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1.
Adv Exp Med Biol ; 1161: 3-12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562617

RESUMO

Keratitis is a sight-threatening inflammatory condition of the cornea that can be caused by both infectious and non-infectious agents. Physical or chemical trauma are typically related to non-infectious keratitis, which may then become secondarily infected or remain non-infected. Etiology of infectious keratitis is most often associated with bacteria; but viruses, fungi, and parasites are common causative pathogens as well. As a global concern, common risk factors include: systemic immunosuppression (secondary to malnutrition, alcoholism, diabetes, steroid use), previous corneal surgery (refractive corneal surgery, penetrating keratoplasty), extended wear contact lens use, pre-existing ocular surface diseases (dry eye, epithelial defect) and ocular trauma (agriculture- or farm-related) [1-8]. Annual rates of incidence include nearly one million clinical visits due to keratitis in the United States, while it has been reported that roughly two million people develop corneal ulcers in India. Clinically, patients may show signs of eye pain (ranging from mild to severe), blurred vision, photophobia, chemosis and redness. Pathogenesis is generally characterized by rapid progression, focal white infiltrates with underlying stromal inflammation, corneal thinning, stromal edema, mucopurulent discharge and hypopyon, which can lead to corneal scarring, endophthalmitis, and perforation. In fact, corneal opacity is not only a complication of keratitis, but among the leading causes of legal blindness worldwide. Despite that empirical treatment effectively controls most of the pathogens implicated in infectious keratitis, improved clinical outcomes are not guaranteed. Further, if treatment is not initiated in a timely manner, good visual outcome is reduced to approximately 50% of keratitis patients [9]. Moreover, resultant structural alterations, loss of tissue and an unresolved host response remain unaddressed through current clinical management of this condition.


Assuntos
Infecções Oculares , Ceratite , Metabolismo dos Lipídeos/fisiologia , Úlcera da Córnea/epidemiologia , Úlcera da Córnea/etiologia , Úlcera da Córnea/fisiopatologia , Infecções Oculares/complicações , Infecções Oculares/microbiologia , Infecções Oculares/parasitologia , Infecções Oculares/virologia , Humanos , Ceratite/epidemiologia , Ceratite/etiologia , Ceratite/microbiologia , Ceratite/fisiopatologia , Lipídeos/química , Estudos Retrospectivos
2.
Cornea ; 38(8): 951-954, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276458

RESUMO

PURPOSE: To describe the outcomes of tuck-in tenon patch graft (TPG) in the management of corneal perforation up to 5-mm size. METHODS: Thirty-one cases of sterile corneal perforation (3-5 mm) underwent autologous TPG. The technique included, freshening of the edges, measuring the size of defect, creating a 360-degree stromal pocket around the perforation margin, harvesting the tenon graft followed by tucking into the stromal pocket, and application of cyanoacrylate glue or suturing the graft using 10-0 monofilament nylon suture. The main outcome measure was rate of healing (percentage of cases healed). RESULTS: The mean age was 52.3 ± 8.9 years with 22 male and 9 female patients. The various etiologies of corneal perforation included trauma (n = 10), neurotrophic keratitis (n = 11), and peripheral ulcerative keratitis (n = 10). The mean size of corneal perforation was 4.2 ± 0.6 mm (range 3-5 mm). The mean duration of epithelial healing was 25.7 ± 6.7 days. Best-corrected visual acuity improved from 1.8 ± 0.4 to 1.2 ± 0.4 logarithm of the minimum angle of resolution units at 4 weeks after surgery (P ≤ 0.01). Twenty-seven (87.1%) cases healed with formation of a leucomatous scar at 16.9 ± 2.7 weeks, whereas 4 cases had a flat anterior chamber. In three-fourths of the cases, a corneal graft was performed. In one case, graft resuturing was performed for post-op aqueous leak, which healed with the formation of a corneo-iridic scar. CONCLUSIONS: TPG is a safe, simple, inexpensive, and an effective technique for the management of corneal perforations. The advantages include the autologous nature of the graft, cost effectiveness, and easy availability.


