INFANTS WITH CONGENITAL ZIKA SYNDROME AND OCULAR FINDINGS FROM SÃO PAULO, BRAZIL: SPREAD OF INFECTION.

BACKGROUND/PURPOSE: To describe the ocular findings of two infants with congenital Zika syndrome born in São Paulo state, Brazil, outside the primary outbreak region. METHODS: Two female infants with congenital Zika syndrome were submitted to a complete screening for infectious diseases, as well as ocular examination, fundus photography, and optical coherence tomography of the retina. One of the infants was submitted to ocular ultrasound. RESULTS: Both children showed positive serology for Zika virus, and other infectious diseases were ruled out. On fundus examination, one newborn had extensive bilateral macular chorioretinal atrophy with hyperpigmented borders associated with gross pigment mottling, as well as atrophic well-limited roundish peripheral lesions in the right eye. Spectral domain optical coherence tomography of the right eye showed complete chorioretinal atrophy in the temporal quadrant. The other infant presented bilateral gross pigment mottling in a paramacular location and a normal optical coherence tomography. DISCUSSION: In this report, the ophthalmologic findings of two infants with Zika syndrome and ocular findings born in São Paulo state, Brazil, are described. Optical coherence tomography findings demonstrate the broad range of retinal damage caused by congenital Zika virus infection. CONCLUSION: The autochthonous cases of infants with congenital Zika syndrome and ocular findings described in this report demonstrate that Zika virus infection is not limited to northeast Brazil, with the potential for even greater spread.

Aqueous misdirection syndrome in persistent fetal vasculature (PFV).

We report a case of a 5-year-old girl with persistent fetal vasculature who presented with unilateral acute angle closure caused by aqueous misdirection syndrome that was apparently associated with regression of cycloplegia. Initial treatment with topical steroids, anti-glaucomatous drops, and atropine showed insufficient control of the intraocular pressure (IOP). Surgical treatment with lensectomy and vitrectomy resulted in satisfactory IOP control and no complications at the 6-month follow-up.

Aqueous misdirection syndrome in persistent fetal vasculature (PFV) / Síndrome de mau direcionamento do humor aquoso em persistência da vasculatura fetal (PVF)

ABSTRACT We report a case of a 5-year-old girl with persistent fetal vasculature who presented with unilateral acute angle closure caused by aqueous misdirection syndrome that was apparently associated with regression of cycloplegia. Initial treatment with topical steroids, anti-glaucomatous drops, and atropine showed insufficient control of the intraocular pressure (IOP). Surgical treatment with lensectomy and vitrectomy resulted in satisfactory IOP control and no complications at the 6-month follow-up.

RESUMO Relatamos o caso de uma criança de 5 anos, sexo feminino com persistência do vítreo primário que apresentou crise de fechamento angular por síndrome do mau direcionamento do humor aquoso, aparentemente associado a regressão da cicloplegia. Tratamento inicial com corticoide tópico, colírios antiglaucomatosos e atropina mostraram controle insuficiente da pressão intraocular (PIO). Tratamento cirúrgico com lensectomia e vitrectomia anterior permitiu o controle satisfatório da PIO, sem intercorrências no seguimento de 6 meses.

Relationship between Daytime Sleepiness and Intrinsically Photosensitive Retinal Ganglion Cells in Glaucomatous Disease.

Patients with glaucoma showed to have higher daytime sleepiness measured by Epworth sleepiness scale. In addition, this symptom was associated with pupillary reflex and polysomnography parameters. These ipRGC functions might be impaired in patients with glaucoma, leading to worse quality of life.

Intrinsically photosensitive retinal ganglion cell activity is associated with decreased sleep quality in patients with glaucoma.

PURPOSE: To use the pupillary light reflex and polysomnography to evaluate the function of intrinsically photosensitive retinal ganglion cells (ipRGCs) and to correlate this function with structural damage in glaucoma. DESIGN: Cross-sectional study. PARTICIPANTS: A study was conducted on both eyes of 45 participants (32 patients with glaucoma and 13 healthy subjects). METHODS: For the pupillary reflex evaluation, patients were tested in the dark using a Ganzfeld system (RETIport; Roland Consult, Brandenburg, Germany); pupil diameter was measured with an eye tracker system. To preferentially stimulate ipRGCs, we used a 1-second 470-nm flash with a luminance of 250 cd/m(2). To stimulate different retinal photoreceptors, we used a 1-second 640-nm flash with a luminance of 250 cd/m(2). All of the subjects underwent polysomnography. Subjects underwent standard automated perimetry and optical coherence tomography (Cirrus HD-OCT; Carl Zeiss Meditec Inc, Dublin, CA). MAIN OUTCOME MEASURES: Correlations between ipRGC activity, as measured by the pupillary light reflex, and polysomnography parameters, and correlations between retinal nerve fiber layer (RNFL) thickness and the pupillary light reflex and polysomnography parameters. RESULTS: The mean patient ages in the healthy and glaucoma groups were 56.8±7.8 years and 61.5±11.6 years, respectively (P = 0.174). Patients with glaucoma had significantly lower average total sleep time, sleep efficiency, and minimum oxyhemoglobin saturation compared with the healthy subjects (P = 0.008, P = 0.002, and P = 0.028, respectively). Patients with glaucoma had significantly higher arousal durations after falling asleep and more periodic limb movements (P = 0.002 and P = 0.045, respectively). There was an inverse correlation between the rapid eye movement latency and the peak of the pupillary response to the blue flash (P = 0.004). The total arousals were inversely correlated with the sustained blue flash response (P = 0.029). The RNFL thickness was associated with the peak and sustained responses to the blue flash (P < 0.001 for both comparisons); however, RNFL thickness was only associated with the mean oxygen desaturation index among the polysomnography parameters (P = 0.023). CONCLUSIONS: This study demonstrated that decreased ipRGC function caused by glaucoma affected pupillary response and sleep quality.

A positive association between intrinsically photosensitive retinal ganglion cells and retinal nerve fiber layer thinning in glaucoma.

PURPOSE: To assess the integrity of intrinsically photosensitive retinal ganglion cells (ipRGCs) using the pupillary light reflex in glaucoma patients. METHODS: A cross-sectional study was conducted, including 76 eyes from 38 patients with primary open-angle glaucoma and 36 eyes from 18 control subjects. The patients were tested in the dark with light stimuli using the Ganzfeld system, and the pupil diameter was measured with the assistance of an eye tracker consisting of two infrared cameras fit to an eyeglass frame. To preferentially stimulate ipRGCs, we used a 1-second 470-nm flash with a luminance of 250 cd/m(2). To stimulate different retinal photoreceptors (cones and rods), we used a 1-second 630-nm flash with a luminance of 250 cd/m(2). Standard automated perimetry (SAP), matrix frequency-doubling technology (FDT), and high-definition optical coherence tomography (Cirrus HD-OCT) were also performed. The correlation between the ipRGC-mediated sustained response following the pupillary light reflex and the structural and functional changes in glaucoma patients was analyzed using generalized estimating equation. RESULTS: An association was observed between the average retinal nerve fiber layer (RNFL) thickness, as measured by Cirrus HD-OCT, and the sustained pupillary response to the blue flash (P = 0.024). The severity of glaucoma, based on the mean deviation of SAP (Hodapp-Anderson-Parrish system), was also associated with the sustained response to the blue flash (P = 0.006). CONCLUSIONS: This study showed a correlation between the mean RNFL thickness and the pupillary light response. A decrease in the number of ipRGCs is potentially related to the reduced RNFL thickness.

Common mental disorders in mothers vs. infant and obstetric outcomes: a review.

INTRODUCTION: Pregnancy has been shown to increase women's vulnerability to mental disorders. Common mental disorders (CMDs) have been studied both in the general population and in pregnant vs. non-pregnant women. During pregnancy, CMDs have been considered a potential predictor of obstetric and infant outcomes. METHODS: A search was conducted on the PubMed/MEDLINE, LILACS, and SciELO databases to find relevant articles written in English, Spanish, and Portuguese. No limit was established for year of publication, but only studies involving human beings were included. RESULTS: A total of 25 articles were selected. There was a consensus among studies that the mean prevalence of CMD during pregnancy is 20%. There was also agreement that the occurrence of CMDs during pregnancy is a predictor of postpartum depression and anxiety disorders and that the disorder remains underdiagnosed and undertreated. As for the positive association between CMDs and obstetric and infant complications, results are still conflicting. In lower-income countries, frequently there is an association between CMD and perinatal changes. It is argued that some confounding factors, such as sociodemographic and cultural differences, health and maternal conditions, and type of instruments used, probably contribute to this lack of consensus. CONCLUSION: We believe that the conflicting results found in the literature are caused by differences in methodology and sociodemographic factors that influence the development of CMDs. Despite these differences, our findings underscore the need for depression and anxiety disorders during pregnancy to be studied and better identified by all professionals who provide antenatal care.

Common mental disorders in mothers vs. infant and obstetric outcomes: a review / Transtornos mentais comuns em mães versus desfechos infantis e obstétricos: uma revisão

INTRODUCTION: Pregnancy has been shown to increase women’s vulnerability to mental disorders. Common mental disorders (CMDs) have been studied both in the general population and in pregnant vs. non-pregnant women. During pregnancy, CMDs have been considered a potential predictor of obstetric and infant outcomes. METHODS: A search was conducted on the PubMed/MEDLINE, LILACS, and SciELO databases to find relevant articles written in English, Spanish, and Portuguese. No limit was established for year of publication, but only studies involving human beings were included. RESULTS: A total of 25 articles were selected. There was a consensus among studies that the mean prevalence of CMD during pregnancy is 20%. There was also agreement that the occurrence of CMDs during pregnancy is a predictor of postpartum depression and anxiety disorders and that the disorder remains underdiagnosed and undertreated. As for the positive association between CMDs and obstetric and infant complications, results are still conflicting. In lower-income countries, frequently there is an association between CMD and perinatal changes. It is argued that some confounding factors, such as sociodemographic and cultural differences, health and maternal conditions, and type of instruments used, probably contribute to this lack of consensus. CONCLUSION: We believe that the conflicting results found in the literature are caused by differences in methodology and sociodemographic factors that influence the development of CMDs. Despite these differences, our findings underscore the need for depression and anxiety disorders during pregnancy to be studied and better identified by all professionals who provide antenatal care (AU)

INTRODUÇÃO: Estudos têm mostrado que a gravidez torna a mulher mais vulnerável a transtornos mentais. Os transtornos mentais comuns (TMCs) têm sido estudados tanto na população geral quanto em mulheres grávidas versus não grávidas. Durante a gravidez, os TMCs são considerados um potencial fator preditivo de desfechos obstétricos e perinatais. MÉTODOS: Uma pesquisa foi realizada nas bases de dados PubMed/MEDLINE, LILACS e SciELO em busca de artigos relevantes publicados em inglês, espanhol e português. Não foi estabelecido um limite para ano de publicação, mas apenas estudos envolvendo humanos foram incluídos. RESULTADOS: Um total de 25 artigos foram selecionados. Houve consenso entre os estudos de que a prevalência média de TMC durante a gravidez é de 20%. Também houve consenso de que a ocorrência de TMCs durante a gravidez é um fator preditivo de depressão pós-parto e transtornos de ansiedade, e de que o transtorno não vem sendo diagnosticado nem tratado. Com relação à associação positiva entre TMCs e desfechos obstétricos e perinatais, os resultados ainda são conflitantes. Em países de baixa renda, frequentemente se observa uma associação entre TMC e alterações perinatais. Argumenta-se que alguns fatores de confusão, tais como diferenças sociodemográficas e culturais, condições de saúde e maternas e tipo de instrumento usado, provavelmente contribuem para essa falta de consenso. CONCLUSÃO: Acreditamos que os resultados conflitantes encontrados na literatura são causados por diferenças na metodologia e fatores sociodemográficos que influenciam o desenvolvimento de TMCs. Apesar dessas diferenças, nossos achados salientam a necessidade de que a depressão e os transtornos da ansiedade durante a gravidez sejam estudados e melhor identificados por todos os profissionais que prestam cuidados pré-natais (AU)