The chemotactic properties of various topical brimonidine tartrate ophthalmic preparations.

BACKGROUND: The study aimed to evaluate and compare the leukocyte chemotactic activities of various brimonidine tartrate (BT) eye drop formulations. METHODS: A 96-well dot-blot platet using a Boyden-style well was used to study the chemotactic effects of BT ophthalmic preparations. A modification was made to create blind wells where the tested agents were placed. Leukocytes were isolated from the peripheral blood of healthy volunteers. As positive controls, we used diluted drugs, benzalkonium chloride solution (BAK), zymosan-activated serum, and formyl-methionine-leucine-phenylalanine peptides. The negative control in our study was a phosphate-buffered saline solution. For each experimental condition, we measured leukocyte migration through a Millipore membrane. The differences in the mean migration distance between groups were compared using the analysis of variance (ANOVA). RESULTS: The measured migration distances (in µm ± SD) were 62.14 ± 3.71 for BT 0.2% with BAK (Alcon Laboratories Inc.); 63.61 ± 3.81 for BT 0.2% with BAK (Allergan Inc); 40.36 ± 3.17 for BT 0.15% without BAK; and 41.02 ± 2.17 for BAK alone. The negative controls showed no chemotactic activity, while the positive controls showed the highest neutrophil migration of all experimental conditions. The differences between BT 0.15% without BAK and the other commercial formulations were statistically significant. CONCLUSION: Commercial ophthalmic preparations of BT 0.2% with BAK 0.005% had higher chemotactic properties than the alternative of a lower concentration of BT and without the preservative BAK. Therefore, the latter should be considered for patients with glaucoma or ocular hypertension in order to minimize iatrogenic ocular inflammation.

Scleral wound healing with cross-link technique using riboflavin and ultraviolet A on rabbit eyes.

PURPOSE: The aim of study was to evaluate the cross-link using riboflavin and ultraviolet A (UVA) for improving scleral wound healing. MATERIALS AND METHODS: This was an experimental study involving four New Zealand rabbits (eight eyes). Therapy procedure was chosen for the right eye and control procedure for the left one. UVA irradiation of 365 nm with a surface irradiance of 3 mW/cm2 and a photosensitizer of riboflavin drops were applied for 30 minutes on the right eye at 2 mm from the limbus. Sclerotomy incision was performed at 2 mm from the limbus in both right (on the cross-link-treated area) and left eye. Then, 30 days after surgery, a morphological analysis and histological staining with hematoxylin-eosin and picrosirius red were performed, and the sclerotomy cicatrization of right and left eyes was compared. The variables investigated were as follows: sclerotomy incision pictures and measurements were made using the ImageJ Software. Scleral thickness was measured (employing the anterior optical coherence tomography and the digital caliper). Collagen fiber density stained with picrosirius red staining was measured using the Image Pro Plus software. RESULTS: The morphological analysis showed that in all samples, the right eye presented sclerotomy closure, and in two eyes, among them, there were no visible edges of the sclerotomies incision. The left eye presented sclerotomy closure and incision edges. The Image Pro demonstrated a higher density of collagen fibers in the right eye when compared to the one. The statistical analysis was significant when compared to the collagen fiber density in the treated eyes with the control eyes. CONCLUSION: The cross-link procedure resulted in a better sclerotomy wound healing.

Comparative electrophysiological responses in anisometropic and strabismic amblyopic children.

PURPOSE: To compare anisometropic hypermetropic amblyopic and strabismic amblyopic responses to pattern electroretinogram (PERG) and pattern visual evocated potential (PVEP). MATERIALS AND METHODS: Fifty-six patients - 18 hypermetropic anisometropic amblyopic children (mean age 9.70±2.5 years), 19 strabismic amblyopic children (mean age 10.30±2.6 years) and 19 normal emetropic subjects (mean age 10.10±2.2 years) - were enrolled in this study. After routine ophthalmic examination, PERG and PVEP were recorded in response to checks reversed at the rate of two reversals/second stimulating macular area. RESULTS: The difference between hypermetropic anisometropic amblyopia and strabismus amblyopia with respect to P100/P50/N95 wave latencies (P=0.055/0.855/0.132) and P100/P50/N95 amplitudes (P=0.980/0.095/0.045) was not statistically significant. However, there was a significant statistical difference between strabismic amblyopia group and controls for P100/P50/N95 latencies (P=0.000/0.006/0.004). CONCLUSION: Our findings indicated that despite clinical differences between anisometropic amblyopic and strabismic amblyopic patients, no differences were found in the responses of PVEP and PERG. The abnormal components of the PVEP and PERG in amblyopic subjects could reflect a retinal dysfunction in the visual pathway.

