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PURPOSE: The Ocular Surface Disease Index (OSDI) is the most frequently used dry eye disease (DED) questionnaire, and the Symptom Assessment iN Dry Eye (SANDE) is the simplest and quickest to apply. We analyze the correlation and level of agreement between these two questionnaires in a large DED heterogeneous population to evaluate their performance and potential interchangeability. METHODS: Prospective, multicenter longitudinal survey-based study performed on patients diagnosed with DED by 99 ophthalmologists from 20/32 Mexican states. Questionnaires were applied in two consecutive visits to analyze the correlation between OSDI and SANDE to evaluate patients with DED clinically. Level of agreement was evaluated with Bland-Altman analysis, and internal consistency of instruments was evaluated individually and combined with Cronbach's alpha index. RESULTS: 3421 patients studied: 1996 (58.3%) women and 1425 (41.7%) men, aged 49.5 ± 15.4 years; 995 (29.1%) patients had aqueous-deficient, 1086 (31.7%) evaporative, and 1340 (39.2%) mixed DED subtypes. Normalized baseline scores were 53.7 (OSDI) and 54.1 (SANDE). After 36.3 ± 24.4 days between visits, scores were reduced to 25.2 (OSDI) and 21.8 (SANDE) points (p < .001). A positive correlation between questionnaires was found at baseline (R = 0.592; p < .001), follow-up (R = 0.543; p < .001) and change between visits (R = 0.630; p < .001). Using both questionnaires together improved the overall reliability of symptom evaluation at baseline (α = 0.7), follow-up (α = 0.7), and both (α = 0.7), compared to individual application (OSDI α = 0.5, SANDE α = 0.6)-the same improvements applied to all DED subtypes. Bland-Altman analysis revealed a differential bias of -0.41% at baseline and +3.6% at follow-up visits between OSDI and SANDE. CONCLUSIONS: We validated the correlation (high precision) between questionnaires in a large-scale population, demonstrating improved reliability (high accuracy) in evaluating DED when used together, challenging their interchangeable use. These results open a venue to improve recommendations toward a more precise and accurate diagnostic and therapeutic evaluation of DED by using OSDI and SANDE concurrently.
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Síndromes do Olho Seco , Masculino , Humanos , Feminino , Avaliação de Sintomas , Reprodutibilidade dos Testes , Estudos Prospectivos , Inquéritos e Questionários , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/epidemiologiaRESUMO
OBJECTIVE: To evaluate early keratometric and refractive results after intra-corneal rings surgery in keratoconus patients. METHOD: 50 eyes of 25 patients with keratoconus within stage 2 and 3, underwent intra-stromal corneal rings surgery by using the femtosecond surgical laser, one month after surgery, corneal keratometries and patient refraction were compared vs pre-operative ones. RESULTS: Mean pre-operative low keratometry was 48.8 ± 3.65 D vs. 46.44 ± 3.65 D post-operative (p < 0.005). Mean pre-operative high keratometry was 53.92 ± 4.50 vs. 49.65 ± 4.15 post-operative (p < 0.005). Mean pre-operative spherical equivalent was -7.39 ± 2.42 D vs. -3.48 ± 2.47 D post-operative (p < 0.005). Mean pre-operative cylinder was -5.65 ± 2.02 D vs. -3.48 ± 2.47 D post-operative (p < 0.005). CONCLUSIONS: Corneal keratometries, spherical equivalent and corneal cylinder, significant decrease at one month after intra-stromal corneal rings surgery in keratoconus patients.
