Aplicações do oftalmoscópio de rastreamento a laser em pacientes portadores de buraco de mácula verdadeiro idiopático

Bordon, Arnaldo F.; Bonono, Pedro Paulo; Jalkh, Alex E.; Farah, Michel E.

doi:10.5935/0004-2749.19960002

RESUMO

Foram analisados 50 olhos de 41 pacientes portadores de buraco macular idiopático, utilizando-se o oftalmoscópio de rastreamento a laser. Foi realizada a perimetria híbrida da área central retiniana. Dez (24,4%) pacientes eram do sexo masculino e 31 (75,6%) do sexo feminino. A média de idade foi 64,9 anos. Nove (22%) casos bilaterais foram identificados. Quanto a microperimetria, 78% dos olhos apresentavam escotoma denso na região do buraco e 22% escotoma denso e relativo. A fixação foi estável em 88% dos olhos e instável em 12%. O descolamento seroso ao redor do buraco estava presente em 52% dos olhos. A presença do descolamento seroso ao redor do buraco foi correlacionada com a presença de escotoma correspondente nessa área em apenas 26,9% dos casos. Somente olhos com ausência do descolamento seroso ao redor do buraco apresentaram acuidade visual entre 20/40 e 20/60 (P = 0,03). A baixa ocorrência de escotoma associado ao descolamento seroso, indica que o tecido retiniano ao redor do buraco é potencialmente viável.

Palavras-chave:
Oftalmoscopia; Laser; Buraco macular; Escotoma

SUMMARY

Fifty eyes (41 patients) with idiopathic macular hole were studied using the scanning laser ophthalmoscope. The technique used was the hybrid perimetry of the central portion of the retina. Ten patients (24.4%) were male, and 31 (75.6%) female. The average age was 64.9 years. Nine (22%) bilateral cases were identified. The microperimetry showed dense scotoma within the hole in 78% of the eyes, and dense plus relative scotoma around the hole in 22% of the eyes. The fixation was stable in 88% of the eyes, and unstable in 12% of the eyes. The serous subretinal fluid halo around the macular hole was present in 52% of the eyes. The existence of a corresponding scotoma to the area of serous subretinal fluid halo was demonstrated in 26.9% of these eyes. Only eyes with absence of serous subretinal fluid halo presented with visual acuity between 20/40 and 20/60 (P = 0.03). The clinical findings of lack of correspondence between serous subretinal fluid halo surrounding the hole and presence of scotoma in this area, indicale that the retinal tissue around the hole is potentially viable.

Key words:
Ophthalmoscopy; Laser; Macular hole; Scotoma

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REFERÊNCIAS BIBLIOGRÁFICAS

¹
GASS, J. D. M. - Idiopathic senil e macular holes: its early stages and pathogenesis. Arch. Ophthalmol., 106: 629-639, 1988.
²
DELORI, F. C.; PARKER, J. S.; MAINSTER, M. A. - Light levels in fundus photography and fluorescein angiography. Vis. Res., 20: 1099-1104, 1980.
³
WEBB, R. H.; HUGHES, G. W.; POMERANTZEFF, O. - Flying spot TV ophthalmoscope. App. Opt., 19: 2991-2997, 1980.
⁴
KATSUMI, O.; TIMBERLAKE, G. T.; HIROSE, T.: VAN DE VELDE, F. J.; SAKAUE, H. - Recording pattern reversal visual evokcd response with the scanning laser ophthalmoscope. Acta Ophthalmologica, 67: 243-248, 1989.
⁵
WOLF, S.; AREND. O.; TOONEN, H.; BERTRAM, B.; JUNG, F.; REIM, M. - Retinal capillary blood llow measurement with scanning laser ophthalmoscope: preliminary results. Ophthalmology 98: 996-1000, 1991.
⁶
JALKH, A. E.; VAN DE VELDE, F. J.; SCHEPENS, C. L. - Scanning laser ophthalmoscope: basic principies and clinicai application. In: KHOO, C. Y. et al. - New Frontiers in Ophthalmology. Singapore, Elsevier Science Publishers, p. 221-227, 1991.
⁷
GASS, J. D. M. - Macular dysfunction caused by vitreous and vitreoretinal interface abnormalities. In: - Stereoscopic atlas of macular diseases. 3rd ed. St. Louis, The C. V. Mosby Company, p. 671-726, 1987.
⁸
ÁVILA, M. P.; JALKH, A. E.; MURAKAMI, K.; TREMPE, C. L.; SCHEPENS, C. L. - Biomicroscopic study of the vitreous in macular breaks. Ophthalmology, 90: 1277-1283, 1983.
⁹
TREMPE. C. L.; WEITER. J. J.; FURUKAWA, H. - Fellow eyes in cases of macular boles: biomicroscopic study of the vitreous. Arch. Ophthalmol., 104: 93-95, 1986.
¹⁰
STÜRMER, J.; SCHRÖDEL, C.; RAPPL, W. - Scanning laser ophthalmoscope for static funduscontrolled perimetry. In: NASEMANN, J. E. & BURK, R. O. W. - Scanning laser ophthalmoscopy and tomography. Müchen, Quintessenz Velags-GmbH, p. 133-146, 1990.
¹¹
ACOSTA, F.; LASHKARI, K.; REYNAUD, X.; JALKH, A. E.; VAN DE VELDE, F.; CHEDID, N. - Characterization of functional changes in macular holes and cysts. Ophthalmology, 98: 1820-1823, 1991.
¹²
SCHOCKET, S. S.; LAKHANPAL, V.; XIAOPING. M.; KELMAN, S.; BILLINGS, E. - Laser treatment of macular holes. Ophthalmology, 95: 574-582, 1988.
¹³
MADREPERLA, S. A.; GEIGER, G. L.; FUNATA, M.; DE LA CRUZ, Z.: GREEN, W. R. - Clinicopathologic correlation of a macular hole treated by cortical vitreous peeling and gas tamponade. Ophthalmology, 101: 682-686, 1994.

Datas de Publicação

Publicação nesta coleção
Dec 1996

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[1] ¹
GASS, J. D. M. - Idiopathic senil e macular holes: its early stages and pathogenesis. Arch. Ophthalmol., 106: 629-639, 1988.

[2] ²
DELORI, F. C.; PARKER, J. S.; MAINSTER, M. A. - Light levels in fundus photography and fluorescein angiography. Vis. Res., 20: 1099-1104, 1980.

[3] ³
WEBB, R. H.; HUGHES, G. W.; POMERANTZEFF, O. - Flying spot TV ophthalmoscope. App. Opt., 19: 2991-2997, 1980.

[4] ⁴
KATSUMI, O.; TIMBERLAKE, G. T.; HIROSE, T.: VAN DE VELDE, F. J.; SAKAUE, H. - Recording pattern reversal visual evokcd response with the scanning laser ophthalmoscope. Acta Ophthalmologica, 67: 243-248, 1989.

[5] ⁵
WOLF, S.; AREND. O.; TOONEN, H.; BERTRAM, B.; JUNG, F.; REIM, M. - Retinal capillary blood llow measurement with scanning laser ophthalmoscope: preliminary results. Ophthalmology 98: 996-1000, 1991.

[6] ⁶
JALKH, A. E.; VAN DE VELDE, F. J.; SCHEPENS, C. L. - Scanning laser ophthalmoscope: basic principies and clinicai application. In: KHOO, C. Y. et al. - New Frontiers in Ophthalmology. Singapore, Elsevier Science Publishers, p. 221-227, 1991.

[7] ⁷
GASS, J. D. M. - Macular dysfunction caused by vitreous and vitreoretinal interface abnormalities. In: - Stereoscopic atlas of macular diseases. 3rd ed. St. Louis, The C. V. Mosby Company, p. 671-726, 1987.

[8] ⁸
ÁVILA, M. P.; JALKH, A. E.; MURAKAMI, K.; TREMPE, C. L.; SCHEPENS, C. L. - Biomicroscopic study of the vitreous in macular breaks. Ophthalmology, 90: 1277-1283, 1983.

[9] ⁹
TREMPE. C. L.; WEITER. J. J.; FURUKAWA, H. - Fellow eyes in cases of macular boles: biomicroscopic study of the vitreous. Arch. Ophthalmol., 104: 93-95, 1986.

[10] ¹⁰
STÜRMER, J.; SCHRÖDEL, C.; RAPPL, W. - Scanning laser ophthalmoscope for static funduscontrolled perimetry. In: NASEMANN, J. E. & BURK, R. O. W. - Scanning laser ophthalmoscopy and tomography. Müchen, Quintessenz Velags-GmbH, p. 133-146, 1990.

[11] ¹¹
ACOSTA, F.; LASHKARI, K.; REYNAUD, X.; JALKH, A. E.; VAN DE VELDE, F.; CHEDID, N. - Characterization of functional changes in macular holes and cysts. Ophthalmology, 98: 1820-1823, 1991.

[12] ¹²
SCHOCKET, S. S.; LAKHANPAL, V.; XIAOPING. M.; KELMAN, S.; BILLINGS, E. - Laser treatment of macular holes. Ophthalmology, 95: 574-582, 1988.

[13] ¹³
MADREPERLA, S. A.; GEIGER, G. L.; FUNATA, M.; DE LA CRUZ, Z.: GREEN, W. R. - Clinicopathologic correlation of a macular hole treated by cortical vitreous peeling and gas tamponade. Ophthalmology, 101: 682-686, 1994.

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