Magno Antonio Ferreira

Ocular Lesions Arising After Stings by Hymenopteran Insects

Purpose. To describe the ocular lesions that occur after stings from hymenopteran insects. Methods. We examined the ocular alterations in five patients who suffered ocular trauma from hymenopteran insect stings. Results. In 4 cases where the insect was identified as a wasp, all the patients presented with persistent corneal decompensation and two presented with total cataract, requiring surgical treatment. In the case of trauma by a bee sting, the patient presented with corneal edema and an inflammatory reaction of the anterior chamber with total regression of these alterations after clinical treatment. Conclusion. Although a rare occurrence, ocular trauma caused by hymenopteran insects can result in severe ocular alterations in humans.

Epidemiology and etiologic diagnosis of infectious keratitis in Uberlandia, Brazil.

Purpose. To study risk factors, microbiological characteristics, and clinical course of nonviral infectious keratitis diagnosed in a referral service of ophthalmology. Methods. A total of 65 charts of patients with microbial keratitis were retrospectively reviewed at the Clinical Hospital of Federal University of Uberlandia, Brazil, from July 2001 through August 2004. All cases were submitted to microbiological tests and treated according to local protocol. Risk factors, clinical course, therapeutic keratoplasty, and visual outcomes were analyzed. Results. The mean age of patients was 45.9 years (2–83 years) and male to female ratio 2.6:1. Symptoms at presentation ranged from 1–3 days in 16 patients out of 65 (24.61%), 4–7 days in 19 cases (19/65; 29.23%), and more than 7 days in 27 patients (27/65; 41.53%). The major risk factor was trauma (28/65; 40%), predominantly by organic material. A total of 32 eyes out of 65 (49.23%) were culture positive. Fungi were the most common isolates (18/32; 56.25%), being headed by Fusarium sp (11/65; 16.92%), and the most common bacteria was Streptococcus pneumoniae (7/65; 10.77%). Final visual acuity was equal to or better than 20/60 in 20 patients out of 65 (30.77%), between 20/60 and 20/400 in 7 patients (7/65; 10.77%), and worse than 20/400 in 35 patients out of 65 (53.85%). A total of 48 eyes out of 65 (73.84%) presented corneal scar, 12 eyes (12/65; 18.46%) needed therapeutic penetrating keratoplasty, and 2 eyes (2/65; 3.08%) were eviscerated. Conclusions. The high incidence of fungal keratitis in the studied population shows their vulnerability to such infections, which may result in devastating visual outcomes.

Posterior hyaloid detachment and internal limiting membrane peeling assisted by anthocyanins from acai fruit (Euterpe oleracea) and 10 other natural vital dyes: experimental study in cadaveric eyes.

Purpose: The purpose of this study was to determine whether natural dyes facilitate posterior hyaloid detachment (posterior vitreous detachment [PVD]) and retinal internal limiting membrane (ILM) peeling in human eyes. Methods: Open-sky vitrectomy with posterior hyaloid and ILM removal was performed in 86 human cadaveric eyes. After core vitrectomy, 11 different dyes were injected into the vitreous cavity to aid hyaloid detachment and ILM removal. The dyes were allowed to settle on the macula for 5 minutes after PVD and were removed by mechanical aspiration. Intraocular forceps were used for ILM peeling, which was confirmed by light microscopy of the peeled tissue. Acai fruit (Euterpe oleracea) extract and 10 additional dyes from plants or animal sources were tested: pomegranate (Punica granatum), logwood (Haematoxylum campechianum), chlorophyll extract from alfalfa (Medicago sativa), cochineal (Dactylopius coccus), hibiscus (Hibiscus rosa-sinensis), indigo (Indigofera tinctoria), paprika (Capiscum annuum), turmeric (Curcuma longa), old fustic (Maclura tinctoria), and grape (Vitis vinifera). Results: The dyes facilitated PVD and ILM peeling. Acai fruit (E. oleracea) extract, logwood (H. campechianum), cochineal (D. coccus), and old fustic (M. tinctoria) facilitated PVD in all cases; dye-assisted PVD was compared with triamcinolone-assisted PVD performed previously in a comparative model. Acai fruit (E. oleracea) extract, cochineal (D. coccus), and chlorophyll extract from alfalfa (M. sativa) showed the best capability for ILM staining; dye-assisted ILM removal was compared with the ILM peeling guided by indocyanine green staining performed previously in a comparative model. Light microscopy confirmed the ILM removal in all cases. Conclusion: Anthocyanin dye of the acai fruit (E. oleracea) and the dyes from cochineal (D. coccus) and chlorophyll extract from alfalfa (M. sativa) resulted in the best capability for posterior hyaloid and ILM staining in human cadaveric eyes and may be a useful tool for vitreoretinal surgery.

