The influence of clinical and psychosocial characteristics on children behaviour during sequential dental visits: a longitudinal prospective assessment.

PURPOSE: This is the first study to adopt a multilevel approach to assess the impact of the order of dental visits on child's behaviour. The aim was to investigate which factors directly interfere with child's behaviour regardless of the order of sequential dental visits. METHODS: In this prospective longitudinal study, children aged 7-12 years were invited to participate. Child behaviour was assessed using the Frankl Scale during four sequential dental visits. Chi-square test was used to analyse the effect of dental fear on children's non-cooperative behaviour according to the presence of dental fear. Multilevel mixed logistic regression model was used to assess the association between predictor variables and the outcome (child behaviour) during the sequential dental visits. RESULTS: Overall, 111 children participated in this study. Maternal dental anxiety, dental pain and complexity of the treatment were associated with the non-cooperative behaviour in children aged 7-12 years. When stratified by dental fear, the complexity of the treatment remained associated with non-cooperative behaviour. CONCLUSIONS: The results provide evidence that, even with the familiarization of child with the dental environment, maternal dental anxiety, dental pain in the last month, and the complexity of dental treatment negatively affect the children's behaviour aged 7-12 years.

Efeitos do treinamento intervalado em variáveis fisiológicas e na performance de ciclistas competitivos / Efectos del entrenamiento de intervalos en las variables fisiológicas y el rendimiento en ciclistas competitivos / Effects of interval training on physiological variables and performance in competitive cyclists

Objetivo: O presente estudo teve como objetivo analisar os efeitos de diferentes métodos de treinamento intervalado (TI) nos parâmetros fisiológicos e no desempenho de ciclistas competitivos. Método: A classificação dos métodos de TI foram: a) sub-máximo (TIsub), b) máximo (TImax) e c ) supra-máximo (TIsup). A estratégia de busca incluiu os seguintes termos: treinamento intervalado, treinamento intervalado em ciclistas, treinamento intervalado de alta intensidade, treinamento intervalado de alta intensidade em ciclistas e sprint. Foram consultadas as seguinte bases de dados: PubMed, Google Scholar e SPORTDiscus. Para isso, foi realizada uma pesquisa entre julho de 2011 e fevereiro de 2012. Resultados: Dentre as diferentes metodologias de TI em ciclistas competitivos, todos os métodos foram suficientes para demonstrar melhorias na potência aeróbia máxima (Pmax), consumo máximo de oxigênio (VO2max), limiares fisiológicos, tempo de exaustão (Tlim) e contra-relógio de 40 km no ciclismo (CR40km ) em ciclistas competitivos. Conclusão: Portanto, os três métodos de TI demonstraram que são necessárias de 6-8 sessões de treino durante um período de 4-6 semanas para se obter ganhos nas variáveis fisiológicas e na performance em ciclistas competitivos

Objetivo. En la presente investigación hemos planteado como objetivo analizar los efectos de diferentes métodos de entrenamiento de intervalos (EI) en los parámetros de la capacidad fisiológica y el desempeño de los ciclistas de competición. Método. La clasificación de los métodos de EI es: a) sub-máxima (EIsub), b) máxima (EImax), y c) supramáxima (EIsup). La estrategia de búsqueda incluyó los términos siguientes: entrenamiento de intervalos, entrenamiento de intervalos en el ciclismo, entrenamiento de intervalo de alta intensidad, entrenamiento de intervalo de alta intensidad en el ciclismo y sprint. Para este fin, se realizó una búsqueda entre julio de 2011 y febrero de 2012 en las bases de datos: PubMed y Google Scholar SPORTDiscus. Resultados. Entre las diferentes metodologías de EI en ciclistas de competición, todos los métodos fueron suficientes para demostrar mejoras de la potencia aeróbica máxima (Pmax), el consumo máximo de oxígeno (VO2max), los umbrales fisiológicos, tiempo hasta el agotamiento (Tlim) y la prueba de 40 km de contrarreloj de ciclismo (CR40km). Conclusión. Los tres métodos de EI mostraron que es necesario 6-8 sesiones de entrenamiento durante un período de 4-6 semanas para que los ciclistas entrenados mejoraron las variables fisiológicas y de rendimiento (AU)

