Abrahão da Rocha Lucena

Estudo epidemiológico do tracoma em comunidade da Chapada do Araripe - Pernambuco - Brasil

OBJETIVOS: Fazer estudo epidemiologico do tracoma no povoado de Serrolândia, municipio de Ipubi, na chapada do Araripe, sertao de Pernambuco, regiao historicamente conhecida como bolsao. METODOS: Em outubro e novembro de 2002 foi realizado trabalho de campo prospectivo, no qual se examinaram 1.239 individuos. A idade dos individuos variou de 1 a 93 anos (media de 25,3 anos). O exame foi realizado com lupa binocular de 2,5 vezes de magnificacao e obedeceu-se a classificacao clinica de tracoma preconizada pela OMS. RESULTADOS: O tracoma foi diagnosticado clinicamente em 250 (20,5%) individuos, com predilecao pelo sexo masculino. A media de idade dos individuos com tracoma folicular (TF) foi 13 anos e com tracoma cicatricial (TS) 49 anos. Observaram-se as seguintes gradacoes do tracoma: 107 (8,6%) casos de TF, 2 (0,2%) de TI (tracoma inflamatorio), 139 (11,2%) de TS, 1 (0,1%) de TT (triquiase tracomatosa) e nenhum caso de CO (opacificacao corneana). CONCLUSOES: Pode-se considerar que o tracoma na comunidade de Serrolândia, Ipubi-PE, apresenta baixa endemicidade (8,8% TF / TI), apesar de localizar-se em regiao de baixo nivel socio-economico da chapada do Araripe, conhecida como bolsao de tracoma. Nao e, portanto, um grave problema de saude publica nessa comunidade.

Upper eyelid entropion and dry eye in cicatricial trachoma without trichiasis

PURPOSE to evaluate the position of the upper eyelid margin and eye surface status in cicatricial trachoma without trichiasis (TS). METHODS Slit-lamp biomicroscopy was employed to evaluate the location of the upper lid mucocutaneous transition of 156 eyes of 78 patients with trichiasis and of 130 eyes of 65 control subjects. For each eye the position of the upper lid mucocutaneous junction was graded with respect to the line of meibomian gland orifices into 3 categories: a) anterior, b) at the line, and c) posterior to the line. Ocular surface dye staining with lissamine green was performed in all eyes. All participants answered a questionnaire with queries on the presence and intensity of dry eye symptoms. RESULTS In the eyes with trichiasis the location of the mucocutaneous transition was posterior to the meibomian gland line in 55 (35.3%), at the line in 77 (49.4%) and anterior to the line in only 24 (15.4%). In the control group these figures were: 5 (3.8%); 42 (42%) and 83 (63.8%). Lissamine staining and dry eye symptoms were also associated with trichiasis. CONCLUSION Different degrees of upper lid entropion are already present in cicatricial trachoma even in the absence of trichiasis. Trichiasis is associated with lissamine green staining and dry eye symptoms. Conjunctivalization of the upper lid margin may play a role in the development of trachomatous dry eye.

Cyclotorsion measurement in laser refractive surgery

PURPOSE The aim of this study was to verify the presence of cyclotorsion in eyes that underwent laser refractive surgery. METHODS This was a comparative observational study, which analyzed the medical records of 61 patients (104 eyes) who underwent laser refractive surgery and compared the axis of astigmatism of the sitting and the supine positions. Regarding the gender, 37.5% were male and 62.5% were female. The age ranged from 20 to 54 years old, with the median of 29 years. The lowest degree of astigmatism was -0.75 cylinder diopters (DC) and the highest was -6.50 DC, with a mean of -3.06 ± 1.16 DC. First, the axis of astigmatism of the seated patient was captured by the Schwinds ORK-CAM. In a second moment, inside the operating room, the axis of astigmatism of the patient in supine position was captured by the laser equipments own camera (Schwind Amaris®), which was then compared with the previous measure. The incyclotorsion was defined by a minus sign (-) and the excyclotorsion, by a plus sign (+). RESULTS The maximum excyclotorsion was +7.7 and the maximum incyclotorsion was -11.0 degrees. The mean torsion (excyclo or incyclo) was 2.74 (56.7%), with a standard deviation of 2.30 degrees. There was no statistically significant change (p=0.985) in the axis of astigmatism between patients sitting versus supine. CONCLUSION There was clinically significant cyclotorsion in 36.5% of the eyes submitted to laser correction.

