Optimized Artificial Intelligence for Enhanced Ectasia Detection Using Scheimpflug-Based Corneal Tomography and Biomechanical Data.

PURPOSE: To optimize artificial intelligence (AI) algorithms to integrate Scheimpflug-based corneal tomography and biomechanics to enhance ectasia detection. DESIGN: Multicenter cross-sectional case-control retrospective study. METHODS: A total of 3886 unoperated eyes from 3412 patients had Pentacam and Corvis ST (Oculus Optikgeräte GmbH) examinations. The database included 1 eye randomly selected from 1680 normal patients (N) and from 1181 "bilateral" keratoconus (KC) patients, along with 551 normal topography eyes from patients with very asymmetric ectasia (VAE-NT), and their 474 unoperated ectatic (VAE-E) eyes. The current TBIv1 (tomographic-biomechanical index) was tested, and an optimized AI algorithm was developed for augmenting accuracy. RESULTS: The area under the receiver operating characteristic curve (AUC) of the TBIv1 for discriminating clinical ectasia (KC and VAE-E) was 0.999 (98.5% sensitivity; 98.6% specificity [cutoff: 0.5]), and for VAE-NT, 0.899 (76% sensitivity; 89.1% specificity [cutoff: 0.29]). A novel random forest algorithm (TBIv2), developed with 18 features in 156 trees using 10-fold cross-validation, had a significantly higher AUC (0.945; DeLong, P < .0001) for detecting VAE-NT (84.4% sensitivity and 90.1% specificity; cutoff: 0.43; DeLong, P < .0001) and a similar AUC for clinical ectasia (0.999; DeLong, P = .818; 98.7% sensitivity; 99.2% specificity [cutoff: 0.8]). Considering all cases, the TBIv2 had a higher AUC (0.985) than TBIv1 (0.974; DeLong, P < .0001). CONCLUSIONS: AI optimization to integrate Scheimpflug-based corneal tomography and biomechanical assessments augments accuracy for ectasia detection, characterizing ectasia susceptibility in the diverse VAE-NT group. Some patients with VAE may have true unilateral ectasia. Machine learning considering additional data, including epithelial thickness or other parameters from multimodal refractive imaging, will continuously enhance accuracy. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Comparing the postoperative refractive predictability of Pentacam HR and IOLMaster 500 after a multifocal intraocular lens implantation / Comparação da previsibilidade refrativa pós-operatória do Pentacam HR e IOLMaster 500 após implante de lentes intraoculares multifocais

ABSTRACT Purpose: To compare the postoperative refractive predictability of IOLMaster 500 and Pentacam HR on the basis of keratometry and anterior chamber depth values in eyes with an indication for multifocal intraocular lens (IOL) implantation. Methods: This was a retrospective study conducted on 118 eyes treated with phacoemulsification and multifocal intraocular lens implantation. Only the eyes that achieved emmetropia in the dynamic refraction performed on postoperative day 30 were included. Haigis' formula was used in each case to calculate the intraocular lens power, and the intraocular lens with the target refraction closest to emmetropia was implanted. Four lens calculation scenarios were tested by combining keratometry and anterior chamber depth measurements obtained using the two devices. Results: IOLMaster 500 and Pentacam HR differed with regard to mean keratometry (D 0.07 ± 0.03 D; p=0.0065) and anterior chamber depth (D 0.08 ± 0.01 mm; p<0.001). In the analysis of covariance, the following differences were obtained using the Haigis' formula when confronted with the biometric values obtained by inserting keratometry and anterior chamber depth values, respectively: Penta/IOL x IOL/Penta (0.13 ± 0.03; p<0.0001); Penta/Penta × IOL/Penta (0.13 ± 0.03; p<0.0001); Penta/IOL × IOL/IOL (0.11 ± 0.03; p=0.001); Penta/Penta × IOL/IOL (0.11 ± 0.03; p=0.002); IOL/IOL × IOL/Penta (0.02 ± 0.03; p=0.865); and Penta/IOL × Penta/Penta (0.002 ± 0.03; p=0.99). The difference was smaller when measuring the anterior chamber depth using the IOLMaster 500, regardless of which device was used to measure keratometry. Conclusions: Pentacam HR significantly differed from IOLMaster 500 when calculating keratometry. As regards the anterior chamber depth, the two devices were equally accurate.

