Jayter Silva Paula

Comparison of Diagnostic Tests in Distinct Well-Defined Conditions Related to Dry Eye Disease

Purpose This study compares signs, symptoms and predictive tools used to diagnose dry eye disease (DED) and ocular surface disorders in six systemic well-defined and non-overlapping diseases. It is well known that these tests are problematic because of a lack of agreement between them in identifying these conditions. Accordingly, we provide here a comparative clinical profile analysis of these different diseases. Methods A spontaneous and continuous sample of patients with Sjögrens syndrome (SS) (n = 27), graft-versus-host-disease (GVHD) (n = 28), Graves orbitopathy (n = 28), facial palsy (n = 8), diabetes mellitus without proliferative retinopathy (n = 14) and glaucoma who chronically received topical drugs preserved with benzalkonium chloride (n = 20) were enrolled. Evaluation consisted of a comprehensive protocol encompassing: (1) structured questionnaire - Ocular Surface Disease Index (OSDI); (2) tear osmolarity (TearLab Osmolarity System - Ocusense); (3) tear film break-up time (TBUT); (4) fluorescein and lissamine green staining; (5) Schirmer test and (6) severity grading. Results One hundred and twenty five patients (aged 48.8 years-old±14.1, male:female ratio = 0.4) were enrolled in the study, along with 24 age and gender matched controls. Higher scores on DED tests were obtained in Sjögren Syndrome (P<0.05), except for tear film osmolarity that was higher in diabetics (P<0.001) and fluorescein staining, that was higher in facial palsy (P<0.001). TFBUT and OSDI correlated better with other tests. The best combination of diagnostic tests for DED was OSDI, TBUT and Schirmer test (sensitivity 100%, specificity 95% and accuracy 99.3%). Conclusions DED diagnostic test results present a broad range of variability among different conditions. Vital stainings and TBUT correlated best with one another whereas the best test combination to detect DED was: OSDI/TBUT/Schirmer.

Mitomycin C versus 5‐fluorouracil as an adjunctive treatment for trabeculectomy: a meta‐analysis of randomized clinical trials

Mitomycin C (MMC) and 5‐fluorouracil (5‐FU) are the most frequently utilized adjuvant therapies in trabeculectomy (TRAB), but there is no general consensus as to the direct comparative efficacy and safety of these two adjuvants. In this study, the authors conducted a meta‐analysis to compare the efficacy and safety of augmenting TRAB with MMC or 5‐FU. A systematic review with meta‐analysis was conducted and five randomized controlled clinical trials comparing MMC versus 5‐FU as adjunctive therapies were identified, totaling 416 participants. A lower pooled mean IOP and higher complete and qualified success rates were observed in the MMC arm than in the 5‐FU arm. Epithelial corneal defects were the unique complication reported more frequently with 5‐FU compared to MMC treatment. Compared to TRAB with 5‐FU, TRAB with MMC was associated with higher rates of complete and qualified surgical success and was not associated with increased incidences of postoperative complications.

Tear film and ocular surface alterations in chronic users of antiglaucoma medications

PURPOSE Tear film can be altered by chronic medications that may disrupt the equilibrium responsible for the functioning of the lacrimal gland and ocular surface. The purpose of this study was to determine if antiglaucomatous chronic treatment induced alterations in the tear film and ocular surface. METHODS After informed consent, 21 patients using antiglaucomatous eye drops for more than 8 months and 20 age- and sex-matched volunteers without eye and systemic medications (control group) were enrolled. The data of ocular discomfort, fluorescein and lisamine green staining, tear film break-up time and Schirmer test were collected and compared by Students t test. The impression cytology data were graded and compared by chi-square test. RESULTS Patients chronically using antiglaucomatous medications presented with significant higher fluorescein staining (p=0.003), lisamine green staining (p=0.02) and lower TFBUT (p=0.001). The other compared parameters, including impression cytology were similar between the treated and control group (p>0.05). CONCLUSIONS The present study shows that the tear film and the ocular surface are altered in patients under antiglaucomatous medications. In common, all medications were preserved with benzalkonium chloride. Efforts to minimize the adverse effects of chronic use of antiglaucomatous drugs must be addressed.

Immunohistochemical expression of HLA-DR in the conjunctiva of patients under topical prostaglandin analogs treatment.

