Corneal reshaping: an experiment with a type I collagen-based vitrigel for remodeling porcine corneas / Remodelamento corneano: relato de um experimento com um vitrigel a base de colágeno tipo I para remodelamento de córneas porcinas

ABSTRACT Purpose: This study aimed to report an experiment designed to determine anatomical changes in porcine corneas following placement of a novel polymer implant into the cornea. Methods: An ex vivo porcine eye model was used. A novel type I collagen-based vitrigel implant (6 mm in diameter) was shaped with an excimer laser on the posterior surface to create three planoconcave shapes. Implants were inserted into a manually dissected stromal pocket at a depth of approximately 200 μm. Three treatment groups were defined: group A (n=3), maximal ablation depth 70 μm; Group B (n=3), maximal ablation depth 64 μm; and group C (n=3), maximal ablation depth 104 μm, with a central hole. A control group (D, n=3) was included, in which a stromal pocket was created but biomaterial was not inserted. Eyes were evaluated by optical coherence tomography (OCT) and corneal tomography. Results: Corneal tomography showed a trend for a decreased mean keratometry in all four groups. Optical coherence tomography showed corneas with implants placed within the anterior stroma and visible flattening, whereas the corneas in the control group did not qualitatively change shape. Conclusions: The novel planoconcave biomaterial implant described herein could reshape the cornea in an ex vivo model, resulting in the flattening of the cornea. Further studies are needed using in vivo animal models to confirm such findings.

RESUMO Objetivo: Relatar um experimento projetado para determinar alterações anatômicas em córneas porcinas após a colocação de um novo implante de polímero na córnea. Métodos: Foi utilizado olho de porco ex vivo. Um novo agente modelador biocompatível, de colágeno tipo 1, com 6mm de diâmetro foi moldado com excimer laser em sua face posterior, para criar três formatos planocôncavos. Os implantes foram inseridos dentro de um bolsão, dissecado manualmente, a 200 micrômetros (μm). Foram definidos três grupos de tratamento: grupo A (n=3), teve a profundidade máxima de ablação de 70 μm; o grupo B (n=3), profundidade máxima de ablação de 64 μm; e o grupo C (n=3), profundidade máxima de ablação de 104 μm, com buraco central. O grupo controle, D (n=3), foi incluído, com a criação do bolsão estromal, porém sem inserir o material. A avaliação desses olhos foi realizada por tomografia de coerência óptica (OCT) e por tomografia corneana. Resultados: A tomografia corneana mostrou uma tendência para diminuição da ceratometria média em todos os 4 grupos. A tomografia de coerência óptica mostrou córneas com implantes localizados no estroma anterior e aplanamento visível, enquanto as córneas não mudaram qualitativamente o formato no grupo controle. Conclusões: O novo implante de biomaterial planocôncavo descrito aqui foi capaz de remodelar a córnea em modelo de animal ex vivo, resultando no aplanamento corneano. Novos estudos são necessários usando modelos animais in vivo para confirmar tais achados.

Masquerade syndrome in ocular surface squamous neoplasia / Síndrome mascarada em neoplasia escamosa da superfície ocular

ABSTRACT The aim of this study was to alert the ophthalmic community to an atypical manifestation of ocular surface squamous neoplasia, which may delay diagnosis and treatment and result in a guarded visual prognosis and significant sequelae. A 61-year-old immunocompetent man presented with an initial diagnosis of necrotizing scleritis in the right eye for 3 months. He was treated with systemic prednisone but experienced persistent pain and low visual acuity. Conjunctival biopsy of the affected region confirmed the diagnosis of invasive ocular surface squamous neoplasia, which progressed with intraocular and orbital invasion; thus, exenteration was performed. Masquerade syndrome should be suspected in patients with nodulo-ulcerative lesions of the conjunctiva and sclera. This clinical can be more aggressive, with a greater likelihood of intraocular and orbital involvement. The earlier the diagnosis and treatment, the better the patient prognosis.

RESUMO O objetivo é alertar a comunidade oftalmológica sobre uma manifestação atípica de neoplasia escamosa da superfície ocular (OSSN) que pode levar a um atraso no diagnóstico e tratamento, evoluindo com prognóstico reservado e significativas sequelas. Homem, imunocompetente, 61 anos com diagnóstico inicial de esclerite necrosante em olho direito há 3 meses, em tratamento com prednisona sistêmica porém com persistência da dor e baixa acuidade visual. Realizado biópsia conjuntival em região acometida e diagnosticado como neoplasia escamosa da superfície ocular invasiva. Evolui com invasão intraocular e orbital sendo submetido a exenteração. Assim sendo, deve-se suspeitar de síndrome mascarada frente a um paciente com lesões nódulo-ulcerativas da conjuntiva e esclera. Essa forma clínica pode ser mais agressiva, com maior chance de comprometimento intraocular e orbital. Quanto mais precoces o diagnóstico e o tratamento, melhor o prognóstico para o paciente.

Corneal reshaping: an experiment with a type I collagen-based vitrigel for remodeling porcine corneas.

