Peperomia pellucida (L.) Kunth and eye diseases: A review on phytochemistry, pharmacology and toxicology / 中西医结合学报

Peperomia pellucida (L.) Kunth is a medicinal plant used to manage inflammatory illnesses such as conjunctivitis, and gastrointestinal and respiratory tract disorders in tropical and subtropical regions. However, little is known about its pharmacological mechanism of action against eye diseases. This review aims to critically discuss the phytochemistry, pharmacology and toxicology of P. pellucida as well as its roles in the treatment of cataract, glaucoma and diabetic retinopathy. Recent developments in the uses of P. pellucida for healthcare and nutraceutical products by the pharmaceutical industry are also covered in this review. For this review, a literature search was performed with PubMed, ScienceDirect, SciFinder Scholar and Scopus databases, using relevant keywords. Among the various phytochemicals identified from P. pellucida, β-caryophyllene, carotol, dillapiole, ellagic acid, pellucidin A, phytol and vitexin exhibit strong pharmacological activities within the mitogen-activated protein kinase and nuclear factor-κB signalling pathways in inflammatory eye diseases. The antihypertensive, anti-inflammatory, antioxidant, antihyperglycemic and anti-angiogenic activities displayed by P. pellucida extracts in many in vitro, in vivo and clinical studies suggest its potential role in the management of inflammatory eye diseases. P. pellucida extract was non-toxic against normal cell lines but displayed mild toxicity in animal models. The growing public interest in P. pellucida has inspired the nutraceutical and pharmaceutical industries to process the plant into health products. Although the potential pharmacological mechanisms against eye diseases have been summarized, further studies of the interactions among constituent phytochemicals from P. pellucida within various signalling pathways shall support the use of the plant as an alternative therapeutic source.

Manifestações oculares na febre Chikungunya / Ocular Manifestations of Chikungunya Fever

Resumo A febre Chikungunya é um problema de saúde pública mundial, com potencial para gerar epidemias de alta morbidade, visto que elevado número de pacientes pode apresentar sequelas articulares prolongadas e alterações oftalmológicas. As manifestações oftalmológicas podem estar presentes na fase aguda da doença ou ter início após várias semanas da instalação do quadro. Na literatura mundial é descrito desde alterações mais comuns e de fácil tratamento como conjuntivites até alterações mais complexas e que podem cursar com sequelas visuais graves como a retinite e neurite óptica.

Abstract Chikungunya fever is a world public health problem with the potential to generate epidemics of high morbidity, since a high number of patients may present prolonged joint sequelae and ophthalmological alterations. Ophthalmologic manifestations may be present in the acute phase of the disease or begin after several weeks of the onset of the disease. In the world literature is described from more common and easy to treat changes such as conjunctivitis to more complex changes and that can occur with severe visual sequelae such as retinitis and optic neuritis.

Cuestiones bioéticas relacionadas con el acceso a medicamentos en el ejercicio de la oftalmología en Colombia / Bioethical issues on the access to drugs in the practice of ophthalmology in Colombia

Resumen La oftalmología se constituye como una especialidad de alto costo en lo que respecta a tratamiento médico, quirúrgico y de innovación tecnológica. Es preocupante que en algunos países los pacientes se vean afectados en su salud visual, y por ende en su calidad de vida, por no contar con los recursos necesarios para un acceso oportuno a medicamentos, citas médicas o procedimientos quirúrgicos. A partir de la búsqueda de artículos relacionados con cuestiones bioéticas y el acceso a medicamentos en el ejercicio de la oftalmología en cuatro bases de datos electrónicas (ScienceDirect, MEDLINE/PubMed, ClinicalKey y SciELO ), así como en libros de bioética y leyes de la jurisdicción colombiana, realizamos una reflexión sobre el problema del acceso a los medicamentos oftalmológicos, centrándonos en el interés por la aplicación de la bioética en la práctica clínica y en el acceso a medicamentos de los pacientes con patologías oftalmológicas. Las consideraciones éticas se abordan desde una mirada del modelo principialista de Beauchamp y Childress, en especial considerando el principio de justicia, de modo que brinde a los profesionales de la salud en este campo, argumentos para la toma de decisiones médicas y éticas que beneficien la atención y el acceso a medicamentos de los pacientes con patologías oftalmológicas.

Abstract Ophthalmology is a high-cost specialty in terms of medical, surgical and technological innovation and treatment. It is worrisome that in some countries patients are affected in their visual health, and therefore in their quality of life because they do not have the necessary resources for timely access to medications, medical appointments or surgical procedures. We searched in four electronic databases (ScienceDirect, MEDLINE/PubMed, ClinicalKey and SciELO), as well as in books on bioethics and Colombian laws, for articles related to bioethical issues and access to medicines in the exercise of ophthalmology. We reflect on the problem of access to ophthalmological drugs, with particular interest on how to apply the principles of bioethics on the clinical practice of patients with ophthalmological conditions. Ethical considerations are approached from the principles of Beauchamp and Childress, especially regarding the principle of justice, in order to provide health professionals in this field with arguments for medical and ethical decisions that benefit the healthcare and access to medicines for patients with ophthalmological conditions.

