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- 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)Dez anos de doação de córneas no Banco de Olhos do Hospital São Paulo: perfil dos doadores de 1996 a 2005(Conselho Brasileiro de Oftalmologia, 2008-04-01) Adán, Consuelo Bueno Diniz [UNIFESP]; Diniz, Amanda Rocha [UNIFESP]; Perlatto, Débora; Hirai, Flávio Eduardo [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)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® 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.
- ItemAcesso aberto (Open Access)Endothelial assessment of donated tectonic corneas: a viable option for posterior lamellar transplantation(Consel Brasil Oftalmologia, 2018) Silva, Rafaella Nascimento e; Sampaio, Lycia Maria Martins Pinho Pedral; Moriyama, Aline Silveira [UNIFESP]; Pereira, Nicolas Cesario [UNIFESP]; Lane, Mark; Silva, Hudson Vergennes da; Forseto, Adriana dos SantosPurpose: Donated corneas are classified as tectonic if there are defects within any layers of the cornea which would prevent a satisfactory visual outcome after transplantation. This study aimed to evaluate whether some tectonic corneas have sufficient endothelial characteristics to allow their use in posterior lamellar keratoplasty, and explored their reclassification for use in this sight-improving procedure. Methods: A retrospective review of all corneal tissues preserved by the Sorocaba Eye Bank from January to April of 2014 was performed. All donated corneas classified as tectonic were included. Endothelial tissue was defined as healthy and viable for posterior lamellar keratoplasty if endothelial cell density was > 2000 cells/mm(2). Additional parameters analyzed included Descemet folds and stretch marks, loss of endothelial cells, corneal endothelial polymegathism/pleomorphism, pseudo-guttata, and reflectivity. Results: During the study period, 2,847 corneas were preserved, of which 423 (14.85%) were classified as tectonic. Of these, 87 (20.56%) were reported as having endothelial viability and were included in the posterior lamellar keratoplasty group. Average corneal endothelial cell density of this group was 2,471 SD +/- 256 cells/mm(2) (range 2012-2967 cells/mm2). Conclusion: A significant number of corneas classified as tectonic showed endothelial viability and were included in the posterior lamellar keratoplasty group (20.56%). Despite stromal and/or epithelial alterations, these corneas could have been potentially distributed for posterior lamellar transplantation to improve vision, thus reducing the corneal transplantation waiting period. This study highlights how corneal tissue reclassification could increase the potential amount of corneal tissue available for optical transplantation.
- ItemAcesso aberto (Open Access)Falência primária pós-transplante de córnea em serviço universitário(Conselho Brasileiro de Oftalmologia, 2002-12-01) Hirai, Flávio Eduardo [UNIFESP]; Klatte, Stefan; Pacini, Keila Mattos [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Hamburgo Faculdade de Medicina; Associação Panamericana de Banco de OlhosPurpose: To analyze the factors related to primary corneal graft failure after penetrating keratoplasty in the Corneal and External Diseases Section of the Federal University of São Paulo, Brazil. Methods: A retrospective study was performed using the charts of patients submitted to penetrating keratoplasty from July 1999 to March 2001. Cases of primary failure (group I) and patients submitted to the surgical procedure at the same period (group II) were selected and compared. Information collected from donors were age, cause of death, endothelial cell count, time between death and enucleation (T1), time between enucleation and preservation of the graft (T2) and time of tissue preservation until surgery (T3). Results: 164 patients were analyzed with 21 cases of primary failure (12.8%). The mean age of the donors of group I was 43.1 years (±22.0) and from group II was 47.9 years (±18.9). There was no statistical difference between the two groups considering the time intervals (T1, T2, T3). Causes of death included trauma, cancer and heart diseases. Conclusion: Differences in all analyzed factors were not significant between both groups. The difficulties in determining the causes of primary corneal graft failure suggests a multifactorial process involved in this problem. Well-trained Eye Bank staff and notifications about postoperative complications are important to decrease the primary failure incidence.
- ItemAcesso aberto (Open Access)Fatores associados à qualidade da córnea doada pelo Banco de Olhos do Hospital São Paulo(Conselho Brasileiro de Oftalmologia, 2009-02-01) Hirai, Flávio Eduardo [UNIFESP]; Adán, Consuelo Bueno Diniz [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)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.
- 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)Modelo de gestão em bancos de olhos e seu impacto no resultado destas organizações(Sociedade Brasileira de Oftalmologia, 2012-02-01) Hilgert, Christiana Velloso Rebello [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Instituto Hilton Rocha; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To analyse the management of Sorocaba Eye Bank (BOS) and Santa Casa de Campo Grande Eye Bank (BOSC) with distinct results regarding number of donations using Prêmio Nacional Gestão em Saúde (PNGS) criteria for performance excellence. METHODS: All the personel of the two eye banks were submitted to an interview using the 'Are We Making Progress?' questionnaire from Malcolm Baldrige Quality Program. The questionnaire items were organized by the seven criteria categories, as the PNGS's (Leadership, Strategic Planning, Customer and Market Focus, Measurement, Analysis and Knowledge Management, Human Resource Focus, Process Management, Bussiness Results). The findings were studied upon Fischers' exact test and Non parametric U test (Mann-Whitney) to compare the medium scores between the two Institutions. RESULTS: Twenty-one employees from BOS and 08 from BOSC were submitted to the questionnaire. The Mann-Whitney test showed a higher level of agreement to the questionnaire proposals from BOS than the ones from BOSC in 6 out from the 7 items studied (Leadership, Strategic Planning, Costumer and Market Focus, Human Resource Focus, Process Management, Bussiness Results). There wasn't any statisticaly significant difference related to the criteria Measurement, Analysis and Knowledge Management. The highest difference on the concordance level between the two organizations was related to Process Management (p<0.001). CONCLUSION: The BOS management performance has distinct and statistically significant aspects compared to BOSC, shown on 6 out of 7 criteria studied by the questionnaire used. These data showed that the BOS performance management is closer to internationally accepted concepts of performance excellence, based on both PNGS Criteria and Malcolm Baldrige Quality Program, than BOSC.