RESUMO Analisamos as amostras das cápsulas anteriores do cristalino de uma paciente com esclerose sistêmica e comparamos com as de um paciente controle. Não foram observadas diferenças significativas entre esclerose sistêmica e controle nos resultados da coloração com hematoxilina-eosina e picrosirius. Nas amostras obtidas da esclerose sistêmica e do controle, obtivemos expressão de caspase, uma molécula expressa na morte celular por apoptose. A heparinase foi expressa de forma mais marcante na amostra de esclerose sistêmica quando comparada ao controle. Portanto, a cápsula anterior do cristalino da paciente com esclerose sistêmica provavelmente foi afetada pela doença, uma vez que mostrou expressão aumentada de heparinase 1.

ABSTRACT This study aimed to analyze the anterior lens capsule specimens from both eyes of a patient with systemic sclerosis and compare them to the eyes of a control patient. No significant differences between systemic sclerosis and control eyes were observed in the results from the hematoxylin-eosin and picrosirius staining. In the samples obtained from both systemic sclerosis and control eyes, there were expressions of caspase, a molecule expressed in cell death by apoptosis. Heparanase was overexpressed in the systemic sclerosis sample compared to the control sample. Therefore, the anterior lens capsule of the patient with systemic sclerosis is probably affected by the disease since it showed marked expression of heparanase 1.

OBJECTIVE: To compare the effects of hydrophobic and hydrophilic materials in square-edged acrylic intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. METHODS: Patients were randomly assigned to group 1 (hydrophobic acrylic square-edged IOLs; 13 eyes) or group 2 (hydrophilic acrylic square-edged IOLs; 13 eyes). The study evaluated PCO rates using Evaluation of Posterior Capsule Opacification (EPCO) 2000 software at one, three, six and 12 months postoperatively. Postoperative measurements also included corrected distance visual acuity (CDVA), neodymium:yttrium‐aluminum‐garnet (Nd:YAG) capsulotomy and postoperative complications other than PCO. RESULTS: Both groups had significant increases in PCO rates after one year. Comparison of the groups showed no significant differences in the EPCO scores at three (group 1, 0.007±0.016 vs group 2, 0.008±0.014; p=0.830), six (group 1, 0.062±0.103 vs group 2, 0.021±0.023; p=0.184), or twelve months postoperatively (group 1, 0.200±0.193 vs group 2, 0.192±0.138; p=0.902). We also found no significant group differences regarding the change (delta, Δ) in EPCO scores between three and six months (group 1, 0.055±0.09 vs group 2, 0.013±0.02; p=0.113) or between six and twelve months postoperatively (group 1, 0.139±0.14 vs group 2, 0.171±0.14; p=0.567). Twenty-three percent of patients required Nd:YAG capsulotomy at the twelve-month visit. CONCLUSIONS: No differences in PCO rates were found between hydrophobic and hydrophilic acrylic square-edged IOLs in children between five and twelve years of age at one year of follow-up.

RESUMO Objetivo: Avaliar a prevalência do astigmatismo corneano antes da cirurgia de catarata em pacientes brasileiros. Métodos: Este estudo transversal de base clínica foi realizado no Hospital Federal de Bonsucesso, Rio de Janeiro, Brasil. Os prontuários de pacientes submetidos à cirurgia de catarata durante um período de dois anos foram revisados retrospectivamente, e as medidas ceratométricas pré-operatórias foram coletadas e analisadas. Resultados: Um total de 1.707 olhos de 1045 pacientes foram incluídos. O astigmatismo corneano foi menor que 1,0 D em 971 olhos (56,9%), 1,0-1,99 D em 496 olhos (29,1%), 2,0-2,99 D em 157 olhos (9,2%) e mais de 3,0 D em 83 olhos (4,9%). A média do astigmatismo corneano foi de 0,92 ± (SD) 0,96 D (intervalo 0-10,25 D). Conclusão: Mais de 40% dos pacientes estudados submetidos à cirurgia de catarata incluídos neste estudo tinham mais de 1,0 D de astigmatismo corneano e podem se beneficiar do uso de lentes intraoculares tóricas. Esses dados podem ser úteis no planejar a disponibilização dessa tecnologia para os pacientes.

