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Background High-intensity focused ultrasound (HIFU) is a cosmetic procedure that aims to tone the skin through thermal collagen coagulation. The energy is delivered in the deep layers of the skin, and because of these characteristics, the risks of severe damage to adjacent tissue and the ocular surface may be underestimated. Previous reports have demonstrated superficial corneal opacities, cataracts, increased intraocular pressure, or ocular refractive changes in different patients following HIFU. In this case, we report deep stromal opacities associated with anterior uveitis, iris atrophy and lens opacity formation following a single HIFU superior eyelid application. Case presentation A 47-year-old female presented to the ophthalmic emergency department complaining of pain, hyperemia and photophobia in the right eye following a HIFU application to the superior right eyelid. A slit lamp examination showed three temporal-inferior corneal infiltrates with edema and severe anterior uveitis. The patient was treated with topical corticosteroids, and six months later, there was residual corneal opacity, iris atrophy and peripherical cataract formation. No surgical procedure was needed, and the final vision was Snellen 20/20 (1.0). Conclusion The risk of severe impairment to the ocular surface and ocular tissues may be underestimated. Cosmetic surgeons and ophthalmologists must be aware of the complications, and the long-term follow-up of these changes needs further investigation and discussion. Safety protocols of the HIFU intensity threshold for thermal lesions in the eye and the use of protective eye devices should be better evaluated.

Our aim was to report the case of endothelial corneal allograft rejection after inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine with an atypical presentation.This was a case report.A 63-year-old woman with previous penetrating keratoplasty and laser in situ keratomileusis presented with clinical signs of endothelial corneal graft rejection 24 hours after CoronaVac (SinoVac Biotech, Beijing/China) vaccine. Slitlamp examination showed corneal edema and interface fluid accumulation. It was partially resolved after treatment with topical corticosteroids and polydimethylsiloxane.Corneal allograft rejection was already reported after another SARS-CoV-2 vaccine. This is the first report in the literature describing a possible association with inactivated SARS-CoV-2 vaccine and corneal allograft rejection, especially with laser in situ keratomileusis interface fluid accumulation presentation. Ophthalmologists should be aware of this potential complication.

Purpose Refractive surgery promotes good quality of vision without optical correction in most cases. Conventional ablation has reduced effectiveness in irregular corneas, where custom ablations are usually a better option. We have evaluated the results of visual acuity and refraction in patients undergoing custom topography-guided ablation. # Setting Oftalmocentro, Porto Alegre – RS – Brazil. # Design This is a case series, retrospective, non-comparative study. # Methods We studied 60 eyes from 48 patients who underwent topography guided customized refractive surgery, from October 2013 to September 2017, performed with excimer laser Schwind Amaris 750. # Results Mean age was 44.2 years, being most men (56.6%). Patients with penetrating keratoplasty (PKP) encompassed 36.6% (n = 22), previous radial keratotomy (RK) 20.0% (n = 12), previous deep anterior lamellar keratoplasty (DALK) 16.6% (n = 10) and 26.5% (n = 16) with other diagnoses. Topo-guided surgeries were trans-photorefractive keratectomy (trans-PRK) (41.5%), femto laser-assisted in situ keratomileusis (femto-LASIK) (35.0%), laser-assisted in situ keratomileusis (LASIK) (11.6%) and photorefractive keratectomy (PRK) (11.6%). Cylinder refraction decreased from −3.91 D (±2.00) to −1.45 D (±1.43) (p

Background/Aims High astigmatism after keratoplasty is the main limiting factor for visual rehabilitation. Among its treatment options the arcuate keratotomy (AK) with the femtosecond laser stands out for its perfection and versatility of the incision making. We designed a study to evaluate the results and safety of femtosecond arcuate keratotomy (femto-AK) in the treatment of high astigmatism after keratoplasty.Methods A prospective interventional cohort study. We enrolled 17 eyes with high degree of irregular astigmatism, scheduled for Femto-AK. IntraLase FS was used to perform arcuate incisions 1.00 mm inside the graft. Patients’ uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BDCVA), and astigmatic change were recorded and followed up to one year after surgery.Results Despite overall improvement in corneal cylinder and visual acuity in one-year follow-up, there was a 52.9% complication rate. Cylinder overcorrection occurred in 6 cases (35.3%) that was managed with compressive sutures; microperforation occurred in two cases (11.7%); and endothelial rejection in one case (5.9%).Conclusion The predictability of astigmatism correction was variable in reducing postkeratoplasty astigmatism and high complication rate was found in our case series. New nomograms and improvements in technique need to be developed in order to reduce the incidence of overcorrections.

Purpose To determine host and pathogen factors predictive of outcomes in a large clinical cohort with keratoconjunctivitis. Design Retrospective analyses of the clinical and molecular data from a randomized, controlled, masked trial for auricloscene for keratoconjunctivitis (NVC-422 phase IIB, NovaBay; clinicaltrials.gov identifier, NCT01877694). Participants Five hundred participants from United States, India, Brazil, and Sri Lanka with clinical diagnosis of keratoconjunctivitis and positive rapid test results for adenovirus. Methods Clinical signs and symptoms and bilateral conjunctival swabs were obtained on days 1, 3, 6, 11, and 18. Polymerase chain reaction (PCR) analysis was performed to detect and quantify adenovirus in all samples. Regression models were used to evaluate the association of various variables with keratoconjunctivitis outcomes. Time to resolution of each symptom or sign was assessed by adenoviral species with Cox regression. Main Outcome Measures The difference in composite scores of clinical signs between days 1 and 18, mean visual acuity change between days 1 and 18, and time to resolution of each symptom or sign. Results Of 500 participants, 390 (78%) showed evidence of adenovirus by PCR. Among adenovirus-positive participants, adenovirus D species was most common (63% of total cases), but a total of 4 species and 21 different types of adenovirus were detected. Adenovirus D was associated with more severe signs and symptoms, a higher rate of subepithelial infiltrate development, and a slower decline in viral load compared with all other adenovirus species. The clinical courses of all patients with non–adenovirus D species infection and adenovirus-negative keratoconjunctivitis were similar. Mean change in visual acuity between days 1 and 18 was a gain of 1.9 letters; worse visual outcome was associated with older age. Conclusions A substantial proportion of keratoconjunctivitis is not associated with a detectable adenovirus. The clinical course of those with adenovirus D keratoconjunctivitis is significantly more severe than those with non–adenovirus D species infections or adenovirus-negative keratoconjunctivitis; high viral load at presentation and non-United States origin of participants is associated with poorer clinical outcome.

