Optical and ultrasound biometry: comparision between the two methods used for the calculation of accommodative intraocular lens

PURPOSE: To compare reproducibility, level of agreement and correlation of two ultrasonic biometers and one optical biometer for the calculation of accommodative intraocular lens. METHODS: Cataract patients were submitted to the examination with 3 different biometers (IOLMaster, Axis II and Humphrey Mod. 820) before the implant of the C&C Vision AT-45 accommodative silicone intraocular lens. The Axis II biometer was used for both contact and immersion biometry. Axial length, anterior chamber depth and keratometry were the analyzed biometric parameters. RESULTS: Thirty-four patients from 53 to 90 years old (mean 70.6 y) were submitted to the examination with the three different biometers. The lowest mean axial length (23.12 mm) was obtained with the Axis II/contact and the highest (23.21 mm) with the Humphrey biometer. The lowest mean anterior chamber depth (2.97mm) was obtained with the Humphrey and the highest (3.10mm) with the IOLMaster. Reproducibility for axial length was high for all the biometers tested (coefficient of variation: 3.02% for Humphrey and Axis II / immersion; 3.07 % for Axis II/contact and 3.19% for IOLMaster). All biometers presented nearly equal results of the analyzed parameters (99.01% for axial length and 94.77% for anterior chamber depth). Pearson's coefficient showed a high correlation between the biometers, regarding the axial length and anterior chamber depth measurements. CONCLUSION: The devices used in this study showed excellent reproducibility and high level of agreement and of the axial length, anterior chamber depth and keratometry measurements, making it possible to reduce errors of intraocular lens calculation and visual insatisfaction after cataract surgery.OBJETIVO: Comparar a precisão e reprodutibilidade de dois biômetros ultra-sônicos convencionais e um biômetro óptico para o cálculo da lente intra-ocular (LIO) acomodativa. MÉTODOS: Pacientes com catarata foram submetidos aos exames em 3 biômetros distintos (IOLMaster®, Axis II® e Humphrey Mod. 820®), antes da cirurgia para implantação da lente intra-ocular acomodativa de silicone (C&C Vision AT-45). No biômetro Humphrey Mod. 820 utilizou-se a técnica de contato e o Axis II foi usado para as técnicas de contato e imersão. O método de interferometria óptica foi realizado pelo IOLMaster. O comprimento axial (AL), profundidade da câmara anterior (ACD) e a ceratometria corneana (K) foram os parâmetros oculares analisados. RESULTADOS: Foram submetidos aos exames 34 pacientes com média de idade de 70,6 anos e idade variando entre 53 e 90 anos. A menor média do comprimento axial (23,12 mm), foi obtida no Axis II (contato) e maior (23,21 mm) no Humphrey Mod. 820 (contato). A maior média da profundidade da câmara anterior (3,10 mm) no IOLMaster e a menor (2,97 mm) no Humphrey Mod. 820 (contato). A reprodutibilidade para os dados de comprimento axial foi significativamente grande para todos os biômetros [3,02%, 3,07 % e 3,19% respectivamente para Humphrey Mod. 820 e Axis II (imersão), Axis II (contato) e IOLMaster]. Os biômetros foram extremamente concordantes nas medidas dos parâmetros analisados (99,01% e 94,77% respectivamente para o comprimento axial e ceratometria corneana). Os coeficientes de Pearson (r) demonstraram alta correlação entre os aparelhos nas medidas do comprimento axial e profundidade da câmara anterior. CONCLUSÃO: Os métodos do estudo para o cálculo da lente intra-ocular acomodativa, demonstraram que houve precisão e reprodutibilidade dos resultados, podendo evitar insatisfação visual do paciente no pós-operatório da cirurgia de catarata decorrente de erros no cálculo da lente intra-ocular.Universidade Federal de São Paulo (UNIFESP) Departamento de Oftalmologia Setor de Pesquisa ClínicaUniversidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUNIFESP, Depto. de Oftalmologia Setor de Pesquisa ClínicaUNIFESP, Depto. de OftalmologiaSciEL

