Low Visual Acuity Due to Acute Macular Neuroretinopathy Associated with COVID-19: A Case Report.

BACKGROUND Retinal sequelae have been reported in patients who have had COVID-19. This is a case report of acute macular neuroretinopathy (AMN), presenting with low visual acuity in the left eye, 14 days after the first symptoms of COVID-19 infection. CASE REPORT A 71-year-old woman presented for ophthalmological evaluation complaining of low visual acuity in the left eye, 14 days after the first symptoms of COVID-19 infection. COVID-19 was confirmed by a reverse-transcription polymerase chain reaction (RT-PCR) test. The left eye examination showed visual acuity of 0.5 logMAR, fundoscopy showed foveal pigment mobilization, fluorescein angiography revealed a hypofluorescent fovea surrounded by irregular hyperfluorescent defects, and spectral-domain optical coherence tomography showed central foveal thinning with disrupted interdigitation and ellipsoid zones. Given the clinical and imaging findings, the diagnosis of AMN was finalized. AMN usually resolves without specific treatment. CONCLUSIONS This case report shows that patients with COVID-19 can develop retinal involvement. AMN can be due to a viral infection, including COVID-19, and usually resolves without specific treatment. In the present case, there was no improvement in the patient's clinical condition in a 2-month follow-up to date.

A study of the vitreoretinal interface in patients with age-related macular degeneration.

PURPOSE: To assess whether hyaloid adhesion is more prevalent in patients with age-related macular degeneration (AMD) than in control patients and to evaluate whether it is more prevalent in exudative AMD than in non-exudative AMD. METHODS: This was a cross-sectional, controlled analytical study. Patients from the Ophthalmology Department of the Public Service Hospital of the State of São Paulo were included if they were diagnosed with AMD that was confirmed by fundus biomicroscopy and fluorescein angiography. Patients were divided into three groups: patients without a vitreoretinal disease (controls), patients with exudative AMD, and patients with non-exudative AMD. For the optimal study of the vitreoretinal interface, all patients were subjected to spectral-domain optical coherence tomography (SD-OCT; Cirrus HD-OCT, version 4000; Carl Zeiss Meditec) and ultrasonography (UltraScan®, Alcon). Results with p values of ≤0.05 were considered statistically significant. RESULTS: We assessed 75 eyes of 23 patients with AMD (14 women and nine men) and 15 the control patients (11 women and four men). In total, 33 eyes had AMD that was consistent with the inclusion criteria, of which 11 had the non-exudative form (non-atrophic) and 22 had the exudative form (11 active and 11 disciform scars). Adherence was observed in eight eyes in the control group (26.67%), in seven eyes with exudative AMD (31.82%), and in five eyes with non-exudative AMD (45.45%). CONCLUSION: Patients with exudative and non-exudative forms of AMD did not present with higher vitreoretinal adhesion than control patients as assessed by SD-OCT and ultrasound. Moreover, patients with exudative AMD (neovascular membrane and disciform scar) did not reveal a higher adherence than those with non-exudative AMD when evaluated by the same methods.

A study of the vitreoretinal interface in patients with age-related macular degeneration / Estudo da interface vitreorretiniana em pacientes com degeneração macular relacionada à idade

ABSTRACT Purpose: To assess whether hyaloid adhesion is more prevalent in patients with age-related macular degeneration (AMD) than in control patients and to evaluate whether it is more prevalent in exudative AMD than in non-exudative AMD. Methods: This was a cross-sectional, controlled analytical study. Patients from the Ophthalmology Department of the Public Service Hospital of the State of São Paulo were included if they were diagnosed with AMD that was confirmed by fundus biomicroscopy and fluorescein angiography. Patients were divided into three groups: patients without a vitreoretinal disease (controls), patients with exudative AMD, and patients with non-exudative AMD. For the optimal study of the vitreoretinal interface, all patients were subjected to spectral-domain optical coherence tomography (SD-OCT; Cirrus HD-OCT, version 4000; Carl Zeiss Meditec) and ultrasonography (UltraScan®, Alcon). Results with p values of ≤0.05 were considered statistically significant. Results: We assessed 75 eyes of 23 patients with AMD (14 women and nine men) and 15 the control patients (11 women and four men). In total, 33 eyes had AMD that was consistent with the inclusion criteria, of which 11 had the non-exudative form (non-atrophic) and 22 had the exudative form (11 active and 11 disciform scars). Adherence was observed in eight eyes in the control group (26.67%), in seven eyes with exudative AMD (31.82%), and in five eyes with non-exudative AMD (45.45%). Conclusion: Patients with exudative and non-exudative forms of AMD did not present with higher vitreoretinal adhesion than control patients as assessed by SD-OCT and ultrasound. Moreover, patients with exudative AMD (neovascular membrane and disciform scar) did not reveal a higher adherence than those with non-exudative AMD when evaluated by the same methods.

RESUMO Objetivo: Avaliar se a adesão hialoidea é mais prevalente em pacientes com degeneração macular relacionada a idade (DMRI) (exsudativa e não exsudativa) comparado ao grupo controle e avaliar se a prevalência é maior na forma exsudativa comparada a forma não exsudativa. Métodos: Trata-se de um estudo transversal, analítico, de grupo controle, com os pacientes atendidos no Departamento de Retina do Serviço de Oftalmologia do Hospital do Servidor Público Estadual de São Paulo (HSPE), que tiveram o diagnóstico de DMRI confirmado após a biomicroscopia de fundo e angiofluoresceinografia. Os pacientes foram divididos em três grupos, um composto por pacientes sem doenças vitreorretinianas (30 olhos), outro pacientes com DMRI exsudativa (22 olhos) e o terceiro grupo por pacientes com DMRI não exsudativa (11 olhos). Para melhor estudo da interface vitreorretiniana, todos os pacientes foram submetidos aos exames de SD-TCO (Cirrus HD-TCO, versão 4000; Carl Zeeis Meditec) e ultrassonografia (UltraScan®, Alcon). Foram considerados significativos os resultados com valor de p≤0,05. Resultados: Foram avaliados 75 olhos de 23 pacientes com DMRI e 15 no grupo controle, sendo que apenas 33 olhos que apresentavam DMRI obedeciam aos critérios de inclusão, sendo 11 pertencentes à forma seca (nenhuma forma atrófica) e 22 à forma exsudativa (11 de forma ativa e 11 disciforme). A adesão foi encontrada em oito olhos no grupo controle (26,67%), em sete olhos com DMRI exsudativa (31,82%) e em cinco olhos no grupo DMRI não exsudativa (45,45%). Conclusão: Neste estudo, pacientes com DMRI (formas exsudativa e não exsudativa) não apresentaram maior adesão vitreorretiniana quando comparados ao grupo controle, ao serem avaliados através SD-TCO (Cirrus HD-TCO, versão 4000; Carl Zeeis Meditec) e ultrassonografia (UltraScan®, Alcon). Neste estudo, pacientes com DMRI exsudativa (ativa e disciforme) não apresentaram maior adesão quando comparados à forma seca, ao serem avaliados pelos mesmos métodos.

Correlations Between Allergen-Specific IgE Serum Levels in Patients With Ocular Allergy.

PURPOSE: To evaluate ocular allergies in patients at the Hospital do Servidor Publico Estadual de Sao Paulo (HSPE) and the correlations with serum allergen-specific immunoglobulin E levels. METHODS: We performed a longitudinal study of patients with ocular allergies who were treated at the Cornea and Immunology and Allergy Department. Patients underwent an ophthalmologic examination to identify their primary presenting signs and symptoms. The allergy types were divided into 4 groups. We conducted the following laboratory tests and measurements: blood count, eosinophil count, total serum IgE, and specific IgE. RESULTS: Among 61 patients, 16 (26.2%) had a clinical diagnosis of seasonal allergic conjunctivitis, 23 (37.7%) had perennial allergic conjunctivitis, 19 (31.1%) had vernal keratoconjunctivitis, and 3 (4.9%) had atopic keratoconjunctivitis. Mixed dust mites were positive in 94.9% of patients. Dermatophagoides pteronyssinus (dp) and Dermatophagoides farinae (df) antigens were positive in 93.2% of patients followed by Blattella germanica, Blomia tropicalis, and mixed animal epithelia (81%, 75.9%, and 25.8%, respectively). CONCLUSIONS: Perennial allergic conjunctivitis was the most prevalent disorder and demonstrated higher positivity in class V/VI for specific antigens (mixed dust mites, dp, and df), indicating high antigenicity. Dust mites, D. pteronyssinus, D. farinae, B. germanica, and B. tropicalis were the primary triggers of the studied ocular allergies.

Avaliação do edema macular após cirurgia não complicada de facoemulsificação com implante de lente intraocular por meio da tomografia de coerência óptica spectral domain / Evaluation of macular edema after uncomplicated phacoemulsification surgery with implantation of intraocular lens by spectral domain optical coherence tomography

OBJETIVO: Avaliar o edema macular após cirurgia não complicada de facoemulsificação com implante de lente intraocular por meio da tomografia de coerência óptica spectral domain (OCT-SD). MÉTODOS: Foi realizado estudo prospectivo em 62 olhos de pacientes submetidos à facoemulsificação com implante de lente intraocular. Os pacientes foram avaliados antes e após a cirurgia, no primeiro dia, e na primeira, segunda e quarta semanas. Acuidade visual (AV), células na câmara anterior e tomografia de coerência óptica macular cubo 200x200 foram medidos. RESULTADOS: Após a cirurgia de facoemulsificação houve melhora da acuidade visual, inflamação decrescente, e a espessura e o volume macular aumentaram. Ocorreu um caso de edema macular cistoide. Houve correlação inversa fraca entre a acuidade visual e a espessura macular central, e entre a acuidade visual e o volume macular. Foi observada correlação direta fraca entre a inflamação e o volume macular. CONCLUSÃO: Edema macular subclínico desenvolve-se mesmo após cirurgia de catarata não complicada em pacientes não predispostos. A tomografia de coerência óptica spectral domain foi capaz de detectar pequenos aumentos na espessura macular no período avaliado.

