complete ophthalmologic exam were 46.4% in the case of the visual screening method and 17.9% in the case of the refractive screening method. The visual screening method using the Snellen chart exhibited a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 58.6%, 64.7%, 41.5%, and 78.6%, respectively. The refractive screening method using the Spot ™ Vision Screener exhibited a sensitivity, specificity, PPV, and NPV of 92.8%, 35.2%, 37.1%, and 92.3%, respectively. CONCLUSION: Refractive screening using the SPOT ™ Vision Screener was more effective than visual screening using the Snellen chart for detecting the causal factors for amblyopia in the studied population.

Purpose To compare the anti-inflammatory efficacy of ketorolac of tromethamine 0.4% and nepafenac 0.1% eye drops for prophylaxis of cystoid macular oedema (CME) after small-incision cataract extraction. Methods Patients were assigned randomly to three groups. Group 1 patients received a topical artificial tear substitute (placebo); group 2 received ketorolac tromethamine 0.4% (Acular LS, Allergan) and group 3 received nepafenac 0.1% (Nevanac, Alcon). The incidence and severity of CME were evaluated by retinal foveal thickness on optical coherence tomography (OCT) after 1, 4 and 12 weeks. Results One hundred and twenty-six eyes of 126 patients were included in this study. The between-group differences in visual outcomes, central corneal thickness and endothelial cell density were not statistically significant. In all retinal thickness measurements, an increase was detected starting from the postoperative first week until 12 weeks. There was no statistically significant difference between the three groups in any measurement performed by spectral-domain OCT. Conclusions Used prophylactically after uneventful cataract surgery, non-steroidal anti-inflammatory drugs were not efficacious in preventing macular oedema compared with placebo. Trial registration number ClinicalTrials: NCT02084576.

PURPOSE: The present study aimed to compare the postoperative contrast sensitivity functions between wavefront-guided LASIK eyes and their contralateral wavefront-guided PRK eyes. METHODS: The participants were 11 healthy subjects (mean age=32.4 ± 6.2 years) who had myopic astigmatism. The spatial contrast sensitivity functions were measured before and three times after the surgery. Psycho and a Cambridge graphic board (VSG 2/4) were used to measure luminance, red-green, and blue-yellow spatial contrast sensitivity functions (from 0.85 to 13.1 cycles/degree). Longitudinal analysis and comparison between surgeries were performed. RESULTS: There was no significant contrast sensitivity change during the one-year follow-up measurements neither for LASIK nor for PRK eyes. The comparison between procedures showed no differences at 12 months postoperative. CONCLUSIONS: The present data showed similar contrast sensitivities during one-year follow-up of wave-front guided refractive surgeries. Moreover, one year postoperative data showed no differences in the effects of either wavefront-guided LASIK or wavefront-guided PRK on the luminance and chromatic spatial contrast sensitivity functions. OBJETIVO: A proposta do presente estudo é comparar funções de sensibilidade ao contraste obtidas após wavefront-LASIK e wavefront-PRK no olho contralateral. MÉTODOS: Os participantes foram 11 sujeitos saudáveis (idade média=32,4 ± 6,2 anos) com astigmatismo miópico. As funções de sensibilidade ao contraste espacial foram obtidas antes e três vezes após a cirurgia. O programa Psycho e uma placa gráfica da Cambridge Research Systems (VSG 2/4) permitiram gerar os estímulos com contraste espacial de luminância e cromático (verde-vermelho e azul-amarelo) de 0,85 até 13,1 ciclos/grau. Análises longitudinais e comparações entre as cirurgias foram realizadas. RESULTADOS: Não houve mudança significativa da sensibilidade ao contraste durante o primeiro ano após a cirurgia para o olho que recebeu o LASIK ou para o olho que recebeu o PRK. A comparação entre as cirurgias também foi semelhante no pós-operatório de um ano. CONCLUSÕES: Os resultados apresentados mostraram sensibilidade ao contraste semelhante durante o primeiro ano após a cirurgia refrativa com o wavefront. Além disso, no pós-operatório de um ano não houve diferença nas funções de sensibilidade ao contraste de luminância e cromático entre os olhos que receberam LASIK e os que receberam PRK.