Nature as a source of drugs for ophthalmology / Natureza como fonte de drogas para oftalmologia

ABSTRACT Nature has always provided an unlimited source of biologically-active compounds. Since the beginning of mankind, humans have sought resources in fauna and flora to treat eye diseases. However, it was only after the Industrial Revolution that extracts of plants and substances of animal origin could be used safely, as has been determined by controlled interventional studies. Two major challenges faced by ocular pharmacology are the following: developing drugs that are able to reduce blindness due to glaucoma; and controlling the pain associated with eye surgery. The search for a drug that effectively lowers intraocular pressure and controls the progression of glaucoma has led to the development of various ocular hypotensive agents, such as physostigmine from the Physostigma venenosum plant. The anesthetic properties of cocaine, extracted from Erythroxylon coca, finally enabled surgical procedures in the eye. Several new natural compounds have been investigated in an attempt to identify substances with the potential to provide additional benefits to eye tissue and vision. Emerging evidence of anti-inflammatory, wound-healing, antimicrobial, antioxidant, antitumor, and antiangiogenic properties attributed to plant extracts and animal tissues has encouraged more investment in research in this area. Despite technological advances in synthesizing drugs, the pharmaceutical industry still seeks new active compounds from natural sources as well as from revisiting already-established naturally derived compounds. Although a large number of naturally-occurring compounds is known, this review article focuses on the bioactive substances with scientifically-proven benefits for ocular tissues.

RESUMO A natureza sempre se forneceu uma fonte inesgotável compostos biologicamente ativos. Desde o início da humanidade, os homens buscaram recursos na fauna e flora para tratar as doenças oculares. Porém, foi somente após a Revolução Industrial que extratos de plantas e substâncias de origem animal puderam ser utilizados com segurança, como foi determinado por estudos controlados de intervenção. Dois grandes desafios enfrentados pela farmacologia foram: desenvolver drogas capazes de reduzir a cegueira pelo glaucoma; e controlar a dor associada à cirurgia ocular. A busca por uma droga que efetivamente reduza a pressão intraocular e controle a progressão do glaucoma levou ao desenvolvimento de diversos hipotensores oculares, como a physostigmine da planta Physostigma venenosum. As propriedades anestésicas da cocaína, extraídas da Erythroxylon coca, finalmente permitiram procedimentos cirúrgicos no olho. Vários novos compostos naturais foram investigados na tentativa de identificar substâncias com potencial para fornecer benefícios adicionais ao tecido ocular e à visão. Evidências emergentes de propriedades anti-inflamatórias, de cicatrização de feridas, antimicrobianas, antioxidantes, antitumorais e antiangiogênicas atribuídas a extratos de plantas e tecidos animais estimularam mais investimentos em pesquisas nessa área. Apesar dos avanços tecnológicos na síntese de drogas, a indústria farmacêutica ainda busca novos princípios ativos a partir de fontes naturais, bem como revisita drogas derivadas já estabelecidas. Embora um grande número de compostos que ocorrem naturalmente seja conhecido, este artigo de revisão concentra-se nas substâncias bioativas com benefícios cientificamente comprovados para os tecidos oculares.

O uso do concentrado de plaquetas na oftalmologia: uma revisão de literatura / The use of platelet rich-plasma in Ophthalmology: a literature review

Resumo Esta revisão tem por objetivo elencar as condições oftalmológicas em que tem sido utilizado o concentrado de plaquetas (CP), assim como as suas propriedades bioquímicas e fisiológicas. O CP possui tanto o potencial anticatabólico, presente no soro autólogo, quanto substâncias com propriedades anabólicas, que em conjunto são responsáveis pelos seus benefícios no tratamento de doenças da superfície ocular. Atualmente há um lapso de ensaios clínicos neste tema, tanto na oftalmologia como em outras áreas médicas, existindo mais estudos e relatos sobre o uso de soro autólogo. Em oftalmologia, o CP tem sido usado no tratamento do olho seco sintomático, úlceras corneanas, queimaduras oculares dentre outras aplicações, sendo uma alternativa eficaz em diversas patologias oculares; portanto, é evidente a importância de mais estudos nesse tema, para comprovar a efetividade do produto.

Abstract The aim of this review is to list the ophthalmological conditions in which platelet concentrate (CP) has been used, as well as its biochemical and physiological properties. The CP has both anticatabolic potential, present in autologous serum, and substances with anabolic properties, which together are responsible for its benefits in the treatment of ocular surface diseases. There is currently a shortage of clinical trials in this area, both in ophthalmology and other medical areas, with more studies and reports on the use of autologous serum. In ophthalmology, CP has been used in the treatment of symptomatic dry eye, corneal ulcers and ocular burns, among other applications, being an effective alternative in several ocular pathologies; therefore, it's evident the importance of more studies in this topic to prove the efficiency of this product.

