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Introducción: El glaucoma es una de las entidades nosológicas con mayor prevalencia y constituye una de las principales causas de ceguera en el mundo desarrollado. La presión intraocular es el único factor de riesgo que puede ser controlado y se asocia a la presencia y progresión de la enfermedad. Objetivo: Describir la evolución de pacientes operados mediante la técnica de trabeculectomía. Métodos: Se realizó un estudio observacional descriptivo, longitudinal y prospectivo de 128 pacientes con glaucoma crónico simple operados mediante la técnica de trabeculectomía en el Centro Oftalmológico de Santiago de Cuba, desde enero del 2017 hasta junio del 2019. Para ello, se analizaron las siguientes variables: edad, sexo, color de piel, agudeza visual preoperatoria y posoperatoria, presión intraocular antes y después de la operación, así como complicaciones posoperatorias. Resultados: Predominaron el sexo masculino (69,5 %), el grupo etario de 60-69 años (44,5 %) y el color de la piel negro (53,1 %). La hipertensión arterial fue la enfermedad asociada con más frecuencia y la hipertensión ocular, el factor de riesgo fundamental; en tanto, la complicación posoperatoria principal fue el hipema. Conclusiones: Con la trabeculectomía se logró controlar la tensión ocular en la mayoría de los pacientes y las complicaciones que se presentaron en algunos de ellos no interfirieron en su evolución. Esta técnica permitió disminuir el daño irreversible que provoca la hipertensión ocular del nervio óptico y, por consiguiente, prevenir la ceguera.
Introduction: Glaucoma is one of the nosologic entities with more prevalence and constitutes one of the main causes of blindness in the developed world. The intraocular pressure is the only risk factor that can be controlled and is associated with the presence and progression of the disease. Objective: To describe the evolution of patients operated by means of trabeculectomy technique. Methods: An observational descriptive, longitudinal and prospective study of 128 patients with simple chronic glaucoma operated by means of trabeculectomy technique was carried out in the Ophthalmology Center of Santiago de Cuba, from January, 2017 to June, 2019. For this purpose, the following variables were analyzed: age, sex, skin color, preoperative and postoperative visual acuteness, intraocular pressure before and after the operation, as well as postoperative complications. Results: There was a prevalence of male sex (69.5%), 60-69 age group (44.5%) and black skin color (53.1%). Hypertension was the most frequent associated disease and the ocular hypertension was the fundamental risk factor; meanwhile, the main postoperative complication was the hyphema. Conclusions: With trabeculectomy was possible to control ocular tension in most of the patients and the complications that were presented in some of them did not interfere in their clinical course. This technique made it possible to reduce the irreversible damage caused by ocular hypertension of the optic nerve and, consequently, to prevent blindness.
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Glaucoma is one of the leading causes of vision loss worldwide. More and more studies have suggested that glaucoma is a complicated retinal neurovascular disease. The homeostasis imbalance of retinal neurovascular unit(RNVU)composed of neurons, glial cells and microvascular cells not only induces changes in microvascular structure and glial cells, but also affects the nerve tissue of the retina, resulting in vision loss, which there is no effective treatment to reverse, currently. Exploring the cellular composition and molecular structure of RNVU and investigating the destruction mechanism of normal cellular environment and intercellular connections in glaucoma are of great significance in exploring the pathogenesis and the treatment of glaucoma. The research progress on structural changes and dysfunction of RNVU in glaucoma are reviewed, hoping to provide new ideas for the treatment of glaucoma.
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AIM: To investigate the application of biological amniotic membrane soaked in pirfenidone(PFD)and to evaluate its anti-scarring effect and toxic side effects on glaucoma model of rabbit eyes.METHODS: The right eyes of 72 healthy New Zealand white rabbits were randomly divided into 0.5%PFD+ biological amniotic membrane group, biological amniotic membrane group, mitomycin C(MMC)group and blank control group after the glaucoma model was established by anterior chamber injection of compound carbomer solution, and 18 rabbits in each group underwent trabeculectomy, in which the 0.5% PFD+ biological amniotic membrane group was placed with 0.5% PFD solution-soaked biological amniotic membrane under the scleral flap, and the biological amniotic membrane group was placed with normal saline-soaked rehydrated biological amniotic membrane under the scleral flap. In the MMC group, a cotton pad soaked in MMC was placed under the scleral flap for 3 min and immediately rinsed with normal saline, while the blank control group received no implant after the scleral flap was made. The intraocular pressure(IOP), filtration blebs, toxic side effects and complications were evaluated, and the histopathological changes in the filtration area were observed by hematoxylin-eosin(HE), Masson staining and immunohistochemical staining.RESULTS: The mean IOP at 14, 21 and 28 d after trabeculectomy were 0.5%PFD+ biological amniotic membrane group<MMC group<biological amniotic membrane group<blank control group(all P<0.05). At 28 d after trabeculectomy, 0.5%PFD+ biological amniotic membrane group had the best effect of anti-inflammatory hyperplasia and inhibition of collagen formation, the highest survival rate of filtration blebs, and the inflammatory reaction was mild.CONCLUSION: Biological amniotic membrane soaked in pirfenidone has more obvious anti-scarring effect on glaucoma model, with less toxic side effects and good safety.
