OPTICAL NEUROPATHY: ANTIGLAUCOMATOUS TREATMENTS OFFERED BY THE UNIQUE HEALTH SYSTEM IN BRAZIL, AN ANALYSIS OF THE LAST DECADE

Introduction: Optical neuropathy with progressive loss of visual field, glaucoma represents the main cause of irreversible blindness. Objectives: To analyze the frequency of antiglaucomatous procedures performed by the Unified Health System (SUS), in the last 10 years, requiring hospitalization and outpatient care. Methods: This is a cross-sectional quantitative retrospective study, carried out through consultations and data analysis of antiglaucomatous procedures in the DATASUS system, between January 2010 and December 2019. Results: In Brazil, trabeculectomy was the most performed procedure in the last 10 years. Outpatient care had an average of 10,661 per year, on the other hand, the need for hospitalization increased by 70%. The second procedure that generated the most hospitalizations was the implantation of an anti-glaucomatous prosthesis, which doubled in the corresponding period. Cyclodialysis was the least used procedure in the 10 years of analysis, both on an outpatient and hospital basis, and is reserved for the final stages of glaucoma. Surgical iridectomy, used for acute treatment, showed a reduction, in 2019 it represented less than a third compared to 2010. As for outpatient procedures using lasers, such as phototrabeculoplasty and iridotomy, they showed significant growth. Conclusion: Trabeculectomy is considered the gold standard, justifying its greater frequency, both on an outpatient and hospital basis. Procedures using laser are expanding, trabeculoplasty as an alternative to primary therapy, and iridotomy for greater safety in acute treatment. As the population ages, glaucoma tends to be increasingly prevalent, contributing to the progressive increase in trabeculectomies.

OCULAR TOXOPLASMOSIS: A CASE REPORT

Introduction: Toxoplasmosis is caused by Toxoplasma gondii, mandatory intracellular protozoan. It’s estimated that one third of the world population is infected with the parasite, a fact that makes it one of the most infectious parasites. Although 80-90% of the immunocompetent infected are asymptomatic, the disease stands out for being one of the main causes of retinochoroiditis, especially among the immunosuppressed. Case report: Patient, 17 years old, white, female, previously healthy, comes to primary care due to a counter-referral with ophthalmology. Patient presented low visual acuity for 6 months, being diagnosed with ocular toxoplasmosis. Standard treatment was started: sulfadiazine, pyrimethamine, folinic acid and oral prednisolone for 6 weeks. Serum antitoxoplasma titers were obtained indicating previous infection: positive IgG and negative IgM. A patient will face another treatment cycle, as the condition doesn’t improve, which includes high doses of systemic corticosteroids. The physical examination showed no changes. The ophthalmologist requested periodic control of patient’s blood pressure and glucose, extending the treatment. Conclusion: In immunocompetent individuals, ocular toxoplasmosis is a consequence of reactivation of a scar that contained a previously inactive cyst, only a minority comes from a new infection. It’s considered the most common cause of posterior uveitis, emphasizing the importance of this report. Ocular reactivation occurs due to a decrease in specific immunity and the peak incidence is at 29 years old. Young patients with ocular toxoplasmosis have higher risk of recurrence when compared to elderly. Antitoxoplasma serology isn’t necessary for treatment, which must be started as clinical diagnosis is established.