RESUMO
Although ocular toxoplasmosis is a leading cause of posterior uveitis worldwide, there is scarce information about the real-life frequency of ocular lesions, visual outcomes, and risk factors for poor prognosis. We conducted a community-based cross-sectional study with 721 adults living in Cássia dos Coqueiros, Southeast Brazil, consisted of visual acuity measurement, dilated ocular examination, a risk-factor questionnaire, and peripheral blood collection for anti-T. gondii serology. Presumed toxoplasmic lesions were recorded on video and analyzed by experienced and masked ophthalmologists. Ocular toxoplasmosis was determined if at least one suspected lesion was appointed by two graders in the presence of positive anti-T. gondii serology. Forty-eight eyes (n = 42 participants; 6.7% among those with positive anti-T. gondii serology) with ocular toxoplasmosis were found. Most lesions were single (n = 28; 58.3%), peripheral (n = 34; 77.1%) and unilateral (85.7% of participants); no active lesions were found. Older age was associated with lesions larger than one-disc diameter (p = 0.047), and lower social stratum (OR: 2.89; CI 1.2-6.97; p = 0.018) was associated with the presence of toxoplasmic lesions. Although there were no differences in visual acuity between participants and eyes with or without ocular lesions (p > 0.05), unilateral blindness associated with ocular toxoplasmosis was identified in a reduced number of individuals.
Assuntos
Oftalmopatias , Inquéritos e Questionários , Toxoplasma , Toxoplasmose , Adolescente , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Estudos Transversais , Oftalmopatias/epidemiologia , Oftalmopatias/parasitologia , Oftalmopatias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Toxoplasmose/epidemiologia , Toxoplasmose/fisiopatologiaRESUMO
RESUMEN La infección por el virus del dengue va en aumento en las regiones tropicales de Asia, África y América. Se estima que se producen de 50 a 100 millones de casos de esta enfermedad al año. En los últimos tiempos han aumentado los reportes de manifestaciones oculares en estos pacientes, las cuales ocurren en un rango de 5 a 7 días posteriores al inicio de los síntomas, aunque también pueden ocurrir más tarde, y generalmente existe buen pronóstico visual. Se realiza una revisión bibliográfica con el objetivo de ampliar el conocimiento sobre un tema poco tratado en nuestro medio. Se consultaron fundamentalmente artículos científicos de revistas, publicados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema en los últimos 5 años, a través de Google académico como motor de búsqueda. Se constató que se han reportado manifestaciones oculares en pacientes con dengue que van desde hallazgos en el segmento anterior sin afectación visual, hasta cuadros más intensos que interesan las estructuras del polo posterior del ojo. La fisiopatología de estos hallazgos aún se encuentra en estudio y no existe consenso para su tratamiento. A pesar de que el pronóstico visual de estas alteraciones es bueno, se reportan casos donde no es así y se precisa mayor comprensión sobre la fisiopatología de estas para un abordaje terapéutico más adecuado en cada caso(AU)
ABSTRACT Infection by dengue virus is on the increase in tropical regions of Asia, Africa and America. It has been estimated that 50 to 100 million cases of this disease occur every year. Recent years have witnessed a rise in the number of reports of ocular manifestations in dengue patients. These manifestations appear 5 to 7 days after symptom onset, though they could also occur later, and the visual prognosis is generally good. A bibliographic review was conducted with the purpose of broadening knowledge about a topic not commonly dealt with in our environment. The search was mainly aimed at scientific papers from journals, published in the databases PubMed and Cochrane, as well as basic texts addressing the study topic in the last 5 years, using the search engine Google Scholar. Ocular manifestations were found to have been reported in dengue patients. These range from findings in the anterior segment without any visual alteration to more intense episodes affecting the structures of the posterior pole of the eye. The physiopathology of these findings is still being studied, and there is no consensus about its treatment. Despite the good visual prognosis of these alterations, cases have been reported of a different outcome. Therefore, a better understanding is required of their physiopathology to achieve a more appropriate therapy for each case(AU)
Assuntos
Humanos , Dengue/etiologia , Oftalmopatias/fisiopatologia , Relatório de Pesquisa , Febre/fisiopatologia , Publicações Periódicas como Assunto , Literatura de Revisão como AssuntoRESUMO
Alport syndrome is an inherited progressive form of glomerular disease that is often associated with sensorineural hearing loss and ocular abnormalities. We report two men with Alport syndrome. Both had chronic kidney disease and consulted for long-term loss of visual acuity. One had auditory abnormalities. On the ophthalmological examination, both had anterior lenticonus and one had dot or fleck retinopathy. Those findings are described in up to 50% and 70% of men with X-linked Alport syndrome, respectively. Both patients had a family history of Alport syndrome or suggestive signs and symptoms.
