RESUMO
RESUMO A ceratopigmentação teve seu primeiro registro pelo filósofo Galeno há muitos séculos como uma estratégia utilizada para o tratamento estético de pacientes com leucomas. As córneas com leucoma são patológicas e, muitas vezes, intolerantes a lentes de contato cosméticas ou próteses oculares, sendo comum a queixa de desconforto excessivo, proporcionado pela superfície corneana irregular. Assim, a ceratopigmentação é uma alternativa para a melhora estética de pacientes com opacidades corneanas. Descrevemos o caso de um paciente do sexo masculino, 39 anos, que apresentou despigmentação precoce em caso de ceratopigmentação associado a quadro de ceratite herpética necrotizante. O paciente foi submetido ao tratamento com aciclovir 2g ao dia e doxiciclina 200mg ao dia, evoluindo com melhora do quadro clínico, apesar da má adesão medicamentosa.
ABSTRACT Keratopigmentation was first recorded many centuries ago by the philosopher Galeno, as a strategy used for the aesthetic treatment of patients with leukomas. Corneas with leucoma are pathological and often intolerant of cosmetic contact lenses or ocular prostheses, with complaints of excessive discomfort provided by the irregular corneal surface being common. Therefore, keratopigmentation is an alternative for the aesthetic improvement of patients with corneal opacities. We describe the case of a 39-year old male patient, who presented early depigmentation in a case of keratopigmentation associated with necrotizing herpetic keratitis. The patient was treated with Acyclovir 2g/day and Doxycycline 200mg/day, evolving with clinical improvement, despite poor medication adherence.
Assuntos
Humanos , Masculino , Adulto , Tatuagem/métodos , Neovascularização da Córnea/etiologia , Córnea/cirurgia , Opacidade da Córnea/cirurgia , Corantes/efeitos adversos , Aciclovir/administração & dosagem , Traumatismos Oculares/complicações , Técnicas Cosméticas , Satisfação do Paciente , Ceratite Herpética/tratamento farmacológico , Doxiciclina/administração & dosagem , Opacidade da Córnea/etiologia , EstéticaRESUMO
The present study aimed to demonstrate the possibility to treat corneal neovascularization using the combination of anti-VEGF injection and argon laser photocoagulation.
Assuntos
Neovascularização da Córnea , Inibidores da Angiogênese , Argônio , Neovascularização da Córnea/diagnóstico , Neovascularização da Córnea/tratamento farmacológico , Neovascularização da Córnea/etiologia , Humanos , Fotocoagulação a Laser , Lasers , Neovascularização Patológica/terapiaRESUMO
PURPOSE: To evaluate the effect of metronidazole ophthalmic solutions on corneal neovascularization (CNV) in a rat model. METHODS: A chemical burn was created in the right central cornea of 40 rats. Animals were randomized and distributed into four study groups (n = 10 rats per group) designated Met_0.1%, Met_0.5%, sham, and untreated groups. Chemical-burned corneas in the Met_0.1% and Met_0.5% groups received ophthalmic solutions of 0.1 and 0.5% metronidazole, respectively. Corneas in the sham group received phosphate-buffered saline (metronidazole diluent). All treated eyes received ophthalmic solution at intervals of 6 h, for up to 30 days. Untreated corneas received no treatment. CNV was evaluated postinjury using corneal photographs at different evaluation time points. The main CNV outcome measures were: burn intensity, index of CNV, and percentage of vascularized corneal area. Five rats from each group were euthanized, on days 15 and 30; the samples were collected for histological analyses. Differences with P < 0.05 were considered significant. RESULTS: CNV was observed in the eyes from day 7 postinjury. However, the indices of CNV for the Met_0.1% and Met_0.5% groups were smaller than those for the sham and untreated groups (P < 0.05). Furthermore, corneas treated with 0.1 or 0.5% metronidazole had smaller vascularized areas compared to control corneas. On histological study, the presence of blood vessels confirmed clinical outcomes. CONCLUSIONS: Regular instillation of 0.1 or 0.5% metronidazole had a significant inhibitory effect for CNV on chemical burns induced in a rat model.
Assuntos
Córnea/patologia , Neovascularização da Córnea/tratamento farmacológico , Metronidazol/administração & dosagem , Animais , Anti-Infecciosos/administração & dosagem , Queimaduras Químicas/complicações , Córnea/efeitos dos fármacos , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Queimaduras Oculares/complicações , Seguimentos , Masculino , Soluções Oftálmicas , Ratos , Ratos Wistar , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE:: To establish and compare protocols of alkaline cauterization for inducing corneal angiogenesis in murine models. METHODS:: Twenty-four adult Wistar rats were distributed into four groups (G1, G2, G3, and G4). The right eye cornea from each rat was cauterized using filter paper (3 mm), soaked in a solution of silver and potassium nitrates (3:1). Cauterization times were 10 (G1 and G4), or 20 seconds (G2 and G3). Cauterized corneas were washed with Ringer's lactate solution. The filter paper was either removed before washing (G1 and G2), or kept on the corneas (G3 and G4). Corneas were photographed at multiple time points (2, 4, 6, 8, 11, 13, and 15 days after the procedure), and neovascularization parameters were assayed. RESULTS:: Neovascularization was observed in 66% of G1 corneas, and 100% of G2, G3, and G4 corneas. On day 15, G1 corneas showed smaller vascularized areas (12.63 ± 12.59%) compared to those in the G3 (41.95 ± 17.32%) and G4 (33 ± 11.74%) (P < 0.05) groups. CONCLUSIONS:: The silver and potassium nitrate solution effectively induced corneal angiogenesis. The G2, G3, and G4 protocols showed excellent reproducibility, and induced vascularization in 100% of corneas.
Assuntos
Cauterização/métodos , Neovascularização da Córnea/etiologia , Modelos Animais de Doenças , Neovascularização Patológica/etiologia , Nitratos , Compostos de Potássio , Prata , Animais , Córnea/irrigação sanguínea , Córnea/cirurgia , Masculino , Ratos Wistar , Valores de Referência , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
Abstract Purpose: To establish and compare protocols of alkaline cauterization for inducing corneal angiogenesis in murine models. Methods: Twenty-four adult Wistar rats were distributed into four groups (G1, G2, G3, and G4). The right eye cornea from each rat was cauterized using filter paper (3 mm), soaked in a solution of silver and potassium nitrates (3:1). Cauterization times were 10 (G1 and G4), or 20 seconds (G2 and G3). Cauterized corneas were washed with Ringer's lactate solution. The filter paper was either removed before washing (G1 and G2), or kept on the corneas (G3 and G4). Corneas were photographed at multiple time points (2, 4, 6, 8, 11, 13, and 15 days after the procedure), and neovascularization parameters were assayed. Results: Neovascularization was observed in 66% of G1 corneas, and 100% of G2, G3, and G4 corneas. On day 15, G1 corneas showed smaller vascularized areas (12.63 ± 12.59%) compared to those in the G3 (41.95 ± 17.32%) and G4 (33 ± 11.74%) (P < 0.05) groups. Conclusions: The silver and potassium nitrate solution effectively induced corneal angiogenesis. The G2, G3, and G4 protocols showed excellent reproducibility, and induced vascularization in 100% of corneas.
Assuntos
Animais , Masculino , Cauterização/métodos , Neovascularização da Córnea/etiologia , Compostos de Potássio , Modelos Animais de Doenças , Neovascularização Patológica/etiologia , Nitratos , Valores de Referência , Fatores de Tempo , Reprodutibilidade dos Testes , Ratos Wistar , Córnea/cirurgia , Córnea/irrigação sanguíneaRESUMO
PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Neovascularização da Córnea/tratamento farmacológico , Endotélio Corneano/efeitos dos fármacos , Inflamação/tratamento farmacológico , Ceratite/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Animais , Anticorpos Monoclonais Humanizados/administração & dosagem , Bevacizumab , Queimaduras Químicas/complicações , Cáusticos , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Endotélio Corneano/crescimento & desenvolvimento , Queimaduras Oculares/complicações , Injeções Intraoculares , Ceratite/patologia , Masculino , Estudos Prospectivos , Coelhos , Distribuição Aleatória , Índice de Gravidade de Doença , Hidróxido de SódioRESUMO
PURPOSES: To evaluate the effect of subconjunctival bevacizumab in an experimental model of neovascularization in rabbit cornea. Determine its effect on vessels extension, inflammation, epithelialization of the cornea and whether the evaluation method used is appropriate to compare neovascular models. METHODS: Experimental, prospective, randomized, blinded study in twenty rabbits subjected to chemical trauma with sodium hydroxide at 1N divided into two groups. The study group received subconjunctival injection of 0.15 ml (3.75 mg) of bevacizumab and was compared with the control group that received subconjunctival injection of 0.15 ml saline solution. After 25 days, digital photographic analysis was performed to assess the vessel's extension and inflammation/diameter according to pre-established criteria. Histopathology of the cornea, which evaluated the state of the epithelium and the number of polymorphonuclear cells was also studied. RESULTS: The length of the neovessels was greater in the control group compared to the study group (P=<0.001). There was no difference in inflammation/vessel diameter between groups. Histopathology analysis showed that there was no difference between groups for the variables state of the epithelium and number of polymorphonuclear cells. The concordance analysis for the variable extension of the vessels and the variable inflammation/vessel diameter was estimated with Kappa coefficients of 0.705 and 0.500 respectively, indicating a good level of agreement in different evaluations and validating the method. CONCLUSIONS: The experimental model is adequate and can be reproduced to evaluate other drugs in the cornea. Bevacizumab inhibit the neovessels' growth but was not effective in preventing the inflammatory response. The drug did not delay the reepithelialization of the cornea.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Queimaduras Químicas/tratamento farmacológico , Neovascularização da Córnea/prevenção & controle , Animais , Anticorpos Monoclonais Humanizados , Bevacizumab , Queimaduras Químicas/complicações , Queimaduras Químicas/patologia , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Masculino , Estudos Prospectivos , Coelhos , Distribuição AleatóriaRESUMO
OBJETIVOS: Avaliar a ação do bevacizumabe subconjuntival em modelo experimental de neovascularização em córnea de coelho. Analisar se o modelo de avaliação empregado é adequado e comparar entre os grupos a extensão dos vasos, inflamação e re-epitelização da córnea. MÉTODOS: Estudo experimental, prospectivo em 20 coelhos submetidos a trauma químico com hidróxido de sódio a 1 N divididos em dois grupos, Imediatamente após a queimadura, o grupo tratado recebeu injeção subconjuntival de 0,15 ml (3,75 mg) de bevacizumabe e o grupo controle, injeção subconjuntival de 0,15 ml de soro fisiológico a 0,9 por cento. Após 25 dias, foi realizada análise fotográfica digital para avaliar a extensão e inflamação/calibre dos vasos segundo critério pré-estabelecido e estudo histopatológico da córnea, no qual foi avaliado o estado do epitélio e o número de polimorfonucleares. RESULTADOS: A extensão dos neovasos corneanos foi menor no grupo estudo em relação ao controle (p<0,001). Não houve diferença significativa entre os grupos na inflamação/calibre dos vasos. A análise histopatológica mostrou que não ocorreu diferença entre os grupos nas variáveis estado do epitélio e número de polimorfonucleares. A análise de concordância para a variável extensão dos vasos e para a variável inflamação/calibre dos vasos teve uma estimativa do coeficiente de Kappa respectivamente de 0,705 e 0,500 indicando bom grau de concordância nas diferentes avaliações cegadas, validando o método empregado. CONCLUSÕES: O modelo de avaliação foi adequado e pode ser reproduzido para avaliar outras drogas na córnea. O bevacizumabe inibiu a neovascularização corneana, porém não foi eficaz em reduzir o processo inflamatório. A droga não atrasou a re-epitelização da córnea.
PURPOSES: To evaluate the effect of subconjunctival bevacizumab in an experimental model of neovascularization in rabbit cornea. Determine its effect on vessels extension, inflammation, epithelialization of the cornea and whether the evaluation method used is appropriate to compare neovascular models. METHODS: Experimental, prospective, randomized, blinded study in twenty rabbits subjected to chemical trauma with sodium hydroxide at 1N divided into two groups. The study group received subconjunctival injection of 0.15 ml (3.75 mg) of bevacizumab and was compared with the control group that received subconjunctival injection of 0.15 ml saline solution. After 25 days, digital photographic analysis was performed to assess the vessel's extension and inflammation/diameter according to pre-established criteria. Histopathology of the cornea, which evaluated the state of the epithelium and the number of polymorphonuclear cells was also studied. RESULTS: The length of the neovessels was greater in the control group compared to the study group (P=<0.001). There was no difference in inflammation/vessel diameter between groups. Histopathology analysis showed that there was no difference between groups for the variables state of the epithelium and number of polymorphonuclear cells. The concordance analysis for the variable extension of the vessels and the variable inflammation/vessel diameter was estimated with Kappa coefficients of 0.705 and 0.500 respectively, indicating a good level of agreement in different evaluations and validating the method. CONCLUSIONS: The experimental model is adequate and can be reproduced to evaluate other drugs in the cornea. Bevacizumab inhibit the neovessels' growth but was not effective in preventing the inflammatory response. The drug did not delay the reepithelialization of the cornea.
Assuntos
Animais , Masculino , Coelhos , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Queimaduras Químicas/tratamento farmacológico , Neovascularização da Córnea/prevenção & controle , Queimaduras Químicas/complicações , Queimaduras Químicas/patologia , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Estudos Prospectivos , Distribuição AleatóriaRESUMO
PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects.
Assuntos
Animais , Masculino , Coelhos , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Neovascularização da Córnea/tratamento farmacológico , Endotélio Corneano/efeitos dos fármacos , Inflamação/tratamento farmacológico , Ceratite/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Queimaduras Químicas/complicações , Cáusticos , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Endotélio Corneano/crescimento & desenvolvimento , Queimaduras Oculares/complicações , Injeções Intraoculares , Ceratite/patologia , Estudos Prospectivos , Distribuição Aleatória , Índice de Gravidade de Doença , Hidróxido de SódioRESUMO
PURPOSE: To report an 81-year-old woman with corneal neovascularization secondary to herpetic stromal keratitis treated with subconjunctival bevacizumab and to discuss the role of this novel antiangiogenic treatment. METHODS: Case report and review of medical literature. RESULTS: A dramatic regression of corneal vessels was observed 1 week after the injection. After a 3-month follow-up, there was no recurrence of corneal revascularization. CONCLUSIONS: Bevacizumab may be a valid complementary treatment in patients with corneal neovascularization caused by herpetic stromal keratitis.