Endotelitis por citomegalovirus y su diagnóstico mediante la microscopia confocal / Cytomegalovirus endotheliitis and its diagnosis by confocal microscopy

Objetivo: Describir las características del endotelio corneal por microscopia confocal en pacientes con lesiones basofílicas de inclusión como patognomónicas de endotelitis por citomegalovirus. Métodos: Se realizó un estudio observacional de casos clínicos en pacientes con diagnóstico de endotelitis por citomegalovirus, atendidos en la Consulta de Córnea del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre febrero del año 2010 y junio del 2018. La muestra incluyó 39 pacientes con diagnóstico clínico de endotelitis, a quienes se les realizó microscopia confocal con el equipo Confoscan 4 (Nidek Technologies). Resultados: De los 39 pacientes, 29 fueron del sexo masculino y 10 del femenino. Todos tenían entre 41 y 60 años de edad. En el 97,4 por ciento de los casos existió el antecedente de una conjuntivitis viral y un solo paciente fue positivo de HIV (2,6 por ciento). La mejor agudeza visual corregida de 0,3 o menos se mostró en el 100 por ciento de ellos antes del tratamiento, y después de este los 39 tenían entre 0,8 y 1,0. En el 100 por ciento de los casos se observaron cuerpos de inclusión basofílicos en el endotelio corneal, que fueron apreciables mediante la microscopia confocal. Conclusiones: Existe una relación entre la presencia de cuerpos de inclusión basofílicos en el endotelio corneal y las pruebas virológicas a citomegalovirus positivas, lo que puede permitir hacer PCR a casos que ya tienen confirmación mediante microscopia confocal de las características patognomónicas del endotelio corneal(AU)

Objective: Describe the characteristics of the corneal endothelium by confocal microscopy in patients with inclusion basophilic lesions as pathognomonic signs of cytomegalovirus endotheliitis. Methods: An observational study was conducted of clinical cases of patients diagnosed with cytomegalovirus endotheliitis attending the Cornea Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2010 to June 2018. The study sample was 39 patients with a clinical diagnosis of endotheliitis who underwent confocal microscopy with a Confoscan 4 device (Nidek Technologies). Results: Of the 39 patients examined, 29 were male and 10 were female. All were aged 41-60 years. 97.4 percent had a history of viral conjunctivitis and only one was HIV positive (2.6 percent). Best corrected visual acuity was 0.3 or less in 100 percent before treatment, and 0.8 to 1.0 after treatment. Inclusion basophilic bodies visible by confocal microscopy were observed in the corneal endothelium of all patients. Conclusions: A relationship exists between the presence of inclusion basophilic bodies in the corneal endothelium and virological tests positive for cytomegalovirus, making it possible to perform PCR testing in cases with confocal microscopy confirmation of the pathognomonic characteristics of the corneal endothelium(AU)

Morfología y morfometría del endotelio corneal en adultos sin alteraciones corneales según cantidad de células evaluadas / Morphology and morphometry of the corneal endothelium in adults without corneal alterations according to the number of evaluated cells

Objetivo: describir las características morfológicas y morfométricas del endotelio corneal en adultos sin alteraciones corneales según cantidad de células evaluadas atendidos en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido de enero a febrero del año 2016. Métodos: se realizó una investigación descriptiva de corte transversal de serie de casos atendidos en el Servicio de Cirugía Refractiva. Después de aplicar los criterios de exclusión, la muestra quedó conformada por 90 ojos de 45 pacientes adultos sanos. Se realizó microscopia endotelial de no contacto SP-3000P, para identificar los valores morfológicos (hexagonalidad y coeficiente de variabilidad) y morfométricos (densidad celular y paquimetría), así como el promedio del tamaño celular corneal según cantidad de células evaluadas. Resultados: según la cantidad de células endoteliales evaluadas no hubo diferencias en cuanto a la paquimetría en ambos ojos (p> 0,05). En relación con la densidad no existieron diferencias significativas entre la cantidad de células evaluadas en ambos ojos (p> 0,05). Los valores de hexagonalidad, coeficiente de variabilidad y tamaño celular promedio no mostraron diferencias significativas (p> 0,05) en ambos ojos según la cantidad de células evaluadas. Conclusiones: el estudio del endotelio corneal mediante la utilización del microscopio especular constituye un método efectivo que permite conocer las características de las células endoteliales sin existir variaciones según la cantidad de células evaluadas(AU)

