Dissertations / Theses on the topic 'Intracameral'

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Intracameral injection is used for treatment and anesthesia of the eye bulb and opioids are known to provide analgesia through this route. The aim of the study was to evaluate the viability and efficacy of intracameral nalbuphine and morphine in dogs. Seven beagle dogs were randomly included in the groups of intracameral nalbuphine (GNIC), intracameral morphine (GMIC), intravenous nalbuphine (GNIV) and intravenous morphine (GMIV) injection of either opioid. Variables were heart rate, respiratory rate, systolic arterial pressure, subjective pain scale, Schirmer's test, pupillary diameter, intraocular pressure, fluorescein test, corneal touch threshold, number and type of local or systemic complications and duration of effect on the cornea. Time point comprised baseline (T0) and measurements every 30 minutes after drugs administration up to 240 minutes. Parametric variables were analyzed through ANOVA for repeated measures and Dunnett's test. Ordinal data were compared through Friedman's test, followed by Dunn's test. Analyses were performed by SAS and were considered significant when P<0.05. Analgesia lasted significantly longer in GNIC, whereas GMIC, GNIV and GMIV did not differ between one another. There was a significant decrease in the IOP at T30 in all groups when compared to baseline measures. As for complications, no difference was found between groups. Therefore, both nalbuphine and morphine can be used for intracameral analgesia, and nalbuphine is the preferred option due to the prolonged analgesia.
FAPESP: 2013/02162-4

Resumo:A injeção intracameral é utilizada para tratamentos e anestesias oftálmicas e os opioides podem promover analgesia por esta via. Objetivou-se avaliar a viabilidade e a eficiência do uso de nalbufina e morfina pela via intracameral em cães. Sete cães da raça beagle foram alocados aleatoriamente nos grupos nalbufina intracameral (GNIC), morfina intracameral (GMIC), nalbufina intravenoso (GNIV) e morfina intravenoso (GMIV). Os parâmetros avaliados foram frequência cardíaca e respiratória, pressão arterial sistólica, escala subjetiva de avaliação da dor, teste da lágrima de Schirmer, diâmetro pupilar, pressão intraocular, teste de tingimento pela fluoresceína, limiar de toque corneal, número e tipo de complicação local e/ou sistêmica e a duração do efeito dos opioides na córnea. Os momentos de estudo foram basal (M0) e a cada 30 minutos após a administração dos grupos até completar 240 minutos. As variáveis numéricas foram submetidas à análise de variância com medidas repetidas e as médias comparadas pelo teste de Dunnett's. As categóricas não paramétricas ordinais foram comparadas pelo teste de Friedman com pós-teste de Dunn. As análises foram efetuadas empregando-se o programa SAS e foram consideradas significativas quando P < 0,05. A duração da analgesia foi significativamente maior no GNIC, enquanto GMIC, GNIV e GMIV não diferiram entre si. Houve redução significativa da PIO em M30 em todos os grupos quando comparado ao M0. Quanto ao número de complicações não houve diferença significativa entre os grupos. Portanto, tanto a nalbufina quanto a morfina são viáveis pela via intracameral sendo a nalbufina mais indicada pela maior duração de seu efeito analgésico.
Abstract:Intracameral injection is used for treatment and anesthesia of the eye bulb and opioids are known to provide analgesia through this route. The aim of the study was to evaluate the viability and efficacy of intracameral nalbuphine and morphine in dogs. Seven beagle dogs were randomly included in the groups of intracameral nalbuphine (GNIC), intracameral morphine (GMIC), intravenous nalbuphine (GNIV) and intravenous morphine (GMIV) injection of either opioid. Variables were heart rate, respiratory rate, systolic arterial pressure, subjective pain scale, Schirmer's test, pupillary diameter, intraocular pressure, fluorescein test, corneal touch threshold, number and type of local or systemic complications and duration of effect on the cornea. Time point comprised baseline (T0) and measurements every 30 minutes after drugs administration up to 240 minutes. Parametric variables were analyzed through ANOVA for repeated measures and Dunnett's test. Ordinal data were compared through Friedman's test, followed by Dunn's test. Analyses were performed by SAS and were considered significant when P<0.05. Analgesia lasted significantly longer in GNIC, whereas GMIC, GNIV and GMIV did not differ between one another. There was a significant decrease in the IOP at T30 in all groups when compared to baseline measures. As for complications, no difference was found between groups. Therefore, both nalbuphine and morphine can be used for intracameral analgesia, and nalbuphine is the preferred option due to the prolonged analgesia.
