Assuntos
Sensibilidades de Contraste , Edema da Córnea , Distrofia Endotelial de Fuchs , Humanos , Distrofia Endotelial de Fuchs/fisiopatologia , Distrofia Endotelial de Fuchs/diagnóstico , Edema da Córnea/diagnóstico , Edema da Córnea/fisiopatologia , Sensibilidades de Contraste/fisiologia , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To assess the outcomes of deep anterior lamellar keratoplasty or penetrating keratoplasty at the scar and the edema stages. METHODS: Forty-five patients (45 eyes) with keratoconus scar stage (scar group, n=26; penetrating keratoplasty a subgroup, n=7; deep anterior lamellar keratoplasty b subgroup, n=19) and keratoconus edema stage (edema group, n=19; penetrating keratoplasty c subgroup, n=12; deep anterior lamellar keratoplasty d group, n=7) who received penetrating keratoplasty or deep anterior lamellar keratoplasty from 2000 to 2022 were retrospectively studied. At 1, 6, and 12 months after surgery, the best-corrected visual acuity, astigmatism, spherical equivalent, corneal endothelial cell density, and complications were analyzed. RESULTS: The best-corrected visual acuity and average corneal endothelial cell loss rate were not significantly different between the scar and edema groups (p>0.05). At 6 and 12 months after surgery, the astigmatism and spherical equivalent in the scar group were significantly lower than those in the edema group (p<0.05). The spherical equivalent of the deep anterior lamellar keratoplasty b subgroup was lower than that of the penetrating keratoplasty a subgroup in the scar group 6 months after surgery (p<0.05). In the edema group, there was no significant difference in spherical equivalent between subgroups (p>0.05). There were no significant differences in best-corrected visual acuity and astigmatism between subgroups within the two groups (p>0.05). In comparison to the scar group, the edema group experienced more complications. According to a survival analysis, there was no statistically significant difference between the scar group and the edema group regarding the progression of vision. CONCLUSIONS: In terms of the outcomes and prognosis for vision after keratoplasty with edema stage and scar stage, deep anterior lamellar keratoplasty may be as effective as penetrating keratoplasty.
Assuntos
Cicatriz , Edema da Córnea , Ceratocone , Ceratoplastia Penetrante , Acuidade Visual , Humanos , Ceratocone/cirurgia , Ceratocone/complicações , Ceratocone/fisiopatologia , Masculino , Feminino , Estudos Retrospectivos , Ceratoplastia Penetrante/métodos , Adulto , Cicatriz/etiologia , Resultado do Tratamento , Edema da Córnea/cirurgia , Edema da Córnea/etiologia , Adulto Jovem , Transplante de Córnea/métodos , Fatores de Tempo , Adolescente , Astigmatismo/cirurgia , Astigmatismo/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Contagem de Células , Endotélio Corneano/patologia , Endotélio Corneano/cirurgiaRESUMO
The cornea is a fundamental ocular tissue for the sense of sight. Thanks to it, the refraction of two-thirds of light manages to participate in the visual process and protect against mechanical damage. Because it is transparent, avascular, and innervated, the cornea comprises five main layers: Epithelium, Bowman's layer, stroma, Descemet's membrane, and endothelium. Each layer plays a key role in the functionality and maintenance of ocular tissue, providing unique ultrastructural and biomechanical properties. Bullous Keratopathy (BK) is an endothelial dysfunction that leads to corneal edema, loss of visual acuity, epithelial blisters, and severe pain, among other symptoms. The corneal layers are subject to changes in their biophysical properties promoted by Keratopathy. In this context, the Atomic Force Microscopy (AFM) technique in air was used to investigate the anterior epithelial surface and the posterior endothelial surface, healthy and with BK, using a triangular silicone tip with a nominal spring constant of 0.4 N/m. Six human corneas (n = 6) samples were used for each analyzed group. Roughness data, calculated by third-order polynomial adjustment, adhesion, and Young's modulus, were obtained to serve as a comparison and identification of morphological and biomechanical changes possibly associated with the pathology, such as craters and in the epithelial layer and exposure of a fibrotic layer due to loss of the endothelial cell wall. Endothelial cell membrane area and volume data were calculated, obtaining a relevant comparison between the control and patient. Such results may provide new data on the physical properties of the ocular tissue to understand the physiology of the cornea when it has pathology.
