Ten-year follow-up of corneal cross-linking and refractive surface ablation in patients with asymmetric corneal topography.

Purpose: Compare the safety and efficacy of wavefront-guided photorefractive keratotomy (PRK) 6 months after cross-linking (CXL) to wavefront-guided PRK alone for refractive correction in patients with bilateral asymmetric corneal topography. Methods: Prospective randomized clinical trial with 16 patients (32 eyes). CXL with subsequent PRK after 6 months in one eye, and PRK alone was performed in contralateral eyes. The follow-up was 10 years. We analyzed visual outcomes, Scheimpflug topography, and corneal haze evaluation. Results: Eyes in the PRK group showed better results than in the CXL + PRK group. Mean postoperative CDVA was 0.044 logmar (SD, 0.073) in the PRK group and 0.1 logmar (SD, 0.21) in the CXL + PRK group, the mean sphere was + 0.21 (SD, 0.6) D in the PRK group and 0.87 (SD, 2.3) D in the CXL + PRK group, and mean SE was -0.35 (SD, 0.65) D in the PRK group and 0.62 (SD, 2.32) D in the CXL + PRK group. In one patient, a steepening of 2.5 D and a thinning of 17 µm occurred in PRK alone group. Two patients in the CXL + PRK group presented corneal haze. The overall complication rate was 18,75% (haze and ectasia). Conclusion: Non-simultaneous CXL and PRK procedures yielded good refractive results, but worse than those obtained with PRK alone. Although one patient in the PRK group developed corneal ectasia, the CXL + PRK group had a higher loss of vision lines, indicating less safety.

Two-year follow-up of corneal cross-linking and refractive surface ablation in patients with asymmetric corneal topography.

AIMS: To evaluate the safety and efficacy of corneal cross-linking (CXL) followed by photorefractive keratectomy (PRK) for refractive correction in patients with bilateral asymmetric topography. METHODS: Forty-four patients (88 eyes) were enrolled in this prospective randomised clinical trial. CXL with subsequent PRK after 6 months was performed in one eye (study group), and PRK alone was performed in contralateral eyes (control group). Patients were followed for 24 months after PRK. Outcome measures investigated included visual acuity (VA), refraction, aberrometry, topography, pachymetry and endothelial cell count. Groups were compared with linear mixed regression and repeated measures logistic regression. Multiple comparison adjustment with the Holm procedure was performed. RESULTS: At baseline, the logMAR VA (best spectacle corrected) in study and control groups was 0.12±0.13 (mean±SD) and 0.08D±0.14, respectively, and axial inferior-superior index (IS) (topographic IS) in study and control groups were 0.59D±0.31D and 0.58D±0.32D, respectively. After 24 months, a mean under correction of -0.50D was observed in both groups. Change from baseline in logMAR VA in study and control groups was 0.00D±0.08D and -0.02D±0.10D, respectively. Frequency of haze at 30 months in study and control group eyes was, respectively, 18.2% and 4.6% (p=0.05). There was no statistical difference between groups in spherical aberration and coma after adjustment for multiple comparisons. CONCLUSIONS: Non-simultaneous CXL followed by PRK may be performed safely, and refractive results over a 2-year follow-up are highly similar in virgin and previously cross-linked corneas. Despite using mitomycin C, corneal haze can be significantly higher in the first year after PRK in eyes pretreated with CXL.

Treatment of ocular graft-versus-host disease with topical cyclosporine 0.05%.

