The majority of ancient people worshipped the sun and viewed it as a health - bringing deity. During the eighteenth and nineteenth century therapeutic benefits of sunlight exposure were beginning to be understood and by the end of the nineteenth century the importance of ultraviolet radiation was being realized. Danish physician Niels Finsen, whom many regard as the father of ultraviolet phototherapy, also stressed that it was ultraviolet radiation in the solar spectrum which cause sunburn. We now recognize that the small portion of ultraviolet radiation which reaches the earth's surface is not necessarily therapeutic, but in fact could be harmful to humans. There are numerous accounts of the harmful effects of UV radiation to the skin and the eye as a whole. These effects may be caused by either acute or chronic exposure to UV radiation. For example, some acute effects of UV-B radiation include conjunctivitis and photokeratitis. "Snow blindness" and "arc welders eye" are further examples of acute ultraviolet damage specifically to the surface of the cornea. On the other hand, chronic exposure to ultraviolet radiation is thought to be responsible for pterygia, climatic droplet keratopathy Hill and Maske (1989), cancers of the external eye, cataracts and various types of retinal diseases. The present study is an extension of ongoing studies on ultraviolet radiation damage to the cornea in the Department of Ophthalmology, University of Cape Town and Groote Schuur Hospital. Their specific interest lies in the causes and treatment of climatic droplet keratopathy. The aims of the present study are: 1) Establish a possible role of ultraviolet B radiation in human corneal diseases such as climatic droplet keratopathy and pterygium using the rabbit as an animal model. 2) Determine by means of SEM the initial effects and subsequent recovery of the epithelium after a 3-hour dose of ultraviolet B radiation. We refer to this study as "acute" response to ultraviolet B radiation. 3) To try and confirm the effects observed by SEM with ultrastructural studies using TEM. 4) In addition, we are also looking at the possible effects after exposing rabbit cornea to a daily dose of low level ultraviolet B radiation, over a long period of time. We refer to this as chronic exposure to ultraviolet B radiation. It is hoped that by exposing rabbits to ultraviolet light, principally ultraviolet B radiation, diseases similar to those found in humans could be simulated and disease progression studied. People are generally exposed to substantial amounts of UV radiation for a very long time. Since people generally live longer they will be exposed to an ever-increasing amount of solar UV radiation and subsequently, there is an increasing risk of developing corneal diseases. The possible threat to the ozone is also a real possibility and could lead to increased levels of ultraviolet radiation reaching the earth's surface. This will require a greater understanding of the very nature of corneal damage due to acute and chronic exposure. This study focusses mainly on the acute response to UV-B radiation since most studies have investigated effects of prolonged exposure to UV light. Accordingly, much less is known about acute exposure. Many people suffering from acute UV B radiation effects probably never visit the ophthalmologist or wait for a couple of days. This could also contribute to the fact that effects of short-term damage is not well documented.

It is of great clinical importance to predict the behaviour of the cornea in various diseases and post-surgical recovery. Therefore, a numerical model that is able to simulate the corneal behaviour, considering corneal material properties obtained from individuals is highly desirable. In this work a combined numerical-experimental technique has been developed that can characterize the mechanical properties of a cornea properties from two aspects: time-dependency and spatial variation. Initially, an analysis of the material properties of porcine corneas was performed to investigate the time-dependent behaviour of the cornea. A simple stress relaxation test was used to determine the viscoelastic properties of a cornea and a rheological model was built based on the Generalized Maxwell (GM) approach. A validation experiment using nano-indentation showed that an isotropic GM model was insufficient for describing the corneal time-dependent behaviour when exposed to a complex stress state. A technique was proposed that takes into account the microstructural composition of the cornea and is based on a combination of nano-indentation experiment, isotropic and transversely isotropic numerical models, and an inverse finite element method. The good agreement using this method suggests that this is a promising technique for measuring the time-dependent properties of the cornea. The spatial variation of the properties was then investigated. This time, the long term structural response of the cornea was targeted. A full field displacement response of a loaded cornea was evaluated from Optical Coherence Tomography (OCT) volume reconstructions of the cornea using Digital Volume Correlation (DVC). The inverse finite element method was employed with two models sequentially; first, a radially partitioned model and then a circumferentially partitioned model, in order to recover the elastic parameters in radial and circumferential directions. The good agreement using this method suggests that this is a promising and reliable technique for identifying the distribution of the corneal properties. In this research, we have shown that it is possible to determine the local time-dependent properties of the cornea and the in-depth (2D) distribution of the properties using the hybrid technique. This technique has the potential to be implemented in vivo. However, further work should focus on the feasibility of this technique in practice.

