RESUMEN
ABSTRACT Purpose: To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis. Methods: For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study. The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment. Results: The prevalence of optic nerve involvement was 14.4%, with the leading cause being the activation of a juxtapapillary lesion (70.5%). We found papillitis in two eyes and neuroretinitis in two eyes (11.7% for each). We only detected one optic nerve involvement secondary to a distant active lesion (5.8%). Sixteen patients (94.1%) had unilateral ocular toxoplasmosis. The overall final best-corrected visual acuity after treatment was 10/10 (LogMAR = 0.0) excluding the three patients with a juxtapapillary scar involving the macula. Conclusions: Optic nerve involvement was common in patients with ocular toxoplasmosis. The main type of optic nerve involvement was caused by activation of an old juxtapapillary lesion. Treatment was quickly effective, but the best-corrected visual acuity was dependent on the presence of a scar in the papillomacular bundle.
RESUMO Objetivos: Avaliar a prevalência, características clínicas e tipos de acometimento do nervo óptico em pacientes com toxoplasmose ocular. Métodos: Para este estudo retrospectivo transversal, examinamos todos os pacientes com toxoplasmose ocular ativa encaminhados ao nosso Setor de Uveíte nos últimos 12 anos, e incluímos pacientes com comprometimento do nervo óptico no estudo. O resultado primário foi a prevalência do envolvimento do nervo óptico, e os resultados secundários incluíram os tipos de envolvimento do nervo óptico e a acuidade visual final melhor corrigida após o tratamento. Resultados: A prevalência de acometimento do nervo óptico foi 14,4%, sendo a principal causa a ativação de uma lesão justapapilar (70,5%). Encontramos papilite em dois olhos e neuroretinite em dois olhos (11,7% para cada um). Apenas detectamos um comprometimento do nervo óptico secundário a uma lesão ativa distante (5,8%). Dezesseis pacientes (94,1%) apresentavam toxoplasmose ocular unilateral. A acuidade visual final com melhor correção após o tratamento foi 10/10 (LogMAR= 0,0) excluindo os três pacientes com uma cicatriz justapapilar envolvendo a mácula. Conclusões: O comprometimento do nervo óptico foi comum em pacientes com toxoplasmose ocular. O principal tipo de comprometimento do nervo óptico foi causado pela ativação de uma lesão justapapilar antiga. O tratamento foi rapidamente eficaz, mas a acuidade visual final com melhor correção foi dependente da presença de uma cicatriz no feixe papilomacular.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Adulto Joven , Enfermedades del Nervio Óptico/parasitología , Enfermedades del Nervio Óptico/patología , Toxoplasmosis Ocular/patología , Nervio Óptico/patología , Nervio Óptico/diagnóstico por imagen , Retinitis/parasitología , Retinitis/patología , Factores de Tiempo , Turquía/epidemiología , Agudeza Visual , Enfermedades del Nervio Óptico/tratamiento farmacológico , Enfermedades del Nervio Óptico/epidemiología , Papiledema/parasitología , Papiledema/patología , Toxoplasmosis Ocular/tratamiento farmacológico , Prevalencia , Estudios Transversales , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Centros de Atención TerciariaRESUMEN
PURPOSE: To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis. METHODS: For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study. The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment. RESULTS: The prevalence of optic nerve involvement was 14.4%, with the leading cause being the activation of a juxtapapillary lesion (70.5%). We found papillitis in two eyes and neuroretinitis in two eyes (11.7% for each). We only detected one optic nerve involvement secondary to a distant active lesion (5.8%). Sixteen patients (94.1%) had unilateral ocular toxoplasmosis. The overall final best-corrected visual acuity after treatment was 10/10 (LogMAR = 0.0) excluding the three patients with a juxtapapillary scar involving the macula. CONCLUSIONS: Optic nerve involvement was common in patients with ocular toxoplasmosis. The main type of optic nerve involvement was caused by activation of an old juxtapapillary lesion. Treatment was quickly effective, but the best-corrected visual acuity was dependent on the presence of a scar in the papillomacular bundle.
