Postoperative anterior uveitis in a patient submitted to combined treatment with cataract surgery and iStent inject®. How to manage? / Uveíte anterior no pós-operatório de facectomia combinada com implante de iStent inject®. Como manejar?

ABSTRACT Minimally invasive glaucoma surgeries are surgical treatment alternatives for glaucoma aimed at reducing intraocular pressure with a better safety profile compared to traditional trabeculectomy. However, in spite of less invasive techniques, complications may develop in any surgical procedure. To the best of our knowledge, this is the first case report of anterior uveitis following combined treatment with cataract surgery and iStent inject® which addresses the management of postoperative inflammation.

RESUMO As cirurgias minimamente invasivas para glaucoma consistem em uma opção de tratamento cirúrgico para glaucoma, a qual promove redução da pressão intraocular com melhor perfil de segurança do que a trabeculectomia. Todavia, complicações são inerentes à realização de procedimentos cirúrgicos, apesar do uso de técnicas menos invasivas. Este é o primeiro relato que apresenta um caso de uveíte anterior após cirurgia combinada de catarata e iStent inject®, além de orientações quanto ao manejo do quadro inflamatório.

Acanthamoeba keratitis in Mexico: Report of a clinical case and importance of sensitivity assays for a better outcome.

Acanthamoeba keratitis (AK) is a sight-threatening corneal infection. The early symptoms include redness, pain, photophobia and intense tearing. Chronic infection usually progresses to stromal inflammation, ring ulcers, corneal opacification and hypopyon. Here we document an AK case in a high myopic 38-year-old woman from Mexico City, with a history of wearing contact lenses while swimming. Corneal scrapes cultures were positive only for amoebae, consequently a treatment including netilmicin 0.3% and oral itraconazole 100 mg/12 h was prescribed. The infection was resolved after 8 months, leaving a slight leucoma outside the visual axis, with a visual acuity of 20/150. In the laboratory, the amoebic isolate was axenized in PYG medium, with an optimal growth at 30 °C, and was identified morphologically as Acanthamoeba polyphaga according to the taxonomic criteria of Page (1988) and placed in the T4 group by genotyping. The virulence of this strain (40%) was determined by intranasal inoculation of 1 × 106/20 µl trophozoites in BALB/c mice recovering from brain, proving their invasion ability and by the interaction with monolayers of epithelial cells of the established MDCK line of canine kidney origin (1:2 ratio of interaction), at 1, 3, 6, 8 and 24 h; trophozoites migrated to cell junctions inducing few lytic zones. In addition to the biological characterization, in vitro drug sensitivity tests were performed using chlorhexidine, itraconazole, netilmicin and voriconazole. Results revealed that voriconazole was the most effective compound. A. polyphaga remains as one of the most frequently isolated species producing AK. The treatment of AK case using netilmicin and oral itraconazole solved the disease, but the healing process was wide-ranging (8 months). The use of voriconazole and chlorhexidine may be an alternative treatment of future AK cases in Mexico.

Tropicamide 1% mydriatic effect: comparison between spray in closed eyes and eye drops in open eyes.

PURPOSE: The aim of this study was to evaluate by serial measurements, pupil mydriasis produced by topical application of tropicamide 1% using a spray in a closed eye or instillation in an open eye in adult and elderly populations. METHODS: The research was done from February to April of 2011 in the Policlinica Ronaldo Gazolla, located in the Arcos da Lapa Campus of Estacio de Sá University, RJ- Brazil. It was a clinical trial, controlled and randomized, made in a series of 50 patients that were being prepared for ophthalmoscopy examination. They were submitted to eye drop administration of 1% tropicamide in an open eye and to eyelid margin vaporization in a closed eye. The eyes were chosen for the administration of drops or spray according to a pseudo-random numbers table from Excel (2007) before application. The pupil diameter was measured before instillation and after 10, 20, and 30 min in both eyes, with a millimeter ruler. Biostat 5.0 software was used for statistical calculations. RESULTS: Tropicamide 1% was vaporized in a group that presented the following average pupil diameters: 3 mm before the application; 4.16 mm in 10 min; 5 mm in 20 min; and 5.35 mm in 30 min. The group in which tropicamide 1% was instilled presented 2.96 mm of average pupil diameter before the application; 4.22 mm at 10 min; 5.02 mm at 20 min; and 5.44 at 30 min. The two way analysis of variance showed P<0.0001, and the Tukey test performed for comparisons among the groups showed statistical significant differences among all groups except when the measurements were done at the same time. CONCLUSION: The vaporized tropicamide 1% mydriatic effect in closed eyes was clinically equivalent to the instillation effect of eye drop in open eyes. Other mydriatic drugs sprayed in closed eyes may not have the same effect.