PurposeSubclinical inflammation may be observed in patients using topical antiglaucomatous drugs. The objective of this study was to investigate inflammation in conjunctiva of glaucoma patients using prostaglandin analogs, by the detection of an immunogenetic marker (HLA-DR) and compare the effect of 3 different drugs: latanoprost, bimatoprost, and travoprost in the induction of this inflammation. Subjects and MethodsThirty-three patients with primary open-angle glaucoma were evaluated without and with prostaglandin analogs topical therapy. Imprints of conjunctival cells were obtained, fixed on glass slides, and prepared for immunohistochemical analysis. ResultsBefore the use of prostaglandin analogs, 4 of the 33 patients evaluated presented expression of HLA-DR in the conjunctiva (mild). After 1 month on prostaglandin analog treatment, all but 1 patient presented HLA-DR staining. HLA-DR expression of these 32 patients was scored as mild (19 patients), medium (11 patients), or intense (2 patients). The differences were statistically significant both when the presence and the increased expression of HLA-DR were considered (P<0.001). When the 3 different groups were analyzed (latanoprost, bimatoprost, and travoprost) no statistically significant difference was found (P=0.27). ConclusionsThe use of prostaglandin analogs eye drops provokes a subclinical inflammatory reaction, observed by HLA-DR expression, even after a short period of treatment, independently of the class of the prostaglandin analogs used.

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.

Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing ahmed glaucoma valve implantation: 2-year follow-up

To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) in eyes with neovascular glaucoma (NVG) undergoing Ahmed glaucoma valve (AGV) implantation.

Bevacizumab-loaded polyurethane subconjunctival implants: effects on experimental glaucoma filtration surgery.

PURPOSE Vascular endothelial growth factor (VEGF) may contribute to the scarring process resulting from glaucoma filtration surgery, since this cytokine may stimulate fibroblast proliferation. The aim of this study was to describe a new bevacizumab-loaded polyurethane implant (BPUI) and to evaluate its effectiveness as a new drug delivery system of anti-VEGF antibody in a rabbit model of glaucoma filtration surgery. METHODS An aqueous dispersion of polyurethane was obtained via the conventional process. Bevacizumab (1.5 mg) was then incorporated into the dispersion and was subsequently dried to form the polymeric films. Films with dimensions of 3×3×1 mm that either did (group BPUI, n=10) or did not contain bevacizumab (group PUI, n=10) were implanted in the subconjunctival space, at the surgical site in 1 eye of each rabbit. The in vitro bevacizumab release was evaluated using size-exclusion high-performance liquid chromatography (HPLC), and the in vivo effects of the drug were investigated in a rabbit experimental trabeculectomy model by examining the bleb characteristics and collagen accumulation, and by performing immunohistological analyses of VEGF expression. RESULTS HPLC showed that only 10% of the bevacizumab in the implants had been released by postoperative day 5. In vivo studies demonstrated that the drug had no adverse effects; however, no significant differences in either the bleb area score or the collagen deposit intensity between the group PUI and the group that BPUI were observed. Moreover, the group BPUI presented a significantly lower proportion of VEGF-expressing fibroblasts than group PUI (0.17±0.03 vs. 0.35±0.05 cells/field, P=0.005). CONCLUSIONS This study demonstrated that bevacizumab release from the BPUIs only occurred for a short time probably from the surface of the films. Nevertheless, they were well tolerated in rabbit eyes and reduced the number of VEGF-expressing fibroblasts.

Capsulorhexis rescue after peripheral radial tear-out: Quick-pull technique

&NA; We describe a technique to rescue the continuous curvilinear capsulorhexis (CCC) in cases in which complete radial tears make it impossible to use normal traction forceps. A circumferential path and rapid movement are applied in the plane of the anterior capsule in the direction of the center pupil. This technique was used in 50 cases. In 47, the CCC could be completed; in 3, it could not and surgery was continued with low‐parameter phacoemulsification. No other intraoperative complications occurred. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Risk factors for blindness in patients with open-angle glaucoma followed-up for at least 15 years

PURPOSE To determine the proportion of blindness and investigate the relationships between risk factors based on clinical characteristics and development of blindness in patients with primary open-angle glaucoma (POAG) treated for at least 15 years. METHODS A retrospective observational chart review was performed with 403 patients referred to a tertiary level hospital, each with a diagnosis of primary open-angle glaucoma, treated for at least 15 years. Blindness attributable to glaucoma was defined based on visual acuity and/or visual field tests. Variables considered to be possible risk factors for blindness were evaluated using odds ratio (OR), confidence interval (95% CI), and univariate and multivariate analyses. RESULTS Thirty-one patients became blind [13/53 (24.5%) - unilaterally and 18/53 (34%) - bilaterally] during the follow-up period of treatment (19.5 ± 4.6 years, range 15-31 years). Multivariate statistics with regression analysis revealed that persistency on initial therapy ≤6 months was significantly associated with blindness, both unilateral (OR: 8.4; 95% CI: 1.3-56.4) and bilateral (OR: 7.2; 95% CI: 1.3-39.6). Other potential factors such as race, age, gender or number of medications were not associated with blindness. CONCLUSION Blindness from primary open-angle glaucoma was not uncommon in this population of treated patients after the long follow-up period proposed. Persistence rates with the first therapy, as measured by a medical decision to change, were low. Persistence ≤6 months was statistically associated with the development of unilateral and bilateral blindness from glaucoma.

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