RESUMO
BACKGROUND: Idiopathic Intracranial Hypertension (IIH) is a secondary headache with a steadily growing incidence. Currently, there is little evidence to guide the treatment of IIH. OBJECTIVE: To review the pathophysiology of IIH, with focus on the role of obesity as a risk factor, and the implications for new therapeutic perspectives. METHODS: in this narrative review, we summarized the current knowledge on treatment options highlighting available evidence for managing intracranial hypertension, obesity, and headache. RESULTS: Clinical Presentation: headache is the most common symptom and a significant cause of quality-of-life impairment. Visual loss is common in the diagnosis. Pathophysiology: there is no unified theory able to explain all symptoms and the evolution of the disease. There is growing data pointing to metabolic changes and obesity with a central role in IIH pathophysiology. Treatment: most published data on IIH treatment is related to pressure control and protection from visual loss. Acetazolamide and cerebrospinal fluid diversion are the best options available. Optic nerve sheath fenestration might be useful to temporally control the pressure over the optic nerve and thus protect from visual deterioration. Recently, venous sinus stenting has proven to be a safe option in selected cases. Finally, bariatric surgery has proven to effectively control elevated intracranial pressure. CONCLUSION: IIH is a potential cause of high disability. Early recognition is important, and treatment should be tailored to the needs of each case. There is a lack of research on headache management, which might persist after ICP control.
Assuntos
Hipertensão Intracraniana , Pseudotumor Cerebral , Acetazolamida/uso terapêutico , Cefaleia/complicações , Cefaleia/terapia , Humanos , Hipertensão Intracraniana/etiologia , Obesidade/complicações , Obesidade/terapia , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/terapia , Transtornos da Visão/etiologia , Transtornos da Visão/terapiaRESUMO
OBJECTIVE: This study evaluates the epidemiological characteristics, ophthalmological manifestations, and different therapeutic options available for patients with multiple sclerosis (MS) in China, Spain, and Cuba. METHODS: A self-designed questionnaire was used to conduct a comparable descriptive cross-sectional study on patients with MS. The survey included patients' demographic data, ocular manifestations related to MS, and treatment methodology followed in the three countries. The online survey was designed using the Wenjuanxing survey platform, and a survey link was circulated through WhatsApp, WeChat, and emails. Quantitative data were expressed as mean and standard deviation, the Kruskal-Wallis test was used for non-parametric variables. Qualitative data were expressed as numerical and percentage. The chi-square test (χ2) was used to compare the group's response categories. The statistical difference was considered significant when p < 0.05. RESULTS: The female-to-male ratio in all the three countries was 2-3:1, and relapsing-remitting MS (RRMS) was the most frequent in all three countries. Vision loss was slow and progressive in half of the patients from the three countries, with no significant differences (p = 0.524). A higher percentage of steroid treatment was observed in Chinese patients in comparison with the patients from other two countries (p < 0.001), and a similar trend was seen in the use of traditional medicines. Almost one-third of patients who did not receive any treatment recovered spontaneously in all the three countries (p = 0.097). CONCLUSIONS: MS occurs more frequently in the relapsing-remitting clinical form and there is a clear female predominance. The first ocular crisis or clinical debut of MS is characterized by slow and progressive visual impairment, increasing and adding to other ocular manifestations during its evolutionary course. Spontaneous recovery of vision after an attack of optic neuritis in the course of MS is possible.
Assuntos
Esclerose Múltipla , Transtornos da Visão , China/epidemiologia , Estudos Transversais , Cuba/epidemiologia , Feminino , Humanos , Internet , Masculino , Esclerose Múltipla/complicações , Espanha/epidemiologia , Inquéritos e Questionários , Transtornos da Visão/epidemiologia , Transtornos da Visão/patologia , Transtornos da Visão/terapiaRESUMO
Abstract Purpose: Study aimed to determine compliance of patients with strabismic amblyopia undergoing occlusion treatment, followed from January 1 st, 2011 to January 1 st, 2017 at an Ophthalmology Reference Center, and identify risk factors for poor compliance. Methods: Retrospective, consecutive cohort study. Compliance reported at each visit was related to visual acuity, family history, changes in occlusion schedules and in patients' care team during treatment. The patients were divided into two groups according to the compliance: poor compliance group and compliance group (subdivided in full compliance subgroup and partial compliance subgroup). Results: Age at treatment beginning vary from 3.7 to 13.7 years, esotropia was the most frequent deviation and the occlusion was realized from 5 to 7 hours a day. Of 220 patients, compliance was achieved by 193 (87.7%), 114 (51.8%) in full compliance subgroup and 79 (35.9%) in partial compliance subgroup, and 27 do not achieved compliance (12.3%). Poor compliance was significantly related to a history of epilepsy, higher rate of suspension of treatment due to inefficacy, higher evasion rate, lower recurrence, and lower rate of maintenance of prophylactic occlusion after treatment. Good compliance was related to family history of strabismus, higher recurrence rate, and higher maintenance of prophylactic occlusion after treatment. No relations were found between poor compliance and changes in occlusion schedules or in patients' care team during treatment. Conclusion: Compliance with occlusion treatment of strabismic ambliopia was similar to other studies that included refractive and strabismic amblyopia and not related to changes in occlusion schedules or in patients' care team during treatment. Family history of strabismus was a protective factor.
