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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.

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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.

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RESUMO Relato de caso não descrito na literatura oftalmológica nacional de múltiplas camadas da membrana de Descemet. Mulher de 59 anos, pseudofácica, com diagnóstico de ceratopatia bolhosa, foi submetida à ceratoplastia penetrante em olho direito, sendo encontrado achado incomum de multiplicidade de camadas da membrana de Descemet, variáveis em forma e espessura, além de corpos ovoides com coloração de metamina de prata de Gocott-Gomori (GMS) negativa. Como a membrana de Descemet tem no seu desenvolvimento um período fetal e outro pós-natal que frequentemente é bem identificável nos cortes histológicos em adultos. No caso apresentado, em que outras camadas estão presentes, há evidência de corpos esféricos que poderiam significar que a potencialidade de produzir outras camadas pode permanecer na fase adulta mais tardia.

ABSTRACT To relate a case not described previously in the national multilateral ophthalmological literature of Descemet's membrane. A 59-year-old pseudophakic woman diagnosed with bullous keratopathy underwent penetrating keratoplasty with an unusual finding of multiple layers of Descemet's membrane, which were variable in shape and thickness. In addition, ovoid bodies with negative Gocott-Gomori (GMS) color were present. Discussion and Conclusion: As Descemet's membrane has a fetal and a postnatal period in its development, it is frequently and well identifiable in histological sections in adults. In the case presented, in which other layers are present, there is evidence of spherical bodies that could mean that the potential to produce other layers may remain into later adulthood.

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PURPOSE: To determine whether sole full-thickness corneal sutures are a feasible treatment for acute corneal hydrops, and if so, report the anatomic and visual results of this technique. METHODS: A retrospective case series was carried out in 17 patients, all of whom received sole full-thickness sutures as a treatment for corneal hydrops. RESULTS: The included patients reported symptom commencement a median of 15 days before the surgical intervention. The patients' median preoperative corneal pachymetry was 1235 µm, whereas 1 month after the surgery, the median corneal thickness was 830 µm, and after 3 months, it was 502 µm (P < 0001). Preoperative best corrected visual acuity (BCVA) was 1.40 LogMAR and a final postsurgical BCVA of 1.00 LogMAR after 3 months of the follow-up (P < 0001). Deep neovascularization was present in 3 patients (17.6%); none of the patients developed cataract formations or pupillary blocks. CONCLUSIONS: Given the improvement of the corneal pachymetry and the BCVA, sole full-thickness sutures seem to be a feasible surgical option to treat severe acute corneal hydrops.

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PURPOSE: The aim of this study is to report our results of toric intraocular lens (IOL) implantation in patients with asymmetric astigmatism, its efficacy and safety in reducing the refractive cylinder. METHODS: This is a retrospective cohort study. Patients with asymmetric astigmatism and non-progressive corneal ectasia, unable to fit hard contact lenses, with poor-corrected visual acuity or unsatisfactory spectacles-corrected visual acuity, underwent cataract surgery with toric IOL implantation. The choice of lens was individually after optical biometry examination. All surgeries were performed by a single surgeon, with a 2.75-mm clear cornea self-sealing incision at 130° axis, from December 2008 to December 2015. RESULTS: We evaluated 88 eyes of 69 patients with asymmetric astigmatism: primary, secondary to leucoma, post-radial keratectomy, post-lamellar or penetrating keratoplasty, post-LASIK, post-PRK and due to pterygium. Snellen best-corrected spectacles visual acuity increased from 0.39 ± 0.23 preoperative to 0.80 ± 0.23 postoperative. The average refractive cylinder reduced from 2.32 ± 1.78 D preoperatively to 0.87 ± 1.09 D after surgery (P < .001). Sixty-three eyes out of 88 (71%) had residual refractive cylinder ≤ 1.0 D. CONCLUSION: The favorable efficacy on visual acuity outcomes we have found suggests that toric IOL can be used in cases of asymmetric astigmatism, in order to provide better-corrected vision, less spectacles dependence and an improved quality of vision overall, which is especially important in contact lenses intolerant patients.