Assuntos
Perfuração da Córnea/cirurgia , Úlcera da Córnea/cirurgia , Cápsula de Tenon/transplante , Adulto , Idoso , Perfuração da Córnea/fisiopatologia , Úlcera da Córnea/fisiopatologia , Cianoacrilatos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura , Adesivos Teciduais/uso terapêutico , Transplante Autólogo , Acuidade Visual/fisiologia , Cicatrização/fisiologia
3.
Curr Opin Ophthalmol ; 29(4): 373-377, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29708927

RESUMO

PURPOSE OF REVIEW: Cytomegalovirus (CMV) keratitis, albeit an uncommon manifestation of this ubiquitous pathogen, can lead to devastating ocular morbidity. Timely diagnosis and appropriate treatment are also unfortunately uncommon. The purpose of this review is to discuss recently published literature regarding the epidemiology, pathophysiology, diagnosis, and therapy of CMV keratitis. RECENT FINDINGS: Classic clinical presentations of CMV keratitis are known; however, current investigations further elucidate characteristics of typical versus atypical disease. Ongoing research stems beyond utilizing PCR analysis towards targeted diagnostic studies with advanced imaging modalities as well as modern genotyping techniques. Strong clinical acumen combined with appropriate handling of these modern technologies are proving invaluable for rapid diagnosis and treatment of this virulent pathogen. SUMMARY: The current recommended treatment for CMV keratitis is systemic ganciclovir. Astute clinicians must consider this diagnosis in any patient with keratitis, anterior uveitis, and intraocular hypertension. Novel diagnostic techniques should be combined with clinical exam findings to accurately and efficiently diagnose, treat, and monitor progression.


Assuntos
Úlcera da Córnea , Infecções por Citomegalovirus , Infecções Oculares Virais , Antivirais/uso terapêutico , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/tratamento farmacológico , Úlcera da Córnea/epidemiologia , Úlcera da Córnea/fisiopatologia , Citomegalovirus/patogenicidade , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/fisiopatologia , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/epidemiologia , Infecções Oculares Virais/fisiopatologia , Ganciclovir/uso terapêutico , Humanos , Uveíte Anterior/diagnóstico
4.
Cornea ; 37(2): 260-262, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29309359

RESUMO

PURPOSE: To report a case of extensive Fuchs superficial marginal keratitis managed with annular lamellar keratoplasty. METHODS: Interventional case report. RESULTS: A 72-year-old man presented with 20/80 best-corrected visual acuity in his left eye and demonstrated 360-degree peripheral deep immune stromal keratitis and pseudopterygia with peripheral stromal thinning. During superficial keratectomy with amniotic membrane transplantation, the thin cornea was perforated while excising pseudopterygia in the superonasal quadrant. Surgery was aborted. Anterior segment optical coherence tomography demonstrated a severely thinned cornea (240 µm nasally, 360 µm temporally) with overlying pseudopterygia peripherally. After allowing 3 months for the cornea to heal, the decision was made to perform lamellar annular (or "donut") keratoplasty. The patient had an unremarkable postoperative course, with 20/50 best-corrected visual acuity 10 months after keratoplasty. CONCLUSIONS: We report an extensive case of Fuchs superficial marginal keratitis treated with 360-degree annular lamellar keratoplasty. This technique provides tectonic support to decrease the likelihood of future perforation while also improving vision by modifying the ectatic cornea. Anterior segment optical coherence tomography may be a helpful tool preoperatively to avoid severely thinned areas (eg, during pseduopterygium removal) and to ensure complete removal of the ectatic cornea.


