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ABSTRACT This review is intended to describe the therapeutic approaches for corneal blindness, detailing the steps and elements involved in corneal wound healing. It also presents the limitations of the actual surgical and pharmacological strategies used to restore and maintain corneal transparency in terms of long-term survival and geographic coverage. In addition, we critically review the perspectives of anabolic agents, including vitamin A, hormones, growth factors, and novel promitotic and anti-inflammatory modulators, to assist corneal wound healing. We discuss the studies involving nanotechnology, gene therapy, and tissue reengineering as potential future strategies to work solely or in combination with corneal surgery to prevent or revert corneal blindness.(AU)

RESUMO O presente trabalho traz uma revisão das abordagens terapêuticas para a cegueira da córnea. O estudo detalha as etapas e os elementos envolvidos na cicatrização da córnea. Ele mostra as limitações das estratégias cirúrgicas e farmacológicas usadas para restaurar e manter a transparência da córnea em termos de sobrevida a longo prazo e alcance geográfico. As perspectivas dos agentes anabólicos, incluindo vitamina A, hormônios, fatores de crescimento e novos moduladores pró-mitóticos e anti-inflamatórios para auxiliar a cicatrização da ferida na córnea, são revisadas criticamente. Aqui, apresentamos estudos envolvendo nanotecnologia, terapia gênica e reengenharia de tecidos como possíveis estratégias futuras para atuar de maneira isolada ou combinada com a cirurgia da córnea para prevenir ou reverter a cegueira corneana.(AU)

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We present two patients who developed visual deterioration due to carbon monoxide poisoning. They were treated with hyperbaric oxygen and recovered not only their vision but also they improved neurological signs and symptoms. We believe that implementation of hyperbaric oxygen, even in a late period of time will be effective in reversing neurological sequelae.

Se presentan dos pacientes que desarrollaron deterioro visual debido a una intoxicación por monóxido de carbono. Ellos fueron tratados con oxígeno hiperbárico y recuperaron no solo su visión, sino que, además, mejoraron su signo-sintomatología neurológica. Se cree que la implementación de oxígeno hiperbárico, incluso en un período tardío, será efectiva para revertir las secuelas neurológicas.

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ABSTRACT The burden of corneal blindness and visual deficiency can be felt worldwide. Its association with several endemic diseases such as childhood blindness, trauma, infectious keratitis (including variants caused by herpes, hanseniasis, and fungi), vitamin A deficiency, diabetes mellitus, and other dry eye syndromes reflects its poorly understood underlying mechanisms and suggests that the actual frequency of the disease is underestimated. The low effectiveness of preventive and therapeutic strategies against corneal scarring or deformity predicts a high frequency of patients with corneal blindness in the future. Corneal blindness is associated with environmental factors and socioeconomic limitations that restrain health assistance and maintain a modest efficiency of the current therapeutic strategies for resolving corneal diseases in large-scale programs. We present here a critical review of the concepts associated with corneal blindness that need to be considered when planning strategies to prevent and treat corneal blindness worldwide (to be able to leave Plato's cave, where corneal blindness is encaged.

RESUMO O problema da deficiência visual e da cegueira corneal abrange o mundo todo e corresponde à quarta causa de cegueira e deficiência visual, com acometimento estimado de mais de 16 milhões de pessoas. A associação com várias doenças endêmicas, como cegueira infantil, trauma, ceratites infecciosas (incluindo herpes, hanseníase e fungos), hipovitaminose A, diabetes mellitus e outras causas de síndromes de olho seco, indicam que a verdadeira frequência é subestimada e que os diferentes mecanismos são pouco conhecidos. A baixa eficácia na prevenção e tratamento da cicatriz e deformidade da córnea permite antecipar que a prevalência da cegueira corneal irá crescer no futuro. As razões para o aumento da cegueira corneal envolvem fatores ambientais, limitações socioeconômicas para ampliar a assistência à saúde e a modesta eficiência das estratégias terapêuticas para resolver o problema em grande escala. O presente trabalho traz uma revisão crítica dos conceitos associados à cegueira corneal. Essa análise é uma etapa necessária para preparar o caminho com o objetivo de deixar a caverna que encarcera a cegueira corneal, em analogia ao mito de Platão, e melhorar as estratégias para prevenir e tratar a cegueira corneal em escala mundial.