PURPOSE: This study aimed to report an experiment designed to determine anatomical changes in porcine corneas following placement of a novel polymer implant into the cornea. METHODS: An ex vivo porcine eye model was used. A novel type I collagen-based vitrigel implant (6 mm in diameter) was shaped with an excimer laser on the posterior surface to create three planoconcave shapes. Implants were inserted into a manually dissected stromal pocket at a depth of approximately 200 µm. Three treatment groups were defined: group A (n=3), maximal ablation depth 70 µm; Group B (n=3), maximal ablation depth 64 µm; and group C (n=3), maximal ablation depth 104 µm, with a central hole. A control group (D, n=3) was included, in which a stromal pocket was created but biomaterial was not inserted. Eyes were evaluated by optical coherence tomography (OCT) and corneal tomography. RESULTS: Corneal tomography showed a trend for a decreased mean keratometry in all four groups. Optical coherence tomography showed corneas with implants placed within the anterior stroma and visible flattening, whereas the corneas in the control group did not qualitatively change shape. CONCLUSIONS: The novel planoconcave biomaterial implant described herein could reshape the cornea in an ex vivo model, resulting in the flattening of the cornea. Further studies are needed using in vivo animal models to confirm such findings.

Masquerade syndrome in ocular surface squamous neoplasia.

The aim of this study was to alert the ophthalmic community to an atypical manifestation of ocular surface squamous neoplasia, which may delay diagnosis and treatment and result in a guarded visual prognosis and significant sequelae. A 61-year-old immunocompetent man presented with an initial diagnosis of necrotizing scleritis in the right eye for 3 months. He was treated with systemic prednisone but experienced persistent pain and low visual acuity. Conjunctival biopsy of the affected region confirmed the diagnosis of invasive ocular surface squamous neoplasia, which progressed with intraocular and orbital invasion; thus, exenteration was performed. Masquerade syndrome should be suspected in patients with nodulo-ulcerative lesions of the conjunctiva and sclera. This clinical can be more aggressive, with a greater likelihood of intraocular and orbital involvement. The earlier the diagnosis and treatment, the better the patient prognosis.

Evaluation of childhood cataract characteristics at a tertiary referral center / Características de catarata na infância em um centro de referência terciário

ABSTRACT Purpose: To examine the epidemiological characteristics of children undergoing cataract surgery at a referral center in Sao Paulo State, Brazil, as well as the facts surrounding treatment delays. Methods: In this transversal observational study, 240 operated eyes from 178 children undergoing cataract surgery were reviewed. The following aspects were analyzed: epidemiological and clinical characteristics, parental observations, red reflex test, operated eye, and age at cataract diagnosis and surgery. Results: The mean ages at the first visit and cataract surgery were 48.9 months (SD=50.0 months) and 64.5 months (SD= 55.4 months), respectively. The most critical sign adverted by parents was leukocoria. The red reflex test was performed on two-thirds of the children, with abnormal results in 28.0%. A family history of cataracts was evident in 30 (20,9%) children (n=144). Previous ocular surgery was found in 37 (16,6%) of the eyes (n=223), anterior segment disorders in 20 (9,0%) eyes (n=221), strabismus in 21 (9,5%) of the eyes (n=220), and nystagmus in 38 (24,4%) of the children (n=156). Conclusions: One of the causes for the delay in admission may have been the failure to complete the red reflex. In terms of etiology, heredity was the most crucial component. The presence of strabismus and nystagmus in many of these children points to late diagnosis. The most significant impediments to adequate cataract treatment in children were the lack of referral programs and children's specialized ophthalmologic centers, in addition to the restricted number of support professionals trained in the field and pediatric ophthalmology specialists.

RESUMO Objetivos: Rever características epidemiológicas de crianças submetidas a cirurgia de catarata, em centro de referência no estado de São Paulo, Brasil, e fatos associados a atrasos no tratamento. Métodos: Um total de 240 olhos submetidos a cirurgia de catarata, em 178 crianças, foram revisados neste estudo transversal observacional. Os seguintes aspectos foram analisados: características clínicas e epidemiológicas, sinais apontados pelos pais, teste do reflexo vermelho, olho operado e idade no diagnóstico e na cirurgia. Resultados: A média de idades na primeira visita e cirurgia de catarata foi de 48.9 meses (DP=50,0 meses) e 64.5 meses (DP=55.4 meses), respectivamente. O sinal mais importante apontado pelos pais foi a leucocoria. O teste do reflexo vermelho foi realizado em dois terços das crianças com resultados anormais em 28%. Histórico familiar de catarata foi evidente em 30 (20,9%) crianças (n=144). Os achados mais prevalentes em termos de histórico de problemas oculares foram: cirurgias oculares prévias em 37 (16,6%) olhos (n= 223), alterações do segmento anterior em 20 (9,0%) olhos (n=221), estrabismo em 21 (9,5%) olhos (n=220) e nistagmo em 38 (24,4%) crianças (n=156). Conclusões: Uma das causas para o atraso na admissão pode ter sido a falha em realizar o teste do reflexo vermelho, apesar de não ter sido possível verificar se todas as crianças foram submetidas ao exame. A hereditariedade foi o fator mais importante quanto à causa da catarata nessas crianças. A presença de estrabismo e nistagmo mais uma vez aponta para o diagnóstico tardio. Ausência de programas de referência e centros oftalmológicos especializados em crianças, além do número restrito de profissionais de apoio treinados na área e especialistas em oftalmologia pediátrica, foram as barreiras mais importantes para o tratamento adequado da catarata em crianças.