Supervivencia libre de enucleación de pacientes con diagnóstico de retinoblastoma tratados con quimioterapia intraarterial en el Hospital Universitario de San Vicente Fundación / Enucleation free survival of patients with retinoblastoma diagnosis treated with intraarterial chemotherapy at University-Based San Vicente Fundacion Hospital

Objetivo: describir la supervivencia libre de enucleación, respuesta al tratamiento y complicaciones de los pacientes sometidos a tratamiento con quimioterapia intraarterial (QIA) para el control del retinoblastoma en el Hospital Universitario de San Vicente Fundación (HUSVF). Tipo de estudio: estudio de cohortes. Materiales y Métodos: se incluyeron todos los pacientes con diagnóstico de retinoblastoma tratados en el husvf con qia supraselectiva de la arteria oftálmica entre agosto del 2011 y agosto de 2013. Resultados: se realizó tratamiento a 21 pacientes, 24 ojos, en un periodo de 23.5 meses. La edad media al momento de inicio de la QIA fué 19 meses (rango 5-60 meses) con un seguimiento promedio de 9.3 meses (rango 3 semanas a 23.5 meses). Se realizaron 78 cateterizaciones, siendo 9 de ellas bilaterales. El salvamento ocular se alcanzó en el 100% de los Grupo A (n1), 100% B (n=2), 100% C (n=5) y 87.5% D (n=16), según la Clasificación Internacional para Retinoblastoma (CIRB). Sólo se reportaron dos eventos adversos importantes, una hemiparesia transitoria y una reacción alérgica severa. Ninguno de los pacientes ha fallecido, ha tenido compromiso metastásico o necesidad de radioterapia externa. Sólo se realizaron dos enucleaciones. La media de supervivencia de los 24 globos oculares tratados es de 10.4 meses ± 1.6. La media de supervivencia de los 21 pacientes tratados es de 10.4 meses ±1.7. Conclusiones: los resultados muestran una respuesta satisfactoria, constituyéndose la QIA como procedimiento seguro y con baja tasa de complicaciones en el tratamiento del retinoblastoma.

Purpose: to describe globe salvage, treatment response and complications of patients following intra-arterial chemotherapy (IAC) for retinoblastoma at Hospital Universitario de San Vicente Fundacion (HUSVF). Type of study: Cohort Study. Materials and methods: We included all patients diagnosed with retinoblastoma and treated with IAC between from August 2011 to August 2013. Results: A total of 21 patients, with a total of 24 eyes, were treated with IAC over a period of 23.5 months. The mean age of patients at time of treatment was 19 months (range 5-60 months) with a mean follow-up time of 9.3 months (range 3 weeks to 23.5 months). 78 catheterizations were performed, nine of them being bilateral. Ocular salvage rate was achieved in 100% of the Group A (n1), 100% in group B (n = 2), 100% in group C (n = 5) and 87.5% in group D (n = 16), according to the International Classification for Retinoblastoma. Only two major adverse events were reported, a transient hemiparesis and a severe allergic reaction. No deaths, metastatic involvement or need for external beam radiotherapy were reported. Two eyes, from group D, required enucleation. The mean survival rate of 24 eyes treated was 10.4 months ± 1.6. The mean survival rate of the 21 patients treated was 10.4 ± 1.7 months. Conclusions: The results show a satisfactory response, becoming the IAC a safe procedure with a low complication rate in retinoblastoma treatment.

A Case of Ocular Toxocariasis Successfully Treated with Albendazole and Triamcinolon

We present a case of ocular toxocariasis treated successfully with oral albendazole in combination with steroids. A 26-year-old male visited the authors' clinic with the chief complaint of flying flies in his right eye. The fundus photograph showed a whitish epiretinal scar, and the fluorescein angiography revealed a hypofluorescein lesion of the scar and late leakage at the margin. An elevated retinal surface and posterior acoustic shadowing of the scar were observed in the optical coherence tomography, and Toxocara IgG was positive. The patient was diagnosed with toxocariasis, and the condition was treated with albendazole (400 mg twice a day) for a month and oral triamcinolone (16 mg for 2 weeks, once a day, and then 8 mg for 1 week, once a day) from day 13 of the albendazole treatment. The lesions decreased after the treatment. Based on this study, oral albendazole combined with steroids can be a simple and effective regimen for treating ocular toxocariasis.

