Navegando por Palavras-chave "cornea"

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    Alterations in blood-aqueous barrier after corneal refractive surgery
    (Lippincott Williams & Wilkins, 1998-03-01) Vita, RCA; Campos, M.; Belfort, R.; Paiva, E. R.; Universidade Federal de São Paulo (UNIFESP)
    Purpose. To assess alterations in the blood-aqueous barrier after radial keratotomy (RK), photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and phototherapeutic keratectomy (PTK). Methods. Aqueous flare was evaluated using the Kowa FM 500 laser flare meter in a total of 87 eyes from 82 patients who underwent refractive surgery. Measurements were obtained preoperatively in 51 eyes of 51 patients who underwent RK or PRK and again at the end of surgery, and at 1 day and 1 week postoperatively. These patients had been randomized (double masked) to receive topical 0.1% dexamethasone, polymyxin B (6,000 U/ml), and 0.5% neomycin 4 times a day for 1 week after surgery, or polymyxin B (6,000 U/ml) and 0.5% neomycin for 1 week. Aqueous flare measurements were also obtained before surgery in 36 eyes (31 patients) that underwent LASIK and again at 1 day and 1 and 2 weeks postoperatively. All patients in this group received topical 0.1% dexamethasone, polymyxin B (6,000 U/ml), and 0.5% Neomycin 4 times a day for 15 days after surgery. Results. Uneventful RK induced a significant increase in flare immediately after surgery, although this did return to baseline 1 day after surgery (Friedman test). Measurements at 7 days after surgery were similar in steroid-treated and untreated groups. Limbal bleeding, which occurred in 23% (12/51) eyes, did not induce significantly increased flare as compared to uneventful RK. Microperforations, which occurred in 18% (9/51) eyes, did induce significant alterations in the blood-aqueous barrier that persisted for >1 day, but measurements returned to preoperative levels by day 7. PRK and LASIK induced substantially increased flare in some eyes. Phototherapeutic keratectomy, in particular, induced an elevation in flare measurements that did not return to normal levels even by 15 days after surgery (Friedman test). Conclusions. Using mean results of laser flare meter evaluation, uneventful RK appears to induce short-lasting elevations in aqueous flare in both steroid-treated and untreated patients. Microperforation induced prominent alterations in flare measurements, although limbal bleeding did not. Both PRK and LASIK did appear to increase flare measurements in some eyes, while PTK induced significant elevations in aqueous flare in the majority of eyes.
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    CD11b+GR1+Myeloid Cells Secrete NGF and Promote Trigeminal Ganglion Neurite Growth: Implications for Corneal Nerve Regeneration
    (Assoc Research Vision Ophthalmology Inc, 2013-09-01) Sarkar, Joy; Chaudhary, Shweta; Jassim, Sarmad H.; Ozturk, Okan; Chamon, Wallace [UNIFESP]; Ganesh, Balaji; Tibrewal, Sapna; Gandhi, Sonal; Byun, Yong-Soo; Hallak, Joelle; Mahmud, Dolores L.; Mahmud, Nadim; Rondelli, Damiano; Jain, Sandeep; Univ Illinois; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE. We characterized fluorescent bone marrow cells (YFP+ BMCs) in the thy1-YFP mouse and determine if they promote trigeminal ganglion (TG) cell neurite growth.METHODS. Excimer laser annular keratectomy was performed in thy1-YFP mice, and corneas were imaged. BMCs were harvested from femur and tibia, and the expression of surface markers on YFP+ BMCs was analyzed by flow cytometry. the immunosuppressive action of BMCs (YFP+ and YFP-) was evaluated in an allogenic mixed lymphocyte reaction (MLR). Neurotrophic action of BMCs (YFP+ and YFP-) was determined in compartmental and transwell cultures of dissociated TG cells.RESULTS. Following annular keratectomy, YFP+ BMCs infiltrated the cornea. YFP+ BMCs shared surface markers (CD11b+Gr1+Ly6C+Ly6G-F4/80(low)) with monocytic myeloid-derived suppressor cells (MDSCs), had similar morphology, and suppressed T-cell proliferation in allogenic MLR in a dose-dependent manner. YFP+ BMCs, but not YFP- BMCs, significantly increased growth of TG neurites in vitro. When cultured in a transwell with TG neurites, YFP+ BMCs expressed neurotrophins and secreted nerve growth factor (NGF) in conditioned medium. YFP+ BMCs that infiltrated the cornea maintained their phenotype and actions (neuronal and immune).CONCLUSIONS. YFP+ BMCs in thy1-YFP mice have immunophenotypic features of MDSCs. They secrete NGF and promote neuroregeneration. Their immunosuppressive and neurotrophic actions are preserved after corneal infiltration. These findings increase our understanding of the beneficial roles played by leukocyte trafficking in the cornea and may lead to therapeutic strategies that use NGF-secreting myeloid cells to repair diseased or injured neurons.
