[Incidence of primary angle-closure glaucoma in the Glaucoma Service of the São Geraldo Hospital]. / Incidência de glaucoma agudo primário no Serviço de Glaucoma do Hospital São Geraldo.

PURPOSE: To determine the incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital, to establish the profile of these patients and to identify the possible risk factors. METHODS: Transversal study. Period of assessment: from September/2005 to August/2006. INCLUSION CRITERIA: diagnosis of primary angle-closure glaucoma. EXCLUSION CRITERIA: presence of cataracts that cause low visual acuity or index-myopia, secondary glaucoma, plateau iris. Number of visits, incidence of primary angle-closure glaucoma, age, gender, race, family history of glaucoma, keratometric, and biometric data were assessed. RESULTS: Of 879 attended patients, 20 (2.3%) had the diagnosis of primary angle-closure glaucoma, therefore, the incidence of the primary angle-closure glaucoma was 22.7 cases per 1000 attended. Of those patients with primary angle-closure glaucoma: 6 (30.0%) were men and 14 (70.0%) women; the age varied from 40 to 73 years (average: 60.4 +/- 8.1 years); 12 (60.0%) were leukodermics and 8 (40.0%) pheodermics; 5 (25.0%) with positive familiar history of glaucoma. The relative risk for women was 1.44 (95% IC). Eleven (55.0%) patients had primary angle-closure glaucoma of the right eye and 9 (45.0%) of the left. When biometric data and keratometry were compared between the affected and contralateral eye, no statistical significant difference was observed. CONCLUSIONS: The incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital was 22.7 cases per 1000 attended. It was more frequent in leukodermic women, without family history of glaucoma and with an average age of 60.4 years. The affected and contralateral eyes were biometrically similar.

[Comparative morphometric assessment between eyes with acute primary angle-closure glaucoma and contralateral eyes]. / Análise morfométrica comparativa entre olhos com glaucoma agudo primário e olhos contralaterais.

PURPOSE: To establish the profile of patients with acute primary angle-closure glaucoma (APACG) and to assess comparatively clinical and morphometric parameters between eyes with APACG and contralateral eyes (CLEs). METHODS: Prospective study including patients attended from September 2005 to March 2007. INCLUSION CRITERIA: diagnosis of APACG. EXCLUSION CRITERIA: presence of cataract (except for "glaukomflecken") that may cause low visual acuity or myopization, secondary glaucoma, previous APAGC or surgical procedure in the (CLE), no possibility to control the acute crisis of glaucoma clinically, plateau iris. The following were evaluated: incidence of APACG, age, gender, race, family history of glaucoma, corrected visual acuity (CVA) and uncorrected visual acuity (UVA), spherical equivalent (SE), cup/disc ratio (C/D), gonioscopy, keratometry (K), central corneal thickness (CCT), and echobiometric data [anterior central chamber depth (ACCD), axial length (AL), lens thickness (LT)] and relation between lens thickness and axial length (LT/AL). RESULTS: One thousand and three hundred and forty-three patients were examined from September 2005 to March 2006; 28 (2.1%) had the diagnosis of APACG. The incidence of the APACG was 20.8 cases per 1000 patients. The patients with APACG were manly white women with a negative familial history of glaucoma and with an average age of 59.6 years. When clinical aspects were compared between eyes with APACG and CLEs, statistical significance was observed: UVA (APACG: 0.27 +/- 0.32; CLE: 0.57 +/- 0.33, p=0.000); CVA (APACG: 0.53 +/- 0.44; CLE: 0.88 +/- 0.23, p=0.000); SE (APACG: +0.49 +/- 1.98; CLE: +1.21 +/- 2.03, p=0.007); C/D (APACG: 0.51 +/- 0.28; CLE: 0.42 +/- 0.20; p=0.031). Also, by gonioscopy, eyes with APACG demonstrated more frequently angle closure than CLEs. The eye of the crisis showed the following characteristics: average K of 45.21 +/- 1.96 D, average CCT of 534.46 +/- 34.15 mm, average ACCD of 2.43 +/- 0.28 mm, average AL of 21.68 +/- 0.96 mm, average LT 4.85 +/- 0.32 mm and average LT/AL of 2.24 +/- 0.16. The CLE presented average K of 44.92 +/- 1.86 D, average CCT of 533.18 +/- 31.41 microm, average ACCD of 2.51 +/- 0.29 mm, average AL of 21.82 +/- 0.92 mm, average LT 4.85 +/- 0.36 mm and average LT/AL of 2.23 +/- 0.18. There were statistically significant differences only in two parameters (K and ACCD) when affected and the CLE were compared. CONCLUSIONS: The incidence of the APACG was 20.8/1000. It was more frequent in white women, leu kodermics, without family history of glaucoma and with an age average of 59.6 years. The eyes with APACG showed, with statistical significance, worse visual acuity, higher C/D, lower hypermetropic SE, higher average K, and lower ACCD than CLEs.

[Cardiovascular and pupillary effects of topical ophthalmic 2.5 and 10.0% phenylephrine in healthy volunteers]. / Efeitos cardiovasculares e midriáticos da fenilefrina tópica a 2,5 e a 10,0% em voluntários sadios.

PURPOSE: To compare the cardiovascular and mydriatic effects of 2.5% and 10.0% phenylephrine. METHODS: A case-control, randomized, crossover clinical trial study. We monitored heart rate (HR), blood pressure (BP) and mydriasis in healthy volunteers aged 18-45 years after the instillation of 2.5% and 10.0% phenylephrine in two different occasions. RESULTS: The sample comprised 28 healthy volunteers, 17 male and 11 female, with a mean age of 26.5 years. No changes in heart rate and systolic blood pressure were observed. No significant variation of the mean diastolic blood pressure was found after 1, 5, 10 and 30- minute instillation of 2.5% phenylephrine. However, with 10.0% phenylephrine, there was an increase in mean diastolic blood pressure after five and ten minutes, followed by a drop after 30 minutes, which was not statistically significant. Mydriasis was more marked in both eyes with a statistically significant difference after instillation of 10.0% phenylephrine. CONCLUSIONS: The mydriatic effect was greater with 10.0% phenylephrine than with 2.5% phenylephrine and the difference was statistically significant. No statistically significant difference was found in relation to cardiovascular effects in both phenylephrine concentrations.

