Rodrigo Pessoa Cavalcanti Lira

Adverse reactions of fluorescein angiography: a prospective study

PURPOSES To determine both the incidence of adverse reactions in patients who underwent fluorescein angiography for the first time and to determine whether systemic arterial hypertension, diabetes or allergy history increases the chance of reaction to intravenous fluorescein. METHODS Data collection was carried out between January 2001 and October 2002 in Recife, Brazil. Patients with prior fluorescein angiography history, pregnant patients or patients in use of corticosteroids, immunosuppressive or antihistamine drugs were excluded. RESULTS Out of 1,500 enrolled patients, 1,039 (69.3%) underwent the test for the first time. The mean age was 58 +/- 16 years and the median age was 60 years. Of these, 628 (60.4%) were women. Nausea occurred in 71 (6.83%) patients, vomiting in 14 (1.35%), urticaria in 11 (1.06%), bronchospasm in 4 (0.38%) and laryngeal edema in 1 (0.01%). Five patients presented more than one adverse reaction. Higher incidences of adverse reactions were observed in diabetic patients [p<0.002, RR=1.80 (CI=1.24-2.60)], patients with systemic arterial hypertension [p<0.002, RR=1.84 (CI=1.26-2.71)] and patients with allergy history [p<0.001, RR=3.90 (CI=2.70-5.63)]. CONCLUSIONS A cumulative incidence of 9.72% adverse reactions was observed in patients who had undergone this test for the first time. The presence of the allergy history, diabetes or systemic arterial hypertension increased the incidence of adverse reactions to the dye.

Clinical features, histopathological analysis and surgical treatment of a free floating vitreous cyst: a case report

The authors present a report of a 44-year-old female patient, with complaints of visual disturbances in the left eye. The symptoms were present for at least 5 years and worsened in the last 2 years, impairing her activities. The patient reported perception of a floating circle, which blurred her vision. There was no previous history of trauma, infectious or inflammatory disease. Clinical evaluation included physical examination, laboratory testing, abdominal ultrasonography, thorax X-ray and head tomography. Ophthalmologic examination consisted of visual acuity, motility tests, biomicroscopy, tonometry and indirect ophthalmoscopy. Complementary investigation was done with a and b scan ocular ultrasonography. The chosen therapeutic approach to excise the cyst was pars plana vitrectomy, successfully performed. Anatomopathologic analysis revealed a pigmented vitreous cyst, of possible congenital origin, described as a cystic choristoma from the primitive hyaloid system. Benign evolution, clinical findings and histopathological analysis corroborated the diagnostic hypothesis of a cystic choristoma of the primitive hyaloid system. Surgery (pars plana vitrectomy) was successful and the patient returned with visual acuity of 20/20 in both eyes, and with no further complaints.

Efficacy and safety of green laser photocoagulation for threshold retinopathy of prematurity

PURPOSE To report the efficacy and safety of green laser photocoagulation for threshold retinopathy of prematurity (ROP). METHODS We reviewed the clinical records of the neonates who had undergone green laser photocoagulation for threshold ROP at the Federal University of Pernambuco in Brazil between January 2004 and January 2006. All procedures were conducted with local anesthetic drops. The neonates were monitored throughout the procedure by a neonatologist. A frequency-doubled solid state laser, diode-pumped, with 532 nm wavelength was used. The presence of tunica vasculosa lentis or cataract were excluded before laser treatment. The following preoperative data were obtained for each patient: age, birth weight and the grade of ROP. Postoperative data included complications associated with the laser treatment, grade of ROP and evaluation whether further surgery was necessary due to failure of laser photocoagulation. RESULTS Twenty-two neonates underwent photocoagulation with green laser for threshold ROP. A total of 31 eyes were included in the study. The mean gestational age was 30 +/- 3 weeks and the mean birth weight was 1120 +/- 490 g. Regression of the disease after laser therapy was observed in 30 eyes (96.7%). Despite treatment one eye presented stage 4A. Only 7 eyes required repetitive laser therapy. No adverse effects such as burning anterior segment tissues or bleeding in the anterior chamber occurred. No posterior segment side-effects were observed. Cataract formation was not observed at the last follow-up examination. CONCLUSIONS Green laser photocoagulation remains an effective and safe alternative to red laser photocoagulation and to cryotherapy in the treatment of threshold ROP.OBJETIVOS: Avaliar a eficacia e seguranca da fotocoagulacao com laser verde na retinopatia da prematuridade (ROP) limiar. METODOS: Foram revisados prontuarios dos neonatos submetidos a fotocoagulacao com laser verde para ROP limiar, na Universidade Federal de Pernambuco, entre janeiro 2004 e janeiro 2006. Tratamento foi realizado com anestesia topica, sob monitorizacao de neonatologistas. Foi utilizado laser verde de estado solido com diodo de frequencia dobrada de 532 nm. Presenca de tunica vasculosa lentis ou catarata foi excluida antes do tratamento. Foram obtidos os seguintes dados pre-operatorios: idade, peso ao nascer e estagio da ROP. Dados pos-operatorios incluiram complicacoes associadas com o tratamento, estagio da ROP e avaliacao da necessidade de cirurgia por falha do tratamento com fotocoagulacao. RESULTADOS: Vinte e dois neonatos foram submetidos a fotocoagulacao com laser verde para ROP limiar. Um total de 31 olhos foi incluido no estudo. A idade gestacional media foi de 30 ± 3 semanas e a media do peso ao nascer foi de 1120 ± 490 g. Regressao da doenca apos terapia com laser foi observada em 30 olhos (96,7%). Apesar do tratamento um olho evoluiu para estagio 4A. Apenas 7 olhos precisaram de mais uma sessao de laser. Nao houve efeitos adversos na câmara anterior como queimaduras ou sangramentos. Tambem nao foram observados efeitos colaterais no segmento posterior. Formacao de catarata nao foi observada ate o final do acompanhamento. CONCLUSOES: A fotocoagulacao com laser verde e uma alternativa efetiva e segura a fotocoagulacao com laser vermelho e a crioterapia para o tratamento da ROP limiar.

Influence of bromopride in the prophylaxis of nausea associated with fluorescein angiography

PURPOSES To determine the efficacy of bromopride in the prophylaxis of nausea during fluorescein angiography, when compared with a placebo. METHODS The study was a double-masked random clinical trial, between December of 2004 and April of 2005. Examinations were performed with 20% intravenous fluorescein sodium in a single dose of 2.5 ml. The patients were divided into two groups: group 1, patients who received a 2 ml intravenous dose of 5 mg/ml bromopride and group 2, patients who received a 2 ml intravenous dose of 0.9% sodium chloride (placebo), both 20 minutes before the dye injection. Cases of nausea were observed during and after the examination. RESULTS 352 patients were enrolled, 176 in each group. Cases of nausea were observed in 12 (6.8%) patients of the bromopride group and in 11 (6.3%) patients of the placebo group (p<0.829 - relative risk=1.05). CONCLUSION Bromopride did not prevent the occurrence of nausea in fluorescein angiography, when compared with a placebo.

The number of citations in a scientific journal does not increase through an administrative act

This content is licensed under a Creative Commons Attributions 4.0 International License. In Brazil, Qualis-Periódicos is a system used by the Brazilian Agency for Support and Evaluation of Gradua te Education (CAPES) to classify the productivity of postgraduate programs in relation to articles published in scientific journals. These journals are ranked in the descending order of quality as A1, A2, B1, B2, B3, B4, B5, and C. Bibliometric indicators are used to evaluate periodicals, taking into account the number of citations received(1). Authors from postgraduate programs need to publish in journals that have a good classification in Qualis-Periódicos, with direct repercussions, for example, for obtaining funding for research. This contributes to a perverse logic: journals with least indicators receive the least citable articles. In an attempt to reverse this situation, the Medicine III (surgery) evaluation area decided, as an experiment, to upgrade the Qualis-Periódicos ranking of two journals. Thus, in 2013-2016, these two journals, which according to the number of citations should be classified as B3, received an artificial upgrade to B1. The objective was to attract authors to publish their more citable articles in these journals(2). We compared the impact factor calculated through the SCImago Journal & Country Rank 2013-2016 (SJR) between the two upgraded journals and other 55 journals with B3 rankings of Medicine III (Table 1). We concluded that the artificial upgrade of the two journals was not enough to guarantee more citations. These data suggested that an administrative act, such as the artificial upgrade of Qualis-Periódicos ranking, was not enough to improve the citation of Brazilian journals. It may be more effective to adopt other measures, such as specialized editorial support, high-level editorial staff, prospect for good articles, restriction on the number of articles, publication of review articles, adoption of English as the standard language, extensive indexing in databases, free or low-cost publication, rigorous and speedy review and publication processes, and advertisements at large scientific meetings(3).

Intracameral moxifloxacin after cataract surgery: a prospective study

OBJECTIVE To study the safety parameters associated with intracameral moxifloxacin application five weeks after cataract surgery. METHODS The study was a prospective case series set in a private hospital in Recife, Pernambuco, Brazil. A consecutive sample of 1,016 cataract surgeries was evaluated. The inclusion criteria were patients with indications for cataract surgery, a minimum of 55 years of age, and no history of allergy to quinolones. Patients were prepared for surgery using a 5% povidone solution diluted as a topical antiseptic agent. The operative technique was phacoemulsification with intraocular lens implantation. A 0.3-mL syringe was partially filled with moxifloxacin and 150 µg/0.03 mL of moxifloxacin was administered through the surgical incision at the end of the surgery. Postoperatively, patients were prescribed: (1) 0.5% moxifloxacin eyedrops 5 times daily for 1 week, and (2) 1% prednisolone acetate eyedrops 5 times daily for 1 week, followed by 4 times daily for 1 week and, subsequently, 2 times daily for 3 weeks. The outcomes were incidence of acute endophthalmitis, mean changes from baseline to 5 postoperative weeks in corneal endothelial cell density, corrected distance visual acuity and intraocular pressure. RESULTS The mean age was 67 ± 5 years, and 56.2% of the patients were female. There were no cases of endophthalmitis. The mean preoperative corrected distance visual acuity was 58 letters ± 10 (SD), and the mean postoperative corrected distance visual acuity was 80 letters ± 4 (SD). The mean change in corneal endothelial cell density was 249 cells/mm (-10.3%). There was almost no difference in intraocular pressure. No study-related adverse events were observed. CONCLUSION The results suggest moxifloxacin is a safe option for intracameral use after cataract surgery.

Distribution of Ocular Component Measures and Refraction in Brazilian School Children.

ABSTRACT Purpose: To describe ocular component values and refraction in 6–17-year-old school children in Campinas, Brazil. Methods: To obtain a representative sample, a total of 1100 6–17-year-old public school students in Campinas, Brazil, were randomly selected and divided into groups according to median ages 6 years (range 5–7 years), 10 years (range 9–11 years), 14 years (range 13–15 years), and 17 years (range 16–18 years). Cycloplegic autorefraction and ocular biometry were performed on each child. Results: Parental consent for participation was obtained for 778 of the 1100 students (70.7%). Of these, 440 (56.6%) were female and 330 (44.4%) male. Sex distributions were similar for each median age group. Median age groups 6, 10, 14, and 17 years displayed significant trends of decreasing mean spherical equivalent refraction (SER; 0.96, 0.89, 0.57, and 0.23 diopters, D, respectively), mean lens thickness (3.50, 3.42, 3.41, and 3.45 mm, respectively), and mean lens power (23.6, 22.7, 21.8, and 21.2D, respectively), but significant trends of increasing mean anterior chamber depth (ACD; 3.00, 3.12, 3.16, and 3.15 mm, respectively), mean vitreous chamber depth (VCD; 16.0, 16.4, 16.6, and 16.8 mm, respectively), and mean axial length (22.5, 23.0, 23.2, 23.4 mm, respectively; all p for trend <0.001). Conclusions: Significant trends towards lower refractive power, increased prevalence of myopia, increased ACD, VCD, and axial length, and decreased lens power were associated with increasing age in these children. There were no significant changes in corneal thickness or corneal curvature.

Gatifloxacin and Iodopovidine preoperatively of phacectomy: Influence on counting bacterial colonies

Objective: To analyze two methods of reducing conjunctivalmicrobiota in patients undergoing cataract surgery. Methods: A clinical trial with a convenience sample of 57 patients diagnosed with senile cataract (57 eyes) who underwent phacoemulsification with intraocular lens implantation in Recife from 2011 to 2013. Patients were divided into two groups: ATB (27 eyes) in which was instilled antibiotic eye drops (gatifloxacin 0.3%) and ASS (30 eyes) with antiseptic eye drops (iodopovidine 5%); both medications were instilled three times (one drop every 20 minutes, an hour prior to surgery). The groups were evaluated from two collections of conjunctival material: first before instilling some eye drops and the second one immediately after surgery. Gram stain, culture and sensitivity were performed. Results: Comparing the reduction in the number of bacteria found in the slides in the pre-and postoperative, there was no statistically significant difference in both groups. Conclusions: Both use of antiseptic or antibiotic, used as prophylaxis forendophthalmitis, can reduce the conjunctivalmicrobiota.

Clinical trials in Brazilian journals of ophthalmology: where we are

PURPOSE To compare clinical trials published in Brazilian journals of ophthalmology and in foreign journals of ophthalmology with respect to the number of citations and the quality of reporting [by applying the Consolidated Standards for Reporting Trials (CONSORT) statement writing standards]. METHODS The sample of this systematic review comprised the two Brazilian journals of ophthalmology indexed at Science Citation Index Expanded and six of the foreign journals of ophthalmology with highest Impact Factor® according ISI. All clinical trials (CTs) published from January 2009 to December 2010 at the Brazilians journals and a 1:1 randomized sample of the foreign journals were included. The primary outcome was the number of citations through the end of 2011. Subgroup analysis included language. The secondary outcome included likelihood of citation (cited at least once versus no citation), and presence or absence of CONSORT statement indicators. RESULTS The citation counts were statistically significantly higher (P<0.001) in the Foreign Group (10.50) compared with the Brazilian Group (0.45). The likelihood citation was statistically significantly higher (P<0.001) in the Foreign Group (20/20 - 100%) compared with the Brazilian Group (8/20 - 40%). The subgroup analysis of the language influence in Brazilian articles showed that the citation counts were statistically significantly higher in the papers published in English (P<0.04). Of 37 possible CONSORT items, the mean for the Foreign Group was 20.55 and for the Brazilian Group was 13.65 (P<0.003). CONCLUSION The number of citations and the quality of reporting of clinical trials in Brazilian journals of ophthalmology still are low when compared with the foreign journals of ophthalmology with highest Impact Factor®.

Preparo do oftalmologista para o tratamento das reações adversas na retinografia fluoresceínica

ABSTRACT Purposes: To evaluate the emergency resources of the clinicsthat perform fluorescein angiography in Pernambuco and,through a short multiple-choice questionnaire, to evaluate theophthalmologists’ performance to treat adverse reactions tocontrast injection and to determine if the time after completingthe specialization course in Ophthalmology influences in theresults. Methods: An interview with the eighteen ophthalmo-logists of the ten clinics where this examination is performedwas made. The multiple-choice questionnaire had ten ques-tions with five options each and only one correct answer. Thisquestionnaire was about adverse reactions to fluoresceininjection. Results: One physician refused to participate andwas excluded from the analysis. Among the others, fifteenphysicians (88.2%) were certified specialists by the BrazilianCouncil of Ophthalmologists. All clinics had the basic structu-re for the initial care of adverse reactions to contrast injection.Half of these clinics (five) performed this examination with thepresence of an anesthesiologist directly monitoring the pa-tient and the other half had one on duty, if necessary. Thenumber of correct answers varied between 3 and 8, with amean of 5.2±1.6. Only four (23.6%) physicians gave more thanseven correct answers. Specialists with five or less years ofpostgraduation in Ophthalmology had better results regar-ding the questionnaire (p<0.001). Conclusions: Despite ap-propriate material resources and support by anesthesiologist,the results of this study suggest that ophthalmologists whoperform fluorescein angiography are not well-prepared to ma-nage the possible adverse reactions, mainly doctors with morethan five years after postgraduation in Ophthalmology.Keywords: Fuorescein angiography; Fluorescein/adverseeffect; Nausea/chemically induced; Vomiting/chemically in-duced; Contrast media; Anaphylaxis; Specialties, medical/education; QuestionnairesOBJETIVOS: Avaliar a estrutura das clinicas que realizam retinografia fluoresceinica em Pernambuco e, por meio de questionario, avaliar o preparo do oftalmologista para contornar reacoes adversas relativas ao exame e determinar se o tempo de conclusao do curso de especializacao influencia nos resultados. METODOS: Foi realizada entrevista com os 18 medicos nas dez clinicas que realizam este exame. O questionario era de multipla escolha com dez questoes. Versava sobre aspectos das reacoes adversas. RESULTADOS: Um medico recusou-se a participar e foi excluido. Entre os demais, quinze (88,2%) possuiam o titulo de especialista. Todas as clinicas estavam bem aparelhadas em relacao a estrutura basica de equipamentos e medicacoes para o atendimento inicial de reacoes adversas. Metade das clinicas (cinco) realizava o exame com a presenca de um anestesista na sala e a outra metade dispunha de um anestesista de sobreaviso dentro da instituicao. O numero de acertos obtidos pelos medicos variou de 3 a 8, com media de 5,2±1,6 acertos. Apenas quatro (23,6%) medicos obtiveram nota igual ou superior a sete acertos. Medicos com ate cinco anos de conclusao do curso de especializacao obtiveram melhor desempenho no questionario (p<0,001). CONCLUSOES: Apesar das clinicas avaliadas contarem com boa estrutura fisica e disponibilidade de assistencia por anestesista, os resultados deste estudo sugerem que a formacao dos medicos oftalmologistas que realizam o exame de retinografia fluoresceinica apresenta deficiencias em relacao a conducao de reacoes adversas deste contraste injetavel, principalmente em medicos com mais de cinco anos de conclusao do curso de especializacao.