Apical bleeding: a rare cause of blindness after orbital decompression / Sangramento apical: uma causa rara de cegueira pós descompressão orbitária

ABSTRACT Orbital decompression is widely performed for the management of proptosis for cosmetic and functional cases of Graves orbitopathy. The main side effects include dry eye, diplopia, and numbness. Blindness after orbital decompression is extremely rare. The mechanisms of vision loss after decompression are not well described in the literature. Considering the devastating effect and rarity of this complication, this study presented two cases of blindness after orbital decompression. In both cases, vision loss was provoked by slight bleeding in the orbital apex.

RESUMO A descompressão orbitária é uma cirurgia amplamente empregada para correção da proptose em casos cosméticos e funcionais da orbitopatia de Graves. Os principais efeitos colaterais induzidos pela descompressão são olho seco, diplopia e parestesias. Amaurose pós descompressão é uma complicação extremamente rara e cujos mecanismos são pouco discutidos na literatura. Considerando o efeito devastador representado pela perda visual e a escassez de relatos dessa complicação, os autores apresentam dois relatos de amaurose após descompressão orbitária. Nos dois casos a perda visual ocorreu devido a sangramento de pequena monta no ápice orbitário.

Características clínico-oftalmológicas y evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social, Paraguay / Clinical-ophthalmological characteristics and evolution of patients with moderately severe active thyroid ophthalmopathy treated with methylprednisolone boluses who attended the Central Hospital of the Instituto de Previsión Social, Paraguay

Introducción: La oftalmopatía tiroidea (OT) es un trastorno debilitante en pacientes con enfermedad tiroidea autoinmune, principalmente enfermedad de Graves, que se desarrolla entre el 30 a 50% de los casos. Objetivos: Describir las características clínico-oftalmológicas y la evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social en el tiempo comprendido entre enero de 2018 y setiembre de 2021. Materiales y métodos: Investigación de diseño observacional, con estudio descriptivo, retrospectivo. Resultados: Se revisaron fichas de 34 pacientes con OT activa moderada severa que recibieron bolos de metilprednisolona basado en las guías EUGOGO 2016, de los cuáles se excluyeron 3 pacientes por tener fichas incompletas y otros 3 pacientes ya que requirieron tratamiento de segunda línea previo al término del esquema de 12 sesiones. De los 28 pacientes estudiados, la edad promedio fue de 43,6 ±13,1 años, el 89% de sexo femenino y el 28,5%, fumadores. En cuanto a la función tiroidea de la población previo al tratamiento, se constató hipertiroidismo en el 82%, hipotiroidismo en el 11% y eutiroidismo en el 7%; y posterior al tratamiento, se constató hipertiroidismo en el 78,6% (subclínico), eutiroidismo en el 17,9% e hipotiroidismo en el 3,5%. La mayoría (92.6%) contaba con anticuerpos contra el receptor de TSH positivo, con un promedio de 18 ± 9,9 mIU/Ml. Respecto a la actividad de la oftalmopatía según la escala CAS, se constató un promedio de 4,1 ±1,0 previo al tratamiento y posterior 1,2 ±1,4; de ellos el 46,4% presentó un estado leve según escala de gravedad, 39% sin criterios de gravedad y 14 % persistió en moderada -severa. Se constató mejoría de la agudeza visual tras el tratamiento (57,1%), el promedio de exoftalmía previo al tratamiento fue 22,2 mm y posterior 21,1 mm; se presentó diplopía en el 7,1% previo al tratamiento y en el 3,6% posterior al tratamiento. Conclusión: El tratamiento con glucocorticoides endovenosos en la oftalmopatía de Graves moderada-severa (esquema EUGOGO 2016) fue muy efectivo, revirtiendo la actividad y consecuentemente ayudando a disminuir la gravedad, en la gran mayoría de nuestros pacientes. Esto podría explicarse porque la oftalmopatía era incipiente y por el alto grado de adherencia de los pacientes en el contexto de un manejo multidisciplinar bien protocolizado.

Introduction: Graves' orbitopathy (GO) is a debilitating disorder in patients with autoimmune thyroid disease, mainly Graves' disease, which develops in 30 to 50% of cases. Objectives: To describe the clinical-ophthalmological characteristics and evolution of patients with moderate-to- severe active GO treated with methylprednisolone boluses who attended the Central Hospital of the Institute of Social Security between January 2018 and September 2021. Materials and methods: Observational design research, descriptive, retrospective study. Results: Records of 34 patients with active moderate-to-severe GO who received boluses of methylprednisolone based on the EUGOGO 2016 guidelines, were reviewed, of which 3 patients were excluded due to having incomplete records and another 3 patients since they required second-line treatment prior to end the 12-session scheme. Of the 28 patients studied, the average age was 43.6 ±13.1 years, 89% were female and 28.5% were smokers. Regarding the thyroid function of the population prior to treatment, hyperthyroidism was found in 82%, hypothyroidism in 11% and euthyroidism in 7%; and after treatment, hyperthyroidism was found in 78.6% (subclinical), euthyroidism in 17.9% and hypothyroidism in 3.5%. The majority (92.6%) had positive thyrotropin receptor antibodies, with an average of 18 ± 9.9 mIU/Ml. Regarding the activity of orbitopathy according to the CAS scale, an average of 4.1 ±1.0 was found before treatment and 1.2 ±1.4 after; Of them, 46.4% presented a mild condition according to the severity scale, 39% without severity criteria and 14% persisted in moderate-severe. Improvement in visual acuity was noted after treatment (57.1%), the average exophthalmia before treatment was 22.2 mm and after 21.1 mm; Diplopia occurred in 7.1% before treatment and in 3.6% after treatment. Conclusion: Treatment with intravenous glucocorticoids in moderate-severe Graves' orbitopathy (EUGOGO 2016 scheme) was very effective, reversing the activity and consequently helping to reduce the severity, in the vast majority of our patients. This could be explained because the orbitopathy was incipient and by the high degree of patient adherence in the context of well-protocolized multidisciplinary management.

Manejo del paciente con Hipertiroidismo en consulta externa de la Unidad Técnica de Endocrinología del Hospital Carlos Andrade Marín / Management of the patient with hyperthyroidism in the outpatient clinic of the Technical Unit of Endocrinology of the Endocrinology Technical Unit of the Carlos Andrade Marín Hospital

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).

Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).

