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Alterações oftalmológicas secundárias a infecção pelo HTLV-1

Alterações oftalmológicas secundárias a infecção pelo HTLV-1. André L. L. Curi. Instituto de Pesquisa Clínica Evandro Chagas IPEC -FIOCRUZ. Alterações oftalmológicas secundárias a infecção pelo HTLV-1. Ceratoconjuntivite sicca Uveíte intermediária Ceratite intersticial Papilite

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Alterações oftalmológicas secundárias a infecção pelo HTLV-1

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  1. Alterações oftalmológicas secundárias a infecção pelo HTLV-1 André L. L. Curi Instituto de Pesquisa Clínica Evandro Chagas IPEC -FIOCRUZ

  2. Alterações oftalmológicas secundárias a infecção pelo HTLV-1 • Ceratoconjuntivite sicca • Uveíte intermediária • Ceratite intersticial • Papilite • Vasculite

  3. Sintomas e Sinais • Miose • Olho vermelho • Sinéquias • Baixa de acuidade visual • Células • Dor ocular • Flare • Fotopsias • Precipitados ceráticos • Escotomas • Aumento/Diminuição da Po • Moscas volantes

  4. Alterações oftalmológicas secundárias a infecção pelo HTLV-1 Asymptomatic carriers HTLV-1 associated myelopathy

  5. Revisão de três casos – Opacidades corneanas Leucemia / Linfoma Hipergamaglobulinemia

  6. 194 indivíduos 119 PET/MAH 75 Assintomáticos 20 pacientes – 18 PET/MAH 2 assintomáticos

  7. 200 pacientes – 123 PET / MAH 77 Assintomáticos 29 uveíte 20 infiltrados corneanos Uveítes casos leves – 10 casos assintomáticos Infiltrados corneanos - ↑ carga proviral

  8. Human T-cell lymphotropic virus type 1 infection and ocular manifestations in São Paulo, Brazil. Yamamoto JH, Segurado AA, Hirata CE, Sampaio MW, Souza EC, Nukui Y, Cliquet M, Saéz-Alquézar A, Olivalves E, Mochizuki M. Arch Ophthalmol. 1999 Apr;117(4):513-7. Immunologic markers, uveitis, and keratoconjunctivitis sicca associated with human T-cell lymphotropic virus type 1. Pinheiro SR, Martins-Filho OA, Ribas JG, Catalan-Soares BC, Proietti FA, Namen-Lopes S, Brito-Melo GE, Carneiro-Proietti AB; GIPH (Interdisciplinary HTLV-I/II Research Group). Am J Ophthalmol. 2006 Nov;142(5):811-15

  9. Ocular manifestations in HTLV-1 patients and its correlation with proviral loadAndré Luiz Land Curi 1 , Eliezer Benchimol 1, Marcus Tulius T Silva 2, Ana Claudia Leite 2, Marco Antonio Lima 2 ,Abelardo Araujo 2, Maria Jose Andrada-Serpa 3

  10. The median HTLV-1 proviral load was of 11,89 copies/100 leukocytes in patients with ocular changes (ranging from 2,93 to 22,34), significantly higher than in patients without ophthalmic abnormalities (median 4,79, ranging from 0,00 to 24,24; p < 0,0001 – Mann-Whitney test)

  11. Five out of 44 individuals without HAM/TSP presented some ocular changes. The proviral load in this group was statistically higher than in patients without HAM and with normal ophthalmologic examination ( p = 0,002 / Mann Whitney test). Proviral load varied from 5,43 to 21,18 ( mean: 13,86) in the group with ocular changes and from 0,00 to 24,24 (mean : 3,84) in the group without ocular changes

  12. Out of 81 patients thirty-three were AC. In 3 of these some ophthalmic abnormality was detected.The median proviral load in these patients was 13,45 copies/100 leukocytes (ranging from 5,43 to 21,18). In AC without ocular changes (N 50) the median load was significantly lower (3,52 copies/100 leukocytes, ranging from 0,00 to 24,24; p = 0,017 – Mann Whitney test)

  13. Conclusion : Corneal abnormalities were the most frequent ocular changes in patients with HTLV-1 infection in this Brazilian cohort study. As in neurologic diseases associated with HTLV-1 infection, proviral load was shown to be a good marker for the presence of ocular changes.

  14. Alterações oftalmológicas secundárias a infecção pelo HTLV-1 Tratamento Injeção peri-ocular Injeção intra-ocular Esteróide sistêmico Imunossupressão

  15. Alterações oftalmológicas secundárias a infecção pelo HTLV-1 2007 – 2011 : 148 pacientes 35 alterações oftalmológicas 22 infiltrados estromais 11 uveíte intermediária 1 Pupila de Adie 1 Neurite óptica

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