Assuntos
Doenças da Córnea , Edema da Córnea , Humanos , Endotélio Corneano/metabolismo , Lâmina Limitante Posterior/metabolismo , Edema da Córnea/metabolismo , Córnea/patologia , Doenças da Córnea/patologiaRESUMO
RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.
ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Venenos de Abelha/efeitos adversos , Edema da Córnea/etiologia , Corpos Estranhos no Olho/complicações , Lesões da Córnea/etiologia , Mordeduras e Picadas de Insetos/complicações , Procedimentos Cirúrgicos Oftalmológicos/métodos , Edema da Córnea/diagnóstico , Edema da Córnea/fisiopatologia , Iridociclite , Corpos Estranhos no Olho/cirurgia , Corpos Estranhos no Olho/diagnóstico , Lesões da Córnea/cirurgia , Lesões da Córnea/diagnóstico , Microscopia com Lâmpada de Fenda , Gonioscopia , Mordeduras e Picadas de Insetos/cirurgia , Mordeduras e Picadas de Insetos/diagnósticoRESUMO
Objetivo: Caracterizar resultados visuales del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos. Métodos: Se realizó un estudio preexperimental, prospectivo, longitudinal con 17 niños, con seguimiento de un año. Se les realizó examen oftalmológico completo y se evaluaron variables como edad, sexo, lateralidad, mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, y complicaciones. Resultados: La edad promedio fue de 13,2 años, masculinos fueron el 64,7 por ciento. La mejor agudeza visual sin corrección en el preoperatorio fue del 47,1 por ciento <0,1 y con corrección de 0,7, al año del posoperatorio fue de 0,43/0,78, respectivamente. La presión intraocular preoperatoria fue de 14,1 mm Hg, y al año 14,71 mm Hg. La densidad celular en el preoperatorio fue de 2559.76 células/mm2 y al año de 2475,88 células/mm2. La hexagonalidad preoperatorio fue del 53,12 por ciento y al año del 56,94 por ciento. El cilindro preoperatorio -1,35 D y el 23,5 por ciento presentó astigmatismo inducido al año del posoperatorio. Conclusiones: La aplicación del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos logra mejorar su agudeza visual y la complicación más frecuente fue el edema corneal(AU)
Objective: To characterize visual outcomes of iris-sutured posterior chamber foldable intraocular lens implantation in traumatic aphakia in pediatric patients. Methods: A pre-experimental, prospective, longitudinal, pre-experimental study was performed with 17 children, with a one-year follow-up. A complete ophthalmologic examination was performed and variables such as age, sex, laterality, best visual acuity without correction, with correction, refractive results, intraocular pressure and complications were evaluated. Results: The average age was 13.2 years, 64.7 percent were male. The best visual acuity without correction preoperatively was 47.1 percent <0.1 and with correction 0.7, one year postoperative visual acuity was 0.43/0.78, respectively. Preoperative intraocular pressure was 14.1 mm Hg, and at one year 14.71 mm Hg. Cell density preoperatively was 2559.76 cells/mm2 and at one year 2475.88 cells/mm2. The preoperative hexagonality was 53.12 percent and at one year 56.94 percent. Preoperative cylinder -1.35 D and 23.5 percent presented induced astigmatism at one year postoperatively. Conclusions: The application of posterior chamber foldable intraocular lens implant sutured to the iris in traumatic aphakia in pediatric patients achieves improved visual acuity and the most frequent complication was corneal edema(AU)
Assuntos
Humanos , Masculino , Criança , Afacia , Edema da Córnea/complicações , Estudos Prospectivos , Estudos LongitudinaisRESUMO
Se presenta un paciente masculino de 60 años de edad, con antecedentes de padecer diabetes mellitus tipo II complicada con retinopatía diabética, así como glaucoma neovascular de tórpida evolución en el ojo izquierdo. Acude a consulta de glaucoma en el Centro Oftalmológico del Hospital Universitario Clínico- Quirúrgico «Arnaldo Milián Castro» de Villa Clara por presentar visión borrosa y molestias oculares en su ojo derecho. Al examen oftalmológico de dicho ojo se observa: disminución de la visión, sangramiento activo proveniente de vaso iridiano, edema corneal, rubeosis iridiana, hipertensión ocular y al fondo de ojo retinopatía diabética; se realizan complementarios hemáticos que muestran cifras de glicemia elevada (20 mmol/l). Se plantea el diagnóstico de glaucoma neovascular del ojo derecho en el curso de una diabetes mellitus tipo II descompensada. Se le indica tratamiento médico - quirúrgico y se logra una evolución favorable.
