ABSTRACT
Resumo Objetivo: Descrever aspectos clínicos e esquema terapêutico dos pacientes com tuberculose ocular presumida tratados em um centro de referência em tuberculose de São Paulo. Métodos: Estudo retrospectivo descritivo. O teste exato de Fisher foi realizado quando apropriado. Resultados: A queixa mais comum foi baixa acuidade visual (83,1%), seguida por dor ocular generalizada (25,3%) e visão turva (22,8%). A uveíte posterior foi a apresentação mais comum (35,7%). O tratamento consistiu no esquema atualmente recomendado de rifampicina, isoniazida, pirazinamida e etambutol (RHZE). A prednisona oral foi incluída no tratamento de 37 pacientes, para tratamento da inflamação aguda, embora não tenha diminuído a prevalência de complicações crônicas, em comparação com a recuperação completa (p = 0,1). O diagnóstico precoce (<70 dias) foi associado a maiores taxas de recuperação total (p = 0,005). Não houve significância estatística quando se comparou a terapia de 6 a 9 meses (p = 0,7). Conclusão: A uveíte tuberculosa pode ser tratada por uma terapia com duração de seis meses. Um breve curso de esteroides melhora os sintomas agudos, embora não reduza as complicações a longo prazo.
Abstract Purpose: To analyze and describe the therapy used in presumed ocular tuberculosis in a referral center in São Paulo, Brazil. Methods: Retrospective, descriptive study. Fisher's exact test was performed when appropriate. Results: The most common complaint was low visual acuity (83.1%), followed by generalized ocular pain (25.3%) and blurred vision (22.8%). Posterior uveitis was the most common presentation (35.7%). Treatment consisted of the currently recommended association of rifampin, isoniazid, pyrazinamide, ethambutol (RHZE) regimen. Oral prednisone was included in the treatment of 37 patients for acute inflammation, although it did not significantly decrease the prevalence of chronic complications compared to full recovery (p = 0,1). Early diagnosis (< 70 days) was associated with higher rates of full recovery (p = 0.005). No statistical significance was observed when comparing 6 to 9-month therapy (p = 0.7). Conclusion: Tuberculous uveitis can be treated with a 6-month duration RHZE therapy. A brief course of steroids may improve acute symptoms, although it did not reduce long-term disabilities.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Tuberculosis, Ocular/diagnosis , Tuberculosis, Ocular/drug therapy , Uveitis/diagnosis , Uveitis/drug therapy , Prednisone/therapeutic use , Tuberculin Test , Visual Acuity , Medical Records , Retrospective Studies , Diagnostic Techniques, Ophthalmological , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/therapeutic useABSTRACT
Indirect traumatic optic neuropathy (ITON) is a primary cause of visual loss following head trauma.For the past decades,it has been a clinical dogma that mega-dose of methylprednisolone is beneficial in the treatment of ITON.However,there is still no convincing clinical evidence to support the effectiveness of these strategies up to now,so growing questions over whether glucocorticosteroid is beneficial for improving visual outcome in ITON patients are raised.Some recent studies even think that the effectiveness of glucocorticosteroid is not good enough for ITON or possible detrimental.Many researchers strongly advocate to carry out evidence-based multicenter randomized clinical trials (RCTs) to clarify this important issue.The current researches about application of glucocorticosteroid in the treatment of ITON are reviewed.