PURPOSE: To evaluate macular edema after uncomplicated phacoemulsification with implantation of intraocular lens by spectral domain optical coherence tomography (OCT). METHODS: Prospective study was conducted in 62 eyes of patients underwent phacoemulsification with implantation of intraocular lens. Patients were evaluated before surgery and after surgery at day 1, week 1, week 2 and week 4. Visual acuity (VA), anterior chamber cells and 200x200 macular cube optical coherence tomography were measured. RESULTS: After phacoemulsification there was an improvement in visual acuity, decreasing inflammation, and increased macular thickness and macular volume. There was one case of cystoid macular edema. There was a weak inverse correlation between visual acuity and central macular thickness, and between visual acuity and macular volume. We observed a week direct correlation between inflammation and macular volume. CONCLUSION: Subclinical macular edema develops even after uncomplicated cataract surgery in patients not predisposed. The spectral domain optical coherence tomography was able to detect small increases in macular thickness in the study period.

[Evaluation of macular edema after uncomplicated phacoemulsification surgery with implantation of intraocular lens by spectral domain optical coherence tomography]. / Avaliação do edema macular após cirurgia não complicada de facoemulsificação com implante de lente intraocular por meio da tomografia de coerência óptica spectral domain.

PURPOSE: To evaluate macular edema after uncomplicated phacoemulsification with implantation of intraocular lens by spectral domain optical coherence tomography (OCT). METHODS: Prospective study was conducted in 62 eyes of patients underwent phacoemulsification with implantation of intraocular lens. Patients were evaluated before surgery and after surgery at day 1, week 1, week 2 and week 4. Visual acuity (VA), anterior chamber cells and 200 x 200 macular cube optical coherence tomography were measured. RESULTS: After phacoemulsification there was an improvement in visual acuity, decreasing inflammation, and increased macular thickness and macular volume. There was one case of cystoid macular edema. There was a weak inverse correlation between visual acuity and central macular thickness, and between visual acuity and macular volume. We observed a week direct correlation between inflammation and macular volume. CONCLUSION: Subclinical macular edema develops even after uncomplicated cataract surgery in patients not predisposed. The spectral domain optical coherence tomography was able to detect small increases in macular thickness in the study period.

[Amsler grid and visual field on screening for chloroquine retinopathy]. / Tela de Amsler e campo visual no rastreamento da retinopatia por cloroquina.

PURPOSE: To compare the modified Amsler grid to the Humphrey(®) 10-2 red visual field in chloroquine users for the detection of early maculopathy, and to correlate with the risk variables. METHODS: The study included 116 eyes of 58 patients followed at the Department of Ophthalmology of Hospital do Servidor Público Estadual de São Paulo, from April, 2006 to April, 2008. All users had normal fundus and more than 2 years of chloroquine therapy. Their clinical data were evaluated and they underwent visual acuity examination, fundus biomicroscopy, visual field and Amsler grid. RESULTS: The incidence of early maculopathy was 7 to 10%, depending on the examination considered. The agreement between the Amsler grid and visual field was low. There was statistical significance with the use of high daily dose, elevated cumulative dose and low visual acuity in patients whose eyes had both abnormal tests; patient age and duration of treatment did not show good correlation in these cases, but their averages (67.4 years and 8.4 years, respectively) were within the range of high risk factors. CONCLUSIONS: The study suggests that Amsler can be useful in complementing the information on the visual field for chloroquine retinopathy periodic screening, especially for those patients who present high risk factors well established, selecting better candidates for objective tests, such as HD OCT and mfERG.

Tela de Amsler e campo visual no rastreamento da retinopatia por cloroquina / Amsler grid and visual field on screening for chloroquine retinopathy

OBJETIVOS: Comparar a tela de Amsler modificada com o campo visual Humphrey® 10-2 vermelho nos usuários de cloroquina, na detecção da maculopatia precoce, e correlacionar com as variáveis de risco. MÉTODOS: Foram analisados 116 olhos de 58 pacientes, acompanhados no Serviço de Oftalmologia do Hospital do Servidor Público Estadual de São Paulo, entre abril de 2006 e abril de 2008. Todos os usuários tinham fundo de olho normal e mais de dois anos de terapia com cloroquina. Os participantes tiveram seus dados clínicos avaliados e foram submetidos ao exame da acuidade visual corrigida, biomicroscopia de fundo, campimetria macular automatizada e tela de Amsler. RESULTADOS: A incidência da maculopatia precoce foi de 7 a 10%, dependendo do exame considerado. A concordância entre a tela de Amsler e o campo visual foi baixa. Para o grupo de olhos que apresentaram ambos os exames alterados, houve significância estatística com a alta dose diária, dose cumulativa elevada e baixa acuidade visual; a idade do paciente e a duração do tratamento não mostraram boa correlação nestes casos, mas suas médias (67,4 anos e 8,4 anos, respectivamente) situaram-se dentro da faixa dos fatores de alto risco. CONCLUSÕES: O estudo sugere que a tela de Amsler pode ser útil na complementação das informações do campo visual no rastreamento periódico da retinopatia por cloroquina, sobretudo naqueles com fatores de alto risco bem estabelecidos, selecionando melhor os candidatos à realização de testes objetivos, como o OCT de alta resolução e o ERG multifocal.

