Correlação entre parâmetros cardiovasculares e alterações glaucomatosas do nervo óptico em portadores de insuficiência cardíaca congestiva / Correlation between cardiovascular parameters and glaucomatous changes in the optic nerve in patients with low-output heart failure

Resumo Objetivos: Correlacionar parâmetros oftalmoscópicos e cardiovasculares em pacientes com diagnóstico de insuficiência cardíaca com fração de ejeção reduzida (ICFER) e avaliar a associação entre ICFER e alterações do nervo óptico sugestivas de glaucoma. Métodos: Estudo descritivo, observacional, prospectivo, composto por amostra 30 pacientes com diagnóstico de ICFER. Os pacientes foram submetidos ao exame oftalmológico, que incluiu biomicroscopia, avaliação da acuidade visual, aferição da PIO (pressão intraocular), gonioscopia e medida de ECC (espessura central corneana). A avaliação de parâmetros cardiovasculares, como PAM (pressão arterial média), FEVE (fração de ejeção do ventrículo esquerdo), comorbidades e tempo de diagnóstico de IC foi realizada a partir de revisão de prontuário médico. Arbitrariamente foi escolhido o olho esquerdo para análise estatística dos dados. A correlação estatística foi realizada através do teste de Spearman, e a comparação através do teste U de Mann-Whitney. Resultados: Observou-se uma alta prevalência de atrofia peripapilar (73,3%), além de uma correlação positiva, moderada e estatisticamente significativa entre FEVE e PPO (pressão de perfusão ocular) (r = 0,517; p = 0,004). Apesar da ausência de significância das comparações pelo Teste U de Mann-Whitney, evidenciou-se uma maior prevalência de atrofia peripapilar nos pacientes que apresentavam uma menor PAM, menor FEVE e menor PPO. Conclusão: A ICFER pode ser um fator de risco para o desenvolvimento de alterações glaucomatosas no disco do nervo óptico. A atrofia peripapilar e a baixa pressão de perfusão ocular resultantes do déficit contrátil cardíaco podem estar relacionadas com a teoria vascular do desenvolvimento do glaucoma de pressão.

Abstract Objectives: To correlate ophthalmoscopic and cardiovascular parameters in patients diagnosed with low-output heart failure (HFrEF) and to evaluate the association between HFrEF and glaucoma-suggestive alterations in the optic nerve. Methods: Descriptive, observational and prospective study, composed of 30 patients diagnosed with HFrEF. The patients were submitted to ophthalmologic examination, which included biomicroscopy, visual acuity, gonioscopy, intraocular pressure (IOP) and central corneal thickness (CCT) measurement. Their cardiovascular parameters evaluation, such as mean arterial pressure (MAP), left ventricular ejection fraction (LVEF), comorbidities and diagnosis time of HFrEF was performed upon a review over their medical chart. The left eye was arbitrarily chosen for statistical analysis of the data. Statistical correlation was performed using the Spearman test, while the comparison was performed using the Mann-Whitney U-test. Results: A high prevalence of peripapillary atrophy (73.3%) was observed, as well as a positive, moderate and statistically significant correlation between LVEF and ocular perfusion pressure (OPP) (r = 0.517; p = 0.004). Despite the lack of significance of the Mann-Whitney U-Test comparisons, a higher prevalence of peripapillary atrophy was found in patients with lower MAP, lower LVEF and lower OPP. Conclusion: HFrEF may be a risk factor for the development of glaucomatous changes in the optic nerve disc. The resulting peripapillary atrophy and low OPP from the contractile deficit may be related to the vascular theory about normal-tension glaucoma development.

