This study was carried out to quantitatively and qualitatively investigate sources of water pollution in Pojuca river\ud basin, in order to define ameliorative interventions.\ud The basin of Pojuca river is located in Recôncavo Norte region, immediately northwards from Salvador da\ud Bahia, capital city of Bahia State (Brazil). River Pojuca is the main water body of the region and it represents a\ud very important potential source of water to be used for drinking purposes, in order to face the rapidly growing\ud population of Salvador da Bahia Metropolitan Area.\ud According to previous studies, its quality did not meet the minimum standards set for surface water withdrawn\ud for potabilization treatment in 2000. In the present study, the most polluting activities have been identified as\ud urban sewage discharges. Wastewater management coverage rate ranged between 30 and 90% in a high\ud number of municipalities in the basin. Wastewaters were commonly discharged on the soil or into it (by\ud means of septic and rudimental tanks) and also urban sewage systems, where existing, often did not convey\ud wastewaters to treatment plants.\ud Polluting loadswere estimated according to amethodology elaborated during the study. The estimationwas based\ud on the data collected by the authors through field visits and the ones available in the federal databases (updated to\ud year 2007). It allowed to establish that diffuse loads were major than point loads: point discharges were quite rare,\ud whereas pipelines discharging in water bodies and infrastructures such as septic or rudimental tanks were widespread.\ud Treatment plants and septic tanks presented small removal efficiencies of nutrients. This justified also the\ud high organic and microbiological concentrations registered in the river as well as the high content of nutrients.\ud Water quality could beimprovedin order tomeet standards for drinkingpurposes bybuilding newwastewater treatment\ud plants or upgrading the existing ones. In particular, in urban areas dynamic systems for wastewater collection\ud and treatment plants should be built, whereas in rural areas scattered households should be provided with septic\ud tanks

University of Brescia and Mahidol University of Bangkok developed a project in Phang Nga province (Thailand), the most damaged by 2004 tsunami. In particular, the study, performed between April and May 2006, dealt with the surface and ground water monitoring in Ban Nam Khem village and the experimental evaluation of possible drinking treatment alternatives. The monitoring highlighted that saline content in the tsunami affected area is decreasing but still very high (conductivity presented values up to 2,600 and 6,230 microS/cm in ground and surface water, respectively); hence, advanced and complicated processes such as reverse osmosis should be adopted to treat such water for drinking purposes. Waiting for ground water salinity to assume acceptable values, activities for the reduction of its organic and microbiological contamination will be started. However, it has to be underlined that the diffusion of drinking water to a greater part of population can be obtained only through the realization of new centralised treatment plants and the improvement of existing ones (serving at the moment about 20% of inhabitants).

Aim:To present the case of a 14-year-old boy with bilateral stage IV keratoconus, treated with a combined MARK + CXL intervention, without the need for a corneal transplantation.Results:The left eye displays considerable improvements, with a follow-up of 13.5 years: Kmax is decreased by 5.53 D, Kmed is decreased by 1.95 D and thinnest pachymetry is increased by 106 µm. The right eye shows equally remarkable parameters, with a follow-up of 9.5 years: Kmax is decreased by 8.16 D, Kmed is decreased by 0.38 D and thinnest pachymetry is increased by 52 µm. Keratoconus has been halted and the patient has a binocular best corrected visual acuity of -0.079 LogMAR (12/10).Conclusion:The MARK + CXL combined intervention, known as the “Rome Protocol”, was successful in halting a bilateral stage IV keratoconus and improving visual acuity in a very young patient, with long-term follow-up. Conservative treatments should always be privileged when treating very young patients with developed stages of the pathology.

