Rotating Scarf osteotomy in treating hallux valgus combined with the first metatarsal rotation / 中国骨伤

OBJECTIVE@#To explore clinical effect of rotational Scarf osteotomy in treating hallux valgus (HV) with rotation of the first metatarsal bone.@*METHODS@#From January 2018 to October 2019, 35 patients (40 feet) with HV and rotation deformity of the first metatarsal were treated with rotational Scarf osteotomy, including 5 males and 30 females;aged from 25 to 76 years old with an average of (40.32±5.43) years old. Hallux valgus angle(HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), the first metatarsal length (FML) were observed and compared, American Orthopedic Foot and Ankle Society(AOFAS) of hallux metatarsophalangeal interphalangeal joint score and visual analogue scale (VAS) were used to evaluate functional evaluation.@*RESULTS@#Thirty-five patients(40 feet) were followed up from 12 to 36 months with an average of (14.35±3.62) months. HVA, IMA and DMAA were corrected from (36.32±4.51) °, (14.21±3.22) ° and (28.35±4.32) ° before operation to (14.32±5.71) °, (5.83±3.97) ° and (7.32±2.14) ° after operation respectively (P<0.05). There was no satistical difference in FML before and after operation (P>0.05). AOFAS score and VAS improved from (57.00±4.31) and (6.00±1.21) before operation to (90.31±3.28) and (1.42±0.83) after operation, respectively, and had significant difference(P<0.05);according to AOFAS score, 23 feet got excellent results, 15 feet good and 2 feet fair.@*CONCLUSION@#Rotational Scarf osteotomy with strong correction and high dimension could effectively correct HV combined with rotation deformity of the first metatarsal bone, improve function of the forefoot, and obtain good clinical results.

Effectiveness of Cyclosporine-steroid Treatment after Cataract Surgery according to Dry Eye Severity

PURPOSE: To evaluate the effectiveness of topically administered 0.05% cyclosporine combined with a topical steroid in the early postoperative period after cataract surgery, and to compare the therapeutic efficacy according to the severity of dry eye. METHODS: One hundred and fifty-six patients who underwent unilateral cataract surgery and received topical cyclosporine 0.05% for 8 weeks combined with a fluorometholone 0.1% steroid for 4-weeks were classified into three groups according to preoperative dry eye level: the control group, non-dry eye (n = 78); group 1, level I dry eye (n = 38); and group 2, level II dry eye (n = 40). The best-corrected distance visual acuity, intraocular pressure, dry eye symptom questionnaire (ocular surface disease index), tear film break-up time (TBUT), and Schirmer test-I (STI) were evaluated. RESULTS: The preoperative score of dry eye symptoms improved significantly at one week postoperatively and continued to improve until postoperative 8-weeks in all groups, especially in group 2 compared with the control. Groups 1 and 2 showed significant improvement in the TBUT at one week, four weeks, and eight weeks postoperatively, compared to eight weeks postoperatively in the control; Group 2, especially, showed significant improvement in TBUT. There was no difference in STI value after cyclosporine-steroid treatment in the control group; however, a significant difference was observed at four weeks postoperatively in dry eyes. No significant differences in STI results were observed among the three groups. CONCLUSIONS: Use of topical cyclosporine 0.05% combined with a topical fluorometholone 0.1% steroid after cataract surgery is more effective in dry eyes level II than in non-dry eyes, especially those with TBUT and dry eye symptoms at eight weeks postoperatively.

Two Cases of Corneal Edema Due to Vaporized Amine

PURPOSE: We report two cases of corneal edema in patients who presented with bilateral blurry vision due to vaporized amines while working in a polyurethane processing plant. CASE SUMMARY: A 28-year-old male presented with bilateral blurred vision. His work involved solidifying polyurethane liquid and he often found himself exposed to polyurethane heat and gas. On examination, the patient's uncorrected visual acuity (UCVA) was 20/40 (right) and 30/50 (left). A slit lamp examination revealed subepithelial microbullae in both eyes. The central corneal thickness (CCT) was also increased in both eyes, measuring 698 µm (right) and 672 µm (left). After prescribing 0.5% moxifloxacin and, 1% fluorometholone eye drops for 3 days in both eyes, the UCVA recovered to 20/40 (right) and 20/20 (left). The CCT decreased to 644 µm (right) and 651 µm (left), and the microbullae improved significantly in the left eye. The second patient was a 34-year-old female who presented with bilateral decreased visual acuity while at work. She worked in a factory that produced car seat filling. Her UCVA was 20/25 (right) and 20/20 (left). The CCT by specular microscopy was 537 µm (right) and 541 µm (left). On slit lamp examination, both eyes demonstrated bilateral central subepithelial edema. The patient did not attend any follow-up outpatient appointments after the initial presentation. CONCLUSIONS: Exposure to vaporized amines such as polyurethane may causereversible corneal toxicityeven without direct contact. Further consideration should be given to ocular safety and protection from amine compounds in the industrial field.

