Navegando por Palavras-chave "keratoprosthesis"
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- ItemSomente MetadadadosAcute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease(Elsevier Science Bv, 2016) Kohanim, Sahar; Palioura, Sotiria; Saeed, Hajirah N.; Akpek, Esen K.; Amescua, Guillermo; Basu, Sayan; Blomquist, Preston H.; Bouchard, Charles S.; Dart, John K.; Gai, Xiaowu; Gomes, Jose Alvaro Pereira [UNIFESP]; Gregory, Darren G.; Iyer, Geetha; Jacobs, Deborah S.; Johnson, Anthony J.; Kinoshita, Shigeru; Mantagos, Iason S.; Mehta, Jodhbir S.; Perez, Victor L.; Pflugfelder, Stephen C.; Sangwan, Virender S.; Sippel, Kimberly C.; Sotozono, Chie; Srinivasan, Bhaskar; Tan, Donald T. H.; Tandon, Radhika; Tseng, Scheffer C. G.; Ueta, Mayumi; Chodosh, JamesOur purpose is to comprehensively review the state of the art with regard to Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to improving the management of associated ocular surface complications. SJS and TEN are two ends of a spectrum of immune-mediated disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. Part I of this review focused on the systemic aspects of SJS/TEN and was published in the January 2016 issue of this journal. The purpose of Part II is to summarize the ocular manifestations and their management through all phases of SJS/TEN, from acute to chronic. We hope this effort will assist ophthalmologists in their management of SJS/TEN, so that patients with this complex and debilitating disease receive the best possible care and experience the most optimal outcomes in their vision and quality of life.
- ItemSomente MetadadadosAvaliação do dano ocular após queimadura química grave na córnea e suas possíveis implicações no implante da ceratoprótese de boston(Universidade Federal de São Paulo (UNIFESP), 2015-12-31) Jorge, Fabiano Cade [UNIFESP]; Siqueira, Wallace Chamon Alves de Siqueira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)A severe chemical burn to the eye usually results in an opaque cornea. Its prognosis depends on the immediate treatment and prevention of further complications. Regardless of medical efforts, surgical rehabilitation with standard penetrating keratoplasty, often repeated, is usually fruitless in the long run, due to limbal stem cell deficiency. Boston Keratoprosthesis (KPro) is reported to give better outcome. However, in chemical burn eyes, optic nerve and retina seem to become more sensitive, developing intraocular complications, such as glaucoma, even with normal intraocular pressure, and retinal detachment. A retrospective review of patients with KPro and severe chemical burns was performed; the number of eyes with a preoperative history or signs of glaucoma was 21 (75%) out of 28 eyes, nine of which had glaucoma progression after KPro implantation. Thus, anti glaucoma medication must be prescribed, and therefore pressure evaluation must have priority in the early burn follow-up. Protection against optic nerve injury should have importance post burn. In addition, inflammation control plays an important role in this scenario. It has been showed that post burn inflammation results in a cloudy cornea and neovascularization. Retina may also be damaged. Two possible mechanisms of retinal damage after ocular surface burn can be hypothesized: first, direct pH-related alkali diffusion from the anterior chamber to the back of the eye, leading to cell cytotoxicity and retinal injury. And second, diffusion of inflammatory cytokines, especially tumor necrosis alpha (TNF-?) from the site of the injury to the posterior segment, causing cell death and retinal damage. The use of infliximab was tested to block TNF-? in mice. In pilot in-vivo and ex-vivo experiments, using larger eyes form pigs and rabbits, respectively, direct pH measurements revealed that the alkalinity in the anterior chamber was significantly elevated. In contrast, pH measurements in the vitreous remained unchanged, suggesting that prompt alkali diffusion posteriorly through the vitreous is very unlikely. In our model, early retinal damage after ocular surface alkali burns, and the protective effects of TNF-? blockade were evaluated. There was significant damage to the retina by 24 hours after corneal burn. TUNEL positive labeling was present in the retinal ganglion cells. Increase in the retinal inflammatory cytokines levels was showed in burned eyes. A single dose of anti-TNF-? antibody provided substantial retinal and corneal protection. This finding could lead to novel and more efficient therapies for chemical injury patients treatment.
- ItemSomente MetadadadosBoston type 1 keratoprosthesis outcomes in ocular burns(Wiley-Blackwell, 2013-09-01) Magalhaes, Fernanda Pedreira [UNIFESP]; Hirai, Flavio Eduardo [UNIFESP]; Sousa, Luciene Barbosa de [UNIFESP]; Oliveira, Lauro Augusto de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries. Methods: This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients' ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures. Results: A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. the mean follow-up period was 25.7 +/- 10.8months. Preoperative best-corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. the overall BKPro retention rate was 90%. the most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p=0.07), although this was not statistically significant. Conclusion: the anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.
