Comparison of anterior segment parameters in patients with pseudoexfoliation glaucoma, patients with pseudoexfoliation syndrome, and normal subjects / Comparação de parâmetros do segmento anterior no glaucoma pseudo-esfoliação, na síndrome de pseudo-esfoliação e em indivíduos normais

ABSTRACT Purpose: To compare the anterior segment parameters of patients with pseudoexfoliation syndrome, patients with pseudoexfoliation glaucoma, and normal subjects. Methods: This prospective, controlled, comparative study included 150 eyes of 150 patients. The patients were divided into the pseudoexfoliation syndrome group, the pseudoexfoliation glaucoma group, and the control group (50 patients in each group). Axial length, central corneal thickness, aqueous depth, anterior chamber depth, lens thickness, K1 and K2 keratometry values, and white to white distance measurements were obtained by optical biometry and compared between the groups. Results: The mean ages of the pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and control patients were 62.18 ± 6.21, 61.80 ± 6.62, and 59.40 ± 6.89 years, respectively. There were no statistically significant differences between the groups in mean age or sex ratio (p>0.05). Mean central corneal thickness was statistically significantly greater, mean aqueous depth and anterior chamber depth were statistically significantly greater, and mean lens thickness was statistically significantly less in the control group than in the pseudoexfoliation syndrome and pseudoexfoliation glaucoma groups (p<0.05). Pairwise comparisons of the pseudoexfoliation syndrome group and the pseudoexfoliation glaucoma group revealed that there were no significant differences between these two groups in central corneal thickness, aqueous depth, anterior chamber depth, and lens thickness (p>0.017). Conclusions: Patients with pseudoexfoliation glaucoma and pseudoexfoliation syndrome had greater lens thickness, shallower aqueous depth and anterior chamber depth, and less central corneal thickness than normal subjects. None of the anterior segment parameters differed between patients with pseudoexfoliation syndrome and patients with pseudoexfoliation glaucoma.

RESUMO Objetivos: Comparar os parâmetros do segmento anterior de casos de síndrome de pseudo-esfoliação, de glaucoma pseudo-esfoliação e de indivíduos normais. Métodos: O presente estudo prospectivo comparativo controlado incluiu 150 olhos de 150 pacientes. Os pacientes foram divididos em três grupos: grupo síndrome de pseudo-esfoliação, grupo glaucoma pseudo-esfoliação e grupo controle (50 em cada grupo). O comprimento axial, a espessura corneana central, a profundidade aquosa, a profundidade da câmara anterior, a espessura da lente, os valores de ceratometria K1 e K2 e as medidas branco a branco, obtidas por biometria óptica, foram comparados entre os grupos. Resultados: As idades médias dos indivíduos do grupo síndrome de pseudo-esfoliação, glaucoma pseudo-esfoliação e controle foram 62,18 ± 6,21, 61,80 ± 6,62 e 59,40 ± 6,89 anos, respectivamente. Entre os grupos, não houve diferenças estatisticamente significativas quanto às idades e ao gênero dos pacientes (p>0,05, para todos). A espessura da córnea central média foi significativamente mais espessa, a profundidade média aquosa e a profundidade da câmara anterior foram significativamente mais profundas e a espessura média da lente foi significativamente mais fina no grupo controle do que nos grupos síndrome de pseudo-esfoliação e glaucoma pseudo-esfoliação (p<0,05, para todos). As comparações por pares do grupo síndrome de pseudo-esfoliação e do grupo glaucoma pseudo-esfoliação (p<0,05, para todos). As comparações por pares do grupo síndrome de pseudo-esfoliação e do grupo glaucoma pseudo-esfoliação não revelaram diferenças significativas entre esses dois grupos quanto à espessura corneana central, à profundidade aquosa, à profundidade da câmara anterior e aos valores de espessura da lente (p>0,017, para cada um). Conclusões: Os casos de glaucoma pseudo-esfoliação e de síndrome de pseudo-esfoliação apresentaram lente mais espessa, menor profundidade aquosa, menor profundidade da câmara anterior e espessura corneana central mais fina do que os indivíduos normais. No entanto, nenhum dos parâmetros do segmento anterior foi diferente entre os indivíduos do grupo síndrome de pseudo-esfoliação e do grupo glaucoma pseudo-esfoliação.

Corneal properties and glaucoma: a review of the literature and meta-analysis / Propriedades da córnea e glaucoma: revisão da literatura e meta-análise

ABSTRACT Purpose: Studies have suggested that corneal biomechanical properties influence intraocular pressure (IOP) measurements, namely central corneal thickness (CCT) and corneal hysteresis (CH). The present study aimed to investigate the associations of CH and CCT with glaucoma development. Methods: We performed a review of the literature and meta-analysis of observational studies (2006-2016) that included both adult glaucoma patients and controls and reported CCT and CH as outcomes. Nineteen studies were conside red eligible, and the mean difference (MD) between groups (patient and control) for both variables was used for statistical analyses. Results: A total of 1,213 glaucoma and 1,055 healthy eyes were studied. Quan titative analysis suggested that CH was significantly lower in the glaucoma group than in the control group (MD=-1.54 mmHg, 95% CI [-1.68, -1.41], P<0.0001). Additionally, CCT was significantly lower in the glaucoma group than in the control group (MD=-8.49 µm, 95% CI [-11.36, -5.62], P<0.001). Conclusion: Corneal properties appear to differ between glaucoma patients and healthy controls. Our results emphasize the importance of corneal biomechanical properties in IOP interpretation and should support further studies on the influence of CH and CCT in glaucoma screening and diagnosis.