Bilateral endogenous endophthalmitis associated with infective endocarditis: case report

Bilateral endogenous endophthalmitis is a rare condition initiated by infection by microbes in the bloodstream, such as those arising from a foci of infective endocarditis. We report a case and discuss the diagnostic aspects and the clinical outcome of a patient with characteristic findings of the disease. The patient was a 49 year old white male who had a metallic aortic valve implanted 7 months previously, and who presented to the hospital with 10 days of fever, cough and dyspnea, then diarrhea and mental confusion. On the second day of hospitalization, he experienced sudden loss of vision in both eyes. A Gram-positive coccobacillus was isolated from the bloodstream, he was treated with fluoroquinolone with disappearance of fever, decreased ocular inflammation, and improvement in his vision to light perception. He later underwent valve replacement surgery but died during the procedure. We review the occurrence of ocular signs and symptoms and their importance in patients with endocarditis.

Color Variation Assay of the Anthocyanins from Açai Fruit (Euterpe oleracea): A Potential New Dye for Vitreoretinal Surgery

AIM The goals of this study were to determine the potential for use of the natural anthocyanins from the açai fruit (Euterpe oleracea) during vitreoretinal surgery and the ideal physicochemical properties of the dye. METHODS We evaluated the color variations of the dye at different pHs and osmolarities with or without the use of mordants as a potential new tool for internal limiting membrane peeling. The extracts of anthocyanin from the açai fruit were analyzed by spectrophotometry to determine the degree of color variations associated with various pHs and osmolarities. The experiments were conducted in test tubes filled with tryptophan soya media and Petri dishes prepared with agar media. RESULTS We observed various shades of green, red, and purple in the extracts of the anthocyanin dye at different pHs and osmolarities. The assay to adjust the anthocyanin solution similar to the physiologic retinal environment (osmolarity, 300 mOsm; pH, 7.00) resulted in a shade of purple that may be useful to stain the intraocular microstructures during vitreoretinal surgery. The physicochemical property of the purple anthocyanin solutions from the açai fruit was observed at physiologic pH and osmolarity. CONCLUSION Anthocyanins from the açai fruit may be useful to enhance visualization of the intraocular microstructures during vitreoretinal surgery.

Development and initial experience with a colored perfluorocarbon liquid for intraocular tamponade in vitreoretinal surgery

Purpose: To present the development and initial experience of a novel colored perfluorocarbon liquid (PFCL) in vitreoretinal surgery. Methods: This was an experimental laboratory study and prospective human interventional study. F6H8 (Fluoron GmbH) was colored by adding 0.3 g/L blue anthraquinone dye. Subsequently, 20% colored F6H8 was prepared by mixing with perfluorooctane or perfluorodecalin (Fluoron GmbH). The novel product is not yet FDA approved for human application. In the laboratory, the colored PFCL was covered with 1) uncolored PFCL, 2) BSS, and 3) silicone oil. Cell toxicity was evaluated in L929 mouse fibroblasts using a growth inhibition assay. Porcine ex vivo eyes were evaluated after vitrectomy followed by intravitreal and subretinal colored PFCL infusion. A pilot, prospective, noncomparative interventional study was conducted in patients with retinal detachment with proliferative vitreoretinopathy (PVR). Results: The density of the colored PFLC mixture was 1.664 g/cm3 for perfluorooctane and 1.802 g/cm3 for perfluorodecalin. There was no relevant cell growth inhibition with any concentration of colored PFCL tested. Experiments in pigs revealed that infusion of the colored PFCL caused neither staining of the internal limiting membrane nor intravitreal residual droplets. In the prospective study, 9 eyes (75%) underwent surgery for rhegmatogenous retinal detachment with at least grade C PVR. The colored PFCL enabled retinal break examination and detection of residual intravitreal droplets in all surgeries. There was no case of separation or leakage of the dye from the PFCL solution that could have caused unwanted staining of the vitreous or epiretinal surface. Conclusion: The colored PFCL enabled intraoperative maneuvers such as endolaser use. In addition, removal of the colored PFCL was easily achieved at the end of surgery.

