title: Ultrasound biomicroscopy after palliative surgical procedures for bullous keratopathy: a descriptive comparative study.
abstract: OBJECTIVE
  To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain.
  
  
  METHODS
  The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain.
  
  
  RESULTS
  In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively (p<0.001); mean ET, 102.1 µm preoperatively and 245.2 µm postoperatively (p<0.001); and mean ST, 654.6 µm preoperatively and 681.5 µm postoperatively (p<0.999). Correlations between CCT and pain intensity in the AMT group (p=0.209 pre- and postoperatively) and the ASP group (p=0.157 preoperatively and p=0.426 at the 180-day follow-up) were not statistically significant. Epithelial and stromal edema, Descemet's membrane folds, epithelial bullae, and the presence of interface fluid were frequently observed qualitative features.
  
  
  CONCLUSIONS
  CCT increased over time in both groups. The magnitude of CCT did not correlate with pain intensity in the sample studied. The presence of interface fluid was a qualitative feature specifically found in some patients who underwent AMT.
authors: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, SP, Brazil.
authors: Fabiana dos Santos
authors: Fdos S
authors: Paris
authors: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, SP, Brazil.
authors: Eliana Domingues
authors: ED
authors: Gonçalves
authors: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, SP, Brazil.
authors: Maira Saad Ávila
authors: MS
authors: Morales
authors: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, SP, Brazil.
authors: Liliane Andrade Almeida
authors: LA
authors: Kanecadan
authors: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, SP, Brazil.
authors: Mauro Silveira de Queiroz
authors: MS
authors: Campos
authors: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, SP, Brazil.
authors: José Álvaro Pereira
authors: JÁ
authors: Gomes
authors: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, SP, Brazil.
authors: Norma
authors: N
authors: Allemann
authors: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, SP, Brazil.
authors: Elcio Hideo
authors: EH
authors: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation; D001768:Blister / Q000601:surgery; D003316:Corneal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004728:Endothelium, Corneal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D058447:Eye Pain / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D033401:Microscopy, Acoustic / Q000379:methods; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods; D011184:Postoperative Period; D057234:Preoperative Period; D011677:Punctures; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult