Avaliação da acuidade visual e do eletrorretinograma multifocal em pacientes com alterações visuais e história pregressa de febre reumática
Data
2023-12-11
Autores
Borges, Milena Leal 
Orientadores
Sacai, Paula Yuri
Tipo
Trabalho de conclusão de curso
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Resumo
Objetivos: Condições inflamatórias sistêmicas podem repercutir na saúde ocular, especificamente na retina. Os objetivos desse estudo foram avaliar a acuidade visual e os achados do eletrorretinograma multifocal em pacientes com alterações visuais e histórico pregresso de febre reumática e identificar as principais queixas visuais. Metodologia: estudo observacional, retrospectivo e descritivo foi realizado a partir dos prontuários de pacientes com queixas visuais encaminhados para um Laboratório Especializado de Eletrofisiologia Visual, nos últimos 10 anos, de ambos os sexos, com idade igual ou superior a 18 anos, histórico prévio de febre reumática e submetidos ao procedimento de eletrorretinograma (ERG) multifocal e avaliação por médico oftalmologista especialista em retina. Os principais critérios de exclusão foram doenças oculares prévias, história positiva para doenças oculares hereditárias ou consanguinidade. A acuidade visual (AV) melhor corrigida foi medida monocularmente para longe, em tabela ETDRS (4 metros) e foram classificados sem deficiência visual quando melhor ou igual a 20/40. O eletrorretinograma multifocal foi realizado compreendendo anéis concêntricos em 0, 5, 10, 15, 20 e 25 graus de excentricidade retiniana. Resultados: De um total de 62 prontuários de pacientes com histórico de febre reumática, foram elegíveis para o estudo 26 pacientes (14 homens), com idades variando de 41 a 63 anos. As principais queixas visuais incluíram nictalopia (96,15%), alteração de campo visual (84,61%), baixa acuidade visual (57,70%), discromatopsia (53,84%) e fotofobia (53,84%). Todos os pacientes tiverem a AV de 20/40 ou melhor, em pelo menos um dos olhos. A média de acuidade visual no melhor olho foi de 0,07 (20/20) ± 0,12 logMAR e AV no pior olho foi de 0,30 (20/40) ± 0,42 logMAR com diferença interocular significante de acuidade visual entre os olhos (t= -2,726; p=0,01). Em 24 pacientes (92,31%), o eletrorretinograma multifocal demonstrou alterações na função macular em ambos os olhos. Na análise do olho de melhor acuidade visual e das amplitudes do ERG multifocal em 0 grau não houve correlação estatisticamente significante (r= -0,315; p=0,124). Conclusões: Todos os pacientes foram classificados sem deficiência visual, ao considerar a acuidade visual no melhor olho. As alterações retinianas na região macular foram evidenciadas pelos achados do ERG multifocal com perda da função na maioria dos pacientes, confirmando que os achados eletrorretinográficos podem preceder a perda da acuidade visual. As principais queixas visuais foram nictalopia e alteração de campo visual. Dessa forma, destaca-se a importância da investigação da saúde ocular, com diferentes exames funcionais complementares nesse pequeno grupo de pacientes com história pregressa de febre reumática e queixas visuais.
Purposes: to evaluate visual acuity and multifocal electroretinogram findings in patients with visual changes and a previous history of rheumatic fever. Methods: the observational, retrospective, and descriptive study was carried out based on the medical records of patients with visual complaints referred to a Laboratory of Visual Electrophysiology, in the last 10 years. The study included both sexes, aged 18 years or over, with a previous history of rheumatic fever who underwent a multifocal electroretinogram (ERG) procedure and evaluation by an ophthalmologist specializing in retina. The main exclusion criteria were previous eye diseases, positive history of hereditary eye diseases, or consanguinity. Best-corrected visual acuity (VA) was measured monocularly at a distance, using an ETDRS table (4 meters) and they were classified as no visual impairment when better than or equal to 20/40. The multifocal ERG was performed comprising concentric rings of 0, 5, 10, 15, 20, and 25 degrees of retinal eccentricity. Results: From a total of 62 medical records of patients with a history of rheumatic fever, 26 patients (14 male; 12 female) were eligible for the study, with ages ranging from 41 to 63 years. The main visual complaints included nyctalopia (96.15%), visual field changes (84.61%), low visual acuity (57.70%), dyschromatopsia (53.84%), and photophobia (53.84%). All patients have a VA of 20/40 or better in at least one eye. The mean visual acuity in the better eye was 0.07 (20/20) ± 0.12 logMAR and VA in the worse eye was 0.30 (20/40) ± 0.42 logMAR with significant interocular difference in visual acuity between the eyes (t= -2.726; p=0.01). In 24 patients (92.31%), the multifocal ERG demonstrated changes in macular function in both eyes. In the analysis of the eye with the best visual acuity and the multifocal ERG amplitudes at 0 degrees, there was no statistically significant correlation (r= -0.315; p=0.124). Conclusions: All patients were classified as having no visual impairment when considering visual acuity in the better eye. Retinal changes in the macular region were evidenced by multifocal ERG findings with loss of function in most patients, confirming that electroretinographic findings may precede loss of visual acuity. The main visual complaints were nyctalopia and visual field changes. Therefore, the study highlights the importance of investigating eye health with some functional tests.
Purposes: to evaluate visual acuity and multifocal electroretinogram findings in patients with visual changes and a previous history of rheumatic fever. Methods: the observational, retrospective, and descriptive study was carried out based on the medical records of patients with visual complaints referred to a Laboratory of Visual Electrophysiology, in the last 10 years. The study included both sexes, aged 18 years or over, with a previous history of rheumatic fever who underwent a multifocal electroretinogram (ERG) procedure and evaluation by an ophthalmologist specializing in retina. The main exclusion criteria were previous eye diseases, positive history of hereditary eye diseases, or consanguinity. Best-corrected visual acuity (VA) was measured monocularly at a distance, using an ETDRS table (4 meters) and they were classified as no visual impairment when better than or equal to 20/40. The multifocal ERG was performed comprising concentric rings of 0, 5, 10, 15, 20, and 25 degrees of retinal eccentricity. Results: From a total of 62 medical records of patients with a history of rheumatic fever, 26 patients (14 male; 12 female) were eligible for the study, with ages ranging from 41 to 63 years. The main visual complaints included nyctalopia (96.15%), visual field changes (84.61%), low visual acuity (57.70%), dyschromatopsia (53.84%), and photophobia (53.84%). All patients have a VA of 20/40 or better in at least one eye. The mean visual acuity in the better eye was 0.07 (20/20) ± 0.12 logMAR and VA in the worse eye was 0.30 (20/40) ± 0.42 logMAR with significant interocular difference in visual acuity between the eyes (t= -2.726; p=0.01). In 24 patients (92.31%), the multifocal ERG demonstrated changes in macular function in both eyes. In the analysis of the eye with the best visual acuity and the multifocal ERG amplitudes at 0 degrees, there was no statistically significant correlation (r= -0.315; p=0.124). Conclusions: All patients were classified as having no visual impairment when considering visual acuity in the better eye. Retinal changes in the macular region were evidenced by multifocal ERG findings with loss of function in most patients, confirming that electroretinographic findings may precede loss of visual acuity. The main visual complaints were nyctalopia and visual field changes. Therefore, the study highlights the importance of investigating eye health with some functional tests.
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Citação
Avaliação da acuidade visual e do eletrorretinograma multifocal em pacientes com alterações visuais e história pregressa de febre reumática / Milena Leal Borges – São Paulo, 2023.