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ABSTRACT Purpose: To estimate the prevalence and risk factors of dry eye disease symptoms and clinical diagnoses in Sao Paulo city, state of Sao Paulo, Brazil. Methods: A total of 582 participants over 18 years old, living in the east zone of Sao Paulo city responded to a short questionnaire. Dry eye disease was on that is defined by the presence of severe symptoms or previous clinical diagnosis of dry eye disease by an ophthalmologist. The association between dry eye disease and possible risk factors was assessed. Results: Overall dry eye disease severe symptoms and/or clinical diagnoses prevalence was calculated as 24.4% for both sexes. Women presented a higher frequency of severe symptoms of dry eye disease (16.07%) than men (8.48%; p=0.0244), as well as the composite of severe symptoms or diagnosed dry eye disease, presented by 26.86% of women and 18.18% of men (p=0.0366). In women, ages between 55 to 75 years old were associated with dry eye disease severe symptoms (OR=3.11; 95%CI 1.56-6.23, p=0.001) and diagnosed dry eye disease (OR=2.02; 95% CI 1.04-3.93, p=0.037). Hypertension was significantly associated with dry eye disease symptoms (OR=1.98; 95% CI 1.14-3.43, p=0.015) and diagnoses (OR=3.54; 95% CI 1.92-6.53, p=0.0001) in women. Eye drops use was associated with severe symptoms of dry eye disease and diagnosed dry eye disease in both women and men (p≤0.01). Conclusions: Dry eye disease prevalence in Sao Paulo city is higher in women than in men. Age and hypertension were stronger risk factors of dry eye disease for women, while eye drops use was a significant indicator of dry eye disease for both sexes.
RESUMO Objetivo Estimar a prevalência e os fatores de risco para os sintomas e o diagnóstico clínico da doença do olho seco na cidade de São Paulo, estado de São Paulo, Brasil. Métodos: Quinhentos e oitenta e dois participantes acima de 18 anos, residentes na zona leste da cidade de São Paulo responderam a um questionário de três perguntas sobre olho seco. A doença do olho seco foi definida pela presença de sintomas severos ou diagnóstico clínico prévio de doença do olho seco por um oftalmologista. A associação entre doença do olho seco e possíveis fatores de risco foi avaliada. Resultados: A prevalência de sintomas graves da doença do olho seco e/ou diagnóstico clínico foi calculada em 24,4% para ambos os sexos. O sexo feminino apresentou uma frequência maior de sintomas severos da doença do olho seco (16,07%) que o sexo masculino (8,48%; p=0,0244), assim como a associação de sintomas severos ou diagnóstico de doença do olho seco, foi de 26,86% no sexo feminino e 18,18% no sexo masculino (p=0,0366). No sexo feminino, a faixa etária entre 55 e 75 anos de idade foi associada com sintomas severos da DOS (odds ratios (OR) = 3,11; IC 95% 1,56-6,23; p=0,001) e com doença do olho seco diagnosticada (OR=2,02; IC 95% 1,04-3,93; p=0,037). Hipertensão foi associado com sintomas da doença do olho seco (OR=1,98; IC 95% 1,14-3,43; p=0,015) e diagnóstico da doença do olho seco (OR=3,54; IC 95% 1,92-6,53; p=0,001) no sexo feminino. Uso de colírios foi associado a sintomas severos e diagnóstico da doença do olho seco em ambos os sexos (p≤0,01). Conclusão: A prevalência da doença do olho seco na cidade de São Paulo é mais frequente no sexo feminino que no masculino. Idade e hipertensão foram fatores de risco maiores para doença do olho seco no sexo feminino, enquanto uso de colírios foi um indicador de doença do olho seco para ambos os sexos.
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Keratoconus is an ectatic corneal disease that affects both men and women, usually at a young age. Risk factors such as eye rubbing, environmental and genetic factors contribute to its pathogenesis. Keratoconus presents a variable prevalence, being as high as 5% of the population in the Middle East. In this review, an English-language search for keratoconus epidemiology was undertaken using the PubMed database. We present and discuss the findings of the most relevant epidemiological studies on keratoconus and describe its characteristics and risk factors, correlating them with its pathogenesis.