RESUMO Objetivo: Comparar a previsibilidade refrativa pós-operatória do IOLMaster 500 e Pentacam HR com base nos valores de ceratometria e profundidade de câmara anterior nos olhos com indicação de implante de lentes intraoculares multifocais. Métodos: Estudo retrospectivo realizado em 118 olhos tratados com facoemulsificação e implante de lentes intraoculares multifocal. Apenas os olhos que atingiram a emetropia na refração dinâmica no 30º dia pós-operatório foram incluídos. A fórmula de Haigis foi usada em cada caso para calcular o poder das lentes intraoculares, e a lente intraocular com a refração alvo mais próxima da emetropia foi implantada. Cenários de cálculo de quatro lentes foram testados pela combinação de medidas de ceratometria e profundidade de câmara anterior obtidas usando os dois dispositivos. Resultados: IOLMaster 500 e Pentacam HR diferiram quanto à média de ceratometria (D 0,07 ± 0,03 D; p=0,0065) e profundidade de câmara anterior (D 0,08 ± 0,01 mm; p<0,001). Na análise da covariância, as seguintes diferenças foram obtidas usando a fórmula de Haigis quando confrontadas com os valores biométricos obtidos pela inserção dos valores de ceratometria e profundidade de câmara anterior, respectivamente: Penta/IOL x IOL/Penta (0,13 ± 0,03; p<0,0001); Penta/Penta x IOL/Penta (0,13 ± 0,03; p<0,0001); Penta/IOL x IOL/IOL (0,11 ± 0,03; p=0,001); Penta/Penta x IOL/IOL (0,11 ± 0,03; p=0,002); IOL/IOL x IOL/Penta (0,02 ± 0,03; p=0,865); Penta/IOL x Penta/Penta (0,002 ± 0,03; p=0,99). A diferença foi menor ao medir a profundidade da câmara anterior usando o IOLMaster 500, independentemente de qual dispositivo foi usado para medir a ceratometria. Conclusões: O Pentacam HR diferiu significativamente do IOLMaster 500 no cálculo de ceratometria. Quanto à profundidade da câmara anterior, os dois dispositivos foram igualmente precisos.

Comparing the postoperative refractive predictability of Pentacam HR and IOLMaster 500 after a multifocal intraocular lens implantation.

PURPOSE: To compare the postoperative refractive predictability of IOLMaster 500 and Pentacam HR on the basis of keratometry and anterior chamber depth values in eyes with an indication for multifocal intraocular lens (IOL) implantation. METHODS: This was a retrospective study conducted on 118 eyes treated with phacoemulsification and multifocal intraocular lens implantation. Only the eyes that achieved emmetropia in the dynamic refraction performed on postoperative day 30 were included. Haigis' formula was used in each case to calculate the intraocular lens power, and the intraocular lens with the target refraction closest to emmetropia was implanted. Four lens calculation scenarios were tested by combining keratometry and anterior chamber depth measurements obtained using the two devices. RESULTS: IOLMaster 500 and Pentacam HR differed with regard to mean keratometry (D 0.07 ± 0.03 D; p=0.0065) and anterior chamber depth (D 0.08 ± 0.01 mm; p<0.001). In the analysis of covariance, the following differences were obtained using the Haigis' formula when confronted with the biometric values obtained by inserting keratometry and anterior chamber depth values, respectively: Penta/IOL x IOL/Penta (0.13 ± 0.03; p<0.0001); Penta/Penta × IOL/Penta (0.13 ± 0.03; p<0.0001); Penta/IOL × IOL/IOL (0.11 ± 0.03; p=0.001); Penta/Penta × IOL/IOL (0.11 ± 0.03; p=0.002); IOL/IOL × IOL/Penta (0.02 ± 0.03; p=0.865); and Penta/IOL × Penta/Penta (0.002 ± 0.03; p=0.99). The difference was smaller when measuring the anterior chamber depth using the IOLMaster 500, regardless of which device was used to measure keratometry. CONCLUSIONS: Pentacam HR significantly differed from IOLMaster 500 when calculating keratometry. As regards the anterior chamber depth, the two devices were equally accurate.

