Oral pilocarpine for the treatment of dry eye in patients with Sjögren's syndrome.

PURPOSE: To evaluate the efficacy of oral pilocarpine (20 mg daily) for the treatment of dry eye in patients with Sjogren's Syndrome. The frequency of side effects reported during the treatment was also investigated. METHODS: In this placebo-controlled crossover study, 32 patients with Sjögren's syndrome were enrolled to receive either oral pilocarpine or placebo for 10 weeks. Following a 2-week washout period, the treatment was inverted for each patient for the same duration. Assessments included the quality of life National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), dry eye specific questionnaire Ocular Surface Disease Index, non-invasive breakup time, invasive breakup time with fluorescein, corneal and conjunctival staining patterns with the use of fluorescein and rose bengal staining, Schirmer's test, and tear ferning test. RESULTS: According to the NEI-VFQ-25, there was statistically significant improvement in the quality of life following oral pilocarpine. Similar results were observed for ocular discomfort, as determined by the Ocular Surface Disease Index. All clinical tests showed favorable and statistically significant results following the use of oral pilocarpine. Regarding the analysis of tear samples, there was an improvement in the quality of tear film. This was evidenced by the modification of the patterns observed in the tear ferning test. Side effects were reported by 96.8% and 56.2% of the patients who received pilocarpine and placebo, respectively. Sweating was the most frequently reported side effect (67.74% versus 11.11%, respectively). CONCLUSIONS: Although the treatment was associated with a high frequency of side effects, oral pilocarpine (20 mg daily) was able to relieve discomfort related to dry eyes in patients with Sjögren's syndrome and induce favorable structural changes in the tear film.

Primary Pediatric Keratoplasty: Etiology, Graft Survival, and Visual Outcome.

PURPOSE: Interventional study to evaluate the etiology, visual outcome and survival of corneal transplantation in children and to identify the risk factors associated with graft failure. DESIGN: Retrospective, interventional consecutive case series. METHODS: Medical records of every child 7 years of age or younger who underwent primary penetrating keratoplasty at Department of Ophthalmology, Federal University of São Paulo were reviewed. The parameters evaluated were indications for keratoplasty, graft survival, and postoperative visual acuity (VA) improvement. Children underwent ophthalmologic examination before and after corneal graft, including VA, assessed by the preferential looking test and visual evoked potential. The analysis of transplant survival was performed using the Kaplan-Meier method. RESULTS: Fifty-six penetrating transplants were performed in 51 eyes of 43 children. The patients were divided into 2 groups: congenital (72.5%) and acquired (17.5%) corneal opacity. The main indication was congenital glaucoma (29.4%). The overall Kaplan-Meier graft survival rates were 64.7% in the postoperative average follow-up period of 24 months. There was no significant difference in graft survival between the congenital and acquired groups (Mantel-Cox P = .1031). There was significant improvement in VA in both groups (P = .0022 for congenital and P < .0001 for acquired). Rejection and diagnosis of congenital glaucoma were risk factors for graft failure. CONCLUSIONS: Congenital glaucoma was the main indication for corneal transplantation and despite the difficulties, prolonged survival and improved VA can be achieved in pediatric transplant. Complications such as rejection and early glaucoma were significantly associated with graft failure.

[Ten years of corneal donation to the Hospital São Paulo Eye Bank: characteristics of cornea donors from 1996 to 2005]. / Dez anos de doação de córneas no Banco de Olhos do Hospital São Paulo: perfil dos doadores de 1996 a 2005.

