Gonioscopy-Assisted Transluminal Trabeculotomy Outcomes Under Different Levels of Glaucoma Severity: A Multicenter, Comparative Study.

PURPOSE: To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) under different levels of glaucoma severity. DESIGN: Retrospective, multicenter, before-and-after study. METHODS: One eye from all primary open-angle glaucoma patients who underwent GATT combined with cataract surgery (Phaco-GATT) or GATT stand-alone with 12 months of follow-up were included and divided according to glaucoma severity (mild = GI, moderate = GII, and advanced = GIII) and the outcomes compared. RESULTS: A total of 270 eyes were included: 90 in GI, 75 in GII, and 105 in GIII. The IOP was reduced from 18.6 ± 6.0 mm Hg in GI, 19.7 ± 6.4 mm Hg in GII, and 21.0 ± 7.9 mm Hg in GIII, preoperatively, to 11.9 ± 2.6 mm Hg in GI, 11.8 ± 2.1 mm Hg in GII, and 11.9 ± 3.0 mm Hg in GIII at 12 months postoperatively (P < .001 for all). The number of hypotensive ocular medications were reduced from 2.7 ± 1.0 in GI, 3.1 ± 0.8 in GII, and 3.2 ± 1.2 in GIII to 0.6 ± 0.9 in GI, 1.0 ± 1.1 in GII, and 1.2 ± 1.1 in GIII at the last postoperative visit (P < .001 for all). Relative success was achieved, at 1 year, in 93.8% of the eyes in GI, 89.0% in GII, and 88.1% in GIII (P = .3). Complete success was achieved in 61.8% of the eyes in GI, 43.8% in GII, and 37.6% in GIII (P = .007). No serious adverse event was observed in any group. CONCLUSIONS: GATT is a safe and effective procedure in glaucoma, regardless of its preoperative severity.

Results of intrastromal corneal ring implantation in advanced keratoconus With the aim of postpoing or avoiding corneal transplantation.

PURPOSE: To evaluate the safety and efficacy of the surgery of intracorneal ring segment implantation with 320° of arc (320-ICRS) in patients with advanced keratoconus stage IV and maximum keratometry (Kmax) above 60 D. METHODS: A prospective, interventional case series study evaluating 25 eyes of 19 patients with keratoconus stage IV and Kmax > 60D in which 320-ICRS were implanted using VisuMax® femtosecond. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometric values (mean - mean-K, flat - K1, and steep - K2), maximum keratometry (Kmax), tomographic astigmatism, refractive astigmatism and asphericity (Q) were assessed preoperatively and at 3, 6 and 12 months after the procedure. RESULTS: The UDVA improved from 1.03 ± 0.28 LogMAR (20/200) to 0.54 ± 0.21 LogMAR (20/60), (p < 0.001), the CDVA (with glasses) improved from 0.63 ± 0.29 LogMAR (20/80) to 0.31 ± 0.16 LogMAR (20/40),(p = 0.004), K1 reduced from 54.41 ± 4.46 D to 49.36 ± 4.11 D (p < 0.001), K2 reduced from 61.15 ± 4.37 D to 53.715 ± 4.05 D, (p < 0.001), mean-K reduced from 57.55 ± 4,17 D to 51.44 ± 3,94 D (p < 0.001), Kmax reduced from 69.80 ± 8.20 D to 63.43 ± 6.31 D (p < 0.001) and asphericity (Q) changed from -1.57 ± 0.35 to -0.77 ± 0.56 (p < 0.001). A total of 89.9% patients reached BCVA wearing scleral contact lens  0.2 LogMAR(20/25). CONCLUSION: 320-ICRS to treat advanced keratoconus appears to be an efficacious and safe procedure, being a surgical alternative to delay or even prevent corneal transplantation.

Trabeculectomy in Eyes With High Myopia.

PRCIS: Primary trabeculectomy was safe and effective at lowering intraocular pressure (IOP) in patients with primary open angle glaucoma and high myopia. PURPOSE: To investigate the efficacy and safety of trabeculectomy in patients with glaucoma and high myopia. PATIENT AND METHODS: Retrospective case-control study. Glaucomatous patients with high myopia undergoing primary trabeculectomy surgery with at least 1 year of follow-up were compared with an age-matched control group without high myopia undergoing the same procedure. Surgical success was defined as: IOP ≤ 15 mm Hg with (qualified) or without (complete) antiglaucoma medications and at least 20% reduction from baseline IOP at the end of 48 months of follow-up. RESULTS: We included a total of 90 eyes from 90 patients (45 eyes with high myopia and 45 controls). Within the 90 eyes, 70 eyes underwent trabeculectomy and 20 eyes underwent combined phacoemulsification and trabeculectomy. Although patients with high myopia had higher chances for failure (37% vs. 22%) compared with controls, the difference was not statistically significant ( P =0.067). In the multivariable analysis, patients of African descent ( P =0.043) and those with juvenile glaucoma ( P =0.001) had more chances of failure, even after adjusting for myopia. There was no statistically significant difference between complication rates in both groups. CONCLUSION: Trabeculectomy was effective in reducing IOP in patients with high myopia and glaucoma, without the additional risk of complications compared with a control group.

