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1.
Rev. cuba. oftalmol ; 33(2): e814, tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139070

RESUMO

RESUMEN Objetivo: Evaluar los valores de referencia de la dinámica circulatoria arterial ocular de los pacientes con hipertensión arterial esencial. Métodos: Se realizó un estudio descriptivo y transversal en 105 pacientes hipertensos y en un grupo de 33 sujetos no hipertensos, con edades comprendidas entre 18 y 60 años, sin antecedentes de padecer diabetes mellitus ni enfermedades oculares como glaucoma, o haber recibido tratamiento quirúrgico por catarata, hipertensión ocular u otras. A todos se les realizó la toma de la presión arterial sistémica, el examen clínico oftalmológico y el ultrasonido Doppler a color de carótida y de los vasos orbitarios. Resultados: Se encontró un predominio de mujeres de piel blanca, entre la cuarta y quinta década de la vida. Existió un incremento del pico de velocidad sistólica, la velocidad final diastólica y el índice de resistencia en la arteria oftálmica, que fue desde un rango normal en el grupo de los no hipertensos a valores promedios elevados en el grupo de hipertensos, los cuales fueron más altos en los casos descontrolados. No se encontraron modificaciones en el análisis de estos parámetros en las arterias centrales de la retina ni en las ciliares posteriores cortas. Conclusiones: En la casuística estudiada, el incremento del pico de la velocidad sistólica en la arteria oftálmica pudiera estar relacionado con áreas de obstrucción vascular localizadas o con vasoespasmo. Se encontró una asociación entre el descontrol de la presión arterial y los valores elevados del índice de resistencia en la arteria oftálmica(AU)


ABSTRACT Objective: Evaluate the reference values for ocular arterial circulation dynamics in patients with essential arterial hypertension. Methods: A descriptive cross-sectional study was conducted of 105 hypertensive patients and a group of 33 non-hypertensive subjects aged 18-60 years with no antecedents of diabetes mellitus or ocular conditions such as glaucoma or having undergone cataract surgery, ocular hypertension or others. All the patients underwent systemic arterial pressure measurement, clinical ophthalmological examination and color Doppler carotid and orbital ultrasonography. Results: A predominance was observed of the female sex, white skin color and age between the fourth and fifth decades of life. There was an increase in peak systolic velocity, end diastolic velocity and the resistive index in the ophthalmic artery, which ranged from normal in the non-hypertensive group to high average levels in the hypertensive group, higher in uncontrolled cases. Analysis of these parameters did not find any change in central retinal or short posterior ciliary arteries. Conclusions: In the cases studied, the peak systolic velocity increase in the ophthalmic artery could be related to localized vascular obstruction areas or vasospasm. An association was found between uncontrolled arterial pressure and high resistive index values in the ophthalmic artery(AU)


Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Ultrassonografia Doppler/métodos , Pressão Arterial , Epidemiologia Descritiva , Estudos Transversais
2.
Sci Rep ; 10(1): 4890, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32184450

RESUMO

Microglial activation is associated with glaucoma. In the model of unilateral laser-induced ocular hypertension (OHT), the time point at which the inflammatory process peaks remains unknown. Different time points (1, 3, 5, 8, and 15 d) were compared to analyze signs of microglial activation both in OHT and contralateral eyes. In both eyes, microglial activation was detected in all retinal layers at all time points analyzed, including: i) increase in the cell number in the outer segment photoreceptor layer and plexiform layers (only in OHT eyes) from 3 d onward; ii) increase in soma size from 1 d onward; iii) retraction of the processes from 1 d in OHT eyes and 3 d in contralateral eyes; iv) increase in the area of the retina occupied by Iba-1+ cells in the nerve fiber layer/ganglion cell layer from 1 d onward; v) increase in the number of vertical processes from 1 d in contralateral eyes and 3 d in OHT eyes. In OHT eyes at 24 h and 15 d, most Iba-1+ cells were P2RY12+ and were down-regulated at 3 and 5 d. In both eyes, microglial activation was stronger at 3 and 5 d (inflammation peaked in this model). These time points could be useful to identify factors implicated in the inflammatory process.


Assuntos
Glaucoma/etiologia , Glaucoma/metabolismo , Lasers/efeitos adversos , Animais , Proteínas de Ligação ao Cálcio/genética , Proteínas de Ligação ao Cálcio/metabolismo , Modelos Animais de Doenças , Pressão Intraocular/fisiologia , Camundongos , Proteínas dos Microfilamentos/genética , Proteínas dos Microfilamentos/metabolismo , Hipertensão Ocular/etiologia , Hipertensão Ocular/metabolismo , Receptores Purinérgicos P2Y12/genética , Receptores Purinérgicos P2Y12/metabolismo , Retina/metabolismo , Retina/patologia , Retina/efeitos da radiação , Células Ganglionares da Retina/metabolismo
3.
Invest Ophthalmol Vis Sci ; 61(3): 13, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32176263

RESUMO

Purpose: To investigate the efficacy of intravitreal administration of resveratrol (RSV) in a microbead-induced high intraocular pressure (IOP) murine model for glaucoma. Methods: Experiments were performed using adult C57BL/6JJcl mice. Polystyrene microbeads were injected into the anterior chamber to induce IOP elevation. Retinal flat-mounts and sections were assessed by immunohistochemistry to detect the expression of reactive oxygen species and acetyl-p53 in retinal ganglion cells (RGCs), brain-derived neurotrophic factor (BDNF) in Müller glial cells (MGCs), and the receptor tropomyosin receptor kinase B (TrkB) in RGCs. Light cycler real-time PCR was also used for confirming gene expression of BDNF in primary cultured MGCs exposed to RSV. Results: Microbeads induced high IOP followed by RGC death and axon loss. Administration of RSV rescued RGCs via decreased reactive oxygen species generation and acetyl-p53 expression in RGCs and upregulated BDNF in MGCs and TrkB expression in RGCs, which exhibited a strong cytoprotective action against cell death through multiple pathways under high IOP. Conclusions: Our data suggest that administration of RSV may delay the progress of visual dysfunction during glaucoma and may therefore have therapeutic potential.


Assuntos
Antioxidantes/uso terapêutico , Hipertensão Ocular/tratamento farmacológico , Resveratrol/uso terapêutico , Células Ganglionares da Retina/efeitos dos fármacos , Acetilação , Animais , Antioxidantes/administração & dosagem , Antioxidantes/farmacologia , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Morte Celular/efeitos dos fármacos , Células Cultivadas , Citoproteção/fisiologia , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos/métodos , Pressão Intraocular/efeitos dos fármacos , Injeções Intravítreas , Masculino , Camundongos Endogâmicos C57BL , Microesferas , Hipertensão Ocular/etiologia , Hipertensão Ocular/metabolismo , Hipertensão Ocular/patologia , Espécies Reativas de Oxigênio/metabolismo , Resveratrol/administração & dosagem , Resveratrol/farmacologia , Células Ganglionares da Retina/metabolismo , Células Ganglionares da Retina/patologia , Sirtuína 1/metabolismo , Proteína Supressora de Tumor p53/metabolismo
4.
Am J Ophthalmol ; 216: 193-200, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32061758

RESUMO

PURPOSE: To investigate the morphologic features of the Schlemm canal and trabecular meshwork in highly myopic eyes with early intraocular pressure (IOP) elevation after cataract surgery. DESIGN: Retrospective case-control study. METHODS: Eighty-eight highly myopic eyes of 88 patients after uneventful cataract surgery were included, 31 of which had early postoperative IOP elevation and 57 of which did not. The morphologic features of the Schlemm canal and trabecular meshwork, collected with swept-source optical coherence tomography before surgery, were reviewed. Backwards stepwise multiple linear regression was used to investigate the anatomic risk factors for early IOP elevation in highly myopic eyes. RESULTS: Highly myopic eyes with early postoperative IOP elevation had smaller Schlemm canal vertical diameter and area, as well as smaller trabecular meshwork thickness and width, in each quadrant than the non-elevation group. There was no significant difference in Schlemm canal horizontal diameter between the IOP elevation and non-elevation groups. In the highly myopic eyes, average Schlemm canal vertical diameter, Schlemm canal area, trabecular meshwork thickness, and width were all correlated negatively with the IOP elevation. A multivariate analysis showed that average Schlemm canal vertical diameter (ß = -0.262, P = .004) and trabecular meshwork thickness (ß = -0.173, P < .001) were significantly associated with early transient IOP elevation in highly myopic cataract eyes. CONCLUSIONS: A smaller vertical diameter of Schlemm canal and a thinner trabecular meshwork are 2 anatomic risk factors for early IOP elevation after cataract surgery in highly myopic eyes.


Assuntos
Câmara Anterior/patologia , Pressão Intraocular/fisiologia , Miopia Degenerativa/complicações , Hipertensão Ocular/etiologia , Facoemulsificação/efeitos adversos , Malha Trabecular/patologia , Idoso , Câmara Anterior/diagnóstico por imagem , Estudos de Casos e Controles , Catarata/etiologia , Feminino , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Tomografia de Coerência Óptica , Malha Trabecular/diagnóstico por imagem
5.
Anesth Analg ; 130(4): 975-982, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31913912

