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1.
Arq. bras. oftalmol ; 87(4): e2021, 2024. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1520231

RESUMO

ABSTRACT Purpose: To longitudinally compare isolated structural parameters obtained using RTVue optical coherence tomography in patients with glaucoma and suspected glaucoma with stable visual fields. Methods: All patients were required to have a reliable SITA Standard 24-2 Humphrey Visual Field test. Visual field stability was defined as having <5 points with p<5% and/or having no points with p<1% and/or p<0.05% in the glaucoma progression analysis comparison graph. Furthermore, the glaucoma assessment strategy was used in optical coherence tomography. Results: The study included 75 eyes from 75 patients, 43 of which had glaucoma and 32 had suspected glaucoma. The mean visual field intervals were 29.57 ± 9.65 months between the first and third tests. No visual field parameter variations (mean deviation, pattern standard deviation, and visual field index) and no retinal nerve fiber layer or optic disk parameter variations between the first and third tests were observed (p>0.05 for all), and no retinal nerve fiber layer parameter variations throughout the study were observed, except for optic disk parameters presenting with cup volume changes (p=0.004). However, ganglion complex cells presented a progressively decreased average ganglion cell complex parameter, with a variability of -0.98% ± 3.71% (p=0.04) between the first and third tests. By contrast, the global loss volume progressively increased throughout the study, with a variability of 14.71% ± 44.52% (p=0.04) between the first and third tests. The inferior ganglion cell complex parameter was significantly decreased between the first and third tests (p=0.02). Conclusion: The present findings suggest that patients with glaucoma or suspected glaucoma with stable visual fields may present structural ganglion complex cell progression as assessed using RTVue optical coherence tomography.


RESUMO Objetivo: Comparar longitudinalmente os parâmetros estruturais isolados obtidos através da tomografia de coerência óptica RTVue em pacientes glaucomatosos e suspeitos de glaucoma com campos visuais estáveis. Métodos: Todos os incluídos deveriam ter Campimetria Computadorizada Humphrey Sita Standard 24-2 confiáveis. A estabilidade campimétrica foi definida se apresentassem menos de cinco pontos com p<5% e/ou nenhum ponto com p<1% e/ou p<0,05% no gráfico de comparação do Glaucoma Progression Analysis. Para a tomografia de coerência óptica, foi utilizado a estratégia de avaliação para glaucoma. Resultados: Foram incluídos 75 olhos de 75 pacientes: 43 com glaucoma e 32 suspeitos. A média dos intervalos do campo visual entre o 1o e 3o exame, foi de 29,57 ± 9,65 meses. Não houve variação para os parâmetros do campo visual (desvio médio, desvio padrão e índice da função visual) entre o primeiro e o último exame (p>0,05 para todos). Não houve variação dos parâmetros da camada de fibras nervosas da retina ao longo do estudo, enquanto que para os parâmetros do disco óptico, apenas cup volume apresentou mudança (p=0,004). Em relação à camada de células ganglionares da retina, notou-se uma redução progressiva na espessura média da Ganglionar Complex Cells com uma variabilidade entre o primeiro e último exame de -0,98 ± 3,71% (p=0,04). Quanto ao Global loss volume, houve um aumento progressivo ao longo do estudo com uma variabilidade entre o primeiro e último exame de 14,71 ± 44,52% (p=0,04). O parâmetro inferior do Ganglionar Complex Cells também reduziu significativamente entre o 1o e 3o exames (p=0,02). Os demais parâmetros da tomografia de coerência óptica RTVue se mantiveram estáveis entre o 1o e 3o exames. Conclusão: Os presentes achados sugerem que pacientes glaucomatosos ou com suspeita de glaucoma e com campos visuais estáveis, podem apresentar progressão estrutural na camada de células ganglionares da retina avaliada por meio da tomografia de coerência óptica RTVue.

2.
Arq. bras. oftalmol ; 86(4): 375-379, July-Sep. 2023. graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1447379

RESUMO

ABSTRACT We report the case of a 39-year-old male patient who presented with visual loss in the right eye for 6 weeks. The best-corrected visual acuity was counting fingers in the right eye and 20/30 in the left eye. The fundus examination demonstrated a right retinal detachment inferiorly extending to the fovea and a left macular serous detachment. After multimodal imaging study, the patient was diagnosed as having a bullous variant of central serous chorioretinopathy and treated with oral spironolactone associated with adjuvant laser photocoagulation. The retinal changes resolved after 6 months. The final visual acuity was 20/20 in both eyes.


RESUMO Relatamos o caso de um homem de 39 anos apresentando perda visual no olho direito há seis semanas. A melhor acuidade visual corrigida foi conta-dedos no olho direito e 20/30 no esquerdo. A fundoscopia demonstrou descolamento de retina direito inferiormente com extensão à fóvea e descolamento macular seroso à esquerda. Após estudos de imagem multimodal, o paciente foi diagnosticado com uma variante bolhosa de coriorretinopatia serosa central e tratado com espironolactona oral associada à fotocoagulação a laser adjuvante. As alterações retinianas resolveram após seis meses. A acuidade visual final foi 20/20 em ambos os olhos.

