Paulo Elias Correa Dantas

Tendência de mudança nas indicações de transplante penetrante de córnea

PURPOSE To identify the indications for penetrating keratoplasty at the Department of Ophthalmology of the Santa Casa of São Paulo from January 1996 to December 2005 and to compare them with those from January 1991 to December 1995. METHODS Charts of patients who had undergone penetrating keratoplasty from January 1996 to December 2006 were retrospectively reviewed. RESULTS There were 587 keratoplasties done in this period. The average age of patients was 49.6 +/- 21.1 years (range 1 to 91 years). The most common indications were infectious keratitis (17.9%), trauma (16%), pseudophakic bullous keratopathy (14.7%), keratoconus (13.1%), regrafts (12.8%) and herpetic keratitis (6.6%). CONCLUSION The leading indications for penetrating keratoplasty were infectious keratitis, trauma, bullous keratopathy, herpetic keratitis. There was a decreasing trend in penetrating keratoplasty for keratoconus and regraft during the last 10 years.

Ipsilateral limbal translocation for treatment of partial limbal deficiency secondary to ocular alkali burn

BACKGROUND/AIM Chemical ocular burn, especially by alkali, may result in damage to the limbal stem cells, fundamental in maintaining the integrity of ocular surface. Clinically, patients manifest abnormal conjunctival-corneal healing with peripheral neovessels, chronic epithelial defect, severe stromal inflammation, and conjunctivalisation of the corneal, which is characteristic of limbal deficiency. Penetrating keratoplasty has a poor prognosis in these cases. Available therapeutic options included limbal autograft and allograft transplantation associated or not with human amniotic membrane transplant. The authors propose an alternative treatment with ipsilateral autologous limbal transplantation, transferring the healthy portion of the limbus from the partially burned eye to the deficient area in patients with partial limbal deficiency secondary to alkali burn. METHODS Ipsilateral limbal autografts were performed in five patients with partial limbal deficiency secondary to alkali burn, transferring the healthy portion of the limbus to the burned area of the same eye, without intervening in the contralateral eye. RESULTS All cases had regression of the limbal deficiency with improvement of visual acuity to a minimum of 20/60–20/20 (partial), without complications during the follow up period (range 7–11 months). CONCLUSION Ipsilateral autologous limbal autograft is a therapeutic option for partial limbal deficient eyes.

Antibacterial activity of anesthetic solutions and preservatives: an in vitro comparative study.

Purpose. To investigate the antibacterial activity of topical anesthetic solutions and their preservatives individually in vitro, to determine involvement with bacterial growth inhibition. Material and Methods. Proparacaine and tetracaine (in concentrations of 0.125%, 0.25%, and 0.50%), edetate disodium (EDTA), benzalkonium chloride, EDTA + benzalkonium chloride, and sterile saline solution were used. Five microliters of each solution were applied to standard filter paper disks and placed in Mueller–Hinton agar previously inoculated with known strains of Pseudomonas aeruginosa and Staphylococcus aureus. Zones of growth inhibition were measured 24 hours later and analyzed. Results. There were no zones of inhibition in the agar inoculated with P. aeruginosa to all tested solutions. Benzalkonium chloride alone and associated with EDTA inhibited growth of S. aureus. All other solutions did not inhibit S. aureus. Conclusion. Preservative-free anesthetic solutions seemed not to interfere with bacterial development in culture media. Benzalkonium chloride alone and associated with EDTA inhibited development of gram positive bacteria, S. aureus, but did not inhibit P. aeruginosa.

Surgical resection of giant papillae and autologous conjunctival graft in patients with severe vernal keratoconjunctivitis and giant papillae.

Purpose Giant papillae (GP) in patients with vernal keratoconjunctivitis (VKC) refractory to clinical treatment may cause serious corneal complications, such as shield ulcer. We propose a surgical treatment—resection of GP—in conjunction with free autologous conjunctival graft to treat severe cases of VKC with GP. Methods Six eyes of five patients with VKC, characterized by GP and shield ulcer refractory to clinical treatment, underwent surgical resection of GP associated with free autologous conjunctival graft. Results No recurrence of GP over the graft was observed during follow-up intervals ranging from 9 months to 27 months. Corneal shield ulcers healed during the first week after treatment and did not recur. Conclusions Patients with refractory VKC and GP associated with corneal shield ulcer may benefit from resection of GP and autologous conjunctival graft.

Spontaneous bilateral corneal perforation of acute hydrops in keratoconus.

Purpose. To report an uncommon case of bilateral spontaneous corneal perforation in keratoconus. Design. Interventional case report. Method. A 63-year-old man with a long history of keratoconus (more than 30 years) experienced acute hydrops and corneal perforation in his right eye. One year later, he had the same clinical features in his left eye. Results. After initial treatment with cyanoacrylate glue and bandage soft contact lenses, therapeutic penetrating keratoplasty was performed with good visual outcome in both eyes. Conclusion. Special attention should be paid to the possibility of spontaneous corneal perforation during acute hydrops in patients with severe corneal thinning, biomicroscopic findings of advanced disease, and high keratometry readings.

Ten-year follow-up of a case series of primary epithelial neoplasms of the lacrimal gland: clinical features, surgical treatment and histopathological findings

PURPOSE To describe and analyze the features of a cases series of patients with primary epithelial neoplasms of the lacrimal gland, its surgical treatment, and histopathological findings. METHODS Retrospective evaluation of files from patients with primary epithelial neoplasms of the lacrimal gland in the period from 1997 to 2007. All patients with primary epithelial tumors of the lacrimal gland were included in this study. Data on gender, age, clinical features, surgical treatment, histopathological findings and follow-up were collected. The slides with histological sections of the tumors were reviewed by the same pathologist. RESULTS During the study period, there were 12 patients, 5 (41.7%) with benign tumors, all pleomorphic adenomas (benign mixed tumor) and 7 (58.3%) with malignant neoplasms, thus distributed: four cases of adenoid cystic carcinoma, two of mucoepidermoid carcinoma and one carcinoma expleomorphic adenoma. Globally, patients mean age was 54.1 years-old (ranging from 14 to 70 years-old), with mean age of 52.4 years-old (ranging from 14 to 65 years-old) for benign neoplasms, and 55.3 years-old for malignant neoplasms (ranging from 26 to 70 years-old). Clinical follow-up information, ranging from 2 to 10 years-old, was available for all patients. Three patients developed distant metastasis and died of disease. CONCLUSIONS The most frequent primary epithelial neoplasms of the lacrimal gland were pleomorphic adenoma and adenoid cystic carcinoma during the study period. Malignant tumors were more frequent than benign tumors. The histopathological diagnosis and the disease initial stage can play a significant role in patients survival.

Retrobulbar Anesthesia With a Flexible Catheter

BACKGROUND AND OBJECTIVES The authors describe a method that seeks to improve the administration of local anesthesia for intraocular surgery, avoiding the risk of potential complications associated with retrobulbar and peribulbar techniques and eliminating the inconveniences of the new methods such as subconjunctival and limbal infiltration. PATIENTS AND METHODS The authors demonstrate the safety and effectiveness of this technique in 50 consecutive cases. This technique consists of a small, blunt dissection of the conjunctiva, Tenons capsule, and intermuscular septum in the inferior nasal quadrant, followed by the insertion of a flexible catheter that is guided to the retrobulbar space, where 3.0 ml of anesthetic solution is injected. RESULTS All of the patients (100%) felt that this procedure was comfortable and painless. No complications were observed. Ultrasonography demonstrated the exact catheter position in the retrobulbar space; therefore, the authors could be sure that this anesthetic infiltration was done in the appropriate and safe place. CONCLUSIONS This is a direct sub-Tenons technique that is simple, effective, and safe and that avoids introducing a sharp or metallic instrument into the orbit.

Diagnóstico e tratamento da síndrome de Sjögren

Sjogrens syndrome is a systemic inflammatory autoimmune disease with worldwide distribution, responsible for considerable impact on the patients quality of life. The aim of this article is to describe its main symptoms, the currently used different diagnostic criteria and the available treatment for the syndrome.Sjögrens syndrome is a systemic inflammatory autoimmune disease with worldwide distribution, responsible for considerable impact on the patients quality of life. The aim of this article is to describe its main symptoms, the currently used different diagnostic criteria and the available treatment for the syndrome.

Efeito terapêutico da aplicação intra-ocular de ozônio em modelo experimental de endoftalmite por Staphylococcus epidermidis em coelhos

PURPOSE: To evaluate the anti-inflammatory and antimicrobial effect of intraocular ozone diluted in BSS on experimental Staphylococcus epidermidis endophthalmitis. METHODS: We injected 0.1ml of S. epidermidis colonies (105 colonies/ml) to produce experimental endophthalmitis in the right eyes of 17 New Zealand rabbits. Seven rabbits were assigned to a control group and received an intravitreal injection of 0.1ml BSS. Ten rabbits were treated with intravitreal injection of 0.1ml BSS-diluted ozone (2 ppm). Data were distributed according to clinical and histological findings after 24 hours, each rabbit receiving a score. Mean scores and standard deviations were compared using the two-sample t test. RESULTS: Mean clinical score for the control group was 11.14 ± 1.04. Mean clinical score for the treated group was 4.90 ± 1.29, which was significantly lower (p<0.01). Mean histological scores were, respectively, 17.00+ 0.57 and 10.20 ±1.30 for the control group and the treated group. The histological scores were significantly lower for the treated group (p<0.01). All cultures in both control and ozone groups were positive after 24 hours of experiment. CONCLUSION: Treatment with diluted ozone significantly reduced the inflammatory reaction in our model of experimental endophthalmitis. This probably occurred due to a decrease in bacterial content after ozone injection. It is necessary to study other ozone concentrations in different experimental models in order to determine ozone efficacy with a higher precision.

Efeito do mel e do soro autólogo na cicatrização do epitélio corneano em coelhos

PURPOSE: To evaluate the efficacy of pure honey and 20% autologous serum and BSS® in corneal epithelial healing in rabbits after 48 hours. METHODS: All solutions were applied after an epithelial removal of 13-millimeters diameter area. Areas of epithelial healing were studied at 12, 24 and 48 hours. The eyes were treated every four hours during 2 days. All treated eyes were assigned to a control group (contralateral eye) treated with a balanced saline solution. RESULTS: All studied groups were not significantly differents. In group one, the eyes treated with honey and the control were similar (p<0.87). In the second group the eyes treated with autologos serum and the control presented no difference in the mean score (p<0.072). CONCLUSION: Corneal epithelial healing in rabbits did not show improvement after application of either honey or autologous serum. It was possible to stabilish that the autologous serum treated eyes were clinicaly better than the control group but without statistical significance.