The increasing use of contact lenses worldwide has led to an increase in cases of Acanthamoeba keratitis, which are often associated with inappropriate cleaning of contact lenses and lens cases. This study aimed to retrospectively review 28 cases of Acanthamoeba keratitis in Porto Alegre (southern Brazil) and identify the risk factors and clinical outcomes of affected patients. Most patients had higher education (66.6%), all were users of contact lenses, mostly women (67.9%). Most patients were soft contact lens wearers (66.7%) and 85.7% used multipurpose cleaning solutions. Sixteen patients (64.0%) used to wear contact lenses while swimming and/or bathing. Pain was the most common symptom (92.6%). For treatment, patients used polyhexamethylene biguanide drops (92.6%), propamidine isethionate drops (81.5%), chlorhexidine drops (55.6%), topical corticosteroids (63.0%), and systemic corticosteroids (37.0%). Herpes simplex keratitis was the most common misdiagnosis (72.7%). The majority of patients (76.0%) underwent a corneal transplant to control the disease.

PURPOSE To evaluate the clinical outcomes after implantation of a new 320°-arc length Ferrara intrastromal corneal ring segment (320-ICRS) in eyes of patients with keratoconus. METHODS A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure. RESULTS The mean follow-up time was 6.2 ± 3.3 (SD) months (range 3-12 months). Mean UDVA improved from 20/250 to 20/60. Mean CDVA improved from 20/100 to 20/40. Mean Q improved from -1.12 ± 0.49 preoperatively to -0.28 ± 0.51 postoperatively (P < 0.001). Mean corneal volume increased from 56.2 ± 4.28 mm preoperatively to 57.6 ± 4.74 postoperatively (P < 0.001). Mean Km reduced from 53.3 ± 5.5 D preoperatively to 47.8 ± 4.6 D postoperatively (P < 0.001). The change in UDVA, CDVA, and topographic astigmatism was statistically significant (P < 0.0001). CONCLUSIONS The 320-ICRS can efficiently and safely improve visual acuity in keratoconus, modifying the corneal shape to a more physiologic, aspheric shape.

Several strains of free-living amoebae belonging to the genusAcanthamoebacan cause a painful sight-threatening disease of the cornea known asAcanthamoebakeratitis (AK). The numbers of AK cases keep rising worldwide mainly due to an increase in contact lens wearers and lack of hygiene in the maintenance of contact lenses and their cases. We report a case of AK in a healthy young woman admitted to the Hospital de Clinicas in Porto Alegre, southern Brazil. Corneal scrapings were examined for the presence ofAcanthamoebastrains. The initial isolate was characterized by morphological and genotypic properties. The isolate belonged to group III according to Pussard and Pons’ cyst morphology. Analysis of its 18S rDNA sequence identified the isolate as genotype T4. The T4 genotype is the most commonly reported among keratitis isolates and the most common in environmental samples.

Objetivo: Avaliar os resultados em longo prazo do transplante alogênico inter vivo de limbo conjuntival para doenças bilaterais da superfície ocular com compatibilidade HLA doador-receptor. Métodos: Estudo retrospectivo, não comparativo e intervencionista de 39 olhos de 32 pacientes submetidos a transplante alogênico de limbo com compatibilidade HLA e diagnóstico de deficiência límbica. Foram analisados como desfechos principais acuidade visual, visão ambulatorial (≥ 20/200) e estabilidade da superfície ocular. Limbo doador foi obtido de parentes do paciente após estudo de compatibilidade HLA classe I e II. Resultados: Com um ano de pós-operatório, a acuidade visual melhorou em 46,2%, visão ambulatorial foi atingida em 48,7% e estabilidade da superfície corneana em 84,6% dos pacientes. Ao final do seguimento (média, 48,7 ± 30,6 meses), 66,6% dos olhos que haviam ganho acuidade visual um ano após a cirurgia mantiveram esta melhora (p=0,28), 94,7% dos olhos que haviam alcançado visão ambulatorial um ano após a cirurgia mantiveram visão de 20/200 ou melhor (p

