E Minguez

Evaluation of in vitro efficacy of combined riboflavin and ultraviolet a for Acanthamoeba isolates.

PURPOSE To evaluate in vitro the amoebicidal effects of riboflavin and ultraviolet A (UVA) collagen cross-linking. DESIGN Experimental study, laboratory investigation. METHODS Two different strains of Acanthamoeba species were tested identically. Four treatment groups were considered: group 1 consisted of 0.1% riboflavin and 30-minute UVA irradiation; group 2 consisted of 0.1% riboflavin and 60-minute UVA irradiation; group 3 consisted of no riboflavin and no UVA exposure; group 4 consisted of 0.1% riboflavin and no UVA exposure. The application of UVA was performed under the parameters used for in vivo corneal collagen cross-linking. RESULTS In all cases, cysts and trophozoites were detected 24 hours after treatment at a radial distance from the center of the seeding point more than 5 mm, indicating that the amoebae were viable. All treated and untreated groups of amoebae from the 2 strains exhibited growth (radii of 14 to 15 mm in groups 1, 3, and 4; radius of 12 mm in group 2). The final morphologic features of the 2 strains of trophozoites that received treatment were similar to those of the initial seeding group and the untreated control group. CONCLUSIONS The results obtained in our study show that a single dose (30 or 60 minutes) of cross-linking cannot achieve eradication in the 2 different Acanthamoeba strains examined. However, in vitro results do not always indicate in vivo efficacy, so future studies should test the validity of this treatment for Acanthamoeba keratitis.

Keratitis after Implantation of Intrastromal Corneal Rings with Spontaneous Extrusion of the Segment.

Purpose: To report a case of bacterial keratitis in a patient with a history of intrastromal corneal ring segments (INTACS®) implantation to correct keratoconus. Methods: The patient’s history, clinical presentation, pathological analysis and therapeutic management were reviewed. Results: A 36-year-old-man was referred to our department due to decreased vision and intense pain in his left eye, 40 days after INTACS® implantation for keratoconus. Slit-lamp examination revealed epithelial defects and stromal infiltrates in the lower channel without evidence of the inferior ring. The anterior chamber also showed a significant fibrin reaction to hypopyon. A low-tension suture was removed at the site of the incision. Microbiological study of the conjunctival swab was positive for Staphylococcus epidermidis, but the corneal culture was sterile. The patient was treated with topical fortified and systemic antibiotics. The infection slowly resolved, leaving opacity at the inferior segment site. Conclusions: Infectious keratitis following INTACS implantation is an infrequent complication that can have important consequences without suitable and early therapeutic management.

Tubulointerstitial nephritis and uveitis syndrome (TINU syndrome) associated with Epstein-Barr virus

Purpose. To report a case of tubulointerstitial nephritis associated with uveitis (TINU) syndrome associated with Epstein-Barr virus, which presented aggressive bilateral uveitis. Methods. Clinical evaluation, serologic testing, and renal biopsy were performed on a 16 year-old boy who presented with bilateral visual loss and constitutional symptoms. Results. Slit lamp biomicroscopy revealed bilateral anterior uveitis with posterior synechiae in both eyes. He was commenced on topical and systemic corticoid treatment. Systemic evaluation revealed renal failure. Renal biopsy confirmed the diagnosis of TINU syndrome. IgM serology was positive for Epstein-Barr virus. While the renal response was good, the uveitis required immunosuppression which resulted in resolution. Conclusions. There have been only 3 previously reported cases of TINU syndrome associated with acute Epstein-Barr infection. In TINU syndrome, it has been reported that microorganisms may act as triggers of the disease in patients who are genetically predisposed. TINU syndrome should be considered in the differential diagnosis of uveitis with constitutional symptoms.

Intraocular scattering, a useful tool for the indication of capsulotomy?

Purpose To evaluate the correlation between the subjective visual parameters and the objective optical quality parameters, before and after the laser YAG‐Neodymium treatment in patients with posterior capsular opacification (PCO).

Loiasis. approach to a form of ocular parasitosis

Purpose We report the case of a 37 year old male from Guinea referring foreign body sensation in his right eye intermittently for 5 years. The slit lamp examination revealed a creeping worm under the conjunctiva. The microbiological analysis after surgical removal confirmed that it was an adult form of Loa‐Loa.

Management of IOLs in pediatric cataracts

Purpose To describe the different possibilities of treatment in pediatric cataract with IOL implantation; analyzing the type of IOL, the position of the haptics AND optic.

Validity of non-mydriatic cameras for screening and follow-up in diabetic retinopathy

Purpose: To determine the validity of a non-mydriatic camera for screening and grading diabetic retinopathy (DR). To establish the number of photographs and the field width needed for a correct DR follow-up. Methods: A cross-sectional, observational study was carried out to assess the validity of the non-mydriatic Topcon TRC-NW6S retinograph. Validity proportions were calculated. Kappa analysis was made to determine the agreement with conventional fundoscopy exploration performed by indirect ophthalmoscopy and retinal biomicroscopy. One 45o single-field non-mydriatic digital photograph was taken in 82 eyes for DR screening. For DR grading, several combinations of retinal fields were photographed in 247 eyes, first without pupillary dilatation and later with mydriasis. Results: In DR screening, 88.2% sensitivity and 96.9% specificity were obtained, where 9% of the tests were invalid. In DR grading diagnosis, the kappa analysis showed close agreement (k>0.8) based on at least two 45o photographs with mydriasis. However, when attempting to detect macular edema (ME), the maximum kappa statistic obtained did not go above 0.71, showing 67% maximum sensitivity. The sensitivity for detecting derivable DR was similar to that obtained with indirect ophthalmoscopy (94-98%). Conclusions: The non-mydriatic retinograph is a valid instrument for DR screening only when taking one 45o non-mydriatic photograph per eye. However, given that the sensitivity for proliferative DR (PDR) was worse, when grading DR, we would recommend obtaining nine retinal photographs (mosaic) with mydriasis. Used in this way, the apparatus is extremely useful for detecting derivable DR cases.

Eccema alérgico de contacto palpebral por ketorolaco trometamol 0,5% tópico

CLINICAL CASE A 65-year-old man had been treated with eye-drops containing NSAIDs (Ketorolac). He developed conjunctival injection, edematous swelling of the eyelids and periorbital dermatitis due to a contact allergy. Allergy to NSAIDs is uncommon. DISCUSSION This is an unusual case because topical application of ketorolac is safe in the vast majority of ophthalmologic patients. However adverse events associated with Ketorolac are similar to that of other NSAIDs.