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PURPOSE: Antineoplastic treatments, mainly chemotherapy, affect the kidneys, causing toxicity, and can trigger acute and chronic kidney injuries. This study aimed to analyze the prevalence of renal disorders in patients with oncohematological neoplasms receiving antineoplastic treatment. METHODS: This retrospective cohort study included 75 patients with hematological cancer who underwent chemotherapy between 2012 and 2018 in the Hematology Sector of the Walter Cantídeo University Hospital of the Federal University of Ceará. Sociodemographic and clinical data, blood biochemical assessment findings, and glomerular filtration rate (GFR) were analyzed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The data were tabulated; transferred to the Statistical Package for the Social Sciences software, version 20.0; and analyzed using Pearson's chi-square test or Fisher's exact test for categorical variables followed by a multinomial logistic regression model (p < 0.05). RESULTS: The prevalence of renal disorders was 52.4% according to the CKD-EPI equation for GFR events. There was a significant association between the decrease in GFRs and the following variables: female sex (p = 0.002), diagnosis of multiple myeloma (p = 0.008), start of treatment within 40 days (p = 0.005), and the following antineoplastic treatments: cyclophosphamide, vincristine, and prednisone (p = 0.026); irarubicin (p = 0.032); azacytidine, dexamethasone, and cyclophosphamide (p < 0.001); zoledronic acid (p < 0.001); and pamidronate (p = 0.012). CALGB 8811 (p < 0.001) was inversely associated with a reduction in the GFR. CONCLUSIONS: The prevalence of renal disorders was high in patients with oncohematological neoplasms receiving antineoplastic treatment. This requires periodic monitoring of the evaluation of renal function since reductions in GFRs were significantly associated with different treatment protocols used.

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BACKGROUND: Acid inhibition from chronic proton pump inhibitor use and a possible increase in gastrin can lead to changes in the regulation of hydrochloric acid production. However, it has not known whether such chronic use changes the presence of gastrin, delta, and enterochromaffin-like cells in the stomach or the relationship between gastrin and delta cells. AIM: To analyze the number of gastrin-producing gastrin cells, somatostatin-producing cells, and histamine-producing cells in patients who were chronic users of proton pump inhibitor, with or without related Helicobacter pylori infection. METHODS: Biopsies from 105 patients, including 81 chronic proton pump inhibitor users (experimental group) and 24 controls, were processed immunohistochemically and subjected to counting of gastrin, delta, and enterochromaffin-like cells in high-magnification microscopic fields and in 10 glands. RESULTS: Gastrin cell, delta cell, and enterochromaffin-like cells counts were similar across the groups and appeared to be unaffected by Helicobacter pylori infection. The ratio between gastrin cells and delta cells was higher in the chronic users of proton pump inhibitor group than in controls. CONCLUSION: Chronic users of proton pump inhibitor does not affect gastrin cell, delta cell, and enterochromaffin-like cell counts significantly, but may alter the ratio between gastrin cells and delta cells.

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ABSTRACT Background: Acid inhibition from chronic proton pump inhibitor use and a possible increase in gastrin can lead to changes in the regulation of hydrochloric acid production. However, it has not known whether such chronic use changes the presence of gastrin, delta, and enterochromaffin-like cells in the stomach or the relationship between gastrin and delta cells. Aim: To analyze the number of gastrin-producing gastrin cells, somatostatin-producing cells, and histamine-producing cells in patients who were chronic users of proton pump inhibitor, with or without related Helicobacter pylori infection. Methods: Biopsies from 105 patients, including 81 chronic proton pump inhibitor users (experimental group) and 24 controls, were processed immunohistochemically and subjected to counting of gastrin, delta, and enterochromaffin-like cells in high-magnification microscopic fields and in 10 glands. Results: Gastrin cell, delta cell, and enterochromaffin-like cells counts were similar across the groups and appeared to be unaffected by Helicobacter pylori infection. The ratio between gastrin cells and delta cells was higher in the chronic users of proton pump inhibitor group than in controls. Conclusion: Chronic users of proton pump inhibitor does not affect gastrin cell, delta cell, and enterochromaffin-like cell counts significantly, but may alter the ratio between gastrin cells and delta cells.

RESUMO Racional: A inibição ácida pelo uso crônico de inibidores de bomba de prótons e o possível aumento da gastrina podem ser seguidos de alterações na regulação da produção do ácido clorídrico. Ainda não está definido se o uso crônico altera a quantidade de células G, D e ECL no estômago ou a razão células G/D. Objetivo: Avaliar o número de células G - produtoras de gastrina -, células D - produtoras de somatostatina - e células ECL - produtoras de histamina -, em pacientes com uso crônico de inibidores de bomba de prótons, com ou sem infecção pelo Helicobacter pylori. Método: Trata-se de estudo retrospectivo avaliando 105 pacientes, 81 usadores crônicos de inibidores de bomba de prótons e 24 controles, através de biópsias com contagem das células G, D e ECL por estudo imunoistoquímico, de forma quantitativa onde havia maior número de células positivas por campo microscópico de grande aumento e em 10 glândulas. Resultados: Não houve diferença estatística comparando-se o número de células G, D e ECL. A razão entre as células G e D foi maior nos pacientes usadores crônicos de inibidores de bomba de prótons. Conclusão: O uso crônico de inibidores de prótons parece não interferir na contagem das células G, D e ECL, porém, interfere na razão entre as células G e D.

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Trypanosoma cruzi and Helicobacter pylori (HP) are pathogens that cause chronic diseases and have been associated with hypergastrinemia. The aim of this study was to evaluate the fasting gastrin levels in patients with different clinical forms of Chagas disease (CD), coinfected or not by HP. The enrolled individuals were outpatients attending at the university hospital. HP infection was assessed by serology and 13 C-urea breath test. Fasting serum gastrin concentration was measured by chemiluminescence assay. Gastric endoscopic and histological features were also evaluated. Associations between CD and serum gastrin level were evaluated in a logistical model, adjusting for age, gender and HP status. A total of 113 patients were evaluated (45 with Chagas disease and 68 controls). In the multivariate analysis, increasing serum gastrin levels (OR= 1.02; 95% CI= 1.01-1.12), increasing age (OR= 1.05; 95% CI= 1.02 - 1.09) and HP-positive status (OR = 2.88; 95% CI = 1.10 - 7.51) remained independently associated with CD. The serum gastrin levels were significantly higher in the group of patients with the cardiodigestive form ( P = 0.03) as well as with digestive form ( P = <0.001) of Chagas disease than in the controls. In conclusion, patients with cardiodigestive and digestive clinical forms of CD have increased basal serum gastrin levels in comparison with controls. Moreover, we also demonstrated that H. pylori coinfection contributes to the hypergastrinemia shown in CD.

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We report a case of ocular sarcoidosis with positive immunoglobulin (Ig) M and IgG serology for toxoplasmosis. The patient was a young female with red painful eyes, bilateral eyelid edema, and panuveitis with periphlebitis. In laboratory testing, she was IgM and IgG positive for toxoplasmosis and anergic in the tuberculin test. Topical treatment for anterior uveitis and oral antibiotics for toxoplasmosis were started, without improvement. Orbit tomography showed increased lacrimal glands bilaterally, and chest X-ray radiographic findings were consistent with pulmonary sarcoidosis, which supported the presumed ocular sarcoidosis diagnosis. The patient was treated with oral prednisone and methotrexate without antibiotics. She showed clinical and vision improvement without recurrences during the 1-year follow-up. Ocular sarcoidosis is an important differential diagnosis requiring careful anamnesis and ophthalmological examinations. Ancillary tests, such as X-ray radiography, tomography, and clinical and laboratory evaluations may help rule out other causes. Treatment mainly consists of corticosteroids and immunosuppression.

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Resumo O Lúpus Eritematoso sistêmico (LES) é uma doença autoimune que pode afetar o olho de diversas formas. A coroidopatia lúpica é rara e apresenta-se com descolamento seroso de retina, descolamento do epitélio pigmentar da retina (EPR) e epiteliopatia pigmentar. A maioria dos casos está associada à atividade sistêmica da doença, podendo ser considerada um fator de gravidade e necessidade de imunossupressão intensa. Geralmente apresenta bom prognóstico visual com o tratamento adequado do LES, apesar de alguns casos evoluírem com danos irreversíveis na retina externa e EPR. Descrevemos um caso de coroidopatia secundaria ao LES com atividade multisistêmica com boa evolução após tratamento clínico com imunossupressão sistêmica.

