Carlos Augusto Moreira Júnior

Retinopatia diabética: estudo de uma associação de diabéticos

Objetivo: Avaliar a prevalencia de retinopatia diabetica (RD) em uma associacao de diabeticos, bem como o nivel de informacao dos pacientes a respeito desta doenca. Metodos: O estudo avaliou, aleatoriamente, 46 pacientes de uma associacao de diabeticos que responderam a perguntas sobre conhecimento da RD e avaliacao oftalmoscopica previa e foram submetidos a exame de fundo de olho por oftalmoscopia binocular indireta. Resultados: Entre os diabeticos tipo 1, o estudo encontrou 44,44% dos pacientes com RD e um caso de RD proliferativa; entre os diabeticos tipo 2, 24,3% possuiam RD; 65,22% dos individuos avaliados nunca haviam feito exame de oftalmoscopia, embora 80,43% ja haviam tido alguma informacao sobre RD. Conclusoes: Concluimos que ha baixa cobertura em termos de prevencao e deteccao da RD nesta associacao de diabeticos, o que contrasta com o nivel de informacao dos pacientes sobre a doenca e com o fato de ser uma entidade voltada exclusivamente para o tratamento do diabete.

Optical coherence tomography in patients undergoing cataract surgery

PURPOSE To assess the ability of spectral domain optical coherence tomography (SD-OCT) to diagnose macular changes pre- and post-cataract surgery and to identify changes in central foveal thickness (CFT) relative to age, sex, and presence of concomitant ophthalmic pathologies, for a period of 6 months post-surgery. METHODS A prospective study of patients evaluated by SD-OCT within 5 h before surgery at 7, 30, 60, 90, and 180 days post-op, with respect to CFT and presence of maculopathy. RESULTS Ninety-eight eyes of 98 patients were evaluated, with the following mean results: age = 71.4 years, pre-op VA = 0.27 logMAR, and final VA = 0.73 logMAR. There were 21 eyes in patients with diabetes mellitus (DM) and 10 eyes with age-related macular degeneration (AMD), three with epiretinal membrane, and four with glaucoma. Sixty eyes had no other ophthalmic-related pathologies (NOO), and had a mean pre-op CFT of 222 μm, which progressively increased up to the 60th day post-op, reaching a mean of 227.2 μm. No pseudophakic cystoid macular edema was observed. The mean CFT was statistically significantly different (p<0.001) between NOO and diabetic patients from 30 days post-op. Four eyes presented with preoperative diagnosis of AMD as measured by ophthalmoscopy. After completion of the OCT, which was performed within 5 h before surgery, six additional patients were found to have AMD. Of the 98 total eyes, 10 were diagnosed with maculopathy only by OCT exam. Binocular indirect ophthalmoscopy (BIO) was unable to detect such changes. CONCLUSION OCT diagnosed preoperative maculopathies in 21.4% of the patients, and was more effective than BIO (11.2%). OCT showed a progressive increase in CFT in diabetics up to 180 days post-operatively, as well as greater CFT in male patients and patients older than 70 years.

Síndrome dos cabelos anágenos frouxos associada à distrofia macular: descrição de uma família

The article describes a family with loose anagen hair syndrome (LAHS) associated with macular dystrophy. Complete dermatological and ophthalmological exams, and hair examination under optical and electron microscopy were performed in eleven index cases. Two individuals demonstrated hair findings with LAHS without ocular problems. Within the four cases with ocular problems, two sisters presented with LAHS and pigmentary dispersion on the retina with macular coloboma. Two brothers presented with LAHS and pigmentary dispersion on the retina without macular coloboma. The findings suggest that this new association is a disorder among the ectodermal dysplasia.

A comparison study of corneal topographic changes following 20-, 23-, and 25-G pars plana vitrectomy.

PURPOSE To evaluate and compare corneal topographic changes following pars plana vitrectomy with the 23-gauge (G) and 25-G transconjuntival sutureless vitrectomy system as well as the standard 20-G vitrectomy system. METHODS We prospectively evaluated corneal topographic changes in 45 eyes of 45 patients divided into three groups according to vitrectomy system used (20-, 23-, and 25-G). All patients underwent computer-assisted videokeratography using an EyeSys System 3000 topographer preoperatively and at one week, one month, and three months postoperatively. RESULTS In the 20-G vitrectomy group, we found statistically significant postoperative changes in corneal curvature parameters with an average steepening of 0.98 ± 0.18 D (P<0.001) and 0.93 ± 0.21 D (P<0.001) at one week and one month, respectively. No statistically significant difference was observed at the three-month follow-up visit. In the 23- and 25-G groups, no statistically significant changes in corneal curvature parameters were observed at any postoperative follow-up visit. CONCLUSION Twenty-three-gauge and 25-gauge transconjunctival sutureless vitrectomy did not induce topographic corneal changes following surgery, whereas 20-G vitrectomy was found to induce transient topographic corneal changes that had returned to preoperative levels at three months postoperatively.

