RESUMO
PURPOSE: To assess the correlation between primary open-angle glaucoma (POAG) and the risk of developing diabetic retinopathy (DR) in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). DESIGN: A retrospective cohort study leveraging the global patient database of TriNetX Research Network. PARTICIPANTS: The study included 44 359 patients with diabetes mellitus (DM) with POAG and 4 393 300 patients with DM without any glaucoma ≥ 18 years of age. Propensity score matching harmonized the cohorts to 39 680 patients each, covering diagnoses from January 1, 2005, to January 1, 2023. METHODS: We analyzed data using specific International Classification of Diseases, 10th Revision (ICD-10) codes for DM and glaucoma. We matched the cohorts using propensity score matching, adjusting for age, sex, race/ethnicity, blood markers, relevant medical history, and ophthalmic service use. MAIN OUTCOME MEASURES: The primary outcome was the first-time occurrence of DR, including nonproliferative DR (NPDR) and proliferative DR (PDR), in patients with DM with and without glaucoma at 1-, 5-, and 10-year intervals from their individual index dates. RESULTS: At 10 years, patients with T1DM with POAG exhibited a heightened risk for any DR (adjusted risk ratios [RRs], 4.12; 95% confidence interval [CI], 3.05-5.57, P < 0.0001) and PDR (RR, 7.02; 95% CI, 3.62-13.61, P < 0.0001). Patients with T2DM and POAG also faced an increased 10-year risk for any DR (RR, 2.47; 95% CI, 2.28-2.68, P < 0.0001) and PDR (RR, 3.82; 95% CI, 3.09-4.70, P < 0.0001). The combined association of POAG on DR risk in those with T1DM and T2DM at 10 years was found to be significantly higher among patients with POAG (5.45%) compared with those without glaucoma (2.12%) (adjusted hazard ratio [aHR], 2.33; 95% CI, 2.14-2.53). The cumulative incidence of DR was significantly higher in the POAG group compared with nonglaucoma counterparts after a decade (log-rank P < 0.001). CONCLUSIONS: Our findings underscore a substantial association between POAG and DR development in both T1DM and T2DM patients, emphasizing the need for vigilant screening and comprehensive management in glaucomatous patients with DM to mitigate the risk of DR. Future research should delve into elucidating the causal mechanisms driving these observed associations. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Assuntos
Bases de Dados Factuais , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Glaucoma de Ângulo Aberto , Humanos , Glaucoma de Ângulo Aberto/epidemiologia , Glaucoma de Ângulo Aberto/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/diagnóstico , Feminino , Masculino , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Estudos Retrospectivos , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Adulto , Incidência , Pressão Intraocular/fisiologiaRESUMO
PURPOSE: To evaluate the repeatability of the steady-state pattern electroretinogram (PERG) and full-field flicker electroretinogram (Flicker ERG) protocols, delivered by the office-based Neuro Optic Vision Assessment (NOVA)™ testing platform, in healthy subjects. METHODS: Healthy individuals underwent PERG (16° and 24°) and Flicker ERG [fixed luminance (FL) and multi-luminance (ML)] testing protocols. Test-retest repeatability of protocols was calculated using intra-class correlation coefficients (ICC). Reference values of the parameters of the aforementioned tests were also calculated. RESULTS: The ICCs for the PERG parameters ranged from 0.793 to 0.911 (p < 0.001). The ICCs for the Flicker ERG parameters ranged from 0.968 to 0.994 (p < 0.001). A linear regression analysis was applied to assess the impact of age on ERG responses. Age had a significant impact on all PERG parameters (16° or 24°). The phase response of the FL Flicker ERG significantly decreased with age (ß = - 0.837, p ≤ 0.001). The FL Flicker ERG Magnitude was also impacted with a significant quadratic effect of age (ß = - 0.0047, p = 0.0004). Similarly, the Phase Area Under the Curve (Phase AUC) of the ML Flicker ERG significantly declined with age (ß = - 0.007, p = 0.009), and the impact on the Magnitude AUC was significant as well, with a negative quadratic age effect. CONCLUSIONS: The PERG and Flicker ERG protocols, delivered by an office-based testing platform, were shown to have good-to-excellent test-retest repeatability when tests were performed in the same order and in immediate succession.
