ABSTRACT
RESUMO As fístulas carótido-cavernosas são uma causa rara, porém grave, de glaucoma secundário por aumento da pressão venosa episcleral. Apresenta-se um caso de uma mulher de 72 anos, negra, atendida no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (HC-UFTM) com dor, sensação de pulsação, proptose, engurgitamento episcleral e quemose em olho direito, com aumento da pressão intraocular (PIO) apesar do uso de mediação anti-glaucomatosa. Na arteriografia foi evidenciada fístula dural para o seio cavernoso à direita, com refluxo para as veias orbitárias ipsilaterais. Realizou-se tratamento com agente líquido de embolização e, após o tratamento cirúrgico, apresentou melhora completa da proptose e congestão dos vasos episclerais, porém manteve PIO aumentada e desenvolvimento de glaucoma de ângulo fechado pela presença de goniossinéquias em 270º, com controle satisfatório com medicação.
ABSTRACT Carotid-cavernous fistulas are a major cause of secondary glaucoma due to increased episcleral venous pressure. We present the case of a 72-year-old female patient, treated at the Hospital de Clínicas at the Universidade Federal do Triângulo Mineiro (HC-UFTM), with pain, proptosis, episcleral engorgement, chemosis and pulsation in the right eye, with increased intraocular pressure (IOP) on anti-glaucomatous medication.Arteriography showed dural fistula to the right cavernous sinus, with reflux to orbital veins.Treatment with liquid embolization agent was performed, following full recovery of proptosis and congestion of the episcleral vessels. However, the patient maintained increased IOP because of narrow-angle glaucoma development due to the presence of goniosynechiae in 270º, which was controlled satisfactorily with medication.
Subject(s)
Humans , Female , Aged , Glaucoma/etiology , Ocular Hypertension/complications , Carotid-Cavernous Sinus Fistula/complications , Polyvinyls/administration & dosage , Magnetic Resonance Imaging , Catheterization , Angiography , Dimethyl Sulfoxide/administration & dosage , Carotid-Cavernous Sinus Fistula/therapy , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Embolization, Therapeutic/methodsABSTRACT
AIM: To investigate changes in central corneal thickness (CCT) and intraocular pressure (IOP) in children after congenital cataract surgery, as well as risk factors associated with these changes. METHODS: 37 eyes of 26 children with congenital cataract undergoing surgery were prospectively recruited. IOP and CCT measurements were performed before the surgery and 6, 12, 18, 24 and 36 months after the procedure. RESULTS: Among the 37 eyes, 15 became aphakic and 22 pseudophakic. Mean CCT significantly increased from 556.24 ± 44.19 to 585.07 ± 56.45 µm (p=0.003) after 3 years, whereas mean IOP significantly increased from 12.05 ± 2.3 to 13.89 ± 2.96 mm Hg (p=0.037). Aphakic eyes underwent surgery at an early age (15.16 ± 32.02 months) compared with pseudophakic eyes (71.48 ± 53.14 months) (p<0.001). After 3 years, mean CCT change in aphakic eyes (56.10 ± 46.97 µm) was significantly higher than in pseudophakic eyes (12.71 ± 38.41 µm) (p=0.015). Age at the time of surgery was inversely correlated to CCT change (r=-0.34, p=0.04), but not to IOP change (r=-0.18, p=0.27). When surgery was performed between 0 and 1 year of age, mean CCT change at 3 years was 70.11 ± 42.3 µm, compared with 6.27 ± 28.09, -17.0 ± 8.04 and 48.33 ± 34.99 µm when surgeries were performed at 1-5, 5-10 and >10 years old, respectively (p<0.001). IOP change was not correlated to CCT change (r=0.31, p=0.06). CONCLUSIONS: CCT increases in eyes undergoing congenital cataract surgery, especially when the surgery is performed at an early age.