Clinical and epidemiological study in patients with primary open-angle glaucoma / Estudo clínico-epidemiológico em indivíduos com glaucoma primário de ângulo aberto

Abstract Objective: To evaluate the clinical and epidemiological profile of patients with primary open-angle glaucoma. Methods: This is a quantitative study with cross-sectional and analytical design, which sample consisted of 425 patients treated in an unit of Specialized Care in Ophthalmology, located in the northern state of Minas Gerais, from 2004 to 2015. We collected the data using formularies that addressed demographic and clinical aspects, risk factors and the presence of undercurrent diseases. We conducted an ophthalmological examination to evaluate anatomical and functional changes. We used statistical analysis, and the results are presented by mean, standard deviation and percentiles 25, 50 and 75. Results: Females predominate (56.8%), the age group of 60 years or older (44%) and mixed skin (81.7%). A minority of participants present risk factors such as high myopia (6.3%) and diabetes mellitus (17.9%). Regarding the clinical examination, there is a prevalence of increased optic nerve excavation (≥ 0.8) and low thickness of the corneas (≤ 535 microns). Conclusion: Most people develop advanced glaucoma, with increased optic nerve excavation and changed visual fields. Other common risk factors are: family history of glaucoma, decreased thickness of the cornea and hypertension. Early diagnosis and treatment can prevent vision loss. Primary care physicians should consider referring patients who have glaucoma risk factors, for an ophthalmologic examination.

Resumo Objetivo: Avaliar o perfil clínico-epidemiológico dos indivíduos com glaucoma primário de ângulo aberto. Métodos: Trata-se de estudo quantitativo com desenho transversal e analítico, mediante amostra constituída de 425 pacientes atendidos em uma Unidade de Atenção Especializada em Oftalmologia localizada no norte do estado de Minas Gerais, Brasil, cadastrados no período de 2004 a 2015. As variáveis analisadas foram: características demográficas e clínicas, fatores de risco e presença de doenças associadas. Foi realizado exame oftalmológico para avaliar alterações anatômicas e funcionais. Para as análises estatísticas foram utilizados os programas Statistical Package for the Social Sciences (SPSS), versão 19.0. Considerou-se nível de significância p<0,05 para as variáveis categóricas. As variáveis descritivas foram apresentadas pela média, desvio-padrão e percentis 25, 50 e 75. Resultados: Predominou o gênero feminino (56,8%), a faixa etária de 60 anos ou mais (44%), e a cor da pele parda (81,7%). Fatores de risco como alta miopia (6,3%) e diabetes mellitus (17,9%) foram relatados pela minoria dos participantes. Em relação ao exame clínico, houve prevalência de escavação do nervo óptico aumentada (≥ 0,8 mm2) e baixa espessura central das córneas (≤ 535 micras). Conclusão: A maioria dos indivíduos apresenta glaucoma avançado, com escavações do nervo óptico aumentadas e campos visuais alterados. Outros fatores de risco frequentes foram: história familiar positiva para glaucoma, espessura central da córnea diminuída e hipertensão arterial sistêmica. Diagnóstico e tratamento precoces podem prevenir contra a perda de visão no glaucoma. Médicos da atenção primária à saúde devem encaminhar os pacientes que tenham fatores de risco para glaucoma, para a consulta especializada e exames oftalmológicos.

Cutaneous sarcoidosis and secondary open-angle glaucoma in a patient: case report and literature review

Abstract The current report presents the case of a 41-year-old male patient with a two-month history of asthenopia and plaques in the frontotemporal region. Computed tomography revealed bilateral hilar and mediastinal lymphadenopathy. Ophthalmological examination showed elevated intraocular pressure. Skin biopsy demonstrated aa dermal inflammatory infiltrate composed mainly of epithelioid cells and a few multinucleated giant cells, but no obvious lymphocytes. Findings of thorough physical examinations and auxiliary examinations suggested the presence of cutaneous sarcoidosis and secondary open-angle glaucoma. Treatment consisted mainly of oral methylprednisolone. Skin lesions, bilateral hilar, and mediastinal lymphadenopathy resolved completely. Cutaneous sarcoidosis is often accompanied by extracutaneous organ involvement. Dermatologists must be aware of the disease's extracutaneous manifestations to ensure accurate diagnosis for further treatments.

Increased Intraocular Pressure after Extensive Conjunctival Removal: A Case Report

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.