Resumo Objetivo: Determinar a adesão de pacientes com ambliopia estrabísmica submetidos a tratamento oclusivo, acompanhados em Centro de Referência em Oftalmologia do Centro-Oeste do Brasil, e identificar fatores de risco para baixa adesão. Métodos: Estudo de coorte retrospectivo e consecutivo. A adesão relatada em cada visita foi relacionada à acuidade visual, história familiar, mudanças no tempo de oclusão e na equipe de atendimento ao paciente durante o tratamento. Os pacientes foram divididos em dois grupos de acordo com a adesão: grupo de não-adesão e grupo adesão (subdividido em subgrupo adesão total e subgrupo adesão parcial). Resultados: A idade ao início do tratamento variou de 3,7 a 13,7 anos, o desvio mais frequente foi a esotropia, o tempo médio de oclusão foi de 5 a 7 horas por dia. Dos 220 pacientes, 193 (87,7%) obtiveram adesão, 114 (51,8%) no subgrupo de adesão total e 79 (35,9%) no subgrupo de adesão parcial, e 27 não aderiram (12,3%). A não-adesão foi relacionada à história de epilepsia, maior taxa de suspensão do tratamento devido à ineficácia, maior taxa de evasão, menor recorrência e menor taxa de manutenção da oclusão profilática pós tratamento. A boa adesão foi relacionada à história familiar de estrabismo, maior taxa de recorrência e maior manutenção da oclusão profilática pós tratamento. Não houve relação entre não-adesão e mudanças nos horários de oclusão ou na equipe de atendimento durante o tratamento. Conclusão: A adesão ao tratamento oclusivo da ambliopia estrabísmica foi semelhante aos estudos que incluíram ambliopia refracional e estrabísmica e não se correlacionou a mudanças no tempo de oclusão ou na equipe de atendimento. A história familiar de estrabismo foi um fator de proteção.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Transtornos da Visão/terapia , Visão Binocular , Ambliopia/terapia , Estrabismo/terapia , Cooperação e Adesão ao Tratamento , Estudos Retrospectivos , Estudos de CoortesRESUMO
BACKGROUND: Scotopic sensitivity syndrome, later called Meares-Irlen syndrome or simply Irlen syndrome (IS) has been described as symptoms of poor reading ability due to poor color matching and distorted graphic images. Individuals with this syndrome are considered slow, ineffective readers with low comprehension and visual fatigue. It is still uncertain whether the disease pathophysiology is an independent entity or part of the dyslexia spectrum. Nevertheless, treatments with lenses and colored filters have been proposed to alleviate the effect of the luminous contrast and improve patients' reading performance. However, no evidence of treatment effectiveness has been achieved. OBJECTIVE: The aim of the present study was to obtain evidence about IS etiology, diagnosis and intervention efficacy. METHODS: A systematic review was performed covering the available studies on IS, assessing the available data according to their level of evidence, focusing on diagnostic tools, proposed interventions and related outcomes. RESULTS: The data showed high heterogeneity among studies, and lack of evidence on the existence of IS and treatment effectiveness. CONCLUSION: The syndrome as described, as well as its treatments, require further strong evidence.
Assuntos
Transtornos da Visão/diagnóstico , Transtornos da Visão/terapia , Lentes de Contato , Dislexia/fisiopatologia , Humanos , Visão Noturna , Síndrome , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologiaRESUMO
ABSTRACT Background: Scotopic sensitivity syndrome, later called Meares-Irlen syndrome or simply Irlen syndrome (IS) has been described as symptoms of poor reading ability due to poor color matching and distorted graphic images. Individuals with this syndrome are considered slow, ineffective readers with low comprehension and visual fatigue. It is still uncertain whether the disease pathophysiology is an independent entity or part of the dyslexia spectrum. Nevertheless, treatments with lenses and colored filters have been proposed to alleviate the effect of the luminous contrast and improve patients' reading performance. However, no evidence of treatment effectiveness has been achieved. Objective: The aim of the present study was to obtain evidence about IS etiology, diagnosis and intervention efficacy. Methods: A systematic review was performed covering the available studies on IS, assessing the available data according to their level of evidence, focusing on diagnostic tools, proposed interventions and related outcomes. Results: The data showed high heterogeneity among studies, and lack of evidence on the existence of IS and treatment effectiveness. Conclusion: The syndrome as described, as well as its treatments, require further strong evidence.
