Avaliação do colírio de brimonidina 0, 2% em comparação à nafazolina 0,025% + feniramina 0,3% nas cirurgias de estrabismo / Evaluation of 0.2% brimonidine eye drops compared to 0.025% naphazoline + 0.3% pheniramine in strabismus surgery

RESUMO Objetivo: Avaliar o efeito do colírio de brimonidina 0,2% na redução da hiperemia e do sangramento ocular durante as cirurgias de estrabismo, em comparação com o colírio de nafazolina 0,025% + feniramina 0,3%. Métodos: Foram avaliados 14 pacientes com estrabismo e indicação de correção cirúrgica bilateral. Foi instilado antes do procedimento, de forma aleatória, um colírio em cada olho dos pacientes avaliados. A análise subjetiva da hiperemia conjuntival e do sangramento perioperatório foi realizada de forma duplo-cega, por dois cirurgiões. A avaliação objetiva do nível de hiperemia conjuntival foi realizada por análise das imagens obtidas por meio do software ImageJ®. Resultados: A análise de modelos multivariados de efeito misto indicou diferenças estatisticamente significantes entre os grupos em relação à hiperemia (avaliador 2) e ao sangramento intraoperatório (avaliadores 1 e 2), com maiores escores nos casos tratados com colírio de nafazolina + feniramina. Entretanto, não houve diferença estatística na análise objetiva realizada por meio da saturação de cores obtidas pelo programa ImageJ®. Conclusão: O colírio de brimonidina pode ser superior ao colírio de nafazolina + feniramina na redução do sangramento, levando-se em conta apenas a análise subjetiva.

ABSTRACT Objective: To evaluate the effect of 0.2% brimonidine eye drops in reducing hyperemia and ocular bleeding during strabismus surgeries, in comparison with 0.025% naphazoline + 0.3% pheniramine eye drops. Methods: Fourteen patients with strabismus and indication for bilateral surgical correction were evaluated. Before the procedure, the eye drops were instilled randomly in each eye of the evaluated patients. The subjective analysis of conjunctival hyperemia and perioperative bleeding was performed in a double-blind manner, by 02 surgeons. The objective assessment of the level of conjunctival hyperemia was performed by analyzing the images obtained using the ImageJ® software. Results: The analysis of multivariate mixed effect models indicated statistically significant differences between the groups in relation to hyperemia (rater 2) and intraoperative bleeding (raters 1 and 2) with higher scores in cases treated with naphazoline + pheniramine eye drops. However, there were no statistically significant differences in the objective analysis of color saturation obtained by the ImageJ® program. Conclusion: Brimonidine eye drops may be superior to naphazoline + pheniramine eye drops in reducing bleeding, taking into account the subjective analysis only.

Inclusão da ligadura da artéria e veia córnea com abraçadeira de naylon para descorna em bovinos / Inclusion of ligadura artery and vein cornea naylon with the clamp to dehorning in cattle / Inclusión de ligadura arteria y la vena cornea naylon con la pinza para descorne de los bovinos

A descorna cirúrgica a campo ainda e uma prática comum em animais de produção, apesar deste procedimento na maioria ainda se realizado por leigos, ou realizada em animais com menos de um ano de idade com ferro candente (avermelhado), esta conduta geralmente é efetuada na propriedade, sendo executada pelo próprio proprietário ou funcionário. O presente experimento usando anestesia geral e bloqueio local do nervo córneo e circularmente na base do corno com abraçadeira de naylon para sutura de pele, associada a ligadura da artéria e veia cornual mostrou ser eficiente reduzindo o tempo cirúrgico a campo e promovendo uma prevenção antecipada de hemorragia que é frequente para este procedimento.(AU)

The surgical dehorning the field and still a common practice in farm animals, although this procedure in most still held by lay people, or performed on animals less than one year old with red-hot iron (red), this conduct is usually done on the property, being executed by the owner himself or employee. This experiment using general anesthesia and local lock of corneal nerve and round the horn base with clamp naylon for skin suture, associated with ligature of the artery and vein cornual is efficient by reducing surgical time field and promoting an early prevention of bleeding is frequent for this procedure.(AU)