Fila cirúrgica digital como instrumento auxiliar de gestão hospitalar: Sugestões de adequações propostas por um serviço universitário de oftalmologia / The preoperative scheduling system as a secondary tool for hospital management: suggestions for adjustments proposed by a university ophthalmology unit

RESUMO Objetivo: Avaliar, através de busca na internet, quais os serviços públicos com atendimento oftalmológico no Brasil que possuem um pacote digital composto de página da instituição na rede digital, prontuário eletrônico, sistema de regulação de atendimento e fila de espera cirúrgica digital. Enfatizar a presença destes elementos de pesquisa com a condição de funcionamento de fila de espera cirúrgica digital com possibilidade de consulta publica pelo paciente usuário. Métodos: Estudo transversal através de busca na internet de serviços de oftalmologia com este pacote digital completo ou parcial em caráter nacional. Os dados foram pesquisados na internet no período de junho à julho de 2015. As instituições foram divididas em grupos de pesquisa, assim designados: hospitais multidisciplinares universitários, hospitais multidisciplinares assistenciais, hospitais uni-disciplinares assistenciais (somente oftalmologia) e banco de olhos (como entidade de atendimento público). Duas variáveis foram avaliadas: número total e parcial de serviços públicos de oftalmologia que possuem este sistema digital e como foi desenvolvido este pacote digital por cada instituição. Os dados foram avaliados através do teste Qui quadrado e prova exata de Fisher. O nível de significância do estudo foi 0,05. Resultados: Foram encontradas 48 instituições públicas oftalmológicas detentoras deste pacote digital, sendo: 24 universitárias, 15 assistenciais, 3 hospitalares uni-disciplinares (somente oftalmologia), 6 bancos de olhos. Somente 10,4 % destas instituições apresentaram uma fila de espera cirúrgica digital. Exclusivamente os bancos de olhos obtiveram dados significativos quanto a presença de fila cirúrgica digital, bem como a origem de seu desenvolvimento. Conclusão: Apenas algumas instituições apresentaram um pacote digital completo, porém a fila de espera cirúrgica digital é o componente mais raro destas instituições. Razões desta constatação são explanadas pelo estudo. Embora com pequena representação, em todo território nacional somente dois bancos de olhos apresentaram fila cirúrgica digital com possibilidade de consulta pública.

ABSTRACT Objective: To evaluate the incidence of a software program package at Brazilian public eye care institutions through an online survey. The package is made up of the institutions' websites, electronic medical records, regulatory assistance control system and the preoperative scheduling system. The aim is to analyze if this type of software facilitates the provisioning of eye care services, the patients' surgical procedure agenda, and access to information about the patients. Methods: Public health care institutions with eye care services were divided into multidisciplinary university hospitals, multidisciplinary health system hospitals, single discipline hospitals (only ophthalmology) and eye banks (when linked to public health care). Two kinds of data were evaluated on the Internet: I) ophthalmology institutions and the correlation with the presence of the software program, II) ophthalmology institutions and the correlation with the software source. A statistical analysis was performed using chi-square and Fisher's exact test. Significance levels were estimated at 0.05. Results: 48 public institutions were evaluated at 24 universities, 15 health care institutions, 3 single discipline hospital institutions (ophthalmology only), and 6 institutions specifically referred to as eye banks. In this survey, the digital preoperative scheduling system was only found in 10.4% of the institutions. After the statistical analysis, the eye bank was the only relevant institution that was significantly related to the presence of the digital preoperative scheduling system. Conclusion: Preoperative scheduling systems are expected to provide a good support tool for administrative management. However, this type of instrument as a software program is rarely found in public health care institutions in Brazil.

Ocular diseases at geriatric clinics in Rio de Janeiro: social and epidemiological considerations among patients with motor locomotion deficit.

OBJECTIVE: To identify the causes of low visual acuity and systemic morbidities that limit ambulation and access to eye care in geriatric clinics in Rio de Janeiro. METHODS: This cross-sectional study evaluated 187 patients from three geriatric clinics in Rio de Janeiro between January 2010 and January 2011. The inclusion criteria were individuals with a visual acuity of less than of equal to 20/200 in either eye (118 individuals), without optical correction. The exclusion criteria were individuals who refused to participate and those unable to undergo screening because of mental disabilities (6 individuals). Of the 187 individuals evaluated, 63 had visual acuity above 20/200. RESULTS: A total of 118 individuals with a visual acuity of ≤20/200 effectively participated in the study after meeting the inclusion and exclusion criteria. In addition, 57 participants (48.3%) presented systemic disabling morbidities. Of the 118 individuals with low visual acuity, 27.96% had cataract and 26.27% had refractive errors. CONCLUSION: Most of the patients from geriatric clinics experienced ocular morbidities, but their proper treatment resulted in improved visual acuity. A more socially oriented problem associated with eye care involved the difficulty of access to ophthalmologic consultations.