Assuntos
Transplante de Córnea , Úlcera da Córnea/cirurgia , Idoso , Paquimetria Corneana , Topografia da Córnea , Úlcera da Córnea/fisiopatologia , Humanos , Masculino , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
5.
J Fr Ophtalmol ; 41(1): 57-61, 2018 Jan.
Artigo em Francês | MEDLINE | ID: mdl-29305170

RESUMO

PURPOSE: To determine the frequency of corneal ulcer in our practice environment. METHODOLOGY: This study was conducted at Saint-Joseph Hospital in Kinshasa and at the Lubumbashi University Clinics in the Democratic Republic of Congo from January 2011 to December 2014. We studied the frequency, demographic and clinical variables of corneal ulcer patients. RESULTS: A total of 380 cases of corneal ulcers were recorded out of 44,722 ophthalmologic consultations performed, with a frequency of 0.85% and a sex ratio ranging from 1.4 to 1.7 men to women. Corneal ulcer was diagnosed in patients of all ages; the mean age was 38.67±18.67 years. Patients with corneal ulcers presented for eye pain (80%), followed by tearing, photophobia, eye redness and blurred vision. The frequency of visual impairment was 10.30%; 2.1% of patients had vision reduced to light perception, and 1% of patients had no light perception. Corneal dystrophy was present in 41.6% of cases. Perforation of the globe and endophthalmitis were observed in 3.4% of cases each. CONCLUSION: Corneal ulceration is one of the leading causes of visual impairment and blindness in our practice environment. An early ophthalmologic consultation at the onset of symptoms and adequate management would improve the visual prognosis of patients.


Assuntos
Úlcera da Córnea/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Úlcera da Córnea/complicações , Úlcera da Córnea/fisiopatologia , República Democrática do Congo/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Acuidade Visual , Adulto Jovem
6.
Vet Ophthalmol ; 21(1): 76-81, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28597994

RESUMO

PURPOSE: To compare corneal sensitivity and tear production in horses with keratitis to horses with other ocular disease. METHOD: Retrospective medical record review was used to identify equine patients presented during a 1-year period for an ocular complaint who had Schirmer Tear Test (STT) or Corneal Touch Threshold (CTT) measured. Variables studied included patient age and sex; affected eye; category of presenting ocular complaint (keratitis vs. other ocular complaint); STT; and CTT. Patients with a complaint of ulcerative keratitis, immune-mediated keratitis, and stromal abscess were categorized in the keratitis group. Patients with a complaint of uveitis, as well as lid, lens, or retinal disease, were categorized in the group having other ocular disease. For patients presenting more than once in 2013, only the first visit at which STT or CTT was measured was included. For patients with bilateral disease, STT and CTT of both eyes were averaged. RESULTS: A total of 108 patients were included, 45 with keratitis and 63 with other ocular disease. Average age was 13.65 years, with more males (77) than females (31). Adjusted for age, STT in affected eyes did not differ significantly between the two groups (keratitis = 29.92 mm/min; other ocular disease = 27.96 mm/min), but CTT was significantly lower in patients with keratitis (33.78 mm) than in patients with other ocular disease (40.10 mm). CONCLUSIONS: Corneal sensitivity may be decreased in patients with keratitis. It is not known whether this is a cause or an effect of corneal disease.


Assuntos
Córnea/fisiopatologia , Úlcera da Córnea/veterinária , Doenças dos Cavalos/fisiopatologia , Doenças do Aparelho Lacrimal/veterinária , Lágrimas/fisiologia , Animais , Úlcera da Córnea/fisiopatologia , Feminino , Cavalos , Doenças do Aparelho Lacrimal/fisiopatologia , Masculino , Estudos Retrospectivos
7.
Vestn Oftalmol ; 133(5): 32-37, 2017.
Artigo em Russo | MEDLINE | ID: mdl-29165410

RESUMO

AIM: to develop a surgical approach to the treatment of purulent corneal ulcer in eyes with neurotrophic keratitis with lagophthalmos after auditory neuroma removal or stroke. MATERIAL AND METHODS: A total of 12 patients (13 eyes) have been managed. All received combined surgery that included simultaneous keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy. RESULTS: Ocular integrity was preserved in all cases, and also vision - in half of them. In 29% of cases, visual acuity increased from 0.09±0.05 up tо 0.21±0.13. Lagophthalmos decreased from 5.86±1.35 mm down to 3.01±0.75 mm. CONCLUSION: Patients with intracranial lesions complicated by neurotrophic keratitis and lagophthalmos often develop progressive purulent ulcers of the cornea. One-step keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy is an effective treatment that can help preserve visual function in such eyes.


