924 resultados para Corneal Perforation
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
A new surgical technique to treat corneal perforations using amniotic membrane and surgical adhesive
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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This case report presents an apical radicular perforation management using new calcium silicate-based cement (Biodentine) in a combined endodontic-periodontal lesion. The presence of apical radicular perforation may interfere in the endodontic treatment prognosis. Radicular perforation filling with bioactive cement through endodontic surgery is a possible treatment. This study presents an apical radicular perforation with periodontal involvement, due to alveolar bone loss on the buccal radicular surface from an incorrect intracanal preparation for the fiber post placing. The chosen alternative was a periapical surgery, the perforation was filled with a silicate and calcium chloride bioactive cement (Biodentine; Septodont, Saint-Maur-des-Fosses Cedex, France), and the radicular surface was etched with citric acid, because the access from root canal was impossible. The follow-up was for 8 months, through clinical and radiographic analysis. At the end of the follow-up, radiographic analyses showed the bone healing, and no clinical changes in periodontal probing depth, gingival recession, and the height of the interproximal mesial and distal papillae were observed. The root perforation treatment has a difficult management, especially when the dental root has a simultaneous periodontal commitment. The Biodentine proves to be a promising material for use in these situations.
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Pós-graduação em Cirurgia Veterinária - FCAV
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Hemangiosarcoma is a malignant neoplasm and its corneal presentation is uncommon in the dog. The present work reports a case of primary corneal hemangiosarcoma on a mongrel female dog, 20kg, nine years old with a 2 month history of a mass with progressive growth in the right eye. The ophthalmic examination of the right eye showed blepharospasm, moderated conjunctival hyperemia and the presence of a reddish irregular nodule on the dorsal region of the cornea, occupying approximately 60% of the cornea. The ocular ultrasound revealed that the neoplasm affected only the cornea and the cytological examination diagnosed a malignant mesenchymal neoplasm. The patient was submitted to keratectomy followed by a third eyelid flap. The excised material was sent for histopathological analysis that diagnosed hemangiosarcoma. Fifteen days after surgery the third eyelid flap was removed and the ophthalmic examination revealed recurrence of the tumor, with the mass occupying the entire cornea and part of the bulbar conjunctiva. The patient was submitted to enucleation. No alterations were observed on the abdominal ultrasound and thoracic radiography, showing the primary characteristics of the disease. Two years after surgery the patient is clinically healthy, without any signs of recurrence or metastasis. Despite the surgical excision of the tumor with free margins, in cases of hemangiosarcoma with aggressive behavior, the enucleation should be considered as a viable option for a successfull therapeutic protocol and better prognosis of the patient.
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ObjectiveThis study aimed to evaluate the benefit and specifically the feasibility of using ultrasound in ophthalmologic periconal block, and the occurrence of complications.Study designProspective experimental study.AnimalsTen healthy New Zealand White rabbits (6-8months of age), weighing 2.0-3.5kg.MethodsRabbits were anesthetized by intramuscular injection of acepromazine (1mgkg(-1)), ketamine (30mgkg(-1)) and xylazine (3mgkg(-1)). Ultrasound-assisted periconal block with lidocaine was performed on 18 eyes. Intraocular pressure was measured by applanation tonometry whereas corneal sensitivity was assessed using an esthesiometer, before and after each periconal anesthesia.ResultsIn all 18 eyes, it was possible to adequately visualize the needle shaft within the periconal space, as well as muscular cone, optic nerve and local anesthetic solution spread. Lidocaine 2% without epinephrine (0.790.19mL) was injected into the periconal space. There was no statistical difference between the intraocular pressure (meanSD) measured before (10.9 +/- 2.9mmHg) and after (11.9 +/- 3.8mmHg) the periconal anesthesia (p=0.38). The effectiveness of the ultrasound-assisted technique was shown according to the values for corneal sensitivity, assessed before and after periconal anesthesia (p<0.0001). Complications were not observed in this study.ConclusionsEye ultrasonography allowed visualization of all anatomic structures necessary to perform a periconal block, as well as the needle insertion and anesthetic spread in real time. Further studies are required to prove the real potential of ultrasound for reducing the incidence of complications associated with ophthalmic blocks, especially when anatomic disorders of the eye could potentially increase the risk.Clinical relevanceUltrasonography is a painless, noninvasive tool that may improve safety of ophthalmic regional blocks, potentially by reducing the prevalence of globe perforation or penetration of the optic nerve associated with the needle-based techniques.
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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Purpose: To evaluate endothelial cell sample size and statistical error in corneal specular microscopy (CSM) examinations. Methods: One hundred twenty examinations were conducted with 4 types of corneal specular microscopes: 30 with each BioOptics, CSO, Konan, and Topcon corneal specular microscopes. All endothelial image data were analyzed by respective instrument software and also by the Cells Analyzer software with a method developed in our lab(US Patent). A reliability degree (RD) of 95% and a relative error (RE) of 0.05 were used as cut-off values to analyze images of the counted endothelial cells called samples. The sample size mean was the number of cells evaluated on the images obtained with each device. Only examinations with RE<0.05 were considered statistically correct and suitable for comparisons with future examinations. The Cells Analyzer software was used to calculate the RE and customized sample size for all examinations. Results: Bio-Optics: sample size, 97 +/- 22 cells; RE, 6.52 +/- 0.86; only 10% of the examinations had sufficient endothelial cell quantity (RE<0.05); customized sample size, 162 +/- 34 cells. CSO: sample size, 110 +/- 20 cells; RE, 5.98 +/- 0.98; only 16.6% of the examinations had sufficient endothelial cell quantity (RE<0.05); customized sample size, 157 +/- 45 cells. Konan: sample size, 80 +/- 27 cells; RE, 10.6 +/- 3.67; none of the examinations had sufficient endothelial cell quantity (RE>0.05); customized sample size, 336 +/- 131 cells. Topcon: sample size, 87 +/- 17 cells; RE, 10.1 +/- 2.52; none of the examinations had sufficient endothelial cell quantity (RE>0.05); customized sample size, 382 +/- 159 cells. Conclusions: A very high number of CSM examinations had sample errors based on Cells Analyzer software. The endothelial sample size (examinations) needs to include more cells to be reliable and reproducible. The Cells Analyzer tutorial routine will be useful for CSM examination reliability and reproducibility.
