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Melissa Dal Pizzol,1,2 Eduarda Correa Freitas,2 Claudete Locatelli,2 Felipe Guareze,2 Paula Reginatto,3 Gabriella Machado,3 Alexandre Fuentefria,3 Diane Marinho1,2 1Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 2Ophthalmology Department, Hospital De Clínicas De Porto Alegre, Porto Alegre, Brazil; 3Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilCorrespondence: Melissa Dal PizzolOphthalmology Department, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Zona 17, Porto Alegre, CEP 90035-903, RS, BrazilTel +55 5133598306Email melissadalpizzol@hotmail.comPurpose: The incidence of fungal infection after corneal transplant has increased significantly in recent years, especially Candida spp. This study aimed to evaluate the efficacy and safety of the addition of cycloheximide in Optisol-GS media in decreasing the growth of Candida spp. strains.Methods: This in vitro laboratory efficacy study measured fungal colony growth in 24 vials of Optisol-GS that were divided into 6 groups of 4 vials each, as follows: (1) MIC/2 cycloheximide, (2) MIC cycloheximide, (3) MICx5 cycloheximide, (4) MICx10 cycloheximide, from MIC values obtained for each strain, (5) unsupplemented optisol-GS as a positive control (added inoculum), and (6) unsupplemented optisol-GS as a negative control (no inoculum). In each group was added Candida albicans, C. glabrata and C. parapsilosis, except in the negative control. The evaluated variables were fungal colony growth from the Optisol-GS vials, corneal endothelial cell density and endothelial cell viability at different concentrations of cycloheximide.Results: In the efficacy study, all strains showed a reduction in fungal cell growth from the second day at all evaluated concentrations of optisol-GS supplemented with cycloheximide, even at subinhibitory concentrations (MIC/2). For C. glabrata, the colony count was reduced to 99%. No evidence of corneal endothelial toxicity was found at any concentration, in the safety study, compared with the paired control.Conclusion: The addition of cycloheximide to optisol-GS decreased the fungal growth, demonstrating fungicide action against C. glabrata and fungistatic action against C. albicans and C.parapsilosis. This drug did not demonstrate toxicity to the corneal endothelium at different concentrations.Keywords: cornea, eye banking, infection, pharmacology

A síndrome KID é uma displasia ectodérmica congênita rara, caracterizada pela associação de lesões hiperceratóticas de pele, surdez neurossensorial e ceratite. O comprometimento ocular ocorre em 95% dos portadores da síndrome. Embora as manifestações dermatológicas tenham sido bastante estudadas, sabe-se pouco sobre o manejo e o prognóstico do acometimento oftalmológico. Até o momento, o tratamento ocular da síndrome KID inclui tratamento sintomático, não havendo na literatura drogas ou tratamento cirúrgico que possam modificar o curso e prognóstico da doença. Neste relato de caso, descrevemos os achados oftalmológicos de um portador de síndrome KID e o uso de bevacizumab (Avastin®) subconjuntival como sugestão para o tratamento da neovascularização corneana. Apesar da ausência de melhora e da raridade da doença, os autores acreditam que a utilização do bevacizumab subconjuntival possa ser útil para o tratamento da neovascularização corneana que se estabelece na síndrome KID e incentivam os pesquisadores a se aprofundar neste tema.KID syndrome is a congenital ectodermal dysplasia characterized by the association of keratitis, hyperkeratotic skin lesions and neurosensorial hearing loss. Ocular involvement occurs in 95% of patients. Although KID syndrome cutaneous manifestations have been studied in-depth, the treatment and prognosis of ophthalmic impairment have not been described in detail. At present, the treatment of the ocular damage caused by the syndrome is symptomatic and there are no studies defining a treatment that could change the disease course. In this case, ophthalmologic findings of a patient with KID syndrome and the use of subconjunctival bevacizumab to treat corneal neovascularization are described. In spite of the absence of improvement in this patient and the few reports of this disease, aditional studies with bevacizumab to treat corneal deep neovascularization are suggested.