Anhand dieser Untersuchung sollte geklärt werden, welchen Einfluss eine extrakapsuläre Kataraktoperation mit clear-cornealer Schnitt-Technik, Phakoemulsifikation und Implantation einer Hinterkammerlinse auf den Augeninnendruck bei Patienten mit Offenwinkelglaukom hat. Dabei wurden sowohl retrospektiv die Daten von 76 Patienten als auch prospektiv die Daten von 49 Patienten aus der Universitätsaugenklinik Würzburg verglichen. Alle Patienten wiesen entweder ein Primäres Offenwinkelglaukom oder ein Pseudoexfoliationsglaukom auf und erhielten eine Kataraktoperation, die anhand einer clear-cornea-Phakoemulsifikation durchgeführt wurde. Keiner der Patienten hatte eine vorangegangene filtrierende Glaukomoperation. Für die retrospektive Analyse wurden IOD und Anzahl an antiglaukomatöser Medikation vor und durchschnittlich 12,9 Monate nach der Operation bestimmt. Hierbei konnte eine Redukion des IOD von 18,3 ± 3,7 mmHg präoperativ auf 16,7 ± 3,3 mmHg postoperativ beobachtet werden (p=0,011*). Die durchschnittliche Anzahl an Medikamenten verringerte sich von 1.4 ± 0.9 präoperativ auf 1.0 ± 0.9 postoperativ (p=0,0004***). Während der prospektiven Untersuchung wurden Augeninnendruck, Anzahl der Medikamente und zusätzlich der Visus jeweils am Tag vor der Kataraktoperation sowie postoperativ am Tag vor Entlassung, nach sechs und nach zwölf Monaten bestimmt. Der IOD sank von durchschnittlichen 17,6 ± 3,8 mmHg präoperativ auf 14,2 ± 3,1 mmHg postoperativ (p=0,0003***), 15,8 ± 2,1 mmHg nach sechs Monaten (p=0,0021**) und 15,4 ± 3,2 mmHg nach zwölf Monaten (p=0,0085**). Die Medikamentenzahl konnte von durchschnittlich 1,6 ± 1,0 präoperativ auf 1,2 ± 1,0 postoperativ (p=0,0098**), 1,1 ± 1,0 nach sechs Monaten (p=0,0019**) und auf 1,1 ± 1,0 nach zwölf Monaten (p=0,0056**) reduziert werden. Der Visus verbesserte sich von durchschnittlich 0,3 ± 0,2 auf 0,63 ± 0,3. Somit ist die clear-cornea-Phakoemulsifikation eine sichere Alternative bei Koexistenz von Offenwinkelglaukom und Katarakt, wenn bestimmte Voraussetzungen erfüllt sind. Sie eignet sich vor allem bei Patienten mit noch nicht zu stark ausgeprägten Glaukomschäden, einer guten Medikamentencompliance und einer nicht zu großen Anzahl an Medikamenten. Dann kann eine gute Visusverbesserung erzielt und gleichzeitig eine Verbesserung oder Stabilisierung der Glaukomkontrolle erreicht werden. Nur bei einer geringen Anzahl von Patienten ist mit einer Verschlechterung zu rechnen. Außerdem lässt dieser operative Zugang die Möglichkeit offen, im weiteren Verlauf noch eine filtrierende Operation durchzuführen. / The issue of this examination was to evaluate changes in intraocular pressure following phacoemulsification cataract extraction with IOL-implantation on patients with glaucoma. We retrospectively reviewed the data of 76 patients and prospectively compared the data of 49 patients. All patients had primary open angle glaucoma (POWG)or pseudoexfoliation glaucoma (PEX)and the IOL was implanted through clear corneal incision. None of the patients had prior filtration surgery. In the retrospective review the mean preoperative IOP was 18,3 ± 3,7 mmHg and 16,7 ± 3,3 mmHg after one year (p=0,011*). The average number of medicaments was reduced from 1,4 ± 0,9 to 1,0 ± 0,9 after one year (p=0,0004***). During the prospective study the mean IOP, number of medicaments and visual acuity were examined the day before operation, some days later, six months and one year after