Layer-by-Layer Investigation of Ultrastructures and Biomechanics of Human Cornea.

The cornea is an avascular, innervated, and transparent tissue composed of five layers: the epithelium, Bowman's layer, stroma, Descemet's membrane, and endothelium. It is located in the outermost fraction of the eyeball and is responsible for the refraction of two-thirds of light and protection from external mechanical damage. Although several studies have been done on the cornea on the macroscopic scale, there is a lack of studies on the micro-nanoscopic scale, especially an analysis evaluating the cornea layer by layer. In this study, atomic force microscopy (AFM) was employed to assess four layers that form the cornea, analyzing: adhesion, stiffness, and roughness. The results showed microvilli in the epithelial and endothelial layers, pores in the basement membrane, and collagen fibers in the Stroma. These data increase the knowledge about the human cornea layers' ultrastructures and adds new information about its biophysical properties.

Vernal Keratoconjunctivitis as the Only Clinical Manifestation of HIV Infection.

INTRODUCTION: This case report describes an 8 year old boy unsuccessfully treated for years for Vernal Keratoconjunctivitis. CASE REPORT: We report a VKC resistant to all types of treatment known in the literature, such as topical and oral corticosteroids, topical and oral cyclosporine, immunotherapy, and third generation anti-histamine eye drops, due to unknown HIV co-infection. During further laboratory tests, patient tested positive for HIV even though he did not present any clinical manifestation of HIV disease. Only after antiretroviral treatment was started the allergy symptoms completely regressed. CONCLUSION: This case report suggests considering investigation of HIV infection in patients with refractory allergic conjunctivitis.

[Marketing role of corneal graft tissue donation to an eye bank and donors' socioeconomic profile]. / Impacto do marketing dos processos de divulgação nas doações de córneas a um banco de tecidos oculares humanos e avaliação do perfil socioeconômico de seus doadores.

UNLABELLED: Penetrating keratoplasty has been the leading and the most successful type of transplant in the world, however corneal deficiency is a commom problem usually presented to corneal surgeons. PURPOSE: Impact evaluation of the number of corneal graft donations to the Sorocaba Eye Bank after the implementation of a corneal graft procurement system; to draw the socioeconomic profile of corneal graft donors of the Sorocaba Eye Bank (SEB). METHODS: Retrospective study on donations to SEB from its creation and after the development of media marketing. Prospective analysis of the socioeconomic profile of corneal graft donors by a questionnaire sent as letters to the families of the donors in a certain month. RESULTS: SEB began its work in 1971 by spreading need of organ donation through lectures in churches, shopping malls, community meetings, radio programs, television programs, etc. In the 70s, the number of retrieved corneal grafts was 1 or 2/month. Between 1984 - 1989 a procurement coordination team was trained to act in mortuaries and by 2000 they also began to work in public hospitals. In 1984 only 260 corneal grafts were retrieved. This number has been increasing to 2,778 corneal graft donations in 2004. The questionnaire was answered by 76 of the 93 donor families, with a response rate of 81.7%. Donor age had a mean of 65.1 +/- 14.7 y/o, forty-two (55.3%) were men. Educational level of the donor families was an important factor for organ donation, once 36.8% had concluded high school and 34.2% completed university. The great majority, sixty-three (82.9%) of the corneal grafts were donated through the efforts of the procurement coordination team. CONCLUSION: The role of the media and institutional credibility are mandatory for public commitment to organ donation. The proficiency of the procurement coordination team requires intensive training, as the results show that 82.9% donations were made thanks to their efforts.

Impacto do marketing dos processos de divulgação nas doações de córneas a um banco de tecidos oculares humanos e avaliação do perfil socioeconômico de seus doadores / Marketing role of corneal graft tissue donation to an eye bank and donors' socioeconomic profile