Orientador:Valéria Nobre Leal de Souza Oliva
Banca:Lídia Mitsuko Matsubara
Banca:Flavia de Almeida Lucas
Banca:Alexandre Lima de Andrade
Banca:Celina Tie Duque Nishimori
Doutor

Background: In order to perform cataract surgery, adequate dilatation of the pupil is essential. This is traditionally achieved by preoperative topical mydriatic eye-drops, commonly cyclopentolate and phenylephrine. This routine has several disadvantages. First, the slow penetration through the cornea delays the onset of mydriasis. Second, the limited bioavailability of topically administered substances with significant systemic absorption may increase the risk for systemic side effects. Third, even if good mydriasis is achieved initially with topical mydriatics (TM), the effect tends to wear off during surgery. In relation to cataract surgery a transient postoperative corneal oedema is sometimes noted, indicating effects on the corneal endothelial pump function. These effects have been ascribed to ultrasonic or mechanical trauma from the phacoemulsification procedure. Corneal endothelial cell loss (ECL) is a commonly studied variable, not least because it is associated with the long-term risk for corneal decompensation. But, there has been a debate whether postoperative corneal swelling after phacoemulsification cataract surgery correlates to ECL. Aims: To evaluate an alternative mydriatic regimen for phacoemulsification cataract surgery: intracameral injection of mydriatics mixed with lidocaine (ICM). Additionally, to determine the correlation between early transient postoperative corneal oedema and permanent ECL after phacoemulsification cataract surgery. Methods: Pupil dilatation with ICM (150 µl of lidocaine 1%, phenylephrine 1.5%, and cyclopentolate 0.1%) was compared to TM (phenylephrine 10% and cyclopentolate 1%) prior to cataract surgery. Additionally, two ICM-groups were randomized to receive either 0.6 µg/ml epinephrine added to the irrigating balanced salt solution or no epinephrine in the irrigation solution. Furthermore, two randomized ICM-groups, with or without cyclopentolate, were analyzed. The patients planned for cataract surgery were examined with ultrasonic pachymetry, specular microscope endothelial photography and Orbscan II slit-scan tomography pre- and postoperatively. Results: With ICM, mydriasis reached 95 ± 3% of its final value within 20 seconds. In the ICM-group, the pupils were smaller than in the TM-group (mean 6.7 ± 1.0 mm versus 7.7 ± 1.0 mm, P<.001), but did not contract intraoperatively as the TM pupils did. Conversely, with ICM the pupil sizes generally increased during the cataract procedures. This increase was significantly greater without epinephrine in the irrigating solution (13 ± 19% versus 4 ± 14%; p = 0.02). No significant differences in pupil sizes were observed between the patients who were given ICM with or without cyclopentolate. The central corneal swelling at the first postoperative day was strongly correlated to the central ECL at 3 months, R2 = 0.785, P < 0.001. Conclusions: ICM is a rapid and safe alternative to TM in phacoemulsification cataract surgery. An irrigating solution without epinephrine can safely be used with ICM. Cyclopentolate, administrated intracamerally, has no immediate additive mydriatic effect to intracameral lidocaine combined with phenylephrine. The degree of permanent corneal endothelial damage in cataract surgery is reflected in the degree of early postoperative corneal swelling.

Background: Compare Goldmann applanation tonometer (GAT) prism and correcting applanation tonometry surface (CATS) prism to intracameral intraocular pressure (IOP), in vivo and in vitro. Methods: Pressure transducer intracameral IOP was measured on fifty-eight (58) eyes undergoing cataract surgery and the IOP was modulated manometrically to 10, 20, and 40 mmHg. Simultaneously, IOP was measured using a Perkins tonometer with a standard GAT prism and a CATS prism at each of the intracameral pressures. Statistical comparison was made between true intracameral pressures and the two prism measurements. Differences between the two prism measurements were correlated to central corneal thickness (CCT) and corneal resistance factor (CRF). Human cadaver eyes were used to assess measurement repeatability. Results: The CATS tonometer prism measured closer to true intracameral IOP than the GAT prism by 1.7+/-2.7 mmHg across all pressures and corneal properties. The difference in CATS and GAT measurements was greater in thin CCT corneas (2.7+/-1.9 mmHg) and low resistance (CRF) corneas (2.8+/-2.1 mmHg). The difference in prisms was negligible at high CCT and CRF values. No difference was seen in measurement repeatability between the two prisms. Conclusion: A CATS prism in Goldmann tonometer armatures significantly improve the accuracy of IOP measurement compared to true intracameral pressure across a physiologic range of IOP values. The CATS prism is significantly more accurate compared to the GAT prism in thin and less rigid corneas. The in vivo intracameral study validates mathematical models and clinical findings in IOP measurement between the GAT and CATS prisms.

Objectiu: Valorar l'efecte de la combinació fixa de midriatics i anestèsic intracamerals (ICMA) en comparació amb les gotes oculars midriàtiques i anestèsiques estàndard sobre la superfície ocular. Disseny: un assaig clínic de fase IV, obert i aleatori, realitzat a l'Institut de Microcirugía Ocular (IMO, Barcelona, Espanya). Mètodes: es van incloure a l'estudi 50 pacients d'entre 40 i 88 anys sotmesos a cirurgia de cataracta als dos ulls. ICMA es va administrar en un sol ull i el tractament estàndard de midriàtics/ anestèsics a l'altre ull. Abans de realitzar la cirurgia de cataracta al primer ull, es van aleatoritzar els subjectes (1:1) per rebre ICMA (amb clorhidrat d'oxibuprocaina 0,4% + clorhidrat de tetracaina 0,1%) o simplement gotes oculars (tropicamida 1%, fenilefrina 10% i clorhidrat d'oxibuprocaina 0,4% + clorhidrat de tetracaina 0,1%). La cirurgia de l'segon ull es va realitzar dins dels 7 dies posteriors a la primera cirurgia. Totes les cirurgies van ser realitzades per un sol cirurgià. Els pacients es van avaluar abans, immediatament després, un dia i 7 dies després de la cirurgia. Resultats: Els dos grups van presentar dades preoperatòries similars. El primer dia postoperatori, la variació en la tinció de la superfície corneal i conjuntival, des del moment basal, va ser lleugerament menor per a la ICMA, però no va ser estadísticament significativa. En els pacients tractats amb ICMA, les alteracions de l’epiteli corneal van ser menys el primer dia postoperatori (p<0,005), la reacció foliculo-papil·lar va ser menys freqüent (p=0,015); els símptomes oculars com irritació / cremor / coïssor van ser menys freqüents i més lleus (p=0,018), la durada de l'procediment va ser més curta (p<0,001) i la satisfacció dels pacients i dels investigadors va ser més alta (p<0,05). La dispersió intraocular i altres canvis postoperatoris generalment van afavorir la ICMA, però no van ser estadísticament significatius. No es van detectar esdeveniments adversos greus i relacionats amb el tractament. Conclusions: L'ús de ICMA en la cirurgia de cataractes va reduir el dany de la superfície ocular a l'disminuir la toxicitat conjuntival i de l'epiteli corneal amb una recuperació més ràpida de la integritat de la superfície ocular, en comparació amb el tractament tòpic. ICMA va reduir el temps de procediment, va augmentar la comoditat intraoperatòria, va disminuir els símptomes postoperatoris i va millorar la satisfacció dels pacients i dels investigadors.