A Case of Monocular Gonococcal Conjunctivitis in an Adult Male / 계명의대학술지

Gonococcal conjunctivitis is rare in adults and, if not treated properly, can cause corneal perforation. Gonococcal conjunctivitis typically presents with a severe mucopurulent discharge, similar to that associated with viral conjunctivitis. Here, we describe a case of monocular gonococcal conjunctivitis, including its clinical characteristics and slit-lamp images, which was initially misdiagnosed as epidemic conjunctivitis. A 20-year-old man was referred to our hospital with no improvement in monocular infection and purulent ocular discharge after 2-wk treatment using antibiotic and 0.1% fluorometholone eye drops at the local ophthalmic clinic. Initially, 0.5% loteprednol eye drops were used since we suspected viral conjunctivitis. Following this treatment, conjunctival infection worsened and a yellow-white ocular discharge covered the conjunctiva and cornea surface. Additional history taking revealed that the patient had sexual contact with a prostitute 1 wk prior to symptom presentation and, after the encounter, he took antibiotics for genital discharge at the local urology clinic, but self-discontinued treatment. A Gram staining showed gram-negative diplococci and culture of collected ocular discharge from the palpebral conjunctiva revealed growth of Neisseria gonorrhoeae, confirming gonococcal conjunctivitis. Following this, the patient was systemically treated with 3rd generation cephalosporin antibiotics. After 3-d treatment, conjunctival infection and purulent ocular discharge had significantly improved. When clinical symptoms are aggravated following steroid eye drop treatment for suspected monocular viral conjunctivitis, gonococcal conjunctivitis must be considered as a differential diagnosis

Periocular Allergic Contact Dermatitis Associated with the Use of Ofloxacin Ophthalmic Ointment: A Case Report / 대한피부과학회지

Allergic contact dermatitis is an inflammatory condition associated with periorbital erythema, edema, and pruritus. The periorbital skin is relatively thin compared with the skin over other facial areas; therefore, it is vulnerable to allergen penetration and may show a variety of cutaneous manifestations. Recently, vision enhancement surgery is a widely performed procedure, and the prevalence of senile cataract and glaucoma is increasing. The prevalence of periocular allergic contact dermatitis is increasing secondary to the growing use of topical ophthalmic medications. Several studies in Korea have reported periocular allergic contact dermatitis secondary to the use of topical ophthalmic medications including latanoprost (Latano®), fluorometholone (Tolon®), polymyxin B (Terramycin®), atropine sulfate (Atropine®), neomycin sulfate (Cambison®), and befunolol hydrochloride (Bentos®), among others. However, ofloxacin (Effexin®)-induced allergic contact dermatitis has not been reported in the domestic and/or foreign literature. We report a case of periocular allergic contact dermatitis secondary to the use of ofloxacin ophthalmic ointment.

Unilateral floppy eyelid syndrome with ipsilateral intolerance to brimonidine / Síndrome da palpebral flácida unilateral com intolerância a brimonidina ipsilateral

Abstract The authors report a case of unilateral floppy eyelid syndrome with ipsilateral intolerance to brimonidine in a 65-year-old man. The singularity of this case is the combination of two rare illnesses of great phlogistic potentiality in the same eye. The purpose of this article is to report a case of unilateral floppy eyelid syndrome with ipsilateral intolerance to brimonidine, emphasizing a possible relation between them. The result was a unilateral keratopathy that emulated an intraepithelial neoplasia. The key to solving the problem was an unexplained anterior uveitis that raised the suspicion of drug toxicity.The upper eyelid eversion of the affected eye during sleep seemed to be the common denominator of both ailments. The bizarre aspect of the epitheliopathy most likely resulted from the combination of trauma, insufficient lubrication, and drug intolerance.

