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Abstract

A esclerectomia profunda não penetrante tem sido uma alternativa à trabeculectomia, pois tem como vantagem a redução da pressão intra-ocular (PIO), sem penetrar na câmara anterior. Desta forma, evitando descompressão brusca, câmara anterior rasa. Neste trabalho, descrevemos o caso de uma paciente, 53 anos, negra, com diagnóstico de glaucoma primário de ângulo aberto, com controle clínico insatisfatório e que foi submetida à esclerectomia profunda não penetrante. A paciente evoluiu com formação de goniossinéquia na região da esclerectomia, após uso inadvertido de colírio midriático no pós-operatório, levando ao aumento da PIO e conseqüente falência da cirurgia. O uso de colírio midriático no pós-operatório da esclerectomia profunda não está indicado, pois neste caso, ocasionou o insucesso da cirurgia.

Keywords: Glaucoma de ângulo aberto; Esclera; Esclerostomia; complicações pós-operatórias; Soluções oftálmicas; Relatos de casos

Abstract

PURPOSE: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil.
METHODS: Using data from the Hospital Cancer Registry of the , patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0–19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20–75, >75 cases).
RESULTS: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1–14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals.
CONCLUSIONS: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

Keywords: Retinoblastoma/diagnosis; Retinoblastoma/epidemiology; Patient care; Humans; Children; Adolescents; Brazil.