Postoperative anterior uveitis in a patient submitted to combined treatment with cataract surgery and iStent inject®. How to manage? / Uveíte anterior no pós-operatório de facectomia combinada com implante de iStent inject®. Como manejar?

ABSTRACT Minimally invasive glaucoma surgeries are surgical treatment alternatives for glaucoma aimed at reducing intraocular pressure with a better safety profile compared to traditional trabeculectomy. However, in spite of less invasive techniques, complications may develop in any surgical procedure. To the best of our knowledge, this is the first case report of anterior uveitis following combined treatment with cataract surgery and iStent inject® which addresses the management of postoperative inflammation.

RESUMO As cirurgias minimamente invasivas para glaucoma consistem em uma opção de tratamento cirúrgico para glaucoma, a qual promove redução da pressão intraocular com melhor perfil de segurança do que a trabeculectomia. Todavia, complicações são inerentes à realização de procedimentos cirúrgicos, apesar do uso de técnicas menos invasivas. Este é o primeiro relato que apresenta um caso de uveíte anterior após cirurgia combinada de catarata e iStent inject®, além de orientações quanto ao manejo do quadro inflamatório.

The Analysis of AC/A Ratio in Nonrefractive Accommodative Esotropia Treated with Bifocal Glasses

PURPOSE: To report the long term results of bifocal treatment in nonrefractive accommodative esotropia and to analyze the changes of accommodative convergence to accommodation (AC/A) ratio. METHODS: Sixteen patients treated with bifocal glasses for at least 5 years were evaluated retrospectively. Angle of deviation at near and distance, refractive error, and AC/A ratio by the lens gradient method were analyzed. The changes of AC/A ratios were also compared after dividing the patients according to continuation or cessation of bifocal therapy. RESULTS: Six patients (38%; bifocal stop group, BSG) were able to stop using bifocal glasses at an average age of 10.8 years (range, 6.5 to 15.4 years) during their follow-up. However, the other ten patients (62%; bifocal continue group, BCG) had to continue using bifocal glasses until the final visit, which was 13.8 years on average (range, 11.3 to 18.5 years). The AC/A ratio decreased from time of bifocal prescription to the last visit in both groups, from 4.4 to 2.7 in the BSG and from 5.9 to 4.5 in the BCG. AC/A ratios were significantly higher (p = 0.03) in the BCG than that of the BSG from the beginning of bifocal treatment and this difference was persistent until the final visit (p = 0.03). CONCLUSIONS: The AC/A ratio decreased with age in both groups but was significantly higher throughout the entire follow-up period in the BCG. AC/A ratio at bifocal prescription could be an important factor in predicting response to bifocal treatment.

Topical tropicamide induced delirium and psychosis: case report / Delírio e psicose induzidos por tropicamida tópica: relato de caso

Acute psychosis and confusional states are known complications of treatment with anticholinergic agents in the elderly. We report an 87-year-old female patient presenting with acute neurobehavioral abnormalities requiring hospitalization immediately after starting treatment for openangle glaucoma with the topic cycloplegic muscarinic receptor blocker tropicamide. Case-effect relationship was confirmed. The authors make a review of the literature trying to identify the clinical manifestations and risk factors for this complication.

Tratamento com drogas anticolinérgicas é uma causa conhecida de alterações agudas do estado mental em idosos. Relata-se o caso de uma paciente de 87 anos de idade com alterações comportamentais agudas, que necessita de internamento imediatamente após início de terapia para glaucoma de ângulo aberto com tropicamida, um agente cicloplégico bloqueador de receptor muscarínico. A relação causa-efeito foi confirmada depois de a droga ter sido reiniciada durante o internamento. É apresentada uma revisão da literatura delineando as manifestações clínicas mais comuns e fatores de risco para essa complicação.

Effective pupil dilatation with a mixture of 0.75% tropicamide and 2.5% phenylephrine: A randomized controlled trial.