3.
Int Ophthalmol ; 43(5): 1665-1676, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36273360

RESUMO

PURPOSE: Compare 12-month (12 M) safety and efficacy of endoscopic cyclophotocoagulation (ECP) + cataract surgery (Group 1) versus ECP + cataract surgery + iStent inject trabecular micro-bypass implantation (Group 2) in Brazilian patients with open-angle glaucoma (OAG). METHODS: This prospective, multicenter, comparative case series included patients with OAG and cataract who were randomized to receive treatment in Group 1 or Group 2. Outcomes included mean and percent reduction versus preoperative in intraocular pressure (IOP) and number of glaucoma medications; visual acuity; occurrence of adverse events; and rate of secondary surgeries. RESULTS: Preoperatively, Groups 1 and 2 had similar mean IOP (mean ± standard deviation 22.1 ± 3.6 and 22.0 ± 2.5 mmHg, respectively) and mean number of medications (3.3 ± 0.6 and 3.4 ± 0.6 medications, respectively). At all follow-up timepoints through 12 M, both groups achieved significant IOP and medication reductions versus preoperative (IOP p < 0.001 and number of medications p < 0.001 for both groups). At 12 M, IOP reductions were 24.2% (Group 1) and 43.6% (Group 2) (p < 0.001); mean medication reductions were 50.2% and 71.5%, respectively. Mean postoperative IOP and number of medications were higher in Group 1 than Group 2 (IOP p < 0.01 all visits, medication p < 0.01 at 6 M and 12 M). Adverse events were generally mild and infrequent in both groups. CONCLUSION: Both treatment groups (ECP + phacoemulsification, with/without iStent inject implantation) achieved significant and safe reductions in IOP and medications versus preoperative in Brazilian OAG patients. Percent reductions were significantly greater, and mean IOP and medications were significantly lower, in the group receiving iStent inject. CLINICAL TRIAL REGISTRATION (CTR): CAAE project identification #20053019.5.0000.5078. Protocol #3.587.147. Clinical Trial Database of the Federal University of Goiás, Brazil. Registration Date: September 19, 2019.


Assuntos
Catarata , Glaucoma de Ângulo Aberto , Glaucoma , Facoemulsificação , Humanos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Brasil/epidemiologia , Estudos Prospectivos , Glaucoma/cirurgia , Pressão Intraocular , Catarata/complicações
4.
J Curr Glaucoma Pract ; 16(2): 111-116, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36128079

RESUMO

Aim: To identify the ideal treatment protocol and success predictors for double-session micropulse transscleral (MP3) laser for glaucoma management. Materials and methods: Patients who underwent double-session MP3, with a minimum follow-up of 6 months, were retrospectively investigated. Logistic regression analysis was used to verify preoperative success predictors. The following comparisons were made: (1) Between eyes that obtained surgical success vs failure, (2) According to the time required for MP3, and (3) Considering only eyes that required retreatment. Results: A total of 191 eyes from 148 patients were included. The preoperative intraocular pressure (IOP) was significantly higher than at last follow-up visit (27.3 ± 6.9 vs 14.6 ± 6.0 mm Hg, p < 0.001). Success was observed in 90.5% of the eyes. On logistic regression analysis with preoperative IOP and MP3 time as independent variables, only previous IOP was identified as a statistically significant factor (p = 0.004), with lower IOP relating to higher success. Eyes that required lower MP3 time underwent more MP3 procedures than those with higher MP3 time (1.2 ± 0.5 vs 1.1 ± 0.3, p = 0.03). In the 36 eyes that underwent retreatment, preoperative IOP was higher (31.6 ± 7.4 vs 26.3 ± 6.4 mm Hg, p < 0.001); eyes with successful IOP treatment had a higher MP3 treatment time at the first surgery than eyes with failed IOP correction (364.1 ± 68.2 vs 330.0 ± 18.0 seconds, p = 0.02). Conclusion: Thus, an ideal double-session MP3 protocol should use a high laser energy at the first surgery, and a high preoperative IOP can be considered as a predictor of surgical failure. Clinical significance: This is the first study to give special attention to the double-session MP3 protocol and success predictors. How to cite this article: Magacho L, Lima FE, Ávila MP. Estimating the Ideal Treatment Protocol and Success Predictors for Double-session Micropulse Transscleral Laser for Glaucoma Management. J Curr Glaucoma Pract 2022;16(2):111-116.

5.
J Cell Mol Med ; 26(11): 3254-3268, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35481949

RESUMO

Despite notable efforts and significant therapeutical advances, age-related macular degeneration remains the single most common reason for vision loss. Retinal progenitor cells (RPCs) are considered promising candidates for cellular treatments that repair and restore vision. In this allogenic study, the phenotypic profile of pig and human RPCs derived using similar manufacturing processes is compared. The long-term (12-week) survival of green fluorescent protein-pig retinal progenitor cells GFP-pRPC after subretinal transplantation into normal miniature pig (mini-pig) retina is investigated. Human eyes are both anatomically and physiologically mimicked by pig eyes, so the pig is an ideal model to show an equivalent way of delivering cells, immunological response and dosage. The phenotypic equivalency of porcine and clinically intended human RPCs was established. Thirty-nine mini-pigs are used in this study, and vehicle-injected eyes and non-injected eyes serve as controls. Six groups are given different dosages of pRPCs, and the cells are found to survive well in all groups. At 12 weeks, strong evidence of integration is indicated by the location of the grafted cells within the neuro-retina, extension of processes to the plexiform layers and expression of key retinal markers such as recoverin, rhodopsin and synaptophysin. No immunosuppression is used, and no immune response is found in any of the groups. No pRPC-related histopathology findings are reported in the major organs investigated. An initial dose of 250 k cells in 100 µl of buffer is established as an appropriate initial dose for future human clinical trials.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Retina , Animais , Diferenciação Celular/fisiologia , Proteínas de Fluorescência Verde/genética , Proteínas de Fluorescência Verde/metabolismo , Retina/metabolismo , Transplante de Células-Tronco , Suínos , Porco Miniatura
6.
J Glaucoma ; 29(3): 205-210, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31876871

