Erasmo Romão

Pain induced by phacoemulsification without sedation using topical or peribulbar anesthesia

Purpose: To evaluate patient‐reported pain induced by phacoemulsification without sedation using topical or peribulbar anesthesia. Setting: Department of Ophthalmology, School of Medicine of Ribeirão Preto, São Paulo, Brazil. Methods: This study assessed patient‐perceived pain during phacoemulsification cataract surgery with peribulbar anesthesia (lidocaine 2%–bupivacaine 0.5% mixture) or with topical anesthesia (tetracaine drops); no patient received sedation. The same surgeon performed all surgeries using a clear corneal approach and in‐the‐bag intraocular lens implantation. Approximately 15 minutes after surgery, patients in the topical anesthesia group (n = 20) were asked to rate their pain during the procedure and patients in the peribulbar anesthesia group (n = 21), during infiltration of the anesthetic solution. Patients graded their pain using a 0‐ to 10‐point visual analog scale (0 = no pain; 10 = unbearable pain). The results in the 2 groups were compared using the nonparametric Mann‐Whitney U test. Results: The median pain score in the topical anesthesia group was 2 (range 0 to 5) and in the peribulbar anesthesia group, 3 (range 0 to 7). The mean rank in the topical anesthesia group (15.78) was significantly lower than the mean rank in the peribulbar anesthesia group (25.98) (P = .0057, Mann‐Whitney U test). Conclusion: In patients having phacoemulsification without sedation, those receiving peribulbar anesthesia reported more pain than those receiving topical anesthesia during anesthetic solution infiltration and during the procedure, respectively.

Atypical pneumococcal scleritis after pterygium excision : Case report and literature review

Purpose: To describe an unusual case of pneumococcal scleritis after pterygium excision and to review the literature on infectious scleritis associated with pterygium excision. Methods: Case report and literature review. Results: A 58-year-old white man underwent excision of a nasal pterygium of the right eye. Two weeks postoperatively, the patient developed an infectious scleritis caused by Streptococcus pneumoniae. The scleritis was complicated with hypopyon and a scleral necrosis area 6 mm away from the superior limbus with a positive Seidel test. Topical and systemic antibiotics resolved the case without any surgical procedures. Conclusion: Streptococcus pneumoniae must be considered as a possible agent in cases of necrotizing scleritis associated with pterygium excision.

Expression of p63 and p16 in primary and recurrent pterygia

Backgroundp63 and p16 have been described as stem-cell markers of squamous epithelium. In an attempt to obtain new insights into the pathogenesis of pterygium, this study aims to evaluate the relationship between p63 and p16 expression in primary and recurrent pterygia.MethodsSamples of primary (n=56) and recurrent (n=14) pterygia and normal bulbar conjunctival tissue (n=11) were submitted to immunohistochemical study to evaluate the expression of p63 and p16 in these tissues.ResultsMost of the cells stained for p63 were located in the basal layer of the normal conjunctiva, in the lower two-thirds of the epithelium of primary pterygia, and throughout all epithelial layers of recurrent pterygia. In normal conjunctivae, p16 expression was rarely expressed. Primary and recurrent pterygium groups exhibited increased p16 expression, with cytoplasmic staining in the primary group, and cytoplasmic or nuclear staining in the recurrent group.ConclusionThe overexpression of p63 and p16 observed in the present study reinforces likelihood of involvement of these genes in the pathogenesis of pterygium, perhaps related to the intense cellular turnover with substitution of superficial epithelial cells by less differentiated forms. This loss of normal cellular differentiation of the epithelial layers could explain the high rates of recurrence overall in the recurrent pterygia.

Eficácia e baixo custo no tratamento do ceratocone com o uso de lentes de contato rígidas gás-permeáveis

OBJETIVO: Avaliar a eficacia da adaptacao de lente de contato rigida gas-permeavel (LCRGP) em pacientes com ceratocone e os custos do tratamento. METODOS: Realizou-se analise retrospectiva dos prontuarios de 126 pacientes atendidos no Ambulatorio de Lente de Contato do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto no periodo de janeiro de 2001 a junho de 2002. Foram analisados sexo, idade e numero de olhos adaptados. A acuidade visual sem e com correcao foi relacionada a curva-base em K (meridiano mais plano da cornea) do paciente e a diferenca ceratometrica dos meridianos corneanos. Determinou-se o custo unitario medio das lentes fornecidas aos pacientes. RESULTADOS: Obteve-se sucesso na adaptacao de lente de contato rigida gas-permeavel em 86,19% dos casos, com visao = 0,8 em 40,00% dos pacientes adaptados. Houve melhora visual tanto nos pacientes com curva-base elevada quanto naqueles que apresentavam alta diferenca ceratometrica entre os meridianos corneanos. A faixa etaria mais acometida encontrou-se entre 15 e 45 anos, sendo 60,31% dos pacientes do sexo feminino. A proporcao de indicacao de transplante de cornea foi de 11,42%. O custo unitario medio da lente foi de R

Secondary glaucoma associated with bilateral Aspergillus niger endophthalmitis in an HIV-positive patient: case report

40,00. CONCLUSAO: A adaptacao proporcionou acentuada melhora visual na maioria dos pacientes portadores de ceratocone a custo relativamente baixo.