El quirúrgica descorne el campo quieto y una práctica común en los animales de granja, aunque este procedimiento en la mayoría todavía en manos de los laicos, o lleva a cabo en animales de menos de un año de edad con hierro al rojo vivo (rojo), este comportamiento se realiza generalmente en la propiedad, los trabajos realizados por el propietario o el propio empleado. Este experimento usando anestesia bloques general y local de los nervios de la córnea y alrededor de la base del cuerno con naylon pinza de sutura de la piel, asociados con la ligadura de la vena y la arteria cornual fue eficiente que reduce el tiempo quirúrgico el campo y la promoción de una prevención temprana sangrado que es común para este procedimiento.(AU)

Periorbital ecchymosis and subconjunctival hemorrhage due to leech therapy for headache / Equimose periorbital e hemorragia subconjuntival devido à terapia com sanguessugas para dor de cabeça

ABSTRACT A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right eye. We noted that her complaints began the day after she underwent leech therapy on the glabella area for headache. On the glabella, 2 leech bites were observed close to the right side. Examination revealed ecchymosis on the bilateral eyelids and subconjunctival hemorrhage on the inferolateral and medial limbus on the right eye. No treatment was initiated, rather control measures were recommended. The follow-up after 1 month revealed that the patient's complaints had disappeared.(AU)

RESUMO Uma paciente de 62 anos procurou nosso ambulatório com queixas de equimose periorbital e hemorragia subconjuntival, visíveis principalmente no olho direito. Descobrimos que suas queixas começaram no dia seguinte a um tratamento para dor de cabeça com sanguessugas na área da glabela. Na glabela, 2 mordidas de sanguessuga foram encontradas próximas ao lado direito. Durante os exames da paciente, foram detectadas equimoses nas pálpebras bilaterais e hemorragia subconjuntival no limbo ínfero lateral e medial do olho direito. Nenhum tratamento foi iniciado, sendo recomendado apenas controle. No acompanhamento, observou-se que as queixas da paciente desapareceram em cerca de um mês.(AU)

Hematoma subperiosteal orbitário secundário a barotrauma em aviação civil / Orbital subperiosteal hematoma secondary to barotrauma in civil aviation

RESUMO Os diagnósticos diferenciais que compõem as proptoses agudas são, muitas vezes, desafiadores. A anamnese e o exame clínico exigem do oftalmologista atenção especial aos detalhes que permitem diferenciar quadros relativamente benignos e autolimitados de quadros que evoluirão com incapacidades permanentes. Relatamos o caso de uma paciente de 49 anos que, durante viagem de avião, apresentou dor ocular, hematoma periorbitário e proptose do olho esquerdo súbitos. Referia diplopia aguda incapacitante. Exames de tomografia e angiorressonância magnética confirmaram diagnóstico de sinusopatia do seio etmoidal esquerdo e hematoma subperiosteal da órbita esquerda, associado ao barotrauma. Apesar de raro, o diagnóstico de hematoma subperiosteal não traumático deve ser considerado diferencial em relação a proptoses agudas, sendo a anamnese fundamental para essa elucidação diagnóstica.

ABSTRACT Differential diagnoses of acute proptosis are often challenging. History and clinical examination require from ophthalmologists special attention to details, which make it possible to differentiate relatively benign and self-limited conditions from those that will progress to permanent disabilities. We report a 49-year-old female patient who had sudden eye pain, periorbital hematoma and proptosis of the left eye during a commercial flight. She also complained of disabling acute diplopia. Computed tomography and magnetic resonance angiography imaging confirmed the diagnosis of subperiosteal hematoma of the left orbit, associated with left ethmoid sinus disease. Although rare, non-traumatic subperiosteal hematoma should be considered in differential diagnoses of acute proptosis, and history taking is fundamental to elucidate the picture.

Bilateral subconjunctival hemorrhage secondary to abciximab use: case report

ABSTRACT CONTEXT: There are no reports on cases of subconjunctival hemorrhage due to use of glycoprotein IIb/IIIa inhibitors. In this report, we present the case of a patient with bilateral subconjunctival hemorrhage after receiving abciximab. CASE REPORT: A 40-year-old male patient underwent coronary angiography after acute anterior myocardial infarction and a coronary stent was placed. Abciximab was added to the therapy because of stent thrombosis. Bilateral subconjunctival hemorrhage was observed after the administration of the abciximab treatment. We treated our patient by stopping abciximab and administering artificial tears. CONCLUSİON: For the first time in the literature, we presented the case of a patient with bilateral subconjunctival hemorrhage after receiving abciximab, which was managed conservatively.