We present a 60-year-old male patient with a history of type II diabetes mellitus complicated by diabetic retinopathy, as well as neovascular glaucoma of torpid evolution in his left eye. He came to the glaucoma consultation in the Ophthalmological Center at "Arnaldo Milián Castro" Clinical and Surgical University Hospital in Villa Clara due to blurred vision and ocular discomfort in his right eye. Decreased vision, active bleeding from the iris vessel, corneal edema, iris rubeosis, ocular hypertension was observed in such eye at ophthalmological examination and diabetic retinopathy at eye fundus; blood tests were performed showing elevated glycemia figures (20 mmol /l). The diagnosis of neovascular glaucoma of the right eye is stated in the course of a decompensated type II diabetes mellitus. Medical and surgical treatment is indicated and a favourable evolution is achieved.
Assuntos
Edema da Córnea , Glaucoma Neovascular , Diabetes Mellitus Tipo 2 , Retinopatia DiabéticaRESUMO
PURPOSE: The aim of this study was to define risks for corneal transplantation associated with fibrous ingrowth among first-time transplant recipients. METHODS: We performed a retrospective case-control study of patients with a histopathologic diagnosis of fibrous ingrowth between 2002 and 2019. Patients with fibrous ingrowth from a first corneal specimen were included. Those with incomplete records were excluded. A 1:2 case-control ratio was used. Controls were matched using surgical indication, surgery year, transplantation method, sex, and age. RESULTS: Seventy-eight eyes (76 patients) were included and matched with 160 control eyes. The incidence of fibrous ingrowth found on a first corneal transplant was 0.6% per year. The most common keratoplasty indications were pseudophakic corneal edema (n = 25, 32%) and aphakic corneal edema (n = 15, 19%). Cases were more likely to have a history of ocular trauma (odds ratio [OR], 2.94; 95% CI, 1.30-6.30; P = 0.007), uveitis (OR, 2.73; 95% CI, 1.12-6.63; P = 0.022), retinal detachment or previous retinal surgery (OR, 2.40; 95% CI, 1.34-4.30; P = 0.003), glaucoma tube-shunt surgery (OR, 2.70; 95% CI, 1.29-5.65; P = 0.007), aphakia (OR, 3.02; 95% CI, 1.61-5.67; P = 0.0004), or iris derangement (OR, 10.52; 95% CI, 5.45-20.30; P <0.0001). A multivariate logistic regression model using iris derangement, history of ocular trauma, history of uveitis, and history of cataract surgery demonstrated 81% sensitivity and 66% specificity in predicting presence of fibrous ingrowth. CONCLUSIONS: A history of ocular trauma, uveitis, retinal detachment or previous retinal surgery, glaucoma tube-shunt surgery, aphakia, and iris derangement are risks for detecting fibrous ingrowth among first-time keratoplasty recipients. Patients with these conditions should be monitored closely for corneal decompensation.
