Alterações oftalmológicas secundárias a infecção pelo HTLV-1

André L. L. Curi

Instituto de Pesquisa Clínica Evandro Chagas IPEC -FIOCRUZ

Ceratoconjuntivite sicca Uveíte intermediária Ceratite intersticial Papilite Vasculite

Alterações oftalmológicas secundárias a infecção pelo HTLV-1

Sintomas e SinaisOlho vermelho

Dor ocular

Baixa de acuidade visual

Miose

Sinéquias

Aumento/Diminuição da Po

Moscas volantes

Fotopsias

Escotomas

Células

Flare

Precipitados ceráticos

Asymptomatic carriers

HTLV-1 associated myelopathy

Alterações oftalmológicas secundárias a infecção pelo HTLV-1

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

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

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.

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

6218N =

Ocular changes

NãoSim

Pro

vira

l loa

d

30

20

10

0

-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)

385N =

Ocular changes

NãoSim

Por

vira

l lo

ad

30

20

10

0

-10

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 HAMand 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

293N =

Ocular changes

NãoSim

Pro

vira

l loa

d

30

20

10

0

-10

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)

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.

Tratamento

Injeção peri-ocularInjeção intra-ocularEsteróide sistêmicoImunossupressão

Alterações oftalmológicas secundárias a infecção pelo HTLV-1

2007 – 2011 : 148 pacientes

35 alterações oftalmológicas

22 infiltrados estromais11 uveíte intermediária1 Pupila de Adie1 Neurite óptica

Alterações oftalmológicas secundárias a infecção pelo HTLV-1