Iris cyst and atypical complications / Cisto de íris e complicações atípicas

ABSTRACT The authors report the case of a male adult presenting significant ocular complications and irreversible visual impairment, resulting from the long-term progression and late diagnosis of an iris cyst in the right eye, probably secondary to trauma. The patient was admitted to Hospital Universitário Antonio Pedro with a total corneal opacity that blocked direct visualization of the anterior chamber. Ultrasound biomicroscopy was crucial for the anatomic study, and the patient was submitted to enucleation for aesthetic improvement and clarifying diagnosis. We concluded athalamia and deformation of the anterior segment, due to expansion of the cyst, led to gradual elevation of the intraocular pressure and damage of the optic nerve, resulting in visual loss.

RESUMO Relatamos o caso de um paciente com evolução e diagnóstico tardios de cisto de íris no olho direito, provavelmente secundário a trauma, com complicações importantes e baixa irreversível da visão, tendo sido admitido no Hospital Universitário Antônio Pedro já com leucoma total da córnea e câmara anterior indevassável. A biomicroscopia ultrassônica se mostrou imprescindível para o estudo anatômico, sendo o paciente finalmente submetido à enucleação, para melhora estética e elucidação diagnóstica. Concluímos que a atalamia e a desestruturação do segmento anterior, consequentes ao crescimento cístico, levaram a um gradativo aumento da pressão intraocular e lesão do nervo óptico, com consequente perda da visão.

Hipertensão ocular recorrente durante hemodiálise em paciente portador de glaucoma / Recurrent intraocular hypertension during hemodialysis in glaucoma patient

RESUMO A hipertensão ocular aguda durante a hemodiálise constitui evento raro e pode ser causa relevante de interrupção do tratamento dialítico devido à dor. Relata-se o caso de um paciente de 70 anos de idade, do sexo masculino, que apresentou quadros recorrentes de intensa dor ocular unilateral durante sessões dialíticas devido ao aumento de pressão intraocular. O paciente era portador de grave diminuição da acuidade visual no olho direito devido a glaucoma neovascular, controlado com medicação hipotensora tópica. Uma hora após o início da sessão dialítica, apresentou dor excruciante no olho direito, sendo necessário interromper o tratamento por diversas vezes. A dor somente era amenizada com uso de opioides por via endovenosa ou após cerca de 6 horas do procedimento. Injeção intraocular de drogas antiangiogênicas e acetazolamida por via oral, assim como tratamentos tradicionais para quadros agudos de hipertensão intraocular, como uso de hipotensor tópico e medicamentos hiperosmolares, foram insuficientes para o controle da dor. O problema se resolveu com ciclofotocoagulação transescleral realizada com laser diodo, com redução da pressão intraocular basal e controle da dor, o que permitiu a realização de sessões completas de hemodiálise. A base fisiopatológica desse evento incomum e suas opções terapêuticas são discutidas aqui.

ABSTRACT Acute ocular hypertension during hemodialysis is a rare event and may lead to interruption of dialytic therapy due to pain. A case of a 70-year-old male patient is reported, who presented recurrent intense unilateral ocular pain episodes during dialysis sessions for increased intraocular pressure. The patient presented with severely decreased visual acuity in the right eye due to neovascular glaucoma, which was controlled with topical hypotensive medication. One hour after initiating dialysis, he presented an excruciating pain on the right eye, which required interruption of treatment several times. Pain relief was possible only with intravenous opioids, or approximately 6 hours after dialysis. Intraocular injection of antiangiogenic drugs and per oris acetazolamide, as well as other traditional treatments for acute episodes of intraocular hypertension, such as topical antihypertensive agents and hyperosmotic medications, were not sufficient to control pain. The problem was solved with transscleral diode laser cyclophotocoagulation, which reduced baseline intraocular pressure and controlled pain, enabling complete hemodialysis sessions. The pathophysiological aspects and therapeutic options of this unusual condition are discussed.

Hipertensión ocular asociada al desprendimiento de la retina regmatógeno / Ocular hypertension associated to rhegmatogenous retinal detachment

Objetivo: Describir el comportamiento de la hipertensión ocular asociada al desprendimiento de la retina regmatógeno. Métodos: Se realizó un estudio observacional descriptivo de corte longitudinal retrospectivo de una serie de casos atendidos en la consulta de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el período comprendido de mayo del año 2016 a diciembre de 2019. Se estudiaron 7 ojos de 7 pacientes. Se utilizaron las siguientes variables: edad, sexo, antecedentes patológicos oculares, tiempo de evolución de la disminución de la visión, tensión ocular, tipo de rotura retinal, cirugía de retina realizada y tratamiento antihipertensivo ocular. Resultados: Predominó el sexo masculino, con un promedio de edad de 27,2 años. La mayoría de los pacientes tuvieron rotura retinal en el cuadrante nasal superior y todos en extrema periferia. Todos los pacientes tuvieron la presión intraocular antes de la cirugía por encima de 30 mmHg. A todos se le indicó tratamiento hipotensor tópico y se les realizó cirugía convencional. Con diferentes fluctuaciones de la presión intraocular posterior a la cirugía, todos los pacientes normalizaron la tensión ocular y mantuvieron la retina aplicada. Conclusiones: El diagnóstico correcto de este síndrome puede ofrecer dificultad porque los signos de una condición pueden enmascarar los de otra. El reconocimiento de la entidad puede ser más fácil si el oftalmólogo tiene en mente que estas entidades pueden aparecer juntas. De esta forma, se hace un diagnóstico y un tratamiento certero que evite la discapacidad visual por esta causa(AU)

Objective: Describe the behavior of ocular hypertension associated to rhegmatogenous retinal detachment. Methods: An observational retrospective longitudinal descriptive study was conducted of 7 eyes of 7 patients attending the Vitreous-Retina Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from May 2016 to December 2019. The variables considered were age, sex, ocular pathological antecedents, time of evolution of vision reduction, ocular tension, type of retinal tear, retinal surgery performed and ocular hypertension treatment. Results: A predominance was found of the male sex, with a mean age of 27.2 years. Most of the patients had retinal tear in the upper nasal quadrant, and all in the extreme periphery. In all cases, intraocular pressure was above 30 mmHg before surgery. All patients were indicated topical hypotensive treatment and underwent conventional surgery. With different intraocular pressure fluctuations after surgery, all patients normalized their ocular tension and retained the retina applied. Conclusions: Correct diagnosis of this syndrome may be difficult to achieve, since the signs of one condition may mask those of another. Identification may be easier if the ophthalmologist bears in mind that these diseases may occur together. An accurate diagnosis may thus be made and an effective treatment indicated which will prevent visual disability due to this cause(AU)

Evaluación de la dinámica de la circulación arterial ocular por eco Doppler en pacientes con hipertensión arterial sistémica esencial / Echo Doppler evaluation of ocular arterial circulation dynamics in patients with systemic essential arterial hypertension

RESUMEN Objetivo: Evaluar los valores de referencia de la dinámica circulatoria arterial ocular de los pacientes con hipertensión arterial esencial. Métodos: Se realizó un estudio descriptivo y transversal en 105 pacientes hipertensos y en un grupo de 33 sujetos no hipertensos, con edades comprendidas entre 18 y 60 años, sin antecedentes de padecer diabetes mellitus ni enfermedades oculares como glaucoma, o haber recibido tratamiento quirúrgico por catarata, hipertensión ocular u otras. A todos se les realizó la toma de la presión arterial sistémica, el examen clínico oftalmológico y el ultrasonido Doppler a color de carótida y de los vasos orbitarios. Resultados: Se encontró un predominio de mujeres de piel blanca, entre la cuarta y quinta década de la vida. Existió un incremento del pico de velocidad sistólica, la velocidad final diastólica y el índice de resistencia en la arteria oftálmica, que fue desde un rango normal en el grupo de los no hipertensos a valores promedios elevados en el grupo de hipertensos, los cuales fueron más altos en los casos descontrolados. No se encontraron modificaciones en el análisis de estos parámetros en las arterias centrales de la retina ni en las ciliares posteriores cortas. Conclusiones: En la casuística estudiada, el incremento del pico de la velocidad sistólica en la arteria oftálmica pudiera estar relacionado con áreas de obstrucción vascular localizadas o con vasoespasmo. Se encontró una asociación entre el descontrol de la presión arterial y los valores elevados del índice de resistencia en la arteria oftálmica(AU)

ABSTRACT Objective: Evaluate the reference values for ocular arterial circulation dynamics in patients with essential arterial hypertension. Methods: A descriptive cross-sectional study was conducted of 105 hypertensive patients and a group of 33 non-hypertensive subjects aged 18-60 years with no antecedents of diabetes mellitus or ocular conditions such as glaucoma or having undergone cataract surgery, ocular hypertension or others. All the patients underwent systemic arterial pressure measurement, clinical ophthalmological examination and color Doppler carotid and orbital ultrasonography. Results: A predominance was observed of the female sex, white skin color and age between the fourth and fifth decades of life. There was an increase in peak systolic velocity, end diastolic velocity and the resistive index in the ophthalmic artery, which ranged from normal in the non-hypertensive group to high average levels in the hypertensive group, higher in uncontrolled cases. Analysis of these parameters did not find any change in central retinal or short posterior ciliary arteries. Conclusions: In the cases studied, the peak systolic velocity increase in the ophthalmic artery could be related to localized vascular obstruction areas or vasospasm. An association was found between uncontrolled arterial pressure and high resistive index values in the ophthalmic artery(AU)

Glaucoma congénito primario: ¿cuándo es preciso sospechar? / Primary congenital glaucoma: when should it be suspected?

