Marcelo Palis Ventura

Central corneal thickness and biomechanical changes after clear corneal phacoemulsification.

PURPOSE To evaluate central corneal thickness (CCT) and ocular biomechanical properties in patients before and after clear corneal phacoemulsification. METHODS Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments) in 36 consecutive patients (47 eyes) who underwent clear corneal phacoemulsification. Central corneal thickness was measured with the Pentacam (Oculus Optikgeräte GmbH). All measurements were performed prior to surgery and at follow-up at 1, 7, and 30 days postoperatively. RESULTS Central corneal thickness was higher at 1 and 7 days compared to preoperatively (P<.05) but not at 30 days. Corneal hysteresis was lower at 1 day than preoperatively (P<.05) but not at 7 and 30 days. Corneal resistance factor was lower at 1, 7, and 30 days compared to preoperatively (P<.05). Corneal-compensated IOP was slightly lower at 1, 7, and 30 days compared to preoperatively, but was not statistically significant (P>.05). Goldmann-correlated IOP was statistically significantly lower at 1 and 7 days than preoperatively (P<.05). CONCLUSIONS Clear corneal phacoemulsification led to a change in ocular biomechanical properties. The increase in CCT after phacoemulsification was followed by a reduction in CRF and CH. Mean IOPcc was similar before and after phacoemulsification, indicating that IOPcc may be a more accurate indicator of true IOP than IOPg.

Microscopic analysis of opacification in Ioflex® hydrophilic acrylic intraocular lenses

Five cases of intraocular lens (IOL) opacification in patients implanted with the Mediphacos Ioflex® IOL are described. Clinical data in each case was obtained from the patients medical record. The five explanted IOLs underwent gross and light microscopic analysis. Selected lenses were processed for further evaluation and multiple sagittal cuts were stained with the alizarin red and von Kossa methods. Light microscope analysis confirmed the presence of deposits on and within the lens, which stained positive for calcium. The reason why calcification has occurred in these cases remains unclear, but surgeons should be aware of this potential late postoperative complication.

Orbital metastasis from breast carcinoma presenting as neurotrophic keratitis

CASE REPORT This is a case report of an 81-year-old woman with previous breast cancer. The patient presented with a history of unilateral painless red eye and displayed on examination a nodule in the superior orbital rim, proptosis, and neurotrophic keratitis. Clinical and radiographic examinations were followed by biopsy of the orbital mass. Computed tomography displayed an extraconal mass adjacent to the left superior orbital rim extending to the soft tissues. Light microscopy findings suggested the diagnosis of orbital metastatic breast carcinoma that was confirmed by immunohistochemistry. The histopathologic diagnosis was metastatic adenocarcinoma of the breast to the left orbit. COMMENTS This study emphasizes that orbital metastasis must be considered in patients with ocular complaints and neoplastic disease thought to be stable.

Scleral buckling surgery and eye pain: assessment of chronic eye pain during the postoperative period of scleral buckling surgery.

Purpose: To assess the progression of eye pain after scleral buckling surgery to treat rhegmatogenous retinal detachment and to investigate the occurrence and characteristics of chronic eye pain. Methods: This was a longitudinal, prospective, and observational study. Eye pain was measured according to a numerical analog scale (range, 0–10) for 6 months after scleral buckling surgery. The sample was divided into two groups, with or without chronic eye pain, to perform statistical analyses. For this study, chronic eye pain was defined as postoperative pain beyond 30 days. The following variables were assessed to investigate the etiology of chronic eye pain: age, gender, ethnicity, degree of myopia, visual acuity, intraocular pressure, and degree of scleral indentation. Results: A total of 100 patients were assessed in this study. One particular sequence of levels on the pain analog scale, specifically 3–2–1–0–0 (intensity of eye pain on postoperative Days 1, 14, 30, 60, and 180, respectively), was identified more frequently during the progression of eye pain in the 180-day follow-up period. The pain resolved for 72% of patients within 30 days. Chronic eye pain occurred in 18% of the patients. Scleral indentation was the only statistically significant variable investigated relative to the etiology of chronic eye pain (P < 0.05). Conclusion: Chronic eye pain correlated significantly with large scleral indentation. Patients with more intense pain at the onset of the postoperative period tended to develop chronic eye pain.

