ABSTRACT
Objetivo: evaluar la efectividad de la remoción del cristalino en el tratamiento del cierre angular primario agudo. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo de serie de casos en 27 ojos de igual número de pacientes con cierre angular primario agudo, distribuidos en tres alternativas: facoemulsificación (faco n= 7), túnel esclerocorneal (túnel n= 12) y túnel postrabeculectomía (túnel pos-TBT n= 8).Se analizaron las variables presión intraocular y número de colirios hipotensores en preoperatorio y posoperatorio a la semana, al mes, a los tres y a los seis meses, al año y a los dos años, así como las variables esfera, cilindro y agudeza visual mejor corregida en preoperatorio y a los dos años posoperatorios. Resultados: la presión intraocular posoperatoria fue estable en el tiempo en los 3 grupos (12-14 mmHg). A los dos años hubo reducción significativa de presión intraocular media en grupo túnel (3,83 ± 5,27 mmHg; p= 0,032); del número de colirios hipotensores en grupo faco (1,29 a 0,14; p= 0,038) y del grupo túnel (1,33 a 0,25; p= 0,006). Se indujo miopía en grupo túnel pos-TBT (-1,16 ± 1,12 D; p= 0,028) y astigmatismo en grupo túnel (1,00 ± 1,05 D; p= 0,016). La agudeza visual mejor corregida promedio se incrementó en los tres grupos, con significación en los grupos túnel y túnel pos-TBT (p= 0,003 y p= 0,012 respectivamente). Conclusiones: en pacientes con cierre angular primario agudo, la facoemulsificación y el túnel esclerocorneal reducen la presión intraocular y el número de colirios hipotensores en el mediano plazo de dos años, a la vez que se mantiene el poder hipotensor de una filtrante previa. Las tres variantes recuperan de manera efectiva la agudeza visual, mientras se induce el error miópico de 1 dioptría en pacientes con trabeculectomía previa y astigmatismo de 1 dioptría mediante túnel esclerocorneal(AU)
Objective: to evaluate the effectiveness of the crystalline lens extraction in the treatment of the acute primary angle-closure. Methods: prospective, longitudinal and descriptive study of a case series of 27 eyes from the same number of patients suffering acute primary angle-closure, distributed according to three alternatives: phacoemulsification (n=7, phaco), sclerocorneal tunnel (n=12, tunnel)and postrabeculectomy tunnel ( n=8, post-TBT tunnel). The variables intraocular pressure and number of hypotensive eyedrops used in the preoperative and postoperative period were analyzed a week, a month, three months, six months, one year and two years after the surgery as well as sphere, cylinder and best corrected visual acuity in the preoperative phase and two years after surgery. Results: postoperative intraocular pressure was steady in the course of time in the three groups (12-14 mmHg). Two years later, there had been a significant reduction of average intraocular pressure in the tunnel group (3.83 ± 5.27 mmHg; p= 0.032), of the number of hypotensive eyedrops used in the phaco group (1.29 to 0.14; p= 0.038) and the tunnel group (1.33 to 0.25; p= 0.006). Myopia in the post-TBT tunnel group(-1.16 ± 1.12 D; p= 0,028) and astigmatism in the tunnel group(1.00 ± 1.05 D; p= 0.016) were both induced. The best average corrected visual acuity increased in the three groups, being significant in the tunnel and the post-TBT tunnel groups (p= 0.003 and p= 0.012, respectively. Conclusions: in those patients with acute primary angle-closure, phacoemultification and sclerocorneal tunnel reduce the intraocular pressure and the number of hypotensive eyedrops to be used in 2 years-term and the hypotensive power of a previous filtering bleb. The three variants can effectively recover the visual acuity whereas the myopic error of one diopter is induced in patients with previous trabeculectomy and one diopter astigmatism through the sclerocorneal tunnel(AU)
Subject(s)
Humans , Glaucoma, Angle-Closure/therapy , Intraocular Pressure , Lens, Crystalline/injuries , Ophthalmic Solutions/therapeutic use , Phacoemulsification/methods , Epidemiology, Descriptive , Longitudinal Studies , Prospective Studies , Visual AcuityABSTRACT
Glaucoma agudo é a apresentação mais sintomática dentro do quadro glaucomatoso, podendo evoluir com perda visual irreversível em poucas horas. Costuma acometer indivíduos com anatomia predisponente. Seu diagnóstico e início rápido do tratamento são fundamentais para preservação do prognóstico visual do paciente.
Acute glaucoma is the most symptomatic presentation of the glaucomatous disease, which can progress to irreversible blindness in just a few hours if left untreated. It typically occurs in patients with predisponent anatomy. It's prompt recognition and fast initiation of therapy is the mainstay to provide a good visual outcome for the patient.
Subject(s)
Glaucoma , Glaucoma, Angle-Closure/diagnosis , Glaucoma, Angle-Closure/drug therapy , EmergenciesABSTRACT
El cierre angular agudo o glaucoma agudo como es conocido mundialmente es un cuadro clínico característico producido por un cierre angular brusco, constituye una urgencia oftalmológica que pone en peligro la función visual si no es resuelto satisfactoriamente en las primeras horas de instaurado. El mecanismo fisiopatológico más frecuente es el bloqueo pupilar primario y el tratamiento de elección es la iridotomía láser periférica. Se debe realizar el diagnóstico diferencial con el bloqueo pupilar secundario y con otras causas sin bloqueo pupilar en las que la iridotomía no es suficiente. El cierre angular agudo es generalmente unilateral aunque se puede presentar de forma bilateral desencadenado por el empleo de drogas que producen dilatación pupilar como en el caso clínico que se describe a continuación
The acute angle closure or acute glaucoma as it is worldwide known is a characteristic clinical picture that is caused by sudden angle closure, It represents ophthalmological emergency that endangers the visual function if not satisfactorily solved in the first hours of occurrence. The most frequent physiopathological mechanism is primary pupil blocking and the treatment of choice is peripheral laser iridotomy. The differential diagnosis must be made with the secondary pupil blocking and with other causes without pupil blocking in which iridotomy is not enough. The acute angular closure is generally unilateral, although it may appear bilaterally and be caused by the use of drugs that give rise to pupil dilation like the clinical case which was described here
Subject(s)
Humans , Female , Aged , Benzodiazepines/adverse effects , Glaucoma, Angle-Closure/complications , Iridectomy/methods , Pupil Disorders/surgeryABSTRACT
JUSTIFICATIVA E OBJETIVOS: Vários fármacos, sejam de uso tópico ou sistêmico, tem a capacidade de elevar a pressão intraocular, desencadeando uma crise aguda de ângulo fechado, tais como agentes adrenérgicos, colinérgicos e anticolinérgicos, antidepressivos e ansiolíticos, derivados da sulfa e anticoagulantes. O objetivo deste estudo foi rever os principais grupos farmacológicos descritos. CONTEÚDO: A maioria destes eventos envolve o bloqueio pupilar em indivíduos que são predispostos (hipermetropes, cristalino espesso, ângulo iridocorneano estreito) quando a pupila é dilatada, como efeito colateral destas medicações. Foram consultados os bancos de dados da Pubmed (Medline), LILACS e a Biblioteca do Centro de Estudos de Oftalmologia. CONCLUSÃO: Deste modo o médico que prescreve, bem como o oftalmologista que vai tratar o paciente deve estar ciente dos potenciais riscos no desencadeamento do fechamento agudo do ângulo.
BACKGROUND AND OBJECTIVES: Several drugs for topic or systemic usage have the capacity of elevating the intraocular pressure, initiating an acute closed angle crisis, such as, adrenergic, anticholinergic and cholinergic, antidepressant and antianxiety, sulfa-based, and anticoagulant agents. The present paper proposes a revision in the main pharmacological groups above mentioned. CONTENTS: Most of these events involving pupillary block occurs in predisposed individuals (hypermetropia, thick lens, narrow iridocorneal angles) when the pupil is dilated due collateral effect of the above medicines. The authors have used the databases of the PubMed (MedLine), LILACS and Library of the Center of Studies of Ophthalmology for their research. CONCLUSION: Therefore the doctor that prescribes, as well as the ophthalmologist treating the patient should be aware of the potential risks of the above medication in initiating the acute angle closure.