Asunto(s)
Enfermedades del Nervio Óptico/patología , Enfermedades del Nervio Óptico/parasitología , Toxoplasmosis Ocular/patología , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Nervio Óptico/diagnóstico por imagen , Nervio Óptico/patología , Enfermedades del Nervio Óptico/tratamiento farmacológico , Enfermedades del Nervio Óptico/epidemiología , Papiledema/parasitología , Papiledema/patología , Prevalencia , Retinitis/parasitología , Retinitis/patología , Estudios Retrospectivos , Centros de Atención Terciaria , Factores de Tiempo , Tomografía de Coherencia Óptica/métodos , Toxoplasmosis Ocular/tratamiento farmacológico , Toxoplasmosis Ocular/epidemiología , Turquía/epidemiología , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: This article reviews the history of Cuban epidemic optic neuropathy (1991-1993), which caused visual loss, peripheral neuralgias, and other neurologic symptoms in over 50,000 persons, an incidence of almost 0.5% of the entire population. The clinical findings, etiology, and treatment are described. We then relate the Cuban epidemic to the fictional epidemic of contagious blindness depicted by Nobel Laureate José Saramago in his 1995 novel Blindness. This novel describes an unnamed modern city in which all inhabitants, except the ophthalmologist's wife, are affected with a white, not black, blindness. DESIGN: Historical review and literary essay. METHODS: The sources for the Cuban epidemic were an extensive review of the published literature and personal communications with physicians who treated these patients. Both authors have analyzed the novel and the critical literature about Saramago's writings. RESULTS: Though Saramago uses the epidemic of blindness as an allegory to comment on human weakness and immorality, he may also have known of the actual Cuban epidemic. Saramago was a lifelong member of the Communist party, as well as a friend of Fidel Castro and admirer of the Cuban government. We have no proof that Blindness was influenced by the Cuban epidemic, but we find it plausible. CONCLUSION: It is valuable to examine the real and fictional epidemics side by side, not least because Saramago's novel depicts the actions of an ophthalmologist during an epidemic of blindness. Ophthalmologists may be interested in a novel that uses the language of eyes, vision, sight, and blindness extensively.
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Ceguera/historia , Medicina en la Literatura/historia , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/historia , Cuba/epidemiología , Brotes de Enfermedades/historia , Epidemias/historia , Hispánicos o Latinos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Incidencia , Portugal/epidemiologíaRESUMEN
From 1991 to 1993, an epidemic of optic and peripheral neuropathy-the largest of the century-broke out in Cuba, affecting more than 50,000 people. Initially the main clinical features were decreased visual acuity, central and cecocentral scotomas, impaired color vision and absence of the papillomacular bundle. Later, peripheral and mixed optic-peripheral forms began to appear. Due to the magnitude of the epidemic, the Cuban government requested help from the international community at the 46th World Health Assembly in 1993. PAHO and WHO immediately responded by sending a mission of international experts. Several hypotheses regarding the pathogenesis of Cuban epidemic neuropathy were put forward including: toxic, nutritional, genetic and infectious. The authors refer to extensive studies by researchers sponsored by the Cuban government and PAHO/WHO, joined by scientists from several other countries, including the USA. This paper describes their multidisciplinary work, particularly devoted to investigating the hypothesis of a primary toxic-nutritional cause of the epidemic. Clinical aspects, such as case definition and clinical description, were vital issues from the start. Cuban physicians who first examined patients received a clear impression of its toxic-nutritional origin, later confirmed by international experts. Research then focused on the mechanisms contributing to damage under the toxic-nutritional hypothesis. These included injuries to the mitochondrial oxidative phosphorylation pathway, nutritional deficiencies, excitotoxicity, formate toxicity and dysfunction of the blood-brain barrier. It was expected that the results of such international collaboration into this major health problem would also shed more light on mechanisms underlying other nutritional or tropical myeloneuropathies. KEYWORDS Optic neuritis, optic neuropathy, peripheral neuropathy, neurotoxicity syndromes, disease outbreaks, international cooperation, Cuba Erratum: Page 30, first complete paragraph, line 7, "Two models were developed independently by Cuban researchers" should read "Two models were developed independently by AAS and AGQ."