RESUMO Background: A síndrome da sensibilidade escotópica, posteriormente denominada síndrome de Meares-Irlen ou simplesmente síndrome de Irlen (SI), foi descrita como indivíduos com sintomas de baixa capacidade de leitura devido à combinação de cores e distorções nas imagens. Indivíduos com essa síndrome podem apresentar leitura lenta e ineficaz, com baixo nível de compreensão e fadiga visual. A fisiopatologia da doença ainda é incerta como uma entidade independente ou como parte do espectro da dislexia. No entanto, tratamentos com lentes e filtros coloridos foram propostos com o objetivo de aliviar o efeito do contraste luminoso e melhorar o desempenho de leitura dos pacientes. Outrossim, nenhuma evidência de eficácia do tratamento foi alcançada. Objetivos: Obter evidências sobre a etiologia, eficácia diagnóstica e intervenção da SI. Métodos: Foi realizada uma revisão sistemática, cobrindo os estudos disponíveis sobre a SI, avaliando os dados disponíveis de acordo com seu nível de evidência, com foco em ferramentas de diagnóstico, intervenções propostas e desfechos relacionados. Resultados: Os dados mostram alta heterogeneidade, falta de evidência sobre a existência da SI e eficácia do tratamento. Conclusões: A síndrome descrita e seus tratamentos exigem evidências mais robustas.
Assuntos
Humanos , Transtornos da Visão/diagnóstico , Transtornos da Visão/terapia , Síndrome , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Lentes de Contato , Dislexia/fisiopatologia , Visão NoturnaRESUMO
ABSTRACT Objective: to understand the experience of families of children and adolescents with visual impairment with an emphasis on the adaptations made in daily life. Method: qualitative, research, which used as a theoretical reference the Symbolic Interactionism and analysis of narrative as method. Data collection through a semi-structured interview, recorded with 18 families of children and adolescents with visual impairment, totaling 61 participants from two municipalities in the interior of the state of São Paulo. Results: the analysis of the narratives allowed the understanding of 2 themes: diagnosis: an unexpected and daily process in front of the knowledge of DV. Final considerations: the family makes its own movement of modifications that have been present throughout the trajectory traveled by the members, which are full of interactions and meanings. It is necessary to train health professionals so that they can support the families of children and adolescents with visual impairment with the necessary information and support.
RESUMEN Objetivo: comprender la experiencia de familias de niños y adolescentes con deficiencia visual con énfasis en las adaptaciones realizadas en el cotidiano. Método: investigación cualitativa, que utilizó como referencial teórico el Interaccionismo Simbólico y análisis de narrativa como método. La recolección de datos por medio de entrevistas semiestructuradas, grabada con 18 familias de niños y adolescentes con discapacidad visual, totalizando 61 participantes de dos municipios del interior del estado de São Paulo. Resultados: el análisis de las narrativas posibilitó la comprensión de 2 temas: diagnóstico: un proceso inesperado y cotidiano frente al conocimiento de la DV. Consideraciones finales: la familia realiza un movimiento propio de modificaciones que estuvieron presentes en toda la trayectoria recorrida por los miembros, esas repletas de interacciones y significados. Se hace necesario la capacitación de los profesionales de salud para que puedan respaldar a las familias de niños y adolescentes con discapacidad visual con informaciones y apoyo necesario.
RESUMO Objetivo: compreender a experiência de famílias de crianças e adolescentes que apresentam baixa visão, com ênfase nas adaptações decorrentes à condição crônica. Metodologia: pesquisa qualitativa, que utilizou o referencial teórico do Interacionismo Simbólico e como método a análise de narrativa. Coleta de dados por meio de entrevista semiestruturada, gravada com 18 famílias de crianças e adolescentes que apresentavam deficiência visual, totalizando 61 participantes de dois municípios do estado de São Paulo. Resultados: análise das narrativas possibilitou a compreensão de dois temas: Diagnóstico: um processo inesperado e O cotidiano da criança com deficiência visual e sua família. As categorias mostram o processo dinâmico vivenciado pela família ao receber o diagnóstico de condicionalidade da criança. A aceitação é gradual e concomitante às atividades exercidas pelas famílias para buscar qualidade de cuidado à criança. Considerações finais: a família realiza um movimento próprio de modificações presentes em toda trajetória percorrida pelos membros, repleta de interações e significados. Faz-se necessária a capacitação dos profissionais de saúde, para que possam respaldar as famílias de crianças e adolescentes que apresentam deficiência visual com informações e apoio. Nesse sentido, este estudo possibilita aprofundar o conhecimento, e potencializa o aprimoramento da assistência a essas crianças, adolescentes e suas famílias.
