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1.
Arq. bras. oftalmol ; 82(3): 225-232, May-June 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1001296

RESUMO

ABSTRACT Purpose: To study the efficacy and safety of treatments with ranibizumab and bevacizumab for exudative age-related macular degeneration. Methods: A parallel randomized clinical trial was conducted to compare the efficacy and safety of three regimens (bevacizumab every month, bevacizumab every 2 weeks, and ranibizumab every month), followed by as-needed retreatments, for 1 year, in previously untreated individuals with age-related macular degeneration. The primary outcome was change in visual acuity and in central macular thickness after 1 year of follow-up. Subjects were assigned randomly to one of the three groups in a 1:1:1 ratio, and investigators and examiners were blinded to the randomization results. Results: We included 15 patients in each group. After 1 year of follow-up, we found statistically significant improvements in visual acuity and central macular thickness reduction in all groups. However, we found no statistically significant differences between the three groups. Conclusions: The bi-weekly follow-up was effective and we found no significant differences in efficacy or safety between the treatments with ranibizumab and bevacizumab.


RESUMO Objetivo: Estudar a eficácia e segurança dos tratamentos com ranibizumabe e bevacizumabe para a degeneração macular relacionada à idade exsudativa. Métodos: Ensaio clínico paralelo randomizado foi conduzido para comparar a eficácia e segurança de três regimes (bevacizumabe a cada mês, bevacizumabe a cada 2 semanas e ranibizumabe todos os meses), seguidos por retratamentos conforme necessidade, durante 1 ano, em indivíduos previamente não tratados com degeneração macular relacionada à idade. O desfecho primário foi alteração na acuidade visual e na espessura macular central após um ano de seguimento. Os indivíduos foram designados aleatoriamente para um dos 3 grupos em uma proporção de 1:1:1, e os investigadores e examinadores foram mascarados para os resultados da randomização. Resultados: Foram incluídos 15 pacientes em cada grupo. Após um ano de seguimento, encontramos melhorias estatisticamente significativas na acuidade visual e na redução da espessura macular central em todos os grupos. No entanto, não encontramos diferenças estatisticamente significativas entre os 3 grupos. Conclusões: O seguimento quinzenal foi eficaz e não encontramos diferenças significativas na eficácia ou segurança entre os tratamentos com bevacizumabe e ranibizumabe.

3.
Arq Bras Oftalmol ; 82(3): 225-232, 2019 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30810619

RESUMO

PURPOSE: To study the efficacy and safety of treatments with ranibizumab and bevacizumab for exudative age-related macular degeneration. METHODS: A parallel randomized clinical trial was conducted to compare the efficacy and safety of three regimens (bevacizumab every month, bevacizumab every 2 weeks, and ranibizumab every month), followed by as-needed retreatments, for 1 year, in previously untreated individuals with age-related macular degeneration. The primary outcome was change in visual acuity and in central macular thickness after 1 year of follow-up. Subjects were assigned randomly to one of the three groups in a 1:1:1 ratio, and investigators and examiners were blinded to the randomization results. RESULTS: We included 15 patients in each group. After 1 year of follow-up, we found statistically significant improvements in visual acuity and central macular thickness reduction in all groups. However, we found no statistically significant differences between the three groups. CONCLUSIONS: The bi-weekly follow-up was effective and we found no significant differences in efficacy or safety between the treatments with ranibizumab and bevacizumab.

4.
Arq Bras Oftalmol ; 81(3): 177-182, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29924191

RESUMO

PURPOSE: To evaluate the long-term outcomes of Boston type I keratoprosthesis (B-Kpro) in the management of patients with ocular burn injuries. METHODS: This prospective study included all patients with ocular burns who underwent B-Kpro implantation at a tertiary eye care center between February 2008 and November 2015. Twelve patients (12 eyes) were enrolled. The procedures performed for managing ocular injury were identified, and information on ocular history, surgical procedures performed, and postoperative outcomes was collected. The main outcome measures were visual acuity, prosthesis retention, postoperative complications, and required surgical procedures. RESULTS: Twelve eyes from 12 patients met the inclusion criteria for B-Kpro implantation, including nine eyes with alkali burns and three eyes with thermal burns. A total of 13 B-Kpro devices were implanted in the 12 eyes. The mean follow-up period was 60.8 months (range, 13-91 months). Preoperative best-corrected visual acuity ranged from counting fingers to light perception. Postoperative best-corrected visual acuity was better than 20/200 in 83.3%, 66.6%, and 57.1% of patients at 12, 48, and 60 months, respectively. The initial keratoprosthesis was retained in 10 (83.3%) eyes and was successfully replaced in one eye. The major cause of worsening of initial visual acuity was advanced glaucoma (four of 12 eyes). CONCLUSION: The anatomical and functional results support the use of B-Kpro for managing bilateral limbal stem cell deficiency secondary to ocular burns. However, glaucoma should be carefully evaluated, as it is a continuous threat that may result in irreversible visual loss in this population.