OBJETIVO: Evaluar los resultados queratométricos y refractivos tempranos de pacientes con queratocono operados con anillos intracorneales. MÉTODO: Se evaluaron 50 ojos de 25 pacientes con queratocono de grado 2 o 3, posoperados con colocación de anillos intracorneales mediante el uso de láser de femtosegundos, al mes del posoperatorio, comparando las queratometrías y las refracciones antes y después de la operación. RESULTADOS: El promedio preoperatorio de las queratometrías planas fue de 48.8 ± 3.65 D y en el posoperatorio fue de 46.44 ± 3.65 D (p < 0.005). El promedio preoperatorio de las queratometrías curvas fue de 53.92 ± 4.50 y en el posoperatorio fue de 49.65 ± 4.15 (p < 0.005). El equivalente esférico preoperatorio fue de −7.39 ± 2.42 D y en el posoperatorio fue de −3.48 ± 2.47 D (p < 0.005). El promedio del cilindro preoperatorio fue de −5.65 ± 2.02 D y en el posoperatorio fue de −3.48 ± 2.47 D (p < 0.005). CONCLUSIONES: La colocación de anillos intracorneales reduce de forma significativa tanto las queratometrías como los equivalentes esféricos y el astigmatismo en pacientes con queratocono en forma temprana.
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Ceratocone , Substância Própria/cirurgia , Topografia da Córnea , Humanos , Ceratocone/cirurgia , Implantação de Prótese/métodos , Resultado do Tratamento , Acuidade VisualRESUMO
Dry eye disease (DED) has a higher prevalence than many important systemic disorders like cardiovascular disease and diabetes mellitus, representing a significant quality of life burden for the affected patients. It is a common reason for consultation in general eye clinics worldwide. Nowadays, the diagnostic and therapeutic approach at the high corneal and ocular surface specialty level should be reserved for cases of severe and chronic dry eye disease associated with systemic autoimmune diseases or complicated corneal and ocular surface pathologies. In such cases, the diagnostic and therapeutic approach is often complex, elaborate, time-consuming, and costly due to the use of extensive dry eye questionnaires, noninvasive electronic diagnostic equipment, and clinical laboratory and ancillary tests. However, other eye care specialists attend a fair amount of DED cases; therefore, its diagnosis, classification, and management should be simple, practical, achievable, and effective. Considering that many patients attending non-specialized dry eye clinics would benefit from better ophthalmological attention, we decided to elaborate a practical DED classification system based on disease severity to help clinicians discriminate cases needing referral to subspecialty clinics from those they could attend. Additionally, we propose a systematic management approach and general management considerations to improve patients' therapeutic outcomes according to disease severity.
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PURPOSE: Dry eye disease is characterized by loss of tear film stability. OC-01 (varenicline solution) is a small-molecule nicotinic acetylcholine receptor agonist administered as a nasal spray that stimulates tear production. METHODS: In MYSTIC (NCT03873246) patients aged ≥22 years with dry eye disease were randomized 1:1:1 to OC-01 0.03 mg, OC-01 0.06 mg, or vehicle (n = 41 per group), administered twice daily via intranasal spray, for 12 weeks (84 days). Primary efficacy endpoint was mean change from baseline in anesthetized Schirmer's test score (STS) in study eye at day (D) 84. RESULTS: Patients receiving OC-01 0.03 and 0.06 mg had statistically significantly increased tear production at D84 versus vehicle; least squares mean changes from baseline in STS were 10.8 mm and 11.0 mm for OC-01 0.03 and 0.06 mg, respectively. A trend toward a higher proportion of patients experiencing ≥10-mm improvement in STS from baseline was observed with OC-01 0.03 mg (36.6%; p > 0.05), and was significant for OC-01 0.06 mg (48.8%; p = 0.024), versus vehicle (24.4%). Non-ocular treatment-emergent adverse events (TEAEs) were reported by 21 patients; the most common was sneezing (OC-01 0.03 mg, 2 [4.9%]; OC-01 0.06 mg, 3 [7.3%]), with similar frequencies between treatment groups. No severe or serious TEAEs were reported. CONCLUSIONS: OC-01 (varenicline solution) nasal spray improved tear production in patients with dry eye disease over a long-term (12-week) period, and represents a receptor neuro-activator with a nasal route of administration that spares the ocular surface to stimulate tear production.