operation. The mean preoperative IOP was 17,6 ± 3,8 mmHg in comparision to 14,2 ± 3,1 mmHg postoperative (p=0003***), after six months it reached a mean IOP of 15,8 ± 2,1 mmHg (p=0,0021**) and 15,4 ± 3,2 mmHg after 12 months (p=0,0085**). The mean number of medications decreased from 1,6 ± 1,0 preoperative to 1,2 ± 1,0 postoperative (p=0.0098**), to 1,1 ± 1,0 after six months and to 1,1 ± 1,0 after one year. The visual acuity improved from 0,3 ± 0,2 to 0,63 ± 0,3. In the management of co-existing cataract and glaucoma the phacoemulsification cataract extraction through clear corneal incision with IOL- implantation is a safe alternative associated with significant decrease in IOP with less medication.

Orientador: José Luiz Laus / Coorientador: Alvio Isao Shiguematsu / Banca: Andreia Vitor Couto do Amaral / Banca: Antonio Carlos Alessi / Banca: Jayter Silva de Paula / Banca: Noeme Sousa Rocha / Resumo: A córnea atua como principal elemento refrativo do olho, para tal tem que manter-se transparente. O endotélio corneal é um peça chave para essa manutenção, possuindo mecanismos como a bomba de Na+ e K+ que ajudam a garantir a desturgescência corneal. Descompensações endoteliais constituem uma importante indicação de transplante da córnea, uma vez que as células endoteliais corneais apresentam limitada capacidade proliferativa. Entretanto, transplantes são procedimentos cirúrgicos complicados e de elevado custo. Alternativas e coadjuvantes medicamentosos vêm sendo estudadas. O fucoidam é uma substância que, dentre outras propriedades, promove migração e proliferação celular, portanto objetivou-se, com a presente pesquisa, avaliar seus efeitos sobre a morfologia, a ploidia e o metabolismo de células endoteliais da córnea de coelhos, após criolesão experimental. Para tal, foram realizadas avaliações quanto à morfologia e viabilidade celular empregando-se dupla marcação com corantes vitais (alizarina vermelha e azul de tripan) e ultraestrutural pela microscopia eletrônica de transmissão e de varredura. Outrossim, avaliou-se a morfometria in vivo e in vitro de seguintes parâmetros: número de células, densidade, hexagonalidade e coeficiente de variação celulares. Estudou-se o metabolismo dessas células empregando-se a imunofluorescência com observação em confocal dos anticorpos Ki-67, Na+K+/ATPase, n-Caderina e Zo-1, conjugados com Alexafluor-488. Visando-se a conseguirem conhecime... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The cornea as the main refractive element of the eye, which has to remain transparent. The corneal endothelium is a key piece for this maintenance, having mechanisms such as the Na + and K + pump that help to ensure corneal dysurgescence. Endothelial decompensations are an important indication for corneal transplantation, since the corneal endothelial cells have limited proliferative capacity. However, transplants are complicated and expensive surgical procedures. Alternatives and drug coadjuvants have been studied. Fucoidam is a substance that, among other properties, promotes cell migration and proliferation, therefore, the objective of this research was to evaluate its effects on the morphology, ploidy and metabolism of rabbit cornea endothelial cells after experimental cryoinjury. For this, evaluations were made for morphology and cell viability using double labeling with vital dye (alizarin red and tripan blue) and ultrastructural analysis by transmission and scanning electron