Association between Chagas disease and changes in the optic nerve and retinal nerve fiber layer.

PURPOSE: To test the hypothesis that Chagas disease predisposes to optic nerve and retinal nerve fiber layer alterations. METHODS: We conducted a cross-sectional study including 41 patients diagnosed with Chagas disease and 41 controls, paired by sex and age. The patients underwent ophthalmologic examinations, including intraocular pressure measurements, optic nerve and retinal nerve fiber layer screening with retinography, optical coherence tomography, and standard automated perimetry. RESULTS: All of the patients with Chagas disease had a recent cardiologic study; 15 (36.6%) had heart failure, 14 (34.1%) had cardiac form without left ventricular dysfunction, and 12 (29.3%) had indeterminate form. Optic nerve/retinal nerve fiber layer alterations were observed in 24 patients (58.5%) in the Chagas disease group and 7 controls (17.1%) (p£0.01). Among these, optic nerve pallor, optic nerve alterations suggestive of glaucoma, notch, peripapillary hemorrhage, and localized retinal nerve fiber layer defect were detected. Alterations were more prominent in patients with Chagas disease and heart failure (11 patients), although they also occurred in those with Chagas disease without left ventricular dysfunction (7 patients) and those with indeterminate form (6 patients). Optical coherence tomography showed that themean of the average retinal nerve fiber layer thickness measured 89 ± 9.7 mm, and the mean of retinal nerve fiber layer superior and inferior thickness measured 109 ± 17.5 and 113 ± 16.8 mm, respectively were lower in patients with Chagas disease. In controls, these values were 94 ± 10.6 (p=0.02); 117 ± 18.1 (p=0.04), and 122 ± 18.4 mm (p=0.03). CONCLUSION: Changes in optic nerve/ retinal nerve fiber layer were more prevalent in patients with Chagas disease.

[Logistic regression analysis in the combination of diagnostic methods in glaucoma]. / Análise de regressão logística na combinação de métodos propedêuticos no diagnóstico do glaucoma.

PURPOSES: In this research was studied the diagnostic ability of the Heidelberg Retinal Tomograph (HRT II), GDx nerve fiber analyzer (GDx), Short-wavelenght Automated Perimetry (SWAP) and Frequency-doubling technology (FDT), all of them together and also separately in the diagnosis of glaucoma. METHODS: Sixty glaucomatous patients and 60 normal ones were submitted to examination with the technology of HRT II, GDx, FDT and SWAP. In the interpretation of HRT, based on the Moorfields regression analysis, were considered abnormal when at least one area of the neuroretinal ring was outside the bounds of normality. GDx was defined as altered, when it was observed that at least one index was considered by equipment program as outside of normal limits, excluding the index symmetry, or when "the deviation from normal graph" appeared a quadrant with significance below 5%. The FDT was considered abnormal when at least one region tested presented with severe defects, or two contiguous moderate defects in at least two reliable tests. For SWAP was adopted the abnormality criteria proposed by Anderson. Logistic regression analysis was performed. RESULTS: When the technologies were studied separately, the Logistic regression analysis showed better odds ratio rates to test positive for glaucoma with HRT (22.49), followed by EAP (21.71), FDT (3.97) and GDx (2.73). When positive tests were associated with different technologies, the odds ratios increased. In cases with HRT, FDT and PAA tests, outside normal bounds, the odds ratio was 252.6. Concerning the HRT, GDx and PAA the result have changed to 173.1. When we associate positive tests from different technologies, the odds ratio of glaucomatous patients have increased considerably, reaching 689.7 with all the tests outside normal bounds, which have happened with 26 patients of this study. CONCLUSIONS: The Logistic Regression analysis confirmed that the abnormal tests of HRT and PAA have shown to be the highest reasons for glaucoma occurrence. The association of abnormal tests increased the odds ratio, especially when the HRT and PAA were out of normal bounds.

Silicone Ahmed glaucoma valve with and without intravitreal triamcinolone acetonide for neovascular glaucoma: randomized clinical trial.

