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De Melo Inagaki A.D.,Federal University of Sergipe | Carvalheiro C.G.,University of Sao Paulo | Cipolotti R.,Federal University of Sergipe | Gurgel R.Q.,Federal University of Sergipe | And 5 more authors.
Tropical Medicine and International Health | Year: 2012

Objectives To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live-born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants. Methods Dried blood spot specimens obtained from 15204 neonates were assayed for the presence of anti-T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti-T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20months. Congenital infection was confirmed in the presence of persisting anti-T. gondii IgG antibodies beyond 12months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1year. Results Fifty-three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow-up. Six of 15204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10000 [CI 95% 1.4-8.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20months of age. Conclusions The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted. © 2012 Blackwell Publishing Ltd.


Selistre S.G.A.,Federal University of Rio Grande do Sul | Selistre S.G.A.,Hospital Of Clinicas Of Porto Alegre Hcpa | Maestri M.K.,Ophthalmology Service | Santos-Silva P.,Federal University of Rio Grande do Sul | And 12 more authors.
BMC Pediatrics | Year: 2016

Background: Retinoblastoma (Rb) is the most common intraocular tumor diagnosed in children in Brazil. However, detailed information is lacking regarding patient clinical demographics. This study aimed to determine the clinical profile of patients with Rb who were treated in a public university hospital in southern Brazil from 1983 to 2012. Methods: Patients' medical records were reviewed to retrospectively identify patients with a principal diagnosis of Rb. Rb was classified as hereditary or non-hereditary. Clinical staging was reviewed by an ophthalmologist. Statistical analysis was performed using SPSS. Results: Of 165 patients with a diagnosis of Rb during this period, 140 were included in the study. Disease was unilateral in 65.0% of patients, bilateral in 32.9%, and trilateral in 2.1%. The mean age at onset of the first sign/symptom was 18.1month, and 35.7% of patients were diagnosed during the first year of life. The most common presenting signs were leukocoria (73.6%) and strabismus (20.7%). The mean age at diagnosis was 23.5months, and time to diagnosis was 5.4months. In patients with clinical features of hereditary Rb, both onset of the first sign/symptom and diagnosis were at an earlier age than in patients without these features (12.3 vs 21.6months [P=0.001] and 15.9 vs 28.0months [P<0.001], respectively). However, there was no significant difference in overall survival between the two groups. Ocular stage at diagnosis was advanced in 76.5% (Reese V) and 78.1% (International Classification D or E). Of patients with unilateral and bilateral disease, 35.2% and 34.8%, respectively, had extraocular disease at diagnosis; 10.7% had metastatic disease at diagnosis. Enucleation was observed in 88.1% and exenteration in 11.9% of patients; 93.6% patients were followed until 2012, and 22.9% relapsed. Overall survival was 86.4%. Conclusions: Most Rb diagnoses are still diagnosed in advanced stages of the disease, considerably reducing overall survival time and the rate of eye and vision preservation. © 2016 Selistre et al.


Giordano V.E.,Retina and Vitreous Service | Hernandez-Da Mota S.E.,Ophthalmology Service | Adabache-Guel T.N.,Retina and Vitreous Service | Chevez A.C.,Glaucoma Service | And 6 more authors.
International Journal of Ophthalmology | Year: 2016

Aim: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. ·Methods: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. ·Results: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. ·Conclusion: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model. © 2016, International Journal of Ophthalmology (c/o Editorial Office). All rights reserved.


PubMed | Pathology Service, Glaucoma Service, Ophthalmology Service and Retina and Vitreous Service
Type: Journal Article | Journal: International journal of ophthalmology | Year: 2016

To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection.Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination.Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases.Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.


Sia R.K.,Fort Belvoir Community Hospital | Ryan D.S.,Fort Belvoir Community Hospital | Stutzman R.D.,Ophthalmology Service | Stutzman R.D.,U.S. National Institutes of Health | And 6 more authors.
Journal of Cataract and Refractive Surgery | Year: 2015

Purpose To compare visual outcomes following Visx Star S4 Customvue wavefront-guided and Allegretto Wave Eye-Q 400 Hz wavefront-optimized photorefractive keratectomy (PRK). Setting Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, Virginia, and Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Design Prospective randomized clinical trial. Methods Active-duty United States military soldiers were randomized to have wavefront-guided (Visx Star S4 Customvue) or wavefront-optimized PRK. Participants were followed up to 12 months postoperatively. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest spherical equivalent (SE). Secondary outcome measures included refractive astigmatism, higher-order aberrations (HOAs), contrast sensitivity, subjective visual complaints, and patient satisfaction. Results The study evaluated 108 soldiers (mean age 30.3 years ± 6.3 [SD]; mean manifest SE -3.51 ± 1.63 D). At 12 months postoperatively, achieved UDVA, CDVA, manifest SE, and refractive astigmatism were comparable between wavefront-guided and wavefront-optimized groups (P >.213). Spherical aberration and total HOAs significantly increased from baseline in both groups (P <.006). The change in coma, trefoil, spherical aberration, and total HOAs (P >.254) were comparable between groups. There were fewer losses of photopic low-contrast visual acuity (LCVA) at 5% contrast after wavefront-guided compared to wavefront-optimized treatment (P =.003). There was no significant difference between treatment groups in visual symptoms, overall vision expectation, and satisfaction (P >.075). Conclusion Wavefront-guided treatment offered a small advantage in photopic LCVA. Refractive outcomes, HOAs, self-reported visual difficulties, overall vision expectation, and satisfaction were otherwise comparable between wavefront-guided and wavefront-optimized treatments. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2015 ASCRS and ESCRS.


PubMed | University of Lausanne, Oncology Service, Ophthalmology Service, Instituto Nacional Of Ciencias Medicas Y Nutricion Salvador Zubiran and Radiology and Imaging Service
Type: Journal Article | Journal: Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion | Year: 2016

Intra-arterial chemotherapy is a novel therapeutic modality for retinoblastoma patients. Intra-arterial chemotherapy involves the administration of a super-selective drug through the ophthalmic artery, resulting in better ocular penetration and low systemic toxicity.The aim of this report was to evaluate the feasibility of intra-arterial chemotherapy in a large referral center in Mexico City.We included patients with bilateral retinoblastoma, one enucleation, and active disease in the other eye after at least two courses of systemic chemotherapy combined with topical treatments. All patients were treated with three courses of a combination of melphalan 4 mg and topotecan 1 mg. Patients were examined under general anesthesia three weeks after each chemotherapy cycle.From 14 eligible patients, three could not be treated due to inaccessibility of the ophthalmic artery. A complete response was observed in 5/11 patients, three in Stage C according to the International Classification for Intraocular Retinoblastoma, one in Stage D, and one in Stage B. The eyes of three patients were enucleated as a result of active/progressive disease, one in Stage B and two in Stage D. Eye preservation was 55% after a mean follow-up of 171 days (range 21-336).Super-selective intra-arterial chemotherapy is safe and effective for preventing the enucleation of 55% of affected eyes in this group of patients.


Timoney P.J.,Ophthalmology Service | Breathnach C.S.,University College Dublin
Irish Journal of Medical Science | Year: 2010

Douglas Argyll Robertson's (1837-1909) experimental work with physostigmine in 1863 sharpened his knowledge of the innervation of the internal muscles of the eye. So he was ideally prepared in 1869 to analyse the conundrum when he saw patients with spinal cord disease who had lost the response to light even though accommodation to near objects was normal. By translating his knowledge of basic science to a clinical problem he drew attention to this phenomenon, known subsequently as the Argyll Robertson pupil that came to be considered pathognomonic of tabes dorsalis, general paresis and neurovascular syphilis. © 2010 Royal Academy of Medicine in Ireland.