Assuntos
Eletrorretinografia/normas , Retina/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Estudos Transversais , Eletrorretinografia/métodos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Adulto JovemRESUMO
PURPOSE: To assess patterns in gonioscopy during initial glaucoma evaluations in the United States. DESIGN: Retrospective, case-control study. METHODS: Patients undergoing initial glaucoma evaluation between 2009-2020 were identified in the Optum Clinformatics DataMart. Initial evaluation was defined as follows: (1) glaucoma suspect, anatomical narrow angle (ANA), or primary/secondary glaucoma diagnosed by an ophthalmologist; (2) continuously observable during a 36-month lookback period; (3) no history of glaucoma medications, laser, or surgical procedures; and (4) optical coherence tomography (OCT) or visual field performed within 6 months of initial diagnosis. Logistic regression models were developed to identify factors associated with no record of gonioscopy based on Current Procedural Terminology (CPT) codes. RESULTS: Among 198,995 patients, 20.4% and 29.5% had recorded gonioscopy on the day of diagnosis or within 6 months, respectively. On multivariable analysis, odds of recorded gonioscopy within 6 months of initial evaluation was lower (P < .001) among non-Hispanic Whites (OR=0.84) but similar for Blacks (OR=1.02) and Hispanics (OR=0.96) compared with Asians. Age ≥60 years (OR<0.82), pseudophakia/aphakia (OR=0.58), or residence outside of the Northeast region (OR=0.66-0.84) conferred lower odds of recorded gonioscopy (P < .001). Angle closure glaucoma (OR=0.85), secondary glaucoma (OR=0.31), or open angle glaucoma/suspect (OR=0.12/0.24, respectively) patients were less likely to have recorded gonioscopy compared to ANA patients (P < .01). CONCLUSIONS: More than 70% patients undergoing initial glaucoma evaluation in the United States do not have a record of gonioscopy, especially elderly, non-Hispanic White, and pseudophakic patients in non-Northeast regions. This pattern does not conform to current practice guidelines and could contribute to misdiagnosed disease and suboptimal outcomes.
Assuntos
Glaucoma , Gonioscopia , Pressão Intraocular , Humanos , Masculino , Feminino , Estudos Retrospectivos , Estados Unidos/epidemiologia , Idoso , Pessoa de Meia-Idade , Pressão Intraocular/fisiologia , Estudos de Casos e Controles , Glaucoma/diagnóstico , Glaucoma/etnologia , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Disparidades em Assistência à Saúde , Idoso de 80 Anos ou maisRESUMO
PURPOSE: To assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States. DESIGN: Retrospective cross-sectional study. METHODS: Eligible patients from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); and 3) no history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤20/200) at first diagnosis of PACG. RESULTS: Among 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (odds ratios [ORs] 1.42 and 1.21, respectively; P < .001) and bilateral (ORs 2.04 and 1.53, respectively; P < .001) blindness compared with non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred a higher risk of blindness (OR > 1.28; P ≤ .01). CONCLUSIONS: Blindness affects 1 of 9 patients with newly diagnosed PACG in the IRIS Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among patients with PACG and the need for improved disease awareness and detection methods.
Assuntos
Glaucoma de Ângulo Fechado , Pressão Intraocular , Humanos , Masculino , Idoso , Estados Unidos/epidemiologia , Idoso de 80 Anos ou mais , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/epidemiologia , Estudos Retrospectivos , Prevalência , Estudos Transversais , Medicare , Cegueira/epidemiologia , Cegueira/etiologia , Fatores de Risco , Sistema de RegistrosRESUMO
Juvenile X-linked retinoschisis (JXR), the most common inherited retinal disorder in young males, presents with a wide range of phenotypic variations. Acute angle closure in children with JXR has been reported in the literature only once before. We present a case of acute-angle closure, temporally associated with pharmacologic dilation, in a 12-year-old boy with JXR.
