Quality of Life (QoL) in Non-Acute Vogt-Koyanagi-Harada Disease (VKHD) at Two Time Points 24 Months Apart.

AIMS: To investigate the changes in quality-of-life (QoL) metrics at a 24-month interval in non-acute VKHD patients and their association with inflammation, treatment, and visual function. METHODS: SF-36 and VFQ-25 questionnaires were administered at two 24-month-apart moments to 22 non-acute VKHD patients followed for ≥12 months since acute disease onset. "Improvement," "unchanged," or "worsening" in questionnaires scores (difference >5-point) between M1 and M2 and their associations were sought. RESULTS: Absence of systemic treatment or optic disc hyperfluorescence was associated with improved general health (SF-36). Improvement in binocular contrast sensitivity resulted in better ocular pain score; absence of anterior uveitis relapse, stable fundus findings, no use of cyclosporine or no intravitreal injections resulted in unchanged/better dependency score; no intravitreal injections resulted in unchanged/better mental health score (VFQ-25). CONCLUSION: Stability/improvement in QoL scores was associated with controlled inflammation, better visual function, and no need for treatment. Subclinical inflammatory signs did not impact QoL scores.

Fingerprint sign in Vogt-Koyanagi-Harada disease: a case series.

BACKGROUND: The tomographic finding, which has been called the "fingerprint sign" in en face reconstructions, seems to be the result of a variety of processes that cause distension of the outer plexiform layer (OPL) and the Henle fiber layer (HFL). The aim of this paper is to describe the appearance of concentric rings at the OPL/HFL interface visualized using en face reconstructions of cross-sectional optical coherence tomography images of patients with Vogt-Koyanagi-Harada disease. METHODS: Retrospective analysis of images of six eyes of three patients obtained by cross-sectional OCT imaging and en face reconstruction at the level of the OPL/HFL interface. RESULTS: All eyes presented with a dentate or saw-tooth pattern of the OPL/HFL interface on cross-sectional OCT with corresponding concentric rings on en face OCT reconstruction, consistent with the recently published "fingerprint sign". Initial OPL/HFL interface changes were observed between the first and fourth months after treatment and resolution of VKHD associated serous retinal detachments. These OPL/HFL interface changes have persisted for many years following the resolution of the active inflammation. CONCLUSIONS: Changes in the OPL/HFL interface can be identified following successful treatment of VKHD. These included both a dentate or saw-tooth pattern on cross-sectional imaging and concentric rings or the "fingerprint sign" on en face reconstructions. These changes persisted for many years despite disease quiescence.

Impact of Inflammation and Treatment on Self-reported Quality of Life in Patients with Non-acute Vogt-Koyanagi-Harada Disease (VKHD).

Aims: To evaluate associations between vision-related (VR-) and health-related (HR-) QoL metrics and inflammation and treatment in non-acute VKHD patients.Methods: Cross-sectional study in a tertiary center in Sao Paulo, Brazil with 22 patients with non-acute VKHD followed prospectively for ≥12 months since acute disease onset, with systematic evaluation and predefined treatment protocols. VR- and HR-QoL aspects were assessed by VFQ-25 and SF-36 questionnaires, respectively. Associations between the questionnaire's subscale item scores with inflammation and systemic medical therapies were assessed.Results: After generalized linear model analysis, worse VA, severe fundus changes, fluctuation of VA and fluctuation of anterior chamber cells impacted negatively on VR-QoL items. Higher cumulative total dose of corticosteroids and use of immunosuppressive therapy impacted negatively on both questionnaires.Conclusion: Worse VA, clinical inflammation and systemic treatment have a significant impact on VR- and HR-QoL questionnaires. Subclinical choroidal inflammation did not seem to impact QoL.

Full-field electroretinogram behavior in Vogt-Koyanagi-Harada disease: a 24-month longitudinal study in patients from acute onset evaluated with multimodal analysis.