Purpose. To evaluate the additional benefits of amniotic membrane transplantation (AMT) when combined with conjunctival limbal autograft (CLAU) in the treatment of chronic chemical burns. Methods. Thirty eyes of 30 rabbits underwent a chemical burn to create limbal deficiency. Forty-five days later, the animals were randomized into three groups of 10 rabbits each. Eyes from group 1 were treated with CLAU, group 2 underwent CLAU and AMT, and group 3 served as control without surgery. Corneal vascularization and opacity were documented with external photographs at postoperative days 30, 60, and 90. The rabbits were killed 3 months after surgery, and their corneas divided into two halves. One half was prepared for hematoxylin-eosin and periodic acid–Schiff staining and the other for frozen sections and immunostaining with AM3 (to MUC 5AC mucin) and AE5 (to K3 keratin). Final clinical outcome was also scored using external photographs at the last follow-up examination. Results. After chemical burn, all groups showed similar degrees of conjunctivalization. After transplantation, corneal vascularization was worse in controls at 60 and 90 days (p < 0.001). At 30 days, eyes from group 1 had less corneal opacity (p < 0.05). At 90 days, corneal opacity was worse in controls but the same in groups 1 and 2 (p < 0.05). At the same time, limbal deficiency was significantly worse in controls (p < 0.05) but similar between groups 1 and 2. Corneal phenotype was present in 70% of the eyes in group 1, 50% in group 2, but in 10% of the controls. Clinical success with clear corneas was significantly more common in groups 1 and 2 when compared with controls (p < 0.001). Conclusions. CLAU is effective in treating limbal deficiency. The concurrent AMT does not add benefits in this rabbit model of chemical burns.

Objetivo: Definir as indicações mais freqüentes de ceratoplastia penetrante no Serviço de Oftalmologia da Universidade Federal do Rio Grande do Sul - a verificação da doença corneana mais transplantada bem como as médias etária e de tempo de preservação das córneas utilizadas. Métodos: Foi realizado um estudo retrospectivo comparativo entre os pacientes atendidos e que tiveram indicação de transplante de córnea (transplantados e em lista de espera) no período de janeiro de 1988 a dezembro de 1997. Resultado: As principais indicações foram: ceratocone (28,6%), ceratopatia bolhosa (20,9%), leucoma (12,6%) e retransplante (11,0%). A doença mais transplantada foi o ceratocone (95% dos casos). As médias etária e de preservação das córneas utilizadas foram 44 anos e 6,6 dias respectivamente. Conclusão: As principais indicações de ceratoplastia penetratnte em nosso meio são o ceratocone, a ceratopatia bolhosa, os leucomas e o retransplante. A doença mais transplantada foi o ceratocone por ser a doença mais incidente e não pelo fato de termos maior oferta de córneas doadoras idosas como suspeitávamos inicialmente. Quanto às médias etária e de tempo de preservação das córneas utilizadas houve preferência estatisticamente significativa pelo uso de córneas mais jovens nos casos de ceratopatia bolhosa.

Purpose To assess the outcomes of laser in situ keratomileusis (LASIK) after penetrating keratoplasty (PKP). Setting Hospital de Clinicas de Porto Alegre, Department of Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. Methods Fourteen eyes of 13 patients who had LASIK after PKP were retrospectively reviewed. The interval between LASIK and PKP was at least 1 year, and the follow-up after LASIK was also at least 1 year. All patients had a stable refractive error for a minimum of 6 months after all sutures were removed, regular and symmetric topographic astigmatism, and a minimal ultrasonic central corneal pachymetry of 500 μm. The Chiron Automatic Corneal Shaper® and the Meditec Aesculap MEL 60 excimer laser were used. Results At 12 months, mean myopia decreased from –5.33 diopters (D) ± 4.22 (SD) to 0.19 ± 1.71 D, mean hyperopia decreased from +5.04 ± 3.32 D to + 0.42 ± 0.46 D, and mean astigmatism decreased from 5.37 ± 2.12 D to 2.82 ± 2.42 D (47.5% of mean percentage reduction). Retreatment was necessary in 42.9% of eyes because of cylindrical undercorrection. Uncorrected visual acuity improved in 11 eyes (78.6%). Best spectacle-corrected visual acuity improved in 6 eyes (42.8%) and was maintained in 4 eyes (28.6%); 5 eyes (35.7%) lost 1 Snellen line. Intraoperative complications included 1 buttonhole flap. Postoperative complications included interface epithelial ingrowth at the periphery (2 eyes) and pseudophakic retinal detachment 2 years after LASIK (1 eye). Conclusion Laser in situ keratomileusis after PKP safely and predictably corrected the spherical component of the refraction. However, the predictability of LASIK in correcting post-PKP astigmatism was poor.

PURPOSE Salivary gland transplantation has been a promising alternative for the treatment of dry eye syndrome. In this article, we describe the results of an autotransplant procedure of labial salivary glands in the upper conjunctival fornix of patients with severe dry eye. METHODS A total of 14 eyes from 14 patients presenting with Stevens-Johnson syndrome and chemical burns were prospectively analyzed after surgery (average follow-up of 14 months). We evaluated their underlying symptoms, visual acuity, biomicroscopy, Schirmer's test, break-up time, and need for lubricants before and after transplantation. RESULTS All patients expressed improvement in their ocular discomfort. Nine eyes showed a slight best-corrected visual acuity improvement, while the vision of the remainder stayed stable. Corneal staining, present in all patients before surgery, was persistent in only four patients, but in a reduced area. Schirmer's test and break-up time showed significant increase in all patients (p < 0.05). In 71% of the patients, the use of lubricants was reduced. CONCLUSION Labial salivary gland transplantation can improve the life quality of patients with compromised ocular surfaces who suffer from severe dry eye syndrome.