RESUMO Objetivo: A literatura sugere que as propriedades biomecânicas da córnea, nomeadamente a espessura central da córnea (ECC) e a histerese corneana (HC), influenciam a medição da pressão intraocular (PIO). Este estudo teve como objetivo investigar a associação entre a ECC e a HC e o desenvolvimento de glaucoma. Métodos: Revisão da literatura e meta-análise. Foram incluídos estudos observacionais, publicados entre 2006 e 2016, que integrassem um grupo controle e um grupo de pacientes com glaucoma em que estes dois grupos apresentassem, igualmente, a ECC e a HC como parâmetros. Dezenove estudos foram considerados elegíveis e a diferença média (MD) daqueles parâmetros nos dois grupos foi utilizada para análise estatística. Resultados: Estudaram-se um total de 1.213 olhos com glaucoma e 1.055 olhos saudáveis. A análise quantitativa revelou que a HC é significativamente mais baixa no grupo de doentes com glaucoma quando comparada com o grupo controle (MD=-1,54 mmHg, intervalo de confiança de 95% [-1,68-1,41], P<0,00001). A ECC foi, também, significativamente mais baixa no grupo glaucoma quando comparada com os indivíduos saudáveis MD=-8,49 µm, intervalo de confiança de 95% [-11,36, -5,62], P<0,001). Conclusão: Os pacientes com glaucoma parecem possuir propriedades corneanas diferentes das que apresentam os indivíduos saudáveis. Os resultados enfatizam a importância das propriedades biomecânicas da córnea na interpretação da PIO e devem contribuir para novos estudos sobre a influência da HC e da ECC no rastreio e diagnóstico do glaucoma.

Fármacos Antiangiogenicos en enfermedades neovasculares de la retina / Antiangiogenic drugs in neovascular retinal diseases

El incremento del factor de crecimiento vascular endotelial (VEGF) en procesos degenerativos, obstructivos e incluso neoplásicos promueve la formación de nuevos vasos sanguíneos aberrantes y perjudiciales para la agudeza visual. En los últimos años, la creación de fármacos antiangiogénicos (anti-VEGF) y su uso intravítreo han revolucionado la terapéutica de las enfermedades neovasculares de la retina incrementando la calidad de vida de las personas que la padecen. El siguiente artículo de revisión narrativa busca analizar la seguridad, eficacia, posología, vía de administración y esquemas internacionales de tratamiento anti-VEGF en la Degeneración Macular Asociada a la Edad (DMAE) Exudativa, Edema Macular Diabético (EMA), Oclusión de la Vena Central de la Retina (OVCR), Oclusión de Rama Venosa de la Retina (ORVR) y en el Retinoblastoma. En la actualidad, el uso de fármacos anti-VEGF representa una elección segura y eficaz en el tratamiento de patologías neovasculares de retina.

An Increased vascular endothelial growth factor in degenerative, obstructive and even neoplastic processes is the main pathophysiological mechanism for the formation of aberrant blood vessels, which are detrimental and put at risk the visual acuity of the individual. In recent years, the creation of antiangiogenic (anti-VEGF) drugs and their intravitreal use have revolutionized the therapy of retinal neovascular diseases and have provided an increase in the quality of life of people suffering from it. The following narrative review article seeks to analyze the safety, efficacy, posology, route of administration and international regimens of anti-VEGF treatment in Exudative Age-Associated Macular Degeneration (AMD), Diabetic Macular Oedema (DME), Occlusion of the Central Retina Vein (CRVO), Retinal Venous Branch Occlusion (BRVO) and Retinoblastoma. The anti-VEGF intraocular therapy represents a safe and effective choice in the treatment of retinal neovascular pathologies.

Choroidal thickness variation in highly myopic eyes during the water drinking test / Variação da espessura de coroide em olhos alto míopes durante o teste de sobrecarga hídrica

ABSTRACT Purpose: To evaluate variations in choroidal thickness (CT) during the water drinking test (WDT) in emmetropic eyes (EE) and highly myopic eyes (ME) using spectral-domain optical coherence tomography (SD-OCT). Methods: Clinical trial performed at a tertiary care hospital comprising 30 randomly selected eyes. The WDT and SD-OCT macular scans were performed 10 and 45 min after water ingestion in 15 myopic and 15 EE of 15 healthy patients in each group. Primary study outcomes were average macular CT measured by SD-OCT and intraocular pressure (IOP) during the WDT. Results: The mean spherical equivalent refraction was 0.15 ± 0.24 D in emmetropic and -7.1 ± 1.75 D in ME (p<0.001). No statistical differences between EE and ME were observed during the WDT response. EE had higher CT compared with ME at the fovea (361.4 ± 55.4 vs 257.9 ± 95.3; p<0.001), 3 mm nasal to the fovea (158.0 ± 71.8 vs 122.5 ± 54.5; p =0.047), and 3 mm temporally to the fovea (310.6 ± 52.4 vs 247.6 ± 90.1; p=0.05). Regarding CT variation, significant differences in foveal CT at 10 min after water ingestion were observed in both EE and ME, with no statistically significant difference observed between groups. A moderate correlation between IOP peak during the WDT and CT was demonstrated in ME (r=0.52; p=0.04). Conclusions: No statistically significant differences in CT variation during the WDT were observed between EE and ME, indicating similar behavior of the choroidal bed during the WDT in both groups. Further, CT was thinner in highly ME, with CT variation unable to explain elevations in IOP observed during the WDT.

