Augusto Paranhos Junior

Aspectos clínicos e epidemiológicos da conjuntivite alérgica em serviço de referência

BACKGROUND: To evaluate demographic and clinical features of patients with allergic conjunctivitis in a reference center. METHODS: Prospective study using sings and symptoms graduated by standardized charts for clinical diagnosis. RESULTS: We evaluated 207 patients, age ranging form 1 to 45 years and of whom 131 (63.28%) were males. Of the patients, 38.65% presented vernal keratoconjunctivitis; 38.65%, atopic keratoconjunctivitis; 12.56%, perennial allergic conjunctivitis and in 10.14% patients the diagnosis was not defined. Extraocular allergy was more frequent in patients with atopic keratoconjunctivitis (91.25%) and less frequent in patients with vernal keratoconjunctivitis (32.5%). Family history of allergy was more frequent in patients without defined diagnosis (59.1%) and less frequent in the vernal group (28.75%). The most itense symptoms were itching and tearing in patients with keratoconjunctivitis. There was a positive correlation between symptom intensity and signs severity. CONCLUSION: Chronic and severe types of ocular allergy, with potential threat to visual function, predominated in the studed group.

Custo real do tratamento do glaucoma para o paciente

Objetivo: Avaliar o custo do tratamento do glaucoma para o paciente, numa instituicao de ensino medico. Casuistica e Metodos: Foram aplicados, aleatoriamente, questionarios, na forma de entrevista ativa, a 94 pacientes do ambulatorio do Setor de Glaucoma do Departamento de Oftalmologia da Universidade Federal de Sao Paulo, analisando gastos pessoais e com medicamentos antiglaucomatosos. Os dados foram agrupados, tabulados e foi realizada separacao da amostra em dois grupos: pacientes cirurgicos e nao-cirurgicos. Resultados: A mediana do gasto total anual estimado com glaucoma foi de R

Intraocular pressure and ocular perfusion during hemodialysis

480,15, o equivalente a 13% da renda anual mediana dos pacientes. Separadamente, o grupo dos pacientes cirurgicos obteve uma mediana dos gastos totais estimados de R

Características dos pacientes atendidos pela primeira vez no Setor de Glaucoma da Universidade Federal de São Paulo - UNIFESP

677,94, o que corresponde a 19% da renda mediana anual. Ja o grupo dos pacientes nao-cirurgicos, apresentou mediana de R

Glaucoma anterior chamber morphometry based on optical Scheimpflug images

393,54, representando 11% da renda mediana anual. Foi encontrada diferenca estatisticamente significante entre os grupos cirurgico e nao-cirurgico para o gasto total anual (p = 0,012). Conclusao: Observou-se que o custo do tratamento na renda familiar de pessoas portadoras de glaucoma e consideravel, mesmo em uma instituicao publica

Redes neurais artificiais aplicadas no estudo de questionário de varredura para conjuntivite alérgica em escolares

AIM To evaluate the intraocular pressure and ocular perfusion pressure during a hemodialysis. METHODS Sixty-seven eyes from thirty-five patients were evaluated at the beggining of hemodialysis, 2 hours and 4 hours after initiation. Intraocular pressure was evaluated using a Tonopen. Systolic and diastolic arterial pressures were measured with a manual sphygmomanometer. The ocular perfusion pressure was estimated by measuring the difference between 2/3 of the mean arterial pressure and the intraocular pressure values. Generalized estimating equations were used to evaluate the difference between the repeated measurements using the appropriate correction for inter-eye dependency. RESULTS There was no statistically significant difference in ocular perfusion pressure, in intraocular pressure (p=0.93) and in systolic arterial pressure (p=0.92) at the three time points (p=0.69). But, when analyzing the extreme values, some patients exhibited lower diastolic perfusion pressures at all time points. CONCLUSION Our results did not support the view that significant changes in ocular perfusion pressure and intraocular pressure occur during hemodialysis session. However, we observed that some patients exhibited lower diastolic perfusion pressures, which could be a poor prognostic factor for glaucoma patients.

Factors affecting the variability of the Heidelberg Retina Tomograph III measurements in newly diagnosed glaucoma patients

OBJETIVO: Avaliar as caracteristicas clinicas dos pacientes portadores de glaucoma em um servico universitario de referencia. METODOS: Realizou-se um estudo retrospectivo e descritivo de 822 prontuarios de pacientes atendidos pela primeira vez no Setor de Glaucoma da Universidade Federal de Sao Paulo - UNIFESP, no periodo de janeiro de 2000 a janeiro de 2001. Os dados obtidos de cada paciente foram oriundos de uma avaliacao dos prontuarios destes pacientes. Avaliaram-se alguns dados sociodemograficos e caracteristicas clinicas dos pacientes glaucomatosos deste setor. RESULTADOS: A amostra era composta, em sua maioria, por pacientes idosos, brancos, femininos, casados e aposentados ou do lar, com cerca de 89,65% procedentes do estado de Sao Paulo. Encontrou-se neste estudo, 56,44% dos olhos avaliados com acuidade visual menor que 1,0 logMAR. Os casos com acuidade visual maior ou igual a 1,0 logMAR corresponderam a 41,9% dos olhos. A escavacao do disco optico ja se encontrava avancada (maior ou igual a 0,8) em 691 (42,03%) olhos, sendo que em 324 (19,7%) existia uma escavacao total do nervo optico. CONCLUSAO: Observou-se que o numero de pacientes em estado avancado da doenca era consideravel, e que 41,90% dos pacientes atendidos pela primeira vez apresentavam cegueira em pelo menos um dos olhos e que 42,03% apresentavam escavacoes do disco optico maiores ou iguais que 0,8, sugerindo casos avancados de glaucoma.

