Oral pilocarpine for the treatment of dry eye in patients with Sjögren's syndrome / Pilocarpina oral no tratamento do olho seco de pacientes com síndrome de Sjögren

ABSTRACT Purpose: To evaluate the efficacy of oral pilocarpine (20 mg daily) for the treatment of dry eye in patients with Sjogren's Syndrome. The frequency of side effects reported during the treatment was also investigated. Methods: In this placebo-controlled crossover study, 32 patients with Sjögren's syndrome were enrolled to receive either oral pilocarpine or placebo for 10 weeks. Following a 2-week washout period, the treatment was inverted for each patient for the same duration. Assessments included the quality of life National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), dry eye specific questionnaire Ocular Surface Disease Index, non-invasive breakup time, invasive breakup time with fluorescein, corneal and conjunctival staining patterns with the use of fluorescein and rose bengal staining, Schirmer's test, and tear ferning test. Results: According to the NEI-VFQ-25, there was statistically significant improvement in the quality of life following oral pilocarpine. Similar results were observed for ocular discomfort, as determined by the Ocular Surface Disease Index. All clinical tests showed favorable and statistically significant results following the use of oral pilocarpine. Regarding the analysis of tear samples, there was an improvement in the quality of tear film. This was evidenced by the modification of the patterns observed in the tear ferning test. Side effects were reported by 96.8% and 56.2% of the patients who received pilocarpine and placebo, respectively. Sweating was the most frequently reported side effect (67.74% versus 11.11%, respectively). Conclusions: Although the treatment was associated with a high frequency of side effects, oral pilocarpine (20 mg daily) was able to relieve discomfort related to dry eyes in patients with Sjögren's syndrome and induce favorable structural changes in the tear film.

RESUMO Objetivos: Avaliar o alívio de sintomas e sinais relacionados à secura ocular e na qualidade de vida de pacientes com síndrome de Sjögren tratados com o uso oral de pilocarpina na dose diária de 20mg. A frequência dos efeitos colaterais relatados com o tratamento também foi estudada. Métodos: Trata-se de estudo cruzado e placebo-controlado, que envolveu 32 pacientes com síndrome de Sjögren em uso de pilocarpina oral ou placebo, por dez semanas. Após duas semanas sem medicações, houve a inversão dos tratamentos para cada paciente, por mais dez semanas. As avaliações foram feitas por meio do questionário de qualidade de vida NEI-VFQ-25, questionário olho seco específico Ocular Surface Disease Index, tempo de ruptura do filme lacrimal não invasivo, tempo de ruptura do filme lacrimal com fluoresceína, avaliação da superfície ocular com os corantes fluoresceína e rosa Bengala, teste de Schirmer e teste de cristalização do filme lacrimal. Resultados: Houve melhora estatisticamente significante na qualidade de vida medida pelo questionário NEI-VFQ-25 e no desconforto ocular avaliado pelo Ocular Surface Disease Index, após o tratamento. Todos os testes clínicos sofreram influência favorável e estatisticamente significante durante a fase de tratamento com pilocarpina oral. Em relação à análise de amostras de lágrimas, ocorreram alterações estruturais indicando melhora no padrão de cristalização do filme lacrimal. Os efeitos colaterais com o uso de pilocarpina foram relatados por 96,8% dos pacientes com a pilocarpina e 56,2% com placebo. Sudorese foi o efeito colateral mais frequentemente relatado (pilocarpina = 67,74%; placebo = 11,11%). Conclusões: O uso oral de pilocarpina na dose diária de 20mg foi capaz de aliviar as queixas de desconforto relacionadas ao ressecamento ocular em pacientes com síndrome de Sjögren, produzir impacto positivo na qualidade de vida dos pacientes e induzir mudanças estruturais favoráveis no filme lacrimal, embora os efeitos colaterais relatados tenham ocorrido com alta frequência.

Donor graft harvesting with air in pterygium surgery.

PURPOSE: Report a new technique for improvement of pterygium surgery: donor graft harvesting with air. CASE REPORTS: We describe a technique that was used with 138 patients who underwent surgery that included a conjunctival autograft and fibrin glue with air injection to dissect the Tenon capsule from the conjunctiva. RESULTS: No complications occurred with this technique and all patients achieved good results. DISCUSSION: The surgical time with this new technique was similar to that reported in the literature. In addition, the graft thickness was close to that reported with femtosecond laser dissection and it was thinner than that reported with aesthetic/saline dissection (unable to determine statistical significance). CONCLUSIONS AND IMPORTANCE: With the injection of an air bubble, we could easily dissect the conjunctiva from the Tenon capsule and quickly acquire thin grafts without any additional costs or complications.

Oral pilocarpine for the treatment of dry eye in patients with Sjögren's syndrome.