Ocular diseases at geriatric clinics in Rio de Janeiro: social and epidemiological considerations among patients with motor locomotion deficit / Morbidades oculares em clínicas geriátricas do Rio de Janeiro: considerações sociais e epidemiológicas associados a indivíduos com déficit de locomoção

Objective: To identify the causes of low visual acuity and systemic morbidities that limit ambulation and access to eye care in geriatric clinics in Rio de Janeiro. Methods: This cross-sectional study evaluated 187 patients from three geriatric clinics in Rio de Janeiro between January 2010 and January 2011. The inclusion criteria were individuals with a visual acuity of less than of equal to 20/200 in either eye (118 individuals), without optical correction. The exclusion criteria were individuals who refused to participate and those unable to undergo screening because of mental disabilities (6 individuals). Of the 187 individuals evaluated, 63 had visual acuity above 20/200. Results: A total of 118 individuals with a visual acuity of ≤20/200 effectively participated in the study after meeting the inclusion and exclusion criteria. In addition, 57 participants (48.3%) presented systemic disabling morbidities. Of the 118 individuals with low visual acuity, 27.96% had cataract and 26.27% had refractive errors. Conclusion: Most of the patients from geriatric clinics experienced ocular morbidities, but their proper treatment resulted in improved visual acuity. A more socially oriented problem associated with eye care involved the difficulty of access to ophthalmologic consultations. .

Objetivo: Identificar causas de baixa acuidade visual e morbidades sistêmicas que dificultem a deambulação e o acesso à tratamento oftalmológico em clínicas geriátricas do Rio de Janeiro. Métodos: Estudo transversal com 187 indivíduos de 3 clínicas geriátricas do Rio de Janeiro, no período de janeiro de 2010 à janeiro de 2011. O critério de inclusão foi todos os indivíduos com acuidade visual menor ou igual a 20/200 em qualquer olho (118 indivíduos) e sem atualização da correção óptica. O critério de exclusão foi indivíduos que se recusaram à participar do estudo e indivíduos incapazes de realizarem os exames por déficit mental (6 indivíduos). Dos 187 indivíduos avaliados, 63 indivíduos tinham acuidade visual melhor que 20/200. Resultados: Participaram do estudo efetivamente, após os critérios de inclusão e exclusão, 118 indivíduos com variadas causas de acuidade visual menor ou igual 20/200. Foram encontrados no estudo 57 (48,3%) indivíduos com a presença de morbidades sistêmicas incapacitantes. Dos 118 indivíduos com baixa acuidade visual, que participaram do estudo, 27,96% apresentaram catarata e 26,27% ametropias. Conclusão: A maioria dos indivíduos destas clínicas geriátricas apresentou morbidades oculares que com tratamento adequado permitem a melhora da acuidade visual. Foi encontrado um problema mais de cunho social pela dificuldade de acesso à consulta oftalmológica. .

Bilateral Sturge-Weber syndrome and glaucoma controlled with ahmed valve implant

Sturge-Weber Syndrome is a rare neuro-oculocutaneous disorder. The authors describe the case of a 13 years old boy, presented with bilateral Sturge-Weber Syndrome and glaucoma. Surgical treatment with Ahmed valve implantation in both eyes was carried out achieving lower levels of intraocular pressure.

A síndrome de Sturge-Weber trata-se de uma doença neuro-óculocutânea rara. Os autores relatam o caso de um paciente do sexo masculino, de 13 anos de idade, que se apresentou com Síndrome de Sturge-Weber bilateral e glaucoma. Foi realizado o tratamento cirúrgico com implante de válvula de Ahmed em ambos os olhos e alcançado a redução da pressão intraocular bilateral.

Immunohistochemical detection of Hsp90 and Ki-67 in pterygium.

BACKGROUND: To examine the immunohistochemical expression of heat shock protein 90 (Hsp90) and Ki-67 protein in human pterygium. MATERIALS AND METHODS: Tissues obtained during pterygium surgery of 15 patients who underwent the bare-sclera procedure and 10 normal conjunctivae were studied. All of these pterygia were primary ones. Recurrent pterygia were excluded. Normal bulbar conjunctivas (2 x 2 mm) were obtained from the nasal region close to the limbus from patients during their cataract and retina surgeries. Immunohistochemical detection of Hsp90 and Ki67 was done using the streptavidin-biotin method in paraffin embedded tissue sections. RESULTS: The percentage of cells stained for Hsp90 was greater for pterygium epithelium (76 ± 10.8) than for normal conjunctiva (1.4 ± 0.8). In each pterygium sample more than 60% of cells were positive. The differences in positive cells between normal and pterygium epithelium were highly significant for Hsp90 (P < 0,001).Pterygium epithelium also showed a higher percentage of cells that stained for Ki67 (10.1 ± 9.5) than for normal conjunctiva (2.1 ± 1.9). The differences in positive cells were also statistically significant for Ki67 (P < 0.01). Although there were significant differences in the majority of samples observed. It was noted that in some samples there was no difference between normal and pterygium epithelium for Ki67. CONCLUSION: Our results indicate an abnormal expression of Hsp90 and ki-67 in pterygium samples when compared to normal conjunctiva.The finding of abnormal expression of levels of Hsp90 in pterygium samples can stimulate new research into pterygium and its recurrence. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1128478792898812.

