Keratoconus: A One-Sided Debate

Background. A 30-year old man diagnosed with refractive amblyopia OD, was referred for a contact lens fitting. After additional testing was completed the diagnosis was changed to unilateral keratoconus and the patient was successfully fit to a specialty gas permeable lens design OD. Case Report. Presenting symptoms included blurry and double vision with haloes around lights and intermittent tearing, OD. Unaided distance visual acuity (DVA) was 20/100 OD and 20/15 OS. Manifest refraction included a significant degree of myopic astigmatism OD and only a minimal amount OS. While performing biomicroscopy keratoconic signs of prominent corneal nerves and Vogt’s Striae were observed OD only. Keratometric mires were distorted OD and clear OS. Corneal mapping with the Humphrey Atlas Topographer revealed a moderately steep apex OD only with abnormal corneal irregularity (CIM) and shape factor (SF) measurements elicited.OD. On pachymetry the central corneal thickness was measured as 466μm OD and 523μm OS. A light feather touch fluorescein pattern with average edge clearance was seen with the prescribed contact lens OD. After adaptation, the DVA was 20/20- OD with the contact lens compared to 20/15 OS without correction, and a resolution of the patient’s presenting symptoms was reported. Conclusion. Keratoconus is sited as a clinically non-inflammatory corneal ectasia that is typically bilateral and asymmetric. The question of whether monocular keratoconus truly exists is controversial. This case reflects a rare circumstance where only the monitoring of progression will determine whether the initial diagnosis of unilateral keratoconus stands the test of time

Estresse pós-traumático da criança sobrevivente de câncer e sua percepção acerca da experiência parental Post-Traumatic stress disorder of the child survivor of cancer and their perception about parental experience

Nas últimas décadas, paralelamente ao aumento progressivo das taxas de cura em Oncologia Pediátrica, evidencia-se um interesse crescente pela sobrevivência ao câncer na infância. Esta investigação teve como objetivo analisar essa experiência de sobrevivência ao câncer na infância, enfatizando a percepção da criança acerca da experiência parental e avaliando o Transtorno de Estresse Pós-traumático infantil nesse contexto. Realizaram-se entrevistas semiestruturadas com a criança, complementadas pela aplicação do UCLA Posttraumatic Stress Disorder Reaction Index for DSM-IV - Child Version. Evidenciaram-se taxas moderadas de diagnóstico total e parcial de Transtorno de Estresse Pós-Traumático. Especificamente no que se refere aos sintomas de estresse pós-traumático, os escores encontrados foram baixos. Os resultados também sugeriram uma relação entre o modo como a experiência parental é percebida pela criança e o escore total de gravidade de Transtorno de Estresse Pós-traumático Infantil. Recomendam-se estudos com amostras mais extensas, visando disponibilizar instrumentos de avaliação para a área da saúde.<br>This investigation aimed to describe, analyze and comprehend the experience of survival after childhood cancer, emphasizing the child's perception of the parent's experience and the evaluation of the child Post-Traumatic Stress Disorder. So, semi-structured interviews were conducted with the participants, who also answered the UCLA Posttraumatic Stress Disorder Reaction Index for DSM-IV - Child Version. The child's perception of the parental experience confirmed evidences pointed out by specialized literature. The total and partial diagnosis rates of Post-Traumatic Stress Disorder were moderate. Finally, it was possible to suggest a likely connection between the way the parental experience is perceived and the total severity score of the Post-Traumatic Stress Disorder in children. Further investigation, with more significant samples, is recommended in order to develop evaluation tools to be applied in other health situations