Spontaneous late in-the-bag intraocular lens dislocation after can-opener capsulotomy: case report

Aspergillus endophthalmitis is usually related to systemic or local dissemination in immunosuppressed subjects. The authors report a rare case of severe bilateral glaucoma secondary to an intraocular infection with Aspergillus niger, in the absence of any detectable focus of aspergillosis, in an HIV-infected patient. There were no confirming signs of injection drug use, and the agent was isolated after inoculation in experimental animals. This case shows that Aspergillus endophthalmitis should be considered in non-injecting drug users and HIV-infected patients even in the absence of systemic aspergillosis.

Comparação entre a dor provocada pela facoemulsificação com anestesia tópica e a pela infiltração peribulbar sem sedação

We report a case of a 58-year-old man presenting with a spontaneous and late in-the-bag intraocular lens dislocation to the vitreous. A previous uneventful extracapsular cataract extraction with can-opener style capsulotomy and implantation of a polymethylmethacrylate three-piece lens was performed and, two years after the surgery, the patient developed capsule contraction syndrome with a fibrotic ring formation and dislocation of the intraocular lens. Although uncommon and related mainly to continuous curvilinear capsulorhexis, capsule contraction syndrome occurs in patients undergoing extracapsular cataract surgery with can-opener style and polymethylmethacrylate lens implantation, and can be the causative factor of intraocular lens dislocation.

Estudo comparativo de testes diagnósticos para olho seco entre crianças saudáveis e portadoras de artrite reumatóide juvenil

PURPOSE To compare pain sensation induced by phacoemulsification with topical anesthesia with that by peribulbar anesthesia, without sedation. METHODS Using a 10-level visual pain analogue scale, the pain induced by phacoemulsification with topical anesthesia (2% tetracaine drops) was measured in 20 patients. The same scale was used to measure the pain induced by peribulbar anesthesia (2% lidocaine and 0.5% bupivacaine) in 21 patients. The same surgeon performed peribulbar infiltrations and surgeries. The phacoemulsifications were done using clear corneal approach followed by in-the-bag intraocular lens implantation. Pain comparison between the two groups was performed by the non-parametrical U Mann-Whitney test. RESULTS The distribution of the pain scores of the patients who underwent cataract extraction with topical anesthesia ranged from 0 to 5 (median value = 2). The scores of the patients who underwent peribulbar infiltration ranged from 0 to 7 (median value = 3). The mean rank of the group of patients who had surgery with topical anesthesia (15.78) was significantly different from the mean rank of the patients who received peribulbar anesthesia (25.98) (p = 0.0057). CONCLUSION Without sedation, the pain induced by phacoemulsification with topical anesthesia was milder than the pain induced by peribulbar infiltration.

Endoftalmite: uma análise de 58 casos

PURPOSE: To compare dry eye diagnostic findings in juvenile rheumatoid arthritis patients and normal children. METHODS: For this transversal study, 30 eyes of 15 patients with juvenile rheumatoid arthritis (group 1) and 22 eyes of 11 normal controls (group 2) were examined clinically and underwent tests for keratoconjunctivitis sicca: Schirmers 1, tear film break-up time and rose bengal staining tests. RESULTS: Six children with juvenile rheumatoid arthritis presented one or more symptoms of keratoconjunctivitis sicca (40%) and five of them (83.3%) presented meibomitis or other signs of this disease. In group 2, no child presented symptoms or signs of keratoconjunctivitis sicca. Mean Schirmer test did not differ between group 1 and 2 (p=0.156). However, the mean tear film break-up time was significantly reduced in group 1 (p=0.0005) and the mean rose Bengal staining score in group 1 was significantly greater than in group 2 (p=0.0038). Five of the fifteen children of group 1 (33%) have two or more abnormal tests and were diagnosed as having definite keratoconjunctivitis sicca, while four children (26%) were labeled with probable keratoconjunctivitis sicca. No child of group 2 had more than one positive test. CONCLUSIONS: Signs and symptoms of keratoconjunctivitis sicca appear to be a common ocular finding in juvenile rheumatoid arthritis children. Although only tear film break-up time and rose bengal staining score were significantly different in these groups, there was a trend toward worsening of the other dry eye tests in juvenile rheumatoid arthritis children.

Implante de lente intra-ocular dobrável acrílica em crianças

Objetivo: Foram estudados 58 casos com diagnostico de endoftalmite no intuito de se obter as caracteristicas regionais desta patologia. Avaliaram-se os fatores predisponentes, quadro clinico, exames complementares, tratamento e resultado funcional. Metodos: Foi feita a analise retrospectiva dos prontuarios dos pacientes atendidos no HCFMRP-USP, com diagnostico de endoftalmite, no periodo de 1993 a 1998. Resultados: Trauma e cirurgia foram os principais fatores desencadeantes (39,05% cada). O quadro clinico predominante foi dor e diminuicao da acuidade visual associado a hiperemia conjuntival e hipopio. Em 70,48% dos casos colheu-se cultura, sendo o resultado positivo em 85,36% das amostras. O agente etiologico mais frequente foi o S. aureus (26,08%), seguido do S. epidermidis e P. aeruginosa (13,04% cada). Todos agentes isolados foram sensiveis a vancomicina e a ceftazidima. Em 65,51% dos casos a acuidade visual final foi ausencia de percepcao luminosa. Conclusoes: Os resultados sugerem algumas alteracoes a serem efetuadas para se melhorar o prognostico visual destes casos, como o uso de vancomicina e ceftazidima intra-ocular.