Computational Models for Optimization of the Intrastromal Corneal Ring Choice in Patients With Keratoconus Using Corneal Tomography Data.

PURPOSE: To evaluate the predictability of asphericity and average keratometry in patients with keratoconus after implantation of intrastromal corneal ring segments (ICRS) using artificial intelligence. METHODS: This study included 209 eyes of 160 patients with keratoconus (grades I, II, and III) who had ICRS implanted. The 160 arc length Ferrara ICRS was implanted in all patients. ICRS thickness varied from 150 to 250 µm. Pentacam (Oculus Optikgeräte, Wetzlar, Germany) corneal tomography parameters, clinical data, and ICRS data formed the basis of the 39 studied parameters. Linear regression was used to create the models. RESULTS: The best mean absolute error value found was 0.19 for asphericity and was 1.18 for mean keratometry. Comparing the mean absolute error values of the nomogram with the average absolute error of the algorithm, there was an improvement of 0.11 for asphericity and 0.09 for mean keratometry in relation to the current nomogram. CONCLUSIONS: The current study showed that the use of computational models could lead to more accurate results and contribute to better surgical decision-making to improve the clinical outcomes in patients with keratoconus implanted with ICRS. [J Refract Surg. 2018;34(8):547-550.].

Tomographic Findings After Implantation of Ferrara Intrastromal Corneal Ring Segments in Keratoconus.

PURPOSE: To analyze and compare changes to the anterior and posterior corneal surfaces after Ferrara intracorneal ring segment (ICRS) (AJL, Boecillo, Spain) implantation and to correlate those changes with visual outcomes. METHODS: This retrospective case series study comprised consecutive patients with keratoconus implanted with the Ferrara ICRS. Computed tomography scans of the two corneal surfaces were obtained preoperatively and postoperatively with a rotating Scheimpflug imaging system. The Wilcoxon test was used to compare groups, and the Pearson's correlation coefficient was used to measure the strength of the correlation between variables. RESULTS: The study evaluated 241 eyes in 182 patients with keratoconus. Both corneal surfaces showed statistically significant decreases in average steep keratometry (K2) values, corneal astigmatism, elevation at the apex and at the thinnest point, maximum elevation in the central 4-mm area, and elevation inside the 3- and 4-mm zones and at the 3-mm ring. Regarding anterior surface parameters, a significant decrease was observed in flat keratometry (K1), whereas asphericity increased. On the posterior corneal surface, no significant changes in K1 and asphericity were observed. Poor correlation was found between visual outcomes and changes in tomographic parameters. The best correlation was obtained for anterior corneal astigmatism. CONCLUSIONS: ICRS implantation led to statistically significant changes in both anterior and posterior corneal surfaces. However, correlation between visual outcomes and tomographic parameters was poor. [J Refract Surg. 2017;33(2):110-115.].

Platelet-rich plasma in diabetic dry eye disease / Plasma rico em plaquetas no olho seco diabético

ABSTRACT Objective: To evaluate the effectiveness of autologous Plasma- rich platelet (PRP) in symptomatic dry eye of diabetic patients. Design A prospective single group interventional study. Participants: Twelve diabetic patients with refractory dry eye disease. Methods Patients were treated with autologous PRP eye drops four times a day for a month. Dry eye symptoms and its frequency, according to DEWS studies, tear film breakup time, improvement of visual acuity lines, and Schirmer test. Results: All the patients had some symptomatic improvement regarding dryness, itching, burning and redness (p=0.002). Five patients, 41.66% (5/12) had improvement of 1 or more lines of visual acuity in both eyes, 50% and 58.33% had no alteration in right and left eye, respectively (p=0.14). Considering Schirmer test, 66.66% (8/12) had improvement in the test value, 25% (3/12) had no alteration in this test value and 8.33% (1/12) had a reduced value in the test after treatment.(p=0.04). Considering the value of BUT test 58.33% (7/12) had improvement in the test value and 41.66% (5/ 12) had no alteration in this test value (p=0.018). Conclusions PRP is safe and an interesting alternative therapy in symptomatic diabetic dry eye. More clinical trials are required to create specific protocols to this treatment.