PURPOSE: To compare the modified Amsler grid to the Humphrey® 10-2 red visual field in chloroquine users for the detection of early maculopathy, and to correlate with the risk variables. METHODS: The study included 116 eyes of 58 patients followed at the Department of Ophthalmology of Hospital do Servidor Público Estadual de São Paulo, from April, 2006 to April, 2008. All users had normal fundus and more than 2 years of chloroquine therapy. Their clinical data were evaluated and they underwent visual acuity examination, fundus biomicroscopy, visual field and Amsler grid. RESULTS: The incidence of early maculopathy was 7 to 10%, depending on the examination considered. The agreement between the Amsler grid and visual field was low. There was statistical significance with the use of high daily dose, elevated cumulative dose and low visual acuity in patients whose eyes had both abnormal tests; patient age and duration of treatment did not show good correlation in these cases, but their averages (67.4 years and 8.4 years, respectively) were within the range of high risk factors. CONCLUSIONS: The study suggests that Amsler can be useful in complementing the information on the visual field for chloroquine retinopathy periodic screening, especially for those patients who present high risk factors well established, selecting better candidates for objective tests, such as HD OCT and mfERG.

[Application of corrective formula for intraocular pressure changes in patients that underwent LASIK]. / Aplicação de fórmula corretiva nas alterações da pressão intraocular dos pacientes submetidos a LASIK.

PURPOSE: To compare the intraocular pressure (IOP) pre and post LASIK, correlating it to changes in central corneal thickness (CCT) and average simulated keratometry (K), as well as verifying the results of a corrective formula previously proposed. METHODS: Longitudinal prospective study conducted in outpatients that underwent to LASIK. Patients underwent complete ophthalmic examination, previously and 2 months after the surgery. Intraocular pressure was evaluated with Goldmann applanation tonometer between 9 am and 11 am, average simulated keratometry was evaluated using corneal topography and central corneal thickness was measured with ultrasound pachymetry, been considered the average of three measurements. Two patients were excluded due to surgery or eye disease, and previous use of topical steroids over the past three months. The surgeries were performed according to standard procedures. The formula [real IOP = IOP measured + (540 - ECC)/71 + (43 - K)/2.7 + 0.75 mmHg] proposed for correcting intraocular pressure was used. RESULTS: Fifteen eyes of eight patients were evaluated, age ranged from 24 to 46 years (mean: 31.37 ± 7.27). There was a statistically significant difference between the measurements of intraocular pressure, central corneal thickness and average simulated keratometry pre and post-LASIK. (p=0.0001). It was observed that each 1D corrected underestimated the IOP 1.06 ± 0.59 mmHg (0.11 a 1.89 mmHg). The use of the corrective formula lead to 80% of eyes within 2.50 mmHg of preoperative intraocular pressure. Although, the two sets of data are statistically different (p=0.0266). CONCLUSIONS: Post LASIK eyes presented lower intraocular pressure than preoperatively. Intraocular pressure was moderately correlated to central corneal thickness and weakly correlated to average simulated keratometry. With the use of the corrective formula, we were able to determine that 80% were within 2.50 mmHg of the preoperative intraocular pressure.

Aplicação de fórmula corretiva nas alterações da pressão intraocular dos pacientes submetidos a LASIK / Application of corrective formula for intraocular pressure changes in patients that underwent LASIK