Assuntos
Oftalmopatias/patologia , Nefrite Hereditária/patologia , Adulto , Oftalmopatias/diagnóstico , Oftalmopatias/fisiopatologia , Perda Auditiva Neurossensorial , Humanos , Masculino , Nefrite Hereditária/diagnóstico , Nefrite Hereditária/fisiopatologia , Retina/patologia , Tomografia de Coerência Óptica , Tonometria Ocular , Acuidade VisualRESUMO
Alport syndrome is an inherited progressive form of glomerular disease that is often associated with sensorineural hearing loss and ocular abnormalities. We report two men with Alport syndrome. Both had chronic kidney disease and consulted for long-term loss of visual acuity. One had auditory abnormalities. On the ophthalmological examination, both had anterior lenticonus and one had dot or fleck retinopathy. Those findings are described in up to 50% and 70% of men with X-linked Alport syndrome, respectively. Both patients had a family history of Alport syndrome or suggestive signs and symptoms.
Assuntos
Humanos , Masculino , Adulto , Oftalmopatias/patologia , Nefrite Hereditária/patologia , Retina/patologia , Tonometria Ocular , Acuidade Visual , Tomografia de Coerência Óptica , Oftalmopatias/diagnóstico , Oftalmopatias/fisiopatologia , Perda Auditiva Neurossensorial , Nefrite Hereditária/diagnóstico , Nefrite Hereditária/fisiopatologiaRESUMO
Ocular involvement is present in 50-60% of granulomatosis with polyangiitis (GPA) patients and can affect any part of the ocular globe. The present study describes ophthalmologic manifestations, association with systemic symptoms, disease activity and damage in GPA. A cross-sectional study was conducted including patients with GPA who underwent rheumatologic and ophthalmologic evaluation. Demographics, comorbidities, ophthalmologic symptoms, serologic markers, radiographic studies, disease activity and damage were assessed. Descriptive statistics, correlation, univariable logistic regression analyses, Student's t, Mann-Whitney U, Chi-square and Fisher's exact tests were performed. Fifty patients were included, 60% female, the median age was 56 years, disease duration 72.5 months. Nineteen (38%) patients had ocular manifestations at GPA diagnosis, scleritis being the most frequent; 27 (54%) patients presented ocular involvement during follow-up, repeated scleritis and dacryocystitis being the most common manifestations. Concomitant ophthalmic and sinonasal involvement was present in 12 (24%). Ocular and ENT damage occurred in 58% and 70%, respectively. Epiphora and blurred vision were the most frequent symptoms; scleromalacia and conjunctival hyperemia (27%) the most frequent clinical abnormalities. Ocular involvement at diagnosis was associated with concomitant ocular and sinonasal involvement at follow-up (OR 4.72, 95% CI 1.17-19.01, p = 0.01). Ocular involvement at follow-up was associated with age at GPA diagnosis (OR 0.94, 95% CI 0.90-0.99, p = 0.03), VDI (OR 1.29, 95% CI 1.03-1.61, p = 0.02), and ENT damage (OR 5.27, 95% CI 1.37-20.13, p = 0.01). In GPA, ocular involvement is frequent, therefore, non-ophthalmologist clinicians should be aware of this manifestation to reduce the risk of visual morbidity and organ damage.
