The Use of Digital Microscopy to Compare the Thicknesses of Normal Corneas and Ex Vivo Rejected Corneal Grafts with a Focus on the Descemet's Membrane.

OBJECTIVE: To compare the thickness of corneal layers, specifically the Descemet's membrane (DM), in normal corneas and in failed grafts due to rejection (FGRs) using the digital histopathology and to propose a model for the measurement of corneal layers using this method. METHODS: This is a prospective, cross-sectional study performed at the MUHC-McGill University Ocular Pathology & Translational Research Laboratory (McGill University, Montreal, Canada). Histopathological sections of 25 normal human corneas and 40 FGRs were fully digitalized and examined. Inclusion criteria: samples diagnosed as normal corneas or FGRs, from patients older than 18 years of age. Exclusion criteria: histopathological sections without adequate tissue or missing epidemiological information. For each sample, the thicknesses of the epithelium, stroma, and DM were acquired. From a perpendicular plane of reference, two central measurements and two nasal and two temporal peripheral measurements were obtained. RESULTS: There were differences between the normal and FGR groups in the mean central thickness of the epithelium (p < 0.001), the nasal and temporal stromal regions (p < 0.001), and of the DM in the nasal and temporal regions (p < 0.001). Compared with the extremities of the sample (nasal and temporal), the mean thickness of the DM in normal corneas was lower in the central region (p < 0.001), and this difference was not found in the FGR group. CONCLUSIONS: Normal corneas have a thinner epithelium in the central region than the FGR group. In addition, the stroma and DM thicknesses of the nasal and temporal periphery were significantly higher in normal corneas than in those from the FGR group. The digital microscopy protocol applied in this study may be useful for further research studies regarding cornea and other tissues.

Indications and visual outcomes of intrastromal corneal ring segment implantation in a large patient series.

OBJECTIVES:: To describe the indications for and visual outcomes of intrastromal corneal ring segment implantation. METHODS:: A large retrospective case-series chart-review study was conducted using Sorocaba Ophthalmological Hospital medical records. This study included 1222 eyes (1196 patients) that were surgically treated between November 2009 and December 2012. The following preoperative data were collected: age, gender, type of medical care and funding source, surgical technique, best-corrected visual acuity, manifest sphere and cylinder refractive error, maximum and minimum central keratometry, and pachymetry measurements of the cornea at the thinnest point and at the ring channel. The postoperative best-corrected visual acuity and patient satisfaction were also determined. The cases were classified into six groups: four keratoconus groups (severe, advanced, moderate and mild), a pellucid marginal degeneration group and a post-graft irregular astigmatism group. This study was approved by the Brazilian Registry of Clinical Trials (UTN number 1111-1182-6181, TRIAL RBR-6S72RF). RESULTS:: The age (mean±standard deviation) of the patients was 31.0±10.0 years. The most prevalent pathology was keratoconus (1147 eyes, 93.8%). A correlation was found between ectasia severity and medical assistance (p<0.001), and the most serious cases was treated by the Brazilian public health system. No complications were found in a total of 1155 surgeries, and after surgery, 959 patients were satisfied. Among the 164 dissatisfied patients, the majority failed to show improved best-corrected visual acuity. CONCLUSION:: Patients in the public health system underwent surgical intervention for keratoconus later than those with private sources of funding. In the vast majority of operated cases, the patients reported improvements in vision.

Indications and visual outcomes of intrastromal corneal ring segment implantation in a large patient series

OBJECTIVES: To describe the indications for and visual outcomes of intrastromal corneal ring segment implantation. METHODS: A large retrospective case-series chart-review study was conducted using Sorocaba Ophthalmological Hospital medical records. This study included 1222 eyes (1196 patients) that were surgically treated between November 2009 and December 2012. The following preoperative data were collected: age, gender, type of medical care and funding source, surgical technique, best-corrected visual acuity, manifest sphere and cylinder refractive error, maximum and minimum central keratometry, and pachymetry measurements of the cornea at the thinnest point and at the ring channel. The postoperative best-corrected visual acuity and patient satisfaction were also determined. The cases were classified into six groups: four keratoconus groups (severe, advanced, moderate and mild), a pellucid marginal degeneration group and a post-graft irregular astigmatism group. This study was approved by the Brazilian Registry of Clinical Trials (UTN number 1111-1182-6181, TRIAL RBR-6S72RF). RESULTS: The age (mean±standard deviation) of the patients was 31.0±10.0 years. The most prevalent pathology was keratoconus (1147 eyes, 93.8%). A correlation was found between ectasia severity and medical assistance (p<0.001), and the most serious cases was treated by the Brazilian public health system. No complications were found in a total of 1155 surgeries, and after surgery, 959 patients were satisfied. Among the 164 dissatisfied patients, the majority failed to show improved best-corrected visual acuity. CONCLUSION: Patients in the public health system underwent surgical intervention for keratoconus later than those with private sources of funding. In the vast majority of operated cases, the patients reported improvements in vision.

