Vitamin D status in active and inactive noninfectious uveitis - data from a reference university hospital in Rio de Janeiro, Brazil.

PURPOSE: This study aimed to investigate the correlation between serum vitamin D levels and disease activity in patients with noninfectious uveitis. METHODS: We conducted a prospective case-control study, assessing 51 patients with noninfectious uveitis, categorized into active (n=22) and inactive (n=29) groups, along with 51 healthy controls. Serum 25-hydroxy vitamin D [25(OH)D] levels were measured. The uveitis group also completed a questionnaire regarding sunlight exposure habits and vitamin D supplementation. RESULTS: Patients with inflammation-related uveitis exhibited low serum 25(OH)D levels in 68% of cases. The median 25(OH)D level in patients with active uveitis was 17.8 ng/mL (interquartile range [IQR], 15-21 ng/mL), significantly lower compared to the 31.7 ng/mL (IQR, 25-39 ng/mL) in patients with inactive uveitis (p<0.001) and the 27 ng/mL (IQR, 23-31 ng/mL) in the Control Group (p<0.001). Significantly, nearly all patients with uveitis taking vitamin D supplementation were in the Inactive Group (p<0.005). Moreover, reduced sunlight exposure was associated with active uveitis (p<0.003). Furthermore, patients with 25(OH)D levels below 20 ng/mL had ten times higher odds of developing active uveitis (p=0.001). CONCLUSIONS: This study revealed a prevalent 25(OH)D deficiency among patients with noninfectious uveitis and suggested a link between low 25(OH)D levels and disease activity. To prevent future episodes of intraocular inflammation, vitamin D supplementation and controlled sunlight exposure could be viable options.

Causes and characteristics of uveitis cases at a reference university hospital in Rio de Janeiro, Brazil / Causas e características das uveítes em hospital universitário de referência no Rio de Janeiro, Brasil

ABSTRACT Purpose: The aim of this study was to describe the epidemiological profile of uveitis cases treated at University Hospital Clementino Fraga Filho and to identify the presentation pattern of intraocular inflammation on the basis of clinical, anatomical, etiological, and demographic criteria. Methods: A retrospective study was conducted using data from the medical records of 408 patients with active disease who attended the ophthalmology service between March and October 2018. Age, sex, visual acuity at the time of diagnosis, anatomical and etiological diagnoses, the clinical aspect, and the main symptoms reported during anamnesis were described. Results: Of the 408 patients in the study, 52% were male and 48% were female. The patients' mean age was 42 years, and most (84%) were between 19 and 64 years old. Anterior uveitis was observed in 37.75% of the patients; posterior uveitis, in 49.75%; panuveitis, in 4.66%; and intermediate uveitis, in 3.43%. Only 18 patients (4.41%) presented with scleritis. Of the 390 patients with anatomical classifications, 76% had known etiologies, with the most prevalent diagnoses being toxoplasmosis (35.4%), followed by juvenile idiopathic arthritis (6.4%), ankylosing spondylitis (5.9%), and syphilis (4.9%). Infectious uveitis corresponded to 49.7% of the patients, while 26.6% of the cases were of noninfectious origin. Anterior uveitis had the highest number of cases classified as idiopathic (49.4%). In the cases of posterior uveitis, the etiology was established 94% of the time. The most frequent symptoms were ocular pain (71.8%) and blurring vision (56.8%). Conclusions: The present study confirmed the historical importance of infectious uveitis in our population, especially ocular toxoplasmosis. Uveitis appears to have no predilection for sex but mainly affects young people of working age, thus generating social and economic consequences. Despite the evolution of diagnostic methods, idiopathic uveitis remains one of the major etiologies. Epidemiological studies point to different presentation patterns of uveitis in different populations, but these may reflect the distinct characteristics of each institution.

RESUMO Objetivo: Descrever o perfil epidemiológico das uveítes atendidas no Hospital Universitário Clementino Fraga Filho - UFRJ. Identificando o padrão de apresentação da inflamação intraocular a partir de critérios clínicos, anatômicos, etiológicos e demográficos. Métodos: Estudo retrospectivo, com base em prontuários de 408 pacientes com doença ativa, atendidos no serviço de oftalmologia no período de março a outubro de 2018. Foram descritos a idade, sexo, acuidade visual no momento do diagnóstico, diagnóstico anatômico e etiológico, aspecto clínico, além dos principais sintomas relatados durante a anamnese. Resultados: Dos 408 pacientes do estudo, 52% eram do sexo masculino e 48% do feminino. A idade média dos pacientes foi de 42 anos, a maioria (84%) entre 19 e 64 anos. Uveíte anterior foi observada em 37,75% dos pacientes, uveíte posterior em 49,75%, panuveíte em 4,66% e uveíte intermediária em 3,43%; apenas 18 pacientes (4,41%) apresentaram diagnóstico de esclerite. Dos 390 pacientes com classificação anatômica, a etiologia foi determinada em 76% deles, com os diagnósticos mais prevalentes sendo Toxoplasmose (35,4%), artrite idiopática juvenil (6,4%), espondilite anquilosante (5,9%) e sífilis (4,9%). ) A uveíte infecciosa correspondeu a 49,7% desses pacientes, enquanto 26,6% eram de origem não infecciosa. A uveíte anterior teve o maior número de casos classificados como idiopáticos (49,4%), enquanto a uveíte posterior teve a etiologia estabelecida em 94% das vezes. Os sintomas mais frequentes foram dor ocular (71,8%) e visão embaçada (56,8%). Conclusões: O presente estudo confirmou a importância histórica da uveíte infecciosa em nossa população, principalmente a toxoplasmose ocular. As uveítes parecem não ter predileção por sexo, mas afetam principalmente jovens em idade ativa, gerando consequências sociais e econômicas. Apesar da evolução nos métodos diagnósticos, a uveíte idiopática continua sendo uma das principais causas. Estudos epidemiológicos apontam para diferentes padrões de uveíte nas populações, estes podem refletir características particulares de cada instituição.

