Ana Luiza Biancardi

Thrombophilic mutations and risk of retinal vein occlusion

PURPOSE The association of retinal vein occlusion and hereditary thrombophilia abnormalities is not established, with controversial results in the literature. This study investigates the association between retinal vein occlusion and three thrombophilic mutations: factor V 1691A (factor V Leiden), prothrombin 20210A (PT 20210A) and homozygous methylenetetrahydrofolate reductase 677T (MTHFR 677TT). METHODS 55 consecutive retinal vein occlusion patients and 55 controls matched by age, gender and race, were tested for the presence of the following mutations: factor V Leiden, PT 20210A and MTHFR 677TT. The frequencies of the three mutations in cases and controls were compared. RESULTS Factor V Leiden was found in 3.6% of patients and in 0% of controls; PT 20210A was found in 1.8% of patients and 3.6% of controls, (matched-pair odds ratio, 0.5; 95% confidence interval, 0.04 to 5.51); MTHFR 677TT was found in 9% of patients and 9% of controls (matched-pair odds ratio, 1; 95% confidence interval, 0.92 to 3.45). Arterial hypertension was more frequent in patients than controls (matched-pair odds ratio, 3.4; 95% confidence interval, 1.25 to 9.21). CONCLUSIONS This study suggests that thrombophilic mutations are not risk factors for RVO. Routine investigation of hereditary thrombophilia in these patients is not justified.

807C/T polymorphism in platelet glycoprotein Ia gene is not associated with retinal vein occlusion.

Dear Editor, Retinal vein occlusion (RVO) is a major cause of visual impairment and blindness, especially in the elderly. Coagulation abnormalities, changes in blood vessel walls and systemic conditions such as hypertension, atherosclerosis and diabetes mellitus seem to be associated with RVO [1]. However, in many cases none of these factors are present, and the question of hidden risk factors is raised. The glycoprotein Ia/IIa complex (GPIa/IIa), also called integrin α2β1, is a receptor for collagen that mediates platelet adhesion to the subendothelium [2]. The GPIa/IIa density on the human platelet membrane is highly variable among healthy individuals [3]. Two linked polymorphisms (C807T/G873A) within the GPIa gene have been identified. Individuals with the 807C and 873G alleles have a low density of receptors, whereas individuals with the 807T and 873A alleles have a high density of receptors [4]. Low receptor density has been associated with bleeding disorders [5], while a high receptor density has been proposed as a possible risk factor for arterial thrombosis [6, 7]. In 2003, the 807T polymorphism of the GP Ia gene was implicated as a risk factor for retinal vein occlusion [8]. Subsequently, two other studies have not confirmed this association [9, 10]. To examine this issue, a 1:1 matched case–control study was performed, including all patients referred to our hemostasis laboratory between March 1999 and January 2005 due to RVO, confirmed by fluorescein angiography. A pool of controls was created, which consisted of healthy individuals brought in by the patients, and not genetically related. Cases and controls were matched by age (+/3 years), sex and racial background. Hypertension, diabetes mellitus, smoking, high serum cholesterol and the C807T polymorphism in the GP Ia/IIa gene were assessed as potential risk factors for retinal vein thrombosis. The series included 30 (43%) men and 40 (57%) women, with a median age of 61 years (range 17–84 years). Fifty patients (71%)were Caucasians and 20 (29%) were AfricanBrazilians. The prevalence of risk factors and C807T genotypes is shown in Table 1. Thirty-six patients (51%) and 43 controls (61%) had the 807T polymorphism (807CT or 807TT). A total of 37 case–control pairs were concordant in regard to the platelet polymorphism. The analysis of the remaining 33 discordant pairs showed a matched-pair odds ratio of 0.65 (95% confidence interval 0.31 to 1.37, p=0.29). Fortytwo patients (60%) and thirty (43%) controls had hypertension ( matched-pair odds ratio 2.71, 95% confidence interval 1.08 to 7.10, p=0.03). The prevalences of other risk factors were similar in the two groups. The prevalence of the 807T genotype was identical in the 37 patients with central RVO and the 33 patients with branch RVO (51%). The prevalence of the 807T genotype was also very similar in patients younger than 60 years old (52%) and in older patients (50%). Also, when individuals with genotype 807TT were compared with those with 807CC, no association with Graefe’s Arch Clin Exp Ophthalmol (2007) 245:1739–1740 DOI 10.1007/s00417-007-0617-2

Perfil socioeconômico e epidemiológico dos pacientes submetidos à cirurgia de catarata em um hospital universitário

PURPOSE: To determine the socio-economic characteristics of the patients who were submitted to cataract surgery in a university hospital, to evaluate the accessibility to the tertiary health service and to determine the waiting time for cataract surgery. METHODS: A cross-sectional study of medical charts from 148 random patients who underwent cataract surgery during the first semester of 2007. RESULTS: The patients in this study had median of age of 70.5 years, and the major prevalence was of female (60.1%), caucasian (48.0%), with low educational level (incomplete fundamental study, 50.7%), best corrected visual acuity 20/200 or worst; the diagnosis of cataract was done at the University Hospital in a routine appointment (47.8%). Only 9.4% of patients submitted to the surgery had his diagnosis done in a cataract campaign. The average time between the diagnosis and the surgery was 3.5 months and the delay was mainly due to pre operative exams. CONCLUSION: The majority of patients in the Brazilian Public Health System have low family income. The system takes a long time to access surgical procedures that need to be addressed in a proper time manner. The result of the long wait is subnormal vision. It is important to highlight the cataract campaign in order to enroll patients with low income in a hospital of high complexity.

