Inflammatory profile of keratoconic corneal epithelium.

BACKGROUND: Recent studies have presented inflammatory features on keratoconus (KC) and many inflammatory markers are described in the tears of patients with this disease. The KC pathogenesis is still unknown just like the correlation with inflammatory patterns. However, environmental and genetic issues may be part of the progress of KC. In addition, some systemic features, such as allergy and obesity, seem to be related to the progression of KC. Our purpose was to evaluate the neuropeptides vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), chemokines ligand 2 (CCL-2) and 5 (CCL-5), and interleukins 6 (IL-6) and 8 (IL-8) on corneal epithelial cells and blood of patients with KC and in healthy controls. In addition, the neutrophil-to-lymphocyte ratio (NLR) was evaluated to predict inflammation. METHODS: This including prospective observational study included 32 KC patients who underwent corneal crosslinking (CXL) and 32 control patients who underwent photorefractive keratectomy (PRK). Patients' corneal epithelial cells were removed surgically, and blood (buffy coat) was analyzed. Samples in triplicate were evaluated on rt-PCR for neuropeptides (VIP e NPY), interleukins (IL-6 e IL-8), and chemokines (CCL-2 and CCL-5). RESULTS: Our study showed statistically higher CCL-5 and IL-8 on corneal epithelial cells in patients with KC. Blood cells were statistically higher in VIP and NPY in the KC group. Interleukin-8 on blood cells was statistically significant in KC'S group; for CCL-2 and CCL-5 they were statistically lower in patients with KC compared with controls. NLR showed no difference between the groups. CONCLUSIONS: Our data support the findings of other studies that suggested altering KC status, such as inflammatory corneal disease. The presence of IL-8 in the cornea and blood samples of KC's group suggested systemic disease with a possible local or repercussion action. Further studies are warranted to elucidate KC pathogenesis and its correlation to systemic disease.

[Ocular surface and hepatitis C]. / Superfície ocular e hepatite C.

PURPOSE: To evaluate the outcomes of the tests used for dry eye diagnosis in patients with hepatitis C virus, and to verify if there is any relationship between the duration of illness and intensity of ocular surface changes. METHODS: 25 patients with hepatitis C virus without treatment, and 29 patients with negative serologic tests for hepatitis C virus were selected. Biomicroscopy, tear film crystallization test, tear film break-up time, evaluation of the corneal staining with 1% fluorescein sodium, Schirmer I test, ocular surface staining with 1% rose bengal and esthesiometry were performed in both groups. RESULTS: In the Schirmer I test, the group of patients with hepatitis C displayed lower values in both eyes (OR p=0.0162; OS p=0.0265). For the tear film break-up time, there was a lower score in the group with hepatitis C, but it was statistically significant only in the left eye (p=0.0007). Regarding the ocular surface damage, the rose bengal staining test showed a higher average in the hepatitis group in both eyes (right p=0.0008; left p=0.0034). There was a difference in the average esthesiometry between the groups, being the average lower in infected patients (OR p=0.0006; OS p=0.0015). There was no linear association between time of hepatitis C infection and intensity observed in dry eye tests. CONCLUSIONS: Hepatitis C virus infection causes dry eye. Further researches are necessary to establish the physiopathology and the relationship with Sjögren syndrome.

Superfície ocular e hepatite C / Ocular surface and hepatitis C

Objetivos: Avaliar os resultados dos testes utilizados para o diagnóstico de olho seco em portadores do vírus da hepatite C, e verificar se há relação entre a duração conhecida da doença e a intensidade das alterações da superfície ocular. MÉTODOS: Foram avaliados 25 pacientes portadores do vírus da hepatite C não tratados e 29 indivíduos com testes sorológicos negativos para hepatite C. Nos dois grupos, foi realizada a mesma sequência de exames: biomicroscopia, teste de cristalização da lágrima, tempo de ruptura do filme lacrimal, avaliação da córnea com fluoresceína, teste de Schirmer I, avaliação da córnea e conjuntiva com corante rosa bengala e estesiometria da córnea. Os pacientes também foram questionados com relação ao tempo conhecido de infecção pelo vírus da hepatite C. RESULTADOS: O grupo com hepatite C apresentou valor menor que o encontrado nos indivíduos sem hepatite C, no teste de Schirmer I tanto para o olho direito (p=0,0162) como esquerdo (p=0,0265). Para o tempo de ruptura do filme lacrimal verificou-se média inferior no grupo com hepatite C nos dois olhos; porém, a diferença apresen tou significância estatística apenas no olho esquerdo (p=0,0007), não sendo detectada diferença no olho direito (p=0,0793). Com relação ao dano presente na superfície ocular, verificado pela pontuação no teste de coloração com rosa bengala, observou-se média superior no grupo com hepatite, tanto no olho direito (p=0,0008) como esquerdo (p=0,0034). Os valores obtidos na medida da sensibilidade corneal dos pacientes infectados evidenciaram que a sensibilidade da córnea encontra-se alterada em comparação com a do grupo controle. O teste de cristalização do filme lacrimal não demonstrou diferenças entre ambos os grupos. Não houve correlação entre tempo de infecção pelo vírus e intensidade das alterações. CONCLUSÕES: Os resultados indicam que a hepatite C é causa de olho seco. Os mecanismos fisiopatológicos não são conhecidos, mas isso deve servir de alerta para cuidados terapêuticos oculares e futuras pesquisas para elucidar a síndrome sicca na hepatite C e suas relações com síndrome de Sjögren.

