Acácio Alves Souza Lima-Filho

“Fomos atingidos por um meteoro”, disse o Ministro Paulo Guedes, em 28 de março de 2020. A pandemia de Covid-19 (Coronavirus Disease 2019), fez com que nosso País fosse realmente atingido pelo meteoro. Até recentemente, entidades associativas de cunho científico trabalhavam com planejamentos e projetos evoluindo lentamente com inovações. No campo da Saúde, certos temas demandavam maiores esforços, como recursos tecnológicos, maior aporte financeiro e apelo social, ou esses esforços se davam por uma combinação desses fatores. A burocracia corrente, com procedimentos, resoluções, carimbos e assinaturas, fazia com que a inovação se desenvolvesse de forma lenta e, algumas vezes, desanimadora. A pandemia de Covid-19 fez com que diferentes categorias de cientistas se envolvessem provocando uma avalanche de informes sérios e outros, por vezes, duvidosos, frases de efeito, comentários, teorias, ações e programas e projetos, sem precedentes na grande maioria dos povos e nações. Inovação passou a ser a palavra de ordem no combate à imensa sobrecarga dos hospitais e das unidades de saúde. Protocolos e paradigmas são revisados, patentes são reavaliadas, tudo na tentativa de salvar vidas e proteger a população. A produção de vacina contra Covid-19 passou a ser o foco da pesquisa de cientistas e de laboratórios, mesmo sabendo-se que isso exige muito tempo para seu desenvolvimento, e o tempo, nesse caso, é nosso inimigo. Meios de comunicação enaltecem uso do álcool-gel para higiene das mãos e de máscaras, caracterizando-os como as mais efetivas formas de prevenção. De outro lado, sociedades científicas preconizam métodos alternativos ao álcool-gel. A cloroquina é defendida e atacada nos meios científicos e nas discussões populares. Cientistas aprovam!! Cientistas reprovam!! Comunidades e associações filantrópicas produzem máscaras e vestimentas cirúrgicas, e, de impressoras 3D, nascem ideias e produtos. Terapias alternativas são propostas, como a utilização do plasma de pacientes curados e a ozonioterapia. A utilização off label de medicamentos também é valorizada como prevenção ou solução, apesar de haver questionamentos sobre a falta de pesquisas clínicas consistentes. Faltam kits de diagnóstico em quantidade suficiente para testar todos os pacientes e para comprovar aqueles que já têm imunidade. Cientistas, economistas, autoridades, epidemiologistas, órgãos de mídia e a população em geral tomam partido a favor ou contra o isolamento social horizontal e o isolamento social vertical. Diversos aparelhos de ventilação de baixo custo ou de custo acessível surgem de núcleos de inovação. A FDA autoriza um aparelho inovador que permite a utilização por quatro pacientes em um único respirador. A Adidas em parceria com empresa de tecnologia Carbon produzem 18.000 máscaras faciais por semana, com ajuda de impressoras 3D. Máscaras que são doadas para organizações de saúde dos EUA e para as comunidades carentes. Enquanto isso, as internações, as mortes e as fake news aumentam rapidamente pelo mundo todo. Hospitais de Campanha são rapidamente construídos e uma imagem emblemática circula na internet: em São Paulo, o tradicional estádio do Pacaembu foi adaptado para se tornar um Hospital de Campanha. Parece ser necessário surgir uma pandemia para que estádios de futebol sejam menos valorizados do que os hospitais e a saúde da população brasileira. Inúmeros aplicativos são criados para novos costumes, governos revisam prazos de recolhimentos tributários e criam normas, visando à sobrevivência de empregos e de pequenas e médias empresas, além de um plano de ajuda financeira para comunidades carentes. A burocracia, o mau uso de recursos públicos e o grande abismo social brasileiro são expostos cruamente nas redes sociais e na imprensa. Nesse rodamoinho, chega e-mail para um médico que inovou em 2010, quando depositou uma patente de instrumento com finalidade cirúrgica, deferida agora, em março de 2020, ou seja, dez anos depois, fora todo o tempo utilizado no trabalho da pesquisa. Com a velocidade do desenvolvimento tecnológico, ainda seria essa patente útil nos dias de hoje? Fica a expectativa de que, passada a pandemia, nosso País tenha aprendido com a dura lição e comece a caminhar, então, com foco na harmonia social e política, rumo ao desenvolvimento exigido pelo mundo moderno. Agora é o momento para que todos se unam com o propósito de promover a integração das diferentes comunidades científicas na busca da sinergia de ações e de soluções para as consequências desse meteoro que atingiu nosso País. Cabe a nós todos ajudarmos a traçar esse novo caminho.