Objective. The aim of this study was to analyze the effects of different methods of interval training (IT) on physiological variables and performance in competitive cyclists. Method. The classification of the IT methods were: a) sub-maximal (ITsub), b) high (ITmax) and c) supramaximum (ITsup). The search strategy included the following terms: interval training, interval training on cycling, high intensity interval training, high intensity interval training in cycling and sprint. We choose for the followed databases: PubMed, Google Scholar and SPORTDiscus. For this purpose, a search were in a period between July 2011 and February 2012. Results. The different methods of IT increased maximal aerobic power (Pmax), maximum oxygen consumption (VO2max), physiological thresholds, time to exhaustion (Tlim) and 40-km cycling time trial CR40km ) in competitive cyclists. Conclusion. Therefore, the three methods of IT showed that 6-8 sessions of training during 4-6 weeks isnecessary to improve physiological variables and cycling performance in competitive cyclists (AU)

Resistance of Sugarcane Cultivars to Mahanarva fimbriolata (Stål) (Hemiptera: Cercopidae).

The spittlebug Mahanarva fimbriolata (Stål) (Hemiptera: Cercopidae) is one of the most important pests of the sugarcane crop in Brazil. Despite of its importance, there is currently a lack of information regarding sugarcane cultivars' resistance to the spittlebug. Therefore, our objective was to evaluate the response of sugarcane genotypes to this species. Two experiments were carried out under laboratory conditions using a random block design with treatments in a factorial arrangement of 2 × 13 (experiment 1) and 2 × 12 (experiment 2), with six replicates. The first factor included two levels of infestation (infested and noninfested plants with spittlebugs), while the second consisted of the cultivars. Nymph survival varied from 47.9 to 84.5%, indicating that there are different levels of antibiosis to M. fimbriolata among the tested cultivars. The highest degree of antibiosis was found in cultivars IACSP96-7586 and IACSP96-2008, in which nymph survival was close to 48%. IACSP96-7586 also presented some degree of tolerance, but IACSP96-7569 and IACSP97-6682 stood out as the most tolerant cultivars to the pest, showing the lowest reduction in weight of aboveground biomass. On average, spittlebug infestations caused a significant reduction in relative leaf chlorophyll content and aboveground biomass weight.

Traumatic dental injuries in primary teeth: severity and related factors observed at a specialist treatment centre in Brazil.

AIM: This retrospective study aimed to analyse demographic data and the severity of traumatic dental injuries (TDIs) to the primary dentition based on children's dental records at a university clinic. STUDY DESIGN: A cross-sectional retrospective study. METHODS: The records of all patients were analysed according to gender, age, aetiology, teeth involved, number of affected teeth, place of occurrence, witness to the trauma, time elapsed between trauma occurrence and care-seeking, type of trauma and severity of injury. RESULTS: A total of 576 children aged 8-89 months suffered injuries to 1,043 teeth. Severe injuries were the most prevalent (45.5%). These occurred at all ages, but their frequency was higher in children aged between 13 and 24 months. The prevalence of mild injury was higher when the cause was a fall from one's own height. No differences were detected in severity according to the place of occurrence and witnesses of the accident. The prevalence of severe injury was higher in cases where three or more teeth were involved. CONCLUSIONS: In this specialist treatment centre, severe injuries were the most common TDIs, which occurred in children aged 13-24 months, mainly due to falls and most occurred at home. Professionals must be prepared to deliver the best and most efficient care to this population.

Plantas medicinais utilizadas pela comunidade do bairro dos Tenentes - município de Extrema, MG, Brasil / Medicinal plants used by the community of Tenentes District - Extrema Municipality, Minas Gerais State, Brazil

Este trabalho teve como objetivo verificar junto à comunidade do bairro dos Tenentes (Extrema, MG) como é feito o tratamento de doenças a partir do uso de plantas medicinais, bem como identificar e relacionar as plantas utilizadas com a literatura científica. Para tanto, foram realizadas entrevistas e coletas de plantas utilizadas na medicina popular local as quais, após processo de herborização e identificação, foram comparadas com informações disponíveis em literatura especializada. Foram identificadas 71 espécies, pertencentes a 33 famílias botânicas, sendo Asteraceae e Lamiaceae as mais expressivas. As folhas e ramos (88 por cento) foram as partes mais utilizadas e a forma de preparo mais freqüente foi a infusão (67 por cento). As plantas foram indicadas principalmente para o tratamento de males associados ao aparelho digestório (23 espécies), respiratório (16), excretor (10), nervoso (6), circulatório (5), endócrino (4), reprodutor feminino (2), e ainda como cicatrizante (7), antiinflamatório (4) e para dores no corpo (5).