RESUMEN Se realiza una actualización sobre el diagnóstico y tratamiento del glaucoma infantil primario, considerando la importancia que tiene un diagnóstico precoz y un tratamiento oportuno para obtener los mejores resultados posibles. Actualmente, a pesar del surgimiento de nuevos fármacos y de técnicas quirúrgicas para tratar esta afección, aún existen discrepancias sobre cómo debemos realizar el diagnóstico positivo; qué tratamiento o técnica quirúrgica emplear; cuándo y cuál sería la mejor. Cuando se trata de glaucoma pediátrico (primario o secundario), presente en etapas tan tempranas de la vida -incluso al nacimiento, donde la cirugía está indicada lo más precozmente posible, con la disyuntiva de cuáles medicamentos podemos emplear o no, por desconocimiento de qué efectos indeseables pudieran presentarse en estas edades y además, teniendo en cuenta que estos niños serán nuestros pacientes para toda la vida- es necesario conocer y repasar una vez más este tema. Se recomienda instruir a pediatras y oftalmólogos generales para lograr la remisión adecuada y precoz del niño a un centro especializado para su tratamiento quirúrgico, y mejorar así su pronóstico visual(AU)

ABSTRACT Updated information is provided about the diagnosis and treatment of primary childhood glaucoma, given the importance of early diagnosis and timely treatment to obtain the best possible results. Despite the emergence of new drugs and surgical techniques to treat this disorder, there is still controversy about how we should perform the positive diagnosis, what treatment or surgical technique should be used and when, and which would be the best. When childhood glaucoma (whether primary or secondary) presents at early stages of life - even at birth -, in which case surgery should be indicated as soon as possible, we are faced with the dilemma of what drugs we may or may not use, due to lack of knowledge about undesirable effects which could appear at these ages, and bearing in mind that these children will be our patients for a lifetime. It is thus necessary to be informed about this topic and go over it once again. It is recommended to instruct pediatricians and ophthalmologists to ensure timely, appropriate referral of the child patient to a specialized center where they will receive surgical treatment, thus improving their visual prognosis(AU)

Does obesity affect intraocular pressure during laparoscopic surgery? / A obesidade afeta a pressão intraocular durante a cirurgia laparoscópica?

ABSTRACT Purpose: Obesity is accepted as a risk factor for postoperative visual loss due to possible perioperative elevations in intraocular pressure. This study investigated whether intraocular pressure changes differed according to the body mass index of patients undergoing laparoscopic cholecystectomy. Methods: Thirty obese and 30 non-obese patients (body mass index cutoff point, 30 kg/m2) undergoing laparoscopic cholecystectomy were enrolled. Intraocular pressure was measured at baseline (T1), after induction of anesthesia (T2), 5 min after initiation of mechanical ventilation (T3), 5 min after pneumoperitoneum inflation (T4), 5 min after the patient was placed in the head-up position (T5), 5 min after deflation with the patient in the supine position (T6), and 5 min after extubation with the patient in the 30 degrees upright position (T7). Results: The mean intraocular pressure values of the obese and non-obese groups were similar at T1 (16.60 ± 2.93 and 16.87 ± 2.85 mmHg respectively). In both groups, intraocular pressure decreased following initiation of anesthesia (T2) (p<0.001, T2 vs T1). Intraocular pressure values at T7 were significantly higher than those at T1 in the obese (20.38 ± 4.11 mmHg, p<0.001) and non-obese (20.93 ± 4.37 mmHg, p<0.01) groups. There were no significant differences between intraocular pressure values of obese and non-obese patients at any time point. Conclusions: Obesity is not correlated with intraocular pressure during short laparoscopic surgeries with the patient in the head-up position.

RESUMO Objetivo: A obesidade é aceita como um fator de risco para a perda visual pós-operatória devido a possíveis elevações perioperatórias da pressão intraocular. Este estudo investigou se as alterações na pressão intraocular diferem de acordo com o índice de massa corporal dos pacientes submetidos à colecistectomia laparoscópica. Métodos: Trinta pacientes obesos e 30 não-obesos (limiar de índice de massa corporal de 30 kg/m2), submetidos à colecistectomia laparoscópica foram incluídos. A pressão intraocular foi medida no início do estudo (T1), após a indução anestésica (T2), 5 min após o início da ventilação mecânica (T3), 5 min após a insuflação do pneumoperitôneo (T4), 5 min após o posicionamento vertical da cabeça (T5), 5 min após a deflação na posição em decúbito dorsal (T6) e 5 min após a extubação com o paciente na posição vertical de 30 graus (T7). Resultados: Os valores médios da pressão intraocular dos grupos obeso e não obeso foram semelhantes no T1 (16,60 ± 2,93 e 16,87 ± 2,85 mmHg, respectivamente). Em ambos os grupos, a pressão intraocular diminuiu após o início da anestesia (T2) (p<0,001, T2 vs T1). Os valores da pressão intraocular em T7 foram significativamente maiores do que aqueles em T1 nos grupos obesos (20,38 ± 4,11 mmHg, p<0,001) e não obesos (20,93 ± 4,37 mmHg, p<0,01). Não houve diferenças significativas entre os valores de pressão intraocular de pacientes obesos e não obesos em qualquer momento. Conclusões: A obesidade não está correlacionada com a pressão intraocular durante cirurgias laparoscópicas curtas com o paciente em posição de cabeça erguida.

Perfil clínico-epidemiológico de pacientes com pico hipertensivo após implante de válvula de Ahmed / Clinical and epidemiological profile of patients with hypertensive peak after Ahmed glaucoma valve implant

Resumo Objetivo: Relatar perfil clínico epidemiológico de pacientes que apresentaram o pico hipertensivo após o IVA e apontar possíveis fatores de risco associados. Métodos: Estudo retrospectivo, observacional e descritivo (revisão de prontuário de pacientes assistidos no IBOPC) de 2014 a 2016. Resultados: Foram analisados 40 pacientes com glaucoma submetidos à implante de válvula de Ahmed. O diagnóstico pré-operatório mais comum foi glaucoma secundário, sendo a indicação pós-transplante penetrante de córnea a mais frequente. 95% das cirurgias foi de implante de tubo isolado. 56% dos pacientes tinham cirurgia anti- glaucomatosa prévia. 46% necessitaram de procedimento cirúrgico posterior para manejo de complicações pós-operatórias, sendo que a mais frequente foi atalamia (9,7%). PIO média no pré-operatório = 28,6 ± 12.20mmHg, com uso de 3,41 medicações. Com 3 semanas a PIO média aumentou para 16mmHg, com uso de 0,42 medicações. Após 3 meses de cirurgia a PIO média estava em 16.5mmHg, com uso de 1,86 de medicações. Após 6 meses de seguimento a PIO média reduziu (16,4 ± 6.74mmHg), com 2,23 ± 1.45 medicações. A média da AV (Snellen) foi de 20/100p no pré-operatório e de 20/200 após 6° mês de cirurgia. Catorze pacientes preencheram os critérios para a FH, destes 6 obtiveram resolução da FH. Dos pacientes que desenvolveram a FH, 78,4% iniciaram a elevação da PIO entre a 2ª e 4ª semana de pós-operatório. Seis (14,6%) pacientes obtiveram sucesso cirúrgico completo, parcial em 36,6% e falência 31%. Conclusão: A fase hipertensiva pode ocorrer em parte dos pacientes após as semanas iniciais do procedimento cirúrgico. O conhecimento deste fenômeno, o preparo prévio do cirurgião, o acompanhamento regular do paciente e o controle da PIO com o uso de medicações são determinantes na resolução desta complicação.

Abstract Objective: To report the clinical epidemiological profile of patients who presented the hypertensive peak after VAT and to indicate possible associated risk factors. Methods: A retrospective, observational and descriptive study (review of medical records of patients assisted in the IBOPC) from 2014 to 2016. Results: We analyzed 40 patients with glaucoma submitted to Ahmed Glaucoma Valve implant. The most common preoperative diagnosis was secondary glaucoma, with the most frequent corneal penetrating post-transplant indication. 95% of the surgeries were of isolated tube implantation. 56% of patients had previous anti-glaucomatous surgery. 46% needed a posterior surgical procedure to manage postoperative complications, and the most frequent was atalamia (9.7%). IOP preoperatively = 28.6 ± 12.20mmHg, with use of 3.41 medications. At 3 weeks the mean IOP increased to 16mmHg, with use of 0.42 medications. After 3 months of surgery the mean IOP was 16.5mmHg, with use of 1.86 of medications. After 6 months of follow-up the mean IOP decreased (16.4 ± 6.74 mmHg), with 2.23 ± 1.45 medications. The mean of the AV (Snellen) was 20 / 100p in the preoperative period and 20/200 after the 6th month of surgery. Fourteen patients fulfilled the criteria for HP, of which 6 obtained HP resolution. Of the patients who developed HP, 78.4% started to elevate IOP between the 2nd and 4th postoperative week. Six (14.6%) patients had complete surgical success, partial in 36.6% and bankruptcy in 31%. Conclusion: The hypertensive phase may occur in part of the patients after the initial weeks of the surgical procedure. The knowledge of this phenomenon, the previous preparation of the surgeon, the regular monitoring of the patient and the control of IOP with the use of medications are determinant in the resolution of this complication.