microscopy. Morphometry (in vivo and in vitro) of the following parameters were also evaluated: cell number, cell density, hexagonality and coefficient of variation. The metabolism of these cells was studied using immunofluorescence with confocal observation of the Ki-67, Na + K + / ATPase, n-Caderin and Zo-1 antibodies, conjugated to Alexafluor-488. In order to obtain additional knowledge regarding the nuclear activity during the healing process of the corneal endothelium in the presence of fucoidam were analyzed, from the feulgen reaction, nuclear perimeter and area, in addition to the chromatin supraorganization. Cryoinjury resulted in worsening of all morphometric parameters, with cell decrease, cell density, the percentage of standard cells with 6 sides and increase in coefficient of variation, the recovery to normal values with time was better in eyes tre... (Complete abstract click electronic access below) / Doutor

As junções GAP são canais intercelulares responsáveis pela comunicação de células vizinhas, por onde passam pequenas moléculas e íons que mantêm a homeostasia celular. A junção GAP é formada seis proteínas, as conexinas. Na célula endotelial encontram-se as conexinas 37, 40 e 43. Nesse estudo, estimulamos a angiogênese em córnea de camundongos, através da cauterização com cristal de nitrato de prata. Foram utilizados camundongos heterozigotos para o gene da conexina 43 (Cx43+/-) e camundongos selvagens (Cx43+/+). As córneas foram analisadas 2 e 6 dias após a cauterização atravéspor meio da morfologia vascular, detecção das Cx37, Cx40, Cx43, PCNA por meio de Western Blot e avaliação ultraestrutural das células endoteliais. Como resultado obtivemos uma menor área de preenchimento vascular nos animais Cx43+/- em 2 e 6 dias após a lesão corneal, porém, em relação a extensão dos vasos não foi observado diferenças entre os grupos. Uma menor proliferação celular foi verificada através da detecção do PCNA, nos animais heterozigotos, somente após 2 dias da lesão corneal. Não houve alteração da Cx37 e Cx40 entres os grupos. A Cx43 parece ser uma conexina importante para a célula endotelial durante o processo de angiogênese. / The GAP junctions are intercellular streams responsible for the communication between close cells, which allow small molecules and ions to pass through them maintaining the cellular homeostasis. The GAP junction is formed of six proteins, the connexin. In the endothelial cell, there are the connexin 37, 40 and 43. In this study, we stimulated the angiogenesis in the mice\'s cornea through its cauterization using silver\'s crystal glass. It was used heterozygote mice to the gene of connexin 43 (Cx43+/-) and wild mice (Cx43+/+). The corneas were analyzed 2 and 6 days after the cauterization through the vascular morphology, detection of Cx37, Cx40, Cx43, PCNA through Western Blot and ultrastructural evaluation of the endothelial cells. As a result, we obtained a smaller area of vascular fillness in the animals Cx43+/- with 2 and 6 days of corneal injury, however, in regard to the extensions of the vessels, it wasn\'t observed any changes between the groups. A smaller proliferation of cells was verified, through the detection of PCNA, in the heterozygote animals only 2 days after the corneal injury. There wasn\'t any modification of the Cx37 and Cx40 between groups. The Cx43 seems to be an important connexin to the endothelial cell during the process of angiogenesis.

