Management of necrotizing scleritis after pterygium surgery with rituximab / Tratamento com rituximabe de esclerite necrosante após cirurgia de pterigeo

ABSTRACT The authors present a case of necrotizing scleritis after pterygium excision successfully treated with rituximab after attempts with high doses of corticosteroids and immunosuppressive drugs. A literature review revealed case reports and a phase I/II dose-ranging randomized clinical trial using rituximab for necrotizing scleritis with or without association with autoimmune disease. This is the only case report on rituximab treatment for necrotizing scleritis after pterygium surgery. In cases with refractoriness to immunosuppressive drugs, a CD20 antibody can be used.

RESUMO Os autores apresentam um caso de sucesso no tratamento com rituximabe de esclerite necrosante após cirurgia de pterígio refratário a altas doses de corticosteroides e drogas imunossupressoras. Uma revisão da literatura direcionada ao uso de rituximabe para tratamento de esclerites necrosantes revelou relatos de casos e um estudo clínico randomizando fase I/II. Este é o único caso descrito de rituximabe para o tratamento de esclerite necrosante pós cirúrgica. O uso de anticorpo anti-CD20 pode ser uma opção em casos refratários aos imunossupressores no tratamento da esclerite necrosante pós-cirúrgica.

Effect of candesartan on the expression of sclera-choroidal intercellular adhesion molecule-1 in hypercholesterolemic models

OBJECTIVE: To evaluate the effect of blocking the angiotensin II AT-1 receptor by the systemic administration of candesartan on the expression of intercellular adhesion molecule-1 in the sclera and choroid of hypercholesterolemic rabbits. METHODS: New Zealand rabbits were divided into 3 groups, as follows: GI, which was fed a rabbit standard diet; GII, which was fed a hypercholesterolemic diet; and GIII, which received hypercholesterolemic diet plus candesartan. Samples of the rabbits' sclera and choroid were then studied by hematoxylin-eosin staining and histomorphometric and immunohistochemical analyses for intercellular adhesion molecule-1 expression. RESULTS: Histological analysis of hematoxylin- and eosin-stained sclera and choroid revealed that macrophages were rarely present in GI, and GII had significantly increased macrophage numbers compared to GIII. Moreover, in GII, the sclera and choroid morphometry showed a significant increase in thickness in comparison to GI and GIII. GIII presented a significant increase in thickness in relation to GI. Sclera and choroid immunohistochemical analysis for intercellular adhesion molecule-1 expression revealed a significant increase in immunoreactivity in GII in relation to GI and GIII. GIII showed a significant increase in immunoreactivity in relation to GI. CONCLUSION: Candesartan reduced the expression of intercellular adhesion molecule-1 and consequently macrophage accumulation in the sclera and choroid of hypercholesterolemic rabbits. .

Estudo experimental da biocompatibilidade de novo material para implante orbitário / Experimental study of new material for biocompatibility as orbital implant

OBJETIVO:Avaliar a biocompatibilidade de material FullCure 720®, que é uma resina, na confecção de implante orbitário. Avaliou-se a resposta clínica dos animais, toxicidade sistêmica e a resposta inflamatória crônica. Os animais foram pesados, exames bioquímicos e resposta inflamatória foram avaliados. Foi efetuada evisceração e colocado implante esférico orbitário. Os animais foram acompanhados durante o período de 60 dias, onde se avaliou o comportamento clínico e sinais locais. Após este período, procedeu-se a eutanásia seguida da enucleação. Foi realizada análise macroscópica e histomorfométrica. Os resultados revelaram comportamento normal dos animais, com ausência de exposição ou extrusão dos implantes, morte de algum animal e ausência de toxicidade sistêmica. Houve formação de uma cápsula fibrosa entre a capa escleral e o implante orbitário, resposta inflamatória considerada normal quando em contato com o tecido do coelho. A resina FullCure 720® utilizada como implante orbitário, mostrou-se biocompatível neste estudo.