This study aimed to verify with the community of Tenentes District (Extrema Municipality, Minas Gerais State, Brazil) how diseases are treated by using medicinal plants, as well as to identify and relate the used plants to the scientific literature. Thus, interviews were done and plants used in the local folk medicine were collected; after the herborization process and identification, the obtained data were compared with information available in the literature. Seventy-one species were identified; they belonged to 33 botanical families, of which Asteraceae and Lamiaceae were most expressive. Leaves and branches (88 percent) were the most used part and the most frequent form of preparation was infusion (67 percent). The plants were indicated especially for the treatment of illness associated with digestive (23 species), respiratory (16), excretory (10), nervous (6), circulatory (5), endocrine (4) and woman reproductive systems (2), as healing (7), anti-inflammatory (4), and for general body aches (5).

Influence of pupil dilation on retinal nerve fibre layer measurements with spectral domain OCT.

PURPOSE: To evaluate the influence of pupil dilation on retinal nerve fibre layer (RNFL) measurements with spectral domain optical coherence tomography (OCT). PATIENTS AND METHODS: In total, 29 healthy individuals and 26 glaucoma patients underwent RNFL measurements with the Cirrus HD-OCT Model 4000 (Carl Zeiss Meditec Inc.) before and 30-40 min after pupil dilation with one drop of tropicamide 1%. Average thickness, quadrant thickness, and clock-hour thickness measurements were compared with the paired Student's t-test. We also compared the quality scores of the images obtained pre- and post-pupil dilation. RESULTS: Mean ages in the glaucoma and control groups were 58.3+/-13.4 and 41.6+/-16.4 years respectively (P<0.001). Mean deviation values were -6.96+6.31 dB in the glaucoma group and -1.26+0.79 dB in the control group (P<0.001). Mean RNFL measurements obtained in the glaucoma group were significantly lower than those obtained in the control group (P<0.001). There were no statistically significant differences between mean quality scores obtained before and after dilation neither in the glaucoma group (7.73+/-0.92 vs 7.54+/-1.10, P=0.232) nor in the control group (8.14+/-0.88 vs 8.00+/-0.71, P=0.380). There was no statistically significant difference between mean RNFL measurements obtained pre- and post-pupil dilation neither among normal individuals (P>0.05), nor among glaucoma patients (P>0.05). CONCLUSION: The results of this study indicate that RNFL measurements obtained with spectral domain OCT are not influenced by pupil size.

Blood pressure and glaucoma.

Although intraocular pressure (IOP) is considered the main risk factor for the development of glaucoma and the only parameter subject to treatment, there is sufficient evidence to suggest that glaucoma may continue to progress despite lowering patients' IOP to targeted levels. Several studies have implicated vascular risk factors in the pathogenesis of glaucoma. Among them, blood pressure (BP) and ocular perfusion pressure have become increasingly important. Although clinicians cannot currently visualise ocular blood flow directly, they can easily measure glaucoma patients' BP and IOP to calculate their ocular perfusion pressure and quantify the vascular changes. The purpose of this review article is to discuss the relationship between BP and IOP, BP and glaucoma, and perfusion pressure and glaucoma. We discuss the importance of autoregulation to maintain the adequate perfusion of the optic nerve head, and suggest that ocular perfusion pressure and its fluctuation may be parameters that need to be measured in glaucoma patients.

Central corneal thickness in children with congenital cataract and children with surgical aphakia: a case-control study.

