Weight-adjusted caffeine and ß-blocker use in novice versus senior retina surgeons: a self-controlled study of simulated performance.

BACKGROUND/OBJECTIVES: Tremor and expertise are potentially influenced variables in vitreoretinal surgery. We investigated whether surgeon experience impacts the association of microsurgical performance with caffeine and ß-blockers weight-adjusted intake. SUBJECTS/METHODS: Novice and senior surgeons (<2 and >10 practice years, respectively) were recruited in this self-controlled, cross-sectional study. A simulator's task sequence was repeated over 2 days, 30 min after the following exposures: day 1, placebo, 2.5 mg/kg caffeine, 5.0 mg/kg caffeine, and 0.6 mg/kg propranolol; and day 2, placebo, 0.2 mg/kg propranolol, 0.6 mg/kg propranolol, and 5.0 mg/kg caffeine. Outcomes were total score (0-700, worst-best), simulation time (minutes), intraocular trajectory (centimeters), and tremor-specific score (0-100, worst-best). RESULTS: We recruited 15 novices (9 men [60%], 1.33 ± 0.49 practice years) and 11 seniors (8 men [72.7%], 16.00 ± 4.24 practice years). Novices performed worse after 2.5 mg/kg caffeine and improved following 0.2 mg/kg propranolol in total score (557 vs. 617, p = 0.009), trajectory (229.86 vs. 208.07, p = 0.048), time (14.9 vs. 12.7, p = 0.048), and tremor-score (55 vs. 75, p = 0.009). Surgical performance improved with propranolol post-caffeine but remained worse than 0.2 mg/kg propranolol in total score (570 vs. 617, p = 0.014), trajectory (226.59 vs. 208.07, p = 0.033), and tremor-score (50 vs. 75, p = 0.029). Seniors' tremor-score was lower after 2.5 mg/kg caffeine compared to 0.2 mg/kg propranolol (8 vs. 37, p = 0.015). Tremor-score following propranolol post-caffeine remained inferior to 0.6 mg/kg propranolol alone (17 vs. 38, p = 0.012). CONCLUSION: While caffeine and propranolol were associated with performance changes among novices, only tremor was affected in seniors, without dexterity changes. The pharmacologic exposure impact on surgical dexterity seems to be offset by increased experience.

Recurrence of Ocular Toxoplasmosis after Vitrectomy: Case Report and Review.

PURPOSE: The purpose of this study is to report one case of ocular toxoplasmosis (OT) recurrence after vitrectomy and review the scientific basis about it. CASE REPORT: A 58-year-old male patient with previous OT, properly treated, underwent vitrectomy due to macular hole. During follow-up, patient evolved with recurrence of the OT. After 1 year, patient presents visual acuity of 20/200 and extensive macular scar. CONCLUSION: There is no consensus on using perioperative antiparasitic therapy aiming recurrence prophylaxis. Studies with better statistical design are necessary to evaluate the recurrence risk after ocular surgeries and the possible recommendation of prophylaxis, especially in countries where the strains are more virulent and the recurrence more common.

Terapia fotodinâmica com verteporfina associada à injeção intravítrea de antifator de crescimento endotelial vascular para tratamento de hemangioma circunscrito de coroide / Photodynamic therapy with verteporfin associated with intravitreal injection of vascular endothelial growth factor for the treatment of circumscribed choroidal hemangioma

RESUMO O hemangioma de coroide é um tumor vascular benigno, de coloração vermelho-alaranjada, bem delimitado, caracterizado por uma placa elevada. É um tumor raro, com prevalência de um caso a cada 40 tumores de coroide. O diagnóstico pode ser feito por meio da clínica associada à avaliação biomicroscópica e a exames complementares para diferenciação de outros tumores. O tratamento pode ser expectante nos casos assintomáticos. Para os casos sintomáticos ou com presença de fluido sub-retiniano, existem diversas terapias. O objetivo deste estudo foi relatar um caso de hemangioma circunscrito de coroide submetido a tratamento combinado de terapia fotodinâmica com verteporfina e injeção intravítrea de antiangiogênico (bevacizumabe). A decisão de tratar um hemangioma de coroide deve ser individualizada com base nos sintomas, na perda visual e em qualquer potencial de sua recuperação. O exame oftalmológico completo é necessário, mesmo em casos assintomáticos, para rastreamento precoce de doenças oculares.

ABSTRACT Choroid hemangioma is a benign, well-delimited orange-red, vascular tumor characterized by an elevated plaque. It is a rare tumor with a prevalence of one case in every 40 choroidal tumors. It can be diagnosed by the clinic associated with biomicroscopic evaluation and complementary tests to differentiate from other tumors. Treatment can be expectant in asymptomatic cases. For symptomatic cases or those with the presence of subretinal fluid, there are several therapies. The objective of this study was to report a case of circumscribed choroidal hemangioma submitted to combined treatment of photodynamic therapy with verteporfin and intravitreal injection of an antiangiogenic agent (bevacizumab). The decision to treat choroidal hemangioma must be individualized based on symptoms, visual loss, and any potential for recovery. A complete eye examination is necessary, even in asymptomatic cases, for early screening for eye diseases.

