Primeiros casos de rejeição em transplante penetrante após vacina contra COVID-19 / First cases of penetrating corneal transplant rejection after COVID-19 vaccines

RESUMO Este artigo descreve dois casos de reação imunológica de rejeição de transplante penetrante após a aplicação de dois tipos de vacina contra a COVID-19 - CoronaVac (Sinopharm/Butantan) e MRNA BNT162&2 (Pfizer-BioNTech) - com intervalo de 1 e 10 dias, respectivamente. A rejeição se manifestou com hiperemia, edema corneano e embaçamento da visão, que responderam rapidamente ao uso de corticoide tópico e subconjuntival. Até onde sabemos, este é o primeiro relato de rejeição de transplante penetrante de córnea pós-vacina anti-COVID-19. Recomendamos, presentemente, como prevenção, colírio de prednisolona a 1% 4 dias antes e durante 2 semanas após receber qualquer tipo de vacina para a COVID-19.

ABSTRACT This paper describes two cases of allograft corneal transplant rejection after the application of two types of COVID-19 vaccines - Coronavac (Sinopharm/Butantan) and MRNA BNT162&2 (Pfizer-BioNTech) vaccines - with an interval of 1 to 10 days, respectively. The rejection manifested in the form of corneal edema, hyperemia and blurred vision, which responded rapidly to the use of topical and subconjunctival corticosteroid. As far as we know, this is the first published report of immunological rejection of penetrating corneal transplant after COVID-19 vaccination. As a preventative measure, we now recommend the use of 1% prednisolone eye drop 4 days before and during 2 weeks after having received any type of COVID-19 vaccine.

Retinosquise peripapilar e descolamento seroso de retina neuro-sensorial após esclerectomia profunda não penetrante / Peripapillary retinoschisis and serous detachment of neurosensory retina after a non-penetrating deep sclerectomy

Resumo Relato de caso de um paciente de 46 anos com glaucoma juvenil de controle clínico insatisfatório, portador de retinosquise peripapilar que, após ser submetido à esclerectomia profunda não penetrante, evoluiu com descolamento seroso da retina neuro-sensorial. A associação entre retinosquise peripapilar e o descolamento seroso pós cirurgia filtrante é de ocorrência rara, tendo sido descrito apenas um caso na literatura. A partir deste relato temos por objetivo, além de enfatizar a raridade da associação, mostrar a importância de investigar retinosquise peripapilar em pacientes glaucomatosos, em especial se associada a camada de fibras nervosas, e a importância da explanação adequada aos pacientes de um possível descolamento seroso de retina no pós-operatório de cirurgia filtrante.

Abstract Case report of a 46-year-old patient with unsatisfactory clinical controlled juvenile glaucoma and peripapillary retinoschisis who, after being submitted to non-penetrating deep sclerectomy, evolved with serous detachment of the neurosensory retina. The association between peripapillary retinoschisis and serous detachment after filtering surgery is rare and only one case has been described in the literature. The purpose of this report is, besides to emphasize the rarity of the association, to show the importance of investigating peripapillary retinoschisis in glaucomatous patients, especially if associated with retinal nerve fiber layer, and the importance of adequate explanation to patients of possible serous detachment of retina in the postoperative of filtering surgery.

Outcomes of Sequential Glaucoma Drainage Implants in Refractory Glaucoma.

PURPOSE: To describe the outcomes of eyes that have undergone a second glaucoma drainage implant (GDI) surgery. METHODS: A retrospective review of eyes that underwent a second GDI surgery from 2006 to 2013 was conducted. Primary outcome measures included intraocular pressure (IOP) reduction and success rates. Secondary outcome measures included glaucoma medication use, visual acuity, and number of reoperations. Success was defined as 6 ≤ IOP ≤ 21 with at least 20% IOP reduction, and no increase in the number of glaucoma medications from baseline at 3 months of follow-up or more. RESULTS: Sixty-five eyes (63 patients) had a mean follow-up of 22.4 ± 19.9 months. The most frequently placed second GDIs were an Ahmed FP7 (49%) or a Baerveldt 250 (26%) in the inferotemporal (46%) or inferonasal (35%) quadrant. At 3-year follow-up, IOP was reduced from 25.8 ± 7.7 to 17.4 ± 9.9 mm Hg (P = 0.004) and the number of glaucoma medications decreased from 3.6 ± 1.2 to 2.5 ± 1.4 (P = 0.01) compared with baseline. The median time to failure was 24.7 ± 5.8 months. There was no significant difference in failure rates for type of sequential GDI (P = 0.80) or plate location (P = 0.34). There was no significant difference in visual acuity between baseline and 3-year follow-up (P = 1.0). The most common postoperative complication was corneal edema (n = 9, 14%). CONCLUSIONS: Most eyes undergoing a second GDI achieve adequate IOP control with fewer antiglaucoma medications. Failure rates were similar regardless of quadrant selection or GDI type.

Initial Experience With the New Ahmed Glaucoma Valve Model M4: Short-term Results.

