RESUMO
ABSTRACT Objective: To evaluate structural and visual field (VF) changes after ≥1 year of a single acute primary angle closure (APAC) attack using spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP). Methods: Patients with a single unilateral APAC crisis at least 1 year ago were included consecutively from 2013 to 2016. Contralateral eye was used as control. All patients underwent ophthalmic examination, RNFL imaging by SD-OCT, and SAP using Octopus 1-2-3. Results: 54 eyes (27 patients) were enrolled. Male-to-female ratio was 1:2. Mean time for the SD-OCT and SAP assessment after the crisis was 5.0±5.1 (1.0-23.5) years, and IOP was 52.5±9.8 mmHg. In APAC eyes, the thicknesses of all quadrants of peripapillary RNFL (36.3%; P<0.001) and some macular sections (from 2.1% to 4.7%; P<0.01) were reduced compared to contralateral eyes. Additionally, in APAC eyes, the mean defect on VF was negatively and statistically correlated with the reduction of all quadrants of peripapillary RNFL thickness. Conclusion: A single episode of APAC was associated with peripapillary RNFL and macular thickness and with VF defects after ≥1 year of the crisis in the affected eye. Statistically meaningful correlations were found between structural and functional damage.
RESUMO Objetivo: Avaliar alterações estruturais e do campo visual 1 ano ou mais após uma crise única de fechamento angular primário agudo utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada. Métodos: Pacientes que apresentaram crise unilateral única de fechamento angular primário agudo há pelo menos 1 ano foram consecutivamente incluídos entre 2013 e 2016. Os olhos contralaterais foram utilizados como controles. Todos os pacientes foram submetidos a exame oftalmológico, avaliação das camadas de fibras nervosas da retina utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada com o Octopus 1-2-3. Resultados: Foram incluídos 54 olhos (27 pacientes) com razão homem:mulher de 1:2. O tempo médio após a crise foi de 5,0±5,1 anos (1,0 a 23,5) e a pressão intraocular na crise foi 52,5±9,8mmHg. Nos olhos com fechamento angular primário agudo, todas as espessuras das camadas de fibras nervosas da retina peripapilares (36,3%; p<0,001) e de algumas seções maculares (de 2,1 a 4,7%; p<0,01) estavam reduzidas em comparação aos olhos contralaterais. Além do mais, nos olhos submetidos a fechamento angular primário agudo, o mean defect do campo visual foi estatisticamente e negativamente correlacionado com a redução da espessura de todos os quadrantes peripapilares da camada de fibras nervosas da retina. Conclusão: Um único episódio de fechamento angular primário agudo foi associado com redução na espessura da camada de fibras nervosas da retina peripapilar e da espessura macular e com defeitos de campo visual 1 ano ou mais após a crise no olho afetado. Correlações estatisticamente significativas foram identificadas entre danos estruturais e funcionais.
Assuntos
Humanos , Masculino , Feminino , Disco Óptico/patologia , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Doenças do Nervo Óptico/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Fibras Nervosas/patologia , Campos Visuais , Glaucoma de Ângulo Fechado/complicações , Doenças do Nervo Óptico/etiologia , Doença Aguda , Iridectomia , Testes de Campo Visual , Pressão Intraocular , Macula LuteaRESUMO
Daratumumab is an anti-CD38 monoclonal antibody approved for use in multiple myeloma in 2015 and under investigation for use in light-chain amyloidosis. We report a case of a patient with amyloidosis who developed bilateral, acute secondary angle closure during an infusion of daratumumab. Ultrasound biomicroscopy obtained 3 days after the onset of her symptoms demonstrated the cause to be bilateral choroidal effusions. Taken together with several previous case reports, the evidence suggests that, like topiramate, daratumumab is associated with the idiosyncratic reaction of choroidal effusions, resulting in a spectrum of clinical outcomes from myopic shift to acute angle closure. The treating oncologist and eye care provider should be aware of these adverse outcomes in any patient undergoing treatment with this medication, as swift recognition and intervention may be vision-saving.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos/efeitos adversos , Glaucoma de Ângulo Fechado/induzido quimicamente , Administração Oftálmica , Amiloidose/tratamento farmacológico , Anticorpos Monoclonais/administração & dosagem , Antineoplásicos/administração & dosagem , Efusões Coroides/diagnóstico por imagem , Efusões Coroides/tratamento farmacológico , Ciclopentolato/uso terapêutico , Combinação de Medicamentos , Oftalmopatias/tratamento farmacológico , Feminino , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glucocorticoides/uso terapêutico , Gonioscopia , Humanos , Infusões Intravenosas , Pressão Intraocular/efeitos dos fármacos , Microscopia Acústica , Pessoa de Meia-Idade , Antagonistas Muscarínicos/uso terapêutico , Prednisolona/uso terapêuticoRESUMO
We report a case of a 5-year-old girl with persistent fetal vasculature who presented with unilateral acute angle closure caused by aqueous misdirection syndrome that was apparently associated with regression of cycloplegia. Initial treatment with topical steroids, anti-glaucomatous drops, and atropine showed insufficient control of the intraocular pressure (IOP). Surgical treatment with lensectomy and vitrectomy resulted in satisfactory IOP control and no complications at the 6-month follow-up.
