A Comparative Study Between the Goldmann Applanation Tonometer and the Non-Contact Air-Puff Tonometer (Huvitz HNT 7000) in Normal Eyes.

OBJECTIVE: To assess whether the non-contact air-puff tonometer (NCT) is an appropriate alternative to the Goldmann applanation tonometer (GAT) for measuring intraocular pressure (IOP). PATIENTS AND METHODS: An observational, cross-sectional, and comparative study with a quantitative approach was carried out. Two techniques for IOP measurements using the standard GAT and the NCT were compared. A total of 180 eyes from 90 patients were included in the study. RESULTS: The total mean IOP according to NCT measurements was 14.12 mmHg, and the total mean IOP according to the GAT was 12.98 mmHg; these values were significantly different (p=0.0018). When dividing the participants into three groups according to the measurement range obtained and comparing the mean NCT and GAT measurements in each group, in Group 1 (10-15 mmHg), no statistically significant difference was found between the means of the two tonometers (p=0.3100), a difference was observed between Group 2 (16-19 mmHg) and Group 3 (20 mmHg or more) (p<0.001). When dividing the participants by age group, the means obtained by the two tonometers also differed significantly between Group 4 (40-59 years) and Group 5 (60 years or more) (p<0.0001). In all groups, the mean measurements by the NCT were higher than those by the GAT. CONCLUSION: The NCT presented an approximate mean of the measures with the GAT in group 1 but was overestimated in the measurements of the groups 2 and 3.

Use of gabapentin in management of postoperative pain after crosslinking / Uso da gabapentina no manejo da dor pós-operatória do crosslinking

ABSTRACT Objective: The objective was to evaluate the efficacy of gabapentin in the management of neuropathic pain in patients with keratoconus, who were treated with fast (10 minutes) epi-off corneal crosslinking (CXL). Methods: This was a prospective, double-blind, randomized study. The sample comprised patients with bilateral progressive keratoconus, aged 12 years or older, who underwent a bilateral epi-off corneal CXL (fast - 10 minutes) procedure. One group was given placebo orally, and the other group received gabapentin 600 mg orally, both preoperatively. The visual analogue scale (VAS) was applied to record postoperative pain up to 48 hours after procedure. The study was conducted at the Belotto Stock Centro Oftalmológico, in the city of Joaçaba, Santa Catarina, Brazil, from June 2018 to September 2019. Results: At no point in the study significant differences were observed between groups, in terms of pain intensity measured by means of the VAS questionnaire, or of opioid use (Paco®), though opioid consumption was 21% lower in the group receiving gabapentin. Conclusion: We concluded gabapentin has no efficacy in postoperative pain control after epi-off corneal CXL (fast - 10 minutes). Although there was no statistically significant difference, the group that received gabapentin suffered less pain, resulting in lower opioid consumption. UTN number: U1111-1256-0330.

RESUMO Objetivo: Avaliar a eficácia do uso da gabapentina no manejo da dor neuropática em pacientes portadores de ceratocone submetidos ao tratamento de crosslinking corneano epi-off fast de 10 minutos. Métodos: Tratou-se de pesquisa prospectiva, duplo-cega, randomizada. A amostra foi composta de pacientes com ceratocone progressivo bilateral, a partir dos 12 anos de idade, submetidos ao procedimento de crosslinking corneano acelerado epi-off fast de 10 minutos bilateral. Um grupo recebeu placebo via oral e o outro, gabapentina 600mg, via oral, ambos no pré-operatório. A Escala Visual Analógica foi aplicada para registrar a dor pós-operatória até 48 horas após o procedimento. A pesquisa foi realizada no período de junho de 2018 a setembro de 2019 em um centro oftalmológico. Resultados: Não foram observadas diferenças estatísticas significativas para ambos os grupos, tanto na intensidade da dor medida pela Escala Visual Analógica, como na redução do uso do opioide (Paco®), em qualquer horário analisado durante um período de 48 horas. No entanto, houve redução de 21% no consumo de opioides pelo grupo que fez uso da gabapentina. Conclusão: A gabapentina não demonstrou eficácia no controle da dor no pós-operatório do crosslinking corneano epi-off fast de 10 minutos. No entanto, observou-se que, mesmo não havendo diferença estatisticamente significativa, houve diminuição da dor no grupo em que foi usada a gabapentina, resultando na redução do consumo de opioides. Número UTN: U1111-1256-0330.