Pseudoxantoma elástico / Pseudoxanthoma elastic

Resumo O pseudoxantoma elástico é uma doença generalizada do tecido conjuntivo envolvendo a pele, olhos e sistema cardiovascular desencadeando a fragmentação e calcificação das fibras elásticas. Geralmente ocorre após a puberdade, as manifestações características são manchas pequenas, circunscritas, amareladas, localizadas no pescoço, axila e pregas inguinais. Estrias angioides na retina, tendência à hemorragia e insuficiência arterial são as complicações mais comuns. Esta doença pode ser herdada como autossômica dominante ou recessiva. O tratamento das manifestações oculares convencional é através da fototerapia a laser impedindo a ocorrência de hemorragias locais. Entretanto, novas abordagens terapêuticas estão sendo desenvolvidas como a utilização em longo prazo de drogas antiangiogênicas, as quais atuam inibindo a neovascularização ocular. Apesar de não ter ainda efetivamente substituído o tratamento original, pesquisas recentes já evidenciam benefícios da nova técnica. O objetivo deste estudo é relatar sobre o caso de uma paciente de 37 anos, portadora do pseudoxantoma elástico, com estrias angioides e hemorragia ocular, e o tratamento eficaz com a terapia antiangiogênica no ambulatório de oftalmologia em Nova Iguaçu, Rio de Janeiro.

Abstract The pseudoxanthoma elasticum is a generalized disease of the connective tissue involving the skin, eyes and cardiovascular system triggering the fragmentation and calcification of elastic fibers. Usually occurs after puberty, the manifestations characteristics are small spots, circumscribed, yellowish, located on the neck, axilla and inguinal folds. Angioid streaks in the retina, tendency to hemorrhage and arterial insufficiency are the most common complications. This disease can be inherited as autosomal dominant or recessive. The treatment of ocular manifestations is through the conventional phototherapy laser preventing the occurrence of local hemorrhages. However, new therapeutic approaches are being developed as the long-term use of drugs antiangiogenic, which act by inhibiting the ocular neovascularization. Despite not having yet effectively replaced the original treatment, recent research already show benefits of new technique. The objective of this study is to report on a case of a patient of 37 years, the carrier of the Pseudoxanthoma Elasticum, with angioid streaks and ocular hemorrhage, and the effective treatment with antiangiogenic therapy at the clinic of Ophthalmology in Nova Iguaçu, Rio de Janeiro.

Safety of warfarin therapy during cataract surgery under topical anesthesia / Segurança da terapia com varfarina durante cirurgia de catarata com anestesia tópica

ABSTRACT Purpose: To analyze the safety of warfarin therapy during cataract surgery under topical anesthesia. Methods: This was a prospective nonrandomized comparative study of 60 eyes of 60 patients treated with or without concurrent oral warfarin anticoagulant therapy, referred for cataract surgery under topical anesthesia. The sample included a treatment (n=30) and a control (n=30) group. Results: There were no records of intraoperative or postoperative intracameral bleeding complications in both the groups. At 1-month postoperative follow-up, 90.0% of patients presented spectacle-corrected visual acuity of at least 20/40. Conclusion: Cataract surgery by phacoemulsification with topical anesthesia can be successfully conducted without discontinuing warfarin. .

RESUMO Objetivo: Avaliar a segurança da cirurgia de catarata com anestesia tópica em pacientes em uso de varfarina. Métodos: Estudo comparativo não aleatorizado, prospectivo de 30 olhos de 30 indivíduos sob terapia anticoagulante por via oral com Varfarina que se submeteram à cirurgia de catarata com anestesia tópica. O grupo controle foi composto por 30 olhos de 30 pacientes, com indicação de cirurgia de catarata, que não faziam uso de terapia anticoagulante. Resultados: Não houve registro de complicações hemorrágicas intracamerais transoperatórias ou pós-operatórias em ambos os grupos. Na visita pós-operatória de 30 dias, 90,0% dos pacientes apresentavam acuidade visual corrigida por óculos de pelo menos 20/40. Conclusão: A cirurgia de catarata por facoemulsificação com anestesia tópica pode ser realizada com sucesso sem interrupção da terapia com varfarina. .

