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Cross-linking (CXL) is a well-established procedure in children with keratoconus (KC), but cases of CXL and osteogenesis imperfecta (OI) have not been published in the literature, despite the association between physiopathology of these diseases. This is the first case, to the best of our knowledge, of a young girl with both OI and KC that underwent a CXL treatment. In this case, CXL was performed at 6-years-old prior to an expected progression, without complications and probably stopped further keratoconus progression.

Intrastromal corneal ring segments (ICRS) have been found to be useful in correcting keratoconus by decreasing irregular astigmatism, thereby potentially improving visual acuity. However, its long-term effects in keratoconus progression are not completely understood, mainly concerning the effects of age on ICRS implantation results. This study aimed to evaluate long-term effects of ICRS implantation according to age at implantation. We conducted a longitudinal retrospective study, where we evaluated patients with keratoconus who underwent ICRS implantation between 2004 and 2012. We evaluated 34 eyes for 5 years post-operatively. The mean age of the 21 men and 7 women was 20.59 ± 4.65 years. Best spectacle-corrected visual acuity (BSCVA) improved from 0.32 ± 0.19 in the preoperative period to 0.46 ± 0.27 6 months post-operatively. After up to 5 years of follow-up, there was no significant difference in mean visual acuity of the group. As expected, there was a significant decrease in keratometric values after corneal ring implantation, which remained stable over the 5-year follow-up. Among the 34 cases analysed, nine (26%) showed signs of disease progression. In eight of the nine documented progression cases, patients were 21 years old or younger, revealing that these patients were sevenfold more likely to progress than those aged over 21 years. In our series of cases, ICRS implantation was shown to be an excellent treatment to reduce corneal curvature and improve visual acuity at all ages, but it did not stabilize the disease, especially in young patients with more aggressive forms of the keratoconus.

The aim of this study is to report our results of toric intraocular lens (IOL) implantation in patients with asymmetric astigmatism, its efficacy and safety in reducing the refractive cylinder. This is a retrospective cohort study. Patients with asymmetric astigmatism and non-progressive corneal ectasia, unable to fit hard contact lenses, with poor-corrected visual acuity or unsatisfactory spectacles-corrected visual acuity, underwent cataract surgery with toric IOL implantation. The choice of lens was individually after optical biometry examination. All surgeries were performed by a single surgeon, with a 2.75-mm clear cornea self-sealing incision at 130° axis, from December 2008 to December 2015. We evaluated 88 eyes of 69 patients with asymmetric astigmatism: primary, secondary to leucoma, post-radial keratectomy, post-lamellar or penetrating keratoplasty, post-LASIK, post-PRK and due to pterygium. Snellen best-corrected spectacles visual acuity increased from 0.39 ± 0.23 preoperative to 0.80 ± 0.23 postoperative. The average refractive cylinder reduced from 2.32 ± 1.78 D preoperatively to 0.87 ± 1.09 D after surgery (P

Purpose: To report risk factors, clinical course, and outcome in patients with infectious keratitis following implantation of intracorneal ring segments (ICRS). Methods: The records of 8 patients with culture-proven infectious keratitis after ICRS (Ferrara® or Intacs®) implantation were retrospectively reviewed. Age, gender, corneal findings, ocular abnormalities, the condition that led to ICRS implantation, immediate prior use of a contact lens, elapsed time between implantation and the onset of symptoms, previous medications, and systemic disorders were noted. Results: Culture-positive infectious keratitis developed in 7 eyes of 7 patients (2 men and 5 women) with a mean age of 35 years who underwent Ferrara implantantion for the treatment of keratoconus and in a 29-year-old man who underwent Intacs implantation for correction of low myopia. Contact lens use, diabetes, and trauma were factors possibly associated with the risk of infection in three cases. Microorganisms, identified in all cases, included Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae, Pseudomonas sp, Nocardia sp, Klebsiella sp, and Paecylomices sp. Onset of symptoms of infection varied from less than 1 week to 22 months postoperatively, depending on the infecting organism. Conclusions: Infectious keratitis following ICRS implantation is a sight-threatening complication for which early recognition and rapid institution of appropriate treatment may result in a better visual outcome.

Uma breve revisão de resultados e complicações da ceratoprótese (KPro) de Dohlman-Doane tipo 1. A KProDohlman-Doane é atualmente uma boa opção em casos graves de cegueira corneana, para os quais o transplante penetrante de córnea não apresenta bom prognóstico. As evoluções no design da KPro e as melhorias no procedimento cirúrgico, aliados a obtenção de condições favoráveis da superfície ocular pré-operatórias, garantem bons resultados da KPro em doenças não autoimunes. As principais complicações da KPro são membrana inflamatória retroprotética de fibrina, glaucoma, necrose corneana, vitreíte e infecção (ceratite e endoftalmite). Acompanhamento constante com exames pós-operatórios periódicos é necessário para monitorar e prevenir complicações sérias. A short review of type 1 Dohlman-DoaneKeratoprosthesis (KPro) addresses results and complications. Dohlman-DoaneKPro is today a good option for cases of corneal blindness with poor prognosis for traditional penetrating keratoplasty. KPro design and surgical improvements along with proper preoperative ocular surface condition allows good results in non-immune diseases. Main complications of this KPro areinflammatory retroprosthetic membrane, glaucoma, corneal melting,vitreitis, and infection (keratitis and endophthalmitis). Comprehensive long-term postoperative follow-up examinationsare needed to monitor for and prevent serious complications.