Uso de C3F8 no descolamento da membrana de Descemet pós-facectomia

INTRODUCTION: Descemets membrane detachment is a rare but serious complication following cataract surgery. Extensive detachments that affect the visual axis may result in poor vision and require penetrating corneal grafts. Some alternatives have been used to reattach Descemets membrane: air bubble, transcorneal sutures and intracameral viscoelastic gel plus SF6 or C3F8 gas. PURPOSE: To describe the use of non-expanding (16%) intracameral C3F8 to reattach Descemets membrane, in six patients, following cataract surgery. METHODS: The patients mean age was 71.3 ± 9.3. Four of the patients were females and two masculine. Immediately afters the gas injection the patient was submitted to slit-lamp evaluation to verify the position of Descemets membrane. The patients who had eyes with central or superior detachments were told to sit upright for two days. The patients whose eyes had inferior detachments were asked to lie on their back. RESULTS: All patients had successful reattachment of Descemets membrane after the gas injection. We observed increase in intraocular pressure in one case. The corneal edema regressed after the second day with total resolution by the fourth day. Visual acuity improved in all cases after regression of the edema and remained stable after forty-five days. CONCLUSION: The use of non-expanding C3F8 alone for reattaching Descemets membrane is reported for the first time in the Brazilian literature. Improvement in visual acuity is fast, the method is safe, effective and easily performed under topical anesthesia.

Epidemiology of trachoma in the village of Araripe plateau - Ceará State

PURPOSE To evaluate the epidemiological factors of trachoma in the Simão village. METHODS Through a field research, 412 individuals (178 men and 234 women) were examined in a village of the Araripe plateau in Ceará State. The median age was 34 years for both genders. Traditional data from trachoma epidemiology were collected and diagnosis of trachoma was performed using binocular loupes of x 2.5. RESULTS 304 (73.8%) individuals were normal and 108 (26.2%) were trachomatous (5 TF, 98 TS, 3 TT and 2 CO). Regarding socio-economic factors relating to individuals, the illiterate were 1.9 times more likely to have trachoma (p<0.0001), but the more affluent were more affected (p<0.0001). As for the face appearance, the disease was more prevalent in patients with dirty faces (p=0.432). A difference was noted in multivariate analysis of socio-economic factors relating to housing; only the variable number of people per room, which was higher in the normal group (p=0.010). CONCLUSIONS The good infrastructure found in the Simão village, especially the amount of houses with piped water and the good personal hygiene habits, favored the low findings of infectious forms.

Síndrome de Bonnet na Oftalmologia: revisão de literatura

1 Specialization Course in Ophthalmology, Escola Cearense de Oftalmologia, Fortaleza, CE, Brazil . 2 Escola Cearense de Oftalmologia, Fortaleza, CE, Brazil. (ORCID: 0000-0002-0426-640X) 3 Discipline of Mental Health, Nursing School, Faculdade Leão Sampaio, Juazeiro do Norte, CE, Brazil. (ORCID: 0000-0001-9405-7996) 4 Escola Cearense de Oftalmologia, Fortaleza, CE, Brazil. (ORCID:0000-0002-2064-9320 ) AbstrAct

Study of asphericity coefficient and longitudinal spherical aberration surface corneal

