Consuelo Bueno Diniz Adán

Bilateral deep keratitis caused by systemic lupus erythematosus

We report the optical and ultrasonic biomicroscopy and confocal microscopy findings in bilateral stromal keratitis (keratoendotheliitis), a rare ocular manifestation of systemic lupus erythematosus (SLE). Examination revealed deposits with polyrefringent crystals. Topical corticosteroid produced regression of the corneal edema, but there was an increase in corneal opacity. Ultrasound biomicroscopy images confirmed the deep location of the corneal opacities, and confocal microscopy showed a disruption of the corneal stroma and crystal-like bodies.

Descarte de córneas por sorologia positiva do doador no Banco de Olhos do Hospital São Paulo: dois anos de estudo

PURPOSE: To investigate discarded corneas due to positive serologic tests in donors from the Hospital Sao Paulo Eye Bank (BOHSP) during a two-year period. METHODS: Retrospective study of records from cornea donors between January 2006 and December 2007. Information such as serologic test results (Hepatitis B, C, and HIV), source of corneal tissue, donors gender and age were tested for correlation. RESULTS: 902 corneas were processed by BOHSP; 12.9% (116) were discarded due to donors positive test for hepatitis B, C, or HIV; 20.5% (185) were also discarded due to inconclusive result of serological tests; percentage of corneas discarded due to positive or inconclusive serological tests during this period was 33.4% (301). CONCLUSION: This study confirms the importance of serological tests in order to prevent disease transmission to corneal transplant recipients. However, new tests are necessary to decrease the number of inconclusive tests and decrease the number of discarded corneas.

Ultra-sonografia ocular em suspeita clínica de endoftalmite

Purpose: To determine ultrasonographic findings in patients with clinical diagnosis of endophthalmitis, a severe purulent inflammatory reaction confined to the interior of the eye. Methods: Ultrasound examination was performed (10MHz transducer, UltraScan® ALCON), during the period of 1997 to 1999. Results: We analyzed 25 eyes with a clinical diagnosis of endophthalmitis (23 exogenous, 2 endogenous). Twelve (12/23) were post-surgery (7 post-cataract surgery, 4 post-glaucoma surgery and 1 post-keratoplasty). Six followed penetrating trauma and 4 were after corneal ulcer. One patient had corneal suture and cataract surgery after penetrating trauma. Two of them presented low-reflectivity echoes, similar to the normal vitreous, and endophthalmitis was ruled out at that time. Twenty-three cases presented (at different degrees) vitreous involvement with low-mobility dense membranes, vitreous organization and vitreous cavitation. Diffuse choroidal thickening (12 cases), choroidal and/or retinal detachment (8 and 5 cases) and orbital abscess (1 case) were found. Conclusions: Ultrasound examination is important to help in clinical suspected endophthalmitis in order to determine the involvement of the posterior segment.

Recomendações para o tratamento da síndrome de Sjögren

The recommendations proposed by the Sjögrens Syndrome Committee of the Brazilian Society of Rheumatology for the treatment of Sjögrens syndrome were based on a systematic review of literature in Medline (PubMed) and the Cochrane databases until October 2014 and on expert opinion in the absence of studies on the subject. 131 items classified according to Oxford & Grade were included. These recommendations were developed in order to guide the appropriate management and facilitate the access to treatment for those patients with an appropriate indication, considering the Brazilian socioeconomic context and pharmacological agents available in this country.

Motivos do descarte de córneas captadas pelo banco de olhos do Hospital São Paulo em dois anos

PURPOSE: To analyze causes of discarded donor corneas which were collected and preserved by Sao Paulo Hospital Eye Bank in a period of two years. METHODS: Retrospective study based in the investigation of donors medical records, for clinical and ocular factors, age, death cause, serology results, body conditions, slit lamp corneal examination and endothelial cells counting. RESULTS: 1,116 corneas were donated and included in the study, 518 (46.41%) were discarded before preservation, 168 (15.05%) were not transplanted for optical purpose, but used for tectonic indication. The main reason of cornea discard was the cause of death in 288 (25.80%) corneas, second the slit lamp analysis of tissues in 174 (15.59%) corneas. CONCLUSION: The analysis of the medical records and the donors clinical history was an important factor of cornea discard of the not preserved tissues, showing the importance of this stage to guarantee the quality of the tissue and to ensure proper safety for the recipient. Also, the biomicroscopy evaluation realized in the slit lamp is a fundamental stage for qualification and classification of the tissue to guarantee a good surgical result.