[Pellucid marginal degeneration: diagnosis and treatment]. / Degeneração marginal pelúcida da córnea: diagnóstico e tratamento.

Pellucid marginal degeneration is characterized by a progressive stromal thinning of the inferior corneal segment, between 4 and 8 o'clock, with a crescentic shape. The area of corneal thinning has a width of about 1 to 2 mm, and it is separated from the corneoscleral limbus by an area of normal corneal tissue. The initial treatment consists of optical correction. However, when the disease progresses to advanced stages, surgical procedures are necessary such as wedge resection, lamellar crescentic resection, penetrating keratoplasty, lamellar keratoplasty, epikeratoplasty and, recently, intracorneal segments.

[Iridociliary cysts on ultrasound biomicroscopic examinations]. / Prevalência de cistos iridociliares em exames de biomicroscopia ultra-sônica.

PURPOSE: To present the prevalence of iridociliary cysts in eyes of patients submitted to UBM examination. METHODS: We analyzed retrospectively the UBM images of 1157 patients in the period from September 1995 to June 2004. The inclusion criterion was the UBM examination had been made on the four quadrants (superior, inferior, nasal and temporal) of the eyes. The cysts were assessed and classified in relation to their number in each quadrant; localization and morphology. Using the UBM Pro 2000 software we took the measurements of the largest diameter, wall thickness and area of the cysts besides the angle recession area (ARA). RESULTS: The prevalence of the cysts was 4.9%. No statistical difference was found between the prevalence of cysts regarding gender or between the right and left eyes. They were more prevalent in the inferior (39.8%) and temporal (29.1%) quadrants. The cysts with the largest diameter and area were located in the temporal and superior quadrants. No difference was found in relation to cysts' wall thickness in all quadrants. CONCLUSIONS: No statistical difference was found between the prevalence of cysts as concerns gender or between the right and left eyes. However, the cysts were more prevalent in the inferior and temporal quadrants. The locations of the largest cysts are preferentially the temporal and superior quadrants. The angle recession area was smaller in the temporal and superior quadrants. The cysts' wall thickness is practically the same in all quadrants. The diagnosis of iridociliary cysts was an occasional finding in 64.3% of the patients.

[Infantile cataract: the importance of early treatment and diagnosis]. / Catarata infantil: importância do diagnóstico e tratamento precoces.

PURPOSE: To establish the frequency of infantile cataract in the Low Vision Service of São Geraldo Hospital (HSG-HCUFMG) and to analyze basis of history, ophthalmologic examination and optical prescription in these patients. METHODS: Retrospective study of infantile cataract recorded in the Low Vision Service from January/1992 to December/2002. Age, sex, race, age at the first evidence of leukocoria and who noticed it, ages at diagnosis and phacectomy, family history of cataract, intraocular lens implantation, visual acuity (VA) and optic prescription were evaluated. RESULTS: There were 44 patients. The age ranged from 0-15 years: 19 (43.0%) 0-3, 14 (32.0%) 4-10 and 11 (25.0%) from 11-15 years. Twenty-eight (63.6%) were female and 19 (43.2%) leukodermic. The first evidence of leukocoria was observed by the mother in 17 patients (38.6%). Leukocoria was observed in the first 2 months of life in 45.5% of the patients; phacectomy was performed in 43.2% of the patients with more than 1 year of age. Optic prescription was performed in 61.4% of the cases with 9.1% of the patients below 1 year of age. Intraocular lens was implanted in 13.6% and 4 patients (9.1%) had a family history of congenital cataract. In 20.4% VA was lower than 20/400 and secondary glaucoma was observed in 18.2% of the cases. Low vision aids included two glasses and one telescope. CONCLUSION: More information about congenital cataract should be provided for families and pediatricians, and early surgical treatment, optic correction and treatment of amblyopia should be performed promptly.

New comparative clinical and biometric findings between acute primary angle-closure and glaucomatous eyes with narrow angle.

PURPOSE: To compare, clinically and biometrically, affected and fellow acute primary angle-closure (APAC) eyes and glaucomatous eyes with narrow angle (NA). METHODS: Comparative case series; 30 patients with APAC and 27 glaucomatous patients with NA were evaluated. Keratometry (K), central corneal thickness (CCT), lens thickness (LT), axial length (AL) and anterior chamber depth (ACD) were measured. Parameters defined as lens posisiton (LP) and relative lens position (RLP) were calculated. RESULTS: Biometric difference between APAC-affected and fellow eyes was found only in LP (P=0.046). When fellow eyes were compared to glaucomatous eyes with NA, differences were found in ACD (P=0.009), AL (P=0.010), and LT/AL (P=0.005). The comparison between APAC-affected and glaucomatous eyes with NA showed significant differences in almost all biometric parameters, except for LT (P=0.148) and RLP (P=0.374). We found that the logistic regression model (LRM), built with three parameters (K, CCT and LT/AL), higher than 0.334 could be a reasonable instrument to differentiate APAC eyes from glaucomatous eyes with NA. CONCLUSIONS: This study showed that APAC-affected and fellow eyes have similar biometric features, and glaucomatous eyes with NA have a less crowded anterior segment. The LRM built showed promising results in distinguishing APAC from glaucomatous eyes with NA.

New considerations on pupillary block mechanism.

