Ultrasound biomicroscopy after palliative surgical procedures for bullous keratopathy: a descriptive comparative study / Biomicroscopia ultrassônica após procedimentos cirúrgicos paliativos na ceratopatia bolhosa: estudo comparativo descritivo

Purpose: To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. Methods: The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. Results: In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively (p<0.001); mean ET, 102.1 µm preoperatively and 245.2 µm postoperatively (p<0.001); and mean ST, 654.6 µm preoperatively and 681.5 µm postoperatively (p<0.999). Correlations between CCT and pain intensity in the AMT group (p=0.209 pre- and postoperatively) and the ASP group (p=0.157 preoperatively and p=0.426 at the 180-day follow-up) were not statistically significant. Epithelial and stromal edema, Descemet’s membrane folds, epithelial bullae, and the presence of interface fluid were frequently observed qualitative features. Conclusion: CCT increased over time in both groups. The magnitude of CCT did not correlate with pain intensity in the sample studied. The presence of interface ...

Objetivo: Descrever as características quantitativas e qualitativas da biomicroscopia ultrassônica (UBM) em olhos com ceratopatia bolhosa avançada, antes e após os procedimentos de punção estromal anterior (ASP) ou transplante de membrana amniótica (AMT) para alívio de dor crônica. Métodos: Estudo comparativo descritivo incluindo 40 olhos de 40 pacientes com dor crônica intermitente devido a ceratopatia bolhosa, randomizados em duas modalidades de tratamento (AMT e ASP). Biomicroscopia ultrassônica (Humphrey, UBM 840, transdutor de 50 MHz, técnica de imersão) foi utilizada, e um questionário de avaliação da intensidade da dor foi aplicado no pré-operatório, e após 90 e 180 dias de pós-operatório. Critérios de exclusão foram: idade abaixo de 18 anos, presença de infecção, hipertensão ocular, e ausência de dor. Resultados: No seguimento de 180 dias, o grupo Transplante de membrana amniótica apresentou: média da espessura corneana central (CCT): 899,4 µm (pré), 1.122,5 µm (pós-operatório) (p<0,001); média da espessura epitelial (ET): 156,4 µm (pré), 247,8 µm (pós-operatório) (p<0,001); média da espessura estromal (ST): 742,9 µm (pré), 826,3 µm (pós-operatório) (p=0,005), e, grupo ASP apresentou: CCT média: 756.7 µm (pré), 914,8µm (pós-operatório) (p<0,001); ET média: 102,1 µm (pré), 245,2 µm (pós-operatório) (p<0,001); ST média: 654,6 µm (pré), 681.5 µm (pós-operatório) (p<0,999). A correlação entre intensidade da dor e espessura corneana central no grupo AMT (p=0,209 pré e pós-operatórios) e no grupo ASP (p=0,157 pré-operatório e p=0,426 aos 180 dias de seguimento) não foi significativa. Edema epitelial e estromal, dobras na membrana de Descemet, bolhas epiteliais, e presença de fluido na interface foram características qualitativas frequentemente observadas. Conclusão: A espessura corneana central aumentou ao longo do tempo em ambos os grupos. A magnitude da espessura corneana central não interfere na intensidade da dor ...

Ultrasound biomicroscopy after palliative surgical procedures for bullous keratopathy: a descriptive comparative study.

PURPOSE: To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. METHODS: The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. RESULTS: In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively (p<0.001); mean ET, 102.1 µm preoperatively and 245.2 µm postoperatively (p<0.001); and mean ST, 654.6 µm preoperatively and 681.5 µm postoperatively (p<0.999). Correlations between CCT and pain intensity in the AMT group (p=0.209 pre- and postoperatively) and the ASP group (p=0.157 preoperatively and p=0.426 at the 180-day follow-up) were not statistically significant. Epithelial and stromal edema, Descemet's membrane folds, epithelial bullae, and the presence of interface fluid were frequently observed qualitative features. CONCLUSION: CCT increased over time in both groups. The magnitude of CCT did not correlate with pain intensity in the sample studied. The presence of interface fluid was a qualitative feature specifically found in some patients who underwent AMT.

Amniotic membrane transplantation versus anterior stromal puncture in bullous keratopathy: a comparative study.

PURPOSE: To compare amniotic membrane transplantation (AMT) and anterior stromal puncture (ASP) in the management of pain in patients with symptomatic bullous keratopathy (BK). METHODS: In this prospective comparative study, 40 eyes of 40 patients with symptomatic BK (chronic intermittent pain) were randomised and divided into two groups (AMT and ASP) according to the technique used to treat symptomatic BK. The patients were examined on days 1, 14, 30, 90 and 180 postoperatively. Patients with BK under the age of 18 with raised eye pressure, concurrent ocular surface infection and those without any pain were excluded. RESULTS: At follow-up at 90 and 180 days the presence of a regular epithelial surface was higher in the AMT group (60% and 50%, respectively) than in the ASP group (16.7% and 6. 3%, p=0.006 and p=0.008, respectively). At 180 days follow-up there was no statistical difference between the two groups in the severity (p=0.391) or duration (p=0.715) of pain. CONCLUSIONS: AMT is similar to ASP in the relief of pain in symptomatic BK. However, ASP is a simple outpatient procedure and should cost less than AMT. NCT 00659308.

