Comparação dos meios de preparação e preservação de membrana amniótica humana para uso no tratamento de doenças da superfície ocular / Comparison of the preparation and preservation techniques of amniotic membrane used in the treatment of ocular surface diseases

Resumo Atualmente a membra amniótica (MA) tem obtido importância devido à comprovada capacidade de reduzir inflamação, auxiliar a cicatrização e epitelização, possuindo propriedades antimicrobianas e antivirais, além de baixa imunogenicidade. As indicações de seu uso na oftalmologia têm aumentado muito nas duas últimas décadas. Objetivo: Descrever a estrutura básica e as propriedades biológicas da MA em relação aos componentes da sua matriz extracelular e fatores de crescimento, as consequências de diferentes técnicas empregadas na sua preservação e esterilização, métodos para remoção do epitélio e a comparação dos custos dos diferentes meios de conservação atualmente empregados. Métodos: Pesquisa nas bases de dados do Portal da Biblioteca Virtual em Saúde (BVS), Pubmed, Cochrane, Scielo e Lilacs com as palavras-chave: membrana amniótica, transplante, reconstrução da córnea, doenças da conjuntiva. Resultados: A literatura é vasta na descrição dos efeitos de diversos agentes e técnicas na preparação da MA, dentre elas sua preservação, esterilização e desepitelização. A membrana desnuda tem sido a escolha para a reconstrução da superfície ocular, pois facilita a cicatrização. Em relação aos agentes conservantes, o glicerol é o meio mais utilizado mundialmente pelo baixo custo e facilidade de manuseio. Conclusão: A comparação das diversas técnicas nos guia na elaboração de protocolos de preparo da MA para uso oftalmológico. A membrana desnuda facilita a cicatrização em relação a com células epiteliais. O glicerol é o meio de conservação mais utilizado pelo baixo custo e facilidade de manuseio.

Abstract Currently, the amniotic membrane (AM) has obtained importance due to its ability to reduce inflammation, helping in the healing and epithelialization processes, having antimicrobial and antiviral properties and low immunogenicity. Its indications in ophthalmology have increased considerably in the past two decades. Objective: To describe the basic structure and biological properties of the AM, the components of the extracellular matrix and growth factors, the consequences of different techniques used in its preservation, and sterilization methods for the epithelium removal. To compare the costs of the different preservation solutions currently employed. Study design: literature review. Methods: Research in BVS databases, PubMed, Cochrane, Scielo and Lilacs with keywords: amniotic membrane transplantation, corneal reconstruction, conjunctival diseases. Results: The literature is vast in describing the effects of different agents and techniques used in the preparation of MA, including its preservation, sterilization and desepithelization. The naked membrane is the choice to reconstruct the ocular surface, as it facilitates the healing course. Regarding the preservatives, glycerol is the most used worldwide due its low cost and easy handling. Conclusion: Comparing different techniques guides us in developing a MA preparation protocol for ophthalmic use. The naked membrane facilitates the healing process compared with the presence of epithelial cells. The glycerol is the most used preservation method because of its low cost and easy handling.

Patología oculoplástica: experiencia de 7 años en Hospital del Sistema de Salud Público de Chile / Oculoplastic Pathology: experience of 7 years in Hospital of the Public Health System of Chile

INTRODUCCIÓN: La cirugía oculoplástica estudia y trata los trastornos de párpados, órbita y vías lagrimales. Entre las patologías más importantes por frecuencia e impacto tenemos: ptosis palpebral, blefarochalasis, ectropión y entropión. OBJETIVO: Analizar la experiencia del Hospital El Pino en cuanto al manejo de patología oculoplástica en manos de un cirujano plástico. MATERIALES Y MÉTODO: Estudio descriptivo y retrospectivo. Se revisaron fichas de pacientes operados con diagnóstico de blefarochalasis, ptosis palpebral, ectropión y entropión entre los años 2010 y 2017. Se analizaron datos como edad, sexo, comorbilidades, causa del defecto, cirugía oculoplástica, tipo de anestesia, complicación posoperatoria, tiempo de seguimiento y resultados. RESULTADOS: Entre los años 2010 y 2017 se operaron 79 pacientes con patología oculoplástica, 17 por ptosis palpebral, 42 por blefarochalasis, 14 por ectropión y 6 por entropión, siendo la principal causa senil (93,7%). Las cirugías realizadas fueron: pexia del elevador para Ptosis palpebral, blefaroplastía para blefarochalasis y para ectropión-entropión tarsal strip. La principal técnica anestésica utilizada fue anestesia local + sedación (54,4%). Entre el total de complicaciones posoperatorias tenemos: lagoftalmo (2 casos), ectropión residual (3 casos), conjuntivitis (3 casos), dehiscencia de herida (2 casos) y hematoma palpebral (1 caso). Se reintervinieron 6 pacientes por complicaciones. Los resultados obtenidos según la evaluación subjetiva del cirujano plástico y pacientes fueron regular (5 casos), bueno (20 casos) y muy bueno (54 casos). CONCLUSIÓN: El manejo de la patología oculoplástica requiere en su mayoría de cirugías ambulatorias con buenos resultados y poca morbilidad, lo cual es factible de realizar en un hospital público. Creemos necesario el uso de algún instrumento objetivo para evaluar de mejor manera los defectos palpebrales y su corrección.

