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In this paper, we describe two adult patients who presented with double lacrimal puncta one of them was asymptomatic and incidentally diagnosed, and the other complained of epiphora. In both patients, unilaterality, preference for the lower lid, and location medial to the normal punctum were common features of the accessory punctum. In the asymptomatic patient, irrigation revealed no obstruction in the punctum or the nasolacrimal drainage system. By contrast, the other patient's nasolacrimal drainage system exhibited obstruction. Therefore, dacryocystorhinostomy surgery and silicone tube intubation were successfully performed. Double lacrimal puncta may be associated with epiphora or dry eye. These manifestations can easily be missed in a routine examination. This report was written to emphasize that unilateral epiphora of dry eye symptoms may be related to supernumerary punctum or canalicular systems and can easily be diagnosed with lid eversion.The intravitreal dexamethasone implant is a sustained-release anti-inflammatory drug system that releases 0.7 mg of dexamethasone into the vitreous cavity. The following case report describes a rare complication accidental injection of the dexamethasone implant into the crystalline lens. A 73-year-old woman was diagnosed with central retina vein occlusion and cystoid macular edema. Initial tSreatment included three monthly intravitreal doses of anti-vascular endothelial growth factor treatment, which was not successful. Treatment was then modified to an intravitreal dexamethasone implant. Ten weeks later, the implant was observed in the posterior cortex of the crystalline lens. Because no improvement had occurred, the patient underwent phacoemulsification surgery, during which part of the lens migrated into the vitreous cavity. Therefore, 23-gauge pars plana complete vitrectomy was performed with trans-surgical administration of intravitreal aflibercept. Crystalline lens injury due to an intravitreal dexamethasone implant is a rare complication and typically results from the injection procedure. Immediate surgical or conservative approaches should be considered on an individual basis.Purpose To measure the central-to-peripheral corneal thickness and its volume according to age and gender in 10-30-year-old patients with Down syndrome (DS) and in matched individuals without DS. Methods In the report, 202 normal pattern right eyes of patients with Down syndrome and 190 right eyes of individuals without Down syndrome and compared averages using independent sample t-tests and multiple linear regression models. The measured variables included the apical corneal thickness; the minimum corneal thickness; the average thickness on rings at 2 mm (R2), 3 mm (R3), and 4 mm (R4); the corneal volume in the central zones at 2-, 3-, 4-, and 10-mm diameters; Ambrosio's relational thickness; and the pachymetric progression indices. Results The mean age of the participants was 16.99 ± 4.70 and 17.22 ± 4.54 years (p=0.636). The means ± SD were 516.7 ± 33.0 and 555.7 ± 33.1 µm for apical corneal thicknesses, 508.0 ± 33.5 and 549.0 ± 40.6 µm for minimum corneal thicknesses, 543.0 ± and 588.4 ± 33.8 µm for R2s, 584.9 ± 35.6 and 637.0 ± µm for R3s, 646.9 ± 38.5 and 707.6 ± 37.1 µm for R4s, 396.4 ± 102.3 and 462.7 ± 96.2 µm for Ambrosio's relational thicknesses, 1.36 ± 0.37 and 1.22 ± 0.18 for pachymetric progression index maximums, 1.62 ± 0.11 and 1.74 ± 0.11 mm3 for corneal volume at 2 mm, 3.73 ± 0.24 and 4.01 ± 0.24 mm3 for corneal volume at 3 mm, 6.76 ± 0.44 and 7.30 ± 0.43 mm3 for corneal volume at 4 mm, and 57.03 ± 3.44 and 61.51 ± 3.40 mm3 for total corneal volume in the Down syndrome and control groups, respectively (all p less then 0.001). All the above indices were inversely related to age, but not to gender. Ambrosio's relational thickness maximum and the pachymetric progression index maximum were independent of age and gender. Conclusion Non-keratoconic patients with Down syndrome had thin corneas with a homogeneous distribution. Therefore, the reference ranges of cornea thickness and volume should be re-defined for this patient population.Purpose Our initial goal was to compare the efficacy and safety of a glaucoma drainage device and trabeculectomy for children with primary congenital glaucoma after angular surgery failure. However, we discontinued the study due to the rate of complications and wrote this report to describe the results obtained with the two techniques in this particular group. Methods This was a parallel, non-masked, controlled trial that included patients aged 0-13 years who had undergone previous trabeculotomy or goniotomy and presented inadequately controlled glaucoma with an intraocular pressure ≥21 mmHg on maximum tolerated medical therapy. We randomized the patients to undergo either placement of a 250-mm2 Baerveldt glaucoma implant or mitomycin-augmented trabeculectomy. The main outcome measure was intraocular pressure control. We calculated complete success (without hypotensive ocular medication) and qualified success (with medication) rates. We defined failure as uncontrolled intraocular pressure, presence of seriousmplications during tube opening. Because of the small sample size, we could not draw conclusions as to the safety data of the studied technique.Purpose A significant transient increase in intraocular pressure in individuals wearing swimming goggles has been demonstrated in previous studies. These findings suggested that wearing swimming goggles could represent a significant risk factor for worsening of corneal parameters in patients with keratoconus who swim regularly. The aim of this study was to investigate corneal parameters in patients with keratoconus after wearing swimming goggles. Methods Comprehensive ocular examinations were performed on 74 eyes of 37 patients with keratoconus. Measurements of the corneal front keratometry values (Kflat, Ksteep, and Kmax), central corneal thickness, corneal apex thickness, thinnest corneal thickness, corneal volume, anterior chamber volume, anterior chamber depth, and iridocorneal angle were performed in outpatient clinics using a Pentacam® Scheimpflug camera (Oculus, Wetzlar, Germany) before the patients wore swimming goggles and after they wore swimming goggles for 1, 10, and 20 min. A p-value of 0.05). However, the anterior chamber volume markedly decreased after wearing swimming goggles (p less then 0.001). Conclusions These findings suggested that the short-term use of swimming goggles does not increase the risk of corneal parameter worsening in patients with keratoconus.To identify and classify available information regarding COVID-19 and eye care according to the level of evidence, within four main topics of interest evidence of the virus in tears and the ocular surface, infection via the conjunctival route, ocular manifestations, and best practice recommendations. A structured review was conducted in PubMed, ScienceDirect, LILACS, SciELO, the Cochrane Library and Google Scholar on COVID-19 and ophthalmology. The Oxford Centre for Evidence Based Medicine 2011 Levels of Evidence worksheet was used for quality assessments. 1018 items were identified in the search; 26 records were included in the qualitative synthesis, which encompassed 6 literature reviews, 10 case series or cross-sectional studies, 4 case reports, and 6 intervention descriptions. Seventeen out of 26 records (65%) were categorized as level 5 within the Oxford CBME methodology grading system, the rest were level 4. Crizotinib mw The evidence generated on COVID-19 and ophthalmology to date is limited, although this is understandable given the circumstances. Both the possible presence of viral particles in tears and conjunctiva, and the potential for conjunctival transmission remain controversial. Ocular manifestations are not frequent and could resemble viral infection of the ocular surface. Most recommendations are based on the strategies implemented by Asian countries during previous coronavirus outbreaks. There is a need for substantive studies evaluating these strategies in the setting of SARS-CoV-2. In the meantime, plans for applying these measures must be implemented with caution, taking into account the context of each individual country, and undergo regular evaluation.Purpose Mitomycin C has been used in ophthalmic surgery to mitigate postoperative scarring. However, the outcomes of endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction with adjunctive mitomycin C in children remain unknown. Our study was aimed to evaluate the efficacy and safety of adjunctive application of mitomycin C after endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in children. Methods This is a retrospective chart review performed in a tertiary eye care hospital involving children with congenital nasolacrimal duct obstruction, who underwent endoscopic-assisted probing from October 2013 to August 2015. We compared children who underwent endoscopic-assisted probing with mitomycin C (mitomycin C group) versus others who underwent endoscopic-assisted probing without mitomycin C (endoscopic-assisted probing group). The mitomycin C group received 0.2 mg/ml within 4 min to the nasolacrimal duct ostium using a cotton tip applicator immediately after probing. Probing was considered successful when patient complaints of tearing were reduced or the results of the dye disappearance test were normal. Demographic data, clinical features, and intraoperative and postoperative variables were correlated to the success rate. Results The study sample comprised 68 lacrimal vies. The majority of children had bilateral obstruction and no previous history of probing. The mean age of the patients was approximately 4 years. Most obstructions were considered complex. The success rates were high in both groups (p>0.05). There were no adverse events related to the use of mitomycin C (p>0.05). Conclusions Although mitomycin C has no adverse effects when applied to the opening of the nasolacrimal duct, its use after lacrimal probing for the treatment of congenital nasolacrimal duct obstruction does not improve the chance of success.Background The Alberta Stroke Program Early CT Score (ASPECTS) scale was developed for monitoring early ischemic changes on CT, being associated with clinical outcomes. The ASPECTS can also associate with peripheral biomarkers that reflect the pathophysiological response of the brain to the ischemic stroke. Objective To investigate the association between peripheral biomarkers with the Alberta Stroke Program Early CT Score (ASPECTS) in individuals after ischemic stroke. Methods Patients over 18 years old with acute ischemic stroke were enrolled in this study. No patient was eligible for thrombolysis. The patients were submitted to non-contrast CT in the first 24 hours of admission, being the Alberta Stroke Program Early CT Score and clinical and molecular evaluations applied on the same day. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale and the Mini-Mental State Examination for clinical evaluation were also applied to all subjects. Plasma levels of BDNF, VCAM-1, VEGF, IL-1β, sTNFRs and adiponectin were determined by ELISA.
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