Marcelo Cunha

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.

Epibulbar tumors in children: a survey of 282 biopsies.

The histopathology of 282 consecutive clinically diagnosed epibulbar tumors excised from children age 15 years and younger was reviewed at a major ophthalmic hospital over a 20-year period. The most common epibulbar tumors of childhood are nevi, choristomas, epithelial inclusion cysts, and papillomas. There was only one malignant tumor among the 282 orbital tumors of childhood.

Membrana amniótica nas cirurgias reconstrutivas da superfície ocular nas ceratoconjuntivites cicatriciais

Purpose: Amniotic membrane has been consolidated as an useful adjunct in the treatment of ocular surface disorders. Its use is based on the ability to improve epithelial healing and to decrease inflammatory, angiogenic and cicatricial processes. The purpose of this study was to report the surgical outcome of human amniotic membrane use for surface reconstruction in ocular cicatricial diseases. 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. Eleven eyes of 10 patients underwent amniotic membrane transplantation, associated (8 eyes) or not (3 eyes) with corneal limbal graft. Ocular surface reconstruction was performed after chemical burns (6 eyes), trauma (1 eye) and Stevens-Johnsons syndrome (SJS) (4 eyes). Results: Mean follow-up time was 5.22 months (range, 2-13 months). One case of SSJ developed early postoperative infection and was excluded from the analysis. Successful ocular surface reconstruction was achieved in 8 eyes (80%). Surgical failure was observed in 2 cases of SJS who presented corneal melting at the time of surgery (20%). Conclusions: This study suggests that amniotic membrane transplantation is an effective alternative for surface reconstruction in stable ocular cicatricial diseases. Larger studies with longer follow-up are necessary to further analyse this procedure.

Transplante autólogo de conjuntiva no tratamento de pterígio primário e recidivado

Apresenta-se a tecnica e os resultados do transplante de conjuntiva autologa para tratamento de pterigeo primario e recidivado numa serie de 22 pacientes (24 olhos). O pterigeo era primario em 13 dos casos e recidivado em 11 olhos. Em todos os casos, foram utilizados retalhos livres de conjuntiva a partir da localizacao bulbar superior do mesmo olho para restaurar a superficie de esclera e musculos extrinsecos expostos apos a excisao do pterigeo. O tempo de seguimento variou de 3 a 38 meses, com media igual a 10,7 meses. Observou-se apenas um caso de recorrencia (4,16 por cento), entretanto este nao requereu cirurgia adicional ate o momento. O procedimento cirurgico em questao mostrou-se seguro e efetivo para tratamento do pterigeo, pois praticamente nao houve complicacoes, nao ha necessidade de adjuntos farmacologicos ou de terapias de radiacao, e, principalmente, porque a taxa de recidiva demonstrada pode ser considerada baixa se comparada as atuais tecnicas empregadas

Impression cytology in the evaluation of ocular surface tumors: review article

Impression cytology (IC) has been widely used as a method for evaluating the ocular surface and superficial cells layers in the diagnosis and follow-up after treatment of several ocular surface tumors of both epithelial and melanocytic origin. Information regarding this can be found in the English-language literature since 1992. Using either cellulose acetate or Biopore membranes for specimen collection, a high correlation has been found between IC and tissue histology. Compared with exfoliative cytology with spatula, IC is less traumatic to the patients eye, provides a precise location of the area being studied, and allows accurate observation of the cells the way they exist in vivo. The additional advantage of IC is the preservation of limbal stem cells responsible for continuous corneal epithelium renewal; these can be affected after incisional or excisional biopsy at the corneoscleral limbus, which is the most frequent site of appearance of tumors in the stratified epithelium. Treatment for ocular surface squamous neoplasia has historically included surgery, but nonsurgical interventions have also been adopted. Hence, in certain cases, ophthalmologists may prefer interventions less invasive than surgical biopsy such as of impression cytology for both initial diagnosis and therapeutic monitoring of treatment for ocular surface lesions. Nevertheless, it should be considered that IC may be less helpful if the results conflict with the clinical picture or if the clinical diagnosis is uncertain and results are negative. In such cases, surgical biopsy is required for accurate diagnosis. The purpose of this review is to examine the published literature on the utilization of IC for the diagnosis and management of ocular surface tumors and to discuss the requirement for further investigation on the subject.

Amelanotic corneally displaced malignant conjunctival melanoma: a case report evaluated with impression cytology

Here we describe the case of a 65-year-old Caucasian female who presented with an amelanotic malignant conjunctival melanoma and highlight the clinical and pathological features of this rare entity that displayed exclusive corneal invasive growth without evidence of conjunctival tumors other than primary acquired melanosis. Impression cytology aided in the initial diagnosis. The patient underwent surgical treatment. Histopathology and immunohistochemistry revealed an invasive amelanotic melanoma limited to the cornea and exhibiting S-100, Melan A, and HMB-45 positivity. The absence of pigmentation delayed early clinical detection and treatment. Awareness of this nonpigmented melanoma is important for early recognition and appropriate management.

