Intrascleral Prosthesis in a Dog - Evisceration and Implantation

Background: There is no hope of preserving vision at the terminal stage of glaucoma, and surgical treatment is indicated in these cases. Among the various surgical techniques used, eye evisceration with implantation of an intrascleral prosthesis provide the best cosmetic results. Even though eye evisceration with prosthesis implantation represents an excellent treatment option for terminal glaucoma, reports on the use of this technique in dogs are scarce in the current literature. The aim of this work is to report a case of a dog with end-stage glaucoma subjected to eye evisceration surgery and implantation of an intrascleral prosthesis.  Case: A 7-year-old bitch mixed breed with a history of glaucoma secondary to uveitis with no response to medical therapy was referred to the Ophthalmology service of the University Veterinary Hospital of Coimbra (HVUC), Portugal At the ophthalmic examination, the glaucomatous left eye was buphthalmic, with congested episcleral blood vessels, mydriasis, and posterior luxation of the lens; there was no response to threat or obfuscation, no direct and consensual pupillary reflex, nor pupillary reflexes to chromatic light. The intraocular pressure (IOP) was 55 mmHg, and the Schirmer’s tear test (STT-1) result was 19 mm/min. Ophthalmoscopy revealed attenuated retinal blood vessels and a pale optic papilla with mild excavation. The right eye was functional, with all parameters assessed on examination and by tests within the normal ranges for the species. An ultrasound examination of the left eye confirmed the presence of posterior luxation of the lens and buphthalmia in the absence of intraocular neoplasm. In view of the patient’s history and results of the clinical examinations, a surgical approach was indicated to treat the glaucomatous eye. The patient’s tutor requested a surgical procedure that produced a more natural aspect; therefore, the procedure chosen was evisceration, with implantation of an intrascleral prosthesis. The prosthesis diameter chosen was 2 mm greater than the horizontal diameter of the cornea of the functional eye. After evisceration, a black spherical silicone prosthesis of 20 mm in diameter was implanted through a scleral incision. The eye surface was protected with a nictitating membrane flap. In the postoperative period, the cornea exhibited areas with neovascularization, pigmentation, and fibrosis, with a final aspect of gray to black in color. A reduction in tear production was also observed, with no other lesions on the eye surface or major complications. Discussion: Causes of secondary glaucoma include uveitis, disorders of the lens, and neoplasms, among other alterations. Glaucoma can cause clinical signs such as buphthalmic eyes, congestion of the episcleral blood vessels, and increased IOP with nonresponsive mydriasis. The presence of severe degenerative retinal alterations, such as atrophy and excavation of the optic nerve, causes irreversible loss of vision. Surgical treatment is indicated for end-stage glaucoma cases. Eye evisceration with implantation of a prosthesis involves replacement of the intraocular contents by a silicone sphere 1-2 mm larger than the healthy contralateral eye. Protection of the eye surface may be provided using additional procedures such as the nictitating membrane flap. The scleral incision may reduce corneal sensitivity and, consequently, reduce the tear reflex and cause a reduction in STT-1 values. After implantation of the prosthesis, the cornea may exhibit neovascularization, edema, fibrosis, and pigmentation; these are considered expected corneal reactions in the postoperative period. This surgical technique allows treatment of sore and blind eyes, and its results are more aesthetically pleasant compared to other procedures. Preservation of the eyeball with implantation of the prosthesis produced an excellent aesthetic result, with an appearance very close to natural in the case presented here. Keywords: surgery, glaucoma, intraocular prosthesis, silicone. Título: Prótese intraescleral em um cão - evisceração e implantaçãoDescritores: cirurgia, glaucoma, prótese intraocular, silicone.

OPHTHALMOLOGICAL EVALUATION OF SHEEP FROM THE ALENTEJO REGION - PORTUGAL

Considering the importance of the flock of Alentejo sheep, the goal of this study was to determine the average values of eye examinations, evaluate the ophthalmoscopic features and fluorescein staining for Merino sheep from Alentejo region, in Portugal. The 48 eyes of 24 healthy, female sheep belonging to the sheep flock at the University of Évora were evaluated. The average values obtained for Schirmer tear test (STT) were 19.0 ± 5.22 mm/min, with a reduction of tear production varying according to the age of the animal, for tear pH were 7.7 ± 0.48 and for intraocular pressure (IOP) was 12.7 ± 3.03 mmHg. Fundus aspects were observed in the tapetal area with shades of blue, green and yellow. The optic disc was predominantly in the transition area between tapetal and non-tapetal regions of elliptical shape, with holoangiotic vascular pattern. None of the animals showed fluorescein staining on the ocular surface. In the context of the investigation, these data may be useful to improve the clinical approach to the species and reference standards of the exam’s value