OBJETIVO: Comparar a pressão intraocular (PIO) pré e pós-LASIK, correlacionando-as com as mudanças da espessura corneana central (ECC) e ceratometria simulada média (K), assim como verificar o resultado de fórmula corretiva proposta anteriormente. MÉTODOS: Estudo longitudinal, prospectivo, realizado em pacientes submetidos a LASIK. Os pacientes foram submetidos ao exame oftalmológico completo, no pré operatório e após 2 meses da cirurgia. A pressão intraocular foi avaliada com tonômetro de aplanação de Goldmann entre 9 h e 11 h da manhã, a ceratometria simulada média foi avaliada por meio de topografia corneana e a espessura corneana central foi aferida por paquímetro ultrassônico, sendo considerada a média de três aferições. Foram excluídos dois pacientes com cirurgias ou doenças oculares prévias, e uso prévio de corticosteróide tópico nos últimos três meses. As cirurgias foram realizadas de acordo com os procedimentos-padrão. Foi utilizada a fórmula [PIO real = PIO aferida + (540 - ECC)/71 + (43 - K)/2,7 + 0,75 mmHg] proposta para correção da pressão intraocular pós-operatória. RESULTADOS: Quinze olhos de oito pacientes foram avaliados, a idade variou de 24 a 46 anos (média: 31,37 ± 7,27). Foi observada diferença estatisticamente significante entre as medidas da pressão intraocular, de ceratometria simulada média e da espessura corneana central pré e pós-LASIK. (p=0,0001). Foi observado que para cada 1D corrigida, há uma subestimação, em média, de 1,06 ± 0,59 mmHg (0,11 a 1,89 mmHg). A aplicação da fórmula corretiva levou a 80 por cento dos olhos com a tonometria estimada entre ± 2,50 mmHg da pré-operatória, no entanto, quando comparada com a tonometria pré-operatória, estas são estatisticamente diferentes (p=0,0266). CONCLUSÕES: Os olhos submetidos a LASIK apresentaram PIO pós-operatória menor do que a pré-operatória. A pressão intraocular pôde ser moderadamente correlacionada com a espessura corneana central e fracamente com a ceratometria simulada média. Não houve correlação entre a profundidade de ablação e a variação da pressão intraocular, no pós-operatório. Usando a fórmula proposta, pudemos averiguar que 80 por cento dos pacientes apresentaram pressão intraocular entre ± 2,50 mmHg da pré-operatória.

PURPOSE: To compare the intraocular pressure (IOP) pre and post LASIK, correlating it to changes in central corneal thickness (CCT) and average simulated keratometry (K), as well as verifying the results of a corrective formula previously proposed. METHODS: Longitudinal prospective study conducted in outpatients that underwent to LASIK. Patients underwent complete ophthalmic examination, previously and 2 months after the surgery. Intraocular pressure was evaluated with Goldmann applanation tonometer between 9 am and 11 am, average simulated keratometry was evaluated using corneal topography and central corneal thickness was measured with ultrasound pachymetry, been considered the average of three measurements. Two patients were excluded due to surgery or eye disease, and previous use of topical steroids over the past three months. The surgeries were performed according to standard procedures. The formula [real IOP = IOP measured + (540 - ECC)/71 + (43 - K)/2.7 + 0.75 mmHg] proposed for correcting intraocular pressure was used. RESULTS: Fifteen eyes of eight patients were evaluated, age ranged from 24 to 46 years (mean: 31.37 ± 7.27). There was a statistically significant difference between the measurements of intraocular pressure, central corneal thickness and average simulated keratometry pre and post-LASIK. (p=0.0001). It was observed that each 1D corrected underestimated the IOP 1.06 ± 0.59 mmHg (0.11 a 1.89 mmHg). The use of the corrective formula lead to 80 percent of eyes within 2.50 mmHg of preoperative intraocular pressure. Although, the two sets of data are statistically different (p=0.0266). CONCLUSIONS: Post LASIK eyes presented lower intraocular pressure than preoperatively. Intraocular pressure was moderately correlated to central corneal thickness and weakly correlated to average simulated keratometry. With the use of the corrective formula, we were able to determine that 80 percent were within 2.50 mmHg of the preoperative intraocular pressure.

Perfil epidemiológico e nível de conhecimento de pacientes diabéticos sobre diabetes e retinopatia diabética / Epidemiologic profile and level of knowledge among diabetic patients about diabetes and diabetic retinopathy

OBJETIVO: Conhecer o perfil epidemiológico e nível de conhecimento de pacientes diabéticos sobre diabetes e retinopatia diabética (RD). MÉTODOS: Estudo transversal com pacientes atendidos no Ambulatório de Retina e Vítreo do Hospital do Servidor Público Estadual de São Paulo, os quais foram divididos em dois grupos: pacientes diabéticos encaminhados para primeira avaliação oftalmológica (G1) e pacientes já acompanhados no Ambulatório (G2). Os pacientes responderam questionário e submeteram-se a exame oftalmológico. Foram utilizados os testes x², exato de Fisher e não paramétricos de Mann-Whitney, presumindo nível de significância de 5 por cento. RESULTADOS: A amostra total foi composta por 357 pacientes (109 no G1 e 248 no G2). A maioria dos pacientes era do sexo feminino, casada, com ensino fundamental incompleto, com média de idade de 63,3 anos e afirmou saber o que é diabetes. Entretanto, 53,2 por cento não sabiam qual o seu tipo de diabetes. As complicações visuais do diabetes são as mais conhecidas. Menos de um terço dos pacientes já tinha ouvido falar em RD e 77,3 por cento não sabiam se eram acometidos. A maioria dos pacientes nunca havia recebido alguma explicação ou algum tipo de material escrito sobre diabetes ou RD. Somente 3,6 por cento dos pacientes participavam de algum programa de educação sobre diabetes. A AV média na amostra, em logMAR, foi de 0,57 no OD e 0,51 no OE. Metade dos pacientes não tinha RD. CONCLUSÃO: A maioria dos pacientes, apesar de receber acompanhamento multidisciplinar, apresentou pouco conhecimento sobre o diabetes e suas complicações.

