Purpose: To improve the predictability, accuracy and stability of laser in-situ keratomileusis (LASIK), by evaluating the clinical, procedural and tissue response factors that affect refractive outcomes. Methods: Myopic LASIK surgeries (n=5,978) were carried out using the Technolas planoscan and Nidek EC-5000 excimer lasers. Clinical variables associated with a refractive outcome of within ??0.50 D of the target were identified using regression analysis. Possible procedural variations such as the timing of the procedure and accuracy of both the chosen keratome and excimer laser were evaluated. The predictability and accuracy of the ablation was assessed by measuring changes in corneal thickness during and after the procedure. Factors influencing the stability of refractive outcome were assessed. Results: Clinical factors associated with a refractive outcome of within ??0.50 D of the target included; corrections less than 5.00 DS (OR 0.21x, 95% CI 0.11-0.40x compared with corrections over -5.00 DS[referent]), patients younger than 40 years (patients over 50 OR 8.27x, 95% CI 3.41-20.03x, patients 40 to 50 years OR 1.93x, 95% CI 0.96-3.90x, compared with patients under 40[referent]) and average pre-operative curvatures between 43.50 and 45.50D (OR 0.39x, 95% CI 0.18-0.83 compared with curvatures of less than 43.50D [referent]). Refractive stability was improved using optic zone sizes between 5.5-6.0 mm, reduced myopic corrections, flatter pre-operative corneal curvatures and thicker corneal flaps (R??=25%, p&lt0.001). Procedural factors associated with poorer outcomes included: thinner measured flap thickness, deeper ablations and the use of the automated corneal shaper (ACS) microkeratome with a novice surgical team (R??=34%, p &lt 0.001). Delaying the ablation from 20 to 90 seconds (s) after flap lift was associated with a more stable refractive outcome at three months (p=0.017). In the 90 s following flap lift, the cornea thinned by 5??3%. The ablation rate per scan varied between procedures, however, the effect on refractive outcome was small (r=0.15, p=0.267). Changes in central corneal thickness indicated refractive stability (p=0.039). Conclusions: Applying the optimal clinical and procedural factors as described afforded a refractive outcome in a further 8% of cases, resulting in 94% to 96% of cases within ??0.50 DS of target. Refractive predictability was limited due to the inability of the keratome to produce a consistent corneal flap thickness and unexpected changes in corneal thickness. The accuracy of refractive outcome will decrease with larger ablations. The degree of refractive inaccuracy with high refractive corrections (&gt -10.00 D) can be over 1.00 D.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

M.Cur. / Refined equipment, heightened technology and improved surgical techniques in the field of ophthalmology have all resulted in a marked shift towards ambulatory, outpatient surgical treatment and day surgery and therefore shortened hospital stay for patients. This leaves patients and their next-of-kin with the responsibility for own care after treatment. To be able to accomplish this, they need adequate and relevant health education. Nurses are faced with the responsibility of imparting this information in order to enable patients to make decisions or choices that will address their health behaviour and thus influence their lifestyle. It is therefore necessary to use strategies of health education that will bring about this change of behaviour. One such strategy is values clarification. The aim of this study was to explore and describe the health education experience of patients undergoing ophthalmic day surgery before and after the health educator attends a workshop in values clarification. The study was conducted in two phases, with a workshop in values clarification as intervention between the phases. During Phase 1, phenomenological interviews were held with patients before the health educator attended the workshop in values clarification. The health educator then attended a workshop in values clarification. Thereafter, phenomenological interviews were again held with patients. Data analysis was done and findings were compared and discussed together with a literature control. The trustworthiness of the study was determined according to Lincoln and Guba's model. Conclusions and recommendations were made and guidelines, based on findings, were set for preoperative health education of patients undergoing ophthalmic surgery.