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AIM: To investigate the characteristics of anterior segment structure in first-degree relatives of patients with primary angle-closure glaucoma(PACG).METHODS: A total of 48 first-degree relatives of PACG patients aged 40-60 who were treated in the Affiliated Eye Hospital of Nanchang University from September 2020 to October 2022 were selected as the observation group. Additionally, 40 cases(40 eyes)of healthy individuals without glaucoma and family history of glaucoma at the same age group were collected as the control group. They were divided into younger group(40-49 years old)and elder group(50-60 years old). All subjects were examined with ultrasound biomicroscopy(UBM)and were measured using camera measure software. The parameters mainly included anterior chamber depth(ACD), anterior chamber area(ACA), anterior chamber width(ACW), anterior segment depth(ASD), angle open distance(AOD500), trabecular iris angle(TIA), trabecular iris area(TISA500), lens vault(LV), iris curve(IC), iris thickness(IT500), scleral ciliary process angle(SCPA), and iris ciliary process distance(ICPD).RESULTS: ACD, ACA, AOD500, TISA500 and TIA in the observation group were lower than those of the control group, and LV and IC were higher than those of the control group(all P<0.05). ACD, ACA, AOD500, TISA500, and TIA of the elder group were lower than those in the age-matched control group, while LV and IC were larger than those of the age-matched control group(all P<0.05). ACD, AOD500, TISA500, and TIA of the younger observation group were smaller than those of the age-matched control group, but LV and IC were significantly larger than those of the age-matched control group(all P<0.05). ACD, ACA, AOD500, TISA500 and TIA of the elder observation group were significantly lower than those of the younger observation group, and LV and IC were significantly larger than those of the younger observation group(all P<0.05). There was a difference in the distribution of ACD between the observation group and the control group(P<0.05), and the proportion of moderate to severe shallow anterior chambers was 10 times that of the control group. Correlation analysis showed that TISA500 was positively correlated with ACD and ACA, and negatively correlated with LV and IC, and TISA500 was mainly influenced by LV. IC had a positive correlation with LV and a negative correlation with ACD and ACA.CONCLUSION: First-degree relatives of PACG with normal axial length have a high risk of angle closure. The anterior segment structures of first-degree relatives of PACG are more crowded than normal individuals, and the lens forward shift may be the initial influencing factor for narrow angle.
