Correlations between different tonometries and ocular biometric parameters in patients with primary congenital glaucoma / Correlações entre diferentes tonometrias e parâmetros biométricos oculares em pacientes com glaucoma congênito primário

PURPOSE: To identify the correlation between the difference of intraocular pressure measurements (IOP) obtained using the Goldmann applanation tonometer (GAT) and three others tonometers (Handheld applanation tonometer - HAT, Dynamic contour tonometer - DCT and Tono-Pen®) with biometric characteristics (corneal diameter, pachymetry, keratometry and axial length) in patients with congenital glaucoma. METHODS: A cross-sectional study was performed on 46 eyes from 46 patients with congenital glaucoma. IOP measurements were obtained in all patients using GAT, HAT, DCT and Tono-Pen®. Keratometry, pachymetry, biometry and corneal diameter measurements were performed after the IOP measurement. The order of the tonometries was randomized. The correlations between the differences of IOP values of GAT and the other tonometers (Delta-IOP), and the different biometric parameters were studied. RESULTS: Tono-Pen® Delta IOP revealed moderate positive correlation to keratometry (r=0.41, p=0.004). The other Delta-IOPs showed no correlation with any of the biometric characteristics evaluated. CONCLUSIONS: IOP differences between GAT (gold standard) and GAT, HAT, DCT or Tono-Pen tonometers seem not to correlate with majority of ocular biometric characteristics. The only exception was the keratometry, which correlated in a positive and moderate way with Tono-Pen® Delta-IOP. This result suggests that the differences of IOP values of Tono-Pen® and GAT increase with the steepness of the cornea.

OBJETIVOS: Identificar correlações entre as diferenças de medições de pressão intraocular (IOP) obtidas usando o tonômetro de aplanação de Goldmann (GAT) e três outros tonômetros (Tonômetro portátil de aplanação - TPA, Tonômetro de contorno dinâmico - TCD e Tono-Pen®) com características biométricas (diâmetro corneano, paquimetria, ceratometria e comprimento axial) em pacientes com glaucoma congênito. MÉTODOS: Estudo transversal prospectivo foi realizado em 46 olhos de 46 pacientes com glaucoma congênito. As medidas de pressão intraocular foram obtidas em todos os pacientes utilizando TAG, TPA, TCD e Tono-Pen®. Ceratometria, paquimetria, biometria e diâmetro corneano foram realizadas após mensuração da pressão intraocular. A ordem da utilização tonômetros foi aleatória. Correlações entre as diferenças de valores de PIO entre cada um dos três tonômetros (PIOs Delta) e o tonômetro de Goldmann e as características biométricas foram analisadas. RESULTADOS: PIO Delta do Tono-Pen®revelou correlação positiva moderada com ceratometria (r=0,41, p=0,004). As outras PIOs Delta não se correlacionaram significativamente com nenhuma das características biométricas. CONCLUSÕES: As diferenças entre as PIOs obtidas pelo TAG (padrão ouro) e TPA, TCD e Tono-Pen®parece não se correlacionar com a maioria das características biométricas. A única exceção foi a ceratometria, a qual se correlacionou de forma positiva e moderada com a PIO Delta do Tono-Pen®. Estes resultados indicam que o aumento da diferença entre a PIO obtida com TAG e Tono-Pen®aumenta com o encurvamento da curvatura corneana.

Correlations between different tonometries and ocular biometric parameters in patients with primary congenital glaucoma.

PURPOSE: To identify the correlation between the difference of intraocular pressure measurements (IOP) obtained using the Goldmann applanation tonometer (GAT) and three others tonometers (Handheld applanation tonometer - HAT, Dynamic contour tonometer - DCT and Tono-Pen®) with biometric characteristics (corneal diameter, pachymetry, keratometry and axial length) in patients with congenital glaucoma. METHODS: A cross-sectional study was performed on 46 eyes from 46 patients with congenital glaucoma. IOP measurements were obtained in all patients using GAT, HAT, DCT and Tono-Pen®. Keratometry, pachymetry, biometry and corneal diameter measurements were performed after the IOP measurement. The order of the tonometries was randomized. The correlations between the differences of IOP values of GAT and the other tonometers (Delta-IOP), and the different biometric parameters were studied. RESULTS: Tono-Pen® Delta IOP revealed moderate positive correlation to keratometry (r=0.41, p=0.004). The other Delta-IOPs showed no correlation with any of the biometric characteristics evaluated. CONCLUSIONS: IOP differences between GAT (gold standard) and GAT, HAT, DCT or Tono-Pen tonometers seem not to correlate with majority of ocular biometric characteristics. The only exception was the keratometry, which correlated in a positive and moderate way with Tono-Pen® Delta-IOP. This result suggests that the differences of IOP values of Tono-Pen® and GAT increase with the steepness of the cornea.

