Luciane Bugmann Moreira

Avaliação espectrofotométrica do azul de Evans na reação inflamatória da córnea: estudo experimental em coelhos

PURPOSE: To detect Evans blue in the normal cornea, attempting to determine the period of maximum concentration of the dye after intravenous injection and to study vascular permeability in an animal model of corneal inflammation induced by alkali burn, after Evans blue injection. METHODS: Fifty rabbits were divided into 3 groups. Group I (25 animals): 20 mg/kg Evans blue were injected and the animals were sacrificed after 8, 10, 12, 14 and 16 hours. The corneas were removed and the dye concentration was measured by a spectrophotometric micromethod. Group II: in 15 animals, 10 hours after injection, the corneas were centrally fragmented with number 6, 8 and 10 mm trephines. Evans blue was extracted the same way as in Group I. Group III: alkali burn was induced in the cornea of the right eyes of 10 animals, using 1 N NaOH. Five days after the procedure, the animals were sacrificed. Ten hours prior to sacrifice, Evans blue was injected. The left corneas were the control. RESULTS: In group I, mean Evans blue concentration is at 10 h: 15.28 ± 0.09 mg/mg. In group II, mean Evans blue concentrations are: 6 mm: 0.93 ± 0.01mg/mg; 8 mm: 1.20 ± 0.06 mg/mg; 10 mm: 1.32 ± 0.05 mg/mg. In group III, mean Evans blue concentrations are: right eyes (alkali burns): 23.74 ± 2.64 mg/mg and left eyes (control): 16.71 ± 2.04 mg/mg. CONCLUSIONS: This is the first time that Evans blue has been quantified in rabbits cornea. It was possible to detect the dye from 8 to 16 hours after intravenous injection. We can conclude that Evans blue detection is a good method to quantify the alteration of vascular permeability in rabbits cornea.

Contact lenses fitting after intracorneal ring segments implantation in keratoconus

PURPOSE Evaluate contact lenses fitting after intracorneal ring implantation for keratoconus, its visual acuity and comfort. METHODS Retrospective study of patients undergoing contact lenses fitting, after intracorneal ring for keratoconus. The criterion for contact lens fitting was unsatisfactory visual acuity with spectacle correction as referred by the patients. All patients were intolerants to contact lenses prior to intracorneal implantation. Visual acuity analysis was done by conversion of Snellen to logMAR scales. The comfort was evaluated according subjective questioning of good, medium or poor comfort. RESULTS Nineteen patients were included in the study. Two patients (10.5%) did not achieved good comfort with contact lenses and underwent penetrating keratoplasties. All the others 17 patients showed good or medium comfort. Four rigid gas-permeable contact lenses were fitted, one piggyback approach, 3 toric soft contact lenses, 2 soft lenses specially design for keratoconus and 7 disposable soft lenses. The average visual acuity improved from 0.77 ± 0.37 to 0.19 ± 0.13 logMAR units after contact lenses fitting. CONCLUSION Contact lens fitting after intracorneal ring is possible, provides good comfort, improves visual acuity, and therefore, may postpone the need for penetrating keratoplasty.

Aspectos psicossociais do paciente com ceratocone

INTRODUCTION: Keratoconus is a progressive and non-inflammatory ectasia of the cornea, mostly bilateral causing low vision because of the irregular astigmatism. The influence of the disease on quality of life is dependent on limiting factors and personality type. PURPOSE: To verify quality of life and personality type of the person with keratoconus. METHODS: Sixty-eight individuals with keratoconus and 52 without the ocular disease were studied. The following data were collected: personal demographic data, keratoconus measurements and specific questions, complete ophthalmologic examination, measurement of quality of life and personality type using standardized instruments. RESULTS: Both groups were demographically similar and comparable. SF-36 and MIPS differed between keratoconus and control patients. SF-36 scores showed that the keratoconus group had lower scores regarding the physical component (353.0 ± 58.2 x 379.1 ± 52.9) (p=0.005) as well as the mental component (326.3 ± 89.9 x 364.2 ± 66.4) (p=0.004), mainly functional capacity (86.3 ± 9.7 x 92.6 ± 9.7) (p<0.0001) and general health (76.8 ± 16.9 x 83.5 ± 16.5) (p=0.014). MIPS scores showed that patients with keratoconus were significantly more pain avoiding (p=0.007) presented more, imaginative intuition (p=0.004), asocial withdrawal (p=0.014) and anxious hesitation (p=0.010) than the control group. CONCLUSION: The results showed psychosocial impairment in the keratoconus group. Keratoconus influenced the quality of life expressed by the SF-36. MIPS showed keratoconus patients to be more pain avoiding, with more imaginative intuition, asocial withdrawal and anxious hesitation than the control group.