Abstract Systemic lupus erythematosus (SLE) is an autoimmune disease in which can affect the eye in different ways. Lupus choroidopathy is rare and include retinal pigment epithelium (RPE) detachment and/or serous retinal detachment and pigment epitheliopathy. Most cases are associated with systemic disease activity and can be considered a factor of gravity and need for intense immunosuppression. Usually has good visual prognosis with proper treatment of SLE, although some cases may have irreversible damage to the outer retina and RPE. We describe a case of choroidopathy secondary to SLE during its multisystem activity with good clinical outcome after treatment with systemic immunosuppression.

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ABSTRACT We report a case of ocular sarcoidosis with positive immunoglobulin (Ig) M and IgG serology for toxoplasmosis. The patient was a young female with red painful eyes, bilateral eyelid edema, and panuveitis with periphlebitis. In laboratory testing, she was IgM and IgG positive for toxoplasmosis and anergic in the tuberculin test. Topical treatment for anterior uveitis and oral antibiotics for toxoplasmosis were started, without improvement. Orbit tomography showed increased lacrimal glands bilaterally, and chest X-ray radiographic findings were consistent with pulmonary sarcoidosis, which supported the presumed ocular sarcoidosis diagnosis. The patient was treated with oral prednisone and methotrexate without antibiotics. She showed clinical and vision improvement without recurrences during the 1-year follow-up. Ocular sarcoidosis is an important differential diagnosis requiring careful anamnesis and ophthalmological examinations. Ancillary tests, such as X-ray radiography, tomography, and clinical and laboratory evaluations may help rule out other causes. Treatment mainly consists of corticosteroids and immunosuppression.

RESUMO Relatamos um caso de sarcoidose ocular com IgM e IgG positivos para toxoplasmose. Mulher jovem com quadro ocular bilateral de dor, vermelhidão, edema palpebral e panuveíte com periflebite. Os testes laboratoriais mostraram IgM e IgG positivos para toxoplasmose, teste tuberculínico anérgico. Realizou-se tratamento tópico da uveíte anterior e antibióticos orais para toxoplasmose, sem melhora. Tomografia de órbita mostrou aumento das glândulas lacrimais bilaterais e radiografia de tórax foi consistente com sarcoidose pulmonar, auxiliando no diagnóstico de sarcoidose ocular presumida. Iniciou-se prednisona e metotrexato orais, sem antibióticos, com melhora clínica e oftalmológica, sem recidivas em 1 ano de follow-up. Sarcoidose ocular é um importante diagnóstico diferencial que exige anamnese e exame oftalmológico cuidadosos. Exames complementares, como raio-X, tomografia computadorizada e avaliação clínica e laboratorial ajudam na avaliação e exclusão de outras causas. O tratamento consiste principalmente no uso de corticosteróide e imunossupressores.

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal adverse drug reaction associated with skin rash, fever, eosinophilia, and multiple organ injury. A number of pharmacological agents are known to cause DRESS syndrome such as allopurinol, anticonvulsants, vancomycin, trimethoprime-sulfamethoxazole, and pyrimethamine-sulfadiazine. Here, we describe two patients who developed DRESS syndrome during ocular treatment. The first case was being treated for late postoperative endophthalmitis with topical antibiotics, intravenous cephalothin, meropenem, and intravitreal injection of vancomycin and ceftazidime before symptoms developed. We were unable to identify the causal drug owing to the large number of medications concurrently administered. The second case presented with DRESS syndrome symptoms during ocular toxoplasmosis treatment. In this case, a clearer association with pyrimethamine-sulfadiazine was observed. As a result of the regular prescription of pharmacological agents associated with DRESS syndrome, ophthalmologists should be aware of the potentially serious complications of DRESS syndrome.

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ABSTRACT Pilomatrixoma is a rare benign tumor, which usually affects young women in the head and neck region. The eyelid is a common site of the disease, though it is very rare in the tarsal conjunctiva.The pilomatrixoma has clinical pleomorphism, which confuses this disease with other similar conditions. The diagnosis is made by pathological examination in most cases. The treatment is surgical, performed by total excision of the lesion with clear margins and recurrence is very uncommon.We present an unusual case of probable recurrent pilomatrixoma in the left upper tarsal conjunctiva.

RESUMO O pilomatricoma é uma neoplasia benigna rara, geralmente acomete mulheres jovens, ocorrendo na região da cabeça e pescoço. A pálpebra é um local comum de aparecimento do pilomatricoma, contudo, seu aparecimento na conjuntiva tarsal é muito raro. O diagnóstico é feito pelo exame anátomo-patológico na maioria dos casos, pois seu pleomorfismo clínico o confunde com outras alterações. O tratamento é cirúrgico, realizado por meio da exérese total da lesão com margens livres. São raros os casos de recidiva. Apresentamos um caso atípico de provável recidiva de pilomatricoma, localizado na conjuntiva tarsal superior à esquerda.