Thelazia rhodesii in the African Buffalo, Syncerus caffer, in Zambia

We report 2 cases of Thelazia rhodesii infection in the African buffaloes, Syncerus caffer, in Zambia. African buffalo calves were captured from the livestock and wildlife interface area of the Kafue basin in the dry season of August 2005 for the purpose to translocate to game ranches. At capture, calves (n=48) were examined for the presence of eye infections by gently manipulating the orbital membranes to check for eye-worms in the conjunctival sacs and corneal surfaces. Two (4.3%) were infected and the mean infection burden per infected eye was 5.3 worms (n=3). The mean length of the worms was 16.4 mm (95% CI; 14.7-18.2 mm) and the diameter 0.41 mm (95% CI; 0.38-0.45 mm). The surface cuticle was made of transverse striations which gave the worms a characteristic serrated appearance. Although the calves showed signs of kerato-conjunctivitis, the major pathological change observed was corneal opacity. The calves were kept in quarantine and were examined thrice at 30 days interval. At each interval, they were treated with 200 microg/kg ivermectin, and then translocated to game ranches. Given that the disease has been reported in cattle and Kafue lechwe (Kobus lechwe kafuensis) in the area, there is a need for a comprehensive study which aims at determining the disease dynamics and transmission patterns of thelaziasis between wildlife and livestock in the Kafue basin.

Alergia ocular / Ocular allergy

En el presente artículo revisaremos los aspectos más relevantes de la alergia ocular: su epidemiología, fisiopatología, cuadros clínicos y su terapéutica. Se encontrará una descripción más detallada de la fisiopatología ya que es, sin duda, la base del éxito terapéutico

In the present article we will review the most important aspectsof ocular allergy: its epidemiology, physiopathology, clinicalcharacteristics and treatment. A more detailed description ofthe physiopathology is addressed because is the basis for asuccessful treatment.

Post-visit at ophthalmology emergency service: frequency and perception of the doctors on duty and users / Pós-consulta em serviço de emergência oftalmológica: frequência e percepção dos plantonistas e usuários

PURPOSE: To check the occurrence of post-visit, the patient's understanding and the assessments of the doctor on duty about the efficacy of the process, at the ophthalmology emergency sector. METHODS: It was conducted a transversal, analytical research among doctors on duty and patients being seen consecutively in the ophthalmology emergency sector of Hospital das Clínicas da Universidade de São Paulo. RESULTS: The sample was made of 28 doctors on duty and 561 patients, 51.3 percent male and 48.7 percent female, with a mean age of 39.8 years old. From 34.1 percent of the patients who were previously seen by other sectors, 8.4 percent looked for two services and 5.7 percent three or more services. In the previous visits, 56.9 percent of the patients mentioned that they did not receive any explanation about their diagnostic. From the patients seen at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, 95.1 percent mentioned that the ophthalmologists explained the diagnostic and from those 84.0 percent understood what was explained. Among 40.4 percent of the patients who received medicine prescriptions in the previous services, 85.5 percent mentioned that they received explanation about its use and 82.9 percent followed the orientation. At Hospital das Clínicas - FMUSP 95.0 percent of the patients understood how and why to use the medicine. At the ophthalmologists point of view, more than 90.0 percent of the patients understood the diagnostic and the prescribed treatment. CONCLUSION: According to this research, for most of the patients, it was provided post-visit orientation and patients' understanding about the disease and the treatments proposed.

OBJETIVO: Verificar a ocorrência de pós-consulta, a compreensão pelo paciente e a avaliação do plantonista sobre a eficácia do processo, em pronto-socorro de oftalmologia. MÉTODOS: Foi realizada pesquisa transversal, analítica em plantonistas e pacientes atendidos consecutivamente no pronto-socorro de oftalmologia do Hospital das Clínicas da Universidade de São Paulo. RESULTADOS: A amostra foi composta por 28 plantonistas e 561 pacientes, 51,3 por cento do sexo masculino e 48,7 por cento do sexo feminino, com média de idade de 39,8 anos. Dos 34,1 por cento pacientes que passaram previamente por outros serviços, 8,4 por cento procuraram dois serviços e 5,7 por cento três ou mais serviços. No atendimento dos serviços prévios, 56,9 por cento dos pacientes mencionaram não ter recebido explicação sobre o diagnóstico. Dos pacientes atendidos no Hospital das Clínicas da FMUSP, 95,1 por cento referiram que os oftalmologistas explicaram o diagnóstico e desses 84,0 por cento entenderam o que foi explicado. Dentre os 40,4 por cento pacientes que receberam prescrição de medicação nos serviços prévios, 85,5 por cento mencionaram terem recebido explicação do seu uso e 82,9 por cento seguiram a orientação. No Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, 95,0 por cento dos pacientes entenderam como e porque usar a medicação. Na percepção dos oftalmologistas, mais de 90,0 por cento dos pacientes entenderam o diagnóstico e o tratamento prescrito. CONCLUSÃO: Nas condições desta pesquisa, para grande maioria dos pacientes, houve o fornecimento de orientação pós-consulta e a compreensão do paciente sobre a doença e tratamento propostos.