Repeatability of central corneal thickness measurement with the Pentacam HR system

PURPOSE: To assess the repeatability of central corneal thickness measurement at the geometrical center (Central Corneal Thickness - CCT) given by the Pentacam High Resolution (HR) Comprehensive Eye Scanner (Oculus, Wetzlar, Germany) over time. METHODS: Prospective, single center, observational study. Two separate CCT measurements were taken by the Pentacam corneal tomography exam (CTm) 3 to 12 months apart, and compared. RESULTS: One hundred and sixteen eyes (n=116) of 62 health patients were included in this study. Average CCT in first and last visits was 541.6±37 µm and 543.6±36.9 µm respectively. Mean difference between both measurements was 9.2±6.4 µm, and there was no statistically significant difference in CCT measurement between visits, with good correlation between them (P = 0.057, r2 = 0,9209). CONCLUSION: Pentacam (HR) CTm gives repeatable CCT measurements over time.

Comparative electrophysiological responses in anisometropic and strabismic amblyopic children

Purpose To compare anisometropic hypermetropic amblyopic and strabismic amblyopic responses to pattern electroretinogram (PERG) and pattern visual evocated potential (PVEP). Materials and methods Fifty-six patients – 18 hypermetropic anisometropic amblyopic children (mean age 9.70±2.5 years), 19 strabismic amblyopic children (mean age 10.30±2.6 years) and 19 normal emetropic subjects (mean age 10.10±2.2 years) – were enrolled in this study. After routine ophthalmic examination, PERG and PVEP were recorded in response to checks reversed at the rate of two reversals/second stimulating macular area. Results The difference between hypermetropic anisometropic amblyopia and strabismus amblyopia with respect to P100/P50/N95 wave latencies (P=0.055/0.855/0.132) and P100/P50/N95 amplitudes (P=0.980/0.095/0.045) was not statistically significant. However, there was a significant statistical difference between strabismic amblyopia group and controls for P100/P50/N95 latencies (P=0.000/0.006/0.004). Conclusion Our findings indicated that despite clinical differences between anisometropic amblyopic and strabismic amblyopic patients, no differences were found in the responses of PVEP and PERG. The abnormal components of the PVEP and PERG in amblyopic subjects could reflect a retinal dysfunction in the visual pathway.

Scleral wound healing with cross-link technique using riboflavin and ultraviolet A on rabbit eyes

Purpose The aim of study was to evaluate the cross-link using riboflavin and ultraviolet A (UVA) for improving scleral wound healing. Materials and methods This was an experimental study involving four New Zealand rabbits (eight eyes). Therapy procedure was chosen for the right eye and control procedure for the left one. UVA irradiation of 365 nm with a surface irradiance of 3 mW/cm2 and a photosensitizer of riboflavin drops were applied for 30 minutes on the right eye at 2 mm from the limbus. Sclerotomy incision was performed at 2 mm from the limbus in both right (on the cross-link-treated area) and left eye. Then, 30 days after surgery, a morphological analysis and histological staining with hematoxylin–eosin and picrosirius red were performed, and the sclerotomy cicatrization of right and left eyes was compared. The variables investigated were as follows: sclerotomy incision pictures and measurements were made using the ImageJ Software. Scleral thickness was measured (employing the anterior optical coherence tomography and the digital caliper). Collagen fiber density stained with picrosirius red staining was measured using the Image Pro Plus software. Results The morphological analysis showed that in all samples, the right eye presented sclerotomy closure, and in two eyes, among them, there were no visible edges of the sclerotomies incision. The left eye presented sclerotomy closure and incision edges. The Image Pro demonstrated a higher density of collagen fibers in the right eye when compared to the one. The statistical analysis was significant when compared to the collagen fiber density in the treated eyes with the control eyes. Conclusion The cross-link procedure resulted in a better sclerotomy wound healing.