Sérgio Felberg

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.

Qualidade de vida após transplante penetrante de córnea

Purpose: To determine the quality of life in patients after penetrating keratoplasty using the VF-14 test and correlating it with final visual acuity. Methods: A total of 58 penetrating keratoplasty operated patients (1 year after surgery) were evaluated by the VF-14 test. Ophthalmological examination data were collected from their charts. Students t test and linear regression were applied. Results: The VF-14 ratio was 69.3. Best scores were obtained in activities such as cooking (90.9), card games (88.0), fine handworks (83.9). On the contrary, worst scores were found for car driving (at night, 22.5; and during the day, 40.9). Results were statistically significant (p< 0.01) and linear regression showed weak correlation between scores and final visual acuity (r=0.41). Conclusion: We observed a weak correlation between the quality of life and final visual acuity and suggest changes in this questionnaire including activities that are more adequate for our patients.

Induction of corneal collagen cross-linking in experimental corneal alkali burns in rabbits

Objective: To evaluate the effect of riboflavin-ultraviolet-A-induced cross-linking (CXL) following corneal alkali burns in rabbits. Methods: The right corneas and limbi of ten rabbits were burned using a 1N solution of NaOH and the animals were then divided into two groups: a control group submitted to clinical treatment alone and an experimental group that was treated 1 h after injury with CXL, followed by the same clinical treatment as administered to the controls. Clinical parameters were evaluated post-injury at 1, 7, 15, and 30 days by two independent observers. Following this evaluation, the corneas were excised and examined histologically. Results: There were no statistically significant differences in clinical parameters, such as hyperemia, corneal edema, ciliary injection, limbal ischemia, secretion, corneal neovascularization, symblepharon, or blepharospasm, at any of the time-points evaluated. However, the size of the epithelial defect was significantly smaller in the CXL group (p<0.05) (day 15: p=0.008 and day 30: p=0.008) and the extent of the corneal injury (opacity lesion) was also smaller (day 30: p=0.021). Histopathology showed the presence of collagen bridges linking the collagen fibers in only the CXL group. Conclusions: These results suggest that the use of CXL may improve the prognosis of acute corneal alkali burns.

Eficácia do adesivo tecidual de fibrina na fixação de enxerto conjuntival autógeno em cirurgias de pterígio primário

PURPOSE To compare the efficacy of conjunctival autograft surgery with the attachment to the scleral bed using fibrin tissue adhesive or mononylon 10-0 suture after resection of primary pterygium. METHODS A comparative, prospective and randomized clinical trial was performed in 47 eyes of 47 patients with primary medial located pterygium. Group 1 (adhesive) was composed by 21 patients that underwent conjunctival autograft closure with fibrin tissue adhesive (Quixil™) and Group 2 (suture) was composed by 26 patients that underwent pterygium surgery with mononylon 10-0 (Ethicon(®)) suture (suture group) after pterygium excision. All surgeries were performed by the same surgeon. Patients were assessed on the preoperative period and on the 1(st), 14(th) and 21(st) postoperative days. They were followed-up with a questionnaire of ocular discomfort and by the surgical time spent, ocular hyperemia, complications and recurrence signals, being the recurrence also evaluated at the 6th postoperative month. Data were submitted to statistical analysis. A value of p<0.005 was considered statistically significant. RESULTS The average surgical time was 19.05 ± 6.12 minutes in group 1 (glue) and 48.15 ± 7.13 minutes in the group 2 (suture) (p<0.001). The ocular discomfort scale analysis showed a lower score in the 1(st) (p<0.005), 7(th) (p<0.001) and 21(th) (p<0.001) postoperative days in group 1. Ocular hyperemia was less intense in all periods of this study in group 1 (p<0.001). Complications were one in each group and both were managed with clinical treatment until the 21(th) postoperative day. There was one recurrence in group 1 and two in group 2 until the 6(th) postoperative month. CONCLUSION In the surgical management of primary pterygium, fibrin tissue adhesive attached the conjunctival autograft, decreased the surgical time and diminished the conjunctival hyperemia and ocular discomfort with similar recurrences on the postoperative period, compared to fixation with mononylon 10.0 suture, proving to be an excellent option for conjunctival autograft attachment in primary pterygium surgery.

Conjunctival Tattoo With Inadvertent Globe Penetration and Associated Complications

Purpose: To report a case of conjunctival tattooing for cosmetic purposes with inadvertent globe penetration resulting in severe inflammation, capsular lens opacity, and secondary glaucoma. Methods: Case report. Results: A 25-year-old woman experienced severe ocular pain and decreased vision in the left eye after conjunctival tattooing for cosmetic purposes on the previous day. Slit-lamp examination revealed black deposits over the conjunctiva, corneal endothelium, anterior chamber angle, iris, and anterior capsular lens due to the tattooing pigment. In addition, severe anterior uveitis triggered by the pigments and, later, secondary glaucoma were diagnosed. The patient underwent clinical and surgical treatments to control ocular inflammation and intraocular pressure. Three months after the injury, the patient was still under follow-up treatment in an effort to control the complications of the eyeball tattooing. Conclusions: An unusual case of conjunctival tattooing resulted in severe inflammation, capsular lens opacity, and secondary glaucoma. Because of the increasing popularity of eyeball tattooing, coupled with the procedure being performed by untrained professionals, potentially severe complications of this procedure may become more common.