PURPOSE: To correlate parameters derived from corneal deformation resulting from non-contact tonometry integrated with an ultra-high-speed (UHS) Scheimpflug camera (Oculus Corvis ST, Scheimpflug Technology; Wetzlar, Germany) with age in normal eyes from young patients. METHODS: Observational, retrospective study involving one eye randomly selected from study participants, totaling 89 healthy eyes. The Scheimpflug images were taken with an ultra-high-speed camera during each measurement by the corvis ST. The deformation amplitude (DA) and other parameters (e.g., pachy apex, intraocular pressure, 1st A time, highest concavity-time, 2nd A time, 1st A Length, 2nd A Length, Wing-Dist, curvature radius highest concavity, curvature radius normal, Vin, Vout) measured by the corvis ST were correlated with age. The Kolmogorov-Smirnov test was applied, and Spearman's correlation test was utilized to evaluate the parameters measured by the Corvis ST and age. RESULTS: Mean patient age was 27.50 ± 6.30 years. The highest concavity-time was the only studied parameter statistically significantly correlated to age (i.e., p=0.04, rs=0.18). All other corvis parameters were not correlated to age. This included DA (p=0.319), intraocular pressure (p=0.854), pachy apex (p=0.066), 1st A time (p=0.959), 2nd A time (p=0.561), 1st Length (0.552), 2nd Length (p=0.697), Wing-Dist (p=0.769), curvature radius HC (p=0.145), curvature radius normal (p=0.513), Vin (p=0.980) and Vout (p=0.592). CONCLUSIONS: In healthy eyes, age and pressure or biomechanics as derived from the Corvis ST parameters were not associated with exception to highest concavity-time, i.e., the time from starting until the highest concavity is reached. OBJETIVO: Correlacionar os parâmetros derivados da deformação da córnea pelo sistema de tonometria de não-contato integrado com a câmera ultra-rápida de Scheimpflug (Oculus Corvis ST, Scheimpflug Technology; Wetzlar, Germany) com a idade de pacientes jovens saudáveis. MÉTODOS: Estudo observacional, retrospectivo envolvendo 89 olhos de 89 pacientes. As imagens de Scheimpflug foram feitas pela câmera acoplada ao sistema de tonometria de não-contato (Corvis ST) em cada paciente e os parâmetros utilizados foram: Deformidade de amplitude (DA), paquimetria, pressão intraocular, 1st A time, tempo de concavidade máxima, 2nd A time, 1st A Length, 2nd A Length, Wing-Dist, raio de curvatura de maior alcance, raio de curvatura normal, Velocidade de entrada (Vin) e de saída (Vout). Estes parâmetros foram correlacionados com a idade. RESULTADOS: A média de idade dos pacientes foi de 27,50 ± 6,30 anos. O tempo de concavidade máxima alcançada da córnea (HC-time) foi o único parâmetro estudado estatisticamente significante correlacionado com a idade (p=0,04, rs=0,18). O valor p das correlações dos parâmetros derivados do Corvis ST e idade foram: DA (p=0,319), pressão intraocular (p=0,854), paquimetria (p=0,066), 1st A time (p=0,959), 2nd A time (p=0,561), 1st Length (0,552), 2nd Length (p=0,697), Wing-Dist (p=0,769), raio de curvatura de maior alcance (p=0,145), curvature radius normal (p=0,513), Vin (p=0,980) e Vout (p=0,592). CONCLUSÃO: Em olhos saudáveis de pacientes jovens, a idade e os parâmetros pressóricos e biomecânicos da deformação da córnea não foram associados, exceto o tempo de concavidade máxima, que é o tempo do início de aplanação até a concavidade máxima alcançada da córnea.

Purpose To report a case of post-LASIK corneal ectasia due to a thick flap, while the contralateral eye did not develop ectasia after an incomplete deep flap cut, followed by a thinner flap LASIK procedure. Methods Case report Results This 45 years old female patient had bilateral myopic LASIK in 1999. Preoperative anterior curvature map was regular with no signs of keratoconus. Central keratometry was 42.88 × 44.70 @ 163 in OD and 43.43 × 45.24 @ 175 in OS. Ultrasound central corneal thickness was 586 μm and 619 μm in the right eye and left eye, respectively. Corneal OCT identified a deep meniscus-shaped LASIK flap, with a central thickness of a 392 μm in the right eye, and an incomplete deep peripheral cut in the left eye with a thinner meniscus-shaped LASIK flap. Conclusion Unilateral ectasia after LASIK may occur due to a thick flap which leads to biomechanical failure of the cornea. How to cite this article Valbon BF, Ambrosio R Jr, Glicéria J, Santos R, Luz A, Alves MR. Unilateral Corneal Ectasia after Bilateral LASIK: The Thick Flap Counts. Int J Kerat Ect Cor Dis 2013;2(2):79-83.