PURPOSE: To evaluate the efficacy of topical cyclosporine-A 0.05% (CsA) in the treatment of dry eye syndrome in ocular graft-versus-host disease after bone marrow transplantation (BMT) of hematopoietic stem cells. METHODS: One-hundred five patients were enrolled in a retrospective, comparative, interventional case series. Eighty-one patients received topical CsA starting 1 month before BMT (treatment group), and 24 patients did not receive CsA until at least 6 months after the transplantation (control group). Mean follow-up time was 17.5 ± 11.0 months (range: 6.0-49.0 months). Clinical history, ocular surface disease index questionnaire, slit-lamp examination, lissamine green and fluorescein staining of the ocular surface, tear breakup time, and Schirmer test with topical anesthesia were obtained to create a composite dry eye-grading score. RESULTS: Dry eye symptoms were significantly more severe in the control group at 3 months, 1 year, and 2 years (P < 0.05). There was no correlation with type of stem cell transplant (related vs. unrelated donor), presenting indication for BMT, or concurrent systemic immunosuppressive medications. CONCLUSIONS: Pre-BMT initiation of topical CsA may reduce the inflammatory response in the lacrimal glands that may be responsible for the development of post-BMT keratitis sicca.

Wound integrity of clear corneal incisions closed with fibrin and N-butyl-2-cyanoacrylate adhesives.

PURPOSE: To compare the integrity of clear corneal incisions closed with fibrin (Tisseel) and n-butyl-2-cyanoacrylate (Histoacryl) tissue adhesives to those closed with conventional sutures. METHODS: Four replicate experiments were performed on porcine eyes with each of the following conditions: three limbal clear corneal incision sizes (3.0 mm, 4.5 mm, and 6.0 mm), three incision closure techniques (fibrin adhesive, n-butyl-2-cyanoacrylate adhesive, and 10-0 interrupted nylon sutures)-1, 2, and 3 sutures at the 3.0-mm, 4.5-mm, and 6.0-mm incision sizes, respectively. Wound integrity was then measured by elevating the intraocular pressure of the eye to the point where wound leakage (IOP(L)) occurred. Two-way repeated measures analysis of variance (ANOVA) was used to analyze the IOP(L) data. RESULTS: Incision closure technique and incision size showed significant interaction in the ANOVA model (p = 0.0008). Fibrin adhesive demonstrated higher IOP(L) compared to suture closure at the 3.0-mm incision size (p < 0.0001). There was no significant difference in IOP(L) when comparing wound closure with fibrin adhesive and sutures at the 4.5-mm and 6.0-mm incision sizes (p = 0.52 and p = 0.56, respectively). There was no significant difference between the three closure techniques for the 6.0-mm incisions (p > 0.15). When comparing the wound closure techniques for all incision sizes, the mean IOP(L) significantly increased in the following order: suture(s), fibrin adhesive, n-butyl-2-cyanoacrylate glue. CONCLUSIONS: Fibrin or n-butyl-2-cyanoacrylate tissue adhesive may be used as a more stable alternative to conventional sutures in the closure of clear corneal incisions.

Long-term outcome of combined penetrating keratoplasty with scleral-sutured posterior chamber intraocular lens implantation.

PURPOSE: To evaluate the long-term outcomes of combined penetrating keratoplasty (PKP) with scleral-sutured posterior chamber intraocular lens (PC-IOL) implantation. METHODS: Medical records from patients with aphakic and pseudophakic bullous keratopathy were retrospectively reviewed for preoperative indications and postoperative results of 105 consecutive patients (105 eyes) who underwent combined PKP and scleral-sutured PC-IOL implantation over a 13-year period. Main outcomes measures were graft survival rate, visual acuity, and intraoperative and postoperative complications. RESULTS: The principal indications for PKP were pseudophakic and aphakic corneal edema. Graft survival rates were 97% at 1 year, 91% at 2 years, 75% at 5 years, and 68% at 7 years. Mean postoperative follow-up was 44.8 +/- 37.0 months (range 1-156). The best-corrected visual acuity improved at least 1 line on the Snellen chart in 59.0% of the patients, with 42.9% of the eyes achieving acuities of 20/100 or better. Postoperative complications included new glaucoma in 21.4%, worsening of pre-existing glaucoma in 28.6%, cystoid macular edema in 17%, infectious endophthalmitis in 3.8%, and intraocular lens dislocation in 1.9%. No intraoperative complications were encountered. CONCLUSIONS: PKP combined with scleral-sutured PC-IOL implantation can achieve acceptable outcomes with a low rate of intraocular lens dislocation, but may be associated with significant short and long-term complications.