O aumento no volume de cirurgias de catarata na segundametade do seculo XX proporcionou uma serie de descobertase melhoramentos tecnologicos nesta area, inclusive a impor-tância do endotelio corneano. Por incrivel que pareca, oconhecimento das funcoes endoteliais de barreira a entrada defluidos e de bomba ativa de transporte de ions e agua para forado estroma corneano, foi desvendado somente a partir dadecada de 50, principalmente por estudos de Davson

A computerized topographic analysis system was used to evaluate corneal changes after strabismus surgery in eight eyes of five patients with Graves' disease. All patients underwent inferior rectus muscle recession; three eyes also had medial rectus recession. Corneal topographic analysis revealed that, postoperatively, corneas steepened inferiorly and inferotemporally at 1.5 mm from corneal apex (p less than 0.05). The opposite effect was observed in the superior quadrant (average flattening of 1.20 +/- 0.32 D at 1.5 mm from corneal apex, and 1.08 +/- 0.39 D at 3.0 mm from corneal apex; p less than 0.05). Superotemporally, the cornea flattened by an average of 0.65 +/- 0.26 D at 3.0 mm from corneal apex, and superonasally 0.72 +/- 0.19 D at 3.0 mm from corneal apex (p less than 0.05). Central, nasal, and temporal cornea did not show statistically significant changes. Spherical equivalent did not change significantly after surgery. The amount of restriction and upgaze measured preoperatively was correlated weakly with inferior corneal steepening (r2 = 0.44; p = 0.046). These results are indicative that corneal topography may be influenced by strabismus surgery for Graves' disease through alteration of extraocular muscle tension or intraocular pressure.

Diurnal changes in corneal topography have been documented to be greater in eyes following radial keratotomy that in normal eyes. To determine whether substantial changes of this nature result from corneal incisions in general or are a specific complication of radial keratotomy, we examined 12 corneas (10 patients) after penetrating keratoplasty for diurnal changes, using a computerized corneal topographic analysis system. Diurnal changes in keratometry readings, central corneal thickness, intraocular pressure, and refraction also were analyzed. From morning to evening, central corneal curvature flattened by an average of 0.74 ± 0.18 diopters in eight eyes (67%), and steepened by an average of 2.00 ± 0.53 D in four eyes (33%). Diurnal changes in central corneal thickness were correlated with diurnal changes in central corneal curvature (r = 0.63.P < .05). These data suggest that changes in corneal thickness over the course of the day may partially account for the changes in corneal curvature demonstrated to occur following penetrating keratoplasty.

Apresentamos aqui uma atualizacao sobre o transplante de conjuntiva, tanto em relacao a sua tecnica cirurgica como em relacao as indicacoes para o pterigio, tumores conjuntivais, ulceras vernais, ceratoconjuntivite limbica superior e necrose conjuntival de fistula glaucomatosa.

Fifty-five eyes of 51 patients with different forms of refractory glaucoma (15 aphakic,12 neovascular, 9 postpenetrating keratoplasty, 8 congenital, 5 secondary to uveitis, 4 associated with aniridia, 1 pseudophakic, and 1 traumatic) underwent antiglaucomatous surgery using a modified 90° Schocket implant. In 25 eyes (45.4%), this was the first surgical procedure. Follow-up ranged from 3 to 27 months (mean, 10.3 ± 5.4 months). The mean preoperative intraocular pressure (IOP) was 39.5 ± 8.6 mmHg (range, 22 to 66 mmHg). The mean postoperative IOP was 17.8 ± 7.6 mmHg (range, 4 to 50 mmHg). Intraocular pressure remained less than 21 mmHg in 50 eyes (90.9%) during the follow-up period. In 13 of these eyes (26.0%), IOP remained under control without any medication. Complications were observed in 13 eyes (23.6%) and were successfully treated in 11 of them. Complications included iris-tube block (5.4%), vitreous-tube block (3.6%), early postoperative flat anterior chamber (1.8%), choroidal effusion (3.6%), tube exteriorization from anterior chamber (3.6%), tube displacement from silicone band (1.8%), retinal detachment (1.8%), tubecornea touch (1.8%), vitreous hemorrhage (1.8%), infectious endophthalmitis (1.8%), and phthisis bulbi (1.8%). Modified 90° Schocket implants are an effective technique in the management of refractory glaucoma.

To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries.A retrospective and non-comparative case series study. 161 eyes were evaluated. The mean age was 51.8 years. Fibrin glue (Beriplast--Aventis Behring, Germany) was used in all patients for tissue adherence or incisional closure.Main preoperatives diseases were pterygium (76 patients), superior limbic keratoconjunctivitis (4 patients), limbal tumor (4 patients), conjunctivochalasis (21 patients), bullous keratopathy (31 patients), limbal stem cell deficiency (7 patients), alkali injury (6 patients), Stevens-Johnson syndrome (2 patients), cataract (5 patients) and glaucoma (5 patients). Complications occurred in 28 patients (17.4%). Detachment of the fixed tissue and granulomatous foreign body reaction were the main complications. Detachment occurred in 10 cases (5.6%) (7 in amniotic membrane transplantation in bullous keratopathy, 2 in autologous conjunctival grafting for pterygium surgery, 1 in autologous limbal transplantation in a Stevens-Johnson syndrome). Granulomatous foreign body reaction was described in 9 patients (5.6%) (5 in amniotic membrane transplantation due to acute alkali injury, 1 in autologous limbal graft due to chronic burn injury, and 3 in autologous conjunctival transplant due to pterygium surgery). All the complications described occurred in the first week after surgery.Despite the limitations related to the retrospective and non-comparative setting, this study suggests that the use of fibrin glue seems to be safe and effective for tissue fixation or incisional closure presenting low rates of complications in ocular surface and anterior segment surgeries.