PURPOSE: To evaluate the efficacy of oral pilocarpine (20 mg daily) for the treatment of dry eye in patients with Sjogren's Syndrome. The frequency of side effects reported during the treatment was also investigated. METHODS: In this placebo-controlled crossover study, 32 patients with Sjögren's syndrome were enrolled to receive either oral pilocarpine or placebo for 10 weeks. Following a 2-week washout period, the treatment was inverted for each patient for the same duration. Assessments included the quality of life National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), dry eye specific questionnaire Ocular Surface Disease Index, non-invasive breakup time, invasive breakup time with fluorescein, corneal and conjunctival staining patterns with the use of fluorescein and rose bengal staining, Schirmer's test, and tear ferning test. RESULTS: According to the NEI-VFQ-25, there was statistically significant improvement in the quality of life following oral pilocarpine. Similar results were observed for ocular discomfort, as determined by the Ocular Surface Disease Index. All clinical tests showed favorable and statistically significant results following the use of oral pilocarpine. Regarding the analysis of tear samples, there was an improvement in the quality of tear film. This was evidenced by the modification of the patterns observed in the tear ferning test. Side effects were reported by 96.8% and 56.2% of the patients who received pilocarpine and placebo, respectively. Sweating was the most frequently reported side effect (67.74% versus 11.11%, respectively). CONCLUSIONS: Although the treatment was associated with a high frequency of side effects, oral pilocarpine (20 mg daily) was able to relieve discomfort related to dry eyes in patients with Sjögren's syndrome and induce favorable structural changes in the tear film.

Conjunctival tattoo: report on an emerging body modification trend.

We report the case of a patient who received conjunctival tattooing for cosmetic purposes with associated complications. A 28-year-old male experienced severe ocular pain after undergoing conjunctival tattooing. Slit-lamp examination revealed blue deposits over the conjunctiva in association with intense conjunctival edema and a 4+ anterior chamber cellular reaction. The patient underwent clinical treatments to control ocular inflammation. Two months after the injury, the patient was still in follow-up to ensure that any further complications were managed and documented. This unusual case of conjunctival tattooing resulted in conjunctival edema and anterior uveitis. Because of the increasing popularity of eyeball tattooing, the potentially severe complications of this procedure may become more common.

Conjunctival tattoo: report on an emerging body modification trend / Tatuagem conjuntival: relato de uma crescente tendência de modificação do corpo

ABSTRACT We report the case of a patient who received conjunctival tattooing for cosmetic purposes with associated complications. A 28-year-old male experienced severe ocular pain after undergoing conjunctival tattooing. Slit-lamp examination revealed blue deposits over the conjunctiva in association with intense conjunctival edema and a 4+ anterior chamber cellular reaction. The patient underwent clinical treatments to control ocular inflammation. Two months after the injury, the patient was still in follow-up to ensure that any further complications were managed and documented. This unusual case of conjunctival tattooing resulted in conjunctival edema and anterior uveitis. Because of the increasing popularity of eyeball tattooing, the potentially severe complications of this procedure may become more common.

RESUMO Relatamos um caso de um paciente que realizou tatuagem conjuntival para fins cosméticos com complicações associadas. Um homem de 28 anos de idade apresentou dor ocular importante após tatuagem conjuntival. O exame da lâmpada de fenda revelou depósitos azuis sobre a conjuntiva, associados a um intenso edema conjuntival e uma reação de câmara anterior de 4+ de células. O paciente foi submetido a tratamentos clínicos para controlar a inflamação ocular. Dois meses após o ocorrido, o paciente ainda estava em acompanhamento para garantir que quaisquer outras complicações fossem gerenciadas e documentadas. Um caso incomum de tatuagem conjuntival resultou em edema conjuntival e uveíte anterior. Devido à crescente popularidade da tatuagem no globo ocular, complicações potencialmente graves deste procedimento podem se tornar mais comuns.

Evaluation of the ocular surface following bariatric surgery.

PURPOSE:: To identify and evaluate changes in the ocular surface in obese patients with bariatric surgery. METHODS:: The study included 89 randomly selected patients; 81 (91.0%) were women, 35 were preoperative, 32 were included 0-12 months after surgery, and 22 were included >12 months after surgery. All patients completed a dry eye-specific questionnaire and were evaluated by the tear ferning test, tear-film breakup time (BUT), Schirmer's test I, examination of the ocular surface by 1% rose Bengal staining, and impression cytology. Patients were questioned about compliance with nutritional supplementation. RESULTS:: The pre- and postoperative groups did not differ significantly in age (p=0.082), but did differ in body mass index (p<0.001). All test values are within the normal range and there was no statistically significant difference in ocular surface disease index score between the preoperative and postoperative periods. The mean tear-film BUT was lower than that considered normal (10 s) at each time it was tested. No statistically significant group differences were observed in Schirmer's test, BUT, rose Bengal staining, or impression cytology. A high rate of noncompliance with nutritional supplementation was observed. CONCLUSIONS:: No symptoms of xerophthalmia developed in this series of bariatric surgery patients. No changes were observed in any of the specific tests used to evaluate the ocular surface up to 5 years after surgery compared with presurgery results.

