Hirlana Gomes Almeida

Intracorneal Ring Segments Implantation for Corneal Ectasia

PURPOSE To provide an overview of the predictability, safety, and efficacy of intrastromal corneal ring segment (ICRS) implantation as a tool to improve visual acuity and its association with other techniques such as corneal collagen cross-linking (CXL), addressing biomechanical outcomes, models, surgical planning and technique, indications, contraindications, and complications in ectatic corneas. METHODS Literature review. RESULTS ICRSs have been used to regularize the corneal shape and reduce corneal astigmatism and higher order aberrations, improve visual acuity to acceptable limits, and delay, or eventually prevent, a corneal keratoplasty in keratoconic eyes. Changes in ICRS thickness and size, combination of techniques, and the addition of femtosecond lasers to dissect more foreseeable channels represent an improvement toward more predictable results. Several studies have shown, over time, the long-term efficacy and safety of ICRS treatment for keratoconus, with variable predictability, maintaining the early satisfactory outcomes regarding visual acuity, keratometry, and corneal thickness. It is just as important to ensure that the disease will not progress as it is to improve the visual acuity. Therefore, many studies have shown combined techniques using ICRS implantation and CXL. Also, further limitations of ICRS implantation can be addressed when associated with phakic intraocular lens implantation and photorefractive keratectomy. CONCLUSIONS ICRS implantation has shown effectiveness and safety in most cases, including combined procedures. In properly selected eyes, it can improve both refraction and vision in patients with keratoconus. [J Refract Surg. 2016;32(12):829-839.].

Perfil epidemiológico de pacientes na fila de transplante de córnea no estado de Pernambuco - Brasil

Purpose: To describe the epidemiological profile of patients waiting for penetrating keratoplasty in state of Pernambuco, Brazil. Methods: Transversal and retrospective study, with 871 patients, in the period of 06/01/2011 a 05/31/2012, were registered on the waiting list for corneal transplantation in the Central of Notification, Captation and Distribution of Organs (CNCDO) of Pernambuco. Registration forms of cornea receiving were used, adapted to the purposes of this research. Results: In relation to frequency, it was obtained 54% female, 35% aged 61 to 80 years; 60% transplanted; 52% from the metropolitan area of Recife; 57% that waited 1 to 6 months the transplant; 82% with optical indication for transplant, 5% with priority on the waiting list (48% of those with ocular perforation) and; 37% whose transplant center was the Fundacao Altino Ventura (FAV). The main indications for corneal transplantation were leukoma (33%), keratoconus (22%) e bullous keratopathy (18%). Conclusion: It was found that most patients were aged 61 to 80 years; was from the metropolitan area of Recife; was submitted to corneal transplantation; waited for one to six months to do the transplantation; had the diagnosis leukoma, followed by keratoconus and bullous keratopathy; was indicated to transplantation optical and had the transplant center to FAV.

Perfil epidemiológico de pacientes na fila de transplante penetrante de córnea no estado do Pará, Brasil

OBJETIVO: Descrever o perfil epidemiologico de pacientes na fila de transplante penetrante de cornea no estado do Para, Brasil. METODOS: Estudo transversal e retrospectivo, com 1261 pacientes, no periodo de janeiro de 2001 a dezembro de 2009, cadastrados na fila de espera para transplante de cornea na Central de Notificacao, Captacao e Distribuicao de Orgaos (CNCDO) do Para. Os dados foram coletados por meio de protocolos baseados nas fichas de cadastro de receptor de cornea na CNCDO, adaptados aos objetivos desta pesquisa. RESULTADOS: Em relacao a frequencia, obteve-se 51% do sexo masculino; 33,9% na faixa etaria de 61 a 80 anos; 18,6% inscritos na CNCDO em 2009; 61% com olho direito acometido; 56% permaneceram ativos na fila; 51,7% que aguardaram 1 a 3 anos o transplante e; 85 transplantes realizados em 2009. As principais indicacoes para transplante de cornea foram ceratopatia bolhosa (28,2%), leucoma (22%) e ulcera corneana (14,8%). CONCLUSAO: Verificou-se que nao houve diferenca entre a frequencia dos sexos sendo que a maioria encontrava-se na faixa etaria de 61 a 80 anos; inscrita na CNCDO no ano de 2009 (ano em que foi realizado o maior numero de transplantes); com o olho direito acometido, permaneceram ativos na fila de espera. Entre os pacientes transplantados, atestou-se que o tempo em fila de espera para transplante de cornea foi longo e inadequado. Ademais, as principais indicacoes para transplante de cornea no estado do Para foram ceratopatia bolhosa, leucoma e ulcera corneana.

Review of developments in corneal transplantation in the regions of Brazil - Evaluation of corneal transplants in Brazil

The aim of this study was to identify inequalities in corneal donation and transplantation among the regions of Brazil. A transversal and retrospective study was specifically conducted using data from the Brazilian Transplant Registry collected by the Brazilian Association of Organ Transplantation between January 2002 and December 2014. The collected data were processed using descriptive statistical methods, and p<0.05 was the rate of rejection of the null hypothesis. From 2002 to 2014, there was an increase in the absolute number of corneal transplants, the annual rate of transplants per million people and the percentage of needed transplants performed in each of the five regions of Brazil. Family refusal and medical contraindication were the most frequent reasons for a lack of corneal donation. Although remarkable progress has been made in the last decade in each of the five Brazilian regions, health professionals’ lack of preparation to approach families with donation requests at the death of a family member appears to be the main obstacle to increasing the number of corneal donations. Thus, the present study suggests the implementation of public policies to make corneal transplants more effective, particularly given that there are considerable disparities in the effectiveness with which regional needs are met and in health professionals’ ability to perform transplants among the Brazilian regions, with higher rates in the South, Southeast and Midwest regions and lower rates in the North and Northeast regions.

Safety of warfarin therapy during cataract surgery under topical anesthesia.

PURPOSE To analyze the safety of warfarin therapy during cataract surgery under topical anesthesia. METHODS This was a prospective nonrandomized comparative study of 60 eyes of 60 patients treated with or without concurrent oral warfarin anticoagulant therapy, referred for cataract surgery under topical anesthesia. The sample included a treatment (n=30) and a control (n=30) group. RESULTS There were no records of intraoperative or postoperative intracameral bleeding complications in both the groups. At 1-month postoperative follow-up, 90.0% of patients presented spectacle-corrected visual acuity of at least 20/40. CONCLUSION Cataract surgery by phacoemulsification with topical anesthesia can be successfully conducted without discontinuing warfarin.

Trends in corneal transplantation from 2001 to 2016 in Brazil

A retrospective and analytical study was conducted by using data from the National Transplantation System on 184,575 corneal transplantations performed between January 2001 and December 2016 in order to analyze thetrends in corneal transplantation from 2001 to 2016 in Brazil. The Cochran-Armitage test, analysis of variance, and Duncans multiple comparisons were used to verify the existence of trends, compare the mean values between regions, and verify the mean differences, respectively. A significance level of 5% was used for all tests. The analysis showed that there was a 2.4-fold increase in the number of corneal transplantations (from 6,193 [35.2 per million people (pmp)] to 14,641 [71 pmp]; p<0.001), a 50.7% increase in the efficacy of meeting the populations demand for corneal transplantation (from 35.3% to 53.2%; p<0.001), an 11-fold increase in the number of corneal transplantation centers (from 32 to 356), and a 2.5-fold increase in the number of corneal transplantation teams (from 276 to 688) in Brazil during the period studied. The waiting list for corneal transplantation decreased by 45.4% (from 23,549 [123 pmp] to 12,865 [62.4 pmp]; p<0.001), and the corneal transplantation teams performed about 19 corneal transplantations per year. The best indices were observed in the southern, midwestern, and southeastern regions, and the worst indices were in the northern and northeastern regions. Brazil has been improving its capacity to perform corneal transplantation in the past 16 years, although this improvement varies across regions. However, the populations demand for corneal transplantation is yet to be satisfactorily met, primarily due to the low number of corneal donations.