Comparação entre dois meios de coleta e transporte para estudo da microbiota conjuntival de indivíduos normais

PURPOSE: To compare the microbiological profile of normal microbiota of healthy people obtained from conjunctival smear using dry swab in Stuarts transport medium and wet swab transported in test tube sealed with cotton. METHODS: A prospective study with random samples, performed at the Departments of Ophthalmology and Pathology of Santa Casa Misericordia de Sao Paulo, in August of 2006. Eighty normal eyes of 40 healthy individuals were analyzed. Samples were collected in the right eye with a dry swab and stored in Stuarts medium, where all microbiological material is kept immersed in the medium and the tube is hermetically sealed. In the left eye, the conjunctival material was collected using a swab embedded in saline solution 0.9%, and stored in dry and sterile test tubes sealed with cotton. The samples were analyzed within 2 hours at most after collection. RESULTS: Out of 40 samples collected with wet swab and transported in dry tube, bacteria were observed in 10 (25%), whereas of 40 samples collected with dry swab and transported in Stuarts medium, 12 (30%) had bacteria. CONCLUSION: The results of the microbiological profile of normal conjunctival microbiota using dry swab in Stuarts medium were statistically similar (p=0.85) to those obtained in wet swab in dry tube for spreading performed within 2 hours after collection of conjunctival specimen.

Superfície ocular e hepatite C

PURPOSE To evaluate the outcomes of the tests used for dry eye diagnosis in patients with hepatitis C virus, and to verify if there is any relationship between the duration of illness and intensity of ocular surface changes. METHODS 25 patients with hepatitis C virus without treatment, and 29 patients with negative serologic tests for hepatitis C virus were selected. Biomicroscopy, tear film crystallization test, tear film break-up time, evaluation of the corneal staining with 1% fluorescein sodium, Schirmer I test, ocular surface staining with 1% rose bengal and esthesiometry were performed in both groups. RESULTS In the Schirmer I test, the group of patients with hepatitis C displayed lower values in both eyes (OR p=0.0162; OS p=0.0265). For the tear film break-up time, there was a lower score in the group with hepatitis C, but it was statistically significant only in the left eye (p=0.0007). Regarding the ocular surface damage, the rose bengal staining test showed a higher average in the hepatitis group in both eyes (right p=0.0008; left p=0.0034). There was a difference in the average esthesiometry between the groups, being the average lower in infected patients (OR p=0.0006; OS p=0.0015). There was no linear association between time of hepatitis C infection and intensity observed in dry eye tests. CONCLUSIONS Hepatitis C virus infection causes dry eye. Further researches are necessary to establish the physiopathology and the relationship with Sjögren syndrome.

Quantitative changes in tear film after refractive surgery: comparative study between PRK and LASIK

PURPOSE To compare quantitative changes induced in the tear film of patients submitted to photorefractive keratectomy and LASIK over a year. METHODS A prospective, longitudinal, comparative, post-interventional study was designed to distinguish tear film changes before and one year after refractive surgery procedures in 48 patients submitted to PRK and 36 patients submitted to LASIK, using type 1 Schirmer test in the right eye and red phenol thread test in the left eye. RESULTS Tear film assessment between the first and third postoperative month demonstrated Schirmer and phenol red measurements below basal values for both procedures. One year after the procedures, measurements returned to presurgical values. CONCLUSION Besides momentary and within normal limit changes in the measurement of tear film, no complications were found in normal patients.

Exfoliative Cytology in the Diagnosis of Ocular Surface Squamous Neoplasms

Purpose: Surface tumors of the eye comprise an ample spectrum of diseases with various clinical manifestations. Diagnosis has been traditionally achieved through core biopsies, but cytology is an innovative, fast, and minimally invasive method. The objective of this study was to investigate the use of exfoliative cytology as an alternative method for the detection of ocular surface squamous neoplasm (OSSN). Methods: Exfoliative cytology of the lesions was performed by collecting smears using plastic brushes followed by smearing the cells onto slides and subsequently fixing them in 90% alcohol. Incisional biopsies were performed at the exact same location and sent for processing in 10% formaldehyde. Both the surgical pathologist and cytopathologist were masked to the clinical characteristics and to the corresponding cytological or histological result. Results: Twenty-two patients were enrolled in the study (12 men and 10 women, median age 52.5 years). Final histological diagnoses comprised 7 cases of pterygium, 7 squamous-cell carcinomas, 4 squamous papillomas, and 4 chronic inflammatory processes. Cytohistological agreement was achieved in 19 (86.4%) of the samples. Cytology showed a sensitivity, specificity, positive predictive value, and negative predictive value of 85.7%, 86.7%, 75%, and 92.9%, respectively, in detecting OSSN. Conclusions: Exfoliative cytology of the conjunctival lesions is a simple procedure, with high agreement to the histological follow-up. Its broad use could augment the early diagnosis of OSSN, with improvement in patient prognosis.