Search

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate the efficacy of oral pilocarpine (20 mg daily) for the treatment of dry eye in patients with Sjogren's Syndrome. The frequency of side effects reported during the treatment was also investigated., Methods: In this placebo-controlled crossover study, 32 patients with Sjögren's syndrome were enrolled to receive either oral pilocarpine or placebo for 10 weeks. Following a 2-week washout period, the treatment was inverted for each patient for the same duration. Assessments included the quality of life National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), dry eye specific questionnaire Ocular Surface Disease Index, non-invasive breakup time, invasive breakup time with fluorescein, corneal and conjunctival staining patterns with the use of fluorescein and rose bengal staining, Schirmer's test, and tear ferning test., Results: According to the NEI-VFQ-25, there was statistically significant improvement in the quality of life following oral pilocarpine. Similar results were observed for ocular discomfort, as determined by the Ocular Surface Disease Index. All clinical tests showed favorable and statistically significant results following the use of oral pilocarpine. Regarding the analysis of tear samples, there was an improvement in the quality of tear film. This was evidenced by the modification of the patterns observed in the tear ferning test. Side effects were reported by 96.8% and 56.2% of the patients who received pilocarpine and placebo, respectively. Sweating was the most frequently reported side effect (67.74% versus 11.11%, respectively)., Conclusions: Although the treatment was associated with a high frequency of side effects, oral pilocarpine (20 mg daily) was able to relieve discomfort related to dry eyes in patients with Sjögren's syndrome and induce favorable structural changes in the tear film.

Purpose: To investigate the seasonality of infectious keratitis in a tertiary hospital in Brazil., Methods: Charts from the Ocular Microbiology Laboratory of the Department of Ophthalmology of the Federal University of Sao Paulo were reviewed from 2005 to 2009. Infectious keratitis were defined as those with positive culture. Data were distributed monthly and linear regressions with seasonal dummy models were used to test for seasonal trends., Results: Total of 1,468 cases of keratitis was diagnosed during the study period. Bacterial keratitis were responsible for 80.3% of all cases, followed by fungal (7%), and Acanthamoeba (6%); 6.7% were mixed cases. Statistical tests showed that there were no seasonal trends for bacteria (p=0.064), fungi (p=0.379), Acanthamoeba (p=0.062) or mixed infections (p=0.441)., Conclusions: No seasonal trends for infectious keratitis were observed in our sample.

Purpose: To compare amniotic membrane transplantation (AMT) and anterior stromal puncture (ASP) in the management of pain in patients with symptomatic bullous keratopathy (BK)., Methods: In this prospective comparative study, 40 eyes of 40 patients with symptomatic BK (chronic intermittent pain) were randomised and divided into two groups (AMT and ASP) according to the technique used to treat symptomatic BK. The patients were examined on days 1, 14, 30, 90 and 180 postoperatively. Patients with BK under the age of 18 with raised eye pressure, concurrent ocular surface infection and those without any pain were excluded., Results: At follow-up at 90 and 180 days the presence of a regular epithelial surface was higher in the AMT group (60% and 50%, respectively) than in the ASP group (16.7% and 6. 3%, p=0.006 and p=0.008, respectively). At 180 days follow-up there was no statistical difference between the two groups in the severity (p=0.391) or duration (p=0.715) of pain., Conclusions: AMT is similar to ASP in the relief of pain in symptomatic BK. However, ASP is a simple outpatient procedure and should cost less than AMT. NCT 00659308.