Ophthalmic manifestations in patients with inflammatory bowel disease: A review

Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.

Anterior and Intermediate Uveitis Following Yellow Fever Vaccination with Fractional Dose: Case Reports

ABSTRACT Purpose: To describe two cases of anterior and intermediate uveitis following yellow fever vaccination with fractional dose. Methods: Case report. Results: Case 1: A 35 year-old healthy woman presented with unilateral anterior uveitis 10 days after the yellow fever vaccination. Testing excluded infectious and rheumatic diseases and the episode was fully recovered after a short course of topical treatment. Case 2: A 21 year-old previously healthy woman presented with blurred vision in the left eye (OS) 14 days after the yellow fever vaccination. The ophthalmic examination of the OS revealed intermediated uveitis. Testing excluded infectious and neurological diseases. After six weeks of treatment with oral prednisone, the ocular inflammation had resolved. Conclusion: Physicians should be aware of the possibility of eye inflammation following the yellow fever vaccination.

Acute Zonal Occult Outer Retinopathy (AZOOR) in a patient with Hashimoto's thyroiditis

Acute zonal occult outer retinopathy (AZOOR) is a rare disease characterized by an acute damage of one or more external retinal zones leading to the visual field or the visual acuity impairment associated with small or no changes in the fundus examination.The main clinical symptoms are scotomas and the sudden onset of photopsias. Abnormal findings on electroretinography and visual field defects are critical for the diagnosis. Central vision is usually preserved and the stabilization occurs in six months in most cases. The objective of this article is to describe a 24-month follow-up of a patient with AZOOR and correlate the findings with the typical features of this disease.

Delayed Descemet's membrane detachment after successful cataract surgery: a case report

O descolamento da membrana de Descemet pode ser uma complicacao grave apos a cirurgia de catarata, resultando em edema de cornea e reducao da acuidade visual. Este relato descreve um caso raro de descolamento da membrana de Descemet seis meses apos cirurgia de catarata com facoemulsificacao sem intercorrencias, documentado com tomografia de coerencia optica do segmento anterior (OCT; RTVue, Optovue). Foram realizadas descemetopexia pneumatica e sutura corneana, com resolucao do descolamento e recuperacao visual. Este relato procura alertar os medicos que o edema de cornea tardio pode estar relacionado ao descolamento tardio da membrana de Descemet, que exige tratamento adequado para evitar descompensacao corneana permanente.

Confirmação do cálculo de lente intraocular através da refração intraoperatória

This paper describes the intraoperative refraction for intraocular lens (IOL) power calculation. Report a case of a 67 year-old male patient reporting a progressive loss of visual acuity in the left eye (OS). Examination revealed best corrected visual acuity (BCVA) of 20/60 (-21,50 -4,00 X 170) related to adherence of silicone oil to the IOL optic. IOL exchange was proposed, however biometry was variable and doubtful. Intraoperative refraction confirmed the IOL power and the patient underwent uneventful IOL explantation and exchange with a three-piece acrylic IOL. After surgery, examination revealed BCVA OS of 20/30 (-1,25 -1,25 X 180). Analysis of explanted IOL confirmed adherence of silicone oil to the IOL optic. Intraoperative refraction is useful to confirm IOL power calculation.

Diagnóstico e tratamento do lenticone anterior

Case report of a 18-year-old male patient with Alports syndrome, who presented with renal failure and hearing loss reporting a progressive loss of vision acuity. Slitlamp examination revealed bilateral anterior lenticonus. The patient underwent pre and post-operative corneal and anterior segment tomography with a rotating Scheimpflug system (Pentacam), integrated whole eye (individual laser beam ray tracing) and corneal surface (Placido) wavefront aberrometry (i-Trace). Phacoemulsification and single piece hydrophobic IOL implantation (Acrysof® SN60AT) was performed uneventfully in both eyes. Pre op Scheimpflug well decomented the anterior lenticonus. Total aberrometry showed myopic astigmatisms with high negative spherical aberrations OU; higher order aberrations (HOAs) greatly influenced the conversion of Snellen E letters. Total aberrations and corneal topographies integration maps OU demonstrated high levels of intraocular aberrations which had more similarity with whole eye aberrations than anterior corneal aberrations. After surgery, BCVA was 20/20 in both eyes. Scheimpflug images revealed topic intraocular lens and the differential maps showed resolution of myopia and decrease of the total ocular HOAs as well as from the internal optics. Adjunctive advanced diagnostic tools were useful to demonstrate the anterior lenticonus and its optical impact along with the resolution of the aberrations post operatively.

Uso de ciclosporina 0,05% tópica no tratamento do olho seco de pacientes portadores do vírus HIV

), testede Schirmer I, tempo de ruptura do filme lacrimal e coloracao da superficie ocular comrosa bengala a 1%. Os pacientes foram distribuidos em dois grupos com dez pacientes(20 olhos) e acompanhados durante seis meses. O grupo I foi tratado com colirio decarboximetilcelulose sodica 0,5% e o grupo II foi tratado com a associacao decarboximetilcelulose sodica 0,5% e ciclosporina 0,05% topica.