Resumo Os autores relatam um caso de síndrome da pálpebra flácida unilateral com intolerância ipsilateral à brimonidina em um homem de 65 anos de idade. A singularidade deste caso é a combinação de duas doenças raras de grande potencialidade inflamatória no mesmo olho. O objetivo deste artigo é relatar um caso de síndrome da pálpebra flácida com intolerância ipsilateral à brimonidina, enfatizando uma possível relação entre eles. O resultado foi uma ceratopatia unilateral que simulou uma neoplasia intra-epitelial. A chave para resolver o problema foi uma uveíte anterior inexplicável que levantou a suspeita de toxicidade medicamentosa. A eversão da pálpebra superior do olho afetado durante o sono parece ser o denominador comum de ambas as doenças. O aspecto bizarro da epiteliopatia provavelmente resultou da combinação de trauma, lubrificação insuficiente e intolerância ao medicamento.

Effects of Corneal Toxicity and Conjunctival Injection of Preservative-free 0.1% Fluorometholone after Pediatric Strabismus Surgery

PURPOSE: To compare the degrees of conjunctival injection and corneal toxicity between preservative and preservative-free topical 0.1% fluorometholone after strabismus surgery. METHODS: A randomized, prospective clinical study was performed to compare the degrees of conjunctival injection and corneal toxicity between preservative and preservative-free topical 0.1% fluorometholone after strabismus surgery. Sixty-one patients with intermittent exotropia were included in this study. They were told to apply antibiotic eye drops (ED) and either preservative or preservative-free topical 0.1% fluorometholone (F1) three times a day. Measurements of the degrees of conjunctival injection and corneal toxicity were performed at postoperative 1 week and 3 weeks each. RESULTS: Seventeen patients (34 eyes) were included in group 1 (preservative F1) and twenty patients (40 eyes) were included in group 2 (preservative-free F1). The average pixel value (measured via the Image J software) representing the degree of conjunctival injection was 31,732 ± 9,946 in group 1 and 38,347 ± 12,189 in group 2 at postoperative 1 week, while the average pixel value was 10,150 ± 4,493 in group 1 and 11,836 ± 4,290 in group 2 at postoperative 3 weeks. There was a significant difference between the decrease in pixel value for the two groups (p = 0.040). There was no significant difference in the mean value of the Oxford stain score between the two groups at postoperative 3 weeks, however the mean questionnaire scores in group 2 were significantly lower than in group 1 (p = 0.001). CONCLUSIONS: Preservative-free 0.1% fluorometholone ED demonstrated a larger decrease in the degree of conjunctival injection than for preservative ED after strabismus surgery. Therefore, the use of preservative-free steroid ED may be beneficial for decreasing both conjunctival injection and postoperative discomfort following strabismus surgery.

The Effect of Anti-glaucoma Eyedrops and 0.1% Fluorometholone on Myopic Regression after LASIK or LASEK

PURPOSE: To evaluate the effect of combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone on visual acuity and refractive errors in patients complaining of blurred vision due to myopic regression after laser-assisted in-situ keratomileusis (LASIK) or laser-assisted sub-epithelial keratectomy (LASEK). METHODS: This study comprised 155 patients (155 eyes) who were diagnosed with myopic regression after LASIK or LASEK and received medical treatment from January 2015 to January 2016. The visual acuity and refractive errors were compared before and after medical treatment and evaluated to determine whether the results differ between LASIK and LASEK. RESULTS: The mean time of medical treatment was 64.1 ± 36.8 months after surgery. The responder group whose vision was improved and whose myopic error was decreased after medical treatment was comprised of 63 patients (41%). Their visual acuity in this group improved -0.21 ± 0.11 logMAR, and the amount of myopic error decreased 0.56 ± 0.32 diopters. The full responder group was 24 patients (15%), and the partial responder group was 39 patients (26%). The frequency of response to medical treatment was higher after LASIK than after LASEK, but the difference was not statistically significant. CONCLUSIONS: The combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone was effective in 41% of patients with regard to visual acuity improvement when used for post-LASIK or post-LASEK myopic regression. The medical treatment was effective after both LASIK and LASEK.