Assuntos
Oftalmopatias , Doenças Retinianas , Retinosquise , Masculino , Criança , Humanos , Retinosquise/diagnóstico , Retinosquise/genética , Doença Aguda , RetinaRESUMO
PURPOSE: To determine the efficacy of an educational intervention on patient adoption and attitudes toward selective laser trabeculoplasty (SLT) as first-line treatment for glaucoma. METHODS: This study is a randomized controlled trial. Subjects include 33 patients within 1-year diagnosis of either primary open-angle glaucoma, ocular hypertension, or pseudoexfoliation syndrome. After informed consent, subjects were randomly assigned to a Usual Care or Educational Intervention group. All subjects completed a pre-intervention questionnaire. The Educational Intervention group was shown a slideshow presentation and a 3-min video and given a post-intervention questionnaire. Follow-up examinations were reviewed for 6 months to determine subject completion of SLT, the primary outcome. Secondary outcomes include assessment of attitude toward SLT before and after intervention. RESULTS: Age, gender, and baseline characteristics between the groups did not differ. The Usual Care group had a higher proportion of African Americans (77% vs 31%, p = 0.04). At 6 months following the intervention, 63% of subjects underwent SLT compared to 35% of Usual Care subjects (p = 0.12). Older age was associated with decreased SLT uptake (OR 0.90, 95% CI 0.82-0.99, p = 0.03). Prior to the intervention, there were no differences in attitudes of both groups regarding SLT therapy. Nineteen percent of Educational Intervention subjects changed positively toward SLT (p = 0.08) and 50% scheduled an SLT appointment after intervention (p = 0.005). CONCLUSIONS: A slideshow and video-based educational intervention may positively enhance patient adoption of SLT.Clinical trial registration name, number, URL: Educational Intervention to Adopt SLT as First-Line Glaucoma Treatment, NCT03365778, https://clinicaltrials.gov/ct2/show/NCT03365778.
Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Terapia a Laser , Trabeculectomia , Glaucoma/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular , Lasers , Resultado do TratamentoRESUMO
PURPOSE: To compare the trabecular outflow by the response to topical pilocarpine administration in patients with and without prior glaucoma filtering surgery. STUDY DESIGN: Prospective, cross-sectional, randomized, double-blinded study. METHODS: Open-angle glaucoma (OAG) patients without any prior glaucoma surgery, and those with prior trabeculectomy or tube shunt surgery aged 18-90 years were included. Both groups were randomized into pilocarpine or artificial tears (ATs). Intraocular pressure (IOP) was measured before and 90 min after the instillation of eye drops. RESULTS: A total of 189 eyes of 189 patients were included: 92 eyes in the pilocarpine and 97 eyes in the ATs group. There was a mean ± standard deviation of - 0.81 ± 3.08 mmHg decrease in IOP with pilocarpine in those without prior surgery, significantly higher than the ATs group (0.55 ± 2.31 mmHg; p = 0.02). No significant change in IOP with pilocarpine was noted in the surgical group compared to the ATs group (p = 0.90). In the surgery group, greater IOP reduction was observed with pilocarpine in those who had undergone surgery within the last three years than those who had surgery three or more years prior (- 1.56 ± 2.64 versus 1.41 ± 2.77 mmHg; p = 0.001). CONCLUSION: Less IOP reduction was observed with pilocarpine in patients who had filtering surgery more than three years previously compared to those with more recent surgery.
Assuntos
Cirurgia Filtrante , Glaucoma de Ângulo Aberto , Glaucoma , Trabeculectomia , Estudos Transversais , Método Duplo-Cego , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular , Pilocarpina , Estudos ProspectivosRESUMO
PRéCIS:: A modification to the surgical technique of Ahmed glaucoma valve (AGV) implantation without plate sutures or surgical glue products has a similar safety and efficacy profile than the standard procedure, in the short and mid-term follow-up. PURPOSE: The purpose of this study was to assess the safety and efficacy of a modified AGV implantation technique without plate sutures. METHODS: A retrospective case-control study including patients seen in the Glaucoma service of an academic institution. Patients that underwent a modified AGV implantation without plate sutures were included as cases and patients that underwent standard AGV implantation, as controls. Success was defined as intraocular pressure (IOP) reduction >20%, IOP >5 and <21 without the need for additional surgical intervention, and maintenance of light perception. RESULTS: A total of 170 eyes were included. Mean (range) follow-up was 11.2±7.39 (3 to 24) months. There was no statistically significant difference in visual acuity and IOP between the groups during the postoperative period. In a univariate analysis, there was a larger decrease in IOP for the no plate suture group at the 6 months (-15.6±11.6 vs. -11.5±10.5, P=0.04) and 1 year (-16.4±10.4 vs. -11.1±10.4, P=0.02) visits. There was also a larger decrease in number of medications in the no plate suture group in the 3 months (-1.65±1.5 vs. -1.13±1.22, P=0.02), 6 months (-1.55±1.44 vs. -0.98±1.3, P=0.01) and 1 year (-1.70±1.5 vs. -1.04±1.2, P=0.04) visits. However, those differences were not confirmed by a multivariable model after adjusting for glaucoma type and number of previous glaucoma surgeries. No differences in the trajectory of the survival curves were noted between groups (P=0.36). CONCLUSION: The comparison of short and mid-term outcomes of patients undergoing AGV implantation using both techniques showed similar outcomes and success rates.
Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Implantação de Prótese/métodos , Suturas , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
PRECIS: Targeted educational interventions for physicians may be useful in increasing adoption of selective laser trabeculoplasty (SLT) as first line therapy for the treatment of glaucoma. PURPOSE: SLT is a safe and effective first line treatment for glaucoma, however, it is underutilized. To evaluate barriers for the widespread adoption of this procedure, we assessed the beliefs and attitudes of ophthalmologists. We developed an educational intervention directed to physicians to increase the consideration of SLT earlier in the glaucoma treatment paradigm. SUBJECTS AND METHODS: In this prospective study, an online survey and educational slide presentation was sent to a group of comprehensive ophthalmologists, ophthalmology residents, and glaucoma specialists. Subjects were asked to respond to questions regarding their beliefs and attitudes towards SLT before and after watching the educational slide presentation. RESULTS: A total of 53 subjects were enrolled. Before watching the slide presentation, 85% of subjects stated they offer SLT to newly diagnosed patients, although only 28% preferred it over medications. While 52% of physicians reported between 0% and 10% of their newly diagnosed patients receive laser therapy, 47% said they would use it as a first line therapy for all or most newly diagnosed glaucoma patients. Most subjects (94%) stated the educational slide presentation convinced them that SLT is appropriate as a first line therapy for treatment of open angle glaucoma. CONCLUSIONS: A better understanding of the barriers for utilizing SLT as a first line therapy provides valuable information to help increase the adoption of this safe and effective procedure. A targeted educational intervention may improve acceptance of SLT as first line therapy for open angle glaucoma.
Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Conhecimentos, Atitudes e Prática em Saúde , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Oftalmologistas/psicologia , Trabeculectomia/métodos , Atitude do Pessoal de Saúde , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
PURPOSE: To assess the effects of surgeon-related factors on laser peripheral iridotomy (LPI) outcomes by comparing residents and glaucoma specialists, and to look for demographic and clinical predictive factors associated with LPI complications. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients who underwent LPI performed by a resident physician were included as cases, and patients who underwent LPI performed by a glaucoma specialist were included as controls. In patients who underwent multiple sessions of laser therapy, only the information from the first session of each eye was included in the study. METHODS: Demographic and clinical information were gathered from the pre-LPI, 1-week, 1-month, and 3-month follow-up visits. The following information was recorded from the LPI session: total laser energy, presence of bleeding, and post-laser intraocular pressure (IOP). Information gathered from the follow-up visits included visual acuity (VA), IOP, hyphema, and need to repeat LPI. A logistic regression analysis with modification for rare events was used to examine the relationship between the dependent variables and the group, adjusted for the clinical and demographic characteristics of patients. MAIN OUTCOME MEASURES: The LPI procedure parameters (total energy), postoperative VA and IOP, risk for complications, and need for re-treatment were compared between groups using odds ratio (OR) measurements. RESULTS: A total of 333 eyes were included in the study. The residents used statistically significant higher total energy compared with the glaucoma specialists' group (P < 0.001). After adjusting for demographic characteristics, antiplatelet/anticoagulant use, and laser energy parameters, we found that the patients of the residents group had a significantly increased likelihood for re-treatment within 3 months (OR, 3.38; 95% confidence interval [CI], 1.31-8.73) and anterior chamber bleeding (OR, 7.48; 95% CI, 1.07-52.02). CONCLUSIONS: Although LPI is an effective and minimally invasive procedure, evidence shows that a higher level of experience leads to clinically and statistically significant better outcomes.