INTRODUCTION: The oculoplastic surgery studies and treats disorders of the eyelids, orbit and lacrimal ways. Among the most important pathologies by frequency and impact are: palpebral ptosis, blepharochalasis, ectropion and entropion. AIM: Analyze the experience of El Pino Hospital regarding the management of oculoplastic pathology in the hands of a plastic surgeon. MATERIALS AND METHOD: Descriptive and retrospective study. We reviewed files of patients operated with diagnosis of blepharochalasis, palpebral ptosis, ectropion and entropion between the years 2010 and 2017. Data were analyzed as age, sex, comorbidities, cause of the defect, oculoplastic surgery, type of anesthesia, postoperative complication, follow-up time and results. RESULTS: Between the years 2010 and 2017, 79 patients with oculoplastic pathology operated, 17 for palpebral ptosis, 42 for blefarochalasis, 14 for ectropion and 6 for entropion, being the main senile cause (93,7%). The surgeries performed were: elevator pexis for palpebral ptosis, blepharoplasty for blefarochalasis and for ectropion-entropion tarsal strip. The main anesthetic technique used was local anesthesia + sedation (54,4%). Among the total postoperative complications, we have: lagophthalmos (2 cases), residual ectropion (3 cases), conjunctivitis (3 cases), wound dehiscence (2 cases) and palpebral hematoma (1 case). Six patients were reoperated due to complications. The results obtained according to the subjective evaluation of the plastic surgeon were regular (5 cases), good (20 cases) and very good (54 cases). CONCLUSION: Management of oculoplastic pathology requires mostly ambulatory surgeries with good results and low morbidity, which is feasible to perform in a public hospital. We believe it is necessary to use some objective instrument to better evaluate the palpebral defects and their correction.

Peripapillary choroidal thickness in contralateral eyes after evisceration of diseased eyes / Espessura coroide peripapilar de olhos contralaterais após evisceração do olho doente

ABSTRACT Purpose: To evaluate peripapillary choroidal thickness changes in contralateral eyes of patients who had undergone evisceration of their diseased eyes. Methods: In this retrospective study, peripapillary choroidal thickness parameters in 34 eyes of 34 patients who had undergone diseased-eye evisceration between March 2014 and May 2016 were evaluated using spectral domain optical coherence tomography. The scans were manually delineated to identify the principal surfaces of Bruch's membrane, the Bruch's membrane opening, and the anterior sclera. Peripapillary choroidal thickness was measured between the Bruch's membrane and the anterior sclera at increasing distance away from the Bruch's membrane opening. The mean peripapillary choroidal thickness values in the contralateral eyes of the patients and those of the control group were compared. Results: The mean peripapillary choroidal thickness was higher in the contralateral eyes of the patients compared with that of normal eyes at all distances from the Bruch's membrane opening. Conclusion: Increased peripapillary choroidal thickness was noted in the contralateral eyes of the patients, potentially resulting in a thicker choroid. Although further investigation is required to determine the cause, these findings indicate the presence of a compensatory factor in the contralateral eyes.

RESUMO Objetivo: Avaliar as alterações da espessura coroide peripapilar em olhos contralaterais de pacientes submetidos à evisceração do olho doente. Métodos: Neste estudo retrospectivo, parâmetros da espessura coróide peripapilar de 34 olhos de 34 pacientes submetidos à evisceração, entre março de 2014 e maio de 2016, foram avaliados com tomografia de coerência óptica de domínio espectral. As varreduras foram manualmente delineadas para identificar as principais superfícies da membrana de Bruch, a abertura da membrana de Bruch e a esclera anterior. A espessura coroide peripapilar foi medida entre a membrana de Bruch e a esclera anterior a uma distância crescente da abertura da membrana de Bruch. Compararam-se os valores médios da espessura coroide peripapilar dos olhos contralaterais dos pacientes e do grupo controle. Resultados: A espessura coroide peripapilar média foi mais espessa nos olhos contralaterais dos pacientes, quando comparada com os olhos normais, em todas as distâncias da abertura da membrana de Bruch. Conclusão: O aumento da espessura coroide peripapilar foi notado nos olhos contralaterais dos pacientes. O espessamento da coroide pode ser resultante do distúrbio. Embora seja necessária uma investigação mais aprofundada para determinar a causalidade, esses achados podem apontar para um fator compensatório dos olhos contralaterais.