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AIM: To explore the dynamic expression of high mobility group box 1(HMGB1)in scar tissues after glaucoma drainage valve implantation, and to further reveal the role and possible mechanism of HMGB1 in scarring after glaucoma surgery.METHODS: A total of 60 New Zealand white rabbits were randomly divided into control group(n=20), model group(n=20, silicone implantation under conjunctival sac)and model with drug administration group(n=20, silicone implantation under conjunctival sac combined with 5-fluorouracil injection). The conjunctival tissues were collected at 4 and 8 wk after surgery. HE staining and Masson staining were used to detect the proliferation and distribution of fibroblasts and collagen fibers in conjunctival tissues. Immunohistochemistry was utilized to detect the distribution and changes of HMGB1, transforming growth factor(TGF)-β1, Smad3 and α-smooth muscle actin(SMA)in conjunctival tissues. RT-PCR and Western blot were adopted to detect the mRNA and protein expression of HMGB1, TGF-β1, Smad3 and α-SMA in conjunctival tissues.RESULTS: HE staining and Masson staining showed that the proliferation of inflammatory cells, fibroblasts and collagen fibers in the model group was significantly higher than that in the control group at both 4 and 8 wk. Meanwhile, the proliferation of fibroblasts and collagen fibers in the model with drug administration group was significantly lower than that in the model group. Immunohistochemical staining showed that the expression of HMGB1, TGF-β1, Smad3 and α-SMA protein was observed in the conjunctival tissues of the model group both 4 and 8 wk, with brown and significantly deeper staining of the model group at 8 wk. Meanwhile, the positive staining in the model with drug administration group at both 4 and 8 wk was significantly lower than that in the model group. There was positive correlations between the number of fibroblasts stained with HE and the expression of HMGB1 in the conjunctival tissue of the model group at both 4 and 8 wk(r=0.602, 0.703, all P<0.05). RT-PCR and Western blot revealed that the mRNA and protein expression levels of HMGB1, TGF-β1, Smad3 and α-SMA in the model group were significantly higher than those in the control group at both 4 and 8 wk(all P<0.05). Meanwhile, the mRNA and protein expression levels of HMGB1, TGF-β1, Smad3 and α-SMA in the model with drug administration group were significantly lower than those in the model group(all P<0.05). There was positive correlations between mRNA expressions of HMGB1 and TGF-β1, Smad3 in the model group and the model with drug administration group(all P<0.05).CONCLUSION: The expression of HMGB1 increased at a time-dependent manner after glaucoma valve implantation. HMGB1 acts an indispensable role in the initiation and progression of scar formation after glaucoma surgery, which may be involved in the regulation of TGF-β/Smad signaling pathway.
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AIM: To compare the clinical outcomes of trabeculectomy combined with phacoemulsification intraocular lens implantation with suture-guided penetrating Schlemm canaloplasty combined with phacoemulsification intraocular lens implantation for the treatment of primary open angle glaucoma(POAG).METHODS: A retrospective case-control study was conducted on 53 cases(53 eyes)with advanced-stage POAG and cataract that received surgery at our hospital from June 2021 to June 2022, among which 26 eyes underwent trabeculectomy combined with phacoemulsification and intraocular lens implantation(group A), and 27 eyes underwent suture-guided penetrating Schlemm canaloplasty combined with phacoemulsification and intraocular lens implantation(group B). The best-corrected visual acuity(BCVA), intraocular pressure, and the number of intraocular pressure lowering drugs were compared between the two groups. Furthermore, the intraoperative and postoperative complications and success rate of surgery were recorded.RESULTS: The intraocular pressure of two groups of patients at 1 wk, 1, 3 and 6 mo after surgery were lower than that before preoperatively(all P<0.017). There was a notable disparity in the frequency of anterior chamber hemorrhage between the two groups(P<0.05), but there was no significant variance in the occurrence of superficial anterior chamber and choroid detachment(all P>0.05). There was no significant difference in BCVA(LogMAR)between the two groups at 6 mo after surgery(group A: 1.29±1.19, group B: 0.78±1.01, P=0.098), and there was no significant difference in the number of anti-glaucoma drugs [group A: 0(0, 2.75), group B: 0(0, 1), P=0.209]. Additionally, there was no significant difference in the success rate of surgery between the two groups at 6 mo postoperatively(Z=0.448, P=0.654).CONCLUSIONS: Suture-guided penetrating Schlemmcanaloplasty is a safe and effective treatment for advanced-stage POAG, with a success rate comparable to that of trabeculectomy.
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Charles Bonnet syndrome(CBS)refers to hallucinations resulting from visual pathway damage in individuals without neuropsychiatric disorders. CBS patients typically have insight into the unreality of their hallucinations, and the disorder may be episodic, periodic, or chronic. The condition's prevalence varies from 0.4% to 30% due to the absence of agreed diagnostic criteria for CBS and some patients' reluctance to acknowledge hallucinations. Massive studies have demonstrated an association between CBS and ocular diseases, such as age-related macular degeneration and glaucoma. Additionally, there have been reports of CBS occurring after ophthalmic surgery or medication. Therefore, clinicians should be vigilant in diagnosing CBS promptly and reassuring patients. There is a lack of literature on CBS in ophthalmology, and further research is needed to explore its pathogenesis and diagnostic and therapeutic options. This article reviews some of the studies related to CBS in recent years.