Implants as drug delivery devices for the treatment of eye diseases / Implantes como dispositivos de distribuição de medicamentos para o tratamento de doenças oculares

The treatment of diseases affecting the posterior segment of the eye is limited by the difficulty in transporting effective doses of drugs to the vitreous, retina, and choroid. Topically applied drugs are poorly absorbed due to the low permeability of the external ocular tissues and tearing. The blood-retina barrier limits drug diffusion from the systemic blood to the posterior segment, thus high doses of drug are needed to maintain therapeutic levels. In addition, systemic side effects are common. Intraocular injections could be an alternative, but the fast flowing blood supply in this region, associated with rapid clearance rates, causes drug concentration to quickly fall below therapeutic levels. To obtain therapeutic levels over longer time periods, polymeric sustained-drug release systems implanted within the vitreous are being studied for the treatment of vitreoretinal disorders. These systems are prepared using different kinds of biodegradable or non-biodegradable polymers. This review aims to demonstrate the main characteristics of these drug delivery implants and their potential for clinical application.

O tratamento de doenças do segmento posterior do olho é limitado pela dificuldade no transporte de doses efetivas de fármacos para o vítreo, retina e coróide. Os fármacos aplicados topicamente são pouco absorvidos por causa da baixa permeabilidade dos tecidos oculares externos e ao lacrimejamento. Embora a administração sistêmica seja capaz de transportar fármacos para o segmento posterior do olho, as barreiras hemato-aquosa e hematorretiniana dificultam a absorção e, normalmente, são necessárias doses elevadas, as quais estão geralmente associadas a potenciais efeitos adversos. Injeções intravitreais são capazes de transportar fármacos para o segmento posterior do olho, mas é uma técnica invasiva, pouco tolerada pelos pacientes e apresenta riscos de infecções oculares e danos aos tecidos. Visando a obtenção de níveis terapêuticos adequados de fármacos no segmento posterior do bulbo do olho por longos períodos, sistemas de liberação poliméricos implantados diretamente no vítreo estão sendo investigados para o tratamento de várias doenças vítreo-retinianas. Esses implantes podem ser preparados a partir de diferentes polímeros biocompatíveis, biodegradáveis ou não-biodegradáveis. Nesta revisão, as principais características destes implantes transportadores de fármacos são descritas, expondo suas potencialidades de aplicação clínica.

Farmacologia ocular aplicada no tratamento de doenças do vítreo, retina e coróide / Ocular pharmacology in the treatment of vitreous, retina and choroid diseases

As doenças que acometem o vítreo, retina e coróide são frequentes causas de cegueira irreversível em nosso meio. O aprofundamento do conhecimento científico permitiu o desenvolvimento de novos medicamentos com ação específica na patogênese dessas doenças, com resultados clínicos superiores aos obtidos no passado. O desenvolvimento da farmacologia ocular exige do médico oftalmologista conhecimentos específicos de biologia molecular, bioquímica e epidemiologia. Entretanto, o tratamento farmacológico das doenças oculares tem sido limitado às formas convencionais de administração de fármacos. Através de revisão da literatura sobre farmacologia ocular e vias de administração de medicamentos, os autores apresentam atualização de importantes aspectos relacionados à prática clínica.

Retinal diseases are frequently causes of impaired visual acuity and blindness. Recent progress in ocular pharmacology leads to the development of new promising drugs and better functional outcomes. Drug delivery and local management of diseases affecting the choroid and retina should enable better a natomical and functional outcomes. An overview of ocular pharmacology, emerging drug technologies and drug delivery is provided. Some relevant clinical features are discussed.

Ocular angiostrongyliasis: first case report from Jamaica / La angiostrongyliasis ocular: primer caso reportado en Jamaica

A 30-year old female presented with a one-month history of blurred vision in her left eye. Examination revealed a live motile worm in the anterior chamber of the left eye. She also had retinal pigment epithelial disturbance with focal intraretinal haemorrhage. The 19.9 mm worm was surgically removed and identified as Angiostrongylus cantonesis. She was treated with oral mebendazole. Her vision improved from counting fingers in the left eye to 6/36. This is the first documented case of ocular angiostrongyliasis in Jamaica.

Una mujer de 30 años se presentó con una historia de visión borrosa en el ojo izquierdo por un mes. El examen reveló la presencia de un gusano móvil vivo en la cámara anterior de su ojo izquierdo. También presentaba una alteración del epitelio pigmentario de la retina con hemorragia intraretiniana focal. El gusano de 19.9 mm fue extraído quirúrgicamente e identificado como Angiostrongylus cantonesis. La paciente fue tratada con mebendazole oral. Su visión mejoró - pasando de poder contar sólo sus dedos con el ojo izquierdo a una visión de 6/36. Se trata del primer caso de angiostrongyliasis ocular documentado en Jamaica.