The identification of some important retinal anatomical regions is a prerequisite for the computer aided diagnosis of several retinal diseases. In this paper, we propose a new adaptive method for the automatic segmentation of the optic disk in digital color fundus images, using mathematical morphology. The proposed method has been designed to be robust under varying illumination and image acquisition conditions, common in eye fundus imaging. Our experimental results based on two publicly available eye fundus image databases are encouraging, and indicate that our approach potentially can achieve a better performance than other known methods proposed in the literature. Using the DRIVE database (which consists of 40 retinal images), our method achieves a success rate of 100% in the correct location of the optic disk, with 41.47% of mean overlap. In the DIARETDB1 database (which consists of 89 retinal images), the optic disk is correctly located in 97.75% of the images, with a mean overlap of 43.65%.

OBJETIVO: Avaliar as diferentes técnicas cirúrgicas oftalmológicas nas quais se pode utilizar a cola biológica e possíveis complicações relacionadas ao seu uso. MÉTODOS: Estudo de série de casos retrospectivo, não-comparativo. Foram avaliados 161 olhos de pacientes com idade média de 51,8 anos em que foi utilizada cola biológica (Beriplast P® - Aventis Behring, Alemanha) para fixação de tecido ou fechamento incisional. RESULTADOS: Foram avaliados 76 pacientes com pterígio, 4 com ceratoconjuntivite límbica superior, 4 com tumor limbar, 21 com conjuntivocálase, 31 com ceratopatia bolhosa, 7 com deficiência límbica, 6 com queimadura alcalina, 2 com Stevens-Johnson, 5 com catarata e 5 com glaucoma. Complicações foram relatas em 28 casos (17,4%). Descolamento do tecido fixado e granuloma foram as complicações mais frequentes. Descolamento ocorreu em 10 casos (5,6%) (7 em transplante de membrana amniótica em ceratopatia bolhosa, 2 em transplante de conjuntiva autólogo após exérese de pterígio, 1 após transplante de limbo autólogo por Stevens-Johnson). Granuloma ocorreu em 9 casos (5,6%) (5 em pacientes com queimadura alcalina aguda tratados com transplante de membrana amniótica, 1 em paciente com sequela de queimadura tratado com transplante de limbo autólogo e 3 em pacientes após exérese de pterígio tratados com transplante de conjuntiva autólogo). Todas as complicações ocorreram dentro da primeira semana de pós-operatório. CONCLUSÃO: Embora o presente seja retrospectivo e não-comparativo, podemos observar que a utilização do adesivo de fibrina parece ser segura e efetiva, além de apresentar baixas taxas de complicações nas cirurgias de superfície ocular e de segmento anterior.PURPOSE: To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries. METHODS: A retrospective and non-comparative case series study. 161 eyes were evaluated. The mean age was 51.8 years. Fibrin glue (BeriplastTM - Aventis Behring, Germany) was used in all patients for tissue adherence or incisional closure. RESULTS: 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 autologus conjunctival grafting for pterygium surgery, 1 in autologus 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 autologus limbal graft due to chronic burn injury, and 3 in autologus conjunctival transplant due to pterygium surgery). All the complications described occurred in the first week after surgery. CONCLUSION: 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.

Aims To evaluate the prevalence of cataract and the possible factors associated with cataract in young type 1 diabetes mellitus (DM). Methods 293 patients were evaluated. The association of cataract with diabetic retinopathy (DR), retinal laser treatment, hypertension, body mass index, peripheral neuropathy, lipid profile, glycemic control, serum creatinine and albuminuria was evaluated. Results Cataract was present in 19.8% ( n =58) of the sample. Patients with cataracts were older, had a higher frequency of history of retina photocoagulation treatment, higher serum creatinine values and higher prevalence of arterial hypertension. There was a progressive increase in cataract frequency according to the number of risk factors, starting to rise with two or more. In logistic regression model cataract was associated with mild/moderate DR (odd ratio (OR) 4.28 95% CI 1.63–11.29), severe DR (OR 4.07 95% CI 1.63–10.23) and macroalbuminuria (OR 2.34 95% CI 1.06–5.16). Conclusion These data indicate a high prevalence of cataract in subjects with type 1 DM attending a general hospital in Southern Brazil and suggest that the more severe the disease process the greater is the risk of having this diabetic complication. Cataract should be suspected in young patients with two or more risk factors.

