Combined use of a femtosecond laser and a microkeratome in obtaining thin grafts for Descemet stripping automated endothelial keratoplasty: an eye bank study

Purpose: To evaluate the use of a femtosecond laser combined with a microkeratome in the preparation of posterior corneal disks for Descemet stripping automated endothelial keratoplasty (DSAEK).
Methods: This experimental study involved ultrathin DSAEK tissue preparation of 22 donor corneas unsuitable for transplantation. The first cut was performed with an Intralase® FS60 laser and the second cut with a Moria CBm 300-µm microkeratome. The thickness of the first cut was modified for each cornea to obtain a final graft thickness of less than 110 µm. Precut and postcut central pachymetry were performed with an ultrasonic pachymeter. Central endothelial cell density (ECD) was calculated before and 24 hours after tissue preparation. 
Results: Final graft thickness was 105.0 ± 26.1 (SD) µm (range 65-117). The mean microkeratome head cut thickness was 324.5 ± 10.9 µm (range 310-345). Precut and postcut ECDs averaged 2250 ± 222 and 2093 ± 286 cells/mm2, respectively, representing 6.9% of cell loss. No corneas were perforated.
Conclusion: Femtosecond FS60 lasers and Moria CBm 300-µm microkeratomes can be used sequentially to prepare consistently thin DSAEK grafts with no irregular cuts or cornea perforations

Femtosecond laser and microkeratome-assisted Descemet stripping endothelial keratoplasty: first clinical results

Purpose: To evaluate the use of a femtosecond laser combined with a microkeratome in the preparation of posterior corneal disks for Descemet stripping automated endothelial keratoplasty (DSAEK).
Methods: This experimental study involved ultrathin DSAEK tissue preparation of 22 donor corneas unsuitable for transplantation. The first cut was performed with an Intralase® FS60 laser and the second cut with a Moria CBm 300-µm microkeratome. The thickness of the first cut was modified for each cornea to obtain a final graft thickness of less than 110 µm. Precut and postcut central pachymetry were performed with an ultrasonic pachymeter. Central endothelial cell density (ECD) was calculated before and 24 hours after tissue preparation. 
Results: Final graft thickness was 105.0 ± 26.1 (SD) µm (range 65-117). The mean microkeratome head cut thickness was 324.5 ± 10.9 µm (range 310-345). Precut and postcut ECDs averaged 2250 ± 222 and 2093 ± 286 cells/mm2, respectively, representing 6.9% of cell loss. No corneas were perforated.
Conclusion: Femtosecond FS60 lasers and Moria CBm 300-µm microkeratomes can be used sequentially to prepare consistently thin DSAEK grafts with no irregular cuts or cornea perforations

Needs assessment for implementation of a parenthood transition program

Este artigo descreve uma avaliação de necessidades para um programa de transição para a parentalidade, feita em dois estudos. Participaram do primeiro estudo treze casais, cujo bebê contava entre 18 a 36 meses. Entrevistas revelaram como estressores os cuidados com o bebê, as mudanças nos papéis familiares e a intrusividade da rede de apoio. Um segundo estudo investigou, através de entrevistas, o conhecimento de oito casais, com filhos recém-nascidos, sobre as suas experiências pessoais de apego e práticas educativas parentais, capacidades sensoriais do bebê, estressores e enfrentamento usado. Os resultados apontaram a exposição a práticas educativas parentais coercitivas e apego inseguro como fatores de risco para a relação pais-bebê. São discutidas as implicações para o planejamento de programas preventivos.This paper describes a needs assessment for the implementation of a parenthood transition program. Two studies were realized using interviews. Thirteen couples, with babies of 18 to 36 months, participated in the first study. This study revealed the following stressors: taking care of the baby, changes in family roles and intrusiveness of the social support group. In the second study eight couples with a newborn baby participated. In this study diverse topics were addressed: personal attachment experiences, parental educational practices, sensorial capacities of the baby, stressors and coping methods used. The results indicated coercive educational practices and insecure attachment as risk factors in the relation between parents and baby. The implications for the planning of preventive programs are discussed

Quantitative evaluation of visual function 12 months after bilateral implantation of a diffractive trifocal IOL