Objetivos: Determinar os efeitos celulares e o mecanismo de ação da mitomicina C tópica na prevenção e tratamento da opacidade corneana em coelhos submetidos à ceratectomia fotorrefrativa (PRK). Métodos: Foram submetidos à cirurgia de PRK 224 coelhos para correção de -9 dioptrias esféricas, associada à aplicação de mitomicina C tópica ou solução salina balanceada. O nível de opacidade corneana foi avaliado por meio de análise à lâmpada de fenda. Os animais foram sacrificados quatro horas, 24 horas, quatro semanas e seis meses após a cirurgia. A análise imunohistoquímica foi realizada com as técnicas de TUNEL e foram utilizados os anticorpos Ki67 e alpha-SMA para a análise da apoptose celular, replicação celular e formação de miofibroblastos, respectivamente. Resultados: Todos os grupos submetidos à aplicação de mitomicina C apresentaram um maior número de células positivamente marcadas pelo ensaio com TUNEL (indicando maior taxa de apoptose celular) e um menor número de células positivamente marcadas pelo anticorpo Ki67 (indicando menor taxa de replicação celular). Uma menor quantidade de miofibroblastos (células positivamente marcadas pelo anticorpo alpha-SMA) foi identificada após a aplicação profilática da mitomicina C, comparada com sua aplicação com finalidade terapêutica. Além disso, identificou-se uma zona de acelularidade no estroma anterior de córneas tratadas com mitomicina C, persistente por um período mínimo de seis meses. Conclusões: A aplicação da mitomicina C diminuiu signficativamente a formação de opacidade corneana em coelhos. Apesar da mitomicina C ter induzido uma maior apoptose de ceratócitos e miofibroblastos, seu principal mecanismo de ação, responsável pela prevenção da opacidade corneana, decorreu do bloqueio da replicação dos ceratócitos ou outras linhagens celulares progenitoras dos miofibroblastos. A aplicação da mitomicina C na concentração de 0,002% mostrou-se tão eficiente quanto sua aplicação na concentração de 0,02%. Não obstante, uma persistente diminuição da densidade de ceratócitos no estroma anterior pode representar um sinal de alerta para possíveis complicações a longo prazo / Purpose: To determine cellular effects and the mechanism through which topical mitomycin C prevents and treats corneal haze after photorefractive keratectomy (PRK) in rabbits. Methods: Minus nine diopters PRK with mitomycin C or balanced salt solution was performed in two hundred and twenty four New Zealand rabbits. Haze level was graded at the slit lamp. Rabbits were sacrificed at 4 hours, 24 hours, 4 weeks or 6 months after surgery and immunohistochemistry was performed with TUNEL assay, Ki67 and alpha-SMA to analyze keratocyte cells apoptosis, keratocyte cells replication and myofibroblast cells formation, respectively. Results: TUNEL-positive cells increased in all mitomycin C groups (representing more keratocyte cells undergoing apoptosis) while Ki67-positive cells decreased significanlty (representing a decreased keratocyte cells replication) following mitomycin C application. A greater decrease in myofibroblasts was noted with prophylactic mitomycin C treatment than therapeutic mitomycin C treatment. There was, however, an anterior stromal acellular zone in eyes treated with mitomycin C that persisted out to the maximum follow-up of 6 months. Conclusion: Mitomycin C application significantly reduced corneal haze formation in rabbits. Its treatment induces apoptosis of keratocytes and myofibroblasts, but the predominate effect in inhibiting or treating haze appears to be at the level of blocked replication of keratocytes or other progenitor cells of myofibroblasts. Treatment with 0.002% mitomycin C appears to be just as effective as higher concentrations (0.02%) in the rabbit model. However, a persistent decrease in keratocyte cells density in the anterior stroma could be a warning sign for future complications

Este trabalho é parte de um projeto destinado a criar um equipamento médico, para ser aplicado com o protocolo de crosslinking de colágeno corneano, para o tratamento do ceratocone, do qual resultou o desenvolvimento de um sistema de irradiação UV-A de córneas para a aplicação clínica oftalmológica. O sistema desenvolvido neste trabalho consiste de um circuito de malha fechada, que estabiliza a potência luminosa emitida (com erro global, após a calibração, menor que 20% durante a emissão), possibilita seu ajuste até 5 mW (6,366 mW/\'CM POT. 2\') e permite selecionar a duração da emissão entre 10 s - 30 min. O sistema irradia com pico em 365 nm \'+ OU -\' 15 nm sendo que o design óptico proporciona spots homogêneos para três diâmetros selecionáveis: 10 mm; 8 mm; e 6 mm. O software desenvolvido tem a função de controlar todo o procedimento médico do crosslinking corneano, além de detectar falhas no sistema. Os resultados obtidos neste trabalho possibilitaram a criação de um equipamento robusto, flexível e estável, capaz de competir diretamente com os produtos internacionais comercializados mundialmente. Até a presente data tem-se conhecimento de apenas dois produtos, para mesma finalidade, comercializados em todo mundo, sendo ambos de empresas européias. Desta maneira, o sistema descrito nesta dissertação integra hoje o único aparelho de crosslinking totalmente projetado e produzido com tecnologia nacional. / This work is part of a project to create a medical device to be applied with the protocol for corneal collagen crosslinking for the treatment of keratoconus, which resulted in the development of an UV-A system for corneas irradiation for ophthalmic clinical application. The developed system consists of a closed loop circuit, which stabilizes the emitted light power (with global error, after calibration, less than 20% over the issue), allows its adjust up to 5 mW (6.366 mW/\'CM POT.2\') and allows to select the emission duration between 10 s - 30 min. The system irradiates with a peak wave length at 365 nm \'+ OU -\' 15 nm and the optical design provides homogeneous spots for three selectable diameter: 10 mm, 8 mm and 6 mm. The developed software has the function of controlling the medical procedure of corneal crosslinking, and detect system failures. The results of this work enabled the creation of a robust equipment, flexible, and stable that can compete directly with international products marketed worldwide. Until the present date, there has been aware of only two products for the same purpose, marketed worldwide, both from European companies. Thus, the system described in this dissertation integrates now the only unit of crosslinking completely designed and produced with national technology.