Assuntos
Humanos , Criança , Adolescente , Família , Cuidado da Criança , Baixa Visão , Crianças com Deficiência , Adaptação a Desastres , Transtornos da Visão/terapia , Transtornos da Visão/diagnóstico por imagem , Autonomia Pessoal , Pesquisa Qualitativa , Óculos , Estigma Social , Interacionismo SimbólicoRESUMO
OBJECTIVE: To evaluate the effectiveness of mobile ophthalmic unit screenings and to investigate barriers between community care and resolution of the problem at a tertiary center. METHODS: This prospective study evaluated a convenience sample from 10 municipalities in São Paulo State, Brazil. Patients were assessed in the municipality by a mobile ophthalmic unit and underwent a complete ophthalmic consultation. Patients were referred as warranted to a tertiary hospital. RESULTS: The mobile ophthalmic unit screened 1,928 individuals and 714 (37%) were referred. The mean age of the referred patients was 57.12 (SD = 19.5) years with best corrected visual acuity of 0.37 (SD = 0.36) logMAR. Forty-seven (6.6%) patients were blind and 185 (26.5%) were visually impaired. Cataracts (44.7%) and pterygium (14.7%) accounted for most referrals. Of those referred, 67.1% presented to the tertiary center. The diagnosis by the mobile ophthalmic unit corresponded to the one by the tertiary center in 88.5% of the cases. There were a significantly higher number of blind and visually impaired persons among those who presented to the hospital. There was a significantly greater attendance among patients living in more distant municipalities from the reference center with a higher number of inhabitants and a greater number of ophthalmologists in the cities of origin (p < 0.05, all comparisons). Complete treatment was performed in 65.6% of patients, and loss to follow-up was the main cause of incomplete treatment in 50.7% of patients. A total of 313 cataract surgeries were performed, which reduced the number of blind patients from 20 to 2 and of visually impaired individuals from 87 to 2 (p < 0.001). CONCLUSIONS: Only 37% of the patients assessed by a mobile ophthalmic unit required referral to a tertiary hospital. Among the referred patients, 67.1% presented to the hospital, and complete resolution after treatment was approximately 65.5%. There was a significant improvement in visual acuity and a reduction in the prevalence of blindness and visual impairment postoperatively.
Assuntos
Programas de Rastreamento/métodos , Unidades Móveis de Saúde , Centros de Atenção Terciária , Transtornos da Visão/diagnóstico , Transtornos da Visão/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Catarata/diagnóstico , Catarata/epidemiologia , Catarata/terapia , Criança , Pré-Escolar , Cidades/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Pterígio/diagnóstico , Pterígio/epidemiologia , Pterígio/terapia , Estatísticas não Paramétricas , Resultado do Tratamento , Transtornos da Visão/epidemiologia , Acuidade Visual , Adulto JovemRESUMO
Introdução: O atraso neuropsicomotor acarreta em prejuízos no processo de aquisição e desenvolvimento de habilidades gerais, dentre elas, a linguagem, e, pode estar associado com outros déficits, como a paralisia cerebral e a deficiência visual. Objetivo: Descrever a intervenção fonoaudiológica em um caso de uma deficiente visual com paralisia cerebral. Relato de caso: Criança de 2,5 anos, sexo feminino, com diagnóstico de distúrbio de linguagem associado a cegueira no olho direito e visão subnormal no olho esquerdo, causados por retinopatia da prematuridade e catarata congênita, em associação com encefalopatia (paralisia cerebral espástica diparética). Após o processo de avaliação fonoaudiológica, foi iniciada a intervenção em linguagem baseada no modelo sócio construtivista com foco na interação, expressão e compreensão da linguagem oral. Durante o processo de avaliação e reabilitação fonoaudiológica foram adaptados objetos concretos (reais), com textura diferenciada ao toque, e associados a sons verbais e não verbais, como recurso para a eliciação de resposta comunicativa. Após 14 sessões de terapia observou-se evolução do comportamento linguístico, com produção oral de palavras isoladas e frases simples com participação ativa na atividade dialógica e compreensão de ordens semicomplexas. Conclusão: Em pacientes com deficiência visual associada a paralisia cerebral, o uso e adaptação de pistas táteis e olfativas auxiliam na percepção e reconhecimento dos objetos, facilitando a intervenção fonoaudiológica.
Introduction:Neuropsychomotor developmental delay leads to losses in the acquisition and development of general abilities, among them language. It may be associated with other deficits, such as cerebral palsy and visual impairment. Objective: Describe the speech-language intervention in a case of a visually impaired person with cerebral palsy. Case report: A 2.5-year-old female was diagnosed with a language disorder associated with blindness in the right eye and subnormal vision in the left eye. The cause was retinopathy of prematurity and congenital cataract in association with encephalopathy (spastic cerebral palsy diphtheric). After speech-language evaluation process, intervention was started based on the socio-constructivist model, which focuses on the interaction, expression, and comprehension of oral language. During the process of evaluation and speech-language rehabilitation, concrete (real) objects with a texture that was differentiated to the touch and associated with verbal and non-verbal sounds were adapted as a resource for the elicitation of communicative response. We observed after 14 sessions of therapy, the evolution of linguistic behavior involving oral production of isolated words and simple sentences with effective participation in the dialogical activity and understanding of semi-complex orders. Conclusion: In patients with visual impairment associated with cerebral palsy, the use and adaptation of tactile and olfactory cues help in the perception and recognition of the objects, which facilitates the speech-language intervention.