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Procesos de Grupo , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/etiología , Enfermedades del Sistema Nervioso Periférico/epidemiología , Enfermedades del Sistema Nervioso Periférico/etiología , Cuba/epidemiología , Brotes de Enfermedades , Epidemias , Abastecimiento de Alimentos , Humanos , Cooperación InternacionalRESUMEN
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect different ocular structures, such as cornea, conjunctiva, episclera, sclera, uveal tract, retina, optic nerve and vessels. Neuro-ophthalmologic manifestations in SLE include different degrees of involvement of retina, choroid and optic nerve. Retinal changes are one of the most common ocular involvements and are frequently used as clinical criteria for activity, even if isolated. Studies show that up to 29% of patients with active SLE manifest retinal disease. The exact prevalence of choroidal disease is unknown, but is thought to be less common than retinopathy, due to under-diagnosis. Optic nerve disease, represented by optic neuritis and anterior/posterior ischaemic optic neuropathy, affects approximately 1% of SLE patients. These ocular manifestations have been associated with neurologic flares, antiphospholipid antibodies, nephropathy, and increased mortality. The aim of this paper is to review the different aspects of neuro-ophthalmologic involvement in SLE. Since these manifestations are frequent and potentially severe, a multi-professional team approach is needed to investigate properly and provide early aggressive treatment in order to avoid visual sequelae.
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Lupus Eritematoso Sistémico/complicaciones , Enfermedades de la Retina/epidemiología , Anticuerpos Antifosfolípidos/metabolismo , Humanos , Lupus Eritematoso Sistémico/inmunología , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/etiología , Enfermedades del Nervio Óptico/patología , Enfermedades de la Retina/etiologíaRESUMEN
BACKGROUND: The objective was to investigate the frequency of fetal alcohol spectrum disorders (FASD) and ophthalmologic anomalies in orphanage children in Brazil. METHODS: A prospective study was performed on 94 children living in an orphanage in Brazil. The children were examined by a multidisciplinary team consisting of specialists in pediatrics, neurology, psychology, neuropsychiatry, and ophthalmology. RESULTS: The main reasons for living in the orphanage, in 61% of the children, were negligence, child abuse, and abandonment. Of all the children studied, 50% had mothers with known alcohol abuse and 47% had one or more diagnoses of neurodevelopmental/behavioral and/or cognitive deficits. General developmental delay was found in 18%, intellectual disability in 3%, cognitive impairment in 27%, attention-deficit/hyperactivity disorder in 14%, and autism in 3%. Altogether 17% had FASD, comprising three children with fetal alcohol syndrome (FAS), six with partial FAS, and seven with alcohol-related neurodevelopmental disorder. 16% had ophthalmological findings such as poor vision, strabismus, and dysmorphology of the optic nerves. Twenty-eight children (30%) were adopted from the orphanage; of these, six had FASD (two FAS, three partial FAS, one alcohol-related neurodevelopmental disorder), five had attention-deficit/hyperactivity disorder, and eight had developmental delay. CONCLUSION: Nearly half of the children living in the orphanage had neurodevelopmental disorders and a considerable number showed signs of damage from prenatal alcohol exposure. A broader look at the problem of FASD in Brazil and other South American countries is desirable to document the burden of disease and provide data for targeting prevention efforts.
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Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Anomalías del Ojo/epidemiología , Trastornos del Espectro Alcohólico Fetal/epidemiología , Trastornos del Neurodesarrollo/epidemiología , Enfermedades del Nervio Óptico/epidemiología , Orfanatos , Adolescente , Brasil , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
Las neuropatías ópticas son causa frecuente de baja visión y ceguera. Se identificaron algunas variables clínico epidemiológicas de los pacientes atendidos con el diagnóstico de neuropatía óptica en la consulta de Baja Visión del Hospital General Provincial Docente: Antonio Luaces Iraola de Ciego de Ávila durante el período comprendido de enero 2009 a octubre 2011. Se realizó un estudio observacional descriptivo retrospectivo en 120 pacientes con el mencionado Diagnóstico. El 57,5 por ciento de los pacientes pertenecían al grupo de edad de 61 a 80 años, predominó el sexo masculino (60 por ciento), el 75 por ciento de los pacientes presentaban atrofia óptica glaucomatosa, del total de pacientes con atrofia óptica glaucomatosa, el 56.7 por ciento de los pacientes procedieron del municipio Ciego de Ávila. Fueron clasificados el 70.8 por ciento como de débiles visuales ligeros y el 65 por ciento de los pacientes se rehabilitó. El grupo de edad de entre 61 y 80 años y el sexo masculino fueron los que aportaron el mayor número de casos, la neuropatía óptica glauco matosa y la procedencia urbana fueron las que predominaron en la investigación, la mayor parte de los pacientes atendidos fueron clasificados de baja visión y rehabilitados (AU)
Optic neuropathies are frequent cause of low vision and blindness. Some clinical epidemiologists variables were identified from patients attended with optic neuropathies diagnosis in the consultation of Low Vision at Dr. Antonio Luaces Iraola Provincial General Teaching Hospital of Ciego de Ávila from January 2009 to October 2011. A retrospective descriptive observacional study was carried out in 120 patients with the diagnosis mentioned before. 57.5 percent of patients belonged to the age group from 61 to 80 years, masculine sex predominated (60 percent), 75 percent of patients presented glaucomatous optic atrophy, from these 56.7 percent came from Ciego de Avila municipality. The 70.8 percent were classified as low vision and 65 percent of the patients were rehabilitated. Masculine sex and the group of age between 61 and 80 years were those that contributed the greater number of cases, the glaucomatous optic neuropathy and the urban origin were those that predominated in the investigation, most of the attended patients were classified as low vision and they were rehabilitated (AU)
Asunto(s)
Humanos , Masculino , Femenino , Enfermedades del Nervio Óptico/epidemiología , Baja Visión , Epidemiología Descriptiva , Estudios Retrospectivos , Estudios Observacionales como AsuntoRESUMEN
Se realiza una reseña histórica de la Neurología en Cuba. La evolución de la especialidad en Cuba ha sido abordada en etapas que se vinculan con el desenvolvimiento histórico general de la salud pública, y se particularizan acorde a diversos aspectos: el desempeño de diversos neurocientíficos notables, la fundación de instituciones especializadas, la formación ydistribución de neurólogos, la introducción de servicios avanzados, los principales problemas de salud neurológicos, etc. Se precisan los principales logros de la Neurología cubana, sin obviar sus insuficiencias y retos(AU)
A historical review was carried out about Cuban neurology. The evolution of neurology in Cuba was considered in stages related with the general historical development of public health, and was divided regarding various aspects: the development of remarkable neuroscientifics, the foundation of neurological institutions, the formation and distributions of neurologist, theintroduction of modern services, the main neurological health problems, etc. The main achievements of Cuban neurology were stated, without obviation of lacks and challenges.Key words. Cuba. Classic neurology literature. History of the Medicine. Neurology. Neurological institutions.Neuroscientifics(AU)
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Cuba , Neurología/historia , Neurocirugia/historia , Epilepsia/historia , Neurociencias/historia , Meningitis Meningocócica/epidemiología , Meningitis Meningocócica/mortalidad , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Nervio Óptico/epidemiología , Internado y Residencia , Unidades HospitalariasRESUMEN
OBJECTIVE: Peripheral neuropathy (PN) and optic neuropathy (ON) associated with linezolid use are described in the adult literature; however limited information is available in pediatrics. The purpose of this communication is to summarize pediatric cases of linezolid-associated neuropathy and to increase awareness of these neurologic side effects so that clinicians can most appropriately balance the benefits and risks of linezolid in the pediatric population. METHODS: A search of the FDA Adverse Events Reporting System was performed for all pediatric cases of neuropathy from April 2000-2009. AERS includes both inpatient and outpatient data. Inpatient utilization patterns for linezolid were also assessed from January 2000 to December 2008. RESULTS: Eight pediatric cases of linezolid-associated neuropathy were identified. Treatment duration ranged from 4 weeks to 1 year. Five patients had PN alone, one had only ON and two had both. Symptoms of PN included pain, numbness, weakness, and paresthesias. Symptoms of ON included decreased visual acuity and color vision. Three children had other adverse events associated with linezolid including acidosis, anemia, and leukopenia. Outcomes were reported in 5 cases. Resolution of symptoms occurred between 2 weeks and 6 months after discontinuation of linezolid. Utilization data showed that during the study period, overall inpatient utilization of linezolid had increased. CONCLUSIONS: While linezolid may be used to treat serious infections often needing extended courses of therapy, potential safety concerns should be kept in mind. In the circumstance of prolonged use of linezolid in children, it is likely that more cases of neuropathy may occur.
