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Scleral and iris fixation of intraocular lenses (IOL) are useful in the treatment of surgical or traumatic aphakia, luxation, and subluxation of IOL if the patient does not present appropriate capsular support. However, there is no consensus in the literature about which of these 2 methods is safer and better. The authors performed a literature review searching the main postoperative outcomes obtained with the use of each surgical method. Scleral and iris fixation of IOL are efficient in correction of the patients’ visual acuity, even though each technique presents distinct complications which depend especially on the experience of the surgeon with the performed surgical method. It is important to understand that individuals submitted to scleral or iris fixation present previous preoperative complications in their eyes. Besides, both procedures are very complex, involving intense manipulation of the eye globe. The success rate of these surgical techniques is highly variable and has a close relation to the preoperative conditions of the patient’s eye and the improvement of the surgeon’s learning curve.

Background: Studies have shown a higher incidence of dry eye among patients with diabetes compared to patients without diabetes. However, information regarding dry eye in patients with proliferative diabetic retinopathy and laser therapy indication is not sufficient. Objective: To estimate the clinical manifestation of dry eye syndrome in patients with proliferative diabetic retinopathy and laser therapy indication. Method: A cross-sectional study was performed during a local evaluation campaign of diabetic patients with vision disabilities at the Instituto Cearense de Oftalmologia in Fortaleza, CE, Brazil. Patients with proliferative diabetic retinopathy and laser therapy indication were included in the study. An anamnesis directly to dry eye complaints was performed, and eligible participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The slit lamp examination was performed with fluorescein staining; the tear break-up time (TBUT) was measured, and conjunctiva and corneal was evaluated using Rose Bengal (RB) staining. Finally, the Schirmer I test was performed. Results: Twenty-five patients were included in the study with a diagnostic time of Diabetes Mellitus ranged from 1 to 35 years, with an average of 17.2 ± 8.7 years. In our sample, 14 patients (56%) reported glycemic control with insulin, while 11 patients (44%) had oral hypoglycemic agents. The most prevalent complaint was blurred vision (96% of patients) followed by low visual acuity (92%). A less prevalent complaint was pain (44%). The mean OSDI score was 49.4 ± 24.2. TBUT was less than 10 seconds in 21 patients (84%), and RB staining grade was more than 3 in 13 patients (52%). The results of the Schirmer I test ranged from 2 to 35 mm, with a mean of 13.57 ± 9.78 mm. It was smaller than 10 mm in 15 patients (60%). Conclusion: The frequency of manifestation of dry eye syndrome was very common in patients with proliferative diabetic retinopathy and laser therapy indication. Ocular surface care should be provided for those patients with significant ocular morbidity.

Purpose: To evaluate the effect of topical instillation of pegaptanib sodium upon inflammatory angiogenesis induced in the rabbit cornea by alkaline cauterization. Methods: Inflammatory angiogenesi...

IntroductionGlaucoma is a progressive optic neuropathy that requires continuous monitoring. The purpose of the study was to develop and evaluate the usability of a mobile application, for iOS and Android platforms, containing functionalities to improve patients’ knowledge about glaucoma and facilitate their treatment. MethodsThe application was developed by a multidisciplinary team using an adapted version of a co-design methodology. Thirty-six volunteers were selected, among patients and patients' relatives, from the Instituto Cearense de Oftalmologia, chosen by rational choice sampling, to answer the System Usability Scale after having prior orientation. The results extracted from the questionnaire were analyzed quantitatively. After grouping by age, a proportions test (z-test) was performed. ResultsIt was possible to develop an application for mobile devices named “GlaucoCheck”. Of the 36 interviewees, the average age was 51 (22-69) years old, 56% were women, and 64% had a university degree. The average APP score for usability in the SUS questionnaire was 75.6 (95% CI 74.1-77.2). DiscussionThere was an appropriate acceptance of patients to the “GlaucoCheck”, as it was considered easy to handle, exhibiting interactive and uncomplicated layout. It was possible to develop an application and to register a positive acceptance by the users, encompassing functions that permits better adherence to treatments and additional knowledge about glaucoma.

