12 research outputs found
The quality of life before and after corneal transplantation
Orientador: Jose Paulo Cabral de VasconcellosDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Avaliação da qualidade de Vida dos Pacientes Antes e Após Realização de Transplante Penetrante de Córnea. OBJETIVO Verificar o impacto do transplante de córnea sobre a qualidade de vida dos indivíduos submetidos à cirurgia no serviço de Oftalmologia HC-UNICAMP no período de outubro de 2005 a outubro de 2006. METODO: O estudo foi aprovado pelo comitê de ética e pesquisa da FCM-UNICAMP. Foram inclusos indivíduos com indicação de transplante de córnea do ambulatório de Doenças Externas da Oftalmologia do HC UNICAMP no período de outubro de 2005 a outubro de 2006 e que aceitaram em participar do estudo. Foram incluídos 32 indivíduos. Os critérios de exclusão foram transplante tectônico, indivíduos com déficit visual importante causado por outra afecção ocular além das alterações corneanas. Realizou-se exame oftalmológico assim como aspectos demográficos e história ocular dos pacientes incluídos no estudo. Métodos objetivos como claridade do transplante e melhor acuidade visual corrigida e método subjetivo, a qualidade de vida, através do questionário SF-36 adaptado. RESULTADOS: Houve diferença significativa de satisfação entre gêneros com maior escore no sexo masculino (p = 0.0319). No método objetivo como a acuidade visual corrigida teve aumento significativo do olho transplantado (p<0.0001); A AV média antes do transplante era de 0,98 ± 0,1 logMAR e após 0,48 ± 0.38 logMAR. Quanto o escore de qualidade de vida (SF-36), método subjetivo, após o transplante houve um aumento significativo (p<0.0001). O escore do SF-36 antes do transplante foi de 49,11% ± 19,28 (média ± DP) e após o transplante de 71, 98% ± 24,28 (média ± DP) com uma melhora de 22, 87% (p<0.0001).Os indivíduos mais satisfeitos foram aqueles que tiveram a pontuação mais alta no SF-36 (r = 0.60; P = 0.0002). A satisfação parece não estar correlacionada com a melhora da AVCC no olho transplantado (r = 0.3186; P = 0.0755). Ocorreu uma fraca correlação entre a melhora da AVCC no olho transplantado e a melhora do SF-36 (r=0.28382; p=0.1154). Não houve diferença significativa do SF-36 nos indivíduos com visão baixa nos dois olhos quando comparado com os pacientes com visão boa em um dos olhos (p=0.2998 ) CONCLUSÃO: O transplante penetrante de córnea proporcionou melhora na pontuação dos métodos subjetivo e objetivos. Os indivíduos com maior satisfação foram melhor avaliados através do método subjetivo (SF-36). Não houve diferença significativa na qualidade de vida dos indivíduos com pior acuidade visual no olho contralateral quando comparado com os indivíduos com boa visão no olho contralateral, mas análise de um maior número de indivíduos é necessáriaAbstract: Purpose: To assess and measures the patient satisfaction before and after penetrating keratoplasty. Methods: The study of approved by the ethics committee of FCM-UNICAMP. Data were collected from 32 patients who underwent penetrating keratoplasty (PK) between October 2005 and October 2006. Demographic, ocular history, objective treatment outcome measures such as clarity of the graft and best-corrected visual acuity (BCVA) of both eyes were collected prospectively. In addition to assessment of quality of life were obtained by an interview before the PK and after at least one year of postoperative. Results: The average age of subjects was 42 ± 22 (mean ± SD) years and 68.75 % were women. On average, men were most satisfied. BCVA was 0,98 ± 0,1 logMAR before and 0,48 ± 0.38 logMAR after PK showing a significant improvement on BCVA (P < 0.0001). SF-36 score was 49.11% ± 19.28% before and 71.98% ± 24.28% after PK showing a significant improvement after the PK (p< 0.0001). The most satisfied patients where those who had a better score on SF-36 (r = 0.60; p = 0.0002). Satisfaction seems not to be correlated to improvement in BCVA at the transplanted eye (r = 0.3186; p = 0.0755). There was weak correlation between improvement in BCVA on the transplanted eye and improvement of SF-36 score (r = 0.28382; p=0.1154). There was no significant improvement in SF-36 in patients with worse BCVA in the other eye (p = 0.2998). Conclusions: Penetrating keratoplasty has a positive effect on objective and subjective outcome measures. Patient satisfaction is better predicted by subjective outcomes. There is no significant difference in quality of life in patients with worse BCVA in the contralateral eye when compared to eye with good BCVA in the contralateral eye, but analysis of a larger number of patients is necessary to confirm thatMestradoOftalmologiaMestre em Ciências Médica
Recommended from our members
Topical Ranibizumab as a Treatment of Corneal Neovascularization
Purpose
To examine the effect of topical ranibizumab on clinically stable corneal neovascularization (NV).