RESUMO

BACKGROUND: Robotic prostatectomy and robotic hysterectomy require steep Trendelenburg positioning. Many authors documented significant increases in intraocular pressure (IOP) during steep Trendelenburg. However, the long-term biological effect of a significant increase in IOP on the structural and functional ocular system is unknown. This study examines the effect of a significant increase in IOP on the visual acuity, retinal nerve fiber layer thickness (RNFLT), and ganglion cell complex (GCC) thickness in 52 patients without preexisting ocular disease of both genders before and 3 months after their procedures. METHODS: This was a prospective cohort study. The total number of patients included was 56, then 3 females and 1 male case were excluded, totaling 28 robotic hysterectomies and 24 robotic prostatectomies were performed. Patients underwent complete eye examination before the procedure and 3 months after, measuring the main outcome of RNFLT and the secondary outcomes of GCC thickness, foveal threshold (FT), mean deviation (MD), and pattern standard deviation (PSD). These outcomes were analyzed using linear mixed-effects models. On the day of surgery, we examined the IOP after induction of anesthesia, at the end of steep Trendelenburg, and in the recovery room. RESULTS: There were significant differences in IOP values at the end of steep Trendelenburg versus after induction and 45-60 minutes post-awakening (P < .001 for both groups). No difference between IOP 45 and 60 minutes post-awakening and IOP after induction was observed in either group. The highest IOPs occurred at the end of the steep Trendelenburg time point for both groups. The mean duration of steep Trendelenburg in robotic prostatectomy was 184.6 minutes (standard deviation [SD] = 30.8), while the mean duration in robotic hysterectomy was 123.0 minutes (SD = 29.8). All ophthalmologic examinations were normal preoperatively and 3 months postoperatively. The ocular parameters in the retina and optic disk did not differ significantly before surgery and 3 months after. CONCLUSIONS: There is a significant increase in IOP during steep Trendelenburg positioning. There was no significant difference in the ocular parameters examined 3 months after the procedure in this cohort.


Assuntos
Decúbito Inclinado com Rebaixamento da Cabeça , Histerectomia/métodos , Pressão Intraocular , Hipertensão Ocular/fisiopatologia , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Cobertura de Condição Pré-Existente , Estudos Prospectivos , Retina/patologia , Células Ganglionares da Retina/patologia , Acuidade Visual , Campos Visuais
6.
J Glaucoma ; 29(2): 92-96, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31821183

RESUMO

PRéCIS:: Our retrospective study examined the use of neodymium laser in 53 eyes with high intraocular pressure (IOP) following Ex-Press filtration device implantation. We found a statistically significant immediate IOP-lowering effect in all eyes, with a mean IOP reduction of 13.34±8.99 mm Hg, and a posttreatment IOP of 14.30±8.57 mm Hg (P<0.0001). Of a subset of 43 eyes on which 6 months follow-up IOP data was available, 28 eyes achieved treatment success (IOP<18 without further surgical interventions) with a mean IOP of 11.39±4.03 mm Hg at 6 months. PURPOSE: The purpose of this study was to report on the use of neodymium laser for treatment of eyes with IOP rise following Ex-Press glaucoma filtration device implantation. METHODS: We retrospectively examined the medical records of 73 patients who underwent Ex-Press device implantation at 4 medical institutions between 2007 and 2015 and subsequently developed an IOP rise. Enrollment criteria included patients with POAG on whom posttreatment IOP data is available. Indications for treatment with neodymium laser were an IOP above target and a flat bleb. To disrupt the presumed microblockage, the neodymium laser was aimed at the axial and relief ports of the Ex-Press device. Applanation tonometry measurements were followed up after neodymium treatment for variable time intervals. Success was defined as an IOP <18 mm Hg at 6 months without further surgical or laser-based glaucoma interventions. RESULTS: A total of 73 charts were reviewed. Twenty patients were excluded due to insufficient data or a diagnosis other than POAG. Data from 53 eyes of the remaining 53 patients was analyzed. The mean duration between Ex-Press implantation and rise in IOP requiring neodymium intervention was 34.2 months (range, 1.1 to 67.2). We found a statistically significant immediate IOP-lowering effect in all eyes, with a mean IOP drop of 13.34±8.99 mm Hg, and a mean posttreatment IOP of 14.30±8.57 mm Hg (P<0.0001). Of a subset of 43 eyes on which 6 months follow-up IOP data was available, 11 eyes required further glaucoma intervention (surgery or laser-based); 4 eyes had an IOP of ≥18 at 6 months. In the remaining 28 successful eyes, a sustained IOP<18 mm Hg was observed at 6 months, with a mean pressure of 11.39±4.03 mm Hg (P<0.0001). Hypotony (IOP<5) occurred in 3 eyes immediately following treatment and self-resolved by 1 week. CONCLUSION: Our retrospective case series suggests that neodymium laser is a potential consideration in eyes with sustained IOP rise after Ex-Press device implantation.


Assuntos
Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Hipertensão Ocular/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Estudos Retrospectivos , Tonometria Ocular , Resultado do Tratamento
7.
Eur J Ophthalmol ; 30(2): 293-298, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30526051

RESUMO

AIM: To evaluate the effectiveness of brinzolamide-brimonidine fixed combination to control the intraocular pressure elevation throughout the first 24 h following uncomplicated phacoemulsification cataract surgery. PATIENTS AND METHODS: A total of 62 patients who underwent phacoemulsification cataract surgery were included in this prospective randomized comparative case series. The brinzolamide-brimonidine fixed combination group (34 eyes) was administered a single dose of brinzolamide-brimonidine fixed combination immediately after phacoemulsification. No treatment was administered in the control group (28 eyes). Intraocular pressure was measured 1 day before surgery (baseline) and at 6, 12 and 24 h postoperatively. RESULTS: The brinzolamide-brimonidine fixed combination group had significantly lower intraocular pressure at 6, 12 and 24 h after phacoemulsification compared to baseline (p < 0.0001 for all comparisons), while in control group, intraocular pressure was significantly higher at 6 and 12 h after surgery compared to baseline (p < 0.001 and p < 0.0001, respectively). In control group, an intraocular pressure elevation ⩾ 5 mm Hg was noted in 32.4% of the eyes at 6 and 12 h and in 5.9% of eyes at 24 h after surgery, while in brinzolamide-brimonidine fixed combination group, only 8.8% of the eyes at 6 h postoperatively had such an intraocular pressure elevation. CONCLUSION: The administration of a single drop of brinzolamide-brimonidine fixed combination effectively prevented intraocular pressure elevations and intraocular pressure spikes during the first 24 h after uneventful phacoemulsification.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/prevenção & controle , Facoemulsificação , Sulfonamidas/uso terapêutico , Tiazinas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Tonometria Ocular
8.
Eur J Ophthalmol ; 30(5): NP32-NP35, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30950286

RESUMO

PURPOSE: To report a case of phacolytic glaucoma with rupture of anterior lens capsule in a case of hypermature cataract. METHODS: Case report and literature review. RESULTS: An 80-year-old woman presented with cloudiness and pain in the left eye for 1 day. The patient had visual acuity limited to perception of light with raised intraocular pressure of 70 mm Hg. Careful slit-lamp evaluation revealed corneal epithelial edema in superior quadrant and a deep and turbid anterior chamber. Ultrasound biomicroscopy confirmed the presence of a deep anterior chamber, a hypermature cataractous nucleus with lax capsular bag, and ruptured anterior lens capsule. The patient underwent extracapsular cataract extraction. Cytological examination of the lenticular fluid revealed the presence of lens protein-laden macrophages. Post-operatively, the patient had best-corrected visual acuity of 6/60 with advanced glaucomatous optic neuropathy. CONCLUSION: Phacolytic glaucoma can present with a cloudy cornea and a turbid anterior chamber mimicking endophthalmitis. Careful examination and ancillary investigations including ultrasound biomicroscopy was helpful in making an accurate diagnosis.


Assuntos
Extração de Catarata , Catarata/complicações , Glaucoma/etiologia , Núcleo do Cristalino/patologia , Idoso de 80 Anos ou mais , Cápsula Anterior do Cristalino/diagnóstico por imagem , Cápsula Anterior do Cristalino/patologia , Câmara Anterior/diagnóstico por imagem , Câmara Anterior/patologia , Anti-Hipertensivos/uso terapêutico , Doenças da Córnea/etiologia , Feminino , Glaucoma/diagnóstico por imagem , Glaucoma/tratamento farmacológico , Humanos , Pressão Intraocular , Núcleo do Cristalino/diagnóstico por imagem , Microscopia Acústica , Hipertensão Ocular/diagnóstico por imagem , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/etiologia , Tonometria Ocular , Acuidade Visual/fisiologia
9.
Exp Eye Res ; 191: 107900, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31874142

RESUMO

Piezo channel is one of the mechanosensitive channels that senses pressure and shearing stress. Previous reports show that Piezo channel is expressed in many tissues such as skin and lung and they have many important roles. In addition, the mRNA of Piezo has been detected in astrocytes in the optic nerve head of mice. However, it is not yet clear where Piezo channel localize in eye and what kind of effects it have. Thus, the purpose of this study was to determine the expression sites of Piezo channel in mouse eyes and effect of Piezo channel on retinal ganglion cells. Immunostaining analysis showed that the Piezo 1/2 were expressed in the cornea, trabecular meshwork of the anterior ocular segment, lens epithelial cells, and on the retinal ganglion cell layer. The expression of retinal Piezo 2 was increased in retinal disorder model mouse caused by high IOP. Piezo 1 agonist Yoda 1 suppressed neurite outgrowth in retinal ganglion cells. On the other hand, Piezo antagonist GsMTx4 promoted neurite outgrowth in retinal ganglion cells. These findings indicate that Piezo channel may contribute to diseases relating the IOP such as glaucoma.