RESUMO Objetivo: Avaliar a eficácia do colírio de concentrado de plaquetas (CCP) autólogo no olho seco sintomático de pacientes diabéticos. Projeto Um estudo de intervenção único grupo prospectivo. Participantes Doze pacientes diabéticos com doença do olho seco refratário. Métodos Os pacientes foram tratados com colírio de PRP autólogo quatro vezes por dia durante um mês. Sintomas de olho seco e sua frequência, seguindo os critérios de DEWS, tempo de ruptura do filme lacrimal, a melhoria das linhas de acuidade visual e teste de Schirmer. Resultados Todos os pacientes tiveram alguma melhora dos sintomas de ressecamento, coceira, ardor e vermelhidão (p = 0,002). Destes, 41,66% (5/12) tiveram melhora de uma ou mais linhas de acuidade visual em ambos os olhos; 50% e 58,33% não tinham alteração no olho direito e esquerdo, respectivamente (p = 0,14) . Considerando o teste de Schirmer, 66,66% (8/12) tiveram melhora no valor do teste, 25% (3/12) não apresentaram alteração neste valor de teste e de 8,33% (1/12) tiveram um valor reduzido no teste após tratamento. (p = 0,04). Considerando o valor de teste BUT 58,33% (7/12) apresentaram melhora no valor de teste e 41,66% (12/05) não apresentaram alteração neste valor de teste (p = 0,018). Conclusões O CCP é seguro e uma terapia alternativa interessante no olho seco diabético sintomático. Mais ensaios clínicos são necessários para criar protocolos específicos para este tratamento.

Clinical features of diabetic patients with dry eye disease in a community in Maceio: a cross-sectional study / Características clínicas de pacientes diabéticos com olho seco em uma comunidade de Maceió: estudo transversal

ABSTRACT Objective: This study was carried out in order to assess the epidemiological profile of symptomatic dry eye in diabetic patients. Methods: Two hundred and twenty-one diabetic patients were evaluated using a specific questionnaire about other diseases and drugs. Of these, 58 who classified as having moderate to severe dry eye were included. Results: In this study, 58 of the 221 diabetic patients had moderate to severe dry eye (26.2%). Of the 58 patients, dry eye was more prevalent at age 61.46 ± 14.18 years for men, and 61.09 ± 10.64 for women (p<0.005). Dry eye was more common in women (75.9%) (p=0.456). Of the 58 patients, 15 (25.9%) had at least one ocular disease.The most common was diabetic retinopathy (13 of 15 patients, 86.7%, 95% CI 69.46-103.87). A total of 19 patients used eye drops (32.8%); and most (14 of the 19 individuals, 73.7%) used lubricants (95%CI 53.88-93.48). Hypertension was the most prevalent associated comorbidity (56.9%) and the most commonly used medications were hypoglycemic agents (98 %, 95%CI 94.00 - 101.92) and angiotensin converting enzyme inhibitors (53.1%, 95%CI 53.06 39.09 - 67.04). Conclusion: Further epidemiologic studies need to be done to establish a real etiologic relationship between diabetes and dry eye, and its correlation to other risk factors. In spite of these limitations, we have strong evidence of this relationship, and in clinical practice, examination for dry eye should be part of the assessment of diabetic disease.

