Carlos Augusto Moreira

In vitro and in vivo studies with sodium hyaluronate as a carrier for intraocular gentamicin

Abstract We compared the in vitro growth of common intraocular pathogens Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa in rabbit vitreous and in sodium hyaluronate (SH) with and without gentamicin. The minimal inhibitory concentration for gentamicin/SH was 0.5, 0.062 and 2.0 mcg/ml for these pathogens, respectively. After posterior capsulotomy, P. aeruginosa was inoculated into the anterior vitreous and all 15 untreated eyes developed endophthalmitis. In a similar group, aqueous gentamicin administered in the anterior chamber reduced the incidence of endophthalmitis to 10 of 15 eyes. Under similar circumstances, the SH/gentamicin combination lowered the incidence of endophthalmitis significantly to 4 of 15 eyes. The half‐life of aqueous gentamicin was 0.9 h, which was shorter than the 2.2 h for SH/gentamicin combination. These results suggest that SH may be a useful carrier for intraocular drug therapy.

Sodium hyaluronate as a carrier for intravitreal gentamicin an experimental study

Abstract Fifty mcg of gentamicin was combined with saline or with 0.8% sodium hyaluronate and injected into the vitreous cavity of rabbit eyes with moderate to severe Staphylococcus aureus endophthalmitis. Endophthalmitis was controlled in 9 of 10 eyes. There was no evidence of toxicity with either treatment regimen. Although the clearance study demonstrated statistical differences at all time points studied, the half‐lives of both treatment regimens were similar (3.3 h for aqueous gentamicin and 3.6 h for sodium hyaluronate/gentamicin). These results suggest that the vitreous played a role in keeping the aqueous gentamicin in the eye for a longer time, as similar half‐lives were shown with both types of treatment. Thus, if a vitrectomy has to be done for the treatment of endophthalmitis, as much as possible of the vitreous should be left in situ to maintain the drug for longer periods in the eye. Also, if it is necessary to remove all vitreous during vitrectomy, it may be more effective to administer the drug with sodium hyaluronate so as to prolong its action inside the eye.

Incidência e etiologia de uveítes em Curitiba

Objetivo: Determinar a incidencia e a etiologia dos casos de uveites em Curitiba-PR. Metodos: Foram estudados 68 casos de uveites em Curitiba, PR, atendidos no ambulatorio de oftalmologia no periodo de janeiro a abril de 1998 procurando estabelecer o diagnostico a partir de ampla investigacao clinica e laboratorial. Resultados: Em nosso estudo, constatamos que a uveite posterior foi a mais encontrada (49%), seguindo-se a panuveite (29%) e, com menor frequencia, a uveite anterior (22%). A etiologia mais frequente para as uveites posteriores foi a toxoplasmose, responsavel por 88% dos casos. Entre as panuveites, novamente a toxoplasmose prevaleceu, com 85% e, dentro das uveites anteriores, a principal causa foi a espondilite anquilosante com 20%. Conclusao: Em Curitiba, ha um predominio de uveites posteriores e panuveites, sendo a causa mais comum a toxoplasmose. No entanto, enfatiza-se que existem outras causas importantes de uveites que devem ser lembradas pelo oftalmologista na investigacao clinica.

Traumas oculopalpebrais no serviço de pronto-atendimento oftalmológico do Hospital Universitário Evangélico de Curitiba

Purpose: To evaluate the epidemiology of patients with oculopalpebral injuries in the city of Curitiba. Methods: We studied, prospectively, 622 patients in the Ophthalmology Emergency Service at the Evangelic Uni-versity Hospital of Curitiba from March to July, 1998. Results: The most affected patients were those between 20 and 50 years of age (73.3%) and the males (6 males:1 female). Among the oculopalpebral traumas the most frequent were foreing body (54.6%), chemical keratocon-junctivitis (12.1%) and blunt trauma (8.8%). The oculopla-pebral injuries happened more frequently in the professional (67,4%) than in the domestic (21.2%) environment. We verified that the majority of the patients (67%) came to the Ophthalmology Service during the first 24 hours after the trauma, although ocular protection was not much used in the professional environment and it was not used at all in the domestic one. Conclusions: The authors stress the great socioeconomical impact of the oculars injuries and the necessity of alerting governmental institutions, physicians (ophthalmo-logists and others), entrepreneurs, workers and the general popu-lation about the importance of oculopalpebral trauma prevention to protect ocular health and to improve the human resources in our society.

Neuropatia óptica isquêmica anterior e poliarterite nodosa: relato de caso

We describe a patient with polyarteritis nodosa being treated with cytostatics and corticosteroids who developed an anterior ischemic optic neuropathy, a rare manifestation of this pathology.