Increased Intraocular Pressure after Extensive Conjunctival Removal: A Case Report

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.

Dilated episcleral veins with secondary open angle glaucoma.

We report a case of dilated episcleral vein with secondary open angle glaucoma. A 65-year-old female presented with redness of both the eyes without any prior systemic history. Her ocular examination revealed dilated episcleral veins and a high intraocular pressure (IOP) of 38 mm Hg in the right eye. Systemic examination was negative for carotid cavernous fistula, low-grade dural arteriovenous fistula, dysthyroid ophthalmopathy, and primary pulmonary hypertension. During follow-up, her IOP remained in high thirties despite maximum medications. She underwent right eye trabeculectomy with partial thickness sclerectomy with sclerotomy. In the beginning, the sclerotomy incision was not deepened into the suprachoroidal space. She developed choroidal effusion during surgery and the sclerotomy was deepened into suprachoroidal space and straw color fluid was drained. Postoperatively, she developed choroidal effusion, which resolved with conservative management. This case highlights the importance of sclerotomy in such cases of high episcleral venous pressure.

Prevalência de diabetes mellitus tipo 2 e outros fatores de risco associados em pacientes com glaucoma / Prevalence of type 2 diabetes mellitus and other associated risk factors in glaucoma patients

OBJETIVO: Avaliar a prevalência de diabéticos em uma amostra de pacientes com glaucoma; verificar se existe associação entre diabetes mellitus e glaucoma na amostra estudada; verificar outros fatores de risco associados. MÉTODOS: Foram analisados de forma retrospectiva os prontuários de 50 pacientes com diagnóstico de glaucoma. Os dados registrados foram sexo, idade, raça, história familiar de glaucoma e história pessoal de diabetes mellitus tipo 2. RESULTADOS: Do total de pacientes avaliados, 5 (10 por cento) apresentavam diabetes mellitus tipo 2. Destes, 3 eram mulheres e 2 eram homens, com mediana de idade de 81 anos (71-88). A prevalência de diabetes nos pacientes com glaucoma não mostrou diferenças significativas (OR: 1,476; Intervalo de Confiança 95 por cento: 0,4438 a 4,910; p= 0,5352) quando comparada à prevalência de diabetes mellitus tipo 2 na população geral brasileira (7,6 por cento). CONCLUSÃO: Nesta amostra de pacientes com glaucoma, a prevalência de diabetes mellitus tipo 2 foi pouco mais elevada que a da população. Entretanto, nenhuma associação foi encontrada entre diabetes mellitus e glaucoma.

PURPOSE: To evaluate prevalence of diabetes mellitus in a group of patients with glaucoma; to verify if there is association between diabetes mellitus and glaucoma; to verify other associated risk factors. METHODS: Fifty(50) glaucoma patients had their medical records analyzed in a retrospective way. Registered data included sex, age, ethnic group, family history of glaucoma and personal history of type 2 diabetes mellitus. RESULTS: Five (10 percent) of all evaluated patients had type 2 diabetes mellitus. 3 of them were female and 2 were male, median age of 81 years old (71-88). Prevalence of diabetes in glaucoma patients did not show significant differences. (OR: 1.476; 95 percent Confidence Interval: 0.4438 to 4.910; p= 0.5352) when compared to the prevalence of type 2 diabetes mellitus in general brazilian population (7.6 percent). CONCLUSION: In this group of patients with glaucoma, prevalence of type 2 diabetes mellitus was slightly higher than in general population. However, no association was found between diabetes mellitus and glaucoma.