Assuntos
Blefaroptose/complicações , Túnica Conjuntiva , Úlcera da Córnea , Ceratite/complicações , Ceratoplastia Penetrante/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Antibacterianos/uso terapêutico , Túnica Conjuntiva/patologia , Túnica Conjuntiva/cirurgia , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/etiologia , Úlcera da Córnea/fisiopatologia , Úlcera da Córnea/cirurgia , Paralisia Facial/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Supuração , Resultado do Tratamento
8.
Cornea ; 36(2): 202-209, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28060068

RESUMO

PURPOSE: To investigate risk factors, clinical features, and treatment outcomes of recurrent Mooren ulcers in China. METHODS: Medical records of 139 patients (173 eyes) with Mooren ulcers, including 37 patients (38 eyes) with recurrence, were retrospectively reviewed. Clinical features and treatment outcomes were evaluated. The risk factors for ulcer recurrence were analyzed with logistic regression; the cumulative risk of recurrence was assessed with Kaplan-Meier analysis. RESULTS: The ratio of males to females with Mooren ulcers was 1.62:1. As to age, 32 of 106 patients aged >35 years and 5 of 33 younger patients (28 males and 9 females) had recurrence. Forty-one patients had bilateral disease (7 eyes removed before their visit to our hospital were excluded) and 98 patients had unilateral disease, with recurrence in 10 and 27 patients, respectively. Thirty eyes had recurrence around the primary lesion; 27 eyes had recurrence within 12 months after treatment. Of all eyes, 97.7% were saved and 81.5% retained vision better than 0.05. The cumulative risk of first recurrence at 6, 12, 24, 36, and 48 months was 10.4%, 17.1%, 22.5%, 27.2%, and 28.6%, respectively. Male sex (P = 0.043) and surgical treatment (P = 0.035) were significantly associated with an increased risk of recurrence. CONCLUSIONS: This study provided the clinical characteristics and treatment outcomes of patients with recurrent Mooren ulcers in China. The cumulative risk of first recurrence at 4 years after treatment was 28.6%. Male patients and patients with severe ulcers that required surgery had an increased risk of recurrence.


Assuntos
Úlcera da Córnea , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Procedimentos Cirúrgicos Oftalmológicos , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/epidemiologia , Úlcera da Córnea/fisiopatologia , Úlcera da Córnea/terapia , Ciclosporina/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Tacrolimo/uso terapêutico , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
9.
Chin Med J (Engl) ; 129(15): 1817-21, 2016 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-27453231

RESUMO

BACKGROUND: Small incision refractive lenticule extraction (SMILE) is an effective laser procedure that treats myopia. This research was to describe a novel approach to treat corneal ulcer or perforation using the corneal lenticules obtained from SMILE and to evaluate the safety and effectiveness of tectonic keratoplasty with femtosecond laser intrastromal lenticule (TEKIL). METHODS: A total of twenty patients (22 eyes) were monitored for at least 6 months and were assessed using slit lamp microscopy, optical coherence tomography, and best-corrected visual acuity (BCVA). Postoperative complications throughout the study period were recorded. RESULTS: Corneal ulcer in 14 patients (16 eyes) and corneal perforation in six patients (6 eyes) were treated with TEKIL. The patients were ten females and ten males, with a mean age of 58.5 ± 16.3 years (range: 16-81 years). In this study, the most causes of corneal ulcer or perforation were immunologic causes (54.5%). After TEKIL procedure, global integrity was achieved in all cases. No immune rejection or perforation was detected. The mean BCVA improved from 0.17 ± 0.20 preoperatively to 0.27 ± 0.25 postoperatively at the final follow-up (t = 2.095, P = 0.052). The postoperative BCVA improved in 12 eyes (54.5%) and maintained in nine eyes (40.9%). Vision function successfully maintained in all eyes (100%). In three cases, corneal ulcers were treated by reoperation of TEKIL at 3 months after the initial surgery for the reason that the residual corneal thickness was <250 µm. CONCLUSIONS: TEKIL seems to be an effective treatment for corneal ulcer and perforation in the condition of emergency and donor shortage.


Assuntos
Córnea/cirurgia , Perfuração da Córnea/cirurgia , Transplante de Córnea/métodos , Úlcera da Córnea/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Perfuração da Córnea/fisiopatologia , Transplante de Córnea/efeitos adversos , Úlcera da Córnea/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Adulto Jovem
10.
Clin Exp Ophthalmol ; 44(9): 763-767, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27329780

RESUMO

BACKGROUND: To determine if pretreatment with antifungal agents is predictive of worse clinical outcome in a fungal keratitis clinical trial. DESIGN: Non-pre-specified subgroup analysis of a randomized controlled trial in a tertiary hospital. PARTICIPANTS: Three hundred twenty-three fungal ulcer cases with an enrolment visual acuity of 20/40 to 20/400. METHODS: The Mycotic Ulcer Treatment Trial I was a randomized, double-masked trial to determine the optimal treatment for filamentous fungal keratitis at the Aravind Eye Care System, India. Enrolled cases were randomized to receive topical natamycin or voriconazole. Prior antifungal medication use, dose and duration were collected at enrolment. A subgroup analysis was performed to determine if patients using natamycin or azoles at presentation have worse clinical outcomes compared with those who were not pretreated. MAIN OUTCOME MEASURES: Three-month visual acuity (primary), 3-month infiltrate or scar size, corneal perforation and/or transplant and re-epithelialization time. RESULTS: Of the 323 patients enrolled, 44% presented on an antifungal agent. Pretreated patients had larger mean baseline infiltrate size (P < 0.001) and epithelial defect size (P = 0.02). Multivariate regression analysis demonstrated that pretreatment was associated with significantly worse 3-month visual acuity (P = 0.006), larger 3-month scar size (P < 0.001) and increased odds of corneal perforation and/or transplant (P = 0.001). CONCLUSIONS: Fungal keratitis that is smear-positive despite being pretreated with appropriate antifungal agents appears to be a risk factor for worse outcomes, likely a result of initial ulcer severity and treatment failure. These patients may benefit from more aggressive multimodal therapy at a tertiary centre.


Assuntos
Antibioticoprofilaxia , Antifúngicos/uso terapêutico , Úlcera da Córnea/prevenção & controle , Infecções Oculares Fúngicas/prevenção & controle , Natamicina/uso terapêutico , Vancomicina/uso terapêutico , Acuidade Visual/fisiologia , Úlcera da Córnea/microbiologia , Úlcera da Córnea/fisiopatologia , Método Duplo-Cego , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária
13.
Middle East Afr J Ophthalmol ; 22(3): 386-8, 2015 Jul-Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26180482

RESUMO

To illustrate amniotic membrane transplant (AMT) with a novel surgical technique ("sandwich technique") for treating patients with malignant Mooren's ulcer. A case report of a patient with bilateral, malignant Mooren's ulcer who had undergone systemic steroid therapy and topical immunosuppresive therapy to stabilize his condition. However, perforation of cornea occurred in one eye. AMT with a new surgical technique ("Motowa's sandwich technique") was performed to treat this case. On the 1(st) day postoperatively, there was no pain, no photophobia, and visual acuity was same as preoperatively. At 4 weeks postoperatively, visual acuity improved in the right eye to 20/160 with pinhole, and there was no fluorescein staining. The right eye was quiet. Amniotic membrane transplant with "Motowa's sandwich technique" resulted in the preservation of the anatomical integrity and progression of disease was halted along with an improved vision. This technique is a novel surgical modality in treating Mooren's ulcer. Further study on a large cohort of patients is required for evidence-based data to verify the outcome of this initial case report.


