Swept-source optical coherence tomography detects anterior-chamber changes in patients with angle-closure after laser peripheral iridotomy / Tomografia de coerência óptica swept-source detecta alterações na câmara anterior em pacientes com fechamento angular após iridotomia

ABSTRACT Purpose: This study aimed to compare an teriorchamber parameters acquired by a swept-source anteriorsegment optical coherence tomography before and after laser peripheral iridotomy. Methods: This study prospectively evaluated 14 patients with primary-angle closure and six patients with primary-angle closure glaucoma. Gonioscopy and anterior-segment optical coherence tomography using the DRI OCT Triton® were performed before and after laser peripheral iridotomy. Anterior-segment optical coherence tomography parameters were studied using scleral spur as reference: angle opening distance at 250, 500, and 750 µm, trabecular-iris space at 500 µm, trabecular-iris angle, trabecular-iris contact length, and iris curvature. Results: Anterior-segment optical coherence tomography identified 61% of the patients with two or more quadrants closed. Gonioscopy identified more closed angles than anterior-segment optical coherence tomography before laser peripheral iridotomy. In angle parameters, only the angle opening distance of 250 µm at the nasal quadrant was not significantly increased after laser peripheral iridotomy. The iris curvature and trabecular-iris contact length showed a significant reduction induced by the laser procedure. Even in eyes in which gonioscopy did not identify angular widening after laser peripheral iridotomy (n=7), the angle opening distance of 750 µm increased (nasal, 0.15 ± 0.10 mm to 0.27 ± 0.16 mm, p=0.01; temporal, 0.14 ± 0.11 mm to 0.25 ± 0.12 mm, p=0.001) and the iris curvature decreased (nasal, 0.25 ± 0.04 mm vs. 0.11 ± 0.07 mm, p=0.02; temporal, 0.25 ± 0.07 mm vs. 0.14 ± 0.08 mm, p=0.007). Conclusions: Anterior-chamber changes induced by laser peripheral iridotomy could be quantitatively evaluated and documented by DRI OCT Triton®

RESUMO Objetivo: Comparar os parâmetros de câmara anterior obtidos através da tomografia de coerência óptica de segmento anterior antes e após a iridectomia periférica a laser. Métodos: Quatorze pacientes com fechamento angular primário e seis com glaucoma primário de ângulo fechado foram prospectivamente avaliados neste estudo. Gonioscopia e tomografia de coerência óptica de segmento anterior com DRI OCT Triton® foram realizadas antes e após a iridectomia periférica a laser. Os seguintes parâmetros de tomografia de coerência óptica de segmento anterior, baseados na localização do esporão escleral, foram avaliados: ângulo de abertura angular a 250 µm, 500 µm e 750 µm, área do espaço entre a íris e o trabeculado a 500 µm, ângulo entre a íris e o trabeculado, extensão do contato entre a íris e o trabeculado e curvatura da íris. Resultados: A tomografia de coerência óptica de segmento anterior identificou 61% dos indivíduos com dois ou mais quadrantes fechados. A gonioscopia identificou mais quadrantes com ângulo fechado do que tomografia de coerência óptica de segmento anterior antes da iridectomia periférica a laser. Quanto aos parâmetros angulares, apenas ângulo de abertura angular a 250 µm no quadrante nasal não aumentou significativamente após a iridectomia periférica a laser. A curvatura da íris e a extensão do contato entre a íris e o trabeculado apresentaram redução significativa induzida pelo procedimento a laser. Mesmo nos olhos em que a gonioscopia não identificou aumento da amplitude angular após iridectomia periférica a laser (n=7), ângulo de abertura angular a 750 µm aumentou (nasal: 0,15 ± 0,10 mm para 0,27 ± 0,16 mm, p=0,01; temporal: 0,14 ± 0,11 mm para 0,25 ± 0,12 mm, p=0,001), e ICURVE diminuiu (nasal: 0,25 ± 0,04 mm vs. 0,11 ± 0,07 mm, p=0,02; temporal: 0,25 ± 0,07 mm vs. 0,14 ± 0,08 mm, p=0,007). Conclusões: As alterações na câmara anterior induzidas pelo iridectomia periférica a laser puderam ser avaliadas quantitativamente e documentadas pelo DRI OCT Triton®.

Baerveldt implant versus trabeculectomy as the first filtering surgery for uncontrolled primary congenital glaucoma: a randomized clinical trial.

PURPOSE: Our initial goal was to compare the efficacy and safety of a glaucoma drainage device and trabeculectomy for children with primary congenital glaucoma after angular surgery failure. However, we discontinued the study due to the rate of complications and wrote this report to describe the results obtained with the two techniques in this particular group. METHODS: This was a parallel, non-masked, controlled trial that included patients aged 0-13 years who had undergone previous trabeculotomy or goniotomy and presented inadequately controlled glaucoma with an intraocular pressure ≥21 mmHg on maximum tolerated medical therapy. We randomized the patients to undergo either placement of a 250-mm2 Baerveldt glaucoma implant or mitomycin-augmented trabeculectomy. The main outcome measure was intraocular pressure control. We calculated complete success (without hypotensive ocular medication) and qualified success (with medication) rates. We defined failure as uncontrolled intraocular pressure, presence of serious complications, abnormal increase in ocular dimensions, or confirmed visual acuity decrease. RESULTS: We studied 13 eyes of 13 children (five in the glaucoma drainage device group; eight in the trabeculectomy group). Both surgical procedures produced a significant intraocular pressure reduction 12 months after intervention from the baseline (tube group, 22.8 ± 5.9 mmHg to 12.20 ± 4.14 mmHg, p=0.0113; trabeculectomy group, 23.7 ± 7.3 mmHg to 15.6 ± 5.9 mmHg, p=0.0297). None of the patients in the tube group and 37.5% of those in the trabeculectomy group achieved complete success in intraocular pressure control after 12 months of follow-up (p=0.928, Chi-square test). Two patients (40%) had serious complications at the time of tube aperture (implant extrusion, retinal detachment). CONCLUSIONS: Both the tube and trabeculectomy groups presented similar intraocular pressure controls, but complete success was more frequent in the trabeculectomy group. Non-valved glaucoma drainage devices caused potentially blinding complications during tube opening. Because of the small sample size, we could not draw conclusions as to the safety data of the studied technique.

Baerveldt implant versus trabeculectomy as the first filtering surgery for uncontrolled primary congenital glaucoma: a randomized clinical trial / Implante de Baerveldt versus trabeculectomia como primeira cirurgia fistulizante no glaucoma congênito primário não controlado: ensaio clínico randomizado

ABSTRACT Purpose: Our initial goal was to compare the efficacy and safety of a glaucoma drainage device and trabeculectomy for children with primary congenital glaucoma after angular surgery failure. However, we discontinued the study due to the rate of complications and wrote this report to describe the results obtained with the two techniques in this particular group. Methods: This was a parallel, non-masked, controlled trial that included patients aged 0-13 years who had undergone previous trabeculotomy or goniotomy and presented inadequately controlled glaucoma with an intraocular pressure ≥21 mmHg on maximum tolerated medical therapy. We randomized the patients to undergo either placement of a 250-mm2 Baerveldt glaucoma implant or mitomycin-augmented trabeculectomy. The main outcome measure was intraocular pressure control. We calculated complete success (without hypotensive ocular medication) and qualified success (with medication) rates. We defined failure as uncontrolled intraocular pressure, presence of serious complications, abnormal increase in ocular dimensions, or confirmed visual acuity decrease. Results: We studied 13 eyes of 13 children (five in the glaucoma drainage device group; eight in the trabeculectomy group). Both surgical procedures produced a significant intraocular pressure reduction 12 months after intervention from the baseline (tube group, 22.8 ± 5.9 mmHg to 12.20 ± 4.14 mmHg, p=0.0113; trabeculectomy group, 23.7 ± 7.3 mmHg to 15.6 ± 5.9 mmHg, p=0.0297). None of the patients in the tube group and 37.5% of those in the trabeculectomy group achieved complete success in intraocular pressure control after 12 months of follow-up (p=0.928, Chi-square test). Two patients (40%) had serious complications at the time of tube aperture (implant extrusion, retinal detachment). Conclusions: Both the tube and trabeculectomy groups presented similar intraocular pressure controls, but complete success was more frequent in the trabeculectomy group. Non-valved glaucoma drainage devices caused potentially blinding complications during tube opening. Because of the small sample size, we could not draw conclusions as to the safety data of the studied technique.