PURPOSE To develop a mobile app that allows photographs to be captured and edited under the overlay of images and projection of a protractor with 360 degrees axis markings, which enables the surgeon to accurately visualize the programmed and marked alignment where the intrastromal corneal ring segments (ICRS) will be implanted, detecting possible marking errors. METHODS A codesign methodology was chosen to develop the Eye Axis Check application. After app development, measurements were obtained, and comparisons were made between manual marks and ICRS alignment with and without the app in 13 eyes that had undergone ICRS implantation for keratoconus. The mobile app was made available to 15 ophthalmic surgeons in different cities to assess its usability. RESULTS The users approved the developed application for ease of use and utility. No difference was found between the markings made manually and those made with the app, and the mean difference between ICRS centralization and assessment made by the app was 4.84 degrees (95% confidence interval: -5.32 to 15.01; P = 0.3193). On comparison of the agreement between app measurements and manual measurements for the ICRS centration, no significant differences were found, and excellent concordance (0.991) and a strong positive linear correlation (0.984) were observed. CONCLUSIONS A mobile app for preoperative planning and intraoperative ICRS alignment was developed and revealed to be useful and easy to use, allowing the surgeon to visualize the programmed alignment where the ICRS will be implanted.

Dense brunescent cataracts represent a major challenge for surgeons. We performed a literature review focusing on surgical challenges dense brunescent cataracts present. All relevant literature was...

According to the World Health Organization, cataract is the major cause of reversible visual impairment in the world. It is present as the cause of decreased visual acuity in 33% of the visual impaired citizens. With the increase of life expectancy in the last decades, the number of patients with cataract is expected to grow for the next 20 years. Nowadays, the only effective treatment for cataracts is surgery and its surgical outcomes have been increasingly satisfactory with the technological advancement.

Introduction: To date, it has never been demonstrated the propagation sound speed in human corneas and lens in vivo. With the advent of Optical Coherence Tomography (OCT), it became possible to determine the dimensions of the ocular tissues without the interference of sound propagation speed and to use this information to define the real propagation sound speed for each patient and individualized structure. Aim: To determine the sound propagation speed in the cornea and lens from patients that theoretically exhibits differences in tissue elasticity (normal corneas and keratoconus, corneas of young and elderly patients, in addition to clear crystalline lens from young and elderly patients with cataract). Then, relate the determined velocity in each group with the expected tissue elasticity of the cornea and lens. Methods: We studied 100 eyes from 50 patients: 50 with keratoconus and no cataract and 50 with cataract and no corneal changes. All patients measured corneal and lens thickness by ultrasound methods (Ultrasonic Biomicroscopy - UBM and Ultrasonic Pachymetry - USP) and by OCT (RTVue®, Lenstar® and Visante®), then were divided into 2 groups: Group 1 (Cornea) analyzed the central corneal thickness (UBM, USP, RTVue®, Visante®, Lenstar®); Group 2 (Lens) analyzed the axial thickness of the lens (UBM and Lenstar®). Based on standard ultrasonic speed from USP (1640 m/s) and UBM (1548 m/s), we calculated the real sound propagation speed in each tissue. Results: Based on USP, the corneal sound speed on control group (1616 m/s) was faster than on keratoconus group (1547 m/s) (P Discussion: It is known that sound propagates faster in materials with lower elasticity. We found that the sound speed on keratoconic corneas (high elasticity) was slower and on cataract lens (lower elasticity) was faster than normal corneas and lens in vivo.

We describe a technique for image-guided femtosecond laser–assisted cataract surgery in a case of Peters anomaly type 2. The femtosecond laser technology enabled reliable construction of a complete capsulotomy despite central corneal opacification and a tented anterior capsule. Use of an image-guided femtosecond laser for cataract extraction in Peters anomaly type 2 is a safe method for removing these complex cataracts while preserving capsular and corneal integrity. Financial Disclosure Dr. De la Cruz is a consultant to Alcon Surgical, Inc. No other author has a financial or proprietary interest in any material or method mentioned.