Assuntos
Glaucoma de Ângulo Fechado/etiologia , Vítreo Primário Hiperplásico Persistente/complicações , Pré-Escolar , Feminino , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glaucoma de Ângulo Fechado/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Ultrassonografia , VitrectomiaRESUMO
We report the case of a 46-year-old female patient who presented with bilateral acute angle closure during the course of dengue infection. Dengue diagnosis was confirmed by serological tests. The patient had plateau iris configuration identified by ultrasound biomicroscopy. This is the second reported case with this condition during dengue fever and the first to describe the characteristics of the angle.
Assuntos
Dengue/complicações , Glaucoma de Ângulo Fechado/etiologia , Feminino , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Humanos , Microscopia Acústica , Pessoa de Meia-Idade , Dengue Grave/complicaçõesRESUMO
ABSTRACT We report the case of a 46-year-old female patient who presented with bilateral acute angle closure during the course of dengue infection. Dengue diagnosis was confirmed by serological tests. The patient had plateau iris configuration identified by ultrasound biomicroscopy. This is the second reported case with this condition during dengue fever and the first to describe the characteristics of the angle.
RESUMO Os autores relatam o caso de uma mulher de 46 anos que teve fechamento agudo de ângulo bilateral durante a infecção por dengue. O diagnóstico de dengue foi confirmado por testes sorológicos. A paciente teve configuração de íris em platô confirmada pela biomicroscopia ultrassônica. Esse é o segundo caso descrevendo essa condição durante um episódio de dengue e o primeiro a descrever as características do ângulo.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Glaucoma de Ângulo Fechado/etiologia , Dengue/complicações , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Dengue Grave/complicações , Microscopia AcústicaRESUMO
ABSTRACT We report a case of a 5-year-old girl with persistent fetal vasculature who presented with unilateral acute angle closure caused by aqueous misdirection syndrome that was apparently associated with regression of cycloplegia. Initial treatment with topical steroids, anti-glaucomatous drops, and atropine showed insufficient control of the intraocular pressure (IOP). Surgical treatment with lensectomy and vitrectomy resulted in satisfactory IOP control and no complications at the 6-month follow-up.
RESUMO Relatamos o caso de uma criança de 5 anos, sexo feminino com persistência do vítreo primário que apresentou crise de fechamento angular por síndrome do mau direcionamento do humor aquoso, aparentemente associado a regressão da cicloplegia. Tratamento inicial com corticoide tópico, colírios antiglaucomatosos e atropina mostraram controle insuficiente da pressão intraocular (PIO). Tratamento cirúrgico com lensectomia e vitrectomia anterior permitiu o controle satisfatório da PIO, sem intercorrências no seguimento de 6 meses.
Assuntos
Humanos , Feminino , Pré-Escolar , Glaucoma de Ângulo Fechado/etiologia , Vítreo Primário Hiperplásico Persistente/complicações , Vitrectomia , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Ultrassonografia , Gonioscopia , Pressão IntraocularRESUMO
We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.
Assuntos
Glaucoma de Ângulo Fechado/etiologia , Granulomatose com Poliangiite/complicações , Doença Aguda , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Glaucoma de Ângulo Fechado/patologia , Glaucoma de Ângulo Fechado/terapia , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/patologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Fatores de Tempo , Tomógrafos Computadorizados , UltrassonografiaRESUMO
ABSTRACT We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.