RESUMO

PRéCIS:: Double-session micropulse transscleral laser was an effective and safe treatment strategy for eyes that have not undergone glaucoma surgery previously. PURPOSE: To evaluate the safety and effectiveness of double-session micropulse transscleral laser (MP3) as a primary treatment modality for glaucoma. MATERIALS AND METHODS: Patients who underwent MP3 therapy with double sessions in each hemifield, with a follow-up period of at least 6 months, were retrospectively considered. Patients were categorized into 2 groups: GI (no previous glaucoma surgery) and GII (with previous glaucoma surgery). Success was defined by either achieving a final intraocular pressure (IOP) between 6 and 18 mm Hg and an IOP reduction of >20%, or a minimum 50% reduction in the number of glaucoma medications, at the last visit, without any serious complications. RESULTS: Eighty-four eyes were included in the GI group and 101 in the GII group, with the latter demonstrating relatively higher preoperative IOP (31.1±5.4 vs. 26.2±6.9 mm Hg, P<0.001). Final IOP (14.9±5.2 vs. 13.6±4.1 mm Hg, P=0.06), average MP3 treatment time (358.0±50.7 vs. 362.7±67.8 s, P=0.5), and follow-up duration (10.8±5.1 vs. 12.3±5.4 mo, P=0.06) were similar between the groups. The percentage reduction with regard to glaucoma medication was higher in GI than in GII (49.1±28.8 vs. 38.8±30.1%, P=0.02). GI underwent fewer MP3 procedures than GII (1.2±0.5 vs. 1.5±0.8, P=0.002). No hypotony or phthisis bulbi was observed in GI (1 and 2 in GII, respectively). Procedural success was noted in 92.9% of the cases in GI and 87.1% in GII. CONCLUSIONS: Double-session MP3 therapy could be considered as a safe and effective procedure to treat glaucoma in eyes that have not undergone any previous glaucoma surgery. Primary eyes achieved a success-rate similar to those with refractory glaucoma with fewer MP3 procedures and fewer glaucoma medications.


Assuntos
Corpo Ciliar/cirurgia , Glaucoma/cirurgia , Fotocoagulação a Laser/métodos , Lasers Semicondutores/uso terapêutico , Adulto , Idoso , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipotensão Ocular/fisiopatologia , Hipotensão Ocular/cirurgia , Oftalmologia , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Esclera/cirurgia , Tonometria Ocular , Resultado do Tratamento , Acuidade Visual/fisiologia
7.
Lasers Med Sci ; 35(7): 1469-1475, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31797236

RESUMO

This study aims to evaluate the effectiveness and safety of double-session micropulse transscleral (MP3) laser for the treatment of glaucoma. This was a retrospective chart review of all patients who underwent MP3 laser with the standard protocol and were within at least 12 months of their follow-up appointments. Eyes were treated at 2000 mW with 31.3% duty cycle for 80 s per treatment session, with double sessions in each hemifield alternating between upper and lower and upper and lower. Success criterion was defined as a greater than 20% reduction in intraocular pressure (IOP) and an IOP between 6 and 18 mmHg at the end of the follow-up period. Eighty-nine eyes of seventy-six glaucoma patients were included; 31 of which were considered primary, i.e., no previous glaucoma surgery. The average pre-treatment IOP was 29.9 ± 6.4 mmHg. At around 16.7 ± 3.1 months of follow-up, the average IOP was 14.8 ± 4.7 mmHg (p < 0.001) (28.8 ± 7.4 to 15.7 ± 5.3 mmHg, p < 0.001, at 17.0 ± 3.1 months in the primary eyes). The number of topical glaucoma medications was reduced from 3.6 ± 0.5 to 1.9 ± 0.9 at the last evaluation (p < 0.001). The best corrected visual acuity in logMAR ranged from 0.41 ± 0.34 preoperatively to 0.45 ± 0.44 at the last visit (p = 0.2), and also remained stable in primary eyes. Success was obtained in 86.5% of the eyes, with 1.5 ± 0.8 procedures, and in 90.3% with 1.2 ± 0.5 MP3 laser procedures in the primary eye group. MP3 laser in two consecutive 80-s sessions was shown to be safe and effective in the treatment of glaucoma. Primary eyes required lower number of MP3 laser procedures.


Assuntos
Glaucoma/cirurgia , Terapia a Laser , Esclera/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
Arq. bras. oftalmol ; 80(6): 386-389, Nov.-Dec. 2017. graf
Artigo em Inglês | LILACS | ID: biblio-888160

RESUMO

ABSTRACT Purpose: To compare the linear measurements of the optic disk cup obtained using RTVue optical coherence tomography (OCT) with those obtained using digital retinography. Methods: This is a cross-sectional study performed with digital retinography and RTVue OCT images from patients with glaucoma or patients suspected of glaucoma. In color retinography, the greatest horizontal and vertical diameters of the optic disk starting from the inner edge of the Elschnig ring were obtained using a pachymeter with a grade of 0.01 mm. In OCT, the delineation of the optic nerve was obtained automatically from the horizontal and vertical cup results. Results: One hundred eyes from 100 subjects with a mean age of 60.1 ± 15.7 years were included. Of these, 79 were the right eye and 21 the left eye, with 61 men and 39 women. The mean horizontal cup obtained with OCT was 0.91 ± 0.10, while that obtained with retinography was 0.79 ± 0.11 (p<0.01). Conclusions: There was poor agreement between the evaluated methods in the measurements of optic disk cup excavations. Measurements obtained automatically with OCT RTVue were higher but were significantly correlated with measurements obtained manually with digital retinography. Poor agreement of the optic disk parameters between the two imaging devices was noted.


