Amniotic membrane use in ophthalmic surgery has been shown to provide an alternative for corneal and conjunctival reconstruction in many clinically challenging situations; however, there is still a lack of scientific evidence based on randomized comparative studies to prove that its use is better than other alternative therapies for ocular surface reconstruction.

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We demonstrated the preliminary results of transplantation of EVCAU for corneal surface reconstruction in cases with total LSCD. Future studies are needed to further assess the long-term efficacy of this procedure.

The effects of implementing Directive 91/271/EEC of 21 May 1991 (Waste Water Treatment Plan Directive) and Directive 91/676/EEC of 12 December (Nitrates Directive) are analysed in 7 Portuguese estuaries (Minho, Lima, Douro, Mondego, Tagus, Sado and Guadiana) and two coastal lagoons (Ria de Aveiro and Ria Formosa), with a modelling approach. MOHID Water Modelling System was used to perform simulations with three nitrogen load scenarios for each system: a reference scenario, a 50% nitrate removal by agriculture scenario and another with a 100% nutrients removal by waste water treatment plants (WWTP). It is shown that the interaction between hydrodynamic and ecological processes is an important feature to study trophic problems in estuaries. Ecological processes such as primary production only occur inside the system if the residence time of water is high enough to enable organismal activity and if the adequate conditions are found (e.g. light, nutrients, temperature). From the model results it is possible to conclude: (i) in systems with short residence time a reduction in nutrient load will only produce a decrease in nutrient transit and will not affect the system's global ecological status (e.g. Douro Estuary); (ii) in systems with long residence time the effects will range from significant, when primary production is mostly limited by nutrients (e.g. Ria de Aveiro), to non-significant, when primary production in the system is light-limited (e.g. Tagus Estuary).

Aims: The aim of this study was to assess the efficacy of currently available topical drugs for vernal keratoconjunctivitis (VKC) through a meta-analysis of randomised clinical trials (RCTs). Methods: Twenty-seven RCTs (n = 2184 eyes) that had evaluated the efficacy of topical drugs for the treatment of VKC were selected according to the set criteria; 10 of these trials were suitable for statistical analysis and were enrolled in the meta-analysis. Articles published up to December 2005 were identified from the following data sources: Medline, Embase, Lilacs, the Cochrane Controlled Trials Register, and references from relevant articles. Articles in any language published with an English abstract, were screened, and those selected for inclusion were written in English, French, German, Italian, Portuguese or Spanish. The quality of the trials was assessed by the Delphi list. Statistical analysis was performed using STATAH software. Results: A significant improvement in all signs and symptoms, except photophobia, was observed after topical treatment for active VKC, independent of the type of treatment. Comparison of the efficacy of different drugs was not possible due to a lack of standardised criteria among studies. Conclusion:The currently available topical drugs are effective in treating acute phases of VKC. However, there is a lack of evidence to support the recommendation of one specific type of medication for treating this disorder. There is a need for standard criteria to assess diagnosis and therapy based on severity. There is also a need for RCTs assessing long-term effects of single drugs to control the disease and to prevent complications. V ernal keratoconjunctivitis (VKC) is a recurrent bilateral chronic allergic inflammatory disease of the ocular surface affecting mainly young males in the first decade of life. Diagnosis is based on signs and symptoms including itching, photophobia, sticky mucous discharge, giant papillae on the upper tarsal conjunctiva or at the limbus, superficial keratopathy and corneal shield ulcer. An immunopathogenic mechanism has been proposed for this disease on the basis of personal or familial history of atopy, increased serum levels of total and specific IgE, the response to antiallergic therapy and the presence of several immune cells and mediators in the conjunctiva. [1][2][3] At present, the exact pathogenic mechanism has not been completely identified. In spite of its generally benign and selflimited presentation, therapeutic measures are required to control signs and symptoms of the disease and to avoid the longstanding permanent inflammatory sequelae that may lead to fibrovascular reaction, new collagen deposition, tissue remodelling and permanent visual damage. 1-3Several reports indicate that topical anti-inflammatory and antiallergic eye-drops are the mainstay of treatment for VKC, but a gold-standard treatment has not yet been established for this disease. In the present report, we systematically reviewed RCTs and conducted a meta-analysis of the combined results ...

Objective: To report the use of preserved amniotic membrane and living related corneal limbal/conjunctival transplantation in total limbal stem cell and conjunctival deficiency secondary to severe Stevens-Johnson syndrome.Design: Prospective, noncomparative, interventional case series.Patients and Methods: Ten eyes of 10 patients with total limbal stem cell and conjunctival deficiency secondary to Stevens-Johnson syndrome underwent excision of cicatricial tissue followed by amniotic membrane and living related corneal limbal/conjunctival transplantation. Main Outcome Measures:Reconstruction of corneal epithelium (clear appearance without epithelial defect, normal fluorescein permeability, and the absence of conjunctiva-derived goblet cells on impression cyto-logic testing), decrease in corneal vascularization, and improvement in visual acuity.Results: During a mean follow-up of 16.7 months, satisfactory ocular surface reconstruction was obtained in 2 eyes (20%), with reduced inflammation and vascularization and a mean epithelialization time of 3 weeks. Surgical failure was observed in 4 cases (40%) and complications (infection) in 4 cases (40%). Visual acuity improved in 4 eyes (40%), remained stable in 5 eyes (50%), and decreased in 1 eye (10%).Conclusions: Amniotic membrane and living related corneal limbal/conjunctival transplantation were successful in 20% of severe cases of total limbal stem cell and conjunctival deficiency secondary to Stevens-Johnson syndrome. A high proportion of postoperative complications, in particular, infection, seemed to jeopardize a favorable outcome.

Treatment with tacrolimus was superior to sodium cromoglycate when comparing severity scores for symptoms of itching, foreign body sensation, and photophobia, as well as for signs of limbal inflammatory activity and keratitis.