AIM: To measure the central corneal thickness (CCT) of children with congenital cataract and surgical aphakia. METHODS: Children with congenital cataract or surgical aphakia were prospectively recruited and divided into four groups: unilateral cataract (group 1, n = 14), bilateral cataract (group 2, n = 17), unilateral aphakia (group 3, n = 32) and bilateral aphakia (group 4, n = 44). An age-, sex-, and race-matched control group of normal individuals was selected. Ultrasonic pachymetry was performed by the same observer. RESULTS: The mean CCT of the control group was not significantly different from the normal (p = 0.747) and cataractous eyes of group 1 (p = 0.252). The mean CCTs of both eyes of group 2 were significantly higher than the control group (p<0.01). The mean CCT of the aphakic eyes in group 3 was significantly higher than the contralateral healthy eyes and control eyes (p<0.001). The mean CCTs of both eyes of group 4 were significantly higher than the control group (p<0.001). The mean CCT was significantly higher in aphakic eyes of groups 3 and 4 than in cataractous eyes of groups 1 and 2 (p<0.001). CONCLUSIONS: Aphakic eyes due to congenital cataract show thicker corneas than normal phakic eyes. Aphakic eyes after congenital cataract extraction show thicker corneas than eyes with congenital cataracts, suggesting that the increase in CCT occurs postoperatively.

Influence of age, central corneal thickness, and quality score on dynamic contour tonometry.

AIMS: To compare the IOP measurements obtained with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT), and to analyse the influence of central corneal thickness (CCT) and age on both measurements, and the influence of the quality score on DCT readings. METHODS: A total of 500 healthy subjects with no prior history of glaucoma or ocular hypertension (age: 7-86 years) were consecutively recruited. GAT, DCT, and CCT measurements were obtained from both eyes of each individual, in this order, by three observers. The mean of five CCT measurements was used for analysis. DCT measurements were accepted when quality scores varied between 1 (higher quality) and 3 (lower quality). RESULTS: Mean DCT measurements were 3.2 mmHg higher than GAT readings. CCT values varied between 449 and 653 microm. IOP measured by GAT correlated strongly with CCT (r(2)=0.28, P=<0.001), whereas DCT readings correlated poorly with CCT (r(2)=0.01, P=0.017). Both DCT (r(2)=<0.01, P=0.044) and GAT (r(2)=0.01, P=<0.001) measurements correlated poorly with age. Bland-Altmann analysis revealed disagreement between DCT and GAT readings, with 95% confidence intervals of +/-6.7 mmHg. Quality scores for DCT measurements were 1 (n=369, 36.9%), 2 (n=340, 34.0%), and 3 (n=291, 29.1%). DCT readings with quality score of 3 (18.8+/-3.4 mmHg) were significantly higher than those with quality scores of 1 (16.7+/-2.9 mmHg) and 2 (17.4+/-2.9 mmHg; P=<0.001). CONCLUSIONS: DCT is not influenced by CCT, unlike GAT. Both DCT and GAT measurements are not influenced by age. DCT measurements with lower quality scores are associated with higher readings.

The effects of prostaglandin analogues on the blood aqueous barrier and corneal thickness of phakic patients with primary open-angle glaucoma and ocular hypertension.

PURPOSE: To evaluate the effects of topical latanoprost, travoprost, and bimatoprost on the blood-aqueous barrier and central corneal thickness (CCT) of patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). DESIGN: Prospective, randomized, masked-observer, crossover clinical trial. METHODS: A total of 34 phakic patients with POAG or OHT with no previous history of intraocular surgery or uveitis completed the study. Patients were randomized to use latanoprost 0.005%, travoprost 0.004%, or bimatoprost 0.03% once daily (2000 hours) for 1 month, followed by a washout period of 4 weeks between each drug. Aqueous flare was measured with a laser flare metre. CCT was calculated as the average of five measurements using ultrasound pachymetry. All measurements were performed by a masked observer (1000 h). RESULTS: There were no statistically significant differences between baseline mean IOP, mean CCT, and mean flare values among the groups. There was no statistically significant increase in mean flare values from baseline in all groups (P>0.05). There were no statistically significant differences between mean flare values among the groups (P>0.05). All medications significantly reduced the mean IOP from baseline (P<0.0001). IOP reduction obtained with travoprost (7.3+/-3.8 mmHg) was significantly higher than that obtained with latanoprost (4.7+/-4.2 mmHg) (P=0.01). A statistically significant reduction in mean CCT (0.6+/-1.3%) from baseline was observed when patients instilled bimatoprost (P=0.01). CONCLUSIONS: Latanoprost, travoprost, and bimatoprost had no statistically significant effect on the blood-aqueous barrier of phakic patients with POAG or OHT. Bimatoprost may be associated with a clinically irrelevant reduction in mean CCT.

