Anestesia peribulbar versus anestesia geral na cirurgia de estrabismo horizontal

PURPOSE: To compare the results of strabismus surgery under peribulbar and general anesthesia in cases of small and moderate angle of horizontal strabismus. METHODS: Medical records of eighty-four patients with small and moderate angle horizontal strabismus who underwent strabismus surgery were reviewed. Forty-two patients were submitted to the surgery under peribulbar anesthesia and forty-two under general anesthesia. The surgery was considered satisfactory when postoperative angle was 10 prism diopters or less. RESULTS: Surgery was satisfactory in all patients. Mann-Whitney test showed no difference in the preoperative angle of deviation (p=0.366) and in the postoperative results (p=0.800) between the two groups. Adjusting for the variables age and type of strabismus (esotropia and exotropia), ANCOVA (analysis of covariance) results showed no statistical difference (p=0.368). There were no complications due to surgery or anesthesia in either group. CONCLUSIONS: This study suggested that there was no difference between the postoperative results of strabismus surgery under peribulbar and general anesthesia in small and moderate angle of horizontal strabismus.OBJETIVO: Comparar os resultados de cirurgias de estrabismo sob anestesia peribulbar e geral em casos de estrabismos horizontais de pequeno e médio ângulo. MÉTODOS: Foram avaliados os prontuários médicos de 84 pacientes com estrabismo horizontal de pequeno e médio ângulo submetidos à cirurgia de estrabismo. Quarenta e dois pacientes foram submetidos à cirurgia sob anestesia peribulbar e quarenta e dois sob anestesia geral. A cirurgia foi considerada satisfatória quando o desvio pós-operatório era de até 10 dioptrias prismáticas (DP). RESULTADOS: A cirurgia foi considerada satisfatória em todos os pacientes. O teste de Mann-Whitney não mostrou diferença no ângulo pré-operatório (p=0,366) nem nos resultados pós-operatórios (p=0,800) entre os dois grupos. Ajustando as variá veis idade e tipo de estrabismo (esotropia e exotropia), o teste ANCOVA (análise de covariância) não mostrou diferença significativa entre os grupos (p=0,368). Não houve complicações decorrentes da cirurgia ou técnica anestésica em nenhum dos grupos. CONCLUSÕES: Este estudo sugere que não há diferença nos resultados pós-operatórios da cirurgia de estrabismo entre anestesia peribulbar e geral em estrabismos horizontais de pequeno e médio ângulo.35235

Evaluation of conjunctival bacterial flora in patients with Stevens-Johnson Syndrome

OBJECTIVE: To determine the conjunctival bacterial flora present in patients with Stevens-Johnson syndrome. METHODS: A prospective study of the conjunctival bacterial flora was performed in 41 eyes of 22 patients with Stevens-Johnson syndrome. The information gathered included the patient's sex and age, the duration of disease, the cause of Stevens-Johnson syndrome, and treatments. Scrapings of the inferior conjunctival fornix were performed in both eyes. Fourteen days before scraping, the patients were asked to interrupt all topical medication and start using 0.5% nonpreserved methylcellulose. The microbiological evaluation included microorganism identification and determination of antibiotic sensitivity. RESULTS: Of 22 patients (41 eyes), 14 (64%) were females, and eight (36%) were males. The mean age was 33.2 years, and the mean duration of disease was 15.6 years. Visual acuity ranged from light perception to 20/25 (1.57 logMar). The treatment received by most patients consisted of tear substitutes, topical antibiotics, and contact lenses. Bacterial identification was positive in 39 eyes (95%) and negative in two eyes (5%). Gram-positive cocci accounted for 55.5% of the microorganisms, whereas gram-positive bacilli and gram-negative bacilli accounted for 19% and 25.5%, respectively. Half of the patients (54%) had multiple bacterial species in their flora, and only one bacterial species was identified in the other half. Resistant bacteria were isolated from four eyes. The antibiotic sensitivity results for the Streptococcus group showed the lowest sensitivity and the highest microbial resistance identified. CONCLUSION: Patients with Stevens-Johnson syndrome have a diverse conjunctival flora that includes many pathogenic species.Federal University of São Paulo Vision Institute Ophthalmology DepartmentUNIFESP, Vision Institute Ophthalmology DepartmentSciEL

Evaluation of conjunctival bacterial flora in patients with Stevens-Johnson Syndrome