Assuntos
Canais Iônicos/farmacologia , Hipertensão Ocular/etiologia , Doenças Retinianas/etiologia , Células Ganglionares da Retina/efeitos dos fármacos , Animais , Western Blotting , Células Cultivadas , Córnea/metabolismo , Células Ependimogliais , Células Epiteliais/metabolismo , Imuno-Histoquímica , Peptídeos e Proteínas de Sinalização Intercelular/farmacologia , Pressão Intraocular , Canais Iônicos/agonistas , Canais Iônicos/antagonistas & inibidores , Canais Iônicos/metabolismo , Cristalino/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos DBA , Crescimento Neuronal/fisiologia , Hipertensão Ocular/metabolismo , Hipertensão Ocular/patologia , Pirazinas/farmacologia , Ratos , Ratos Sprague-Dawley , Doenças Retinianas/metabolismo , Doenças Retinianas/patologia , Células Ganglionares da Retina/metabolismo , Células Ganglionares da Retina/patologia , Venenos de Aranha/farmacologia , Tiadiazóis/farmacologia , Malha Trabecular/metabolismo
10.
World Neurosurg ; 133: e479-e486, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541756

RESUMO

BACKGROUND: Cavernous carotid fistulas (CCF) are anatomically complex vascular lesions. Treatment via the venous approach has been previously described and is highly dependent on the patency of the drainage pathways. The use of a unilateral approach to contralateral or bilateral shunts is technically challenging and not commonly described. We present our experience with the unilateral across-the-midline approach to both cavernous sinuses to treat shunts according to anatomic compartments to achieve anatomic cure. METHODS: Patients included in this study presented with either bilateral or unilateral shunts with unilateral venous drainage. We used a transarterial guiding catheter for road mapping and control angiography. A venous triaxial system was used to achieve support for distal navigation across the midline via the coronary sinus to the contralateral cavernous sinus. Coils were favored for embolization, with occasional complementary liquid embolic material. RESULTS: Five patients underwent complete occlusion in a single session. One patient required additional complementary transarterial embolization. Despite a successful unilateral approach to bilateral cavernous sinuses, 1 patient needed an additional ipsilateral transophthalmic venous approach to obliterate the anterior compartment of the cavernous sinus. No complications were encountered. Complete angiographic cure was observed in all patients by the end of the final procedures, with persistent occlusion in their follow-up imaging. CONCLUSIONS: Careful inspection of the venous anatomy and fistulization sites is critical when treating unilateral or bilateral carotid cavernous shunts. The contralateral venous route can serve as a safe approach when visualized. Crossing the midline via the anterior or posterior coronary sinuses is feasible and efficacious.


Assuntos
Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/diagnóstico por imagem , Cateterismo , Seio Cavernoso , Angiografia Cerebral , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Veias
11.
Am J Case Rep ; 20: 1308-1313, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31481649

RESUMO

BACKGROUND Infantile nephropathic cystinosis is the most common and severe variant of cystinosis, which is a rare autosomal recessive condition related to a defect in the transportation of the protein cystine resulting in its deposition in various organs. Due to the rarity of this condition, only 1 case with extensive ocular involvement has been found in the English-language literature. Here, we report a second such case to highlight the significance of early diagnosis in avoiding devastating but preventable vision loss. CASE REPORT We describe the extensive asymmetrical ocular involvement in a 22-year-old woman who had nephropathic cystinosis since childhood. Despite frequent follow up and systemic and topical cysteamine therapy, she developed ocular complications, including increased intraocular pressure, uveitis, and retinal changes with complete loss of vision in her left eye. In addition, her general condition requires a renal transplant in the near future. CONCLUSIONS Ophthalmologists should be aware of cystinosis and the sequalae of ocular involvement in this disease, despite its rarity. Identification of the earliest corneal deposits should not be overlooked, especially in the context of other systemic manifestations that are indicative of the nephropathic variant of cystinosis.


Assuntos
Cegueira/etiologia , Cistinose/complicações , Hipertensão Ocular/etiologia , Uveíte/etiologia , Feminino , Humanos , Adulto Jovem
12.
Rev. cuba. oftalmol ; 32(3): e770, jul.-set. 2019. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1099085

RESUMO

RESUMEN Se realiza una actualización sobre el diagnóstico y tratamiento del glaucoma infantil primario, considerando la importancia que tiene un diagnóstico precoz y un tratamiento oportuno para obtener los mejores resultados posibles. Actualmente, a pesar del surgimiento de nuevos fármacos y de técnicas quirúrgicas para tratar esta afección, aún existen discrepancias sobre cómo debemos realizar el diagnóstico positivo; qué tratamiento o técnica quirúrgica emplear; cuándo y cuál sería la mejor. Cuando se trata de glaucoma pediátrico (primario o secundario), presente en etapas tan tempranas de la vida -incluso al nacimiento, donde la cirugía está indicada lo más precozmente posible, con la disyuntiva de cuáles medicamentos podemos emplear o no, por desconocimiento de qué efectos indeseables pudieran presentarse en estas edades y además, teniendo en cuenta que estos niños serán nuestros pacientes para toda la vida- es necesario conocer y repasar una vez más este tema. Se recomienda instruir a pediatras y oftalmólogos generales para lograr la remisión adecuada y precoz del niño a un centro especializado para su tratamiento quirúrgico, y mejorar así su pronóstico visual(AU)