Repeatability of central corneal thickness measurement with the Pentacam HR system / Reprodutibilidade da medida da espessura central da córnea com o sistema Pentacam HR

PURPOSE: To assess the repeatability of central corneal thickness measurement at the geometrical center (Central Corneal Thickness - CCT) given by the Pentacam High Resolution (HR) Comprehensive Eye Scanner (Oculus, Wetzlar, Germany) over time. METHODS: Prospective, single center, observational study. Two separate CCT measurements were taken by the Pentacam corneal tomography exam (CTm) 3 to 12 months apart, and compared. RESULTS: One hundred and sixteen eyes (n=116) of 62 health patients were included in this study. Average CCT in first and last visits was 541.6±37 µm and 543.6±36.9 µm respectively. Mean difference between both measurements was 9.2±6.4 µm, and there was no statistically significant difference in CCT measurement between visits, with good correlation between them (P = 0.057, r² = 0,9209). CONCLUSION: Pentacam (HR) CTm gives repeatable CCT measurements over time.

OBJETIVO: Avaliar a reprodutibilidade da medida da espessura corneana central, no seu centro geométrico, com medidas obtidas pelo sistema Pentacam de Alta Resolução (HR) com o decorrer do tempo. MÉTODOS: Realizado estudo observacional prospectivo em Centro Oftalmológico. Duas medidas isoladas da espessura central da córnea (ECC) foram realizadas com exame de tomografia do segmento anterior Pentacam HR em períodos com intervalos maiores que 3 e em até 12 meses, sendo então comparadas os resultados. RESULTADOS: Cento e dezesseis olhos (n = 116) de 62 pacientes saudáveis foram incluídos neste estudo. A média das medidas da ECC na primeira e na última avaliação foi de 541,6 ± 37 µm e 543,6 ± 36,9 µm, respectivamente. A diferença média entre as duas medições foi de 9,2 ± 6,4 µm, e não houve diferença estatisticamente significativa das medida da ECC entre as visitas, com boa correlação entre si (P = 0,057, r2 = 0,9209). CONCLUSÃO: O Tomógrafo de Segmento Anterior Pentacam HR apresentou medidas de ECC reprodutíveis ao longo do tempo.

Central corneal thickness and biomechanical changes after clear corneal phacoemulsification.

PURPOSE: To evaluate central corneal thickness (CCT) and ocular biomechanical properties in patients before and after clear corneal phacoemulsification. METHODS: Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments) in 36 consecutive patients (47 eyes) who underwent clear corneal phacoemulsification. Central corneal thickness was measured with the Pentacam (Oculus Optikgeräte GmbH). All measurements were performed prior to surgery and at follow-up at 1, 7, and 30 days postoperatively. RESULTS: Central corneal thickness was higher at 1 and 7 days compared to preoperatively (P<.05) but not at 30 days. Corneal hysteresis was lower at 1 day than preoperatively (P<.05) but not at 7 and 30 days. Corneal resistance factor was lower at 1, 7, and 30 days compared to preoperatively (P<.05). Corneal-compensated IOP was slightly lower at 1, 7, and 30 days compared to preoperatively, but was not statistically significant (P>.05). Goldmann-correlated IOP was statistically significantly lower at 1 and 7 days than preoperatively (P<.05). CONCLUSIONS: Clear corneal phacoemulsification led to a change in ocular biomechanical properties. The increase in CCT after phacoemulsification was followed by a reduction in CRF and CH. Mean IOPcc was similar before and after phacoemulsification, indicating that IOPcc may be a more accurate indicator of true IOP than IOPg.

Danish type gelsolin-related amyloidosis in a Brazilian family: case reports.

Familial amyloidosis of the Finnish type (FAF) is an autosomal dominant form of systemic amyloidosis showing marked geographic clustering in Finland. The disease is caused by a point mutation, 654G-A, in the gelsolin gene. The Danish-subtype of FAF has been previously described in three families, the patients present clinical findings similar to FAF, and the mutation 654G-T in the gelsolin gene. Three members from two generations of the same family, with familial amyloidosis, were screened for mutations in the GSN gene. Genomic DNA was extracted from peripheral blood lymphocytes and the polymerase chain reaction (PCR) was carried out under standard conditions, using appropriate primers. Sequence analysis showed the presence of a G to T transition at nucleotide 654 of the gelsolin gene. This is the first report of gelsolin-related familial amyloidosis in a Brazilian family, and the result is particularly significant as this pedigree presents an unusual mutation, described previously in three families, with no known Finnish ancestors (Danish type).

Danish type gelsolin-related amyloidosis in a Brazilian family: case reports / Amiloidose familiar relacionada ao gene gelsolin em uma família brasileira: relato de casos

Familial amyloidosis of the Finnish type (FAF) is an autosomal dominant form of systemic amyloidosis showing marked geographic clustering in Finland. The disease is caused by a point mutation, 654G-A, in the gelsolin gene. The Danish-subtype of FAF has been previously described in three families, the patients present clinical findings similar to FAF, and the mutation 654G-T in the gelsolin gene. Three members from two generations of the same family, with familial amyloidosis, were screened for mutations in the GSN gene. Genomic DNA was extracted from peripheral blood lymphocytes and the polymerase chain reaction (PCR) was carried out under standard conditions, using appropriate primers. Sequence analysis showed the presence of a G to T transition at nucleotide 654 of the gelsolin gene. This is the first report of gelsolin-related familial amyloidosis in a Brazilian family, and the result is particularly significant as this pedigree presents an unusual mutation, described previously in three families, with no known Finnish ancestors (Danish type).

Amiloidose familiar do tipo finlandes (FAF) é uma forma de amiloidose sistêmica autossômica dominante com grande concentração geográfica na Finlândia. É causada por uma mutação, 654G-A, no gene gelsolin. O subtipo dinamarquês da FAF foi previamente descrito em três famílias, com achados clínicos similares mas com a mutação 654G-T no gene gelsolin. Três membros de duas gerações da mesma família, com diagnóstico de amiloidose familiar, foram submetidos a screening de mutações no gene gelsolin. O DNA genômico foi extraído de linfócitos do sangue periférico, sendo realizada reação em cadeia de polimerase (PCR) em condições padronizadas. A análise do sequenciamento revelou uma transição de G para T no nucleotidio 654 do gene gelsolin. Este é o primeiro relato de uma amiloidose familiar relacionada ao gene gelsolin em uma família brasileira, que apresenta uma forma rara de mutação, descrita previamente em três famílias, sem ancestrais finlandeses (tipo dinamarquês).

Ocular pulse amplitude in patients with asymmetric primary open-angle glaucoma.

AIM: To evaluate ocular pulse amplitude (OPA) using the dynamic contour tonometer (DCT) in patients with asymmetric primary open-angle glaucoma (POAG) and asymmetric intra-ocular pressure (IOP). METHODS: The participants consisted of 48 patients (96 eyes) with asymmetric POAG. Three measurements of IOP and OPA were taken using DCT. The diagnosis of asymmetry required a difference of glaucomatous visual field loss greater than 6 dB in the global index MD and a difference of 5 mmHg in IOP measured by Goldmann tonometry between the more affected and the contra-lateral eye. All participants underwent full ophthalmologic clinical assessment including ultrasonic pachymetry and biometric measurements. Exclusion criteria were corneal diseases or scars, topical or systemic glaucomatous medications, and previous ocular surgery. RESULTS: No difference (p = 0.142) was found between the axial length measurements of the better eyes group (22.95 ± 0.91 mm) and worse eyes group (22.85 ± 0.97 mm). There was a statistically significant difference (p = 0.011) between the central corneal thickness values of the better eyes group (537.08 ± 29.54 µm) and worse eyes group (534.40 ± 29.87 µm). The OPA values of the better eyes group (3.32 ± 1.14 mmHg) were significantly lower (p = 0.001) than those obtained in the worse eyes group (3.83 ± 1.27 mmHg). When correcting the OPA readings by the IOP there was no statistical difference between groups (p = 0.996). CONCLUSION: Higher OPA values were found in eyes with higher IOP levels and advanced glaucoma's lesions in asymmetric hypertensive POAG patients. However, after the OPA correction by the IOP levels there was no more statistical difference between eyes.

A one-stage correction of the blepharophimosis syndrome using a standard combination of surgical techniques.

BACKGROUND: The aim of this study was to evaluate the efficacy of a one-stage treatment for the blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) using a combination of standard surgical techniques. METHODS: This is a retrospective interventional case series study of 21 BPES patients with a 1-year minimum follow-up period. The one-stage intervention combined three different surgical procedures in the following order: Z-epicanthoplasty for the epicanthus, transnasal wiring of the medial canthal ligaments for the telecanthus, and a bilateral fascia lata sling for ptosis correction. Preoperative and postoperative measurements of the horizontal lid fissure length (HFL), vertical lid fissure width (VFW), nasal intercanthal distance (ICD), and the ratio between the intercanthal distance and the horizontal fissure length (ICD/HFL) were analyzed using Student's t test for paired variables. RESULTS: The mean preoperative measurements were 4.95 ± 1.13 mm for the VFW, 20.90 ± 2.14 mm for the HFL, 42.45 ± 2.19 mm for the ICD, and 2.04 ± 0.14 mm for the ICD/HFL ratio. The mean postoperative measurements were 7.93 ± 1.02 mm for the VFW, 26.36 ± 1.40 mm for the HFL, 32.07 ± 1.96 mm for the ICD, and 1.23 ± 0.09 mm for the ICD/HFL ratio. All these values and their differences were statistically significant (P < 0.0001). All of the patients developed symmetric postoperative inferior version lagophthalmus, a complication that tended to decrease over time. CONCLUSION: One-stage correction of BPES is safe and efficient with the surgical techniques described.