BACKGROUND: Despite all efforts towards the improvement of the eye bank system, the shortage of corneal tissue for transplant is still an important issue in Brazil. The Hospital São Paulo Eye Bank aims to provide high-quality ocular tissues for surgery starting with rigorous selection of donors. PURPOSE: To investigate the characteristics of cornea donors to the Hospital São Paulo Eye Bank during a 10-year period. METHODS: Retrospective analysis of Hospital São Paulo Eye Bank records from January 1996 to December 2005. RESULTADS: 3,624 corneas were evaluated by the Hospital São Paulo Eye Bank during this 10-year period. Mean age of donors was 56.8 years the highest proportion being in the 70-79 years age category. The most common cause of death was cardiovascular disease followed by cancer and trauma. Mean "enucleation" and "preservation" times were 3.8 and 3.6 hours, respectively. The number of corneas received by our eye bank from other eye banks decreased substantially whereas the number of corneas harvested by the Hospital São Paulo Eye Bank staff increased. Optisol GS(R) were the most utilized preservation media and a high proportion of corneas classified as "Excellent" or "Good" came from young donors. CONCLUSIONS: In a period of 10 years, there was a decreasing trend in the number of donated corneas provided by other eye banks to the Hospital São Paulo Eye Bank and an increase in the number of corneas harvested and processed by the Hospital São Paulo Eye Bank staff with a significant reduction of preservation time. Most donors were male and the main cause of death was cardiovascular disease. Although a great proportion of donated corneas came from older donors, the majority of corneas used for optical transplants came from younger ones.

[Reproducibility of the classification of ocular ferning patterns in Sjogren's syndrome patients]. / Reprodutibilidade na classificação do teste de cristalização do filme lacrimal em pacientes com síndrome de Sjögren.

PURPOSE: To verify the reproducibility of Rolando's classification of the tear ferning test using five different examiners and to compare the patterns of crystallization found in Sjögren's syndrome patients and normal subjects. METHODS: Tear ferning analysis of 29 patients with Sjögren's syndrome and of 45 patients without ocular disease were done using polarized light microscopy and the Rolando classification for tear ferning. Five examiners classified the ferning patterns of all the patients. ROC curve (Receiver Operating Characteristic) was used to find out the best score for the correct syndrome diagnosis. Kappa index (p<0.0001) was used to compare the results of the examiners among them and check the test's reproducibility. Charts were drawn to compare the two groups' results. RESULTS: Throught the ROC curve the score of 2.50 for diagnosis of Sjögren's syndrome was stablished. Considering the aggregated patterns I with II and III with IV, the examiners' level of pattern agreement was excellent (Kappa ranging from 0.82 to 0.97, p<0.0001). The group with Sjögren's syndrome was classified mostly as patterns III and IV and the patients without ocular disease mostly as I and II. CONCLUSION: The patterns associated with Sjögren's syndrome and normal patients matched the ones in the literature. The tear ferning test classification is reproductible when the Rolando classification was used for Sjögren's syndrome patients.

Oral pilocarpine for the treatment of dry eye in patients with Sjögren's syndrome / Pilocarpina oral no tratamento do olho seco de pacientes com síndrome de Sjögren

ABSTRACT Purpose: To evaluate the efficacy of oral pilocarpine (20 mg daily) for the treatment of dry eye in patients with Sjogren's Syndrome. The frequency of side effects reported during the treatment was also investigated. Methods: In this placebo-controlled crossover study, 32 patients with Sjögren's syndrome were enrolled to receive either oral pilocarpine or placebo for 10 weeks. Following a 2-week washout period, the treatment was inverted for each patient for the same duration. Assessments included the quality of life National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), dry eye specific questionnaire Ocular Surface Disease Index, non-invasive breakup time, invasive breakup time with fluorescein, corneal and conjunctival staining patterns with the use of fluorescein and rose bengal staining, Schirmer's test, and tear ferning test. Results: According to the NEI-VFQ-25, there was statistically significant improvement in the quality of life following oral pilocarpine. Similar results were observed for ocular discomfort, as determined by the Ocular Surface Disease Index. All clinical tests showed favorable and statistically significant results following the use of oral pilocarpine. Regarding the analysis of tear samples, there was an improvement in the quality of tear film. This was evidenced by the modification of the patterns observed in the tear ferning test. Side effects were reported by 96.8% and 56.2% of the patients who received pilocarpine and placebo, respectively. Sweating was the most frequently reported side effect (67.74% versus 11.11%, respectively). Conclusions: Although the treatment was associated with a high frequency of side effects, oral pilocarpine (20 mg daily) was able to relieve discomfort related to dry eyes in patients with Sjögren's syndrome and induce favorable structural changes in the tear film.