Quantitative and qualitative corneal endothelial morphology of Omani patients with pseudoexfoliation syndrome

Pseudoexfoliation [PEX] syndrome is one of the leading causes of secondary open angle glaucoma and blindness. This study explored whether in PEX eyes, preoperative changes in corneal endothelial cell morphology might be a risk factor for postoperative corneal decompensation. One hundred twenty six eyes of 69 preoperative cataract patients [43 males, 26 females] were enrolled in this cross-sectional study from the Ophthalmology Department at Sultan Qaboos University Hospital between 2003-2005. All patients were subjected to confocal biomicroscopy. The mean age of patients with PEX eyes was 63.2 years. One hundred and eight [85.7%] eyes with PEX had endothelial cell counts within the normal range [1650-3500/mm[2]]. The qualitative morphology of the endothelium of PEX corneas was highly abnormal in term of polymegathism and pleomorphism. Twelve eyes had endothelial cell counts higher than normal for that age group. Only 6 eyes had endothelial cell counts lower than normal. The mean value for the pleomorphism was found to be significantly lower than normal and for polymegathism significantly more than normal. The relationship between pleomorphism and polymegathism was stronger for males than for females and stronger for patients under 60 years than patients over 60 years. The same relationship between pleomorphism and polymegathism showed a stronger relationship for the glaucoma group as compared to the non-glaucoma group. This study revealed that corneal decompensation in PEX eyes can occur in presence of abnormalities in polymegathism and pleomorphism, even when the endothelial cell counts may be normal

Aqueous levels of anti-hekicobacter pylori IgG antibody in patients with primary open angle and pseudoexfoliation glaucoma

Glaucoma is a progressive optic neuropathy and is one of the leading causes of blindness worldwide. Different factors have been contributed in the pathogenesis of glaucoma including H. pylori infection. To determine the levels of anti-H. pylori IgG antibody in the aqueous humor of patients with pseudoexfoliation and primary open angle glaucoma, in comparison with age and sex matched cataract patients. This study was conducted on 41 cases of glaucoma [21 with pseudoexfoliation and 20 with primary open angle glaucoma] and 39 cases of cataract as control group. Aqueous humor was aspirated at the beginning of glaucoma or phacoemulsification cataract surgery in glaucoma and cataract patients, respectively. Anti-H. pylori IgG concentration was measured by means of an enzyme- linked immunosorbent assay. Results: The aqueous levels of anti-H. pylori IgG in primary open angle glaucoma [0.44'0.64 U/ml] had no significant difference with cataract [0.24 +/- 0.52U/ml] and pseudoexfoliation glaucoma group [0.63 +/- 0.71U/ml] [P=0.18 and 0.44, respectively]. However, the concentration of this antibody was higher in the aqueous humor of pseudoexfoliation glaucoma patients compared to the control group [p=0.03]. The results of this study did not support a relation between H. pylori infection and primary open angle glaucoma. The elevated concentration of anti-H. pylori IgG in pseudoexfoliation glaucoma compared to cataract patients may be due to the breakdown of blood-aqueous-barrier

Inadvertent filtering bleb following sutureless cataract surgery.

The case history of a sixty-two-year-old lady, who presented with a bleb in the upper part of her left eye following cataract surgery was studied. The patient had no prior history of any glaucoma surgery. Gonioscopy revealed fishmouthing of the internal aspect of the scleral tunnel incision. The diagnosis of post-cataract filtering bleb was made which was managed by resuturing the wound. This case highlights the use of gonioscopy to visualise and evaluate the internal wound and discusses intraoperative recognition of internal leak and its management with horizontal sutures.

Corneal thickness and daily curve of intraocular pressure in suspected and glaucomatous patients