PURPOSE: To study the mechanisms of pupillary block in eyes with occludable angle by ultrasound biomicroscopy. METHODS: Initially, a pilot study of 13 eyes with acute primary angle-closure without medication was executed. Ultrasound biomicroscopy measurements of the angle, posterior chamber depth and iris thickness were performed in the temporal quadrant under light and dark conditions. Afterwards, ultrasound biomicroscopy measurements of iris-lens contact distance and iris-lens angle in the temporal quadrant and central anterior chamber depth were made in 32 eyes with acute primary angle-closure or intermittent primary angle-closure without medication, under light and dark conditions before and after laser peripheral iridectomy. RESULTS: In the pilot study, a significant decrease in the angle as well as a significant increase in the iris thickness occurred when comparing light to dark conditions. Before and after laser peripheral iridectomy (second study), significant differences were found in iris-lens contact distance (P<0.001) and iris-lens angle (P<0.001) under light and dark conditions. Also, significant differences were found in light and dark conditions, before laser peripheral iridectomy, in iris-lens angle (P=0.005), and after laser peripheral iridectomy, in iris-lens contact distance (P<0.001). No significant change occurred with anterior chamber depth. CONCLUSIONS: A decreased angle was correlated to an increase in iris thickness. After laser peripheral iridectomy, acute primary angle-closure or primary angle-closure eyes had an increased iris-lens contact distance and a decreased iris-lens angle. The anterior chamber depth did not change. These findings contradict the theory that pupillary block is the mechanism of acute primary angle-closure.

Plateau iris configuration in eyes with narrow-angle: an ultrasound biomicroscopic study.

PURPOSE: To investigate, through ultrasound biomicroscopy images, the presence of plateau iris configuration in eyes with narrow-angle from patients with open-angle glaucoma and in eyes with previous acute primary angle-closure and compare the biometric features of eyes with plateau iris configuration with those of normal eyes. METHODS: Ultrasound biomicroscopic images from 196 patients with open-angle glaucoma and narrow-angle and 32 patients with acute primary angle-closure were retrospectively analyzed. The inclusion and specific criteria for the diagnosis of plateau iris configuration was the presence of an anterior positioning of the ciliary processes, supporting the peripheral iris so that it was parallel to the trabecular meshwork; the iris root had a steep rise from its insertion point, followed by a downward angulation from the corneoscleral wall; presence of a central flat iris plane; an absent (complete plateau iris configuration) or partially absent (incomplete plateau iris configuration) ciliary sulcus. The ultrasound biomicroscopic parameters were compared between complete and incomplete plateau iris configuration. The same parameters of both groups were compared with those of normal eyes. The following measurements were performed: anterior chamber depth; angle opening distance at 500 microm from the scleral spur; peripheral iris thickness at 500 microm from the scleral spur; iris-ciliary process distance; trabecular-ciliary process distance and angle recess area. RESULTS: Plateau iris configuration was found in 33 eyes of 20 (10.2%) out of 196 patients with open-angle glaucoma and narrow-angle and in 4 eyes of 2 (6.3%) out of 32 patients with acute primary angleclosure. Seventeen (77.3%) patients with plateau iris configuration were female and 5 (22.7%) male. Twenty-three (62.2%) out of 37 eyes had complete plateau iris configuration, and 14 (37.8%) had incomplete plateau iris configuration. Complete and incomplete plateau iris configuration presented similar biometric features with the exception of the iris-ciliary process distance. All plateau iris configuration eyes showed biometric parameters completely different from those of normal eyes except for peripheral iris thickness at 500 microm from the scleral spur. CONCLUSIONS: Plateau iris configuration was present in 10.2% of patients with open-angle glaucoma and narrow-angle and in 6.3% of patients with acute primary angle-closure. Biometric features were similar in eyes with complete and incomplete plateau iris configuration with the exception of iris-ciliary process distance. Compared to normal eyes, all plateau iris configuration eyes showed biometric parameters completely different except for peripheral iris thickness at 500 microm from the scleral spur.

Comparative biometric study between plateau iris configuration and primary open angle glaucoma with narrow angle.

PURPOSE: To investigate biometrically the differences between plateau iris configuration (PIC) eyes and primary open angle glaucoma with narrow angle eyes. METHODS: A comparative study involving a case series with 20 eyes of 11 plateau iris configuration patients and 45 eyes of 27 primary open angle glaucoma with narrow angle eyes patients was done. The following measurements were taken: corneal curvature, central corneal thickness, anterior chamber depth, lens thickness (LT), axial length (AL), lens thickness and axial length ratio, lens position (LP) and relative lens position (RLP). RESULTS: The plateau iris configuration eyes presented a higher corneal cuvature value than primary open angle glaucoma with narrow angle eyes eyes but not with clinical and statistical difference (P=0.090). The plateau iris configuration eyes demonstrated a higher central corneal thickness, with statistical significance, when compared to primary open angle glaucoma with narrow angle eyes (P=0.010). Statistical significant difference between plateau iris configuration and primary open angle glaucoma with narrow angle eyes was found in axial length (21.69 +/- 0.98 vs. 22.42 +/- 0.89; P=0.003). No significant difference was found when anterior chamber depth (2.62 +/- 0.23 vs. 2.71 +/- 0.31; P=0.078), LT (4.67 +/- 0.36 vs. 4.69 +/- 0.45; P=0.975), LT/AL (2.16 +/- 0.17 vs. 2.10 +/- 0.21; P=0.569), LP (4.95 +/- 0.25 vs. 5.06 +/- 0.34; P=0.164) and RLP (0.23 +/- 0.01 vs. 0.22 +/- 0.14; P=0.348) were evaluated. CONCLUSION: The eyes with plateau iris configuration presented statistical significantly shorter axial length and higher central corneal thickness than primary open angle glaucoma with narrow angle eyes.

Plateau iris.

The term plateau iris was first coined in 1958 to describe the iris configuration of a patient. Two years later the concept of plateau iris was published. In 1977, the plateau iris configuration was classically defined as presurgical changes of an eye with a relative normal central anterior chamber depth, flat iris by conventional biomicroscopy, but displaying an extremely narrow or closed angle on gonioscopic examination. On the other hand, the plateau iris syndrome was defined as an acute glaucoma crisis in one eye with a relative normal central anterior chamber depth and patent iridotomy on direct examination, presenting angle closure confirmed by gonioscopic examination after mydriasis. In 1992, the anatomic aspects of plateau iris were studied using ultrasound biomicroscopy. Finally, plateau iris has been considered an anatomic variant of iris structure in which the iris periphery angulates sharply forward from its insertion point and then again angulates sharply and centrally backward, along with an anterior positioning of the ciliary processes seen on ultrasound biomicroscopy. The clinical treatment of plateau iris syndrome is carried out with topical use of pilocarpine. However, the definitive treatment should be fulfilled by performing an argon laser peripheral iridoplasty.