Objective: To assess the number of eyes with silicone oil in the vitreous after intravitreal injection. Methods: This cross-sectional, comparative study was divided into 2 groups: (1) treatment—eyes subjected to antiangiogenic therapy; (2) control—no history of intravitreal injection. Subjects were assessed regarding age, gender, clinical diagnosis, lens status, visual acuity and number of previous intravitreal injections. All eyes underwent a meticulous slit-lamp and ultrasound examination for the identification of silicone oil. ImageJ software was used to quantify the index of silicone oil (IOS) by ultrasonography. Results: Sixty-seven eyes (30 controls, 37 treated) were included. Slit-lamp examination found silicone oil droplets in 25 out of 37 (67.57%) treated eyes and in none of the control group. Ultrasonography identified silicone oil in 28 out of 37 (75.68%) treated eyes and in 1 out of 30 (3.33%) controls. An observed agreement of 85.07% and a Cohen’s Kappa coefficient of 69.10% (p < 0.0001) between ultrasonography and biomicroscopy were found. Wilcoxon test showed a statistically significant difference (p = 0.0006) in IOS between controls (0.41 ± 0.43%) and treated eyes (2.69 ± 2.55%). Spearman’s correlation test (0.61; p < 0.0001) showed that the greater the number of injections, the higher the IOS. Conclusions: Silicone oil droplets were found in the majority of the eyes previously treated with antiangiogenic intravitreal injection. The greater the number of injections, the higher the likelihood of finding silicone oil. An improvement in the technique of injection and better-quality syringes post-injection silicone oil droplets.

BACKGROUND AND OBJECTIVE: To determine factors causing inflammation after intravitreal aflibercept injections. PATIENTS AND METHODS: This case-control study included aflibercept-treated eyes with inflammation post-injection and aflibercept-treated control eyes. Medical records were analyzed to identify contributing factors. Biophysical tests were performed to characterize properties of particle aggregation. Institutional review board approval was obtained. RESULTS: Inflammation developed in six eyes; three patients had anterior uveitis, and five had vitreous cells. Oil droplets were seen in all cases. Saldanha Rodrigues (SR) syringes were used in all cases. Among controls, SR and Becton-Dickinson syringes were used in 10 and 17 eyes, respectively. Regression analysis showed an association between SR syringes and inflammation (odds ratio = 21.66; 95% confidence interval, 1.10–425.06; P = .043). Biophysical analyses primarily showed aggregation possibly from free oil droplets or protein-oil droplet aggregation. CONCLUSIONS: Post-injection inflammation was associated with SR syringes. Silicone oil droplets, especially after syringe agitation, might play a role in the inflammatory reaction. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:288–294.]

Background/aims To assess silicone oil (SO) release by different brands of syringes used for intravitreal injection under different handling conditions. Methods Eight syringes were analysed: from the USA, Terumo 0.5 mL, Becton-Dickinson (BD) Tuberculin 1 mL, BD Luer-lok 1 mL, BD Ultra-Fine 0.3 mL and Exel Insulin 0.3 mL; from Germany, Braun Omnifix-F 1 mL and Braun Injekt-F 1 mL and from Spain, BD Plastipak 1 mL. The impact of air, priming the plunger, agitation by flicking and fluid temperature on SO release were assessed by light microscopy. Fourier transform infrared spectroscopy (FTIR) was performed to identify the molecular compound in each syringe. Results Five hundred and sixty syringes were analysed. Terumo 0.5 mL and BD Ultra-Fine 0.3 mL released more SO than all others. BD Luer-lok 1 mL, BD Plastipak and Braun Omnifix-F 1 mL released little SO; BD Tuberculin 1 mL, Exel 0.3 mL and Braun Injekt-F 1 mL released the least SO. Priming the syringe and different temperatures did not significantly affect SO release. Agitation by flicking caused a significantly higher proportion of samples to have SO droplets and an increased number of oil droplets. Air had an additive effect on the release of oil in the agitation groups. FTIR identified polysiloxane in all syringes but Injekt-F. Conclusion Syringes commonly used for intravitreal injections frequently release SO droplets, especially when agitated by flicking. To avoid unnecessary ocular risks, syringes should not be agitated before intravitreal injection. It is desirable that syringes be manufactured specifically for ophthalmic use.

