摘要
RESUMO O óleo de silicone é um importante tampão utilizado na retinopexia cirúrgica de casos graves de descolamento de retina. O aumento da pressão intraocular e o desenvolvimento de glaucoma secundário são frequentes complicações da sua utilização. A depender do período de aparecimento, diversos mecanismos justificam a ocorrência de tais complicações. Compreender os fatores de riscos e a patogênese do aumento da pressão intraocular associada a aplicação de óleo de silicone em cirurgia retiniana ajuda a orientar o tratamento adequado para cada paciente. O objetivo deste artigo é revisar a literatura sobre a patogenia, a incidência, os fatores de risco e o tratamento desta condição clínica.
ABSTRACT Silicone oil has been an important intraocular tamponade in retinopexy in cases of complicated retinal detachment surgery. The increase of intraocular pressure and development of secondary glaucoma are a known complication of its use. A variety of mechanisms have been proposed for the pathogenesis, depending on the onset. This article aims to review the literature about pathogenesis, the incidence and risk factors, as well as the treatment of this pathology.
Subject(s)
Humans , Silicone Oils/adverse effects , Silicone Oils/therapeutic use , Retinal Detachment/therapy , Glaucoma/chemically induced , Ocular Hypertension/chemically induced , Intraocular Pressure/drug effects , Postoperative Complications , Trabecular Meshwork , Retinal Detachment/surgery , Trabeculectomy , Glaucoma/surgery , Risk Factors , Glaucoma Drainage Implants , Laser Therapy , Therapeutic Occlusion/methods , Light Coagulation摘要
We report the spectrum of ocular toxicity following accidental inoculation of latex of Calotropis procera (Sodom apple) in 29 eyes between January 2003 and December 2006. All patients presented with sudden painless dimness of vision with photophobia. Twenty-five (86%) patients had initial visual acuity of less than 20/60. All eyes had conjunctival congestion and mild to severe corneal edema with Descemet's folds. Three (10%) eyes had an epithelial defect, nine (31%) had iridocyclitis, and seven (24%) had associated secondary glaucoma. After treatment with topical corticosteroids, antiglaucoma agents, cycloplegics, hypertonic saline and tears supplements, 27 (93%) eyes recovered completely within 3-14 days. After three months, 17 (74%) out of 23 eyes showed a significant low endothelial cell count compared to the normal fellow eye ( P 0.001). The latex of Calotropis procera causes significant ocular morbidity which may be preventable by simple health education. The long-term effect on corneal endothelium has to be studied further.
Subject(s)
Adult , Aged , Antihypertensive Agents/therapeutic use , Calotropis/adverse effects , Conjunctival Diseases/chemically induced , Conjunctival Diseases/diagnosis , Conjunctival Diseases/drug therapy , Corneal Edema/chemically induced , Corneal Edema/diagnosis , Corneal Edema/drug therapy , Female , Glaucoma/chemically induced , Glaucoma/diagnosis , Glaucoma/drug therapy , Glucocorticoids/therapeutic use , Humans , Iridocyclitis/chemically induced , Iridocyclitis/diagnosis , Iridocyclitis/drug therapy , Latex/adverse effects , Male , Middle Aged , Mydriatics/therapeutic use , Photophobia/chemically induced , Retrospective Studies , Vision Disorders/chemically induced , Visual Acuity摘要
Topiramato é um tipo de sulfa monossacarídica de uso oral usado primariamente como anticonvulsivante e não apresenta relação estrutural com outros agentes antiepilépticos. Esta medicação anti-epiléptica de amplo espectro também tem sido usada no manejo de enxaqueca, depressão e dor neuropática. Desde a sua aprovação como anticonvulsivante, diversos relatos tem sido publicados relacionando-o a efeitos oftalmológicos adversos. Os achados patológicos incluem glaucoma secundário a fechamento de ângulo, miopia transitória, hiperemia ocular, efusões uveais, podendo ou não estar presente midríase.
Topiramate is a kind of sulfamate-substituted monosaccharide of oral presentation to be used primarily as an anticonvulsant and it doesn't have structural relation with any other antiepileptic agents. This wide range antiepileptic drug has been used in the management of migraine, depression and neuropathic pain. Since it was approved as an anticonvulsant, many reports related to ophthalmological adverse effects have been published. The pathological findings include secondary angle closure glaucoma, transitory myopia, ocular hyperemia, uveal effusions, with or without mydriasis.