Uso intravítreo de anti-vegf nas patologias oculares: novas perspectivas / Use of intravitreal anti-VEGF in eye diseases: new perspectives

A terapia intravítrea para determinadas patologias oculares é um tema atual, com poucos dados disponíveis na literatura, mas já faz parte da prática clínica diária . O objetivo desse trabalho é revisar o uso intravítreo de agentes antiangiogenocos como novas opções terapêuticas nas patologias oculares proliferativas (retinopatia diabética , degeneração macular relacionada á idade), visando esclarecer as indicações bem estabelecidas na literatura e descrever as novas perspectivas.

Técnica para injeção intravítrea de drogas no tratamento de doenças vítreorretinianas / Technique of intravitreal drug injection for therapy of vitreoretinal diseases

A injeção intravítrea é atualmente a técnica mais utilizada no tratamento de várias doenças vítreorretinianas. Neste artigo serão discutidas a técnica e complicações da injeção intravítrea de drogas no tratamento de doenças vítreorretinianas. Em resumo, a técnica envolve várias etapas. Inicialmente dias antes da injeção pode-se realizar aplicação de antibióticos e acetazolamida para prevenção de infecção e redução da pressão intra-ocular. Antes do procedimento deve-se dilatar a pupila e executar anestesia tópica com colírios ou gel anestésico. A antissepsia pré-operatória envolve aplicação de colírios de iodo-povidona 5 por cento no fundo de saco conjuntival ao menos 10 minutos antes do procedimento. A injeção deve ser realizada no centro cirúrgico com uso de luvas estéreis e máscara pelo cirurgião. O olho deve ser exposto com blefarostato estéril, e proteção com "sterile-drape" para evitar contato entre a agulha e pálpebras/cílios. A agulha deve ser posicionada no momento da injeção a 3,5 - 4 mm do limbo, e leve mobilização da conjuntiva com um cotonete estéril ou uma pinça facilitam a penetração da agulha através da conjuntiva e esclera. A agulha deve ser inserida gentilmente para dentro da cavidade vítrea até 6 mm de profundidade. Imediatamente após a injeção o paciente deve ser examinado por técnica de oftalmoscopia binocular indireta. Caso a acuidade visual seja ausência de percepção luminosa ou oclusão vascular arterial retiniana seja observada, terapias para diminuição da pressão como paracentese na camada anterior ou massagem por oculopressão diretamente sobre o globo ocular devem ser imediatamente tomadas. A alta ambulatorial deve ser realizada quando o cirurgião estiver ciente da ausência de complicações intra-operatórias; o paciente deverá sair do centro cirúrgico com curativo oclusivo. O paciente deve ser submetido a exame oftalmológico completo no primeiro dia pós-operatório quando associação de antibióticos com corticosteróides...

Intravitreal injections are the standard technique applied in the treatment of some vitreoretinal diseases. In this paper the technique and complications of intravitreal injections are presented. In summary, the procedure involves various consecutive steps. Initially, days before the treatment topical antibiotics and acetazolamide may be prescribed for reduction of the ocular flora and intraocular pressure. Before the injection, the pupil should be dilated and topical anesthesia should be achieved. Injection shall be performed in the operating room under sterile conditions, the surgeon should wear surgical gloves and mask. The eye is then exposed with sterile blepharostat and sterile-drape thereby providing protection of the needle against the contact with contaminated lashes and lids. Injection is done 3.5 mm from the limbus through the pars plana. The needle should be inserted up to 6 mm into the vitreous cavity. Immediately after injection the patient must be examined by indirect ophthalmoscopy to verify central artery perfusion and complications as vitreous hemorrhage. Visual acuity better than light perception should be detected right after injection. If persistent central retinal artery occlusion is diagnosed, anterior chamber paracentesis should be performed. The patient may be discharged with an occlusive patch. Examination at the first postoperative day should exclude various complications such as endophthalmitis, and topical steroid and antibiotics should be prescribed for 7 days. Some complications encountered after intravitreal injections include retinal detachment, vitreous hemorrhage, cataract, uveitis, ocular hypertension, or endophthalmitis.

Cost of ocular medications at Priest Hospital.

OBJECTIVE: To evaluate the cost of ocular medications, both in and out of the national drug lists (NDL) in the year 2004 used for priests and novices of Priest Hospital. MATERIAL AND METHOD: The present study was retrospective and reviewed the prescriptions for out and in patients who received the treatment at Priest Hospital. 4,508 prescriptions were prescribed between October 2006 and March 2007 evaluated. Comparison of the cost of medications prescribed for each disease category was performed. RESULTS: The total of 331 types of drugs was prescribed. The total cost of medications use was 2,292,935 Baht. This included drugs in the NDL in the year 2004 which cost 813,238 (35.47%) Baht and 1,479,697 (64.53%) Baht of drugs not on the NDL. Item D was found to have maximum cost (40.11%), followed by Item A (29.23%), Item C (22.10%), and Item B (8.56%), respectively. Regarding all medications used at Priest Hospital, eye medications, cost most followed by cardiovascular and central nervous system medications. The eye medication that cost the most was for glaucoma (73.09%), followed by corticosteroid and other anti-inflammatory preparations (12.95%) and ocular lubricants and astringents (6.49%). CONCLUSION: Ocular medications cost are the most expensive when compared to other medications both on and outside the NDL. Among the ocular medication prescribed, glaucoma medication was the most expensive.