OBJECTIVE: To determine whether there is an association between corneal affection asymmetry in keratoconus and preferred sleeping position. METHODS: A prospective clinical study was performed. All participants answered a questionnaire to report their preferred sleeping position. Regardless of the decubitus (lateral or ventral), the eye that was positioned inferiorly during sleep was classified as the “dependent eye”, and the eye positioned superiorly was classified as the “non-dependent eye”. RESULTS: This study indicated greater topographic changes in the dependent eyes of keratoconus carriers; this finding may be associated with the patient’s sleeping position. Regardless of the right or left lateral decubitus positions, greater topographic abnormalities were observed in the corneas of the dependent eye. This finding may be explained by the occurrence of mechanical traumas during sleep and may be secondary to the preferred sleeping position. CONCLUSION: In the treatment of keratoconus, it is essential to identify and reduce the risk factors associated with disease progression. Considering the fact that humans spend a considerable amount of time sleeping, keratoconus patients may benefit from clarifications on position preferences and sleeping habits.

OBJETIVOS: Avaliar a adesão dos escolares do primeiro ano do ensino fundamental ao uso do primeiro par de óculose identificar barreiras ao uso da correção óptica. MÉTODOS. Foi realizado um estudo transversal descritivo em população de 62 escolares do primeiro ano do ensino fundamental da cidade de Santana do Ipanema (Alagoas) que tiveram a prescrição do primeiro par de óculos durante a realização da Campanha "olho no Olho-2002". Para a escolha da armação dos óculos utilizou-se um kit composto por armações de três tamanhos (pequeno, médio e grande), um modelo com cor sugestiva para o sexo feminino, um sugestivo para o sexo masculino e outro unissex. Após 3 meses da entrega dos óculos, voltou-se as escolas públicas, em data previamente marcada, quando as crianças responderam a um questionário com questões abertas sobre a melhora ou piora da visão com os óculos, razões do não uso dos óculos, frequência do uso dos óculos, razões de gostar ou não dos óculos, comentários sobre o que os seus colegas de classe e seus pais pensam sobre o uso dos óculos e se tem familiar usuário de óculos. Para o processamento dos dados foi construído um banco de dados com o software Access do Office 2000. As análises estatísticas foram feitas com o programa SPSS 10.0. RESULTADOS: A idade, o sexo, ter familiar usuário de óculos e AV sem correção menor do que 1,0 em ambos os olhos, ou AV sem correção 1,0 em pelo menos um dos olhos, não influenciaram na adesão ao uso dos óculos. Os comentários dos colegas de classe sobre o uso de óculos foram principalmente negativos (45,16%), enquanto o dos pais foram principalmente positivos (79,03%). O gostar dos óculos influenciou na adesão ao uso dos óculos. As razões apontadas pelos que não gostaram dos óculos foram dificuldade de ajuste da armação no rosto e preconceito dos colegas de classe. CONCLUSÃO: A adesão ao primeiro par de óculos tem pouco a ver com a melhora da AV e muito com o mundo social da criança. Os principais fatores relacionados com a adesão parecem ser uma armação de óculos bem adaptada à face e a aprovação pelos colegas estudantes. PURPOSE:To evaluate the acceptance of initial spectacle wear by children in their first year at a public primary school, andto identify barriers in the use of optical correction. METHODS: A descriptive cross-sectional study was performed. The study group consisted of 62 children in their first year at primary school in the town of Santana do Ipanema (State of Alagoas, Brazil). The children had been referred to ophthalmological examination following visual acuity (VA) screening in "Olho no Olho-2002" (Eye to Eye - 2002), a public health campaign jointly sponsored by the Brazilian Ministry of Health and the Brazilian Ophthalmologic Council. The children chose spectacle frames from a kit containing small, medium and large sizes, in three fashionable designs aimed at girls, boys and a unisex style. Three months after spectacle delivery the children were asked to fill in a questionnaire on: vision improvement or worsening after wearing the spectacles; reasons for and against wearing them; frequency of spectacle wear; reasons for liking or disliking the spectacles; peers, parents and relatives opinion on spectacle wear and how many, if any, relatives/family members wore spectacles. A database for processing the results was built using Access Office 2000 software. Statistical analysis were performed with SPSS 10.0 program. RESULTS: Age, sex, spectacle-wearing relatives, uncorrected VA under 1.0 (20/20) in both eyes and uncorrected 1.0 (20/20) VA in at least one eye did not affect acceptance. Comments from peers about spectacles were unfavourable in 45.16% of cases while those from parents were favourable in 79.03%. Enthusiasm for wearing spectacles favoured acceptance. Poor frame to face adjustment and peer disapproval were the main reasons cited for spectacle rejection. CONCLUSION: Vision improvement apparently bears no relation to acceptance. Rather, good frame fit and peer approval seems to be the determinant factors for spectacle wear.