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ABSTRACT Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal adverse drug reaction associated with skin rash, fever, eosinophilia, and multiple organ injury. A number of pharmacological agents are known to cause DRESS syndrome such as allopurinol, anticonvulsants, vancomycin, trimethoprime-sulfamethoxazole, and pyrimethamine-sulfadiazine. Here, we describe two patients who developed DRESS syndrome during ocular treatment. The first case was being treated for late postoperative endophthalmitis with topical antibiotics, intravenous cephalothin, meropenem, and intravitreal injection of vancomycin and ceftazidime before symptoms developed. We were unable to identify the causal drug owing to the large number of medications concurrently administered. The second case presented with DRESS syndrome symptoms during ocular toxoplasmosis treatment. In this case, a clearer association with pyrimethamine-sulfadiazine was observed. As a result of the regular prescription of pharmacological agents associated with DRESS syndrome, ophthalmologists should be aware of the potentially serious complications of DRESS syndrome.

RESUMO Síndrome DRESS (drug reaction with eosinophilia and systemic symptoms) é uma reação adversa a medicamentos rara e potencialmente fatal, associada à rash cutâneo, febre, eosinofilia e lesão de múltiplos órgãos. Algumas drogas podem desencadeá-la, como: alopurinol, anticonvulsivantes, vancomicina, sulfametoxazol-trimetoprim, sulfadiazina-pirimetamina, entre outras. Descrevemos dois casos que desenvolverem DRESS síndrome durante tratamento ocular. O primeiro caso apresentou os sintomas durante tratamento para endoftalmite pós-operatória tardia com antibióticos tópicos, cefalotina e meropenem intravenosos e injeção intravítrea de vancomicina e ceftazidima; não podemos identificar a droga causadora, pois múltiplas medicações foram utilizadas. O segundo caso desenvolveu os sintomas durante tratamento clássico para toxoplasmose ocular, então a associação com sulfadiazina-pirimetamina foi mais clara. Como muitos oftalmologistas prescrevem regularmente drogas que podem desencadear a síndrome DRESS, esse diagnóstico deve ser lembrado já que pode levar a sérias complicações.

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Objective: To identify microscopic morphological alterations in the surface of silicone tubes used for intubation of the lachrymal system after exposure to ophthalmological lubricants. Methods: Experimental, descriptive and longitudinal study consisted of the application of ophthalmological lubricants in silicone tubes. The tubes were divided in: Group 1 (Cylocort®), 2 (Epitezan®), 3 (Labcaína®), 4 (Liposic®), 5 (Maxinom®) and 6 (Vista Gel®). One tube was not exposed to any lubricant, used as control. The tubes were observed and photographed after 2 hours, 30 days, 45 days before and after cleaning the surface and lumen. The following aspects were observed: surface (regularity, transparency, quantity, size and shape of the substances) and lumen (obstruction). Results: Control: irregular surface with pores after 2 hours: Group 1 – irregular surface with presence of film; Groups 2, 3 and 5 – abundant and irregular quantity of ointment at the surface; Group 4 – discrete modification at the surface; Group 6 – growth of pigmented (brownish) structures with filaments in the lumen, with discrete film in the surface. 30 Days: Groups 1, 4 and 5 – increase of the irregular superficial film; Group 2 – crust with notorious horizontal lines; Group 3 – diminution of the superficial film; Group 4 – crust less evident. Group 6 – increase of the structure seen with 2 hours of exposition, arboriform aspect. Forty-five days pre cleaning: Group 4 – diminution of the surface crust; Group 6 – expansion of the arboriform structure; unaltered findings in other groups. 45 days after cleaning: Groups 1 and 5 – light diminution of the surface crust; Groups 2, 3 and 4 – kept the modifications; Group 6 – the structure inside the lumen was not identified, clear surface, without evidence of film. Conclusions: Microscopic morphological alterations in the surface and lumen of silicone...