There is a growing recognition that removal of an eye may cause a significant impact on a person's body image and her or his role in society; and may evoke a variety of emotional responses. The loss of an eye does not only signal disfigurement, it also means a loss of a body part and a vital sense; that of sight. Without vision, individuals have difficulty communicating. The emotional responses to this loss many a times, go unrecognized as the doctors and nurses who are in close contact with the patient at this time are not necessarily prepared to provide emotional care. This study seeks to address this gap by identifying the emotional impact of loss of an eye and sight on people's lives and the implication it has for health care workers, especially nurses. The eliciting of the different feelings and experiences of these patients can provide information for the formulation and design of protocols for holistic health care management. A non-experimental exploratory and descriptive design was used to conduct In-depth conversational interviews with seven purposively selected participants who had enucleation or evisceration between 2000 and 2005. Information-rich data yielded findings that clearly stressed the need for greater sensitization to the problem. All the participants expressed shock at the final diagnosis of enucleation or evisceration even if this was on their request. Patients wanted to know about the operation and its outcome, the prosthesis, how will it look like and its fit. Findings indicate that answers to these questions were not provided. Patients were not adequately emotionally prepared pre-operatively and were therefore not appropriately cared for post-operatively. Families were not satisfactorily involved and as such were not in a position to provide emotional support that the patients needed The recommendation was that a study to explore the health care team's knowledge in the psychological and emotional management of patients in crisis should be conducted as a benchmark for further training. / Health Studies / M.A. (Health Studies)

There is a growing recognition that removal of an eye may cause a significant impact on a person's body image and her or his role in society; and may evoke a variety of emotional responses. The loss of an eye does not only signal disfigurement, it also means a loss of a body part and a vital sense; that of sight. Without vision, individuals have difficulty communicating. The emotional responses to this loss many a times, go unrecognized as the doctors and nurses who are in close contact with the patient at this time are not necessarily prepared to provide emotional care. This study seeks to address this gap by identifying the emotional impact of loss of an eye and sight on people's lives and the implication it has for health care workers, especially nurses. The eliciting of the different feelings and experiences of these patients can provide information for the formulation and design of protocols for holistic health care management. A non-experimental exploratory and descriptive design was used to conduct In-depth conversational interviews with seven purposively selected participants who had enucleation or evisceration between 2000 and 2005. Information-rich data yielded findings that clearly stressed the need for greater sensitization to the problem. All the participants expressed shock at the final diagnosis of enucleation or evisceration even if this was on their request. Patients wanted to know about the operation and its outcome, the prosthesis, how will it look like and its fit. Findings indicate that answers to these questions were not provided. Patients were not adequately emotionally prepared pre-operatively and were therefore not appropriately cared for post-operatively. Families were not satisfactorily involved and as such were not in a position to provide emotional support that the patients needed The recommendation was that a study to explore the health care team's knowledge in the psychological and emotional management of patients in crisis should be conducted as a benchmark for further training. / Health Studies / M.A. (Health Studies)