Purpose To investigate the long-term results (at least 5 years of follow-up) of the mini asymmetric radial keratotomy (MARK) and corneal cross-linking (CXL) combined intervention, also known as the ‘Rome protocol,’ for patients with progressive stage I and II keratoconus and contact lens intolerance. Methods This was a retrospective observational case series. Fifteen eyes of 12 patients were evaluated, with a mean follow-up of 6.9 years. To assess the efficacy and stability of the MARK + CXL combined protocol, best spectacle-corrected visual acuity, mean pachymetry, and mean keratometry were recorded preoperatively and at least 1, 3, and 5 years postoperatively. Statistical analysis was performed using the R platform and involved the Wilcoxon signed-rank and Kruskal-Wallis non-parametric tests. Results Best spectacle-corrected visual acuity improved for all patients, from 0.46 ± 0.69 logarithm of the minimum angle of resolution (20 / 60) to 0.15 ± 0.69 logarithm of the minimum angle of resolution (20 / 30, p = 0.0006), while mean pachymetry increased in 93% of patients, from 442.80 ± 61.02 to 464.50 ± 62.72 µm ( p = 0.003). Lastly, mean keratometry improved in 87% of patients after 6.9 years of observation from 48.82 ± 5.00 to 43.25 ± 3.58 diopters ( p = 0.008). No intraoperative or postoperative complications were observed. Conclusions The MARK + CXL combined protocol was effective in treating keratoconus by halting corneal thinning and bulging. In addition, this procedure significantly improved visual acuity based on long-term follow-up data. Analysis of data from a larger cohort of patients would be useful to support these findings.

Aim: To present long-term results of mini asymmetric radial keratotomy (MARK) for the treatment of mild to moderate keratoconus, with an average follow-up of 7.3 years and a minimum of 6 years. Design: Retrospective clinical study. Materials and methods: The postoperative outcomes of 66 eyes (45 patients) were selected and retrospectively analyzed. Inclusion criteria were progressive stages I and II keratoconus (Kc) and contact lens intolerance, while exclusion criteria were advanced stages of the pathology and chronic or recurrent ocular infections. Tomography-and topography-guided miniincisions were customised and performed sectorally with a calibrated diamond knife and custom-made corneal markers. Results: After a minimum follow-up of 6 years, mean keratometry improved in 91% of cases (from 47.25 D to 44.61 D), and mean pachymetry improved in 98% of cases (from 446 μm to 484 μm), while best spectacle-corrected visual acuity improved for 95% of patients, from 0.23 LogMAR (5.9/10) to 0.095 LogMAR (7.7/10). Conclusion: MARK improved both mean keratometry and mean pachymetry, thus halting the progression of keratoconus, while improving visual acuity. The long-term results suggest that MARK should be considered as one of the conservative treatments for moderate to mild progressive keratoconus.

Background: Keratoconus is a corneal dystrophy characterized by progressive thinning, conical shape of the cornea and irregular astigmatism. It is particularly insidious when it occurs in very young patients. Case: We report the case of a 10-yearold child with an aggressive stage III keratoconus, who was suggested to undergo a Penetrating Keratoplasty. We performed Corneal Collagen Cross-linking with epithelium removal instead, which was successful in arresting the rapid progression of keratoconus. Observations: Eighteen months later, Kmax had decreased by 1.3 D, astigmatism by 0.8 D, thinnest pachimetry had improved by 69 µm and CDVA was 20/32. Conclusion: This case confirms that Corneal Collagen Cross-linking is a safe and effective procedure for the treatment of keratoconus even in its aggressive forms. We encourage ophthalmic surgeons to favor conservative treatments when dealing with very young patients.

Aim To present and discuss the outcomes of the mini asymmetric radial keratotomy (MARK) and corneal cross-linking (CXL) combined intervention, also known as the “Rome protocol”, for patients with progressive stage I, II, and III keratoconus (KC) and contact lens intolerance (CLI). Design Retrospective, observational study. Materials and Methods The postoperative outcomes of 48 eyes (35 patients) were selected and retrospectively analyzed, with an average follow-up of 3.8 years. To assess the efficacy of the MARK plus CXL combined protocol, mean keratometry, mean pachymetry, and best spectacle-corrected visual acuity were evaluated. Results Mean keratometry improved in 90% of cases (from 48.3 D to 45 D), mean pachymetry improved in 83% of cases (from 439 to 460 μm), and best spectacle-corrected visual acuity improved in all cases (from +0.4 to +0.15 logMAR). Conclusion The MARK plus CXL intervention effectively halted the KC progression and improved the visual acuity, which suggests that this combined procedure should be taken into account when considering refractive procedures combined with corneal cross-linking (CXL plus), if the relevant inclusion criteria can be satisfied. How to cite this article Abbondanza M, Abbondanza G, De Felice V. Mini Asymmetric Radial Keratotomy and Corneal Cross-linking for the Treatment and the Optical Rehabilitation of Keratoconus. Int J Kerat Ect Cor Dis 2019;8(2):35–39.

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