Objetivo: Evaluar los efectos de la combinación fija intracameral de midriáticos y anestésico (ICMA) en comparación con el tratamiento estándar con gotas oftálmicas de midriáticos y anestésicos en la superficie ocular. Diseño: un ensayo clínico de fase IV, abierto y aleatorizado, realizado en el Instituto de Microcirugía Ocular (IMO, Barcelona, España). Métodos: 50 pacientes, de 40 a 88 años, sometidos a cirugía de catarata en ambos ojos fueron incluidos en el estudio. ICMA se administró en un ojo y los midriáticos/anestésicos tópicos en el otro. Antes de la cirugía en el primer ojo, se aleatorizó a los sujetos (1:1) a recibir el primer tratamiento: ICMA tras la instilación de clorhidrato de oxibuprocaína 0,4% + clorhidrato de tetracaína 0,1% o solo los colirios midriáticos y anestésicos (tropicamida 1%, fenilefrina 10% y clorhidrato de oxibuprocaína 0,4% + clorhidrato de tetracaína 0,1%). La cirugía del segundo ojo se realizó dentro de los 7 días posteriores a la primera cirugía. Todas las cirugías fueron realizadas por un solo cirujano. Los pacientes fueron evaluados antes, inmediatamente después, 1 día y 7 días después de la cirugía. Resultados: Ambos grupos presentaron datos preoperatorios similares. El primer día postoperatorio, la variación en la tinción de la superficie corneal y conjuntival, desde el momento basal, fue ligeramente menor para ICMA, pero no fue estadísticamente significativo. Para los pacientes tratados con ICMA, las alteraciones del epitelio corneal fueron menores el primer día postoperatorio (p<0.005), la reacción folículo-papilar conjuntival fue menos frecuente (p=0.015), los síntomas oculares como irritación/ardor/escozor fueron menos frecuentes y más leves (p=0.018), la duración del procedimiento fue más corta (p<0.001), y la satisfacción de los pacientes e investigadores fue mayor (p<0.05). La dispersión intraocular y otros cambios postoperatorios generalmente favorecieron a ICMA, pero no fueron estadísticamente significativos. No se detectaron eventos adversos graves ni relacionados con el tratamiento. Conclusiones: El uso de ICMA en la cirugía de cataratas redujo el daño de la superficie ocular al disminuir la toxicidad conjuntival y del epitelio corneal con una recuperación más rápida de la integridad de la superficie ocular, en comparación con el tratamiento tópico. ICMA acortó el tiempo del procedimiento, aumentó la comodidad intraoperatoria, disminuyó los síntomas postoperatorios y mejoró la satisfacción de los pacientes e investigadores.
Purpose: To assess the effect of intracameral fixed combination of mydriatics and anaesthetic (ICMA) compared to standard mydriatic and anaesthetic eye drops on ocular surface. Design: A phase IV, open-label, randomized clinical trial conducted in the Institute of Ocular Microsurgery (IMO, Barcelona,Spain). Methods: 50 patients, aged 40 to 88 years, undergoing cataract surgery in both eyes were included in the study. ICMA was administered in one eye and the standard mydriatic/anaesthetic eye drops in the fellow eye. Before performing the cataract surgery in the first eye, subjects were randomized (1:1) to receive ICMA (with oxybuprocain chlorhydrate 0.4%+ tetracaine chlorhydrate 0.1%) or just eye drops (tropicamide 1%, phenylephrine 10% and oxybuprocain chlorhydrate 0.4% + tetracaine chlorhydrate 0.1%). Surgery of the fellow eye was performed within 7 days after the first surgery. All surgeries were performed by one single surgeon. Patients were evaluated before, immediately after, 1 day and 7 days after the surgery. Results: Both groups presented similar preoperative data. The first postoperative day, the change from baseline in corneal and conjunctival surface staining was slightly less for ICMA, but not statistically significant. For the ICMA treated patients, corneal epithelial alterations were fewer the first postoperative day (p<0.005), conjunctival folliculo-papillary reaction was less frequent (p=0.015), ocular symptoms such as irritation/burning/stinging were less frequent and milder (p=0.018), length of procedure was shorter (p<0.001), and patient and investigator satisfaction were higher (p<0.05). Intraocular scattering and other postoperative changes generally favoured ICMA but were not statistically significant. Serious and related adverse events were not detected. Conclusions: ICMA in routine cataract surgery reduced ocular surface damage by decreasing corneal epithelial and conjunctival toxicity with faster recovery of ocular surface integrity, compared to topical eye drops. ICMA shortened the procedure time, increased the intraoperative comfort, decreased the postoperative symptoms and improved patient and investigator satisfaction.