Purpose: To describe the characteristics of human ocular tissue donors from the Cascavel Eye Bank in the State of Paraná (PR) and investigate the impact of hepatitis B serologic test positivity on discarded ocular tissues., Methods: Cross-sectional study of data collected between March 2006 and April 2007 at the Cascavel Eye Bank. Information such as age, gender, cause of death, time between death and enucleation, and serologic tests results was collected. Data were used to characterize the study population and stratified according to hepatitis B (anti-HBc) status., Results: Mean age of donors was 54.2 ± 20.6 years and a greater proportion of men (64,7%) was observed. Mean time between death and enucleation was 3.8 ± 2.4 hours, cardiovascular diseases were the main cause of death (34.5%). Positivity of anti-HBc and HBsAg tests was 47.4% and 1.5%, respectively. Hepatitis B was the main reason for discarding corneas. Donors whose serologic tests were positive for anti-HBc had higher mean age compared to those with negative tests (p<0.001). Only 0.8% of all donations tested positive for hepatitis C and donors with positive HIV test were not seen in our study., Conclusions: Activities of the Cascavel Eye Bank significantly increased the availability of corneas for transplant in the State of Paraná. The main contraindication for availability of ocular tissues was positivity of serologic tests for anti-HBc. Biosafety studies should be performed in order to investigate the potential transmission of hepatitis B virus for donors with positive tests for anti-HBc. The inclusion of these donors would increase the number of corneas available for transplant.

Aim: To evaluate, by impression cytology (IC), the cytological features of the central area of corneal epithelial surface of patients with symptomatic bullous keratopathy (BK). Design Cross-sectional observational case series., Methods: IC of the central cornea was performed in 72 eyes of 72 patients with symptomatic BK between June 2005 and December 2006. Patients were divided into two groups according to the presence (group GC) or not of goblet cells (group NGC). The diagnosis of limbal stem cell deficiency (LSCD) was defined by the presence of one or more intact goblet cells on the corneal surface. Squamous metaplasia was classified according to Murube and Rivas., Results: Epithelial squamous metaplasia was found in 72 (100%) eyes, along with conjunctival goblet cells in 25 (34.72%) eyes. Squamous metaplasia was grade 1 in group GC and more advanced grades in group NGC. Corneal neovascularisation was present in 62 (82.11%) eyes. Vessel measure was more than 4 mm in 11 eyes (23.4%) in group NGC and 10 eyes (40%) in group GC (p=0.559), and they were mostly subepithelial in 23 eyes (48.9%) in group NGC and 12 (48%) eyes in group GC (p=0.822)., Conclusion: Squamous metaplasia was the most frequent finding associated with advanced BK. The presence of goblet cells on the surface of corneas with squamous metaplasia grade 1, in a significant number of patients, suggests that limbal stem cell deficiency is a common condition associated with advanced cases of BK.

Purpose: To investigate discarded corneas due to positive serologic tests in donors from the Hospital São Paulo Eye Bank (BOHSP) during a two-year period., Methods: Retrospective study of records from cornea donors between January 2006 and December 2007. Information such as serologic test results (Hepatitis B, C, and HIV), source of corneal tissue, donor's gender and age were tested for correlation., Results: 902 corneas were processed by BOHSP; 12.9% (116) were discarded due to donor's positive test for hepatitis B, C, or HIV; 20.5% (185) were also discarded due to inconclusive result of serological tests; percentage of corneas discarded due to positive or inconclusive serological tests during this period was 33.4% (301)., Conclusion: This study confirms the importance of serological tests in order to prevent disease transmission to corneal transplant recipients. However, new tests are necessary to decrease the number of inconclusive tests and decrease the number of discarded corneas.