Purpose: To compare the efficacy in pupil dilatation between a mixture containing 0.75% tropicamide and 2.5% phenylephrine and the alternate application of 1% tropicamide and 10% phenylephrine eye drops. Material and Methods: Patients requiring pupil dilatation were randomized to receive one drop of the mixture every 10 min for four times or our standard application of one drop of 1% tropicamide alternating with one drop of 10% phenylephrine every 10 min for two cycles. Pupil size was measured under bright light with the pupil gauge before, and every 5 min after initial application for 40 min. Application of the drops was discontinued once the pupil diameter reached 7 mm. Blood pressure and pulse rate were monitored every 15 min. Results: Of 40 patients (age 57.3±10.9 years, range 35-70 years), 22 were randomized into the mixture group and 18 into the alternate drug group. Baseline pupil sizes were 1.7±0.5 mm in the mixture group and 1.8±0.4 mm in the alternate drug group. The pupils were successfully dilated to 7 mm within 40 min in 17 patients of the mixture group compared to seven patients in the alternate drug group (P=0.004, Log Rank test). The mean pupil sizes at 40 min were 6.6±0.8 and 6.0±0.9 mm in the mixture and alternate drug groups respectively (P=0.050, t-test). Blood pressure and pulse rate were stable and similar in both groups. Conclusions: The mixture of 0.75% tropicamide and 2.5% phenylephrine is superior to our standard application of 1% tropicamide alternating with 10% phenylephrine. It provides faster and more successful pupil dilatation within 40 min.

The Comparison of Mydriatic Effect Between Two Drugs of Different Mechanism

PURPOSE: To maximize effective use of mydriatic drugs through comparing the pupillary dilation effects between 1% tropicamide and 2.5% phenylephrine. METHODS: Fifty people requiring pupillary dilation were divided into 3 groups. Group 1 was treated with one drop of 1% tropicamide in the right eye and one drop of 2.5% phenylephrine in the left eye. Group 2 was treated twice during a 5-minute interval with 1% tropicamide in the right eye. Group 3 was treated twice during a 5-minute interval with 2.5% phenylephrine in the right eye. Groups 2 and 3 were treated with 2.5% phenylephrine and 1% tropicamide in the left eye, administered during a 5-minute interval. The pupillary size was measured in all groups for 40 minutes following eye drops administration. RESULTS: The mean patient age was 15.7 years. Group 1 included 10 patients, and groups 2 and 3 included 20 patients each. Eight patients in group 1 and 16 patients in group 2 developed a larger right pupil. Fourteen patients in group 3 developed a larger left pupil. CONCLUSIONS: Our study showed that 1% tropicamide, with its parasympathetic antagonistic mechanism of action, was more effective at inducing pupillary dilation than 2.5% phenylephrine, and the combination of 1% tropicamide and 2.5% phenylephrine was more effective than multiple drops of single eye drops.

Goniossinéquia como complicação na esclerectomia profunda não penetrante por uso inadvertido de midriático: relato de caso / Goniosynechiae as a complication of non-penetrating deep sclerectomy by inappropriate use of mydriatic: case report

A esclerectomia profunda não penetrante tem sido uma alternativa à trabeculectomia, pois tem como vantagem a redução da pressão intra-ocular (PIO), sem penetrar na câmara anterior. Desta forma, evitando descompressão brusca, câmara anterior rasa. Neste trabalho, descrevemos o caso de uma paciente, 53 anos, negra, com diagnóstico de glaucoma primário de ângulo aberto, com controle clínico insatisfatório e que foi submetida à esclerectomia profunda não penetrante. A paciente evoluiu com formação de goniossinéquia na região da esclerectomia, após uso inadvertido de colírio midriático no pós-operatório, levando ao aumento da PIO e conseqüente falência da cirurgia. O uso de colírio midriático no pós-operatório da esclerectomia profunda não está indicado, pois neste caso, ocasionou o insucesso da cirurgia.