Assuntos
Queimaduras Oculares/cirurgia , Próteses e Implantes , Implantação de Prótese/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próteses e Implantes/efeitos adversos , Implantação de Prótese/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual
5.
Arq. bras. oftalmol ; 81(3): 177-182, May-June 2018. graf
Artigo em Inglês | LILACS-Express | ID: biblio-950447

RESUMO

ABSTRACT Purpose: To evaluate the long-term outcomes of Boston type I keratoprosthesis (B-Kpro) in the management of patients with ocular burn injuries. Methods: This prospective study included all patients with ocular burns who underwent B-Kpro implantation at a tertiary eye care center between February 2008 and November 2015. Twelve patients (12 eyes) were enrolled. The procedures performed for managing ocular injury were identified, and information on ocular history, surgical procedures performed, and postoperative outcomes was collected. The main outcome measures were visual acuity, prosthesis retention, postoperative complications, and required surgical procedures. Results: Twelve eyes from 12 patients met the inclusion criteria for B-Kpro implantation, including nine eyes with alkali burns and three eyes with thermal burns. A total of 13 B-Kpro devices were implanted in the 12 eyes. The mean follow-up period was 60.8 months (range, 13-91 months). Preoperative best-corrected visual acuity ranged from counting fingers to light perception. Postoperative best-corrected visual acuity was better than 20/200 in 83.3%, 66.6%, and 57.1% of patients at 12, 48, and 60 months, respectively. The initial keratoprosthesis was retained in 10 (83.3%) eyes and was successfully replaced in one eye. The major cause of worsening of initial visual acuity was advanced glaucoma (four of 12 eyes). Conclusion: The anatomical and functional results support the use of B-Kpro for managing bilateral limbal stem cell deficiency secondary to ocular burns. However, glaucoma should be carefully evaluated, as it is a continuous threat that may result in irreversible visual loss in this population.


RESUMO Objetivo: Avaliar os resultados em longo prazo do implante da ceratoprótese de Boston tipo 1 (B-Kpro) no tratamento de pacientes vítima de queimadura ocular. Métodos: Trata-se de um estudo prospectivo envolvendo todos os casos de implante de B-Kpro 1 para queimadura ocular em um centro de oftalmologia terciário durante o período de fevereiro/2008 e novembro/2015. Doze pacientes (doze olhos) foram incluídos no estudo. Os procedimentos realizados para o manejo da queimadura ocular foram identificados, e os dados foram coletados com relação à história oftalmológica do paciente, procedimentos cirúrgicos realizados, e resultados pós-operatórios. Os principais parâmetros avaliados foram acuidade visual, retenção da prótese, complicações pós-ope ratórias e intervenções cirúrgicas necessárias. Resultados: Doze pacientes preencheram os critérios de inclusão para implante da B-Kpro, incluindo 09 olhos vítimas de queimadura por álcali e 03 olhos pós queimadura térmica. Um total de 13 B-Kpro tipo 1 foram implantadas em 12 olhos de 12 pacientes. O tempo de seguimento médio foi de 60,8 meses (variando, 13-91 meses). Melhor acuidade visual corrigida pré-operatória variou de conta dedos à percepção luminosa. Melhor acuidade visual corrigida pós-operatória foi melhor que 20/200 em 83,3%, 66,6% e 57,1% dos pacientes em 12 meses, 48 meses e 60 meses, respectivamente. A ceratoprótese inicialmente implantada permaneceu retida em 10 (83,3%) dos olhos e foi re-implantada com sucesso em um olho. A principal causa de piora da acuidade visual inicialmente atingida foi glaucoma avançado (4 de 12 olhos). Conclusão: Os resultados anatômicos e funcionais reportados neste estudo dão suporte ao uso da B-Kpro para o tratamento da deficiência límbica bilateral secundária a queimadura ocular. Glaucoma é o principal fator limitante e pode causar perda visual irreversível nesses pacientes.

6.
Arq Bras Oftalmol ; 81(2): 148-152, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29846423

RESUMO

Differentiating glaucomatous from nonglaucomatous optic disc cupping remains challenging. We present a case of a 48-year-old woman with an internal carotid aneurysm of approximately 3.5 mm × 6.5 mm that mimicked normal-tension glaucoma. The patient had a 2-year history of low vision acuity in her left eye and frontal oppressive headache. Owing to the carotid aneurysm, she developed an asymmetric vertical cup-to-disc ratio above 0.2, and marked inferotemporal neuronal rim loss and pallor of the residual rim were noted in the left disc. She also developed a visual field defect with an arcuate scotoma in the left eye. The patient was referred to a neurosurgeon and underwent endovascular aneurysm occlusion. This case highlights the diagnostic importance of recognizing that many neurological defects remain underdiagnosed.