Efficacy of Standard and Accelerated (10 Minutes) Corneal Crosslinking in Keratoconus Stabilization.

PURPOSE: To evaluate whether Accelerated CXL for 10 minutes is as effective as standard CXL for 30 minutes for the treatment of progressive keratoconus. PATIENTS AND METHODS: Eighty-two eyes of 62 patients with keratometry examinations performed before and 6 months after surgery were studied. A total of 39 eyes underwent standard CXL with UVA irradiation of 3 mW/cm2 for 30 minutes and 32 eyes underwent Accelerated CXL UVA irradiation of 9 mW/cm2 for 10 minutes. The eyes of all patients had corneal thicknesses of at least 450 microns (400 microns after epithelium removal). RESULTS: The means of the keratometry measurements in the preoperative period for the eyes subjected to standard CXL were 46.27 dioptres (D) on the flat axis (K1) and 48.93 D on the steep axis (K2). Postoperatively, K1 was 46.21 D and K2 was 48.97 D, a difference without statistical significance (p = 0.47 and p = 0.48, respectively). In the Accelerated CXL protocol, the preoperative measurements were 44.55 D and 46.19 D for K1 and K2, respectively. In the postoperative period, K1 was 43.37 D, and K2 was 46.64 D (p = 0.38 and p = 0.27, respectively). In the standard group, the mean maximum keratometry (Kmax) preoperatively was 55.87 D, with no statistical significance (p = 0.29). In the preoperative period, the Kmax of the Accelerated group was 51.15 D, with no statistical significance (p = 0.32). CONCLUSION: Based on the keratometry results, the accelerated protocol was as effective as the standard protocol for keratoconus stabilization.

Intestinal preparations for colonoscopy. Comparative study: mannitol, picosulphate and macrogol / Preparos intestinais para colonoscopia. Estudo comparativo: manitol, picossulfato e macrogol

ABSTRACT Bowel preparation is mandatory prior to elective colonoscopy and their effectiveness is closely related to the quality of the examination. There are many preparations on the market and there is no consensus on which is best. This study aimed to compare three solutions for colon preparation in patients undergoing colonoscopy. We conducted a prospective study with 61 patients divided randomly into three groups: one that received a standard dose of macrogol, another received a standard dose of 10% mannitol and another received a standard dose of sodium picosulphate. Patients and examining endoscopists responded to questionnaires for compiling data. In the results we noticed that 10% mannitol, despite being less tolerated by the patient when compared to sodium picosulphate, presents better results in colonic cleaning, being therefore superior in this regard. Macrogol was considered as an intermediate in relation to the other two preparations. As for tolerability, preference is given to sodium picosulphate as best tolerated, followed by mannitol and by macrogol, which is poorly tolerated by the patient. We conclude that as the main objective of bowel preparation in colonoscopy is the quality of colonic cleaning, 10% mannitol was superior to the other preparations studied.

RESUMO O preparo intestinal é mandatório antes da realização das colonoscopias eletivas e sua eficácia está intrinsecamente relacionada à qualidade do exame. Existem diversos preparos no mercado e não há consenso sobre qual é melhor. Este estudo teve como objetivo comparar três soluções para preparo de cólon em pacientes submetidos à colonoscopia. Foi realizado um estudo prospectivo com 61 pacientes distribuídos de forma randomizada em três grupos: um recebeu macrogol, outro manitol a 10% e outro picossulfato de sódio em doses padrão. Os pacientes e os endoscopistas examinadores responderam a questionários para compilação de dados. Nos resultados notamos que o manitol a 10%, apesar de ser menos tolerado pelo paciente quando comparado ao picossulfato de sódio, apresenta melhores resultados na limpeza colônica, sendo, portanto, superior neste quesito. O macrogol foi considerado como intermediário em relação aos outros dois preparos. Quanto à tolerabilidade, a preferência recai sobre o picosulfato de sódio como o mais bem tolerado, seguido pelo Manitol; macrogol foi o menos tolerado pelo paciente. Concluímos que, como o principal objetivo do preparo intestinal na colonoscopia é a qualidade da limpeza colônica, o manitol a 10% mostrou-se superior aos demais preparos estudados.