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AIM: To understand the publication status, research trends, and cutting-edge and hot topics in this field by conducting a bibliometrics analysis of relevant literatures on the pathogenesis of primary open angle glaucoma(POAG)in the past 30 a.METHODS:A total of 986 relevant literatures on the pathogenesis of POAG published on the core databases of China National Knowledge Infrastructure(CNKI)and Web of Science(WOS)from 1 September 1993 to 1 September 2023 were retrieved. CiteSpace(6.2.R.4)and VOSviewer(1.6.18)software were used to conduct knowledge graph analysis on the retrieved literature, including publication volume, author, research institution, country/region, and keywords.RESULTS:The United States(243 articles)has the highest number of publications, followed by China(121 articles). The foreign institution with the highest number of publications is Harvard University(37 articles), while domestic institutions such as Zhongshan Ophthalmic Center, Sun Yat-sen University, ophthalmology department of Xuanwu Hospital of Capital Medical University, and Peking University First Hospital tied for the highest number of publications. Louis R. Pasquale(21 articles)is the most prolific English author. Wang Ningli is the most active Chinese researcher in this field. Keywords include trabecular meshwork, intraocular pressure, aqueous humor, glucocorticoid, hemorheology, etc.CONCLUSION: The research on the pathogenesis of POAG is in a period of vigorous development. The United States has the largest number of publications in this field, and Harvard University is a leading institution in this field. The research focus in the field of POAG has shifted from the structural aspect to the genetic level, and gene research and traditional Chinese medicine treatment have broad application prospects in this field.
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AIM: To evaluate the efficacy of high-intensity focused ultrasound cyclo plasty(UCP)in the treatment of glaucoma and to investigate related influencing factors.METHODS: The study involved a total of 110 patients(134 eyes)who received UCP treatment between January 2019 and January 2022 at three medical centers: Tianjin Eye Aier Eye Hospital, Chongqing Aier Eye Hospital, and Chongqing Nanping Aier Eye Hospital. Patients were classified into three categories: primary angle-closure glaucoma, primary open-angle glaucoma, and secondary glaucoma. Best corrected visual acuity, intraocular pressure, and the usage of anti-glaucoma medications, etc., were recorded at 6 and 12 mo postoperatively.RESULTS: After 6 months of the UCP procedure, statistically significant differences in intraocular pressure were observed across all groups(all P<0.05). At 12 mo postoperatively, intraocular pressure of the primary angle-closure and primary open-angle glaucoma groups showed differences(all P<0.05). Notably, there were no significant changes in visual acuity at either the 6 or 12 mo compared to preoperative values across all patient groups(all P>0.05). Furthermore, the study identified a statistically significant correlation between the changes in intraocular pressure at 6 mo and factors such as age, history of previous glaucoma surgery, baseline white-to-white(corneal diameter), and the extent of UCP treatment(all P<0.05).CONCLUSION: The UCP procedure has been demonstrated to effectively lower intraocular pressure in patients with glaucoma. The efficacy appears to be influenced by variables including patient age, previous glaucoma surgery history, baseline white-to-white(corneal diameter), and the scope of UCP treatment. Importantly, UCP treatment did not adversely affect visual acuity, underscoring its favorable safety profile.
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Rapidly increasing intraocular pressure(IOP)is a typical manifestation of acute angle-closure glaucoma and an important cause of ocular tissue damage, vision loss and even blindness in glaucoma patients. The sharp increase of intraocular pressure in a short period of time in acute angle-closure glaucoma will cause characteristic damage to the structure and function of retina, choroid and optic nerve. Currently, the diagnosis and evaluation of the course of glaucoma is largely dependent on the state of high IOP, changes in the optic nerve and visual field damage, but irreversible damage to the fundus has already been made in glaucoma patients by this time. The microstructural changes in the posterior segment of the eye are more sensitive to high IOP and often appear before optic nerve and visual field damage, which can indicate the damage of high IOP to the eye earlier. Through the evaluation of the imaging characteristics of the posterior segment of the eye, the morphological characteristics that affect the prognosis of glaucoma can be explored, which is clinically important for the early diagnosis of glaucoma.
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In recent years, the combined surgery of phacoemulsification, intraocular lens implantation, and goniosychialysis has gradually emerged as a primary and effective approach in treating primary angle-closure glaucoma with cataracts. However, with the continuous progress of medical technology, postoperative intraocular pressure control is no longer the sole pursuit. Patients increasingly aspire to achieve higher postoperative visual quality. In order to ensure that patients attain a better refractive status and higher visual quality postoperatively, it is essential to minimize the negative impact caused by primary angle-closure glaucoma. This involves personalized selection of different intraocular lenses or calculation formulas,etc. Evaluation metrics for visual quality encompass visual acuity, contrast sensitivity, higher-order aberrations, subjective perception, etc. Therefore, this paper provides a comprehensive review of postoperative refractive shift, higher-order aberrations, contrast sensitivity and their influencing factors, and the selection of intraocular lenses for patients undergoing combined surgery for primary angle-closure glaucoma with cataracts.