RESUMO Objetivo: O estudo foi realizado para descrever o perfil epidemiológico de pacientes diabéticos com olho seco sintomático. Métodos: Duzentos e vinte e um pacientes diabéticos foram avaliados por meio de questionário específico sobre outras doenças e medicamentos. Destes, 58 foram diagnosticados com olho seco moderado a severo e foram incluídos no estudo. Resultados: Neste estudo, 58 dos 221 pacientes diabéticos tinham olho seco moderado a severo (26,2%). Dos 58 pacientes, o olho seco, foi mais prevalente na faixa etária de 61,46 ± 14,18 anos para os homens e 61,09 ± 10,64 para as mulheres (p <0,005). O olho seco foi mais comum em mulheres (75,86%) (p = 0,456). Dos 58 pacientes, 15 (25,9%) tinham pelo menos uma doença ocular. A mais comum foi a retinopatia diabética (13 de 15 pacientes, 86,7%, IC de 95% 69,46-103,87). Um total de 19 pacientes utilizavam colírios (3,8%); lubrificantes foram os mais usados (14 dos 19 indivíduos, 73, 7%, (IC de 95%, 53,88-93,48). A hipertensão foi a doença mais prevalente associada (56.9%) e os medicamentos mais utilizados foram hipoglicemiantes orais (98%, IC 95% 94,00 - 10,92) e inibidores da enzima conversoras da angiotensina (53,1%, IC 95%, 53,06 39,09 - 67,04). Conclusão: Novos estudos epidemiológicos devem ser feitos para avaliar a real relação etiológica entre olho seco e diabetes e sua correlação com outros fatores de risco. Apesar das limitações, temos fortes evidências da relação entre olho seco e diabetes. Na prática clínica, o exame de olho seco deve ser parte da avaliação dos diabéticos.

Bioestatísticas: conceitos fundamentais e aplicações práticas / Biostatistics: fundamental concepts and practical applications

A bioestatística ganha crescente importância e relevância nos últimos anos, sendo um dos principais pilares da investigação científica. Possui uma série de conceitos e regras que devem ser bem compreendidos para se realizar ou analisar um artigo. Nesta revisão são abordadas algumas das principais ferramentas utilizadas nos trabalhos de interesse da área oftalmológica, suas aplicações e limitações.

The biostatistics has gained significant importance in recent years, being one of the mainstays of current scientific research. It has a series of concepts and rules that must be understood to carry out or analyze an article. In this review we will discuss some of main tools utilized in works of interest in ophthalmology, its applications and limitations.

Analysis of waveform-derived ORA parameters in early forms of keratoconus and normal corneas.

PURPOSE: To evaluate the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Depew, NY) performance in differentiating grades I and II keratoconus from normal corneas using 41 parameters individually and to assess the effect of analyzing all parameters together. METHODS: This study compared the mean value of 41 ORA parameters in grades I and II keratoconus with healthy age-matched control eyes. Only eyes with a central corneal thickness between 500 and 600 µm were included. The area under the receiver operating characteristic curve was calculated for each of the 41 parameters independently and for all of the parameters together. RESULTS: This study included 136 eyes with normal corneas and 68 eyes with grades I and II keratoconus. When analyzed individually, four ORA parameters (p1area, p1area1, p2area, and p2area1) had an area under the curve greater than 0.900 for discriminating between both groups. The p2area was the parameter that achieved the largest area under the curve individually (0.931). The area under the curve increased to 0.978 when analyzing all parameters together. CONCLUSION: Alternative ORA parameters are better for differentiating grades I and II keratoconus from normal corneas than the four parameters originally available for ophthalmologists (corneal hysteresis, Goldmann-correlated intraocular pressure, corneal-compensated intraocular pressure, and corneal resistance factor). Although the ORA did not achieve 100% accuracy, the discrimination between these two groups was optimized by combining all parameters.

Intrastromal corneal ring segment implantation to correct astigmatism after penetrating keratoplasty.

