Polytetrafluoroethylene And Human Sclera In Surgical Treatment Of Scleral Perforation In Rabbits [politetrafluoroetileno E Esclera Humana No Tratamento Cirúrgico De Perfura̧ão Escleral Em Coelhos]

Purpose: An experimental study to evaluate the behavior of polytetrafluoroethylene (Gore-Tex®) compared with human sclera, in scleral perforations induced in rabbits eyes was performed. Methods: Twenty-two eyes of rabbits were submitted to scleral perforation followed by Gore-Tex® graft in the left eye and human sclera graft in the right eye respectively. During one month the postoperative evolution was analyzed every day: intensity of hyperemia, presence of infection, secretion, rejection and tonicity of the eyes. Results: No cases of secretion, infection or rejection were observed. The histological sections showed fibrosis in the eyes with Gore-Tex®, good adhesion and epithelization. Conclusion: The Gore-Tex® showed to be a plausible material to be used as graft in scleral defects with some advantages such as easy obtention, good handling and durability.646563567Koenig, S.B., Kaufman, H.E., The treatment of necrotizing scleritis with an autogenous periosteal graft (1983) Ophthalmic Surg, 14, pp. 1029-1032Blum Jr., F.G., Salamoun, S.G., Scleromalacia perforans: A useful surgical modification in fascia lata or scleral grafting (1963) Arch Ophthalmol, 69, p. 287Merz, E.H., Scleral reinforcement with aortic tissue (1964) Am J Ophthalmol, 57, pp. 66-70Huang, W.J., Hu, F.R., Chang, S., Clinicopathologic study of gore tex path grafting corneoscleral surgery (1994) Cornea, 13, pp. 82-86Mauriello Jr., J.A., Pokorny, K., Use of split-tickness dermal grafts to repair corneal and scleral defets-a study of 10 patients (1993) Br J Ophtalmol, 377, pp. 327-331Nishiwaki-Dantas, M.C., Abbott, R.L., Dantas, P.E.C., Use of corneal patch graft repair scleral defect secondary to pterygium excision and topical mitomycin-C therapy (1995) Arq Bras Oftalmol, 58, pp. 170-173Koenig, S.B., Sanitato, J.J., Kaufman, H.E., Long-term follow-up study of scleroplasty using autogenous periosteum (1990) Cornea, 9, pp. 139-143Legeais, J.M., Renard, G., D'Hermies, F., Rossi, C., Pouliquen, Y., Surgical management of corneal perforation with explanded polytetrafluorethylene (Gore Tex) (1991) Ophthalmic Surg, 22, pp. 213-217Bick, M.W., Surgical treatment of scleromalacia perforans (1959) Arch Ophthalmol, 61, pp. 907-917Mauriello Jr., J.A., Fiore, P.M., Pokorny, K.S., Cinotti, D.J., Use of split-tickness dermal grafts in the surgical treatment of corneal and scleral defects (1988) Am J Ophthalmol, 105, pp. 244-247Nishiwaki-Dantas, M.C., Abbott, R.L., Dantas, P.E.C., Reparação de defeito escleral ou corneo-escleral com enxerto corneano (1995) Arq Bras Oftalmol, 58, pp. 295-298Florian, A., Cohn, L.H., Dammin, G.J., Collins, J.J., Small vessel replacement with Gore-Tex (expanded polytetrafluoroethylene) (1976) Arch Surg, 111, pp. 267-270Kenyon, K.R., Wagoner, M.D., Hettinger, M.T., Conjunctival autograft transplantation for advanced and recurrent pterygium (1985) Ophthalmology, 92, pp. 1461-1470Obear, M.F., Winter, F.C., (1964) Technique of Overlay Scleral Homograft Arch Ophthalmol, 71, pp. 837-838Raizman, M.B., De La Dsainz Maza, M., Foster, C.S., Tectonic keratoplasty for peripheral ulcerative keratitis (1991) Cornea, 10, pp. 312-316Breslin, C.W., Katz, J.I., Kaufman, H.E., Surgical treatment of necrotizing scleritis (1977) Arch Ophthalmol, 95, pp. 2038-2040Tawakol, M.E., Peyman, G., Lui, K.R., Kaufman, H.E., Gore-Tex soft tissue bands as scleral explants in rabbits a preliminary histologic study (1989) Ophtthalmic Surg, 20, pp. 199-201Whitmore, W.G., Harrison, W., Curtis, B.J., Scleral reinforcement in rabbits using synthetic graft materials (1990) Ophthalmic Surg, 21, pp. 327-33

Influence Of The Topic Use Of Mitomycin C On The Differentiation Process Of Rabbit Cornea Epithelium [influência Do Uso Tópico De Mitomicina C No Processo De Diferenciação Do Epitélio Corneano De Coelhos]

Purpose: To evaluate the effects of mitomycin C eye drops (0.2 mg/ml) on the corneal epithelium of rabbits. The changes in clinical examination, histopathologic and immunohistochemical analysis were investigated. Methods: Mitomycin C and distilled water (controls) were instilled 4 times daily for 14 consecutive days in the eyes with intact ocular surface. The ocular surface was evaluated by slit-lamp examination, during the days of the drug instillation. The animals were sacrificed on the 15th, 50th and 100th day of the experiment. The histopathologic analysis of the corneal epithelium was complemented by immunohistochemical studies using monoclonal antibodies to cytokeratins (AE1 and AE5). Results: During the use of mitomycin C eye drops mild conjunctival hiperemia was detected. It disappeared 7 days after the drug was discontinued. There was no other clinical sign by slit-lamp examination. No histopathologic alterations in the corneal epithelium were detected, epithelium continuity was observed as well as maturation and presence of atypical cells. The use of 0.02% mitomycin C not influence the differentiation pattern of the corneal epithelial cell. Conclusion: The results of this investigation, in conditions of the study, showed that 0.02% mitomycin C, instilled 4 times daily for 14 consecutive days, showed a low toxic potential regarding the intact ocular surface.673463467Thoft, R.A., Friend, J., The X, Y, Z hypothesis of corneal epithelial maintenance (1983) Invest. Ophthalmol Vis Sci, 24, pp. 1442-1443Schermer, A., Galvin, S., Sun, T.T., Differentiation-related expression of a major 64K corneal keratin in vivo and in culture suggests limbal location of corneal epithelial stem cells (1986) J Cell Biol, 103, pp. 49-62Tseng, S.C.G., Concept and application of limbal stem cells (1989) Eye, 3 (PT 2), pp. 141-157Dua, H.S., Azuara-Blanco, A., Limbal stem cells of the corneal epithelium (2000) Surv Ophthalmol, 44, pp. 415-425Jabbur, N.S., Blair, S.D., Rubinfeld, R.S., Zieske, J.D., Foster, C.S., The effect of mitomycin C on corneal limbal stem cells (1994) Invest Ophthalmol Vis Sci, 35, p. 1797Ando, H., Ido, T., Kawai, Y., Yamamoto, T., Kitazawa, Y., Inhibition of corneal epithelial wound healing. A comparative study of mitomycin C and 5-fluorouracil (1992) Ophthalmology, 99, pp. 1809-1814Frucht-Pery, J., Rozenman, Y., Mitomycin C therapy for corneal intraepithelial neoplasia (1994) Am J Ophthalmol, 117, pp. 164-168Holzchuh, N., Alves, M.R., Santo, R.M., Matayoshi, S., Kara-José, N., Efeitos do uso do colírio de mitomicina C na superfície ocular de coelhos (1997) Rev Med (São Paulo), 76, pp. 303-306Ebato, B., Friend, J., Thoft, R., Comparison of limbal and peripheral corneal epithelium in tissue culture (1988) Invest Ophthalmol Vis Sci, 29, pp. 1533-1537Calabresi, P., Parks Jr., R.E., Agentes antiproliferativos e drogas usadas na imunossupressão (1987) Goodman e Gilman: As Bases Farmacológicas da Terapêutica, pp. 817-856. , Gilman AG, Goodman LS, Rall TW, Murad F, editors. 7ed., Rio de Janeiro, Guanabara KooganAlves, M.R., Saldiva, P.H.N., Lemos, M., Kara-José, N., Efeitos do uso tópico da mitomicina C no epitélio corneano de coelhas. Análise histopatológica pela morfometria (1996) Arq Bras Oftalmol, 59, pp. 431-437Kiritoshi, A., Sundar, R.A., Thoft, R.A., Differentiation in cultured limbal epithelium as defined by keratin expression (1991) Invest Ophthalmol Vis Sci, 32, pp. 3073-3077Shapiro, M.S., Thoft, R.A., Friend, J., Parrish, R.K., Gressel, M.G., 5-fluorouracil toxicity to the ocular surface epithelium (1985) Invest Ophthalmol Vis Sci, 26, pp. 580-583Mattar, D.B., Alves, M.R., Silva, M.H.T., Kara-José, N., Estudo comparativo da ação do tiotepa e da mitomicina C na reparação do epitélio corneano, em coelhas (1994) Arq Bras Oftalmol, 57, pp. 270-273Donnenfeld, E.C., Perry, H.D., Wallerstein, A., Caronia, R.M., Kanellopoulos, A.J., Sforja, P.D., Subconjunctival mitomycin C for the treatment of ocular cicatricial pemphigoid (1999) Ophthalmology, 106, pp. 72-7

Mitomycin C Toxicity In The Corneal Epithelium Of Rabbits [toxicidade Da Mitomicina C No Epitélio Corneano De Coelhos]

Objective: To evaluate the effects of mitomycin C eye drops (0.2 mg/ml) on the corneal epithelium of rabbits. Methods: Mitomycin C and distilled water (controls) were instilled 4 times daily for 14 consecutive days in the eyes with intact ocular surface. The animals were sacrificed in the 15th, 50th and 100th day of the experiment. The histopathologic analysis of the corneal epithelium was complemented by morphometry. Epithelium area, number of nuclei, nucleus-cytoplasm relation, epithelial cell and cytoplasm area were studied. Results: The morphometric analysis was performed by point counting under light microscopy. It showed variations characterized by alteration of the epithelium area, nucleus area and cytoplasm area, epithelial cell hypertrophy, alteration of the nucleuscytoplasm relationship and decrease of the number of nuclei. Conclusion: The results of this investigation, in the study conditions, showed that 0.02% mitomycin C, instilled 4 times daily for 14 consecutive days, has low toxic potential in the intact ocular surface.675713716Burstein, N.L., Corneal cytotoxicity of topically applied drugs, vehicles and preservatives (1980) Surv. Ophthalmol., 25 (1), pp. 15-30Alves, M.R., Saldiva, P.H.N., Lemos, M., Kara-José, N., Efeitos do uso tópico da mitomicina C no epitélio corneano de coelhas: Análise histopatológica pela morfometria (1996) Arq Bras Oftalmol, 59 (5), pp. 431-437Mattar, D.B., Alves, M.R., Silva, M.H.T., Kara-José, N., Estudo da influência da aplicação subconjuntival da mitomicina C na reparação de defeito epitelial corneano em coelhas (1995) Arq Bras Oftalmol, 58 (1), pp. 65-67Holzchuh, N., Alves, M.R., Santo, R.M., Matayoshi, S., Kara-José, N., Efeitos do uso do colírio de mitomicina C na superfície ocular de coelhos (1997) Rev Med. (São Paulo), 76 (6), pp. 303-306Frucht-Pery, J., Rozenman, Y., Mitomycin C therapy for corneal intraepithelial neoplasia (1994) Am J Ophthalmol, 117 (2), pp. 164-168Gundersen, H.J.G., Jensen, E.B., The efficiency of systematic sampling in stereology and its prediction (1987) J Microsc, 147 (PT. 3), pp. 229-263Mandarim-de-Lacerda, C.A., (1995) Métodos quantitativos em morfologia, 131p. , Rio de Janeiro EDUERJCotran, R.S., Kumar, V., Robbins, S.L., Shoen, F.J., Cellular injury and cellular death (1994) Robbins Pathologic Basis of Disease, 1425p. , Cotran RS, Kumar V, Collins P., 6.ed. Philadelphia: SaundersCotran, R.S., Kumar, V., Robbins, S.L., Shoen, F.J., Cellular growth and differentiation: Normal regulation and adaptations (1994) Robbins Pathologic Basis of disease, p. 1425. , Cotran RS, Kumar V, Collins P., 6.ed. Philadelphia: SaundersCrooke, S.T., Bradner, W.T., Mitomycin C: A review (1976) Cancer Treat Rev, 3 (3), pp. 121-13

Systemic lupus erythematosus and ocular involvement: an overview

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease of undefined etiology and with remarkably heterogeneous clinical features. Virtually any organ system can be affected, including the eye. SLE-related eye involvement can be diagnosed in approximately one-third of the patients and is usually indicative of disease activity. An early diagnosis and the adoption of suitable therapeutic measures are necessary to prevent sight-threatening consequences, especially in patients with juvenile SLE. Periocular lesions, such as eyelid involvement and orbital inflammation, are relatively rare and, in case of orbital masses, may require a biopsy control. Keratoconjunctivitis sicca or secondary Sjogren's syndrome is the most frequent ophthalmic manifestation of SLE. According to its variable severity, lubricating tear drops may be sufficient in mild cases, whereas cyclosporine-A ophthalmic solution, glucocorticoids (GCs), methotrexate, and/or other immunosuppressive drugs may be required in the more severe cases. Partial occlusion of the lacrimal punctum by thermal cautery is rarely applied. Although uncommon, episcleritis and scleritis can sometimes be detected as an initial finding of SLE and reveal themselves as moderate to intense ocular pain, redness, blurred vision, and lacrimation. Unilateral or more often bilateral retinopathy is responsible for visual loss of variable severity and is ascribed to vasculitis of the retinal capillaries and arterioles. In addition to the combined treatment suitable for all patients with active SLE, intravitreal bevacizumab should be considered in cases of severe vaso-occlusive retinopathy and laser photocoagulation in cases of neovascularization. Purtscher-like retinopathy is likely ascribable to the formation of microemboli that results in retinal vascular occlusion and microvascular infarcts. Choroidal disease is characterized by monolateral or bilateral blurred vision. Because of the choroidal effusion, retinal detachment and secondary angle-closure glaucoma may occur. Ischemic optic neuropathy is characterized by acute-onset and progressive binocular visual impairment as a consequence of occlusion of the small vessels of the optic nerves due to immune complex vasculitis. Intravenous GC boluses followed by oral GCs and/or, in case of recurrence, intravenous cyclophosphamide and/or rituximab are commonly employed. Neovascularization can be treated by intravitreal bevacizumab and progression of retinal ischemic areas by retinal laser photocoagulation. Ocular adverse events (AE) have been described following the long-term administration of one or more of the drugs presently used for the treatment of SLE patients. Posterior subcapsular cataracts and secondary open-angle glaucoma are common AE of the prolonged GC administration. The long-term administration of hydroxychloroquine (HCQ) sulfate is well known to be associated with AE, such as vortex keratopathy and in particular the often irreversible and sight-threatening maculopathy. Length of administration > 5 years, > 1000 g total HCQ consumption, > 6.5 mg/kg daily dosing, coexistence of renal disease, and preexisting maculopathy are all considered risk factors for HCQ-induced retinopathy. Ocular AE of additional immunosuppressive and biological agents are still poorly known, given the worldwide more limited experience with their long-term use.A thorough ophthalmological control is strongly recommended at closer intervals for all SLE patients, in step with the total length of exposure to the drugs and the cumulative dose administered