Pesquisa de vírus no líquido cefalorraqueano na síndrome de Vogt-Koyanagi: registro de um caso

: Research was carried out on isolating and identification of a virus in the cerebrospinal fluid of a patient with the Vogt-Koyanagi syndrome (uveomeningeal encephalitis). Results were negative. It was not possible to detect any virus causing the disease in this case. This research was the first such study carried out in Brazil.Research was carried out on isolating and identification of a virus in the cerebrospinal fluid of a patient with the Vogt-Koyanagi syndrome (uveomeningeal encephalitis). Results were negative. It was not possible to detect any virus causing the disease in this case. This resarch was the first such study carried out in Brazil.

Úveo-meningo-encefalite tratada pela piretoterapia

A case of uveo-meningo-encephalitis diagnosed as Haradas disease is reported. After treatment with corticosteroids, antibiotics of large spectrum, tripsine, gama-globulin, total blood transfusion and vitamin C, the persistence of some clinical signs and cerebrospinal fluids alterations indicating that the virus was still active gave the authors the opportunity of trying the pi-retotherapy. The clinic results were satisfactory and the laboratory tests became negative. The idea is that the cure was done by the stimulation of body defenses and by a positive action of tyndallization obtained by the piretotherapy over microrganisms sensible to intermittent temperature. A close control has been maintained for over a year on the patient who presents good health up to now.

Ophthalmic evaluation, treatment, and follow-up of two cases of incontinentia pigmenti

Incontinentia pigmenti (IP) is an X-linked dominant disorder affecting the skin, teeth, eyes, and central nervous system. Ocular changes are common and may lead to severe vision loss. We report on the ocular manifestations in two young girls with IP, with emphasis on the asymmetry of this condition in both eyes and associated retinal problems. The outcomes of laser treatment of the ischemic peripheral retina were good and resulted in stability of vision.

Internal eye wall resection of uveal tumors: long-term evaluation

The authors report five cases of uveal tumors managed with internal eye wall resection and evaluate the long-term results. Patient age varied from 31 to 61 years. Four patients were female and one was male. Uveal tumors involved ciliary body and choroid in three patients and choroid alone in the other two. Histopathological examination demonstrated three uveal melanomas, one leiomyoma, and one meduloepithelioma. The largest tumor diameter ranged from 8 to 15 mm and tumor thickness from 5 to 11 mm. Follow-up of the patients was over a period of 6 to 23 years. Final visual acuity was 20/20 in 3 patients and 20/200 in one patient, and in the fifth patient, the affected eye was enucleated. No cases of metastatic disease or local recurrence of the tumor were observed, suggesting that internal eye wall resection is a valid alternative for the treatment of selected cases of uveal tumors.

Satisfação do paciente com degeneração macular relacionada à idade após terapia térmica transpupilar

OBJETIVO: Comparar resultados subjetivos (satisfacao dos pacientes) aos dados objetivos (melhora da acuidade visual - AV) apos o tratamento de degeneracao macular relacionada a idade e/ou membrana neovascular sub-retiniana por terapia termica transpupilar. METODOS: Foram avaliados retrospectivamente 23 prontuarios de pacientes com diagnostico angiofluresceinografico de degeneracao macular relacionada a idade submetidos a uma unica aplicacao de terapia termica transpupilar. Observou-se a acuidade visual antes e um mes apos a aplicacao, e a satisfacao dos pacientes obtida com o tratamento. RESULTADOS: Avaliamos 23 pacientes, com idades variando entre 53 e 88 anos (media 74,08), dos quais 15 eram do sexo feminino, e 8 do sexo masculino. Foram encontrados 12 olhos com melhora da acuidade visual, 6 olhos sem alteracao da acuidade visual, 6 olhos com acuidade visual piorada. Em relacao a satisfacao, os resultados obtidos foram: muito satisfeitos (4 olhos), satisfeitos (13 olhos), insatisfeitos (7 olhos) e ainda cruzando-se os dados obteve-se muito satisfeitos com melhora da AV (3 olhos) e muito satisfeitos sem melhora da AV (1 olho); satisfeitos com melhora da AV (7 olhos), satisfeitos sem melhora da AV (3 olhos), e satisfeitos com piora da AV (3 olhos); insatisfeitos com melhora da AV (2 olhos), insatisfeito sem melhora da AV (2 olhos), e insatisfeitos com piora da AV (3 olhos). CONCLUSAO: Em relacao a acuidade visual, esta foi melhorada em 12 olhos, dos 24 estudados; a quantidade de pacientes muito satisfeitos ou satisfeitos atingiu a quantidade de 17 olhos, no intervalo de um mes. Observando-se os resultados acima, pode-se considerar a terapia termica transpupilar como terapia alternativa ou adjuvante para o tratamento de degeneracao macular relacionada a idade.