Qualidade de vida em portadores de glaucoma: comparação entre pacientes do sistema público de saúde e clínica privada / Quality of life in glaucoma patients: comparison between public health system and private practice

OBJETIVO: Avaliar a qualidade de vida de portadores de glaucoma, comparando pacientes do sistema público de saúde com pacientes atendidos no sistema particular, através do Questionário de Função Visual de 25 itens do National Eye Institute (NEI-VFQ). MÉTODOS: Realizou-se um estudo transversal, desenvolvido mediante a aplicação do questionário NEI-VFQ, em 83 pacientes glaucomatosos não consecutivos em diferentes estágios da doença, sendo 51 do Hospital Universitário Antonio Pedro (instituição pública), e 32 pacientes de clínica particular (instituição privada). RESULTADOS: Houve diferença estatística significativa entre os grupos nos subdomínios referentes à "saúde geral", "visão geral", "dor ocular", "atividades para perto", "atividades para longe", "saúde mental" e "atividades de vida diária". Não foi encontrada diferença significativa nos subdomínios referentes a "aspectos sociais", "dependência", "capacidade para dirigir", "visão de cores" e "visão periférica". O escore geral demonstrou diferença estatística significativa entre os grupos, com média de 73,13 para instituição pública e 86,07 para instituição privada. CONCLUSÃO: O impacto do glaucoma na qualidade de vida foi maior nos pacientes de instituição pública, quando comparados com aqueles de instituição privada através do questionário NEI-VFQ.

PURPOSE: To evaluate the quality of life of glaucoma patients comparing public health system, and private practice, through the questionnaire National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ). METHODS: A cross-sectional study, developed through the application of NEI-VFQ questionnaire in 83 non-consecutive glaucoma patients at different stages of the disease, and 51 from public health system, and 32 patients from private clinic. RESULTS: Statistically significant difference between groups was demonstrated in subdomains related to the "general health", "general vision", "ocular pain", "near activities", "distance activities", "mental health" and "role difficulties" no significant difference was demonstrated in "social functioning", "dependency", "driving", "color vision" and "peripheral vision". Regarding the overall score given by the questionnaire statistical difference was observed with an average of 73.13 in the public institutions and 86.07 in the private practice. CONCLUSION: The impact on quality of life was higher in patients from the public institution when compared to those of the private practice through the NEI-VFQ questionnaire.

Glaucoma anterior chamber morphometry based on optical Scheimpflug images / Morfometria da câmara anterior no glaucoma avaliada pelas imagens de Scheimpflug

Purpose: To compare the performance of gonioscopy and noncontact morphometry with anterior chamber tomography (High Resolution Pentacam - HR) using optical Scheimpflug images in the evaluation of the anterior chamber angle (ACA). Methods: Transversal study. 112 eyes from 74 subjects evaluated at the Glaucoma Department, Fluminense Federal University, underwent gonioscopy and Pentacam HR. Using gonioscopy, the ACA was graded using the Shaffer Classification (SC) by a single experienced examiner masked to the Pentacam HR findings. Narrow angle was determined in eyes in which the posterior trabecular meshwork could not be seen in two or more quadrants on non-indentation gonioscopy (SC Grade 2 or less). Pentacam HR images of the nasal and temporal quadrants were evaluated by custom software to automatically obtain anterior chamber measurements, such as: anterior chamber angle (ACA), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results: Based on gonioscopy results, 74 (60.07 percent) eyes of patients classified as open-angle (SC 3 and 4) and 38 (33.93 percent) eyes of patients classified as narrow-angle (SC 1 and 2). Noncontact morphometry with Scheimpflug images revealed a mean ACA of 39.20 ± 5.31 degrees for open-angle and 21.18 ± 7.98 degrees for narrow-angle. The open-angle group showed significant greater ACV and ACD values when compared to narrow-angle group (ACV of 193 ± 36 mm³ vs. 90 ± 25 mm³, respectively, p<0.001; and ACD of 3,09 ± 0,42 mm vs. 1,55 ± 0,64 mm, respectively, p<0.0001.). In screening eyes with open-angle and narrow-angle with the Pentacam ACA of 20º (SC Grade 2) using the ROC curves, the analysis showed 52.6 percent of sensitivity and 100 percent of specificity. Conclusions: The Pentacam showed ability in detecting eyes at risk for angle closure analyzing ACV and ACD.

Objetivo: Comparar os resultados da gonioscopia com as medidas morfométricas do segmento anterior obtidas pela tomografia (Pentacam High Resolution - HR), utilizando imagens ópticas de Scheimpflug na avaliação do ângulo da câmara anterior (ACA). Métodos: Realizado estudo transversal com avaliação de 112 olhos de 74 pacientes avaliados no Setor de Glaucoma da Universidade Federal Fluminense, submetidos ao exame da gonioscopia e do Pentacam HR. Na gonioscopia o ACA foi classificado utilizando a Classificação de Shaffer (SC), realizado por um único examinador experiente, e seus resultados foram comparados às medidas do Pentacam HR. Ângulos estreitos foram classificados nos olhos em que a malha posterior trabecular não foi observada em dois ou mais quadrantes na gonioscopia tradicional (SC Grau 2 ou menor). As imagens dos quadrantes nasal e temporal obtidas pelo Pentacam HR foram avaliadas por um software personalizado que obtêm automaticamente as seguintes medidas da câmara anterior: ângulo da câmara anterior (ACA), volume da câmara anterior (ACV) e profundidade da câmara anterior (ACD). Resultados: Com base nos resultados gonioscopia, 74 (60,07 por cento) olhos foram classificados como ângulo aberto (SC 3 e 4) e 38 (33,93 por cento) olhos foram classificados como ângulo estreito (SC 1 e 2). A morfometria de não contato com as imagens Scheimpflug revelou uma média de ACA 39,20 ± 5,31 graus nos ângulos abertos e 21,18 ± 7,98 graus nos ângulos estreitos. O grupo classificado como ângulo aberto mostrou medidas significativamente maiores de ACV e ACD quando comparado ao grupo de ângulo estreito (ACV de 193 ± 36 mm³ vs 90 ± 25 mm³, respectivamente, p <0,001 e ACD de 3,09 ± 0,42 mm vs 1,55 ± 0,64 mm, respectivamente, p<0,0001). Na diferenciação dos olhos com ângulo aberto e olhos com ângulo estreito no Pentacam, a análise das curvas ROC demonstraram que na medida de 20º (SC Grau 2) resultaram em 52,6 por cento de sensibilidade em 100 por cento de especificidade. Conclusões: O Pentacam HR mostrou habilidade em detectar os olhos com risco de fechamento angular na analise do ACV e do ACD.

Processos judiciais em oftalmologia: análise de possíveis fatores desencadeantes / Litigation in ophthalmology: analysis of possible triggers

Objetivo: Analisar os possíveis fatores de desencadeamento de processos judiciais na área de oftalmologia. Método: Estudo retrospectivo de 70 casos de processos judiciais cíveis em oftalmologia. Foram avaliados em cada processo, a anamnese, o exame oftalmológico, os dados do paciente no momento do incidente, sexo, idade, diagnóstico inicial e diagnóstico da causa do processo, número de consultas antes e após o fato desencadeante, a realização de exames pré-operatórios mínimos de acordo com os protocolos da Cooperativa Estadual de Serviços Administrativos em Oftalmologia - COOESO, termo de consentimento informado, as folhas de descrição do procedimento, de enfermagem, de materiais e medicamentos do centro cirúrgico, do anestesista, da alta hospitalar e o valor da indenização. Resultados: Dos 70 casos analisados, com relação à acuidade visual final, 45 (64,3 por cento) apresentavam amaurose. Quanto às condições prévias ao tratamento, os diagnósticos foram: catarata 46 (65,7 por cento), ametropias 12 (17,1 por cento), trauma ocular 8 (11,4 por cento), glaucoma 3 (4,3 por cento) e descolamento de retina 1 (1,4 por cento). Com relação às principais complicações secundárias ao tratamento efetuado que deram motivação à lide, os diagnósticos foram: descolamento de retina 37 (52,8 por cento), acuidade visual insatisfatória pós cirurgia de catarata 12 (17,1 por cento), irregularidades corneanas após cirurgia refrativa 8 (11,4 por cento), endoftalmites 4 (5,7 por cento), desconforto com óculos prescritos 4 (5,7 por cento) e atrofia bulbar 4 (5,7 por cento). O número de consultas antes do início do processo foi de até duas em 67,1 por cento dos casos. Os processos decorrentes de cirurgia representaram 94,3 por cento da amostra. Termo de consentimento informado não foi utilizado em 63 por cento do total de casos cirúrgicos. Os valores de indenização pagos foram menores do que 50 mil reais em 72,7 por cento. Conclusões: Foram fatores importantes relacionados aos processos judiciais oftalmológicos: amaurose, tratamento cirúrgico, descolamento de retina, número reduzido de consultas pré-operatórias e ausência de termo de consentimento.

