The retina in hypertensive disorders of pregnancy: a study of the prevalence and association with severity of disease in a tertiary referral centre in India

Background: Hypertensive disorders of pregnancy remains to be a major cause of maternal and fetal morbidity and mortality. The retina offers the unique opportunity to directly observe changes in the vasculature due to preeclampsia. Fundoscopy can be used to prognosticate and assess the severity of disease and offer an optimum time of delivery to improve fetomaternal outcome. There are limited number of studies from northern India assessing the relationship between hypertensive disorders of pregnancy and retinopathy. This study was undertaken to bridge this gap.Methods: This was an observational cohort study undertaken in a tertiary hospital, 225 patients of preeclampsia coming to the department were identified and a structured proforma used to gather relevant information. All patients underwent fundoscopy and were classified into groups on the basis of fundal grade observed. The groups were compared in terms of clinicodemographic variables. Appropriate statistical tests were applied.Results: A total 68% patients had retinal changes of which the most common grade was grade 1 There was a significant rise in the mean systolic and diastolic blood pressure with increasing grade of fundal change. The (p-value 0.001). 65.5% of patients of preeclampsia without severe features (i.e. mild cases) had no retinopathy. None of these patients had grade 3 or 4 changes. In the patients of preeclampsia with severe features, 88.9% cases had varying degrees of retinopathy.Conclusions: As severity of preeclampsia increases, incidence of retinopathy also increases. Fundoscopy is a useful diagnostic aid and should be done to optimize fetomaternal outcome.

Achados de fundoscopia de pacientes diabéticos e/ou hipertensos / Fundoscopy findings of diabetic and/or hipertensive patients

Resumo Objetivo: Analisar a prevalência de alterações na fundoscopia de pacientes portadores de Diabetes Mellitus (DM) e/ou Hipertensão Arterial Sistêmica (HAS) encaminhados ao Serviço de Referência de Oftalmologia, localizado em uma Unidade Básica de Saúde do município de Patos, Paraíba (PB). Metodos: Estudo de caráter descritivo, transversal e com abordagem quantitativa, que envolveu um total de 22 pacientes. Para a coleta de dados, foi utilizado um questionário sobre a saúde ocular. Além disso, os integrantes da pesquisa participaram do teste da acuidade visual de Snellen e acuidade visual para perto, da medida da pressão intra-ocular e do exame da oftalmoscopia direta. Os que obtiveram pior acuidade visual foram conduzidos para a realização de retinografia. Os dados foram avaliados através de análises estatísticas utilizando o Statistical Package for the Social Sciences - SPSS. Resultados: Do total de 22 pacientes, 11 foram submetidos ao exame de retinografia. Destes, 36,3 % eram apenas diabéticos; 27,4% eram apenas hipertensos e 36,3% eram diabéticos e hipertensos. As principais alterações encontradas foram retinopatia diabética, retinopatia hipertensiva, catarata, glaucoma, nevus de coroide, retinose pigmentar e estafiloma peripapilar. Conclusão: Percebe-se que DM e HAS tem grande impacto negativo sobre a saúde ocular. Para diminuir esse efeito nocivo é necessário que o exame de fundo de olho seja realizado anualmente com a finalidade de diagnosticar precocemente certas patologias e evitar complicações futuras, culminando em menores custos para o sistema de saúde e mais qualidade de vida para os pacientes.

Abstract Objective: To analyze the prevalence of alterations in funduscopy of patients with Diabetes Mellitus (DM) and/or Systemic Arterial Hypertension (SAH) referred to the Ophthalmology Reference Service, located in a Basic Health Unit of the city of Patos, Paraíba). Methods: A descriptive, cross-sectional study with a quantitative approach, which involving a total of 22 patients. For data collection, a questionnaire on ocular health was used. In addition, the research members participated in the Snellen visual acuity test and visual acuity near, intraocular pressure measurement and direct ophthalmoscopy examination. Those who obtained worse visual acuity were conducted for retinography. The data were evaluated through statistical analysis using the Statistical Package for the Social Sciences - SPSS. Results: Of the total of 22 patients, 11 were submitted to retinography. Of these, 36.3% were diabetics only; 27.4% were hypertensive only and 36.3% were diabetic and hypertensive. The main alterations found were diabetic retinopathy, hypertensive retinopathy, cataract, glaucoma, choroidal nevus, pigmentary retinitis and peripapillary staphyloma. Conclusion: It is noticed that DM and SAH have a great negative impact on ocular health. To reduce this harmful effect it is necessary that the fundus eye exam be performed annually for the purpose of early diagnosis of certain pathologies and avoid future complications, culminating in lower costs for the health system and more quality of life for patients.

A study on idiopathic intracranial hypertension

Background: IIH is defined as an elevated intracranial pressure but no clinical, laboratory or radiological evidence of hydrocephalus, infection, tumor or vascular abnormality. Aim: To study the clinical and radiological profile of Idiopathic Intracranial Hypertension (IIH). Materials and methods: Total 31 IIH cases were studied. Patients were subjected to Fundoscopy, CT/MRI brain and CSF analysis. Results: Females were predominant and Headache was the most common presenting symptom. All patients had papilledema. Mean CSF pressure was 318.1 mm of H2O. MRI findings included prominent subarachnoid space, vertical tortuosity of optic nerves, flattening of posterior sclera. Conclusion: IIH predominantly affects women with headache being the most common symptom. Medical management and Life style medication is mostly useful. Surgical management is imperative in patients with impending vision loss.

Avaliação oftalmológica em pacientes com AIDS e neurotoxoplasmose / Ophthalmological evaluation of patients with AIDS and neurotoxoplasmosis

INTRODUÇÃO: Descrever os achados fundoscópicos em pacientes com AIDS e neurotoxoplasmose em fase ativa. MÉTODOS: Foi desenvolvido estudo prospectivo tipo série de casos incluindo 70 pacientes, de ambos os sexos, com idade variando de 20 a 63 anos, internados nas enfermarias de três hospitais públicos da Cidade do Recife, Pernambuco, com diagnósticos de AIDS e neurotoxoplasmose firmados segundo os critérios do Centers for Disease Control and Prevention (1992), no período de janeiro a outubro de 2008. Os pacientes se caracterizavam por: primeiro episódio de neurotoxoplasmose (65; 92,9 por cento) ou recidiva (5; 7,1 por cento); desconhecimento de ter AIDS (23; 32,9 por cento), contagem média de linfócitos T CD4 de 139,8 ± 3,04 células/mm3 e carga viral média igual a 137.080 ± 39.380 cópias/mL. Todos foram submetidos a exame oftalmológico, consistindo de: inspeção ocular; aferição da acuidade visual; investigação da função muscular extrínseca ocular e fundoscopia, empregando oftalmoscópio indireto binocular (modelo OHN 3.5 (Eyetec®) e lente externa de 20 dioptrias (Volk®). RESULTADOS: Os achados consistiram em: exsudatos algodonosos retinianos (8,6 por cento), constricção arteriolar difusa leve (8,6 por cento); lesões de retinocoroidite cicatricial, características de toxoplasmose ocular (5,7 por cento), atrofia do epitélio pigmentar retiniano (2,9 por cento), descolamento da retina (2,9 por cento), aumento de escavação papilar (1,4 por cento), degeneração periférica retiniana (1,4 por cento), macroaneurisma (1,4 por cento), papiledema bilateral (1,4 por cento), tração vítreo-retiniana (1,4 por cento). CONCLUSÕES: Pacientes com AIDS e neurotoxoplasmose podem apresentar alterações fundoscópicas características da toxoplasmose ocular, na forma ativa ou cicatricial, relacionadas ao HIV ou, ainda, a outras doenças oportunistas ou sistêmicas, podendo ser de grande auxílio num tratamento integral do paciente por uma equipe multiprofissional.

INTRODUCTION: To describe fundoscopic findings among patients with AIDS and active-phase neurotoxoplasmosis. METHODS: A prospective study of case series type was developed, including 70 patients of both sexes and ages ranging from 20 to 63 years who were admitted to the wards of three public hospitals in the city of Recife, Pernambuco, Brazil, from January to October 2008, with diagnoses of AIDS and neurotoxoplasmosis determined according to the criteria of the Centers for Disease Control and Prevention (1992). The patients were characterized by a first episode of neurotoxoplasmosis (65; 92.9 percent) or recurrence (5; 7.1 percent), unawareness of having AIDS (23; 32.9 percent), mean T CD4+ count of 139.8 ± 3.04 lymphocytes/mm³ and mean viral load of 137,080 ± 39,380 copies/ml. All patients underwent ophthalmological examination consisting of ocular inspection, gauging of visual acuity, investigation of ocular extrinsic muscle function and fundoscopy using a binocular indirect ophthalmoscope (model OHM 3.5 Eyetec®) and external lens of 20 diopters (Volk®). RESULTS: The findings consisted of retinal cotton-wool spot exudates (8.6 percent), slight diffuse arteriolar constriction (8.6 percent), retinochoroiditis scars characteristic of ocular toxoplasmosis (5.7 percent), atrophy of retinal pigment epithelium (2.9 percent), retinal detachment (2.9 percent), increased papillary excavation (1.4 percent), retinal peripheral degeneration (1,4 percent), macroaneurysm (1.4 percent), bilateral papilledema (1.4 percent) and vitreous-retinal traction (1.4 percent). CONCLUSIONS: Patients with AIDS and neurotoxoplasmosis may present fundoscopic abnormalities characteristic of ocular toxoplasmosis, either in active or in scar form, related to HIV or even to other opportunist or systemic diseases, which can be of great aid for integral treatment of patients by a multiprofessional team.