PURPOSE: To evaluate the clinical outcomes of the new Ahmed glaucoma valve (AGV) model M4. The device consists of a porous polyethylene shell designed for improved tissue integration and reduced encapsulation of the plate for better intraocular pressure (IOP) control. METHODS: Medical records of patients with an AGV M4 implantation between December 1, 2012 and December 31, 2013 were reviewed. The main outcome measure was surgical failure, defined as either (1) IOP<5 mm Hg or >21 mm Hg and/or <20% reduction of IOP at last follow-up visit, (2) a reoperation for glaucoma, and/or (3) loss of light perception. RESULTS: Seventy-five eyes of 73 patients were included. Postoperative IOP at all follow-up visits significantly decreased from a baseline IOP of 31.2 mm Hg (P<0.01). However, IOP increased significantly at 3 months (20.4 mm Hg), 6 months (19.3 mm Hg), and 12 months (20.3 mm Hg) compared with 1 month (13.8 mm Hg) postoperatively (P<0.05). At 6 months and 1 year, the cumulative probability of failure was 32% and 72%, respectively. CONCLUSIONS: The AGV M4 effectively reduced IOP in the first postoperative month, but IOP steadily increased thereafter. Consequently, failure rates were high after 1 year of follow-up.

Segmental Analysis of Macular Layers in Patients With Unilateral Primary Open-Angle Glaucoma.

PURPOSE: To measure the thicknesses of the inner layers of the macula in both eyes of patients with unilateral primary open-angle glaucoma (POAG) and compare them with normal control eyes. METHODS: This prospective, cross-sectional pilot study enrolled patients with unilateral POAG, who had visual field defect in only 1 eye, and controls with a normal eye examination. Horizontal and vertical B-scan images centered on the fovea were obtained using spectral domain optical coherence. Semiautomatic delineation and segmentation of the inner layers of the retina were performed to evaluate macular retinal nerve fiber layer (mRNFL), ganglion cell complex (GCC) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses. Mean, superior, inferior, nasal, and temporal inner macular layer thicknesses were compared between affected eyes, fellow eyes without visual field defect, and control eyes. RESULTS: Nineteen patients with unilateral POAG and 14 normal control eyes were enrolled. In the affected POAG eyes, thinning of the mRNFL, GCC, and GC-IPL layers on horizontal and vertical scans were significant when compared with controls (P<0.05), particularly on vertical scans (P<0.001). The mean regional macular GCC and GC-IPL were most severely thinned in the inferior and temporal perifoveal regions. The unaffected eye of patients with unilateral POAG showed significant thinning of the mRNFL only in the vertical scan when compared with normal controls (P<0.05). CONCLUSIONS: Spectral domain optical coherence tomography detected significant thinning of the mRNFL, GCC, and GC-IPL in the affected eyes of patients with unilateral POAG. Fellow eyes showed early structural changes only in the vertical mRNFL scans when compared with normal controls.

Telefone celular: domínio ou incógnita médica? / Mobile phone: physician’s awareness or unfamiliarity

Introdução: A abrangência do uso do telefone celular suscita indagações e debates sobre possíveis efeitos aos seres humanos. O conhecimento adequado dos seus riscos à saúde poderia guiar políticas de saúde pública. O objetivo desta pesquisa é apresentar uma revisão dos trabalhos publicados nas últimas décadas sobre o tema e cotejá-los com o nível de conhecimento de alunos de medicina sobre a evolução do assunto. Metodologia: O trabalho foi dividido em duas etapas: a) pesquisa via internet, http://www.pubmed.gov, usando a palavra-chave: mobile phones; b) questionário, realizado por sorteio, de 30 alunos de cada ano letivo do curso de Medicina da FMABC de 2002 (n=180), avaliando a possibilidade de o aluno possuir um aparelho celular móvel e seu nível de conhecimento sobre artigos relacionados ao tema. Resultados: a) Os artigos incluídos (127) foram agrupados segundo as variáveis: “temas” e “categoria de risco”; b) da enquete, 95,93% dos alunos referiram possuir telefone celular, enquanto apenas 32% possuíam conhecimento adequado sobre os riscos da saúde. Discussão: Apesar de a maioria dos estudantes possuir o aparelho, apenas uma minoria detinha um conhecimento mais apurado sobre o assunto. A tendência deste pouco conhecimento dos alunos não segue os padrões de evidências (temas e categorias de risco) encontrados pela pesquisa na internet. Conclusão: O nível de conhecimento sobre temas lidos pelos alunos diverge daqueles obtidos na rede mundial de computadores, sugerindo a atualização de profissionais da saúde a campos ainda incógnitos e ilustrando um novo conteúdo literário àqueles responsáveis pela orientação da saúde pública.

Introduction: The widespread use of mobile phones arise questions and debates about the potential effects that mobile phones may have on human beings. These effects could pose important challenges to the public health authorities. The objective of this paper is to review, classify and compare theexisting literature to the knowledge of medical students on the subject. Methodology: The research was divided in two phases: a) internet research at http://www.pubmed.gov, usingthe keyword: “mobile phone”; b) a survey with 30, randomly chosen, FMABC students from each of the school years (n=180), assessing whether the students had a mobile phone and the student’s knowledge on subjects relatedto the theme. Results: a) The researched literature - 127 articles - was classified according to the variables: “specificsubject” and “risk category”; b) the research with students demonstrated that 95.3% of students own a mobile phone, whereas only 32% of students had knowledge on the subject. Discussion: Although most of the students own a mobile phone, few of them had any knowledge on the effectsthat mobile phones may have in human beings. Actually, the patterns on the knowledge of the students about thesubject differed from those on the literature. Conclusion: This article presents an updated review of the literature on the subject, that is relevant for public health authorities, and points out the fact that health professionals must get updated on the subject in order to fully understand the challenges the mobile phones may pose