Neurite óptica secundária a infecção pelo Chikungunya Vírus / Optic neuritis secondary to chikungunya virus infection

RESUMO Apresentamos um caso de um paciente de 46 anos, sexo masculino com diagnóstico de neurite ótica em olho direito associado a infecção aguda por Chikungunya. Os sintomas iniciais eram dor e baixa acuidade visual em olho direito associado a febre e poliartralgia simétrica há uma semana. Ao exame a acuidade visual era de 20/60 em olho direito e 20/20 em olho esquerdo, fundoscopia evidenciou edema de papila à direita. Foi iniciado imediatamente pulsoterapia com metilprednisolona por 7 dias e foi observada melhora do quadro de neurite no seguimento de 1, 3 e 12 meses, porém melhora parcial da acuidade visual, Dentre as causas investigadas identificou-se sorologia anti Chikungunya IgM positivo.

ABSTRACT We present a case of optic neuritis secondary to Chikungunya virus infection. Male, 46 yo, initial symptoms were pain and low visual acuity in the right eye associated to fever and symmetrical polyarthralgia one week ago. At the examination the visual acuity was 20/60 in the right eye and 20/20 in the left eye, fundoscopy showed papillo edema on the right eye. Immediately initiated pulse therapy with methylprednisolone for 7 days and improvement of the neuritis was observed in the follow-up of 1, 3 and 12 months, but partial improvement of the visual acuity. Among the investigated causes, Chikungunya IgM positive serology was identified.

Accelerated corneal collagen crosslinking: Technique, efficacy, safety, and applications.

Corneal collagen crosslinking (CXL) is an approach used to increase the biomechanical stability of the stromal tissue. Over the past 10 years, it has been used to halt the progression of ectatic diseases. According to the photochemical law of reciprocity, the same photochemical effect is achieved with reduced illumination time and correspondingly increased irradiation intensity. Several new CXL devices offer high ultraviolet-A irradiation intensity with different time settings. The main purpose of this review was to discuss the current use of different protocols of accelerated CXL and compare the efficacy and safety of accelerated CXL with the efficacy and safety of the established conventional method. Accelerated CXL proved to be safe and effective in halting progression of corneal ectasia. Corneal shape responses varied considerably, as did the demarcation line at different irradiance settings; the shorter the exposure time, the more superficial the demarcation line. FINANCIAL DISCLOSURE: Dr. Santhiago is a consultant to Ziemer Ophthalmic Systems AG and Alcon Laboratories, Inc. None of the authors has a financial or proprietary interest in any material or method mentioned.

Intracorneal Ring Segments Implantation for Corneal Ectasia.

PURPOSE: To provide an overview of the predictability, safety, and efficacy of intrastromal corneal ring segment (ICRS) implantation as a tool to improve visual acuity and its association with other techniques such as corneal collagen cross-linking (CXL), addressing biomechanical outcomes, models, surgical planning and technique, indications, contraindications, and complications in ectatic corneas. METHODS: Literature review. RESULTS: ICRSs have been used to regularize the corneal shape and reduce corneal astigmatism and higher order aberrations, improve visual acuity to acceptable limits, and delay, or eventually prevent, a corneal keratoplasty in keratoconic eyes. Changes in ICRS thickness and size, combination of techniques, and the addition of femtosecond lasers to dissect more foreseeable channels represent an improvement toward more predictable results. Several studies have shown, over time, the long-term efficacy and safety of ICRS treatment for keratoconus, with variable predictability, maintaining the early satisfactory outcomes regarding visual acuity, keratometry, and corneal thickness. It is just as important to ensure that the disease will not progress as it is to improve the visual acuity. Therefore, many studies have shown combined techniques using ICRS implantation and CXL. Also, further limitations of ICRS implantation can be addressed when associated with phakic intraocular lens implantation and photorefractive keratectomy. CONCLUSIONS: ICRS implantation has shown effectiveness and safety in most cases, including combined procedures. In properly selected eyes, it can improve both refraction and vision in patients with keratoconus. [J Refract Surg. 2016;32(12):829-839.].

Corneal Collagen Cross-linking in Advanced Keratoconus: A 4-Year Follow-up Study.

PURPOSE: To analyze the safety and efficacy of standard corneal collagen cross-linking (CXL) in advanced cases of progressive keratoconus after 4 years of follow-up. METHODS: A retrospective case series of patients with advanced progressive keratoconus (stages 3 and 4 of Amsler-Krumeich classification) underwent standard CXL treatment. The parameters examined were changes in uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), keratometry values (mean, flat, steep, and apical), pachymetry, and endothelial cell count at the baseline and at 12, 24, and 48 months postoperatively. RESULTS: Forty eyes of 40 patients were enrolled in the study. The mean patient age was 22.5 years (range: 15 to 37 years). Both mean UDVA and CDVA remained stable during the time points; no statistically significant change was noted. Although a slight reduction was observed in all keratometric readings, a statistically significant reduction was only reached in the apical keratometry (P = .037) at 4 years after CXL. A significant reduction in the corneal thickness was also found (ultrasonic: 388 ± 49 to 379 ± 48 µm; slit-scanning: 362 ± 48 to 353 ± 51 µm); however, this change was likely not clinically meaningful. Endothelial cell count was not significantly different at the end of the study. Treatment failure or progression was noted in two patients (5%) over the follow-up period. CONCLUSIONS: Standard CXL treatment was safe and able to stabilize both visual acuity and topographic parameters at 4 years of follow-up in eyes with advanced keratoconus. [J Refract Surg. 2016;32(7):459-464.].