Subject(s)
Humans , Female , Adult , Anticonvulsants/adverse effects , Glaucoma, Angle-Closure/diagnosis , Glaucoma/chemically induced , Myopia , Ocular Hypertension , Vision Disorders , Hyperemia , Mydriasis摘要
PURPOSE: Evaluation of oculohypotensive activity of single drop application of aqueous extract of Foeniculum vulgare in experimental models of glaucoma. METHODS: The evaluation of oculohypotensive activity of Foeniculum vulgare was done in rabbits with normal intraocular pressure (IOP) and with experimentally elevated IOP. The experimental increase in IOP was achieved using water loading and steroid induced glaucoma models. RESULTS: The aqueous seed extract of Foeniculum vulgare exhibited 17.49, 21.16 and 22.03% reduction of intraocular pressure (IOP) in normotensive rabbits at 0.3%, 0.6% and 1.2% (w/v) concentrations respectively. The 0.6% concentration was further evaluated in acute and chronic models of glaucoma. A maximum mean difference of 31.20% was observed between vehicle treated and extract treated eyes in water loading model while a maximum mean IOP lowering of 31.29% was observed in steroid induced model of glaucoma. CONCLUSIONS: The aqueous extract of Foeniculum vulgare possesses significant oculohypotensive activity, which was found to be comparable to that of timolol. Further investigations into the mechanism of action, possible toxicity and human clinical trials are warranted before the Foeniculum vulgare finds place in the arsenal of antiglaucoma drugs prescribed by physicians.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Animals , Female , Foeniculum/chemistry , Glaucoma/chemically induced , Intraocular Pressure/drug effects , Male , Ocular Hypertension/chemically induced , Plant Extracts/therapeutic use , Rabbits , Seeds/chemistry , Steroids , Timolol/therapeutic use , Pharmaceutical Vehicles , Water Intoxication/physiopathology摘要
To determine the frequency of glaucoma in children with vernal conjunctivitis using topical steroids, referred to a tertiary eye care centre. Descriptive case series. This study was carried out at department of Ophthalmology, Liaquat University Eye Hospital Hyderabad, Sindh - Pakistan, from July 2002 to December 2004 [Thirty months]. A total of 200 patients with chronic allergic conjunctivitis using topical steroids [Betamethasone, Dexamethasone, Prednisolone] for more than six months were examined. A thorough examination including visual acuity, Goldmann applanation tonometry, Schiot'z tonometry, Gonioscopy, slit lamp examination and dilated Ophthalmoscopy were performed. Out of 200 patients examined, fifteen [7.5%] were found having raised intraocular pressure [secondary glaucoma] due to prolonged use of topical steroids. The rise of intraocular pressure was bilateral in three patients [1.5%], and unilateral in twelve patients [6.0%]. The topical steroids were discontinued. One patient with vernal conjunctivitis using topical steroids since more than two years developed left optic disc pallor with constriction of visual field, and posterior sub capsular cataract. The intraocular pressure was not controlled by ocular hypotensive agents, and glaucoma filtration surgery was advised. This study identifies the risk of intraocular pressure elevation in patients with allergic conjunctivitis, using topical steroids for longer periods. Long term use of topical and systemic steroids produces secondary open angle glaucoma similar to chronic simple glaucoma. We can conclude that Dexamethasone and Prednisolone are possible risk factors for producing glaucoma
Subject(s)
Humans , Male , Female , Glaucoma/chemically induced , Conjunctivitis, Allergic , Prednisolone/adverse effects , Intraocular Pressure , Betamethasone/adverse effects , Child , Dexamethasone/adverse effects摘要
O objetivo deste trabalho é demonstrar a eficácia da prótese iriana na resolução do glaucoma refratário, provocado pela presença de óleo de silicone na câmara anterior. Trata-se de paciente que sofreu trauma por estilhaços de projétil de arma de fogo. A cirurgia vítreo-retiniana visou a remoção dos corpos estranhos intra-oculares e posicionamento da retina, que se encontrava descolada. Devido à ausência parcial do tecido iriano e a afacia, o óleo de silicone introduzido na câmara vítrea, para manter a retina colada, migrou para a câmara anterior e provocou gradativa diminuição do número de células endoteliais e aumento da pressão intra-ocular incontrolável clinicamente. Optamos pela fixação transescleral da prótese de íris para corrigir tais complicações. Após 45 meses de evolução, a acuidade visual estabilizou-se em conta dedos a 1 metro e a pressão intra-ocular em 14 mmHg. Concluímos que a tríade composta pela ausência do diafragma iriano, afacia e impossibilidade da remoção do óleo de silicone, devido a inexorável recorrência de descolamento de retina, deve levar o cirurgião a ponderar sobre a fixação transescleral da prótese de íris. Esta conduta poderá controlar a pressão intra-ocular e/ou preservar a transparência corneana, impedindo o contato do óleo de silicone com a malha trabecular e com o endotélio corneano.