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BACKGROUND: Keratoconus may progress to acute corneal hydrops even after cross-linking. In some cases, keratoconus progresses during pregnancy. In this report, we present a case of a patient with increased anterior stromal resistance after cross-linking that would favor nonprogression of keratoconus during pregnancy. CASE PRESENTATION: We report that cross-linking is likely to have had a protective effect in a white pregnant patient with acute corneal hydrops who showed rapid improvement, as documented by corneal topography. Improvement occurred within 8 days, whereas up to 250 days are reported in the literature. No keratoconus progression occurred in the 20-month follow-up period. CONCLUSIONS: Cross-linking failed to prevent the occurrence of acute corneal hydrops after rupture of Descemet's membrane but most likely helped to accelerate the resolution of the condition. Corneal hardening resulting from cross-linking may have also contributed to stabilizing keratoconus during pregnancy.

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PURPOSE: Corneal involvement in mitochondrial disease is seldom described. Kearns-Sayre syndrome (KSS) is a mitochondrial disorder characterized by retinitis pigmentosa, external ophthalmoplegia, and heart block. We report 2 patients with KSS with corneal lesions involving the endothelium, which improved with Coenzyme Q10 (CoQ10). Based on recent research regarding the role of dysfunctional oxidative metabolism in Fuchs Endothelial Corneal Dystrophy (FECD), we propose that mitochondrial diseases and FECD share a final pathway. METHODS: A chart review was performed and a review of the literature was completed with a PubMed search using the terms "Kearns-Sayre Syndrome", "mitochondria", "endothelium", "Fuchs endothelial corneal dystrophy", and "cornea". RESULTS: There are 19 reports of corneal involvement in clinical phenotypes of mitochondrial disease. Nine of these 19 cases had findings consistent with KSS. Our patients with KSS had microcystic changes throughout the cornea and excrescences on the endothelial surface seen with ultrasound biomicroscopy, similar to the clinical findings in FECD. CoQ10 improved corneal disease in both children. CoQ10 deficiency has been reported in a variety of mitochondrial diseases, and efficacy of supplementation has been demonstrated. It may be beneficial in these patients because of its antioxidant properties and role in oxidative phosphorylation. CONCLUSIONS: The common deletion found in patients with KSS has recently been implicated in FECD, which has recently been shown to be a disease related to dysfunctional oxidative metabolism. Future research should explore the use of antioxidants, such as CoQ10 in patients with FECD.

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El síndrome de Chandler es una de las variaciones clínicas del síndrome iridocorneoendotelial, donde el denominador común es una alteración del endotelio corneal cuyo diagnóstico es, en ocasiones, muy difícil de realizar por la complejidad y la variabilidad de sus signos y síntomas. Se presenta una paciente de 67 años con disminución importante de la visión del ojo izquierdo. A la exploración existía un edema corneal severo, una midriasis pupilar, una corectopia leve hacia el sector temporal con tracción iridiana hacia el ángulo y sinequias anteriores angulares en el lado de la corectopia. La realización de un recuento endotelial demostró alteraciones cuali y cuantitativas del endotelio en el ojo izquierdo. Se concluyó que la microscopia especular es fundamental para el diagnóstico y la evaluación en casos sospechosos de síndrome de Chandler(AU)

Chandler's syndrome is a clinical variant of the iridocorneal endothelial syndrome in which the common aspect is the altered corneal endothelium that is sometimes very difficult to be diagnosed on account of the complexity and variability of signs and symptoms. This article was aimed at showing the effectiveness of specular microscopy for diagnosis. Here is a 67 years-old female patient who had significant reduction of vision in her left eye. On examination, there were observed severe corneal edema, pupillary mydriasis, mild corectopia towards the temporal sector with angled iridal traction and anterior angle synechias on the corectopia side. The endothelial counting revealed qualitative and quantitative alterations in the left eye. It was concluded that the specular microscopy is the key to diagnosis and assessment of suspected Chandler's syndrome cases(AU)

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El síndrome de Chandler es una de las variaciones clínicas del síndrome iridocorneoendotelial, donde el denominador común es una alteración del endotelio corneal cuyo diagnóstico es, en ocasiones, muy difícil de realizar por la complejidad y la variabilidad de sus signos y síntomas. Se presenta una paciente de 67 años con disminución importante de la visión del ojo izquierdo. A la exploración existía un edema corneal severo, una midriasis pupilar, una corectopia leve hacia el sector temporal con tracción iridiana hacia el ángulo y sinequias anteriores angulares en el lado de la corectopia. La realización de un recuento endotelial demostró alteraciones cuali y cuantitativas del endotelio en el ojo izquierdo. Se concluyó que la microscopia especular es fundamental para el diagnóstico y la evaluación en casos sospechosos de síndrome de Chandler(AU)