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Síndromes do Olho Seco , Sprays Nasais , Vareniclina , Síndromes do Olho Seco/tratamento farmacológico , Humanos , Lágrimas , Resultado do Tratamento , Vareniclina/efeitos adversosRESUMO
PURPOSE: To present a case series of non-healing corneal ulcers treated by solid activated platelet-rich plasma (PRP) combined with silicone-hydrogel soft contact lens. METHODS: Three eyes from three patients with unresponsive corneal ulcers were included. A clot of PRP was applied directly onto the corneal ulcer and covered with a soft contact lens. The primary outcome was corneal healing. Changes in corneal ulcer area were measured by analyzing slit-lamp photographs taken using ImageJ software. RESULTS: Successful corneal healing was achieved in all patients within two weeks, with no recurrences or signs of infection through the last follow-up. In two of the three cases, treatment was applied twice. CONCLUSIONS: This novel procedure was easy to perform, economically advantageous, and a possible alternative to surgical approaches for enhancing epithelial wound healing in patients with non-healing corneal ulcers. Further prospective and comparative studies are needed to assess the efficacy of this treatment.
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Lentes de Contato Hidrofílicas , Úlcera da Córnea , Plasma Rico em Plaquetas , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/cirurgia , Humanos , Hidrogéis , Silicones , ÚlceraRESUMO
OBJECTIVE: To evaluate confocal microscopy finding after SMILE surgery by in vivo confocal microscopy and stromal lenticule and stromal interface accuracy planed vs measured. METHOD: Thirty eyes of 15 patients were evaluated before and 1 month after SMILE surgery by using confocal microscopy. Cellular morphology was studied. Planed stromal lenticule thickness was compared vs measured stromal lenticule thickness after surgery by comparing the total stromal corneal thickness before vs after surgery. Stromal corneal interface was evaluated and depth of this planed interface was compared vs measured post-surgery interface depth. RESULTS: Sub-epithelial nerve plexus was absent at 1 month after surgery. Activated keratocytes were found before and after stromal corneal interface depth. There was not statistical significant difference between mean planed stromal lenticule vs. post-surgery measured (102.3 ± 25.7 vs. 104.2 ± 29.9 mm; p = 0.73). There was not statistical significant difference between mean planed stromal interface depth vs. post-surgical measured (113.7 ± 8.2 vs. 120.5 ± 17.3 mm; p = 0.058). CONCLUSIONS: Confocal microscopy is useful to evaluate changes after SMILE surgery; lenticule thickness and stromal interface depth are exact.
OBJETIVO: Evaluar los hallazgos mediante microscopía confocal in vivo de pacientes operados de cirugía SMILE, la exactitud del lentículo estromal y la profundidad de la interfaz estromal planeados versus medidos. MÉTODO: Treinta ojos de 15 pacientes operados de SMILE se estudiaron mediante microscopía confocal antes y al mes de la cirugía. Se evaluaron la morfología celular, el espesor del lentículo estromal planeado versus el medido en el posoperatorio mediante la diferencia entre el espesor estromal preoperatorio y el postoperatorio, así como la interfaz estromal, y se comparó la profundidad de esta interfaz estromal planeada con la medida en el posoperatorio. RESULTADOS: Se observó la ausencia del plexo nervioso subepitelial al mes del posoperatorio y una activación de queratocitos anterior y posterior a la profundidad de la interfaz estromal. No hubo diferencia en el lentículo estromal planeado versus el medido en el posoperatorio (102.3 ± 25.7 vs. 104.2 ± 29.9 mm; p = 0.73). No hubo diferencia entre la profundidad de la interfaz estromal planeada y medida (113.7 ± 8.2 vs. 120.5 ± 17.3 mm; p = 0.058). CONCLUSIONES: Tras la cirugía SMILE se pueden evaluar los cambios mediante microscopía confocal; el espesor del lentículo y la profundidad de la interfaz son exactos.