ABSTRACT Updated information is provided about the diagnosis and treatment of primary childhood glaucoma, given the importance of early diagnosis and timely treatment to obtain the best possible results. Despite the emergence of new drugs and surgical techniques to treat this disorder, there is still controversy about how we should perform the positive diagnosis, what treatment or surgical technique should be used and when, and which would be the best. When childhood glaucoma (whether primary or secondary) presents at early stages of life - even at birth -, in which case surgery should be indicated as soon as possible, we are faced with the dilemma of what drugs we may or may not use, due to lack of knowledge about undesirable effects which could appear at these ages, and bearing in mind that these children will be our patients for a lifetime. It is thus necessary to be informed about this topic and go over it once again. It is recommended to instruct pediatricians and ophthalmologists to ensure timely, appropriate referral of the child patient to a specialized center where they will receive surgical treatment, thus improving their visual prognosis(AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Tonometria Ocular/métodos , Trabeculectomia/métodos , Hipertensão Ocular/etiologia , Diagnóstico Precoce , Gonioscopia/métodos
13.
Acta Ophthalmol ; 97(8): e1123-e1129, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31386801

RESUMO

PURPOSE: To evaluate the effect of preoperative intraocular pressure (IOP) and the vacuum level on IOP during femtosecond laser-assisted cataract surgery. METHODS: Intraocular pressure was measured in 40 enucleated porcine eyes by intracameral manometry prior, during and after vacuum application using the VICTUS femtosecond laser platform (Bausch&Lomb, Technolas Perfect Vision GmbH, Germany). Twenty combinations of different preoperative IOP levels (12, 16, 20 and 24 mmHg) and different vacuum levels (350-550 mbar) were investigated. RESULTS: Multivariate regression analysis indicated that both the vacuum level (beta = 0.138; p < 0.001) but much stronger the preoperative IOP (beta = 0.861; p < 0.001) were predictive factors for IOP rise during vacuum application. Mean IOP was 28.23 ± 3.86, 34.23 ± 3.92, 40.35 ± 4.41 and 46.82 ± 4.11 mmHg in groups with baseline IOP of 12, 16, 20 and 24 mmHg, respectively. In the 350, 450 and 550 mbar group, and mean IOP was 35.85 ± 7.85, 37.33 ± 7.90 and 39.00 ± 8.04 mmHg, respectively. Lowering the preoperative IOP by 2 mmHg and reducing the vacuum from maximum to minimum resulted in a similar reduction in IOP during vacuum application (-3.10 ± 0.79 mmHg versus -3.15 ± 0.88 mmHg; p = 0.015). Furthermore, decreasing the baseline IOP from 20 to 12 mmHg resulted in a 30.0% reduction in intraoperative IOP. CONCLUSION: Preoperative IOP was a stronger predictive factor for intraoperative IOP rise than the applied vacuum level. Measurements and critical interpretation of preoperative IOP in a preliminary examination could help estimating the individual risk of significant IOP rise during femtosecond laser-assisted cataract surgery and could help taking early countermeasures in selected cases. Due to the porcine ex vivo model, further studies are needed to verify these findings.


Assuntos
Extração de Catarata/métodos , Pressão Intraocular/fisiologia , Complicações Intraoperatórias/diagnóstico , Terapia a Laser/efeitos adversos , Hipertensão Ocular/diagnóstico , Animais , Modelos Animais de Doenças , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Hipertensão Ocular/etiologia , Hipertensão Ocular/fisiopatologia , Valor Preditivo dos Testes , Período Pré-Operatório , Fatores de Risco , Suínos , Tonometria Ocular , Vácuo
14.
Acta Reumatol Port ; 44(2): 151-154, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31455751

RESUMO

INTRODUCTION: We report a 9-year follow-up of a child with refractory juvenile idiopathic arthritis (JIA) with associated uveitis in which tocilizumab proved to be effective in achieving disease control. CASE REPORT: A 16-month child was diagnosed with JIA and at the age of 3 developed bilateral non-granulomatous anterior uveitis. Throughout the follow-up, the patient presented frequent joint and ocular flares. Refractory anterior uveitis and topical corticosteroid therapy resulted in the development of bilateral cataract and high intraocular pressure (IOP). The patient underwent multiple ocular surgeries along with corticosteroids, immunosuppressive therapy with Methotrexate and Adalimumab failing to reach disease control. Only after the introduction of Tocilizumab a lower disease activity was achieved. DISCUSSION: Management of JIA-associated uveitis is challenging and requires a close collaboration between paediatric rheumatologists and ophthalmologists. Clinical remission can be difficult to achieve. However, one should always pursuit JIA inactivity with IOP and inflammation control. This report supports Tocilizumab as a useful therapeutic option for JIA-associated uveitis.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Juvenil/complicações , Uveíte Anterior/tratamento farmacológico , Corticosteroides/efeitos adversos , Articulação do Tornozelo , Catarata/etiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Articulação do Joelho , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/etiologia , Fatores de Tempo , Uveíte Anterior/etiologia
15.
Arch. Soc. Esp. Oftalmol ; 94(8): 377-383, ago. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-185623