Causes and characteristics of uveitis cases at a reference university hospital in Rio de Janeiro, Brazil.

PURPOSE: The aim of this study was to describe the epidemiological profile of uveitis cases treated at University Hospital Clementino Fraga Filho and to identify the presentation pattern of intraocular inflammation on the basis of clinical, anatomical, etiological, and demographic criteria. METHODS: A retrospective study was conducted using data from the medical records of 408 patients with active disease who attended the ophthalmology service between March and October 2018. Age, sex, visual acuity at the time of diagnosis, anatomical and etiological diagnoses, the clinical aspect, and the main symptoms reported during anamnesis were described. RESULTS: Of the 408 patients in the study, 52% were male and 48% were female. The patients' mean age was 42 years, and most (84%) were between 19 and 64 years old. Anterior uveitis was observed in 37.75% of the patients; posterior uveitis, in 49.75%; panuveitis, in 4.66%; and intermediate uveitis, in 3.43%. Only 18 patients (4.41%) presented with scleritis. Of the 390 patients with anatomical classifications, 76% had known etiologies, with the most prevalent diagnoses being toxoplasmosis (35.4%), followed by juvenile idiopathic arthritis (6.4%), ankylosing spondylitis (5.9%), and syphilis (4.9%). Infectious uveitis corresponded to 49.7% of the patients, while 26.6% of the cases were of noninfectious origin. Anterior uveitis had the highest number of cases classified as idiopathic (49.4%). In the cases of posterior uveitis, the etiology was established 94% of the time. The most frequent symptoms were ocular pain (71.8%) and blurring vision (56.8%). CONCLUSIONS: The present study confirmed the historical importance of infectious uveitis in our population, especially ocular toxoplasmosis. Uveitis appears to have no predilection for sex but mainly affects young people of working age, thus generating social and economic consequences. Despite the evolution of diagnostic methods, idiopathic uveitis remains one of the major etiologies. Epidemiological studies point to different presentation patterns of uveitis in different populations, but these may reflect the distinct characteristics of each institution.

Manejo da coroidite interna punctata complicada por membrana neovascular sub-retiniana / Management of punctate inner choroidopathy complicated by subretinal neovascular membrane

RESUMO Este trabalho visou evidenciar a importância da detecção precoce da coroidite interna punctata e destacar sua fisiopatologia inflamatória e possíveis diagnósticos diferenciais dentro das white dot syndromes. O destaque foi dado principalmente à coroidite multifocal e à panuveíte, ao se demonstrar sua epidemiologia peculiar em mulheres jovens, caracterizar sua apresentação clínica típica na fundoscopia e explorar as vantagens e as desvantagens de realizar os exames complementares que fazem parte da análise multimodal útil para o diagnóstico (especialmente a angiografia fluoresceínica, a tomografia de coerência óptica e a indocianina verde). Descreve-se o caso de uma mulher de 28 anos diagnosticada com coroidite interna punctata com membrana neovascular coroidal em olho direito. O tratamento foi realizado com injeção intravítrea de aflibercepte e corticoterapia sistêmica 1mg/kg ao dia. Este relato é importante por permitir debater o manejo da coroidite interna punctata durante a gestação e a decisão de realizar o tratamento mediante uma diversidade de opções terapêuticas.

ABSTRACT This work aimed to demonstrate the importance of early detection of punctate inner choroidopathy, highlighting the pathophysiology of inflammation and the differential diagnoses among white dot syndromes. Special attention was given to multifocal choroiditis and panuveitis, by demonstrating the peculiar epidemiology in young women, characterizing the typical clinical presentation in ophthalmoscopy, and exploring the advantages and disadvantages of performing the complementary examinations, which are part of the multimodal analysis useful for diagnosis (particularly fluorescein angiography, optical coherence tomography, and indocyanine green). We report the case of a 28-year-old female, diagnosed as punctate inner choroidopathy with choroidal [N.T. no título aparece subretinal = subrretiniana] neovascular membrane in the right eye. She was treated with intravitreal injection of aflibercept and systemic corticosteroid 1 mg/kg/day. This case report is important for addressing the management of punctate inner choroidopathy during pregnancy, and the decision to carry out treatment considering diverse therapeutic options.

Arterite sifilítica / Retinal arteritis related to syphilis

Resumo Apresentamos um caso de neurosífilis em um homem jovem, com queixa de baixa acuidade visual (BAV) em olho esquerdo. Cursou com lesões eritemato-descamativas nas palmas das mãos, plantas dos pés e úlceras orais, sem lesões genitais. O exame oftalmológico revelou arterite em arcada nasal superior no olho afetado. Apresentou VDRL (1:4096) e FTA-Abs positivos. O exame do líquor cefalorraquidiano foi negativo. O tratamento foi realizado com ceftriaxona 2g/ dia por 14 dias, associado à prednisona 0,5mg/kg oral 48h após início do antibiótico. Após 15 dias de tratamento, houve melhora da AV, regressão da vasculite e redução da titulação do VDRL para 1:128.