[Central corneal thickness and its correlations with other ocular biometric data in patients with congenital glaucoma]. / Espessura corneana central e suas correlações com outros dados biométricos oculares em pacientes portadores de glaucoma congênito.

PURPOSE: To study the distribution of the central corneal thickness and its correlations with other biometric data in patients with congenital glaucoma. METHODS: Patients had been divided into two groups: group "A", composed of patients with congenital glaucoma, being subdivided in two sub-groups: with Haab striae (A1) and without Haab striae (A2), and group"B" that represented the controls. RESULTS: The group A presented corneal diameter between 11 and 15.5 mm, with mean of 14.13 mm and standard deviation (SD) of 1.28, while group B presented values between 11.5 and 12.5 mm, with average of 12.01 mm SD of 0.09 (t=-8.9723 and p=1.5083 in level 0.05). Glaucomatous patients presented greater mean values of axial diameter (t=-6.46315, p=9.2498 with level of significance of 0.05), and smaller mean keratometry in relation to the controls. The A1 sub-group presented mean central corneal thickness of 539 ± 46 µm, the A2 presented 571 ± 56 µm, and Group B 559 ± 28 µm (t=0.43746 and p=0.66291). The correlation between corneal and axial diameters was positive in both groups. The correlation between corneal diameter and mean keratometric values was negative in both groups. CONCLUSIONS: Patients with congenital glaucoma presented greater mean of axial dia meter and smaller mean keratometric values compared to the controls. No statistical significant difference of the central corneal thickness was demonstrated. Corneal and axial diameters were correlated positively. Corneal diameter was correlated negatively with the mean keratometry. It was not possible to establish correlations between the central corneal thickness and other biometric data.

Espessura corneana central e suas correlações com outros dados biométricos oculares em pacientes portadores de glaucoma congênito / Central corneal thickness and its correlations with other ocular biometric data in patients with congenital glaucoma

OBJETIVO: Estudar a distribuição da espessura corneana central e suas correlações com outros dados biométricos em pacientes com glaucoma congênito. MÉTODOS: Pacientes foram divididos em dois grupos, o A composto por portadores de glaucoma congênito, sendo este subdividido em subgrupos: com estrias de Haab (A1) e sem estrias de Haab (A2). O B representou o grupo controle. RESULTADOS: O grupo A apresentou diâmetro corneano entre 11 e 15,5 mm, com média de 14,13 mm e desvio padrão de 1,28, enquanto o grupo B apresentou valores entre 11,5 e 12,5 mm, com média de 12,01 mm com desvio padrão de 0,09 (t=-8,9723 e p=1,5083 em nível 0,05). Os glaucomatosos apresentaram maiores valores médios de diâmetro axial (t=-6,46315, p=9,2498 em nível de significância de 0,05), e menores valores médios ceratométricos em relação aos controles. O subgrupo A1 apresentou espessura corneana central de 539 ± 46 µm, o subgrupo A2 apresentou média de 571 ± 56 µm e o grupo B de 559 ± 28 µm (t=0,43746 e p=0,66291). As correlações entre diâmetro corneano e axial foram positivas nos dois grupos. Já entre diâmetro corneano e ceratometria média foram negativas nos dois grupos. CONCLUSÃO: Os glaucomatosos apresentaram maior média de diâmetro axial e menor média ceratométrica em relação aos controles. Não houve diferença estatisticamente significativa da espessura corneana central. O diâmetro corneano se correlacionou positivamente como diâmetro axial e negativamente com a ceratometria média. Não se pode estabelecer correlações entre espessura corneana central e os demais dados biométricos.