PURPOSE: To evaluate the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS) in patients with astigmatism after penetrating keratoplasty (PKP). SETTING: Private clinic, Belo Horizonte, Brazil. DESIGN: Retrospective consecutive case series. METHODS: Chart records of post-PKP patients who had ICRS implantation from May 2005 to September 2009 were retrospectively reviewed. The following parameters were studied: corrected distance visual acuity (CDVA), keratometry (K) values, spherical equivalent (SE), spherical refractive error, corneal topographic astigmatism, minimum K, and maximum K. RESULTS: The study evaluated 59 eyes (54 patients). The mean CDVA (logMAR) improved from 0.45 ± 0.17 (SD) (range 0.18 to 1.00) to 0.30 ± 0.17 (range 0.00 to 1.00). The mean SE was -6.34 ± 3.40 diopters (D) (range 0.37 to -16.50 D) preoperatively and -2.66 ± 2.52 D (range 0.87 to -10.50 D) postoperatively. The mean spherical refractive error decreased from -7.10 ± 3.07 D (range 2.15 to 16.68 D) preoperatively to -3.46 ± 2.05 D (range 0.88 to 10.79 D) postoperatively. No patient lost visual acuity. The mean corneal topographic astigmatism decreased from 3.37 ± 1.51 D preoperatively to 1.69 ± 1.04 D postoperatively. The mean maximum K value decreased from 48.09 ± 2.56 D to 44.17 ± 2.67 D and the mean minimum K value, from 44.90 ± 2.54 D to 42.46 ± 2.63 D. All changes were statistically significant (P<.0001). CONCLUSION: Intrastromal corneal ring segments effectively reduced corneal cylinder in patients with astigmatism after PKP.

Outcomes of radiofrequency in advanced keratoconus.

PURPOSE: To evaluate the use of radiofrequency energy to correct advanced keratoconus. SETTING: Universidade Federal de Minas Gerais, Belo Horizonte, and Universidade de Ciências da Saúde de Alagoas, Maceió, Brazil. METHODS: In this prospective comparative study, radiofrequency was applied to 25 eyes of 21 consecutive patients. One group comprised patients with a K-reading between 54.0 diopters (D) and 58.0 D; 8 thermal spots were placed at the 4.0 mm optical zone. The other group comprised patients with a K-reading greater than 58.0 D; 16 spots were applied at the 4.0 mm and 5.0 mm optical zones. The minimum follow-up was 18 months in all patients. Differences between preoperative and postoperative uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, and K-readings were clinically and statistically evaluated. RESULTS: At end of the 18-month follow-up, the mean BSCVA in the 8-spot group improved from 20/100 (0.71+/-0.25 logMAR) preoperatively to 20/40 (0.32+/-0.11 logMAR) and in the 16-spot group, from 20/200 (1.03+/-0.30 logMAR) to 20/60 (0.62+/-0.22 logMAR). The mean manifest refractive spherical equivalent (MRSE) improved from -7.70 D+/-5.20 (SD) preoperatively to -6.82+/-4.41 D after 18 months in the 8-spot group and from -11.33+/-6.70 to -8.38+/-5.12 D, respectively, in the 16-spot group. The mean best contact lens-corrected visual acuity was 20/30 (0.18+/-0.24 logMAR) in the 8-spot group and 20/40 (0.31+/-0.19 logMAR) in the 16-spot group. A dense corneal scar was seen in 1 patient in the 16-spot group at the 6-month follow-up. CONCLUSIONS: Radiofrequency appeared safe for the treatment of advanced keratoconus. Contact lens fitting was stable in all cases.

Ceratoplastia pela rádio-freqüência para correção de hipermetropia pequena a moderada: resultado de 18 olhos com seguimento de 16 a 25 meses / Keratoplasty by radio frequency for the correction of low to moderate hyperopia: results of 18 eyes in a follow-up from 16 up to 25 months

Objetivo: Mostrar o resultado de 18 olhos submetidos à ceratoplastia pela rádio-freqüência para a correção de hipermetropia pequena a moderada, com seguimento de 16 a 25 meses. Local: Hospital São Geraldo - Universidade Federal de Minas Gerais. Métodos: Dezoito olhos com hipermetropia pequena a moderada foram submetidos à ceratoplastia pela rádio-freqüência denominada ceratoplastia condutiva. Foram avaliadas eficácia, estabilidade e segurança do procedimento. Resultados: A acuidade visual não-corrigida (AVNC) média aos 18 meses de período pós-operatório foi de 20/30; 25 porcento dos pacientes tiveram AVNC melhor ou igual a 20/25, 56 porcento melhor ou igual a 20/30 e 75 porcento melhor ou igual a 20/40. O equivalente esférico médio aos 18 meses de pós-operatório foi de +0,95 D (dp = +-0,66). O equivalente esférico em 18 meses foi de +-0,50 D em 31,3 porcento, de +-1,00 D em 56,3 porcento e de +-2,00 D em 100 porcento dos olhos. Não ocorreu perda de linha em nenhum olho operado. Todos os pacientes ficaram satisfeitos com o resultado cirúrgico. Conclusão: A ceratoplastia pela rádio-freqüência mostrou ser procedimento seguro para correção cirúrgica de hipermetropia leve a moderada. Entretanto, observou-se regressão do efeito cirúrgico com o passar do tempo em todos os casos.