Background: Goldmann applanation tonometry (GAT) error relative to intracameral intraocular pressure (IOP) has not been examined comparatively in both human cadaver eyes and in live human eyes. Futhermore, correlations to biomechanical corneal properties and positional changes have not been examined directly to intracameral IOP and GAT IOP. Methods: Intracameral IOP was measured via pressure transducer on fifty-eight (58) eyes undergoing cataract surgery and the IOP was modulated manometrically on each patient alternately to 10, 20, and 40 mmHg. IOP was measured using a Perkins tonometer in the supine position on 58 eyes and upright on a subset of 8 eyes. Twenty one (21) fresh human cadaver globes were Intracamerally IOP adjusted and measured via pressure transducer. Intracameral IOP ranged between 5 and 60 mmHg. IOP was measured in the upright position with a Goldmann Applanation Tonometer (GAT) and supine position with a Perkins tonometer. Central corneal thickness (CCT) was also measured. Results: The Goldmann-type tonometer error measured on live human eyes was 5.2 +/- 1.6 mmHg lower than intracameral IOP in the upright position and 7.9 +/- 2.3 mmHg lower in the supine position (p <.05). CCT also indicated a sloped correlation to error (correlation coeff. = 0.18). Cadaver eye IOP measurements were 3.1+/-2. 5 mmHg lower than intracameral IOP in the upright position and 5.4+/- 3.1 mmHg in the supine position (p <.05). Conclusion: Goldmann IOP measures significantly lower than true intracameral IOP by approximately 3 mmHg in vitro and 5 mmHg in vivo. The Goldmann IOP error is increased an additional 2.8 mmHg lower in the supine position. CCT appears to significantly affect the error by up to 4 mmHg over the sample size.

Propósito: Determinar en intervenciones de facoemulsificación de pacientes que toman tamsulosina el efecto de la profilaxis de la fenilefrina intracameral sobre la incidencia y el grado de síndrome del iris fláccido intraoperatorio comparado con no recibir la fenilefrina intracameral. Métodos: Se revisaron todas las historias clínicas de los pacientes que se operaron de cataratas por facoemulsificación entre enero de 2009 y julio de 2010. Se detectaron previamente los pacientes que tomaban tamsulosina y se decidió establecer un grupo con fenilefrina intracameral (casos) y otro grupo sin fenilefrina (controles). El IFIS se definió y clasificó por la presencia de cualquiera de los tres fenómenos que constituyen el síndrome (ondulación del iris, prolapso del iris y la constricción pupilar). Se registraron los tiempos quirúrgicos, incidencias y complicaciones. Resultados: Se identificaron con una revisión de 3156 intervenciones de catarata, 100 intervenciones de 64 pacientes que tomaban tamsulosina en el momento de la cirugía. Se determinó una incidencia de toma de tamsulosina de 3,1% en el total de las intervenciones. 70 ojos recibieron profilaxis con fenilefrina intracameral y la incidencia de IFIS fue del 12%, presentándose el 9% en grado 1 y el 3% en grado 2. 28 ojos no recibieron fenilefrina intracameral y la incidencia de IFIS fue del 68%, presentándose el 11% en grado 1, el 39% en grado 2 y el 18% en grado 3. Por otro lado, 2 ojos se excluyeron del análisis final por la utilización de ganchos retractores del iris al inicio de la intervención, imposibilitando valorar la presencia de IFIS. Se reportaron como complicaciones en 2 ojos la rotura de la cápsula posterior con pérdida del vítreo (2%), estos casos correspondían a ojos que no recibieron fenilefrina intracameral y que presentaron grado 3. Se observaron tiempos quirúrgicos más prolongados en los ojos sin fenilefrina intracameral, que necesitaron 3 minutos más de media. Por otro lado a mayor grado de IFIS fue necesario mayor tiempo quirúrgico para finalizar la intervención. Conclusiones: La incidencia de IFIS en el grupo sin fenilefrina fue similar a otras publicaciones. Los ojos sin fenilefrina intracameral presentaron 5,77 veces más riesgo de desarrollar IFIS. El uso profiláctico de fenilefrina intracameral redujo la incidencia y el grado de IFIS. En este grupo el tiempo quirúrgico fue menor y no se produjeron complicaciones. Se compararon los datos obtenidos con publicaciones con resultados comparables. Divulgación financiera: No hay ningún interés financiero en cualquier material o método mencionado.
Purpose: To determine the grade and incidence of intraoperative floppy iris syndrome (IFIS) in patients who are under treatment with tamsulosine and are performed cataract extraction surgery through phacoemulsification, compared to patients with the same characteristics but who are not applied intracameral phenylephrine during phacoemulsification. Methods: The files of all the patients who were done cataract surgery extraction through phacoemulsification from January 2009 to July 2010 were checked. Previously, the patients who were under treatment with tamsulosine were identified and to these latter two groups were established under the basis of a case-control study: the cases were the patients that were treated transurgically with intracameral phenylephrine and the controls were the patients with the same conditions but that were not treated with transurgical intracameral phenylephrine. IFIS was defined and classified by the presence of any phenomena that constitute this syndrome (iris ondulation, iris prolapse through the wounds and pupillary constriction). The surgical time, surgical incidents and complications were registered. Results: With a total of 3156 cataract surgeries, 100 eye surgical interventions were identified of 64 patients who were taking tamsulosine at the moment of the surgery. In the total of the surgical interventions, the incidence of tamsulosine intake was 3.1%. 70 eyes received prophylaxis with intracameral phenylephrine and the IFIS incidence was of 12%. Out of this 12%, 9% was grade 1, and 3% grade 2. 28 eyes that did not receive intracameral pheyleprhine presented and IFIS incidence of 68%, with 11% being grade 1, 29% grade 2 and 18% grade 3. On the other hand, 2 eyes were excluded from the final analysis because of iris hooks use at the beginning of the surgery. As part of the complications reported, posterior capsular rupture with vitreous loss was present in 2 eyes that presented grade 3 IFIS, and none of these were treated with prophylactic intracameral phenylephrine. The patients that were not treated with prophylactic intracameral phenylephrine presented longer time in the surgical intervention, with an average of an excess of 3 minutes. On the other hand, the higher the grade of the IFIS, the longer was the surgical time. Conclusions: The incidence of IFIS in the group without phenylephrine was similar to the one reported in other publications. The latter presented 5.77 times more risk of presenting IFIS. The use of prophylactic intracameral phenylephrine significantly reduced the grade and incidence of IFIS. In this group the surgical time was less and no complications were presented. The data obtained was compared with other publications with similar results. Financial disclosure: The authors of this study do not have financial interests.