Objetivo: Avaliar a prevalência de catarata e seus fatores de risco em uma população portadora de diabetes mellitus tipo 1 (DM1). Métodos: Estudo de casos e controles de um banco de dados de 181 pacientes (362 olhos) com diagnóstico de diabetes mellitus tipo 1. Os pacientes foram classificados como casos quando apresentavam diagnóstico de catarata. As variáveis estudadas foram a presença ou não de retinopatia diabética, tratamento com panfotocoagulação, presença de hipertensão arterial sistêmica e neuropatia periférica, colesterol total, triglicerídios séricos, HDL, LDL, índice de massa corporal, creatinina sérica, albuminúria, hemoglobina glicosilada e glicemia de jejum. Resultados: A prevalência de catarata foi de 19,9%. Na análise univariada foi encontrada associação estatisticamente significativa (p

OBJETIVO: Relatar a evolução de 9 olhos (8 pacientes) submetidos ao implante da ceratoprótese de Dohlman-Doane tipo 1, com tempo médio de seguimento de 11,2 meses (2 a 25 meses). MÉTODOS: Trabalho retrospectivo, não comparativo, intervencionista de uma série de casos. Quanto à doença de base, em 4 olhos foram queimadura alcalina, 3 falência de múltiplos transplantes de córnea, 1 síndrome de Stevens-Johnson e 1 queimadura térmica. A acuidade visual pré-operatória era de movimento de mãos ou pior em todos os olhos. Três olhos apresentavam glaucoma pré-operatório, sendo submetidos a implante valvulado de Ahmed. RESULTADOS: A acuidade visual com correção pós-operatória foi melhor ou igual a 20/100 em 88,9% dos olhos e melhor ou igual a 20/40 em 44,4% dos olhos. Como intercorrências pós-operatórias, 3 olhos apresentaram opacidade de cápsula posterior tratada com capsulotomia com YAG laser; 3 olhos membrana retroprotética de fibrina tratada com injeção tPA ou corticoterapia; 2 olhos glaucoma tratado com medicação; 1 olho "melting" corneano tratado com a troca do botão e 1 olho endoftalmite fúngica tratada com transplante a quente, vitrectomia anterior, explante da ceratoprótese e da LIO e tratamento antifúngico. CONCLUSÃO: A ceratoprótese de Dohlman-Doane é uma boa opção para casos graves de cegueira corneana, em que o transplante penetrante de córnea não apresenta bom prognóstico. Sua principal vantagem é não necessitar imunossupressão sistêmica. Casos de queimadura alcalina e de alta chance de rejeição apresentaram os melhores resultados.PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Sulfametoxazol e trimetoprima (cotrimoxazol) é uma combinação de drogas amplamente usada no tratamento e profilaxia de inúmeras infecções sistêmicas. Esta droga e outras derivadas da sulfa podem causar uma síndrome ocular rara caracterizada por efusão coroidal supracililar com miopização transitória e glaucoma por fechamento angular. A maioria dos autores atribui o glaucoma ao edema do corpo ciliar que leva ao deslocamento anterior do diafragma irido-cristaliniano causando fechamento do ângulo camerular. Este trabalho descreve um caso raro no qual a síndrome ocorreu após o uso desta combinação de drogas e evoluiu para um desfecho desfavorável. Paciente de 49 anos, sexo masculino, branco com diagnóstico de síndrome da imunodeficiência adquirida iniciou tratamento profilático para Pneumocystis carinii com cotrimoxazol. Quatro dias após, apresentou quadro de dor ocular, hiperemia e quemose conjuntival, glaucoma agudo por fechamento angular com pressões intra-oculares maiores que 50 mmHg e efusão coroidal 360º, com os achados presentes nos dois olhos. Nesse mesmo dia, a medicação foi suspensa com diminuição da pressão intra-ocular após quatro dias. O paciente evoluiu com catarata total e phthisis bulbi bilateral nos dois meses subseqüentes. Os casos já descritos mencionam a melhora clínica completa do quadro ocular após a suspensão da medicação. Este seria o primeiro caso na literatura no qual a evolução foi desfavorável apesar do diagnóstico e da suspensão precoce da medicação causadora.