Non-penetrating deep sclerectomy has been an alternative to trabeculectomy, because it has the advantage of reducing intraocular pressure (IOP), without penetrating the anterior chamber. Thus, it avoids a sudden decompression and a plain anterior chamber. In this paper, we described a case of a female patient, 53 years old, black, with diagnosis of open-angle primary glaucoma, with unsatisfactory clinical control and who was submitted to non-penetrating deep sclerectomy. The patient developed goniosynechiae at the site of the sclerectomy, after inappropriate use of mydriatic eye-drops during the postoperative period, leading to an increase of IOP and, therefore, failure of the surgery. The use of mydriatic eye-drops during the postoperative period of deep sclerectomy is not indicated, because in this case, it led to surgery failure.

Single dose of 1% tropicamide and 10% phenylephrine for pupil dilation.

OBJECTIVE: To compare the efficacy of pupil dilation between a single dose and three doses of 1% tropicamide and 10% phenylephrine for binocular indirect ophthalmoscopy. MATERIAL AND METHOD: A prospective randomized double-blind clinical controlled trial was conducted. All patients underwent the binocular indirect ophthalmoscopy and met the inclusion criteria were randomized into two groups using block randomization. Group A received a single dose of 1% tropicamide and 10% phenylephrine eye drops, and Group B received three doses of the same drugs. The primary outcome was the horizontal pupil diameter measured by slit-lamp biomicroscope (Haag-Streit model 900) before and at 10, 15, 20, 25 and 30 minutes after eye drop instillation. The clinical equivalence of the efficacy of pupil dilation between the two groups was defined as the difference of less than or equal to 1 mm (-1 mm to + 1 mm). RESULTS: Eighty patients (160 eyes) were randomized into 40 patients (80 eyes) in group A and 40 patients (80 eyes) in group B. The mean pupil sizes at baseline of group A were 3.51 +/- 0.63 mm in the right eye and 3.39 +/- 0.67 mm in the left eye. Those in group B were 3.61 +/- 0.67 mm in the right eye and 3.66 +/- 0.72 mm in the left eye. The mean pupil diameters at 30 minutes of group A were 7.34 +/- 0.51 mm in the right eye and 7.41 +/- 0.56 mm in the left eye, whereas those of group B were 7.49 +/- 0.45 mm in the right eye and 7.51 +/- 0.40 mm in the left eye. The mean difference of the pupil size between the two groups was 0.15 mm (p = 0.175) in the right eye and 0.l0 mm (p = 0.362) in the left eye. The 95% confidence intervals of the difference in pupil size were -0.36 to 0.07 mm in the right eye and -0.32 to 0.12 mm in the left eye. CONCLUSION: The 95% confidence interval of the difference in pupil size lay entirely within the range of equivalence. The single dose of 1% tropicamide and 10% phenylephrine was clinically equivalent to the three doses of the same drugs.

Estudo comparativo da acomodaçäo residual após instilaçäo de colírios de tropicamida a 1 por cento, ciclopentolato a 1 por cento e associaçäo de tropicamida a 1 por cento + ciclopentolato a 1 por cento / Comparative study of residual accomodation after instillation of the eye drops with 1 per cent tropicamide, 1 per cent cyclopentolate, and association of 1 per cent tropicamide + 1 per cent cyclopentolate

Objetivo: Avaliar a acomodaçäo residual após a instilaçäo de duas drogas ciclopégicas, o ciclopentolato a 1 por cento e a tropicamida a 1 por cento e a associaçäo entre elas. Material e métodos: Selecionamos pacientes de 15 a 25 anos, com íris grau 4 e 5 pela classificaçäo de Seddon e sem nenhum tipo de doença ocular, que procuraram de maneira espontânea o ambulatório de Oftalmologia da Santa Casa de Säo Paulo no período de outubro de 1997 a setembro de 1998. Os 46 pacientes foram submetidos a três exames oftalmológicos completos, em que se testava o potencial de acomodaçäo monocularmente, após a instilaçäo de tropicamida a 1 por cento, com tempo de espera de 20 minutos, ciclopentolato a 1 por cento com tempo de espera de 40 minutos e tropicamida a 1 por cento + ciclopentolato a 1 por cento com intervalo entre as drogas de 5 minutos e com latência de 30 minutos. O intervalo entre os exames era de no mínimo sete dias. Resultados: Näo houve diferença entre os grupos dos emétropes, dos hipermétropes e dos míopes com nenhuma droga instilada (p>0,005). O ciclopentolato a 1 por cento e a associaçäo entre as drogas proporcionaram menor acomodaçäo residual estatisticamente significante, em comparaçäo com a tropicamida a 1 por cento no grupo dos hipermétropes e dos míopes. Conclusäo: O ciclopentolato a 1 por cento e a associaçäo entre as drogas säo seguras para o exame refratométrico estático em pacientes jovens, com íris escura e sem doença ocular, pois proporcionaram uma média da acomodaçäo residual em todos os grupos pesquisados de no máximo 1,21 + ou - 0,7 dioptrias esféricas (DE).

