Uveítis asociada a la artritis idiopática juvenil / Uveitis associated to juvenile idiopathic arthritis

Objetivo: Caracterizar las uveítis asociadas a la artritis idiopática juvenil. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, donde se evaluaron las variables edad, raza, sexo, lateralidad de la uveítis, clasificación anatómica, agudeza visual mejor corregida, presencia de complicaciones y tratamiento. Resultados: Predominaron los mayores de seis años, el sexo femenino y la raza blanca. En cuanto a la lateralidad hubo mayor predominio de las bilaterales, con localización anatómica anterior. En los resultados visuales sobresalieron los que presentaban una agudeza visual mejor corregida ≥ 0,5. Las complicaciones más frecuentes fueron: la pérdida visual, la hipertensión ocular y la queratopatía en banda. Con respecto al tratamiento, la mayoría de los pacientes tenían asociado metotrexate al tratamiento tópico y oral con esteroides. Conclusión: La uveítis asociada a la artritis idiopática juvenil sigue siendo un problema importante de salud en la infancia a pesar de los avances en los programas de atención a esta enfermedad; por tanto, el diagnóstico precoz, el seguimiento estricto y el tratamiento adecuado son los pilares para una mejor evolución(AU)

Objective: Characterize uveitis associated to juvenile idiopathic arthritis. Methods: A cross-sectional observational descriptive study was conducted based on evaluation of the following variables: age, race, sex, laterality of uveitis, anatomical classification, best corrected visual acuity, presence of complications and treatment. Results: A predominance was observed of patients aged over six years, female sex and white race. Bilateral uveitis prevailed, with anterior anatomical location. Patients with a best corrected visual acuity ≥ 0.5 stood out for their visual results. The most common complications were visual loss, ocular hypertension and band keratopathy. Most patients had methotrexate associated to topical and oral treatment with steroids. Conclusion: Uveitis associated to juvenile idiopathic arthritis continues to be an important health problem in childhood, despite the progress in the care of this condition. Therefore, early diagnosis, strict follow-up and appropriate treatment are the pillars of a better evolution(AU)

Glaucoma secundário a fístula carótido-cavernosa / Secondary glaucoma following carotid cavernous fistula

RESUMO As fístulas carótido-cavernosas são uma causa rara, porém grave, de glaucoma secundário por aumento da pressão venosa episcleral. Apresenta-se um caso de uma mulher de 72 anos, negra, atendida no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (HC-UFTM) com dor, sensação de pulsação, proptose, engurgitamento episcleral e quemose em olho direito, com aumento da pressão intraocular (PIO) apesar do uso de mediação anti-glaucomatosa. Na arteriografia foi evidenciada fístula dural para o seio cavernoso à direita, com refluxo para as veias orbitárias ipsilaterais. Realizou-se tratamento com agente líquido de embolização e, após o tratamento cirúrgico, apresentou melhora completa da proptose e congestão dos vasos episclerais, porém manteve PIO aumentada e desenvolvimento de glaucoma de ângulo fechado pela presença de goniossinéquias em 270º, com controle satisfatório com medicação.

ABSTRACT Carotid-cavernous fistulas are a major cause of secondary glaucoma due to increased episcleral venous pressure. We present the case of a 72-year-old female patient, treated at the Hospital de Clínicas at the Universidade Federal do Triângulo Mineiro (HC-UFTM), with pain, proptosis, episcleral engorgement, chemosis and pulsation in the right eye, with increased intraocular pressure (IOP) on anti-glaucomatous medication.Arteriography showed dural fistula to the right cavernous sinus, with reflux to orbital veins.Treatment with liquid embolization agent was performed, following full recovery of proptosis and congestion of the episcleral vessels. However, the patient maintained increased IOP because of narrow-angle glaucoma development due to the presence of goniosynechiae in 270º, which was controlled satisfactorily with medication.

The prevalence of ocular surface complaints in Brazilian patients with glaucoma or ocular hypertension / Prevalência de sintomas da doença da superfície ocular em pacientes brasileiros com glaucoma ou hipertensão ocular

PURPOSE: To examine the prevalence of ocular surface complaints in Brazilian patients with glaucoma or ocular hypertension who used topical intraocular pressure (IOP)-lowering regimens. METHODS: In this multicenter, noninterventional, single-visit study, adults with glaucoma or ocular hypertension treated with an IOP-lowering regimen were administered the 12-item ocular surface disease index (OSDI) questionnaire. Each response was scored on a 5-point scale, with 0 indicating symptom present none of the time and 4 indicating symptom present all of the time. The average of the 12 item responses for each patient was transformed to a scale from 0 to 100, with higher scores representing worse disabilities. OSDI results then were categorized as absence of OSD (scores of 0-12), mild OSD (scores of 13-22), moderate OSD (scores of 23-32), or severe OSD (scores of 33100). RESULTS: The 173 enrolled patients had a mean age of 61.2 years, were women in 65.3% of cases, and had glaucoma in 89.0% of cases and ocular hypertension in 11.0% of cases. OSDI scores for 158 patients using 1 IOP-lowering therapy indicated no OSD in 37.3% of patients (59/158), mild OSD in 20.9% (33/158), moderate OSD in 17.1% (27/158), and severe OSD in 24.7% (39/158). For the 120 patients using 1 IOP-lowering medication and having a known duration of diagnosis of glaucoma or ocular hypertension, mean OSDI scores were numerically higher (worse) for the 39 patients with a diagnosis ≥6 years long (score 25 [± 20], indicating moderate OSD) than for the 81 patients with a diagnosis lasting <6 years (score 22 [± 20], indicating mild OSD); however, no significant differences in OSDI scores by duration of diagnosis were evident in means (P=0.49), distributions (P≥0.26), or correlation (P=0.77). CONCLUSIONS: A large proportion of Brazilian patients treated with 1 IOP-lowering therapy had some ocular surface complaints.

OBJETIVO: Avaliar a prevalência de sintomas decorrentes de doença de superfície ocular (DSO) em pacientes brasileiros com glaucoma ou hipertensão ocular que utilizam tratamento ocular tópico para redução da pressão intraocular (PIO). MÉTODO: Neste estudo multicêntrico, não intervencional de uma única visita, pacientes adultos com glaucoma ou hipertensão ocular em tratamento para redução da pressão intraocular (PIO) responderam aos 12 itens do questionário "índice de doença da superfície ocular" (OSDI). Cada resposta foi pontuada numa escala de 5 pontos, com 0 (zero) indicando a ausência de sintomas e 4 indicando sintomas presentes todo o tempo. A média de respostas dos 12 itens para cada paciente foi transformada numa escala de 0 a 100, com pontuações mais elevadas representando piores deficiências. Os resultados do OSDI foram categorizados como ausência de DSO (pontuação de 0-12), DSO leve (pontuação de 13-22), DSO moderada (pontuação de 23-32) ou DSO grave (pontuação de 33-100). RESULTADOS: Os 173 pacientes incluídos apresentavam idade média de 61,2 anos, 65,3% eram mulheres (65,3%), tinham glaucoma em 89,0% dos casos e hipertensão ocular em 11,0% dos casos. As pontuações do OSDI para os 158 pacientes utilizando uma medicação para redução da PIO indicaram "DSO ausente" em 37,3% dos pacientes (59/158), "DSO leve" em 20,9% (33/158), "DSO moderada" em 17,1% (27/158) e "DSO grave" em 24,7% (39/158). Para os 120 pacientes utilizando medicação redutora da PIO e com duração conhecida do diagnóstico de glaucoma ou hipertensão ocular, a pontuação média do OSDI foi numericamente superior (pior) para 39 pacientes com diagnóstico realizado há mais de 6 anos (pontuação 25 [± 20] indicando DSO moderado) do que para 81 pacientes com o diagnóstico realizado há menos de 6 anos (pontuação 22 [± 20] indicando DSO leve); no entanto, não houve diferença estatisticamente significativa na média da pontuação OSDI na duração do diagnóstico (P=0.49), distribuição (P≥0,26), ou correlação (P=0,77). CONCLUSÃO: Uma grande proporção de pacientes brasileiros tratados com uma medicação para redução da PIO apresenta sintomas decorrentes de doença da superfície ocular (DSO).