Longitudinal evaluation of RTVue optical coherence tomography in patients with glaucoma and suspected glaucoma and stable visual fields / Avaliação longitudinal da tomografia de coerência óptica RTVue em pacientes glaucomatosos e suspeitos de glaucoma com campos visuais estáveis

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.

Estimating the Ideal Treatment Protocol and Success Predictors for Double-session Micropulse Transscleral Laser for Glaucoma Management.

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.

Use of computerized campimetry and/or optical coherence tomography for glaucoma diagnosis by non-glaucoma specialists / Uso da campimetria e/ou da tomografia de coerência óptica no diagnóstico do glaucoma por oftalmologistas generalistas

ABSTRACT Purpose: To compare the use of visual field and/or optical coherence tomography (OCT) combined with color retinography by non-glaucoma specialists for differentiating glaucoma from physiological cupping. Methods: Eighty patients with glaucoma or physiological cupping (40 of each) were randomized according to the examination used (GI: color retinography, GII: color retinography + visual field, GIII: color retinography + optical coherence tomography, GIV: color retinography + visual field + optical coherence tomography). Twenty non-specialist ophthalmologists diagnosed glaucoma from PowerPoint slide images, without direct patient examination. Results: Inter-examiner agreement was good for GII (ĸ: 0.63; 95%CI, 0.53-0.72), moderate for GIII (ĸ: 0.58; 95%CI, 0.48-0.68) and GIV (ĸ: 0.41; 95%CI, 0.31-0.51), and low for GI (ĸ: 0.30; 95%CI, 0.20-0.39) (p<0.001). Diagnostic accuracy was higher in GIII (15.8 ± 1.82) than GI (12.95 ± 1.46, p<0.001) and higher in GII (16.25 ± 2.02) than GI and GIV (14.10 ± 2.24) (both p<0.001). For glaucoma patients only, diagnostic accuracy in GII and GIII was superior to that in GI and GIV (both p<0.001). Sensitivity and specificity were 59% and 70.5% in GI; 86.5% and 76% in GII, 86.5% and 71.5% in GIII; and 68.5% and 72.5% in GIV, respectively. Accuracy was highest in GII (81.3% [95%CI, 77.1-84.8]), followed by GIII (79% [95%CI, 74.7-82.7]), GIV (70,5% [95%CI, 65.9-74.8]), and GI (64.8% [95%CI, 60.0-69.3]). Conclusions: Non-glaucoma specialists could not differentiate glaucoma from increased physiological cupping when using color retinography assessment alone. Diagnostic accuracy and inter-rater agreement improved significantly with the addition of visual field or optical coherence tomography. However, the use of both modalities did not improve sensitivity/specificity.(AU)

RESUMO Objetivos: Verificar a influência do campo visual e/ou tomografia de coerência óptica, quando analisados em associação à retinografia colorida, na diferenciação entre indivíduos com glaucoma daqueles com aumento fisiológico de escavação. Métodos: Oitenta pacientes com glaucoma ou aumento fisiológico de escavação (40 cada) foram randomizados de acordo com o exame testado (GI: retinografia colorida, GII: retinografia colorida + campo visual, GIII: retinografia colorida + tomografia de coerência óptica, GIV: retinografia colorida + campo visual + tomografia de coerência óptica). Vinte oftalmologistas não especialistas em glaucoma diagnosticaram glaucoma através de slides do PowerPoint, sem o exame direto do paciente. Resultados: A concordância interexaminador foi boa para o GII (ĸ: 0,63; 95%CI, 0,53-0,72), moderada para GIII (ĸ: 0,58; 95%CI, 0,48-0,68) e GIV (ĸ: 0,41; 95%CI, 0,31-0,51), e baixa para o GI (ĸ: 0,30; 95%CI, 0,20-0,39) (p<0,001). Acurácia diagnostica foi maior no GIII (15,8 ± 1,82) em comparação ao GI (12,95 ± 1,46, p<0,001) e o GII (16,25 ± 2,02) maior em comparação ao GI e GIV (14,10 ± 2,24) (para ambos, p<0,001). Para os pacientes com glaucoma, a acurácia diagnostica nos grupos GII e GIII foi superior do que em GI e GIV (ambos p<0,001). Sensibilidade e especificidade foram 59% e 70,5% no GI; 86,5% e 76% no GII, 86,5% e 71,5% no GIII; 68,5% e 72,5% no GIV, respectivamente. A acurácia foi maior no GII (81,3% [95%CI, 77,1-84,8]), seguido pelo GIII (79% [95%CI, 74,7-82,7]), GIV (70,5% [95%CI, 65,9-74,8]), e GI (64,8% [95%CI, 60,0-69,3]). Conclusões: A avaliação isolada da retinografia colorida por oftalmologistas não especialistas em glaucoma não pode diferenciar pacientes com glaucoma daqueles com aumento fisiológico de escavação. Houve aumento da acurácia diagnóstica e da concordância interobservador com o acréscimo do campo visual ou da tomografia de coerência óptica. Entretanto, o uso de ambas as modalidades não melhorou a sensibilidade/especificadade.(AU)

