Persistent hypotony after primary trabeculectomy with mitomycin C Hipotonia persistente depois de trabeculectomia primária com mitomicina C

Purpose: To describe the clinical findings and treatment modalities of persistent hypotony following primary trabeculectomy with mitomycin C. Methods: We retrospectively analyzed 9 eyes with persistent hypotony, which was defined as intraocular pressure less than or equal to 5 mmHg for more than 2 months. Results: Mean hypotony duration was 7.4 months (standard deviation (SD) &plusmn; 6.7 months, range 2 to 23 months). Associated findings included choroidal detachment (2 eyes) and maculopathy (5 eyes). All patients who developed maculopathy were relatively young (mean age = 37 years old, SD &plusmn; 16, range 18 to 79 years). Treatments included bandaged contact lens, autologous blood injection, phacoemulsification, resuturing of the scleral flap, scleral patch graft, and Simmons' shell. After treatment, intraocular pressure (IOP) raised in all patients (mean final IOP = 11.1 mmHg, SD &plusmn; 3.5). On the first day of hypotony, the mean IOP was 3 mmHg (SD &plusmn;1.7). At the last follow up, visual acuity (VA) was unchanged in 3 eyes, worsened in 2 eyes (by 2 Snellen lines), and improved (by 1 to 4 Snellen lines) in 4 eyes. Of those eyes whose VA improved, 3 had undergone phacoemulsification. Conclusion: Hypotony after trabeculectomy with mitomycin C can be reversed with possible improvement in vision.<br>Objetivo: Descrever os achados clínicos e as modalidades de tratamento da hipotonia persistente após trabeculectomia primária com mitomicina C. Método: Foram retrospectivamente analisados 9 olhos com hipotonia persistente, a qual foi definida como pressão intra-ocular igual ou menor que 5 mmHg por mais que 2 meses. Resultado: Tempo médio de duração da hipotonia foi de 7.4 meses, desvio padrão &plusmn; 6.7 meses. Complicações associadas à hipotonia incluíram descolamento de coróide (2 olhos), maculopatia (5 olhos). Todos os pacientes que desen-volveram maculopatia eram relativamente novos (idade media de 37 anos, desvio padrão &plusmn;16). Tratamentos incluíram lente de contato, injeção autóloga de sangue, facoemulsificação, re-sutura do retalho escleral, e concha de Simmons. Após tratamento, houve melhora da pressão intra-ocular (PIO) em todos os pacientes (média final da PIO= 11.1 mmHg, desvio padrão &plusmn;3.51, média da PIO no 1&deg; dia = 3 mmHg, desvio padrão &plusmn;1.7). Na última visita, a acuidade visual (AV) permaneceu constante em 3 olhos, piorou em 2 olhos ( piora de 2 linhas de Snellen). Houve melhora da AV em 4 olhos (1 a 4 linhas de Snellen). Foi realizada facoemulsificação em 3 olhos dentre aqueles em que houve melhora da acuidade visual. Conclusão: Hipotonia pós-trabeculectomia com mitomicina C pode ser reversível com possível melhora da visão

Desenvolvimento e Validação de Método para Aferição de Retinografias

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Desenvolvimento e Validação de Método para Aferição de Retinografias

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Are Retinal Vessels Calibers Influenced by Blood Pressure Measured at the Time of Retinography Acquisition?

Retinal arterial narrowing is associated with higher office blood pressure (BP) and ambulatory blood pressure monitoring, and increased incidence of cardiovascular disease, but it is still unknown if the vessel caliber is associated with BP measured at the time of retinography acquisition.Retinal arteriolar and venular calibers were measured by the microdensitometric method in 448 patients with hypertension. Participants underwent 24-hours ambulatory blood pressure (24-h ABP) monitoring simultaneously with the retinography acquisition. Association between arteriolar and venular calibers with increase of 10 mmHg in the mean 24-hours, daily, and nightly BP, and with BP measured at the time of retinography, was evaluated by ANOVA and multivariate analyses.Mean 24-hours, daytime and nighttime systolic and diastolic BP were inversely associated with the arteriolar caliber, but not with the venular caliber. Arteriolar caliber decreased -0.8 (95% CI -1.4 to -0.2) μm per 10-mmHg increase in 24-hours mean systolic BP, adjusted for age, gender, fellow vessel, and duration of hypertension (P = 0.01). The corresponding decreasing in arteriolar caliber by 10 mmHg of increasing in mean diastolic BP was -1.1 μm (-2.0 to -0.2, P = 0.02). The decrease of arteriolar caliber by the same increasing of BP measured at the time of retinography was lower and not statistically significant, particularly for mean diastolic BP and outer arterioles calibers: -1.0 (-1.8 to -0.2) μm in the daytime BP average versus -0.3 (-0.9 to 0.3) at the moment of retinography acquisition.These findings suggest that the caliber of arteriolar retinal vessels in patients with uncontrolled hypertension are not significantly influenced by blood pressure measured at the time of retinography acquisition

Characteristics of study population (n = 448).

<p>Characteristics of study population (n = 448).</p

Retinal Assessment System used to determine vessel caliber.

<p>Retinal Assessment System used to determine vessel caliber.</p