Alteraçöes topográficas da área central da córnea após cirurgia de descolamento de retina / Central corneal topographic changes after retinal detachment surgery

Objetivo: Analisar alteraçöes corneais precoces induzidas por cirurgia de cerclagem, para melhor entender sua influência sobre a curvatura corneal e a reabilitaçäo visual. Método: Doze pacientes com deslocamento de retina regmatogênico periférico sem envolvimento macular foram avaliados quanto à acuidade visual melhor corrigida, biomicroscopia, tonometria, fundoscopia, cumprimento axial por ultrassonografia e topografia de córnea, tanto no periódo pré-operatório. Testes t parteados foram usados para comparar valores pré e pós-operatórios. Resultado Encontramos aplanamento central significante estatisticamente em 11 dos 12 pacientes com média de 1,22 Dioptrias mais ou menmos 1,73 (p <0,05). Houve mínima alteraçäo no comprimento axial, sem significância estatística. Conclusäo: Alteraçöes refrativas após procedimento de cerclagem säo fregüentes e desempenham importante papel na acuidade visual final, especialmente em pacientes que näo apresentaram comprometimento macular. A natureza destas alteraçöes dependem aparentemente do tipo de procedimento feito.

Sterile corneal epithelial defect associated with hypopyon

Noninfectious epithelial defect is characterized by absence of stromal cellular infiltration. Hypopyon is usually associated with stromal infiltration (bacterial, viral and fungal ulcers). Noninfectious hypopyon may occur in uveitis (e.g. Behcet's Syndrome) without epithelial defect. We repost 6 cases of corneal epithelial defect with hypopyon irydocyclitis: 3 related with bullous keratopathy, 2 with contact lenses and 1 with neurotrophic keratopathy. Studies have been done suggesting that the persistence of an epithelial defect increases the regular secretion of tPA (tissue plasminogen activator) from the focal contacts of the basal cell surfaces at the edge of the epithelial sheet. The resulting increased secretion of tPA, instead of promotion epithelial healing, promotes delay or nonhealing of the defect and according to our study, the development of stromal ulceration and hypopyon. With this studies, we hope to emphasize that hypopyon can be seen in any patient with sterile corneal epithelial defect, whatever the etiology is, as the level of tPA is increased when a corneal epithelial defect is present. Patching and/or a bandage contact lens are often helpful, inducing a prompt epithelial healing.