RESUMO Objetivos: Avaliar o alívio de sintomas e sinais relacionados à secura ocular e na qualidade de vida de pacientes com síndrome de Sjögren tratados com o uso oral de pilocarpina na dose diária de 20mg. A frequência dos efeitos colaterais relatados com o tratamento também foi estudada. Métodos: Trata-se de estudo cruzado e placebo-controlado, que envolveu 32 pacientes com síndrome de Sjögren em uso de pilocarpina oral ou placebo, por dez semanas. Após duas semanas sem medicações, houve a inversão dos tratamentos para cada paciente, por mais dez semanas. As avaliações foram feitas por meio do questionário de qualidade de vida NEI-VFQ-25, questionário olho seco específico Ocular Surface Disease Index, tempo de ruptura do filme lacrimal não invasivo, tempo de ruptura do filme lacrimal com fluoresceína, avaliação da superfície ocular com os corantes fluoresceína e rosa Bengala, teste de Schirmer e teste de cristalização do filme lacrimal. Resultados: Houve melhora estatisticamente significante na qualidade de vida medida pelo questionário NEI-VFQ-25 e no desconforto ocular avaliado pelo Ocular Surface Disease Index, após o tratamento. Todos os testes clínicos sofreram influência favorável e estatisticamente significante durante a fase de tratamento com pilocarpina oral. Em relação à análise de amostras de lágrimas, ocorreram alterações estruturais indicando melhora no padrão de cristalização do filme lacrimal. Os efeitos colaterais com o uso de pilocarpina foram relatados por 96,8% dos pacientes com a pilocarpina e 56,2% com placebo. Sudorese foi o efeito colateral mais frequentemente relatado (pilocarpina = 67,74%; placebo = 11,11%). Conclusões: O uso oral de pilocarpina na dose diária de 20mg foi capaz de aliviar as queixas de desconforto relacionadas ao ressecamento ocular em pacientes com síndrome de Sjögren, produzir impacto positivo na qualidade de vida dos pacientes e induzir mudanças estruturais favoráveis no filme lacrimal, embora os efeitos colaterais relatados tenham ocorrido com alta frequência.

[Artificial neural networks applied to study allergic conjunctivitis screening questionnaire]. / Redes neurais artificiais aplicadas no estudo de questionário de varredura para conjuntivite alérgica em escolares.

PURPOSE: To evaluate sensibility and specificity of a screening questionnaire with multivariable analysis, compare them and elaborate an artificial neural network for future screenings. METHODS: Observational, transversal study performed at UNIFESP, with 48 patients with allergic conjunctivitis and 54 children without the disease. Their age ranged between 3 and 14 years and there was no restriction related to gender, systemic allergy or treatment. The questionnaire was applied and multivariable statistical analysis was performed. Finally, an artificial neural network was elaborated. RESULTS: Mean age was 8.4 years (7-13) and male gender was more frequent (60.7%). Mean score was 10.04 (0-18), and it was higher in the study group (p < 0.001). Allergic diagnosis was increased with the inclusion of the fifth question in 68.8%. Kappa coefficient was low (0.337; p = 0.071) and showed no agreement between diagnosis made by the questionnaire and clinical examination. Only the question number five had good sensitivity (85.4%) and specificity (85.1%). The cutoff point to separate allergic patients was 10 (sensitivity = 77.08% and specificity = 79.63%). The artificial neural network predicted allergic diagnosis in 100% using 7 of the 15 existent items. CONCLUSIONS: An efficient model was developed using seven questions, in a manner that its application might be easy to large populations.

Amniotic membrane for reducing the formation of adhesions in strabismus surgery: experimental study in rabbits.