OBJECTIVE: To determine the conjunctival bacterial flora present in patients with Stevens-Johnson syndrome. METHODS: A prospective study of the conjunctival bacterial flora was performed in 41 eyes of 22 patients with Stevens-Johnson syndrome. The information gathered included the patient's sex and age, the duration of disease, the cause of Stevens-Johnson syndrome, and treatments. Scrapings of the inferior conjunctival fornix were performed in both eyes. Fourteen days before scraping, the patients were asked to interrupt all topical medication and start using 0.5% nonpreserved methylcellulose. The microbiological evaluation included microorganism identification and determination of antibiotic sensitivity. RESULTS: Of 22 patients (41 eyes), 14 (64%) were females, and eight (36%) were males. The mean age was 33.2 years, and the mean duration of disease was 15.6 years. Visual acuity ranged from light perception to 20/25 (1.57 logMar). The treatment received by most patients consisted of tear substitutes, topical antibiotics, and contact lenses. Bacterial identification was positive in 39 eyes (95%) and negative in two eyes (5%). Gram-positive cocci accounted for 55.5% of the microorganisms, whereas gram-positive bacilli and gram-negative bacilli accounted for 19% and 25.5%, respectively. Half of the patients (54%) had multiple bacterial species in their flora, and only one bacterial species was identified in the other half. Resistant bacteria were isolated from four eyes. The antibiotic sensitivity results for the Streptococcus group showed the lowest sensitivity and the highest microbial resistance identified. CONCLUSION: Patients with Stevens-Johnson syndrome have a diverse conjunctival flora that includes many pathogenic species

Topical tacrolimus for the treatment of severe allergic keratoconjunctivitis in children

Purpose: Administration of eye drops containing antihistamines or sodium cromoglycate and its derivatives for the treatment of allergic keratoconjunctivitis is often insufficient and usually requires the addition of corticosteroids. However, the risk of complications, such as glaucoma and cataract, limits the use of corticosteroids to short courses, resulting in inadequate long-term treatment response. Immunosuppressive drugs have been considered as a valid alternative to steroids for atopic keratoconjunctivitis and vernal keratoconjunctivitis. This study aimed to evaluate the use of topical tacrolimus (TCL) in improving the clinical signs of severe allergic keratoconjuctivitis in children. Methods: Patients with severe allergic keratoconjunctivitis associated with corneal epitheliopathy, gelatinous limbal infiltrates, and/or papillary reaction, along with a history of recurrences and resistance to conventional topical anti-allergy agents, were included in this open clinical trial. Patients were treated with 0.03% TCL ointment for ocular use. A severity score ranging from 0 to 9, with 9 being the highest and 0 being the lowest, was assigned based on signs observed on biomicroscopy prior to and following TCL treatment. Results: Analyses included 66 eyes of 33 patients. After a mean follow-up period of 13 months (range, 12-29 months), TCL treatment significantly decreased the mean symptom score severity for the right (from 5.56 +/- 1.18 to 2.76 +/- 1.5p<0.001) and left (from 5.94 +/- 1.16 to 2.86 +/- 1.64p<0.001). Conclusion: Topical TCL was effective and significantly improved the clinical signs of allergic keratoconjuctivitis in children. Thus, it is a potential new option for severe and challenging cases of ocular allergy.Univ Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, SP, BrazilWeb of Scienc

Trans-ethnic study confirmed independent associations of HLA-A*02:06 and HLA-B*44:03 with cold medicine-related Stevens-Johnson syndrome with severe ocular surface complications

Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), are acute inflammatory vesiculobullous reactions of the skin and mucous membranes. Cold medicines including non-steroidal anti-inflammatory drugs and multi-ingredient cold medications are reported to be important inciting drugs. Recently, we reported that cold medicine related SJS/TEN (CM-SJS/TEN) with severe mucosal involvement including severe ocular surface complications (SOC) is associated with HLA-A*02:06 and HLA-B*44:03 in the Japanese. in this study, to determine whether HLA-B*44:03 is a common risk factor for CM-SJS/TEN with SOC in different ethnic groups we used samples from Indian, Brazilian, and Korean patients with CM-SJS/TEN with SOC, and investigated the association between CM-SJS/TEN with SOC and HLA-B*44:03 and/or HLA-A*02:06. We found that HLA-B*44:03 was significantly associated with CM-SJS/TEN with SOC in the Indian and Brazilian but not the Korean population, and that HLA-A*02:06 might be weakly associated in the Korean-but not the Indian and Brazilian population.Ministry of Education, Culture, Sports, Science and Technology of the Japanese governmentJapanese Ministry of Health, Labour and WelfareKyoto Foundation for the Promotion of Medical ScienceIntramural Research Fund of Kyoto Prefectural University of MedicinePromotion Project of Knowledge-Based Industrial Clustering of Okinawa PrefectureKyoto Prefectural Univ Med, Dept Ophthalmol, Kyoto, JapanDoshisha Univ, Fac Life & Med Sci, Res Ctr Inflammat & Regenerat, Kyoto 602, JapanLV Prasad Eye Inst, Prof Brien Holden Eye Res Ctr, Hyderabad, Andhra Pradesh, IndiaUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilSeoul Natl Univ, Coll Med, Dept Ophthalmol, Seoul, South KoreaChonnam Natl Univ, Dept Ophthalmol, Kwangju, South KoreaYonsei Univ, Coll Med, Severance Hosp, Inst Vis Res,Dept Ophthalmol, Seoul, South KoreaCatholic Univ Korea, Seoul St Marys Hosp, Coll Med, Dept Ophthalmol & Visual Sci, Seoul, South KoreaLV Prasad Eye Inst, Cornea & Anterior Segment Serv, Hyderabad, Andhra Pradesh, IndiaUniv Tokyo, Grad Sch Med, Dept Human Genet, Tokyo, JapanUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc