Association between Chagas disease and changes in the optic nerve and retinal nerve fiber layer.

Flávia Da Silva Villas-Bôas,Luiz Cláudio Lemos Correia,Wilker Malta De Sousa,Alexandre Campelo Ramiro,Marcia Maria Noya-Rabelo,João Antônio Prata Júnior,Thaís De Santana Machado Martins

doi:10.5935/0004-2749.20190036

Abstract

To test the hypothesis that Chagas disease predisposes to optic nerve and retinal nerve fiber layer alterations. We conducted a cross-sectional study including 41 patients diagnosed with Chagas disease and 41 controls, paired by sex and age. The patients underwent ophthalmologic examinations, including intraocular pressure measurements, optic nerve and retinal nerve fiber layer screening with retinography, optical coherence tomography, and standard automated perimetry. All of the patients with Chagas disease had a recent cardiologic study; 15 (36.6%) had heart failure, 14 (34.1%) had cardiac form without left ventricular dysfunction, and 12 (29.3%) had indeterminate form. Optic nerve/retinal nerve fiber layer alterations were observed in 24 patients (58.5%) in the Chagas disease group and 7 controls (17.1%) (p£0.01). Among these, optic nerve pallor, optic nerve alterations suggestive of glaucoma, notch, peripapillary hemorrhage, and localized retinal nerve fiber layer defect were detected. Alterations were more prominent in patients with Chagas disease and heart failure (11 patients), although they also occurred in those with Chagas disease without left ventricular dysfunction (7 patients) and those with indeterminate form (6 patients). Optical coherence tomography showed that themean of the average retinal nerve fiber layer thickness measured 89 ± 9.7 mm, and the mean of retinal nerve fiber layer superior and inferior thickness measured 109 ± 17.5 and 113 ± 16.8 mm, respectively were lower in patients with Chagas disease. In controls, these values were 94 ± 10.6 (p=0.02); 117 ± 18.1 (p=0.04), and 122 ± 18.4 mm (p=0.03). Changes in optic nerve/ retinal nerve fiber layer were more prevalent in patients with Chagas disease.

Highlights

Discovered in 1909 by the Brazilian physician and researcher Carlos Chagas, Chagas disease is a systemic parasitic infection caused by the protozoan Trypanosoma cruzi. with a chronic phase following an acute phase[1]
This was the first study to demonstrate the occurrence of optic nerve (ON)/retinal nerve fiber layer (RNFL) changes in chronic chagasic patients
Alterations in ON/RNFL included ON pallor, ON changes suggestive of glaucoma, peripapillary hemorrhage, presence of notch, RNFL defect on retinography, and/or decrease in peripapillary RNFL thickness detected on optical coherence tomography (OCT)

Summary

Introduction

Discovered in 1909 by the Brazilian physician and researcher Carlos Chagas, Chagas disease is a systemic parasitic infection caused by the protozoan Trypanosoma cruzi. with a chronic phase following an acute phase[1]. With a chronic phase following an acute phase[1]. Chagas disease is recognized by the World Health Organization as one of the 13 most neglected tropical diseases in the world, and it remains a social and economic problem in several Latin American countries[2]. Few studies have evaluated the ocular repercussions of Chagas disease, Romaña’s sign was one of the first acute phase manifestations to be reported[3]. Conjunctivitis, keratitis, scleritis, iridocyclitis, and choroiditis anterior and posterior uveitis have been described in congenital Chagas disease with remission after treatment of the disease[4]. Autonomic nervous system (ANS) involvement, characteristic of the chronic phase of Chagas disease, was reported in studies showing abnormal pupillary responses to diluted pilocarpine and intraocular pressure (IOP) postural variability[5,6]. In the chronic phase of the disea se, chronic heart failure (CHF) occurs in some chagasic patients and may be involved in alterations of the optic nerve (ON) and retinal nerve fiber layer (RNFL)(7)

Methods

Results

Conclusion