Assuntos
Humanos , Feminino , Pré-Escolar , Transtornos da Visão/terapia , Fonoaudiologia , Transtornos do Neurodesenvolvimento/terapia , Retinopatia da Prematuridade/terapiaRESUMO
ABSTRACT OBJECTIVE To evaluate the effectiveness of mobile ophthalmic unit screenings and to investigate barriers between community care and resolution of the problem at a tertiary center. METHODS This prospective study evaluated a convenience sample from 10 municipalities in São Paulo State, Brazil. Patients were assessed in the municipality by a mobile ophthalmic unit and underwent a complete ophthalmic consultation. Patients were referred as warranted to a tertiary hospital. RESULTS The mobile ophthalmic unit screened 1,928 individuals and 714 (37%) were referred. The mean age of the referred patients was 57.12 (SD = 19.5) years with best corrected visual acuity of 0.37 (SD = 0.36) logMAR. Forty-seven (6.6%) patients were blind and 185 (26.5%) were visually impaired. Cataracts (44.7%) and pterygium (14.7%) accounted for most referrals. Of those referred, 67.1% presented to the tertiary center. The diagnosis by the mobile ophthalmic unit corresponded to the one by the tertiary center in 88.5% of the cases. There were a significantly higher number of blind and visually impaired persons among those who presented to the hospital. There was a significantly greater attendance among patients living in more distant municipalities from the reference center with a higher number of inhabitants and a greater number of ophthalmologists in the cities of origin (p < 0.05, all comparisons). Complete treatment was performed in 65.6% of patients, and loss to follow-up was the main cause of incomplete treatment in 50.7% of patients. A total of 313 cataract surgeries were performed, which reduced the number of blind patients from 20 to 2 and of visually impaired individuals from 87 to 2 (p < 0.001). CONCLUSIONS Only 37% of the patients assessed by a mobile ophthalmic unit required referral to a tertiary hospital. Among the referred patients, 67.1% presented to the hospital, and complete resolution after treatment was approximately 65.5%. There was a significant improvement in visual acuity and a reduction in the prevalence of blindness and visual impairment postoperatively.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Transtornos da Visão/diagnóstico , Programas de Rastreamento/métodos , Centros de Atenção Terciária , Unidades Móveis de Saúde , Transtornos da Visão/terapia , Transtornos da Visão/epidemiologia , Catarata/diagnóstico , Catarata/terapia , Catarata/epidemiologia , Brasil/epidemiologia , Pterígio/diagnóstico , Pterígio/terapia , Pterígio/epidemiologia , Acuidade Visual , Prevalência , Estudos Prospectivos , Cidades/epidemiologia , Resultado do Tratamento , Estatísticas não ParamétricasRESUMO
Any of the various layers of the eye may suffer injury in systemic lupus erythematosus, ranging from keratoconjunctivitis sicca to retinopathy and optic neuritis. Rheumatologists must always be aware of ocular involvement in those patients since rapid diagnosis and a prompt intervention in those severe cases can prevent visual loss or even irreversible blindness. We present here the case of a 14-year-old girl who, despite a short period of disease, developed chorioretinopathy with transitory visual impairment with a good treatment response.
Assuntos
Doenças da Coroide/etiologia , Lúpus Eritematoso Sistêmico/complicações , Doenças Retinianas/etiologia , Transtornos da Visão/etiologia , Adolescente , Idade de Início , Doenças da Coroide/patologia , Doenças da Coroide/terapia , Feminino , Humanos , Doenças Retinianas/patologia , Doenças Retinianas/terapia , Fatores de Tempo , Transtornos da Visão/terapiaRESUMO
OBJECTIVE: To describe the epidemiology, etiology, pathogenesis, clinical characteristics, and management of pemphigus, with an emphasis on ocular involvement. METHODS: Literature review. RESULTS: Pemphigus is an autoimmune epithelial blistering disease of the skin and mucous membranes. The typical pathological finding is acantholysis of the epidermis that leads to blister formation. Immunofluorescence techniques show autoantibody deposition on the epidermal intercellular substance. Although a genetic background is necessary, environmental factors are crucial for the onset and perpetuation of the disease. Exposure to some drugs, toxic agents, and foods and associations with other autoimmune diseases and lymphoproliferative conditions should be assessed. Generally, the skin is the most commonly affected tissue. Ocular involvement might be present and exhibit a clinical course that is independent of skin compromise. Visual function may be affected depending on the severity of the presentation. In untreated cases, mortality is high because of bacterial sepsis and hydroelectrolyte imbalance. A multidisciplinary approach should be used involving a dermatologist, ophthalmologist, and immunologist. Immunosuppressive agents are the mainstay of treatment; corticosteroids typically with azathioprine or mycophenolate mofetil are the drugs of choice. Surgical treatment of trichiasis and malposition of the eyelids and tectonic procedures for corneal perforation are sometimes required in very severe and recalcitrant cases. CONCLUSIONS: Pemphigus is a potential life- and sight-threatening disease. Understanding the disease facilitates the adequate assessment of the modifiable factors and the prompt initiation of immunotherapy. Ocular involvement can develop in patients with pemphigus. Adequate ophthalmological care is needed, in particular, prevention of infections, scarring, and corneal perforation.
