Nível de inflamação e análise microbiológica da cavidade anoftálmica de usuários de prótese ocular unilateral
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Data
2021-12-03
Autores
Penitente, Paulo Augusto [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A prótese ocular possui importante papel na recuperação psicossocial e fisiológica de indivíduos anoftálmicos. Porém, irritação conjuntival, adesão de biofilme e queixas de olho seco ou lacrimejamento excessivo podem ocorrer. O objetivo deste ensaio clínico foi avaliar a influência do repolimento de próteses oculares sobre aspectos microbiológicos, inflamatórios, sensoriais e de produção lacrimal de voluntários anoftálmicos unilaterais. Dezesseis indivíduos usuários da mesma prótese ocular por pelo menos 2 anos foram divididos em 2 grupos: intervenção (IN) (n = 10) e sem intervenção (SIN) (n = 6). Além destes, um terceiro grupo com voluntários sem deficiências oculares foi o controle positivo (CP) (n = 5). Foram avaliados cavidade anoftálmica, olho contralateral e superfície das próteses oculares dos voluntários anoftálmicos e o olho direito do grupo CP em 3 períodos (inicial e em 15 e 30 dias após o repolimento). A análise microbiológica avaliou as unidades formadoras de colônias (UFC) de fungos da espécie Candida albicans, de bactérias totais e das do gênero Staphylococcus (Staphylococcus epidermidis e S. aureus). A citologia esfoliativa foi realizada para a qualificação do quadro de células inflamatórias da conjuntiva de todos os voluntários. A análise sensorial foi feita através do teste sensorial mecânico quantitativo com monofilamentos de nylon em três pontos da pálpebra superior e inferior de todos os voluntários e um ponto central interno da cavidade anoftálmica. A produção lacrimal foi avaliada pelo teste de Schirmer. A inflamação conjuntival foi avaliada clinicamente. Para a comparação entre grupos no período inicial, foi utilizado o teste de Kruskal Wallis, exceto para nível de inflamação (teste de Mann-Whitney). Para a análise entre períodos no grupo IN, foi realizado o teste de Friedman. Os dados qualitativos foram submetidos à estatística descritiva, sendo aplicado o teste Q de Cochran, quando necessário. Todas as análises foram realizadas com significância de 5%. Na análise microbiológica, houve maior formação de microrganismos na cavidade anoftálmica e prótese que no olho contralateral no período inicial. Na cavidade anoftálmica do grupo IN, a quantidade de todos os microrganismos avaliados foi estatisticamente maior no período inicial que em 15 e 30 dias após o repolimento. Na prótese ocular, houve maior acúmulo de bactérias totais e Candida albicans no período inicial que em 15 e 30 dias após o repolimento. Foi observada maior inflamação palpebral na cavidade anoftálmica que no olho contralateral. Houve redução estatisticamente significante dos sinais clínicos inflamatórios em 15 e 30 dias após o repolimento no grupo IN. A análise citológica não mostrou redução significativa do infiltrado de células inflamatórias em 15 e 30 dias após o repolimento. Houve diferença na produção lacrimal, onde o grupo IN - olho contralateral apresentou menor produção lacrimal que o grupo SIN - cavidade anoftálmica. Na análise da sensibilidade palpebral, não foram observadas diferenças estatísticas entre os grupos, tampouco em relação com os períodos analisados no grupo IN. É possível concluir que o repolimento foi benéfico na redução de microrganismos ao longo do tempo e na redução dos sinais clínicos inflamatórios.