Methods
This was a prospective, open-label, monocentric, uncontrolled, non-comparative study. Ten eyes of 9 patients with corneal NV received topical ranibizumab (1%) 4 times a day for 3 weeks with a follow-up of 16 weeks. The main corneal neovascularization outcome measures were: neovascular area (NA), the area occupied by the corneal neovessels; vessel caliber (VC), the mean diameter of the corneal neovessels; and invasion area (IA), the fraction of the total cornea area covered by the vessels. This study was conducted at the Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
Results
Statistically significant decreases in NA (55.3%, P<0.001), which lasted through 16 weeks, and VC (59%, P<0.001), which continued to improve up to week 16, were observed after treatment. No significant decrease was observed in IA (12.3%, P=0.49). There was no statistically significant change in visual acuity or intraocular pressure. No adverse events ascribed to the treatment were noted.
Conclusions
Topical application of ranibizumab is effective in reducing the severity of corneal NV in the context of established corneal NV, mostly through decrease in VC rather than IA
Recommended from our members
Effects of Topical and Subconjunctival Bevacizumab in High-Risk Corneal Transplant Survival
Purpose.
To investigate whether corneal graft survival could be improved by topical or subconjunctival bevacizumab in a murine model of vascularized high-risk corneal transplantation.
Methods.
Before corneal transplantation, intrastromal sutures were placed for 2 weeks in the corneas of BALB/c mice, inducing intense angiogenesis. Allogeneic corneal transplantation was performed using C57BL/6 donor mice. Topical bevacizumab (2.5%) was delivered 3 times a day for 3 weeks in one treatment group, and 0.02 mL (0.5 mg) bevacizumab was injected subconjunctivally at days 0, 4, 8, and 15 after transplantation in the other treatment group. The control group received no treatment. Grafts were examined twice a week for 8 weeks by slit-lamp microscopy and were photographed once a week by slit-lamp digital camera and scored for opacity. For assessment of corneal neovascularization (NV), a quantitative method was used to measure three primary metrics including neovascular area, vessel caliber, and neovessel invasion area.
Results.
Both topical and subconjunctival bevacizumab treatment reduced neovascular area and vessel caliber; however, the regression of corneal NV was more profound when treated subconjunctivally. The mean percentage reduction of neovascular area was 55% (P < 0.05) by week 8 in the subconjunctival treatment group and 33% (P = 0.15) in the topical group. Only subconjunctival bevacizumab treatment resulted in significant regression of neovessel invasion area (P < 0.05). All corneal transplants in both the control and the topical groups were rejected by 4 weeks after transplantation. However, in the subconjunctival treatment group, 33% of corneal grafts survived (P < 0.01).
Conclusions.
Subconjunctival bevacizumab may offer an adjunctive measure to conventional therapies in preventing graft rejection in high-risk corneal transplantation
Recommended from our members
Therapeutic Efficacy of Topical Epigallocatechin Gallate in Murine Dry Eye
Objective
To study the efficacy of topical epigallocatechin gallate (EGCG) for treatment of dry eye disease (DED).
Methods
Female 7–8 week old C57BL/6 mice were housed in the controlled environment chamber to induce DED. Topical 0.01% or 0.1% EGCG, or vehicle, was applied to the eyes of DED mice. Corneal fluorescein staining and the number of corneal CD11b+ cells were assessed in the different groups. Expression of IL-1β, tumor necrosis factor (TNF)-α, Chemokine ligand 2 (CCL2) and VEGF-A/C/D were evaluated by real-time PCR in the corneas at day 9. Corneas were stained for LYVE-1 to evaluate lympangiogenesis, and the TUNEL assay was used to evaluate apoptosis of corneal epithelial cells.
