Consulta de Diabetes Ocular. Primeiros Resultados do Rastreio da Retinopatia Diabética por Câmara Não Midriática

Introdução: a retinopatia diabética (RD) é, nos países industrializados, uma das principais causas de cegueira. A perda de visão na RD diminui com o diagnóstico precoce e instituição terapêutica2 adequada possibilitados por programas de rastreio sistemático. O rastreio efectuado por fotografias do polo posterior com câmara não midriática é simples e apresenta boa sensibilidade e especificidade3. Material e Métodos: estudo prospectivo, observacional, dos doentes diabéticos sem seguimento oftalmológico regular, seguidos na consulta de Medicina do Centro Hospitalar de Lisboa Central desde Setembro de 2008 a Julho de 2009. Incluíram-se 86 doentes. Um ortoptista fez a aquisição de imagens do polo posterior com uma câmara não midriática e a impressão de fotografias compostas, coloridas, que foram posteriormente analisadas por um oftalmologista da consulta de Diabetes Ocular. Resultados: foram excluídos 7 olhos (4,2%) por não existir qualidade de imagem. Identificou-se a existência de RD em 26% dos 165 olhos incluídos ( 28% dos doentes), apresentando 21% RD não proliferativa e 5% proliferativa. Apurou-se uma relação estatisticamente significativa entre a existência de RD, a idade (p= 0,253 x 10-1) e a duração da diabetes (p= 7,16 x 10-5). Relativamente ao encaminhamento, 57,8% foram referenciados para rastreio anual e 42,2% para a Consulta Geral de Oftalmologia. Todos os excluídos foram igualmente encaminhados para a Consulta Geral de Oftalmologia. Conclusões: a percentagem de doentes rastreados que apresentou RD foi elevada (28%). O rastreio sistemático da população diabética com câmara não midriática pareceu-nos ser um método simples e eficaz no despiste da RD.

Impacto do Diâmetro do Nervo Óptico na Amplitude de Pulso Ocular no Glaucoma Primário de Ângulo Aberto

Introdução: A pressão intra-craniana (PIC) tem sido descrita como estando envolvida no glaucoma primário de ângulo aberto (GPAA). A sua avaliação está contudo limitada pela necessidade de métodos invasivos, como a punção lombar. A ecografia ocular permite uma avaliação indirecta da PIC através da medição do diâmetro da bainha do nervo óptico (NO). Desconhece-se se esta nova variável tem capacidade de modular factores de risco normalmente investigados em doentes com GPAA. Objectivo: Avaliar o impacto do diâmetro da bainha do NO na pressão intra-ocular (PIO) e na amplitude de pulso ocular (OPA) de doentes com GPAA. Métodos: Quinze doentes com GPAA foram submetidos a medição da PIO por tonometria de contorno dinâmico, avaliação topográfica do disco óptico e ecografia ocular modo B com sonda doppler. Apenas o olho com maior dano glaucomatoso foi seleccionado por doente. Resultados: A média do diâmetro da bainha do NO foi de 5,6±0,67mm, a PIO média de 17,8±2,2mmHg e a OPA de 3,1±1,7mmHg. O diâmetro da bainha do NO correlacionou-se negativamente a OPA (r=-0.54, p=0.05), não tendo influenciado a PIO (r=-0,25, p=0,41). Da avaliação hemodinâmica, apenas o índice de resistência da artéria central da retina (CRA) foi influenciado pelo diâmetro da bainha do NO (r=-0.52, p=0.04). Conclusão: O diâmetro da bainha do NO correlaciona-se negativamente com a OPA. Este efeito poderá ser explicado pela alteração da resistência vascular da artéria que atravessa este espaço subaracnoideu, a CRA. O estudo da região retrobulbar e do balanço entre as pressões aí exercidas é assim um campo cuja importância será crescente na avaliação do doente com GPAA.

Physical therapy with drug treatment in bell palsy: a focused review

ABSTRACT: The physical therapy (PT) associated with standard drug treatment (SDT) in Bell palsy has never been investigated. Randomized controlled trials or quasirandomized controlled trials have compared facial PT (except treatments such as acupuncture and osteopathic) combined with SDT against a control group with SDT alone. Participants included those older than 15 yrs with a clinical diagnosis of Bell palsy, and the primary outcome measure was motor function recovery by the House-Brackmann scale. The methodologic quality of each study was also independently assessed by two reviewers using the PEDro scale. Four studies met the inclusion criteria. Three trials indicate that PT in association with SDT supports higher motor function recovery than SDT alone between 15 days and 1 yr of follow-up. On the other hand, one trial showed that electrical stimulation added to conventional PT with SDT did not influence treatment outcomes. The present review suggests that the current practice of Bell palsy treatment by PT associated with SDT seems to have a positive effect on grade and time recovery compared with SDT alone. However, there is very little quality evidence from randomized controlled trials, and such evidence is insufficient to decide whether combined treatment is beneficial in the management of Bell palsy.

Epilepsy and Cerebral Palsy: Characteristics and Trends in Children Born in 1976 - 1998

Background: Although epilepsy is common in children with cerebral palsy (CP), no data exists on prevalence rates of CP and epilepsy. Aims: To describe epilepsy in children with CP, and to examine the association between epilepsy and neonatal characteristics, associated impairments and CP subtypes. Methods: Data on 9654 children with CP born between 1976 and 1998 and registered in 17 European registers belonging to the SCPE network (Surveillance of Cerebral Palsy in Europe)were analyzed. Results: A total of 3424 (35%) children had a history of epilepsy. Among them, seventy-two percent were on medication at time of registration. Epilepsy was more frequent in children with a dyskinetic or bilateral spastic type and with other associated impairments. The prevalence of CP with epilepsy was 0.69 (99% CI, 0.66e0.72) per 1000 live births and followed a quadratic trend with an increase from 1976 to 1983 and a decrease afterwards. Neonatal characteristics independently associated with epilepsy were the presence of a brain malformation or a syndrome, a term or moderately preterm birth compared with a very premature birth, and signs of perinatal distress including neonatal seizures, neonatal ventilation and admission to a neonatal care unit. Conclusions: The prevalence of CP with epilepsy followed a quadratic trend in 1976e1998 and mirrored that of the prevalence of CP during this period. The observed relationship between epilepsy and associated impairments was expected; however it requires longitudinal studies to be better understood.

Lagochilascariasis leading to severe involvement of ocular globes, ears and meninges

A case report of a 31 year-old woman from Paraíba State (North-Eastern Brazil) that presented severe involvement of ocular globes, ears and meninges. Diagnosis was established after enucleation of her left eye, when adult worms were seen in the midst of a granulomatous inflammatory process. Her response to the initial treatment with levamisole and cambendazole was good, but there was a relapse after the fifth month of treatment even with maintenance doses of both medications. She later received ivermectin and albendazol and responded well.

Ocular Toxoplasmosis Reactivation During Pregnancy – A Case Report

Introduction: Toxoplasmosis is caused by Toxoplasma gondii and may be acquired from food or water contaminated with cat feces or by vertical transmission. Severe fetal complications can overcome during pregnancy. There are also rare case-reports of congenital toxoplasmosis from previously immunized pregnant women; usually these women being had prior retinal toxoplasmic lesions. Immunosuppresion is one of the risk factors which accounts for some of these cases. Case report: 30 year-old pregnant woman, OI 2002, brazilian, previously healthy, admitted in Ophtalmology Department because of sudden left eye amaurosis in June, 2010. The fundoscopy revealed retinal scars suggesting previous infections; she was treated with corticoids and spiramycin for ocular toxoplasmosis reactivation. Previous serum analysis (2008) showed immunity to T. Gondii, but in July the IgM was negative and high levels of specific IgG were found (1227UI/mL). The serologic findings were later confirmed by a more accurate laboratory technique which found the IgM to be also positive. An amniocentesis was performed and it was negative for fetal transmission. Clinical and ultrasound follow-up throughout the rest of the gestational period was normal; daily spiramycin intake was maintained. An uneventful term delivery was performed. Neither the newborn’s serum analysis nor the histopathological study of the placenta were positive for congenital infection. Conclusion: Toxoplasmosis reactivation in pregnant women without immunosuppression is rare but is more likely to occur if previous post-infectious retinal scars are present. T. gondii infection is endemic in Brazil, so the geographical origin is important. If risk factors are present, fundoscopy should be performed every three months during pregnancy and one should always be aware of any visual symptoms. If you suspect reactivation, start medical prophylaxis for fetal transmission, perform amniocentesis and regular ultrasound follow-up.