Double-session micropulse transscleral laser (CYCLO G6) for the treatment of glaucoma.

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.

Double-Session Micropulse Transscleral Laser (CYCLO G6) as a Primary Surgical Procedure for Glaucoma.

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.

Comparison of biometric predictability and final refraction expected in phacoemulsification surgery with and without trabeculectomy / Comparação da previsibilidade biométrica e refração final esperada em cirurgia de facoemulsificação com e sem trabeculectomia

Abstract Objective: The main purpose of this article is to compare the predictability of biometric results and final refractive outcomes expected in patients undergoing cataract surgery through phacoemulsification with and without associated trabeculectomy. Methods: Cataract patients who have undergone phacoemulsification surgery alone (control group) or associated with trabeculectomy (study group) screened. All surgeries were performed following standard protocol. For enrollment, biometrics calculated by IOL Master (Carl Zeiss Meditec, Inc.) biometry, refraction and intraocular pressure (IOP) before and after surgery were required. Data was compared between groups in addition to the correlation between variation of IOP and final refraction. Results: Thirty eyes per group were enrolled. Only prior IOP (p <0.001), IOP post-surgery (p = 0.01) and the difference in IOP (p <0.001) were statistically significant. Axial length, IOL diopter used, expected spherical refraction by biometrics and astigmatism pre- and post-surgery were similar in both groups (p=0.1; 0.4; 0.4; 0.5 and 0.3, respectively). Spherical predictability by biometrics within 0.25 diopters was noted in both the control group (range 0.06 ± 0.45) and study group (range 0.25 ± 0.97, p = 0.3). There was no statistical significance between groups for the difference between final cylinder and corneal astigmatism (p = 0.9), and the difference between axis of refractive and corneal astigmatism (p = 0.7). Conclusion: The biometric predictability in phacoemulsification surgery and the expected final refraction are significant, andare not modified by trabeculectomy in the combined surgeries.

Resumo Objetivo: Comparar a previsibilidade dos resultados refracionais e da biometria em pacientes submetidos à cirurgia de catarata por facoemulsificação com e sem trabeculectomia (Trec) associada. Métodos: Pacientes com catarata submetidos à cirurgia de facoemulsificação isolada (grupo controle) ou associada a Trec (catarata + glaucoma, grupo estudo) foram consecutivamente selecionados. Todas as cirurgias foram feitas seguindo protocolo padrão. Para inclusão, era necessário apresentar biometria calculada pelo biômetro IOL Master (Carl Zeiss, Meditec, Inc), refração e pressão intraocular (Pio) pré e pós-operatórios. Os dados foram comparados entre os grupos, além da correlação entre a variação da Pio e a refração final. Resultados: Foram incluídos 30 olhos por grupo. Na comparação, apenas a Pio prévia (p<0,001), Pio pós cirurgia (p=0,01) e a diferença de Pio pré-pós cirurgia (3,8 ± 4,4mmHg vs. 15,5 ± 9,3mmHg, grupos controle e estudo, respectivamente, p<0,001) foram estatisticamente significativos. Diâmetro axial, dioptria da Lio utilizada, dioptria esperada pela biometria e astigmatismo prévio e pós- cirurgia foram estatisticamente semelhantes entre os grupos (p=0,1; 0,4; 0,4; 0,5 e 0.3, respectivamente). Notou-se previsibilidade esférica pela biometria dentro de 0,25 dioptrias, tanto no grupo controle (variação de 0,06 ± 0,45), quanto no grupo estudo (variação de 0,25 ± 0,97, p=0,3). Não houve significância estatística entre os grupos para a diferença entre o cilindro final e o astigmatismo corneano em dioptrias (p=0,9), e diferença entre o eixo do astigmatismo refracional e corneano (p=0,7). Conclusão: A previsibilidade biométrica e a refração na cirurgia de facoemulsificação aferida pelo biômetro IOL Master é significativa, e não sãoalteradas na cirurgia combinada com trabeculectomia.