OBJETIVO: Verificar em pacientes suspeitos de glaucoma e glaucomatosos se existe correlação entre a espessura corneana central (ECC) e a pressão intra-ocular (Po), medidos durante a curva diária de pressão intra-ocular (CDPo), incluindo-se as medidas da ECC e da Po às 6:00 horas da manhã no leito. Avaliar também comparativamente o diâmetro axial ântero-posterior (Diâm. axial) em ambos os grupos. MÉTODOS: 114 olhos de 73 pacientes selecionados no Serviço de Glaucoma do Hospital São Geraldo, foram divididos em dois grupos: grupo I - pacientes suspeitos de glaucoma e grupo II - pacientes glaucomatosos. Ambos os grupos foram submetidos à CDPo com medidas da Po nos horários de 9h00, 12h00, 18h00, 22h30 (paciente sentado) e no dia seguinte às 6h00 no leito e no escuro antes de o paciente levantar-se. Utilizando-se o paquímetro ultra-sônico DGH 5100®, realizou-se a medida do Diâm. axial e as medidas da ECC nos horários de 9h00 (após a tonometria), 18h00 (antes da tonometria), 22h30 (após a tonometria) e no dia seguinte às 6h00 no leito antes de o paciente levantar-se (após a tonometria). RESULTADOS: Na amostra global e, separadamente em cada grupo, a Po média foi mais elevada às 6h00, decrescendo nos outros horários da CDPo. Comparando-se os grupos, verificou-se que a Po média foi significativamente menor no grupo I (suspeitos de glaucoma) em todos os horários das medidas. A espessura corneana central não variou significativamente entre os diferentes horários intragrupo. Também não se evidenciou diferença, comparativamente, de espessura corneana entre os dois grupos. O Diâm. axial médio do grupo I foi de 23,07±0,95 mm e o do grupo II, 23,62±1,27 mm, não tendo havido diferença estatisticamente significativa entre eles. CONCLUSÕES: Em pacientes suspeitos de glaucoma e glaucomatosos, não houve variação significativa da ECC em diferentes horários, o que significa que apenas uma medida da ECC é suficiente. Não se evidenciou diferença estatisticamente significativa na ECC entre pacientes suspeitos de glaucoma e glaucomatosos. Também não houve diferença estatisticamente significativa no Diâm. axial entre os dois grupos.

Posterior capsular dehiscence following blunt injury causing delayed onset lens particle glaucoma.

A late onset lens-particle glaucoma secondary to trauma is reported. It was treated by cataract extraction and intraocular lens placement.

Five-year risk of progression of ocular hypertension to primary open angle glaucoma. A population-based study.

PURPOSE: To report the progression of ocular hypertension (OHT) to primary open angle glaucoma (POAG) during a 5-year follow up of a population-based sample. METHODS: Twenty-nine patients diagnosed to have OHT and 110 randomly selected normals from a population-based study in 1995 were invited for ocular examination in 2000. All patients underwent a complete ophthalmic examination; including the daytime diurnal variation of intraocular pressure (IOP) and measurement of central corneal thickness (CCT). The "corrected" IOP was used for analysis. Progression to POAG was based on typical optic disc changes with corresponding field defects on automated perimetry. RESULTS: Twenty-five of the 29 persons with OHT who could be contacted were examined. After correcting for CCT, two persons were reclassified as normal. Four of 23 (17.4%; 95% CI: 1.95-32.75) had progressed to POAG. One person amongst the 110 normals progressed to normal tension glaucoma (NTG). The relative risk of progression amongst OHT was 19.1 (95% CI: 2.2-163.4). All those who progressed had bilateral OHT. The mean and peak IOP in those who progressed was 25.4 mm Hg and 29.3 mm Hg compared to 23.9 mm Hg and 25.7 mm Hg in those who did not. Those who progressed had more than 8 mm Hg diurnal variation. The diurnal variation was less than 6 mm Hg in those who did not progress. No patient developed blindness due to glaucoma. CONCLUSION: The 5-year incidence of POAG amongst OHT in this population was 17.4% (3.5% per year). Bilateral OHT, higher peak IOP and large diurnal variation may be the risk factors for progression.