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    Clinical and Histopathological Outcomes of Subconjunctival Triamcinolone Injection for the Treatment of Acute Ocular Alkali Burn in Rabbits
    (Lippincott Williams & Wilkins, 2012-02-01) Saud, Esper E.; Moraes, Haroldo V.; Marculino, Leonardo G. C. [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Allodi, Silvana; Miguel, Nadia C. O.; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP)
    Purpose: To evaluate the efficacy and safety of subconjunctival injection of triamcinolone in the treatment of acute ocular alkali burn in rabbits.Methods: Two groups of 5 rabbits were subjected to alkali burn (1 N NaOH). One group was treated with 1 subconjunctival injection of 0.3 mL of triamcinolone and the other with 1 subconjunctival injection of 0.3 mL of 0.9% saline. the affected corneas were observed for vascularization and opacity approximately 10 minutes after the burn and also after 7, 14, and 21 days. Photographs were taken for observation and statistical analyses. At all time intervals, the corneas were classified according to predetermined scores. Twenty-one days after the treatment, the animals were anesthetized, and their eyes were enucleated and processed for histopathology.Results: Greater vascularization and opacity appeared in the animals that were treated with saline than in those treated with subconjunctival triamcinolone (vascularization: 7 days, P = 0.0107; 14 days, P = 0.0099; and 21 days, P = 0.0088; opacity: 7 days, P = 0.0079; 14 days, P = 0.0112; and 21 days, P = 0.0255). These results were also compatible with the morphological and statistical analyses, which revealed a more intense inflammatory process in the group treated with saline (P = 0.0317). No complications, such as corneal melting, perforation, or infection, were observed.Conclusions: Subconjunctival injection of triamcinolone may be a therapeutic option for the treatment of acute ocular burn because it reduced the corneal inflammatory process, opacity, and vascularization, with no apparent clinical changes in the general state of the animal.
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    Comparison of EphA receptor tyrosine kinases and ephrinA ligand expression to EphB-ephrinB in vascularized corneas
    (Lippincott Williams & Wilkins, 2007-06-01) Kojima, Takashi; Chung, Tae-Young; Chang, Jin-Hong; Sayegh, Rony; Casanova, Fábio Henrique Cacho [UNIFESP]; Azar, Dimitri T.; Univ Illinois; Sungkyunkwan Univ; Harvard Univ; Universidade Federal de São Paulo (UNIFESP)
    Purpose: Eph cell surface receptors and their ligands, ephrins, are involved in neuronal patterning and neovascularization. Our purpose is to compare and characterize the expression of ephrinA ligands and EphA receptors to ephrinB; ligands and EphB receptors in excised mouse corneal tissue, in corneal epithelial and keratocyte cell lines, and during corneal angiogenesis.Methods: Mouse corneal epithelial cells and keratocytes were immortalized using SV40T antigen viral infection of primary cultures. The immortalized epithelial cells and keratocytes were cloned and characterized using antibodies to keratin, vimentin, integrin alpha 5 beta 1, and alpha-smooth muscle actin. Basic fibroblast growth factor pellets were implanted to induce corneal neovascularization. The eyes of wild-type, ephrinB2(tlacZ/+), and EphB4(tlacZ/+) heterozygous mice were harvested and sectioned 7 days after pellet implantation. Confocal immunohistochemistry was performed to compare the expression of the Eph/ephrinA family (EphA1-8, ephrinA1-5) and Eph/ephrinB family (EphB1-4, EphB6 ephrinB1-3).Results: EphA1, EphA3, ephrinA1, ephrinA2, EphB1, EphB4, ephrinB1, and ephrinB2 were detected in wild-type mouse corneal epithelial cells and keratocytes. EphA2 was immunolocalized only in epithelial cells. Also, EphA3, ephrinA1, EphB1, EphB4, and ephrinB1 were immunolocalized to the comeal epithelium and stroma. In the vascularized corneas, ephrinB1 was immunolocalized mainly to the keratocytes around the vessels, and ephrinB2, EphB 1, and EphB4 were colocalized mainly with CD31 to the vascular endothelial cells.Conclusions: The characterization of ephrin ligand and Eph receptor expression during cornea angiogensis in this study suggests that the Eph/ephrin family of receptor tyrosine kinases and their ligands may play a role in the regulation of corneal angiogenesis.