Assuntos
Aneurisma/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Glaucoma de Baixa Tensão/diagnóstico por imagem , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/patologia , Artéria Carótida Interna/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Pressão Intraocular , Glaucoma de Baixa Tensão/patologia , Glaucoma de Baixa Tensão/fisiopatologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Testes de Campo Visual
7.
Arq. bras. oftalmol ; 81(2): 148-152, Mar.-Apr. 2018. graf
Artigo em Inglês | LILACS-Express | ID: biblio-950435

RESUMO

ABSTRACT Differentiating glaucomatous from nonglaucomatous optic disc cupping remains challenging. We present a case of a 48-year-old woman with an internal carotid aneurysm of approximately 3.5 mm × 6.5 mm that mimicked normal-tension glaucoma. The patient had a 2-year history of low vision acuity in her left eye and frontal oppressive headache. Owing to the carotid aneurysm, she developed an asymmetric vertical cup-to-disc ratio above 0.2, and marked inferotemporal neuronal rim loss and pallor of the residual rim were noted in the left disc. She also developed a visual field defect with an arcuate scotoma in the left eye. The patient was referred to a neurosurgeon and underwent endovascular aneurysm occlusion. This case highlights the diagnostic importance of recognizing that many neurological defects remain underdiagnosed.


RESUMO diferenciação de escavações glaucomatosas e não glaucomatosas ainda permanece um desafio ainda nos dias de hoje. Nos descrevemos um caso de aneurisma de carótida interna medindo 3.5mm x 6.5mm que simulava um glaucoma de pressão normal. O caso é sobre uma paciente feminino de 48 anos com história de 2 anos de baixa acuidade visual no olho esquerdo e cefaléia frontal. Devido ao aneurisma de carótida a paciente desenvolveu uma assimetria de escavação vertical maior que 0.2 no olho esquerdo em relação ao direito com defeito localizado da camada de fibras nervosas temporal inferior. Ela também apresentava um defeito arqueado temporal superior a esquerda, cruzando a linha média vertical consistente. Após o diagnostico confirmado pela ressonância magnética funcional, a paciente foi enviada para o neurocirurgião para realização de uma oclusão endovascular do aneurisma. Esse caso nos alerta da importância de se lembrar que não apenas o glaucoma gera escavações suspeitas no disco óptico e que ainda muitos defeitos por causas neurológicas são subdiagnosticados.

8.
Arq. bras. oftalmol ; 79(6): 366-368, Nov.-Dec. 2016. graf
Artigo em Inglês | LILACS-Express | ID: biblio-838754

RESUMO

ABSTRACT Purpose: The optical quality of the interface after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique has been shown to be excellent, leading to results comparable to penetrating keratoplasty. However, there is little in the literature with respect to the controversy surrounding the preparation of the donor cornea. The purpose of this study was to evaluate visual acuity (VA) in patients with keratoconus who underwent DALK without removal of the donor graft endothelium. Methods: The records of 90 patients who underwent DALK without the removal of the Descemet membrane (DM) and endothelium were retrospectively reviewed. Data collected included uncorrected VA (UCVA) and spectacle-corrected VA (SCVA) at 7, 30, 180 days, and 1 year postoperatively. Contact lens-corrected visual acuity (CLVA) was evaluated after 1 year of the procedure. Results: UCVA was significantly better than preoperative values at 7 days (p<0.001), 30 days (p<0.001), 180 days (p<0.001), and 1 year (p<0.001) after surgery. The 1-year postoperative mean SCVA and CLVA also improved when compared with preoperative SCVA (p<0.001 for both). Conclusions: DALK utilizing donor corneas with attached Descemet membrane and endothelium results in satisfactory VA in patients with keratoconus.