Assuntos
Âmnio/transplante , Úlcera da Córnea/cirurgia , Limbo da Córnea/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Idoso de 80 Anos ou mais , Úlcera da Córnea/fisiopatologia , Seguimentos , Humanos , Masculino , Acuidade Visual/fisiologia
14.
Asia Pac J Ophthalmol (Phila) ; 4(1): 19-24, 2015 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26068609

RESUMO

PURPOSE: Infliximab is frequently used in the treatment of refractory rheumatic diseases. We report our initial local experience at a tertiary eye center in Hong Kong in using infliximab as treatment of various refractory ocular inflammatory diseases that have failed with conventional corticosteroid and immunosuppressant therapy. DESIGN: This is a retrospective, interventional case series. METHODS: We reviewed all the medical records of patients who had refractory ocular inflammatory diseases and received infliximab as part of their treatment. We collected data regarding the visual acuity, status of inflammation, and any complications arising from the treatment. RESULTS: Seven eyes from 3 male and 2 female patients were recruited. Two patients had peripheral ulcerative keratitis, whereas the remaining patients had uveitis. Two patients had bilateral diseases, and the rest were unilateral. All patients achieved quiescence after 3 doses of infliximab infusions during the period of 3 months. Most of the patients retained a useful visual acuity of 20/70 or better at the end of the study. There were no serious adverse effects or complications encountered from the infliximab therapy. CONCLUSIONS: Infliximab is a valuable and potent option that may be considered in the management of various refractory ocular inflammatory diseases. However, larger controlled studies are needed to evaluate the safety profile, optimal treatment schedule, and adverse effects of long-term infliximab therapy.


Assuntos
Anti-Inflamatórios/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Infliximab/uso terapêutico , Ceratite/tratamento farmacológico , Uveíte/tratamento farmacológico , Adulto , Anticorpos Monoclonais/uso terapêutico , Úlcera da Córnea/fisiopatologia , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
15.
Clin Transl Sci ; 8(5): 558-62, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25996570

RESUMO

Corneas with severe pathologies have a high risk of rejection when conventionally grafted with human donor tissues. In this early observational study, we grafted bioengineered corneal implants made from recombinant human collagen and synthetic phosphorylcholine polymer into three patients for whom donor cornea transplantation carried a high risk of transplant failure. These patients suffered from corneal ulcers and recurrent erosions preoperatively. The implants provided relief from pain and discomfort, restored corneal integrity by promoting endogenous regeneration of corneal tissues, and improved vision in two of three patients. Such implants could in the future be alternatives to donor corneas for high-risk patients, and therefore, merits further testing in a clinical trial.


Assuntos
Queimaduras Químicas/cirurgia , Transplante de Córnea/métodos , Úlcera da Córnea/cirurgia , Queimaduras Oculares/cirurgia , Implantes Experimentais , Doadores de Tecidos/provisão & distribução , Engenharia Tecidual/métodos , Idoso , Idoso de 80 Anos ou mais , Queimaduras Químicas/diagnóstico , Queimaduras Químicas/etiologia , Queimaduras Químicas/fisiopatologia , Transplante de Córnea/efeitos adversos , Úlcera da Córnea/induzido quimicamente , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/fisiopatologia , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/diagnóstico , Queimaduras Oculares/fisiopatologia , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Visão Ocular
16.
Eye Contact Lens ; 41(5): 314-7, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25828513

RESUMO

OBJECTIVES: To report a series of patients with neurotrophic keratopathy and to correlate visual outcomes with the causative condition, grade of ulceration, and degree of cornea hypoesthesia. METHODS: A retrospective review of patients with neurotrophic keratopathy was conducted. The causality, visual acuities, ulcer grade, quantitative corneal sensitivity, treatments, and ocular comorbidities were recorded. RESULTS: Forty-six eyes were identified, and 20 experienced corneal sensation quantified by the Cochet-Bonnet aesthesiometer. Diabetes followed by herpes simplex and neurosurgical sequelae were the most common causes. Grade II ulcers were the most commonly seen ulcers. Twenty-eight percent of eyes failed conservative treatment and required surgical therapy. Overall, the initial (20/289) and final (20/158) acuities were poor, although the improvement was significant (P=0.05). However, there was no difference in visual recovery by disease (P=0.46). There was little correlation between ulcer grade and visual improvement (rs=0.24). Corneal sensation ranged from 0 to 3 cm generally for all causality of disease. There were little correlations between corneal hypoesthesia and ulcer grade (rs=-0.25), between corneal hypoesthesia and visual improvement (r=0.16), or between corneal hypoesthesia and final visual outcome (r=-0.36). A large percentage of eyes had significant ocular comorbidities. CONCLUSIONS: Visual outcomes for neurotrophic keratopathy can be poor because of both the cornea and the underlying disease. We did not find correlations regarding the causality of the disease, severity of ulceration, or degree of hypoesthesia with visual recovery or outcome. We hope future studies will shed further light on the disease to help better predict patient outcomes and thereby improve therapies.


