Newton Kara-José

Prognostic Factors in Open Globe Injuries

Purposes: To evaluate the main factors related to visual outcome after open globe injuries (excluding intraocular foreign bodies). Methods: Retrospective study analyzing consecutive ocular lacerations, primarily repaired in this institution, between January 1993 and January 2000. Of the 364 cases, 283 (77.75%) lacerations were statistically analyzed, correlating the preoperative variables with the postoperative visual acuity (VA). Excluded from this study were all patients with less than 6 months of follow-up, previous ocular surgery, unreliable information on VA, intraocular foreign bodies and endophthalmitis. When a bilateral injury was detected, only 1 eye was randomly chosen. Results: It was observed, after statistical analysis (multivariate analysis), that the most important factors related to postoperative poor VA (less than 20/100) were: the length of the laceration, the elapsed time between the injury and the surgery and the presence or absence of vitreous loss, cataract (lens damage), hyphema, laceration posterior to rectus muscle insertion and retinal detachment. Conclusion: With this study, it was possible to point out the most important factors related to visual prognosis in open globe injuries. The results found are similar to results previously reported.

Episclerite e esclerite

The most frequent scleral diseases are inflammatory, divided into episcleritis and scleritis. Episcleritis is a benign disease, with inflammatory response of the superficial episcleral tissue. On the other hand, scleritis is a progressive severe disease, with inflammatory response of superficial, deep epis cleral and scleral tissues. The association with systemic rheumathological diseases requires systematic clinical approach of patients with scleral inflammation.The most frequent scleral diseases are inflammatory, divided into episcleritis and scleritis. Episcleritis is a benign disease, with inflammatory response of the superficial episcleral tissue. On the other hand, scleritis is a progressive severe disease, with inflammatory response of superficial, deep epis cleral and scleral tissues. The association with systemic rheumathological diseases requires systematic clinical approach of patients with scleral inflammation.

Cirurgia de catarata: o porquê dos excluídos

Cataracts are the main cause of blindness in the world, although they can be treated with relatively simple and inexpensive surgery. This study was carried out in 1997 and 1998 in five cities in the state of São Paulo, Brazil, to identify the reasons for persons not having cataract surgery. The population studied were patients seen at a community project for the rehabilitation of cataract-caused blindness, Projeto Zona Livre de Catarata (the Cataract-free-Zone Project). A questionnaire was used to interview 776 individuals with cataracts who sought assistance at the project and who had a visual acuity of 20/100 or less in the better eye. Six hundred and eighty-three patients had previously sought ophthalmic care, most frequently (27%) at public health services. The main reasons for subjects not having had cataract surgery were financial (69% of respondents) and the feeling of still having good eyesight (69% of respondents). Among patients who said they were afraid of surgery, the main reason was concern about being left blind. All the subjects whom the project deemed suitable for surgery agreed to undergo the procedure. Apparently, there is a gap between searching for ophthalmic services and the surgical resolution of cataracts. The predominant reasons for not having surgery were financial and logistical. There is a need to facilitate access to cataract surgery by decentralizing social services and by developing community projects to prevent cataract-caused blindness.A catarata e a principal causa de cegueira no mundo, embora seja passivel de recuperacao por intervencao cirurgica relativamente simples e de baixo custo. O presente estudo, realizado em 1997 e 1998 em cinco municipios do Estado de Sao Paulo, Brasil, teve o proposito de identificar as razoes para a falta de acesso ao tratamento cirurgico por parte dos deficientes visuais por catarata senil. Foram entrevistados pacientes atendidos em um projeto comunitario de reabilitacao da cegueira por catarata, o Projeto Zona Livre de Catarata. Obteve-se uma amostra prontamente acessivel, composta por 776 sujeitos que procuraram a assistencia do projeto e que apresentavam acuidade visual menor do que 0,2 no olho melhor (media de idade = 70 anos). Foi aplicado um questionario por entrevista. Dentre os pacientes, 683 haviam procurado atendimento oftalmologico antes do Projeto Catarata; o tipo mais comum de atendimento procurado foi o servico publico de saude (27%). Dificuldades financeiras (69%) e ainda enxergar bem (69%) foram as razoes predominantes alegadas pelos pacientes para nao terem se submetido a cirurgia de catarata. Dentre os que manifestaram receio da cirurgia, a principal alegacao foi medo de ficar cego. Todos os pacientes que receberam indicacao cirurgica no periodo do estudo concordaram em se submeter a cirurgia. Aparentemente, existe uma lacuna entre a busca de servicos oftalmologicos e a resolucao cirurgica da catarata. Os fatores predominantes para a nao realizacao da cirurgia foram economicos e logisticos. E necessario facilitar o acesso da populacao a cirurgia de catarata por meio de modelos assistenciais descentralizados e de projetos e campanhas comunitarias de prevencao da cegueira por catarata.

Endoscopic study of the intranasal ostium in external dacryocystorhinostomy postoperative. Influence of saline solution and 5-fluorouracil

PURPOSEnTo study, through endoscopy, the postoperative structural changes of the intranasal ostium following external dacryocystorhinostomy and to evaluate the influence of saline solution and 5-fluorouracil.nnnMETHODSnFifty patients were distributed into the following groups: Group SS-dacryocystorhinostomy and an injection of saline solution during surgery (13 patients); Group 5--FU1-dacryocystorhinostomy and an injection of 5 fluorouracil during surgery (17 patients); Group C--dacryocystorhinostomy only (11 patients); Group 5--FU3-dacryocystorhinostomy and 3 injections, 1 during surgery and 1 on the third and fifth postsurgical days (9 patients).nnnRESULTSnPair-wise group comparisons using the nonparametric Mann-Whitney test revealed that there was a significant reduction of the ostium area only in Group 5-FU1 vs. Group SS on the 60th postoperative day (P <.01); however, a comparative study among the 4 groups using the Kruskal-Wallis test showed no significant changes in the ostium area on the 60th postoperative day. The ostium area within groups at the 30th vs 60th postoperative day was significantly reduced for Group C (P < .05; Mann-Whitney test); no significant changes were found for the other groups.nnnDISCUSSIONnThese results suggest that the use of 5-fluorouracil in external dacryocystorhinostomy does not significantly influence the final size of the surgical fistula as determined 2 months postsurgery.

Are routine preoperative medical tests needed with cataract surgery

OBJECTIVEnThe objective of this study was to investigate whether routine medical testing before cataract surgery reduces the rate of complications during the perioperative period in adults.nnnMETHODSnThe study was carried out in an academic medical center in Brazil, between 10 February 2000 and 10 January 2001. The scheduled cataract operations were randomly assigned to one of two groups: 1) to be preceded by routine testing (the routine-testing group) or 2) not to be preceded by routine medical testing (the selective-testing group). If the patient was assigned to the selective-testing group, it was requested that no preoperative testing be performed unless the patient presented with a new or worsening medical problem that would warrant medical evaluation with testing. In the case of patients assigned to the routine-testing group, three tests were requested: a 12-lead electrocardiogram, a complete blood count, and measurements of serum glucose.nnnRESULTSnThe sample of 1,025 patients scheduled to undergo cataract surgery was comprised of 512 assigned to the routine-testing group and of 513 assigned to the selective-testing group. The two groups had similar proportions of operations canceled and not subsequently rescheduled, 2% in each group. The cumulative rate of medical events was similar in the two groups, 9.6% in the routine-testing group and 9.7% in the selective-testing group (P = 0.923). The types of medical events were also similar in both groups.nnnDISCUSSIONnThe results of this study suggest that routine medical testing before cataract surgery does not reduce the rate of complications during the perioperative period. The results also suggest it would be more efficient not to request routine preoperative tests unless indicated by patient history or physical examination.

Case-control study of subconjunctival triamcinolone acetonide injection vs intravenous methylprednisolone pulse in the treatment of endothelial corneal allograft rejection

PurposeTo assess the safety and effectiveness of treating corneal endothelial rejection with a subconjunctival injection of 20u2009mg triamcinolone acetonide in combination with topical application of 1% prednisolone acetate, as compared to treatment with an intravenous pulse of 500u2009mg methylprednisolone in combination with topical application of 1% prednisolone acetate.MethodsA case–controlled study including a literature review was performed. Patients who presented with an initial episode of corneal endothelial rejection were treated with subconjunctival injection of 20u2009mg triamcinolone in combination with topically applied 1% prednisolone and were retrospectively matched for age and diagnosis to patients who received a single intravenous injection of 500u2009mg methylprednisolone in combination with topical 1% prednisolone. Patients were analysed regarding reversion of the rejection episode, intraocular pressure, and visual acuity after 1 year.ResultsOverall, the triamcinolone group had a better outcome regarding reversion of corneal transplant rejection (P=0.025), with 15 of 16 patients in the triamcinolone group having clear grafts, compared to only 10 of 16 patients in the methylprednisolone group. Intraocular pressure (IOP) was increased in both groups at day 30 (P=0.002), although there was no statistically significant difference in IOP between the groups (P=0.433). Visual acuity improved in both groups after 1 year (P=0.049), although slightly more improvement was observed in the triamcinolone group (P=0.002).ConclusionsThe results observed in this case–controlled study suggest that the use of subconjunctival triamcinolone acetonide may benefit patients with corneal transplant rejection.

Antifúngicos em infecções oculares: drogas e vias de administração

O tratamento das infeccoes oculares por fungos representa um desafio a pratica oftalmologica. Para obtermos resposta terapeutica adequada, alem do uso da droga correta, e necessaria a administracao desta de forma eficaz. Este manuscrito reune informacoes a respeito das principais drogas antifungicas utilizadas em infeccoes oculares, suas concentracoes e principais vias de administracao.1Post-graduation Programme in Ophthalmic Medical Sciences, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas/ SP, Brazil. 2Department of Ophthalmology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas/SP, Brazil. Institution: Work conducted at the University Hospital of the State University of Campinas (UNICAMP), Campinas/SP, Brazil. ABSTRACT

Suspensão de cirurgia de catarata e suas causas

Com o objetivo de verificar as causas de suspensao de cirurgia de catarata e sugerir medidas para melhorar a eficiencia do servico prestado a populacao, foi realizado um estudo transversal no servico de oftalmologia de um hospital universitario do Estado de Sao Paulo. A amostra foi composta por 200 individuos. A media de idade foi de 68± 11,4 anos. As causas de suspensao de cirurgia foram: condicao clinica desfavoravel (23,1%); horario cirurgico insuficiente (35,9%); e nao comparecimento do paciente (41%). Os fatores causadores foram, majoritariamente, as razoes sociais e o funcionamento do hospital.

Ocular health myths among a hospital staff

In order to evaluate their common beliefs in the field of ocular health, an exploratory survey was carried out among 122 professionals belonging to different ranks and specialty areas of the University of Campinas Clinical Hospital (UNICAMP-CH), São Paulo, Brazil. The non-structured questionnaire used asked about common ophthalmologic problems as well as the presence of popular myths about ocular health, such as: cure of visual problems by the use of glasses; reading under insufficient lighting or watching TV too much close to the apparatus is harmful; consequences from the intensive use of the eyes; or special food being needed for better vision. The results indicated the existence of various misconceptions, even among health professionals, such as: belief in the cure of refractive problems by the use of glasses (40.0%); or damage to vision due to insufficient lighting, watching TV too much close to the apparatus or from the intensive use of the eyes (86.7%). Among the professionals performing activities within the ophthalmology department, 62.5% admitted believing in visual damage as a result of conditions such as those mentioned above and 37.5% stated that reading in a moving vehicle is detrimental to vision. From these data, one is entitled to conclude that misconceptions continue to be present, even among professionals in the health area; this indicates that educational programs in ocular health should be provided, especially for individuals working within a hospital ophthalmological service.

Are routine preoperative medical tests needed with cataract surgery? Study of visual acuity outcome.

Purpose. The aim of this prospective randomized clinical trial was to investigate whether routine medical testing before cataract surgery reduced the rate of ocular surgical complications and to study its impact on visual acuity outcome. Methods. The study was carried out in an academic medical center in Brazil, at State University of Campinas, between 10 February 2000 and 10 January 2001. The scheduled cataract operations were randomly assigned to one of two groups: 1) to be preceded by routine medical testing (the “routine-testing group”) or 2) not to be preceded by routine medical testing (the “selective-testing group”). If the patient was assigned to the selective-testing group, it was requested that no preoperative testing be performed unless the patient presented with a new or worsening medical problem that would warrant medical evaluation with testing. In the case of patients assigned to the routine-testing group, three tests were requested: a 12-lead electrocardiogram, a complete blood count, and measurements of serum glucose. Ocular surgical complications, preoperative and postoperative best-corrected visual acuity were recorded on a standardized form. Results. The sample of 1025 patients scheduled to undergo cataract surgery was comprised of 512 assigned to the routine-testing group and of 513 assigned to the selective-testing group. The two groups had similar proportions of operations canceled and not subsequently rescheduled, 2% in each group. The cumulative rate of ocular surgical complications was similar in the two groups, 20.5% in the routine-testing group and 19.3% in the selective-testing group (p = 0.624). The preoperative and the postoperative best-corrected visual acuity were similar in both groups (p = 0.999 in the former and p = 0.664 in the latter). Conclusions. The results of this study suggest that routine medical testing before cataract surgery did not reduce the rate of ocular surgical complications and did not influence visual acuity outcome.