Patricia Maria Fernandes Marback

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.

Ceratoconjuntivite alérgica e complicações no segmento ocular anterior de pacientes

INTRODUCAO: A alergia ocular e condicao que pode ocasionar sintomas de coceira, ardor e lacrimejamento, podendo tambem ser ameacadora para visao. A fisiopatologia envolve mecanismos de hipersensibilidade imunologica. Devido a fatores imunologicos, o segmento anterior destes pacientes esta mais suscetivel a alteracoes que ameacam a acuidade visual, tais como: opacidades corneanas, ceratocone e catarata. METODOS: Foram revistos, retrospectivamente, 186 pacientes com ceratoconjuntivite alergica e selecionados pacientes que possuiam alteracoes de segmento anterior e acuidade visual menor ou igual a 0,6 corrigida em um ou ambos os olhos. A AV 0,6 foi escolhida aleatoriamente a fim de agrupar os pacientes. Estes pacientes foram analisados quanto a idade, sexo, tipo de alergia, tempo de aparecimento da doenca (considerado como tempo de aparecimento de sintomas), tempo de latencia (tempo que surgiu a complicacao apos o primeiro dia de atendimento), alteracoes sistemicas, efeitos colaterais das drogas e complicacoes oculares. Estes pacientes nao poderiam melhorar a AV com tratamento topico e tinham acompanhamento minimo de 3 meses. RESULTADOS: As alteracoes de segmento anterior que causaram AV menor ou igual a 0,6 (refracao ou estenopeico) sem possibilidade de melhora com medicacao topica foram: ulcera em escudo: 5 casos, catarata: 3 casos, opacidade corneana: 6 casos, perfuracao ocular: 2 casos e ceratocone: 13 casos. CONCLUSAO: Pacientes com ceratoconjuntivite alergica podem ter como principais causas de baixa acuidade visual alteracoes de segmento anterior, entre elas, opacidades corneanas, ceratocone e catarata.

Foreign body after pterygium surgery simulating an epibulbar tumor.

A 60-year-old woman was referred for evaluation of a rapidly growing conjunctival neoplasm after pterygium surgery. The lesion proved to be a foreign body granuloma, with exogenous material that seemed to be cotton mesh, probably used for tamponade of subconjunctival bleeding that was unintentionally left in place.

Síndrome de compressão orbitária relacionada à anemia falciforme

Objetivo: Relatar caso raro de sindrome de compressao orbitaria bilateral secundaria a hematoma subperiosteo em crianca portadora de anemia falciforme. Metodos: Relato de caso de crianca aos 08 anos de idade, com anemia falciforme (eletroforese de hemoglobina - SS) e sindrome de compressao orbitaria bilateral assimetrica apresentando-se com hematomas extradurais espontâneos, proptose e dor em ambos os olhos. Evoluiu com remissao completa dos sinais e sintomas em 20 dias apenas com tratamento sintomatico. Sao apresentados os exames de imagem da fase aguda e apos resolucao do quadro clinico. Conclusao: Anemia falciforme deve ser incluida entre as causas de sindrome de compressao orbitaria.

Comparaçäo do uso tópico de cetotifeno com a olopatadina no tratamento de conjuntivites alérgicas

Purpose: To evaluate and compare the efficacy and tolerance to the topical use of 0.05% ketotifen fumarate and 0.1% olopatadine hydrochloride in the treatment of patients with allergic conjunctivitis. Methods: A masked, randomized clinical study was performed in order to compare the efficacy, safety and side effects of the use of 0.05% ketotifen fumarate and 0.1% olopatadine hydrochloride ophthalmic solutions for the alleviation of symptoms and signs in patients with allergic conjunctivitis. Thirty-four patients, fulfilling the inclusion criteria of the protocol were divided into two groups and received a flask with the masked drug, instilling one drop twice daily in each eye for 30 days. Signs and symptoms of these patients were evaluated on a visit before treatment and on five visits during the treatment (days 1, 2, 7, 14 and 30). Results: Severity of allergic conjunctivitis was the same in both studied groups. Both ketotifen and olopatadine were equivalent and efficient regarding decrease in itching, burning and lacrimation symptoms. Bulbar conjunctival hyperemia was attenuated in both groups. Evaluation of adverse reactions showed the occurrence of burning on administration of both drugs and ketotifen led to occurrence of itching. No hypersensitivity reaction to the studied drugs was observed. Conclusions: This study evidences that 0.05% ketotifen fumarate and 0.1% olopatadine hydrochloride ophthalmic solutions, when instilled twice daily for 30 days, were efficient and safe regarding alleviation of the main symptoms and signs of allergic conjunctivitis.

Granuloma conjuntival causado por fibras sintéticas

Objetivo: Relatar caso de granuloma de conjuntiva por fibras sinteticas. Relato do Caso: Paciente de seis anos, sexo feminino com historia de tumoracao em conjuntiva tarsal inferior do olho direito ha seis meses. Foi realizada exerese da lesao. O laudo anatomo-patologico mostrou reacao inflamatoria granulomatosa do tipo corpo estranho com celulas gigantes multinucleadas fagocitando material birrefringente, compativel com fibras sinteticas. Discussao: O granuloma de fibras sinteticas de conjuntiva e raro e descrito principalmente em criancas, com acometimento unilateral, em conjuntiva tarsal inferior ou fundo de saco inferior. O frequente contato com material de pelucia nesta faixa etaria tem sido apontado como fator etiologico. Granuloma de fibras sinteticas de conjuntiva deve ser considerado no diagnostico diferencial de lesoes tumorais de conjuntiva em criancas.

Influência da cicloplegia sobre a ação hipotensora do latanoprost em indivíduos normais

Purpose: To analyze the influence of cicloplegia on latanoprost ocular hypotensive effect in normal subjects. Patients, material and methods: The study included 17 normal volunteers without previous ocular diseases, trauma or surgeries. One drop of 0.005% latanoprost was given to both eyes and after 20 minutes one drop of 1% ciclopentolate was instilled only in right eyes. Intraocular pressure (IOP) was measured using Goldmann tonometry in both eyes at the following time points: before latanoprost, after 20 minutes, 1 hour and 20 minutes, 3 hours and 20 minutes and 4 hours and 20 minutes. IOP was compared between right and left eyes (Wilcoxon test) and among the different times of study for each eye (Friedman test). Percentual IOP change from initial reading was calculated and compared between OD and OS. Results: No statistical differences were detected regarding the initial, 20 minute, 1 hour and 20 minute and 3 hours and 20 minute measurements. For the 4 hours and 20 minute readings the comparison of IOP levels and their percentual change between OD and OS showed statistical differences. The mean IOP was lower in OD (IOPOD = 10.9 ± 2.2; IOPOS = 11.8 ± 2.2; p = 0.009). The right eyes showed statistically higher IOP percentual reduction than left eyes (D%OD = -28.1±7.4; D%OS = -21.6 ± 9.6; p = 0.006). Conclusion: The results showed a higher short-term latanoprost IOP reduction in eyes treated with ciclopento-late 1%, as compared to the contralateral eyes.