Patologías Oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital de referencia

Introducción: Las afecciones oftalmológicas en niños menores de 6 meses pueden producir alteraciones visuales e incluso la ceguera total. Objetivos: Describir la frecuencia y los tipos de patologías oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital infantil. Materiales y Métodos: estudio observacional, descriptivo, retrospectivo. Se revisó la base de datos del servicio de oftalmopediatría. Por muestreo de casos consecutivos fueron incluidos lactantes con edad ≤6 meses, que consultaron en el periodo de marzo a septiembre del 2022, en cuyas fichas figuraban el número telefónico. Variables: edad, sexo, motivo de consulta, antecedentes perinatales y de patologías oftalmológicas, resultado del examen oftalmológico y tratamiento. Los datos fueron analizados en SPSS con estadísticas descriptivas. El comité de ética aprobó el protocolo con consentimiento de los padres. Resultados: Ingresaron 137 lactantes con edad 2,9 ± 1,8 meses, peso de nacimiento 2995 ± 621, edad gestacional 38 ± 2,1 semanas, 53% varones, 31% para control, el 83%, con antecedente de patología ocular. Presentaron patología ocular el 32% (44/137), 59% (26/44) de origen congénito y 41%(18/44) adquiridas. El 18% (8/44) de las alteraciones oculares recibieron tratamiento quirúrgico. Conclusión: El 32% de los lactantes atendidos en el servicio de oftalmopediatria presentaron patologías oculares, de las cuales el 59% fueron congénitas, las dos más frecuentes la catarata congénita y la obstrucción del conducto nasolagrimal.

Introduction: Ophthalmological conditions in children under 6 months can cause visual disturbances and even total blindness. Objectives: To describe the frequency and types of ophthalmological pathologies in infants under 6 months of age in a pediatric ophthalmology service at a children's hospital. Materials and Methods: this was an observational, descriptive and retrospective study. The database of the ophthalmopediatric service was reviewed. By sampling consecutive cases, infants aged ≤6 months, who consulted from March to September 2022 and whose records included the telephone number were included. Variables: age, sex, chief complaint, perinatal history and ophthalmological pathologies, result of ophthalmological examination and treatment. Data were analyzed in SPSS with descriptive statistics. The ethics committee approved the protocol and parental consent was obtained. Results: 137 infants, aged 2.9 ± 1.8 months, birth weight 2995 ± 621, gestational age 38 ± 2.1 weeks, of which 53% were male were selected for this study. 31% presented for a routine follow-up, 83% had a history of ocular pathology. 32% (44/137) presented ocular pathology, 59% (26/44) congenital and 41% (18/44) acquired. 18% (8/44) of the ocular alterations received surgical treatment. Conclusions: 32% of the infants seen in the ophthalmopediatric service presented ocular pathologies, of which 59% were congenital, the two most frequent being congenital cataracts and nasolacrimal duct obstruction.

Adverse effects associated with peribulbar injection of triamcinolone for the treatment of thyroid eye disease: a retrospective case series / Efeitos adversos de injeções peribulbares de triancinolona na doença ocular da tireoide: estudo retrospectivo de uma série de casos

ABSTRACT Purpose: Peribulbar injection of triamcinolone is an alternative treatment for thyroid eye disease; however the safety profile of this therapeutic option remains controversial. The aim of this study was to describe the occurrence of local and systemic adverse effects after peribulbar injection of triamcinolone in patients with thyroid eye disease. Methods: This was a retrospective case series. Medical records of patients with thyroid eye disease treated with peribulbar injections of triamcinolone at a single academic institution between 2007 and 2019 were analyzed. Local and systemic complications were documented. Results: A total of 123 patients were treated. Only 11 patients (8.9%) developed local complications. The most frequent complication was the presence of superficial eyelid ecchymosis (nine patients; 7.3%). Notably, systemic complications (hyperglycemic and suprarenal inhibition after stop treatment) occurred in two patients (1.6%). All complications were transient, and the patients did not have any long-term sequelae. Conclusions: Peribulbar injection of triamcinolone for the treatment of thyroid eye disease is linked to a very low rate of local or systemic complications. Prospective studies are warranted to delve into this topic.

RESUMO Objetivo: A injeção peribulbar de triancinolona é um tratamento alternativo para doenças oculares da tireoide; no entanto, a segurança desse procedimento continua controversa. O objetivo deste artigo é descrever os efeitos adversos locais e sistêmicos de injeções peribulbares de triancinolona em pacientes com doença ocular da tireoide. Métodos: Estudo retrospectivo de uma série de casos. Foram analisados os prontuários médicos dos pacientes com doença ocular da tireoide tratados com injeções de triancinolona peribulbar em uma única instituição acadêmica entre 2007 e 2019. Foram documentadas as complicações locais e sistêmicas. Resultados: Um total de 123 pacientes foram tratados. Apenas 11 (8,9%) pacientes apresentaram complicações locais, sendo a mais frequente a presença de equimoses palpebrais superficiais (7,3%), enquanto 2 (1,6%) pacientes apresentaram complicações sistêmicas (hiperglicemia e inibição da suprarrenal após a interrupção do tratamento). Todas estas complicações foram transitórias e nenhum paciente apresentou sequelas de longo prazo. Conclusões: As injeções peribulbares de triancinolona nas doenças oculares da tireoide têm uma taxa muito baixa de complicações, tanto locais quanto sistêmicas. São necessários estudos prospectivos para aprofundar este tópico.

Intraocular pressure values during the water drinking test in a Colombian population / Comportamiento de la presión intraocular durante la prueba de sobrecarga hídrica en población colombiana

Background: Intraocular pressure (IOP) peaks are key factors on the onset and progression of glaucoma. The water drinking test (WDT) detects IOP fluctuations and estimates the maximum IOP. Objective: To assess the IOP variations during the WDT in patients diagnosed or suspected of glaucoma treated at an ophthalmology clinic. Methods: This is an observational, descriptive, and retrospective study, using clinical records of patients whom underwent the WDT between January 2017 and August 2019. Results: The study included 300 eyes. The WDT was positive in 23.3% of the eyes. Basal IOP at 15, 30, and 45 min, as well as the maximum pressure, presented a similar mean, median, and mode, as well as a varying coefficient without much variability. The negative test group had a maximum IOP of 18.9 mmHg, compared with 20.3 mmHg in the positive test group. Conclusion: In a Colombian cohort of patients with diagnosed or suspected glaucoma whom underwent a WDT, 23.3% had positive result. 90% of the tests were positive at the 30-min interval. This test is a complementary tool in the follow-up of patients with glaucoma.