Sistemas de transporte de drogas para o segmento posterior do olho: bases fundamentais e aplicações / Drug delivery systems for the posterior segment of the eye: fundamental basis and applications

As doenças do segmento posterior do olho são responsáveis pela maioria dos casos de cegueira irreversível no mundo inteiro. Este cenário estimula o desenvolvimento de novas modalidades de tratamento para estas doenças. O sucesso no tratamento visa, essencialmente, o transporte de doses efetivas de drogas diretamente para os locais a serem tratados. Devido às dificuldades encontradas no transporte de drogas para o segmento posterior do olho, pesquisas têm sido realizadas no sentido de desenvolver sistemas de administração intra-oculares que permitam liberar concentrações terapêuticas das drogas por período prolongado. Tais sistemas podem proporcionar inúmeras vantagens, como: aumentar a biodisponibilidade e a concentração local da droga, atingir especificamente um tipo de tecido ou célula, reduzir a freqüência de injeções intra-oculares. Tais vantagens podem aumentar o conforto do paciente e reduzir as complicações observadas com a utilização das injeções intra-oculares. Diferentes sistemas de transporte de drogas têm sido desenvolvidos com as finalidades acima descritas. Estes sistemas podem ser compostos por polímeros biodegradáveis ou não-biodegradáveis ou serem formulações lipídicas. Os sistemas de transporte de drogas são representados, principalmente, pelas micro e nanopartículas e pelos implantes, sendo eles compostos por diferentes polímeros; pelos lipossomos, que são compostos por lípides e emulsionantes; e pela iontoforese, que se baseia na aplicação de corrente elétrica. Nesta revisão, as principais características dos diferentes sistemas de transporte de drogas serão descritas, expondo suas potencialidades de aplicação clínica.

The diseases of the posterior segment of the eye are responsible for most cases of irreversible blindness worldwide. These conditions stimulate the development of new modalities of treatment for vitreoretinal diseases. The success in the treatment aims, mainly, the delivery of effective doses of pharmacological agents directly to the target sites. Because of the difficulties in delivering drugs to the posterior segment of the eye, the development of intraocular delivery systems that allow the delivery of therapeutic concentrations of drugs for long periods are being studied. These systems offer many advantages, such as increase in drug bioavailability, obtaining constant and sustained drug release, to achievement of elevated local concentrations of drugs without systemic side effects, targeting one specific tissue or cell type, reducing the frequency of intraocular injections. These advantages can increase the comfort of the patient and reduce the complications observed with intraocular injections. Several drug delivery systems are being developed with the above described purposes. These systems may be prepared with biodegradable or non-biodegradable polymers or they may be lipid formulations. The drug delivery systems are represented, mainly, by micro- e nanoparticles and implants, composed of different polymers; by liposomes, which are made of lipids and surfactants; and by iontophoresis, that is based on the application of an electric current. In this review, the main characteristics of the different drug delivery systems will be shown, with their potentialities of clinical application.

Condições oftalmológicas de pacientes com síndrome da imunodeficiência adquirida com longo tempo de seguimento / Ophthalmologic conditions of aids patients with long-term follow-up

OBJETIVO: Avaliar as condições oftalmológicas atuais de pacientes com síndrome da imunodeficiência adquirida (SIDA), previamente avaliados por oftalmologista, levando em consideração algumas características gerais relacionada com essa doença. MÉTODOS: Estudo observacional de 42 pacientes com SIDA, subdivididos em dois grupos: Grupo I: 8 pacientes com SIDA e diagnóstico prévio de retinite por citomegalovírus; Grupo II: 34 pacientes com SIDA sem retinite por citomegalovírus. Os dados gerais relacionados com a SIDA foram obtidos pela análise dos prontuários médicos. RESULTADOS: A maioria dos pacientes apresentou acuidade visual no melhor olho entre logMAR 0,0 (68,3 por cento) e 0,1 (26,9 por cento). Prescrição óptica para longe beneficiou 39,4 por cento dos pacientes do Grupo II mas nenhum dos paciente do Grupo I. Presbiopia foi corrigida em 27,3 por cento no Grupo II e 12,5 por cento no Grupo I. Não foram encontradas manifestações oculares atuais relacionadas a SIDA em nenhum dos grupos. As alterações fundoscópicas encontradas em 10 pacientes foram todas alterações cicatriciais de retinite/retinocoroidite, sendo 7 (16,7 por cento) pacientes pertencentes ao Grupo I e 3 (7,1 por cento) pacientes pertencentes ao Grupo II. CONCLUSÃO: Dez (24,4 por cento) pacientes apresentaram alteração visual decorrente do envelhecimento. Com exceção dos pacientes com cicatrizes prévias de retinite ou retinocoroidite, todos os outros participantes estavam em boas condições oftalmológicas e a maioria dos mesmos se encontrava em recuperação imunológica, devido ao uso da terapia anti-retroviral de alta potência.