Assuntos
Hipestesia/etiologia , Ceratite/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Úlcera da Córnea/etiologia , Úlcera da Córnea/fisiopatologia , Feminino , Humanos , Hipestesia/fisiopatologia , Ceratite/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual/fisiologia , Adulto Jovem
17.
Acta Ophthalmol ; 93(6): e481-7, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25773445

RESUMO

PURPOSE: The aim of this study was to determine the long-term treatment efficacy of glycerine-preserved human amniotic membrane transplantation in patients suffering from corneal ulcers. METHODS: This was a retrospective, non-controlled, monocentric analysis. Included were patients with corneal ulcers that were non-responsive to ointment or contact lenses and had been treated by amniotic membrane transplantation with either the overlay or sandwich procedure. Analysis parameters were visual acuity before and following treatment, recurrence rate and subjective comfort at the last follow-up. RESULTS: Of the 371 amniotic membrane transplantations that were conducted, 135 surgical treatments in 108 patients (51.9% male, 48.1% female; mean age 63.7 years) met the inclusion criteria. In total, 99 overlay and 36 multilayer amniotic membrane transplantations were performed. The follow-up period was 47.5 ± 66.7 weeks (mean ± SD). The recurrence rate at the last follow-up was 47.8% with overlay membranes and 51.8% with the sandwich technique. There was no significant change in best-corrected visual acuity following treatment with overlays (p = 0.219) or sandwich procedure (p = 0.703). At the last follow-up, 72.1% (overlay) and 78.3% (sandwich) of the patients reported either no pain or increased comfort. CONCLUSION: The recurrence rates and changes in visual acuity following overlay or sandwich amniotic membrane transplantation in patients suffering from corneal ulcer were lower than reported elsewhere in the literature. More than half of the patients profited from each of the amniotic membrane transplantation techniques with respect to recurrence and postoperative comfort.


Assuntos
Âmnio/transplante , Curativos Biológicos , Úlcera da Córnea/cirurgia , Glicerol , Soluções para Preservação de Órgãos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nylons , Recidiva , Estudos Retrospectivos , Técnicas de Sutura , Suturas , Acuidade Visual/fisiologia
18.
Cornea ; 34(3): 303-7, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25625360

RESUMO

PURPOSE: The aim of this study was to determine the effect of nicergoline in patients with neurotrophic keratopathy. METHODS: This is a prospective, noncomparative interventional study. The study included 27 eyes of 24 patients with neurotrophic keratopathy who were unresponsive to conventional therapy. Patients were treated with 10 mg of oral nicergoline twice daily for at least 2 weeks. Slit-lamp examination, photography, corneal fluorescein dye testing, Cochet-Bonnet corneal sensitivity, and best-corrected visual acuity tests were performed before and after treatment. Tear nerve growth factor levels were measured before and after treatment. RESULTS: In 23 eyes (85%), epithelial defects healed completely between 7 and 30 days of treatment with nicergoline (mean, 15.6 ± 8.0 days). Epithelial defects persisted in 4 eyes (15%). The mean corneal sensitivity before and after treatment with nicergoline was 20.5 ± 8.5 and 30.2 ± 10.8 mm, respectively (P < 0.001). The best-corrected visual acuity (measured in units according to the logarithm of the minimum angle of resolution) was significantly improved from 1.1 ± 0.6 to 0.8 ± 0.6 (P < 0.001). The tear nerve growth factor levels were significantly higher ranging from 3.2 ± 0.3 to 6.2 ± 0.3 pg/mL (P < 0.001). CONCLUSIONS: Treatment with nicergoline helps patients with neurotrophic keratopathy in whom conventional treatment has failed.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Nicergolina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Úlcera da Córnea/metabolismo , Úlcera da Córnea/fisiopatologia , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fator de Crescimento Neural/metabolismo , Estudos Prospectivos , Lágrimas/metabolismo , Acuidade Visual/fisiologia
19.
Cornea ; 34(1): 54-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25162758