PURPOSE: To assess the epidemiologic profile and level of knowledge of diabetic patients about diabetes and diabetic retinopathy (DR). METHODS: Cross-sectional study with patients seen at Retina and Vitreous sector of Hospital do Servidor Público Estadual de São Paulo. The subjetcs were assigned into two groups: diabetic patients sent for first ophthalmologic evaluation (G1) and patient already followed in the sector (G2). The patients answered a questionnaire and were submitted to ophthalmologic examination. It had been used chi-square (x²), exact of Fisher and non-parametric of Mann-Whitney tests, with level of significance of 5 percent. RESULTS: The total sample was composed for 357 patients (109 in G1 and 248 in G2). The majority of the patients were female, married, with incomplete basic education, age average of 63.3 years and affirmed to know what it is diabetes. However, 53.2 percent did not know their type of diabetes. The visual complications of diabetes are most known. Less of one third of the patients had heard of DR and 77.3 percent did not know if they had it. The majority of the patients had never received any explanation or lecture about diabetes or DR. Only 3.6 percent of the patients had participated of programs of education on diabetes. The visual acuity, in logMAR scale, was of 0.57 in OD and 0.51 in the OS. Half of the patients did not have DR. CONCLUSION: The majority of the patients have low knowledge about diabetes and its complications.

[Study of visual acuity and intraocular pressure in the treatment of macular diabetic edema with intravitreous triamcinolone]. / Avaliação da acuidade visual e da pressão intraocular no tratamento do edema macular diabético com triancinolona intravítrea.

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide in patients with diffuse diabetic macular edema on the visual acuity and intraocular pressure. To report the potential adverse events and to analyze the potential relationship between age and visual acuity and intraocular pressure variability. METHODS: This clinical controlled study included 14 patients (28 eyes), 14 of the eyes received an intravitreal injection of 4 mg triamcinolone acetonide for the treatment of diabetic macular edema. The study group was compared to a control group of 14 eyes, without diabetic macular edema. The follow-up period was of 3 months. RESULTS: Pressure spikes >21 mmHg occurred in 28.7% of eyes, with a significant difference of intraocular pressure between the study group and the control group in the first week after treatment. Visual acuity showed a significant improvement when compared with the control group since the second day after the treatment. There was no association between age and variability of visual acuity and intraocular pressure. CONCLUSION: Intravitreal triamcinolone acetonide showed to be effective for improving visual acuity in patients with diabetic macular edema, in the first three months of treatment. The incidence of intraocular hypertension was 28.7%, easily manageable.

Avaliação da acuidade visual e da pressão intraocular no tratamento do edema macular diabético com triancinolona intravítrea / Study of visual acuity and intraocular pressure in the treatment of macular diabetic edema with intravitreous triamcinolone

OBJETIVOS: Avaliar os efeitos do acetato de triancinolona intravítreo em pacientes com edema macular diabético difuso na acuidade visual e pressão intraocular. Relatar os possíveis efeitos adversos e analisar a possível relação da idade dos pacientes com as variações da acuidade visual e pressão intraocular. MÉTODOS: O ensaio clínico controlado incluiu 14 pacientes (28 olhos), sendo que 14 olhos receberam injeção de 4 mg de acetato de triancinolona intravítreo para o tratamento de edema macular diabético difuso. O grupo tratado foi comparado a um grupo controle de 14 olhos sem edema macular diabético difuso. O tempo de seguimento foi de três meses. RESULTADOS: Os picos de pressão intraocular >21 mmHg ocorreram em 28,57 por cento, com diferença significante entre a pressão intraocular do grupo tratado com o grupo controle na primeira semana após o tratamento. A acuidade visual mostrou uma significativa melhora quando comparada com o grupo controle desde o segundo dia após o tratamento. Não houve associação entre a idade com as variações da acuidade visual e a pressão intraocular. CONCLUSÃO: O acetato de triancinolona intravítreo mostrou-se ser eficiente para melhorar a acuidade visual em pacientes com edema macular diabético difuso, nos primeiros três meses de tratamento. A incidência de hipertensão intraocular foi de 28,57 por cento, podendo ser caracterizada como de fácil controle.

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide in patients with diffuse diabetic macular edema on the visual acuity and intraocular pressure. To report the potential adverse events and to analyze the potential relationship between age and visual acuity and intraocular pressure variability. METHODS: This clinical controlled study included 14 patients (28 eyes), 14 of the eyes received an intravitreal injection of 4 mg triamcinolone acetonide for the treatment of diabetic macular edema. The study group was compared to a control group of 14 eyes, without diabetic macular edema. The follow-up period was of 3 months. RESULTS: Pressure spikes >21 mmHg occurred in 28.7 percent of eyes, with a significant difference of intraocular pressure between the study group and the control group in the first week after treatment. Visual acuity showed a significant improvement when compared with the control group since the second day after the treatment. There was no association between age and variability of visual acuity and intraocular pressure. CONCLUSION: Intravitreal triamcinolone acetonide showed to be effective for improving visual acuity in patients with diabetic macular edema, in the first three months of treatment. The incidence of intraocular hypertension was 28.7 percent, easily manageable.