The process of consent in clinical trials: from elaboration to accomplishment

The consent form is a document recommended for international declarations, resolutions and specific laws currently used in research on health. The practice or the accomplishment of the informed consent in the exercise of the medicine and the research in human beings is pertains to the last decades and characterizes the perfectioning of biomedical ethics, constitutes a legal and ethical requirement in clinical research involving human beings. The main challenge of the consent process is to guarantee the adequate understanding of the individual, however the social, cultural and intellectual aspects as well as the relationship between physician and patient, sometimes, can affect this process. The purpose of this paper is to present important criteria in the consent process that need to be highlighted in accordance with specific tenets and resolutions, such as Resolution 196/96 of the National Council of Health.O termo de consentimento é um documento recomendado por declarações internacionais, códigos de ética, resoluções e leis específicas para ser utilizado no cotidiano de pesquisas em saúde. A prática ou a obtenção do consentimento informado no exercício da medicina e da pesquisa em seres humanos é própria das últimas décadas e caracteriza o aperfeiçoamento da ética biomédica, constitui um requerimento legal e ético na pesquisa clínica envolvendo seres humanos. O principal desafio do processo de consentimento é garantir a compreensão adequada do indivíduo, entretanto os aspectos sociais, culturais e intelectuais dos indivíduos, ou mesmo a relação existente entre médico e paciente, às vezes, podem comprometer esse processo. O objetivo desse trabalho é apresentar critérios importantes no processo de consentimento que merecem ser destacados e abordados de acordo com normas e resoluções específicas.Universidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUNIFESP, Depto. de OftalmologiaSciEL

Intravitreal Clindamycin and Dexamethasone for Zone 1 Toxoplasmic Retinochoroiditis at Twenty-four Months

Purpose: To report the anatomic and functional outcomes of intravitreal clindamycin and dexamethasone for the treatment of zone 1 toxoplasmic retinochoroiditis (TRC). Patients had 1 or more of the following indications for local therapy: intolerance to oral medication, contraindication to oral medication because of pregnancy, lack of response despite oral antimicrobial treatment, or treatment with concomitant oral and local therapy to avoid or limit foveal or optic disc involvement.Design: Noncomparative, retrospective, multicentric interventional case series.Participants: We reviewed the medical records of 12 consecutive patients (eyes) with posterior pole (zone 1) TRC who were treated weekly or every 4 weeks (during pregnancy) with intravitreal injections of clindamycin (1.5 mg/0.1 ml) and dexamethasone (400 mu g/0.1 ml).Methods: Ophthalmic evaluation included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA); assessment of central macular thickness (CMT); resolution of inflammation by optical coherence tomography (OCT), clinical examination, and fluorescein angiography; and assessment of adverse events. Patients were followed for 24 months.Main Outcome Measures: Resolution of TRC, changes in BCVA, and OCT.Results: Resolution of TRC was achieved in all cases with a mean number of injections of 3.6 (range: 2-5 injections) with a mean interval of 15.5+/-4 days. At 24 months a significant reduction in CMT by OCT was observed, from 387.6+/-70.1 mu m to 185.2+/-44.7 mu m (P = 0.0004). Baseline BCVA was logarithm of the minimal angle of resolution (logMAR) 1+/-0.4 (20/200), which improved to 0.5+/-0.4 (20/63) (P = 0.002) at the end of follow-up. Ten eyes (83.3%) improved >= 2 ETDRS lines of BCVA, and 2 eyes (20%) remained stable at 24 months. One patient's vision was limited because of macular scarring. No ocular or systemic adverse events were observed. No recurrences at 24 months of follow-up were observed.Conclusions: the combination of intravitreal clindamycin and dexamethasone was associated with resolution of zone 1 TRC and functional and anatomic improvement in patients who did not tolerate, had contraindications to, or did not respond to oral medications.Arevalo-Coutinho Foundation for Research in Ophthalmology, Caracas, VenezuelaClin Oftalmol Ctr Caracas, Retina & Vitreous Serv, Caracas 1010, VenezuelaUniv Valencia, La Fe Hosp, Valencia, SpainUniversidade Federal de São Paulo, Vis Inst, São Paulo, BrazilUniversidade Federal de São Paulo, Vis Inst, São Paulo, BrazilWeb of Scienc

Fundus Autofluorescence and Spectral Domain Optical Coherence Tomography in Recurrent Serpiginous Choroiditis: Case Report