Assuntos
Dacriocistite/fisiopatologia , Granulomatose com Poliangiite/fisiopatologia , Doenças Nasais/fisiopatologia , Doenças dos Seios Paranasais/fisiopatologia , Esclerite/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Túnica Conjuntiva/etiologia , Doenças da Túnica Conjuntiva/fisiopatologia , Estudos Transversais , Dacriocistite/etiologia , Oftalmopatias/etiologia , Oftalmopatias/fisiopatologia , Feminino , Granulomatose com Poliangiite/complicações , Humanos , Hiperemia/etiologia , Hiperemia/fisiopatologia , Doenças do Aparelho Lacrimal/etiologia , Doenças do Aparelho Lacrimal/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças Nasais/etiologia , Doenças dos Seios Paranasais/etiologia , Esclerite/etiologia , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Adulto JovemRESUMO
Resumo Doença do Enxerto-versus-hospedeiro (do inglês Graft-versus-Host Disease - GVHD) é uma complicação importante e com altas taxas de morbidade e mortalidade nos pacientes submetidos ao transplante alogênico de células-tronco hematopoiéticas. O acometimento ocular, denominado GVHD ocular, pode acometer todas as estruturas dos olhos, porém a unidade lacrimal (glândulas lacrimais e superfície ocular) é o principal alvo da resposta inflamatória mediada por células T doadas. O desenvolvimento de doença do olho seco grave é a principal manifestação clínica ocular, e a associação de diversas opções terapêuticas se faz necessário. O objetivo desta revisão é descrever as manifestações clínicas, os critérios diagnósticos, o impacto na qualidade de vida, o tratamento atual e as perspectivas desta doença, que precisa de um acompanhamento multidisciplinar.
Abstract Graft-versus-host Disease (GVHD) is a major complication with high morbidity and mortality rates on patients undergoing hematopoietic stem cell transplantation. The ocular involvement, named ocular GVHD, may affect all structures of the eyes, but the lacrimal unit (lacrimal glands and ocular surface) is the main target of the inflammatory response mediated by the donor T cells. The development of dry eye disease is the main clinical ocular manifestation, and the association of a variety of therapeutics options is necessary. The aim of the review is to describe the clinical manifestations, diagnostic criteria, impact in quality of life, the current treatment and future perspectives of this disease that demands a multidisciplinary follow-up.
Assuntos
Humanos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Oftalmopatias/etiologia , Doença Enxerto-Hospedeiro/etiologia , Qualidade de Vida , Transplante Homólogo , Perfil de Impacto da Doença , Oftalmopatias/diagnóstico , Oftalmopatias/fisiopatologia , Oftalmopatias/terapia , Doença Enxerto-Hospedeiro/complicações , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/fisiopatologia , Doença Enxerto-Hospedeiro/psicologia , Doença Enxerto-Hospedeiro/terapiaRESUMO
PURPOSE: To determine the prevalence of reduced visual acuity and ocular disease in the children of migrant farmworkers in Georgia. METHODS: A retrospective chart review of data acquired by a vision screening was performed on 156 Haitian and Hispanic children of migrant farmworkers attending a summer school in Georgia. Reduced visual acuity at presentation was analyzed and stratified by ethnicity, type of ocular disease, and immediate resolution with refractive correction. RESULTS: The authors found that 20% of migrant farmworker children have a high prevalence of reduced visual acuity in the worse eye. Of those with worse-eye reduced visual acuity, 83% had uncorrected refractive error. The prevalence of uncorrected refractive error from astigmatism and high astigmatism was significantly higher among Hispanics than Haitians. The prevalence of amblyopia suspects among migrant farmworker children was 3%. Of the amblyopia suspects, 80% were anisometropic. CONCLUSIONS: Children of migrant farmworkers in Georgia have a higher rate of reduced visual acuity, largely from uncorrected refractive error, when compared to other Hispanic and African American children in the United States with a prevalence more aligned to children in Asian and Latin American countries than school children in the United States. This illustrates the need for improved access to screening and care in this vulnerable population. [J Pediatr Ophthalmol Strabismus. 2019;56(1):28-34.].
