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Introduction: The indications for pars plana vitrectomy (PPV) have increased over the years. The vitreous is no longer considered an inert ocular structure and it is well known that its removal has anatomical and physiological consequences. The vitreous is no longer considered an inert ocular structure. The vitreous plays a key role as an intraocular physiologic oxygen regulator. In order to maintain its transparency, the crystalline lens needs protection from an excessive oxygen exposure. PPV leads to progression of nuclear sclerosis in most eyes.Methods: A systematic review of the literature was conducted using Embase and Medline databases. Articles studying the physiology, pathogenesis and surgical treatment of cataract after PPV were included in this review.Results: The pathogenesis of cataract formation after PPV remains unclear. Predisposing factors include advanced patient age, preexisting nuclear sclerosis, light toxicity, intraoperative oxidation of lens proteins, use of silicone oil or intravitreal gas, mechanical trauma and the duration of exposure to an irrigating solution.Conclusion: Cataract surgery in vitrectomized eyes presents with more technical difficulties, is more challenging and often has a higher risk of intraoperative and postoperative complications than in non vitrectomized eyes. There is no standardized technique or management in these cases; therefore, it requires more precautions during surgery.
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Extração de Catarata , Catarata , Catarata/etiologia , Humanos , Estudos Retrospectivos , Óleos de Silicone , Acuidade Visual , VitrectomiaRESUMO
Chagas disease is an inflammatory, infectious disease caused by the parasite Trypanosoma cruzi found in the feces of the triatomine bug, which can cause a sudden, brief acute illness, or it may become a long-lasting chronic condition. Chagas disease is common in South America and Central America, however, the constantly expanding global community has brought Chagas disease to the forefront of non-endemic areas, particularly the United States and Europe. The authors present a case of a 47-year-old healthy farmer diagnosed with a right orbital cellulitis refractory to systemic antibiotics. Based on clinical symptoms, the patient's medical/demographical history and a proper differential diagnosis, an acute phase of Chagas disease was diagnosed. After antiparasitic treatment, the patient had a proper recovery and continued with a regular follow-up to monitor the possible development of a chronic phase.
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Doença de Chagas , Celulite Orbitária , Trypanosoma cruzi , Doença de Chagas/diagnóstico , Doença de Chagas/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Estados UnidosRESUMO
Keratoconus (KC) shows several distinctive features in clinical appearance, disease progression, and treatment in children compared with adults. Therefore, diagnostic, clinical care, and therapeutic approaches are different. However, pediatric keratoconus is often undiagnosed and thus untreated in many cases. Once diagnosis has been made, compliance with treatment recommendations is often poor. Pediatric keratoconus also tends to have more rapid progression than in adults; therefore, early detection and treatment are paramount to prevent serious vision impairment, which can affect the child's development. This review of pediatric keratoconus discusses important issues such as worldwide epidemiology, clinical features in children compared to adults, and challenges in diagnosis and treatment and focuses on the most appropriate management strategies based on the best available current evidence.
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The aim of the study is to evaluate the safety and efficacy of trans-epithelial accelerated corneal cross-linking (TE-ACXL) in children with progressive keratoconus. Retrospective, case-series of 23 eyes of 14 children who underwent TE-ACXL. Evaluations were performed at baseline and 1, 3, 6, 12 and 18mo postoperatively. Mean follow-up time of 23.82±3.15mo and mean age was 13.7±1.4y (range 11 to 16y). Mean preoperative uncorrected distance visual acuity changed from 0.92±0.45 logMAR (20/160) to 0.71±0.40 logMAR (20/100) (P=0.001). Mean keratometry (Km) changed from 53.87± 6.03 to 53.00±5.81 (P=0.001). Pachymetry did not have significant changes at last follow-up (P=0.30). The mean preoperative sphere was -5.58±2.48 and -4.89±4.66 D (P=0.11) at last follow-up; refractive cylinder from -5.58±2.48 to -5.02±2.23 (P=0.046). In conclusion, tomographic and refractive stability are shown in over 91% of eyes with pediatric progressive keratoconus who underwent TE-ACXL.