Objective: to describe the morphological and morphometric characteristics of the corneal endothelium in adults without corneal alterations according to the number of evaluated cells, who had been seen at the refractive survey service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to February, 2016. Methods: descriptive, cross-sectional case-series research study of patients seen at the refractive surgery service. After applying the exclusion criteria, the sample was finally made up of 90 eyes from 45 healthy adult patients. SP-3000P non-contact endothelial microscopy was performed to determine the morphological (hexagonality and variability coefficient) and morphometric (cell density and pachymetry) values and the average of the average cellular corneal size according to the number of evaluated cells. Results: according to the number of evaluated endothelial cells, there were no differences as for the pachymetry in both eyes (p> 0.05). Regarding the cell density, there were no significant differences among the number of evaluated cells in both eyes (p> 0.05). The hexagonality, variability coefficient and average cell size did not show significant differences (p> 0.05) in both eyes according to the number of evaluated cells. Conclusions: the study of the corneal endothelium using the specular microscope is an effective method that allows to know the characteristics of the endothelial cells without no previous variations, according to the number of evaluated cells(AU)

Morfología y morfometría del endotelio corneal en adultos sin alteraciones corneales / Morphology and morphometry of the corneal endothelium in adults without corneal alterations

Objetivo: describir las características morfológicas y morfométricas del endotelio corneal en adultos sin alteraciones corneales atendidos en el Servicio de Córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido de enero a julio del año 2015. Métodos: se realizó una investigación descriptiva de corte transversal de serie de casos, en el Servicio de Córnea. Después de aplicar los criterios de exclusión, la muestra quedó conformada por 324 ojos de 162 pacientes adultos. Se realizó microscopia endotelial de no contacto SP-3000P, para identificar los valores morfológicos (hexagonalidad-coeficiente de variabilidad) y morfométricos (densidad celular-paquimetría) y el promedio del tamaño celular. Resultados: según los grupos de edades, no hubo diferencias en cuanto a la paquimetría en ambos ojos (p> 0,05). En relación con la densidad, existieron diferencias significativas entre los diferentes grupos de edades en ambos ojos (p< 0,001). Los valores de las medias de la hexagonalidad y del coeficiente de variabilidad no mostraron diferencias significativas (p> 0,05) en ambos ojos. Los valores de las medias del tamaño celular promedio según grupos de edades fueron diferentes de forma significativa en ambos ojos (p< 0,001). No existieron diferencias significativas (p< 0,05) entre los sexos según ojos derecho e izquierdo. Conclusiones: el estudio del endotelio corneal mediante la utilización del microscopio especular constituye un método efectivo que permite conocer las características de las células endoteliales(AU)

Objective: to describe the morphological and morphometric characteristics of the corneal endotelium in adults without corneal alterations at the cornea care service of Ramón Pando Ferrer Cuban Institute of Ophthalmology in the period of January to July 2015. Methods: descriptive, cross-sectional case series study conducted in a final sample of 324 eyes from 162 adult patients at the cornea care service after using the exclusion approaches. SP-3000P non-contact endothelial microscopy was performed to identify the morphological (hexagonality and variability coefficient) and morphometric (cellular density-pachymetry) values as well as the average cell size. The analyzed period embraced from January to July of 2015. Results: there were no differences as for the pachymetry in both eyes (p>0,05) by age groups. Regarding density, significant differences in both eyes among the different group ages (p< 0,001) were found. The mean values of hexagonality and the variability coefficient did not show significant differences (p> 0.05) in both eyes. The mean values of the average cell size by age groups were significantly different in both eyes (p< 0.001). Significant differences were not found (p< 0.05) between sexes in terms of the left and right eyes. Conclusions: the study of the corneal endothelium by means of the specular microscope is an effective method that allows identifying the endothelial cell characteristics(AU)