Subconjunctival Loa loa worm: first case report in Brazil.

We report the first case of ocular infestation by Loa loa in Brazil. Loiasis is caused by infestation with Loa loa, a filarial parasite originally found in the rainforests of western and central Africa. It is transmitted by the bite of the fly Chrysops and has been recently described in other places other than Africa, in African immigrants or travellers. Our case is a 33 year-old woman from Cameroon who was living in São Paulo, Brazil, for 5 years. She was asymptomatic until one morning she started feeling "something moving" in the left eye. Under topical anesthesia, on the slit lamp, a moving worm was removed from the subconjunctival space, which later was confirmed to be a male Loa loa adult specimen. Blood tests revealed microfilaraemia of 129 mf/mL. The patient was treated with 400 mg oral albendazole for 3 weeks and 60 mg prednisone. This report illustrates an unusual ocular disease, which is extremely rare outside of Africa, but easily diagnosed and treated. Ophthalmologists should be aware of it, in face of an increasingly globalized world.

Subconjunctival Loa loa worm: first case report in Brazil / Verme subconjuntival da espécie Loa loa: primeiro caso no Brasil

We report the first case of ocular infestation by Loa loa in Brazil. Loiasis is caused by infestation with Loa loa, a filarial parasite originally found in the rainforests of western and central Africa. It is transmitted by the bite of the fly Chrysops and has been recently described in other places other than Africa, in African immigrants or travellers. Our case is a 33 year-old woman from Cameroon who was living in São Paulo, Brazil, for 5 years. She was asymptomatic until one morning she started feeling "something moving" in the left eye. Under topical anesthesia, on the slit lamp, a moving worm was removed from the subconjunctival space, which later was confirmed to be a male Loa loa adult specimen. Blood tests revealed microfilaraemia of 129 mf/mL. The patient was treated with 400 mg oral albendazole for 3 weeks and 60 mg prednisone. This report illustrates an unusual ocular disease, which is extremely rare outside of Africa, but easily diagnosed and treated. Ophthalmologists should be aware of it, in face of an increasingly globalized world.

Este é o primeiro relato na literatura nacional e internacional de infestação ocular por Loa loa no Brasil. A loíase é uma filariose causada pelo parasita Loa loa, encontrado nas florestas tropicais da África equatorial. A transmissão se dá pela picada do mosquito Chrysops e casos têm sido descritos em países não africanos, em imigrantes e viajantes. O presente caso trata-se de uma paciente de 33 anos natural de Camarões e residente em São Paulo, Brasil, há 5 anos. Até então assintomática, uma manhã sentiu algo "se mexendo" em seu olho esquerdo. Sob anestesia tópica, na lâmpada de fenda, um verme altamente móvel foi removido do espaço subconjuntival e enviado para identificação, que confirmou tratar-se de um espécime macho adulto de Loa loa. Testes sanguíneos revelaram microfilaremia de 129 mf/mL. A paciente foi tratada com albendazol 400 mg e prednisona 60 mg esquema regressivo por 3 semanas. Este relato ilustra uma doença excepcionalmente rara no Brasil, e praticamente desconhecida dos oftalmologistas em nosso país.

Microbial keratitis at a referral center in Brazil.

To describe the epidemiological and laboratory characteristics of microbial keratitis at a referral center in Brazil. Charts of all patients referred to the Ocular Microbiology Laboratory at Federal University of São Paulo (UNIFESP) from July 1975 to September 2007 were retrospectively reviewed. The following data were recorded: age, gender, involved eye, use of ocular medication, previous trauma or surgery, contact lens wear and the results of laboratory cultures. The study included 6,804 corneal cultures. The mean age was 42.1 ± 21.4 years. The male-to-female ratio was 1.5:1. Positive cultures were obtained in 3,309 (48.6%) cases. Of these, bacteria were isolated in 2,699 (39.7%), fungi in 364 (5.3%) and Acanthamoeba in 246 (3.6%) samples. Positive bacterial cultures were 2.7-fold more frequent in patients with previous use of steroids (P < 0.01), and a 30% reduction in positive bacterial cultures was observed in patients with previous use of antibiotics (P < 0.01). A total of 1,524 patients (22.4%) had a past history of ocular surgery. Contact lens wearers showed a 1.7 times greater chance of having an Acanthamoeba-positive culture (P < 0.01). Previous ocular trauma was present in 1,118 (16.4%) cases and injury caused by plants showed a 3.8 times greater chance of a positive fungal culture (P < 0.01). Bacterial organisms were identified as the most frequent agent followed by fungi and Acanthamoeba. Prescription of steroids and antibiotics prior to corneal scrapings may modify the laboratory test results. Previous corneal surgery, contact lens wear and ocular trauma have been shown to be risk factors for bacterial, Acanthamoeba and fungal keratitis, respectively.

