Vasculitis retinal / Retinal vasculitis

La vasculitis retinal es una enfermedad inflamatoria que amenaza la visión y afecta los vasos retinales (capilares, venas y arterias). Puede ocurrir como una condición idiopática o como complicación de enfermedades infecciosas y neoplásicas o en asociación con enfermedades sistémicas inflamatorias. Sus manifestaciones clínicas típicas incluyen revestimiento perivascular, envainamiento, filltración vascular y oclusión. Puede estar asociada con signos de isquemia retinal (puntos algodonosos y hemorragias intraretinales). Es clasificada en diferentes estadíos: inflamación, isquemia, neovascularización y complicaciones. En su diagnóstico es importante la biomicroscopia, la oftalmoscopia del segmento posterior y la prueba de angiografía fluoresceínica. Se presenta un paciente de 30 años con buena historia de salud anterior. El paciente comenzó con enrojecimiento del ojo izquierdo y la observación de flotadores en ambos ojos. Fue examinado y los signos clínicos fueron descritos en el examen oftalmológico. El examen del fondo de ojo con lente de 90 dioptrias y el oftalmoscopio binocular indirecto fue realizado para un cuidadoso examen. La retinografía del fondo y las imágenes del test de angiografía y otros estudios complementarios indicados permitieron conocer que presentaba una vasculopatía obliterativa retinal ideopática (Enfermedad de Eales), y el diagnóstico diferencial fue discutido. El tratamiento indicado fue la fotocoagulación con láser y evaluar la indicación de los estudios bioquímicos del cultivo del vítreo, por antígenos de leucocito humano, factor de crecimiento endotelial vascular e interleukinas que han sido observados en este examen(AU)

Retinal vasculitis is an inflammatory disease that threatens vision and affects retinal vessels (capillaries, veins and arteries). It may occur as an isolated idiopathic condition and as a complication of infective or neoplastic disorders, in association with systemic inflammatory diseases. Typical clinical manifestations including perivascular sheathing or cuffing, vascular leakage and occlusion. It may be associated with signs of retinal ischemia (cotton-wool spots and intra-retinal hemorrhage). It is classified into different stages: lnflamation, ischemia, neovascularization and complications. In the diagnosis, biomicroscopy and ophtalmoscopic of the posterior segment and fluorescein angiography test are important. A case report is presented of a 30-year-old male patient with a history of good health. In October 2015 the patient had started out with reddening of his left eye and the viewing of floaters with both eyes. Funduscopy was performed with a 90-dioptric lens and a binocular indirect ophthalmoscope. Fundus retinography, angiographic imaging and other complementary studies revealed an idiopathic obliterative retinal vasculopathy (Eales disease). The treatment indicated was photocoagulation, as well as a recommendation to evaluate the biochemical studies of the vitreous culture, since the test had found human leukocyte antigens, vascular endothelial growth factor and interleukins(AU)

Desprendimiento seroso macular asociado a fosetas papilares tratado con fotocoagulación / Serous macular detachment associated to optic disc pits treated with photocoagulation

Las fosetas congénitas papilares son poco comunes. Se trata de una entidad caracterizada típicamente por depresiones papilares unilaterales, ovales, de color blanco grisáceo. Reportamos un caso con dicha entidad asociada al desprendimiento seroso tratado con fotocoagulación. Se realizó un estudio descriptivo a una paciente femenina de 14 años quien refirió pérdida de visión del ojo izquierdo de un mes de evolución. Se realizó fotocoagulación láser al borde yuxtapapilar temporal de la foseta, con evoluciones al mes y a los 3, 6, 9, 12 y 24 meses posteriores, mediante tomografía de coherencia óptica, mejor agudeza visual corregida y oftalmoscopia. Se logró progresiva disminución del desprendimiento macular y mejoría de la agudeza visual desde el primer mes de control. A los 9 meses se observó normal arquitectura macular en la tomografía de coherencia óptica y mejoría de la agudeza visual a 20/25 (95 VAR), con iguales resultados en los controles a los 12 y 24 meses. La terapéutica con fotocoagulación puede resultar eficiente, simple, mínimamente invasiva y económica para la maculopatía asociada a la foseta papilar(AU)

Congenital optic disc pits are an infrequent condition typically characterized by unilateral oval grayish-white papillary depressions. A case report is presented of this condition associated to serous detachment treated with photocoagulation. A descriptive study was conducted of a 14-year-old female patient who reported loss of vision in her left eye with a month of evolution. Laser photocoagulation was performed on the temporal juxtapapillary edge of the pit, with evolution checks at 3, 6, 9, 12 and 24 months by optical coherence tomography, best corrected visual acuity and ophthalmoscopy. Progressive macular detachment reduction and visual acuity improvement were observed since the first control. At 9 months optical coherence tomography showed a normal macular architecture and visual acuity improvement to 20/25 (95 VAR) with identical results at 12 and 24 months. Photocoagulation therapy may be efficient, simple, minimally invasive and economical for maculopathy associated to optic disc pits(AU)

Estrategias en el tratamiento de la retinopatía diabética / Treatment strategies for diabetic retinopathy

Con este trabajo nos proponemos revisar las evidencias científicas relacionadas con el tratamiento de la retinopatía diabética. Para la investigación documental se examinaron los artículos de la temática indexados en las bases de datos Pubmed, Pubmed Central y Scielo, que correspondieron a los descriptores DeCs-MeSH: retinopatía diabética y tratamiento actual. La evaluación de los datos se realizó mediante el análisis de contenido de tipo directo. El progreso de la retinopatía diabética va desde los estados más benignos hasta los más severos cuando no se aplica una intervención médica apropiada. Es importante reconocer cada estado de la retinopatía diabética para que el tratamiento sea más efectivo. Varias décadas de estudios clínicos han proporcionado excelentes datos sobre el curso natural de la enfermedad y la estrategia de tratamiento que son efectivas en alrededor de un 90 por ciento para prevenir la pérdida visual severa(AU)

The purpose of the study was to present scientific evidence associated with the treatment of diabetic retinopathy. Document analysis was conducted based on examination of papers about the topic indexed in the databases PubMed, PubMed Central and SciELO, using the DeCs-MeSH terms 'diabetic retinopathy' and 'current treatment'. Data were evaluated with the method of direct content analysis. Diabetic retinopathy evolves from its most benign stages to the severest when appropriate medical action is not taken. It is important to identify each stage of diabetic retinopathy and apply the most effective treatment. Several decades of clinical studies have provided excellent data about the natural course of the disease, as well as about treatment strategies which are effective in around 90 percent of the cases to prevent severe visual loss(AU)

Láser micropulsado IRIDEX IQ 577 nm / IRIDEX IQ 577 nm micropulse laser

El micropulso es una tecnología láser que consiste en proporcionar solo una fracción de la energía usualmente utilizada para la realización del efecto deseado. La eficacia clínica del láser 577 nm ha mostrado una respuesta terapéutica favorable con mínimos daños colaterales tanto en los tratamientos convencionales de onda continua como en modo micropulsado para algunas enfermedades maculares, como edema macular diabético, retinopatía serosa central y oclusión venosa retiniana. IQ577TM ofrece, además, la tecnología TxCell, la que permite el uso de patrones con múltiples spots, aumenta la eficiencia al aplicar la terapia y hace el proceso menos doloroso para el paciente. Por otra parte, tiene ventajas en el tratamiento del glaucoma, ya que la trabeculoplastia láser con micropulso no es destructiva, a diferencia de la trabeculoplastia tradicional, y permite la posibilidad de retratamientos a los pacientes que no alcanzan la presión intraocular deseada. Con el objetivo de caracterizar el láser micropulsado IRIDEX IQ577TM se realizó la presente revisión de la literatura mediante búsquedas en diferentes publicaciones relacionadas con la especialidad, para lo cual se utilizaron las bases de datos de revistas líderes de Oftalmología(AU)

Micropulse is a laser technology that consists in providing only a fraction of the energy typically used to obtain a given effect. The clinical efficacy of 577 nm laser manifests in a favorable therapeutic response with minimal collateral damage both in conventional continuous wave treatments and in micropulse mode for some macular diseases, such as diabetic macular edema, central serous retinopathy and retinal vein occlusion. IQ577TM also offers TxCell technology, which allows the use of multi-spot patterns, increasing efficiency when applying the therapy and making the process less painful for patients. On the other hand, it has advantages for the treatment of glaucoma, because, unlike traditional trabeculoplasty, micropulse laser trabeculoplasty is not destructive, making it possible to re-treat patients not achieving the desired intraocular pressure. The purpose of the study was to characterize micropulse laser IRIDEX IQ577TM. A bibliographic review was conducted based on a search in various publications related to the specialty, using the databases of leading ophthalmology journals(AU)

La retinopatía de la prematuridad en Sancti Spíritus: epidemiología y clínica / Retinopathy of prematurity in Sancti Spíritus province: epidemiology and clinical aspects

Objetivo: determinar las características epidemiológicas y clínicas de la retinopatía de la prematuridad en Sancti Spíritus desde el año 2004 al 2015. Métodos: se realizó un estudio descriptivo, retrospectivo, en 1 165 recién nacidos prematuros examinados. Se empleó el análisis descriptivo, sustentado en el empleo de gráficos y tablas de distribución de frecuencia, considerando las tasas de incidencia y de prevalencia, así como las variables clínicas relacionadas con la entidad. Resultados: la retinopatía de la prematuridad presentó tasas de incidencia similares a las cubanas y menores a las de algunos países; también tasas de prevalencia en incremento. Los municipios con más pacientes diagnosticados fueron Sancti Spíritus, Cabaiguán y Jatibonico. En la pesquisa existió un predominio de los varones (54,5 opr ciento) y el color de la piel blanca (54,8 por ciento). Los factores de riesgo más frecuentes en los 108 pacientes con retinopatía de la prematuridad fueron la edad gestacional al nacimiento baja, el bajo peso extremo y el apgar bajo. Los grados de la entidad que más se presentaron en el período fueron el I y III. La fotocoagulación con láser fue el tratamiento aplicado a los pacientes que lo requirieron. Conclusiones: la retinopatía de la prematuridad es una realidad en la provincia espirituana, donde esta enfermedad presenta una relación directa con la prematuridad extrema, y su manejo ha sido oportuno en los pacientes que la han desarrollado(AU)

Objective: to determine the epidemiological and clinical characteristics of retinopathy of prematurity in Sancti Spíritus province from 2004 to 2015. Methods: retrospective and descriptive study of 1 165 examined premature newborns. Descriptive analysis based on the use of charts and frequency distribution tables and considering incidence and prevalence rates as well as related clinical variables was used. Results: retinopathy of prematurity showed incidence rates similar to those at national level and lower than those of other countries whereas the prevalence rates were increasing. The municipalities with higher numbers of diagnosed patients were Sancti Spíritus, Cabaiguán and Jatibonico; males (54,5 percent) and Caucasians (54,8 percent) predominated. The most frequent risk factors in the 108 patients with retinopathy of were the low gestacional age, the extreme low weight and low Apgar. The main grades of retinopathy in the period were I and III. The laser photocoagulation was the treatment given to patients that required it. Conclusions: retinopathy of prematurity is a real situation in Sancti Spíritus province and had a direct relationship with extreme prematurity. Timely management of the disease has been observed in affected patients(AU)

Desprendimiento seroso macular asociado a foseta papilar congénita y coloboma de papila: ¿Qué opciones terapéuticas tenemos? / Macular serous detachment associated to congenital papillary pit and papillary coloboma: What treatment options do we have?

La foseta papilar es una rara anomalía congénita que forma parte del espectro de las anormalidades congénitas del disco óptico. Se trata de invaginaciones intrapapilares que suelen localizarse en el margen del disco óptico. La mayoría se localiza a nivel temporal; en torno al 20 por ciento son de localización central seguidas por las fosetas superiores, inferiores o nasales. La bilateralidad se estima en un 10-15 por ciento y su incidencia se ha establecido en torno al 0,19 por ciento. Suelen ser asintomáticas, aunque en aproximadamente el 50 por ciento de los casos se produce afectación macular por el paso de fluido procedente desde la foseta papilar hacia las diferentes capas retinianas, lo que afecta secundariamente la agudeza visual y es, por tanto, el motivo de consulta. Hasta el momento se han descrito múltiples alternativas terapéuticas para el tratamiento de los desprendimientos de retina serosos asociados a foseta de papila, pero ninguna de estas alternativas se ha impuesto sobre el resto. El tratamiento de esta enfermedad consiste en cerrar la comunicación entre la foseta y el espacio subretiniano con diversas opciones terapéuticas como: la fotocoagulación láser, la neumoretinopexia, la indentación escleral posterior, la fenestración del nervio óptico, la vitrectomía o alguna combinación de las anteriores. La actual revisión bibliográfica se propone profundizar en el tema, sobre la base de pacientes en consulta con dicha afección retiniana(AU)

Papillary pit is a rare congenital anomaly that is part of the congenital optic disc anomaly spectrum. It deals with intrapapillary invaginations that may be located at the border of the optic disc. Most of them is located at temporal level, around 20 percent are located centrally followed by upper, lower and nasal pits. Bilateral pits are estimated to be 10-15 percent and their incidence has been set at 0.19 percent. They are asymptomatic although 50 percent of cases suffer macular damage due to the passing of fluid from the papillary pit to the different retinal layers, which affecgs in a secondary way the visual acuity and thus it is the reason to go to the ophthalmologist. Multiple therapeutic alternatives for the treatment of papillary pit-associated serous retinal detachments have been described but none of them has predominated over the others. The treatment of this disease consists of closing the communication between the pit and the subretinal space with several therapeutic options such as laser photocoagulation, pneumoretinopexia, posterior scleral indentation, optic nerve fenestration, vitrectomy or any combination of the above-mentioned methods(AU)

Ciclofotocoagulación transescleral de contacto, una opción válida en el tratamiento del glaucoma neovascular / Contact transscleral cyclophotocoagulation, a valuable option for treatment of the neovascular glaucoma

Objetivo: describir los resultados de la ciclofotocoagulación tranescleral de contacto como opción de tratamiento en el glaucoma neovascular. Métodos: se realizó un estudio descriptivo, longitudinal prospectivo, en 100 pacientes con glaucoma neovascular atendidos en la Consulta Provincial de Glaucoma de la provincia de Pinar del Río, que cumplían con las indicaciones de la ciclofotocoagulación transescleral con láser. Resultados: el 69 por ciento de los pacientes tratados se encontraron entre los 61 y 80 años de edad. Hubo un predominio del sexo masculino. La agudeza visual se mantuvo estable posterior al tratamiento y hubo una reducción de la presión intraocular en el 91 por ciento de los casos. En el 62 por ciento se reportaron cifras inferiores a los 21 mmHg a los 3 meses posoperatorio; en el 89 por ciento de los pacientes se logró alivio del dolor y en el 75 por ciento hubo regresión de los neovasos. Conclusiones: la ciclofotocoagulación transescleral de contacto proporciona una reducción de la presión intraocular con alivio del dolor y regresión de los neovasos en los pacientes con glaucoma neovascular, y no se produce variación de la agudeza visual(AU)

Objective: to describe the results of contact transscleral cyclophotocoagulation as therapeutical alternative in the neovascular glaucoma. Methods: prospective, longitudinal and descriptive study of one hundred patients with neovascular glaucoma, who had been seen at the provincial glaucoma service of Pinar del Rio province and met the criteria for transscleral cyclophotocoagulation using laser. Results: sixty nine percent of treated patients were 61-80 years old. Males predominated. Visual acuity remained stable after treatment and the intraocular pressure lowered in 91 percent of cases. Sixty two percent reported figures lower than 231 mmHg three months after surgery, 89 percent of patients relieved their pain and the regression of neovessels occurred in 75 percent of cases. Conclusions: contact transscleral cyclophotocoagulation achieves the reduction of the intraocular pressure with pain relief and regression of neovessels in patients with neovascular glaucoma; the visual acuity does not change(AU)

Pain in the treatment of vitreoretinal diseases

Treatment of vitreoretinal diseases comprises a range of options that has increased in the past several years, allowing more individuals to benefit from new therapeutic approaches. The use of lasers in the retina, new surgical techniques, and intravitreal drug administration constitute common treatment options. These retinal and vitreal procedures have both benefits and drawbacks. Among the drawbacks is discomfort associated with the procedure, constituting a relevant issue because it can compromise adherence to treatment. We reviewed aspects of pain associated with vitreoretinal procedures and the available options for its control. With regard to vitreoretinal procedures, laser photocoagulation is associated with a higher pain score compared with vitrectomy and intravitreal injection using traditional anesthesia methods, suggesting that laser photocoagulation still needs to be improved with regard to comfort during the procedure. In some cases, a combination of analgesic options may be the best choice for pain-sensitive individuals. Individual differences and the specific condition that is treated should be considered when deciding the best treatment option.

Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy / Dor em panfotocogulação retiniana versus injeção intravítrea em pacientes com retinopatia diabética proliferativa de alto risco

PURPOSE: To compare pain related to intravitreal injection and panretinal photocoagulation in the management of patients with high-risk proliferative diabetic retinopathy. METHODS: Prospective study including patients with high-risk proliferative diabetic retinopathy and no prior laser treatment randomly assigned to receive panretinal photocoagulation (PRP group) or panretinal photocoagulation plus intravitreal ranibizumab (PRPplus group). In all patients, panretinal photocoagulation was administered in two sessions (weeks 0 and 2), and intravitreal ranibizumab was administered at the end of the first laser session in the PRPplus group. Retreatment was performed at weeks 16 and 32 if active new vessels were detected at fluorescein angiography. Patients in the PRPplus group received intravitreal ranibizumab and patients in the PRP group received 500-µm additional spots per quadrant of active new vessels. After the end of retreatment, a 100-degree Visual Analog Scale was used for pain score estimation. The patient was asked about the intensity of pain during the whole procedure (retinal photocoagulation session or intravitreal ranibizumab injection). Statistics for pain score comparison were performed using a non-parametric test (Wilcoxon rank sums). RESULTS: Seventeen patients from PRPplus and 14 from PRP group were evaluated for pain scores. There were no significant differences between both groups regarding gender, glycosylated hemoglobin and disease duration. Mean intravitreal injection pain (±SEM) was 4.7 ± 2.1 and was significantly lower (p<0.0001) than mean panretinal photocoagulation pain (60.8 ± 7.8). Twelve out of 17 patients from the PRPplus group referred intensity pain score of zero, while the minimal score found in PRP group was found in one patient with 10.5. CONCLUSION: In patients with high-risk proliferative diabetic retinopathy who needed retreatment for persistent new vessels, there was more comfort for the patient when retreatment was performed with an intravitreal injection in comparison with retinal photocoagulation. Further larger studies are necessary to confirm our preliminary findings.

OBJETIVO: Comparar a dor relacionada à injeção intravítrea e panfotocoagulação no tratamento de pacientes com retinopatia diabética proliferativa de alto risco. MÉTODOS: Estudo prospectivo incluindo pacientes com retinopatia diabética proliferativa de alto risco e nenhum tratamento a laser prévio aleatoriamente designados para receber panfotocoagulação retiniana (grupo PRP) ou panfotocoagulação e ranibizumabe intravítreo (grupo PRPplus). Em todos os pacientes, a panfotocoagulação foi administrada em duas sessões (semanas 0 e 2), e ranibizumabe intravítreo foi administrado no final da primeira sessão de laser no grupo PRPplus. Retratamento foi realizado nas semanas 16 e 32 se neovasos ativos fossem detectados na angiofluoresceinografia, utilizando ranibizumabe intravítreo no grupo PRPplus e laser adicional grupo PRP. Após o fim do retratamento, uma Escala Analógica Visual de 100-unidades foi utilizada para a estimativa da pontuação da dor. O paciente foi questionado sobre a intensidade da dor durante todo o procedimento (sessão de fotocoagulação de retina ou injeção intravítrea de ranibizumabe). A comparação dos índices de dor foi realizada utilizando um teste não-paramétrico (Wilcoxon rank sums). RESULTADOS: Dezessete pacientes do grupo PRPplus e 14 do grupo PRP foram avaliados para os índices de dor. Não houve diferenças significativas entre os dois grupos quanto ao sexo, hemoglobina glicosilada e duração da doença. A média de dor da injeção intravítrea (±SEM) foi 4,7 ± 2,1, significativamente menor (p<0,0001) do que a dor média da panfotocoagulação (60,8 ± 7,8). Doze dos 17 pacientes do grupo PRPplus referiram pontuação de intensidade da dor zero, enquanto que o índice mínimo no grupo PRP foi encontrado em um paciente com 10,5. CONCLUSÃO: Em pacientes com retinopatia diabética proliferativa de alto risco que necessitaram de retratamento por neovasos persistentes, houve mais conforto para o paciente quando o retratamento foi realizado com uma injeção intravítrea em comparação com fotocoagulação da retina. Estudos posteriores são necessários para confirmar nossos achados preliminares.

Complicaciones tardías de la terapia láser como tratamiento de la transfusión feto-fetal: caso clínico / Late complications of laser therapy as a treatment for feto-fetal transfusion: clinical case

Presentamos la descripción del diagnóstico y manejo de una secuencia anemia-policitemia (SAP) que se presenta como complicación de una terapia láser exitosa en un embarazo gemelar monocorial cursando una transfusión feto-fetal (TFF) severa. Describimos la manifestación de esta complicación tardía de la terapia láser de la TFF severa y realizamos una revisión de la literatura internacional al respecto. A pesar del éxito de la introducción de la terapia láser en cuanto a la sobrevida y secuelas neonatales, recientemente se han descrito una serie de complicaciones de presentación tempranas o tardías. Entre las tardías, destacan la muerte de uno o ambos gemelos, recidiva de la TFF, y aparición de una SAP. Varios autores han descrito que la SAP sería secundaria a la presencia, o persistencia, de comunicaciones vasculares extremadamente pequeñas de flujo lento, las cuales llevan a una discordancia en los niveles de hemoglobina entre ambos gemelos, sin diferencias en sus volúmenes sanguíneos.

We describe the diagnosis and management of twin anemia-polycythemia sequence (TAPS), which occurs as a late complication of successful laser therapy in twin monochorionic pregnancies developing severetwin to twin transfusion syndrome (TTTS). We offer a description of this late complication of laser therapy in this condition and a review of the related medical literature. Despite the successful introduction of laser therapy on the survival and neonatal sequelae, various early and late complications related to this procedure have been recently described. Among the late, stands out the death of one or both twins, recurrence of TTTS, and the appearance of TAPS. With regards TAPS, several authors have reported that it would be secondary to the presence, o persistence, of extremely small slow flow vascular communications, which lead to discre-pancies in the hemoglobin levéis between the twins, with no differences in blood volume.

Facoemulsificação e ciclofotocoagulação endoscópica como tratamento primário para catarata e glaucoma coexistentes / Phacoemulsification and endoscopic cyclophotocoagulation as primary surgical procedure in coexisting cataract and glaucoma

OBJETIVO: Avaliar a eficácia e segurança da facoemulsificação associada à ciclofotocoagulação endoscópica (CFE) no tratamento cirúrgico primário para catarata e glaucoma coexistentes. MÉTODOS: Trezentos e sessenta e oito olhos de 243 pacientes portadores de glaucoma primário de ângulo aberto (GPAA) e catarata foram incluídos no estudo. Todos os pacientes submetidos à facoemulsificação e CFE, no mesmo ato cirúrgico, no Centro Brasileiro de Cirurgia de Olhos, entre outubro de 1998 e dezembro de 2006 com, no mínimo, dois anos de seguimento, foram retrospectivamente avaliados. As cirurgias foram realizadas por um único cirurgião (FEL). Os pacientes eram excluídos se apresentassem história de qualquer cirurgia ocular ou laserterapia para o glaucoma, prévia ao procedimento. Sucesso qualificado foi definido como 5 mmHg < pressão intraocular (Pio) < 21 mmHg com ou sem medicações antiglaucomatosas tó­picas, e sucesso total como 5 mmHg < Pio < 21 mmHg sem o uso de medicações antiglaucomatosas em todas as visitas de acompanhamento. A necessidade de outras intervenções antiglaucomatosas durante qualquer período do acompanhamento caracterizava falência. RESULTADOS: O período médio de seguimento foi de 35,15 + 8,14 meses. A Pio prévia (23,07 + 5,52 mmHg) foi significativamente maior que no primeiro pós-operatório (13,14 + 6,09 mmHg), e meses 1 (11,03 + 2,59 mmHg), 6 (12,33 + 3,01 mmHg), 12 (12,19 + 2,19 mmHg), 24 (12,14 + 2,89 mmHg) e na última consulta (12,29 + 2,44 mmHg) (p<0,001 em todas as ocasiões). O nú­mero de medicações pré-operatórias (1,44 + 0,97) foi estatisticamente superior ao número de medicações na última consulta (0,37 + 0,74) (p<0,001). Houve melhora significativa na acuidade visual ao final do seguimento (p=0,01). Sucesso qualificado foi obtido em 334 (90,76 por cento) olhos, e sucesso total em 205 (55,7 por cento) dos 368 olhos operados. Observou-se como complicações Pio > 40 mmHg no pós-operatório imediato em 14,4 por cento (53/368) dos olhos, exsudato inflamató­rio na câmara anterior em 7,06 por cento (26/368), edema macular cistóide em 4,34 por cento (16/368), hipotonia transitória em 2,17 por cento (8/368), e íris bombé em 1,08 por cento (4/368) dos olhos. CONCLUSÃO: Facoemulsificação associada à ciclofotocoagulação endoscópica é uma alternativa eficaz e segura, a médio prazo, para o tratamento de catarata e glaucoma coexistentes.

PURPOSE: To evaluate the safety and efficacy of phacoemulsification and endoscopic cyclophotocoagulation (ECP) as a primary surgical treatment for glaucoma and cataract. METHODS: Three hundred and sixty-eight eyes from 243 patients with primary open-angle glaucoma and cataract from the Centro Brasileiro de Cirurgia de Olhos that underwent an uncomplicated surgery from October, 1998 to December, 2006 with at least 2 years of follow-up were retrospectively enrolled. The patients were excluded if presented a previous ocular history of any intraocular surgery or glaucoma laser treatment. Qualified success was defined as 5 mmHg < intraocular pressure (IOP) < 21 mmHg with or without topical antiglaucomatous drugs, and complete success as the same IOP levels without therapy at all timepoints. Additionally, the requirement of any further glaucoma surgery was defined as failure. RESULTS: The mean follow-up was 35.15 + 8.14 months. The preoperative IOP (23.07 + 5.52 mmHg) was significantly greater than in the first postoperative day (13.14 + 6.09 mmHg), and months 1 (11.03 + 2.59 mmHg), 6 (12.33 + 3.01 mmHg), 12 (12.19 + 2.19 mmHg), 24 (12.14 + 2.89 mmHg) and in the last appointment (12.29 + 2.44 mmHg) (p<0.001 in all timepoints). The number of preoperative medications (1.44 + 0.97) decreased (0.37 + 0.74) (p<0.001). Furthermore, there was a significant improvement in the logMAR visual acuity (p=0.01). Three hundred and thirty-four eyes (90.76 percent) achieved qualified success, and 205 (55.7 percent) complete success. Complications included immediate postoperative IOP spike 14.4 percent (53/368), postoperative fibrin exudates in anterior chamber 7.06 percent (26/368), cystoid macular edema 4.34 percent (16/368), transitory hypotony 2.17 percent (8/368), iris bombé 1.08 percent (4/368). CONCLUSION: Phacoemulsification associated with endoscopic cyclophotocoagulation is safe and effective as a primary procedure for combined glaucoma and cataract.

Catarata e diabetes mellitus tipo 1 / Cataract and type 1 diabetes mellitus

OBJETIVO: Avaliar a prevalência de catarata e seus fatores de risco em uma população portadora de diabetes mellitus tipo 1 (DM1). MÉTODOS: Estudo de casos e controles de um banco de dados de 181 pacientes (362 olhos) com diagnóstico de diabetes mellitus tipo 1. Os pacientes foram classificados como casos quando apresentavam diagnóstico de catarata. As variáveis estudadas foram a presença ou não de retinopatia diabética, tratamento com panfotocoagulação, presença de hipertensão arterial sistêmica e neuropatia periférica, colesterol total, triglicerídios séricos, HDL, LDL, índice de massa corporal, creatinina sérica, albuminúria, hemoglobina glicosilada e glicemia de jejum. RESULTADOS: A prevalência de catarata foi de 19,9 por cento. Na análise univariada foi encontrada associação estatisticamente significativa (p<0,005) entre a presença de catarata e retinopatia diabética, neuropatia periférica, creatinina sérica elevada, panfotocoagulação e hipertensão arterial. Após a análise de regressão logística a variável que permaneceu com associação estatisticamente significativa foi a presença de retinopatia diabética. CONCLUSÃO: A prevalência de catarata foi de 19,9 por cento, sendo a presença e a gravidade da retinopatia diabética os principais fatores de risco para desenvolvimento desta.

PURPOSE: To evaluate the prevalence of cataract and associated risk factors in a diabetic type 1 population. METHODS: 181 patients (362 eyes) were evaluated in a case-control study. Cases were classified when cataract was present at the time of the examination. The studied outcomes were the presence of diabetic retinopathy, retinal panphotocoagulation, high blood pressure, peripheral neuropathy, total cholesterol levels, triglyceride levels, HDL, LDL, body mass index, creatinine levels, albuminuria, glycosylated hemoglobin and glycemia levels. RESULTS: Cataract was present in 19.9 percent of the studied patients. The association of the presence of cataract and diabetic retinopathy, peripheral neuropathy, elevated levels of creatinine, panphotocoagulation and high blood pressure were statistically significant (univariate analysis). After the logistic regression analysis the presence of cataract was significantly associated with the presence of diabetic retinopathy. CONCLUSION: The prevalence of cataract was 19.9 percent and the presence and severity of the diabetic retinopathy were the main risk factors for its development.

Corneal edema following diode laser cyclophotocoagulation in an eye with secondary glaucoma.

A 70-year-old man had undergone a complicated cataract extraction followed by repair of iris prolapse ending up with secondary glaucoma. Refusing routine filtering surgery, patient underwent contact transconjunctival diode laser cyclophotocoagulation. This report highlights the occurrence of corneal edema restricted to the inferior half of cornea following a diode laser cyclophotocoagulation performed in the inferior 180 degrees. The necessity to perform a routine specular microscopy in all such cases is highlighted, especially in eyes with good visual acuity.

Avaliação da camada de fibras nervosas na retinopatia diabética tratada por panfotocoagulação com laser de argônio / Examination of the retinal nerve fiber layer in diabetic retinopathy treated by argon laser panphotocoagulation

OBJETIVO: Avaliar alterações na camada de fibras nervosas da retina na retinopatia diabética tratada por panfotocoagulação com laser de argônio. MÉTODOS: Estudo prospectivo de portadores de retinopatia diabética submetidos a panfotocoagulação retiniana. Inicialmente, foram realizados exame oftalmológico completo e tomografia de coerência óptica. Todos pacientes foram submetidos a panfotocoagulação em um dos olhos. A camada de fibras nervosas foi avaliada por meio da tomografia de coerência óptica na 1ª semana, no primeiro, terceiro e sexto meses do tratamento. RESULTADOS: A amostra foi composta por 27 pacientes (27 olhos) portadores de diabetes mellitus tipo 2. A idade variou entre 41 e 64 anos (média de 53,7 ± 6,2 anos), sendo 10 (37 por cento) pacientes do sexo masculino e 17 (63 por cento) do feminino. Quanto ao tipo de retinopatia, 22,2 por cento apresentavam RD proliferativa e 77,8 por cento, RD não proliferativa muito grave. Houve aumento significante nas medidas da espessura da camada de fibras nervosas, permanecendo nos setores temporal, 3 e 4 horas após seis meses de seguimento. Não foi observada qualquer redução na espessura em todos parâmetros analisados. CONCLUSÃO: Não foi evidenciada, a curto e médio prazo, redução na espessura da camada de fibras nervosas em portadores de retinopatia diabética tratada por panfotocoagulação que possa ser identificável por meio da tomografia de coerência óptica. Por outro lado, alguns setores mostraram aumento na espessura durante o seguimento.

PURPOSE: To evaluate the alterations in the retinal nerve fiber layer in diabetic retinopathy treated by argon laser panphotocoagulation. METHODS: Prospective study of patients with diabetic retinopathy submitted to retinal panphotocoagulation. Initially, complete ophthalmologic examination and optical coherence tomography were performed. All patients were submitted to panphotocoagulation with argon laser in one of the eyes. The retinal fiber layer was evaluated by means of optical coherence tomography in the first week, in the first, third and sixth months after treatment. RESULTS: The sample was composed of 27 patients (27 eyes) with type 2 diabetes mellitus. The age varied from 41 to 64 years (mean of 53.7 ± 6.2 years), with 10 (37 percent) males and 17 (63 percent) females. Regarding the retinopathy, 22.2 percent presented proliferative DR and 77.8 percent very severe non proliferative DR. There was a significant increase in the fiber layer thickness measurements, remaining in the temporal sectors, 3 and 4 hours, after 6 months of follow-up. Reduction of thickness was not observed in any of the analyzed parameters. CONCLUSIONS: Reduction of the fiber layer thickness, identifiable by means of optical coherence tomography, in short and average term, was not observed in patients with diabetic retinopathy treated with panphotocoagulation. On the other hand, some sectors showed thickness increase during the follow-up.

Efficacy and safety of green laser photocoagulation for threshold retinopathy of prematurity

PURPOSE: To report the efficacy and safety of green laser photocoagulation for threshold retinopathy of prematurity (ROP). METHODS: We reviewed the clinical records of the neonates who had undergone green laser photocoagulation for threshold ROP at the Federal University of Pernambuco in Brazil between January 2004 and January 2006. All procedures were conducted with local anesthetic drops. The neonates were monitored throughout the procedure by a neonatologist. A frequency-doubled solid state laser, diode-pumped, with 532 nm wavelength was used. The presence of tunica vasculosa lentis or cataract were excluded before laser treatment. The following preoperative data were obtained for each patient: age, birth weight and the grade of ROP. Postoperative data included complications associated with the laser treatment, grade of ROP and evaluation whether further surgery was necessary due to failure of laser photocoagulation. RESULTS: Twenty-two neonates underwent photocoagulation with green laser for threshold ROP. A total of 31 eyes were included in the study. The mean gestational age was 30 ± 3 weeks and the mean birth weight was 1120 ± 490 g. Regression of the disease after laser therapy was observed in 30 eyes (96.7 percent). Despite treatment one eye presented stage 4A. Only 7 eyes required repetitive laser therapy. No adverse effects such as burning anterior segment tissues or bleeding in the anterior chamber occurred. No posterior segment side-effects were observed. Cataract formation was not observed at the last follow-up examination. CONCLUSIONS: Green laser photocoagulation remains an effective and safe alternative to red laser photocoagulation and to cryotherapy in the treatment of threshold ROP.

OBJETIVOS: Avaliar a eficácia e segurança da fotocoagulação com laser verde na retinopatia da prematuridade (ROP) limiar. MÉTODOS: Foram revisados prontuários dos neonatos submetidos à fotocoagulação com laser verde para ROP limiar, na Universidade Federal de Pernambuco, entre janeiro 2004 e janeiro 2006. Tratamento foi realizado com anestesia tópica, sob monitorização de neonatologistas. Foi utilizado laser verde de estado sólido com diodo de freqüência dobrada de 532 nm. Presença de túnica vasculosa lentis ou catarata foi excluída antes do tratamento. Foram obtidos os seguintes dados pré-operatórios: idade, peso ao nascer e estágio da ROP. Dados pós-operatórios incluíram complicações associadas com o tratamento, estágio da ROP e avaliação da necessidade de cirurgia por falha do tratamento com fotocoagulação. RESULTADOS: Vinte e dois neonatos foram submetidos à fotocoagulação com laser verde para ROP limiar. Um total de 31 olhos foi incluído no estudo. A idade gestacional média foi de 30 ± 3 semanas e a média do peso ao nascer foi de 1120 ± 490 g. Regressão da doença após terapia com laser foi observada em 30 olhos (96,7 por cento). Apesar do tratamento um olho evoluiu para estágio 4A. Apenas 7 olhos precisaram de mais uma sessão de laser. Não houve efeitos adversos na câmara anterior como queimaduras ou sangramentos. Também não foram observados efeitos colaterais no segmento posterior. Formação de catarata não foi observada até o final do acompanhamento. CONCLUSÕES: A fotocoagulação com laser verde é uma alternativa efetiva e segura à fotocoagulação com laser vermelho e à crioterapia para o tratamento da ROP limiar.

Extração do cristalino translúcido: resultados visuais e freqüência de vítreo-retinopatias / Clear lens extraction: visual outcomes and vitreoretinopathy frequence

OBJETIVO: Avaliar os resultados visuais e a freqüência de vítreo-retinopatias e descolamento de retina em pacientes, com e sem fotocoagulação profilática pré-operatória da retina pré-equatorial, submetidos à extração de cristalino translúcido (ECT) para correção de miopia. MÉTODOS: Trinta e cinco pacientes (60 olhos) foram submetidos à extração de cristalino translúcido na Fundação Altino Ventura com tempo mediano de acompanhamento de 20,5 meses, sendo divididos em 3 grupos: Grupo I (22 olhos) submetidos à fotocoagulação da retina periférica 360° pré-operatória; Grupo II (8 olhos) submetidos à fotocoagulação pré-operatória circundando lesões predisponentes e Grupo III (30 olhos) não submetidos à fotocoagulação pré-operatória. Foram avaliados a acuidade visual corrigida (AVL c/c), o equivalente esférico refracional (EE) e a presença de membrana neovascular sub-retiniana (MNVSR), lesões predisponentes e descolamento de retina (DR) pré e pós-operatórios. RESULTADOS: O valor mediano da acuidade visual corrigida AVLc/c melhorou de 0,2 no pré-operatório para 0,5 no pós-operatório e o equivalente esférico refracional EE de -17DE para -1,7DE. Não houve casos de descolamento de retina, mas surgiram áreas de tração vítreo-retiniana em 4 olhos (2 submetidos ao laser 360° e 2 olhos não submetidos ao laser) e 1 caso de membrana neovascular sub-retiniana. CONCLUSÃO: A extração de cristalino translúcido mostrou-se cirurgia eficaz e previsível nas reduções de altas miopias e, ainda, procedimento aparentemente seguro em pacientes com e sem fotocoagulação profilática da retina pré-equatorial. Tempo de acompanhamento maior dos pacientes e o aumento da amostra estudada podem ratificar sua segurança como procedimento refrativo.

PURPOSE: To evaluate visual results and vitreoretinopathy and retinal detachment frequencies in patients with and without prophylactic pre-equatorial retinal photocoagulation, who underwent clear lens extraction (CLE) to correct myopia. METHODS: Thirty-five patients (60 eyes) that underwent clear lens extraction at the "Fundação Altino Ventura" had median follow-up of 20.5 months. They were classified into 3 groups: Group I that was submitted to preoperative 360° preequatorial retinal photocoagulation; Group II that was submitted to prophylactic photocoagulation around predisposing lesions; and Group III that was not submitted to preoperative retinal photocoagulation. The presence of corrected visual acuity (CVA), refractional spherical equivalent (RSE) and choroidal neovascularization (CNV), predisposing lesions and retinal detachment (RD) was evaluated. RESULTS: Median corrected visual acuity value rose from 0.2 in the preoperative period to 0.5 in the postoperative period and refractional spherical equivalent decreased from -17SD to -1.7SD. There was no retinal detachment, but vitreous retinal traction areas appeared in 4 eyes (2 submitted to 360° laser and 2 not submitted to laser) and 1 case of choroidal neovascularization also occurred. CONCLUSIONS: Clear lens extraction was an effective and predictable surgery to reduce myopias and an apparently safe procedure in patients with and without prophylactic preequatorial retinal photocoagulation. A longer follow-up in a larger group may validate its safety as a refractive surgery.

Necrotizing scleritis following diode laser trans-scleral cyclophotocoagulation.

We report a case of necrotizing scleritis following diode cyclo-photocoagulation (CPC). A-64-year-old-Asian Indian male presented with pseudophakic corneal decompensation with secondary angle closure glaucoma that was uncontrolled with maximum medical therapy. Trans-scleral diode CPC was performed in the inferior 180-degree section using a standard diode laser with a G-probe. One month later, the patient developed features suggestive of necrotizing scleritis that resolved with systemic steroid therapy. Necrotizing scleritis following diode CPC has been rarely reported. Ophthalmologists should be aware of the possible occurrence of surgically induced nectotizing scleritis following diode CPC.

Management of choroidal neovascularization following laser photocoagulation for central serous chorioretinopathy

Little is known about the natural history and management of choroidal neovascularization (CNV) which developed as a complication of laser photocoagulation for central serous chorioretinopathy (CSC). We experienced two patients with CNV which developed after laser treatment for CSC. Submacular membranectomy was performed on both cases after the confirmation of subretinal CNV with optical coherence tomography. One patient received photodynamic therapy for recurrent CNV. The vision of both patients has been improved over 6 months of follow up. These cases suggest that active intervention, including submacular surgery, improves the visual prognosis of this condition.

Frequency doubled Nd:YAG (532 nm) laser photocoagulation in corneal vascularisation: efficacy and time sequenced changes.

PURPOSE: To evaluate the efficacy of frequency-doubled Nd:YAG (532 nm) laser treatment in quiescent corneal vascularisation, and to record the sequential changes in lasered vessels and complications in eyes with one and two quadrant vascularisation. METHODS: Thirty eyes (30 patients)--15 eyes (15 patients) with one-quadrant and 15 eyes (15 patients) with two-quadrant corneal vascularisation were treated. Frequency-doubled Nd:YAG laser (532 nm) was used at laser setting of 120-480 mw power, 50-150 mm spot size and 0.05 sec pulse duration. The area of corneal vascularisation, status of treated corneal vessels, area of corneal opacity and visual acuity were recorded before treatment, at one week after treatment and thereafter at monthly intervals up to three months. RESULTS: The mean area of corneal vascularisation decreased from 20.09% to 8.31% of the total corneal area in group I (p<0.01) and from 44.34% to 20.67% of the total corneal area in group II (p<0.01) at 3 months' follow-up. The mean reduction in the area of corneal vascularisation was 58.64% in group I and 53.38% in group II (p>0.05). Of 148 corneal vessels treated, 60 (44.6%) were totally occluded, 44 (30%) partially occluded, 37 (28%) recanalized and there was one shunt vessel at one week following laser treatment. At three months' follow-up, 80 (54.15%) vessels were totally occluded, 14 (9%) partially occluded, 52 (35.14%) recanalised and two shunt vessels appeared. Thus, at three months' follow-up, the number of totally occluded vessels increased and partially occluded vessels decreased. Superficial corneal haemorrhage was observed in 4 (14%) patients. CONCLUSION: Frequency-doubled Nd:YAG (532 nm) laser photocoagulation appears a safe and effective means of reducing the area of corneal vascularisation in quiescent eyes with vascularised corneal opacities.