Eliana Domingues Gonçalves

Impression cytology findings in bullous keratopathy

Aim To evaluate, by impression cytology (IC), the cytological features of the central area of corneal epithelial surface of patients with symptomatic bullous keratopathy (BK). Design Cross-sectional observational case series. Methods IC of the central cornea was performed in 72 eyes of 72 patients with symptomatic BK between June 2005 and December 2006. Patients were divided into two groups according to the presence (group GC) or not of goblet cells (group NGC). The diagnosis of limbal stem cell deficiency (LSCD) was defined by the presence of one or more intact goblet cells on the corneal surface. Squamous metaplasia was classified according to Murube and Rivas. Results Epithelial squamous metaplasia was found in 72 (100%) eyes, along with conjunctival goblet cells in 25 (34.72%) eyes. Squamous metaplasia was grade 1 in group GC and more advanced grades in group NGC. Corneal neovascularisation was present in 62 (82.11%) eyes. Vessel measure was more than 4 mm in 11 eyes (23.4%) in group NGC and 10 eyes (40%) in group GC (p=0.559), and they were mostly subepithelial in 23 eyes (48.9%) in group NGC and 12 (48%) eyes in group GC (p=0.822). Conclusion Squamous metaplasia was the most frequent finding associated with advanced BK. The presence of goblet cells on the surface of corneas with squamous metaplasia grade 1, in a significant number of patients, suggests that limbal stem cell deficiency is a common condition associated with advanced cases of BK.

Ceratopatia bolhosa: etiopatogênese e tratamento

A ceratopatia bolhosa caracteriza-se pelo edema corneano estromal acompanhado de bolhas epiteliais e subepiteliais devido a perda de celulas e/ou alteracoes da juncao endotelial. Nos casos mais avancados, ocorre espessamento do estroma e presenca de fibrose subepitelial e vascularizacao corneana. Apresenta baixa de acuidade visual devido a diminuicao da transparencia da cornea e pode estar acompanhada de sensacao de corpo estranho, lacrimejamento e dor devido as alteracoes epiteliais como a presenca de bolhas integras ou rotas. Ceratite bolhosa e uma das principais causas de transplante de cornea em diferentes regioes e paises. A principal etiologia e a perda de celulas endoteliais, principalmente apos cirurgia de catarata e na distrofia endotelial de Fuchs. Sabe-se que atualmente ha cerca de 20 milhoes de pessoas com catarata no mundo, e esta complicacao pode afetar 1 a 2% das cirurgias de catarata. Este texto faz uma revisao sobre a etiopatogenese da ceratopatia bolhosa e sobre os tratamentos clinicos e cirurgicos disponiveis para a doenca.Bullous keratopathy is characterized by corneal stromal edema with epithelial or subepithelial bullae due to cell loss and endothelial decompensation. In more advanced cases, subepithelial fibrosis, formation of a posterior collagenous layer or retrocorneal fibrous membrane, and corneal vascularization can occur. Decreased vision is present because the loss of corneal transparency with symptoms like tearing and pain caused by epithelial bullae that can rupture. Currently, bullous keratopathy is the most common indication for penetrating keratoplasty and regraft. The main etiology is the endothelial cell loss after ophthalmic surgeries as cataract surgery. Cataract affects approximately 20 million people worldwide, and this complication can occur in 1 to 2% of cataract surgeries. This study revised bullous keratopathy etiopathogenesis, clinical and surgical treatment available for this corneal disease.

Amniotic membrane transplantation versus anterior stromal puncture in bullous keratopathy: a comparative study

Purpose To compare amniotic membrane transplantation (AMT) and anterior stromal puncture (ASP) in the management of pain in patients with symptomatic bullous keratopathy (BK). Methods In this prospective comparative study, 40 eyes of 40 patients with symptomatic BK (chronic intermittent pain) were randomised and divided into two groups (AMT and ASP) according to the technique used to treat symptomatic BK. The patients were examined on days 1, 14, 30, 90 and 180 postoperatively. Patients with BK under the age of 18 with raised eye pressure, concurrent ocular surface infection and those without any pain were excluded. Results At follow-up at 90 and 180 days the presence of a regular epithelial surface was higher in the AMT group (60% and 50%, respectively) than in the ASP group (16.7% and 6. 3%, p=0.006 and p=0.008, respectively). At 180 days follow-up there was no statistical difference between the two groups in the severity (p=0.391) or duration (p=0.715) of pain. Conclusions AMT is similar to ASP in the relief of pain in symptomatic BK. However, ASP is a simple outpatient procedure and should cost less than AMT. NCT 00659308