ABSTRACT Purpose: To assess the frequency of corneal astigmatism before cataract surgery in a Brazilian sample. Methods: This clinic-based cross-sectional study was conducted at the Bonsucesso Federal Hospital, Rio de Janeiro, Brazil. Charts of patients who underwent cataract surgery over a two-year period were retrospectively reviewed, and preoperative keratometric measurements were collected and analyzed. Results: A total of 1707 eyes of 1045 patients were enrolled. The corneal astigmatism was less than 1.0 D in 971 eyes (56.9%), 1.0-1.99 D in 496 eyes (29.1%), 2.0-2.99 D in 157 eyes (9.2%), and more than 3.0 D in 83 eyes (4.9%). The mean corneal astigmatism was 0.92 ± (SD) 0.96 D (range 0 - 10.25 D). Conclusion: Over 40% of the patients undergoing cataract surgery enrolled in this study had more than 1.0 D of corneal astigmatism and may benefit from the use of toric intraocular lenses. These data can be useful for planning to make this technology available for patients.

OBJECTIVES: To compare long-term postoperative complications of pediatric cataract surgery with primary intraocular lens (IOL) implantation associated with posterior capsulotomy (PC) and anterior vitrectomy (AV) between patients treated with a corneal or pars plicata/pars plana approach. METHODS: Children who underwent cataract surgery with in-the-bag primary IOL implantation were divided into two groups according to PC and AV surgical approach: a corneal approach (group 1) and a pars plicata/pars plana approach (group 2). Only patients with a follow-up duration of more than two years were included. Long-term surgical outcomes were retrospectively reported. RESULTS: The mean follow-up period was 10.00±3.13 years. No cases of glaucoma or retinal detachment were reported. The mean age at surgery was 34.57±22.66 months. Forty-six children were included (27 eyes in group 1 and 29 eyes in group 2). The most frequent postoperative complication was corectopia, followed by visual axis opacification. Both complications occurred more frequently in group 1 (p<0.001). After cataract surgery, the rate of additional surgeries in group 1 was 51.9%, while in group 2, the rate was 27.6% (p=0.1132). CONCLUSION: The pars plicata/pars plana approach with PC and vitrectomy with primary in-the-bag IOL implantation for pediatric cataracts is a safe procedure.

Resumo O objetivo deste artigo foi reunir estudos que reportam resultados disponíveis na literatura científica, considerando a previsibilidade, segurança, eficácia, e estabilidade das lentes intraoculares fácicas de câmara posterior. E relatar as complicações documentadas para estas lentes. A revisão criteriosa dos estudos publicados na literatura ate o momento revelam resultado satisfatórios quanto à eficácia, elevada previsibilidade, estabilidade e segurança do implante de lente intraocular de câmara posterior, para correção das miopia, hipermetropia e astigmatismo.

Abstract The objective of this article was to gather studies that report results available in the scientific literature, considering the predictability, safety, efficacy, and stability of posterior chamber phakic intraocular lenses. And report the documented complications for these lenses.

RESUMO O objetivo desta revisão é de determinar as indicações e eficácia da cirurgia que promove novas ligações covalentes entre as fibras de colágeno da córnea, conhecida como Cross-Linking (CXL), assim como esclarecer seus objetivos. O ceratocone é uma doença ectasica da córnea, bilateral, assimétrica, que, principalmente, cursa com encurvamento e afinamentos progressivo, e se inicia em geral na segunda década de vida. O uso primário do CXL tem sido na interrupção da progressão do Ceratocone. Apesar do conhecido encurvamento no estroma da córnea ocorrer nesses pacientes, a fisiopatologia por trás do ceratocone ainda é desconhecida e parece ser multifatorial. Pela evidencia literária disponível até o momento, o CXL da córnea esta, portanto indicado nos pacientes com doença em progressão. Concluímos que existe evidencia suficiente para afirmar que o CXL da córnea é eficaz na estabilização da doença ectásica da cornea.