A membrana amniótica tem se consolidado no tratamento das afecções da superfície ocular. Assim, o objetivo deste estudo foi avaliar a viabilidade e a eficácia do implante de MA eqüina, preservada em glicerina a 98%, na reparação de ceratoplastias lamelares em cães, por meio do estudo da avaliação clínica pós-operatória dos animais, do tempo de cicatrização, da reconstrução da arquitetura da córnea, da resposta inflamatória, e da composição colágena do estroma corneal no local do implante. Foram selecionados 12 cães, sem raça definida, machos ou fêmeas, divididos em quatro grupos de três, que tiveram tempos de observação distintos: 2, 7, 21 e 40 dias. Foi realizada ceratoplastia lamelar de 5 mm de diâmetro em um dos olhos de cada animal, seguida da aplicação do implante de membrana amniótica eqüina de 6 mm. Durante o período de observação, exame clínico oftalmológico foi realizado nos cães, com intervalos de 48 horas e ao final deste período, foram submetidos á eutanásia. Os olhos em estudo foram enucleados e fixados para posterior análise. Foram utilizados três métodos de coloração para o estudo histológico do tecido implantado: hematoxilina-eosina (HE), ácido periódico de Schiff (PAS) e picrossirius. Além disso, procedeu-se a imunomarcação para colágenos tipo I, III, e V, com uso de pepsina para digestão das fibras colágenas heterotípicas exposição dos epítopos. Clinicamente os implantes foram completamente epitelizados em aproximadamente 10 dias, os neovasos apresentaram involução progressiva a partir dos 20 dias de pós-operatório, estando ausentes ao final dos 40 dias de observação, restando apenas uma nébula no local da lesão. À microscopia óptica, observou-se resposta inflamatória moderada, presença de epitélio pavimentoso estratificado aos sete dias e epitelização completa aos 21 dias. Aos 40 dias a membrana basal do epitélio apresentou-se reconstituída. O colágeno tipo I teve sua expressão no estroma intensificada aos 21 dias de pós- operatório. O colágeno tipo III está presente na membrana amniótica, sua a ausência no local do implante, aos 21 dias, mostrou remodelamento do tecido implantado. O colágeno tipo V, presente no estroma da córnea, teve sua expressão aumentada aos 7 e 21 dias, retornando à distribuição normal aos 40 dias de pós-operatório. Assim concluí-se que: a membrana amniótica eqüina é viável como implante em córnea de cão, sendo incorporada ao estroma, resultando em restabelecimento parcial da transparência no local de implante; o colágeno do tecido implantado é remodelado e substituído já aos 21 dias de pós-operatório; a pepsina foi eficiente na digestão das fibras e exposição dos epítopos dos colágenos nas fibras heterotípicas / The amniotic membrane has consecrated itself in the treatment of ocular surface diseases. The objective of this study was to evaluate the efficiency and viability of the equine amniotic membrane graft, preserved in glycerin at 98%, in the lamellar keroplasty recovery in dogs. Evaluation was based on clinical post-surgical exam, healing time, corneal architectural reconstruction, inflammatory response and collagen composition of the corneal stroma at the graft site. Twelve mixed-breed, male and female dogs were divided into four groups of three dogs. Each group was submitted to different observation periods of 2, 7, 21 and 40 days. Each dog was submitted to a 5 mm lamellar keratoplasty in one eye, followed by a 6 mm equine amniotic membrane graft. Each animal was submitted to clinical ophthalmologic exam every 48 hours. At the end of the evaluation period, the animal was euthanized and the grafted eye was removed and fixated for posterior analysis. For the histological study of the tissue graft, three methods of coloration were used: hematoxylin eosin (HE), periodic acid of Schiff (PAS) and picrosirius. Immunolocalization for the collagen types I, III and V using pepsin for fiber digestion of heterotypic fibrils and epitope exposure, was made. Clinically, the grafts were completely epithelized in approximately 10 days and neovascularization regressed progressively 20 days after