[The pupil in the chronic phase of Chagas disease and the reaction to pilocarpine and phenylephrine]. / A pupila na fase crônica da doença de Chagas e reação à pilocarpina e à fenilefrina.

To develop a method to analyse pupillary disturbances in patients with chronic Chagas disease in an endemic area, ten chagasic and ten normal subjects were matched according to sex, age and race. Pupillary diameter and area were determined using projection and topography techniques and compared between groups. Both pupils were visualised simultaneously. In each case three photographs were taken under standardised illumination. The first photo was obtained without medication, the second, 30 minutes after instillation of 0,1% pilocarpine and the last 30 minutes after instillation of 3% phenylephrine (60 minutes after pilocarpine). Pupils of chagasic patients had a statistically significant greater initial diameter and area, irregularity of the pupil border, greater percentual reduction in diameter and area after pilocarpine 0.1% and greater percentual increase in diameter and area after 3% phenylephrine eyedrops. The method developed for this study was considered satisfactory. The results suggest ocular autonomic nervous system disturbances in chagasic patients.

[Anisocoria in the chronic phase of Chagas' disease]. / Anisocoria na fase crônica da doença de Chagas.

To compare the frequency of anisocoria in patients with chronic Chagas' disease a prospective double-blind study was done in 131 patients with positive serology for Chagas' disease and 138 negative, at Mambaí (GO-Brazil), which is an endemic area for Chagas' disease. To detect anisocoria, pupillometry was done with a millimetric ruler. Anisocoria was seen in 10(7.6%) patients with Chagas' disease and in 3(2.1%) normal subjects. The chi-square test showed statistical significance at level of 5%. Chagas' disease must be included among the causes of anisocoria.

Trabeculectomy in pseudophakic patients: postoperative 5-fluorouracil versus intraoperative mitomycin C antiproliferative therapy.

Trabeculectomy outcome in pseudophakic glaucoma patients treated with mitomycin C (MMC) or 5-fluorouracil (5-FU) was analyzed retrospectively in 46 cases (46 eyes). Thirty patients received intraoperative MMC; 16, 5-FU. There were no significant differences between the two groups in terms of preoperative data (demographics, number of previous filtering procedures, visual acuity, and intraocular pressure [IOP]). After a mean follow up of 13.4 +/- 8.1 and 11.5 +/- 5.8 months for the 5-FU and MMC groups, respectively, 12 5-FU eyes (75%) and 21 MMC eyes (70%) were deemed at least qualified successes (IOP < or = 21 mm Hg with or without antiglaucoma medications). Six (37.5%) of the 5-FU eyes and 13 (43.3%) of the MMC eyes were complete successes (IOP < or = 21 mm Hg without antiglaucoma medications). There were no significant differences between the two groups in terms of duration of follow up, number of qualified successes, and number of complete successes (P = .35, .9, and .7, respectively). Nor were there any significant differences in the mean final IOPs and visual acuities. Excluding transient corneal effects associated with 5-FU therapy, there were no significant differences in the frequency of postoperative complications. These results suggest that 5-FU and MMC antiproliferative therapy are associated with similar short-term success rates and postoperative complications.

Apraclonidine and early postoperative intraocular hypertension after cataract extraction.

The efficacy of topical 1% apraclonidine in controlling early postoperative IOP rise after cataract extraction was evaluated. Topical 1% apraclonidine was applied to 20 patients who underwent extracapsular cataract extraction with posterior intraocular lens implantation. On another 20 patients, who acted as control group a placebo (artificial tears) was given. The IOP was measured before preoperative medication and postoperatively at 6, 12 and 24 h, using the Perkins hand-held applanation tonometer. In the control group, 9 patients (45%) developed intraocular hypertension and in the treated group only 2 (10%) showed hypertension, but with short duration and a moderate IOP rise. The difference in frequency of intraocular hypertension between the groups was statistically significant (p less than 0.02). The statistical analysis showed that the postoperative IOP of operated treated eyes was significantly smaller than the IOP of operated control eyes. Furthermore, the postoperative IOP and the initial IOP did not differ statistically. The results of this study demonstrate the efficacy of topical apraclonidine 1% in controlling the early and transient intraocular hypertension following cataract extraction.