Objetivo: Hallar una dosis de cloruro de benzalconio (BAC) que, inyectada por vía intracameral en conejos, provoque daño selectivo sobre el endotelio corneal, sin afectar al resto de estructuras intraoculares, creando un modelo animal repetible y reproducible de enfermedad endotelial corneal. Materiales y métodos: Estudio ex vivo inicial con 40 ojos de conejo obtenidos post-mortem, que se dividieron en 8 grupos en función del compuesto inyectado por vía intracameral: control (sin inyección), BSS (solución salina balanceada), y concentraciones crecientes de BAC (0,005%, 0,01%, 0,025%, 0,05%, 0,1% y 0,2%). Estudio in vivo con 24 conejos, que fueron divididos en 4 grupos: BSS (grupo control) y BAC al 0,025%, 0,05% y 0,1%. Solamente se emplearon conejos sanos y ojos sin alteraciones. Las inyecciones intracamerales se efectuaron en el limbo esclerocorneal utilizando una aguja de 27G. con la ayuda de gafas lupa. En ambos estudios, se realizaron evaluaciones de exploración oftalmológica, paquimetría y microscopía especular (a las 0, 6, 24 y 48 horas en el estudio ex vivo; y a los 0, 2, 7 y 14 días en el estudio in vivo). A los 14 días, los conejos del estudio in vivo fueron eutanasiados. Al final de cada estudio, se realizaron tinciones vitales de las córneas para evaluar la morfología y viabilidad de las células endoteliales corneales (CECs). En el estudio in vivo también se hizo histopatología de los globos oculares. Resultados: Estudio ex vivo: Comparado con BSS, la densidad de las CECs comenzó a disminuir de manera significativa a la concentración de BAC 0,025%, mientras que la superficie de las CECs, el grado de edema corneal y el espesor corneal aumentaron de forma significativa con BAC al 0,05%, 0,005% y 0,1%, respectivamente. Concentraciones de BAC al 0,05% y superiores ocasionaron aumentos significativos en la mortalidad y el pleomorfismo de las CECs, en comparación con el control y BSS. Estudio in vivo: Comparado con el BSS, concentraciones de BAC al 0,025% y superiores provocaron aumento significativo en el grado de edema y espesor corneales, y en la superficie y el polimegatismo de las CECs. La mortalidad de las CECs fue significativamente mayor a partir de BAC 0,05%. La densidad y hexagonalidad de las CECs disminuyeron significativamente en todos los grupos de BAC. BAC al 0,1% ocasionó mayor número de casos de congestión conjuntival y úlceras corneales. La histopatología no reveló alteraciones significativas que afectasen al resto de las estructuras oculares tras la inyección de BAC. Conclusiones: La inyección intracameral de 0,1 ml de BAC al 0,05% en conejos provoca daño selectivo sobre el endotelio corneal, sin afectar al resto de estructuras intraoculares. Esta técnica, desarrollada y validada en un estudio ex vivo y otro in vivo, puede utilizarse para inducir un modelo animal repetible y reproducible de enfermedad endotelial corneal en conejos.
Objective: Find a dose of benzalkonium chloride (BAC) which, injected into the anterior chamber in rabbits, causes a selective damage on the corneal endothelium, without affecting the rest of intraocular structures and thus can be used to induce a repeatable and reproducible animal model of corneal endothelial disease. Material and Methods: First, an ex vivo study was performed using 40 rabbit eyes obtained postmortem, which were classified into 8 groups depending on the injected compound: Control (no injection), Balance salt solution (BSS), and increasing concentrations of BAC (0.005%, 0.01%, 0.025%, 0.05%, 0.1% and 0.2%). Secondly, an in vivo study was performed using 24 New Zealand White rabbits, which were classified into 4 groups: BSS (control group); and 0.025%, 0.05% and 0.1% BAC. Only healthy rabbits and eyes without abnormalities were used. The intracameral injections were made at the corneoscleral limbus using a 27G needle and magnifying loupes. In both studies, follow-up assessments of ophthalmological examination, pachymetry and specular microscopy were performed (at 0, 6, 24 and 48 hours in the ex vivo study; and at 0, 2, 7 and 14 days in the in vivo study). Fourteen days after injection, the rabbits from the in vivo study were euthanized. At the end of each study, corneas were vital-stained and evaluated under the light microscope in order to assess the morphology and viability of the corneal endothelial cells (CECs). In the in vivo study, histopathology of the eye globes was also performed. Results: Ex vivo study: Compared to BSS, the CECs density began to decrease significantly with 0.025% BAC, while the CECs area, the degree of corneal edema and the corneal thickness increased significantly with 0.05%, 0.005% and 0.1% BAC, respectively. BAC concentrations of 0.05% and above caused significant increases in CECs mortality and pleomorphism, compared to control and BSS. In vivo study: Compared to BSS, concentrations of 0.025% BAC and above caused a significant increase in the degree of corneal edema and corneal thickness, and in CECs area and polymeghetism. CECs mortality was significantly higher with 0.05% BAC and above concentrations. The CECs density and hexagonality decreased significantly in all BAC groups. A concentration of 0.1% BAC resulted in a higher number of cases presenting with conjunctival congestion and corneal ulcers. Histopathology revealed no significant alterations affecting the rest of the ocular structures after BAC injection. Conclusions: Intracameral injection of 0.1 ml 0.05% BAC in rabbits causes a selective damage on the corneal endothelium, without affecting the rest of intraocular structures. This technique, developed and validated in an ex vivo and an in vivo study, could be used to induce a repeatable and reproducible animal model of endothelial corneal disease in rabbits.