PURPOSE: To evaluate the outcomes of the tests used for dry eye diagnosis in patients with hepatitis C virus, and to verify if there is any relationship between the duration of illness and intensity of ocular surface changes. METHODS: 25 patients with hepatitis C virus without treatment, and 29 patients with negative serologic tests for hepatitis C virus were selected. Biomicroscopy, tear film crystallization test, tear film break-up time, evaluation of the corneal staining with 1 percent fluorescein sodium, Schirmer I test, ocular surface staining with 1 percent rose bengal and esthesiometry were performed in both groups. RESULTS: In the Schirmer I test, the group of patients with hepatitis C displayed lower values in both eyes (OR p=0.0162; OS p=0.0265). For the tear film break-up time, there was a lower score in the group with hepatitis C, but it was statistically significant only in the left eye (p=0.0007). Regarding the ocular surface damage, the rose bengal staining test showed a higher average in the hepatitis group in both eyes (right p=0.0008; left p=0.0034). There was a difference in the average esthesiometry between the groups, being the average lower in infected patients (OR p=0.0006; OS p=0.0015). There was no linear association between time of hepatitis C infection and intensity observed in dry eye tests. CONCLUSIONS: Hepatitis C virus infection causes dry eye. Further researches are necessary to establish the physiopathology and the relationship with Sjögren syndrome.

Photorefractive keratectomy with mitomycin C after penetrating and lamellar keratoplasty.

PURPOSE: To assess the safety and efficacy of photorefractive keratectomy with mitomycin C (PRK-MMC) to correct refractive errors after corneal transplantation. METHODS: This was a prospective and noncomparative study of 36 eyes that underwent PRK-MMC after penetrating (n = 34) or lamellar (n = 2) keratoplasty. After mechanical epithelial removal and photoablation, a sponge with mitomycin C 0.02% was applied to the stromal bed for 1 minute. The uncorrected and best-corrected visual acuities, refraction, and complications were assessed. RESULTS: The average follow-up was 16.27 ± 8.38 months (range, 6-30.5 months). The spherical equivalent decreased from -3.95 ± 4.11 to -1.07 ± 1.45 diopters (D) postoperatively (P < 0.001). The mean preoperative astigmatism was 4.42 ± 1.69 D (range, 1.00-7.25 D); however, surgical correction was limited to 6.00 D. Vector analysis of astigmatic correction showed an index of success of 55%. At the last follow-up, 41.7% (n = 15) and 61.1% (n = 22) of the eyes were within ±0.50 and ±1.00 D of emmetropia, respectively. Nineteen eyes (52.8%) achieved an uncorrected visual acuity of 20/40 or better. The best-corrected visual acuity remained within 1 line of the preoperative values in 26 cases (72.2%), improved in 8 (22.2%), and decreased in 2 (5.6%). Endothelial cell decompensation was observed in 1 eye (2.8%) 11 months postoperatively, and haze developed in 3 cases (8.3%). CONCLUSIONS: PRK-MMC may be an option to correct refractive errors after keratoplasty. A low preoperative endothelial cell count and haze may affect the safety outcomes.

