Luciene Barbosa de Sousa

Amniotic membrane transplantation for partial and total limbal stem cell deficiency secondary to chemical burn.

PURPOSE To evaluate the surgical outcome of preserved amniotic membrane transplantation (AMT) for ocular surface reconstruction in chemical burn with limbal stem cell deficiency. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS Twenty eyes of 20 consecutive patients with limbal stem cell deficiency secondary to ocular chemical injury. INTERVENTION AMT with or without adjunctive limbal transplantation using limbal tissue from either the healthy contralateral eye (CLAU) or a living related donor (lr-CLAL). MAIN OUTCOME MEASURES Reconstruction of corneal epithelium (clear appearance without epithelial defect, normal fluorescein permeability and the absence of conjunctiva-derived goblet cells on impression cytology), decrease in corneal vascularization and improvement in visual acuity. RESULTS With a mean follow-up time of 19 months (range, 8-27 months), satisfactory ocular surface reconstruction was obtained in 15 eyes (75%), with reduced inflammation and vascularization of the ocular surface and a mean epithelialization time of 3.3 weeks. Success was observed in all cases of partial limbal stem cell deficiency (PLD) and in 68.75% (11 eyes) of cases of total limbal stem cell deficiency (TLD). Surgical failure was observed in five severe cases (31.25%). A significant visual improvement was observed in all cases after surgery, except for 2 eyes that maintained preoperative visual acuity. CONCLUSIONS AMT seems to be an efficient adjunct for ocular surface reconstruction in chemical burns with PLD. When performed in conjunction with limbal stem cell transplantation, it is also effective in most cases of TLD.

An outbreak of Mycobacterium chelonae infection after LASIK

OBJECTIVE To describe an outbreak of mycobacterial keratitis after laser in situ keratomileusis (LASIK), including the microbiologic investigation, clinical findings, treatment response, and outcome. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Patients (n = 10) who underwent LASIK surgery between August 22 and September 4, 2000, and developed mycobacterial infection. METHODS Patients were prospectively followed in relation to microbiologic investigation, clinical findings, treatment response, and outcome. MAIN OUTCOME MEASURES Most patients underwent bilateral simultaneous LASIK. Postoperative infection was signaled by the appearance of corneal infiltrates in the third postoperative week. The microbiologic workup was performed on cultures obtained either by direct scraping of the cornea or by lifting the flap. Medical therapy was instituted based on drug susceptibility testing. Surgical interventions such as corneal debridement and flap removal were performed during recurrences or when there was no satisfactory clinical response. RESULTS Cultures revealed Mycobacterium subspecies chelonae. Patients were treated with topical clarithromycin (1%), tobramycin (1.4%), and ofloxacin (0.3%). Oral clarithromycin (500 mg twice a day) was prescribed for those patients who did not respond clinically to topical treatment. Four eyes healed on this regimen. Flap removal was necessary in seven eyes. CONCLUSIONS This report highlights mycobacteria as an etiologic infectious agent after LASIK. Diagnosis can be difficult and is often delayed. The treatment mainstay is prolonged antibiotic therapy. Surgical debridement and flap removal may shorten the disease course.

Infectious post-LASIK crystalline keratopathy caused by nontuberculous mycobacteria.

Purpose. To report three cases of infectious crystalline keratopathy caused by non-tuberculous mycobacteria after LASIK surgery. Methods. Interventional case reports and literature review. Results. Infectious keratitis with clinical features of crystalline keratopathy after LASIK is described. Culture revealed Mycobacterium chelonae from the corneal scrapings of the three patients, all of whom underwent medical and surgical (debridement) treatment. Conclusions. Mycobacteria may cause infectious crystalline keratopathy after LASIK. The presence of crystalline keratopathy in patients that underwent LASIK must be considered an indicator of nontuberculous mycobacteria infection. Microbiologic work-up of a corneal specimen is required for the institution of appropriate therapy.

Microbiota evaluation of patients with a Boston type I keratoprosthesis treated with topical 0.5% moxifloxacin and 5% povidone-iodine.