RESUMO

PURPOSE: To investigate the corneal topography and visual function of patients with Mooren ulcer using 3-dimensional anterior segment optical coherence tomography (3-D AS-OCT). METHODS: Fourteen eyes of 9 patients with Mooren ulcer were studied. Pachymetric and axial power maps were obtained by 3-D AS-OCT. The axial power maps were classified into 3 patterns by visual inspection. The distribution of the corneal dioptric power was analyzed by Fourier harmonic expansion. The magnitudes of the spherical component, asymmetry, regular astigmatism, higher-order irregularity, and radial distance from the corneal vertex to the thinnest point of the lesion were determined. RESULTS: The axial power maps of 9 eyes were classified into arcuate patterns, 4 into crab-claw patterns, and 1 eye into an intermediate pattern. The radial distance from the corneal vertex to the thinnest point of the lesion was significantly shorter in the crab-claw pattern group than in the arcuate pattern group (P = 0.007). The magnitudes of asymmetry, regular astigmatism, and higher-order irregularity of the crab-claw pattern group were significantly greater than those of the arcuate pattern group (P = 0.017, P = 0.011, and P = 0.030, respectively). CONCLUSIONS: Three-dimensional AS-OCT is able to evaluate the corneal topography of opacified peripheral lesions in eyes with Mooren ulcer, and the results showed that irregular astigmatism is higher when the lesion is closer to the center of the cornea.


Assuntos
Córnea/patologia , Topografia da Córnea , Úlcera da Córnea/diagnóstico , Tomografia de Coerência Óptica , Adulto , Idoso , Paquimetria Corneana , Úlcera da Córnea/classificação , Úlcera da Córnea/fisiopatologia , Feminino , Análise de Fourier , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Acuidade Visual/fisiologia
20.
Vestn Oftalmol ; 130(4): 68-70, 2014 Jul-Aug.
Artigo em Russo | MEDLINE | ID: mdl-25306727

RESUMO

The article presents a case of severe purulent corneal ulcer in the only functional eye of a young patient with Frank-Kamenetsky glaucoma and high-degree myopia. Combination therapy was ineffective and the patient developed a descemetocele. Due to the absence of cadaver corneas and small size of the only available conserved Alloplant cornea, the contralateral cornea (of the blind eye, which was enucleated under general anesthesia) was used for urgent therapeutic penetrating autokeratoplasty. Postoperative period was complicated with ocular hypertension, which was surgically resolved. To overcome the critical situation around keratoplasty, with results from Russian regulation gaps, the authors suggest creating interregional eye banks in large cities that would provide sampling, conservation and storage control of donor material in accordance with the existing legislation.


Assuntos
Úlcera da Córnea/cirurgia , Lâmina Limitante Posterior , Ceratoplastia Penetrante , Hipertensão Ocular , Complicações Pós-Operatórias/cirurgia , Transplante Autólogo , Adulto , Cegueira/complicações , Úlcera da Córnea/complicações , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/etiologia , Úlcera da Córnea/fisiopatologia , Lâmina Limitante Posterior/patologia , Lâmina Limitante Posterior/cirurgia , Técnicas de Diagnóstico Oftalmológico , Glaucoma/complicações , Humanos , Ceratoplastia Penetrante/efeitos adversos , Ceratoplastia Penetrante/métodos , Masculino , Miopia/complicações , Hipertensão Ocular/etiologia , Hipertensão Ocular/cirurgia , Reoperação , Índice de Gravidade de Doença , Supuração , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
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