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- ItemAcesso aberto (Open Access)Aplicação de modelos epidemiológicos para determinar fatores associados a qualidade de córneas em banco de olhos(Universidade Federal de São Paulo (UNIFESP), 2016-11-29) Aquino, Nathalia Mayumi Thomaz de [UNIFESP]; Hirai, Flavio Eduardo [UNIFESP]; http://lattes.cnpq.br/6575096591259140; http://lattes.cnpq.br/9462387847581411; Universidade Federal de São Paulo (UNIFESP)Objective: To develop a methodology using epidemiological models to identify factors related to transplanted cornea?s quality in Eye Banks. Methods: A case-control study was conducted to determine factors related to primary graft failure in the state of São Paulo between January 2010 and December 2013. Primary graft failure cases were defined as irreversible corneal edema in the immediately postoperative period, unresponsive to topical treatment. Controls were randomly selected from corneal transplants performed one week before or after the cases. Donors data were evaluated as cause of death, sex, age, endothelial cell count, time between death and enucleation, time to corneal preservation and preservation time before surgery. Statistical analysis between groups was performed and the odds ratio was calculated to determine factors related to primary failure. Results: Thirty-eight cases of primary graft failure were reported to the São Paulo State Transplant Center during the study period, leading to a selection of 152 controls. The cases had between 16 years to 79 years, averaging 46.1 years (SD = 16.5 years) and controls 4-79 years, mean 39.8 years (SD = 16.5 years) (p = 0.037). There were more men in both groups, 60.5% among cases and 66.4% among controls (p = 0.493). Time between death and enucleation was 4.6 hours for cases (sd = 3.7 hours) and 3.5 hours for controls (sd = 5.8horas), p = 0.255. Time between enucleation and tissue preservation was 5.7 hours (SD = 3.5 hours) for cases and 4.6 hours (SD = 5.1 hours) for controls, p 0.238. It was also verified that the time between the preservation and transplantation in cases averaged 9.5 days (SD = 2.7 days) and controls 7.9 days (SD = 2.8 days) (p = 0.001). In the multivariate analysis, each extra day of preservation increased the risk of primary failure by 23%. Regarding endothelial cell count, were verified 2518.3 cells / mm 2 (SD = 259.4 cells / mm2) in cases and 2627.0 cells / mm 2 (SD = 346.1 cells / mm2) in controls (p = 0.084). The main cause of death in both groups were cardiovascular disease (50.0% of cases and 49.3% among controls). Death from external causes were found in 18.4% of cases and 45.4% of controls. Other causes, such as cancer, accounted for 31.6% of deaths among cases and 5.3% among controls. The corneas of those who died from other causes than cardiovascular disease were 6.6 times more likely to develop primary graft failure after adjusting for other variables (odds ratio 6.6 (2.1 to 20.5)). Conclusion: The case-control study was useful to determine factors associated with primary graft failure and could be used as a tool for quality control in Eye Banks. In this study, primary graft failure was multifactorial and reflects directly the tissues quality and it?s processing. Factors such as gender, endothelial cell count, time between death and enucleation and time between enucleation and preservation were not associated with the morbidity. However, age, time between preservation and surgery and cause of death could influence the tissue?s quality, leading to higher rates of primary graft failure. Therefore, may be factors to be considered during the selection of corneas in Eye Banks.
- ItemAcesso aberto (Open Access)Características dos doadores de córneas do Banco de Olhos de Cascavel: impacto do exame anti-HBc para hepatite B(Conselho Brasileiro de Oftalmologia, 2011-02-01) Shiratori, Cesar Nobuo; Hirai, Flávio Eduardo [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Banco de Olhos de Cascavel; Universidade Federal de São Paulo (UNIFESP)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.
- ItemAcesso aberto (Open Access)Conhecimento e atitude da população do Hospital São Paulo sobre doação de córneas(Conselho Brasileiro de Oftalmologia, 2002-12-01) Rodrigues, Adriana Maria [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To analyze the knowledge and attitude of the general population in order to identify the main deficiencies and to suggest measures to increase the number of cornea donations by the general population. Methods: Study through questionnaire polls answered by 321 people at the São Paulo Hospital. Results: Among the general population, 79.4% said to be cornea donors. The reason for the other 20.6% not to be donors was fear of trade of organ and not to receive proper treatment by the medical staff for being a potential donor. There was a statistically significant difference of knowledge about transplantation between those who said to be donors and those who did not. Conclusion: The authors concluded that better information on corneal transplantation for the general population would be of great help in increasing the number of cornea donations.
