Marinho Jorge Scarpi

Avaliação da resolutividade e da satisfação da clientela de um serviço de referência secundária em oftalmologia da Universidade Federal de São Paulo - UNIFESP

Universidade Federal de Sao Paulo (UNIFESP) Centro de Referencia Secundaria em Oftalmologia

Microbiota bacteriana da conjuntiva de doadores de córnea

PURPOSE: To identify and qualify bacterial organisms in conjunctival tissue of donor corneas. To correlate the frequency of positive cultures with donor age, cause of death, and time from death to collection of conjunctival samples. To investigate bacterial susceptibility to specific antibiotics. METHODS: Conjunctival samples obtained from the inferior conjunctival fornix of 242 eyes of cornea donors were collected between January and March, 1994. The samples were transferred to Stuart´s medium and then inoculated into blood, acid blood, chocolate, McConkey agars, and thioglycolate broth. Donor age, time and cause of death were recorded. Bacterial susceptibility to antibiotics was tested using the diffusion method on agar modified by Kirby and Bauer. Statistical analysis was done using the chi-square, Fishers exact and Mann-Whitney tests. RESULTS: Microorganisms were identified in 91.7% of the samples. The most frequently isolated microorganism was coagulase-negative Staphylococcus (27.3%). Time from death to collection of the conjunctival sample was on the average 4.2 hours. The most frequent cause of death was cardiovascular disease (26.4%). The median donor age was 62 years. No significant correlation between positive cultures and the investigated variables was found. Vancomycin inhibited bacterial growth in 100% of Gram-positive microorganisms. The sensitivity of Gram-negative bacteria to gentamicin ranged from 36.7 to 92.3%. CONCLUSION: The frequency of positive conjunctival cultures of donor corneas was 91.7%. No significant statistical difference was found between positive cultures and the investigated parameters. Vancomycin inhibited the growth of Gram-positive bacteria in 100% of the cases and the sensitivity of Gram-negative bacteria to gentamicin varied.

Associação entre dois diferentes tipos de estrangulamento com a variação da pressão intraocular em atletas de jiu-jitsu

PURPOSE To verify the association between two different types of strangling with intraocular pressure variation in jiu-jitsu athletes. METHODS An observational study was performed on 9 athletes of jiu-jitsu, with at least 6 month of training, male, aged 20 to 30 years, without any physical and eyeball lesions. Associations between intraocular pressure and Cross Choke from the guard strangling (E1), and E2 - Cross Choke from mount strangling were gotten. Intraocular pressure was determined by using Perkins tonometer, at first in the absence of physical exercise over the last 24 hours and after each strangling. Then it was carried out the intraocular pressure measure at each 3 minutes, during 12 minutes of exercise recovery (R1, R2, R3, and R4) keeping the athletes lied down. Statistical analysis was done using ANOVA test and Bonferroni post-test. RESULTS Meaningful reduction of both eyes intraocular pressure occurred at the E2 situation comparing to the E1 situation at all exercise recovery measures: R1 (OD: 8.22 +/- 1.39 vs.11.33 +/- 2.00 / OE: 8.55 +/- 1.23 vs. 11.88 +/- 1.90), R2 (OD: 8.44 +/- 1.87 vs.10.22 +/- 2.53 / OE: 9.00 +/- 1.80 vs. 10.44 +/- 2.35), R3 (OD: 8.44 +/- 1.74 vs.9.78 +/- 2.54 / OE: 8.55 +/- 1.42 vs. 10.33 +/- 1.93) all with p<0,01 e R4 (OD: 8.88 +/- 2.08 vs.9.55 +/- 2.87 / OE: 9.11 +/- 1.53 vs. 10.44 +/- 2.18) with p<0.05. Meaningful IOP reduction (p<0.05) was observed at the R1 moment of E2 strangling (OD: 10.77 +/- 1.92 vs.8.22 +/- 1.39 / OE: 11.44 +/- 1.94 vs. 8.55 +/- 1.23). CONCLUSION There is association between intraocular pressure and jiu-jitsu strangling exercises, with intraocular pressure reduction.