[Complications after Descemet's stripping endothelial keratoplasty]. / Complicações em ceratoplastia endotelial com desnudamento da Descemet (DSEK).

PURPOSE: To describe the complication rate and type of intraoperative and postoperative complications of Descemet stripping endothelial keratoplasty (DSEK). METHODS: Retrospective medical records review of patients who underwent DSEK between 2008 and 2010 at the Sorocaba Ophthalmological Hospital. The study was descriptive, using a quantitative approach. RESULTS: One hundred nineteen eyes of 118 patients were evaluated. According to the diagnoses, most patients were diagnosed with Fuchs' dystrophy (60 eyes, 50.4%), followed by patients with pseudophakic bullous keratopathy in 55 eyes (46.2%). The most common procedure performed was DSEK alone, performed in 65 eyes (54.6%), followed by the DSEK associated to phacoemulsification (PHACO-DSEK) in 47 eyes (39.5%) and DSEK associated to other surgeries (7 eyes, 5.9%). Eight patients were excluded from the study due to insufficient information in the surgical record. In relation to the intra-operative complications, isolated cases of pupillary block, irregular manual dissection of button, inverted implantation of the button, button-holing and posterior capsule rupture were noticed. Among the documented early postoperative complications, button detachment was observed in 21.5% of the DSEK alone group; 34.0% in PHACO-DSEK group and 57.1% when DSEK was held jointly with other surgical techniques. Regarding to late complications, interface haze was observed in 16.9%, 8.5% and 14.2%, and glaucoma was observed in 4.6%, 2.1% and 14.2% in DSEK, PHACO-DSEK and DSEK associated to other techniques, respectively. Post rejection graft failure was observed in 15.3% and 12.7% of the eyes after DSEK and. PHACO-DSEK, respectively. CONCLUSION: Endothelial corneal transplant accomplished in this sample showed a high rate of complications when compared to the conventional penetrating keratoplasty. The most frequent complications were related to detachment of the button and graft failure.

Complicações em ceratoplastia endotelial com desnudamento da Descemet (DSEK) / Complications after Descemet's stripping endothelial keratoplasty

OBJETIVO: Descrever a taxa de complicações e os tipos de complicações intraoperatórias e pós-operatórias da ceratoplastia endotelial com desnudamento da Descemet (DSEK). MÉTODOS: Revisão retrospectiva de prontuários de pacientes submetidos à DSEK de 2008 a 2010 no Hospital Oftalmológico de Sorocaba. O estudo teve caráter descritivo, com abordagem quantitativa. RESULTADOS: Cento e dezenove olhos de 118 pacientes foram avaliados. Segundo a doença ocular de base, a maior parte dos pacientes eram portadores da distrofia de Fuchs (60 olhos, 50,4%), seguidos dos portadores de ceratopatia bolhosa do pseudofácico com 55 olhos (46,2%). A cirurgia mais comumente realizada foi o transplante endotelial isoladamente (DSEK), realizado em 65 olhos (54,6%), seguida do DSEK associado à facoemulsificação de cristalino (PHACO-DSEK) em 47 olhos (39,5%) e DSEK associado a outras cirurgias (7 olhos, 5,9%). Oito pacientes foram excluídos do trabalho devido informações cirúrgicas insuficientes em prontuário médico. Em relação às complicações cirúrgicas transoperatórias, foram observados casos isolados de bloqueio pupilar, dissecção irregular do botão, implante reverso do botão, "button-holing" e ruptura de cápsula posterior. Entre as complicações precoces, observou-se descolamento de botão em 21,5% dos olhos no grupo do DSEK, 34,0% no grupo PHACO-DSEK e 57,1% no grupo DSEK associado a outras técnicas cirúrgicas. No que se refere às complicações tardias, observou-se "haze" (opacidade) em interface em 16,9%, 8,5% e 14,2% e glaucoma foi observado em 4,6%, 2,1% e 14,2% dos olhos nos grupos DSEK, PHACO-DSEK e DSEK associado a outras técnicas, respectivamente. Falência pós-rejeição foi observada em 15,3% e 12,7% dos grupos DSEK e PHACO-DSEK, respectivamente. CONCLUSÃO: O transplante endotelial de córnea realizado nesta amostra teve uma taxa de complicações considerada alta se comparado aos transplantes penetrantes convencionais. As complicações mais frequentes foram aquelas relacionadas ao descolamento de botão e à falência pós-rejeição.

PURPOSE: To describe the complication rate and type of intraoperative and postoperative complications of Descemet stripping endothelial keratoplasty (DSEK). METHODS: Retrospective medical records review of patients who underwent DSEK between 2008 and 2010 at the Sorocaba Ophthalmological Hospital. The study was descriptive, using a quantitative approach. RESULTS: One hundred nineteen eyes of 118 patients were evaluated. According to the diagnoses, most patients were diagnosed with Fuchs' dystrophy (60 eyes, 50.4%), followed by patients with pseudophakic bullous keratopathy in 55 eyes (46.2%). The most common procedure performed was DSEK alone, performed in 65 eyes (54.6%), followed by the DSEK associated to phacoemulsification (PHACO-DSEK) in 47 eyes (39.5%) and DSEK associated to other surgeries (7 eyes, 5.9%). Eight patients were excluded from the study due to insufficient information in the surgical record. In relation to the intra-operative complications, isolated cases of pupillary block, irregular manual dissection of button, inverted implantation of the button, button-holing and posterior capsule rupture were noticed. Among the documented early postoperative complications, button detachment was observed in 21.5% of the DSEK alone group; 34.0% in PHACO-DSEK group and 57.1% when DSEK was held jointly with other surgical techniques. Regarding to late complications, interface haze was observed in 16.9%, 8.5% and 14.2%, and glaucoma was observed in 4.6%, 2.1% and 14.2% in DSEK, PHACO-DSEK and DSEK associated to other techniques, respectively. Post rejection graft failure was observed in 15.3% and 12.7% of the eyes after DSEK and. PHACO-DSEK, respectively. CONCLUSION: Endothelial corneal transplant accomplished in this sample showed a high rate of complications when compared to the conventional penetrating keratoplasty. The most frequent complications were related to detachment of the button and graft failure.

Avaliação da associação entre mês de nascimento e sensibilização doméstica em uma população específica / Evaluation of the association between the month of bird and sensitization to grass pollen or house dust mites in a specific population

Objetivo: Investigar a associação entre o mês de nascimento e a sensibilização a ácaros da poeira doméstica e a polens de gramíneas em pacientes encaminhados a uma clínica privada de alergia do município de Passo Fundo-RS. Pacientes e Métodos: Estudo transversal com análise de 4650 prontuários no período de 1987 a 2006. Incluídos pacientes com até vinte anos de idade, diagnóstico de doença atópica (asma, rinite alérgica e/ou eczema) e monossensibilizados para ácaros da poeira doméstica ou polens de gramíneas. O grupo de comparação consistiu no total de nascidos vivos em Passo Fundo durante o mesmo período do estudo. Foram analisados idade, gênero e sensibilização alérgica, e todos os pacientes foram submetidos a testes cutâneos (puntura) para ambos os alérgenos estudados. Resultados: Neste estudo, 1303 pacientes (28 per cent) preencheram os critérios de inclusão, sendo que 42,8 per cent eram do sexo feminino, com idade variando entre dois e 20 anos. Desses, 1125 (86,3 per cent) apresentaram positividade apenas para ácaros da poeira doméstica e 178 (13,7 per cent) apenas para polens de gramíneas, sendo que a média de idade para os grupos foi, respectivamente, de 9,4 ± 5,1 anos (IC95 per cent: 9,1 a 9,7) e de 11,8 ± 5,8 anos (IC95 per cent = 11,0 a12,7). Não foi encontrada associação estatisticamente significativa entre o mês de nascimento e a sensibilização a ácaros da poeira doméstica (p = 0,55) e polens de gramíneas (p = 0,10). Conclusão: Não houve associação estatisticamente significativa entre mês de nascimento e sensibilização a aeroalérgenos nos pacientes estudados.

Purpose: To investigate the association between the month of birth and sensitization to house dust mites and grass pollen in patients evaluated in an outpatient allergy c1inic in Passo Fundo-RS. Methods: Cross-sectional study was performed with 4650 patient reports from 1987 to 2006. The patients were aged from 2 to 20 years old, had the diagnosis of atopic disease (asthma, allergic rinitis and/or eczema) and were monosensitizated to house dust mites or grass pollen. The comparison group consisted in total live births in Passo Fundo during the same period of the study. Age, gender and allergic sensitization were analyzed and prick test was performed in all the patients. Results: In this study, 1303 patients (28 per cen) full field the inclusion criteria, 42,8 per cent were female, with age varying from 2 to 20 years. Among the patients, 1125 (86,3 per cent) showed positivity only to house dust mites and 178 (13,7 per cent) only to grass pollen, and the mean of age for the both groups was, respectively, 9,4 ± 5,1 years (95 per cent CI = 9,1 - 9,7) and 11,8 ± 5,8 years (95 per cent CI = 11,0 - 12,7). Statistically significant association was not found between the month of birth and sensitization to house dust mites (p = 0,55) or grass pollen (p = 0,10). Conclusion: Month of birth did not show statistically significant association with sensitization to aeroallergens among the patients evaluated in the study. .