Consequences of cataract surgery public policies run by private contractors

In 1998, on the initiative of the Brazilian Council of Ophthalmology (CBO) and the Health Ministry, with the support of medical schools, the National Cataract Campaign was established. Access to treatment was made easy with nationwide campaigns conducted for diagnosis and later for surgery (Cataract Projects). This action had the greatest impact on visual health in Brazil as the number of performed surgeries has almost doubled. By means of epidemiologic studies, the effectiveness and safety of cataract surgeries performed in university hospitals on a large scale were confirmed and Cataract Projects were improved. Nevertheless, in 2006, the Health Ministry discontinued the National Campaign due to lack of funds for all surgeries, and public hospitals were granted limited quotas for surgical procedures. This measure negatively impacted progression in the number of surgeries performed annually by reducing the use of the installed cataract surgery capability in public hospitals; thus, an additional barrier was created to limit the access of the needy population to corrective surgery: limitation of surgical offering. Despite the clinical evidence demonstrated by published epidemiologic studies that the methodology used in the National Campaign for blindness eradication by cataract surgery was successful in Brazil, the National Government and several municipalities have opted for a new strategy to deal with the problem. Currently, many public health projects for cataract surgery are implemented by means of bidding, in which private companies, some with mobile surgical units, negotiate the least value for quotas on thousands of surgeries. The analysis and interpretation of epidemiological data on total cataract surgeries performed by the public health system in Brazil from January 2000 to December 2015 demonstrated that the number of surgeries between 2010 and 2015 has increased by approximately 246%, while the amount spent annually on surgeries increased by 371% over the same period (Table 1). The number of cataract surgeries performed at the Hospital das Clínicas of the Medical School of the University of São Paulo (HCFMUSP, a reference public teaching hospital) has decreased by approximately 23%, from 2005 to 2015 (Table 2).

Avaliação das urgências oftalmológicas em um hospital público de referência em Pernambuco

Purpose: To evaluate ophthalmological emergencies in a public reference hospital in Pernambuco. Methods: Cross-sectional retrospective study with 26.358 patients attended in the ophthalmic emergency Altino Ventura Foundation, in the period january to june 2013. Data were collected using protocols based on electronic registration forms of ophthalmological emergency Results: It was observed that 52.5% of patients were male, 42.5% were aged 21-40 years; 90.8% were from the region metropolitan area of Recife; 55% classified as less severe. The main diagnoses were conjunctivitis (35.17%) and ocular trauma (19.25%). Conclusion: The prevalence of male patients, aged 21-40 years, from the metropolitan area of Recife, classified as low complexity, attended in January, on Monday, with the diagnosis of conjunctivitis, followed by ocular trauma.

Evaluation of the care characteristics of ophthalmic emergencies in a public hospital in greater São Paulo

Purpose: Evaluate the characteristics of patients seen in the emergency department of ophthalmology in order to identify measures to improve the effectiveness of care and guide the enhancement of other emergency services. Methods: Cross-sectional, observational study with 300 patients treated at the Municipal Hospital of Santo Andre - Sao Paulo from 15 to 22 august 2011. Data were collected through interviews with patients based on a questionnaire. Results: It was observed that 73.7% lived at a distance of up to 20 km from the hospital and 71.6% of real emergencies and 61.3% of false emergencies sought treatment within a week of the onset of symptoms. Conclusions: Considered the need to provide information to the population about the type and severity of ocular emergencies, with emphasis on prevention and the importance of the most prevalent diseases such as corneal foreign body and corneal ulcer, and health policies aimed at creation of regional centers of specialized care in order to minimize barriers to access and increase the speed in the treatment of ocular emergencies.

Analgesia preemptiva com nepafenaco 0,1% na fotocoagulação da retina

Objetivo: Avaliar o efeito preemptivo com nepafenaco 0,1% em pacientes submetidos a fotocoagulacao da retina para tratamento da retinopatia diabetica proliferativa. Metodos: Trinta pacientes foram submetidos a fotocoagulacao com laser de argonio em ambos os olhos. O olho contralateral de cada paciente foi o controle. O nepafenaco e o placebo foram utilizados 30 minutos antes da aplicacao do laser. Ambos os olhos foram fotocoagulados no mesmo dia. A intensidade da dor foi avaliada por meio da escala analogica visual e da escala descritiva de dor. Resultados: A analise da interacao instilacao versus nepafenaco mostrou que os pacientes do grupo placebo apresentaram niveis de dor semelhantes em ambos os olhos, e os do grupo nepafenaco apresentaram reducao importante do nivel de dor no olho em que foi instilado a suspensao de 0,1% quando comparado ao olho contralateral que recebeu placebo (p=0,023). Conclusao: Este estudo sugere que a suspensao de 0,1% de nepafenaco foi util na analgesia preemptiva de pacientes submetidos a fotocoagulacao de retina quando comparada ao placebo.