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    Descemet Membrane Detachment in Femtosecond Laser-Assisted Cataract Surgery
    (Lippincott Williams & Wilkins, 2016) Nosé, Ricardo M. [UNIFESP]; Rivera-Monge, Maria Daniela [UNIFESP]; Forseto, Adriana dos Santos [UNIFESP]; Nosé, Walton [UNIFESP]
    Purpose: To report a case series of 4 patients with Descemet membrane detachment (DMD) after undergoing femtosecond laser-assisted cataract surgery incisions. Methods: Case report. Results: DMD was noted at the secondary incision (n = 2) or at the main incision (n = 2). All the secondary incision and 1 main incision DMD were resolved with intraoperative maneuvers. Delay in recognizing DMD intraoperatively at the principal incision in 1 case led to inadvertent aspiration of a part of it and persistent postoperative corneal edema. This complication was handled with Descemet membrane endothelial keratoplasty 1 month after initial surgery. Conclusions: DMD can occur after femtosecond laser-assisted cataract surgery, although it is a rare complication as it is in traditional phacoemulsification. The surgeon must be prepared to recognize it, manage it intraoperatively, and treat it postoperatively to reduce the risk of permanent damage to the eye.
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    The effects of the subconjunctival injection of bevacizumab (Avastin®) on angiogenesis in the rat cornea
    (Academia Brasileira de Ciências, 2007-09-01) Barros, Luiz F.m.; Belfort, Rubens Junior [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    The purpose of this study was to evaluate the effects of the use of the subconjunctival injection of bevacizumab (Avastin®) on angiogenesis in the rat cornea. Corneas of 20 Wistar male rats were cauterized with silver nitrate crystal. Animals were divided in four groups: control group (GC) that received subconjunctivally 0.02 ml of 0.9% saline solution on the day of the lesion; group GO that received subconjunctivally 0.02 ml of bevacizumab just after the lesion; group G3 that received bevacizumab on day 3 and group G5 that received bevacizumab on day 5 after lesion. Animals were euthanized on day 7. The newly formed vessels were quantified after China Ink perfusion and photographs were obtained and analyzed in a computerized system (Image Pro-Plus®). In the control group, neovascularization covered 53.56% ± 15.11 (mean ± SD) of the corneal surface, compared with 35.57% ± 18.80 (mean ± SD) in the G0 group, 30.60%±11.82 (mean±SD) in the G3 and 35.86%±0.07 (mean±SD) in the G5. The results showed an inhibition of angiogenesis when the control group was compared with all treated groups. These results suggest that subconjunctival injection of bevacizumab is able to inhibit corneal angiogenesis independently of the day of treatment.
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    Effects of topical 2% cyclosporine A on the corneas of dogs subjected to lamellar keratoplasty with a graft of equine pericardium preserved in glycerin: clinical and morphological evaluation
    (Universidade Federal de Santa Maria, 2004-02-01) Teixeira, Roseli Borges; Barros, Paulo Sergio De Moraes; Martins, Maria Cristina [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    The effects of topical 2% cyclosporine A on the cornea of dogs subjected to experimental lamellar keratoplasty with an equine pericardial graft were evaluated. Ten dogs were grouped to be evaluated 3, 7, 15, 30 and 60 days after surgery. Animals received bilateral grafts followed by the application of a 2% cyclosporine A ointment on the left eye (treated eye) and the ointment base on the right eye (control eye) twice a day. The ophthalmic evaluation showed profound bilateral blepharospasm, photophobia and a mucous secretion until the 7th day after surgery; corneal vascularization starting in the limbus was observed as early as the 3rd day in both eyes; opacification and vascularization were more intense in the treated cornea on days 15 and 30 after surgery. Vascularization was still evident on the 60th day, and looked similar in treated eyes and control eyes. The histologic evaluation showed a complete bilateral reepithelization and corneal vascularization three days after the surgery; intense vascularization in both eyes on days 15 and 30, that was much more pronounced in the treated cornea; and a bilateral predominance of polymorphonuclear cells until day 15, and mononuclear cells on day 30. Intact epithelium and stroma with new vessels, as well as graft absorption, in both eyes, were seen on the 60th day. The lamellar keratoplasty with equine pericardial graft was an effective model to study the inflammatory kinetics and corneal vascularization phenomenon. In this study, cyclosporine A did not inhibit corneal vascularization and it did not interfere in the corneal cicatricial process.