To describe 9 eyes in 8 patients who received Dohlman-Doane type 1 keratoprosthesis (KPro) with a mean follow-up of 11.2 months (2 to 25 months).A retrospective, non-comparative interventional case series. Previous corneal disease was alcaline burn in 4 eyes, multiple graft failure in 3 eyes, Stevens-Johnson syndrome in 1 eye and thermal injury in 1 eye. Best corrected visual acuity (BCVA) was hand motions or worse in all patients. Glaucoma was present preoperatively in 3 eyes and received Ahmed valve implantation.88,9% eyes achieved BCVA of better than or equal to 20/100, and 44,4% better than or equal to 20/40. In the postoperative period, 3 eyes developed posterior capsule opacity treated with YAG laser capsulotomy; 3 retroprosthetic membrane treated with tPA injection or steroids; 2 glaucoma in clinical treatment; 1 corneal melting, treated with donor cornea bottom exchange; and 1 fungic endophthalmitis, treated with corneal transplant, anterior vitrectomy, KPro and intraocular lens explantation, and specific intravitreal and endovenous treatment.Dohlman-Doane K-Pro seems to be a good option for cases of corneal blindness with poor prognosis for traditional penetrating keratoplasty. Its main advantage is not requesting systemic immunossuppression. Best results were achieved in non-immune diseases.

Keratoconus is one of the leading causes of corneal blindness and a frequent indication for penetrating keratoplasty (PK) (1). One of the most effective methods for visual rehabilitation of keratoconus patients is rigid contact lenses use, but a high percent of these patients are contact lens intolerant. Various types of surgical procedures have been suggested for keratoconus as an alternative for PK, including apex cauterization, epikeratophakia, sectorial keratotomy, photorefractive keratotomy (PRK), Lasik, and lamellar keratoplasty, but with worse results when compared to PK (2).

Purpose: To assess the outcome of Ferrara intracorneal ring segments for keratoconus. Setting: Private practice and university hospital, Porto Alegre, Brazil. Methods: In this retrospective noncomparative interventional case series, 51 keratoconus eyes of 47 patients that had Ferrara intracorneal ring segment implantation were reviewed. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), central corneal curvature, corneal astigmatism, surface regularity index, surface asymmetry index, and complications were analyzed. Results: At a mean follow-up of 13.0 months ± 8.7 (SD), the BSCVA improved in 86.4% of eyes, was unchanged in 1.9%, and worsened in 11.7%. The UCVA improved in 86.4% of eyes, was unchanged in 7.8%, and worsened in 5.8%. The mean spherical equivalent (SE) was reduced from −6.08 ± 5.01 diopters (D) to −4.55 ± 5.71 D and the mean refractive astigmatism, from −3.82 ± 2.13 D to −2.16 ± 2.07 D. The mean central corneal curvature was reduced from 48.76 ± 3.97 D to 43.17 ± 4.79 D. Eyes with central keratoconus had statistically significantly better results than eyes with inferior keratoconus in topographic astigmatism, SE, and refraction cylinder. Penetrating keratoplasty was avoided in 38 eyes (74.5%) during the follow-up. Intracorneal ring segment decentration occurred in 2 eyes (3.9%), segment extrusion in 10 eyes (19.6%), bacterial keratitis in 1 eye (1.9%) with segment extrusion, and a disciform keratitis in 1 eye (1.9%). Conclusion: Implantation of Ferrara intracorneal ring segments in patients with keratoconus was a safe and reversible procedure that led to stable results and avoided or delayed PKP in many cases.

To determine potential acuity meter (PAM) accuracy in patients with cataract as the only ocular disease.Hospital de Clínicas de Porto Alegre, Brazil.This prospective study comprised 74 eyes with cataract. Patients with other ocular pathology diagnosed before or after surgery, as well as those with complicated surgeries, were excluded. All patients had PAM evaluation before surgery; these results were compared to the final postoperative visual acuity. Patients were divided into 4 cataract groups based on the Lens Opacity Classification System II: Group 1, early cataracts (nuclear opalescence [NO] 1 and/or posterior subcapsular cataracts [P] 1 and/or cortical opacity [C]2); Group 2, definite cataracts (NO2 and/or C2, with or without P1); Group 3, posterior cataracts (P2 or P3); Group 4, mature cataracts (N3 and/or Cor = 3, with or without P1). The PAM result was considered accurate if it was within 2 lines of the postoperative best spectacle-corrected visual acuity (BSCVA) 3 months after surgery.All patients had a BSCVA of 20/20. Accuracy of the PAM was 58.3% in Group 1, 50.0% in Group 2, 27.8% in Group 3, and 6.7% in Group 4 (P =.000 017). Patient age did not influence the results.The PAM may be used as a complementary tool in evaluating early and nondense cataracts; however, patients should not be excluded as candidates for cataract surgery based solely on PAM results.

The authors report a case of typical corneal epithelial rejection two months after allogenic limbal-conjunctival graft for a recurrent limbal-conjunctival papilloma in a 62- year-old female patient. The HLA donor-recipient pair was haploidentical (50% identity). This observation suggests a clear conjunctival epithelial transdifferentiation onto corneal epithelium. This is the first report, to the best of the authors’ knowledge, of allograft conjunctival transplantation for this disease and of corneal epithelial rejection after such a procedure. In this case, there was no rejection of the conjunctival graft, and corneal rejection was successfully treated with oral prednisone and topical 1% prednisolone.