Impression cytology findings in bullous keratopathy.

AIM: To evaluate, by impression cytology (IC), the cytological features of the central area of corneal epithelial surface of patients with symptomatic bullous keratopathy (BK). Design Cross-sectional observational case series. METHODS: IC of the central cornea was performed in 72 eyes of 72 patients with symptomatic BK between June 2005 and December 2006. Patients were divided into two groups according to the presence (group GC) or not of goblet cells (group NGC). The diagnosis of limbal stem cell deficiency (LSCD) was defined by the presence of one or more intact goblet cells on the corneal surface. Squamous metaplasia was classified according to Murube and Rivas. RESULTS: Epithelial squamous metaplasia was found in 72 (100%) eyes, along with conjunctival goblet cells in 25 (34.72%) eyes. Squamous metaplasia was grade 1 in group GC and more advanced grades in group NGC. Corneal neovascularisation was present in 62 (82.11%) eyes. Vessel measure was more than 4 mm in 11 eyes (23.4%) in group NGC and 10 eyes (40%) in group GC (p=0.559), and they were mostly subepithelial in 23 eyes (48.9%) in group NGC and 12 (48%) eyes in group GC (p=0.822). CONCLUSION: Squamous metaplasia was the most frequent finding associated with advanced BK. The presence of goblet cells on the surface of corneas with squamous metaplasia grade 1, in a significant number of patients, suggests that limbal stem cell deficiency is a common condition associated with advanced cases of BK.

Postoperative subconjunctival corticosteroid injection to prevent pterygium recurrence.

PURPOSE: To report the outcome of postoperative subconjunctival injection of triamcinolone in eyes that underwent pterygium surgery and were at risk for recurrence. METHODS: Twelve eyes of 11 patients with primary (7 eyes) or recurrent (5 eyes) pterygia underwent excision and conjunctival autografting (4 eyes, 33.3%), amniotic membrane grafting (6 eyes, 50%), or both (2 eyes, 16.6%). All of these eyes had signs that were considered to be risk factors for recurrence (conjunctival inflammation, hemorrhage, granuloma, and fibrovascular proliferation); accordingly, they also underwent subconjunctival injection of triamcinolone. RESULTS: Among the 11 patients, there were 8 (72.7%) men and 3 (27.3%) women; the mean age was 41 years (range, 20-56 years). In 5 (41.7%) eyes, the pterygium was graded as T2 (intermediate) and in 7 (58.3%) eyes was graded as T3 (fleshy). The time between surgery and the first injection ranged from 2 to 5 weeks (mean, 3.4 weeks), and 1-3 injections were necessary (mean, 1.7) to achieve the desired effect. After injection, 1 (8.3%) eye developed inflammation, and 2 (16.7%) eyes from another patient developed intraocular hypertension that was controlled with a topical beta-blocker. The follow-up after the last injection ranged from 8 to 36 months (mean, 14.5 months); only 1 recurrence (grade 3) occurred during this period. CONCLUSIONS: The postoperative use of subconjunctival triamcinolone seems to benefit patients at increased risk of pterygium recurrence. It is relatively safe and is accompanied by few complications, but controlled and prospective studies are necessary to confirm its efficacy.

Uniäo da Vitória: crescendo sem drogas e álcool / Uniäo da Vitória: growing without drugs and alcohol

Uniäo da Vitória é considerado um dos bairros mais pobres de Londrina tendo como principais fatores o desemprego e a marginalizaçäo. Nascido de um conflito entre trabalhadores rurais e a mecanizaçäo da lavoura, este bairro tem uma força e uma uniäo característica de luta pelos direitos humanos. Pesquisou-se o que os moradores da Uniäo da Vitória na faixa etária entre 13 e 25 anos possuíam de informaçöes sobre álcool e drogas. Foi um desafio enfrentado pelo grupo com o objetivo de conseguir transmitir algo produtivo e construtivo para uma populaçäo com a mente pré-formada nas bases do seu cotidiano

Depoimentos sobre a construcao coletiva e participativa de um novo modelo para a saude / Staments about collective and participative construction of a new health model

Rompendo com a visao tradicional dos Postinhos de Saude, a Prefeitura do Municipio de Londrina, atraves da Secretaria de Saude, com a participacao da comunidade e do Centro de Ciencias da Saude da Universidade Estadual de Londrina, atraves do PROUNI, inaugurou uma nova concepcao arquitetonica, uma nova forma de envolvimento da populacao com os equipamentos publicos de saude e uma nova forma de interacao docente-assistencial. Apresenta a visao dos profissionais dos servicos de saude, dos alunos e dos professores sobre o significado da construcao deste novo modelo para a saude