Purpose: To evaluate the efficacy of a prophylactic regimen of daily topical 0.5% moxifloxacin and 5% povidone–iodine (PI) in patients with Boston type I keratoprosthesis (KPro) and to assess the applicability of a novel molecular diagnostic technique to analyze the ocular surface microbiota in these patients. Methods: Ten patients had their inferior conjunctival fornix sampled for standard culture methods before the addition of topical 5% PI to the prophylactic regimen and were considered the control group (group 1). The inferior conjunctival fornix and the KPro–donor cornea interface of 10 patients treated with the mentioned prophylactic regimen were sampled and analyzed by standard culture methods and using a polymerase chain reaction/electrospray ionization mass spectrometry assay (group 2). Results: Samples from the inferior conjunctival fornix were positive for coagulase-negative staphylococcus in 3 patients and for Aerobasidium pullulans in 1 patient in group 1. The inferior conjunctival fornix and the KPro–donor cornea interface scrapings were positive for coagulase-negative staphylococcus in 2 patients and 1 patient, respectively, in group 2. No bacteria and fungi growth were detected in any patient from group 2 with the molecular diagnostic approach. None of the patients with culture-positive results developed keratitis or endophthalmitis during the study. Conclusions: Topical 0.5% moxifloxacin associated with topical 5% PI is an effective prophylactic regimen in patients with Boston type I KPro. The molecular diagnostic approach using serial polymerase chain reaction and mass spectrometry was comparable with standard microbiologic techniques as a surveillance tool in these patients.

Boston type 1 keratoprosthesis outcomes in ocular burns.

Purpose:  To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries.

Clinic-cytologic study of conjunctivochalasis and its relation to thyroid autoimmune diseases : Prospective cohort study

Purpose: To determine the prevalence of conjunctivochalasis in patients with immune thyroid diseases, to determine whether there is any association between the 2 diseases, and to determine cytologic study of conjunctivochalasis through the cytology impression test. Methods: A clinical prospective cohort study carried out by the External Diseases Department in the Ophthalmology Sector and the Thyroid Department in the Endocrinology Sector at Federal University of Sao Paulo (UNIFESP). The patients included were divided into 2 groups following these inclusion criteria: a control group of 25 patients without thyroid diseases, confirmed after clinical and laboratory examinations (thyroid hormones), or any other ocular diseases. The study group consisted of 31 patients with thyroid diseases, the diagnosis of which was confirmed by the Endocrinology Sector. The thyroidopathies included were autoimmune diseases but excluded nonautoimmune diseases. A protocol endorsed by the UNIFESP was followed, using clinical and ophthalmological history, biomicroscopy, and impression cytology. Results: Fifty-two percent of patients without thyroid diseases and 88% of patients with thyroid diseases presented with conjunctivochalasis. The risk ratio was 1.705 (Pr > χ2 = 0.0038), indicating that there is an association between them. For the impression cytology in inferior bulbar conjunctiva, there was an association between the result of the impression cytology and conjunctivochalasis (Pearson χ2 = 10.1190 Pr = 0.006). Conclusion: The prevalence of conjunctivochalasis in patients with autoimmune thyroid diseases was 88%. Patients with autoimmune thyroidopathy presented higher percentages of conjunctivochalasis than the control group, confirming the association between them. The cytologic study showed the highest prevalence of abnormal surface features in eyes with conjunctivochalasis.

Boston type I keratoprosthesis: Review

Regardless of significant progress in the field of corneal transplantation to treat corneal opacification, some cases of corneal blindness still present a poor prognosis for conventional penetrating keratoplasty. In patients with repeated graft failure and/or with severe ocular surface disease, the Boston type I keratoprosthesis (type I BKPro) has become a viable option. Modifications in its design and postoperative management have improved the long-term outcomes of visual acuity, retention, and postoperative infection rates. These advances made the type I BKPro be considered a safe alternative for visual rehabilitation in many patients with corneal pathologies. However, postoperative handle of chronic comorbidities, such as glaucoma, is still critical for preserving the visual gains achieved with BKPro.

