Postoperative anterior uveitis in a patient submitted to combined treatment with cataract surgery and iStent inject®. How to manage? / Uveíte anterior no pós-operatório de facectomia combinada com implante de iStent inject®. Como manejar?

ABSTRACT Minimally invasive glaucoma surgeries are surgical treatment alternatives for glaucoma aimed at reducing intraocular pressure with a better safety profile compared to traditional trabeculectomy. However, in spite of less invasive techniques, complications may develop in any surgical procedure. To the best of our knowledge, this is the first case report of anterior uveitis following combined treatment with cataract surgery and iStent inject® which addresses the management of postoperative inflammation.

RESUMO As cirurgias minimamente invasivas para glaucoma consistem em uma opção de tratamento cirúrgico para glaucoma, a qual promove redução da pressão intraocular com melhor perfil de segurança do que a trabeculectomia. Todavia, complicações são inerentes à realização de procedimentos cirúrgicos, apesar do uso de técnicas menos invasivas. Este é o primeiro relato que apresenta um caso de uveíte anterior após cirurgia combinada de catarata e iStent inject®, além de orientações quanto ao manejo do quadro inflamatório.

Manifestação ocular incomum em paciente com incontinência pigmentar / Unusual ocular manifestation in a patient with incontinentia pigmenti

RESUMO Incontinência pigmentar, também conhecida como síndrome de Bloch-Sulzberger, é uma doença rara de herança dominante ligada ao X cujas manifestações clínicas incluem lesões dermatológicas típicas combinadas com acometimento neurológico, oftalmológico e dentário. Alterações oculares são comuns e variadas, sendo o acometimento da retina o mais frequente e associado a perda visual severa. Foi relatado um caso de uma criança com perda visual grave decorrente de glaucoma, sem alteração retiniana significativa.

ABSTRACT Incontinentia pigmenti, also known as Bloch-Sulzberger syndrome, is a rare dominant X-linked inheritance disease whose clinical manifestations include typical dermatological lesions combined with neurological, ophthalmic and dental involvement. Ocular involvment is common and diverse and retinal changes are the most frequent and associated with serious visual loss. We reported a case of a child with severe visual loss due to glaucoma, with no significant retinal changes.

Mismatch between TOF MR Angiography and CT Angiography of the Middle Cerebral Artery may be a Critical Sign in Cerebrovascular Dynamics

PURPOSE: Although time-of-flight (TOF)-magnetic resonance angiography (MRA) can clearly depict intracranial arteries, the arterial flow of middle cerebral artery (MCA) is occasionally not detected. We evaluated this phenomenon with reference to cerebrovascular dynamics. MATERIALS AND METHODS: Seventeen patients with suspected occlusion of MCA or internal carotid artery on TOF-MRA were enrolled. All patients underwent CT angiography (CTA) and quantitative cerebral blood flow (CBF) examination for measurement of resting CBF and cerebrovascular reactivity (CVR). Depending on appearance, patients were categorized into three groups. Group A (n=6) had MCA delineation on both MRA and CTA, while groups B (n=6) and C (n=5) had no signal on MRA, but Group B had a MCA delineation on CTA.

Acetazolamide for Cystoid Macular Oedema in Bietti Crystalline Retinal Dystrophy

Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.

Cilioretinal artery occlusion following intranasal cocaine insufflations.

Cocaine is used to produce a euphoric effect by abusers, who may be unaware of the devastating systemic and ocular side effects of this drug. We describe the first known case of cilioretinal artery occlusion after intranasal cocaine abuse.

A Case of Pediatric Idiopathic Intracranial Hypertension Presenting with Divergence Insufficiency

An 11-year-old female presenting diplopia only at distance was found to have comitant esotropia of 20 prism diopters (PD) at distance and normal alignment at nearer proximity. Other ocular movement, including abduction, was normal and a thorough neurologic examination was also normal. The deviation angle of esotropia was increased to 35 PD in 6 months, and a brain magnetic resonance imaging with venogram at that time demonstrated no intracranial lesion. A lumbar puncture showed increased opening pressure but the cerebrospinal fluid composition was normal. The patient was diagnosed as having idiopathic intracranial hypertension and treated with oral acetazolamide. Three months after treatment, the deviation angle decreased to 10 PD. This is a case report of divergence insufficiency in pediatric idiopathic intracranial hypertension, with an increasing deviation angle of esotropia. Although sixth cranial nerve palsy is a common neurologic manifestation in intracranial hypertension, clinicians should be aware of the possibility of divergence insufficiency. Also, ophthalmoparesis may not be apparent and typical at first presentation, as seen in this case, and therefore ophthalmologists should be aware of this fact, while conducting careful and proper evaluation, follow-up, and intervention.

Hipertension intracraneal idiopática: estudio retrospectivo de 116 pacientes evaluados en la unidad de Neuro-Oftalmología del Hospital Vargas de Caracas (1980-1996) / Idiopatic intracraneal hypertension: retrospective study of 116 patients evaluated in the unit of the Hospital Vargas of Caracas (1986-1996)

Estudiamos retrospectivamente los antecedentes, las características clínicas y la evolución de 116 pacientes con el diagnóstico de Hipertensión Intracraneal idiopática, vistos a lo largo de 16 años en la Unidad de Neuro-Oftalmología del Hospital Vargas de Caracas, tratando de establecer su importancia como causa de morbilidad visual. La edad promedio fue de 31.1 años ñ 12.1 DE, con predominio del sexo femenino (84,5 por ciento). La obesidad presente en un 44,8 por ciento de los pacientes, y el reciente aumento de peso en el 27,6 por ciento constituyeron los dos factores de riesgo más frecuentes en la muestra. Antecedentes de ingestión de corticosteroides y anticonceptivos orales fueron los más reportados, en 17,2 por ciento y 13,8 por ciento respectivamente. Los síntomas más comunes fueron la cefalea (79,3 por ciento), los oscurecimientos visuales transitorios (50,9 por ciento) y el zumbido intracraneal (42,2 por ciento). El 31,0 por ciento de los 232 ojos evaluados, tenían disminución de la Agudeza Visual (AV) para el momento del diagnóstico, con 1.3 por ciento de ceguera total. La pérdida del Campo visual (CV), determinada por pantalla tangente, estuvo presente en 198 ojos (86.1 por ciento). Durante el seguimiento y con el tratamiento, el grado de AV y las alteraciones en el CV mejoraron, o no exprimentaron mayor deterioro en 90.2 por ciento y 91.5 por ciento respectivamente. En base a estos resultados recomendamos el uso aislado de la Acetazolamida como tratamiento inicial en pacientes con HHI. Si controles periódicos evidencian deterioro de la función sensorial visual, debe recurrirse al tratamiento quirúrgico, de referencia, la descompresión de la vaina del nervio óptico. El deterioro uni o bilateral de la función sensorial visual en pacientes con HHI es frecuente, pero a menudo reversible y su evolución dicta la pauta del tratamiento más idóneo en pro de la prevención o recuperación del daño visual

Evaluación de la trabeculoplastía láser argón a mediano plazo: efectividad a mediano plazo de la trabeculoplastía de 360º / Evaluation of trabeculoplasty by laser-argon at middle term: effectiviness at middle term from trabeculoplasty of 360º

Se estudian los resultados a mediano plazo de la Trabeculoplastía Laser Argón (TPLA) de 360º en 38 ojos portadores de glaucoma crónico de ángulo abierto primario (21), como de otras formas de glaucoma de ángulo abierto (17). Se definen como fracasos: reducción insuficiente de la PO, aumento del tratamiento médico o necesidad de trabeculectomía. Los porcentajes de éxito son: de 3 años a 3 años 11 meses, 57,9 por ciento (38 casos). De 4 a 4 años 11 meses, 53,9 por ciento (26 casos). De 5 años a 6 años, 57,1 por ciento (14 casos). Se comparan estos resultados con los publicados. Luego se analizan los factores pronósticos de la TPLA

Parálisis flácida e hipokalemia en un joven de 17 años / Flaccid paralysis and hypokalemia in a young man of 17 years old

Se presenta un paciente de 17 años que ingresa por un cuadro de tetraplejía, con conservación de la movilidad de los músculos de la cara y con valores de K de 1.5 meq/1. El cuadro clínico revierte en forma completa con la terapéutica de reposición de K, realizándose el diagnóstico de Parálisis Periódica Hipokalémica por biopsia muscular. La falta de antecedentes familiares, así como también la ausencia de enfermedades que pudieran ocasionar Parálisis Periódica Esporádica, nos llevó al diagnóstico de Parálisis Periódica Esporádica Idiopática

Inibiçäo da anidrase carbônica no tratamento de edema macular crônico associado a gliose macular idiopática / Inhibition of carbonic anhydrase in the treatment of chronic macular edema associated to idipatic gliosis

Durante 1989 e 1990 foram documentados 14 pacientes com edema macular crônico associado à gliose idiopática pré-macular. Destes, 9 aceitaram submeter-se a um teste terapêutico com acetazolamida oral. Seis casos (66,6//) mostraram resoluçäo angiográfica parcial ou completa no curso do tratamento. Nenhum dos 5 pacientes do grupo-controle mostrou esta evoluçäo. Este resultado sugere que os inibidores da anidrase carbônica podem oferecer algum auxílio terapêutico nesta situaçäo

Achievement of surgically soft and safe eyes--a comparative study.

With the advent of intra ocular lens implantation at the time of cataract extraction, especially by intracapsular method, it has become very important to prevent the loss of vitreous during surgery. This can be achieved by lowering the intraocular pressure by various methods. In order to find out the best method to achieve a soft & safe eye before surgery, a study was conducted on 90 patients, undergoing intracapsular cataract extraction. The patients were divided into 9 groups of 10 each, & different methods of lowering intraocular pressure were tried and results compared. It was observed that intravenous mannitol given preoperatively and pressure with mercury column together, formed the best combination to achieve the maximum tension lowering effect.

Edema macular cistóide / Cystoid macular edema

Dez casos de Edema Macular Cistóide de etiologia variável foram tratados com Triamcinolona e Acetazolamida. Houve melhora objetiva (uma a duas linhas na tabela de Snellen) e/ou subjetiva em todos eles

Efectos oculares y sistémicos de la administración preoperatoria de acetézolamida en la cirugía de la catarata senil / Ocular and systemic effects preoperative administration of acetozolamide in surgery of senile cataract

Se analizam los efectos de la administración preoperatoria de acetazolamida, tanto en forma fraccionada como em dosis única, sobre la presión intraocular preoperatoria, la presión vítrea intraoperatoria, el equilibrio ácido-base y los electrolitos plasmáticos en 99 casos de catarata senil pura operados por el autor en el Servicio de Oftalmología del Hospital José Joaquím Aguirre entre los años 1980 y 1982, divididos al azar en tres grupos de estudio, a saber: grupo I, 33 pacientes que recibieron acetazolamida en dosis de 250 mgr por vía oral 18, 10 y 2 horas antes de la operación; grupo II, 33 pacientes que recibieron acetazolamida en dosis única de 500 mgr por vía oral 2 horas antes de la operación; y grupo III, 33 pacientes que no recibieron premedicación (grupo control). La disminución de la presión intraocular observada con ambos tipos de premedicación fue leve (aproximadamente 7%) y estadísticamente no significativa. La premedicación fraccionada provocó mayores alteraciones sistémicas que la premedicación en dosis única, caracterizadas por una acidosis metabólica moderada, compensada con hiperventilación. Los electrolitos plasmáticos no experimentaron modificaciones significativas. No se apreció relación entre la acidosis metabólica inducida por la droga y la cuantía del efecto hipotensor ocular, ni se evidenció una mayor efectividad de la acetazolamida en el control de la presión vítrea durante la extracción de la catarata en comparación con el grupo de pacientes que no recibió premedicación

Acetazolamida e manitol: estudo comparativo do efeito hipotensor ocular / Acetalozamide and mannitol: comparative study of ocular hypotensive effect

Estuda-se a participaçäo dos hipotensores oculares, Acetazolamida (500 mg) e o Manitol endovenoso (2 g/Kg), no pré-operatório das cirurgias oculares, para que se busque o "ótimo" de hipotensäo ocular durante o ato cirúrgico. Estudam-se 50 pacientes normotensos selecionados. Após comentários sobre o mecanismo de açäo das duas drogas hipotensoras, conclui-se que: 1 - Com Diamox em dose única (500 mg), via oral: - a queda máxima da Po obtida foi em torno de 8.50 mmHg, após 120'; - o retorno ao nível inicial (12.00 mmHg) de morou 330'. 2 - Com Manitol endovenoso a 20% (2 g/Kg de peso aproximadamente): - a queda máxima da Po obtida foi em torno de 7.60 mmHg, após 90'; - o retorno ao nível inicial (12.00 mmHg) demorou 450'. 3 - Com a associaçäo Diamox + Manitol, nas mesmas doses: - a queda máxima da Po obtida foi em torno de 7.10 mmHg, após 90'; - o retorno ao nível inicial (12.00 mmHg) demorou 450'. 4 - Os resultados favoreceram ligeiramente a associaçäo, porém sem interesse clínico: O Manitol isoladamente lhe corresponde. 5 - O início da cirurgia näo deve ser precipitado, lembrando-nos de que 90 - 120' constitui o interregno para se atingir o declínio tensional máximo

Effect of Long-Term Administration of Secretory Suppressives on Rat Pancreas (1)

Atropine (2.5 mg/kg), hexamethonium (1 mg/kg), Trasylol (1,000 u/kg), acetazolamide (100 mg/kg), cortisone (5 mg /kg) or procaine (5 mg/kg) were injected intraperitoneally once a day for 21 days into rats (both sexes) fed a low protein diet. The rats were fasted and sacrificed 24 hr after the last injection. Atropine and cortisone, but not the other agents, cause a significant increase in both pancreatic weight and enzymes. Serum amylase increased markedly in the cortisone group and serum GOT and GPT increased but slightly in the atropine group. Enlargement of the pancreatic acini, cellular hypertrophy and increases of zymogen granules were observed in all the groups except the procaine and normal control group. The hypertrophy of acini was more prominent in the atropine and cortisone groups. None of drugs used could induce decrease or depress the enzyme formation and weight of pancreas. This data indicates that long-term administration of these drugs, particularly atropine, cortisone or even other Ragents may induce preferential formation of pancreatic enzymes to exocrine secretions and consequently may cause enlargement of the pancreatic acini.