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Selective laser trabeculoplasty (SLT) has been used for treatment of primary open-angle glaucoma, ocular hypertension, pigmenter and pseudoexfoliative glaucoma being considered a low-risk procedure. Therefore, transitory and permanent adverse effects have been reported, including corneal changes, subclinical edema, and reduction in endothelial cells and in central corneal thickness. Despite rarer, serious corneal complications after SLT can be permanent and lead to visual impairment, central corneal haze, opacity and narrowing. The mechanism involves increase of vasoactive and chemotactic cytokines causing inflammatory infiltrate, destruction of stromal collagen by fibroblasts and increase of matrix metalloproteinases type 2, which impair reepithelization. SLT also increases free radical production and reduces antioxidant enzymes, resulting in endothelium damages. Low-power laser therapy (LPLT) has been used in regenerative medicine based on its biostimulatory and anti-inflammatory effects. Biostimulation occurs through the interaction of laser photons with cytochrome C oxidase enzyme, which activates intracellular biochemical cascades causing synthesis of a number of molecules related to anti-inflammatory, regenerative effects, pain relief and reduction in edema. It has been showed that LPLT reduces gene expression related to pro-inflammatory cytokines and matrix metalloproteinases, and it increases expression of growth factors related to its proliferative and healing actions. Although radiations emitted by low-power lasers are considered safe and able to induce therapeutic effects, researches based on experimental models for glaucoma could bring important data if LPLT could be an alternative approach to improve acceptation for patients undergoing SLT.

Syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum. Ocular involvement can occur at any time, and it may affect 10% of patients in the secondary stage, and from 2% to 5% in the tertiary stage. Uveitis is the most common presentation of ocular syphilis, affecting 0.4% to 8% of patients with systemic disease. Chorioretinitis is the most common posterior alteration. We present the case of a 53-year-old male patient, presenting with bilateral low visual acuity and nyctalopia for 3 years. His physical examination revealed decreased pupillary reflex, anterior vitreous cells, physiologic papillae, arteriolar attenuation, reduced foveal reflex, diffuse retinal pigment epithelium atrophy, peripapillary and perivascular punctate pigment accumulation and peripheral chorioretinitis. Full-field electroretinogram was extinct in both eyes. Treponemal syphilis test was positive. Previously diagnosed as retinitis pigmentosa, evolved to blindness, despite proper treatment. Our case shows syphilis as a significant cause of blindness. Atypical presentations of retinitis pigmentosa must warn ophthalmologists to etiologies of pseudoretinitis pigmentosa, such as syphilis.

The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.

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BackgroundThe evaluation of the size of the optic nerve papilla in ophthalmoscopy is an important tool for the diagnosis of glaucoma in individuals who do not present elevated intraocular pressure (IOP) levels. The calibration of the IOP is performed through Goldmann’s tonometry, which consists of flattening the central cornea with a tonometer. Patients with Systemic Lupus Erythematosus (SLE) have circulating autoantibodies and immunocomplexes that alter corneal biomechanics, resulting in underestimated IOP values.ObjectivesTo evaluate the IOP values and the presence of increased excavation in patients with SLE, reinforcing the importance of ophthalmoscopy in this population.MethodsDescriptive study. Analysis of IOP measurement and papillary excavation of 50 SLE patients.ResultsAll patients had IOP values within the normal range (8–21 mmHg). In a total of 100 eyes evaluated, four (4%) had increased papillary excavation.ConclusionsType I collagen is essential for the maintenance of biomechanical parameters and resistance of the cornea. At the corneal level, the activation of the complement system results in the lysis of type I collagen fibres, reducing corneal thickness and resistance. Therefore, IOP values for tonometry will be reduced and underestimated. Comparing the IOP values of SLE patients and healthy volunteers, there are lower results (p<0.001) in lupus patients. In the present study, no patient had IOP changes. However, 4% of the eyes revealed increased excavation. These findings reflect the results of Yazici at al, and reinforce the importance of ophthalmoscopy in the screening of glaucoma in SLE patients.References[1] Silpa-archa S, Lee J, Foster CSl. Ocular manifestations in systemic lupus erythematosus. Br J Ophtalmol. 2016;100:135–41.[2] Moreira CA, Alves MR. Semiologia Básica em Oftalmologia. 3. ed. Rio de Janeiro: Cultura Médica: Guanabara Koogan; 2013.[3] Yazici AT, Kara N, Yüksel K, Altinkaynak H, Baz O, Bozkurt E, et al. The biomechanical properties of the cornea in patients with systemic lupus erythematosus. Eye. 2011;25:1005–9.Disclosure of InterestNone declared

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