Direct cyclopexy surgery for post-traumatic cyclodialysis with persistent hypotony: ultrasound biomicroscopic evaluation

PURPOSE To compare the performance of gonioscopy and noncontact morphometry with anterior chamber tomography (High Resolution Pentacam - HR) using optical Scheimpflug images in the evaluation of the anterior chamber angle (ACA). METHODS Transversal study. 112 eyes from 74 subjects evaluated at the Glaucoma Department, Fluminense Federal University, underwent gonioscopy and Pentacam HR. Using gonioscopy, the ACA was graded using the Shaffer Classification (SC) by a single experienced examiner masked to the Pentacam HR findings. Narrow angle was determined in eyes in which the posterior trabecular meshwork could not be seen in two or more quadrants on non-indentation gonioscopy (SC Grade 2 or less). Pentacam HR images of the nasal and temporal quadrants were evaluated by custom software to automatically obtain anterior chamber measurements, such as: anterior chamber angle (ACA), anterior chamber volume (ACV) and anterior chamber depth (ACD). RESULTS Based on gonioscopy results, 74 (60.07%) eyes of patients classified as open-angle (SC 3 and 4) and 38 (33.93%) eyes of patients classified as narrow-angle (SC 1 and 2). Noncontact morphometry with Scheimpflug images revealed a mean ACA of 39.20 ± 5.31 degrees for open-angle and 21.18 ± 7.98 degrees for narrow-angle. The open-angle group showed significant greater ACV and ACD values when compared to narrow-angle group (ACV of 193 ± 36 mm³ vs. 90 ± 25 mm³, respectively, p<0.001; and ACD of 3,09 ± 0,42 mm vs. 1,55 ± 0,64 mm, respectively, p<0.0001.). In screening eyes with open-angle and narrow-angle with the Pentacam ACA of 20º (SC Grade 2) using the ROC curves, the analysis showed 52.6% of sensitivity and 100% of specificity. CONCLUSIONS The Pentacam showed ability in detecting eyes at risk for angle closure analyzing ACV and ACD.

The potential neuroprotective effects of weekly treatment with glatiramer acetate in diabetic patients after panretinal photocoagulation

OBJETIVO: Avaliar sensibilidade e especificidade de questionario escrito de varredura para alergia ocular por analises multivariaveis. Comparacao entre os modelos de analise multivariavel; elaboracao de rede neural artificial para varreduras futuras. METODOS: Estudo observacional, transversal realizado na UNIFESP, com 48 pacientes portadores de conjuntivite alergica e 54 criancas sadias. A idade variou entre 3 e 14 anos, sem restricao quanto ao sexo, doenca alergica sistemica ou tratamento. Aplicou-se questionario desenvolvido e procedeu-se a uma analise estatistica multivariavel. Por fim, elaborou-se uma rede neural artificial. RESULTADOS: A media de idade dos participantes foi 8,4 anos (4 a 13 anos), com predominio do sexo masculino (60,8%). A pontuacao media do questionario foi 10 (0 a 18). A media do escore do grupo controle foi inferior ao grupo estudo (p<0,001). O diagnostico de alergia foi melhorado em 68,8% com a inclusao da questao 5. Nao houve concordância entre os diagnosticos clinico e o efetuado pelo questionario (kappa = 0,337, p=0,071). Somente a questao 5 apresentou boas sensibilidade (85,4%) e especificidade (85,1%). O ponto de corte capaz de separar doentes de nao-doentes foi 10 (sensibilidade= 77,0%, especificidade= 79,6%, acuracia de 85,7%). A rede neural foi capaz de predizer os pacientes alergicos em 100% dos casos, com 7 das 15 questoes. CONCLUSOES: Conseguiu-se chegar a um modelo confiavel, utilizando apenas sete itens, tornando facil a aplicacao do QE em larga escala.

Agreement between optical coherence tomography and fundus fluorescein angiography in post-cataract surgery cystoid macular edema

PURPOSE To determine factors associated with the test-retest variability of optic nerve head (ONH) topography measurements with confocal scanning laser ophthalmoscopy (CSLO) in newly diagnosed glaucomatous patients. METHODS Consecutive patients with newly diagnosed primary open-angle glaucoma were prospectively enrolled. Patients presenting with any ocular disease other than glaucoma were excluded. All patients underwent CSLO using the Heidelberg Retina Tomograph III (HRT-III) in one randomly selected eye (three consecutive scans; performed by the same examiner). For each Heidelberg Retina Tomograph III parameter, repeatability was assessed using within subject standard deviation (Sw) and coefficient of variation (CVw), repeatability coefficient (RC) and intraclass correlation coefficient (ICC). Scatter plots and regression lines were constructed to identify which factors influenced test-retest measurement variability. RESULTS A total of 32 patients were included (mean age, 65.4 ± 13.8 years). Most patients were female (65%) and white (50%). Among all Heidelberg Retina Tomograph III parameters evaluated, rim area and mean cup depth had the best measurement repeatability. Vertical cup-to-disc ratio (CDR, as determined by optic disc stereophotograph examination) was significantly associated (R²=0.21, p<0.01) with test-retest measurement variability. Eyes with larger CDR showed less variable measurements. Other factors, including age, disc area, central corneal thickness and intraocular pressure were not significant (p>0.14). CONCLUSION Heidelberg Retina Tomograph III showed good test-retest repeatability for all ONH topographic measurements, mainly for rim area and mean cup depth. Test-retest repeatability seemed to improve with increasing CDR. These findings suggest that HRT-III topographic measurements should be cautiously interpreted when evaluating longitudinally glaucoma patients with early structural damage (small CDR).