[Epidemiologic profile and level of knowledge among diabetic patients about diabetes and diabetic retinopathy]. / Perfil epidemiológico e nível de conhecimento de pacientes diabéticos sobre diabetes e retinopatia diabética.

PURPOSE: To assess the epidemiologic profile and level of knowledge of diabetic patients about diabetes and diabetic retinopathy (DR). METHODS: Cross-sectional study with patients seen at Retina and Vitreous sector of Hospital do Servidor Público Estadual de São Paulo. The subjects were assigned into two groups: diabetic patients sent for first ophthalmologic evaluation (G1) and patient already followed in the sector (G2). The patients answered a questionnaire and were submitted to ophthalmologic examination. It had been used chi-square (x²), exact of Fisher and non-parametric of Mann-Whitney tests, with level of significance of 5%. RESULTS: The total sample was composed for 357 patients (109 in G1 and 248 in G2). The majority of the patients were female, married, with incomplete basic education, age average of 63.3 years and affirmed to know what it is diabetes. However, 53.2% did not know their type of diabetes. The visual complications of diabetes are most known. Less of one third of the patients had heard of DR and 77.3% did not know if they had it. The majority of the patients had never received any explanation or lecture about diabetes or DR. Only 3.6% of the patients had participated of programs of education on diabetes. The visual acuity, in logMAR scale, was of 0.57 in OD and 0.51 in the OS. Half of the patients did not have DR. CONCLUSION: The majority of the patients have low knowledge about diabetes and its complications.

[Diagnostic methods for chloroquine diphosphate induced retinopathy in systemic lupus erythematosus]. / Métodos diagnósticos para retinopatia induzida pelo difosfato de cloroquina nos portadores de lúpus eritematoso sistêmico.

PURPOSE: To evaluate different diagnostic methods for high risk chloroquine retinopathy due to prolonged use of chloroquine (more than 5 years) by systemic lupus erythematosus patients. METHODS: Seventy-two eyes of 36 consecutive patients, followed in the Division of Rheumatology, School of Medicine, University of São Paulo, were analyzed from July 2007 to April 2008. Demographic and clinical data were evaluated in order to study risk factors and to compare the following different ophthalmological methods: visual acuity, biomicroscopy, fundus examination, retinography, fluorescein angiogram, visual field test and, color vision tests. RESULTS: From 36 patients, 34 (94.4%) were female. The mean age was 39.9 +/- 9.8 years and the disease duration was 13.9 +/- 6.6 years. Besides chronic use of chloroquine, patients also showed high daily and cumulative doses. These high risk factors were not related to a higher retinopathy prevalence. Visual field showed 38.9% of retinopathy prevalence. Other ophthalmological methods failed in detecting most cases. CONCLUSION: High prevalence of retinopathy in high risk patients was observed by visual field test, but other ophthalmological methods failed in detecting alterations. Ophthalmological assessment of these patients should include visual field, even in the absence of clinical alterations.

[Tissue plasminogen activator and intravitreal gas for the treatment of Terson's syndrome: case report]. / Ativador do plasminogênio tecidual e gás intravítreo no tratamento da síndrome de Terson: relato de caso.

The case of a 35 year-old male patient is reported. The patient had a clinical history of craniocerebral trauma and premacular hemorrhage of Terson syndrome in the left eye. After waiting for 45 days, without hemorrhage resolution, the patient received an intravitreal injection of sulfur hexafluoride gas and tPA; an almost complete hemorrhage absorption occurred after a week as well as a considerable improvement of visual acuity. In the report, relevant aspects of Terson syndrome and of intravitreal injection of gas and tPA are also described through a literature review.

Métodos diagnósticos para retinopatia induzida pelo difosfato de cloroquina nos portadores de lúpus eritematoso sistêmico / Diagnostic methods for chloroquine diphosphate induced retinopathy in systemic lupus erythematosus