Assuntos
Doenças da Túnica Conjuntiva/etiologia , Doenças Palpebrais/etiologia , Pênfigo/complicações , Corticosteroides/uso terapêutico , Doenças da Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/terapia , Doenças Palpebrais/patologia , Doenças Palpebrais/terapia , Humanos , Imunossupressores/uso terapêutico , Pênfigo/patologia , Pênfigo/terapia , Fatores de Risco , Transtornos da Visão/etiologia , Transtornos da Visão/terapiaRESUMO
La epidermólisis bullosa es una genodermatosis, que comprende un grupo heterogéneo de enfermedades ampollares de la piel y las mucosas, localizadas en la membrana basal epidérmica y la capa basal del epitelio estratificado queratinizado o mucoso, con la consiguiente fragilidad de la piel y severidad variable en su presentación clínica. Con el objetivo de describir y mostrar los hallazgos oftalmológicos más comunes de esta afección, presentamos un caso cuyos síntomas iniciaron a los dos meses de edad con presencia de vesículas y ampollas localizadas en la región frontal, nasal, mejillas y caras laterales del cuello de la frente y las extremidades superiores e inferiores. Las manifestaciones oftalmológicas comenzaron a los seis meses de edad en ambos ojos con leucoma corneal cicatrizal total, simblefaron en 360º, que alcanzó región perilímbica. Todo lo anterior afectó su desarrollo visual y por consiguiente su desarrollo psicomotor. Esta afección requiere tratamiento multidisciplinario con especial atención a la superficie ocular externa para prevenir alteraciones que afecten la visión(AU)
Epidermolysis bulosa is defined as genodermatosis involving a heterogenous group of blistering diseases in the skin and the mucosas, located in the epidermal basal membrane and the basal layer of the stratified, keratinized or mucosal epithelium, with resulting fragility of the skin and variable severity in its clinical presentation. The most common eye findings of this disease were described and shown. The treatment of epidermolysis bulosa should be multidisciplinary, paying special attention to the outer ocular surface to prevent alterations that may affect the vision(AU)
Assuntos
Humanos , Lactente , Membrana Basal/lesões , Transtornos da Visão/terapia , Epidermólise Bolhosa/diagnóstico , Técnicas de Diagnóstico OftalmológicoRESUMO
OBJECTIVES: To determine the prevalence of blindness and visual impairment in Honduras, its causes and the response by the health services to growing demand. METHODS: A cross-sectional population study was conducted between June and December 2013 using the standard methodology of the Rapid Assessment of Avoidable Blindness. A random sample survey was done in 63 clusters of 50 individuals aged ≥ 50, representative of the country as a whole. Visual acuity (VA) was assessed using a Snellen eye chart, and the condition of the lens and posterior pole was examined by direct ophthalmoscopy. Cataract surgical coverage was calculated and an assessment made of its quality, the causes of VA < 20/60 and the barriers to accessing surgical treatment. RESULTS: A total of 2 999 people were examined (95.2% of the forecast total). Blindness prevalence was 1.9% (confidence interval of 95%: 1.4-2.4%) and 82.2% of these cases were avoidable. The main causes of blindness were unoperated cataracts (59.2%) and glaucoma (21.1%). Uncorrected refraction error was the main cause of severe (19.7%) and moderate (58.6%) visual impairment. Cataract surgical coverage was 75.2%. 62.5% of the eyes operated for cataracts achieved a VA > 20/60 with available correction. The main barriers against cataract surgery were cost (27.7%) and the lack of availability or difficulty of geographical access to the treatment (24.6%). CONCLUSIONS: The prevalence of blindness and visual impairment in Honduras is similar to that of other Latin American countries. 67% of cases of blindness could be resolved by improving the response capacity of the ophthalmological services, especially of cataract surgery, improving optician services and incorporating eye care in primary health care.
Assuntos
Cegueira/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Cegueira/prevenção & controle , Catarata/complicações , Catarata/epidemiologia , Extração de Catarata , Estudos Transversais , Feminino , Glaucoma/complicações , Glaucoma/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Inquéritos Epidemiológicos , Honduras/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos de Amostragem , Transtornos da Visão/epidemiologia , Transtornos da Visão/terapiaRESUMO
Carotid cavernous fistulas (CCFs) can be classified as direct and indirect, depending on their flow rates and their etiology. Both forms can cause the same characteristic ophthalmological symptoms and signs. We analyzed these ocular characteristics and determined the prognostics factors associated with treatment outcome. Forty-seven patients with an angiographically confirmed diagnosis of CCF, a preoperative ophthalmic evaluation and at least one ophthalmic sign or symptom at the initial presentation were retrospectively evaluated. The patients were followed-up ophthalmically until the end of treatment, and the complications and the remaining ophthalmological signs and symptoms were then recorded. The patients' ages ranged from 13 to 89 years, with an average of 55.78 (±20.73) years, and a predominance of 28 female (57.8 %) patients. The patients with a direct CCF had a lower average age (p = 0.02). The most common symptoms were blurred vision in 17 (36.2 %) and proptosis in 37 (78.7 %) patients. Elevated intraocular pressure (IOP) was more prevalent in patients with an indirect CCF (p = 0.02). Thrill was more prevalent in patients with direct CCF (p = 0.01). The presence of an initial decrease of visual acuity at the first ophthalmic evaluation was significantly associated with the persistence of ocular symptoms after fistula treatment (odds ratio 3.33). In conclusion our study shows a slight difference in ophthalmic symptoms among patients with different types of fistula. Elevated IOP was significantly associated with indirect fistulas, whereas thrill was significantly associated with direct fistulas. The presence of an initial decrease of visual acuity was significantly associated with a worse ophthalmic prognosis.
Assuntos
Fístula Carótido-Cavernosa/diagnóstico , Diplopia/diagnóstico , Exoftalmia/diagnóstico , Hipertensão Ocular/diagnóstico , Oftalmoplegia/diagnóstico , Transtornos da Visão/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Carótido-Cavernosa/terapia , Diplopia/terapia , Embolização Terapêutica , Exoftalmia/terapia , Feminino , Angiofluoresceinografia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/terapia , Oftalmoplegia/terapia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Transtornos da Visão/terapia , Acuidade Visual/fisiologia , Adulto JovemRESUMO
PURPOSE: To describe the procedures used in developing Clinical and Regulatory Protocols for primary care teams to use in the management of the most common scenarios of impaired vision in Southern Brazil. METHODS: A retrospective review of 1.333 referral forms from all primary care practitioners was performed in Ribeirão Preto city, during a 30-day period. The major ophthalmic diagnostic categories were evaluated from those referrals forms. The Clinical and Regulatory Protocols development process was held afterwards and involved scientific cooperation between a university and the health care system, in the form of workshops attended by primary care practitioners and regulatory system team members composed of health care administrators, ophthalmologists, and professors of ophthalmology and social medicine. RESULTS: The management of impaired vision was chosen as the theme, since it accounted for 43.6% of the ophthalmology-related referrals from primary care providers of Ribeirão Preto. The Clinical and Regulatory Protocols developed involve distinctive diagnostic and therapeutic interventions that can be performed at the primary care level and in different health care settings. The most relevant clinical and regulatory interventions were expressed as algorithms in order to facilitate the use of the Clinical and Regulatory Protocols by health care practitioners. CONCLUSIONS: These Clinical and Regulatory Protocols could represent a useful tool for health systems with universal access, as well as for health care networks based on primary care and for regulatory system teams. Implementation of these Clinical and Regulatory Protocols can minimize the disparity between the needs of patients with impaired vision and the treatment modalities offered, resulting in a more cooperative health care network.