RESUMO Objetivo: O objetivo inicial era comparar a eficácia e a segurança do implante de drenagem e a trabeculectomia em crianças com glaucoma congênito primário após falência de cirurgia angular. Como o estudo foi descontinuado devido à taxa de complicações, o objetivo deste artigo foi descrever os resultados das duas técnicas neste grupo específico. Métodos: Ensaio clínico randomizado, não mascarado, incluindo pacientes com idade de 0 a 13 anos previamente submetidos à goniotomia ou trabeculotomia. Os pacientes, que apresentavam glaucoma não controlado com pressão intraocular ≥21 mmHg em terapia medicamentosa máxima, foram randomizados para o implante de drenagem de Baerveldt 250 mm2 (Grupo Tubo) ou trabeculectomia com mitomicina (grupo TREC). O principal desfecho avaliado foi o controle da pressão intraocular. Sucesso completo (sem medicação ocular hipotensora) e sucesso qualificado (com medicação) foram descritos. A falência foi baseada na pressão intraocular não controlada, presença de complicações sérias, aumento anormal das dimensões oculares e diminuição confirmada da acuidade visual. Resultados: Treze olhos de 13 crianças foram estudados (cinco no grupo Tubo e oito no grupo TREC). Ambos os procedimentos reduziram a pressão intraocular em relação às medidas iniciais após 12 meses da intervenção (grupo Tubo 22.8 ± 5.9 mmHg para 12.20 ± 4.14 mmHg, p=0.0113; grupo TREC, 23.7 ± 7.3 mmHg para 15.6 ± 5.9 mmHg, p=0.0297). Nenhum paciente no grupo Tubo e 37.5% do grupo TREC alcançaram o sucesso completo após 12 meses de acompanhamento (p=0.928, teste qui-quadrado). Dois pacientes (40%) apresentaram sérias complicações no momento da abertura do tubo (extrusão do implante e descolamento de retina). Conclusão: Os dois grupos estudados apresentaram resultados semelhantes quanto ao controle da pressão intraocular, mas o sucesso completo foi mais frequente no grupo da trabeculectomia. Implantes de drenagem não valvulados podem cursar com potenciais complicações visuais no momento da abertura do tubo. Devido ao pequeno tamanho da amostra, não foi possível determinar quaisquer dados de segurança conclusivos em relação à técnica estudada.

Glaucoma Workup in Congenital Zika Syndrome.

PURPOSE: The main aim of this study was to perform a glaucoma workup in infants with congenital Zika syndrome (CZS). PATIENT AND METHODS: This cross-sectional study included 188 eyes of 107 children (1.1±0.3 y; range, 0.3 to 1.8 y) with CZS. The confirmation of the syndrome was possible in 77 of 107 (72.0%) of the enrolled infants based on positive immunoglobulin M antibody capture enzyme-linked immunosorbent assay for Zika virus in the cerebrospinal fluid. All infants underwent a complete ophthalmic examination and bilateral fundus imaging was captured using a wide-angle digital fundus camera (RetCam). RESULTS: Five eyes (2.6%) presented 2 criteria for glaucoma diagnosis: 1 eye (0.5%) presented increased intraocular pressure and increased vertical cup-to-disc ratio (CDR); 3 eyes (1.6%) presented increased horizontal corneal diameter and increased vertical, and 1 eye (0.5%) presented myopia related to increased axial length and increased vertical CDR. When excluding the CDR criterion, there was no case of glaucoma in this sample. A significant correlation was observed between high vertical CDR and small cephalic perimeter at birth (P=0.002) and the presence of clinical macular lesions (P=0.031). CONCLUSION AND RELEVANCE: Although childhood glaucoma was not detected in this sample, increased vertical CDR is present in children with CZS, associated with microcephaly and clinical macular lesions at birth. This finding may lead to a misdiagnosis of glaucoma.

Trichothiodystrophy: a case report of childhood glaucoma associated with non-acquired systemic disease / Tricotiodistrofia: relato de caso de glaucoma infantil associado a doença sistémica não adquirida

ABSTRACT Trichothiodystrophy belongs to a group of rare genetic diseases characterized by DNA repair anomalies. Ocular manifestations can occur in 50% of cases, including cataract, refractive errors, strabismus, microcornea, microphthalmia, dry eye, and pigmentary macular changes. We report a case of childhood glaucoma in a patient with trichothiodystrophy who underwent trabeculectomy in the left eye. To our knowledge, this is the first clinical report of childhood glaucoma associated with trichothiodystrophy.