Objetivo: Identificar alterações morfológicas na superfície de tubos de silicone usados para intubação do sistema lacrimal após exposição a lubrificantes oftalmológicos. Métodos: Estudo experimental, descritivo e longitudinal que consistiu na aplicação de lubrificantes oftalmológicos em tubos de silicone. Os tubos foram divididos em: Grupo 1 (Cylocort®), 2 (Epitezan®), 3 (Labcaína®), 4 (Liposic®), 5 (Maxinom®) e 6 (Vista Gel®). Um tubo não foi exposto a nenhum lubrificante, sendo usado como controle. Os tubos foram observados e fotografados após 2 horas, 30 dias, 45 dias antes e após limpeza da sua superfície e lúmen. Os seguintes aspectos foram observados: superfície (regularidade, transparência, quantidade, tamanho e formato das substâncias) e lúmen (obstrução). Resultados: Controle – superfície irregular com poros. Após 2 horas: Grupo 1 – superfície irregular com presença de filme; Grupos 2,3 e 5 – quantidade abundante e irregular de pomada na superfície; Grupo 4 – discreta modificação da superfície; Grupo 6 – crescimento de estrutura pigmentada (marrom) com filamentos no lúmen, com discreto filme na superfície. Trinta dias: Grupos 1, 4 e 5 – aumento do filme irregular na superfície; Grupo 2 – crosta com linhas horizontais; Grupo 3 – diminuição do filme superficial; Grupo 4 – crosta menos evidente; Grupo 6 – aumento da estrutura vista com 2 horas de exposição, aspect arboriforme. Quarenta e cinco pré-limpeza: Grupo 4 – diminuição da crosta superficial; Grupo 6 – aumento da estrutura arboriforme; os demais grupos sem alterações. Quarenta e cinco dias pós-limpeza: Grupo 1 e 5 – discreta diminuição da crosta superficial; Grupos 2, 3 e 4 – modificações mantidas; Grupo 6 – a estrutura dentro do lúmen não foi visualizada, superfície limpa sem evidência de filme. Conclusão: As modificações na morfologia microscópica na superfície e lúmen de tubos de...

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Here we report the case of a 73-year-old man who was diagnosed with metachronous, multiple primary tumors with non-Hodgkin B-cell mantle cell lymphoma involving the orbit on the basis of biopsy and immunohistochemistry in 2012. The patient had been diagnosed with non-Hodgkin small cell lymphoma and basal cell skin carcinoma in 2010 and intestinal adenocarcinoma with metastasis to the regional lymph nodes in 2011, thus representing a typical case of metachronous, multiple primary tumors. Mantle cell lymphoma is a rare disease and its prognosis is quite poor, particularly when it is associated with other metachronous malignancies. Therefore, physicians should consider mantle cell lymphoma as a differential diagnosis for neoplasms of the orbit.

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Here we describe the rare case of a 55-year-old man with medial rectus muscle myositis as an atypical presentation of non-Hodgkin B-cell mucosa-associated lymphoma (MALT). Pathology and immunohistochemistry of the affected muscle confirmed the diagnosis of a neoplasm. The primary etiology of orbital myositis is Graves' ophthalmopathy, but several other diseases may cause this clinical presentation. Therefore, the neoplastic causes must be eliminated from the differential diagnoses. non-Hodgkin B-cell mucosa-associated lymphoma is the most common histological type of lymphoma in the orbit, with the conjunctiva and lacrimal glands being the most commonly affected sites. However, it may also present in atypical forms involving others sites and tissues.

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Here we describe the rare case of a 55-year-old man with medial rectus muscle myositis as an atypical presentation of non-Hodgkin B-cell mucosa-associated lymphoma (MALT). Pathology and immunohistochemistry of the affected muscle confirmed the diagnosis of a neoplasm. The primary etiology of orbital myositis is Graves' ophthalmopathy, but several other diseases may cause this clinical presentation. Therefore, the neoplastic causes must be eliminated from the differential diagnoses. non-Hodgkin B-cell mucosa-associated lymphoma is the most common histological type of lymphoma in the orbit, with the conjunctiva and lacrimal glands being the most commonly affected sites. However, it may also present in atypical forms involving others sites and tissues.