Midriasis farmacológica en conejos inducida por antagonistas de histamina / Pharmacologic midriasis induced by histamine antagonist in rabits

El propósito de este trabajo es determinar el efecto de antagonistas de histamina sobre el esfínter pupilar y la superficie ocular en conejos pigmentados. Para ello se realizó un estudio experimental, longitudinal y comparativo. Se estudiaron 50 ojos de 25 conejos, divididos en 4 grupos: I cimetidina, II clorfenamina, III tropicamida al 1 por ciento y IV fenilefrina al 10 por ciento + ciclopentolato al 1 por ciento. Como resultado, se demostró que la combinación de cimetidina y tropicamida al 1 por ciento produce pérdida de reflejo pupilar a los 5 minutos, midriasisi máxima a los 15 minutos, delcinando a los 45 minutos de su aplicacion. Se concluye que la combinación de cimetidina y tropicamida al 1 por ciento en forma tópica, induce pérdida del reflejo pupilar y midriasis a corto plazo desapareciendo rápidamente el afecto

Correlación campimétrica y electrorretinográfica en la degeneración macular relacionada con la edad / Correlation in electroretinogram and perimetry related macular degeneration

Se estudiaron 13 ojos de 9 pacientes con diagnóstico de degeneración macular relacionada con la edad (DMRE) y 11 ojos de 8 sujetos control de edades similares: a los que se les realizó exploración oftalmológica completa, como campimetría central, periférica y electrorretinograma (ERG). Las áreas de campimetría fueron medidas en mm² y en el ERG la amplitud en mV y la latencia en ms. Se realizaron mediante el programa de análisis estadístico Kwikstat, "Coeficientes de Correlación de Pearson" entre las campimetrías central y periférica, y a su vez entre éstas y el ERG de los pacientes del grupo control y del estudio; encontrando a pesar de ser escaso el número de pacientes y por lo tanto la correlación pobre, una mejor correlación en el grupo de estudio entre la campimetría central y periférica; y en el control entre flicker y campimetría periférica.

Hemorragias retinales del polo posterior en recién nacidos de término con parto normal de término con parto normal y sus secuelas a 4 años / Retinal hemorrhages of posterior pole in term newborn with normal delivery and its sequeles after 4 years

Se estudiaron prospectivamente 374 recién nacidos de término, en el Hospital San Juan de Dios, Santiago, Chile, se realizó un examen de fondo de ojo, antes de las 48 horas de vida, con oftalmoscopía directa, previamente dilatados con Tropicamida al 0,5 por ciento, en busca de hemorragias retinales (H.R.) de polo posterior (fundamentalmente papila y mácula). Las H.R. son más frecuentes en primíparas y tienen una frecuencia de 23,5 por ciento. Se controlaron prospectivamente los pacientes con Fondo de Ojo, estudio sensorio motor y agudeza visual hasta los 4 años de edad, para restablecer si existe relación con tropía y/o ambliopía. No hay relación entre la presencia de H.R. de polo posterior al nacer en el grupo estudiado y el desarrollo de tropía y/o ambliopía. El seguimiento es difícil por la no asistencia a los controles de los pacientes