Influência de polimorfismos nos genes antioxidantes GSTM1, GSTT1 e GSTP1 no desenvolvimento de complicações oftalmológicas em diabéticos tipo 2 / Influence of polymorphisms in the GSTM1, GSTT1, and GSTP1 antioxidant genes on the development of ophthalmic complications in persons with type 2 diabetes

Introdução: A diabetes tipo 2 (DM2) é uma desordem metabólica ocasionada pela disfunção das células beta pancreáticas que interferem na produção de insulina e/ou pela resistência dos órgãos alvos a esse hormônio. Níveis elevados de radicais livres em conjunto com o declínio das defesas antioxidantes presente na DM2 podem ocasionar danos a organelas celulares, promovendo complicações da doença. As glutationas S- transferases (GST) são as principais enzimas antioxidantes que participam da defesa celular contra o estresse oxidativo. Os polimorfismos nos genes que codificam essas enzimas podem acarretar o surgimento de complicações oftalmológicas em diabéticos. Este trabalho avaliou a influência dos polimorfismos nos genes GST no desenvolvimento de doenças como a catarata e o glaucoma em pacientes com DM2 na Grande Vitória (ES). Metodologia: Os polimorfismos dos genes GSTM1 e GSTT1 foram investigados através da técnica de PCR multiplex. Para o gene GSTP1 utilizou-se a técnica PCR- RFLP. A análise estatística foi realizada através do teste exato de Fisher ou do teste do qui-quadrado com P-valor < 0.05. Resultados: Não foi encontrada relação entre os polimorfismos nos genes GSTM1, GSTT1 e GSTP1 e o surgimento de doenças como glaucoma e catarata em pacientes com DM2. Conclusão: Nossos dados sugerem que os polimorfismos nulos nos genes GSTM1 e GSTT1 e o polimorfismo Ile105Val no gene GSTP1 não estão associados com a suscetibilidade individual para o desenvolvimento de complicações oftalmológicas em pacientes com DM2. (AU)

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder caused by beta cell dysfunction that interferes with insulin production and/or by the resistance of target organs to this hormone. An increase in free radicals together with a decline in antioxidant defenses, present in T2DM, can damage cellular organelles and promote the occurrence of disease complications. Glutathione S-transferases (GSTs) are the main antioxidant enzymes involved in cellular defense against oxidative stress, and polymorphisms in genes encoding GSTs can lead to ophthalmic complications in persons with diabetes. In this study, we evaluated the influence of GST polymorphisms on the development of diseases such as cataract and glaucoma in patients with T2DM in Grande Vitória, Espírito Santo, Brazil. Methods: GSTM1 and GSTT1 polymorphisms were investigated using a multiplex PCR technique. PCR-RFLP was used for the GSTP1 gene. Statistical analysis was performed with Fisher's exact test or the chi-square test, with P-value <0.05. Results: There was no relationship between GSTM1, GSTT1, or GSTP1 polymorphisms and the occurrence of diseases such as glaucoma and cataract in patients with T2DM. Conclusion: Our data suggest that the GSTM1 and GSTT1 null polymorphisms and the ile105Val polymorphism in the GSTP1 gene are not associated with individual susceptibility to the development of ophthalmic complications in persons with T2DM. (AU)

Comparison of Clinical Manifestations between Patients with Ocular Myasthenia Gravis and Generalized Myasthenia Gravis

PURPOSE: To compare the clinical manifestations between patients with ocular myasthenia gravis and those with generalized myasthenia gravis (MG). METHODS: The medical records of 71 patients diagnosed with MG between January 1995 and December 2007 were reviewed. Demographics, sensitivities of diagnostic methods, the presence of systemic autoimmune diseases, ophthalmic complications caused by MG, and treatments were evaluated and compared. RESULTS: Fourteen patients (20%) were diagnosed with ocular MG and 57 patients (80%) with generalized MG. Sensitivities of anti-acetylcholine receptor antibody and repetitive nerve stimulation tests were significantly higher in the generalized MG group (84%, 89%) compared to those in the ocular MG group (50%, 54%) (p = 0.011, p = 0.008). The sensitivity of the neostigmine test was the highest in both groups (98% of generalized MG, 79% of ocular MG), and the difference between the two groups was borderline significant (p = 0.058). The most common symptoms were ptosis and diplopia, and both groups presented with pain, blurred vision, and tearing. Systemic autoimmune disease was more prominent in the generalized MG group (21%) than in the ocular MG group (14%), and steroid therapy was used more frequently in the generalized MG group (82%) than in the ocular MG group (57%). Ophthalmic complications associated with long-term steroid treatment were more profound in the generalized MG (30%) compared to those of the ocular MG (21%). CONCLUSIONS: The generalized MG group was associated with higher sensitivities to diagnostic tests, more systemic steroid use, higher ophthalmic complications caused by systemic autoimmune disease, and long-term steroid treatment compared to those of the ocular MG group.