PURPOSE: To prospectively evaluate the dynamic changes of the full-field electroretinogram (ff-ERG) and its association with inflammatory signs in patients with Vogt-Koyanagi-Harada disease (VKHD) followed up after acute onset. METHODS: Twelve acute VKHD patients, who were followed up for at least 24 months, were enrolled at a tertiary center from June 2011 to January 2017. Treatment consisted of intravenous methylprednisolone followed by 1 mg/kg/day of oral prednisone with a slow tapering associated with late non-steroidal immunosuppressive therapy in previously defined cases. Inflammation was systematically evaluated with clinical and posterior segment imaging (PSI) exams (fluorescein angiography, FA, indocyanine green angiography, ICGA, enhanced depth imaging optical coherence tomography, EDI-OCT). A ff-ERG was performed upon enrollment as well as at predefined intervals. Scotopic ff-ERG parameters changes between the 12th and 24th months defined the ERG-stable or ERG-worsening groups. "Flare" was defined as an appearance or worsening of inflammatory signs (after the initial 6 months following disease onset) under the predefined treatment protocol. RESULTS: ff-ERG parameters initially improved in all eyes; in the evaluation between the 12th and 24th months, ff-ERG results were stable in 17 eyes (71 %) and worsened in 7 eyes (29 %). Subnormal ff-ERG results were observed in 15 eyes (62 %) at the 24th month. On the other hand, the flare was observed in 8 eyes (33 %) as cells in the anterior chamber and in 24 eyes (100 %) as any PSI inflammatory sign. The ERG-worsening group presented thicker subfoveal choroid at the first month (p = 0.001) and fluctuations in choroidal thickness more often during follow-up when compared to the ERG-stable group (p = 0.02). CONCLUSIONS: Scotopic ff-ERG parameters worsened between the 12th and 24th months in a quarter of the patients. Subclinical inflammation detected as an increase in CT seems to be related to worsening in visual function measured with ffERG.

Mycophenolate mofetil as an immunomodulator in refractory noninfectious uveitis / Micofenolato mofetila como agente imunomodulador no tratamento das uveítes não infecciosas refratárias

ABSTRACT Purpose: To evaluate the efficacy and tolerance of mycophenolate mofetil (MMF) for the treatment of noninfectious uveitis using the methods advocated by the Standardization of Uveitis Nomenclature (SUN) Working Group and to compare this with other studies of immunosuppression in ocular inflammation. Methods: Retrospective case series. Patients with noninfectious uveitis, followed at a tertiary Uveitis Service in São Paulo, Brazil, from 2007 to 2014 and receiving oral MMF for a minimum of 6 months, were retrospectively reviewed. After reaching an optimal dose of MMF, patients were evaluated after 6 (T6), 12 (T12), and 24 months (T24). The optimal dose varied for each patient (medium 2.2 g/day, range 1.0-3.0 g/day). The main outcome measures were: 1) success on achieving complete control of inflammation in both eyes and/or oral prednisone dosage reduction to ≤10 mg per day, and 2) the length of time required to reduce oral prednisone to ≤10 mg/day, partial control of ocular inflammation, and side effects. Results: In a cohort of 16 patients with refractory noninfectious uveitis, 67% reached the ideal prednisone dose after 1 year of MMF treatment and 83% after 2 years of MMF treatment. Complete or partial inflammation control was achieved in 43.7% at T12. Two patients (14%) had disease remission after 4.7 years of MMF treatment. Adverse effects were gastrointestinal disturbances, infection, insomnia, and liver function abnormalities at a rate of 0.03 patient-year each. Conclusions: This small retrospective case series is consistent with the literature concerning the high efficacy and moderate tolerability of MMF in noninfectious uveitis. Observation of patients should be continued for at least 1 year to clearly determine MMF efficacy.

RESUMO Objetivo: Avaliar a eficácia e tolerância do micofenolato de mofetila (MMF) para o tratamento das uveítes não infecciosas refratárias, utilizando os métodos de análises definidos pelo "Standardization of Uveitis Nomenclature Working Group." Método: Estudo retrospectivo de série de casos. Foram incluídos pacientes com uveíte não infecciosa, em tratamento oral com MMF por um período mínimo de seis meses, acompanhados no Serviço de Uveítes, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil, no período de 2007 a 2014. Todos os pacientes faziam uso de pelo menos um imunossupressor e apresentavam doença ocular ativa. Os pacientes foram avaliados aos seis meses (T6), 12 meses (T12) e 24 meses (T24) após atingir a dose ótima do MMF. A média da dose ótima foi 2,2g/dia (intervalo 1,0-3,0g/dia). Os principais desfechos analisados foram: 1) Sucesso no controle total da inflamação em ambos os olhos e/ou redução da dose de prednisona oral para ≤10 mg/dia; 2) Intervalo até a redução da prednisona oral para ≤10 mg/dia, controle parcial de inflamação ocular e efeitos adversos. Resultados: Na presente coorte com 16 pacientes com uveíte não infecciosa refratária, observou-se 67% e 83% de probabilidade de alcançar a dose ideal de prednisona em T12 e T24, respectivamente. Controle total ou parcial da inflamação foi observado em 43,7% dos pacientes em T12. Dois pacientes (14%) tiveram remissão da doença após 4,7 anos do início de MMF. Os efeitos adversos foram distúrbios gastrintestinais, infecção, insônia e anormalidade da função hepática com 0,03 eventos paciente-ano (PPY) respectivamente. Conclusões: Esta pequena série retrospectiva de casos ratifica os achados na literatura sobre a alta eficácia e tolerância moderada de MMF em uveítes não infecciosas. Uma importante observação é que, para melhor avaliar a eficácia do MMF, deve se esperar o intervalo mínimo de um ano.

Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes.

Vogt-Koyanagi-Harada disease (VKHD) is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin and hair. This disease is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA-DRB1*0405 allele. The absence of ocular trauma or previous intraocular surgery sets VKHD appart from sympathetic ophthalmia, its main differential diagnosis. The disease has an acute onset of bilateral blurred vision with hyperemia preceded by flu-like symptoms. The acute uveitic stage is characterized by a diffuse choroiditis with serous retinal detachment and optic disc hyperemia and edema. Fluorescein angiography in this phase demonstrates multiple early hyperfluorescent points. After the acute uveitic stage, ocular and integumentary system pigmentary changes may appear. Ocular findings may be accompanied by lymphocytic meningitis, hearing impairment and/or tinnitus in a variable proportion of patients. Prompt diagnosis followed by early, aggressive and long-term treatment with high-dose corticosteroids is most often ensued by good visual outcomes. However, some patients may experience chronic uveal inflammation with functional eye deterioration. The current review discusses the general features of VKHD, including epidemiology, classification into categories, differential diagnosis and current therapeutic approaches.

Mycophenolate mofetil as an immunomodulator in refractory noninfectious uveitis.

PURPOSE:: To evaluate the efficacy and tolerance of mycophenolate mofetil (MMF) for the treatment of noninfectious uveitis using the methods advocated by the Standardization of Uveitis Nomenclature (SUN) Working Group and to compare this with other studies of immunosuppression in ocular inflammation. METHODS:: Retrospective case series. Patients with noninfectious uveitis, followed at a tertiary Uveitis Service in São Paulo, Brazil, from 2007 to 2014 and receiving oral MMF for a minimum of 6 months, were retrospectively reviewed. After reaching an optimal dose of MMF, patients were evaluated after 6 (T6), 12 (T12), and 24 months (T24). The optimal dose varied for each patient (medium 2.2 g/day, range 1.0-3.0 g/day). The main outcome measures were: 1) success on achieving complete control of inflammation in both eyes and/or oral prednisone dosage reduction to ≤10 mg per day, and 2) the length of time required to reduce oral prednisone to ≤10 mg/day, partial control of ocular inflammation, and side effects. RESULTS:: In a cohort of 16 patients with refractory noninfectious uveitis, 67% reached the ideal prednisone dose after 1 year of MMF treatment and 83% after 2 years of MMF treatment. Complete or partial inflammation control was achieved in 43.7% at T12. Two patients (14%) had disease remission after 4.7 years of MMF treatment. Adverse effects were gastrointestinal disturbances, infection, insomnia, and liver function abnormalities at a rate of 0.03 patient-year each. CONCLUSIONS:: This small retrospective case series is consistent with the literature concerning the high efficacy and moderate tolerability of MMF in noninfectious uveitis. Observation of patients should be continued for at least 1 year to clearly determine MMF efficacy.

Análise integrada de parâmetros clínicos, estruturais e funcionais nas fases aguda e não aguda da doença de Vogt-Koyanagi-Harada: estudo longitudinal / Integrated analysis of clinical, structural and functional parameters in the acute and non-acute phases of Vogt-Koyanagi-Harada disease: a prospective study