Purpose: To analyze the possible predisposing factors of lawsuits involving ophthalmologists. Methods: Retrospective study of 70 lawsuits involving the practice of Ophthalmology. The patient's gender, age, medical and ophthalmic history were reviewed. The eye disorder that generated the prosecution, the pre-existing ophthalmic diagnosis, the preoperative exams and the operating room data were also analyzed. The informed consent form, the outcome of the litigation and the value of compensation were recorded. Results: Blindness was reported in 45 (64.3 percent) of the 70 lawsuits and was the principal eye disorder related to litigation. The pre-existing eye diseases associated with legal claims were: cataracts in 46 (65.7 percent) lawsuits, refractive errors in 12 (17.1 percent), ocular trauma in 8 (11.4 percent), glaucoma in 3 (4.3 percent) and retinal detachment in 1 (1.4 percent) lawsuit. The major surgical complications that possibly motivated the patient to sue the ophthalmologist were retinal detachment in 37 (52.8 percent) lawsuits, poor visual acuity after cataract surgery in 12 (17.1 percent), corneal disorders following refractive surgery in 8 (11.4 percent), endophthalmitis in 4 (5.7 percent), discomfort with refractive prescriptions in 4 (5.7 percent) and ocular atrophy in 4 (5.7 percent) lawsuits. Ophthalmic surgery was involved in 94.3 percent of the 70 prosecutions analyzed. Two or less visits to the ophthalmologist preceding the surgical or refractive event leading to legal dispute were recorded in 67.1 percent of the lawsuits. A pre-surgical Informed consent form was not used in 63 percent of the 66 surgical procedures leading to litigation. 62.9 percent of the lawsuits were unfavorable to the Ophthalmologist and the amount of compensation was less than R$ 50,000 in 72.7 percent of these legal claims. Conclusions: Blindness, surgery, retinal detachment, few pre-operative ophthalmic visits and the lack of informed consent forms were possible risk factors associated with lawsuits in the field of Ophthalmology.

Bilateral and simultaneous cystoid macular edema associated with latanoprost use: report of two cases.

Cystoid macular edema is an uncommon, but well known, side effect of latanoprost. Two cases of bilateral and simultaneous cystoid macular edema associated with latanoprost use are described, which complete resolution of the edema is observed upon drug discontinuation.

Bilateral and simultaneous cystoid macular edema associated with latanoprost use: report of two cases / Edema macular cistóide bilateral e simultâneo associado com o uso de latanoprost: relato de dois casos

Cystoid macular edema is an uncommon, but well known, side effect of latanoprost. Two cases of bilateral and simultaneous cystoid macular edema associated with latanoprost use are described, which complete resolution of the edema is observed upon drug discontinuation.

O edema macular cistóide é um efeito colateral incomum, porém bem conhecido, do latanoprost. São descritos dois casos de edema macular cistóide bilateral e simultâneo associado ao uso de latanoprost, em que foi observada completa resolução do edema após a suspensão da droga.

Glaucoma anterior chamber morphometry based on optical Scheimpflug images.

PURPOSE: To compare the performance of gonioscopy and noncontact morphometry with anterior chamber tomography (High Resolution Pentacam - HR) using optical Scheimpflug images in the evaluation of the anterior chamber angle (ACA). METHODS: Transversal study. 112 eyes from 74 subjects evaluated at the Glaucoma Department, Fluminense Federal University, underwent gonioscopy and Pentacam HR. Using gonioscopy, the ACA was graded using the Shaffer Classification (SC) by a single experienced examiner masked to the Pentacam HR findings. Narrow angle was determined in eyes in which the posterior trabecular meshwork could not be seen in two or more quadrants on non-indentation gonioscopy (SC Grade 2 or less). Pentacam HR images of the nasal and temporal quadrants were evaluated by custom software to automatically obtain anterior chamber measurements, such as: anterior chamber angle (ACA), anterior chamber volume (ACV) and anterior chamber depth (ACD). RESULTS: Based on gonioscopy results, 74 (60.07%) eyes of patients classified as open-angle (SC 3 and 4) and 38 (33.93%) eyes of patients classified as narrow-angle (SC 1 and 2). Noncontact morphometry with Scheimpflug images revealed a mean ACA of 39.20 ± 5.31 degrees for open-angle and 21.18 ± 7.98 degrees for narrow-angle. The open-angle group showed significant greater ACV and ACD values when compared to narrow-angle group (ACV of 193 ± 36 mm³ vs. 90 ± 25 mm³, respectively, p<0.001; and ACD of 3,09 ± 0,42 mm vs. 1,55 ± 0,64 mm, respectively, p<0.0001.). In screening eyes with open-angle and narrow-angle with the Pentacam ACA of 20º (SC Grade 2) using the ROC curves, the analysis showed 52.6% of sensitivity and 100% of specificity. CONCLUSIONS: The Pentacam showed ability in detecting eyes at risk for angle closure analyzing ACV and ACD.