Citation information: Debert I, de Alencar LM, Polati M, Souza MB & Alves MR. Oculometric parameters of hyperopia in children with esotropic amblyopia. Ophthalmic Physiol Opt 2011, 31, 389–397. doi: 10.1111/j.1475-1313.2011.00850.x Abstract Purpose: To study the oculometric parameters of hyperopia in children with esotropic amblyopia, comparing amblyopic eyes with fellow eyes. Methods: Thirty-seven patients (5–8 years old) with bilateral hyperopia and esotropic amblyopia underwent a comprehensive ophthalmic examination, including cycloplegic refraction, keratometry and A-scan ultrasonography. Anterior chamber depth, lens thickness, vitreous chamber depth and total axial length were recorded. The refractive power of the crystalline lens was calculated using Bennett’s equations. Paired Student’s t-tests were used to compare ocular biometric measurements between amblyopic eyes and their fellow eyes. The associations of biometric parameters with refractive errors were assessed using Pearson correlation coefficients and linear regression. Multivariable models including axial length, corneal power and lens power were also constructed. Results: Amblyopic eyes were found to have significantly more hyperopic refraction, less corneal power, greater lens power, shorter vitreous chamber depth and shorter axial length, despite similar anterior chamber depth and lens thickness. The strongest correlation with refractive error was observed for the axial length/corneal radius ratio (r36 = −0.92, p

OBJETIVO: Desenvolver uma rede neural artificial para classificar em normal ou portador de ceratocone os pacientes submetidos ao exame do Orbscan II TM. MÉTODOS: Foi realizado um estudo retrospectivo envolvendo 98 exames de 59 pacientes. Utilizando o programa Java Neural Network 1.1 foi criada uma rede neural artificial para classificar os exames entre os dois grupos (normais e portadores de ceratocone). Foram utilizados 73 exames para treinamento e validação da rede, e 25 para testar o seu funcionamento. RESULTADOS: Dos 73 exames utilizados no treinamento da rede, 59 eram normais e 14 mostravam alterações relacionadas ao ceratocone. O método utilizado para treinamento da rede foi o "backpropagation". A taxa de aprendizado utilizada foi de 0,2, e a taxa de tolerância de erro 0,05. Dos 25 exames utilizados para a avaliação da eficácia da rede, 19 eram normais, e 6 apresentavam ceratocone. Após o treinamento a rede apresentou sensibilidade e especificidade de 83 e 100%, respectivamente. CONCLUSÃO: A rede neural artificial representa uma opção útil e viável para auxiliar na classificação de exames realizados com o Orbscan II TM. PURPOSE: To evaluate an artificial neural network in order to correctly identify Orbscan II TM tests of patients with normal and keratoconus corneas. METHODS: A retrospective analysis included 98 Orbscan II TM tests of 59 subjects and an artificial neural network was created and trained based on the Java Neural Network 1.1 software. Seventy-three tests (59 normal tests and 14 keratoconus examinations) were applied to train the neural network and 25 eyes were used to test the method (19 normal eyes and 6 cases of keratoconus corneas). RESULTS: Backpropagation method was performed to train the neural network to 5% error and 0.2 learning rate. The trained neural network presented sensibility and specificity of 83 and 100% respectively. CONCLUSION: Artificial neural network can accurately help clinicians to classify keratoconus in Orbscan II TM tests.

