Luiz Antonio Vieira

Ceratite bilateral por Acanthamoeba: relato de caso

Acanthamoeba keratitis is a severe ocular infection which even with recent progress in diagnosis and treatment still causes long morbidity and loss of visual acuity. We describe a case of bilateral Acanthamoeba keratitis in a user of contact lenses, which is the first case discussed in Brazilian literature.

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.

Distrofia corneana amorfa posterior: relato de caso

The purpose of this paper is to warn the ophthalmologist about the possibility of facing rare cases of corneal dystrophies. Clinical findings of a case of posterior amorphous dystrophy were correlated with refraction, topography, and ultrasound biomicroscopy.

Ceratoconjuntivite cicatricial bilateral associada a líquen plano: relato de caso

Descrevemos um caso de ceratoconjuntivite cicatricial bilateral em uma paciente portadora de liquen plano e apresentamos revisao da literatura mundial sobre esse assunto. Cicatrizacao conjuntival, com formacao de simblefaro, olho seco, infiltracao corneana, neovascularizacao e afinamento foram os sinais observados. Diagnostico foi baseado nos achados clinicos e biopsia, apos exclusao das causas tipicas de ceratoconjuntivite cicatricial.

Membrana amniótica no tratamento dos afinamentos corneais e esclerais

PURPOSE: To evaluate the use of amniotic membrane (AM) as an adjunct to the treatment of corneal and scleral thinnings. METHODS: Amniotic membrane was obtained at the time of cesarean section and was preserved at -80oC in glycerol and cornea culture media at a ratio of 1:1. Seven eyes from 7 patients were divided into Group 1: neurotrophic ulcers secondary to herpes simplex virus keratitis (2 cases), after corneal transplantation (1 case), and post palpebral radiation (1 case); and Group 2: scleral thinning after pterygium surgery with (2 cases) or without (1 case) beta-therapy. All cases underwent amniotic membrane transplantation to restore thickness and promote epithelialization. RESULTS: Mean follow-up time was 12 months (range, 11-15 months). One case of neurotrophic ulcer secondary to radiotherapy was unsuccessful. A successful outcome was observed in the other 6 cases. Regarding visual acuity, 1 case improved and the other 6 cases remained unchanged. The mean epithelialization time was 26.6 ± 5.8 days for group 1 and 10.6 ± 4.0 days for group 2. CONCLUSIONS: The use of amniotic membrane represents a useful alternative to ocular surface reconstruction in corneal and scleral thinning. More cases and a longer follow up are necessary to better evaluate this procedure.

Acanthamoeba keratitis in patients wearing scleral contact lenses

PURPOSE To report a series of cases of Acanthamoeba keratitis (AK) in scleral lens wearers with keratoconus to determine whether this type of contact lens presents a greater risk for development of infection. METHODS This study reports three patients who wore scleral contact lenses to correct keratoconus and developed AK. The diagnoses of AK were established based on cultures of the cornea, scleral contact lenses, and contact lens paraphernalia. This study investigated the risk factors for infections. RESULTS The possible risks for AK in scleral contact lens wearers are hypoxic changes in the corneal epithelium because of the large diameter and minimal tear exchange, use of large amounts of saline solution necessary for scleral lens fitting, storing the scleral lens overnight in saline solution rather than contact lens multipurpose solutions, not rubbing the contact lens during cleaning, and the space between the cornea and the back surface of the scleral lens that might serve as a fluid reservoir and environment for Acanthamoeba multiplication. Two patients responded well to medical treatment of AK; one is still being treated. CONCLUSIONS The recommendations for use and care of scleral contact lenses should be emphasized, especially regarding use of sterile saline (preferably single use), attention to rubbing the lens during cleaning, cleaning of the plunger, and overnight storage in fresh contact lens multipurpose solutions without topping off the lens solution in the case.

Nodular scleritis and granulomatous polyangiitis (Wegener) mimicking tuberculosis

Granulomatous polyangiitis is a systemic disease that may affect any organ, with a predilection for the upper respiratory tract, lungs and kidneys. This article aims to report a case of a patient with atypical nodular scleritis as the initial manifestation of granulomatous polyangiitis (Wegener), mimicking a case of tuberculosis. The patient presented ocular hyperemia and lower progressive visual acuity for 1.5 years, followed by eye pain for two months. The patient had subpleural nodules with soft tissue density, increased pulmonary lymph nodes and discrete bilateral pleural thickening, with negative alcohol-resistant acid bacilli (BAAR). The histological diagnosis revealed a granulomatous vasculitis suggestive of non-infectious vasculitis (granulomatous polyangiitis). Cyclophosphamide pulse therapy was initiated.

Segunda opinião em Oftalmologia

PURPOSE: To evaluate the percentage of ophthalmologic patients who search for a second opinion and to verify the main reason for this search. METHODS: The methodology of the present study consists of a direct interview with 806 ophthalmologic patients, attended at a specialized hospital, through an adequately elaborated questionnaire, containing variables that can be related to the search for this second opinion. RESULTS: It was observed that 32% of the ophthalmologic patients ask for a second opinion and, of these, 31% search for other physicians in order to confirm the diagnosis. CONCLUSION: Most search for the second opinion in Ophthalmology is directly linked to the doctor/patient relationship. Such situation serves to warn the present professional teaching, pointing to the need for dedication, effort and greater investment in learning, regarding both the present and the future professionals. In addition, it is important to emphasize the necessity in improving the working conditions and wages. Maybe, the review of these aspects can contribute to decrease the mentioned problems.