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Acetamidas/efectos adversos , Enfermedades del Nervio Óptico/inducido químicamente , Oxazolidinonas/efectos adversos , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Adolescente , Antiinfecciosos/efectos adversos , Argentina/epidemiología , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Infecciones/tratamiento farmacológico , Linezolid , Masculino , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Sistema Nervioso Periférico/epidemiología , Factores de RiesgoRESUMEN
When Cuba was hit by a neuropathy epidemic two decades ago, Dr Rosaralis Santiesteban was one of the Cuban health professionals who played a key role in its management, as reflected in a recent issue of Seminars in Ophthalmology. She was well prepared for her part: trained in medicine at the University of Havana before completing a residency in ophthalmology and eventually a doctorate in medical sciences, she has received multiple honors for her research, publishing and teaching. In 2007, she was named Distinguished Researcher by the Cuban Ministry of Science, Technology and the Environment. She has headed the Department of Neuro-ophthalmology at Cuba's Neurology and Neurosurgery Institute since 1977. Now called Cuban Epidemic Neuropathy, the 1990s epidemic that affected over 50,000 Cubans is the largest and best-documented of its kind in history. As researchers pressed to unravel the mystery of its etiology to hasten the epidemic's end, Dr Santiesteban recognized that similar outbreaks had occurred during Cuba's wars of independence in the late 1800s--described in her book, Epidemias y Endemias de neuropatía en Cuba. In the proverbial eye of the storm during the 1990s epidemic, she shares her reflections below on the context, causes, evolution and lessons learned from the challenge that put Cuba's health system to the test.
Asunto(s)
Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Sistema Nervioso Periférico/epidemiología , Trastornos de la Visión/epidemiología , Cuba/epidemiología , Brotes de Enfermedades , Femenino , Humanos , Cooperación Internacional , Masculino , Enfermedades del Nervio Óptico/tratamiento farmacológico , Enfermedades del Nervio Óptico/etiología , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/etiología , Administración en Salud Pública , Trastornos de la Visión/etiología , Trastornos de la Visión/rehabilitaciónRESUMEN
The similarities and differences between toxic/nutritional and hereditary optic neuropathy and the pathophysiologic mechanisms that they have in common are described. This is based on data from the epidemic suffered in Cuba in 1992, which affected the optic nerves of many individuals and the experience of the authors in dealing with various toxic optic neuropathies, as well as Leber's hereditary optic neuropathy.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Atrofias Ópticas Hereditarias/epidemiología , Fumar/epidemiología , Cuba/epidemiología , Humanos , Atrofias Ópticas Hereditarias/diagnóstico , Atrofias Ópticas Hereditarias/fisiopatología , Atrofia Óptica Hereditaria de Leber/diagnóstico , Atrofia Óptica Hereditaria de Leber/epidemiología , Atrofia Óptica Hereditaria de Leber/fisiopatología , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/fisiopatologíaRESUMEN
PURPOSE: To investigate the correlation between optic disc hemorrhages (ODHs) and the position of the central retinal vessel trunk (RVT) in patients with glaucoma. METHODS: Fundus photographs of 1,830 participants were reviewed. The exit position of the central retinal vessel trunk was classified as being in the superior or inferior hemisphere of the optic disc and the relative vertical position was expressed as a fraction of the disc diameter (ratio between the position of the trunk and the diameter of the disk). A group of patients from the same population, but without ODHs, was randomly selected and compared with the patients with ODHs. RESULTS: Among the 1,830 patients, 53 hemorrhages were detected in 41 patients with glaucoma or suspected glaucoma. We found an inverse relationship between the inferior/superior position of the central RVT and the inferior/superior position of the hemorrhages (Kappa=-0.34). Using the trunk/disc ratio, we found that superior ODHs correlated with inferior RVTs (trunk/disc ratio, 0.450; SD=0.070) and inferior ODHs correlated with superior RVTs (trunk/disc ratio, 0.510; SD=0.054) (p=0.027). The number of patients with normal tension glaucoma was significantly higher among patients with ODHs than among those without ODHs (p=0.009). CONCLUSION: Our patients had a negative correlation between the position of central RVT and the location of the ODHs. Normal tension glaucoma was more prevalent among patients with ODHs than among those without it.
Asunto(s)
Hemorragia del Ojo/patología , Glaucoma/complicaciones , Disco Óptico/patología , Enfermedades del Nervio Óptico/patología , Vasos Retinianos/patología , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Métodos Epidemiológicos , Hemorragia del Ojo/epidemiología , Femenino , Fondo de Ojo , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Hipertensión Ocular/epidemiología , Hipertensión Ocular/patología , Hipertensión Ocular/fisiopatología , Enfermedades del Nervio Óptico/epidemiología , FotograbarRESUMEN
OBJETIVOS: Avaliar a correlação entre as hemorragias peripapilares (HPPs) e a posição do tronco vascular na cabeça do nervo óptico. MÉTODOS: Retinografias de 1.830 pacientes foram revisadas. A posição do tronco vascular retiniano (TVR) foi classificada de acordo com sua localização no hemisfério superior ou inferior e sua posição relativa através da razão entre a distância entre o TVR e o ponto mais inferior do disco óptico e o diâmetro vertical do disco óptico (razão tronco/disco). Pacientes da mesma população, com glaucoma e sem HPPs foram aleatoriamente selecionados para comparação. RESULTADOS: Dos 1.830 pacientes, 46 apresentaram HPPs. Foram detectadas 53 hemorragias em 41 pacientes com glaucoma ou suspeitos de glaucoma, principalmente na região temporal inferior (47,2 por cento). Observou-se concordância negativa entre a localização superior ou inferior do TVR e das HPPs (Kappa= -0,34). Considerando a posição relativa do TVR em relação ao diâmetro vertical do disco óptico (razão tronco/disco), encontramos melhor correlação (valores médios da razão tronco/disco: 0,450-hemorragias superiores e 0,510-hemorragias inferiores; p=0,027). No grupo com HPPs, observamos porcentagem significativamente maior de pacientes com glaucoma de pressão normal (GPN) se comparado ao grupo sem hemorragia (p=0,009). CONCLUSÃO: HPPs foram mais comuns no hemisfério oposto ao da emergência do TVR. Observamos maior prevalência de GPN nos pacientes com hemorragias que nos sem hemorragia.
PURPOSE: To investigate the correlation between optic disc hemorrhages (ODHs) and the position of the central retinal vessel trunk (RVT) in patients with glaucoma. METHODS: Fundus photographs of 1,830 participants were reviewed. The exit position of the central retinal vessel trunk was classified as being in the superior or inferior hemisphere of the optic disc and the relative vertical position was expressed as a fraction of the disc diameter (ratio between the position of the trunk and the diameter of the disk). A group of patients from the same population, but without ODHs, was randomly selected and compared with the patients with ODHs. RESULTS: Among the 1,830 patients, 53 hemorrhages were detected in 41 patients with glaucoma or suspected glaucoma. We found an inverse relationship between the inferior/superior position of the central RVT and the inferior/superior position of the hemorrhages (Kappa= -0.34). Using the trunk/disc ratio, we found that superior ODHs correlated with inferior RVTs (trunk/disc ratio, 0.450; SD=0.070) and inferior ODHs correlated with superior RVTs (trunk/disc ratio, 0.510; SD=0.054) (p=0.027). The number of patients with normal tension glaucoma was significantly higher among patients with ODHs than among those without ODHs (p=0.009). CONCLUSION: Our patients had a negative correlation between the position of central RVT and the location of the ODHs. Normal tension glaucoma was more prevalent among patients with ODHs than among those without it.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hemorragia del Ojo/patología , Glaucoma/complicaciones , Disco Óptico/patología , Enfermedades del Nervio Óptico/patología , Vasos Retinianos/patología , Brasil/epidemiología , Métodos Epidemiológicos , Hemorragia del Ojo/epidemiología , Fondo de Ojo , Presión Intraocular/fisiología , Hipertensión Ocular/epidemiología , Hipertensión Ocular/patología , Hipertensión Ocular/fisiopatología , Enfermedades del Nervio Óptico/epidemiología , FotograbarRESUMEN
BACKGROUND AND PURPOSE: There are practically no references to cerebrospinal fluid (CSF) studies in tropical or nutritional neuropathies. In the present paper we present the results of CSF studies in patients with Cuban Epidemic Optic Neuropathy (CEON) during epidemic and endemic periods, with an appraisal as to the contribution of brain barriers' function in the pathophysiology of this disease. METHODS: Two hundred and five patients with CEON were studied during the epidemic period (1992-1993) and 12 patients outside the outbreak (1995-1997). CSF protein determination and electrophoresis were carried out, as well as serum and CSF albumin and immunoglobulin G (IgG) quantitation for calculating IgG and Q(alb) indexes, in order to evaluate intrathecal IgG synthesis and the permeability of the blood-CSF barrier (B-CSF B). RESULTS: One fourth of the patients had increased permeability of the B-CSF B, but damage was more frequent between 16 and 60 days from onset of disease, disappearing after 120 days. B-CSF B dysfunction was more prevalent in patients with severe neurological impairment, although it was not related to the severity of ophthalmological damage. The group of patients studied outside of the outbreak (endemic period) showed similar results. DISCUSSION: The possible association of increased permeability of the B-CSF B with oxidative stress, which lies on the basis of this epidemic outbreak, is discussed.
