Assuntos

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Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn's disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.

Assuntos

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Purpose. To evaluate the refractive and the quality of vision outcomes of toric IOL implantation in patients with low astigmatism. Design. Prospective study of single-arm. Methods. Patients with corneal astigmatism range from 0,75 D to 1,5 D and cataract that underwent cataract surgery with toric IOL. The measurements were performed preoperatively and 6 weeks after the surgery. Patients were evaluated for visual acuity with and without correction, contrast sensitivity, static and dynamic refraction, and quality of life questionnaire. Pre- and postoperative values were compared and their variations were evaluated for linear correlation. Results. 21 eyes of 21 patients. Postoperative mean uncorrected visual acuity was 0.80 ± 0.19, and the best corrected visual acuity was 0.97 ± 0.15. p < 0.001 compared to preoperative values. The average postoperative refractive cylinder was -0.34 ± 0.39. The questionnaire's total value before and after surgery was, respectively, 43.20 ± 15.76 and 79.70 ± 10.11 (p < 0.001). The correlation coefficients between the values of the questionnaire variation and the UCVA, BCVA, and CS variation were, respectively, 0.548 (p = 0.005), 0.508 (p = 0.009), and 0.409 (p = 0.033). Conclusion. Patients with low astigmatism who underwent phacoemulsification with toric IOL implantation experienced significant decrease in refractive astigmatism and improvement in their quality of life.

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PURPOSE: To determine the relationship between the length of ciliary processes as measured by ultrasound biomicroscopy and the duration, localization and severity of uveitis. METHODS: We analyzed in this prospective study, 58 individuals including patients with different stages of uveitis and normal patients (112 eyes including 18 normal), between August 2001 and August 2002, at the Cleveland Clinic Foundation, Ohio, USA. All patients were referred to ultrasound biomicroscopy by the Uveitis Department, after a complete ophthalmological examination. A 50 MHz-transducer UBM model 840 (Zeiss-Humphrey) was used under topical anesthesia and immersion technique. RESULTS: The most frequent etiology was idiophatic uveitis (27.8%). Recurrent, aggressive and diffuse uveitis lead to significant damage of the ciliary processes. The most significant loss of the ciliary processes was found in the inferior quadrant and the highest in normal patients and in the temporal quadrant. Hypotonic eyes have their ciliary processes reduced. CONCLUSIONS: Ultrasound biomicroscopy has proved to be useful in evaluating anatomical changes of ciliary processes in uveitis and in ocular hypotony, and provides a basis to, make recommendations regarding baseline screening of uveitis patients. Patients who are found to have atrophy of the ciliary processes may need a more aggressive treatment for any signs of inflammation to prevent further damage and eventual hypotony.

Assuntos

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PURPOSE: To evaluate the number, shape and topography of leakage points in patients with central serous chorioretinopathy (CSC). METHODS: Digital photographic files of fluorescein angiography with the diagnosis of CSC were reviewed by the author. The cases considered in remission and the examinations related to the same episode were excluded. The author filled out a form containing medical record number, initials, sex, age, date of the examination and leakage point characteristics (number, shape, and topography) of the selected cases. RESULTS: The examinations of 418 patients (455 eyes) were included, with a male:female ratio of 2.32:1. Ninety-one point fifteen percent of the patients presented the disease unilaterally and 8.85% bilaterally. The mean age was 43.04 years (range, 19-68 years). Among the 455 selected eyes, 88.35% presented typical forms of CSC while 10.11% decompensation of the retinal pigment epithelium and 1.54% with isolated retinal pigment epithelium (RPE) detachment. The evaluation of typical forms of CSC showed a leakage point with uniform dye spread (inkblot) in 88.81% and 11.19% with a smoke-stack phenomenon. Regarding the leakage points, 46.01% were located in the upper nasal quadrant, 23.27% in the upper temporal quadrant, 19.18% in the lower nasal quadrant, 11.01% in the lower temporal quadrant and 0.53% in the subfoveal area. CONCLUSIONS: In our series men were affected approximately two times more often then women, most of them with a unilateral involvement and in around the fourth decade of life. About 90% of the patients presented the typical forms, with 1 or 2 inkblot points or leakage. The superior nasal quadrant was the most affected. The isolated RPE detachment rarely occurred. Decompensation of RPE affected about 10% of the patients.

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