PURPOSE: To evaluate the resin FullCure 720® biocompatibility as orbital implant. Clinical response and signs of systemic toxicity to the resin were evaluated, local biocompatibility and microscopic analysis regarding chronic local inflammatory response to the implant. The animals were weighted, biochemical exams and inflammatory response were evaluated. All animals were eviscerated and implantation of the spheres was carried out. Animals were followed for 60 days. Clinical behavior of animals and local signals of inflammation had been observed. After this period animals underwent euthanasia followed by enucleation. Macroscopic and histomorphometric analysis were performed. The results showed normal behavior of the animals, without implant exposure, extrusion, death or systemic toxicity. Capsule tissue formation was observed between the sclera and the implant. Normal inflammatory response to the foreign material in contact with the rabbit soft tissue was observed. The resin FullCure 720®, demonstrated to be biocompatible as an orbital implant in this study.

Toxicidade da mitomicina C ao endotélio da córnea de coelhos / Mitomycin C toxicity in rabbit corneal endothelium

OBJETIVO: Avaliar alterações do endotélio corneano após aplicação de mitomicina C na esclera por meio de microscopia eletrônica de transmissão e de varredura e correlacionar as alterações com tempo, concentração e entre os dois métodos de avaliação. MÉTODOS: Foi avaliado o endotélio corneano dos olhos de 32 coelhos albinos distribuídos em 4 grupos experimentais com 8 coelhos cada um. A mitomicina C foi aplicada sob retalho escleral no olho direito por 5 minutos. Nos grupos G1 e G2 a concentração da mitomicina C foi de 0,5 mg/ml e nos grupos G3 e G4 a concentração foi de 0,2 mg/ml. O exame foi realizado com 15 dias após nos grupos G1 e G3 e com 30 dias nos grupos G2 e G4. Dos 8 animais 4 foram preparados para microscopia eletrônica de transmissão e 4 para microscopia eletrônica de varredura. Os olhos esquerdos de todos animais serviram como controle. RESULTADOS: À microscopia eletrônica de transmissão foram observadas alterações do endotélio corneano em todos os grupos experimentais: rarefação do citoplasma, dilatação e fragmentação das cisternas do retículo endoplasmático rugoso, aparelhos de Golgi com dilatação das cisternas, redução de vacúolos e irregularidades da membrana celular interna sendo mais intensas em G1 e G2. À microscopia eletrônica de varredura foram observadas alterações em todos grupos experimentais, exceto G1: alteração de forma e tamanho das células e projeções filopoidais mais longas. CONCLUSÕES: 1 - A mitomicina C causou alteração no endotélio da córnea tanto na concentração de 0,5 mg/ml como de 0,2 mg/ml observadas 15 e 30 dias após a aplicação; 2 - As alterações foram mais intensas com a maior concentração de mitomicina C (0,5 mg/ml) na microscopia eletrônica de transmissão e não na microscopia eletrônica de varredura; 3 - As alterações tiveram correlação com o tempo na microscopia eletrônica de varredura e não na microscopia eletrônica de transmissão.

PURPOSE: To evaluate corneal endothelium alterations after applying mitomycin C to the sclera using transmission and scanning electron microscopy, correlating alterations with time, concentration, and evaluation methods. METHODS: The corneal endothelium of both eyes of 32 albino rabbits was evaluated and distributed into four groups of 8. Mitomycin C was applied under a scleral flap in the right eye for 5 minutes. Mitomycin C concentrations were 0.5 mg/ml for G1 and G2 and 0.2 mg/ml for G3 and G4. Examinations were performed 15 days after application to G1 and G3, and 30 days after application to G2 and G4. Four cornea in each group were prepared for transmission electron microscopy and four for scanning electron microscopy. Left eyes of all animals were used as controls. RESULTS: Transmission electron microscopy showed corneal endothelium alterations in all groups: rarefied cytoplasm, dilation and fragmentation of rough endoplasmic reticulum cisternae, Golgi apparatus with cisternal dilation, reduced vacuoles, and irregularities of internal membrane more noticeable in G1 and G2. Scanning electron microscopy revealed alterations in all groups except G1: changes in the shape and size of cells and longer filopodial projections. CONCLUSIONS: 1 - Corneal endothelium alterations were seen at both 0.5 and 0.2 mg/ml concentrations and at 15 and 30 days after mytomicin C application; 2 - Alterations were more intense with higher mytomicin C concentration by transmission electron but not by scanning electron microscopy; 3 - The alterations correlated with time by scanning electron microscopy but not by transmission electron microscopy.