Alterações oculares em crianças com toxoplasmose congênita precoce

Purpose: To describe the ocular findings in children with early toxoplasmosis and sistemic manifestation of the disease Methods: Fifty children with early congenital toxoplasmosis were included in this study and all data collected from their medical charts from the Hospital de Clinicas de Uberlândia. These children had their diagnosis based on clinical features and serological tests. All of them presented with systemic manifestations at birth and were examined by an ophthal-mologist. Results: Ocular manifestations were present in 86% of the patients. Retinochoroiditis was the most frequent lesion and was present in 76% of the patients that underwent indirect ophthalmoscopy, being bilateral in 54% of them. Neurolo-gical findings were seen in 69% of the patients with retino-choroiditis. Conclusion: The authors consider that ocular manifestations are common in children with early congenital toxoplasmosis showing systemic manifestations at birth. Ocular examination should be performed in all suspected or confirmed cases due to its important help not only in the diagnosis but also because it leads to early visual stimulation.

Aspectos da tomografia de coerência óptica na oftalmia simpática: relato de caso

The sympathetic ophthalmia is a granulomatous panuveitis that starts after ocular trauma. The prognosis is poor and depends of both early diagnosis and treatment. The authors describe one case of a patient with sympathetic ophthalmia using optical coherence tomography who was submitted to early treatment, and it suggests that the optical coherence tomography can corroborate as a ancillary method in the study of retina characteristics in sympathetic ophthalmia disease specially in cases of rare presentation, with serous retinal detachment as an isolated ophthalmological manifestation.

Estudo histopatológico da retina de coelhos após injeção intravítrea de lidocaína

Purpose: To study the retinal alterations in rabbit eyes after intravitreal injection of 0.5, 1.0 and 2.0% lidocaine through histopathological analysis with light and transmission electron microscopy. Methods: Forty eyes of 20 New Zeland albino rabbits were submitted to intravitreal injection of 0.5 (group II), 1.0 (group III) and 2.0 % (group IV) lidocaine in the right eyes and saline solution in the left eyes (group I - control) after general anesthesia. Bilateral indirect ophthalmoscopy was performed before the intravitreal injection, during the procedure, one hour postoperative and on days 1, 3, 7 and 15. On the same days one eye of group II, two eyes of group III and one eye of group IV were enucleated and examined under light and transmission electron microscopy. Results: No alterations were found under bilateral indirect ophthalmoscopy before and during the intravitreal injection, but on days 1, 3, 7 and 15 after the procedure the retina showed a whitish aspect, an elevation of the vitreous-retinal interface, retinal edema and virtual condensation ring in all groups. No alterations were found using light and transmission electron microscopy analysis. Conclusion: Intravitreal injection of 0.5, 1.0 and 2.0% lidocaine morphologically showed no toxicity to New Zeland albino rabbit retina, based on light and transmission electron microscopy analysis.

Toxicidade ocular experimental do Perfluorotribulitalimine

Perfluorotributilamine (PFTA) e um importante adjunto na cirurgia vitrea. Alteracoes do eletrorretinograma em coelhos tem sido reportadas apos PFTA ser deixado na cavidade vitrea por duas a quatro semanas. Neste estudo nos nos propusemos a determinar se estas alteracoes sao reversiveis apos a remocao do mesmo. Dezessete coelhos submeteram-se a vitrectomia e PFTA foi injetado em 13 olhos. Em oito olhos o PFTA foi removido apos 12 dias (Grupo I), em 5 olhos PFTA foi mantido intra-ocular ate o dia da enucleacao, que ocorreu 35 dias apos a injecao (Grupo 2) e 4 olhos submeteram-se a cirurgia sem utilizacao de PFTA (Grupo 3). Nenhuma alteracao clinica foi observada por oftalmoscopia indireta em nenhum coelho. Eletrorretinograma foi resgitrado em 12 coelhos antes da cirurgia (dia 0) e nos dias 9, 19, 25 e 35. Nos observamos uma diminuicao da amplitude da onda B na estimulacao escotopica 8x e 16x em todos os grupos, sendo mais severa no grupo 2. A remocao do PFTA resulta em recuperacao da amplitude da onda b para valores proximos do valor pre-operatorio.