Long-term intraocular pressure control of eyes that developed encapsulated blebs following trabeculectomy.

PURPOSE: To evaluate the long-term intraocular pressure (IOP) control of eyes that developed an encapsulated bleb (EB) following trabeculectomy. METHODS: Between 1994 and 1995, 25 eyes developed EBs and were randomized to medical treatment or needling without adjunct antimetabolites. Among the 25 patients who developed an EB, 21 were followed for at least 6 months. A control group of 21 consecutive eyes, which underwent trabeculectomy during the same period and that did not develop EBs was retrospectively selected. Success was defined as IOP <21 mmHg with or without medications. Kaplan-Meier survival analysis was performed to compare the groups. RESULTS: Among the 21 eyes that developed EBs, 12 (57%) had undergone transconjunctival needling and nine (43%) had received medical treatment. Mean follow-ups were 30.0 +/- 14.0 months, 33.3 +/- 18.5 months, and 37.4 +/- 2.6 months for the needling, medical treatment, and control groups, respectively (P = 0.19). Kaplan-Meier survival curves demonstrated that the control group showed a significantly lower chance of failure than both the needling and the medical treatment groups (P < 0.0001). CONCLUSION: Encapsulated blebs may be associated with an increased risk for surgical failure.

Discrimination between normal and glaucomatous eyes with scanning laser polarimetry and optic disc topography: a preliminary report.

PURPOSE: To test the ability of structural parameters (as measured by scanning laser polarimetry (SLP) software 1.0.12 and confocal scanning laser ophthalmoscopy (CSLO) to discriminate between normal and glaucomatous eyes. METHODS: A total of 112 patients with primary open-angle glaucoma and 88 normal individuals were enrolled in the study. All individuals underwent a thorough ophthalmic evaluation, a 24-2 full threshold Humphrey visual field, SLP with the GDx, and CSLO with the TOPSS. Patients with marked cataract or low vision were excluded from the study. Cut-off points were selected and receiver operator characteristic (ROC) curves were created for each individual CSLO and SLP parameter. Finally, multivariate dicriminant formulas were developed in order to achieve a better sensitivity (Se)/specificity (Sp) ratio for the diagnosis of glaucoma, initially separately for each device, and then combining parameters from CSLO and SLP. RESULTS: The mean deviation for the glaucoma group was -10.63 +/- 7.58 dB. Multivariate discriminant formulas resulted in better sensitivity/specificity ratios than any individual parameter, either for CSLO (Se: 90%; Sp: 81%; accuracy: 86%) or SLP (Se: 87%; Sp: 86%; accuracy: 86%). The multivariate formula combining parameters from both devices resulted in an improvement in the ability to diagnose glaucoma. An area under the ROC curve of 0.97 was obtained, with a sensitivity of 93%, a specificity of 91%, and an accuracy of 92%. CONCLUSIONS: The combination of structural parameters derived from CSLO and SLP in a multivariate discriminant formula may enhance the ability to diagnose glaucoma. Further studies investigating a random population are needed in order to test the validity of this formula.

Retinal nerve fibre layer loss in patients with type 1 diabetes mellitus without retinopathy.

BACKGROUND/AIM: There is evidence suggesting the occurrence of neurovisual abnormalities in patients with diabetes without retinopathy. However, the determination of abnormalities in the neural and glial elements in vivo is difficult. The aim of this study was to investigate whether a retinal nerve fibre layer (RNFL) defect (as determined by scanning laser polarimetry, SLP) is present in patients without clinical manifestations of diabetic retinopathy. METHODS: 12 patients with type 1 diabetes mellitus (DM) without retinopathy or other diabetes induced microvascular complications, underwent a complete ophthalmological examination, including automated perimetry and RNFL measurements with a nerve fibre layer analyser GDx. The data were compared with a normal control group matched for age and sex. RESULTS: The superior segment retardation in patients with diabetes was lower than in the control group, based on the superior integral (0.19 (SD 0.06) v 0.23 (0.04) mm(2), p=0.03) and the superior average (71.0 (11.05) v 84.27 (10.56) microm, p=0.007) parameters. CONCLUSION: This finding may be indicative of significant nerve fibre loss in the superior segment of the retina in patients with type 1 diabetes mellitus but without retinopathy. The meaning of intraretinal differences in RNFL retardation, indicating asymmetric NFL loss, in patients with diabetes is yet not understood.