RESUMO Objetivo: Avaliar a espessura de coroide (EC) e sua variação durante o teste de sobrecarga hídrica (TSH) em olhos emétropes (EE) e míopes (ME) utilizando a tomografia de coerência óptica Spectral-Domain (SD-OCT). Métodos: Ensaio clinico realizado em um hospital terciário. 30 olhos selecionados randomizadamente, 15 míopes e 15 emétropes de 15 pacientes em cada grupo foram submetidos ao TSH e scans maculares com SD-OCT realizados 10 e 45 minutos após a ingestão de água. Os principais resultados avaliados foram média da EC na região macular pelo SD-OCT e pressão intraocular (PIO) durante o TSH. Resultados: O equivalente esférico médio foi de 0.15 ± 0.24 dioptrias em emétropes e -7,1 ± 1,75 dioptrias nos olhos míopes (p<0,001). Não foram encontradas diferenças estatísticas durante a resposta ao TSH entre EE e ME. EE apresentaram maior EC em comparação com ME, tanto na região foveal (361,4 ± 55,4 vs 257,9 ± 95,3; p<0,001), 3 milímetros nasal à fóvea (158,0 ± 71,8 vs 122,5 ± 54,5; p=0,047) e 3 mm temporal à fóvea (310,6± 52.4 vs 247,6 ± 90,1; p=0,05). Em relação à variação da EC, diferenças estatisticamente significativas foram demonstrados na região foveal, 10 minutos após a ingestão de água em ambos EE e ME, sem diferenças entre os grupos. Moderada correlação entre pico de PIO durante o TSH e EC foi demonstrada em ME ( r=0,52; p=0,04). Conclusão: A diferença na variação da EC provocada pelo TSH não foi estatisticamente diferente entre olhos emétropes e míopes, o que sugere um comportamento semelhante da coroide nestes dois grupos quando submetidos ao TSH. Além disso, a EC é mais fina nos olhos alto míopes, e a variação na EC não explica o aumento da PIO durante o TSH.

Evaluation of posterior ocular changes using enhanced depth imaging-optical coherence tomography in patients with obstructive sleep apnea syndrome / Avaliação das alterações oculares posteriores utilizando tomografia de coerência óptica de profundidade aprimorada em pacientes com síndrome de apneia obstrutiva do sono

ABSTRACT Purpose: Evaluation of the nerve fiber thicknesses of the macula, choroid, and retina using the apnea-hypopnea index in individuals with obstructive sleep apnea syndrome (OSAS) without systemic components. Methods: Prospective, controlled study. The central macular, choroidal, and retinal nerve fiber layer (RNFL) thicknesses were evaluated using enhanced depth imaging-spectral domain optical coherence tomography in individuals with OSAS. In people with severe OSAS who had received treatment, posterior ocular structures were examined over 3 months (4th and 12th weeks), and changes were evaluated. Only the right eyes of the participants were evaluated in the study. Results: A total of 72 people were involved in the study, with 18 in the control group and 19 with mild, 16 with moderate, and 19 with severe OSAS. No significant difference was found among the groups in terms of demographic measures. No significant differences were found among the groups in terms of the measures of central macular, central subfoveal choroidal (CSCT), temporal choroidal, nasal choroidal, and RNFL thicknesses. In severe OSAS cases in which treatment was administered, although subjective clinical recovery was observed, statistically significant thinning was detected during the 3-month follow-up period in the CSCT, general RNFL, as well as in the inferior and superior nasal quadrants, and temporal superior quadrant (p=0.005, p=0.009, p=0.039, p=0.003, and p=0.02, respectively). Conclusion: In the group with severe OSAS, thinning in some posterior ocular tissues was observed. Although patients with severe OSAS may experience clinical recovery, we recommend that they would be followed up in terms of ocular ischemic injury.

RESUMO Objetivo: Avaliação de espessuras das fibras nervosas da mácula, coroide e da retina de acordo com os índices de apnéia e hipopnéia (AHI) em indivíduos com síndrome da apneia obstrutiva do sono (OSAS), sem componentes sistêmicos. Métodos: Estudo prospectivo, controlado. As espessuras centrais maculares, da coroide e da camada de fibras nervosas da retina foram avaliadas tomografia de coerência óptica de domínio espectral de profundidade aprimorada em indivíduos com síndrome da apneia obstrutiva do sono. Em pessoas com OSAS grave a quem foi aplicado o tratamento, estruturas oculares posteriores foram examinados por três meses (4ª e 12ª semanas) e as alterações foram avaliadas. Apenas os olhos direitos dos participantes foram envolvidos no estudo. Resultados: 72 pessoas foram envolvidas no estudo, 18 no grupo controle e, 19 com OSAS leve, 16 com OSAS moderada e 19 com OSAS grave. Não houve diferença significativa entre os grupos em relação às medidas demográficas. Não houve diferenças significativas estavam presentes entre os grupos em termos de medidas de espessura macular central (CMT), espessura subfoveal central da coroide (CSCT), espessura da coroide temporal (TCT), espessura da coroide nasal (NCT) e, a camada de fibras nervosas da retina (RNFL). Em casos de OSAS graves onde o tratamento foi aplicado, apesar de ter sido observada recuperação clínica subjetiva, detectou-se afinamento estatisticamente significativo durante os três meses de acompanhamento, em CSCT, RNFL geral, quadrantes nasais inferior e superior, e quadrante temporal superior (p=0,005, p=0,009, p=0,039, p=0,003, p=0,02). Conclusão: No grupo com OSAS grave, foi observado afinamento em algumas áreas posteriores dos tecidos oculares. Embora os pacientes com OSAS grave possam apresentar recuperação clínica, recomendamos que eles sejam seguidos em termos de lesão isquêmica ocular.