Assuntos
Oftalmopatias/etnologia , Fazendeiros , Migrantes , Transtornos da Visão/etnologia , Seleção Visual/métodos , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Oftalmopatias/fisiopatologia , Feminino , Haiti/etnologia , Humanos , Incidência , Masculino , México/etnologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Transtornos da Visão/fisiopatologiaRESUMO
PURPOSE: To report surgical outcomes in a series of cases with symptomatic vitreomacular traction that met MIVI-TRUST (Microplasmin for intravitreous injection-traction release without surgical treatment) criteria for ocriplasmin use who underwent primary 25-gauge vitrectomy. MATERIALS AND METHODS: A single-center retrospective chart review study was performed in patients who underwent primary 25-gauge vitrectomy for symptomatic vitreomacular traction (VTM) from January 2013 through January 2016. Pre- and postoperative visual acuity (measured by the early treatment diabetic retinopathy acuity test), and posterior hyaloid focal attachment to the macula (demonstrated by high-definition optical coherence tomography) were analyzed. In addition, intra- and postoperative complications were obtained from medical records. RESULTS: Fifteen consecutive cases of symptomatic VMT traction that underwent primary 25-gauge vitrectomy were included. All met the MIVI-TRUST criteria for ocriplasmin use. In all cases, VMT resolution, macular hole closure, and improvement in best corrected visual acuity (BCVA) were observed. Mean visual acuity improved from 56.53 ± 16.04 letters at baseline to 73.13 ± 7.46 letters at 24 weeks of follow-up. The mean BCVA improvement from baseline was 16.60 letters (range 6-44), which was statistically significant (P < 0.0001). Ten of fifteen patients (66.6%) showed significant improvement of their BCVA to 20/40 or better (70 or more in ETDRS visual acuity test). No significant intra- or postoperative complications were documented. CONCLUSIONS: Primary 25-gauge pars plana vitrectomy in eyes with symptomatic vitreomacular traction is able to efficiently resolve VMT and macular holes, improving vision in candidates for intravitreal injection of ocriplasmin. This well-tolerated surgical procedure may be a reliable and predictable alternative for resolving VMT pathology.
Assuntos
Oftalmopatias/cirurgia , Fibrinolisina/administração & dosagem , Fibrinolíticos/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Corpo Vítreo/cirurgia , Idoso , Terapia Combinada , Oftalmopatias/diagnóstico por imagem , Oftalmopatias/fisiopatologia , Feminino , Humanos , Injeções Intravítreas , Masculino , Microcirurgia , Pessoa de Meia-Idade , Perfurações Retinianas/diagnóstico por imagem , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Corpo Vítreo/diagnóstico por imagem , Corpo Vítreo/fisiopatologiaRESUMO
PURPOSE: To determine the vision status, ophthalmic findings, and quality of life among the very elderly. METHODS: This was a cross-sectional observational study of individuals aged 80 years and above. A comprehensive ophthalmic exam was performed with mea surement of both the presenting (PVA) and best-corrected visual acuity. The Quality of Life Short Form-36 (SF-36) and the Visual Function Questionnaire (VFQ-25) were also administered. RESULTS: A total of 150 non-institutionalized participants were assigned to three age groups: 80-89 years (n=70), 90-99 years (n=50), and 100 years and older (n=30). PVA and best-corrected visual acuity were normal (≥20/30) in 20 (13.3%) and 37 participants (24.7%), respectively. Regarding PVA, mild visual impairment (<20/30 to ≥20/60) was found in in 53 (35.4%), moderate visual impairment (<20/60 to ≥20/200) in 50 (33.3%), severe visual impairment (<20/200 to ≥20/400) in 8 (5.3%), and blindness (<20/400) in 19 (12.7%) participants. Regarding best-corrected visual acuity, mild, moderate, and severe visual impairments were present in 55 (36.7%), 38 (25.3%), and 5 (3.3%) participants, respectively, and blindness was present in 15 (10%). The main causes of visual impairment/blindness were cataract (43.8%), refractive errors (21.5%), age-related macular degeneration (17.7%), and myopic degeneration (3.8%). SF-36 scores were worse in those with low visual acuity, while VFQ-25 domain scores were poorer in those with vision impairment/blindness. CONCLUSION: Vision impairment and blindness was present in three-quarters of this sample, but it was notable that adequate correction with spectacles improved visual acuity. This reinforces the need for regular ophthalmic care in elderly patients to improve their quality of life by optimizing vision.