RESUMO Objetivos: A qualidade óptica da interface após ceratoplastia lamelar anterior profunda (DALK) utilizando a técnica de "Big Bubble" mostrou-se ser excelente, levando a resultados comparáveis aos da ceratoplastia penetrante. No entanto, há poucos dados na literatura com respeito à controvérsia em torno da preparação da córnea doadora. O objetivo deste estudo foi avaliar a acuidade visual (VA) em pacientes com ceratocone submetidos DALK sem a remoção da membrana de descemet e endotélio do tecido doador. Métodos: Os prontuários de 90 pacientes que foram submetidos a DALK sem a remoção da membrana Descemet (DM) e do endotélio foram avaliados retrospectivamente. Os dados coletados incluíram VA sem correção (UCVA) e VA corrigida por óculos (SCVA) aos 7, 30, 180 dias, e 1 ano de pós-operatório. A acuidade visual corrigida por lente de contato (CLVA) foi avaliada após 1 ano do procedimento. Resultados: UCVA no pós-operatório melhorou após 7 dias (p<0,001); 30 dias (p<0,001); 180 dias (p<0,001); e após 1 ano (p<0,001). Ocorreu melhora da SCVA pré-operatória quando comparada com a SCVA e CLVA após 1 ano (p<0,001 para ambos). Conclusão: Transplante lamelar anterior utilizando córneas doadas com membrana de Descemet e endotélio demonstrou resultados visuais satisfatórios em pacientes com ceratocone.

9.
Arq Bras Oftalmol ; 79(6): 366-368, 2016 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28076561

RESUMO

Purpose:: The optical quality of the interface after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique has been shown to be excellent, leading to results comparable to penetrating keratoplasty. However, there is little in the literature with respect to the controversy surrounding the preparation of the donor cornea. The purpose of this study was to evaluate visual acuity (VA) in patients with keratoconus who underwent DALK without removal of the donor graft endothelium. Methods:: The records of 90 patients who underwent DALK without the removal of the Descemet membrane (DM) and endothelium were retrospectively reviewed. Data collected included uncorrected VA (UCVA) and spectacle-corrected VA (SCVA) at 7, 30, 180 days, and 1 year postoperatively. Contact lens-corrected visual acuity (CLVA) was evaluated after 1 year of the procedure. Results:: UCVA was significantly better than preoperative values at 7 days (p<0.001), 30 days (p<0.001), 180 days (p<0.001), and 1 year (p<0.001) after surgery. The 1-year postoperative mean SCVA and CLVA also improved when compared with preoperative SCVA (p<0.001 for both). Conclusions:: DALK utilizing donor corneas with attached Descemet membrane and endothelium results in satisfactory VA in patients with keratoconus.


Assuntos
Lâmina Limitante Posterior/cirurgia , Epitélio Posterior/transplante , Ceratocone/cirurgia , Ceratoplastia Penetrante/métodos , Doadores de Tecidos , Acuidade Visual/fisiologia , Adolescente , Adulto , Feminino , Rejeição de Enxerto , Humanos , Masculino , Tratamentos com Preservação do Órgão/métodos , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Rev. bras. oftalmol ; 73(6): 329-334, Nov-Dec/2014. tab, graf
Artigo em Português | LILACS-Express | ID: lil-741907

RESUMO

Objetivo: Medir e comparar o tamanho e forma de capsulotomias realizadas com laser de femtossegundo com os de capsulorrexes curvilíneas contínuas (CCC) realizadas com auxilio guiado por imagem digital e avaliar o resultado refracional. Métodos: Durante cirurgia de catarata, 40 olhos de 40 pacientes tiveram a capsulotomia realizada com auxílio do laser de femtossegundo e seus resultados foram comparados com os de 40 olhos de 40 outros pacientes que tiveram a capsulorrexe guiada por sistema de imagem digital. Os parâmetros de circularidade, forma e overlap foram medidos usando o Adobe Photoshop (Adobe Systems Inc.) e os resultados refracionais pós-operatórios foram avaliados em ambos os grupos. Resultados: Os diâmetros, tamanho e forma de alta precisão e previsibilidade foram atingidos com laser de femtossegundo e houve diferença estatística entre os grupos. Quando comparado o equivalente esférico entre os grupos, não houve diferença estatística. Conclusão: As capsulotomias realizadas pelo laser de femtossegundo possuem circularidade programada, diâmetro pretendido e valores de desvio padrão médios, indicando resultados reprodutíveis mais elevados. No entanto, CCC realizada por um cirurgião experiente com auxílio guiado de imagem digital, com configurações apropriadas, fornece resultados semelhantes e sugere que diferentes técnicas são igualmente eficazes. .


Purpose: To measure and compare size and shape parameters of femtosecond laser capsulotomy with manually continuous curvilinear digital guided capsulorhexis (CCC) and their refractive outcomes. Methods: Laser capsulotomies in 40 eyes of 40 patients were performed using LenSx femtosecond laser device (Alcon, Forthworth, US) and its results were compared with the CCC digital guided carried out in 40 eyes of 40 patients using the Callisto Eye digital image system (Zeiss, Germany). Capsulorhexis circularity, shape and capsule overlap were measured using Adobe Photoshop (Adobe Systems Inc.) and postoperative refraction outcomes were evaluated in both groups. Results: Highly accurate and predictable capsulotomy diameter, size and shape were achieved with femtosecond laser capsulotomy compared with capsulorhexis and showed statistical difference between groups. Spherical equivalent comparison between groups showed no statistical difference. Conclusions: Femtosecond laser anterior capsulotomy with programed circularity had the intended diameter with average standard deviation values, indicating higher reproducible outcomes. Capsulorhexis performed by an experienced surgeon with auxiliary image guide and appropriate settings provides similar results our results suggest that different techniques are equally effective. .