Results
Treatment with 0.1% EGCG showed a significant decrease in corneal fluorescein staining compared with the vehicle (24.6%, P=0.001), and untreated controls (41.9%, P<0.001). A significant decrease in the number of CD11b+ cells was observed in 0.1% EGCG treated eyes, compared with the vehicle in the peripheral (23.3%, P=0.001) and central (26.1%, P=0.009) corneas. Treatment with 0.1% EGCG was associated with a significant decrease in the corneal expression of IL-1β (P=0.029), and CCL2 (P=0.001) compared to the vehicle, and in VEGF-A and -D levels compared to the untreated group (P=0.002, P=0.005, respectively). 0.01% EGCG also showed a decrease in inflammation at the molecular level, but no significant changes in the clinical signs of DED. No cellular toxicity to the corneal epithelium was observed with 0.01% or 0.1% EGCG.
Conclusions
Topical EGCG treatment is able to reduce the clinical signs and inflammatory changes in DED through suppressing the inflammatory cytokines expression and infiltration of CD11b+ cells in the cornea
Recommended from our members
Efficacy of Topical Blockade of Interleukin-1 in Experimental Dry Eye Disease
PURPOSE
To evaluate the therapeutic efficacy of topical IL-1Ra in the treatment of Dry Eye Disease (DED).
DESIGN
Laboratory Investigation.
METHODS
DED was induced in C57BL/6 female mice through exposure to a desiccating environment within a controlled environment chamber. Topical formulations containing 5% IL-1Ra, 1% methylprednisolone, 0.05% cyclosporin A (CsA), and a vehicle control containing carboxymethylcellulose sodium (CMC) were applied following the induction of dry eye. Corneal fluorescein staining (CFS) was performed by a masked observer in the different treatment groups. Immunohistochemical studies were undertaken to enumerate corneal CD11b+ cells, as well as to evaluate corneal lymphangiogenesis. Real-time polymerase reaction was used to quantify the expression of IL-1β in the cornea.
RESULTS
A significant decrease in CFS was observed following topical treatment with 5% IL-1Ra (P<0.01), 1% methylprednisolone (P<0.01), and 0.05% CsA (P<0.03). Additionally, a significant decrease in the numbers of central corneal CD11b+ cells (P<0.05), corneal lymphatic growth (P<0.05), and corneal IL-1β expression (P<0.003), compared to vehicle treated, were only demonstrated following treatment with 5% IL-1Ra and 1% methylprednisolone, and were absent following CsA treatment.
CONCLUSIONS
Topical treatment with IL-1Ra is efficacious in ameliorating the clinical signs of the DED, as well as in reducing underlying inflammation.These effects are comparab le to treatment with topical methylprednisolone. Topical IL-1Ra may hold promise as a novel therapeutic strategy in the treatment of dry eye
Recommended from our members
PDE4 Inhibition Suppresses IL-17–Associated Immunity in Dry Eye Disease
Purpose.
To determine the effect of phosphodiesterase type-4 (PDE4) inhibition on IL-17–associated immunity in experimental dry eye disease (DED).
Methods.
Murine DED was induced, after which a PDE4 inhibitor (cilomilast), dexamethasone, cyclosporine, or a relevant vehicle was administered topically. Real-time PCR, immunohistochemical staining, and flow cytometry were employed to evaluate the immuno-inflammatory parameters of DED with a focus on IL-17–associated immunity. Corneal fluorescein staining (CFS) was performed to evaluate clinical disease progression.
Results.
DED induction increased proinflammatory cytokine expression, pathogenic immune cell infiltration, and CFS scores. Cilomilast significantly decreased the expression of TNF-α in the cornea (P ≤ 0.05) and IL-1α, IL-1β, and TNF-α in the conjunctiva (P ≤ 0.05) as compared with vehicle control. Cilomilast treatment markedly decreased the presence of CD11b+ antigen-presenting cells in the central and peripheral cornea (P ≤ 0.05), and led to decreased conjunctival expression of cytokines IL-6, IL-23, and IL-17 (P ≤ 0.05). Moreover, cilomilast decreased the expression of IL-17 and IL-23 in the draining lymph nodes (P ≤ 0.05). Topical cilomilast was significantly more effective than vehicle at reducing CFS scores (P ≤ 0.05). The therapeutic efficacy of cilomilast was comparable or superior to that of dexamethasone and cyclosporine in all tested measures.
Conclusions.