Abstract We present a case of neurosyphilis in a young man with a complaint of low visual acuity in the left eye. He had erythematous-scaly lesions on the palms of the hands, soles of the feet and oral ulcers, without genital lesions. The ophthalmic examination revealed arteritis in the upper nasal arcade in the affected eye. He presented VDRL (1: 4096) and FTA-Abs positive. The cerebrospinal fluid cerebrospinal fluid test was negative. The treatment was performed with ceftriaxone 2g / day for 14 days, associated with prednisone 0.5mg / kg oral 48h after antibiotic onset. After 15 days of treatment, there was improvement of AV, regression of vasculitis and reduction of VDRL titration to 1: 128.

Esporotricose ocular: manifestações atípicas / Ocular sporotrichosis: atypical manifestations

Resumo A esporotricose humana e animal é uma infecção subaguda a crônica causada pelo fungo dimórfico Sporothrix schenckii. A esporotricose ocular tem ganhado destaque em função da epidemia de esporotricose urbana enfrentada pelo estado do Rio de Janeiro na última década e se apresenta classicamente como conjuntivite granulomatosa, mas formas atípicas podem ocorrer. Este artigo tem por objetivo relatar 2 casos atípicos de esporotricose ocular em pacientes imunocompetentes, ambos apresentando quadro clínico compatível com a síndrome oculoglandular de Parinaud associada à dacriocistite em um caso e presumivelmente à coroidite no outro caso.

Abstract Human and animal sporotrichosis is an infection caused by the dimorphic fungus Sporothrix schenckii, which is classified from subacute to chronic. Ocular sporotrichosis has been highlighted due to the epidemic of urban sporotrichosis faced by the state of Rio de Janeiro in the last decade and presents classically as granulomatous conjunctivitis, but atypical forms may occur. This article aims to report two atypical cases of ocular sporotrichosis in immunocompetent patients, both presenting a clinical picture compatible with Parinaud oculoglandular syndrome associated with dacryocystitis in one case and presumably to choroiditis in the other case.

Síndrome de Blau: infiltrados subepiteliais como manifestações oftalmológicas incomuns / Blau Syndrome: subepithelial infiltrates as uncommon ophthalmologic manifestation

Resumo A Síndrome de Blau é uma doença de caráter hereditário autossômico dominante a qual também pode ocorrer de forma esporádica via mutação "de novo". Em geral, tem aparecimento precoce ainda na primeira infância e sua tríade clássica inclui artrite, dermatite e uveíte. Este trabalho visa relatar as manifestações clínicas e principalmente oftalmológicas de uma paciente diagnosticada com Síndrome de Blau com ênfase ao achado incomum de infiltrados corneanos subepiteliais, raramente descrito na literatura.

Abstract The Blau syndrome is an autosomal dominant hereditary disease which can also occur sporadically via "de novo" mutation. Overall it has early onset and its classic triad includes arthritis, dermatitis and uveitis. This paper describes clinical and mainly especially ophthalmologic manifestations of a patient diagnosed with Blau syndrome with emphasis on an uncommon finding of corneal subepithelial infiltrates, rarely described in the literature.

Descolamento seroso de coroide como manifestação tardia da síndrome de Vogt-Koyanagi-Harada / Serous choroidal detachment in chronic stage of Vogt-Koyanagi-Harada syndrome

Resumo Relatamos um caso atípico de uma paciente de 40 anos com apresentação completa da Síndrome de Vogt-Koyanagi-Harada (SVKH) que após 17 anos do diagnóstico inicial evoluiu com descolamento seroso de coroide. A paciente procurou atendimento com queixa de dor em olho esquerdo (OE). O exame oftalmológico revelou acuidade visual (AV) igual a de movimento de mãos, à biomicroscopia foi observada reação inflamatória granulomatosa na câmara anterior, a tonometria foi igual a 0 mmhg, e a fundoscopia indevassável pela pouca midríase e turvação de meios em OE. O descolamento seroso de coroide foi avaliado através de ultrassonografia ocular. A abordagem terapeutica intituida para paciente consistiu em prednisona 1mg/kg/dia via oral, dexametasona 1mg/mL e atropina 1% colírios. A evolução do quadro foi satisfatória, com melhora da AV para 20/40, ausência de reação inflamatória em câmara anterior, normalização da pressão intraocular e resolução do descolamento seroso de coroide em OE. Concluimos que a fase crônica da SVKH, apesar da manifestação classicamente descrita ser uveíte anterior, pode ter outras apresentações e o descolamento seroso da coroide é uma rara complicação.

Abstract We report an atypical case of a 40-year-old woman with complete presentation of Vogt-Koyanagi-Harada Syndrome (VKH) who presented with unilateral serous choroidal detachment 17 years after the diagnosis. The patient complained of pain in the left eye, the ophthalmologic examination revealed visual acuity (VA) equal to hand motion; biomicroscopy revealed a granulomatous inflammatory reaction in the anterior chamber, tonometry was equal to 0 mmhg, and the fundoscopy was impracticable. Serous choroidal detachment was assessed by ocular ultrasonography. The therapeutic approach proposed for the patient consisted of prednisone 1mg / kg / day orally, dexamethasone 1mg / mL and atropine 1% eye drops. The evolution of the condition was satisfactory, with VA improvement to 20/40, absence of inflammatory reaction in anterior chamber, normalization of intraocular pressure and resolution of serous choroidal detachment in OS. We conclude that the chronic phase of VKH, although classically described as anterior uveitis, may have other presentations and the serous choroid detachment is a rare complication.