Evaluation of anterior segment parameters in patients with pseudoexfoliation syndrome using Scheimpflug imaging / Avaliação de parâmetros do segmento anterior por imagem Scheimpflug em pacientes com síndrome de pseudoexfoliação

ABSTRACT Purpose: To evaluate anterior segment parameters in patients with pseudoexfoliation syndrome (PXS) using Scheimpflug imaging. Methods: Forty-three PXS patients and 43 healthy control subjects were included in this cross-sectional study. All participants underwent a detailed ophthalmologic examination. Anterior segment parameters were measured using a Scheimpflug system. Results: Considering the PXS and control groups, the mean corneal thicknesses at the apex point (536 ± 31 and 560 ± 31 µm, respectively, p=0.001), at the center of the pupil (534 ± 31 and 558 ± 33 µm, respectively, p=0.001), and at the thinnest point (528 ± 30 and 546 ± 27 µm, respectively, p=0.005) were significantly thinner in PXS patients. Visual acuity was significantly lower (0.52 ± 0.37 versus 0.88 ± 0.23, p<0.001) and axial length was significantly longer (23.9 ± 0.70 mm versus 23.2 ± 0.90 mm, p=0.001) in the PXS eyes than in the control eyes. There were no statistically significant differences in the mean values of keratometry, anterior chamber angle, anterior chamber depth, corneal volume, and anterior chamber volume between the PXS and control eyes. Conclusions: The patients with PXS had thinner corneas, worse visual acuity, and longer axial length compared with those in the healthy controls.

RESUMO Objetivo: Avaliar os parâmetros do segmento anterior em pacientes com síndrome de pseudoexfoliação (PXS) utilizando imagens de Scheimpflug. Métodos: Quarenta e três pacientes com PXS e 43 indivíduos saudáveis foram incluídos neste estudo transversal. Todos os participantes foram submetidos ao exame oftalmológico detalhado. Parâmetros do segmento anterior foram medidos por sistema de Scheimpflug. Resultados: Considerando os grupos PXS e controle, respectivamente, as espessuras médias da espessura corneana no ápice (536 ± 31 µm e 560 ± 31 µm, p=0,001), no centro da pupila (534 ± 31 µm e 558 ± 33 µm, p=0,001), e no ponto mais fino (528 ± 30 µm e 546 ± 27 µm, p=0,005), foram significativamente mais finas em pacientes com PXS. A acuidade visual foi significativamente menor (0,52 ± 0,37 contra 0,88 ± 0,23, p<0,001) e comprimento axial foi significativamente maior (23,9 ± 0,70 milímetros contra 23,2 ± 0,90 milímetros, p=0,001) em olhos com PXS comparados com os olhos controle. Não houve diferenças estatisticamente significativas entre PXS e controle olhos em valores médios de ceratometria, ângulo da câmara anterior, profundidade da câmara anterior, volume da córnea e volume de câmara anterior. Conclusões: Os pacientes com PXS tem córneas mais finas, pior acuidade visual, e maior comprimento axial em comparação com controles saudáveis.

Apoptosis y necroptosis en las enfermedades oftalmológicas / Apoptosis and necroptosis in ocular deseases

La apoptosis es un término relativamente reciente mediante el cual se denomina a un tipo de muerte celular programada, que se encuentra ligada a diferentes procesos patológicos (cáncer, enfermedades inflamatorias y degenerativas). Actualmente se considera otro tipo de muerte celular no programada, que es la necrosis, la cual ocurre por mecanismos no modulados y se menciona una variedad de esta última: la necroptosis. Ambos procesos (apoptosis y necroptosis) se encuentran presentes en la fisiopatología de algunas enfermedades oftalmológicas, lo que nos motivó a realizar una revisión bibliográfica renovada acerca del tema, con el objetivo de acrecentar el conocimiento sobre el tema y su relación con algunas enfermedades oftalmológicas en las que participan. Se revisaron textos básicos de Oftalmología y se localizaron artículos sobre el tema de los últimos 5 años a través Google como motor de búsqueda, el directorio LILACS y la consulta de las bases de datos PubMed y Hinari. Aún queda mucho por recorrer en el estudio de estos procesos que ocurren a nivel celular y que en ocasiones solo se han podido constatar a través de estudios de laboratorio y con modelos de animales. Su mayor comprensión puede constituir una vía para el surgimiento de nuevas terapéuticas antiapoptóticas y antinecroptóticas(AU)

Apoptosis is a relatively recent term to define a process of programmed cellular death related to different pathological processes (cancer, inflammatory and degenerative diseases). There is currently another process of non-programmed cellular death named necrosis, which occurs through non-modulated mechanisms and a variety is called necroptosis. Both processes (apoptosis and necroptosis) can be found in the physiopathology of some ophthalmological disorders, which prompted us to carry out an updated literature review on this topic. The objective was to increase the amount of knowledge on the topic and its relation to some of the ophthalmological disorders in which it is involved. Basic texts of ophthalmology were reviewed and articles published in the last five years were tracked down using Google as search engine, the LILACS directory and the consultation of the PubMed and Hinari databases. There is still much to be studied on these processes that take place at the cell level and that have only been verified through lab studies and with animal models. Better understanding of this process may pave the way for the emergence of new anti-apoptosis and anti-necroptosis therapies(AU)

Correlations between different tonometries and ocular biometric parameters in patients with primary congenital glaucoma / Correlações entre diferentes tonometrias e parâmetros biométricos oculares em pacientes com glaucoma congênito primário