Descrição de nova distrofia macular associada à síndrome dos cabelos anágenos frouxos

Purpose: To describe the ophthalmological, dermatological, light microscopy (LM) and scanning electron microscopy (SEM) findings of a new macular dystrophy associated with the loose anagen hair syndrome (LAHS). Methods: A family of seven patients, four of them affected, was examined. The patients underwent a complete ophthalmological examination, color test (Ishihara and Farnsworth D-15), ecography, angiography, laboratory and dermatological tests, sweat test, light microscopy and scanning electron microscopy of the hair. Results: In two affected sisters we found on eye fundoscopy pigmentary dispersions in the posterior pole of the retina, with macular staphyloma. In two brothers, the same pigmentary dispersions in the posterior pole was found, with more pigmentation and a yellow coloring in the macular area and without staphyloma. The light microscopy and scanning electron microscopy evaluation of the affected individuals confirmed loose anagen hair syndrome. In a not affected woman and man all examinations were normal, except the light microscopy and scanning electron microscopy that showed some similarities with the affected individuals. As for the way of inheritance, the pedigree is compatible with autosomal recessive inheritance with partial expression of the heterozygote. Conclusions: There is only one report in the international literature of loose anagen hair syndrome association with ocular coloboma. In this study we describe the findings of a new macular dystrophy associated with the loose anagen hair syndrome, a dystrophy whose fundoscopy findings are different between men and women. Since it is the first report in the literature, the described findings strongly suggest that this association can be part of a new nosological entity.

Discromatopsias congênitas e condução de veículos

Purpose: To determine the importance of the Ishihara test for the diagnosis of congenital dyschromatopsias and evaluate their incidence in a population of drivers, to assess the most common mistakes in the Color Box test and to study the relationship between dyschromatopsia, driving and traffic accidents. Methods: 523 drivers were examinated, in conformity with Contran resolution 734/89. The drivers were submitted to the color test with Ishihara plates, and those who had dyschromatopsia were submitted to the Color Box test (red, yellow and green), with LEDs as used in a traffic light. Results: An incidence of 5.5% (29 patients) of dyschromatopsias was observed. Of these patients, 3 were excluded from the study, 16 had severe disease and 10 had mild disease. In the latter group, 7 presented deuteranomaly and 3 protanomaly. Of those with deuteranomaly, 3 presented alterations in the Color Box test and 4 did not. Of those with protanomaly, 1 patient had abnormal results and 2 were normal. Of the patients with severe disease, 14 presented deuteranopia and 2 protanopia. All of them had an abnormal Color Box test. Conclusion: All patients with severe disease and half of those with moderate disease, made mistakes in the Color Box test. This study concludes that the Color Box test does not need to be performed in those patients who had the Ishihara Plate test done to diagnose congenital dyschromatopsias.

Vitrectomia e troca fluido-gasosa para o tratamento do descolamento seroso da mácula por fosseta de disco óptico: avaliação de longo prazo

PURPOSE: To evaluate 5 patients with serous macular detachment due to optic disc pit that were submitted to pars plana vitrectomy and were followed for at least 7 years. METHODS: Patients were submitted to pars plana vitrectomy, posterior hyaloid removal, autologous serum injection and gas-fluid exchange, without laser photocoagulation, and were evaluated pre and post-operatively with visual acuity and Amsler grid testing, retinography, and recently, with autofluorescence imaging and high resolution OCT. RESULTS: All 5 eyes improved visual acuity significantly following the surgical procedure maintaining good vision throughout the follow-up period. Mean pre-operative visual acuity was 20/400 and final visual acuity was 20/27 with a mean follow-up time of 13.6 years. No recurrences of serous detachments were observed. OCT examinations demonstrated an attached retina up to the margin of the pit. CONCLUSION: Serous macular detachments due to optic disc pits were adequately treated with pars plana vitrectomy and gas fluid exchange, without the need for laser photocoagulation, maintaining excellent visual results for a long period of time.OBJETIVO: Avaliar 5 olhos com descolamento seroso da macula devido a fosseta de disco optico que foram submetidos a vitrectomia via pars plana e seguidos por pelo menos 7 anos. METODOS: Os pacientes foram submetidos a vitrectomia via pars plana, remocao da membrana hialoide posterior, injecao de soro autologo e troca fluido-gasosa, sem aplicacao de fotocoagulacao a laser, e foram testados quanto a acuidade visual, tela de Amsler, retinografia e, recentemente, retinografia com autofluorescencia e OCT de alta resolucao. RESULTADOS: Todos os 5 olhos operados tiveram significativa melhora da visao apos o procedimento cirurgico, mantendo boa visao durante todo periodo de acompanhamento. A acuidade visual pre-operatoria media foi de 20/400 enquanto a acuidade visual final foi de 20/27 com um tempo medio de seguimento de 13,6 anos. Nao foram observadas recorrencias do descolamento seroso da macula e os exames de OCT mostraram a retina perfeitamente aplicada ate a margem da fosseta de disco optico. CONCLUSAO: Descolamentos serosos da macula causados por fosseta de disco optico sao adequadamente tratados com vitrectomia via pars plana e troca fluido-gasosa, sem a necessidade de fotocoagulacao da retina, mantendo excelente acuidade visual por varios anos apos o procedimento, sem o aparecimento de recorrencias.