RESUMO

Objetivo: Estudiar la presión intraocular postoperatoria (PIOP) elevada tras la intervención de catarata pediátrica en un centro de referencia y comparar los resultados obtenidos con aquellos más relevantes de la literatura mundial. Materiales y métodos: Estudio retrospectivo observacional. Recogida de información de historias clínicas de 99 pacientes (142 ojos) operados de catarata pediátrica unilateral o bilateral entre los años 2000 y 2008. Resultados: La frecuencia de PIOP elevada (≥ 20 mmHg) fue de 79,3% en el grupo de catarata bilateral frente al 20,7% en el grupo de catarata unilateral (p = 0,032). La frecuencia de PIOP elevada entre los ojos con cirugía de catarata antes del mes de edad fue mayor, 50%, que entre los ojos en los que la cirugía de catarata se realizó después del mes de edad, 17,2% (p = 0,009). Los valores de PIOP ≥ 20mmHg se asociaron con una menor agudeza visual mejor corregida a los 5 años de la cirugía de catarata (p = 0,020). La proporción de ojos con PIOP ≥ 20 mmHg y sin lentes intraoculares fue mayor, 69%, que la proporción de ojos con PIOP ≥ 20 mmHg y lentes intraoculares, 31% (p < 0,001). Conclusiones: Un 20,4% del total de ojos estudiados presentaron PIOP elevada ≥ 20 mmHg en un periodo de seguimiento de 5 años, apareciendo con más frecuencia en aquellos con catarata bilateral que unilateral, y en ojos afáquicos que en pseudofáquicos. La elevación de la PIOP se asoció con la realización de la cirugía de la catarata a edades tempranas


Objective: To study elevated postoperative intraocular pressure (PIOP) after paediatric cataract surgery in a reference centre and to compare the results obtained with the most relevant world literature. Materials and methods: A retrospective observational study was conducted, collecting information from clinical records of 99 patients (142 eyes) operated on due to unilateral or bilateral paediatric cataracts between 2000 and 2008. Results: The proportion of eyes with PIOP ≥ 20 mmHg and bilateral cataracts was higher, 79.3%, than the proportion of eyes with PIOP ≥ 20mmHg and a unilateral cataract, 20.7% (P = .032). The proportion of eyes with PIOP ≥ 20 mmHg between the eyes with cataract surgery before one month of age was higher, 50%, than between the eyes in which the cataract surgery was performed after one month of age, 17.2% (P=.009). PIOP values ≥ 20 mmHg were associated with a lower best corrected visual acuity at 5 years after cataract surgery (P = .020). The proportion of eyes with PIOP ≥ 20 mmHg and without intraocular lenses was higher, 69%, than the proportion of eyes with PIOP ≥ 20 mmHg and intraocular lenses, 31% (P < .001). Conclusions: A PIOP > 20 mmHg was observed in 20.4% of eyes in a 5-year follow-up period, appearing more frequently in eyes with bilateral cataract than unilateral, and in aphakic eyes more than pseudophakic eyes. Elevation of the PIOP was associated with the performance of cataract surgery at early ages


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Catarata/congênito , Extração de Catarata/efeitos adversos , Hipertensão Ocular/etiologia , Complicações Pós-Operatórias/etiologia , Fatores Etários , Catarata/patologia , Extração de Catarata/métodos , Extração de Catarata/estatística & dados numéricos , Pressão Intraocular , Implante de Lente Intraocular , Microftalmia/complicações , Hipertensão Ocular/diagnóstico , Estudos Retrospectivos , Acuidade Visual
17.
J Cataract Refract Surg ; 45(8): 1172-1176, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31213327

RESUMO

PURPOSE: To measure intraocular pressure (IOP) elevations in porcine eyes during laser in situ keratomileusis (LASIK) performed using 3 femtosecond laser platforms. SETTING: Clínica Novovisión, Madrid, Spain. DESIGN: Experimental study. METHODS: Three femtosecond devices, the iFS 150 kHz, which is the newest-generation IntraLase with a flat interface, and the Victus and LenSx, which are both dual femtosecond lasers with curved interfaces, were used to create lamellar corneal flaps in freshly enucleated porcine eyes. The IOP was recorded during placement of the suction ring on the eye (suctioning phase) and during the intrastromal laser application for flap creation (cutting phase) using a manometric technique with direct cannulation to the anterior chamber. RESULTS: Twenty-one eyes were analyzed (7 per group). The mean IOP increase during suctioning was significantly higher with the iFS system (78.14 mm Hg ± 23.6 [SD]) than with the Victus system (20.28 ± 6.7 mm Hg) (P = .0001). The LenSx system performed the suctioning and applanation phases simultaneously, making it impossible to obtain the results of the suctioning phase alone. The mean IOP elevation during the cutting phase was significantly lower with the LenSx system (20 ± 5.3 mm Hg) than with the iFS (108.1 ± 17.0 mm Hg) and Victus (96.4 ± 16.8 mm Hg) systems (P = .0001). The total surgical time was significantly lower with the LenSx system (17.21 ± 0.7 seconds) than with the iFS (25.10 ± 4.3 seconds) and Victus (33.40 ± 0.7 seconds) systems (P = .0001). CONCLUSION: The preliminary results suggest that the iFS and Victus systems induced higher IOP increases and required longer surgical times to cut a LASIK flap than the LenSx system.