New comparative ultrasound biomicroscopic findings between fellow eyes of acute angle closure and glaucomatous eyes with narrow angle.

PURPOSE: To compare morphometric features between fellow acute primary angle-closure (APAC) eyes and glaucomatous or suspect eyes with narrow angle (NA). METHODS: Fellow eyes of 30 patients with unilateral APAC and 30 with NA were evaluated by ultrasound biomicroscopy (UBM) under light and dark conditions. UBM parameters such as anterior chamber depth (ACD), angle opening distance at 250 microm/500 microm from the scleral spur (AOD250/AOD500), trabecular ciliary process distance (TCPD) and iris-lens contact distance (ILCD) were measured in the superior (SQ) and inferior (IQ) quadrants. RESULTS: Significant differences between APAC fellow and NA eyes were found in ACD, P<0.001; AOD250 at SQ and IQ, P<0.001; AOD500 at SQ and IQ, P<0.001; TCPD light, P=0.010 and TCPD dark at SQ, P=0.031; and TCPD light at IQ, P=0.010. Significant differences between light and dark examinations of APAC fellow eyes were found in ILCD (P=0.009) at SQ and ILCD at IQ (P=0.006), and of NA eyes in ILCD at SQ (P=0.047) and ILCD at IQ (P<0.001). CONCLUSIONS: APAC fellow eyes have a more crowded anterior segment and shallower ACD than NA eyes. ILCD decreases in both groups when the illumination conditions change from light to dark.

New comparative clinical and biometric findings between acute primary angle-closure and glaucomatous eyes with narrow angle / Novos achados comparativos clínicos e biométricos entre olhos com fechamento angular primário agudo e olhos glaucomatosos com seio camerular estreito

Purpose: To compare, clinically and biometrically, affected and fellow acute primary angle-closure (APAC) eyes and glaucomatous eyes with narrow angle (NA). Methods: Comparative case series; 30 patients with APAC and 27 glaucomatous patients with NA were evaluated. Keratometry (K), central corneal thickness (CCT), lens thickness (LT), axial length (AL) and anterior chamber depth (ACD) were measured. Parameters defined as lens posisiton (LP) and relative lens position (RLP) were calculated. Results: Biometric difference between APAC-affected and fellow eyes was found only in LP (P=0.046). When fellow eyes were compared to glaucomatous eyes with NA, differences were found in ACD (P=0.009), AL (P=0.010), and LT/AL (P=0.005). The comparison between APAC-affected and glaucomatous eyes with NA showed significant differences in almost all biometric parameters, except for LT (P=0.148) and RLP (P=0.374). We found that the logistic regression model (LRM), built with three parameters (K, CCT and LT/AL), higher than 0.334 could be a reasonable instrument to differentiate APAC eyes from glaucomatous eyes with NA. Conclusions: This study showed that APAC-affected and fellow eyes have similar biometric features, and glaucomatous eyes with NA have a less crowded anterior segment. The LRM built showed promising results in distinguishing APAC from glaucomatous eyes with NA.

Objetivo: Comparar, clinica e biometricamente, olhos acometidos por fechamento angular primário agudo (FAPA) com seus contralaterais e olhos com glaucoma primário de ângulo aberto e estreito. Métodos: Série de casos comparativos; 30 pacientes com FAPA e 27 glaucomatosos com ângulo estreito (AE) foram avaliados. Olhos afetados por FAPA e seus contralaterais foram analisados. Ceratometria (K), espessura corneana central (ECC), espessura do cristalino (CR), diâmetro antero-posterior do olho (AXL), e profundidade central da câmara anterior (PCA) foram medidos. PC (posição do cristalino) e PRC (posição relativa do cristalino) foram calculadas. Resultados: Diferença biométrica entre olhos afetados por FAPA e seus contralaterais foi encontrada somente na PC (P=0,046). Quando os olhos contralaterais foram comparados com os olhos glaucomatosos com AE, diferenças foram encontradas na PCA (P=0,009), AXL (P=0,010), e CR/AXL (P=0,005). A comparação entre os olhos afetados e os olhos glaucomatosos com AE mostrou diferenças significativas em quase todos os parâmetros biométricos, exceto na CR (P=0,148) e PRC (P=0,374). Verificamos que o modelo de regressão logística (MRL), construído com 3 parâmetros (K, ECC e CR/AXL), quando apresenta valores maiores de 0,334 pode ser um instrumento razoável para diferençar olhos com FAPA de olhos glaucomatosos com AE. Conclusões: O presente estudo mostrou que olhos afetados por FAPA e seus contralaterais apresentam características biométricas similares, e olhos glaucomatosos com AE apresentam um segmento anterior menos aglomerado. O MRL construído mostrou resultados promissores para diferençar olhos com FAPA de olhos glaucomatosos com AE.

Plateau iris configuration in eyes with narrow-angle: an ultrasound biomicroscopic study / Configuração da íris em platô em olhos com seio camerular estreito: um estudo ultrabiomicroscópico

PURPOSE: To investigate, through ultrasound biomicroscopy images, the presence of plateau iris configuration in eyes with narrow-angle from patients with open-angle glaucoma and in eyes with previous acute primary angle-closure and compare the biometric features of eyes with plateau iris configuration with those of normal eyes. METHODS: Ultrasound biomicroscopic images from 196 patients with open-angle glaucoma and narrow-angle and 32 patients with acute primary angle-closure were retrospectively analyzed. The inclusion and specific criteria for the diagnosis of plateau iris configuration was the presence of an anterior positioning of the ciliary processes, supporting the peripheral iris so that it was parallel to the trabecular meshwork; the iris root had a steep rise from its insertion point, followed by a downward angulation from the corneoscleral wall; presence of a central flat iris plane; an absent (complete plateau iris configuration) or partially absent (incomplete plateau iris configuration) ciliary sulcus. The ultrasound biomicroscopic parameters were compared between complete and incomplete plateau iris configuration. The same parameters of both groups were compared with those of normal eyes. The following measurements were performed: anterior chamber depth; angle opening distance at 500 µm from the scleral spur; peripheral iris thickness at 500 µm from the scleral spur; iris-ciliary process distance; trabecular-ciliary process distance and angle recess area. RESULTS: Plateau iris configuration was found in 33 eyes of 20 (10.2 percent) out of 196 patients with open-angle glaucoma and narrow-angle and in 4 eyes of 2 (6.3 percent) out of 32 patients with acute primary angleclosure. Seventeen (77.3 percent) patients with plateau iris configuration were female and 5 (22.7 percent) male. Twenty-three (62.2 percent) out of 37 eyes had complete plateau iris configuration, and 14 (37.8 percent) had incomplete plateau iris configuration. ...