Evaluation of the ocular surface following bariatric surgery / Avaliação da superfície ocular após cirurgia bariátrica

ABSTRACT Purpose: To identify and evaluate changes in the ocular surface in obese patients with bariatric surgery. Methods: The study included 89 randomly selected patients; 81 (91.0%) were women, 35 were preoperative, 32 were included 0-12 months after surgery, and 22 were included >12 months after surgery. All patients completed a dry eye-specific questionnaire and were evaluated by the tear ferning test, tear-film breakup time (BUT), Schirmer's test I, examination of the ocular surface by 1% rose Bengal staining, and impression cytology. Patients were questioned about compliance with nutritional supplementation. Results: The pre- and postoperative groups did not differ significantly in age (p=0.082), but did differ in body mass index (p<0.001). All test values are within the normal range and there was no statistically significant difference in ocular surface disease index score between the preoperative and postoperative periods. The mean tear-film BUT was lower than that considered normal (10 s) at each time it was tested. No statistically significant group differences were observed in Schirmer's test, BUT, rose Bengal staining, or impression cytology. A high rate of noncompliance with nutritional supplementation was observed. Conclusions: No symptoms of xerophthalmia developed in this series of bariatric surgery patients. No changes were observed in any of the specific tests used to evaluate the ocular surface up to 5 years after surgery compared with presurgery results.

RESUMO Objetivos: Analisar os resultados dos testes de avialiação da superfície ocular em pacientes com obesidade submetidos à cirurgia bariátrica e identificar a presença e intensidades das alterações oculares após cirurgia bariátrica. Métodos: O estudo foi composto de 89 pacientes, amostra randômica, sendo 81 mulheres (91,0%). Os pacientes foram agrupados com relação à relação da cirurgia bariátrica: pré-operatório (35 pacientes), pós-operatório 0 a 12 meses (32 pacientes) e mais de 12 meses (22 pacientes). Todos os pacientes foram submetidos a seguinte sequencia de exames: questionário olho seco específico, teste de cristalização do filme lacrimal, teste da tempo de ruptura do filme lacrimal, Schirmer teste I, avaliação da superfície ocular usando rosa bengala, citologia de impressão. Os pacientes foram questionados quanto ao uso da suplementação nutricional. Resultados: Não houve diferença estatística entre os grupos quanto à idade (p=0,082). BMI foi significativamente diferente entre os grupos (p<0,001). Quanto ao OSDI, os valores foram normais, sem diferença estatística entre os períodos pré-operatório e pós-operatório. A média do tempo de ruptura do filme lacrimal foi abaixo do considerado normal (10 segundos) em todos os momentos avaliados. Não houve di ferença estatisticamente significante entre os grupos com relação aos exames: teste de Schirmer, BUT, biomicroscopia com rosa bengala 1% e citologia de impressão. Elevada taxa de uso incorreto da suplementação nutricional foi encontrada (73%). Conclusão: Não houve surgimento de sintomas de xeroftalmia nos pacientes submetidos à cirurgia bariátrica e não foram encontrados alterações em nenhum teste utilizado para avaliar a superfície ocular em cinco anos após a cirurgia em comparação com os pacientes antes da cirurgia.

Conjunctival Tattoo With Inadvertent Globe Penetration and Associated Complications.

PURPOSE: To report a case of conjunctival tattooing for cosmetic purposes with inadvertent globe penetration resulting in severe inflammation, capsular lens opacity, and secondary glaucoma. METHODS: Case report. RESULTS: A 25-year-old woman experienced severe ocular pain and decreased vision in the left eye after conjunctival tattooing for cosmetic purposes on the previous day. Slit-lamp examination revealed black deposits over the conjunctiva, corneal endothelium, anterior chamber angle, iris, and anterior capsular lens due to the tattooing pigment. In addition, severe anterior uveitis triggered by the pigments and, later, secondary glaucoma were diagnosed. The patient underwent clinical and surgical treatments to control ocular inflammation and intraocular pressure. Three months after the injury, the patient was still under follow-up treatment in an effort to control the complications of the eyeball tattooing. CONCLUSIONS: An unusual case of conjunctival tattooing resulted in severe inflammation, capsular lens opacity, and secondary glaucoma. Because of the increasing popularity of eyeball tattooing, coupled with the procedure being performed by untrained professionals, potentially severe complications of this procedure may become more common.

Exfoliative Cytology in the Diagnosis of Ocular Surface Squamous Neoplasms.

PURPOSE: Surface tumors of the eye comprise an ample spectrum of diseases with various clinical manifestations. Diagnosis has been traditionally achieved through core biopsies, but cytology is an innovative, fast, and minimally invasive method. The objective of this study was to investigate the use of exfoliative cytology as an alternative method for the detection of ocular surface squamous neoplasm (OSSN). METHODS: Exfoliative cytology of the lesions was performed by collecting smears using plastic brushes followed by smearing the cells onto slides and subsequently fixing them in 90% alcohol. Incisional biopsies were performed at the exact same location and sent for processing in 10% formaldehyde. Both the surgical pathologist and cytopathologist were masked to the clinical characteristics and to the corresponding cytological or histological result. RESULTS: Twenty-two patients were enrolled in the study (12 men and 10 women, median age 52.5 years). Final histological diagnoses comprised 7 cases of pterygium, 7 squamous-cell carcinomas, 4 squamous papillomas, and 4 chronic inflammatory processes. Cytohistological agreement was achieved in 19 (86.4%) of the samples. Cytology showed a sensitivity, specificity, positive predictive value, and negative predictive value of 85.7%, 86.7%, 75%, and 92.9%, respectively, in detecting OSSN. CONCLUSIONS: Exfoliative cytology of the conjunctival lesions is a simple procedure, with high agreement to the histological follow-up. Its broad use could augment the early diagnosis of OSSN, with improvement in patient prognosis.