Assuntos
Anticoagulantes/farmacologia , Glaucoma de Ângulo Fechado/cirurgia , Iridectomia/métodos , Iris/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Acuidade Visual , Feminino , Seguimentos , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Glaucoma de Ângulo Fechado/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgiões , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the test-retest repeatability of a computer-based contrast sensitivity (CS) test, the Spaeth/Richman contrast sensitivity (SPARCS) test, and to determine the effects of age and lens status on CS in normal eyes. STUDY DESIGN: Prospective cross-sectional study. METHODS: The participants were assessed by use of the SPARCS test in each eye 3 times. The first 2 sessions were supervised, while the third was unsupervised. CS was determined for 5 areas of vision (central, superotemporal, superonasal, inferotemporal, and inferonasal) and combined to provide a total score. The test-retest repeatability was determined using Bland-Altman analysis and the intraclass correlation coefficient (ICC). RESULTS: The total SPARCS scores (maximum possible score = 100) ranged from 86.37 (±1.09) (for those aged 20 to 29 years) to 70.71 (±2.64) (for those aged 80 to 87 years). Individuals aged between 10 and 87 years with a normal eye examination (n = 205) were enrolled. When the SPARCS scores for the first 2 sessions were compared, the ICC was 0.79, and the repeated tests were fairly equivalent (mean difference = -0.29, P = .491). The test-retest 95% limits of agreement (95% LoA) ranged from -11.07 to +11.35. When the supervised sessions were compared with the unsupervised session, the ICC was 0.80, and there was slight improvement in the CS scores during the unsupervised session (mean difference = -1.15, P = .0001). The test-retest 95% LoA ranged from -9.18 to +10.60. The CS declined with advanced age and increased cataract severity (P <0.0001). CONCLUSION: Strong agreement was found between repeated SPARCS scores. Older age and increased lens opacity were associated with decline in CS in 5 areas of the visual field. The SPARCS test provides reliable and reproducible assessment of CS in normal eyes.
Assuntos
Catarata/diagnóstico , Sensibilidades de Contraste/fisiologia , Testes Visuais/métodos , Acuidade Visual , Campos Visuais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Catarata/fisiopatologia , Criança , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto JovemRESUMO
Purpose: To investigate: 1) the impact of reduced contrast sensitivity (CS) in specific areas of vision on subjective assessment of vision-related quality of life (VRQoL) and objective performance-based measures in patients with primary open-angle, primary angle-closure, and pseudoexfoliation glaucoma; and 2) correlations between measurements of contrast sensitivity (CS) in specific areas of vision and visual field (VF) tests. Methods: The Spaeth/Richman Contrast Sensitivity Test (SPARCS) measured CS in the inferior, superior, and central areas, while the Pelli-Robson test measured central CS. Visual fields were tested in participants using standard-automated perimetry. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) assessed VRQoL, and the Compressed Assessment of Ability Related to Vision (CAARV) assessed vision-related performance. Results: Three hundred and twenty-two eyes of 161 participants were included in our analysis. Significant correlations were found between CS and VF scores in the inferior, central, and superior areas (P < .0001 for all). Significant correlations were found between SPARCS scores in the inferior areas in both eyes and most CAARV scores (P < .05). Significant correlations were also found between SPARCS scores in the inferior and superior areas in the worse eye and most NEI-VFQ -25 scores (P < .05). Conclusion: Contrast sensitivity and VF scores significantly correlated in all tested areas. Reduced CS in the inferior areas of both eyes affected most performance-based measures. Measurement of CS areas using SPARCS is a meaningful way to assess VRQoL and ability to perform daily activities in participants with glaucoma.
