Rosane Silvestre de Castro

Epidemiology and medical prediction of microbial keratitis in southeast Brazil

PURPOSE The goals of the study were the following: 1) to show the epidemiology of microbial keratitis (MK) in the southeast Brazil, 2) to compare the epidemiological differences between fungal (FK) and bacterial keratitis (BK), and 3) to evaluate the frequency which ophthalmologists accurately differentiate bacterial keratitis from fungal keratitis based on clinical diagnosis. METHODS A retrospective chart analysis of all clinically diagnosed microbial keratitis patients presenting between October, 2003 and September, 2006 was performed. Demographic features, ocular and laboratory findings, and information regarding the risk factors and clinical evolution were recorded. RESULTS Among 118 consecutive patients with a clinical diagnosis of microbial keratitis, the positive culture rate was 61%. The predominant bacterial and fungal pathogens isolated were S. epidermidis and Fusarium spp. Prior corneal injury was more frequent among fungal keratitis than bacterial keratitis cases (p<0.0001). Coexisting systemic diseases, ocular diseases, and previous ocular surgery were more frequent among BK cases (p=0.001; p=0.001; p=0.004; respectively). The following clinical findings were more frequent in bacterial keratitis: hypopion, corneal peripheral superficial vascularisation, and ulceration area >20 mm² (p<0.05). The diagnosis was predicted correctly in 81.6% of bacterial keratitis cases and in 48.1% of fungal keratitis cases. CONCLUSION Medical judgment of microbial keratitis agent is possible based on clinical and epidemiological data, but it is more difficult for fungal infection. Thus, such data cannot be the only basis for the diagnosis of suspected microbial keratitis, but oriented clinical suspicion based on these data may be beneficial for guiding antimicrobial treatment and earlier therapy.

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

Dexamethasone/Povidone Eye Drops versus Artificial Tears for Treatment of Presumed Viral Conjunctivitis: A Randomized Clinical Trial

Abstract Purpose: To determine whether topical dexamethasone 0.1%/povidone-iodine 0.4% reduces the duration of presumed viral conjunctivitis better than artificial tears and whether the treatment relieves the symptoms of this disease. Methods: Randomized, masked and controlled trial. One-hundred twenty-two patients with a clinical diagnosis of presumed viral conjunctivitis were randomized to either the treatment group or the control group. Physicians and patients were masked to the treatment. Swabs were taken from the conjunctival fornix for adenovirus PCR analyses. Patients in the treatment group received topical dexamethasone 0.1%/povidone-iodine 0.4% eye drops four times daily, and patients in the placebo group received artificial tears four times daily, both for seven days. Symptoms were recorded on the day of recruitment and at the time of a follow-up examination 5, 10 and 30 d later. The main outcome was duration of the disease. The others outcomes were overall discomfort, itching, foreign body sensation, tearing, redness, eyelid swelling, side effects of the eye drops, intraocular pressure and the incidence of subepithelial corneal infiltrates. Results: There was no statistically significant difference between the treatment group and the control group in terms of the patients’ symptoms, intraocular pressure and incidence of subepithelial cornea infiltrates during the entire follow-up period. Patients of the treatment group reported more stinging (p < 0.001) and a shorter conjunctivitis duration (9.4 ± 4.6 d in the dexamethasone 0.1%/povidone-iodine 0.4% group versus 11.8 ± 4.9 d in the artificial tears group, p = 0.009). Conclusions: The use of topical dexamethasone 0.1%/povidone-iodine 0.4% eye drops four times daily appears to reduce the duration of conjunctivitis, although it causes more stinging than artificial tears.

Rejeição de transplantes de córnea: tratamento tópico vs. pulsoterapia - resultados de 10 anos

PURPOSE: To evaluate the efficacy of intravenous 500 mg methylprednisolone in addition to topical treatment with 1% prednisolone in the treatment of the first episode of corneal endothelial rejection in patients that were submitted to corneal allograft transplantation. METHODS: Retrospective case-control study with 81 patients that presented the first episode of corneal endothelial rejection and were treated within the first 15 days of the onset of symptoms. RESULTS: 67 patients were treated with 1% topical prednisolone acetate and pulsed intravenous methylprednisolone 500 mg at the diagnosis of corneal allograft rejection. Fourteen patients were submitted to topical treatment only, thus forming the control group. Forty-one of 67 patients (61.2%) that were submitted to pulsed steroid had good outcome and 26 (38.8%) presented corneal graft failure while only 4 of 14 patients (28.57%) that received only topical steroids evolved with clear grafts and the remaining 10 patients (71.43%) with graft failure. Chi-square showed statistically significant association (p<0.05) to greater success with pulsed methylprednisolone. CONCLUSIONS: This study suggests that the use of 500 mg intravenous methylprednisolone in addition to 1% topical prednisolone acetate for the treatment of endothelial corneal allograft rejection presents better outcomes in reverting corneal allograft rejection when compared to isolated use of 1% topical prednisolone acetate.

Perfil epidemiológico das ceratomicoses atendidas no HC-UNICAMP

INTRODUCAO: A ceratite fungica e uma importante causa de infeccao corneana, principalmente em paises tropicais. Com alta morbidade devido a demora no diagnostico, o exame laboratorial torna-se obrigatorio nesses casos. Dificuldades tecnicas na obtencao das amostras, porem, geram um grande numero de exames falso-negativos. Nesses casos, uma detalhada avaliacao do paciente em busca de caracteristicas especificas dessa entidade pode auxiliar na elucidacao diagnostica. OBJETIVOS: Formar um perfil epidemiologico dos portadores de ceratomicose para auxiliar no diagnostico e tratamento precoces. METODOS: Realizou-se estudo retrospectivo em base de dados de portadores de ulceras corneanas em busca de pacientes com diagnostico de ceratomicose. Foram coletadas informacoes a respeito de sexo, situacao do domicilio, grau de instrucao, profissao, idade, fatores desencadeantes e predisponentes (oculares e sistemicos), hipotese etiologica inicial, resultado laboratorial, tempo de cicatrizacao, complicacoes e tratamentos adjuvantes. RESULTADOS: Dos 599 pacientes atendidos por ulcera de cornea, 150 (25%) foram diagnosticados como de etiologia fungica. Houve maior prevalencia em homens em idade produtiva e baixo nivel de escolaridade. Trauma com material vegetal esteve presente em 74 (49,33%) casos. Demais fatores identificados como trabalhadores e moradores de areas rurais tambem suportam o trauma vegetal como principal fator de risco identificado no estudo. CONCLUSOES: Com base nos dados do estudo foi possivel formar um perfil dos portadores de ulceras fungicas atendidos pelo HC-UNICAMP.

Translation and validation of the Portuguese version of a dry eye disease symptom questionnaire

Purposes: A symptom questionnaire is an important tool used to quantify and qualify the impact of a disease on a patients related quality of life and to estimate the prevalence of a certain condition within a population. Ophthalmologists frequently encounter patients with dry eye disease (DED), and therefore, evaluating the symptoms reported by these patients influences diagnosis, therapeutic monitoring, and evaluations of disease progression. The latest consensus on dry eye (Dry Eye Workshop, DEWS), published in 2007, led to the standardization of several questionnaires and a better understanding of the prevalence, severity, and overall effect of DED on the patients quality of life. Methods: In this study, we translated into Portuguese a symptom questionnaire from DEWS that has already been used in several other population-based studies. For subsequent validation, the translated questionnaire was applied by two independent observers to a population of 30 subjects, and the results were compared in a concordance analysis. Results: The processes of translating to Portuguese and back translating the dry eye symptom questionnaire were conducted without difficulty. The high-correlation coefficients obtained when comparing the results of the initial application and the re-administration of this questionnaire to a sample of 30 individuals indicated excellent concordance with regard to results, repeatability, and reliability. Conclusions: This translated and validated questionnaire can be applied to a larger population with the intent to determine the prevalence of DED symptoms in the overall Brazilian population, as well as in distinct regions of the country.