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Ocular diseases pose a significant challenge to global health. The field of metabolomics, which involves the systematic identification and quantification of metabolites within a biological system, has emerged as a promising research approach for unraveling disease mechanisms and discovering novel biomarkers. Through its application, metabolomics has yielded valuable knowledge pertaining to the initiation and advancement of various ocular diseases. This review presents an overview of metabolomics and examines recent research progess in four ocular diseases, specifically diabetic retinopathy, age-related macular degeneration, glaucoma, and dry eye, summarizing potential biomarkers and metabolic pathways associated with these diseases. Additionally, this review offers insights into the future prospects of utilizing metabolomics for the management and treatment of ocular diseases.
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Primary angle-closure glaucoma(PACG)is a common cause of blindness, and angle closure is a fundamental pathologic process in PACG. With the development of ophthalmic equipment, the pathogenesis of PACG has been better understood. In addition to the traditional mechanisms of pupillary block and plateau iris, it has been found that its pathogenesis is not only related to abnormal ocular anatomy, but also more closely related to ocular dynamics, genetic factors, and psychophysiologic stressors. This article summarizes the pathogenesis and risk factors of PACG in conjunction with literature reports, with a view to providing guidance for clinical work and useful theoretical support for early diagnosis and treatment options for glaucoma.
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ABSTRACT Purpose: To determine the relationship of ocular surface disease, the number of glaucoma medications prescribed and its influence on treatment adherence. Methods: In this cross-sectional study, demographic data of patients with glaucoma were collected, and patients completed the ocular surface disease index questionnaire and the glaucoma treatment compliance assessment tool. Ocular surface parameters were assessed by "Keratograph 5M." Patients were stratified into two groups according to the amount of prescribed ocular hypotensive eye drops (Group 1, one or two classes of medications; Group 2, three or four classes) Results: In total, 27 eyes of 27 patients with glaucoma were included: 17 using 1 or 2 topical medications (Group 1) and 10 eyes using 3 or 4 classes (Group 2). For the Keratograph assessment, patients using ≥3 medications had significantly smaller tear meniscus height (0.27 ± 0.10 vs. 0.43 ± 0.22; p=0.037). The analysis of Ocular Surface Disease Index questionnaire showed higher scores among the groups using more hypotensive eye drops (18.67 ± 13.53 vs. 38.82 ± 19.72; p=0.004). Regarding the glaucoma treatment compliance assessment tool, Group 2 had worse scores in components of forgetfulness (p=0.027) and barriers due to lack of drops (p=0.031). Conclusion: Patients with glaucoma using more hypotensive eye drops had worse tear meniscus height and ocular surface disease index scores than those using fewer topical medications. Patients using three or four drug classes had worse predictors of glaucoma adherence. Despite worse ocular surface disease results, no significant difference in self-reported side effects was found.
RESUMO Objetivo: Determinar a relação entre doença da superfície ocular (OSD), número de medicamentos prescritos para o glaucoma, e como isso influencia na adesão ao tratamento. Métodos: Neste estudo transversal, pacientes com glaucoma foram submetidos à coleta de dados demográficos, preenchimento do questionário Ocular Surface Disease Index e do Glaucoma Treatment Compliance Assessment Tool. Os parâmetros da superfície ocular foram avaliados pelo "Keratograph 5M". Indivíduos foram estratificados em 2 grupos de acordo com a quantidade de colírios hipotensores oculares prescritos (Grupo 1: uma ou duas classes de medicamentos; Grupo 2: três ou quatro classes). Resultados: No total, 27 olhos de 27 pacientes com glaucoma foram incluídos: 17 usando 1 ou 2 medicamentos tópicos (Grupo 1) e 10 olhos usando 3 ou 4 classes (Grupo 2). Na avaliação do Keratograph, os pacientes em uso de 3 ou mais medicamentos apresentaram altura do menisco lacrimal significativamente menor (0,27 ± 0,10 vs. 0,43 ± 0,22; p=0,037). Análise do questionário OSDI mostrou escores mais altos entre o grupo que usou mais colírios hipotensores (18,67 ± 13,53 vs. 38,82 ± 19,72; p=0,004). Em relação ao Glaucoma Treatment Compliance Assessment Tool, o Grupo 2 apresentou piores escores nos componentes de esquecimento (p=0,027) e barreiras por falta de colírios (p=0,031). Conclusão: O estudo demonstrou que pacientes com glaucoma usando mais colírios hipotensivos apresentaram piores escores de altura do menisco lacrimal e Ocular Surface Disease Index, em comparação com aqueles que usaram menos medicamentos tópicos. Pacientes em uso de 3 ou 4 classes de colírios tiveram piores preditores de adesão ao glaucoma. Apesar dos piores resultados de doença da superfície ocular, não houve diferença significativa nos efeitos colaterais relatados.