Dry Eye Syndrome in Intensive Care Units: a concept analysis / Ojo Seco en Unidad de Terapia Intensiva: un análisis de concepto / Olho Seco em Unidade de Terapia Intensiva: uma análise de conceito

ABSTRACT Purpose: To analyse the concept of Dry Eye Syndrome in patients admitted to Intensive Care Units (ICU). Method: This is a concept analysis, according to Walker's and Avant's method, conducted using an integrative review, through search in the database. Science Direct, Scopus, Cinahl, Pubmed, Lilacs, Cochrane and Web of Science. The following keywords were used: "Keratoconjuntivite Sicca", "Risk Factors", "Dry eye Syndromes" and "Intensive Care Units". After selection, 85 articles have been kept. Results: Antecedents found: age, lagophthalmos, environmental factors, use of medications, systemic diseases, mechanical ventilation and eye surgeries. Attributes: Tear Break-up Time < 10 s, Schirmer's test I < 10 mm, Schirmer's test II < 5 mm and signs and symptoms. Consequents: eye damage and discomfort; unstable vision. The Model Case and the Contrary Case were used to illustrate it. Conclusion: The research provided clarification of the concept and consequent understanding of the Dry Eye Syndrome, which is preventable especially in ICU.

RESUMEN Objetivo: Analizar el concepto del Ojo Seco en pacientes hospitalizados en Unidades de Terapia Intensiva (UTI). Método: Esto es un análisis de concepto, según el método de Walker y Avant, operacionalizado mediante revisión integrativa por medio de la búsqueda en las bases de datos: Science Direct, Scopus, Cinahl, Pubmed, Lilacs, Cochrane e Web of Science. Fueron utilizados los descriptores: "Queratoconjuntivitis Seca", "Factores de Riesgo", "Síndromes del Ojo Seco" y "Unidades de Terapia Intensiva". Después de la selección, resultaron 85 artículos. Resultados: Identificamos como antecedentes: edad, lagoftalmia, factores ambientales, uso de medicamentos, enfermedades sistémicas, ventilación mecánica y cirugías oftalmológicas. Atributos: Tear Break-up Time < 10 s, test de Schirmer I < 10 mm, test de Schirmer II < 5 mm y señales y síntomas. Consecuencias: daño e incomodidad a la superficie ocular, inestabilidad visual. Como representación se presentó el Caso Modelo y el Caso Contrario. Conclusión: El estudio posibilitó clarificación del concepto y consecuente entendimiento del fenómeno, lo cual es evitable, sobre todo en la UTI.

RESUMO Objetivo: Analisar o conceito de Olho Seco em pacientes internados em Unidade de Terapia Intensiva (UTI). Método: Trata-se de uma análise de conceito, segundo método de Walker e Avant, operacionalizada mediante revisão integrativa por meio da busca nas bases de dados: Science Direct, Scopus, Cinahl, Pubmed, Lilacs, Cochrane e Web of Science. Foram utilizados os descritores: "Keratoconjuntivite Sicca", "Risk Factors", "Dry eye Syndromes" e "Intensive Care Units". Após seleção, resultaram 85 artigos. Resultados: Identificaram-se como antecedentes: idade, lagoftalmia, fatores ambientais, uso de medicamentos, doenças sistêmicas, ventilação mecânica e cirurgias oftálmicas. Atributos: Tear Break-up Time < 10 s, teste de Schimer I < 10 mm, teste de Schimer II < 5 mm e sinais e sintomas. Consequentes: dano e desconforto à superfície ocular, instabilidade visual. Como ilustração apresentaram-se o Caso Modelo e o Caso Contrário. Conclusão: O estudo promoveu clarificação do conceito e consequente entendimento do fenômeno, o qual é evitável, sobretudo na UTI.

Resultados visuales y sobrevida de injerto obtenidos en una población pediátrica sometida a queratoplastia / Visual outcomes and graft survival in pediatric patients underwent penetrating keratoplasty

Objetivo: Describir resultados visuales y complicaciones de una serie de casos de pacientes pediátricos a los que se les realizó queratoplastia penetrante en el Hospital de San José, en Bogotá, Colombia. Diseño: Estudio observacional descriptivo, retrospectivo, serie de casos. Método: Se evaluaron 14 ojos de 12 pacientes menores de 16 años a quienes se les realizó queratoplastia penetrante entre los años 1999-2014. Se hizo una revisión de la literatura sobre etiología, manejo quirúrgico, seguimiento y sobrevida de injerto. Resultados: De los 14 ojos estudiados 8 ojos (57,1%) tenían patología congénita con injerto claro en 6 ojos (75%) entre los 3 y 9 meses, 3 ojos (21,4%) tenían etiología traumática, de estos, todos los injertos permanecieron claros en un rango de 3 meses a 11 años y 3 ojos (21,4%) tenían leucomas, queratitis o inminencia de perforación, de estos el injerto permaneció claro entre los 3 y 18 meses. Se encontró una mejoría de visión en 8 de los ojos evaluados (57,1%). Las complicaciones encontradas en estos pacientes fueron: glaucoma en 5 ojos (35.7%), falla de injerto en 6 ojos (42.8%), rechazo endotelial en 7 ojos (50%) y desprendimiento de retina en 1 ojo (7.14%). Conclusión: En el estudio, la mejoría visual fue ligeramente menor a la reportada en la literatura. Las complicaciones presentadas fueron principalmente rechazo endotelial y falla de injerto, lo que difiere de la literatura donde la catarata es la principal complicación.