- ItemSomente MetadadadosMicrobiota Evaluation of Patients With a Boston Type I Keratoprosthesis Treated With Topical 0.5% Moxifloxacin and 5% Povidone-Iodine(Lippincott Williams & Wilkins, 2013-04-01) Magalhaes, Fernanda Pedreira [UNIFESP]; Nascimento, Heloisa Moraes do [UNIFESP]; Ecker, David J.; Sannes-Lowery, Kristin A.; Sampath, Rangarajan; Rosenblatt, Mark I.; Sousa, Luciene Barbosa de [UNIFESP]; Oliveira, Lauro Augusto de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Ibis Biosci Inc; Weill Cornell Med CollPurpose: To evaluate the efficacy of a prophylactic regimen of daily topical 0.5% moxifloxacin and 5% povidone-iodine (PI) in patients with Boston type I keratoprosthesis (KPro) and to assess the applicability of a novel molecular diagnostic technique to analyze the ocular surface microbiota in these patients.Methods: Ten patients had their inferior conjunctival fornix sampled for standard culture methods before the addition of topical 5% PI to the prophylactic regimen and were considered the control group (group 1). the inferior conjunctival fornix and the KPro-donor cornea interface of 10 patients treated with the mentioned prophylactic regimen were sampled and analyzed by standard culture methods and using a polymerase chain reaction/electrospray ionization mass spectrometry assay (group 2).Results: Samples from the inferior conjunctival fornix were positive for coagulase-negative staphylococcus in 3 patients and for Aerobasidium pullulans in 1 patient in group 1. the inferior conjunctival fornix and the KPro-donor cornea interface scrapings were positive for coagulase-negative staphylococcus in 2 patients and 1 patient, respectively, in group 2. No bacteria and fungi growth were detected in any patient from group 2 with the molecular diagnostic approach. None of the patients with culture-positive results developed keratitis or endophthalmitis during the study.Conclusions: Topical 0.5% moxifloxacin associated with topical 5% PI is an effective prophylactic regimen in patients with Boston type I KPro. the molecular diagnostic approach using serial polymerase chain reaction and mass spectrometry was comparable with standard microbiologic techniques as a surveillance tool in these patients.
- ItemSomente MetadadadosPediatric corneal transplants(Lippincott Williams & Wilkins, 2017) Trief, Danielle; Marquezan, Maria C. [UNIFESP]; Rapuano, Christopher J.; Prescott, Christina R.Purpose of reviewPediatric keratoplasty poses unique challenges in clinical and surgical management. However, successful transplantation can afford a child vision in an otherwise poorly seeing eye. This review will provide an update on recent advances in pediatric keratoplasty.Recent findingsAlthough children who receive corneal transplants remain at increased risk of rejection, infection, and graft dehiscence compared with adult corneal transplant recipients, new surgical techniques, and advances in clinical management have led to better outcomes. Surgical modifications in penetrating keratoplasty (PKP) offer increased stabilization of the delicate pediatric eye. Lamellar surgery, including endothelial keratoplasty and deep anterior lamellar keratoplasty, can target specific diseased tissue in children with potentially fewer complications. The keratoprosthesis can be used successfully in children when the chance of success with PKP is especially low.SummaryAs our knowledge of prognostic indicators and surgical techniques continues to grow, we can offer children safer and more targeted surgeries for some of the most challenging corneal diseases. Ultimately, successful transplantation with long-term graft survival can be obtained by a multidisciplinary approach, with care across ophthalmic specialties, and a commitment to long-term follow-up by the patient's family.
- ItemSomente MetadadadosStevens-Johnson syndrome: The role of an ophthalmologist(Elsevier Science Inc, 2016) Jain, Rajat; Sharma, Namrata; Basu, Sayan; Iyer, Geetha; Ueta, Mayumi; Sotozono, Chie; Kannabiran, Chitra; Rathi, Varsha M.; Gupta, Nidhi; Kinoshita, Shigeru; Gomes, Jose A. P. [UNIFESP]; Chodosh, James; Sangwan, Virender S.Stevens-Johnson syndrome (SJS) is an acute blistering disease of the skin and mucous membranes. Acute SJS leads to the acute inflammation of the ocular surface and chronic conjunctivitis. If not properly treated, it causes chronic cicatricial conjunctivitis and cicatricial lid margin abnormalities. Persistent inflammation and ulceration of the ocular surface with cicatricial complications of the lids leads to chronic ocular sequelae, ocular surface damage, and corneal scarring. The destruction of the glands that secrete the tear film leads to a severe form of dry eye that makes the management of chronic SJS difficult. The option that is routinely used for corneal visual rehabilitation, keratoplasty, is best avoided in such cases. We describe the management strategies that are most effective during the acute and chronic stages of SJS. Although treatments for acute SJS involve immunosuppressive and immunomodulatory therapies, amniotic membrane transplantation is also useful. The options for visual rehabilitation in patients with chronic SJS are undergoing radical change. We describe the existing literature regarding the management of SJS and highlight recent advances in the management of this disorder. (C) 2016 Elsevier Inc. All rights reserved.