Purpose: The purpose of this study is to evaluate the efficacy of allogenic conjunctival transplantation in bilateral surface disorders and to correlate with human leukocyte antigen (HLA) typing and cross-matching. Methods: A prospective study of allogenic conjunctival transplantation was undertaken in 12 eyes of 10 patients with bilateral surface disorders. Five eyes had StevensJohnson syndrome, three had Lyell syndrome, three had bilateral alkali burns, and one had a bilateral thermal burn. Human leukocyte antigen typing and cross-matching were retrospectively performed in eight patients and their respective donors. Stabilization of corneal epithelia, visual acuity, and rejection episodes were examined after the procedure. Results: Eleven (91.6%) of 12 eyes had improved visual acuity, corneal transparency and surface lubrication, stabilization of corneal epithelia, and decreased corneal neovascularization and photophobia after an average follow-up of 17.2 months. Three patients (25%) had rejection episodes, with no disturbance in corneal surface in two. Two of these three patients had 100% incompatible HLA donor—recipient pairs; HLA of the third patient was not available. Patients with favorable evolution were either HLA identical or haplo-identical (50% identity) with their donors. Donor eyes did not present any epithelial problems during the follow-up period. Conclusions: Human leukocyte antigen-matched allogenic conjunctival transplantation proved to be an adequate method of treating severe bilateral surface disorders, with minimal complications.

RESUMO Um número crescente de cirurgiões vem realizando extração da catarata por facoemulsificação, e assim a capsulorrexis circular contínua tem significativamente aumentado de popularidade. Tem-se observado recentemente uma complicação desta técnica de capsulotomia anterior que é a contração capsular, raramente encontrada em capsulotomias tipo “abridor de lata”. Suas consequências incluem a diminuição extrema da abertura capsular anterior, deslocamento da abertura capsular, redução do diâmetro capsular equatorial e deslocamento da lente intra-ocular, complicações estas encontradas mais freqüentemente em capsulorrexis muito pequenas, pacientes idosos, portadores da Síndrome de pseudo-esfoliação e/ou uveíte anterior severa. Apresentamos aqui 3 casos de contração da abertura capsular anterior após capsulorrexis em facoemulsificação, um deles com deslocamento da lente intra-ocular. SUMMARY As phacoemulsification has been gained space among cataract surgeons, continuous circular capsulorhexis has also been performed more frequently. A complication of this technique has been recently observed, that is, capsule contraction syndrome, which rarely develop in can-opener capsulectomies. Undesired effects of such contraction are the extreme reduction of capsulectomy opening, malpositioning of the opening, reduction in equatorial capsular diameter, and displacement of intraocular lens. These complications occur more frequently in small capsulorhexis openings, older patients, pseudoesfoliation syndrome and/or in eyes with severe uveitis. We report herein 3 cases of a capsule contraction syndrome after capsulorhexis in phacoemulsification, one of them developing intraocular lens displacement.

Objetivo: Descrever complicação rara em área doadora de retalho conjuntival. Métodos: Os autores descrevem os aspectos clínico, cirúrgico, pós-operatório e histológico de granuloma da cápsula de Tenon em área doadora de conjuntiva que seguiu cirurgia não complicada de excisão de pterígio com transplante conjuntival. Resultados: O exame histológico evidenciou estrutura tipo hemangiomatosa com áreas de granuloma de corpo estranho envolvendo células epiteliais necróticas. Conclusão: Granuloma piogênico é nomenclatura inadequada para descrever reação inflamatória não supurativa de fácil excisão cirúrgica que pode seguir a retirada de conjuntiva em pacientes suscetíveis. Purpose: To describe a rare complication at the donor site of conjunctival transplantation. Methods: The authors report the clinical, surgical, postoperative and histologic aspects of a Tenon's granuloma that followed an uneventful pterygium excision with conjunctival transplantation. Results: Histology identified an hemangiomatous-like structure with some areas of foreign body granuloma overlying necrotic epithelial cels, easily excised surgically. Conclusions: Pyogenic granuloma is an inadequate term to describe an inflammatory nonsuppurative reaction that may follow uneventful conjunctival surgery in susceptible individuals.

Contraction of corneal wounds as the incisions heal may account for changes in corneal topography after radial keratotomy; such contractility of avascular corneal wounds has been demonstrated in vitro. Using a cat model of radial keratotomy, we demonstrated in vivo contractility of radial keratotomy incisions. In eight eyes of adult female cats, four-incision radial keratotomies were performed, producing central corneal flattening. After 3 and 8 days, serotonin (1 mg/mL) was applied. On day 3, application of topical serotonin resulted in corneal steepening (P < .0001); serotonin produced no topographic changes when applied on day 8 and had no effect on normal unoperated corneas. Vehicle produced no change in corneal curvature before or at any time after radial keratotomy. Fluorescence microscopy revealed cells with myofibroblastic differentiation at the incisions. These data suggest that cells with contractile abilities play a role in determining corneal topography after radial keratotomy.

Corneal scarring as a consequence of bacterial keratitis is an important cause of visual loss and a major indication for penetrating keratoplasty. Anti-inflammatory agents might be useful in this condition for limiting corneal damage, but benefit from adjunctive anti-inflammatory therapy has never been demonstrated. In this limited pilot study, we compared the effect on clinical outcome of treating Pseudomonas keratitis in guinea pigs with prednisolone (a corticosteroid), flurbiprofen (a cyclo-oxygenase inhibitor), nordihydroguaiaretic acid (a lipoxygenase inhibitor), and a leukotriene antagonist, SKF104353 [R-(R*, S*)]-beta-[(2-carboxyethyl) thio-alpha-hydroxy-2-(8-phenyloctyl) benzenepropanoic acid, zinc salt]. None of the anti-inflammatory agents prevented sterilization of ulcers with antibiotic (ofloxacin) therapy. Therapy with the leukotriene antagonist appeared to reduce infiltrate size more quickly and produce a more rapid reduction in lesion size, but the differences were not statistically significant. Sample size calculations suggest that very large numbers of animals would be required to prove efficacy. The role of anti-inflammatory agents in reducing the stromal destruction caused by bacterial keratitis remains controversial.

