Enyr Saran Arcieri

A study of glaucoma after penetrating keratoplasty.

Purpose. To identify the incidence and risk factors associated with the development of glaucoma after penetrating keratoplasty. Methods. A retrospective study was carried out in 228 patients who underwent penetrating keratoplasty from January 1995 to January 2000 at the Cornea Section of the Ophthalmology Service at the School of Medicine, Federal University of Uberlândia MG, Brazil. Follow-up time ranged from 4 to 60 months (mean, 17.14 ± 13.65). Results. Two hundred twenty-eight patients undergoing penetrating keratoplasty were evaluated and 49 (21.5%) developed glaucoma. Risk factors for developing glaucoma were bullous keratopathy [relative risk (RR) = 2.1774), herpesvirus (RR = 1.8979), and trauma (RR = 1.0575). Mean intraocular pressure before transplantation was 15.26 ± 5.37 mm Hg. Intraocular pressure after transplantation ranged from 22 to 58 mm Hg, with a mean value of 30.04 ± 7.06 mm Hg. Thirty-six (73.5%) patients had medical treatment, 10 (20.4%) had medical and surgical treatment, and three (6.1%) had surgical treatment. Final intraocular pressure ranged from 4 to 34 mm Hg (mean, 16.79 ± 5.36). Conclusion. The incidence of glaucoma after penetrating keratoplasty is high, and the risk factors include aphakic/pseudophakic bullous keratopathy, herpes simplex virus, and trauma.

Blood pressure and glaucoma

Although intraocular pressure (IOP) is considered the main risk factor for the development of glaucoma and the only parameter subject to treatment, there is sufficient evidence to suggest that glaucoma may continue to progress despite lowering patients’ IOP to targeted levels. Several studies have implicated vascular risk factors in the pathogenesis of glaucoma. Among them, blood pressure (BP) and ocular perfusion pressure have become increasingly important. Although clinicians cannot currently visualise ocular blood flow directly, they can easily measure glaucoma patients’ BP and IOP to calculate their ocular perfusion pressure and quantify the vascular changes. The purpose of this review article is to discuss the relationship between BP and IOP, BP and glaucoma, and perfusion pressure and glaucoma. We discuss the importance of autoregulation to maintain the adequate perfusion of the optic nerve head, and suggest that ocular perfusion pressure and its fluctuation may be parameters that need to be measured in glaucoma patients.

Ocular Lesions Arising After Stings by Hymenopteran Insects

Purpose. To describe the ocular lesions that occur after stings from hymenopteran insects. Methods. We examined the ocular alterations in five patients who suffered ocular trauma from hymenopteran insect stings. Results. In 4 cases where the insect was identified as a wasp, all the patients presented with persistent corneal decompensation and two presented with total cataract, requiring surgical treatment. In the case of trauma by a bee sting, the patient presented with corneal edema and an inflammatory reaction of the anterior chamber with total regression of these alterations after clinical treatment. Conclusion. Although a rare occurrence, ocular trauma caused by hymenopteran insects can result in severe ocular alterations in humans.

Comparing the fixed combination brimonidine-timolol versus fixed combination dorzolamide-timolol in patients with elevated intraocular pressure

ABSTRACT Purpose: To evaluate the efficacy of fixed combination brimonidine-timolol (FCBT) versus fixed combination dorzolamide-timolol (FCDT) given twice daily in patients with primary open angle glaucoma (POAG) or ocular hypertension (OH). Design: Prospective, multicentre, masked-observer, crossover comparison. Participants: Sixteen patients with POAG and 14 with OH. Methods: The participants of the study were washed out from their previous medication and randomized to fixed FCBT or FCDT for the first 4‑week treatment period. Subjects then were washed for 4 weeks and started on the opposite medication forthe second 4‑week period. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometer at 8:00 a.m., 12:00 noon and 4:00 p.m. at each baseline and at the end of each treatment period. Unsolicited ocular adverse events were also recorded. Main outcome measures: Comparison of the IOP lowering effect of FCBT and FCDT. Results: The baseline mean diurnal IOP for all 30 subjects (30 eyes) was 22.9 ± 1.6 mmHg. Both fixed combinations significantly reduced IOP compared with baseline ( p < 0.00001). The mean diurnal IOP following 4 weeks of therapy was 15.0 ± 2.1 mmHg for FCBT and 15.4 ± 2.1 mmHg for FCDT ( p = 0.510). The mean diurnal IOP reduction was 7.8 ± 1.9 mmHg for FCBT and 7.4 ± 1.8 mmHg for FCDT ( p = 0.430). Overall, 14 subjects complained about ocular adverse events: two only for FCBT, seven only for FCDT and five for both drugs. Although there was no significant difference between the number of subjects that reported ocular adverse events with FCBT (n = 7) and FCDT (n = 12) ( p = 0.359), FCDT caused more ocular stinging upon instillation (n = 9) than FCBT (n = 1) ( p = 0.027). Conclusion: This study suggests that FCBT and FCDT, each given twice daily, have similar efficacy in patients with POAG or OH.

Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing ahmed glaucoma valve implantation: 2-year follow-up

To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) in eyes with neovascular glaucoma (NVG) undergoing Ahmed glaucoma valve (AGV) implantation.

Bilateral endogenous endophthalmitis associated with infective endocarditis: case report

Bilateral endogenous endophthalmitis is a rare condition initiated by infection by microbes in the bloodstream, such as those arising from a foci of infective endocarditis. We report a case and discuss the diagnostic aspects and the clinical outcome of a patient with characteristic findings of the disease. The patient was a 49 year old white male who had a metallic aortic valve implanted 7 months previously, and who presented to the hospital with 10 days of fever, cough and dyspnea, then diarrhea and mental confusion. On the second day of hospitalization, he experienced sudden loss of vision in both eyes. A Gram-positive coccobacillus was isolated from the bloodstream, he was treated with fluoroquinolone with disappearance of fever, decreased ocular inflammation, and improvement in his vision to light perception. He later underwent valve replacement surgery but died during the procedure. We review the occurrence of ocular signs and symptoms and their importance in patients with endocarditis.

Infectious Keratitis Secondary to Histoplasma capsulatum: The First Case Reports in Humans

The authors report an unusual case of fungal keratitis caused by Histoplasma capsulatum in a male immunocompetent patient. PCR confirmed the presence of the fungus DNA in the material studied. To our knowledge this is the first reported case in humans described all over the world.

Curva de aprendizado e flutuações a curto e longo prazos com perimetria de freqüência dupla (FDT)

OBJECTIVE: To evaluate the learning effect, short-term fluctuation and long-term fluctuation in healthy subjects undergoing frequency doubling perimetry (FDP). METHODS: Twenty healthy young subjects underwent FDT (program N30, full threshold) in one eye (right). Each subject was tested once in the first three sessions and three times in the fourth session. Both short- and long-term fluctuations were studied as the average fluctuation of all the tested points or as a point-to-point fluctuation. To study the learning effect, the MDs values of the first session were compared to the second, third and fourth sessions. RESULTS: In the short-term analysis (3 examination done in the last session), the total mean sensitivity was 31.91 ± 1.20 dB and the mean MD and PSD were 0.84 ± 1.85 and 3.73 ± 1.55 dB, respectively. The average short-term fluctuation was 1.72 ± 0.38 dB. When the four examination, performed at different visits, were compared, the average mean sensitivity of all sessions and the average long-term fluctuation were 31.75 ± 1.11 and 2.16 ± 0.26 dB, respectively. The MD averages of the first, second, third and fourth tests were 0.11 ± 2.14 dB, 0.47 ± 1.64 dB, 1.16 ± 1.62 dB and 0.98 ± 1.92 dB respectively. The MD difference between the first and the third and between the first and the fourth examinations were statistically significant (p<0.05). CONCLUSION: The threshold sensitivity detected by FDP is influenced by both short- and long-term fluctuations. We observed a mild learning effect that shoud be taken into account whenever a patient undergoes this test for the first time.

Síndrome ocular isquêmica associada a glaucoma neovascular: relato de um caso

The authors present a case of neovascular glaucoma secondary to ocular ischemic syndrome as the initial manifestation of carotid occlusive disease. Color Doppler imaging of the carotids and orbit showed all the factors associated with a greater risk of developing this syndrome: severe bilateral carotid stenosis, high-grade carotid stenosis, and reversed ophthalmic artery blood flow. The authors also discuss how the neovascular glaucoma was controlled with only one topical medication.

Full threshold vs. Swedish interactive threshold algorithm (SITA) em pacientes glaucomatosos submetidos à perimetria computadorizada pela primeira vez

PURPOSE: To compare the Full Threshold (FT) and SITA Standard (SS) strategies in glaucomatous patients undergoing automated perimetry for the first time. METHODS: Thirty-one glaucomatous patients who had never undergone perimetry underwent automated perimetry (Humphrey, program 30-2) with both FT and SS on the same day, with an interval of at least 15 minutes. The order of the examination was randomized, and only one eye per patient was analyzed. Three analyses were performed: a) all the examinations, regardless of the order of application; b) only the first examinations; c) only the second examinations. In order to calculate the sensitivity of both strategies, the following criteria were used to define abnormality: glaucoma hemifield test (GHT) outside normal limits, pattern standard deviation (PSD) <5%, or a cluster of 3 adjacent points with p<5% at the pattern deviation probability plot. RESULTS: When the results of all examinations were analyzed regardless of the order in which they were performed, the number of depressed points with p<0.5% in the pattern deviation probability map was significantly greater with SS (p=0.037), and the sensitivities were 87.1% for SS and 77.4% for FT (p=0.506). When only the first examinations were compared, there were no statistically significant differences regarding the number of depressed points, but the sensitivity of SS (100%) was significantly greater than that obtained with FT (70.6%) (p=0.048). When only the second examinations were compared, there were no statistically significant differences regarding the number of depressed points, and the sensitivities of SS (76.5%) and FT (85.7%) (p=0.664). CONCLUSION: SS may have a higher sensitivity than FT in glaucomatous patients undergoing automated perimetry for the first time. However, this difference tends to disappear in subsequent examinations.