RESUMO Objetivo: Comparar as medidas lineares da escavação do disco óptico, obtidas com o OCT RTVue com as obtidas pela retinografia digital. Métodos: Trata-se de um estudo transversal. Utilizou-se imagens de retinografia digital e exames de OCT obtidos pelo aparelho RTVue de pacientes suspeitos ou com glaucoma. Na retinografia colorida, foram obtidos os maiores diâmetros horizontal e vertical do disco óptico, a partir da borda interna do Anel de Elschnig através de paquímetro com graduação de 0,01 mm. No OCT, a delineação do nervo óptico foi obtida automaticamente e a partir dos resultados foi registrado o diâmetro horizontal e vertical da escavação. Resultados: Foram incluídos 100 olhos de 100 indivíduos, com idade média de 60,1 ± 15,7 anos. Desses, 79 foram do olho direito e 21 do olho esquerdo, sendo 61 homens e 39 mulheres. Verificou-se que as médias das escavações horizontais obtidas com o OCT foram de 0,91 ± 0,10, enquanto que as obtidas pela retinografia foram 0,79 ± 0,11 (p<0,01). Conclusões: Nota-se fraca concordância entre os métodos avaliados para quantificar as medidas das escavações do disco óptico. As medidas obtidas automaticamente pelo OCT RTVue foram maiores, porém correlacionadas com as medidas obtidas manualmente pela retinografia digital. Além disso, notou-se fraca concordância nos parâmetros do disco óptico entre os dois dispositivos de imagens.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Glaucoma/diagnóstico por imagem , Retina/diagnóstico por imagem , Estudos Transversais , Tomografia de Coerência Óptica , Técnicas de Diagnóstico Oftalmológico
9.
Rev. bras. oftalmol ; 76(6): 285-288, nov.-dez. 2017. graf
Artigo em Inglês | LILACS | ID: biblio-899096

RESUMO

Abstract Objective: To determine the influence of visual field results in the diagnosis of glaucoma. Methods: A questionnaire with ophthalmologists was conducted where slides of a digital photograph of the optic disc and computerized visual field exam were presented.(Physicians were instructed to answer whether glaucoma was observed in each of the slides). No other information was given to those examiners. Half of the patients had glaucoma with corresponding visual field, and the other half had physiological cupping and normal visual field. The slides were equally divided between retinography and corresponding visual field (same patient) and exams randomly exchanged, where an optic disc of glaucoma with a normal visual field was placed, and vice-versa. The order in which the slides were presented was also randomized. Results: Forty slides were evaluated by 29 ophthalmologists. No glaucoma specialist was included. The overall agreement among the examiners (Kappa) was 0.270 ± 0.281, and 0.261 ± 0.238 for the exams of the same eye and was 0.274 ± 0.217 from the slides with the exams changed (p=0.4). The diagnosis was made correctly in glaucoma patients with corresponding visual field exam in 66.89% of the cases, and in 66.20% of patients with physiological cupping. When the exams were exchanged, the results dropped to 34.13% and 35.86%, respectively (p<0.001 for both). Conclusion: Visual field results may influence the diagnosis of glaucoma by non-glaucoma specialists.


Resumo Objetivo: Avaliar a influência da campimetria computadorizada no diagnóstico do glaucoma. Métodos: Foi realizado questionário com oftalmologistas apresentando slides com uma fotografia digital de disco óptico e campo visual computadorizado. Os médicos deveriam assinalar se o exames apresentados eram de glaucoma ou não. Nenhuma outra informação foi passada para os examinadores. Metade dos pacientes apresentavam glaucoma com dano correspondente de campo visual, e a outra metade aumento fisiológico da escavação e campo visual normal. Os slides foram igualmente divididos em: retinografia e campo visual correspondentes (mesmo paciente) e exames invertidos de forma aleatória, colocando um disco óptico de glaucoma com um campo visual normal e vice-versa. A ordem de apresentação dos slides foi randomizada previamente. Resultados: Foram incluídos 40 slides, avaliados por 29 oftalmologistas. Nenhum especialista em glaucoma foi incluído. A concordância entre os examinadores (Kappa) foi de 0,270 ± 0,281, sendo de 0,261 ± 0,238 para os exames correspondentes e 0,274 ± 0,217 para os slides com os exames trocados (p=0,4). O diagnóstico foi realizado corretamente nos pacientes com glaucoma com o campo visual correspondente em 66,89% dos casos, e em 66,20% nos pacientes com aumento da escavação (normais). Quando houve a troca da correspondência dos exames, os valores caíram para 34,13% e 35,86%, respectivamente (p<0,001 para ambos). Conclusão: O conhecimento prévio dos resultados do campo visual pode influenciar o diagnóstico do glaucoma.


Assuntos
Humanos , Disco Óptico/diagnóstico por imagem , Fotografação , Glaucoma/diagnóstico , Testes de Campo Visual , Retina/diagnóstico por imagem , Campos Visuais , Variações Dependentes do Observador , Inquéritos e Questionários , Reprodutibilidade dos Testes , Oftalmologistas , Fibras Nervosas/patologia
10.
Clin Ophthalmol ; 11: 1265-1272, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28740362

RESUMO

PURPOSE: The aim of study was to evaluate the cross-link using riboflavin and ultraviolet A (UVA) for improving scleral wound healing. MATERIALS AND METHODS: This was an experimental study involving four New Zealand rabbits (eight eyes). Therapy procedure was chosen for the right eye and control procedure for the left one. UVA irradiation of 365 nm with a surface irradiance of 3 mW/cm2 and a photosensitizer of riboflavin drops were applied for 30 minutes on the right eye at 2 mm from the limbus. Sclerotomy incision was performed at 2 mm from the limbus in both right (on the cross-link-treated area) and left eye. Then, 30 days after surgery, a morphological analysis and histological staining with hematoxylin-eosin and picrosirius red were performed, and the sclerotomy cicatrization of right and left eyes was compared. The variables investigated were as follows: sclerotomy incision pictures and measurements were made using the ImageJ Software. Scleral thickness was measured (employing the anterior optical coherence tomography and the digital caliper). Collagen fiber density stained with picrosirius red staining was measured using the Image Pro Plus software. RESULTS: The morphological analysis showed that in all samples, the right eye presented sclerotomy closure, and in two eyes, among them, there were no visible edges of the sclerotomies incision. The left eye presented sclerotomy closure and incision edges. The Image Pro demonstrated a higher density of collagen fibers in the right eye when compared to the one. The statistical analysis was significant when compared to the collagen fiber density in the treated eyes with the control eyes. CONCLUSION: The cross-link procedure resulted in a better sclerotomy wound healing.