Dermatoceratoconjuntivite atópica em pacientes do Ambulatório de Dermatologia Infanto-Juvenil em centro de referência / Atopic keratoconjunctivitis in patients of the pediatric dermatology ambulatory in a reference center

OBJETIVO: Avaliar a frequência de dermatoceratoconjuntivite atópica, seus sintomas e alterações em pacientes do Ambulatório de Dermatologia Infanto-Juvenil da Irmandade da Santa Casa de Misericórdia de São Paulo com diagnóstico prévio de dermatite atópica. MÉTODOS: Foram avaliados 52 portadores de dermatite atópica do Ambulatório de Dermatologia Infanto-Juvenil, menores de 16 anos (média de idade 8,9 ± 4,1 entre 2 e 16 anos) por meio de um protocolo de questões de sintomas e avaliação oftalmológica dos sinais. Os sinais e sintomas foram graduados de 0 (ausente) a 4 (maior intensidade), e em alguns casos apenas como presentes ou não. A análise foi descritiva e estatística, com nível de significância de 5 por cento. RESULTADOS: A frequência da dermatoceratoconjuntivite atópica foi de 76,9 por cento entre os 52 pacientes com dermatite atópica, dos quais 26,7 por cento com conjuntivite atópica e 50,2 por cento com blefarite atópica. No grupo de dermatite atópica encontramos maior número de pacientes do sexo feminino e no grupo conjuntivite atópica maior número de pacientes do sexo masculino. A idade foi praticamente igual nos grupos estudados. Os sintomas mais frequentes foram olho vermelho e prurido, principalmente no grupo de conjuntivite atópica. Este último foi o sintoma com escore mais intenso e presentes em todos os pacientes do grupo conjuntivite atópica. Papilas e blefarite foram os sinais mais encontrados. O tempo de ruptura do filme lacrimal encontrava-se alterado na maioria dos pacientes. CONCLUSÕES: A frequência de dermatoceratoconjuntivite atópica foi de 76,9 por cento nos pacientes com dermatite atópica. O prurido foi o sintoma mais frequente, seguido por olhos vermelhos, mais relacionados ao grupo de conjuntivite atópica. A blefarite e as papilas foram os sinais mais encontrados, também no grupo de conjuntivite atópica. Devido ao crescimento da prevalência da dermatite atópica na população infantil, seria prudente realizar...

PURPOSE: To evaluate the frequency of atopic keratoconjunctivitis, its symptoms and changes in patients of Pediatric Dermatology Service of "Santa Casa de Misericordia de São Paulo" Hospital with a previous diagnosis of atopic dermatitis. METHODS: Fifty-two patients with atopic dermatitis under 16 years old (mean age 8.9 ± 4.1 between 2 and 16 years old) were evaluated through a protocol of questions and assessment of signs and symptoms. The signs and symptoms were graded from 0 (absent) to 4 (highest intensity), and in some cases only as present or not. The analysis was descriptive and statistical, with a 5 percent significance level. RESULTS: The frequency of atopic keratoconjunctivitis was 76.9 percent among the 52 patients with atopic dermatitis, including atopic conjunctivitis (26.7 percent) and atopic blepharitis (50.2 percent). Atopic dermatitis is more frequent in female patients and atopic conjunctivitis in male. Age was practically the same in both groups. The most frequent symptoms were red eye and itching, especially in the atopic conjunctivitis group. Itching was the most intense symptom and was present in all patients of the atopic conjunctivitis group. Blepharitis and papillae were the most common signs. Other signs were less frequent. The tear break-up time was changed in most patients. CONCLUSIONS: The prevalence of atopic keratoconjunctivitis was 76.9 percent in patients with atopic dermatitis. Itching was the most frequent symptom, followed by red eye, in patients with atopic conjunctivitis. Blepharitis and papillae were the most frequent signs in patients with atopic conjunctivitis. Due to the increasing prevalence of atopic dermatitis in children, it would be prudent to perform a routine ophthalmologic evaluation of these patients. From the patients evaluated in this study, none had been previously monitored with ophthalmological exams.

Treatment of eyelid xanthelasma with 70% trichloroacetic acid.

PURPOSE: To analyze the results of treatment of eyelid xanthelasma (EX) with 70% trichloroacetic acid (TCA) with regard to efficacy, cosmetic appearance, patient satisfaction, and recurrence rate. METHODS: Twenty-four patients with EX of up to one third of the affected palpebral area were treated with 70% TCA. All patients were photographed at the start of treatment and 3 months after the last application. The recurrence rate was analyzed at the end of 6 months of treatment. RESULTS: The average number of applications of 70% TCA until the xanthelasma resolved was 1.5. Eleven patients (45.8%) had an excellent result, 8 (33.3%) a good result, and 5 (20.8%) had a satisfactory result. The most common complication was hypopigmentation (33.3%). All patients reported an improved final cosmetic result. Six patients (25%) treated with 70% TCA had a recurrence 6 months after treatment. CONCLUSIONS: The results of prospective treatment of 24 patients with EX with 70% TCA indicated that this is a simple and effective method, achieves a satisfactory cosmetic result, has an acceptable recurrence rate, and high patient satisfaction.

Improved automated perimetry performance in elderly subjects after listening to Mozart.

PURPOSE: To evaluate the performance of automated perimetry of elderly subjects naïve to AP after listening to a Mozart sonata. INTRODUCTION: Automated perimetry (AP) is a psychophysical test used to assess visual fields in patients with neurological disorders and glaucoma. In a previous study, Fiorelli et al. showed that young subjects who listened to a Mozart sonata prior to undergoing AP performed better in terms of reliability than those who did not listen to the sonata. METHODS: Fifty-two AP-naïve, normal subjects underwent Automated perimetry (SITA 24-2). The study group (25 subjects) underwent AP after listening to Mozart's Sonata for Two Pianos in D Major, and the control group (27 subjects) underwent Automated perimetry without prior exposure to the music. RESULTS: The study group had significantly lower false negative rates and a lower visual field reliability score than the controls (P=0.04 and P=0.04, respectively). The test time was shorter for the study group (P=0.03). DISCUSSION: This study shows that elderly subjects, when exposed to the Mozart sonata immediately before AP testing, have lower false negative rates and lower visual field reliability scores when compared with an age- and gender-matched control group. Our results differ from those of Fiorelli et al. who found lower false positive rates and less fixation loss in addition to lower false negative rates. CONCLUSION: Listening to a Mozart sonata seems to improve automated perimetry reliability in elderly subjects.

[Atopic keratoconjunctivitis in patients of the pediatric dermatology ambulatory in a reference center]. / Dermatoceratoconjuntivite atópica em pacientes do Ambulatório de Dermatologia Infanto-Juvenil em centro de referência.

PURPOSE: To evaluate the frequency of atopic keratoconjunctivitis, its symptoms and changes in patients of Pediatric Dermatology Service of 'Santa Casa de Misericordia de São Paulo' Hospital with a previous diagnosis of atopic dermatitis. METHODS: Fifty-two patients with atopic dermatitis under 16 years old (mean age 8.9 +/- 4.1 between 2 and 16 years old) were evaluated through a protocol of questions and assessment of signs and symptoms. The signs and symptoms were graded from 0 (absent) to 4 (highest intensity), and in some cases only as present or not. The analysis was descriptive and statistical, with a 5% significance level. RESULTS: The frequency of atopic keratoconjunctivitis was 76.9% among the 52 patients with atopic dermatitis, including atopic conjunctivitis (26.7%) and atopic blepharitis (50.2%). Atopic dermatitis is more frequent in female patients and atopic conjunctivitis in male. Age was practically the same in both groups. The most frequent symptoms were red eye and itching, especially in the atopic conjunctivitis group. Itching was the most intense symptom and was present in all patients of the atopic conjunctivitis group. Blepharitis and papillae were the most common signs. Other signs were less frequent. The tear break-up time was changed in most patients. CONCLUSIONS: The prevalence of atopic keratoconjunctivitis was 76.9% in patients with atopic dermatitis. Itching was the most frequent symptom, followed by red eye, in patients with atopic conjunctivitis. Blepharitis and papillae were the most frequent signs in patients with atopic conjunctivitis. Due to the increasing prevalence of atopic dermatitis in children, it would be prudent to perform a routine ophthalmologic evaluation of these patients. From the patients evaluated in this study, none had been previously monitored with ophthalmological exams.

Improved automated perimetry performance in elderly subjects after listening to Mozart

PURPOSE: To evaluate the performance of automated perimetry of elderly subjects naïve to AP after listening to a Mozart sonata. INTRODUCTION: Automated perimetry (AP) is a psychophysical test used to assess visual fields in patients with neurological disorders and glaucoma. In a previous study, Fiorelli et al. showed that young subjects who listened to a Mozart sonata prior to undergoing AP performed better in terms of reliability than those who did not listen to the sonata. METHODS: Fifty-two AP-naïve, normal subjects underwent Automated perimetry (SITA 24-2). The study group (25 subjects) underwent AP after listening to Mozart's Sonata for Two Pianos in D Major, and the control group (27 subjects) underwent Automated perimetry without prior exposure to the music. RESULTS: The study group had significantly lower false negative rates and a lower visual field reliability score than the controls (P=0.04 and P=0.04, respectively). The test time was shorter for the study group (P=0.03). DISCUSSION: This study shows that elderly subjects, when exposed to the Mozart sonata immediately before AP testing, have lower false negative rates and lower visual field reliability scores when compared with an age- and gender-matched control group. Our results differ from those of Fiorelli et al. who found lower false positive rates and less fixation loss in addition to lower false negative rates. CONCLUSION: Listening to a Mozart sonata seems to improve automated perimetry reliability in elderly subjects.