PURPOSE: To compare the effect on intraocular pressure (IOP) of the silicone Ahmed glaucoma valve with and without an intravitreal injection of triamcinolone acetonide. PATIENTS AND METHODS: Forty-nine patients with clinically uncontrolled neovascular glaucoma were included in the study; 22 were randomly assigned to the study group (silicone Ahmed glaucoma valve implant with intravitreal triamcinolone acetonide) and 27 to the control group (silicone Ahmed glaucoma valve). IOP was the primary outcome measure in this study. The secondary outcome measure was success, defined by IOP lower than 22 mm Hg and higher than 5 mm Hg, and no serious complications. Success rates in both the groups were compared using Kaplan-Meier survival curves and the log-rank test. IOP levels were compared using mixed linear model analysis to correct for repeated measures correlation. RESULTS: Forty-three patients, 18 in the study group and 25 in the control group, completed the study (follow-up of 12 mo). The mean IOP was significantly lower after 1 year in both the groups (P<0.001). The mean IOP in the first month of follow-up was lower in the study group (control; 20.4±9.7, study; 13.6±6.5, P<0.01). The success rate at 1 year was 78% for the study group and 76% for the control group (P=0.82). Complication rates were not different between the groups. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide in neovascular glaucoma did not affect the intermediate-term success of the silicone Ahmed valve nor reduce the incidence of complications. The mean IOP spike in the first month was lower in the triamcinolone group.

[Discriminant analysis of patients with primary open-angle glaucoma by color Doppler exam and visual field]. / Análise discriminante dos pacientes portadores de glaucoma primário de ângulo aberto através do exame de Doppler colorido e do campo visual.

PURPOSE: To determine if variables from color Doppler and visual field exam could discriminate normal from glaucomatous eyes. METHODS: Prospectively, 36 patients with primary open-angle glaucoma (glaucoma group) and 20 normal volunteers (control group) were studied. Gender, age, central corneal thickness, intraocular pressure, Octopus automated perimetry global indices (mean defect and loss variance) and several parameters of the color Doppler (peak systolic velocity and resistivity index) were compared between groups. RESULTS: There was no statistically significant difference in age, central corneal thickness and intraocular pressure. Discriminant analysis showed that the variables: resistivity index (RI) in the short posterior ciliary artery (SPCA), mean defect (MD) and loss variance (LV) had presented significant influence for the positive diagnosis of glaucoma. The gotten discriminant function was: -3.637 + 0.109 x MD + 0.028 x LV + 4.325 x RI SPCA. Considering score -1.61, the probability of positive diagnosis of glaucoma was 90%. CONCLUSION: Through discriminant analysis it was possible to identify which of the color Doppler variables that associated to the visual field variables allowed differentiate normal from glaucomatous patients. These variables were: resistivity index in the short posterior ciliary artery, and the visual field variables, mean defect and loss variance.

Lack of circadian change of concentration of C-type natriuretic peptide in rabbit aqueous humor.

PURPOSE: To determine whether there is a circadian change of the concentration of C-type natriuretic peptide (CNP) in rabbit aqueous humor. METHODS: Forty-one male white New Zealand rabbits were submitted to a 12 h light and 12 dark lighting schedule; lights on was at 0 h, lights off at 12 h. C-type natriuretic peptide was assayed at 3 light (2 h, 6 h and 10 h) and 3 dark (14,18 and 22 h) times. All groups consisted of four animals but two had more animals to increase the power of tests (6 h, n = 12; 22 h, n = 13). Dependence between the two eyes was tested by Pearson's correlation. The mean of two eyes was considered for analysis. Differences in concentration in pg/200 ml were evaluated by one-way ANOVA, t test and COSINOR analysis. RESULTS: There were no significant differences between the 6 analyzed groups (one-way ANOVA p = 0.157). Pooled into two groups (light and dark), the C-type natriuretic peptide concentration of the light group was lower, 2.626 +/- 0.92 pg/200 ml compared with the dark group 3.02 +/- 1.16 pg/200 ml but did not reach a significant difference (t test; p = 0.23). COSINOR analysis was not statistically significant (R% = 7.72 p = 0.209). CONCLUSION: These data demonstrate that the concentration of CNP in aqueous humor did not show a statistically significant circadian change in rabbits entrained to a 12 h light: 12 h dark lighting schedule.