OBJETIVO: Descrever prospectivamente o curso da doença de Vogt-Koyanagi-Harada (DVKH) com integração de parâmetros de atividades clínicos, estruturais e funcionais. MÉTODOS: Foram incluídos pacientes com diagnóstico da DVKH na fase aguda (parte I) e não aguda (tempo de doença maior que 12 meses; parte II). Os pacientes na fase aguda receberam tratamento inicial padronizado com pulsoterapia de metilprednisolona seguido de corticoterapia oral em doses lentamente regressivas, pelo período de 15 meses. As avaliações consistiram em exame clínico, retinografia, angiografias com fluoresceína (AGF) e indocianina verde (AIV) e tomografia de coerência óptica (TCO). Foram realizadas nos seguintes momentos: parte I, no diagnóstico e meses 1, 2, 4, 6, 9 e 12; parte II, na inclusão e a cada três meses. Eletrorretinograma campo total (ERGct) e eletrorretinograma multifocal (ERGmf) foram realizados na parte I, no 1.o mês e a cada seis meses e, na parte II, na inclusão e com 12 meses. A leitura dos exames, na parte I, foi efetuada por duas leitoras, não mascaradas; na parte II, foi realizada por três leitores mascarados e treinados, sendo considerada a leitura concordante entre, pelo menos, dois examinadores. As angiografias e TCO foram realizadas no aparelho Spectralis® (HRA+OCT, Heidelberg Engineering). Tratamento adicional com corticoterapia em doses imunossupressoras ou intensificação da imunossupressão sistêmica foi indicado nos casos com recidivas clínicas, na presença de sinais de atividade à AGF ou duas pioras consecutivas >= 30% no ERGct. Os sinais de atividade detectados na AGF, AIV e TCO foram denominados sinais subclínicos. RESULTADOS: Na parte I, foram incluídos nove pacientes (7F/2M) com idade mediana de 33 anos e intervalo mediano entre início dos sintomas e tratamento de 13 dias. Na apresentação inicial, sinais clínicos característicos da doença (coroidite difusa com hiperemia do disco óptico, descolamento seroso de retina e uveíte anterior acompanhados de...

OBJECTIVES: To describe the course of Vogt-Koyanagi-Harada disease (VKHD) prospectively, integrating clinical, structural and functional parameters. METHODS: Patients with VKHD in the acute (part I) and non-acute (more than 12 months from diagnosis) phases (part II) were included. Patients in the acute phase received a standard treatment with methylprednisolone pulsetherapy followed by high-dose oral corticosteroids with slow tapering during 15 months. Evaluations included clinical exams, fluorescein (FA) and indocyanine green (ICGA) angiographies and optical coherence tomography (OCT). In part I, they were performed at inclusion, then after 1,2,4,6,9,and 12 months; in part II, they were performed at inclusion then every 3 months for up to 12 months. Functional evaluation using electroretinography (ERG) was performed at inclusion and every 6 months in part I and at inclusion and at 12 months in part II. Two non-blinded readers analyzed the imaging exams in part I. In part II, three trained and blinded-readers performed the imaging exams analysis. For study`s purpose, at least two concordant readings were considered. Imaging exams utilized the Spectralis® (HRA+OCT, Heidelberg engineering). Inflammatory signs detected on FA, ICGA and OCT were denominated as subclinical signs. Additional treatment with high doses of corticosteroids or more intensive systemic immunosuppression was indicated in cases with clinical signs of inflammation, with subclinical signs on FA or with two consecutive worsening > 30% on ERG. RESULTS: Nine patients (7F/2M) were included in part I; median age was 33 years old and median time elapsed from onset of symptoms to treatment was 13 days. At disease presentation, classic signs (choroiditis, anterior uveitis, serous retinal detachment, optic disc hyperemia and extraocular manifestations) were observed; they improved in 30 days after treatment. Subclinical signs improved in variable periods of time: subfoveal choroidal thickness (CT)...

Diagnosis and classification of Vogt-Koyanagi-Harada disease.