OBJETIVOS: Avaliar comparativamente aspectos clinicos da adaptacao de lentes rigidas gas-permeaveis Monocurva externa e Bicurva, desenho Soper-McGuire, em pacientes portadores de ceratocone. METODOS: Estudo clinico, prospectivo e randomizado, com acompanhamento minimo de seis meses, de dois grupos compostos por 63 individuos, um adaptado com Monocurva externa e o outro com Bicurva Soper-McGuire. RESULTADOS: No decorrer do estudo, observou-se reducao do numero de olhos com cones avancados e centrais adaptados com Monocurva externa e aumento de numero de adaptados com Bicurva Soper-McGuire. A Monocurva determinou aplanamento do meridiano mais plano e do mais curvo da cornea, ao passo que a Soper-McGuire determinou encurvamento do meridiano mais plano e aplanamento do mais curvo da cornea. Houve reducao da acuidade visual corrigida com lentes no grupo Monocurva. A estimativa de permanencia no uso da lente inicialmente adaptada foi igual a 60,32% no grupo Monocurva e 71,43% no grupo Soper-McGuire. CONCLUSOES: O estudo mostrou que devido as variacoes observadas na topografia corneal, o mesmo desenho de lente de contato usado no inicio da adaptacao nao proporcionou a melhor relacao lente X cornea com o passar do tempo. A lente Soper-McGuire demonstrou melhor desempenho clinico do que a Monocurva em ceratocones avancados e centrais.

PURPOSE: To evaluate the visual performance by high contrast visual acuity, contrast sensitivity and wavefront in myopic patients with or without astigmatism corrected with spectacles and with three different soft contact lenses [Acuvue® 2 (Vistacon J&J Vision Care Inc., USA), Biomedics® 55 (Ocular Science, USA), and Focus® 1-2 week (Ciba Vision Corporation, USA)]. METHODS: An interventional prospective clinical trial studied a sample of 40 myopic patients (-1.00 to -4.50 sph, with or without astigmatism up to -0.75 cyl). Each patient had one eye randomized to visual performance evaluation. RESULTS: The Zywave aberrometer detected a over refraction and significant difference between Acuvue® 2 and Biomedics® 55 regarding spheric refractive components and spheric equivalent. Both soft contact lenses showed hypercorrection as compared to Focus® 1-2 week. Visual performance was not significantly different with spectacles and the three soft contact lenses in visual acuity and contrast sensitivity measurements. The wavefront analysis detected a significant difference in a third order aberration with and without soft contact lenses, with better visual performance with Acuvue® 2 and Biomedics® 55. CONCLUSION: In visual performance evaluation with spectacles and soft contact lenses the wavefront analysis was a more sensible measurement of visual function when compared to high contrast visual acuity and contrast sensitivity. The evaluation model of visual performance with wavefront analysis developed in this investigation may be useful for further similar studies.

PURPOSE: In order to maintain its clear and uniform structure, the corneal epithelium needs constant equilibrium between production (division) and desquamation of its epithelial cells. The author aimed to evaluate the cell kinetics of corneal epithelium of rabbits in three situations (control, hypoproliferation and hyperproliferation) using BrdU, Ki-67/MIB-1 and AgNORs proliferation markers. METHODS: Fifteen white female rabbits had their eyes randomly divided into three groups (A, B and. C). Group A included eyes submitted to phosphate buffer saline instillation (total 10 eyes); group B, instillation of phosphate buffer saline after removing a 10 mm central area of the corneal epithelium (total 10 eyes) and group C, instillation of 5-fluorouracil in normal epithelium (total 10 eyes). RESULTS: The results of the mean number and standard deviation of the marked cells using BrdU in groups A, B e C were, respectively, 7.17 ± 0.74; 35.00 ± 3.01 e 0.22 ± 0.1 marked cells per 100 basal cells. Differences among groups were statistically significant. The mean number and standard deviation of the labelled cells using Ki-67 were 7.55 ± 1.22 in group A; 35.55 ± 3.84 in group B and 0.34 ± 0.14 in group C. Differences among groups were statistically significant. The mean area and standard deviation of NORs in group A were 1.92 ± 0.24, in group B, 3.61 ± 0.27 and in group C, 1.71 ± 0.26. CONCLUSIONS: The markers BrdU, Ki-67 and AgNOR showed a positive correlation with statistical significance among the cellular proliferation situations studied (control, hypoproliferation and hyperproliferation); the AgNOR did not show statistically significant differences among the control and hypoproliferation situations and there was more agreement in the results among markers BrdU and Ki-67 in three cell proliferation situations.