Subject(s)
Glaucoma , Intraocular Pressure , Pharmaceutical Preparations/adverse effectsABSTRACT
O topiramato, uma sulfa monossacarídica, usada primariamente como um anticonvulsivante, é uma droga relativamente nova no mercado brasileiro. Devido às potencialidades terapêuticas do topiramato em uma gama variada de patologias (enxaquecas, transtornos do humor, etc.), assim como pelas diversas novas apresentações comerciais surgidas no país ultimamente, espera-se que seu uso venha a ser cada dia mais comum. O presente relato se refere a um grave efeito colateral decorrente do uso da medicação em questão, ocorrido em um homem de 36 anos - o glaucoma agudo bilateral, evento ainda pouco relatado na literatura mundial. Por conta de tal quadro, o paciente teve de se submeter a uma iridotomia bilateral.
The topiramate, a monosaccharide sulfa, primarily used as an anticonvulsant, was recently introduced in Brazilian trade. Through therapeutic potentialities of topiramate in a considerable scale of illness (migraine, disorders of humor, etc.), thus by the recent presentation, in Brazil, of several news commercial presentation of medication, it is expected that its use be more common each day. This present study reports a severe side effect that comes from the use of the drug in evidence, occurred in a 36 year-old man - the bilateral acute glaucoma, event of report not usual in the world literature. Because of this event, the patient had to be submitted to a bilateral iridotomy.
Subject(s)
Humans , Male , Adult , Anticonvulsants/adverse effects , Anticonvulsants/therapeutic use , Glaucoma, Angle-Closure/diagnosis , Glaucoma, Angle-Closure/chemically induced , Intraocular Pressure , Brazil , IridectomyABSTRACT
Acute angle closure glaucoma is an eye affection characterized by a sudden increase of intraocular pressure, which can produce an irreversible damage of optic nerve if diagnosis and treatment are late. That's why general practitioners must know well its basic diagnosis and treatment. The onset includes ocular pain, headache, nausea, vomiting and blurred vision and its signs are central red eye, pupilar dilation, etc. Diagnosis is confirmed by tests performed for an ophthalmologist. For management in emergency rooms it is suggested, hydration, control of pain, nausea and vomiting and drugs to decrease high intraocular pressure with topical agent such as pilocarpine and timolol, and systemic agents such as acetazolamide and manitol. Definitive treatment includes laser iridotomy or incisional iridectomy and the administration of topical agents like the ones mentioned above and others like prostaglandinic analogs, etc. Sequels may include complete loss of vision of affected eye if early treatment is not initiated.
El glaucoma de ángulo cerrado es una afección aguda del ojo caracterizada por aumento súbito de la presión intraocular, que sin diagnóstico oportuno y bien manejado puede producir daño irreversible del nervio óptico. Por lo anterior el médico general debe conocer las bases para su diagnóstico y manejo. Como síntomas destacan dolor ocular, cefalea, epífora, visión borrosa, alteraciones vegetativas y como signos, ojo rojo central, midriasis, entre otros. La presunción diagnóstica debe ser confirmada por oftalmólogo por lo que ante la sospecha la interconsulta es perentoria. En el servicio de urgencias, se recomienda control de signos neurovegetativos y dolor, hidratación y agentes depresores tópicos de la presión intraocular (pilocarpina y timolol), y sistémicos (acetazolamida y manitol). El tratamiento definitivo lo constituye la iridotomía láser o iridectomía incisional y el uso de agentes depresores tópicos o sus derivados a mantención según corresponda, y otros como análogos de prostaglandinas. De no mediar tratamiento precoz las secuelas pueden incluir pérdida total de visión en el ojo afectado.