OCT to identify macular changes not clinically detectable in elderly patients with cataract.

PURPOSE: To demonstrate the importance of optical coherence tomography (OCT) in identifying macular changes not detected at clinical examination preceding cataract surgery in patients older than 60 years. SETTING: Hospital Oftalmológico Visão Laser, Santos, São Paulo, Brazil. DESING: Prospective case series. METHODS: Patients older than 60 years were selected for this cross-sectional prospective study conducted during preoperative examination for cataract surgery. Eyes with a previous diagnosis or clinical evidence of macular disease or with media opacity preventing OCT from being performed were excluded from the study. All the study participants underwent OCT and were then divided into 2 groups: patients with macular changes and patients without macular changes found on OCT. RESULTS: Of 364 eyes screened (212 patients), 300 eyes (180 patients) were included in the study. OCT identified macular changes in 40 eyes (13.3%), with age-related macular degeneration being found in 13 eyes (4.3%), epiretinal membrane in 12 eyes (4%), intraretinal fluid in 12 eyes (4%), and macular hole in 3 eyes (1%). In the group with macular changes, the mean age was 74.4 ± 6.3 years compared with 70.4 ± 6.7 years for those without changes ( P < .001). CONCLUSIONS: OCT proved an effective method for identifying macular diseases not detected at clinical evaluation before cataract surgery. Therefore, the relevance of performing OCT in these cases was confirmed and should be taken into consideration, particularly when evaluating patients older than 60 years.

Síndrome do ápice orbitário, apresentação aguda e implicações tardias: uma série de casos / Orbital apex syndrome, acute presentation and late implications: a series of cases

RESUMO O ápice orbitário é uma região na qual estão contidas estruturas ósseas, vasculares e neurais. Patologias que acometem essa região podem desencadear um conjunto de sinais e sintomas característicos, dando origem a síndrome do ápice orbitário. É uma entidade rara, que consiste em sinais de envolvimento das estruturas nervosas, que atravessam o forame óptico e a fissura orbitária superior, comprometendo os nervos oculomotor, troclear, abducente; a divisão oftálmica do nervo trigêmeo e o nervo óptico. Suas causas incluem afecções neoplásicas, vasculares, traumáticas, infecciosas, inflamatórias e idiopáticas. Muitas vezes, nós nos deparamos com patologias sem tratamento curativo, portanto deve-se atentar para o controle da sintomatologia e a prevenção das possíveis implicações tardias. O objetivo desta série de casos é relatar algumas das causas da síndrome do ápice orbitário e sua apresentação clínica aguda, além de alertar sobre as possíveis implicações crônicas.

ABSTRACT Orbital apex is a region involving bone, vascular and neural structures. Pathologies involving this region may lead to several symptoms and signals and to orbital apex syndrome. It is a rare syndrome that is characterized by signals involving nervous ocular motor nerves through the optic foramen and the superior orbital fissure. This can affect the oculomotor, the third canal and abducens nerves; the ophthalmic division of the fifth cranial nerve and the optic nerve. Its causes include neoplastic, vascular, traumatic, infectious, inflammatory, and idiopathic conditions. We often deal with conditions with no treatment, so it is necessary to control the symptoms and prevent late implications. The purpose of this case series is to report on the causes of orbital apex disease and its potential chronic implications.