Cistos primários do epitélio pigmentar da íris e corpo ciliar: aspectos de biomicroscopia ultra-sônica

Objetivo: Descrever as caracteristicas, incidencia e distribuicao dos cistos primarios de epitelio pigmentar de iris e corpo ciliar ao exame de biomicroscopia ultra-sonica, que devem ser diferenciados de lesoes solidas. Metodos: Foram estudados de modo retrospectivo os prontuarios de 73 pacientes, 82 olhos, com diagnostico ecografico de cisto primario de iris ou corpo ciliar durante o periodo de janeiro/97 a dezembro/99. Utilizou-se o biomicroscopio ultra-sonico, aplicando tecnicas padronizadas de imersao. Resultados: A biomicroscopia ultra-sonica os cistos caracterizaram-se por apresentarem paredes finas e regulares, e conteudo anecoico. Quarenta e oito pacientes (65,7%) eram do sexo feminino. A maior incidencia (28,8%) ocorreu para o grupo incluido no intervalo de 20 a 29 anos de idade. Observou-se uma caracteristica distribuicao, predominantemente nos quadrantes temporais inferiores. Conclusoes: A biomicroscopia ultra-sonica mostrou-se util no diagnostico de cistos primarios do epitelio pigmentar da iris e do corpo ciliar, auxiliando na diferenciacao de patologias tumorais e avaliando possiveis complicacoes. O conhecimento dos criterios ecograficos e da distribuicao epidemiologica facilitam o diagnostico destas lesoes.

AB0533 Recommendations of Brazilian Society of Rheumatology for the Treatment of SjÖGren's Syndrome

Objectives Recommendations of Brazilian Society of Rheumatology for the treatment of Sjögrens syndrome (SS) were developed to guide management of SS considering the Brazilian social and economic context. Methods It was based on specialists opinion and systematic review on MEDLINE (PubMed) and Cochrane database until October 2014, including 127 articles classified according Oxford & Grade. Results Forty-four recommendations were organized in 3 main topics: Part 1. General recommendations and patient education: The management of SS should be conducted by multidisciplinary team. Systemic treatment should be according disease severity measured by EULAR Sjögrens Syndrome Disease Activity (ESSDAI). Patients should avoid caffeine, tobacco, alcohol, toothpaste with abrasive, and mouthrinses with alcohol. Patient should be educated about preventive measures for oral health and hydration. Aerobic exercise improves fatigue and quality of life. Immunization to influenza and pneumococo are indicated. Serum levels of vitamin D should be evaluated and supplemented if it is necessary. Part 2. Symptomatic treatment of dryness: Topical treatment for dry mouth includes saliva substitutes, sugar-free candies and gums. Topical treatments for dry eye are lubricants (glucanes or carboximethylcelulose), cyclosporine 0.05%, and punctual occlusion. Topical glucocorticoids may be used for severe dry eye for short time avoiding complications. Pilocarpine and cevimeline should be used for dry mouth and for severe dry eye. N-acetylcysteine may be used for dryness symptoms, including patients showing intolerance for muscarinic agonists. Omega-3 supplementation may be used to dry eye. Part 3. Systemic treatment: Immunosupressant and/or biological therapy are not indicated to dryness treatment. Hydroxichloroquine, glucocorticoid, and immunossupressants (azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine) should be indicated according severity of systemic involvement. Rituximab is indicated to treat systemic manifestations without improvement with immunosuppressive therapy. Abatacept and belimumab may be considered in patients not responding to rituximab and with high level of disease activity. Acknowledgements Sociedade Brasileira de Reumatologia (SBR) Disclosure of Interest None declared