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Purpose: The methodology currently used for interpretation of the cornea and anterior segment tomography for the diagnosis of corneal ectasia and its susceptibility. Methods: Description of the methodology and clinical interpretation of corneal and anterior segment tomography indexes; report of three cases demonstrating the importance of this new diagnostic tool (Pentacam HR (R)) in ophthalmological practice. Conclusion: The use of corneal and anterior segment tomography seems to be an effective method to increase the sensitivity and specificity for the diagnosis and early detection of corneal ectasia.
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How is the corneal epithelium restored when all of it plus the limbus have been eliminated? This investigation explored the possibility that this may be achieved through the conjunctival epithelium. The corneal epithelium of the right eye of 12 rabbits (Oryctolagus cuniculus) was totally scraped followed by surgical excision of the limbus plus 1.0-1.5 mm of the adjacent conjunctiva. Antibiotics and corticosteroids were applied for 1 week after surgery. Histological and immunohistochemical techniques were used to monitor the events taking place on the eye surface 2 weeks and 1, 3 and 6 months thereafter. Initially, the corneal surface was covered by conjunctival-like epithelium. After 1 month and more prominently at 3 and 6 months an epithelium displaying the morphological features of the cornea and reacting with the AE5 antibody was covering the central region. It is likely that the corneal epithelium originated from undifferentiated cells of the conjunctiva interacting with the corneal stroma.
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Nitric oxide (NO) has been pointed out as being the main mediator involved in the hypotension and tissue injury taking place during sepsis. This study aimed to investigate the cellular mechanisms implicated in the acetylcholine (ACh)-induced relaxation detected in aortic rings isolated from rats submitted to cecal ligation and perforation (CLP group), 6 h post-CLP. The mean arterial pressure was recorded, and the concentration-effect curves for ACh were constructed for endothelium-intact aortic rings in the absence (control) or after incubation with one of the following NO synthase inhibitors: L-NAME (non-selective), L-NNA (more selective for eNOS), 7-nitroindazole (more selective for nNOS), or 1400W (selective for iNOS). The NO concentration was determined by using confocal microscopy. The protein expression of the NOS isoforms was quantified by Western blot analysis. The prostacyclin concentration was indirectly analyzed on the basis of 6-keto-prostaglandin F-1 alpha (6-keto-PGF(1 alpha)) levels measured by enzyme immunoassay. There were no differences between Sham- and CLP-operated rats in terms of the relaxation induced by acetylcholine. However, the NOS inhibitors reduced this relaxation in both groups, but this effect remained more pronounced in the CLP group as compared to the Sham group. The acetylcholine-induced NO production was higher in the rat aortic endothelial cells of the CLP group than in those of the Sham group. eNOS protein expression was larger in the CLP group, but the iNOS protein was not verified in any of the groups. The basal 6-keto-PGF(1 alpha) levels were higher in the CLP group, but the acetylcholine-stimulated levels did not increase in CLP as much as they did in the Sham group. Taken together, our results show that the augmented NO production in sepsis syndrome elicited by cecal ligation and perforation is due to eNOS up-regulation and not to iNOS. (C) 2012 Elsevier Inc. All rights reserved.
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PURPOSE: To assess corneal wavefront-guided photorefractive keratectomy (PRK) to correct hyperopia after radial keratotomy (RK). SETTING: Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil. DESIGN: Case series. METHODS: Excimer laser corneal wavefront-guided PRK with intraoperative mitomycin-C (MMC) 0.02% was performed. Main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, spherical equivalent (SE), corneal aberrations, and haze. RESULTS: The mean time between RK and PRK in the 61 eyes (39 patients) was 18.8 years +/- 3.8 (SD). Before PRK, the mean SE was +4.17 +/- 1.97 diopters (D); the mean astigmatism, -1.39 +/- 1.04 D; and the mean CDVA, 0.161 +/- 0.137 logMAR. At 24 months, the mean values were 0.14 +/- 0.99 D (P<.001), -1.19 +/- 1.02 D (P=.627), and 0.072 +/- 0.094 logMAR (P<.001), respectively; the mean UDVA was 0.265 +/- 0.196 (P<.001). The UDVA was 20/25 or better in 37.7% of eyes and 20/40 or better in 68.9%. The CDVA improved by 1 or more lines in 62.3% of eyes. Two eyes (3.3%) lost 2 or more lines, 1 due to corneal ectasia. Thirty eyes (49.2%) were within +/- 0.50 D of intended SE and 45 (73.8%) were within +/- 1.00 D. From 6 to 24 months, the mean SE regression was +0.39 D (P<.05). A significant decrease in coma, trefoil, and spherical aberration occurred. Three eyes developed peripheral haze more than grade 1. CONCLUSION: Corneal wavefront-guided PRK with MMC for hyperopia after RK significantly improved UDVA, CDVA, and higher-order corneal aberrations with a low incidence of visually significant corneal haze.