[Considerations about administration angle of prostaglandin analogs]. / Considerações sobre o ângulo de administração de colírios antiglaucomatosos análogos das prostaglandinas.

PURPOSE: To investigate if there is any difference in volume and drop weight of prostaglandin analogs when adopting drip angles of 45 masculine and 90 masculine, regarding a horizontal line. METHODS: An experimental study was conducted using the follow ophthalmic solutions: latanoprost, travoprost and bimatoprost. In this study the ophthalmic solutions were dripped according to an angle of 45 masculine or 90 masculine. Prostaglandin analogs were chosen due to their common use in ophthalmology and their cost. The first drop and other ten drops were weighed, alternating the drip angle (45 masculine or 90 masculine). Statistical analysis was done with SPSS 12.0 (Microsoft), using quantitative comparisons with the ANOVA test. An odds value (P) below 0.001 was considered a statistical significant difference. RESULTS: We verified differences in weight and size of the travoprost and bimatoprost drops instilled at 45 masculine and 90 masculine. The drip at 45 masculine produces a smaller drop of travoprost (P<0.001), and the inverse occurs for bimatoprost. There were no statistical significant differences in weight of latanoprost drops according to the instillation angle. CONCLUSIONS: Once there was statistical difference in weight--which has direct relationship with size--of the drops of two kinds of prostaglandin analogs and in another one we did not observe this variation, we infer that cost and therapy duration estimates should be analyzed carefully, especially if this kind of drip measure is used.

Considerações sobre o ângulo de administração de colírios antiglaucomatosos análogos das prostaglandinas / Considerations about administration angle of prostaglandin analogs

OBJETIVO: Investigar se há diferença no peso e volume das gotas de colírios análogos das prostaglandinas em ângulos de gotejamento de 45º e 90º com relação ao plano horizontal. MÉTODOS: Foi realizado estudo experimental utilizando os colírios latanoprosta, travoprosta e bimatoprosta, pelo qual se gotejava as soluções com angulação de 45º e 90º. Estes colírios foram escolhidos em virtude do seu uso rotineiro em oftalmologia e do seu custo. A primeira gota e dez gotas seguintes foram pesadas em ângulo de 45º e 90º. A análise estatística foi realizada por meio do programa SPSS® 12.0 (Microsoft), utilizando o teste de variância ANOVA, sendo considerada diferença estatisticamente significante um valor P<0,001. RESULTADOS: Verificou-se que há diferença no peso, e conseqüentemente no volume, das gotas instiladas a 45º e a 90º dos colírios de travoprosta e bimatoprosta. Para o colírio travoprosta o gotejo a 45º produz uma gota menor que em 90º. O inverso ocorre para o colírio de bimatoprosta. Já para o colírio de latanoprosta, não houve diferença estatisticamente significante. CONCLUSÕES: Como houve diferença estatística no peso das gotas de dois colírios análogos das prostaglandinas e em outro não se verificou esta variação, - e como este possui relação direta com o volume - infere-se que devemos ser críticos diante de estimativas de custo ou duração da terapia com base no gotejamento dos colírios considerando número de gotas por frasco e volume.

PURPOSE: To investigate if there is any difference in volume and drop weight of prostaglandin analogs when adopting drip angles of 45º and 90º, regarding a horizontal line. METHODS: An experimental study was conducted using the follow ophthalmic solutions: latanoprost, travoprost and bimatoprost. In this study the ophthalmic solutions were dripped according to an angle of 45º or 90º. Prostaglandin analogs were chosen due to their common use in ophthalmology and their cost. The first drop and other ten drops were weighed, alternating the drip angle (45º or 90º). Statistical analysis was done with SPSS® 12.0 (Microsoft), using quantitative comparisons with the ANOVA test. An odds value (P) below 0.001 was considered a statistical significant difference. RESULTS: We verified differences in weight and size of the travoprost and bimatoprost drops instilled at 45º and 90º. The drip at 45º produces a smaller drop of travoprost (P<0.001), and the inverse occurs for bimatoprost. There were no statistical significant differences in weight of latanoprost drops according to the instillation angle. CONCLUSIONS: Once there was statistical difference in weight - which has direct relationship with size - of the drops of two kinds of prostaglandin analogs and in another one we did not observe this variation, we infer that cost and therapy duration estimates should be analyzed carefully, especially if this kind of drip measure is used.