Intense pulsed light therapy: A promising complementary treatment for dry eye disease. / Terapia de luz pulsada intensa regulada: un tratamiento complementario prometedor para la enfermedad de ojo seco.

OBJECTIVE: To propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease. MATERIAL AND METHODS: Retrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee. RESULTS: 50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P<.05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P<.05, for all measurements). CONCLUSION: IPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease.

Clinical, surgical, and histopathologic characteristics of corneal keloid.

PURPOSE: To describe the cause, diagnosis, and management of a case of bilateral corneal keloid. METHODS: We describe a 17-year-old white boy with enlarging nontraumatic bilateral corneal scars whose growth was exacerbated by a superficial keratectomy. The patient underwent a penetrating keratoplasty (PK) in his left eye. Light and electron microscopy of the corneal button were performed. RESULTS: The histopathologic and ultrastructural features of the corneal button were haphazardly arranged collagen fascicles with activated fibroblasts but no inflammatory cells. The clinical outcome was excellent, although there has been continuous growth of the outer margin of the initial lesion not included in the PK. This growth has not affected vision. The unoperated right corneal lesion progressively enlarged during these years. CONCLUSION: A corneal keloid, although unusual, should be suspected in cases of enlarging white glistening avascular corneal scars regardless of a traumatic antecedent. Light and electron microscopy confirmed the diagnosis. Management is by PK when the visual axis is involved and carries an excellent prognosis.

Use of nonpreserved human amniotic membrane for the reconstruction of the ocular surface.

PURPOSE: To describe the use of nonpreserved human amniotic membrane (NP-AMT) as an alternative to preserved human amniotic membrane (AMT) for the reconstruction of the ocular surface in several diseases. METHODS: NP-AMT was used in the treatment of five patients with the following diseases: noninvasive conjunctival squamous cell carcinoma, corneal persistent epithelial defect, severe alkali burn, near total limbal deficiency secondary to multiple surgeries, and ocular cicatricial pemphigoid. In some cases, a limbal autograft or allograft was employed simultaneously, sutured on top of the NP-AMT. All sutures were made with 10-0 Nylon and were removed at two weeks. RESULTS: Ocular surface was satisfactorily reconstructed, eyes were quiet, and patients were comfortable despite prolonged deepithelialization in some cases. There was a case of a limbal autograft ischemia--in the burned patient--that caused partial corneal conjunctivalization. Initially, the NP-AMT looks thickened but thins around the fifth day and looks similar to AMT. CONCLUSION: Results using NP-AMT are similar to those of AMT. It is a good alternative and it is easily obtained in places were AMT is not available or is too expensive to procure.

Piggyback posterior chamber multifocal intraocular lenses in anisometropia.

A 63-year-old white man with anisometropic hyperopia presented with cataract in both eyes. He had uneventful temporal limbal phacoemulsification with intracapsular placement of a multifocal 3-piece silicone intraocular lens (IOL) in his right eye (model SA-40N, Allergan, Inc.). One week later, 2 intracapsular 3-piece silicone IOLs (1 monofocal backward, Allergan model SI-40NB; 1 multifocal in front, Allergan model SA-40N) were implanted in his left eye. At 8 days postoperatively, uncorrected visual acuity was 20/20 for distance and J1 for near vision in the right eye and 20/30 and J2, respectively, in the left. These values remained constant until the patient was seen 7 months postoperatively. Power calculation and insertion order of the piggyback IOLs were considered.

Incidence of retinal detachment following clear-lens extraction in myopic patients. Retrospective analysis.

OBJECTIVE: A retrospective study was performed to establish the incidence of retinal detachment among 107 patients (165 eyes) with pathologic myopia who underwent clear-lens extraction. INTERVENTIONS: The techniques employed were intracapsular extraction (3.0%), aspiration (59.4%), and extracapsular extraction (37.6%); average follow-up was 31 months. RESULTS: Retinal detachment developed in 12 eyes (7.3%) an average (SD) of 30.7 +/- 26.6 months postoperatively; the mean age of these patients was 34 years. We found a clear association between postoperative YAG laser/surgical posterior capsulotomy and the incidence of retinal detachment (11% vs 5.5%) but no association between intraoperative rupture of the posterior capsule and the ultimate incidence of retinal detachment. The retina was reattached in nine cases (75%).

Silicone oil in the management of giant retinal tears.

To evaluate the results of using and removing silicone oil in the management of giant retinal tears, 24 cases of vitrectomy with fluid-silicone oil exchange were reviewed. We did not use cryotherapy in any case. For chorioretinal adherence, we used either endolaser or postoperative external laser and a narrow buckle. The retina was reattached successfully in 22 (91.6%) of the 24 eyes. Of these, visual acuity was 20/200 or better in 18 (75%) eyes. This was significantly better than the preoperative visual acuity (P = .02). After removing the silicone oil in 15 cases, 13 (92.8%) had visual acuities of 20/200 or better, which was considerably better than that of the group in which the silicone oil was not removed (P = .006). We recommend removing the silicone oil and additional peeling of membranes an average of six months postoperatively when the eye is stable.

Extraction of intraocular foreign bodies by pars plana vitrectomy. A retrospective study.

We reviewed the medical records of 44 patients who underwent a pars plana vitrectomy to remove posttraumatic intraocular foreign bodies. The group most affected was that of males with a mean age of 28 years, who sustained a job injury, presenting with a single corneal laceration less than 2 mm in extension. There were 31 (70.45%) metallic foreign bodies. At surgery, 27 (61.36%) of the 44 foreign bodies were removed with forceps and 17 (38.63%) with the rare-earth magnet. From these patients, 84.61% obtained a final visual acuity equal or better than that on admission. We did not find a statistically significant difference between the groups with different timing on their vitrectomy, nor between groups presenting with and without vitreous hemorrhage.