7.1- 1) Com relação às características das lesões de RCST conclui-se que: tinham em média 2,71 DD de tamanho; localizavam-se em 85,2% em zona 2; encontravam-se cicatrizadas em 88,9% dos casos; e apresentavam-se em número de 1,46 lesões em média por olho.
2) Com relação ao episódio ativo anterior à cirurgia conclui-se que: o tempo decorrido entre o início do último episódio ativo de retinocoroidite e a cirurgia foi de 11,10 meses em média; a presença de vitreíte grave durante o episódio ativo de RCST esteve presente em 64% dos casos, sendo importante na persistência da opacidade vítrea e na formação de DRR e DRT; e o tratamento sistêmico prévio nada acrescentou ao estudo.
3) O grau de opacidade vítrea no momento da cirurgia em 62,9% dos olhos foi de 1+/4+ e 2+/4+.
4) Não houve relação estatisticamente significativa entre as variáveis estudadas.
7.2- 1) A principal indicação cirúrgica na toxoplasmose ocular foi a associação de DRT e DRR em 46,3% dos casos, seguida de perto pela OV persistente (24,1%) e membrana epiretiniana (22,2%).
2) Com relação aos resultados da cirurgia conclui-se que:
a) ocorreu sucesso anatômico em 85,2% dos casos, e apenas dois casos evoluíram para phthisis bulbi (3,7%);
b) foram freqüentes as complicações pós-operatórias (63%), principalmente nos casos de DRR e DRT; a catarata (56,1%) foi a principal complicação encontrada; o DR (22%) foi a principal
complicação vitreo-retiniana; e foram redescolamentos na maioria dos casos;
c) foram necessários novos procedimentos em 29,6% dos casos e a cirurgia de catarata foi a mais realizada (68,7%);
d) a AV final melhorou ou permaneceu inalterada em 75,9% dos casos; as melhores AV foram nos pacientes operados de OV, membrana epiretiniana e hemorragia vítrea.
3) Pode ocorrer reativação ou nova lesão de RCST após cirurgia vitreo-retiniana; a freqüência foi de 7,4% e o tempo decorrido entre a cirurgia e o novo episódio ativo teve em média de 11,75 meses.
8- SUMMARY
OBJECTIVES: This study seeks to evaluate vitreoretinal surgeries in retrospect accomplished in patient bearers of ocular toxoplasmosis. This study seeks to evaluate specifically: the surgical
indications; the results of the surgery; and the reactivation presence or new retinochoroiditis lesion after the accomplishment of the surgery.
METHODS: This study consisted of a retrospective evaluation of 54 handbooks of patients
accompanied in service of uveitis of Academical Hospital that submitted the vitreoretinal surgery due to the vitreoretinal complications secondary the ocular toxoplasmosis. They were researched episodes previous of cases of subsequent uveitis by toxoplasmosis, ocular previous surgeries, previous clinical treatment used, the time of the beginning of this last active episode to the surgery, the characteristics of the retinochoroiditis lesion (activity, size, location and number of lesions), the surgical indications, the degree of vitreous opacity in the moment of the surgery, the techniques surgical maids, the results of the surgery (anatomical success, complications, new accomplished procedures, and the final visual acuity), and the reactivation presence or new retinochoroiditis lesion after the accomplishment of the surgery. The variables were compared in the attempt of relating statistically.
RESULTS: The age varied from 13 to 54 years, with average of 29,5. They were 29 patient male (53,7%) and 25 female (46,3%). The characteristics of the lesions were: six active lesions (11,1%) and 48 scarred lesions (88,9%); on average of 1,46 lesions, varying of one ties four lesions; it varied from 0,5 to 9 DD in size, with average of 2,71DD; and they were located seven lesions in zone 1 (13%) ,40 lesions in zone 2 (74,1%), a lesion in zone 3 (1,9%), and six lesions in the zones 1 and 2 (11,1%). The time of continuation (in months) of the patient after the accomplishment of the surgery varied from six to 67 months, with average of 20,26. The time elapsed between the beginning of the last active episode of retinochoroiditis and the surgery (in months) it varied from 1 to 41 months, with the average of 11,10. The graduation of the vitreitis during the last active episode of the retinochoroiditis had 18 eyes (36%) classified as no-severe and 32 eyes (64%) as severe. The systemic corticosteroid was used by 48 patient (88,9%), and 47 patient (87%) they made use of several anti-infectious drugs. Seven patients (13%) they were previously operated. Four patient (7,4%) they had active episode of retinochoroiditis after the accomplished surgery and the time elapsed between the surgery and the reactivation varied from 3 to 17 months, with average of 11,75. The main surgical indications were 15 eyes (27,8%) with tractional
retinal detachment, 13 eyes (24,1%) with vitreous opacities, 12 eyes (22,2%) with epiretinal
membrane, 10 eyes (18,5%) with rhegmatogenous retinal detachment, two eyes (3,7%) with vitreous hemorrhage and other two eyes (3,7%) with macular hole to blemish associate to the epiretinal membrane . The degree of vitreous opacity in the moment of the surgery had 11 eyes with 1+/4+ (20,4%), 23 with 2+/4+ (42,6%), 12 with 3+/4+ (22,2%) and eight with 4+/4+(14,8%). The association pars plana vitrectomy + membrane peelling + intravitreous gas injection (10 eye-18,5%) and the association retinopexy + pars plana vitrectomy + endolaser + silicon oil injection (10 eye-18,5%), they were the techniques more used. 46 eyes (85,2%) they presented favorable anatomical result. They were 34 eyes (63%) that presented some type of postoperative complication, and the cataract was the main complication with 56,1%. They happened nine retinal detachments, being seven redetachments. New procedures were accomplished in 16 eyes (29,6%) and the cataract surgery was the more accomplished (68,7%). The initial visual acuity (LOGMAR) varied from 0,5 to 3,0, with average of 1,956; the final varied from 0,0 to 3,0, with average of 1,606. There was gets better of the visual acuity in 29 patient (53,7%), it stayed unaffected in 12 patient (22,2%) and it worsened in 13 patient (24,1%). Several variables were compared amongst themselves, and there was not differentiates significant statistically (p < 0,05) in none of the situations.
CONCLUSIONS: This study allowed to end regarding the characteristics of the lesions of ocular toxoplasmosis in eyes submitted to the vitreoretinal surgery that: the lesions of ocular toxoplasmosis had 2,71 DD of size on average; they were located in 85,2% in zone 2; they were scarred in 88,9% of the cases; they came in number of 1,46 on average. According to the previous active episode the
surgery :the time elapsed between the beginning of the last active episode of retinochoroiditis and the surgery was of 11,10 months on average; the presence of severe vitreitis during the active episode of ocular toxoplasmosis was present in 64% of the cases, being important in the persistence of the vitreous opacity and in the formation of rhegmatogenous retinal detachment and tractional retinal detachment; the previous systemic treatment anything help. The main surgical indication in the ocular toxoplasmosis is the association of tractional retinal detachment and rhegmatogenous retinal detachment, followed closely by persistent vitreous opacity and epiretinal membrane. The degree of vitreous opacity in the moment of the surgery in 62,9% of the eyes it was of 1+/4+ and 2+/4+, showing the tendency of improvement of vitreous opacities along the time and not to have relationship with the results of the surgery. This study can conclude if regarding the results of the surgery that: they got anatomical success in 85,2% of the cases; they were frequent the postoperative complications (63%), mainly in the cases of
rhegmatogenous retinal detachment and tractional retinal detachment; the cataract was the
main complication with 56,1%. The retinal detachment was the main vitreoretinal complication with 22%. They were new necessary procedures in 29,6% of the cases and the cataract surgery was the more accomplished (68,7%). Final visual acuity got better or it stayed unaffected in 75,9% of the cases; best visual acuity are in the operated patients of vitreous opacities, epiretinal membrane and vitreous
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