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This study attempts to review whether the coronavirus disease-2019 (COVID-19) is transmitted through the ocular surface and examine the symptoms and signs of ocular disease. Considering that COVID-19 is transmitted by airborne droplets and close contact with infected individuals, we will also review the conditions to which eye clinics and ophthalmologists should pay attention to prevent the transmission of the disease. Although some researchers have argued that COVID-19 transmission cannot occur through the ocular surface, most of them are of the opinion that the ocular surface is a potential pathway of transmission. Until date, ocular signs and symptoms have been rarely reported in the COVID-19 patients. However, there are case reports of conjunctivitis as the first, and rarely, the only clinical symptom of the disease. In addition, low coronavirus RNA positivity can be detected in the ocular surface samples. Further laboratory and clinical investigations are needed to ascertain whether the ocular surface is one of the potential transmission pathways through which severe acute respiratory syndrome-coronavirus 2 can gain entry into the human body. RESUMO Rever se o COVID- 19 é transmitido através da su perfície ocular e seus sintomas e sinais na doença ocular. Dado que o COVID-19 é transmitido por gotículas de ar e contato próximo, também analisaremos, também, as condições às quais os oftalmologistas e as clínicas oftalmológicas devem prestar atenção a fim de evitar a transmissão da doença. Embora alguns autores tenham argumentado que a transmissão de COVID-19 não pode ocorrer através da superfície ocular, a maioria dos autores acredita que a superfície ocular é uma via potencial de transmissão. Até à data, foram notificados, muito raramente, sinais e sintomas oculares em doentes com COVID- 19. No entanto, há relatos de casos de conjuntivite como sendo, raramente, o primeiro e único sintoma clínico da doença. Além disso, a baixa positividade do RNA coronavírus pode ser detectada nas amostras da superfície ocular. São necessárias mais investigações clínicas laboratoriais sobre se a superfície ocular é uma das vias de transmissão através das quais o SARS-COV-2 penetra no corpo humano.

Purpose: To evaluate causes and management of congenital corneal opacities (CCO) diagnosed in a tertiary care eye center and to compare the data with a previous study at the same institution. Methods: Computerized medical records in all patients with congenital corneal opacities diagnosed in the Cornea Service at Wills Eye Hospital (Philadelphia, PA) between January 1, 2007, and December 31, 2015, were retrospectively reviewed. Children aged 12 years and younger at the first visit were included in the study. Patients’ demographics, ocular diagnosis, laterality, associated ocular abnormalities, other ocular surgery performed prior or subsequent to the first visit, and their treatment were extracted from the medical records. Results: A total of 77 eyes in 56 patients were examined. The mean age at presentation was 32.8 ± 44.2 months, with the mean follow-up period of 26.7 ± 30.1 months. The most frequent diagnosis was Peters anomaly (53.2%), followed by limbal dermoid (13.0%), aniridia with glaucoma and microphthalmos (6.5%), sclerocornea and congenital glaucoma (5.2%), idiopathic (3.9%), Axenfeld-Rieger anomaly and Hurler syndrome (2.6%), and microcornea (1.3%). Primary keratoplasty was performed in 26 eyes, with the outcome rate in the clear cornea of 76.0% during the follow-up. Conclusion: Peters anomaly is the most common cause of congenital corneal opacities encountered at our institution. Penetrating keratoplasty is the most frequent choice of corneal surgery to treat congenital corneal opacities. Additional interventions during penetrating keratoplasty were moderately positively correlated with graft failure. This study also shows the rates of some etiologies of that changed over the recent decades in our tertiary care Cornea Service. Although Peters anomaly remains the most common presenting reason for congenital corneal opacities, its rate appears to be increasing over the recent decade. Congenital corneal opacities due to birth trauma, which is one of the preventable causes, were observed in a previous study in our clinic; however, no new cases were noted in this study. RESUMO Objetivo: Avaliar as causas e o controle das opa cidades corneanas congênitas diagnosticadas em um centro oftal mológico de atendimento terciário e comparar os dados com um estudo anterior realizado na mesma instituição. Métodos: Prontuários médicos informatizados de todos os pacientes com opacidade corneana congênita diagnosticada no Serviço de Córnea no Wills Eye Hospital (Filadélfia, PA) entre 1º de ja neiro de 2007 e 31 de dezembro de 2015 foram revisados retrospectivamente. Crianças com 12 anos ou menos na primeira consulta foram incluídas no estudo. A demografia dos pacientes, o diagnóstico ocular, a lateralidade, as anormalidades oculares associadas, outras cirurgias oculares realizadas antes ou após a primeira consulta e o tratamento foram extraídos dos prontuários médicos. Resultados: Um total de 77 olhos de 56 pacientes foi examinado. A idade média de apresentação foi de 32,8 ± 44,2 meses, com um tempo médio de acompanhamento de 26,7 ± 30,1 meses. O diagnóstico mais frequente foi anomalia de Peters (53,2%), seguido por dermóide límbico (13,0%), aniridia com glaucoma e microftalmia (6,5%), esclerocórnea e glaucoma congênito (5,2%), idiopático (3,9%), síndrome de Axenfeld-Rieger e síndrome de Hurler (2,6%) e microcórnea (1,3%). Ceratoplastia primária foi realizada em 26 olhos, com desfecho de córnea clara de 76,0% durante o acompanhamento. Conclusão: A anomalia de Peters é a causa mais comum de opacidade corneana congênita encontrada em nossa instituição. A ceratoplastia penetrante é a escolha mais frequente de cirurgia corneana para o tratamento de opacidades corneanas congênitas. Intervenções adicionais durante a ceratoplastia penetrante foram moderadamente correlacionadas positivamente com a falha do enxerto. Este estudo também mostra as taxas de algumas etiologias do que mudou ao longo faz últimas décadas em nosso serviço de córnea de atendimento terciário. Embora a anomalia de Peters continue a ser a causa mais comum das opacidades congênitas da córnea, sua taxa parece estar aumentando na última década. Opacidades congênitas da córnea devido a trauma no nascimento, que é uma das causas evitáveis, foram observadas em um estudo anterior em nossa clínica; no entanto, nenhum caso novo foi observado neste estudo.