Sulfametoxazol e trimetoprima (cotrimoxazol) é uma combinação de drogas amplamente usada no tratamento e profilaxia de inúmeras infecções sistêmicas. Esta droga e outras derivadas da sulfa podem causar uma síndrome ocular rara caracterizada por efusão coroidal supracililar com miopização transitória e glaucoma por fechamento angular. A maioria dos autores atribui o glaucoma ao edema do corpo ciliar que leva ao deslocamento anterior do diafragma irido-cristaliniano causando fechamento do ângulo camerular. Este trabalho descreve um caso raro no qual a síndrome ocorreu após o uso desta combinação de drogas e evoluiu para um desfecho desfavorável. Paciente de 49 anos, sexo masculino, branco com diagnóstico de síndrome da imunodeficiência adquirida iniciou tratamento profilático para Pneumocystis carinii com cotrimoxazol. Quatro dias após, apresentou quadro de dor ocular, hiperemia e quemose conjuntival, glaucoma agudo por fechamento angular com pressões intra-oculares maiores que 50 mmHg e efusão coroidal 360º, com os achados presentes nos dois olhos. Nesse mesmo dia, a medicação foi suspensa com diminuição da pressão intra-ocular após quatro dias. O paciente evoluiu com catarata total e phthisis bulbi bilateral nos dois meses subseqüentes. Os casos já descritos mencionam a melhora clínica completa do quadro ocular após a suspensão da medicação. Este seria o primeiro caso na literatura no qual a evolução foi desfavorável apesar do diagnóstico e da suspensão precoce da medicação causadora.Sulfamethoxazole-trimethoprim (cotrimoxazole) is an antibiotic combination widely used for infections treatment and prophylaxis. These and others sulfonamides have been implicated in a rare syndrome of choroidal effusion with transient myopia and angle-closure glaucoma. Previous cases reported in literature evolved to complete resolution after drug withdrawal. In contrast, we describe a rare case in which a patient developed the syndrome while taking cotrimoxazole, but did not recover visual acuity. A 49-year-old man started Pneumocystis carini prophylaxis with cotrimoxazole; four days later, the patient presented severe ocular pain, hyperemia and chemosis. Intraocular pressure reached more than 50 mmHg in both eyes a 360° choroidal effusion occurred. Medication was removed soon after the diagnosis was suspected and intraocular pressure decreased in four days. Even so total cataract and phthisis bulbi occurred in both eyes two months later. This would be the first case in the literature in which the outcome was unfavorable despite early diagnosis and withdrawal of the drug.

Current computer-aided diagnosis (CAD) systems tend to neglect the detection and grading of Diabetic Macular Edema (DME) signs. This chapter introduces a new computer based scheme for detecting and grading DME signs using color eye fundus images. The grading scheme integrates methods for: (a) detecting retinal structures (e.g. optic disk and fovea); (b) detecting lesions in the retina (e.g. exudates); (c) analyzing the spatial distribution of DME signs in the retina; and (d) grading the severity of a DME case as absent, mild, moderate or severe. In a preliminary experimental evaluation of our DME grading scheme using publicly available eye fundus images (i.e., DIARETDB1 image database), an accuracy of 94.29 % was obtained with respect to the mode of the evaluations of the same DME cases by four experts. This is encouraging, since a similar DME grading performance is achieved by a DME expert. In order to calculate the clinicians grading performance, we assumed the mode of all experts DME gradings as the reference evaluation for each case. Thus, if an expert assigned each DME case to the class identified as the mode of the experts severity gradings, that expert achieved an accuracy of 100 %.

Purpose. A case of Phialemonium curvatum wound corneal infection after phacoemulsification is reported. Methods. Case report. Results. The marked aggressiveness of this fungus is demonstrated by the absence of therapeutic response to both medical and surgical treatment. Conclusions. The poor outcome resulted in evisceration of the affected eye.

A sindrome KID e uma displasia ectodermica congenita rara, caracterizada pela associacao de lesoes hiperceratoticas de pele, surdez neurossensorial e ceratite. O comprometimento ocular ocorre em 95% dos portadores da sindrome. Embora as manifestacoes dermatologicas tenham sido bastante estudadas, sabe-se pouco sobre o manejo e o prognostico do acometimento oftalmologico. Ate o momento, o tratamento ocular da sindrome KID inclui tratamento sintomatico, nao havendo na literatura drogas ou tratamento cirurgico que possam modificar o curso e prognostico da doenca. Neste relato de caso, descrevemos os achados oftalmologicos de um portador de sindrome KID e o uso de bevacizumab (Avastin®) subconjuntival como sugestao para o tratamento da neovascularizacao corneana. Apesar da ausencia de melhora e da raridade da doenca, os autores acreditam que a utilizacao do bevacizumab subconjuntival possa ser util para o tratamento da neovascularizacao corneana que se estabelece na sindrome KID e incentivam os pesquisadores a se aprofundar neste tema.

