Publications by authors named "Ana Luisa Hofling-Lima"

91 Publications

Characterization and distribution of viridans group streptococci isolated from infectious endophthalmitis and keratitis.

Arq Bras Oftalmol 2020 Nov-Dec;83(6):463-472

Ophthalmology and Visual Sciences Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Purpose: The aims of this study were to characterize alpha-hemolytic streptococci among isolates from cases of infectious endophthalmitis and keratitis and to determine their distributions.

Methods: The sample included 27 and 35 nonduplicated isolates of alpha-hemolytic streptococci recovered from patients with infectious endophthalmitis (2002-2013) and keratitis (2008-2013), respectively. Isolates were identified by the optochin susceptibility and bile solubility tests, using a biochemical identification system. The minimum inhibitory concentration was determined by the broth microdilution method. Molecular identification was performed by analyses of three constitutive genes and the complementary multilocus sequence. The molecular epidemiology of Streptococcus pneumoniae was investigated using multilocus sequence typing, and the presence of the capsular polysaccharide-encoding gene was assessed using conventional polymerase chain reaction. Outcomes were evaluated using the patients' medical records.

Results: Phenotypic tests differentiated S. pneumoniae from other alpha-hemolytic streptococci, consistent with later molecular identifications. Streptococcus oralis was significantly prevalent among the endophthalmitis isolates, as was S. pneumoniae in the keratitis isolates. High levels of susceptibility to antibiotics were observed, including vancomycin, cephalosporins, and fluoroquinolones. High genetic variability was detected among the 19 S. pneumoniae strains, with 15 predicted to be encapsulated. The medical records of patients with infectious endophthalmitis were reviewed (n=15/27; 56%), and final visual acuity was assessed in 12 cases (44%). Many patients progressed to a final visual acuity state of "no light perception" (6/12; 50%), "light perception" (3/12; 25%), or "hand motion" (1/12; 8%). The medical records of patients with infectious keratitis were also reviewed (n=24/35; 69%), and final visual acuity was assessed in 18 cases (51%). Similarly, most patients progressed to a final visual acuity state of "no light perception" (6/18; 33%), "light perception" (1/18; 6%), or "hand motion" (6/18; 33%). Overall, the majority of patients progressed to a final visual acuity state of "no light perception" (12/30), "light perception" (4/30), or "hand motion" (7/30).

Conclusions: The distribution of alpha-hemolytic streptococci in ocular infections suggested the presence of a species-specific tissue tropism. The prognoses of patients with ocular streptococcal infections were highly unfavorable, and antibiotic resistance did not contribute to the unfavorable clinical progressions and poor outcomes.
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http://dx.doi.org/10.5935/0004-2749.20200087DOI Listing
February 2021

Ectatic diseases.

Exp Eye Res 2021 Jan 1;202:108347. Epub 2020 Dec 1.

Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil; Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil; Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil; Department of Ophthalmology, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil; Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), USA. Electronic address:

Ectatic corneal disease (ECD) comprises a group of disorders characterized by progressive thinning and subsequent bulging of the corneal structure. Different phenotypes have been recognized, including keratoglobus, pellucid marginal degeneration (PMD), and keratoconus (KC). Keratoconus has been widely investigated throughout the years, but the advent of laser refractive surgery boosted an immediate need for more knowledge and research about ectatic diseases. This article discusses nomenclature of ectatic disease, etiology and pathogenesis, along with treatment options, with special focus ok KC and forme fruste keratoconus.
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http://dx.doi.org/10.1016/j.exer.2020.108347DOI Listing
January 2021

The Role of Corneal Biomechanics for the Evaluation of Ectasia Patients.

Int J Environ Res Public Health 2020 03 23;17(6). Epub 2020 Mar 23.

Instituto de Olhos Renato Ambrósio, Rio de Janeiro 20520050, Brazil.

Purpose: To review the role of corneal biomechanics for the clinical evaluation of patients with ectatic corneal diseases.

Methods: A total of 1295 eyes were included for analysis in this study. The normal healthy group (group N) included one eye randomly selected from 736 patients with healthy corneas, the keratoconus group (group KC) included one eye randomly selected from 321 patients with keratoconus. The 113 nonoperated ectatic eyes from 125 patients with very asymmetric ectasia (group VAE-E), whose fellow eyes presented relatively normal topography (group VAE-NT), were also included. The parameters from corneal tomography and biomechanics were obtained using the Pentacam HR and Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany). The accuracies of the tested variables for distinguishing all cases (KC, VAE-E, and VAE-NT), for detecting clinical ectasia (KC + VAE-E) and for identifying abnormalities among the VAE-NT, were investigated. A comparison was performed considering the areas under the receiver operating characteristic curve (AUC; DeLong's method).

Results: Considering all cases (KC, VAE-E, and VAE-NT), the AUC of the tomographic-biomechanical parameter (TBI) was 0.992, which was statistically higher than all individual parameters (DeLong's; < 0.05): PRFI- Pentacam Random Forest Index (0.982), BAD-D- Belin -Ambrosio D value (0.959), CBI -corneal biomechanical index (0.91), and IS Abs- Inferior-superior value (0.91). The AUC of the TBI for detecting clinical ectasia (KC + VAE-E) was 0.999, and this was again statistically higher than all parameters (DeLong's; < 0.05): PRFI (0.996), BAD-D (0.995), CBI (0.949), and IS Abs (0.977). Considering the VAE-NT group, the AUC of the TBI was 0.966, which was also statistically higher than all parameters (DeLong's; < 0.05): PRFI (0.934), BAD- D (0.834), CBI (0.774), and IS Abs (0.677).

Conclusions: Corneal biomechanical data enhances the evaluation of patients with corneal ectasia and meaningfully adds to the multimodal diagnostic armamentarium. The integration of biomechanical data and corneal tomography with artificial intelligence data augments the sensitivity and specificity for screening and enhancing early diagnosis. Besides, corneal biomechanics may be relevant for determining the prognosis and staging the disease.
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http://dx.doi.org/10.3390/ijerph17062113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7143615PMC
March 2020

Dynamic corneal deformation response and integrated corneal tomography.