Intravitreal silicone oil droplets have been found in the vitreous. The aim of this study is to compare the rates of silicone oil released by different brands of commonly used syringes for intravitreal injection after agitation by flicking. Three models of two brands of syringes were analyzed for their rates of silicone oil release: Saldanha Rodrigues (SR) 1 mL insulin syringe (SR, Brazil, syringe 1), Becton–Dickinson (BD) Plastipak 1 mL insulin syringe (Brazil, syringe 2), and BD Safety-Glide 1 mL insulin syringe (USA, syringe 3). All syringes were tested under four different conditions: positive control (fluid with addition of silicone oil) without agitation (group 1, n = 5); positive control with agitation (group 2, n = 3); fluid only without agitation (group 3, n = 5); and fluid only with agitation (group 4, n = 5). Masked graders performed all analyses using light microscopy. All syringes (1, 2, and 3) released silicone oil droplets in the positive control group regardless of the agitation status (groups 1 and 2). When no oil was added and the syringes were not agitated, only syringe 1 released silicone oil droplets (40% of samples). After agitation, syringes 1 and 3 released silicone oil droplets in all samples. Quantitative analysis showed a significantly (P = 0.011; 11.2 ± 2.9 vs. 0.6 ± 0.9, respectively) higher mean number of silicone oil droplets released by syringe 1 after agitation compared to no agitation. Syringe 1 also had significantly (P = 0.002, 11.2 ± 2.9 vs. 0.0 ± 0.0 vs. 2.2 ± 0.8, respectively) more droplets than syringes 2 and 3 after agitation. Syringes commonly used for intravitreal injections frequently release silicone oil droplets when agitated by flicking, especially the SR insulin ones. We recommend that they not be agitated at the time of intravitreal injection and that the manufacturers consider producing syringes adapted for intraocular use.

To test the applicability of the acai dye at a 25% concentration for identifying the posterior hyaloids and internal limiting membranes (ILMs) during pars plana vitrectomy (PPV) in human eyes with macular holes (MHs).

Purpose. To classify and quantify anthocyanins in a vital dye extracted from the acai fruit (Euterpe oleracea), adjust pH and osmolarity, and perform lyophilization to develop a new chromovitrectomy dye. Methods. Three dye concentrations 10%, 25%, and 35% (equivalent to 100, 250, and 350 mg of lyophilized acai fruit pulp extract samples) were evaluated when diluted in 1 ml of phosphate-buffered solution (pH 7 and 300 mOsm). The dye was analyzed by mass spectrometry and high-performance liquid chromatography (HPLC) to identify and quantify anthocyanins molecules. Results. The pH and osmolarity correction and lyophilization were performed without damaging the anthocyanin molecular structure. Mass spectrometry confirmed the presence of five anthocyanins in the three concentrations of the dye. Cyanidin-3-O-glucoside was the major anthocyanin found. HPLC showed that the concentration of anthocyanin was similar, independent of the dye concentration tested. Conclusions. Lyophilization and the correction of pH and osmolarity (7.00 and 300 mOsm, resp.) were performed successfully. Five anthocyanins are present in the dye from the acai fruit. The major anthocyanin is cyanidin-3-O-glucoside. Independent of the dye concentration tested, the anthocyanin concentration was similar. Standardized chemical characteristics of this new dye may allow its use during chromovitrectomy in humans.

Nature has always provided an unlimited source of biologically-active compounds. Since the beginning of mankind, humans have sought resources in fauna and flora to treat eye diseases. However, it was only after the Industrial Revolution that extracts of plants and substances of animal origin could be used safely, as has been determined by controlled interventional studies. Two major challenges faced by ocular pharmacology are the following: developing drugs that are able to reduce blindness due to glaucoma; and controlling the pain associated with eye surgery. The search for a drug that effectively lowers intraocular pressure and controls the progression of glaucoma has led to the development of various ocular hypotensive agents, such as physostigmine from the Physostigma venenosum plant. The anesthetic properties of cocaine, extracted from Erythroxylon coca, finally enabled surgical procedures in the eye. Several new natural compounds have been investigated in an attempt to identify substances with the potential to provide additional benefits to eye tissue and vision. Emerging evidence of anti-inflammatory, wound-healing, antimicrobial, antioxidant, antitumor, and antiangiogenic properties attributed to plant extracts and animal tissues has encouraged more investment in research in this area. Despite technological advances in synthesizing drugs, the pharmaceutical industry still seeks new active compounds from natural sources as well as from revisiting already-established naturally derived compounds. Although a large number of naturally-occurring compounds is known, this review article focuses on the bioactive substances with scientifically-proven benefits for ocular tissues.