Luciene Barbosa de Souza

Corneal infections after implantation of intracorneal ring segments.

Purpose: To report risk factors, clinical course, and outcome in patients with infectious keratitis following implantation of intracorneal ring segments (ICRS). Methods: The records of 8 patients with culture-proven infectious keratitis after ICRS (Ferrara® or Intacs®) implantation were retrospectively reviewed. Age, gender, corneal findings, ocular abnormalities, the condition that led to ICRS implantation, immediate prior use of a contact lens, elapsed time between implantation and the onset of symptoms, previous medications, and systemic disorders were noted. Results: Culture-positive infectious keratitis developed in 7 eyes of 7 patients (2 men and 5 women) with a mean age of 35 years who underwent Ferrara implantantion for the treatment of keratoconus and in a 29-year-old man who underwent Intacs implantation for correction of low myopia. Contact lens use, diabetes, and trauma were factors possibly associated with the risk of infection in three cases. Microorganisms, identified in all cases, included Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae, Pseudomonas sp, Nocardia sp, Klebsiella sp, and Paecylomices sp. Onset of symptoms of infection varied from less than 1 week to 22 months postoperatively, depending on the infecting organism. Conclusions: Infectious keratitis following ICRS implantation is a sight-threatening complication for which early recognition and rapid institution of appropriate treatment may result in a better visual outcome.

Estudo laboratorial das micoses oculares e fatores associados às ceratites

PURPOSE: To analyze the frequency and the etiology of mycotic infectious eye diseases diagnosed by culture at the Ocular Diseases Laboratory of the Federal University of Sao Paulo (LOFT-UNIFESP), Sao Paulo, SP, Brazil, and the factors associated with fungal keratitis. METHODS: We retrospectively analyzed the 14,391 laboratory requests regarding infectious eye diseases between 1975 and May 2003. For the fungal culture proven examinations we observed the morphologic type of the isolated fungus, the gender and age of the patient, the site of ocular involvement, the year of identification, and the factors associated with keratitis cases, according to the identified etiologic agent. Results were considered significant if p<0.05. RESULTS: We verified 296 (2.05%) ocular mycosis cases with 265 keratitis (89.5%), 27 intraocular infections (9.1%), and 4 infections at other sites (1.3%). Filamentous fungi were isolated in 233 cases (78.7%) 74.7% being male (n=174) and 25.3% female (n=59). Yeasts were isolated in 63 cases (21.3%) 49.2% being male (n=31) and 50.8% female (n=32). Ages varied between 2 and 99 years in the filamentous fungi group and between 14 and 88 years in the yeast group. The most frequently found etiologic agents of the filamentous fungi isolations were Fusarium (n=137; 58.8%), Aspergillus (n=28; 12.0%), and Penicillium (n=12; 5.2%); and in yeasts, Candida (n=59; 93.7%). Regarding keratitis, 95.1% had at least one associated factor. Ocular trauma was significantly associated with filamentous fungi keratitis (p=0.0002); and previous surgeries (p=0.0002), ocular (p=0.0002) and systemic diseases (p=0.0002) with yeast keratitis. The use of topic antibiotics showed association with filamentous fungi keratitis, at a lower statistical significance (p=0.0224). CONCLUSIONS: Laboratory analysis showed predominance of filamentous fungi over the yeasts, and keratitis was the main observed ocular infection. Fungal keratitis involved at least one associated factor in most cases.

Bilateral deep keratitis caused by systemic lupus erythematosus

We report the optical and ultrasonic biomicroscopy and confocal microscopy findings in bilateral stromal keratitis (keratoendotheliitis), a rare ocular manifestation of systemic lupus erythematosus (SLE). Examination revealed deposits with polyrefringent crystals. Topical corticosteroid produced regression of the corneal edema, but there was an increase in corneal opacity. Ultrasound biomicroscopy images confirmed the deep location of the corneal opacities, and confocal microscopy showed a disruption of the corneal stroma and crystal-like bodies.