Influence of pupillary diameter, ciliary muscle tone, and ambient light on nerve fiber layer measurements with scanning laser polarimetry.

PURPOSE: To evaluate the influence of the pupillary diameter, ciliary muscle tone, and room light on nerve fiber layer measurements with the scanning laser polarimeter (GDx). METHODS: One randomly selected eye of ten normal volunteers was examined with the GDx in a two-day protocol under eight testing conditions (pilocarpine 1%, phenylephrine 10%, tropicamide 1%, or no drops with room lights on or off). The twelve parameters, obtained by the GDx, were compared under the eight testing conditions, using two way ANOVA for repeated measurements and Tukey HSD post hoc test. RESULTS: Ten of the twelve parameters were statistically significantly different (P < 0.05) when measured under the three medication or no medication conditions, controlling for the ambient light status. There were no significant differences when measured with the light on or off, controlling for use of drops. CONCLUSIONS: Nerve fiber layer measurements with the GDx were influenced by drugs affecting pupillary diameter, but not by the status of room light or ciliary muscle tone.

Comparação do volume da gota e custo do tratamento dos genéricos de maleato de timolol 0, 5 por cento / Drop volume and cost of treatment with generic 0.5 percent timolol maleate preparations

OBJETIVO: Comparar o volume da gota das medicações genéricas de maleato de timolol a fim de determinar o custo real do tratamento em relação à medicação de referência. MÉTODOS: Foi determinado o volume da gota do Timoptol® 0,5 por cento (Merck Sharp & Dome) e dos genéricos maleato de timolol 0,5 por cento dos laboratórios Allergan-Lok, Cristália e Falcon. Cinco frascos de 5 ml de cada medicação foram adquiridos no mercado. Dez gotas de cada frasco foram pesadas em balança de precisão individualmente, bem como, um mililitro de cada frasco para a determinação do volume da gota. Com base no volume da gota foi calculada a duração média em dias e o custo anual, considerando-se o gasto diário de 4 gotas e o preço máximo ao consumidor publicado em maio de 2003 com alíquota de 18 por cento. RESULTADOS: Observaram-se diferenças estatisticamente significantes do volume da gota entre as medicações (p<0,0001 por cento). A maior gota foi a do maleato de timolol 0,5 por cento Allergan-Lok (35,1 æl) e a menor do maleato de timolol Falcon (27,3 æl). A medicação de referência (Timoptol®) proporcionou gota média de 27,9 æl. O custo anual do tratamento foi de R$ 68,87 para o Timoptol, de R$ 72,76 para o maleato de timolol Allergan-Lok, de R$ 50,00 para o maleato de timolol Cristália e de R$ 43,11 para o maleato de timolol Falcon (p<0,0001). O maleato de timolol Allergan-Lok foi estatisticamente mais caro que os demais sendo 68,8 por cento mais oneroso que o mais barato. CONCLUSAO: Existem diferenças no volume da gota das medicações genéricas acarretando diferenças no custo anual do tratamento. O volume da gota deve ser considerado na análise de qualidade dos medicamentos antiglaucomatosos genéricos.

O atendimento oftalmologico de criancas carentes com estrabismo / Ophthalmological evaluation of needy children with strabismus

Avaliar o tempo decorrido entre o aparecimento do estrabismo e a primeira consulta oftalmologica em pacientes carentes, com inicio de quadro antes...

Alteraçöes oculares na doença de Chagas crônica: comprovaçäo na regiäo endêmica de Agua Comprida (MG) / Ocular alterations in chronic Chaga's disease: evidence at endemic Agua Comprida (MG) region

Objetivo: Comprovar na regiäo endêmica de Agua Comprida (MG) a maior incidência de anisocoria e menor pressäo intra-ocular (Po) em chagásicos anteriormente observados em outra regiäo endêmica da doença de Chagas (Mambaí, GO). Material e métodos: Em estudo prospectivo, mascarado e pareado quanto a idade, sexo e cor, foram analisados 190 pacientes (95 pares de chagásicos e näo-chagásicos). Em 84 pares, realizou-se estudo fotográfico da pupila para a determinaçäo do diâmetro pupilar e frequências de anisocoria (diferença>0,3 mm). Em 95 pares, foi estudada a pressäo intra-ocular entre chagásicos e näo-chagásicos. Resultados: No grupo chagásicos foram observados 25 casos de anisocoria (29,8 por cento) e nos näo-chagásicos, 10 ocorrências (11,9 por cento), diferença essa estatisticamente significante (p = 0,007). Näo houve diferenças estatisticamente significantes para o diâmetro pupilar entre os grupos tanto para OD quanto para OE. Os chagásicos mostraram uma Po média de 11,3 + ou - 2,5 mmHg em OD e de 11,3 + ou - 2,4 mmHg em OE e os näo chagásicos uma Po de 13,1 + ou - 2,6 e 13,1 + ou - 2,5 mmHg respectivamente, diferenças essas estatisticamente significantes entre chagásicos e näo-chagásicos tanto para OD quanto para OE (pOD=pOE<0,0001). Tais diferenças mantiveram-se quando a Po foi comparada quanto ao sexo (feminino p=0,002, masculino p=0,003). Conclusäo: Os resultados comprovam a maior frequência de anisocoria e menores valores de pressäo intra-ocular em pacientes portadores da forma crônica da doença de Chagas.

Pressäo intra-ocular na forma crônica da doença de Chagas / Intraocular pressure in chronic Chagas` disease

Foram examinados em estudo duplo cego, em área endêmica da doença de Chagas, 166 pacientes, sendo 83 chagásicos e 83 näo chagásicos (controle), para comparaçäo da pressäo intraocular (Po). Estes pacientes näo apresentavam glaucoma, hipertensäo intraocular ou patologias eventualmente capazes de influenciar a Po. Os resultados obtidos mostraram valores médios da Po menores nos portadores da forma crônica da doença de Chagas (13,5 ñ 2,3 mmHg) em relaçäo aos seus pares (14,4 ñ 2,4 mmHg), diferenças estas estatisticamente significantes (p=0,04). Nos controles observou-se uma correlaçäo diretamente proporcional entre idade e Po de forma estatisticamente significante, o que näo ocorreu nos chagásicos. Os chagásicos apresentaram menores valores de Po em ambos os sexos, porém significância estatística foi observada somente para o sexo masculino. Em relaçäo à raça, näo houve diferença estatística nos valores da Po. Os resultados mostram que a Po foi estatisticamente menor em indivíduos chagásicos em relaçäo aos controles, sendo que as diferenças foram mais evidentes entre os pacientes do sexo masculino e na faixa etária após os 40 anos

A pupila na fase crônica da doença de Chagas e reaçäo à pilocarpina e à fenilefrina / The pupil in patients with chronic Chagas' disease and reaction to pilocarpine and phenylephrine

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

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

Para verificar a freqüência de anisocoria em portadores da fase crônica da doença de Chagas foi feito estudo prospectivo e duplo cego. Foram submetidos a exame oftalmológico 131 pacientes com sorologia positiva para doença de Chagas e 138 indivíduos com sorologia negativa, da populaçao do município de Mambaí (GO), regiao endêmica de doença de Chagas. Para a avaliaçao da presença ou nao de anisocoria foi realizada a pupilometria com régua. Observamos a presença de anisocoria em 10(7,6 por cento) pacientes chagásicos e em 3(2,1 por cento) controles. O teste do qui-quadrado revelou que as diferenças detectadas foram estatisticamente significantes ao nível de 5 por cento. A doença de Chagas deve ser incluída entre as causas de anisocoria.