PURPOSE: To evaluate the effect of amniotic membrane in reducing inflammation, fibrosis, adhesion formation, and ocular motility restrictions following strabismus surgery. METHODS: In the first stage of this prospective, randomized study, 17 rabbits underwent superior rectus muscle recession in both eyes. Surgery was performed in the same manner, but human amniotic membrane was placed over the muscle without sutures in the right eye after recession. After 15 days, the rabbits were killed and their orbits were exenterated and evaluated histopathologically to quantify tissue inflammation and fibrosis. In the second stage, 5 rabbits underwent the same procedure but were killed after 30 days. A dynamometer was used to measure the force required to displace all eyes. RESULTS: At 15 days postoperatively, eyes with amniotic membrane exhibited an increased inflammatory response and less fibrosis than eyes without amniotic membrane. At 30 days postoperatively, eyes with amniotic membrane continued to exhibit increased inflammation and less fibrosis than eyes without amniotic membrane. In the dynamometer test, more force was needed to displace eyes without amniotic membrane after 15 days, but there was no significant difference between the forces required at 30 days. CONCLUSIONS: Human amniotic membrane in rabbits led to an increase in the inflammatory process and a decrease in fibrosis formation following strabismus surgery.

Induction of corneal collagen cross-linking in experimental corneal alkali burns in rabbits.

Objective: To evaluate the effect of riboflavin-ultraviolet-A-induced cross-linking (CXL) following corneal alkali burns in rabbits. Methods: The right corneas and limbi of ten rabbits were burned using a 1N solution of NaOH and the animals were then divided into two groups: a control group submitted to clinical treatment alone and an experimental group that was treated 1 h after injury with CXL, followed by the same clinical treatment as administered to the controls. Clinical parameters were evaluated post-injury at 1, 7, 15, and 30 days by two independent observers. Following this evaluation, the corneas were excised and examined histologically. Results: There were no statistically significant differences in clinical parameters, such as hyperemia, corneal edema, ciliary injection, limbal ischemia, secretion, corneal neovascularization, symblepharon, or blepharospasm, at any of the time-points evaluated. However, the size of the epithelial defect was significantly smaller in the CXL group (p<0.05) (day 15: p=0.008 and day 30: p=0.008) and the extent of the corneal injury (opacity lesion) was also smaller (day 30: p=0.021). Histopathology showed the presence of collagen bridges linking the collagen fibers in only the CXL group. Conclusions: These results suggest that the use of CXL may improve the prognosis of acute corneal alkali burns.

Ultrasound biomicroscopy after palliative surgical procedures for bullous keratopathy: a descriptive comparative study.

PURPOSE: To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. METHODS: The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. RESULTS: In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively (p<0.001); mean ET, 102.1 µm preoperatively and 245.2 µm postoperatively (p<0.001); and mean ST, 654.6 µm preoperatively and 681.5 µm postoperatively (p<0.999). Correlations between CCT and pain intensity in the AMT group (p=0.209 pre- and postoperatively) and the ASP group (p=0.157 preoperatively and p=0.426 at the 180-day follow-up) were not statistically significant. Epithelial and stromal edema, Descemet's membrane folds, epithelial bullae, and the presence of interface fluid were frequently observed qualitative features. CONCLUSION: CCT increased over time in both groups. The magnitude of CCT did not correlate with pain intensity in the sample studied. The presence of interface fluid was a qualitative feature specifically found in some patients who underwent AMT.

Keratoconus and corneal stability after radial keratectomy in the fellow eye: case report.

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.

Amniotic membrane transplantation versus anterior stromal puncture in bullous keratopathy: a comparative study.

PURPOSE: To compare amniotic membrane transplantation (AMT) and anterior stromal puncture (ASP) in the management of pain in patients with symptomatic bullous keratopathy (BK). METHODS: In this prospective comparative study, 40 eyes of 40 patients with symptomatic BK (chronic intermittent pain) were randomised and divided into two groups (AMT and ASP) according to the technique used to treat symptomatic BK. The patients were examined on days 1, 14, 30, 90 and 180 postoperatively. Patients with BK under the age of 18 with raised eye pressure, concurrent ocular surface infection and those without any pain were excluded. RESULTS: At follow-up at 90 and 180 days the presence of a regular epithelial surface was higher in the AMT group (60% and 50%, respectively) than in the ASP group (16.7% and 6. 3%, p=0.006 and p=0.008, respectively). At 180 days follow-up there was no statistical difference between the two groups in the severity (p=0.391) or duration (p=0.715) of pain. CONCLUSIONS: AMT is similar to ASP in the relief of pain in symptomatic BK. However, ASP is a simple outpatient procedure and should cost less than AMT. NCT 00659308.

