[Main pathogens and in vitro antimicrobial susceptibility in bacterial keratitis: 5-year study, 2005-2009]. / Principais patógenos e susceptibilidade in vitro antimicrobiana em ceratites bacterianas: revisão de cinco anos, 2005 a 2009.

PURPOSE: To determine the most common pathogens involved in the etiology of bacterial keratitis at the Sorocaba Ophthalmological Hospital and the in vitro susceptibility of main antimicrobial used in the treatment of this pathology. METHODS: Retrospective study of all patients suspected of infectious keratitis that underwent microbiological exam at the Sorocaba Ophthalmological Hospital, between 2005 and 2009. To test susceptibility of antimicrobial drugs, antibiograms were made through the standard method of discs diffusion and interpretation following the National Committee on Clinical Laboratory Standards (NCCLS, Villanova, PA, USA). RESULTS: 963 samples were obtained in this period and 278 (28.86%) were positive for some pathogen. Among the positive for bacteria, the most common were Staphylococcus aureus (30.56%), Staphylococcus epidermidis (30.56%), Streptococcus sp (9.43%) and Pseudomonas sp (9.43%). Dividing in Gram's method, 191 (72.08%) were Gram-positive and 74 (27.92%) were Gram-negative. Analyzing in vitro antimicrobial effectiveness, the majority presented good susceptibility rates, beyond 85%, except cephalotin which presented 53.13%. At the same analysis, higher resistance rates with cephalotin (33.47%) and ciprofloxacin (11.36%) were noted. CONCLUSION: Gram-positive bacteria were the most common pathogen isolated at microbiologic exams, especially staphylococci. despite the increasing number of isolated Gram-negative bacteria, meanly represented by Pseudomonas, related with the widespread use of contact lenses. Laboratorial exam revealed high sensibility values for most of antibiotics (more than 85%), except for cephalotin (53.13%). Higher resistance values were observed with cephalotin (33.47%) and ciprofloxacin (11.36%). With all these important variability of antibiotic susceptibility and pathogens involved in bacterial keratitis etiology, it is very important to know the specific characteristics of each infection for a better patient care.

Principais patógenos e susceptibilidade in vitro antimicrobiana em ceratites bacterianas: Revisão de cinco anos, 2005 a 2009 / Main pathogens and in vitro antimicrobial susceptibility in bacterial keratitis: 5-year study, 2005-2009

OBJETIVO: Determinar os principais patógenos envolvidos na etiologia das ceratites bacterianas no Hospital Oftalmológico de Sorocaba/SP e a susceptibilidade in vitro dos principais antimicrobianos utilizados no tratamento desta afecção ocular. MÉTODOS: Estudo retrospectivo de todos os prontuários submetidos a exame microbiológico por suspeita de ceratite infecciosa, atendidos no Hospital Oftalmológico de Sorocaba/SP, entre 2005 e 2009. Para testar a susceptibilidade dos antimicrobianos, foram realizados antibiogramas através do método padrão de difusão em discos e a interpretação da sensibilidade foi realizada seguindo-se a padronização do National Committee on Clinical Laboratory Standards (NCCLS, Villanova, PA, USA). RESULTADOS: De 963 coletas, 278 (28,86 por cento) foram positivas para algum patógeno. Dentre as coletas positivas para bactérias, os principais patógenos identificados foram: Staphylococcus aureus (30.56 por cento), Staphylococcus epidermidis (30,56 por cento), Streptococcus sp (9,43 por cento) e Pseudomonas sp (9,43 por cento). No total, 191 (72,08 por cento) dos patógenos identificados eram Gram-positivos e 74 (27,92 por cento) eram Gram-negativos. O exame laboratorial evidenciou altos índices de sensibilidade para a maioria dos antimicrobianos (acima de 85 por cento), com exceção da cefalotina (53,13 por cento). Os maiores índices de resistência foram observados com a cefalotina (33,47 por cento) e a ciprofloxacina (11,36 por cento). CONCLUSÕES: Bactérias Gram-positivas foram as principais isoladas nos exames microbiológicos neste estudo, com número expressivo de estafilococos, apesar de um crescente número de bactérias Gram-negativas como principais patógenos isolados, principalmente representado por Pseudomonas, relacionado ao uso disseminado de lentes de contato. O exame laboratorial evidenciou altos índices de sensibilidade para a maioria dos antimicrobianos (acima de 85 por cento), com exceção da cefalotina (53,13 por cento). Os maiores índices de resistência foram observados com a cefalotina (33,47 por cento) e a ciprofloxacina (11,36 por cento). Diante desta variabilidade importante tanto de principais patógenos envolvidos na etiologia da ceratite bacteriana como de susceptibilidade antimicrobiana, torna-se muito importante saber qual o perfil das infecções com as quais estamos lidando, para que tal afecção seja conduzida da maneira correta, seguindo-se a individualidade de cada localidade.