ABSTRACT The purpose of this review is to determine the indications and efficacy of the surgery that promotes new covalent bonds between the collagen fibers of the cornea, known as Cross-Linking (CXL), as well as to clarify its objectives. Keratoconus is a bilateral, asymmetric ectasic disease of the cornea that mainly courses with steepening and progressive thinning, and usually begins in the second decade of life. The primary use of CXL has been in discontinuing the progression of keratoconus. Although known corneal stromal remodeling occurs in these patients, the pathophysiology behind keratoconus is still unknown and appears to be multifactorial. By the literary evidence available to date, the CXL of the cornea is safely indicated in patients with progressing disease. We conclude that there is sufficient evidence to affirm that cornea CXL is effective in stabilizing corneal ectasic disease.

RESUMO Laser in situ Keratomileusis (LASIK) é uma das técnicas mais aceitas na cirurgia refrativa atualmente. Sua previsibilidade, reprodutibilidade, segurança e baixos índices de efeitos colaterais justificam a ampla difusão dessa técnica. Trata-se de um procedimento cirúrgico a laser cujo objetivo consiste na modificação da estrutura corneana, permitindo uma mudança do ponto focal do olho. Dessa forma, é possível corrigir ametropias tais como a miopia, astigmatismo e pequenos graus de hipermetropia. A técnica do LASIK consiste na criação de um flap corneano por meio da utilização de um microcerátomo ou do laser de femtossegundo. Em seguida, é realizada a aplicação do excimer laser sobre o leito estromal com posterior reposicionamento do flap, criando-se uma interface entre as lamelas anterior e posterior da córnea. Apesar das inúmeras vantagens, existem patologias que resultam de complicações primárias da interface do flap, que podem causar confusão no momento do diagnóstico, por possuírem semelhanças quanto à sua apresentação clínica. O objetivo desse trabalho é definir, caracterizar e comparar tais entidades com intuito de facilitar o diagnóstico diferencial dessas patologias evitando a adoção de um tratamento equivocado. Como resultado do estudo, são apresentadas recomendações quanto à conduta nos casos de cada patologia de interface, com investigação por meio da anamnese e exame clínico, a fim de permitir diagnóstico diferencial entre as principais entidades primárias da interface do procedimento LASIK.

ABSTRACT Laser in situ Keratomileusis (LASIK) is one of the most accepted techniques in refractive surgery today. Its predictability, reproducibility, safety and low incidence of side effects justify the wide diffusion of this technique. This is a laser surgical procedure which purpose consists in the modification of corneal structure, allowing a shift of the focal point of the eye. Thus, it is possible to correct refractive errors such as myopia, astigmatism and small degrees of hyperopia. The LASIK technique creates a corneal flap interface with the use of a microkeratome or femtosecond laser. Then, excimer laser is applied on the stroma bed followed by repositioning of the flap, creating an interface between the anterior and posterior corneal lamella. Despite the numerous advantages there are patologies that originate from primary complications of the interface which can caused confusion during diagnosis because they have similarities in their clinical presentation. The aim of this work is to define, characterize and compare those entities with the intention of making the diagnosis easier so that there is appropriate conduct. As result, this study presents recommendations for the management of each kind of interface disease through investigation by medical history and physical examination, in order to allow differential diagnosis between the main primary entities of the LASIK procedure interface.