[Distribution of infectious keratitis in a tertiary hospital in Brazil]. / Distribuição das ceratites infecciosas em hospital terciário no Brasil.

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.

[Characteristics of corneal donors in the Cascavel Eye Bank: impact of the anti-HBc test for hepatitis B]. / Características dos doadores de córneas do Banco de Olhos de Cascavel: impacto do exame anti-HBc para hepatite B.

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.

Impression cytology findings in bullous keratopathy.

AIM: To evaluate, by impression cytology (IC), the cytological features of the central area of corneal epithelial surface of patients with symptomatic bullous keratopathy (BK). Design Cross-sectional observational case series. METHODS: IC of the central cornea was performed in 72 eyes of 72 patients with symptomatic BK between June 2005 and December 2006. Patients were divided into two groups according to the presence (group GC) or not of goblet cells (group NGC). The diagnosis of limbal stem cell deficiency (LSCD) was defined by the presence of one or more intact goblet cells on the corneal surface. Squamous metaplasia was classified according to Murube and Rivas. RESULTS: Epithelial squamous metaplasia was found in 72 (100%) eyes, along with conjunctival goblet cells in 25 (34.72%) eyes. Squamous metaplasia was grade 1 in group GC and more advanced grades in group NGC. Corneal neovascularisation was present in 62 (82.11%) eyes. Vessel measure was more than 4 mm in 11 eyes (23.4%) in group NGC and 10 eyes (40%) in group GC (p=0.559), and they were mostly subepithelial in 23 eyes (48.9%) in group NGC and 12 (48%) eyes in group GC (p=0.822). CONCLUSION: Squamous metaplasia was the most frequent finding associated with advanced BK. The presence of goblet cells on the surface of corneas with squamous metaplasia grade 1, in a significant number of patients, suggests that limbal stem cell deficiency is a common condition associated with advanced cases of BK.

[Factors associated with quality of donated corneas in the Hospital São Paulo Eye Bank]. / Fatores associados à qualidade da córnea doada pelo Banco de Olhos do Hospital São Paulo.

PURPOSE: To investigate factors associated with the morphological quality of corneal tissue at the Hospital São Paulo Eye Bank (BOHSP) - UNIFESP. METHODS: Retrospective study of records from the BOHSP between 2001 and 2006. Information about donors such as age, gender, and cause of death were collected as well as time between death and enucleation (time-to-enucleation), time between enucleation and tissue preservation (time-to-preservation), preservation media, and source of corneal tissue. Biomicroscopic examination was performed in preserved corneas which were classified as 'Excellent' or 'Good' (group A) or 'Regular', 'Bad', or 'Unacceptable' (group B). Multivariate logistic regression models were used to assess factors that were independently associated with corneal quality. RESULTS: Data from 870 cornea donors were analyzed. The mean +/- standard error age in groups A and B was 40.7 +/- 16.1 and 56.3 +/- 17.5 years, respectively (p<0.01). Time-to-preservation was significantly lower in group A (5.2 vs. 6.6 hours, p<0.01). There was no statistically significant difference between the two groups regarding gender (p=0.82) and time-to-enucleation (p=0.17). A higher proportion of traumas was observed in group A compared to group B (p<0.01). Overall, Optisol was the most commonly used preservation medium and approximately half of the corneas were harvested by BOHSP. Factors that were independently associated with corneal quality were: age (Odds ratio 95% CI, 1.05 (1.04 - 1.06), for 1 year), time-to-preservation (1.05 (1.02 - 1.08), for 1 hour), source (1.53 (1.12 2.09), for Others vs. BOHSP) and cause of death (2.06 (1.43 -2.96), for Chronic diseases vs. External causes). CONCLUSIONS: This study showed some factors that were independently associated with morphological quality of donated corneas in the BOHSP such as age, time-to-preservation, source, and cause of death. Similar studies are necessary in order to determine factors that might influence the quality of corneas delivered to ophthalmic surgeons.

