In many parts of the world, parasitic infections of the eye are a major cause of blindness. The parasites Toxocara canis, Onchocerca volvulus, Taenia solium, Ancylostoma caninum, and Cysticercus celulosae all have been responsible for blinding ocular infections. The nematodes T. canis and Toxocara cati are parasitic roundworms that infect dogs (toxocarosis), other canidae, and cats. Ocular toxocariasis is an uncommon worldwide infection caused by the nematode larvae of T. canis, commonly found in dogs. Human transmission is usually via geophagia, the ingestion of food contaminated with Toxocara eggs, or contact with infected puppies, often resulting in devastating ocular or systemic effects. Ocular toxocariasis is typically a monocular disease of young children, and its clinical findings include posterior and peripheral retinochoroiditis, optic papillitis, and endophthalmitis. The inflammatory response created by ocular involvement may result in epiretinal membrane formation, traction retinal detachment, and combined traction-rhegmatogenous retinal detachment. Diffuse unilateral subacute neuroretinitis is another ocular parasitic infection that usually results in severe visual loss. Evidence suggests that diffuse unilateral subacute neuroretinitis is caused by a solitary unidentified nematode of two different sizes, but to date, only a small number of nematodes have been recovered from eyes affected with the infection. Diffuse unilateral subacute neuroretinitis occasionally can affect the fellow eye.

PURPOSE: To assess the effectiveness and safety of an intravitreal injection of 1.25 mg bevacizumab (IVB) as a preoperative adjunct to small-gauge pars plana vitrectomy (PPV) compared with PPV alone in eyes with tractional retinal detachment secondary to proliferative diabetic retinopathy.METHODS: This prospective, double-masked, randomized, multicenter, active-controlled clinical trial enrolled 224 eyes of 224 patients between November 2013 and July 2015. All eyes underwent a baseline examination including best-corrected visual acuity, color photos, optical coherence tomography, and fluorescein angiography. Data were collected on intraoperative bleeding, total surgical time, early (<1 month) postoperative vitreous hemorrhage, and mean change in best-corrected visual acuity at 12 months. P < .05 was considered statistically significant. RESULTS: A total of 214 patients (214 eyes) were randomized in a 1:1 ratio to PPV plus IVB ([study group] 102 eyes) or PPV plus sham ([control] 112 eyes). Iatrogenic retinal breaks were noted intraoperatively in 35 eyes (34.3%) in the study group, and 66 eyes (58.9%) in the control group (P [ .001). Grade 2 intraoperative bleeding was noted in 32 (31.3%) eyes in the study group and 58 (51.7 %) eyes in the control group (P [ .001). Endodiathermy was necessary in 28 (27.4 %) eyes in the study group, compared with 75 (66.9%) eyes in the control group (P [ .0001). Mean surgical time was 71.3 ± 32.1 minutes in the study group and 83.6 ± 38.7 minutes in the control group (P [ .061). CONCLUSION: Preoperative IVB seems to reduce intraoperative bleeding, improving surgical field visualization, and reducing intraoperative and postoperative complications. NOTE: Publication of this article is sponsored by the

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RESUMOA retinopatia diabética é a causa mais frequente de cegueira na população ativa nos países desenvolvidos. A prevalência da retinopatia diabética aumenta com a duração da diabetes, e praticamente 100% dos pacientes com diabetes tipo I (DM I) e mais do que 60% dos pacientes com o tipo II (DM II) apresentarão algum sinal de retinopatia após 20 anos. Além de um controle sistêmico rigoroso dos níveis glicêmicos, lipídicos, colesterol e da pressão arterial, o exame oftalmológico de rotina, com a identificação precoce da retinopatia diabética, podem detectar anormalidades em estágios primários, o que possibilita o tratamento ainda na fase inicial do problema; o uso adequado da fotocoagulação e a utilização da terapia antiangiogênica pode reduzir o número de pacientes com hemorragia vítrea ou descolamento tracional da retina. Infelizmente, em vários pacientes, a retinopatia progride mesmo com as melhores condutas tomadas pelo paciente e pelo oftalmologista, embora vários olhos podem se beneficiar com o tratamento cirúrgi-co, a vitrectomia posterior via pars plana. Esta revisão apresenta as indicações atuais para cirurgia vitreorretiniana em pacientes portadores de retinopatia diabética proliferativa.

The scleral punch provides a safe and effective method for constructing and revising full-thickness sclerectomies in the nanophthalmic eye, minimizing the risk of choroidal trauma. The use of topical MMC may reduce the risk of late failure of trans-scleral outflow due to fibrosis.

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Aims-To verify and evaluate the eVect of reinsertion of the lower eyelid retractor aponeurosis to correct involutional entropion. Methods-The involutional entropion is one aVection that occurs mainly in the lower eyelid of patients over 60 years old. The surgical techniques proposed to correct this condition are based on correction of horizontal laxity-the preseptal orbicularis muscle overrides the pretarsal muscle, and the reinsertion of the lower eyelid retractor aponeurosis. 30 patients clinically diagnosed with involutional entropion and randomly selected underwent reinsertion of the lower eyelid retractor aponeurosis to the tarsal plate, without horizontal shortening or resection of the skin or orbicularis muscle. Results-Good anatomical and functional correction was achieved in 96.6% of the patients and no recurrence was observed on 29 month follow up examination. The surgical result was very satisfactory. Conclusions-It was concluded that this procedure is eVective and has low recurrence rate, showing the important role of the reinsertion of the lower eyelid retractor aponeurosis in this surgical correction. (Br J Ophthalmol 2000;84:606-608)

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