Optical coherence tomography angiography in herpetic leucoma.

BACKGROUND: Herpes simplex virus (HSV) keratitis remains a leading infectious cause of blindness worldwide. Although all forms of HSV keratitis are commonly recurrent, the risk is greatest in stromal keratitis, which is the most likely to result in corneal scarring, thinning, and neovascularization. Recent studies showed the ability of Optical Coherence Tomography Angiography (OCTA) to detect and study vascular abnormalities in the anterior segment, including abnormal corneal vessels. This study intends to investigate the potential of OCTA device to image and describe quantitatively the vascularization in eyes diagnosed with herpetic leucoma and to discuss and review the usefulness of this technique in this pathology. METHODS: A Cross-sectional study was made, including 17 eyes of 15 patients with leucoma secondary to herpetic keratitis. All eyes underwent anterior segment Slit-Lamp photography (SLP), and OCTA with en-face, b-scans and c-scans imaging. The vessel density (VD) was analyzed in the inferior, nasal and temporal corneal margin in all patients, and in the central area, in eyes with central corneal neovascularization (CoNV). The measurements were calculated after binarization with ImageJ software, using OCTA scans with 6 × 6 mm in a depth of 800 µm. RESULTS: Patients included had a mean age 53.267 ± 21.542 (years ± SD). The mean total vessel area was 50.907% ± 3.435%. VD was higher in the nasal quadrant (51.156% ± 4.276%) but there were no significant differences between the three analyzed areas (p = 0.940). OCTA was able to identify abnormal vessels when SLP apparently showed no abnormal vessels; OCTA was able to distinguish between larger and smaller vessels even in central cornea; OCTA scans allowed the investigation of several corneal planes and the relation of them with clinical findings. CONCLUSIONS: OCTA can be useful in both qualitative and quantitative follow-up of patients and may become a non-invasive alternative to objectively monitor treatment response in eyes with corneal vascularization due to herpetic infection.

EVALUATION OF POST-SURGICAL MANAGEMENT OF FRAGILITY FRACTURES.

OBJECTIVE: To evaluate the conduct of Brazilian orthopedists regarding preventive treatment after fragility fracture surgery. METHODS: A questionnaire was applied to Brazilian orthopedists. Statistical analyses were performed using the SPSS 16.0 program. RESULTS: 257 participants were analyzed. Most participants, 90.7% (n = 233), reported that they cared for patients with fractures and 62.3% (n = 160) treated them. The most indicated treatments were vitamin D (22.6%; n = 134) and calcium supplementation (21.4%; n = 127). According to the experience of the physicians - experienced (n = 184) and residents (n = 73) - fragility fractures were more common in the routine of residents (98.6%; n = 72) than experienced physicians (87.5%; n = 161), p = 0.0115. While treatment conduction was more reported by experienced physicians (63.6%; n = 117) than residents (58.9%; n = 43), p = 0.004. More experienced orthopedists (21.4%; n = 97) indicated treatment with bisphosphates than residents (14.2%; n = 20), p = 0.0266. CONCLUSION: Although most professionals prescribe treatment after fragility fracture surgery, about 40% of professionals still do not treat it, with differences in relation to experience. In this sense, we reinforce the importance of secondary prevention in the management of fragility fractures. Level of Evidence II, Prospective comparative study.

OBJETIVO: Avaliar a conduta adotada por ortopedistas brasileiros em relação ao tratamento adjuvante após a cirurgia de fraturas de fragilidade. MÉTODOS: Foi aplicado um questionário aos ortopedistas brasileiros. A estatística foi realizada no programa SPSS 16.0. RESULTADOS: Foram analisados 257 participantes. A maioria dos participantes 90,7% (n = 233) relataram atender os pacientes com fraturas e 62,3% (n = 160) relataram tratar. Os tratamentos mais indicados foram a suplementação de vitamina D (22,6%; n = 134) e de cálcio (21,4%; n = 127). De acordo com a comparação médicos experientes (n = 184) versus médicos residentes (n = 73), a rotina de fraturas de fragilidade foi mais observada por médicos residentes (98,6%; n = 72) que por médicos experientes (87,5%; n = 161), p = 0,0115. Enquanto a conduta de tratamento foi mais relatada por médicos experientes (63,6%; n = 117) versus médicos residentes (58,9%; n = 43), p = 0,004. A maior proporção de médicos experientes (21,4%; n = 97) indicaram o tratamento com bifosfatos versus médicos residentes (14,2%; n = 20), p = 0,0266. CONCLUSÃO: Apesar da maioria dos profissionais prescreverem um tratamento após a cirurgia de fraturas de fragilidade, cerca de 40% dos profissionais ainda não tratam, sendo observadas diferenças em relação à experiência. Neste contexto, reforçamos a importância da prevenção secundária na conduta de fraturas de fragilidade. Nível de Evidência II, Estudo prospectivo comparativo.