Transposição da comissura labial para correção de coloboma palpebral em gato: Relato de caso

Coloboma ou agenesia palpebral é um defeito congénito comum em gatos. A ausência de segmentos palpebrais muitas vezes pode exibir distúrbios oculares secundários graves. O único tratamento eficaz é a correção cirúrgica. Diferentes técnicas cirúrgicas podem ser utilizadas para a correção do coloboma palpebral em gatos. Objetivou relatar o reparo de coloboma palpebral em um gato, utilizando a técnica cirúrgica de transposição da comissura labial. A técnica consiste na obtenção de um retalho mucocutâneo que simula uma pálpebra natural, originada da comissura labial e transposta até o defeito palpebral. A técnica foi eficaz na reparação do defeito palpebral, proporcionando bom resultado funcional, melhor proteção da córnea e cosmeticamente aceitável

OPHTHALMOLOGICAL EVALUATION OF SHEEP FROM THE ALENTEJO REGION -PORTUGAL

Considering the importance of the flock of Alentejo sheep, the goal of this study was to determine the average values of eye examinations, evaluate the ophthalmoscopic features and fluorescein staining for Merino sheep from Alentejo region, in Portugal. The 48 eyes of 24 healthy, female sheep belonging to the sheep flock at the University of Évora were evaluated. The average values obtained for Schirmer tear test (STT) were 19.0 ± 5.22 mm/min, with a reduction of tear production varying according to the age of the animal, for tear pH were 7.7 ± 0.48 and for intraocular pressure (IOP) was 12.7 ± 3.03 mmHg. Fundus aspects were observed in the tapetal area with shades of blue, green and yellow. The optic disc was predominantly in the transition area between tapetal and non-tapetal regions of elliptical shape, with holoangiotic vascular pattern. None of the animals showed fluorescein staining on the ocular surface. In the context of the investigation, these data may be useful to improve the clinical approach to the species and reference standards of the exam’s value

IN VITRO PHOTODYNAMIC THERAPY ON OCULAR MELANOMA CELLS

Purpose. To evaluate the effect of newly developed Ring-fused chlorins on cell proliferation of ocular melanoma. Methods. Human cell line MP-41 and a canine primary culture were subjected to the photosensitizers at concentrations between 0,5-1000 nM for 24 hours. The cells were irradiated with 10J (ƛ>570nm). Control groups included: untreated cells and cells submitted only to the administration vehicle (dimethylsulfoxide). The cytotoxicity (MTT) assessment was performed 24 hours after photodynamic therapy (PDT). Results. The dihydroxymethyl ring-fused chlorin (PS1) was the most active, with an IC50 value of 95.1 nM. The dihydroxymethyl-Pt(II) ring-fused chlorin (PS3) also showed promising photodynamic activity with an IC50 value of 114.8nM in MP-41 cells. These chlorins also showed highly satisfactory results in canine cells, with IC50 of 0.6nM for the PS1 and 2.2 nM for PS3. The dicarboxylic acid ring-fused chlorin (PS2) and dicarboxylic acid Pt(II) ring-fused chlorin (PS4) were less efficient in both ocular melanoma cells. PDT had a direct effect on ocular melanoma cell metabolic activity. High activity was obtained at very low concentrations. Conclusion. Satisfactory outcomes were achieved using new photosensitizers, particularly PS1 and PS3. The photosensitizers used are promising, particularly PS1 and PS3. This approach might become an option in treating eye melanoma in medicine and veterinary medicine. Supported by FCT, Portugal, SFRH/BD/139319/2018, SFRH/BD/116794/2016, UID/NEU/04539/2019, UIDB/04539/2020, UIDP/04539/2020 and POCI-01-0145-FEDER-007440. None

Localização subcelular do novo fotossensibilizador em células do melanoma ocular através de microscopia confocal

Introdução: O melanoma ocular é o objetivo de várias investigações em medicina e medicina veterinária devido à baixa taxa de resposta aos tratamentos conservadores convencionais1. A terapia fotodinâmica (PDT) é uma terapia mais conservadora para os tecidos não neoplásicos, que induz e ativa as vias de morte celular nos tecidos neoplásicos alvo2,3. O fotossensibilizador, luz e oxigenio são os três componentes vitais não tóxicos da reação fotodinâmica. Quando o fotossensibilizador é ativado por uma fonte de luz (600-800 nm), ocorre a produção de espécies reativas de oxigenio (ROS) que exerce efeito terapêutico sobre a neoplasia2. A oxidação irreversível leva à morte da célula tumoral por apoptose, necrose e autofagia2. A morte celular pode ser ativada pela via extrínseca, que envolve recetores da membrana plasmática, ou pela via intrínseca, em que a mitocôndria tem um papel central2,3. A localização subcelular dos fotossensibilizadores constitui o local de dano primário da terapia fotodinâmica e é determinante nas vias de atuação ativadas pela reação fotodinâmica3. Recentemente, desenvolvemos um grupo de novas clorinas, que são fotossensibilizadores muito eficazes em células de melanoma2,3,4. Dessa forma o objetivo do trabalho foi avaliar a localização subcelular (núcleo e mitocôndria) da nova clorina em células do melanoma ocular. Métodos: Células da linha celular de melanoma ocular (MP-41) cultivadas em meio RPMI com 25% de FBS, foram semeadas em placas de 24 poços com lamelas esterilizadas. As células foram incubadas com 500 nM da nova clorina (derivado dihidroximetilo de 4,5,6,7-tetra-hidropirazolo[1,5-a]piridina fundido com tetrafenilclorina) por 24 h. Após este período, as culturas foram submetidas a duas lavagens com PBS, de modo a remover todo o fotossensibilizador no exterior das células, e procedeu-se à marcação dos organelos. As células que foram marcadas com o corante nuclear Hoechst 33252 (blue) e incubadas com uma solução de 5 μg/ml da sonda em PBS durante 15 minutos no escuro. As culturas celulares que foram marcadas com a sonda mitocondrial MitoTracker® Green FM foram incubadas com uma solução de 200 nM da sonda em PBS durante 30 minutos, a 37ºC, no escuro. Após as incubações com as respetivas sondas as células foram lavadas com PBS as lamelas foram montadas sobre lâminas e observadas ao microscópio confocal (Carl Zeiss MicroImaging LSM710, objetiva 40X) e fotografadas. As imagens foram analisadas no software ImageJ e a colocalização avaliada pelo coeficiente de correlação de Pearson. Resultados: Os estudos de localização subcelular confirmaram a internalização celular do novo fotossensibilizador. A média para coeficiente de Pearson foi -0,114 para colocalização núclear, certificando a existência 43% de correlação negativa, para as imagens analisadas, demostrando que não ocorre internalização nuclear do novo fotossensibilizador. No que respeita a mitocôndria, verificou-se a existência de 66%, correlação de Pearson positiva, que foi igual a média 0,366 para as imagens analisadas, demostrando que ocorre internalização mitocondrial do novo fotossensibilizador. Conclusão: Verificou-se que o novo fotossensibilizador é captado pelas células de melanoma ocular e que se acumula nas mitocôndrias, mas não penetra no núcleo celular

Tendências epidemiológicas da Leishmaniose Visceral em Guanambi, Bahia: um estudo de 10 anos

A Leishmaniose Visceral (LV) é uma zoonose causada pelo protozoário do gênero Leishmania, transmitida principalmente pela picada de flebotomíneos fêmeas infectadas. Na Bahia, estado localizado na Região Nordeste do Brasil, a LV é endêmica e representa um sério problema de saúde pública. O presente estudo tem como objetivo avaliar a epidemiologia dos casos confirmados de Leishmaniose Visceral no município de Guanambi, Bahia, no período de 2014 a 2023, comparando as características epidemiológicas dos grupos de óbito e não óbito, além de analisar a taxa de letalidade por faixa etária e as características do grupo com coinfecção HIV-LV. Trata-se de uma pesquisa observacional retrospectiva, quantitativa e descritiva realizada por meio da análise das fichas de notificação epidemiológica dos casos confirmados de LV no município de Guanambi, Bahia, no período de 2014 a 2023, fornecidas pelo setor de vigilância Epidemiológica do município. Nos últimos 10 anos, o município de Guanambi registrou 42 casos confirmados de leishmaniose visceral (LV). Realizando a análise por sexo, observamos que dos casos confirmados, 76,2% foram em pacientes do sexo masculino e 23,8% em pacientes do sexo feminino. Em relação à evolução dos casos no município de Guanambi, dos pacientes confirmados, 79% evoluíram com cura da doença e 21% faleceram. A taxa global de letalidade no período de estudo foi de 21,4%. Nesta análise, dividimos os nossos pacientes de acordo com a evolução dos mesmos em grupo geral, grupo cura e grupo óbito. Comparando o grupo de pacientes que evoluíram para óbito, cura e o grupo geral, observamos que os sintomas mais frequentes permaneceram os mesmos, porém o grupo que evoluiu para óbito apresentou um percentual maior na frequência de todos os sintomas, exceto hepatomegalia. Os sintomas menos frequentes, como infecção, hemorragia e edema, foram mais acentuados no grupo que evoluiu para o óbito. A taxa de coinfecção Leishmaniose/HIV em Guanambi foi de 16,7% apresentando um total de 07 pacientes no período. Um deles evoluiu para óbito, com uma taxa de letalidade neste grupo de 14,2%, menor do que a taxa de letalidade do grupo geral. É essencial ressaltar a importância da vigilância epidemiológica contínua e de medidas preventivas eficazes para controlar a disseminação da doença. Estratégias de educação em saúde e treinamento da equipe de saúde são fundamentais para garantir o diagnóstico precoce e o tratamento adequado. Este estudo contribui para o conhecimento da epidemiologia da LV em nível local, fornecendo informações importantes para a implementação de políticas de saúde mais eficazes e direcionadas às necessidades da população

Síndrome Asia relacionada à prótese mamária de silicone: uma revisão literária

Objetivo: O estudo, em questão, tem por objetivo elucidar a discussão sobre a Síndrome ASIA e sua correlação com o implante mamário. Método: As informações foram obtidas por meio de revisão da literatura e artigos selecionados na base de dados do Google Scholar. Considerações finais: O tema apresentado e as publicações levantadas trazem à luz a discussão da abordagem de uma situação ainda pouco estudada e conhecida, que é a ocorrência da Síndrome ASIA mediante o implante mamário de silicone e evidenciam que quando bem executadas a investigação e a conduta, estas se mostram capazes de obter resultados satisfatórios no que diz respeito ao alívio sintomático e melhoria da qualidade de vidas das pacientes

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Clinical Aspects of Amniotic Membrane Implants in Corneal Repair in Dogs with Complicated Ulcers

Background: Among numerous disorders treated by veterinary ophthalmology, therapies employed to solve corneal ulcers stand out. Amniotic membrane transplantation is an effective surgical technique for the treatment of complicated corneal ulcers in the dog, with highly satisfactory visual and cosmetic outcomes. However, in veterinary ophthalmology, reports on the use of the amniotic membrane and its corneal reconstructive potential are scarce. The objective of this work was to evaluate, for 21 days, the clinical aspects and the effectiveness of transplantation of canine amniotic membrane for corneal healing in two cases of complicated ulcers in dogs.Cases: Two Shih-Tzu dogs were diagnosed with complicated corneal ulcer. They underwent surgical treatment with the use of a glycerin-preserved canine amniotic membrane implant, which was secured on the cornea or the limbus. A surgical microscope at a magnification of 16x was used. The devitalized tissues at the periphery of the ulcer were excised, and multiple layers of amniotic membranes were sutured onto the cornea and near the limbus with interrupted absorbable suture. Protection of the canine amniotic membrane implants was performed with a scarified third eyelid flap, which was attached to the upper eyelid, and maintained for 14 days. During the first 14 days after the procedure, topical treatment with antibiotic eye drops was administered; protease inhibitors were also used. Antibiotics were used systemically for 10 days. Between days 14 and 21 after the transplantation procedure, protease inhibitors, corticosteroids, and lubricant were administered topically. Healing and clinical aspects were evaluated on days 0, 14, and 21. The parameters evaluated were blepharospasm, dazzle and direct pupillary reflexes, and consensual and threat responses. Corneal vascularization, hypopyon, synechia, opacity, and fluorescein dye penetration into the cornea were evaluated. The patient whose membrane was attached to the cornea was named COr, and the animal whose membrane was attached to the corneal limbus was named PLi. Blepharospasm and positive fluorescein test were detected only on the first day of the experiment; whereas, the dazzle and pupillary reflexes, as well as the consensual response, were present in both animals at all evaluated time points. Only COr exhibited hypopyon on day 0. Synechia was not observed in any of the animals at any of the time points. On the 21st day, COr exhibited deep vascularization and an opaque scar, while PLi exhibited only discrete vessels without blood perfusion, secondary to corneal repair.Discussion: A smooth operation of the central and peripheral ophthalmic system was maintained at all periods evaluated. The protection provided by the membrane contributed to corneal healing by reducing stimulation of nerve endings on the epithelium and stroma, and suppressing the blepharospasm reflex. The amniotic membrane used as an adjuvant has antimicrobial and anti-inflammatory properties, inhibits proteinases and mediators of inflammation, and exerts a mechanically protective effect. The corneal vascularization observed in both animals is related to the healing processes stimulated by filling the deep corneal lesions with the membrane. When used in addition to drug therapy, the amniotic membrane can inhibit postinflammatory neovascularization, fibroblast activity, collagen deposition, scarring, and opacifications. Accurate diagnosis, and correct therapeutic and surgical management, is fundamental for the successful treatment of corneal ulcers. In this work, canine amniotic membrane preserved in glycerin was used for the surgical treatment of complicated ulcers in dogs along with adequate clinical therapy. This was effective independent of the different anchorage techniques used, and led to satisfactory clinical results and short-term corneal healing.