Navegando por Palavras-chave "Úlcera de córnea"
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- ItemAcesso aberto (Open Access)Contact lens-associated microbial keratitis(Conselho Brasileiro de Oftalmologia, 2008-12-01) Moriyama, Aline Silveira [UNIFESP]; Hofling-Lima, Ana Luisa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: Contact lens-associated microbial keratitis is a severe condition with sight-threatening potential and increasing incidence. Information regarding the etiological agents is essential in guiding management and may vary geographically. The aim of this study was to analyze the microbiological results of corneal scrapings collected from patients presenting with contact lens-associated microbial keratitis. METHODS: Retrospective analysis of the records of all patients who were clinically diagnosed with contact lens-associated microbial keratitis and had corneal scrapings sent to the Laboratory of Ocular Microbiology, UNIFESP/EPM during a 5-year period from January 2002 to December 2007. RESULTS: The etiological agent was identified in 239 patients. Bacterial isolates accounted for 166 (69.46%) cases, Acanthamoeba for 95 (39.75%) cases and fungi for 4 (1.67%) cases. Among the bacterial infections, coagulase-negative Staphylococcus was demonstrated in 74 cases, while Pseudomonas spp was found in 32 patients. All coagulase negative Staphylococcus and Pseudomonas were susceptible to ciprofloxacin and ofloxacin. Resistance to gentamicin was documented in a single case of Pseudomonas. Fourth-generation flouoroquinolone resistance was not observed among Pseudomonas cases. CONCLUSION: Coagulase-negative Staphylococcus was the most frequent isolate, and such data must be considered when determining empiric treatment. Second-generation fluoroquinolones ciprofloxacin and ofloxacin and fourth-generation fluoroquinolones moxifloxacin and gatifloxacin showed a good antibacterial profile and therefore could be good options for initial management.
- ItemAcesso aberto (Open Access)Distribuição das ceratites infecciosas em hospital terciário no Brasil(Conselho Brasileiro de Oftalmologia, 2013-12-01) Marujo, Fábio Iglesias; Hirai, Flávio Eduardo [UNIFESP]; Yu, Maria Cecília Zorat [UNIFESP]; Hofling-Lima, Ana Luisa [UNIFESP]; Freitas, Denise de [UNIFESP]; Sato, Elcio Hideo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To investigate the seasonality of infectious keratitis in a tertiary hospital in Brazil. METHODS: Charts from the Ocular Microbiology Laboratory of the Department of Ophthalmology of the Federal University of São Paulo were reviewed from 2005 to 2009. Infectious keratitis were defined as those with positive culture. Data were distributed monthly and linear regressions with seasonal dummy models were used to test for seasonal trends. RESULTS: Total of 1,468 cases of keratitis was diagnosed during the study period. Bacterial keratitis were reponsible for 80.3% of all cases, followed by fungal (7%), and Acanthamoeba (6%); 6.7% were mixed cases. Statistical tests showed that there were no seasonal trends for bacteria (p=0.064), fungi (p=0.379), Acanthamoeba (p=0.062) or mixed infections (p=0.441). Conclusions: No seasonal trends for infectious keratitis were observed in our sample.
- ItemAcesso aberto (Open Access)Manifestações destrutivas da córnea e esclera associadas a doenças do tecido conectivo: relato de 9 casos(Conselho Brasileiro de Oftalmologia, 2004-08-01) Santos, Namir Clementino [UNIFESP]; Sousa, Luciene Barbosa de; Trevisani, Virgínia Fernandes Moça [UNIFESP]; Freitas, Denise de [UNIFESP]; Vieira, Luis Antonio; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual do Piauí; Universidade Estadual do Piauí setor de Doenças Externas Oculares e CórneaPURPOSE: To study the clinical features, diagnosis, treatment, and outcome of nine patients with corneal and scleral involvement associated to connective tissue disease. METHODS: Description of anterior segment abnormalities observed in nine patients with connective tissue disease, five of them previously diagnosed and four with the ocular involvement being the first manifestation of the disease. All patients were evaluated at the Corneal and External Diseases outpatient clinic of the Federal University of São Paulo - Escola Paulista de Medicina (UNIFESP-EPM) between July/1999 to December/2000 and were submitted to a complete ophthalmologic examination, clinical evaluation and laboratory investigation. Clinical or surgical treatment was indicated according to the ocular disease evolution. RESULTS: The clinical diagnoses of the patients with anterior segment inflammatory disease were rheumatoid arthritis in seven patients (77.8%), systemic sclerosis and Wegener´s granulomatosis in each of the remaining patients (22.2%). The most frequent ocular manifestation was scleritis (66.6%), followed by peripheral ulcerative keratitis (55.5%) and dry eye syndrome (44.4%). Eighty-nine percent (89%) of the patients required immunosuppressive therapy to control the ocular inflammatory disease. Remission of the ocular symptoms were observed after 3 months of the beginning of imunossupressive therapy on average. In 55.5% of the patients a surgical approach (conjunctival resection, application of cyanoacrylate tissue adhesive, penetrating keratoplasty and scleral patch graft) was necessary. CONCLUSION: The finding of corneal and scleral involvement associated with connective tissue disease is a sign of the disease activity and usually requires imunossupressive therapy. The ophthalmologists should be aware of these conditions in order to early diagnose and apply the appropriate treatment.
- ItemAcesso aberto (Open Access)Úlcera de córnea bilateral por Pseudomonas em usuário de lente de contato descartável(Conselho Brasileiro de Oftalmologia, 1999-12-01) Lipener, César [UNIFESP]; Ribeiro, André Luiz Parolin [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Although the use of contact lenses is appa-rently very simple, it is necessary to obey criteria for their correct use, conservation and disposal. Corneal bacterial ulcers are a much-feared complication for users of contact lenses and can be related to various factors such as hygiene, storage and most of all long-term use. Purpose: To describe a case of bilateral ulcer, caused by Pseudomonas in a patient who was a user of disposable lenses. This study highlights and discusses the importance of prior examination, instruction and adequate supervision. In addition it is emphasized that although the lenses are disposable, they are not free from the possibility of serious complications. Case Study: A seventeen-year-old student who had used contact lenses for six months without prior examination or medical prescription complained of pain in the left eye. When he was examined, we observed a corneal ulcer infiltrated in the median periphery. Samples were collected and a treatment with fortified eye-drops was started. After eight hours the patient returned now complaining of pain in the right eye which we examined and observed diffuse keratitis with a mucopurulent secretion. The treatment was the same. Laboratory tests revealed Pseudomonas in both eyes and the ailment was healed within a week's treatment without leaving sequelae. Discussion: The author discuss the factors involved in the occurrence of infectious keratitis in users of contact lenses illustrating that even though disposable lenses are appa-rently very simple they can cause serious problems. It also demonstrates that the long-term use of contact lenses is considered to be a main risk factor. The description of a case of bilateral keratitis is a warning about the use of this kind of lens without proper orientation and supervision.