[Discarded corneas due to positive donor's serologic test in the Hospital São Paulo Eye Bank: a two-year study]. / Descarte de córneas por sorologia positiva do doador no Banco de Olhos do Hospital São Paulo: dois anos de estudo.

PURPOSE: To investigate discarded corneas due to positive serologic tests in donors from the Hospital São Paulo Eye Bank (BOHSP) during a two-year period. METHODS: Retrospective study of records from cornea donors between January 2006 and December 2007. Information such as serologic test results (Hepatitis B, C, and HIV), source of corneal tissue, donor's gender and age were tested for correlation. RESULTS: 902 corneas were processed by BOHSP; 12.9% (116) were discarded due to donor's positive test for hepatitis B, C, or HIV; 20.5% (185) were also discarded due to inconclusive result of serological tests; percentage of corneas discarded due to positive or inconclusive serological tests during this period was 33.4% (301). CONCLUSION: This study confirms the importance of serological tests in order to prevent disease transmission to corneal transplant recipients. However, new tests are necessary to decrease the number of inconclusive tests and decrease the number of discarded corneas.

Induction of corneal collagen cross-linking in experimental corneal alkali burns in rabbits / Indução de ligações covalentes de colágeno em queimaduras corneanas experimentais por álcali em coelhos

Objective: To evaluate the effect of riboflavin-ultraviolet-A-induced cross-linking (CXL) following corneal alkali burns in rabbits. Methods: The right corneas and limbi of ten rabbits were burned using a 1N solution of NaOH and the animals were then divided into two groups: a control group submitted to clinical treatment alone and an experimental group that was treated 1 h after injury with CXL, followed by the same clinical treatment as administered to the controls. Clinical parameters were evaluated post-injury at 1, 7, 15, and 30 days by two independent observers. Following this evaluation, the corneas were excised and examined histologically. Results: There were no statistically significant differences in clinical parameters, such as hyperemia, corneal edema, ciliary injection, limbal ischemia, secretion, corneal neovascularization, symblepharon, or blepharospasm, at any of the time-points evaluated. However, the size of the epithelial defect was significantly smaller in the CXL group (p<0.05) (day 15: p=0.008 and day 30: p=0.008) and the extent of the corneal injury (opacity lesion) was also smaller (day 30: p=0.021). Histopathology showed the presence of collagen bridges linking the collagen fibers in only the CXL group. Conclusions: These results suggest that the use of CXL may improve the prognosis of acute corneal alkali burns. .

Objetivo: Avaliar o efeito de ligações covalentes de colágeno (cross-linking [CXL]) induzidas pelo tratamento com riboflavina e radiação ultravioleta A após queimaduras por álcali em córneas de coelhos. Métodos: Dez coelhos foram submetidos a queimadura ocular direita abrangendo estruturas da córnea e limbo usando uma solução de NaOH a 1N. A seguir, os animais foram divididos em dois grupos: um grupo controle submetido a tratamento clínico pós dano corneano e um grupo experimental que foi tratado com CXL uma hora após o dano, seguido pelo mesmo tratamento clínico administrado aos controles. Os parâmetros clínicos foram avaliados 1, 7, 15 e 30 dias após a lesão, por dois observadores independentes. Na etapa seguinte, foi realizada a excisão e o exame histológico das córneas. Resultados: Não houve diferenças estatisticamente significantes nos parâmetros clínicos de hiperemia, edema da córnea, injeção ciliar, isquemia límbica, secreção, neovascularização da córnea, simbléfaro ou blefaroespasmo, em qualquer dos momentos da avaliação. Entretanto, o grupo CXL apresentou um defeito epitelial menor (p<0,05) (dia 15: p=0,008 e dia 30: p=0,008) e menor extensão da lesão na córnea (lesão opaca) (dia 30: p=0,021). O exame histopatológico revelou a presença de pontes de colágeno conectando as fibras de colágeno somente no grupo CXL. Conclusões: Estes resultados sugerem que o uso de CXL pode melhorar o prognóstico de queimaduras agudas da córnea causadas por alcáli. .

Ultrasound biomicroscopy after palliative surgical procedures for bullous keratopathy: a descriptive comparative study / Biomicroscopia ultrassônica após procedimentos cirúrgicos paliativos na ceratopatia bolhosa: estudo comparativo descritivo

Purpose: To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. Methods: The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. Results: In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively (p<0.001); mean ET, 102.1 µm preoperatively and 245.2 µm postoperatively (p<0.001); and mean ST, 654.6 µm preoperatively and 681.5 µm postoperatively (p<0.999). Correlations between CCT and pain intensity in the AMT group (p=0.209 pre- and postoperatively) and the ASP group (p=0.157 preoperatively and p=0.426 at the 180-day follow-up) were not statistically significant. Epithelial and stromal edema, Descemet’s membrane folds, epithelial bullae, and the presence of interface fluid were frequently observed qualitative features. Conclusion: CCT increased over time in both groups. The magnitude of CCT did not correlate with pain intensity in the sample studied. The presence of interface ...

Objetivo: Descrever as características quantitativas e qualitativas da biomicroscopia ultrassônica (UBM) em olhos com ceratopatia bolhosa avançada, antes e após os procedimentos de punção estromal anterior (ASP) ou transplante de membrana amniótica (AMT) para alívio de dor crônica. Métodos: Estudo comparativo descritivo incluindo 40 olhos de 40 pacientes com dor crônica intermitente devido a ceratopatia bolhosa, randomizados em duas modalidades de tratamento (AMT e ASP). Biomicroscopia ultrassônica (Humphrey, UBM 840, transdutor de 50 MHz, técnica de imersão) foi utilizada, e um questionário de avaliação da intensidade da dor foi aplicado no pré-operatório, e após 90 e 180 dias de pós-operatório. Critérios de exclusão foram: idade abaixo de 18 anos, presença de infecção, hipertensão ocular, e ausência de dor. Resultados: No seguimento de 180 dias, o grupo Transplante de membrana amniótica apresentou: média da espessura corneana central (CCT): 899,4 µm (pré), 1.122,5 µm (pós-operatório) (p<0,001); média da espessura epitelial (ET): 156,4 µm (pré), 247,8 µm (pós-operatório) (p<0,001); média da espessura estromal (ST): 742,9 µm (pré), 826,3 µm (pós-operatório) (p=0,005), e, grupo ASP apresentou: CCT média: 756.7 µm (pré), 914,8µm (pós-operatório) (p<0,001); ET média: 102,1 µm (pré), 245,2 µm (pós-operatório) (p<0,001); ST média: 654,6 µm (pré), 681.5 µm (pós-operatório) (p<0,999). A correlação entre intensidade da dor e espessura corneana central no grupo AMT (p=0,209 pré e pós-operatórios) e no grupo ASP (p=0,157 pré-operatório e p=0,426 aos 180 dias de seguimento) não foi significativa. Edema epitelial e estromal, dobras na membrana de Descemet, bolhas epiteliais, e presença de fluido na interface foram características qualitativas frequentemente observadas. Conclusão: A espessura corneana central aumentou ao longo do tempo em ambos os grupos. A magnitude da espessura corneana central não interfere na intensidade da dor ...

Keratoconus and corneal stability after radial keratectomy in the fellow eye: case report / Ceratocone e estabilidade corneana após ceratectomia radial no outro olho: relato de caso

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.

Distribuição das ceratites infecciosas em hospital terciário no Brasil / Distribution of infectious keratitis in a tertiary hospital in Brazil

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.