Evaluation of childhood cataract characteristics at a tertiary referral center.

PURPOSE: To examine the epidemiological characteristics of children undergoing cataract surgery at a referral center in Sao Paulo State, Brazil, as well as the facts surrounding treatment delays. METHODS: In this transversal observational study, 240 operated eyes from 178 children undergoing cataract surgery were reviewed. The following aspects were analyzed: epidemiological and clinical characteristics, parental observations, red reflex test, operated eye, and age at cataract diagnosis and surgery. RESULTS: The mean ages at the first visit and cataract surgery were 48.9 months (SD=50.0 months) and 64.5 months (SD= 55.4 months), respectively. The most critical sign adverted by parents was leukocoria. The red reflex test was performed on two-thirds of the children, with abnormal results in 28.0%. A family history of cataracts was evident in 30 (20,9%) children (n=144). Previous ocular surgery was found in 37 (16,6%) of the eyes (n=223), anterior segment disorders in 20 (9,0%) eyes (n=221), strabismus in 21 (9,5%) of the eyes (n=220), and nystagmus in 38 (24,4%) of the children (n=156). CONCLUSIONS: One of the causes for the delay in admission may have been the failure to complete the red reflex. In terms of etiology, heredity was the most crucial component. The presence of strabismus and nystagmus in many of these children points to late diagnosis. The most significant impediments to adequate cataract treatment in children were the lack of referral programs and children's specialized ophthalmologic centers, in addition to the restricted number of support professionals trained in the field and pediatric ophthalmology specialists.

Three Decades of Contact Lens-associated Microbial Keratitis in a Referral Hospital in São Paulo, Brazil / Ceratite Microbiana Associada a Lentes de contato em um Hospital de Referência em São Paulo, Brasil

ABSTRACT Purpose: The aim of this study was to analyze patient data and the laboratory results of corneal samples collected from patients followed at the Ophthalmology Department, Hospital São Paulo, Brazil over a 30-year period, and correlate the analize with contact lens wearing. Methods: Corneal samples from patients diagnosed clinically with microbial keratitis between January 1987 and December 2016 were included in this study. Cultures that were positive for bacteria, fungi, and Acanthamoeba spp. were analyzed retrospectively. To ascertain if the number of patients with contact-lens-associated microbial keratitis (as a risk factor for microbial infection) changed over time, the analysis was divided into three decades: 1987-1996, 1997-2006, and 2007-2016. Information pertaining to patient gender and age, as well as type of organism isolated, were compared among these periods. Results: The corneal samples of 10.562 patients with a clinical diagnosis of microbial keratitis were included in the study, among which 1.848 cases were related to the use of contact lenses. The results revealed that the frequency of contact-lens-associated microbial keratitis increased over the last two decades. Overall, females had contact-lens-associated microbial keratitis more frequently (59.5%). Patients aged 19-40 years also had contact-lens-associated microbial keratitis more frequently in all study periods. Staphylococcus spp. and Pseudomonas spp. were the most frequent Gram-positive and Gram-negative bacteria, respectively, in the microbial keratitis groups. Among the fungal cases of microbial keratitis, filamentous fungi were the most frequent fungi over the entire study period, with Fusarium spp. being the most frequent fungi in the group with microbial keratitis not associated with contact lens wearing (p<0.001). Samples positive for Acanthamoeba spp. and Pseudomonas spp. were significantly correlated with contact-lens-associated microbial keratitis (p<0.001). Conclusions: Females and young adults aged 19-40 years exhibited the highest frequency of contact-lens-associated microbial keratitis in our study. Staphylococcus spp. and Fusarium spp. were the predominant bacteria and fungi, respectively, isolated from corneal samples. Pseudomonas spp. and Acanthamoeba spp. were significantly correlated with contact-lens-associated microbial keratitis in this study.