Objective: To correlate the asphericity coefficient (Q) with longitudinal spherical aberration (LSA) of the corneal surface, also correlating each of these variables with the average keratometry Methods: An observational study was conducted by collecting preoperative data from the medical records of individuals candidate cataract surgery, i.e., patient sex and age, as well as Q, LSA of the corneal surface and mean keratometry (Km). Patients who had been subjected to any corneal surgical procedure who would alter Q, LSA and Km measuements were excluded. The corneanl topograph selected, fixedly, a 4.5 mm area of the anterior surface of the cornea for the measurement of Q and LSA, having the pupillary axis as the central point, since the occurrence of LSA is relevant in dim environments in individuals with a pupil wider than 3 mm Results: The sample consisted of 70 eyes of 35 individuals, 24 of them women (68.6%) and 11 men (31.4%) ranging in age from 48 to 89 years (mean: 69.97 ± 8.29). Km ranged from 41.00 to 46.50 D, with a mean of 43.94 ± 1.48D, and mean Q of the corneal surface was -0.15 ± 0.15. Six corneas showed a spherical design (Q= 0.0) and only one showed an aspheric design with Q = -0.50, generating an LSA of 0.0. Mean LSA of the corneal surface was +0.33 ± 0.14 μm. Only one eye showed an LSA equal to 0.0μm, and five showed an LSA of +0.10 to +0.30μm. No eye showed a negative LSA of the corneal surface. There was no correlation between Km and Q (r = -0.005 / p = 0.965) or between Km and LSA (r = 0.167 / p = 0.170). A correlation (r = 0.962 / p = 0.000) was observed between Q and LSA Conclusion: There was a correlation between Q and LSA of the corneal surface. There was no correlation between the sphericity coefficient or longitudinal spherical aberration with the average keratometry.

Fluência do laser e tempo de parada cirúrgica, por perda de fixação, como fatores relacionados à precisão refracional

OBJECTIVE: To evaluate the correlation of flow and stopping time intraoperative loss of attachment factors as hypertension or hipocorrecoes of refractive errors after Lasik. METHODS: The age ranged between 19 and 61 years (mean= 31.27 ± 9.99). The minimum follow-up period was 90 days. Individuals with: corneal topography preoperative maximum keratometry greater than 46.5D or presence of irregularities, corneal curvature postoperative simulated smaller 36.0D, pupils more 6mm; corneal thickness smaller 500 µm; Myopia more -8.0, hyperopia more +5.0DE and astigmatism more -4.0DC. The laser was used with Esir Schwind Eye-Tracking and 350Hz scanning spot of 0.8 mm. The microkeratome used was the Moria M2 with programming 130µm thick. RESULTS: The visual acuity logMAR preoperative correction ranged from 0.40 to 0 (mean= 0.23 ± 0.69) and postoperative uncorrected 0.40-0 (x= 0.30 ± 0, 68). The Median= 0 logMAR for both time points (p= 0.424). For spherical equivalent before and after surgery, we found an obvious difference, with the pre (mean= -4.09 ± 2.83) and post (mean= -0.04 ± 0.38). The Median was -4.75 in the pre and zero postoperatively (p <0.0001). Sixty-nine cases (78.3%) were plan ± 0.25. Fluency minimum= 0.513 mJ/cm2 and maximum= 0.581 mJ/cm2 (mean= 0.545 ± 0.01), no correlation (r = -0.03266, 95% CI -0.241 to 0.178, p = 0.762) between the flow and spherical equivalent (mean = -0.04 ± 0.38) in eyes operated. The minimal downtime during surgery was 02 seconds and maximum was 12 seconds (mean= 4.90 ± 3.47). Making a correlation (r = 0.08865, 95% CI = -0.123 to 0.293, p = 0.411) between the postoperative spherical equivalent and downtime during surgery, not perceived differences. CONCLUSION: There was no correlation between the fluency of the laser during surgery and downtime due to loss of fixation with hipocorrecoes in hyper-or post-Lasik ametropia.