Vogt-Koyanagi-Harada (VKH) disease is a systemic autoimmune disorder that affects pigmented tissues of the body, with its most dire manifestations affecting the eyes. This review focuses on the diagnostic criteria of VKH disease, including some information on history, epidemiology, appropriate clinical and classification criteria, etiopathogenesis, treatment and outcomes. Expert review of most relevant literature from the disease's first description to 2013 and correlation with the experience in the care of VKH disease patients at a tertiary Uveitis Service in Brazil gathered over the past 40 years. The clinical manifestations and ancillary assessment of VKH disease have been summarized in the Revised Diagnostic Criteria proposed in 2001 in a manner that allows systematic diagnosis of both acute and chronic patients. It includes the early acute uveitic manifestations (bilateral diffuse choroiditis with bullous serous retinal detachment and optic disk hyperemia), the late ocular manifestations (diffuse fundus depigmentation, nummular depigmented scars, retinal pigment epithelium clumping and/or migration, recurrent or chronic anterior uveitis), besides the extraocular manifestations (neurological/auditory and integumentary). There are two exclusion criteria, i.e. absence of previous ocular penetrating trauma or surgery and any other ocular disease that could be confounded with VKH disease. HLA-DRB1*0405 plays an important role in pathogenesis, rendering carriers more susceptible to disease. The primary ocular pathological feature is a diffuse thickening of the uveal tract in the acute phase. Later on, there may be a compromise of choriocapillaris, retinal pigment epithelium and outer retina, mostly due to an "upstream" effect, with clinical correlates as fundus derangements. Functional tests (electroretinogram and visual field testing) as well as imaging modalities (retinography, fluorescein/indocyanine green angiography, optical coherence tomography and ultrasound) play an important role in diagnosis, severity grading as well as disease monitorization. Though high-dose systemic corticosteroids remain gold-standard therapy, refractory cases may need other agents (cyclosporine A, anti-metabolites and biological agents). In spite of good visual outcomes in the majority of patients, knowledge about disease progression even after the acute phase and its impact on visual function warrant further investigation.

Enhanced depth imaging optical coherence tomography in long-standing Vogt-Koyanagi-Harada disease.

AIM: To evaluate the choroidal thickness (CT) in patients with long-standing Vogt-Koyanagi-Harada (VKH) disease using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: A prospective case-control study developed at a tertiary centre at São Paulo, Brazil. EDI-OCT images were obtained in 16 patients (30 eyes) with VKH disease who had had the disease for more than 6 months since disease onset, and in 17 normal individuals controlled by age (32 eyes). Comprehensive ophthalmic examination and EDI-OCT evaluation were performed. CT was measured at the fovea and at 1000 µm intervals from the foveal centre in both temporal and nasal directions. CT was correlated with disease duration, clinical disease activity and fundus-based disease severity. RESULTS: Mean subfoveal CT was 333 µm (±85.8) in controls and 250.7 µm (±93.3) in VKH patients (p=0.002). The choroid was significantly thinner in patients when compared to controls in all but one nasal point. In patients, the CT measurements at the foveal centre presented a negative correlation with disease duration (p<0.001). No significant difference in CT measurements was observed between eyes with and without clinical inflammation (p=0.42). There was a trend towards more severe fundus changes being associated with a thinner choroid (p=0.28). CONCLUSIONS: Patients with VKH and long-standing disease had thinner choroids when compared to controls. Progressive choroidal thinning related to disease duration was observed at the macula of these patients. Whether this finding is part of the natural history of the disease or the result of a clinically undetected choroidal inflammation remains to be determined.

Influência da idade no comportamento da pressão intraocular em uma população da região Sul-brasileira / Influence of age on intraocular pressure in a South Brazilian population

OBJETIVO: Verificar influência da idade no comportamento da pressão intraocular (PIO) em população acima de 40 anos. MÉTODOS: Neste estudo observacional transversal realizado no município de Piraquara - PR, a PIO foi aferida através da tonometria de Goldmann. Todos os indivíduos foram submetidos a exame de triagem, sendo os suspeitos de glaucoma ou hipertensão ocular encaminhados ao atendimento de retorno para realização de exame oftalmológico completo. Para fins de análise estatística, os pacientes foram divididos em grupos etários (40-49; 50-59; 60-69 e acima de 70 anos). Posteriormente todos os pacientes portadores de glaucoma ou suspeita, hipertensão arterial sistêmica (HAS) ou Diabetes mellitus (DM) foram excluídos. RESULTADOS: Avaliaram-se 3360 indivíduos com média de idade de 54,04 ± 10,52 anos, sendo 59,79 por cento do sexo feminino. Não se observou diferença estatisticamente significativa entre a média da PIO nos diferentes grupos etários (p=0,19; teste ANOVA). Da mesma forma, não foi observada correlação significativa entre a PIO e a idade (p = 0,11; correlação linear de Pearson). Após exclusão dos indivíduos portadores de HAS (1671), DM (n=360), glaucoma ou suspeita de glaucoma (n=161) não se observou diferença estatisticamente significativa entre a média da PIO e a idade (p=0,17; teste ANOVA). No entanto, uma fraca correlação negativa, porém significativa, foi encontrada entre PIO e idade (p=0,03; R=-0,055, correlação linear Pearson). CONCLUSÃO: Na presente amostra, não foi observada influência significativa da idade na PIO, entretanto, após a exclusão de indivíduos com glaucoma, HAS e DM, observou-se uma fraca correlação linear negativa e significativa entre as duas variáveis.