RESUMO Objetivo: O objetivo deste estudo foi analisar da dos epidemiológicos de pacientes e resultados laboratoriais para todas as amostras de córnea coletadas de pacientes atendidos no Departamento de Oftalmologia do Hospital São Paulo, Brasil, durante um período de 30 anos e correlacionar com o uso de lentes de contato. Métodos: Amostras de córnea de pacientes com diagnóstico clínico de ceratite microbiana (de janeiro de 1987 a dezembro de 2016) foram incluídas neste estudo. Resultados laboratoriais para culturas positivas para bactérias, fungos e Acanthamoeba spp. foram analisados retrospectivamente. Para verificar se o número de pacientes com ceratite microbiana associada à lente de contato, fator de risco para infecção microbiana, mudou ao longo do tempo, a análise foi dividida em três décadas: 1987-1996, 1997-2006 e 2007-2016. As informações incluindo o sexo do paciente, idade e tipo de organismo isolado foram comparadas entre os períodos. A análise estatística foi realizada no software SAS/STAT 9.3 e SPSS (v20.0). Resultados: Amostras de córnea de 10.562 pacientes com ceratite microbiana foram incluídas no estudo, das quais 1.848 foram relacionadas ao uso de lentes de contato. Os resultados revelaram que a frequência de ceratite microbiana associada à lente de contato aumentou nas últimas duas décadas analisadas. No geral, os homens compreendiam uma proporção maior do grupo ceratite microbiana não associada à lente de contato (CMNLC) (60,3%) e as mulheres eram mais frequentes no grupo ceratite microbiana associada à lente de contato (59,5%). Pacientes com idade entre 19 e 40 anos foram mais frequentemente observados no grupo ceratite microbiana associada à lente de contato em todos os períodos. Staphylococcus spp. foi a bactéria Gram-positiva mais frequentes, enquanto Pseudomonas spp. foi a bactéria Gram-negativa nos grupos ceratite microbiana. Entre os fungos ceratite microbiana, os fungos filamentosos foram os fungos mais frequentes durante todo o período do estudo, com Fusarium spp. sendo o mais frequente no grupo ceratite microbiana não associada à lente de contato. Acanthamoeba spp. e Pseudomonas spp. amostras positivas foram significativamente correlacionadas com ceratite microbiana associada à lente de contato. Conclusões: A maior prevalência de ceratite microbiana associada à lente de contato no nosso estudo foi observada em mulheres e adultos jovens com idade entre 19 e 40 anos. Staphylococcus spp. e Fusarium spp. foram as bactérias e fungos predominantes isolados nas amostras da córnea. Pseudomonas spp. e Acanthamoeba spp. foram significativamente correlacionados a ceratite microbiana associada à lente de contato neste estudo.

Effect of steroid eyedrops after trabeculectomy in glaucoma patients: a keratograph analysis / Efeito de colirios esteróides pré-operatório em pacientes com glaucoma: análise com keratograph

ABSTRACT Purpose: To investigate the use of preoperative steroid eyedrops in glaucoma patients undergoing trabeculectomy for ocular surface disease. Methods: A total of 31 eyes of 31 glaucoma patients were included. Only glaucoma patients who had been using at least three topical intraocular pressure-lowering medications for longer than 6 months were included. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% four times per day for 1 week before trabeculectomy. Data from baseline (day of surgery) and the follow-up visit (2 weeks after surgery) were included. All patients underwent a detailed ophthalmologic examination. Ocular surface disease was evaluated using the Ocular Surface Disease Index questionnaire and clinical measures, including tear breakup time, conjunctival hyperemia, and biomicroscopy to detect the presence or absence of keratitis. Ocular Surface Disease Index scores greater than 13 indicated a clinically relevant presence of ocular surface disease. In addition, all patients underwent keratograph analysis. The comparison of ocular surface disease before and after trabeculectomy was assessed using a paired test. Results: The mean age of the glaucoma patients was 69.90 ± 10.77 years. The average visual acuity was 0.40 ± 0.34 logMAR. The overall Ocular Surface Disease Index prevalence rate was 27.20 ± 17.56 units. Clinical assessment revealed no significant difference in bulbar redness, breakup time, or keratitis before and after surgery (p>0.05 for all comparisons). Keratograph analysis showed that the only two parameters that were significantly different before and after trabeculectomy ewere the bulbar redness by keratograph (BR-K) and the average noninvasive tear breakup time. Patients presented more conjunctival hyperemia and shorter noninvasive tear breakup time after trabeculectomy as compared with before surgery (p=0.013 and p=0.041, respectively). Conclusions: The present study not only confirms the high prevalence of clinical findings of ocular surface disease in glaucoma patients but also reveals new objective parameters measured by keratograph analysis. Apart from using loteprednol etabonate ophthalmic suspension 0.5% 1 week before the surgery, our sample presented a worsening of conjunctival hyperemia (bulbar redness by keratograph) and also a shorter noninvasive tear breakup time postoperatively.

RESUMO Objetivo: Investigar a ação de colírios esteróides na doença de superfície ocular em pacientes a serem submetidos a cirurgia de trabeculectomia. Métodos: Foram incluídos 31 olhos de 31 pacientes com glaucoma em uso de pelo menos 3 medicações tópicas anti- hipertensivas há mais de 6 meses. Todos os pacientes foram tratados com colírio de etabonato de loteprednol 0,5% (1 gota a cada 6 horas) durante os 7 dias precedentes à cirurgia de trabeculectomia. Além disso, foram submetidos a exame oftalmológico completo e responderam questionário validado que visa avaliar parâmetros subjetivos correlacionados a doenças da superfície ocular (Ocular Surface Disease Index). Os aspectos clínicos avaliados foram: tempo de ruptura lacrimal, coloração da córnea após colírio de fluoresceína (ceratite) e hiperemia conjuntival. Os pacientes foram, ainda, submetidos à análise da superfície ocular através de novo software tecnológico denominado "Keratographic", tecnologia não invasiva que permite avaliar a doença da superfície ocular. A comparação da doença de superfície ocular antes e após a trabeculectomia foi avaliada estatisticamente através do teste pareado. Resultados: A média de idade dos participantes foi de 69,90 ± 10,77 anos. A AV média foi de 0,40 ± 0,34 logMAR. A taxa de prevalência global da Ocular Surface Disease Index foi de 27,20 ± 17,56 unidades. Em relação à avaliação clínica, não houve diferença significativa em relação hiperemia, ruptura lacrimal e ceratite antes e após a cirurgia (p>0,05 para todas as comparações). Em relação à análise com o "keratograph (menisco lacrimal, hiperemia, tempo de ruptura do filme lacrimal, meibografia para a pálpebra superior e inferior), os dois únicos parâmetros que diferiram significativamente antes e após a trabeculectomia, foram hiperemia e a média do tempo de rupture do filme lacrimal. Após a cirurgia de trabeculectomia, os pacientes apresentaram aumento da hiperemia conjuntival e diminuição do tempo de ruptura do filme lacrimal (p=0,013 e p=0,041, respectivamente). Conclusões: O presente estudo, não somente confirma a elevada prevalência da doença de superfície ocular em pacientes com glaucoma, como também demonstra que a mesma pode ser mensurada objetivamente através de parâmetros mensurados pelo Keratograph. Apesar de ter utilizado etabonato de loteprednol 0,5% uma semana antes da cirurgia, nossa amostra apresentou piora da hiperemia conjuntival e diminuição no tempo de ruptura do filme lacrimal no pós-operatório.