PURPOSE: To identify the correlation between the difference of intraocular pressure measurements (IOP) obtained using the Goldmann applanation tonometer (GAT) and three others tonometers (Handheld applanation tonometer - HAT, Dynamic contour tonometer - DCT and Tono-Pen®) with biometric characteristics (corneal diameter, pachymetry, keratometry and axial length) in patients with congenital glaucoma. METHODS: A cross-sectional study was performed on 46 eyes from 46 patients with congenital glaucoma. IOP measurements were obtained in all patients using GAT, HAT, DCT and Tono-Pen®. Keratometry, pachymetry, biometry and corneal diameter measurements were performed after the IOP measurement. The order of the tonometries was randomized. The correlations between the differences of IOP values of GAT and the other tonometers (Delta-IOP), and the different biometric parameters were studied. RESULTS: Tono-Pen® Delta IOP revealed moderate positive correlation to keratometry (r=0.41, p=0.004). The other Delta-IOPs showed no correlation with any of the biometric characteristics evaluated. CONCLUSIONS: IOP differences between GAT (gold standard) and GAT, HAT, DCT or Tono-Pen tonometers seem not to correlate with majority of ocular biometric characteristics. The only exception was the keratometry, which correlated in a positive and moderate way with Tono-Pen® Delta-IOP. This result suggests that the differences of IOP values of Tono-Pen® and GAT increase with the steepness of the cornea.

OBJETIVOS: Identificar correlações entre as diferenças de medições de pressão intraocular (IOP) obtidas usando o tonômetro de aplanação de Goldmann (GAT) e três outros tonômetros (Tonômetro portátil de aplanação - TPA, Tonômetro de contorno dinâmico - TCD e Tono-Pen®) com características biométricas (diâmetro corneano, paquimetria, ceratometria e comprimento axial) em pacientes com glaucoma congênito. MÉTODOS: Estudo transversal prospectivo foi realizado em 46 olhos de 46 pacientes com glaucoma congênito. As medidas de pressão intraocular foram obtidas em todos os pacientes utilizando TAG, TPA, TCD e Tono-Pen®. Ceratometria, paquimetria, biometria e diâmetro corneano foram realizadas após mensuração da pressão intraocular. A ordem da utilização tonômetros foi aleatória. Correlações entre as diferenças de valores de PIO entre cada um dos três tonômetros (PIOs Delta) e o tonômetro de Goldmann e as características biométricas foram analisadas. RESULTADOS: PIO Delta do Tono-Pen®revelou correlação positiva moderada com ceratometria (r=0,41, p=0,004). As outras PIOs Delta não se correlacionaram significativamente com nenhuma das características biométricas. CONCLUSÕES: As diferenças entre as PIOs obtidas pelo TAG (padrão ouro) e TPA, TCD e Tono-Pen®parece não se correlacionar com a maioria das características biométricas. A única exceção foi a ceratometria, a qual se correlacionou de forma positiva e moderada com a PIO Delta do Tono-Pen®. Estes resultados indicam que o aumento da diferença entre a PIO obtida com TAG e Tono-Pen®aumenta com o encurvamento da curvatura corneana.

A Formula to Predict Spectral Domain Optical Coherence Tomography (OCT) Retinal Nerve Fiber Layer Measurements Based on Time Domain OCT Measurements

PURPOSE: To establish and validate a formula to predict spectral domain (SD)-optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness from time domain (TD)-OCT RNFL measurements and other factors. METHODS: SD-OCT and TD-OCT scans were obtained on the same day from healthy participants and patients with glaucoma. Univariate and multivariate linear regression relationships were analyzed to convert average Stratus TD-OCT measurements to average Cirrus SD-OCT measurements. Additional baseline characteristics included age, sex, intraocular pressure, central corneal thickness, spherical equivalent, anterior chamber depth, optic disc area, visual field (VF) mean deviation, and pattern standard deviation. The formula was generated using a training set of 220 patients and then evaluated on a validation dataset of 105 patients. RESULTS: The training set included 71 healthy participants and 149 patients with glaucoma. The validation set included 27 healthy participants and 78 patients with glaucoma. Univariate analysis determined that TD-OCT RNFL thickness, age, optic disc area, VF mean deviation, and pattern standard deviation were significantly associated with SD-OCT RNFL thickness. Multivariate regression analysis using available variables yielded the following equation: SD-OCT RNFL = 0.746 x TD-OCT RNFL + 17.104 (determination coefficient [R2] = 0.879). In the validation sample, the multiple regression model explained 85.6% of the variance in the SD-OCT RNFL thickness. CONCLUSIONS: The proposed formula based on TD-OCT RNFL thickness may be useful in predicting SD-OCT RNFL thickness. Other factors associated with SD-OCT RNFL thickness, such as age, disc area, and mean deviation, did not contribute to the accuracy of the final equation.

The Effect of Axial Length on the Variability of Stratus Optical Coherence Tomography

PURPOSE: To evaluate the effect of axial length on the variability of retinal nerve fiber layer (RNFL) thickness measurements using the Stratus optical coherence tomography (OCT) in normal and glaucomatous eyes. METHODS: We measured the RNFL thickness in 474 subjects using the Stratus OCT twice during the same day. Axial length was measured with the IOLMaster, and refractive error was the absolute value of the spherical equivalent measured with an auto ref-keratometer. Standard deviation in overall mean RNFL thickness was used as the dependent variable to identify significant correlations. RESULTS: Long axial length affected the variability in the RNFL thickness value by stratus OCT at the temporal quadrant (p = 0.006) and clock-hour sector 9 (p = 0.001). Refractive error also affected the variability of the RNFL thickness value by stratus OCT at the temporal quadrant (p = 0.025) and clock-hour sector 9 (p = 0.024). CONCLUSIONS: It is clinically significant that longer axial length demonstrates greater variability in temporal area as detected by OCT, a measurement which correlates with the preferably damaged position in the myopic glaucoma eye.