Purpose: To report fundus autofluorescence (FA) and spectral domain optical coherence tomography (SDOCT) findings in serpiginous choroiditis.Design: Case report.Methods: SDOCT and FA imaging of a 37-year-old woman with bilateral recurrent serpiginous choroiditis.Results: Active new lesions disclosed hyperautofluorescence, in contrast to hypoautofluorescent scarred lesions. SDOCT showed increased reflectance of the choroid and deeper retinal layers, along with disruption of the photoreceptor inner and outer segment junction in both active and inactive lesions.Conclusion: Autofluorescence imaging and SDOCT are useful noninvasive methods for the evaluation of serpiginous choroiditis. Autofluorescence imaging allows identification of recurrences and retinal pigment epithelium involvement in the follow-up of this disease.Universidade Federal de São Paulo, Dept Ophthalmol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, BR-04023062 São Paulo, BrazilWeb of Scienc

Uveitis in juvenile idiopathic arthritis

Objective: to evaluate the frequency of chronic anterior uveitis in patients with juvenile idiopathic arthritis and its association with the presence of antinuclear antibodies. Patients and methods: we retrospectively studied 72 patients with juvenile idiopathic arthritis. All of them were submitted to slit-lamp examination of the anterior chamber at diagnosis. Both antinuclear antibodies and rheumatoid factor were determined. Patients with positive results for antinuclear antibodies were evaluated every three months and those with negative results were assessed every six months.Results: forty patients were male (55.5%) and 36 were Caucasoid (50%). The mean age at the onset of juvenile idiopathic arthritis was 6.4 years (range = 1 to 14 years) and the mean age at the beginning of the study was 10.4 years (1 to 19 years). According to the type of disease at onset, 32 were pauciarticular (44.4%) (17 boys and 15 girls), 30 were polyarticular (41.6%) (17 boys and 13 girls) and 10 were systemic (14%) (6 boys and 4 girls). We observed chronic anterior uveitis in five patients (6.5%) (mean age = 11.4 years). Among them, four (80%) had pauciarticular juvenile idiopathic arthritis at disease onset (three girls with type I juvenile idiopathic arthritis and positive antinuclear antibodies and one boy with type I juvenile idiopathic arthritis and negative antinuclear antibodies) and one girl with polyarticular juvenile idiopathic arthritis (negative antinuclear antibodies and rheumatoid factor). In this group, the mean age at the onset of juvenile idiopathic arthritis was 5.1 years and the mean age of uveitis onset was 9 years. Antinuclear antibodies were positive in 3/5 patients (60%) with uveitis. Antinuclear antibodies were positive in 12% of the patients without uveitis (n = 67). Among the patients with uveitis, three had only one flare and the other two had four flares with cataract. The frequency of antinuclear antibodies was statistically higher in the patients with uveitis (P< 0.05).Conclusion: although the incidence of uveitis in our study was lower than that reported in the literature, the frequency of uveitis was higher in females, in those with pauciarticular juvenile idiopathic arthritis and in patients with positive antinuclear antibodies.Objetivo: avaliar a freqüência de uveíte anterior crônica em pacientes com artrite idiopática juvenil (AIJ) e sua associação com a presença do fator antinúcleo (FAN). Casuística e métodos: foram avaliadas, retrospectivamente, 72 crianças com diagnóstico confirmado de AIJ, que tiveram avaliação oftalmológica através da biomicroscopia para exame da câmara anterior da úvea, determinação do FAN (imunofluorescência indireta) e fator reumatóide (FR) (prova do látex) no período inicial da doença. Para os pacientes com FAN positivo, esta avaliação foi realizada a cada três meses, e, caso contrário, a cada seis meses.Resultados: dos 72 pacientes com AIJ, 40 (55,5%) crianças eram do sexo masculino e 36 (50%) caucasóides. A idade média de início da AIJ foi 6,4 anos (1 a 14 anos), e a idade média na época do estudo foi de 10,4 anos (1 a 19 anos). De acordo com o tipo de início da AIJ, em 32 (44,4%) crianças era pauciarticular (17 meninos e 15 meninas), em 30 (41,6%) era poliarticular (17 meninos e 13 meninas), e em 10 (14%) era sistêmico (6 meninos e 4 meninas). A presença de uveíte anterior crônica foi detectada em cinco (6,5%) crianças com idade média de 11,4 anos. Destas, quatro (80%) eram do tipo de início pauciarticular (três meninas do tipo I, com FAN positivo, e um menino do tipo I, FAN negativo), e uma menina com doença poliarticular (FAN e FR negativos). Neste grupo, a idade de início da AIJ foi em média 5,1 anos (3 a 12 anos), e a idade de início da uveíte foi em média de 9 anos (4 a 16 anos). O FAN foi positivo em 3/5 pacientes (60%) com uveíte. Dentre os pacientes com AIJ e sem uveíte (67 crianças), oito (12%) apresentaram FAN positivo. Quanto à evolução dos pacientes com comprometimento ocular, três crianças tiveram apenas um episódio de uveíte, e duas crianças apresentaram quatro recorrências da uveíte com catarata sem atividade articular associada. A presença do FAN foi estatisticamente mais freqüente na população de pacientes com AIJ associada com uveíte (60%) do que naqueles sem uveíte (12%) (p<0,05).Conclusão: concluímos que, apesar do pequeno número de pacientes com AIJ e uveíte anterior crônica encontrados (6,5%), a freqüência foi maior no sexo feminino e na doença de início pauciarticular, com presença do FAN na maioria dos casos