Factores asociados a la hipertensión ocular después de una facoemulsificación no complicada / Patient factors associated to ocular hypertension after uncomplicated phacoemulsification

Objetivo: identificar los factores del paciente que se asocian con el aumento de la presión intraocular en el posoperatorio inmediato de una facoemulsificación sin complicaciones. Métodos: se realizó una investigación observacional, descriptiva-correlacional y retrospectiva, en una serie de 131 pacientes operados de catarata mediante técnica de facoemulsificación en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Los pacientes se dividieron en dos grupos según las cifras de presión intraocular, un grupo con hipertensión ocular posoperatoria (grupo HTO=32) y otro sin hipertensión ocular después de la facoemulsificación (grupo No HTO=99). Las distintas variables estudiadas fueron extraídas de las historias clínicas de los pacientes de ambos grupos, las cuales se analizaron y se compararon estadísticamente entre sí. Resultados: la edad y el sexo no difirieron estadísticamente entre ambos grupos de estudio. El color de piel no blanca (p= 0,023) y los valores de presión intraocular preoperatoria más altos (p= 0,00) se asociaron a la hipertensión ocular después de la facoemulsificación. No se encontró asociación con los antecedentes patológicos personales, los parámetros biométricos oculares ni del endotelio corneal preoperatorios de ambos grupos de pacientes. Conclusiones: el color de la piel no blanca y los valores de la presión intraocular preoperatoria más altos son factores del paciente que se asocian a hipertensión ocular después de una facoemulsificación sin complicaciones(AU)

Objective: identify the patient factors associated to an increase in intraocular pressure in the immediate postoperative period of uncomplicated phacoemulsification. Methods: an observational retrospective correlational-descriptive study was conducted of a series of 131 patients undergoing cataract surgery by phacoemulsification technique at the Center for Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology. The patients were divided into two groups based on intraocular pressure values: a group with postoperative ocular hypertension (Group OHT= 32), and the other without ocular hypertension after phacoemulsification (Group No OHT=99). Data on the study variables were obtained from the medical records of the patients making up the two groups. These variables were analyzed and statistically compared among themselves. Results: age and sex did not differ statistically between the two study groups. Non-white skin color (p= 0.023) and the highest preoperative intraocular pressure values (p= 0.00) were associated to ocular hypertension after phacoemulsification. No association was found with preoperative personal pathological antecedents, ocular biometric parameters or the corneal endothelium of patients in the two groups. Conclusions: Non-white skin color and higher preoperative intraocular pressure values are the patient factors associated to ocular hypertension after uncomplicated phacoemulsification(AU)

Secondary glaucoma induced by bilateral acute depigmentation of the iris / Glaucoma secundário à despigmentação bilateral aguda da íris

Abstract We report a case of a middle-aged woman who developed acute, bilateral, symmetrical, slightly transilluminating depigmentation of the iris and pigment discharge into the anterior chamber following the use of oral moxifloxacin for bacterial sinusitis. She had been misdiagnosed as having autoimmune uveitis, treated with steroids and tropicamide, and underwent severe ocular hypertension and glaucoma despite posterior correct diagnosis.

Resumo Relato de um caso de uma paciente do sexo feminino de meia idade que desenvolveu despigmentação bilateral simultânea aguda com dispersão de pigmentos na câmara anterior e discreta transiluminação após o uso de moxifloxacino oral para tratamento de sinusite bacteriana. Ela Havia sido diagnosticada com uveite autoimune e tratada com corticosteroide tópico e tropicamida e evoluiu com hipertensão ocular grave e glaucoma apesar de ,posteriormente, o diagnóstico ter sido correto.

Optic neuritis complicating herpes zoster ophthalmicus in an immunocompetent patient / Zoster optic neuritis in immunocompentent

A 58-year-old woman presented with rash over the left side of the face and intense acute uveitis. Following careful review of the symptoms and dilated fundus examination unilateral optic neuritis was discovered. The rash was typical of varicella zoster dermatitis. Patients presenting with herpes zoster ophthalmicus should always undergo dilated fundus examination, as there is a potential risk of unexpected posterior segment inflammation. Early diagnosis and prompt treatment can avoid visual sequelae.

Paciente de 58 anos de idade apresentando erupção cutânea no lado esquerdo da face e intensa uveíte unilateral. Após cuidadosa revisão dos sintomas e exame de fundo do olho foi detectada neurite óptica. O rash era típico de dermatite por varicella zoster. Pacientes apresentando quadro de herpes zoster oftálmico devem ser submetidos ao exame de fundo do olho devido ao risco de inesperada inflamação do segmento posterior. Diagnóstico precoce e tratamento imediato podem evitar danos visuais.

The correlation between body mass index and intraocular pressure in children / Correção entre o índice de massa corpórea e a pressão intraocular em crianças

PURPOSE: There is evidence from some studies that support an association between obesity in adults and higher intraocular pressure (IOP). However, this association has not been completely studied in children. Our aim is to evaluate the association between child body mass index (BMI) and IOP. METHODS: Ninety-six children attending the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) in Brazil were studied. Thirty-three were overweight/obese with a mean BMI of 29.7 ± 5.2 and 63 with a mean BMI of 20.8 ± 3.3. IOP was measured using the Goldmann applanation tonometer and was corrected for corneal thickness. The coefficient of correlation between BMI and IOP was calculated. RESULTS: There was no significant difference in the IOP of children with or without overweight/obesity. The mean IOP was 13.5 and 13.0 mmHg for the right eye and 13.1 and 12.9 mmHg for left eye, respectively (p=0.38 and p=0.71). The results remained the same after correction by pachymetry; 13.0 and 13.1 mmHg for the right eye and 12.4 and 12.9 mmHg for the left eye, respectively (p=0.88 and p=0.41). The coefficient of correlation between BMI and IOP was 0.070 (p=0.496). CONCLUSION: These results do not show a correlation between body mass index and IOP in children. Further studies are warranted to clarify the association between BMI and IOP in children.

OBJETIVO: Alguns estudos apontam para uma associação entre obesidade e aumento da pressão intraocular em adultos. Entretanto, essa associação ainda não foi completamente estudada em crianças. O objetivo do estudo é avaliar a associação entre o índice de massa corpórea (IMC) e a pressão intraocular em crianças. MÉTODOS: Noventa e seis crianças atendidas no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Brasil, foram estudadas. Trinta e três apresentavam excesso de peso ou obesidade com uma média de IMC de 29,7 ± 5,2 e os outros 63 tinham uma média de IMC de 20,8 ± 3,3. A pressão intraocular foi medida por meio do tonômetro de aplanação de Goldmann, corrigida pela espessura da córnea. O coeficiente de correlação entre o IMC e a pressão intraocular foi calculado. RESULTADOS: Não foi observada diferença significativa na pressão intraocular entre as crianças com e sem excesso de peso/obesidade. A média da pressão intraocular foi de 13,5 e 13,0 mmHg no olho direito e 13,1 e 12,9 mmHg no olho esquerdo, respectivamente (p=0,38 e p=0,71). Os resultados permaneceram os mesmos após a correção pela paquimetria; 13,0 e 13,1 mmHg para o olho direito e 12,4 e 12,9 mmHg para o olho esquerdo, respectivamente (p=0,88 e p=0,41). O coeficiente de correlação entre o IMC e a pressão intraocular foi 0,070 (p=0,496). CONCLUSÃO: O índice de massa corpórea não parece apresentar correlação com a pressão intraocular em crianças. Novos estudos são necessários para esclarecer a associação entre o IMC e a pressão intraocular.

Ophthalmic findings among Jordanian patients with chronic renal failure on haemodialysis at Prince Ali Military Hospital in the south of Jordan

To characterize the ocular and peri-ocular findings in patients with chronic renal failure undergoing haemodialysis at Prince Ali Bin Al- Hussein Military Hospital. This is a descriptive study. Data were collected from patients with chronic renal failure undergoing haemodialysis from June 2012 till January 2013. The medical files were reviewed to report medical, surgical and ophthalmic history of all candidate patients. All patients underwent full ophthalmic examination on day one of recruitment. Forty-four patients [87 eyes] were reported. Mean age was 56.9 years [56.9 +/- 12.5]. Male to female ratio was 2:1. Aetiologies of chronic renal failure were: Hypertension [n=17, 39%], glomerulonephritis [n=13, 30%], and diabetes mellitus [n=10, 23%]. Some other aetiologies were also found like: Small kidney [n=4, 9%], renal stones [n=2, 5%], polycystic kidney [n=2, 5%], familial [n=2, 5%] and analgesic nephropathy [n=1, 2%]. Ocular findings were seen in 75 eyes [86%], including lid edema [n=66, 76%] conjunctival congestion [n=54, 62%], cataract [n=47, 54%], and dry eye [n=44, 51%]. Ocular and peri-ocular findings were frequent in chronic renal failure patients who were undergoing hemodialysis, which urges regular ophthalmic examination to detect and treat sight threatening complications early.

The management of complicated glaucoma.

Complicated glaucomas present considerable diagnostic and management challenges. Response to treatment can be unpredictable or reduced compared with other glaucomas. However, target intraocular pressure and preservation of vision may be achieved with selected medical, laser and surgical treatment. The evidence for such treatment is expanding and consequently affords clinicians a better understanding of established and novel techniques. Herein we review the mechanisms involved in the development of complicated glaucoma and the current evidence supporting its management.

Complex genetic mechanisms in glaucoma: An overview.

Glaucomas comprise a group of hereditary optic neuropathies characterized by progressive and irreversible visual field loss and damage to the optic nerve head. It is a complex disease with multiple molecular mechanisms underlying its pathogenesis. Genetic heterogeneity is the hallmark of all glaucomas and multiple chromosomal loci have been linked to the disease, but only a few genes have been characterized, viz. myocilin (MYOC), optineurin (OPTN), WDR36 and neurotrophin-4 (NTF4) in primary open angle glaucoma (POAG) and CYP1B1 and LTBP2 in congenital and developmental glaucomas. Case-control-based association studies on candidate genes involved in different stages of glaucoma pathophysiology have indicated a very limited involvement. The complex mechanisms leading to glaucoma pathogenesis indicate that it could be attributed to multiple genes with varying magnitudes of effect. In this review, we provide an appraisal of the various efforts in unraveling the molecular mystery in glaucoma and also some future directions based on the available scientific knowledge and technological developments.

Impact of early rise of intraocular pressure on visual outcome following diabetic vitrectomy.

Objective: The objective was to study the incidence and risk factors for an early rise in intraocular pressure (IOP) following pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) and to correlate its impact on visual outcome. Materials and Methods: This was a longitudinal prospective study. IOP and best corrected visual acuity (BCVA) for 73 cases of PDR (52 males and 21 females) who underwent PPV were recorded at day 1, week 1, and months 1, 3, and 6. Risk factors for the early IOP rise, defined as IOP ≥ 30 mmHg at day 1, were evaluated using cross-tabulation and the t-test. Results: Mean IOP at day 1 was 21.8 ± 9.8 mmHg with 15 cases (20.5%) having an early rise in IOP. Risk factors for the early IOP rise included intraoperative fibrovascular frond removal (P = 0.003), lens removal (P = 0.043), and intraoperative vitreous bleed (P = 0.008). The early rise in IOP was also associated with consistently raised IOP (P = 0.02), defined as IOP > 21 mmHg during first three consecutive follow-up visits. Further, difference in BCVA at 6 months among the two groups, i.e., with and without an early IOP rise was statistically significant (3.11 ± 1.52 logMAR vs. 2.11 ± 1.49 logMAR; P = 0.025). Conclusion: An early rise in IOP is a significant risk factor which compromises the visual outcome of patients undergoing diabetic vitrectomy.

Inflammatory glaucoma

Glaucoma is seen in about 20% of the patients with uveitis. Anterior uveitis may be acute, subacute, or chronic. The mechanisms by which iridocyclitis leads to obstruction of aqueous outflow include acute, usually reversible forms [e.g., accumulation of inflammatory elements in the intertrabecular spaces, edema of the trabecular lamellae, or angle closure due to ciliary body swelling] and chronic forms [e.g., scar formation or membrane overgrowth in the anterior chamber angle]. Careful history and follow-up helps distinguish steroid-induced glaucoma from uveitic glaucoma. Treatment of combined iridocyclitis and glaucoma involves steroidal and nonsteroidal anti-inflammatory agents and antiglaucoma drugs. However, glaucoma drugs can often have an unpredictable effect on intraocular pressure [IOP] in the setting of uveitis. Surgical intervention is required in case of medical failure. Literature on the Medline database was searched using the PubMed interface

Association of raised intraocular pressure and its correlation to the energy used with raised versus normal intraocular pressure following Nd: YAG laser posterior capsulotomy in pseudophakes

To determine the frequency of raised intraocular pressure [IOP] after Nd: YAG laser posterior capsulotomy and its association with the energy used with raised versus normal intraocular pressure in pseudophakes. Comparative, cross-sectional study. Ophthalmology Department, PNS Shifa Hospital, Karachi, from August 2008 to February 2009. Pseudophakes having poor vision due to posterior capsular opacification [PCO] in an otherwise normal looking eye and intraocular pressure between 10-20 mmHg were included in the study. Patients with diabetic retinopathy, corneal diseases, inflammatory eye diseases, posterior segment surgery, glucoma, trabeculectomy, maculopathy and any systemic disease were excluded from the study. Particulars of the eligible patients and pre-laser intraocular pressure were entered in specially designed proforma. Nd: YAG laser posterior capsulotomy was done. Laser energy used was noted and then their post-laser intraocular pressure was checked after 4 hours. Unpaired t-test was used for comparison of means of IOP and energy levels. Chi-square test was applied to compare the proportions of patients with raised and the normal IOP with YAG laser energy used during posterior capsulotomy. Raised intraocular pressure IOP >/= 5 mmHg from the baseline] after Nd: YAG laser posterior capsulotomy was noted in both the low energy and the 'high energy' groups but it was more common in the high energy group [p < 0.001, r=0.512]. Higher YAG laser energy has significantly higher chances of raising IOP. Hence, it was recommended that each patient undergoing Nd: YAG laser capsulotomy should receive minimum possible laser energy and must be followed up for raised intraocular pressure

Descolamento seroso tardio e recorrente da coróide após trabeculectomia: relato de caso / Late and recurrent serous choroidal detachment after trabeculectomy: case report

O presente caso refere-se a um paciente do sexo masculino, de 85 anos de idade, com catarata senil e glaucoma primário de ângulo aberto avançado nos dois olhos, não controlado com medicação máxima, hialose asteróide no OD e degeneração macular relacionada à idade no OE, submetido a facotrabeculectomia em ambos os olhos com mitomicina C. Diante da falência da cirurgia nos dois olhos, mesmo após lise de suturas com laser de argônio, uso de 5-fluorouracil e agulhamento, foi necessário prescrever novamente hipotensores oculares. Com a combinação fixa timolol 0,5 por cento + dorzolamida 2 por cento, o paciente apresentou descolamento seroso coroidiano bilateral com marcante hipotonia; e com brinzolamida 1 por cento o quadro ocorreu apenas no olho esquerdo. Suspensos os colírios, a pressão intraocular se elevava e o descolamento da coróide regredia completamente. O agulhamento associado às aplicações de 5-fluorouracil resolveu a hipertensão ocular.

A case of an 85 year-old white man with bilateral senile cataract and advanced primary open-angle glaucoma uncontrolled with maximal medical therapy, asteroid hyalosis in OD and age-related macular degeneration in OS, submitted to a phacotrabeculectomy OU with mitomycin-C is reported. Because the surgery failed in both eyes, even after laser suture lysis, 5-FU injections and needling, it was necessary to reintroduce hypotensive agents. With the fixed combination of 0.5 percent timolol + 2 percent dorzolamide, a serous choroidal detachment with marked hypotony developed in both eyes; with 1 percent brinzolamide it only occurred in the OS. The IOP raised and the choroidal detachment resolved completely after discontinuation of the medications. The dilemma was finally solved through repeat needling with subconjunctival 5-FU injections.

Keratouveitis caused by Euphorbia plant sap.

The milky sap or latex of Euphorbia plant is highly toxic and an irritant to the skin and eye. This report illustrates the spectrum of ocular inflammation caused by accidental inoculation of latex of Euphorbia plant. Three patients presented with accidental ocular exposure to the milky sap of Euphorbia species of recent onset. The initial symptoms in all cases were severe burning sensation with blurring of vision. Visual acuity reduced from 20/60 to counting fingers. Clinical findings varied from kerato-conjunctivitis, mild to severe corneal edema, epithelial defects, anterior uveitis and secondary elevated intraocular pressure. All symptoms and signs had resolved by 10-14 days with active supportive medication. People who handle Euphorbia plants should wear eye protection. It is always advisable to ask the patient to bring a sample of the plant for identification.

Enfisema orbitário compressivo após asseio nasal: relato de caso / Sight-threatening orbital emphysema after nose blowing: case report

O enfisema orbitário é caracterizado pela presença anormal de ar na órbita. Sua ocorrência espontânea não é frequente e a maioria dos casos está associada à fratura de órbita. Relatamos o caso de uma paciente do sexo feminino de 40 anos com quadro de enfisema orbitário unilateral, secundário a asseio vigoroso do nariz. A paciente evoluiu com redução aguda da acuidade visual em decorrência de elevação da pressão intraocular, sendo indicado tratamento de urgência. Foi realizada punção orbitária com agulha 24-gauge próximo à região da incisura supraorbital, com melhora imediata do quadro clínico e recuperação da acuidade visual.

Orbital emphysema is the abnormal presence of air in the orbit. Occurrence in the absence of orbital fracture is rare. We report a case of a 40-year-old female presenting unilateral orbital emphysema after vigorous nose blowing. She developed sudden visual loss as a result of elevated intraocular pressure and urgent treatment was required. She underwent an orbital decompression, performed using a 24-gauge needle puncture adjacent to the supraorbital notch. After treatment, she reported considerable decrease of symptoms.