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PURPOSE: To estimate the prevalence and risk factors of dry eye disease symptoms and clinical diagnoses in Sao Paulo city, state of Sao Paulo, Brazil. METHODS: A total of 582 participants over 18 years old, living in the east zone of Sao Paulo city responded to a short questionnaire. Dry eye disease was on that is defined by the presence of severe symptoms or previous clinical diagnosis of dry eye disease by an ophthalmologist. The association between dry eye disease and possible risk factors was assessed. RESULTS: Overall dry eye disease severe symptoms and/or clinical diagnoses prevalence was calculated as 24.4% for both sexes. Women presented a higher frequency of severe symptoms of dry eye disease (16.07%) than men (8.48%; p=0.0244), as well as the composite of severe symptoms or diagnosed dry eye disease, presented by 26.86% of women and 18.18% of men (p=0.0366). In women, ages between 55 to 75 years old were associated with dry eye disease severe symptoms (OR=3.11; 95%CI 1.56-6.23, p=0.001) and diagnosed dry eye disease (OR=2.02; 95% CI 1.04-3.93, p=0.037). Hypertension was significantly associated with dry eye disease symptoms (OR=1.98; 95% CI 1.14-3.43, p=0.015) and diagnoses (OR=3.54; 95% CI 1.92-6.53, p=0.0001) in women. Eye drops use was associated with severe symptoms of dry eye disease and diagnosed dry eye disease in both women and men (p≤0.01). CONCLUSIONS: Dry eye disease prevalence in Sao Paulo city is higher in women than in men. Age and hypertension were stronger risk factors of dry eye disease for women, while eye drops use was a significant indicator of dry eye disease for both sexes.
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Síndromes do Olho Seco , Hipertensão , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Adolescente , Brasil/epidemiologia , Prevalência , Fatores de Risco , Síndromes do Olho Seco/epidemiologia , Síndromes do Olho Seco/diagnóstico , Soluções OftálmicasRESUMO
In this research we evaluated the supramolecular organizations and the optical anisotropical properties of the de-epithelialized human amniotic membrane and rabbit limbal stroma, before and after explant culture. Birefringence, monochromatic light spectral absorption and linear dichroism of the main extracellular matrix biopolymers, that is, the fibrillar collagens and proteoglycans, were investigated by polarized light microscopy combined with image analysis. Our results demonstrated that the culture procedure-induced stimuli altered the supra-organizational characteristics (in terms of collagens/proteoglycans spatial orientation and ordered-aggregational state) of the amniotic and limbal extracellular matrix, which led to changes in optical anisotropical properties.
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PURPOSE: There are few studies comparing different surgical procedures for the treatment of corneal thinning. Lamellar corneal transplantation (LCT) has been reported to be efficient, but its results can be jeopardized by allograft rejection, opacification, or high astigmatism. Amniotic membrane transplantation (AMT) has been considered a good alternative, but it is not as resistant as LCT and the tissue can be reabsorbed after surgery. METHODS: A prospective, randomized, interventional, and comparative study of consecutive patients with corneal thinning over 6 months was performed. Ophthalmological examination was performed before transplant surgery and then repeated 1, 7, 15, 30, 90, and 180 days after surgery and ultrasound biomicroscopy was performed before and then 30, 90, and 180 days after surgery to assess corneal thinning. RESULTS: Herpes simplex infection was the main cause of corneal thinning (9 eyes), followed by surgery (cataract, glaucoma, 5 cases), rheumatoid arthritis (1), chemical burn (1), perforating trauma (1), previous band keratopathy treatment (1), and Stevens-Johnson syndrome (1). Although all patients showed significant increase in final thickness in the area of thinning, it was higher in those submitted to LCT at 180 days postoperatively. Regardless of the surgical technique, all patients showed epithelialization. Patients undergoing AMT showed an 89% decrease in neovascularization. Final corrected distance visual acuity was better in patients submitted to AMT. CONCLUSIONS: LCT proved to be the best option for treating corneal thinning. AMT represents an alternative that allows good visual recovery but does not restore corneal thickness as efficiently as LCT.
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Âmnio/transplante , Córnea/patologia , Doenças da Córnea/cirurgia , Transplante de Córnea , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Córnea/etiologia , Doenças da Córnea/fisiopatologia , Paquimetria Corneana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Período Pós-Operatório , Estudos Prospectivos , Acuidade Visual/fisiologiaRESUMO
PURPOSE: The aim of this study was to compare the use of multilayer amniotic membrane transplantation (AMT) with lamellar corneal transplantation (LCT) and lamellar scleral transplantation (LST) for the treatment of scleral thinning after pterygium surgery associated with beta therapy. METHODS: Twenty-six eyes from 26 different patients with scleral thinning as a consequence of beta therapy after pterygium surgery were evaluated at the Federal University of São Paulo, Brazil. Ophthalmologic examination and ultrasound biomicroscopy were performed to assess scleral thinning before the transplant surgery and then repeated at 30, 90, and 180 days after surgery. An increase in scleral thickness, epithelialization of the ocular surface, and preservation of the ocular globe were the main outcome measures. RESULTS: Irrespective of the surgical technique used (AMT, LCT, or LST), no clinical or statistical changes in corrected distance visual acuity were found in any of the patients during this study. The median preoperative scleral thickness was similar in all 3 groups: AMT = 0.45 mm, LST = 0.48 mm, and LCT = 0.52 mm (P = 0.257); however, 6 months after surgery, the median thickness in the AMT group (0.19) was significantly less than that of the LCT group (0.57) (P = 0.27) or the LST group (0.76) (P = 0.19). Epithelialization occurred in all the patients. CONCLUSIONS: LCT was the best option for the structural treatment of scleral thinning, followed by LST with a conjunctival flap. A high rate of reabsorption was found with AMT, which was the least effective of the 3 therapeutic options and should not be used for this condition.
