Bruno Castelo Branco

Corneal infections after implantation of intracorneal ring segments.

Purpose: To report risk factors, clinical course, and outcome in patients with infectious keratitis following implantation of intracorneal ring segments (ICRS). Methods: The records of 8 patients with culture-proven infectious keratitis after ICRS (Ferrara® or Intacs®) implantation were retrospectively reviewed. Age, gender, corneal findings, ocular abnormalities, the condition that led to ICRS implantation, immediate prior use of a contact lens, elapsed time between implantation and the onset of symptoms, previous medications, and systemic disorders were noted. Results: Culture-positive infectious keratitis developed in 7 eyes of 7 patients (2 men and 5 women) with a mean age of 35 years who underwent Ferrara implantantion for the treatment of keratoconus and in a 29-year-old man who underwent Intacs implantation for correction of low myopia. Contact lens use, diabetes, and trauma were factors possibly associated with the risk of infection in three cases. Microorganisms, identified in all cases, included Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae, Pseudomonas sp, Nocardia sp, Klebsiella sp, and Paecylomices sp. Onset of symptoms of infection varied from less than 1 week to 22 months postoperatively, depending on the infecting organism. Conclusions: Infectious keratitis following ICRS implantation is a sight-threatening complication for which early recognition and rapid institution of appropriate treatment may result in a better visual outcome.

Limbal Relaxing Incisions to Correct Corneal Astigmatism During Phacoemulsification

PURPOSE To evaluate the safety and efficacy of limbal relaxing incisions for the correction of corneal astigmatism during phacoemulsification. METHODS Fifty eyes of 37 patients (mean age 66.5 years, range: 45 to 80 years) with cataract and coexisting topographic astigmatism were included in the study. Eyes were randomly divided into two groups: eyes that underwent cataract surgery with limbal relaxing incisions (cataract LRI group) and eyes that underwent cataract surgery only (control group). All limbal relaxing incisions were performed during phacoemulsification. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), and corneal topography were recorded preoperatively and 1, 3, and 6 months postoperatively. RESULTS A statistically significant improvement in BSCVA was seen in the cataract LRI eyes from 0.9 +/- 0.7 preoperatively to 0.1 +/- 0.1 at 1, 3, and 6 months postoperatively (P < .01). A statistically significant improvement in BSCVA was seen in control eyes from 0.8 +/- 0.6 before surgery to 0.2 +/- 0.2 at 1, 3, and 6 months after surgery (P < .01). No difference in postoperative BSCVA was noted between the groups. A statistically significant reduction in the mean topographic astigmatism was seen in the cataract LRI eyes from 1.93 +/- 0.58 diopters (D) preoperatively to 1.02 +/- 0.60 D 6 months postoperatively (P < .05). The control eyes did not show a statistically significant change in topographic astigmatism. CONCLUSIONS Limbal relaxing incisions performed during phacoemulsification surgery appear to be a safe, effective, and stable procedure to reduce pre-existing corneal astigmatism.

Evaluation of normal ocular bacterial flora with two different culture media.

BACKGROUND The purpose of this study was to determine if the use of broth culture medium is efficient in investigating bacterial flora of the normal eyelid and conjunctiva. METHODS Samples from the conjunctiva and eyelid of healthy patients of various ages who were undergoing ocular surgeries were obtained and cultured at 3 periods: before topical antibiotic prophylaxis, in the postoperative period during topical antibiotic treatment, and 15 days after discontinuation of antibiotic use. Samples were inoculated into both brain heart infusion broth and blood agar plate, and the growth results of both media were analyzed. RESULTS Brain heart infusion broth medium showed a significantly higher bacterial growth of gram-positive cocci in most periods. The solid blood agar medium had a higher recovery of gram-positive bacilli before prophylaxis only in the older patients. INTERPRETATION Our results show that a more complete analysis of eyelid and conjunctival flora can be obtained using both liquid and solid media to increase the chances of isolate recovery. The inclusion of liquid media in this analysis was even more relevant in the period of concomitant use of antibiotic treatment.

Management of prominent iris vascular tufts causing recurrent spontaneous hyphema.