Assuntos
Atividades Cotidianas/psicologia , Sensibilidades de Contraste/fisiologia , Síndrome de Exfoliação/fisiopatologia , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Qualidade de Vida/psicologia , Campos Visuais/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome de Exfoliação/psicologia , Feminino , Glaucoma de Ângulo Fechado/psicologia , Glaucoma de Ângulo Aberto/psicologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Perfil de Impacto da Doença , Inquéritos e Questionários , Testes Visuais , Acuidade Visual/fisiologia , Testes de Campo VisualRESUMO
PURPOSE: To determine the efficacy, safety, and surgical outcomes of trabecular microbypass stent (iStent) surgery performed by resident trainees and attending surgeons. SETTING: Wills Eye Hospital, Philadelphia, Pennsylvania, USA. DESIGN: Retrospective case series. METHODS: Records of all patients who had microbypass stent surgery by a resident at Wills Eye Hospital were retrospectively reviewed. The attending-performed group included any patient who had a microbypass stent implanted by an attending surgeon on the same day a resident case was performed. RESULTS: Between 2016 and 2018, 31 microbypass stents were implanted by a resident supervised by an attending and 93 microbypass stents were implanted by an attending surgeon on the day a resident case was performed. The mean follow-up was 16.2 months ± 17.9 (SD). The mean intraocular pressure (IOP) decreased from 16.0 ± 4.6 mm Hg at baseline to 14.0 ± 3.1 mm Hg at most recent follow-up visit in the resident group (P = .02) and from 17.5 ± 4.8 mm Hg to 15.1 ± 4.3 mm Hg, respectively, in the attending group (P < .001). The final mean IOP and mean number of hypotensive medications were similar between the 2 groups (P = .83 and P = .12, respectively). Self-resolving hyphema occurred in 1 resident case and 2 attending cases. The resident group had 1 case of iridodialysis, which did not require additional surgery. One eye in the attending group ultimately required a trabeculectomy. CONCLUSION: Microbypass stent implantation by resident trainees with attending supervision had similar efficacy and safety as surgery performed by attending surgeons.
Assuntos
Educação de Pós-Graduação em Medicina/métodos , Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto/cirurgia , Internato e Residência/métodos , Oftalmologia/educação , Malha Trabecular/cirurgia , Trabeculectomia/educação , Idoso , Competência Clínica , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this study was to determine how clinical measures, performance-based measures and subjective assessments of vision-related quality of life (VRQoL) are affected in patients with rapid glaucoma progression. METHODS: Prospective longitudinal study that included 153 patients diagnosed with moderate glaucoma. A subset of patients that presented with rapid glaucoma progression (n=22), defined as visual field (VF) mean deviation (MD) loss >2.0 dB/y, were compared with patients with nonrapid progression (n=131). Groups were compared using t tests, χ, or Fisher exact test. Main outcome measures were visual acuity (VA), VF MD, retinal nerve fiber layer thickness (RNFL), contrast sensitivity (CS), Compressed Assessment of Ability Related to Vision (CAARV), and Rasch calibrated National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores. RESULTS: At baseline, patients who progressed rapidly had lower measurements of VA (P=0.041), VF MD (P<0.001), Pelli-Robson score (P=0.004), Spaeth/Richman Contrast Sensitivity (SPARCS) score (P=0.001), RNFL thickness (P=0.009), CAARV total score (P<0.001), and NEI-VFQ-25 composite score (P=0.03). A multivariable logistic regression was performed and showed VF MD to be the only baseline independent predictor of rapid progression. After 1 year, patients who progressed rapidly also had a significant decrease in SPARCS score (P=0.04). CONCLUSIONS: Factors associated with rapid glaucoma progression included worse VF MD decreased scores of performance-based measures and subjectively worse VRQoL. After 1 year, rapid progressors had a significant reduction in contrast sensitivity as measured by SPARCS.
Assuntos
Glaucoma/diagnóstico , Qualidade de Vida/psicologia , Transtornos da Visão/diagnóstico , Visão Ocular/fisiologia , Adulto , Idoso , Sensibilidades de Contraste , Progressão da Doença , Feminino , Glaucoma/fisiopatologia , Glaucoma/psicologia , Humanos , Pressão Intraocular/fisiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Perfil de Impacto da Doença , Inquéritos e Questionários , Transtornos da Visão/fisiopatologia , Transtornos da Visão/psicologia , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologiaRESUMO
Cyclodestructive techniques have been a treatment option for refractory glaucoma since its first use in the 1930s. Over the past nine decades, cyclodestruction has advanced from the initial cyclodiathermy to micropulse transscleral cyclophotocoagulation (MP-TSCPC) which is the current treatment available. Complications associated with cyclodestruction including pain, hyphema, vision loss, hypotony and phthisis have led ophthalmologists to shy away from these techniques when other glaucoma treatment options are available. Recent studies have shown encouraging clinical results with fewer complications following cyclophotocoagulation, contributing greatly to the current increase in the use of cyclophotocoagulation as primary treatment for glaucoma. We performed our literature search on Google Scholar Database, Pubmed, Web of Sciences and Cochrane Library databases published prior to September 2017 using keywords relevant to cyclodestruction, cyclophotocoagulation and treatment of refractory glaucoma.