Introducción: Los picos de presión intraocular son factores importantes para la aparición y progresión del glaucoma. La prueba de sobrecarga hídrica permite detectar fluctuaciones de presión intraocular y estimar la presión máxima. Objetivo: Evaluar las variaciones en la presión intraocular durante la prueba de sobrecarga hídrica en pacientes de una clínica oftalmológica. Métodos: Estudio observacional, descriptivo, retrospectivo de revisión de historias clínicas de pacientes sometidos a la prueba de sobrecarga hídrica entre enero de 2017 y agosto de 2019. Resultados: Se incluyeron 300 ojos. La prueba de sobrecarga hídrica fue positiva en el 23,3% de los ojos. La presión intraocular basal, a los 15, 30 y 45 min, al igual que la presión máxima, tuvieron una media, mediana y moda similares, con un coeficiente de variación sin mucha variabilidad. El grupo con resultados negativos tuvo una presión intraocular máxima de 18,9 mmHg comparado con 20,3 mmHg del grupo con resultados positivos. Conclusión: En una cohorte colombiana de pacientes con diagnóstico o sospecha de glaucoma quienes se les realizó la prueba de sobrecarga hídrica, el 23,3% tuvo resultados positivos. El 90% de las pruebas fueron positivas en el intervalo de 30 min. Esta prueba es una herramienta complementaria en el seguimiento de pacientes con glaucoma.

Trends in Graves' orbitopathy research in the past two decades: a bibliometric analysis / Tendências na pesquisa da orbitopatia de Graves nas últimas duas décadas: uma análise bibliométrica

ABSTRACT Purpose: This study was conducted to identify trends in Graves' orbitopathy research in the past two decades and to elaborate on hot topics in the field. Methods: The Web of Science database was used to extract articles on Graves' orbitopathy or its synonyms. Full data and references were exported to VOSviewer software to be analyzed. Visualization maps and charts were constructed accordingly. Results: We retrieved 1067 articles on Graves' orbitopathy from the Web of Science database. The United States ranked first in terms of the article count (25), followed by Italy (141) and the People's Republic of China (120). Wiersinga's and the University of Amsterdam's articles received the highest citation count (1509 and 3052, respectively). The University of Pisa and Thyroid published the highest number of articles (65 and 93, respectively). Co-authorship analysis showed four clusters of country collaborations: red cluster, European countries; green cluster, the United States, Brazil, Canada, South Korea, and Taiwan; a yellow cluster, People's Republic of China; and blue cluster, Japan, Australia, and Poland. Keyword analysis revealed five clusters of topics: pathogenesis, management, association, quality of life, and surgery. Analysis of co-cited references also revealed five clusters: pathogenesis, management, risk factors, clinical assessment, and surgical management. Conclusion: Research on Graves' orbitopathy has grown during the past two decades. Hot research topics are pathogenesis, management, risk factors, quality of life, and complications. Research trends have changed in the past two decades. Increasing interest in exploring Graves' orbitopathy mechanisms and associations is evident. European countries are cooperating in this field of research. The United States has established more extensive international cooperation than other countries. We believe that more international collaboration involving developing countries is required.

RESUMO Objetivo: Identificar tendências no campo de pesquisa da orbitopatia de Graves nas últimas duas décadas e analisar os ramos de maior concentração de pesquisas nessa área. Métodos: O banco de dados Web of Science foi usado para extrair artigos com "orbitopatia de Graves" ou seus sinônimos no título. Dados completos e referências foram exportados para o programa VOSviewer para serem analisados. Mapas e gráficos de visualização foram construídos a partir desses dados. Resultados: Foram obtidos 1067 artigos sobre a orbitopatia de Graves a partir do banco de dados Web of Science. Os EUA ficaram em primeiro lugar em termos de número de publicações, seguidos pela Itália e pela República Popular da China. Dentre os autores, os artigos de Wiersinga WM tiveram o maior número de citações. Quanto às instituições, os artigos da Universidade de Amsterdã tiveram o maior número de citações, mas a Universidade de Pisa publicou o maior número de artigos. Dentre os periódicos, a revista Thyroid publicou o maior número de artigos. A análise de coautoria mostrou quatro agrupamentos de colaboração entre países. O primeiro agrupamento engloba países europeus; o segundo engloba os EUA, Brasil, Canadá, Coreia do Sul e Taiwan. A República Popular da China compreende um agrupamento por si só. O quarto agrupamento inclui Japão, Austrália e Polônia. A análise das palavras-chave revelou cinco agrupamentos de tópicos de palavras-chave: patogênese, gerenciamento, associação, qualidade de vida e cirurgia. A análise das referências citadas em conjunto revelou cinco agrupamentos: patogênese, manejo, fatores de risco, avaliação clínica e manejo cirúrgico. Conclusão: A pesquisa no campo da orbitopatia de Graves cresceu nos últimos vinte anos. Os tópicos com a maior concentração de pesquisas são: patogênese, gerenciamento, fatores de risco, qualidade de vida e complicações. As tendências de pesquisa mudaram nas últimas duas décadas. Ficou evidente um aumento do interesse em explorar os mecanismos e associações da orbitopatia de Graves. Observou-se uma cooperação entre países europeus neste campo de pesquisa. Os EUA estabeleceram uma cooperação internacional mais ampla que outros países. Acreditamos que mais colaboração internacional envolvendo países em desenvolvimento seria recomendável.

Diabetes mellitus y salud visual como referentes esenciales en la práctica médica / Diabetes mellitus and visual health as essential references in medical practice

Introducción: La diabetes mellitus, requiere atención médica multifactorial y multisectorial. La oftalmopatía diabética demanda sistemas de salud integrados que faciliten la prevención, detección y tratamiento de las complicaciones en los niveles de atención primaria, secundaria y terciaria. Objetivo: Exponer los conceptos teóricos, prácticos y las tendencias actuales sobre diabetes mellitus y salud visual. Métodos: Se realizó una revisión bibliografía y documental sobre diabetes mellitus y salud visual, estudios y documentos publicados por instituciones nacionales e internacionales, temas vinculados a la diabetes mellitus y la salud visual, se accedió a artículos desde diferentes fuentes, revistas indexadas, metaanálisis y fuentes primarias no publicadas, tesis de maestría, y doctorados. Resultados: Para conservar la salud visual es necesario llevar a cabo medidas que conlleven a prevenir la pérdida de la visión por catarata, glaucoma, retinopatia y edema macular diabético, que incluyen no sólo un buen control de los parámetros metabólicos y las revisiones periódicas al oftalmólogo, sino también el cumplimiento de la educación diabetológica por un equipo multidisciplinario y actualización sobre este tema de los prestadores de salud. La disminución visual que provoca la catarata y otras enfermedades oculares puede conducir a padecer discapacidades como, pérdida de autonomía para administrarse los medicamentos, limitar las actividades de la vida cotidiana e incapacidad laboral y social, con la consiguiente afectación de la calidad de vida Conclusiones: Acudir al oftalmólogo con frecuencia, mantener el control glucémico, del colesterol y presión arterial representan el pilar fundamental para preservar la salud visual en el paciente diabético(AU)

Introduction: Diabetes mellitus requires multifactorial and multisectoral medical attention. Diabetic ophthalmopathy demands integrated health systems that facilitate the prevention, detection and treatment of complications at the primary, secondary and tertiary care levels. Objective: To show the theoretical and practical concepts and current trends on diabetes mellitus and visual health. Methods: A bibliographic and documentary review on diabetes mellitus and visual health was carried out. Studies and documents published by local and international institutions, articles, topics related to diabetes mellitus and visual health were retrieved from different sources, indexed journals, meta-analysis and unpublished primary sources, research degree and master's, theses. Results: To preserve visual health, it is necessary to carry out reading that lead to preventing vision loss due to cataract, glaucoma, retinopathy and diabetic macular edema, which include not only good control of metabolic parameters and regular check-ups with the ophthalmologist , but also compliance with diabetes education by a multidisciplinary team and updating the health providers on this subject. The visual decrease caused by cataract and other eye diseases can lead to disabilities such as loss of autonomy to manage medications, limit activities of daily life and work and social incapacity, with the consequent impact on quality of life. Conclusions: Frequently going to the ophthalmologist, maintaining glycemic, cholesterol and blood pressure control represent the fundamental pillar to preserve visual health in diabetic patients(AU)

Analysis of ocular emergencies in a reference eye center in Brazil / Análise das emergências oculares em um centro de referência oftalmológica no Brasil

ABSTRACT Purpose: To determine the incidence of ocular emergencies and patient profiles in a public health eye center in Brazil. Methods: The medical record database of the Fundação Altino Ventura, Recife, Brazil was retrospectively analyzed and included all patients assisted at the ophthalmic emergency room between January 2017 and January 2018. Medical records with incomplete data and outpatient complaints were excluded. For records with multiple visits, only the initial visit was considered. Results: In 1 year, 134,788 patients (mean age at admission: 38.7 ± 22 years; range: 0-99 years) were admitted at the emergency room of the Fundação Altino Ventura. The most frequent diagnoses were conjunctivitis (52,732 cases; 37.3%), blepharitis (7,213 cases; 5.1%), and corneal/conjunctival foreign body (6,925 cases; 4.9%). Corneal/conjunctival foreign body and ocular trauma had an eight- and two-fold higher incidence in male patients, respectively (both p<0.001). Female patients presented a two-fold higher incidence of trichiasis and blepharitis than males (p<0.001). Corneal/conjunctival foreign body and ocular trauma affected more patients in a productive age (>15 years), while corneal ulcers, blepharitis, and trichiasis affected more elderly patients. All diagnostic clusters (e.g., infectious diseases, ocular trauma, foreign bodies, retinopathies, eyelid disorders, corneal diseases, glaucomatous crisis, and neuroophthalmological diseases) were more common during the spring season (p<0.001). Conclusion: The most common ocular emergencies in the present study were infectious diseases and foreign body. However, the incidence of ophthalmological emergencies was influenced by the age and sex of patients, as well as the time of the year.

RESUMO Objetivo: Determinar a incidência de emergências oculares em um centro oftalmológico de referência no Brasil. Métodos: O banco de dados de prontuários da Fundação Altino Ventura, Recife, Brasil, foi analisado retrospectivamente e incluiu pacientes atendidos, entre janeiro de 2017 e janeiro de 2018, na sala de emergência oftalmológica. Foram excluídos os prontuários com dados incompletos e com quadros ambulatoriais. Apenas o primeiro atendimento na emergência foi considerado para análise. Resultados: Em um ano, 134.788 pacientes (idade média de 38,7 ± 22 anos [0-99 anos]) foram admitidos na emergência da Fundação Altino Ventura. Os diagnósticos mais frequentes foram conjuntivite (52.732 casos [37,3%]), blefarite (7.213 casos [5,1%]) e corpo estranho na córnea/conjuntiva (6.925 casos [4,9%]). Corpo estranho na córnea/conjuntiva e trauma ocular foram cerca de 8 vezes e 2 vezes mais incidente em indivíduos do sexo masculino, respectivamente (p<0,001 em ambos). Triquíase e blefarite afetaram ~2 vezes mais pacientes do sexo feminino, respectivamente (p<0,001 em ambos). Corpo estranho na córnea/conjuntiva e trauma ocular afetaram mais pacientes em idade produtiva (>15 anos), enquanto úlcera, blefarite e triquíase da córnea afetaram mais pacientes idosos. Todos os grupamentos de diagnóstico (doenças infecciosas, trauma ocular, corpos estranhos, retinopatias, doenças das pálpebras, doenças da córnea, crise glaucomatosa e doenças neurooftalmológicas) foram mais incidentes na primavera (valor de p<0,001). Conclusão: As emergências oftalmológicas mais comuns no presente estudo foram as doenças infecciosas e o corpo estranho. Porém, a incidência das emergências oculares são fluências pela faixa etária e gênero do paciente, além da época do ano.

Resultados de la tiroidectomía total en el tratamiento del hipertiroidismo / Results of total thyroidectomy in the treatment of hyperthyroidism

INTRODUCCIÓN: En el tratamiento del hipertiroidismo se recurre a la cirugía en casos de bocio grande, fracaso del tratamiento médico o indicación social de tratamiento definitivo. OBJETIVO: Analizar los resultados en cuanto a función tiroidea del tratamiento del hipertiroidismo mediante tiroidectomía total (TT). MATERIAL Y MÉTODO: Estudio retrospectivo de 26 pacientes con hipertiroidismo, intervenidos en el Hospital de la Plana durante 2015-2018, con seguimiento de 36 meses. Tras estudio estadístico descriptivo e inferencial, se analizó la probabilidad de recidiva del hipertiroidismo mediante el método de Kaplan-Meier, y se utilizó el modelo de Cox para ajustar los efectos sobre la recidiva de las diferentes variables. RESULTADOS: El 73,1% tenían normofunción tiroidea; el 19,2%, hiperfunción, y en otro 7,7% existía hipofunción. El tiempo medio de supervivencia (normofunción) fue de 25,87 meses (IC: 17,52-34,21). En el estudio de supervivencia con el log-rank en función de la variable anatomía patológica y complicaciones, no hay diferencias estadísticamente significativas en la supervivencia de ambos grupos. DISCUSIÓN: Coincide con otros trabajos publicados. CONCLUSIÓN: La TT es un método efectivo de tratamiento para el hipertiroidismo, con baja incidencia de complicaciones. Sin embargo, no hemos encontrado ninguna variable que nos permita predecir el resultado.

INTRODUCTION: Surgery is used in the management of hyperthyroidism in cases of large goiter, failure of medical treatment or social indication of definitive treatment. AIM: To analyze the results of the treatment of hyperthyroidism by total thyroidectomy (TT) regarding to thyroid function. MATERIAL AND METHODS: Retrospective study of 26 patients with hyperthyroidism, operated on the Hospital de la Plana during 2015-2018, with a follow-up of 36 months. After a descriptive and inferential statistical study, the probability of recurrence of hyperthyroidism was analyzed using the Kaplan-Meier method, and the Cox model was used to adjust the effects on recurrence of the different variables. RESULTS: 73.1% had thyroid normofunction; in 19.2% there was hyperfunction, and in another 7.7% there was hypofunction. The average survival time (normofunction) was 25,87 months (CI: 17,52-34,21). In the study of survival with the log-rank depending on the pathological results and complications, there are no statistically significant differences in the survival of both groups. DISCUSSION: This coincides with other published works. CONCLUSION: TT is an effective method of treatment for hyperthyroidism, with a low incidence of complications. However, we have not found any variable that allows us to predict the result.

Toxoplasmose ocular felina: relato de caso / Feline ocular toxoplasmosis: case report / Felino toxoplasmosis ocular: reporte de un caso

A toxoplasmose é causada por um protozoário intracelular, o Toxoplasma gondii. A toxoplasmose ocular não é tão frequente em felinos, fatores iatrogênicos ou infecção como o Vírus da Imunodeficiência Felina e Vírus da Leucemia Felina podem reativar a infecção. A doença pode causar uveíte, não sendo um sinal patognomônico da doença de diagnóstico diferencial. Desta forma o objetivo é relatar os aspectos clínicos oculares e alterações em exames complementares manifestado em um gato doméstico. Na realização de exames oftalmológicos e complementares, foi possível detectar alterações oculares em decorrência da infecção por T. gondii. Ressalta-se a importância da toxoplasmose em felinos com sinais oculares, pois quanto mais cedo for diagnosticado, maiores são as chances de se preservar a visão.

Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii. The ocular toxoplasmosis is not so frequent in felines, iatrogenic factors or infection as the Feline Immunodeficiency Virus and Feline Leukaemia Virus can reactivate the infection. The disease can cause uveitis, not being a pathognomonic sign of the disease of differential diagnosis. In this way the objective is to report the ocular clinical aspects and alterations in complementary exams manifested in a domestic cat. In the accomplishment of opthalmological and complementary examinations, it was possible to detect ocular alterations as a result of infection by T. gondii. Emphasizes the importance of toxoplasmosis in felines with ocular signs, because the earlier it is diagnosed, the greater the chances of preserving the vision.

La Toxoplasmosis es causada por un protozoario intracelular, el Toxoplasma gondii. La toxoplasmosis ocular no es tan frecuente en los felinos, factores iatrogénicos o infección como el Virus de la Inmunodeficiencia Felina y el Leucemia Felina pueden reactivar la infección. La enfermedad puede causar uveítis, no siendo un signo patognomónico de la enfermedad de diagnóstico diferencial. De esta manera el objetivo es informar a los aparencia clinico ojo y alteraciones oculares en exámenes complementarios se manusfesrs en un gato doméstico. En la realización de exámenes oftalmológica y proyecciones complementarias, es posible detectar alteraciones ojo a consecuencia de la infección por T. gondii. Es de descatar la importancia de la toxoplasmosis en felinos con signos ojo, pues cuanto más temprano sea porque antes se diagnosticado, mayores son las posibilidades de preservarse la visión.

Toxoplasmose ocular felina: relato de caso / Feline ocular toxoplasmosis: case report / Felino toxoplasmosis ocular: reporte de un caso

A toxoplasmose é causada por um protozoário intracelular, o Toxoplasma gondii. A toxoplasmose ocular não é tão frequente em felinos, fatores iatrogênicos ou infecção como o Vírus da Imunodeficiência Felina e Vírus da Leucemia Felina podem reativar a infecção. A doença pode causar uveíte, não sendo um sinal patognomônico da doença de diagnóstico diferencial. Desta forma o objetivo é relatar os aspectos clínicos oculares e alterações em exames complementares manifestado em um gato doméstico. Na realização de exames oftalmológicos e complementares, foi possível detectar alterações oculares em decorrência da infecção por T. gondii. Ressalta-se a importância da toxoplasmose em felinos com sinais oculares, pois quanto mais cedo for diagnosticado, maiores são as chances de se preservar a visão.(AU)

Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii. The ocular toxoplasmosis is not so frequent in felines, iatrogenic factors or infection as the Feline Immunodeficiency Virus and Feline Leukaemia Virus can reactivate the infection. The disease can cause uveitis, not being a pathognomonic sign of the disease of differential diagnosis. In this way the objective is to report the ocular clinical aspects and alterations in complementary exams manifested in a domestic cat. In the accomplishment of opthalmological and complementary examinations, it was possible to detect ocular alterations as a result of infection by T. gondii. Emphasizes the importance of toxoplasmosis in felines with ocular signs, because the earlier it is diagnosed, the greater the chances of preserving the vision.(AU)

La Toxoplasmosis es causada por un protozoario intracelular, el Toxoplasma gondii. La toxoplasmosis ocular no es tan frecuente en los felinos, factores iatrogénicos o infección como el Virus de la Inmunodeficiencia Felina y el Leucemia Felina pueden reactivar la infección. La enfermedad puede causar uveítis, no siendo un signo patognomónico de la enfermedad de diagnóstico diferencial. De esta manera el objetivo es informar a los aparencia clinico ojo y alteraciones oculares en exámenes complementarios se manusfesrs en un gato doméstico. En la realización de exámenes oftalmológica y proyecciones complementarias, es posible detectar alteraciones ojo a consecuencia de la infección por T. gondii. Es de descatar la importancia de la toxoplasmosis en felinos con signos ojo, pues cuanto más temprano sea porque antes se diagnosticado, mayores son las posibilidades de preservarse la visión.(AU)

Comparison of choroidal thickness in patients with active and stable thyroid eye disease / Comparação da espessura da coroide em pacientes com doença ocular tireoidiana ativa e estável

ABSTRACT Purpose: To compare the choroidal thickness in active and stable phases of thyroid eye disease. Methods: Forty-seven eyes of 47 patients with thyroid eye disease were prospectively studied. Patients were evaluated on the basis of their clinical activity scores, with scores 33 defined as active disease. Subfoveal, temporal macular, nasal macular, temporal peripapillary, and nasal peripapillary choroidal thickness measurements were performed with Cirrus enhanced depth imaging spectral-domain optical coherence tomography, and the results in the two groups were compared. Results: Twenty-four patients were int he active group, whereas 23 patients were in the stable group. Choroidal thickness was significantly higher in the subfoveal and temporal macular regions in the active group. Although the nasal macular and peripapillary values were also higher in the active group, the difference was insignificant. Conclusions: Subfoveal choroidal thickness was significantly higher in patients with thyroid eye disease in the active phase than in those with stable phase disease.

RESUMO Objetivo: Comparar a espessura da coroide nas fases ativa e estável da doença ocular tireoidiana. Métodos: Quarenta e sete olhos, de 47 pacientes com doença ocular tireoidiana foram estudados prospectivamente. Os pacientes foram avaliados com base em seus escores de atividade clínica, com escore de 33 definidos como doença ativa. As medidas subfoveais, maculares temporais, maculares nasais, peripapilares temporais e da espessura da coroide peripapilar foram realizadas com tomografia de coerência óptica de domínio espectral Cirrus EDI, e os resultados nos dois grupos foram comparados. Resultados: Vinte e quarto pacientes estavam no grupo ativo, enquanto 23 pacientes estavam no grupo estável. A espessura da coroide foi significativamente maior nas regiões macular subfoveal e temporal no grupo ativo. Embora os valores maculares e peripapilares nasais também fossem maiores no grupo ativo, a diferença foi insignificante. Conclusões: A espessura da coroide subfoveal foi significativamente maior em pacientes com doença ocular tireoidiana na fase ativa do que naqueles com doença na fase estável.

Biomicroscopia ultrassônica na oftalmologia veterinária - revisão de literatura / Ultrasound biomicroscopy in veterinary ophthalmology - literature review / Biomicroscopía ultrasónica en oftalmología veterinaria - revisión de literatura

A biomicroscopia ultrassônica (UBM) ou ultrassonografia de alta frequência (35-100 MHz) é uma ferramenta utilizada na ecografia ocular. Por ter alcance de 4 a 8 mm de profundidade, é capaz de avaliar com maiores detalhes o segmento anterior do bulbo ocular, auxiliando no diagnóstico, no prognóstico e no monitoramento das oftalmopatias. É um exame não invasivo, capaz de individualizar diferentes estruturas do bulbo ocular, tais como córnea, esclera, câmara anterior, íris, corpo ciliar, câmara posterior, ângulo iridocorneano de drenagem e lente. Esta revisão bibliográfica tem por objetivo apresentar o uso da UBM na medicina veterinária de pequenos animais, demonstrando suas vantagens, limitações e indicações na clínica oftalmológica.

Ultrasonic biomicroscopy (UBM) or high frequency ultrasound (35-100 MHz) is a tool used for ocular imaging. The 4 to 8 mm tissue depth range enables assessment of the anterior segment of the eye, aiding in the diagnosis, prognosis and monitoring of ocular diseases. It is a noninvasive test able to identify different structures of the eye, such as cornea, sclera, anterior chamber, iris, ciliary body, posterior chamber, iridocorneal drainage angle and lens. This review aims to present the use of UBM in veterinary medicine, demonstrating its advantages, limitations and indications in the ophthalmology of small animals.

La biomicroscopía ultrasónica (UBM) o ultrasonografía de alta frecuencia (35-100 MHz) es una herramienta utilizada en el estudio ecográfico del globo ocular. Debido a su alcance de 4 a 8 mm de profundidad, es posible analizar con mayor detalle el segmento anterior del ojo, ayudando en el diagnóstico, pronóstico y control de las enfermedades oculares. Es un examen no invasivo capaz de individualizar estructuras como la córnea, esclera, cámara anterior, iris, cuerpo ciliar, cámara posterior, ángulo irido corneal (drenaje) y cristalino. Esta revisión de literatura tiene como objetivo presentar el uso de la UBM en medicina veterinaria de pequeños animales, mostrando sus ventajas, limitaciones e indicaciones en oftalmología.

Biomicroscopia ultrassônica na oftalmologia veterinária - revisão de literatura / Ultrasound biomicroscopy in veterinary ophthalmology - literature review / Biomicroscopía ultrasónica en oftalmología veterinaria - revisión de literatura

A biomicroscopia ultrassônica (UBM) ou ultrassonografia de alta frequência (35-100 MHz) é uma ferramenta utilizada na ecografia ocular. Por ter alcance de 4 a 8 mm de profundidade, é capaz de avaliar com maiores detalhes o segmento anterior do bulbo ocular, auxiliando no diagnóstico, no prognóstico e no monitoramento das oftalmopatias. É um exame não invasivo, capaz de individualizar diferentes estruturas do bulbo ocular, tais como córnea, esclera, câmara anterior, íris, corpo ciliar, câmara posterior, ângulo iridocorneano de drenagem e lente. Esta revisão bibliográfica tem por objetivo apresentar o uso da UBM na medicina veterinária de pequenos animais, demonstrando suas vantagens, limitações e indicações na clínica oftalmológica.(AU)

Ultrasonic biomicroscopy (UBM) or high frequency ultrasound (35-100 MHz) is a tool used for ocular imaging. The 4 to 8 mm tissue depth range enables assessment of the anterior segment of the eye, aiding in the diagnosis, prognosis and monitoring of ocular diseases. It is a noninvasive test able to identify different structures of the eye, such as cornea, sclera, anterior chamber, iris, ciliary body, posterior chamber, iridocorneal drainage angle and lens. This review aims to present the use of UBM in veterinary medicine, demonstrating its advantages, limitations and indications in the ophthalmology of small animals.(AU)

La biomicroscopía ultrasónica (UBM) o ultrasonografía de alta frecuencia (35-100 MHz) es una herramienta utilizada en el estudio ecográfico del globo ocular. Debido a su alcance de 4 a 8 mm de profundidad, es posible analizar con mayor detalle el segmento anterior del ojo, ayudando en el diagnóstico, pronóstico y control de las enfermedades oculares. Es un examen no invasivo capaz de individualizar estructuras como la córnea, esclera, cámara anterior, iris, cuerpo ciliar, cámara posterior, ángulo irido corneal (drenaje) y cristalino. Esta revisión de literatura tiene como objetivo presentar el uso de la UBM en medicina veterinaria de pequeños animales, mostrando sus ventajas, limitaciones e indicaciones en oftalmología.(AU)

Apresentação atípica da oftalmopatia de Graves / Atypical presentation of Graves’ ophthalmopathy

A oftalmopatia de Graves é a doença orbitária mais comum e acomete 25 a 50% dos pacientes portadores da Doença de Graves e é mais frequente no sexo feminino, entre a segunda e quinta décadas de vida. A doença apresenta uma fase aguda e uma crônica, evoluindo lenta e progressivamente até estabilizar, sendo raros os casos de resolução espontânea. O tratamento dependerá da fase em que a doença se encontra e está baseado principalmente na corticoterapia via oral e endovenosa e/ou radioterapia, sendo a colchicina empregada em casos isolados. No seguinte relato de caso, abordaremos uma forma atípica de manifestação clínica da Oftalmopatia de Graves em paciente eutireoideia com anticorpos negativos na sua apresentação inicial.

Graves ‘ophthalmopathyis themost commonorbital diseaseand affects25-50% of the patients withGraves’ disease. It`s morecommon in females, between the second andfifth life`s decade. The disease hasanacute andachronic stage, slowly progressing until it stabilizes, with rarecasesof spontaneous resolution.The treatment depends on thestage andthe disease ismainly treated withoralor intravenous corticosteroids with or without radiotherapy;colchicine is usedin individual cases. In the followingcase report, we discuss an atypicalmanifestation ofGraves’ ophthalmopathyin an euthyroid patientwith negative antibodiesin the inicial presentation.

Oftalmopatía de Graves y tratamiento con I131 / Graves´ Ophthalmopathy and Radioiodine Treatment

La oftalmopatía de Graves (OG) es un desorden autoinmune que representa la manifestación extratiroidea más frecuente de la Enfermedad de Graves. Se describen múltiples factores que pueden influir en el desarrollo/progresión de la enfermedad, entre ellos el tratamiento con I131. El objetivo de esta monografía es analizar la bibliografía existente sobre la relación entre OG y tratamiento con I131, teniendo en cuenta su fisiopatología así como los factores de riesgo asociados y su profilaxis.

Graves´ ophthalmopathy (GO) is an autoimmune disorder representing the most common extrathyroidal manifestation of Graves' disease. Multiple factors can influence the development / progression of the disease, including treatment with 131I. The aim of this paper is to analyze the existing literature on the relationship between OG and treatment with I131, considering the pathophysiology and associated risk factors and prophylaxis.

FarmacOft: software educativo para la farmacología contra las afecciones oftalmológicas / FarmacOft: educational software for pharmacology against ophthalmological affections

Fundamento: el uso adecuado de fármacos contra las afecciones oculares es un contenido esencial en la asignatura Farmacología II de tercer año de Medicina. Objetivo: diseñar un software educativo sobre el uso de fármacos contra las afecciones oculares. Métodos: se realizó una investigación cualitativa en la Universidad de Ciencias Médicas de Villa Clara en el curso 2013-2014. Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción para la interpretación y procesamiento de la información y los referentes teóricos del tema; empíricos: análisis documental de los programas y orientaciones metodológicas, y la encuesta en su modalidad de cuestionario a estudiantes para diagnosticar los conocimientos adquiridos sobre la prescripción y uso racional de medicamentos contra las afecciones oftalmológicas y en forma de entrevista a informantes clave. Resultados: en el programa no se contempla la farmacología contra las afecciones oftalmológicas ni se establecen suficientes nexos interdisciplinares desde una perspectiva integradora para consolidar las habilidades de los alumnos en este campo; no hay bibliografía especializada sobre el tema ni medios de enseñanza en formato digital para estos contenidos; por lo que se diseñó un software educativo utilizando la herramienta de CrheaSoft con una combinación de elementos visuales. Conclusiones: el software proporciona un material educativo didáctico de consulta y de apoyo a la docencia en Farmacología II, facilita la motivación y permite que los estudiantes construyan el conocimiento sobre la aplicación de medicamentos contra afecciones oftalmológicas. Fue valorado por los especialistas como pertinente, útil y factible por su cientificidad y carácter pedagógico.

Background: the appropriate use of drugs against ocular affections is an essential content in the subject Pharmacology II of the third year of Medicine. Objective: to design educational software on the use of drugs against ocular affections. Methods: it was carried out a qualitative research work in Villa Clara University of Medical Sciences in the academic year 2013-2014. Theoretical methods were used: analysis-synthesis and induction-deduction for the processing and interpretation of information and the theoretical foundations of the topic; empiric: documental analysis of the programs and methodological orientations, and the survey in questionnaire modality was applied to the students to diagnose the acquired knowledge on the prescription and rational use of medications against ocular affections and an interview was applied to key informants. Results: the pharmacology against ocular affections is not contemplated in the program and there aren´t settle down enough interdisciplinary connections from an integrative perspective to consolidate the abilities of the students in this field; there is not specialized bibliography on the topic neither teaching means in digital format for these contents; that´s why an educational software was designed using the tool of CrheaSoft with a combination of visual elements. Conclusions: the software provides a didactic educational material of consultation and support to teaching in Pharmacology II, it facilitates the motivation and it allows the students to build knowledge on the application of medications against ocular affections. It was valued by the specialists as pertinent, useful and feasible for its scientific and pedagogic character.

Eficiencia del tratamiento con esteroides para la oftalmopatía tiroidea: Revisión narrativa con rigor metodológico

La Oftalmopatía Tiroidea (OT) es la manifestación extra-tiroidea más común y más importante de la enfermedad tiroidea autoinmune. El uso de esteroides en administración oral o endovenosa (EV) es una de las estrategias para el tratamiento. En esta revisión se evalúa el efecto de la administración de esteroides por vía EV comparativamente con esteroides administrados por vía oral en el tratamiento de la OT. Para ello, se identificaron ensayos clínicos disponibles en la literatura desde enero de 1980 hasta noviembre de 2013. Los estudios fueron seleccionados de forma independiente por los revisores. Se evaluaron 4 ensayos clínicos. Todos los pacientes que recibieron algún tipo de esteroide, sin importar la forma de administración presentaron mejoría con respecto a su condición antes del inicio del tratamiento. Tres de los estudios mostraron diferencias estadísticamente significativas en la mayoría de los parámetros evaluados en favor de los que recibieron el esteroide por vía EV. En general, los esteroides son bien tolerados, pero los efectos adversos son más frecuentes en los pacientes que reciben la terapia esteroidea por vía oral (p˂0,0001). Tres de los estudios utilizaron un mismo esquema y dosis para la administración de metilprednisolona EV. Para la administración oral cada estudio presentó un esquema diferente. Se concluye que la evaluación de los pacientes que tienen indicación para el uso de esteroides para el manejo de la OT debe ser integral y multidisciplinaria. Los que mayor beneficio tienen son los que se presentan con OT clasificada como moderada o severa, y con un puntaje en escala de actividad >4. Los pacientes con OT que reciben tratamiento con metilprednisolona EV, comparados con los que reciben tratamiento con prednisona o metilprednisolona oral, tienen un mayor porcentaje de mejoría de la OT; además, ésta mejoría se observa de forma más temprana, con menor tasa de eventos adversos.

Thyroid-associated ophthalmopathy (TO) is the most common extra thyroid manifestation and the most important of autoimmune thyroid disease. The use of oral or intravenous steroids administration is one of the strategies for treating. This review evaluates the effect of intravenous steroid administration versus orally administered in the treatment of TO. Clinical trials were identified in the literature from January 1980 to November 2013. Studies were selected independently by the reviewers. We found four clinical trials comparing the use of intravenous versus oral steroid in the management of TO. All patients receiving steroid regardless of method of administration have improvement with respect to their condition before the start of treatment. Three studies show statistically significant differences in the improvement of the parameters evaluated in favor of receiving the steroid intravenously. Steroids are generally well tolerated, but adverse effects are more frequent in patients receiving oral therapy (p˂0,0001). Three of the studies used the same doses and schedule for administration of intravenous methylprednisolone. For oral administration each study presents a different scheme. We conclude that the evaluation of patients who receive steroids for the management of thyroid ophthalmopathy should be comprehensive and multidisciplinary. Those who have most benefit are those who present with moderate or severe classified as OT, and with a scale score of activity >4. TO patients receiving intravenous methylprednisolone therapy, compared to those treated with oral prednisone or methylprednisolone have a greater percentage of improvement in the TO, and this improvement was also observed earlier and with fewer adverse events.

Tratamento medicamentoso de ulceração corneana e abscesso estromal em equinos / Medicament Treatment of Corneal Ulcer and Stromal Abscess in Horses

Background: The equine eyelids and cilia protect the eye and promote normal ocular physiological function. Disorders in these structures may result in corneal alterations such as ulcers and stromal abscess. An abscess is a focal mixture of cellular debris, necrotic tissue, leucocytes and possibly infectious agents that initially create a lesion surrounded by a zone of reactive infl ammation. Ulcers and corneal stromal abscess cause severe ocular pain and loss of vision quality in horses. Medical and surgical treatments for stromal abscess have been developed and have evolved over many years. The aim of this work is to report a case of stromal abscess in a horse, after a corneal ulcer related to eyelid deficiency, focusing on therapeutic methods. Case: A 10-year-old crossbreed mare was referred to the Veterinary Clinics Hospital (HCV) of UFPel with an ophthalmic disorder. The mare had an eyelid lesion 2 years before, and since this event she had had recurrent episodes of ophthalmologic disorders. On attendance at the HCV, the mare had photophobia, blepharospasm, conjunctival hyperemia, neovascularization, myosis, uveitis, intense ocular pain, eyelid deficiency and a corneal ulcer about 2 cm long x 2 cm wide in the right eye. Surgical correction of eyelid and corneal disorder was recommended, but not authorized by the owner. Treatment was based on cleaning with physiological solution, gentamicin eyewash, autologus serum every 4 h, atropine 1% every 12 h topically, flunixin meglumin every 12 h intravenously. After 7 days, the corneal ulcer shrank, although there was no improvement in blepharospasm and ocular pain. A corneal abscess 3 cm x 2 cm was noticed. Gentamicin eyewash and autologus serum were administered topically every 4 h for 10 more days. After 14 days of treatment, there was neither blepharospasm nor corneal ulcer and the abscess was shrinking. Gentamicin eyewash was maintained every 6h for 3 more days. After 65 days there was minimal scar tissue in the eye. Discussion: The mare had an ocular traumatic injury 2 years ago and since this event she had presented uveitis and corneal ulcer recurrently, due to loss of eyelid and cilia functional integrity. Equine cornea is avascularized and vascularization of the affected lesion is necessary for resolution and abscess healing. Medical treatment of superfi cial stromal abscess is more economical than surgery and can result in good visual outcomes with mild scarring. Medical treatment consists of a combination of antimicrobial, mydriatic/cycloplegic and anti-inflammatory medications. Flunixin meglumin seems to be the most effective intravenous anti-inflammatory for controlling uveitis in horses. The anti-inflammatory dose may be reduced when there is a decrease in the anterior segment signs of infl ammation and ocular pain. Besides systemic colateral effects, anti-inflammatory therapy also reduces corneal vascularization, and therefore should be used carefully. Antibiotic topical therapy is highly recommended, due to ocular microflora and microorganism encapsulation, and it was used in the present report until there was full epithelial healing. A mydriatic/cycloplegic (atropine 1%) drug was administered aiming to dilate the pupil in order to prevent adherences and to reduce ocular discomfort. Antiproteases agents (autologus serum) are recommended when there is a corneal epithelial loss of integrity. This agent reduces collagen degradation and helps corneal healing. Stromal abscess in horses is usually associated with previous corneal ulceration, and in the present report it also involved eyelid functional deficiency. Medical treatment was effective, ensuring quality of future vision for the animal.