Celso Antonio de Carvalho

Clinical Findings and Hemodynamic Changes Associated with Severe Occlusive Carotid Artery Disease

OBJECTIVE The purpose of the study was to evaluate the ophthalmologic findings and to analyze the retrobulbar hemodynamics of patients with severe (greater than 70% stenosis) occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI). DESIGN A case-controlled study. PARTICIPANTS Fifty-six consecutive patients with severe OCAD and an age- and sex-matched control group consisting of 56 healthy patients without OCAD were studied. INTERVENTION All 112 patients underwent a complete ophthalmologic examination. Color Doppler imaging of both orbits was performed by one masked investigator. MAIN OUTCOME MEASURES Peak systolic velocity, end diastolic velocity, and the resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters measured in patients with severe OCAD with those obtained in the control group. The hemodynamic parameters of patients with asymmetric OCAD (stenosis > 70% in one internal carotid artery and stenosis < 50% in the contralateral artery) were also compared. In an attempt to determine risk factors associated with the ocular ischemic syndrome (OIS), the authors compared patients with severe OCAD and OIS with patients with severe OCAD without OIS. RESULTS Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were significantly lower in patients with severe OCAD (P < 0.01). The mean resistive indices in the central retinal and temporal short posterior ciliary arteries were higher in the group with severe OCAD (P < 0.01). Similar results were obtained in the analysis of 25 patients with asymmetric carotid stenosis. Younger age (P = 0.012), severe bilateral OCAD (P = 0.01), high-grade carotid stenosis (P = 0.013), and reversed ophthalmic artery flow (P = 0.038) were significant risk factors for OIS. CONCLUSIONS Patients with severe OCAD show hemodynamic changes that suggest reduced retrobulbar blood flow. Patients with severe bilateral OCAD, high-grade carotid stenosis, and reversed ophthalmic artery flow may have a greater risk of developing OIS.

The effects of carotid endarterectomy on the retrobulbar circulation of patients with severe occlusive carotid artery disease: An investigation by color Doppler imaging

OBJECTIVE To analyze the effects of carotid endarterectomy on the retrobulbar circulation of patients with severe occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI). DESIGN Prospective. PARTICIPANTS A total of 17 consecutive patients with severe OCAD and neurologic symptoms (with a history of transitory ischemic attack or cerebral vascular accident) participated. INTERVENTION All 17 patients underwent carotid endarterectomy. The CDI of both orbits was performed by one masked investigator before surgery and at 1 week and 1 month after surgery. MAIN OUTCOME MEASURES Peak systolic velocity, end diastolic velocity, and resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters at all intervals. RESULTS Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries increased significantly 1 week and 1 month after carotid endarterectomy (P < 0.05). After surgery, the resistive indices in the central retinal and temporal short posterior ciliary arteries decreased significantly at both intervals (P < 0.05). The six patients who had reversed ophthalmic artery flow before surgery showed forward ophthalmic artery flow after carotid endarterectomy. The contralateral orbits showed no significant hemodynamic change after endarterectomy (P < 0.05). CONCLUSIONS Hemodynamic changes in patients with severe OCAD undergoing carotid endarterectomy suggest improvement in the ipsilateral retrobulbar blood flow.

Collateral blood supply through the ophthalmic artery: A steal phenomenon analyzed by color Doppler imaging

OBJECTIVE This study aimed to evaluate the retrobulbar circulatory effects of reversed ophthalmic artery flow (ROAF) on the ophthalmic artery branches by means of color Doppler imaging. DESIGN The design was a case-controlled study. PARTICIPANTS Among 56 consecutive patients with severe (>70% stenosis) occlusive carotid artery disease, 15 patients (26.8%) with ROAF were identified. The control group consisted of 15 patients with similar degrees of carotid artery stenosis and forward ophthalmic artery flow. INTERVENTION Arteriography and measurement of the retrobulbar hemodynamic parameters with color Doppler imaging were performed. MAIN OUTCOME MEASURES Blood flow velocities and resistive index in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. RESULTS Arteriography confirmed the diagnosis of ROAF in all 15 patients. There was no patient with ROAF diagnosed by arteriography and not diagnosed by color Doppler imaging. The frequency of bilateral severe occlusive carotid artery disease was significantly higher in the ROAF group (40%) compared to the control group (6.6%) (P = 0.04). Patients with ROAF showed significantly reduced vascular resistance in the ophthalmic artery (P = 0.03), higher vascular resistance, and lower blood flow velocities in the central retinal and temporal short posterior ciliary arteries (P < 0.05). CONCLUSION This study suggests that patients with ROAF show a steal phenomenon, characterized by a shunt to the low-resistance intracranial circuit and reduction of retrobulbar blood flow.

Automated perimetry: a study of the glaucoma hemifield test for the detection of early glaucomatous visual field loss.

Summary: In order to verify the ability of the Glaucoma Hemifield Test in detecting early glaucomatous alterations, as well as its sensitivity, specificity, and reproducibility, 78 glaucoma patients, glaucoma suspects, and normals were selected. In those eyes who presented alterations of the optic disc suggestive of glaucomatous damage, but with no typical lesions in the visual field, the test was positive in 18.4% of the cases. The sensitivity, specificity, and reproducibility of the test were 100, 100, and 83.3%, respectively.

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 < -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.

Results of Goniotomy and Trabeculotomy as the Initial Surgical Procedure in the Treatment of Congential Glaucoma

Since 1968, we have been studying patients with congenital glaucoma according to the classification of gonioscopic features proposed by BUSACCA and CARVALHO (1, 2). Three gonioscopic pictures have been considered: persistence, metaplasia, and aplasia of the reticular system of the pectinate ligament, depending on the intensity of the dysplasic process.

Glaucoma crônico simples: modificaçöes de conceito

O proposito dessa revisao foi apresentar o ponto de vista pessoal do autor sobre conceitos de glaucoma cronico simples resultante de um extensivo estudo bibliografico. Ha uma forte tendencia no presente de esgotar a importância do perigo do glaucoma do nervo optico e campo visual como ponto fundamental para a definicao e tratamento da doenca

Relation between axial length and refraction in eyes with congenital glaucoma

The purpose of the present communication was the evaluation of the frequency of refractive error in 107 patients with congenital glaucoma which had their intra-ocular pressure surgically controlled. Those findings were correlated to the respective biometric values of the axial length of the eye. The biometric study was obtained by ultrasonography. The biometric findings and its respective refractive error in the congenital glaucoma group were compared to the same parameters of a group of normal eyes in three different age groups up to the age of 15 years.