Sergio Henrique Sampaio Meirelles

Evaluation of the factors associated with the reversal of the disc cupping after surgical treatment of childhood glaucoma.

PurposeTo evaluate the change in optic disc cupping after surgical procedure for congenital glaucoma and assess the factors that may intervene on this process. MethodsProspective study involving 45 eyes of 36 patients with childhood glaucoma, who underwent surgical treatment at the Hospital Municipal da Piedade, Rio de Janeiro, Brazil, between January 1998 and December 2005. The study included patients <5 years old with intraocular pressure (IOP) <19 mm Hg for at least 6 months after surgery. Children who were ≥5 years old, IOP ≥19 mm Hg after surgery, and cloudy media were excluded from analysis. All patients were submitted a complete examination under narcosis before surgery and 1, 3, and 6 months after surgery. After this period, the follow-up was performed every 6 months until the study finished. To meet study criteria, vertical axis of the cup-to-disc ratio (C/D) was considered. The optic disc cupping was assessed independently before and after surgery by the same clinicians and the stabilization of the optic disc was confirmed in at least 2 consecutive tests. The variables evaluated with the reduction of the C/D were age at the time of the surgery, vertical axis of the optic disc cup, IOP and the horizontal corneal diameter preoperatively, quantity and type of surgical procedures performed, range of IOP reduction, number of antiglaucomatous drops taken postoperatively, and the type of glaucoma. The statistical methods were performed by the BioEstat 3.0 program. ResultsThere was a significant difference between the preoperative (0.75±0.15) and postoperative (0.62±0.22) C/D and the IOP measured preoperative (22.40±4.93 mm Hg) and postoperative (12.33±3.84 mm Hg). The variables that disclosed statistical significance were age at the time of surgery (P=0.008) and the reduction of the IOP after surgery (P=0.048). A higher reduction of cupping was observed in children ≤1 year old (0.18±0.12) at the time of the surgery. ConclusionsOptic disc cupping can be reversed at an early stage of primary congenital glaucoma, especially before 1 year of age, after successful reduction of IOP by surgery.

Perfil do paciente com ceratopatia bolhosa pós-facectomia atendidos em hospital público

Objetivo: Identificar e analisar criticamente o perfil dos pacientes com ceratopatia bolhosa atendidos em um hospital municipal. Metodos: Foi realizada analise retrospectiva de 35 olhos de 35 pacientes em acompanhamento no setor de cornea e doencas externas do Hospital da Piedade, que apresentavam ceratopatia bolhosa pos-facectomia. Foram excluidos aqueles onde nao se conseguiu determinar caracteristicas pre e per-operatorias fundamentais em nossa pesquisa. Esta selecao de pacientes foi realizada durante o periodo de janeiro de 2007 a junho de 2007. Resultados: Como principais resultadosobservou-se que a ceratopatia bolhosa ocorreu em 22.86 % (8 olhos) dos casos pos-facectomia extracapsular (FEC) e 74.28 % (26 olhos) pos- facoemulsificacao. Em 25.71 % (9 olhos) foi documentado rotura de capsula posterior (RCP) com perda vitrea. Em 94.29 % (33 olhos) a lente intraocular se localizava na câmara posterior, e dois pacientes estavam afacicos. A acuidade visual de todos os pacientes era pior que 20/200. O tempo medio de evolucao entre a facectomia e o diagnostico de ceratopatia bolhosa foi 11,93 meses (1 - 44 meses). Conclusao: A analise adequada do endotelio corneano e condicao essencial para o sucesso da cirurgia de catarata com transparencia corneal, e que a ceratopatia bolhosa parece estar mais associada a facoemulsificacao. Esta informacao deve ser interpretada com cautela, ja que esta relacao pode vir do maior numero de facoemulsificacoes realizadas no Hospital onde foi realizado o estudo e muitas destas por cirurgioes em treinamento.

