Epidemic of unilateral panuveitis in children from Brazilian Amazonia: clinical and etiological aspects in seven patients.

OBJECTIVES: To describe clinical presentation and results of diagnostic and therapeutic procedures in seven children from an epidemic of panuveitis in the Brazilian Amazonia, as well as environmental analysis and etiological aspects involved. METHODS: Patients underwent full pediatric and ophthalmic examinations, B-scan, ultrasound biomicroscopy, and serological tests. Ocular samples were thoroughly analyzed, including two enucleation specimens. Environmental investigation encompassed water, soil, and river fauna. RESULTS: All patients had bathed in the waters of a regional river, the Araguaia. Six of them presented with intermediate uveitis, with snowbanking. Five had cataract and four showed inferior endothelial opacity, with localized anterior synechiae. One showed total leukoma, with flat anterior chamber. Only two had active uveitis, one of them with anterior chamber nodule. Serology revealed high prevalence of anti-Toxocara canis immunoglobulin G (IgG) antibodies. In three cases, vitreous and lens samples disclosed spicules of freshwater sponges Drulia uruguayensis and D. ctenosclera, also detected in the waters of the river. CONCLUSION: Freshwater sponge spicules could be potential new etiological agents of ocular pathology, but further studies are needed, considering the heterogeneity of the ocular lesions and results of serological and environmental studies.

[Central and peripheral corneal thickness: influence on the iop measurement by Tonopen]. / Espessura central e periférica da córnea: influência na medida da pressão intra-ocular pelo Tonopen.

PURPOSE: To assess the influence of central and peripheral corneal thickness on the IOP measurement by Tonopen. METHODS: The IOP of 58 eyes from suspected and glaucomatous patients was evaluated by Goldmann's tonometry (GT) and, by Tonopen XL on the central (TC) and peripheral (TP) regions of the cornea. Using the DGH 5100e pachymeter, we also measured the corneal thickness in its central (CCT) and peripheral (at 6:00 h) regions (PCT). Patients with any corneal changes were excluded. The mean values of all measurements was comparatively analyzed (GT x TC; GT x TP; TC x TP; CCT x PCT) by the paired t test and by regression and correlation analysis. RESULTS: The means (+/- standard deviation) of IOP obtained with GT, TC and TP were respectively 14.6 (+/-) mmHg; 18.9 (+/-2.9) mmHg and 20.7 (+/-3.7) mmHg with a statistical highly significant difference (p<0.001). The means (+/- standard deviation) of central and peripheral corneal thickness were respectively 526 (+/-42.3) and 639 (+/-52.9) microm, also with a statistical highly significant difference (p<0.001). The correlation coefficients (r) between the measurements were 0.71 (p<0.001) for GT and TC; 0.65 (p<0.001) for GT and TP and 0.64 (p<0.001) for TC and TP. CONCLUSIONS: There was a positive correlation between the measurements performed with Tonopen XL and Goldmann's tonometer at the central region of the cornea and the mean IOP was higher with Tonopen XL. The mean IOP obtained by TP was higher than that obtained by TC. These data showed that Tonopen XL, besides providing higher IOP readings than those with Goldmann's tonometer, is influenced by the corneal thickness presenting higher IOP readings in the periphery than in the central region of the cornea.

Espessura central e periférica da córnea: influência na medida da pressão intra-ocular pelo Tonopen / Central and peripheral corneal thickness: influence on the iop measurement by Tonopen

OBJETIVO: Avaliar a influência da espessura corneana central e periférica na medida da pressão intra-ocular (Po) obtida com o Tonopen XL. MÉTODOS: Avaliou-se a Po de 58 olhos de pacientes suspeitos ou portadores de glaucoma crônico simples com o tonômetro de aplanacão de Goldmann e com o Tonopen XL na região central (Tonopen Central) e na periferia corneana (Tonopen Periférico), além da espessura corneana (paquímetro DGH 5100e), também na região central (Paquimetria Central) e na periferia da córnea (Paquimetria Periférica). Compararam-se estatisticamente os grupos Goldmann com Tonopen Central, Goldmann com Tonopen Periférico, Tonopen Central com Tonopen Periférico e Paquimetria Central com Paquimetria Periférica. RESULTADOS: A Po média (n desvio-padrão) em mmHg com o Goldmann foi de 14,6 (n3,3), com o Tonopen Central de 18,9 (n2,9) e com o Tonopen na periferia da córnea de 20,7 (n3,7), tendo sido encontrada diferenca altamente significativa (p<0,0001). A média (n desvio-padrão) da Paquimetria Central em micra foi de 526 (n42,3) e da Paquimetria Periférica foi de 639 (n52,9), sendo esta diferenca altamente significativa (p<0,001). Houve correlacão positiva entre as medidas da Po pelo Goldmann e Tonopen Central (r=0,71, p<0,001) e entre as medidas pelo Goldmann e Tonopen Periférico (r=0,65, p<0,0001) e Tonopen Central e Tonopen Periférico (r=0,64, p<0,0001). CONCLUSÕES: Houve correlacão positiva entre as medidas com o Tonopen XL e o Goldmann, mas a Po média pelo Tonopen foi maior que aquela obtida pelo Goldmann. A Po média pelo Tonopen Periférico foi maior que a pelo Tonopen Central. O Tonopen, além de fornecer valores de Po maiores que o Goldmann, é influenciado pela espessura corneana apresentando valores de Po mais elevados na periferia da córnea que na região central.