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
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Ceratoconjuntivite sicca
Uveíte intermediária
Ceratite intersticial
Papilite
Vasculite
Sintomas e Sinais
Olho vermelho
Miose
Baixa de acuidade visual Sinéquias
Dor ocular
Fotopsias
Escotomas
Moscas volantes
Células
Flare
Precipitados ceráticos
Aumento/Diminuição da Po
Alterações oftalmológicas secundárias
a infecção pelo HTLV-1
Asymptomatic carriers
HTLV-1 associated myelopathy
Revisão de três casos – Opacidades corneanas
Leucemia / Linfoma
Hipergamaglobulinemia
194 indivíduos
119 PET/MAH
75 Assintomáticos
20 pacientes – 18 PET/MAH
2 assintomáticos
200 pacientes – 123 PET / MAH
77 Assintomáticos
29 uveíte
20 infiltrados corneanos
Uveítes casos leves – 10 casos assintomáticos
Infiltrados corneanos - ↑ carga proviral
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
Ocular manifestations in HTLV-1 patients
and its correlation with proviral load
André 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
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)
30
20
Pr oviral load
10
0
-10
N=
18
62
Sim
Não
O cular changes
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
30
20
Porviral load
10
0
-10
N=
5
38
Sim
Não
O cular changes
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)
30
20
Pr oviral load
10
0
-10
N=
3
29
Sim
Não
O cular changes
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.
Alterações oftalmológicas secundárias
a infecção pelo HTLV-1
Tratamento
Injeção peri-ocular
Injeção intra-ocular
Esteróide sistêmico
Imunossupressão
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