José Ricardo Diniz

Degeneração macular relacionada à idade: prevalência e fatores de risco em dois centros oftalmológicos de referência em Pernambuco

PURPOSE To evaluate age-related macular degeneration (AMD) prevalence and its risk factors in two different populations, with distinct socioeconomic conditions, at two ophthalmological centers in Pernambuco state, Brazil. METHODS A cross-sectional study was performed in 200 volunteers aged 55 years or older. One hundred were cared for by the Public Health System (in the Fundação Altino Ventura FAV-SUS) and 100 were cared for at a private hospital (Hospital de Olhos de Pernambuco-HOPE). There were 400 eyes altogether. Age-related macular degeneration was graded using fundoscopic examination using AREDS classification (Age-Related Eye Disease Study). RESULTS Presence of age-related macular degeneration was observed in 61 eyes (30%) of the patients of the Fundação Altino Ventura and in 46 eyes (23%) of the patients of the Hospital de Olhos de Pernambuco. The age-related macular degeneration frequency difference between these populations, that are not similar regarding their socioeconomic level, was not significant (p=0.113). There was a positive association between aging and the age-related macular degeneration frequency (p<0.0001). This association was also present in the female gender (p=0.0451), the presence of cataract (p=0.0447), cataract surgery (p=0.0432) and obesity (p<0.0001). No age-related macular degeneration association with race (p=0.1367), hypertension (p=0.1985), diabetes (p=0.6712), smoking (p=0.6374), alcohol intake (p=0.7359), ocular sunlight exposure (p=0.9399), light-colored iris (p=0.1691), hyperopia (p=0.5098) and the usage of antioxidants (p=0.8251) was observed. CONCLUSIONS The age-related macular degeneration frequency in the two studied ophthalmological centers varied from 23 to 30%. Age-related macular degeneration association with age; female gender; cataract; cataract surgery; and obesity was observed. No age-related macular degeneration association with socioeconomic level was found in this study.

Doenças oculares em neonatos

Objetivo: Identificar as principais doencas oculares numa populacao de neonatos assistidos pelo Sistema Unico de Saude em maternidades de referencia no Estado de Pernambuco, orientando o seguimento e tratamento necessario. Metodos: Realizou-se estudo de corte transversal numa populacao de recem-nascidos em tres maternidades publicas, no periodo de abril a outubro de 2000. Procedeu-se ao exame oftalmologico durante visitas semanais, orientando-se o seguimento e tratamento dos casos com alteracoes oculares ou fatores de risco. Resultados: Examinaram-se 3280 recem-nascidos: 1403 (42,8%) na Maternidade da Encruzilhada (CISAM), 1232 (37,5%) na Maternidade do Hospital Barao de Lucena (MHBL) e 645 (19,7%) na Maternidade do Hospital Agamenon Magalhaes (MHAM). 387 eram pre-termo (11,8% dos casos). Encaminharam-se ao servico especializado 701 neonatos (21,4% do total examinado) com alteracoes oculares ou com fatores de risco. Destes, 46,4% eram pre-termo e 37,9% receberam oxigenoterapia, observando-se maior numero porcentual na MHBL (45,4%). Observou-se conjuntivite em 3,0% dos olhos, leucocoria em 0,4% e hemorragia subconjuntival em 2,0%. A fundoscopia, encontraram-se hemorragias retinianas em 7,8% dos casos, com acometimento macular em 4,3%. Conclusoes: As doencas oculares mais frequentes foram: hemorragias retinianas e conjuntivites. Os principais fatores de risco observados foram: prematuridade e doencas infecciosas neonatais. Os autores enfatizam que o exame ocular deve ser realizado rotineiramente nos neonatos.

Rapid Elisa for Plague

Recently, an enzyme linked immunosorbent assay (ELISA) for plague was proposed in our laboratories using a modified polymer, polyvinil alcohol (PVA) glutaraldehyde, as an alternative solid phase (AM Araujo et al. 1996 Mem Inst Oswaldo Cruz 91: 195-198). An antigen (F1) obtained from Yersinia pestis was covalently fixed onto PVA-glutaraldehyde discs. The synthesis of these discs is simple and the low prices of the employed reagents are economically attractive. The present study describes a modification of this method, aiming to reduce the time of procedure from 36 hr to 3 hr. The discs were introduced into flat bottomed microplates covered with 100 ml of diluted F1 antigen (1.3 mg/well) and left at 28°C for 1 hr (instead of overnight as in the original method). These treated discs were washed twice with PBS, containing 0.05% Tween 20 (Labsynth); blocked with skimmed milk (Molico, Nestle) for 1 hr (instead of overnight as in the original method) at 28°C and washed with PBS/Tween once. Diluted serum (100 ml of a 1:200 dilution in PBS) was incubated with the antigen-disc into clean microplates at 37°C for 30 min (instead of 1 hr as previously). After washing the antigen-antibodydisc complex five times with PBS/Tween, 100 ml of goat anti-human IgG (Sigma) conjugated to peroxidase diluted 1,500 times in 3% w/v skimmed milk were added and incubated at 37°C for 30 min (instead of 1 hr as previously). Afterwards, five washings with PBS/Tween were carried out. Then, the substrate solution (100 ml), composed of 0.325% w/v orthophenylenediamine dihydrocloride (OPD-Sigma) and 0.085% H2O2 prepared in 0.3M Tris-citrate buffer, pH 6.0, was added. After incubation at room temperature (28°C) for 15 min, in the dark, the reaction was stopped with 2.5M H2SO4 (25 ml), the discs removed and the plates read in ELISA reader (Bio-rad) at 492 nm. Tables I and II show the results obtained using this rapid ELISA in human sera from patients and health individuals living at different plague foci in the northeast Brazil, respectively.

The use of polyvinyl alcohol glutaraldehyde as solid-phase in ELISA for plague

Discs of polyvinyl alcohol cross-linked with glutaraldehyde were synthesized under acid catalysis (H2SO4). Then, the antigen F1 purified from Yersinia pestis was covalently linked to this modified polymer. Afterwards, an enzyme-linked immunosorbent assay (ELISA) was established for the diagnosis of plague in rabbit and human. The best conditions for the method were achieved by using 1.3 micrograms of F1 prepared in 0.067 M phosphate buffer, pH 7.2, containing 1 M NaCl (PBS); anti-IgG peroxidase conjugate diluted 6,000 times and as a blocking agent 3% w/v skim milk in PBS. The titration of positive rabbit serum according to this procedure detected antibody concentrations up to 1:12,800 times. The present method, the conventional ELISA and passive haemagglutination assay are compared.

Polyvinyl alcohol-glutaraldehyde as solid-phase in Elisa for Schistosomiasis

Soluble adult Schistosoma mansoni antigen preparation (SWAP) was covalently fixed onto polyvinyl alcohol-glutaraldehyde discs and an enzyme linked-immunosorbent assay (ELISA) was set up. The best conditions for the assay were established and it was found that small amount of antigen such as 1.5 micrograms was required. A comparison between this procedure and the conventional ELISA was proceeded. A reliable method of antigen immobilization was achieved and the low prices of the employed reagents are economically attractive.

Perfluoroctano líquido como tamponante vitreorretiniano de curta duração no pós-operatório de portadores de descolamento de retina por ruptura gigante

OBJETIVOS: Relatar os resultados de vitrectomia via pars plana com utilizacao de perfluocarbono liquido (Perfluoroctano-Ophtalmos®), como tamponante vitreo-retiniano de curta duracao, no pos-operatorio de portadores de descolamento de retina, por ruptura gigante. METODOS: Estudaram-se dez desses pacientes. Todos os casos eram complicados por vitreorretinopatia proliferativa grau B ou pior com rupturas que variavam em extensao de 90o a 210o. O perfluorocarbono liquido foi introduzido, por via pars plana, com o volume necessario para ultrapassar o limite posterior da ruptura, permanecendo no pos-operatorio por cinco dias, estando os pacientes em decubito dorsal. Apos esse periodo submetiam-se a segunda intervencao para troca do perfluorocarbono liquido para gas ou oleo de silicone. RESULTADOS: Apos periodo de acompanhamento medio de 16,2 ± 12,4 meses (2 a 43 meses), 80% das retinas estavam aplicadas, sendo necessaria a repeticao desta tecnica em 1 caso (10%) caso e em 2 casos (20%) nao houve reaplicacao da retina por vitreorretinopatia avancada. Houve melhora da acuidade visual em 5 casos (50%). CONCLUSAO: Observaram-se bons resultados quanto a aplicacao da retina (80%) e melhora da acuidade visual (50%) quando do uso do perfluorocarbono liquido como tamponante vitreorretiniano de curta duracao no pos-operatorio de cirurgias de descolamento de retina por rupturas gigantes.

Ocular alterations associated with bungee jumping: case report

The popularization of bungee jumping is causing an increase in occurrences of lesions associated with its practice, including ocular lesions. The purpose of this study is to describe a case of acute decrease in vision and visual field defects following a bungee jump. The authors present a case of a 48-year-old woman, without history of systemic or ocular disorders, seen at an ophthalmologic emergency service with visual loss complaint following a bungee jump. On initial ophthalmologic evaluation, hemorrhages in the posterior pole of both eyes were found. Fluorescein angiography showed hypofluorescent areas, without other vascular alterations. The patient was evaluated after 14 weeks, the hemorrhages cleared up and there was atrophy of the pigmented epithelium of the retina in the posterior pole, but the patient remained with complaint of scotoma and visual field defects even 5 months after the initial event. The occurrence of body lesions, including ocular lesions, with risk of decrease in visual acuity should be informed to candidates for the practice of this sport, and the ophthalmologist would do well to provide information to the population about possible ocular disorders, in this sport and in daily life.

Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna

PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT) were evaluated pre- and postoperatively. The macular hole index (ratio of hole height to base diameter of the hole) was calculated and correlated with minimum diameter of the macular hole and postoperative gain in visual acuity. RESULTS: Macular hole closure was observed in all operated patients. In 86.7%, there was a visual gain of at least three lines. Macular hole index was significantly negative correlated with the minimum diameter of the macular hole (r=0.811). There was no significant correlation between macular index and postoperative gain in visual acuity (r=0.351). CONCLUSION: Functional outcomes with internal limiting membrane removal were good in this group of patients. Macular index was compatible with spatial configuration of the macular hole, however visual outcomes were not predictable.PURPOSE To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT) were evaluated pre- and postoperatively. The macular hole index (ratio of hole height to base diameter of the hole) was calculated and correlated with minimum diameter of the macular hole and postoperative gain in visual acuity. RESULTS Macular hole closure was observed in all operated patients. In 86.7%, there was a visual gain of at least three lines. Macular hole index was significantly negative correlated with the minimum diameter of the macular hole (r=0.811). There was no significant correlation between macular index and postoperative gain in visual acuity (r=0.351). CONCLUSION Functional outcomes with internal limiting membrane removal were good in this group of patients. Macular index was compatible with spatial configuration of the macular hole, however visual outcomes were not predictable.