Síndrome de Vogt-Koyanagi-Harada: Avaliação da fase da doença na qual os pacientes recebem o primeiro atendimento em serviço especializado / Vogt-Koyanagi-Harada syndrome: evaluation of the disease phase in which patients receive the first specialized attendance

Resumo Objetivo: Avaliar em qual fase da síndrome de Vogt-Koyanagi-Harada (SVKH) os pacientes recebem o primeiro atendimento em serviço especializado. Métodos: Foram analisados prontuários de 14 pacientes atendidos no Setor de Uveítes do Hospital Universitário Clementino Fraga Filho da UFRJ no período de janeiro de 2014 a março de 2017. Nesta análise, foram observados o sexo, a idade, a fase da doença e a acuidade visual destes pacientes com ao menos doença provável da SVKH. Resultados: Observamos que 35,4% dos pacientes apresentavam a doença ainda na fase uveítica e que 78,5% destes pacientes apresentava acuidade visual igual ou pior que 0,05. Destes pacientes, 78,5% eram do sexo feminino e 21,5% do sexo masculino e a mediana de idades foi de 34 anos. Conclusão: Os pacientes analisados obtiveram dificuldade em ter acesso precoce a um setor especializado, afetando assim, diretamente o tratamento e prognóstico visual.

Abstract Objective: To evaluate in which phase of Vogt-Koyanagi-Harada (VKH) syndrome the patients receive the first attendance in specialized service. Methods: A retrospective study was conduted to evaluate medical records of 14 patients with VKH in the Clementino Fraga Filho University Hospital of the Federal University of Rio de Janeiro from January 2014 to March 2017. In this analysis, gender, age, stage of disease and visual acuity of these patients with at least probable VKH were recorded. Results: Of these patients, 78.5% were female and 21.5% male and the median age was 34 years. We observed that 35.4% of the patients had the disease still in the uveitic phase and that 78.5% of these patients had visual acuity equal to or worse than 0.05. Conclusion: There is a delay in the admission of these patients to a specialized sector, thus affecting directly the treatment and visual prognosis.

Reduced occurrence of programmed cell death and gliosis in the retinas of juvenile rabbits after shortterm treatment with intravitreous bevacizumab.

OBJECTIVE: Bevacizumab has been widely used as a vascular endothelial growth factor antagonist in the treatment of retinal vasoproliferative disorders in adults and, more recently, in infants with retinopathy of prematurity. Recently, it has been proposed that vascular endothelial growth factor acts as a protective factor for neurons and glial cells, particularly in developing nervous tissue. The purpose of this study was to investigate the effects of bevacizumab on the developing retinas of juvenile rabbits. METHODS: Juvenile rabbits received bevacizumab intravitreously in one eye; the other eye acted as an untreated control. Slit-lamp and fundoscopic examinations were performed both prior to and seven days after treatment. At the same time, retina samples were analyzed using immunohistochemistry to detect autophagy and apoptosis as well as proliferation and glial reactivity. Morphometric analyses were performed, and the data were analyzed using the Mann-Whitney U test. RESULTS: No clinical abnormalities were observed in either treated or untreated eyes. However, immunohistochemical analyses revealed a reduction in the occurrence of programmed cell death and increases in both proliferation and reactivity in the bevacizumab-treated group compared with the untreated group. CONCLUSIONS: Bevacizumab appears to alter programmed cell death patterns and promote gliosis in the developing retinas of rabbits; therefore, it should be used with caution in developing eyes.

Reduced occurrence of programmed cell death and gliosis in the retinas of juvenile rabbits after shortterm treatment with intravitreous bevacizumab

OBJECTIVE: Bevacizumab has been widely used as a vascular endothelial growth factor antagonist in the treatment of retinal vasoproliferative disorders in adults and, more recently, in infants with retinopathy of prematurity. Recently, it has been proposed that vascular endothelial growth factor acts as a protective factor for neurons and glial cells, particularly in developing nervous tissue. The purpose of this study was to investigate the effects of bevacizumab on the developing retinas of juvenile rabbits. METHODS: Juvenile rabbits received bevacizumab intravitreously in one eye; the other eye acted as an untreated control. Slit-lamp and fundoscopic examinations were performed both prior to and seven days after treatment. At the same time, retina samples were analyzed using immunohistochemistry to detect autophagy and apoptosis as well as proliferation and glial reactivity. Morphometric analyses were performed, and the data were analyzed using the Mann-Whitney U test. RESULTS: No clinical abnormalities were observed in either treated or untreated eyes. However, immunohistochemical analyses revealed a reduction in the occurrence of programmed cell death and increases in both proliferation and reactivity in the bevacizumab-treated group compared with the untreated group. CONCLUSIONS: Bevacizumab appears to alter programmed cell death patterns and promote gliosis in the developing retinas of rabbits; therefore, it should be used with caution in developing eyes.