Microbial keratitis in the elderly: a 32-year review.

PURPOSE: To describe the demographic characteristics, associated factors and causative agents of infectious keratitis in the elderly in a tertiary referral center in São Paulo, Brazil. METHODS: A retrospective review of all patients aged 60 years and over with a presumptive diagnosis of infectious keratitis who had material collected for microbiological analysis, between the years 1975 and 2007 (32-year span). RESULTS: From a total of 7,060 age-independent cases of microbial keratitis, 1,545 cases in the elderly were reviewed, which had a mean age of 71.0 ± 7.8 years, ranging from 60 to 101 years. There were 707 males (45.6%) and 838 females (54.3%). Associated factors were: past ocular surgery (25.1%), ocular trauma (7.2%) and contact lens use (3.0%). Bacterioscopy was positive in 40.5% of cases. Culture positivity for any agent was 53.5% (bacteria 47.0%, fungi 6.1%, Acanthamoeba 0.4%). The most frequent bacteria were the gram-positive cocci (mostly coagulase-negative Staphylococci) and gram-negative bacilli (mostly the genera Pseudomonas, Moraxella and Proteus), while the most frequent fungi were the filamentous (mostly the genus Fusarium). CONCLUSIONS: This study represents a large series of microbial keratitis in the elderly in a single referral center. The most important factor associated with this condition in the elderly was past ocular surgery. The most frequent causative agents were bacteria, especially gram-positive cocci and gram-negative bacilli.

Microbial keratitis in the elderly: a 32-year review / Ceratite infecciosa em idosos: revisão de 32 anos

PURPOSE: To describe the demographic characteristics, associated factors and causative agents of infectious keratitis in the elderly in a tertiary referral center in São Paulo, Brazil. METHODS: A retrospective review of all patients aged 60 years and over with a presumptive diagnosis of infectious keratitis who had material collected for microbiological analysis, between the years 1975 and 2007 (32-year span). RESULTS: From a total of 7,060 age-independent cases of microbial keratitis, 1,545 cases in the elderly were reviewed, which had a mean age of 71.0 ± 7.8 years, ranging from 60 to 101 years. There were 707 males (45.6 percent) and 838 females (54.3 percent). Associated factors were: past ocular surgery (25.1 percent), ocular trauma (7.2 percent) and contact lens use (3.0 percent). Bacterioscopy was positive in 40.5 percent of cases. Culture positivity for any agent was 53.5 percent (bacteria 47.0 percent, fungi 6.1 percent, Acanthamoeba 0.4 percent). The most frequent bacteria were the gram-positive cocci (mostly coagulase-negative Staphylococci) and gram-negative bacilli (mostly the genera Pseudomonas, Moraxella and Proteus), while the most frequent fungi were the filamentous (mostly the genus Fusarium). CONCLUSIONS: This study represents a large series of microbial keratitis in the elderly in a single referral center. The most important factor associated with this condition in the elderly was past ocular surgery. The most frequent causative agents were bacteria, especially gram-positive cocci and gram-negative bacilli.

OBJETIVO: Descrever as características demográficas, fatores associados e agentes etiológicos das ceratites infecciosas em idosos em um centro de referência terciário em São Paulo, Brasil. MÉTODOS: Análise retrospectiva de todos os pacientes a partir de 60 anos com diagnóstico clínico de ceratite infecciosa que tiveram material colhido para análise microbiológica, entre os anos de 1975 e 2007 (intervalo de 32 anos). RESULTADOS: De um total de 7.060 casos de ceratite infecciosa em todas as idades, 1.545 casos em idosos foram revisados. A idade média foi de 71,0 ± 7,8 anos, variando de 60 a 101 anos. Foram 707 homens (45,6 por cento) e 838 mulheres (54,3 por cento). Os principais fatores associados foram: cirurgia ocular prévia (25,1 por cento), trauma ocular (7,2 por cento) e uso de lentes de contato (3,0 por cento). Bacterioscopia foi positiva em 40,5 por cento dos casos. A positividade das culturas para qualquer agente foi de 53,5 por cento (bactérias 47,0 por cento, fungos 6,1 por cento, Acanthamoeba 0,4 por cento). As bactérias mais frequentes foram os cocos gram positivos (principalmente Staphylococcus coagulase negativo) e bacilos gram negativos (principalmente Pseudomonas, Moraxella e Proteus), enquanto os fungos mais frequentes foram os filamentosos (Fusarium). CONCLUSÕES: Este estudo representa até o momento a maior série de casos de ceratite infecciosa em idosos em um centro único. O fator mais associado a esta condição em idosos foi cirurgia ocular prévia. Os agentes etiológicos mais frequentes foram as bactérias, principalmente cocos gram positivos e bacilos gram negativos.