Usefulness of corneal esthesiometry for screening diabetic retinopathy

OBJECTIVE To assess the usefulness of corneal esthesiometry for screening diabetic retinopathy. METHODS A cross-sectional study was carried out comprising 575 patients attending a diabetic retinopathy-screening program in the city of São Paulo. Corneal esthesiometry was assessed with the Cochet-Bonnet esthesiometer. The presence of diabetic retinopathy was detected with indirect fundoscopy. The validity of corneal esthesiometry in identifying diabetic retinopathy was evaluated by the Receiver Operating Characteristic (ROC) curve. RESULTS Sensitivity and specificity analyses of the corneal esthesiometry for detecting the stages of diabetic retinopathy using different cut-offs showed values less than 80%. The best indices (72.2% sensitivity and 57.4% specificity) were obtained for the identification of patients with proliferative diabetic retinopathy. CONCLUSIONS In the study series, corneal esthesiometry was not a good indicator of diabetic retinopathy.

Transplante de córnea em ceratocone: avaliação dos resultados e complicações obtidos por cirurgiões experientes e em treinamento

PURPOSE: Refractive and visual analysis in corneal transplantations performed for keratoconus by two groups of surgeons. METHODS: Seventy eyes of seventy patients, which had been submitted to penetrating keratoplasty (PK) for keratoconus, were examined and their charts were reviewed retrospectively for long-term results after all sutures had been removed. The patients were divided into two groups, Group I had surgery performed by skillful surgeons and Group II by surgeons in training. The results of best correct visual acuity, refractive error, postoperative complications and computerized videokeratoscopy were compared. RESULTS: The mean follow-up was 7.9 years with a range of 1.6 - 20 years. Each group consisted of 35 eyes. There were 35 females and 35 males. The donor age was different between the two groups. The surgical technique was the same in both groups, but the number of sutures was different. Preoperative mean logMAR visual acuity was low in the two groups, but statistically different and no relationship was found between the results. All the refractive, topographic and visual acuity results were similar between both groups. Endothelial rejection was more frequent in Group II. Only three grafts lost graft clarity. These patients belonged to Group II. CONCLUSION: In a corneal referral practice, the visual results after PK were similar to those related to the PK performed by either expert surgeons or in training.

Variação da pressão intraocular após teste submáximo de força no treinamento resistido

ABSTRACT Purpose: To verify the intraocular pressure (IOP) after sub-maximal strength test. Methods: 145 Physical Educationfreshmen (22.04 ± 4.17 years old; female and male) from Supe-rior Physical Education School of Jundiai (ESEFJ) were eva-luated in an observacional study. The exclusion criteria were:media opacity and eyeball absence or changes. All subjectsagreed to take part in this research and signed up the InformedConsent. IOP was measured by Perkins tonometer: i) pretest:just before the submaximal strength test performance and ii)post-test: immediately after the strength test. The strength testconsisted in the one-repetition-maximum-assessment throughrepetition until fatigue. Resistance training exercises such asbench press, pulley dorsal high, shoulder press, arm curl andleg press 45o were performed. Statistical analyses were obtai-ned through paired Student’s “t” test. Results: Decrease ofIOP was observed after the strength test: 13.48 ± 3.32 vs.10.20 ±3.72 (p<0.001) in the right eye and 13.13 ± 3.96 vs.9.74 ± 3.33(p<0.001) in the left eye.

Achados oculares em crianças de zero a seis anos de idade, residentes na cidade de São Caetano do Sul, SP

OBJETIVO: Determinar a prevalencia de erros refrativos, estrabismo, ambliopia e anisometropia nas criancas pertencentes a populacao em estudo, utilizando dois metodos de rastreamento (triagem na escola e triagem durante o dia da vacinacao contra a poliomielite). METODOS: Foram examinadas 2.640 criancas, residentes da cidade de Sao Caetano do Sul, entre zero e seis anos de idade, divididas em duas amostras (A e B). A amostra A consistiu de 476 criancas que foram examinadas por dez oftalmologistas e onze tecnicos oftalmicos, durante o Dia Nacional de Vacinacao (20 de junho de 1998) contra a Poliomielite. A amostra B consistiu de 2.164 criancas que frequentavam escolas municipais, entre quatro e seis anos de idade e foram examinadas por dois oftalmologistas durante o ano de 1998. RESULTADOS: Na amostra A, a prevalencia de estrabismo foi de 3,36% e de anisometropia foi de 1,26%. O principal tipo de erro refrativo encontrado foi a hipermetropia < 2D. Necessitaram de prescricao optica 14,11% das criancas. Em relacao a amostra B, a prevalencia de estrabismo foi de 1,43%. Nas criancas que falharam na triagem, a prevalencia de ambliopia foi de 1,39%, 2,8% de anisometropia e necessitaram de prescricao optica, 56,48%. O principal tipo de erro refrativo encontrado foi o astigmatismo hipermetropico composto. CONCLUSAO: Embora em municipio com perfil socioeconomico privilegiado, a prevalencia de estrabismo, anisometropia, ambliopia e erro refrativo nao foi inferior a relatada na literatura. Com relacao a metodologia de rastreamento, o Dia Nacional de Vacinacao contra a Poliomielite mostrou-se eficiente ferramenta metodologica ja que houve grande participacao da populacao alvo.

Prevalência de tracoma em crianças pré-escolares e escolares da periferia da cidade de Joinville, Estado de Santa Catarina, Brasil

Joinville e a maior cidade do Estado de Santa Catarina. Gracas ao seu desenvolvimento industrial, principalmente nos ultimos 15 anos, a cidade tem recebido muitos migrantes vindos de area rurais, na maioria dos Estados de Santa Catarina e Parana. Um estudo de prevalencia de tracoma foi realizado entre 2.822 criancas pre-escolares e escolares, com idade variando de 3 meses a 15 anos (media igual a 8,4 anos), que frequentavam 6 instituicoes educacionais publicas localizadas em diferentes regioes da periferia de Joinville. 53,2% das criancas eram do sexo masculino. O tracoma foi avaliado de acordo com o esquema simplificado de gradacao da OMS. A prevalencia de TF foi de 7.9% e a de TS foi de 1,1%. Nao se observou TI, TT ou CO. 65% das criancas tracomatosas eram procedentes de centros urbanos e 35% eram de areas rurais. A citologia com a coloracao pelo anticorpo monoclonal fluorescente foi positiva em 57% dos casos de TF

The change in axial length in the pseudophakic eye compared to the unoperated fellow eye in children with bilateral cataracts

PURPOSE To compare the change in ocular axial length of the pseudophakic eye versus the fellow eye in children with bilateral cataracts who had surgery in only one eye. METHODS In this prospective cohort study, 50 eyes of 25 children with bilateral lamellar cataracts were analyzed. A complete ophthalmic examination and evaluation of axial length measurements by contact ultrasound biometry were performed in all eyes undergoing cataract surgery with IOL implantation and in contralateral eyes. The primary outcome measure was the percentage rate of growth between the final and initial measurements, defined as the initial minus the final measurement, with the difference being divided by the initial measurement and the result multiplied by 100. RESULTS Children aged 4-10 years of age were followed for a mean of 28.5 months. The values for axial length percentage rate of growth were significantly lower in pseudophakic eyes than in the unoperated, contralateral eyes (0.64% vs 2.09%, P < 0.05). Final visual acuity, follow-up time, and initial axial length did not affect the results. Pseudophakic eyes with posterior capsule opacification that underwent neodymium YAG laser showed a significantly higher rate of growth than unoperated eyes. CONCLUSIONS Axial length in children older than 4 years showed a trend toward stabilization, with lower changes in axial length measurements in pseudophakic eyes and a higher rate of axial growth in contralateral eyes.

Aspectos epidemiológicos do traumatismo ocular fechado contuso

Purpose: To describe the epidemiologic aspects of closed-globe injury with contusion and its alterations. Methods: Forty patients with closed-globe injury, were analyzed prospectively between January 1998 and February 1999. They were attended at the Ocular Trauma Outpatient Clinic of the Department of Ophthalmology of the Escola Paulista de Medicina-Federal University of Sao Paulo. A complete ophthalmologic examination was performed in all patients and they were classified according to the new classification proposed by Pieramici et al (1997). Results: Sixty-seven and a half percent (67.5%) of the studied patients were less than 30 years old. The main causes were: accidents at home and acts of violence with 32.5% each. In relation to visual acuity, with best correction, 60.0% of the patients did not achieve 20/100 visual acuity. Seventy-five per cent (75.0%) showed improvement in visual acuity during follow-up and most in less than 1 month. Fifty-two and a half percent (52.5%) were classified as zone III. Fifty percent (50%) of the patients developed hyphema and 67.5% had some grade of angle recession, higher than 180° in 30.0%. Conclusions: In relation the patients attended at the Ocular Trauma Outpatient Clinic of the Federal University of Sao Paulo Escola Paulista de Medicina, more than 13 years old, males, with closed-globe injury we may conclude: 1. it is more prevalent in adults; 2. the main causes were domestic accidents and violence (32.5% each); 3. it presents good visual acuity recovery, except for zone III patients; 4. fifty per cent developed hyphema; 5. more than a half had angle recession (67.5%) and 30.0% had angle recession over 180°.