KID syndrome is a congenital ectodermal dysplasia characterized by the association of keratitis, hyperkeratotic skin lesions and neurosensorial hearing loss. Ocular involvement occurs in 95% of patients. Although KID syndrome cutaneous manifestations have been studied in-depth, the treatment and prognosis of ophthalmic impairment have not been described in detail. At present, the treatment of the ocular damage caused by the syndrome is symptomatic and there are no studies defining a treatment that could change the disease course. In this case, ophthalmologic findings of a patient with KID syndrome and the use of subconjunctival bevacizumab to treat corneal neovascularization are described. In spite of the absence of improvement in this patient and the few reports of this disease, additional studies with bevacizumab to treat corneal deep neovascularization are suggested.

Objetivo: Avaliar as diferentes técnicas cirúrgicas oftalmológicas nas quais se pode utilizar a cola biológica e possíveis complicações relacionadas ao seu uso. Métodos: Estudo de série de casos retrospectivo, não-comparativo. Foram avaliados 161 olhos de pacientes com idade média de 51,8 anos em que foi utilizada cola biológica (Beriplast P® - Aventis Behring, Alemanha) para fixação de tecido ou fechamento incisional. Resultados: Foram avaliados 76 pacientes com pterígio, 4 com ceratoconjuntivite límbica superior, 4 com tumor limbar, 21 com conjuntivocálase, 31 com ceratopatia bolhosa, 7 com deficiência límbica, 6 com queimadura alcalina, 2 com Stevens-Johnson, 5 com catarata e 5 com glaucoma. Complicações foram relatas em 28 casos (17,4%). Descolamento do tecido fixado e granuloma foram as complicações mais frequentes. Descolamento ocorreu em 10 casos (5,6%) (7 em transplante de membrana amniótica em ceratopatia bolhosa, 2 em transplante de conjuntiva autólogo após exérese de pterígio, 1 após transplante de limbo autólogo por Stevens-Johnson). Granuloma ocorreu em 9 casos (5,6%) (5 em pacientes com queimadura alcalina aguda tratados com transplante de membrana amniótica, 1 em paciente com sequela de queimadura tratado com transplante de limbo autólogo e 3 em pacientes após exérese de pterígio tratados com transplante de conjuntiva autólogo). Todas as complicações ocorreram dentro da primeira semana de pós-operatório. Conclusão: Embora o presente seja retrospectivo e não-comparativo, podemos observar que a utilização do adesivo de fibrina parece ser segura e efetiva, além de apresentar baixas taxas de complicações nas cirurgias de superfície ocular e de segmento anterior. Purpose: To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries. Methods: 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. Results: 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 autologus conjunctival grafting for pterygium surgery, 1 in autologus 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 autologus limbal graft due to chronic burn injury, and 3 in autologus conjunctival transplant due to pterygium surgery). All the complications described occurred in the first week after surgery. Conclusion: 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 pre- senting low rates of complications in ocular surface and anterior segment surgeries.

Objetivo: Relatar a evolução de 9 olhos (8 pacientes) submetidos ao implante da ceratoprótese de Dohlman-Doane tipo 1, com tempo médio de seguimento de 11,2 meses (2 a 25 meses). Métodos: Trabalho retrospectivo, não comparativo, intervencionista de uma série de casos. Quanto à doença de base, em 4 olhos foram queimadura alcalina, 3 falência de múltiplos transplantes de córnea, 1 síndrome de Stevens-Johnson e 1 queimadura térmica. A acuidade visual pré-operatória era de movimento de mãos ou pior em todos os olhos. Três olhos apresentavam glaucoma pré-operatório, sendo submetidos a implante valvulado de Ahmed. Resultados: A acuidade visual com correção pós-operatória foi melhor ou igual a 20/100 em 88,9% dos olhos e melhor ou igual a 20/40 em 44,4% dos olhos. Como intercorrências pós-operatórias, 3 olhos apresentaram opacidade de cápsula posterior tratada com capsulotomia com YAG laser; 3 olhos membrana retroprotética de fibrina tratada com injeção tPA ou corticoterapia; 2 olhos glaucoma tratado com medicação; 1 olho “melting” corneano tratado com a troca do botão e 1 olho endoftalmite fúngica tratada com transplante a quente, vitrectomia anterior, explante da ceratoprótese e da LIO e tratamento antifúngico. Conclusão: A ceratoprótese de Dohlman-Doane é uma boa opção para casos graves de cegueira corneana, em que o transplante penetrante de córnea não apresenta bom prognóstico. Sua principal vantagem é não necessitar imunossupressão sistêmica. Casos de queimadura alcalina e de alta chance de rejeição apresentaram os melhores resultados. Purpose: 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). Methods: A retrospective, noncomparative 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. Results: 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. Conclusion: 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.