Indian J Ophthalmol 2018 Mar;66(3):373-382

Department for Ophthalmology, The Federal University of Sao Paulo, Sao Paulo, Brazil; Rio de Janeiro Corneal Tomography and Biomechanics Study Group; Department of Ophthalmology, Instituto De Olhos Renato Ambrósio and VisareRIO, Rio de Janeiro, Brazil.

Measuring corneal biomechanical properties is still challenging. There are several clinical applications for biomechanical measurements, including the detection of mild or early forms of ectatic corneal diseases. This article reviews clinical applications for biomechanical measurements provided by the Corvis ST dynamic non contact tonometer.
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http://dx.doi.org/10.4103/ijo.IJO_831_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859590PMC
March 2018

Pilot Study Comparing Topical Anesthetic Agents in Pterygium Surgery: Subconjunctival Injection Versus 2% Lidocaine Gel Versus 5% Lidocaine Gel.

Cornea 2018 Feb;37(2):194-198

Ophthalmology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.

Purpose: To compare the efficacy of different concentrations of topical lidocaine gel with standard subconjunctival anesthesia.

Methods: This was a prospective randomized controlled pilot study with 3 different groups. Group SC received subconjunctival lidocaine and proparacaine drops as needed during surgery. Group L2 received 2% lidocaine gel and group L5 received 5% lidocaine gel. Both lidocaine gel groups could receive another gel dose as needed during the procedure. The primary outcome was pain, which was experienced during and after surgery. The assessment was done using a 10-point linear analog scale at predetermined stages of surgery (1-first incision, 2-pterygium body excision, 3-conjunctival suturing, 4-immediate postoperative period after patching, and 5-assessment by a trained nurse in the absence of a surgeon after operation).

Results: We enrolled 45 consecutive patients who underwent primary pterygium surgery. Statistical significance between groups was found in mean pain at administration (2.2 vs. 0.4 vs. 0.0 in SC, L2, and L5 groups, respectively, with P < 0.05). The number of reapplications of anesthetic drops did not differ between the groups. We found a correlation between reapplication of the anesthetic and pain at administration and duration of the procedure.

Conclusions: We demonstrated that the use of lidocaine gel at concentrations of 2% and 5% in pterygium surgery was as effective as subconjunctival injection of lidocaine in reducing intraoperative and postoperative pain, producing significantly less pain during initial administration of the anesthetic.
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http://dx.doi.org/10.1097/ICO.0000000000001451DOI Listing
February 2018

Identification of the Infection Source of an Outbreak of Mycobacterium Chelonae Keratitis After Laser in Situ Keratomileusis.

Cornea 2018 Jan;37(1):116-122

Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil. Martins Bispo is now with at the Departments of Ophthalmology, Microbiology and Immunobiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Purpose: Nontuberculous mycobacteria keratitis is a rare but challenging complication of laser in situ keratomileusis (LASIK). This study was conducted to determine the source(s) of infection in a cluster of cases of keratitis after LASIK and to describe this outbreak and patients' outcomes.

Methods: In this retrospective, case series, single-center study, 86 patients were included who underwent LASIK or photorefractive keratectomy between December 2011 and February 2012. Corneal scrapes from the affected eyes, samples of tap and distilled water, water from the reservoir of the distilling equipment, steamer, and autoclave cassette; antiseptic and anesthetic solutions and surgical instrument imprints were cultivated in liquid and on solid media. Gram-negative bacteria and yeasts were identified using automated systems and mycobacteria by polymerase chain reaction-restriction enzyme analysis of the hsp65 gene (PRA-hsp65) and DNA sequencing. Mycobacterial isolates were typed by pulsed-field gel electrophoresis. The cases and outcomes are described. The main outcome measure was identification of the source(s) of the mycobacterial infections.

Results: Eight (15 eyes) of 86 patients (172 eyes) who underwent LASIK developed infections postoperatively; no patients who underwent photorefractive keratectomy developed infections. Mycobacterium chelonae was isolated from 4 eyes. The distilled water collected in the surgical facility contained the same M. chelonae strain isolated from the patients' eyes. Different gram-negative bacteria and yeasts were isolated from samples collected at the clinic but not from the patients' eyes.

Conclusions: Tap water distilled locally in surgical facilities may be a source of infection after ocular surgery and its use should be avoided.
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http://dx.doi.org/10.1097/ICO.0000000000001423DOI Listing
January 2018

Patient pain during intravitreal injections under topical anesthesia: a systematic review.

Int J Retina Vitreous 2017 3;3:23. Epub 2017 Jul 3.

Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Rua Pastor William Richard Schisler 900/apto 1011, Florianópolis, SC 88034-100 Brazil.

Background: Intravitreal injection (IVI) is a very common vitreoretinal procedure, and multiple injections are often required per patient. This systematic review was conducted to evaluate the effectiveness of various local anesthetic techniques in reducing pain during injection.

Methods: A systematic review was conducted based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the gray literature (Google Scholar). The end search date was February 19, 2016, across all databases. We classified pain by converting visual analog scale (VAS) scores (0-100 mm) into Jensen's classification levels: 0-4, no pain; 5-44, mild pain; 45-74, moderate pain; and 75-100, severe pain. An intervention was considered clinically significant when pain score change was >12 mm on a 100-mm scale.

Results: Eight studies out of 23 met the eligibility criteria. The total number of patients was 847. Most studies (5/8 [62.5%]) were at unclear risk of bias because of unclear randomization, thus providing only moderate evidence to this review. The anesthetic techniques included eye drops with proparacaine, tetracaine or cocaine, a lidocaine pledget or gel, and subconjunctival injection of 2% lidocaine or 0.75% levobupivacaine. No study comprised all of the techniques. Pain was mild (VAS scores, 5-44 mm) regardless of anesthetic technique. A clinically significant intervention (pain score change >12 mm) was found for only one study comparing proparacaine drops, lidocaine gel, and subconjunctival lidocaine; in that study, a subconjunctival injection of 2% lidocaine provided the greatest pain reduction. A meta-analysis was not possible due to study heterogeneity.

Conclusions: Patient pain during IVI under topical anesthesia is mild regardless of anesthetic technique. A subconjunctival injection of 2% lidocaine could be an option for highly sensitive patients. However, with moderate level of evidence, no single anesthetic technique could be defined as the best option for IVI.
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http://dx.doi.org/10.1186/s40942-017-0076-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494853PMC
July 2017

Detection of herpes simplex-1 and -2 and varicella zoster virus by quantitative real-time polymerase chain reaction in corneas from patients with bacterial keratitis.

Arq Bras Oftalmol 2017 Mar-Apr;80(2):84-87

Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Objective:: Bacterial keratitis occurs worldwide, and despite recent developments, it remains a potentially blinding condition. This study assesses the presence of herpes simplex virus (HSV-1 and -2) and varicella zoster virus (VZV) by quantitative real-time polymerase chain reaction (qPCR) in corneal scrapings from patients with bacterial keratitis.

Methods:: A total of 65 patients with clinical diagnoses of infectious corneal ulcers prospectively underwent clinical eye examinations. Corneal scrapings were investigated by Gram staining, Giemsa staining, culture, and qPCR (the study group). Risk factors and epidemiological data were recorded. The control group comprising 25 eyes with typical herpes dendritic keratitis was also analyzed by qPCR.

Results:: From the study group (n=65), nine patients (13.8%) had negative smears, cultures, and qPCR findings. Fifty-six (86.2%) patients had positive cultures: 51 for bacteria, 4 for fungi, and 1 for amoebae. Of the patients who had positive bacterial cultures, qPCR identified 10 patients who were also positive for virus: one for VZV and nine for HSV-1. Of the 25 patients in the control group, 21 tested positive for HSV-1 by qPCR analysis.

Conclusions:: Herpes may be present in patients with bacterial corneal ulcers, and qPCR may be useful in its detection.
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http://dx.doi.org/10.5935/0004-2749.20170021DOI Listing
September 2017

Role of the corneal epithelium measurements in keratorefractive surgery.

Curr Opin Ophthalmol 2017 Jul;28(4):326-336

aRio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro bDepartment of Ophthalmology, Federal University of São Paulo, São Paulo cDepartment of Ophthalmology, Pontific Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil dDepartment of Ophthalmology, University of Florida, Gainesville, Florida, USA eDepartment of Ophthalmology, Hospital de Braga, Braga, Portugal.

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. VIDEO ABSTRACT.
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http://dx.doi.org/10.1097/ICU.0000000000000379DOI Listing
July 2017

Conjunctival impression cytology evaluation of patients with dry eye disease using scleral contact lenses.

Cont Lens Anterior Eye 2017 Jun 6;40(3):151-156. Epub 2017 Jan 6.

Department of Ophthalmology, Ocular Surface Advanced Center, Federal University of Sao Paulo, 821 Botucatu St-Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.

Purpose: To evaluate conjunctival impression cytology and HLADR expression changes after wearing scleral contact lenses (ScCLs) for moderate to severe dry eye disease (DED).

Design: Prospective interventional case series.

Methods: Forty-one eyes from 25 patients with moderate to severe DED were evaluated for Esclera ScCL treatment. Best-corrected visual acuity (BCVA) and slit-lamp findings were assessed. Impression cytology specimens were obtained from DED patients at the baseline and after wearing ScCLs for 12 months. The impression cytology specimens were analyzed using morphological results score, and HLA-DR positive cells were detected and quantified. The values were compared to assess the IC changes after wearing ScCLs.

Results: Forty-one eyes from 25 patients were fitted with ScCLs to manage DED. The underlying diseases were Stevens-Johnson syndrome (22 eyes), Sjogren's syndrome (11 eyes), graft-versus-host disease (2 eyes), dry eye after keratomileusis (2 eyes) and undifferentiated ocular surface disease (4 eyes). The HE-PAS impression cytology score did not differ significantly before and after wearing ScCLs for 12 months in DED patients (p>0.05). The percentage of eyes expressing the HLA-DR antigen in the temporal conjunctiva after wearing ScCL for 12 months significantly increased in patients with Sjogren's syndrome (11.11% to 66.66%; p=0.0498). In groups with Stevens Johnson syndrome and other ocular surface disorders, we did not observe statistically significant differences (p>0.05).

Conclusions: The ScCLs did not change the parameters used to evaluate inflammatory processes, which were measured using conjunctival impression cytology and HLA-DR expression, except in Sjogren syndrome, in which there was an unexpected increase in HLA expression.
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http://dx.doi.org/10.1016/j.clae.2016.12.008DOI Listing
June 2017

Microbiological and epidemiological study of infectious keratitis in children and adolescents.

Arq Bras Oftalmol 2016 Sep-Oct;79(5):289-293

Departamento de Infectologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Purpose:: To analyze epidemiological and microbiological aspects of microbial keratitis in children and adolescents.

Methods:: This retrospective cohort study was conducted at the Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, between July 15, 1975, and December 31, 2010. We analyzed corneal samples from 859 patients with clinical suspicion of infectious keratitis, comparing epidemiological and microbiological characteristics of bacterial keratitis with those of non-bacterial and non-viral keratitis. We also compared Gram-positive and Gram-negative pathogens in patients with bacterial keratitis. We created a susceptibility profile of the bacterial microorganisms studied.

Results:: Of the 859 patients, 346 (40.3%) showed positive culture results for non-viral microorganisms. Teenagers (13-18 years) made up the group with the highest number of patients with keratitis (164, 47.4%). The most frequent risk factors for keratitis were trauma (33.5%) and previous ocular surgery (24.9%). Gram-positive bacteria (71.8%) were the most often isolated, with coagulase-negative Staphylococcus (23.8%) the most prevalent microorganism. Logistic regression analysis showed age (p=0.002), topical antimicrobial drug use (p=0.01), and trauma due to non-chemical burns (p=0.005) were risk factors for non-bacterial keratitis. Age (p=0.01) was also a risk factor for Gram-negative bacterial keratitis.

Conclusion:: Our study showed that in the age range studied, the prevalence of keratitis caused by Gram-negative bacteria or by the non-viral microorganisms evaluated increases with age. Previous use of topical antimicrobial drug and trauma due to non-chemical burns are associated with non-bacterial keratitis. Knowledge of the risk factors and the microorganisms involved may help improve treatment of keratitis in children and adolescents and minimize visual impairment.
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http://dx.doi.org/10.5935/0004-2749.20160084DOI Listing
July 2017

Analysis of Intraocular Lens Biofilms and Fluids After Long-Term Uncomplicated Cataract Surgery.

