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RESUMO A fim de verificar alterações nas indicações de ceratoplastia penetrante (CP) no Hospital São Geraldo (UFMG) foram revistos os prontuários de 265 pacientes submetidos a CP de 1983-87 e 1988-92. O sexo masculino representou 56,3% dos pacientes e 65% encontravam-se entre 10 e 49 anos. As principais indicações de CP foram: ceratocone-66 casos (24,9%), leucoma-60 casos (22,6%), opacificação pós transplante-53 casos (20%), ceratopatia bolhosa-41 casos (15,5%), ceratites-17 casos (6,4%) e distrofias-14 casos (5,3%). A maior média de idade ocorreu na ceratopatia bolhosa (56,5 anos) e a menor no ceratocone (22,5 anos). A distribuição dos 265 casos de CP com relação à freqüência das indicações por período mostrou diminuição do leucoma (27,9 % em 83-87 e 15,3% em 88-92) e aumento da ceratopatia bolhosa (11,7% em 83-87 e 20,7% em 88-92). O atual estudo mostra o ceratocone como principal indicação de transplante, descordando da maioria dos estudos que aponta a ceratopatia bolhosa. Foram detectadas alterações evidentes nas indicações de CP entre os dois períodos analisados nesse estudo. SUMMARY The files of 265 patients who underwent penetrating keratoplasty (PK) at São Geraldo Hospital (UFMG) during the periods of 198387 and 1988-92 were reviewed in order to verify the changes in the indications for surgery. Males constituted 56.3 percent of the patients and 65 percent were from 10 to 49 years of age. The main indications for PK were as follows: keratoconus-66 cases (24,9%), scarring-60 cases (22,6%), regraft-53 cases (20%), bullous keratopathy-41 cases (15,5%), keratilis-17 cases (6,4%) and dystrophy-14 cases (5,3%). The highest age average was in bullous keratopathy (56,5 years of age) and the lowest in keratoconus (22,5 years of age). The distribution of 265 PK cases regarding the frequency of indications per period showed decrease of scarring and increase of bullous keratopathy. There was no agreement between the present study and literature; the latter shows bullous keratopathy and the former keratoconus as the main indication for PK. Marked changes in the indications for PK were found between the two analyzed periods.

Purpose: This report describes the use of Descemet membrane endothelial keratoplasty for the management of endothelial decompensation after multifocal intraocular lens implantation. Methods: In this retrospective study, we reviewed and assessed the surgical outcomes of 9 patients (9 eyes) who underwent Descemet membrane endothelial keratoplasty after multifocal intraocular lens implantation. Results: Corneal edema occurred due to Fuchs endothelial corneal dystrophy (n=3), pseudophakic bullous keratopathy (n=3), Descemet’s membrane detachment (n=2), and toxic anterior segment syndrome (n=1). The Descemet membrane endothelial keratoplasty surgeries were uneventful in all eyes, but rebubbling procedures were necessary in 2 eyes. One month after the surgery, all the corneas were clear. After 6 months, excluding 1 eye with amblyopia, the mean distance corrected visual acuity was 0.10 logMAR, with all eyes achieving 0.18 logMAR or better. Conclusions: This is the first report of Descemet membrane endothelial keratoplasty after multifocal intraocular lens implantation, and it suggests that good results can be achieved without multifocal intraocular lens exchange.

RESUMO A diminuição da visão devido à importante opacidade corneana não é comum em aniridia, e existem poucos relatos de transplante de córnea nesta condição. Relatamos aqui dois casos de transplante de córnea em dois pacientes com aniridia familiar, discutindo os cuidados técnicos do procedimento. Um dos pacientes apresentava anomalia de Peters e rubéola congênita associadas, e o outro, catarata e sífilis congênita. Houve melhora significativa da acuidade visual após o transplante de córnea em ambos os casos durante o período de seguimento de 32 meses. As complicações pós-operatórias foram defeito epitelial persistente, ceratopatia verticilata, dois episódios de rejeição e glaucoma, todos no mesmo paciente e controlados clinicamente.

We report a case of central corneal perforation treated with an autologous lamellar scleral graft and histologic findings obtained after a subsequent penetrating keratoplasty. A corneal perforation within a large Pseudomonas ulcer in a 55-year-old male rigid gas permeable contact lens wearer was sealed by a lamellar scleral graft from the same eye, followed by an uneventful penetrating keratoplasty 6 months later. Histology of the excised button revealed that the well-apposed graft, which maintained the irregular arrangement of the scleral collagen fibers, was embedded in the corneal stroma over the deep blood vessels and a rupture in Descemet's membrane. The clinical and histologic findings showed that autologous lamellar scleral grafts can be successfully used for the emergency treatment of corneal perforation when a corneal transplant is not available. The distinctive scleral structure revealed by histology and the inadequate graft transparency indicate that visual rehabilitation of eyes with a central corneal perforation can be achieved only by a subsequent optic penetrating keratoplasty.

We present the case of a 31-year-old patient with toxic anterior segment syndrome (TASS) that developed after undergoing deep anterior lamellar keratoplasty (DALK). She had keratoconus, and despite wearing hard contact lenses for many years in the left eye, her vision had deteriorated; therefore, DALK was performed on this eye. The preoperative visual acuity (VA) was finger counting at 3 m. Routine DALK was performed using the "big-bubble" technique. The corneal entry incision was hydrated at the end of the surgery, which was terminated by air injection into the anterior chamber. On postoperative day 1, VA was at the level of hand movements, and the cornea was edematous. Topical high-dose dexamethasone and oral steroids were initiated considering the diagnosis of TASS. Subsequently, the patient's VA increased, and the corneal edema decreased. We believe that the use of re-sterilized cannulas may have been the likely cause of TASS. Although DALK can be performed without interfering with the anterior chamber, one should keep in mind that TASS may occur in response to the solution used to hydrate the incision site and the air injected into the anterior chamber.

RESUMO Apresentamos dois irmaos com a associacao de retardo mental e ceratocone bilateral, filhos de pais consanguineos, onde a avaliacao genealogica sugere um padrao de heranca autossomica recessiva. Uma nova sindrome monogenica pode ser sugerida. Um dos pacientes foi submetido a transplante de cornea penetrante e evoluiu com ulcera corneana infecciosa, com boa resposta ao tratamento clinico. Bons resultados podem ser obtidos se a indicacao de transplante de cornea em retardados mentais for criteriosa.