Combined vitreous and cataract surgeries in highly hyperopic eye

We report a case of a patient with a highly hyperopic eye who underwent cataract surgery combined with vitreous surgery to create a posterior vitreous detachment (PVD) to prevent choroidal neovascularization (CNV). A 78-year-old man noticed a decrease in his vision due to a cataract in his right eye. The patient had a severe visual loss in his left eye because of a CNV 2 years after a cataract surgery. His visual acuities were 20/30 OD and 20/600 OS, and funduscopic examination showed an orange-colored lesion OD and degenerative subretinal fibrosis OS. The posterior vitreous was attached to the retina in both eyes. The axial length was 18.9 mm OD and 19.0 mm OS. Cataract surgery combined with vitreous surgery to create PVD was performed on the right eye, and the vision improved to 20/20 with no signs of developing CNV after 5 years. We conclude that cataract surgery combined with vitreous surgery to create a PVD may prevent the development of CNV in highly hyperopic eyes

In vitro evaluation of composite resin fluorescence after natural aging

Some composite resins contain luminophorous agents in order to reproduce tooth fluorescence. The objective of this study was to compare the fluorescence spectra emitted by composite resins with those of human enamel and dentin, and their emission behaviour after a 90-day natural aging period. Nine shades of the composite resins Z350XT/3M (XT), Opallis/FGM (OP) and Empress Direct/Ivoclar-Vivadent (ED) were analyzed. Five specimens (10.0 mm x 2.0mm) were fabricated for each shade. Enamel (5.0 mm x 0.30 mm) and dentin (5.0 mm x 1.0 mm) specimens were obtained from sound human third molars. Fluorescence spectra of human dentin and enamel as well as the composite specimens immediately after fabrication were measured at the excitation peaks of 375, 395 and 410 nm. To assess composite resin fluorescence intensity changes over time, measurements were conducted after 30, 60 and 90 days, at 395 nm. Differences in fluorescence intensity over time were analyzed with ANOVA and Tukey?s test (p<0.05). Fluorescence spectra baseline values of composites demonstrated no differences in intensity among the excitation peaks tested, with maximum emission found at the peak of 450 nm. Enamel and dentin spectra varied with different excitations, and the greater the excitation, the longer the wavelength in comparison to composite resins. After 90 days, XT presented an increase in fluorescence intensity, while OP and ED showed a reduction when compared with baseline values. Fluorescence intensity of composite resins changed during the period analyzed, with an emission behavior different from that of human enamel and dentin. The main changes occurred in the first 30 days

Musculoskeletal injuries in young handball players: a cross-sectional study

O objetivo deste estudo foi descrever a população, as características do treinamento e o histórico de lesões musculoesqueléticas em atletas de handebol do gênero feminino e investigar possíveis associações entre as características de treinamento com lesões musculoesqueléticas relacionadas ao handebol. Participaram deste estudo transversal 220 atletas, que responderam a um questionário autorreportado que abordava dados pessoais, características do treinamento e lesões prévias relacionadas ao handebol nos últimos 12 meses. Os dados foram analisados por estatística descritiva e modelos de regressão logística. Os resultados demonstram que a maioria era constituída de atletas com idade aproximada de 15 anos, com índice de massa corpórea classificado como normal, que realizavam 3 treinos por semana, com carga horária semanal de aproximadamente 8 horas e 30 minutos. As principais lesões encontradas foram as entorses e as tendinopatias, sendo o tornozelo e o joelho as regiões mais acometidas. Somente a experiência no esporte acima de 6 anos mostrou relação estatística com lesões prévias (p=0,032). A prevalência de lesões nos últimos 12 meses nesta população foi de 53,60%.This study aimed to describe the population, training features and history of musculoskeletal injuries in young female handball players and to investigate possible associations between these features and previous musculoskeletal injuries related to handball. The subjects of this cross-sectional study were 220 athletes who completed a self-reported questionnaire about personal data, training features and previous injuries related to handball in the last 12 months. Data were analyzed using descriptive statistics and logistic regression models. The results showed that most of the athletes were approximately 15 years old, had a body mass index was classified as normal, worked out at an average of 3 times a week and their weekly workload was approximately 8 hours and 30 minutes. The main injuries found were sprains and tendinopathies, with the ankle and knee being the most affected regions. Only the sport practice of over 6 years showed statistical relationship with previous injuries (p=0.032). The prevalence of injuries in the last 12 months in this population was 53.60%.Este estudio tuvo los propósitos de describir la población, las características de entrenamiento y el historial de lesiones musculo esqueléticas en atletas de balonmano del género femenino y de investigar posibles asociaciones entre las características del entrenamiento a este tipo de lesiones relacionadas con la práctica del balonmano. Han participado de este estudio transversal 220 atletas, que contestaron a un cuestionario auto reportado que contenían datos personales, características del entrenamiento y lesiones previas relacionadas con la práctica del balonmano en los últimos 12 meses. Se han evaluados los datos por estadística descriptiva y modelos de regresión logística. Los resultados muestran que la mayoría se constituía por atletas de edad cercana a los 15 años, con índice de masa corporal clasificado como normal, que hacían entrenamiento 3 veces por semana, con carga horaria semanal de cerca de 8 horas y 30 minutos. Se han encontrado las principales lesiones: esguinces y tendinopatías, en que el tobillo y la rodilla eran los más afectados. Se ha mostrado relación estadística con lesiones previas (p=0,032) solamente la experiencia de más de 6 años en la práctica del deporte. El 53,60% fue la prevalencia de lesiones en los últimos 12 meses en la población investigada