Descrevemos um raro caso de miosite do músculo reto medial como forma atípica de apresentação de linfoma não-Hodgkin de células B tipo MALT. A anatomia patológica e imuno-histoquímica do músculo afetado confirmaram o diagnóstico definitivo do caráter neoplásico da doença. As miosites orbitárias têm como principal etiologia a oftalmopatia de Graves, porém diversas outras causas podem apresentar-se dessa forma. Sendo assim, as causas neoplásicas devem ser descartadas. O linfoma não-Hodgkin de células B tipo MALT é o tipo histológico mais comum de linfoma orbitário, as regiões mais frequentemente acometidas são a conjuntiva e glândula lacrimal. No entanto, pode apresentar-se com formas clínicas atípicas, acometendo outras regiões e tecidos.

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Here we report the case of a 73-year-old man who was diagnosed with metachronous, multiple primary tumors with non-Hodgkin B-cell mantle cell lymphoma involving the orbit on the basis of biopsy and immunohistochemistry in 2012. The patient had been diagnosed with non-Hodgkin small cell lymphoma and basal cell skin carcinoma in 2010 and intestinal adenocarcinoma with metastasis to the regional lymph nodes in 2011, thus representing a typical case of metachronous, multiple primary tumors. Mantle cell lymphoma is a rare disease and its prognosis is quite poor, particularly when it is associated with other metachronous malignancies. Therefore, physicians should consider mantle cell lymphoma as a differential diagnosis for neoplasms of the orbit.

Relatamos um caso de linfoma não-Hodgkin de células B subtipo células do manto acometendo região orbital, com o diagnóstico confirmado pela biópsia e testes imuno-histoquímicos em 2012. O paciente apresentava história de linfoma não-Hodgkin de pequenas células em 2010, carcinoma basocelular de pele no mesmo ano e adenocarcinoma intestinal com metástase para linfonodos regionais em 2011; caracterizando um caso de tumor primário múltiplo metacrônico. O linfoma de células do manto é uma doença rara, ainda mais quando associado a outras neoplasias metacrônicas, apresentando prognóstico bastante reservado. Dessa forma, deve estar entre os diagnósticos diferenciais de neoplasias da órbita.

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Keratoconus has usually been described as bilateral but asymmetric disease. Corneal ectasia is one of the long-term complications of modern refractive surgery, especially those submitted to laser in situ keratomileusis (LASIK). We describe a patient with keratoconus in the right eye that was submitted to radial keratectomy (RK) in the left eye 19 years ago with no progression of the ectatic cornea and no complications related to the refractive surgery. Because unilateral keratoconus is rare, we believe that RK was performed on an already ectatic cornea (not clinically detected) or with fruste keratoconus. However, neither corneal ectasia progressed, nor ectasia was induced by RK in the fellow eye.

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Keratoconus has usually been described as bilateral but asymmetric disease. Corneal ectasia is one of the long-term complications of modern refractive surgery, especially those submitted to laser in situ keratomileusis (LASIK). We describe a patient with keratoconus in the right eye that was submitted to radial keratectomy (RK) in the left eye 19 years ago with no progression of the ectatic cornea and no complications related to the refractive surgery. Because unilateral keratoconus is rare, we believe that RK was performed on an already ectatic cornea (not clinically detected) or with fruste keratoconus. However, neither corneal ectasia progressed, nor ectasia was induced by RK in the fellow eye.

O ceratocone é descrito como uma doença bilateral porém assimétrica e vários dados na literatura comprovam que a ectasia corneana é uma das complicações de longo prazo da cirurgia refrativa moderna, especialmente do laser in situ keratomileusis (LASIK). Nós descrevemos um caso de uma paciente com ceratocone no olho direito e que foi submetida à ceratotomia radial no olho esquerdo há 19 anos, desde então sem sinais de progressão da ectasia corneana nem de complicações relativas à cirurgia refrativa. Como o ceratocone unilateral é raro, acreditamos que a cirurgia refrativa tenha sido realizada num olho com ectasia corneana não detectada clinicamente ou com ceratocone frustro. Entretanto, a ectasia do olho direito não progrediu e também não houve sinais de ectasia no olho submetido à cirurgia refrativa nesse período de 19 anos de acompanhamento.