We describe a combined technique of trocar-assisted sutureless scleral-fixated intraocular lens implantation and silicone oil injection at the same session. Two 3 mm scleral tunnels were created 2 mm away from and parallel to the limbus with the 23-gauge vitrectomy trocars entering the sclera transconjunctivally at an angle of approximately 10° at the 3 o’clock and 9 o’clock meridians. After the 3-piece foldable IOL was delivered to the anterior chamber through the corneal incision, the tip of one of the IOL haptics was grasped with a 23-gauge serrated retinal forceps entered through the trocar located at the 3 o’clock meridian. Then the haptic was removed from the scleral tunnel together with the trocar out of the globe. The same procedure was applied to the other haptic. A transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. The ends of the haptics were cauterized to make a flange. The resultant flanges of the haptics were pushed back and fixed into the scleral tunnels. Perfluorooctane was taken out of the eye with vitreoretinal surgery and the silicone was injected into the eye to prevent hypotonia. No complications were seen intraoperatively or postoperatively. After 1-month follow-up period, IOL was seen stabilized., GMS Ophthalmology Cases; 10:Doc03

Objective: To report a new technique for Descemet’s membrane endothelial keratoplasty (DMEK) in aphakic and vitrectomized eyes. Case description: A 56-year-old man presented with corneal decompensation in the left eye after combined pars plana vitrectomy and lensectomy for the management of a traumatic eye injury. DMEK graft and recipient bed were prepared as regular. The posterior half of the donor stroma was dissected with a crescent knife to form a temporary stromal barrier tissue. The prepared donor stromal tissue was implanted into the anterior chamber (AC) to form a barrier over the iris and pupilla. Then, the endothelial graft was safely injected into the anterior chamber and deployed by gently tapping on the corneal surface. Air tamponade was applied into the AC for 10 minutes to allow the graft to attach. Afterwards, the stromal barrier tissue was removed through the main incision and the AC was refilled with air tamponade. There were no intraoperative or postoperative complications during 1-month follow-up. Conclusion: Insertion of a temporary posterior stromal tissue as a barrier over the iris and pupilla successfully provided AC stability and prevented posterior dislocation of the graft or air tamponade. This new technique was a safe and effective approach for DMEK in aphakic and vitrectomized eyes., GMS Ophthalmology Cases; 10:Doc02