Distrofia retiniana com onda rápida escotópica (DRORE) associada à síndrome dos cabelos anágenos frouxos (SCAF). Parte II: Genética

OBJETIVOS: Propor complementacao da atual classificacao do eletrorretinograma (ERG) com a inclusao deste novo tipo de onda, discutir os possiveis mecanismos para a distrofia retiniana com onda rapida escotopica (DRORE) associada a sindrome dos cabelos anagenos frouxos (SCAF) e analise do heredograma da familia estudada. METODO: Foram descritos na parte I deste trabalho. RESULTADOS: A analise do heredograma da familia demonstrou tratar-se de heranca autossomica recessiva com expressao parcial no heterozigoto; outros resultados foram descritos na parte I deste trabalho. CONCLUSOES: Por se tratar do primeiro relato na literatura, os achados descritos sugerem fortemente que a distrofia retiniana com onda rapida escotopica associada a sindrome dos cabelos anagenos frouxos pode ser uma nova entidade nosologica. Neste trabalho propomos uma classificacao inedita de todas as distrofias maculares e degeneracoes retinianas associadas a disturbios capilares no grupo B das displasias ectodermicas.

Ophthalmological manifestation of the Klippel Trenaunay Syndrome

The Klippel-Trenaunay Syndrome (KTS) is a rare congenital disease, which the prevalence is higher in males, and its incidence of 25:100,000. It is presented in its classic form as the triad of port-wine stains, enlarged limbs and venous and / or lymphatic malformation. The diagnosis is essentially clinical and due to the complexity of the syndrome, the progressive characteristic and the wide variety of clinical presentations, a multidisciplinary team should treat patients individually. The ocular changes associated with KTS include vascular, orbit, iris, retina, choroid and optic nerve abnormalities. Case report: A 23-year-old female patient, carrier KTS, being followed at Vision Center - Federal University of Parana, complaining of decreased visual acuity in the right eye. The patient had port-wine stains in right hemibody and hypertrophy of ipsilateral members. Glaucoma was diagnosed and eye exams were performed to assess the degree of impairment of visual fields and fundus. The best correction was checked at 20/100 OD and 20/20 OS. At fundoscopy, there was increased excavation of the optic nerve right - 0.75 x 0.90 mm. Clinical treatment was chosen with Dorzolamide Hydrochloride, Latanoprost, Brimonidine and Timolol, presenting good long-term results - the tonometry showed 19 mmHg OD and 15 mmHg OS, despite the difficulty in stabilizing the disease. Conclusion: Reports have shown that the results of clinical and surgical treatments of glaucoma in association with KTS are unsatisfactory compared to other types of glaucoma - clinical control is not possible in about 1/ 3 of patients and the surgical management has a high rate of complications. Significant studies are needed to establish the correlation between glaucoma and KTS, and base the treatment of choice.

Distrofia retiniana com onda rápida escotópica (DRORE) associada à síndrome dos cabelos anágenos frouxos (SCAF). Parte I: Achados oftalmológicos

OBJETIVOS: Descrever os achados oftalmologicos de nova distrofia macular associada a sindrome dos cabelos anagenos frouxos (SCAF). METODOS: Uma familia de onze pacientes, quatro deles afetados ocularmente, foram examinados. Sete pacientes foram submetidos aos seguintes exames: avaliacao oftalmologica completa, teste de cores, ecografia, angiografia, campo visual, topografia de papila, eletro-oculograma (EOG), eletrorretinograma (ERG), testes laboratoriais e exame dermatologico, teste de suor, microscopia optica (MO) e microscopia eletronica de varredura (MEV) dos fios de cabelo. Em quatro pacientes, filhos dos afetados, realizamos somente exame oftalmologico, microscopia optica e microscopia eletronica de varredura dos fios de cabelo. RESULTADOS: Dos quatro pacientes afetados, em duas irmas encontramos no fundo de olho dispersoes pigmentares em polo posterior da retina, com coloboma macular. Em dois de seus irmaos foram encontradas as mesmas alteracoes oculares, com maior pigmentacao e coloracao amarelada em area macular e ausencia de coloboma. Os resultados do eletro-oculograma e eletrorretinograma estavam dentro dos limites de normalidade em tres pacientes sem alteracoes oculares; por outro lado, o eletro-oculograma foi subnormal e o eletrorretinograma foi subnormal com tempo de culminacao diminuido (rapido) na fase escotopica dos pacientes com a distrofia macular, sugerindo que a alteracao dessa distrofia se encontra em nivel do epitelio pigmentado da retina. Devido a esse comportamento peculiar do tempo de culminacao, este achado pode ser considerado como fundamental para o diagnostico desta distrofia. A denominacao sugerida e de distrofia retiniana com onda rapida escotopica (DRORE). A microscopia optica e microscopia eletronica de varredura dos fios de cabelo confirmaram a sindrome dos cabelos anagenos frouxos. CONCLUSOES: Descrevemos os achados da distrofia retiniana com onda rapida escotopica associada a sindrome dos cabelos anagenos frouxos, distrofia cujos achados fundoscopicos sao diferentes entre homens e mulheres e com tracado eletrorretinografico caracteristico.