Anatomic and functional outcome of eyes with massive submacular hemorrhage secondary to retinal macroaneurysm submitted to vitrectomy

Purpose: To report the anatomic and functional outcome in patients with severe visual loss after acute massive submacular hemorrhage secondary to retinal arterial macroaneurysm submitted to vitrectomy and subretinal recombinant tissue plasminogen activator injection. Methods: Retrospective, observational, case-series of 4 eyes of 4 patients submitted to pars plana posterior vitrectomy (ppV) combined with internal limiting membrane (ILM) removal and subretinal recombinant tissue plasminogen activator (rtPA-12.5 mg/0.1 ml) injection with dilute (20%) sulfur hexafluoride (SF6) gas in the vitreous cavity of eyes with recent onset (≤7 days) massive macular hemorrhage due to retinal arterial macroaneurysm (RAMA). Optical coherence tomography (OCT) was obtained both at presentation and during follow up. Results: Patients ranged in age from 63 to 78 years and all had systemic arterial hypertension. Visual acuity at presentation ranged from hand motions to count fingers at 50 cm. All eyes showed extensive retinal hemorrhage involving more than two-thirds of macular area. The time between the onset of symptoms and the surgery ranged from 3 to 7 days. After a mean postoperative follow-up of 15.5 ± 5.19 months (range, 10-22 months), all eyes showed visual acuity improvement and final visual acuity ranged from 20/30 to 20/80. All had complete displacement of the subretinal hemorrhage from the fovea after the surgery. OCT images showed neurosensory retina thinning and disruption of the reflective line that represents the junction between inner and outer photoreceptors segments (IS/OS line) beneath the macular area and absence of the external limiting membrane (ELM). Conclusions: ppV associated with subretinal rtPA injection with intravitreal gas seems to be a safe and effective technique to promote visual improvement in patients with multilevel macular hemorrhage secondary to RAMA. Despite functional improvement, OCT images demonstrate that...

Objetivo: Relatar os resultados anatômicos e funcionais em uma série de pacientes com perda visual grave por hemorragia submacular maciça aguda secundária a macroaneurisma arterial de retina (MAR) e descrever a técnica cirúrgica utilizada. Métodos: Este é um estudo retrospectivo, observacional, série de casos, incluindo 4 olhos de 4 pacientes que foram submetidos à cirurgia de vitrectomia posterior (VP), associada a peeling da membrane limitante interna (MLI) e injeção sub-retiniana de ativador do plasminogênio tecidual recombinante (rtPA-12,5 mg/0.1 ml) por hemorragia submacular maciça recente (≤7 dias) secundária MAR. Em todos os casos, o exame de tomografia de coerência óptica (OCT) foi obtido na consulta inicial e nas subsequentes para avaliação das alterações estruturais da retina. Resultados: A idade dos pacientes variou entre 63 a 78 anos e todos apresentavam hipertensão arterial sistêmica. A acuidade visual inicial nos olhos afetados variou de movimento de mãos a conta dedos a 50 cm. Todos os olhos apresentaram hemorragia retiniana extensa ocupando mais do que dois terços da região macular. O tempo decorrido entre a perda visual e a cirurgia variou entre 3 a 7 dias. Após um seguimento médio de 15.5 ± 5.19 meses (variando entre 10 a 22 meses), a acuidade visual pós-operatória variou entre 20/30 e 20/80. Todos os olhos apresentaram um deslocamento completo da hemorragia subretiniana da região macular central no pós operatório. As imagens seccionais da retina obtidas pela OCT revelaram um afilamento da retina neurossensorial e interrupções na linha refletiva que representa a junção entre os segmentos internos e externos dos fotorreceptores na região macular, além de falhas na membrane limitante externa em todos os casos. Conclusão: De acordo com os resultados do presente estudo, a VP associada à injeção sub-retiniana de rtPA parece ser uma técnica segura e eficaz em promover melhora visual em pacientes com hemorragia submacular...

patient of terson's syndrome for ocular surgery: Perianesthetic concerns

Terson's syndrome may be challenging for the anesthesiologist in view of its multisystem involvement including neurological, cardiovascular, and ophthalmological involvement. We describe anesthetic management of a 55-year-old male having Terson's syndrome for pars plana viterctomy

Eye bleeding due to leech infestation in an ischemic heart-disease patient

A 49-year-old Iranian male with diagnosis of ischemic heart disease [IHD] and arterial hypertension [AH] was admitted at Emergency Ward of Vase'ee Hospital of Sabzevar, Iran. As well, the patient had red eye and left eye bleeding. On eye examination, leech infestation was found to be the cause of the eye bleeding. In the endemic regions in a patient presenting red eye and eye bleeding, leech infestation came up to be an important differential diagnosis. Therefore, to prevent leech infestation in endemic regions, local people are advised to be informed more effectively about the necessity to use safe, clean, and filtered drinking water, and a perfect scrutiny for leeches or other sources of infestation that should be undertaken before bathing

Barotrauma ocular durante mergulho autônomo / Ocular barotrauma during scuba diving

Relato de um caso de barotrauma ocular bilateral relacionado ao mergulho autônomo, com hemorragia conjuntival e periocular. Alguns conceitos de física e cuidados durante o mergulho são reportados para um melhor entendimento da fisiopatogenia do quadro, de modo que se possa melhor orientar os pacientes quanto à prevenção.

Report of a case of bilateral ocular barotrauma related to scuba diving, with conjunctival and periocular hemorrhage. Some concepts about Physics and caution are provided to better understanding the pathophysiology of the barotrauma, so proper orientation regarding prevention might be provided.

Presumed sclerotomy site bleeding inflowing into the anterior chamber after the removal of a 23-gauge microcannula in 23-gauge sutureless vitrectomy.

We experienced two cases of the influx of the sclerotomy site bleeding into the anterior chamber during 23-gauge sutureless vitrectomy for pseudophakic rhegmatogenous retinal detachment. Soon after the removal of a 23-gauge microcannula at the end of the surgery, presumed sclerotomy site hemorrhage was rapidly fluxed into the anterior chamber. The anterior chamber bleeding might come from the sclerotomies rather than from episcleral vessels. The posterior pressure in the gas-filled pseudophakic eye might have pushed the sclerotomy site bleeding into the anterior chamber. We could not find any vitreous hemorrhages. The hemorrhage within the anterior chamber spontaneously absorbed within 14 days.

Hemorragia peripapilar em pacientes com glaucoma e sua relação com o tronco vascular retiniano / Association between optic disc hemorrhages and the position of central retinal vessels

OBJETIVOS: Avaliar a correlação entre as hemorragias peripapilares (HPPs) e a posição do tronco vascular na cabeça do nervo óptico. MÉTODOS: Retinografias de 1.830 pacientes foram revisadas. A posição do tronco vascular retiniano (TVR) foi classificada de acordo com sua localização no hemisfério superior ou inferior e sua posição relativa através da razão entre a distância entre o TVR e o ponto mais inferior do disco óptico e o diâmetro vertical do disco óptico (razão tronco/disco). Pacientes da mesma população, com glaucoma e sem HPPs foram aleatoriamente selecionados para comparação. RESULTADOS: Dos 1.830 pacientes, 46 apresentaram HPPs. Foram detectadas 53 hemorragias em 41 pacientes com glaucoma ou suspeitos de glaucoma, principalmente na região temporal inferior (47,2 por cento). Observou-se concordância negativa entre a localização superior ou inferior do TVR e das HPPs (Kappa= -0,34). Considerando a posição relativa do TVR em relação ao diâmetro vertical do disco óptico (razão tronco/disco), encontramos melhor correlação (valores médios da razão tronco/disco: 0,450-hemorragias superiores e 0,510-hemorragias inferiores; p=0,027). No grupo com HPPs, observamos porcentagem significativamente maior de pacientes com glaucoma de pressão normal (GPN) se comparado ao grupo sem hemorragia (p=0,009). CONCLUSÃO: HPPs foram mais comuns no hemisfério oposto ao da emergência do TVR. Observamos maior prevalência de GPN nos pacientes com hemorragias que nos sem hemorragia.