Three Decades of Contact Lens-associated Microbial Keratitis in a Referral Hospital in São Paulo, Brazil.

PURPOSE: The aim of this study was to analyze patient data and the laboratory results of corneal samples collected from patients followed at the Ophthalmology Department, Hospital São Paulo, Brazil over a 30-year period, and correlate the analize with contact lens wearing. METHODS: Corneal samples from patients diagnosed clinically with microbial keratitis between January 1987 and December 2016 were included in this study. Cultures that were positive for bacteria, fungi, and Acanthamoeba spp. were analyzed retrospectively. To ascertain if the number of patients with contact-lens-associated microbial keratitis (as a risk factor for microbial infection) changed over time, the analysis was divided into three decades: 1987-1996, 1997-2006, and 2007-2016. Information pertaining to patient gender and age, as well as type of organism isolated, were compared among these periods. RESULTS: The corneal samples of 10.562 patients with a clinical diagnosis of microbial keratitis were included in the study, among which 1.848 cases were related to the use of contact lenses. The results revealed that the frequency of contact-lens-associated microbial keratitis increased over the last two decades. Overall, females had contact-lens-associated microbial keratitis more frequently (59.5%). Patients aged 19-40 years also had contact-lens-associated microbial keratitis more frequently in all study periods. Staphylococcus spp. and Pseudomonas spp. were the most frequent Gram-positive and Gram-negative bacteria, respectively, in the microbial keratitis groups. Among the fungal cases of microbial keratitis, filamentous fungi were the most frequent fungi over the entire study period, with Fusarium spp. being the most frequent fungi in the group with microbial keratitis not associated with contact lens wearing (p<0.001). Samples positive for Acanthamoeba spp. and Pseudomonas spp. were significantly correlated with contact-lens-associated microbial keratitis (p<0.001). CONCLUSIONS: Females and young adults aged 19-40 years exhibited the highest frequency of contact-lens-associated microbial keratitis in our study. Staphylococcus spp. and Fusarium spp. were the predominant bacteria and fungi, respectively, isolated from corneal samples. Pseudomonas spp. and Acanthamoeba spp. were significantly correlated with contact-lens-associated microbial keratitis in this study.

Effect of steroid eyedrops after trabeculectomy in glaucoma patients: a keratograph analysis.

PURPOSE: To investigate the use of preoperative steroid eyedrops in glaucoma patients undergoing trabeculectomy for ocular surface disease. METHODS: A total of 31 eyes of 31 glaucoma patients were included. Only glaucoma patients who had been using at least three topical intraocular pressure-lowering medications for longer than 6 months were included. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% four times per day for 1 week before trabeculectomy. Data from baseline (day of surgery) and the follow-up visit (2 weeks after surgery) were included. All patients underwent a detailed ophthalmologic examination. Ocular surface disease was evaluated using the Ocular Surface Disease Index questionnaire and clinical measures, including tear breakup time, conjunctival hyperemia, and biomicroscopy to detect the presence or absence of keratitis. Ocular Surface Disease Index scores greater than 13 indicated a clinically relevant presence of ocular surface disease. In addition, all patients underwent keratograph analysis. The comparison of ocular surface disease before and after trabeculectomy was assessed using a paired test. RESULTS: The mean age of the glaucoma patients was 69.90 ± 10.77 years. The average visual acuity was 0.40 ± 0.34 logMAR. The overall Ocular Surface Disease Index prevalence rate was 27.20 ± 17.56 units. Clinical assessment revealed no significant difference in bulbar redness, breakup time, or keratitis before and after surgery (p>0.05 for all comparisons). Keratograph analysis showed that the only two parameters that were significantly different before and after trabeculectomy ewere the bulbar redness by keratograph (BR-K) and the average noninvasive tear breakup time. Patients presented more conjunctival hyperemia and shorter noninvasive tear breakup time after trabeculectomy as compared with before surgery (p=0.013 and p=0.041, respectively). CONCLUSIONS: The present study not only confirms the high prevalence of clinical findings of ocular surface disease in glaucoma patients but also reveals new objective parameters measured by keratograph analysis. Apart from using loteprednol etabonate ophthalmic suspension 0.5% 1 week before the surgery, our sample presented a worsening of conjunctival hyperemia (bulbar redness by keratograph) and also a shorter noninvasive tear breakup time postoperatively.