11.
Eur J Ophthalmol ; 26(3): 221-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26449256

RESUMO

PURPOSE: To compare the use of mitomycin C (MMC) or bevacizumab (BEV) as adjunctive in the needling revision of failed trabeculectomy blebs. METHODS: Glaucoma patients with failed trabeculectomy were included. Cystic blebs were excluded. All procedures were performed by the same surgeon at the operating room under peribulbar blockade. Rate of success, intraocular pressure (IOP), and number of antiglaucoma drugs in use were compared before and after the procedures. The IOP was measured postoperatively at days 1, 30, 90, and 180. Absolute success was defined as IOP ≤18 mm Hg, without any complication or use of any antiglaucomatous drugs. Qualified success was the same criteria, but with the use of any antiglaucomatous drugs. RESULTS: Twenty-nine eyes of 29 patients were included: 15 eyes with MMC and 14 eyes with BEV. There was no statistical difference in the IOP reduction between the groups (MMC 32.6 ± 16.1% vs BEV 30.1 ± 12.0%, p = 0.6). The BEV group showed similar reduction in the number of antiglaucoma drugs compared to the MMC group (p = 0.6). Absolute success was found in 28.5% of the BEV group and in 6.6% of patients with MMC. Qualified success was found in 64.3% and 73.4%, respectively, both limited to 180 days. CONCLUSIONS: In this selected and limited group of patients, bevacizumab can be considered as an alternative to MMC in the needling revision of failed trabeculectomy. Studies with a larger number of patients and longer follow-up are needed to confirm the hypothesis suggested here.


Assuntos
Alquilantes/uso terapêutico , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Glaucoma/terapia , Mitomicina/uso terapêutico , Trabeculectomia/métodos , Idoso , Quimioterapia Adjuvante , Feminino , Glaucoma/tratamento farmacológico , Glaucoma/fisiopatologia , Glaucoma/cirurgia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Agulhas , Estudos Prospectivos , Reoperação , Tonometria Ocular , Malha Trabecular/cirurgia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
12.
Retina ; 33(1): 120-7, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22810148

RESUMO

PURPOSE: To evaluate decafluoro-di-n-pentyl ether (DFPE) as a vitreous tamponade by examining ocular tolerance in rabbits' eyes. METHODS: Thirteen rabbits were divided into 4 groups after mechanical vitrectomy and were followed up to 12 months. The tamponade remained in the eye for 6 months in group 1 (DFPE) and Group 3 (DFPE and silicone oil) and for 12 months in group 2 (DFPE). Group 4 served as control. RESULTS: In groups 1, 2, and 3, dispersion of the fluid appeared 2 weeks postoperatively. Posterior subcapsular cataracts appeared in rabbits' eyes with large fills of DFPE (>50%). Histologic findings in groups 1 and 2 showed no detectable change in outer nuclear layer thickness. Except for some vacuolations, the inner retina was well preserved in all injected rabbits' eyes. On the electroretinography of injected rabbits' eyes, there was no effect on the a wave amplitude and b wave implicit time, but the b wave amplitude was elevated with statistical significance (P < 0.001) at 1, 3, and 6 months postoperatively but with no statistical significance (P > 0.05) after that period when compared with group 4 and unoperated fellow rabbits' eyes of each group. CONCLUSION: Decafluoro-di-n-pentyl ether demonstrated minimum adverse effects in retinal rabbits; further studies are needed before clinical use as short-term tamponade.


Assuntos
Catarata/induzido quimicamente , Tamponamento Interno , Éteres/toxicidade , Cristalino/efeitos dos fármacos , Retina/efeitos dos fármacos , Doenças Retinianas/induzido quimicamente , Corpo Vítreo , Animais , Catarata/patologia , Combinação de Medicamentos , Eletrorretinografia/efeitos dos fármacos , Injeções Intravítreas , Masculino , Coelhos , Retina/patologia , Doenças Retinianas/patologia , Óleos de Silicone/toxicidade , Vitrectomia
13.
Retina ; 32(1): 10-8, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21817963

RESUMO

PURPOSE: To evaluate the long-term safety and visual acuity outcomes associated with epimacular strontium 90 brachytherapy combined with intravitreal bevacizumab for the treatment of subfoveal choroidal neovascularization because of age-related macular degeneration. METHODS: Thirty-four treatment-naive patients with predominantly classic, minimally classic, and occult subfoveal choroidal neovascularization lesions participated in this prospective, 2-year, nonrandomized multicenter study. Subjects from 1 center (n = 19) were reconsented and followed-up for 3 years. Each subject received a single 24-Gy beta irradiation treatment via an intraocular delivery device and 2 planned injections of bevacizumab at treatment and 1 month later. Additional bevacizumab therapy was permitted based on prespecified retreatment criteria. Adverse events were observed, and best-corrected visual acuity was measured using Early Treatment Diabetic Retinopathy Study vision charts. Subjects were evaluated every 3 months during the first year of follow-up and every 6 months during Years 2 and 3 of follow-up. RESULTS: All 34 subjects were followed-up for 24 months and 19 were followed-up through 36 months. With up to 24 months of follow-up, 12 of 24 phakic patients (50%) exhibited ≥ 2 grades of progression in Lens Opacification Classification System (LOCS) II lens classification; 5 eyes underwent cataract extraction before the Month 36 visit. There was 1 case of nonproliferative retinopathy identified at 36 months of follow-up that did not have an adverse effect on visual acuity, was stable at 43 months of follow-up, and was isolated to the parafoveal region. Mean best-corrected visual acuity demonstrated an average gain of +15.0 and -4.9 letters at 12 months and 24 months, respectively; the drop in mean gain at Month 24 was largely attributable to cataract formation. At 36 months (n = 19), the mean best-corrected visual acuity was +3.9, 90% (17 of 19) of eyes had lost <15 letters from baseline, 53% (10 of 19) had gained ≥ 1 letter, and 21% (4 of 19) had gained ≥ 15 letters. Through 36 months, 11 eyes required additional bevacizumab retreatment therapy and received a mean of 3.0 injections (range, 2-7 injections). CONCLUSION: Epimacular brachytherapy shows promise as a therapeutic option for subfoveal neovascular age-related macular degeneration. The procedure was safe and well tolerated, with a reasonable risk-benefit profile that warrants further study in larger subject populations. The most common adverse event was cataract progression/formation. Surgical complications are similar to those expected from standard vitrectomy trials. This novel device is currently being evaluated in two prospective, randomized, controlled trials in treatment-naive subjects (CABERNET) and in subjects already treated with anti-vascular endothelial growth factor therapy (MERLOT).


Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Braquiterapia/métodos , Neovascularização de Coroide/terapia , Degeneração Macular/complicações , Idoso , Bevacizumab , Braquiterapia/efeitos adversos , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/fisiopatologia , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Radioisótopos de Estrôncio/uso terapêutico , Acuidade Visual/efeitos da radiação , Radioisótopos de Ítrio/uso terapêutico
14.
J Refract Surg ; 27(10): 723-8, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21853963

RESUMO

PURPOSE: To compare visual acuity, aberrometry, and contrast sensitivity in patients who had a spherical intraocular lens (IOL) (SoFlex SE, Bausch & Lomb) implanted in one eye and an aspheric IOL (SofPort AO, Bausch & Lomb) implanted in the fellow eye during uncomplicated cataract surgery. METHODS: A prospective, multicenter, double-blind study was performed. Forty patients (80 eyes) underwent bilateral phacoemulsification with implantation of a spherical IOL in one eye and an aspheric IOL in the fellow eye. Postoperatively, visual acuity, aberrometry, and contrast sensitivity tests were performed. Statistical analyses were performed using Student t and Wilcoxon tests, and mixed effects were used for each contrast condition situation. RESULTS: Thirty-nine patients (30 women, 9 men; 78 eyes) with a mean age of 69.3±6.17 years (range: 51 to 82 years) completed the study. No statistical differences were found regarding visual acuity among eyes. Lower levels of higher order aberrations were achieved in the aspheric group. No statistical difference between groups under photopic conditions was noted. In low spatial frequencies, better performance was observed with the aspheric IOL under mesopic conditions. In high spatial frequencies, the spherical IOL produced better quality of vision. Comparing mesopic conditions with glare, visual performance was statistically better using the aspheric IOL. CONCLUSIONS: Cataract surgery results cannot be measured by means of visual acuity alone. Quality of vision must be considered, and implantation of IOLs with low levels of spherical aberrations and better contrast sensitivity are preferred. In this study, the aspheric IOL demonstrated better visual function, especially at night, when compared with spherical IOLs.


Assuntos
Sensibilidades de Contraste/fisiologia , Aberrações de Frente de Onda da Córnea/fisiopatologia , Implante de Lente Intraocular , Facoemulsificação , Pseudofacia/fisiopatologia , Aberrometria , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acuidade Visual/fisiologia
15.
Retina ; 29(2): 157-69, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19202425

RESUMO

PURPOSE: The purpose of this study was to evaluate the short-term safety and feasibility of intraocular, epiretinal delivery of beta radiation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration for 12 months. A 3-year follow-up period is planned to assess the long-term safety of the procedure. METHODS: In this nonrandomized, multicenter feasibility study, 34 treatment-naïve patients with predominantly classic, minimally classic, or occult lesions due to subfoveal choroidal neovascularization secondary to age-related macular degeneration received a single treatment with either 15 Gray (Gy) (8 patients) or 24 Gy (26 patients) beta radiation (strontium-90) using a novel intraocular delivery device. Adverse events and safety endpoints were observed and recorded. Visual acuity was measured preoperatively and postoperatively using standard Early Treatment Diabetic Retinopathy Study vision charts. RESULTS: Twelve months after treatment, no adverse events associated with exposure to radiation were observed. All patients in both 15 Gy (n = 4) and 24 Gy cohorts (n = 17) who met inclusion criteria and were treated according to protocol lost fewer than three lines of vision. Fifty percent (2/4) of the 15 Gy-treated patients and 76% (13/17) of the 24 Gy-treated patients improved or maintained their visual acuity at 12 months. In the 24 Gy group, 29% (5/17) gained three lines or more in visual acuity. The mean change in visual acuity observed at month 12 was +10.3 letters in the 24 Gy study cohort and -1.0 letters in the 15 Gy cohort. CONCLUSION: The short-term safety and efficacy of intraocular, epiretinal delivery of beta radiation for the treatment of subfoveal choroidal neovascularization was promising in this small study group and should be studied in a larger cohort of patients.


