Effect of epithelial debridement on human cornea proteoglycans

Corneal transparency is attributed to the regular spacing and diameter of collagen fibrils, and proteoglycans may play a role in fibrillogenesis and matrix assembly. Corneal scar tissue is opaque and this opacity is explained by decreased ultrastructural order that may be related to proteoglycan composition. Thus, the objectives of the present study were to characterize the proteoglycans synthesized by human corneal explants and to investigate the effect of mechanical epithelial debridement. Human corneas unsuitable for transplants were immersed in F-12 culture medium and maintained under tissue culture conditions. The proteoglycans synthesized in 24 h were labeled metabolically by the addition of 35S-sulfate to the medium. These compounds were extracted by 4 M GuHCl and identified by a combination of agarose gel electrophoresis, enzymatic degradation with protease and mucopolysaccharidases, and immunoblotting. Decorin was identified as the main dermatan sulfate proteoglycan and keratan sulfate proteoglycans were also prominent components. When the glycosaminoglycan side chains were analyzed, only keratan sulfate and dermatan sulfate were detected (~50% each). Nevertheless, when these compounds were 35S-labeled metabolically, the label in dermatan sulfate was greater than in keratan sulfate, suggesting a lower synthesis rate for keratan sulfate. 35S-Heparan sulfate also appeared. The removal of the epithelial layer caused a decrease in heparan sulfate labeling and induced the synthesis of dermatan sulfate by the stroma. The increased deposit of dermatan sulfate proteoglycans in the stroma suggests a functional relationship between epithelium and stroma that could be related to the corneal opacity that may appear after epithelial cell debridement.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de BioquímicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de OftalmologiaUNIFESP, EPM, Depto. de BioquímicaUNIFESP, EPM, Depto. de OftalmologiaSciEL

Quality of life of pseudophakic patients with accommodative intraocular lens implant

PURPOSE: To evaluate the visual function and satisfaction of patients who underwent cataract surgery and were implanted with an accommodative intraocular lens and the impact in their quality of life. METHODS: Retrospectively, questionnaires applied one year after cataract surgery of 22 patients who were included in a clinical trial to evaluate the safety and effectiveness of a silicone multipiece intraocular lens designed to provide distance and near vision were analyzed. RESULTS: Twenty-two patients with mean age of 70.2 years were enrolled in the study. Sixteen (73%) patients received bilateral and 6 (27%) unilateral implants of the unilateral implant group, 5 (83.3%) patients declared marked improvement of vision, 1 (16.7%) referred maximum improvement. Regarding satisfaction, 5 (83.3%) declared to be satisfied and 1 (16.7%) was very satisfied with the results of the surgery in general. Night vision was declared as without difficulty by 3 patients (50.0%), mild difficulty by 2 (33.3%) and moderate difficulty by 1 (16.7%). In the bilateral group, 7 (43.8%) considered near vision to be of excellent quality, 7 (43.8%) very good, 1 (6.2%) adequate and 1 (6.2%) poor. The quality of intermediate vision was classified as excellent by 6 (37.5%) patients, very good by 9 (56.3%) and adequate by 1 (6.2%). The quality of distance vision was considered excellent by 9 (56.3%) patients, very good by 3 (43.8%), adequate by 2 (12.5%) and not very good by 2 (12.5%). Regarding night vision, 9 (56.3%) patients declared no difficulty, 5 (31.2%) mild difficulty and 2 (12.5%) moderate difficulty. CONCLUSION: Considering IOL optical property, most patients presented important improvement of visual function, without need to wear spectacles and with positive impact on their quality of life.OBJETIVO: Avaliar a função visual e satisfação dos pacientes submetidos à cirurgia de catarata com implante de lente intra-ocular acomodativa e o impacto na sua qualidade de vida. MÉTODOS: Retrospectivamente, foram avaliados questionários aplicados após um ano da cirurgia de 22 pacientes que foram incluídos num estudo clínico para avaliar segurança e eficácia de uma lente intra-ocular de silicone de câmara posterior designada para corrigir visão para longe e perto. RESULTADOS: Do total dos pacientes operados, 16 (73%) eram bilaterais e 6 (27%) unilaterais, com idade média de 70,2 anos. Dos pacientes com implante unilateral, 5 (83,3%) declararam melhora acentuada da visão e 1 (16,7%) referiu máxima melhora. Quanto ao nível de satisfação, 5 (83,3%) ficaram satisfeitos e 1 (16,7%) muito satisfeito com o resultado cirúrgico. A visão noturna foi declarada como sem dificuldade por 3 (50,0%), pouca dificuldade por 2 (33,3%) e dificuldade moderada por 1 (16,7%). No grupo bilateral, 7 (43,8%) consideraram excelente a qualidade da visão para perto, 7 (43,8%) muito boa, 1 (6,2%) adequada e 1 (6,2%) ruim. A visão intermediária foi classificada como excelente por 6 (37,5%), muito boa por 9 (56,3%) e adequada por 1 (6,2%). A qualidade da visão para longe foi considerada excelente por 9 (56,3%), muito boa por 3 (43,8%), adequada por 2 (12,5%) e não muito boa por 2 (12,5%). Em relação à visão noturna 9 (56,3%) declararam não ter dificuldade alguma, 5 (31,2%) pouca dificuldade e 2 (12,5%) dificuldade moderada. CONCLUSÕES: Considerando a propriedade óptica da LIO, a maioria dos pacientes apresentou uma melhora considerável da função visual, sem a necessidade de correção óptica, e, portanto, com impacto positivo na qualidade de vida.Universidade Federal de São Paulo (UNIFESP) Departamento de Oftalmologia Setor de Pesquisa ClínicaUniversidade Federal de São Paulo (UNIFESP) Instituto da Catarata Departamento de OftalmologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Oftalmologia Setor de Cirurgia ExperimentalUniversidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUNIFESP, Depto. de Oftalmologia Setor de Pesquisa ClínicaUNIFESP, Instituto da Catarata Depto. de OftalmologiaUNIFESP, Depto. de Oftalmologia Setor de Cirurgia ExperimentalUNIFESP, Depto. de OftalmologiaSciEL

Optical and ultrasound biometry: comparision between the two methods used for the calculation of accommodative intraocular lens

PURPOSE: To compare reproducibility, level of agreement and correlation of two ultrasonic biometers and one optical biometer for the calculation of accommodative intraocular lens. METHODS: Cataract patients were submitted to the examination with 3 different biometers (IOLMaster, Axis II and Humphrey Mod. 820) before the implant of the C&C Vision AT-45 accommodative silicone intraocular lens. The Axis II biometer was used for both contact and immersion biometry. Axial length, anterior chamber depth and keratometry were the analyzed biometric parameters. RESULTS: Thirty-four patients from 53 to 90 years old (mean 70.6 y) were submitted to the examination with the three different biometers. The lowest mean axial length (23.12 mm) was obtained with the Axis II/contact and the highest (23.21 mm) with the Humphrey biometer. The lowest mean anterior chamber depth (2.97mm) was obtained with the Humphrey and the highest (3.10mm) with the IOLMaster. Reproducibility for axial length was high for all the biometers tested (coefficient of variation: 3.02% for Humphrey and Axis II / immersion; 3.07 % for Axis II/contact and 3.19% for IOLMaster). All biometers presented nearly equal results of the analyzed parameters (99.01% for axial length and 94.77% for anterior chamber depth). Pearson's coefficient showed a high correlation between the biometers, regarding the axial length and anterior chamber depth measurements. CONCLUSION: The devices used in this study showed excellent reproducibility and high level of agreement and of the axial length, anterior chamber depth and keratometry measurements, making it possible to reduce errors of intraocular lens calculation and visual insatisfaction after cataract surgery.OBJETIVO: Comparar a precisão e reprodutibilidade de dois biômetros ultra-sônicos convencionais e um biômetro óptico para o cálculo da lente intra-ocular (LIO) acomodativa. MÉTODOS: Pacientes com catarata foram submetidos aos exames em 3 biômetros distintos (IOLMaster®, Axis II® e Humphrey Mod. 820®), antes da cirurgia para implantação da lente intra-ocular acomodativa de silicone (C&C Vision AT-45). No biômetro Humphrey Mod. 820 utilizou-se a técnica de contato e o Axis II foi usado para as técnicas de contato e imersão. O método de interferometria óptica foi realizado pelo IOLMaster. O comprimento axial (AL), profundidade da câmara anterior (ACD) e a ceratometria corneana (K) foram os parâmetros oculares analisados. RESULTADOS: Foram submetidos aos exames 34 pacientes com média de idade de 70,6 anos e idade variando entre 53 e 90 anos. A menor média do comprimento axial (23,12 mm), foi obtida no Axis II (contato) e maior (23,21 mm) no Humphrey Mod. 820 (contato). A maior média da profundidade da câmara anterior (3,10 mm) no IOLMaster e a menor (2,97 mm) no Humphrey Mod. 820 (contato). A reprodutibilidade para os dados de comprimento axial foi significativamente grande para todos os biômetros [3,02%, 3,07 % e 3,19% respectivamente para Humphrey Mod. 820 e Axis II (imersão), Axis II (contato) e IOLMaster]. Os biômetros foram extremamente concordantes nas medidas dos parâmetros analisados (99,01% e 94,77% respectivamente para o comprimento axial e ceratometria corneana). Os coeficientes de Pearson (r) demonstraram alta correlação entre os aparelhos nas medidas do comprimento axial e profundidade da câmara anterior. CONCLUSÃO: Os métodos do estudo para o cálculo da lente intra-ocular acomodativa, demonstraram que houve precisão e reprodutibilidade dos resultados, podendo evitar insatisfação visual do paciente no pós-operatório da cirurgia de catarata decorrente de erros no cálculo da lente intra-ocular.Universidade Federal de São Paulo (UNIFESP) Departamento de Oftalmologia Setor de Pesquisa ClínicaUniversidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUNIFESP, Depto. de Oftalmologia Setor de Pesquisa ClínicaUNIFESP, Depto. de OftalmologiaSciEL