OBJETIVO: Investigar, através de imagens de biomicroscopia ultrassônica, a presença de configuração da íris em platô em olhos com seio camerular estreito em portadores de glaucoma primário de ângulo aberto e em olhos com fechamento angular primário agudo. Avaliar as características biométricas nestes olhos, comparando-os a olhos normais. MÉTODOS: As imagens de biomicroscopia ultrassônica foram analisadas retrospectivamente, sendo que 196 pacientes eram portadores de glaucoma primário de ângulo aberto e 32 pacientes eram portadores de fechamento angular primário agudo. O critério de inclusão para configuração da íris em platô baseado em imagens de biomicroscopia ultrassônica foi definido pela presença de corpo ciliar posicionado anteriormente, íris acentuadamente angulada em seu ponto de inserção seguida de uma angulação descendente a partir da parede corneoescleral, íris central plana e sulco ciliar ausente (configuração da íris em platô completa) ou parcialmente ausente (configuração da íris em platô incompleta). Os parâmetros biométricos medidos pela biomicroscopia ultrassônica foram comparados entre os olhos com configuração da íris em platô completa e incompleta. Os mesmos parâmetros de ambos os grupos foram comparados com os de olhos normais. Foram medidos: profundidade central da câmara anterior; a distância da abertura do ângulo a 500 µm do esporão escleral; a espessura da íris a 500 µm do esporão escleral; a distância íris-processo ciliar, a distância faixa trabecular-processo ciliar e a área de recesso angular. RESULTADOS: A configuração da íris em platô foi encontrada em 33 olhos de 20 pacientes portadores de glaucoma primário de ângulo aberto (10,2 por cento de um total de 196) e 4 olhos de 2 pacientes portadores de fechamento angular primário agudo (6,3 por cento de um total de 32). Dezessete (77,3 por cento) eram do sexo feminino e 5 (22,7 por cento) do sexo masculino. Dos 37 olhos, 23 (62,2 por cento) apresentaram configuração ...

New considerations on pupillary block mechanim / Novas considerações sobre o mecanismo do bloqueio pupilar

PURPOSE: To study the mechanisms of pupillary block in eyes with occludable angle by ultrasound biomicroscopy. METHODS: Initially, a pilot study of 13 eyes with acute primary angle-closure without medication was executed. Ultrasound biomicroscopy measurements of the angle, posterior chamber depth and iris thickness were performed in the temporal quadrant under light and dark conditions. Afterwards, ultrasound biomicroscopy measurements of iris-lens contact distance and iris-lens angle in the temporal quadrant and central anterior chamber depht were made in 32 eyes with acute primary angle-closure or intermittent primary angle-closure without medication, under light and dark conditions before and after laser peripheral iridectomy. RESULTS: In the pilot study, a significant decrease in the angle as well as a significant increase in the iris thickness occurred when comparing light to dark conditions. Before and after laser peripheral iridectomy (second study), significant differences were found in iris-lens contact distance (P<0.001) and iris-lens angle (P<0.001) under light and dark conditions. Also, significant differences were found in light and dark conditions, before laser peripheral iridectomy, in iris-lens angle (P=0.005), and after laser peripheral iridectomy, in iris-lens contact distance (P<0.001). No significant change occurred with anterior chamber depth. CONCLUSIONS: A decreased angle was correlated to an increase in iris thickness. After laser peripheral iridectomy, acute primary angle-closure or primary angle-closure eyes had an increased iris-lens contact distance and a decreased iris-lens angle. The anterior chamber depth did not change. These findings contradict the theory that pupillary block is the mechanism of acute primary angle-closure.

OBJETIVO: Investigar o mecanismo do bloqueio pupilar em olhos com fechamento angular primário agudo ou intermitente por meio da biomicroscopia ultrassônica. MÉTODOS: Inicialmente, fez-se estudo piloto de 13 olhos com fechamento angular primário agudo sem medicação. Medimos pela biomicroscopia ultrassônica, no claro e no escuro, a amplitude do seio camerular, a profundidade da câmara posterior e a espessura da íris no quadrante temporal. Posteriormente, avaliamos pela biomicroscopia ultrassônica 32 olhos com fechamento angular primário agudo ou fechamento angular intermitente sem medicação, no claro e no escuro e antes e após iridectomia periférica. Medimos a distância de contato irido-cristaliniano e o ângulo irido-cristaliniano no quadrante temporal e a profundidade central da câmara anterior. RESULTADOS: No estudo piloto, demonstrou-se com significância estatística redução da amplitude do seio camerular e aumento da espessura iriana quando se passou do claro para o escuro. Antes e após a iridectomia periférica, foram encontradas diferenças estatisticamente significativas na distância de contato irido-cristaliniano (p<0,001) e no ângulo irido-cristaliniano (p<0,001) ambos no claro e no escuro. Foram encontradas diferenças, estatisticamente significativas, no claro e no escuro, antes da iridectomia periférica no ângulo irido-cristaliniano (p=0,005) e, após a iridectomia periférica na distância de contato irido-cristaliniano (p<0,001). Nenhuma diferença significativa ocorreu na profundidade central da câmara anterior. CONCLUSÕES: A diminuição da amplitude do seio camerular correspondeu somente ao aumento da espessura da íris. Após a iridectomia periférica, os olhos com fechamento angular primário agudo ou fechamento angular intermitente apresentaram, com significância estatística, aumento da distância de contato irido-cristaliniano e diminuição do ângulo irido-cristaliniano. A profundidade central da câmara anterior não se alterou. Esses ...

Comparative biometric study between plateau iris configuration and primary open angle glaucoma with narrow angle / Estudo biométrico comparativo entre configuração da íris em platô e glaucoma primário de ângulo aberto com seio camerular estreito

PURPOSE: To investigate biometrically the differences between plateau iris configuration (PIC) eyes and primary open angle glaucoma with narrow angle eyes. METHODS: A comparative study involving a case series with 20 eyes of 11 plateau iris configuration patients and 45 eyes of 27 primary open angle glaucoma with narrow angle eyes patients was done. The following measurements were taken: corneal curvature, central corneal thickness, anterior chamber depth, lens thickness (LT), axial length (AL), lens thickness and axial length ratio, lens position (LP) and relative lens position (RLP). RESULTS: The plateau iris configuration eyes presented a higher corneal cuvature value than primary open angle glaucoma with narrow angle eyes eyes but not with clinical and statistical difference (P=0.090). The plateau iris configuration eyes demonstrated a higher central corneal thickness, with statistical significance, when compared to primary open angle glaucoma with narrow angle eyes (P=0.010). Statistical significant difference between plateau iris configuration and primary open angle glaucoma with narrow angle eyes was found in axial length (21.69 ± 0.98 vs. 22.42 ± 0.89; P=0.003). No significant difference was found when anterior chamber depth (2.62 ± 0.23 vs. 2.71 ± 0.31; P=0.078), LT (4.67 ± 0.36 vs. 4.69 ± 0.45; P=0.975), LT/AL (2.16 ± 0.17 vs. 2.10 ± 0.21; P=0.569), LP (4.95 ± 0.25 vs. 5.06 ± 0.34; P=0.164) and RLP (0.23 ± 0.01 vs. 0.22 ± 0.14; P=0.348) were evaluated. CONCLUSION: The eyes with plateau iris configuration presented statistical significantly shorter axial length and higher central corneal thickness than primary open angle glaucoma with narrow angle eyes.

OBJETIVO: Comparar, biometricamente, olhos portadores de configuração da íris em platô (CIP) e olhos portadores de glaucoma primário de ângulo aberto com seio camerular estreito. MÉTODOS: Estudo prospectivo comparativo envolvendo 20 olhos de 11 pacientes portadores de íris em platô e 45 olhos de 27 pacientes portadores de glaucoma primário de ângulo aberto com seio camerular estreito. Os parâmetros avaliados foram: curvatura corneana, espessura central da córnea, profundidade central da câmara anterior, espessura do cristalino (EC), comprimento axial (CAx), relação entre a espessura do cristalino e o comprimento axial (EC/CAx), posição do cristalino (PC) e posição relativa do cristalino (PRC). RESULTADOS: Os olhos com íris em platô apresentaram valores ceratométricos superiores àqueles dos olhos com glaucoma primário de ângulo aberto com seio camerular estreito, embora sem diferença clínica ou estatística (P=0,090). Os olhos com configuração da íris em platô apresentaram maior espessura central da córnea com diferença estatisticamente significativa, quando comparados aos olhos com CIP (P=0,010). Diferença estatisticamente significativa foi encontrada entre os olhos com configuração da íris em platô e os olhos com glaucoma primário de ângulo aberto com seio camerular estreito no CAx (21,69 ± 0,98 vs. 22,42 ± 0,89; P=0,003). Não houve diferença significativa entre: profundidade central da câmara anterior (2,62 ± 0,23 e 2,71 ± 0,31; P=0,078); EC (4,67 ± 0,36 e 4,69 ± 0,45; P=0,975); EC/CAx (2,16 ± 0,17 e 2,10 ± 0,21; P=0,569); PC (4,95 ± 0,25 e 5,06 ± 0,34; P=0,164) e PRC (0,23 ± 0,01 e 0,22 ± 0,14; P=0,348). CONCLUSÃO: Os olhos com configuração da íris em platô possuem menor comprimento axial e maior espessura central da córnea em comparação aos olhos com glaucoma primário de ângulo aberto com seio camerular estreito, com significância estatística.

Incidência de glaucoma agudo primário no Serviço de Glaucoma do Hospital São Geraldo / Incidence of primary angle-closure glaucoma in the Glaucoma Service of the São Geraldo Hospital

OBJETIVOS: Determinar a incidência do glaucoma agudo primário no Serviço de Glaucoma do Hospital São Geraldo; estabelecer o perfil destes pacientes e identificar possíveis fatores de risco. MÉTODOS: Estudo transversal. Período de análise: setembro/2005 a agosto/2006. Inclusão: diagnóstico de glaucoma agudo primário. Exclusão: presença de catarata que acarrete baixa acuidade visual ou miopização, glaucomas secundários, íris em platô. Foram avaliados: número de atendimentos, incidência de glaucoma agudo primário, idade, sexo, raça, história familiar de glaucoma, ceratometria, e dados biométricos. RESULTADOS: Dentre 879 pacientes atendidos, 20 (2,3 por cento) tiveram o diagnóstico de glaucoma agudo primário, desse modo, a incidência de glaucoma agudo primário foi de 22,7 por 1000 atendimentos. Dos pacientes com glaucoma agudo primário: 6 (30,0 por cento) eram do sexo masculino e 14 (70,0 por cento) feminino; a idade variou de 40 a 73 anos (média: 60,4 ± 8,1 anos); 12 (60,0 por cento) eram leucodérmicos e 8 (40,0 por cento) feodérmicos; 5 (25,0 por cento) com história familiar positiva para glaucoma. O risco relativo para o sexo feminino foi de 1,44 (IC 95 por cento). Onze (55,0 por cento) pacientes tiveram glaucoma agudo primário no olho direito e 9 (45,0 por cento) no esquerdo. Não houve diferença estatisticamente significativa na comparação dos parâmetros biométricos e ceratometria entre os olhos afetados e os contralaterais. CONCLUSÕES: A incidência de glaucoma agudo primário no Serviço de Glaucoma do Hospital São Geraldo foi de 22,7 por 1000 atendimentos, sendo mais freqüente em mulheres, leucodérmicas, com história familiar negativa para glaucoma e média de idade de 60,4 anos. Os olhos afetados e olhos contralaterais foram semelhantes nos parâmetros biométricos.