[Ocular and electroretinographic changes in sickle cell disease]. / Alterações oculares e eletrorretinográficas na doença falciforme.

PURPOSE: The primary objective of this case series was to get electroretinographic data in subjects with sickle cell disease. The secondary purpose was to identify ocular changes, their frequency and stage of evolution. METHODS: 90 patients aged between 8 and 75 years were evaluated. They were subjected to complete ophthalmological examination, indirect ophthalmoscopy, retinography, angiography and electroretinography. Electroretinograms with amplitude of wave b less than 400 mW were considered subnormal. Prevalence study was conducted using the Chi-square test, P<0.001. RESULTS: The electroretinogram was subnormal in 27 (30%) of 90 patients, but of these, only 4 (4.4%) had proliferative retinopathy. The sign of comma in 95% of individuals, the retinal vascular tortuosity in 36.6% and black sunburst in 24.4% were the most frequent changes. CONCLUSION: No correlation between sickle cell disease and electroretinographics changes, as described in other studies, were noted. On the other hand, the ocular findings corroborate the previous researches.

Alterações oculares e eletrorretinográficas na doença falciforme / Ocular and electroretinographic changes in sickle cell disease

OBJETIVO: O objetivo principal desta série de casos foi obter dados eletrorretinográficos em indivíduos portadores de síndrome falcêmica. O objetivo secundário foi identificar alterações oculares, sua frequência e o estágio de evolução. MÉTODOS: Foram avaliados 90 portadores de doença falciforme, com idade entre 8 e 75 anos, submetidos a exame oftalmológico completo, mapeamento de retina, retinografia, angiografia fluoresceínica e eletrorretinografia. Eletrorretinogramas com amplitude da onda b inferior a 400 mW foram considerados subnormais. Foi realizado estudo de prevalência, utilizando o teste do Chi-quadrado, sendo P<0,001. RESULTADOS: O eletrorretinograma se mostrou subnormal em 27 (30 por cento) dos 90 pacientes, mas destes, apenas 4 (4,4 por cento) apresentavam retinopatia proliferativa. O sinal da vírgula em 95 por cento dos indivíduos, a tortuosidade vascular retiniana em 36,6 por cento e o "black sunburst" em 24,4 por cento foram as alterações mais encontradas. CONCLUSÃO: Não foi observada correlação entre a doença falciforme e alterações eletrorretinográficas, como descrito em outros estudos. Por outro lado, os achados oculares corroboram pesquisas anteriores.

PURPOSE: The primary objective of this case series was to get electroretinographic data in subjects with sickle cell disease. The secondary purpose was to identify ocular changes, their frequency and stage of evolution. METHODS: 90 patients aged between 8 and 75 years were evaluated. They were subjected to complete ophthalmological examination, indirect ophthalmoscopy, retinography, angiography and electroretinography. Electroretinograms with amplitude of wave b less than 400 mW were considered subnormal. Prevalence study was conducted using the Chi-square test, P<0.001. RESULTS: The electroretinogram was subnormal in 27 (30 percent) of 90 patients, but of these, only 4 (4.4 percent) had proliferative retinopathy. The sign of comma in 95 percent of individuals, the retinal vascular tortuosity in 36.6 percent and black sunburst in 24.4 percent were the most frequent changes. CONCLUSION: No correlation between sickle cell disease and electroretinographics changes, as described in other studies, were noted. On the other hand, the ocular findings corroborate the previous researches.

[Correlation between central corneal thickness and axial length in patients with glaucoma and normal eyes]. / Correlação entre a espessura corneana central e o comprimento axial ocular nos portadores de glaucoma e em olhos normais.

PURPOSE: To evaluate and to correlate the central corneal thickness with the ocular axial length in patients with primary open-angle glaucoma, primary angle-closure glaucoma and individuals with normal eyes. METHODS: The sample was composed of 94 patients' eyes, divided into three groups constituted of 33 eyes of 33 primary open-angle glaucoma patients, 30 eyes of 30 primary angle-closure glaucoma patients and 31 normal eyes of 31 individuals. The central corneal thickness and the axial length were measured by ultrasonic pachymeter and biometry by A-scan ultrasound, respectively. RESULTS: The results showed a mean of 535.1 mm central corneal thickness in primary angle-closure glaucoma group, 520.6 mm in primary open-angle glaucoma group and 519.2 mm in normal eyes (p=0.18). The ocular axial length on primary angle-closure glaucoma group was 22.16 mm and on primary open-angle glaucoma and normal eyes group was 22.68 mm and 22.64 mm, respectively (p=0.13). There was no significant correlation between corneal thickness and axial length in the primary angle-closure glaucoma group (r=-0.085; p=0.65), the open-angle glaucoma group (r=-0.070; p=0.69) and the normal eyes group (r=-0.120; p=0.52). CONCLUSIONS: The results of this assay suggest that there is no correlation between the central corneal thickness and the axial length in patients with glaucoma and individuals with normal eyes.

[Subclinical diabetic macular edema and mild non-proliferative diabetic retinopathy: data correlation with the retinal thickness analyzer (RTA)]. / Edema macular diabético subclínico e retinopatia diabética não proliferativa leve: correlação de dados com o analisador de espessura da retina (RTA).