Cheikhrouhou F.,Laboratory of parasitology and mycology | Makni F.,Laboratory of parasitology and mycology | Neji S.,Laboratory of parasitology and mycology | Trigui A.,Ophthalmology service | And 5 more authors.
Journal de Mycologie Medicale | Year: 2014

Fungal keratitis is responsible for a significant burden of blinding disease in the developing world. Objective: The aim of this study was to determine the etiological agents, predisposing factors and therapy of keratomycosis in our region. Methods: Retrospective study of 60 patients with clinically and cultured confirmed fungi keratitis, who were attended at department of mycology in Sfax (1995 to 2012). Results: The mean age of patients was 47.2 years (sex ratio: 1.58). At least, one presumed predisposing factor was identified in 83.3% of cases. Corneal traumatism was established as the most common predisposing factor (61.6%) with vegetative matter (42.4%). Patients had corneal ulcer in 40% or abscess in 47.6%. All cases were positive on direct microscopy and 93% of cultures were positive. Filamentous fungi form the major etiologic agents (83%): Fusarium species (49% with F.solani [66%]), Aspergillus sp. (22%), Alternaria (5%), S. cedosporium sp. (2%); and non-identified mold in (5%). Yeast were identified in 17% of cases. Topical agents were used in 97% of cases: ketoconazole 2%, amphotericin B (0.5%). Fluconazole per os was administrated for 11% of cases, itraconazole (2 cases) and voriconazole (one case). Keratoplasty was indicated for 27% of cases. The outcome was favorable in 16% of patients. Among the patients, 71% had persistent corneal deposit sequelae. Four patients lost the eyeball. Conclusion: Corneal traumatism was the principal risk factor for fungal keratitis in young and middle-aged farmers. Fusarium solani is the predominant cause in Sfax. Early diagnosis, coupled with appropriate treatment, is crucial for increasing the chance of complete recovery. © 2014 Elsevier Masson SAS.


PubMed | Experimental Research Center, Ophthalmology Service and Federal University of Rio Grande do Sul
Type: | Journal: BMC pediatrics | Year: 2016

Retinoblastoma (Rb) is the most common intraocular tumor diagnosed in children in Brazil. However, detailed information is lacking regarding patient clinical demographics. This study aimed to determine the clinical profile of patients with Rb who were treated in a public university hospital in southern Brazil from 1983 to 2012.Patients medical records were reviewed to retrospectively identify patients with a principal diagnosis of Rb. Rb was classified as hereditary or non-hereditary. Clinical staging was reviewed by an ophthalmologist. Statistical analysis was performed using SPSS.Of 165 patients with a diagnosis of Rb during this period, 140 were included in the study. Disease was unilateral in 65.0% of patients, bilateral in 32.9%, and trilateral in 2.1%. The mean age at onset of the first sign/symptom was 18.1month, and 35.7% of patients were diagnosed during the first year of life. The most common presenting signs were leukocoria (73.6%) and strabismus (20.7%). The mean age at diagnosis was 23.5months, and time to diagnosis was 5.4months. In patients with clinical features of hereditary Rb, both onset of the first sign/symptom and diagnosis were at an earlier age than in patients without these features (12.3 vs 21.6months [P=0.001] and 15.9 vs 28.0months [P<0.001], respectively). However, there was no significant difference in overall survival between the two groups. Ocular stage at diagnosis was advanced in 76.5% (Reese V) and 78.1% (International Classification D or E). Of patients with unilateral and bilateral disease, 35.2% and 34.8%, respectively, had extraocular disease at diagnosis; 10.7% had metastatic disease at diagnosis. Enucleation was observed in 88.1% and exenteration in 11.9% of patients; 93.6% patients were followed until 2012, and 22.9% relapsed. Overall survival was 86.4%.Most Rb diagnoses are still diagnosed in advanced stages of the disease, considerably reducing overall survival time and the rate of eye and vision preservation.


PubMed | Ophthalmology Service
Type: | Journal: The Pan African medical journal | Year: 2016

Retinochoroiditis is the most common ocular manifestation of congenital toxoplasmosis, but other associated ophthalmological pathologies can also occur. Ophthalmologists are rarely able to distinguish between toxoplasmic retinochoroiditis due to infection acquired before or after birth, unless other clinical or serological indications are present. This article reports a case of a 3-year-old boy with abnormalities suggestive of congenital toxoplasmosis. The clinical and complementary examinations are discussed. The education of pregnant women is crucial for the prevention of congenital toxoplasmosis. Awareness of antenatal and postnatal presenting signs and symptoms is important for clinicians, because early diagnosis and treatment may minimize sequelae. Untreated, the majority of affected infants will develop chorioretinitis, deafness and/or neurological symptoms.

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