Post-traumatic pars plana vitrectomy indications, timing of surgery and outcomes

Objective: To improve vision prognosis after ocular trauma by evaluating the indications for pars plana vitrectomy [PPV], the appropriate timing for surgery, and to find the key predictors of outcomes

Methods: This is a retrospective study. The medical charts of 48 patients presenting with blunt or penetrating eye injury and necessitating a PPV between 2009 and 2016 were reviewed. We studied the indications to operate and the timing of the surgery. The outcome depended on the comparison of the best corrected visual acuity [BCVA], evaluated according to the log-MAR scale before surgery and at 1 week and 6 months post surgery

Results: Forty-eight patients [42 males, 6 females] with mean age 32.4 +/- 17.3 years were recruited; 42 subjects had a penetrating eye injury out of which 21 presented with an intraocular foreign body [IOFB], and 6 had a blunt trauma. Mean preoperative BCVA was at 2.35 [logMAR], 2.25 at 1 week postoperatively, and 1.45 at 6 months. An epiretinal membrane [ERM] and drop of lens material in the vitreous were more likely to develop after blunt traumas. Initial assessment of retinal detachment [RD] was associated with the need to perform a 2[nd] vitrectomy [p = 0.011], poorer BCVA at 6 months [p = 0.001], and lower postoperative intraocular pressure [IOP] [p = 0.014]. Moreover, preoperative BCVA was worse in eyes with posterior scleral perforation [p = 0.008]. Shorter intervals between the trauma and the 1[st] PPV predicted a more frequent need to perform a 2[nd] vitrectomy [p = 0.045]. Patients who developed proliferative vitreoretinopathy [PVR] had poorer vision preoperatively and at 1-week post-op [p = 0.04 and p = 0.01 respectively]. The BCVA preoperatively, at 1 week, and at 6 months were positively correlated. Preoperative BCVA could be regarded as an important forecaster of outcome at 6 months [p = 0.009]; whereas the timing of PPV and of IOFB removal did not show any significant correlation with the final BCVA [r = 0.358, p = 0.132]

Discussion: The major indications for post-traumatic PPV are RD, IOFB, vitreous hemorrhage, retinal tear, ERM, and PVR. An initial RD resulted in poorer visual outcome at 6 months and increased the need for a 2[nd] PPV. Posterior scleral perforation caused inferior vision at presentation. The existence of a PVR lowered the vision initially and at 1 week post-op

Conclusion: The shorter the delay between the trauma and the 1[st] PPV, the more often a 2[nd] PPV was needed. The BCVA at the 3 points in time were positively correlated. Finally, the initial BCVA is a key predictor of outcome, contrarily to the timing of PPV or of the foreign body removal

Azithromycin 1.5% ophthalmic solution: efficacy and treatment modalities in chronic blepharitis / Solução oftálmica de azitromicina 1,5%: eficácia e modalidades de tratamento em blefarite crônica

PURPOSE: To assess the efficacy of topical 1.5% azithromycin in the treatment of moderate to severe chronic blepharitis and to compare the efficacy of two different treatment modalities. METHODS: A randomized clinical trial included 67 patients with chronic anterior and/or posterior blepharitis, followed-up for 3 months. Signs and symptoms were graded according to severity. Patients were randomized into two groups: 33 patients in group I and 34 patients in group II. Group I patients were treated with topical 1.5% azithromycin twice a day for three days, and Group II patients were treated with topical 1.5% azithromycin twice a day for three days then at bedtime for the rest of the month. All patients were instructed to apply warm compresses and an eye-friendly soap twice daily. RESULTS: Patients in both groups tolerated the treatment with minimal irritation. A significant improvement in signs and symptoms was noted at the one week follow-up visit. Group II showed a more pronounced and longer-lasting improvement that persisted after three months of follow-up. CONCLUSION: Topical 1.5% azithromycin ophthalmic solution is an effective treatment option for chronic blepharitis. In moderate to severe blepharitis, a one month treatment is safe and shows better improvement than the three-day protocol with no significant relapse until three months of follow-up.