本研究採用結紮眼血管的方法誘發短暫性視網膜缺血，針對同缺血時間同存活時間化成年金黄地鼠中視網膜節細胞的存活和小型膠質細胞的激活。首先，我們的據顯示，和假缺血手術組相對應的存活時間比較，暫時性視網膜缺血10分鐘或30分鐘沒有導致視網膜節細胞的存活明顯下。暫時性視網膜缺血60分鐘再灌注後7天，視網膜節細胞的存活下至58%，14後為51%，28後為44%。暫時性視網膜缺血120分鐘之後再灌注7天，視網膜節細胞的存活急劇下，僅保22%，至14天，僅剩17%, 之後節細胞的死亡速減緩，至28天時，仍由18%存活。視網膜缺血10分鐘、30分鐘、60分鐘和120分鐘均引起大小型膠質細胞激活，激活在第七天達到頂峰，之後在14天和28天顯著並逐步下。相關性分析發現損傷後7天，視網膜節細胞的死亡和視網膜節細胞層中的小型膠質細胞存在緊密的相關性。 / 其次，我們首次證實缺血性預處僅有於提高視網膜節細胞對抗視網膜缺血/再灌注損傷，還對視神經斷後的視網膜節細胞同樣具有保護作用。結果顯示無是5分鐘還是10分鐘的缺血性預處，無是軸突橫斷術前1天還是前3天實施預處，都對視網膜節細胞有明顯的保護作用。在缺血性預處對抗神經橫斷損傷的實驗組, 的表達只表現在陽性細胞上的明顯優勢，但占全部存活細胞的百分比存在差；而缺血性預處對抗視網膜缺血再灌注損傷的實驗組，的陽性節細胞的無論還是存活百分比都存在差。在預處組和假處組的比較中， 的表達也只是陽性細胞上較多，占全部存活細胞的百分比存在差。在缺血性預處加視網膜缺血分鐘的實驗組中，我們測視網膜矢片中各層的厚。結果顯示，缺血性預處組中，視網膜的整體厚和節細胞層的厚都與正常組相當，而假處組中，這層的厚明顯減少。 / 進一步地，我們研究遠端缺血性後處對視網膜節細胞對抗視神經軸突橫斷術的保護作用。我們選用鉗夾右股動脈作為遠端缺血性後處的方法，鉗夾股動脈分鐘，之後放開，再鉗夾再放開，共個循環。結果顯示，軸突橫斷術后分鐘實施缺血性后處組，視網膜節細胞的存活較假處組明顯增加，包括術後天和天；軸突橫斷術后小時實施缺血性後處組，視網膜節細胞的存活只在術後天較假處組明顯較多，但在天的實驗組，者的差消失；軸突橫斷術小時實施缺血性後處組，視網膜節細胞的存活比假處組多。在缺血性後處的實驗中，視神經橫斷術后分鐘實施遠端缺血性後處的實驗組與假處組比較，的表達僅表現在陽性細胞上的明顯增加，而且占全部存活細胞的百分比也明顯增加。的表達與預處實驗組的結果相似，只存在上的優勢。 / 我们的實驗證明，缺血性預處在對抗視神經橫斷和視網膜缺血的損傷中，可以為節細胞提供有效的保護作用，遠端缺血性後處可以對抗視神經橫斷損傷提高節細胞的存活。陽性節細胞在三個同條件的實驗中，表現出同的結果，这可能暗示遠端缺血性後處對抗視神經橫斷術的損傷，節細胞的再生能較優，與遠端缺血性後處對抗視神經橫斷術的神經保護作用有一定關。的表達在三個實驗組中，處組與假處組比較，均只表現出陽性細胞上的優勢，占存活細胞的百分比就存在差，可能意味著與缺血性預處和後處的保護作用關係不大。 / Ligature of the ophthalmic vessels (LOV) was used as an animal model to study transient retinal ischemia/reperfusion in adult hamsters. Firstly, we quantified the loss of retinal ganglion cells (RGCs) and activation of microglia after10 min, 30 min, 60 min or 120 min retinal ischemia at 7, 14 and 28 days post-ischemia. The results showed that after 10-min or 30-min retinal ischemia, the number of RGCs had no significant decrease compared to sham LOV group at 7 days. In the retinal ischemia 60 min group, there were 58% of the RGCs population remained alive at 7 days, 51% at 14 days and 44% at 28 days post-ischemia, respectively. In the retinal ischemia 120 min group, the number of RGCs was reduced to 22% at 7 days and 17% at 14 days, but cell death slowed down from 14 to 28 days. Meanwhile, the number of microglia was increased sharply at 7 days and decreased gradually from 7 to 28 days. At the same time, it was found that the loss of RGCs and activation of microglia in the ganglion cell layer at 7 days post-insult existed strong positive correlation. / Secondly, the effects of ischemic preconditioning (IPC) were proved to promote RGCs survival after axotomy or retinal ischemia 120 min. It was presented firstly that a 5 or 10 min brief IPC which performed 1 or 3 days prior to axotomy enhanced the RGCs survival at 7 days and 14 days post-axotomy. The number of HSP27-positive RGCs was significantly higher in the IPC plus axotomy subgroup compared with the sham-operated subgroup, while the percentage of HSP27-positive RGCs did not show significant difference between subgroups. For the IPC plus retinal ischemia 60 min group, both the number and the percentage of HSP27-positive RGCs had no significant difference between IPC and sham-operated subgroups. The number of HSP70-positive RGCs exhibited significant difference but not the percentage in IPC plus axotomy or retinal ischemia 60 min experimental groups. The thicknesses of the whole retina and GCL were similar to the normal value in the IPC plus ischemia 60 min subgroup, while in the sham-operated subgroup, these two values decreased significantly. / Consequently, the effect of remote ischemic postconditioning (RIPostC) was also explored to promote RGCs survival after axotomy. Four cycles of 10 min occlusion and 10 min release of the right femoral artery were initiated on animals at 10 min, 6 h or 24 h after axotomy. In the10 min group, the effect of RIPostC on promoting RGCs survival was significant at both 7 and 14 days post-injury. In the 6 h group, the survival of RGCs was more in the RIPostC treatment subgroup at 7 days, while there was no significant difference at 14 days post-axotomy. In the 24 h group, RGC survival was not significantly different at 7 days post-axotomy. Both the number and the percentage of HSP27-positive RGCs were significantly higher in the RIPostC treatment subgroup. The results of the induction of HSP70 only showed a priority in absolute number of the HSP70-positive RGCs in the RIPostC treatment subgroup. / In summary, the effect of IPC has been proved that it could protect RGCs against axotomy and retinal ischemia/reperfusion injury, in addition, the application of RIPostC also protected RGCs from axotomy. The proportion of HSP27-positive RGCs increased significantly in the process of RIPostC against axotomy, which may clue that the ability of axonal regeneration is stronger which induced by the RIPostC intervention. The upregulation of HSP27 might play a role in the neuroprotection of the RIPostC against axotomy. The expression of HSP70 maybe plays a little role in the neuroprotection of the IPC and RIPostC. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Liu, Xia. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 182-196). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract --- p.i / Abstract in Chinese --- p.iv / Acknowledgements --- p.vii / Table of Abbreviations --- p.viii / Table of Contents --- p.ix / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter Chapter 2 --- Changes of retinal ganglion cells and microglia after different types of injuries / Introduction --- p.38 / Materials and Methods --- p.43 / Results --- p.49 / Discussion --- p.57 / Figures and tables --- p.71 / Chapter Chapter 3 --- Ischemic preconditioning protect retinal ganglion cells against axotomy and retinal ischemia/reperfusion injury and expression of heat shock protein 27 and 70 / Introduction --- p.93 / Materials and Methods --- p.98 / Results --- p.103 / Discussion --- p.109 / Figures and tables --- p.116 / Chapter Chapter 4 --- Remote ischemic postconditioning protect retinal ganglion cells against axotomy and expression of heat shock protein 27 and 70 / Introduction --- p.143 / Materials and Methods --- p.147 / Results --- p.150 / Discussion --- p.154 / Figures and tables --- p.161 / Chapter Chapter 5 --- General Discussion --- p.175 / References --- p.182

Made available in DSpace on 2014-06-11T19:27:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-09-05Bitstream added on 2014-06-13T19:35:14Z : No. of bitstreams: 1 jardim_ja_me_araca.pdf: 472042 bytes, checksum: b9755020678e0301b794f0e096fed08b (MD5) / Objetivo: Este trabalho teve por objetivos: avaliar a eficácia da técnica da dacriocistorrinostomia e sua evolução clínica posoperatória, bem como a microbiota conjuntival, a longo prazo. Métodos: Foram incluídos 12 cães de diferentes raças, sexo e idade, sendo 23 olhos operados. Observaram-se os sinais clínicos de: blefarospasmo, secreção e hiperemia conjuntival, ceratite ulcerativa e o teste de Jones aos sete, quinze, trinta, sessenta, cento e vinte e duzentos e quarenta dias de posoperatório. Também foi avaliada a microbiota conjuntival e nasal no momento do ato cirúrgico e conjuntival aos sessenta, cento e vinte e duzentos e quarenta dias de posoperatório. As amostras foram colhidas com auxilio de swabs e transportadas ao laboratório em meio de transporte. Foi investigada a presença de bactérias anaeróbicas, aeróbicas e fungos. Resultados: O blefarospasmo foi observado em 27,3% (n=3) sob a forma severa no olho direito; o mesmo ocorreu com a ceratite ulcerativa, a secreção conjuntival e a hiperemia ocular que se apresentaram de forma semelhante, sendo severa nos momentos iniciais da avaliação e regredindo nos momentos subsequentes. O teste de Jones foi positivo em apenas um olho direito antes do tratamento cirúrgico, e ao término das avaliações apresentou positividade de 63,3% (n=7) e 58,3% (n=7) nos olhos direito e esquerdo, respectivamente. Observou-se predomínio de bactérias Gram-positivas (66,7%, n=8) na microbiota nasal antes da instituição do tratamento cirúrgico. A microbiota conjuntival, no mesmo momento, era constituída em 66,5% (n=8) por bactérias Gram-negativas e, ao longo da evolução clínica, houve um equilíbrio entre ambos os tipos de bactérias. Ao final da observação clínica ocorreu uma modificação com predomínio de bactérias Gram-positivas... / Objective: This study aimed to evaluate the efficacy of the technique of dacryocystohrinostomy and postoperative clinical course, as well as the conjunctival microbiota in the long-term. Methods: Were included twelve dogs of different breeds, sex and age, and 23 yes were operated. Clinical signs such as: blepharospasm, secretion and conjunctival hyperemia, ulcerative keratitis and Jones test were evaluated at seven, fifteen, thirty, sixty, a hundred twenty and two hundred and forty days of postoperative. Were analyzed the nasal and conjunctival