Purpose: To report the management of recurrent, spontaneous hyphema associated with florid iris vascular tufts in a patient presenting for cataract surgery. Methods: Interventional case report and review of the literature; presentation of clinical findings, iris angiography, and the argon laser regimen used to minimize potential corneal complications with increased total treatment energy. Results: An 80-year-old man with a 20-year history of bilateral, recurrent, spontaneous hyphema associated with extensive iris vascular tufts presented with visually significant cataracts. Serial argon laser photocoagulation treatment of the prominent, circumferential iris vascular tufts of the left eye arrested further episodes of spontaneous hyphema and facilitated uneventful cataract surgery. Argon laser parameters were titrated to therapeutic effect during the initial treatment sessions, and sectoral photocoagulation of the circumferential vascular tufts was performed during a 5-month period to accommodate increased laser power and energy. The total energy required to complete treatment of the extensive lesions was substantially more than that in similar previous reports; however, no adverse corneal complications were associated with the laser therapy. Conclusions: This case appears to represent the first description of chronic, bilateral, recurrent spontaneous hyphema associated with iris vascular tufts. Argon laser treatment of symptomatic iris vascular tufts promotes resolution of recurrent, spontaneous hyphema and may serve to mitigate the risk of hemorrhage from these lesions during subsequent intraocular surgery. Conservative management of increased total treatment energy may minimize the potential risk of corneal decompensation with argon laser therapy.

Rejeição corneana pós transplante de córnea: análise de dados do Banco de Olhos do Hospital São Paulo - Escola Paulista de Medicina

Purpose: Among all grafts, corneal transplantation is the most commonly performed. Graft outcome is usually good, but some cases failure due to rejection can be observed.There are some well-known risk factors for corneal graft rejection. The purpose of this study is to analyze cases of corneal graft rejection in our Service focusing on peculiar risk factors. Methods: We analyzed 113 cases of penetrating keratoplas-ties performed in 1998. Cases of corneal graft rejection were evaluated in relation to preoperative diagnosis, existence of synechia, corneal vascularization, increased intraocular pressure, previous graft rejection, donor age, time of enu-cleation and preservation of the donor cornea and the surgeons surgical experience. Results: We were able to identify 20 (17.69%) cases of graft rejection. Among these 9 had synechia, 4 corneal neovas-cularization, 8 increased intraocular pressure and 7 pre-vious graft rejection. Conclusions: Our results are in agreement with those of the literature. It seems that the surgeons experience plays a role in corneal graft rejection. It is important to call attention to the fact that reference services handle difficult and more complicated cases which may be at a higher risk to rejection.

Uso ocular de água boricada: condições de manuseio e ocorrência de contaminação

PURPOSE: To evaluate use conditions and detect contamination in bottles of boric acid solution. METHODS: A convenience sample of 42 recruited patients using boric acid solution came to the Ophthalmology Emergency Room of the Sao Paulo Hospital from February to March of 2003. Cultures were taken from material of the conjunctival sac, inner surface of bottle edge, inner part of cap and from 1 ml of boric acid solution of each bottle. RESULTS: Of the 42 boric acid solution bottles, 17 (40.5%) showed contamination: 1 (2.4%) in the solution, 17 (40.5%) in the inner cap and 6 (14.3%) in the inner part of the bottle edge. Of the 17 contaminated bottles, 10 (58.8%) were handled inappropriately and 13 (76.5%) of the bottles were not discharged after first use. The most common microorganisms found in the caps and edges of the bottles were Staphylococcus sp (69.6%), followed by Gram-positive bacillus (26.1%). Sixteen bottles (38.1%) had been opened more than a month ago and 5 (31.3%) of those showed contamination. The boric acid solution bottle directions shown on the labels were incomplete and not clear. The use of boric acid solution was on recommendation of their own, friends or relatives in 26 (61.9%) cases; pharmacists in 8 (19.0%) cases, ophthalmologists in 5 (11.9%) cases and general practitioners in 3 (7.1%) cases. CONCLUSION: In most cases, the topic use of boric acid solution was recommended by non-physicians. The bottles, in general, were handled inappropriately, and hence presented a much higher level of contamination that did the boric acid solution inside. The lower level of contamination in the solution is possibly associated with the anti-septic characteristics of the boric acid solution.

Avaliação da contaminação microbiana da membrana amniótica e líquido amniótico

PURPOSE: To verify and compare the possible microbiological contamination of amniotic fluid, and amniotic membranes at time zero and at different times after delivery. METHODS: Nine amniotic fluid samples were collected by intrauterine aspiration and nine amniotic membranes were collected after cesarean deliveries of patients with negative serology (HIV, syphilis, hepatitis B and C). Samples were collected at different times after delivery (zero, thirty, sixty minutes). The samples were inoculated in culture media for bacteria and fungi. RESULTS: Bacteria were retrieved from four amniotic fluid samples, as well as from all nine amniotic membranes. Coagulase-negative Staphylococcus was the most prevalent bacteria. At time zero, coagulase-negative Staphylococcus was revealed in all nine amniotic membranes, Staphylococcus aureus in two, Neisseria sp., Enterobacter and Streptococcus viridans in one. Thirty minutes after delivery, coagulase negative Staphylococcus grew in all nine amniotic membranes and Streptococcus viridans in one. Sixty minutes after delivery, coagulase-negative Staphylococcus was shown in eight, Staphylococcus aureus in two and Streptococcus viridans in one sample. Coagulase-negative Staphylococcus was found in three amniotic fluids and corresponding membranes. CONCLUSION: Amniotic membrane contamination was a problem in all samples, and the processing protocol used at the Federal University of Sao Paulo was efficient to decontaminate the AM. Care must be taken before the use of AM. Further studies are necessary to establish the accurate variation of AM contamination at different times after delivery.

In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin, gatifloxacin and other fluoroquinolones

OBJETIVOS: Conhecer e comparar a susceptibilidade in vitro de bacterias isoladas do olho a fluoroquinolonas, incluindo moxifloxacina e gatifloxacina. METODOS: Um total de 154 bacterias isoladas de ceratites e conjuntivites foram submetidas a testes de sensibilidade antimicrobiana aos antibioticos usando o metodo de difusao em disco. RESULTADOS: Das 51 bacterias isoladas da cornea, 46 (90,2%) foram sensiveis a ciprofloxacina, 45 (88,2%) a ofloxacina e 41 (80,4%) a lomefloxacina. Todas as bacterias isoladas da cornea foram sensiveis a moxifloxacina e a gatifloxacina. Das 103 bacterias isoladas da conjuntiva 101 (98,1%) e 103 (100%) foram sensiveis a gatifloxacina e moxifloxacina, respectivamente. Duas cepas de Streptococcus sp do grupo viridans mostraram-se resistentes a gatifloxacina. Um total de 82 (79,6%) especimes foi sensivel a lomefloxacina, 89 (86,4%) e 96 (93,2%) a ciprofloxacina e ofloxacina, respectivamente. CONCLUSOES: As quinolonas de 4a geracao, aqui exemplificadas pela moxifloxacina e gatifloxacina, apresentam eficacia antimicrobiana maior do que a ciprofloxacina, ofloxacina e lomefloxacina contra os organismos frequentemente isolados em pacientes com infeccoes bacterianas da cornea e da conjuntiva.

Microbiological efficacy of lomefloxacin and other drug's regarding microorganisms isolated from the human conjunctiva

Purpose: To evaluate and compare the in vitro susceptibility of human conjunctival bacterial isolates to various antimicrobial agents, including lomefloxacin, other fluoroquinolones (ciprofloxacin, norfloxacin, and ofloxacin), aminoglycosides (gentamicin, tobramycin, and amicacin), and cephalosporin (cephalothin). Methods: Antibiotic susceptibility tests conducted over a period of 27 months with 613 bacterial isolates from the conjunctiva were retrospectively analyzed. Results: In relation to the total number of positive isolates, the fluoroquinolones showed greater in vitro effectiveness than the other analyzed antibiotics. All bacterial isolates showed significantly higher susceptibility to ciprofloxacin than to lomefloxacin. Conclusion: The fluoroquinolones are not only equally effective against all conjunctival bacterial isolates, but they also show superior antimicrobial activity in comparison to aminoglycosides and cephalothin. These results suggest that fluoroquinolones, such as lomefloxacin, can be beneficially prescribed for conjunctival infections and also as prophylaxis in ocular surgery.

Anterior capsule staining using 0.025% trypan blue in cataracts without red reflex

Purpose: To describe the use of anterior capsule staining in cataracts without red reflex using a 0.025% trypan blue solution. Methods: Six eyes of 6 patients with cataracts without red reflex were submitted to phacoemulsification using a direct injection of 0.2 to 0.5 ml of 0.025% trypan blue in the anterior chamber previous to viscoelastic injection. All patients had an ophthalmologic examination prior to surgery, as well as pre and postoperative corneal endothelial cell count. Results: In all cases the capsule became stained with a faint blue color that enabled an adequate visibility of the flap during the continuous curvilinear anterior capsulotomy (CCC). There were no intra-or postoperative complications. The endothelial cell loss varied between 1.8% and 26.6% (mean 12.8%). Conclusion: Staining the anterior capsule with 0.025% trypan blue solution allows a good visibility of the capsular flap and facilitates the confection of CCC in cataracts without red reflex.