A ceratoplastia penetrante tem-se tornado a forma de transplante de maior emprego e sucesso nos Estados Unidos. No Brasil, ela teve início em 1964. OBJETIVOS: Avaliar o impacto no número de doações de córneas ao Banco de Olhos de Sorocaba a partir da implementação de um sistema de captação de córneas e traçar o perfil socioeconômico dos doadores de córneas no Banco de Olhos de Sorocaba (BOS). MÉTODOS: Foi realizado um estudo retrospectivo do volume de doações ao BOS do início de sua criação (1971) após a realização de uma intensa política de marketing interno e externo. A análise do perfil socioeconômico dos doadores de córneas foi avaliada, prospectivamente, por meio de cartas com questionário, enviadas às referidas famílias em um dado mês. RESULTADOS: O BOS iniciou o trabalho em 1971 com a divulgação da necessidade de doação de órgãos sendo feita com a utilização de palestras em igrejas, shoppings e reuniões de comunidade, programas de rádio, programas de televisão, etc. Na década de 1970 e no início da década de 1980, o número de córneas captadas oscilava entre 1 a 2/mês. Entre 1984 e 1989, houve formação de uma equipe de abordagem com treinamento de 60 horas anuais atuante em funerárias, e a partir de 2000, estas também começaram a agir em hospitais. Em 1984 foram captadas somente 260 córneas. Este número foi aumentando gradativamente, até chegar em 2004 com o total de 2.778 córneas doadas. Os questionários aplicados foram respondidos pelas famílias de 76 dos 93 doadores, dando-nos uma taxa de resposta de 81,7 por cento. A idade dos doadores foi em média de 65,1 ± 14,7 anos, 42 (55,3 por cento) eram do sexo masculino. O nível de educação da família dos doadores foi fator importante na doação de órgãos, uma vez que 36,8 por cento apresentavam ensino médio completo e 34,2 por cento apresentavam ensino superior completo. A grande maioria, 63 (82,9 por cento) das 76 doações (152 córneas) decorreu do esforço da equipe de abordagem. O papel da mídia aliado à credibilidade da instituição são obrigatórios na conscientização da população sobre a doação de órgãos. A profissionalização das equipes de abordagem requer intenso treinamento, entretanto, o resultado é percebido quando 82,9% das doações foram obtidas devido a esse trabalho.

Penetrating keratoplasty has been the leading and the most successful type of transplant in the world, however corneal deficiency is a commom problem usually presented to corneal surgeons. PURPOSE: Impact evaluation of the number of corneal graft donations to the Sorocaba Eye Bank after the implementation of a corneal graft procurement system; to draw the socioeconomic profile of corneal graft donors of the Sorocaba Eye Bank (SEB). METHODS: Retrospective study on donations to SEB from its creation and after the development of media marketing. Prospective analysis of the socioeconomic profile of corneal graft donors by a questionnaire sent as letters to the families of the donors in a certain month. RESULTS: SEB began its work in 1971 by spreading need of organ donation through lectures in churches, shopping malls, community meetings, radio programs, television programs, etc. In the 70s, the number of retrieved corneal grafts was 1 or 2/month. Between 1984 - 1989 a procurement coordination team was trained to act in mortuaries and by 2000 they also began to work in public hospitals. In 1984 only 260 corneal grafts were retrieved. This number has been increasing to 2,778 corneal graft donations in 2004. The questionnaire was answered by 76 of the 93 donor families, with a response rate of 81.7 percent. Donor age had a mean of 65.1 ± 14.7 y/o, forty-two (55.3 percent) were men. Educational level of the donor families was an important factor for organ donation, once 36.8 percent had concluded high school and 34.2 percent completed university. The great majority, sixty-three (82.9 percent) of the corneal grafts were donated through the efforts of the procurement coordination team. CONCLUSION: The role of the media and institutional credibility are mandatory for public commitment to organ donation. The proficiency of the procurement coordination team requires intensive training, as the results show that 82.9 percent donations were made thanks to their efforts.

[Evaluation of corneal tissue by slit lamp and specular microscopy during the preservation period]. / Avaliação de córneas doadoras em lâmpada de fenda e microscopia especular durante o período de armazenamento.

PURPOSE: To analyze changes evaluation of corneal grafts by slit lamp and electron microscopy examination in order to ensure a donor cornea of good quality level for the patient. METHODS: 203 corneas donated to the Sorocaba Eye Bank between September 2002 and February 2003 were prospectively evaluated. The evaluation was graded from 0 to 3 according to the following factors: exposure and epithelial damage, stromal opacity, Descemet folds, pleomorphism, polymegatism and guttata, endothelial snail track, edema, reflectivity. The data were correlated with time between death and preservation, endothelial cell count and donor's age. RESULTS: 203 corneas were evaluated. The mean age of donors was 55 years (dp= 14.8 years). The mean time between death and preservation was 9.1 h (minimum of 2 h and maximum of 25 h). Eighty-six corneas suffered worsening of evaluation, whereby 66.3% had less than 2,500 endothelial cell count and 59.3% presented time between death and preservation over 6 hours. The mean day of the grading change was the 5th. CONCLUSIONS: Corneal grafts from younger donors had significantly better evaluation than those of older donors. The mean time of the evaluation change was on the 5th day in 50% of the corneas, however, an expressive number of corneas suffered changes on the 6th, 7th and 8th day. Corneal graft preserved after 6 hours of death had a greater tendency to lower cell count and to decrease in evaluation grades.