Expression of the Na(+)-K(+)-2Cl(-)-Cotransporter 2 in the Normal and Pressure-Induced Ischemic Rat Retina

PURPOSE: To evaluate the expression of the Na(+)-K(+)-2Cl(-)-cotransporter 2 (NKCC2) in the ischemic rat retina. METHODS: Retinal ischemia was induced by pressures 90 to 120 mmHg, above systemic systolic pressure. Immunohistochemistry and western blot analysis were performed. RESULTS: NKCC2 is expressed in the normal retina and its expression is increased by ischemia caused by intraocular pressure elevation. NKCC2 immunoreactivity was observed mainly in axon bundles of ganglion cells and horizontal cell processes in the retina. NKCC2 expression continuously increased with a peak value 3 days (to 415% of normal levels) after ischemic injury, and then gradually decreased to 314% of controls until 2 weeks post injury. The mean density of NKCC2-labeled ganglion cells per mm2 changed from 1,255 +/- 109 in normal retinas to 391 +/- 49 and 185 +/- 37 at 3 days and 2 weeks after ischemia, respectively (p < 0.05), implying cell death of ganglion cells labeled with NKCC2. CONCLUSIONS: Taken together, these results suggest that NKCC2, which is expressed in retinal ganglion and horizontal cells, may contribute to cell death by ischemic injury in the retina, although the molecular mechanisms involved remain to be clarified.

An Indian perspective on primary angle closure and glaucoma.

Aim: To provide a synopsis of primary angle closure disease in India, and Indian studies on the same. Results: Primary angle closure glaucoma forms almost half of all adult primary glaucomas seen in a hospital setting in India. Anatomically, corneal diameters and anterior chamber depths were least in acute and chronic PACG eyes as compared to subacute eyes and controls. Besides relative pupillary block, a Valsalva maneuver during activities of daily living may be responsible for intermittent angle closure and raised IOP in predisposed eyes. Iridotomy alone, controlled the intraocular pressure in 66.7% of subacute eyes and 12.9% of the acute. Medical therapy was additionally required for 35.5% of the acute eyes, 12.1% of the subacute and 30.0% of the chronic cases. There was a greater mean and peak IOP reduction, achieved with 0.005% latanoprost once daily, 8.2 ± 2.0 mm Hg, compared with 0.5% timolol twice daily, 6.1 ± 1.7 mm Hg2. A progression of PACS to PAC was seen in 22%, PAC to PAC OHT in 38.7% and PAC OHT to PACG in 30.7% over 5 years. Conclusions: Primary angle closure disease is common in India, and can be managed well with iridotomy, followed by an appropriate control of IOP.

Current concepts in the pathophysiology of glaucoma.

Glaucoma, the second leading cause of blindness, is characterized by changes in the optic disc and visual field defects. The elevated intraocular pressure was considered the prime factor responsible for the glaucomatous optic neuropathy involving death of retinal ganglion cells and their axons. Extensive investigations into the pathophysiology of glaucoma now reveal the role of multiple factors in the development of retinal ganglion cell death. A better understanding of the pathophysiological mechanisms involved in the onset and progression of glaucomatous optic neuropathy is crucial in the development of better therapeutic options. This review is an effort to summarize the current concepts in the pathophysiology of glaucoma so that newer therapeutic targets can be recognized.The literature available in the National Medical Library and online Pubmed search engine was used for literature review.

Comportamiento clínico de la extracción extracapsular de cataratas realizada por médicos residentes de tercer año de oftalmología en el centro nacional de oftalmología, Managua-Nicaragua, en el período comprendido de abril 2004- a marzo 2007 / Clinical behavior of the extraction extracapsular of waterfalls carried out by medical third year-old residents in the national center of ophthalmology, Managua-Nicaragua, in the understood period of April 2004 - to March 2007

Se realizó un estudio descriptivo, longitudinal de corte transversal, con el objetivo de conocer el Comportamiento clínico de la extracción extracapsular de catarata realizada por médicos residentes de tercer año de oftalmología en el Centro Nacional de Oftalmología, Managua-Nicaragua, en el período comprendido de abril 2004 a marzo 2007. El universo estuvo constituido por 728 ojos de pacientes operados de cataratas durante el periodo comprendido del estudio, la muestra correspondió a un total de 139 ojos, para un 19. 09 porciento del universo. Los resultados revelaron que la media de edad en los pacientes fue de 64.24 años. El 33.81 porciento eran mayores de 70 años. En los ojos operados el 60.43 porciento fue del sexo femenino y 39.56 porciento masculino. La agudeza visual preoperatoria fue menor de 20/200 en el 94.96 porciento. La agudeza visual postquirúrgica presentó una media de 20/120 al primer día, 20170 a la primera semana, 20/60 al primer mes, 20/50 al segundo mes y de 20/40 al tercer mes. El astigmatismo prequirúrgico presentó una media de — 0.32 dioptrías. En el grupo de mayor de 70 años, el 22.29 porciento fue en contra de la regla y en el 7.9 porciento a favor de la regla. En el 34.53 porciento se presentó valores entre + 0.25 a + 1.00 dioptrias. El astigmatismo postquirúrgico tuvo una media de +4.91 dioptrías a la primera semana, de + 4.08 D al primer mes, +2.07 D al segundo mes y de + 1.45 0 al tercer mes. En 11.52 porciento fue contra la regla al tercer mes y en 76.25 porciento a favor. Las complicaciones transoperatorias se presentaron en el 9.35 porciento, siendo la mas frecuente la ruptura de la cápsulaposterior con salida vitrea en el 3.59 porciento. Las complicaciones postquirúrgicas se presentaron en un 27.33 porciento, siendo la hipertensión ocular transitoria la mas frecuente en un 14.4 porciento. De los ojos operados el 53.95 porciento fue derecho y el restante 46.04 porciento izquierdos...

Bilateral Spontaneous Anterior Lens Dislocation in a Retinitis Pigmentosa Patient

PURPOSE: To report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa (RP). METHODS: A 45-year-old male with RP presented with elevated intraocular pressure (IOP) in the right eye and was treated with laser iridotomy (LI). After LI, complete crystalline lens dislocation into the anterior chamber occurred. Surgical intervention, including anterior vitrectomy, intracapsular cataract extraction (ICCE), and IOL scleral fixation was performed. Two years later, the same episode occurred in his left eye and a similar treatment was done. RESULTS: Surgery was successful in both eyes. CONCLUSIONS: This is the first report of bilateral spontaneous anterior lens dislocation in a RP patient.

Regressão refrativa total pós-LASIK: relato de caso / Total refractive regression post-LASIK: case report

Os corticoesteróides podem aumentar a pressão intra-ocular quando administrados de maneira tópica, sistêmica e até mesmo inalatória. É rotina sua utilização após cirurgias refrativas para diminuir ou prevenir reação inflamatória. No presente relato, apresentamos o caso de uma paciente de 36 anos que, após duas semanas de cirurgia de LASIK para correção de miopia leve, teve regressão total da miopia causada pela hipertensão ocular cortisônica. O objetivo desse relato é descrever como foi conduzido o caso, as hipóteses de diagnósticos que foram levantadas, e salientar a importância da mensuração da pressão intra-ocular no pós-operatório.

Ganglion Cell Death in Rat Retinaby Persistent Intraocular Pressure Elevation

Glaucoma is characterized by loss of retinal ganglion cells (RGCs) and their axons. Retrograde axoplasmic transport blockade and excitotoxicity were proposed to be a major cause of RGC apoptosis. We conducted this study to characterize the episcleral vessel cauterization glaucoma model in the rat with respect to decreased retrograde axoplasmic flow and subsequent apoptotic RGC death. After episcleral vessels were cauterized in Sprague-Dawley rats, Fluorogold was injected into their superior colliculi by stereotactic method. Retrograde axoplasmic flow and TUNEL-stained apoptotic dead cells were observed microscopically. Elevated intraocular pressure was maintained for up to 6 weeks during follow-up. Retrograde axoplasmic flow to the rat retina was significantly decreased. Apoptotic RGC was selectively TUNELstained in the retina, especially at the ganglion cell layers. We concluded that elevated intraocular pressure caused apoptotic RGC death through retrograde axoplasmic flow blockage. Further studies will elucidate the neuroprotection strategies in glaucoma patients.

Five-year risk of progression of ocular hypertension to primary open angle glaucoma. A population-based study.

PURPOSE: To report the progression of ocular hypertension (OHT) to primary open angle glaucoma (POAG) during a 5-year follow up of a population-based sample. METHODS: Twenty-nine patients diagnosed to have OHT and 110 randomly selected normals from a population-based study in 1995 were invited for ocular examination in 2000. All patients underwent a complete ophthalmic examination; including the daytime diurnal variation of intraocular pressure (IOP) and measurement of central corneal thickness (CCT). The "corrected" IOP was used for analysis. Progression to POAG was based on typical optic disc changes with corresponding field defects on automated perimetry. RESULTS: Twenty-five of the 29 persons with OHT who could be contacted were examined. After correcting for CCT, two persons were reclassified as normal. Four of 23 (17.4%; 95% CI: 1.95-32.75) had progressed to POAG. One person amongst the 110 normals progressed to normal tension glaucoma (NTG). The relative risk of progression amongst OHT was 19.1 (95% CI: 2.2-163.4). All those who progressed had bilateral OHT. The mean and peak IOP in those who progressed was 25.4 mm Hg and 29.3 mm Hg compared to 23.9 mm Hg and 25.7 mm Hg in those who did not. Those who progressed had more than 8 mm Hg diurnal variation. The diurnal variation was less than 6 mm Hg in those who did not progress. No patient developed blindness due to glaucoma. CONCLUSION: The 5-year incidence of POAG amongst OHT in this population was 17.4% (3.5% per year). Bilateral OHT, higher peak IOP and large diurnal variation may be the risk factors for progression.

Pulsatile ocular blood flow among normal subjects and patients with high tension glaucoma.

PURPOSE: To estimate pulsatile ocular blood flow (POBF) among normal subjects and to compare various parameters in eyes of primary open angle glaucoma with high intraocular pressure (IOP). METHODS: POBF was estimated in 95 eyes of 95 normal subjects above the age of 40 years and in 35 eyes of 35 primary open angle glaucoma patients using the OBF system (OBF Labs Ltd., UK). Correlation of age, gender, IOP, pulse amplitude, pulse volume and pulse rate with POBF was studied. POBF values were measured in glaucomatous patients before IOP control and one month later after control of IOP to < 22 mmHg. RESULTS: The mean POBF among normal subjects was 1382.2 +/- 413 ml/min (range 636-2291 m/min). Females had a significantly higher mean POBF (1512 +/- 347 ml/min) than males (1193 +/- 312 ml/min). The mean IOP among normal subjects was 12.6 mmHg and in glaucoma patients, 29.1 mmHg. Mean POBF in glaucomatous eyes with initially elevated IOP was 718.9 +/- 322.6 ml/min, which improved after IOP control to 1129 +/- 291 ml/min. IOP had a strong (P < .01) negative correlation with POBF (r = -0.667) CONCLUSIONS: POBF among eyes of normal subjects in this study is higher than reported among Caucasian eyes. Primary open angle glaucoma eyes with high IOP have significantly reduced ocular blood flow. Therapy aimed at lowering IOP has a positive effect onocular haemodynamics.

Cefaléia da pressäo intra-ocular: entre a pressäo intra-ocular saudável e o glaucoma de baixa pressäo / Intraocular pressure's headache: between the healthy intraocular pressure and low-tension glaucoma

Em aproximadamente 10 por cento dos pacientes, a pressäo intraocular entre 17 e 23mmHg foi causa de cefaléia, estando relacionada com a ingestäo diária de líquidos e outros fatores. Esta cefaléia, por ser desconhecida dos médicos, usualmente é mal diagnosticada como enxaqueca ou outras moléstias e inadequadamente tratada, ocasionando sofrimentos e despesas por muitos anos. Os pacientes com esas cefaléias situam-se entre os pacientes assintomáticos, porque estäo saudáveis, e aqueles sintomáticos porque estäo glaucomatosos. Deixar a pressäo intra-ocular acima de 16mmHg sem tratamento, além de manter os pacientes sofrendo de cefaléia repetitiva, também pode propiciar, em alguns deles, a progressiva lesäo das fibras do nervo óptico, o que é irreversível e pode levar ao glaucoma. Recomendamos o diagnóstico e tratamento das cefaléias da pressäo intra-ocular através da reduçäo da pressäo intra-ocular ao deitar (com exceçäo dos pacientes diabéticos), e da modificaçäo de alguns hábitos (especialmente de bebida)

Intraocular pressure changes and mountaineering--preliminary observations and possible application.

Measurement of intraocular pressure (IOP) has been suggested as an indirect way of assessing the intra cranial pressure (ICP) because of the anatomical relationship between the brain and the eyeball. Mountain-sickness during high altitude climbing results from acute rise in ICP. In this preliminary study, we have observed gradual increase in IOP with gain in altitude in a group of healthy mountain trekkers. Although the rise in IOP had not been steep in most climbers who did not experience any significant symptoms, the rise had been steep into two subjects who experienced symptoms of acute mountain sickness with raised IOP. While clearly further work is needed in this field with larger number of subjects, measurement of IOP appears to be a useful non-invasive screening test in high altitude climbers to avert the risk of acute mountain sickness.

Alterações oculares após capsulotomia posterior com nd: yag laser: estudo comparativo com e sem uso de colírios timolol 0, 5 / e dexametasona 0, 1 / Ocular damages after Nd: yag laser posterior capsulotomy: comparative study with and without the use of timolol 0, 5 and dexamethasone 0, 1 eyedrops

Objetivo: Analisar as complicações e necessidade do uso de drogas antiinflamatórias e hipotensoras oculares após o procedimento com laser de Nd: YAG para tratamento de opacidade de cápsula posterior após facectomia extra-capsular não complicada. Método: Estudo prospectivo randomizado de 35 olhos de 35 pacientes submetidos a capsulotomia com Nd: YAG laser sem outra patologia ocular ou sistêmica. Após o procedimento, dividimos os pacientes em dois grupos. Grupo I (controle) que não fez uso de medicação no período pós-laser e o grupo II que usou colírio antiinflamatório e hipotensor pós-laser. Resultado: Entre as complicações, a mais freqüente nos dois grupos foi a hipertensão ocular (85% Grupo I e 73,33% Grupo II) que ocorreu após 3 horas pós laser. Na avaliação após 24 horas, 9 olhos do grupo I e 2 do grupo II apresentavam níveis aumentados de pressão ocular. A reação inflamatória com células em câmara anterior esteve presente em 2 olhos (1%) do Grupo I até o 7dia após o procedimento, enquanto que no Grupo II em todos os casos, após o 3 dia do laser, já não encontramos células em câmara anterior. Não foram encontradas alterações oculares severas que pudessem levar a baixa de acuidade visual. Conclusão: Uso de Nd: YAG laser é um procedimento seguro e hipotensores oculares associados a corticóides tópicos diminuem os riscos de complicações como hipertensão ocular e reação inflamatória em câmara anterior.

Bilateral glaucomatocyclitic crisis in a patient with Holmes Adie syndrome.

A patient with pre-existing bilateral tonic pupils presented with simultaneous bilateral glaucomatocyclitic crisis. Deep tendon reflexes were absent although they were documented to be present 6 years ago. A possibility of a progressive autonomic dysfunction in both these conditions is discussed.

Hemorragia expulsiva espontânea durante crise hepertensiva: relato de dois casos / Spontaneous expulse hemorrhage during hypertensive crisis: report of two cases

Hemorragia expulsiva espontânea é um evento desastroso e incomum, geralmente associado ao glaucoma. Neste artigo, relatamos dois casos ocorridos durante episódios de crise hipertensiva arterial, uma associaçäo que ainda näo havia sido discutida na literatura. Acreditamos que a pressäo arterial gravemente elevada possa desempenhar um papel direto na patogênese dessa condiçäo

Glaucomas post-queratoplastias / Glaucomas post-keratoplasties

El glaucoma post injerto de córnea es una complicación de relativa alta incidencia. Puede producirse por múltiples causas. Se presentan sobre 50 pacientes estudiados, 22 glaucomas post-queratoplastias (44 por ciento). La hipertensión ocular puede ocurrir en un período temprano (menos de 3 meses) o tardío (más de 3 meses). En nuestra serie, 13 de 22 casos ocurrieron en el primer período y 9 tras los 3 meses. Se indican el diagnóstico prequirúrgico y el tratamiento: 50 por ciento mejoró con medicación y el resto requirió distintos tipos de cirugía.