Assuntos
Pressão Intraocular , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Lasers de Excimer/efeitos adversos , Hipertensão Ocular/etiologia , Animais , Duração da Cirurgia , Retalhos Cirúrgicos , Suínos , Tonometria Ocular
19.
Arch Soc Esp Oftalmol ; 94(8): 377-383, 2019 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31221471

RESUMO

OBJECTIVE: To study elevated postoperative intraocular pressure (PIOP) after paediatric cataract surgery in a reference centre and to compare the results obtained with the most relevant world literature. MATERIALS AND METHODS: A retrospective observational study was conducted, collecting information from clinical records of 99 patients (142 eyes) operated on due to unilateral or bilateral paediatric cataracts between 2000 and 2008. RESULTS: The proportion of eyes with PIOP≥20mmHg and bilateral cataracts was higher, 79.3%, than the proportion of eyes with PIOP≥20mmHg and a unilateral cataract, 20.7% (P=.032). The proportion of eyes with PIOP≥20mmHg between the eyes with cataract surgery before one month of age was higher, 50%, than between the eyes in which the cataract surgery was performed after one month of age, 17.2% (P=.009). PIOP values≥20mmHg were associated with a lower best corrected visual acuity at 5 years after cataract surgery (P=.020). The proportion of eyes with PIOP≥20mmHg and without intraocular lenses was higher, 69%, than the proportion of eyes with PIOP≥20mmHg and intraocular lenses, 31% (P<.001). CONCLUSIONS: A PIOP>20mmHg was observed in 20.4% of eyes in a 5-year follow-up period, appearing more frequently in eyes with bilateral cataract than unilateral, and in aphakic eyes more than pseudophakic eyes. Elevation of the PIOP was associated with the performance of cataract surgery at early ages.


Assuntos
Extração de Catarata/efeitos adversos , Catarata/congênito , Hipertensão Ocular/etiologia , Complicações Pós-Operatórias/etiologia , Fatores Etários , Catarata/patologia , Extração de Catarata/métodos , Extração de Catarata/estatística & dados numéricos , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pressão Intraocular , Implante de Lente Intraocular , Microftalmia/complicações , Hipertensão Ocular/diagnóstico , Estudos Retrospectivos , Acuidade Visual
20.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 2025-2032, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31222404

RESUMO

PURPOSE: To evaluate the correlation of the intraocular pressure measurements (IOP) with non-contact tonometer Corvis Scheimpflug technology (Corvis ST), Goldmann applanation tonometry (GAT), ocular response analyzer (ORA), and iCARE rebound tonometer in patients with thyroid-associated orbitopathy (TAO) and eye-healthy subjects (control group). METHODS: Twenty-nine consecutive patients with TAO (79% female) and 30 eye-healthy subjects (60% female) were included in this prospective, age- and sex-matched study. The IOP measurement with Corvis, ORA, GAT, iCARE, and central corneal thickness (CCT) with Corvis was obtained from all study participants. RESULTS: The mean age of the patients was 51 ± 10 years in patients with TAO and 56 ± 13 years in the control group. The mean IOP measurements with GAT, Corvis, ORA, and iCARE were 15.93 ± 4.42 mmHg, 18.10 ± 7.54 mmHg, 18.40 ± 7.93 mmHg, and 16.61 ± 7.96 mmHg in patients with TAO and 14.52 ± 3.02 mmHg, 14.48 ± 3.38 mmHg, 15.29 ± 4.64 mmHg, and 14.13 ± 3.85 mmHg in the control group (P = 0.157, P = 0.004, P = 0.017, and P = 0.176 respectively). The mean CCT was 547.5 ± 39.2 µm in patients with TAO and 560.8 ± 49.8 µm in the control group ( P= 0.261). CONCLUSIONS: The data collected shows an agreement between the iCARE and GAT IOP measurements in TAO patients and in eye-healthy patients. However, the mean value of IOP measurements with Corvis and ORA was significantly higher in patients with TAO in comparison with the control group (P = 0.044 and P = 0.029 respectively).


Assuntos
Oftalmopatia de Graves/fisiopatologia , Pressão Intraocular/fisiologia , Hipertensão Ocular/diagnóstico , Tonometria Ocular/instrumentação , Adulto , Idoso , Desenho de Equipamento , Feminino , Seguimentos , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Hipertensão Ocular/fisiopatologia , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes
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