Avaliação de córneas doadoras em lâmpada de fenda e microscopia especular durante o período de armazenamento / Evaluation of corneal tissue by slit lamp and specular microscopy during the preservation period

OBJETIVO: Analisar as mudanças de notas de avaliação por meio da biomicroscopia e microscopia eletrônica de córneas doadas, e desta forma assegurar córnea doadora de padrão satisfatório ao paciente. MÉTODOS: Foram avaliadas prospectivamente 203 córneas entre setembro de 2002 e fevereiro de 2003, doadas ao Banco de Olhos de Sorocaba. A avaliação constava de graduação de 0 a 3 que variava mediante os seguintes fatores: exposição e defeito epitelial, opacidade e infiltrado estromal, dobras ou estrias de Descemet, pleomorfismo, polimegatismo e guttata, "endothelial snail track", edema, refletividade. Os dados encontrados foram correlacionados com o intervalo entre óbito e preservação, contagem de células endoteliais e idade dos doadores. RESULTADOS: Duzentos e três córneas foram avaliadas. A idade média dos doadores foi de 55 anos (dp=14,8 anos). O tempo médio do óbito à preservação foi de 9,1 h (mínimo de 2 horas e máximo de 25 horas). Oitenta e seis córneas sofreram pioras de avaliação, sendo que 66,3 por cento delas tinham até 2.500 células endoteliais e 59,3 por cento delas tinham tempo superior a 6 horas entre o óbito e a preservação. O dia da mudança teve por mediana 5. CONCLUSÕES: Córneas de doadores mais jovens possuem significativamente avaliações melhores que doadores mais velhos. O tempo médio de mudança de avaliação foi com 5 dias em 50 por cento das córneas, entretanto, expressiva parcela de córneas apresentou alteração nos dias 6°, 7° e 8°. Córneas preservadas após 6 horas do óbito têm maior tendência à perda de células e redução dos índices de avaliação.

PURPOSE: To analyze changes evaluation of corneal grafts by slit lamp and electron microscopy examination in order to ensure a donor cornea of good quality level for the patient. METHODS: 203 córneas donated to the Sorocaba Eye Bank between September 2002 and February 2003 were prospectively evaluated. The evaluation was graded from 0 to 3 according to the following factors: exposure and epithelial damage, stromal opacity, Descemet folds, pleomorphism, polymegatism and guttata, endothelial snail track, edema, reflectivity. The data were correlated with time between death and preservation, endothelial cell count and donor's age. RESULTS: 203 corneas were evaluated. The mean age of donors was 55 years (dp= 14.8 years). The mean time between death and preservation was 9.1 h (minimum of 2 h and maximum of 25 h). Eighty-six corneas suffered worsening of evaluation, whereby 66.3 percent had less than 2,500 endothelial cell count and 59.3 percent presented time between death and preservation over 6 hours. The mean day of the grading change was the 5th. CONCLUSIONS: Corneal grafts from younger donors had significantly better evaluation than those of older donors. The mean time of the evaluation change was on the 5th day in 50 percent of the corneas, however, an expressive number of corneas suffered changes on the 6th, 7th and 8th day. Corneal graft preserved after 6 hours of death had a greater tendency to lower cell count and to decrease in evaluation grades.

[Corneal transplant utilizing a corneal graft that had undergone laser surgery--case report]. / Transplante de córnea com uso inadvertido de córnea de doador previamente submetido à cirurgia refrativa--relato de caso.

Report on a successful clinical case of a corneal penetrating keratoplasty using inadvertently a corneal graft that had undergone laser assisted in situ keratomileusis (LASIK). Review of a clinical case of a patient of the Cornea Department of the "Hospital Oftalmológico de Sorocaba" who underwent a penetrating keratoplasty (PK) to correct keratoconus in his left eye. A corneal graft from a donor who had LASIK surgery was used. Surgery was completed without complications, although a separation of the corneal lamellae was noted during surgery. Patient evolution was good with a final corrected visual acuity of 20/40. PAM was also 20/40. Epithelial growth was noticed on the flap interface, although, without progression of this finding. Eye Banks should improve screening techniques to rule out refractive surgery in the donor corneas; there was no impairment of the final result of this transplant until the 6th month after surgery; long-term follow-up is necessary to reveal if surgical success was impaired by prior refractive surgery.

Transplante de córnea com uso inadvertido de córnea de doador previamente submetido à cirurgia refrativa: relato de caso / Corneal transplant utilizing a corneal graft that had undergone laser surgery: case report

Relato de caso de paciente atendido no Departamento de Córnea do Hospital Oftalmológico de Sorocaba e submetido a transplante penetrante de córnea para correção de ceratocone no olho esquerdo. Foi utilizada córnea doadora previamente submetida a LASIK. A cirurgia foi completada sem intercorrências, embora durante o ato cirúrgico o cirurgião tenha percebido que havia um "flap" no botão doador. O paciente está no 6º mês pós-operatório com visão de 20/40 com correção. O PAM era de 20/40. Há epitélio na interface superior do "flap" sem sinais de progressão. Devem-se procurar novos métodos de avaliação de córneas doadoras; a utilização inadvertida de córnea doadora submetida a LASIK não interferiu até o 6º mês pós-operatório no resultado final do transplante; acompanhamento prolongado é necessário para avaliar a transparência e evolução da ceratometria e erro refracional deste transplante a longo prazo.