Patients with diffuse uveitis and inactive toxoplasmic retinitis lesions test PCR positive for Toxoplasma gondii in their vitreous and blood

Background/aims To determine if patients with inactive chorioretinitis lesions who experience chronic toxoplasmic uveitis test PCR positive for Toxoplasma in their ocular fluids.Methods Two patients undergoing long-term anti-toxoplasmic treatment developed chronic uveitis and vitritis. They underwent therapeutic and diagnostic pars plana vitrectomy. Patient specimens were tested for toxoplasmosis by real-time PCR and nested PCR. Patient specimens were also tested for the presence of Toxoplasma antibodies that recognise allelic peptide motifs to determine parasite serotype.Results Patients tested positive for Toxoplasma by real-time PCR at the B1 gene in the vitreous and aqueous humours of patient 1, but only the vitreous of patient 2. Patients were not parasitemic by real-time PCR in plasma and blood. During surgery, only old hyperpigmented toxoplasmic scars were observed; there was no sign of active retinitis. Multilocus PCR-DNA sequence genotyping at B1, NTS2 and SAG1 loci established that two different non-archetypal Toxoplasma strains had infected patients 1 and 2. A peptide-based serotyping ELISA confirmed the molecular findings.Conclusions No active lesions were observed, but both patients possessed sufficient parasite DNA in their vitreous to permit genotyping. Several hypotheses to explain the persistence of the vitritis and anterior uveitis in the absence of active retinitis are discussed.National Institute of Allergy and Infectious Diseases, National Institutes of HealthConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Ophthalmol, BR-04023062 São Paulo, BrazilNIAID, Parasit Dis Lab, Bethesda, MD 20892 USAHosp Albert Einstein, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, BR-04023062 São Paulo, BrazilCNPq: 237252/2012Web of Scienc

Auswirkungen einer spezifischen Endothelin- A -Rezeptorblockade auf die okuläre Hämodynamik am Gesunden

PURPOSE: To describe 3 cases of children submitted to posterior subtenon steroid injection (PSSI) of triamcinolone acetonide (Kenalog® 40mg) for the treatment of intermediate uveitis, with development of refractory glaucoma. METHODS: Case report. RESULTS: Three children with the diagnosis of intermediate uveitis were treated with PSSI of triamcinolone for the control of a chronic vitreous inflammation and/or cystoid macular edema. After treatment they developed refractory glaucoma and were submitted to surgery, for removal of the steroid deposit and/or filtering surgery to control the intraocular pressure (IOP). CONCLUSION: The use of PSSI can represent a high risk for development of secondary glaucoma, with difficult control in children. Surgery to remove the remaining steroid may control IOP, but in some cases filtering surgery may be necessary.OBJETIVO: Descrever 3 casos de crianças submetidas à injeção subtenoniana posterior de acetato de triancinolona (Kenalog® 40mg) para tratamento de uveíte intermediária, com desenvolvimento de glaucoma secundário refratário. MÉTODOS: Relato de caso. RESULTADOS: Três crianças com diagnóstico de uveíte intermediária, submetidas à injeção subtenoniana posterior de acetato de triancinolona para tratamento de inflamação vítrea crônica e/ou edema macular cistóide, desenvolveram glaucoma refratário e foram submetidos à excisão cirúrgica do corticóide de depósito e/ou cirurgia filtrante para controle da pressão intra-ocular (PIO). CONCLUSÃO: Corticóide de depósito periocular pode representar alto risco para desenvolvimento de glaucoma secundário, de difícil controle em crianças. Excisão cirúrgica do corticóide de depósito pode resultar em controle da PIO, porém, em alguns casos, a realização de cirurgia filtrante é necessária