Aspectos socioeconômicos em pacientes portadores de vícios de refração

Objetivo: Estudar os custos de correcao dos vicios de refracao em grupos de pessoas de distinto poder aquisitivo. Metodos: Os autores estudaram cinquenta pacientes portadores de vicios de refracao. Estes foram separados em dois grupos: grupo I com pacientes escolhidos de forma aleatoria na primeira consulta ao ambulatorio de Oftalmologia do Hospital Evangelico de Curitiba (HUEC), e grupo II com voluntarios medicos do HUEC e academicos de medicina da Faculdade Evangelica de Medicina do Parana (FEMPAR). Foram analisados dados referentes a sexo, faixa etaria, profissao, renda, grau de instrucao, uso de correcao (oculos ou lentes) e seu custo, consultas oftalmologicas. Os pacientes foram submetidos ao exame oftalmologico de rotina. Resultados: Encontramos no grupo I predominância de pacientes de meia idade (48,5 anos), com renda entre 1 a 5 salarios minimos (SM) e hipermetropes; e no grupo II, pacientes jovens (24,4 anos), com renda acima de 20 SM e miopes foram mais frequentes. Conclusao: O gasto medio anual com oculos fica no minimo em R

Investigação experimental da utilidade da medicação no pós-operatório em cirurgia refrativa

46,50 (0,3 SM); com lentes de contato, no minimo R

Satisfação do paciente com degeneração macular relacionada à idade após terapia térmica transpupilar

196,66 (1,4 SM); e com cirurgia refrativa em R

Conjuntivite presumível por Acanthamoeba

800,00 (5,9 SM). O estudo sugere a cirurgia refrativa como boa indicacao para ambos os grupos.

Prevalência de tracoma no Municipio de Miraselva, Estado do Paraná, Brasil

PURPOSE: To harvest microorganisms from the microkeratome after LASIK. To induce experimental infectious keratitis and investigate the use of routine postoperative medication. METHODS: During eight consecutive days, we cultured the plate of the microkeratome after routine LASIK. Dilutions of the most frequent microorganism was prepared according to the MacFarland scale. Ten microliters were injected into both corneas of eight guinea pigs. The right cornea was used as control and the left cornea was treated with 0.3% ciprofloxacin associated with dexamethasone and ketorolac tromethamine every 4 hours for 24 hours (group 2). The animals were sacrificed and the corneas were divided into two halves, which were sent to analyzed by the microbiology and histopathology laboratory. RESULTS: In the control group, Staphylococcus aureus could be retrieved from all corneas, while in group 2, only 50% showed positive cultures (p=0.0128). Histopathology concerning polymorphonuclear cells showed an intense degree of inflammation in group 1 (p=0.0203) and regarding monomorphonuclear cells, it was also more intense in group 1 (p=0.0051). CONCLUSION: This study suggests that the use of wide-spectrum antibiotic associated with anti-inflammatory eye drops has a significant effect on the reduction of a potential infectious and inflammatory process after refractive surgery.

Transplante de membrana amniótica na ceratopatia bolhosa

OBJETIVO: Comparar resultados subjetivos (satisfacao dos pacientes) aos dados objetivos (melhora da acuidade visual - AV) apos o tratamento de degeneracao macular relacionada a idade e/ou membrana neovascular sub-retiniana por terapia termica transpupilar. METODOS: Foram avaliados retrospectivamente 23 prontuarios de pacientes com diagnostico angiofluresceinografico de degeneracao macular relacionada a idade submetidos a uma unica aplicacao de terapia termica transpupilar. Observou-se a acuidade visual antes e um mes apos a aplicacao, e a satisfacao dos pacientes obtida com o tratamento. RESULTADOS: Avaliamos 23 pacientes, com idades variando entre 53 e 88 anos (media 74,08), dos quais 15 eram do sexo feminino, e 8 do sexo masculino. Foram encontrados 12 olhos com melhora da acuidade visual, 6 olhos sem alteracao da acuidade visual, 6 olhos com acuidade visual piorada. Em relacao a satisfacao, os resultados obtidos foram: muito satisfeitos (4 olhos), satisfeitos (13 olhos), insatisfeitos (7 olhos) e ainda cruzando-se os dados obteve-se muito satisfeitos com melhora da AV (3 olhos) e muito satisfeitos sem melhora da AV (1 olho); satisfeitos com melhora da AV (7 olhos), satisfeitos sem melhora da AV (3 olhos), e satisfeitos com piora da AV (3 olhos); insatisfeitos com melhora da AV (2 olhos), insatisfeito sem melhora da AV (2 olhos), e insatisfeitos com piora da AV (3 olhos). CONCLUSAO: Em relacao a acuidade visual, esta foi melhorada em 12 olhos, dos 24 estudados; a quantidade de pacientes muito satisfeitos ou satisfeitos atingiu a quantidade de 17 olhos, no intervalo de um mes. Observando-se os resultados acima, pode-se considerar a terapia termica transpupilar como terapia alternativa ou adjuvante para o tratamento de degeneracao macular relacionada a idade.