Influence of visual field results in the glaucoma diagnosis / Influência dos resultados do campo visual no diagnóstico de glaucoma

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.

Comparison of linear measurements of optic cup-to-disk ratio obtained with RTVue OCT and digital retinography / Comparação entre as medidas lineares da relação escavação/disco óptico obtidas com o OCT RTVue e a retinografia digital

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.

Prospective study comparing mitomycin C or bevacizumab as adjuvant in trabeculectomy revision by needling.

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.

Combined ab externo and ab interno revision of failed filtering blebs with adjunctive mitomycin C.

PURPOSE: To report the results of combined ab externo and ab interno revision with mitomycin C (MMC) of failed filtering blebs in glaucoma patients. METHODS: Glaucoma patients with a failed trabeculectomy who had undergone internal and external revision with MMC in the last 6 years with at least 12 months of follow-up were considered. All study patients followed the same protocol in the operating room: injection of 0.2 mL of MMC (0.4 mg/mL) 2 cm lateral from the bleb followed by internal revision with an iris spatula and external revision with a 26-G × ½" needle. Success was defined as an intraocular pressure (IOP) ≥6 mm Hg and ≤18 mm Hg with (qualified) or without (absolute) any ocular hypotensive drugs. RESULTS: The study included 25 eyes of 22 glaucoma patients. Mean age was 65.2 ± 10.5 years. Mean follow-up was 26.9 ± 10.3 months. The IOP was reduced from 24.5 ± 6.0 mm Hg preoperatively to 10.0 ± 3.3 mm Hg at the last visit (p<0.001). The number of ocular hypotensive medications was reduced from 1.8 ± 1.0 to 0.2 ± 0.6 (p<0.001). There was no change in visual acuity (0.83 ± 0.75 vs 0.83 ± 0.74, p = 0.7). Three patients developed choroidal detachment, another eye had a transient hypotony with maculopathy, and 2 patients developed cataract. Absolute success was achieved in 80% of eyes, and qualified success in 16% of eyes. CONCLUSIONS: Combined ab externo and ab interno revision with MMC can be an effective technique to revitalize failed filtering blebs in glaucoma patients with minimal complications.

Análise da camada de fibras nervosas da retina pela tomografia de coerência óptica em pacientes com anemia falciforme / Evaluation of the retinal nerve fiber layer in sickle cell disease with optical coherence tomography

OBJETIVO: Avaliar a camada de fibras nervosas da retina (CFNR) em pacientes com anemia falciforme sem glaucomaatravés da tomografia de coerência óptica (OCT). MÉTODOS: O estudo selecionou pacientes com anemia falciforme (homozigotos SS), provenientes do ambulatório de hematologia da Universidade Federal de Goiás, e voluntários normais controlados por raça e idade. Para serem incluídos, os integrantes de ambos os grupos deveriam apresentar acuidade visual e" 20/30 sem correção, pressão intraocular (Pio) d" 21mmHg, campo visual SITA Standard 24-2 e disco óptico sem alterações sugestivas de glaucoma. Os pacientes eram encaminhados para exame da CFNR por meio do OCT, estratégia Fast RNFL, e os dados comparados entre os grupos. RESULTADOS: Foram selecionados 24 pacientes (24 olhos) por grupo. A média da idade foi de 25,2 ± 14,9 anos no grupo da anemia falciforme e 20,5 ± 12,5 anos nos pacientes normais (p=0,09). Não houve diferença estatisticamente significativa ao se comparar a espessura média da CFNR entre o grupo de estudo e o grupo controle para todos os quadrantes pesquisados. CONCLUSÃO: O presente estudo não evidenciou lesão da CFNR aferida através da Tomografia de Coerência Óptica em pacientes com anemia falciforme sem alterações oftalmológicas presentes ao exame clínico.