The authors report a case of Listeria monocytogenes endophthalmitis in a patient who had undergone cardiac revascularization surgery and was receiving systemic corticosteroids. The organism was isolated both in the aqueous humor and in blood culture. The infection was successfully treated with intravenous crystalline penicillin, but the patient developed a bullous keratopathy and secondary glaucoma, resulting in poor visual acuity (counting fingers at 0.5 m). The visual acuity recovered to 20/30 after a penetrating keratoplasty and the glaucoma was controlled with a Molteno implant and a trabeculectomy combined with administration of mitomycin. Listeria monocytogenes endogenous endophthalmitis should be suspected in any immunosuppressed patient with severe anterior uveitis, especially when a brown hypopyon, high intraocular pressure and corneal edema are present.

Objetivo: Relatar a evolução de 9 olhos (8 pacientes) submetidos ao implante da ceratoprótese de Dohlman-Doane tipo 1, com tempo médio de seguimento de 11,2 meses (2 a 25 meses). Métodos: Trabalho retrospectivo, não comparativo, intervencionista de uma série de casos. Quanto à doença de base, em 4 olhos foram queimadura alcalina, 3 falência de múltiplos transplantes de córnea, 1 síndrome de Stevens-Johnson e 1 queimadura térmica. A acuidade visual pré-operatória era de movimento de mãos ou pior em todos os olhos. Três olhos apresentavam glaucoma pré-operatório, sendo submetidos a implante valvulado de Ahmed. Resultados: A acuidade visual com correção pós-operatória foi melhor ou igual a 20/100 em 88,9% dos olhos e melhor ou igual a 20/40 em 44,4% dos olhos. Como intercorrências pós-operatórias, 3 olhos apresentaram opacidade de cápsula posterior tratada com capsulotomia com YAG laser; 3 olhos membrana retroprotética de fibrina tratada com injeção tPA ou corticoterapia; 2 olhos glaucoma tratado com medicação; 1 olho “melting” corneano tratado com a troca do botão e 1 olho endoftalmite fúngica tratada com transplante a quente, vitrectomia anterior, explante da ceratoprótese e da LIO e tratamento antifúngico. Conclusão: A ceratoprótese de Dohlman-Doane é uma boa opção para casos graves de cegueira corneana, em que o transplante penetrante de córnea não apresenta bom prognóstico. Sua principal vantagem é não necessitar imunossupressão sistêmica. Casos de queimadura alcalina e de alta chance de rejeição apresentaram os melhores resultados. Purpose: To describe 9 eyes in 8 patients who received Dohlman- Doane type 1 keratoprosthesis (KPro) with a mean follow-up of 11.2 months (2 to 25 months). Methods: A retrospective, noncomparative interventional case series. Previous corneal disease was alcaline burn in 4 eyes, multiple graft failure in 3 eyes, Stevens-Johnson syndrome in 1 eye and thermal injury in 1 eye. Best corrected visual acuity (BCVA) was hand motions or worse in all patients. Glaucoma was present preoperatively in 3 eyes and received Ahmed valve implantation. Results: 88,9% eyes achieved BCVA of better than or equal to 20/100, and 44,4% better than or equal to 20/40. In the postoperative period, 3 eyes developed posterior capsule opacity treated with YAG laser capsulotomy; 3 retroprosthetic membrane treated with tPA injection or steroids; 2 glaucoma in clinical treatment; 1 corneal melting, treated with donor cornea bottom exchange; and 1 fungic endophthalmitis, treated with corneal transplant, anterior vitrectomy, KPro and intraocular lens explantation, and specific intravitreal and endovenous treatment. Conclusion: Dohlman-Doane K-Pro seems to be a good option for cases of corneal blindness with poor prognosis for traditional penetrating keratoplasty. Its main advantage is not requesting systemic immunossuppression. Best results were achieved in non-immune diseases.

A patient with Terrien's corneal marginal degeneration and a previous trabeculectomy had planned extracapsular cataract extraction with intraocular lens implantation. A corneal incision was made with a diamond blade on the degeneration furrow superiorly and was closed with a 10-0 nylon double-running suture with keratoscopic control.

A distrofia corneana gelatinosa em gotas é uma desordem rara e pouco descrita em nossa literatura. O caso apresentado demonstra a dificuldade de realizar o diagnóstico nas fases mais iniciais da doença. O uso de modernos exames de imagem, como a tomografia de coerência óptica de segmento anterior, auxilia no diagnóstico e pode ser crucial para definir a melhor conduta terapêutica. Apresentaremos as alterações histopatológicas e as características clínicas desta incomum distrofia. Gelatinous drop-like corneal dystrophy is a rare disorder with few cases described in the present literature. The following report will show how difficult it is to diagnose this disease in early stages. Modern image exams, such as optical coherence tomography helps to diagnose and can be crucial to establish the best treatment. We will present the histopathological changes and clinical features in this unusual dystrophy.