Principais indicações de transplante penetrante de córnea em um serviço de referência no interior de São Paulo (Sorocaba - SP, Brasil)

PURPOSE: To identify the main indications for corneal transplantation, analyze the results and provide demographic and epidemiological profile of patients referred to the Corneal Transplantation Project. METHODS: A retrospective analysis, from June to December 2003, of patients referred to the Corneal Transplantation Project. RESULTS: Total of 171 patients. One hundred and two (59.6%) patients were male and 69 (40.3%) female; mean age was 37 years. One hundred and six (49%) patients had indication for corneal transplantation. The origins of patients were: Sao Paulo (68%), Minas Gerais (6%), Parana (6%), Rio de Janeiro (5%), Maranhao (3%) and others (12%). The main indications: keratoconus 65%, pseudophakic bullous keratopathy 21%, corneal scarring 10%, Fuchs dystrophy 1.9%, lattice dystrophy 0.9% and Stevens-Johnson syndrome 0.9%. CONCLUSION: Many patients referred to corneal transplantation had no indication for such procedure. This fact demonstrates the poor knowledge of general ophthalmologists about the real indications of penetrating keratoplasty. Keratoconus was the major indication followed by pseudophakic bullous keratopathy.

Análise laboratorial de ceratites fungicas em Serviço Universitário

Purpose: To present the frequency and type of identified fungi from infectious keratitis. Methods: Retrospective survey of the cases of mycotic keratitis in the period from 1995 to 1998, at the Laboratory of Ocular Microbiology of the Department of Ophthalmology of the Federal University of Sao Paulo. Description of the fungal isolations, analysis of the causative factors and relation to the number of infectious keratitis in the same period. Results/Conclusion: Mycotic keratitis was diagnosed in 61 (5.48%) of the 1,113 patients who presented ulcer of the cornea of infectious etiology, ranging from 3.4 to 9.25%, per year. Filamentous fungi were identified in 47 cases (77.04%) and yeasts in 14 (22.95%). Fusarium was the most frequent genus (50.82%), followed by Candida (22.95%) and Aspergillus (8.19%). Phaeosiaria sp, Phoma sp, Fonsecaea pedrosoi, Exserohilum rostratum, that are rare etiological fungal agents of keratitis, were also isolated.

Transplante de membrana amniótica em casos agudos graves de queimadura ocular química e síndrome de Stevens-Johnson

OBJETIVO: Investigar o potencial terapeutico do transplante de membrana amniotica nos casos agudos graves de queimadura ocular quimica e sindrome de Stevens-Johnson. METODOS: Foram analisados retrospectivamente os prontuarios de oito pacientes, com um total de dez olhos, submetidos a transplante de membrana amniotica para tratamento de queimadura ocular quimica e sindrome de Stevens-Johnson na fase aguda entre janeiro de 1999 e maio de 2008 no Departamento de Oftalmologia da UNIFESP. Dados referentes a sexo, idade, grau da queimadura, etiologia, olho acometido, achados oftalmologicos, extensao da membrana amniotica, operacoes adicionais, tempo em dias entre a lesao e a cirurgia, acuidade visual antes e depois da cirurgia, defeito epitelial em dias, complicacoes e tempo de seguimento em meses foram coletados. RESULTADOS: A idade media dos pacientes foi de 35,7 ± 23,04 anos, dos quais seis eram homens e dois eram mulheres. Tres pacientes (quatro olhos) apresentaram sindrome de Stevens-Johnson e cinco pacientes (seis olhos) apresentaram queimadura ocular quimica. O defeito epitelial foi cicatrizado em media de 27,8 ± 4,7 dias (variando de 20 a 35 dias). Todos os pacientes evoluiram com deficiencia limbica em seguimento medio de 7,8 ± 2,8 meses (variando entre cinco e doze meses) e quatro olhos desenvolveram simblefaro. CONCLUSOES: Os resultados sugerem que o transplante de membrana amniotica representa um aditivo que pode ser realizado nos casos agudos graves de queimadura ocular quimica e sindrome de Stevens-Johnson com a finalidade de promover a epitelizacao e suprimir a inflamacao e suas consequencias, se comparado a outros trabalhos que trataram casos semelhantes com terapia medicamentosa somente. Por outro lado, nao e capaz de evitar a deficiencia limbica nesses casos, que futuramente necessitarao de transplante de celulas-tronco do limbo ou outras cirurgias para correcao da superficie ocular.

Clinical treatment of corneal infection due to Fonsecaea pedrosoi: case report

UNLABELLED To report an unusual case of fungus keratitis due to Fonsecaea pedrosoi that developed after corneal trauma. CASE REPORT A 18-year-old male presented with a corneal ulcer in the right eye, 28 days after a trauma with glass fragments. Corneal scrapings were collected for smears and culture. Dematiaceous hyphae were seen on wet mounts of the scrapings and dark pigmented colonies grew repetitively on the culture media; all colonies were identical, and were subsequently identified as Fonsecaea pedrosoi. Treatment was initiated with topical natamycin at one hour intervals, 200 mg oral ketoconazole per day and later changed to a combination of 200 mg ketoconazole and amphotericin B. In humid tropical regions Fonsecaea pedrosoi is one of the primary causes of human chronic cutaneous mycosis, chromoblastomycosis. Combination of systemic and topical antifungal medications may provide the best option for cure in corneal chromoblastomycosis.

Avaliação de tecido corneano processado por um Banco de Olhos de referência

PURPOSE To evaluate the quality of the corneas processed by Sorocaba Eye Bank (BOS) - SP and transplanted out of the Ophthalmology Hospital of Sorocaba (HOS), as well as the corneas that had re-entered in the BOS, being transplanted or not in the HOS, during the year of 2007. METHODS Ophthalmologists that transplanted corneas processed by BOS outside of the Ophthalmology Hospital of Sorocaba were contacted, as well as those who had used re-entried corneas, to collect the following information: period from eye enucleation until transplant, transparency of the donated tissue, time of transplant and primary failure. RESULTS During the year of 2007, Sorocaba Eye Bank distributed three hundred and ninety-two corneas for outside HOS. From these, six had returned to BOS and had been transplanted in the Ophthalmology Hospital of Sorocaba. From those, none was rejected; however, two presented some opacity in the visual axis. After attempt to congregate information regarding the 386 transplanted corneas outside HOS, data of only 48 keratoplasty were available. The average time from the enucleation until the keratoplasty was of 5.5 days (1-13 days), and of postoperative average follow-up, 9.8 months (4-15 months). Three corneas had developed primary failure; three presented opacity in the visual axis; one presented infectious keratitis, requiring therapeutic keratoplasty; a patient died and another one lost follow-up. The other 39 corneas did not present any problems until the time this study was ended. CONCLUSION Because of the difficulties to congregate informations of the patients transplanted in other hospitals, it is difficult to define the quality of the distributed corneas by Sorocaba Eye Bank. Thus, other analysis are necessary in order to define changes and new directions for future studies on selection and preservation of donated corneas.

Ceratite infecciosa em crianças: estudo microbiológico e epidemiológico em um hospital universitário de Assunção - Paraguai

PURPOSE: To describe the microbiologic aspects of infectious keratitis in children (0-18 years old) examined at the Department of Ophthalmology of the National University of Asuncion - Paraguay, during a 14-year period (1988-2002). METHODS: The authors retrospectively studied 146 children, under 18 years old, with infectious keratitis at the Department of Ophthalmology of the National University of Asuncion - Paraguay, from 1988 to 2002. RESULTS: The cultures were positive in 113 patients (77%) with 70% of bacterial and 30% of fungal etiology. Coagulase-negative Staphylococcus (23.1%), Staphylococcus aureus (19.2%), Pseudomonas aeruginosa (12.8%) and Streptococcus pneumoniae (12.8%) were the most common microorganisms isolated. Acremonium ssp (25%), Fusarium ssp (14%) and Aspergillus fumigatus (14%) were the fungi isolated. CONCLUSIONS: Ulcerative keratitis in children examined at the Department of Ophthalmology of the National University of Asuncion - Paraguay is of bacterial origin in most of the cases.

Transplante de córnea e o conhecimento do procedimento pelos pacientes

PURPOSE: To evaluate the understanding of the patient submitted to corneal transplant regarding the type of surgery, used treatment, rejection signs and final outcome satisfaction, at Cornea and External Disease Sector of the Federal University of Sao Paulo (UNIFESP). METHODS: 42 patients submitted to corneal transplant were interviewed using a questionnaire that includes multiple variables regarding knowledge on the general procedure, postoperative treatment, rejection signs and satisfaction with the final outcome. We also collected data about the diagnosis and the transplant. The data were tabulated and analyzed. RESULTS: 67% of 42 interviewed patients did not know what a corneal transplant is, 67% did not know about rejection signs, 30% did not know the purpose of postoperative medicines and 71% were satisfied with the final outcome. CONCLUSIONS: Most of transplanted patients do not know the meaning of corneal transplant, rejections signs and the correct use of medicines but are satisfied with the final outcome.