Am J Ophthalmol 2016 09 15;169:46-57. Epub 2016 Jun 15.

Department of Surgery (School of Medicine) & Hospital Clínic de Barcelona (IDIBAPS), University of Barcelona, Barcelona, Spain; CellTec-UB, University of Barcelona, Barcelona, Spain. Electronic address:

Purpose: Postoperative endophthalmitis is a potentially sight-threatening complication of cataract surgery. However, the pathophysiological mechanisms are not completely understood. We sought to study and evaluate the intraocular environment (aqueous and vitreous humors), the capsular tissue, and the intraocular lens (IOL) surfaces of normal eyes after long-term uncomplicated cataract surgery.

Design: Experimental laboratory investigation.

Methods: We studied 69 eyes donated for transplantation that had previously undergone cataract surgery with posterior chamber IOL implantation and that had no recorded clinical history of postoperative inflammation. We assessed the intraocular environment (DNA traces and biofilm formation) by microbiological evaluation of intraocular fluids using conventional microbiology and molecular techniques, including assessment for the presence of microbes (biofilm formation) on the IOL surface by scanning electron microscopy and ultrastructural capsular remnants by transmission electron microscopy.

Results: Isolated or aggregated cocci were probable in 18.8% of IOL optic surfaces (n = 13) studied by scanning electron microscopy, suggesting the presence of bacterial biofilm. In 3 intraocular fluid samples for IOLs with biofilm, we identified 16S rDNA by polymerase chain reaction and sequencing. No microbial contamination was found in intraocular fluids by conventional microbiological methods.

Conclusions: Our data suggest the possibility of bacterial biofilm formation on the optic surface of IOLs in normal eyes after long-term uncomplicated cataract surgery even in the absence of clinical or subclinical symptoms.
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http://dx.doi.org/10.1016/j.ajo.2016.06.012DOI Listing
September 2016

The Use of the Esclera Scleral Contact Lens in the Treatment of Moderate to Severe Dry Eye Disease.

Am J Ophthalmol 2016 Mar 14;163:167-173.e1. Epub 2015 Dec 14.

Department of Ophthalmology, Ocular Surface Advanced Center, Federal University of Sao Paulo, Sao Paulo, Brazil.

Purpose: To evaluate the efficacy of the Esclera scleral contact lens (SCL) treatment and its impact on clinical testing for moderate to severe dry eye disease (DED).

Design: Prospective interventional case series.

Methods: A total of 41 eyes from 25 patients with moderate to severe DED were evaluated for the Esclera SCL treatment. Best-corrected visual acuity (BCVA), tear osmolarity, the Schirmer I test, tear film breakup time (TBUT), corneal and conjunctival staining, meibomian grading, and Ocular Surface Disease Index and SF-36v2 questionnaires were assessed before and after the SCL treatment. These values were compared to assess the real benefit of using SCL as a treatment for DED.

Results: Forty-one eyes from 25 patients were fitted with SCL for management of DED. The underlying diseases were Stevens-Johnson syndrome (22 eyes), Sjogren syndrome (11 eyes), graft-vs-host disease (2 eyes), dry eye after keratomileusis in situ (2 eyes), and undifferentiated ocular surface disease (4 eyes). BCVA improved from 0.703 ± 0.55 logMAR with habitual correction to 0.406 ± 0.43 logMAR with SCL (P < .001). There was a significant decrease in tear osmolarity values (338.1 ± 27.1 to 314.25 ± 38.8 mOsm/L, P < .001) and van Bijsterveld scores (3.63 ± 2.33 to 2.63 ± 2.46 grade, P = .015) between the baseline and 12 months after SCL wear. There were also significant improvements in dry eye symptoms and quality of life as assessed by the OSDI and SF-36v2 questionnaires (both with P < .001).

Conclusions: The Esclera SCL treatment had a positive impact on tear osmolarity and van Bijsterveld score, as well as an improvement in the patients' BCVA, dry eye symptoms, and quality of life.
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http://dx.doi.org/10.1016/j.ajo.2015.11.034DOI Listing
March 2016

The use of ocular anatomical measurements using a rotating Scheimpflug camera to assist in the Esclera® scleral contact lens fitting process.

Cont Lens Anterior Eye 2016 Apr 20;39(2):148-53. Epub 2015 Oct 20.

Department of Ophthalmology, Federal University of São Paulo, São Paulo, SP, Brazil.

Purpose: To test for associations between Pentacam(®) derived topography variables and to evaluate the predictive power of those variables in relation to scleral contact lens (SCL) fit.

Setting: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo-SP, Brazil.

Design: Prospective observational non-randomised, non-comparative study.

Methods: Forty-seven patients (63 eyes) were indicated for the use of Esclera(®) SCL. All patients underwent Scheimpflug imaging before the initial SCL evaluation. The following parameters were measured by Pentacam: corneal elevations, thickness, density, and anterior chamber depth (ACD). Correlations between the SCL parameters and the Pentacam measurements were analysed with Pearson's correlation coefficients. A simple linear regression model was created for each lens parameter using the most-correlated Pentacam variable.

Results: In the total group, the results show correlations between the SCL parameters and the corneal astigmatism, ACD and pentacam-measured corneal height (Hm), with p<0.001 each. In addition, an inverse correlation between the lens sagittal depth (LSD) and the anterior radii minimum was shown (p<0.001). In the keratoconus group, the results show correlations between the SCL parameters and ACD and Hm (p<0.001, each). An inverse correlation between the LSD and the total thickness corneal density average was also observed (p=0.003).

Conclusion: There was a positive correlation between the LSD and ACD, even as LD and ACD in the keratoconus group. Thus, these results suggest that certain Pentacam measurements can be good predictors of the most appropriate Esclera lens to be fitted in keratoconus patients.
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http://dx.doi.org/10.1016/j.clae.2015.09.007DOI Listing
April 2016

Absence of bacterial or fungal growth in vials of reconstituted botulinum toxin type A after storage.

Aesthet Surg J 2015 Feb;35(2):189-93

Drs T. Osaki, M.H. Osaki, T.H. Osaki and A.E. Sant'Anna are from Division of Ophthalmic Plastic Surgery, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil. Drs M. Cecilia and A.L. Hofling-Lima are from Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil.