Subject(s)
Humans , Male , Adult , Aniridia/etiology , Eye Foreign Bodies/complications , Iris/surgery , Prostheses and Implants , Anterior Chamber , Aniridia/surgery , Wounds, Gunshot/complications , Glaucoma/chemically induced , Silicone Oils/adverse effects , Treatment Outcome摘要
PURPOSE: To present a case of a unilateral diffuse retinal hemorrhage in a 15-year-old girl, who underwent bilateral trabeculectomy for steroid induced glaucoma. METHODS: Despite the maximally tolerable medical treatment, IOP in the right eye remained above 50 mmHg for four months, and was simultaneously elevated in the left eye. So we performed bilateral trabeculectomy. RESULTS: On the first postoperative day, diffuse retinal hemorrhages were observed in the right eye; however, no retinal hemorrhage was found in the left eye. The hemorrhages resolved completely without consequences two months later. CONCLUSIONS: In the case of high IOP for a long period, sudden lowering of IOP may acutely increase the blood flow and consequently rupture multiple retinal capillaries because of altered autoregulatory function. Special care is therefore needed to prevent an abrupt fall in IOP before, during, and after surgery, especially when IOP has been highly elevated for an extended period.
Subject(s)
Adolescent , Female , Humans , Administration, Topical , Fluorescein Angiography , Fundus Oculi , Glaucoma/chemically induced , Retinal Hemorrhage/diagnosis , Steroids/administration & dosage , Trabeculectomy/adverse effects , Uveitis/drug therapy摘要
Patients on corticosteroid therapy, specially for a long period are likely to develop many adverse effects related to the therapy. A physician should be conversant with these to ensure early detection, management and prevention, where possible. Thus, all patients on a long-term corticosteroid therapy should have a baseline and 3 monthly assessments for weight, height, blood pressure and other clinical features of Cushing's syndrome. A 2 hours postprandial blood sugar and serum electrolyte estimation should also be included. Ophthalmic evaluation for glaucoma and cataract should be carried out at 6 monthly intervals and densitometry annually for early detection of osteopenia. In addition, a high index of suspicion should be maintained for timely detection of infections, avascular bone necrosis, myopathy and pseudotumor cerebri.
Subject(s)
Child , Cushing Syndrome/chemically induced , Gastrointestinal Tract/drug effects , Glaucoma/chemically induced , Glucocorticoids/administration & dosage , Humans , Hyperglycemia/chemically induced , Osteonecrosis/chemically induced摘要
Previous reported ocular complications of interferon alfa administration are extremely rare. These include oculomotor palsy, corneal allograft rejection, retinal hemorrhage and cotton wool patches. A 15-year-old boy with chronic hepatitis B was treated with interferon alpha for six months, and then developed glaucoma. After the interferon therapy had been discontinued the glaucoma improved. Accordingly, we report a case of glaucoma development during the course of interferon alpha therapy for chronic hepatitis B.
Subject(s)
Humans , Male , Adolescent , Glaucoma/chemically induced , Hepatitis B, Chronic/drug therapy , Interferon-alpha/adverse effects摘要
Los glucocorticoides han demostrado ser sumamente útiles en muchos padecimientos, pero también pueden propiciar patologías oculares como son cataratas o glaucoma al ser administrados por un tiempo prolongado o a dosis altas. Se ha demostrado una incidencia mayor en niños o jóvenes asmáticos o con artritis reumatoide. Las cataratas en su inicio se comportan de una forma característica, apareciendo una opacidad subcapsular posterior, pero fácilmente puede confundirse con las causadas por radiaciones ultravioletas, diabéticas (metabólicas) o seniles, aunque los antecedentes nos indican clinicamente la diferencia. El glaucoma inducido por los glucocorticoides también se debe a la aplicación prolongada y a la dosis. Un factor importante que debemos tomar en cuenta son los antecedentes hereditarios del glaucoma primario de ángulo abierto, que propician su aparición y desaparecen en algunos casos al suspender los glucocorticoides. En otros casos se tendrá que administrar tratamiento antiglaucomatoso. Eventualmente puede ser necesaria un intervención quirúrgica. Se hace relevante la necesidad de hacer un exhaustivo estudio previo a los pacientes cuando se requiera de la administración de glucocorticoides, y durante su administración se debe realizar un seguimiento oftalmológico adecuado que implique una exploración con lámpara de hendidura, campimetrías, tonomemtrías y evaluación de fondo de ojo con frecuencia trimestral
Subject(s)
