A Case of Accidental Macular Injury by Nd: YAG Laser and Subsequent 6 Year Follow-Up

Here, we report the case of a patient who sustained Nd: YAG laser macular injury with subsequent 6 year follow-up evaluation. A 23-year-old female was accidentally exposed to a Q-switched Nd: YAG laser without protective goggles. Upon initial evaluation, the best-corrected visual acuity of her affected eye was 20/100 OD. Fundoscopic examination revealed a macular laser burn and vitreous hemorrhage. Corticosteroids, in the form of 60 mg prednisolone, were administered orally with a 10 mg per week taper. Nineteen days following exposure, fundoscopic examination revealed a distinct epiretinal membrane which resolved within six months. The best-corrected visual acuity of the affected eye remained 20/100 OD. This clinical course is similar to those of previously reported cases including vitreous hemorrhage and subsequent epiretinal membrane formation. However, visual acuity did not recover despite spontaneous regression of the epiretinal membrane and at 6 year follow-up, there was neither choroidal neovascularization nor macular hole formation.

Ultra B2 - Promoção de ligações covalentes do colágeno corneal (Corneal cross-linking) no tratamento de ceratocone: resultados preliminares / Corneal Cross-linking for the treatment of keratoconus: preliminary results

OBJETIVO: Apresentar os resultados visuais e ceratométricos, seis meses após tratamento foto-terapêutico com luz ultravioleta (UV) e vitamina B2 (Ultra B2), em pacientes com ceratocone progressivo. MÉTODOS: Vinte e cinco olhos de 20 pacientes (15 homens e 5 mulheres) com ceratocone progressivo, determinado pelo aumento de curvatura em exames seriados de topografia corneal, nos últimos seis meses foram avaliados. Acuidade visual não corrigida (UVA), acuidade visual melhor corrigida com óculos (BSCVA), equivalente esférico (SEQ), cilindro refrativo manifesto e a curvatura máxima (max K) pré e pós-operatórios (1, 3 e 6 meses) foram determinadas. Todos os pacientes foram submetidos ao tratamento Ultra B2 usando riboflavina (vitamina B2) e a luz ultravioleta (UV, 370 nm). O epitélio corneal foi removido após assepsia, colocação de blefarostato e anestesia tópica com proparacaína, por meio de solução de álcool hidratado (20 por cento) utilizada por 30 segundos. A córnea foi saturada com vitamina B2 por 15 minutos; em seguida, foi irradiada por luz UV por 30 minutos. Ao final do procedimento, foi colocada lente de contato terapêutica (LCT), mantida até a epitelização total. RESULTADOS: Houve melhora na UVA após o primeiro mês (de 0,15 ± 0,15 para 0,23 ± 0,20), com contínua mudança no terceiro e sexto mês pós-operatório, atingindo a diferença estatisticamente significante nesse período (p=0,025 e p=0,037 respectivamente). BSCVA melhorou de 0,41 ± 0,27 para 0,49 ± 0,29 no sexto mês, sem atingir a diferença estatisticamente significante. A progressão do ceratocone após o procedimento não foi notada em nenhum paciente, em comparação com o avanço topográfico nos 6 meses precedentes. Após 6 meses do procedimento, max K diminuiu em mais que 2,00 D (de 53,02 ± 8,42 para 50,88 ± 6,05 D), SEQ em menos que 1 D (de -3,27 ± 4,08 para -2,68 ± 3,02 D) e o cilindro refrativo em menos que 0,5 D (de -2,29 ± 1,77 para -1,86 ± 0,92), sem atingir diferença estatisticamente...