PURPOSE: To determine the most common pathogens involved in the etiology of bacterial keratitis at the Sorocaba Ophthalmological Hospital and the in vitro susceptibility of main antimicrobial used in the treatment of this pathology. METHODS: Retrospective study of all patients suspected of infectious keratitis that underwent microbiological exam at the Sorocaba Ophthalmological Hospital, between 2005 and 2009. To test susceptibility of antimicrobial drugs, antibiograms were made through the standard method of discs diffusion and interpretation following the National Committee on Clinical Laboratory Standards (NCCLS, Villanova, PA, USA). RESULTS: 963 samples were obtained in this period and 278 (28.86 percent) were positive for some pathogen. Among the positive for bacteria, the most common were Staphylococcus aureus (30.56 percent), Staphylococcus epidermidis (30.56 percent), Streptococcus sp (9.43 percent) and Pseudomonas sp (9.43 percent). Dividing in Gram's method, 191 (72.08 percent) were Gram-positive and 74 (27.92 percent) were Gram-negative. Analyzing in vitro antimicrobial effectiveness, the majority presented good susceptibility rates, beyond 85 percent, except cephalotin which presented 53.13 percent. At the same analysis, higher resistance rates with cephalotin (33.47 percent) and ciprofloxacin (11.36 percent) were noted. CONCLUSION: Gram-positive bacteria were the most common pathogen isolated at microbiologic exams, especially staphylococci. despite the increasing number of isolated Gram-negative bacteria, meanly represented by Pseudomonas, related with the widespread use of contact lenses. Laboratorial exam revealed high sensibility values for most of antibiotics (more than 85 percent), except for cephalotin (53.13 percent). Higher resistance values were observed with cephalotin (33.47 percent) and ciprofloxacin (11.36 percent). With all these important variability of antibiotic susceptibility and pathogens involved in bacterial keratitis etiology, it is very important to know the specific characteristics of each infection for a better patient casre.

[Evaluation of corneal tissue processed by a reference Eye Bank]. / Avaliação de tecido corneano processado por um Banco de Olhos de referência.

PURPOSE: To evaluate the quality of the corneas processed by Sorocaba Eye Bank (BOS) - SP and transplanted out of the Ophthalmology Hospital of Sorocaba (HOS), as well as the corneas that had re-entered in the BOS, being transplanted or not in the HOS, during the year of 2007. METHODS: Ophthalmologists that transplanted corneas processed by BOS outside of the Ophthalmology Hospital of Sorocaba were contacted, as well as those who had used re-entried corneas, to collect the following information: period from eye enucleation until transplant, transparency of the donated tissue, time of transplant and primary failure. RESULTS: During the year of 2007, Sorocaba Eye Bank distributed three hundred and ninety-two corneas for outside HOS. From these, six had returned to BOS and had been transplanted in the Ophthalmology Hospital of Sorocaba. From those, none was rejected; however, two presented some opacity in the visual axis. After attempt to congregate information regarding the 386 transplanted corneas outside HOS, data of only 48 keratoplasty were available. The average time from the enucleation until the keratoplasty was of 5.5 days (1-13 days), and of postoperative average follow-up, 9.8 months (4-15 months). Three corneas had developed primary failure; three presented opacity in the visual axis; one presented infectious keratitis, requiring therapeutic keratoplasty; a patient died and another one lost follow-up. The other 39 corneas did not present any problems until the time this study was ended. CONCLUSION: Because of the difficulties to congregate informations of the patients transplanted in other hospitals, it is difficult to define the quality of the distributed corneas by Sorocaba Eye Bank. Thus, other analysis are necessary in order to define changes and new directions for future studies on selection and preservation of donated corneas.