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Miopia , Procedimentos Cirúrgicos Refrativos , Substância Própria/diagnóstico por imagem , Substância Própria/cirurgia , Humanos , Lasers de Excimer , Microscopia Confocal , Miopia/cirurgia , Estudos ProspectivosRESUMO
PURPOSE: To investigate the efficacy of photoactivated chromophore corneal collagen cross-linking (PACK)-CXL in the management of treatment-resistant infectious keratitis. DESIGN: Observational cohort study. PARTICIPANTS: Forty-two eyes from 41 patients with treatment-resistant infectious keratitis. METHODS: Eyes underwent PACK-CXL treatment with the Dresden modified protocol in addition to standard antimicrobial therapy. The primary endpoint was the size of the corneal ulcer. Descriptive statistics, Wilcoxon rank test, McNemar test and Spearman correlation coefficient were used for statistical analysis, and p values lower than 0.05 were considered statistically significant. RESULTS: Success rate at third postoperative month was of 90.5%. Statistical analyses showed a significant effect of (PACK)CXL with standard antimicrobial therapy to reduce corneal ulcer size (p=0.031). CONCLUSION: As adjuvant therapy to standard antimicrobial treatment, PACK-CXL improves the outcomes in patients with treatment-resistant corneal ulcers.
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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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Córnea/patologia , Edema da Córnea/cirurgia , Técnicas de Sutura , Acuidade Visual , Doença Aguda , Adolescente , Adulto , Criança , Córnea/cirurgia , Edema da Córnea/diagnóstico , Paquimetria Corneana/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Meibography is a diagnostic test that allows in vivo evaluation of meibomian gland (MG). Nowadays, it is unknown whether the two available computer programs are equivalent to evaluate the glandular loss area. METHODS: This is a prospective, longitudinal, and observational study. A random selection of meibography photographs from healthy patients from the ocular surface clinic at Destellos de Luz foundation is made. The upper eyelid images were taken with the Antares® meibography (CSO, Florence, Italy); they were classified in five sessions with a week of separation between each measurement by an expert observer for each program, Phoenix (MAGL) and ImageJ (LAGB). An analysis of the meibomian gland loss area was performed, calculating it semiautomatically with Phoenix and manually with ImageJ. Intra-observer agreement was assessed through an intra-class correlation coefficient and the mean of standard deviations within subjects. Comparison between the two computational programs MG loss was made trough a nonparametric test. RESULTS: Fifty-four images from x patients (n, 67.3% female) were analyzed. The limits of concordance analysis between the two programs showed a range between - 18.55 and 9.14%. The mean MG loss area through ImageJ by observer 1 was 27.91 ± 14.82% (IC 95% 23.87 to 31.96), and that by observer 2 was 29.05 ± 15.17% (95% CI 24.91 to 33.19). The mean MG loss area through Phoenix by observer 1 was 24.48 ± 13.97% (IC 95% 20.67 to 28.29), and that by observer 2 was 24.93 ± 12.70% (95% CI 21.46, 28.40) CONCLUSIONS: The comparison of the measurement of meibomian gland loss with both programs showed a statistically significant difference. Intra-observer repeatability and inter-observer repeatability were good, with no clinical or statistical difference.