Database of the alumni performance of the Ophthalmology Stricto sensu Postgraduate Program at Escola Paulista de Medicina, UNIFESP.

PURPOSE: To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. METHODS: The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. RESULTS: The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. CONCLUSION: For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.

Ocular surface changes in the treatment of rosacea: comparison between low-dose oral isotretinoin and doxycycline / Alterações da superfície ocular no tratamento da Rosácea: comparação entre isotretinoína oral em baixa dosagem e doxiciclina

ABSTRACT Purpose: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. Methods: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. Results: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. Conclusion: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.

RESUMO Objetivos: Comparar o impacto das alterações oculares entre o tratamento sistêmico de doxiciclina e isotretinoína em baixa dosagem em pacientes com rosácea papulopustulosa moderada a grave. Métodos: Os pacientes form randomizados para receber isotretinoína 0,3 a 0,4 mg/kg (grupo A) ou doxiciclina 100mg/dia (grupo B) por 16 semanas. Os sintomas oculares foram pesquisados e avaliados, incluindo melhor acuidade visual corrigida, teste de Schirmer, tempo de ruptura do filme lacrimal, coloração de rosa bengala e graduação da disfunção de glândula de Meibomius. Os pacientes foram novamente testados no final do tratamento. Resultados: O presente estudo incluiu 39 pacientes (30 mulheres e 9 homens). A melhor acuidade visual corrigida foi >20/30 em >90% dos pacientes em ambos os grupos e não se alterou após o tratamento. A melhora dos sintomas oculares e da disfunção de glândula de Meibomius foi mais pronunciada no grupo B (p<0,05) após o tratamento; as demais variáveis não atingiram significância estatística. Conclusão: A doxiciclina melhorou a disfunção de glândula de Meibomius, os sintomas oculares e a superfície ocular de pa cientes com rosácea. Mesmo que alguns pacientes tenham piorado a disfunção e os sintomas da glândula de Meibomius, nenhum indivíduo apresentou complicações graves após a admi nistração de baixas doses de isotretinoína.

Ocular surface changes in the treatment of rosacea: comparison between low-dose oral isotretinoin and doxycycline.

PURPOSE: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. METHODS: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. RESULTS: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. CONCLUSION: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.

Ocular tissue distribution in the State of São Paulo: analysis on corneal discarding reasons. / Distribuição do tecido ocular no Estado de São Paulo: análise por razões de descarte de córneas.

OBJECTIVE: to identify the reasons for refusal of corneas. METHOD: this was a cross-sectional, retrospective, descriptive and correlational study composed of 5,560 optical corneas. The information was taken from the notification, organ procurement and distribution centers database as well as donor records. Descriptive statistics were used for the analysis of categorical variables and specific tests with a significance level of 5% for assessing the associations between variables. This study met the ethical aspects of scientific research. RESULTS: 60% of the donors were male and 40% died by circulatory problems. The main reason for refusal as informed by transplant teams is the donor's age and the endothelial cell count. For each year added to the donor's age, there is a 1% decrease in the chance that this cornea will be used for transplantation, and the increase of 100 cells per mm2 increases the chances that this cornea will be used by 9%. CONCLUSION: the main cause of refusal in the acceptance of corneal tissue is related to the age and the endothelial cell count.

A case of recurrent keratitis caused by Paecilomyces lilacinus and treated by voriconazole / Uso do voriconazol na ceratite recorrente causada por fungo Paecilomyces lilacinus

ABSTRACT - We describe here a case of a 21-year-old woman who presented with low visual acuity, pain, and hyperemia in the left eye for 45 days. Her eye had extensive corneal infiltrate, with melting and a central perforation that was glued with cyanoacrylate, but with Seidel (+). She underwent tectonic corneal transplantation, and anterior chamber lavage with subconjunctival infiltration with voriconazole, as well as intracameral injections of amphotericin B. Laboratory tests revealed Paecilomyces lilacinus as the infectious agent. The patient was then maintained with oral voriconazole and eye drops for three months, after which the infection was considered cured. However, in the sixth postoperative month she presented with endothelial rejection, and two weeks later signs of recurrence of the fungal infection. She was treated with two further washes of the anterior chamber and subconjunctival injection of voriconazole, followed by intravenous voriconazole that was replaced with drops after ten days. The infection initially worsened, but then regressed, and at last follow-up, the patient was still infection-free.