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.

To evaluate the prevalence of cataract and associated risk factors in a diabetic type 1 population.181 patients (362 eyes) were evaluated in a case-control study. Cases were classified when cataract was present at the time of the examination. The studied outcomes were the presence of diabetic retinopathy, retinal panphotocoagulation, high blood pressure, peripheral neuropathy, total cholesterol levels, triglyceride levels, HDL, LDL, body mass index, creatinine levels, albuminuria, glycosylated hemoglobin and glycemia levels.Cataract was present in 19.9% of the studied patients. The association of the presence of cataract and diabetic retinopathy, peripheral neuropathy, elevated levels of creatinine, panphotocoagulation and high blood pressure were statistically significant (univariate analysis). After the logistic regression analysis the presence of cataract was significantly associated with the presence of diabetic retinopathy.The prevalence of cataract was 19.9% and the presence and severity of the diabetic retinopathy were the main risk factors for its development.

Sulfamethoxazole-trimethoprim (cotrimoxazole) is an antibiotic combination widely used for infections treatment and prophylaxis. These and others sulfonamides have been implicated in a rare syndrome of choroidal effusion with transient myopia and angle-closure glaucoma. Previous cases reported in literature evolved to complete resolution after drug withdrawal. In contrast, we describe a rare case in which a patient developed the syndrome while taking cotrimoxazole, but did not recover visual acuity. A 49-year-old man started Pneumocystis carini prophylaxis with cotrimoxazole; four days later, the patient presented severe ocular pain, hyperemia and chemosis. Intraocular pressure reached more than 50 mmHg in both eyes a 360 degrees choroidal effusion occurred. Medication was removed soon after the diagnosis was suspected and intraocular pressure decreased in four days. Even so total cataract and phthisis bulbi occurred in both eyes two months later. This would be the first case in the literature in which the outcome was unfavorable despite early diagnosis and withdrawal of the drug.

OBJETIVO: Quantificar a experiência clínica do Serviço de Cirurgia Geral do Complexo Hospitalar da Santa Casa de Porto Alegre, criando um diagnóstico epidemiológico de demanda e traçando um perfil do paciente de risco de evisceração, através da análise do manejo e conduta mais adequados. MÉTODO: No período de 2000 a 2001, foram estudados prospectivamente 1182 pacientes submetidos a laparotomias, dos quais 13 evoluiram com evisceração. RESULTADOS: Dos 13 pacientes eviscerados, 69,2% eram homens, com idade média de 55,9 anos. A neoplasia foi a patologia de base mais prevalente (61,5%), e o tempo médio de evisceração foi de 12,1 dias. A albumina sérica média encontrada foi de 2,8 g/dl e a sutura contínua a técnica de fechamento mais utilizada no Serviço. CONCLUSÃO: O perfil do paciente eviscerado nesta série,inclui homens com mais de 50 anos e obesos, com doença maligna e hipoalbuminemia. Esses pacientes têm maior probabilidade de desenvolver complicações locais, tais como infecção e aumento da pressão intra-abdominal, contribuindo para a deiscência total da parede abdominal. A análise destes fatores deve ser imperiosa na decisão de ancoragem primária dessa população. BACKGROUND: To quantify the clinical experience and epidemiological diagnosis of eviscerations, creating a profile of risk factors. METHODS: During the years 2000 to 2001, 1182 patients were studied, including 13 with eviscerations, followed prospectively by research protocol. RESULTS: Of 13 cases of evisceration, 69,2% were men, with mean age of 55,9 years. Neoplasic disease was the most frequent base disease (61,5%) and the mean time of evisceration was 12,1days. The mean albumin serum level found was 2.8g/dl and continuous suture was the most frequent abdominal wall closure technique. CONCLUSION: The profile of patient for evisceration include men, obeses, older than 50 years with malignant disease and hipoalbuminemia. These patient have high risk to develop local complications such as infection and elevation of intra-abdominal pressure, and, abdominal wall dehiscence. The analisis of risks factors must be mandatory in decision of primary ancorage of this population.