The ocular prosthesis has an important role in the psychosocial and physiological recovery of anophthalmic individuals. However, conjunctival irritation, biofilm adhesion, and complaints of dry eye or excessive tearing may occur. The aim of this clinical trial was to evaluate the influence of ocular prostheses repolishing on microbiological, inflammatory, sensory, and tear production aspects of unilateral anophthalmic volunteers. Sixteen subjects wearing the same ocular prosthesis for at least 2 years were divided into 2 groups: intervention (IN) (n = 10) and no intervention (NIN) (n = 6). In addition, a third group with volunteers without ocular disability was the positive control (PC) (n = 5). The anophthalmic cavity, contralateral eye, and ocular prosthesis surface of anophthalmic volunteers and the right eye of the PC group were evaluated at 3 periods (initial period and at 15 and 30 days after repolishing). The microbiological analysis evaluated by the colony forming units (CFU) of Candida albicans fungi, total bacteria, and of the Staphylococcus genus (Staphylococcus epidermidis and S. aureus). Exfoliative cytology was performed to quantify the appearance of conjunctival inflammatory cells in all volunteers. Sensory analysis was performed using a quantitative mechanical sensory test with nylon monofilaments in three points of the upper and lower eyelid of all volunteers and an internal central point of the anophthalmic cavity. Tear production was assessed by Schirmer's test. Conjunctival inflammation was clinically assessed. For comparison between groups in the initial period, the Kruskal Wallis test was used, except for inflammation level (Mann-Whitney test). For the analysis among periods in the IN group, the Friedman's test was performed. Qualitative data were submitted to descriptive statistics, and the Cochran's Q test was applied, when necessary. All analyzes were performed at a 5%-significance level. Microbiological analysis showed greater microorganism formation in both anophthalmic cavity and prosthesis than in the contralateral eye in the initial period. In the anophthalmic cavity of the IN group, the amount of all microorganisms evaluated was statistically higher in the initial period than in 15 and 30 days after repolishing. In the ocular prosthesis, there was a greater accumulation of total bacteria and Candida albicans in the initial period than at 15 and 30 days after repolishing. More eyelid inflammation was observed in the anophthalmic cavity than in the contralateral eye. There was a statistically significant reduction in clinical inflammatory signs at 15 and 30 days after repolishing in the IN group. Cytological analysis showed no significant reduction in inflammatory cell infiltrate at 15 and 30 days after repolishing. There was a difference in tear production, where the IN group - contralateral eye had lower tear production than the NIN group - anophthalmic cavity. In the eyelid sensitivity analysis, no statistical differences were observed between the groups, nor in relation to the analyzed periods in the IN group. It is possible to conclude that repolishing was beneficial in reducing microorganisms over time and in reducing clinical inflammatory signs.
The ocular prosthesis has an important role in the psychosocial and physiological recovery of anophthalmic individuals. However, conjunctival irritation, biofilm adhesion, and complaints of dry eye or excessive tearing may occur. The aim of this clinical trial was to evaluate the influence of ocular prostheses repolishing on microbiological, inflammatory, sensory, and tear production aspects of unilateral anophthalmic volunteers. Sixteen subjects wearing the same ocular prosthesis for at least 2 years were divided into 2 groups: intervention (IN) (n = 10) and no intervention (NIN) (n = 6). In addition, a third group with volunteers without ocular disability was the positive control (PC) (n = 5). The anophthalmic cavity, contralateral eye, and ocular prosthesis surface of anophthalmic volunteers and the right eye of the PC group were evaluated at 3 periods (initial period and at 15 and 30 days after repolishing). The microbiological analysis evaluated by the colony forming units (CFU) of Candida albicans fungi, total bacteria, and of the Staphylococcus genus (Staphylococcus epidermidis and S. aureus). Exfoliative cytology was performed to quantify the appearance of conjunctival inflammatory cells in all volunteers. Sensory analysis was performed using a quantitative mechanical sensory test with nylon monofilaments in three points of the upper and lower eyelid of all volunteers and an internal central point of the anophthalmic cavity. Tear production was assessed by Schirmer's test. Conjunctival inflammation was clinically assessed. For comparison between groups in the initial period, the Kruskal Wallis test was used, except for inflammation level (Mann-Whitney test). For the analysis among periods in the IN group, the Friedman's test was performed. Qualitative data were submitted to descriptive statistics, and the Cochran's Q test was applied, when necessary. All analyzes were performed at a 5%-significance level. Microbiological analysis showed greater microorganism formation in both anophthalmic cavity and prosthesis than in the contralateral eye in the initial period. In the anophthalmic cavity of the IN group, the amount of all microorganisms evaluated was statistically higher in the initial period than in 15 and 30 days after repolishing. In the ocular prosthesis, there was a greater accumulation of total bacteria and Candida albicans in the initial period than at 15 and 30 days after repolishing. More eyelid inflammation was observed in the anophthalmic cavity than in the contralateral eye. There was a statistically significant reduction in clinical inflammatory signs at 15 and 30 days after repolishing in the IN group. Cytological analysis showed no significant reduction in inflammatory cell infiltrate at 15 and 30 days after repolishing. There was a difference in tear production, where the IN group - contralateral eye had lower tear production than the NIN group - anophthalmic cavity. In the eyelid sensitivity analysis, no statistical differences were observed between the groups, nor in relation to the analyzed periods in the IN group. It is possible to conclude that repolishing was beneficial in reducing microorganisms over time and in reducing clinical inflammatory signs.
Descrição
Palavras-chave
Inflamação, Olho artificial, Resinas acrílicas, Biofilmes, Inflammation