Glaucoma cortisônico em crianças e adolescentes com leucemia linfóide aguda: proposta de um protocolo para identificação e tratamento precoce

• Autor(a) principal: Tavares, Mayo Kayann Guerra Silva
• Data de Publicação: 2017
• Tipo de documento: Trabalho de conclusão de curso
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: http://ri.ufs.br/jspui/handle/riufs/7536
• topic: Leucemia linfoblástica aguda; Pressão Intraocular; Antineoplásicos; Acute lymphoblastic leukemia; Intraocular pressure; Antineoplastic agents; CIENCIAS DA SAUDE::MEDICINA

Objective: To identify changes in intraocular pressure (IOP) and other ophthalmic damage in pediatric patients undergoing treatment for acute lymphoid leukemia (ALL). Methods: A prospective, descriptive study were conducted with children and adolescents with ALL registered for starting chemotherapy in a public service specialized in pediatric oncology localized in the northeastern region of Brazil between July 1, 2013 and June 30, 2017. Intraocular pressure (IOP) was measured before treatment (D0), eighth (D8), twentyeighth (D28) days and six months (6M) treatment. IOP results above 21 mmHg were considered ocular hypertension. During the six months follow-up the patients were evaluated for identification of other ophthalmological changes besides intraocular hypertension. Results and conclusions: Fifty-four patients were evaluated and 22 died during treatment. Two protocols were used, the LLA-99, proposed in 1999 (29 patients) and the update of this in 2009, the LLA-09 (25 patients). Eleven patients had IOP values higher than 21 mmHg. The31 IOP of 23 patients rised up by 4 or more mmHg, 16 of them inluded in the ALL-99 protocol and seven from the ALL-09 protocol (p = 0.038). Among patients with cerebrospinal fluid (CSF) infiltrated with leukemic blasts at some time in the six-month follow-up, four had an increase of four or more mmHg in IOP and there was no increase in IOP among those whose CSF was not infiltrated during the study period p = 0.021). The total amount of patients with a direct or indirect ocular involvement was 17. The most recently used LLA-09 protocol proved to be protective in relation to IOP elevation when compared to the previous one, ALL-99. The possibility that IOP increase predicted CSF involvement and estimate the patients relapse chance requires more prospective studies in larger scale. Ophthalmologic evaluation with IOP measurement prior to initiation of treatment and repeated at eight and 28 days and six months of treatment may allow early diagnosis of IOP increasing and other ophthalmologic damage at those patients.