PURPOSE: To measure, using the retinal thickness analyzer, the mean foveal thickness and the mean perifoveal thickness values on patients suffering from mild non-proliferative diabetic retinopathy without clinically detectable macular edema (classified by the ETDRS study), and compare them with healthy individuals. METHODS: Observational analytical retrospective case-controlled study, on a sample of 79 eyes (39 affected and 40 control). The sample was selected from by exams previously taken at Centro Brasileiro de Cirurgia de Olhos (CBCO) (from 1999 to 2003) stored in the retinal thickness analyzer. The control group was selected according to specific criteria. The affected group was formed according to the research inclusive and exclusive criteria. The results were submitted to statistical tests for reliability. RESULTS: In the control group the values obtained for mean foveal thickness were around (mean=147.4 micra+/-15.4 micra standard deviation) and for mean perifoveal thickness were around (mean=193.8 micra+/-24.6 micra standard deviation). Patients with mild non-proliferative diabetic retinopathy presented foveal thickness around (mean=198.9 micra+/-48.3 micra standard deviation) and perifoveal thickness around (mean=194.2 micra+/-26.4 micra standard deviation). CONCLUSION: An increase of mean foveal thickness on diabetic patients who have not shown clinical signs of macular edema was noted, which was proved by statistical tests. Such results are similar to the values found in medical literature.

Correlação entre a espessura corneana central e o comprimento axial ocular nos portadores de glaucoma e em olhos normais / Correlation between central corneal thickness and axial length in patients with glaucoma and normal eyes

OBJETIVO: Correlacionar a espessura corneana central com o comprimento axial ocular nos portadores de glaucoma primário de ângulo aberto, com glaucoma primário de fechamento angular e indivíduos com olhos normais. MÉTODOS: A amostra foi constituída de 94 olhos de 94 pacientes, divididos em três grupos compostos por 33 olhos de 33 pacientes portadores de glaucoma primário de ângulo aberto, 30 olhos de 30 pacientes com glaucoma primário de fechamento angular e 31 olhos normais de 31 indivíduos. A espessura corneana e o comprimento axial do olho foram obtidos pela paquimetria ultrassônica e ecobiometria, respectivamente. RESULTADOS: A média da espessura corneana central foi de 535,1 mm no glaucoma primário de fechamento angular; 520,6 mm no glaucoma primário de ângulo aberto e 519,2 mm nos olhos normais (p=0,18). A média do comprimento axial do globo ocular nos portadores de glaucoma primário de fechamento angular foi de 22,16 mm e nos grupos com glaucoma primário de ângulo aberto e olhos normais foram de 22,68 mm e 22,64 mm, respectivamente (p=0,13). Não houve correlação significativa entre a espessura corneana central e comprimento axial do globo ocular nos grupos com glaucoma primário de fechamento angular (r=-0,085; p=0,65), glaucoma primário de ângulo aberto (r=-0,070; p=0,69) e olhos normais (r=-0,120; p=0,52). CONCLUSÃO: Os resultados deste trabalho sugerem não haver correlação entre a espessura corneana central e o comprimento axial do globo ocular nos portadores de glaucoma e indivíduos com olhos normais.

PURPOSE: To evaluate and to correlate the central corneal thickness with the ocular axial length in patients with primary open-angle glaucoma, primary angle-closure glaucoma and individuals with normal eyes. METHODS: The sample was composed of 94 patients' eyes, divided into three groups constituted of 33 eyes of 33 primary open-angle glaucoma patients, 30 eyes of 30 primary angle-closure glaucoma patients and 31 normal eyes of 31 individuals. The central corneal thickness and the axial length were measured by ultrasonic pachymeter and biometry by A-scan ultrasound, respectively. RESULTS: The results showed a mean of 535.1 mm central corneal thickness in primary angle-closure glaucoma group, 520.6 mm in primary open-angle glaucoma group and 519.2 mm in normal eyes (p=0.18). The ocular axial length on primary angle-closure glaucoma group was 22.16 mm and on primary open-angle glaucoma and normal eyes group was 22.68 mm and 22.64 mm, respectively (p=0.13). There was no significant correlation between corneal thickness and axial length in the primary angle-closure glaucoma group (r=-0.085; p=0.65), the open-angle glaucoma group (r=-0.070; p=0.69) and the normal eyes group (r=-0.120; p=0.52). CONCLUSIONS: The results of this assay suggest that there is no correlation between the central corneal thickness and the axial length in patients with glaucoma and individuals with normal eyes.

Edema macular diabético subclínico e retinopatia diabética não proliferativa leve: correlação de dados com o analisador de espessura da retina (RTA) / Subclinical diabetic macular edema and mild non-proliferative diabetic retinopathy: data correlation with the retinal thickness analyzer (RTA)

