Francisco Jose de Lima Bocaccio

Allograft conjunctival transplantation for bilateral ocular surface disorders

PURPOSE The purpose of this study is to evaluate the efficacy of allogenic conjunctival transplantation in bilateral surface disorders and to correlate with human leukocyte antigen (HLA) typing and cross-matching. METHODS A prospective study of allogenic conjunctival transplantation was undertaken in 12 eyes of 10 patients with bilateral surface disorders. Five eyes had Stevens-Johnson syndrome, three had Lyell syndrome, three had bilateral alkali burns, and one had a bilateral thermal burn. Human leukocyte antigen typing and cross-matching were retrospectively performed in eight patients and their respective donors. Stabilization of corneal epithelia, visual acuity, and rejection episodes were examined after the procedure. RESULTS Eleven (91.6%) of 12 eyes had improved visual acuity, corneal transparency and surface lubrication, stabilization of corneal epithelia, and decreased corneal neovascularization and photophobia after an average follow-up of 17.2 months. Three patients (25%) had rejection episodes, with no disturbance in corneal surface in two. Two of these three patients had 100% incompatible HLA donor-recipient pairs; HLA of the third patient was not available. Patients with favorable evolution were either HLA identical or haplo-identical (50% identity) with their donors. Donor eyes did not present any epithelial problems during the follow-up period. CONCLUSIONS Human leukocyte antigen-matched allogenic conjunctival transplantation proved to be an adequate method of treating severe bilateral surface disorders, with minimal complications.

Steatocystoma simplex of the eyelid.

A 68-year-old woman presented with a nodular pretarsal tumor on her right upper eyelid that had slowly grown over 6 months. Excisional biopsy was performed through an eyelid crease approach, and histopathology evidenced the lesion to be steatocystoma simplex. Steatocystoma simplex is an uncommon benign cutaneous lesion thought to be a circumscribed malformation arising from the pilosebaceous duct junction, rarely reported to occur in the periorbital region.

HLA-matched living-related conjunctival limbal allograft for bilateral ocular surface disorders: long-term results

PURPOSE To evaluate the long-term outcome of HLA-matched lr-CLAL for bilateral ocular surface disorders. METHODS A retrospective, non-comparative interventional case series study of 39 eyes of 32 patients with bilateral surface disorders and clinical diagnosis of limbal stem cell deficiency who underwent HLA-matched lr-CLAL. Visual acuity (VA), ambulatory vision (> or = 20/200) and ocular surface stability were evaluated as main outcomes. Donor limbus was obtained from a sibling or a parent of the patient, after an appropriate Class I and II HLA match. RESULTS One year after surgery, VA improved in 46.2%, ambulatory vision was achieved in 48.7% and a stable corneal surface was achieved in 84.6% of the eyes. At the final follow-up (mean, 48.7 +/- 30.6 months), 66.6% of the eyes that had gained VA one year after surgery maintained an improved VA (p=0.28), 94.7% of eyes that had achieved ambulatory vision one year after surgery maintained 20/200 or better (p<0.001) and 93.9% still had a stable corneal surface (p=0.043) at the final follow-up. CONCLUSIONS HLA-matched lr-CLAL can be an adequate method of treatment for bilateral ocular surface disorders, with a reasonable percentage of success of long-term results.

Cicatricial ectropion correction in a patient with pyoderma gangrenosum: case report

A 19 year old female with pyoderma gangrenosum was referred to the oculoplastic clinic for evaluation of severe cicatricial ectropion of the right lower eyelid. Examination evidenced important scarring of lower eyelid and malar region with secondary ectropion. A full-thickness skin graft associated with a lateral tarsal strip procedure and scar tissue release was performed. The patients corticosteroid dose was raised for the procedure, and after surgery there was no healing problem or ulcer formation in the eyelid or in the graft donor site. As pyoderma gangrenosum is associated with a pathergy phenomenon in up to 25% of the cases, the onset of new lesions is a relevant concern when performing surgery in these patients. In this case, the surgery was safely performed under corticosteroid immunosuppression.

Effect of Low-Concentration, Nonmydriatic Selective Alpha-Adrenergic Agonist Eyedrops on Upper Eyelid Position

BACKGROUND Ptosis after botulinum toxin injection is a disturbing complication. Decongestant and antiglaucoma eyedrops are frequently prescribed for temporary improvement of eyelid ptosis. Although frequently cited on informal communications, the effect of these drugs on eyelid position has never been compared in a formal study. OBJECTIVE To measure the effect of low-concentration, nonmydriatic selective alpha agonist eyedrops on upper eyelid position. METHODS AND MATERIALS This nonrandomized clinical trial enrolled 20 healthy subjects aged 18 to 50 years. The upper margin–reflex distance (MRD1) was measured before, 30, 60, and 120 minutes after administration of 1 drop of brimonidine 0.2%, phenylephrine 0.12%, or naphazoline 0.05% to the left eye. RESULTS There was no statistically significant difference in mean MRD1 between the brimonidine and phenylephrine groups when comparing baseline to all other study time points. After administration of naphazoline 0.05%, MRD1 had a mean increase of 0.56 ± 0.11 mm (p < 0.001) after 30 minutes, 0.47 ± 0.12 mm (p = 0.001) after 60 minutes, and 0.26 ± 0.09 mm (p = 0.028) after 120 minutes when compared with baseline. CONCLUSION Brimonidine 0.2% and phenylephrine 0.12% have no effect on eyelid aperture, but naphazoline 0.05% eyedrops could be useful for temporary relief of upper eyelid ptosis in selected patients.

O perfil oftalmológico dos candidatos à carteira de motorista na cidade de Pelotas - RS

Purpose: To study visual acuity of the candidates for driving licences in the city of Pelotas and its relationship with sociodemographic characteristics of the candidates. Methods: One thousand and ten candidates for driving license were examined in a Detran approved medical service. To check the social, demographic and visual characteristics of candidates, visual acuity, with or without correction, as well as its relation to color, gender, age and profession of the interviewed persons was evaluated, through analysis of frequencies and association. Results: In this study 72.5% were males, 33.8% were between 18 and 45 years old, 52.0% were in the service sector and 25.4% used some instrument of visual correction, 0.5% of the interviewed from the ophthalmological viewpoint, would not be able to drive automotor vehicles and 4.7% should only would get a driving license in the A and B categories. A low visual acuity has been associated with a higher longevity. Conclusion: Based on the results, a shorter time period for visual reavaluation of the C, D and E categories drivers is suggest.

Corneal Epithelial Rejection after Allograft Conjunctival Transplantation for Limbal Papilloma

The authors report a case of typical corneal epithelial rejection two months after allogenic limbal-conjunctival graft for a recurrent limbal-conjunctival papilloma in a 62- year-old female patient. The HLA donor-recipient pair was haploidentical (50% identity). This observation suggests a clear conjunctival epithelial transdifferentiation onto corneal epithelium. This is the first report, to the best of the authors’ knowledge, of allograft conjunctival transplantation for this disease and of corneal epithelial rejection after such a procedure. In this case, there was no rejection of the conjunctival graft, and corneal rejection was successfully treated with oral prednisone and topical 1% prednisolone.