PURPOSE: To evaluate the efficacy and safety of mitomycin C (MMC) 0.02% in inhibiting haze formation after excimer laser photorefractive keratectomy (PRK) for residual myopia following radial keratotomy (RK). METHODS: A prospective, nonrandomized, noncomparative interventional case series was conducted of 22 eyes (14 patients) with residual myopia after RK performed at a single institution. All eyes were treated with PRK and a single intraoperative topical application of MMC 0.02% solution for 2 minutes using a soaked cellulose sponge placed over the ablated area. Refraction, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and slit-lamp evidence of corneal opacity (haze) were evaluated over 12 months. RESULTS: Twelve months postoperatively, 3 eyes showed grade 1 haze, and 2 eyes showed grade 0.5 haze. Twelve months postoperatively, 2 (9%) eyes had UCVA ≥20/20. No eye before and 17 (77%) eyes after treatment had UCVA 3*20/40, and no eye before and 9 eyes (40.9%) after treatment had UCVA 2=20/25. Best spectacle-corrected visual acuity was 2=20/40 in all (100%) eyes and 21 (95%) eyes before and after treatment, respectively, and 2=20/25 in 12 (54.5%) eyes before and after treatment. One (4.5%) eye lost 1 line of BSCVA. Mean spherical equivalent refraction achieved was -0.18 diopters (D) (range: -0.75 to +0.50 D) compared to -2.72 D (range: -1.50 to -4.00 D) before treatment. Twelve months after treatment, 19 (85.5%) eyes had a refractive outcome within ±0.50 D. CONCLUSIONS: A single intraoperative application of MMC 0.02% for 2 minutes appears to be effective in preventing subepithelial haze after PRK for residual myopia in patients with undercorrection or regression following RK. [J Refract Surg. 2007;23:226-232.]

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Purpose: To evaluate the clinical outcome(s) and complication(s) of subcon junctival bevacizumab treatment in patients with recurrent pterygium. Methods: This prospective case series included patients who had undergone pterygium surgery and were diagnosed with recurrent pterygium. All patients received one subconjunctival injection of 0.5 mL of bevacizumab (2.5 mg/0.1 mL). The main outcome was the change in size and clinical appearance. The clinical appearance of the pterygium was graded according to Tan and colleagues. The horizontal size of the pterygium (from limbus to apex) was recorded from baseline to 2 months after injection. Treatmentrelated complications and adverse events were reported. Results: We included 36 eyes of 36 patients (18 males) with a mean age of 58.75 ± 10.98 years. Totally, 30.6% patients developed recurrent pterygium in both eyes (only the worst eye was treated), with 47.2% developing it in the left eye and 22.2% in the right eye. More than half the patients (58.3%) had a family history of pterygium. There was a significant difference in the size of pterygium at different intervals (P<0.05). Approximately twothirds (66.7%) of patients pre sented with hyposphagma on the 2 nd day after subconjunctival application; this value decreased to 30.6% by day 7 and to 0% at 1 month. Most patients (69.4%) ex hibited amelioration of irritative symptoms within 2 days, 88.9% after 7 days, and 97.2% after 1 month. Conclusions: Subconjunctival bevacizumab injection is useful for the manage ment of patients with recurrent pterygium, with no significant local or systemic adverse effects.

Objective: To examine the effect of indomethacin, a cyclooxygenase (CO) inhibitor, on laser-induced subretinal neovascularization (SRN)

A miopia é uma das maiores causas de cegueira legal em todo o mundo. O déficit visual ocorre em idade precoce, comparado à faixa etária das outras quatro principais causas: catarata, retinopatia diabética, glaucoma e degeneração macular relacionada à idade, que ocorrem décadas depois. Do ponto de vista social, a miopia causa um enorme impacto, pois pode alterar o desempenho de indivíduos na etapa produtiva de suas vidas (1) . Entre as causas de cegueira associadas à miopia predominam as alterações do segmento posterior do bulbo ocular, tais como: descolamento regmatogênico da retina (DR), alterações degenerativas maculares, estafilomas posteriores com ectasia macular, neovascularização sub-retiniana macular, buraco de mácula e glaucoma (2)(3) . A miopia aumenta o risco de DR, além de favorecer o aparecimento precoce da lesão, por causa direta __ pela deficiência da matriz que une os fotorreceptores ao epitélio pigmentado retiniano e/ou pela alteração do mecanismo de bomba do epitélio pigmentado retiniano __ ou por causa indireta __ pelo estiramento da retina, deixando-a suscetível a lesões degenerativas e roturas causadas por uma menor resistência à tração vítreo-retiniana (4)(5)(6) . O DR está associado às degenerações periféricas da retina as quais são identificadas por meio da observação clínica, podendo ser classificadas pela morfologia, prognóstico e predisposição ou não ao DR (7) . A cirurgia refrativa realizada em grande escala é um procedimento recente. Mais recente ainda é a técnica laser in situ keratomileusis (LASIK) que vem se popularizando desde a segunda metade da década passada até hoje. Portanto é escassa a informação existente no que tange à injúria da retina após o LASIK, existindo poucos relatos na literatura que atribuem ao LASIK causa de DR. Como o número de míopes que se submetem ao LASIK é cada vez maior, é natural que entre esses pacientes estejam incluídos aqueles predispostos ao DR, bem como à hemorragia macular e às outras doenças vítreo-retinianas, sendo compreensível que essas anormalidades, e/ou suas exacerbações, sejam associadas ao próprio LASIK (8) . O DR afeta uma pequena percentagem da população geral, dependendo da presença ou ausência de degenerações periféricas retinianas. Na população geral, ocorre na proporção de 1:10.000 por ano. Aproximadamente 40 a Degenerações periféricas da retina do olho míope X LASIK O objetivo deste artigo é apresentar as degenerações periféricas mais comuns na retina dos olhos míopes, discutindo aquelas que oferecem maiores riscos para o descolamento regmatogênico da retina, seu relacionamento com a cirurgia de LASIK e a indicação para o tratamento profilático.