RESUMO Relatamos um caso glaucoma bilateral agudo de ângulo fechado em um paciente sem diagnóstico prévio de granulomatose com poliangeíte (Wegener). Um homem de 59 anos apresentou-se com uma forte dor de cabeça, dor nos olhos, visão turva, dificuldade em respirar e febre baixa. Observamos quemose conjuntival, edema da córnea e câmara anterior rasa. A gonioscopia demonstrou ângulos fechados bilateralmente. Ele foi tratado com manitol intravenoso, acetazolamida oral, olho e colírios antiglaucomatosos. Durante os dois dias seguintes a sua visão melhorou e as pressões intra-oculares diminuíram. A seguir, foram realizadas iridotomias a laser bilateralmente e ele foi referido para os departamentos de doenças pulmonares, nefrologia e reumatologia. Ele foi diagnosticado com poliangeíte granulomatosa. Glaucoma bilateral agudo de ângulo fechado é uma entidade clínica muito rara e sua associação com a granulomatose de Wegener é desconhecida e deve acrescentar-se à lista de manifestações oculares de granulomatose com poliangeíte.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Glaucoma de Ângulo Fechado/etiologia , Granulomatose com Poliangiite/complicações , Fatores de Tempo , Radiografia Torácica , Glaucoma de Ângulo Fechado/patologia , Glaucoma de Ângulo Fechado/terapia , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Tomógrafos Computadorizados , Granulomatose com Poliangiite/patologia , Granulomatose com Poliangiite/diagnóstico por imagem , Doença Aguda , Ultrassonografia , Pressão IntraocularRESUMO
PURPOSE: To investigate, through ultrasound biomicroscopy images, the presence of plateau iris configuration in eyes with narrow-angle from patients with open-angle glaucoma and in eyes with previous acute primary angle-closure and compare the biometric features of eyes with plateau iris configuration with those of normal eyes. METHODS: Ultrasound biomicroscopic images from 196 patients with open-angle glaucoma and narrow-angle and 32 patients with acute primary angle-closure were retrospectively analyzed. The inclusion and specific criteria for the diagnosis of plateau iris configuration was the presence of an anterior positioning of the ciliary processes, supporting the peripheral iris so that it was parallel to the trabecular meshwork; the iris root had a steep rise from its insertion point, followed by a downward angulation from the corneoscleral wall; presence of a central flat iris plane; an absent (complete plateau iris configuration) or partially absent (incomplete plateau iris configuration) ciliary sulcus. The ultrasound biomicroscopic parameters were compared between complete and incomplete plateau iris configuration. The same parameters of both groups were compared with those of normal eyes. The following measurements were performed: anterior chamber depth; angle opening distance at 500 microm from the scleral spur; peripheral iris thickness at 500 microm from the scleral spur; iris-ciliary process distance; trabecular-ciliary process distance and angle recess area. RESULTS: Plateau iris configuration was found in 33 eyes of 20 (10.2%) out of 196 patients with open-angle glaucoma and narrow-angle and in 4 eyes of 2 (6.3%) out of 32 patients with acute primary angleclosure. Seventeen (77.3%) patients with plateau iris configuration were female and 5 (22.7%) male. Twenty-three (62.2%) out of 37 eyes had complete plateau iris configuration, and 14 (37.8%) had incomplete plateau iris configuration. Complete and incomplete plateau iris configuration presented similar biometric features with the exception of the iris-ciliary process distance. All plateau iris configuration eyes showed biometric parameters completely different from those of normal eyes except for peripheral iris thickness at 500 microm from the scleral spur. CONCLUSIONS: Plateau iris configuration was present in 10.2% of patients with open-angle glaucoma and narrow-angle and in 6.3% of patients with acute primary angle-closure. Biometric features were similar in eyes with complete and incomplete plateau iris configuration with the exception of iris-ciliary process distance. Compared to normal eyes, all plateau iris configuration eyes showed biometric parameters completely different except for peripheral iris thickness at 500 microm from the scleral spur.
Assuntos
Glaucoma de Ângulo Fechado/diagnóstico por imagem , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Doenças da Íris/diagnóstico por imagem , Adulto , Idoso , Biometria , Estudos de Casos e Controles , Feminino , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Aberto/complicações , Humanos , Doenças da Íris/complicações , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: To study the mechanisms of pupillary block in eyes with occludable angle by ultrasound biomicroscopy. METHODS: Initially, a pilot study of 13 eyes with acute primary angle-closure without medication was executed. Ultrasound biomicroscopy measurements of the angle, posterior chamber depth and iris thickness were performed in the temporal quadrant under light and dark conditions. Afterwards, ultrasound biomicroscopy measurements of iris-lens contact distance and iris-lens angle in the temporal quadrant and central anterior chamber depth were made in 32 eyes with acute primary angle-closure or intermittent primary angle-closure without medication, under light and dark conditions before and after laser peripheral iridectomy. RESULTS: In the pilot study, a significant decrease in the angle as well as a significant increase in the iris thickness occurred when comparing light to dark conditions. Before and after laser peripheral iridectomy (second study), significant differences were found in iris-lens contact distance (P<0.001) and iris-lens angle (P<0.001) under light and dark conditions. Also, significant differences were found in light and dark conditions, before laser peripheral iridectomy, in iris-lens angle (P=0.005), and after laser peripheral iridectomy, in iris-lens contact distance (P<0.001). No significant change occurred with anterior chamber depth. CONCLUSIONS: A decreased angle was correlated to an increase in iris thickness. After laser peripheral iridectomy, acute primary angle-closure or primary angle-closure eyes had an increased iris-lens contact distance and a decreased iris-lens angle. The anterior chamber depth did not change. These findings contradict the theory that pupillary block is the mechanism of acute primary angle-closure.