Prevalência de complicações oftalmológicas em portadores de fraturas do complexo zigomático / Prevalence of ophthalmic complications in individuals with fractures of the zygomatic complex

OBJETIVO: Realizar estudo observacional e retrospectivo da prevalência de complicações oftalmológicas em indivíduos portadores de fratura de complexo zigomático. MATERIAL E MÉTODO: Foi realizada a análise retrospectiva por consulta a prontuários dos pacientes atendidos no ambulatório de Cirurgia Buco-Maxilo-Facial do Hospital Geral Roberto Santos, no período de janeiro de 2005 a junho de 2009. RESULTADOS: Este estudo mostrou uma maior incidência de fraturas no sexo masculino, sendo a amostra composta por 70 homens (92,2%) e 6 mulheres (7,8%) com idade média de 20 a 39 anos. Dentre as causas, destacaram-se os acidentes de trânsito, envolvendo, motocicleta, carros e bicicleta que foram os agentes etiológicos mais comuns em ambos os sexos, perfazendo um total de 41 casos (54,0%). As complicações oftalmológicas observadas podem ser classificadas em menores (transitórias) e maiores (que necessitam de tratamento adicional). CONCLUSÃO: Pacientes portadores de fraturas 67 do complexo zigomático apresentam incidência elevada de complicações oftalmológicas, o que justifica o atendimento multidisciplinar desses pacientes.

OBJECTIVES: To conduct an observational and retrospective study of the prevalence of ophthalmic complications in individuals with fractures of the zygomatic complex. MATERIAL AND METHODS: This retrospective analysis was carried out by consulting the records of the patients treated at the Oral and Maxillofacial Surgery Clinic of the Roberto Santos General Hospital from January 2005 to June 2009. RESULTS: The study, comprising 70 men (92.2%) and 6 women (7.8%) aged between 20 and 39 years, showed a higher incidence of fractures in males. Road accidents involving motorcycles, cars and bicycles were the most common etiological agent in both sexes, accounting for a total of 41 cases. The ophthalmic complications observed can be classified as minor (transitory) and major (requiring further treatment). CONCLUSIONS: Patients with fractures of the zygomatic complex present a high incidence of ophthalmic complications, which justifies their treatment in a multidisciplinary fashion.

Visual Loss due to Inflammatory Sinus Diseases

PURPOSE: Visual loss secondary to inflammatory sinus diseases is an infrequent but disastrous complication. We analyzed the clinical features of patients with paranasal sinusitis who had signs of optic nerve dysfunction. METHODS: Medical records of 10 patients (11 eyes), who presented with visual loss associated with inflammatory sinus diseases, were reviewed retrospectively. RESULTS: The mean age was 53.7 years (range, 33-68 years). Involved sinuses were the sphenoid (10 eyes) and posterior ethmoid (7 eyes). The radiological evidence of orbital apex infiltration was shown in 8 eyes. Headache was the most common presenting symptom. The mean symptom duration before their first visit was 51.4 days. The underlying sinus pathology included fungal infection (5) and mucoceles (5). Fungal sinusitis and initially lower visual acuity were associated with poor visual prognosis, while mucocele showed good prognosis. CONCLUSIONS: The inflammatory sinus disease could leave a permanent visual deficit, especially in cases of fungal sinusitis and initially lower visual acuity. Multidisciplinary diagnostic and therapeutic approaches are essential to prevent serious ophthalmic complications such as permanent visual loss.

Ophthalmic Complications After Paranasal Sinus Surgery

Various ophthalmic complications can occur after intranasal sinus surgery due to closed anatomic relation between orbit and paranasal sinuses. A study was undertaken to identify those patients with ophthalmic complication after intranasal sinus surgery. A consecutive series of 80 cases undergoing sinus surgery at department of ENT between Jan. 1992 and Jul. 1992 was studied prospectively. We recorded preoperative and postoperative best corrected visual acuity, intraocular pressure, exophthalmometric measurement, levator function, funding, lacrimal excretory function, extraocular muscle motility. Several patients were noticed a variety of ophthalmic problems after intranasal sinus surgery: 1 case of orbital hematoma and transient blepharoptosis, 2 cases of diplopia with limited duction, 4 cases of subcutaneous hemorrhage, tearing and blurring, 5 cases of conjunctival injection with chemosis, 7 cases of ocular discomfort, 42 cases of lid swelling. Orbital hematoma was treated with puncture and aspiration but other problems were recovered spontaneously within several days.