Photorefractive keratectomy with mitomycin-C for consecutive hyperopia after radial keratotomy.

PURPOSE: To evaluate the safety, efficacy, and stability of excimer laser photorefractive keratectomy (PRK) and mitomycin-C (MMC) 0.02% for consecutive hyperopia after radial keratotomy (RK). METHODS: A prospective, nonrandomized, noncomparative interventional case series of 35 eyes (22 patients) with consecutive hyperopia after RK. All eyes were treated with PRK, using a single intraoperative topical application of MMC 0.02% for 60 seconds. Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, slit-lamp evidence of corneal haze, and endothelial cell counts were evaluated for up to 18 months after surgery. RESULTS: Postoperative follow-up was 9.6 +/- 5.5 months (ranged from 3 to 18 months). The mean spherical equivalent was +3.36 +/- 1.94 diopters preoperatively and +0.27 +/- 1.38 diopters 12 months after surgery. The uncorrected visual acuity was > or =20/30 in 37.1% of the eyes at 1 month and 78.6% of the eyes at 12 months. At 12 months, 14% of the eyes lost up to 1 line of Snellen acuity in the best spectacle-corrected visual acuity. No corneal haze was observed and the endothelial cell counts remained unchanged postoperatively (P > 0.05). CONCLUSION: PRK with MMC 0.02% for consecutive hyperopia after RK seems to be a safe and effective procedure at least in the short-term period of 6 months.

Femtosecond laser-assisted keratoplasty: laboratory studies in eye bank eyes.

PURPOSE: To optimize the surgical technique for performing femtosecond laser-assisted keratoplasty (FLAK) using the IntraLase FS to cut both recipient and donor cornea buttons in eye bank globes. METHODS: FLAK was performed in six globes and six corneoscleral buttons for each of the following trephination patterns: top hat, mushroom, tongue-groove, and vertical. Manual trephination was performed as control. The wound integrity was tested in incisions closed with 8 sutures, 8 sutures with fibrin adhesive, and 16 sutures by measuring the intraocular pressure required to produce graft-host wound leakage (IOP(L)). Light microscopy (LM) and scanning electron microscopy (SEM) were performed to assess cut surface quality and graft-host interface regularity. RESULTS: Mushroom and top hat FLAK had significantly higher IOP(L) than vertical or manual trephination (p < 0.0001) for wounds closed with 16 sutures. There was no difference in IOP(L) between top hat, mushroom, and tongue-groove FLAK in wounds closed with 8 sutures with fibrin adhesive (p > 0.75). LM and SEM demonstrated cut surfaces with good quality and smooth edges. CONCLUSIONS: These preliminary studies show that FLAK produces precise trephination cuts of superior wound strength and stability to that of manual trephination. Adjuvant fibrin glue may further improve wound integrity.

Femtosecond lasers in ophthalmology.

PURPOSE: To provide an update and review of femtosecond (FS) lasers in clinical ophthalmology. DESIGN: Perspective, literature review, and commentary. METHODS: Selected articles from the literature and the authors' clinical and laboratory studies. RESULTS: The FS laser employs near-infrared pulses to cut tissue with minimal collateral tissue damage. Although its major use at present is in the cutting of laser in situ keratomileusis flaps, the laser has proven its versatility in laser-assisted anterior and posterior lamellar keratoplasty, cutting of donor buttons in endothelial keratoplasty, customized trephination in penetrating keratoplasty, tunnel creation for intracorneal ring segments, astigmatic keratotomy, and corneal biopsy. Current laboratory studies include all-FS laser refractive keratomileusis sans flap, cutting corneal pockets for insertion of biopolymer keratoprostheses, noninvasive transscleral glaucoma surgery, retinal imaging and photodisruption, presbyopia surgery, and anterior lens capsulorrhexis. CONCLUSIONS: Advances in ultra-fast laser technology continue to improve the surgical safety, efficiency, speed, and versatility of FS lasers in ophthalmology.