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A catarata situa-se entre as afecções oculares mais frequentes em cães. A facoemulsificação é o método que melhor se adéqua à terapia e o preferido entre os oftalmologistas. A celularidade do endotélio é condição a ser considerada para o sucesso da cirurgia, uma vez que lesões endoteliais podem induzir descompensação corneal permanente. Avaliou-se o papel antioxidante do ácido ascórbico intracameral sobre o endotélio corneal e sobre o fator de necrose tumoral alfa (TNF-α) expresso no humor aquoso, em cães submetidos à facoemulsificação. Utilizaram-se 40 olhos de 20 pacientes, machos ou fêmeas, com 7 a 12 anos, portando catarata senil bilateral. Conceberam-se dois grupos (n=20). Grupo 1 (G1), recebeu solução salina balanceada (BSS); Grupo 2 (G2), recebeu 0,001M de ácido ascórbico estéril diluído em BSS. O endotélio corneal foi avaliado à microscopia especular de não contato, antes e em diferentes momentos após a facoemulsificação. Avaliaram-se a densidade (células/mm2) e a área (mm2) celular, a espessura corneal (mm), a hexagonalidade e o coeficiente de variação do tamanho celular. O humor aquoso foi avaliado quanto à expressão do fator de necrose tumoral alfa (TNF-α). Valores de p iguais ou inferiores a 0,05 foram considerados significativos. Com relação à densidade de células endoteliais, ambos os grupos apresentaram perdas, porém essas foram menores no G2. Relativamente à espessura corneal, não houve diferença. A hexagonalidade diminuiu significativamente no pós-operatório imediato no G1. Ainda no G1, o coeficiente de variação do tamanho celular aumentou significativamente. Não se encontrou reação marcada do TNF-α em ambos os grupos. De consoante com os resultados obtidos, admiti-se que o ácido ascórbico contribuiu para se minimizarem perdas celulares, relativamente ao endotélio corneal na facoemulsificação
Cataract is among the most common eye diseases in dogs. Phacoemulsification is the method that best fits to therapy and a favorite among veterinary ophthalmologists. The cellularity of the corneal endothelium is considered to be a condition for the success of the surgery, since a permanent endothelial injury can induce corneal decompensation. The goal of this study was to evaluate the antioxidant effects of ascorbic acid on the corneal endothelium, as well as the expression of the tumor necrosis factor alpha (TNF-α) in the aqueous humor was evaluated of dogs submitted to phacoemulsification. It was used 40 eyes of 20 dogs, male or female, with 7 to 12 years, and bilateral senile cataracts. The dogs were separated into two groups (n = 20), differing only in the composition of the solution used to irrigate the eyes in the phacoemulsification. Group 1 (G1) received balanced salt solution (BSS) and Group 2 (G2) received sterile BSS containing 0.001 M ascorbic acid. The corneal endothelium was evaluated by non-contact specular microscopy before and at different times after phacoemulsification, in terms of cell density (cells/mm2), cell area (mm2), corneal thickness (mm), hexagonality, and coefficient of variation in cell size. The expression of TNF-α in the aqueous humor was measured by competitive enzyme immunoassay. P values equal to or less than 0.05 were considered significant. Regarding the density of endothelial cells, both groups showed losses, but these were lower in G2. There were no significant differences in corneal thickness (P>0.05). The hexagonality significantly reduced in the immediate postoperative of G1. Also in G1, the coefficient of variation in cell size increased. TNF-α expression was not observed in the aqueous humor in G1 and G2. According to the results, it can be assumed that ascorbic acid was able to minimize losses in endothelial cellularity arising from phacoemulsification

Orientador: José Luiz Laus
Banca: Paola Castro Moraes
Banca: Marcela Aldrovani Rodrigues
Banca: Arianne Pontes Oria
Banca: Adriana Morales
Resumo: A catarata situa-se entre as afecções oculares mais frequentes em cães. A facoemulsificação é o método que melhor se adéqua à terapia e o preferido entre os oftalmologistas. A celularidade do endotélio é condição a ser considerada para o sucesso da cirurgia, uma vez que lesões endoteliais podem induzir descompensação corneal permanente. Avaliou-se o papel antioxidante do ácido ascórbico intracameral sobre o endotélio corneal e sobre o fator de necrose tumoral alfa (TNF-α) expresso no humor aquoso, em cães submetidos à facoemulsificação. Utilizaram-se 40 olhos de 20 pacientes, machos ou fêmeas, com 7 a 12 anos, portando catarata senil bilateral. Conceberam-se dois grupos (n=20). Grupo 1 (G1), recebeu solução salina balanceada (BSS); Grupo 2 (G2), recebeu 0,001M de ácido ascórbico estéril diluído em BSS. O endotélio corneal foi avaliado à microscopia especular de não contato, antes e em diferentes momentos após a facoemulsificação. Avaliaram-se a densidade (células/mm2) e a área (mm2) celular, a