Purpose: To determine the ten-year visual results and outcomes of excimer laser pho totherapeutic keratectomy (PTK) for recurrent corneal erosions. Methods: Twenty-six eyes of 23 patients with recurrent corneal erosions were treated by PTK from 1996 to 2000 at the Goiania Eye Institute, Brazil. All eyes had failed to respond to conventional therapy. Data regarding preoperative and postopera ti ve best-spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE), sympto matic relief, incidence of recurrence, and complications arising from the laser treatment were analyzed. The mean duration of symptoms prior to PTK was 18 months (range, 8 to 36 months). The corneal epithelium was debrided, and laser ablation was performed to a depth of 5 micron with an ablation zone of 7 to 9 mm, using the Technolas 217C Plano Scan excimer laser. Mean postoperative follow-up was 12 years (range, 10 to 14 years). Results: At the last follow-up visit, 15 eyes (57.69%) were symptomsfree. Five eyes (19.2%) had occasional mild symptoms of irritation and photophobia upon awakening. Recurrence of painful corneal erosions occurred in six eyes (23.07%), which required a PTK retreatment. Twenty-four eyes had a preserved or improved BCVA, while 2 eyes showed deterioration of 1 line on Snellen test. Eleven eyes (42.3%) had no change in SE, and the others (57.69%) had a change of less than +/-0.75 diopters (D). There were no major complications during the follow-up period. Conclusion: Ten-year data show that PTK is a safe, fast, effective and minimal invasive choice of treatment for recurrent corneal erosions in patients who do not respond to conventional treatments.

Purpose: To evaluate the thinnest corneal thickness changes during and after corneal collagen cross-linking treatment with ultraviolet-A irradiation, using hypo-osmolar riboflavin solution in thin corneas. Methods: Eighteen eyes of 18 patients were included in this study. After epithelium removal, iso-osmolar 0.1% riboflavin solution was instilled to the cornea every 3 minutes for 30 minutes. Hypo-osmolar 0.1% riboflavin solution was then applied every 20 seconds for 5 minutes or until the thinnest corneal thickness reached 400 µm. Ultraviolet-A irradiation was performed for 30 minutes. During irradiation, iso-osmolar 0.1% riboflavin drops were applied every 5 minutes. Ultrasound pachymetry was performed at approximately the thinnest point of the cornea preoperatively, after epithelial removal, after iso-osmolar riboflavin instillation, after hypo-osmolar riboflavin instillation, after ultraviolet-A irradiation, and at 1, 6 and 12 months after treatment. Results: Mean preoperative thinnest corneal thickness was 380 ± 11 µm. After epithelial removal it decreased to 341 ± 11 µm, and after 30 minutes of iso-osmolar 0.1% riboflavin drops, to 330 ± 7.6 µm. After hypo-osmolar 0.1% riboflavin drops, mean thinnest corneal thickness increased to 418 ± 11 µm. After UVA irradiation, it was 384 ± 10 µm. At 1, 6 and 12 months after treatment, it was 372 ± 10 µm, 381 ± 12.7, and 379 ± 15 µm, respectively. No intraoperative, early postoperative, or late postoperative complications were noted. Conclusions: Hypo-osmolar 0.1% riboflavin solution seems to be effective for swelling thin corneas. The swelling effect is transient and short acting. Corneal thickness should be monitored throughout the procedure. Larger sample sizes and longer follow-up are required in order to make meaningful conclusions regarding safety.

Aumento da prevalência de miopia em um serviço oftalmológico de referência em Goiânia-Goiás RESUMO Objetivo: Avaliar o aumento da prevalência de miopia entre pacientes atendidos em períodos diferentes em um serviço oftalmológico de Goiânia. Métodos: Foram comparados dados coletados em dois estudos científicos realizados em um serviço de oftalmologia, em diferentes períodos de tempo, que avaliaram dentre outros fatores, os erros refracionais dos participantes a partir destes dados comparou-se a porcentagem de pacientes portadores de miopia presentes nos estudos. Resultados: Observou-se um aumento na prevalência de Miopia dentre os participantes dos dois estudos. Na avaliação realizada entre 1995 e 2000 a porcentagem de pessoas com miopia representou 3,6% do total, já no estudo realizado no ano de 2014 a prevalência de pacientes com miopia foi de 9%. Dentre os pacientes com erros refracionais a prevalência de miopia no primeiro estudo foi de 9,97%, já no segundo a prevalência foi de 22%. Conclusão: Observou-se um aumento na prevalência de miopia entre os dois estudos, dados esses que corroboram com análises feitas que mostram um aumento da prevalência de miopia em todo mundo nos últimos 30 anos. Porém em uma proporção menor do que a observada em outros estudos populacionais.