OBJETIVO: Avaliar a eficácia do uso tópico de azitromicina 1,5% no tratamento de blefarite crônica moderada a grave, comparando a eficácia de duas diferentes modalidades de tratamento. MÉTODOS: Um ensaio clínico randomizado incluiu 67 pacientes com blefarite anterior e/ou posterior crônica, acompanhados por três meses. Os sinais e sintomas foram classificados de acordo com a gravidade. Os pacientes foram randomizados em dois grupos: 33 pacientes no grupo I e 34 pacientes no grupo II. Os pacientes do grupo I foram tratados com azitromicina tópica 1,5% duas vezes ao dia durante três dias, e os pacientes do grupo II foram tratados com azitromicina tópica 1,5% duas vezes ao dia durante três dias e, em seguida, ao deitar, durante o resto do mês. Todos os pacientes foram instruídos a aplicarem compressas quentes e higiene palpebral duas vezes ao dia. RESULTADOS: Os pacientes em ambos os grupos toleraram o tratamento com irritação mínima. Melhora significativa dos sinais e sintomas foi observada na visita de uma semana de acompanhamento. Grupo II mostrou uma melhora mais acentuada e mais duradoura que persistiu após três meses de acompanhamento. CONCLUSÕES: A solução de azitromicina oftálmica tópica 1,5% é uma opção eficaz de tratamento para a blefarite crônica. Em blefarite moderada a grave, o tratamento de um mês é seguro e demonstrou melhora acentuada em relação ao protocolo de três dias, sem recidiva significante até três meses de acompanhamento.

Alterações microscópicas em linfonodos de bovinos sorologicamente positivos para brucelose / Microscopic changes in cattle lymph odes serologically positive for brucellosis / Cambios microscópicos en ganglios linfáticos de bovinos serológicamente positivos para brucelosis

A Brucelose é uma doença infecto-contagiosa provocada por bactérias intracelulares facultativas do gênero Brucella spp., zoonose de distribuição mundial. As principais manifestações clínicas da doença provocam redução na produção dos animais, e suas implicações econômicas causam barreiras na comercialização. Objetivou-se pesquisar alterações microscópicas nos linfonodos de bovinos sorologicamente positivos para brucelose, relacionando à reação inflamatória ganglionar como achado indicativo para o diagnóstico histopatológico da doença. Foram colhidas amostras de linfonodos cervicais superiores em vinte bovinos fêmeas, 10 da raça Gir e 10 da raça Nelore, enviadas ao Laboratório de Patologia Animal da Universidade de Uberaba. Ao realizar o exame macroscópico dos linfonodos, verificou-se que todos se apresentavam reacionais, mesmo que discretamente. Na leitura das lâminas histopatológicas, diagnosticou-se em 100% deles linfadenite crônica, compatível com o quadro de brucelose. O impacto econômico e zoonótico da doença justificam a necessidade definitiva do estabelecimento de programas de controle e erradicação, sendo que o diagnóstico representa grande relevância neste processo, e o exame histopatológico perfaz importante auxílio na confirmação do diagnóstico sorológico.

Brucellosis is an infectious and contagious disease caused by intracellular bacteria of the genus Brucella spp., zoonosis of worldwide distribution. The main clinical manifestations of this disease cause reduction in the animals’ production, and their economic implications provoke barriers in trade. The aim of this study is to find microscopic changes in cattle lymph nodes from animals serologically positive for brucellosis, associating the inflammatory reaction nodes as indicative findings for the histopathologic diagnosis of the disease. Samples were collected from upper cervical lymph nodes in twenty cows, ten from Gir breed, and ten, Nellore, sent to Laboratory of Animal Pathology at the University of Uberaba. In macroscopic examination of the lymph nodes, it was found that all had been reactive even if discretely. In reading the histopathological slides, it was diagnosed in 100% of cases, the same chronic lymphadenitis, compatible with the framework of brucellosis. The economic impact and the zoonotic characteristic of the disease justify the definitive need to establish programs of control and eradication, as the diagnosis is very relevant in this process, histopathological examination turns an important aid to confirm serological diagnosis.

La brucelosis es una enfermedad infectocontagiosa causada por bacterias intracelulares facultativas del género Brucella spp, zoonosis de distribución mundial. Las principales manifestaciones clínicas de la enfermedad provocan reducción en la producción de los animales, y sus implicaciones económicas causan obstáculos en la comercialización. En esta investigación se buscó encontrar cambios microscópicos en los ganglios linfáticos de ganados sorológicamente positivos para brucelosis, listando la reacción inflamatoria de los ganglios linfáticos como indicativo para el diagnóstico histopatológico de la enfermedad. Las muestras fueron recolectadas en los ganglios linfáticos superiores del cuello de veinte vacas, diez de la raza Gir, y diez de la raza Nelore, y enviadas al Laboratorio de Patología Animal de la Universidad de Uberaba. Al realizar el examen macroscópico de los ganglios linfáticos, se comprobó que todos se presentaban reactivos, aunque discretamente. En la lectura de las diapositivas histopatológicas, se diagnosticó en 100% de ellos linfadenitis crónica, compatible con el cuadro de brucelosis. El impacto económico y zoonótico de la enfermedad justifican la necesidad definitiva de establecer programas de control y erradicación, siendo que el diagnóstico representa gran relevancia en este proceso, y el examen histopatológico se convierte en importante ayuda en la confirmación del diagnóstico serológico.