Recurrence of Pseudomonas keratitis during treatment with corticosteroids has been reported previously in humans. Rabbits with keratitis due to Pseudomonas aeruginosa or Streptococcus pneumoniae were treated with antibiotics and either vehicle, methylprednisolone acetate, flurbiprofen, or nordihydroguaiaretic acid (NDGA). Cultures performed after 7 days were negative, and antibiotics were discontinued. Two weeks later, Pseudomonas keratitis recurred in 6 of 7 (85.7%) steroid-treated rabbits, 1 of 8 (12.5%) flurbiprofen-treated rabbits, 1 of 8 (12.5%) NDGA-treated rabbits, and none of 8 vehicle-treated rabbits. None of the 31 rabbits infected with Streptococcus pneumoniae experienced recurrence. These data confirm the clinical observation that Pseudomonas keratitis may recur if antibiotic therapy is discontinued and corticosteroids are administered; the risk of recurrence appears to be much less with nonsteroidal antiinflammatory agents.

A computerized videokeratography system was used to evaluate diurnal changes in corneal curvature of both untreated and surgically treated eyes of 11 patients who had undergone unilateral radial keratotomy. The mean postoperative interval was 34.5 months. Both corneas operated on and those not operated on steepened on average from morning to evening. For untreated eyes, this diurnal steepening was statistically significant at a distance of 0.5 mm from the corneal apex (mean +/- SE, 0.36 +/- 0.07 diopter) and in the inferotemporal quadrant (0.28 +/- 0.08 D); in eyes that had undergone radial keratotomy, steepening was significant at from 1.0 to 3.0 mm from the corneal apex (0.39 +/- 0.07 D) and temporal, inferotemporal, inferior, inferonasal, nasal, and superonasal to the corneal apex (0.42 +/- 0.08 D). The greatest steepening in the eyes treated with radial keratotomy compared with the untreated eyes occurred at 1.5 to 2.5 mm peripheral to the corneal apex in the inferonasal and nasal octants. Diurnal changes in intraocular pressure, corneal thickness, number of incisions, clear-zone size, postoperative period, and patient sex were not predictive of the magnitude of morning-to-evening change. Furthermore, diurnal changes in corneal curvature of untreated eyes were not predictive of diurnal changes in the fellow eyes after radial keratotomy.

RESUMO Os autores analisaram, retrospectivamente, a adaptação de lentes de contato em pacientes com afacia traumática unilateral. Foram examinadas as fichas de 52 pacientes (52 olhos), cuja idade variou entre 3 e 63 anos (média de 25,50 anos). A causa de trauma mais freqüente foi a perfuração (55,77%). Em 84,61% dos casos houve sucesso na adaptação, sendo que complicação mais freqüente durante o seguimento dos pacientes foi a intolerância por ceratite puntata. Do total de lentes de contato adaptadas, 47,73% foram do tipo gelatinosas, 36,36% rígidas gás-permeáveis e 15,91% rígidas convencionais; Em 27 pacientes (51,92%) a acuidade visual final foi igual ou melhor a 20/40. São discutidas as possíveis causas do insucesso na adaptação. SUMMARY A retrospective study of contact lenses fitting in unilateral traumatic aphakia was undertaken in 52 eyes of 52 patients, aging from 3 to 63 years. The most frequent type of trauma was perforation (55,77%). Success in contact lenses fitting was achieved in 84,61%. Poor visual acuity with contact lenses was the major factor for the insuccess of the remaining (15,39%). Contact lenses intolerance was found to be the most common complication during the follow-up period. The contact lenses types fitting was: 47,73% diary soft contact lenses, 36,36% GP rigid contact lenses 15,91% rigid contact lenses. The final corrected visual acuity was 20/40 or better in 27 patients (51,92%). The causes of fitting insuccess are discussed.

Streptococcus mitis isolated from a human with infectious crystalline keratitis was injected intrastromally into corneas of adult New Zealand white rabbits that were treated with tetracycline hydrochloride, methylprednisolone acetate, or a combination of tetracycline and methylprednisolone. Animals were followed up for up to 44 days; untreated corneas and those treated with tetracycline developed no disease or "fluffy" stromal infiltrates with overlying epithelial defects representing an abscess. Corneas treated with the combination of tetracycline and corticosteroid usually developed crystalline stromal opacities that on histopathologic examination were shown to be intrastromal aggregates of cocci. Transmission electron microscopy of crystalline lesions within 10 days of infection revealed typical cocci intermixed with a fibrillar material having periodicity characteristic of fibrinogen or fibrin, and immunoperoxidase staining for fibrinogen was positive. By 1 month, electron microscopy revealed aggregates of degenerated bacteria that were surrounded by cellular processes of activated keratocytes. Our studies demonstrate a model for crystalline keratitis in which organisms are seen to reside within the stroma for up to 44 days without an inflammatory response. Periocular corticosteroids appear to be necessary to create this model. It is possible that the organisms are isolated from the host response by fibrin or by keratocytes.

Twenty samples of 2% hydroxypropylmethylcellulose for intraocular surgery, obtained from two Brazilian laboratories, were studied to determine the presence and type of impurities in the solutions. These were compared with ten samples of balanced salt solution (control group). Using light and scanning electron microscopy, five types of particles were identified: cellulose fibers, vegetable flakes, crystals, glass fragments, and other impurities. At least one of these contaminants was present in each sample of 2% hydroxypropylmethylcellulose. The vegetable matter was also seen in a sample of the raw material from which the clinical material had been prepared. Control solutions (i.e., balanced salt solution) were free of vegetable matter and of crystals, but glass fragments and other impurities were present. The average number of foreign particles in the solutions of hydroxypropylmethyl cellulose (91.2 and 96.7 particles per milliliter for each of the two groups) was statistically greater than in the balanced salt solutions (13.7 particles per milliliter).