microbiota at the time of surgery and the conjunctival microbota at sixty, a hundred twenty and two hundred and forty days postoperative. The samples were collected with the aid of swabs and taken to the laboratory in a bacterial transport medium. It was investigate the presence of anaerobic and aerobic bacteria and fungi. Results: The blepharospasm was observed in 27,3% (n=3) under severe form in the right eye; the same happened with ulcerative keratitis, conjunctival secretion and ocular hyperemia, that had similarly been severe in the early stages of evaluation and regressing in subsequent moments. The Jones test was positive in only one right eye before surgery, and at the end of the evaluation was positive in 63,3% (n=7) and 58,3 (n=7) in the left and right eyes, respectively. There was a predominance of Gram positive (66,7%, n=8) in the nasal microbiota before setting surgical treatment. The conjunctival microbiota, at the same time, it was establish in 66,5% (n=8) by Gram negative and, along the clinical course, there was a balance between both types of bacteria. At the end of a clinical observation there was a change with a predominance of Gram positive (85%, n=9). Conclusion: The dacryocystohrinostomy was able to promote the formation... (Complete abstract click electronic access below)

De nombreux processus fondamentaux ont lieu sur des échelles de temps femtosecondes à plusieurs centaines de picosecondes. En outre, les demandes continues d'augmentation de résolution et de précision dans l'industrie du micro-usinage de pointe exigent la compréhension fine des mécanismes physiques d'ablation et l'identification précise des conditions optimales de mise en œuvre des systèmes laser femtosecondes. Ces systèmes doivent ainsi permettre la production de structures de taille micrométrique de manière contrôlée et étalonnée. Dans ce travail de thèse, nous étudions l'interaction d'un laser femtoseconde (500 fs @ 1025 nm) avec une cible diélectrique en utilisant un banc d'essai spécifique. La première partie de cet ouvrage décrit les aspects fondamentaux du dépôt d'énergie laser dans les diélectriques (SiO2) et de dissipation au sein du réseau ainsi que le processus d'ablation de la matière, au moyen de techniques pompe-pompe et pompe-sonde résolues en temps. L'étude expérimentale est accompagnée d'une modélisation prenant en compte la propagation du faisceau dans la matière (équation de Helmholtz monodimensionnelle), le processus de dépôt d'énergie en régime hors équilibre (modèle à deux températures) et l'ionisation du matériau (équation de population de la densité d'électrons libres). Enfin, nous mettons en évidence l'intérêt des lasers femtosecondes pour la modification de la matière (notamment pour l'endommagement en surface et l'ablation) et les applications, notamment dans le domaine du micro-usinage et de la chirurgie de la cornée par laser. / Numerous fundamental processes take place on time scales from several femtoseconds to hundreds of picoseconds. Moreover, the continuous demands of downscaling and increase of precision in the cutting-edge micromachining industry require the comprehension of the physical mechanisms and the identification of key laser parameters for an optimized use of femtosecond laser systems. Those systems shall allow production of controlled and calibrated micrometer-size structures with high spatial selectivity. In this PhD work, we study the interaction of a femtosecond laser (500 fs @ 1025 nm) with a dielectric target using a dedicated test-bench. The first part of this work describes the fundamental aspects of laser energy deposition in dielectrics (SiO2), its redistribution to the lattice and the process of laser ablation by means of pump-pump and time-resolved pump-probe experiments. The experimental study is accompanied by a computational modeling taking into account the beam propagation (one-dimensional Helmholtz equation), the non-equilibrium process of the energy deposition (two-temperature model) and the matter ionisation (rate equation describing the free electron density change). Finally, we put in evidence the interest of femtosecond lasers for material modification (notably for surface damage and ablation) which high specific benefit in such applications as micromachining and laser corneal surgery.