RESUMO A tricotiodistrofia pertence a um grupo de doenças genéticas raras caracterizadas por anomalias da reparação do DNA. Manifestações oculares podem ocorrer em 50% dos casos, incluindo catarata, erros refrativos, estrabismo, microcórnea, microftalmia, olho seco e alterações maculares pigmentares. Relatamos um caso de glaucoma infantil em um paciente com tricotiodistrofia submetido à trabeculectomia no olho esquerdo. No nosso conhecimento, este é o primeiro caso descrito de glaucoma infantil associado à tricotiodistrofia.

Trichothiodystrophy: a case report of childhood glaucoma associated with non-acquired systemic disease.

Trichothiodystrophy belongs to a group of rare genetic diseases characterized by DNA repair anomalies. Ocular manifestations can occur in 50% of cases, including cataract, refractive errors, strabismus, microcornea, microphthalmia, dry eye, and pigmentary macular changes. We report a case of childhood glaucoma in a patient with trichothiodystrophy who underwent trabeculectomy in the left eye. To our knowledge, this is the first clinical report of childhood glaucoma associated with trichothiodystrophy.

Maculopatia hipotônica pós ciclodiálise traumática por arma de fogo / Hypotonic maculopathy post traumatic cyclodialysis with firearms

Resumo Um traumatismo ocular contuso pode gerar uma vasta gama de lesões intraoculares que são dependentes da quantidade de energia que o objeto transfere ao olho durante o impacto. As lesões da íris, malha trabecular e corpo ciliar podem repercutir na drenagem do humor aquoso. A ocorrência de uma ciclodiálise caracterizada pelo descolamento do corpo ciliar da parede escleral, criando uma comunicação entre a câmara anterior e o espaço supracoroidiano, pode provocar importante redução da pressão intraocular. Esta diminuição pressórica é a responsável pela ocorrência da maculopatia hipotônica que pode cursar com diminuição irreversível da acuidade visual. Não existe consenso na literatura sobre o tratamento das ciclodiálises. Neste relato, descrevemos um caso de ciclodiálise traumática pós impacto com projétil de arma de fogo tratada com aplicação de laser de argônio.

Abstract Blunt eye trauma can generate a wide range of intraocular lesions that are dependent on the amount of energy the object transfers to the eye during the impact. Lesions of the iris, trabecular meshwork and ciliary body may influence aqueous humor drainage. The cyclodialysis which is characterized by the detachment of ciliary body from the scleral wall, creating a communication between the anterior chamber to supracoroid space, can cause a several reduction of intraocular pressure. This pressure decrease is responsible for the occurrence of hypotonic maculopathy which may induce a severe impact on visual acuity. There is no consensus in the literature about cyclodialysis treatment. In this report, we describe a case of traumatic cyclodialysis after impact with a firearm projectile treated with argon laser photocoagulation.

The Estimates of Retinal Ganglion Cell Counts Performed Better than Isolated Structure and Functional Tests for Glaucoma Diagnosis.

PURPOSE: To evaluate the diagnostic accuracy of retinal ganglion cell (RGC) counts as estimated by combining data from standard automated perimetry (SAP) and spectral domain optical coherence tomography (SD-OCT). METHODS: Healthy individuals and glaucoma patients were included in this cross-sectional study. All eyes underwent 24-2 SITA SAP and structural imaging tests. RGC count estimates were obtained using a previously described algorithm, which combines estimates of RGC numbers from SAP sensitivity thresholds and SD-OCT retinal nerve fiber layer (RNFL) average thickness. RESULTS: A total of 119 eyes were evaluated, including 75 eyes of 48 healthy individuals and 44 eyes of 29 glaucoma patients. RGC count estimates performed better than data derived from SD-OCT RNFL average thickness or SAP mean deviation alone (area under ROC curves: 0.98, 0.92, and 0.79; P < 0.001) for discriminating healthy from glaucomatous eyes, even in a subgroup of eyes with mild disease (0.97, 0.88, and 0.75; P < 0.001). There was a strong and significant correlation between estimates of RGC numbers derived from SAP and SD-OCT (R2 = 0.74; P < 0.001). CONCLUSION: RGC count estimates obtained by combined structural and functional data showed excellent diagnostic accuracy for discriminating the healthy from the glaucomatous eyes and performed better than isolated structural and functional parameters.

