Homero Gusmão de Almeida

Neovascular glaucoma: a review

Neovascular glaucoma (NVG) is a secondary glaucoma generally associated with poor visual prognosis. The development of new vessels over the iris and the iridocorneal angle can obstruct aqueous humor outflow and lead to increased intraocular pressure. The underlying pathogenesis in most cases is posterior segment ischemia, which is most commonly secondary to proliferative diabetic retinopathy or central vein retinal occlusion. The neovascularization process in the eye is driven by the events that alter the homeostatic balance between pro-angiogenic factors, such as the vascular endothelial growth factor and anti-angiogenic factors, such as the pigment-epithelium-derived factor. Early diagnosis of this condition through slit lamp examination of the iris, iridocorneal angle and retina can help to avoid the development of goniosynechia and obstruction of aqueous humor outflow, with consequent intraocular pressure elevation. Historically, NVG treatment was focused on reducing the posterior segment ischemic process that caused the formation of new vessels, through panretinal photocoagulation. Recently, several studies have investigated the application of intravitreal anti-VEGF therapies in NVG. If clinical treatment with the use of hypotensive topical drops is not sufficient, laser and/or surgical procedures are required for intraocular pressure control.

Despigmentação aguda bilateral da íris (BADI): primeiro relato de caso no Brasil

Despigmentacao aguda bilateral da iris (BADI) e uma nova doenca caracterizada pela despigmentacao aguda da iris, dispersao de pigmentos na câmara anterior e intensa deposicao de pigmentos no seio camerular. O acometimento e sempre bilateral, simultâneo e simetrico. Relatamos o caso de um paciente de 61 anos, com dor ocular bilateral aguda, hiperemia e intensa fotofobia. Ao exame, apresentava denso fuso de Krukenberg, importante dispersao de pigmentos na câmara anterior, extensos defeitos a transiluminacao iriana e densa deposicao de pigmentos no seio camerular em ambos os olhos. O paciente recebeu corticoide topico, terapia hipotensora maxima e valacyclovir oral. A pressao intraocular chegou a 48 mmHg em ambos os olhos mas foi reduzindo gradativamente ao longo do segundo e terceiro meses, permitindo a suspensao gradativa da medicacao. A resolucao completa da dispersao pigmentar demorou 18 semanas. A acuidade e os campos visuais permaneceram normais, mas o paciente manteve a fotofobia.

Distrofia policromática posterior da córnea

The authors describe two cases of posterior polychromatic corneal dystrophy, a pre-Descemet dystrophy, poorly described in national and world literatures, characterized by diffuse polychromatic points on the posterior corneal stroma, without visual impairment.

Antiphospholipid syndrome and retinal vein occlusion

A 34-year-old white man presented with a sudden unilateral recurrent visual loss. Fundus examination and fluorescein angiography revealed severe retinal vein occlusion. An antiphospholipid syndrome was discovered during etiological check up. A mutation of Leiden V factor was discovered and the patient started long term anticoagulation after the second occlusive event. However, secondary neovascular glaucoma has developed and despite treatment the affected eye had an important reduction of visual acuity. The purpose of this case report is to demonstrate that retinal vascular occlusion can be the initial manifestation of the antiphospholipid syndrome and that its diagnosis is important because this disease generally affects young people and may endanger ocular and vital prognosis. This diagnosis may imply a long lasting anticoagulative or antiaggregative treatment to reduce the risk of recurrent thrombotic events.

Morfometria comparativa entre discos ópticos de familiares de glaucomatosos e normais pelo HRTII

PURPOSE: To investigate whether there is a difference in topographic characteristics of optic nerve head analyzed by Heidelberg retina tomography (HRTII) in relatives of normal patients with or without history of open angle glaucoma. METHODS: Retrospective study analyzing the optic disc morphometry of normal patients with or without family history of glaucoma. Each participant underwent a routine examination, visual field testing, pachimetry and optic nerve head topography. Patients were classified according their family history of glaucoma in groups as first-degree (group 1), far second-degree (group 2) and no siblings with glaucoma (control group). Optic disc analyzed parameters were: disc area, rim area, cup area, cup/disc ratio (E/D) and linear cup/disc ratio. Statistical analysis was made through the SPSS 12.0 program considering only one randomized eye. A P value of less than 0.05 was considered statistically significant. RESULTS: Seventy-four patients (74 eyes) were included. The average age was 42.58 years. In the stereometric analysis, the comparison between the disc area from the group 1 and group 2 was statistically significant (P < 0.005), with marked overlap in group 1, fact that was repeated for the variables disc area, cup area, cup/disc ratio linear cup/disc ratio comparing first -degree and control group. There was no statistical difference comparing group 2 and 3 in the stereometric analysis. CONCLUSION: First-degree siblings of glaucoma patients present stereometric differences in optic disc when compared with patients without history of glaucoma. These differences were found in patients with no signs of the disease.

Gonioscopia: proposta de classificação (APIC)

A brief historical review of gonioscopy since the pioneering works published by Trantas and Salzmann is presented. The techniques of examination are described and the advantages and disadvantages of each one are discussed. Based on the classifications in the literature, a new one is proposed: the APIC classification. In this classification each one of the elements of the anterior chamber angle are graduated: A = anterior chamber angle Amplitude; P = Pigmentation; I = iris Implantation; and C = iris Configuration.