Orientador: Alexandre Lima de Andrade / Banca: Adriana Morales / Banca: Flávia de Rezende Eugênio / Resumo: Objetivo: Este trabalho teve por objetivos: avaliar a eficácia da técnica da dacriocistorrinostomia e sua evolução clínica posoperatória, bem como a microbiota conjuntival, a longo prazo. Métodos: Foram incluídos 12 cães de diferentes raças, sexo e idade, sendo 23 olhos operados. Observaram-se os sinais clínicos de: blefarospasmo, secreção e hiperemia conjuntival, ceratite ulcerativa e o teste de Jones aos sete, quinze, trinta, sessenta, cento e vinte e duzentos e quarenta dias de posoperatório. Também foi avaliada a microbiota conjuntival e nasal no momento do ato cirúrgico e conjuntival aos sessenta, cento e vinte e duzentos e quarenta dias de posoperatório. As amostras foram colhidas com auxilio de swabs e transportadas ao laboratório em meio de transporte. Foi investigada a presença de bactérias anaeróbicas, aeróbicas e fungos. Resultados: O blefarospasmo foi observado em 27,3% (n=3) sob a forma severa no olho direito; o mesmo ocorreu com a ceratite ulcerativa, a secreção conjuntival e a hiperemia ocular que se apresentaram de forma semelhante, sendo severa nos momentos iniciais da avaliação e regredindo nos momentos subsequentes. O teste de Jones foi positivo em apenas um olho direito antes do tratamento cirúrgico, e ao término das avaliações apresentou positividade de 63,3% (n=7) e 58,3% (n=7) nos olhos direito e esquerdo, respectivamente. Observou-se predomínio de bactérias Gram-positivas (66,7%, n=8) na microbiota nasal antes da instituição do tratamento cirúrgico. A microbiota conjuntival, no mesmo momento, era constituída em 66,5% (n=8) por bactérias Gram-negativas e, ao longo da evolução clínica, houve um equilíbrio entre ambos os tipos de bactérias. Ao final da observação clínica ocorreu uma modificação com predomínio de bactérias Gram-positivas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: This study aimed to evaluate the efficacy of the technique of dacryocystohrinostomy and postoperative clinical course, as well as the conjunctival microbiota in the long-term. Methods: Were included twelve dogs of different breeds, sex and age, and 23 yes were operated. Clinical signs such as: blepharospasm, secretion and conjunctival hyperemia, ulcerative keratitis and Jones test were evaluated at seven, fifteen, thirty, sixty, a hundred twenty and two hundred and forty days of postoperative. Were analyzed the nasal and conjunctival microbiota at the time of surgery and the conjunctival microbota at sixty, a hundred twenty and two hundred and forty days postoperative. The samples were collected with the aid of swabs and taken to the laboratory in a bacterial transport medium. It was investigate the presence of anaerobic and aerobic bacteria and fungi. Results: The blepharospasm was observed in 27,3% (n=3) under severe form in the right eye; the same happened with ulcerative keratitis, conjunctival secretion and ocular hyperemia, that had similarly been severe in the early stages of evaluation and regressing in subsequent moments. The Jones test was positive in only one right eye before surgery, and at the end of the evaluation was positive in 63,3% (n=7) and 58,3 (n=7) in the left and right eyes, respectively. There was a predominance of Gram positive (66,7%, n=8) in the nasal microbiota before setting surgical treatment. The conjunctival microbiota, at the same time, it was establish in 66,5% (n=8) by Gram negative and, along the clinical course, there was a balance between both types of bacteria. At the end of a clinical observation there was a change with a predominance of Gram positive (85%, n=9). Conclusion: The dacryocystohrinostomy was able to promote the formation... (Complete abstract click electronic access below) / Mestre