Glomerulopatia por IgA com crescentes fibrocelulares e associada à psoríase

Alguns estudos têm demonstrado uma ligação entre glomerulonefrite por IgA e psoríase e/ou uso de drogas anti-TNF. Descrevemos o caso de um paciente com artrite psoriática, em uso de anti-TNF por quatro anos, que apresentou nefropatia por IgA agravada por crescentes na biópsia renal e insuficiência renal necessitando de hemodiálise. Após a realização de terapia com metilprednisolona IV e três meses de corticoide oral, houve melhora significativa na função renal e proteinúria. O tratamento de diálise foi interrompido e tratamentos com SGLT-2 inibidores foram iniciados

Ophthalmology

To characterize the genotypic and phenotypic spectrum of foveal hypoplasia (FH). Multicenter, observational study. A total of 907 patients with a confirmed molecular diagnosis of albinism, PAX6, SLC38A8, FRMD7, AHR, or achromatopsia from 12 centers in 9 countries (n = 523) or extracted from publicly available datasets from previously reported literature (n = 384). Individuals with a confirmed molecular diagnosis and availability of foveal OCT scans were identified from 12 centers or from the literature between January 2011 and March 2021. A genetic diagnosis was confirmed by sequence analysis. Grading of FH was derived from OCT scans. Grade of FH, presence or absence of photoreceptor specialization (PRS+ vs. PRS-), molecular diagnosis, and visual acuity (VA). The most common genetic etiology for typical FH in our cohort was albinism (67.5%), followed by PAX6 (21.8%), SLC38A8 (6.8%), and FRMD7 (3.5%) variants. AHR variants were rare (0.4%). Atypical FH was seen in 67.4% of achromatopsia cases. Atypical FH in achromatopsia had significantly worse VA than typical FH (P < 0.0001). There was a significant difference in the spectrum of FH grades based on the molecular diagnosis (chi-square = 60.4, P < 0.0001). All SLC38A8 cases were PRS- (P = 0.003), whereas all FRMD7 cases were PRS+ (P < 0.0001). Analysis of albinism subtypes revealed a significant difference in the grade of FH (chi-square = 31.4, P < 0.0001) and VA (P = 0.0003) between oculocutaneous albinism (OCA) compared with ocular albinism (OA) and Hermansky-Pudlak syndrome (HPS). Ocular albinism and HPS demonstrated higher grades of FH and worse VA than OCA. There was a significant difference (P < 0.0001) in VA between FRMD7 variants compared with other diagnoses associated with FH. We characterized the phenotypic and genotypic spectrum of FH. Atypical FH is associated with a worse prognosis than all other forms of FH. In typical FH, our data suggest that arrested retinal development occurs earlier in SLC38A8, OA, HPS, and AHR variants and later in FRMD7 variants. The defined time period of foveal developmental arrest for OCA and PAX6 variants seems to demonstrate more variability. Our findings provide mechanistic insight into disorders associated with FH and have significant prognostic and diagnostic value

Ophthalmologic and psychophysical evaluation of the visual system of individuals with albinism