PURPOSE: To evaluate the retinal nerve fiber layer (RNFL) in sickle cell disease with optical coherence tomography (OCT). METHODS:The present study selected patients with sickle cell disease (SS) from the Federal University of Goias, and normalvolunteers, controlled by age and sex. Inclusion criteria for both groups were: visual acuity e" 20/30 without correction, intraocular pressure d" 21mmHg and a reliable and normal 24-2 Sita Standard visual field and optic disc. Thereafter, all subjects were submitted to OCT, Fast RNFL strategy, and the results compared between groups. RESULTS: Twenty-four patients (24 eyes) were included per group. The mean age was 25.2 ± 14.9 years in the sickle cell group and 20.5 ± 12.5 years in the normal subjects (p=0.09). There was no statistically difference in the mean RNFL thickness between both groups in all areas evaluated. CONCLUSION: There was no statistically difference in the mean RNFL thickness measured by OCT between normal individuals and patients with sickle cell disease with normal ophthalmic.

[Comparison of the analgesic effect between 90 mg etoricoxib and dipyrone after exeresis of primary pterygium with conjunctival autograft]. / Comparação do efeito analgésico entre etoricoxib 90 mg e dipirona sódica na exérese de pterígio primário com transplante autólogo de conjuntiva.

PURPOSE: To compare the analgesic effect between dipyrone, 90 mg etoricoxib, and placebo after excision of primary pterygium with conjunctival autograft. METHODS: Prospective, randomized, double-masked clinical trial. Three groups of 26 patients (one eye per patient) were submitted to surgery and received the study drugs for five days after surgery. A scale of pain was used, graduated from zero to ten, for patient evaluation in the first, third and fifth postoperative days. The pain was classified as absent (zero), mild (1 to 3), moderate (4 to 7) and severe (8 to 10). Statistical analysis was performed with the SPSS, version 11.5. RESULTS: A statistically significant difference was found between etoricoxib and dipyrone in the first and third postoperative days (p=0.001 and p=0.01; respectively). Etoricoxib was superior to placebo only in the first postoperative day (p=0.04). There was no significance in the comparison between dipyrone and placebo. CONCLUSIONS: Analgesia of etoricoxib was superior to placebo in the first postoperative day and to dipyrone in the third and fifth days after excision of primary pterygium with conjunctival autograft. There was no significant difference between dipyrone and placebo in all time points.

Comparação do efeito analgésico entre etoricoxib 90 mg e dipirona sódica na exérese de pterígio primário com transplante autólogo de conjuntiva / Comparison of the analgesic effect between 90 mg etoricoxib and dipyrone after exeresis of primary pterygium with conjunctival autograft

OBJETIVO: Comparar o efeito analgésico entre dipirona sódica e etoricoxib 90 mg após exérese de pterígio primário com transplante autólogo de conjuntiva. MÉTODOS: Trata-se de um ensaio clínico prospectivo, randomizado, duplo-mascarado. Três grupos de 26 pacientes (1 olho por paciente) foram operados e receberam as medicações em estudo durante os cinco dias seguintes à cirurgia. Foi utilizada uma escala de dor, numerada de zero a dez, para avaliação pelo paciente no 1É, 3É e 5É dias pós-operatórios. A dor foi classificada em ausente (zero), leve (1 a 3), moderada (4 a 7) e intensa (8 a 10). A análise estatística foi realizada com o software SPSS, versão 11.5. RESULTADOS: Foi observada diferença estatisticamente significativa entre etoricoxib e dipirona no 1É e 3É dia pós-operatório (PO) (p=0,001 e p=0,01; respectivamente). O etoricoxib foi superior ao placebo apenas no 1É PO (p=0,04). Não houve diferença de resultados entre dipirona e placebo. CONCLUSÕES: A analgesia do etoricoxib foi superior à do placebo no PO1 e à da dipirona no PO1 e PO3, na exérese de pterígio primário com transplante autólogo de conjuntiva. Não houve diferença significativa da analgesia pós-operatória entre dipirona e placebo no mesmo procedimento.

Purpose: To compare the analgesic effect between dipyrone, 90 mg etoricoxib, and placebo after excision of primary pterygium with conjunctival autograft. METHODS: Prospective, randomized, double-masked clinical trial. Three groups of 26 patients (one eye per patient) were submitted to surgery and received the study drugs for five days after surgery. A scale of pain was used, graduated from zero to ten, for patient evaluation in the first, third and fifth postoperative days. The pain was classified as absent (zero), mild (1 to 3), moderate (4 to 7) and severe (8 to 10). Statistical analysis was performed with the SPSS, version 11.5. RESULTS: A statistically significant difference was found between etoricoxib and dipyrone in the first and third postoperative days (p=0.001 and p=0.01; respectively). Etoricoxib was superior to placebo only in the first postoperative day (p=0.04). There was no significance in the comparison between dipyrone and placebo. CONCLUSIONS: Analgesia of etoricoxib was superior to placebo in the first postoperative day and to dipyrone in the third and fifth days after excision of primary pterygium with conjunctival autograft. There was no significant difference between dipyrone and placebo in all time points.

Efeitos da ibopamina 2 por cento tópica nos resultados da campimetria visual computadorizada / Effects of 2 percent ibopamine eye drops on computerized visual field results

OBJETIVO: Avaliar os efeitos do uso do colírio de ibopamina a 2 por cento nos resultados da campimetria visual computadorizada em indivíduos normais. MÉTODOS: Voluntários oriundos do CEROF-UFG, sem alterações ao exame oftalmológico que pudessem afetar o campo visual foram selecionados. Os indivíduos foram submetidos a exame de perimetria computadorizada SITA-standard 24-2 antes e após dilatação com o colírio de ibopamina a 2 por cento ou ciclopentolato, com intervalo mínimo de 3 dias entre si e em ordem aleatória. Índices globais e número de pontos alterados foram comparados entre os grupos. RESULTADOS: Foram avaliados 30 olhos de 30 indivíduos normais. Não houve diferença estatisticamente significativa entre o "mean deviation" (MD) nos pacientes não dilatados e nos mesmos após a instilação da ibopamina (MD: -1,05 ± 0,26 dB vs. -1,47 ± 0,20 dB, P=0,08), o que ocorreu após cicloplegia (MD: -3,19 ± 0,29 dB), P<0,001 para ambos. Na avaliação entre cicloplegia e pré-dilatação, nota-se significância para o "pattern standard deviation" (P=0,04), o que não ocorreu na avaliação com ibopamina. O número de pontos alterados no "pattern deviation" não apresentou diferença significativa entre todos os pares. Quanto ao número de pontos do "total deviation", houve diferença estatisticamente significativa antes da dilatação e após o uso do cicloplégico (n: 8,86 ± 1,51 vs. 25,72 ± 2,96 pontos, P<0,001) e entre olhos após a instilação do cicloplégico e da ibopamina (ibopamina: 9,75 ± 1,85 pontos, P<001). CONCLUSÃO: O colírio de ibopamina 2 por cento aparentemente não afeta os resultados da perimetria computadorizada em indivíduos normais.

PURPOSE: To evaluate the influence of 2 percent ibopamine eye drops on the results of computerized visual field exams. METHODS: Normal volunteers from CEROF-UFG were selected, with no variance in the ophthalmologic examination that could affect the visual field test. The volunteers underwent computerized visual field test before and after dilation with 2 percent ibopamine eye drop or cyclopentolate, with a minimum interval of three days between them and in a random order. Global indices and number of altered points were compared between the groups. RESULTS: Thirty eyes of 30 normal individuals were selected. There was no statistically significant difference on Mean Deviation (MD) before and after dilation with ibopamine (MD: -1.05 ± 0.26 dB vs. -1.47 ± 0.20 dB, P=0.08). However, after cycloplegia (MD: -3.19 ± 0.29 dB), there was a significant difference on MD (P<0.001 for both ibopamine and pre-dilation). No significant difference was detected in the Pattern Standard Deviation when comparing ibopamine with pre-dilation and cycloplegia values, but it was statistically significant comparing pre-dilation to cycloplegia (P=0.04). The number of altered points in the Pattern Deviation graphic were not significant comparing all pairs. There was a statistically significant difference in the number of altered points in the total deviation graphic before dilation and after cycloplegia (n: 8.86 ± 1.51 vs. 25.72 ± 2.96 points, P<0.001), and comparing cycloplegia with ibopamine (ibopamine: 9.75 ± 1.85 points, P<0.001). CONCLUSION: Ibopamine 2 percent eye drops seem to not modify the results of visual field tests in normal individuals.

Estudo comparativo entre agulhas de 25 × 0, 70 mm ou 20 × 0, 55 mm para anestesia retrobulbar com baixo volume anestésico em tratamento de catarata por facoemulsificação / Estudio comparativo entre agujas de 25 × 0, 70 mm o de 20 × 0, 55 mm para la anestesia retrobulbar con bajo volumen anestésico en tratamiento de catarata por facoemulsificación / A comparative study between 25 × 0.70 mm and 20 × 0.55 mm needles for retrobulbar block with small volume of anesthetic for the treatment of cataracts by phacoemulsification