The Result of Photorefractive Keratectomy Treated with 0.1% Fluorometholone and Tranilast Eye Drops

PURPOSE: To determine the effectiveness of the method for preventing corneal opacity and minimizing the intraocular pressure (IOP) increase after photorefractive keratectomy treated with 0.1% fluorometholone and tranilast (0.5% tranilast, Krix®, JW pharmaceutical, Seoul, Korea), especially in cases with elevated IOP. METHODS: The patients who underwent photorefractive keratectomy from May 2014 to May 2015 were enrolled in the present study. The data of 49 patients (49 eyes) with elevated IOP at 1 month postoperatively and who used 0.1% fluorometholone and tranilast eye drops (tranilast group) were analyzed and compared with the control group consisting of patients who underwent the same surgery from December 2012 to October 2013 but used only 0.1% fluorometholone. RESULTS: The visual acuity at postoperative 6 months was log MAR -0.08 ± 0.05 and log MAR -0.08 ± 0.04 in the tranilast group and control group, respectively. The eye drops were used postoperatively for 17.7 ± 3.3 weeks in the tranilast group and for 20.5 ± 3.7 weeks in the control group (p < 0.01). Anti-glaucoma eye drops were used for 18.4 ± 3.2 weeks and 20.9 ± 3.7 weeks postoperatively in the tranilast group and control group, respectively (p < 0.01). CONCLUSIONS: Adding tranilast eye drops to patients whose IOP was elevated because of 0.1% fluorometholone use after photorefractive keratectomy is an effective method for preventing corneal haze and minimizing IOP elevation.

An uncommon ocular manifestation of Sweet syndrome: peripheral ulcerative keratitis and nodular scleritis / Uma manifestação ocular rara de síndrome de Sweet: ceratite ulcerativa periférica e esclerite nodular

Sweet syndrome (acute febrile neutrophilic dermatosis) is characterized by fever, neutrophilic leukocytosis, and abrupt appearance of painful erythematous nodules and plaques, particularly on the face, neck, and limbs. In this study, we report a very rare case of Sweet syndrome in which the patient presented nodular scleritis and peripheral ulcerative keratitis during the dermatologically inactive period of the disease.

A síndrome de Sweet (dermatose neutrofílica febril aguda) é caracterizada por febre, leucocitose neutrofílica, aparecimento abrupto de nódulos eritematosos dolorosos e placas, principalmente na face, pescoço e membros. Neste artigo, relatamos um caso muito raro de síndrome de Sweet, que tinha esclerite nodular e ceratite ulcerativa periférica no período dermatologicamente inativo da doença.

Long-Term Outcome of Treatment with Topical Corticosteroids for Severe Dry Eye Associated with Sjogren's Syndrome / 전남의대학술지

This retrospective study was performed to analyze the long-term outcome of topical corticosteroid treatment for severe dry eye associated with Sjogren's syndrome (SS). Patients who had severe dry eye associated with SS were topically treated with loteprednol etabonate 0.5% (group A, n=66) or fluorometholone 0.1% (group B, n=67) twice daily and were followed up for 2 years. Visual acuity (VA), intraocular pressure (IOP), Schirmer test, tear film breakup time (BUT), keratoepitheliopathy, and symptom scores were measured at baseline and 6, 12, 18, and 24 months after treatment. VA and IOP were not changed significantly during follow-up in either group. Schirmer test results, keratoepitheliopathy, and symptom scores at 6, 12, 18, and 24 months (p<0.05) and tear film BUT at 12, 18, and 24 months (p<0.05) significantly improved after treatment compared with baseline in both groups. No significant differences between the groups were found in any parameter during follow-up. At 24 months, the number of patients with IOP elevation of more than 2 mmHg compared with baseline was 4 in group A (6.1%) and 9 in group B (13.4%). The mean IOP in these patients was lower in group A than in group B (15.00+/-0.82 mmHg versus 16.50+/-1.12 mmHg; p=0.04). Long-term application of low-dose topical corticosteroids is effective for controlling signs and symptoms of chronic, severe dry eye associated with SS. Loteprednol etabonate 0.5% may have a lower risk for IOP elevation than fluorometholone 0.1%.