Avaliação de tecido corneano processado por um Banco de Olhos de referência / Evaluation of corneal tissue processed by a reference Eye Bank

OBJETIVO: Avaliar a qualidade das córneas processadas pelo Banco de Olhos de Sorocaba - SP e transplantadas fora do Hospital Oftalmológico de Sorocaba, bem como das córneas que tiveram reentrada no Banco de Olhos de Sorocaba durante o ano de 2007. MÉTODOS: Foram contatados os oftalmologistas que transplantaram córneas captadas pelo Banco de Olhos de Sorocaba fora do Hospital Oftalmológico de Sorocaba, bem como os que utilizaram córneas reentradas, a fim de colher as seguintes informações: período desde a captação da córnea até o transplante, transparência do tecido doador, tempo de transplante e falência primária. RESULTADOS: Trezentas e noventa e duas córneas tiveram saída do Banco de Olhos de Sorocaba ao longo do ano de 2007. Dessas, 6 retornaram ao Banco de Olhos de Sorocaba e foram transplantadas no Hospital Oftalmológico de Sorocaba, sendo que nenhuma foi rejeitada; todavia, 2 apresentaram alguma opacidade no eixo visual. Após tentativa de reunir informações a respeito das 386 córneas transplantadas fora do Hospital Oftalmológico de Sorocaba, obtiveram-se dados apenas de 48 transplantes. O tempo médio desde a captação até o transplante foi de 5,5 dias (1-13 dias), e o de seguimento médio pós-operatório, de 9,8 meses (4-15 meses). Três córneas desenvolveram falência primária, 3 evoluíram com opacidade no eixo visual, 1 apresentou ceratite infecciosa que necessitou de transplante tectônico; 1 paciente faleceu e 1 perdeu seguimento. As demais 39 córneas apresentavam-se transparentes. CONCLUSÃO: Por causa das dificuldades de reunir as informações dos pacientes transplantados em outros hospitais, torna-se difícil definir a qualidade das córneas liberadas pelo Banco de Olhos de Sorocaba. Assim, outras análises como as desse estudo são necessárias a fim de definir mudanças e rumos para estudos futuros sobre seleção e conservação das córneas doadas.

PURPOSE: To evaluate the quality of the corneas processed by Sorocaba Eye Bank (BOS) - SP and transplanted out of the Ophthalmology Hospital of Sorocaba (HOS), as well as the corneas that had re-entered in the BOS, being transplanted or not in the HOS, during the year of 2007. METHODS: Ophthalmologists that transplanted corneas processed by BOS outside of the Ophthalmology Hospital of Sorocaba were contacted, as well as those who had used re-entried corneas, to collect the following information: period from eye enucleation until transplant, transparency of the donated tissue, time of transplant and primary failure. RESULTS: During the year of 2007, Sorocaba Eye Bank distributed three hundred and ninety-two corneas for outside HOS. From these, six had returned to BOS and had been transplanted in the Ophthalmology Hospital of Sorocaba. From those, none was rejected; however, two presented some opacity in the visual axis. After attempt to congregate information regarding the 386 transplanted corneas outside HOS, data of only 48 keratoplasty were available. The average time from the enucleation until the keratoplasty was of 5.5 days (1-13 days), and of postoperative average follow-up, 9.8 months (4-15 months). Three corneas had developed primary failure; three presented opacity in the visual axis; one presented infectious keratitis, requiring therapeutic keratoplasty; a patient died and another one lost follow-up. The other 39 corneas did not present any problems until the time this study was ended. CONCLUSION: Because of the difficulties to congregate informations of the patients transplanted in other hospitals, it is difficult to define the quality of the distributed corneas by Sorocaba Eye Bank. Thus, other analysis are necessary in order to define changes and new directions for future studies on selection and preservation of donated corneas.

Baixa prevalência de discromatopsia, pela 4ª edição do teste pseudoisocromático HRR (Hardy, Rand e Rittler), da população indígena de etnia terena da aldeia lalima na região de Miranda: Mato Grosso do Sul / Low prevalence of dyschromatopsia using the fourth edition of HRR (Hardy, Rand and Rittler) pseudoisochromatic plate test among the Indian population of Lalima village, Terena