Mucocele con expansión orbitaria / Mucocele with orbital expansion

El mucocele es una lesión quística benigna, que se desarrolla en el interior de los senos perinasales por la obstrucción de su drenaje natural en el curso de los procesos inflamatorios, traumas y cirugías. Se presentan tres casos con mucocele frontoetmoidal y expansión intraorbitaria, los cuales fueron atendidos en el Hospital Hermanos Ameijeiras entre los meses de febrero a diciembre del año 2013. El propósito del presente estudio es el análisis de los resultados terapéuticos obtenidos y determinar la posible influencia de la vía de abordaje utilizada sobre la efectividad terapéutica y la recidiva tumoral en cada uno de estos pacientes(AU)

Mucocele is a benign cystic lesion that emerges inside the perinasal sinuses due to the obstruction of their natural drainage in inflammatory processes, traumas and surgeries. Here are three cases with frontoethmoidal mucocele and intraorbital expansion, which were treated at Hermanos Ameijeiras hospital from February to December, 2013. The objective of this study was to analyze the therapeutic results and to determine the possible influence of the approach path on the therapeutic effectiveness and the tumor recurrence in each of the patients(AU)

Estudo do endotélio corneano em cirurgias de cataratas duras: extração extracapsular planejada da catarata e facoemulsificação / Endothelial damage after planned extracapsular cataract extraction and phacoemulsification of hard cataracts

OBJETIVO: Avaliar o dano endotelial em cirurgias de catarata com núcleo duro, comparando as técnicas da extração extracapsular planejada da catarata e a facoemulsificação. MÉTODOS: Estudo prospectivo, incluindo 41 pacientes com catarata senil e núcleo muito duro, que foram divididos aleatoriamente em dois grupos: grupo 1 (21 pacientes) foi submetido à extração extracapsular da catarata (EECC) e grupo 2 (20 pacientes) à facoemulsificação (FACO); em todos casos foram implantadas lentes intra-oculares no saco capsular. Exame oftalmológico completo, microscopia especular e paquimetria foram realizados no pré-operatório e com um, três e seis meses de pós-operatório. Perda endotelial, pleomorfismo, polimegatismo e paquimetria foram aspectos estudados. RESULTADOS: Nos dois grupos, ocorreu perda endotelial significativa, comparando os valores pré e pós-operatórios, mas não houve diferença entre os tempos pós-operatórios (um, três e seis meses). Não houve diferença estatística da perda endotelial entre os grupos da extração extracapsular da catarata e facoemulsificação, em todos tempos estudados. A média de perda endotelial com seis meses de cirurgia no grupo 1 (EECC) foi de 28,50 por cento e no grupo 2 (FACO), de 34,77 por cento. Não houve diferença significativa nas medidas da paquimetria, polimegatismo e pleomorfismo, entre os dois grupos. CONCLUSÕES: As diferenças percentuais da densidade endotelial, polimegatismo, pleomorfismo e paquimetria não foram estatisticamente significantes entre o grupo da extração extracapsular da catarata e da facoemulsificação, em todos tempos estudados.

PURPOSE: To evaluate and compare the endothelial damage after planned extracapsular cataract extraction (ECCE) and phacoemulsification of very hard cataracts. METHODS: In this prospective, randomized study, 41 patients with age-related and very hard cataract were divided into two groups: in group 1 (21 patients) an extracapsular cataract extraction was performed and in group 2 (20 patients), phacoemulsification. In both groups, intraocular lenses were implanted in the capsular bag. Preoperatively and 1, 3 and 6 months postoperatively, a complete ophthalmological examination, endothelial specular microscopy, and ultrasonic pachymetry were done. Endothelial cell loss, pleomorphism, polymegathism and corneal thickness were studied. RESULTS: Both groups presented an endothelial cell loss in the postoperative time, as compared with the preoperative values, but there were no significant differences among the postoperative values (1, 3 and 6 months). Six months after surgery, mean cell loss was 28.50 percent in group 1 and 34.77 percent in group 2. There were no differences among the indexes of pachymetry, polymegathism and pleomorphism between the two groups. CONCLUSIONS: Endothelial response was not statistically different between the two studied groups.