O albinismo e uma alteracao genetica rara que compromete a producao de melanina. As alteracoes clinicas consistem na falta de pigmentacao da pele, cabelo e pelos. Apresenta alteracoes oftalmologicas importantes, que comprometem a acuidade visual de forma severa, na grande maioria dos casos. As alteracoes oftalmologicas sao, ametropias, nistagmo, rarefacao do epitelio pigmentado da iris e da retina, hipoplasia foveal e decussacao anomala do nervo optico. Este estudo foi dividido em tres diferentes partes com os seguintes objetivos principais: Parte 1: Analise comparativa entre o grau de transparencia da iris (GTI), o grau de transparencia da retina (GTR) e a espessura da regiao macular com a acuidade visual nos pacientes com albinismo. Parte 2: Teste de sensibilidade ao contraste espacial de luminancia e ofuscamento com lentes de contato filtrantes em ambientes claros e escuros. Parte 3: Avaliacao da visao de cores, utilizando\\se o teste de Pranchas de Ishihara e o Cambridge Color Test (CCT). Material\' e\' Métodos: Participaram do estudo 121 individuos albinos, com idade media de 31,18 (} 15,47) anos, o que totalizou 242 olhos. Os participantes foram divididos em diferentes grupos nas tres partes do estudo, alguns participaram de uma ou mais partes. Na primeira parte os participantes foram submetidos a consulta oftalmologica, classificacao do grau de transparencia da iris e da retina em uma nova classificacao baseada em quatro diferentes graus de transparencia, alem de avaliacao foveal pelo exame de Tomografia de Coerencia Optica (OCT). Na segunda parte, os participantes foram submetidos ao teste de contraste computadorizado, utilizando lentes de contato filtrante e transparentes, em ambientes claros e escuros. Nesta etapa foi avaliada a influencia da lente filtrante na sensibilidade de contraste visual dos individuos com albinismo. Na terceira parte, os participantes foram submetidos aos testes de Pranchas de Ishihara e de Cambridge Colour Test (CCT), para avaliacao da visao de cores nos pacientes albinos. Resultados: Os resultados foram os seguintes: Parte\'1: A correlacao entre AV logMAR e GTI foi positiva (+0,569) e significativa (p<0,001). A correlacao entre AV logMAR e GTR foi positiva (+0,531) e significativa (p<0,001). A correlacao entre AV logMAR e a espessura macular nao foi significativa (p=0,105). A correlacao entre GTI e GTR foi positiva (+ 0,627) e significativa (p<0,001). A correlacao entre espessura macular e GTI nao foi significativa (p=0,397). A correlacao entre espessura macular e GTR nao foi significativa (p=0,458). Parte 2: Houve melhora estatisticamente significante da sensibilidade ao contraste com as lentes filtrantes em relacao as lentes transparentes no ambiente de ofuscamento (claro), na frequencia de 0,3 cpg, 0,6 cpg e 1,0 cpg (ciclos por grau). Nao houve melhora significante nas frequencia 2,0 cpg e 4,0 cpg. Nao houve melhora estatisticamente significante da sensibilidade ao contraste de lentes filtrantes em relacao as lentes transparentes no ambiente escuro (penumbra) em nenhuma das frequencias espaciais estudadas. Parte\' 3: Todos os individuos com albinismo nao apresentaram nenhuma alteracao de visao de cores no teste de Pranchas de Ishihara. O CCT demonstrou piora no limiar de deteccao de cores significativa nos eixos protan (p=0,021) e deutan (p=0,017), mas nao houve diferenca no eixo tritan (p=0,212). Os testes estatisticos sugerem que uma amostra maior seja estudada para validacao dos resultadosAlbinism is a rare genetic alteration that compromises the production of melanine in all body tissues. The clinical alterations are the lack of pigment in the skin and hair. It presents important ophthalmological changes that compromise the visual acuity, in most cases. The ophthalmological changes are: ametropia, nystagmus, iris pigmented epithelium rarefaction, retina pigmented epithelium rarefaction, foveal hipoplasia and abnormal optic nerve decussation. This study has been divided in three different parts and had the following main objectives: Part 1, comparative analysis of the iris transparency degree (ITD), the retina transparency degree (RTD) and macular thickness with the visual acuity in albino patients. Part 2: Spatial contrast sensitivity test of luminance and outshine wearing contact lenses with filters in light and dark environments. Part 3: color vision evaluation using the Ishihara Test and the Cambridge Color Test (CCT). For the study 121 individuals with albinism were included with an average of 31,18 years old } 15,47, a total of 242 eyes. The participants were divided in different groups in the three parts of the study, some participated in one or more parts. In the first part the participants have been through an ophthalmological exam, classification of the iris transparency degree (ITD) and the retinal transparency degree (RTD) by a new classification based in 4 different degrees of transparency. Foveal evaluation by the Optic Coherence Tomography exam (OCT) was made in the first part of this study. In the second part, the participants have been submitted to the computerized contrast test, using filtered and transparent contact lenses in light and dark environments. In this part the influence of the filtering lenses in the visual contrast sensitivity in the albinism patients has been evaluated. In the third part, the participants have been submitted to Ishihara Test and Cambridge Color Test in order to evaluate the color vision in albino patients. The results are as follows: Part\' 1: the correlation between visual acuity in Logarithm of the Minimum Angle of Resolution (logMAR) and ITD was positive (+0,569) and significant (p<0,001). The correlation between visual acuity in logMAR and RTD was positive (+0,531) and significant (p<0,001). The correlation between visual acuity in logMAR and the macular thickness was not significant (p=0,105). The correlation between ITD and RTD was positive (+ 0,627) and significant (p<0,001). The correlation between the macular thickness and the ITD was not significant (p=0,397). The correlation between the macular thickness and the RTD was not significant (p=0,458). Part\'2: There has been a statistically significant improvement of the contrast sensitivity wearing the filtering lenses in relation to the transparent ones in bright environment, in the frequencies of 0,3 cycles per degree (cpd), 0,6 cpd and 1,0 cpd. There has been no significant improvement in the frequencies 2,0 cpd and 4,0 cpd. There has been no statistically significant improvement in contrast sensitivity wearing the filtering lenses in relation to the transparent one in the dark environment (shadow) in any of the spatial frequencies studied. Part\' 3: all albinism patients did not present any color vision change in the Ishihara Test. The CCT has shown a worsening in the color detection threshold in the protan axis (p=0,021) and deutan axis (p=0,017), but there has been no difference in the tritan axis (p=0,212). The statistic tests show that a bigger sample is recommended to confirm part 3 result