PURPOSE:To study the distribution of the central corneal thickness and its correlations with other biometric data in patients with congenital glaucoma. METHODS: Patients had been divided into two groups: group "A", composed of patients with congenital glaucoma, being subdivided in two sub-groups: with Haab striae (A1) and without Haab striae (A2), and group"B" that represented the controls. RESULTS: The group A presented corneal diameter between 11 and 15.5 mm, with mean of 14.13 mm and standard deviation (SD) of 1.28, while group B presented values between 11.5 and 12.5 mm, with average of 12.01 mm SD of 0.09 (t=-8.9723 and p=1.5083 in level 0.05). Glaucomatous patients presented greater mean values of axial diameter (t=-6.46315, p=9.2498 with level of significance of 0.05), and smaller mean keratometry in relation to the controls. The A1 sub-group presented mean central corneal thickness of 539 ± 46 µm, the A2 presented 571 ± 56 µm, and Group B 559 ± 28 µm (t=0.43746 and p=0.66291). The correlation between corneal and axial diameters was positive in both groups. The correlation between corneal diameter and mean keratometric values was negative in both groups. CONCLUSIONS: Patients with congenital glaucoma presented greater mean of axial dia meter and smaller mean keratometric values compared to the controls. No statistical significant difference of the central corneal thickness was demonstrated. Corneal and axial diameters were correlated positively. Corneal diameter was correlated negatively with the mean keratometry. It was not possible to establish correlations between the central corneal thickness and other biometric data.

Estudo comparativo entre imagens ultra-sonográficas obtidas com sondas de 10MHz e 20 MHz na avaliação de anormalidades do segmento posterior do globo ocular / Comparative study of ultrasound images obtained with 10MHz and 20 MHz probes in the evaluation of the abnormalities of the posterior segment of the globe

A ecografia se constitui em método importante na avaliação de anormalidades do segmento posterior do globo ocular. OBJETIVO: Comparar as vantagens e desvantagens da sonda de 10 e 20 MHz da ultra-sonografia B-scan, na avaliação de imagens do segmento posterior do globo ocular. MÉTODOS: Pacientes acompanhados no ambulatório do Hospital das Clínicas da USP (HCFMUSP) entre fevereiro de 2006 e abril de 2007 foram submetidos a exame ultra-sonográfico usando o aparelho CINE-Scan® (Quantel Medical Inc.) com sondas de 10 e 20 MHz. Os pacientes foram examinados por três oftalmologistas experientes, em decúbito dorsal, após instilação de colírio de tetracaína a 1 por cento, inicialmente com a sonda sobre as pálpebras e em seguida diretamente em contato com a esclera ou córnea. As imagens obtidas com sondas de 10 e 20 MHz foram comparadas entre si, durante e após a realização do exame. RESULTADOS: A sonda de 20 MHz mostrou-se superior na avaliação da detecção, forma e limites de estruturas do pólo posterior e a de 10 MHz avaliou com mais detalhes o humor vítreo. Não foram encontradas diferenças nas imagens obtidas com exame transpalpebral ou transescleral com a sonda de 10 MHz. Com a sonda de 20 MHz, as imagens obtidas em contato direto com o globo ocular apresentaram melhor qualidade. CONCLUSÕES: As sondas de 10 e 20 MHz têm diferentes intervalo de alcance ideal, assim como diferentes meios específicos de aquisição de melhores imagens.

The ultrasound is an important method in the evaluation of abnormalities of the posterior segment of the eye. PURPOSE: To compare the advantages and disadvantages of 10 and 20 MHz probe on B- scanning ultra-sonography in evaluation of vitreous and posterior pole diseases, providing recommendations for their use. METHODS: Patients from Hospital das Clinicas of the University of São Paulo (HC-FMUSP), attended between February 2006 and April 2007, were submitted to ultrasound exams using CINE-Scan® (Quantel Medical Inc) B-scan with 10 and 20MHz probe. The patients were examined by three experienced ophthalmologists, in horizontal dorsal position, after instillation of tetracaine 1 percent drops, first with the probe in direct contact with eyelids, and then with the probe placed directly in contact with the sclera or cornea. Theimages obtained were compared immediately during and after the examination. RESULTS: The 20 MHz probe reveled a superior resolution to study details, like shape and limits, on the posterior pole, and the 10 MHz probe provided better evaluation on vitreous humor. There were no differences if the exam was performed on eyelids or directly on sclera with the 10 MHz probe, but with the 20 MHz probe, the images had better resolution when the probe was used in direct contact with the eye. CONCLUSIONS: The 10 and 20 probes have different ideal range of reach, as different better specific means of image achieving.