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Diagnóstico por Computador/métodos , Pálpebras/patologia , Disfunção da Glândula Tarsal/diagnóstico , Glândulas Tarsais/patologia , Software , Lágrimas/metabolismo , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Masculino , Disfunção da Glândula Tarsal/metabolismo , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Adulto JovemRESUMO
PURPOSE: We describe the functioning of a novel device, aimed to assess patient head position after a pneumatic retinopexy. METHODS: We enrolled patients with the clinical diagnosis of rhegmatogenous retinal detachment. All patients were asked to wear a specially designed headband with a monitoring device composed of an accelerometer, gyroscope, and magnetometer, powered by a 3.7V lithium battery. Every 200 ms, the device measured neck flexion and extension, left and right rotation, and left and right flexion. Patients were asked to come back the next morning for follow-up and headband retrieving. RESULTS: The device was worn an average of 19.17 ± 2.1 hours and performed a mean number of 57,670 ± 8663 measurements without power failures or program errors. An acceptable head position was kept for a mean of 3.33 ± 1.8 hours. The hardest axis to maintain was the right and left flexion of the neck (5.5 ± 2.54 hours of acceptable positioning). CONCLUSION: Real-time monitoring of patient head position after a vitreoretinal procedure is feasible. Maintaining a fixed head position for more than 5 consecutive hours is difficult to achieve and physicians should consider this difficulty when planning treatment. TRANSLATIONAL RELEVANCE: In addition to a significant improvement to the basic design of similar devices, our device allows for assessment of patient adherence to postoperative instructions objectively for the first time to our knowledge. This information could be used in the future to elaborate more detailed position nomograms to improve outcomes.
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PURPOSE: To translate and validate a Spanish-language adaptation of the 5-Item Dry Eye Questionnaire for the Mexican population. METHODS: Based on the MAPI Institute guidelines, the linguistic validation procedures consisted of four steps. Every step was reviewed by the committee. The translated validated questionnaire was applied to 25 Mexican subjects. The questionnaires were completed by the same subjects at three time points, 8 h apart on the same day and then 3 days later. Sensitivity and specificity of the DEQ-5 to predict DE signs was subsequently estimated in 200 patients see in the Asociación para Evitar la Ceguera ophthalmology clinic. RESULTS: During the forward translation step analysis, the committee decided to change the severity scale, as the words "constantly" and "frequently" are synonymous in Spanish, so it was modified by changing "constantly" to "always" for better understanding. Overall, the intra-test intra-class correlation coefficient from tests administered on the same day was 0.9 (95% CI 0.77-0.95, p = 0.0005). The intra-test intra-class correlation coefficient from tests administered 3 days apart was 0.9 (95% CI 0.88-0.97, p = 0.0005). When applying the questionnaire to 200 patients seen in an eye clinic, we found a sensitivity of 76% and a specificity of 31% for a DEQ-5 score of ≥ 6, against 2 or more positive signs of dry eye. CONCLUSION: MAPI methodology proved to be a reliable strategy for the transcultural Dry Eye Questionnaire for translation from English to Spanish for the Mexican population.
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Comparação Transcultural , Síndromes do Olho Seco/diagnóstico , Psicometria/instrumentação , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Diagnóstico Oftalmológico/estatística & dados numéricos , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Traduções , Adulto JovemRESUMO
PURPOSE: To analyze potential risk factors for ocular surface damage in a representative population of Mexican patients with dry eye disease (DED). PATIENTS AND METHODS: A prospective and cross-sectional population-based epidemiologic cohort study was conducted through a survey of patients with symptoms, signs, known preexisting diagnosis, and clinical conditions related to DED. Fluorescein staining, tear break-up time (TBUT), and Oxford lissamine green staining were performed on both eyes of patients enrolled in the study. RESULTS: A total of 2,725 surveys including 1,543 (56.6%) women and 1,182 (43.3%) men were analyzed. Most common pre-existing diagnosis included dry eye (58%), chronic blepharitis (17%), and ocular allergy (15%). More than 70% of patients had a positive fluorescein test, and this prevalence increased proportionally to the number of reasons for consultation. The same was true for gender (P<0.001) and age (P<0.0001), with women showing a strong correlation with age (R2=0.93912, P=0.001). The association between positive fluorescein staining and diagnosis was significant for dry eye (P<0.0001), Sjögren's syndrome (P<0.0001), and glaucoma (P<0.05). No significant association between TBUT and age or gender was found, but the shorter the TBUT, the larger the prevalence of fluorescein staining. Reduced TBUT was seen more frequently in patients with dry eye (57%), ocular allergy (16%), and chronic blepharitis (15%). Most patients (39%) with Oxford grades III and IV were older, complained of red eye (51.0%), foreign body sensation (47.0%), burning (46.0%), and were using eye drops (67%) and systemic medications (47%). CONCLUSION: The Mexican profile of patients with significant ocular surface damage related to DED includes women at older ages, complaining of red eye, foreign body, and burning sensation. Diagnoses of dry eye, Sjögren's syndrome, and glaucoma were also risk factors for significant ocular surface damage, along with long-term use of preserved eyes drops and systemic medications.