Estudo dos achados oculares na síndrome de Stevens-Johnson em pacientes de centro de referência de atendimento terciário

PURPOSE: To evaluate the epidemiology, possible etiologic factors, complications and treatment of a group of patients with ocular complications secondary to Stevens-Johnson syndrome. METHODS: Twenty-two consecutive patients with Stevens-Johnson syndrome were studied. The patients were examined according to the following protocol: identification, previous clinical history, systemic and ophthalmologic manifestations and possible etiologic factors. RESULTS: A total of 22 patients with Stevens-Johnson syndrome were identified. Fifteen patients (68%) were female, 7 (32%) male. Ten patients were caucasian (45.4%), 9 brownish (22%), 2 black (9%) and 1 yellow (4.5%). Mean age was 27.1 (8 to 62). Medications were the most commonly identified etiologic factor (90.9%), followed by skin herpetic infection (4.5%) and idiopathic (4.5%). Dipirone (36.3%) was the most frequently identified agent, followed by seizure medications (22.7%), non-steroidal anti-inflammatory drugs (13.6%), sulfonamides (9.0%), penicillin (4.5%), spironolactone (4.5%) and dihydroprogestagen and stradiol (4.5%). Twenty-one patients (95.4%) had ophthalmologic complications and sixteen patients (72.7%) underwent ophthalmologic surgical procedures. CONCLUSIONS: The results of this study show important epidemiological aspects of Stevens-Johnson syndrome in our environment, specially related to age, etiology and ocular complications.

Punções do estroma anterior no tratamento da ceratopatia bolhosa

Objetivo: Avaliar o efeito terapeutico das puncoes do estroma anterior corneal em pacientes com ceratopatia bolhosa (CB). Metodos:Vinte e cinco pacientes com CB sintomaticos, com baixa visao, com e sem indicacao de transplante de cornea, foram avaliados antes, uma, 4 e 12 semanas apos puncoes estromais anteriores realizadas com agulha #25 a lâmpada de fenda. Em cada visita, os pacientes foram questionados sobre intensidade da dor, fotofobia, sensacao de corpo estranho, alem de serem submetidos a exame oftalmologico completo, estesiometria e paquimetria. Resultados: As comparacoes realizadas entre os valores antes e apos o procedimento referentes a dor (p<0,001), fotofobia (p=0,0198), sensacao de corpo estranho (CE) (p<0,001), insonia (p=0,0015) e estesiometria (p=0,00654) apresentaram diferencas estatisticamente significantes quanto a diminuicao desses sintomas e da sensibilidade corneal. A paquimetria media nao apresentou diferenca estatisticamente significante entre as avaliacoes antes e apos as puncoes estromais (p=0,873). Nao foram observadas alteracoes importantes na vascularizacao corneal apos o procedimento. Conclusao: As puncoes do estroma anterior da cornea representam uma modalidade efetiva, simples e de baixo custo para o tratamento dos pacientes com CB sintomaticos.

Conjunctival Follicular Lymphoma after Treatment for Invasive Squamous Cell Carcinoma

Backgrounds/Aims: The authors describe the case of a 79-year-old Caucasian woman who presented an ocular adnexal lesion as the first clinical manifestation of a systemic follicular lymphoma, highlighting the clinicopathological features of this rare entity and its potential to be misdiagnosed as marginal zone lymphoma of the mucosa-associated lymphoid tissue. Methods: Conjunctival impression cytology was performed for a rapid initial diagnosis of lymphoma, and subsequent histopathological and immunohistochemical studies were carried out for its confirmation and to identify the best therapeutic regimen. Results: After the initial presentation and diagnosis, she was submitted to complete clinical evaluation; confluent retroperitoneal lymphadenopathy was detected through abdominal computed tomography, characterizing clinical stage III. Conclusion: Awareness of this lymphoma is important when making a diagnosis of ocular adnexal lymphoid neoplasms for its appropriate evaluation and management.

Alterações motoras após cirurgia refrativa no paciente estrábico

PURPOSE: To evaluate patients with strabismus submitted to excimer laser refractive procedure. METHODS: Complete eye examination was performed, including motor and sensorial evaluation in 15 patients from October, 2000 to September, 2001. Follow-up was at least 6 months after excimer laser procedure. Patients who had been submitted to laser were named the first group and those who were seen before laser formed the second group. RESULTS: All patients of the first group required strabismus surgery in order to control symptoms of double vision or to correct the ocular deviation. The majority of the patients of the second group had worsening of their sensorial condition and some also presented worsening of their motor conditions. Half of the patients of the second group showed some relief of astenopia when eyeglasses for near were used. Those with accomodative esotropia did not have any or had less symptoms after the laser procedure and the follow-up showed more stable clinical feature. CONCLUSIONS: Refractive surgeons must select their patients and avoid underestimating some conditions that might compromise fusion capability after laser. We recommend motor and sensorial evaluation as part of their preoperative work up for candidates for refractive surgery.