Trocar-assisted intraocular lens (IOL) reposition surgery using a scleral fixation method was performed for a patient with a dislocated sulcus IOL. Two 3-mm-long scleral tunnels 2 mm from and parallel to the limbus were formed using a 23-gauge vitrectomy trocar transconjunctivally entering the sclera at an angle of approximately 10°. Haptics were collected using a 23-gauge serrated retinal forceps entering from the trocar cannula and externalized from the scleral tunnels together with the trocar. The same procedure was applied for the other haptic. Both haptics were pushed into the scleral tunnel and a transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. Sutures were removed 1 week later. No complications occurred intraoperatively or postoperatively. At a 10-month follow-up, IOL was stabilized. IOL reposition surgery using the trocar-assisted IOL scleral fixation method is a viable alternative to intrascleral fixation surgery. RESUMO Relatamos uma cirurgia de reposição de lentes intraoculares (LIO) usando o método de fixação escleral de lentes intraoculares usando o trocarte em paciente com lentes intraoculares deslocada no sulco. Nós formamos dois túneis esclerais de 3 mm de comprimento, de 2 mm e paralelos ao limbo, com trocarte de vitrectomia de calibre 23 passando pela esclera transconjonctivalmente em um ângulo de aproximadamente 10 graus. Os hápticos foram capturados por uma pinça dentária dentada de calibre 23 que entrou na cânula do trocarte e os hápticos foram externalizados pelos túneis esclerais, através do trocarte. O mesmo procedimento aplicado para o outro háptico. Ambos os hápticos foram empurrados para o túnel escleral e uma sutura segura transconjuntival é colocada no local de entrada do túnel escleral em torno do háptico com uma sutura de nylon 10-0. As suturas foram removidas uma semana depois. Não foram observadas complicações intraoperatórias ou pós-operatórias. Após o período de seguimento de 10 meses, a lentes intraoculares foi vista estabilizada. A cirurgia de reposição de lentes intraoculares usando o método de fixação escleral de lentes intraoculares assistido com trocarte é uma cirurgia alternativa de fixação intraescleral.

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 o relato de uma paciente com 31 anos de idade, que desenvolveu síndrome tóxica do segmento anterior (TASS) após o procedimento de transplante lamelar anterior profundo (DALK). Ela apresentava ceratocone e, apesar de ter usado lentes de contato rígidas por muitos anos no olho esquerdo, apresentou deterioração da visão nesse olho que foi submetido a procedimento DALK. A acuidade visual (VA) era de conta dedos a três metros. O procedimento DALK de rotina foi realizado utilizando técnica de bolha grande (Big Bubble). A incisão de entrada da córnea foi hidratada ao final da cirurgia que foi terminada com a injeção de ar na câmara anterior. No primeiro dia de pós-operatório a VA era de percepção de movimentos da mão e a córnea estava edemaciada. Dexametasona tópica em alta dose e esteróides orais foram iniciadas ao se considerar o diagnóstico de TASS. Acreditamos que o uso de cânulas reesterilizadas podem ter sido a causa provável da TASS. A VA melhorou e o edema da córnea do diminuiu durante a evolução. Embora o procedimento DALK foi realizado sem interferir com câmara anterior, deve-se ter em mente que TASS pode ocorrer com a solução utilizada para hidratar o local da incisão e o ar injetado na câmara anterior.

A 40-year-old female patient with a 5-year history of systemic lupus erythematosus was referred to our policlinic with complaints of erythema, atrophy, and telangiectasia on the upper eyelids for 8 months. No associated mucocutaneous lesion was present. Biopsy taken by our ophthalmology department revealed discoid lupus erythematosus. Topical tacrolimus was augmented to the systemic therapeutic regimen of the patient, which consisted of continuous antimalarial treatment and intermittent corticosteroid drugs. We observed no remission in spite of the 6-month supervised therapy. Periorbital discoid lupus erythematosus is very unusual and should be considered in the differential diagnosis of erythematous lesions of the periorbital area..

Letter to the editor