Femtosecond laser-assisted lamellar keratoplasty.

Lamellar keratoplasty consists of transplanting partial-thickness donor cornea onto a complementary recipient bed. Manual lamellar dissection is technically very difficult, time-consuming, and imprecise. Also, the manually-dissected lamellar interface often has topographical irregularities that may optically degrade the best-corrected visual acuity. The femtosecond clinical laser (IntraLase FS Laser, Irvine, CA) is a recent innovation that can be programmed to produce bladeless, precise lamellar cuts at any depth with accompanying trephination cuts for both anterior and posterior lamellar transplantation. Posterior laser cuts may be used to assist in deep lamellar endothelial keratoplasty or Descemet's stripping automated endothelial keratoplasty.

Femtosecond laser-assisted lamellar keratoplasty / Transplante lamelar auxiliado pelo laser de fentosegundo

Lamellar keratoplasty consists of transplanting partial-thickness donor cornea onto a complementary recipient bed. Manual lamellar dissection is technically very difficult, time-consuming, and imprecise. Also, the manually-dissected lamellar interface often has topographical irregularities that may optically degrade the best-corrected visual acuity. The femtosecond clinical laser (IntraLase FS LaserTM, Irvine, CA) is a recent innovation that can be programmed to produce bladeless, precise lamellar cuts at any depth with accompanying trephination cuts for both anterior and posterior lamellar transplantion. Posterior laser cuts may be used to assist in deep lamellar endothelial keratoplasty or Descemet's stripping automated endothelial keratoplasty.

A ceratoplastia lamelar consiste em transplante de espessura parcial da córnea doadora em um leito receptor complementar. A dissecção lamelar manual é técnica de difícil realização, imprecisa e que demanda tempo. Além disso, a interface lamelar freqüentemente apresenta irregularidade topográfica que pode comprometer a acuidade visual final. O laser clínico "femtosecond" (IntraLase FS LaserTM, Irvine, CA) é uma recente inovação que pode ser utilizado para produzir cortes lamelares precisos em qualquer profundidade da córnea, acompanhados de cortes verticais tanto para transplantes lamelares anteriores como posteriores sem a utilização de lâminas. Os cortes posteriores podem ser utilizados para a realização de ceratoplastia endotelial lamelar profunda ou ceratoplastia endotelial com remoção da membrana de Descemet.

Diamond burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions.

PURPOSE: To evaluate the efficacy and safety of diamond burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions. METHODS: A retrospective review of 23 eyes (23 patients). Pre- and postoperative visual acuities and refractions, slit-lamp biomicroscopic findings, and the incidence of recurrence of disease after keratectomy were studied. RESULTS: Nineteen eyes had map-dot-fingerprint basement membrane dystrophy and 4 had Salzmann's nodular degeneration. All patients presented with decreased vision, as well as varying degrees of glare, halos, and monocular diplopia. Postoperative follow-up ranged from 3 to 39 months (mean 10.6 months), and no recurrence of the original disease occurred within this period. This procedure improved the best-corrected visual acuity from 20/36 (LogMar 0.250) to 20/24 (LogMar 0.076) by LogMar statistical evaluation (p<0.001) and caused a statistically non-significant (p=0.232) myopic change in the mean refractive spherical equivalent (-0.36 diopter +/- SD 2.28 preoperatively to -0.71 +/- 2.26 postoperatively). Glare and monocular diplopia were subjectively reduced or eliminated in all patients. One patient had mild anterior stromal haze which decreased the bestcorrected visual acuity from 20/25 to 20/30. CONCLUSION: Diamond burr superficial keratectomy appears to be an effective and safe method of removing visually-significant anterior corneal opacities.