Visual impairment secondary to congenital glaucoma in children: visual responses, optical correction and use of low vision AIDS.

INTRODUCTION: Congenital glaucoma is frequently associated with visual impairment due to optic nerve damage, corneal opacities, cataracts and amblyopia. Poor vision in childhood is related to global developmental problems, and referral to vision habilitation/rehabilitation services should be without delay to promote efficient management of the impaired vision. OBJECTIVE: To analyze data concerning visual response, the use of optical correction and prescribed low vision aids in a population of children with congenital glaucoma. METHOD: The authors analyzed data from 100 children with congenital glaucoma to assess best corrected visual acuity, prescribed optical correction and low vision aids. RESULTS: Fifty-five percent of the sample were male, 43% female. The mean age was 6.3 years. Two percent presented normal visual acuity levels, 29% mild visual impairment, 28% moderate visual impairment, 15% severe visual impairment, 11% profound visual impairment, and 15% near blindness. Sixty-eight percent received optical correction for refractive errors. Optical low vision aids were adopted for distance vision in 34% of the patients and for near vision in 6%. A manual monocular telescopic system with 2.8 x magnification was the most frequently prescribed low vision aid for distance, and for near vision a +38 diopter illuminated stand magnifier was most frequently prescribed. DISCUSSION AND CONCLUSION: Careful low vision assessment and the appropriate prescription of optical corrections and low vision aids are mandatory in children with congenital glaucoma, since this will assist their global development, improving efficiency in daily life activities and promoting social and educational inclusion.

Ultrasonographic findings in patients examined in cataract detection-and-treatment campaigns: a retrospective study.

INTRODUCTION: A cataract is defined as an opacity of any portion of the lens, regardless of visual acuity. In some advanced cases of cataracts, in which good fundus visualization is not possible, an ultrasound examination provides better assessment of the posterior segment of the globe. OBJECTIVES: This study aims to evaluate the ultrasonographic records of patients with advanced cataracts who were examined during cataract campaigns. METHODS: The ultrasonographic findings obtained from 215 patients examined in cataract campaigns conducted by the Hospital das Clínicas Department of Ophthalmology of the Faculdade de Medicina da Universidade de São Paulo between the years of 2005 and 2007 were evaluated, and the utility of this exam in changing the treatment procedures was studied. RESULTS: A total of 289 eyes from 215 patients were examined. Of the eyes examined, 77.5% presented with findings in the vitreous cavity and the posterior pole. A posterior vitreous detachment with no other complications was observed in 47.4% of the eyes. The remaining 30.1% presented with eye diseases that could result in a reduced visual function after surgery. The most frequent eye diseases observed were diffuse vitreous opacity (12.1% of the eyes) and detachment of the retina (9.3% of the eyes). DISCUSSION: In many cases, the ultrasonographic evaluation of the posterior segment revealed significant anomalies that changed the original treatment plan or contra-indicated surgery. At the very least, the evaluation was useful for patient counseling. CONCLUSION: The ultrasonographic examination revealed and differentiated between eyes with cataracts and eyes with ocular abnormalities other than cataracts as the cause of poor vision, thereby indicating the importance of its use during ocular evaluation.

Visual impairment secondary to congenital glaucoma in children: visual responses, optical correction and use of low vision AIDS

INTRODUCTION: Congenital glaucoma is frequently associated with visual impairment due to optic nerve damage, corneal opacities, cataracts and amblyopia. Poor vision in childhood is related to global developmental problems, and referral to vision habilitation/rehabilitation services should be without delay to promote efficient management of the impaired vision. OBJECTIVE: To analyze data concerning visual response, the use of optical correction and prescribed low vision aids in a population of children with congenital glaucoma. METHOD: The authors analyzed data from 100 children with congenital glaucoma to assess best corrected visual acuity, prescribed optical correction and low vision aids. RESULTS: Fifty-five percent of the sample were male, 43 percent female. The mean age was 6.3 years. Two percent presented normal visual acuity levels, 29 percent mild visual impairment, 28 percent moderate visual impairment, 15 percent severe visual impairment, 11 percent profound visual impairment, and 15 percent near blindness. Sixty-eight percent received optical correction for refractive errors. Optical low vision aids were adopted for distance vision in 34 percent of the patients and for near vision in 6 percent. A manual monocular telescopic system with 2.8 × magnification was the most frequently prescribed low vision aid for distance, and for near vision a +38 diopter illuminated stand magnifier was most frequently prescribed. DISCUSSION AND CONCLUSION: Careful low vision assessment and the appropriate prescription of optical corrections and low vision aids are mandatory in children with congenital glaucoma, since this will assist their global development, improving efficiency in daily life activities and promoting social and educational inclusion.