Biomechanical and histological evaluation of glycerol-preserved human sclerae

PURPOSE: To determine the histological and biomechanical characteristics of glycerol-preserved human sclera. METHODS: A total of 114 paired human sclerae were cleaned and preserved with 98 percent glycerol under refrigeration at 4 to 8ºC. The samples were divided into a control group with no preservation and 5 groups of 19 sclerae in 7, 15, 30, 90 and 180 days of preservation. Each specimen was submitted to histological examination and tested for traction distensibility functions. RESULTS: Preservation in glycerol did not cause alterations in the histological architecture of the scleral tissue. The mean load required to break the scleral tissue increased according to preservation time as a sigmoid function. A significant increase in mechanical resistance and decrease in distension of scleral tissue occurred after 90 days of preservation. CONCLUSIONS: Scleral preservation in glycerol keeps tissue integrity. The preserved material is less distensible after 90 days. Surgeons who use sclera in ophthalmic procedures should be aware of the mechanical characteristics of glycerol-preserved sclera and take into account tissue preservation time.

OBJETIVO: Determinar as características histológicas e biomecânicas de escleras humanas preservadas em glicerol. MÉTODOS: Escleras de ambos os olhos de 55 doadores foram limpas e preservadas com glicerol a 98 por cento sob refrigeração (4 a 8ºC). A amostra foi dividida em grupo controle sem preservação e 5 grupos de 19 escleras com 7, 15, 30, 90 e 180 dias de preservação. Todas as amostras foram submetidas à avaliação histológica e aos testes de tração e distensão. RESULTADOS: A preservação em glicerol não provocou alterações na arquitetura histológica do tecido escleral. A carga média necessária para romper o tecido escleral aumentou com o tempo de preservação segundo uma função sigmóide. Um incremento significativo na resistência mecânica e diminuição da elasticidade do tecido ocorreram após 90 dias de preservação. CONCLUSÕES: A preservação escleral com glicerol mantém a integridade tecidual. O material preservado torna-se menos distensível após 90 dias de preservação. Cirurgiões que usam esclera preservada em procedimentos oftalmológicos devem estar conscientes das propriedades mecânicas do material e levar em conta o tempo de preservação do material.

Análise comparativa entre esclera tratada com glicerina e esclera tratada com irradiação gama, álcali e glicerina em reconstrução de cavidade anoftálmica: estudo experimental em coelhos / Comparative analysis between sclera treated with glycerin and sclera treated with gamma irradiation, alkali and glycerin in the reconstruction of anophthalmic socket: experimental study in rabbits

OBJETIVO: Comparar dois métodos de descontaminação de escleras: tratamento com glicerina versus tratamento com irradiação gama, álcali e glicerina, visando detectar as alterações clínicas e histológicas em cavidades anoftálmicas de coelhos, reconstruídas com esferas de polimetilmetacrilato envolvidas com esclera. MÉTODOS: Trinta e nove coelhos da raça Nova Zelândia foram divididos em 2 grupos: grupo I, cujos animais foram submetidos à enucleação de um olho e reconstrução com esfera de polimetilmetacrilato envolvida em esclera tratada com glicerina; grupo II, quando houve a enucleação e a reconstrução foi feita com esfera de polimetilmetacrilato, envolvida em esclera tratada com irradiação gama, álcali e glicerina. Os 2 grupos foram observados em 4 momentos: 7, 21, 42 e 84 dias após a cirurgia. Decorridos os tempos prefixados, os coelhos foram sacrificados, as órbitas exenteradas, sendo o material processado para emblocamento em parafina, cortado com 5 mm de espessura e corado pelas técnicas de hematoxilina-eosina e tricrômio de Masson. As escleras foram submetidas à análise morfométrica e semiquantitativa. Os resultados foram comparados pelo teste não paramétrico de Mann-Whitney. RESULTADOS: A análise comparativa da vascularização da interface cirúrgica apontou diferença significativa na avaliação feita 21 dias após o implante (P<0,001), tendo o grupo II apresentado neovascularização maior. A comparação da espessura da cápsula fibrosa apontou uma diferença significativa nos momentos correspondentes a 21 dias (P<0,001) e 42 dias (P<0,001), sendo que, nestes dois momentos, o grupo II apresentou cápsula fibrosa mais espessa do que o grupo I. Houve também variação na espessura da esclera, sendo mais espessa no grupo II, também nos momentos pós-implante de 21 dias (P=0,003) e 42 dias (P=0,024). Quando os grupos foram analisados ao longo do período de experimentação, observou-se diminuição da vascularização da interface cirúrgica, entre os...