Exogenous vasopressin influences intraocular pressure via the V(1) receptors.

PURPOSE: To compare central, peripheral, and ocular effects of exogenously given vasopressin on intraocular pressure (IOP) and to identify the related receptor mechanisms of action in rabbits. METHODS: Young adult New Zealand albino rabbits were entrained under a daily 12-hour light and 12-hour dark cycle. In the early light period, bolus injections of vasopressin or desmopressin (a specific V(2) receptor agonist) were given either to the central nervous system (CNS) through an implanted cannula to the 3(rd) ventricle or to the systemic circulation via the ear vein in conscious rabbits. Changes in IOP and pupil size were monitored for up to 6 hours and dose-response curves were generated. Effects of centrally and peripherally given vasopressin on IOP were further examined following pretreatments with a selective V(1) receptor antagonist administered into the 3(rd) ventricle and into the ear vein, respectively. In order to clarify whether or not exogenously given vasopressin can alter IOP by mechanisms inside the eye, vasopressin was injected into the anterior chamber or the vitreous chamber unilaterally in conscious rabbits. Changes in IOP and pupil size were monitored. After an anterior chamber or intravitreal injection of the V(1) receptor antagonist, changes in IOP and pupil size due to an intravenous injection of vasopressin were determined to study the involvement of the related receptor mechanism. RESULTS: A dose-dependent elevation of IOP appeared after injections of vasopressin into the 3(rd) ventricle. There was no pupillary change. This IOP elevation was blocked by the pretreatment with the V(1) receptor antagonist. Following intravenous injections of vasopressin, significant reductions of IOP and pupil size occurred. These reductions were blocked by the pretreatment with the V(1) receptor antagonist. Intracerebroventricular or intravenous injection of desmopressin had no effect on IOP or pupil size. Injection of vasopressin into the anterior chamber or the vitreous chamber caused significant reductions of IOP and pupil size. Pretreatment with the V(1) receptor antagonist into the anterior chamber or the vitreous chamber prevented the reductions of IOP and pupil size following an intravenous injection of vasopressin. CONCLUSIONS: Intracerebroventricular and intravenous injections of vasopressin cause opposite effects on IOP. The central effect of vasopressin on IOP and the peripheral effects of vasopressin on IOP and pupil size are due to stimulations of the V(1) receptors. Reductions of IOP and pupil size following intravenous injections of vasopressin are at least partially due to stimulations of the V(1) receptors inside the eye.

Intraoperative mitomycin-C without conjunctival and Tenon's capsule touch in primary trabeculectomy.

OBJECTIVE: To verify whether intraoperative mitomycin C (MMC) without conjunctival and Tenon's touch is effective in inhibiting the development of thin, avascular blebs in eyes undergoing primary trabeculectomy. DESIGN: Noncomparative, interventional study. PARTICIPANTS: Fifteen eyes of 15 consecutive patients undergoing primary trabeculectomy. INTERVENTION: All eyes underwent trabeculectomy with intraoperative MMC (0.25 mg/ml for 3 minutes) without either conjunctival or Tenon's touch. Patients were examined 1 month, 3 months, 6 months, and 12 months after surgery. Intraocular pressure (IOP) and number of medications were evaluated at each examination. The appearance of the bleb was classified at the last examination into one of three groups: flat and vascularized; elevated but not avascular; or elevated, thin, and avascular. MAIN OUTCOME MEASURES: Intraocular pressure, number of antiglaucoma medications, and appearance of the bleb. RESULTS: Preoperative mean IOP was 30.57 +/- 10.92 mmHG: Statistically significant IOP reductions were observed 1 month, 3 months, 6 months, and 1 year after surgery (P < 0.01). Twelve months after surgery, the mean IOP was 14.92 +/- 6.53 mmHG: Five eyes (33.3%) showed an IOP less than 15 mmHg without antiglaucoma medication at the 12-month examination. The bleb was considered elevated, thin, and avascular in 12 of 15 eyes (80%) at the end of follow-up. CONCLUSIONS: Intraoperative MMC at 0.25 mg/ml for 3 minutes without either conjunctival or Tenon's touch was not effective in eliminating the development of thin, avascular blebs in eyes undergoing primary trabeculectomy.