Purpose: To investigate factors associated with the morphological quality of corneal tissue at the Hospital São Paulo Eye Bank (BOHSP) - UNIFESP., Methods: Retrospective study of records from the BOHSP between 2001 and 2006. Information about donors such as age, gender, and cause of death were collected as well as time between death and enucleation (time-to-enucleation), time between enucleation and tissue preservation (time-to-preservation), preservation media, and source of corneal tissue. Biomicroscopic examination was performed in preserved corneas which were classified as 'Excellent' or 'Good' (group A) or 'Regular', 'Bad', or 'Unacceptable' (group B). Multivariate logistic regression models were used to assess factors that were independently associated with corneal quality., Results: Data from 870 cornea donors were analyzed. The mean +/- standard error age in groups A and B was 40.7 +/- 16.1 and 56.3 +/- 17.5 years, respectively (p<0.01). Time-to-preservation was significantly lower in group A (5.2 vs. 6.6 hours, p<0.01). There was no statistically significant difference between the two groups regarding gender (p=0.82) and time-to-enucleation (p=0.17). A higher proportion of traumas was observed in group A compared to group B (p<0.01). Overall, Optisol was the most commonly used preservation medium and approximately half of the corneas were harvested by BOHSP. Factors that were independently associated with corneal quality were: age (Odds ratio 95% CI, 1.05 (1.04 - 1.06), for 1 year), time-to-preservation (1.05 (1.02 - 1.08), for 1 hour), source (1.53 (1.12 2.09), for Others vs. BOHSP) and cause of death (2.06 (1.43 -2.96), for Chronic diseases vs. External causes)., Conclusions: This study showed some factors that were independently associated with morphological quality of donated corneas in the BOHSP such as age, time-to-preservation, source, and cause of death. Similar studies are necessary in order to determine factors that might influence the quality of corneas delivered to ophthalmic surgeons.

Background: Despite all efforts towards the improvement of the eye bank system, the shortage of corneal tissue for transplant is still an important issue in Brazil. The Hospital São Paulo Eye Bank aims to provide high-quality ocular tissues for surgery starting with rigorous selection of donors., Purpose: To investigate the characteristics of cornea donors to the Hospital São Paulo Eye Bank during a 10-year period., Methods: Retrospective analysis of Hospital São Paulo Eye Bank records from January 1996 to December 2005. RESULTADS: 3,624 corneas were evaluated by the Hospital São Paulo Eye Bank during this 10-year period. Mean age of donors was 56.8 years the highest proportion being in the 70-79 years age category. The most common cause of death was cardiovascular disease followed by cancer and trauma. Mean "enucleation" and "preservation" times were 3.8 and 3.6 hours, respectively. The number of corneas received by our eye bank from other eye banks decreased substantially whereas the number of corneas harvested by the Hospital São Paulo Eye Bank staff increased. Optisol GS(R) were the most utilized preservation media and a high proportion of corneas classified as "Excellent" or "Good" came from young donors., Conclusions: In a period of 10 years, there was a decreasing trend in the number of donated corneas provided by other eye banks to the Hospital São Paulo Eye Bank and an increase in the number of corneas harvested and processed by the Hospital São Paulo Eye Bank staff with a significant reduction of preservation time. Most donors were male and the main cause of death was cardiovascular disease. Although a great proportion of donated corneas came from older donors, the majority of corneas used for optical transplants came from younger ones.

Purpose: To verify the reproducibility of Rolando's classification of the tear ferning test using five different examiners and to compare the patterns of crystallization found in Sjögren's syndrome patients and normal subjects., Methods: Tear ferning analysis of 29 patients with Sjögren's syndrome and of 45 patients without ocular disease were done using polarized light microscopy and the Rolando classification for tear ferning. Five examiners classified the ferning patterns of all the patients. ROC curve (Receiver Operating Characteristic) was used to find out the best score for the correct syndrome diagnosis. Kappa index (p<0.0001) was used to compare the results of the examiners among them and check the test's reproducibility. Charts were drawn to compare the two groups' results., Results: Throught the ROC curve the score of 2.50 for diagnosis of Sjögren's syndrome was stablished. Considering the aggregated patterns I with II and III with IV, the examiners' level of pattern agreement was excellent (Kappa ranging from 0.82 to 0.97, p<0.0001). The group with Sjögren's syndrome was classified mostly as patterns III and IV and the patients without ocular disease mostly as I and II., Conclusion: The patterns associated with Sjögren's syndrome and normal patients matched the ones in the literature. The tear ferning test classification is reproductible when the Rolando classification was used for Sjögren's syndrome patients.