espessura corneal (mm), a hexagonalidade e o coeficiente de variação do tamanho celular. O humor aquoso foi avaliado quanto à expressão do fator de necrose tumoral alfa (TNF-α). Valores de p iguais ou inferiores a 0,05 foram considerados significativos. Com relação à densidade de células endoteliais, ambos os grupos apresentaram perdas, porém essas foram menores no G2. Relativamente à espessura corneal, não houve diferença. A hexagonalidade diminuiu significativamente no pós-operatório imediato no G1. Ainda no G1, o coeficiente de variação do tamanho celular aumentou significativamente. Não se encontrou reação marcada do TNF-α em ambos os grupos. De consoante com os resultados obtidos, admiti-se que o ácido ascórbico contribuiu para se minimizarem perdas celulares, relativamente ao endotélio corneal na facoemulsificação
Abstract: Cataract is among the most common eye diseases in dogs. Phacoemulsification is the method that best fits to therapy and a favorite among veterinary ophthalmologists. The cellularity of the corneal endothelium is considered to be a condition for the success of the surgery, since a permanent endothelial injury can induce corneal decompensation. The goal of this study was to evaluate the antioxidant effects of ascorbic acid on the corneal endothelium, as well as the expression of the tumor necrosis factor alpha (TNF-α) in the aqueous humor was evaluated of dogs submitted to phacoemulsification. It was used 40 eyes of 20 dogs, male or female, with 7 to 12 years, and bilateral senile cataracts. The dogs were separated into two groups (n = 20), differing only in the composition of the solution used to irrigate the eyes in the phacoemulsification. Group 1 (G1) received balanced salt solution (BSS) and Group 2 (G2) received sterile BSS containing 0.001 M ascorbic acid. The corneal endothelium was evaluated by non-contact specular microscopy before and at different times after phacoemulsification, in terms of cell density (cells/mm2), cell area (mm2), corneal thickness (mm), hexagonality, and coefficient of variation in cell size. The expression of TNF-α in the aqueous humor was measured by competitive enzyme immunoassay. P values equal to or less than 0.05 were considered significant. Regarding the density of endothelial cells, both groups showed losses, but these were lower in G2. There were no significant differences in corneal thickness (P>0.05). The hexagonality significantly reduced in the immediate postoperative of G1. Also in G1, the coefficient of variation in cell size increased. TNF-α expression was not observed in the aqueous humor in G1 and G2. According to the results, it can be assumed that ascorbic acid was able to minimize losses in endothelial cellularity arising from phacoemulsification
Doutor

Trabajo de Investigación Requisito para optar al Título de Cirujano Dentista
Introducción: Las opciones de tratamiento para dientes no vitales con cambio de coloración incluyen los blanqueamientos, carillas o coronas. La ventaja del blanqueamiento es ofrecer un manejo simple y conservador en la remoción de tinciones, blanqueando dientes decolorados sin dañar la estructura dentaria. La técnica más utilizada en dientes no vitales es “WalkingBleach” y los agentes más usados son Peróxido de Hidrógeno y Peróxido de Carbamida. El objetivo de este estudio es comparar espectrofotométricamente la regresión del color post blanqueamiento intracoronario con dos agentes blanqueadores (Peróxido de Hidrógeno o Peróxido de Carbamida) con la técnica de WalkingBleach. Materiales y Métodos: Estudio de seguimiento: participaron 41 pacientes de un grupo de 47 previamente clareados mediante la técnica WalkingBleach, que cumplieran con los criterios de inclusión y exclusión, divididos en dos grupos según el agente blanqueador utilizado: Peróxido de Hidrógeno al 35% (G1) y Peróxido de Carbamida al 37% (G2). Se midió la variación total del color (medido como delta E), que representaba la diferencia entre cada control con el baseline respecto a los valores de los ejes tridimensional: L, a y b, con el espectrofotómetro Vita Easyshade® a los 3 meses, 6 meses y año post-clareamiento. Los datos obtenidos con el espectrofotómetro fueron analizados por el test de Shapiro Wilk para evaluar normalidad de la distribución, y posteriormente sometidos a la prueba Mann-Whitney U y Wilcoxon W. Los datos se consideraron estadísticamente significativos cuando p<0,05. Resultados: El Delta E (ΔE) a los 3 meses fue: 14.15 mediana (G1) y 15.01 mediana (G2), delta E a los 6 meses: 13.44 mediana (G1) y 14.06 mediana (G2) y Delta E al año: 13.21 mediana (G1) y 14.48 mediana (G2). No existen diferencias estadísticamente significativas en cada grupo (p>0,05). No existen diferencias estadísticamente significativas al comparar ambos grupos (p>0,05) Conclusiones: El color presentó estabilidad a los 3 meses, 6 meses y año. No existen diferencias al comparar ambos grupos en ninguno de los períodos de tiempo.