Avaliação da função lacrimal, da superfície ocular e do filme lacrimal em pacientes soropositivos para o HIV / Evaluation of tear film function, ocular surface and tear film in HIV-seropositive patients

Objetivo Avaliar a função lacrimal, a superfície ocular e o filme lacrimal de pacientes com sorologia positiva para o vírus HIV. Métodos Estudo observacional, transversal, quantitativo e analítico, realizado entre junho e outubro de 2011, no Departamento de Oftalmologia do Hospital do Servidor Público Estadual “Francisco Morato de Oliveira”, com 32 pacientes no total, sendo 16 soropositivos para o HIV e 16 soronegativos. Resultados Não houve diferença estatística significante na média de idade entre os grupos estudados (p = 0,083). O padrão do teste de cristalização da lágrima foi estatisticamente diferente no grupo de pacientes HIV (com predomínio dos padrões III e IV) em relação ao grupo controle (no qual predominaram os padrões I e II), tanto no olho direito como no esquerdo (p = 0,019 e p < 0,001, respectivamente). As demais variáveis estudadas não mostraram-se estatisticamente relevantes entre os grupos. Conclusão Os pacientes soropositivos para o HIV não apresentaram alterações da função lacrimal e da superfície ocular, porém amostras de lágrimas evidenciaram diferenças consideradas estatisticamente significantes nos padrões dos testes de cristalização do filme lacrimal, quando comparadas com amostras obtidas de pacientes controles...

Objective Evaluate tear function, tear film and ocular surface in patients with positive serology for HIV. Methods Observational, cross-sectional, quantitative and analytical study, performed between june and october 2011, in the HSPE-FMO, SP, Ophthalmology Department, including 32 patients. Sixteen were HIV-positive patients and 16 HIV-negative. Results There was no significant statistical difference in the middle age between both groups (p=0.083). The ferning test was statistically different in HIV group (with predominance of III and IV) compared to the control group (in which predominated the patterns I and II), both in the right and the left eye (p = 0.019 and p=0.001, respectively). Other parameters were not statistically significant between the groups Conclusion HIV-positive patients had no changes in lacrimal function and ocular surface, however, samples of tears showed differences considered statistically significant in the crystallization test, compared with samples obtained from controls...

Evaluation of tear film function, ocular surface and tear film in HIV-seropositive patients / Avaliação da função lacrimal, da superfície ocular e do filme lacrimal em pacientes soropositivos para o HIV

Objective: Evaluate tear function, tear film and ocular surface in patients with positive serology for HIV. Methods: Observational, cross-sectional, quantitative and analytical study, performed between june and october 2011, in the HSPE-SP Ophthalmology Department, including 32 patients. Sixteen were HIV-positive patients and 16 HIV-negative. Results: There was no significant statistical difference in the middle age between both groups (p=0.083). The ferning test was statistically different in HIV group (with predominance of III and IV) compared to the control group (in which predominated the patterns I and II), both in the right and the left eye (p = 0.019 and p < 0.001, respectively). Other parameters were not statistically significant between the groups. Conclusions: HIV-positive patients had no changes in lacrimal function and ocular surface, however, samples of tears showed differences considered statistically significant in the crystallization test, compared with samples obtained from controls.

Objetivo: Avaliar a função lacrimal, a superfície ocular e o filme lacrimal de pacientes com sorologia positiva para o vírus HIV. Métodos: Estudo observacional, transversal, quantitativo e analítico, realizado entre junho e outubro de 2011, no Departamento de Oftalmologia do HSPE-SP, com 32 pacientes no total, sendo 16 soropositivos para o HIV e 16 soronegativos. Resultados: Não houve diferença estatística significante na média da idade entre os grupos estudados (p = 0,083). O padrão do teste de cristalização da lágrima foi estatisticamente diferente no grupo de pacientes HIV (com predomínio dos padrões III e IV) em relação ao grupo controle (no qual predominaram os padrões I e II), tanto no olho direito como no esquerdo (p = 0,019 e p < 0,001, respectivamente). As demais variáveis estudadas não mostraram-se estatisticamente relevantes entre os grupos. Conclusão: Os pacientes soropositivos para o HIV não apresentaram alterações da função lacrimal e da superfície ocular, porém amostras de lágrimas evidenciaram diferenças consideradas estatisticamente significantes nos padrões dos testes de cristalização do filme lacrimal, quando comparadas com amostras obtidas de pacientes controles.

Induction of corneal collagen cross-linking in experimental corneal alkali burns in rabbits.

Objective: To evaluate the effect of riboflavin-ultraviolet-A-induced cross-linking (CXL) following corneal alkali burns in rabbits. Methods: The right corneas and limbi of ten rabbits were burned using a 1N solution of NaOH and the animals were then divided into two groups: a control group submitted to clinical treatment alone and an experimental group that was treated 1 h after injury with CXL, followed by the same clinical treatment as administered to the controls. Clinical parameters were evaluated post-injury at 1, 7, 15, and 30 days by two independent observers. Following this evaluation, the corneas were excised and examined histologically. Results: There were no statistically significant differences in clinical parameters, such as hyperemia, corneal edema, ciliary injection, limbal ischemia, secretion, corneal neovascularization, symblepharon, or blepharospasm, at any of the time-points evaluated. However, the size of the epithelial defect was significantly smaller in the CXL group (p<0.05) (day 15: p=0.008 and day 30: p=0.008) and the extent of the corneal injury (opacity lesion) was also smaller (day 30: p=0.021). Histopathology showed the presence of collagen bridges linking the collagen fibers in only the CXL group. Conclusions: These results suggest that the use of CXL may improve the prognosis of acute corneal alkali burns.

Induction of corneal collagen cross-linking in experimental corneal alkali burns in rabbits / Indução de ligações covalentes de colágeno em queimaduras corneanas experimentais por álcali em coelhos

Objective: To evaluate the effect of riboflavin-ultraviolet-A-induced cross-linking (CXL) following corneal alkali burns in rabbits. Methods: The right corneas and limbi of ten rabbits were burned using a 1N solution of NaOH and the animals were then divided into two groups: a control group submitted to clinical treatment alone and an experimental group that was treated 1 h after injury with CXL, followed by the same clinical treatment as administered to the controls. Clinical parameters were evaluated post-injury at 1, 7, 15, and 30 days by two independent observers. Following this evaluation, the corneas were excised and examined histologically. Results: There were no statistically significant differences in clinical parameters, such as hyperemia, corneal edema, ciliary injection, limbal ischemia, secretion, corneal neovascularization, symblepharon, or blepharospasm, at any of the time-points evaluated. However, the size of the epithelial defect was significantly smaller in the CXL group (p<0.05) (day 15: p=0.008 and day 30: p=0.008) and the extent of the corneal injury (opacity lesion) was also smaller (day 30: p=0.021). Histopathology showed the presence of collagen bridges linking the collagen fibers in only the CXL group. Conclusions: These results suggest that the use of CXL may improve the prognosis of acute corneal alkali burns. .

Objetivo: Avaliar o efeito de ligações covalentes de colágeno (cross-linking [CXL]) induzidas pelo tratamento com riboflavina e radiação ultravioleta A após queimaduras por álcali em córneas de coelhos. Métodos: Dez coelhos foram submetidos a queimadura ocular direita abrangendo estruturas da córnea e limbo usando uma solução de NaOH a 1N. A seguir, os animais foram divididos em dois grupos: um grupo controle submetido a tratamento clínico pós dano corneano e um grupo experimental que foi tratado com CXL uma hora após o dano, seguido pelo mesmo tratamento clínico administrado aos controles. Os parâmetros clínicos foram avaliados 1, 7, 15 e 30 dias após a lesão, por dois observadores independentes. Na etapa seguinte, foi realizada a excisão e o exame histológico das córneas. Resultados: Não houve diferenças estatisticamente significantes nos parâmetros clínicos de hiperemia, edema da córnea, injeção ciliar, isquemia límbica, secreção, neovascularização da córnea, simbléfaro ou blefaroespasmo, em qualquer dos momentos da avaliação. Entretanto, o grupo CXL apresentou um defeito epitelial menor (p<0,05) (dia 15: p=0,008 e dia 30: p=0,008) e menor extensão da lesão na córnea (lesão opaca) (dia 30: p=0,021). O exame histopatológico revelou a presença de pontes de colágeno conectando as fibras de colágeno somente no grupo CXL. Conclusões: Estes resultados sugerem que o uso de CXL pode melhorar o prognóstico de queimaduras agudas da córnea causadas por alcáli. .

[Ocular surface and hepatitis C]. / Superfície ocular e hepatite C.

PURPOSE: To evaluate the outcomes of the tests used for dry eye diagnosis in patients with hepatitis C virus, and to verify if there is any relationship between the duration of illness and intensity of ocular surface changes. METHODS: 25 patients with hepatitis C virus without treatment, and 29 patients with negative serologic tests for hepatitis C virus were selected. Biomicroscopy, tear film crystallization test, tear film break-up time, evaluation of the corneal staining with 1% fluorescein sodium, Schirmer I test, ocular surface staining with 1% rose bengal and esthesiometry were performed in both groups. RESULTS: In the Schirmer I test, the group of patients with hepatitis C displayed lower values in both eyes (OR p=0.0162; OS p=0.0265). For the tear film break-up time, there was a lower score in the group with hepatitis C, but it was statistically significant only in the left eye (p=0.0007). Regarding the ocular surface damage, the rose bengal staining test showed a higher average in the hepatitis group in both eyes (right p=0.0008; left p=0.0034). There was a difference in the average esthesiometry between the groups, being the average lower in infected patients (OR p=0.0006; OS p=0.0015). There was no linear association between time of hepatitis C infection and intensity observed in dry eye tests. CONCLUSIONS: Hepatitis C virus infection causes dry eye. Further researches are necessary to establish the physiopathology and the relationship with Sjögren syndrome.

[Efficacy of fibrin tissue adhesive in the attachment of autogenous conjuntival graft on primary pterygium surgery]. / Eficácia do adesivo tecidual de fibrina na fixação de enxerto conjuntival autógeno em cirurgias de pterígio primário.

PURPOSE: To compare the efficacy of conjunctival autograft surgery with the attachment to the scleral bed using fibrin tissue adhesive or mononylon 10-0 suture after resection of primary pterygium. METHODS: A comparative, prospective and randomized clinical trial was performed in 47 eyes of 47 patients with primary medial located pterygium. Group 1 (adhesive) was composed by 21 patients that underwent conjunctival autograft closure with fibrin tissue adhesive (Quixil™) and Group 2 (suture) was composed by 26 patients that underwent pterygium surgery with mononylon 10-0 (Ethicon(®)) suture (suture group) after pterygium excision. All surgeries were performed by the same surgeon. Patients were assessed on the preoperative period and on the 1(st), 14(th) and 21(st) postoperative days. They were followed-up with a questionnaire of ocular discomfort and by the surgical time spent, ocular hyperemia, complications and recurrence signals, being the recurrence also evaluated at the 6th postoperative month. Data were submitted to statistical analysis. A value of p<0.005 was considered statistically significant. RESULTS: The average surgical time was 19.05 ± 6.12 minutes in group 1 (glue) and 48.15 ± 7.13 minutes in the group 2 (suture) (p<0.001). The ocular discomfort scale analysis showed a lower score in the 1(st) (p<0.005), 7(th) (p<0.001) and 21(th) (p<0.001) postoperative days in group 1. Ocular hyperemia was less intense in all periods of this study in group 1 (p<0.001). Complications were one in each group and both were managed with clinical treatment until the 21(th) postoperative day. There was one recurrence in group 1 and two in group 2 until the 6(th) postoperative month. CONCLUSION: In the surgical management of primary pterygium, fibrin tissue adhesive attached the conjunctival autograft, decreased the surgical time and diminished the conjunctival hyperemia and ocular discomfort with similar recurrences on the postoperative period, compared to fixation with mononylon 10.0 suture, proving to be an excellent option for conjunctival autograft attachment in primary pterygium surgery.

Superfície ocular e hepatite C / Ocular surface and hepatitis C

Objetivos: Avaliar os resultados dos testes utilizados para o diagnóstico de olho seco em portadores do vírus da hepatite C, e verificar se há relação entre a duração conhecida da doença e a intensidade das alterações da superfície ocular. MÉTODOS: Foram avaliados 25 pacientes portadores do vírus da hepatite C não tratados e 29 indivíduos com testes sorológicos negativos para hepatite C. Nos dois grupos, foi realizada a mesma sequência de exames: biomicroscopia, teste de cristalização da lágrima, tempo de ruptura do filme lacrimal, avaliação da córnea com fluoresceína, teste de Schirmer I, avaliação da córnea e conjuntiva com corante rosa bengala e estesiometria da córnea. Os pacientes também foram questionados com relação ao tempo conhecido de infecção pelo vírus da hepatite C. RESULTADOS: O grupo com hepatite C apresentou valor menor que o encontrado nos indivíduos sem hepatite C, no teste de Schirmer I tanto para o olho direito (p=0,0162) como esquerdo (p=0,0265). Para o tempo de ruptura do filme lacrimal verificou-se média inferior no grupo com hepatite C nos dois olhos; porém, a diferença apresen tou significância estatística apenas no olho esquerdo (p=0,0007), não sendo detectada diferença no olho direito (p=0,0793). Com relação ao dano presente na superfície ocular, verificado pela pontuação no teste de coloração com rosa bengala, observou-se média superior no grupo com hepatite, tanto no olho direito (p=0,0008) como esquerdo (p=0,0034). Os valores obtidos na medida da sensibilidade corneal dos pacientes infectados evidenciaram que a sensibilidade da córnea encontra-se alterada em comparação com a do grupo controle. O teste de cristalização do filme lacrimal não demonstrou diferenças entre ambos os grupos. Não houve correlação entre tempo de infecção pelo vírus e intensidade das alterações. CONCLUSÕES: Os resultados indicam que a hepatite C é causa de olho seco. Os mecanismos fisiopatológicos não são conhecidos, mas isso deve servir de alerta para cuidados terapêuticos oculares e futuras pesquisas para elucidar a síndrome sicca na hepatite C e suas relações com síndrome de Sjögren.