11.
Clin Ophthalmol ; 8: 493-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24623973

RESUMO

PURPOSE: To analyze the influence of manual correction of the automatically determined edge of the optic nerve head (ONH) in optic disc measurements in cases in which the optical coherence tomography did not identify the disc limits correctly. METHODS: The study included 127 eyes from 127 consecutive patients with glaucoma, suspects, and healthy individuals. In a retrospective analysis, eyes that underwent testing with the Stratus OCT (software version 4.0, Carl Zeiss Meditec, Dublin, CA, USA) Fast Optic Disc protocol were evaluated. Forty-seven eyes in which either the manual assignment was not necessary or the signal strength was below six were excluded. After image acquisition and processing, one expert examiner manually corrected the determination of the edge of the ONH, identified as the end of the retinal pigment epithelium/choriocapillaris complex. Disc area, cup area, rim area, and cup/disc area ratio results were compared before and after the optic disc margin manually corrected determination. Paired t-test was performed to evaluate the differences, and Bland-Altman plots were used to display the relationships between measurements. RESULTS: Eighty eyes from 80 individuals were included in the analyses. No statistically signifiant difference (P=.538) was found when analyzing results obtained with automated and manual determination of rim area (mean ± standard deviation; 1.30±0.45 mm(2) and 1.29±0.39 mm(2), respectively). Cup area (1.39±0.58 mm(2) and 1.31±0.55 mm(2), respectively), cup/disc area ratio (0.50±0.16 mm(2) and 0.49±0.15 mm(2), respectively), and disc area results (2.69±0.55 mm(2) and 2.60±0.51 mm(2), respectively) were significantly different. CONCLUSION: The Stratus OCT ONH Report results were little influenced when optic disc limits were manually determined. Therefore the standard automated Stratus OCT disc margin assignment is adequate, and manual correction is not necessary.

12.
Ophthalmic Epidemiol ; 21(1): 33-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24467560

RESUMO

PURPOSE: To evaluate the prevalence of type 2 diabetes mellitus and diabetic retinopathy (DR) in a Brazilian population. METHODS: Population-based, cross-sectional study conducted in 9 cities located in the Midwest region of the state of São Paulo, Brazil, between 2006 and 2007, including 4690 individuals aged ≥30 years. Diabetes was self-reported and DR was assessed by indirect ophthalmoscopy. RESULTS: The prevalence of type 2 diabetes was 8.68% (95% confidence interval, CI, 7.87-9.48%), and DR was present in 7.62% (95% CI 5.02-10.20%) of participants with self-reported type 2 diabetes. Approximately 35.4% of individuals diagnosed with DR did not know they had diabetes prior to DR diagnosis. Prevalences of low vision and blindness were higher among those with diabetes and DR. Cataract was still a major cause of blindness in this population. CONCLUSION: This is the first large population-based study on DR in Brazil. High rates of visual impairment were found in persons with type 2 diabetes, but cataract is still one of the main causes of blindness. Large surveys are necessary for public health policy advocacy in developing countries.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Pressão Intraocular , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Acuidade Visual
13.
Arq. bras. oftalmol ; 76(6): 350-353, nov.-dez. 2013. ilus, graf
Artigo em Inglês | LILACS | ID: lil-701285

RESUMO

PURPOSE: To study the prevalence of methicillin-resistant Staphylococcus aureus among S. aureus ocular infections in a tertiary health center in Brazil and compare antibiotic susceptibility patterns between MRSA and methicillin-susceptible S. aureus isolates. METHODS: Electronic records from the ocular microbiology laboratory of the Universidade Federal de São Paulo were retrospectively reviewed. During a 10-year period (between January 2000 and December 2009) all conjunctivitis, keratitis, and endophthalmitis cases with a positive culture for S. aureus were identified. Antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method. RESULTS: Five hundred sixty-six S. aureus isolates were identified; of those, 56 (9.9%) were resistant to methicillin. Throughout the 10-year period, Staphylococcus aureus showed a significant increasing trend from 7.55% to 16.18% among overall S. aurues infections (p=0.001) and from 3.7% to 13.16% in conjunctivitis (p=0.001). Conversely, we did not observe the same trend among those with keratitis (p=0.38). Staphylococcus aureus isolates showed higher resistance rates to tobramycin, gentamicin, ciprofloxacin, gatifloxacin, and moxifloxacin when compared with S. aureus isolates (p< 0.001). All cases were susceptible to vancomycin. CONCLUSION: We observed an increasing trend in the overall prevalence of Staphylococcus aureus ocular infections and statistically significant higher resistance rates to commonly used antibiotics compared to Staphylococcus aureus. Our data supports the need for constant bacterial surveillance and should be taken into consideration before initiating empiric treatment of ocular infections.