JUSTIFICATIVA E OBJETIVOS: Comparar a qualidade e a segurança da anestesia retrobulbar (ARB) para tratamento de catarata por facoemulsificação utilizando agulhas de dois diferentes tamanhos: 25 x 0,70 mm ou 20 x 0,55 mm. MÉTODOS: Seleção prospectiva de candidatos a bloqueio oftálmico para tratamento de catarata por facoemulsificação. Após sedação e monitorização padronizada, foi realizada anestesia retrobulbar (ARB) em punção única ínfero-lateral com 4 mL de ropivacaína 1 por cento, contendo hialuronidase. No Grupo I (GI) a agulha utilizada foi de 25 x 0,70 mm e no Grupo II (GII), de 20 x 0,55 mm. Em um paciente de cada grupo foram realizadas tomografias computadorizadas no momento da realização do bloqueio oftálmico e após cinco minutos da administração da solução anestésica com contraste radiológico. A mobilidade ocular foi avaliada após três, cinco e dez minutos. Por meio de um questionário padronizado, foram comparadas a incidência de complicações entre os grupos, a satisfação dos pacientes e cirurgiões. RESULTADOS: Foram avaliados 54 pacientes adultos (27 por grupo). Nenhum paciente relatou dor ou percepção luminosa intra-operatória. O procedimento anestésico foi considerado muito bom (MB) ou excelente (E) em 96,30 por cento dos casos nos dois grupos. A mesma avaliação foi feita por 100 por cento dos pacientes. Não houve diferença na necessidade de repetição do bloqueio entre os grupos (p = 1,0). O GI apresentou menor mobilidade ocular aos 3 minutos (p = 0,03). Observou-se o posicionamento da agulha em posição retrobulbar intraconal em ambos os grupos. A dispersão anestésica foi similar entre os grupos aos 5 minutos. CONCLUSÃO: A ARB realizada com a agulha de 20 × 0,55 mm, em punção única ínfero-lateral, utilizando baixas doses de anestésicos, se apresenta como uma opção eficaz e segura para tratamento de catarata por facoemulsificação.

BACKGROUND AND OBJECTIVES: The objective of this study was to compare the quality and safety of retrobulbar block for the treatment of cataracts by phacoemulsification using needles of different sizes: 27 × 0.70 mm and 20 × 0.55 mm. METHODS: Candidates for ophthalmic block for the treatment of cataracts by phacoemulsification were selected prospectively. After sedation and standardized monitoring, a retrobulbar block with 4 mL of 1 percent ropivacaine containing hyaluronidase was performed with a single inferolateral puncture. In Group I (GI), the 25 × 0.70 mm needle was used, while in Group II (GII) a 20 × 0.55 mm needle was used. All patients had a CT scan at the time of the blockade and five minutes after the administration of the anesthetic solution with radiologic contrast. Ocular mobility was assessed after three, five, and ten minutes. The incidence of complications in both groups and the satisfaction of patients and surgeons were compared by applying a standardized questionnaire. RESULTS: Fifty-four adult patients were evaluated (27 per group). Patients did not complain of intraoperative pain or perception of light. The anesthetic procedure was considered very good (VG) or excellent (E) in 96.3 percent of the cases in both groups. All patients were subjected to the same assessment. The need of block repetition between both groups did not differ (p = 1.0). Patients in GI showed decreased ocular mobility at 3 minutes (p = 0.03). The intraconal retrobulbar placement of the needle was observed on both groups. Anesthetic dispersion at 5 minutes was similar in the two groups. CONCLUSIONS: Retrobulbar block with a single inferolateral puncture with a 20 × 0.55 mm needle, using low doses of anesthetics, is an effective and safe option for the treatment of cataracts by phacoemulsification.

JUSTIFICATIVA Y OBJETIVOS: Comparar la calidad y la seguridad de la anestesia retrobulbar (ARB) para tratamiento de catarata por facoemulsificación, utilizando agujas de dos diferentes tamaños: 25 x 0,70 mm o de 20 x 0,55 mm. MÉTODOS: Selección prospectiva de candidatos a bloqueo oftálmico para tratamiento de catarata por facoemulsificación. Después de la sedación y monitoreo estandarizado, se realizó anestesia retrobulbar (ARB) en punción única ínfero-lateral con 4 mL de ropivacaina 1 por ciento, con hialuronidasa. En el Grupo I (GI), la aguja utilizada fue de 25 x 0,70 mm y en el Grupo II (GII), de 20 x 0,55 mm. En un paciente de cada grupo fueron realizadas tomografías computadorizadas al momento de la realización del bloqueo oftálmico y después de cinco minutos de la administración de la solución anestésica con contraste radiológico. La movilidad ocular se evaluó después de tres, cinco y diez minutos. A través de un cuestionario estandarizado, se compararon la incidencia de complicaciones entre los grupos, y la satisfacción de los pacientes y de los cirujanos. RESULTADOS: Fueron evaluados 54 pacientes adultos (27 por grupo). Ningún paciente relató dolor o percepción luminosa intraoperatoria. El procedimiento anestésico fue considerado muy bueno (MB) o excelente (E) en un 96,30 por ciento de los casos en los dos grupos. La misma evaluación se hizo en un 100 por ciento de los pacientes. No hubo diferencia en la necesidad de repetición del bloqueo entre los grupos (p = 1,0). El GI presentó menor movilidad ocular a los 3 minutos (p = 0,03). Se observó el posicionamiento de la aguja en posición retrobulbar intraconal en los dos grupos. La dispersión anestésica fue similar entre los grupos a los 5 minutos. CONCLUSIÓN: La ARB realizada con la aguja de 20 x 0,55mm, en punción única ínfero-lateral, utilizando bajas dosis de anestésicos, se presenta como una opción eficaz y segura para el tratamiento de catarata por facoemulsificación.

Ibopamina 2 por cento vs. sobrecarga hídrica como teste provocativo para glaucoma / 2 percent ibopamine vs. water-drinking test as a provocative test for glaucoma

OBJETIVO: Comparar o teste da ibopamina 2 por cento com o teste de sobrecarga hídrica como testes provocativos para glaucoma. MÉTODOS: Pacientes com glaucoma primário de ângulo aberto, e indivíduos normais foram selecionados do CEROF-Universidade Federal de Goiás - UFG, e submetidos, de forma randomizada, e com intervalo mínimo de 1 semana, aos testes provocativos da ibopamina 2 por cento, e sobrecarga hídrica. A pressão intra-ocular (Pio) antes e após os testes, confrontação entre os métodos (gráfico de Bland-Altman) além da melhor relação sensibilidade/especificidade (realizados por meio de curvas ROC) foram obtidos. RESULTADOS: Foram incluídos 47 olhos de 25 pacientes (27 olhos de 15 pacientes com glaucoma e 20 olhos de 10 pacientes normais), com idade média de 54,2 ± 12,7 anos. O MD médio dos pacientes com glaucoma foi de -2,8 ± 2,11 dB. Nos pacientes com glaucoma, não houve diferença estatisticamente significativa na Pio basal (p=0,8), ao passo que se notou diferença na Pio após os testes provocativos (p=0,03), e na variação da Pio após os testes (4,4 ± 1,3 mmHg para ibopamina e 3,2 ± 2,2 mmHg para ingestão hídrica, p=0,01). Nos pacientes normais, não houve diferença estatisticamente significativa entre os grupos para todos os parâmetros avaliados. O gráfico de Bland-Altman mostrou grande dispersão dos resultados. Finalmente, obteve-se áreas abaixo das curvas ROC de 0,987 para o teste da ibopamina e 0,807 para a ingestão hídrica. CONCLUSÃO: O teste provocativo da ibopamina apresentou melhor relação sensibilidade/especificidade que o teste de ingestão hídrica nesse subgrupo selecionado de pacientes com glaucoma com dano perimétrico inicial.

PURPOSE: To compare the 2 percent ibopamine provocative test with the water drinking test as a provocative test for glaucoma. METHODS: Primary open-angle glaucoma patients and normal individuals were selected from CEROF-Universidade Federal de Goiânia UFG, and underwent the 2 percent ibopamine provocative test and the water drinking test in a randomized fashion, at least 1 week apart. Intraocular pressure (IOP) before and after both tests, Bland-Altman graph, sensitivity and specificity (as mesured by ROC curves) were obtained for both methods. RESULTS: Forty-seven eyes from 25 patients were included (27 eyes from 15 glaucoma patients and 20 eyes from 10 normal individuals), with a mean age of 54.2 ± 12.7 years. The mean MD of glaucoma patients was -2.8 ± 2.11 dB. There was no statistically difference in the baseline IOP (p=0.8) comparing glaucoma patients, but positive after the provocative tests (p=0.03), and in the IOP variation (4.4 ± 1.3 mmHg for ibopamine and 3.2 ± 2.2 mmHg for water drinking test, p=0.01). There was no difference in all studied parameters for normal individuals. The Bland-Altman graph showed high dispersion comparing both methods. The areas under the ROC curve were 0.987 for the ibopamine provocative test, and 0.807 for the water-drinking test. CONCLUSION: In this selected subgroup of glaucoma patients with early visual field defect, the ibopamine provocative test has shown better sensitivity/specificity than the water drinking test.