PURPOSE: To evaluate the outcomes of the tests used for dry eye diagnosis in patients with hepatitis C virus, and to verify if there is any relationship between the duration of illness and intensity of ocular surface changes. METHODS: 25 patients with hepatitis C virus without treatment, and 29 patients with negative serologic tests for hepatitis C virus were selected. Biomicroscopy, tear film crystallization test, tear film break-up time, evaluation of the corneal staining with 1 percent fluorescein sodium, Schirmer I test, ocular surface staining with 1 percent rose bengal and esthesiometry were performed in both groups. RESULTS: In the Schirmer I test, the group of patients with hepatitis C displayed lower values in both eyes (OR p=0.0162; OS p=0.0265). For the tear film break-up time, there was a lower score in the group with hepatitis C, but it was statistically significant only in the left eye (p=0.0007). Regarding the ocular surface damage, the rose bengal staining test showed a higher average in the hepatitis group in both eyes (right p=0.0008; left p=0.0034). There was a difference in the average esthesiometry between the groups, being the average lower in infected patients (OR p=0.0006; OS p=0.0015). There was no linear association between time of hepatitis C infection and intensity observed in dry eye tests. CONCLUSIONS: Hepatitis C virus infection causes dry eye. Further researches are necessary to establish the physiopathology and the relationship with Sjögren syndrome.

Eficácia do adesivo tecidual de fibrina na fixação de enxerto conjuntival autógeno em cirurgias de pterígio primário / Efficacy of fibrin tissue adhesive in the attachment of autogenous conjuntival graft on primary pterygium surgery

OBJETIVO: Comparar a eficácia da fixação do enxerto autógeno de conjuntiva ao leito escleral após exérese de pterígio primário, utilizando-se adesivo tecidual de fibrina ou sutura de monofilamento de nylon 10-0. MÉTODOS: Estudo comparativo, prospectivo e aleatório foi realizado em 47 olhos de 47 pacientes com pterígio primário de localização medial. O grupo 1 (adesivo) foi constituído de 21 pacientes submetidos à fixação do enxerto conjuntival com adesivo tecidual de fibrina (QuixilTM); enquanto que o grupo 2 (sutura), foi constituído de 26 pacientes, cuja fixação do enxerto foi feita com sutura em pontos separados de monofilamento de nylon 10-0 (Ethicon®) após a excisão do pterígio feita pelo mesmo cirurgião. Os pacientes foram avaliados antes da cirurgia, no 1º, 14º e 21º dia após a cirurgia. Utilizou-se uma escala visual de desconforto ocular e verificou-se o tempo cirúrgico, hiperemia ocular e presença de complicações, além de sinais de recidiva, sendo sua presença também avaliada no 6º mês após a cirurgia. As variáveis foram submetidas à análise estatística. Valores de p<0,05 indicaram significância estatística. RESULTADOS: O tempo cirúrgico médio foi de 19,05 ± 6,12 minutos para o grupo 1 e 48,15 ± 7,13 minutos para o grupo sutura (p<0,001). A escala referente ao desconforto ocular demonstrou um menor escore no 1º (p<0,005), 7º (p<0,001) e 21º (p<0,001) dia após a cirurgia com a utilização do adesivo tecidual. A hiperemia ocular mostrou-se menor em todos os períodos do estudo após a cirurgia (p<0,001) no grupo cola. As complicações encontradas, uma em cada grupo, resolveram-se com tratamento clínico até o 21º dia após a cirurgia. Houve uma recidiva no grupo 1 e duas no grupo 2 até o 6 º mês após a cirurgia. CONCLUSÃO: Em cirurgia de fixação de enxerto autógeno de conjuntiva para tratamento de pterígio primário, adesivo tecidual de fibrina reduziu o tempo do ato cirúrgico, desencadeou menor hiperemia conjuntival e desconforto no período pósoperatório, com índice de recidiva semelhante em comparação com o uso de sutura de mononylon 10.0, demonstrando ser uma excelente opção para a fixação do enxerto conjuntival no tratamento cirúrgico do pterígio primário.

PURPOSE: To compare the efficacy of conjunctival autograft surgery with the attachment to the scleral bed using fibrin tissue adhesive or mononylon 10-0 suture after resection of primary pterygium. METHODS: A comparative, prospective and randomized clinical trial was performed in 47 eyes of 47 patients with primary medial located pterygium. Group 1 (adhesive) was composed by 21 patients that underwent conjunctival autograft closure with fibrin tissue adhesive (QuixilTM) and Group 2 (suture) was composed by 26 patients that underwent pterygium surgery with mononylon 10-0 (Ethicon®) suture (suture group) after pterygium excision. All surgeries were performed by the same surgeon. Patients were assessed on the preoperative period and on the 1st, 14th and 21st postoperative days. They were followed-up with a questionnaire of ocular discomfort and by the surgical time spent, ocular hyperemia, complications and recurrence signals, being the recurrence also evaluated at the 6th postoperative month. Data were submitted to statistical analysis. A value of p<0.005 was considered statistically significant. RESULTS: The average surgical time was 19.05 ± 6.12 minutes in group 1 (glue) and 48.15 ± 7.13 minutes in the group 2 (suture) (p<0.001). The ocular discomfort scale analysis showed a lower score in the 1st (p<0.005), 7th (p<0.001) and 21th (p<0.001) postoperative days in group 1. Ocular hyperemia was less intense in all periods of this study in group 1 (p<0.001). Complications were one in each group and both were managed with clinical treatment until the 21th postoperative day. There was one recurrence in group 1 and two in group 2 until the 6th postoperative month. CONCLUSION: In the surgical management of primary pterygium, fibrin tissue adhesive attached the conjunctival autograft, decreased the surgical time and diminished the conjunctival hyperemia and ocular discomfort with similar recurrences on the postoperative period, compared to fixation with mononylon 10.0 suture, proving to be an excellent option for conjunctival autograft attachment in primary pterygium surgery.