Síndrome de Fraser: relato de caso nas vias lacrimais

Fraser syndrome is a systemic condition characterized by cryptophthalmos, syndactyly and abnormal genitalia, which may be associated with urinary tract, ear, nose, larynx and skeletal abnormalities. Cryptophthalmos can be an isolated finding (that has been reported as an autosomal dominant trait) or associated with other congenital anomalies (reported as an autosomal recessive disorder). Child, female, nine month of life, evaluated in the lacrimal setor of Federal University of Sao Paulo. Child of consanguineous parents. Her physical examination showed total unilateral cryptophthalmos (left side), epiphora (right side) with mucopurulent discharge, depressed nasal bridge, low set ears, atresia of the external auditory canal, prominent labia majora and syndactyly of the fingers and toes. Ocular ultrasonography showed brachycephaly, absence of septu pellucidum prominence of the lateral ventricles, a major bone defect in the skull, the presence of thinning of the mantle tissue of the brain,a reduced anterior-posterior ocular diameter, anterior segment disorganization, absence of the lens and total retinal detachment in the left eye.

Dacriocistocele congênita: relato de caso e conduta

A dacriocistocele representa uma rara anomalia congenita da regiao medial da orbita, causada pela obstrucao distal (ao nivel da valvula de Hasner) e proximal (ao nivel da valvula de Rosenmuller) da via lacrimal, com subsequente dilatacao do saco lacrimal. Recebe o nome de mucocele, quando seu conteudo representa muco, ou amniocele, quando o seu conteudo e preenchido por fluido amniotico. Acomete somente 0.1% das criancas, com obstrucao do ducto lacrimonasal, sendo comumente unilateral e mais frequente no sexo feminino e com predisposicao familiar. O diagnostico e realizado pelas caracteristicas clinicas: lesao cistica tensa, abaixo do tendao cantal medial, de coloracao azulacinzentada, rosea ou vermelha acompanhada por epifora desde o nascimento. No entanto podemos utilizar exames de imagem para diagnosticar esta anomalia congenita tais como: tomografia computadorizada, ressonância magnetica e ultrassonografia.

Ultrasound biomicroscopy after palliative surgical procedures for bullous keratopathy: a descriptive comparative study

PURPOSE To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. METHODS The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. RESULTS In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively (p<0.001); mean ET, 102.1 µm preoperatively and 245.2 µm postoperatively (p<0.001); and mean ST, 654.6 µm preoperatively and 681.5 µm postoperatively (p<0.999). Correlations between CCT and pain intensity in the AMT group (p=0.209 pre- and postoperatively) and the ASP group (p=0.157 preoperatively and p=0.426 at the 180-day follow-up) were not statistically significant. Epithelial and stromal edema, Descemets membrane folds, epithelial bullae, and the presence of interface fluid were frequently observed qualitative features. CONCLUSION CCT increased over time in both groups. The magnitude of CCT did not correlate with pain intensity in the sample studied. The presence of interface fluid was a qualitative feature specifically found in some patients who underwent AMT.

LASIK em programa de treinamento médico: complicações relacionadas a microcerátomos

PURPOSE: To evaluate microkeratome complications related to laser in situ keratomileusis - LASIK - in a residency program. METHODS: A total of 1,611 eyes were retrospectively evaluated after being submitted to laser in situ keratomileusis - LASIK surgery from January 1998 to June 2000 in the Refractive Surgery Clinic. RESULTS: There were 26 (1.61%) complications on performing the flap with the microkeratome and, described as 9 (34.61%) incomplete flap, 9 (34.61%) thin, 2 (7.69%) free cap, 5 (19.23%) irregular, 1 (3.84%) buttonhole. CONCLUSION: The prevalence of microkeratome complications in a residency program was low and the training of residents and trainees in refractive surgery has shown to be a viable practice.