PURPOSE: To evaluate the ophthalmologic conditions of patients with AIDS, with long-term follow-up, previously evaluated by an ophthalmologist, considering general conditions related with AIDS. METHODS: Observational study of 42 patients with AIDS divided into two groups: Group I: 8 patients with previous AIDS-related cytomegalovirus retinitis, Group II: 34 patients with AIDS without cytomegalovirus retinitis. Each patient had been submitted to one ophthalmologic examination. General data of the patients were obtained from the medical records. RESULTS: The majority of the patients presented visual acuity in the best eye between logMAR 0.0 (68.3 percent) and 0.1 (26.9 percent). Optic prescription for refractive errors benefited 39.4 percent of the patients in Group II but none of the patients in Group I. Presbyopia was corrected in 27.3 percent of Group II and in 12.5 percent of Group I patients. No current ocular AIDS-related manifestations were detected in any group. Ocular posterior segment alterations, all of them consisting of retinitis / retinochoroiditis scars, were found in 10 patients, 7 (16.7 percent) belonging to Group I and 3 (7.1 percent) to Group II. CONCLUSION: Ten (24.4 percent) patients presented visual alteration due to age. Except for the patients presenting previous retinitis and retinochoroiditis, all the other patients were in good ophthalmic conditions and most of them were in immunologic recovery due to the use of highly active antiretroviral therapy.

Diagnóstico de granulomatosis de Wegener en pacientes con enfermedades oculares inflamatorias / Diagnosis of Wegener's granulomatosis in patients with ocular inflamatory disease

Objetivo. Informar las manifestaciones oftalmológicas en pacientes con granulomatosis de Wegener (GW). Método. Se revisó la base de datos del Instituto de Oftalmología Conde de Valenciana. Se recolectó la exploración oftalmológica completa, los exámenes de laboratorio y de gabinete, el tratamiento y la evolución. Resultados. Se incluyeron 11 pacientes con GW (18 ojos). Siete pacientes masculinos y 4 femeninos con edad promedio de 43.7 años (28-55). Tres habían tenido diagnóstico previo de GW y los 8 restantes se diagnosticaron en nuestro departamento. Siete presentaron cuadros bilaterales y 4 unilaterales. Las formas de presentación clínica fueron escleritis necrosante con queratitis ulcerativa periférica (QUP) (7/18), escleritis difusa (3/18), escleritis nodular (1/18), uveítis anterior no granulomatosa (1/18), neuropatía óptica isquémica (1/18), neuropatía óptica retrobulbar (1/18), desprendimiento de retina seroso (2/18) y dacriocistitis (2/18). De los 18 ojos, la capacidad visual final fue mejor o igual a 20/40 en 13, 20/400 en 3, cuenta dedos a 30cm o no-percepción de luz en 1. Actualmente 7 pacientes se encuentran en fase inactiva. Conclusiones. Las manifestaciones oftalmológicas más frecuentes en pacientes con GW fueron: escleritis necrosante y QUP. En la mayoría, la GW se diagnosticó después de las manifestaciones oftalmológicas, sin embargo, todos presentaron síntomas sistémicos u oftalmológicos previos.

OBJECTIVE: Report the ophthalmologic manifestations among patients with Wegener 's Granulomatosis (WG). METHOD: We reviewed the database of the Instituto de Oftalmologia Fundación Conde de Valenciana in order to collect information regarding complete ophthalmic examination, laboratory and cabinet tests, treatment, and disease progression. RESULTS: We included 11 patients with WG (18 eyes). Seven men and four women, mean age 43.7 years (range = 28-55). Three patients had a prior diagnosis of WG and the remaining eight patients were diagnosed by our study team. Seven subjects developed a bilateral affection and four had unilateral involvement. The clinical presentation was necrotizing scleritis with peripheral ulcerative keratitis (PUK) (7/18), diffuse scleritis (3/18), nodular scleritis (1/18), non-granulomatous uveitis (1/18), optic ischemic neuropathy (1/18), retrobulbar neuritis (1/18), serous retinal detachment (2/18), and dacryocystitis (2/18). Final visual acuity was better or equal to 20/40 (13/18), 20/400 (3/18), finger-counting or no-perception of light in 1/18. Currently, seven patients are symptom free. CONCLUSIONS: The most frequent ophthalmic manifestations among our patients with WG were: necrotizing scleritis and PUK. In most cases, WG was diagnosed after ophthalmic manifestations; however, all patients displayed prior systemic or ocular symptoms.