RESUMO - Descrevemos aqui um caso de uma mulher de 21 anos que apresentou baixa acuidade visual, dor e hiperemia no olho esquerdo por 45 dias. O olho apresentava infiltrado corneano extenso, com fusão e perfuração central colada com cianoacrilato, mas com Seidel (+). Ela foi submetida a transplante de córnea tectônica e lavagem de câmara anterior com infiltração subconjuntival com voriconazol, além de injeções intracamerais de anfoterecina B. Testes laboratoriais revelaram Paecilomyces lilacinus como agente infeccioso. A paciente foi então mantida com voriconazol oral e colírio por período de três meses, após o qual a infecção foi considerada curada. No entanto, no sexto mês de pós-operatório, ela apresentou rejeição endotelial e, duas semanas após, sinais de recidiva de infecção fúngica. Ela foi tratada com mais duas lavagens de câmara anterior e injeção subconjuntival de voriconazol, seguida por voriconazol intravenoso que foi substituído por gotas após 10 dias. A infecção piorou inicialmente, mas depois regrediu e, no último seguimento, o paciente ainda estava livre de infecção.

Evaluating the diameter of eyedropper tips using a computer vision system / Avaliação do diâmetro de bicos de conta-gotas de colírios por visão computacional

ABSTRACT Purpose: This study aimed to determine the variation in diameters of outer and inner apertures of eyedropper tips using a computer vision system. Standardizing the size of eye drop nozzles is crucial to reduce the treatment cost of chronic eye diseases and to ensure a continued use of medication. An eyedropper volume of >20 µL (maximum storage of the conjunctival sac) causes medication wastage and increases treatment costs. Methods: We measured the diameters of the outer and inner apertures of eyedropper tips and evaluated variations in diameters using a computerized visual inspection system. Results: The computer visual inspection system identified anomalies in the apertures of eyedropper tips that resulted in diameter variations. Conclusions: The results of the present study show discrepancies in diameters of eyedropper tips, suggesting a variation in eyedropper size and medication wastage.

RESUMO Objetivo: Este estudo teve como objetivo determinar a variação dos diâmetros das aberturas externa e interna dos bicos conta-gotas utilizando sistema de visão computacional. A padronização do tamanho dos colírios conta-gotas é importante para reduzir o custo do tratamento de doenças crônicas e garantir o uso contínuo de medicamentos. O volume da gota maior do que 20 µl (volume de armazenamento máximo do saco conjuntival) gera desperdício da medicação e aumenta o custo do tratamento. Métodos: Medimos os diâmetros das aberturas externa e interna das pontas dos conta-gotas e avaliamos as variações no diâmetro usando um sistema de inspeção visual computadorizado. Resultados: O sistema de inspeção visual por computador identificou anomalias nas aberturas dos bicos dos frascos conta-gotas que resultaram em variações de diâmetro. Conclusões: Os resultados do presente estudo mostram discrepâncias nos diâmetros dos bicos dos frascos dos conta-gotas, sugerindo uma variação no tamanho das gotas e no desperdício de remédios.

Evaluating the diameter of eyedropper tips using a computer vision system.

PURPOSE: This study aimed to determine the variation in diameters of outer and inner apertures of eyedropper tips using a computer vision system. Standardizing the size of eye drop nozzles is crucial to reduce the treatment cost of chronic eye diseases and to ensure a continued use of medication. An eyedropper volume of >20 µL (maximum storage of the conjunctival sac) causes medication wastage and increases treatment costs. METHODS: We measured the diameters of the outer and inner apertures of eyedropper tips and evaluated variations in diameters using a computerized visual inspection system. RESULTS: The computer visual inspection system identified anomalies in the apertures of eyedropper tips that resulted in diameter variations. CONCLUSIONS: The results of the present study show discrepancies in diameters of eyedropper tips, suggesting a variation in eyedropper size and medication wastage.

Distribuição do tecido ocular no Estado de São Paulo: análise por razões de descarte de córneas / Ocular tissue distribution in the State of São Paulo: analysis on corneal discarding reasons / Distribución del tejido ocular en el estado de Sao Paulo: análisis sobre razones de descarte corneal

Objetivo identificar os motivos da recusa de córneas. Método estudo transversal, retrospectivo, descritivo e correlacional, composto por 5.560 córneas ópticas. As informações foram extraídas do banco de dados da Central de Notificação, Captação e Doação de Órgãos (CNCDO), bem como de prontuários de doadores. A estatística descritiva foi utilizada para a análise das variáveis categóricas e testes específicos, com nível de significância de 5% para avaliar as associações entre as variáveis. Este estudo atendeu aos aspectos éticos da pesquisa científica. Resultados 60% dos doadores eram do sexo masculino e 40% morreram por problemas circulatórios. Os principais motivos de recusa informados pelas equipes de transplante são a idade do doador e a contagem de células endoteliais. Para cada ano adicionado à idade do doador, há uma redução de 1% na chance de que essa córnea seja usada para transplante, e para cada acréscimo de 100 células por mm2 aumenta as chances de que essa córnea seja usada em 9%. Conclusão a principal causa de recusa na aceitação do tecido corneano está relacionada à idade e à contagem de células endoteliais.

Objective to identify the reasons for refusal of corneas. Method this was a cross-sectional, retrospective, descriptive and correlational study composed of 5,560 optical corneas. The information was taken from the notification, organ procurement and distribution centers database as well as donor records. Descriptive statistics were used for the analysis of categorical variables and specific tests with a significance level of 5% for assessing the associations between variables. This study met the ethical aspects of scientific research. Results 60% of the donors were male and 40% died by circulatory problems. The main reason for refusal as informed by transplant teams is the donor's age and the endothelial cell count. For each year added to the donor's age, there is a 1% decrease in the chance that this cornea will be used for transplantation, and the increase of 100 cells per mm2 increases the chances that this cornea will be used by 9%. Conclusion the main cause of refusal in the acceptance of corneal tissue is related to the age and the endothelial cell count.