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OBJECTIVE: To evaluate early in vivo corneal wound healing findings after Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) by using in vivo confocal microscopy. METHOD: A total of 15 eyes of 15 patients were included. In vivo confocal microscopy (Confoscan 4, Fortune Technologies, Italy) was performed from 4 to 7 weeks after DSAEK. Measurements were scanned from the corneal endothelium to the corneal surface with a Navis® software (NIDEK, Multi-Instrument Diagnostic System, Japan). RESULTS: Donor-receptor interface was found in an average of 114 ± 12.4 microns. Corneal stromal folds were observed from 111.1 ± 3.5 microns from the endothelium to 286 ± 94 microns (mean 175 ± 90.5 microns of the corneal stroma). Keratocites were activated in the donor tissue from 12 ± 1.4 microns from the endothelium to 105 ± 38.2 microns (mean 93 ± 36.9 microns of the corneal stroma). CONCLUSIONS: Donor keratocites are activated up to 7 weeks after DSAEK. Several corneal folds are present in proximity to the donor-receptor interface after DSAEK. Further evaluation of these findings is justified to determine its clinical significance.
OBJETIVO: Evaluar los hallazgos cicatriciales tempranos en la córnea de pacientes operados de DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty) mediante microscopía confocal in vivo. MÉTODO: Se incluyeron 15 ojos de 15 pacientes. Se realizó microscopía confocal (Confoscan 4, Fortune Technologies, Italy) entre las 4 y las 7 semanas después de la cirugía de DSAEK. Las mediciones se realizaron desde el endotelio al epitelio corneal utilizando el programa Navis® software (NIDEK, Multi-Instrument Diagnostic System, Japan). RESULTADOS: La interface donador-receptor se encontró a 114 ± 12.4 micras en promedio. Se comenzaron a observar pliegues en el estroma a 111.1 ± 3.5 micras desde el endotelio corneal hasta 286 ± 94 micras (promedio de 175 ± 90.5 micras del estroma corneal). Se comenzó a observar activación de queratocitos en el tejido donador a 12 ± 1.4 micras desde el endotelio hasta 105 ± 38.2 micras (promedio de 93 ± 36.9 micras del estroma corneal). CONCLUSIONES: Los queratocitos del tejido donador se encontraron activados hasta 7 semanas después de la cirugía de DSAEK. En la proximidad de la interface donador-receptor se encontraron grandes pliegues en el estroma después de cirugía de DSAEK. Se requieren futuras evaluaciones para determinar la significancia clínica de estos hallazgos.
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Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Endotélio Corneano/diagnóstico por imagem , Endotélio Corneano/transplante , Microscopia Confocal , Idoso , Cicatriz/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
To evaluate indications and outcomes of pediatric keratoplasty in a tertiary eye center, and identify factors that affect visual outcomes.We performed a retrospective review of penetrating keratoplasty in children aged 0 to 18 years between 1995 and 2011 in the Asociación para Evitar la Ceguera en México IAP, Hospital "Dr. Luis Sánchez Bulnes".A total of 574 penetrating keratoplasties were performed during the study interval. Median follow-up was 5.0 years. Main indications included keratoconus (55.58%), postherpetic scarring (9.58%), traumatic opacities (7.49%), and bullous keratopathy (6.09%). Rejection rates at 5 years were 27% overall, and among indications, keratoconus showed the best graft survival at 60-months follow-up (85%). The percentage of patients with best corrected visual acuity (BCVA) posttransplant >20/400 at 5 years in the nonrejection group was 81.25% and 82.74% in < and > 10 years of age (YOA) groups, respectively, versus a BCVA posttransplant > 20/400 at 5 years in the rejection group of 53.68% and 51.72% in < and > 10 YOA groups, respectively. There was a statistically significant reduced rejection rate between genders at 18 months of follow-up, favoring males.Despite being considered a high-risk procedure in children, penetrating keratoplasty can achieve good results, especially in patients with keratoconus. It can achieve significative improvements of visual acuity, provided there is an adequate follow-up and treatment adherence.