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ABSTRACT Purpose: To evaluate the influence of atmospheric pressure changes on the behavior of intraocular pressure of healthy military individuals-students and instructors of the National Navy's Diving & Rescue School at the "ARC BOLÍVAR" naval base-during a simulated immersion in the hyperbaric chamber of the Naval Hospital of Cartagena. Methods: A descriptive exploratory study was performed. The intraocular pressure was measured at different atmospheric pressures during 60-min sessions in the hyperbaric chamber while breathing compressed air. The maximum simulated depth was 60 feet. Participants were students and instructors of the Naval Base's Diving and Rescue Department. Results: A total of 48 eyes from 24 divers were studied, of which 22 (91.7%) were male. The mean age of the participants was 30.6 (SD=5.5) years, ranging from 23 to 40. No participant had a history of glaucoma or ocular hypertension. The mean base intraocular pressure at sea level was 14 mmHg, which decreased to 13.1 mmHg (decreased by 1.2 mmHg) at 60 feet deep (p=0.0012). However, during the safety stop at 30 feet, the mean IOP kept decreasing until reaching 11.9 mmHg (p<0.001). By the end of the session, the mean intraocular pressure reached 13.1 mmHg, which is inferior and statistically significant when compared with the intraocular pressure base mean (p=0.012). Conclusions: In healthy individuals, the intraocular pressure decreases when reaching a depth of 60 feet (2.8 absolute atmosphere pressure) and it decreases even more during ascension at 30 feet. Measurements at both points were significantly different when compared with base intraocular pressure. The final intraocular pressure was lower than the baseline intraocular pressure, suggesting a residual and prolonged effect of the atmospheric pressure on intraocular pressure.
RESUMO Objetivo: Avaliar a influência das alterações da pressão atmosférica no comportamento da pressão intraocular de indivíduos militares saudáveis-alunos e instrutores da Escola de Mergulho e Resgate da Marinha Nacional na base naval "ARC BOLÍVAR"-durante uma imersão simulada na câmara hiperbárica do Hospital da Marinha de Cartagena. Métodos: Realizamos um estudo exploratório descritivo. A pressão intraocular foi medida em diferentes pressões atmosféricas durante sessões de 60 minutos na câmara hiperbárica respirando ar comprimido. A profundidade máxima simulada foi de 60 pés. Os participantes eram alunos e instrutores do Departamento de Mergulho e Resgate da Base Naval. Resultados: Quarenta e oito olhos de 24 mergulhadores foram estudados. Vinte e dois participantes (91,7%) eram do sexo masculino. A média de idade dos participantes foi de 30,6 (DP=5,5) anos, variando de 23 a 40. Nenhum participante tinha histórico de glaucoma ou hipertensão ocular. A média de base da pressão intraocular ao nível do mar foi de 14 mmHg, diminuindo para 13,1 mmHg (queda de 1,2 mmHg) a 60 pés de profundidade (p=0,0012). Entretanto, durante a parada de segurança a 30 pés, a pressão intraocular média continuou diminuindo até atingir 11,9 mmHg (p<0,001). Ao final da sessão, a pressão intraocular média atingiu 13,1 mmHg, valor inferior e estatisticamente significativo quando comparada à média de base da pressão intraocular (p=0,012). Conclusões: Em indivíduos saudáveis, a pressão intraocular diminui ao atingir uma profundidade de 60 pés (2,8 de pressão atmosférica absoluta) e diminui ainda mais durante a ascensão a 30 pés. As medidas em ambos os pontos foram significativamente diferentes quando comparadas à pressão intraocular de base. A pressão intraocular final foi menor do que a pressão intraocular de base, sugerindo um efeito residual e prolongado da pressão atmosférica sobre a pressão intraocular.