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    Fator de crescimento vascular endotelial na neovascularização corneana de camundongos
    (Universidade Federal de São Paulo (UNIFESP), 2014-09-30) Oliveira, Hailton Barreiros de [UNIFESP]; Siqueira, Wallace Chamon Alves de Siqueira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Angiogenesis is defined as the formation of new vessels from existing vessels. It is a complex multistep process that includes proliferative migration and differentiation of endothelial cells, degradation of extracelluar matrix, microtubule formation, and sprouting of new capillary branches. Angiogenic factors such as basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) have been used as angiogenic inducers. bFGF is the prototype member of 13 structurally related heparin-binding growth factors and it is known as a mitogen for several types of cells, including vascular endothelial cells and fibroblasts. Miquerol and collaborators have produced mice that express VEGF-LacZ. This was possible by inserting a gene identifier (reporter) 3i non-transcribed region of the endogenous VEGF gene. Thus, it was possible to produce VEGF mRNA containing the LacZ indentifier (reporter). The balance between angiogenic and antiangiogenic factors is responsible for the regulation of angiogenesis. Studies show the effects of a specific inhibitor of VEGF. VEGF TrapR1R2, which is a fusion protein of human Fc domain to the second domain and the third domain receptor R1 receptor R2 . This protein is able to sequester VEGF, antagonize and therefore prevent the formation of blood vessels. The objectives of this study are: demonstrate that mice cornea produces VEGF when stimulated by bFGF and to demonstrate that intraperitoneal administration of VEGF TrapR1R2 inhibits VEGF production and angiogenesis. Control pellets or pellets containing 80 ng bFGF were surgically implanted into wild-type C57BL/6 and VEGF-LacZ mouse corneas. The corneas were photographed, harvested, and the percentage of corneal NV was calculated. The corneas were evaluated for the expression of VEGF and neovascularization using Confocal Microscopy. VEGF-LacZ mice received tail vein injections of an endothelial-specific lectin after pellet implantation to determine the temporal and spatial relationship between VEGF expression and corneal NV using confocal microscopy. Western blot was used to analyze the presence of VEGF in corneas of mice that received wild implantation of pellets containing bFGF. Neovascularization was assessed on corneas that received the implant pellet containing bFGF after administration of intraperitoneal injections of VEGF TrapR1R2 or control IgG-Fc protein. NV of the corneal stroma began on day 4 and was sustained through day 21 following bFGF pellet implantation. Progression of vascular endothelial cells correlated with increased VEGF-LacZ expression. Western Blot analysis showed increased VEGF expression in the corneal NV zone. Following bFGF pellet implantation, the area of corneal NV in untreated controls was 1.05±0.12 mm² and 1.53±0.27 mm² at days 4 and 7, respectively. This was significantly greater than that of mice treated with VEGF TrapR1R2 (0.24±0.11 mm² and 0.35±0.16 mm² at days 4 and 7, respectively; p<0.05). The avascular cornea depends on a balance between various endogenous angiogenic factors (including VEGF , bFGF) and anti - angiogenic factors , when this balance is broken for some reason , corneal neovascularization occurs. This study suggests that the mice cornea produces VEGF when stimulated with bFGF. VEGF proteins are of great importance in corneal neovascularization, as function stimulating factors such as vascular endothelial cells. However, the specific mechanism of regulation of VEGF production by stimulation of bFGF has not yet been fully elucidated. It has been shown that injection of VEGF TrapR1R2 blocks the formation of blood vessels in the corneas of mice subjected to suturing. Using different technique to induce neovascularization, we demonstrate that VEGF TrapR1R2 blocks neovascularization in corneas that had implantation of sediments containing bFGF. More experiments are needed to dissect the role of bFGF in the production of VEGF and blocking using VEGF TrapR1R2. Probably, this mechanism contributes to the prevention of corneal neovascularization. The cornea of mice expressed VEGF after stimulation by bFGF. Systemic administration of VEGF TrapR1R2 blocks the vascularization of the mice cornea triggered by implanting pellets containing bFGF. Systemic administration of VEGF TrapR1R2 may have potential therapeutic applications in the management of corneal NV.
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    Guia de boas práticas para departamento hospitalar e ambulatorial de oftalmologia
    (Universidade Federal de São Paulo (UNIFESP), 2016-12-21) Traverso, Maria Rossana Almeida [UNIFESP]; Rodrigues, Eduardo Buchele [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This project was conceived in order to develop a good practice guide directed to the Department of Ophthalmology, which aims to facilitate the access to the good practice information that involve all procedures used in hospitals and clinics, correlating them with the current regulations. Sectors of the Department of Ophthalmology were considered, focusing on procedures regulated by Rules of the Federal, State and / or Municipal to then critically analyze and interpret the regulatory rules, consisting of laws, decrees, resolutions, guidelines and ordinances relevant to the department of ophthalmology and medical staff involved. Regulated procedures were described by preparing the Good Practice Guide for Hospital and Clinical Department of Ophthalmology and distributed in 8 chapters, which correspond to different categories of procedures adopted in the hospital and clinical department of ophthalmology. At a later stage, through the analysis of the Good Practice Guide for Hospital and Clinical Department of Ophthalmology, it was elaborated a checklist to be filled by doctors and/or professionals working in the hospital and / or clinical Department of Ophthalmology as a tool to help them in the control of the compliance with applicable rules. Evaluating the activities carried out in hospitals and clinical ophthalmology departments, correlating them with regulatory issues and good practice, a total of 17 Resolutions, 6 Ordinances, 2 Laws, 1 Decree, 1 Procedure, 1 Script, 1 Informative and 3 guides were identified, which were used as a reference for obtaining the information necessary for the preparation of the Good Practice Guide for Hospital and Clinical Department of Ophthalmology. Through the guide to good practice for hospital and clinical department of ophthalmology, the access to information necessary to ensure the quality and safety of services becomes easier.