PURPOSE: To quantitatively evaluate visual function 12 months after bilateral implantation of the Physiol FineVision® trifocal intraocular lens (IOL) and to compare these results with those obtained in the first postoperative month. METHODS: In this prospective case series, 20 eyes of 10 consecutive patients were included. Monocular and binocular, uncorrected and corrected visual acuities (distance, near, and intermediate) were measured. Metrovision® was used to test contrast sensitivity under static and dynamic conditions, both in photopic and low-mesopic settings. The same software was used for pupillometry and glare evaluation. Motion, achromatic, and chromatic contrast discrimination were tested using 2 innovative psychophysical tests. A complete ophthalmologic examination was performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Psychophysical tests were performed 1 month after surgery and repeated 12 months postoperatively. RESULTS: Final distance uncorrected visual acuity (VA) was 0.00 ± 0.08 and distance corrected VA was 0.00 ± 0.05 logMAR. Distance corrected near VA was 0.00 ± 0.09 and distance corrected intermediate VA was 0.00 ± 0.06 logMAR. Glare testing, pupillometry, contrast sensitivity, motion, and chromatic and achromatic contrast discrimination did not differ significantly between the first and last visit (p>0.05) or when compared to an age-matched control group (p>0.05). CONCLUSIONS: The Physiol FineVision® trifocal IOL provided satisfactory full range of vision and quality of vision parameters 12 months after surgery. Visual acuity and psychophysical tests did not vary significantly between the first and last visit

Intravitreal ranibizumab for myopic choroidal neovascularization: 12-month results

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of intravitreal ranibizumab after 12 months in the treatment of choroidal neovascularization secondary to pathologic myopia. METHODS: This was a prospective, multicenter, consecutive, nonrandomized, interventional case series. The study included 34 eyes of 32 patients with choroidal neovascularization secondary to pathologic myopia; 13 eyes had previous photodynamic therapy, and 21 eyes had no previous treatment. The patients were followed for > or = 12 months. Best-corrected visual acuity, optical coherence tomography, and the presence of metamorphopsia were assessed monthly. RESULTS: Mean visual acuity improved 8 letters from baseline to 12-month follow-up, and the difference was statistically significant (P or = 3 lines, 44% improved > or = 2 lines, 65% improved > or = 1 line, and 79% improved > or = 0 lines. Central retinal thickness decreased significantly from baseline to the 12-month follow-up (P < 0.01). A mean of 3.6 treatments were performed during the 12-month follow-up, and no systemic or ocular side effects were registered during that time. CONCLUSION: One-year results of intravitreal ranibizumab for myopic choroidal neovascularization are very promising. Additional prospective studies are necessary to better determine long-term efficacy and safety

Surgical Management of Bilateral Limbal Stem Cell Deficiency

At the age of 43 years-old, a man was left with bilateral limbal stem cell deficiency after an ocular alkaline burn with lime, which resulted in corneal opacification. After multiple unsuccessful surgical attempts to restore vision, including penetrating keratoplasties and Boston keratoprosthesis, visual acuity was counting fingers in the left eye. At 73 years of age, the patient underwent another surgery in his left eye. Cauterization of neovessels and removal of the vascular pannus were followed by partial excision of Tenon’s capsule. Penetrating keratoplasty was followed by an intrastromal injection of anti-VEGF (vascular endothelial growth factor), and the ocular surface was covered with amniotic membrane. Postoperatively, the graft was clear with no signs of inflammation; vision improved to 20/50 and remained stable throughout the following two years. Herein we describe some adjunctive procedures that might have delayed failure and rejection of the corneal graft. This case demonstrates the difficulties in treating bilateral limbal stem cell deficiency in a tertiary eye care center with no capacity to perform stem cell therapy

Os problemas de gestão das pequenas cooperativas: caso prático cooperativa vivans

The management of an organization is a challenge today. In this context the small co-ops are facing difficulties, especially in matters related to decision-making, participation of cooperative members and transparency. The general objective of this research was to analyze the panorama of small cooperative organizations in order to identify their main challenges. The adopted methodology was the application of questionnaires to the directors of the cooperative VIVANS. This questionnaire was structured based on the cooperatives management development programm (PDGC). Through this method it was possible to learn more about organization’s operation and to identify its main gaps. The results obtained in the research highlight importance of participation in the cooperative management process. Administrative issues have been identified, of supervision and standardization of practices and processes that can hamper the achievement of institutional goals. These problems can be minimized through a more participatory and democratic management.A gestão de uma organização se constitui como um desafio da atualidade. Nesse contexto as pequenas cooperativas vêm enfrentando dificuldades, principalmente nos assuntos relacionados às tomadas de decisão, participação dos cooperados e transparência. O objetivo geral dessa pesquisa foi analisar o panorama das pequenas organizações cooperativas a fim de identificar seus principais desafios. A metodologia adotada foi a aplicação de questionários aos diretores da cooperativa VIVANS. Esse questionário foi estruturado através uma adaptação feita com base no Programa de Desenvolvimento da Gestão das Cooperativas (PDGC). Através dessa metodologia foi possível conhecer melhor o funcionamento da organização e identificar seus principais gargalos. Os resultados obtidos na pesquisa evidenciam importância da participação no processo de gestão das cooperativas. Foram identificados problemas administrativos, de fiscalização e padronização das práticas e dos processos, que podem dificultar o alcance dos objetivos institucionais. Esses problemas podem ser minimizados através de uma gestão mais participativa e democrática.