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Âmnio/transplante , Transplante de Córnea , Complicações Pós-Operatórias , Pterígio/terapia , Esclera/transplante , Doenças da Esclera/cirurgia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Estudos Transversais , Feminino , Humanos , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Pterígio/radioterapia , Pterígio/cirurgia , Reepitelização , Doenças da Esclera/diagnóstico por imagem , Doenças da Esclera/etiologia , Radioisótopos de ÍtrioRESUMO
PURPOSE: The aim of this study was to compare the outcome of conjunctival limbal transplantation with and without the use of amniotic membrane (AM) transplantation for the treatment of limbal deficiency after chemical burns to the eyes. METHODS: This is a retrospective, comparative, interventional case series that included 34 eyes (34 patients) with total limbal deficiency after chemical burns, who were submitted to conjunctival limbal transplantation. Two groups were formed: group 1 (15 eyes) limbal transplantation associated with AM transplantation and group 2 (19 eyes) only limbal transplantation. Success and failure rates, epithelialization time, and visual acuity were compared between the 2 groups. RESULTS: The mean follow-up period was 19.71 ± 5.6 months in group 1 and 18.26 ± 7.78 months in group 2. The proportion of conjunctival limbal autograft and living-related conjunctival limbal allograft was similar in both groups (P = 0.914). Time until complete epithelialization of the corneal surface was significantly longer in group 1 (P = 0.007). Graft survival was similar in both groups (P = 0.581). Failure rate was also similar in both groups (P = 0.232). The most common cause of failure was transplanted stem cell depletion in group 1 (20% of cases) and rejection in group 2 (10.5%). The visual acuity improved postoperatively in 12 eyes (80%) in group 1 and 16 (84.2%) in group 2 (P = 0.430). CONCLUSIONS: Results with the use of AM associated with conjunctival limbal transplantation in ocular surface reconstruction were similar to those obtained with limbal transplantation alone. Both techniques were found to be satisfactory for ocular surface reconstruction in patients with total limbal deficiency after chemical burns.
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Queimaduras Químicas/cirurgia , Túnica Conjuntiva/citologia , Doenças da Córnea/cirurgia , Células Epiteliais/transplante , Queimaduras Oculares/induzido quimicamente , Limbo da Córnea/patologia , Transplante de Células-Tronco , Adolescente , Adulto , Aloenxertos , Âmnio/transplante , Queimaduras Químicas/fisiopatologia , Criança , Pré-Escolar , Doenças da Córnea/fisiopatologia , Queimaduras Oculares/patologia , Feminino , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Células-Tronco/patologia , Transplante Autólogo , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To report the outcomes of transplantation of autologous conjunctival epithelial cells cultivated ex vivo (EVCAU) in patients with total limbal stem cell deficiency (LSCD). METHODS: EVCAU were cultivated on denuded human amniotic membrane and transplanted in 12 eyes of 10 patients with total LSCD. We evaluated the improvement in the defined clinical parameters of LSCD (loss of corneal epithelial transparency, superficial corneal neovascularization and epithelial irregularity/recurrent epithelial breakdown), vision acuity, impression cytology, immunocytochemical analysis (CK3/CK19), and the appearance of a regular hexagonal basal layer of cells on corneal confocal microscopy. Histologic and immunohistochemical features were studied in 3 corneal buttons of patients submitted to penetrating keratoplasty after EVCAU. RESULTS: Cultivated conjunctival epithelium formed 4 to 5 layers with the formation of basement membrane-like structures. Immunocytochemical analysis showed positivity for CK3, CK19, MUC5AC, Ki-67, P63, and ABCG2. The improvement of the clinical parameters for this treatment in our cohort was 10 of 12 (83.3%) in a mean follow-up time of 18.5 months (range, 15-26 months), and these eyes showed an improvement in impression cytology, immunocytochemistry, and in vivo confocal analysis. Corneal buttons showed a well-formed epithelium with 5 to 6 layers, with rare cells periodic acid-Schiff+, and positivity for CK3, CK19, P63, connexin 43, and MUC5AC. CONCLUSION: We demonstrated the preliminary results of transplantation of EVCAU for corneal surface reconstruction in cases with total LSCD. Future studies are needed to further assess the long-term efficacy of this procedure.