Assuntos
Neovascularização de Coroide/radioterapia , Degeneração Macular/radioterapia , Retina/efeitos da radiação , Acuidade Visual/fisiologia , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/fisiopatologia , Estudos de Viabilidade , Feminino , Angiofluoresceinografia , Seguimentos , Fóvea Central , Humanos , Degeneração Macular/complicações , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Radioisótopos de Estrôncio/efeitos adversos , Radioisótopos de Estrôncio/uso terapêutico , Resultado do Tratamento
16.
Rev. bras. anestesiol ; 57(4): 391-400, jul.-ago. 2007. ilus, tab
Artigo em Português | LILACS | ID: lil-458057

RESUMO

JUSTIFICATIVA E OBJETIVOS: O CEROF-HC é uma instituição pública especializada em oftalmologia. A realização de bloqueios anestésicos para intervenções cirúrgicas oftálmicas é prática comum e eficiente. Como técnica não é isenta de riscos, há possibilidade de perfuração de meninges e a injeção de anestésico local (AL) na região do sistema nervoso central (SNC). O objetivo deste relato foi mostrar um caso de anestesia do tronco encefálico como complicação do bloqueio oftálmico e chamar a atenção para a profilaxia do acidente e o tratamento das complicações. RELATO DO CASO: Paciente do sexo feminino, 60 anos, ASA II, com diagnóstico de catarata grau II, indicada para facectomia com implante de lente intra-ocular no olho direito. Histórico clínico de hipertensão arterial e antecedente de vitrectomia. Exames físicos, laboratoriais e cardiológicos normais. Foi realizado bloqueio retrobulbar extraconal, com anestésico local (lidocaína e bupivacaína) e hialuronidase (volume total de 5 mL). Imediatamente após, a paciente apresentou apnéia e perda da consciência. Foi tratada com intubação traqueal (IOT) e ventilação mecânica, mantendo-se estável. Foi realizada a operação. Começou a se movimentar 30 minutos após IOT, recuperando-se totalmente, sem apresentar qualquer seqüela. CONCLUSÕES: O bloqueio oftálmico, apesar de seguro, não é isento de riscos. O principal fator de risco é a inadequada realização da técnica anestésica. O anestésico local (AL), no bloqueio oftálmico, pode atingir o SNC por punção inadvertida da artéria oftálmica ou por punção das meninges que envolvem o nervo óptico, com a dispersão para o espaço subaracnóideo. Embora rara, pode levar a complicação grave, com parada respiratória, que, se não diagnosticada e tratada prontamente, pode ser fatal. São apresentadas as possibilidades de ocorrência dessa complicação, assim como a discussão da nomenclatura dos bloqueios anestésicos realizados em oftalmologia. Ressalta-se a importância...


BACKGROUND AND OBJECTIVES: The CEROF-HC is a public hospital specialized in ophthalmology. Anesthetic blocks for ophthalmic surgeries are common and effective. But the technique is not devoid of risks, and there is the possibility of meningeal perforation and injection of the local anesthetic (LA) in the central nervous system (CNS). The objective of this study was to report a case of brainstem anesthesia as a complication of the ophthalmologic regional anesthesia, stress the importance of preventing this accident, and discuss the treatment. CASE REPORT: A female patient, 60 years old, ASA II, with a diagnosis of grade II cataract, was scheduled for a facectomy and implantation of intraocular lens in the right eye. The patient had a past medical history of hypertension and vitrectomy. Physical exam, laboratory and cardiologic exams were normal. An extraconal retrobulbar block was performed with local anesthetic (lidocaine and bupivacaine) and hyaluronidase (total volume of 5 mL). Immediately after, the patient developed apnea and loss of consciousness. She was treated with tracheal intubation and mechanical ventilation, remaining stable. The surgery was performed as planned. Thirty minutes after the intubation, the patient began to move, recovering completely, without deficits. CONCLUSIONS: Although safe, ophthalmic block is not devoid of risks. The main risk factor is improper anesthetic technique. In the ophthalmic block, the local anesthetic (LA) can reach the CNS by inadvertently puncturing the ophthalmic artery or the meninges that surround the optic nerve, with dispersion to the subarachnoid space. Although rare, it can lead to a severe complication with respiratory arrest that can be fatal if it is not diagnosed promptly. Here we present the possibilities of such a complication, and discuss the nomenclature of anesthetic blocks used in ophthalmology. The importance of the knowledge of this and other complications by the surgical...


JUSTIFICATIVA Y OBJETIVOS: El CEROF-HC es una institución pública especializada en oftalmología. La realización de bloqueos anestésicos para intervenciones quirúrgicas oftálmicas es una práctica común y eficiente. Como técnica no está exenta de riesgos, existe la posibilidad de perforación de meninges y la inyección de anestésico local (AL) en la región del sistema nervioso central (SNC). El objetivo de este relato fue mostrar un caso de anestesia del tronco encefálico como complicación del bloqueo oftálmico y destacar la profilaxis del accidente y el tratamiento de las complicaciones. RELATO DE CASO: Paciente del sexo femenino, 60 años, ASA II, con diagnóstico de catarata grado II, indicada para facectomía con implante de lente intraocular en el ojo derecho. Hoja clínica de hipertensión arterial y antecedente de vitrectomía. Exámenes físicos, laboratoriales y cardiológicos normales. Fue realizado bloqueo retrobulbar extraconal con anestésico local (lidocaína y bupivacaína) e hialuronidasis (volumen total de 5 mL). Inmediatamente después, la paciente presentó apnea y pérdida de la conciencia. Fue tratada con intubación traqueal (IOT) y ventilación mecánica, manteniéndose estable. Se realizó la operación. Empezó a moverse 30 minutos después del IOT, recuperándose totalmente sin presentar ninguna secuela. CONCLUSIONES: El bloqueo oftálmico, a pesar de seguro, no está exento de riesgos. El principal factor de riesgo es la inadecuada realización de la técnica anestésica. El anestésico local (AL), en el bloqueo oftálmico, puede alcanzar el SNC por punción inadvertida de la arteria oftálmica o por punción de las meninges que envuelven el nervio óptico, con la dispersión para el espacio subaracnoideo. Aunque sea rara, puede conllevar a complicación grave, con parada respiratoria, que, si no se diagnostica y se trata rápidamente, puede ser fatal. Se presentan las posibilidades de esta complicación, y la discusión de la nomenclatura de los bloqueos...


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Anestesia Local/efeitos adversos , Bupivacaína/uso terapêutico , Extração de Catarata , Lidocaína , Complicações Pós-Operatórias
17.
Rev Bras Anestesiol ; 57(4): 391-400, 2007 Aug.
Artigo em Português | MEDLINE | ID: mdl-19462114

RESUMO

BACKGROUND AND OBJECTIVES: The CEROF-HC is a public hospital specialized in ophthalmology. Anesthetic blocks for ophthalmic surgeries are common and effective. But the technique is not devoid of risks, and there is the possibility of meningeal perforation and injection of the local anesthetic (LA) in the central nervous system (CNS). The objective of this study was to report a case of brainstem anesthesia as a complication of the ophthalmologic regional anesthesia, stress the importance of preventing this accident, and discuss the treatment. CASE REPORT: A female patient, 60 years old, ASA II, with a diagnosis of grade II cataract, was scheduled for a facectomy and implantation of intraocular lens in the right eye. The patient had a past medical history of hypertension and vitrectomy. Physical exam, laboratory and cardiologic exams were normal. An extraconal retrobulbar block was performed with local anesthetic (lidocaine and bupivacaine) and hyaluronidase (total volume of 5 mL). Immediately after, the patient developed apnea and loss of consciousness. She was treated with tracheal intubation and mechanical ventilation, remaining stable. The surgery was performed as planned. Thirty minutes after the intubation, the patient began to move, recovering completely, without deficits. CONCLUSIONS: Although safe, ophthalmic block is not devoid of risks. The main risk factor is improper anesthetic technique. In the ophthalmic block, the local anesthetic (LA) can reach the CNS by inadvertently puncturing the ophthalmic artery or the meninges that surround the optic nerve, with dispersion to the subarachnoid space. Although rare, it can lead to a severe complication with respiratory arrest that can be fatal if it is not diagnosed promptly. Here we present the possibilities of such a complication, and discuss the nomenclature of anesthetic blocks used in ophthalmology. The importance of the knowledge of this and other complications by the surgical team is paramount, as well as the preparation and adequate monitoring to diagnose and treat immediately this complication to minimize the risks to the patient.

18.
Rev. bras. oftalmol ; 62(10): 740-746, out. 2003. ilus, tab
Artigo em Português | LILACS | ID: lil-360999

RESUMO

Objetivo: Verificar a influência do diâmetro pupilar na Perimetria de Frequência Dupla (FDT) em indivíduos normais. Local: Centro de Referência em Oftalmologia (CEROF) da Universidade Federal de Goiás. Métodos: Vinte pacientes normais foram submetidos à FDT, estratégia de screening C-20-5, inicialmente com a pupila sem alterações, e em seguida em miose ou midríase, aleatóriamente. Os exames foram realizados com intervalo máximo de 15 dias. O número de pontos alterados, índices de confiabilidade e tempo de exame foi comparado entre os exames. Resultados: Os voluntários apresentaram menor tempo de exame em midríase (p=0,006) comparado com a pupila sem alterações. Não houve diferença estatísticamente significante com relação ao exame de pupila em miose (p=0,7). Não observamos alterações estatisticamente significantes no número total de pontos alterados entre o exame com a pupila sem alterações (0,8 +- 1,76 pontos) e miose (2,0 +- 4,3 pontos) (p=0,3). entretanto, observamos melhora considerável nos pacientes após midríase (0,1 +- 0,30 pontos alterados) (p=0,04). Conclusão: Apesar de não apresentar diferença estatisticamente significante no número total de pontos alterados, os olhos em miose demonstraram maior número de áreas acometidas, podendo refletir em diferenças clínicas. Entretanto, os pacientes em midríase apresentaram menor número de pontos alterados com um menor tempo de exame.


Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Glaucoma , Miose , Midríase , Pupila , Testes de Campo Visual , Pressão Intraocular , Acuidade Visual
20.
Semin Ophthalmol ; 17(3-4): 199-205, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12759851

RESUMO

With refinement of vitrectomy techniques over the past 30 years, the treatment of rhegmatogenous retinal detachment (RRD) has transitioned from the almost exclusive use of extraocular techniques to the present time in which intraocular interventions are available and, in some practices, enjoy almost exclusive use for primary repair of RRD. Except for those situations in which a retinal detachment is associated with obvious immediate complications related to the cataract surgery, the considerations for the treatment of pseudophakic RRD are quite similar to those of phakic RRD. The current options are: use of an extraocular buckling device, vitrectomy-related procedures, intraocular gas injection with associated retinopexy, and combinations of these. Disagreement on the ideal intervention for pseudophakic retinal detachment is not uncommon and particularly so in those RRDs which lie somewhere in the spectrum between complex and simple. As is so often the case in the surgical treatment of disease, there may not be one ideal technique for a particular type of RRD; but knowledge of alternatives logically increases the likelihood of a successful result. The goal of this paper is to outline the clinical factors shown to be of importance in deciding which technique will have the greatest chance at not only achieving retinal re-attachment but also in optimizing long-term vision.


Assuntos
Pseudofacia/cirurgia , Descolamento Retiniano/cirurgia , Extração de Catarata/efeitos adversos , Criocirurgia , Humanos , Pseudofacia/etiologia , Descolamento Retiniano/etiologia , Recurvamento da Esclera , Vitrectomia
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