OBJETIVO: Estudar a prevalência do Staphylococcus aureus resistente à meticilina nas infecções oculares causadas por S. aureus em um centro de saúde terciário no Brasil e comparar o perfil de suscetibilidade antimicrobiana entre as cepas de Staphylococcus aureus resistente à meticilina e S. aureus susceptível à meticilina MÉTODOS: Foi realizada uma análise retrospectiva dos arquivos do laboratório de microbiologia ocular da Universidade Federal de São Paulo e selecionados todos os casos de conjuntivite, ceratite e endoftalmite com cultivo positivo para S. aureus, durante um período de 10 anos (entre janeiro de 2000 e dezembro de 2009). Foi avaliada a prevalência de Staphylococcus aureus resistente à meticilina e comparado o perfil de susceptibilidade antimicrobiano dos Staphylococcus aureus resistente à meticilina e S. aureus susceptível à meticilina. RESULTADOS: Quinhentos e sessenta e seis isolados de S. aureus foram identificados. Desses, 56 (9,9%) apresentaram resistência à meticilina. Durante o período de 10 anos estudado, Staphylococcus aureus resistente à meticilina mostrou uma tendência significante de aumento de 7,6% para 16,2% entre as infecções oculares causadas por S. aureus em geral (p=0,001) e de 3,7% para 13,2% nas conjuntivites (p=0,001). A mesma tendência não foi observada entre as amostras de ceratite (p=0,38). Os isolados de Staphylococcus aureus resistente à meticilina mostraram maiores taxas de resistência à tobramicina, gentamicina, ciprofloxacino, gatifloxacino e moxifloxacino em comparação com os isolados de S. aureus susceptível à meticilina (p<0,001). Todos os casos foram susceptíveis à vancomicina. CONCLUSÃO:Foi observada uma tendência de aumento na prevalência do Staphylococcus aureus resistente à meticilina nas infecções oculares causadas por S. aureus, bem como taxas de resistência significantemente maiores aos antibióticos comumente utilizados na prática oftalmológica. Nossos dados alertam para a necessidade de constante vigilância de resistência bacteriana a antimicrobianos e devem ser considerados na eleição do tratamento empírico das infecções oculares.


Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infecções Oculares Bacterianas/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Antibacterianos/farmacologia , Brasil/epidemiologia , Conjuntivite/epidemiologia , Farmacorresistência Bacteriana , Endoftalmite/epidemiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Ceratite/epidemiologia , Prevalência , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Centros de Atenção Terciária
14.
Arq. bras. oftalmol ; 76(6): 370-373, nov.-dez. 2013. graf, tab
Artigo em Português | LILACS | ID: lil-701290

RESUMO

OBJETIVO: Investigar sazonalidade de ceratities infecciosas em serviço terciário no Brasil. MÉTODOS: Estudo retrospectivo de dados coletados do Laboratório de Microbiologia Ocular do Departamento de Oftalmologia da Universidade Federal de São Paulo de 2005 a 2009. Foram definidas como ceratites infecciosas aquelas com cultura positiva para o agente. Dados foram distribuídos de acordo com os meses do ano e modelos de regressão linear com variáveis "dummy" foram utilizados para testar sazonalidade. RESULTADOS: Foram diagnosticados 1.468 casos de ceratite infecciosa durante o período do estudo. Bactérias foram responsáveis por 80,3% dos casos seguidas por fungos (7%), Acanthamoeba (6%) e casos mistos (6,7%). Testes estatísticos não mostraram sazonalidade para bactérias (p=0,064), fungos (p=0,379), Acanthamoeba (p=0,062) ou casos mistos (p=0,441). CONCLUSÃO: Não foi observada sazonalidade nas ceratites infecciosas em nossa amostra.