Advances in femtosecond laser technology.

Femtosecond laser technology has become widely adopted by ophthalmic surgeons. The purpose of this study is to discuss applications and advantages of femtosecond lasers over traditional manual techniques, and related unique complications in cataract surgery and corneal refractive surgical procedures, including: LASIK flap creation, intracorneal ring segment implantation, presbyopic treatments, keratoplasty, astigmatic keratotomy, and intrastromal lenticule procedures.

Ectasia risk factors in refractive surgery.

This review outlines risk factors of post-laser in situ keratomileusis (LASIK) ectasia that can be detected preoperatively and presents a new metric to be considered in the detection of ectasia risk. Relevant factors in refractive surgery screening include the analysis of intrinsic biomechanical properties (information obtained from corneal topography/tomography and patient's age), as well as the analysis of alterable biomechanical properties (information obtained from the amount of tissue altered by surgery and the remaining load-bearing tissue). Corneal topography patterns of placido disk seem to play a pivotal role as a surrogate of corneal strength, and abnormal corneal topography remains to be the most important identifiable risk factor for ectasia. Information derived from tomography, such as pachymetric and epithelial maps as well as computational strategies, to help in the detection of keratoconus is additional and relevant. High percentage of tissue altered (PTA) is the most robust risk factor for ectasia after LASIK in patients with normal preoperative corneal topography. Compared to specific residual stromal bed (RSB) or central corneal thickness values, percentage of tissue altered likely provides a more individualized measure of biomechanical alteration because it considers the relationship between thickness, tissue altered through ablation and flap creation, and ultimate RSB thickness. Other recognized risk factors include low RSB, thin cornea, and high myopia. Age is also a very important risk factor and still remains as one of the most overlooked ones. A comprehensive screening approach with the Ectasia Risk Score System, which evaluates multiple risk factors simultaneously, is also a helpful tool in the screening strategy.

Accelerated Corneal Collagen Cross-linking for Postoperative LASIK Ectasia: Two-Year Outcomes.

PURPOSE: To evaluate the effectiveness and safety of accelerated corneal collagen cross-linking for postoperative LASIK ectasia after 2 years. METHODS: A prospective, single-center case series was performed with patients treated for postoperative LASIK ectasia. All eyes underwent accelerated corneal collagen cross-linking (CCL-Vario Crosslinking; Peschke Meditrade GmbH, Zurich, Switzerland) at 9 mW/cm(2) for 10 minutes. The main outcome measures were changes in uncorrected distance visual acuity, corrected distance visual acuity, central corneal thickness, corneal topography, and endothelial cell density. These parameters were assessed at baseline and at the 6-month and 1- and 2-year follow-up visit. RESULTS: The study enrolled 40 eyes of 24 patients (15 male and 9 female) with a mean age of 33.8 ± 7.5 years (range: 24 to 52 years) that attained at least 2 years of follow-up. The surgical procedure was uneventful in all cases. All eyes stabilized after treatment without any further signs of progression and no statistically significant changes in the mean uncorrected distance visual acuity (P = .649), corrected distance visual acuity (P = .616), mean keratometry (P =.837), steep keratometry (P = .956), ultrasonic pachymetry (P = .135), slit-scanning pachymetry (P = .276), and endothelial cell density (P = .523). In addition, 72.5% of the patients presented stable or gains of Snellen lines over time. CONCLUSIONS: Accelerated corneal collagen cross-linking seems to be safe and effective in halting postoperative LASIK ectasia progression after 2 years of follow-up. However, a longer follow-up period with a larger cohort is needed to validate these findings.

Intense Early Flattening After Corneal Collagen Cross-linking.

PURPOSE: To report two cases of significant flattening after corneal cross-linking (CXL) for keratoconus and discuss its potential explanations and implications. METHODS: Observational case report. RESULTS: One year after standard CXL protocol (3 mW/cm(2) for 30 minutes and total energy of 5.4 J/cm(2)), a 28-year-old woman presented a flattening of greater than 14 diopters and a 14-year-old boy presented a flattening of 7 diopters. CONCLUSIONS: Although rare, a significant flattening effect may occur during the first year after CXL, probably related to intense wound healing, increase in corneal elasticity, CXL effective depth, and central cone location. These cases suggest the necessity of a patient-specific approach and a better understanding regarding the actual mechanism behind its potent effect.

Diabetes Mellitus: diagnóstico e complicações / Diabetes Mellitus: diagnosis and complications

Diabetes mellitus (DMI) é um dos mais importantes problemas mundiais de saúde na atualidade, tanto em termos de prevalência , incapacitações e mortalidade prematura como dos custos envolvidos no seu controle e no tratamento de suas complicações. O presente estudo tem como objetivo enfatizar a importância do diagnóstico precoce e as possíveis abordagens clínicas que visam o retardo da progressão das temíveis complicações crônicas inerentes a esta patologia.

Diabetes mellitus (DM) is one of the most important health issues in the actual days, much in terms of affected people, incapacitation and premature mortality as the budget involved in its control and in the complications of its treatment. The present study has the goal to enphasize the importance of the early diagnosis and the possible clinic approaches which leads to a goal to avoid the progression of the hard complications proper of this pathology.