Asunto(s)
Barrera Hematoencefálica/patología , Brotes de Enfermedades , Enfermedades del Nervio Óptico/líquido cefalorraquídeo , Enfermedades del Nervio Óptico/epidemiología , Adulto , Anciano , Cuba/epidemiología , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/líquido cefalorraquídeo , Masculino , Persona de Mediana Edad , Enfermedades del Nervio Óptico/patología , TiempoRESUMEN
PURPOSE: To assess the prevalence of glaucoma in a South Brazilian population. METHODS: Subjects older than 40 years underwent a screening examination that included a medical interview, slit lamp examination, tonometry, and fundoscopy. Those with suspected glaucoma (based on optic disc appearance and/or intraocular pressure) underwent a comprehensive ophthalmic evaluation during the definitive examination. Glaucoma was diagnosed based on the International Society of Geographical and Epidemiologic Ophthalmology classification. RESULTS: A total of 1636 subjects were examined (76.5% participation rate); 71% of the study population self-reported their race as white and 24% as nonwhite (most black and mixed-black/white). Glaucoma was found in 56 subjects (crude prevalence of all glaucoma: 3.4%; 95% CI, 2.5-4.3), primary open-angle glaucoma (POAG) was found in 40 (2.4%; 95% CI, 1.7-3.2), and primary angle-closure glaucoma (PACG) in 12 (0.7%; 95% CI, 0.3-1.1). Six (12%) subjects with primary glaucoma had a previous diagnosis of the disease. Nonwhite persons had a higher prevalence rate of POAG than did white participants, although this difference was not significant (3.8% vs. 2.1%, respectively, P = 0.11). Unilateral blindness due to primary glaucoma was observed in seven subjects (five POAG/2 PACG), and nonwhites had a higher rate of unilateral blindness than did whites (five versus two cases, respectively, P = 0.014). CONCLUSIONS: Compared to incidence in Hispanic and European populations, PACG was more common among South Brazilians, whereas the POAG rates were similar. The rate of undiagnosed glaucoma was almost 90%. The higher POAG prevalence in the population self-reported as nonwhite may affect the estimation of glaucoma in Brazil, as more than 40% of the population self-report their race as nonwhite.
Asunto(s)
Glaucoma de Ángulo Cerrado/epidemiología , Glaucoma de Ángulo Abierto/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Femenino , Glaucoma de Ángulo Cerrado/diagnóstico , Glaucoma de Ángulo Abierto/diagnóstico , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Disco Óptico/patología , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/epidemiología , Prevalencia , Trastornos de la Visión/diagnóstico , Campos VisualesRESUMEN
PURPOSE: To determine causes of visual impairment in children at the Low Vision Service of the Ophthalmic Clinic at the University of São Paulo and at the Brazilian Association for the Visually Impaired People (Laramara), located in São Paulo, Brazil. PATIENTS AND METHODS: This study evaluated 3,210 visually impaired children (49% female, 51% male; average age, 5.9 years). Visual impairment was present in 57% (visually impaired group) and 43% presented another associated disability (multiple disability group). RESULTS: The main causes of visual impairment in the visually impaired group were toxoplasmic macular retinochoroiditis (20.7%), retinal dystrophies (12.2%), retinopathy of prematurity (11.8%), ocular malformation (11.6%), congenital glaucoma (10.8%), optic atrophy (9.7%), and congenital cataracts (7.1%). The main causes of visual impairment in the multiple disability group were optic atrophy (37.7%), cortical visual impairment (19.7%), toxoplasmic macular retinochoroiditis (8.6%), retinopathy of prematurity (7.6%), ocular malformation (6.8%), congenital cataracts (6.1%), and degenerative disorders of the retina and macula (4.8%). The retina was the most frequently affected anatomic site in the visually impaired group (49.2%) and the optic nerve in the multiple disability group (39%). CONCLUSION: Primary, secondary, and tertiary prevention efforts for childhood blindness and visual rehabilitation must be considered in Latin America.
Asunto(s)
Ceguera Cortical/complicaciones , Catarata/complicaciones , Anomalías del Ojo/complicaciones , Glaucoma/complicaciones , Enfermedades del Nervio Óptico/complicaciones , Enfermedades de la Retina/complicaciones , Baja Visión/etiología , Adolescente , Ceguera Cortical/epidemiología , Brasil/epidemiología , Catarata/congénito , Catarata/epidemiología , Niño , Preescolar , Evaluación de la Discapacidad , Anomalías del Ojo/epidemiología , Femenino , Glaucoma/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Enfermedades del Nervio Óptico/epidemiología , Prevalencia , Pronóstico , Enfermedades de la Retina/epidemiología , Estudios Retrospectivos , Baja Visión/diagnóstico , Baja Visión/rehabilitaciónRESUMEN
Alzheimer's disease (AD), is a major public health problem among the elderly in industrialized countries and a growing problem in developing countries. In Cuba, 14,6% of the population is older than 60 years. The AD prevalence in Cuba lies between 5,13-7,14%. Several studies have shown the relationship between the low nutritional status of B vitamins, hyperhomocysteinaemia with loss of neuro-cognitive function and AD. In studies during the epidemic neuropathy that affected Cuba between 1992-1993, B vitamins deficiency and smoking habits were strongly associated with the epidemic. Some studies in healthy adults and elderly after this epidemic have shown a sub-clinical deficiency of some B vitamins and a high prevalence of infection by Helicobacter pylori. The possibility that B vitamin deficiencies could be an additional risk factor for the high prevalence of the AD in Cuba is discussed.
Asunto(s)
Enfermedad de Alzheimer/epidemiología , Estado Nutricional , Deficiencia de Vitamina B/complicaciones , Anciano , Enfermedad de Alzheimer/sangre , Enfermedad de Alzheimer/etiología , Cuba/epidemiología , Femenino , Humanos , Hiperhomocisteinemia/complicaciones , Hiperhomocisteinemia/epidemiología , Masculino , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/etiología , Enfermedades del Sistema Nervioso Periférico/epidemiología , Enfermedades del Sistema Nervioso Periférico/etiología , Deficiencia de Vitamina B/epidemiologíaRESUMEN
OBJECTIVE: To study the distribution of septo-optic dysplasia (SOD) and optic nerve hypoplasia (ONH) in the Greater Manchester and Lancashire (GM&L) region of Northwest England, and to analyze occurrence by location and over time. STUDY DESIGN: A population-based incidence study was undertaken for cases of SOD/ONH from GM&L. Standardized incidence ratio (SIR) for each district, relationships between SIRs and possible geographically varying risk factors, and spatial and space-time clustering were analyzed. RESULTS: Eighty-seven cases had a confirmed diagnosis of ONH/SOD giving an incidence of 10.9/100,000 per year in GM&L. SIRs ranged widely but were significantly elevated (lower confidence limit >100) in three districts: 167%, 192%, and 198%, respectively. All three were high population density, inner-city locations. SIRs were significantly correlated with higher rates of unemployment (r = 0.49, P = .01), dependent children in non-earning households (r = 0.47, P = .02), underage conceptions (r = 0.46, P = .02), and underage pregnancies (r = 0.44, P = .03). There was no evidence of spatial or space-time clustering. CONCLUSIONS: The incidence of ONH/SOD in GM&L was higher than that reported elsewhere. Cases were more common in areas that had higher unemployment and teenage pregnancy rates.