Diamond burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions / Ceratectomia superficial com broca de diamante no tratamento de lesões anteriores da córnea

PURPOSE: To evaluate the efficacy and safety of diamond burr superficial keratectomy in the treatment of visually-significant anterior corneal lesions. METHODS: A retrospective review of 23 eyes (23 patients). Pre- and postoperative visual acuities and refractions, slit-lamp biomicroscopic findings, and the incidence of recurrence of disease after keratectomy were studied. RESULTS: Nineteen eyes had map-dot-fingerprint basement membrane dystrophy and 4 had Salzmann's nodular degeneration. All patients presented with decreased vision, as well as varying degrees of glare, halos, and monocular diplopia. Postoperative follow-up ranged from 3 to 39 months (mean 10.6 months), and no recurrence of the original disease occurred within this period. This procedure improved the best-corrected visual acuity from 20/36 (LogMar 0.250) to 20/24 (LogMar 0.076) by LogMar statistical evaluation (p<0.001) and caused a statistically non-significant (p=0.232) myopic change in the mean refractive spherical equivalent (-0.36 diopter ± SD 2.28 preoperatively to -0.71 ± 2.26 postoperatively). Glare and monocular diplopia were subjectively reduced or eliminated in all patients. One patient had mild anterior stromal haze which decreased the bestcorrected visual acuity from 20/25 to 20/30. CONCLUSION: Diamond burr superficial keratectomy appears to be an effective and safe method of removing visually-significant anterior corneal opacities.

OBJETIVO: Avaliar a eficácia e segurança da ceratectomia superficial com broca de diamante no tratamento das lesões anteriores da córnea. MÉTODOS: Foi realizado estudo retrospectivo de 23 olhos de 23 pacientes. Foram avaliados acuidade visual e refração pré e pós-operatório, biomicroscopia e incidência de recorrência da doença após ceratectomia. RESULTADOS: Dos 23 olhos avaliados, 19 olhos apresentavam distrofia da membrana basal (map-dot-fingerprint) e 4 degeneração nodular de Salzmann. Todos os pacientes apresentavam diminuição da acuidade visual, assim como graus variados de ofuscamento, halos e diplopia monocular. O seguimento pós-operatório variou entre 3 e 39 meses (média de 10,6 meses) e não houve recorrência da doença original nesse período. O procedimento melhorou a acuidade visual com melhor correção de 20/36 (LogMar 0,250) para 20/24 (LogMar 0,076) com p<0,001. Em relação as mudanças refracionais não houve significância (p=0,232) sendo o equivalente esférico pré-operatório de - 0,36 ± 2,28DE e pós-operatório de -0,71 ± 2,26DE. As queixas de ofuscamento e diplopia monocular diminuíram ou foram eliminadas em todos os pacientes. Apenas 1 paciente apresentou nubécula no estroma anterior com diminuição da acuidade visual com melhor correção de 20/25 para 20/30. CONCLUSÃO: Ceratectomia superficial com broca de diamante parece ser método efetivo e seguro para remover opacidades anteriores de córnea.

[Risk of contamination of trypan blue dye after first use]. / Risco de contaminação do corante azul de tripano após primeira utilização.