Chandler's syndrome is a clinical variant of the iridocorneal endothelial syndrome in which the common aspect is the altered corneal endothelium that is sometimes very difficult to be diagnosed on account of the complexity and variability of signs and symptoms. This article was aimed at showing the effectiveness of specular microscopy for diagnosis. Here is a 67 years-old female patient who had significant reduction of vision in her left eye. On examination, there were observed severe corneal edema, pupillary mydriasis, mild corectopia towards the temporal sector with angled iridal traction and anterior angle synechias on the corectopia side. The endothelial counting revealed qualitative and quantitative alterations in the left eye. It was concluded that the specular microscopy is the key to diagnosis and assessment of suspected Chandler's syndrome cases(AU)

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Se describe el caso clínico de un paciente de 34 años de edad con un carcinoma basocelular nodular de párpado inferior del ojo izquierdo, de 3 años de evolución. Se procedió a aplicar el HeberPAG en inyección perilesional 3 veces por semana durante 3 semanas consecutivas. Terminadas las aplicaciones de este producto desaparecieron los signos clínicos del tumor. Se comenta el potencial destructor de este tumor, así como las técnicas utilizadas en el manejo de esta patología(AU)

We report a case of a 34 year old with a nodular basal cell carcinoma of the lower eyelid left eye, with 3 years of evolution. It was treated with perilesional HeberPAG 3 times each week for 3 weeks. With the applications of this product, the clinical signs of the cell carcinoma disappeared. The destructive potential of this tumor as well as the techniques used to manage this pathology were commented on in this article(AU)

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Se describe el caso clínico de un paciente de 34 años de edad con un carcinoma basocelular nodular de párpado inferior del ojo izquierdo, de 3 años de evolución. Se procedió a aplicar el HeberPAG en inyección perilesional 3 veces por semana durante 3 semanas consecutivas. Terminadas las aplicaciones de este producto desaparecieron los signos clínicos del tumor. Se comenta el potencial destructor de este tumor, así como las técnicas utilizadas en el manejo de esta patología(AU)

We report a case of a 34 year old with a nodular basal cell carcinoma of the lower eyelid left eye, with 3 years of evolution. It was treated with perilesional HeberPAG 3 times each week for 3 weeks. With the applications of this product, the clinical signs of the cell carcinoma disappeared. The destructive potential of this tumor as well as the techniques used to manage this pathology were commented on in this article(AU)

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Objetivo: identificar el riesgo de edema relacionado con los parámetros morfofuncionales del endotelio corneal en pacientes con indicación de cirugía de catarata. Métodos: se realizó un estudio descriptivo, transversal en 200 ojos de pacientes en la consulta preoperatoria de cirugía de catarata. Las variables estudiadas fueron edad, sexo, riesgo de edema, pleomorfismo y polimegatismo para lo cual se examinó a cada uno de ellos con microscopia especular. Además se examinaron en lámpara de hendidura en busca de la presencia de guttas corneales. Resultados: se obtuvo una edad media de 70,7 años y existió un predominio de las mujeres (67,7 por ciento) frente a los hombres (32,3 por ciento). No hubo riesgo de edema en un 80,5 por ciento y sí lo hubo en 39 ojos para un 19,5 por ciento. Se relacionó el polimegatismo y la edad estando presente en 176 ojos para un 88,0 por ciento y con un predominio del estadio leve en todos los grupos de edades con un 80,5 por ciento. El pleomorfismo estuvo presente en 186 ojos (93 por ciento) y de ellos 103 (51,5 por ciento) se encontraron en el estadio leve y 78 (39,0 por ciento) en el moderado. Conclusiones: la disminución de la densidad celular no es el único parámetro que indica que un endotelio es de riesgo para una cirugía de catarata, otros como el polimegatismo, el pleomorfismo, así como la presencia de guttas; también son de importancia(AU)

Objective: to identify the risk of edema associated with the morphological and functional parameters of the corneal endothelium in those patients with indication of cataract surgery. Methods: a cross-sectional and descriptive study was performed in 200 eyes from the patients attending the preoperative cataract surgery service. The studied variables were age, sex, risk of edema, pleomorphism and polymegatism. Each patient was examined with the specular microscopy and also a slit-lamp examination was made to look for cornea guttata. Results: the average age of the group was 70.7 years, with females predominating (67.7 percent) over males (32.3 percent). There was no risk of edema in 80.5 percent of cases whereas the risk was present in 19.5 percent (39 eyes). Polymegatism and age were associated, being this problem present in 176 eyes for 88 percent of the total number and predominant in its mild staging in all the age groups for 80.5 percent. Pleomorphism affected 186 eyes (93 percent) and 103 of them (51.5 percent) was at the mild staging and 78 (39 percent) at the moderate staging. Conclusions: reduction in the cell density is not the only parameter indicative of a risky endothelium for a cataract surgery, since others such as polymegatism, pleomorphism and presence of cornea guttata are also important(AU)