Assuntos
Afacia , Edema da Córnea , Transplante de Córnea , Traumatismos Oculares , Glaucoma , Descolamento Retiniano , Uveíte , Humanos , Edema da Córnea/cirurgia , Estudos Retrospectivos , Descolamento Retiniano/cirurgia , Estudos de Casos e Controles , Transplante de Córnea/efeitos adversos , Traumatismos Oculares/complicações , Fatores de Risco , Glaucoma/cirurgia , Afacia/cirurgia , Uveíte/complicaçõesRESUMO
PURPOSE: The aim of this study was to evaluate the visual, pachymetric, tomographic, and biomicroscopic findings in a series of cases with laser in situ keratomileusis (LASIK) flap interface fluid syndrome (IFS) after Descemet membrane endothelial keratoplasty (DMEK). METHODS: Six cases were included in this study; all patients had a history of LASIK and underwent DMEK for the treatment of bullous keratopathy. After uneventful surgery, all patients presented with corneal edema and IFS under the LASIK flap, which was demonstrated with anterior segment optical coherence tomography (AS-OCT). Visual acuity, clinical findings, pachymetry, endothelial cell count, and AS-OCT were documented during the management of these cases. RESULTS: IFS appears 2.33 days (±1.03) after DMEK. One case improved with conservative treatment. In 5 cases, the LASIK flap was lifted, the fluid was drained, and the flap was replaced. The mean best-corrected visual acuity after fluid drainage was 0.44 logMAR (range 0.18-1.0) and mean central corneal thickness was 538 µm ± 160. Total resolution of the IFS was achieved at 14.5 days (range 4-30) after DMEK. AS-OCT showed resolution of the flap interface in 5 of 6 cases, while 1 patient required second DMEK due to reaccumulation of the interface fluid. CONCLUSIONS: IFS can occur after DMEK in patients with previous LASIK. AS-OCT is a valuable tool for monitoring these cases preoperatively and postoperatively. Early surgical management is often needed to achieve resolution.
Assuntos
Edema da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Ceratomileuse Assistida por Excimer Laser In Situ , Humanos , Lâmina Limitante Posterior/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Acuidade Visual , Edema da Córnea/diagnóstico , Edema da Córnea/etiologia , Edema da Córnea/cirurgia , Estudos Retrospectivos , Endotélio Corneano/cirurgiaRESUMO
We report a case of acute corneal hydrops followed by corneal perforation five years after corneal cross-linking for keratoconus. A healthy 24-year-old female patient underwent Dresden protocol cross-linking in her left eye due to advanced keratoconus. After five years of a stable cornea, she returned with epiphora, blurred vision, and a soft left eye. Acute hydrops and corneal perforation were diagnosed. There was no history of pregnancy, atopy, eye rubbing, trauma, or contact lens use. Local antibiotic and eye patching were applied. Three months after the resolution of the acute episode, she retained useful visual acuity with no need for further surgery. Although cross-linking efficiently halts keratoconus, progression can occur, leading to corneal hydrops and perforation, even in the absence of any risk factors.
Assuntos
Edema da Córnea , Perfuração da Córnea , Ceratocone , Humanos , Feminino , Adulto Jovem , Adulto , Ceratocone/complicações , Ceratocone/tratamento farmacológico , Ceratocone/cirurgia , Perfuração da Córnea/etiologia , Crosslinking Corneano , Edema/complicações , Edema da Córnea/etiologia , Topografia da CórneaRESUMO
PURPOSE: The purpose of this study was to describe the genotypic and phenotypic characteristics of an infant with a SLC4A11 mutation associated with bilateral corneal edema, hearing loss, and hydronephrosis present since birth. METHODS: This was a case report. Ophthalmic and systemic examination of the proband, histopathologic and ultrastructural characteristics of bilateral corneal discs, and molecular genetic evaluation by whole-exome sequencing are described. RESULTS: A male infant was born with bilateral corneal opacities, sensorineural hearing loss, and hydronephrosis to healthy parents after an uneventful pregnancy. Penetrating keratoplasty of the left eye at age 10 months demonstrated minimal corneal edema with normal thickness Descemet membrane and cellular endothelium with intracytoplasmic vacuoles and degenerative changes in rare cells. Penetrating keratoplasty of the right eye 6 months later disclosed prominent corneal edema with a thickened posterior banded layer of Descemet membrane and severe endothelial atrophy. Whole-exome sequencing of the proband and parents' blood demonstrated a homozygous mutation in SLC4A11 gene (c.1735_1737delCTC,p.Leu579del). The combined clinical, histopathologic, and molecular genetic findings raised consideration of an unusual phenotype of Harboyan syndrome manifesting as congenital hereditary endothelial dystrophy with a prelingual rather than, as previously described, postlingual hearing loss. CONCLUSIONS: We report a novel homozygous SLC4A11 variant with a previously undocumented phenotype of CHED in association with prelingual sensorineural hearing loss and hydronephrosis, thus broadening our understanding of the spectrum of genotypic and phenotypic findings of Harboyan syndrome.