The Toxicity of Nonsteroidal Anti-inflammatory Eye Drops against Human Corneal Epithelial Cells in Vitro

This study investigated the toxicity of commercial non-steroid anti-inflammatory drug (NSAID) eye solutions against corneal epithelial cells in vitro. The biologic effects of 1/100-, 1/50-, and 1/10-diluted bromfenac sodium, pranoprofen, diclofenac sodium, and the fluorometholone on corneal epithelial cells were evaluated after 1-, 4-, 12-, and 24-hr of exposure compared to corneal epithelial cell treated with balanced salt solution as control. Cellular metabolic activity, cellular damage, and morphology were assessed. Corneal epithelial cell migration was quantified by the scratch-wound assay. Compared to bromfenac and pranoprofen, the cellular metabolic activity of diclofenac and fluorometholone significantly decreased after 12-hr exposure, which was maintained for 24-hr compared to control. Especially, at 1/10-diluted eye solution for 24-hr exposure, the LDH titers of fluorometholone and diclofenac sodium markedly increased more than those of bromfenac and pranoprofen. In diclofenac sodium, the Na+ concentration was lower and amount of preservatives was higher than other NSAIDs eye solutions tested. However, the K+ and Cl- concentration, pH, and osmolarity were similar for all NSAIDs eye solutions. Bromfenac and pranoprofen significantly promoted cell migration, and restored wound gap after 48-hr exposure, compared with that of diclofenac or fluorometholone. At 1/50-diluted eye solution for 48-hr exposure, the corneal epithelial cellular morphology of diclofenac and fluorometholone induced more damage than that of bromfenac or pranoprofen. Overall, the corneal epithelial cells in bromfenac and pranoprofen NSAID eye solutions are less damaged compared to those in diclofenac, included fluorometholone as steroid eye solution.

The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy

PURPOSE: To analyze the time and incidence of increased intraocular pressure (IOP) induced by 0.1% fluorometholone used to prevent corneal haze after photorefractive keratectomy (PRK). METHODS: The present study included 826 patients (826 eyes) who underwent PRK between November 2012 and October 2013 and were followed up for more than 6 months. After surgery the patients were treated with 0.1% fluorometholone for 3-6 months according to their corneal conditions. The time and incidence was analyzed with the time and incidence when anti-glaucoma eye drops were used. RESULTS: Anti-glaucoma eye drops were used in 312 eyes (38%). The anti-glaucoma eye drops were started before 4 weeks postoperatively in 105 eyes (13%) and postoperatively at 5-8 weeks in 86 eyes (10%), at 9-12 weeks in 83 eyes (10%), at 13-16 weeks in 25 eyes (3%) and after 17 weeks in 13 eyes (2%). CONCLUSIONS: The overall incidence of increased IOP when treated with 0.1% fluorometholone for 3-6 months after PRK was approximately 38%. The incidence of increased IOP in each month for the first 3 months was almost identical implying that the longer 0.1 fluorometholone was used, the higher incidence of increased IOP occurred. These results can be helpful in educating patients regarding the risk of increased IOP and determining the follow-up period after PRK.

The Incidence of Increased Intraocular Pressure when Using 0.1% Fluorometholone after Photorefractive Keratectomy

PURPOSE: To analyze the time and incidence of increased intraocular pressure (IOP) induced by 0.1% fluorometholone used to prevent corneal haze after photorefractive keratectomy (PRK). METHODS: The present study included 826 patients (826 eyes) who underwent PRK between November 2012 and October 2013 and were followed up for more than 6 months. After surgery the patients were treated with 0.1% fluorometholone for 3-6 months according to their corneal conditions. The time and incidence was analyzed with the time and incidence when anti-glaucoma eye drops were used. RESULTS: Anti-glaucoma eye drops were used in 312 eyes (38%). The anti-glaucoma eye drops were started before 4 weeks postoperatively in 105 eyes (13%) and postoperatively at 5-8 weeks in 86 eyes (10%), at 9-12 weeks in 83 eyes (10%), at 13-16 weeks in 25 eyes (3%) and after 17 weeks in 13 eyes (2%). CONCLUSIONS: The overall incidence of increased IOP when treated with 0.1% fluorometholone for 3-6 months after PRK was approximately 38%. The incidence of increased IOP in each month for the first 3 months was almost identical implying that the longer 0.1 fluorometholone was used, the higher incidence of increased IOP occurred. These results can be helpful in educating patients regarding the risk of increased IOP and determining the follow-up period after PRK.

