Objetivo: Estudo comparativo da pressão intraocular (PIO) após agulhamento transconjuntival (ATC) com 5-fluoracil (5-FU) e tratamento clínico (TC) em olhos glaucomatosos com bolha encapsulada e PIO não controlada após trabeculectomia com mitomicina C (MMC), no final de 12 meses de seguimento. Desenho: Estudo prospectivo, randomizado, intervencionista. Participantes: 40 olhos de 39 pacientes com bolha encapsulada, desenvolvida em 5 meses ou menos, após trabeculectomia primária com mitomicina e PIO >= 20mmHg. Métodos: Os olhos foram randomizados para ATC com 5-FU e TC. Um máximo de dois ATC foi permitido no estudo. Todos os olhos foram acompanhados por 12 meses. O sucesso foi definido como PIO <= 18 mmHg e redução de 20% da PIO basal (sem medicações no grupo ATC). Resultados: A média da PIO em 12 meses de acompanhamento foi de 12,14 ± 2,80 mmHg no grupo do ATC e 15,13 ± 2,07 mmHg no grupo do TC (p = 0,004). 14 olhos (70%) foram considerados sucesso no grupo do ATC e 15 olhos (75%) no grupo do TC (p = 0,89). O número médio de agulhamentos foi de 1,35 ± 0,49 e a quantidade média de medicamentos foi de 2,15 ± 0,74. Conclusões: Houve uma taxa de sucesso semelhante nos olhos randomizados para ATC com 5-FU em comparação com TC em 12 meses de seguimento. No entanto, foi observada uma significativa menor média da PIO, após o ATC / Objective: To compare de efficacy of transconjuctival needling revision (TNR) with 5-fluorouracil (5-FU) and medical treatment (MT) in glaucomatous eyes with encapsulated bleb and uncontrolled intraocular pressure (IOP) after trabeculectomy with mitomycin C (MMC) at 12 months follow-up. Design: Prospective, randomized, interventional study. Participants: Forty eyes of 39 patients with encapsulated bleb developed in 5 months or less following primary trabeculectomy with mitomycin and IOP >= 20mmHg. Methods: Eyes were randomized to either TNR with 5-FU or MT. A maximum of two TNR was allowed in the study. All eyes were followed-up for 12 months. Success of treatment was defined as IOP <= 18mmHg and a 20% reduction from baseline (no medications in TNR group). Results: Mean IOP at 12 months follow-up was 12.14 ± 2.80 mmHg in the TNR group and 15.13 ± 2.07 mmHg in the MT group (p=0.004). Fourteen eyes (70%) were considered a success in the TNR group and 15 eyes (75%) in the MT group (p=0.89). The number of needling procedure was 1.35 ± 0.49 procedures and the number of medication was 2.15 ± 0.74 medications. Conclusions: We have demonstrated a similar success rates in eyes randomized to MT in comparison to TNR with 5-FU at the last follow-up. However, a significant lower mean IOP after TNR was observed

Hypertrophic scarring is a common occurrence for severe burn victims leading to major functional, physiological, and aesthetic effects to the patients. Limiting the hypertrophic scarring of the patients alleviates the functional, physiological, and aesthetic effects. Silicone gels, over the past decade, have been widely used to remediate and limit hypertrophic scarring but the mechanism of action is yet to be determined. One explanation has been that hydration of the outermost area of the burn is induced by the silicone gel . However, non-silicone polymers which increase hydration could not mimic the effect. An alternative interpretation is that there may be silicone species that migrate from the silicone gel into the viable tissue to mediate reactions in the extra-cellular matrix that result in a decreased deposition of excessive amounts of collagen - a central feature of the hypertrophic scar. A novel and informative technique to study these species is MALDI-TOF/MS (Matrix Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry) in conjunction with gel permeation chromatography. MALDI-TOF/MS, which has allowed the detection of intact molecular species that were not possible with more established mass spectrometric techniques. The mobile species that may migrate from polydimethylsiloxane medical gel sheeting into skin have been identified by MALDI-MS. The bulk gel contains predominantly cyclic oligomers with a mass distribution peaking at n = 19 (number of repeating siloxane units), but in an aqueous environment the species at the surface of the silicone medical gel are predominantly methyl/methylol-terminated linear siloxanes. By using a gelatine matrix as a model substrate, the distribution of silicon after application of the silicone gel for 16 weeks was determined by Energy-dispersive X-Ray mapping of the sectioned gelatine. The association of the linear and cyclic oligomers with proteins relevant in hypertrophic scarring are considered. The mobility of silicone species across stratum corneum was confirmed by Attenuated Total Reflectance Fourier Transform Infrared spectroscopy (ATR-FT/IR). This method confirms our hypothesis that not only are the low molecular weight silicone species mobile, but also that they do traverse the natural barrier, the stratum corneum, to levels that are detectable by ATR after a continuous application over approximately 11 days. Invitro studies of the effects of LMWS on primary line fibroblast cells indicate a response that down regulates the proliferation of fibroblast cells and protein production. Preliminary results indicate that a family of pendant functional LMWS are effective in down regulating hypertrophic-derived fibroblast primary cells. Studies on hypertrophic scar tissue treated with silicone medical gel indicate that LMWS permeate across the stratum corneum into viable scar tissue. In some areas, the LMWS tend to pool as detected by SEM/EDX elemental silicon analysis. These areas of LMWS pooling tend to be composed of highly disorganised collagen nodules.

Objetivo: Estudo comparativo da pressão intraocular (PIO) após agulhamento transconjuntival (ATC) com 5-fluoracil (5-FU) e tratamento clínico (TC) em olhos glaucomatosos com bolha encapsulada e PIO não controlada após trabeculectomia com mitomicina C (MMC), no final de 12 meses de seguimento. Desenho: Estudo prospectivo, randomizado, intervencionista. Participantes: 40 olhos de 39 pacientes com bolha encapsulada, desenvolvida em 5 meses ou menos, após trabeculectomia primária com mitomicina e PIO >= 20mmHg. Métodos: Os olhos foram randomizados para ATC com 5-FU e TC. Um máximo de dois ATC foi permitido no estudo. Todos os olhos foram acompanhados por 12 meses. O sucesso foi definido como PIO <= 18 mmHg e redução de 20% da PIO basal (sem medicações no grupo ATC). Resultados: A média da PIO em 12 meses de acompanhamento foi de 12,14 ± 2,80 mmHg no grupo do ATC e 15,13 ± 2,07 mmHg no grupo do TC (p = 0,004). 14 olhos (70%) foram considerados sucesso no grupo do ATC e 15 olhos (75%) no grupo do TC (p = 0,89). O número médio de agulhamentos foi de 1,35 ± 0,49 e a quantidade média de medicamentos foi de 2,15 ± 0,74. Conclusões: Houve uma taxa de sucesso semelhante nos olhos randomizados para ATC com 5-FU em comparação com TC em 12 meses de seguimento. No entanto, foi observada uma significativa menor média da PIO, após o ATC / Objective: To compare de efficacy of transconjuctival needling revision (TNR) with 5-fluorouracil (5-FU) and medical treatment (MT) in glaucomatous eyes with encapsulated bleb and uncontrolled intraocular pressure (IOP) after trabeculectomy with mitomycin C (MMC) at 12 months follow-up. Design: Prospective, randomized, interventional study. Participants: Forty eyes of 39 patients with encapsulated bleb developed in 5 months or less following primary trabeculectomy with mitomycin and IOP >= 20mmHg. Methods: Eyes were randomized to either TNR with 5-FU or MT. A maximum of two TNR was allowed in the study. All eyes were followed-up for 12 months. Success of treatment was defined as IOP <= 18mmHg and a 20% reduction from baseline (no medications in TNR group). Results: Mean IOP at 12 months follow-up was 12.14 ± 2.80 mmHg in the TNR group and 15.13 ± 2.07 mmHg in the MT group (p=0.004). Fourteen eyes (70%) were considered a success in the TNR group and 15 eyes (75%) in the MT group (p=0.89). The number of needling procedure was 1.35 ± 0.49 procedures and the number of medication was 2.15 ± 0.74 medications. Conclusions: We have demonstrated a similar success rates in eyes randomized to MT in comparison to TNR with 5-FU at the last follow-up. However, a significant lower mean IOP after TNR was observed