Purpose: To describe visual results and complications in a case series of paediatric patients who underwent penetrating keratoplasty at Hospital de San José in Bogotá, Colombia. Design: Observational, descriptive and retrospective study, series of cases. Method: 14 eyes of 12 patients under 16 years (2 months - 16 years) who underwent penetrating keratoplasty in Hospital de San Jose from 1999 to 2014 were evaluated. A literature review of etiology, surgical management, monitoring and graft survival of pediatric patients was done. Results: Of the 14 eyes studied, 8 eyes (57.1%) had congenital pathology with clear graft in six eyes between 3 and 9 months, 3 eyes (21.4%) had traumatic aetiology, of these, all graft s remained clear in a range of 3 months to 11 years and 3 eyes (21.4%) had leucoma, keratitis or impending perforation, of these, the graft remained clear between 3 and 18 months. An improvement in vision was found in eight of the evaluated eyes (57.1%). The complications found in these patients were: glaucoma in 5 eyes (35.7%), graft failure in 6 eyes (42.8%), endothelial rejection in 7 eyes (50%) and retinal detachment in 1 eye (7.14%). Conclusion: In our study, the visual improvement was slightly lower than that reported in the literature. The complications presented were mainly endothelial rejection and graft failure, which differs from the literature where cataract is the main complication.

Effects of Systemic Administration of Dexmedetomidine on Intraocular Pressure and Ocular Perfusion Pressure during Laparoscopic Surgery in a Steep Trendelenburg Position: Prospective, Randomized, Double-Blinded Study

Increased intraocular pressure (IOP) during surgery is a risk factor for postoperative ophthalmological complications. We assessed the efficacy of systemically infused dexmedetomidine in preventing the increase in IOP caused by a steep Trendelenburg position, and evaluated the influence of underlying hypertension on IOP during surgery. Sixty patients undergoing laparoscopic surgery in a steep Trendelenburg position were included. Patients in the dexmedetomidine group received a 1.0 µg/kg IV loading dose of dexmedetomidine before anesthesia, followed by an infusion of 0.5 µg/kg/hr throughout the operation. Patients in the saline group were infused with the same volume of normal saline. IOP and ocular perfusion pressure (OPP) were measured 16 times pre- and intraoperatively. In the saline group, IOP increased in the steep Trendelenburg position, and was 11.3 mmHg higher at the end of the time at the position compared with the baseline value (before anesthetic induction). This increase in IOP was attenuated in the dexmedetomidine group, for which IOP was only 4.2 mmHg higher (P < 0.001 vs. the saline group). The steep Trendelenburg position was associated with a decrease in OPP; the degree of decrease was comparable for both groups. In intragroup comparisons between patients with underlying hypertension and normotensive patients, the values of IOP at every time point were comparable. Dexmedetomidine infusion attenuated the increase in IOP during laparoscopic surgery in a steep Trendelenburg position, without further decreasing the OPP. Systemic hypertension did not seem to be associated with any additional increase in IOP during surgery. (Registration at the Clinical Research Information Service of Korea National Institute of Health ID: KCT0001482)

Usos de membrana amniótica en patología ocular pediátrica / Use of amniotic membrane in childhood ocular disease

Introducción: La membrana amniótica (MA) posee varias propiedades clínicas que la hacen útil en el tratamiento de diferentes patologías. El principal efecto clínico es que permite la epitelización de los tejidos, favorece el crecimiento, adhesión y diferenciación de las células epiteliales, además de prevenir su apoptosis, reduciendo la cicatrización. Objetivo: Describir la utilidad de la membrana amniótica como alternativa en el tratamiento de la superficie ocular. Son abordados tópicos como las diferentes formas de obtención, preparación y conservación de la misma, así como sus mecanismos de acción y aplicaciones. Resultados: En el Servicio de Oftalmología del Hospital de Pediatría J. P. Garrahan se usaron 429 membranas amnióticas en 294 pacientes desde el año 2002 hasta octubre 2014 para el tratamiento de distintas patologías oculares. Los pacientes estudiados presentaron reducción de la inflamación, vascularización y mejor cicatrización. Conclusión: la MA es en la actualidad una alternativa en el tratamiento de patologías de difícil manejo que no responden a las terapias médicas convencionales. Sin embargo, su empleo deberá ser racional, para evitar falsas expectativas de considerarla como panacea en toda patología corneal o conjuntival (AU)

Introduction: Amniotic membrane has several clinical properties rendering it useful in different pathologies. Its main clinical effect is the epithelization of tissue, favoring growth, adhesion and differentiation of epithelial cells as well as prevention of apoptosis and reduction of scarring. Objective: To determine the usefulness of amniotic membrane as an alternative for ocular surface treatment. Issues such harvesting techniques, preparation, and storage of the amniotic membrane, as well as mechanisms of action and use are discussed. Results: At the Department of Ophthalmology of the Pediatric Hospital J. P. Garrahan 429 amniotic membranes were used in 294 patients between 2002 and October 2014 for the treatment of different eye pathologies. The patients studied presented with reduced inflammation and better vascularisation and scarring. Conclusion: Amniotic membrane is currently a treatment option in difficult-to-treat pathologies that do not respond to conventional therapies. Nevertheless, it should be used rationally to avoid unrealistic expectations considering it the panacea for all corneal or conjunctival pathologies (AU)