PURPOSE: To determine the potential risk of contamination of a trypan blue bottle (TB) after first use and after being stored under different temperature and humidity conditions, as well as to identify possible contamination factors, most frequently involved microorganisms and simultaneously evaluate bacteriostatic and bactericide properties of the dye. METHODS: An experimental and prospective study was carried out, in which 30 TB bottles were divided into 3 groups (A: control, B: refrigerator storage and C: cabinet storage). The dye was suctioned and cultivated in agar blood plates and Sabouraud agar tube. In group A, TB was cultivated immediately after the opening of the bottles (temperature zero - T0), in groups B and C cultivation occurred in T0, T1 (1 day), T2 (2 days), T7 (7 days) and T10 (10 days) after the opening of the bottles. On the 10th day, groups B and C bottles were also submitted to scraping of their inner walls after opening. Concurrently, the inhibitory action measurement test was conducted on the TB dye for the study of bacteriostatic and bactericidal activity. RESULTS: Cultivation procedures conducted in T0 presented no contamination. Among T1 and T10, added to the scraping there was only one contaminated bottle stored in the refrigerator. The encountered microorganism was Aspergillus niger. It has been proven that the dye does not show bactericide and bacteriostatic properties against the bacteria which were tested. CONCLUSIONS: Under this study's conditions there was no contamination of the bottles stored in cabinets and 1 bottle (10%) stored in the refrigerator showed contamination after opening and initial use. The source of contamination may possibly be the outer part of the product. TB does not show bactericidal and bacteriostatic properties against the tested bacteria and in the applied concentration.

Risco de contaminacão do corante azul de tripano após primeira utilizacão / Risk of contamination of trypan blue dye after first use

OBJETIVOS: Determinar o potencial risco de contaminacão do frasco de azul de tripano (AT) depois de utilizado pela primeira vez e estocado em diferentes condicões de temperatura e umidade, assim como identificar os possíveis fatores de contaminacão, microrganismos mais freqüentemente envolvidos e simultaneamente avaliar as propriedades bacteriostáticas e bactericidas do corante. MÉTODOS: Realizado estudo experimental, prospectivo, em que 30 frascos de AT foram divididos em três grupos (A: controle, B: armazenamento em geladeira e C: armazenamento em armário). O corante era aspirado e semeado em placas de ágar sangue e tubo de ágar Sabouraud. No grupo A o AT foi semeado apenas logo após a abertura dos frascos (tempo zero - T0), nos grupos B e C ocorreu semeadura nos T0, T1 (1 dia), T2 (2 dias), T7 (7 dias) e T10 (10 dias) após abertura dos frascos. No 10º dia os frascos dos grupos B e C também foram submetidos a um raspado do lado interno do frasco após abertura. Concomitantemente foi realizado teste de acão inibitória do corante AT para estudo da atividade bacteriostática e bactericida. RESULTADOS: As semeaduras realizadas no T0 não apresentaram contaminacão. Entre os T1 e T10 mais o raspado houve apenas 1 frasco contaminado armazenado em geladeira. O microrganismo encontrado foi o Aspergillus niger. Foi comprovado que o corante não apresenta acão bactericida e bacteriostática para as bactérias testadas. CONCLUSÕES: Nas condicões do estudo não houve contaminacão dos frascos armazenados em armário e 1 frasco (10 por cento) armazenado em geladeira apresentou contaminacão após abertura e uso inicial. A fonte de contaminacão talvez seja o lado externo do produto. O AT não apresenta propriedades bactericidas e bacteriostáticas para as bactérias testadas e na concentracão utilizada.

[Reliability of corneal thickness measurements by Orbscan II and ultrasound pachymeter]. / Confiabilidade das medidas de espessura central da córnea com Orbscan II e paquímetro ultra-sônico.

PURPOSE: To access the reliability of corneal thickness measurements by Orbscan II and ultrasound pachymeter. METHODS: A retrospective study of 134 eyes from 67 normal subjects between January and June 2001 was obtained. Sex, age, visual acuity, refractive error and corneal thickness measurements by Orbscan II and ultrasound pachymetry were evaluated. All results were analyzed by the paired t test (p<0.05). RESULTS: Sixty-seven subjects, 34 (50.7%) female and 33 (49.3%) male, with a mean age of 32.44+/-9.98 were evaluated. The mean of spherical equivalent was -2.68+/-2.62. The mean corneal thickness was 534.81+/-34.45 with the Orbscan II system and 535.00+/-29.53 with the ultrasound pachymeter, values that were not significantly different (p=0.8922). The correlation coefficient between both instruments was 0.8774, and it is effective. CONCLUSIONS: Both methods are similar showing good correlation. In this study, the Orbscan II showed reliability, and this tool is extremely useful to evaluate subjects regarding refractive surgery.