PURPOSE: To investigate the seasonality of infectious keratitis in a tertiary hospital in Brazil. METHODS: Charts from the Ocular Microbiology Laboratory of the Department of Ophthalmology of the Federal University of Sao Paulo were reviewed from 2005 to 2009. Infectious keratitis were defined as those with positive culture. Data were distributed monthly and linear regressions with seasonal dummy models were used to test for seasonal trends. RESULTS: Total of 1,468 cases of keratitis was diagnosed during the study period. Bacterial keratitis were reponsible for 80.3% of all cases, followed by fungal (7%), and Acanthamoeba (6%); 6.7% were mixed cases. Statistical tests showed that there were no seasonal trends for bacteria (p=0.064), fungi (p=0.379), Acanthamoeba (p=0.062) or mixed infections (p=0.441). Conclusions: No seasonal trends for infectious keratitis were observed in our sample.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Parasitárias/epidemiologia , Ceratite/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Acanthamoeba/patogenicidade , Brasil/epidemiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Parasitárias/microbiologia , Ceratite/microbiologia , Estudos Retrospectivos , Estações do Ano , Fatores de Tempo
15.
Arq Bras Oftalmol ; 76(3): 195-6, 2013 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23929084

RESUMO

Keratoconus has usually been described as bilateral but asymmetric disease. Corneal ectasia is one of the long-term complications of modern refractive surgery, especially those submitted to laser in situ keratomileusis (LASIK). We describe a patient with keratoconus in the right eye that was submitted to radial keratectomy (RK) in the left eye 19 years ago with no progression of the ectatic cornea and no complications related to the refractive surgery. Because unilateral keratoconus is rare, we believe that RK was performed on an already ectatic cornea (not clinically detected) or with fruste keratoconus. However, neither corneal ectasia progressed, nor ectasia was induced by RK in the fellow eye.


Assuntos
Ceratocone/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Ceratotomia Radial/métodos , Adulto , Topografia da Córnea , Progressão da Doença , Feminino , Humanos , Resultado do Tratamento
16.
Arq. bras. oftalmol ; 76(3): 195-196, maio-jun. 2013. ilus
Artigo em Inglês | LILACS | ID: lil-681856

RESUMO

Keratoconus has usually been described as bilateral but asymmetric disease. Corneal ectasia is one of the long-term complications of modern refractive surgery, especially those submitted to laser in situ keratomileusis (LASIK). We describe a patient with keratoconus in the right eye that was submitted to radial keratectomy (RK) in the left eye 19 years ago with no progression of the ectatic cornea and no complications related to the refractive surgery. Because unilateral keratoconus is rare, we believe that RK was performed on an already ectatic cornea (not clinically detected) or with fruste keratoconus. However, neither corneal ectasia progressed, nor ectasia was induced by RK in the fellow eye.


O ceratocone é descrito como uma doença bilateral porém assimétrica e vários dados na literatura comprovam que a ectasia corneana é uma das complicações de longo prazo da cirurgia refrativa moderna, especialmente do laser in situ keratomileusis (LASIK). Nós descrevemos um caso de uma paciente com ceratocone no olho direito e que foi submetida à ceratotomia radial no olho esquerdo há 19 anos, desde então sem sinais de progressão da ectasia corneana nem de complicações relativas à cirurgia refrativa. Como o ceratocone unilateral é raro, acreditamos que a cirurgia refrativa tenha sido realizada num olho com ectasia corneana não detectada clinicamente ou com ceratocone frustro. Entretanto, a ectasia do olho direito não progrediu e também não houve sinais de ectasia no olho submetido à cirurgia refrativa nesse período de 19 anos de acompanhamento.


Assuntos
Adulto , Feminino , Humanos , Ceratocone/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Ceratotomia Radial/métodos , Topografia da Córnea , Progressão da Doença , Resultado do Tratamento
17.
Acta Ophthalmol ; 91(6): e432-6, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23406295

RESUMO

PURPOSE: To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries. METHODS: This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients' ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures. RESULTS: A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. The mean follow-up period was 25.7 ± 10.8 months. Preoperative best-corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. The overall BKPro retention rate was 90%. The most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p = 0.07), although this was not statistically significant. CONCLUSION: The anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.


Assuntos
Órgãos Artificiais , Bioprótese , Queimaduras Químicas/cirurgia , Doenças da Córnea/cirurgia , Queimaduras Oculares/induzido quimicamente , Implantação de Prótese , Adulto , Álcalis , Doenças da Córnea/induzido quimicamente , Queimaduras Oculares/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Resultado do Tratamento , Acuidade Visual/fisiologia
18.
Arq Bras Oftalmol ; 76(6): 350-3, 2013 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24510081