Objetivo identificar los motivos para el rechazo de córneas. Método estudio transversal, retrospectivo, descriptivo y correlacional, compuesto por 5.560 córneas ópticas. La información se obtuvo de la bases de datos de Centros de Notificación, Obtención de Órganos y Distribución, así como de los registros de los donantes. Se utilizaron estadísticas descriptivas para analizar las variables categóricas y pruebas específicas con un nivel de significación de 5%, para evaluar las asociaciones entre variables. Este estudio contempla los aspectos éticos de una investigación científica. Resultados el 60% de los donantes eran hombres y el 40% falleció por problemas circulatorios. La principal razón del rechazo, informada por los equipos de trasplante, es la edad del donante y el recuento de las células endoteliales. Por cada año agregado a la edad del donante, existe una disminución de 1% en la probabilidad de que la córnea pueda ser utilizada para trasplante; el aumento de 100 células por mm2 aumenta la posibilidad de que esta córnea será usada por 9%. Conclusión la principal causa de rechazo en la aceptación del tejido corneal está relacionada con la edad y el recuento de células endoteliales.

Variação do volume de gotas de colírios lubrificantes disponíveis no mercado brasileiro / Variation in the volume of lubricating eyedrops available in the brazilian market

RESUMO Objetivo: Avaliar a variação intra e interexaminadores do volume de gotas dispensados de frascos de colírios lubrificantes disponíveis no mercado. Métodos: Foram estudados cinco frascos de colírios lubrificantes e dezenove voluntários participaram deste estudo. A massa média de gotas de 20µl dos colírios foi obtida utilizando micropipeta e balança de precisão e como padrão para comparação com a massa das gotas obtidas pelos voluntários. Cinco gotas de cada frasco foram pesadas individualmente com o tubo de colírio perpendicular à balança, usando o primeiro e segundo dedos da mão direita, de forma que a pressão fosse aplicada somente no meio do frasco. Os experimentos foram realizados em uma sala climatizada a temperatura ambiente (21±1°C). Resultados: Todos os frascos de colírios apresentaram variação estatisticamente significante das massas das gotas obtidas pelos examinadores quando comparadas com a massa média padrão de 0,0182±0,0014g, com exceção da comparação entre os dados do colírio A com o colírio D, que não apresentou variação estatisticamente significante. Conclusão: O presente estudo demonstra a ausência de uniformidade das gotas dispensadas pelos frascos de colírios disponíveis no mercado e a sua inadequação à real necessidade, uma vez que as gotas dispensadas são maiores do que o indicado. Esse fato torna-se um problema quando se trata de período de tratamento prolongado, especialmente com colírios dispendiosos como os indicados para a terapêutica do glaucoma. Nesse sentido, a padronização das gotas de colírios se faz necessária.

ABSTRACT Objective: To evaluate the intra and inter variations of eye drops volume dispensed from bottles available on the market. Methods: Five bottles of lubricant eye drops were studied and nineteen volunteers participated in this study. The average mass from 20µl of eye drops was obtained using accuracy micropipette and balance, and used as standard for comparison with the mass of the drops obtained by the volunteers. Five drops of each vial were individually weighed with the tube perpendicular to the balance, using the first and second fingers of the right hand, so that the pressure was applied only in the middle of the flask. The experiments were performed in a room temperature (21±1°C). Results: All eye drops bottles showed a statistically significant variation on masses of the drops obtained by examiners when compared with the standard average weight of 0.0182±0,0014g, except when compared A with D eye drops, with no statistically significant variation. Conclusion: This study demonstrates the lack of uniformity of drops dispensed by eye drops bottles available in the market and its inadequacy to the real need, since the dispensed drops are larger than indicated.This fact becomes a problem when it comes to long treatment period, especially with expensive drops as indicated for glaucoma therapy. In this sense, the standardization of drops of eye drops is necessary.

Herpes zoster ophthalmicus and varicella zoster virus vasculopathy.

Herpes zoster (HZ) corresponds to the reactivation of varicella zoster virus (VZV). Among adults, the ophthalmic division of the trigeminal nerve is one of the most common sites of involvement. Vasculopathy caused by HZ is associated with significant morbidity and mortality, affecting structures such as the brain, which can lead to stroke. In this review, we analyzed the epidemiological and clinical aspects of the vascular involvement of VZV, focusing on the peculiarities of its association with ocular HZ. A review of the available literature indicated that ocular involvement of HZ was a risk factor for vasculopathy after adjusting for age, sex, body mass index, smoking, indicators of metabolic syndrome, and vascular and heart diseases. Considering the severity of this complication, vascular disease mediated by VZV requires early diagnosis and aggressive treatment. Finally, the anti-HZ vaccine has been recommended as a prophylactic measure in the elderly, but it should be used with caution in immunocompromised individuals.