RESUMO A mitomicina C teve seu uso profilático e terapêutico estabelecido, ao longo dos anos, para diminuir o haze depois da ablação superficial. A mitomicina C é segura e eficaz como uma terapia adjuvante aplicada após um procedimento primário de ceratectomia fotorrefrativa ou após um retratamento com ceratectomia fotorrefrativa após o laser in situ keratomileusis LASIK. A mitomicina age modulando a cicatrização após a cirurgia. Constitui-se num potente inibidor de mitose, bloqueia a ativação e a profliferação dos fibroblastos e a diferenciação dos miofibroblastos. Embora existam muitos estudos apontando a segurança da mitomicina nas doses ultilizadas, ainda persistem dúvidas quanto à segurança, a longo prazo, do uso da mitomicina. Quando as córneas são examinadas com microscópios confocal, após depleção inicial dos ceratócitos, a densidade celular parece retornar ao normal seis a 12 meses após o uso de mitomicina C . A maioria dos estudos clínicos não encontrou diferença significativa entre a densidade endotelial celular préoperatória e pós-operatória quando a mitomicina C 0.02% foi aplicada durante a cirurgia com um tempo de exposição de 2 minutos ou menos. Em aproximadamente 14 anos, a mitomicina C mostrou-se eficaz na prevenção e tratamento do haze corneano.

ABSTRACT Over the years, mitomycin C has been used by refractive surgeons to prophylactically decrease haze after surface ablation procedures and therapeutically in the treatment of preexisting haze. Development of mitomycin C treatments has had a significant role in the revival of surface ablation techniques. We reviewed the literature regarding mechanism of action of mitomycin C, its role in modulating wound healing after refractive surgery, and its safety and efficacy as adjuvant therapy applied after primary photorefractive keratectomy surgery or after photorefractive keratectomy re-treatment after laser in situ keratomileusis and other corneal surgeries and disorders. The drug is a potent mitotic inhibitor that effectively blocks keratocyte activation, proliferation, and myofibroblast differentiation. Many studies have suggested that mitomycin C is safe and effective in doses used by anterior surface surgeons, although there continue to be concerns regarding long-term safety. After initial depletion of anterior keratocytes, keratocyte density seems to return to normal 6 to12 months after the use of mitomycin C when corneas are examined with the confocal microscope. Most clinical studies found no difference between preoperative and postoperative corneal endothelial cell densities when mitomycin C 0.02% was applied during refractive surgery,with exposure time of 2 minutes or less. After approximately 14 years of use, mitomycin C has been found to be effective when used for prevention and treatment of corneal haze.

RESUMO Objetivo: Avaliar a segurança da cirurgia de catarata com anestesia tópica em pacientes em uso de varfarina. Métodos: Estudo comparativo não aleatorizado, prospectivo de 30 olhos de 30 indivíduos sob terapia anticoagulante por via oral com Varfarina que se submeteram à cirurgia de catarata com anestesia tópica. O grupo controle foi composto por 30 olhos de 30 pacientes, com indicação de cirurgia de catarata, que não faziam uso de terapia anticoagulante. Resultados: Não houve registro de complicações hemorrágicas intracamerais transoperatórias ou pós-operatórias em ambos os grupos. Na visita pós-operatória de 30 dias, 90,0% dos pacientes apresentavam acuidade visual corrigida por óculos de pelo menos 20/40. Conclusão: A cirurgia de catarata por facoemulsificação com anestesia tópica pode ser realizada com sucesso sem interrupção da terapia com varfarina.

ABSTRACT Purpose: To analyze the safety of warfarin therapy during cataract surgery under topical anesthesia. Methods: This was a prospective nonrandomized comparative study of 60 eyes of 60 patients treated with or without concurrent oral warfarin anticoagulant therapy, referred for cataract surgery under topical anesthesia. The sample included a treatment (n=30) and a control (n=30) group. Results: There were no records of intraoperative or postoperative intracameral bleeding complications in both the groups. At 1-month postoperative follow-up, 90.0% of patients presented spectacle-corrected visual acuity of at least 20/40. Conclusion: Cataract surgery by phacoemulsification with topical anesthesia can be successfully conducted without discontinuing warfarin.

Objetivo: Avaliar se o implante de uma lente intraocular (LIO) asférica reduz a aberração ocular (alta ordem e esférica), melhora a sensibilidade ao contraste e consequentemente, provoca mudanças nos valores da perimetria de frequência dupla (FDT ). Métodos: Trata-se de um estudo prospectivo envolvendo 25 pacientes com catarata bilateral (50 olhos) que foram randomizados para receberem uma LIO asférica (Akreos AO) em um olho e uma LIO esfércia (Akreos Fit) no olho contralateral. Com 12 meses de pós-operatório a sensibilidade ao contraste (condições fotópicas e mesópicas) e a aberração de alta ordem foram computados. A FDT foi dividida em 4 áreas para análise da variação dos valores em diferentes localizações. Os valores médios dos limiares locais (área média de sensibilidade ao contraste [MACS]) obtidos com essa divisão foram calculados. Resultados: O grupo da Akreos AO apresentou menores valores de aberração de alta ordem e aberração esférica. Houve diferença estatisticamente significativa na sensibilidade ao contraste em condições mesópicas em todas frequências. Não houve diferença estatística nos valores do mean deviation e pattern standard deviation da FDT. A LIO asférica apresentou maiores MACS em todas as áreas, embora diferença estatística foi encontrada apenas na área de 20 graus de campo visual (P=0,043). Conclusões: A lente asférica reduziu significativamente a quantidade de aberração de alta ordem e esférica, melhorando a sensibilidade ao contraste em condições mesópicas. Embora houve uma melhora nos valores da FDT no grupo da LIO asférica, essa diferença não foi estatisticamente significativa.

Purpose: To evaluate whether implantation of an aspheric intraocular lens (IOL) results in reduced ocular aberrations and improved contrast sensitivity after cataract surgery and, therefore, changes on frequency-doubling technology (FDT) testing. Methods: The present prospective clinical study enrolled 25 patients with bilateral cataract (50 eyes), who randomly received either an aspheric (Akreos AO) or a spherical (Akreos Fit) IOL in one eye and the other IOL in the second eye. Assessment 12 months postoperatively included photopic and mesopic contrast sensitivity testing. Higher-order aberrations (HOAs) were computed. FDT testing was divided into four areas to evaluate the variation of the values at different points. The median values of the local pattern thresholds (median area contrast sensitivity [MACS]) obtained with that division were calculated. Results: The Akreos AO group obtained statistically significantly lower values of HOAs and spherical aberration compared with the Akreos Fit group. There was a statistically significant between-group difference in contrast sensitivity under mesopic conditions at all spatial frequencies. No statistically significant differences were observed in mean deviation and pattern standard deviation. The aspheric IOL exhibited higher MACS in all areas, although a statistically significant difference was reached only in the 20-degree field area (P=0.043). Conclusion: Aspheric IOLs significantly reduced spherical aberration and HOAs, improving mesopic contrast sensitivity. Although there was a trend toward slightly improved FDT in the aspheric IOL group, it was not statistically significant.

RESUMO OBJETIVO: Avaliar as características clínicas relacionadas à opacificação tardia de lente intraocular (LIO) acrílica hidrofílica, quatro anos após a cirurgia. MÉTODOS: Foram avaliados seis casos de opacificação tardia de Lentes Intraoculares Ioflex, comparados com 24 pacientes (grupo controle). Ambos os grupos realizaram facoemulsificação em uma campanha comunitária para pessoas carentes, em Pernambuco, Brasil. Pacientes que operaram os dois olhos tiveram apenas o olho direito incluído no estudo para evitar vieses. Os pacientes foram submetidos a exame oftalmológico incluindo medida da acuidade visual corrigida para distancia e exame biomicroscópico na lâmpada de fenda. O histórico médico detalhado dos pacientes e os detalhes da cirurgia foram obtidos. RESULTADOS: Quatro pacientes apresentaram hipertensão arterial sistêmica no grupo de casos e onze no grupo controle. Nao houve diferença estatisticamente significante entre a freqüência da hipertensão arterial entre ambos os grupos. Apenas um paciente do grupo controle apresentou diabetes; por isso, não foi considerado para análise estatística. Nenhum fator ambiental foi relacionado. Não houve diferença estatisticamente significante entre as médias da acuidade visual de ambos os grupos nos períodos em que foram analisados. Um olho no grupo controle apresentou o mesmo número de lote de uma das Lentes Intraoculares opacificadas. CONCLUSÃO: Nenhum fator clínico dos pacientes apresentou relação com a opacificação tardia da Lente Intraocular Ioflex.

OBJECTIVE: To evaluate clinical features of patients related to opacification of hydrophilic acrylic intraocular lenses, four years after surgery. METHODS: We evaluated six cases of late opacification of Ioflex intraocular lenses (case group) compared to 24 patients (control group) with no opacification. Both groups underwent phacoemulsification as a result of a community campaign for underprivileged people. Patients who underwent bilateral cataract surgery had only the right eye included on the study. The patients were submitted to ophthalmic examination, including measurements of corrected distance visual acuity and biomicroscopy slitlamp evaluation. Detailed medical histories were obtained. Surgical details were retrieved. RESULTS: Systemic arterial hypertension was recorded in 4 patients from the case group and 11 in the control group, with no statistically significant difference between groups. A single patient in the control group had diabetes mellitus, and so was not considered for statistical analysis. No environmental factor could be related. There were no statistically significant differences for mean visual acuity between the groups of patients regarding the evaluation periods. One eye in the control group received an Ioflex intraocular lens with the same lot number as one of the opacified lenses. CONCLUSION: No clear patient factor could be related to late Ioflex lens opacification.

OBJECTIVE: This study sought to compare the effects and outcomes of two ophthalmic viscosurgical devices, 1.6% hyaluronic acid/4.0% chondroitin sulfate and 2.0% hydroxypropylmethylcellulose, during phacoemulsification. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that received phacoemulsification performed by the same surgeon using a standardized technique. Patients were randomly assigned to receive either 1.6% hyaluronic acid/4.0% chondroitin sulfate or 2.0% hydroxypropylmethylcellulose on the first eye. The other eye was treated later and received the other viscoelastic agent. Preoperative and postoperative examinations (5, 24 and 48 hours; 7 and 14 days; 3 and 6 months) included measurements of the total volume of the ophthalmic viscosurgical device, ultrasound and washout times to completely remove the ophthalmic viscosurgical device, intraocular pressure, central corneal thickness and best-corrected visual acuity. The corneal endothelial cell count was measured at baseline and at six months postoperatively. ClinicalTrials.gov: NCT01387620. RESULTS: There were no statistically significant differences between groups in terms of cataract density or ultrasound time. However, it took longer to remove 2.0% hydroxypropylmethylcellulose than 1.6% hyaluronic acid/ 4.0% chondroitin sulfate, and the amount of viscoelastic material used was greater in the 2.0% hydroxypropylmethylcellulose group. In addition, the best-corrected visual acuity was significantly better in the hyaluronic acid/ chondroitin sulfate group, but this preferable outcome was only observed at 24 hours after the operation. There were no statistically significant differences between the two ophthalmic viscosurgical devices regarding the central corneal thickness or intraocular pressure measurements at any point in time. The corneal endothelial cell count was significantly higher in the hyaluronic acid/chondroitin sulfate group. CONCLUSION: The ophthalmic viscosurgical device consisting of 1.6% hyaluronic acid/4.0% chondroitin sulfate was more efficient during phacoemulsification and was easier to remove after IOL implantation than 2.0% hydroxypropylmethylcellulose. In addition, the corneal endothelial cell count was significantly higher following the use of hyaluronic acid/chondroitin sulfate than with hydroxypropylmethylcellulose, which promoted an improved level of corneal endothelium protection.

PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects.