Impacto da COVID-19 na Cirurgia de Transplantação Corneana: Primeiro EuCornea Educational Webinar

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Secondary Endothelial Keratoplasty—A Narrative Review of the Outcomes of Secondary Corneal Endothelial Allografts

Background: We review the literature on the efficacy and safety outcomes of secondary Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK). Methods: Literature search of English-written publications up to September 27, 2020 in PubMed database, using the terms "endothelial keratoplasty" in combination with keywords "secondary" or "repeat." In addition, we manually searched the references of the primary articles. Results: Twenty-seven studies (n = 651 eyes) were retained and reviewed, including 10 studies on repeat DSEK, 8 studies on repeat DMEK, 6 studies of DMEK following DSEK, and 3 studies of DSEK after failed DMEK. All studies reported significant improvement in visual acuity after secondary endothelial keratoplasty (EK). Twelve studies compared visual outcomes between primary and secondary EK, reporting conflicting findings. Sixteen studies reported endothelial cell loss rates after secondary EK, and only 1 study reported significantly increased endothelial cell loss rates compared with primary EK. Allograft rejection episodes occurred in 1.8% of eyes (range, 0%-50%). Six studies compared complication rates between primary and secondary EK eyes, and only 1 study found a higher median number of complications. However, 2 studies reported higher regraft failure rates compared with primary EK eyes. Conclusions: Secondary EK is surgically feasible and renders significant visual improvement after failed primary EK, although it is not clear whether visual outcomes and allograft survival are comparable with primary EK, raising the question of whether secondary EK eyes are "low risk" as primary EK eyes. Further larger, prospective studies are encouraged to obtain additional quality data on secondary corneal endothelial allotransplantation.info:eu-repo/semantics/publishedVersio

Outcomes of Cystoid Macular Edema Following Descemet's Membrane Endothelial Keratoplasty in a Referral Center for Keratoplasty in Spain: Retrospective Study

The aim of this study was to analyze the outcomes of eyes with visually significant cystoid macular œdema (vs-CMO) after Descemet membrane endothelial keratoplasty (DMEK) in a referral center for keratoplasty in Spain. We conducted a retrospective, single-surgeon case series of eyes that developed post-DMEK vs-CMO performed between January 2011 and December 2020. Data collected included: indication for DMEK; biometric data; ocular comorbidities; past medical history; time to detection of vs-CMO after DMEK (T, weeks); best-corrected visual acuity (BCVA, logMAR) and central retinal thickness (CRT, µm) at diagnosis of vs-CMO, after resolution of CMO, and at last follow-up; and management strategy. Main outcomes analyzed were incidence of vs-CMO, improvement in BCVA and CRT after treatment of vs-CMO. Of 291 consecutive DMEK surgeries, 14 eyes of 13 patients (4.8%) developed vs-CMO. Five patients (38.5%) had history of CMO, and 28.6% of eyes had ophthalmic comorbidities. Median (P25-P75) T was 4 (3-10) weeks. Treatment success was observed in 12/13 eyes (92.3%), two of which required second-line treatment. In successful cases (median time-to-resolution 3.0 (2.0-3.5) months), median BCVA improved from 0.60 (0.40-0.80) logMAR to 0.30 (0.15-0.40) logMAR (p = 0.002) after treatment, and median CRT improved from 582.5 (400.0-655.0) µm to 278.0 (258.0-294.0) µm (p = 0.005). In our study, we found a 4.8% rate of post-DMEK vs-CMO, with most cases occurring in the first 3 months after surgery. Good functional and anatomical outcomes are expected in most eyes, without treatment-related complications or implications in graft outcomes. Additional studies are encouraged to determine a standardized protocol for post-DMEK vs-CMO.info:eu-repo/semantics/publishedVersio

XEN® Implant and Trabeculectomy Medium-Term Quality of Life Assessment and Comparison of Results

AIM: To evaluate and compare the quality of life of patients submitted to XEN® implant or trabeculectomy and the relationship with potentially involved variables. METHODS: A cross-sectional study of patients with advanced open-angle glaucoma who underwent implantation of XEN® (group 1) and trabeculectomy (group 2) between October 2015 and February 2017. The studied variables were: age, gender, follow-up time, need of topical anti-hypertensive therapy, visual acuity and intraocular pressure (IOP). The quantification of the quality of life was attained through the Glaucoma Symptom Scale (GSS) questionnaire. RESULTS: Totally 34 eyes (34 patients) were included, 17 in each group. The mean GSS scores for group 1 were 42.6±6.8 (median, 47; p25, 36.5; p75, 48.5) and for group 2 it was 41.6±7.0 (median, 43; p25, 36.5; p75, 47.0; P=0.34). There was a strong negative correlation between the need for topical anti-hypertensive drugs and the GSS result in both groups (r=-0.88, P<0.01, r=-0.59, P=0.01, respectively) and a moderate negative correlation with IOP in group 1 (r=-0.50, P=0.03). CONCLUSION: The analysis demonstrates the non-inferiority of medium-term quality of life of one group in relation to the other (XEN® implant and trabeculectomy). The number of topical anti-hypertensive drugs and IOP negatively influenced the quality of life.info:eu-repo/semantics/publishedVersio

Omega-3 intake is associated with attenuated inflammatory response and cardiac remodeling after myocardial infarction

Myocardial infarction (MI) elicits an intense acute inflammatory response that is essential for cardiac repair. However, an excessive inflammatory response also favors myocardial apoptosis, cardiac remodeling, and cardiovascular mortality. Omega-3 polyunsaturated fatty acids (-3) bear anti-inflammatory effects, which may mitigate the inflammatory response during MI. This study investigated whether -3 intake is associated with attenuation of the MI-related inflammatory response and cardiac remodeling. ST-elevation MI (STEMI) patients (n=421) underwent clinical, biochemical, nutritional, 3D echocardiogram, Cardiac Magnetic Resonance imaging (CMRi) at 30 days and 3D echocardiogram imaging at six months after the MI. Blood tests were performed at day one (D1) and day five (D5) of hospitalization. Changes in inflammatory markers (D5-D1) were calculated. A validated food frequency questionnaire estimated the nutritional consumption and -3 intake in the last 3months before admission. The intake of -3 below the median (<1.7g/day) was associated with a short-term increase in hs-C-reactive protein [OR:1.96(1.24-3.10); p=0.004], Interleukin-2 [OR:2.46(1.20-5.04); p=0.014], brain-type natriuretic peptide [OR:2.66(1.30-5.44); p=0.007], left-ventricle end-diastolic volume [OR:5.12(1.11-23.52)]; p=0.036] and decreases in left-ventricle ejection fraction [OR:2.86(1.47-6.88); p=0.017] after adjustment for covariates. No differences were observed in the extension of infarcted mass obtained by CMRi. These findings suggest that a reduced daily intake of -3 may intensify outcome-determining mechanisms after STEMI, such as acute inflammatory response and late left ventricular remodeling.18CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ308550/2010-

Antimicrobial evaluation of quinones and heterocyclic compounds against mycobacterium marinum, M. kansasii and M. abscessus

The resistance to antimicrobials and biocides observed in mycobacteria which do not cause tuberculosis (MNT) determines the necessity to develop drugs. The present study evaluated the activity of naphthoquinones and heterocyclic derivatives obtained from lapachol against Mycobacterium kansasii, M. marinum, and M. abscessus, through the REMA method. It was observed that lapachol was inactive against the three mycobateria species, while β-lapachone and nor-β-lapachone showed activity only against M. marinum. The most active substances for M. kansasii were the derivates 2, 3, 7, and 11, in which compound 2 (CMI = 0.96 μM) was the most active. For M. marinum, 2, 11, and 14 were the most active, while against M. abcessus the compound 3 was the only active. The results showed a wide and diversified resistance spectrum among the species studied, which could be related to the molecular structure and position of the substituting groups, indicating the potentiality of these molecules as antimicrobial prototypes.Colegio de Farmacéuticos de la Provincia de Buenos Aire