Background: Botulinum toxin type A (BTX-A; Botox) is supplied as individual freeze-dried preparations that should be administered within 24 hours after reconstitution. To avoid wasting this expensive drug, some physicians have resorted to storing vials of reconstituted BTX-A beyond the recommended duration. However, there is insufficient evidence to indicate that the sterility of previously reconstituted BTX-A is maintained during storage.

Objectives: The authors sought to determine whether bacterial and/or fungal proliferation occurred in vials of reconstituted BTX-A and subsequent storage of the remaining solution under refrigeration for 4 weeks.

Methods: A portion of the contents of 88 consecutive 100-U vials of BTX-A was administered aseptically to 108 patients for essential blepharospasm, hemifacial spasm, or facial rejuvenation. The vials were then stored for 4 weeks in a refrigerator, after which the contents were transferred to various media (blood agar, chocolate agar, Sabouraud agar, brain-heart infusion medium, and thioglycolate broth) and assessed for bacterial and/or fungal growth by standard methods.

Results: None of the BTX-A vials contained detectable bacterial or fungal contamination after 4 weeks of storage.

Conclusions: Storing vials of reconstituted BTX-A for 4 weeks after administration to patients was not associated with detectable growth of bacteria or fungi.
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http://dx.doi.org/10.1093/asj/sju072DOI Listing
February 2015

DNA extraction methods for panbacterial and panfungal PCR detection in intraocular fluids.

Curr Eye Res 2015 Jul 6;40(7):697-706. Epub 2014 Oct 6.

Department of Surgery, School of Medicine, University of Barcelona (UB) , Barcelona , Spain .

Purpose: Three different methods of DNA extraction from intraocular fluids were compared with subsequent detection for bacterial and fungal DNA by universal PCR amplification.

Material And Methods: Three DNA extraction methods, from aqueous and vitreous humors, were evaluated to compare their relative efficiency. Bacterial (Gram positive and negative) and fungal strains were used in this study: Escherichia coli, Staphylococcus epidermidis and Candida albicans. The quality, quantification, and detection limit for DNA extraction and PCR amplification were analyzed. Validation procedures for 13 aqueous humor and 14 vitreous samples, from 20 patients with clinically suspected endophthalmitis were carried out.

Results: The column-based extraction method was the most time-effective, achieving DNA detection limits ≥10(2) and 10(3 )CFU/100 µL for bacteria and fungi, respectively. PCR amplification detected 100 fg, 1 pg and 10 pg of genomic DNA of E. coli, S. epidermidis and C. albicans respectively. PCR detected 90.0% of the causative agents from 27 intraocular samples collected from 20 patients with clinically suspected endophthalmitis, while standard microbiological techniques could detect only 60.0%. The most frequently found organisms were Streptococcus spp. in 38.9% (n = 7) of patients and Staphylococcus spp. found in 22.2% (n = 4).

Conclusions: The column-based extraction method for very small inocula in small volume samples (50-100 µL) of aqueous and/or vitreous humors allowed PCR amplification in all samples with sufficient quality for subsequent sequencing and identification of the microorganism in the majority of them.
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http://dx.doi.org/10.3109/02713683.2014.957327DOI Listing
July 2015

Evaluation of conjunctival bacterial flora in patients with Stevens-Johnson Syndrome.

Clinics (Sao Paulo) 2014 Mar;69(3):168-72

Federal University of São Paulo, Vision Institute, Ophthalmology Department, São PauloSP, Brazil, Federal University of São Paulo (UNIFESP), Vision Institute, Ophthalmology Department, São Paulo/SP, Brazil.

Objective: To determine the conjunctival bacterial flora present in patients with Stevens-Johnson syndrome.

Methods: A prospective study of the conjunctival bacterial flora was performed in 41 eyes of 22 patients with Stevens-Johnson syndrome. The information gathered included the patient's sex and age, the duration of disease, the cause of Stevens-Johnson syndrome, and treatments. Scrapings of the inferior conjunctival fornix were performed in both eyes. Fourteen days before scraping, the patients were asked to interrupt all topical medication and start using 0.5% nonpreserved methylcellulose. The microbiological evaluation included microorganism identification and determination of antibiotic sensitivity.

Results: Of 22 patients (41 eyes), 14 (64%) were females, and eight (36%) were males. The mean age was 33.2 years, and the mean duration of disease was 15.6 years. Visual acuity ranged from light perception to 20/25 (1.57 logMar). The treatment received by most patients consisted of tear substitutes, topical antibiotics, and contact lenses. Bacterial identification was positive in 39 eyes (95%) and negative in two eyes (5%). Gram-positive cocci accounted for 55.5% of the microorganisms, whereas gram-positive bacilli and gram-negative bacilli accounted for 19% and 25.5%, respectively. Half of the patients (54%) had multiple bacterial species in their flora, and only one bacterial species was identified in the other half. Resistant bacteria were isolated from four eyes. The antibiotic sensitivity results for the Streptococcus group showed the lowest sensitivity and the highest microbial resistance identified.

Conclusion: Patients with Stevens-Johnson syndrome have a diverse conjunctival flora that includes many pathogenic species.
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http://dx.doi.org/10.6061/clinics/2014(03)04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935124PMC
March 2014

Characterization of ocular methicillin-resistant Staphylococcus epidermidis isolates belonging predominantly to clonal complex 2 subcluster II.

J Clin Microbiol 2014 May 12;52(5):1412-7. Epub 2014 Feb 12.

Special Clinical Microbiology Laboratory, Infectious Diseases Division, Federal University of Sao Paulo, Sao Paulo, Brazil.