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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.
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ABSTRACT Implantation of glaucoma drainage devices is a valuable therapeutic option, particularly in children with glaucoma refractory to primary surgical treatment. Glaucoma drainage devices are typically used when conjunctival scarring hampers filtration surgery or prior angle procedures are not effective in controlling intraocular pressure. Despite known complications, the use of glaucoma drainage devices in children has increased in recent years, even as the primary surgical option. In this review, we evaluate the results of recent studies involving the implantation of glaucoma drainage devices in children, discussing new advances, and comparing the success rates and complications of different devices.
RESUMO O implante de dispositivos de drenagem para glaucoma (DDGs) é uma opção terapêutica valiosa, principalmente em crianças com glaucoma refratário ao tratamento cirúrgico primário. Os dispositivos de drenagem para glaucoma têm sido utilizados principalmente quando a cicatrização conjuntival dificulta a cirurgia fistulizante ou procedimentos angulares prévios não foram eficazes no controle da pressão intraocular. Apesar das complicações conhecidas, o uso de dispositivos de drenagem para glaucoma em crianças tem aumentado nos últimos anos, inclusive como opção cirúrgica primária. Nesta revisão, atualizamos os resultados de estudos recentes envolvendo o implante de dispositivos de drenagem para glaucoma em crianças, discutindo novos avanços e comparando diferentes dispositivos, taxas de sucesso e complicações.
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SUMMARY INTRODUCTION: Congenital glaucoma is a disease that involves increased intraocular pressure and can result in irreversible visual deterioration. The study of epidemiology allows the delineation of the characteristics associated with patients and specific risk factors. OBJECTIVE: The objective of this study was to examine epidemiological trends, place of residence, duration of gestation, sex, and race of the newborn diagnosed with congenital glaucoma in Brazil. METHODS: Data from SINASC (National Live Birth System) were used to analyze the period from 2017 to 2021 in Brazil. Linear regression and analysis of variance tests were employed to assess significance. The statistical significance was determined by p<0.05. RESULTS: A total of 47 cases of congenital glaucoma were identified in Brazil during the study period, with the highest incidence between the years of 2018 and 2021. The analysis of the distribution indicated that the states with the highest incidence were São Paulo, followed by Rio Grande do Sul and Pernambuco. Approximately 60% of cases occurred in male individuals, compared with 19 female cases. The ethnic analysis showed the highest incidence among whites and mixed. Regarding the length of pregnancy, statistical differences were observed between newborns of different periods of gestation. Infants born from pregnancies lasting between 28 and 31 weeks and 32 and 36 weeks were significant when analyzed with the group between 37 and 41 weeks. CONCLUSION: Studies on the mechanisms of congenital glaucoma seek to improve knowledge about the disease. Epidemiological evaluation is essential for identifying demographic and clinical patterns of the disease.
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RESUMO Objetivo Avaliar os resultados preliminares em médio prazo (até 6 meses) do uso isolado ou em combinação com a cirurgia de catarata do dispositivo XEN® Gel Stent na população brasileira. Métodos Realizou-se um estudo longitudinal retrospectivo de olhos portadores de glaucoma primário de ângulo aberto consecutivamente submetidos à cirurgia de implante de XEN® Gel Stent isolada (Grupo XEN®) ou em combinação com a cirurgia de catarata (Grupo Faco-XEN®) no mesmo centro entre abril e dezembro de 2023. Analisou-se a capacidade de redução da pressão intraocular e da quantidade de medicamentos hipotensores oculares, além das intercorrências intra e pós-operatórias. O critério de sucesso foi pressão intraocular < 18 mmHg e pelo menos 20% de redução da pressão intraocular pré-operatória (sucesso absoluto: sem medicação; sucesso relativo: com ou sem medicação). Avaliou-se ainda a duração do procedimento cirúrgico ao longo da curva de aprendizado. Resultados Foram incluídos 37 olhos no estudo (15 no Grupo Faco-XEN® e 22 no Grupo XEN®). A pressão intraocular média reduziu de 19,35 mmHg, no pré-operatório, para 13,05 mmHg, ao fim do acompanhamento (p < 0,001). Já a quantidade de medicamentos caiu de 2,95 para 0,22 por olho, no mesmo período (p < 0,001). A maioria dos pacientes (83%) chegou ao fim do acompanhamento livres de colírios. Não houve diferenças entre os dois grupos em relação à capacidade de redução pressórica e dos colírios. A taxa de sucesso absoluto foi de 81,2 e 86,7% nos Grupos XEN® e Faco-XEN®, respectivamente (p = 0,532). Seis olhos apresentaram falência da bolha e necessitaram de reintervenção cirúrgica. Houve uma redução significativa do tempo de cirurgia ao longo do acompanhamento. Conclusão O dispositivo XEN® Gel Stent foi efetivo, tanto em cirurgia isolada quando combinada, em reduzir a pressão intraocular e a quantidade de medicamentos, com elevado perfil de segurança na população brasileira.
ABSTRACT Objective To evaluate the preliminary medium-term results (up to 6 months) of the stand-alone use of XEN® Gel Stent implantation or in combination with cataract surgery in the Brazilian population. Methods A retrospective longitudinal study was carried out on eyes with primary open-angle glaucoma consecutively submitted to XEN® Gel Stent implantation surgery alone (XEN® Group) or in combination with cataract surgery (Phaco-XEN® Group) in the same center between April and December 2023. The ability to reduce intraocular pressure and the amount of ocular hypotensive medications were analyzed, in addition to intra- and postoperative complications. The success criterion was intraocular pressure < 18 mmHg and at least 20% reduction from the preoperative intraocular pressure (absolute success: without medication; relative success: with or without medication). The duration of the surgical procedure was also evaluated throughout the learning curve. Results Thirty-seven eyes were included in the study (15 in the Phaco-XEN® group and 22 in the XEN® group). The mean intraocular pressure was reduced from 19.35 mmHg preoperatively to 13.05 mmHg at the end of the follow-up (p < 0,001). The amount of medication decreased from 2.95 to 0.22 per eye in the same period (p < 0,001). Of the patients, 83% reached the end of follow-up without no need for eye drops. There were no differences between the two groups in terms of intraocular pressure reduction capacity and eye drops. The absolute success rate was 81.2 and 86.7% in the XEN® and Phaco-XEN® Groups, respectively (p = 0.532). Six eyes presented bleb failure and required surgical reintervention. There was a significant reduction in surgery time throughout follow-up. Conclusion The XEN® gel stent implantation was effective, both in stand-alone and in combined surgery, in reducing intraocular pressure and the medication burden, with a high safety profile in the Brazilian population.
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RESUMO O objetivo deste trabalho foi relatar um caso raro de glaucoma neovascular em paciente portador de diabetes mellitus tipo 1 que evoluiu para esclerite necrosante com inflamação. Homem, 22 anos e com diabetes mellitus tipo 1 mal controlada apresentou perda visual dolorosa súbita no olho direito. Acuidade visual em olho direito sem percepção luminosa e 20/80 em olho esquerdo. Pressão intraocular de 35mmHg e exame compatível com glaucoma neovascular em olho direito. Foi iniciado tratamento com colírios hipotensores no olho direito e panfotocoagulação a laser no olho esquerdo. Após 3 semanas, houve piora da dor, hiperemia e aparecimento de afinamento escleral na região superior de olho direito, com posterior protrusão uveal. Quadro compatível com esclerite anterior necrosante com inflamação, apesar das sorologias para doenças autoimunes negativas. Ainda que raro, este relato de associação de glaucoma neovascular e esclerite justifica a discussão dos mecanismos inflamatórios em comum nessas doenças, para melhor compreensão da patogênese dessas graves apresentações clínicas.
ABSTRACT The aim of this study was to report a rare case of neovascular glaucoma in a patient with type 1 diabetes mellitus that progressed to necrotizing scleritis with inflammation. A 22-year-old male with poorly controlled type 1 diabetes mellitus experienced sudden painful vision loss on the right eye. Visual acuity on the right eye was no light perception, while it was 20/80 in the left eye. Intraocular pressure was measured at 35 mmHg, and the examination was consistent with neovascular glaucoma on the right eye. Treatment with hypotensive eye drops was initiated in the right eye, and panphotocoagulation laser therapy was performed on the left eye. After three weeks, there was worsening pain, redness, and the appearance of scleral thinning in the upper region of the right eye, followed by uveal protrusion. This presentation was consistent with necrotizing anterior scleritis with inflammation, despite negative serology for autoimmune diseases. Although rare, this report of the association between neovascular glaucoma and scleritis justifies the discussion of common inflammatory mechanisms in these diseases to enhance the understanding of the pathogenesis of these severe clinical presentations.