PURPOSE: To present early visual and keratometric results for corneal cross-linking with riboflavin and UV irradiation in patients with progressive keratoconus. METHODS: Twenty-five eyes of twenty patients (15 males and 5 females) with a progressive keratoconus in the previous 6 months were followed. Unaided visual acuity (UVA), best spectacle corrected visual acuity (BSCVA), spherical equivalent (SEQ), manifest cylinder, and maximal corneal curvature (max K) values were followed at 1, 3 and 6 months. All patients were submitted to corneal cross-linking using riboflavin (vitamin B2) as the photosensitizer and ultraviolet light (UV, wavelength 370 nm). Epithelium was removed with 20 percent alcohol, cornea was soaked with vitamin B2 for 15 min, and then irradiated with UV light for 30 min, after which a bandage contact lens (BCL) was placed. RESULTS: UVA increased after one month (from 0.15 ± 0.15 to 0.23 ± 0.20), and went on increasing at 3 and 6 months, reaching statistical significance (p=0.025 e p=0.037, respectively). BSCVA increased from 0.41 ± 0.27 to 0.49 ± 0.29 at month six, without reaching statistical significance at any time point. Progression of keratoconus stopped in all patients, in contrast with progression in all of them in the six-month period prior to the surgery. Max K decreased by more than 2 D (from 53.02 ± 8.42 to 50.88 ± 6.05 D), SEQ less that 1 D (from -3.27 ± 4.08 to -2.68 ± 3.02 D), while refractive cylinder decreased less than 0.5 D (from -2.29 ± 1.77 to -1.86 ± 0.92 D), without reaching a statistically significant difference. None of the eyes lost any line of BSCVA, 12 maintained the preoperative BSCVA, 7 gained one line, 5 gained two lines, and 1 patient gained three lines of BSCVA. CONCLUSIONS: Corneal cross-linking with riboflavin and UV light seems to be a safe (no loss of BSCVA) and effective (anatomical and optical properties maintained) procedure, which has shown to stop the progression of the keratoconus...

Neurorretinite idiopática estrelada de Leber / Leber idiopathic stellate neuroretinitis

Os autores apresentam um caso de paciente jovem, do sexo feminino, com a neurorretinite idiopática estrelada de Leber. A paciente apresentou na angiografia fluoresceínica da retina staining do corante na papila e um pequeno defeito hipetfluorescente do epitélio pigmentar da retina

Retinopatia solar: relato de 5 casos / Solar retinopathy: reporta of five cases

A retinopatia solar se caracteriza por lesöes maculares causadas por fototraumatismo em indivíduos que olham diretamente para o sol. Nos últimos oito anos 17 casos de retinopatia solar foram examinados pelos autores. Cinco desses casos säo aqui apresentados. Todos os olhos acometidos apresentavam um buraco lamear faveolar ou justafaveolar como sequela permanente. A excessäo de um caso, todos apresentavam retorno da acuidade visual a níveis normais ou próximo do normal, embora persistam, em alguns, escotoma central ou outras queixas de natureza subjetiva. Os autores apresentam e discutem aspectos históricos, epidemiológicos, clínicos, etiopatológicos, terapêuticos e preventivos desse fototraumatismo.

Extracapsular cataract extraction with posterior chamber IOL implantation at Helpers eye hospital, Quetta

We have only recently started intraocular lens [IOL] implantation surgery in Quetta, Baluchistan at the Helpers Eye Hospital, and this is the first report of our results of the manual extracapsular cataract extraction with posterior chamber [IOL] implantation. The procedure was performed on 134 patients. An important socioeconomic aspect of cataract surgery in our region was brought home by the fact that 31 of these patients did not return for follow-up. Another three patients died of acute myocardial infarction. In the remaining 100 patients, postoperative visual acuity ranged from 3/60 to 6/6; 79 patients regained unaided visual acuity of 6/24 [20/80], which improved to 6/9 [20/30] or better with correction; 14 patients had vision below 6/36 [20/120], which improved to 6/12 [20/40] with glasses; five patients could improve only to 6/60 [20/200] with best correction; two patients' visual acuity did not improve beyond 3/60 [10/200] due to the advanced macular degeneration. The postoperative complications include posterior capsule thickening in eight patients [8%]; anterior uveitis in seven patient [7%]; vascular congestion at and around the wound persisting after one month in 20 patients [20%]; traumatic wound dehiscence in three patients [3%]; IOL decentration in two patients [2%]; elevated intraocular pressure in two patients [2%]; traumatic vitreous hemorrhage in one patient [1%]; distortion of pupil in one patient [1%]; and endophthalmitis in one patient [1%]. [Pakistan Journal of Ophthalmology, 10:49-50, April and July, 1994]