Long-Term Outcome of Treatment with Topical Corticosteroids for Severe Dry Eye Associated with Sjogren's Syndrome / 전남의대학술지

This retrospective study was performed to analyze the long-term outcome of topical corticosteroid treatment for severe dry eye associated with Sjogren's syndrome (SS). Patients who had severe dry eye associated with SS were topically treated with loteprednol etabonate 0.5% (group A, n=66) or fluorometholone 0.1% (group B, n=67) twice daily and were followed up for 2 years. Visual acuity (VA), intraocular pressure (IOP), Schirmer test, tear film breakup time (BUT), keratoepitheliopathy, and symptom scores were measured at baseline and 6, 12, 18, and 24 months after treatment. VA and IOP were not changed significantly during follow-up in either group. Schirmer test results, keratoepitheliopathy, and symptom scores at 6, 12, 18, and 24 months (p<0.05) and tear film BUT at 12, 18, and 24 months (p<0.05) significantly improved after treatment compared with baseline in both groups. No significant differences between the groups were found in any parameter during follow-up. At 24 months, the number of patients with IOP elevation of more than 2 mmHg compared with baseline was 4 in group A (6.1%) and 9 in group B (13.4%). The mean IOP in these patients was lower in group A than in group B (15.00+/-0.82 mmHg versus 16.50+/-1.12 mmHg; p=0.04). Long-term application of low-dose topical corticosteroids is effective for controlling signs and symptoms of chronic, severe dry eye associated with SS. Loteprednol etabonate 0.5% may have a lower risk for IOP elevation than fluorometholone 0.1%.

Long-Term Outcome of Treatment with Topical Corticosteroids for Severe Dry Eye Associated with Sjogren's Syndrome / 전남의대학술지

This retrospective study was performed to analyze the long-term outcome of topical corticosteroid treatment for severe dry eye associated with Sjogren's syndrome (SS). Patients who had severe dry eye associated with SS were topically treated with loteprednol etabonate 0.5% (group A, n=66) or fluorometholone 0.1% (group B, n=67) twice daily and were followed up for 2 years. Visual acuity (VA), intraocular pressure (IOP), Schirmer test, tear film breakup time (BUT), keratoepitheliopathy, and symptom scores were measured at baseline and 6, 12, 18, and 24 months after treatment. VA and IOP were not changed significantly during follow-up in either group. Schirmer test results, keratoepitheliopathy, and symptom scores at 6, 12, 18, and 24 months (p<0.05) and tear film BUT at 12, 18, and 24 months (p<0.05) significantly improved after treatment compared with baseline in both groups. No significant differences between the groups were found in any parameter during follow-up. At 24 months, the number of patients with IOP elevation of more than 2 mmHg compared with baseline was 4 in group A (6.1%) and 9 in group B (13.4%). The mean IOP in these patients was lower in group A than in group B (15.00+/-0.82 mmHg versus 16.50+/-1.12 mmHg; p=0.04). Long-term application of low-dose topical corticosteroids is effective for controlling signs and symptoms of chronic, severe dry eye associated with SS. Loteprednol etabonate 0.5% may have a lower risk for IOP elevation than fluorometholone 0.1%.

Trombose parcial do seio cavernoso / Cavernous sinus thrombosis

A trombose do seio cavernoso (TSC) é uma situação clínica rara, resultando normalmente da complicação de um processo infeccioso dos seios paranasais. Outras causas incluem alterações pró-trombóticas, anemia e trauma. Os sinais e sintomas são extremamente variados e inespecíficos, sendo o seu diagnóstico efetuado através de ressonância magnética nuclear (RMN). Os autores apresentam um caso clínico de uma doente com 75 anos de idade, que recorre ao serviço de urgência devido à dor em olho direito vermelho associado à cefaléias frontais com quatro dias de evolução. Ao exame oftalmológico observou-se defeito pupilar aferente relativo no olho direito (OD); na biomicroscopia vasos episclerais dilatados, catarata nuclear e à fundoscopia um edema discreto da papila com apagamento do rebordo nasal, hemorragias punctiformes dispersas e tortuosidade vascular em OD. A realização de angio-RMN confirmou o diagnóstico tendo a doente sido tratada com enoxaparina. Apesar do tratamento da TSC ser um tratamento etiológico, foi demonstrado que a anticoagulação está associada à diminuição da taxa de mortalidade.