OBJETIVO: Mensurar, utilizando o analisador de espessura retiniana, valores de média de espessura foveal e média de espessura perifoveal de pacientes portadores de retinopatia diabética não proliferativa leve com ausência de edema macular clinicamente detectável (classificados pelo estudo ETDRS), comparando-os com os de indivíduos normais. MÉTODOS: Estudo retrospectivo analítico observacional, caso-controle sobre uma amostra de 79 olhos (39 acometidos e 40 controles). A amostra foi selecionada dentro dos exames já realizados no Centro Brasileiro de Cirurgia de Olhos (CBCO) (de 1999 a 2003) arquivados no analisador de espessura retiniana (RTA). O grupo controle foi selecionado segundo critérios específicos. O grupo acometido foi constituído de acordo com os critérios de inclusão e exclusão da pesquisa. Os resultados encontrados foram submetidos a testes estatísticos para validação. RESULTADOS: No grupo controle, os valores encontrados para média de espessura foveal foram em torno de (média=147,4 micra ± desvio padrão de 15,4 micra) e média de espessura perifoveal em torno de (média=193,8 micra ± desvio padrão de 24,6 micra). Os pacientes com retinopatia diabética não proliferativa leve apresentaram espessura foveal em torno de (média= 198,9 micra ± desvio padrão de 48,3 micra) e espessura perifoveal em torno de (média de 194,2 micra ± desvio padrão de 26,4 micra). CONCLUSÃO: Foi observado um aumento da média de espessura foveal em pacientes diabéticos que ainda não apresentam sinais clínicos de edema macular, comprovado através de testes estatísticos. Os resultados estão de acordo com os valores encontrados na literatura.

PURPOSE: To measure, using the retinal thickness analyzer, the mean foveal thickness and the mean perifoveal thickness values on patients suffering from mild non-proliferative diabetic retinopathy without clinically detectable macular edema (classified by the ETDRS study), and compare them with healthy individuals. METHODS: Observational analytical retrospective case-controlled study, on a sample of 79 eyes (39 affected and 40 control). The sample was selected from by exams previously taken at Centro Brasileiro de Cirurgia de Olhos (CBCO) (from 1999 to 2003) stored in the retinal thickness analyzer. The control group was selected according to specific criteria. The affected group was formed according to the research inclusive and exclusive criteria. The results were submitted to statistical tests for reliability. RESULTS: In the control group the values obtained for mean foveal thickness were around (mean=147.4 micra ± 15.4 micra standard deviation) and for mean perifoveal thickness were around (mean=193.8 micra ± 24.6 micra standard deviation). Patients with mild non-proliferative diabetic retinopathy presented foveal thickness around (mean=198.9 micra ± 48.3 micra standard deviation) and perifoveal thickness around (mean= 194.2 micra ± 26.4 micra standard deviation). CONCLUSION: An increase of mean foveal thickness on diabetic patients who have not shown clinical signs of macular edema was noted, which was proved by statistical tests. Such results are similar to the values found in medical literature.

Uso de ciclosporina 0.05% tópica no tratamento do olho seco de pacientes portadores do vírus HIV / Topical cyclosporine 0.05% for the treatment of dry eye disease in patients infected with the human immunodeficiency virus

Objetivo: O presente estudo comparou a eficácia do tratamento da síndrome do olho seco em pacientes infectados pelo HIV com suplementação lacrimal (carboximetilcelulose sódica 0,5%) ou com suplementação lacrimal associada à terapia anti-inflamatória (carboximetilcelulose sódica 0,5% e ciclosporina 0,05%). Métodos: Vinte pacientes portadores do vírus HIV provenientes do ambulatório de Infectologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro foram selecionados. O diagnóstico de síndrome do olho seco foi baseado no questionário para olho seco (Ocular Surface Disease Index - OSDI®), teste de Schirmer I, tempo de ruptura do filme lacrimal e coloração da superfície ocular com rosa bengala a 1%. Os pacientes foram distribuídos em dois grupos com dez pacientes (20 olhos) e acompanhados durante seis meses. O grupo I foi tratado com colírio de carboximetilcelulose sódica 0,5% e o grupo II foi tratado com a associação decarboximetilcelulose sódica 0,5% e ciclosporina 0,05% tópica. Resultados: Comparando os resultados no início e no final do tratamento, a associação com ciclosporina 0,05% mostrou-se superior (p < 0,05) para o teste de Schirmer I. Conclusão: O presente estudo sugere que o uso de ciclosporina 0,05% tópica melhora a produção lacrimal em pacientes infectados pelo HIV, apresentando um importante papel como adjuvante no tratamento do olho seco nestes pacientes.

Purpose: This study evaluates the use of topical cyclosporine 0.05% and sodium carboxymethylcellulose 0.5% for the treatment of dry eye disease in patientsinfected with the human immunodeficiency virus. Methods: Twenty HIV-positive-patients were selected from the Department of Infectious Diseases of the Federal University of Rio de Janeiro Hospital. Dry eye diagnosis was based on a dry eye questionnaire (Ocular Surface Disease Index - OSDI®), Schirmer I test, break up time and 1% rose bengal staining of the ocular surface. The patients were divided into two groups with ten patients (20 eyes). Group I received sodium carboxymethylcellulose0.5% drops and group II received sodium carboxymethylcellulose 0.5% drops and topical cyclosporine 0.05% for six months. Results: Comparing the results at the beginning and in the end of the treatment, the use of cyclosporine was superior (p < 0.05) for the Schirmer I test. Conclusion:This study suggests that topical cyclosporine improves lacrimal production and has animportant role as an adjuvant therapy for dry eye disease in patients infected with the human immunodeficiency virus.