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Túnica Conjuntiva/citologia , Doenças da Córnea/cirurgia , Células Epiteliais/transplante , Células-Tronco/patologia , Membro 2 da Subfamília G de Transportadores de Cassetes de Ligação de ATP , Transportadores de Cassetes de Ligação de ATP/metabolismo , Adulto , Idoso , Biomarcadores/metabolismo , Transplante de Células , Células Cultivadas , Epitélio Corneano/metabolismo , Epitélio Corneano/patologia , Feminino , Humanos , Imuno-Histoquímica , Queratina-19/metabolismo , Queratina-3/metabolismo , Ceratoplastia Penetrante , Antígeno Ki-67/metabolismo , Limbo da Córnea/patologia , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Mucina-5AC/metabolismo , Proteínas de Neoplasias/metabolismo , Estudos Prospectivos , Células-Tronco/metabolismo , Transplante Autólogo , Acuidade Visual/fisiologia , Adulto JovemRESUMO
PURPOSE: Amniotic membrane transplantation (AMT) has been used as a graft or as a dressing in ocular surface reconstruction, facilitating epithelization, maintaining normal epithelial phenotype, and reducing inflammation, vascularization, and scarring. The corneal transparency is due, at least in part, to the arrangement in orthogonal lamellae of collagen fibrils, surrounded by proteoglycans (PGs). These PGs regulate fibrilogenesis, the matrix assembly, and ultimately the corneal transparency. The purpose of the present study was to investigate the effects of AMT upon the corneal PGs after severe limbal injury. METHODS: Experiments were performed on the right corneas of 22 New Zealand female albino rabbits, and their left corneas were used as matched controls. These animals were divided into 3 groups: G1 (n=10): total peritomy and keratolimbectomy, followed by application of 0.5 M NaOH; G2 (n=10): submitted to the same trauma as G1, and treated by AMT; G3: no trauma, only AMT (n=2). The right corneas of G2 and G3 were covered by DMSO4 cryopreserved human amniotic membrane, fixed by interrupted 9-0 mononylon sutures, with its stromal face toward the ocular surface. After 7 or 30 days, the corneas were removed and PGs were extracted. RESULTS: Normal corneas contained approximately 9 mg of PGs per gram of dry tissue. AMT on intact cornea (G3) did not cause any changes in the concentration of PGs. In contrast, injured corneas contained much less PGs, both on the seventh and on the 30th day posttrauma. The PG concentration was even lower in injured corneas treated by AMT. This decrease was due almost exclusively to dermatan sulfate PGs, and the structure of dermatan sulfate was also modified, indicating changes in the biosynthesis patterns. CONCLUSIONS: Although beneficial effects have been observed on clinical observation and concentration of soluble proteins after AMT, the normal PG composition of cornea was not attained, even 30 days postinjury, indicating that the normal ocular surface reconstruction, if possible, is a long-term process.
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Âmnio/transplante , Curativos Biológicos , Traumatismos Oculares/cirurgia , Limbo da Córnea/cirurgia , Proteoglicanas/biossíntese , Cicatrização/fisiologia , Animais , Modelos Animais de Doenças , Eletroforese em Gel de Ágar , Traumatismos Oculares/metabolismo , Traumatismos Oculares/patologia , Feminino , Glicosaminoglicanos/biossíntese , Humanos , Immunoblotting , Limbo da Córnea/lesões , Limbo da Córnea/metabolismo , Coelhos , Espectrofotometria , Resultado do TratamentoRESUMO
PURPOSE OF REVIEW: The purpose of this review is to describe the most recent and relevant clinical and experimental data about the use of amniotic membrane in ophthalmology. RECENT FINDINGS: The amniotic membrane is a biologic tissue that has been used as a graft for corneal and conjunctival reconstruction in a variety of ocular surface diseases. It is avascular and possesses anti-angiogenetic, anti-scarring and antiinflammatory properties. It is not a substitute but rather a substrate upon which cells can migrate and regenerate, forming new and healthy tissue. The amniotic membrane can also be used as a biologic patch, as a bandage, to treat acute inflammatory disorders. With the development of cell therapy, amniotic membrane can be also used as a carrier of limbal stem cells or their progeny, cultivated in vitro. SUMMARY: Amniotic membrane use in ophthalmic surgery has been shown to provide an alternative for corneal and conjunctival reconstruction in many clinically challenging situations; however, there is still a lack of scientific evidence based on randomized comparative studies to prove that its use is better than other alternative therapies for ocular surface reconstruction.