Discrimination between normal and glaucomatous eyes with visual field and scanning laser polarimetry measurements.

AIM: To evaluate the ability of structural parameters (as determined by retinal nerve fibre layer (RNFL) measurements obtained with the scanning laser polarimeter (SLP-NFA/GDx)) and functional parameters (as determined by automated perimetry) to discriminate between normal and glaucomatous eyes. METHODS: In a case-control study, a total of 91 normal subjects and 94 patients with glaucoma underwent automated perimetry and RNFL measurements obtained with the SLP. Three independent scans of each eye were obtained and a mean image was created and used for further analysis. Only one eye per individual was randomly included in the study. The sensitivity (Se) and specificity (Sp) of 12 RNFL parameters were calculated according to the SLP internal normative database. The Se and Sp of the visual field (VF) global indices and the glaucoma hemifield test (GHT) were also calculated according to the instrument's normative database. Receiver operator characteristic (ROC) curves were built for each SLP parameter and VF index. Fisher's linear discriminant formulas (LDFs) were developed for VF indices (VF LDF), SLP measurements (SLP LDF), and both examinations (combined LDF). RESULTS: According to the SLP internal database, the parameters with better Se and Sp were: superior/nasal ratio (Se = 58.5%; Sp = 86.8%), and GDx the number (Se = 43.3%; Sp = 96.7%). The construction of an ROC curve for the number resulted in Se = 84% and Sp = 79%. The creation of LDFs improved both the sensitivities and specificities when compared with isolated parameters SLP LDF (Se = 90.4%; Sp = 82.4%), VF LDF (Se = 89.4%; Sp = 89.0%), and combined LDF (Se = 93.0%; Sp = 90.1%). The sensitivity to diagnose early and moderate glaucomatous damage observed with the GHT was lower than that obtained with the number (p < 0.01). CONCLUSIONS: Creation of LDFs enhanced the Se and Sp for both VF and SLP. Integration of SLP and VF in a combined LDF reached the highest Se/Sp relation, suggesting that these examinations may be additive concerning the diagnosis of glaucoma. The SLP parameter the number may be more sensitive than the GHT in diagnosing early and moderate glaucomatous damage.

Latanoprost in glaucoma associated with Sturge-Weber syndrome: benefits and side-effects.

PURPOSE: This study was conducted to evaluate the ocular hypotensive efficacy, safety, and side effects of latanoprost 0.005% administered as adjunctive therapy in patients with Sturge-Weber syndrome (SWS) and glaucoma. METHODS: Commercially available latanoprost 0.005% was added as a single drop once daily to other antiglaucoma medications. Intraocular pressure (IOP) was measured at 1, 3, and 6 months of treatment. A successful response was defined as a reduction of at least 20% in IOP at the final follow-up evaluation without additional medical or surgical therapy and no adverse events related to latanoprost. RESULTS: 18 eyes of 18 patients with SWS and glaucoma were enrolled from 9 clinical centers. Mean baseline IOP was 28.4 +/- 7.1 mmHg (range, 17-42 mmHg). Using Kaplan-Meier analysis, a successful response to latanoprost was observed in 3 of 18 (16.7%) patients at the 6-month interval. Seven (38.9%) patients required surgery; three (16.7%) patients required additional medical therapy, seven (38.9%) patients had no change in therapy. One (5.6%) patient discontinued latanoprost treatment because of intolerable conjunctival hyperemia. Two successfully treated patients had significantly greater episcleral vessel engorgement after initiation of latanoprost therapy. CONCLUSION: Patients with SWS and glaucoma respond poorly to adjunctive latanoprost therapy and often require additional medical or surgical intervention. Increased episcleral vascular engorgement might result in greater operative risks should filtration surgery become necessary in these patients.