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Objetivo: identificar el riesgo de edema relacionado con los parámetros morfofuncionales del endotelio corneal en pacientes con indicación de cirugía de catarata. Métodos: se realizó un estudio descriptivo, transversal en 200 ojos de pacientes en la consulta preoperatoria de cirugía de catarata. Las variables estudiadas fueron edad, sexo, riesgo de edema, pleomorfismo y polimegatismo para lo cual se examinó a cada uno de ellos con microscopia especular. Además se examinaron en lámpara de hendidura en busca de la presencia de guttas corneales. Resultados: se obtuvo una edad media de 70,7 años y existió un predominio de las mujeres (67,7 por ciento) frente a los hombres (32,3 por ciento). No hubo riesgo de edema en un 80,5 por ciento y sí lo hubo en 39 ojos para un 19,5 por ciento. Se relacionó el polimegatismo y la edad estando presente en 176 ojos para un 88,0 por ciento y con un predominio del estadio leve en todos los grupos de edades con un 80,5 por ciento. El pleomorfismo estuvo presente en 186 ojos (93 por ciento) y de ellos 103 (51,5 por ciento) se encontraron en el estadio leve y 78 (39,0 por ciento) en el moderado. Conclusiones: la disminución de la densidad celular no es el único parámetro que indica que un endotelio es de riesgo para una cirugía de catarata, otros como el polimegatismo, el pleomorfismo, así como la presencia de guttas; también son de importancia

Objective: to identify the risk of edema associated with the morphological and functional parameters of the corneal endothelium in those patients with indication of cataract surgery. Methods: a cross-sectional and descriptive study was performed in 200 eyes from the patients attending the preoperative cataract surgery service. The studied variables were age, sex, risk of edema, pleomorphism and polymegatism. Each patient was examined with the specular microscopy and also a slit-lamp examination was made to look for cornea guttata. Results: the average age of the group was 70.7 years, with females predominating (67.7 percent) over males (32.3 percent). There was no risk of edema in 80.5 percent of cases whereas the risk was present in 19.5 percent (39 eyes). Polymegatism and age were associated, being this problem present in 176 eyes for 88 percent of the total number and predominant in its mild staging in all the age groups for 80.5 percent. Pleomorphism affected 186 eyes (93 percent) and 103 of them (51.5 percent) was at the mild staging and 78 (39 percent) at the moderate staging. Conclusions: reduction in the cell density is not the only parameter indicative of a risky endothelium for a cataract surgery, since others such as polymegatism, pleomorphism and presence of cornea guttata are also important

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PURPOSE: To investigate the pachymetric changes of collagen cross-linking in corneas with edema because of endothelial dysfunction. METHODS: Interventional case series included 25 eyes of 25 consecutive patients with corneal edema for at least 4 months related to Fuchs endothelial dystrophy, corneal graft failure, and postoperative bullous keratopathy. Central corneal thickness was measured preoperatively, 1, 3, and 6 months after the procedure by ultrasound pachymetry and optical coherence tomography. RESULTS: Mean central corneal thickness measured by ultrasound pachymetry decreased after corneal cross-linking (mean +/- SD): 712.0 +/- 99.7, 618.3 +/- 103.0, and 657.5 +/- 114.8 for preoperative, 1-, and 3-month follow-up, respectively. Differences between preoperative value and 1- and 3-month follow-up values were statistically significant (P < 0.01). Similar results were found with the optical coherence tomography (mean +/- SD): 777.3 +/- 131.0, 711.6 +/- 133.1, 746.4 +/- 142.4, and 830.6 +/- 198.7, for preoperative, 1-, 3-, and 6-month follow-up values, respectively. Fourteen patients (56%) developed new epithelial bullae after 3 months; 11 patients (44%) remained asymptomatic until their last visit. CONCLUSION: Corneal cross-linking showed to be a safe procedure and potential therapeutic alternative for the treatment of corneal edema.