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PURPOSE: To report a case series of 7 eyes of 6 patients with posterior keratoconus, evaluating corneal Scheimpflug tomographic changes and anterior-segment optical coherence tomography (OCT). METHODS: In our descriptive study, 6 patients were diagnosed with posterior keratoconus: 5 unilateral (7-, 33-, and 42-year-old males and 64- and 60-year-old female) and 1 bilateral (45-year-old female). Patients were diagnosed with slit-lamp examination, which revealed corneal opacity with an underlying posterior corneal depression. Additional analysis with anterior-segment OCT and Scheimpflug tomography evaluation was performed. RESULTS: Localized paracentral posterior keratoconus was diagnosed in 7 eyes. Scheimpflug images demonstrated posterior corneal depression. Clinical findings were examined by OCT. Genetic analysis revealed no alterations or associated syndromes. All patients were amblyopic in the affected eye, and no surgery was offered to improve their visual acuity. CONCLUSIONS: Posterior keratoconus is a rare noninflammatory condition usually present at birth and sometimes related to developmental abnormalities. Posterior keratoconus is usually unilateral and can present as a generalized or localized change in posterior corneal curvature.
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Endotélio Corneano/diagnóstico por imagem , Ceratocone/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adulto , Criança , Topografia da Córnea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Lâmpada de Fenda , Acuidade VisualAssuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias da Túnica Conjuntiva/tratamento farmacológico , Interferon-alfa/administração & dosagem , Estadiamento de Neoplasias , Idoso , Carcinoma de Células Escamosas/diagnóstico , Neoplasias da Túnica Conjuntiva/diagnóstico , Feminino , Seguimentos , Humanos , Fatores Imunológicos/administração & dosagem , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Proteínas Recombinantes/administração & dosagemRESUMO
The global incidence and prevalence of diabetes mellitus (DM) have reached epidemic proportions. Estimates indicate that more than 360 million people will be affected by DM by 2030. All of these individuals will be at risk of developing diabetic retinopathy (DR). It is extremely important to categorize, classify and stage the severity of DR in order to establish adequate therapy. With proper management more than 90% of cases of visual loss can be prevented. The purpose of the current paper is to review the classification of DR with a special emphasis on the International Clinical Disease Severity Scale for DR. This new classification is simple to use, easy to remember and based on scientific evidence. It does not require specialized examinations such as optical coherence tomography or fluorescein angiography. It is based on clinical examination and applying the Early Treatment of Diabetic Retinopathy Study 4:2:1 rule.
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PURPOSE: To compare the short-term visual and anatomic outcomes after intravitreal injections of 2 different tumor necrosis factor-α inhibitors to continued antivascular endothelial growth factor (VEGF) therapy in eyes with choroidal neovascularization (CNV) secondary to age-related macular degeneration that responded suboptimally to anti-VEGF agents. METHODS: Retrospective comparative case series of 26 eyes. Eyes were injected intravitreally with 1 mg infliximab, 2 mg infliximab, 2 mg adalimumab, or 1.25 mg bevacizumab. The main outcomes measured were the best-corrected visual acuity (BCVA) and the central macular thickness (CMT) at 3 months of follow-up. RESULTS: The mean log minimal angle of resolution BCVA changed from 1.04±0.23 at baseline to 1.06±0.51 at 3 months (P=0.9455) in the 1-mg infliximab group; 0.94±0.48 at baseline to 0.85±0.43 in the 2-mg infliximab group (P=0.2802); 1.58±0.50 at baseline to 1.38±0.43 in the adalimumab group (P=0.1116); and 1.08±0.1 at baseline to 1.03±0.16 in the bevacizumab group (P=0.9928). The mean CMT changed from 387±54 µm at baseline to 342±108 µm (P=0.1053) in the 1-mg infliximab group; 301±42 µm at baseline to 284±73 µm (P=0.4854) in the 2-mg infliximab group; remained unchanged at 348±106 µm (P=0.308) in the adalimumab group; and 362±66 µm to 340±27 µm in the bevacizumab group (P=0.4622). Adverse events included uveitis in 37.5% (6/16) of eyes injected with infliximab. CONCLUSION: Intravitreal infliximab and adalimumab do not appear to benefit eyes with CNV that responded suboptimally to anti-VEGF agents. Intravitreal injections of infliximab may elicit a severe intraocular inflammatory reaction.