Influência da toxina botulínica tipo A na função lacrimal de pacientes com distonias faciais / Botulinum toxin type A influence on the lacrimal function of patients with facial dystonia

OBJETIVO: Avaliar a influência da toxina botulínica na função lacrimal de pacientes com distonias faciais. MÉTODOS: Pacientes com diagnóstico de espasmo hemifacial ou blefaroespasmo essencial em atividade foram clinicamente avaliados e responderam questionário de desconforto ocular (OSDI) e foram submetidos aos testes de Schirmer I e basal, tempo de ruptura do filme lacrimal e clearance da lágrima para avaliação da função lacrimal. No dia seguinte, os pacientes receberam tratamento padronizado com toxina botulínica. O questionário e todos os exames iniciais foram repetidos 30 dias após o tratamento pelo mesmo examinador. RESULTADOS: Foram incluídos 26 pacientes no estudo, sendo 15 (57,7 por cento) com espasmo hemifacial e 11(42,3 por cento) com blefaroespasmo essencial. Nos pacientes com espasmo hemifacial a média de idade foi 70,9 ± 13,3 anos e a relação masculino/feminino foi de 1:1,5. Nos pacientes com blefaroespasmo essencial a mé­dia de idade foi 68,9 ± 8,4 anos com predomínio do sexo feminino (90,9 por cento). Após o tratamento o escore do OSDI e os valores dos testes de Schirmer I e basal diminuíram significantemente nos dois grupos. O valor médio da ruptura do filme lacrimal aumentou significantemente nos dois grupos. No teste do clearance da lágrima houve um aumento no número de olhos que apresentaram drenagem completa da lágrima após o tratamento nos dois grupos. CONCLUSÃO: O tratamento com toxina botulínica melhorou os sintomas de olho seco em pacientes com distonias faciais. Apesar da porção aquosa da lágrima ter diminuído, as alterações no piscar aumentaram a estabilidade e melhoraram a drenagem da lágrima.

PURPOSE: To analyze the influence of botulinum toxin on the lacrimal function of patients with facial dystonias. METHODS: Patients with the diagnosis of hemifacial spasm or benign essential blepharospasm were evaluated and invited to answer the Ocular Surface Index Disease (OSID) questionnaire. All patients underwent Schirmer I and basal tests; break-up time (BUT) test and lacrimal clearance evaluation. On the following day, the patients were treated with botulinum toxin. The Ocular Surface Index Disease questionnaire and all the initial tests were reapplied 30 days after the treatment by the same examiner. RESULTS: Twenty-six patients were enrolled in this study, 15 (57.7 percent) with hemifacial spasm and 11 (42.3 percent) with benign essential blepharospasm. The mean age of patients with hemifacial spasm was 70.9 ± 13.3 years and the male:female ratio was 1:1.5. In the group of patients with benign essential blepharospasm, the mean age was 68.9 ± 8.4 years with a female preponderance (90.0 percent). After the treatment, the Ocular Surface Index Disease score, Schirmer I and basal tests score decreased in both groups. The mean of Break-up time test increased significantly in both groups. The lacrimal clearance evaluation showed a greater number of eyes that achieved a complete drainage of the tears after the treatment in both groups. CONCLUSION: The treatment with botulinum toxin improved dry eye symptoms in patients with facial dystonia. Despite of the aqueous portion of tear have decreased, blink modifications improved the tear stability and drainage.

[Botulinum toxin type A influence on the lacrimal function of patients with facial dystonia]. / Influência da toxina botulínica tipo A na função lacrimal de pacientes com distonias faciais.

PURPOSE: To analyze the influence of botulinum toxin on the lacrimal function of patients with facial dystonias. METHODS: Patients with the diagnosis of hemifacial spasm or benign essential blepharospasm were evaluated and invited to answer the Ocular Surface Index Disease (OSID) questionnaire. All patients underwent Schirmer I and basal tests; break-up time (BUT) test and lacrimal clearance evaluation. On the following day, the patients were treated with botulinum toxin. The Ocular Surface Index Disease questionnaire and all the initial tests were reapplied 30 days after the treatment by the same examiner. RESULTS: Twenty-six patients were enrolled in this study, 15 (57.7%) with hemifacial spasm and 11 (42.3%) with benign essential blepharospasm. The mean age of patients with hemifacial spasm was 70.9 ± 13.3 years and the male:female ratio was 1:1.5. In the group of patients with benign essential blepharospasm, the mean age was 68.9 ± 8.4 years with a female preponderance (90.0%). After the treatment, the Ocular Surface Index Disease score, Schirmer I and basal tests score decreased in both groups. The mean of Break-up time test increased significantly in both groups. The lacrimal clearance evaluation showed a greater number of eyes that achieved a complete drainage of the tears after the treatment in both groups. CONCLUSION: The treatment with botulinum toxin improved dry eye symptoms in patients with facial dystonia. Despite of the aqueous portion of tear have decreased, blink modifications improved the tear stability and drainage.