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    Histopathological study of 49 cases of keratoconus
    (Lippincott Williams & Wilkins, 2008-01-01) Fernandes, Bruno F.; Logan, Patrick; Zajdenweber, Moyses E.; Santos, Leonardo N.; Cheema, Devinder P.; Burnier, Miguel N. [UNIFESP]; McGill Univ; Henry C Witelson Ocular Pathol Lab; Universidade Federal de São Paulo (UNIFESP)
    Aims: Keratoconus is a bilateral and asymmetrical corneal ectasia. the pathophysiology of this disorder has yet to be fully elucidated. the purpose of our study was to document the prevalence of the most common morphological features of keratoconic corneas.Methods: A retrospective analysis of 49 cases diagnosed as keratoconus between 2001 and 2006 was undertaken. Histopathological reports were reviewed to obtain data such as age and gender. Specimens were fixed in 10% buffered paraformaldehyde solution for 24h, bisected through the centre of the button, and embedded in paraffin. Sections were stained with haematoxylin and eosin (HE) and periodic acid-Schiff (PAS) for light microscopic examination.Results: the studied group was composed of 29 men and 20 women. Age at the time of the penetrating keratoplasty was 3914 years (mean +/- standard deviation). Forty of the 49 specimens (82%) presented with epithelial thinning. Other common features of keratoconus included breaks in Bowman's layer in 35 (71%), compaction of the stromal collagen fibres in 31 (63%), and folds in Descemet's membrane in 31 (63%) cases. Other less common histopathological findings were: presence of superficial iron deposits in 14 (29%), deep stromal scarring in 12 (24%), epithelial scarring in 11 (22%), endothelial cell loss in 11 (22%), and breaks in Descemet's membrane in nine (18%) cases.Conclusions: Some of the histopathological findings associated with keratoconus are subtle. It is important to be aware of them in order to properly confirm the clinical diagnosis.
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    Inflammation-related scarring after photorefractive keratectomy
    (Lippincott Williams & Wilkins, 1998-11-01) Campos, M.; Takahashi, R.; Tanaka, Hatune; Chamon, W.; Allemann, N.; Universidade Federal de São Paulo (UNIFESP)
    Purpose. To study two cases of corneal scarring due to trauma (one case) and infection (one case) unrelated to a previous photorefractive keratectomy (PRK) for the correction of myopia. Methods. the patients are part of an Institutional Review Board-approved study of the safety and efficacy of PRK. Both patients underwent bilateral, nonsimultaneous corneal ablation based on preoperative spherical equivalent. Results. Seven months after PRK, the first patient sustained an alkali burn in one eye that caused severe corneal scarring and myopic regression. the other patient developed bilateral keratoconjunctivitis, more intense in the right eye (1 month after the operation) than in the left eye (4 months after the operation). This right eye subsequently developed diffuse scarring and loss of visual acuity. Conclusion. Patients who have undergone PRK may develop severe corneal scarring after relatively mild ocular traumas or infections.
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    Lamellar keratoplasty in rabbits using human and rabbit amniotic membrane grafts: a comparative study
    (Wiley-Blackwell, 2015-05-01) Godoy-Esteves, Cintia A. L.; Gomes, José Álvaro Pereira [UNIFESP]; Yazbek, Karina; Guerra, Jose L.; Barros, Paulo S. M.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Agener Saude Anim
    ObjectiveTo compare the behavior of human and rabbit amniotic membrane (AM) grafts in surgically induced corneal thinning in rabbits.Animals studiedThirty two NZWR were randomly assigned to two groups of 16 animals each according to AM type (Human AM: group HAM and Rabbit AM: group RAM).ProcedureAll animals were submitted to right keratectomy at a depth of 0.1mm using a 5mm trephine. Animals from HAM group had a button of 5mm of human AM sutured into the corneal bed with a continuous pattern and 10.0 nylon monofilament suture, while animals from the RAM group had a button of 6mm diameter of rabbit AM. Four animals in each group were euthanized 2, 7, 15, and 30days postoperatively. Their corneas were harvested, fixed in 2% glutaraldehyde solution, and stained with haematoxylin-eosin, picrosirius red, and alcian blue for evaluation under light optical microscopy. Microscope images were digitalized and inflammatory cells and stromal blood vessels were counted.ResultsThere were no clinically significant differences between groups, and complete corneal epithelialization was observed in all animals in 30days. Light optical microscopy revealed AM incorporation and resorption in both groups. However, the number of inflammatory cells and blood vessels was significantly higher in group HAM than in group RAM (P<0.05, Mann-Whitney test). Clinical responses to human or rabbit AM were similar; however, human AM induced greater inflammatory reaction and stromal neovascularization in the rabbit cornea than in rabbit AM.ConclusionThese differences may reflect a potential reaction to the xenograft. More studies are needed to further characterize these findings.
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    One-Year Clinical Outcomes of a Corneal Inlay for Presbyopia
    (Lippincott Williams & Wilkins, 2017) Beer, Sandra M. C. [UNIFESP]; Santos, Rodrigo [UNIFESP]; Nakano, Eliane M. [UNIFESP]; Hirai, Flavio [UNIFESP]; Nitschke, Enrico J. [UNIFESP]; Francesconi, Claudia [UNIFESP]; Campos, Mauro [UNIFESP]
    Purpose: To report the results of a 1-year follow-up analysis of the safety and efficacy of the Flexivue Microlens corneal inlay. Methods: The Flexivue Microlens corneal inlay was implanted in the nondominant eye of patients with emmetropic presbyopia (a spherical equivalent of 20.5 to 1.00 diopter) after the creation of a 300-mm deep stromal pocket, using a femtosecond laser. The patients were followed up according to a clinical protocol involving refraction, anterior segment imaging analysis (Oculyzer), and optical quality analysis (OPD-Scan). Results: Thirty-one patients were enrolled in this ongoing study. The mean age was 50.7 years (range 45-60 yrs), and 70% of the patients were female. The mean uncorrected near visual acuity improved to Jaeger 1 in 87.1% of the eyes treated with the inlays. All eyes improved 4 lines at all visits. The binocular uncorrected distance visual acuity was 20/20 in all patients. Ninety percent of the patients reported that their near vision was good or excellent. Some of the patients (16.1%) lost more than 3 lines of corrected distance visual acuity. At the latest follow-up, induction of a corneal spherical aberration to improve near visual acuity was statistically significant. No other intraoperative or postoperative complication was noted. Conclusions: The Flexivue Microlens provided patients with improved near vision, as a result of a negative spherical aberration. A significant loss of corrected distance visual acuity in the operated eyes was observed. Overall, this intracorneal inlay was an effective alternative to other procedures for the correction of presbyopia.
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    Randomized Trial Comparing Amniotic Membrane Transplantation with Lamellar Corneal Graft for the Treatment of Corneal Thinning
    (Lippincott Williams & Wilkins, 2016) Farias, Charles Costa de [UNIFESP]; Allemann, Norma [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]
    Purpose: There are few studies comparing different surgical procedures for the treatment of corneal thinning. Lamellar corneal transplantation (LCT) has been reported to be efficient, but its results can be jeopardized by allograft rejection, opacification, or high astigmatism. Amniotic membrane transplantation (AMT) has been considered a good alternative, but it is not as resistant as LCT and the tissue can be reabsorbed after surgery. Methods: A prospective, randomized, interventional, and comparative study of consecutive patients with corneal thinning over 6 months was performed. Ophthalmological examination was performed before transplant surgery and then repeated 1, 7, 15, 30, 90, and 180 days after surgery and ultrasound biomicroscopy was performed before and then 30, 90, and 180 days after surgery to assess corneal thinning. Results: Herpes simplex infection was the main cause of corneal thinning (9 eyes), followed by surgery (cataract, glaucoma, 5 cases), rheumatoid arthritis (1), chemical burn (1), perforating trauma (1), previous band keratopathy treatment (1), and Stevens-Johnson syndrome (1). Although all patients showed significant increase in final thickness in the area of thinning, it was higher in those submitted to LCT at 180 days postoperatively. Regardless of the surgical technique, all patients showed epithelialization. Patients undergoing AMT showed an 89% decrease in neovascularization. Final corrected distance visual acuity was better in patients submitted to AMT. Conclusions: LCT proved to be the best option for treating corneal thinning. AMT represents an alternative that allows good visual recovery but does not restore corneal thickness as efficiently as LCT.
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    Randomized Trial Comparing Multilayer Amniotic Membrane Transplantation With Scleral and Corneal Grafts for the Treatment of Scleral Thinning After Pterygium Surgery Associated With Beta Therapy
    (Lippincott Williams & Wilkins, 2014-11-01) Farias, Charles Costa de [UNIFESP]; Sterlenich, Telma [UNIFESP]; Sousa, Luciene Barbosa de [UNIFESP]; Vieira, Luiz Antonio [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: The aim of this study was to compare the use of multilayer amniotic membrane transplantation (AMT) with lamellar corneal transplantation (LCT) and lamellar scleral transplantation (LST) for the treatment of scleral thinning after pterygium surgery associated with beta therapy.Methods: Twenty-six eyes from 26 different patients with scleral thinning as a consequence of beta therapy after pterygium surgery were evaluated at the Federal University of Sao Paulo, Brazil. Ophthalmologic examination and ultrasound biomicroscopy were performed to assess scleral thinning before the transplant surgery and then repeated at 30, 90, and 180 days after surgery. An increase in scleral thickness, epithelialization of the ocular surface, and preservation of the ocular globe were the main outcome measures.Results: Irrespective of the surgical technique used (AMT, LCT, or LST), no clinical or statistical changes in corrected distance visual acuity were found in any of the patients during this study. The median preoperative scleral thickness was similar in all 3 groups: AMT = 0.45 mm, LST = 0.48 mm, and LCT = 0.52 mm (P = 0.257); however, 6 months after surgery, the median thickness in the AMT group (0.19) was significantly less than that of the LCT group (0.57) (P = 0.27) or the LST group (0.76) (P = 0.19). Epithelialization occurred in all the patients.Conclusions: LCT was the best option for the structural treatment of scleral thinning, followed by LST with a conjunctival flap. A high rate of reabsorption was found with AMT, which was the least effective of the 3 therapeutic options and should not be used for this condition.
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    Retained Host Descemet Membrane (Auto-DMET) During Conversion of Deep Anterior Lamellar Keratoplasty to Penetrating Keratoplasty: A Case Report
    (Lippincott Williams & Wilkins, 2014-08-01) Vianna, Lucas Monferrari Monteiro [UNIFESP]; Woreta, Fasika; Kiely, Amanda E.; Jun, Albert S.; Johns Hopkins Sch Med; Universidade Federal de São Paulo (UNIFESP); Universidade do Estado do Rio de Janeiro (UERJ)
    Purpose: The aim of this study was to relate a case of deep anterior lamellar keratoplasty (DALK) converted to penetrating keratoplasty in which the host central Descemet membrane (DM) with a large perforation was left attached to the host cornea.Methods: This is a case report of a 34-year-old man who underwent an attempted DALK for keratoconus in his left eye, which became complicated with a large rupture in DM during dissection. The host DM was left in place, the donor cornea with DM intact was sutured onto the host bed, and air was injected into the anterior chamber. The patient was monitored by biomicroscopy, pachymetry, topography, anterior segment optical coherence tomography, and specular microscopy.Results: The postoperative course resulted in improved uncorrected visual acuity, best spectacle-corrected visual acuity, and topography. Corneal edema was observed in the host cornea peripheral to the graft. Three months after the surgery, the endothelial cell density was reduced by 63% compared with the preoperative donor cell density.Conclusions: Leaving the host DM during conversion of DALK to penetrating keratoplasty was uneventful in this case, although corneal edema was observed in the area overlying the host cornea. It is possible that the retained DM could provide additional autologous endothelial cells to prolong graft survival.
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    Role of the corneal epithelium measurements in keratorefractive surgery
    (Lippincott Williams & Wilkins, 2017) Salomao, Marcella Q. [UNIFESP]; Hofling-Lima, Ana Luisa [UNIFESP]; Lopes, Bernardo T. [UNIFESP]; Canedo, Ana Laura C.; Dawson, Daniel G.; Carneiro-Freitas, Rui; Ambrosio, Renato, Jr. [UNIFESP]
    Purpose of review Refractive surgery has stimulated considerable progress in corneal and anterior segment imaging, and optical characterization of the eye. From front surface corneal topography, we evolved to three-dimensional corneal tomography with limbus to limbus characterization of the front and back corneal surfaces and pachymetric mapping. Corneal anatomical evaluation has further evolved to layered or segmental tomography with the ability to characterize corneal epithelial thickness profile and the elevation of stromal front surface. Further characterization of even more specific structures, such as Bowman's layer and Descement's membrane, has been also demonstrated. The applications of such understanding in keratorefractive surgery are reviewed. Recent findings Understanding the corneal epithelial profile is of interest in many areas of ophthalmology, especially in refractive surgery. The most relevant applications include screening candidates at higher risk for complications (i.e. progressive ectasia and tear dysfunction syndrome), planning primary procedures, enhancements, and therapeutic surgery, and also postoperatively understanding the wound healing and clinical outcomes. Summary Corneal epithelial thickness was first available using digital very-high-frequency ultrasound. Advances in anterior segment optical coherence tomography enabled such fundamental evaluation, which accelerated progress. Such knowledge significantly impacts safety and efficacy of refractive surgery, and also allows for significant improvement for therapeutic procedures.
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    Serine-like proteolytic enzymes correlated with differential pathogenicity in patients with acute Acanthamoeba keratitis
    (Wiley-Blackwell, 2011-04-01) Souza Carvalho, F. R. de [UNIFESP]; Carrijo-Carvalho, L. C.; Chudzinski-Tavassi, A. M.; Foronda, Annette Silva [UNIFESP]; Freitas, D. de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    P>Acute ocular infection due to free-living amoebae of the genus Acanthamoeba is characterized by severe pain, loss of corneal transparency and, eventually, blindness. Proteolytic enzymes secreted by trophozoites of virulent Acanthamoeba strains have an essential role in the mechanisms of pathogenesis, including adhesion, invasion and destruction of the corneal stroma. in this study, we analysed the relationship between the extracellular proteases secreted by clinical isolates of Acanthamoeba and the clinical manifestations and severity of disease that they caused. Clinical isolates were obtained from patients who showed typical symptoms of Acanthamoeba keratitis. Trophozoites were cultivated axenically, and extracellular proteins were collected from cell culture supernatants. Secreted enzymes were partially characterized by gelatin and collagen zymography. Acanthamoeba trophozoites secreted proteases with different molecular masses, proteolysis rates and substrate specificities, mostly serine-like proteases. Different enzymatic patterns of collagenases were observed, varying between single and multiple collagenolytic activities. Low molecular weight serine proteases were secreted by trophozoites associated with worse clinical manifestations. Consequently, proteolytic enzymes of some Acanthamoeba trophozoites could be related to the degree of their virulence and clinical manifestations of disease in the human cornea.
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    Suture technique for Descemet stripping and endothelial keratoplasty
    (Lippincott Williams & Wilkins, 2007-10-01) Macsai, Marian Sue; Kara José, Andrea Cotait [UNIFESP]; Evanston Northwestern Healthcare; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To describe a suture technique for Descemet stripping and endothelial keratoplasty (DSEK).Methods: The technique was performed in 2 eyes of 2 patients with Fuchs endothelial corneal dystrophy. A double-armed 10-0 prolene suture on a CIF-4 needle was used to pull the donor corneal button into the recipient's anterior chamber without the use of forceps to hold the button. The suture was also used to unfold the lenticule in the eye without marking the stroma with gentian violet, to center the lenticule and to secure that in place.Results: No intraoperative problems occurred in either case. The suture technique was successfully used to pull the donor button into the host's eye and to unfold and center the button. Both lenticules were well centered and had minimal corneal edema. At 6 months, the central endothelial loss was 8% in the first case and 10% in the second.Conclusion: This suture technique for DSEK avoids the use of forceps and allows less traumatic donor button manipulation. It may be an effective alternative with low endothelial damage; further follow-up will determine the long-term effect on the central endothelial cell count.
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    Therapeutic agents and biocides for ocular infections by free-living amoebae of Acanthamoeba genus
    (Elsevier Science Inc, 2017) Carrijo-Carvalho, Linda Christian [UNIFESP]; Sant'ana, Viviane Peracini [UNIFESP]; Foronda, Annette Silva [UNIFESP]; de Freitas, Denise [UNIFESP]; de Souza Carvalho, Fabio Ramos [UNIFESP]
    Acanthamoeba keratitis is a sight-threatening infectious disease. Resistance of the cystic form of the protozoan to biocides and the potential toxicity of chemical compounds to corneal cells are the main concerns related to long-term treatment with the clinically available ophthalmic drugs. Currently, a limited number of recognized antimicrobial agents are available to treat ocular amoebic infections. Topical application of biguanide and diamidine antiseptic solutions is the first-line therapy. We consider the current challenges when treating Acanthamoeba keratitis and review the chemical properties, toxicities, and mechanisms of action of the available biocides. Antimicrobial therapy using anti-inflammatory drugs is controversial, and aspects related to this topic are discussed. Finally, we offer our perspective on potential improvement of the effectiveness and safety of therapeutic profiles, with the focus on the quality of life and the advancement of individualized medicine. (C) 2016 Elsevier Inc. All rights reserved.