Cavernous sinus thrombosis (CST) is a rare condition, usually results from a late complication of an infection of the paranasal sinuses. Other causes include prothrombotic disorders, anemia and trauma. The signs and symptoms are extremely varied and nonspecific, being the diagnosis made through magnetic resonance imaging (MRI). The authors present a 75-year-old woman, admitted in the emergency room complaining of ocular pain in the right eye (RE), red eye and frontal headache. She presented on ophthalmic examination of the RE: dilated episcleral vessels, nuclear cataract and a relative afferent pupillary defect. Fundoscopy examination of the RE revealed disc edema with nasal disc margin blurred, small dot hemorrhages and vascular tortuosity. The MRI angiography confirmed the diagnosis and the patient was treated with low molecular weight heparin. Despite treatment of CST is directed to the causal situation, being shown that anticoagulation is associated with reduction in mortality.

Efficacy and Safety of Topical Unpreserved 0.1% Fluorometholone Ophthalmic Solution on Dry Eye Syndrome

PURPOSE: To evaluate the efficacy and safety of topical unpreserved 0.1% fluorometholone (FML) ophthalmic solution in patients with dry eye syndrome. METHODS: Patients with mild to moderate dry eye syndrome were divided into the control group (Group I), topical unpreserved 0.1% FML group (Group II), and topical preserved 0.1% FML group (Group III). Intraocular pressure (IOP), Ocular Surface Disease Index (OSDI), tear film break-up time (TF-BUT), Oxford stain score (OSS), and tear osmolarity (Tosm) were evaluated at 2 weeks, 4 weeks, 8 weeks, and 12 weeks (Trial 1). Patients with severe dry eye syndrome were divided into 1% methylprednisolone (MP) group (Group I) and 0.1% unpreserved FML group (Group II). Same parameters were evaluated in both groups (Trial 2). RESULTS: In clinical trial I, OSS scores of Group II were lower than other groups (p < 0.05). For severe dry eye patients in clinical trial 2, there were no significant differences in all parameters between the 2 groups. CONCLUSIONS: Topical unpreserved 0.1% fluorometholone was shown to be an effective and relatively safe treatment in patients with dry eye syndrome.

A Case of Supratarsal Injection of Triamcinolone in Management of Chronic Thygeson's Superficial Punctate Keratitis

PURPOSE: To report a case of supratarsal injection of triamcinolone for the management of chronic, steroid-dependent Thygeson's superficial punctate keratitis. CASE SUMMARY: A 37-years-old woman complained of redness, photophobia, and tearing in both eyes, which lasted for 6 years. The slit lamp examination revealed multiple intraepithelial and subepithelial, punctated corneal lesions which were elevated and scattered diffusely upon staining with fluorescein dye in both eyes. The patient was diagnosed with Thygeson's superficial punctate keratitis and treated with 0.1% fluorometholone, 0.05% cyclosporin, and 0.15% ganciclovir in both eyes. After 10 months of follow-up, recurrences were reported twice in the right eye, and 7 times in the left eye. The patient was treated with a supratarsal injection of triamcilonone in both eyes and after injection, the patient was treated only with artificial tears. Four months later, the patient did not complain of any symptoms and her cornea was clear. CONCLUSIONS: A supratarsal injection of triamcinolone may be an effective method to prevent recurrence of chronic, steroid-dependent Thygeson's superficial punctate keratitis.

A Case of Keratitis Caused by Combined Infection of Multidrug-Resistant Acinetobacter Baumannii and Candida Parapsilosis

PURPOSE: To report a case of keratitis caused by Acinetobacter baumannii and Candida parapsilosis in a patient using 0.5% levofloxacin and 0.1% fluorometholone for an extended period of time. CASE SUMMARY: A 55-year-old male patient in the neurosurgery department with conjunctival injection and discharge in his left eye was consulted for ophthalmic evaluation and treatment. He was hospitalized in the state of akinetic mutism and given 0.5% levofloxacin and 0.1% fluorometholone for 2 years. On slit-lamp examination, a 3.5 x 4.5-mm dense stromal infiltrate with an overlying epithelial defect was observed. Corneal scraping culture revealed multidrug-resistant A. baumannii and C. parapsilosis. According to the susceptibility result, the patient was treated with topical 10% piperacillin/tazobactam and 0.125% amphotericin B hourly. The corneal ulcer healed gradually with corneal opacity remaining after 8 weeks of treatment. CONCLUSIONS: The authors of the present study report a case of treated multidrug-resistant A. baumannii and C. parapsilosis keratitis in a patient using topical antibiotics and steroid for an extended period of time.