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BACKGROUND: The primary purpose of this survey was to determine how veterinary ophthalmologists manage cases of irreversible blindness and to report the most common causes of blindness. METHODS: Respondents completed a questionnaire sent by email with the cooperation of the American College of Veterinary Ophthalmologists, the European College of Veterinary Ophthalmologists and the Latin American College of Veterinary Ophthalmologists. The questionnaire was developed containing 12 questions with both open and closed multiple-choice response options. RESULTS: One hundred and eight veterinary ophthalmologists answered the questionnaire. Of the respondents, 83 per cent had graduated for more than 10 years. Glaucoma (63.56 per cent) was the main cited cause of blindness, followed by progressive retinal atrophy (PRA) (17.80 per cent) and retinal detachment (6.78 per cent). The major concerns of owners refer to the impact of blindness on quality-of-life, (39.31 per cent), followed by depression and anxiety (20 per cent), and environment adaptation (11.72 per cent). General recommendations include avoidance of changes in the domestic environment (18.45 per cent), use of auditory stimulation (14.09 per cent) and avoidance of dangerous areas (12.75 per cent). Almost 31 per cent of professionals do not recommend the use of literature on how to deal with blind pets. CONCLUSIONS: The survey determined glaucoma and PRA as the most common causes of irreversible blindness in pets. Several recommendations that are frequently given to owners of blind pets are presented.

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OBJECTIVE: To propose an algorithm of treatment for sudden visual loss following filler injections and perform an English-written literature search for assignment of evidence level and grade recommendation. METHODS: Algorithm of treatment includes ocular physical Maneuvers, hyAluronidase administration, intravenous STEroids, intraocular pressure Reduction, and Supplemental Oxygen (M.A.STE .R.S) based on previous acute management reports. Special consideration for algorithm buildup was made for ophthalmic diseases that share physiopathological features such as central retinal artery occlusion, systemic vasculitis affecting vision, and acute glaucoma. Finally, a systematic cross-review of the reported cases with visual loss was done to identify the level of evidence and grant a recommendation grade. RESULTS: A search through PubMed and Medscape databases for English-written scientific papers using the terms facial filler, retinal artery occlusion, management, treatment, complications, and adverse events quoted a total of 46 papers (190 cases) which were then analyzed. A high variability on management for treatment of sudden visual loss after facial filler injections was observed. This was attributed partially to the great diversity of medical specialists performing cosmetic facial procedures such as dermatologists, plastic surgeons, esthetic doctors and ophthalmologists, and the lack of high evidence level studies. CONCLUSIONS: The proposed algorithm provides an initial guideline based on prior literature reports and physiopathology involving facial filler injection complications. Analysis identified 22 successfully treated cases with vision recovery (11.57%). Ocular physical maneuvers had the best evidence-based level and grade recommendation (A) for the management of acute vision loss secondary to facial filler injections.

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Injectable fillers have become one of the most performed aesthetical treatments worldwide over the past two decades. They are frequently applied to the face, offering effective and safe alternatives to more invasive surgical procedures. Nevertheless, there are serious risks associated with filler-based treatment. Visual impairment stands as a rare yet catastrophic adverse event associated with intravascular embolization of injected material to the retina or other areas of the central nervous system; potentially leading to permanent visual loss. This article presents a comprehensive revision of blindness secondary to aesthetical filler injections, offering up-to-date strategies for prevention and management.

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The monobloc frontofacial osteotomy provides aesthetic and functional improvement in the treatment of various craniofacial deformities. This procedure, through highly complex, has had some significant associated complication, such as cerebrospinal fluid leakage, hematoma, infection, and bone resorption. Distraction has been successfully used to gradually elongate bone and soft tissue. This method seems to provide improved results over conventional surgery, with less morbidity. We present a case of a patient with Apert syndrome who underwent monobloc advancement using the Rigid External Device (RED) device and who developed a transient bilateral amaurosis on the fourth postoperative day before distraction. A second procedure was performed to push back the frontal bandeau, maintaining the device in position. The blindness was resolved with this procedure as well as treatment with systemic steroids. The distraction was started thereafter, and the desired improvement was acquired. To our knowledge, this is the first case of transient bilateral amaurosis in a patient undergoing monobloc distraction.

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Information technologies are increasingly helping to integrate and socially include people with visual disabilities. Computing technologies have contributed grandly to attain this goal through innovative techniques and applications. Virtual environments, I/O interfaces, and sound based applications altogether with usability and cognitive impact studies are some of the most used research designs for children with visual disabilities. This study presents the design and usability evaluation of three-dimensional (3D) interactive environments for children with visual disabilities. We introduce AudioChile and AudioVida, interactive virtual environments that can be navigated through 3D sound to enhance spatiality and immersion throughout the environments 3D sound is used to orientate, to avoid obstacles, and to identify the position of diverse personages and objects within the environment. Usability evaluation results indicated that sound can be fundamental for attention and motivation purposes during interaction.