- ItemAcesso aberto (Open Access)Contaminação de halos doadores córneo-esclerais em ceratoplastia penetrante no Hospital de Clínicas de Porto Alegre(Conselho Brasileiro de Oftalmologia, 2008-02-01) Borowsky, Cláudia Martins; Wallau, Anelise Dutra [UNIFESP]; Reetz, Aline; Kwitko, Sérgio [UNIFESP]; Rymer, Samuel; Locatelli, Claudete Inês; Universidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre; Universidade Federal de São Paulo (UNIFESP); Universidade de Passo Fundo; Hospital de Clínicas de Porto Alegre; UFRGS Faculdade de Medicina; UFRGS Hospital de Clínicas de Porto Alegre; UFRGSPURPOSE: To determine the incidence of positive corneoscleral rim cultures preserved in Optisol GS medium, to identify pathogens involved and possible recipient eye infection. METHODS: A hundred sixty-three corneoscleral rim cultures penetrating keratoplasties performed from January 2001 to January 2003 in the Hospital de Clínicas de Porto Alegre were reviewed. Enucleations and corneal storage were done as aseptic as possible and gentamicin 0.3% was instilled. Corneoscleral rim was divided into two segments, half was inoculated into Sabouraud broth and the other half into thioglycolate broth; inoculation into blood agar, chocolate agar and MacConkey agar was done later if necessary for pathogen identification. The receiver's eye data were reviewed. RESULTS: There were eleven positive cultures (6.7%) out of 163 evaluated corneoscleral rim cultures. Of these, four were Staphylococcus epidermidis, one was Staphylococcus aureus, one was Serratia sp., one was Pseudomonas aeruginosa and the other four were different subtypes of Candida (two Candida sp., one Candida albicans and one Candida parapapilosis). All pathogens were resistant to gentamicin. None of the eleven cases of positive corneoscleral rim cultures resulted in ocular infection at the receiver's eyes (six months follow-up). CONCLUSIONS: We found low rates of positive corneoscleral rim cultures after penetrating keratoplasty at the Porto Alegre Clinical Hospital. The most frequent involved pathogens were Staphylococcus sp and Candida sp. Although we did not identify any postoperative infection at the receiver's eyes, we recommend corneoscleral rim culture for guidance of postoperative infection, a rare but possible devastating ocular event.
- ItemAcesso aberto (Open Access)Descarte de córneas por sorologia positiva do doador no Banco de Olhos do Hospital São Paulo: dois anos de estudo(Conselho Brasileiro de Oftalmologia, 2009-04-01) Viegas, Marco Túlio Chater [UNIFESP]; Pessanha, Lucas Calmon [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Hirai, Flávio Eduardo [UNIFESP]; Adán, Consuelo Bueno Diniz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)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.
- ItemAcesso aberto (Open Access)Impacto do marketing dos processos de divulgação nas doações de córneas a um banco de tecidos oculares humanos e avaliação do perfil socioeconômico de seus doadores(Conselho Brasileiro de Oftalmologia, 2008-02-01) Farias, Roberta Jansen De Mello [UNIFESP]; Sousa, Luciene Barbosa De; Universidade Federal de São Paulo (UNIFESP); Hospital Oftalmológico de SorocabaABSTRACT Penetrating keratoplasty has been the leading and the most successful type of transplant in the world, however corneal deficiency is a commom problem usually presented to corneal surgeons. PURPOSE: Impact evaluation of the number of corneal graft donations to the Sorocaba Eye Bank after the implementation of a corneal graft procurement system; to draw the socioeconomic profile of corneal graft donors of the Sorocaba Eye Bank (SEB). METHODS: Retrospective study on donations to SEB from its creation and after the development of media marketing. Prospective analysis of the socioeconomic profile of corneal graft donors by a questionnaire sent as letters to the families of the donors in a certain month. RESULTS: SEB began its work in 1971 by spreading need of organ donation through lectures in churches, shopping malls, community meetings, radio programs, television programs, etc. In the 70s, the number of retrieved corneal grafts was 1 or 2/month. Between 1984 - 1989 a procurement coordination team was trained to act in mortuaries and by 2000 they also began to work in public hospitals. In 1984 only 260 corneal grafts were retrieved. This number has been increasing to 2,778 corneal graft donations in 2004. The questionnaire was answered by 76 of the 93 donor families, with a response rate of 81.7%. Donor age had a mean of 65.1 ± 14.7 y/o, forty-two (55.3%) were men. Educational level of the donor families was an important factor for organ donation, once 36.8% had concluded high school and 34.2% completed university. The great majority, sixty-three (82.9%) of the corneal grafts were donated through the efforts of the procurement coordination team. CONCLUSION: The role of the media and institutional credibility are mandatory for public commitment to organ donation. The proficiency of the procurement coordination team requires intensive training, as the results show that 82.9% donations were made thanks to their efforts.