Long-term Surgical Outcomes of the Multi-purpose Conical Porous Synthetic Orbital Implant

PURPOSE: We present clinical results of the use of the multipurpose conical porous synthetic orbital implant (MCOI) in surgical procedures of evisceration, enucleation, and secondary enucleation in ophthalmology patients. METHODS: A retrospective review was performed of 59 eyes in which conical implants were used, including 36 cases of eviscerations, 11 enucleations, and 9 secondary enucleations. In all of the cases, the follow-up period was greater than six months between 2004 and 2013. The results focus on documenting surgical findings, as well as postoperative complications among patients. RESULTS: Superior sulcus deformities were found in six eyes (10.2% of conical implant patients), and two eyes received additional surgical interventions to correct the deformities (3.4%). Blepharoptosis was found in four eyes (6.8%), two of which received upper eyelid blepharoplasty (3.4%). Fornix shortening was reported in only one eye (1.7%). Forty-one eyes had a satisfactory cosmetic appearance after the final prosthetic fitting of conical implants (69.5%). The most frequent postoperative complication was orbital implant exposure, which seemed to occur when the preoperative status of the conjunctiva, Tenon's capsule, and sclera preservation were poor in the eyes of the patients. CONCLUSIONS: There was a lower incidence of blepharoptosis and fornix shortening with the MCOI in comparison to spherical implants, while the incidence of orbital implant exposure was similar with the MCOI in comparison to other types of orbital implants. In addition, the MCOI may have advantages with respect to postoperative cosmetic outcomes.

Desarrollo de las consultas oculoplastia y cirujía implanto-refractiva del Sistema alas BQO / Development of the consultations oculoplasty and implanto-refractive surgery of System alas BQO

En la actualidad, la gestión de la información en las consultas oftalmológicas de Oculoplastia y Cirugía Implanto-Refractiva se realiza de forma manual. Esto ha provocado duplicidad de datos, acumulación de la información y deterioro de registros médicos, incidiendo como una vulnerabilidad a la hora de procesar la información. La presente investigación tiene como meta, la informatización de los procesos correspondientes a estas consultas, guiada durante todo el ciclo de vida por el Proceso Unificado de Desarrollo (RUP), con el propósito de garantizar un medio para el almacenamiento seguro de la información y de su procesamiento. Se utiliza Visual Paradigm como herramienta de modelado. Para la implementación de las funcionalidades se emplea la plataforma .NET mediante el lenguaje de programación C#, auxiliado por el Framework 2.0 y Postgres SQL como gestor de bases de datos. Como resultado de su implementación se espera proporcionar al usuario una forma viable de gestionar la información en las consultas oftalmológicas, brindado una mayor confiabilidad y seguridad tanto al personal de la institución como a los pacientes que requieren de dichos servicios. Por otra parte, los especialistas contarán con una Historia Clínica Electrónica única, que permitirá el seguimiento de la salud del paciente y la disponibilidad de la información para que puedan ser examinados los diagnósticos emitidos de estos con anterioridad(AU)

Currently, the information management in the ophthalmological queries of Oculoplasty and Refractive Implant Surgery is performed manually. This has resulted in duplication of data, accumulation of information and deterioration of the medical records, becoming an invulnerability when processing of information occurs. The present research is intended to the computerization of the processes of this consultations, guided throughout the life cycle by the Rational Unified Process (RUP), in order to guarantee a means for the safe storage and processing of the information. The Visual Paradigm is employed as a modeling tool. For the implementation of the functionalities we used the platform .NET, through the programming language C#, helped by the Framework 2.0 and the Postgres SQL as a database manager. As a result from its implementation, it is expected to provide the user with a viable way of managing the information on the eye care consultations, providing also a better reliability and safety to both, the institution staff and the patients requiring that system. Moreover, the specialists will have a single electronic health record that will allow monitoring the patient´s health and the availability of the information so that the latest diagnoses can be examined. better reliability and safety to both, the institution staff and the patients requiring that system. Moreover, the specialists will have a single electronic health record that will allow monitoring the patient´s health and the availability of the information so that the latest diagnoses can be examined(AU)

Resultados visuales y anatómicos post-operatorios obtenidos mediante el empleo de vitrectomía pars plana en el pelaje de membranas epirretinianas idiopáticas / Anatomical and visual post-operative results using pars plana vitrectomy in idiopathic epiretinal membranes peeling procedure