Staphylococcus epidermidis is an abundant member of the microbiota of the human skin and wet mucosa, which is commonly associated with sight-threatening infections in eyes with predisposing factors. Ocular S. epidermidis has become notorious because of its capability to form biofilms on different ocular devices and due to the evolving rates of antimicrobial resistance. In this study, the molecular epidemiology of 30 ocular methicillin-resistant S. epidermidis (MRSE) isolates was assessed using multilocus sequence typing (MLST). Antimicrobial resistance, accessory gene-regulator and staphylococcal cassette chromosome mec (SCCmec) types, biofilm formation, and the occurrence of biofilm-associated genes were correlated with MLST clonal complexes. Sequence types (STs) frequently found in the hospital setting were rarely found in our collection. Overall, 12 different STs were detected with a predominance of ST59 (30%), ST5 and ST6 (13.3% each). Most of the isolates (93.3%) belonged to the clonal complex 2 (CC2) and grouped mainly within subcluster CC2-II (92.9%). Isolates grouped within this subcluster were frequently biofilm producers (92.3%) with a higher occurrence of the aap (84.5%) and bhp (46.1%) genes compared to icaA (19.2%). SCCmec type IV (53.8%) was predominant within CC2-II strains, while 38.4% were nontypeable. In addition, CC2-II strains were frequently multidrug resistant (80.7%) and demonstrated to be particularly resistant to ciprofloxacin (80.8%), ofloxacin (77%), azithromycin (61.5%), and gentamicin (57.7%). Our findings demonstrate the predominance of a particular MRSE cluster causing ocular infections, which was associated with high rates of antimicrobial resistance and particularly the carriage of biofilm-related genes coding for proteinaceous factors implicated in biofilm accumulation.
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http://dx.doi.org/10.1128/JCM.03098-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993641PMC
May 2014

[Distribution of infectious keratitis in a tertiary hospital in Brazil].

Arq Bras Oftalmol 2013 Nov-Dec;76(6):370-3

Purpose: To investigate the seasonality of infectious keratitis in a tertiary hospital in Brazil.

Methods: Charts from the Ocular Microbiology Laboratory of the Department of Ophthalmology of the Federal University of Sao Paulo were reviewed from 2005 to 2009. Infectious keratitis were defined as those with positive culture. Data were distributed monthly and linear regressions with seasonal dummy models were used to test for seasonal trends.

Results: Total of 1,468 cases of keratitis was diagnosed during the study period. Bacterial keratitis were responsible for 80.3% of all cases, followed by fungal (7%), and Acanthamoeba (6%); 6.7% were mixed cases. Statistical tests showed that there were no seasonal trends for bacteria (p=0.064), fungi (p=0.379), Acanthamoeba (p=0.062) or mixed infections (p=0.441).

Conclusions: No seasonal trends for infectious keratitis were observed in our sample.
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http://dx.doi.org/10.1590/s0004-27492013000600011DOI Listing
September 2014

Prevalence and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus in ocular infections.

Arq Bras Oftalmol 2013 Nov-Dec;76(6):350-3

Purpose: To study the prevalence of methicillin-resistant Staphylococcus aureus among S. aureus ocular infections in a tertiary health center in Brazil and compare antibiotic susceptibility patterns between MRSA and methicillin-susceptible S. aureus isolates.

Methods: Electronic records from the ocular microbiology laboratory of the Universidade Federal de São Paulo were retrospectively reviewed. During a 10-year period (between January 2000 and December 2009) all conjunctivitis, keratitis, and endophthalmitis cases with a positive culture for S. aureus were identified. Antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method.

Results: Five hundred sixty-six S. aureus isolates were identified; of those, 56 (9.9%) were resistant to methicillin. Throughout the 10-year period, Staphylococcus aureus showed a significant increasing trend from 7.55% to 16.18% among overall S. aurues infections (p=0.001) and from 3.7% to 13.16% in conjunctivitis (p=0.001). Conversely, we did not observe the same trend among those with keratitis (p=0.38). Staphylococcus aureus isolates showed higher resistance rates to tobramycin, gentamicin, ciprofloxacin, gatifloxacin, and moxifloxacin when compared with S. aureus isolates (p< 0.001). All cases were susceptible to vancomycin.

Conclusion: We observed an increasing trend in the overall prevalence of Staphylococcus aureus ocular infections and statistically significant higher resistance rates to commonly used antibiotics compared to Staphylococcus aureus. Our data supports the need for constant bacterial surveillance and should be taken into consideration before initiating empiric treatment of ocular infections.
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http://dx.doi.org/10.1590/s0004-27492013000600006DOI Listing
September 2014

Fusarium keratitis in Brazil: genotyping, in vitro susceptibilities, and clinical outcomes.

Clin Ophthalmol 2013 29;7:1693-701. Epub 2013 Aug 29.

Ophthalmology Department, Federal University of São Paulo, São Paulo, Brazil.

Background: The purpose of this paper is to describe clinical characteristics and determine correlations between clinical outcomes and antifungal susceptibility among molecularly characterized ocular Fusarium isolates in Brazil.

Methods: Forty-one Fusarium isolates obtained from 41 eyes of 41 patients were retrieved from the ophthalmic microbiology laboratory at São Paulo Federal University and grown in pure culture. These isolates were genotyped and antifungal susceptibilities determined for each isolate using a broth microdilution method. The corresponding medical records were reviewed to determine clinical outcomes.

Results: The 41 isolates were genotypically classified as Fusarium solani species complex (36 isolates, 88%), Fusarium oxysporum species complex (two isolates, 5%), Fusarium dimerum species complex (one isolate, 2%) and two isolates that did not group into any of the species complexes. Final best corrected visual acuity varied from 20/20 to light perception and was on average 20/800 (logarithm of the minimum angle of resolution (LogMAR) 1.6). A history of trauma was the most common risk factor, being present in 21 patients (51%). Therapeutic penetrating keratoplasty was necessary in 22 patients (54%). Amphotericin B had the lowest minimum inhibitory concentration for 90% of isolates (MIC90) value (2 μg/mL) and voriconazole had the highest (16 μg/mL). There was an association between a higher natamycin MIC and need for therapeutic penetrating keratoplasty (Mann-Whitney test, P < 0.005).

Conclusion: Trauma was the main risk factor, and therapeutic penetrating keratoplasty was necessary in 54% of patients. Amphotericin B had the lowest MIC90 (2 μg/mL) of the three antifungal agents tested. There was an association between higher natamycin MIC levels and corneal perforation, emphasizing the need for antifungal susceptibility testing and tailoring of antifungal strategies.
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http://dx.doi.org/10.2147/OPTH.S40063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769409PMC
September 2013

Assessment of ocular surface toxicity after topical instillation of nitric oxide donors.

Arq Bras Oftalmol 2013 Jan-Feb;76(1):38-41

Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Purpose: To evaluate the ocular surface toxicity of two nitric oxide donors in ex vivo and in vivo animal models: S-nitrosoglutathione (GSNO) and S-nitroso-N-acetylcysteine (SNAC) in a hydroxypropyl methylcellulose (HPMC) matrix at final concentrations 1.0 and 10.0 mM.

Methods: Ex vivo GSNO and SNAC toxicities were clinically and histologically analyzed using freshly excised pig eyeballs. In vivo experiments were performed with 20 albino rabbits which were randomized into 4 groups (5 animals each): Groups 1 and 2 received instillations of 150 µL of aqueous HPMC solution containing GSNO 1.0 and 10.0 mM, respectively, in one of the eyes; Groups 3 and 4 received instillations of 150 µL of aqueous HPMC solution-containing SNAC 1.0 and 10.0 mM, respectively, in one of the eyes. The contralateral eyes in each group received aqueous HPMC as a control. All animals underwent clinical evaluation on a slit lamp and the eyes were scored according to a modified Draize eye test and were histologically analyzed.

Results: Pig eyeballs showed no signs of perforation, erosion, corneal opacity or other gross damage. These findings were confirmed by histological analysis. There was no difference between control and treated rabbit eyes according to the Draize eye test score in all groups (p>0.05). All formulations showed a mean score under 1 and were classified as "non-irritating". There was no evidence of tissue toxicity in the histological analysis in all animals.

Conclusion: Aqueous HPMC solutions containing GSNO and SNAC at concentrations up to 10.0 mM do not induce ocular irritation.
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http://dx.doi.org/10.1590/s0004-27492013000100011DOI Listing
December 2013

Ocular rosacea--a review.

Arq Bras Oftalmol 2012 Oct;75(5):363-9

Department of Ophthalmology, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brazil.

Rosacea is a prevalent chronic cutaneous disorder with variable presentation and severity. Although considered a skin disease, rosacea may evolve the eyes in 58-72% of the patients, causing eyelid and ocular surface inflammation. About one third of the patients develop potentially sight-threatening corneal involvement. Untreated rosacea may cause varying degrees of ocular morbidity. The importance of early diagnosis and adequate treatment cannot be overemphasized. There is not yet a diagnostic test for rosacea. The diagnosis of ocular rosacea relies on observation of clinical features, which can be challenging in up to 90% of patients in whom accompanying roseatic skin changes may be subtle or inexistent. In this review, we describe the pathophysiologic mechanisms proposed in the literature, clinical features, diagnosis and management of ocular rosacea, as well as discuss the need for a diagnostic test for the disease.
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http://dx.doi.org/10.1590/s0004-27492012000500016DOI Listing
October 2012

Comparison of culture media for ex vivo cultivation of limbal epithelial progenitor cells.

Mol Vis 2013 17;19:69-77. Epub 2013 Jan 17.

Ocular Surface Advanced Center, Federal University of São Paulo, São Paulo, Brazil.

Purpose: To compare the effectiveness of three culture media for growth, proliferation, differentiation, and viability of ex vivo cultured limbal epithelial progenitor cells.

Methods: Limbal epithelial progenitor cell cultures were established from ten human corneal rims and grew on plastic wells in three culture media: supplemental hormonal epithelial medium (SHEM), keratinocyte serum-free medium (KSFM), and Epilife. The performance of culturing limbal epithelial progenitor cells in each medium was evaluated according to the following parameters: growth area of epithelial migration; immunocytochemistry for adenosine 5'-triphosphate-binding cassette member 2 (ABCG2), p63, Ki67, cytokeratin 3 (CK3), and vimentin (VMT) and real-time reverse transcription polymerase chain reaction (RT-PCR) for CK3, ABCG2, and p63, and cell viability using Hoechst staining.

Results: Limbal epithelial progenitor cells cultivated in SHEM showed a tendency to faster migration, compared to KSFM and Epilife. Immunocytochemical analysis showed that proliferated cells in the SHEM had lower expression for markers related to progenitor epithelial cells (ABCG2) and putative progenitor cells (p63), and a higher percentage of positive cells for differentiated epithelium (CK3) when compared to KSFM and Epilife. In PCR analysis, ABCG2 expression was statistically higher for Epilife compared to SHEM. Expression of p63 was statistically higher for Epilife compared to SHEM and KSFM. However, CK3 expression was statistically lower for KSFM compared to SHEM.

Conclusions: Based on our findings, we concluded that cells cultured in KSFM and Epilife media presented a higher percentage of limbal epithelial progenitor cells, compared to SHEM.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559094PMC
September 2013

Fusarium keratitis: genotyping, in vitro susceptibility and clinical outcomes.

Cornea 2013 May;32(5):667-73

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.

Purpose: To determine differences in the clinical characteristics and antifungal susceptibility patterns among molecularly characterized ocular Fusarium sp isolates.

Methods: Fifty-eight isolates of Fusarium sp obtained from 52 eyes of 52 patients were retrieved from the Ocular Microbiology Laboratory of the Bascom Palmer Eye Institute and grown in pure culture. These isolates were characterized based on DNA sequence analysis of the ITS1/2 and ribosomal deoxyribonucleic acid regions. Antifungal susceptibilities were determined for each isolate using broth microdilution methods, and the corresponding medical records were reviewed to determine the clinical outcomes.

Results: Fusarium solani isolates had significantly higher values of minimum inhibitory concentration for 90% isolates (MIC90) with voriconazole than F. non-solani organisms (16 and 4 μg/mL, respectively). Isolates of F. solani also exhibited a significantly longer time to cure (65 vs. 40.5 days), a worse follow-up best-corrected visual acuity (20/118 vs. 20/36), and an increased need for urgent surgical management (7 vs. 0 penetrating keratoplasties) when compared with those of F. non-solani.

Conclusions: This is the first report to examine the correlation between ocular genotyped Fusarium sp and clinical outcomes. It supports the overall worse prognosis of F. solani versus F. non-solani isolates, including higher voriconazole resistance by the former. The clinical implementation of molecular-based diagnostics and antifungal efficacy testing may yield important prognostic and therapeutic information that could improve the management of fungal ocular infections.
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http://dx.doi.org/10.1097/ICO.0b013e318277ac74DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3622819PMC
May 2013

Intrastromal injection of bevacizumab in patients with corneal neovascularization.

Arq Bras Oftalmol 2012 Jul-Aug;75(4):277-9

Vision Institute, Department of Ophthalmology, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brazil.

Corneal neovascularization (NV) not only reduces visual acuity, but it also causes loss of the cornea's immune privilege, strongly contributing to a worse prognosis in penetrating keratoplasty. Several mediators participate in corneal angiogenesis, and the role of vascular endothelial growth factor (VEGF) has been extensively proven. Anti-VEGF agents have been shown to be effective in slowing the growth of corneal neovessels. Bevacizumab, an anti-VEGF agent, has been successfully used in the treatment of corneal neovascularization. In this paper, we report a series of patients who underwent intracorneal bevacizumab injections to treat corneal vascularization.
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http://dx.doi.org/10.1590/s0004-27492012000400012DOI Listing
September 2013

Bactericidal effect of S-nitrosothiols against clinical isolates from keratitis.

Clin Ophthalmol 2012 20;6:1907-14. Epub 2012 Nov 20.

Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.

Background: The purpose of this study was to evaluate the antimicrobial activity of two nitric oxide donors, ie, S-nitrosoglutathione (GSNO) and S-nitroso-N-acetylcysteine (SNAC), against clinical isolates from patients with infectious keratitis.

Methods: Reference broth microdilution assays were performed to determine the minimum inhibitory and bactericidal concentrations for GSNO and SNAC against four American Type Culture Collection strains and 52 clinical isolates from patients with infectious keratitis as follows: 14 (26.9%) Pseudomonas species; 13 (25.0%) coagulase-negative Staphylococci; 10 (19.2%) Staphylococcus aureus; nine (17.3%) Serratia marcescens; and six (11.5%) Enterobacter aerogenes. Sterility control and bacterial growth control were also performed.

Results: SNAC showed lower minimum inhibitory and bactericidal concentrations than GSNO for all clinical isolates from patients with infectious keratitis. For Gram-positive bacteria, mean minimum inhibitory and bactericidal concentrations were 2.1 ± 1.3 and 8.6 ± 3.8 mM for SNAC and 4.6 ± 3.2 and 21.5 ± 12.5 mM for GSNO (P < 0.01). For Gram-negative bacteria, mean minimum inhibitory and bactericidal concentrations were 3.3 ± 1.4 and 6.1 ± 3.4 mM for SNAC and 12.4 ± 5.4 and 26.5 ± 10.1 mM for GSNO (P < 0.01). The minimum bactericidal to inhibitory concentration ratio was ≤8 in 100% of all isolates tested for SNAC and in 94.2% tested for GSNO.

Conclusions: SNAC and GSNO had effective inhibitory and bactericidal effects against bacterial isolates from keratitis. SNAC showed greater antimicrobial activity than GSNO against all bacteria. Gram-positive bacteria were more susceptible to the inhibitory and bactericidal effects of the S-nitrosothiols.
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http://dx.doi.org/10.2147/OPTH.S34830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508747PMC
December 2012

Safety and efficacy of moxifloxacin-dexamethasone eyedrops as treatment for bacterial ocular infection associated with bacterial blepharitis.

Adv Ther 2012 May 3;29(5):416-26. Epub 2012 May 3.

Vision Institute, Federal University of São Paulo, Rua Botucatu 822, 04023-062, São Paulo, Brazil.

Introduction: Treatments that offer two medications in a fixed combination have the potential to offer efficacious and safe treatment with advantages such as a regimen that is simpler than administering two separate solutions. This study evaluated the safety and efficacy of fixed-combination versus concomitant moxifloxacin 0.5% and dexamethasone 0.1% ocular solutions for the treatment of bacterial ocular inflammation and infection.

Methods: The clinical study design was a randomized, double-masked, active-controlled, parallel-group trial of 102 subjects with bacterial blepharitis in which two patients also had bacterial conjunctivitis. All subjects received two bottles of study medication: either a fixed combination of moxifloxacin 0.5%/dexamethasone 0.1% ophthalmic solution and placebo eye drops (fixed-dose group), or moxifloxacin 0.5% ophthalmic solution and dexamethasone 0.1% (concomitant group). One drop of each study medication was instilled bilaterally four times per day for 7 days. Clinical resolution, signs, symptoms, and safety were assessed. Microbiological specimens were collected from the eyelid margin and conjunctivae of each eye from each patient at the time of enrollment and at the exit visit.

Results: Clinical resolution occurred similarly in both groups (81.6% of eyes, fixed-dose group; 82.3% of eyes, concomitant group). Moreover, the microbiological efficacy of the treatment was also similar for both the fixed-dose group (84%) and the concomitant group (83%). Ocular symptoms and signs improved over time, with no significant differences between groups after 7 days of treatment, except the fixed-dose group had significantly more eyes with clinical resolution in eyelid erythema (100%, n = 98/98, fixed-dose group; 92.7%, n = 89/96, concomitant group; P = 0.0194) and eyelid scaling/crusting (98%, n = 96/98, fixed-dose group; 89.6%; n = 86/96 eyes, concomitant group; P = 0.0337). Both regimens were safe and well tolerated.

Conclusion: The fixed-dose combination of moxifloxacin, 0.5% and dexamethasone, 0.1% was therapeutically equivalent and as well tolerated as the concomitant dosage.
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http://dx.doi.org/10.1007/s12325-012-0018-8DOI Listing
May 2012

Sebaceous carcinoma of the eyelid - different diagnostic times, different outcomes: case reports.

Arq Bras Oftalmol 2011 Nov-Dec;74(6):444-6

Department of Ophthalmology, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brazil.

Sebaceous carcinoma of the eyelid is a very rare slow-growing tumor and is considered an aggressive eyelid neoplasm. It can reach mortality rate of about 6%. Diagnosis is often delayed because of its ability to masquerade as other periocular lesions, both clinically and histologically. We present three cases of sebaceous carcinoma, with different surgical outcomes, showing the importance of early diagnosis.
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http://dx.doi.org/10.1590/s0004-27492011000600013DOI Listing
October 2012