Perfil socioeconômico e epidemiológico dos pacientes submetidos à cirurgia de catarata em um hospital universitário / Socioeconomic and epidemiologic profile of patients submitted to cataract surgery at a university hospital

OBJETIVO: Determinar as características sócioeconômicas dos pacientes operados de catarata em hospital universitário, avaliar o acesso à unidade terciária e determinar o tempo de espera até o tratamento cirúrgico. MÉTODOS: Estudo transversal, realizado através da revisão de prontuários de 148 pacientes operados de catarata escolhidos aleatoriamente durante o primeiro semestre de 2007. RESULTADOS: Os pacientes apresentaram idade mediana de 70,5 anos, com maior prevalência de mulheres (60,1 por cento), da raça branca (48,0 por cento), com baixo grau de instrução (ensino fundamental incompleto, 50,7 por cento), acuidade visual igual ou pior a 20/200 (57,4 por cento) e diagnóstico realizado em consulta regular no hospital universitário (47,8 por cento). Apenas 9,4 por cento dos pacientes operados foram diagnosticados na campanha de catarata. O tempo médio entre o diagnóstico e a cirurgia foi 3,5 meses e relacionou-se principalmente à realização dos exames oftalmológicos e clínicos pré-operatórios. CONCLUSÃO: Os pacientes com baixa renda familiar são os principais usuários do Sistema Único de Saúde (SUS) e o acesso ao tratamento cirúrgico é demorado, resultando em visão subnormal incapacitante. Ressalta-se a importância da campanha de catarata no ingresso de pacientes carentes ao hospital de alta complexidade.

PURPOSE: To determine the socio-economic characteristics of the patients who were submitted to cataract surgery in a university hospital, to evaluate the accessibility to the tertiary health service and to determine the waiting time for cataract surgery. METHODS: A cross-sectional study of medical charts from 148 random patients who underwent cataract surgery during the first semester of 2007. RESULTS: The patients in this study had median of age of 70.5 years, and the major prevalence was of female (60.1 percent), caucasian (48.0 percent), with low educational level (incomplete fundamental study, 50.7 percent), best corrected visual acuity 20/200 or worst; the diagnosis of cataract was done at the University Hospital in a routine appointment (47.8 percent). Only 9.4 percent of patients submitted to the surgery had his diagnosis done in a cataract campaign. The average time between the diagnosis and the surgery was 3.5 months and the delay was mainly due to pre operative exams. CONCLUSION: The majority of patients in the Brazilian Public Health System have low family income. The system takes a long time to access surgical procedures that need to be addressed in a proper time manner. The result of the long wait is subnormal vision. It is important to highlight the cataract campaign in order to enroll patients with low income in a hospital of high complexity.

Reticulação do colágeno corneano com radiação ultravioleta e riboflavina para tratamento do ceratocone: resultados preliminares de um estudo brasileiro / Corneal collagen crosslinking with riboflavin and ultraviolet radiation for keratoconus treatment: preliminary results of a Brazilian study

OBJETIVO: Avaliar o efeito clínico e topográfico da reticulação do colágeno corneano (crosslinking) em pacientes com ceratocone pertencentes à população brasileira. MÉTODOS: Trinta e sete olhos de 37 pacientes (22 mulheres e 15 homens) com diagnóstico de ceratocone em progressão e com espessura mínima de 395 micra, foram submetidos à técnica de indução da reticulação do colágeno corneano através da aplicação durante 30 minutos de luz ultravioleta (370nm) associada à solução de riboflavina 0,1 por cento (instilada a cada 5 minutos). Foram comparados os valores ceratométricos e a melhor acuidade visual corrigida antes e após o procedimento, com intervalos de 40 e 90 dias. RESULTADOS: Houve redução do poder dióptrico médio (PDM) nos 3mm centrais em 83,8 por cento dos pacientes após três meses. O PDM reduziu em média 0,4D nos 3mm centrais (p<0,01) e 0,33D nos 5mm centrais (p<0,01). O valor ceratométrico máximo reduziu em média 0,6D (p<0,01). A acuidade visual corrigida do olho tratado evoluiu com melhora média de 6,27 letras (p<0,01) após 90 dias. CONCLUSÃO: Observamos uma melhora menos acentuada dos índices topográficos e de acuidade visual em comparação aos resultados encontrados em outras populações. São necessários mais estudos com um maior número de pacientes e maior tempo de seguimento para que esta técnica confirme seu propósito de estabilização da doença com apenas uma aplicação, e possa talvez se tornar, no futuro, o método de escolha para o tratamento do ceratocone.

PURPOSE: Assess the clinical and topographical effects of corneal collagen crosslinking in patients with keratoconus on Brazilian population. METHODS: Thirty seven eyes of 37 patients (22 female and 15 male) with diagnosis of progressive keratoconus and corneal paquimetry higher than 395 micra, were treated with riboflavin and ultraviolet A radiation, over 30 minutes, to induce corneal collagen crosslinking. Keratometric values were compared as well as the best corrected visual acuity, before and after the procedure, with ranges of 40 and 90 days. RESULTS: There was a reduction of mean dioptric power (PDM) in central 3mm in 83.8 percent of patients after three months.The PDM reduced 0.4D on average in central 3mm (p<0,01) and 0.33D in central 5mm (p<0,01). The maximum keratometric value decreased 0.6 D on average (p<0,01). The corrected visual acuity of the treated eye evolved with improvement average of 6,27 letters (p<0,01) after 90 days. CONCLUSION: We could observe a less pronounced improvement of the topographical values and visual acuity in comparison of the findings in other populations. Further studies with a larger number of patients and longer follow-up are necessary to confirm this technique's purpose of stabilizing the disease with only one application, and allow that to become the method of choice for keratoconus treatment.