Estudo comparativo entre a curva diária de pressão intra-ocular e a associação da curva ambulatorial com o teste de sobrecarga hídrica no glaucoma primário de ângulo aberto, glaucoma de pressão normal e olhos normais

PURPOSE To evaluate and correlate the peaks and the fluctuation of intraocular pressure seen in the association of the ambulatory intraocular pressure curve with the water-drinking test versus the peaks and the fluctuation seen in the daily intraocular pressure curve. METHODS The sample was as follows: 77 eyes belonging to 77 patients who were divided into three groups composed of 31 eyes belonging to 31 patients with primary open-angle glaucoma, 26 eyes belonging to 26 patients with normal tension glaucoma and 20 normal eyes belonging to 20 individuals. RESULTS A significant correlation could be observed between the pressure peaks collected from the daily intraocular pressure curve and the pressure peaks seen in the ambulatory intraocular pressure curve, on the water-drinking test, as well as in the association of the ambulatory intraocular pressure curve with the water-drinking test. The procedure which showed the highest rate of correlation between the pressure peaks and the peaks of the daily intraocular pressure curve was the ambulatory intraocular pressure curve (r2= 0.81). However, no statistically significant difference was found between the pressure peaks and the correlation coefficients observed in the other methods. The correlation between the fluctuation of intraocular pressure obtained in the association of the ambulatory intraocular pressure curve with the water-drinking test and the fluctuation of the pressure seen in the daily intraocular pressure curve showed a slight association (r2= 0.21). CONCLUSIONS The association between ambulatory intraocular pressure curve and water-drinking test was not efficient to estimate peaks and the fluctuation of daily intraocular pressure curve. The ambulatory intraocular pressure curve and the water-drinking test must be analyzed separately. When predicting the peak and the fluctuation of the daily intraocular pressure curve, the ambulatory intraocular pressure curve was the most efficient procedure.

Relação entre a espessura corneana e a gravidade de defeito de campo visual no glaucoma primário de ângulo aberto

PURPOSE To assess whether central corneal thickness is related to glaucomatous visual field loss severity among patients with office-controlled intraocular pressure in the normal range. METHODS This transversal study included 85 eyes of 85 patients with treated primary open-angle glaucoma and documented intraocular pressure below 19 mmHg. The patients were divided into three groups according to Anderson criteria of field abnormality. The groups were composed of 30 eyes with mild defect, 28 eyes with moderate defect and 27 eyes with severe defect. Intraocular pressure and central cornea thickness were compared and evaluated between the three groups. RESULTS Central corneal thickness was statistically thinner in the severe group (mean= 513 +/- 26 microm) compared with the mild defect group (mean= 535 +/- 35 microm) and the moderate group (mean= 533 +/- 30 microm) (p = 0.0182). There was no statistically significant difference between intraocular pressures in the three groups (p = 0.0851). The severe group showed a statistically higher age and number of medications than the other groups. CONCLUSIONS The central corneal thickness measurement is desirable when establishing target intraocular pressure of patients with open-angle glaucoma. Central corneal thickness is a clinical factor in determining glaucoma severity. Patients with severe field loss showed lower corneal thickness compared with patients with mild and moderate visual field loss.

Facectomia na infância: quem são nossos pacientes?

OBJECTIVE: To analyze the profile of the patients who were submitted to phakectomy at the cataract service of the Hospital da Piedade, under the age of 10 years old, evaluating the main indications, the socioeconomic and gestational profiles in the relevant cases. METHODS: Data of 60 patients under the age of 10 years old submitted to lensectomy, were retrospectively analyzed, during the period between January of 2006 and December of 2007. All the surgeries were performed at the cataract service of the Hospital da Piedade, by the same surgeon. RESULTS: Of the 60 patients, 25 were female (42%) and 35 were male (58 %). 42 patients (70%) had the diagnostic of congenital cataract, 8 (13%) had subluxated lens and 10 (17%) had lensectomy for traumatic cataract. Considering congenital cataract patients mothers, 40 (95%) underwent prenatal exams with more than 5 appointments, 9 (22.5%) of them were infected by rubella virus during the pregnancy. In subluxation cases, 8 had Marfans syndrome. 10 cases of trauma occurred in boys. CONCLUSION: It was possible to verify that the majority of our patients submitted to phakectomy had congenital cataract and there is an important number of cases that still associated to rubella. Decreasing time since the suspect until the specialized consultation, will improve the visual prognosis of the children.

Acute angle closure glaucoma following ileostomy surgery

Angle-closure glaucoma can be induced by drugs that may cause pupillary dilatation. We report a case of a patient that developed bilateral angle closure glaucoma after an ileostomy surgery because of systemic atropine injection. This case report highlights the importance of a fast ophthalmologic evaluation in diseases with ocular involvement in order to make accurate diagnoses and appropriate treatments.

Neuroblastoma com metástase orbitária

Neuroblastoma is the most frequent extracranial solid tumor among pediatric patients, and orbital metastatic disease is not uncommon in these children. Physical signs as a consequence of orbital metastases, such as proptosis and periorbital ecchymosis, frequently are encountered. However, subsequent blindness is rare. We report on a 2 year old child with orbital metastasis of a primary neuroblastoma in the left suprarenal region that evaluated to a bilateral blindness. We discuss the importance of the early diagnosis, and more studies of this disease to define the ideal treatment and prevent the occurrence of blindness.

Estudo comparativo entre o tonômetro de aplanação de Goldmann e o tonômetro de contorno dinâmico de Pascal no glaucoma primário de ângulo aberto e olhos normais

OBJETIVO: Comparar as medidas da pressao intra-ocular (PIO) obtidas com o tonometro de aplanacao de Goldmann (TAG) e o tonometro de contorno dinâmico (TCD) e correlaciona-las com a espessura central da cornea (ECC). METODOS: Estudo transversal, com os pacientes divididos em dois grupos: glaucoma primario de ângulo aberto (GPAA) e olhos normais (ON). As medidas da PIO foram obtidas em todos os pacientes com o TAG e o TCD. Um examinador realizou as tonometrias com o TAG e outro examinador com o TCD. A ECC foi obtida pelo paquimetro ultrassonico. Os resultados foram avaliados atraves do teste Z para amostras independentes, teste t de Student para amostras relacionadas, teste de correlacao linear de Pearson e grafico de Bland-Altman. RESULTADOS: Foram incluidos 134 olhos de 71 pacientes. O grupo GPAA foi constituido por 85 olhos de 45 pacientes e o grupo ON por 49 olhos de 26 individuos com olhos normais. Nao houve diferenca significativa da ECC entre os dois grupos em ambos os olhos (p= 0,54 OD; p= 0,71 OE). As tonometrias realizadas com o TCD foram maiores nos dois grupos (GPAA: p< 0,01; ON: p= 0,01). Houve correlacao significativa entre as tonometrias do TAG e do TCD nos dois grupos separados ou em conjunto (p< 0,001). Nao houve correlacao significativa entre o TAG ou o TCD e a ECC, exceto no olho direito dos dois grupos em conjunto (p= 0,03; r2 = 0,07). O grafico de Bland-Altman mostrou pouca concordância entre os dois procedimentos. CONCLUSAO: Nenhum dos metodos mostrou boa correlacao com a ECC. Houve pouca concordância entre os dois metodos, sendo maiores, as tonometrias obtidas com o TCD. As medidas realizadas no TCD parecem ser menos influenciadas pelos valores da ECC do que as medidas realizadas no TAG.

Influência do peso corporal e do índice de massa corporal no teste de sobrecarga hídrica

OBJETIVO: Avaliar a influencia do peso corporal e do indice de massa corporal (IMC) nos picos e na flutuacao da pressao intra-ocular (PIO) no teste de sobrecarga hidrica (TSH) em pacientes com glaucoma primario de ângulo aberto (GPAA), glaucoma de pressao normal (GPN) e olhos normais (ON). METODOS: Estudo transversal em que foram avaliados 32 olhos de 32 pacientes com GPAA, 30 olhos de 30 pacientes com GPN e 20 olhos de 20 ON. Nenhum dos pacientes glaucomatosos havia iniciado o tratamento da doenca. O TSH foi realizado as 17h, sendo avaliada a correlacao entre o peso corporal e o IMC e os picos e a flutuacao da PIO durante o TSH. Os resultados foram analisados atraves dos testes de Anova-fator unico com teste de Bonferroni e correlacao linear de Pearson. Foi considerado significativo valor de p menor que 0,05. RESULTADOS: Nao houve diferenca significativa na idade (p=0,13), no peso corporal (p=0,13) e no IMC (p=0,83) entre os tres grupos. Foi encontrada correlacao estatisticamente significativa no grupo GPAA entre o peso corporal e a flutuacao da PIO no TSH (p=0,02; r=-0,42) e entre o IMC e a flutuacao da PIO no TSH (p=0,02; r=-0,41). Nao houve correlacao significativa entre o peso corporal e o IMC e os picos de PIO nos tres grupos e entre o peso corporal e o IMC e a flutuacao da PIO nos grupos GPN e ON.. CONCLUSAO: Os resultados do presente estudo sugerem que o peso corporal e o IMC devem ser considerados ao se avaliar os resultados do TSH em portadores de GPAA e que pacientes portadores de GPAA com maior IMC e maior peso corporal podem apresentar menor flutuacao da PIO no TSH.