Jul-Ago - Sociedade Brasileira de Oftalmologia

More documents

Recommendations

Info

ARTIGO ORIGINAL 211Diagnosis and treatment of hyperfiltering blebsDiagnóstico e tratamento de bolsas fistulantes hiperfuncionantesSebastião Cronemberger 1 , Daniela Silveira de Faria 2 , Jamile Moreira Reimann 3 , Heloisa AndradeMaestrini 4 , Nassim Calixto 1ABSTRACTPurpose: To report on a new treatment for hyperfiltering bleb as well as its diagnostic criteria. Methods: Twenty eyes withhypotony due to hyperfiltering bleb caused by trabeculectomy with mitomicin C were treated with bleb resection. The diagnosisof hyperfiltering bleb followed these criteria: intraocular pressure lower than six mmHg (Goldmann tonometer); no inflammationin the anterior segment; presence of an elevated and/or diffuse and avascular bleb with or without microcysts; negative Seidel test;no ciliochoroidal detachment found with ultrasound biomicroscopy. We registered the following data pre and post operatively:type of glaucoma, visual acuity, bleb aspect and fundoscopic findings. A successful resolution of hypotony was achieved whenintraocular pressure ranged from six to 14 mmHg with or without antiglaucomatous medication. Results: At a minimum followupof 19 months ocular hypotony had been reversed in all eyes. At the last exam, intraocular pressure varied from eight to 14mmHg in 18 (90%) eyes; 12 (66.7%) eyes had no medication and six (33.3%) used antiglaucomatous medication. In two (10%)eyes, another trabeculectomy was necessary to control intraocular pressure. Hypotonic maculopathy developed preoperativelyin seven eyes and was reversed after bleb resection. Visual acuity improved in 15 (75%) eyes but did not change in five (25%).Conclusion: Bleb resection is a safe and adequate treatment for ocular hypotony due to hyperfiltering bleb. It also restores visionin a considerable number of patients. The diagnosis of hyperfiltering bleb must follow rigorous criteria.Keywords: Trabeculectomy/adverse effects; Mitomycin/therapeutic use; Ocular hypotension; Treatment outcome.1Full Professor, Faculdade de Medicina da Universidade Federal de Minas Gerais – UFMG – Belo Horizonte (MG), Brazil;2MD, Glaucoma service, Hospital São Geraldo – Hospital das Clínicas, Universidade Federal de Minas Gerais – UFMG – BeloHorizonte (MG), Brazil;3Especialista em Oftalmologia pelo Hospital São Geraldo - Hospital das Clínicas da Universidade Federal de Minas Gerais – UFMG– Belo Horizonte (MG), Brazil;4PhD, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG – Belo Horizonte (MG), Brazil;Study carried out at Department of Ophthalmology, Glaucoma Service, Hospital São Geraldo, Hospital das Clínicas, UniversidadeFederal de Minas Gerais – UFMG – Belo Horizonte (MG), Brasil;The authors have no commercial interest in the products and equipment used in this studyRecebido para publicação em: 24/9/2010 - Aceito para publicação em 27/4/2011Rev Bras Oftalmol. 2011; 70 (4): 211-17
212Cronemberger S, Faria DS, Reimann JM, Maestrini HA, Calixto NRESUMOObjetivo: Relatar os resultados de uma nova técnica para o tratamento de bolsa hiperfuncionante, assim como seuscritérios diagnósticos. Métodos: Vinte olhos (20 pacientes) com hipotonia ocular causada por bolsa hiperfuncionante apóstrabeculectomia com mitomicina C foram tratados com ressecção da bolsa. O diagnóstico de bolsa hiperfuncionante obedeceuaos seguintes critérios: pressão intraocular inferior a seis mmHg (tonometria de Goldmann); ausência de inflamação dosegmento anterior ocular; presença de bolsa fistulante elevada e/ou difusa e avascular com ou sem microcistos; teste de Seidelnegativo; ausência de descolamento ciliocoroidiano ao exame de UBM. Foram registrados no pré e pós-operatório: o tipo deglaucoma, a acuidade visual, o aspecto da bolsa e os achados oftalmoscópicos. A resolução da hipotonia foi alcançada quandoa pressão intraocular variou de seis a 14 mmHg sem ou sob medicação tópica antiglaucomatosa. Resultados: No seguimentomínimo de 19 meses, a hipotonia ocular foi revertida nos 20 olhos. No último exame, a pressão intraocular variou de oito a 14mmHg em 18 (90%) olhos; 12 (66,7%) olhos sem medicação e seis (33,3%) olhos sob medicação tópica. Em dois (20%) olhosfoi necessário nova trabeculetomia para controle da pressão intraocular. Maculopatia hipotônica foi diagnosticada no préoperatórioem sete olhos e foi revertida em todos eles após a ressecção da bolsa. A acuidade visual melhorou em 15 (75%)olhos e não se alterou em cinco (25%). Conclusão: A ressecção da bolsa é eficaz no tratamento da hipotonia ocular consequentea sua hiperfunção. Esse procedimento também recupera a visão num considerável número de pacientes. O diagnóstico debolsa hiperfuncionante deve obedecer a critérios rigorosos.Descritores: Trabeculectomia/efeitos adversos; Mitomicina/uso terapêutico; Hipotensão ocular; Resultado de tratamentoINTRODUCTIONTrabeculectomy has proved effective in reducingintraocular pressure (IOP) and delaying theprogression of glaucoma (1-4) . This surgery canbring benefits such as improvement in quality of liferesulting from the reduction or total discontinuation ofmedications. It may even lead to lower and safer IOPlevels, particularly for patients in an advanced stage ofglaucoma (1) . In cases of refractory glaucoma,antimetabolites are used to improve trabeculectomyresults. However, antimetabolites can causecomplications such as postoperative ocular hypotony,which may be associated with shallow or a flat anteriorchamber, ciliochoroidal effusion, cataract andmaculopathy (5) .To date, the correct diagnosis and ideal treatmentof hyperfiltering bleb have not been conclusivelyestablished.Intrableb autologous blood injection (6-9) , freeconjunctival autografts (10) , free conjunctival patch (11) ,fascia lata (12) , Nd:YAG laser (13,14) , compression suture (15) ,and wide-diameter contact lenses (16-18) have all been usedto treat ocular hypotony with varied degrees ofeffectiveness, thereby proving a lack of consensus on thissubject.The surgical approach to hyperfiltering bleb datesback to the 1960s (19-22) . In 2004 we published a fivecasepilot study of ocular hyptony (23) in which criteria forthe correct diagnosis of hyperfiltering bleb and itstreatment were established.The purposes of this study are: 1) to report resultsof treatment in a series of patients with ocular hypotonycaused by hyperfiltering bleb who underwent blebresection; 2) to substantiate criteria (23) for the correctdiagnosis of hyperfiltering bleb.METHODSTwenty eyes (20 patients) with ocular hypotonyafter trabeculectomy with mitomycin C (MMC) werediagnosed with hyperfiltering bleb (HB) after beingexamined by the same doctor (SC). Five eyes in this paperwere included in a smaller pilot study previouslypublished. (23) This study was performed according to thetenets of the Declaration of Helsinki and approved bythe ethics committee of the Federal University of MinasGerais. All patients were informed of the purposes of thestudy and gave informed consent. The diagnosis of HBwas made with the following criteria: IOP lower than sixmmHg; (23) no inflammation in the anterior segment;elevated and/or diffuse and avascular bleb with or withoutmicrocysts (Figure 1A); negative Seidel test (absence ofaqueous humour leakage in the Seidel test, even afterslight compression of the ocular globe); no ciliochoroidaldetachment (CCD) found on the ultrasoundbiomicroscopy (UBM) carried out in the superior, inferior,nasal and temporal quadrants. Once criteria had beenfulfilled, we attempted to normalize the IOP with 1%atropine (one drop every 12 hours) and 0.1%dexamethasone (one drop every six hours) for at least30 days (24) . As clinical treatment failed to reverse ocularhypotony, all patients were submitted to HB resection bythe same surgeon (SC).Rev Bras Oftalmol. 2011; 70 (4): 211-17
Page 1 and 2: vol. 70 - nº 4 - Julho / Agosto 20
Page 3 and 4: 204Revista Brasileira de Oftalmolog
Page 5 and 6: 206235 New technique to demonstrate
Page 7 and 8: 208 Ambrósio Júnior RGerard Mouro
Page 9: 210Ambrósio Júnior RDiferentes pl
Page 13 and 14: 214Cronemberger S, Faria DS, Reiman
Page 15 and 16: 216Cronemberger S, Faria DS, Reiman
Page 17 and 18: 218ARTIGO ORIGINALUso profilático
Page 19 and 20: 220Oliveira PRP, Simão LF, Simão
Page 21 and 22: 222Oliveira PRP, Simão LF, Simão
Page 23 and 24: 224ARTIGO ORIGINALPercepção da ad
Page 25 and 26: 226Portes AJF, Silva MGO, Viana M,
Page 27 and 28: 228Portes AJF, Silva MGO, Viana M,
Page 29 and 30: 230ARTIGO ORIGINALExpectativas e co
Page 31 and 32: 232Kara-Junior N, Mourad PCA , Esp
Page 33 and 34: 234Kara-Junior N, Mourad PCA , Esp
Page 35 and 36: 236 Marques FF, Marques DMV, Osher
Page 37 and 38: 238ARTIGO ORIGINALPerfil da demanda
Page 39 and 40: 240Pereira FB, Frasson M, D’Almei
Page 41 and 42: 242Pereira FB, Frasson M, D’Almei
Page 43 and 44: 244 Corso DD, Bonamigo EL, Corso MA
Page 45 and 46: 246Corso DD, Bonamigo EL, Corso MA,
Page 47 and 48: 248RELATO DE CASOPupila dilatada fi
Page 49 and 50: 250Batista JLA, Grisolia ABD, Pazos
Page 51 and 52: 252RELATO DE CASOPolypoidal choroid
Page 53 and 54: 254Amaro MH, Roller AB, Motta CTPS,
Page 55 and 56: 256Amaro MH, Roller AB, Motta CTPS,
Page 57 and 58: 258Biancardi AL, Ambrosio Júnior R
Page 59 and 60: 260Biancardi AL, Ambrosio Júnior R
Page 61 and 62:
262Amaro MH, Amaro FAH, Roller AB,
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
268Instruções aos autoresA Revist
Page 69:
270RevistaBrasileira deOftalmologia
show all

Jul-Ago - Sociedade Brasileira de Oftalmologia

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?