The disc damage likelihood scale: Diagnostic accuracy and correlations with cup-to-disc ratio, structural tests and standard automated perimetry.

Our objective was to compare the diagnostic accuracies of and to determine the correlations between the disc damage likelihood scale (DDLS) and anatomical and functional tests used for glaucoma detection. A total of 54 healthy subjects (54 eyes) and 47 primary open-angle glaucoma patients (47 eyes) were included in this cross-sectional observational study. DDLS scores and cup-to-disc (C/D) ratios were evaluated. Subjects underwent standard automated perimetry (SAP), optic disc and retinal nerve fiber layer (RNFL) imaging with time and spectral-domain optical coherence tomography (TD and SD-OCT), Heidelberg Retina Tomograph (HRT II), and scanning laser polarimetry (GDx-VCC). Areas under the receiver operating characteristic curves (AROCs) for DDLS and diagnostic tests parameters were calculated. DDLS correlations (Spearman's rank) among these parameters were analyzed. Fifty-four eyes were healthy and 47 had glaucoma, including 16 preperimetric glaucoma. DDLS, vertical and horizontal C/D ratios had the largest AROCs (0.92, 0.94 and 0.91, respectively). DDLS diagnostic accuracy was better than the accuracies of HRT II parameters, TD and SD-OCT RNFL thicknesses, and SAP mean deviation (MD) index. There were no significant differences between the accuracies of the DDLS and the C/D ratios, TD-OCT vertical (0.89) and horizontal (0.86) C/D ratios, TD-OCT C/D area ratio (0.89), and GDx-VCC NFI (0.81). DDLS showed significant strong correlations with vertical (r = 0.79) and horizontal (0.74) C/D ratios, and with the parameters vertical C/D ratio and C/D area ratio from HRT II (both 0.77) and TD-OCT (0.75 and 0.72, respectively). DDLS had significant moderate correlations with most of the other structural measurements and SAP MD. The optic disc clinical evaluation with DDLS system and C/D ratio demonstrated excellent accuracy in distinguishing glaucomatous from healthy eyes. DDLS had moderate to strong correlations with most structural and functional parameters. These findings stress the importance of optic disc clinical examination to detect glaucoma in a clinical scenario.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient.

Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient / Panoftalmite com celulite orbitária após implante de drenagem em glaucoma congênito

ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

RESUMO Relato de um caso de uma criança portadora de glaucoma congênito primário, refratário a cirurgias angulares e trabeculectomias prévias, submetido à implante de drenagem do tipo Ahmed®. O paciente evoluiu com panoftalmite e celulite orbitária de aparecimento súbito, sendo submetido à remoção do tubo e antibioticoterapia endovenosa e intravítrea. O processo infeccioso foi resolvido em três semanas, porém o olho evoluiu para phthisis bulbi.

Functional and transcriptomic recovery of infarcted mouse myocardium treated with bone marrow mononuclear cells.

Although bone marrow-derived mononuclear cells (BMNC) have been extensively used in cell therapy for cardiac diseases, little mechanistic information is available to support reports of their efficacy. To address this shortcoming, we compared structural and functional recovery and associated global gene expression profiles in post-ischaemic myocardium treated with BMNC transplantation. BMNC suspensions were injected into cardiac scar tissue 10 days after experimental myocardial infarction. Six weeks later, mice undergoing BMNC therapy were found to have normalized antibody repertoire and improved cardiac performance measured by ECG, treadmill exercise time and echocardiography. After functional testing, gene expression profiles in cardiac tissue were evaluated using high-density oligonucleotide arrays. Expression of more than 18% of the 11981 quantified unigenes was significantly altered in the infarcted hearts. BMNC therapy restored expression of 2099 (96.2%) of the genes that were altered by infarction but led to altered expression of 286 other genes, considered to be a side effect of the treatment. Transcriptional therapeutic efficacy, a metric calculated using a formula that incorporates both recovery and side effect of treatment, was 73%. In conclusion, our results confirm a beneficial role for bone marrow-derived cell therapy and provide new information on molecular mechanisms operating after BMNC transplantation on post ischemic heart failure in mice.