Human amniotic membrane for the treatment of large and refractory macular holes: a retrospective, multicentric, interventional study.

BACKGROUND: The purpose of the current study is to report the anatomical and functional results of off-label human amniotic membrane graft as primary intervention to repair large to giant macular holes and in reoperations when wide internal limiting membrane peeling was unsuccessful. METHODS: Retrospective chart review was carried out in five different centers to identify all cases that had undergone off-label human amniotic membrane graft for the treatment of large or failed macular holes (MH). Data collected included age, gender, other concomitant diagnosis, symptoms duration, lens status, number of previous surgeries, macular hole measurements (minimum and base linear diameters), mean post-operative follow-up (months), and pre- and post-operative best corrected visual acuity (BCVA). Main outcome measures were anatomical MH closure rates and final BCVA (in logMAR). Nonparametric Wilcoxon rank-sum test was used because the data was not normally distributed, a P values < 0.05 were considered statistically significant. RESULTS: Nineteen eyes of 19 patients were identified and included in the study. Mean age was 66.21 ± 14.96 years and predominantly females (84%). All eyes had successfully closed MH with a single intervention with no recurrences during a mean of 9 ± 3.87 months follow-up. The median BCVA in logMAR preoperative was 1.30 ± 0.44 (0.80-2.0), approximately 20/400 on Snellen chart and the median BCVA in logMAR postoperative was 1.0 ± 0.72 (0.4-3.0) approximately 20/200 (p < 0.0001) with median of three lines of visual improvement. CONCLUSION: The use of human amniotic membrane graft seems to be a viable and effective alternative for the treatment of large and persistent macular holes. However, further larger prospective controlled studies are necessary to confirm our preliminary results of this new surgical technique.

Epidemiology and etiologic diagnosis of infectious keratitis in Uberlandia, Brazil.

PURPOSE: To study risk factors, microbiological characteristics, and clinical course of nonviral infectious keratitis diagnosed in a referral service of ophthalmology. METHODS: A total of 65 charts of patients with microbial keratitis were retrospectively reviewed at the Clinical Hospital of Federal University of Uberlandia, Brazil, from July 2001 through August 2004. All cases were submitted to microbiological tests and treated according to local protocol. Risk factors, clinical course, therapeutic keratoplasty, and visual outcomes were analyzed. RESULTS: The mean age of patients was 45.9 years (2-83 years) and male to female ratio 2.6:1. Symptoms at presentation ranged from 1-3 days in 16 patients out of 65 (24.61%), 4-7 days in 19 cases (19/65; 29.23%), and more than 7 days in 27 patients (27/65; 41.53%). The major risk factor was trauma (28/65; 40%), predominantly by organic material. A total of 32 eyes out of 65 (49.23%) were culture positive. Fungi were the most common isolates (18/32; 56.25%), being headed by Fusarium sp. (11/65; 16.92%), and the most common bacteria was Streptococcus pneumoniae (7/65; 10.77%). Final visual acuity was equal to or better than 20/60 in 20 patients out of 65 (30.77%), between 20/60 and 20/400 in 7 patients (7/65; 10.77%), and worse than 20/400 in 35 patients out of 65 (53.85%). A total of 48 eyes out of 65 (73.84%) presented corneal scar, 12 eyes (12/65; 18.46%) needed therapeutic penetrating keratoplasty, and 2 eyes (2/65; 3.08%) were eviscerated. CONCLUSIONS: The high incidence of fungal keratitis in the studied population shows their vulnerability to such infections, which may result in devastating visual outcomes.

Toxicidade ocular experimental do Perfluorotribulitalimine / Experimental ocular toxicity of perfluorotributylamine

Perfluorotributilamine (PFTA) é um importante adjunto na cirurgia vítrea. Alteraçöes do eletrorretinograma em coelhos tem sido reportadas após PFTA ser deixado na cavidade vítrea por duas a quatro semanas. Neste estudo nós nos propusemos a determinar se estas alteraçöes säo reversíveis após a remoçäo do mesmo. Dezessete coelhos submeteram-se á vitrectomia e PFTA foi injetado em 13 olhos. Em oito olhos o PFTA foi removido após 12 dias (Grupo I), em 5 olhos PFTA foi mantido intra-ocular até o dia da enucleaçäo, que ocorreu 35 dias após a injeçäo (Grupo 2) e 4 olhos submeteram-se á cirurgia sem utilizaçäo de PFTA (Grupo 3). Nenhuma alteraçäo clínica foi observada por oftalmoscopia indireta em nenhum coelho. Eletrorretinograma foi resgitrado em 12 coelhos antes da cirurgia (dia 0) e nos dias 9, 19, 25 e 35. Nós observamos uma diminuiçäo da amplitude da onda B na estimulaçäo escotópica 8x e 16x em todos os grupos, sendo mais severa no grupo 2. A remoçäo do PFTA resulta em recuperaçäo da amplitude da onda b para valores próximos do valor pré-operatório.