PURPOSE: To investigate the correlation between optic disc hemorrhages (ODHs) and the position of the central retinal vessel trunk (RVT) in patients with glaucoma. METHODS: Fundus photographs of 1,830 participants were reviewed. The exit position of the central retinal vessel trunk was classified as being in the superior or inferior hemisphere of the optic disc and the relative vertical position was expressed as a fraction of the disc diameter (ratio between the position of the trunk and the diameter of the disk). A group of patients from the same population, but without ODHs, was randomly selected and compared with the patients with ODHs. RESULTS: Among the 1,830 patients, 53 hemorrhages were detected in 41 patients with glaucoma or suspected glaucoma. We found an inverse relationship between the inferior/superior position of the central RVT and the inferior/superior position of the hemorrhages (Kappa= -0.34). Using the trunk/disc ratio, we found that superior ODHs correlated with inferior RVTs (trunk/disc ratio, 0.450; SD=0.070) and inferior ODHs correlated with superior RVTs (trunk/disc ratio, 0.510; SD=0.054) (p=0.027). The number of patients with normal tension glaucoma was significantly higher among patients with ODHs than among those without ODHs (p=0.009). CONCLUSION: Our patients had a negative correlation between the position of central RVT and the location of the ODHs. Normal tension glaucoma was more prevalent among patients with ODHs than among those without it.

Diagnóstico del ojo rojo para el médico de atención primaria / Red eye diagnosis for the general practitioner in primary care

El ojo rojo es uno de los motivos de consulta más comunes en atención ocular primaria, y el médico no oftalmólogo tiene la vital función de discernir cuando se trata de una patología que pueda amenazar la visión. En este artículo revisamos el enfoque diagnóstico del ojo rojo de acuerdo a nuestra experiencia profesional y empleando Medline para localizar artículos sobre el tema. Adicionalmente sugerimos un flujograma que esperamos guíe al médico de atención primaria al enfrentarse a estos casos. [Galvis V, Tello A, Díaz CA. Diagnóstico del ojo rojo para el médico de atención primaria. MedUNAB 2008; 11:231-238].

A red eye is one of the most common causes of consultation to ocular primary healthcare and non-ophthalmologist physician has the crucial role of detect conditions which can threat vision. In this article we review the diagnostic approach of red eye according to our professional experience and using Medline to locate articles on the subject. Also we suggest a diagnostic flow chart that we expect guide the primary healthcare provider when facing these cases. [Galvis V, Tello A, Díaz CA. Red eye diagnosis for the general practitioner in primary care. MedUNAB 2008; 11:231-238].

Disc Hemorrhages in Patients with both Normal Tension Glaucoma and Branch Retinal Vein Occlusion in Different Eyes

PURPOSE: To document the clinical features of disc hemorrhage in patients with branch retinal vein occlusion (BRVO) and normal tension glaucoma (NTG), and to evaluate the relationship between BRVO and NTG with disc hemorrhages. METHODS: From July 2001 to May 2006, sixteen patients with both NTG and BRVO in different eyes were successively collected from outpatient population of Seoul National University Hospital in this observational case series. The frequency and location of disc hemorrhages, history of associated systemic diseases, and the order of the time of diagnosis between NTG and BRVO were studied. RESULTS: All patients had unilateral BRVO, and their mean age was 63.3+/-10.6 years. Disc hemorrhages were detected in eight patients (50%) during the mean follow-up of 26.8 months (range, 3-96 months). Six patients (75%) had disc hemorrhages in the non-BRVO eyes and two patients (25%) in BRVO eyes. Five hemorrhages (62.5%) were located at inferior-temporal quadrant of the optic disc. History of systemic hypertension was identified in 12 patients (75.0%). In 11 patients (68.8%), NTG was diagnosed at the same time as BRVO. CONCLUSIONS: A higher frequency of disc hemorrhages was identified in patients with both BRVO and NTG. Therefore, some cases of NTG, especially with disc hemorrhages, may share a common vascular pathophysiology with BRVO.

Spontaneous onset corneoscleral hematic cyst.

Corneoscleral cysts are a rare entity. We report a case of spontaneous corneoscleral hematic cyst, which was treated by cyst excision and lamellar corneal patch graft. No recurrence of cyst was noticed during the 6 years of followup.

unusual case of bloody tears

Conjunctival bleeding is usually caused by non accidental or accidental conjunctival laceration, conjunctival tumors and nasolacrimal sac tumors. We report here a rare case of conjunctival bleeding which was self induced using cinnamon bark