A double-blind, placebo-controlled, randomized, crossover pilot study of the safety and efficacy of multiple doses of intra-oral tropicamide films for the short-term relief of sialorrhea symptoms in Parkinson's disease patients.

OBJECTIVE: This proof-of-concept, pilot study aimed to explore the safety and anti-sialorrhea efficacy of single doses of intra-oral slow dissolving thin films containing tropicamide (NH004) or placebo. METHODS: Nineteen non-demented, idiopathic stable or fluctuating PD patients who complained of sialorrhea received 3 doses (0.3, 1, 3mg) of tropicamide and placebo in random order, separated by 7 days. A 10-cm visual analog scale (VAS) was used to measure the patient's subjective feelings of saliva levels at baseline and at 15, 30, 45, 90 and 120 min after treatment administration. For the last 7 patients, saliva volume was measured at baseline and 75 min after treatment. Fluctuating patients were evaluated in the ON-condition. RESULTS: The mean age of included patients was 67±12 years, 78% were male. Median disease duration was 8 years. The mean decrease in VAS score from baseline to 120 min were -0.55±0.54, -1.08±0.54, -1.53±0.52 and -0.81±0.51 for placebo and 0.3, 1 and 3mg tropicamide, respectively (F=0.6 p=0.6, ANOVA). Tropicamide 1mg resulted in a significant VAS score decrease (95%CI: -2.57 to -0.48). Saliva volume was reduced by 27%, 33% or 20% after tropicamide 0.3, 1 or 3mg vs 5% with placebo (p=0.5, Friedman). No adverse events were detected in any of the treatment sequences. DISCUSSION: Results of this pilot, proof-of-concept study show that NH004 was safe and exerted antisialorrhea effects worthy of further exploration.

Topical tropicamide induced delirium and psychosis: case report / Delírio e psicose induzidos por tropicamida tópica: relato de caso

Acute psychosis and confusional states are known complications of treatment with anticholinergic agents in the elderly. We report an 87-year-old female patient presenting with acute neurobehavioral abnormalities requiring hospitalization immediately after starting treatment for openangle glaucoma with the topic cycloplegic muscarinic receptor blocker tropicamide. Case-effect relationship was confirmed. The authors make a review of the literature trying to identify the clinical manifestations and risk factors for this complication.

Tratamento com drogas anticolinérgicas é uma causa conhecida de alterações agudas do estado mental em idosos. Relata-se o caso de uma paciente de 87 anos de idade com alterações comportamentais agudas, que necessita de internamento imediatamente após início de terapia para glaucoma de ângulo aberto com tropicamida, um agente cicloplégico bloqueador de receptor muscarínico. A relação causa-efeito foi confirmada depois de a droga ter sido reiniciada durante o internamento. É apresentada uma revisão da literatura delineando as manifestações clínicas mais comuns e fatores de risco para essa complicação.

Comparison between obtained mydriasis in type 2 diabetics and non-diabetic patients.

BACKGROUND/AIMS: To evaluate and compare obtained mydriasis with phenylephrine 10% associated with tropicamide 1% in type 2 diabetics and non-diabetic patients. METHODS: A total of 50 patients (100 eyes) scheduled for fundoscopy were dilated with phenylephrine 10% and yropicamide 1% (group 0: n = 20 type 2 diabetic patients, 40 eyes, and group 1: n = 30 non-diabetic patients, 60 eyes). Only one drop per eye of each drug was administered. In both groups, pupil diameter was measured after 40 minutes of eye drops instillation. RESULTS: Both groups were similar regarding age (p = 0.06, Mann-Whitney test). Mean pupil diameter in group 0 was 8.57 and 8.73 in group 1. There was no statistic difference between both groups (p = 0.44). Pupil diameter was greater than 7 mm in all patients (100%). CONCLUSION: When an appropriate drug combination is used, diabetic patients can achieve mydriasis as satisfactory as non-diabetic patients, allowing adequate fundus examination and/or retinopathy treatment.

Mydriatic and cardiovascular effects of phenylephrine 2.5% versus phenylephrine 10%, both associated with tropicamide 1%.