Human ocular sparganosis in southern Brazil

We report the first case of human ocular sparganosis in the state of Santa Catarina, southern Brazil. A young female patient presented with three periocular moveable inflammatory masses in her right eye, during two years. By surgical excisional biopsy, a helminth larval stage was removed and identified as sparganum. Clinical, laboratory and epidemiological data on this parasite are presented.

Perspectivas do Estudo da Diabetes Ocular numa Consulta Pediátrica

A duração da diabetes mellitus é um factor de risco no aparecimento de complicações oculares. A prevalência da retinopatia diabética é praticamente nula antes dos 10 anos de idade, independentemente da duração da doença, atingindo 95% após 20-30 anos de evolução. Na Consulta de Oftalmologia Pediátrica do Hospital D. Estefânia avaliámos retrospectivamente 62 crianças com diagnóstico de diabetes meliitus tipo I, no intervalo d etempo compreendido entre 1 de Janeiro de 1999 e 31 de Junho de 2000. As idades oscilavam entre os 3 e os 17 anos(média 11,8 anos), tendo sido 29 casos do sexo feminino e 33 do sexo masculino. O período de evolução da doença variava entre 6 meses e 16 anos (média 6,2 anos). Na população estudada constatámos uma incidência de 6,4% de lesões oculares. Vericámos 1 caso (1,6%) de retinopatia de fundo, numa adolescente de 17 anos de idade e 11 anos de evoluão da doença, e 3 casos (4,8%) de catarata bilateral. Na diabetes juvenil a probabilidade de ocorrência de lesões oculares precoces é baixa. Exceptuando a catarata que pode ocorrer com alguma precocidade, a retinopatia clínica é raramente demosntrável antes do inicio da puberdade.

Hereditary Neuropathy with Liability to Pressure Palsy Presenting with Hand Drop in a Young Child

Hereditary neuropathy with liability to pressure palsy (HNPP) results from the deletion of the PMP22 gene in chromosome 17p11.2. Clinically, it presents with painless pressure palsies, typically in the 2nd and 3rd decades of life, being a rare entity in childhood. We present the case study of a six-year-old male child who presented with left hand drop that he kept for over four weeks. Electrophysiological studies suggested HNPP and genetic studies confirmed it. With this paper, we pretend to create awareness to this entity as a diagnosis to be considered in a child with painless monoparesis and to emphasize the importance of electrophysiological studies in the diagnosis.

Development of The Viking Speech Scale to Classify the Speech of Children with Cerebral Palsy

Surveillance registers monitor the prevalence of cerebral palsy and the severity of resulting impairments across time and place. The motor disorders of cerebral palsy can affect children’s speech production and limit their intelligibility. We describe the development of a scale to classify children’s speech performance for use in cerebral palsy surveillance registers, and its reliability across raters and across time. Speech and language therapists, other healthcare professionals and parents classified the speech of 139 children with cerebral palsy (85 boys, 54 girls; mean age 6.03 years, SD 1.09) from observation and previous knowledge of the children. Another group of health professionals rated children’s speech from information in their medical notes. With the exception of parents, raters reclassified children’s speech at least four weeks after their initial classification. Raters were asked to rate how easy the scale was to use and how well the scale described the child’s speech production using Likert scales. Inter-rater reliability was moderate to substantial (k > .58 for all comparisons). Test–retest reliability was substantial to almost perfect for all groups (k > .68). Over 74% of raters found the scale easy or very easy to use; 66% of parents and over 70% of health care professionals judged the scale to describe children’s speech well or very well. We conclude that the Viking Speech Scale is a reliable tool to describe the speech performance of children with cerebral palsy, which can be applied through direct observation of children or through case note review.

OCULAR SYPHILIS IN A KIDNEY TRANSPLANT RECIPIENT

We present a case of ocular syphilis after a renal transplantation involving progressive vision loss without clinically identifiable ocular disease. Electroretinography showed signs of ischemia, especially in the internal retina. A serological test was positive for syphilis. Lumbar puncture revealed lymphocytic meningitis and a positive serologic test for syphilis in the cerebrospinal fluid. The patient was treated with penicillin, and had a quick vision improvement. In the case of transplant recipients, clinicians should always consider the diagnosis of ocular syphilis in cases with unexplained visual acuity decrement, as this condition may cause serious complications if not treated.

Análise Retrospectiva e Caracterização Epidemiológica de 151 Casos de Inflamação Ocular

Objectivo: Analisar e caracterizar uma amostra de doentes de uma consulta de inflamação ocular. Material e Métodos: Análise retrospectiva de 503 consultas realizadas por um clínico entre 1 de Agosto de 2012 e 31 de Agosto de 2013 no Centro Hospitalar de Lisboa Central com recurso aos respectivos processos clínicos. Na análise da casuística da consulta foram incluídos 151 doentes. Desses, 24 padeciam de doenças auto-imunes em seguimento para monitorização de toxicidade a fármacos mas sem registo de qualquer episódio de uveíte, pelo que foram excluídos da avaliação estatística referente às uveítes. Dos 127 doentes com uveíte foram incluídos 197 olhos. Resultados: A média de idades foi de 53,8±16,5 anos, sendo 60% do sexo feminino e 40% masculino. A inflamação foi bilateral em 70 e unilateral em 57 doentes. O tipo de uveíte mais frequente foi a anterior (51,2%), seguida da panuveíte (21,3%), posterior (19,7%), intermédia (3,9%), episclerite (3,2%) e esclerite (0,8%). As etiologias foram agrupadas em: doenças sistémicas (34%), doenças infecciosas (30%), idiopáticas (27%) e patologias oculares específicas (9%). A acuidade visual média nos olhos com uveíte anterior foi 0.8, panuveíte 0.2, uveíte posterior 0.2, uveíte intermédia 0.7, episclerite e esclerite 1.0. Dos 197 olhos com uveíte, 27 (13,7%) foram submetidos a cirurgia de catarata e 5 (2,5%) a cirurgia de glaucoma. Conclusões: Apesar de se tratar de uma amostra relativamente pequena, reveste-se de importância dado ser fundamental conhecer a realidade em cada centro de referência de forma a optimizar os recursos disponíveis e a melhorar a abordagem clínica.

Ocular Pulse Amplitude and Doppler Waveform Analysis in Glaucoma Patients

PURPOSE: To determine the correlation between ocular blood flow velocities and ocular pulse amplitude (OPA) in glaucoma patients using colour Doppler imaging (CDI) waveform analysis. METHOD: A prospective, observer-masked, case-control study was performed. OPA and blood flow variables from central retinal artery and vein (CRA, CRV), nasal and temporal short posterior ciliary arteries (NPCA, TPCA) and ophthalmic artery (OA) were obtained through dynamic contour tonometry and CDI, respectively. Univariate and multiple regression analyses were performed to explore the correlations between OPA and retrobulbar CDI waveform and systemic cardiovascular parameters (blood pressure, blood pressure amplitude, mean ocular perfusion pressure and peripheral pulse). RESULTS: One hundred and ninety-two patients were included [healthy controls: 55; primary open-angle glaucoma (POAG): 74; normal-tension glaucoma (NTG): 63]. OPA was statistically different between groups (Healthy: 3.17 ± 1.2 mmHg; NTG: 2.58 ± 1.2 mmHg; POAG: 2.60 ± 1.1 mmHg; p < 0.01), but not between the glaucoma groups (p = 0.60). Multiple regression models to explain OPA variance were made for each cohort (healthy: p < 0.001, r = 0.605; NTG: p = 0.003, r = 0.372; POAG: p < 0.001, r = 0.412). OPA was independently associated with retrobulbar CDI parameters in the healthy subjects and POAG patients (healthy CRV resistance index: β = 3.37, CI: 0.16-6.59; healthy NPCA mean systolic/diastolic velocity ratio: β = 1.34, CI: 0.52-2.15; POAG TPCA mean systolic velocity: β = 0.14, CI 0.05-0.23). OPA in the NTG group was associated with diastolic blood pressure and pulse rate (β = -0.04, CI: -0.06 to -0.01; β = -0.04, CI: -0.06 to -0.001, respectively). CONCLUSIONS: Vascular-related models provide a better explanation to OPA variance in healthy individuals than in glaucoma patients. The variables that influence OPA seem to be different in healthy, POAG and NTG patients.