The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil

OBJECTIVES: Viral conjunctivitis is a common, highly contagious disease that is often caused by an adenovirus. The aim of this study was to evaluate the prevalence of adenoviral conjunctivitis by analyzing data from a prospective clinical study of 122 consecutively enrolled patients who were treated at the Clinical Hospital of the State University of Campinas (UNICAMP) after a clinical diagnosis of infectious conjunctivitis between November 2011 and June 2012. METHODS: Polymerase chain reaction was used to evaluate all cases of clinically diagnosed infectious conjunctivitis and based on the laboratory findings, the prevalence of adenoviral infections was determined. The incidence of subepithelial corneal infiltrates was also investigated. RESULTS: Of the 122 patients with acute infectious conjunctivitis included, 72 had positive polymerase chain reaction results for adenoviruses and 17 patients developed subepithelial corneal infiltrates (13.93%). CONCLUSIONS: The polymerase chain reaction revealed that the prevalence of adenoviral conjunctivitis was 59% in all patients who presented with a clinical diagnosis of infectious conjunctivitis from November 2011 to June 2012. The prevalence of adenoviral conjunctivitis in the study population was similar to its prevalence in other regions of the world.

Eficácia na utilização de córneas no transplante penetrante

PURPOSES: 1) To verify the impact of the creation of the Single Technical Record (STR) at the University of Campinas (Unicamp) Hospital das Clinicas, on the preservation period of corneas which were used in elective penetrating keratoplasties, and 2) to compare the primary failure incidence in cornea penetrating keratoplasties regarding the periods before and after the creation of STR. METHODS: A retrospective study was conducted at the Unicamp Hospital, which evaluated 15 consecutive cornea penetrating keratoplasties between January 1st and April 30th, 2000 and 24 consecutive penetrating keratoplasties between May 1st and September 20th of the same year (corneas under the control of the STR), totaling 39 keratoplasties. RESULTS: The mean time between cornea preparation and transplantation was 3.8 days (±1.78) in the period before STR creation, and 6.0 days (±2.97) after STR creation, representing a 36.7% increase in the preservation time. There was a statistically significant difference (p=0.02) between the two groups. No corneal primary failure was observed among the 39 transplanted patients in both groups. CONCLUSION: Based on the results of this study, it can be concluded that this new concept of the State Transplantation System has caused a statistically significant increase in the conservation period of corneas, which may reduce the period of a clear transplant due to an increased loss of endothelial cells, as well as increase the primary failure incidence or result in a high number of corneas that cannot be used due to having exceeded the preservation time recommended by the literature.

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.

Repeated penetrating corneal transplantation in patients with a previous tectonic transplant

Objective: To analyze, in a university hospital of reference, the rate of a new penetrating corneal transplantation in patients that had previously undergone a tectonic keratoplasty and analyze the results after one year of surgery. Methods: Retrospective review of patients undergoing penetrating corneal transplantation, from november of 2010 to november of 2014. Comparative analysis of best corrected visual acuity (BCVA), intraocular pressure and corneal transparency before surgery and after one year, in the group of patients in which it was performed a re-graft after a failed tectonic transplantation. Results: A total of 318 patients underwent penetrating corneal transplantation during the study period. Of the 199 patients who underwent tectonic transplantation, 36 were subjected to re-graft and re-grafts were performed more than once in 2 eyes, with total of 38 transplants (19,09%). The results showed improvement of BCVA in 20 (52.63%), worsening in 8 (21.05%) and unchanged in 10 (26.31%); improvement of intraocular pressure in 3 (7.89%), deterioration in 3 (7.89%) and unchanged in 32 (84.21%); improvement of corneal transparency 25 (65.78%), worsening 4 (10.52%) and 9 unchanged (23.68%) patients. Conclusion: This study demonstrated a considerable number of repeated penetrating keratoplasty in patients with a history of failed tectonic corneal transplantation. In spite of bad prognosis in cases where there is high-risk corneal recipients and history of a failed tectonic transplant, there was improvement of the corneal transparency and best corrected visual acuity even after a year of surgery.