surgery, being completely absent after 40 days, when only a nebula remained at the graft site. Optic microscopy revealed mild inflammatory response and presence of stratified pavement epithelium after 7 days and complete epithelization 21 days after surgery. At the end of 40 days the basal membrane was reconstituted. Type I collagen had its expression in the stroma intensified 21 days after the surgery. By day 21 the absence of collagen III in the corneal stroma showed graft remodeling, since this was formerly present in the amniotic membrane. The expression of type V fiber in the corneal stroma showed a mildly intensified expression at 7 and 21 days of observation, but returned to its normal distribution 40 days after surgery. Conclusion was that the equine amniotic membrane is a viable graft for the dog\'s cornea as it is incorporated to the stroma, resulting in partial transparency at the site of the graft. Twenty-one days after surgery, collagen from the graft is already remodeled and substituted. Pepsin is efficient for fiber digestion and collagen epitope exposure in heterotypical fibers.

O objetivo deste trabalho e desenvolver um instrumento computadorizado para análise da superfície anterior da córnea humana, gerando para isto, um mapa topográfico bidimensional em código de cores. Utilizando a córnea como um espelho esférico convexo, projeta-se anéis luminosos sobre sua superfície e aquisiciona-se com uma câmera a imagem por ela refletida. Esta imagem e digitalizada e armazenada em um microcomputador para posterior processamento. Através de técnicas de computação gráfica e processamento de imagens digitais, extrai-se da imagem as informações necessárias para construção da topografia desejada. Por fim, a topografia e apresentada em forma de mapas coloridos, sendo cada cor associada a uma determinada dioptria, transmitindo ao médico oftalmologista uma noção exata da superfície da córnea do paciente em análise. / The main goal of this work is to develop a computerized instrument for the analysis of the anterior portion of the human cornea, which displays its result in topographic color maps. Approximating the cornea to a spherical convex mirror, and by projecting a known pattern over it, the reflected image is captured and stored. By means of computer graphics technology and image processing, the necessary information for mathematical calculations is extracted. The resulting maps are color-coded in accordance to the degree of power of each corneal region, that is, to the diopter value. The ophthalmologist can then make important diagnostics and surgery tactics from the analysis of these topographic maps.

Patients with keratoconus exhibit a biomechanically weakened cornea which loses its proper shape and thereby loses its refractive power. It is usually progressive, beginning with poor visual acuity and eventually necessitating corneal transplant. The cause is likely multifactorial, but involves the weakening of the collagen structure of the corneal stroma, resulting in characteristic thinning and conical distortion. Collagen cross-linking is the first treatment to demonstrate efficacy in halting the progression of the disease. UVA radiation is used to activate riboflavin and photochemically induce cross-linking reactions among collagen and proteoglycans within the stroma, thereby stiffening and strengthening the tissue, and preventing further loss of shape. The current standard treatment, which gained FDA approval less than one year ago, has proven to be efficacious, but has been modified very little since pioneering experiments. Optimization aims to maximize clinical effect while maintaining safety and reducing total treatment time. Major procedural modifications involve increasing light intensity over a reduced exposure duration, and varying the method of delivering riboflavin to the stroma. Theoretical modeling, informed by and scaled to experimental results, has the potential to predict clinical effect as a function of treatment parameters, enabling tailoring of individual treatments to the specific needs of each patient.