Assuntos
Atenção Primária à Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde , Transtornos da Visão/diagnóstico , Brasil , Protocolos Clínicos , Humanos , Setor Público , Encaminhamento e Consulta , Estudos Retrospectivos , Transtornos da Visão/etiologia , Transtornos da Visão/terapiaRESUMO
La diabetes mellitus constituye un problema global de salud. Ha sido estimada la existencia de 120 millones de diabéticos. Una de las principales complicaciones de la diabetes mellitus, la retinopatía diabética se sitúa entre las más importantes causas de ceguera en Cuba. Se realizó un estudio longitudinal prospectivo para aplicar por primera vez una estrategia terapéutica en adultos mayores con retinopatía diabética y así mejorar su calidad visual; en la consulta de retina del servicio de oftalmología del hospital provincial general Docente Dr Antonio Luaces Iraola de Ciego de Ávila. La muestra fue de 180 pacientes. Se utilizaron variables de interés que se vertieron en una historia clínica previamente confeccionada al efecto. El grupo de edad más afectado fue el de 60-69 años y el sexo predominante fue el femenino. La hipertensión arterial fue el antecedente patológico personal más referido y la catarata como antecedente ocular. La gravedad de la retinopatía fue incrementándose con la edad de los pacientes. Se aplicó a todos los ojos triamcinolona subtenoniana, Grid macular y Panfotocoagulación con láser, lográndose mejorar considerablemente la agudeza visual de los mismos. Se evaluó el grado de satisfacción según escala, los pacientes refirieron estar satisfechos con el tratamiento
Diabetes mellitus is a global health problem. It has been estimated that there are 120 million diabetics. One of the main complications of diabetes mellitus, diabetic retinopathy is among the leading causes of blindness in Cuba. A prospective longitudinal study was carried out to apply for the first time a therapeutic strategy in elderly with diabetic retinopathy and improve visual quality, in the retina consultation of Ophthalmology service of Provincial General Teaching Hospital Dr Antonio Luaces Iraola Ciego Avila. The sample consisted of 180 patients. Variables of interest were used that poured into a clinical history previously drawn up. The age group most affected was 60-69 years and female was the predominant sex. Hypertension was the antecedent personal medical history most referred and eye cataracts as ocular history. The severity of retinopathy was increasing with age of the patients. It was applied to all eyes Tenon triamcinolone, macular grid and laser photocoagulation, achieving significant improvement in visual acuity of them. It assessed satisfaction degree by scale, patients reported being satisfied
Assuntos
Humanos , Masculino , Feminino , Idoso , Qualidade de Vida , Retinopatia Diabética/terapia , Transtornos da Visão/terapia , Estudos Longitudinais , Estudos ProspectivosRESUMO
PURPOSE: To describe the procedures used in developing Clinical and Regulatory Protocols for primary care teams to use in the management of the most common scenarios of impaired vision in Southern Brazil. METHODS: A retrospective review of 1.333 referral forms from all primary care practitioners was performed in Ribeirão Preto city, during a 30-day period. The major ophthalmic diagnostic categories were evaluated from those referrals forms. The Clinical and Regulatory Protocols development process was held afterwards and involved scientific cooperation between a university and the health care system, in the form of workshops attended by primary care practitioners and regulatory system team members composed of health care administrators, ophthalmologists, and professors of ophthalmology and social medicine. RESULTS: The management of impaired vision was chosen as the theme, since it accounted for 43.6 percent of the ophthalmology-related referrals from primary care providers of Ribeirão Preto. The Clinical and Regulatory Protocols developed involve distinctive diagnostic and therapeutic interventions that can be performed at the primary care level and in different health care settings. The most relevant clinical and regulatory interventions were expressed as algorithms in order to facilitate the use of the Clinical and Regulatory Protocols by health care practitioners. CONCLUSIONS: These Clinical and Regulatory Protocols could represent a useful tool for health systems with universal access, as well as for health care networks based on primary care and for regulatory system teams. Implementation of these Clinical and Regulatory Protocols can minimize the disparity between the needs of patients with impaired vision and the treatment modalities offered, resulting in a more cooperative health care network.
OBJETIVO: Descrever os procedimentos utilizados no desenvolvimento de Protocolos Clínicos e de Regulação, para equipes de atenção primária à saúde, voltados à condução dos cenários clínicos mais comuns de dificuldade visual observados na região sudeste do Brasil. MÉTODOS: Realizou-se a revisão retrospectiva de 1.333 guias de encaminhamento advindas de todos os profissionais da atenção primária da cidade de Ribeirão Preto, durante um período de 30 dias. As principais categorias diagnósticas oftalmológicas foram avaliadas nessas guias de referência. O processo de desenvolvimento dos Protocolos Clínicos e de Regulação ocorreu na sequência e envolveu a cooperação científica entre a universidade e o sistema de saúde, sob a forma de oficinas com médicos da atenção primária e membros da equipe do sistema de regulação, composto por gestores de saúde, oftalmologistas, além de professores de oftalmologia e medicina social. RESULTADOS: A dificuldade visual foi escolhida como tema central, uma vez que representou 43,6 por cento dos encaminhamentos oftalmológicos advindos de serviços de atenção primária de Ribeirão Preto. Os Protocolos Clínicos e de Regulação desenvolvidos envolveram diferentes procedimentos diagnósticos e terapêuticos que podem ser executados na atenção primária e outros níveis ou contextos de cuidados à saúde. As intervenções clínicas e de encaminhamento mais relevantes foram expressas como algoritmos, a fim de facilitar a utilização do protocolo pelos profissionais da saúde. CONCLUSÕES: Os Protocolos Clínicos e de Regulação poderão representar uma ferramenta útil para os sistemas de saúde que contam com acesso universal, bem como para as redes de cuidados de saúde baseadas na atenção primária e nos sistemas de regulação. A implementação de Protocolos Clínicos e de Regulação poderá minimizar a disparidade entre as necessidades dos pacientes com dificuldade visual e as formas de condução de casos oftalmológicos, resultando em uma rede de saúde mais eficiente.