OBJETIVOS: Avaliar diferentes métodos diagnósticos para a avaliação de pacientes portadores de lúpus eritematoso sistêmico, usuários crônicos do difosfato de cloroquina (DFC) e, portanto, com alto risco para retinopatia tóxica. MÉTODOS: Foram analisados 72 olhos de 36 pacientes consecutivos, seguidos no Serviço de Reumatologia do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, de julho de 2007 a abril de 2008. Dados demográficos e clínicos foram avaliados com o intuito de estudar os fatores de alto risco e comparar os seguintes métodos oftalmológicos: acuidade visual, biomicroscopia da córnea, biomicroscopia do fundo, retinografia, angiofluoresceinografia da retina, campo visual macular com mira branca. RESULTADOS: Dos 36 pacientes, 34 (94,4 por cento) eram mulheres. A média de idade foi 39,9 ± 9,8 anos, com tempo de doença igual a 13,9 ± 6,6 anos. Além do uso crônico da cloroquina, os pacientes apresentaram altas doses diárias (>3 mg/kg) e cumulativas. Não foi observada relação entre estes fatores de alto risco e maior prevalência de retinopatia. Foi encontrada prevalência de retinopatia igual a 38,9 por cento, confirmada por alterações bilaterais, centrais ou paracentrais e reprodutíveis no exame de campo visual. Outros exames indicados para seguimento, como acuidade visual, biomicroscopia de fundo e angiofluoresceinografia não foram capazes de diagnosticar a maioria das alterações confirmadas pelo campo visual. CONCLUSÃO: Foi observada alta prevalência de retinopatia por cloroquina entre os pacientes com alto risco, usuários crônicos do DFC, segundo os achados do campo visual. A avaliação desses pacientes deve considerar a realização do exame de campo visual em intervalos menores que os propostos, mesmo quando não há suspeita clínica.

PURPOSE: To evaluate different diagnostic methods for high risk chloroquine retinopathy due to prolonged use of chloroquine (more than 5 years) by systemic lupus erythematosus patients. Methods: Seventy-two eyes of 36 consecutive patients, followed in the Division of Rheumatology, School of Medicine, University of São Paulo, were analyzed from July 2007 to April 2008. Demographic and clinical data were evaluated in order to study risk factors and to compare the following different ophthalmological methods: visual acuity, biomicroscopy, fundus examination, retinography, fluorescein angiogram, visual field test and, color vision tests. RESULTS: From 36 patients, 34 (94.4 percent) were female. The mean age was 39.9 ± 9.8 years and the disease duration was 13.9 ± 6.6 years. Besides chronic use of chloroquine, patients also showed high daily and cumulative doses. These high risk factors were not related to a higher retinopathy prevalence. Visual field showed 38.9 percent of retinopathy prevalence. Other ophthalmological methods failed in detecting most cases. CONCLUSION: High prevalence of retinopathy in high risk patients was observed by visual field test, but other ophthalmological methods failed in detecting alterations. Ophthalmological assessment of these patients should include visual field, even in the absence of clinical alterations.

Ativador do plasminogênio tecidual e gás intravítreo no tratamento da síndrome de Terson: relato de caso: [revisão] / Tissue plasminogen activator and intravitreal gas for the treatment of Terson's syndrome: case report: [review]

Relata-se o caso de um paciente de 35 anos de idade, sexo masculino, com história de trauma cranioencefálico, que evoluiu com hemorragia pré-macular da síndrome de Terson no olho esquerdo. Após 45 dias de conduta expectante, sem resolução da hemorragia, foi realizada injeção intravítrea de gás hexafluoreto de enxofre e tPA, evoluindo com absorção quase completa da hemorragia após uma semana e considerável melhora da acuidade visual. Descreve-se também aspectos importantes da síndrome de Terson e da injeção intravítrea de gás e tPA por meio de revisão da literatura.

The case of a 35 year-old male patient is reported. The patient had a clinical history of craniocerebral trauma and premacular hemorrhage of Terson syndrome in the left eye. After waiting for 45 days, without hemorrhage resolution, the patient received an intravitreal injection of sulfur hexafluoride gas and tPA; an almost complete hemorrhage absorption occurred after a week as well as a considerable improvement of visual acuity. In the report, relevant aspects of Terson syndrome and of intravitreal injection of gas and tPA are also described through a literature review.

[Uveal effusion associated with presumed tuberculosis: case report]. / Efusão uveal associada à tuberculose presumida: relato de caso.

The authors report a rare association of uveal effusion with presumed ocular tuberculosis in a male patient who presented clinical improvement with the systemic use of prednisone 40 mg/d and rifampicin 600 mg/d. In addition, relevant aspects of the uveal effusion such as the pathogenesis, evolution of the disease, differential diagnosis and treatment are described through a revision of the literature.

Efusão uveal associada à tuberculose presumida: relato de caso / Uveal effusion associated with presumed tuberculosis: case report

Os autores relatam a rara associação de efusão uveal e tuberculose ocular presumida em paciente do sexo masculino que apresentou melhora clínica com o uso sistêmico de prednisona 40 mg/d e rifampicina 600 mg/d. Descrevem, ainda, aspectos relevantes da efusão uveal, como etiopatogenia, evolução da doença, diagnóstico diferencial e tratamento, por meio de revisão da literatura.

The authors report a rare association of uveal effusion with presumed ocular tuberculosis in a male patient who presented clinical improvement with the systemic use of prednisone 40 mg/d and rifampicin 600 mg/d. In addition, relevant aspects of the uveal effusion such as the pathogenesis, evolution of the disease, differential diagnosis and treatment are described through a revision of the literature.