Objetivo: examinar resultados anatómicos y visuales de los pacientes con membranas epirretinianas idiopáticas (MER) tratados mediante pelaje de membranas y su correlación funcional post-operatoria. Métodos: Estudio de serie de casos donde se revisaron las historias clínicas de 27 pacientes elegidos de manera aleatoria y a quienes se realizó pelaje de membranas epirretinianas idiopáticas con seguimiento clínico por 6 meses del post-operatorio. Al 90% (n=24) de los pacientes se les realizó cirugía combinada de facovitrectomía. Se tomaron como variables a analizar la agudeza visual pre y post-operatoria a la semana, al mes y a los 6 meses, tomografía de coherencia óptica pre y post-operatoria al mes y a los 6 meses de la cirugía. Se comparó la agudeza visual y el grosor retiniano en el milímetro central entre la medida pre y postoperatoria utilizando la prueba de t de student. Resultados: la media de agudeza visual pre-operatoria fué de 20/60 y post-operatoria (6 meses) de 20/30. La media del grosor retiniano en el milímetro central pre-operatoria resultó 409.7 micras con un valor post-operatoria (6 meses) de 341 micras. En el 82% de los pacientes se observó una mejoría en la agudeza visual post-operatoria a los 6 meses. Los pacientes con mejores agudezas visuales fueron aquellos cuya agudeza visual pre-operatoria estuvo alrededor del 20/50. Conclusiones: la agudeza visual y el grosor retiniano pre-operatorio son los mejores factores pronósticos para estimar la agudeza visual post-operatoria en pacientes operados con diagnóstico de MER. La agudeza visual post-operatoria definitiva se alcanza posterior a los 6 meses de la cirugía. Se recomienda establecer como punto de corte para la decisión quirúrgica aquellos pacientes con agudezas visuales de 20/50 o peor.

Objective: to examine anatomic and visual outcomes in patients undergoing epiretinal membrane surgery. Methods: a case series study. Twentyseven eyes from 27 patients who underwent epiretinal membrane surgery were reviewed. Correlations between preoperative and first week, one and six months post-operative bestcorrected visual acuity and Optical Coherence Tomography (OCT) findings were obtained and analyzed using t student test. Results: mean pre-operative best corrected visual acuity (BCVA) was 20/60 and six months post-op was 20/30. Mean pre-op retinal central thickness was 409.7 microns and six months post-op was 341 microns. BCVA significantly improved in 82% of the patients after six months of surgery. Patients whom achieved higher BCVA levels post-op were those with pre-op BCVA around 20/50. Conclusions: pre-operative BCVA and central retinal thickness are the most importante factors to estimate post-operative BCVA. Highest BCVA levels were achieved after six months of surgery. It is recommended to use pre-op BCVA of 20/50 as cut-off level to consider surgical treatment.

Asteroid hyalosis: clinical review of 58 cases / Asteroides hialoides - revisão de 58 casos clínicos

OBJECTIVE: Understand the behavior, functional repercussion and relationship with epidemiological factors of asteroid hyalosis (AH) and retrospective observational case series. METHODS: Fifty-eight patients diagnosed with AH (24 women and 34 men) were studied. All patients were submitted to a thorough ophthalmological examination. RESULTS: We observed a statistical association between the presence of AH and male sex (p=0,042). An increase in prevalence of this pathology was observed with increasing age. We determined an odds ration of 5,24 of a patient over 50 years old having AH, when compared to patients bellow this threshold. Eighty-six percent of patients had unilateral vitreous deposits. We measured a lower IOP in the affected eye, with the difference being in average 2,68 ± 1,45 mmHg (p=0,037). We observed no statistical association between AH and age related macular degeneration, diabetes or glaucoma. Five eyes were submitted to facoemulsification combined with pars plana vitrectomy with an average gain of 7 lines (Snellen) in visual acuity (p=0,03). CONCLUSION: In our sample a clear association between AH, ageing and male sex was observed. The majority of patients had unilateral vitreous deposits. Vitrectomy in association with facoemulsification is a safe and effective intervention in this group of patients.

OBJETIVO: Compreender o comportamento dos asteroides hialoides, sua repercussão funcional em relação aos fatores epidemiológicos,de modo retrospectivo e observacional de casos clínicos. MÉTODOS: Cinquenta e oito doentes com diagnóstico de asteroides hialoides (24 mulheres e 34 homens) foram estudados. Todos os doentes foram submetidos a exame oftalmológico completo. RESULTADOS: Observamos uma associação estatística entre a presença de asteroides hialoides e o sexo masculino (p=0,042). Verificamos um aumento de prevalência desta patologia com o aumento da idade sendo o risco relativo após os 50 anos de 6,25 face aos doentes abaixo desta idade. Oitenta e seis por cento dos doentes estudados apresentavam depósitos unilaterais. Não observamos associação estatística entre a presença de asteroides hialoides e a degeneração macular ligada à idade, diabetes mellitus ou glaucoma. Em 5 dos olhos estudados avaliamos o resultado funcional de cirurgia de facoemulsificação associada à vitrectomia via pars plana e observamos um ganho médio de 7 linhas de acuidade visual de Snellen (p=0,03) pós-cirurgia. CONCLUSÃO: A amostra apresenta uma clara associação entre o envelhecimento e sexo masculino e a incidência de asteroides hialoides. Na maioria dos doentes estudados os depósitos foram unilaterais. A vitrectomia via pars plana, associada à facoemulsificação é uma terapêutica segura e eficaz neste grupo de doentes.