The Effect of Various Factors on Variability of Retinal Nerve Fiber Layer Thickness Measurements Using Optical Coherence Tomography

PURPOSE: To evaluate the effects of various factors on the variability of retinal nerve fiber layer (RNFL) thickness measurements using the Stratus optical coherence tomography (OCT) in normal and glaucomatous eyes. METHODS: Four hundred seventy-four subjects (103 normal eyes and 371 glaucomatous eyes) were scanned to determine the RNFL thickness measurements using the Stratus OCT. Measurements were obtained twice during the same day. The standard deviation (SD) was used to compare the variability in RNFL thickness measurements of the normal subjects to that of the glaucomatous patients. Multivariate regression analysis was used to evaluate which covariates were independent predictors of SD in overall mean RNFL thickness. RESULTS: The mean SD of all RNFL thickness measurements was larger in the glaucoma group except in one sector. In the multivariate regression analysis, the average signal strength (SS) and the relative SS change (difference in SS between initial and repeat scans, divided by initial SS) were independent predictors of the SD in the RNFL thickness measurements (partial R2 = 0.018, 0.013; p = 0.016, 0.040, respectively). CONCLUSIONS: Glaucomatous eyes tend to be more variable than normal eyes in RNFL thickness measurement using the Straus OCT. The average SS and the relative SS changes appear to correlate with the variability in RNFL thickness measurement. Therefore, the results of the RNFL analysis should not be interpreted independently of these factors.

Ability of spectral domain optical coherence tomography peripapillary retinal nerve fiber layer thickness measurements to identify early glaucoma.

Purpose: To evaluate the ability of spectral domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness (RNFLT) parameters to distinguish normal eyes from those with early glaucoma in Asian Indian eyes. Design: Observational cross-sectional study. Materials and Methods: One hundred and seventy eight eyes (83 glaucoma patients and 95 age matched healthy subjects) of subjects more than 40 years of age were included in the study. All subjects underwent RNFLT measurement with spectral OCT/ scanning laser ophthalmoscope (SLO) after dilatation. Sensitivity, specificity and area under the receiving operating characteristic curve (AROC) were calculated for various OCT peripapillary RNFL parameters. Results: The mean RNFLT in healthy subjects and patients with early glaucoma were 105.7 ± 5.1 μm and 90.7 ± 7.5 μm, respectively. The largest AROC was found for 12 o’clock- hour (0.98), average (0.96) and superior quadrant RNFLT (0.9). When target specificity was set at ≥ 90% and ≥ 80%, the parameters with highest sensitivity were 12 o’clock -hour (91.6%), average RNFLT (85.3%) and 12 o’ clock- hour (96.8 %), average RNFLT (94.7%) respectively. Conclusion: Our study showed good ability of spectral OCT/ SLO to differentiate normal eyes from patients with early glaucoma and hence it may serve as an useful adjunct for early diagnosis of glaucoma.

Inflammatory glaucoma

Glaucoma is seen in about 20% of the patients with uveitis. Anterior uveitis may be acute, subacute, or chronic. The mechanisms by which iridocyclitis leads to obstruction of aqueous outflow include acute, usually reversible forms [e.g., accumulation of inflammatory elements in the intertrabecular spaces, edema of the trabecular lamellae, or angle closure due to ciliary body swelling] and chronic forms [e.g., scar formation or membrane overgrowth in the anterior chamber angle]. Careful history and follow-up helps distinguish steroid-induced glaucoma from uveitic glaucoma. Treatment of combined iridocyclitis and glaucoma involves steroidal and nonsteroidal anti-inflammatory agents and antiglaucoma drugs. However, glaucoma drugs can often have an unpredictable effect on intraocular pressure [IOP] in the setting of uveitis. Surgical intervention is required in case of medical failure. Literature on the Medline database was searched using the PubMed interface

Comportamiento de la visión de color en pacientes sospechosos de glaucoma y glaucomatosos como daño precoz de las células ganglionares de la retina / Colour vision of patients suspected of and diagnosed with glaucoma as an early damage of ganglionary cells of the retina

Se realizó un estudio descriptivo y analítico en 60 pacientes (sospechosos de glaucoma y con diagnóstico de glaucoma crónico simple estadio inicial) que concurrieron a la consulta de Oftalmología del Hospital Militar Central Dr Carlos J Finlay en el período comprendido entre los años 2003 y 2006. La muestra se conformó con 30 pacientes con sospecha de glaucoma y 30 con diagnóstico de glaucoma que cumplieron los requisitos de inclusión y exclusión. Los primeros 30 pacientes de cada grupo que fueron atendidos durante ese período fueron los seleccionados. Se les aplicaron diferentes test para evaluar la visión de colores, como daño precoz de las células ganglionares de la retina. Se consideró sospechoso de glaucoma todo paciente que tuviese al menos tres de los más importantes factores de riesgos (HTO, edad mayor de 40 años, raza negra y antecedentes familiares de primer grado que padezcan la enfermedad). Se diagnosticó como glaucomatoso aquel paciente que presentó síntomas y signos de la enfermedad y alteraciones incipientes del campo visual (aumento mancha ciega, escalón nasal o escotoma Seidel). También se utilizó en el estudio una muestra de 31 sujetos supuestamente sanos de la investigación realizada en el Hospital Hermanos Ameijeiras bajo las mismas condiciones de exploración como grupo control -que se tituló Estudio de la visión cromática en una población sana. El método de evaluación de los pacientes consistió en un examen inicial oftalmológico donde se recogieron sus datos generales paciente, síntomas y signos clínicos hallados, así como factores de riesgo de la enfermedad. Se constató que los sujetos sanos no presentaban alteraciones en relación con los colores y que los sospechosos y glaucomatosos sí las presentaron en un índice significativo.

A descriptive analytical study of 60 patients suspected of glaucoma and diagnosed with simple chronic glaucoma at initial stage, who went to the Ophtalmology service of Dr Carlos J Finlay Military Hospital in the period from 2003 to 2006. The sample covered 30 patients suspected of and 30 patients diagnosed with glaucoma that fulfilled inclusion and exclusion requirements. The first 30 patients of each group seen in that period were selected. Several tests were apppied to evaluate colour vision, as an early damage in ganglionary cells of the retina. Every patient having at least three important risk factors (high blood pressure, age over 40 years, black race and family history of first degree relatives suffering the dissease) was considered suspect of having glaucoma. The patients were diagnosed as glaucomatous when they presented with symptoms and signs of the disease and incipient alterations of the visual field (increase of blind stain, nasal step or Seidel scotoma). This study also used a sample of 31 supposedly healthy subjects, who had participated as control group under the same exploratory conditions in a prior research study at Hermanos Ameijeiras hospital. The title of that research was Study of chromatic vision in a healthy population. The evaluation method consisted of an initial ophthalmological exam where general data, clinical symptoms and signs as well as risk factors were collected. It was observed that healthy subjects did not present alterations in relation to colours and that individuals suspected of and diagnosed with glaucoma did have a significant index.

Central corneal thickness and intraocular pressure in Puerto Rican glaucoma patients

OBJECTIVE: To compare the variations in central corneal thickness and intraocular pressure measurements according to race, gender, and age. METHODS: A non-concurrent prospective study of 372 (744 eyes) glaucoma patients was conducted. Central corneal thickness was measured with ultrasound pachymeter and intraocular pressure with Goldmann tonometer. The relationship between CCT, race, gender, and age was evaluated using both descriptive and statistical analysis. RESULTS: The population age was 64 +/- 19.52 years. The mean central corneal thickness was 546 +/- 43.84 microm. The mean corrected intraocular pressure was 17 +/- 5.26 mm Hg. Central corneal thickness of male patients (549 +/- 43.43 pm) was thicker than that of female patients (546 +/- 41.83 microm). The mean corrected intraocular pressure in male patients (16 +/- 5.41 mm Hg) was less than that of female patients (17 +/- 5.18 mm Hg). The mean central corneal thickness in patients 0 to 9 years-of-age was 548 +/- 36.08 microm; 10 to 19 years-of-age was 606 +/- 82.30 microm; 20 to 29 years-of-age was 564 +/- 29.23 microm; 30 to 39 years-of-age was 579 +/- 15.32 microm; 40 to 49 years-of-age was 546 +/- 48.29 microm; 50 to 59 years-of-age was 550 +/- 38.12 mirom; 60 to 69 years-of-age was 545 +/- 40.22 microm; 70 to 79 years-of-age was 541 +/- 34.71 microm; 80 to 89 years-of-age was 541 +/- 34.05 microm; older than 90 years-of-age was 527 +/- 46.90 microm. CONCLUSIONS: Central corneal thickness of glaucoma patients in Puerto Rico was similar to that of Hispanics in the continental United States. However, the intraocular pressure and corrected intraocular pressure of glaucoma patients in Puerto Rico were statistically higher than that of Hispanics with glaucoma in the continental United States. In our study population, central corneal thickness and intraocular pressure were not affected by gender or age.

Histopathological analysis of 150 enucleated eyes.

Enucleation or complete removal of eye is considered to be a mainstay of therapy for many end-stage diseases of eye. We aimed to determine the frequency and indications for enucleations perfomed at a tertiary care hospital in eastern India. A total of 150 enucleated eyes from 146 patients were analyzed. The formalin fixed paraffin embedded sections of all enucleated eyes were examined microscopically and histopathological analysis was done. In the present series, malignant tumours were most frequent indication of enucleation (64%) followed by ocular inflammation (14.7%), staphyloma (6.7%), trauma (5.3%), painful blind eye due to glaucoma (4%). Retinoblastoma, a malignant tumour emerged as commonest indication (52%). Three major indications for enucleation were malignant tumours, ocular inflammation and staphyloma altogether 92%. Malignant melanoma though commonest ophthalmic tumour requiring enucleation in many parts of the world was not very common in our studies comprising 18.7% of all malignant tumours.

The Relationship between Optical Coherence Tomography and Scanning Laser Polarimetry Measurements in Glaucoma

PURPOSE: To investigate the relationship between optical coherence tomography (OCT) and scanning laser polarimetry (SLP) in measuring peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous eyes. METHODS: Fifty glaucomatous eyes were evaluated in this study. Evaluations were analyzed two ways. First, parameters of the Stratus OCT (average thickness, superior/ inferior average) and GDx VCC (TSNIT average, nerve fiber indicator (NFI), superior/ inferior average) were correlated using the Pearson's correlation coefficient (r). Secondly, comparison (r) of these parameters was completed using the mean deviation (MD) of visual field defect. RESULTS: The following parameters were found to be significantly correlated (P<0.005). TSNIT average/average thickness (r=0.673), NFI/average thickness (r=-0.742), superior average (r=0.841), and inferior average (r=0.736). In the correlation analysis using the severity of visual field defect, all these parameters had statistically meaningful correlations (P<0.005). CONCLUSIONS: GDx VCC and Stratus OCT are highly correlated in glaucomatous eyes. Therefore, peripapillary RNFL thickness measured by Stratus OCT and GDx VCC may be equally helpful in the diagnosis of glaucoma.

Glucagonoma una evalución estadística de 136 casos reportados en la literatura: informe de un caso / Glucagonoma a statistical evaluation of 136 reported cases of the literature: case presentation

Conocer las principales características clínico-patológicas del glucagonoma, mediante la realización de un estudio descriptivo. Se revisaron artículos publicados en la literatura internacional referente a la patología, que abarcaron un período de 25 años (1979 – 2004), de los cuales se seleccionaron 135 casos, a estos se les sumó un caso examinado por el grupo de investigadores. La edad promedio del estudio general fue de 53.08 años; donde 58.82 por ciento de los pacientes eran hombres y 41.18 por ciento mujeres. El grupo etario predominante fue el de 50 a 59 años que representó 29.41 por ciento de la población total en estudio. Entre las principales características clínicas tenemos que 64.71 por ciento de los pacientes presentaron eritema migratorio necrolítico, 48.53 por ciento pérdida de peso y 43.38 por ciento diabetes mellitus, 6.62 por ciento de los casos fue asintomático. La ubicación más frecuente fue a nivel de la cola del páncreas con 41.91 por ciento. El 9.56 por ciento se encontró asociado a neoplasia endocrina múltiple tipo I (MEN – I). El Glucagonoma es una entidad clínico-patológica inusual, asociada a tumor de las células alfa 2 de los islotes pancreático que secreta excesiva cantidad de glucagón. Está caracterizado por: eritema migratorio necrolítico, diabetes mellitus, pérdida de peso, anemia normocítica y normocrómica, hipoaminoacidemia, trombosis venosa, entre otros. Localizado más frecuentemente en la cola del páncreas. Se presenta típicamente en la quinta década de vida; aunque estudios previos reportaron ser más frecuente en el sexo femenino, en nuestro estudio no se observó esta tendencia

Optic Nerve Head Topographic Measurements and Retinal Nerve Fiber Layer Thickness in Physiologic Large Cups

PURPOSE: To evaluate the parameters of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in patients with large cup/disc ratio (CDR) and normal neuroretinal rim configuration who have normal perimetry (physiologic large cups, LC) and to compare these parameters with those of the normal and early glaucoma patients. METHODS: Using Heidelberg retinal tomography (HRT) and optical coherence tomography (OCT), 30 patients with LC, 29 normal subjects, and 31 early glaucoma patients were examined. One eye from each subject was randomly selected. RESULTS: Significant differences between LC and glaucomatous eyes (GE) were found in parameters indicating loss of nerve fibers, such as rim area, rim volume, and mean RNFL thickness. However, there was no difference between LC and normal eyes (NE) in RNFL thickness, rim area, and rim volume. LC was able to be defined as a normal central excavation with a large disc and large CDR with a normal rim area. CONCLUSIONS: HRT ONH parameters and RNFL thickness obtained with OCT may be useful for differentiating between glaucoma and LC eyes.

Estudo do comportamento da pressão intra-ocular em pacientes diabéticos, hipertensos e normais (Projeto Glaucoma) / Analysis of the intraocular pressure in diabetes hypertensive and normal patients (Glaucoma Project)

Objetivo: Analisar os valores da pressão intra-ocular (PIO) entre diferentes grupos de pacientes (diabéticos, hipertensos com ou sem retinopatia) e a população normal. Métodos: Realizou-se a aferição da pressão intra ocular (PIO) em um total de 924 olhos de 482 pacientes com idade igual ou maior que 40 anos (x=56,70;dp=11,89) examinados segundo um protocolo de estudo que incluiu medida da PIO, pressão arterial e glicemia, além da fundoscopia. A determinação da PIO foi obtida pelo tonômetro de aplanação de "Goldmannn" e a glicemia foi aferida por meio de tiras reativas (Destrostix-Bayer). Em seguida os pacientes foram divididos em 7 (sete) grupos: hipertensos, hipertensos com retinopatia, diabéticos, diabéticos com retinopatia, hipertensos e diabéticos, hipertensos e diabéticos com retinopataia e a população controle.

Purpose: To correlate the values of intraocular pressure (IOP) obtained by applanation tonometer (Haag-Streit, Bern, Switzerland) in patients with diabetes mellitus (with or without diabetic retinopathy), hypertension (with or without hypertensive diabetic retinopathy) and the normal population. Patients and Methods: Subjects participating in the Glaucoma Project (n = 924, 40 or more years old) were examined according to standard protocols including IOP measurement, fundoscopy, blood pressure and glucose determination. Patients were divided into seven groups: diabetic patients without diabetic retinopathy, hypertensive patients without hypertensive retinopathy, diabetic hypertensive patients without retinopathy, diabetic patients with diabetic retinopathy, hypertensive patients with hypertensive retinopathy, diabetic hypertensive patients with retinopathy and population-based control. Results: Applying the one-way ANOVA test to a normal distribution at 5% significance, it was observed that IOP values were higher in the groups of hypertensive patients without retinopathy (mean = 16.10), hypertensive patients with hypertensive retinopathy (mean = 16.33) and diabetic hypertensive patients with retinopathy (mean = 16.95) when compared with the other groups. Conclusion: The mean IOP value increases progressively with the evolution of systemic hypertensive disease and when it is associated with diabetes.