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Âmnio/transplante , Curativos Biológicos , Doenças da Túnica Conjuntiva/cirurgia , Doenças da Córnea/cirurgia , Técnicas de Cocultura , Epitélio Corneano/transplante , Humanos , Limbo da Córnea/citologia , Transplante de Células-Tronco , Células-Tronco/citologiaRESUMO
PURPOSE: To evaluate the survival of conjunctival limbal grafts and amniotic membrane transplantation (AMT) for total limbal stem cell deficiency (LSCD) and the influence of several parameters as cause of LSCD, dry eye, keratinization, eyelid abnormalities, HLA compatibility, systemic immunosuppression, and keratoplasty (PKP) on surgical outcome. DESIGN: Prospective, noncomparative, interventional case series. METHODS: Thirty-three eyes of 31 patients with total LSCD that underwent conjunctival limbal grafts and AMT at the Department of Ophthalmology, Federal University of São Paulo were included in this study. Cumulative graft survival as well as the influence of several variables on surgical outcome was analyzed. RESULTS: Ten eyes (30%) underwent conjunctival limbal autograft and 23 (70%) underwent conjunctival limbal allograft from living HLA-matched donor. Graft survival was seen in 13 eyes (40%) at 1 year and in 11 eyes (33.3%) at 2 years, with a cumulative survival of 33% after a mean follow-up time of 33 months. Increase in postoperative visual acuity was observed in 20 eyes (60.6%) during this period. Marked impact on graft survival was observed for patients with Stevens-Johnson syndrome, dry eye, keratinization, eyelid abnormalities, and allogeneic conjunctival limbal transplantation (independently of HLA compatibility) (P < .05). Preoperative dry eye was the most important prognostic parameter for surgical outcome (P < .001). CONCLUSIONS: Conjunctival limbal grafts associated with AMT are useful for restoring corneal epithelium phenotype in eyes with total LSCD. However, the cumulative survival declines substantially over a 2-year period. Considering all investigated variables, dry eye was the most important prognostic parameter.
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Âmnio/transplante , Túnica Conjuntiva/citologia , Doenças da Córnea/cirurgia , Células Epiteliais/transplante , Sobrevivência de Enxerto/fisiologia , Limbo da Córnea/patologia , Células-Tronco/patologia , Adulto , Doenças da Córnea/patologia , Feminino , Seguimentos , Teste de Histocompatibilidade , Humanos , Masculino , Estudos Prospectivos , Transplante Autólogo , Transplante Homólogo , Acuidade Visual/fisiologia , CicatrizaçãoRESUMO
OBJECTIVE: To report the use of preserved amniotic membrane and living related corneal limbal/conjunctival transplantation in total limbal stem cell and conjunctival deficiency secondary to severe Stevens-Johnson syndrome. DESIGN: Prospective, noncomparative, interventional case series. PATIENTS AND METHODS: Ten eyes of 10 patients with total limbal stem cell and conjunctival deficiency secondary to Stevens-Johnson syndrome underwent excision of cicatricial tissue followed by amniotic membrane and living related corneal limbal/conjunctival transplantation. MAIN OUTCOME MEASURES: Reconstruction of corneal epithelium (clear appearance without epithelial defect, normal fluorescein permeability, and the absence of conjunctiva-derived goblet cells on impression cytologic testing), decrease in corneal vascularization, and improvement in visual acuity. RESULTS: During a mean follow-up of 16.7 months, satisfactory ocular surface reconstruction was obtained in 2 eyes (20%), with reduced inflammation and vascularization and a mean epithelialization time of 3 weeks. Surgical failure was observed in 4 cases (40%) and complications (infection) in 4 cases (40%). Visual acuity improved in 4 eyes (40%), remained stable in 5 eyes (50%), and decreased in 1 eye (10%). CONCLUSIONS: Amniotic membrane and living related corneal limbal/conjunctival transplantation were successful in 20% of severe cases of total limbal stem cell and conjunctival deficiency secondary to Stevens-Johnson syndrome. A high proportion of postoperative complications, in particular, infection, seemed to jeopardize a favorable outcome.