Confiabilidade das medidas de espessura central da córnea com Orbscan II e paquímetro ultra-sônico / Reliability of corneal thickness measurements by Orbscan II and ultrasound pachymeter

OBJETIVO: Avaliar a confiabilidade das medidas de espessura central de córnea comparando o Orbscan II com o paquímetro ultra-sônico. MÉTODOS: Foi realizado estudo retrospectivo de 134 olhos, por meio do levantamento de prontuários de 67 pacientes avaliados entre o período de janeiro a junho de 2001. Foram avaliados o sexo, idade, acuidade visual com a melhor correção, refração e medidas de espessura central corneal pelo paquímetro ultra-sônico e Orbscan II. Os dados paquimétricos foram submetidos à análise do teste t pareado e as diferenças consideradas significativas se p<0,05. RESULTADOS: Dos 67 pacientes avaliados 34 (50,7 por cento) eram do sexo feminino e 33 (49,3 por cento) eram do sexo masculino. A idade variou entre 20 e 59 anos com média de 32,44 anos (±9,98). A média do equivalente esférico foi de -2,68±2,62, da espessura central corneal avaliada com o Orbscan II foi de 534,81±34,45 e pelo paquímetro US foi de 535,00±29,53 não havendo diferença significativa entre os resultados das medidas de ECC (p = 0,8922). O coeficiente de correlação entre as duas medidas paquimétricas foi de 0,8774, sendo esta uma correlação forte. CONCLUSAO: A análise de regressão demonstrou que houve alto grau de concordância entre as medidas do paquímetro ultra-sônico e do Orbscan II. O coeficiente de correlação (0,8774) demonstra que os dois métodos possuem significativa correlação linear na medida da espessura central da córnea. Desta maneira, na amostra estudada, o Orbscan II apresentou boa confiabilidade, demonstrando ser exame extremamente útil em pacientes que necessitam serem avaliados para posterior intervenção refrativa.

Síndrome do ápice orbital associado com herpes zoster oftálmico em paciente HIV positivo: relato de caso / Orbital apex syndrome and herpes zoster ophthalmicus in an HIV positive patient: case report

O presente relato tem como objetivo apresentar um caso raro de síndrome do ápice orbital associado com herpes zoster oftálmico de prognóstico reservado em paciente HIV positivo que procurou o pronto-socorro com quadro clínico de lesões crostosas em hemiface esquerda, dolorosa, acompanhado de baixa acuidade visual, diminuição da sensibilidade corneal e oftalmoplegia completa do olho esquerdo. A síndrome do ápice orbital é entidade rara que se caracteriza por ptose, proptose, oftalmoplegia interna e externa (acometimento do II, III, IV e VI nervos cranianos), prejuízo funcional da primeira divisão do nervo trigêmeo (nervo oftálmico) e graus variados de diminuição da acuidade visual. O tratamento do herpes zoster oftálmico baseia-se no uso de antivirais sistêmicos, sendo que o prognóstico irá variar conforme o acometimento ocular.

Técnica da instilação de colírios em pacientes portadores de glaucoma crônico / Eye drop instillation technique in chronic glaucoma patients

OBJETIVO: Verificar a técnica da instilação de colírio em pacientes portadores de glaucoma crônico. MÉTODOS: Estudo prospectivo realizado em 193 pacientes glaucomatosos. Para cada participante era entregue um frasco de colírio lubrificante (Dunason®, Laboratório Alcon, São Paulo, Brasil) e solicitado que realizasse uma instilação. RESULTADOS: Os participantes utilizaram, em média, 1,64 ± 1,26 gotas de colírio por instilação e 54,5 por cento dos pacientes fizeram contato do bico do colírio com a superfície ocular. Em 3,1 por cento das instilações nenhuma gota de medicamento atingiu o olho, com o paciente não se dando conta do fato. A oclusão do ponto lacrimal ou a manutenção do olho fechado por dois minutos após a instilação não foi realizada em 87,0 por cento dos participantes, e 61,6 por cento piscaram repetidas vezes imediatamente após instilar a droga. CONCLUSÕES: Verificou-se que a maior parte dos participantes deste estudo efetuou a instilação do colírio de modo incorreto. Isto significa desperdiçar grande parte do conteúdo do frasco, aumentar as possibilidades de toxicidade sistêmica, não aproveitar a plenitude do efeito hipotensor das drogas e contaminar a extremidade do frasco de colírio. Portanto, o ensino da técnica adequada da instilação de colírio é absolutamente necessária para todos os pacientes.

Condiçöes de adaptaçäo e venda de lentes de contato em óticas do estado de Säo Paulo / Conditions of contact lenses fitting and sale by optician stores Säo Paulo state

Objetivo: Avaliar as condiçöes de adaptaçäo e venda de lentes de contato (LC) em óticas de quatro cidades do Estado de Säo Paulo, Brasil. Métodos: Realizou-se estudo por meio de respostas a um questionário aplicado por quatro estudantes de Medicina em óticas situadas em várias cidades do Estado de Säo Paulo. Foram obtidos dados sobre a necessidade da apresentaçäo de receita médica para a compra das LC, os tipos de LC vendidas/ adaptadas, o profissional que orienta a venda e/ou adaptaçäo, os equipamentos usados no teste de tolerância, a conduta do cliente diante de complicaçöes quando da adaptaçäo da LC ou durante o uso, orientaçäo quanto a possíveis sinais e sintomas de perigo, as doenças que contra indiquem o uso e a higiene do usuário, as horas de uso e a possibilidade de pernoite. Resultados:Das 198 óticas pesquisadas,121(61,11 por cento) vendem LC. Näo foi necessária receita médica para a compra das lentes em 112 óticas (92,56 por cento), sendo que nessas, a graduaçäo era determinadapela medida dos óculos em 69 (61,61 por cento) casos e porrelato verbal em 28 (25,00 por cento) casos. Quanto aos equipamentos, 102 (91,07 por cento) óticas possuíam lensômetro; 41(36,61 por cento) possuíam ceratômetro e 14 (12,50 por cento), lâmpada de fenda. Lentes descartáveis hidrofílicas foram encontradas para venda/adaptaçäo em 66 (54,55 por cento) óticas; lentes hidrofílicas de uso prolongado ou diário em 68 (56,20 por cento) e lentes rígidas, em 54 (44,63 por cento). Em 103 (85,12 por cento) óticas, foram feitos testes de tolerância, sendo os responsáveis pelo atendimento e pela monitorizaçäo dos testes os profissionais autodenominados contatólogos em 78 (64,46 por cento) dessas óticas, balconista em 20 (16,53 por cento), óptico em 12 (9,92 por cento) e oftalmologistas em 9 (7,44 por cento). Quanto às complicaçöes na adaptaçäo, em 66 (54,55 por cento) óticas, afirmou-se que elas só ocorreriam, se evidenciadas no teste de tolerância; em 35 (28,93 por cento), aconselhou-se tratamento com oftalmologista e em 20 (16,53 por cento), sugeriu-se o retorno à ótica para indicaçäo de tratamento. Em apenas 15 (13,39 por cento), o profissional orientou quanto à possível sintomatologia de perigo e em 13 (11,61 por cento), preocupou-se com doenças que contra-indicassem o uso de LC. Em 105 (93,75 por cento) óticas, a orientaçäo foi insuficiente em relaçäo à higiene com as LC, às horas de uso e à possibilidade de pernoite...