BACKGROUND/AIMS: To evaluate and compare cardiovascular effects (blood pressure and heart rate) of phenylephrine 2.5% versus phenylephrine 10%, and compare pupil diameter before and after instillation of eyedrops. METHODS: A total of 58 patients scheduled for funduscopy were dilated with either phenylephrine 2.5% and tropicamide 1% (group 0, n = 29 patients, 58 eyes) or phenylephrine 10% and tropicamide 1% (group 1, n = 29 patients, 58 eyes). Only one drop per eye of each drug was administered. In both groups, pupil diameter, blood pressure and heart rate were measured before and 40 min after eyedrop instillation. RESULTS: We did not observe significant changes in blood pressure or heart rate. Mean pupil diameter in group 0, before the instillation of eyedrops, was 3.51 mm and, in group 1, 2.66 mm. After medication, mean values were 7.38 mm in group 0 and 7.42 mm in group 1. Mean variation was 3.87 mm in group 0 and 4.76 mm in group 1 (p < 0.001). CONCLUSION: Our results corroborate the finding that one single drop of either 2.5 or 10% phenylephrine is safe and, when 1% tropicamide is combined, satisfactory pupil dilation is achieved.

[Goniosynechiae as a complication of non-penetrating deep sclerectomy by inappropriate use of mydriatic: case report]. / Goniossinéquia como complicação na esclerectomia profunda não penetrante por uso inadvertido de midriático: relato de caso.

Non-penetrating deep sclerectomy has been an alternative to trabeculectomy, because it has the advantage of reducing intraocular pressure (IOP), without penetrating the anterior chamber. Thus, it avoids a sudden decompression and a plain anterior chamber. In this paper, we described a case of a female patient, 53 years old, black, with diagnosis of open-angle primary glaucoma, with unsatisfactory clinical control and who was submitted to non-penetrating deep sclerectomy. The patient developed goniosynechiae at the site of the sclerectomy, after inappropriate use of mydriatic eye-drops during the postoperative period, leading to an increase of IOP and, therefore, failure of the surgery. The use of mydriatic eye-drops during the postoperative period of deep sclerectomy is not indicated, because in this case, it led to surgery failure.

Goniossinéquia como complicação na esclerectomia profunda não penetrante por uso inadvertido de midriático: relato de caso / Goniosynechiae as a complication of non-penetrating deep sclerectomy by inappropriate use of mydriatic: case report

A esclerectomia profunda não penetrante tem sido uma alternativa à trabeculectomia, pois tem como vantagem a redução da pressão intra-ocular (PIO), sem penetrar na câmara anterior. Desta forma, evitando descompressão brusca, câmara anterior rasa. Neste trabalho, descrevemos o caso de uma paciente, 53 anos, negra, com diagnóstico de glaucoma primário de ângulo aberto, com controle clínico insatisfatório e que foi submetida à esclerectomia profunda não penetrante. A paciente evoluiu com formação de goniossinéquia na região da esclerectomia, após uso inadvertido de colírio midriático no pós-operatório, levando ao aumento da PIO e conseqüente falência da cirurgia. O uso de colírio midriático no pós-operatório da esclerectomia profunda não está indicado, pois neste caso, ocasionou o insucesso da cirurgia.

Non-penetrating deep sclerectomy has been an alternative to trabeculectomy, because it has the advantage of reducing intraocular pressure (IOP), without penetrating the anterior chamber. Thus, it avoids a sudden decompression and a plain anterior chamber. In this paper, we described a case of a female patient, 53 years old, black, with diagnosis of open-angle primary glaucoma, with unsatisfactory clinical control and who was submitted to non-penetrating deep sclerectomy. The patient developed goniosynechiae at the site of the sclerectomy, after inappropriate use of mydriatic eye-drops during the postoperative period, leading to an increase of IOP and, therefore, failure of the surgery. The use of mydriatic eye-drops during the postoperative period of deep sclerectomy is not indicated, because in this case, it led to surgery failure.

Delayed pupillary capture and noninvasive repositioning of a posterior chamber intraocular lens after pupil dilation.

We present a case of pupillary capture of a posterior chamber intraocular lens after routine pupil dilation during a follow-up visit 6 years postoperatively. A noninvasive approach was used to resolve the capture. The possible causes and measures to avoid this complication are discussed.

Estudo comparativo da acomodaçäo residual após instilaçäo de colírios de tropicamida a 1 por cento, ciclopentolato a 1 por cento e associaçäo de tropicamida a 1 por cento + ciclopentolato a 1 por cento / Comparative study of residual accomodation after instillation of the eye drops with 1 per cent tropicamide, 1 per cent cyclopentolate, and association of 1 per cent tropicamide + 1 per cent cyclopentolate