Corneal decompensation after Phacoemulsification in Fuchs endothelial dystrophy

To evaluate the efficacy of performing phacoemulsification in patients with endothelial dysfunction and the risk of subsequent corneal decompensation. A retrospective design was employed on 21 patients [21 eyes] diagnosed as endothelial dystrophy based on clinical signs and pachymetry readings. Patients were divided into three groups based on corneal thicknesses: < 600 micro m, between 600-650 micro lm and > 650 micro m, respectively. None of our patients had clinical signs of corneal epithelial edema preoperatively Patients with corneal thickness greater than 600 micro m were added to our penetrating keratoplasty waiting list as a precaution and warned about the risk of possible corneal decompensation. Outcome measures evaluated were pre- and postoperative visual acuity, pre- and postoperative corneal thickness measurement using ultrasonic pachymetry, phaco time and power used intraoperatively, and follow-up duration and patient satisfaction. A modified phaco technique was used in order to avoid corneal decompensation and minimize possible endothelial injury. The range of preoperative visual acuity was between counting fingers and 20/50 with a median of 20/80-207 100. Postoperative visual acuity range was between 20/25-20/50 with a median of 20/30. Preoperative corneal thickness was 12 eyes less than 600 micro m, seven eyes between 600-650 micro m, and two eyes greater than 650 micro m. All eyes remained within the same range of corneal thickness postoperatively. Average phaco time was 2.2 minutes [range, 1-3 minutes]. All cases were operated by the same surgeon using ALCON Legacy phacoemulsification machine. Average phaco power was 26% [range, 16-36%]. Patients were followed for an average of 26 weeks [range, 6-88 weeks] with no clinical signs or pachymetry readings suggestive of corneal decompensation or worsening. Patient satisfaction was reported based on a verbal questionnaire. Most patients reported moderate to significant improvement postoperatively. A modified phaco technique without PKP is successful in patients with corneal thickness greater than 600 micro m. Pachymetry is a reliable estimate of the endothelial function. Phacoemulsification without PKP may result in significant visual acuity improvement and patient satisfaction in Fuchs' endothelial dystrophy even with corneal thickness greater than 600 micro m. We had no postoperative corneal decompensation during the follow-up period

Precipitados ceráticos atípicos em um paciente com hanseníase virchowiana: relato de caso / Atypical keratic precipitates in a lepromatous leprosy patient: case report

Modelo de Estudo: Relato de caso. Importância do problema: A hanseníase é uma afecção que conduz a inúmeras alterações nos globos e anexos oculares, primordialmente no segmento anterior do olho, com relativa alta prevalência em países subdesenvolvidos. A iridociclite e as alterações corneanas provocadas cronicamente por essa infecção são as manifestações mais freqüentemente envolvidas no estabelecimento da cegueira. Comentários: O caso descrito mostra um achado atípico do acometimento do segmento anterior do olho pela Hanseníase. À biomicroscopia observou-se precipitados ceráticos ovalados, acastanhados, distribuídos na metade inferior do endotélio corneano com aproximadamente 2mm de diâmetro. Essas características ímpares, ainda não foram descritas na literatura. Após tratamento houve recuperação da acuidade visual do paciente, com manutenção dos achados de córnea. São feitas considerações a respeito dos aspectos epidemiológicos e de exame oftalmológico revisados sobre Hanseníase.

Endothelial F-actin changes in the alkali burned rabbit cornea

The healing mechanism of corneal endothelium after alkali burn was not completely understood. Rabbit cornea was burned with 1N sodium hydxoside for 1 minute. Endothelial F-actin was stained with NBD-phallacidin in regular sequence to find out the details of endothelial healing after alkali burn. F-actin was completely destroyed leaving a sharp margin against the unaffected area 1 hour after the burn. In the 3, 5 and 7 day specimens, highly active F-actin reactions were noted at the wound margin. New multiple F-actin layers, arising from the intact endothelium near the wound margin, were noted in the 9 day specimen. In the 8 1/2 month specimen, the endothelial defected area was covered by large primitive cells, each of which showed F-actin fiber bundles in the cytoplasm with a large nuclear shadow. Nearly all of the large primitive cells showed F-actin fibers arranged in shapes of cell junctions. Twelve months after the burn, endothelial defects were not found. Nearly all of the endothelial cells were normal in size and shape except for some mushroom-like projections toward the anterior chamber in some areas. Nineteen months after the burn, the endothelial cells were normal. Endothelial wound healing process can be continued even 1 year after the alkali burn in rabbit cornea.