PURPOSE:To compare two sclera decontamination methods: treatment with glycerin versus treatment with gamma irradiation, alkali and glycerin, aiming to detect the clinical and histological alterations in rabbit anophthalmic sockets reconstructed with sclera-involved polymethylmethacrylate spheres. METHODS:Thirty-nine New Zealand-breed rabbits were divided into two groups: group I, whose animals were submitted to enucleation of one eye and reconstruction with a polymethylmethacrylate sphere involved in glycerin-treated sclera; group II, where there was enucleation, and reconstruction performed with a polymethylmethacrylate sphere involved in sclera treated with gamma irradiation, alkali and glycerin. The two groups were observed at four moments, at 7, 21, 42 and 84 days after surgery. Preset times elapsed, the rabbits were euthanized, sockets were exenterated, the material was processed for embedment in paraffin, cut into 5 æm sections thick and stained with hematoxylin-eosin and Masson's trichrome techniques. The scleras were submitted to morphometric and semiquantitative analysis. Results were compared by Mann-Whitney's non-parametric test. RESULTS: Comparative analysis of vascularization of the surgical interface pointed out a significative difference in the evaluation done 21 days after the implant (P<0.001), with group II showing greater neovascularization. Comparison of the fibrous capsule thickness displayed a significative difference at moments corresponding to 21 days (P<0.001) and 42 days (P<0.001). At both moments, group II presented a thicker fibrous capsule than group I. Likewise, there was variation in sclera thickness, being thicker in group II, at the 21-day post-implant (P=0.003) moment, and at the 42-day moment (P=0.024), as well. Along the experimental period, when groups were analyzed we could observe statistically significative diminution of vascularization in the surgical interface, in group I, as well as in group...

Results of intraoperative 5-fluorouracil in patients undergoing trabeculectomy--pilot trial.

To study the effect of 5-Fluorouracil (5-FU) in glaucoma filtration surgery, 13 eyes of 12 patients with glaucoma were subjected to trabeculectomy with intraoperative one minute exposure of 50 mg/ml 5-FU. The average age of patients was 36.42 +/- 18.78 years. Two of the patients had developed hypotony in the fellow eye following the use of Mitomycin C with trabeculectomy. The mean follow-up period was 9.54 +/- 5.17 weeks. Two patients developed a shallow anterior chamber with choroidals postoperatively which responded to conservative treatment. One patient developed an encysted bleb one month after surgery. Single one minute intraoperative exposure to 5-FU is a convenient and inexpensive method which appears to have no significant side effects. It may be a useful adjunctive treatment to optimise the results of glaucoma filtration surgery particularly in young and myopic patients. The long term effects, however, are not known.

Effects of mitomycin C on delayed adjustment in experimental strabismus surgery

In adjustable strabismus surgery, a satisfactory final result would be achieved with delayed adjustment. However, the postoperative adhesions following strabismus surgery make delayed adjustment impossible. We evaluated the efficacy of mitomycin C in reducing the severity of postoperative adhesions following strabismus surgery and in delaying the time adjustment after surgery. Experimental rabbits underwent a hang-back recession procedure in the superior rectus muscle. A topical application of mitomycin C was made between the conjunctiva and the sclera for 5 minutes during the operation. We then studied the possible time of delayed adjustment and estimated the minimal forces required for the adjustment. The topical application of 0.1 mg/ml mitomycin C between the conjunctiva and sclera allowed for a 2-week delayed adjustment after surgery, and 0.2 mg/ml mitomycin C prevented the adhesions between these tissues and the muscle 5 weeks after surgery. These results suggest that topical mitomycin C may enhance the success rate of strabismus surgery with delayed adjustment and reduce postoperative adhesions.

Scleral rigidity in glaucoma, before and during topical antiglaucoma drug therapy.

A study of 30 subjects (10 normal and 20 having glaucoma) was done to find out the scleral rigidity in glaucoma cases as compared to normal. The effect of miotics, timolol (0.25%) and pilocarpine (2%) eye drops on the scleral rigidity in cases of glaucoma was observed.