RESUMO

PURPOSE: To study the prevalence of methicillin-resistant Staphylococcus aureus among S. aureus ocular infections in a tertiary health center in Brazil and compare antibiotic susceptibility patterns between MRSA and methicillin-susceptible S. aureus isolates. METHODS: Electronic records from the ocular microbiology laboratory of the Universidade Federal de São Paulo were retrospectively reviewed. During a 10-year period (between January 2000 and December 2009) all conjunctivitis, keratitis, and endophthalmitis cases with a positive culture for S. aureus were identified. Antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method. RESULTS: Five hundred sixty-six S. aureus isolates were identified; of those, 56 (9.9%) were resistant to methicillin. Throughout the 10-year period, Staphylococcus aureus showed a significant increasing trend from 7.55% to 16.18% among overall S. aurues infections (p=0.001) and from 3.7% to 13.16% in conjunctivitis (p=0.001). Conversely, we did not observe the same trend among those with keratitis (p=0.38). Staphylococcus aureus isolates showed higher resistance rates to tobramycin, gentamicin, ciprofloxacin, gatifloxacin, and moxifloxacin when compared with S. aureus isolates (p< 0.001). All cases were susceptible to vancomycin. CONCLUSION: We observed an increasing trend in the overall prevalence of Staphylococcus aureus ocular infections and statistically significant higher resistance rates to commonly used antibiotics compared to Staphylococcus aureus. Our data supports the need for constant bacterial surveillance and should be taken into consideration before initiating empiric treatment of ocular infections.


Assuntos
Infecções Oculares Bacterianas/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Brasil/epidemiologia , Criança , Conjuntivite/epidemiologia , Farmacorresistência Bacteriana , Endoftalmite/epidemiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Humanos , Ceratite/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Centros de Atenção Terciária , Adulto Jovem
19.
Arq Bras Oftalmol ; 76(6): 370-3, 2013 Nov-Dec.
Artigo em Português | MEDLINE | ID: mdl-24510086

RESUMO

PURPOSE: To investigate the seasonality of infectious keratitis in a tertiary hospital in Brazil. METHODS: Charts from the Ocular Microbiology Laboratory of the Department of Ophthalmology of the Federal University of Sao Paulo were reviewed from 2005 to 2009. Infectious keratitis were defined as those with positive culture. Data were distributed monthly and linear regressions with seasonal dummy models were used to test for seasonal trends. RESULTS: Total of 1,468 cases of keratitis was diagnosed during the study period. Bacterial keratitis were responsible for 80.3% of all cases, followed by fungal (7%), and Acanthamoeba (6%); 6.7% were mixed cases. Statistical tests showed that there were no seasonal trends for bacteria (p=0.064), fungi (p=0.379), Acanthamoeba (p=0.062) or mixed infections (p=0.441). CONCLUSIONS: No seasonal trends for infectious keratitis were observed in our sample.


Assuntos
Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Parasitárias/epidemiologia , Ceratite/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Acanthamoeba/patogenicidade , Adulto , Brasil/epidemiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Parasitárias/microbiologia , Feminino , Humanos , Ceratite/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estações do Ano , Fatores de Tempo , Adulto Jovem
20.
Arq Bras Oftalmol ; 74(1): 17-20, 2011 Jan-Feb.
Artigo em Português | MEDLINE | ID: mdl-21670901

RESUMO

PURPOSE: To describe the characteristics of human ocular tissue donors from the Cascavel Eye Bank in the State of Paraná (PR) and investigate the impact of hepatitis B serologic test positivity on discarded ocular tissues. METHODS: Cross-sectional study of data collected between March 2006 and April 2007 at the Cascavel Eye Bank. Information such as age, gender, cause of death, time between death and enucleation, and serologic tests results was collected. Data were used to characterize the study population and stratified according to hepatitis B (anti-HBc) status. RESULTS: Mean age of donors was 54.2 ± 20.6 years and a greater proportion of men (64,7%) was observed. Mean time between death and enucleation was 3.8 ± 2.4 hours, cardiovascular diseases were the main cause of death (34.5%). Positivity of anti-HBc and HBsAg tests was 47.4% and 1.5%, respectively. Hepatitis B was the main reason for discarding corneas. Donors whose serologic tests were positive for anti-HBc had higher mean age compared to those with negative tests (p<0.001). Only 0.8% of all donations tested positive for hepatitis C and donors with positive HIV test were not seen in our study. CONCLUSIONS: Activities of the Cascavel Eye Bank significantly increased the availability of corneas for transplant in the State of Paraná. The main contraindication for availability of ocular tissues was positivity of serologic tests for anti-HBc. Biosafety studies should be performed in order to investigate the potential transmission of hepatitis B virus for donors with positive tests for anti-HBc. The inclusion of these donors would increase the number of corneas available for transplant.


Assuntos
Bancos de Olhos/estatística & dados numéricos , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Hepatite B/diagnóstico , Doadores de Tecidos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Seleção do Doador/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
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