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INTRODUCTION: Scleritis is a rare, progressive and serious disease, the signs of which are inflammation and edema of episcleral and scleral tissues and is greatly associated with systemic rheumatoid diseases. PURPOSE: To perform a prospective and comparative study between ophthalmologic manifestations, serologic findings and therapeutic response of patients with isolated scleritis and scleritis associated with systemic rheumatoid disease. METHODS: Thirty-two outpatients with non-infectious scleritis were studied, from March 2006 to March 2008. The treatment was corticoid eye drops associated with anti-inflammatory agents, followed by systemic corticoids and immunosuppressive drugs if necessary, was considered successful after six months without scleritis recurrence. RESULTS: Fourteen of 32 patients had scleritis associated with systemic rheumatoid disease, of which nine had rheumatoid arthritis, two systemic lupus erythematosus, one Crohn's disease, one Behçet's disease and one gout. There were no difference in relation to involvement and ocular complications, there was predominance of nodular anterior scleritis and scleral thinning was the most frequent complication. The scleritis associated with systemic rheumatoid disease group had 64.3 percent of autoantibodies, versus 27.8 percent among those with isolated scleritis and this difference was statistically significant. In the isolated scleritis group 16.7 percent used anti-inflammatory, 33.3 percent corticosteroids, 27.8 percent corticosteroids with one immunosuppressive drug, 5.5 percent two immunosuppressive drugs, 16.7 percent corticosteroids with two immunosuppressive drugs and 33.3 percent pulse of immunosuppressive drugs, there was remission in 88.9 percent. In the scleritis associated with systemic rheumatoid disease group 7.1 percent used anti-inflammatory, 7.1 percent corticosteroids, 50 percent corticosteroids with one immunosuppressive drug, 7.1 percent two immunosuppressive drugs and 22.2 percent pulse of immunosuppressive drugs, 100 percent had treatment success. CONCLUSION: Prevalence of unilateral nodular scleritis was noted in both groups and higher rates of all the parameters tested were noted in the scleritis associated with systemic rheumatoid disease group. There were no differences between the groups with respect to the use of immunosuppressive drugs and therapeutic response, which was fully satisfactory in the scleritis associated with systemic rheumatoid disease group and satisfactory in the isolated scleritis group.

INTRODUÇÃO: Esclerite é uma doença grave, rara e progressiva, que envolve inflamação e edema dos tecidos episcleral superficial, profundo e escleral e está associada com doenças sistêmicas reumatológicas em muitos casos. OBJETIVOS: Realizar um estudo prospectivo comparativo entre as manifestações oftalmológicas, achados sorológicos e resposta terapêutica de pacientes com esclerite isolada e com esclerite associada a doenças sistêmicas reumatológicas. MÉTODOS: Trinta e dois pacientes com esclerite não infecciosa participaram do estudo, de março de 2006 a março de 2008. O tratamento realizado baseou-se no uso de colírios de corticoides associados aos anti-inflamatórios não-hormonais, seguidos de corticoides sistêmicos e imunossupressores, se necessário. O sucesso do tratamento foi considerado como seis meses sem crises de esclerite. RESULTADOS: Quatorze dos 32 pacientes apresentaram esclerite associada à doença sistêmica, dos quais nove com artrite reumatóide, dois com lúpus eritematoso sistêmico, um com doença de Crohn, um com doença de Behçet e um com gota. Não houve diferenças em relação ao envolvimento ocular e suas complicações, predominando a esclerite anterior nodular e o afinamento escleral, respectivamente. O grupo com esclerite associada a doenças sistêmicas apresentou 64,3 por cento de positividade de autoanticorpos contra 27,8 por cento no grupo com esclerite isolada, sendo tal diferença estatisticamente significante. No grupo com esclerite isolada, 16,7 por cento fez uso de apenas anti-inflamatórios, 33,3 por cento de corticoide sistêmico, 27,8 por cento de corticoide com um imunossupressor, 5,5 por cento dois imunossupressores, 16,7 por cento corticoide com dois imunossupressores e 33,3 por cento pulsoterapia com imunossupressor; sendo que houve sucesso do tratamento em 88,9 por cento. No grupo com esclerite associada à doença sistêmica, 7,1 por cento fez uso de anti-inflamatórios, 7,1 por cento corticoide sistêmico, 50 por cento corticoide com um imunossupressor, 7,1 por cento dois imunossupressores e 22,2 por cento pulsoterapia com imunossupressor; com 100 por cento de sucesso no tratamento nesse grupo. CONCLUSÃO: Em ambos os grupos houve predomínio da esclerite nodular unilateral e o grupo com esclerite associada a doença sistêmica apresentou taxas maiores de todos os autoanticorpos testados. Não houve diferença entre os grupos em relação ao uso de imunossupressores e à resposta terapêutica, a qual foi totalmente satisfatória no grupo com esclerite associada à doença sistêmica e satisfatória no grupo com esclerite isolada.

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