Evaluación de un programa psicoeducativo de transición para la parentalidad

Este estudo teve por objetivo avaliar um programa longitudinal de apoio à transição para a parentalidade por meio da avaliação de necessidades e de processo. Um casal participou de uma intervenção longitudinal, com nove visitas domiciliares, focadas no desenvolvimento de habilidades parentais e empoderamento da dupla. As interações pais-bebê e reações do casal à intervenção foram gravadas em vídeo e posteriormente registradas no Protocolo de Avaliação de Processo. A análise dos dados evidencia que o casal sentiu-se satisfeito com o programa e fez uso das informações e estratégias recebidas, com impacto positivo nas dimensões da conjugalidade, com melhor comunicação e solução de problemas interpessoais e da parentalidade, com a construção de conhecimentos sobre o desenvolvimento do bebê, mudanças em crenças sobre práticas educativas parentais violentas, responsividade na relação com o bebê e menor estresse parental. São recomendadas replicações deste estudo em amostras maiores e avaliação de follow-up.This paper describes a needs assessment and a process evaluation of a longitudinal support program to first-time parents. A couple participated in a longitudinal intervention, with nine home visits, focused on the development of parental skills and couple empowerment. The baby-parents interaction and the couple's reactions to the intervention were video recorded and afterwards registered into the Process Evaluation Protocol. Data analysis showed that the couple felt satisfied with the program and used the information and strategies received, with a positive impact on the dimensions of conjugality, better communication and interpersonal problem solving and parenthood, development of knowledge on the infant's development, change in beliefs related to violent parental educational practices and responsiveness in the relationship between the baby and the parents, besides lower parental stress. Replications of this study in bigger samples with follow-up evaluations are recommended.La finalidad de este artículo fue evaluar un programa longitudinal de apoyo a la transición hacia la parentalidad mediante la evaluación de necesidades y proceso. Una pareja participó en una intervención longitudinal que constituye una serie de nueve visitas domiciliares, focalizadas en el desarrollo de habilidades parentales y empoderamiento de la pareja. Las interacciones padres-bebé y las reacciones de la pareja a la intervención fueron grabadas en video y posteriormente registradas en el protocolo de evaluación de proceso. El análisis de los datos demostró satisfacción de la pareja con el programa y la utilización de las informaciones y estrategias recibidas, con impacto positivo en las dimensiones de la conyugalidad, con mejor comunicación y solución de problemas interpersonales; y de la parentalidad, con la construcción de conocimientos sobre el desarrollo del bebé, cambios en creencias sobre las prácticas educativas parentales violentas, sensibilidad en la relación con el bebé y menor estrese parental. Se recomienda que el estudio sea reaplicado en muestras con más participantes y con evaluaciones de seguimiento

Tabebuia avellanedae naphthoquinones: activity against methicillin-resistant staphylococcal strains, cytotoxic activity and in vivo dermal irritability analysis

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococcus infections are a worldwide concern. Currently, these isolates have also shown resistance to vancomycin, the last therapy used in these cases. It has been observed that quinones and other related compounds exhibit antibacterial activity. This study evaluated the antibacterial activity, toxicity and in vivo dermal irritability of lapachol extracted from Tabebuia avellanedae and derivatives against methicillin-resistant staphylococcal isolates. In addition, its mechanism of action was also analyzed. METHODS: The compounds β-lapachone, 3-hydroxy β N lapachone and α-lapachone were tested to determine the MIC values against methicillin-resistant S. aureus, S. epidermidis and S. haemolyticus strains, being the two last ones hetero-resistant to vancomycin. Experiments of protein synthesis analysis to investigate the naphthoquinones action were assessed. In vitro toxicity to eukaryotic BSC-40 African Green Monkey Kidney cell cultures and in vivo primary dermal irritability in healthy rabbits were also performed. RESULTS: The compounds tested showed antibacterial activity (MICs of 8, 4/8 and 64/128 μg/mL to β-lapachone, 3-hydroxy β N lapachone and α-lapachone, respectively), but no bactericidal activity was observed (MBC > 512 μg/mL for all compounds). Although it has been observed toxic effect in eukaryotic cells, the compounds were shown to be atoxic when applied as topic preparations in healthy rabbits. No inhibition of proteins synthesis was observed. CONCLUSION: Our results suggest that quinones could be used in topic preparations against wound infections caused by staphylococci, after major investigation of the pharmacological properties of the compounds. Studies about the use of these compounds on tumoral cells could be carried on, due to their effect in eukaryotic cells metabolism