RESUMO Dezenove olhos de 17 pacientes, portadores de diferentes formas de glaucoma (glaucoma congénito (5), glaucoma neovascular (5), glaucoma do afácico (4), glaucoma pós-ceratoplastia penetrante (3) e glaucoma pós-traumatismo (2), foram submetidos a cirurgia antiglaucomatosa, com implante de MOLTENO. A média das pressões intra-oculares pré-operatórias era 36,3 mmHg ± 6,7 e a média das pressões intra-oculares pós-operatórias foi 15,1 mmHg ± 5,2. O tempo médio de seguimento foi 8,0 meses ± 4,9. Dos 19 olhos, três evoluíram para atrofia bulbar. Dos 16 olhos restantes, apenas um teve pressão intra-ocular maior ou igual a 21 mmHg. Nove olhos mantiveram a pressão intra-ocular menor ou igual a 21 mmHg, sem qualquer medicação. Seis olhos tiveram pressão intra-ocular menor ou igual a 21 mmHg com medicação adicional.

RESUMO Doze olhos de onze pacientes, portadores de glaucoma neovascu lar (7 olhos de pacientes diabéticos e 5 olhos com obstrução da veia central da retina), receberam implante de Schocket modificado co mo primeiro procedimento cirúrgico. Eram sete homens e quatro mulheres. A média das pressões oculares pré-operatórias era 45.3 ± 11.9 mmHg. A média das pressões oculares pós-operatórias foi 25.2 ± 11.7 mmHg. O período médio de seguimento foi 9.8 ± 7.6 meses, com variação de 3 a 27 meses. Sete olhos mantiveram a pressão ocular igual ou menor que 21 mmHg. Em três olhos houve obstrução da extremidade intracamerular do tubo pela íris. Em um olho houve expulsão do tubo da câmara anterior. O implante de Schocket é uma opção válida para o tratamento do glaucoma neovascular.

RESUMO Ceratite intersticial não sifilítica com sintomas vestíbulo-auditivos (Síndrome de Cogan) é uma entidade clínica rara. Os autores descrevem um caso de uma paciente feminina de 34 anos de idade que apresentou sinais e sintomas vestíbulo-auditivos característicos da doença e manifestações oculares atípicas. O quadro corneano era de opacidade estromal anelar bilateral por possíveis depósitos de colesterol e no fundo do olho, observava-se edema de papila bilateral durante a evolução. SUMMARY Nonsyphilitic intersticial Keratitis with vestibulo-auditory dysfunction (Cogan' s Syndrome) is a rare clinical entity. The authors describe a 34-years-old woman that had vestibulo-auditory symptoms that usually occurs in this syndrome and ocular manisfestations not so typical. Slitlamp examination of the cornea revealed bilateral ring stromal opacities resembling cholesterol deposits and the fundi showed bilateral disc edema during the course of the illness.

Replacement of the entire anterior segment of the eye is a very ambitious and complex endeavor and it is not known whether the retina remains functional when the anterior structures have been removed. We used routine histo-pathologic evaluation and electroretinographic measurements to determine the structural and functional status of rabbit retinas following surgical removal of the internal anterior structures (iris, ciliary body, and lens) and replacement of the vitreous with silicone oil. In some cases, we were able to record both a scotopic and a photopic electroretinographic response as long as 15 weeks after complete removal of the internal anterior segment structures. Although many hurdles remain and more efficacious surgical techniques and biomaterials need to be developed, our results suggest that, in the rabbit, the retina may continue to function in the absence of critical anterior segment structures.

A computerized videokeratoscopy system was used to evaluate changes in corneal topography after muscle surgery in 36 eyes of 18 rabbits. Topographic analysis revealed a significant flattening of the cornea in the superior and superotemporal octants after superior rectus recession (mean +/- SE, -1.78 +/- 0.16 diopters) compared with control eyes undergoing a sham procedure (-0.17 +/- 0.18 D; P less than .05). Excision of all rectus muscles caused a generalized corneal flattening (-1.42 +/- 0.13 D; P less than .001). A computerized, finite element model of the globe, including the rectus muscles, demonstrated corneal deformation as a result of extraocular muscle tension; recession of an extraocular muscle in this model caused corneal flattening in the quadrant of the recessed muscle. These data suggest that corneal topography is affected by extraocular muscle tension, corroborating clinical reports of refractive change after strabismus surgery.

Computer-assisted photokeratoscopy was used to evaluate the topographic characteristics of corneas preoperatively and postoperatively in seven patients who underwent surgery for correction of postkeratoplasty astigmatism. The steep hemimeridians were typically separated by an angle other than 180 degrees (mean, 162.5 degrees) and the flat hemimeridians were often not orthogonal to the steep hemimeridians. Asymmetry of power (1.5 or more diopters) between these two major hemimeridians was also observed in three patients. Relaxing incisions were placed in the two steep hemimeridians and compression sutures were placed in the flat hemimeridians. The mean percent of reduction of astigmatism (vector-corrected) was 81.1%. The amount of keratometric astigmatism, and the degree of asymmetry of the hemimeridians were not correlated with the percent of reduction of astigmatism after placement of the relaxing and compression sutures. Computer-assisted topographic analysis may prove useful in planning transverse keratotomies centered on the steep hemimeridians and in placement of compression sutures in flat hemimeridians.