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Cicatriz/cirurgia , Doenças da Córnea/cirurgia , Transplante de Córnea/efeitos adversos , Rejeição de Enxerto/epidemiologia , Adolescente , Criança , Cicatriz/virologia , Doenças da Córnea/etiologia , Transplante de Córnea/métodos , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Acuidade VisualRESUMO
OBJECTIVE: To determine the prevalence of symptoms of ocular surface disease (OSDI) surface disease and its relationship with associated risk factors in patients of ophthalmic practices using OSDI questionnaire. METHOD: A cross-sectional survey was conducted Between September and December 2014 to assess the prevalence and risk factors for OSDI. RESULTS: The OSDI average value was 40.46 ± 23.62 points, with 86.4% of patients (1967) having a OSDI score higher than 12 points. Women had OSDI symptoms more frequently than men (odds ratio: 1.17; 95% confidence interval: 1.08-1.28) and higher OSDI score (42.12 ± 24.03 vs. 38.01 ± 22.81 points). Patients without disease were younger than the patients with severe disease (45.30 ± 18.32 vs. 50.62 ± 18.86). CONCLUSIONS: Ophthalmological patients have a prevalence of 80.4% of OSDI. Female and older age was associated with ocular surface disease.
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Doenças da Túnica Conjuntiva/epidemiologia , Fatores Etários , Intervalos de Confiança , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores Sexuais , Inquéritos e Questionários , Xeroftalmia/epidemiologiaRESUMO
PURPOSE: The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE) among patients attending a tertiary care ophthalmology center in Mexico. METHODS: Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer's test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected. RESULTS: The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22%) in our population than evaporative deficiency (94%). Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry mouth. CONCLUSION: This is the first study to demonstrate the frequency of symptomatic and clinical DE in a tertiary care ophthalmology center in Mexico. The frequency of DE ranged from 30% using a symptomatic definition to 94% using objective measures. Different risk factors were found for different aspects of DE, suggesting differing underlying pathophysiologies behind different DE subtypes.
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PURPOSE: To report a case of corneal ectasia secondary to pars planitis corneal endotheliopathy METHODS: Clinical case description and proposed hypothesis regarding development of corneal ectasia RESULTS: Eight-year-old male presented with 360° peripheral corneal endotheliopathy and edema, granulomatous keratic precipitates, and mild iritis OD. A progressive corneal ectasia then developed. Twenty months later, OS presented similarly and anterior chamber inflammatory cells, vitreous snowballs, and retinal vasculitis were observed OU. Classic pars planitis was diagnosed CONCLUSION: This is the first case of endotheliopathy as the first manifestation of pars planitis and as a cause of a secondary central cornea ectasia developed.
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PURPOSE: To report a patient who developed corneal flap dislocation following air bag injury 48 months after LASIK. METHODS: Evaluation by slit-lamp microscopy and fluorescein angiography. RESULTS: A 29-year-old man was treated after air bag injury that occurred 48 months after LASIK. Examination revealed corneal flap dislocation, with severe folds and flap edema. Preoperative visual acuity was finger counting at 1 m. Visual acuity was 20/400 24 hours after repositioning the corneal flap. Retinal angiography revealed Berlin macular edema, which was injected with periocular steroids. Five days after injection, visual acuity remained 20/400, but improved to 20/40 1 month after injection. CONCLUSIONS: Significant trauma can dislocate a corneal flap many months after surgery.