RESUMO
PURPOSE: Phacoemulsification has been cited as a possible cause of bleb failure in eyes with prior trabeculectomy. No method has been developed to directly evaluate the risk of bleb failure after phacoemulsification. We investigate the use of trypan blue during cataract surgery in the setting of a preexisting trabeculectomy to evaluate the functional status of the bleb and predict postoperative bleb function. MATERIALS AND METHODS: In total, 14 patients contributing 1 eye each with a history of prior trabeculectomy with mitomycin C undergoing phacoemulsification with intraocular lens implantation were enrolled in this prospective, nonrandomized clinical trial. At the time of phacoemulsification, trypan blue was instilled into the anterior chamber before capsulorhexis creation. Staining of the bleb was grouped as being mild or diffuse using intraoperative photographs. These eyes were followed for 1 year postoperatively and evaluated for intraocular pressure (IOP) control. RESULTS: The change in IOP was not significantly different between the 2 groups (P=0.14). A trend towards greater need for IOP-lowering medications was noted (P<0.10) in eyes with mild bleb staining. No statistically significant difference in rates of decreased bleb function was noted at 1-year follow-up after phacoemulsification. CONCLUSION: The intensity of bleb staining with trypan blue during phacoemulsification is not associated with changes in IOP postoperatively. A trend towards decreased need for IOP-lowering medications was noted in eyes with diffuse bleb staining at 1 year after cataract surgery.
Assuntos
Corantes/administração & dosagem , Facoemulsificação/métodos , Estruturas Criadas Cirurgicamente/fisiologia , Azul Tripano/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Alquilantes/administração & dosagem , Terapia Combinada , Túnica Conjuntiva/efeitos dos fármacos , Feminino , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Implante de Lente Intraocular , Masculino , Mitomicina/administração & dosagem , Complicações Pós-Operatórias , Estudos Prospectivos , Coloração e Rotulagem , Tonometria Ocular , Trabeculectomia/métodosRESUMO
For more than half a century, Urrets-Zavalia syndrome (fixed dilated pupil) has been described as a postoperative complication of ophthalmic surgery. Since first reported as a complication of penetrating keratoplasty for keratoconus in patients receiving atropine, the characteristic features of Urrets-Zavalia syndrome have been expanded. In previous literature, a total of 110 cases resulted in a fixed and dilated pupil. Increased intraocular pressure (IOP) in the immediate postoperative period, phakia, and air or gas in the anterior chamber appear to be the most important risk factors for Urrets-Zavalia syndrome following ophthalmic procedures. Mannitol, IOP control, the removal of air or gas in the anterior chamber, and iridectomy have all demonstrated utility in managing Urrets-Zavalia syndrome.
Assuntos
Ceratoplastia Penetrante/efeitos adversos , Distúrbios Pupilares/etiologia , Distúrbios Pupilares/prevenção & controle , Humanos , Pressão Intraocular , Doenças da Íris/etiologia , Doenças da Íris/prevenção & controle , Ilustração Médica , Fatores de Risco , Síndrome , Tomografia de Coerência ÓpticaAssuntos
Implantes para Drenagem de Glaucoma , Glaucoma , Glaucoma/cirurgia , Humanos , Pressão Intraocular , SuturasRESUMO
OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.
Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Pneumonia Bacteriana/mortalidade , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Carbapenêmicos/uso terapêutico , Cefalosporinas/uso terapêutico , Criança , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Feminino , Hospitais de Ensino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Valor Preditivo dos Testes , Quinolonas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Adulto JovemRESUMO
Community-acquired pneumonia (CAP) exhibits mortality rates, between 20% and 50% in severe cases. Biomarkers are useful tools for searching for antibiotic therapy modifications and for CAP diagnosis, prognosis and follow-up treatment. This non-systematic state-of-the-art review presents the biological and clinical features of biomarkers in CAP patients, including procalcitonin, C-reactive protein, copeptin, pro-ANP (atrial natriuretic peptide), adrenomedullin, cortisol and D-dimers.