Topical cilomilast suppresses the generation of IL-17–associated immunity in experimental DED
Recommended from our members
Topical Interleukin 1 Receptor Antagonist for Treatment of Dry Eye Disease
Importance
The immunopathogenic mechanisms of dry eye disease (DED), one of the most common ophthalmic conditions, is incompletely understood. Data from this prospective, double-masked, randomized trial demonstrate that targeting interleukin 1 (IL-1) by topical application of an IL-1 antagonist is efficacious in significantly reducing DED-related patient symptoms and corneal epitheliopathy.
Objective
To evaluate the safety and efficacy of treatment with the topical IL-1 receptor antagonist anakinra (Kineret; Amgen Inc) in patients having DED associated with meibomian gland dysfunction.
Design and Setting
Prospective phase 1/2, randomized, double-masked, vehicle-controlled clinical trial.
Participants
Seventy-five patients with refractory DED.
Interventions
Participants were randomized to receive treatment with topical anakinra, 2.5% (n=30), anakinra, 5% (n=15), or vehicle (1% carboxymethylcellulose) (n=30) 3 times daily for 12 weeks.
Main Outcomes and Measures
Primary outcomes were corneal fluorescein staining (CFS), complete bilateral CFS clearance, dry eye–related symptoms as measured by the Ocular Surface Disease Index, tear film breakup time, and meibomian gland secretion quality.
Results
Topical anakinra was well tolerated compared with vehicle, with no reports of serious adverse reactions attributable to the therapy. After 12 weeks of therapy, participants treated with anakinra, 2.5%, achieved a 46% reduction in their mean CFS score (P=.12 compared with vehicle and P<.001 compared with baseline); participants treated with anakinra, 5%, achieved a 17% reduction in their mean CFS score (P=.88 compared with vehicle and P=.33 compared with baseline); and patients treated with vehicle achieved a 19% reduction in their mean CFS score (P=.11). Complete bilateral CFS clearance was noted in 8 of 28 patients (29%) treated with anakinra, 2.5%, vs in 2of 29 patients (7%) treated with vehicle (P=.03). By week 12, treatment with anakinra, 2.5%, and treatment with anakinra, 5%, led to significant reductions in symptoms of 30% and 35%, respectively (P=.02 and P=.01, respectively, compared with vehicle); treatment with vehicle led to a 5% reduction in symptoms.
Conclusions and Relevance
Treatment with topical anakinra, 2.5%, for 12 weeks was safe and significantly reduced symptoms and corneal epitheliopathy in patients with DED. These data suggest that the use of an IL-1 antagonist may have a role as a novel therapeutic option for patients with DED
Recommended from our members
Short-Term Topical Bevacizumab in the Treatment of Stable Corneal Neovascularization
Purpose
To evaluate the safety and efficacy of topical bevacizumab in the treatment of corneal neovascularization (NV).
Design
Prospective, non-randomized, interventional case series.
Methods
Setting
Institutional, multicenter clinical trial.
Study Population
Twenty eyes from 20 patients with stable corneal NV.
Intervention Procedures
Patients were treated with topical 1.0% for 3 weeks and monitored for a total of 24 weeks.
Main Outcome Measures
Primary outcome measures included: neovascular area, defined as the area of the corneal vessels themselves; vessel caliber, defined as the mean corneal vessel diameter; and invasion area, defined as the fraction of the total cornea into which the vessels extended. The occurrence of ocular and systemic adverse events was closely monitored.
Results
As compared to the baseline visit, patients exhibited a statistically significant improvement in neovascular area by week 6 (P = .007) and vessel caliber by week 12 (P = .006). At the final visit, neovascular area, vessel caliber, and invasion area were reduced by 47.5%, 36.2%, and 20%, respectively. The decreases in neovascular area and vessel caliber were statistically significant (P < .001 and P = .003, respectively); however, the reduction in invasion area did not reach statistical significance (P = .06). There were no significant changes in the secondary outcomes and there were no adverse events.
Conclusions
Short-term topical bevacizumab treatment reduced the extent of stable corneal NV as measured by neovascular area and vessel caliber with no associated adverse events. Interestingly, the degree of treatment efficacy was inversely proportional to the baseline invasion area
Interferon-γ-secreting NK cells promote induction of dry eye disease
NK cells participate in the induction of dry eye disease via secretion of IFNγ which acts on both target tissue and secondary lymphoid tissue