Epidemiological profile and visual outcome of ocular trauma in a referral center in northeastern Brazil / Perfil epidemiológico e prognóstico visual do trauma ocular em um centro de referência da região nordeste do Brasil

Abstract Objectives: To evaluate the epidemiological profile and prognosis of patients with mechanical ocular trauma. Methods: Descriptive cross-sectional observational study of consecutive patients evaluated during a one-year period at a public referral center in São Luis, Maranhão, Brazil. The Ocular Trauma Score (OTS) was used to estimate final visual acuity. The variables were analyzed using the chi-square test with a significance level of 5%. Results: Out of a total of 154 patients (mean age of 30.1 years), 27.92% were younger than 16 years, and 81.8% were men, with most coming from the state's countryside (55.2%). Most of the patients were dependents (34%) or rural workers (19%). Regarding the OTS prognosis, 33.77% of the patients were category 5 and 31.16% category 1 or 2, indicating worse prognosis. The best prognoses (visual outcomes) were inversely proportional to age and time to treatment (p<0.001). Conclusion: Ocular trauma remains an important cause of ocular morbidity in childhood and in informal work. Adult supervision and socio-educational measures are mandatory to change this scenario.

Resumo Objetivos: Avaliar o perfil epidemiológico e o prognóstico visual de pacientes com trauma ocular mecânico. Métodos: Estudo observacional transversal descritivo de pacientes consecutivos atendidos durante o período de um ano em um centro de referência público em São Luís, Maranhão. O Ocular Trauma Score foi aplicado a fim de estimar a acuidade visual final. As variáveis foram analisadas por meio do teste de Qui-quadrado com nível de significância de 5%. Resultados: Encontrou-se 154 pacientes tratados, a média de idade foi 30,1 anos, 27,92% menores que 16 anos, homens (81,8%) e do interior do Estado (55,2%). A maioria eram dependentes (34%), dos trabalhadores ocorreu o predomínio do trabalhador rural (19%). Quanto ao prognóstico, 33,77% dos pacientes apresentavam-se na categoria 5 e 31,16% na 1 ou 2, de pior prognóstico. Os melhores prognósticos foram inversamente proporcionais a idade e ao tempo até o atendimento (p<0,001). Conclusão: O trauma ocular se mantém como importante causa de morbidade ocular na infância e no trabalho informal. A supervisão de adultos e medidas socioeducativas são fundamentais para mudar esse cenário.

Wounded embryonic corneas exhibit nonfibrotic regeneration and complete innervation.

PURPOSE: Wound healing in adult corneas is characterized by activation of keratocytes and extracellular matrix (ECM) synthesis that results in fibrotic scar formation and loss of transparency. Since most fetal wounds heal without scaring, we investigated the regenerative potential of wounded embryonic corneas. METHODS: On embryonic day (E) 7 chick corneas were wounded by making a linear incision traversing the epithelium and anterior stroma. Wounded corneas were collected between E7 and E18, and analyzed for apoptosis, cell proliferation, staining of ECM components, and corneal innervation. RESULTS: Substantial wound retraction was observed within 16-hours postwounding (hpw) and partial re-epithelialized by 5-days postwounding (dpw). Corneal wounds were fully re-epithelialized by 11 dpw with no visible scars. There was no difference in the number of cells undergoing apoptosis between wounded and control corneas. Cell proliferation was reduced in the wounded corneas, albeit mitotic cells in the regenerating epithelium. Staining for alpha-smooth muscle actin (α-SMA), tenascin, and fibronectin was vivid but transient at the wound site. Staining for procollagen I, perlecan, and keratan sulfate proteoglycan was reduced at the wound site. Wounded corneas were fully regenerated by 11 dpw and showed similar patterns of staining for ECM components, albeit an increase in perlecan staining. Corneal innervation was inhibited during wound healing, but regenerated corneas were innervated similar to controls. CONCLUSIONS: These data show that minimal keratocyte activation, rapid ECM reconstruction, and proper innervation occur during nonfibrotic regeneration of the embryonic cornea.

Natural protective mechanisms against endoscopic white-light injury in the fetal lamb eye.

OBJECTIVE: To evaluate light transmission, possible light trauma, and techniques for protection of the fetal eyes during intrauterine videoendoscopic surgery in a sheep model. METHODS: In vitro studies were done at various gestational ages, including spectrometry of light output by a halogen light source and telescope and light transmission by spectrophotometry in the range of 180-3000 nm through amniotic fluid (AF) and fetal eyelids. In vivo electron-microscopic, morphologic analysis of the retinas of 65-, 95-, 108-, and 112-day-old fetal lambs with (n = 8) and without (n = 8) 30 minutes' light exposure to the open eye was also done. RESULTS: The light spectrum at the tip of the telescope was 400-750 nm, with a maximum irradiance of 3x10(-3) W/cm2 at 580 nm. In the ultraviolet spectrum (less than 300 nm), irradiance was less than 0.5x10(-3) W/cm2. Light transmission through ovine AF ranged from 30% at 300 nm to 89% at 700 nm at 84 days' gestation, decreasing to less than 0.01% (300 nm) and 70% (700 nm) at 112 days. Fetal eyelids did not transmit more than 1% of light (any wavelength). After direct in vivo light exposure, no retinal damage was found. Photoreceptors were present from 108 days onward, but chromophores were scant or absent at all ages studied. CONCLUSION: The light spectrum of a standard endoscope is limited to 400-750 nm; ultraviolet light is filtered out. The AF transmits harmful blue light poorly. Fetal eyelids seem to protect the eye by extremely low transmission and light dispersion. Even with the eye open, no morphologic retinal damage was found. The strong light sources used with fetal endoscopy did not appear to pose a threat to the fetal retina.