Experience with Boston keratoprosthesis type 1 in the developing world

OBJECTIVE To report the experience of the Federal University of São Paulo, Brazil, in performing Boston keratoprosthesis type 1 implantation in the developing world. METHODS We analyzed 30 eyes of 30 patients who underwent Boston type 1 keratoprosthesis surgery between 2008 and 2012 in a prospective interventional study. Preoperative, perioperative, and postoperative parameters were analyzed, including visual acuity (VA), keratoprosthesis stability, and postoperative complications. RESULTS Preoperative diagnoses were failed grafts in 16 eyes (53.33%), chemical injury in 10 eyes (33.33%) and Stevens-Johnson syndrome in 4 eyes (13.33%). Also, 16 eyes (53.33%) had preoperative glaucoma. Preoperative best corrected VA ranged from 20/400 to light perception. With an average follow-up of 32 months (range 1-55 months), postoperative vision improved to >20/200 in 24 eyes (80%). Postoperative VA was statistically improved compared with the preoperative measurement during all postoperative follow-ups (up to 36 months). During the follow-up period (32 months), retention of the initial keratoprosthesis was 93.3%. The incidence of retroprosthetic membrane was 26.66%. Progression of glaucoma occurred in 7 of 16 eyes (43%). Three patients experienced development of glaucoma after keratoprosthesis implantation. One eye experienced development of infectious keratitis, and 2 eyes had retinal detachment. CONCLUSIONS Performing Boston type 1 keratoprosthesis in a developing country is a viable option after multiple keratoplasty failures and conditions with a poor prognosis for keratoplasty. Our experience appears similar to major reports in the field from investigators in developed countries. Adjustments to postoperative management must be considered according to the particular location.

Ceratoconjuntivite alérgica e complicações no segmento ocular anterior de pacientes

INTRODUCAO: A alergia ocular e condicao que pode ocasionar sintomas de coceira, ardor e lacrimejamento, podendo tambem ser ameacadora para visao. A fisiopatologia envolve mecanismos de hipersensibilidade imunologica. Devido a fatores imunologicos, o segmento anterior destes pacientes esta mais suscetivel a alteracoes que ameacam a acuidade visual, tais como: opacidades corneanas, ceratocone e catarata. METODOS: Foram revistos, retrospectivamente, 186 pacientes com ceratoconjuntivite alergica e selecionados pacientes que possuiam alteracoes de segmento anterior e acuidade visual menor ou igual a 0,6 corrigida em um ou ambos os olhos. A AV 0,6 foi escolhida aleatoriamente a fim de agrupar os pacientes. Estes pacientes foram analisados quanto a idade, sexo, tipo de alergia, tempo de aparecimento da doenca (considerado como tempo de aparecimento de sintomas), tempo de latencia (tempo que surgiu a complicacao apos o primeiro dia de atendimento), alteracoes sistemicas, efeitos colaterais das drogas e complicacoes oculares. Estes pacientes nao poderiam melhorar a AV com tratamento topico e tinham acompanhamento minimo de 3 meses. RESULTADOS: As alteracoes de segmento anterior que causaram AV menor ou igual a 0,6 (refracao ou estenopeico) sem possibilidade de melhora com medicacao topica foram: ulcera em escudo: 5 casos, catarata: 3 casos, opacidade corneana: 6 casos, perfuracao ocular: 2 casos e ceratocone: 13 casos. CONCLUSAO: Pacientes com ceratoconjuntivite alergica podem ter como principais causas de baixa acuidade visual alteracoes de segmento anterior, entre elas, opacidades corneanas, ceratocone e catarata.

Effect of topical 0.5% povidone-iodine compared to 5% natamycin in fungal keratitis caused by Fusarium solani in a rabbit model: a pilot study

PURPOSE To evaluate the efficacy of topical administration of 0.5% povidone-iodine in experimental Fusarium solani keratitis in rabbits. METHODS Fungal keratitis caused by Fusarium solani was induced in the right eye of 24 New Zealand rabbits. The rabbits were randomly divided into 3 different treatment groups: Group I (povidone-iodine) - treated with topical 0.5% povidone-iodine; Group II (natamycin) - treated with topical 5% natamycin; and Group III (control) - treated with topical saline solution. In all groups the rabbits were treated for three days and then sacrificed. The corneas were excised, macerated and immersed in 10 mL BHI. Culture samples were plated daily on Sabourauds agar for 7 days, and the number of colony-forming units (CFU) was counted. The rabbits were clinically evaluated during the treatment period. RESULTS The povidone-iodine and natamycin groups demonstrated better efficacy than the control group based on the number of rabbits with no colonies growing. However, there were no statistically significant differences between the three groups when the number of CFU was analyzed (p>0.05). CONCLUSIONS Our study demonstrates important methodological considerations in the use of in vivo animal models for the testing of antifungal agents. Using this sample size and methodology of counting CFU, topical 0.5% povidone-iodine demonstrated no benefit in the treatment of experimental Fusarium solani when compared with topical 5% natamycin.