PURPOSE: To assess the influence of age on intra-ocular pressure (IOP) in subjects aged over 40 years old. METHODS: This transversal and observational study realized at Piraquara city (PR) measured the IOP using Goldmann applanation tonometry. All subjects were submitted to a screening exam and patients considered as glaucoma suspects or ocular hypertensive patients were invited to a second evaluation, where a complete ophthalmological exam was performed. For the data analysis, all subjects were separated by age (40-49; 50-59; 60-69; and above 70 years of age). Further analysis excluded all patients with glaucoma and/or glaucoma suspects, systemic arterial hypertension (SAH) and diabetes. RESULTS: A total of 3360 subjects were evaluated of whom 2001 (59,79 percent) were females. The mean age was 54,04 ± 10,52 years. There was no difference in mean IOP among age groups (p = 0.19; ANOVA test). It was not observed any significant correlation between age and IOP (p = 0,11; Pearson linear correlation). When all the subjects with glaucoma and/or glaucoma suspects (n=161), DM (n=360) and SAH (n=1671) were excluded, there was no difference in mean IOP among age groups (p = 0.17; ANOVA test). However, it was observed a weak and significant negative correlation between age and IOP (p = 0,03; R = - 0,055; Pearson linear correlation). CONCLUSION: In our sample, there was no significant influence of age in IOP. However, after all subjects with glaucoma and/or glaucoma suspects, diabetes and SAH were excluded, it was observed a weak negative influence of age in IOP.

Long ciliary processes with no ciliary sulcus and appositional angle closure assessed by ultrasound biomicroscopy.

PURPOSE: Nonpupil block mechanisms and appositional angle closure after laser iridotomy (LI) have been reported as common findings in Asians. We evaluated the presence of these findings in a cohort of Brazilian patients using ultrasound biomicroscopy (UBM). METHODS: This observational case-control study included 22 open angle eyes and 31 eyes with occludable angles on gonioscopy (defined by 2 examiners). UBM radial scans through a typical ciliary process were obtained in both light and dark conditions, at 6 and 12-o'clock positions. Long ciliary processes with no ciliary sulcus were determined on the basis of a reference line drawn perpendicular to the iris plane passing through a point located 750 mum from scleral spur. Trabecular ciliary processes distance was measured on 6-o'clock UBM images. RESULTS: After LI, 52% of occludable angle eyes had appositional angle closure in both 6 and 12-o'clock UBM images. We also observed this finding in 14% and 23% of the control eyes (in 6 and 12-o'clock UBM images, respectively). A long ciliary process with no ciliary sulcus was observed in 61% of occludable angle eyes, and also in 32% of control eyes (6-o'clock UBM images). Control eyes had longer trabecular ciliary processes distance than occludable angle eyes (P<0.001). CONCLUSIONS: The UBM finding of long ciliary processes associated with the absence of ciliary sulcus is not necessarily related to an anterior positioning of the ciliary processes. Whether UBM appositional angle closure after LI is associated with further angle closure process and/or poor intra-ocular pressure control remains to be evaluated.

Síndrome de Íris Plateau: relato de 17 casos / Iris Plateau syndrome: case report of 17 cases