Tratamento cirúrgico da catarata pediátrica / Surgical treatment of pediatric cataract

Objetivo: Descrever as diferentes abordagens dos casos cirúrgicos de catarata pediátrica (CP) em pacientes do Serviço de Córnea e Catarata do Hospital Säo Geraldo da Universidade Federal de Minas Gerais (UFMG), no período de junho de 1998 a novembro de 2000. Métodos: Foram estudados prospectivamente 37 olhos de 31 crianças. Trinta e cinco olhos (94,6 por cento) apresentavam catarata congênita e dois olhos (5,4 por cento) catarata traumática. A abordagem cirúrgica variou de acordo com a idade dos pacientes, que foram divididos nos seguintes grupos: Grupo 1(abaixo de l ano de idade): facectomia por aspiraçäo manual, sem implantaçäo de lente intra-ocular (LIO) com capsulotomia posterior primária, nos primeiros 2 olhos; capsulorrexe posterior primária (CPP) nos demais, e vitrectomia anterior (VA) via límbica em todos. Grupo II: (entre 1 e 5 anos de idade): facectomia por aspiraçäo manual, com implantaçäo de LIO com CPP e VA via límbica. Grupo III: (entre 1 e 5 anos de idade): facectomia por aspiraçäo manual, com implantaçäo de LIO, capsulotomia posterior primária e VA via pars-plana. Grupo IV: (acima de 5 anos de idade): facectomia por aspiraçäo manual, com implantaçäo de LIO sem capsulotomia/CPP e VA. Para confecçäo da capsulorrexe anterior e posterior (quando indicada), também foi utilizado aparelho de radiofreqüência. A capsulotomia posterior primária era realizada com vitreófago do aparelho de facoemulsificaçäo Universal - Alcon. Resultados: LIO foi implantada em 31olhos (83,8 por cento), sendo que 28 (90,3 por cento) dentro do saco capsular e 3 (9,7 por cento) no sulco ciliar. O seguimento pós-operatório variou entre 2 e 27 meses. No grupo IV, houve opacificaçäo secundária da cápsula posterior em 53,8 por cento dos casos (7 olhos), sendo estes submetidos a capsulotomia com YAG-laser. Conclusäo: O uso da radiofreqüência na realizaçäo da capsulorrexe anterior e CPP, assim como a VA melhoraram o resultado cirúrgico da CP.

Perfil dos pacientes com ceratocone atendidos no serviço de córnea do Hospital Säo Geraldo (UFMG) nos últimos cinco anos / Characteristics of Keratoconus patients registered at Hospital Säo Geraldo (UFMG) during the last five years

Estudaram-se, retrospectivamente, todos os prontuári,os dos pacientes com diagnóstico de ceratocone atendidos nos últimos cinco anos no Serviço de Córnea do Hospital Säo Geraldo (HSG) da UFMA. Foram analisados os prontuários de 107 pacientes (203 olhos) quantoa idade à admissäo no serviço, idade do diagnóstico, tempo de diagnóstico, sewxo, cor da pele, bilateralidade, uso prévio de lentes de contato, doenças associadas, localizaçäo e classificaçäo do ceratocone. Os resultados encontrados revelam o perfil predominante dos paciwentes com ceratocone e as condutas tomadas no serviço. Trantam-se de pacientes apresentando ceratocone em fase mais avançada, geralmente referidos de outras instituiçöes ou encaminhados pelo Serviço de Lentes de Contato do HSG (ufmg). A indicaçäo de ceratoplasia penetrante foi 72,9 (por cento), maior quando comparada coma populaçäo geral dos pacientes com ceratocone