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Purpose: To evaluate the efficacy of a preservative free sodium hyaluronate/chondroitin sulfate ophthalmic solution (SH/CS-PF) in patients with dry eye disease (DED).Methods: This was a randomized phase IV, multicentric, prospective, double-blind clinical trial. Intent-to-treat (ITT) and per-protocol (PP) analyses were performed. Patients were assigned to receive either SH/CS-PF, Systane® Ultra (PEG/PG) or Systane® Ultra PF (PEG/PG-PF) for 90 days. A total of 326 patients were included in the ITT, and 217 in the PP analysis. Efficacy endpoints were goblet cell density, Nelson's grades (conjunctival impression cytology), tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), and Schirmer's test. Other parameters included were tolerability, measured by the ocular symptomatology; and safety, measured through corneal staining, intraocular pressure, visual acuity and adverse events.Results: In the ITT, there was a significant increase in mean goblet cell density in all treatments compared with their baseline (28.4% vs 21.4% and 30.8%), without difference between arms (p = .159). Eyes exposed to SH/CS-PF, PEG/PG and PEG/PG-PF showed Grade 0-I squamous metaplasia (85.5%, 87.9% and 93.2%, respectively). Similar improvements were observed for TBUT (1.24 ± 2.3s vs 1.27 ± 2.4s and 1.39 ± 2.3s) and OSDI scores at day 90 (-8.81 ± 8.6 vs -7.95 ± 9.2 and -8.78 ± 9.8), although no significant intergroup difference was found. Schirmer's test also presented improvement compared to baseline (1.38 ± 4.9 vs 1.50 ± 4.7 and 2.63 ± 5.9), with a significantly higher variation for PEG/PG-PF. There were no significant differences between treatments for any tolerability and safety parameter, nor between ITT and PP analyses for any outcome.Conclusions: The topical application of SH/CS-PF is as effective, safe and well tolerated as that of PEG/PG or PEG/PG-PF. The results suggest that SH/CS-PF may lead to normalization of clinical parameters and symptom alleviation in patients treated for DED.
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Sulfatos de Condroitina/administração & dosagem , Síndromes do Olho Seco/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Administração Oftálmica , Adulto , Idoso , Idoso de 80 Anos ou mais , Sulfatos de Condroitina/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Síndromes do Olho Seco/fisiopatologia , Feminino , Fluorofotometria , Humanos , Ácido Hialurônico/efeitos adversos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Conservantes Farmacêuticos , Estudos Prospectivos , Lágrimas/fisiologia , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto JovemRESUMO
PURPOSE: To investigate the efficacy of photoactivated chromophore corneal collagen cross-linking (PACK)-CXL in the management of treatment-resistant infectious keratitis. DESIGN: Observational cohort study. PARTICIPANTS: Forty-two eyes from 41 patients with treatment-resistant infectious keratitis. METHODS: Eyes underwent PACK-CXL treatment with the Dresden modified protocol in addition to standard antimicrobial therapy. The primary endpoint was the size of the corneal ulcer. Descriptive statistics, Wilcoxon rank test, McNemar test and Spearman correlation coefficient were used for statistical analysis, and p values lower than 0.05 were considered statistically significant. RESULTS: Success rate at third postoperative month was of 90.5%. Statistical analyses showed a significant effect of (PACK)CXL with standard antimicrobial therapy to reduce corneal ulcer size (p=0.031). CONCLUSION: As adjuvant therapy to standard antimicrobial treatment, PACK-CXL improves the outcomes in patients with treatment-resistant corneal ulcers.
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To evaluate indications and outcomes of pediatric keratoplasty in a tertiary eye center, and identify factors that affect visual outcomes.We performed a retrospective review of penetrating keratoplasty in children aged 0 to 18 years between 1995 and 2011 in the Asociación para Evitar la Ceguera en México IAP, Hospital "Dr. Luis Sánchez Bulnes".A total of 574 penetrating keratoplasties were performed during the study interval. Median follow-up was 5.0 years. Main indications included keratoconus (55.58%), postherpetic scarring (9.58%), traumatic opacities (7.49%), and bullous keratopathy (6.09%). Rejection rates at 5 years were 27% overall, and among indications, keratoconus showed the best graft survival at 60-months follow-up (85%). The percentage of patients with best corrected visual acuity (BCVA) posttransplant >20/400 at 5 years in the nonrejection group was 81.25% and 82.74% in < and > 10 years of age (YOA) groups, respectively, versus a BCVA posttransplant > 20/400 at 5 years in the rejection group of 53.68% and 51.72% in < and > 10 YOA groups, respectively. There was a statistically significant reduced rejection rate between genders at 18 months of follow-up, favoring males.Despite being considered a high-risk procedure in children, penetrating keratoplasty can achieve good results, especially in patients with keratoconus. It can achieve significative improvements of visual acuity, provided there is an adequate follow-up and treatment adherence.
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Cicatriz/cirurgia , Doenças da Córnea/cirurgia , Transplante de Córnea/efeitos adversos , Rejeição de Enxerto/epidemiologia , Adolescente , Criança , Cicatriz/virologia , Doenças da Córnea/etiologia , Transplante de Córnea/métodos , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Acuidade VisualRESUMO
OBJECTIVE: To determine the prevalence of symptoms of ocular surface disease (OSDI) surface disease and its relationship with associated risk factors in patients of ophthalmic practices using OSDI questionnaire. METHOD: A cross-sectional survey was conducted Between September and December 2014 to assess the prevalence and risk factors for OSDI. RESULTS: The OSDI average value was 40.46 ± 23.62 points, with 86.4% of patients (1967) having a OSDI score higher than 12 points. Women had OSDI symptoms more frequently than men (odds ratio: 1.17; 95% confidence interval: 1.08-1.28) and higher OSDI score (42.12 ± 24.03 vs. 38.01 ± 22.81 points). Patients without disease were younger than the patients with severe disease (45.30 ± 18.32 vs. 50.62 ± 18.86). CONCLUSIONS: Ophthalmological patients have a prevalence of 80.4% of OSDI. Female and older age was associated with ocular surface disease.
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Doenças da Túnica Conjuntiva/epidemiologia , Fatores Etários , Intervalos de Confiança , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores Sexuais , Inquéritos e Questionários , Xeroftalmia/epidemiologiaRESUMO
PURPOSE: The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE) among patients attending a tertiary care ophthalmology center in Mexico. METHODS: Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer's test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected. RESULTS: The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22%) in our population than evaporative deficiency (94%). Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry mouth. CONCLUSION: This is the first study to demonstrate the frequency of symptomatic and clinical DE in a tertiary care ophthalmology center in Mexico. The frequency of DE ranged from 30% using a symptomatic definition to 94% using objective measures. Different risk factors were found for different aspects of DE, suggesting differing underlying pathophysiologies behind different DE subtypes.
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This retrospective report describes our 20 months'experience using intravitreal injections of bevacizumab for the treatment of several retinal diseases. We describe our experience after 1765 intravitreal injections of bevacizumab in the treatment of different proliferative retinopathies - retinopathy of prematurity, choroidal neovascularization, diabetic retinopathy, among others. We believe that the findings reported in this study move us closer to a better treatment for different pathologies. However, further studies need to be performed in order to determine the safety and long-term efficacy of intravitreal bevacizumab either as first line therapy, after failure of conventional therapy, or in combination with conventional therapy.
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Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Neovascularização de Coroide/tratamento farmacológico , Doenças Retinianas/tratamento farmacológico , Inibidores da Angiogênese/efeitos adversos , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Bevacizumab , Retinopatia Diabética/tratamento farmacológico , Humanos , Recém-Nascido , Injeções , Degeneração Macular/tratamento farmacológico , Vasos Retinianos , Retinopatia da Prematuridade/tratamento farmacológico , Estudos Retrospectivos , Corpo VítreoRESUMO
Objetivo: Observar y describir, mediante microscopía confocal, los cambios asociados al proceso de cicatrización de quemadura por álcali, en córneas sanas de conejo. Método: Se realizó microscopía confocal (ConfoScan 2.0, Fortune Technologies Srl.,Italy) para el análisis morfológico del proceso de cicatrización corneal secundaria a quemadura por álcali, previo a la quemadura, a la semana, al mes y a los tres meses. Resultados: Se observó una cicatriz subepitelial cuya densidad aumenta al profundizar al estroma anterior, desde la primer semana hasta 3 meses después. El epitelio se encontró re-epitelizado desde la primer semana a la quemadura por álcali. Conclusiones: La microscopía confocal demuestra la pronta recuperación del epitelio corneal de los conejos, no obstante se requiere de un estudio a mayor largo plazo para determinar si existen cambios en el proceso de cicatrización del estroma corneal.
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Animais , Coelhos , Queimaduras Oculares , Substância Própria/lesões , Microscopia ConfocalRESUMO
Objetivo: Analizar las estructuras celulares corneales mediante microscopia confocal en córneas aparentemente sanas. Método: Se realizó microscopia confocal (ConfoScan 2.0, Fortune Tecnologies Srl., Italy) para el análisis morfológico de las diferentes estructuras corneales, in vivo, de manera no invasiva y en tiempo real a 10 córneas. Resultados: Se observó el epitelio superficial, las células basales epiteliales, el plexo nervioso subepitelial, el estroma y el endotelio corneal. Conclusiones: Hemos demostrado la utilidad del microscopio confocal para observar y analizar la población celular corneal, lo cual tiene un papel potencial en la valoración de los cambios dinámicos y estructurales de importancia en el diagnóstico y evaluación del paciente.