Ultrasonographic findings in patients examined in cataract detection-andtreatment campaigns: a retrospective study

INTRODUCTION: A cataract is defined as an opacity of any portion of the lens, regardless of visual acuity. In some advanced cases of cataracts, in which good fundus visualization is not possible, an ultrasound examination provides better assessment of the posterior segment of the globe. OBJECTIVES: This study aims to evaluate the ultrasonographic records of patients with advanced cataracts who were examined during cataract campaigns.METHODS: The ultrasonographic findings obtained from 215 patients examined in cataract campaigns conducted by the Hospital das Clínicas Department of Ophthalmology of the Faculdade de Medicina da Universidade de São Paulo between the years of 2005 and 2007 were evaluated, and the utility of this exam in changing the treatment procedures was studied. RESULTS: A total of 289 eyes from 215 patients were examined. Of the eyes examined, 77.5% presented with findings in the vitreous cavity and the posterior pole. A posterior vitreous detachment with no other complications was observed in 47.4% of the eyes. The remaining 30.1% presented with eye diseases that could result in a reduced visual function after surgery. The most frequent eye diseases observed were diffuse vitreous opacity (12.1% of the eyes) and detachment of the retina (9.3% of the eyes). DISCUSSION: In many cases, the ultrasonographic evaluation of the posterior segment revealed significant anomalies that changed the original treatment plan or contra-indicated surgery. At the very least, the evaluation was useful for patient counseling. CONCLUSION: The ultrasonographic examination revealed and differentiated between eyes with cataracts and eyes with ocular abnormalities other than cataracts as the cause of poor vision, thereby indicating the importance of its use during ocular evaluation.

[Automated perimetry in patients with primary congenital glaucoma]. / Perimetria automatizada em pacientes com glaucoma congênito primário.

PURPOSE: To identify and characterize defects using the automated perimetry test in patients with primary congenital glaucoma. METHODS: Automated visual fields and charts of 81 eyes (48 patients) with congenital glaucoma were retrospectively analyzed, 15 being normal eyes (group N) and 66 eyes with primary congenital glaucoma (group G). Eyes of group G were grouped in eyes without perimetric changes and with early defects, characterized by MD > -6 dB (group G I= 41 eyes), and eyes with mild/advanced perimetric defects characterized by MD < or = -6 dB (group G II= 25 eyes). MAIN OUTCOME MEASURES: reliability indices, global indices, GHT report, foveal threshold index and descriptive visual field defects. RESULTS: The majority of patients showed good reliability. In group G I, 68% had normal visual fields; 22% showed localized defects and 10% showed general reduction of sensitivity. In group G II, 56% of the visual fields showed general reduction of sensitivity and 44% showed localized defects. The most common localized change was inferior paracentral scotoma. Eyes with normal visual fields in group G I had foveal threshold and MD values lower than normal eyes. The hemifield test was normal in 68% of eyes in group G I, and was abnormal in 100% of eyes in group G II. CONCLUSIONS: Automated perimetry test was able to show typical defects of glaucoma contributing to initial evaluation and giving reliable parameters for the follow-up of eyes in patients with congenital glaucoma.

Perimetria automatizada em pacientes com glaucoma congênito primário / Automated perimetry in patients with primary congenital glaucoma

OBJETIVO: Identificar e caracterizar os defeitos nos exames de perimetria automatizada encontrados nos pacientes com diagnóstico de glaucoma congênito primário. MÉTODOS: Foram avaliados retrospectivamente os campos visuais automatizados de 81 olhos (48 pacientes), sendo 15 olhos sem glaucoma (grupo N) e 66 olhos com glaucoma (grupo G). Os olhos com glaucoma foram divididos em olhos com alterações campimétricas incipientes, caracterizadas pelo MD> -6 dB (grupo G I= 41 olhos) e olhos com alterações campimétricas moderadas/avançadas, caracterizadas pelo MD < -6 dB (grupo G II= 25 olhos). RESULTADOS: No grupo G I observaram-se 68 por cento de campos visuais normais, 22 por cento de alterações localizadas e 10 por cento com baixa difusa da sensibilidade. No grupo G II observaram-se 56 por cento de baixa difusa da sensibilidade e 44 por cento de defeitos localizados. O defeito campimétrico localizado mais comum foi o escotoma paracentral inferior. Os campos visuais normais do grupo G I revelaram limiar foveal e MD mais baixos que o grupo N. O "glaucoma hemifield test" foi normal em 68 por cento dos olhos no grupo G I, e foi anormal em 100 por cento dos olhos no grupo G II. CONCLUSÃO: O exame de perimetria automatizada mostrou-se eficaz em revelar as alterações campimétricas típicas do glaucoma, sendo importante para avaliação imediata e fornecendo parâmetros para seguimento dos pacientes com glaucoma congênito.

PURPOSE: To identify and characterize defects using the automated perimetry test in patients with primary congenital glaucoma. METHODS: Automated visual fields and charts of 81 eyes (48 patients) with congenital glaucoma were retrospectively analyzed, 15 being normal eyes (group N) and 66 eyes with primary congenital glaucoma (group G). Eyes of group G were grouped in eyes without perimetric changes and with early defects, characterized by MD> -6 dB (group G I= 41 eyes), and eyes with mild/advanced perimetric defects characterized by MD < -6 dB (group G II= 25 eyes). Main outcome measures: reliability indices, global indices, GHT report, foveal threshold index and descriptive visual field defects. RESULTS: The majority of patients showed good reliability. In group G I, 68 percent had normal visual fields; 22 percent showed localized defects and 10 percent showed general reduction of sensitivity. In group G II, 56 percent of the visual fields showed general reduction of sensitivity and 44 percent showed localized defects. The most common localized change was inferior paracentral scotoma. Eyes with normal visual fields in group G I had foveal threshold and MD values lower than normal eyes. The hemifield test was normal in 68 percent of eyes in group G I, and was abnormal in 100 percent of eyes in group G II. CONCLUSIONS: Automated perimetry test was able to show typical defects of glaucoma contributing to initial evaluation and giving reliable parameters for the follow-up of eyes in patients with congenital glaucoma.

Corneal thickness in congenital glaucoma.

PURPOSE: To compare central corneal thickness between eyes with congenital glaucoma and normal controls and to correlate this parameter with corneal diameter and axial length. METHODS: Eyes of consecutive children with congenital glaucoma with previous glaucoma surgery and eyes of children with inadequacy of lacrimal drainage system with age less than 3 years old were examined under inhalatory general anesthesia. Complete ophthalmologic examination, central corneal thickness, axial length, and corneal diameter measurements were performed. All patients presented with intraocular pressure (IOP) less than 21 mm Hg and no clinical sign of corneal edema. RESULTS: Fifty-five eyes of 55 patients (30 congenital glaucoma and 25 controls) were examined (mean age = 16.6 +/- 10.6 months; 20 female/ 35 males). There was no significant difference in age and gender between glaucoma patients and normal subjects. Mean IOP was higher in glaucomatous eyes (P = 0.02). Corneal diameter and axial length between glaucomatous eyes and controls were significantly different (P < 0.0001 for both). Central corneal thickness was significantly thinner in glaucomatous eyes (P = 0.01). There was a significant correlation between corneal diameter and central corneal thickness and also between central corneal thickness and axial length (r2 = 0.32 and r2 = 0.18, respectively; P < 0.0001 for both). CONCLUSION: Central corneal thickness was significantly thinner in children with congenital glaucoma. This finding may be another confounding factor when measuring IOP in those patients. Pachymetry should be considered during their examination.

Resultados pressóricos a longo prazo do tratamento do glaucoma congênito primário / Lon time intraocular pressure results in treatment of primary congenital glaucoma

Objetivo: O objetivo do presente estudo foi o de avaliar o comportamento da pressão intra-ocular, a longo prazo, em olhos portadores de glaucoma congênito primários e que haviam se submetido à cirurgia nos primeiros anos de vida. Método: Cinquenta olhos de 30 pacientes com glaucoma congênito primário foram estudados e companhados por um período mínimo de 10 anos. Todos os olhos haviam se submetido à cirurgia anti-glaucomatosa (uma a três cirurgias) e permaneceram com a pressão intra-ocular (PIO) controlada (abaixo de 20mmHg) por um período mínimo de 5 anos, sendo que alguns necessitaram de tratamento clínico adicional para manter a pressão ocular controlada. Resultados e Conclusões: Dos 50 olhos estudados, 9 olhos (quase 20 porcento) revelaram descontrole da PIO após um período mínimo de 5 anos, durante os quais a PIO e a doença se mantiveram supostamente controladas, sendo necessário a indicação de nova cirurgia para os referidos olhos. A necessidade de se manter olhos com glaucoma congênito sob controle, por um período longo de tempo, é enfatizada considerando a probabilidade de possível descontrole pressórico, em alguns casos, após longo tempo em que a doença se mantém aparentemente controlada.

Aspectos da biomicroscopia ultrassônica no glaucoma congênito / Ultrasound biomicroscopy in congenital glaucoma

O objetivo do presente estudo foi o de avaliar, através da biomicroscopia ultrassônica (UBM), os aspectos anatômicos presentes no segmento anterior dos olhos com glaucoma congênito, bem como caracterizar as alteraçöes anatômicas das áreas relacionadas aos procedimentos cirúrgicos anteriormente realizados nestes olhos. Método: A biomicroscopia ultrassônica foi realizada em 20 olhos (de 15 pacientes) com glaucoma congênito primário, Síndrome de Rieger e Aniridia. Resultados: Nem sempre foi possível detectar a presença de ligamento pectíneo nos olhos examinados. A íris se revelou fina na maioria dos olhos e os processos ciliares se revelaram comumente alongados nos olhos com glaucoma congênito primário. Presença de aderências ou sinéquias na periferia da câmara anterior foi detectada em olhos com Síndrome de Rieger ou Aniridia. Em relaçäo ao estudo da área cirúrgica, nos olhos submetidos á goniotomia e trabeculectomia, na maioria da vezes näo foi possível caracterizar, pela, UBM, presença de sulco ou "cleft" cirúrgico relacionado ao procedimento cirúrgico realizado. Nos casos submetidos á trabeculectomia, por sua vez, as imagens obtidas permitiram a diferenciaçäo dos casos com fístulas funcionais daqueles com fístula näo funcionante.

Efeito do maleato de timolol sobre a pressäo intra-ocular no glaucoma congênito / Timolol maleate effects on intraocular pressure in congenital glaucoma

Foram estudados 19 olhos de 11 pacientes portadores de glaucoma congênito hereditário simples, ou primário (média etária de 19 anos). Todos os olhos já haviam sido operados (no mínimo uma vez e no máximo 3 vezes)para tratamento da doença. Estavam sob uso de colírio de maleato de timolol 0,5 por um perodo näo inferior a 4 meses, prescrito em virtude de näo apresentarem pressäo intra-ocular devidamente controlada pela(s) cirurgia(s). Foram determinadas as medidas tonométricas nos horários de 8 - 11 e 14 hs. A medicaçäo ocular foi entäo suspensa por um período de 15 dias tendo após este tempo sido determinado novamente os valores da pressäo intra-ocular nos mesmos horários anteriormente considerados. Os valores tonométricos obtidos com mediçäo foram comparados com os valores sem medicaçäo. As variaçöes tonométricas percentuais também foram determinadas. observou-se diferença significativa dos valores tonométricos com medicaçäo em relaçäo aos valores sem medicaçäo, sendo mais baixos os valores obtidos sob o uso da droga. Os resultados mostraram que o maleato de timolol 0.5 pode ser pode ser efetivo em reduzir a pressäo intra-ocular no glaucoma congênito hereditário simples, com a doença näo devidamente controlada cirurgicamente.

Avaliaçäo da pressäo intra-ocular em olhos glaucomatosos com pressäo intra-ocular normalizada pelo tratamento / IOP evaluation in glaucomatous eyes under treatment

Com o objetivo de verificar quais as formas de tratamento do glaucoma que podem evitar picos de pressäo e garantir níveis médios de pressäo intra-ocular (PIO) mais baixos, estudamos pacientes submetidos à trabeculoplastia e apenas ao uso de medicaçäo hipotensora ocular. A PIO foi avaliada pelo prova de sobrecarga hídrica. Encontramos uma diminuiçäo significativa da PIO nos três grupos de pacientes após o tratamento, sendo maior no grupo da trabeculectomia em comparaçäo aos outros dois grupos. Este grupo também teve na prova de sobrecarga hídrica (com) menor elevaçäo pressórica, sugerindo ser esta modalidade de tratamento a mais eficaz em evitar picos pressóricos em olhos supostamente bem controlados com o tratamento instituido

Significado do diâmetro corneano e do diâmetro axial total do globo ocular no controle evolutivo do glaucoma congênito / Significance of the corneal diameter and the axial length of the eye in the evaluation of congenital glaucoma

Um total de 38 olhos de 21 crianças até 1 ano de idade e portadoras de glaucoma congênito, foram estudados. Os olhos foram divididos em dois grupos, segundo apresentavam a doença controlada ou näo controlada (segundo os valores da pressäo intra-ocular). Foram obtidas e comparadas as variaçöes ocorridas nas dimensöes do diâmetro corneano e do diâmetro axial total do globo ocular, nos dois grupos. Concluiu-se pela importância dos dois parâmetros (diâmetro corneano e diâmetro axial) em diferenciar os olhos com pressäo intra-ocular controlada daqueles com a pressäo intra-ocular näo controlada. No entanto, o diâmetro axial mostrou variaçöes (aumento) mais significativas em relaçäo ao diâmetro corneano, nos olhos com a doença näo controlada.

Nanoftalmia: aspectos da biomicroscopia ultra-sônica / Nanophthalmos: ultrasonic biomicroscopy

A nanoftalmia, condiçäo rara, foi estudada em 8 pacientes pela biomicroscopia ultra-sônica para avaliar o aspecto ecográfico destes olhos. Foi medida a profundidade de câmara anterior, cuja média foi de 1,89mm nos olhos fácicos. Avaliamos qualitativament o ângulo da câmara anterior, o sulco ciliar, a posiçäo do corpo e processos ciliares. Os achados ecográficos näo foram uniformes em relaçäo às características clínicas. Na maioria dos olhos nanoftálmicos que apresentavam glaucoma, encontramos o sulco ciliar apagado, o corpo ciliar deslocado anteriormente e algumas íris com aspecto de platô

Herança no glaucoma congênito / Congenital glaucoma heredity

No presente trabalho foram estudadas 80 famílias, perfazendo um total de 184 filhos, sendo 80 portadores de glaucoma congênito. As famílias foram divididas segundo o número de filhos de cada casal e procurou-se verificar em qual dos filhos, segundo a ordem de nascimento, incidiu o glaucoma congênito. Concluiu-se que tais estudos säo pouco informativos. No entanto, entre outros achados, foi observado que o glaucoma congênito ocorreu no primeiro filho em näo mais do que 47,5% dos casos e que a ocorrência da doença em mais de uma vez numa mesma família é esporádica e até certo ponto rara

Refraçäo e biometria ocular no glaucoma congênito / Ocular refraction and biometry in congenital glaucoma

107 olhos de pacientes portadores de glaucoma congênito foram estudados, com o objetivo de avaliar a incidência de vícios de refraçäo (componente esférico) na populaçäo estudada, assim como também correlacionar os achados refracionais com a biometria ultrasonográfica da câmara anterior, do cristalino, da cavidade vítrea e do diâmetro ântero-posterior total do globo ocular. Os resultados foram comparados com um grupo controle de olhos normais, distribuidos em 3 faixas etárias até os 15 anos de idade. A miopia (pequena e grande) foi o achado refracional mais frequentemente encontrado nos olhos portadores de glaucoma congênito, embora a emetropia e a pequena hipermetropia também tenham sido encontradas com uma freqüência de 25%. Foi possível observar uma certa correlaçäo entre o tipo de ametropia e a biometria da câmara anterior, da cavidade vítrea e principalmente com o diâmetro ântero-posterior total