Assuntos
Avaliação Geriátrica/métodos , Qualidade de Vida , Transtornos da Visão/epidemiologia , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Fatores Etários , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Brasil/epidemiologia , Estudos Transversais , Oftalmopatias/epidemiologia , Oftalmopatias/fisiopatologia , Feminino , Humanos , Masculino , Prevalência , Estatísticas não Paramétricas , Inquéritos e Questionários , Transtornos da Visão/etiologiaRESUMO
ABSTRACT Purpose: To determine the vision status, ophthalmic findings, and quality of life among the very elderly. Methods: This was a cross-sectional observational study of individuals aged 80 years and above. A comprehensive ophthalmic exam was performed with mea surement of both the presenting (PVA) and best-corrected visual acuity. The Quality of Life Short Form-36 (SF-36) and the Visual Function Questionnaire (VFQ-25) were also administered. Results: A total of 150 non-institutionalized participants were assigned to three age groups: 80-89 years (n=70), 90-99 years (n=50), and 100 years and older (n=30). PVA and best-corrected visual acuity were normal (≥20/30) in 20 (13.3%) and 37 participants (24.7%), respectively. Regarding PVA, mild visual impairment (<20/30 to ≥20/60) was found in in 53 (35.4%), moderate visual impairment (<20/60 to ≥20/200) in 50 (33.3%), severe visual impairment (<20/200 to ≥20/400) in 8 (5.3%), and blindness (<20/400) in 19 (12.7%) participants. Regarding best-corrected visual acuity, mild, moderate, and severe visual impairments were present in 55 (36.7%), 38 (25.3%), and 5 (3.3%) participants, respectively, and blindness was present in 15 (10%). The main causes of visual impairment/blindness were cataract (43.8%), refractive errors (21.5%), age-related macular degeneration (17.7%), and myopic degeneration (3.8%). SF-36 scores were worse in those with low visual acuity, while VFQ-25 domain scores were poorer in those with vision impairment/blindness. Conclusion: Vision impairment and blindness was present in three-quarters of this sample, but it was notable that adequate correction with spectacles improved visual acuity. This reinforces the need for regular ophthalmic care in elderly patients to improve their quality of life by optimizing vision.
RESUMO Objetivos: Determinar a visão, achados oftalmológicos e qualidade de vida em longevos. Métodos: Estudo observacional transversal em indivíduos com idade entre 80 anos ou mais. Realizado exame oftalmológico com medida da acuidade visual apresentada e da acuidade visual melhor corrigida. Foram administrados os questionários: Qualidade de Vida Forma Curta - 36 (SF-36) e Qualidade de Função Visual (VFQ-25). Resultados: Total de 150 indivíduos não-institucionalizados foram estudados, divididos em três faixas etárias: 80 a 89 anos (n=70); 90 a 99 anos (n=50) e 100 anos ou mais (n=30). Acuidade visual apresentada normal (≥20/30) foi encontrada em 20 (13,3%) participantes; deficiência visual leve (<20/30 a ≥20/60), em 53 (35,4%); deficiência visual moderada (< 20/60 a ≥20/200) em 50 (33,3%); deficiência visual grave (<20/200 para ≥20/400) em 8 (5,3%) e cegueira (<20/400) em 19 (12,7%). A acuidade visual com a melhor correção aumentou para 37 (24,7%) indivíduos normais; deficiência leve aumentou para 55 (36,7%); deficiência visual moderada diminuiu para 38 (25,3%); deficiência visual grave foi reduzida para 5 (3,3%) e cegueira foi reduzida para 15 (10%). As principais causas de deficiência visual/cegueira foram: catarata (43,8%) erro refrativo (21,5%), degeneração macular relacionada à idade (17,7%), e degeneração miópica (3,8%). A pontuação no Questionário de Qualidade de Vida foi pior naqueles com baixa visão para perto. No questionário VFQ -25 os domínios com menor pontuação ocorreram nos indivíduos com baixa visão/cegueira. Conclusão: Deficiência visual/cegueira mostrou-se presente em três quartos desta amostra de longevos. A prescrição de óculos adequados proporcionou melhora da acuidade visual, reforçando a necessidade de atendimento oftalmológico regular desses pacientes para assegurar a qualidade de vida e de visão.