Objetivo: Relatar 17 casos diagnosticados como Síndrome da Íris Plateau (17 olhos), enfocando a apresentação clínica, abordagem diagnóstica e conduta. Métodos: Os pacientes foram diagnosticados como Síndrome de Íris Plateau, baseado nos exames de gonioscopia e biomicroscopia ultra-sônica (UBM), realizados após a iridectomia a laser. Todos os pacientes foram acompanhados por um período de tempo médio de 46,7 + 11,7 meses. Aforma completa da síndrome foi determinada pela presença de crise congestiva recidiva ou teste da prono-posição em quarto escuro positivo. Resultados: No primeiro grupo, oito olhos se apresentaram na primeira consulta com glaucoma agudo. Dois destes olhos apresentaram teste provocativo positivo (2) após a iridectomia e seis deles apresentaramcrise congestiva recidiva durante o tempo de seguimento - síndrome da íris em Plateau completa. No segundo grupo, nove olhos não apresentaram glaucoma agudo, antes ou após a iridectomia, e devido aos achados nos exames de gonioscopia e UBM foram diagnosticados como portadores do mecanismo da íris em Plateau – possíveis casos de síndrome da íris em Plateau incompleta. Mesmo após a realização da iridectomia,dois olhos do segundo grupo apresentaram progressão das sinéquias anteriores periféricas (SAP). Conclusão: Casos de síndrome da íris em Plateau podem evoluir apresentando crise congestiva recidiva e/ou progressão das SAP. A gonioscopia sempre deve ser realizada após a iridectomia a laser a fim de verificar a eficácia do procedimento em abrir o ângulo irido-corneano. Entretanto, estudos prospectivos longitudinais são ecessários para determinar quais os fatores de risco relacionados ao processo de fechamento angularsecundário ao mecanismo da íris em Plateau.

Objective: To report 17 cases of Plateau Iris Syndrome (17 eyes) focusing on clinical presentation, diagnosis approach and treatment. Methods: All patients were diagnosed as iris Plateau syndrome cases based on gonioscopy and ultrasound biomicroscopy (UBM) exam findings, performed after laser iridectomy. The mean follow up time was 46,7 + 11,7 months. The completeform of the syndrome was determined by the presence of recurrent acute angle closure episode or a positive darkroom prone position test. Results: In the first group, eight eyes had an acute angle closure episode at the time of thefirst evaluation. Two of them had a positive dark room prone position test even after iridotomy and six of themhad a recurrent acute angle closure episode during the follow-up period - complete plateau iris syndrome cases.In the second group, nine eyes that did not have an acute attack before or after iridotomy were included. All of themhad gonioscopy and UBM findings compatible with plateau iris mechanisms – possible incomplete plateau iris syndrome cases. We observe progression of peripheralanterior synechiae (PAS) in two eyes of the second group even after iridotomy. Conclusion: Plateau iris syndromecases may develop recurrent acute angle closure episodes and/or further PAS formation. The gonioscopy exam must always be performed after the iridotomy in order to verify the opening of the irido-corneal angle. Further studies should address the risk factors related to the maintenance of the angle closure process even after iridotomy.

Projeto glaucoma: resultados parciais 2000 na regiäo de Piraquara-PR / Glaucoma project: partials results 2000 in the region of Piraquara - PR

Objetivo: Realizar um levantamento epidemiológico do glaucoma em populaçäo de uma regiäo brasileira tendo como grupo de estudo a populaçäo acima de 40 anos do município de Piraquara - PR, analisando a importância dos métodos de triagem. Métodos: Este é um estudo descritivo realizado durante a primeira etapa do Projeto Glaucoma do HC-UFPR no período de junho de 1999 a dezembro de 2000. Neste estudo foram triados 1953 pacientes acima de 40 anos, os quais foram submetidos a uma anamnese dirigida, avaliaçöes das câmaras anteriores, medida da pressäo intra-ocular (Po) e fundoscopia. Os pacientes suspeitos de glaucoma foram encaminhados para retornar ao ambulatório de Oftalmologia do Hospital das Clínicas da Universidade Federal do Paraná - HC - UFPR para exame oftalmológico completo. Resultados: Do total de pacientes triados retornaram 184 pacientes de 282 suspeitos. Nestes retornos foram confirmados 73 casos de glaucoma primário de ângulo aberto (GPAA), sendo 35 (1,79 porcento) de glaucoma crônico simples (GCS) e 38 (1,95 porcento) de glaucoma de pressäo normal (GPN); além de 6 pacientes com diagnósticos de glaucoma secundário ou glaucoma de ângulo estreito. Do grupo de GCS 22 eram mulheres e 13 eram homens; já no grupo GPN 17 eram mulheres e 22 eram homens. Foi também demonstrada a freqüência de hipertensos e diabéticos nos dois grupos, assim como outras doenças. Foram calculadas as médias dos valores da Po da espessura corneana central (ECC) que demonstram diferença estatisticamente significativa entre os dois grupos. Conclusäo: Nesta amostra da populaçäo, as prevalências de GCS eGPN encontradas foram semelhantes, o que serve como alerta para o fato de que a fundoscopia é exame muito importante na triagem para detecçäo do glaucoma.