PURPOSE: To determine the incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital, to establish the profile of these patients and to identify the possible risk factors. METHODS: Transversal study. Period of assessment: from September/2005 to August/2006. Inclusion criteria: diagnosis of primary angle-closure glaucoma. Exclusion criteria: presence of cataracts that cause low visual acuity or index-myopia, secondary glaucoma, plateau iris. Number of visits, incidence of primary angle-closure glaucoma, age, gender, race, family history of glaucoma, keratometric, and biometric data were assessed. RESULTS: Of 879 attended patients, 20 (2.3 percent) had the diagnosis of primary angle-closure glaucoma, therefore, the incidence of the primary angle-closure glaucoma was 22.7 cases per 1000 attended. Of those patients with primary angle-closure glaucoma: 6 (30.0 percent) were men and 14 (70.0 percent) women; the age varied from 40 to 73 years (average: 60.4 ± 8.1 years); 12 (60.0 percent) were leukodermics and 8 (40.0 percent) pheodermics; 5 (25.0 percent) with positive familiar history of glaucoma. The relative risk for women was 1.44 (95 percent IC). Eleven (55.0 percent) patients had primary angle-closure glaucoma of the right eye and 9 (45.0 percent) of the left. When biometric data and keratometry were compared between the affected and contralateral eye, no statistical significant difference was observed. CONCLUSIONS: The incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital was 22.7 cases per 1000 attended. It was more frequent in leukodermic women, without family history of glaucoma and with an average age of 60.4 years. The affected and contralateral eyes were biometrically similar.

Plateau iris / Íris em platô

The term plateau iris was first coined in 1958 to describe the iris configuration of a patient. Two years later the concept of plateau iris was published. In 1977, the plateau iris configuration was classically defined as presurgical changes of an eye with a relative normal central anterior chamber depth, flat iris by conventional biomicroscopy, but displaying an extremely narrow or closed angle on gonioscopic examination. On the other hand, the plateau iris syndrome was defined as an acute glaucoma crisis in one eye with a relative normal central anterior chamber depth and patent iridotomy on direct examination, presenting angle closure confirmed by gonioscopic examination after mydriasis. In 1992, the anatomic aspects of plateau iris were studied using ultrasound biomicroscopy. Finally, plateau iris has been considered an anatomic variant of iris structure in which the iris periphery angulates sharply forward from its insertion point and then again angulates sharply and centrally backward, along with an anterior positioning of the ciliary processes seen on ultrasound biomicroscopy. The clinical treatment of plateau iris syndrome is carried out with topical use of pilocarpine. However, the definitive treatment should be fulfilled by performing an argon laser peripheral iridoplasty.

O termo íris em platô foi primeiramente inventado em 1958 para descrever a configuração da íris de um paciente. Dois anos depois o conceito de íris em platô foi publicado. Em 1977, a configuração de íris em platô foi classicamente definida como alterações pré-cirúrgicas de um olho com uma profundidade de câmara anterior relativamente normal, íris plana pela biomicroscopia convencional, mas mostrando um ângulo extremamente estreito ou fechado pela gonioscopia. Por outro lado, a síndrome de íris em platô foi definida como uma crise de glaucoma agudo em um olho com uma profundidade de câmara anterior relativamente normal e uma iridectomia patente ao exame direto, apresentando fechamento angular confirmado pela gonioscopia após midríase. Em 1992, as alterações anatômicas dessa anomalia foram estudadas utilizando a biomicroscopia ultra-sônica. Finalmente, a configuração de íris em platô refere-se à alteração anatômica em que há a angulação anterior da periferia da íris, do seu ponto de inserção na parede do ângulo iridocorneal e centralmente, com anteriorização dos processos ciliares, diagnosticada pela biomicroscopia ultra-sônica. O tratamento clínico da síndrome da íris em platô pode ser feito com a administração tópica de pilocarpina, porém o tratamento definitivo é feito com a iridoplastia periférica com o laser de argônio.

New comparative ultrasound biomicroscopic findings between fellow eyes of acute angle closure and glaucomatous eyes with narrow angle / Novos achados comparativos de biomicroscopia ultra-sônica entre olhos contralaterais com fechamento angular agudo e olhos glaucomatosos com ângulo estreito

PURPOSE: To compare morphometric features between fellow acute primary angle-closure (APAC) eyes and glaucomatous or suspect eyes with narrow angle (NA). METHODS: Fellow eyes of 30 patients with unilateral APAC and 30 with NA were evaluated by ultrasound biomicroscopy (UBM) under light and dark conditions. UBM parameters such as anterior chamber depth (ACD), angle opening distance at 250 µm/500 µm from the scleral spur (AOD250/AOD500), trabecular ciliary process distance (TCPD) and iris-lens contact distance (ILCD) were measured in the superior (SQ) and inferior (IQ) quadrants. RESULTS: Significant differences between APAC fellow and NA eyes were found in ACD, P<0.001; AOD250 at SQ and IQ, P<0.001; AOD500 at SQ and IQ, P<0.001; TCPD light, P=0.010 and TCPD dark at SQ, P=0.031; and TCPD light at IQ, P=0.010. Significant differences between light and dark examinations of APAC fellow eyes were found in ILCD (P=0.009) at SQ and ILCD at IQ (P=0.006), and of NA eyes in ILCD at SQ (P=0.047) and ILCD at IQ (P<0.001). CONCLUSIONS: APAC fellow eyes have a more crowded anterior segment and shallower ACD than NA eyes. ILCD decreases in both groups when the illumination conditions change from light to dark.

OBJETIVO: Comparar características morfométricas entre olhos contralaterais com fechamento angular primário agudo (FAPA) e olhos glaucomatosos ou suspeitos com ângulo estreito (AE). MÉTODOS: Olhos contralaterais de 30 pacientes com FAPA unilateral e olhos de 30 pacientes com AE foram avaliados através da biomicroscopia ultra-sônica (BUS) no claro e escuro. Parâmetros da BUS como a profundidade central de câmara anterior (PCA), distância da abertura angular a 250 µm/500 µm do esporão escleral (AOD250/AOD500), distância entre o processo ciliar e o trabeculado (TCPD) e distância do contato iris-cristalino (ILCD) foram medidos nos quadrantes superior (QS) e inferior (QI). RESULTADOS: Diferenças significativas entre olhos contralaterais de FAPA e olhos com AE foram encontradas na PCA, p<0,001; AOD250 no QS e QI, p<0,001; AOD500 no QS e QI, p<0,001; TCPD no claro, p=0,010 e TCPD no escuro no QS, p=0,031; e TCPD no claro no QI, p=0,010. Diferenças significativas entre exames no claro e escuro realizados em olhos contralaterais com FAPA foram encontradas na ILCD (p=0,009) no QS e ILCD no QI (p=0,006), e em olhos com SE na ILCD no QS (p=0,047) e ILCD no QI (p<0,001). CONCLUSÕES: Olhos contralaterais de FAPA apresentam um segmento anterior mais aglomerado e uma PCA menor que olhos com AE. ILCD diminui em ambos os grupos quando as condições de iluminação mudam do claro para o escuro.

Análise morfométrica comparativa entre olhos com glaucoma agudo primário e olhos contralaterais / Comparative morphometric assessment between eyes with acute primary angle-closure glaucoma and contralateral eyes

OBJETIVOS: Estabelecer o perfil dos pacientes com glaucoma agudo primário (GAP) e proceder a uma análise clínica e morfométrica comparativa entre o olho que sofreu a crise de GAP e o olho contralateral (OCL). Métodos: Estudo prospectivo. Foram avaliados pacientes no período de setembro de 2005 a março de 2007. Critério de inclusão: diagnóstico de GAP. Critérios de exclusão: catarata (exceto "glaukomflecken") à biomicroscopia que acarrete baixa acuidade visual ou miopização, glaucomas secundários, sinais de crise GAP prévio ou de procedimento cirúrgico anterior no OCL, impossibilidade de controle clínico do GAP, íris em platô. Foram avaliados: incidência do GAP, idade, sexo, raça, história familiar de glaucoma, acuidade visual com (AVCC) e sem correção (AVSC) na escala decimal, equivalente esférico (EE), escavação do disco óptico (E/D), gonioscopia, ceratometria (K), espessura central da córnea (ECC) e dados ecobiométricos [profundidade central da câmara anterior (PCCA), diâmetro axial ântero-posterior do olho (AXL), espessura do cristalino (CR)], e relação espessura do cristalino e diâmetro axial (CR/AXL). RESULTADOS: Foram admitidos 1346 pacientes no período de setembro de 2005 a março de 2007, 28 (2,1 por cento) tiveram o diagnóstico de GAP. A incidência de GAP no SGHSG (Serviço de Glaucoma do Hospital São Geraldo) foi de 20,8 por 1000 atendimentos. Os pacientes com GAP eram, na grande maioria, do sexo feminino, leucodérmicos, com história familiar negativa para glaucoma e média de idade de 59,6 anos. Na comparação entre olhos com GAP e os OCLs verificou-se diferença estatisticamente significativa nos seguintes parâmetros clínicos: AVSC (GAP:0,27 ± 0,32; OCL:0,57 ± 0,33, p=0,000); AVCC (GAP:0,53 ± 0,44; OCL:0,88 ± 0,23, p=0,000); EE (GAP: +0,49 ± 1,98; OCL: +1,21 ± 2,03, p=0,007); E/D (GAP: 0,51 ± 0,28; OCL: 0,42 ± 0,20; p=0,031). Além disso, à gonioscopia, os olhos com GAP apresentaram com maior freqüência os seios camerulares fechados...

PURPOSE: To establish the profile of patients with acute primary angle-closure glaucoma (APACG) and to assess comparatively clinical and morphometric parameters between eyes with APACG and contralateral eyes (CLEs). METHODS: Prospective study including patients attended from September 2005 to March 2007. Inclusion criteria: diagnosis of APACG. Exclusion criteria: presence of cataract (except for "glaukomflecken") that may cause low visual acuity or myopization, secondary glaucoma, previous APAGC or surgical procedure in the (CLE), no possibility to control the acute crisis of glaucoma clinically, plateau iris. The following were evaluated: incidence of APACG, age, gender, race, family history of glaucoma, corrected visual acuity (CVA) and uncorrected visual acuity (UVA), spherical equivalent (SE), cup/disc ratio (C/D), gonioscopy, keratometry (K), central corneal thickness (CCT), and echobiometric data [anterior central chamber depth (ACCD), axial length (AL), lens thickness (LT)] and relation between lens thickness and axial length (LT/AL). RESULTS: One thousand and three hundred and forty-three patients were examined from September 2005 to March 2006; 28 (2.1 percent) had the diagnosis of APACG. The incidence of the APACG was 20.8 cases per 1000 patients. The patients with APACG were manly white women with a negative familial history of glaucoma and with an average age of 59.6 years. When clinical aspects were compared between eyes with APACG and CLEs, statistical significance was observed: UVA (APACG: 0.27 ± 0.32; CLE: 0.57 ± 0.33, p=0.000); CVA (APACG: 0.53 ± 0.44; CLE: 0.88 ± 0.23, p=0.000); SE (APACG: +0.49 ± 1.98; CLE: +1.21 ± 2.03, p=0.007); C/D (APACG: 0.51 ± 0.28; CLE: 0.42 ± 0.20; p=0.031). Also, by gonioscopy, eyes with APACG demonstrated more frequently angle closure than CLEs. The eye of the crisis showed the following characteristics: average K of 45.21 ± 1.96 D, average CCT of 534.46 ± 34.15 mm, average ACCD of 2.43 ±...