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Blue eye (olho azul) é uma reação imune ocular pós-vacinal do adenovírus canino tipo I presente na vacina óctupla, que resulta em intenso edema corneano, uveíte, desconforto ocular e úlceras de córnea secundárias ao autotraumatismo do animal. Foi atendido no Hospital Veterinário do CCA-UFES, um cão da raça Beagle, macho com seis meses de idade, recém vacinado, apresentando alterações oculares há três dias. O teste de fluoresceína detectou presença de úlcera de córnea no olho direito, secundário ao blue eye. O animal foi tratado para as duas doenças, retornando após 21 dias com ausência de alterações oftálmicas

Blue eye is a post-vaccinal immune ocular reaction of the canine adenovirus type 1, present in the octuple vaccine, wich results in a deep cornean edema, uveite, ocular uncomfort and secondary cornea ulcer at the animal self-traimatism. In the CCA-UFES veterinary hospital, a six month old male Beagle, recently vaccinated, presenting ocular alteration for three days, was attended. The fluorescein test detected the presence of cornea ulcer in the right eye, secondary to blue- eye. Both diseases were treated, and the animal returned without oftalmic alterations in 21 days

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Blue eye (olho azul) é uma reação imune ocular pós-vacinal do adenovírus canino tipo I presente na vacina óctupla, que resulta em intenso edema corneano, uveíte, desconforto ocular e úlceras de córnea secundárias ao autotraumatismo do animal. Foi atendido no Hospital Veterinário do CCA-UFES, um cão da raça Beagle, macho com seis meses de idade, recém vacinado, apresentando alterações oculares há três dias. O teste de fluoresceína detectou presença de úlcera de córnea no olho direito, secundário ao blue eye. O animal foi tratado para as duas doenças, retornando após 21 dias com ausência de alterações oftálmicas(AU)

Blue eye is a post-vaccinal immune ocular reaction of the canine adenovirus type 1, present in the octuple vaccine, wich results in a deep cornean edema, uveite, ocular uncomfort and secondary cornea ulcer at the animal self-traimatism. In the CCA-UFES veterinary hospital, a six month old male Beagle, recently vaccinated, presenting ocular alteration for three days, was attended. The fluorescein test detected the presence of cornea ulcer in the right eye, secondary to blue- eye. Both diseases were treated, and the animal returned without oftalmic alterations in 21 days(AU)

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We report the optical and ultrasonic biomicroscopy and confocal microscopy findings in bilateral stromal keratitis (keratoendotheliitis), a rare ocular manifestation of systemic lupus erythematosus (SLE). Examination revealed deposits with polyrefringent crystals. Topical corticosteroid produced regression of the corneal edema, but there was an increase in corneal opacity. Ultrasound biomicroscopy images confirmed the deep location of the corneal opacities, and confocal microscopy showed a disruption of the corneal stroma and crystal-like bodies.

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Objetivo: Comparar as características clínicas e os resultados do tratamento cirúrgico entre casos com e sem hidropisia aguda, do total de 567 pacientes com ceratocone. Métodos: Foram revistos os prontuários de todos os casos de ceratocone acompanhados entre 1982 e 2000 no Hospital Universitário Antônio Pedro - UFF e na Clínica Oftalmológica Souza pena, em Niterói. Acuidade visual, tempo de evolução, tipo de correção ótica, morfologia do ceratocone, classificação ceratométrica e resultados cirúrgicos foram as principais variáveis comparadas entre os dois grupos. Resultados: A incidência de hidropisia aguda foi 5,8 por cento. Não houve diferença estatisticamente significativa entre os grupos quanto ao sexo, história familiar e atopia. No grupo da hidropisia aguda, 72,7 por cento dos casos foram classificados como periféricos, contrastando com 21,4 por cento do grupo controle (p<0,05). Dezenove por cento dos pacientes foram submetidos à ceratoplastia penetrante. Dentre os 1062 olhos que não desenvolveram hidropisia aguda, 8,4 por cento foram operados, ao passo qu 88,4 por cento dos olhos com hidropisia submeteram-se ao transplante de córnea (p<0,05). O resultado pós-operatório não diferiu entre os dois grupos. Conclusão: O ceratocone periférico esteve mais associado à hidropisia aguda e , consequentemente, à indicação de ceratoplasti penetrante. O prognóstico do tratamento cirúrgico não diferiu entre os grupos desta amostra.

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