- ItemAcesso aberto (Open Access)Influência da lista única de uma regional de transplantes de córnea em um Banco de Olhos vinculado a um hospital escola(Conselho Brasileiro de Oftalmologia, 2003-10-01) Oliveira, Lauro Augusto De; Corrêa, Beatriz Soares [UNIFESP]; Almeida Jr, Gildásio Castello De; Ferrari, Marta Teixeira; Kashiwabuchi, Luiz Kazuo; Faculdade de Medicina de São José do Rio Preto Departamento de Oftalmologia; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina de São José do Rio Preto Departamento de Oftalmologia Setor de Córnea e Moléstias Externas; Faculdade de Medicina de São José do Rio Preto serviço de OftalmologiaPURPOSE: To evaluate how the implantation of a single regional list for corneal transplants influenced an eye bank of a university hospital. To analyze the influence of the regional list on the corneas (procurement and destiny), the number of transplantations made and the average waiting time for surgery. METHODS: A retrospective study was made to compare the records of patients who underwent penetrating keratoplasty and also the data of the eye bank of the Medical School of São José do Rio Preto, São Paulo, Brazil. The study compared the data of the service one year before and one year after the creation of the single regional list. RESULTS: The number of transplantations increased from 60 to 92 procedures. The monthly average of directly acquired corneas increased from 13.83 + 6.57 to 18.16 + 4.8 (p-value = 0.07). The number of corneas sent to other institutions was greater than the number of corneas received from other eye banks (p-value = 0.003). There was no significant difference between the waiting time for surgery before and after the creation of the list except for the period of adaptation. CONCLUSIONS: This eye bank served as a supplier of corneas for other institutions. By the end of the first year of operation of the single regional list, there was no alteration in the waiting time as compared to that before its creation. Nonetheless, a tendency of homogenization in the waiting time for penetrating keratoplasty among the patients was observed.
- ItemAcesso aberto (Open Access)Rejeição corneana pós transplante de córnea: análise de dados do Banco de Olhos do Hospital São Paulo - Escola Paulista de Medicina(Conselho Brasileiro de Oftalmologia, 2000-02-01) Chalita, Maria Regina Catai [UNIFESP]; Diazgranados, Eileen Beatriz Mejia [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Branco, Bruno Castelo [UNIFESP]; Freitas, Denise de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: Among all grafts, corneal transplantation is the most commonly performed. Graft outcome is usually good, but some cases failure due to rejection can be observed.There are some well-known risk factors for corneal graft rejection. The purpose of this study is to analyze cases of corneal graft rejection in our Service focusing on peculiar risk factors. Methods: We analyzed 113 cases of penetrating keratoplas-ties performed in 1998. Cases of corneal graft rejection were evaluated in relation to preoperative diagnosis, existence of synechia, corneal vascularization, increased intraocular pressure, previous graft rejection, donor age, time of enu-cleation and preservation of the donor cornea and the surgeon's surgical experience. Results: We were able to identify 20 (17.69%) cases of graft rejection. Among these 9 had synechia, 4 corneal neovas-cularization, 8 increased intraocular pressure and 7 pre-vious graft rejection. Conclusions: Our results are in agreement with those of the literature. It seems that the surgeon's experience plays a role in corneal graft rejection. It is important to call attention to the fact that reference services handle difficult and more complicated cases which may be at a higher risk to rejection.