Insulin-like growth factor-I gene cloning and protein expression in bovine trabecular meshwork tissue and cells / 华中科技大学学报（医学）（英德文版）

Whether cultured bovine trabecular meshwork cells and trabecular tissue ex vivo express insulin-like growth factor-I (IGF-I) messenger RNA (mRNA) and protein was investigated. Total RNA of cultured bovine trabecular meshwork cells as well as trabecular meshwork tissue freshly excised from bovine eyes was extracted, and reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect IGF-I mRNA. RT-PCR product was verified by sequencing. Immunohistochemical stain was used to detect IGF-I protein. The results showed that a single PCR amplified product was obtained, and the sequence was homologous to the known sequence.. IGF-I immunostain was positive in the cytoplasm of trabecular meshwork cells. It was concluded that trabecular meshwork cells produce IGF-I and contribute to the presence of IGF-I in trabecular meshwork microenvironment as well as aqueous humor. Trabecular meshwork cells were affected by IGF-I not only through paracrine, but also autocrine action. Whether abnormal down-regulations in IGF-I production may contribute to the pathogenesis of primary open-angle glaucoma and the possibility of promoting the autocrine action of IGF-I by trabecular meshwork cells to treat the disease is worth further investigation.

Síndrome de dispersión pigmentaria / Pigmentary dispersion syndrome

Se hace una revisión histórica del síndrome de dispersión pigmentaria. Se presentan los argumentos que proponen diferentes investigadores para apoyar que la presencia del pigmento es la causa, por azolve, del aumento de la presión intraocular, así como las teorías que abogan que es la lesión de las células endoteliales trabeculares el factor producto del glaucoma. Se hace referencia a los estudios genéticos con relación a la determinación de la presencia clínica de este síndrome. Se discute sobre los posibles mecanismos de aumento de la presión con el ejercicio y el cuadro clínico y la evolución natural de la enfermedad. Se hace un análisis de los métodos de tratamiento médico y quirúrgico

Management of phacolytic glaucoma: experience of 135 cases.

We retrospectively analyzed 135 eyes with phacolytic glaucoma. A trabeculectomy was added to standard cataract surgery if symptoms endured for more than seven days, or if preoperative control of intraocular pressure (IOP) with maximal medical treatment was inadequate. In the early postoperative period, IOP was significantly lower in the combined surgery group (89 eyes) compared to the cataract surgery group (46 eyes) (p < 0.001). At 6 months there was no difference in IOP or visual acuity between the two groups. There were no serious complications related to trabeculectomy. It is reasonable to conclude that in eyes with a long duration of phacolytic glaucoma, addition of a trabeculectomy to cataract surgery is safe, prevents postoperative rise in intraocular pressure and decreases the need for systemic hypotensive medications. A randomized trial is on to further address this question.

Phacolytic glaucoma--its treatment by planned extracapsular cataract extraction with posterior chamber intraocular lens implantation.

Phacolytic glaucoma has traditionally been treated with intracapsular lens extraction to avoid any anaphylaxis. Various mechanisms have been described for the rise of intraocular pressure in these cases. The present study was undertaken to evaluate the response of extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation (PC IOL) in five cases of phacolytic glaucoma that occurred between March 1989 and August 1990. A planned extracapsular cataract extraction with can-opener capsulectomy was done in all the cases with placement of a sulcus-fixated modified J-loop Sinskey design intraocular lens. With a mean follow-up period of two years, all patients (100%) maintained a normal postoperative intraocular pressure of less than 20 mm Hg without any additional medical therapy. The final best-corrected visual acuity in 4 cases (80%) was 6/12 or better, while in one case it was 6/24 due to a senile maculopathy. These results show that ECCE with PC IOL implantation is a safe and efficacious method of visual rehabilitation in cases of phacolytic glaucoma.

Glaucoma inducido por corticoides / Corticoide's glaucoma induced

Un uso inadecuado e indiscriminado en forma topica y con menor frecuencia en forma sistemica de esteroides, puede levar la presion intraocular en personas, con predisposicion genetica o con factores de riesgo, simulando un Glaucoma Primario de Angulo abierto, que se presenta con mayor facilidad enpacientes con antecedentes anormales de Humor Acuoso. Diagnosticado el Glaucoma o la elevacion de la Presion Intraocular, debera suspenderse de inmediato la administracion o aplicacion de esteroides y recurir a un tratamiento medico, caso contrario a uno quirurgico. Es por eso que es de vital importancia tomar medidas preventivas para el uso adecuado y racional de estos farmacos