OBJETIVO: Avaliar a freqüência de discromatopsias através da 4ª edição do teste pseudoisocromático HRR (Hardy, Rand and Rittler) entre a população indígena masculina da aldeia Lalima, etnia Terena, na região de Miranda-MS. MÉTODOS: Foram realizadas viagens à aldeia Lalima em Miranda-MS, nos meses de janeiro e fevereiro de 2005. As viagens para realizar os exames só foram iniciadas após o projeto ter sido avaliado e aprovado pelos Comitê de Ética e Pesquisa da UFMS, Comitê Nacional de Ética e Pesquisa, Fundação Nacional do índio e do cacique da aldeia Lalima. O teste HRR foi aplicado em 226 índios após terem sido submetidos a exame oftalmológico para detecção de anormalidades que pudessem comprometer a aplicabilidade do teste. O teste foi realizado sob luz natural, em dias ensolarados, sem incidência direta de sol. O teste foi aplicado e interpretado pelo mesmo examinador em todos os índios. RESULTADOS: Realizaram-se 226 exames (60,1 por cento) de uma população de 376 homens entre 10 e 45 anos de idade, que vivem na Aldeia Lalima. Não foi encontrado nenhum caso de discromatopsia na população examinada com o teste HRR. CONCLUSÃO: O resultado do presente estudo mostra a baixa prevalência de discromatopsia nesta população indígena de etnia Terena, uma vez que não se detectou nenhum caso de discromatopsia na população estudada, sendo a prevalência de discromatopsia entre homens caucasianos de 6 a 8 por cento. A ausência de discromatopsia na população estudada, no entanto, deve ser mais bem avaliada tentando aumentar o tamanho da amostra, utilização de outros testes e, principalmente, por estudos genéticos para verificar os genes codificadores dos fotopigmentos para melhor compreensão das condições relacionadas à visão de cores dessa comunidade indígena.

PURPOSE: to evaluate the frequency of dyschromatopsias among the 10 to 45-year-old male Indian population of Lalima village, Terena ethnicity, in Miranda-MS, using the fourth edition of the pseudoisochromatic HRR test (Hardy, Rand and Rittler). METHODS: Lalima village in Miranda-MS was visited in January and February 2005. The visits only occurred after the approval of the project by the Committee of Ethics and Research of UFMS, by the National Committee of Ethics and Research, by the Indian National Foundation, and by the chief of Lalima village. The test was applied in 226 Indians who had been previously submitted to ophthalmologic examination for the detection of abnormalities that could doubt the applicability of the test. The test was performed under natural illumination, in sunny days, however with no direct sunlight. The test was applied and analyzed by the same experimenter in all the Indians. RESULTS: Two hundred and twenty-six men were examined (60.1 percent) of the total male population of 376 individuals between 10 and 45 years old who live in Lalima village. No cases of dyschromatopsia were found in this population examined with the HRR test. CONCLUSIONS: Once it is known that incidence of dyschromatopsias among the white male Caucasian population is about 6-8 percent, the results of the present study indicate a low prevalence of dyschromatopsias in this Indian population of Terena ethnicity, since no cases were detected in the examined sample. Other studies using different methods must be made to reinforce the present results. It would also be interesting to genetically examine this population and verify the genes that code for photopigments.

Metástases de coróide de origem testicular: relato de caso / Choroid metastasis of testicular primary site: case report

Descrição do caso de um paciente masculino de 22 anos de idade, cor parda, com decréscimo da acuidade visual em olho esquerdo e com diagnóstico de tumor testicular e metástases para pulmão e rim. Avaliação da evolução da lesão coroideana compatível com metástase ocular de tumor testicular por meio de exame oftalmológico e ecográfico. Houve resolução da lesão intra-ocular juntamente com melhora radiológica pulmonar após quimioterapia durante aproximadamente 4 meses de acompanhamento. Apesar da remissão da lesão ocular, o paciente faleceu por complicações decorrentes de metástase cerebral. Abordada na literatura como rara, não foi encontrado qualquer relato de caso sobre a metástase de coróide com sítio testicular, sendo esta, talvez, sua primeira descrição.

Description of a male patient case, 22 years old, presenting visual acuity decrease in the left eye associated with the diagnosis of metastatic testicular tumor to lung and kidney. Evaluation of the evolution of a choroid lesion compatible with ocular metastasis of testis tumor through ophthalmologic and echographic examinations. There was resolution of the intraocular lesion together with lung radiologic improvement after chemotherapy during approximately 4 months of follow-up. In spite of the remission of the ocular lesion, the patient died due to complications of cerebral metastasis. Approached in the literature as rare, no report was found of a case of choroidal metastasis of a testicular site, this being, perhaps, its first description.

[Choroid metastasis of testicular primary site: case report]. / Metástases de coróide de origem testicular: relato de caso.

Description of a male patient case, 22 years old, presenting visual acuity decrease in the left eye associated with the diagnosis of metastatic testicular tumor to lung and kidney. Evaluation of the evolution of a choroid lesion compatible with ocular metastasis of testis tumor through ophthalmologic and echographic examinations. There was resolution of the intraocular lesion together with lung radiologic improvement after chemotherapy during approximately 4 months of follow-up. In spite of the remission of the ocular lesion, the patient died due to complications of cerebral metastasis. Approached in the literature as rare, no report was found of a case of choroidal metastasis of a testicular site, this being, perhaps, its first description.