Análise das córneas do Banco de Olhos da Santa Casa de São Paulo utilizadas em transplantes Analysis of the transplanted corneas at Santa Casa de São Paulo Eye Bank

Objetivo: Traçar o perfil do doador de olhos e avaliar os fatores que influenciam na qualidade das córneas captadas pelo Banco de Olhos da Santa Casa de Misericórdia de São Paulo (SCMSP), no período de junho de 2000 a janeiro de 2004. Métodos: Foram estudados os dados dos prontuários de 151 pacientes submetidos a transplante penetrante de córnea, cadastrados no Banco de Olhos da SCMSP, no período entre junho de 2000 e janeiro de 2004, totalizando 180 operações. Resultados: A média da idade dos doadores foi de 55,57 ± 19,74 anos (variando de 9 meses a 97 anos de idade), sendo 54,44% dos pacientes do sexo masculino. As causas mortis predominantes foram as cardiovasculares, com 50,55%, seguidas das doenças consumptivas 17,77%, traumáticas 14,44% e outras, que somadas representam 17,22%. Em relação à qualidade da córnea, não houve diferença estatística significativa em relação aos quatro grupos causas mortis p=0,527), e o tempo decorrido entre o óbito e a preservação (p=0,053). Houve diferença estatisticamente significativa entre a qualidade das córneas de doadores da faixa etária acima de 61 anos de idade em relação às outras faixas etárias (p= 0,037). Conclusão: As causas mortis mais frequentes foram as cardiovasculares, seguidas das causas pulmonares, outras e traumáticas. Observamos também que entre os fatores inerentes ao doador, a faixa etária acima de 60 anos, predispôs à pior qualidade anatômica das córneas, e fatores como a causa mortis e o tempo decorrido entre o óbito e a preservação, não influenciaram na qualidade das mesmas.<br>Purpose: To identify the donors' profile and evaluate the factors influencing the quality of the donated corneas in Santa Casa Eye Bank, from July, 2000 to January, 2004. Methods: Data from the charts of 151 patients submitted to penetrating keratoplasty, registered in Santa Casa Eye Bank, from July, 2000 to January 2004 resulted in 180 surgeries. Results: Mean age of the donors was 57.57 ± 19.74 years old (varied from 9 months to 97 years old) and 54.44% were male. The cause of death was predominantly cardiovascular (50.55%), followed by consumptive diseases (17.77%), trauma (14.44%) and others (17.22%). Considering the quality of the cornea, there was no statistically significant difference among the three main groups of cause of death (p=0.527) and time from death to corneal preservation (p=0.053). There was a statistically significant difference between quality of donated corneas above 61 years old and other ages (p=0.037). Conclusion: The most frequent cause of death was cardiovascular, followed by pulmonary diseases and trauma. We could also note that factors inherent to donor like age (>60 years old) predisposed to a worse anatomical quality of the cornea and factors like cause of death and time between death and preservation did not influence the quality of the cornea