Objetivo: Avaliar a acomodaçäo residual após a instilaçäo de duas drogas ciclopégicas, o ciclopentolato a 1 por cento e a tropicamida a 1 por cento e a associaçäo entre elas. Material e métodos: Selecionamos pacientes de 15 a 25 anos, com íris grau 4 e 5 pela classificaçäo de Seddon e sem nenhum tipo de doença ocular, que procuraram de maneira espontânea o ambulatório de Oftalmologia da Santa Casa de Säo Paulo no período de outubro de 1997 a setembro de 1998. Os 46 pacientes foram submetidos a três exames oftalmológicos completos, em que se testava o potencial de acomodaçäo monocularmente, após a instilaçäo de tropicamida a 1 por cento, com tempo de espera de 20 minutos, ciclopentolato a 1 por cento com tempo de espera de 40 minutos e tropicamida a 1 por cento + ciclopentolato a 1 por cento com intervalo entre as drogas de 5 minutos e com latência de 30 minutos. O intervalo entre os exames era de no mínimo sete dias. Resultados: Näo houve diferença entre os grupos dos emétropes, dos hipermétropes e dos míopes com nenhuma droga instilada (p>0,005). O ciclopentolato a 1 por cento e a associaçäo entre as drogas proporcionaram menor acomodaçäo residual estatisticamente significante, em comparaçäo com a tropicamida a 1 por cento no grupo dos hipermétropes e dos míopes. Conclusäo: O ciclopentolato a 1 por cento e a associaçäo entre as drogas säo seguras para o exame refratométrico estático em pacientes jovens, com íris escura e sem doença ocular, pois proporcionaram uma média da acomodaçäo residual em todos os grupos pesquisados de no máximo 1,21 + ou - 0,7 dioptrias esféricas (DE).

Midriasis farmacológica en conejos inducida por antagonistas de histamina / Pharmacologic midriasis induced by histamine antagonist in rabits

El propósito de este trabajo es determinar el efecto de antagonistas de histamina sobre el esfínter pupilar y la superficie ocular en conejos pigmentados. Para ello se realizó un estudio experimental, longitudinal y comparativo. Se estudiaron 50 ojos de 25 conejos, divididos en 4 grupos: I cimetidina, II clorfenamina, III tropicamida al 1 por ciento y IV fenilefrina al 10 por ciento + ciclopentolato al 1 por ciento. Como resultado, se demostró que la combinación de cimetidina y tropicamida al 1 por ciento produce pérdida de reflejo pupilar a los 5 minutos, midriasisi máxima a los 15 minutos, delcinando a los 45 minutos de su aplicacion. Se concluye que la combinación de cimetidina y tropicamida al 1 por ciento en forma tópica, induce pérdida del reflejo pupilar y midriasis a corto plazo desapareciendo rápidamente el afecto

Correlación campimétrica y electrorretinográfica en la degeneración macular relacionada con la edad / Correlation in electroretinogram and perimetry related macular degeneration

Se estudiaron 13 ojos de 9 pacientes con diagnóstico de degeneración macular relacionada con la edad (DMRE) y 11 ojos de 8 sujetos control de edades similares: a los que se les realizó exploración oftalmológica completa, como campimetría central, periférica y electrorretinograma (ERG). Las áreas de campimetría fueron medidas en mm² y en el ERG la amplitud en mV y la latencia en ms. Se realizaron mediante el programa de análisis estadístico Kwikstat, "Coeficientes de Correlación de Pearson" entre las campimetrías central y periférica, y a su vez entre éstas y el ERG de los pacientes del grupo control y del estudio; encontrando a pesar de ser escaso el número de pacientes y por lo tanto la correlación pobre, una mejor correlación en el grupo de estudio entre la campimetría central y periférica; y en el control entre flicker y campimetría periférica.

Hemorragias retinales del polo posterior en recién nacidos de término con parto normal de término con parto normal y sus secuelas a 4 años / Retinal hemorrhages of posterior pole in term newborn with normal delivery and its sequeles after 4 years

Se estudiaron prospectivamente 374 recién nacidos de término, en el Hospital San Juan de Dios, Santiago, Chile, se realizó un examen de fondo de ojo, antes de las 48 horas de vida, con oftalmoscopía directa, previamente dilatados con Tropicamida al 0,5 por ciento, en busca de hemorragias retinales (H.R.) de polo posterior (fundamentalmente papila y mácula). Las H.R. son más frecuentes en primíparas y tienen una frecuencia de 23,5 por ciento. Se controlaron prospectivamente los pacientes con Fondo de Ojo, estudio sensorio motor y agudeza visual hasta los 4 años de edad, para restablecer si existe relación con tropía y/o ambliopía. No hay relación entre la presencia de H.R. de polo posterior al nacer en el grupo estudiado y el desarrollo de tropía y/o ambliopía. El seguimiento es difícil por la no asistencia a los controles de los pacientes