Humans , Cataract/chemically induced , Glaucoma/chemically induced , Glucocorticoids/adverse effects摘要
Trinta e três crianças (dezesseis do sexo masculino e dezessete do sexo feminino), com idade variando entre dois a quinze meses e história de uso de corticósteroides, foram examinadas no serviço de glaucoma do Hospital Säo Geraldo, de 1976 a 1996. O propósito deste estudo foi estabelecer o quadro clínico do glaucoma cortisônico pseudo-congênito, de acôrdo com os dados obtidos nos exames de rotina. Cinquenta e cinco olhos foram expostos aos corticosteróides e quarenta desenvolveram aumento da Po. O tempo de uso foi de 2,7 ñ 1,8 meses (a idade no início da exposiçäo dos corticosteróides foi de 1,2 ñ 1,7 meses). Os corticosteróides foram prescritos para tratamento de epífora e conjuntivite em 94 por cento dos olhos. O intervalo médio entre o ínicio do uso e a época na qual o glaucoma foi notado variou de cinco dias a um ano, com média de quatro meses. Os corticosteróides mais frequentemente usados foram a dexametasona e betametasona. A história familiar para glaucoma congênito foi negativa. As crianças foram examinadas sob anestesia geral, em máscara aberta, com o uso do metoxifluorano, até junho de 1990, e depois halotano. O exame oftalmológico obedecia a seguinte rotina: tonometria de aplanaçäo, medida do diâmetro corneano horizontal, ecobiometria, biomicroscopia, gonioscopia e biomicroscopia do fundo de olho. Os olhos apresentaram-se claros e sem secreçäo. No primeiro exame, a Po foi estatisticamente maior nos olhos que apresentavam glaucoma. Na maioria dos casos, um aumento nos diâmetros oculares (corneano em 95 por cento e axial em 81,8 por cento) foi encontrado. A biomicroscopia mostrou alteraçöes corneanas (edema corneano e/ou rupturas da membrana de Descemet em 95 por cento), enquanto a íris e o cristalino eram normais. Na gonioscopia, o seio camerular era normal, com parede externa completamente livre. A relaçäo C/D foi maior que 0,5 em 70 por cento dos olhos no primeiro exame. A interrupçäo do corticosteróides, só ou associada a tratamento médico, normalizou a pressäo em alguns olhos (quatro olhos). A trabeculotomia foi a cirurgia da escolha: a Po foi normalizada em todos os olhos nos quais foi ela executada.
Subject(s)
Humans , Male , Female , Infant , Adrenal Cortex Hormones/adverse effects , Glaucoma/chemically induced , Academic Dissertation , Intraocular Pressure/drug effects , Manometry , Retrospective Studies摘要
Haloperidol, a dopaminergic antagonist, was found to be very effective in lowering intraocular pressure in normal and glaucomatous eyes. The potential ocular hypotensive effect of haloperidol can be utilized for the treatment of glaucoma.
Subject(s)
Animals , Dopamine Antagonists/pharmacology , Evaluation Studies as Topic , Female , Glaucoma/chemically induced , Haloperidol/pharmacology , Intraocular Pressure/drug effects , Male , RabbitsSubject(s)
Humans , Adrenal Cortex Hormones/adverse effects , Eye/drug effects , Adrenal Cortex Hormones/therapeutic use , Conjunctivitis, Allergic/immunology , Conjunctivitis, Allergic/drug therapy , Eye/immunology , Eye/pathology , Glaucoma/chemically induced , Glaucoma/etiology , Ocular Hypertension/complications , Ocular Hypertension/chemically induced , Mast Cells/enzymology摘要
Säo estudados no presente trabalho 16 casos (20 olhos) de glaucoma cortisônico pseudo-congênito. Após breve resenha histórica, os autores descrevem suas observaçöes realçando o seguinte: 1. O uso indiscriminado de colírios contendo corticosteróides em recém-nascidos e lactantes também pode causar glaucoma como no adulto. 2. Aqui também a automedicaçäo é freqüente. 3. A gonioscopia, em geral, e a biomicroscopia näo mostram alteraçöes típicas de glaucoma congênito nesses olhos em relaçäo ao seio camerular e à íris. Entretanto, em dois (10%) dos vinte olhos, foram encontradas alteraçöes gonioscópicas típicas do glaucoma congênito (um olho com persistência exuberante do sistema reticular e outro com aplasia do sistema reticular). 4. Como no adulto, a interrupçäo do colírio de corticosteróide associada ao tratamento clínico pode curar o glaucoma em alguns casos. 5. A trabeculotomia dá bons resultados quando for indicado o tratamento cirúrgico. 6. Teoricamente näo há indicaçäo para se realizar a goniotomia nesses casos
Subject(s)
Infant , Humans , Male , Female , Adrenal Cortex Hormones/adverse effects , Glaucoma/chemically induced , Glaucoma/congenital , Iatrogenic Disease , Lacrimal Duct Obstruction/drug therapy摘要
A injeçäo na câmara anterior de olhos de coelhos, de hemácias autólogas fixadas em glutaraldeído determina um aumento constante e duradouro da pressäo intra-ocular. A técnica cirúrgica utilizada determina uma diminuiçäo estatisticamente significante da pressäo intra-ocular