Adscrito a Proyecto Niveles de RANKL-OPG extraradicular y efectividad del blanqueamiento intracoronario en dientes no vitales. PRIO-DO No. 03/016

Trabajo de Investigación Requisito para optar al Título de Cirujano Dentista
Introducción: La sonrisa es percibida como parte esencial de la estética facial. Existe una creciente demanda de la gente para tratar manchas y cambios de color en los dientes, ya que decoloración de éstos puede afectar la calidad de vida de las personas, aumentando la sensación de disconfort e impacto psicosocial. El tratamiento incluye blanqueamientos, carillas o coronas, dentro de los cuales el blanqueamiento se destaca como la opción más conservadora y que no impide otro tratamiento en el futuro. La técnica más utilizada en dientes no vitales es la “Walking Bleach” y entre los agentes más frecuentemente empleados se encuentran el Peróxido de Hidrógeno y Peróxido de Carbamida, aunque no existen muchos estudios que comparen la efectividad de estos dos agentes en dientes desvitalizados. El objetivo de este estudio es evaluar clínicamente la efectividad del blanqueamiento intracoronario mediante la técnica “Walking Bleach” con Peróxido de Hidrógeno y Peróxido de Carbamida, con medición visual. Materiales y métodos: El estudio corresponde a un ensayo clínico aleatorio doble ciego. La muestra fue conformada inicialmente por 50 pacientes voluntarios, cuyas edades fluctuaron entre los 19 y 65 años, de ambos sexos, de los cuales 46 participaron en el estudio, quienes firmaron un consentimiento informado. El estudio fue realizado en 50 dientes con cambio de coloración, utilizando la técnica de blanqueamiento “Walking Bleach”. La muestra fue dividida en dos grupos de 25 dientes cada una. El grupo 1 (G1) fue blanqueado con Peróxido de Hidrógeno al 35% y el grupo 2 (G2) fue blanqueado con Peróxido de Carbamida al 37%, cada uno en un protocolo de 4 sesiones de blanqueamiento. El color fue medido con escala Vita Classical y Vita Bleachguide 3D-Master otorgándole valor numérico ordenado por luminosidad. Se registró el color de los dientes al inicio del tratamiento (“baseline”), luego en cada sesión de blanqueamiento, en los controles a la semana y al mes post-tratamiento. Los datos se consideraron estadísticamente significativos cuando p<0.05. Resultados: Ambos grupos mostraron cambios de color al compararse a los valores iniciales, siendo G1 el que presentó las mayores variaciones en todas las mediciones. Las diferencias entre G1 y G2 resultaron estadísticamente significativas en casi todos los tiempos de medición. Discusión: Se considera que ambos geles son efectivos en el blanqueamiento dental. También, que el Peróxido de Hidrógeno produce una decoloración más dramática de los dientes tratados, mayor a la producida por Peróxido de Carbamida. Se distingue la diferencia de medición entre las guías Vita Classical y Vita Bleachguide 3D-Master, lo cual se condice la forma de fabricación de las mismas, ya que la primera fue diseñada basada principalmente en el tono del color mientas la segunda se creada en un orden por valor. Conclusiones: El Peróxido de Hidrógeno al 35% y el Peróxido de Carbamida al 37% son geles efectivos para el tratamiento en cuestión, teniendo el primero mayores diferencias de color que el segundo.
Adscrito a Proyecto Niveles de RANKL-OPG extraradicular y efectividad del blanqueamiento intracoronario en dientes no vitales. PRI-ODO No. 03/016

Trabajo de Investigación Requisito para optar al Título de Cirujano Dentista
Introducción: La odontología actual se centra en la sonrisa, en la cual el color de los dientes tiene un rol protagónico. La decoloración en un único diente genera una mayor incomodidad, debido a que la atención se centra en ese diente, uno de los tratamientos a elección en este caso es el blanqueamiento intracoronario en el cual la técnica más común y usada es la técnica “Walking bleach”. El objetivo de este estudio es evaluar y comparar la regresión del color posterior al blanqueamiento intracoronario de dos agentes blanqueadores en un periodo de 6 y 12 meses usando la técnica “Walking bleach”. Materiales y métodos: Se citaron a control pacientes participantes del proyecto “Niveles de RANKL-OPG extraradicular y Efectividad del Blanqueamiento Intracoronario en Dientes No Vitales” PRI-ODO N° 03/016, el cual consistió en un blanqueamiento intracoronario utilizando la técnica “Walking Bleach”. Según criterios de inclusión y exclusión la muestra conformada por 50 dientes fue reducida a 41 dientes, de los cuales 21 dientes correspondientes al grupo G1 fueron blanqueados con Peróxido de Hidrógeno al 35% y 20 dientes correspondientes al grupo G2 fueron tratados con Peróxido de Carbamida al 37%. Estos pacientes fueron citados a control a los 6 meses y 12 meses para evaluar el color dentario con escala VITA classical A1-D4® y VITA Bleachedguide 3D- MASTER® otorgándoles un valor numérico ordenado por luminosidad. Se registró el color en los siguientes tiempos: baseline, al mes, a los 6 meses y a los 12 meses. Los datos no se distribuyeron de forma normal, por lo que se utilizó la prueba de U. de Mann-Whitney para comparar la regresión entre ambos compuestos en los distintos tiempos y la prueba de Wilcoxon para medir la regresión para cada compuesto en los distintos tiempos, se consideró estadísticamente significativo cuando p<0,05. Resultados: No se observaron diferencias estadísticamente significativas (p>0,05) al comparar ambos grupos en ninguno de los tiempos evaluados. Al comparar los tiempos “mes 6-mes 12” se obtuvieron diferencias estadísticamente significativas para ambos agentes blanqueadores en ambas escalas. Conclusiones: No existen diferencias en la regresión del color posterior al tratamiento intracoronario entre los grupos tratados con Peróxido de Hidrógeno 35% y Peróxido de Carbamida 37% en ninguno de los tiempos evaluados. Existen diferencias estadísticamente significativas al comparar cada agente blanqueador, entre los 6 y 12 meses hubo una regresión del color para ambos agentes en ambas escalas de color, exceptuando Peróxido de Carbamida al 37% medido con escala VITA classical A1-D4®.
Adscrito a Proyecto Niveles de RANKL-OPG extraradicular y efectividad del blanqueamiento intracoronario en dientes no vitales. PRIO-DO No. 03/016