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In melanoderms it is estimated that over 10 percent of the adult population is afflicted with open angle glaucoma. This disease is painless, chronic and gradually reduces vision leading eventually to blindness. There is no cure but with early diagnosis, patient education and treatment glaucoma is controllable. The anatomy, physiology, and pharmacology of the eye will be discussed. Surgical management will also be discussed as well as the social and economic effects of this disease in developing countries.(AU)

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A psycho-social study was performed in 19 Colombian families with 40 affected individuals with Usher syndrome, identified through our national screening program for this disease in Colombia. The study was aimed to understand their needs, kind of familial inter-relationships, and social and familial implications of the patients' double sensorial limitation, in order to provide enough information to support the importance of early diagnosis, appropriate genetic counseling, and the establishment of adequate educational and rehabilitation programs in Colombia.

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O trauma ocular perfurante é importante causa de cegueira prevenível. Há necessidade de conhecer suas causas para tomada de medidas preventivas. Para tal, avaliamos os traumas perfurantes atendidos no H.C. da FMB-UNESP, nos últimos 5 anos. Observamos que a maioria dos caos ocorreu em indivíduos masculinos 73 (por cento), crianças e adultos jovens, em atividades domesticas 77,92 (por cento), geralmente provocados por objetos metálicos 40,54 (por cento), sendo mais frequente a perfuraçäo corneoescleral 46,75 (por cento). A gravidade do trauma perfurante é constatada pelo número expressivo de cegos (AV menor que 0,1) no final do tratamento

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O trauma ocular, causa comum de cegueira unilateral, é mais frequente em crianças e adultos jovens (predominantemente do sexo masculino). Habitualmente é provocado por agressöes, acidentes domésticos e com veículos motores e constitue a quarta causa mais importante de cegueira na maioria dos países da America LAtina. Em decorrênciade trauma ocular penetrante, um microrganismo pode ter acesso ao lho, com ou sem a presença de corpo estranho intra-ocular, ou mesmo após uma perfuraçäo auto-selante (selt sealing). Neste estudo, na Fundaçäo e Instituto Hilton Rocha, em Belo Horizonte, o autor analisa 213 casos de trauma ocular, em pacientes de 1979 a 1993. O estudo confirma dados da literatura concernentes a idade, tipo de acidente, os sinais oculares mais frequentes, o manejo do trauma ocular, etc. É nessaltada a ocorrência de endoftalmite, sua profilaxia e tratamento, e os organismos infectantes mais frequentes, assim como outros aspectos importantes da literatura

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1- As manifestaçoes oculares da hanseníase podem ser causa de cegueira em aproximadamente 250.000 indivíduos no mundo. Portanto, é claro que a hanseníase ocular se constitue em importante fonte de cegueira evitável. Há necessidades claras de açoes coordenadas para prevenir a perda visual nos pacientes com hanseníase. 2- A detecçao precoce e tratamento da hanseníase é de grande importancia para previnir futuras complicaçoes e incapacidades devidas à doença, incluindo a perda visual. Programas nacionais de controle da hanseníase e prevençao de cegueira devem, portanto, ter uma atuaçao ativa na identificaçao e tratamento destes pacientes com risco de cegueira. 3- Há uma forte necessidade de alertar os profissionais que trabalham com oftalmologia para hanseníase ocular e suas consequências. Com este objetivo os treinamentos nas escolas médicas em nível de graduaçao e pós graduaçao necessitam ser enfatizados. 4- Recomenda-se que todas as reunioes nacionais e internacionais de hanseníase devem dar particular atençao para a hanseníase ocular. 5- Profissionais de saúde que atuam com a hanseníase e assistentes oftalmológicos devem ter um papel chave na detecçao e conduçao da morbidade ocular

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As crianças com visäo subnormal devem ser submetidas a programas de estimulaçäo precoce, iniciada desde o primeiro ano de vida, que consiste em aplicaçäo de métodos integrados sensorialmente de estimulaçäo táctil, auditiva e visual. Com a evoluçäo inicia-se também um processo de correçäo postural visando a posiçäo de pé e a de ambulaçäo. A finalidade do método consiste finalmente em devolver a criança uma capacidade de exercer todas as funçöes sensoriais e motoras que näo estäo comprometidas organicamente fazendo-a ser aceita pela comunidade e permitindo-lhe satisfazer suas próprias necessidades econômicas

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