Temperature distribution simulation of the human eye exposed to laser radiation

Human eye is a sensitive part of human body with no direct protection and due to its lack of protection against the external heat waves, studying the temperature distribution of heat waves on the human eye is of utmost importance. Various lasers are widely used in medical applications such as eye surgeries. The most significant issue in the eye surgeries with laser is estimation of temperature distribution and its increase in eye tissues due to the laser radiation intensity. Experimental and invasive methods to measure the eye temperature usually have high risks. In this paper, human eye has been modeled through studying the temperature distribution of three different laser radiations, using the finite element method. We simulated human eye under 1064 nm Neodymium-Doped Yttrium Aluminium Garnet [Nd: YAG] laser, 193 nm argon fluoride [ArF] excimer laser, and 1340 nm Neodymium doped Yttrium Aluminum Perovskite [Nd: YAP] laser radiation. The results show that these radiations cause temperature rise in retina, lens and cornea region, which will in turn causes serious damages to the eye tissues. This simulation can be a useful tool to study and predict the temperature distribution in laser radiation on the human eye and evaluate the risk involved in using laser to perform surgery.

Fifteen-year trends in indications for enucleation from a tertiary care center in South India.

Aim: To analyze the trends in clinicopathologic indications for enucleations over a 15-year period. Materials and Methods: Clinicopathologic details of all eyes that underwent enucleation from January 1996 to December 2010 were drawn up from a computerized database. The study was divided into three periods of 5 years each and comparison tables for each cause of enucleation during these periods were generated. Chi-square test was used to compare proportions. Results: Out of a total 1467 enucleations performed during the study period, 693 (46%) were attributable to retinoblastoma, 189 (12.5%) to uveal melanoma, 228 (15%) to trauma, and 149 (10%) to phthisis bulbi. Intraocular tumors accounted for more than 63% of all enucleations performed. Over the three time periods, proportion of enucleations secondary to retinoblastoma increased from 38% in the 1st period to 58% in the 3rd period (P < 0.001). Enucleations for trauma showed statistically significant reduction in trends over the three periods (24% in the 1st period vs. 4.4% in the 3rd period, P < 0.001). Similar trends were also seen in the proportion of enucleations due to intractable glaucoma and chronic uveitis. The absolute number of enucleations secondary to retinoblastoma out of the total cases seen during the study period did not change over the three periods (range 51–60%). Conclusion: Intraocular tumors were the commonest indications for enucleation in our patient population despite the availability of globe-conserving treatments such as chemotherapy and radioactive plaques. We observed increasing trends in the proportion of enucleations due to retinoblastoma and reduction of enucleations secondary to trauma, chronic uveitis, and glaucoma.

Surgical treatment of globe subluxation in the active phase of the myogenic type of Graves orbitopathy: case reports / Tratamento cirúrgico da subluxação do globo ocular na fase ativa do subtipo miogênico da orbitopatia de Graves: relatos de casos

The purpose of the present article is to present and discuss two cases of globe su­blu­xation in the active phase of myogenic Graves' orbitopathy and to evaluate the prevalence of this phenomenon. Two patients with the myogenic variant of Graves' orbitopathy that had being treated with oral and intravenous steroid pulses developed globe subluxation. Both had to have urgent eyelid and orbital decompression. After these observations, we reviewed the medical records of a sample of 284 patients (482 orbits) who had had orbital decompression at our Institution from 1992 to 2010, with a search for cases presenting severe proptosis or globe subluxation in the active phase of myogenic Graves' orbitopathy. No patient had to have decompression for globe subluxation in the active phase of Graves' orbitopathy. The prevalence of this event as an indication for surgery in the myogenic variant of Graves' orbitopathy was therefore 0.7% (2/284) or even less. The combination of lowering the upper eyelid and orbital decompression had a dramatic therapeutic effect on these patients des­pite the presence of intense inflammatory signs in the orbits. In conclusion, patients affected with the myogenic variant of Graves' orbitopathy may develop globe subluxation. Urgent surgical treatments should not be postponed despite the presence of active inflammation.

O objetivo do presente trabalho é apresentar e discutir dois casos de subluxação do globo ocular na fase ativa do subtipo miogênico da orbitopatia de Graves e avaliar a prevalência desse fenômeno. Dois pacientes com o subtipo miogênico da orbitopatia de Graves tratados com corticosteroide oral e pulsos intravenosos desenvolveram subluxação do globo ocular. Após estas observações, analisamos os prontuários de uma amostra de 284 pacientes (482 órbitas) que foram submetidos à descompressão orbitária em nossa Instituição no período de 1992 a 2010, buscando os casos que apresentaram proptose severa ou subluxação do globo ocular na fase ativa da orbitopatia de Graves miogênica. Nenhum paciente tinha sido descomprimido para subluxação do globo ocular na fase ativa da orbitopatia de Graves. A prevalência desse evento como uma indicação para cirurgia na variante miogênica da orbitopatia de Graves foi 0,7% (2/284) ou até menos. A combinação da correção da retração da pálpebra superior e da descompressão da órbita obteve um efeito terapêutico excelente nesses pacientes, apesar da intensa presença de sinais inflamatórios nas órbitas. Em conclusão, pacientes afetados com orbitopatia de Graves do subtipo miogênico podem desenvolver subluxação do globo. Tratamentos cirúrgicos de urgência não devem ser adiados apesar da presença de inflamação ativa.

Dexmedetomidine versus propofol for sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia

The purpose of this study was to evaluate the hemodynamic, respiratory effects, the recovery profile, surgeons, and patients satisfaction with dexmedetomidine sedation compared with those of propofol sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia. Sixty patients were enrolled in this prospective, single-blind, randomized study. The patients were divided into two groups to receive either dexmedetomidine [group D] or propofol [group P]. Sedation level was titrated to a Ramsay sedation scale [RSS] of 3. Hemodynamic and respiratory effects, postoperative recovery time, analgesic effects, surgeons and patients satisfaction were assessed. Both groups provided a similar significant reduction in heart rate and mean arterial pressure compared with baseline values. The respiratory rate values of the dexmedetomidine group were significantly higher than those in the propofol group. The oxygen saturation values of the dexmedetomidine group were significantly higher than those of the propofol group. The expired CO[2] was similar in both groups. Postoperatively, the time to achieve an Aldrete score of 10 was similar in both groups. Dexmedetomidine patients have significantly lower visual analog scale for pain than propofol patients. The surgeon satisfaction with patients' sedation was similar for both groups. The patients' satisfaction was higher in the dexmedetomidine group. Dexmedetomidine at similar sedation levels with propofol was associated with equivalent hemodynamic effects, maintaining an adequate respiratory function, similar time of discharge from PACU, better analgesic properties, similar surgeon's satisfaction, and higher patient's satisfaction. Thus, dexmedetomidine may prove to be a valuable adjuvant for sedation in patients undergoing vitreoretinal surgery under sub-Tenon's anesthesia

Staged penetrating sclerokeratoplasty and penetrating keratoplasty for management of advanced acquired anterior staphyloma

Herein we describe a staged surgical technique consisting of penetrating sclerokeratoplasty [PSKP] followed by penetrating keratoplasty [PKP] and present its clinical course and complications over two years of follow-up. A 23-year-old man presented with cosmetically unacceptable protrusion of the globe corresponding to the cornea and sclera. PSKP was performed transplanting a full-thickness beveled 13 mm corneoscleral tectonic graft. Hypotony developed subsequently and was successfully managed medically, however corneal graft failure occurred. After 15 months, a 7.5 mm PKP was performed for optical reasons, which subsequently remained clear with a healthy epithelium. In this particular case, cosmetic, tectonic, therapeutic, and optical requirements were met. PSKP is a surgical procedure which entails a high rate of complications but may be the only alternative when the main goal of intervention is restoration of the globe in complicated cases such as our patient

Cavidades anoftálmicas atípicas / Atypical anophthalmic cavities

OBJETIVO: Determinar el comportamiento de las cavidades anoftálmicas atípicas en nuestro centro en cuanto a edad, sexo, causas de pérdida del globo ocular, técnica quirúrgica y sus principales alteraciones. MÉTODOS: Se realizó un estudio descriptivo de tipo prospectivo de 239 pacientes con diagnóstico confirmado de cavidades anoftálmicas atípicas que acudieron a la consulta de prótesis del ICO Ramón Pando Ferrer en el período de junio a diciembre del 2007. RESULTADOS: El 3 por ciento fueron menores de 20 años, el 30 por ciento entre los 21 y los 40 años, el 43 por ciento entre los 41 y 60 años y el 24 por ciento mayores de 60 años. El 74 por ciento fueron del sexo masculino. La pérdida del globo ocular por traumatismo fue en 115 pacientes para un 48,1 por ciento seguido de infecciones y glaucoma. El 69,5 por ciento fueron eviscerados y el 30,5 por ciento enucleados. El 64 por ciento tuvo patología conjuntival de ellos el 28 por ciento por retracción del férnix inferior. La pseudoptosis se presentó en el 49 por ciento. CONCLUSIONES: Las cavidades anoftálmicas atípicas resultaron más frecuentes entre los 41 y 60 años. Predominó el sexo masculino. Las principales causas de pérdida del globo ocular fueron el traumatismo seguido de infecciones. Predominó la evisceración como técnica quirúrgica. La mayoría de las cavidades atípicas resultaron ser por pérdida de fondo de saco inferior y malposiciones palpebrales

OBJECTIVE: To determine the situation of atypical anophthalmic cavities in our center in terms of age, sex, causes of eyeball loss, surgical technique and main alteration of the technique. METHODS: A prospective descriptive study was conducted in 239 patients with confirmed diagnosis in the period of June to December 2007. RESULTS: In this group of patients, 3 percent were under 20 years of age, 30 percent aged 21 to 40 y, 43 percent was in 41-60 y group and 24 percent were over 60 years. Males accounted for 74 percent. The eyeball loss due to trauma affected 115 patients for 48,1 percent followed by infections and glaucoma. In these patients, 69,5 percent were eviscerated and 30,5 percent were enucleated. Conjunctival pathology was present in 64 percent of them whereas lower fornix retraction affected 28 percent. Pseudoptosis was observed in 49 percent. CONCLUSIONS: Atypical anophthalmic cavities were more common in the 41-60y age group. Males prevailed. The main causes of the eyeball loss were trauma and infections. Evisceration was the most used surgical technique. Most of these atypical cavities were due to loss of the lower sac fundus and to palpebral malpositions

Fibrin glue in ophthalmology.

Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue.